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Psychological
Disorders
Chapter 13
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Psychological Disorders
• any behavior or emotional state
that causes an individual great
suffering, is self-destructive,
seriously impairs the person’s
ability to work or get along with
others, or endangers others or
the community
DSM-V
• American Psychiatric Association publishes a
standard reference manual used to diagnose
psychological disorders
• Diagnostic and Statistical Manual of Mental
Disorders fifth edition
• diagnosis: determination that a person’s
psychological problems comprise a particular
mental disorder
• classification system: list of disorders with
description of symptoms and guidelines for
assigning individuals to categories
Psychological Disorders
• Worldwide, 450 million people
suffer from mental or behavioral
disorders
• 26% of adult Americans suffer from
a diagnosable mental disorder at
some point during a given year
What Is a Psychological Disorder?
An ongoing pattern of
thoughts, feelings, or actions
that are:
• Deviant. Different from most
other people who share one’s
culture.
• Distressful. Causing distress to
the person or to others.
• Dysfunctional. Behaviors
interfere with normal day-today life.
Nonsuicidal Self-injury (NSSI)
• harm own body by cutting, burning, stabbing,
hitting, and excessive rubbing
• most commonly, trying to reduce negative
emotions such as intense anger, anxiety, and
tension; some cases: seen as a deserved selfpunishment
• during moment of self-injury, go from feeling
unhappy & anxious to feeling relieved &
calmer; usually followed by feelings of shame
and guilt; then cycle of painful emotions
reemerges
Why self-injure?
• physical injury distracts from
painful emotions or helps
person feel a sense of control
over what seems like an
uncontrollable situation
• an external way to express
internal feelings
Self-injury Reasons
• believe they don't fit in or that no one
understands them
• death of an important person
• escape a sense of emptiness
• relationship problems or social rejection
• punishment for perceived faults
• attempt to get attention or manipulate
others
Additional Explanations
• sometimes associated with depression,
bipolar disorder, eating disorders,
obsessive thinking, or compulsive
behaviors
• problems with drug or alcohol abuse
• traumatic experience, such as living
through violence, abuse, or a disaster
Teenagers and Self-injury
• often begins in early teen years
• teenagers are learning to cope with
strong emotions
• may encounter more social isolation,
peer pressure, and challenges dealing
with their parents or other adult figures
• teenagers who hang out with other
people who self-injure are more likely to
self-injure
Anxiety Disorders
• anxiety-feeling of apprehension or tension in
reaction to stressful situations
• anxiety-central nervous system’s
physiological and emotional response to a
vague sense of danger or threat
• involve fears that are uncontrollable;
disproportionate to the actual danger
• most common mental disorders in U.S.
• in any given year around 18% of adults suffer
from one or another of anxiety disorders
classified in DSM-V
Anxiety Disorders
• Psychological disorders
characterized by distressing,
persistent anxiety or
maladaptive behaviors that
reduce anxiety
–generalized anxiety
disorder
–panic disorder
–phobias
Generalized Anxiety Disorder: GAD
DSM-5 Checklist
• experience long-term, persistent anxiety
and uncontrollable worry for at least 6
months
• sometimes experience anxiety about
identifiable issues involving money,
family, work, or health
• some cases: feel that something
dreadful is about to happen, but cannot
identify reason; feel anxiety throughout
24 hour day
GAD Physical Symptoms
• headache
• dizziness
• heart palpitations
• insomnia
• difficulty swallowing
• sweating
Possible Causes of GAD
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set impossible self-standards
very strict and critical parents
excessive uncontrollable traumas
negative thought pattern when feeling
stressed
• genetic predisposition
• GABA problems: decreased receptor sites or
GABA slow to bind to receptor sites
• abnormalities in sympathetic nervous system
activity
Panic Disorder
• panic attack: recurrent, sudden
onset of intense apprehension or
terror, often without warning
and with no specific cause
• high anxiety with a sense of
impending, unavoidable doom
Some Physical Symptoms
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vary from person to person:
heart palpitations
shortness of breath
sweating
faintness and dizziness
gastric sensations
exhaustion after panic attack
Possible Causes
• genetic predisposition: heritability
around 40-48%
• smaller amygdala
• overactive autonomic nervous
system
• norepinephrine or GABA
neurotransmitter irregularities
Phobia
• irrational, overwhelming, persistent fear
of a particular object or situation
