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Psychological Disorders and
Treatment
Blind Pig Syndrome
The
belief that one has all
illnesses which one hears
about.
Insanity Defense
 M’Naughten
Rule: Insanity is
a legal term that one is not
aware or responsible for their
own actions.
 1954 Durham Rule, says one
is not responsible for their
actions.
Defining Abnormal Behavior

Any behavior state of emotional
distress that causes personal
suffering that is self-destructive or
maladaptive.
 Statistical
Deviation: If normal is
what most people do, Abnormal
behavior deviates from the norm.
Defining Abnormal Behavior
 Violation
of Cultural
Standards: Any action that violates
the standards of the group. Having
visions: religious blessing in some
cultures: Schizophrenic in others.
 Maladaptive behavior:
Interrupts everyday life significantly.
Defining Abnormal Behavior
 Emotional Distress: Feels,
angry, anxious afraid or depressed most
of the time.
 Impaired Judgment: Cannot tell
right from wrong or control their own
behavior.
Deviant, Distressful & Dysfunctional
1.
3.
Carol Beckwith
2.
Deviant behavior (going
naked) in one culture
may be considered
normal, while in others
it may lead to arrest.
Deviant behavior must
accompany distress.
If a behavior is
dysfunctional it is
clearly a disorder.
In the Wodaabe tribe men
wear costumes to attract
women. In Western society
this would be considered
abnormal.
Understanding Psychological Disorders
Ancient Treatments of psychological disorders
include trephination, exorcism, being caged like
animals, being beaten, burned, castrated,
mutilated, or transfused with animal’s blood.
Trephination (boring holes in the skull to remove evil forces)
Medical Model
When physicians discovered that syphilis led to
mental disorders, they started using medical models
to review the physical causes of these disorders.
Etiology: Cause and development of the
disorder.
2.
Diagnosis: Identifying (symptoms) and
distinguishing one disease from another.
Treatment: Treating a disorder in a psychiatric
hospital.
4.
Prognosis: Forecast about the disorder.
1.
3.
Medical Perspective
Philippe Pinel (1745-1826) from France, insisted
that madness was not due to demonic
possession, but an ailment of the mind.
George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago
Dance in the madhouse.
Biopsychosocial Perspective
Assumes that biological, socio-cultural, and
psychological factors combine and interact to
produce psychological disorders.
Psychological Disorders

Thomas Szasz
believes that mental illnesses are
socially, not medically, defined.
Classifying Psychological Disorders
The American Psychiatric Association rendered
a Diagnostic and Statistical Manual of Mental
Disorders (DSM) to describe psychological
disorders.
The most recent edition, DSM-IV-TR (Text
Revision, 2000), describes 400 psychological
disorders compared to 60 in the 1950s.
Multiaxial Classification
Axis I
Is a Clinical Syndrome (cognitive, anxiety,
mood disorders [16 syndromes]) present?
Axis II
Is a Personality Disorder or Mental
Retardation present?
Axis III
Is a General Medical Condition (diabetes,
hypertension or arthritis etc) also present?
Axis IV
Are Psychosocial or Environmental Problems
(school or housing issues) also present?
Axis V
What is the Global Assessment of the
person’s functioning?
Multiaxial Classification
Note 16 syndromes in Axis I
Multiaxial Classification
Note Global Assessment for Axis V
Goals of DSM
1.
2.
Describe (400) disorders.
Determine how prevalent the
disorder is.
Disorders outlined by DSM-IV are reliable.
Therefore, diagnoses by different professionals
are similar.
Others criticize DSM-IV for “putting any kind of
behavior within the compass of psychiatry.”
Prevalence





Approximately 48% of adults experienced symptoms
at least once in their lives
Approximately 80% who experienced symptoms in
the last year did NOT seek treatment
Most people seem to deal with symptoms without
complete debilitation
Women have higher prevalence of depression and
anxiety
Men have higher prevalence of substance abuse and
antisocial personality disorder
Psychological DisordersEtiology

Neurotic Disorder (term seldom used now)
 usually distressing but that allows one
to think rationally and function socially

