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Psychological Disorders
Book authors:
R. H. Ettinger
Chapter 15
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Copyright 2003 Allyn & Bacon
What Is Abnormal?
 Defining mental disorders
– Several questions can help determine what
behavior is abnormal:
 Is the behavior considered strange within the person’s own
culture
 Does the behavior cause personal distress
 Is the behavior maladaptive
 Is the person a danger to self of others
 Is the person legally responsible for his or her acts
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What Is Abnormal?
 Prevalence of psychological disorders
– Mental disorders have a lifetime prevalence rate of
nearly 50%
– Mental disorders represent a significant source of
personal misery for individuals and lost productivity
for society
 Explaining psychological disorders
– Biological perspective
 Views abnormal behavior as arising from a physical cause,
such as genetic inheritance, biochemical abnormalities or
imbalances, structural abnormalities within the brain,
and/or infections
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What Is Abnormal?
 Explaining psychological disorders (continued)
– Biopsychosocial perspective
 Agrees that physical causes are of central importance but
also recognizes the influence of biological, psychological,
and social factors in the study, identification, and treatment
of psychological disorders
– Psychodynamic perspective
 Originally proposed by Feud
 Maintains that psychological disorders stem from early
childhood experiences and unresolved, unconscious
conflicts, usually of a sexual or aggressive nature
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Psychological Disorders
Biological
(Evolution,
individual
genes, brain
structures
and chemistry)
Sociocultural
(Roles, expectations,
definition of normality
and disorder)
 Bio-psycho-social
Perspective
Psychological
(Stress, trauma,
learned helplessness,
mood-related perceptions
and memories)
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– assumes that
biological,
sociocultural, and
psychological factors
combine and interact
to produce
psychological
disorders
What Is Abnormal?
 Explaining psychological disorders (continued)
– Learning perspective
 Psychological disorders are thought to be learned and
sustained in the same way as any other behavior
– Cognitive perspective
 suggests that faulty thinking or distorted perceptions can
contribute to some types of psychological disorders
– Irrespective of theoretical perspective, all clinicians
and researchers use the same set of criteria to
classify psychological disorders
– The American Psychiatric Association publishes a
manual (DSM-IV-TR) listing these criteria
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Anxiety Disorders
 Generalized anxiety disorder
– An anxiety disorder in which people experience
excessive anxiety or worry that they find difficult to
control
– These people expect the worst
– Their excessive anxiety may cause them to feel
tense, tired, and irritable, and to have difficulty
concentrating and sleeping
– This disorder affects twice as many women as men
and leads to considerable distress and impairment
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Anxiety Disorders
 Panic disorder
– An anxiety disorder in which a person experiences
recurrent unpredictable attacks of overwhelming
anxiety, fear, or terror
– Panic attacks
 An attack of overwhelming anxiety, fear, or terror
– Panic-disorder patients tend to overuse the health
care system and are at increased risk for abuse of
alcohol and other drugs
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Anxiety Disorders
 Phobias
– An intense fear of being in a situation form which
immediate escape is not possible or in which help is
not immediately available in case of incapacitating
anxiety
– Agoraphobia
 A persistent, irrational fear of an object, situation, or activity
that the person feels compelled to avoid
 An agoraphobic often will not leave home unless
accompanied by a friend or family member and, in severe
cases, not even then
 Women are four times more likely than men to be
diagnosed with agoraphobia
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Anxiety Disorders
 Phobias (continued)
– Social phobia
 An irrational fear and avoidance of social situations in
which one might embarrass or humiliate oneself by
appearing clumsy, foolish, or incompetent
