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CHAPTER 12 PSYCHOLOGICAL DISORDERS ▲ TABLE OF CONTENTS To access the resource listed, click on the hot linked title or press CTRL + click To return to the Table of Contents, click on click on ▲ Return to Chapter 12 Table of Contents To return to a section of the Lecture Guide, click on ► Return to Lecture Guide ► LECTURE GUIDE Perspectives on Psychological Disorders (p. 2) Mood Disorders (p.4) Anxiety Disorders (p. 6) Psychosomatic and Somatoform Disorders (p.8) Dissociative Disorders (p. 8) Sexual and Gender-Identity Disorders (p. 9) Personality Disorders (p.10) Schizophrenic Disorders (p.11) Childhood Disorders (p.12) Gender and Cultural Differences in Psychological Disorders (p. 13) Chapter Review (p. 13) ▼ FULL CHAPTER RESOURCES Learning Objectives (p. 14) Rapid Review (p. 16) Lecture Launchers and Discussion Topics (p. 20) Activities and Exercises (p. 40) Handouts (p.51) APS Current Directions Reader (p.72) Forty Studies that Changed Psychology (p.73) Web Resources (p.74) Video Resources (p.78) Multimedia Resources (p.84) Transparencies (p.86) Copyright © 2010 Pearson Education, Inc. All rights reserved. 2 CHAPTER 12 PSYCHOLOGICAL DISORDERS ►LECTURE GUIDE PERSPECTIVES ON PSYCHOLOGICAL DISORDERS (TEXT PAGE 430) Compare the three perspectives on what constitutes abnormal behavior. Explain what is meant by the statement "Identifying behavior as abnormal is also a matter of degree." Distinguish between the prevalence and incidence of psychological disorders, and between mental illness and insanity (text pp. 391-392, 395-396). • Three perspectives on abnormal behavior: o Society – considers abnormal behaviors to be those actions which deviate from the social o o • • • • norms which cultural and social institutions enforce. Individual – abnormal behaviors are those actions which create feelings of unhappiness or anxiety in oneself. Mental Health Professional – personality traits and/or behaviors which negatively impact functioning and coping with everyday life are considered “abnormal.” “Abnormal is a matter of degree” – it is more accurate to think of mental illness as being quantitatively different from normal behavior. If the “abnormal” behavior happened less often or was more subtle, it might not be considered “abnormal.” Prevalence refers to the frequency with which a given disorder occurs at a given time (see Figure 12-2 on page 396 of the text for the prevalence of selected mental disorders in the U.S.). Incidence refers to the number of new cases that arise in a given period. Insanity – a legal term, not a psychological one, applied to defendants who do not know right from wrong or are unable to control their behavior. o Competence – in addition to the issue of insanity is the question of whether the accused is capable of understanding the charges against him/her and if the accused can participate in his/her defense in court. These are issues of competence that must be addressed by a court-appointed expert before a decision can be made about holding a trial. Describe the key features of the biological, psychoanalytic, cognitive-behavioral, diathesisstress, and systems models of psychological disorders (text pp. 393-395). The Biological Model • Biological Model – view that psychological disorders have a biochemical or physiological basis. • Researchers assume the origin of these malfunctions is often hereditary. • Advances in neuroscience and neuropharmacology have led to the development of new psychoactive drugs have been developed to treat mental disorders. • To date, no neuroimaging technique has definitively differentiated among the various mental disorders, and medications alleviate the symptoms of some mental disorders, but most of the available drugs can not cure mental disorders. The Psychoanalytic Model • Psychoanalytic Model – view that psychological disorders result from unconscious internal conflicts. • According to this model, many of the problems that adults encounter are the product of childhood traumas or unresolved conflicts. • Little scientific evidence supports the psychoanalytic model’s explanations for mental disorders or its treatment methods. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 3 Cognitive-Behavioral Model • Cognitive-Behavioral Model – view that psychological disorders result from learning maladaptive ways of thinking and behaving. • Treatment focuses on maladaptive thought patterns and the problems and hindrances they cause. • This approach has been helpful with treating some kinds of psychological disorders, but it is criticized for its limited perspective and emphasis on environmental causes for mental disorders. Diathesis-Stress Model and Systems Theory • Diathesis-Stress Model – view that people biologically predisposed to a mental disorder (those with a certain diathesis) will tend to exhibit the disorder when particularly affected by stress. • Diathesis – biological predisposition. • Systems Approach – also known as the biopsychosocial model, this view holds that biological, psychological, and social risk factors combine to produce psychological disorders. • In effect, emotional problems are “lifestyle diseases” that result from a combination of risk factors and stresses. Explain what is meant by "DSM-IV-TR" and describe the basis on which it categorizes disorders (text p. 397). Classifying Abnormal Behavior • DSM-IV-TR – in 2000 the American Psychiatric Association issued its fourth edition—text revision of the “Diagnostic and Statistical Manual of Mental Disorders” that contains an extensive list of symptoms and behaviors which, taken together, classify all psychological disorders. • Table 12-2 on page 397 of the text presents an overview of the many diagnostic categories of the DSM-IV-TR. Lecture Launchers/Discussions Topics: Mental Illness as Myth Art and Mental Illness Parameters of Mental Illness Cross-Cultural Comparisons of Mental Illness Impulse Control Disorders Ch-Ch-Ch-Changes Classroom Activities, Demonstrations, and Exercises: Abnormal Behavior in the College Student Misconceptions about Mental Illness Defining Abnormal Behavior What Is Abnormal? Gender Stereotypes and Labeling Mental Illness Trick or Treat—Using Costumes to Portray a Psychological Disorder The Client Diagnosing Mental Disorders Forty Studies that Changed Psychology: Who’s Crazy Here, Anyway? You’re Getting Defensive Again! Copyright © 2010 Pearson Education, Inc. All rights reserved. 4 CHAPTER 12 PSYCHOLOGICAL DISORDERS Web Resources: Supersites Multimedia Resources: Watch: Going Crazy Explore More: about psychological disorders Hear More: Psychology in the News podcast Explore: The Axes of the DSM Simulation: Overview of Clinical Assessment Methods Listen: Roger’s View of Adjustment ▲ Return to Chapter 12 Table of Contents MOOD DISORDERS (TEXT PAGE 398) Explain how mood disorders differ from ordinary mood changes. List the key symptoms that are used to diagnose major depression, dysthymia, mania, and bipolar disorder. Describe the causes of mood disorders (text pp. 398-399, 401-402). • • Mood disorders – disturbances in mood or prolonged emotional state. Most people have a wide range of emotions that they experience. In those people with mood disorders, the range of emotion is greatly restricted. Some mood disorders result in consistently excited or consistently sad moods, regardless of life circumstances; other mood disorders consist of alternating extremes of euphoria and sadness. Depression • Depression – a mood disorder characterized by overwhelming feelings of sadness, lack of interest in activities, and perhaps excessive guilt or feelings of worthlessness. o Depression is the most common mood disorder, and it is 2-3 times more prevalent in women than in men. • Clinical depression differs from the “normal” depressed moods that people feel from time to time in that it is long-lasting and more intense than the typical reaction to stressful life events. o Major depressive disorder – a depressive disorder characterized by an episode of intense sadness, depressed mood, or marked loss of interest or pleasure in nearly all activities; these episodes may last for months. o Dysthymia – a depressive disorder where the symptoms are generally less severe than for major depressive disorder, but are present most days and persist for at least 2 years. o The “Applying Psychology – Recognizing Depression” feature on page 399 of the text presents an excellent synopsis of how clinicians distinguish between sadness and major depression. Mania and Bipolar Disorder • Mania – a mood disorder characterized by euphoric states, extreme physical activity, excessive talkativeness, distractedness, and sometimes grandiosity. • Bipolar disorder – a mood disorder in which periods of mania and depression alternate, sometimes with periods of normal mood intervening. o Bipolar disorder can also occur in a mild form, and unlike depression, its prevalence is the same for women and men. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 5 Causes of Mood Disorders Biological Factors • Studies with identical twins suggest a genetic link to depression. • A specific variation on the 22nd chromosome appears to be linked to the susceptibility to bipolar disorder. • Recent research indicates that a diathesis leaves some people vulnerable to a certain stress hormone. Adverse or traumatic experiences early in life can result in high levels of those stress hormones, which increases the likelihood of a mood disorder later in life. Psychological Factors • Cognitive distortions – an illogical and maladaptive response to early negative life events that leads to feelings of incompetence and unworthiness that are reactivated whenever a new situation arises that resembles the original events. The resulting negative self-concept, with its accompanying feelings of worthlessness, leads to depression. Social Factors • Difficulties in social relationships, when accompanied by a genetic predisposition toward depression or by cognitive distortions, can result in a mood disorder. Describe the factors that are related to a person’s likelihood of committing suicide. Contrast the three myths about suicide with the actual facts about suicide (text pp. 400-401). Suicide • Suicide is the 11th leading cause of death in the United States (although suicide rates in the U.S. are below the international averages). • More women than men attempt suicide, but more men complete suicide, in part, because men use more lethal means. • Suicide rates are highest for older White males, but suicide rates are increasing for adolescents and young adults. • Three widely-believed myths about suicide are raised and refuted on page 400 of the text. • A common feeling associated with suicide is hopelessness, which is also typical of depression. Lecture Launchers/Discussions Topics: Identifying Individuals Who May Be Suicidal Classroom Activities, Demonstrations, and Exercises: Dare to Be Perfect—A Road to Self-Defeat APS Reader: Depression: The Brain Finally Gets Into the Act Forty Studies that Changed Psychology: Learning to be Depressed Web Resources: Mood Disorders Suicide Video Resources: Depression and Manic Depression Everett – Major Depression Feliziano: Bipolar Disorder Copyright © 2010 Pearson Education, Inc. All rights reserved. 6 CHAPTER 12 PSYCHOLOGICAL DISORDERS Multimedia Resources: Watch: Helen: Major Depression Watch More: with a video on bipolar disorder Explore: Bipolar Disorder Listen: Bipolar Disorder Watch: Depression Among the Amish Watch: Nathan: Bipolar Disorder Watch: Bipolar Disorder ▲ Return to Chapter 12 Table of Contents ANXIETY DISORDERS (TEXT PAGE 403) Explain how anxiety disorders differ from ordinary anxiety. Briefly describe the key features of phobias, panic disorders, generalized anxiety disorder, and obsessive–compulsive disorder (text pp. 403-405). • • When we experience ordinary anxiety, our fear is caused by something appropriate and identifiable, and it passes with time.’ Anxiety disorders – disorders in which anxiety is a characteristic feature or the avoidance of anxiety seems to motivate abnormal behavior. In the case of anxiety disorders, either the person does not know what is causing the anxiety, or the anxiety is inappropriate for the situation. Specific Phobias • Specific phobias -- anxiety disorder characterized by an intense, paralyzing fear of something. • Almost 10% of the people in the United States suffer from at least one specific phobia. • Social phobias – anxiety disorders characterized by excessive, inappropriate fears connected with social situations or performances in front of other people. • Agoraphobia – an anxiety disorder that involves multiple, intense fears of crowds, public places, and other situations that require separation from a source of security such as the home. Panic Disorder • Panic disorder – an anxiety disorder characterized by recurring episodes of a sudden, unpredictable, and overwhelming fear or terror. • Panic attacks not only cause tremendous fear while they are happening, but those with panic attacks live in fear of having another attack, and this fear can persist for days or weeks after an attack. Other Anxiety Disorders • Generalized anxiety disorder – an anxiety disorder characterized by prolonged vague but intense fears that are not attached to any particular object or circumstance. o The term neurotic might be descriptive of the way in which generalized anxiety disorder is manifested. o Those with generalized anxiety disorder are unable to relax, experience muscle tension, rapid heartbeat, apprehensiveness about the future, constant alertness to potential threats, and sleeping difficulties. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 • • PSYCHOLOGICAL DISORDERS 7 Obsessive-compulsive disorder (OCD) – an anxiety disorder in which a person feels driven to think disturbing thoughts or to perform senseless actions. o Obsessions – involuntary thoughts or ideas that keep recurring despite attempts to stop them. o Compulsions – repetitive, ritualistic behaviors that a person feels compelled to perform. Anxiety disorders that are clearly caused by a specific, highly stressful event, can manifest themselves in two different ways: o Acute stress disorder – an anxious reaction that occurs soon after a stressful event. o Posttraumatic stress disorder – an anxious reaction that occurs long after the event is over. Describe the causes of anxiety disorders (text p. 405). Causes of Anxiety Disorders • Psychologists with a biological perspective propose that a predisposition to anxiety disorders may be inherited because these types of disorders tend to run in families. • Cognitive psychologists suggest that people who believe that they have no control over stressful events in their lives are more likely to suffer from anxiety disorders than other people are. • Evolutionary psychologists hold that we are predisposed by evolution to associate certain stimuli with intense fears, serving as the origin of many phobias. • Psychoanalytic thinkers focus on inner psychological conflicts and the defense mechanisms they trigger as the sources of anxiety disorders. Lecture Launchers/Discussions Topics: Here We Go Again! Classroom Activities, Demonstrations, and Exercises: The Obsessive-Compulsive Test Forty Studies that Changed Psychology: Crowding into the Behavioral Sink APS Reader: Resilience in the Face of Potential Trauma Web Resources: Anxiety Disorders Video Resources: Panic Disorder The Compulsive Mind: Tourette’s Syndrome Hair Pulling Sara – Post Traumatic Stress Disorder Multimedia Resources: Watch: Anxiety Disorders Learn More: about phobias Watch: Donald: Panic Disorder Watch: Phobias Watch: John: Obsessive-Compulsive Disorder Watch: Larry: Panic Disorder Watch: Panic Disorder Watch: Clinical Anxiety Watch: Margo: Obsessive-Compulsive Disorder ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 8 CHAPTER 12 PSYCHOLOGICAL DISORDERS PSYCHOSOMATIC AND SOMATOFORM DISORDERS (TEXT PAGE 406) Distinguish between psychosomatic and somatoform disorders, somatization disorder, conversion disorders, hypochondriasis, and body dysmorphic disorder. Explain what is meant by the statement that "all physical ailments are to some extent psychosomatic" (text pp. 406-408). • • • Psychosomatic disorders – illnesses that have a valid physical basis, but are largely caused by psychological factors such as excessive stress and anxiety. o Since there is a clear connection between stress (and anxiety and emotional arousal) and the functioning of the body’s organs and immune system, modern medicine endorses the idea that all physical ailments are to some extent psychosomatic. Somatoform disorders – disorders that are characterized by physical symptoms without any identifiable physical cause. o Somatization disorder – a somatoform disorder that is characterized by recurrent vague somatic complaints without a physical cause. o Conversion disorder – a somatoform disorder that consists of a dramatic specific disability without organic cause. o Hypochondriasis – a somatoform disorder in which one interprets minor symptoms as signs of a serious illness in the absence of any organic evidence of such illness. o Body dysmorphic disorder – a somatoform disorder involving imagined ugliness in some part of the body. The causes of somatoform disorders are difficult to pinpoint. Freud linked them to past traumatic experiences that produced long-term effects on unconscious processes; cognitivebehavioral theorists try to identify ways in which the somatoform characteristics are being rewarded; biological theorists have found that some somatoform disorders actually were real physical illnesses that were overlooked or misdiagnosed. Interestingly, conversion disorders are just as perplexing to current medical science as they were when Freud was observing them. Lecture Launchers/Discussion Topics: Uncommon Psychiatric Syndromes ▲ Return to Chapter 12 Table of Contents DISSOCIATIVE DISORDERS (TEXT PAGE 408) Explain what is meant by dissociation. Briefly describe the key features of dissociative amnesia, dissociative fugue, dissociative identity disorder, and depersonalization disorder (text p. 408). • • • • Dissociative disorders – disorders in which some aspect of the personality seems separated from the rest. Dissociation usually involves memory loss and a complete (although temporary) change in identity. Dissociative amnesia – a disorder characterized by loss of memory for past events without organic cause. Total amnesia, in which a person forgets everything, is very rare. Dissociative fugue – a disorder that involves flight from home and the assumption of a new identity with amnesia for past identity and events. Dissociative identity disorder – commonly known as multiple personality disorder – a disorder characterized by the separation of the personality into two or more distinct personalities. o Sometimes the personalities are aware of one another, sometimes not. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 9 The personalities usually contrast sharply with one another, representing different aspects of the person. Depersonalization disorder – a dissociative disorder whose essential feature is that the person suddenly feels changed or different in a strange way. o Feelings of depersonalization are not uncommon during adolescence and young adulthood, but long-term depersonalization is uncommon. o • Multimedia Resources: • Simulation: Multiple Selves ▲ Return to Chapter 12 Table of Contents SEXUAL AND GENDER-IDENTITY DISORDERS (TEXT PAGE 409) Identify the three main types of sexual disorders that are recognized in the DSM-IV-TR (text pp. 409-412). • • • Sexual dysfunction – the loss or impairment of the ability to function effectively during sex. o Erectile disorder or erectile dysfunction (ED) – the inability of a man to achieve or keep an erection. o Female sexual arousal disorder – the inability of a woman to become sexually excited or to reach orgasm. o Sexual desire disorders – involve a lack of interest in or an active aversion to sex. o Orgasmic disorders – occurs when people experience both desire and arousal but are unable to reach orgasm. o Premature ejaculation – the male’s inability to inhibit orgasm as long as desired. o Vaginismus – involuntary muscle spasms in the outer part of a woman’s vagina during sexual excitement that make intercourse impossible. Paraphilias – involve the use of unconventional sex objects or situations. These disorders include: o Fetishism – a paraphilia in which a nonhuman object is the preferred or exclusive method of achieving sexual excitement. o Voyeurism – desire to watch others having sexual relations or to spy on nude people. o Exhibitionism – compulsion to expose one’s genitals in public to achieve sexual arousal. o Frotteurism – compulsion to achieve sexual arousal by touching or rubbing against a nonconsenting person in public situations. o Transvestic fetishism – wearing the clothes of the opposite sex to achieve sexual gratification. o Sexual sadism – obtaining sexual gratification from humiliating or physically harming a sex partner. o Sexual masochism – inability to enjoy sex without accompanying emotional or physical pain. o Pedophilia – desire to have sexual relations with children as the preferred or exclusive method of achieving sexual excitement. Gender-identity disorders – involve the desire to become, or the insistence that one really is, a member of the other sex. o Gender-identity disorder in children – characterized by rejection of one’s biological gender as well as the clothing and behavior society considers appropriate to that gender during childhood. Copyright © 2010 Pearson Education, Inc. All rights reserved. 10 CHAPTER 12 PSYCHOLOGICAL DISORDERS Lecture Launchers and Discussion Topics • Paraphilias • Pedophiles (Not in My Backyard) Classroom Activities, Demonstrations, and Exercises • Defining Normal Sexual Behavior ▲ Return to Chapter 12 Table of Contents PERSONALITY DISORDERS (TEXT PAGE 412) Identify the distinguishing characteristic of personality disorders. Briefly describe schizoid, paranoid, dependent, avoidant, narcissistic, borderline, and anti-social personality disorders (text pp. 412-414). • • Personality disorders – enduring, inflexible, and maladaptive ways of thinking and behaving learned early in life that cause distress to the person or conflicts with others. o Schizoid personality disorder – characterized by a lack of ability or desire to form social relationships and an absence of warm feelings for other people. o Paranoid personality disorder – individuals with this disorder are inappropriately suspicious, hypersensitive, and argumentative. o Dependent personality disorder – a disorder in which the person is unable to make choices and decisions independently and cannot tolerate being alone. o Avoidant personality disorder – personality disorder in which the person’s fears of rejection by others lead to social isolation. o Narcissistic personality disorder – personality disorder in which the person has an exaggerated sense of self-importance and needs constant admiration. o Borderline personality disorder – characterized by marked instability in self-image, mood, and interpersonal relationships. o Antisocial personality disorder – involves a pattern of violent, criminal, or unethical and exploitative behavior and an inability to feel affection for others. Causes of Personality Disorders: o Psychoanalysts blame an inadequate resolution to the Oedipal complex for personality disorders, stating that this results in a poorly developed superego. o Cognitive-learning theorists see personality disorders as a set of learned behavior that has become maladaptive—bad habits learned early on in life. Belief systems of the personality disordered person are seen as illogical. o Biological relatives of people with personality disorders are more likely to develop similar disorders, supporting a genetic basis for such disorders. o Biological explanations look at the lower-than-normal stress hormones in antisocial personality disordered persons as responsible for their low responsiveness to threatening stimuli. o Other possible causes of personality disorders may include disturbances in family communications and relationships, childhood abuse, neglect, overly strict parenting, overprotective parenting, and parental rejection. Web Resources: Personality Disorders Multimedia Resources: Watch: Janna: Borderline Personality Disorder ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 11 SCHIZOPHRENIC DISORDERS (TEXT PAGE 415) Describe the common feature in all cases of schizophrenia. Explain the difference between hallucinations and delusions. Briefly describe the key features of disorganized, catatonic, paranoid, and undifferentiated schizophrenia (text p. 415). • Schizophrenic disorders – involve dramatic disruptions in thought and communication, inappropriate emotions, and bizarre behavior that lasts for years. o People with schizophrenia are out of touch with reality (which is to say, psychotic). o People with schizophrenia often suffer from hallucinations – false sensory perceptions that usually take the form of hearing voices that are not there. o People with schizophrenia often have delusions – false beliefs about reality that have no basis in fact. These delusions are often paranoid, leading to the belief that someone is out to harm them. o People with this disorder usually cannot live a normal life unless successfully treated with medication. Types of Schizophrenic Disorders • • • • Disorganized schizophrenia – behavior is bizarre and childish and thinking, speech, and motor actions are very disordered. Catatonic schizophrenia – the person experiences periods of statue-like immobility mixed with occasional bursts of energetic, frantic movement and talking. Paranoid schizophrenia – the person suffers from delusions of persecution, grandeur, and jealousy, combined with extreme suspiciousness. Undifferentiated schizophrenia – the person shows no particular pattern of symptoms, may shift from one pattern to another, and do not clearly meet the criteria for disorganized, paranoid, or catatonic schizophrenia. Describe the causes of schizophrenic disorders (text pp. 415-417). Causes of Schizophrenia • Biological explanations focus on dopamine and glutamate, structural defects in the brain, early prenatal infection or disturbance, and genetic influences in schizophrenia. Rates of risk of developing schizophrenia increase drastically as genetic relatedness increases, with the highest risk faced by an identical twin whose twin sibling has schizophrenia. • Behaviorists focus on how reinforcement, observational learning, and shaping affect the development of the behavioral symptoms of schizophrenia. • According to systems theory, genetic factors predispose some people to schizophrenia, and family interaction and life stress activate the predisposition. Lecture Launchers/Discussions Topics: Thought Disorders and Delusions Schizophrenia and Cigarettes Age of Onset and Schizophrenia Digging for the Roots of Schizophrenia Catching Madness In the Act Viral Infection and Schizophrenia Classroom Activities, Demonstrations, and Exercises: Abnormal Psychology in Literature: The Eden Express Demonstrating Schizophrenia Copyright © 2010 Pearson Education, Inc. All rights reserved. 