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Chapter 14
Psychological Disorders
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I. Dysfunctional Behavior
 What is “abnormal” behavior?
– The 3 clinical criteria
• Deviant
• Maladaptive
• Causing personal distress

A continuum of normal/abnormal
Mild
AVERAGE
PERSON
Occasional
suspicious
thoughts
Moderate
PARANOID
PERSONALITY
A suspicious
cognitive style
(no behavioral
impairment)
Severe
PARANOID
PERSONALITY
DISORDER
DELUSIONAL
(PARANOID)
DISORDER
PARANOID
SCHIZOPHRENIC
A suspicious
cognitive style
that it impairs
effective
behavior; no
delusions; reality
testing is intact
A stable and
chronic
delusional
system; reality
testing good in
all other areas
Multiple delusions that
are likely to be
fragmented,
accompanied by
marked loosening of
associations, obvious
hallucinations,
disorganization, reality
testing markedly
distorted.
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“Abnormal” Behavior con’t
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Six Contemporary Views of Psychological Disorders
Psychological disorders are a result of...

Biomedical model


Cognitive model

Physical, biochemical or genetic
abnormalities
Faulty or unusual ways of thinking

Psychoanalytic model

Childhood or unconscious conflict

Behavioral


Sociological
Faulty contingencies of
reinforcements
Variables such as social class,
gender and living environment

Bio-Psycho-Social


bio, psycho and social factors
combine to produce disorders
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Bio–Psycho–Social Perspective
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Prevalence, Causes, and Course

Epidemiology
– the study of the distribution of mental or physical disorders in the
population

Prevalence
– the percentage of a population that exhibits a disorder during a
specified time period

Lifetime prevalence
– percentage of people who have been diagnosed with a specific
disorder at any time in their lives
– Ex: current estimates predict about 44% of the adult population will
have some sort of psychological disorder at some point in their lives.


Diagnosis
Etiology
– apparent causation and developmental history of an illness

Prognosis
– forecast about the probable course of an illness.
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Did you know…
some ancient treatments involved
exorcism, trephining, beating,
burning, castration, blood letting,
and blood replacement?
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Psychodiagnosis:
The Classification of Disorders

Two Classification Systems
– ICD-10 and the DSM-IV
– Introduced after WWII
– Both systems developed from Emil Kraepelin’s early
classification work (1913)

ICD -10
– World Health Organization (WHO)
– Contains various physical & psychological disorders
– Identifies 11 categories of mental disorders
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The Classification of Disorders con’t

DSM–IV TR (
Diagnostic and Statistical Manual of Mental Disorders – 4th ed. Revised text)
– American Psychiatric Association (APA)
– Multiaxial system
• 5 dimensions or Axes
–
–
–
–
–
Axis
Axis
Axis
Axis
Axis
I – Clinical Syndromes
II – Personality Disorders or Mental Retardation
III – General Medical Conditions
IV – Psychosocial and Environmental Problems
V – Global Assessment of Functioning
• The first two axes are for diagnosis and the last three
provide supplemental information.
* Both the DSM-IV and the ICD-10 share terminology
and are intentionally written to be similar.
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You SHOULD know…
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neurosis is no longer used in the
DSM (it is in the ICD-10).
However, did you know…
psychosis is no longer used in the
ICD-10, but is in the DSM?
Some psychiatric
concepts simply
outlive their
publications.
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An OLD

(but valuable)
Neurosis

Distinction
Psychosis
– Maintains contact w/
reality, based in anxiety
– Breaks from reality
– Only part of the
personality is affected
– The whole personality is
affected
– Has insight (recognizes
problem - neurotic
paradox)
– Lacks insight
– Neurotic behavior is
viewed as an
exaggeration of normal
behavior
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• Distorted perceptions
(i.e. hallucinations)
• Irrational ideas/delusions
– Psychotic behaviors are
seen as discontinuous w/
normal behavior
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II. Axis I Clinical Syndromes
Discussed in Text







A. Anxiety Disorders
B. Somatoform Disorders
C. Dissociative Disorders
D. Mood Disorders
E. Sexual Disorders
F. Delusional Disorders
G. Schizophrenic Disorders
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A. Anxiety–Based Disorders
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a class of disorders marked by feelings of
excessive apprehension and/or maladaptive
behaviors that reduce anxiety, prevalence=17%
1. Generalized anxiety disorder (GAD)
• chronic, high level of anxiety that is not tied to any specific
threat
• “free-floating anxiety”
• a state of autonomic nervous system arousal
• Facts:
– Prevalence: 3%, Lifetime prevalence: 5%
– Onset: anytime (higher btw. childhood & middle-age)
– 2X higher in women than men/familial pattern
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Anxiety – Based Disorders con’t

