Download Psychological Disorders

Psychological Disorders
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Dysfunctional Behavior
Dysfunctional or abnormal behavior is any behavior judged to be disturbing, atypical, maladaptive
or unjustifiable
It can be irrational, unpredictable and unconventional
The person can feel distress and discomfort from their behaviors
It is different from insanity which is a legal defense
• insanity means that the individual could understanding the difference between right and
wrong, and is unable to control their actions
• confidentiality—patient confidentiality can come into play in legal investigations
• insanity defense—not understanding the difference between right and wrong
Major Perspectives
There are four perspectives on psychopathology or the study of dysfunctional behavior:
• medical (or biological) model: dysfunctional behavior is the result of an organic cause
• Philippe Pinel and Emil Kraepelin created two of the first medical classification systems
for psychological disorders
• behavioral model: abnormal behavior is the result of maladaptive learning (reinforcement)
• cognitive model: dysfunctional behavior is the result of irrational or distorted thinking that
leads to emotional problems and maladaptive behaviors
• psychodynamic model: dysfunctional behavior is the result of internal, unconscious conflicts
and motives
Other Perspectives
Also considered are these perspectives:
– humanistic model: abnormal behavior is the result of roadblocks that people encounter on the
path to self-actualization whereby people become detached from their true selves and adopt a
distorted self-image which leads to emotional problems
– ethical model: dysfunctional behavior is the result of a lack of or improper ethical values
– sociocultural model: abnormal behavior is the result the stress involved in coping with poverty
and other social ills such as unemployment and racism
– interactionist (or biopsychosocial) perspective: dysfunctional behavior is the result of a
complex interaction between biological processes and genetic predispositions, psychological
dynamics and social influences
– evolutionary perspective—dysfunctional behavior is a result of any or all of a variety of factors:
psychological defenses, side effects of genetics, the frequency by which behaviors are carried
out by existing genetic codes, absence or malfunctioning of a particular biological system, a
mismatch between the current environment and other environments one has previously
mastered, or extremes in the distribution of traits influenced by more than one gene
Reasons for Classification
Psychological disorders have been classified for four main reasons:
1. describe the disorder
2. predict the course it will take in the future
3. render appropriate treatment
4. prompt further research into its causes and treatments
DSM-V
In the United States, the DSM-V (or Diagnostic and Statistical Manual for Mental Disorders, 5th
edition) is considered the authoritative source on diagnosing and treating psychological disorders
Neurosis versus Psychosis
• neurotic disorders which are affective (or emotional) disorders
• psychotic disorders which are affective and cognitive (or thinking) disorders
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Medical Student Syndrome
One caution in examining both mental and physical disorders is a phenomenon called medical
student syndrome
In this, students who study specific disorders begin to convince themselves that they are suffering
from that disorder because they may have one or more general symptoms
Typically this is not the case and worry shifts from the current disorder being studied to the next
Determining “Normal”
Who determines what's "normal?"
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you: individuals constantly assess the normalcy of their behaviors
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society: society imposes labels of normal and abnormal behavior
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the experts: applying their skill and knowledge in diagnosing and treating psychological
disorders
Psychologists have established six criteria in determining the distinction between normal and
abnormal behavior:
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unusualness
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social deviance
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emotional distress
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maladaptive behavior
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dangerousness
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faulty perceptions or interpretations of reality.
Labeling
Experts caution that labeling individuals with certain disorders can predispose them to certain
self-fulfilling prophesies and cause those around them to perceive them differently based on
stereotypical beliefs
Anxiety Disorders
Anxiety disorders involve:
• behaviors the surround overwhelming anxiety
• attempts to reduce this anxiety through maladaptive means
Anxiety disorders are among the most common psychological disorders treated by professionals
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is one in which the individual feels continually and
unexplainable tense or anxious, worries that bad things might happen
This anxiety occurs consistently for at least six months
The individual typically can hide these symptoms but physical symptoms such as insomnia or
racing heart) may occur
Freud called this a "free-floating" anxiety because the individual cannot identify what's causing
their anxiety; this makes it hard to control it
Lifetime prevalence: 5%
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Panic Attack
A panic attack or panic disorder is a condition in which a person suffers a period of intense
anxiety
Physical reactions include disorientation, tunnel vision, a feeling a disconnectedness, increased
blood pressure, increase heart rate, shortness of breath
Panic attacks typically begin in the mid-20s
Agoraphobia is an intense fear of situations with no escape or help in the event of a panic attack
panic attacks are acute and short in duration, whereas GAD is less intense for a longer period of
time
Lifetime prevalence: 1-4%
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Phobias
A phobia is an intense irrational fear
The individual usually actively avoids the situation or object of their phobia
Specific phobias involve fear and avoidance of specific objects or situations
Social phobias involve fear and avoidance of social situations or performance situations
Lifetime prevalence: specific phobia 7-11%, social phobia 3-13%.
