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Chapter 18: Mental Disorders
For those living with mental disorders, the world can often seem like a
Warning:
As we progress through chapter 18, some of you may be
tempted to say, “Hey, that sounds like me…oh, and that’s me,
too!” Many of us will feel like we share some of the same
characteristics as some of these mental disorders; however, it
does not mean we have the disorder. The same type of thing
can happen when we look up information on Web MD or other
websites. This is a normal temptation. Anyone of us can share
some of the symptoms described in this chapter.
On a second note, there is nothing wrong with having a mental
disorder. Just like any other syndrome or disease, it is beyond
the person’s control.
I.
The Nature of Mental Disorders
A. It is extremely difficult to define a mental disorder.
1. A handful of the disturbed are dangerous, the
average mental patient is confused and
withdrawn, bothering no one.
2. Statistically, mental patients are less violent than
those making up the “normal” general public.
3. Emotionally disturbed people are not that much
different from you or your friends in most areas,
except for the exaggeration of certain behaviors.
4. The person distorts or exaggerates characteristics
that are shared by all of us. It comes down to a
matter of degree.
If mental health is all a matter of degree, this implies that we’re all a little
crazy—or at least we all have the potential to be crazy. Writers like Edgar
Allan Poe, Rod Serling, and Stephen King know all about this continuum.
They describe people who are walking a tightrope between madness and
normalcy and who can fall at any time. If their stories were about people
who were just severely disturbed, they wouldn’t be as compelling.
B. Definitions of Abnormal Behavior
1. There is something “abnormal” in all “normal” people.
2. One very workable definition of those who do need
help has three parts to it:
a. The person suffers from discomfort more or less
continuously.
1) Suffers from extreme anxiety
2) Suffers from endless worry
3) Suffers from long periods of depression
4) The person feels that something is wrong with his or
her life far more than the average person does.
b. Possibly the person behaves in a bizarre fashion.
1) He or she constantly misinterprets what is going on
and what others are doing or saying.
2) He or she is afraid to go to work or school.
3) He or she falls apart over minor things or sinks into
depression.
c. People who need help can be very inefficient.
1) They are unable to perform their life roles properly.
a) An alcoholic who refuses to accept that there is
a problem.
b) A person who does nothing while his or her
family life is falling apart.
c) A parent at home with children who cannot
even cope with the dirty dishes.
3. Many people in need of help have trouble getting along
with others and are typically inflexible.
4. Another characteristic is that these people constantly
see a threatening environment.
II. Classifying Disorders—The DSM-V (It was updated in 2013)
A. Diagnostic and Statistical Manual of Mental Disorders V—A
book that classifies the symptoms of mental problems into
formal categories.
B. Remember that even though these categories have
names and symptoms, no person really fits into any one
category perfectly, and symptoms overlap with one
another.
C. The DSM system is used only to provide some degree of
order when trying to decide the kind of problem the
patient has.
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What are some signs of abnormal behavior?
 Continuous discomfort
 Acting in a bizarre fashion
 Inefficiency
 Inflexibility
 Constantly perceiving a threatening environment
One of the problems of labeling someone mentally ill is
the stigma attached to the label. There’s nothing wrong
with labels; we use them all the time. But when the labels
limit us, because of our own shame or the attitudes of
others, then the labels become destructive.
Mental illness is a heavy load in itself, and each of us
needs to avoid attaching any extra burdens with our own
stereotypes and irrational fears.
Mental illness is serious. Mental illness is treatable.
III. Anxiety Disorders
A. Anxiety—A generalized feeling of apprehension and
pending disaster.
B. Anxiety Disorder—A disorder whose major symptom is
anxiety.
1. Panic Disorder—A type of anxiety disorder in which one
cannot relax and is plagued by frequent and
overwhelming attacks of anxiety.
2. Phobic Disorder—A type of anxiety disorder in which a
person becomes disabled and overwhelmed by fear in
the presence of certain objects or events.
a. Specific Phobia—A major anxiety that arises when
faced with a specific object or situation, such as a
snake, dog, elevator, heights, and so on.
b. Agoraphobia—The fear of leaving a familiar
environment, especially home.