2. Panic disorder
• recurrent attacks of sudden, unexpected overwhelming anxiety &
senseless feeling of terror
• Characterized by:
–
–
–
–
Heart palpitations
Sweating
Shortness of breath
Feeling of helplessness
• May lead to development of agoraphobia
– 1in 3 may lead to agoraphobia
• Facts:
– Lifetime prevalence: 2-3%
– Onset: late adolescence, early adulthood
– Familial pattern (first-degree relatives – 8x higher, if onset before age 20
then may be 20x higher)
– 2X higher in women than men
– May be linked to depression
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Anxiety – Based Disorders con’t
 3. Phobic disorder
– Persistent and irrational fear of a specific object or
situation that presents no realistic danger
– Fear is out of proportion w/ reality
– Fears often linked to evolutionary significance
• Fear of “modern” objects less common
– Today’s phobia categories
• 1) simple phobias (7-11% of population)
• 2) social phobias (3 - 13%)
• 3) agoraphobia (6%)
– Facts of a “typical” phobic disorder
•
•
•
•
•
•
Prevalence: 4 - 8%
Bimodal onset: early childhood, then adulthood
2X higher in women than men (social phobia is equal)
Familial pattern, possibly due to learning
May vary by age, culture and gender
Duration: 24-31 years
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Common and Uncommon Fears
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Phobias may be acquired through classical
conditioning, then maintained through
operant conditioning.
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Just for Kicks!
Test your Phobia Knowledge

Common phobias
– Acrophobia
• fear of heights
– Claustrophobia
• fear of small, enclosed
places
– Brontophobia
• fear of storms
– Hydrophobia
•
fear of water

Interesting Phobias
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Anxiety – Based Disorders con’t
 4. Obsessive Compulsive disorder (OCD)
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– Obsessions – unwelcome, involuntary and persistent
thoughts/intrusions into the individual’s awareness
• often center on inflicting harm on others, personal failures,
suicide, or sexual acts
– Compulsions - urges to engage in senseless rituals
• i.e.: hand washing, repetitive cleaning, endless checking and
rechecking of locks
• Individual feels a need to resist, but anxiety increases if thought
/action is prevented
– Facts:Lifetime prevalence: ~3%
• Familial patter (twin study support)
• Onset: adolescence, early adulthood
– Characteristics of OCD individual:
• Upper – income. Intelligent
• Equally male & female (early onset males)
• Tend to stay unmarried
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Anxiety–Based Disorders/OCD con’t
Myers, 7th ed.
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Anxiety–Based Disorders/OCD con’t
Note the high
metabolic activity
(red) in frontal lobe
areas involved with
directing attention
PET Scan of brain of person with
Obsessive/ Compulsive disorder
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Don’t trust that
Bost-lady… she’s
polluting your
mind with
gooblygook!
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Anxiety – Based Disorders con’t

5. Post-traumatic Stress Disorder (PTSD)
– Anxiety disorder in which a traumatic situation is relived
through memory flashbacks or dreams
– Common features:
•
•
•
•
•
•
•
Lifetime prevalence: 8%
Evidence of a heritable component
Onset: any age
2X higher in women than men
Avoidance of activities linked to the trauma
Numbed emotions
Sleep disturbances
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Etiology (causes) of Anxiety Disorders

Biological factors
• Genetic predisposition (twin studies), anxiety sensitivity
• Neurotransmitter disruption (ie - abnormalities in GABA levels in
the brain = anxiety)

Conditioning and learning
• Maintained through operant conditioning
• Acquired through classical conditioning or observational learning
(parent models)
• * Especially pertinent to phobias

Cognitive factors
• Certain styles of thinking make some vulnerable, such as over
interpreting harmless situations as threatening (see next slide)

Personality factors
• Neuroticism

Stress
• A precipitating factor
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Cognitive Factors In Anxiety Disorders
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B. Somatoform Disorders
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Somatoform disorders are physical ailments
that cannot be explained by organic conditions.

