copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
Many people in society could profit from a change of attitude about psychological disorders. "Mental illness" is something we don't like to talk about. Few like hearing that in a given year, about 30% of the adult population will experience a diagnosable mental illness. In one lifetime, approximately 50% of adults will suffer from a psychological disorder.
Therefore, we see that psychological disorders are common. Some are very dramatic and a few are devastating. Most are not beyond the experience of any of us. And most can be treated successfully, even cured if treated. In this lesson we will discuss basic psychological disorders.
What is Abnormal?
We all have a basic idea of what is meant by abnormal, mental illness, or psychological disorder. But if we think about it for long, abnormality is more difficult to define. Abnormal refers to maladaptive thinking, affect, and/or behaviors that are contrary with social expectations and result in distress or discomfort. Literally, abnormal means "not average" or "not within normal limits". Therefore, those behaviors that are rare could be considered abnormal and of course they are. The problem with this statistical approach is that it would categorize the behaviors of Alla Pugachiova, Boris Yeltsin, and ----- as abnormal. There are very few others who do as these people do, but as far as we know, none of them has a psychological disorder. Psychological disorders are not determined by statistics alone.
The reactions of people with psychological disorders are maladaptive. This is a critical part of our definition. The thoughts, feelings and behaviors are such that the person does not function as well as he or she could without the disorder. To be different does not in itself mean that someone has a psychological disorder. There must be some impairment, some self-defeating mechanism that interferes with one's growth and functioning in society.
Another observation as shown in our definition is that abnormality may show itself in a number of ways. A person with a psychological disorder may have abnormal affect, engage in abnormal behaviors, have abnormal thinking patterns, or any combination of these.
Meditate Word By Word On These Verses:
Luke 11:14-26.
Any definition of psychological abnormality should recognize social and/or cultural expectations. What may be clearly abnormal and disordered in one culture may be viewed as quite normal in another. In some cultures, loud crying and wailing at a funeral is considered normal; in other cultures, it is considered deviant. In some cultures, if you claim to have communicated with your ancestors, this would be taken as a sign of mental disturbance; in others, this behavior would be treated as a great gift.
Question:
1. How do cultural and social roles help define abnormality?
(One or more of the following answers may be correct.)
Anything that is not average or within normal limits for a society.
If a person does not fulfill his role in society, he is abnormal.
Loud crying and wailing is considered normal in some cultures.
One additional issue needs to be addressed: psychological disorders involve distress or discomfort. People we consider abnormal are suffering, or are the source of suffering in others. Psychological disorders cause emotional distress, and these individuals cause distress to family and friends who are concerned about them. The definition for psychological disorders is complex, but there is a reason for each word: behavior or mental processes that are maladaptive, at odds with social expectations, and they result in distress or discomfort.
Question:
2. What are the ways in which abnormality is expressed?
Comorbidity
Another potential problem is comorbidity, or the occurrence of two or more disorders in the same individual. People who experience a disorder in their lifetime, most (79%) will have two or more disorders. A study of combat veterans found an average of 3 disorders per person in their sample. An average of four disorders was found in suicidal patients.
Anxiety Disorders
Anxiety is a feeling of general apprehension or dread accompanied by predictable physiological changes: increased muscle tension; shallow rapid breathing; cessation of digestion; rapid breathing, increased perspiration; and drying of the mouth. Thus anxiety has two level of reaction: subjective feelings (fear and dread) and physiological responses (rapid breathing). The major symptom of anxiety disorders is felt anxiety together with attempts to resist or avoid any situation that seems to produce anxiety.
Anxiety disorders are the most common of all disorders. They are diagnosed two to three times more often in women than men. It is estimated that 25 percent of the population has had an anxiety disorder at some time in their lives.
Generalized Anxiety Disorder
The major symptom of generalized anxiety disorder is distressing, felt anxiety. With this disorder we find unrealistic, excessive, persistent worry. People with generalized anxiety disorder report that the anxiety they feel causes substantial interference in their lives and that they need a significant dose of medication to control their symptoms. It is difficult for them to control their anxiety.
The experience of this disorder may be very intense, but it is also diffuse, meaning that it is not brought on by anything specific in a person's environment. It just seems to come and go without reason or warning. People with this disorder are usually in a state of uneasiness and seldom have any clear insight about what caused their anxiety. The self-reports of persons with this disorder show that their major concerns are an inability to relax, tenseness, difficulty concentrating, feeling frightened, and being afraid of losing control. This disorder is disruptive and brings emotional pain. Although people continue to function in social situations and on the job, they may be particularly prone to drug and alcohol abuse to calm the symptoms.
Question:
3. What are the major symptoms of generalized anxiety disorder?
(Only one of the following answers is correct.)
Acute anxiety, sharp attacks of worry, uncontrollable anxiety.
Continual worry, usually in a state of uneasiness, tension.
