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Chapter 12
Psychopathology
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Evolving Concepts of Mental
Disorder
• How do we define “abnormality”?
• Medical model
“disease” view, biological causes
• Psychological models
Psychogenic –
Caused by psychological factors
(thoughts, beliefs, childhood, experiences)
Indicators of Abnormality
Distress
Maladaptiveness
Irrationality
Unpredictability
Unconventional
and undesirable
behavior
Observer
discomfort
Classifying System
DSM-IV – (1994)
Fourth edition of the Diagnostic and Statistical
Manual of Mental Disorders
• the most widely accepted classification
system in the United States
• Common terminology across disciplines
• Etiology –
The causes of, or factors related to, the
development of a disorder
Explosion of Mental Disorders
•
•
Supporters of new
categories answer that
is important to
distinguish disorders
precisely.
Critics point to an
economic reason:
diagnoses are needed
for insurance reasons
so therapists will be
compensated.
Problems with DSM-IV
• Danger of overdiagnosis
• Power of labels (self-fulfilling prophecy)
• Confusion of serious disorders with
normal problems
• Illusion of objectivity and universality
What are the Consequences
of Labeling People?
• Diagnostic labels can compound the
problem (Rosenhan Study**)
• The cultural context of mental
disorder
I. Anxiety Disorders
:general state of apprehension or psychological
tension
Generalized Anxiety disorder (GAD)
Post-traumatic Stress disorder (PTSD)
Panic disorder –
Marked by panic attacks that have no connection
to events in a person’s present experience
Phobias
Agoraphobia- Fear of public places/open spaces
Social Phobia- fear of being observed by others
Anxiety Disorders
Obsessive-compulsive disorder –
Condition characterized by patterns
of persistent, unwanted thoughts and
behaviors
II. Dissociative Disorders
Amnesia
Dissociative fugue
Dissociative
identity disorder
A loss of memory
for personal
information
Dissociative Disorders
Amnesia
Dissociative fugue
Dissociative
identity disorder
Amnesia with the
addition of “flight”
from one’s home,
family, and job
Dissociative Disorders
Amnesia
Dissociative Fugue
Dissociative
identity disorder
Condition in which
individual displays
multiple identities
The D.I.D./M.P.D. Controversy
• First view
– MPD is common but often unrecognized or
misdiagnosed.
– The disorder starts in childhood as means of
coping.
– Trauma produced a mental splitting.
• 2nd view
– Created through pressure and suggestions by
clinicians.
– Range: Only Handfuls of people to 10000 since
1980.
III. Mood Disorders
Bipolar disorder –
Mental abnormality involving swings of
mood from mania to depression
Mania –
Pathologically excessive elation or
manic excitement
Depression –
Pathological sadness or despair
Mood Disorders
Unipolar depression
• Incidence
• Causes of depression
• Seasonal affective disorder (SAD) –
Believed to be caused by deprivation of
sunlight
Symptoms of Depression
•
•
•
•
•
•
•
•
•
DSM IV Requires 5 of these
within the past 2 weeks
Depressed mood.
Reduced interest in almost all activities.
Significant weight gain or loss, without dieting.
Sleep disturbance
Change in motor activity
Fatigue or loss of energy.
Feelings of worthlessness or guilt.
Reduced ability to think or concentrate.
Recurrent thoughts of death.
Vulnerability-Stress
Model
IV. Schizophrenic Disorders
Schizophrenia –
Psychotic disorder involving distortions
in thoughts, perceptions, and/or
emotions
(most likely to hospitalized)
Major Types of Schizophrenia
Disorganized
Catatonic
Paranoid
Undifferentiated
Features incoherent
speech,
hallucinations,
delusions, and bizarre
behavior
Major Types of Schizophrenia
Disorganized
Catatonic
Paranoid
Undifferentiated
Involves stupor or
extreme excitement
Major Types of Schizophrenia
Disorganized
Catatonic
Paranoid
Undifferentiated
Prominent feature:
combination of
delusions and
hallucinations
Major Types of Schizophrenia
Disorganized
Catatonic
Paranoid
Undifferentiated
Persons displaying a
combination of
symptoms that do not
clearly fit in one of the
other categories
Theories of Schizophrenia
•
•
•
•
Genetic predispositions
Structural brain abnormalities
Neurotransmitter abnormalities
Prenatal abnormalities
V. Problem Personalities
•
Personality Disorder
–
•
Narcissistic Personality Disorder
–
–
•
Rigid, maladaptive patterns that cause personal
distress or an inability to get along with others.
exaggerated sense of self-importance and selfabsorption.
preoccupation with fantasies of success and
power, and a need for constant attention
Paranoid Personality Disorder
–
habitually unreasonable and excessive
suspiciousness and jealousy.
Personality Disorders cont’d
Antisocial personality disorder –
Characterized by aggressiveness, lack of guilt, and
exploitation of others
• Must have 3 of these criteria and a history of behaviors
–
–
–
–
–
–
–
Repeatedly break the law.
They are deceitful, using aliases and lies to con others.
They are impulsive and unable to plan ahead.
They repeatedly get into physical fights or assaults.
They show reckless disregard for own safety or that of others.
They are irresponsible, failing to meet obligations to others.
They lack remorse for actions that harm others
VI. Somatoform Disorders
Somatoform disorders –
Psychological problems appearing in
the form of bodily symptoms or
physical complaints
Conversion disorder –
marked by paralysis, weakness, or
loss of sensation, but with no
discernable physical cause
Somatoform Disorders
Glove Anesthesia
Somatoform Disorders
Hypochondriasis –
Somatoform disorder involving
excessive concern about health and
disease
VII. Drug Abuse and Addiction
• Biology and addiction.
– a person’s biochemistry,
– metabolism, and
– genetic predisposition
Learning, Culture, and Addiction
• Addiction patterns vary according to cultural
practices and the social environment.
• Policies of total abstinence tend to increase
addiction rates rather than reduce them.
• Not all addicts have withdrawal symptoms
when they stop taking a drug.
• Addiction does not depend on the properties
of the drug alone, but also on the reason for
taking it.
Failure of the Addiction Prediction
•
•
•
•
75% of US Soldiers who
tested “drug positive” in
reported being addicted
during their tour.
Fewer reported postVietnam drug use (blue
bar).
Even fewer still showed
dependency(green bar).
This contradicts what the
biomedical model of
addiction would predict.**
Debating the Causes of Addiction
• Problems with drugs are more likely when:
– A person has a physiological vulnerability to a
drug.
– A person believes she or he has no control over
the drug.
– Laws or customs encourage people to take the
drug in binges, and moderate use is neither
tolerated nor taught.
– A person comes to rely on a drug as a method
of coping with problems, suppressing anger or
fear, or relieving pain.
– Peer group uses drugs or drinks heavily, forcing
the person to choose between using drugs or
losing friends.