1. Somatization Disorder
– a history of diverse physical complaints that appear to be
psychological in origin (ex: combo of pain, gastrointestinal and
psuedoneurological problems).
– Occurs mostly in women/ LP up to 2%
– Often coexists with depression and anxiety disorders.

2. Conversion Disorder
– Psychological conflict is “converted” into a significant loss of
physical function
– usually involves a single organ system…i.e. loss of vision, partial
paralysis, mutism
– no apparent organic basis (Ex: glove anesthesia is neurologically
impossible)
– LP up to 3%
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I’m
serious…she is
a “person of
suspicion”!
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Somatoform Disorders con’t

3. Hypochondriasis
– excessive preoccupation with health concerns
and incessant worry about developing physical
illnesses.
– Characterized by:
•
•
•
•
Acute awareness of one’s body
Detailed accounts of one’s medical history
“Doctor-shopping”
Poor insight
– Facts:
• Prevalence: 1-5%
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Somatoform Disorders con’t
Etiology
 Biological factors
• Reactive autonomic nervous system

Conditioning and learning
• “the sick role” (learned avoidance strategies, reinforced
by attention and sympathy)

Cognitive factors
• focus excess attention on their physiological processes

Personality factors
• Highly suggestible, histrionic type Neuroticism

Stress
• A precipitating factor
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C. Dissociative Disorders
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a psychological adaptation to stress/trauma
that involves a break in which conscious
awareness becomes separate from previous
memories, thoughts, feelings or identity

1. Dissociative amnesia
– sudden loss of memory for personal information too extensive to be
due to normal forgetting
– loss may be for a single traumatic event or for an extended time
period around the event.

2. Dissociative fugue
– Loss of memory and sense of personal identity
– “amnesia with travel”
– Functional memories stay intact
• i.e. forget their name, family, where they live, etc., but still know how to
do math and drive a car.
– Prevalence .2%
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Dissociative Disorders con’t

3. Dissociative identity disorder
the coexistence of two or more complete, distinct personalities in
one person
* Formerly multiple personality disorder
– Etiology
• severe emotional trauma during childhood
• child abuse elevates the likelihood of many disorders, especially among
females.
– Facts:
• Prevalence - RARE
• Only ¼ of American psychiatrists in the sample indicated that they felt
there was solid evidence for the scientific validity of DID
• Media creation?
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You don’t need
psychology…just
jump on a few
couches and
you’ll feel better.
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D. Mood/Affect Disorders
a class of disorders marked by
emotional disturbances/extremes that
may spill over to physical, perceptual,
social, and thought processes
* Evidence suggests prevalence is
increasing.
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Mood/Affect Disorders con’t

1. Major depressive disorder (Unipolar Depression)
– Profound sadness that appears to have no apparent reason
(*may follow a loss or stressful event, but continues long afterward)
– Symptoms:
•
•
•
•
•
•
•
•
Loss of interest in usual activities
Low self-esteem
Feelings of blame, worthlessness, helplessness
Change in sleep patterns, change in appetite
Suicidal ideation/attempts
Health concerns
Self-destructive behavior
Cognitive changes
– Slowed thought process/difficulty concentrating
– Unwanted, negative thoughts
– Mood congruent memory
*Symptoms are present nearly every day for at least two weeks.
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Are you still taking
these psych
notes? Why? She
is polluting your
mind… you don’t
really believe her
do you?
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Mood/Affect Disorders con’t
Note: lower
activity
(less yellow
& white).
http://www.mayoclinic.com/health/pet-scan/CA00052
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Note: it
doesn’t say
“normal”.
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Mood/Affect Disorders con’t
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– Facts:
• LPrevalence: 10-25% female/ 5-12%male (Onset: any age (median
onset age 32)
• Women attempt suicide 2-3x as often as men; BUT 4x a many men as
women die by suicide
• Evidence suggests prevalence is increasing, particularly in certain age
cohorts
• Often co-occurs with anxiety disorders and substance abuse
– Additional Types of Depression
• Situational
• Seasonal Affect Disorder (SAD)
– Dysthymic disorder
• chronic depression that is insufficient in severity to justify diagnosis of
major depression (symptoms must persist for at least two years in adults to meet the
criteria)
• Lifetime prevalence: 6%
• Onset: any age (median onset age 31)
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Seriously, are
you not listening
to me???
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Mood/Affect Disorders con’t

