PSYCHOPATHOLOGY

DIAGNOSIS
AND
TREATMENT STRATEGIES
 ANXIETY, SOMATOFORM, AND DISSOCIATIVE DISORDERS

Disorder Subtypes Major Symptoms

Anxiety
disorders
Phobias
InRev15a
Intense, irrational fear of objectively nondangerous situations or things,
leading to disruptions of behavior.

Generalized anxiety Excessive anxiety not focused on a specific situation or object; free-
disorder floating anxiety.

Panic disorder Repeated attacks of intense fear involving physical symptoms such as
faintness, dizziness, and nausea.

Obsessive-compulsive Persistent ideas or worries accompanied by ritualistic behaviors

disorder performed to neutralize the anxiety-driven thoughts.

Somatoform Conversion disorder A loss of physical ability (e.g., sight, hearing) that is related to
disorders psychological factors.

Hypochondriasis Preoccupation with or belief that one has serious illness in the absence
of any physical evidence.

Somatization disorder Wide variety of somatic complaints that occur over several years and
are not the result of a known physical disorder.

Pain disorder Preoccupation with pain in the absence of physical reasons for the
pain.

Dissociative Amnesia/fugue Sudden, unexpected loss of memory, which may result in relocation
disorders and the assumption of a new identity.

Dissociative identity Appearance within same person of two or more distinct identities, each
disorder (multiple with a unique way of thinking and behaving. 2
personality disorder)
 ANXIETY DISORDERS
◆ PANIC DISORDER
◆ GENERALIZED ANXIETY DISORDER
◆ PHOBIAS
◆ OBSESSIVE-COMPULSIVE DISORDER
◆ POST-TRAUMATIC STRESS DISORDER

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PANIC DISORDER
Experience reoccurring episodes of anxiety attacks;
unpredictable;
some situations might become related to it.
Anxiety attack: 5 needed may last a couple of minutes to hours

heart palpitations
tense muscles, especially chest muscles often misinterpreted
for heart attack,
choking sensation from tight neck muscles,
faint or dizzy feeling,
increase sweat,
hot or cold flashes.

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 GENERALIZED ANXIETY
DISORDER

Persistent level of anxiety lasting at least one month

Symptoms:
Motor: Tension of muscles: shakes, tremble,
unable to relax, twitch, startle easily
Autonomic hyperactivity: Sweat, increased heart
rate, cold hands, hot, cold flashes, light headed
and dizzy
Apprehension--worry constantly
Vigilance and scanning: hyperattentive to things in
the environment, distractible, hard to
concentrate, impatient, irritable.

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 PHOBIA
Irrational fear response of specific
stimuli
SOCIAL PHOBIAS
AGORAPHOBIA
SPECIFIC PHOBIAS

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 OBSESSIVE-COMPULSIVE
DISORDER

Marked by overt ritualistic

behavior and persistent
intruding thoughts

Occurs at a frequency so high

as to interfere with daily
functioning

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 SOMATOFORM DISORDERS

◆ HYPOCHONDRIASIS
◆ CONVERSION HYSTERIA

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 HYPOCHONDRIASIS

Preoccupation with body and illness

No relief if given healthy diagnosis
Just as tense--travel and search for
new physicians

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CONVERSION DISORDER

Individual has dramatic physical symptoms with no organic cause.

1. Paralysis of legs/arms/ total

2. Anesthesia--lost sense of touch with parts of body
3. Analgesia--feel no pain
4. Other common experiences: nausea, lower back pain, dizziness,
hysterical blindness, deafness, unexplained headaches
5. Unusually INDIFFERENT to symptoms
6 .Secondary gain for having symptoms
7. May disappear while asleep or under hypnosis
8. Craft Paralysis: symptoms selective to job--paralyzed hands of
violinist or tennis player.
9. Symptoms make no common sense neurologically

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 DISSOCIATIVE DISORDERS

◆ DISSOCIATIVE AMNESIA
◆ DISSOCIATIVE FUGUE
◆ DISSOCIATIVE IDENTITY DISORDER

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DISSOCIATIVE AMNESIA

Memory for certain events from 1 hour to 3

months is lost

Person is not distressed by loss of memory--

intellectual and skills still there.

Theorized as a loss of memory (repression) for

traumatic event

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DISSOCIATIVE FUGUE

Amnesia for entire life & self

Starts a new life in a new location
-called travelling amnesiac

Cause: extreme stress & need to flee

Can last for days, weeks, years.
Extremely rare except on Soaps!

