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Psychological Disorders
CHAPTER 12
Psychopathology
 What was formerly known as mental illness or
mental disorder is now often referred to as
psychopathology.

Some feel “mental illness” puts the basis for the illness on
biology, even though psychologists have shown that
environment is often the cause of the disorder.
 Psychopathology is any pattern of emotions,
behavior, or thoughts inappropriate to the situation
and leading to personal distress or the inability to
achieve important goals.
Prevalence of Psychopathology
 In America, mental illness is far more common than
most people realize.
 Another study found that during any given year, the
behaviors of over 56 million Americans meet the
criteria for a diagnosable psychological disorder
(Carson et al. 1996).
 Over the lifespan, as many as 32% of Americans
suffer from some psychological disorder (Regier et
al., 1988).
What is Psychological Disorder?
 How do we discern what is normal and abnormal?
Consider eccentric personalities:
 What about a soldier who risks his life in war? A grief
stricken mother who cannot return to her normal
routines three months after losing her son?
3 Classical Symptoms of
Severe Mental Illness
 The more extreme a disorder is, the more easily it
is detected. When trying to diagnose a patient,
doctors look for three classic symptoms of sever
psychopathology:
Hallucinations-false sensory experiences.
 Delusions-extreme disorders that involve persistent false beliefs.
 Affect (emotion)-characteristically depressed, anxious, manic, or
no emotional response.

Psychological Disorders as a Continuum
No Disorder
Mild Disorder
Moderate
Disorder
Severe
Disorder
Absence of signs of
psychological
disorder
Few signs of distress
or other indicators of
psychological
disorder
Indicators of
disorders are more
pronounced and
occur more frequently
Clear signs of
psychological
disorder, which
dominate the
person’s life
Absence of
behavioral problems
Few behavior
problems; responses
usually appropriate to
the situation
More distinct
behavior is often
inappropriate to the
situation
Severe and frequent
behavior problems;
behavior is usually
inappropriate to the
situation
No problems with
interpersonal
relationships
Few difficulties with
relationships
More frequent
difficulties with
relationships
Many poor
relationships or lack
of relationships
Disorders are exaggerations of normal behavior and responses.
Two Contrasting Views
 As with most topics in psychology, there are
multiple perspectives on psychological
disorders.
 The medical model takes a “disease” view.
Psychology, on the other hand, sees
psychological disorders as an interaction of
biological, mental, social and behavioral
factors.
Historical Roots
 In the ancient world, psychopathology was thought
to be caused by demons and spirits that had taken
possession of the person’s mind and body.
 Part of daily life in ancient worlds was spent doing
rituals aimed at outwitting or placating these
supernatural beings.
Hippocrates
 In 400 B.C. the Greek physician Hippocrates took
the first step toward a scientific view of mental
illness when he said that abnormal behavior had
physical causes.
 He taught his disciples to interpret the symptoms of
psychopathology as an imbalance among our body
fluids called “humors.”
Humors
Origins
Temperament
Blood
Heart
Sanguine (cheerful)
Choler (yellow bile)
Liver
Choleric (angry)
Melancholer (black bile)
Spleen
Melancholy (depressed)
Phlegm
Brain
Phlegmatic (sluggish)
Regression in Thought
 Then in the Middle Ages, superstition eclipsed the
Hippocratic model. Under the influence of the
medieval Church, physicians and clergy reverted to
the old ways of explaining abnormal behavior.
Hippocrates
Salem Witch Trials
 As a result of erroneous thinking, thousands of
mentally disturbed people were executed.
 In Salem Massachusetts, was one example of the
problems with this type of thinking.
 A modern analysis of the Salem witch trials has
concluded that the girls were probably suffering
from poisoning by a fungus growing on rye grainthe same fungus that produces the hallucinogenic
drug LSD.
The Medical Model
 In the late 18th century, the “disease view”
reemerged.
 The result was the medical model, a view that
mental disorders are diseases of the mind that, like
ordinary physical diseases, have objective causes
and require specific treatment.
Medical Model in Practice
 The medical model led to mental hospitals or
“asylums.” In this supportive atmosphere,
many patients actually improved, even thrived,
on rest, contemplation and simple but useful
work.
Problems with the Medical Model
 Despite its success, modern psychologists find fault
with relying solely on the medical model.
 They suggest that treating the disorder as a
“disease” leads to a doctor-knows-best approach in
which the therapist takes all the responsibility for
diagnosing and correcting the problem.
 In this model, the patient becomes a passive
recipient of medication and advice.
Psychologists vs. Psychiatrists
 The other problem psychologists have with the
medical model (doctor-knows-best), is that it takes
responsibility away from psychologists and gives it to
psychiatrists.
 According to our authors, it assigns psychologists to
second-class professional status.
Social-Cognitive-Behavioral Approach
 As psychology has evolved, theories which were
originally at odds, have now been combined to offer
more thorough explanations, for example, cognitive
psychology and behaviorism.
 Cognitive psychology looks inward, emphasizing
mental processes. Behaviorism looks outward and
emphasizes the influences of the environment.
 Psychologists from these perspectives see these two
as complementary, and add that cognitions and
behavior usually happen in social context, requiring
social perspective.
Combining Perspectives
 The behavioral perspective tells us that abnormal
behaviors can be acquired in the same fashion as
healthy behaviors-- through behavioral learning.
 The cognitive perspective suggests that we must
consider how people think about themselves and
their relations with other people.
 Social-cognitive-behavioral approach, then, is an
alternative to the medical model combining all three
of psychology’s major perspectives.
The
Biopsychology of Mental Disorder
 Modern biopsychology assumes that some mental
disturbances involve the brain or nervous system
in some way.
 Subtle changes in the brain’s tissue or its chemical
messengers- the neurotransmitters- can
profoundly alter thoughts and behaviors.
 Genetic factors, brain injury, infection, and
learning are some of the factors that can tip the
balance towards psychopathology.
Indicators of Abnormality
 While psychologists look for the three classical
symptoms, not all disorders have such sever
symptoms. A few others are:





Distress: Does the individual show unusual or prolonged levels
of anxiety?
Maladaptiveness: Does the person act in ways that make others
fearful?
Irrationality: Does the person act or talk in ways that are
irrational or incomprehensible to others?
Unpredictability: Does the individual behave erratically and
inconsistently at different times?
Unconventional/undesirable behavior: Does the person act
in ways that are statistically rare and violate social norms?
The More the Better
 Clinicians are more confident in labeling behavior as
“abnormal” when two or more of the indicators are
present.

Extremes and prevalence = greater confidence in diagnosis
DSM-IV-TR
 The American Psychological Association developed the
most widely used classification system for
psychological disorders.
 The book is called the Diagnostic and Statistical
Manuel of Mental Disorders.
*IV=4th edition
**TR=Text revised
DSM-IV-TR
 The DSM-IV-TR offers practitioners a common
and concise language for the description of
psychopathology.
 The DSM also contains language for diagnosing
each of the disorders.
Experiment in a Mental Hospital
 A young psychologist, David Rosenhan, set up an
experiment to see if mental hospitals could really
detect someone with mental illness.
 He felt that terms like “sanity,” “insanity,”
“schizophrenia,” “mental illness” and “abnormal”
might have fuzzier boundaries and more fluid
definitions than those in the medical world were
giving them credit for.
Rosenhan Experiment
 Rosenhan also suspected that some strange
behaviors seen in mental patients might originate in
the abnormal atmosphere mental hospitals, rather
than in the patients themselves.
 To test these theories, Rosenhan and seven collogues
conducted the Rosenhan Experiment in the early
1970s.
David Rosenhan
Explaining Rosenhan
 Rosenhan said that the mistaken diagnosis were
most likely a result of the lack of time the doctors
spent with the patients.
 Surprisingly, the other hospital patients readily
detected the experiment. The pseudo-patients
reported that the other patients regularly voiced
their suspicions.
After the Experiment
 All of the people who served in the original study
were eventually discharged from the hospital with
the label of "schizophrenic in remission."
 To put it another way, they were still considered
schizophrenic, but they were temporarily free of
symptoms.
Mood Disorders
 Mood disorders are abnormal disturbances in
emotion or mood. They are also referred to as
affective disorders.
 The two most common are major depression and
bipolar disorder.
Major Depression
 Major depression is a form of depression that does
not alternate with mania (happiness).
 It is normal to become depressed after a sad or
unfortunate even but if a person remains
depressed weeks or months after that event, it may
be classified as major depression.
 Major depression does not give way to manic
episodes.
Major Depression
 By many accounts,
depression is under
diagnosed and under treated.
 Globally speaking, studies
indicate that depression is
the single most prevalent
disability.
 While some differences may
be a result of reporting, other
factors seem to be at work
too:


Taiwan/Korea = low divorce rate
Lebanon = war in Middle East
Lifetime Risk of a
Depressive Episode
lasting a Year or More
Taiwan
1.5%
Korea
2.9%
Puerto Rico
4.3%
U.S.
5.2%
Germany
9.2%
Canada
9.6%
New Zealand
11.6%
France
16.4%
Lebanon
19%
Causes of Depression
 Some causes of major depression involve genetic
predisposition. Severe bouts of depression often run in
families.

Further indication of a biological basis for depression are
that drugs that affect the brains levels of certain
neurotransmitters are very effective.
 However, biology alone cannot account for everything.
Cognitive Explanations
 Probably because of low self-esteem, depression-
prone people are more likely to perpetuate the
depression cycle by attributing negative events to
their own personal flaws or external conditions
they feel helpless to change.
 Martin Seligman calls this learned helplessness.
Cognitive-Behavioral Cycle of
Depression
Fred decides to be more
sociable, but when he
asks Teresa for a date she
already has plans.
Fred concludes that he is
not very interesting or
attractive and that people
don’t like him.
Low self-esteem
and negative
interpretations
Negative
events
Because of Fred’s
negative behaviors,
people avoid himreinforcing his symptoms.
Fred feels completely
alone and unhappy
Social rejection
and loneliness
Depression
Negative
behaviors
Fred avoids people, skips
school and neglects
personal hygiene
The Cognitive Approach
 The cognitive approach to depression points out that
negative thinking styles are learned and modifiable.
*Think classical and operant conditioning.
Beck’s Basics
 Aaron Beck suggests that depression is a result of negative
thinking which he called ‘cognitive errors’ (errors in logic)
 Beck identified three negative thoughts that seemed to be really
automatic and occurred without delay in depressed patients. The
“Cognitive Triad:”



Self
External World
Future
 Beck believes that faulty thinking leads to depression. The
question remains though, which came first, the depression or the
faulty thoughts.
WHO BECOMES DEPRESSED?
 Studies show that depression rates are higher in
women. The difference may be in the way men and
women handle emotional situations.

Women tend to be introspective:


Think about their feelings and what may be causing them.
Men, on the other hand, try to distract themselves from
the depressed feelings.
 This suggests the more ruminative response of
women increases their vulnerability to depression.

Depression breeds depression
Increasing Rates of Depression
 Rates of depression have increased 10-20 times
what they were 50 years ago.
 The
average age of people experiencing depression
has gone down.
 Seligman identifies three causes for this trend:
1. Out-of-control individualism/self-
centeredness-focuses on individual successes
and failures rather than group accomplishments.
Increasing Rates of Depression
2. The self-esteem movement- teaching a
generation of children they should feel good about
themselves, irrespective of their efforts and
achievements.
3. A culture of victimology- reflexively pointing the
finger of blame at someone or something else.
Bipolar Disorder
 Formerly known as manic-depressive disorder, bipolar
disorder is a mental abnormality involving swings of
mood from mania to depression.
 A strong genetic component is well established, although
the exact genes involved are not known.