2. Bipolar disorder (manic-depressive disorder)
– Disorder in which an individual experiences one or more
manic episodes accompanied by periods of depression
– Divided into two categories: Bipolar I (LP 0.4-1.6%) and
Bipolar II (LP .5%)
• Bipolar I is marked by a higher level of mania
– Individuals alternate btw. depression and mania
• Symptoms of Mania:
–
–
–
–
–
Elevated mood/euphoria
Hyperactivity/irritability
Increased sociability
Bizarre behavior
Cognitive changes
» Incoherent speech, play on words (often loud)
» Grandiose, unrealistic self-evaluation
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Comparing Symptoms
Mania vs. Depression
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http://www.nimh.nih.gov/publicat/bipolar.cfm#bp1
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Bipolar disorder con’t
– Facts:
•
•
•
•
•
Prevalence: Bipolar I (LP 0.4-1.6%) and Bipolar II (LP .5%)
Equally common in males & females
Onset: first manic episode - early twenties (median age 25)
Manic episodes tend to be shorter in duration, end abruptly
“rapid cyclers” - four or more episodes occur w/in a 12 mo.
period (about 15% of cases)*
* Develops later in illness, more women than men
– Cyclothymic disorder
• chronic but relatively mild symptoms of bipolar disturbance.
• LP 0.4- 1%
http://www.nimh.nih.gov/publicat/numbers.cfm#MajorDepressive – Prevalence rates
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Bipolar Disorder
PET Scan at Various States
Depressed state
Manic state
High activity
Depressed state
Low activity
Note: Brain energy consumption rises and falls with emotional switches
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Mood/Affect Disorders con’t

Etiology: Major Depression
– Genetic vulnerability
– Neurochemical factors
• Disrupted chemical levels at
the norepinephrine and
serotonin synapses
• Serotonin = low levels
– Disrupted circadian rhythm
– Cognitive factors
• Learned helplessness
• Pessimistic explanatory style
(Martin Seligman)
– Interpersonal roots
– Precipitating stress

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Etiology: Bipolar Disorder
– Genetic vulnerability
– Vulnerability + personal or
environment triggers
– Neurochemical factors
• acetylcholine sensitivity (?)
• hypothyroidism
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Why won’t anyone
believe me…
“There is no such thing
as a chemical
imbalance.”
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Over one hundred years
of research is wrong. I
am right because I have
“read a book”.
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E. Sexual Disorders (only some)

Paraphilias
– Arousal to objects or activities involving either
• (1) nonhuman objects (i.e. fetishism)
• (2) the suffering or humiliation (not merely simulated) of oneself
or one's partner (i.e. sadism/masochism)
• (3) children or other nonconsenting persons (i.e. pedophilia,
voyeurism, exhibitionism)
• The diagnosis is made only if the person has acted on these
urges, or is markedly distressed by them.
• Prevalence: difficult to determine
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Ever have the sensation that
someone is watching you?
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F. Delusional Disorders
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class of disorders characterized by a wellorganized system of false beliefs, yet lacking
schizophrenic symptoms

Facts:
–
–
–
–

Reality testing is good in other areas
Prevalence - .03%
Onset: 40-50 years old
Anti-psychotics may be used as treatment
Some types:
–
–
–
–
Paranoid
Jealous
Erotomatic
Granduer
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G. Schizophrenia
psychological disorder characterized by
faulty reality testing and gross cognitive
disturbances

General symptoms
– Faulty reality testing
• Delusions (false beliefs) and irrational thought
• Hallucinations - sensory perceptions that occur in the absence
of a real, external stimulus or are gross distortions of perceptual
input
– Deterioration of adaptive behavior
• deficits in routine functioning (work, social, hygiene)
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Schizophrenia
General symptoms con’t
– Disturbed (flat or inappropriate) emotions
– Cognitive Processing Disturbances
• Incoherent or chaotic thinking
– Loose associations or word salad
– Memory deficits
• Incoherent or chaotic speech
– Odd motor behavior
– Altered sense of self (possible loss of identity, may be part of
delusional system)
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Subtyping of Schizophrenia
*Note: general symptoms are present to warrant a schizophrenic
diagnosis, however, distinct patterns of behavior may warrant
diagnosis of a specific subtype