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It is very likely that a person with a panic
disorder will develop phobias.
If a person has an anxiety attack near a dog,
she may associate the dog with the attack
and later feels uneasy around dogs
(conditioning – chapter 7).
Anxiety attacks can last one –two minutes.
This seems short, but the attacks can be very
overwhelming.
3. Obsessive-compulsive Disorder—Having continued
thoughts (obsession) about performing a certain act
over and over (compulsion).
a. Obsession—An endless preoccupation with an urge
or thought.
b. Compulsion—A symbolic, ritualized behavior that a
person must keep acting out in order to avoid
anxiety.
Crash Course OCD and Anxiety Disorders
Video: 48 Hours: Obsessive Compulsive Disorder
Additional Information:
 People with OCD are usually good workers. They strive to do
a perfect job.
 Freud’s term for OCD was Anal Retentiveness or Anal Fixation
 People with OCD seem to have an imbalance of serotonin.
Antidepressants have been found to be an effective
treatment.
Activity: Psychological Disorder Chapter 18 WS #1
Quick Check…Name the Disorder
1. A person must chew food exactly twenty-five times before
swallowing.
Obsessive-Compulsive Disorders
2. A person is suddenly overcome with a racing heart, difficulty breathing,
and a feeling of impending doom for no apparent reason.
Panic Disorder
3. A person has an intense fear of learning.
Phobia (specifically Sophophobia)
IV. Somatoform Disorders
A. Somatoform Disorder—Condition in which psychological
issues are expressed in bodily symptoms in the absence
of any real physical problems.
1. Conversion Disorder—Disorder in which a serious
psychological trauma is changed into a symbolic
physical dysfunction. (Very Rare)
a. Hysterical Blindness—Someone becomes blind after
seeing something horrific like a person being
tortured.
b. Hysterical Paralysis—A person becomes
“paralyzed” after a traumatic event like a train
wreck. (The person will not be able to move.
Physically they should be able to move, but if you
were to put a pin in her leg, she would not be able
to feel it. They are not faking…it is VERY real, but
unexplainable.)
2. Hypochondriasis—Disorder characterized by
feeling excessive concern about one’s health and
exaggerating the seriousness of minor physical
complaints.
a. Usually comes about by associating illness with
attention. (Not the same as Munchhausen
Syndrome.)
b. Spend lots of time at the doctor’s office, and
can think a headache is a brain tumor or the
is pneumonia.
Interesting Facts
 Conversion Disorder was called Hysteria during the time of
Freud.
 Some father’s experience sympathy pains when their wives
are pregnant. You wouldn’t call this a disorder but if it went
further, and the husbands’ bellies actually began to enlarge,
conversion disorder would be a fitting description.
V. Dissociative Disorders
A. Dissociative Disorders—Disorders in which a part of one’s
life becomes disconnected from other parts.
1. Psychogenic Amnesia—A dissociative disorder in
which traumatic events disappear from memory.
a. Selective Forgetting—Forgetting only things that are
very traumatic.
1) A soldier might forget his battalion and everything
about fighting in a war if he experienced a
traumatic event.
2. Psychogenic Fugue—The condition of having amnesia
for one’s current life and starting a new one somewhere
else.
a. More common among men.
b. Doesn’t last long, and when the person “comes out
of it”, he or she cannot remember what happened
during the fugue state.
3. Dissociative Identity Disorder—Condition in which a
person divides himself or herself into two (possibly
more) separate personalities that can act
independently.
a. Formerly called Multiple Personality Disorder.
b. Often confused with Schizophrenia; however, with
DID, a person has two or more sides that tend to live
independently, but the basic core person is the
same.
c. Extremely rare
d. Typically Include: haunted, confused personality,
childhood abuse, a history of traumatic
experiences, and a long-term habit of escaping
from almost any problem.
Interesting Facts
 When you associate you join together. When you dissociate, you
separate. In this case, you separate a memory from your self.
 During hypnosis, you are asked to “leave yourself” for a while. You
are still in full control; you are simply focused. In the case of
dissociative disorders, your ability to control this “disconnection” is
impaired.
