Abnormal psychology - exam 2 - Chapter 5-9

MindTech: Virtual Reality Therapy: Better Than the Real Thing?

Exposure-based treatment is the best intervention for people with PTSD •Earlier treatment: In vivo exposure more effective than covert exposure •Today: Virtual reality exposure now standard in PTSD treatment Virtual reality therapy is becoming more common in treatment of other anxiety disorders and phobias •"Virtual" exposure: Back to a battle scene in Iraq •Exposure-based therapy may be the single most helpful intervention for people with PTSD. •In virtual reality therapy, clients use wraparound goggles and joysticks to navigate their way through a computer-generated military convoy, battle, or bomb attack in a landscape that looks like Iraq or Afghanistan.

PsychWatch: Peculiarities of Memory

Many memory peculiarities have been identified •Absentmindedness •Déjà vu •Jamais vu •Tip-of-the-tongue phenomenon •Eidetic images •Memory while under anesthesia •Memory for music •Visual memory

Biological Treatments for Unipolar Depression - •Reuptake and Antidepressants

•(Left) Soon after a neuron releases neurotransmitters such as norepinephrine or serotonin into its synaptic space, it activates a pumplike reuptake mechanism to reabsorb excess neurotransmitters. In depression, however, this reuptake process is too active, removing too many neurotransmitters before they can bind to a receiving neuron. •(Right) Tricyclic and most second-generation antidepressant drugs block the reuptake process, enabling norepinephrine or serotonin to remain in the synapse longer and bind to the receiving neuron.

What Triggers a Suicide? - •Alcohol and other drug use

•70 percent of suicide attempters drink alcohol just before the act •One-fourth of these people are legally intoxicated •Use of other kinds of drugs may have similar ties to suicide, particularly in teens and young adults

Unipolar Depression: The Depressive Disorders - How common is unipolar depression?

•8 percent of U.S. adults suffer from severe unipolar depression in any given year; 5 percent suffer from mild forms •20 percent of all adults experience unipolar depression at some time in their lives •Average age of onset is 19 years •Higher rate among chronically ill elderly people •Lifetime prevalence: 26 percent of women versus 12 percent of men •Among children, the prevalence is similar among boys and girls. •Approximately 85 percent of people with unipolar depression recover, some without treatment. •Around half will experience another episode later in their lives.

The Sociocultural Model of Unipolar Depression - •Family-social perspective

•A decline in social rewards impacts depression •Depressed people often demonstrate social deficits that may cause avoidance by others, thereby decreasing their social contacts and rewards •Depression is tied to weak or unavailable social support, isolation, and lack of intimacy. Sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds people. This belief is supported by the finding that depression is often triggered by outside stressors, The connection between declining social rewards and depression (as discussed by the behaviorists) is a two-way street: •Depressed people often display social deficits that make other people uncomfortable and may cause them to avoid the depressed individuals. •This leads to decreased social contact and a further deterioration of social skills. Consistent with these findings, depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriage. •People who are separated or divorced display three times the depression rate of married or widowed persons and double the rate of people who have never been married. •There is a high correlation between level of marital conflict and degree of sadness that is particularly strong among those who are clinically depressed. •People who are isolated and without intimacy are particularly likely to become depressed in times of stress. In a widely used research design called cyberball, a participant lies in an fMRI scanner and is told (falsely) that he or she is playing a game of cyber catch with two players in other rooms. As the other players increasingly exclude the participant from the three-way catch, the fMRI records which parts of his or her brain are being affected. As shown in these brain scans, subregions of the anterior cingulate cortex (left) and the prefrontal cortex (right), which are key structures in the depression-related brain circuit, become active during this lab-induced social exclusion, just as they do in cases of clinical depression.

Acute and Posttraumatic Stress Disorders - •Checklist

•A person is exposed to a traumatic event—death or threatened death, severe injury, or sexual violation •A person experiences at least one of the following intrusive symptoms: •Repeated, uncontrolled, and distressing memories •Repeated and upsetting trauma-linked dreams •Dissociative experiences such as flashbacks •Significant upset when exposed to trauma-linked cues •Pronounced physical reactions when reminded of the event(s) •The person continually avoids trauma-linked stimuli •The person experiences negative changes in trauma-linked cognitions and moods, such as being unable to remember key features of the event(s) or experiencing repeated negative emotions •The person displays conspicuous changes in arousal or reactivity, such as excessive alertness, extreme startle responses, or sleep disturbances •The person experiences significant distress or impairment, with symptoms lasting more than a month

The Sociocultural Model of Unipolar Depression - •Multicultural perspective

•A strong link exists between gender and depression •Across various cultures, women are twice as likely as men to receive a diagnosis of unipolar depression •Women with depression appear to be younger, have more frequent and longer-lasting bouts, and respond less successfully to treatment •Multicultural perspective: Gender and depression explanations •Artifact theory •Hormone explanation •Life stress theory •Body dissatisfaction explanation •Lack-of-control theory •Rumination theory •The artifact theory holds that women and men are equally prone to depression, but that clinicians often fail to detect depression in men. •The hormone explanation holds that hormone changes trigger depression in many women. •The life stress theory suggests that women in our society experience more stress than men do. •The body dissatisfaction explanation states that females in Western society are taught, almost from birth, but particularly during adolescence, to seek a low body weight and slender body shape—goals that are unreasonable, unhealthy, and often unattainable. •The lack-of-control theory draws on the learned helplessness research and proposes that women may be more prone to depression because they feel less control than men over their lives. •Research reveals that women are more likely than men to ruminate when their mood darkens, perhaps making them more vulnerable to the onset of clinical depression. •Depression is found worldwide and core symptoms have been reported •Precise picture of depression varies from country to country •Depressed people in non-Western countries are more likely to be troubled by physical symptoms of depression than by cognitive ones •As countries become more Westernized, depression seems to take on the more cognitive character it has in the West Reported symptoms include sadness, joylessness, tension, lack of energy, loss of interest, loss of ability to concentrate, ideas of insufficiency, and thoughts of suicide. •Few differences in depression symptoms or overall rate of depression among members of U.S. racial or racial groups •Striking differences between ethnic and racial groups in depression recurrence •Uneven distribution of depression within some minority groups

What Triggers a Suicide? - •Modeling: Contagion of suicide

•A suicidal act appears to serve as a model for other such acts, especially among teens •Common models •Family members and friends •Celebrities •Highly publicized cases •Coworkers and colleagues

Dissociative Disorders - •How do theorists explain dissociative amnesia and dissociative identity disorder?

•A variety of theories have been proposed to explain dissociative disorders •Older explanations have not received much investigation •Newer viewpoints, which combine cognitive, behavioral, and biological principles, have captured the interest of clinical scientists

Acute and Posttraumatic Stress Disorders - •How do clinicians treat acute and posttraumatic stress disorders?