1% of the population has bipolar attacks, having an identical twin
with the problem inflates a person’s chances to about 70%
Anxiety Disorders
 Everyone has
experienced some level of
anxiety in their life. For
some people, a spider, or
a tall ladder are enough
to send chills down the
spine.
 Psychopathology anxiety
is far more sever than the
anxiety associated with
normal life challenges.
Prevalence of Mental Disorders
=Anxiety
Disorder
Generalized Anxiety Disorder
 Generalized anxiety disorder is a psychological
problem characterized by persistent and pervasive
feelings of anxiety, without any external cause.
May experience times when your worries don't completely
consume you, but you still feel rather anxious
 May feel on edge about many or all aspects of your life
 May have a general sense that something bad is about to happen,
even when there's no apparent danger.
 May not remember when you last felt relaxed or at ease.


GAD often begins at an early age, and the signs and symptoms
may develop slowly.
Panic Disorder
 Panic disorder is a disturbance marked by sudden and severe
anxiety attacks that have no obvious connections with events in
the person’s life.

Usually free of anxiety between panic attacks
Panic attack symptoms:
* Rapid heart rate
* Chest pain
* Sweating
* Headache
* Trembling
* Dizziness
* Shortness of breath
* Faintness
* Hyperventilation
* Trouble swallowing
* Chills
* A sense of
* Hot flashes
impending death
* Nausea
* Abdominal cramping
Panic Disorder
 Many people who suffer from panic disorder also
have agoraphobia. A condition which involves
panic that develops when people find themselves
in situations from which they cannot easily escape:
crowed places, open spaces, etc.

Occurs in about 2% of Americans and affect women
more than men.
Phobic Disorders
 In contrast to panic disorder, phobias involve
persistent and irrational fear associated with a
specific object, activity or situation.
 While many of us have fears, or dislikes of specific
objects or situations, these only become
psychopathology when they have a cause
substantial disruptions in our lives.
Preparedness Hypothesis
 This theory suggests that we carry an innate
biological tendency, acquired through natural
selection, to respond quickly and automatically to
stimuli that posed a survival threat to our ancestors.

May explain why we develop phobias for snakes and lightening
much more easily than automobiles and electrical outlets
Obsessive-Compulsive Disorder
 OCD is a condition characterized by patterns of
persistent, unwanted thoughts and behaviors.
 The obsessive component consists of thoughts,
images or impulses that recur or persist despite a
person’s efforts to suppress them.
Obsessive-Compulsive Disorder
 The compulsive component are repetitive,
purposeful acts performed according to certain
private “rules,” in response to an obsession.
 Many characters on TV and in movies have OCD:
Jack Nicolson in As Good As It Gets; Monica on
Friends; Monk

Others?
Obsessive-Compulsive Disorder
 When they are calm, people with obsessive-
compulsive disorder view their compulsions as
senseless. However, when anxiety arises, they
cannot resist performing the compulsive behavior
rituals to relieve tension.

OCD has a tendency to run in families


A clear genetic connection
Environment seems to play a factor

Behavioral therapy helps many OCD sufferers
Somatoform Disorders
 Somatoform disorders are psychological problems
appearing in the form of bodily symptoms or physical
complaints such as weakness or excessive worry about
disease.

Conversion Disorder: A disorder marked by paralysis,
weakness or loss of sensation but with no discernable physical
cause.

Hypochondriasis: A disorder involving excessive worry
about health and disease.
How a hypochondriac might see himself
Dissociative Disorders
 Dissociative disorders are a group of pathologies
involving the “fragmentation” of the personality, in
which some parts of the personality have become
detached from other parts.
 Dissociative Amnesia: A psychologically induced
loss of memory for personal information, like one’s
identity.
 Usually
the result of a stressful situation, it is often
associated with Post Traumatic Stress Disorder (PTSD).
PTSD
 Post Traumatic Stress Disorder dates back to 6 B.C.
where reports of battlefield stress had an adverse
affect on soldiers.
 In the past PTSD has been referred to as railway
spine, shell shock, battle fatigue, traumatic war
neurosis, or post-traumatic stress syndrome.
 Today treatment involves therapy and anti-anxiety
drugs. During WWI treatment looked much
different:
Shell Shock/Shock Therapy
 New PTSD Therapy