• dread object or situation: avoid at any
cost
• realize fears are irrational, but often find
that facing, or even thinking about
facing feared object or situation brings
on a panic attack or severe anxiety
Most Common Phobias
• A strong fear may become a phobia if it
provokes a compelling, but irrational desire
to avoid dreaded object or situation
Social Anxiety Disorder
• previously named social phobia
• overwhelmingly anxious and excessively selfconscious in everyday social situations
• intense, persistent, and chronic fear of being
watched and judged by others
• fear of doing things that are embarrassing
• worry for days or weeks before a dreaded
social situation
• fear interferes with work, school, and other
ordinary activities
Physical Symptoms
• Blushing
• Sweating
• Trembling
• Nausea
• Difficulty talking
Possible Causes
• imbalance in neural circuit that includes
the thalamus, amygdala, and cerebral
cortex
• serotonin imbalance
• trait tendency
• traumatic childhood experience
• overprotective parent-child interactions
during childhood
• fears can be acquired through associative
learning and observational learning
Obsessive-Compulsive disorder (OCD)
• anxiety-provoking thoughts that will not go away
and/or urges to perform repetitive, ritualistic
behaviors to prevent or produce some future
situation
• recurrent and unwanted thoughts, a drive to
perform repetitive and rigid actions, or both
• obsession: thought, urge, or image that recurs
repeatedly, is intrusive and unwelcome, and often
causes feelings of intense anxiety and distress
• compulsion: repetitive and rigid behaviors or
mental acts that people feel they must perform in
order to reduce or prevent anxiety
Obsessive-Compulsive disorder
• extreme anxiety if cannot execute
ritualistic behavior, even if it is something
they want to stop
• obsessive thinking: common themes- dirt
or contamination, harm, violence,
aggression, orderliness, religion, and
sexuality
• compulsions: common themes- excessive
checking, cleaning, counting, seeking order
and symmetry
Some Possible Causes
• genetic factor : if a parent or sibling has an OCD
diagnosis, risk of developing OCD is twice as high as
someone whose first-degree relatives do not have the
disorder
• increased levels of gray matter in thalamus (relay center
for messages) and left frontal cortex (language related)
• frontal cortex or basal ganglia are so active that
numerous impulses reach thalamus, creating obsessive
thoughts or compulsive actions
• low levels of serotonin and irregularities in dopamine,
GABA, and glutamate
• amygdala may be smaller
• sometimes occurs during a period of stress such as
change in marital status or birth of child
• reinforcement of behavior through rituals helps
maintain compulsions
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Trauma and stressor-related disorders:
Post-Traumatic Stress Disorder
Symptoms include:
re-experiencing the traumatic event
avoidance
reduced responsiveness
increased arousal
increased negative feelings
guilt
Symptoms continue longer than a month,
then a diagnosis of PTSD is given
Physical Changes
• abnormal activity of cortisol and norepinephrine
have been found in blood, urine, and saliva of
victims of traumatic events
• evidence from brain imaging studies have shown
that individuals with PTSD experience continual
biochemical arousals and that this continuing
arousal may damage key brain areas
• dysfunctional hippocampus may help produce
intrusive memories and constant arousal
• dysfunctional amygdala may help produce repeated
emotional symptoms and strong emotional
memories
Mood Disorders
• a disturbance in emotional
experience that is strong enough
to intrude on everyday living
• includes behavioral, cognitive,
and physical symptoms as well
as interpersonal difficulties
Major depressive disorder (MDD)
• very depressed mood or loss of interest in
pleasurable activities for two weeks plus other
symptoms such as changes in sleep or weight
• 15 million people in U.S. suffer from it
• almost 1 in 5 people in the US experience major
depression at some point in life
• women are twice as likely to experience major
depression as men-approximately 1/4th of all
females will have it at some point in their lives
• Persistent depressive disorder (dysthymia): mild
or moderate depressed mood most days for at
least two years
Major Depressive disorder (MDD)
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Signs and symptoms include:
Persistent sad, anxious, or "empty" feelings
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Irritability, restlessness
Loss of interest in activities or hobbies once pleasurable, including
sex
Fatigue and decreased energy
Difficulty concentrating, remembering details, and making
decisions
Insomnia, early-morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Aches or pains, headaches, cramps, or digestive problems that do
not ease even with treatment.