12 CHAPTER 12 PSYCHOLOGICAL DISORDERS Web Resources: Schizophrenia Video Resources: Origins of Schizophrenia A Troubled Mind Genetic Schizophrenia Multimedia Resources: Listen: Schizophrenic Disorder Learn More: about undifferentiated and residual categories of schizophrenia Explore More: with a simulation on schizophrenia Watch: Rodney: Schizophrenia Explore: Types and Symptoms of Schizophrenia Watch: Genetic Schizophrenia Simulation: Schizophrenia Simulation ▲ Return to Chapter 12 Table of Contents CHILDHOOD DISORDERS (TEXT PAGE 417) Describe the key features of attention-deficit hyperactivity disorder and autistic spectrum disorder including the difference between autism and Asperger syndrome (text pp. 417-418). • • • • Attention-deficit hyperactivity disorder (ADHD) – children with ADHD are highly distractible, often fidgety and impulsive, and almost constantly in motion. Psychostimulants are frequently prescribed for ADHD; they appear to slow such children down because they increase the ability to focus attention on routine tasks. Autistic disorder – a profound developmental problem identified in the first few years of life; it is characterized by a failure to form normal social attachments, by severe speech impairment or a peculiar speech pattern (echolalia), and by strange motor behaviors. Autistic spectrum disorder (ASD) is a much broader range of developmental disorders used to describe individuals with symptoms that are similar to those seen in autistic disorder, but may be less severe as is the case in Asperger syndrome. o Children with Asperger syndrome are high functioning, showing little or no problem with speech or intellectual development, but exhibiting great difficulty interacting with other people. APS Reader: Three Reasons Not to Believe in an Autism Epidemic Video Resources: David: Asperger’s Syndrome Jimmy: Attention Deficit/Hyperactivity Disorder (ADHD) Multimedia Resources: Watch: Attention-Deficit Hyperactivity Disorder Watch: Alternative Approaches to Treating ADHD ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 13 GENDER AND CULTURAL DIFFERENCES IN PSYCHOLOGICAL DISORDERS (TEXT PAGE 419) Describe the differences between men and women in psychological disorders including the prevalence of disorders and the kinds of disorders they are likely to experience. Explain why these differences exist. Explain why "it is increasingly important for mental health professionals to be aware of cultural differences" in psychological disorders (text pp. 419420). Gender Differences • Although nearly all psychological disorders affect both men and women, there are some gender differences in the degree to which some disorders are found. o Men are more likely to suffer from substance abuse and antisocial personality disorder; o Women show higher rates of depression, agoraphobia, simple phobia, obsessive– compulsive disorder, and somatization disorder. o In general, gender differences are less likely to be seen in disorders that have a strong biological component. o Married women have higher rates of mental illness than do married men. o Women are more likely than men to seek professional help for their problems. Cultural Differences o Cultural differences are observed in disorders not heavily influenced by genetic and biological factors. o Many disorders are culture-specific: ataque de nervios (“attack of nerves”) is seen predominantly among Latinos; tajin kyofusho (“fear of people” being offended by one’s body or actions) is seen in Japan. o Prevalence of childhood disorders varies by culture, as does the type of disorder (internalizing versus externalizing). o Gender and cultural differences support the systems view that biological, psychological, and social forces interact as causes of abnormal behavior. ▲ Return to Chapter 12 Table of Contents CHAPTER REVIEW (TEXT PAGE 421) Classroom Activities, Demonstrations, and Exercises: Reviewing Perspectives Abnormal Psychology in Film Crossword Puzzle Fill in the Blank Multimedia Resources: Audio file of the chapter Test Yourself—practice quizzes ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 14 CHAPTER 12 PSYCHOLOGICAL DISORDERS ▼CHAPTER 12 Learning Objectives After reading this chapter, students should be able to respond to each of the bulleted objectives below: Perspectives on Psychological Disorders • Compare the three perspectives on what constitutes abnormal behavior. Explain what is meant by the statement "Identifying behavior as abnormal is also a matter of degree." Distinguish between the prevalence and incidence of psychological disorders, and between mental illness and insanity. • Describe the key features of the biological, psychoanalytic, cognitive-behavioral, diathesis-stress, and systems models of psychological disorders. • Explain what is meant by "DSM-IV-TR" and describe the basis on which it categorizes disorders. Mood Disorders • Explain how mood disorders differ from ordinary mood changes. List the key symptoms that are used to diagnose major depression, dysthymia, mania, and bipolar disorder. Describe the causes of mood disorders. • Describe the factors that are related to a person’s likelihood of committing suicide. Contrast the three myths about suicide with the actual facts about suicide. Anxiety Disorders • Explain how anxiety disorders differ from ordinary anxiety. Briefly describe the key features of phobias, panic disorders, generalized anxiety disorder, and obsessive–compulsive disorder. • Describe the causes of anxiety disorders. Psychosomatic and Somatoform Disorders • Distinguish between psychosomatic and somatoform disorders, somatization disorder, conversion disorders, hypochondriasis, and body dysmorphic disorder. Explain what is meant by the statement that "all physical ailments are to some extent psychosomatic." Dissociative Disorders • Explain what is meant by dissociation. Briefly describe the key features of dissociative amnesia, dissociative fugue, dissociative identity disorder, and depersonalization disorder. Sexual and Gender-Identity Disorders • Identify the three main types of sexual disorders that are recognized in the DSM-IV-TR. Personality Disorders • Identify the distinguishing characteristic of personality disorders. Briefly describe schizoid, paranoid, dependent, avoidant, narcissistic, borderline, and anti-social personality disorders. Schizophrenic Disorders • Describe the common feature in all cases of schizophrenia. Explain the difference between hallucinations and delusions. Briefly describe the key features of disorganized, catatonic, paranoid, and undifferentiated schizophrenia. • Describe the causes of schizophrenic disorders. Childhood Disorders • Describe the key features of attention-deficit hyperactivity disorder and autistic spectrum disorder including the difference between autism and Asperger syndrome. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 15 Gender and Cultural Differences in Psychological Disorders • Describe the differences between men and women in psychological disorders including the prevalence of disorders and the kinds of disorders they are likely to experience. Explain why these differences exist. Explain why "it is increasingly important for mental health professionals to be aware of cultural differences" in psychological disorders. ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 16 CHAPTER 12 PSYCHOLOGICAL DISORDERS ▼CHAPTER 12 Rapid Review (From the Study Guide accompanying Morris/Maisto, Understanding Psychology, 9th edition, ISBN 0205790119) Vignettes featuring the unique cases of Jack, Claudia, and Jonathan open this chapter on psychological disorders. Mental health professionals define a psychological disorder as a condition that either seriously impairs a person’s ability to function in life or creates a high level of inner distress, or both. This view does not mean that the category “disordered” is always easy to distinguish from the category “normal.” In fact, it may be more accurate to view abnormal behavior as merely quantitatively different from normal behavior. In early societies, abnormal behavior was often attributed to supernatural powers. As late as the 18th century, the mentally ill were thought to be witches or possessed by the devil. In modern times, three approaches have helped to advance our understanding of abnormal behavior: the biological, the psychoanalytic, and the cognitive behavioral. The biological model holds that abnormal behavior is caused by physiological malfunction, especially of the brain. Researchers assume the origin of these malfunctions is often hereditary. Although neuroscientists have demonstrated that genetic/biochemical factors are involved in some psychological disorders, biology alone cannot account for most mental illnesses. The psychoanalytic model originating with Freud holds that abnormal behavior is a symbolic expression of unconscious conflicts that generally can be traced to childhood. The cognitive–behavior model states that psychological disorders arise when people learn maladaptive ways of thinking and acting. What has been learned can be unlearned, however. Cognitive–behavioral therapists strive to modify their patients’ dysfunctional behaviors and distorted, self-defeating thought processes. According to the diathesis–stress model, which integrates the biological and environmental perspectives, psychological disorders develop when a biological predisposition (known as a diathesis) is triggered by stressful circumstances. Another attempt at integrating causes is the systems (biopsychosocial) approach, which contends psychological disorders are “lifestyle diseases” arising from a combination of biological risk factors, psychological stresses, and societal pressures. According to research, 15% of the population is suffering from one or more mental disorders at any given point in time. The term insanity should be understood as a legal, not a psychological, one. It is typically applied to defendants who were so mentally disturbed when they committed their offense that they either did not know right from wrong or were unable to control their behavior. The current fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) provides careful descriptions of the symptoms of different disorders so that diagnoses based on them will be reliable and consistent among mental health professionals. The DSM-IV-TR includes little information on causes and treatments. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 17 The chapter continues with a discussion of mood disorders, beginning with how they differ from ordinary mood changes. Most people have a wide emotional range, but in some people with mood disorders, this range is greatly restricted. They seem stuck at one or the other end of the emotional spectrum, or they may alternate back and forth between periods of mania and depression. The most common mood disorder is depression, in which a person feels overwhelmed with sadness, loses interest in activities, and displays such other symptoms as excessive guilt, feelings of worthlessness, insomnia, and loss of appetite. Major depressive disorder is an episode of intense sadness that may last for several months; in contrast, dysthymia involves less intense sadness but persists with little relief for a period of 2 years or more. Regarding the question of suicide, more women than men attempt suicide, but more men succeed. Suicide attempt rates among American adolescents and young adults have been rising. A common feeling associated with suicide is hopelessness, which is also typical of depression. People suffering from mania become euphoric (“high”), extremely active, excessively talkative, and easily distracted. They typically have unlimited hopes and schemes, but little interest in realistically carrying them out. At the extreme, they may collapse from exhaustion. Manic episodes usually alternate with depression. Such a mood disorder, in which both mania and depression are alternately present and are sometimes interrupted by periods of normal mood, is known as bipolar disorder. Mood disorders can result from a combination of biological, psychological, and social factors. Genetics and chemical imbalances in the brain seem to play an important role in the development of depression and, especially, bipolar disorder. Cognitive distortions (unrealistically negative views about the self) occur in many depressed people, although it is uncertain whether these cause the depression or are caused by it. Finally, social factors, such as troubled relationships, have also been linked with mood disorders. Next, the chapter looks at anxiety disorders, whose effects extend beyond the experience of normal anxiety. Normal fear is caused by something identifiable and the fear subsides with time. With anxiety disorder, however, either the person doesn’t know the source of the fear or the anxiety is inappropriate to the circumstances. A specific phobia is an intense, paralyzing fear of something that it is unreasonable to fear so excessively. A social phobia is excessive, inappropriate fear connected with social situations or performances in front of other people. Agoraphobia, a less common and much more debilitating type of anxiety disorder, involves multiple, intense fears such as the fear of being alone, of being in public places, or of other situations involving separation from a source of security. Panic disorder is characterized by recurring sudden, unpredictable, and overwhelming experiences of intense fear or terror without any reasonable cause. Generalized anxiety disorder is defined by prolonged vague, but intense fears that, unlike phobias, are not attached to any particular object or circumstance. In contrast, obsessive–compulsive disorder involves either involuntary thoughts that recur despite the person’s attempt to stop them or compulsive rituals that a person feels compelled to perform. Two other types of anxiety disorder are caused by highly stressful events. If the anxious reaction occurs soon after the event, the diagnosis is acute stress disorder; if it occurs long after the event is over, the diagnosis is posttraumatic stress disorder. Psychologists with a biological perspective propose that a predisposition to anxiety disorders may be inherited because these types of disorders tend to run in families. Cognitive psychologists suggest that people who believe that they have no control over stressful events in their lives are more likely to suffer Copyright © 2010 Pearson Education, Inc. All rights reserved. 18 CHAPTER 12 PSYCHOLOGICAL DISORDERS from anxiety disorders than other people are. Evolutionary psychologists hold that we are predisposed by evolution to associate certain stimuli with intense fears, serving as the origin of many phobias. Psychoanalytic thinkers focus on inner psychological conflicts and the defense mechanisms they trigger as the sources of anxiety disorders. The chapter focuses next on psychosomatic and somatoform disorders, followed by a brief look at dissociative disorders. Psychosomatic disorders are illnesses that have a valid physical basis, but are largely caused by psychological factors such as excessive stress and anxiety. In contrast, somatoform disorders are characterized by physical symptoms without any identifiable physical cause. Examples are somatization disorder, characterized by recurrent vague somatic complaints without a physical cause, conversion disorder (a dramatic specific disability without organic cause), hypochondriasis (insistence that minor symptoms mean serious illness), and body dysmorphic disorder (imagined ugliness in some part of the body). In dissociative disorders, some part of a person’s personality or memory is separated from the rest. Dissociative amnesia involves the loss of at least some significant aspects of memory. When an amnesia victim leaves home and assumes an entirely new identity, the disorder is known as dissociative fugue.In dissociative identity disorder (multiple personality disorder), several distinct personalities emerge at different times. In depersonalization disorder, the person suddenly feels changed or different in a strange way. Sexual and gender-identity disorders are explored next in the chapter. The DSM-IV-TR recognizes three main types of sexual disorders: sexual dysfunction, paraphilias, and gender-identity disorders. Sexual dysfunction is the loss or impairment of the ability to function effectively during sex. In men, this may take the form of erectile disorder (ED), the inability to achieve or keep an erection; in women, it often takes the form of female sexual arousal disorder, the inability to become sexually excited or to reach orgasm. Sexual desire disorders involve a lack of interest in or an active aversion to sex. People with orgasmic disorders experience both desire and arousal but are unable to reach orgasm. Other problems that can occur include premature ejaculation—the male’s inability to inhibit orgasm as long as desired—and vaginismus—involuntary muscle spasms in the outer part of a woman’s vagina during sexual excitement that make intercourse impossible. Paraphilias involve the use of unconventional sex objects or situations. These disorders include fetishism, voyeurism, exhibitionism, frotteurism, transvestic fetishism, sexual sadism, and sexual masochism. One of the most serious paraphilias is pedophilia, the engaging in sexual relations with children. Gender-identity disorders involve the desire to become, or the insistence that one really is, a member of the other sex. Gender-identity disorder in children is characterized by rejection of one’s biological gender as well as the clothing and behavior society considers appropriate to that gender during childhood. The chapter continues with sections on personality and schizophrenic disorders. Personality disorders are enduring, inflexible, and maladaptive ways of thinking and behaving that are so exaggerated and rigid that they cause serious inner distress or conflicts with others. One group of personality disorders is characterized by odd or eccentric behavior. People who exhibit schizoid personality disorder lack the ability or desire to form social relationships and have no warm feelings for other people; those with paranoid personality disorder are inappropriately suspicious, hypersensitive, and argumentative. Another cluster of personality disorders is characterized by anxious or fearful behavior. Examples are dependent personality disorder (the inability to think or act independently) and avoidant personality disorder (social anxiety leading to isolation). A third group of personality disorders is characterized by dramatic, emotional, or erratic behavior. For instance, people with narcissistic personality disorder have Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 19 a highly overblown sense of self-importance, whereas those with borderline personality disorder show much instability in self-image, mood, and interpersonal relationships. Finally, people with antisocial personality disorder chronically lie, steal, and cheat with little or no remorse. Because this disorder is responsible for a good deal of crime and violence, it creates the greatest problems for society. In multiple-personality disorder, consciousness is split into two or more distinctive personalities, each of which is coherent and intact. This condition is different from schizophrenic disorders, which involve dramatic disruptions in thought and communication, inappropriate emotions, and bizarre behavior that lasts for years. People with schizophrenia are out of touch with reality (which is to say, psychotic) and usually cannot live a normal life unless successfully treated with medication. They often suffer from hallucinations (false sensory perceptions) and delusions (false beliefs about reality). Subtypes of schizophrenic disorders include disorganized schizophrenia (childish disregard for social conventions), catatonic schizophrenia (mute immobility or excessive excitement), paranoid schizophrenia (extreme suspiciousness related to complex delusions), and undifferentiated schizophrenia (characterized by a diversity of symptoms). The chapter continues with material covering a spectrum of childhood disorders. DSM-IV-TR contains a long list of disorders usually first diagnosed in infancy, childhood, or adolescence. Children with attention-deficit hyperactivity disorder (ADHD) are highly distractible, often fidgety and impulsive, and almost constantly in motion. The psychostimulants frequently prescribed for ADHD appear to slow such children down because they increase the ability to focus attention on routine tasks. Autistic disorder is a profound developmental problem identified in the first few years of life. It is characterized by a failure to form normal social attachments, by severe speech impairment, and by strange motor behaviors. A much broader range of developmental disorders known as autistic spectrum disorder (ASD) is used to describe individuals with symptoms that are similar to those seen in autistic disorder, but may be less severe as is the case in Asperger syndrome. Finally, the chapter concludes with a section on gender and cultural differences in psychological disorders. Although nearly all psychological disorders affect both men and women, there are some gender differences in the degree to which some disorders are found. Men are more likely to suffer from substance abuse and antisocial personality disorder; women show higher rates of depression, agoraphobia, simple phobia, obsessive–compulsive disorder, and somatization disorder. In general, gender differences are less likely to be seen in disorders that have a strong biological component. This tendency is also seen crossculturally, where cultural differences are observed in disorders not heavily influenced by genetic and biological factors. These gender and cultural differences support the systems view that biological, psychological, and social forces interact as causes of abnormal behavior. ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 20 CHAPTER 12 PSYCHOLOGICAL DISORDERS ▼ LECTURE LAUNCHERS AND DISCUSSION TOPICS Mental Illness as Myth Art and Mental Illness Parameters of Mental Illness Cross-Cultural Comparisons of Mental Illness Uncommon Psychiatric Syndromes Impulse Control Disorders Thought Disorders and Delusions Ch-Ch-Ch-Changes Here We Go Again! Paraphilias Pedophiles (Not In My Backyard) Schizophrenia and Cigarettes Age of Onset and Schizophrenia Digging for the Roots of Schizophrenia Catching Madness In the Act Viral Infection and Schizophrenia Identifying Individuals Who May Be Suicidal ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Mental Illness as Myth Two categories of mental illness were applied to many slaves during the early years of the nineteenth century. Drapetomania was seen in the uncontrollable urge to escape from slavery, while the symptoms of dysathesia aethiopica were seen in the destruction of property on the plantation, disobedience, refusals to work, and fighting back when being beaten. While we might experience a flash of anger or a wave of guilt upon learning of such cruel and self-serving uses of psychiatric diagnosis, most psychiatrists assume that such foolishness is a thing of the past. Whatever our particular cultural background, we often share a belief in progress, and often seem quite certain in the faith that science, particularly medical science, is leading us out of such ignorance. After all, as the authors note, for diagnostic categories to be included in the Manual of Mental Disorders (DSM), they must now meet a set of solid scientific criteria. It is against such faith in the progress of medical science that Thomas Szasz (1961/1967) spoke nearly thirty years ago. His book, The Myth of Mental Illness, spelled out a fundamental challenge to the medical mode of conceptualizing and treating psychological distress. Szasz wrote that labeling people as ill harms them, for it assigns them the social role of a “patient” who must wait upon the ministrations of doctors and mental health professionals. The harm here, according to Szasz, is that it distracts people (and not just the “patients”) from taking responsible action in addressing the social causes of their problems. Szasz is not alone in this critique. Social constructionists, feminists, and existential-phenomenological psychologists, as well as family therapists each articulate critiques of the “myth” of mental illness. What is mythic is the way of seeing psychological distress through the lens of the medical model, viewing distress as disease and not recognizing that way of seeing as a particular way of constructing its meaning. Thus, according to this critique, the problem is not simply one of clarifying the empirically verifiable categories of mental disorders. This critique challenges the medicalization of psychological distress and dysfunctions in living. For example, according to this critique, the problem with the diagnoses of drapetomania and dysathesia aethiopica is not simply that these are fallacious, culturally biased, and politically oppressive diagnostic categories. It is more fundamental than that. It is the problem of making sense out of individuals’ Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 21 “abnormal” behavior (violating cultural norms) in terms of a disturbance “within” the individual rather than as a function of the intolerable social conditions in which that individual lives. Laura Brown (1992) captures this line of critique when she writes: Basic questions, such as that of whether what we call “psychopathology” or “mental illness” is in fact that, or some other phenomenon, for example, manifestations of cultural inequities or social injustice, are barely addressed or actively ignored by the mainstream of thinking regarding psychopathology. Sickness or dysfunction are assumed to be within the person; the health of the social norms is rarely questioned. Syndromes that might constitute a normative, if not frankly normal response to abnormal events in the social and interpersonal environment, continue to be construed as forms of psychopathology if their manifestations bring a person into psychotherapy (p. 213). Viewing psychological distress and/or abnormal behaviors as mental illness blinds us to the interpersonal and socio-political circumstances that may in fact be the source of distress or abnormality. For family therapists, it is not the “identified patient” who is in need of their care, but the network of family relationships within which the “patient” lives and out of which their distress emerges that needs care. This issue can be brought home to students by considering the recent media attention given to depression. Due to the successes of the new anti-depressant medications in the alleviation of mood problems, depression is most often described as an illness. Like many other medical problems, according to this line of reasoning, depression can be treated successfully with medication. It is important to point out to students that when medication alone is used in the treatment of depression, repeated episodes are far more likely. Medications do not change behaviors. Nor do they give individuals an opportunity to explore and make the needed changes in the relational and societal contexts in which the depression occurs. Brown, L. (1992). A feminist critique of the personality disorders. In M. Ballou & L. Brown, (eds.). Personality and psychopathology: Feminist reappraisals. New York: Guilford Press. Szasz, T. (1961/1967). The myth of mental illness. New York: Dell Delta. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Art and Mental Illness The link between creativity and madness has piqued the imagination of scholars, artists, and laypeople alike. There has been a spate of research and popular books exploring this presumed fine line. However, another aspect of this link seems to increasingly vie for popular attention. Outsider art, or art produced by people on the fringes of society, has become the “hot ticket” among critics and collectors within recent years. The term “outsider art” has been broadly applied to works produced by transients, the criminally insane, and the mentally ill; art that can be found primarily in thrift stores; art produced in isolation and discovered only upon the artist’s death; art that at one time would have qualified as a “primitive” style (e.g., the work of Grandma Moses); as well as work that typically conveys a singular, often idiosyncratic view of mundane subjects. (This multiplicity of definitions no doubt reflects the premium and price tag currently put on this type of work. Where the “outside” boundary lies is often determined by a buyer and seller.) In this regard, the work of Rev. Howard Finster (who painted the cover of the Talking Heads album Little Creatures) or anything done on velvet (from Elvis to large-eyed weeping children to clowns) would qualify. Better-known examples would include Munch’s The Scream, Louis Wain’s famous Copyright © 2010 Pearson Education, Inc. All rights reserved. 22 CHAPTER 12 PSYCHOLOGICAL DISORDERS paintings of cats (which grew more bizarre as his schizophrenia progressed), or much of the work of Van Gogh. At one time, however, “outsider art” referred exclusively to the works of the mentally ill (inter alios, the criminally insane). Art brut, or art of the insane, actually has enjoyed popularity for a number of decades in underground circles. The paintings of convicted serial killer John Wayne Gacy, for example, were quietly acquired by various collectors before his execution. (After his death a single collector acquired all he could for the express purpose of publicly destroying them.) There have also been exhibitions of such work in several respected galleries, as well as a collection housed at the Musée de l’Art Brut in Lausanne. Without arguing its merits or value, it is nonetheless fascinating to study art brut for what it reveals about the psychological state of the person producing it. In some instances it easily reflects the turmoil experienced by a moderately depressed person or someone suffering from an anxiety disorder. In other cases it is art that is unusual, yet doesn’t seem to map onto a tidy diagnosis. At the Landers Clinic in Gugging, Austria, for example, there is an artists’ wing dedicated exclusively to a handful of patients. These painters and a sole poet have produced artwork that has been shown worldwide and has been acquired by collectors for handsome prices. (All profits are maintained in trust funds for the artists.) In the opinion of the ward’s director, Johann Feilacher, had these patients not become ill they nonetheless would have been talented artists. In this sense art brut becomes the work of artists who happen to be mentally ill, rather than a mentally ill person’s artistic products. The many meanings of art brut discussed in this lecture suggestion can be shared with your students to stimulate discussion. You might address the link between creativity and madness, explore the definition of what constitutes art brut, or discuss the therapeutic and diagnostic value of having patients express themselves in this way. If possible, share with your students some of this work. A convenient source of art produced by the mentally ill is Schizophrenia Bulletin. Each issue of this journal features cover artwork and brief commentary by a schizophrenic patient. Prinzhorn (1995). Artistry of the mentally ill. New York: Springer-Verlag. Staff (1994, November/December). When out is in. Psychology Today, p. 13. Theoz, M. (1976). Art brut. New York: Rizzoli Press. Tuchman, M. (1992). Parallel visions: Modern artists and outsider art (LACMA Exhibition). Princeton University Press. Weiss, A. S. (1992). Shattered forms: Art brut, phantasms, modernism. Albany, NY: SUNY Press. Weinberg, S. (1995, August 6). Portraits of the mental patient as inspired artist. The New York Times Magazine, pp. 42– 43. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Parameters of Mental Illness A research team at the University of Michigan conducted the National Comorbidity Study, the first study to administer a structured psychiatric interview on a national scale. The study revealed that nearly onehalf of all Americans between the ages of 15 and 54 have experienced an episode of psychiatric disorder at some time in their lives. Moreover, 30 percent of them have experienced a disorder within the past year. Altogether, about 5.2 million Americans account for 90 percent of all episodes of severe mental illness each year. Comorbidity, or the clustering of psychiatric illnesses in a single person, presents a challenge to accurate diagnosis and treatment. Because a single individual may present aspects of several disorders, it may be difficult to simultaneously and effectively identify or treat them all. Comorbidity was definitely revealed Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 23 in the survey. Fifty-six percent of people with a history of one psychiatric disturbance also showed a range of other disorders. The survey revealed some surprising findings as well. For example, blacks have a lower incidence of anxiety and substance abuse than whites, even though blacks typically face generally inferior financial and economic conditions. Also, perhaps counterintuitively, it was found that Americans living in rural areas were just as likely as their urban fellows to suffer from either year-long or lifetime psychiatric disorders. The survey also found other demographic trends: • The rates of almost all psychiatric disorders decline with increasing income and education. An exception is lifelong substance abuse, which tends to be significantly higher among the middleeducation group. • People between the ages of 25 and 34 experience the highest overall rates of mental illness. Beyond that range, rates of mental illness tend to decline with age. • Seventeen percent of the population have experienced one or more episodes of major depression at some point in their lives. • Women seem to suffer from anxiety disorders and affective disorders, whereas men show higher rates of substance abuse and antisocial disorders. Lifelong substance abuse disorders and lifelong antisocial personality disorders also tended to be highest in the West, whereas lifelong anxiety disorders were highest in the Northeast. • Although one sixth of the population suffers from one or more lifetime psychiatric disorders, only 40 percent ever receive psychiatric care. Staff (1994, July/August). The culture of distress. Psychology Today, pp. 14–15. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Cross-Cultural Comparisons of Mental Illness At various times we have been said to be living in the “Age of Anxiety,” the “Age of Alienation,” or the “Age of Insanity.” These descriptions are more figural than literal, meant to capture the spirit of a particular time. But their underlying theme contains a particular bias. In most cases, these “Ages of Whatever” are meant to describe the conditions in developed, Westernized societies. A more provocative question is this: How do approaches to and descriptions or rates of Psychological Disorders compare across societies? Researchers are beginning to address this topic more enthusiastically; Thomas Oltmanns and Bob Emery have discussed two studies that provide some interesting comparisons. Jane Murphy, a Harvard anthropologist, lived with the Inuit of Alaska and the Yoruba of tropical Nigeria during the 1970s. She collected reports from native healers among the Yoruba and from a key Inuit informant about the lives of the respective, relatively small cultures. Particular attention was devoted to descriptions of Psychological Disorders. Both cultures recognized behaviors as “crazy,” such as hearing voices when no one is nearby, talking in peculiar ways that don’t make sense to others, or behaving in bizarre or erratic ways. The parallels with the Western notion of schizophrenia are obvious and striking. Copyright © 2010 Pearson Education, Inc. All rights reserved. 24 CHAPTER 12 PSYCHOLOGICAL DISORDERS However, some of these descriptions could also be applied to the behavior of shamans within these cultures. Both the Inuit and the Yoruba distinguish between the “craziness” of the shaman and the behaviors just described. In the case of the shaman, it is a controlled or purposeful “craziness;” the shaman is able to voluntarily control his actions and direct them toward a particular goal (e.g., healing a sick member of the group). A more recent study was initiated by the World Health Organization. Some 1200 hospitalized psychiatric patients in nine countries (Columbia, Czechoslovakia, Denmark, England, India, Nigeria, Taiwan, Russia, and the United States) were studied. In each setting the frequency of schizophrenia was approximately the same, despite obvious cultural differences (i.e., developing nations, such as India or Nigeria, versus developed countries, such as Denmark or the U.S.). Like Murphy’s earlier study, the WHO study found some cross-cultural variation in the description, behaviors, and subtypes used to define schizophrenia. These studies suggest that rather than being a Westernized concept, severe forms of mental illness (such as schizophrenia) have some cross-cultural commonality to them. Jablensky, A., Sartorius, N., Ernberg, G., Anker, M., Korten, A., Cooper, J. E., Day, R., & Bertelsen, A. (1992). Schizophrenia: Manifestations, incidence, and course in different cultures: A World Health Organization ten-country study. Psychological Medicine, Monograph Supplement 20, 1–97. Murphy, J. M. (1976). Psychiatric labeling in cross-cultural perspective. Science. Oltmanns, T. F., & Emery, R. E. (2007). Abnormal psychology (5th ed). Upper Saddle River, NJ: Pearson Education. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Uncommon Psychiatric Syndromes After presenting an overview of the major DSM-IV classes of disorders and the specific disorders that represent them, your students may be interested to hear about more unusual cases of mental disturbances. David Enoch and Sir William Trethowan (1991) published a handbook of psychiatric disorders that are at the outposts of mental disturbance. Although some of them are increasingly discussed in textbooks and the popular press (e.g., Tourette’s syndrome) and others border on anthropological and social analyses (e.g., possession and exorcism), many are worth presenting to illustrate the extremes of psychopathology. Capgras’s Syndrome In 1923 Capgras and Reboul-Lachaux described a syndrome in which a patient believes that a person close to him or her has been replaced by an exact double. The syndrome typically accompanies other functional psychoses (such as schizophrenia or affective disorders), although it tends to be the dominating feature. In such cases the misidentification is quite specific; the patient acknowledges the striking resemblance of a loved one but insists the person is a duplicate. The syndrome is also seen in concert with some organic disorders, where it is characterized by more confusion about the misidentification. To date there has been no reliable link between experiencing Capgras’s syndrome and being a devotee of the science fiction classic Invasion of the Body Snatchers. Capgras’s syndrome is often placed in a family of Delusional Misidentification Syndromes that includes other similar disorders. For example, the illusion of Fregoli (named for a famous stage actor and presented by Courbon and Fail in 1927) finds the patient convinced that his or her persecutors are changing faces, so that the person’s spouse, doctor, coworker, or mail carrier are alternately presented as the same one person. Courbon also described the illusion of intermetamorphosis in which a patient Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 25 believes that those in his or her surroundings are changing from one to another: Bob becomes Mitch, Mitch becomes Roger, and Roger becomes Bob. The subjective doubles syndrome involves a patient’s conviction that others have been transformed into the patient; this was described by Christadoulou in 1978. Finally, reduplicative paramnesia, described by Pick in 1903 and regarded as a neurological syndrome, involves the perception that a physical location has been duplicated. Ekbom’s Syndrome Ekbom’s syndrome, or delusional parasitosis, refers to patients who suffer delusions of infestation. Those afflicted believe quite certainly that lice, maggots, insects, or other small vermin are living on them, in their skin, or in some cases in their bodies. Although reference is made to delusional parasitosis during the late 1800s, Ekbom first thoroughly described the manifestations of the delusion in 1937. By most accounts, the syndrome is very rare: One study estimated that three cases were seen in 1,869 psychiatric admissions over 18-1/2 years. Among those suffering from it, however, it appears to be rather intractable once established. Munchausen Syndrome Munchausen syndrome by proxy has received increasing attention by practitioners and researchers as a form of child endangerment. It involves a caregiver’s persistent fabrication of medical symptoms and signs in the person cared for (typically a mother/child relationship), leading to illness, endangerment, and unnecessary invasive or hazardous treatments. Munchausen syndrome itself refers to such behavior in a single individual. The patient is usually admitted to a hospital presenting some acute illness that has a dramatic but plausible origin. It is subsequently discovered that the history is riddled with falsehoods, and that the patient has similarly deceived the staff of several other hospitals. Patients often discharge themselves against medical advice, often after arguing about a course of treatment or after some medical intervention has been initiated. The key elements in both of these manifestations are the presence of physical symptoms that are selfinduced (or other-induced, in the case of proxy), and pathological lying reminiscent of Baron Munchausen, a renowned teller of tall tales. Some illustrative cases include: • Acute abdominal disturbances: A young nurse swallowed a dinner fork on six separate occasions to necessitate gastrostomy each time; she eventually died as a result of this practice. • Hemorraghic disturbances: Patients have pricked their fingers and contaminated the wounds with urine, or used an animal spleen to simulate a blood clot in the mouth. • Neurological disturbances: Some patients have undergone craniotomy or prefrontal leucotomy as a result of their presentations. • Respiratory disturbances: Some patients have inserted needles into their chests; others have ingested infected sputum from other patients. Other patients repeatedly swallow safety pins or needles; some self-inflict stab wounds or purposely irritate scabs and blisters to prevent healing and promote infection. ► Return to Lecture Guide: Psychosomatic and Somatoform Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 26 CHAPTER 12 PSYCHOLOGICAL DISORDERS Lecture/Discussion: Impulse Control Disorders “Self-control disorders” can encompass a range of pathologies, from eating disorders to criminal acts to aggressive outbursts. A better-defined subset of this classification is impulse control disorders, which are characterized by three essential features: an inability to not act on impulses that are harmful to the actor or to others; a compelling pressure to act experienced just before the behavior takes place; and a sense of pleasure or gratification upon completing the behavior. Several well-known, and a few more obscure, disorders meet these criteria. • Kleptomania. This disorder is characterized by a desire to steal, rather than by a desire to acquire. Kleptomaniacs are less interested in what they steal than in the act itself. Although most laypeople have heard of this disorder and would think it somewhat prevalent, it is most often seen clinically in the context of other disorders. This suggests that kleptomania may be a symptom of some other disorder, one that is perhaps biologically based. Evidence supporting this conclusion is that Prozac, which increased serotonin activity, has been found to be helpful is treating kleptomania. • Pathological gambling. When does the neighborhood poker game turn pathological? When Lenny has one too many beers and starts to belly dance on the table. Besides that, though, “Lotto fever,” being obsessed with “hitting it big” at the track, entering every office football pool, or playing the dollar slots for nine straight hours in Vegas may be signs of an impulse-control disorder. Pathological gambling is debilitating financially, psychologically, and interpersonally. Betting becomes the focus of existence for these gamblers, which in turn becomes financially draining when the big wins turn to big losses, which places stress on family and loved ones. The prevalence of drinking, smoking, eating disorders, and suicide attempts among spouses of pathological gamblers has been estimated to be inordinately high. Pathological gambling is usually associated with the presence of other disorders, such as narcissistic, antisocial, or aggressive personality disorders; low tolerance for boredom; and proneness to addiction. Treatment usually follows a behaviorist approach, relying on aversive therapy or imaginal desensitization. • Trichotillomania. This rare disorder involves an irresistible urge to pull out one’s hair. Beyond a simple eyebrow pluck or desire for electrolysis, people with trichotillomania acquire bald patches, lost eyelashes, missing armpit or pubic hair, and in extreme cases may swallow the hair after pulling it out, leading to a range of other harmful consequences. This disorder may be linked to obsessive-compulsive disorder, although trichotillomaniacs tend to suffer from other disorders, such as mood, anxiety, eating, or substance abuse disorders. Behavioral treatments seem effective in reducing the frequency of hair pulling. • Pyromania. This impulse control disorder refers to the compelling and intense desire to prepare, start, or watch fires. It is a relatively rare disorder; even among fire starters, only 2% to 3% would be considered pyromaniacs. The disorder often gets its start in childhood, and although it has been linked to sexual paraphilias, there has been little systematic research exploring this connection. Pyromania is seen in conjunction with other disorders, however. David Berkowitz, the Son of Sam serial killer, set more than 2,000 fires in New York City during the 1970s. • Intermittent explosive disorder. This disorder is characterized by sudden, brief bouts of extreme rage. Like most impulse-control disorders, the difficulty lies in suppressing a common inclination. Many of us feel enraged from time to time, but we are able to control our tempers or Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 27 channel our aggressive impulses elsewhere. Biological origins of intermittent explosive disorder seem most likely. Serotonin, insulin, and norepinephrine deficits have all been implicated, and a link to epilepsy is being explored. • Sexual impulsivity. Frequent and indiscriminate sexual activity is the hallmark of this disorder. People who are sexually impulsive often come from family backgrounds where excessive guilt, sexual abuse, or restrictive attitudes toward sex predominated. One pathological reaction to this environment would be sexual aversion; sexual impulsivity may be a reaction at the opposite extreme. Halgin, R. P., & Whitbourne, S. K. (1994). Abnormal psychology: The human experience of psychological disorders. Fort Worth: Harcourt Brace. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Thought Disorders and Delusions Delusional or disordered thought is a hallmark of many forms of mental illness, especially schizophrenia. Some of the more common delusions (false beliefs that are inconsistent with the thinker’s background or level of intelligence) and thought disorders (disrupted patterns of cognition, language, or logic) have been summarized by Richard Halgin and Susan Whitbourne. Delusions • Persecution. The belief that another person or group is trying to harm the individual or his or her loved ones. An example might be believing that General Motors is maintaining a file on your activities and is plotting to destroy your homestead. • Grandeur. These delusions can be either specific or somewhat vague. For example, believing that you are Abraham Lincoln is a rather focused delusion, whereas believing that you are someone who has been preordained to play an important role in history is more diffuse. Delusions of grandeur in general involve an exaggerated view of one’s own importance. • Somatic. These beliefs involve a preoccupation with one’s body, especially that some disease or disorder is present. Mistakenly believing that tapeworms are gnawing away your stomach lining would be a somatic delusion. (Compare with Ekbom’s psychosis, discussed earlier.) • Nihilism. The delusion that the world, others, and/or oneself is nonexistent. A spooky sense of unreality or believing that one is “living in a dream” often accompanies this delusion. • Reference. Delusions of reference are beliefs that the behaviors of others or certain events have been targeted specifically toward oneself. Believing that the storyline of The O.C. has been taken (literally) from your own life would be an example. • Thought broadcasting. The notion that one’s thoughts are being broadcast to everyone in the vicinity. For example, you might believe that your mental rehearsal of your grocery list can be heard by your coworkers around you. Copyright © 2010 Pearson Education, Inc. All rights reserved. 