•About half of all cases of PTSD improve within 6 months; the remainder may persist for years •Treatment procedures vary depending on the type of trauma General goals •End lingering stress reactions •Gain perspective on painful experiences Return to constructive living •Combat veterans •Antidepressant drugs •Cognitive-behavioral therapy •Cognitive processing therapy •Mindfulness-based techniques •Exposure techniques; prolonged exposure •Eye movement desensitization and reprocessing (EMDR) •Couple or family therapy •Group therapy •Combination of some of the above Couple or family therapy •Counseling for spouses and children •Group therapy •Rap groups •Individual counseling Combination of some of the above Psychological debriefing (critical incident stress debriefing) •Crisis intervention in which victims of trauma talk extensively about their feelings and reactions within days of the critical incident •Unsupported in research

Biological Treatments for Unipolar Depression- •Biological approaches: antidepressant drugs - Tricyclics

•Act on neurotransmitter reuptake mechanisms of key neurons •Block an overly vigorous reuptake process and allow serotonin and norepinephrine to remain in the synapses longer •Can produce side effects; relapse may occur if therapy is ended too quickly after recovery In searching for medications to treat schizophrenia, researchers discovered that imipramine relieved depressive symptoms. Imipramine and related drugs are known as tricyclics because they share a three-ring molecular structure. Most patients who immediately stop taking tricyclics upon relief of symptoms relapse within one year. •Patients who take tricyclics for five additional months ("continuation therapy") have a significantly decreased risk of relapse. •Patients who take antidepressant drugs for three or more years after initial improvement ("maintenance therapy") may reduce the risk of relapse even more. Tricyclics are believed to reduce depression by affecting neurotransmitter (NT) reuptake mechanisms. •To prevent an NT from remaining in the synapse too long, a pumplike mechanism recaptures the NT and draws it back into the presynaptic neuron. •The reuptake process appears to be too efficient in some people, drawing in too much of the NT from the synapse. •This reduction in NT activity in the synapse is thought to result in clinical depression. •Tricyclics block the reuptake process, thereby increasing NT activity in the synapse.

Acute and Posttraumatic Stress Disorders

•Acute stress disorder •Symptoms begin within four weeks of event and last for less than one month Posttraumatic stress disorder (PTSD) •Symptoms may begin either shortly after event, or months or years afterward •As many as 80 percent of all cases of acute stress disorder develop into PTSD Lingering impact More than four decades after the Vietnam War, over a quarter million veterans of that war are still suffering from PTSD. Until his death in 2016, one such veteran was King Charsa Bakari Kamau. He is seen here playing the piano at a mall in Denver, Colorado, an avocation that he considered to be his best therapy. During and immediately after trauma, we may temporarily experience levels of arousal, anxiety, and depression. For some, symptoms persist well after the trauma. These people may be suffering from: •Acute stress disorder •Posttraumatic stress disorder (PTSD) The precipitating event usually involves actual or threatened serious injury to self or others. The situations that cause these disorders would be traumatic to anyone (unlike other anxiety disorders). Aside from differences in onset and duration, symptoms of acute stress disorders and PTSD are almost identical •Increased arousal, anxiety, and guilt •Reexperiencing the traumatic event •Avoidance •Reduced responsiveness and dissociation •Can occur at any age and affect all aspects of life •Affect at least 3.5 percent of people in the United States each year •More common among women (2:1) and people with low incomes •Two-thirds of affected people seek treatment at some point •More likely to be caused by some event—combat, disasters, abuse, and victimization •Approximately 7 to 9 percent of people in the United States are affected sometime during their lifetime. •After trauma, approximately 20 percent of women and 8 percent of men develop disorders.

Biological Treatments for Unipolar Depression - •Transcranial magnetic stimulation (TMS)

•An electromagnetic coil is placed on or above the patient's head and sends a current into the individual's brain •Increases neuron activity in the prefrontal cortex and improves function throughout the brain's depression-related circuit •Reduces depression when administered daily for 4 to 6 weeks

Biological Treatments for Unipolar Depression - •Deep brain stimulation (Mayberg et al.)

•An experimental treatment in which electrodes are implanted in a key component of the depression-related brain circuit (subgenual cingulate) and attached to a battery •Repeated stimulation reduces structure activity to a normal level and helps recalibrate the brain circuit •Has been successful with a small number of severely depressed clients

Treatment and Suicide - •Do suicide prevention programs work?

•Assessment of program effectiveness is difficult •Variety of program types, variables, and confounds •Mixed results •Accurate suicide risk assessment is elusive •Newer assessment approaches •Nonverbal behaviors •Psychophysiological measures •Brain scans •Self-Injury Implicit Association Test (Nock)

The Psychological Models of Unipolar Depression - •Negative thinking

•Beck: Unipolar depression is produced by a combination of maladaptive attitudes, cognitive triad, errors in thinking, and automatic thoughts •Cognitive triad: Negative view of experiences, oneself, and future •Seligman learned helplessness theory: Depression occurs when people feel loss of control over life reinforcements Such loss is attributed to internal, global, and stable causes

Treatments for Bipolar Disorders

•Before 1970, treatments for people with bipolar disorders were largely ineffective •In 1970, FDA approved the use of lithium •Mood-stabilizing (antibipolar) drugs were later developed •Lithium: A metallic element that occurs in nature as a mineral salt and is an effective treatment for bipolar disorders. •Mood-stabilizing drugs: Psychotropic drugs that help stabilize the moods of people suffering from bipolar disorder; also known as antibipolar drugs.

Psychodynamic Treatments for Unipolar Depression - •Cognitive-behavioral therapy

•Behavioral activation •Therapist works systematically to increase the number of constructive and pleasurable activities and events in a client's life •Reintroduce pleasurable events and activities •Appropriately reward nondepressive and depressive behaviors •Help improve social skills (Lewinsohn) •Most effective when combined with cognitive techniques Cognitive-behavioral therapists combine behavioral and cognitive techniques to help clients suffering from depression. •On the behavioral side, they seek to get the clients moving again—to engage in and enjoy more activities. •On the cognitive side, they guide the clients to think in more adaptive, less negative ways. The behavioral techniques seem to be of only limited help when just one of them is applied. When two or more of the techniques are combined, behavioral treatment does seem to reduce depressive symptoms, particularly if they are mild. •Beck's cognitive therapy: Used to guide clients in four phases to recognize and change negative cognitive processes •Increasing activities and elevating mood •Challenging automatic thoughts •Identifying negative thinking and biases Changing primary attitudes •New-wave cognitive-behavioral therapists •Disagree with Beck's proposition about the need to fully discard negative cognitions to overcome depression •Use mindfulness training and other techniques to help clients recognize negative cognitions as streams of thinking Research suggests that approaches of this kind are particularly useful as ongoing procedures that help prevent recurrences of depression once individuals recover from an episode.

Biological Treatments for Unipolar Depression(part 1)

•Biological approaches: antidepressant drugs •In the 1950s, two kinds of drugs were found to reduce the symptoms of depression •Monoamine oxidase (MAO) inhibitors •Tricyclics •These drugs have been joined in recent years by the second-generation antidepressants

Acute and Posttraumatic Stress Disorders - •Why do people develop acute and posttraumatic stress disorders?