Dissociative Fugue
 Dissociative fugue is a combination of fugue, or
“flight, and amnesia. Sufferers not only suffer from a
lost sense of identity, they also flee their homes, jobs
and families.
 While most episodes last only a few hours or days, it
can last longer.
 Heavy use of alcohol may predispose a person to
dissociative fugue. While this suggest that some
brain impairment may be involved, no specific cause
has been identified.
Depersonalization Disorder
 Depersonalization disorder is an abnormality
involving the sensation that mind and body have
separated.
 Often times sufferers explain episodes as out of body
experiences.
 Like all of the other dissociative disorders,
depersonalization disorder occurs far more
frequently following a prolonged period of stress or a
traumatic event.
Dissociative Identity Disorder
 Once called multiple personality
disorder, dissociative identity
disorder is a condition where an
individual displays multiple
identities or personalities.
 Experts say this disorder appears
first in childhood and may be a
defensive response to abusive
situations or terrifying events.
 Most of the emerging
personalities contrast in some
significant way with the original
self.
http://www.youtube.com/watch?
v=YXuG2zI39yA
Hershel Walker was recently
diagnosed with DID.
Schizophrenia
 http://www.youtube.com/watch?v=gGnl8dqEoPQ
 Schizophrenia is a psychological disorder involving
distortions in thoughts, perceptions and/or
emotions.

This is the disorder people are referring to when they use
terms like “madness,” “psychosis,” or “insanity.”
What Does it Look Like
 For sufferers of schizophrenia, the mind can be
twisted in terrible ways.
 May
become bleak and devoid of meaning
 Can become very overwhelming and filled with
stimuli, hallucinations and delusions.
 In schizophrenia, emotions become blunted,
thoughts turn bizarre, and language takes a strange
turn. Take the following for example:
Sample Speech From Schizophrenic
Patient
 The lion will have to change from dogs into cats until I
can meet my father and mother and we dispart some
rats. I live on the front of Whitton’s head. You have to
work hard if you don’t want to get into bed…It’s all
over for a squab true tray and there ain’t no squabs,
there ain’t no men, there ain’t no music, there ain’t
nothing besides my mother and my father who stand
along upon the Island of Capri where is no ice. Well it’s
my suitcase sir. (Roger, 1982)
Prevalence of Schizophrenia
 One out of every 100 Americans, 2 million people over
the age of 18-will be affected.
 For men, schizophrenia usually shows up before age
25, and between the ages of 25 and 40 for women.
 Currently, schizophrenia is the diagnosis for over 40%
of patients in public mental hospitals. This may be due
to the fact that there is no cure, and often times
patients will need need therapy for the remainder of
their lives.
5 Major Types of Schizophrenia
 Disorganized type: typical image of mental illness with
incoherent speech, hallucinations, delusions and odd
behaviors http://www.youtube.com/watch?v=avbfd_OkLoU
 Catatonic type: a range of motor dysfunctions


Stupor: long periods of coma like, motionless state
Excitement: agitated and hyperactive
 Paranoid type: delusions and hallucinations but no catatonic
symptoms and none of the incoherence of disorganized type
 Undifferentiated type: a catchall term for schizophrenia
symptoms that are erratic and do not it into one of the other
categories, but are clear symptoms of the disorder
 Residual type: the diagnosis for individuals who have
suffered from schizophrenia, but have no major symptoms at
the time
Positive and Negative Categories
 Often times, researchers now simply
characterize symptoms of schizophrenia into
positive and negative categories.
 Positive
symptoms refer to active process such as
delusions, and hallucinations.
 Negative symptoms refer to passive processes
like social withdrawal.
Causes of Schizophrenia
 Freud originally thought schizophrenia was a result
of defective parenting or repressed childhood
trauma.
 Impact of Drugs