Need for significant doses of medication, prone to drug and alcohol abuse.
Panic Disorder
In the generalized anxiety disorder, the experience of anxiety may be characterized as chronic in nature. This means that anxiety is always present, sometimes it is greater than at other times. For a person suffering from panic disorder, however, the major symptom is more acute. It is a recurrent, unpredictable, unprovoked onset of sudden and intense anxiety. These attacks may last for a few minutes or a few hours. Attacks are associated with all sorts of physical symptoms - a pounding heart, labored breathing, chest pains, sweating hands. nausea, dizziness, numbness, and trembling in the hands and feet. There is no one stimulus that causes the symptoms. The panic attack is unexpected. It simply happens. Usually there is a recurrence of attacks and a building worry about future attacks. At some time in their lives, 1.5% to 3.5% of the population will experience a panic disorder.
The age of onset for panic disorder is between adolescence and mid-twenties. Initial panic attacks are often associated with stress, particularly from the loss of an important relationship. A complication of panic disorder is that it can be accompanied by feelings of depression or comorbidity. The rate of suicide and suicide attempts is high for persons with this diagnosis - 20%. This is higher than for those diagnosed with depression alone - 15%.
Question:
4. What are the major symptoms of panic disorder?
Phobic Disorders
The essential feature of phobic disorders is a persistant and excessive fear of some object, activity, or situation that consistently leads a person to aviod that object. The fear is intense enough to be disruptive. It is usually a fact that there is no real or significant threat involved in the stimulus. The fear is unreasonable, exaggerated, or inappropriate.
Many things are frightening or life threatening. Few of us enjoy the company of bees. That we do not like bees and prefer that they not be around does not mean that we have a phobic disorder. Key to a diagnosis is the intensity of the response. People who have a phobic reaction to bees may refuse to leave the house in the summer for fear of encountering a bee. They may become genuinely anxious at the sound of any insect, fearing it to be a bee.
There are many phobias. The two main categories of phobic disorder are specific and social phobias. Specific phobias involve the fear of animals, physical environment, blood, injections, or injury, or a specific situation (tunnels, heights, water). Social phobias are significant and persistent fears of social and performance situations where one can be embarrassed. Fears of speaking or being in large crowds qualify as social phobias. The prognosis is good for phobic disorders. Therapy for people with phobias is likely to be successful, but few people seek professional help.
Question:
5. What are two main categories of phobias?
(Only one of the following answers is correct.)
Fear of bees and fear of heights.
Fear of injections and fear of tunnels.
Specific fears and social fears.
A commonly treated phobia is agoraphobia, which means the fear of open places. It is an exaggerated fear of our going into the world alone. People with this disorder avoid crowds, streets, and stores. They establish a safe place for themselves and may refuse to leave. Agoraphobia is often a complication of panic disorder.
Question:
6. Have you had experience with a person who has a phobic disorder? Write a few paragraphs about it.
Obsessive-Compulsive Disorder
The obsessive-compulsive disorder is an anxiety disorder characterized by a pattern of recurrent obsessions and compulsions. Obsessions are ideas or thoughts that involuntarily and constantly intrude into awareness. Generally speaking, obsessions are pointless thoughts most commonly about cleanliness, disease, danger, or doubt. Many of us have experienced mild, obsessive-like thoughts. For example, you may worry if you really did turn off the stove at home during the first few days that you are on vacation. To qualify as an obsessive-compulsive disorder, obsessions must be disruptive; they must interfere with normal functioning.
Compulsions are constantly intruding, repetitive behaviors. The most commonly reported compulsions are hand washing, grooming, and counting or checking behaviors, such as checking the door to be sure it is locked. Have you ever checked an answer sheet over and over to find out if you have really answered all the questions and checked it again and again? It serves no real purpose and provides no sense of satisfaction, although it is done to reduce stress or anxiety. People with this disorder realize that their behaviors serve not purpose; they know they are unreasonable, but cannot stop them. It is as if such a person has these compulsive behaviors to prevent some other behaviors from happening.
Question:
7. What is an obsession? What is a compulsion?
(Select the best answer.)
Worrying if you turned off the stove, or if you unplugged the iron.
Worrying about catching a cold, changing clothes three times a day.
Pointless thoughts, constantly intruding behaviors.
An example of this behavior is the case of a happily married young man. He is an accountant and the father of three children. For reasons he cannot explain, he has become obsessed with the fear of contracting AIDS. There is no reason for him to be concerned: he has never used drugs, he is monogamous; he has never had a blood transfusion. He washes his hands at every opportunity and changes his clothing three times per day to avoid contact with the AIDS virus. You can imagine how distressing this can be for him.
This type of compulsiveness is different from being a compulsive gambler, compulsive eater, or compulsive practical joker. What is different about the use of this term in these cases is that the person who does them habitually, gets pleasure from them. Such people may not enjoy the long-term effects of their actions, but they feel little discomfort about the behaviors themselves.