•Biological factors •Childhood experiences •Personal styles •Social support systems •Severity and nature of the traumas Let's take a look at each of these. Biological factors •Brain-body stress pathways •Brain's stress circuit •Inherited predisposition Childhood experiences •Chronic neglect or abuse •Poverty •Parental separation or divorce •Catastrophe Family members with psychological disorders Some research suggests abnormal neurotransmitter and hormone activity (especially norepinephrine and cortisol). Once a stress disorder sets in, further biochemical arousal and damage may also occur (especially in the hippocampus and amygdala). There may be a biological/genetic predisposition to such reactions. Researchers have found that certain childhood experiences increase risk for later stress disorders. Risk factors: •An impoverished childhood •Psychological disorders in the family •The experience of assault, abuse, or catastrophe at an early age •Being younger than 10 years old when parents separated or divorced Personal styles •Preexisting high anxiety and negative worldview versus resiliency and positive attitudes Social support systems •Weak family and social support systems • Some studies suggest that people with certain personalities, attitudes, and coping styles are particularly likely to develop stress disorders. Risk factors: •Preexisting high anxiety •Negative worldview A set of positive attitudes (called resiliency or hardiness) is protective against developing stress disorders. •Severity and nature of the trauma •More severe or prolonged trauma •More direct exposure to trauma •Intentionally inflicted trauma •Mutilation, severe physical injury, or sexual assault •Developmental psychopathology perspective •Timing of stressors and traumas over developmental course and •Inherited or acquired biological predisposition for overreactivity in brain-body stress pathways and dysfunction in brain stress circuit •Principles of multifinality and equifinality

Biological Treatments for Unipolar Depression - •Brain stimulation

•Biological treatments that directly or indirectly stimulate certain areas of the brain •Electroconvulsive therapy (ECT) •Vagus nerve stimulation •Transcranial magnetic stimulation Deep brain stimulation Biological treatments can bring great relief to people with unipolar depression. Usually biological treatment means antidepressant drugs, but for severely depressed individuals who do not respond to other forms of treatment, it sometimes includes electroconvulsive therapy or brain stimulation. •Researchers surmised they might be able to stimulate the brains of individuals with depression by electrically stimulating the vagus nerve through the use of a pulse generator implanted under the skin of the chest. •This procedure brings significant relief to as many as 40 percent of those persons with treatment-resistant depression. •As with ECT, researchers do not yet know precisely why this technique reduces depression. •Electroconvulsive therapy (ECT) •One of the most controversial forms of treatment •Procedure consists of targeted electrical stimulation to cause a brain seizure •6 to 12 sessions spaced over 2 to 4 weeks; bilateral or unilateral •ECT is used frequently because it is an effective and fast-acting intervention. •The techniques for administering ECT have changed significantly since the treatment's early days. Today, patients are given drugs to help them sleep, muscle relaxants to prevent severe jerks of the body and broken bones, and oxygen to guard against brain damage. •Discovery of ECT's effectiveness was accidental and based on a fallacious link between psychosis and epilepsy •The procedure has been modified in recent years to reduce some of the negative effects •Patients generally report some memory loss •Clearly effective in treating unipolar depression: Leads to improvement in 60 to 80 percent of patients

The Biological Model of Unipolar Depression - •Brain circuits

•Brain circuit dysfunction •Brain imaging studies •Subgenual cingulate makes a distinct contribution •Abnormal activity and flow rate in various brain locations •Structure problems: interconnectivity •Abnormal neurotransmitter activity Researchers believe that the brain circuit involved in unipolar depression includes the prefrontal cortex, hippocampus, amygdala, and subgenual cingulate, among other structures. Biological researchers have determined that emotional reactions of various kinds are tied to brain circuits. •These networks of brain structures work together, triggering each other into action and producing a particular kind of emotional reaction. •It appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCD. Although research is far from complete, a circuit responsible for unipolar depression has begun to emerge. •Likely brain areas in the circuit include the prefrontal cortex, hippocampus, amygdala, and Brodmann Area 25.

PsychWatch: Repressed Childhood Memories or False Memory Syndrome?

•Claims of recovery of childhood memories of abuse have declined in recent years •Repressed childhood sexual abuse memories emerge in various settings Counterargument: Suggestibility •Memories may be flawed illusions or false images formed by a confused mind; created in laboratory •Some people are more prone to false memories Details of child sexual abuse are often remembered

Acute and Posttraumatic Stress Disorders - •Triggers

•Combat •Disasters and accidents •Victimization •Sexual assault and rape •Terrorism Torture Combat and stress disorders are called "shell shock" or "combat fatigue." Post-Vietnam War clinicians discovered that soldiers also experienced psychological distress after combat. •As many as 29 percent of Vietnam combat veterans suffered acute or posttraumatic stress disorders. •An additional 22 percent had some stress symptoms. •Some 10 percent are still experiencing problems. •A similar pattern is currently unfolding among 2.7 million veterans of wars in Afghanistan and Iraq. Acute or posttraumatic stress disorders may also follow natural and accidental disasters. •Types of disasters include earthquakes, floods, tornadoes, fires, airplane crashes, and serious car accidents. •Because they occur more often, civilian traumas have been implicated in stress disorders at least 10 times as often as combat traumas. Victimization and stress disorders: •People who have been abused or victimized often experience lingering stress symptoms. •Research suggests that more than one-third of all victims of physical or sexual assault develop PTSD. Terrorism and torture: •The experience of terrorism or the threat of terrorism often leads to posttraumatic stress symptoms, as does the experience of torture.

Stress and Arousal

•Components of stress •Stressor •Event that creates demands •Causes fear when viewed as threatening •Stress response •Person's reactions to demands •Extraordinary stress and trauma •Can play a central role in certain psychological disorders •Fear is a "package" of responses that are physical, emotional, and cognitive. •People who experience a large number of stressful events are particularly vulnerable to the onset of anxiety and other psychological disorders. Stress and psychological disorders •Acute stress disorder •Posttraumatic stress disorder (PTSD) •DSM-5 lists these as "trauma and stressor-related disorders" Stress and physical (psychophysiological) disorders •DSM-5 lists these under "psychological factors affecting medical condition"

The Sociocultural Model of Unipolar Depression - •Multicultural treatments

•Culture-sensitive therapies address unique issues of cultural minority groups •Special training on cultural values and stressors •Often combined with traditional psychotherapy forms • • • Culture-sensitive approaches increasingly are being combined with traditional forms of psychotherapy to help maximize the likelihood of minority clients overcoming their disorders.

Dissociative Disorders - •Depersonalization-derealization disorder

•DSM-5 categorizes this as a dissociative disorder, but not as one characterized by the memory difficulties found in the other dissociative disorders •Central symptom is persistent and recurrent episodes of depersonalization and/or derealization Characteristics •Feeling of detachment from own mental processes or body •Observing self from outside •Feeling people or objects are unreal or detached •Transient depersonalization and derealization experiences are relatively common, while depersonalization-derealization disorder is not Depersonalization experiences by themselves do not indicate a depersonalization disorder. •Transient depersonalization reactions are fairly common. •The symptoms of a depersonalization disorder are persistent or recurrent, cause considerable distress, and interfere with social relationships and job performance.

What Is Suicide? - •Intentional death (Shneidman)

•Death seekers: Clearly intend to end their lives •Death initiators: Intend to end their lives because they believe that the process of death is already under way •Death ignorers: Do not believe that their self-inflicted death will mean the end of their existence •Death darers: Have ambivalent feelings about death and show this in the act itself

The Psychological Models of Unipolar Depression - •Cognitive-behavioral view

•Depression results from problematic behaviors and dysfunctional thinking •Theoretical perspectives •Behavioral dimension •Negative thinking •Complex cognitive and behavioral factor interplay

Depressive and Bipolar Disorders

•Depression: Low, sad state marked by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms •Mania: State or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking •Depressive disorders: Group of disorders marked by unipolar depression •Unipolar depression: Depression without a history of mania •Bipolar disorder: Disorder marked by alternating or intermixed periods of mania and depression

Integrating the Models

•Developmental psychopathology perspective •Unipolar depression is caused by a combination of the factors cited by various models •Genetically inherited biological predisposition influenced by significant early life trauma •Magnitude and timing of negative factors •Resiliency linked to moderate and manageable adversities throughout childhood •These factors unfold and intersect in a developmental sequence

Dissociative Disorders - •How do theorists explain dissociative amnesia and dissociative identity disorder? - •Cognitive-behavioral perspective

•Dissociation grows from normal memory processes and is a response learned through operant conditioning •Behaviorists rely largely on case histories to support their view of dissociative disorders •These explanations fail to explain all aspects of these disorders •Momentary forgetting of trauma leads to a drop in anxiety, which increases the likelihood of future forgetting. •Like psychodynamic theorists, behaviorists see dissociation as escape behavior.