28 CHAPTER 12 • PSYCHOLOGICAL DISORDERS Thought insertion. The idea that thoughts are being inserted into one’s mind by outside forces. David Berkowitz, the Son of Sam, reportedly believed that his thoughts were being implanted in his mind by his neighbor’s dog. Thought Disorders • Incoherence. This thought disturbance is probably the best known among laypeople. Incoherence involves speech that is incomprehensible or lacking in meaning and structure, such as saying, “The sheep are on the roof because twelve is New Jersey” when asked one’s name. • Flight of ideas. Here speech is intelligible, but marked by a fast pace and rapid acceleration, often with abrupt changes of topic. Flight of ideas has the quality of a speaker ready to burst forth with a spew of sentences. • Loosening of associations. A cognitive disruption characterized by an illogical, unfocused, or vague train of thought. When asked how you are feeling, replying “Healthy, wealthy, and wise. Three wise men run the bank, you know; they have the wealth of nations” might be an example. • Neologisms. The invention of new words or distortion of existing ones, often to match some selfperceived meaning. Describing the “wretchedivism” of your “tetramatic” lifestyle would be an example. • Clanging. In this thought disorder, the sounds of words, rather than their meaning, determines the content of one’s speech. For example, you might respond, “The note in the till, by the goat eating swill, sank the boat on the hill” when asked how you arrived at the psychiatric clinic. • Circumstantiality. Speech filled with unnecessary, tedious, and inconsequential detail, leading to rambling descriptions of events or responses to questions. It’s late at night, now, when I’m trying to think of an example of this, although this morning when I woke up I felt as though today would be a productive day of writing. While I was eating my Cap’n Crunch, as a matter of fact, that thought occurred to me. Especially when I was pouring my milk, which is always nonfat. I try to cut down on my fat intake wherever possible. I think the milk came from Safeway, but I can’t remember. Anyway, by now you get the idea.... • Perseveration. Not clanging, but clinging to the same idea, word, phrase, or sound repeatedly. “I must stop writing. I must stop writing. I have to finish this. I must stop writing. I have to finish this writing. I must stop” would be an example. Halgin, R. P., & Whitbourne, S. K. (1994). Abnormal psychology: The human experience of psychological disorders. Fort Worth: Harcourt Brace. ► Return to Lecture Guide: Schizophrenic Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 29 Lecture/Discussion: Ch-Ch-Ch-Changes “The more that things change, the more they stay the same.” This pithy observation may serve to make us look erudite after a few beers at the bar, but for many people it doesn’t ring true. From plastic surgery to career changes to relocating hearth and home, people seek change because it isn’t the same old thing. What can and cannot change, however, is another matter. Looking over the research, psychologist Martin Seligman sketches traits, disorders, and behavior patterns that seem more or less resistant to change. Panic Specific Phobias Sexual Dysfunctions Social Phobia Agoraphobia Depression Sex Role Change Obsessive-Compulsive Disorder Sexual Preferences Anger Everyday Anxiety Alcoholism Overweight Post-traumatic Stress Disorder Sexual Orientation Sexual Identity Curable Almost Curable Marked Relief Moderate Relief Moderate Relief Moderate Relief Moderate Relief Moderate Mild Relief Moderate Mild Change Mild Moderate Relief Mild Moderate Relief Mild Relief Temporary Change Marginal Relief Probably Unchangeable Probably Unchangeable Seligman, M. E. P. (1994, May/June). What you can change and what you cannot change. Psychology Today, pp. 35–41, 70, 72–74, 84. Used by permission. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Here We Go Again! “I’d better check......one more time.....just let me make sure.....I’d better go back....” In isolation these comments might come from anyone wondering whether the headlights are turned off on the car. But as the mantra of people suffering from obsessive-compulsive disorder these thoughts plague their daily lives. Whether its washing one’s hands 25 times a day or checking to make sure the stove burner is off every hour on the hour, OCD can severely hobble one’s peace of mind. More rightly, it may be a piece of brain that produces these intrusive thoughts. UCLA’s Jeffrey Schwartz and his colleagues used PET scans to study the brains of obsessive-compulsive patients. They found that the orbital cortex, the part of the brain responsible for sensing when something is amiss, seemed to be stuck on ACTIVE. For example, when most of us notice that the dishes in the sink need washing, our caudate nucleus clicks on to signal us to respond. If the caudate nucleus misfires, the orbital cortex in turn becomes perpetually engaged. The result, according to psychiatrist Schwartz, is that the thought that something needs to be checked or fixed or is yet-to-be done doesn’t go away. To remedy this, Schwartz and his colleagues propose the use of behavioral modification and cognitive therapy. When an intrusive thought makes its appearance, OCD patients are trained to relabel the thought Copyright © 2010 Pearson Education, Inc. All rights reserved. 30 CHAPTER 12 PSYCHOLOGICAL DISORDERS for what it is: an obsession. They next attribute that obsession to a biochemical imbalance in their brain. Finally, patients focus on some constructive activity, such as paying the bills or weeding the garden, for 15 minutes, to allow their stuck caudate nucleus to become unstuck and shift to other thoughts. This technique has had limited success, with only 12 of 18 OCD patients reporting substantial relief from their intrusive thoughts. When it is successful the evidence is clear: PET scans show a much more subdued caudate nucleus after 8 to 12 weekly therapy sessions, combined with the relabeling and refocusing done by the patient at home. In the final analysis, it may indeed be that a piece of mind alters a piece of brain to restore peace of mind. Begley, S., & Biddle, N. A. (1996, February 26). For the obsessed, the mind can fix the brain. Newsweek, 60. Reprinted from Instructor’s Resource Manual for Psychology (2005) by S. Kassin. Upper Saddle River, N.J.: Pearson Education. ► Return to Lecture Guide: Anxiety Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Paraphilias Fetishism The word “fetish” has a somewhat magical meaning and is used to refer to objects that have become associated with supernatural powers. In sexual fetishism, a specific object or part of the body becomes the focus of sexual interest and arousal. What kinds of objects can become associated with sexual arousal and become a fetish? Shoes, wigs, underwear, certain materials like rubber, leather, or fur are common fetishes, as are feet, hair, legs, and breasts. Instead of becoming sexually aroused by the whole person, the fetishist’s sexual attraction is focused on that particular object or body part. Fetishists may collect these objects and manipulate them while masturbating, or may wear clothing made from the fetishist materials to achieve sexual arousal. The most reasonable explanation for sexual fetishism is that it is a form of accidental classical conditioning that may have its origins in early childhood. For example, a child might have used a soft piece of fur to masturbate when young, and the pairing of the fur (conditioned stimulus) with the masturbation (unconditioned stimulus) would cause a learned response of sexual arousal when fur is touched in the future. Although human evidence for this explanation is in the form of anecdotes and personal memories, research with animals shows a definite connection between conditioning and fetishism. One study found that male rats who often had sexual intercourse in a particular cage showed high levels of the pleasure-producing chemicals that are normally present during sexual activity, even if no female rat or female rat scent was present in the cage (Coolen, 2003). The cage may have acted as a contextual cue for sexual arousal, just as other fetishist objects may act as such cues. Exhibitionism Although some people might call a person who has to have the biggest, most expensive car, wears the most expensive jewelry, and has the biggest, showiest house an exhibitionist, that is not the kind of exhibitionism meant here. Sexual exhibitionism involves what is commonly termed “indecent exposure,” or the exposure of normally clothed parts of the body to unsuspecting and typically unwilling viewers. This paraphilia includes the male “flasher” who might wear a long coat and open it in front of children or women to reveal that he is wearing nothing at all underneath it, and may also include people who “moon” Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 31 others—exposing the buttocks in inappropriate places and manners. The key is whether or not sexual arousal is involved. A stripper, for example, may take off her clothes in front of customers, but she is not considered a sexual exhibitionist unless she gets sexual arousal or pleasure from doing so. Voyeurism Voyeurism involves sexual arousal and gratification obtained through watching other people engage in sexual behavior or undress. While some voyeurs are known as “Peeping Toms” and watch their targets through windows or peepholes while the target person is unaware, others may watch while the target person or persons engages in sexual activity or masturbation in full knowledge that the voyeur is watching. Most voyeurs are male and prefer to watch from a distance, often engaging in masturbation either during or after the voyeuristic experience. Frotteurism Frotteurism is the act of becoming sexually aroused or gratified through rubbing up against another person. While in the context of two consenting adults this is not seen as abnormal, when it involves a person who did not consent to this kind of sexual touching, it is considered a sexually deviant behavior and sexual assault. The frotteur (person practicing frotteurism) typically picks a crowded public place and rubs up against an unsuspecting and unwilling victim, perhaps touching them with a hand in a private place, and then runs away before being caught. Crowded elevators and busy city sidewalks are two common places this activity may take place. Part of the sexual thrill no doubt comes from the unwillingness an outrage of the victim. Sadomasochism Some people derive a great deal of sexual pleasure from inflicting pain and humiliation on their sexual partners. This behavior is called sadism after the Marquis de Sade, who wrote books filled with such images of sexual torture and bondage. Other people get sexually aroused when they are the target of pain and humiliation in a sexual context, and this is called masochism, also after an author (Leopold von Sacher-Masoch). Again, this is one of those touchy areas where it may be difficult to draw the line between “kinky” and “deviant.” When a sadist and a masochist practice their unusual form of sexual pleasuring together, it is called sadomasochism. It becomes sexually deviant when real physical damage occurs or when one of the partners is unwilling to participate. As with fetishism, many psychologists and other experts believe that sadomasochism results from classical conditioning in which pain somehow gets associated with sexual arousal early in life. Necrophilia Although in some circumstances some of the paraphilias, such as fetishism and sadomasochism, may not be considered illegal when taking place in private between two consenting adults, necrophilia is without a doubt illegal. Necrophilia is a special kind of fetish in which the sexual arousal comes from touching or even having intercourse with a corpse—a dead body. While many psychologists might see this as an example of previous classical conditioning, Erich Fromm (1973) believed that necrophilia comes from an obsession with destruction and a desire for all that is dead and decaying. Necrophilia is sometimes a part of what serial killers do with their victims as well, which leads to the belief that a need to have absolute control might be at least part of the reason for this behavior. Copyright © 2010 Pearson Education, Inc. All rights reserved. 32 CHAPTER 12 PSYCHOLOGICAL DISORDERS Transvestism Also a kind of fetishism, transvestism involves getting sexual arousal and pleasure from wearing the clothing of the opposite sex. Also known as “cross-dressing,” this sexual behavior can be part of a relatively healthy sexual relationship. Some transvestites, however, can only achieve arousal through this means and cross-dress at inappropriate times and places—emergency rooms are full of stories of welldressed male accident victims who are found to be wearing frilly women’s undergarments under their business suits. Actually, most transvestites are heterosexual males who may be married and enjoy normal sexual relationships with their wives. The transvestite, who cross-dresses for sexual excitement, should not be confused with a homosexual male who cross-dresses for other reasons. As for women, there seems to be little evidence that women who wear men’s clothing do so for sexual arousal purposes. In fact, it is quite socially acceptable in modern Western society for women to wear clothing that once was considered male. We think nothing of a woman wearing pants, a suit jacket, and even a tie, but would look oddly at a man wearing a skirt or a dress, right? In a sense, then, if the culture does not prevent a woman from wearing male-type clothing, there is no “shock” value to doing so—and this may be a big factor in the excitement for men who wear women’s clothing. The risk of being “found out” adds to the sexual thrill. Pedophilia Pedophilia is another sexual deviancy that is illegal and considered immoral in almost every culture if it is carried out. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (1994) describes a pedophile as a person who has recurring sexual thoughts, fantasies, or behavior toward prepubescent children (children who have not yet entered puberty). These urges cause great psychological distress, and if acted upon, they are considered criminal acts. A person must be at least 16 years old and have an age difference of at least 5 years between the person and the object of the sexual fantasies to be considered a pedophile. Contrary to the image most people have of a “dirty old man,” the typical pedophile is a young adult male who may be sexually attracted to either females or males of the right age. As with necrophilia, the actions of the pedophile may be more concerned with feelings of power, control, and domination over the much younger, weaker child than they are with actual sexual needs. Many pedophiles are married and have sexual relationships with their wives, yet still engage in their pedophilic fantasies or behavior. When the victim of the pedophile is female, it is typically a daughter or some other close relative, but male victims are often unrelated to the pedophile—they may be the child of a neighbor or even a friend. Female pedophiles are rare, but they do exist. Physiological explanations of pedophilia tend to focus on aggression and male hormones, which may explain why pedophilia in women is so rare. Another possibility is that male victims of female pedophiles tend not to report the incidents, and may even be inclined to view sexual activity with an older woman as desirable. The hormone testosterone has been implicated in pedophilia as well, which fits well with the observation that pedophilic behavior often decreases and may even cease after age 40, the age at which testosterone levels begin to decline, and with the finding that testosterone-reducing drugs have had some success in reducing pedophilic fantasies and behavior (Nathan et al., 1999). ► Return to Lecture Guide: Sexual and Gender-Identity Disorders ▼Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12: Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 33 Lecture/Discussion: Pedophiles (Not in My Backyard) Several recent high-profile child murders committed by sex offenders have sparked much fear and outrage across the country. Most students will be familiar with some of the following examples: 9-year-old Jessica Lunsford was abducted from her home in Homossassa, Fla by convicted sex offender John Couey. She was found buried behind his trailer which was located 150 yards from her home. Although police questioned Couey, they did not realize he was a sex offender at that time, despite his name on the registry. According to Couey, Jessica was alive when the police visited his trailer the first time. On May 16, 2005 Shasta and Dylan Groene were abducted from their Idaho home by Joseph Edward Duncan III after he murdered the children’s mother, brother, and mother’s boyfriend. On July 5th, Shasta was spotted in a Denny’s restaurant with Duncan, but her brother was nowhere to be found. His body was later discovered in Montana. Shasta and Dylan had been repeatedly sexually assaulted by Duncan. Duncan committed his first act of sexual assault 30 years ago when he was just 12 years old. Since then he has been linked to a number of violent sexual assaults on children. According to Duncan he had raped 13 younger boys by the time he was 16 years old. Much of the research regarding recidivism rates of sex offenders paints a bleak picture regarding the chances of rehabilitation. Some of the professionals specializing in sex offender treatment argue that having the right treatment for the right amount of time could prove successful. Unfortunately, the prison and mental health systems have failed in their efforts to provide long-term treatment. If those treatments don’t work, what can be done? The legal system has stepped in by providing sex offender registries and tracking systems. Registries have been in place for years but they rely on the sex offender to register and for the probation department to track the offenders. Many times this has not worked. Many communities have implemented notification programs for communities when a sex offender is released into their neighborhood. There are some arguments regarding potential violations of civil rights. In one case, a man felt so harassed when inaccurate posters were placed around his neighborhood that he committed suicide. Due to several recent incidents involving sex offenders, Florida has moved to have GPS ankle tracking devices placed on sex offenders so it will be easier to know where they are. In other recent moves, several Florida counties have increased the restrictions regarding where sex offenders may live, work, and play. The ultimate purpose appears to be a desire to rid the community of these individuals. Many people are concerned that these moves may make sex offenders more reluctant to register and identify themselves, thereby making the situation more dangerous. http://www.apa.org/monitor/julaug03/newhope.html http://www.msnbc.msn.com/id/8485031/ Memmott, M. (2005). Girl’s death raises questions about tracking of sex offenders. USA Today, March 25. Seager, J. A., Jellicoe, D., Dhaliwal, G. K. (2004). Refusers, dropouts, and completers: Measuring Sex Offender Treatment Efficacy. International Journal of Offender Therapy & Comparative Criminology, 48(5), 600–612. ► Return to Lecture Guide: Sexual and Gender-Identity Disorders ▼Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12: Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 34 CHAPTER 12 PSYCHOLOGICAL DISORDERS Lecture/Discussion: Schizophrenia and Cigarettes It’s been noted that among psychotic patients, schizophrenics are often the heaviest smokers. New research may hold an answer to why this is the case, as well as suggest avenues for treating this devastating mental illness. A research team led by Robert Freedman of the Denver Veterans Affairs Medical Center discovered something that apparently many people with schizophrenia had known for some time: A long drag can bring brief relief to information overload. Freedman identified a gene linked to the inherited trait of being able to filter out sources of stimulation, such as a dripping water faucet or the buzz of a fluorescent light bulb. Although most people can achieve this selective attention quite readily, it is often difficult for schizophrenics to reduce the stimulation of the external world. The researchers also linked the gene to a brain receptor site which appears to be stimulated by nicotine. In short, ingesting nicotine can trigger a momentary increase in the ability to filter information. Although the research team has not yet identified the genetic mutation that would cause the link between this particular schizophrenic characteristic and the nicotine receptor gene, there is some evidence in support of this line of research. Clozapine, for example, is a psychoactive drug that appears to help the information filtering problem in schizophrenics, and many patients report smoking fewer cigarettes while on the drug. Clozapine’s exact mechanism is unknown, but in conjunction with genetic research new treatment options may be found. At the very least, friends and family members may be more understanding of why a schizophrenic person is so reluctant to kick the habit. Neergaard, L. (January 21, 1997). Scientists find link between schizophrenia gene, nicotine. Austin American-Statesman, A2. Reprinted from Instructor’s Resource Manual for Psychology (2005) by S. Kassin. Upper Saddle River, N.J.: Pearson Education. ► Return to Lecture Guide: Schizophrenic Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Age of Onset and Schizophrenia One factor that can complicate the search for the causes of schizophrenia is that the subtypes of schizophrenia may have different causes. Grouping all five subtypes together when looking for possible causes may obscure the search for a common etiology. A common finding that may help researchers is that males develop schizophrenia at an earlier age than females. Both Bleuler and Kraepelin observed this sex difference in age of onset. A related question that has not been adequately addressed is, are there sex differences in the age of onset for the five subtypes of schizophrenia? Researchers have now provided an answer to this question in a study of 200 individuals diagnosed with schizophrenia and admitted to a Greek psychiatric hospital. Some of the key findings are: • the mean age of onset for all female patients (26.6) was significantly later than the mean age for all male patients (23.0). Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 35 • disorganized schizophrenia had the earliest onset of the five subtypes; the mean age of onset was 17 for the combined male and female samples. This age of onset was approximately five years earlier than the undifferentiated and residual subtypes, and 13 years earlier than the paranoid subtype. All of the cases of disorganized schizophrenia occurred between the ages of 11 and 20. • the major difference in age of onset occurred in the paranoid subtype, which accounted for the greatest number of patients. The mean age of onset for the paranoid subtype was 26.7 for males and 33.5 for females. The paranoid subtype also had the most variability in the age of onset: new cases appeared between the ages of 17 and 60. These data support the validity of the DSM subtypes of schizophrenia as distinct clinical entities. They also suggest the possibility that there may be biological differences among the subtypes or groups of subtypes and these differences should be considered when researchers investigate possible causes of schizophrenia. Beratis, S., Gabriel, J., & Hoidas, S. (1994). Age at onset in subtypes of schizophrenia disorders. Schizophrenia Bulletin, 20, 287–296. Reprinted from Instructor’s Resource Manual for Psychology (2005) by S. Kassin. Upper Saddle River, N.J.: Pearson Education. ► Return to Lecture Guide: Schizophrenic Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Digging for the Roots of Schizophrenia It is estimated that one person out of 100 either has chronic schizophrenia or has had one or more acute episodes of schizophrenia. This rate of incidence seems to be fairly constant from society to society and it is believed by some to have persisted over centuries of time. Some types of schizophrenia provide the stereotype that people associate with “insanity,” “madness,” or “lunacy.” Untreated schizophrenics can be unrestrained in their behavior, discarding clothing, attacking others for no apparent reason, urinating and defecating in inappropriate places, and masturbating in the presence of others. They may hear voices and have delusions of grandeur and persecution. They may maintain a bizarre posture for hours or days. They may speak in a language that cannot be understood, or withdraw so completely that they go for long periods without speaking. Their emotional responses can be grossly inappropriate: laughing at death and tragedy and crying when good fortune occurs. To this day the cause of schizophrenia is not known. Scientists may be getting closer to an answer, but if the lesson of history is heeded, they will be cautious before claiming that the culprit has been identified. Others before have thought they had the answer to the riddle of schizophrenia only to have their explanations rejected. The first evidence of efforts to treat mental illness, probably schizophrenia, was discovered by archaeologists. The archaeologists found skulls that had holes bored into them. This ancient “remedy” is called trephining. We do not know what effect this treatment was supposed to have. Perhaps it was to relieve pressure or to allow the brain to cool off. During the era of Greek dominance of the ancient world, physicians came to look more toward biological causes of psychological disorders. Hippocrates suggested that disorders result from an imbalance of body fluids, and prescribed rest in tranquil surroundings and good food. This was an enlightened view, Copyright © 2010 Pearson Education, Inc. All rights reserved. 