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Obsessive-Compulsive Disorder
An obsession is an uncontrollable thought
A compulsion is an uncontrollable act
These frequently go together in the form of an obsessive-compulsive disorder (OCD)
This disorder is characterized by a combination of repetitive thoughts and uncontrollable acts
The onset of this disorder occurs in childhood or adolescence
Research now indicates that there is a biological link to OCD
Part of the problem lies in the pathway between the basal ganglia and the frontal lobe
Research indicates that four structures in the brain are linked along a circuit to promote OCD
behaviors:
• the amygdala
• the orbital frontal cortex
• the caudate nucleus
• the thalamus
This circuit is abnormally active in individuals with OCD
Research also indicates genetic markers on six sites in five chromosomes in children of family
members with OCD
A seventh gene, located on the ninth chromosome, appears to regulate the brain chemical
glutamate
Excessive amounts of glutamate stimulate the alarm centers in the brain which facilitates the
obsessive-compulsive behavior
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Drug medication that regulates an individual's serotonin level has shown great success in twothirds of patients
The most common obsessions are dirt or germs (40%), that something terrible will happen
(24%), symmetry or order (17%) and religious obsessions (13%)
The most common compulsions are ritualized hand washing and showering (85%), repeating
rituals (51%), checking (46%), removing contaminants from contacts (23%) and touching (20%)
Lifetime prevalence: 2-3%.
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The most common expressions of OCD:
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Relationship substantiation—searching for tiny but disqualifying flaws in someone else
Fear of injuring others--a preoccupation of losing control and injuring or killing someone else
Responsibility anxiety--a fear of negligently hurting others
Scrupulosity--intolerance of disorder or asymmetry
Contamination anxiety--compulsive hand-washing and fear of contamination from other
objects
• Sexual-orientation fears--fear of homosexual stirrings in people who have no moral or social
objections to it
• Obsessive hypochondria--fear of illness in the face of evidence to the contrary and the tendency
to reject that opinion of experts
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• Hoarding disorder—persistent difficulty in getting rid of or parting with possessions
• There is a perceived need to save them
• Individuals feel distress at parting with these possessions
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Post-Traumatic Stress Disorder
Posttraumatic stress disorder (PTSD) involves overwhelming anxiety, flashbacks and troubling
recollections of a highly traumatic event
• veterans who have seen heavy combat duty and women who have been raped or assaulted
may suffer from this
The individual attempts to avoid situations or objects that might trigger the disorder
Other symptoms include reduced involvement in the external world, hyperaltertness, and
concentration difficulties
Success of treatment depends on:
• whether the individual had any psychological disorders prior to PTSD
• their social support group
• whether the individual is currently experiencing any other psychological disorders.
Causes of Anxiety Disorders
The causes of anxiety disorders depend on the model of psychopathology:
– biological: disorders are the result of organic causes; neurotransmitter imbalances (anxiety,
mood and schizophrenic disorders) and hereditary genetics (schizophrenia) cause the
disorder; GAD is treated with benzodiazepines because it’s associated with too little inhibitory
neurotransmitters in the brain; OCD and panic disorders are treated with antidepressants
associated with low levels of serotonin
– behavioral: behaviors result from prior reinforcement or conditioning of the maladaptive
behavior: rewarding avoidance behaviors can contribute to phobias; relieve from anxiety
(negative reinforcement) reinforces OCD ; anxiety disorders are acquired through classical
conditioning and maintained through operant conditioning
– cognitive: anxiety is based on incorrect reasoning, a distortion of real events and unrealistic
expectations; misinterpretation of minor changes in bodily sensations promotes anxiety and
panic attacks; social phobias may occur because of an obsessive fear of social embarrassment
or negative judgments
– evolutionary: enhanced vigilance occurs even in the absence of a real threat
– psychodynamic: anxiety disorders are the result of an unconscious conflict or fear; desire to
avoid a previously abrasive experience can generate ritualistic behaviors to reduce anxiety
(OCD); phobias may be a result of childhood traumas that have been repressed
Psychosomatic Disorders
Psychosomatic (or psychophysiological) disorders are where there are real physical disorders but
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no organic or biological cause
These illnesses are brought on by psychological not physiological factors
The two most common types of psychosomatic disorders are migraine headaches and stomach
ulcers
These are usually brought on by overwhelming stress
Somatoform Disorders
Somatoform disorders are where there is an apparent physical illness but no organic or biological
cause.