 About one-third of social phobics fear only speaking in
public
 In its extreme form, it can seriously affect people’s
performance at work, prevent them from advancing in their
careers or pursuing an education, and severely restrict
their social lives
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Anxiety Disorders
 Phobias (continued)
– Specific phobia
 A marked fear of a specific object or situation
 The categories of specific phobias, in order of frequency of
occurrence, are (1) situational phobias (2) fear of the
natural environment (3) animal phobias and (4) bloodinjection-injury phobia
– A person has three times the risk of developing a
phobia if a close relative suffers form one
– A therapist my use classical conditioning principles
to teach patients to associate pleasant emotions
with feared objects or situations
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Anxiety Disorders
Common and uncommon fears
100
Percentage 90
of people 80
surveyed
70
60
50
40
30
20
10 Snakes Being Mice Flying Being SpidersThunder Being Dogs Driving Being Cats
in high,
on an closed in, and
and alone
a car
In a
0
exposed
places
Afraid of it
airplane in a insectslightning In a
small
house
place
at night
Bothers slightly
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Not at all afraid of it
crowd
of people
Anxiety Disorders
 Obsessive compulsive disorder (OCD)
– An anxiety disorder in which a person suffers form
obsessions and/or compulsions
– Obsessions
 A persistent, recurring, involuntary though, image, or
impulse that invades consciousness and causes great
distress
– People with obsessions might worry about
contamination or about whether they performed a a
certain act, such as turning off the stove or locking
the door
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Anxiety Disorders
 Obsessive compulsive disorder (continued)
– Compulsion
 A persistent, irresistible, irrational urge to perform an act or
ritual repeatedly
– The individual knows such acts are irrational and
senseless but cannot resist performing them without
experiencing an intolerable buildup of anxietyanxiety that can be relieved only by yielding to the
compulsion
– People with OCD realize their behavior is not
normal; but they simply cannot help themselves
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Anxiety Disorders
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Anxiety Disorders
 PET Scan of brain of
person with
Obsessive/
Compulsive disorder
 High metabolic activity
(red) in frontal lobe
areas involved with
directing attention
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Anxiety Disorders
Common Obsessions and Compulsions Among
People With Obsessive-Compulsive Disorder
Thought or
Behavior
Obsessions (repetitive thoughts)
Percentage*
Reporting Symptom
Concern with dirt, germs, or toxins
40
Something terrible happening (fire, death, illness)
40
Symmetry order, or exactness
24
Compulsions (repetitive behaviors)
Excessive hand washing, bathing, tooth brushing,
or grooming
Repeating rituals (in/out of a door,
up/down from a chair)
Checking doors, locks, appliances,
car brake, homework
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85
51
46
Identifying Anxiety Disorders
Read each of the four descriptions below and place a checkmark beside
each description that sounds like you or someone you know.
1.
You are always worried about things, even when there are
Generalized
no signs of trouble. You have frequent aches and pains
Anxiety
that can’t be traced to physical illness or injury. You tire
Disorder
easily, and yet you have trouble sleeping. Your body is
constantly tense.
Panic
2.
Out of the blue, your heart starts pounding. You feel dizzy.
Disorder
You can’t breathe. You feel like you are about to die.
You’ve had these symptoms over and over again.
Agoraphobia 3.
Every day you fear you will do something embarrassing.
You’ve stopped going to parties because you’re afraid to
meet new people. When other people look at you, you
break out in a sweat and shake uncontrollably. You stay
home from work because you’re terrified of being called on
in a staff meeting
Obsessive/
4.
You are so afraid of germs that you wash you hands
Compulsive
repeatedly until they are raw and sore. You can’t leave the
Disorder
house until you check the locks on every window and door
over and over again. You are terrified that you will harm
someone you care about. You just can’t get those thoughts
(From NIMH,
out of your head
1999.)