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 DISSOCIATIVE IDENTITY
DISORDER

Dominance of 2 or more distinct

personalities

Generally amnesic for existence of

others

Controversial Diagnosis

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56

Fig131
Precursors Diathesis Stress Outcome

Genetic Poor self-

factors understanding

Brain disease
Disorder (e.g.
Vulnerability
schizophrenia)
Early learning Stressful family
experiences dynamics

Bad family
Social stresses
dynamics

Diathesis Stress Model of Disorders

 AFFECTIVE DISORDERS

◆ MAJOR DEPRESSION
◆ DYSTHYMIC DISORDER
◆ BIPOLAR DISORDER
◆ CYCLOTHYMIC DISORDER
◆ SEASONAL AFFECTIVE DISORDER

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CLINICAL DEPRESSION

Emotions major disturbing problem but also problem in

cognition (self-defeating thoughts)

1. Dysphoric mood for a minimum of 2 weeks

plus 4 of following:
Change in appetite usually decrease
Change in sleep--insomnia or hypersomnia
Change in amount of psychomotor activity-slow or agitated
Fatigue or loss of energy
Feelings of worthlessness, self critical or inappropriate guilt
Poor concentration
Suicide or suicidal ideation

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 BIPOLAR DISORDER
MANIC-DEPRESSION
Elevated mood-elation and mania alternating with
depressive thoughts

Mania:
inflated self esteem: too self confident
talkative w/flight of ideas
increased activity, interests, social
decreased need of sleep, distracted
concern that will harm selves
not judge consequences of actions
shopping spree--self destructive buying pattern

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57

INCIDENCE OF DEPRESSION
80
Major depression
Fig147
Bipolar disorder

70
60
50
Risk 40
30
20
10

Prevalence in Prevalence in
general population general population
Fraternal twins Fraternal twins
Identical twins Identical twins

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 Creativity and Madness
Artists
Paul Gauguin (SA),
Vincent van Gogh (H, S),
Ern st Ludwig Kirchner (H, S),
Edward Lear,
Michelangelo,
Edvard Meunch (H),
Georgia O'Keeff e (H),
George Romney,
Dante Gabriel Rossetti(SA)
Writers Poets
Hans Chr istian Andersen William Blake
William Faulkner (H) Robert Burn s
F. Scott Fitzgerald (H), Lord Byron
ErnestHemingway (H, S), Samuel Taylor Coleridge
Hermann Hesse (H, SA), EmilyDickinson
Henrik I bsen T.S. Eliot (H)
Henry James
Oliver Goldsmith
William James
Gerard Manley Hopkins
Samuel Clemens (MarkTwain)
Victor Hugo
Joseph Conrad (SA)
Samuel Johnson
Charles Dickens
John Keats
I sak Dinesen (SA)
James Russell Lowell
Ralph Waldo Emerson
Herman Melville Robert Lowell (H)
Eugene O'Neill (H , SA) Edna St. Vincent Mill ay (H)
Mary Shelley Bori s Pasternak (H)
Robert Louis Stevenson Sylvia Plath (H, S)
Leo Tolstoy Edgar A llan Poe (SA)
Tennessee Williams (H) Ezra Pound (H)
MaryWollstonecraft ( SA) Anne Sexton (H, S)
Virginia Woolf ( H, S) Percy Bysshe Shelley (SA)
Alfred, Lor d Tennyson,
Dylan Thomas
Walt Whitman
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 SCHIZOPHRENIA

◆ PARANOID
◆ CATATONIA
◆ DISORGANIZED HEBEPHRENIA
◆ SIMPLE
◆ RESIDUAL

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 SCHIZOPHRENIA

Aspect Key Features

Common
Symptoms
InRev15b
Disorders of Disturbed content, including delusions; and disorganization,
thought including loose associations, neologisms, and word salad.

Disorders of Hallucinations, or false perceptions; poorly focused attention.

perception

Disorders of Flat affect; or inappropriate tears, laughter, or anger.

emotion

Possible Causes
Biological Genetics; abnormalities in brain structure; abnormalities in
dopamine systems; neurodevelopmental problems.

Psychological Learned maladaptive behavior; disturbed patterns of family

communication.

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15_05

Max Fig15_5
C Schizophrenic
behavior

Challenging Threshold
events

Normal
behavior D

Min B

Low Vulnerabilit High

y
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PERSONALITY DISORDERS

ANTISOCIAL AVOIDANT BORDERLINE

DEPENDENT HISTRIONIC NARCISSISTIC

OBSESSIVE- PARANOID SCHIZOTYPAL

COMPULSIVE

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Fig15_5
Type Typical Features
Paranoid Suspiciousness and distrust of others, all of whom are assumed to be hostile.

Schizoid
Tab15_5
Detachment from social relationship; restricted range of emotion.

Schizotypal Detachment from, and great discomfort in, social relationships; odd
perceptions, thoughts, beliefs, and behaviors.

Depedent Helplessness; excessive need to betaken care of; submissive and clinging
behavior; difficulty in making decisions.

Obsessive- Preoccupation with orderliness, perfection, and control.

compulsive

Avoidant Inhibition in social situations; feelings of inadequacy; oversensitivity to criticism.

Histrionic Excessive emotionality and preoccupation with being the center of attention;
emotional shallowness; overly dramatic behavior.

Narcissistic Exaggerated ideas of self-importance and achievements; preoccupation with

fantasies of success; arrogance.

Borderline Lack of stability in interpersonal relationships, self-image, and emotion;

impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal
gestures.

