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Psychological Disorders
What is a psychological disorder?
Anxiety disorders, OCD, and PTSD
Substance use and addictive disorders
Mood disorders
Schizophrenia
Other disorders
What Is a Psychological Disorder?
Defining psychological disorders
THINKING CRITICALLY ABOUT: ADHD—
Normal high energy or disordered behavior?
Understanding psychological disorders
Classifying disorders—and labeling people
CLOSE-UP: Are people with psychological
disorders dangerous?
What Is a Psychological Disorder?
Theorists and clinicians consider many perspectives
How should we define psychological disorders?
How should we understand disorders?
How do underlying biological factors contribute to disorder? How
do troubling environments influence our well-being? And how do
these effects of nature and nurture interact?
How should we classify psychological disorders? How can we
use labels to guide treatment without stigmatizing people or
excusing their behavior?
Defining Psychological Disorders
Psychological disorder
A syndrome marked by a clinically significant
disturbance in a person’s thoughts, feelings, or
behaviors
Culture and time
Diagnosis of specific disorders has varied from
culture to culture and over time in the same culture
Percentage of Americans Reporting Certain
Psychological Disorders in the Past Year
The Granger Collection, NYC -- All rights reserved.
Understanding
Psychological
Disorders
“MORAL TREATMENT” Under
Philippe Pinel’s influence,
hospitals sometimes sponsored
patient dances, often called
“lunatic balls,” depicted in this
painting by George Bellows
(Dance in a Madhouse).
Once upon a time…
Middle Ages: Wide variety
of therapies (often cruel or
barbaric by today’s
standards) used to drive
out demons or modify
madness
Pinel: Opposed brutal
treatment and proposed
moral treatment; viewed
madness as a sickness of
mind caused by severe
stress and inhumane
treatment
Understanding Psychological Disorders
The medical model
1800s: Search for physical causes of mental
disorders and for curative treatments
Mental illness is diagnosed on the basis of symptoms
and cured through therapy, including treatment
The biopsychosocial approach
General approach positing that biological,
psychological, and social-cultural factors, all play a
significant role in human functioning in the context of
disease or illness
ADHD—Normal High Energy or Disordered
Behavior?
Attention-deficit/hyperactivity disorder (ADHD)
11 percent of American 4- to 17-year-olds receive this
diagnosis after displaying its key symptoms (extreme
inattention, hyperactivity, and impulsivity); 2.5 percent
have ADHD symptoms
Symptoms can be treated with medication and other
therapies
Debate continues over whether normal high energy is too
often diagnosed as a psychiatric disorder, and whether
there is a cost to the long-term use of stimulant drugs in
treating ADHD
Are psychological disorders universal, or are they
culture-specific? Explain with examples.
What is the biopsychosocial perspective, and why
is it important in our understanding of
psychological disorders?
Classifying Disorders—and Labeling People
Classification in psychiatry and
psychology
Provides name and description
Attempts to predict the future of a disorder
Suggests treatment
Classifying Disorders—and Labeling People
DSM-5
American Psychiatric Association’s 2013 Diagnostic
and Statistical Manual of Mental Disorders (DSM-5)
Changes
Some label changes (e.g., Autism spectrum disorder;
intellectual disability)
New or altered diagnoses (e.g., disruptive mood
dysregulation disorder; prolonged
bereavement/depression)—some controversial
Classifying Disorders—and Labeling People
DSM-5 Criticism
Antisocial personality disorder and generalized
anxiety disorder did poorly on field trials
DSM-5 contributes to pathologizing of everyday life
System labels are society’s value judgments
Rosenhan (1973)
DSM-5 Benefits
System helps mental health professionals
communicate and is useful in research
What is the value, and what are the dangers, of
labeling individuals with disorders?
Anxiety Disorders, OCD, and PTSD
Generalized anxiety disorder
Panic disorder
Phobias
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Understanding anxiety disorders, OCD, and PTS
Anxiety Disorders, OCD, and PTSD
Anxiety disorders are marked by distressing,
persistent anxiety or maladaptive behaviors that
reduce anxiety
Generalized anxiety disorder
Person is constantly tense and uneasy for no
apparent reason
Panic disorder
Person experiences sudden episodes of intense
dread and often lives in fear of when the next attack
might strike
Phobias
Person feels irrationally and intensely afraid of a
specific object or situation
Obsessive-compulsive disorder
Person is troubled by repetitive thoughts or actions
Posttraumatic stress disorder
Person has lingering memories, nightmares, and
other symptoms for weeks after a severely
threatening, uncontrollable event
LIVING WITH ANXIETY
DISORDER
Garrett Ellwood/NBAE/Getty Images
NBA basketball player
Royce White speaks
openly about his
generalized associated
fear of flying (Wrenn,
2012).
