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Psychological Disorders
Chapter
Psychological Disorders
An Introduction
Psychological Disorder
• A “harmful dysfunction” in which behavior
is judged to be atypical, disturbing,
maladaptive and unjustifiable.
What is abnormal, disturbing maladaptive
and unjustifiable depends on:
•Culture
•Time Period
•Environmental Conditions
•Individual Person
Maladaptive
• An exaggeration of normal, acceptable
behaviors
• Destructive to oneself or others
Unjustifiable
• A behavior which does not have a
rational basis
Disturbing
• A behavior which is troublesome to
other people
Atypical
• A behavior so different from other
people’s behavior that it violates a norm
• Norms vary from culture to culture
MUDA
• A mnemonic device used to remember
the four attributes of a psychological
disorder
– Maladaptive
– Unjustifiable
– Disturbing
– Atypical
Early Theories
• Afflicted people
were
possessed by
evil spirits or
sinners.
During the Middle Ages treatment methods were
inhumane and cruel
• Music or singing was
often used to chase
away spirits.
•In some cases
trephening was
used:
Cutting a hole in
the head of the
afflicted to let out
the evil spirit.
Trephening
Early Theories
• Another theory was to make the body
extremely uncomfortable.
History of Mental Disorders
• In the 1800’s,
disturbed people
were no longer
thought of as
madmen, but as
mentally ill.
They were first put in hospitals.
Did this mean better treatment?
Early Mental Hospitals
• They were nothing more than barbaric
prisons.
•The patients were chained
and locked away.
•Some hospitals even charged admission
for the public to see the “crazies”, just like
a zoo.
Philippe Pinel (1745-1826)
• French physician who worked to reform the
treatment of people with mental disorders
• Encouraged more humane treatment
Philippe Pinel
• Pinel said “take the
chains off and
declare that these
people are sick” “a
cure must be
found!!!”
Somatogenic
• At this time- it was believed that mental
illness had a bodily cause- Somatogenic.
General Paresis and Syphilis Example.
But Somatogenic could not explain
disorders such as hysteria (now
called conversion disorder).
Many disorders are psychogenic: the
origin is psychological, not physical.
The Medical Model
• Concept that mental illnesses have
physical causes that can be diagnosed,
treated, and in most cases, cured.
• Psychological disorders can be
diagnosed based on their symptoms and
treated or cured through therapy.
• Psychological disorders are similar to a
physical illness.
Current Perspectives
• Bio-Psycho-Social Perspective:
assumes biological, psychological and
sociocultural factors combine to interact
causing psychological disorders.
Used to be called Diathesis-Stress Model:
diathesis meaning predisposition and stress
meaning environment.
Bio-Psycho-Social Perspective
DSM-IV-TR
• Diagnostic and
Statistical Manual of
Mental Disorders –
Fourth Edition
• The text of the DSMIV was recently
revised, hence “TR” at
the end
DSM-IV-TR
• Divides mental disorders into 17 major
categories
• Includes the symptoms but not the
causes of each disease
• Has changed significantly since the first
edition
DSM-IV-TR Axis
DSM-IV-TR Axis
DSM-IV-TR Axis
DSM-IV-TR Axis
Labeling Stigmas
• Studies show a clear bias against people
diagnosed with mental disorders.
Thomas Eagleton and George McGovern 1972
Anxiety Disorders
a group of conditions where the
primary symptoms are anxiety or
defenses against anxiety.
the patient fears something
awful will happen to them.
Anxiety and Anxiety Disorders
• Anxiety: Vague feeling of
apprehension or
nervousness
• Anxiety disorder: where
anxiety begins to take
control and dominate a
person’s life
What is anxiety?
• is a state of
intense
apprehension,
uneasiness,
uncertainty, or
fear.
