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Psychological
Disorders
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by Jim Foley
© 2013 Worth
Publishers
Module 41: Other Disorders
More conditions involving
Client distress and dysfunction
Anxiety Disorders:
 Generalized Anxiety
Disorder
 Panic Disorder
 Phobias
 OCD
 PTSD
 Causes of Anxiety
Disorders
 Dissociative Identity
Disorder
 Antisocial Personality
Disorder
 Eating Disorders
 Genetic, biological,
social, and cultural
influences
Anxiety Disorders: Our self-protective,
risk-reduction instincts in overdrive
 Generalized Anxiety
Disorder: Painful
worrying
 Panic Disorder: Fear of
the next attack
 Phobias: Don’t even
show me a picture
 OCD: I know it doesn’t
make sense, but I can’t
help it
 PTSD: Stuck Reexperiencing Trauma
Causes of Anxiety
Disorders:
 Fear Conditioning
 Observational
Learning
 Genetic/Evolutionary
Predispositions
 Brain involvement
GAD: Generalized
Anxiety Disorder
 Emotional-cognitive
symptoms include worrying,
having anxious feelings and
thoughts about many
subjects, and sometimes
“free-floating” anxiety with
no attachment to any subject.
Anxious anticipation
interferes with concentration.
 Physical symptoms include
autonomic arousal,
trembling, sweating,
fidgeting, agitation, and sleep
disruption.
Panic Disorder:
“I’m Dying”
A panic attack is not just an
“anxiety attack.” It may include:
 many minutes of intense dread
or terror.
 chest pains, choking,
numbness, or other frightening
physical sensations.
 a feeling of a need to escape.
Panic disorder refers to repeated
and unexpected panic attacks, as
well as a fear of the next attack.
Specific Phobia
A specific phobia is more than just
a strong fear or dislike. A specific
phobia is diagnosed when there is
an uncontrollable, irrational,
intense desire to avoid the some
object or situation. Even an image
of the object can trigger a
reaction--“GET IT AWAY FROM
ME!!!”--the uncontrollable,
irrational, intense desire to avoid
the object of the phobia.
Some Fears and Phobias
Which varies
more, fear or
phobias?
What does
this imply?
Some Other Phobias
Agoraphobia is the avoidance
of situations in which one will
fear having a panic attack.
Social phobia: an intense fear of
being watched and judged by others,
often showing as a fear of possibly
embarrassing public appearances.
Obsessive-Compulsive Disorder [OCD]
 Obsessions are intense, unwanted
worries, ideas, and images that
repeatedly pop up in the mind.
 A compulsion is a repeatedly strong
feeling of “needing” to carry out an
action, even though it doesn’t feel like
it makes sense.
 When is it a “disorder”?
 Distress: when you are deeply
frustrated with not being able to
control the behaviors
or
 Dysfunction: when the time and
mental energy spent on these
thoughts and behaviors interfere
with everyday life
Common OCD Behaviors
Percentage of children and adolescents with OCD reporting
these obsessions or compulsions:
Common pattern: RECHECKING
Although you know that you’ve already
made sure the door is locked, you feel
you must check again. And again.
Post-Traumatic Stress
Disorder [PTSD]
About 10 to 35 percent of
people who experience
trauma not only have
burned-in memories, but also
four weeks to a lifetime of:
 repeated intrusive recall of
those memories.
 nightmares and other reexperiencing.
 social withdrawal or phobic
avoidance.
 jumpy anxiety or
hypervigilance.
 insomnia or sleep problems.
Which people develop PTSD?
 Those with sensitive
emotion-processing limbic
systems
 Those who are asked to
relive their trauma as they
report it
 Those previously
traumatized
Understanding Anxiety Disorders:
Explanations from Different Perspectives
Classical
conditioning:
overgeneralizing
a conditioned
response
Genes:
predisposed to
some fears
Operant
conditioning:
rewarding
avoidance
The Brain:
active anxiety
pathways
Cognitive
appraisals:
uncertainty is
danger
Natural
Selection:
surviving by
avoiding danger
Classical Conditioning
and Anxiety
Operant Conditioning
and Anxiety
 In the experiment by
Watson in 1920, Little
Albert learned to feel fear
around a rabbit because he
had been conditioned to
associate the bunny with a
loud scary noise.