36 CHAPTER 12 PSYCHOLOGICAL DISORDERS inasmuch as the world at the time generally favored the idea of demonic possession. You may recall Biblical accounts of Christ’s having “cast out demons.” After the fall of Rome and the onset of the Dark Ages, the idea of demonic possession prevailed as the explanation for schizophrenia and other severe psychological disorders. Treatment was aimed at making the schizophrenic’s body a very uncomfortable place for the demon to live. The patient was fed dreadful concoctions, chilled, and physically abused to encourage the demon to move out. Beginning late in the Middle Ages and into the 17th century, the demonic possession explanation evolved into the witchcraft theory. An important difference between these views is that in demonic possession, the demon was believed to move in uninvited; witchcraft was the result of an intentional transaction with the forces of evil. The Pope issued a papal brief in 1484 in which he exhorted the clergy of Europe to leave no stone unturned in the detection of witches. In the document he quoted Exodus 22:18, “Thou shalt not suffer a witch to live.” Thousands of mentally ill people, probably primarily schizophrenics, were tortured and killed in the 16th and 17th centuries and the idea that psychological disorders represent punishment by God or deliberate association with the devil persisted into the 19th century. Through the effort of enlightened and humane individuals, mistreatment of the mentally ill diminished in the 19th century. When Kraepelin published the first classification of psychological disorders in 1883, he attributed what we now call schizophrenia to disturbed metabolism. Explanation had returned to the Greek idea of biological causes. Freud stressed the view that psychological disorders are rooted in psychosexual causes. He thought schizophrenia was a drastic regression to childhood modes of thought and behavior as a defense against unbearable conflict. He did not think psychoanalysis was very effective in the treatment of schizophrenia. During the Victorian era (approximately 1840 to 1900) and into the 20th century, there was a popular belief that schizophrenia was brought on by masturbation. This idea was refuted by G. Stanley Hall, the founder of developmental psychology, but he claimed that masturbation can result in premature baldness and several other problems. We are now into the 20th century, the age of rational thought and scientific progress, and the search for the roots of schizophrenia continues. In 1935, Nolan Lewis, a psychiatrist, reviewed 1800 research reports that had been written since 1920. His article led to the conclusion that almost anything that can be weighed or measured has been suggested as the cause of schizophrenia. Proposed explanations included the following: carbohydrate metabolism, muscle fatigue, tooth decay, abnormality of the spinal fluid, blood vessel rigidity, and iodine in the brain. These hypotheses were often inspired by comparing hospitalized schizophrenics with normal controls. Most of the differences found in this type of study were later attributed to prolonged residence in a mental institution. In our “enlightened” century, tens of thousands of schizophrenics were permanently brain damaged as a result of psychosurgery. The physician who first prescribed and perfected the prefrontal lobotomy (Moniz) was awarded the Nobel Prize in 1949 for his work. Electroconvulsive therapy (ECT) was rather dangerous at that time, but it was used in conjunction with and as an alternative to psychosurgery, even though there was little or no evidence that it was effective in the treatment of schizophrenia. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 37 A breakthrough in the treatment of schizophrenia came in the late 1950s. It was noted that a drug given to French soldiers in the Indochina War had a side effect of calming severely wounded soldiers. The physician who noted this was instrumental in having the drug tested to treat schizophrenia, and it worked. It dramatically reduced symptoms of schizophrenia in the majority, but not all, of schizophrenics. The search for the cause of schizophrenia now focused on what the drug does to reduce schizophrenic symptoms. In 1963, a Danish scientist linked the antipsychotic drugs with the neurotransmitter dopamine. The original form of the dopamine hypothesis is that schizophrenia, or at least one form of it, is a result of excessive dopamine activity in the brain. It was soon realized that this hypothesis is an oversimplification, and other neurotransmitters became involved as hypotheses became more complex. Research continues on the relationship between schizophrenia and synaptic transmission. In the meantime, other explanations have been suggested. In 1977, it was reported that hemodialysis led to dramatic improvement in a significant number of schizophrenics. Studies sponsored by the National Institute of Mental Health (NIMH) failed to support the idea that schizophrenia is related to contaminated blood. It has also been suggested that viral infection plays a role in schizophrenia. Perhaps the cause is a slow-acting virus that takes years to flare up into an active infection that produces schizophrenic symptoms. Fetal brain damage during the first trimester of pregnancy has been suggested as a factor that predisposes people to schizophrenia. A study of 50 male schizophrenics showed that they were much more likely than nonschizophrenics to have minor physical abnormalities that presumably resulted from the same interruption of fetal development. There is a great deal of evidence from family and twin studies to support the idea of a genetic component in schizophrenia, but a genetic marker has not been identified. Research on psychosocial causes also continues. Many mental health professionals take an interactionist view, the position that schizophrenia results when biological vulnerability is combined with adverse environmental circumstances. Some psychologists have pointed to intrafamily problems and parents have been labeled “schizophrenogenic” because they presumably increase the probability of schizophrenia in their children. Stress has also been suggested as a causal factor in schizophrenia. Research has led scientists to the conclusion that schizophrenia is probably not a single, unitary disorder — that there are schizophrenias, several or many disorders, that have different causes. ► Return to Lecture Guide: Schizophrenic Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Catching Madness In the Act David Silbersweig and Emily Stern, of the Cornell Medical Center in New York, received some popular press recently. One reason was because of a new technique they developed for capturing PET scans of very short durations. The other reason was because of how they applied the technique. Silbersweig and Stern, along with colleagues in London, were able to use PET technology to capture an image of the schizophrenic brain in the process of hallucinating. Copyright © 2010 Pearson Education, Inc. All rights reserved. 38 CHAPTER 12 PSYCHOLOGICAL DISORDERS Six volunteers agreed to provide this rare glimpse to the researchers. All experienced hallucinations; one patient, for example, heard voices that bellowed “How horrible!” or “Don’t act stupid!” whereas another was tormented by images of rolling, decapitated heads that shouted orders to him. Once in the PET scanner, patients pressed a button to indicate the onset of hearing hallucinatory voices and pressed it again when the experience stopped. The PET scans revealed that the structures active during this period were deep inside the brain. For example the hippocampus, thalamus, and striatum seemed abuzz with activity; these structures usually integrate emotion, memory, and perception, suggesting that a miswired neural circuitry may be implicated in schizophrenia. Importantly, none of the brain structures that should have activated did. For example, there was no significant activity in the prefrontal cortex, suggesting that the reality-monitoring functions of the prefrontal lobe were not at work. Furthermore, when a control group heard actual voices PET scans revealed that the auditory cortex was activated, and none of the deep structures were. The immediate application of these results, and to some extent, their exact interpretation, is not clear. At a minimum they suggest that schizophrenia may involve more than simply a chemical disruption; indeed, 5 of the 6 patients in the study obtained no relief from standard medication. Further research may reveal whether aberrant brain circuitry is present and where it might be; eventually, a surgical intervention may be used in treating schizophrenia. For now, researchers are satisfied to have gained a new tool for shedding light on a very private and very scary event. Begley, S. (1995, November 20). Lights of madness. Newsweek, 76–77. ► Return to Lecture Guide: Schizophrenic Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Lecture/Discussion: Viral Infection and Schizophrenia A recent theory about the cause of schizophrenia argues that viral infections play a critical role in the onset of the disorder. Research has demonstrated that viral infections may spread to the central nervous system by moving along nerves. The viral hypothesis proposes that infant respiratory viruses may infect the brain by traveling along the maxillary nerve and trigeminal ganglion. The virus would remain dormant, however, until activated either by hormones released during puberty or another viral infection during early adulthood. Schizophrenia researcher E. Fuller Torrey noted that this hypothesis may explain the finding that schizophrenia tends to be more common among individuals born during the spring and winter months. These are also periods during which there is a high incidence of upper respiratory infections. In addition, he also noted that the higher rate of birth complications found among schizophrenics may indicate the possibility of slight brain damage due to anoxia that makes them more susceptible to brain infections. Torrey, E. F. (1991). A viral-anatomical explanation of schizophrenia. Schizophrenia Bulletin, 17, 15–18. Adapted from Instructor’s Resource Manual for Psychology 5th edition (2007) by S. F. Davis and J. J. Palladino. Upper Saddle River, NJ: Pearson Education. ► Return to Lecture Guide: Schizophrenic Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 39 Lecture/Discussion: Identifying Individuals Who May Be Suicidal Explain to students that individuals with mood disorders are at high risk for suicide. Just one of the many tragedies of suicide is that many people will respond with disbelief, saying that the person “seemed just fine.” There have been attempts to try to predict suicide using personality tests like the MMPI; these predictions are often incorrect (Clopton, Post, & Lande, 1983). Even if some effective, scientific, predictive measure was available, the general public might not know about it or, worse yet, might be unable to recall it. Patterson, Dohn, and Patterson (1983) have devised an acronym to summarize the risk factors of suicide: SAD PERSONS. S: A: D: P: E: R: S: O: N: S: Sex Females are more likely to attempt suicide, but males are more often successful. Age Young and old people are more likely to attempt suicide. Depression Depression is often a precipitant in suicide. Previous attempt A history of suicide attempts increases the risk for suicide in the future. Ethanol abuse Abuse of alcohol is found in some who commit suicide. Rational thought Not thinking clearly or rationally is a risk factor. Social supports lacking Not having people to talk to and confide in increases the risk. Organized plan A person who has a concrete, organized plan is more likely to attempt suicide. No spouse Single people are at higher risk than married people. Sickness Being ill puts people at high risk. Clopton, J. R., Post, R. D., & Lande, J. (1983). Identification of suicide attempters by means of MMPI profiles. Journal of Clinical Psychology, 39, 868–871. Patterson, W. M., Dohn, H., & Patterson, G. A. (1983). Evaluation of suicidal patients: The SAD PERSONS scale. Psychometrics, 24, 343–349. ► Return to Lecture Guide: Mood Disorders ◄ Return to complete list of Lecture Launchers and Discussion Topics for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 40 CHAPTER 12 PSYCHOLOGICAL DISORDERS ▼CLASSROOM ACTIVITIES, DEMONSTRATIONS, AND EXERCISES Abnormal Behavior in the College Student Misconceptions about Mental Illness Defining Abnormal Behavior What Is Abnormal? Gender Stereotypes and Labeling Mental Illness Trick or Treat--Using Costumes to Portray a Psychological Disorder The Client Diagnosing Mental Disorders The Obsessive-Compulsive Test Dare to Be Perfect--A Road to Self-Defeat Defining Normal Sexual Behavior Demonstrating Schizophrenia Abnormal Psychology in Literature: The Eden Express Abnormal Psychology in Film Reviewing Perspectives Crossword Puzzle Fill in the Blank ▲ Return to Chapter 12 Table of Contents Activity: Abnormal Behavior in the College Student Objective: To help students learn more about how people respond to individuals who behave abnormally. Materials: Handout Master 12.1 Procedure: Assign students to engage in a public act of deviant behavior. Emphasize that the act cannot be illegal, dangerous (to the student, an observer, or the public), or against school rules. Since the students have just had your lecture on defining abnormality, they should have a good idea of the types of behaviors you are expecting. Have the students go in pairs, one as the “deviant” and one as an observer who will take notes on the reactions of others in the environment. Ask the students to reverse these roles. Tell the students to concentrate on their feelings as they behave abnormally, and ask the observer to concentrate on the reactions of others. Divide students into groups to compare their observations; have students use Handout Master 12.1 to report on their experiences. Conclusion: Students should be better able to empathize with individuals who suffer from serious mental disorders such as schizophrenia. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: Misconceptions about Mental Illness Begin class by asking students to record their response of True or False to each of the following statements as you read them aloud: 1. Abnormal behaviors are always bizarre. 2. A clear distinction can be drawn between “normal” and “abnormal” behaviors. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 3. 4. 5. 6. 7. PSYCHOLOGICAL DISORDERS 41 As a group, former mental patients are unpredictable and dangerous. Mental disorders indicate a fundamental deficiency in personality, and are thus shameful. Because mental illness is so common, there is reason to be fearful of one’s own vulnerability. Geniuses are particularly prone to emotional disorders. Most mental disorders are incurable. The correct answer for each of these statements is False, but it is likely that many students will answer True to one or more. Here are some more details about each of the questions: 1. Abnormal behaviors are always bizarre. This view may be perpetuated by the media because often the extremes of behavior are more likely to be reported. 2. A clear distinction can be drawn between “normal” and “abnormal” behaviors. Abnormality is a matter of degree; all people do not neatly fall into one of two categories. Abnormality consists of a poor fit between behavior and the situations in which it is enacted (e.g., talking to oneself when alone as opposed to talking to oneself in the grocery store). 3. As a group, former mental patients are unpredictable and dangerous. The typical former mental patient is no more volatile or dangerous than people in general. Again, exceptions to this rule generate the most media attention. 4. Mental disorders indicate a fundamental deficiency in personality, and are thus shameful. As far as we know, everyone shares the potential for becoming disordered and behaving abnormally. 5. Because mental illness is so common, there is reason to be fearful of one’s own vulnerability. Mental disorders should be understood as maladaptive responses that are understandable within a given context. The average person has an excellent chance of never becoming disordered and of recovering completely if it should happen. 6. Geniuses are particularly prone to emotional disorders. Terman’s study of high IQ children showed that high-IQ people actually may be more well-adjusted than the population in general. 7. Most mental disorders are incurable. Between 70 and 80 percent of those hospitalized as mental patients eventually recover. Reprinted from Instructor’s Resource Manual for Psychology (2005) by S. Kassin. Upper Saddle River, N.J.: Pearson Education. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: Defining Abnormal Behavior (Group Activity) Psychologists use several criteria to distinguish between normal and abnormal behavior, including statistical rarity, interference with day-to-day functioning, personal distress, and social norms. Students often have their own definitions of abnormality that may or may not be related to these criteria. The following exercise, adapted from one proposed by Gardner (1976), is designed to enable students to explore their own definition of psychology and its relationship to these criteria. First ask your students to Copyright © 2010 Pearson Education, Inc. All rights reserved. 42 CHAPTER 12 PSYCHOLOGICAL DISORDERS list and then share synonyms for mental illness, explaining the origin of any unusual terms. Next, divide the class into small groups and have half of the groups construct a definition of abnormality or mental illness while the remainder are to define normal or mentally healthy behavior. Tell the students that their definitions should not include any of the synonyms generated in the first part of the exercise. After about 10 to 15 minutes, have group spokespersons share their definitions. You can relate the group definitions to the various criteria described in the textbook. Also, have your students discuss the difficulties they had in generating appropriate definitions for abnormality or normality without recourse to using synonyms. Gardner, J. M. (1976). The myth of mental illness game: Sick is just a four letter word. Teaching of Psychology, 3, 213– 214. Reprinted from Instructor’s Resource Manual for Psychology (2005) by S. Kassin. Upper Saddle River, N.J.: Pearson Education. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: What Is Abnormal? Objective: To expose students to the problem of identifying normal and abnormal behavior in a series of vignettes Materials: Handout Master 12.2 Procedure: This activity may be done by students in groups or individually. Give each student a copy of Handout Master 12.2. For each item, the students should indicate whether they believe the behavior described is normal or abnormal. After the handout has been completed, ask your students to identify the criterion they used to determine abnormality. The identification of abnormal behavior is a difficult task. One must consider context, culture, and era among other criteria. For example, item 12 states, “Luke often urinates on the street.” A clear case of abnormal behavior, right? What if Luke is a golden retriever? What about Alana in item 4? Does it matter if Alana is Muslim and living in Saudi Arabia? ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: Gender Stereotypes and Labeling Mental Illness Broverman et al. (1970) reported the results of a study of clinically-trained experts (i.e., psychiatrists, clinical psychologists, social workers) that investigated characteristics associated with mental health for a female, male, and average adult (sex not specified). The results showed that the characteristics associated with a healthy individual (sex unspecified) were more likely to resemble those characteristics associated with mental health for a male than for a female. The following exercise was designed to replicate the Broverman et al. results in class (Anonymous, 1981). The questionnaires to be used in the exercise are reproduced in Handout Master 12.3; versions A, B, and C ask students to rate the characteristics of a healthy male, female, and average adult, respectively. Randomly distribute the three versions of the questionnaire to your students without revealing that they are getting different forms. After they have completed the questionnaire, count the number of times that each phrase was selected for each target person. Ask the students if their results are similar to those of Broverman et al. That is, are items selected for a person similar to those for a male? Do items selected for a female differ from those chosen for a person and a male? If your students’ results differ from those of Broverman et al., have them discuss why. Some possibilities may be changes in societal attitudes since the original study, the class size may be too small to produce differences, or that students’ beliefs and attitudes are different from those of professionals. Finally, have your students consider the effects of gender stereotypes on diagnosis and Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 43 treatment. You could also relate the issue of gender stereotypes to the criticisms raised about the sexism inherent in Freud’s theory. Anonymous. (1981). Sex role stereotypes and mental health. In L. T. Benjamin, Jr. & K. D. Lowman (Eds.), Activities handbook for the teaching of psychology (pp. 141–142). Washington, DC: American Psychological Association. Broverman, I. K., Broverman, D. M., Clarkson, F. E., Rosenkrantz, P. S., & Vogel, S. R. (1970). Sex role stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology, 34, 1–7. Adapted from Instructor’s Resource Manual for Psychology 5th edition (2007) by S. F. Davis and J. J. Palladino. Upper Saddle River, NJ: Pearson Education. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: Trick or Treat--Using Costumes to Portray a Psychological Disorder Halonen (1986) suggests an entertaining but educational way to explore student’s understanding of psychological disorder. For this exercise, ask students to volunteer to come to the next class in a costume that will nonverbally portray a disorder discussed in the text or lecture. Then, during that class period (preferably sometime near Halloween, if you can swing it), all students participate in trying to diagnose the disorders. Clever examples reported by Halonen include a narcissist (e.g., a student strapped to a fulllength mirror) and a hypochondriac (e.g., a student carrying a medicine chest). A benefit of this exercise is that students learn about the disorders not only by diagnosing them, but also in trying to accurately portray them. Because of the deviant nature of the assignment, Halonen suggests making this an optional exercise, perhaps by awarding bonus points for successful portrayals. Halonen, J. S. (1986). Teaching critical thinking in psychology. Milwaukee: Alverno Productions. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: The Client In this exercise (described by Halonen, 1986), you (or a guest actor, if you prefer) play the role of a client with some undisclosed psychological disorder that class members must try to accurately diagnose. On the assigned day (which should be after you have covered the broad spectrum of psychological disorders), tell students at the start of class that you are a client entering a clinician’s office for the first time and that you want them (as the therapists) to interview you in order to make a diagnosis. From that point on, you should sit quietly and respond only to their questions; in other words, they should derive a diagnosis based on your verbal answers rather than from any active behavior on your part. Instruct students beforehand that you will stop the exercise (and play teacher again) only when they have agreed on a diagnosis and can provide evidence to support their conclusions. Because disorders vary in how easily they are identified, you may want to try this exercise more than once, once with a relatively clear-cut disorder and once with a more ambiguous one. Halonen, J. S. (1986). Teaching critical thinking in psychology. Milwaukee: Alverno Productions. Reprinted from Instructor’s Resource Manual for Psychology (2005) by S. Kassin. Upper Saddle River, N.J.: Pearson Education. ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 44 CHAPTER 12 PSYCHOLOGICAL DISORDERS Activity: Diagnosing Mental Disorders After you’ve reviewed the psychological disorders, test your students’ ability to apply their knowledge to realistic case studies. Handout Master 12.7 contains several scenarios that depict a wide range of disorders. Duplicate and distribute copies of the handout to students (this will also make an excellent study tool for the exam) and have them write their diagnoses on the handout. Be sure to go over the answers with students, and to discuss any confusing similarities between related disorders. The correct answers are given below. 