Types of Anxiety Disorders
• Anxiety disorders are divided into:
– Generalized Anxiety Disorder
– Panic Disorder
– Phobia
– Obsessive-Compulsive Disorder
– Posttraumatic Stress Disorder
Anxiety Disorders
Generalized Anxiety Disorder
• An anxiety disorder in which a person
is continuously tense, apprehensive and
in a state of autonomic nervous system
arousal.
The patient is constantly tense and worried,
feels inadequate, is oversensitive, can’t
concentrate and suffers from insomnia.
Symptoms of Generalized Anxiety
• Must have at least three of the following:
– Restlessness
– Feeling on edge
– Difficulty concentrating/mind going
blank
– Irritability
– Muscle Tension
– Sleep Disturbance
Panic Disorder
• An anxiety disorder marked by a
minutes-long episode of intense dread in
which a person experiences terror and
accompanying chest pain, choking and
other frightening sensations.
Can cause secondary disorders, such as
agoraphobia.
Panic Disorder
• An anxiety disorder characterized by
sudden bouts of intense, unexplained
anxiety
• Often associated with physical
symptoms like choking sensations or
shortness of breath
• Panic attacks may happen several times
a day
Phobias
• A person experiences sudden
episodes of intense dread.
Phobia
• An anxiety disorder characterized by
disruptive, irrational fears of specific
objects or situations
• The fear must be both irrational and
disruptive.
Social Phobia
• Phobias which produce fear in social
situations
• Fear of speaking in public
Agoraphobia
• Fear of situations the person views as
difficult to escape from
• Fear of leaving one’s home or room in
the house
The Phobia
List Link
Obsessive-Compulsive Disorder
• An anxiety disorder characterized by
unwanted, repetitive thoughts and
actions
• Obsessions – repetitive thoughts
• Compulsions – repetitive actions
• The obsessions/compulsions begin to
take control of the person’s life.
Common Examples of OCD
Common Obsessions:
Contamination fears of germs, dirt,
etc.
Imagining having harmed self or
others
Common
Compulsions:
Washing
Repeating
Imagining losing control of
aggressive urges
Checking
Intrusive sexual thoughts or urges
Touching
Excessive religious or moral doubt
Counting
Forbidden thoughts
Ordering/arranging
A need to have things "just so"
Hoarding or saving
A need to tell, ask, confess
Praying
Posttraumatic Stress Disorder
• An anxiety disorder characterized by
reliving a severely upsetting event in
unwanted recurring memories
(flashbacks) and dreams
Explanations for Anxiety
Disorders
• You Learn them through conditioning.
•Evolution
•Genes
•Physiology (the brain)
Biological Factors
• Hereditary factors may result in a
predisposition for developing anxiety
disorders
• Brain functions appear to be different in
an anxiety disorder patient
• Evolutionary factors may lead to anxiety
disorders.
Learning Factors
• Through classical conditioning people
may associate fear with an object.
• Observational learning--watching
another experiencing fearfulness--may
result in developing fear.
• Fear of an object may be reinforced
when by avoiding the feared objects.
Mood Disorders
Mood Disorders
• Classification of disorders where there
is a disturbance in the person’s emotions
• Major types of mood disorders include:
– Major Depressive Disorder
– Bipolar Disorder
– Dysthymic Disorder
Mania
• Period of abnormally high emotion and
activity
Depression
• Extended period of feeling sad, listless,
and drained of energy
Major Depressive Disorder
• A mood disorder in which a person, for
no apparent reason, experiences at least
two weeks of
– depressed moods,
– diminished interest in activities, and
– other symptoms, such as feelings of
worthlessness
Bipolar Disorder
• A mood disorder in which the person
alternates between the hopelessness of
depression and the overexcited and
unreasonably optimistic state of mania
• Formerly called manic-depressive
disorder
• Many times will follow a cyclical
pattern
Biological Factors
• Mood disorders have a hereditary nature
to them.
• Depressed individuals tend to have
depressed brains.
– PET scans indicate less activity during
periods of depression.
Social-Cognitive Factors
• Depression may be a variation of
learned helplessness.