Copyright © 2004
2007 Allyn
Horizon
& Bacon
Textbook
All rights
Publishing
reserved
All rights reserved
Mood Disorders
 Disorders characterized by extreme and
unwarranted disturbances in feeling or mood
 Depressive disorders
– Major depressive disorder
 A mood disorder marked by feelings of great sadness,
despair, guilt, worthlessness, and hopelessness
 Key symptoms of major depressive disorder are
psychomotor disturbances
– Depression can be so severe tat its victims suffer
form delusions or hallucinations, which are
symptoms of psychotic depression
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Mood Disorders
 Culture, gender, and depression
– One large study involving participants form ten
countries revealed that the lifetime risk for
developing depression varied greatly around the
world
– Before boys reach puberty, they are more likely than
girls to be depressed, but at adolescence a dramatic
reversal in the gender-related depression rates
takes place
– Not only are women more likely to suffer form
depression, they are also more likely to be affected
by negative consequences as a result
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Mood Disorders-Depression
25
Percentage
of
population
aged 18-84
experiencing
major
depression
at some
point In life
Around the world
women are more
susceptible to
depression
20
20
15
15
10
10
5
5
0
USA Edmonton Puerto
Rico
0
Males
Paris
West
Florence Beirut
Germany
Females
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Taiwan
Korea
New
Zealand
Mood Disorders-Depression
10%
Percentage
depressed 8
Females
6
4
Males
2
0
12-17 18-24 25-34 35-44 45-54 55-64 65-74 75+
Age in Years
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Mood Disorders
 Bipolar disorder
– A mood disorder in which manic episodes alternate
with periods of depression, usually with relatively
normal periods in between
– Manic episode
 A period of extreme elation, euphoria, and hyperactivity,
often accompanied by delusions of grandeur and by
hostility if activity is blocked
 Such episodes are marked by excessive euphoria, inflated
self-esteem, wild optimism, and hyperactivity
 People in a manic state have temporarily lost touch with
reality and frequently have delusions of grandeur along
with their euphoric highs
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Mood Disorders
 Bipolar disorder (continued)
– Bipolar disorder is much less common than major
depressive disorder
– Bipolar disorder tends to appear in late adolescence
or early childhood, and, unfortunately, about 90% of
those with the disorder have recurrences, and half
experiences another episode within a year of
recovering form a previous one
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Mood Disorders-Bipolar
 PET scans show that brain energy
consumption rises and falls with emotional
swings
Depressed state
Manic state
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Depressed state
Mood Disorders
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Mood Disorders-Depression
Brain
chemistry
Cognition
Mood
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 Altering any
one
component
of the
chemistrycognitionmood circuit
can alter the
others
Mood Disorders-Depression
1
Stressful
experiences
4
Cognitive and
behavioral changes
 The vicious
cycle of
depression
can be
broken at
any point
2
Negative
explanatory style
3
Depressed
mood
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Mood Disorders-Depression
Percentage 35%
of
observations 30
25
20
15
Negative
behaviors
 A happy or
depressed
mood
strongly
influences
people’s
ratings of
their own
Positive
behavior
behaviors
Self-ratings
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Mood Disorders
 Causes of mood disorders
– Biological factors such as genetic inheritance and
abnormal brain chemistry play a major role in
bipolar disorder and major depressive disorder
– Drevets and others
 Located a brain area that may trigger both the sadness of
major depression and the mania of bipolar disorder
 A small, thimble-size patch of brain tissue in the lower
prefrontal cortex hereditary depression
– Researchers have found that patterns of dopamine,
GABA, and norepinephrine production, transport,
and reuptake in people suffering from mood
disorders differ from those of normal individuals
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Mood Disorders
 Causes of mood disorders (continued)
– In one twin study, researchers found that 50% of the
identical twins of bipolar sufferers had also been
diagnosed with a mood disorder, compared to only
7% of fraternal twins
– Depressed individuals view themselves, their world,
and their future all in negative ways
– Depressed persons believe they are deficient,
unworthy, and inadequate, and they attribute their
perceived failures to their own physical, mental, or
moral inadequancies
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Mood Disorders
 Causes of mood disorders (continued)
– The vast majority of first episodes of depression
strike after major life stress
– Cui and Vaillant
 Found that negative life events as well as family history
played significant roles in the development of mood
disorders
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Mood Disorders
 Suicide and race, gender, and age
– Whites are more likely to commit suicide than