Antisocial Shameless disregard for, and violation of, other people's rights. 25
PSYCHO-SEXUAL
DISORDERS

Fetishism
Zoophilia
Sadism
Masochism
Exhibitionism
Pedophilia
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 DEVELOPMENTAL
DISORDERS
Autism

Academic Skills Disorder

Attention Deficit Disorder

w/hyperactivity

Senile Dementia

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 TREATMENT

PSYCHOANALYSIS
BEHAVIOR
HUMANISTIC
COGNITIVE
BIOMEDICAL
SIGMUND FREUD
PSYCHOANALYSIS

Resistance
Catharsis
Transference
Interpretation
Insight

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DEINSTITUTIONALIZATION

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 APPROACHES TO PSYCHOLOGICAL TREATMENT
Classical Contemporary
Dimension Psychoanalytic Psychodynamic Phenomenological Behavioral
Nature of the human Driven by sexual and
being aggressive urges InRev16a
Driven by the need for
human relationships
Has free will, choice, and
capacity for self-
actualization
A product of social
learning and conditioning;
behaves on the basis of
past experience

Therapist’s role Neutral; helps client Active; develops Facilitates client’s growth; Teacher/trainer who
explore meaning of free relationship with client as some therapists are helps client replace
associations and other a model for other active, some nondirective undesirable thoughts and
material from the relationships behaviors; active, action-
unconscious oriented

Time frame Emphasizes unresolved Understanding the past, Here and now; focus on Current behavior and
unconscious conflicts but focusing on current immediate experience thoughts; may not need
from the distant past relationships to know original causes in
order to create change

Goals Psychosexual maturity Correction of effects of Expanded awareness, Changes in thinking and
through insight; failures of early fulfillment of potential; behaving in particular
strengthening of ego attachment; development self-acceptance classes of situations;
functions of satisfying intimate better self-management
relationships

Typical methods Free association; dream Analysis of transference Reflection-oriented Systematic

analysis, analysis of and countertransference interviews designed to
transference convey unconditional
positive regard, empathy,
congruence; exercises to
promote self-awareness
desensitization, modeling,
assertiveness and social
skills training, positive
rein-
forcement, aversive
conditioning, punishment,
extinction, cog-
nitive restructuring
 CARL ROGERS
CLIENT CENTERED

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 HUMANISTIC THERAPY
55

BASIC HUMAN OTHERS'

NEEDS RESPONSES RESULT

Unconditional Self-actualization
positive regard MENTAL HEALTH
Need for
self-actualization EFFECTS
SELF GUIDES
Sadness
Self = ideals Disappointment
Need for Depression
positive regard
Conditional Self-
positive regard discrepancies
Anxiety
Self = oughts Shame
Guilt

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 ROLLO MAY
EXISTENTIAL THERAPY

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ALBERT BANDURA
MODELING

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BEHAVIOR AND COGNITIVE

SY STEM A TI C M OD ELI N G
D ESEN SI TI ZA TI ON
R A TI ON A L
F LOOD I N G EM OTI V E
ELLI S

I M P LOSI V E STR ESS

I N N OCU LA TI ON

A V ER SI ON COGN I TI V E --BECK

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 BIOLOGICAL TREATMENTS FOR PSYCHOLOGICAL DISORDERS

Typical
Method Disorders Treated Possible Side Effects Mechanism of Action

Electroconvulsive
InRev16b
Severe depression Temporary confusion, Uncertain
therapy (ECT) memory loss

Psychosurgery Schizophrenia, Listlessness, Uncertain

severe depression, overemotionality,
obsessive- epilepsy
compulsive
disorder

Psychoactive Anxiety disorders, Variable, depending on Alteration of

drugs depression, drug used: movement neurotransmitter
obsessive- disorders, physical systems in the brain
compulsive dependence
disorder, mania,
schizophrenia

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ELECTRO-CONVULSIVE SHOCK
TREATMENT (ECT)
◆ Single most effective treatment for psychotic
depression
◆ Used as treatment of last resort
◆ Actual understanding of how it works is not
complete--disrupts electrical impulses of brain
◆ Within two to four weeks many see profound mood
elevation
◆ Side Effects include memory loss (usually short term)

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 PSYCHOSURGERY
◆ PREFRONTAL LOBOTOMY
◆ Removal of brain tissue to relieve symptoms
◆ Pre-frontal lobotomy first used on gorillas and found to calm
aggression; applied to patients in mental institutions
beginning in the 1950’s
◆ Often used on schizophrenics bringing flat affect
◆ Today smaller amount of tissue can be removed from specific
areas showing malfunction--cingulotomy
◆ Can be very effective at removing tumor and other tissue
causing abnormal behaviors

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 BIOMEDICAL TREATMENTS

◆Drug Treatment Options:

◆ Anti-Anxiety Xanax
◆ GABA neurotransmitter
◆ Anti-Depressant drugs Prozac
◆ Serotonin and Norepinephrine
◆ Anti-Psychotic drugs Thorazine
◆ Dopamine

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 Average Average
untreated treated
person person
Number
of
people

80% of
untreated
persons

No improvement Outstanding
improvement

PSYCHOTHERAPY VS NONE 41