• Depressed individuals attribute events
using the following characteristics:
– Stable: the bad situation will last for a
long time
– Internal: they are at fault
– Global: all of life is bad
Attribution and Depression
Determination of Mood
Personality Disorders
Psychological disorders characterized by
inflexible and enduring behavior patterns
that impair social functioning.
Personality Disorders
• Psychological disorders characterized
by rigid and lasting behavior patterns
that disrupt social functioning
• Divided into three clusters:
– Related to anxiety
– With odd and eccentric behaviors
– With dramatic or impulsive behaviors
Personality Disorders
Avoidant Personality Disorder
• So sensitive about being rejected that
personal relationships become difficult
Avoidant personality disorder
• characterized by a pervasive pattern of
social inhibition, feelings of inadequacy,
and extreme sensitivity to negative
evaluation.
• consider themselves to be socially inept
or personally unappealing, and avoid
social interaction for fear of being
ridiculed or humiliated.
Dependent Personality Disorder
• Behave in clingy, submissive ways and
displays a strong need to have others
take care of them
Dependent personality disorder
• characterized by a pervasive
psychological dependence on other
people.
• has difficulty making everyday decisions
without an excessive amount of advice
and reassurance from others
Paranoid Personality Disorder
• Paranoid personality
disorder is
characterized by a
distrust of others
and a constant
suspicion that people
around you have
sinister motives.
Paranoid Personality Disorder
• They search for hidden meanings in
everything and read hostile intentions into
the actions of others.
•They are quick to challenge the loyalties of
friends and loved ones and often appear cold
and distant to others. They usually shift
blame to others and tend to carry long
grudges.
Schizoid Personality Disorder
• Is detached from social relationships
• Are true hermits, preferring life alone
and avoiding intimate interactions at all
costs
Schizoid Personality Disorder
• People with schizoid
personality disorder
avoid relationships
and do not show
much emotion
They genuinely prefer to be alone and do
not secretly wish for popularity.
Schizoid Personality Disorder
• They tend to seek jobs that require
little social contact
Their social skills are often weak and they
do not show a need for attention or
acceptance
They are perceived as humorless and
distant and often are termed "loners."
Borderline Personality Disorder
• characterized by mood instability and
poor self-image
People with this disorder are prone to
constant mood swings and bouts of
anger.
Borderline Personality
Disorder
• they will take their
anger out on
themselves, causing
themselves injury
Suicidal threats and actions
are not uncommon
They are quick to anger when their
expectations are not met.
Antisocial Personality Disorder
• Personality disorder in which the person
shows a lack of conscience for
wrongdoing
• Shows no respects for the rights others
• Usually male
• Also known as psychopathic or
sociopathic personality disorder
Antisocial Personality Disorder
• antisocial personality disorder is
characterized by a lack of conscience
•People with this disorder are prone to
criminal behavior, believing that their victims
are weak and deserving of being taken
advantage of. They tend to lie and steal
Antisocial Personality Disorder
• they are careless with money and take
action without thinking about
consequences
They are often aggressive and are much
more concerned with their own needs
than the needs of others.
Histrionic Personality Disorder
• constant attention seekers
They need to be the center of
attention all the time, often
interrupting others in order to
dominate the conversation.
Histrionic Personality
Disorder
• They may dress
provocatively or
exaggerate
illnesses in order
to gain attention.
They also tend to exaggerate friendships
and relationships, believing that everyone
loves them
Narcissistic Personality Disorder
• characterized
by selfcenteredness
They exaggerate their achievements,
expecting others to recognize them as
being superior
Narcissistic Personality Disorder
They tend to be
choosy about
picking friends,
since they believe
that not just
anyone is worthy of
being their friend.
They are generally uninterested in the
feelings of others and may take advantage
of them.
Schizotypal Personality Disorder
• characterized by a need for social
isolation, odd behavior and thinking, and
often unconventional beliefs such as
being convinced of having extra sensory
abilities.