Dissociative Disorders - •Kinds of dissociative disorders

•Dissociative amnesia •Dissociative fugue •Dissociative identity disorder (multiple personality disorder) •Subpersonalities Alternate personalities Managing without memory Andy Wray developed dissociative amnesia after witnessing several horrific deaths in his work as a policeman. His disorder is marked by continuous forgetting. Every few days, many of his new memories disappear, leaving him unable to recognize friends, relatives, and events in any detail. To help him get on with his life, he uses countless notebooks and reminder cards like the ones he is looking at here.

Dissociative Disorders - •How do theorists explain dissociative amnesia and dissociative identity disorder? - •Psychodynamic perspective

•Dissociative disorders are caused by repression •People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness •Dissociative amnesia and fugue are single episodes of massive repression •DID results from a lifetime of excessive repression, motivated by very traumatic childhood events •Most of the support for this model is drawn from case histories, which report brutal childhood experiences •Yet only a small fraction of abused children develop this disorder

Unipolar Depression: The Depressive Disorders - •Symptoms

•Emotional symptoms •Feeling "miserable," "empty," or "humiliated" •Experiencing little pleasure •Motivational symptoms •Lacking drive, initiative, and spontaneity •Between 6 percent and 15 percent of those with severe depression die by suicide •Behavioral symptoms •Less active, less productive •Cognitive symptoms •Hold negative views of themselves •Blame themselves for unfortunate events •Pessimistic •Physical symptoms Headaches, dizzy spells, or general pain

Dissociative Disorders - •Dissociative fugue

•Extreme version of dissociative amnesia •People not only forget their personal identities and details of their past, but also flee to an entirely different location •May be brief or more severe •For some, fugue is brief—a matter of hours or days—and ends suddenly. •For others, the fugue is more severe: People may travel far from home, take a new name and establish new relationships, and even enter a new line of work; some display new personality characteristics. •When people are found before their fugue has ended, therapists may find it necessary to continually remind them of their own identity. •The majority of people regain most or all of their memories and never have a recurrence.

Stress and Arousal: The Fight-or-Flight Response

•Features of arousal and fear are set in the hypothalamus Two important systems are activated •Autonomic nervous system (ANS) •An extensive network of nerve fibers that connect the central nervous system (the brain and spinal cord) to all other organs of the body •Endocrine system •A network of glands throughout the body that release hormones Two pathways by which ANS and the endocrine system produce arousal and fear reactions •Sympathetic nervous system pathway •Hypothalamic-pituitary-adrenal pathway •The Endocrine System: The HPA Pathway •When we face a dangerous situation, the hypothalamus first excites the sympathetic nervous system, which stimulates key organs either directly or indirectly. •When the perceived danger passes, the parasympathetic nervous system helps return body processes to normal. •The reactions on display in these two pathways are collectively referred to as the fight-or-flight response. •Each person has a particular pattern of autonomic and endocrine functioning and, therefore, a particular way of experiencing arousal and fear. •Hypothalamic-pituitary-adrenal pathway: The hypothalamus signals the pituitary gland, which stimulates the adrenal cortex to release corticosteroids (stress hormones) into the bloodstream.

Bipolar Disorders - •Manic episode

•For 1 week or more, person displays a continually abnormal, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity, for most of every day •Person also experiences at least three of the following symptoms •Grandiosity or overblown self-esteem •Reduced sleep need •Rapidly shifting ideas or the sense that one's thoughts are moving very fast •Attention pulled in many directions •Heightened activity or agitated movements •Excessive pursuit of risky and potentially problematic activities •Significant distress or impairment

Unipolar Depression: The Depressive Disorders - •Major depressive episode

•For a 2-week period, person displays an increase in depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day •For the same 2 weeks, person also experiences at least 3 or 4 of the following symptoms: •Considerable weight change or appetite change •Daily insomnia or hypersomnia •Daily agitation or decrease in motor activity •Daily fatigue or lethargy •Daily feelings of worthlessness or excessive guilt •Daily reduction in concentration or decisiveness •Repeated focus on death or suicide, a suicide plan, or a suicide attempt. Significant distress or impairment •Presence of a major depressive episode •No pattern of mania or hypomania •Persistent depressive disorder •Person experiences the symptoms of major or mild depression for at least 2 years •During the 2-year period, symptoms not absent for more than 2 months at a time •No history of mania or hypomania •Significant distress or impairment Major depressive disorder: Criteria 1 and 2 are met. Dysthymic disorder: Symptoms are "mild but chronic." •Depression is longer lasting but less disabling •Consistent symptoms for at least two years When dysthymic disorder leads to major depressive disorder, the sequence is called "double depression."

The Psychological Models of Unipolar Depression - •Psychodynamic view

•Freud and Abraham: When some people experience real or imagined losses (symbolic loss) •Regression to an earlier stage of development •Introjection of feelings for the lost object •Eventually becoming depressed •Object relations theorists: Depression results when people's relationships leave them feeling unsafe and insecure (especially in early life) Link between depression and grief •When a loved one dies, an unconscious process begins and the mourner regresses to the oral stage and experiences introjection—a directing of feelings for the loved one onto oneself. •For most people, introjection is temporary. •For some, grief worsens over time; if grief is severe and long-lasting, depression results. •Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression. •Instead of actual loss, some people experience "symbolic" (or imagined) loss instead. •Strengths •General research support: Depression may be triggered by major loss; early losses set the stage for later depression •Depression after loss related to poorly met childhood needs •Limitations •Early losses and inadequate parenting sometimes lead to depression but may not be typically responsible for development of the disorder •Many research findings are inconsistent •Certain features of the model are nearly impossible to test •

What Are the Underlying Causes of Suicide?- •Biological view

•Genetics •Early twin studies point to genetic links to suicide •Brain development •Low serotonin activity and abnormalities in depression-related brain circuits contribute to suicide •Both aid in the production of aggressive feelings and impulsive behavior Key psychosocial factors

Dissociative Disorders

•Group of disorders triggered by traumatic events •When such changes in memory lack a clear physical cause, they are called "dissociative" disorders •One part of the person's memory typically seems to be dissociated, or separated, from the rest •The key to our identity—the sense of who we are and where we fit in our environment—is memory. •Our recall of past experiences helps us to react to present events and guides us in making decisions about the future. •People sometimes experience a major disruption of their memory: •They may not remember new information. •They may not remember old information. •Dissociative symptoms are often found in cases of acute or posttraumatic stress disorders. •When such symptoms occur as part of a stress disorder, they do not necessarily indicate a dissociative disorder (a pattern in which dissociative symptoms dominate).