Individuals are usually seen in medical settings and complain of a variety of physical symptoms
Those afflicted complain of anxiety, and maladaptive feelings, thoughts and behaviors.
Somatoform Disorders
Somatic symptom disorder (SSD) is a disorder where the person has vague physical symptoms and
repeatedly seeks medical treatment but no organic cause is found for the illness
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The individual has repeatedly seen physicians, taken medicine and changed his or her
lifestyle
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Duration of symptoms: 6 months
Conversion disorder is a disorder where the person suffers from paralysis, blindness, deafness,
seizures. loss of feeling or false pregnancy but with no physiological reason for it
Symptoms persist as long as the anxiety exists
– in about 80% of suspected cases, the cause turns out to be medical
– this disorder is rare
Illness anxiety disorder (IAD) is a disorder where a person takes insignificant physical symptoms
and interprets them as a sign of a serious illness despite a lack of evidence of any organic cause.
Formerly called hypochondriasis
Duration of symptoms: 6 months
Body dysmorphic disorder is a disorder in which a person become preoccupied with his or her
imagined physical ugliness that makes normal life impossible
Causes of Somatoform Disorders
The causes of somatoform disorders depend on the model:
• biological: there is no biological argument since there are no biological reasons for these
disorders
• behavior: believe the disorder allows the person to avoid the anxiety-producing situation (see
psychodynamic explanation); further reinforcement for the disorder comes in the form of
sympathy and support from others for having the physical ailment
• cognitive: people are misinterpreting and exaggerating minor bodily sensations as signs of
serious illness
• psychodynamic: these disorders are an outward sign of an unconscious conflict; in stopping
the expressions of the id by the ego, leftover sexual or aggressive energy is converted into a
physical symptom
• the symptom itself is symbolic of the underlying struggle (e.g. immobilization of the arm
would prevent the person from carrying out a violent act)
• the symptom has the secondary gain of preventing the person from having to confront the
conflict
• socio-cognitive: SSD patients focus too much on internal rather than external experiences
which leads to incorrect cognitive conclusions
Organic/Neurocognitive Disorders
The DSM-V calls these neurocognitive disorders
The World Health Organization’s International Statistical Classification of Diseases and Related
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Health Problems (ICD-10) calls these organic disorders
These are disorders in which medical conditions produce a psychological disorder
There can be a loss of attention ability, learning, memory impairments, deficits in language, motor
skills or social skills
Specific diseases or brain damage an be the cause
For example, a brain injury or thyroid disorder may directly produce a mood disturbance
All of these can result in dementia—the loss of mental ability
Alzheimer’s disease—degenerative neurological disease that is ultimately fatal
– characterized by loss of memory, loss of control of bodily movements, and learning and
memory impairment
• Delirium—impaired attention and lack of awareness of the surrounding environment
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characterized by memory loss, and disturbances in language and perception
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Dissociative Disorders
Dissociative disorders involve a separation (or dissociation) of conscious awareness of the world
around the individual and previous thoughts and memories
This can cause a sudden memory loss or even the person may not be able to remember their own
identity
Stress is so extreme that the individual blocks out part of their memory to reduce their anxiety
The causes of dissociative disorders may involve an attempt to disconnect from consciousness to
avoid awareness of traumatic or painful experiences
It may be an attempt to protect the self from this trauma
Severe and continual physical or sexual abuse as a child is a prominent precursor to dissociative
identity disorders.
Major Dissociative Disorders
Major dissociative disorders include the following:
• Dissociative amnesia involves partial or total memory loss
• This is usually caused by overwhelming stress
• Amnesia is usually limited to memories associated with anxiety-producing or traumatic
events that result in a strong, negative emotional reaction
• This disorder is rare
• Dissociative fugue (or generalized amnesia) involves memory and identity loss
• The individual may forget their home and past life for days to years
• This is extremely rare
• Dissociative identity disorder (DID) was previously called multiple personality disorder or MPD
• This involves the two or more distinct personalities inhabiting the same body
• Identities can be either sex and handedness sometimes switches
• Brain studies indicate that eye-muscle balance and visual acuity are different in the
different personalities
• this study was compared to subjects pretending to be have multiple identities in
which there were no differences in these factors
• This disorder is extremely rare
Opinions on DID
There is still some skepticism regarding the existence of DID
Only a few cases were reported prior to 1970; thousands have been reported in the 1990s
Some psychologists believe DID is a legitimate disorder; others believe it is a form of attention-
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seeking role playing
Others believe these alternate personalities are a result of therapy
To help deal with a history of abuse, therapists promote the enactment of alternate personalities
to cope with these feelings; patients identify too closely with this role and it becomes reality to
them
Depressive Disorders
Depressive disorders (also called affective or mood disorders) involve extremes in emotion.