1. Paranoid Schizophrenia 2. Body Dysmorphic Disorder 3. Autistic Disorder 4. Borderline Personality Disorder 5. Specific Phobia (claustrophobia) 6. Dissociative Fugue 7. Post-Traumatic Stress Disorder 8. Frotteurism 9. Dependent Personality Disorder 10. Panic Attack/Disorder 11. Depersonalization Disorder 12. Agoraphobia 13. Major Depression 14. Obsessive-Compulsive Disorder 15. Somatization Disorder ► Return to Lecture Guide: Perspectives on Psychological Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: The Obsessive-Compulsive Test One of the anxiety disorders described in the textbook is obsessive-compulsive disorder. All of us experience occasional obsessive thoughts. However, in obsessive-compulsive disorder these thoughts and their related behaviors are often uncontrollable and generate high anxiety. Gardner provided a test designed to measure obsessive-compulsive thoughts and behaviors, reproduced in Handout Master 12.4, that you can administer in class. After students have completed the test, instruct them to add the total value of the circled numbers. Gardner’s proposed scoring and interpretation of results are as follows: 25 – 45 46 – 55 56 – 70 71 – 100 Not obsessive-compulsive Mildly obsessive-compulsive—it is adaptive and generally beneficial Moderately obsessive-compulsive—although still adaptive, you experience short periods of high tension Severely obsessive-compulsive—although adaptive, you may be insecure and hard-driving, experiencing extended periods of high tension Because Gardner didn’t provide any information concerning the development of this test, you should emphasize that this exercise is simply meant to help the student understand obsessive-compulsive behavior, and it is not meant to be used as a diagnostic tool. For example, you may want to have the students discuss test construction issues related to ambiguity in the wording and interpretation of some of the test items. You can also use the test as the basis for a discussion of variations between normal and abnormal levels of obsessive-compulsive behavior. Gardner, R. M. (1980). Exercises for general psychology. Minneapolis, MN: Burgess Publishing. Reprinted from Instructor’s Resource Manual for Psychology (2005) by S. Kassin. Upper Saddle River, N.J.: Pearson Education. ► Return to Lecture Guide: Anxiety Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 45 Activity: Dare to Be Perfect – A Road to Self-Defeat As an attention-getter, ask students to complete the Perfectionism Scale (Handout Master 12.5), which can be distributed to students as they enter the classroom. Once completed, instruct each student to calculate his or her score by adding up the scores on all items, noting that plus numbers and minus numbers cancel each other out. A score of: +20 = –20 = high perfectionism nonperfectionism. About half the population can be expected to score between +2 and +16, indicating varying degrees of perfectionism. Setting unrealistic and unattainable goals may contribute to mood disorders such as depression. Perfectionists are individuals who set personal standards so high that they cannot attain them. Perfectionism is related to poor self-control, low self-esteem, poor health, and a variety of mood disorders such as depression and loneliness. David Burns (Feeling Good: The New Mood Therapy. New York: New American Library, 1981) identifies three types of mental distortions common among perfectionists: All-or-none thinking. Overgeneralization. The use of “should” statements. Thus, when perfectionists fail, they do not engage in constructive self-evaluation, but rather engage in nonproductive self-deprecation. Burns links the inefficiency and defeatism of perfectionism to learned helplessness, and suggests that children learn to fear failure and to overvalue success as a result of their interactions with perfectionist parents. These are parents who dichotomize positive and negative emotional consequences of the child’s successes and failures. A lecture on perfectionism enables the instructor to link depression and other mood disorders to selfconcept, child-rearing values, need for achievement, and fear of failure. The combined impact of these topics should have immediate relevance to college students, who routinely are in situations that challenge their immediate course goals as well as their long-range vocational plans and life goals. ► Return to Lecture Guide: Mood Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: Defining Normal Sexual Behavior (Due to the nature of the content of this exercise, instructors may wish to consider their particular student population before using this exercise.) A classroom exercise described by Mary Kite is effective in addressing difficulties associated with defining sexual behavior as normal or abnormal. Prior to discussing sexual disorders, distribute Kite’s questionnaire on normal sexual behavior that is reproduced in Handout Master 12.6. After students have individually completed the questionnaire, divide them into groups and assign them the task of developing a definition of normal sexual behavior. A representative of each group is then asked to share the group’s definition. An alternative approach suggested by Kite focuses on sex differences in perceptions of normal sexual behavior. She proposed administering two versions of the questionnaire, one referring to men and Copyright © 2010 Pearson Education, Inc. All rights reserved. 46 CHAPTER 12 PSYCHOLOGICAL DISORDERS the other to women. After the students anonymously complete the questionnaire, you can collect them and tabulate the results. Kite suggested that class discussion after the exercise could focus on topics such as differences and similarities in the definitions, the difficulties experienced in arriving at a group consensus on the definition, the role of personal choices in affecting one’s definition, the influence of social norms on definitions, and whether there are sex differences in definitions of normal sexual behavior. After you have reviewed the material in the textbook on sexual disorders, you can also relate these diagnostic categories to some of the items on the questionnaire and have the students compare their responses to items defined in the DSM as abnormal. You might want to discuss the following research by Robert Michael and colleagues (1994). They surveyed 3,500 randomly selected Americans between the ages of 18 and 50.They found the following: Americans tend to fall into 1 of 3 categories: • 1/3 have sex twice a week or more • 1/3 have sex a few times a month • 1/3 have sex a few times a year or not at all • cohabitating (incl. married) couples have sex the most and they are also more likely to have orgasms when they do • most Americans do not engage in kinky sexual acts (1st place—vaginal sex; 2nd place—watching a partner undress; 3rd place—oral sex) • adultery is an exception rather than the rule in married couples • men think about sex far more often than women do (54% of the men said they think about sex every day or several times a day, whereas 67% of the women said they think about it only a few times a week or a few times a month) Kite, M. E. (1990). Defining normal sexual behavior: A classroom exercise. Teaching of Psychology, 17, 118–119. ► Return to Lecture Guide: Sexual and Gender-Identity Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: Demonstrating Schizophrenia Timothy Osberg described a demonstration that is effective in simulating the bizarre verbalizations and thoughts of a schizophrenic. Prior to discussing schizophrenia and without warning, deliver the monologue shown below. Osberg suggested practicing it beforehand to increase its spontaneity and using either blunted or inappropriate affect during its presentation. After students have gotten over their reactions to the monologue, explain that it was meant to illustrate the language, thought processes, and affect of schizophrenia. Ask the students to share what they were thinking during the monologue. Osberg suggested using their responses to generate a discussion of how people might respond to schizophrenics and how these responses might be perceived by the schizophrenic. After describing some of the disturbances of thought and language characteristics of schizophrenia, Osberg suggested showing an overhead transparency of the monologue and asking students to identify examples of these disturbances in the monologue. The “Disordered Monologue,” as originally written by Osberg (1992, p. 47), is given below. Okay class, we’ve finished our discussion of mood disorders. Before I go on I’d like to tell you about some personal experiences I’ve been having lately. You see I’ve [pause] been involved in high abstract [pause] type of contract [pause] which I might try to distract [pause] from your gaze [pause] if it were a new craze [pause] but the sun god has put me into it [pause] the planet of the lost star Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 47 [pause] is before you know [pause] and so you’d better not try to be as if you were one with him [pause] always fails because one and one makes three [pause] and that is the word for three [pause] which must be like the tiger after his prey [pause] and the zommon is not common [pause] it is a zommon’s zommon. [pause] But really class, [holding your head and pausing] what do you think about what I am thinking about right now? You can hear my thoughts can’t you? I’m thinking I’m crazy and I know you [point to a student] put that thought in my mind. You put that thought there! Or could it be that the dentist did as I thought? She did! I thought she put that radio transmitter into my brain when I had the Novocain! She’s making me think this way and she’s stealing my thoughts! Osberg, T. M. (1992). The disordered monologue: A classroom demonstration of the symptoms of schizophrenia. Teaching of Psychology, 19, 47–48. Reprinted from Instructor’s Resource Manual for Psychology 5th edition (2007) by S. F. Davis and J. J. Palladino. Upper Saddle River, NJ: Pearson Education. ► Return to Lecture Guide: Schizophrenic Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: Abnormal Psychology in Literature: The Eden Express Michael Gorman (1984) suggests that Mark Vonnegut’s The Eden Express (an autobiographical account of the author’s schizophrenic breakdown) provides an excellent opportunity for students to apply abnormal psychology principles from the text and lecture to a real case study. After your students have read the book, ask them to write a paper describing the cause and cure of Vonnegut’s schizophrenia in terms of the different theoretical perspectives of psychological disorder. Gorman notes that although Vonnegut himself attributes his illness to biomedical factors, there is also evidence to support behavioral, humanistic, and psychoanalytic theories if one looks hard enough. Importantly, in trying to apply the different perspectives, students should learn the relative strengths and weaknesses of each perspective and also acknowledge the importance of multiple perspectives in explaining complex behavior. Gorman, M. E. (1984). Using the Eden Express to teach introductory psychology. Teaching of Psychology, 11, 39–40. Vonnegut, M. (1975). The Eden Express. New York: Bantam Books. ► Return to Lecture Guide: Schizophrenic Disorders ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: Abnormal Psychology in Film Abnormal behavior is a consistently popular subject for feature films; practically every disorder ever discovered has been portrayed at one time or another. For this assignment, ask students to write a paper analyzing a character’s illness in terms of the theoretical perspectives (e.g., biological, psychoanalytic, cognitive-behavioral, biopsychosocial) presented in the text. Students should include in their paper a description of the character’s diagnosis in terms of the DSM-IV and a discussion of which perspective of mental illness best explains the development of the character’s symptoms. If applicable, students should describe any treatment received by the character and also comment on whether they would recommend a similar or different treatment. All of the films suggested below contain excellent depictions of psychological disorder and should make good choices for this assignment. Note that a few of the films are also noteworthy for their portrayal of the therapeutic process; thus, these are listed in the next chapter as well. Adapted from Chrisler, J. C. (1990). Novels as case-study materials for psychology students. Teaching of Psychology, 17, 55–57. Copyright © 2010 Pearson Education, Inc. All rights reserved. 48 CHAPTER 12 PSYCHOLOGICAL DISORDERS • Henry: Portrait of a Serial Killer (1990). Michael Rooker stars in this fascinating but grisly look into the life of a serial killer (loosely based on real-life Texas murderer Henry Lee Lucas). This unpleasant movie, although not exploitative, depicts several scenes of rapes and murders and includes the gruesome reactions of Henry and his roommate. This movie is not for everyone, and should most certainly be optional. Nonetheless, if you think your students can stomach the violence, they will get some incredible insights into the workings of the mind of an individual with antisocial personality disorder (MPI; 90 min). • Clean, Shaven (1995). Peter Greene stars in this haunting, disturbing look at the world through the eyes of a schizophrenic. Writer/director Lodge Kerrigan masterfully captures the disorientation, confusion, and paranoia of the protagonist’s world as he searches fitfully for his daughter. Along the way we share his frustrations at simple tasks such as making a sandwich or pouring sugar in his coffee. We also witness his self-mutilation as he tries to pry a misperceived transmitter/receiver set from his scalp and thumb. A good film for generating discussion. (Orion Home Video; 80 min). • One Flew Over the Cuckoo’s Nest (1975). Jack Nicholson stars in this moving drama as Randall P. McMurphy, a rebellious prisoner who stirs things up in a mental hospital after his transfer there. In going head to head with the authoritarian Nurse Ratchet, he revives the spirit of the other patients who have been browbeaten into submission by the institution. Although somewhat dated and stereotypical, this surprisingly entertaining film portrays a wide variety of deviant behavior and also highlights controversial therapeutic techniques (e.g., prefrontal lobotomy, electroconvulsive therapy), depicts the often inhumane conditions in mental institutions, and contains fascinating character studies of McMurphy and the other patients (HBO; 129 min). [Note: This film could also be assigned in the personality chapter as a fascinating case study of the character of sane misfit McMurphy.] Kesey, K. (1975). One flew over the cuckoo’s nest. New York: New American Library. • Sybil (1977). Sally Field won an Emmy for her performance in this made-for-TV drama that depicts the story of a woman with 17 different personalities. Although at times disturbing, it convincingly portrays the relatively rare condition of multiple personality disorder (also referred to as “dissociative identity disorder”). Importantly, it depicts Sybil’s adoption of different personalities as an adaptive response to an unbearably abusive childhood, and in doing so provides valuable insights into a unique therapeutic relationship (CBS/Fox; 122 min). Based on the book by Flor Schreiber. Schreiber, F. (1974). Sybil. New York: Warner. ► Return to Lecture Guide: Chapter Review ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Activity: Reviewing Perspectives Objective: To help students understand and retain information about perspectives on abnormal behavior Materials: Handout Master 12.10 Procedures: Students should use the text and their lecture notes to fill in the chart. They can do so individually or in groups. ► Return to Lecture Guide: Chapter Review ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 49 Activity: Crossword Puzzle Copy and distribute Handout Master 12.8 to students as a homework or in-class review assignment. The answers for the crossword puzzle are: Across 10. false sensory perceptions, such as hearing voices that do not really exist. hallucinations 11. disorders in which the main symptom is excessive or unrealistic anxiety and fearfulness. anxiety 17. somatoform disorder in which the person is terrified of being sick and worries constantly, going to doctors repeatedly, and becoming preoccupied with every sensation of the body. hypochondriasis 18. a state of immobility. catatonia 19. in psychology, an emotional reaction. affect 20. fear of being in a small, enclosed space. claustrophobia 21. the break away from an ability to perceive what is real and what is fantasy. psychotic 22. false beliefs held by a person who refuses to accept evidence of their falseness. delusions 23. type of schizophrenia in which behavior is bizarre and childish and thinking, speech, and motor actions are very disordered. disorganized Down 1. the tendency to interpret a single negative event as a never-ending pattern of defeat and failure. overgeneralization 2. severe disorder in which the person suffers from disordered thinking, bizarre behavior, hallucinations, and is unable to distinguish between fantasy and reality. schizophrenia 3. severe mood swings between major depressive episodes and manic episodes. bipolar 4. an irrational, persistent fear of an object, situation, or social activity. phobia 5. cutting holes in the skull of a living person. trephining 6. term referring to someone with antisocial personality disorder. sociopath 7. type of schizophrenia in which the person suffers from delusions of persecution, grandeur, and jealousy, together with hallucinations. paranoid 8. disorder that consists of mood swings from moderate depression to hypomania and lasts two years or more. cyclothymia 9. anything that does not allow a person to function within or adapt to the stresses and everyday demands of life. maladaptive 12. having the quality of excessive excitement, energy, and elation or irritability. Manic 13. fear of being in a place or situation from which escape is difficult or impossible. agoraphobia 14. a moderate depression that lasts for two years or more and is typically a reaction to some external stressor. dysthymia 15. fear of heights. acrophobia 16. the study of abnormal behavior. psychopathology ► Return to Lecture Guide: Chapter Review ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 50 CHAPTER 12 PSYCHOLOGICAL DISORDERS Activity: Fill in the Blank Copy and distribute Handout Master 12.9 to students as a homework or in-class review assignment. Answer Key: Chapter 12 Psychological Disorders – Fill-in-the-Blank 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. biological model psychoanalytic model cognitive-behavioral model diathesis-stress model diathesis systems approach insanity DSM-IV-TR mood disorders depression Major depressive disorder Dysthymia mania bipolar disorder cognitive distortions anxiety disorder specific phobia social phobia Agoraphobia Panic disorder Generalized anxiety disorder Obsessive-compulsive disorder Psychosomatic disorders Somatoform disorders conversion disorders body dysmorphic disorder 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. dissociative disorders dissociative identity disorder Sexual dysfunction Sexual desire disorders; orgasmic disorders Paraphilias voyeurism; frotteurism; transvestic fetishism sexual sadism; sexual masochism pedophilia Gender-identity disorders Personality disorders schizoid personality disorder paranoid personality disorder Dependent personality disorder; avoidant personality disorder narcissistic personality disorder; borderline personality disorder antisocial personality disorder schizophrenic disorders psychotic; hallucinations; delusions catatonic schizophrenia; paranoid schizophrenia attention-deficit hyperactivity disorder psychostimulants Autistic disorder Asperger syndrome ► Return to Lecture Guide: Chapter Review ◄ Return to complete list of Classroom Activities, Demonstrations and Exercises for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 51 ▼HANDOUT MASTERS 12.1 Deviant Behavior 12.2 What Is Abnormal? 12.3 Mental Health Questionnaire (A, B & C) 12.4 Obsessive-Compulsive Test 12.5 The Perfectionism Scale 12.6 Sexual Behavior Questionnaire 12.7 Diagnosing Mental Disorders 12.8 Crossword Puzzle 12.9 Fill in the Blank 12.10 Perspectives on Abnormal Behavior 12.11 Summary of Major DSM-IV Categories ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 52 CHAPTER 12 PSYCHOLOGICAL DISORDERS Handout Master 12.1 Deviant Behavior 1. Describe the deviant behavior you chose to engage in: 2. What is it that makes you define this behavior as abnormal or deviant? Are there circumstances under which it would be normal? 3. Where did you engage in this behavior? 4. How many people observed you? 5. What were their reactions? 6. How did you feel as you engaged in this behavior? How did you feel when you observed the reactions of others? ► Return to Activity: Abnormal Behavior in the College Student ◄ Return to complete list of Handout Masters for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 53 Handout Master 12.2 What Is Abnormal? After each of the descriptions below place an “A” (for abnormal) or an “N” (for normal) based on your analysis of each person. Then, after a class discussion of the criteria for abnormality, indicate which criterion (or criteria) applies to each item. 1. Henry, the editor of a medium-size city’s only newspaper, does not believe that women are capable of serving on the editorial board. He has decided not to promote Karen, a wellqualified veteran of the staff, to the board. __________ 2. Terry has been having terrible nightmares at least three times a week from which he wakes up shaking and sweating. __________ 3. Vanda has visions and hallucinations that she often uses to guide her important decisions. __________ 4. Alana always covers her face when she goes out in public. __________ 5. Tanya hears voices speaking only to her whenever she turns on television, but she is not upset about it. _________ 6. Sam is afraid of snakes. __________ 7. Sally is vaguely dissatisfied because she feels that she is not living up to her potential. __________ 8. Sandy has been plotting to assassinate the governor the next time she appears locally. __________ 9. Even though public transportation is easily accessible, Tom drives to work during a summer ozone alert when the mayor has asked people to use their cars as little as possible. __________ 10. Mary continues to be very upset about her sister’s death, even though the accident that killed her happened two years ago. She still wears dark mourning clothes and cries almost every day whenever she thinks of her sister. __________ 11. Harry is so fearful of crowds that he can no longer ride the bus to work. __________ 12. Luke often urinates on the street. __________ ► Return to Activity: What Is Abnormal? ◄ Return to complete list of Handout Masters for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 54 CHAPTER 12 PSYCHOLOGICAL DISORDERS Handout Master 12.3 (A) Mental Health Questionnaire Instructions: Think of a normal adult male. Check each item below that describes a “mature, healthy, socially competent adult male.” _____ not at all aggressive ____ easily influenced _____ conceited about appearance _____ very objective _____ very ambitious _____ very self-confident _____ almost always acts as a leader _____ has difficulty making decisions _____ very independent _____ dependent _____ does not hide emotions at all _____ likes math and science very much _____ sneaky _____ very direct _____ very active _____ very passive _____ very logical _____ knows the way of the world _____ not at all competitive _____ excitable in a minor crisis _____ feelings easily hurt _____ very adventurous _____ not at all emotional _____ very submissive _____ very strong need for security _____ not uncomfortable about being aggressive Adapted from Anonymous, 1981, “Sex role stereotypes and mental health,” in L. T. Benjamin, Jr. & K. D. Lowman (Eds.), Activities handbook for the teaching of psychology (pp. 141–142). Copyright 1981 by the American Psychological Association. Adapted with permission. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 55 Handout Master 12.3 (B) Mental Health Questionnaire Instructions: Think of a normal adult female. Check each item below that describes a “mature, healthy, socially competent adult female.” _____ not at all aggressive _____ easily influenced _____ conceited about appearance _____ very objective _____ very ambitious _____ very self-confident _____ almost always acts as a leader _____ has difficulty making decisions _____ very independent _____ dependent _____ does not hide emotions at all _____ likes math and science very much _____ sneaky _____ very direct _____ very active _____ very passive _____ very logical _____ knows the way of the world _____ not at all competitive _____ excitable in a minor crisis _____ feelings easily hurt _____ very adventurous _____ not at all emotional _____ very submissive _____ very strong need for security _____ not uncomfortable about being aggressive Adapted from Anonymous, 1981, “Sex role stereotypes and mental health,” in L. T. Benjamin, Jr. & K. D. Lowman (Eds.), Activities handbook for the teaching of psychology (pp. 141–142). Copyright 1981 by the American Psychological Association. Adapted with permission. Copyright © 2010 Pearson Education, Inc. All rights reserved. 56 CHAPTER 12 PSYCHOLOGICAL DISORDERS Handout Master 12.3 (C) Mental Health Questionnaire Instructions: Think of a normal, average adult. Check each item below that describes a “mature, healthy, socially competent adult.” _____ not at all aggressive _____ easily influenced _____ conceited about appearance _____ very objective _____ very ambitious _____ very self-confident _____ almost always acts as a leader _____ has difficulty making decisions _____ very independent _____ dependent _____ does not hide emotions at all _____ likes math and science very much _____ sneaky _____ very direct _____ very active _____ very passive _____ very logical _____ knows the way of the world _____ not at all competitive _____ excitable in a minor crisis _____ feelings easily hurt _____ very adventurous _____ not at all emotional _____ very submissive _____ very strong need for security _____ not uncomfortable about being aggressive Adapted from Anonymous, 1981, “Sex role stereotypes and mental health,” in L. T. Benjamin, Jr. & K. D. Lowman (Eds.), Activities handbook for the teaching of psychology (pp. 141–142). Copyright 1981 by the American Psychological Association. Adapted with permission. ► Return to Activity: Gender Stereotypes and Labeling Mental Illness ◄ Return to complete list of Handout Masters for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 57 Handout Master 12.4 Obsessive-Compulsive Test Instructions: Read each of the statements below and ask yourself if they apply to you. For each question, mark whether these statements apply to you using this scale: 1—none or a little of the time 2—some of the time 3—a good part of the time 4—most or all of the time 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 I prefer things to be done my way. I am critical of people who don’t live up to my standards or expectations. I stick to my principles, no matter what. I am upset by changes in the environment or in the behavior of people. I am meticulous and fussy about my possessions. 