No history of manic episodes
NIMH, 2014
Depression with other Disorders
• sometimes other disorder begins first and
sometimes depression begins first-each person
and each situation is different
• anxiety disorders, including post-traumatic
stress disorder (PTSD), obsessive-compulsive
disorder (OCD), panic disorder, social phobia,
and generalized anxiety disorder (GAD); alcohol
and other substance abuse or dependence;
heart disease, stroke, cancer, HIV/AIDS,
diabetes, and Parkinson's disease
Genetic Factors
• risk of depression increases if you have a
parent or sibling with depression
• one identical twin is diagnosed with major
depression, there is a 50% chance other one
will be too
• some genetic research has shown that risk
for depression results from influence of
several genes acting together with
environmental or other factors
Brain Disorders
• brain-imaging technologies, such as functional magnetic
resonance imaging (fMRI) show brains of people who have
depression look different than those of people without
depression
• among depressed people, activity and blood flow are low in
certain parts of the prefrontal cortex; the hippocampus is
undersized and its production of new neurons is low; and
activity and blood flow are elevated in the amygdala
• low activity of two neurotransmitters dopamine,
norepinephrine and serotonin has been strongly linked to
depression; research suggests that interactions between
them or between them and other neurotransmitters in
brain, may account for depression
• body’s endocrine system may play a role in depression;
people with depression have abnormally high levels of
cortisol
Psychological and Social Influences
• negative thoughts and negative moods
interact
• self-defeating thoughts can arise from
learned helplessness
• women’s increased vulnerability to
depression may be related to tendency
to over-think factors
• outlook influences whether an event
will become depressing
Explanatory Style and Depression
A Chicken-and-Egg Problem
• Which comes first: pessimistic explanatory
style, or depressed mood?
• depressed mood may trigger negative
thoughts
• people put in bad or sad moods tend to
become more pessimistic
• these negative thoughts also worsen
depression, thus completing a cycle
Depression’s Vicious Cycle
• Rejection and
depression feed each
other
• Recognizing the
cycle, we can break it
– Each of the 4 points
offers an exit
Other Factors
• lower socioeconomic status, especially people
living in poverty are more likely to develop
depression
• longitudinal study of adults revealed that
depression increased as standard of living and
employment circumstances worsened
• presence of MDD among children ranges from
1.5 – 2.5% in school-aged children and 15-20% in
adolescents
• women are twice as likely to be depressed as
men- depression among single women who are
heads of households and among young married
women who have unsatisfying jobs has been
found to be high in U.S.