What Triggers a Suicide? - •Stressful events and situations

•Immediate stressors •Loss of loved one through death, divorce, or rejection •Loss of job or significant financial loss Natural disasters In 2015, Aaron Hernandez, a star tight end in the National Football League, was convicted of first-degree murder and sentenced to life in prison without parole for the 2013 killing of an acquaintance. Hernandez, shown here at a locker room press interview during his playing days, killed himself by hanging at a Massachusetts prison in 2017, just days after being acquitted of two additional killings. Around 11 percent of all prison deaths are due to suicide (BJS, 2016). •Long-term stressors •Social isolation •Serious illness •Abusive or repressive environment •Occupational stress Researchers have counted more stressful events in the lives of suicide attempters than in the lives of nonattempters.

Factitious Disorder

•Imposed on self •False creation of physical or psychological symptoms, or deceptive production of injury or disease, even without external rewards •Presentation of oneself as ill, damaged, or hurt •Munchausen syndrome •Imposed on another •False creation of physical or psychological symptoms, or deceptive production of injury or disease, in another person, even without external rewards •Presentation of another person (victim) as ill, damaged, or hurt •Munchausen syndrome by proxy

Dissociative Disorders - •Dissociative amnesia

•Inability to recall important information, usually of an upsetting nature, about one's life •Memory loss much more extensive than normal forgetting and is not caused by physical factors •Often the amnesia episode is directly triggered by a specific upsetting event' •Checklist •Dissociative amnesia •Person cannot recall important life-related information, typically traumatic or stressful information. The memory problem is more than simple forgetting. •Leads to significant distress or impairment •Symptoms are not caused by a substance or medical condition •Dissociative identity disorder •Person experiences a disruption to his or her identity, as reflected by at least two separate personality states or experiences of possession •Person repeatedly experiences memory gaps regarding daily events, key personal information, or traumatic events, beyond ordinary forgetting •Leads to significant distress or impairment •Symptoms are not caused by a substance or medical condition •Localized: Most common type; loss of all memory of events occurring within a limited period •Selective: Loss of memory for some, but not all, events occurring within a period •Generalized: Loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends •Continuous: Forgetting continues into the future; quite rare in cases of dissociative amnesia •All forms of the disorder are similar in that the amnesia interferes mostly with a person's memory. •Memory for abstract or encyclopedic information usually remains intact. •Clinicians do not known how common dissociative amnesia is, but many cases seem to begin with serious threats to health and safety.

What Is Suicide? - •Subintentional death

•Indirect, covert, partial, or unconscious •Self-injury or self-mutilation Creative expression At least 17 percent of teenagers and young adults purposely injure themselves, particularly by skin cutting (MHA, 2017). Olivia Stewart, a high school student in Colorado, chose mental illness as the topic for her senior project and produced this remarkable sculpture on self-mutilation. Stewart, whose project also featured art representations of other psychological disorders, hopes that her work will help increase education and public awareness regarding mental disorders.

Sociocultural Treatments for Unipolar Depression - •Family-social treatments

•Interpersonal psychotherapy (IPT; Klerman and Weissman) •Interpersonal problems may lead to depression •Interpersonal loss •Interpersonal role dispute •Interpersonal role transition •Interpersonal deficits •Useful for depression related to social conflicts or social role changes •Studies suggest that IPT is as effective as cognitive therapy for treating depression Sociocultural theorists trace the causes of unipolar depression to the broader social structure in which people live and the roles they are required to play. •Couple therapy •Two people sharing a long-term relationship •Integrative behavioral couples therapy •Cognitive-behavioral therapy and sociocultural techniques to teach the couple specific communication and problem-solving techniques •More effective than other techniques when one couple member is depressed; may enhance marriage satisfaction •If marriage is filled with conflict, is as effective as other therapies for reducing depression

What Are the Underlying Causes of Suicide? - •Interpersonal view

•Interpersonal-psychological theory (Joiner et al.) Perceptions related to desire for suicide •Perceived burdensomeness •Thwarted belongingness •Psychological ability to carry out suicide Important to examine variables collectively

Dissociative Disorders - How do theorists explain dissociative amnesia and dissociative identity disorder? - State-dependent learning

•Learning becomes associated with the conditions under which it occurred, so that it is best remembered under the same conditions •People who are prone to develop dissociative disorders have state-to-memory links that are unusually rigid and narrow Each thought, memory, and skill is tied exclusively to a particular state of arousal, so that a person recalls a given event only when he or she experiences an arousal state almost identical to the state in which the memory was first acquired.

Unipolar Depression: The Depressive Disorders - DSM-5 lists several types of depressive disorders

•Major depressive disorder •Persistent depressive disorder •Premenstrual dysphoric disorder Major depressive disorder: Severe pattern of depression that is disabling and is not caused by such factors as drugs or a general medical condition. Persistent depressive disorder: Chronic form of unipolar depression marked by depression. Premenstrual dysphoric disorder: Disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation.

What Triggers a Suicide? - •Mood and thought changes

•Many suicide attempts are preceded by changes in mood and shifts in thinking patterns •Hopelessness •Sadness, anxiety, tension, frustration, shame •Psychache •Dichotomous thinking

Treatment and Suicide - •Treatments after suicide attempts

•Medical care •Appropriate follow-up with psychotherapy or drug therapy •Therapies •Psychodynamic therapy •Drug therapy •Group and family therapies •Cognitive-behavioral therapy (Beck) •Mindfulness-based •Dialectical behavior •Therapy goals •Keep the patient alive •Reduce psychological pain •Achievement of nonsuicidal state of mind and a sense of hope Development of better ways of stress management

Treatments for Bipolar Disorders - •Effectiveness of lithium and other mood stabilizers

•More than 60 percent of patients with mania improve on these medications •Most individuals experience fewer new episodes while on the drugs •These drugs may help prevent symptoms from developing •Mood stabilizers also help those with bipolar disorder overcome their depressive episodes, albeit to a lesser degree Given the drugs' less powerful impact on depressive episodes, many clinicians use a combination of mood stabilizers and antidepressant drugs to treat bipolar depression, although research suggests that antidepressants may trigger manic episodes in some patients.

What Causes Bipolar Disorders? - •Biological research and perspectives

•Neurotransmitter activity: Mania may be related to high norepinephrine activity along with a low level of serotonin activity •Ion activity: Improper transport of ions back and forth between the outside and the inside of a neuron's membrane •Brain structure •Brain imaging and postmortem studies have identified a number of abnormal brain structures in people with bipolar disorder —in particular, the basal ganglia and cerebellum •Not clear what role such structural abnormalities play •Genetic factors •Many theorists believe that people inherit a biological predisposition to develop bipolar disorders •Family pedigree studies •Molecular biology techniques Neurotransmitters •After finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine levels and mania; this theory is supported by some research studies. •Because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists expected that mania would also be related to high serotonin activity. •Although no relationship with high serotonin has been found, bipolar disorder may be linked to low serotonin activity, which seems contradictory. This apparent contradiction is addressed by the "permissive theory" about mood disorders: •Low serotonin may "open the door" to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take: •Low serotonin + low norepinephrine = depression •Low serotonin + high norepinephrine = mania Ion activity •Ions, which are needed to send incoming messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder. •Some theorists believe that irregularities in the transport of these ions cause neurons to fire too easily (mania) or to stubbornly resist firing (depression); there is some research support for this theory.