Psychotic Disorder
 person loses contact with reality
 experiences irrational ideas and
distorted perceptions
Psychological Disorders
To study the abnormal is the best way of
understanding the normal.
1.
2.
William James (1842-1910)
There are 450 million people suffering from
psychological disorders (WHO, 2004).
Depression and schizophrenia exist in all cultures
of the world.
Problems with Diagnosis
Inconsistent
Overlapping
Self-Fulfilling
prophecy
Stereotyping/Labeling
Anxiety Disorder
 Those
diagnosed are usually
psychologically healthy in
other ways. Know their
behavior is irrational.
 Characterized by persistent
thoughts if dread or fear and
impending doom.
Generalized Anxiety Disorder
Continuous state of anxiety, lasts a
month or more. Show 3 of the
following.
 Motor Tension
 Autonomic Hyperactivity
 Apprehensive
 Viligence or Scanning

Model of Development of GAD
GAD has some genetic component
 Related genetically to major depression
 Childhood trauma also related to GAD

Genetic predisposition
or childhood trauma
Hypervigilance
GAD following life
change or major even
Phobias
An unrealistic fear of a specific
situation: Activity or thing. Simple
phobias (I.e. Claustrophobia).
 Agoraphobia: half of all phobia
cases: Fear of being alone in public
places from which escape or help
might be difficult. Usually home is a
safe place.
 Heritable component

Panic Attacks
A
brief feeling of intense fear
and impending doom or death
accompanied by intense
physiological symptoms such
as rapid breathing, dizziness
and sweaty palms.
Post-Traumatic Stress Disorder
Four or more weeks of the following symptoms
constitute post-traumatic stress disorder (PTSD):
1.
Haunting memories
2.
Nightmares
3.
Social withdrawal
5.
Jumpy anxiety
Sleep problems
Bettmann/ Corbis
4.
Resilience to PTSD
Only about 10% of women and 20% of men react to
traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience
against traumatic situations.
All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
Obsessive-Compulsive Disorders
Obsessions: persistent thoughts that
seem to come unbidden. Reflect
maladaptive ways of reasoning and
processing information.
 Compulsions: Repetitive ritualized
behavior that a person carries out in a
stereotypical fashion. Designed to
prevent some disaster.

Anxiety Disorders


PET Scan of brain of
person with Obsessive/
Compulsive disorder
High metabolic activity
(red) in frontal lobe
areas involved with
directing attention
Behavioral Therapies
Work on changing current behaviors
and attitudes. Assumes that behavior
IS the problem.
 Systematic Desensitization: (Wolpe)
Step-by-Step process of getting a
subject acclimated to a feared object.
Relaxing in a hierarchy that gradually
leads to greater fear. Must be relaxed
before moving on.

Behavioral Therapies
 Flooding: (Implosive Therapy) Take
patient directly into their most feared
situation. Can be physically harmful.
 Counter
conditioning: (Mary Cover
Jones) Conditions new responses to
stimuli that trigger unwanted behavior.
Based on classical conditioning.
Behavioral Therapies
 Aversive
Conditioning:
Punishment to replace positive
reinforcement that perpetuates a bad
habit.
 Behavioral Records: and contracts:
Ways of changing unwanted habits,
keep a running record of when a given
habit or behavior occurs.
Behavioral Therapies
Token Economy: Rewards desired
behaviors, patient exchanges tokens for
various privileges or treats. Usually
used in mental health care facilities.
 Criticisms: When reinforcement stops,
so does wanted behavior. Extrinsically
rewarding: person in control of
someone else’s behavior.