Postpartum Depression Symptoms
• loss of appetite, insomnia, intense
irritability and anger, overwhelming
fatigue, loss of interest in sex, lack of joy
in life, feelings of shame, and guilt or
inadequacy
• severe mood swings, difficulty bonding
with the baby, withdrawal from family
and friends, and thoughts of harming
self or baby
A Few Possible Causes
• physical, emotional and lifestyle factors
• after childbirth, a dramatic drop in hormones in body
(estrogen and progesterone)
• other hormones produced by thyroid gland may drop
sharply — feel tired, sluggish and depressed
• changes in blood volume, blood pressure, immune
system and metabolism can be further stresses that
contribute to fatigue and mood swings
• sleep deprived and overwhelmed
• anxious about ability to care for a newborn
• feel less attractive or struggle with sense of identity
• lost control over life
Postpartum Psychosis
• typically develops within first two
weeks after delivery
• signs and symptoms are even more
severe: confusion and
disorientation, hallucinations and
delusions, paranoia, and attempts
to harm self and/or baby
Bipolar Disorders Involve Mania
• extreme mood swings that include
one or more episodes of mania:
• elevated mood, racing thoughts,
extreme distractibility, impulsive
behavior
• feel intense happiness, power,
invulnerability, and energy
• less sleep
Two Types of Bipolar Disorder
• severity of manic episodes is used to classify
two types of bipolar disorder
• bipolar I disorder: people who have
extremely elevated moods- manic episodesduring which they have hallucinations
• bipolar II disorder: alternating between
mildly elevated mood for at least 4 days and
extremely depressed mood for 2 weeks
Symptoms of mania or a manic episode
include:
Mood Changes
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A long period of feeling "high," or an overly happy or
outgoing mood
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Extremely irritable mood, agitation, feeling "jumpy" or
"wired."
Behavioral Changes
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Talking very fast, jumping from one idea to another,
having racing thoughts
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Being easily distracted
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Increasing goal-directed activities, such as taking on new
projects
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Being restless
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Sleeping little
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Having an unrealistic belief in one's abilities
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Behaving impulsively and taking part in a lot of
pleasurable,
high-risk behaviors, such as spending sprees, impulsive
sex, and impulsive business investments.
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NIMH, 2014
Symptoms of depression or a depressive
episode include:
Mood Changes
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A long period of feeling worried or empty
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Loss of interest in activities once enjoyed,
including sex.
Behavioral Changes
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Feeling tired or "slowed down"
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Having problems concentrating,
remembering, and making decisions
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Being restless or irritable
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Changing eating, sleeping, or other habits
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Thinking of death or suicide, or attempting
suicide.
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NIMH, 2014
Bipolar Disorder
• multiple cycles of depression
interspersed with mania
• can have manic and depressive episodes
four or more times a year, but they
usually are separated by six months to a
year
• usually periods of depression last longer
than periods of mania
• Bipolar disorder usually lasts a lifetime
Bipolar Disorder: Mania
• In milder forms, mania’s energy and
free-flowing thinking can fuel creative
energy
Madonna
Mark Twain
Virginia Woolf
Tim Burton
Genetic Factors
• person with an identical twin with
bipolar disorder has a more than
60% chance of also having disorder
• fraternal twin has a more than 10%
chance of having disorder
• researchers focused on identifying
several specific genes that may be
involved
Brain Activity Differences
• PET scans of people with bipolar
disorder show metabolic activity
in cerebral cortex: brain’s energy
consumption falls in depression
and rises in mania (use of
glucose)
Neurotransmitter Imbalances
• lower levels of serotonin in synaptic gap
during depression
• serotonin regulates moods
• manic episodes associated with high levels of
norepinephrine
• norepinephrine contributes to our fight or
flight response
• increased dopamine, a neurotransmitter
effecting emotions and perceptions, is linked
to psychotic symptoms such as hallucinations
Schizophrenia
• serious psychological disorder called a
psychotic disorder
• psychotic disorders involve alterations
in thought, in perceptions, or in
consciousness
• essence of schizophrenia is a loss of
contact with reality