The Psychological Models of Unipolar Depression - •Behavioral dimension

•Number of life rewards related to presence or absence of depression •Large reduction in positive life rewards may cause increasingly fewer positive behaviors, even lower positive rewards rate, and eventual depression •Social rewards are important in downward depression spiral Depression results from changes in the rewards and punishments that people receive in their lives. •Lewinsohn suggests that the positive rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors, and they spiral toward depression. •Research supports the relationship between the number of rewards received and the presence or absence of depression. •Social rewards are especially important.

Bipolar Disorders - •Cyclothymic disorder (DSM-5)

•Numerous periods of hypomanic symptoms and mild depression symptoms •Symptoms continue for two or more years, with normal moods for days or weeks in between •No gender differences •May evolve into bipolar I or bipolar II

Bipolar Disorders - •Bipolar I disorder

•Occurrence of a manic episode •Hypomanic or major depressive episodes may precede or follow the manic episode

Dissociative Disorders - How do theorists explain dissociative amnesia and dissociative identity disorder? - •Self-hypnosis

•Parallel between hypnotic amnesia and dissociative disorders •Powerful suggestions to forget •Suggestions put into practice through social and cognitive mechanisms •Although hypnosis can help people remember events that occurred and were forgotten years ago, it can also help people forget facts, events, and their personal identity. •People with dissociative amnesia and fugue often recover on their own. •Only sometimes do their memory problems linger and require treatment. •People with DID usually require treatment to regain their lost memories and develop an integrated personality. •Treatment for dissociative amnesia and fugue tends to be more successful than treatment for DID.

PsychWatch: Sadness at the Happiest of Times

•Postpartum (peripartum) depression •Symptoms may last up to a year or more •Extreme sadness, despair, tearfulness, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks, inability to cope, suicidal thoughts •Impact on mother-infant relationship and child well-being •Causes •Triggered by hormonal changes of childbirth •Genetic predisposition •Psychological and social change •Treatment •Self-help groups •Antidepressant medications, cognitive-behavioral therapy, interpersonal psychotherapy, or combination of these Treatment helps most women if it is sought

Bipolar Disorders - •Bipolar II disorder

•Presence or history of major depressive episode(s) •Presence or history of hypomanic episode(s) •No history of a manic episode

Treatment and Suicide •Suicide prevention

•Prevention programs and crisis hotlines •Staffed by professionals or paraprofessionals •Offered through various modalities •Suicide prevention goals for initial contact •Establishing a positive relationship •Understanding and clarifying the problem •Assessing suicide potential •Assessing and mobilizing the caller's resources •Formulating a plan •Longer-term prevention •Referral •Therapy •Reduction of access to common suicide means Another way to prevent suicide may be to limit the public's access to common means of suicide—for example, through gun control, safer medications, better bridge barriers, and car emissions controls.

Disorders Featuring Somatic Symptoms •DSM-5 categories identify somatic symptoms

•Primarily caused by psychological factors •Symptoms trigger excessive anxiety or concern •Factitious disorder •Conversion disorder •Somatic symptom disorder •Illness anxiety disorder Psychological factors affecting other medical conditions

Trending: Internet Horrors

•Pro-suicide Web sites •Found across the Internet and have tripled over past seven years •Provide constructive advice or information about how to kill self to 7.5 percent of teenagers •Live-streaming suicides •Concerted social networking efforts to identify people at risk and provide aid and information

Dissociative Disorders - •How do therapists help individuals with dissociative amnesia?

•Psychodynamic therapists guide patients to search their unconscious and bring forgotten experiences into consciousness •In hypnotic therapy, patients are hypnotized and guided to recall forgotten events •In drug therapy, intravenous injections of barbiturates are sometimes used to help patients regain lost memories Often called "truth serums," the key to the drugs' success is their ability to calm people and free their inhibitions.

Treatments for Bipolar Disorders - •Adjunctive psychotherapy

•Psychotherapy or mood stabilizing alone is rarely helpful for persons with bipolar disorder •Individual, group, or family therapy is often used as an adjunct to lithium (or other medication-based) therapy •Adjunctive therapy improves a variety of client behaviors, especially in those persons with a cyclothymic disorder •Thirty percent or more of patients with these disorders may not respond to lithium or a related drug, may not receive the proper dose, or may relapse while taking it. •Adjunctive therapy improves client adherence to medication regimen, reduces hospitalization, improves social function, and increases the ability to obtain and hold a job.

Treatments for Bipolar Disorders - •Mode of operation of mood stabilizers

•Researchers do not fully understand how mood-stabilizing drugs operate •Theories •Mood stabilizers change synaptic activity in neurons, but in a different way than do antidepressant drugs •Mood stabilizers increase the production of neuroprotective proteins, which may decrease bipolar symptoms •Mood stabilizers correct bipolar functioning by directly changing sodium and potassium ion activity in neurons Although antidepressant drugs affect a neuron's initial reception of neurotransmitters, mood stabilizers seem to affect a neuron's second messengers.

Biological Treatments for Unipolar Depression- •Biological approaches: antidepressant drugs - Second-generation antidepressants

•Selective serotonin reuptake inhibitors (SSRIs) •Structurally different from MAO inhibitors and tricyclics •Increase serotonin activity without affecting norepinephrine or other neurotransmitters •Few undesired, but still some, side effects •Failure rate may be 40 percent or higher Second-generation antidepressants: A third group of effective antidepressant that are is structurally different from the MAO inhibitors and tricyclics. •Selective serotonin reuptake inhibitors (SSRIs): Increase serotonin activity specifically (no other NTs are affected). This class includes fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro). •Selective norepinephrine reuptake inhibitors •Serotonin-norepinephrine reuptake inhibitors In terms of effectiveness and speed of action, these drugs are on a par with the tricyclics, yet their sales have skyrocketed. •Clinicians often prefer these drugs because it is harder to overdose on them than with other kinds of antidepressants. •There are no dietary restrictions, as there are with MAO inhibitors. •They have fewer side effects than the tricyclics. These drugs may cause some undesired effects of their own, including a reduction in sex drive.

The Psychological Models of Unipolar Depression - •Learned helplessness

•Seligman: Depression occurs when people believe they have no control over life's reinforcements and assume responsibility for this helpless state •Attribution-helplessness theory •Rubenstein and others revision: People question self when events are beyond control •Attribution to some internal global and stable cause = depression •Attribution to more specific, unstable, or external causes = less likelihood of learned helplessness and depression •Liu and others: Attributions that produce hopelessness = depression Beck theorizes four interrelated cognitive components combine to produce unipolar depression: •Maladaptive attitudes: Self-defeating attitudes are developed during childhood; upsetting situations later in life can trigger an extended round of negative thinking. •Cognitive triad: Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways that lead them to feel depressed. •Errors in thinking •Arbitrary inferences •Minimization of the positive and magnification of the negative •Automatic thoughts: A steady train of unpleasant thoughts that suggest inadequacy and hopelessness.