 Organic Amnesia usually only causes problems with RECENT
memories that become hazy. The person may have difficulty
paying attention, and she may seem disoriented; however, with
psychogenic amnesia past memories are lost, too. Attention may
be seemingly unimpaired. The memory loss is preceded by an
argument, a firing, and so on.
 It seems that different personalities of a sufferer of dissociative
identity disorder may serve different functions. For example, one
may be the “work personality”, and the other personalities will
allow this one to be dominant during the work week for obvious
reasons. Or personality A may start a fight, become apprehensive,
then fade into the background to let personality B fight the battle.
Personality Activity
• Students will fill out a short personality survey.
• Students are to answer honestly.
• Students will turn in their survey when finished.
Part II:
• Students will receive someone else’s survey.
• Students will read through the survey a couple of times.
• Students will go and talk to someone else (think chit chat at
a party). You are to take on the characteristics of this other
person. Use their first name and act how he/she would act.
Introduce yourself. Discuss your interests, etc.
• Visit with a couple of different people.
• Come back to your seats…discuss. Connect to DID.
Sybil
Who was Sybil?
 Movie
 Activity
One Pager
After watching Sybil, students will do a one pager in order
to analyze dissociative identity disorder in the movie Sybil.
Students can write about a variety of topics, but must
address DID.
• Should include a quick intro with thesis (purpose…what
will you be writing about).
• One to two body paragraphs that analyze aspects of
DID and Sybil.
• A final paragraph wrapping up the main idea of your
one pager.
• Look at the rubric. You need to make sure you have
checked your essay for mechanics and grammar
issues.
VI. Mood Disorders
A. Mood Disorders—A category of mental disorder
characterized by one’s emotional state. It includes
depression and mania.
1. Dysthymic Disorder—A moderate depression.
a. Comes from Greek; means “low spirits”
b. Fairly common problem, and of all mental
disorders, most likely to clear up eventually
without treatment.
c. Referred to as the common cold of mental
health.
d. May be caused by the death of a loved one.
e. Typical symptoms: lack of energy,
unhappiness, loss of interest in activities and
people, loss of sense of humor, sadness, and
rock-bottom feelings of self worth.
2. Major Depression—An extremely low emotional
state, severe depression; involves loss of
appetite, lack of energy, hopelessness, and
suicidal thoughts.
a. Most patients have trouble carrying out
simple daily tasks.
b. Some may even lay motionless in a rolled-up
fetal position for hours at a time.
c. Many have a great deal of anger at
themselves or it is broad and unfocused.
d. It can last for a couple of weeks to several
months.
Draw it!
Take 3-4 minutes. Draw a quick picture of what YOU
believe depression feels like. The artistic ability doesn’t
matter. It can be abstract or realistic in design.
Mrs. Fry will call on students to share vocally what they
drew. You do not have to SHOW your drawing unless you
want to.
Discuss it!
• What are some common reasons that teens get
depressed?
• What are common reasons that all people get
depressed?
• Why do you think more women than men report being
depressed?
3. Mania—A mood disorder involving extreme
agitation, restlessness, rapid speech, and
trouble concentrating.
a. It is Greek meaning “mad excitement”.
b. Opposite from depression – extreme up
moods.
c. Flight of Ideas—A confused state in which
thoughts and speech go in all directions with
no unifying concept.
4. Bipolar Disorders—A disorder with up and down
swings of moods from “high” to “low”.
a. Formerly called Manic Depressive Disorder.
b. People who suffer from major depression or
bipolar disorder can become psychotic.
5. Cause of Mood Disorders
a. Chemical imbalance
1) Serotonin—The brain chemical that in
excess leads to mania; in too low
concentration, it leads to depression.
b. Most of the time mood disorders correct
themselves within 6 months 80-90% of the
time.
c. Hereditary—Maybe?
1)Depression is psychologically
“contagious”.
Crash Course: Moods
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Points to Stress:
As noted earlier, an imbalance of serotonin may play
a part in anxiety disorders, too.