• literally, schizophrenia means “split
mind,” which refers to a split between
thought and emotion
Schizophrenia
• usually diagnosed in early
adulthood
• estimated .5% - 1% of population
• about 50% in psychiatric hospitals
• suicide risk for individuals with
schizophrenia is eight times that for
general population
Positive Symptoms of
Schizophrenia
• a distortion or an excess of normal
function
• are positive because they reflect
something added that is beyond
normal behavior
• not positive in the sense of being
good or desirable
Hallucinations
• one of clearest positive symptoms is
presence of hallucinations
• hallucinations are imaginary sensations
• sensory experiences that do not have an
external source of stimulation
• usually auditory, often visual, and
sometimes take the form of smells or
tastes
• auditory hallucinations are often
accusatory voices
Delusions
• common positive symptom
• false, unique, and sometimes magical beliefs
that are not generally shared by others in
individual’s culture
• common delusions and associated beliefs:
• delusions of persecution: others are
persecuting, spying, or trying to harm person
• delusions of grandeur: have enormous power,
talent, or knowledge
• delusions of identity: person is someone else
• delusions of control: thoughts and behaviors are
controlled by external forces
Disorganized Speech: Loosening of
Associations
• a positive symptom
• disorganized speech: does not follow one line
of thought to completion, but just shifts from
one subject to another in conversation or
writing
• nicknamed “word salad”- person may say: I
market mom ate television gardening drove
flowers
• sometimes speaking and suddenly stop
talking in the middle of a sentence. I went to
the…..
Grossly Disorganized Behavior
• positive symptom
• can include such things as childlike
silliness, inappropriate sexual behavior
such as masturbating in public,
disheveled appearance, and peculiar
dress
• unpredictable agitation includes shouting
and swearing
• unusual motor behaviors including
strange gestures, facial expressions, or
postures
Inappropriate Affect
• positive symptom
• strange facial expressions, tone of voice,
and gestures that do not reflect emotion
that you would expect under the
circumstances
• cry when watching a comedy and laugh
when watching a news story about a
fatal car accident
• walk around mumbling to himself or
alternate between anger and laughter
Negative Symptoms
• social withdrawal, behavioral disabilities, and
decrease in normal functions
• flat affect-a zombielike state of displaying little
or no emotion
• may speak in monotone, have blank and
emotionless facial expressions, and act and
move more like robots
• may have no goals, very limited speech, and
poor hygiene and grooming
• not everyone with schizophrenia has negative
symptoms
• more common in men than women
Five Subtypes
• paranoid type
• disorganized type
• catatonic type
• undifferentiated type
• residual type
Genetic Component
• runs in families
• genetic problems produce subtle abnormalities
in brain
• nearly 1-in-100 odds of any person developing
schizophrenia become about 1 in 10 if a family
member has it, and close to 1 in 2 if an identical
twin has disorder
• adoption studies confirm genetic contribution:
adopted child’s probability of developing
disorder is greater if biological parents have
schizophrenia
• genetic component represents a predisposition
to it rather than an absolute
Biological Factors
• rare mutations of DNA about three to four
times more often than healthy individuals,
especially found in genes related to brain
development and neurological functions
• certain forms of schizophrenia linked with
abnormal brain chemistry
• some positive symptoms of schizophrenia may
be due to an excessive number of neuron
receptors for dopamine
• much of brain’s dopamine activity occurs in
limbic system, which is involved in human
emotions
Other Brain Abnormalities and
Impairments
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decrease in volume of hippocampus
reduced numbers of neurons in frontal lobes
enlargement of ventricles
abnormalities in thalamus: becomes very
active during hallucinations
• impaired cognitive abilities, especially in
working memory, episodic memory, selective
attention, and problem solving
• slow communication between left and right
hemispheres
Environmental Influences
• damage to fetal brain significantly
increases likelihood of schizophrenia
• may occur if mother suffers from
malnutrition
• possible: mid-pregnancy viral infection
impairs fetal brain development
• complications during birth injure baby’s
brain
Synaptic Pruning
• another factor occurs in adolescence:
overly aggressive pruning of synapses
• reasons for this excessive pruning are
not yet known, but it may involve
genetic factors, abnormal fetal brain
development, or stressful life
experiences
• greatest losses appear in sensory and
motor regions
Multiple Gene/Environment
Interaction
• nutritional deficiencies
• stressful life events
• being born or raised in an urban
area
Substance-Related Disorders
• Maladaptive patterns of substance use can
lead to significant impairment or distress
• Substances are often psychoactive drugs,
chemical substances that alter perceptions or
moods.