What Triggers a Suicide? - •Common triggers

•Stressful events •Mood and thought changes •Alcohol and other drug use •Mental disorders •Modeling

The Biological Model of Unipolar Depression - •Biological view

•Studies of genetic factors, biochemical factors, brain circuits, and the immune system suggest unipolar depression has biological causes •Genetic factors •Family pedigree studies •Twin studies •Gene studies •Molecular biology •Biochemical factors •Low activity of two neurotransmitters: serotonin and norepinephrine •Early studies on high blood pressure and antidepressant drugs •Later neurotransmitter interaction research •Hormones and HPA pathway •Stress studies •Dracula hormone; seasonal affective disorder Neurotransmitters: serotonin and norepinephrine •In the 1950s, medications for high blood pressure were found to cause depression •Some lowered serotonin; others lowered norepinephrine. •The discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, confirmed the NT role. •Depression likely involves not just serotonin nor norepinephrine; a complicated interaction is at work, and other NTs may be involved. People with depression have been found to have abnormal melatonin secretion, termed the "Dracula hormone." Other researchers are investigating deficiencies of important proteins within neurons as tied to depression. •Immune system •Under intense stress, dysregulation of the immune system occurs and contributes to depression •Slower functioning of lymphocytes, increased CRP production, and greater inflammation •Higher incidence of migraines, irritable bowel syndrome, chronic fatigue syndrome, rheumatoid arthritis, and other illnesses caused by CPR production and body inflammation The immune system is the body's network of activities and cells that fight off bacteria and other foreign invaders. When stressed, the immune system may become dysregulated, which some believe may help produce depression. •Support for this explanation is circumstantial but compelling.

Dissociative Disorders - •How do subpersonalities differ?

•Subpersonalities often display dramatically different characteristics •Identifying features •Abilities and preferences Physiological responses Identifying features: •Subpersonalities may differ in features as basic as age, sex, race, and family history. Abilities and preferences: •Although encyclopedic information is not usually affected by dissociative amnesia or fugue, in DID it is often disturbed. •It is not uncommon for different subpersonalities to have different abilities, including being able to drive, speak a foreign language, or play an instrument. Physiological responses: •Researchers have discovered that subpersonalities may have physiological differences, such as differences in autonomic nervous system activity, blood pressure levels, and allergies.

Is Suicide Linked to Age? •Adolescents

•Suicidal actions become much more common after the age of 13 •About 8 of every 100,000 U.S. teenagers commit suicide yearly •12 percent have persistent suicidal thoughts 4 to 8 percent make suicide attempts •Teenage suicide links •Developmental stress of adolescence •Long- and short-term stressors, especially among LGBTQ teens •Clinical depression, low self-esteem, hopelessness •Anger, impulsiveness, alcohol or drug problems •Internet and in-person modeling •Far more teens attempt suicide than succeed •Ratio may be as high as 200:1 •Factors linked to suicide attempts •Competition for jobs, college position, academic and athletic honors •Weakening family ties •Availability of alcohol/drugs •Mass media •U.S. teen suicide rates vary by ethnicity •Young white Americans are more suicide-prone than African Americans or Hispanic Americans at this age •Highest suicide rates are displayed by American Indians •Incidence rates are closing among all groups The Blue Whale Game, or Blue Whale Challenge, is an Internet "game" that is currently stirring great public concern. The challenge consists of daily tasks that participants are assigned by administrators, culminating, on the 50th day, with an instruction to kill oneself. It is estimated that dozens of teenagers across the world have died by suicide while playing the game, whose name is derived from the behavior of whales that strand themselves on beaches and die.

What Is Suicide? - •Suicide

•Suicide •Self-inflicted death in which one makes intentional, direct, and conscious effort to end one's life

Psychological and Biological Insights Lag Behind

•Suicide has received much more examination from the sociocultural model than from any other •Sociocultural factors shed light on the general background and triggers of suicide, but typically leave us unable to predict that a given person will attempt suicide •Clinicians do not yet fully understand why some people kill themselves while others in similar circumstances manage to find better ways of addressing their problems

Is Suicide Linked to Age? •Children

•Suicide is infrequent among children •Suicide by very young is often preceded by behavioral struggles •Many child suicides appear to be based on a clear understanding of death and a clear wish to die The intense training and testing that characterize Japan's educational system produce high levels of stress in many students. This child, wearing a headband that translates to "Struggle to Pass," participates in summer juku, a camp where children receive special academic training, extra lessons, and exam practice 11 hours a day. Suicide is infrequent among children. •Rates have been increasing over the past several decades. •1 of 100 children attempt self-harm; many are hospitalized for self-destructive acts. Between 6 and 33 percent of school children have thought about suicide.

Suicide

•Suicide is one of the leading causes of death in the world •Approximately 1 million people die by suicide each year, including more than 42,000 in the United States •Classification •Not officially classified as a mental disorder in DSM-5 •Suicidal behavior disorder has been proposed for the next revision

What Are the Underlying Causes of Suicide? - •Durkheim's sociocultural view

•Suicide probability is determined by attachment to social groups such as family, religious institutions, and community •Suicide categories •Egoistic: Isolated, alienated; nonreligious people •Altruistic: Socially well-integrated people •Anomic: Inhabitants of personally unstable social environment and structure •Egoistic suicides are committed by people over whom society has little or no control. •Altruistic suicides are committed by people who are so well integrated into their society that they intentionally sacrifice their lives for its well-being. •Anomic suicides are those committed by people whose social environment fails to provide stable structures that support and give meaning to life. •A major change in an individual's immediate surroundings can also lead to this type of suicide.

What Is Suicide? - •Patterns and statistics

•Suicide rates vary •Country to country •Gender and marital status •Race and ethnicity •Social environment •Religious devoutness (not exclusively affiliation) •Underreporting may exist In the United States, American Indians have the highest suicide rates among both males and females. (Information from AFSP, 2017; CDC, 2016, 2014, 2010; SPRC, 2013.)

What Are the Underlying Causes of Suicide? - •Psychodynamic view

•Suicide results from •Depression and anger at others that is redirected toward self (Stekel) •An introjecting lost person (Freud; Abraham): Anger over a lost loved one turns to self-hatred and then depression •Later suicidal behaviors related to childhood losses (Freud) •Death instincts/Thanatos (Freud)

MindTech: Texting: A Relationship Buster?

•Texting is the leading communication medium for most people •Some researchers suggest texting may negatively affect relationships (Turkle) •Avoidance of direct communication or possible confrontations •Reduction of emotional connections •Misunderstandings and relationship damage •Broader feelings of stress and unhappiness The average 18- to 24-year-old, for example, sends and receives a total of 128 texts each day. In fact, surveys suggest that people often fail to fully attend to their current activities as they struggle to juggle their text conversations.

Is Suicide Linked to Age?

•The likelihood of committing suicide increases with age, although people of all ages may try to kill themselves. •In the United States, suicide rates keep rising through middle age, then fall during the first decade of old age, then rise again among people over the age of 74. (Information from AFSP, 2017; CDC, 2016.)

What Triggers a Suicide? - •Mental disorders

•The majority of suicide attempters have a psychological disorder •Unipolar or bipolar depression (70 percent) •Chronic alcoholism (20 percent) •Schizophrenia (10 percent) Risk increases with multiple disorders •Other psychological disorders •Posttraumatic stress disorder (PTSD) •Panic disorder •Substance use disorder •Often in conjunction with schizophrenia or borderline personality disorder

Dissociative Disorders - •How do subpersonalities interact?

•Three kinds of relationships •Mutually amnesic relationships •Mutually cognizant patterns •One-way amnesic relationships •Average number subpersonalities is now thought to be 15 for women and 8 for men; often appear in groups of 2 or 3 The relationships between or among subpersonalities varies from case to case. •Mutually amnesic relationships: Subpersonalities have no awareness of one another. •Mutually cognizant patterns: Each subpersonality is well aware of the rest. •One-way amnesic relationships: Most common pattern; some personalities are aware of others, but the awareness is not mutual. Those who are aware ("co-conscious subpersonalities") are "quiet observers."