Mania is characterized by rapid speech, restlessness,
and agitation.
Just as depression may be one way to deal with
anxiety, as noted earlier, mania may be one way of
overcoming, albeit briefly, the feelings of worthlessness
typical of depression.
Some psychologists view depression as the flip side of
anxiety. Rather than feel anxious, which can be quite
disturbing, we become depressed. In fact,
antidepressant drugs are often used to treat anxiety
disorders—even when no depression is exhibited.
Comprehension Check
Selective forgetting of events is involved in which kind of dissociative
disorder?
Amnesia
Which mood disorder includes restlessness?
Mania or Bipolar
Which mood disorder includes temporary loss of interest in activities and
people?
Dysthymic Disorder
Which mood disorder includes frequent thoughts of death or suicide?
Major Depression or Bipolar
Students will work on Psychological Disorders Chapter 18
WS II
VII. Characteristics of Psychotic Disorders
A. Psychosis or Psychotic Disorder—Severe mental
disorder involving major problems with emotional
responses, disorganized thought processes, and
distorted perceptions of the world.
1. Four major symptoms can appear in psychosis,
but typically at least two will.
a. Thought disorder—a serious distortion of the
ability to think or speak in a lucid and coherent
way.
b. Hallucinating—Seeing or hearing something
that is not present.
c. Delusion—A belief in something (for example,
that you are king or queen) that is not true.
d. Psychotics have a great deal of trouble with
emotional responses; the emotions shown are
inappropriate.
VIII. Schizophrenic Disorders
A. Schizophrenia—The most serious mental disturbance,
involving loss of contact with reality, thought disorders,
hallucinations, and delusions.
1. Schizophrenia results from physical or chemical
problems.
a. Appears in late adolescence or early adulthood.
b. Rarely occurs at any other time.
2. 1/3 of the schizophrenics have one episode and get
better; 1/3 have severe symptoms and do not
respond to treatment; 1/3 are consistently in and
out of mental institutions all their lives.
3. Word Salad—Speech in which words are mixed
together incoherently.
4. Clang Associations—Psychotic speech in which
words are rhymed.
Rhymes
Combined
Words
B. Types of Schizophrenia
1. There are several subtypes of schizophrenia
a. Catatonic Schizophrenia—Type of
schizophrenia characterized by disturbances of
movement. (Don’t move or speak – rare)
b. Paranoid Schizophrenia—Schizophrenia marked
by strong feelings of suspiciousness and
persecution.
c. Undifferentiated Schizophrenia—Schizophrenia
that lacks any distinguishing symptoms.
C. Psychotic Episodes—Periods of psychotic behavior
that can alternate with periods of relative coherence
and calm.
D. Environment may play a small part in this disorder.
Read about Michael W. on page 523-524.
E. Research shows that schizophrenics have abnormally
high levels of dopamine—The brain chemical present
in excess in schizophrenics, which causes nerve cells
to fire too rapidly and leads to thought and speech
confusion.
1. Keep in mind that:
a. The rapidity of thought with the schizophrenics
does not ever resemble that of the manic.
Schizophrenics speak and act as if they are
exhausted from too much thought.
b. The chemical defect in mood disorders does not
involve dopamine. That chemical is serotonin.
Crash Course: Understanding Schizophrenia
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Other Info
In general, the chances of becoming schizophrenic are
about 1%. If your brother or sister is schizophrenic, your
chance is about 10%. If your identical twin in schizophrenic,
your chance is roughly 50%.
The fact that some schizophrenics get worse, some better,
and some volley between better and worse is called the rule
of thirds.
Although psychotic people are out of touch with reality, they
are not out of touch with reality all of the time.
Although clang associations are amusing, they are relatively
uncommon.
Catatonic schizophrenia is extremely rare. Paranoid
schizophrenia is the most common.
It makes sense that paranoid schizophrenics would develp
grandiose beliefs. Maybe this helps them deal with their
delusions of persecution.
Comprehension Check
Which type of schizophrenics have grandiose beliefs?
Paranoid
Which display a disturbance of movement?