• A drug’s effect depends on the biological
effects and the user’s psychological
expectations, which vary with cultures
Guidelines for Substance Abuse
Tolerance, Addiction, and Dependence
• Tolerance: diminishing effects with regular
use, requiring larger doses to experience
effect
• Addiction: compulsive drug craving and use
• Withdrawal: discomfort and distress
following discontinuing drug use
• Physical dependence: A physiological need
for a drug, marked by withdrawal symptoms
• Psychological dependence: a psychological
need for a drug, to relieve negative emotions
Substance Dependence
Types of Psychoactive Drugs
• Depressants
• Stimulants
• Hallucinogens
• Work at the brain’s synapses
• Stimulate, inhibit, or mimic the activity of
neurotransmitters
Depressants
• Calm neural activity and slow body functions
• Alcohol
• Barbiturates
• Opiates
Alcohol Effects
• Slows neural processing. Slow sympathetic
nervous system activity.
• Memory disruption. Suppresses REM sleep,
which helps to consolidate memories
• Effects of expectations. User’s expectations
influence behavior:
– People who think they have been drinking
alcohol are more likely to feel uninhibited
and sexually interested
Alcohol Dependence
• Chronic alcohol abuse shrinks the brain
Alcohol Dependence
Barbiturates
• Barbiturates, or tranquilizers,
depress activity of the central
nervous system, reducing anxiety
but impairing memory and
judgment
• Sometimes prescribed to induce
sleep or reduce anxiety
Opiates
• Opium and its derivatives, morphine
and heroin
• Depress neural activity, lessening
pain and anxiety
• Mimic the effects of endorphins, the
body’s natural painkillers
• Highly addictive
Stimulants
• Stimulants excite neural activity and
speed up body functions
–Caffeine
–Nicotine
–Amphetamines
–Cocaine
–Ecstasy
Is smoking really this cool?
Nicotine
The stimulating
and highly
addictive
psychoactive
drug in tobacco
How Cocaine Works
Methamphetamine
• A powerfully addictive drug
• Triggers release of dopamine
– Enhances energy and mood
• After effects include irritability, insomnia,
high blood pressure, seizures, periods of
disorientation, and violent behavior
• Over time, can permanently reduce brain’s
normal dopamine output– leading to craving
more meth
Ecstasy (MDMA)
• MDMA is a synthetic stimulant and mild
hallucinogen
–Produces euphoria and social intimacy
–Short-term health risks
–Long-term harm to serotoninproducing neurons as well as to mood
and cognition
Hallucinogens
• Psychedelic drugs that distort perceptions and
evoke sensory images without sensory input
• LSD: a powerful hallucinogen
– Interferes with serotonin transmission
• Near-death experience:
altered state of consciousness
reported after close brush
with death, may be similar to
drug-induced hallucinations
Psychoactive Drugs
Understanding Substance Abuse
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Biological Influences
Adopted persons more likely to have alcohol
dependence if a biological parent was
alcoholic
Identical twins have correlated alcohol
dependence
Boys at age 6 who are excitable and fearless
are more likely as teens to smoke, drink, and
abuse other drugs
Researchers have bred rats and mice that
prefer alcoholic drinks to water
Understanding Substance Abuse
Psychological and Social-Cultural
Influences
• Substance abusers may
have experienced
significant stress or failure
and depression
• Can have social roots –
contributions from media
and culture
• Location matters – more
opportunities and less
supervision in cities
• Peer pressure
Peer pressure: To use, or not to use