African Americans
– Native American suicide rates are similar to those of
whites; rates for Hispanic Americans are similar to
those of African Americans
– Suicide rates are far lower for both White and
African American women than for men
– Older Americans are at far greater risk for suicide
than younger people
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Mood Disorders
 Suicide and race, gender, and age (continued)
– Poor general health, serious illness, loneliness, and
decline in social and economic status are conditions
that may push many older Americans, especially
those aged 75 and over, to commit suicide
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Mood Disorders- Suicide
Suicides per 70
100,000 people 60
50
The higher suicide rate
among men greatly
increases in late
adulthood
40
30
20
10
0
15-24 25-34 35-44 45-44 55-64 65-74 75-84
85+
Males
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Females
Mood Disorders-Suicide
Increasing rates of teen suicide
12%
Suicide
rate,
ages 15 to
19
(per
100,000)
10
8
6
4
2
0
1960
1970
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1980
Year
1990
2000
Schizophrenia
 A severe psychological disorder characterized
by loss of contact with reality, hallucinations,
delusions, inappropriate or flat affect, some
disturbance in thinking, social withdrawal,
and/or other bizarre behavior
 Positive symptoms of schizophrenia
– Positive symptoms are the abnormal behaviors that
are present in people with schizophrenia
– Hallucinations
 A sensory perception in the absence of any external
sensory stimulus; an imaginary sensation
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Schizophrenia
 Positive symptoms of schizophrenia
(continued)
– Schizophrenic patients may see, hear, feel, taste, or
smell strange things in the absence of any stimulus
in the environment, but hearing voices is the most
common type of hallucinations
– Delusions
 A false believe, not generally shared by other in the culture,
that cannot be changed despite strong evidence to the
contrary
– Delusions of grandeur
 A false belief that one is a famous person or a person who
has some great knowledge, ability, or authority
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Schizophrenia
 Positive symptoms of schizophrenia
(continued)
– Delusions of persecutions
 A false belief that a person or group is trying in some way
to harm one
– Another positive symptom is the loosening of associations, or
derailment, when a schizophrenic does not follow one line of
though to completion, but on the basis of vague connections
shifts from one subject to another in conversation or writing
– Schizophrenics may also display inappropriate affect; that is,
their facial expressions, tone of voice, and gestures ma not
reflect the emotion that would be expected under the
circumstances
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Schizophrenia
 Negative symptoms of schizophrenia
– A negative symptom of schizophrenia is a loss of or
deficiency in thoughts and behaviors that are
characteristic of normal functioning
– Negative symptoms include social withdrawal,
apathy, loss of motivation, lack of goal-directed
activity, very limited speech, slowed movements,
poor hygiene and grooming, poor problem-solving
abilities, and a distorted sense of time
– Flat affect
 Showing practically no emotional response at all, even
though they often report feeling the emotion
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Schizophrenia
 Brain abnormalities in schizophrenics
– Many schizophrenics have defects in the neural
circuitry of the cerebral cortex and limbic system
– There is also evidence of reduced volume in the
hippocampus, amygdala, thalamus, frontal lobe gray
matter
– Abnormal activity in the brain’s dopamine system is
found in many schizophrenics
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Schizophrenia
 Types of schizophrenia
– Paranoid schizophrenia
 A type of schizophrenia characterized by delusions of
grandeur or persecution
 Paranoid schizophrenics often show exaggerated anger
and suspiciousness
– Disorganized schizophrenia
 The most serious type of schizophrenia, marked by
inappropriate affect, silliness, laughter, grotesque
mannerisms, and bizarre behavior
 Tends to occur at an earlier age than the others types
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Schizophrenia
 Types of schizophrenia (continued)
– Catatonic schizophrenia
 A type of schizophrenia characterized by complete stillness
or stupor and/or periods of great agitation and excitement;
patients may assume an unusual posture and remain in it
for long periods
– Undifferentiated schizophrenia
 A catchall term for people who display symptoms of
schizophrenia but who do not fit into other categories
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Schizophrenia
Subtypes of Schizophrenia
Paranoid:
Preoccupation with delusions or hallucinations
Disorganized:
Disorganized speech or behavior, or flat or inappropriate
emotion
Catatonic:
Undifferentiated
or residual:
Immobility (or excessive, purposeless movement),
extreme negativism, and/or parrotlike repeating of
another’s speech or movements
Schizophrenia symptoms without fitting one of the
above types
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Schizophrenia