The Learning Perspective
Investigators believe that fear responses are
inculcated through observational learning.
Young monkeys develop fear when they watch
other monkeys who are afraid of snakes.
Parents transmit their fears to their children.
The Biological Perspective
Natural Selection has led our ancestors to learn
to fear snakes, spiders, and other animals.
Therefore, fear preserves the species.
Twin studies suggest that our genes may be
partly responsible for developing fears and
anxiety. Twins are more likely to share phobias.
The Biological Perspective
General anxiety, panic
attacks, and even
obsessions and
compulsions are
biologically measurable
as an overarousal of
brain areas involved in
impulse control and
habitual behaviors.
(PET scans)
Anterior Cingulate Cortex
of an OCD patient.
Somatoform Disorders

Somatoform Disorders
psychological disorders in which the
symptoms take a somatic (bodily) form
without apparent physical cause.
Somatoform Disorders
Conversion Disorders
a rare somatoform disorder in which a
person experiences very specific
genuine physical symptoms for which
no physiological basis can be found.

Somatoform Disorders

Hypochondriasis
a somatoform disorder in which a
person misinterprets normal physical
sensations as symptoms of a disease.
Mood Disorders

Major Depression: Number one
reason that people seek treatment.
Tearful for no reason, often think of
death and ignore or discount positive
events. Thoughts of suicide. Loss of
interest in usual activities. Enormous
effort just to get up.
Seasonal Affective Disorder
A
change in mood as seasons
change, generally depression in
the winter.
Dysthmic Disorder
 Minor
depressive episode, fills
most of the day nearly everyday
for two or more years.
Neurotransmitters & Depression
A reduction of
norepinephrine and
serotonin has been
found in depression.
Drugs that alleviate
mania reduce
norepinephrine.
Pre-synaptic
Neuron
Serotonin
Norepinephrine
Post-synaptic
Neuron
Biological Perspective
Genetic Influences: Mood disorders run in
families. The rate of depression is higher in
identical (50%) than fraternal twins (20%).
Jerry Irwin Photography
Linkage analysis and
association studies link
possible genes and
dispositions for depression.
The Depressed Brain
PET scans show that brain energy consumption
rises and falls with manic and depressive
episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
Cognitive Bases for Depression

A.T. Beck: depressed people hold
pessimistic views of
– themselves
– the world
– the future

Depressed people distort their
experiences in negative ways
– exaggerate bad experiences
– minimize good experiences
Cognitive Bases for Depression
 Hopelessness theory
– depression results from a pattern of thinking
– person loses hope that life will get better
– negative experiences are due to stable,
global reasons
• e.g., “I didn’t get the job because I’m stupid
and inept” vs. “I didn’t get the job because the
interview didn’t go well”
Depression Cycle
1.
2.
3.
4.
Negative stressful events.
Pessimistic explanatory
style.
Hopeless depressed state.
These hamper the way the
individual thinks and acts,
fueling personal rejection.
Anti-Depressants

Stimulants that influence
neurotransmitters in the brain. Elevates
levels of seretonin. Non-addictive, side
effects dry mouth, constipation.
Anti-Depressants
Prozac: blocks reabsorption and
removal of seretonin from synapses.
Cousin of Zoloft and Paxil, side effects,
weight gain, dry mouth and dizzy spells.
 Lithium: Calms people with manicdepressive disorder. Can be
dangerous.

Anti-Depressants
Valium: Tranquilizers, depressants,
frequently prescribed to people
complaining of unhappiness or anxiety.
Least effective and addictive.
 Anti-Anxiety Drugs: reduce tension
and anxiety without causing excessive
sleepiness. Reduce symptoms without
resolving underlying problem.

Bipolar Disorder (ManicDepressive)
 Alternate
between depression
and mania.
Mania

High state of exhilaration (flight of ideas)
feelings of power, plans, ambition,
widely optimistic. Inflated sense of selfesteem. Speaks dramatically, many
jokes or puns.
Personality Disorders