Classifying Disorders—and Labeling People
General anxiety disorder
Symptoms: Continual worrying, often jittery, sleep
deprived, concentration difficulties, often experienced
with depression
Two-thirds are women; decreases with age in many
Panic disorder
Symptoms: Irregular heartbeat, cheat pains,
shortness of breath, choking, dizziness, trembling
Smoking increases the risk for attacks
SOME COMMON AND UNCOMMON SPECIFIC FEARS
Researchers surveyed Dutch people to identify the most
common events or objects they feared. A strong fear
becomes a phobia if it provokes a compelling but
irrational desire to avoid the dreaded object or situation.
(From Marja et al., 2008.)
Sam Greenwood/Getty Images
Classifying
Disorders
PLAYING THROUGH PANIC
Golfer Charlie Beljan
suffered panic and a
racing pulse during a
2012 PGA golf
tournament
After finishing, he left
and spent the night
in a hospital before
returning the next
day and winning
$846,000
Unfocused tension, apprehension, and arousal is
called ________ disorder. If a person is focusing
anxiety on specific feared objects or situations,
that person may have a(n) ________. Those who
experience unpredictable periods of frightening
physical sensations, may be diagnosed with a(n)
________ disorder.
Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD)
A disorder characterized by unwanted repetitive
thoughts (obsessions) and/or actions (compulsions)
Occurs when obsessive thoughts and compulsive
behaviors interfere with everyday life and cause
distress
Post traumatic Stress Disorder (PTSD)
Post Traumatic stress disorder (PTSD)
A disorder characterized by haunting memories,
nightmares, social withdrawal, jumpy anxiety,
numbness of feeling, and/or insomnia lingering for
four weeks or more after a traumatic experience
Often involves battle-scarred veterans (7.6 percent of
combatants; 1.4 of noncombatants) and survivors of
accidents, disasters, and violent and sexual assaults
(two-thirds of prostitutes)
Women are at higher risk
Post traumatic Stress
Disorder (PTSD)
Whitney Shefte/ The Washington Post via Getty Images
During his three deployments
to Iraq, this Marine Staff
Sergeant suffered traumatic
brain injury. After his return
home, he was diagnosed with
posttraumatic stress disorder.
He regularly travels two hours
each way with his wife to
Bethesda Naval Hospital for
psychiatric and medical
appointments.
BRINGING THE WAR HOME
PTSD
Some believe it’s overdiagnosed because of a
broad definition of “trauma”
May include “normal” bad memories
“Debriefing” may exacerbate the problem;
reliving the situation may be traumatic
Those who express anxiety through unwanted
repetitive thoughts or actions may have a(n)
________ disorder. Those with symptoms of
withdrawal, jumpy anxiety, numbness of feeling,
and/or insomnia for weeks after a traumatic event
may be diagnosed with ________ disorder.
Understanding Anxiety Disorders, OCD, and
PTSD: How Do Anxious Feelings Arise?
Conditioning
Classical conditioning research helps explain how
panic-prone people associate anxiety with certain
cues
Stimulus generalization research demonstrates how a
fearful event can later become a fear of similar events
Reinforcement (operant conditioning) can help
maintain a developed and generalized phobia
Understanding Anxiety Disorders, OCD, and
PTSD: How Do Anxious Feelings Arise?
Cognition
Observing others can contribute to the
development of some fears
Olsson and colleagues: Wild monkey research
findings
Interpretations and expectations shape
reactions
Hypervigliance
Understanding Anxiety
Disorders, OCD, and
PTSD
Biology
The brain: Trauma is linked
to new fear pathways,
hyperactive danger
detection, impulse control,
and habitual behavior areas
of the brain
Natural selection: Biological
preparedness to fear
threats—easily conditioned
and difficult to extinguish
Tim Boyles/ Getty Images
Genes: Genetic
predisposition to anxiety,
OCD, and PTSD
FEARLESS? The biological
perspective helps us understand
why most of us have more fear of
heights than does Nick Wallenda,
shown here crossing the Grand
Canyon in 2013 without a security
harness or safety net.