• Some people believe that schizotypal
personality disorder is a mild form of
schizophrenia.
Obsessive Compulsive Personality
Disorder
• characterized by a general psychological
inflexibility, rigid conformity to rules
and procedures, perfectionism, and
excessive orderliness.
• people with OCPD tend to stress
perfectionism above all else, and feel
anxious when they perceive that things
aren't "right".
Dissociative Disorders
Dissociative Disorders
• Disorders in which the sense of self has
become separated (dissociated) from
previous memories, thoughts, or feelings
Types of Dissociative Disorders
• Three main types:
– Dissociative Amnesia
– Dissociative Fugue
– Dissociative Identity Disorder
Dissociative Disorders
Dissociative Disorders
• Disorders in which
conscious
awareness becomes
separated
(dissociated) from
previous memories,
thoughts and
feelings.
Dissociative Amnesia
• This disorder is
characterized by a
blocking out of
critical personal
information, usually
of a traumatic or
stressful nature.
Dissociative Amnesia
• A dissociative disorder characterized by
loss of memory in reaction to a
traumatic event
• Example: soldiers in combat
Dissociative Amnesia
• Dissociative amnesia, unlike other types
of amnesia, does NOT result from other
medical trauma (e.g. a blow to the head).
Dissociative Amnesia
• Localized amnesia is present in an individual who has no
memory of specific events that took place, usually
traumatic. The loss of memory is localized with a specific
window of time. For example, a survivor of a car wreck
who has no memory of the experience until two days later
is experiencing localized amnesia.
• Selective amnesia happens when a person can recall
only small parts of events that took place in a defined
period of time. For example, an abuse victim may recall
only some parts of the series of events around the abuse.
• Generalized amnesia is diagnosed when a person's
amnesia encompasses his or her entire life.
• Systematized amnesia is characterized by a loss of
memory for a specific category of information. A person
with this disorder might, for example, be missing all
memories about one specific family member.
Dissociative Fugue
• A dissociative disorder characterized by
loss of identity and travel to a new
location
• The person may develop a new identity
and begin a new life.
Dissociative Fugue
• An individual with dissociative fugue
suddenly and unexpectedly takes
physical leave of his or her surroundings
and sets off on a journey of some kind.
•These journeys can last hours, or even
several days or months.
Dissociative Fugue
• Individuals experiencing a dissociative fugue
have traveled over thousands of miles.
An individual in a fugue state is unaware of or
confused about his identity, and in some
cases will assume a new identity (although
this is the exception).
Depersonalization Disorder
• is marked by a feeling of detachment or
distance from one's own experience,
body, or self.
One can easily relate to feeling as they
in a dream, or being "spaced out."
A person's experience with depersonalization
can be so severe that he or she believes the
external world is unreal or distorted.
Dissociative Identity Disorder
• A rare dissociative disorder in which
a person exhibits two or more
distinct and alternating personalities.
•Also known as multiple personality
disorder.
Dissociative Identity Disorder
• Rare and controversial dissociative
disorder in which an individual
experiences two or more distinct and
alternating personalities
• Formerly called multiple personalities
Dissociative Identity Disorder
• Personalities can be different ages, sex,
and self perception of characteristics
• Three Faces of Eve
• Sybil
Schizophrenia
Schizophrenia
• Group of severe disorders characterized by
disorganized and delusional thinking,
disturbed perceptions, and inappropriate
emotions and actions
• Is not one disorder but a family of disorders
• Is not “split personality”
• Occurs in about 1% of the population
Symptoms of Schizophrenia
• Symptoms of schizophrenia include:
– Delusions (false beliefs)
– Hallucinations (false perceptions)
– Inappropriate emotions or behaviors
Symptoms of Schizophrenia
How Prevalent?
• About 1 in every 100 people are
diagnosed with schizophrenia.
Symptoms of Schizophrenia
• Disorganized thinking.