Psychological Disorders in which rigid,
maladaptive personality patterns cause
personal distress or inability to get along
with others. Must be repeating, longterm pattern of behavior.
Personality Disorders
 Paranoid
personality:
Unreasonable and excessive
suspiciousness, jealousy, or mistrust.
May occur as a personality disorder or
with schizophrenia. Interpret other’s
actions as threatening; think others are
trying to harm them.
Personality Disorders
 Avoidant
Personality: Extremely
sensitive to rejection, therefore avoid
relationships unless they bring critical
acceptance.
Personality Disorders
 Narcissistic: Exaggerated sense of
self-importance and self-absorption.
Find criticism hard to accept. Require
constant attention and feel entitled to
special favors, exploit others, arrogant.
Preoccupation with one’s self.
Personality Disorders
 Histrionic: Displays shallow,
attention seeking behavior. Will go to
great lengths to gain others praise and
reassurance.
 Sadistic: Marked by the use of cruel,
demeaning and aggressive behavior
towards others.
Personality Disorders
 Borderline: Display unstable
relationships and emotions. Manipulate
others. Often involves drastic mood
shifts and behavior and may include
self-mutilation. Many short-lived
relationships.
Personality Disorders
 Antisocial:
(Psychopath;
Sociopath): Characterized by lying,
stealing, cheating and lack of social
emotions. Feel no remorse, have no
conscience. Can lie, seduce and
manipulate others.
Dissociative Disorders
Conditions in which normally integrated
consciousness or identity is split or
altered. Results in memory loss or
change of identity.
 Psychogenic Amnesia: Partial or
complete loss of memory. Not Organic,
usually a result of intolerable stress.
Little concern for lost memories.

Dissociative Disorders
 Psychogenic
Fugue: Person takes
on a new identity; may remarry, get a
new job, live contentedly until suddenly
waking up with no memory of the Fugue
state.
Dissociative Disorders
Dissociative Identity Disorder:
Person with 2 or more distinct
personalities, each with their own name
and history. Core personality aware of
reality so NOT SCHIZOPHRENIA.
 Causes: Predisposition, childhood
abuse or severe trauma.

Somatoform Disorders

Repeated; Multiple vague physical
complaints lasting for several years
without medical cause. (Dizziness,
shortness of breath).
Somatoform Disorders
 Conversion
Disorders: Single
physical disturbance that seems to
express a physiological conflict. Usually
stems from trauma. Lacks physical
evidence. Post Traumatic Stress
Disorder
Somatoform Disorders
 Hypochondriac: Unrealistic fear of
disease; exaggerate normal physical
sensations. Constantly concerned with
health. Preoccupied with bodily
functions.
Drug Abuse and Addiction

May be influenced by family history.
Blackouts, loss of memory; Impaired
ability to work or get along with others.
Physical illness, Intoxication throughout
the day, inability to stop or cut down.
Schizophrenia
Schizophrenia
 Delusions: Thoughts that have no basis
in fact; Paranoid Schizophrenics take
innocent events as evidence. Some have
delusions of grandeur. False beliefs.
 Hallucinations: Usually take the form of
voices and consistent or garbled odd words.
Conversation in head seems real.
Schizophrenia
 Loose Word Associations: (Word
salad, clang associations). Illogical jumble of
ideas linked by meaningless rhyming words
or by remote associations.
 Severe Emotional Abnormalities:
Inappropriate or exaggerated emotions; laugh
at sad news; weep for no reason. Eventually
lose the ability to feel any emotion at all.
Schizophrenia
 Withdrawal into Inner World: Live
in their own minds. Oblivious to everything
around them.
 Flat Effect: Zombie like state
characteristics of some schizophrenics.
 Catatonic: Immobility; abnormal cluster of
genes on chromosome 5. Stupor in motor
ability. May hold a position for hours, shows
definite signs of psychosis.
Schizophrenia
 Paranoid: Preoccupied with hallucinations
and delusions. Suspicions of others harming
one, overly precautions.
 Undifferentiated: Does not fit into other
categories, but meets basic criteria for
schizophrenia.
 Disorganized: Disorganized speech or
behavior, or flat or inappropriate emotion.
Theories of Schizophrenia
 Biological: Chromosomes 6 & 22 related
to schizophrenia, but so many symptoms, no
single physical deficiency. Abnormal levels of
Dopamine. May be overly sensitive to
everyday stimuli.
 Genetic Factors: 1 in 100 in normal
pop,1 in 10 if sibling, 1 in 2 if identical twin.
 Brain Disorder: Lack of oxygen to the
brain, toxic chemicals; infection (syphilis).
Time of year born (Jan-Mar).
Biological Factors
Abnormal Brain Morphology
Schizophrenia patients may exhibit
morphological changes in the brain like
enlargement of fluid-filled ventricles.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
Abnormal Brain Activity
Brain scans show abnormal activity in the
frontal cortex, thalamus, and amygdala of
schizophrenic patients. Adolescent
schizophrenic patients also have brain lesions.
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
Environmental Factors
Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection (flu)
during the middle of their fetal development.
Family Influences on Schizophrenia
Family variables
– parental communication that is
disorganized, hard-to-follow, or highly
emotional
– expressed emotion
• highly critical, over-enmeshed families
Cultural Differences in Schizophrenia
Prevalence of symptoms is similar no
matter what the culture
 Less industrialized countries have better
rates of recovery than industrialized
countries