Catatonic
Which have thought disorders?
All types
Did you know…
• Catatonics are so rigid at times that you can
actually raise their hand or arm and it will stay
where you put it. And since catatonics
sometimes remain in one particular posture,
circulation problems may develop. At the
other extreme, every once in a while, they will
leave their stupor and become quite
animated.
• Another type of schizophrenia is called
Disorganized Schizophrenia which is marked
by extreme thought disorders. These people
are usually part of the third of the
schizophrenics who never get better, who
spend most of their lives in institutions.
The following slides depict art by people with schizophrenia
This was done by
a paranoid
schizophrenic
This is a series of paintings by Louis Wain. These pictures show
the perceptual changes caused by psychedelic drugs like
mescaline and LSD.
This slide depicts the auditory hallucinations of a schizophrenic.
This rendition is
entitled “Motifs of
Mania”.
This depiction shows
various creatures
attached to his
head. It explains the
confusion of a
schizophrenic.
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Did you know…
Approximately half of all patients admitted to mental
hospitals are diagnosed as schizophrenic.
One family factor that researchers have studied is called
double-bind communication. This is when a parent expresses
love and a sort of hostility at the same time. For example, a
parent may say, “Why don’t you ever tell me you love me?
And when you do, you don’t mean it. What’s wrong with
you?” These kinds of messages don’t make us schizophrenic,
but they do wear on us.
Amphetamines raise one’s dopamine level.
The dopamine theory is not as simple as it might seem.
Increasing the level of dopamine may cause schizophrenic
symptoms, but it doesn’t necessarily follow that
schizophrenics have high levels of dopamine. It is possible
that schizophrenics have a normal dopamine level, but too
many dopamine receptors in the brain.
The DSM
• The DSM has gone through several changes.
• Until 1974 homosexuality was listed as a disorder.
• In the past, people with boarderline personality
disorders have been listed as schizophrenic.
• Post-traumatic Stress Disorder is a newer listing.
• A new labels to the DSM-5 include: hoarding disorder,
caffeine withdrawl, excoriation disorder (skin picking),
cannabis withdrawl, and binge eating disorder. (These
are just a few.)
IX. Personality Disorders
A. Personality disorder—A disorder in which a person
has formed a peculiar or unpleasant personality.
1. These individuals do NOT fit into the other categories.
2. They have peculiar and unpleasant personality
patterns like extremely secretive, completely selfcentered, or consistently suspicious.
B. Antisocial Personality Disorder—A personality disorder in
which the person is in constant conflict with the law and
seems to have no conscience.
1. Formerly called psychopaths.
2. Sociopath—Same as antisocial personality disorder.
3. Show little or no concern, guilt, or anxiety; frequently in
conflict with the law.
4. Smooth and agreeable on the outside; they will agree
to treatment, and then go right back to committing
crimes.
C. Borderline Personality Disorder—Personality disorder
marked by unstable emotions and relationships,
dependency, and manipulative self-destructive behavior.
1. Characterized by: clingy/emotionally needy; selfdestructive behavior to manipulate others (suicide
threats, self-harm, or accidents); very dependent;
violent outbursts or belittle others; trouble controlling
impulses.
2. Cause is unclear; tends to run in families, but
researchers are not sure if it is biology or learning.
3. They do not do well in therapy because of their
suspicious and manipulative behavior.
Crash Course: Personality Disorders
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What Else Do You Need to Know?
It is possible for a person to have more than one disorder.
For example, many people with borderline personality
disorder also tend to be diagnosed with major depression.
Other personality disorders include: paranoid, narcissistic,
schizoid, histrionic, avoidant, and passive-aggressive.
Remember…you may have some of the same
characteristics as borderline personality disorder; however,
don’t assume you suffer from this disorder. These individuals
have these characteristics the majority of the time.
Criteria for commitment to a mental hospital are simple:
1. Does the person harm himself or herself or others?
2. Can the person take care of his or her basic needs?
 It is easier to get released from a mental hospital
than it is to get admitted.
Comprehension Check
What type of disorder does a sociopath have?
Antisocial Personality Disorder