4 subtypes (DSM-IV)
– Paranoid type
• dominated by delusions of persecution, along with delusions of
grandeur
– Catatonic type
• marked by striking motor disturbances, ranging from muscular rigidity
(catatonic stupor) to random motor activity.
– Disorganized type (hebephrenic)
• severe deterioration of adaptive behavior , childlike/silly behavior,
incoherence, complete social withdrawal, delusions centering on bodily
functions.
– Undifferentiated type
• clearly schizophrenic, but cannot be placed in any of the above
subtypes
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I think I can beat up
Matt Laurer! Wait until I
see him again on the
today show.
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Schizophrenia con’t

Critics push for new model of classification
– Positive vs. negative symptoms
• positive symptoms – behavioral excesses or peculiarities
(hallucinations, delusions, bizarre behavior)
• negative symptoms – behavioral deficits (flattened emotions, social
withdrawal, apathy, impaired attention, poverty of speech)

Facts:
– Prevalence: 1% population
– First classified by Emil Kraepelin as “dementia praecox” (premature
madness)
– Eugen Bleuler coined term “schizophrenia” 1911
– Affects men and women equally
– Onset: men – late teens, early twenties
women – twenties, early thirties
– Favorable prognostic factors
•
•
•
•
Acute onset @ later age
Adaptive behavior prior to onset
Low negative symptoms
Support system
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Etiology of Schizophrenia

1. Biological and/or Genetic vulnerability
• Family history, twin studies
• Defect on chromosome 5
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Etiology of Schizophrenia con’t

2. Neurochemical factors
• Dopamine Hypothesis = elevated levels of dopamine
Dopamine, dopamine & MORE dopamine!!!!!!
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Etiology of Schizophrenia con’t

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3. Structural abnormalities of the brain
• Enlarged ventricles (correlation w/ lower alpha waves)
• Metabolic abnormalities in prefrontal (positive symptoms) and temporal
lobes (negative symptoms)
• Left hemisphere activity even when not engaged in problem solving
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Etiology of Schizophrenia con’t

4. Neurodevelopmental hypothesis
• Maturational disruptions (prenatal or early life)

5. Diathesis-stress hypothesis
• Environmental stressors trigger onset
– Stressor examples: Double binds, low SES, highly critical or emotionally
over involved families
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H. Developmental Disorders
class of varied disorders that first become
evident between infancy & adolescence

Autism
– Prevalence: recent increase
– Marked by severe impairment in…
– Communication
– Social relationships
– Activity
Clip: "In My Language" with Amanda Baggs (Utube video – I can’t connect to it
in school, so if you want to see it go to Utube. It’s a good one – you have to
watch it all the way to the end to “get it”.)

ADHD
– Prevalence 3%, more boys than girls
– Marked by
• Inattentive
• Hyperactivity
• Impulsiveness



Academic Skills Disorders
Enuresis (past age 5 - @ night)
Encopresis (past age 3)
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Axis II Disorders
I. Personality Disorders
a class of disorders marked by enduring, inflexible and
maladaptive behavior patterns that impair social functioning
(usually without anxiety, depression, or delusions)
* May resemble personality characteristics that are seen in people functioning
adaptively

Anxious-fearful cluster
– Avoidant, dependent, obsessive-compulsive

Dramatic-impulsive cluster
– Histrionic, narcissistic, borderline, antisocial

Odd-eccentric cluster
– Schizoid, schizotypal, paranoid

Etiology
– Genetic predispositions
– Inadequate socialization in dysfunctional families
See class handout for details!
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Did you know…
boys who were later convicted of a crime
showed relatively low arousal?
Myers, 8th ed.
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Good details – if you want to, put on right hand side.
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Inside a Criminal Mind
Normal
Murderer
PET scans show reduced activation in a
murderer’s frontal cortex
65
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Are you diagnosing me?
Don’t do it or you too will
be a person of
suspicion!!!!
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Psychological Disorders and the
Law

Insanity (legal term)
– M’naghten rule - insanity exists when a mental disorder
makes a person unable to distinguish right from wrong at the
time of the crime

Involuntary commitment (temporary: 24-72 hours)
– danger to self
– danger to others
– in need of treatment
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Remember, the
availability
heuristic
influences our
perception of
how often the
insanity defense
is used.
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IV. Culture and Pathology
* Note: Culture-bound disorders illustrate the
diversity of abnormal behavior around the world, as
well as cultural influence.

Examples of culture bound disorders
– Anorexia nervosa
– Windigo
– Koro
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THE END!
Keep Working on your note cards.
The test will be after we talk about
treatments.
Don’t let that Bost-lady win.
I am the supreme voice on
psychology…don’t trust
her!
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