Depressive Disorders
Major mood disorders include the following:
• Major depressive disorder involves feelings of worthlessness, a depressed mood and a
reduction in pleasure from most activities for a period of at least two weeks
There is typically a change in eating and sleeping patterns
Low self-esteem, pessimism, negativity and slow thought processes are also accompanying
symptoms
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this is an extreme depression, not to be confused with feeling blue from time to time.
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Lifetime prevalence: 10-25% for women and 5-12% for men
• Seasonal affective disorder (SAD) is a pattern of severe depression in the fall and winter, and
elevated moods in the spring and summer
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this has been successfully treated with artificial light therapy
• Dysthymic disorder is a mild, chronic depression for long period of time, typically five years or
more
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Lifetime prevalence: 6%
• Premenstrual dysphoric disorder—occurs in women who are between menarche and menopause
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Symptoms include (must have at least five of these) mood swings, sensitivity to rejection,
increased irritability, increased interpersonal conflicts, a depressed mood, marked anxiety,
decrease in energy, changes in appetite, insomnia, and feelings of being “out of control”
Causes of Depressive Disorders
The causes of depression are explained from different perspectives:
biological: disorders are the result of organic causes, particularly levels of serotonin and
norepinephrine
 behavioral: feelings result from lack of positive reinforcement and an overabundance on
punishment
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this is an imbalance between behavioral output and reinforcement input
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this becomes a viscous cycle as behavior diminishes and reinforcement is consequently absent
 cognitive: feelings are caused by negative thinking, pessimistic views of self and the world
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this becomes a distorted thinking pattern and a mental filter that bias people toward
exaggerating events and conflicts
 psychodynamic: anxiety disorders are the result of an unresolved childhood emotions and
unconscious conflicts
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Freud believed depression was anger turned inward against one's self
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Additional Causes
Additionally, the learned helplessness model believes that people become depressed when they
believe they cannot control the reinforcement in their lives
This is combined with attributional style which refers to where people place the cause of events:
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internal or external factors, global or specific factors, and stable or unstable factors
Depressive attributional style consists of internal, global and stable attributions; this means the
person thinks that negative situation are because:
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they are at fault (internal)
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they don't possess the abilities to deal with the issue (global)
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they'll never learn to cope with them (stable)
Bipolar and Related Disorders
Mania is a period of hyperactivity where the individual has unrealistic hope and dreams
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it is an wildly optimistic, euphoric state
When this manic behavior is coupled with depression, the individual experiences bipolar
disorder
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this is extreme mood swings between both mania and depression
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bipolar disorder is rare
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lifetime prevalence: .4-1.6%
Cyclothymic disorder is a milder form of bipolar disorder, with less severe swings in mood
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unlike unipolar depression which is more common in women, bipolar and cyclothymic
disorder are equally common among both men and women
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Schizophrenia
Schizophrenia is a collection of several disorders that are characterized by:
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disorganized thinking and language
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delusions (or false beliefs)
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hallucinations (or false sensory experiences)
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grossly inappropriate behavior
Schizophrenic has a flattened affect (or lack of emotional dynamic) and tend to become
withdrawn from social settings
Life prevalence: 1%
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Causes of Schizophrenia
The causes of schizophrenia fall predominantly around the biological model
Freud did not have any good explanation for schizophrenia
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In terms of genetic factors, one stands a 13% chance of developing schizophrenia if one of his or
her parents is schizophrenic, and a 45- 50% chance if his or her identical twin suffers from the
disorder
If heredity was the sole factor, it would be expected that fraternal twins would have a 100%
chance of both being schizophrenic
In fraternal twins there is about a 17% chance if one has schizophrenia that the other will as well
These statistics have been supported through adoption studies as well
Biochemical factors involve overreactivity or overabundance of dopamine levels in the brain
The brain does not have more dopamine, rather schizophrenia patients seem to have more
dopamine receptors and these may be overly sensitive
Excess dopamine promotes hallucinations and delusional thinking
Antipsychotic drugs such as Thorazine and Mellaril reduce dopamine activities
Tardive dyskinesia can result from long-term use of dopaminergic anatogonist medications—
muscle tremors and stiffness can result
Parkinson’s disease has similar muscle tremors and stiffness
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treated with L-dopa to increase dopamine levels
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excessive L-dopa can cause schizophrenic-like symptoms
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Brain abnormalities also seem to contribute to schizophrenia
These abnormalities develop during certain critical prenatal periods
Areas that are most effected are the prefrontal cortex (thought formation and organization) and
the limbic system (memory and emotion)
Brain asymmetries and an abnormality on the fifth chromosome may be associated with
schizophrenia
The diathesis-stress model suggests that stress works with genetic factors in bringing on
schizophrenia in genetically vulnerable individuals
Sources of stress include early brain trauma, dysfunctional family environments and negative life
events
It is suggested that these factors combine to produce brain abnormalities and disturbances in
thinking, memory and perception
Schizophrenia and DID
Schizophrenia is frequently confused with dissociative identity disorder because the word
"schizophrenia" literally means "split mind"
This is because their is a break with reality and a disintegration of personality
Because of this, schizophrenic disorders are considered psychotic disorders
Characteristics
Schizophrenia is usually diagnosed in the late teens or early twenties and occurs in only 1% of
the population
There is a fairly strong genetic link to schizophrenia and recent research believes the limbic
system is involved in the disorder.