Major tranquilizers which inhibit dopamine, can suppress
the symptoms of schizophrenia
Drugs that provide excess dopamine can cause
schizophrenic type behaviors in healthy people.
Causes of Schizophrenia
 Loss of grey matter: Magnetic resonance images (MRI
scanswere created after repeatedly scanning 12
schizophrenia subjects over five years, and comparing
them with 12 healthy controls, scanned at the same ages
and intervals.
•Severe loss of gray matter is
indicated by red and pink
colors, while stable regions
are in blue.
•STG =superior temporal
gyrus
•DLPFC =dorsolateral
prefrontal cortex.
Causes of Schizophrenia
 While the exact cause of the disorder still remains somewhat of a
mystery, there is very strong evidence that it has a genetic link.


People who have an identical twin who suffers from schizophrenia
have a 50% chance of suffering from the disorder too, even if they
were raised in separate environments.
Similarly, a child with one parent suffering from schizophrenia has a
13% chance of developing the disorder, but a child of two parents
with the disorder has a 46% chance of developing schizophrenia.
Schizophrenia Treatments
 Much like the treatment for all psychological disorders, the
treatment of schizophrenia has come a long way:
Lobotomies
 Insulin Shock Therapy

 Current treatment for schizophrenia is usually a
combination of therapy and medication:

Schizophrenia Medication
Lobotomies
 One of the earliest treatments were lobotomies.
This procedure consisted of cutting the
connections to and from, or simply destroying, the
prefrontal cortex.
The Process
 Doctors would access the frontal lobes through the
eye sockets, instead of through drilled holes in the
scalp. In 1945, he took an ice pick from his own
kitchen and began to test the new surgical
technique on cadavers.
The Process
 The technique involved lifting the upper eyelid and placing the
point of a thin surgical instrument under the eyelid and
against the top of the eye socket.
•A hammer was
used to drive the
pick through the
bone, into the brain.
It was then moved
from side to side,
severing nerve
fibers connecting
the frontal lobes to
the thalamus.
Other Types of Disorders
 Most people get stuck thinking about depression and
schizophrenia when they think about psychological
disorders. In reality there are far more. Some of the
more common, and more studied disorders are:



Eating Disorders:
Personality Disorders:
Developmental Disorders:
Eating Disorders
 Of the eating disorders that exist,
two are most prevalent and most
studied:

Anorexia nervosa: an eating disorder
that causes a persistent loss of appetite
that endangers an individuals health
Stems from emotional or psychological
reasons rather than natural causes
 Usually a distorted view of oneself
 1% of population affected
 3.4% with partial syndrome anorexia

Eating Disorders
 The other common eating
disorder is bulimia nervosa.
 Bulimia Nervosa: An eating
disorder characterized by binges
and purges



Induced vomiting, or laxatives
.6% of population affected with
bulimia
Up to 4.2% of females
The History of Bulimia-Nervosa
 It was believed that the
ancient Romans used a
vomitorium to rid
themselves of food.
 Bulimia was not established
as a psychological disorder
until the late 1970’s.
 95-85% of cases of
anorexia/bulimia are women
in the US (National Institute
of Mental Health)
Personality Disorders
 Personality disorders are conditions involving a
chronic, pervasive, inflexible and maladaptive
pattern of thinking, emotion, social relationships or
impulse control

Narcissistic Personality Disorder: Grandiose sense of
self importance and preoccupation with fantasies of success

Antisocial Personality Disorder: Longstanding pattern of
irresponsible behavior indicating lack of conscience and
responsibility towards others.

Borderline Personality Disorder: Unstable and given to
extreme impulses without clear reasoning.
Development Disorders
 Developmental disorders are a group of disorders
that can appear at any age, but most commonly show
signs during childhood.

Autism: Marked by disabilities in language, social interaction
and the inability to understand another person’s state of mind


1 in 500 children; recent increase in cases
Dyslexia: A reading disorder where letters words and
numbers are perceived out of order, upside down or
completely incomprehensible

http://www.mhhe.com/socscience/psychology/faces/#