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 I get upset if I don’t finish a task. I insist on full value for everything I purchase. I like everything I do to be perfect. I follow an exact routine for everyday tasks. I do things precisely to the last detail. 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 I get tense when my day’s schedule is upset. I plan my time so that I won’t be late. It bothers me when my surroundings are not clean and tidy. I make lists for my activities. I think that I worry about minor aches and pains. 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 I like to be prepared for any emergency. I am strict about fulfilling every one of my obligations. I think that I expect worthy moral standards in others. I am badly shaken when someone takes advantage of me. I get upset when people do not replace things exactly as I left them. 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 I keep used or old things because they might be useful. I think that I am sexually inhibited. I find myself working rather than relaxing. I prefer being a private person. I like to budget myself carefully and live on a cash-and-serve basis. Reprinted from Instructor’s Resource Manual for Psychology (2005) by S. Kassin. Upper Saddle River, N.J.: Pearson Education. ► Return to Activity: The Obsessive-Compulsive Test ◄ Return to complete list of Handout Masters for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 58 CHAPTER 12 PSYCHOLOGICAL DISORDERS Handout Master 12.5 The Perfectionism Scale Decide how much you agree with each statement, using the following scale: +2 +1 0 –1 –2 = = = = = I agree very much I agree somewhat I feel neutral about this I disagree slightly I disagree strongly Fill in the blank preceding each statement with the number that best describes how you think most of the time. Be sure to choose only one answer for each attitude. There are no “right” or “wrong” answers, so try to respond according to the way you usually feel and behave. ____ 1. If I don’t set the highest standards for myself, I am likely to end up a second-rate person. ____ 2. People will probably think less of me if I make a mistake. ____ 3. If I cannot do something really well, there is little point in doing it at all. ____ 4. I should be upset if I make a mistake. ____ 5. If I try hard enough, I should be able to excel at anything I attempt. ____ 6. It is shameful for me to display weaknesses or foolish behavior. ____ 7. I shouldn’t have to repeat the same mistake many times. ____ 8. An average performance is bound to be unsatisfying to me. ____ 9. Failure at something important means I’m less of a person. ____ 10. If I scold myself for failing to live up to my expectations, it will help me to do better in the future. ► Return to Activity: Dare to Be Perfect – A Road to Self-Defeat ◄ Return to complete list of Handout Masters for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 59 Handout Master 12.6 Sexual Behavior Questionnaire Instructions: Please rate whether or not each of the following activities represents normal sexual behavior by placing either a Y (yes) or N (no) in the blank. _______ 1. Watching X-rated movies several times a week. _______ 2. Having sex with more than one person at the same time. _______ 3. Preferring oral sex over intercourse. _______ 4. Having intercourse with a member of the same sex. _______ 5. Fantasizing about having sex with a member of the same sex. _______ 6. Fantasizing about a person other than one's partner during sexual intercourse _______ 7. Masturbating in front of a partner. _______ 8. Having sex somewhere other than a bed (e.g., floor, shower, kitchen, outdoors). _______ 9. Never engaging in masturbation. ______ 10. Becoming excited by exposing oneself in public. ______ 11. Being celibate. ______ 12. Being unable to achieve orgasm. ______ 13. Enjoying being physically restrained during sex (e.g., bondage). ______ 14. Becoming aroused by voyeurism (e.g., Peeping Toms). ______ 15. Playing with food (e.g., fruit and whipped cream) during sex. ______ 16. Dressing in the clothing of the other sex. ______ 17. Preferring that one's partner initiates sex. ______ 18. Inflicting pain during sex. ______ 19. Receiving pain during sex. ______ 20. Using sex toys (e.g., a vibrator) during sex. ______ 21. Having rape fantasies. ______ 22. Masturbating after marriage. ______ 23. Not being aroused by a nude member of the other sex. ______ 24. Being aroused by receiving an obscene phone call. ______ 25. Being aroused by making an obscene phone call. Copyright © 2010 Pearson Education, Inc. All rights reserved. 60 CHAPTER 12 PSYCHOLOGICAL DISORDERS ______ 26. Engaging in sex with animals. ______ 27. Deriving sexual pleasure from seeing or touching dead bodies. ______ 28. Becoming aroused by being urinated on. ______ 29. Becoming aroused by soiling the clothing of the other sex. ______ 30. Becoming aroused by viewing or touching feces. Reprinted with permission from M. E. Kite, Defining normal sexual behavior: A classroom exercise, Teaching of Psychology, 17, 118–119. Copyright 1990 by Lawrence Erlbaum Associates, Inc. ► Return to Activity: Defining Normal Sexual Behavior ▼Return to complete list Handout Masters for Chapter 12 ▲ Return to Chapter 12: Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 61 Handout Master 12.7 Diagnosing Mental Disorders Instructions: For each of the following case studies, play the role of a clinician and make the most accurate diagnosis possible from the given information. Write your response in the blank space beneath each description. 1. If you interacted with Scott briefly, you might think that he is normal. However, once he told you about the government’s plot against him and how he was going to be rescued by some alien friends, you would start to suspect that he is disordered. 2. Matthew, although a good-looking guy, is so preoccupied with what he thinks is his large, unsightly nose that he is unable to realistically evaluate his own looks and often talks with his hands in front of his face. He will likely have plastic surgery some day. 3. As a baby, Charlie resisted being held and showed no interest in human stimulation. Usually passive, he sometimes played with his wind-up toys but did not respond to his name being called and showed outbursts of temper if someone moved even one of his little cars from where he had placed it. 4. Shannon’s moods seem to swing abruptly, and she often seems unable to control her impulses. She has had many sexual encounters and often complains of boredom, though she is seldom alone and often caught up in very intense, stormy relationships. Her friends are on edge around her because of her JekyllHyde behavior. 5. Emmit, who has just suffered a serious knee injury, cannot undergo an MRI because he has an irrational fear of narrow, enclosed places. 6. Frank awoke one morning and suddenly realized that he had another name and a family in another state. He had no idea how he came to be living his present life. 7. Although Karina was not personally injured in the earthquake, the experience was a terrifying one and her house was badly damaged. She has frequent nightmares about earthquakes, and even when awake she sometimes gets flashes as if she’s reliving the experience. The slightest noise or movement around her causes her heart to pound rapidly. 8. Roger loves to go to the mall on Saturdays, when it is most crowded, because there are lots of opportunities for him to rub up against women without them knowing it. Few activities make Roger as sexually aroused as this one. Copyright © 2010 Pearson Education, Inc. All rights reserved. 62 CHAPTER 12 PSYCHOLOGICAL DISORDERS 9. Although Elaine is a kind, considerate person, she has trouble making decisions by herself. She leans heavily on her friends and family for advice, even for seemingly trivial decisions. 10. While teaching her class one day, Theresa suddenly begins having difficulty breathing. Her heart starts pounding wildly, and she feels weak and dizzy. She feels as if she’s having a heart attack and is honestly afraid that she’s going to die in the next minute or two. (Assume that Theresa is not having a heart attack). 11. Although Jack is enjoying watching the football game, he feels oddly detached, as though he is watching himself and his actions from outside of his own body. Because this has happened several times recently, Jack is startled for fear that he will totally lose control of his thoughts and behavior. 12. Sarah has an unrealistic fear of shopping in crowded stores and walking through crowded streets. She has begun to spend more and more time home alone in order to avoid the panicky feeling she gets when she goes out in public. 13. Sam’s friends are starting to worry about him. Normally energetic and fun-loving, Sam has become withdrawn and sullen. He has lost weight, is constantly tired, and hasn’t been showing up to lacrosse practice or to his fraternity meetings. In his conversations with others, he expresses feelings of doubt and unworthiness, and seems to be entertaining suicidal thoughts. 14. Because Amy feels “dirty” a lot of the time, she spends much of her day at the sink, washing and rewashing her hands hundreds of times until they are red and raw. 15. Joan has seen several specialists and undergone numerous diagnostic tests to determine the cause of her recurring headaches and episodes of dizziness. The doctors are perplexed and can seem to find no physiological cause for Joan’s symptoms. Reprinted from Instructor’s Resource Manual for Psychology (2005) by S. Kassin. Upper Saddle River, N.J.: Pearson Education. ► Return to Activity: Diagnosing Mental Disorders ◄ Return to complete list of Handout Masters for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 63 Handout Master 12.8 Crossword Puzzle Activity Chapter 12: Psychological Disorders Copyright © 2010 Pearson Education, Inc. All rights reserved. 64 CHAPTER 12 PSYCHOLOGICAL DISORDERS Across 10. false sensory perceptions, such as hearing voices that do not really exist. 11. disorders in which the main symptom is excessive or unrealistic anxiety and fearfulness. 17. somatoform disorder in which the person is terrified of being sick and worries constantly, going to doctors repeatedly, and becoming preoccupied with every sensation of the body. 18. a state of immobility. 19. in psychology, an emotional reaction. 20. fear of being in a small, enclosed space. 21. the break away from an ability to perceive what is real and what is fantasy. 22. false beliefs held by a person who refuses to accept evidence of their falseness. 23. type of schizophrenia in which behavior is bizarre and childish and thinking, speech, and motor actions are very disordered. Down 1. the tendency to interpret a single negative event as a never-ending pattern of defeat and failure. 2. severe disorder in which the person suffers from disordered thinking, bizarre behavior, hallucinations, and is unable to distinguish between fantasy and reality. 3. severe mood swings between major depressive episodes and manic episodes. 4. an irrational, persistent fear of an object, situation, or social activity. 5. cutting holes in the skull of a living person. 6. term referring to someone with antisocial personality disorder. 7. type of schizophrenia in which the person suffers from delusions of persecution, grandeur, and jealousy, together with hallucinations. 8. disorder that consists of mood swings from moderate depression to hypomania and lasts two years or more. 9. anything that does not allow a person to function within or adapt to the stresses and everyday demands of life. 12. having the quality of excessive excitement, energy, and elation or irritability. 13. fear of being in a place or situation from which escape is difficult or impossible. 14. a moderate depression that lasts for two years or more and is typically a reaction to some external stressor. 15. fear of heights. 16. the study of abnormal behavior. ► Return to Activity: Crossword Puzzle ◄ Return to complete list of Handout Masters for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 65 Handout Master 12.9 Fill in the Blank Class Activity 1. The _______________ _______________ holds that abnormal behavior is caused by physiological malfunction, especially of the brain. 2. The _______________ _______________ originating with Freud holds that abnormal behavior is a symbolic expression of unconscious conflicts that generally can be traced to childhood. 3. The _______________-_______________ _______________ states that psychological disorders arise when people learn maladaptive ways of thinking and acting. 4. According to the_______________-_______________ _______________, psychological disorders develop when a biological predisposition is triggered by stressful circumstances. 5. A _______________ is a biological predisposition. 6. The _______________ _______________ contends psychological disorders are “lifestyle diseases” arising from a combination of biological risk factors, psychological stresses, and societal pressures. 7. The term _______________ should be understood as a legal term, not a psychological one, and it is typically applied to defendants who were mentally disturbed when they committed their offense. 8. The American Psychiatric Association (APA) has issued a manual, the abbreviated title of which is _______________, that describes and classifies the various kinds of psychological disorders. 9. Most people have a wide emotional range, but in some people with _______________ _______________, this range is greatly restricted. 10. The most common mood disorder is _______________, in which a person feels overwhelmed with sadness, loses interest in activities, and displays such other symptoms as excessive guilt, feelings of worthlessness, insomnia, and loss of appetite. 11. _______________ _______________ _______________ is an episode of intense sadness that may last for several months; in contrast, 12. _______________ involves less intense sadness but persists with little relief for a period of 2 years or more. 13. People suffering from _______________ become euphoric (“high”), extremely active, excessively talkative, and easily distracted. 14. A mood disorder in which both mania and depression are alternately present and are sometimes interrupted by periods of normal mood is known as _______________ _______________. 15. A psychological factor related to depression is _______________ _______________, which are illogical and maladaptive responses to early life events that lead to feelings of incompetence and unworthiness. Copyright © 2010 Pearson Education, Inc. All rights reserved. 66 CHAPTER 12 PSYCHOLOGICAL DISORDERS 16. Normal fear is caused by something identifiable and the fear subsides with time, but with _______________ _______________, either the person doesn’t know the source of the fear or the anxiety is inappropriate to the circumstances. 17. A _______________ _______________ is an intense, paralyzing fear of something that it is unreasonable to fear so excessively. 18. A _______________ _______________ is excessive, inappropriate fear connected with social situations or performances in front of other people. 19. _______________ is a debilitating anxiety disorder that involves multiple, intense fears such as the fear of being alone, of being in public places, or of other situations involving separation from a source of security. 20. _______________ _______________ is characterized by recurring sudden, unpredictable, and overwhelming experiences of intense fear or terror without any reasonable cause. 21. _______________ _______________ _______________ is defined by prolonged vague, but intense fears that, unlike phobias, are not attached to any particular object or circumstance. 22. _______________-_______________ _______________ involves either involuntary thoughts that recur despite the person’s attempt to stop them or compulsive rituals that a person feels compelled to perform. 23. _______________ _______________ are illnesses that have a valid physical basis, but are largely caused by psychological factors such as excessive stress and anxiety. 24. _______________ _______________ are characterized by physical symptoms without any identifiable physical cause. 25. There are various forms of somatoform disorders. One of the more dramatic forms of these disorders are _______________ _______________ that involve complaints of paralysis, blindness, deafness, or other significant conditions, but no physical causes exist. 26. A recently-identified form of somatoform disorder is _______________ _______________ _______________ in which a person becomes so preoccupied with his/her imagined ugliness that normal life is not possible. 27. In _______________ _______________, some part of a person’s personality or memory is separated from the rest. 28. In _______________ _______________ _______________ – commonly known as multiple personality disorder – several distinct personalities emerge at different times. 29. _______________ _______________is the loss or impairment of the ability to function effectively during sex. 30. _______________ _______________ _______________ involve a lack of interest in or an active aversion to sex, while people with _______________ _______________ experience both desire and arousal but are unable to reach orgasm. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 67 31. _______________ involve the use of unconventional sex objects or situations to obtain sexual arousal. 32. There exist numerous forms of paraphilias, including _______________ (desire to watch others having sexual relations), _______________ (achieving sexual arousal through contact with a nonconsenting person in public), and _______________ _______________ (obtaining sexual gratification by wearing the clothes of the opposite sex). 33. Obtaining sexual satisfaction from humiliating or harming a sex partner is called _______________ _______________, while the inability to enjoy sex without experiencing emotional or physical pain is called _______________ _______________. 34. One of the most serious paraphilias is _______________, the engaging in sexual relations with children. 35. _______________-_______________ _______________ involve the desire to become, or the insistence that one really is, a member of the other sex. 36. _______________ _______________ are enduring, inflexible, and maladaptive ways of thinking and behaving that are so exaggerated and rigid that they cause serious inner distress or conflicts with others. 37. People who exhibit _______________ _______________ _______________ lack the ability or desire to form social relationships and have no warm feelings for other people. 38. People with _______________ _______________ _______________ are inappropriately suspicious, hypersensitive, and argumentative. 39. _______________ _______________ _______________ is characterized by the inability to think or act independently, while _______________ _______________ _______________ is characterized by timidity and social anxiety that lead to isolation. 40. People with _______________ _______________ _______________ have a highly overblown sense of self-importance, whereas those with _______________ _______________ _______________ show much instability in self-image, mood, and interpersonal relationships. 41. People with _______________ ______________ _______________ chronically lie, steal, and cheat with little or no remorse. 42. Dramatic disruptions in thought and communication, inappropriate emotions, and bizarre behavior that lasts for years are symptomatic of _______________ _______________. 43. People with schizophrenia are _______________ (out of touch with reality), and they often suffer from _______________ (false sensory perceptions) and _______________ (false beliefs about reality). 44. There are several subtypes of schizophrenia; among them are _______________ _______________ (characterized by mute immobility) and _______________ _______________ (characterized by extreme suspiciousness related to complex deulsions). Copyright © 2010 Pearson Education, Inc. All rights reserved. 68 CHAPTER 12 PSYCHOLOGICAL DISORDERS 45. Children with _______________-_______________ ______________ _______________ are highly distractible, often fidgety and impulsive, and almost constantly in motion. 46. Treatment of ADHD often involves prescriptions for _______________ because they increase the ability of the child to focus attention on task at hand. 47. _______________ _______________ is characterized by a failure to form normal social attachments, by severe speech impairment, and by strange motor behaviors. 48. Autistic spectrum disorder (ASD) is used to describe individuals with symptoms that are similar to those seen in autistic disorder, but may be less severe, as is the case in _______________ _______________. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 69 Words to Use: agoraphobia antisocial personality disorder anxiety disorder Asperger syndrome attention-deficit hyperactivity disorder autistic disorder avoidant personality disorder biological model bipolar disorder body dysmorphic disorder borderline personality disorder catatonic schizophrenia cognitive-behavioral model cognitive distortions conversion disorders delusions dependent personality disorder depression diathesis diathesis-stress model dissociative disorders dissociative identity disorder DSM-IV-TR Dysthymia frotteurism gender-identity disorders generalized anxiety disorder hallucinations insanity major depressive disorder mania mood disorders narcissistic personality disorder obsessive-compulsive disorder orgasmic disorders panic disorder paranoid personality disorder paranoid schizophrenia paraphilias pedophilia personality disorders psychoanalytic model psychosomatic disorders psychostimulants psychotic schizoid personality disorder schizophrenic disorders sexual desire disorders sexual dysfunction sexual masochism sexual sadism social phobia somatoform disorders specific phobia systems approach transvestic fetishism voyeurism ► Return to Activity: Fill in the Blank ◄ Return to complete list of Handout Masters for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 70 CHAPTER 12 PSYCHOLOGICAL DISORDERS Handout Master 12.10 Perspectives on Abnormal Behavior Definition of Perspective Biological View of Abnormal Behavior Causes: Treatments: Biopsychosocial Causes: Treatments: Psychodynamic Causes: Treatments: Learning Causes: Treatments: Cognitive Causes: Treatments: Humanistic Causes: Treatments: ► Return to Activity: Reviewing Perspectives ◄ Return to complete list of Handout Masters for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 71 Handout Master 12.11 Summary of Major DSM-IV Categories Type of disorder Subtype (examples) Disorders usually first diagnosed in infancy, childhood, or adolescence mental retardation; attention deficit with hyperactivity; separation anxiety; eating disorders; gender identity disorder Delirium, dementia, amnesia, and other cognitive disorders Alzheimer’s disease Substance-related disorders alcohol abuse and dependence; drug abuse and dependence; nicotine dependence Schizophrenic and other psychotic disorders schizophrenia (one of five varieties) Delusional disorders paranoia (one of six varieties) Mood disorders depression; bipolar disorders Anxiety disorders phobias; panic disorder; obsessive-compulsive disorder; generalized anxiety disorder Somatoform disorders conversion disorder (hysterical neurosis); hypochondriasis Dissociative disorders psychogenic amnesia; fugue; dissociative identity disorder Sexual disorders and gender identity disorders paraphilias; sexual dysfunctions Impulse control disorders pathological gambling; pyromania; kleptomania Personality disorders schizoid; histrionic; paranoid; narcissistic; compulsive; antisocial; passive-aggressive Sleep disorders insomnia Eating disorders anorexia; bulimia Adjustment disorders adjustment disorder ◄ Return to complete list of Handout Masters for Chapter 12 ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 72 CHAPTER 12 PSYCHOLOGICAL DISORDERS ▼APS: READINGS FROM THE ASSOCIATION OF PSYCHOLOGICAL SCIENCE Current Directions in Introductory Psychology, Second Edition (0137143508) Edited by Abigail A. Baird, with Michele M. Tugade and Heather B. Veague Barry L. Jacobs Depression: The Brain Finally Gets Into the Act. (Vol. 13, No. 3, 2004, pp. 103—106) p. 129 in the APS Reader The theory of clinical depression presented here integrates etiological factors, changes in specific structural and cellular substrates, ensuing symptomatology, and treatment and prevention. According to this theory, important etiological factors, such as stress, can suppress the production of new neurons in the adult human brain, thereby precipitating or maintaining a depressive episode. Most current treatments for depression are known to elevate brain serotonin neurotransmission, and such increases in serotonin have been shown to significantly augment the ongoing rate of neurogenesis, providing the neural substrate for new cognitions to be formed, and thereby facilitating recovery from the depressive episode. This theory also points to treatments that augment neurogenesis as new therapeutic opportunities. ► Return to Lecture Guide: Mood Disorders ▲ Return to Chapter 12 Table of Contents Morton Ann Gernsbacher, Michelle Dawson, H. Hill Goldsmith Three Reasons Not to Believe in an Autism Epidemic. (Vol. 14, No. 2, 2005, pp. 55—58) p.136 in the APS Reader According to some lay groups, the nation is experiencing an autism epidemic—a rapid escalation in the prevalence of autism for unknown reasons. However, no sound scientific evidence indicates that the increasing