25% of those who experience a schizophrenic episode fully recover
50% have reoccurrences which can be controlled through medication
25% show little to no sign of recovery
Process v. Reactive
Schizophrenia can be one of two types:
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process (or chronic) schizophrenia develops gradually over time
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reactive (or acute) schizophrenia comes on suddenly, usually in response to environmental
cues
Prognosis is worse for process schizophrenia and better for reactive schizophrenia.
Positive Symptoms
Some schizophrenic patients have positive symptoms which include:
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excessive laughing and emotional outbursts
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disorganized speech and thinking
Those exhibiting these symptoms tend to have:
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normal brain structures
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excessive amounts of dopamine
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show overactivity and aggressive behavior during adolescence
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have a greater prognosis for treatment
Negative Symptoms
Other patients have negative symptoms which include:
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rigid bodies
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lack of emotional response
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faces with no expression
Those exhibiting these symptoms tend to have:
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more abnormal brain structures
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more frontal and parietal lobe deficits
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are more clearly genetically linked
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have lower educational levels
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have a poorer prognosis for treatment
Types of Schizophrenia
The major types of schizophrenia are:
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paranoid: fear or persecution is present, as are delusions of grandeur, or feelings of extreme
self-importance as the reason they are being singled out for persecution
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disorganized: disorganized thinking and speech patterns accompanied by flat emotions
and/or grossly inappropriate behavior
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catatonic: a freezing up of the body in response to overwhelming stress accompanied by
extreme negativism and/or mimicking of language patterns or body movements
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undifferentiated (residual): schizophrenic symptoms that do not fit one of the specific types
listed above
Personality Disorders
Personality disorders involve enduring, inflexible behavior patterns that impair social functioning
These are usually first identified in adolescence
10-20% of the population has one type of personality disorder
The DSM-V classifies three types of personality disorder
Odd/Eccentric Disorders
paranoid personality disorder: extreme suspiciousness and mistrust of others based on
unjustified reasoning
schizoid personality disorder: indifference or lack of interpersonal relationships
schizotypal personality disorder: generally odd thinking, showing suspicion and mistrust
Dramatic/Emotionally Problematic
narcissistic personality disorder: an overexaggeration of self-importance and love of one's self
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requires constant attention and admiration
antisocial personality disorder: exercises his or her own needs or wants over the feelings of
others
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hedonistic (seeks self-gratification); no emotional reaction to others' suffering
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commonly called a psychopath or sociopath
histrionic personality disorder: over-dramatizes situations and behaviors
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blows things out of proportion and overreacts to situations
borderline personality disorder: unpredictable and impulsive, irritable and emotionally unstable
Chronic Fearfulness/Avoidant
dependent personality disorder: overly dependent on others due to low self-esteem and lack of
confidence
avoidant personality disorder: avoids relationships because of an exaggerated fear of rejection
obsessive-compulsive personality disorder: too serious, emotionally insensitive, too preoccupied
with structure and rules
AP Check
AP students in psychology should be able to do the following:
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Describe contemporary and historical conceptions (p. 642) of what constitutes psychological
disorders.
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Recognize the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
published by the American Psychiatric Association as the primary reference for making
diagnostic judgments.
Discuss the major diagnostic categories, including anxiety and somatoform disorders, mood
disorders, schizophrenia, organic disturbance, personality disorders, and dissociative
disorders, and their corresponding symptoms.
Evaluate the strengths and limitations of various approaches to explaining psychological
disorders: medical model, psychoanalytic, humanistic, cognitive, biological, and sociocultural.
Identify the positive and negative consequences of diagnostic labels (e.g. the Rosenhan study).
Discuss the intersection between psychology and the legal system (e.g. confidentiality,
insanity defense).