– families tend to be less critical of the patients
– less use of antipsychotic medications, which may
impair full recovery
– think of it as transient, rather than chronic and lasting
disorder
Summary of Schizophrenia

Many biological factors seem involved
– heredity
– neurotransmitters
– brain structure abnormalities
Family and cultural factors also important
 Combined model of schizophrenia

– biological predisposition combined with psychosocial
stressors leads to disorder
– Is schizophrenia the maladaptive coping behavior of
a biologically vulnerable person?
Theories on Schizophrenia
 Anti-Psychotic
Drugs: Major
tranquilizers (Theorizing, Halodel).
Previously used padded cells and
straight jackets. Reduce pain and
agitation. Shorten episodes. Block
receptor sites for dopamine.
Anti-Psychotic Drugs
 Clorazil: Sometimes awakens
catatonic patients.
 Clozapine: Dampens responsiveness
to irrelevant stimuli.
 Thorazine: Omits delusions and
hallucinations.
Psychosurgery
 Frontal
Lobe Lobotomy: Cut fibers
in the frontal lobe. In the 1950s many
were conducted, today is is generally
illegal, only used in the most severe
cases.
Cognitive Therapy
Tries to teach people more positive
ways of thinking. Attempts to replace
negative thoughts with rational
responses.
 Internalized Sentences: Talking to
one’s self, using self-defeating thoughts.
Personalize failure; overgeneralize,
jump to conclusions.

Cognitive Therapy
 Thought
Processes: Need to
change thoughts from being
internalized, stable and global.
 Rational-Emotive
Therapy: Albert
Ellis (Aaron Beck), vigorously
challenges peoples illogical, selfdefeating attitudes and assumptions to
stop catastrophizing and awufilizing.
Humanistic Therapy

Try to move one toward self-fulfillment
and to take responsibility for their
actions.
 Client-Centered
Therapy:
(Rogers), listening with genuine
acceptance to help them begin to heal
themselves (non-directive).
Humanistic Therapy
 Existential
Therapy: Helps clients
find meaning in existence. Gives them
the power to control their own destinies.
 Active
Listening: Echoing,
Restating, and seeking clarification of
what a person expresses.
Humanistic Therapy
 Unconditional
Positive Regard:
Therapists must be warm and show
unshakeable regard for their client.
They must be genuine and honest.
Group Therapy

Helps patients express their problems
and show that they are not alone in
suffering from this illness.
Gestalt Therapy

Commonly used in institutions and
prisons. Focuses on looking at an
individual as a whole. Can teach
individuals to be more self-assertive and
to use more self-revelation.
Family Therapy

Usually used to help children and
adolescents. Role-Play, facilitate good
communication.
Eclectic Approach

Combine one or more treatments to
most effectively treat the client. More
popular type of treatment.
Effectiveness of Psychotherapy

Good Relationships with therapist
seems to be more effective than type of
treatment used.
 Alternatives: Encounter Groups,
self-help tapes, books
Psychosurgery

Destroys selective area of the brain.
Last resort.
 Electroconvulsive
Therapy
(ECT): used with major depression;
increase brain activity; electrodes
attatched to head, throws patient into a
short seizure.