number of diagnosed cases of autism arises from anything other than purposely broadened diagnostic criteria, coupled with deliberately greater public awareness and intentionally improved case finding. Why is the public perception so disconnected from the scientific evidence? In this article we review three primary sources of misunderstanding: lack of awareness about the changing diagnostic criteria, uncritical acceptance of a conclusion illogically drawn in a Californiabased study, and inattention to a crucial feature of the “child count” data reported annually by the U.S. Department of Education. ► Return to Lecture Guide: Childhood Disorders ▲ Return to Chapter 12 Table of Contents George A. Bonanno Resilience in the Face of Potential Trauma. (Vol. 14, No. 3, 2005, pp. 135-138) p. 143 in the APS Reader Until recently, resilience among adults exposed to potentially traumatic events was thought to occur rarely and in either pathological or exceptionally healthy individuals. Recent research indicates, however, that the most common reaction among adults exposed to such events is a relatively stable pattern of healthy functioning coupled with the enduring capacity for positive emotion and generative experiences. A surprising finding is that there is no single resilient type. Rather, there appear to be multiple and sometimes unexpected ways to be resilient, and sometimes resilience is achieved by means that are not fully adaptive under normal circumstances. For example, people who characteristically use self-enhancing biases often incur social liabilities but show resilient outcomes when confronted with extreme adversity. Directions for further research are considered. ► Return to Lecture Guide: Anxiety Disorders ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 73 ▼Forty Studies that Changed Psychology: Explorations into the History of Psychological Research, Sixth Edition (013603599X) By Roger Hock Who’s Crazy Here, Anyway? Rosenhan, D. L. (1973). On being sane in insane places. Science, 179, 250—258. ► Return to Lecture Guide: Perspectives on Psychological Disorders ▲ Return to Chapter 12 Table of Contents You’re Getting Defensive Again! Freud, A. (1946). The ego and the mechanisms of defense. New York: International Universities Press. ► Return to Lecture Guide: Perspectives on Psychological Disorders ▲ Return to Chapter 12 Table of Contents Learning to be Depressed Seligman, M. E. P., & Maier, S. F. (1967). Failure to escape traumatic shock. Journal of Experimental Psychology, 74, 1—9. ► Return to Lecture Guide: Mood Disorders ▲ Return to Chapter 12 Table of Contents Crowding into the Behavioral Sink Calhoun, J. B. (1962). Population density and social pathology. Scientific American, 206(3), 139—148. ► Return to Lecture Guide: Anxiety Disorders ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 74 CHAPTER 12 PSYCHOLOGICAL DISORDERS ▼WEB RESOURCES Supersites Art Brut: http://www.artbrut.com/ A collection of art by the mentally ill. Not sponsored by Mr. Arthur Brut Internet Mental Health: http://www.mentalhealth.com/ Links related to Abnormal Psychology Mental Health Infosource: http://www.mhsource.com/ Use the searchable database to learn more about various aspects of mental health and illness. Mental Health Net: http://www.mhnet.org/disorders/ Comprehensive descriptions of the symptoms and treatment of mental disorders are presented here. Brush up on your DSM-IV categories and information about a variety of conditions as you prepare your classroom discussions. Symptoms of Mental Illness: http://psychcentral.com/disorders/ The symptoms and treatments of various mental disorders are summarized. Teaching Clinical Psychology: http://www.rider.edu/users/suler/tcp.html Resources for teaching about abnormal psychology, disorders, and treatment. Wonderful World of Diseases!: http://www.diseaseworld.com/disease.htm Information, information, and more information on physical and mental disorders. ► Return to Lecture Guide: Perspectives on Psychological Disorders Anxiety Disorders Answers to Your Questions About Panic Disorder: http://www.apa.org/pubinfo/panic.html Information prepared by the American Psychological Association. Anxiety Disorders Association of America (ADAA): http://www.adda.org Comprehensive site related to anxiety disorders. National Center for PTSD: http://www.ncptsd.org/ Post-traumatic Stress Disorder finds a home at this site. Learn more about PTSD and related disorders. Obsessive Compulsive Foundation: http://www.ocfoundation.org/ Information about the disorder and links to related sites. OCD: http://www.mentalhealth.com/dis/p20-an05.html Check this site for information about OCD. OC and Spectrum Disorders Association: http://www.ocdhelp.org/ Information about obsessive compulsive disorder and related disorders. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 75 Reliving Trauma: Post-Traumatic Stress Disorder: http://www.nimh.nih.gov/publicat/reliving.cfm Information from the National Institute of Mental Health. ► Return to Lecture Guide: Anxiety Disorders Mood Disorders Bipolar Disorder: http://www.nimh.nih.gov/publicat/bipolar.cfm Informative text on bipolar disorder prepared by the National Institute of Mental Health. Bipolar Disorders Information Center: http://www.mhsource.com/bipolar/index.html Information about bipolar disorder. Depression: http://www.nimh.nih.gov/publicat/depression.cfm An online brochure prepared by the National Institute of Mental Health. Dysthymic Disorder: http://www.mentalhealth.com/dis/p20-md04.html Links to information and online articles on dysthymic disorder from Internet Mental Health. Dysthymic Disorder: http://www.mentalhealth.com/dis1/p21-md04.html Diagnostic criteria, presented by Internet Mental Health. Famous People with Bipolar Disorder: http://www.pendulum.org/pwbpd/famous.htm - top Major Depression: http://sandbox.xerox.com/pair/cw/testing.html Interactive online screening test for major depression. National Depression and Manic-Depressive Association: http://www.ndmda.org/ DMDA offers information about bipolar disorder, depression, and related disorders. ► Return to Lecture Guide: Mood Disorders Personality Disorders Antisocial Personality Disorder: http://www.mentalhealth.com/fr20.html Links to information on this topic, from Internet Mental Health. Go to this page, then choose “Antisocial Personality” from the list on the left side of the page. Borderline Sanctuary: http://www.mhsanctuary.com/borderline/ Although this site sounds like an “almost haven,” it provides useful information about borderline personality disorder. Crime Times: http://www.crime-times.org/titles.htm (Research Reviews and Information on Biological Causes of Violent, Criminal, and Psychopathic Behavior)—links to resources on this topic. Is Your Stockbroker a Psychopath?: http://www.geocities.com/WallStreet/8587/psycho.html Maybe, maybe not. Decide for yourself. Copyright © 2010 Pearson Education, Inc. All rights reserved. 76 CHAPTER 12 PSYCHOLOGICAL DISORDERS National Television Violence Study: http://www.mediascope.org/pubs/intvs.htm and http://www.mediascope.org/pubs/intvsca.htm Project overview and summary of findings and recommendations. Personality Disorder Test: http://www.4degreez.com/misc/personality_disorder_test.mv Take this test to (maybe) find out if you have a personality disorder. Self- Injury Resources: http://www.palace.net/~llama/psych/injury.html Resources for those who injure themselves and those who care about those who injure themselves. What Makes Kids Care?:Teaching Gentleness in a Violent World: http://www.apa.org/pubinfo/altruism.html A summary by the American Psychological Association. ► Return to Lecture Guide: Personality Disorders Schizophrenia Delusional Parasitosis: http://www.fpnotebook.com/DER187.htm Some people think there are icky, crawly things living in their bodies. Find out more about the symptoms and treatments for this disorder. Demonic Possession: http://serendip.brynmawr.edu/bb/neuro/neuro99/web3/Bromwell.html Learn more about this once-popular view of mental illness. Dr. Rosemary F. Rodgers: http://www.tapping.org/ Dr. Rodgers has been diagnosed as a paranoid schizophrenic, yet she believes that she is simply experiencing a normal response to stress. Her letters are presented on this site. Mauritzio Baldini’s Story: http://www.mentalhealth.com/story/p52-sc01.html Written for Internet Mental Health,August 1995, first-person account of the author’s experiences with schizophrenia. Schizophrenia: http://www.mentalhealth.com/p20-grp.html Description, diagnostic criteria, and links to further information brought to you by Internet Mental Health. Schizophrenia: http://schizophrenia.mentalhelp.net/ Nicely organized information about this disorder from Mental Health Net. Schizophrenia—Adrift in an Anchorless Reality: http://www.mentalhealth.com/story/p52-sc03.html Janice C. Jordan’s story of her own illness, originally published in Schizophrenia Bulletin,Volume 21, No. 3, 1995, presented on the Web by Internet Mental Health. Schizophrenia: A Handbook for Families: http://www.schizophrenia.com/ Extensive, well-organized information on schizophrenia, published by Health Canada in cooperation with the Schizophrenia Society of Canada, presented on the Schizophrenia Home Page—information about schizophrenia and extensive links to related resources. ► Return to Lecture Guide: Schizophrenic Disorders Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 77 Suicide New Understanding of Suicide: http://www.abc.net.au/quantum/info/q95-17-3.htm Craig, O. (Researcher). (1995). Quantum. Older Adults: Depression and Suicide Facts: http://www.nimh.nih.gov/publicat/elderlydepsuicide.cfm Information presented by the National Institute of Mental Health. Rates of Suicidal Deaths in Specific Age Groups, by Race and Sex—United States, 1995: http://suicidepreventtriangle.org/UsRates.htm Data presented in tabular form, by the Suicide Prevention Triangle. The SPT Assessment: http://suicidepreventtriangle.org/Cspt.htm A self-assessment tool designed to assess suicide risk, provides online feedback about your risk for suicide, presented by the Suicide Prevention Triangle. Suicide and Suicide Prevention: http://www.psycom.net/depression.central.suicide.html Links related to this topic from Dr. Ivan’s Depression Central. Suicide Awareness\Voices of Education (SA\VE): http://www.save.org/ Links to information about suicide and its relation to depression. ► Return to Lecture Guide: Mood Disorders ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 78 CHAPTER 12 PSYCHOLOGICAL DISORDERS ▼VIDEO CLIPS AVAILABLE FOR CHAPTER 12 PSYCHOLOGICAL DISORDERS Bipolar Syndrome (1:51) Origins of Schizophrenia (3:12) Sara – Post Traumatic Stress Disorder (16:39) Everett – Major Depression (23:36) Hair Pulling (10:03) A Troubled Mind (19:33) Panic Disorder (1:40) Genetic Schizophrenia (1:45) Bonnie: Post Traumatic Stress Disorder (9:25) David: Asperger’s Syndrome (8:39) Feliziano: Bipolar Disorder (8:40) The Compulsive Mind: Tourette’s Syndrome (2:27) Depression and Manic Depression (1:41) Jimmy: Attention Deficit/Hyperactivity Disorder (ADHD) (17:21) ▲ Return to Chapter 12 Table of Contents ▼From Introductory Psychology Teaching Films Boxed Set ISBN (0131754327) Disc #4: Psychological Disorders (9 clips) Bipolar Syndrome Source: Films for Humanities & Sciences Video: Depression and Manic Depression Run Time: 1:51 Description: Bipolar syndrome (“manic depression”) has affected several well-known people, including Virginia Woolfe, Abraham Lincoln, Winston Churchill, Mike Wallace, Charlie Parker, and Vincent van Gogh. One sufferer talks about her experiences with bipolar disorder, noting the incredible exuberance she felt during the manic stages and the crushing blackness she grappled with during bouts of depression. Uses: This segment shows a brief montage of politicians, artists, and celebrities who have suffered from bipolar disorder. Students will know doubt recognize these individuals, and you might supplement this list with several more well-known individuals. Use these examples to illustrate how psychological disorders can affect people from all walks of life, and to illustrate the importance of overcoming the stigma surrounding mental illness and therapy. ► Return to Lecture Guide: Mood Disorders ► Return to Video Clip List Origins of Schizophrenia Source: Films for Humanities & Sciences Video: Schizophrenia: New Definitions…. Run Time: 3:12 Description: This segment from NewsHour with Jim Lehrer examines the origins of schizophrenia. The disorder’s biological basis is described in straightforward terms, and researcher Reuben Gur explains how brain scan technology can capture the disordered thought of schizophrenia in action. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 79 Uses: This segment is a good way to disabuse students of many misconceptions about schizophrenia: that it is synonymous with “multiple personality,” that it is caused by maladaptive family patterns, that there is no remediation for schizophrenia, and so on. Use this clip midway through your presentation on disorders and therapy; after some basic definitions and examples are given, but before a detail of causes and consequences of the disorder are considered. ► Return to Lecture Guide: Schizophrenic Disorders ► Return to Video Clip List Sara – Post Traumatic Stress Disorder Source: Pearson Education Run Time: 16:39 Description: In this interview, Sara discusses the Post-traumatic Stress Disorder that developed from a nine-year abusive relationship. During the course of that relationship, her boyfriend, who was an alcohol and cocaine abuser, began to collect and threaten her with numerous guns. This abuse led her to develop fear and paranoia, which eventually became so strong that she abandoned the relationship and went into hiding. Now Sara has begun to put her life back in order but still experiences flashbacks and nightmares relating to her time in the relationship. She avoids places she used to go and feels physiological effects at the time of night when her boyfriend used to arrive even though now she realizes her fears are illogical. Of particular interest in this interview is Sara’s discussion of the symptoms of PTSD, both psychological and physical. ► Return to Lecture Guide: Anxiety Disorders ► Return to Video Clip List Everett – Major Depression Source: Pearson Education Run Time: 23:36 Description: In this interview, Everett talks about the major depression he has experienced since childhood. Beginning at the age of two, Everett explains how his depression has affected many important areas of his life: he had difficulties with relationships, low self-esteem, poor occupational functioning, etc. To deal with his illness, Everett began self-medicating with prescription drugs as well as alcohol and eventually tried to commit suicide. He was reluctant to be hospitalized fearing stigma, but eventually spent more than six months in a hospital. Now he feels he has turned his life around and is working to “tear down the walls” he built in his relationships during the first 48 years of his life. A particularly interesting segment is his discussion of how one feels during a Depressive Episode. ► Return to Lecture Guide: Mood Disorders ► Return to Video Clip List Copyright © 2010 Pearson Education, Inc. All rights reserved. 80 CHAPTER 12 PSYCHOLOGICAL DISORDERS Hair Pulling Source: ABC News – 20/20 (4/25/2003) Run Time: 10:03 Description: A little known psychological disorder called Trichotillomania, in which sufferers pull out their own hair, is presented. Uses: Shows how unusual, harmful behavior can persist even when the person is not considered to have a “serious” mental disorder. ► Return to Lecture Guide: Anxiety Disorders ► Return to Video Clip List A Troubled Mind Source: ABC News – Nightline (3/22/02) Run Time: 19:33 Description: Compares and contrasts Hollywood’s portrayal of paranoid schizophrenia to the real experience. Uses: Open a discussion about the stigma associated with mental illness. ► Return to Lecture Guide: Schizophrenic Disorders ► Return to Video Clip List Panic Disorder Source: ScienCentral Run Time: 1:40 Description: This video clip looks at brain imaging during a screening for panic disorder. Such tests provide new insight about treatment for the disorder. Use: This video segment gives students the opportunity to see the importance of new technological discoveries about the brain and psychological disorders. ► Return to Lecture Guide: Anxiety Disorders ► Return to Video Clip List Genetic Schizophrenia Source: ScienCentral Run Time: 1:45 Description: This video looks at a possible genetic cause for schizophrenia. Genetically engineered mice are used to identify the genes that cause this disorder. Use: This video will be a good introduction into the possible causes of schizophrenia. The introduction also proves a good example of how someone with schizophrenia might view the world. ► Return to Lecture Guide: Schizophrenic Disorders ► Return to Video Clip List ▲ Return to Chapter 11 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 81 ▼ From: Pearson Education Teaching Films Introductory Psychology: Instructor’s Library 2-Disk DVD Annual Edition (ISBN 0205652808) Bonnie: Post Traumatic Stress Disorder Source: Pearson Run Time: 9:25 Description: Bonnie is an EMT who attended to the 9/11 disaster, and has since experienced the horror of seeing death and being buried alive after the towers collapsed. Her post traumatic stress disorder includes feeling guilty for leaving the scene, inability to sleep, agoraphobia, and feeling unsafe and paranoid. ► Return to Lecture Guide: Anxiety Disorders ► Return to Video Clip List David: Asperger’s Syndrome Source: Pearson Run Time: 8:39 Description: David discusses being diagnosed with Asperger’s Syndrome, a form of high-end autism. He covers features of it including intelligence, the inability to interact socially and read others’ emotions, and needing clear expectations and to think about what to do and say. ► Return to Lecture Guide: Childhood Disorders ► Return to Video Clip List Feliziano: Bipolar Disorder Source: Pearson Run Time: 8:40 Description: Feliziano talks about the highs and lows of his bipolar disorder. During depression, he feels tired, introverted, nervous, paranoid, and has thoughts of suicide; during hypomania, he has lots of energy and feels outgoing. ► Return to Lecture Guide: Mood Disorders ► Return to Video Clip List Copyright © 2010 Pearson Education, Inc. All rights reserved. 82 CHAPTER 12 PSYCHOLOGICAL DISORDERS ▼From Introductory Psychology Teaching Films Boxed Set ISBN (0131754327) Disc #2 Human Development: Jimmy: Attention Deficit/Hyperactivity Disorder (ADHD) Source: Pearson Run Time: 17:21 Description: In this interview, Jimmy and his mother discuss his ADHD and the effect it has had on him and the family. Note that although Jimmy seems to have average verbal abilities for his age, his speech is incomprehensible at times due to its rapidity. Also, notice that he has physical agitation at some points, moving his hands or body. Jimmy’s mother discusses his problems paying attention in school and working on large projects that require extended periods of concentration. Jimmy notes that he does not usually have difficulty concentrating with his friends though, especially when they are engaged in imaginative play. In addition to his school difficulties, Jimmy is also impatient and disorganized and tends to drift into his “own world” and “tune out” everything else. Interesting things to point out include the rapidity of Jimmy’s speech, his motor agitation, his problems concentrating and remembering certain information, and the strategies he and his mother use to overcome these difficulties. ► Return to Lecture Guide: Childhood Disorders ► Return to Video Clip List ▼ From: Lecture Launcher Video for Introductory Psychology (ISBN 013048640X): VIDEO TITLE: SEGMENT TITLE: RUN TIME The Compulsive Mind: Tourette’s Syndrome Tourette’s Syndrome 2:27 Description: Tourette’s Syndrome is an unusual disorder characterized by vocal outbursts, tics, and unexpected body movements. A psychiatrist who suffers from Tourette’s is profiled, and expert opinion about the origin of Tourette’s and its designation as a form of “mental illness” is presented. Uses: Tourette’s Syndrome has received popular attention recently, probably more attention than is warranted by the prevalence of the disorder. Television shows, press accounts, documentaries, and sitcoms have presented characterizations of Tourette’s patients. This clip presents accurate evidence about the nature of the disorder, and provides a first-hand account from a Tourette’s patient who should know something about the disease, a psychiatrist. ► Return to Lecture Guide: Anxiety Disorders ► Return to Video Clip List VIDEO TITLE: SEGMENT TITLE: RUN TIME Depression and Manic Depression Bipolar Syndrome 1:41 Description: Bipolar syndrome (“manic depression”) has affected several well-known people, including Virginia Woolfe, Abraham Lincoln, Winston Churchill, Mike Wallace, Charlie Parker, and Vincent van Gogh. One sufferer talks about her experiences with bipolar disorder, noting the incredible exuberance she felt during the manic stages and the crushing blackness she grappled with during bouts of depression. Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 83 Uses: This segment shows a brief montage of politicians, artists, and celebrities who have suffered from bipolar disorder. Students will know doubt recognize these individuals, and you might supplement this list with several more well-known individuals. Use these examples to illustrate how psychological disorders can affect people from all walks of life, and to illustrate the importance of overcoming the stigma surrounding mental illness and therapy. ► Return to Lecture Guide: Mood Disorders ► Return to Video Clip List ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 84 CHAPTER 12 PSYCHOLOGICAL DISORDERS ▼MULTIMEDIA RESOURCES MyPsychLab Highlights for Chapter 12: Psychological Disorders Psychology in the News (2:50) Psychology in the News podcast on cultural differences and definitions of “normal” behavior connects real world events to the chapter content. Have students listen and then open up the discussion in class on cultural differences in communication as highlighted in the podcast. Audio File of the Chapter A helpful study tool for students—they can listen to a complete audio file of the chapter. Suggest they listen while they read, or use the audio file as a review of key material. Chapter 12 Multimedia Content available at www.mypsychlab.com Perspectives on Psychological Disorders Watch: Going Crazy Explore More: about psychological disorders Hear More: Psychology in the News podcast: Cultural Influences on Abnormality and Psychology Explore: The Axes of the DSM Simulation: Overview of Clinical Assessment Methods Listen: Roger’s View of Adjustment ► Return to Lecture Guide: Perspectives on Psychological Disorders Mood Disorders Watch: Helen: Major Depression See More: with a video on bipolar disorder Explore: Bipolar Disorder Listen: Bipolar Disorder Watch: Depression Among the Amish Watch: Nathan: Bipolar Disorder Watch: Bipolar Disorder ► Return to Lecture Guide: Mood Disorders Anxiety Disorders Watch: Anxiety Disorders Learn More: about phobias Watch: Donald: Panic Disorder Watch: Phobias Watch: John: Obsessive-Compulsive Disorder Watch: Larry: Panic Disorder Watch: Panic Disorder Watch: Clinical Anxiety Watch: Margo: Obsessive-Compulsive Disorder ► Return to Lecture Guide: Anxiety Disorders Copyright © 2010 Pearson Education, Inc. All rights reserved. CHAPTER 12 PSYCHOLOGICAL DISORDERS 85 Dissociative Disorders Simulation: Multiple Selves ► Return to Lecture Guide: Dissociative Disorders Schizophrenia Listen: Schizophrenic Disorder Learn More: about undifferentiated and residual categories of schizophrenia Explore More: with a simulation on schizophrenia Watch: Rodney: Schizophrenia Explore: Types and Symptoms of Schizophrenia Watch: Genetic Schizophrenia Simulation: Schizophrenia Simulation ► Return to Lecture Guide: Schizophrenic Disorders Personality Disorders Watch: Janna: Borderline Personality Disorder ► Return to Lecture Guide: Personality Disorders Childhood Disorders Watch: Attention-Deficit Hyperactivity Disorder Watch: Alternative Approaches to Treating ADHD ► Return to Lecture Guide: Childhood Disorders Chapter Review Audio file of the chapter Test Yourself—practice quizzes ► Return to Lecture Guide: Chapter Review ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved. 86 CHAPTER 12 PSYCHOLOGICAL DISORDERS ▼TRANSPARENCIES Two sets of transparencies are available: I. Prentice Hall Transparencies for Introductory Psychology (ISBN 0131926993): T78: Major Types of Psychological Disorders T79: Symptoms of Panic T80: Some Phobias T82: Symptoms of Depression T83: Vulnerability-Stress Model of Depression T84: Subtypes of Schizophrenia T85: Characteristics of Personality Disorders II. Allyn & Bacon Transparencies for Introductory Psychology (ISBN 0205398626): T177 Perspectives on Psychological Disorders T178 Annual Prevalence Rates of Selected Psychological Disorders among Adults in the United States T179 The Diathesis-Stress Model T180 Major DSM-IV Categories of Mental Disorders T181 Some Common Specific Phobias T182 Lifetime Prevalence of Anxiety Disorders T183 Personality Disorders T184 Diagnostic Criteria for Major Depressive Disorder T185 Lifetime Risk for Developing Depression in Ten Countries T186 Beck’s Negative Triad T187 Seasonal Mood Changes T188 Common Misconceptions of Suicide T189 Positive and Negative Symptoms of Schizophrenia T190 Four Subtypes of Schizophrenia, According to DSM-IV T191 Genetic Similarity and Probability of Developing Schizophrenia T192 Body Image Distortion ▲ Return to Chapter 12 Table of Contents Copyright © 2010 Pearson Education, Inc. All rights reserved.