Researchers believe that anxiety disorders, OCD,
and PTSD are influenced by conditioning and
cognition. What other factors contribute to these
disorders?
Substance Use and Addictive
Disorders
Tolerance and addiction
Depressants
Stimulants
Hallucinogens
Understanding substance use disorder
Substance Use and Addictive Disorders
• Substance use disorder
• Involves continued substance craving and use
despite significant life disruption and/or physical risk
• Psychoactive drugs
• Include chemicals that change perceptions and mood
• Drug effectiveness
• Depends on biological effects and the user’s
psychological expectations
Tolerance and
Addiction
• Tolerance
• With repeated use, the
desired effect requires
larger doses
• Addiction
• Compulsive craving of
drugs or certain behaviors
(such as gambling) despite
known harmful
consequences
• Withdrawal
• Discomfort and distress
that follow discontinuing an
addictive drug or behavior
DRUG TOLERANCE
When Is Drug Use a Disorder?
What is the process that leads to drug tolerance?
Substance Use and Addictive Disorders
Can you identify the three major categories of
psychoactive drugs?
Depressants: Alcohol
Unleashing urges
Helpful and harmful tendencies are increased
Destructive behaviors and consequences occur
Binge drinking occurs
Slowed neural processing
Sympathetic nervous system slows
Potential sedative effect and lowered inhibitions
Moral and physical judgment is impaired
Depressants: Alcohol
Memory disruption
Processing of recent experiences into long-term
memory is disrupted (blackouts)
Long-term effects on the brain (rat studies)
The death of nerve cells and the birth of new cells
and impaired growth of synaptic connections is linked
to binge drinking
Expectations
Alcohol users’ expectations influence their behavior
Daniel Hommer, NIAAA, NIH, HHS
ALCOHOL USE DISORDER SHRINKS THE BRAIN
MRI scans show brain shrinkage in women with
alcohol use disorder (left) compared with women in
a control group (right).
Depressants
Barbiturates
Depress the activity of the central nervous system, reducing
anxiety but impairing memory and judgment
Can impair memory and judgment; potentially lethal when
combined with alcohol
Nembutal, Seconal, and Amytal
Opiates
Include opium and its derivatives, such as codeine, morphine
and heroin; addictive
Constrict pupils, slows breathing, causes lethargy
Depress neural activity, temporarily lessening pain and anxiety
Cause withdrawal when ingestion is stopped
Alcohol, barbiturates, and opiates are all in
a class of drugs called ________.
Stimulants
Stimulant drugs
Include caffeine, nicotine, and the more powerful
amphetamines (cocaine, Ecstasy, and
methamphetamine) that excite neural activity and
speed up body functions
Involve dilation of pupils, increase in heart and
breathing rates, rise in blood sugar, and drop in
appetite
Often involve increase in energy and self-confidence
Nicotine
The stimulating and highly addictive psychoactive
drug in tobacco
Signals the central nervous system to release a flood
of neurotransmitters
Diminishes appetite, boosts alertness and mental
efficiency, calms anxiety, and reduces sensitivity to
pain
Involves challenging acute craving and withdrawal
symptoms which contribute to relapse
Where there’s smoke . . .
The physiological effects of nicotine
• Nicotine reaches
the brain within 7
seconds, twice as
fast as intravenous
heroin.
• Within minutes, the
amount in the blood
soars.
Why do tobacco companies try so hard to get
customers hooked as teens?