 Sometimes, such a
conditioned response
becomes overgeneralized.
We may begin to fear all
animals, everything fluffy,
all experimenters.
 The result is a phobia or
generalized anxiety.
 We may feel anxious in a
situation and make a
decision to leave. This makes
us feel better and our
anxious avoidance was just
reinforced.
 If we know we have locked a
door but feel anxious and
compelled to re-check,
rechecking will help us
temporarily feel better.
 The result is an increase in
anxious thoughts and
behaviors.
Observational
Learning and
Anxiety
 Experiments with humans
and monkeys show that
anxiety can be acquired
through observational
learning. If you see
someone else avoiding or
fearing some object or
creature, you might pick up
that fear and adopt it even
after the original scared
person is not around.
 In this way, fears get passed
down in families.
Cognition and
Anxiety
 Cognition includes worried
thoughts, as well as
interpretations, appraisals,
beliefs, predictions, and
ruminations.
 Cognition includes mental
habits such as hypervigilance
(persistently watching out for
danger). This accompanies
anxiety in PTSD.
 In anxiety disorders, such
cognitions appear repeatedly
and make anxiety worse.
Biology and Anxiety: Genes
 Studies show that
identical twins, even
raised separately,
develop similar phobias
(more similar than two
unrelated people).
 Some people seem to
have an inborn highstrung temperament,
while others are more
easygoing.
 Temperament may be
encoded in our genes.
Genes and
Neurotransmitters
 Genes regulate levels of
neurotransmitters.
 People with anxiety have
problems with a gene
associated with levels of
serotonin, a neurotransmitter
involved in regulating sleep
and mood.
 People with anxiety also have
a gene that triggers high levels
of glutamate, an excitatory
neurotransmitter involved in
the brain’s alarm centers.
Biology and Anxiety: The Brain
 Traumatic
experiences can burn
fear circuits into the
amygdala; these
circuits are later
triggered and
activated.
 Anxiety disorders
include overarousal
of brain areas
involved in impulse
control and habitual
behaviors.
The OCD brain shows extra
activity in the ACC, which
monitors our actions and checks
for errors.
ACC = anterior cingulate gyrus
Biology and Anxiety:
An Evolutionary Perspective
1. Human phobic objects: 2. Similar but non-phobic objects:
Snakes Fish
Heights Low places
Closed spaces Open spaces
Darkness Bright light
3. Dangerous yet non-phobic subjects:
We are likely to become cautious about, but not phobic about:
Guns
Electric wiring
Cars
 Evolutionary psychologists believe that ancestors
prone to fear the items on list #1 were less likely to
die before reproducing.
 There has not been time for the innate fear of list #3
(the gun list) to spread in the population.
Dissociative
Disorders
 Dissociation: a separation of
conscious awareness from
thoughts, memory, bodily
sensations, feelings, or even from
identity.
 Dissociative disorder:
dysfunction and distress caused
by chronic and severe
dissociation.
Examples:
Dissociative
Fugue state
Fugue = “Running away”; wandering away from one’s
life, memory, and identity, with no memory of them
Dissociative
Identity
Disorder
(D.I.D.)
Development of separate personalities
Dissociative Identity Disorder (D.I.D.)
formerly “Multiple Personality Disorder”
In the rare actual cases of
D.I.D., the personalities:
 are distinct, and not
present in consciousness
at the same time.
 may or may not appear to
be aware of each other.
Alternative Explanations
for D.I.D.
 Dissociative “identities”
might just be an extreme
form of playing a role.
 D.I.D. in North America
might be a recent cultural
construction, similar to the
idea of being possessed by
evil spirits.
 Cases of D.I.D. might be
created or worsened by
therapists encouraging
people to think of different
parts of themselves.
D.I.D., or DID Not?