Question:
8. What are the characteristics of obsessive-compulsive disorder?
Researchers think that this disorder has a biological basis. They think the source of the problem is the pathways that communicate between the frontal lobes of the brain and the basal ganglia. The neurotransmitter serotonin is also a part of the problem. Support of the biological basis comes from the observation that certain antidepressant drugs successfully eliminate symptoms. The prognosis for obsessive-compulsive disorders is not good: only about 50% of patients have their symptoms decrease after seven years of treatment.
As Christians, I think we need to be cautious about this behavior. We need to know if there is some underlying sin that the person is trying to remove from his consciousness that causes this behavior. In such a case, confession and restitution is necessary to clear the conscience. We also must be careful not to label the true obsessive-compulsive disorder as underlying sin.
Posttraumatic Stress Disorders
There has been much public discussion about this type of anxiety disorder in the past ten years. This disorder involves distressing symptoms that come some time after the experience of a highly traumatic event. The trauma is defined as:
- the person has witnessed, experienced, or confronted with an event that involves actual or threatened death,
- the person's response is intense fear, helplessness, or horror.
There are three clusters of symptoms that define this disorder:
- re-experiencing the traumatic event perhaps through nightmares or flashbacks,
- avoidance of any possible reminders of the event including the people who were there are the time of the traumatic event,
- increased arousal or hyper-alertness meaning irritability, insomnia, and difficulty concentrating.
Question:
9. What are the criteria for a posttraumatic stress disorder?
(One or more of the following answers may be correct.)
Witnessing actual or threatened death, and avoiding possible reminders of it.
Hyper-alertness, difficulty concentrating, insomnia.
Re-experiencing the traumatic event, and a feeling of helplessness.
Witnessing or experiencing an event that involves death, and a response of fear or helplessness.
The traumatic events that trigger this disorder are many. They may be natural disasters such as floods or hurricanes; life-threatening situations such as kidnappings, assault, rape, or combat; to the loss of property such as a robbery or fire that destroys one's home. This disorder especially affects soldiers in time of war.
We often find that this disorder is associated with alcohol and substance abuse or depression. The prognosis for posttraumatic stress disorder is related to the comorbid disorders that accompany it, the extent that the person had psychological problems before the traumatic event, and the amount of social support that is available for the person. Researchers have found that a person with high cognitive abilities seems to have "protection" against the disorder.
Question:
10. What are the symptoms of post-traumatic stress disorder?
Somatoform Disorders
Soma means "body". Hence, the somatoform disorders involve physical, bodily symptoms or complaints. They are psychological disorders in that there is no known medical or biological cause. We will consider two of them.
Question:
11. What is a somatoform disorder?
(Only one of the following answers is correct.)
Physical symptoms or complaints with no biological cause.
Soma means "body".
Psychological disorders with a medical cause.
Hypocondriasis
Hypocondriasis is the diagnosis for someone preoccupied with the fear of a serious disorder. These persons are aware of every ache and pain. They read popular magazines related to health, and feel free to diagnose their own ailments. They constantly seek medical attention and are not convinced of their good health despite the best medical opinion and a visually healthy body. For example, a man with chest pains may be convinced that he has lung cancer. Even after thorough examinations and reassurances by physicians, the man's fears are not put to rest. He says, "They are just trying to make me feel better by not telling me, but they know as I do that I have lung cancer."
It is not difficult to imagine why someone develops hypochondriasis. If a person believes that he has contracted some serious disease, three problems might be solved.
Question:
12. What is hypochondrasis?
Conversion Disorder
Conversion disorder is rare. It is more common in rural areas or in underdeveloped countries. Indeed, in some cultures, some of the symptoms are considered quite normal. The symptoms of conversion disorder are striking. There is a loss or altering of physical function that suggests a physical disorder. The symptoms are not intentionally produced and cannot be explained by any physical disorder. The "loss of functioning" is typically of great significance: blindness, paralysis, and deafness are classical examples. As difficult as it may be to believe, the symptoms are real in that the person cannot see, feel, or hear. I think that we should be aware that these symptoms may happen as a result of the powers of the Devil and casting of powers upon people.
One type of common conversion order is glove anesthesia. It is a condition where the hands lose feeling and become paralyzed from the wrist down. As it happens, it is physically impossible to have such a paralysis and loss of feeling in the hands alone. There would have had to be some paralysis in the forearm, upper arm, and shoulder because paralysis must follow nerve pathways. One remarkable symptom of the disorder (which occurs in only some patients) is indifference over their condition. They feel comfortable accepting their infirmity.
Conversion disorder holds as important place in psychology's history. Sigmund Freud was intrigued with this disorder and founded a new therapy as a result. The Greeks called this disorder hysteria and believed that it was found only in women.
Question:
13. What are the symptoms of a conversion disorder?