Stimulants
Cocaine
Produces a quick rush of euphoria
Involves a crash of agitated depression within 15 to
30 minutes after neurotransmitters drop
Produces psychological effects depending on dosage
and form consumed and user’s expectations and
personality
Cocaine Euphoria and Crash
Stimulants
Cocaine
Methamphetamine
Ecstasy (MDMA)
• Produces quick rush
of euphoria
• Involves crash of
agitated depression
within 15 to 30
minutes after
neurotransmitters
drop
• Produces
psychological effects
depending on
dosage and form
consumed and
user’s expectations
and personality
• Is powerfully
addictive
• A synthetic stimulant
and mild
hallucinogen
• Produces euphoria,
but with short-term
health risks and
longer term harm to
mood and cognition
Hallucinogens
Hallucinogens
Distort perceptions and call up sensory images without any
input from the senses
Marijuana
Has leaves containing THC (delta-9tetrahydrocannabinol) which are smoked or eaten to
produce increased sensitivity to colors, sounds,
tastes, and smells; lingers in body longer
Can also relax, disinhibit, and impair motor and
perceptual skills and reaction time
From Hallucinations by Ronald K. Siegel, Scientific American 237, 132 - 139 (1977)
HALLUCINATION OR NEAR DEATH
VISION? People under the influence
of hallucinogenic drugs often see “a
bright light in the center of the field of
vision…”
Hallucinogens
LSD
Powerful
hallucinogenic drug;
also known as acid
(lysergic acid
diethylamide)
Interferes with
serotonin
neurotransmitter
system
A Guide to Selected Psychoactive Drugs
“How strange would appear to be this thing that
men call pleasure! And how curiously it is related
to what is thought to be its opposite, pain! . . .
Wherever the one is found, the other follows up
behind.”-- Plato, Phaedo, fourth century B.C.E.
How does this pleasure-pain description apply to
the repeated use of psychoactive drugs?
Understanding Substance Use Disorder
Evidence of biological vulnerability to particular
drugs
Twin studies (Kendler et al., 2002)
Genetically influenced traits in boys (Masse & Tremblay, 1997)
Genes that produce deficiencies in the dopamine reward system
Evidence of psychological and social-cultural
influences
Links between heavy drug use, significant stress or failure,
sexual abuse, eating disorders, and depression
Exposure to media models
Ethnic difference in rates of smoking, drinking, and cocaine use
Location and peer influence create additional risk
Studies have found that people who begin drinking
in the early teens are much more likely to develop
an alcohol use disorder than are those who begin
at age 21 or after. What possible explanations
might there be for this correlation?
Mood Disorders
Major depressive disorder
Bipolar disorder
Suicide and self-injury
Understanding mood disorders
Mood Disorders
Major depressive disorders appear in two
principal forms
Major depressive disorder
A persistent state of hopeless depression
Occurs when signs of depression last two or more weeks and
are not caused by drugs or a medical condition
Bipolar disorder
An alternation between depression and overexcited
hyperactivity; less common
May include seasonal patterns; involves a surge in diagnosis
GENDER AND MAJOR DEPRESSION
Interviews with 89,037 adults in 18 countries (10 of which
are shown here) confirm what many smaller studies have
found.
Women’s risk of major depression is nearly double that of
men’s (Bromet et al., 2011).
Diagnosing Major Depressive Disorder
Suicide and Self-Injury
Suicide
1 million people worldwide; higher risk with diagnosis
of depression but may occur with rebound
Is more likely to occur when people feel disconnected
from or a burden to others
Nonsuicidal self-injury (NSS)
Includes cutting, burning, and hitting oneself, pulling
out hair, inserting objects under the nails or skin, and
self-administered tattooing
Why?
People engage in NSSI to
Gain relief from intense negative thoughts
through the distraction of pain
Ask for help and gain attention
Relieve guilt by self-punishment
Get others to change their negative behavior
(bullying, criticism)
Fit in with a peer group
Understanding Mood Disorders
Findings that any theory of depression must
explain
Behaviors and thoughts change with depression
Depression is widespread
Women’s risk of major depression is nearly double
men’s
Most major depressive episodes end on their own
With each new generation, depression is striking
earlier in life and affecting more people
Risk increases if a family
member has the disorder
Twin studies data estimate
heritability of major
depression at 37 percent
Linkage analysis points to
“chromosome
neighborhood”
Many genes work together
and produce interacting
small effects that increase
the risk for depression
The Heritability of
Various Psychological
Disorders
Understanding Mood Disorders
The depressed brain
Brain activity slows during depression
Left frontal lobe is less active
Scarcity of norepinephrine and serotonin
Courtesy of Drs. Lewis Baxter and Michael E. Phelps, UCLA
School of Medicine
THE UPS AND DOWNS OF BIPOLAR DISORDER
PET scans show that brain energy consumption rises and
falls with the patient’s emotional switches. Red areas are
where the brain is using energy most rapidly.