•Disturbed Perceptions
•Inappropriate Emotions and
Actions
Disorganized Thinking
• The thinking of a person with
Schizophrenia is fragmented and
bizarre and distorted with false beliefs.
•Disorganized thinking comes from a
breakdown in selective attention.they cannot filter out information.
Often causes………
Delusions (false beliefs)
• Delusions of
Persecution
• Delusions of
Grandeur
Delusions
• False beliefs that are symptoms of schizophrenia
and other serious psychological disorders
• Four major types of delusions:
– Grandeur
– Persecution
– Sin or guilt
– Influence
Delusions of Grandeur
• False beliefs that a person is more
important than they really are
• Patients may believe they are a famous
person (e.g. Napoleon)
Delusions of Persecution
• False beliefs that people are out to get
the person
• Believe they are being followed, the
phone is wiretapped, etc.
Delusions of Sin or Guilt
• False beliefs that the person is
responsible for some misfortune
Delusions of Influence
• False beliefs of being controlled by
outside forces
Hallucinations
• False perceptions that are symptoms of
schizophrenia or other serious psychological
disorders
• Types of hallucinations:
– Auditory (hearing voices)
– Visual (seeing things)
– Tactile (feeling skin sensations)
• Can also have distorted smell and taste
Disturbed Perceptions
• hallucinations- sensory experiences
without sensory stimulation.
Inappropriate Emotions/Behaviors
• Flat affect – showing little or no
emotional response
• Word salad – nonsense talk
• Waxy flexibility – the person’s arms and
legs will remain in place after being
moved there
Inappropriate Emotions and
Actions
• Laugh at
inappropriate times.
• Flat Effect
• Senseless,
compulsive acts.
• Catatonia- motionless
Waxy Flexibility
Positive v. Negative Symptoms
Positive Symptoms
• Presence of
inappropriate
symptoms
Negative Symptoms
• Absence of
appropriate ones.
Types of Schizophrenia
Paranoid Schizophrenia
• preoccupation
with delusions
or
hallucinations.
• Somebody is out
to get me!!!!
Paranoid Schizophrenia
• Characterized by
delusions, especially
grandeur and
persecution. Auditory
and other
hallucinations support
the delusions.
A Beautiful Mind
Disorganized Schizophrenia
• disorganized speech or behavior, or flat or
inappropriate emotion.
Disorganized Schizophrenia
• Characterized by bizarre behavior,
delusions, and hallucinations.
• Very disturbed thought and language
(word salad)
Catatonic Schizophrenia
• parrot like repeating of another’s speech
and movements
Catatonic Schizophrenia
• Characterized by variations in voluntary
movement
• Catatonic excitement – rapid movements
with delusions and hallucinations
• Catatonic stupor – little or no activity,
movement, or speech (waxy flexibility)
Undifferentiated Schizophrenia
• Many and varied Symptoms.
Undifferentiated Schizophrenia
• Symptoms that don’t clearly fit into one
of the other types of schizophrenia but
still show clear symptoms of
schizophrenia
Biological Factors - Genetics
• Schizophrenia tends to run in families.
• Genetics appears to produce a
predisposition (increased likelihood) to
develop schizophrenia.
Genain Quadruplets
Genetics and Schizophrenia
Biological Factors – Brain Structure
• Brain structure of those with
schizophrenia is different than the
normal brain
• Those with schizophrenia have smaller
amounts of brain tissue and larger fluid
filled spaces.
• The thalamus is smaller in those with
schizophrenia.
Biological Factors – Brain Function
• The brain of those with schizophrenia
operates differently than the normal
brain.
• The frontal lobes show less activity.
• Those with schizophrenia have a larger
number of receptor sites for the
neurotransmitter dopamine.
Biological Factors – Brain Function
Biological Factors – Prenatal Viruses
• A viral infection during the middle of
pregnancy may increase schizophrenia
risk.
Psychological Factors
• Two main areas:
– Stress
– Disturbed family
– It’s unclear whether these are causes
or consequences of schizophrenia.