 Risk factors in schizophrenia
– Schizophrenia develops when there is both a
genetic predisposition toward the disorder and more
stress than a person can handle
– Schizophrenia is more likely to strike men than
women
– The earlier age of onset of the disorder among
males appears to be independent of culture and
socioeconomic variables
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Schizophrenia
40
Lifetime risk
of developing
schizophrenia
for relatives of
a schizophrenic
30
20
10
0
General
Siblings
population
Children
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Fraternal Children
Identical
twin
of two
twin
schizophrenia
victims
Somatoform and Dissociative
Disorders
 Somatoform disorders
– Disorders in which physical symptoms are present
that are due to psychological rather than physical
causes
– People with somatoform disorders are not
consciously faking illness to avoid work or other
activities
– Hypochondriasis
 A somatoform disorder in which persons are preoccupied
with their health and convinced they have some serious
disorder despite reassurance from doctors to the contrary
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Somatoform and Dissociative
Disorders
 Somatoform disorders (continued)
– Conversion disorder
 A somatoform disorder in which a person suffers a lost of
motor or sensory functioning in some part of the body; the
loss has no physical cause but solves some psychological
problem
– A person may become blind, deaf, or unable to
speak or may develop a paralysis in some part of
the body
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Somatoform and Dissociative
Disorders
 Dissociative disorders
– Dissociation
 The loss of one’s ability to integrate all the components of
self into a coherent representation of one’s identity
– Dissociative disorder
 Disorders in which, under stress, one loses the integration
of consciousness, identity, and memories of important
personal events
– Dissociative amnesia
 A dissociative disorder in which there is a lost of memory of
limited periods in one’s life or of one’s entire identity
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Somatoform and Dissociative
Disorders
 Dissociative disorders (continued)
– Dissociative fugue
 A dissociative disorder in which one has a complete loss of
memory of one’s entire identity, travels away from
home,and may assume a new identity
 When people recover from the fugue, they often have no
memory of events that occurred during the episode
– Dissociative identity disorder (DID)
 A dissociative disorder in which tow or more distinct
personalities occur in the same person, each taking over a
t different times; also called multiple personality
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Somatoform and Dissociative
Disorders
 Dissociative disorders (continued)
– Dissociative identity disorder (continued)
 The alternate personalities, or alter personalities, may differ
radically in intelligence, speech, accent, vocabulary,
posture, body language, hairstyle, taste in clothes,
manners, and even handwriting and sexual orientation
 There is the common complaint of “lot time”-periods for
which a given personality has no memory because he or
she was not in control of the body
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Sexual Disorders
 Sexual disorders
– Disorders that are destructive, guilt- or anxietyproducing, compulsive, or cause of discomfort or
harm to one or both parties involved
– Perhaps the most common of all of the sexual
disorders are the sexual dysfunctions
– Drug treatment for sexual dysfunctions in both men
and women have proved successful
– Depression is both a cause and an effect of sexual
dysfunctions
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Sexual Disorders
 Sexual disorders (continued)
– Paraphilias
 Disorders in which recurrent sexual urges, fantasies, and
behaviors involve nonhuman objects, children, other
nonconsenting persons, or the suffering or humiliation of
the individual or his/her partner
– Gender identity disorders
 Disorders characterized by a problem accepting one’s
identity as male or female
 An individual may feel so strongly that she or he is
psychologically of the other gender that sex-reassignment
surgery is sought
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Sexual Motivation
Sex is a physiologically based motive,
like hunger, but it is more affected by
learning and values
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Sexual Motivation
Androgens
– A sex hormone, secreted
in greater amounts by
males than by females
Estrogen
– a sex hormone, secreted
in greater amounts by
females than by males
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Sexual Motivation
Sexual Response Cycle
– the four stages of sexual responding described by
Masters and Johnson
 Excitement
 Plateau
 Orgasm
 Resolution
Refractory Period
– resting period after orgasm, during which a man
cannot achieve another orgasm
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The Sexual Response Cycle
Orgasm
Plateau
Resolution
Excitement
Resolution
with orgasm
Males
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Females
Sexual Motivation
Same drives, different attitudes
“Do you think it is, or is not, wrong for a couple to have a baby if they are not
married?”