What Causes Bipolar Disorders?

•Throughout the first half of the twentieth century, the search for the cause of bipolar disorders made little progress •More recently, biological research has produced some promising clues •These insights have come from research into neurotransmitter activity, ion activity, brain structure, and genetic factors

Dissociative Disorders - How common is DID?

•Traditionally, DID was believed to be rare •The number of people diagnosed with the disorder has increased •Although the disorder is still uncommon, thousands of cases have been documented in the United States and Canada alone •Despite changes, many clinicians continue to question the legitimacy of this category Two factors may account for this increase: •A growing number of clinicians believe that the disorder does exist and are willing to diagnose it. •Diagnostic procedures have become more accurate. Some researchers argue that many or all cases are iatrogenic—that is, they are unintentionally produced by practitioners. •These arguments are supported by the fact that many cases of DID first come to attention only after a person is already in treatment. •This is not true of all cases, however.

Bipolar Disorders - •Diagnosing bipolar disorders

•Two kinds of bipolar disorder (DSM-5) •Bipolar I disorder •Bipolar II disorder •Worldwide, 1 to 2.6 percent of all adults have bipolar disorder at any given time: 4 percent have it at some point in life •No gender differences, but higher rates in low-income populations •Without treatment, mood episodes tend to recur for people with either type of bipolar disorder •Four or more episodes within a one-year period are classified as rapid cycling •Depression tends to be experienced more than mania and lasts longer •Onset usually occurs between the ages of 15 and 44 years. •In most cases, the manic and depressive episodes eventually subside, only to recur at a later time. •Generally, when episodes recur, the intervening periods of normality grow shorter and shorter.

Dissociative Disorders - •Dissociative identity disorder (multiple personality disorder)

•Two or more distinct personalities (subpersonalities) develop •Each has unique set of memories, behaviors, thoughts, and emotions •Sudden movement from one subpersonality to another (switching) is usually triggered by stress Women diagnosed three times more often than men At any given time, one of the subpersonalities dominates the person's functioning. •Usually one of these subpersonalities—called the primary, or host, personality—appears more often than the others. •The transition from one subpersonality to the next ("switching") is usually sudden and may be dramatic. Most cases are first diagnosed in late adolescence or early adulthood. •Symptoms generally begin in childhood after episodes of abuse. •Typical onset is before age 5.

Is Suicide Linked to Age? •The Elderly

•U.S. elderly are most likely to commit suicide and most successful •Contributory factors •Illness •Loss of close friends and relatives •Loss of control over one's life •Loss of social status •Ethnicity A right to die? Although she has not tried to end her life, Nel Bolten, a resident of the Netherlands, recently brought attention to the right-to-die debate when she had her chest tattooed with these words (which mean "Do not resuscitate. I am 91 plus."). The Dutch health minister has confirmed that the tattoo is a legally binding declaration in that country, where euthanasia and physician-assisted suicide are permitted.

Making Sense of All That Is Known

•Unipolar depression factors •Biological abnormalities •Positive reinforcement reduction •Negative thinking •Perception of helplessness •Life stress Sociocultural influences •Bipolar depression factors •Biological abnormalities •Inherited Stress triggered

The Psychological Models of Unipolar Depression - •Psychodynamic therapy

•Unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people •Psychodynamic therapists seek to bring these issues into consciousness and work through them •Free association •Therapist interpretation •Review of past events and feelings Psychodynamic therapists expect that in the course of treatment, depressed clients will eventually gain awareness of the losses in their lives, become less dependent on others, cope with losses more effectively, and make corresponding changes in their functioning. •Psychodynamic therapy strengths •Successful case reports •Most successful with modestly or moderately depressed clients with a clear history of abuse •Long-term therapy is only occasionally helpful in unipolar depression cases •Psychodynamic therapy limitations •Depressed clients often are too passive and weary to participate fully •Clients may become discouraged and end treatment too early

Bipolar Disorders - •Symptoms

•Unlike those experiencing depression, people in a state of mania typically experience dramatic and inappropriate rises in mood •Emotional symptoms •Motivational symptoms •Behavioral symptoms •Cognitive symptoms •Physical symptoms •Emotional symptoms: Active, powerful emotions in search of an outlet •Motivational symptoms: Need for constant excitement, involvement, companionship •Behavioral symptoms: Very active—move quickly; talk loudly or rapidly; flamboyance is not uncommon •Cognitive symptoms: Show poor judgment or planning; may have trouble remaining coherent or in touch with reality •Physical symptoms: High energy level—often in the presence of little or no rest

Dissociative Disorders - How do therapists help individuals with dissociative identity disorder?

•Unlike victims of dissociative amnesia or fugue, people with DID do not typically recover without treatment •Treatment for this pattern, like the disorder itself, is complex and difficult Unlike victims of dissociative amnesia, people with dissociative identity disorder do not typically recover without treatment. Therapists usually try to help the clients •Recognize fully the nature of their disorder •Bonding with primary personality •Hypnosis, group, and family therapy •Recover the gaps in their memory •Psychodynamic therapy, hypnotherapy, drug treatment •Integrate their subpersonalities into one functional personality •Fusion, ongoing therapy to maintain a complete personality

What Is Suicide? - •How is suicide studied?

•Using retrospective analysis as psychological autopsy Studying people who survive their suicide attempts

Biological Treatments for Unipolar Depression - •Vagus nerve stimulation

•Vagus nerve serves as the primary communication link between the brain and major organs •An implanted pulse generator sends regular electrical signals to the vagus nerve, which then stimulates the brain •The positive effects of ECT are achieved without ECT's negative side effects or trauma •Significant relief is reported for severely depressed people for whom other treatment was not successful •An implanted pulse generator sends electrical signals to the vagus nerve, which signals to the brainThis stimulation of the brain helps reduce depression in many patients

Treatments for Bipolar Disorders - •Lithium

•Very effective in treating bipolar disorders and mania •Determining the correct dosage for a given patient is a delicate process •Too low = no effect •Too high = lithium intoxication (poisoning) •49 percent of all people with bipolar disorder receive treatment in any given year •Other mood stabilizers •Some patients respond better to other drugs or to combinations of drugs

The Autonomic Nervous System (ANS)

•When the sympathetic division of the ANS is activated, it stimulates some organs and inhibits others. The result is a state of general arousal. In contrast, activation of the parasympathetic division leads to an overall calming effect. •Sympathetic nervous system: The nerve fibers of the autonomic nervous system that quicken the heartbeat and produce other changes experienced as arousal. •Parasympathetic nervous system: The nerve fibers of the autonomic nervous system that help return bodily processes to normal.

Biological Treatments for Unipolar Depression - •Biological approaches: antidepressant drugs - •MAO inhibitors

•Work biochemically by slowing down the body's production of MAO •May cause a rise in blood pressure when combined with certain common foods •Approximately half of patients who take these drugs are helped by them •MAO breaks down norepinephrine; MAO inhibitors stop this breakdown from occurring. This leads to a rise in norepinephrine activity and a reduction in depressive symptoms. •When people who take MAO inhibitors eat foods containing the chemical tyramine—including such common foods as cheeses, bananas, and certain wines—their blood pressure may rise to a dangerous level.