During depression
Brain activity slows
Left frontal lobe is less active
Scarcity of norepinephrine and serotonin
Understanding Mood Disorders
THE VICIOUS CYCLE OF DEPRESSED THINKING
Understanding Mood Disorders
Psychological and social influences: Socialcognitive perspective
Depressed people view the self and the world
negatively
Learned helplessness may exist with self-defeating
beliefs, self-focused rumination, and a self-blaming
and pessimistic explanatory style
What does it mean to say that “depression is a
whole-body disorder”?
Schizophrenia
Symptoms of schizophrenia
Onset and development of schizophrenia
Understanding schizophrenia
Schizophrenia
Definition
Psychological disorder characterized by delusions,
hallucinations, disorganized speech, and/or
diminished, inappropriate emotional expression
Symptoms
Disorganized speech
Disturbed perceptions
Diminished and inappropriate emotions and actions
Schizophrenia
Onset and development
Sudden appearance for some; slow-developing for
others
Recovery is more difficult for slow-developing onset
Men are struck earlier, more severely, and slightly
more often
Understanding Schizophrenia
Brain abnormalities
Brain chemistry
Excess number of dopamine receptors
Abnormal brain activity and anatomy
Problems with several brain regions and their
interconnections
Low activity in frontal lobes
More rapid brain tissue loss
Understanding Schizophrenia
Prenatal environment and risk
Low birth weight
Lack of oxygen during delivery
Maternal prenatal nutrition
Midpregnancy viral infection (e.g., flu, dense
population, season of birth)
RISK OF DEVELOPING
SCHIZOPHRENIA
The lifetime risk of
developing schizophrenia
varies for family members
of a person with this
disorder.
Understanding Schizophrenia
Genetics and risk
The odds of being diagnosed with schizophrenia are
nearly 1 in 100; 1 in 10 for those with diagnosed
family member
Adopted children’s risk is related to the biological
parents
Schizophrenia is influenced by many genes
Epigenetic factors influence gene expression
A person with schizophrenia who has ________
(positive/negative) symptoms may have an
expressionless face and toneless voice.
What factors contribute to the onset and
development of schizophrenia?
Other Disorders
Eating disorders
Dissociative disorders
Personality disorders
Other Disorders
Eating disorders
Anorexia nervosa
Person (usually an adolescent female) maintains a starvation
diet despite being significantly underweight
Bulimia nervosa
Person alternates binge eating (usually of high-calorie foods)
with purging (by vomiting or laxative use), fasting, or excessive
exercise
Binge-eating disorder
Significant binge eating, followed by distress, disgust, or guilt,
but without the purging, fasting, or excessive exercise that marks
bulimia nervosa
People with ________ (anorexia nervosa/bulimia
nervosa) continue to want to lose weight even
when they are underweight.
Those with ________ (anorexia nervosa/bulimia
nervosa) tend to have weight that fluctuates within
or above normal ranges.
Other Disorders
Dissociative disorder
Conscious awareness becomes separated
(dissociated) from previous memories, thoughts, and
feelings
Dissociative identity disorder (DID)
Rare dissociative disorder in which a person exhibits
two or more distinct and alternating personalities—
formerly called multiple personality disorder
Dissociative Disorders: The Arguments
Critics question
Short history of DID
Lower incidence outside North America
Suggest it could be self-perception instead of a disorder
Others support
Different areas of the brain and body states associated
with differing personalities
What do you think?
The psychodynamic and learning perspectives
agree that dissociative identity disorder symptoms
are ways of dealing with anxiety. How do their
explanations differ?
Personality Disorders
Personality disorder
Inflexible and enduring behavior pattern that impairs social
functioning; may include withdrawal or avoidance of social
contact, insecurity, instability, or manipulative behaviors
Antisocial personality disorder
Lack of conscience for wrongdoing, even toward friends
and family members; impulsive, fearless, irresponsible;
some genetic tendencies, including low arousal
Typically male; emerges before age 15; influenced by
nature and nurture
Are people with psychological disorders
dangerous?
The majority of violent crimes are committed by those
with no diagnosed disorders
There is little risk of violence or harm to a stranger
from casual contact with an individual who has a
mental disorder
Alcohol or drugs, previous violence, and gun
availability are better predictors of violence