100%
Percent 90
answering 80
wrong 70
60
50
40
30
20
10
0
Iceland Germany Great Canada Mexico United India
Britan
States
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Country
Taiwan Singapore
Sexual Motivation
Changing attitudes
100%
Extramarital sex is “always wrong”
80
60
Homosexual sex is “always
wrong”
40
20
1987
1998
Year
0
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Source: National Opinion Research Center
(University of Chicago) General Social Survey
Forces Affecting Sexual Motivation
Physiological
readiness
Imaginative
stimuli
Sexual motivation
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External
stimuli
Sexual Motivation
 Births to unwed parents
40%
Percentage
of births
to unwed
mothers
35
30
United States
25
20
Canada
15
10
Britain
5
Japan
0
1960
1970
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1980
Year
1990
2000
Sexual Motivation
Sexual Orientation
– an enduring sexual attraction toward
members of either one’s own gender
(homosexual orientation) or the other
gender (heterosexual orientation)
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Personality Disorders
 Personality disorders
– A continuing, inflexible, maladaptive pattern of inner
experience and behavior that causes great distress
or impaired functioning and differs significantly form
the patterns expected in the person’s culture
– Characteristics of personality disorders
 People who suffer form other disorders, especially the
mood disorders, are often diagnosed with personality
disorders as well
 People with personality disorders are extremely difficult to
get along with
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Personality Disorders
 Personality disorders (continued)
– Types of personality disorders
 Those who suffer from paranoid personality disorder
display extreme suspiciousness, while those with schizoid
personality disorder isolate themselves from others and
appear to be unable to form emotional bonds
 Individuals diagnosed with schizotypal personality disorder
are often mistakenly classified as schizophrenic because
their odd appearances, magical thinking, and lack of social
skills are also often seen in schizophrenics
 A pervasive desire to be the center of others’ attention is
characteristic of both narcissistic personality disorder and
histrionic personality disorder, as is a lack of concern for
others
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Personality Disorders
 Personality disorders (continued)
– Types of personality disorders (continued)
 People with borderline personality disorder are highly
unstable and fear of abandonment is the primary theme of
their social relationships
 A significant proportion of borderline personality disorder
patients have histories of abuse or other disturbances in
childhood attachment relationships
 People who suffer from antisocial personality disorder have
a “pervasive pattern of disregard for, and violation of, the
rights of other that begins in childhood or early
adolescence and continues into adulthood”
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Personality Disorders
 Personality disorders (continued)
– Types of personality disorders (continued)
 Individuals diagnosed with obsessive-compulsive
personality fear falling short of perfectionistic standards
 Avoidant personality disorder and dependent personality
disorder, represent opposite approaches to social
relationships
 The avoidant personality shuns relationships because of
excessive sensitivity to criticism and rejection
 The dependent personality relies on others to an
inappropriate degree
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Personality Disorders
 PET scans illustrate reduced activation in a murderer’s
frontal cortex
Normal
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Murderer
Personality Disorders
35
30
Percentage 25
of criminal
offenders 20
15
10
5
0
Total crime
Childhood
poverty
Thievery
Obstetrical
complications
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Violence
Both poverty
and obstetrical
complications
Rates of Psychological Disorders
Percentage of Americans Who Have Ever Experienced Psychological Disorders
Ethnicity
Gender
Disorder
White
Black
Hispanic
Men
Women
Alcohol abuse
or dependence
13.6%
13.8%
16.7%
23.8%
4.6%
Generalized anxiety
3.4
6.1
3.7
2.4
5.0
3.8
Phobia
9.7
23.4
12.2
10.4
17.7
14.3
Obsessive-compulsive
disorder
2.6
2.3
1.8
2.0
3.0
2.6
Mood disorder
8.0
6.3
7.8
5.2
10.2
7.8
Schizophrenic
disorder
1.4
2.1
0.8
1.2
1.7
1.5
Antisocial personality
disorder
2.6
2.3
3.4
4.5
0.8
2.6
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Totals
13.8%