Evidence that D.I.D. is Real
Different personalities have
involved:
 different brain wave
patterns.
 different left-right
handedness.
 different visual acuity and
eye muscle balance
patterns.
Patients with D.I.D. also show
heightened activity in areas of
the brain associated with
managing and inhibiting
traumatic memories.
Explaining fragmentation
of personality from
different perspectives
Psychoanalytic perspective:
diverting id
Cognitive perspective:
coping with abuse
Learning perspective:
dissociation pays
Social influence:
therapists encourage
Eating
Disorders
Anorexia nervosa
Bulimia nervosa
Binge-eating disorder
Anorexia
Nervosa
Bulimia
Nervosa
Binge-Eating
Disorder
These may involve:
 unrealistic body image and
extreme body ideal.
 a desire to control food and the
body when one’s situation can’t
be controlled.
 cycles of depression.
 health problems.
Definition
Prevalence
Compulsion to lose weight,
0.6 percent
coupled with certainty about
meet criteria at
being fat despite being 15 percent
some time
or more underweight
during lifetime
Compulsion to binge, eating large
amounts fast, then purge by losing
1.0 percent
the food through vomiting,
laxatives, and extreme exercise
Compulsion to binge, followed by
2.8 percent
guilt and depression
Eating Disorders: Associated Factors
Family factors:
 having a mother focused on her
weight, and on child’s appearance
and weight
 negative self-evaluation in the family
 for bulimia, if childhood obesity runs
in the family
 for anorexia, if families are
competitive, high-achieving, and
protective
Cultural factors:
 unrealistic ideals of body appearance
Personality
Disorders
Personality disorders
are enduring patterns of
social and other
behavior that impair
social functioning.
There are three “clusters”/categories of personality
disorders.
 Anxious: e.g., Avoidant P.D., ruled by fear of social
rejection
 Eccentric/Odd: e.g. Schizoid P.D., with flat affect,
no social attachments
 Dramatic: e.g. Histrionic, attention-seeking;
narcissistic, self-centered; antisocial, amoral
Antisocial Personality Disorder [APD]
Antisocial personality
disorder: Persistently
acting without
conscience, without a
sense of guilt for harm
done to others
(strangers and family
alike).
The diagnostic criteria
include a pattern of
violating the rights of
others since age 15,
including three of these:
Deceitfulness
Disregard for safety of self or
others
Aggressiveness
Failure to conform to social
norms
Lack of remorse
Impulsivity and failure to plan
ahead
Irritability
Irresponsibility regarding jobs,
family, and money
Which Kids May Develop APD as Adults?
About half of children with
persistent antisocial
behavior develop lifelong
APD.
Which kids are at risk?
Psychological factors:
 those who in preschool
were impulsive,
uninhibited,
unconcerned with social
rewards, and low in
anxiety.
 those who endured
child abuse, and/or
inconsistent, unavailable
caretaking.





Biological APD Risk Factors
Antisocial or unemotional
biological relatives increases risk.
 Some associated genes have
been identified.
Lower levels of stress hormones
and low physiological arousal in
stressful situations
Fear conditioning is impaired.
Reduced prefrontal cortex tissue
leads to impulsivity.
Substance dependence is more
likely.
Antisocial PD ≠ Criminality
Criminals: people
who repeatedly
commit crimes
People with
antisocial
personality
disorder
Many career criminals do show empathy and
selflessness with family and friends.
Many people with A.P.D. do not commit crimes.
Antisocial Crime: Associated factors
Though antisocial
personality disorder is
not a full picture of most
criminal activity, what
can we say about people
who commit crime,
especially violent crime?
Lower levels of
physiological arousal
(measured here as
adrenaline levels) under
stress may enable taking
violent action without
feeling anxiety or panic.
Biosocial Roots of Crime: The Brain
People who
commit murder
seem to have
less tissue and
activity in the
part of the
brain that
suppresses
impulses.
Other differences include:
 less amygdala response when viewing violence.
 an overactive dopamine reward-seeking system.