Download Chapter 14: Psychological Disorders





2 factors of sandwich making: Time and Ingredients
2 factors of mental disorder: Environment and
Genetics
The Diathesis-Stress Model is a broadly applicable
framework for understanding human behavior. It is
based upon the premise that a dynamic interaction
exists between a diathesis and life stressors. By
examining the effects of this interaction, we can
better understand a person's behavior, coping
strategies, and decision making.
A diathesis is defined as a person's predisposition
towards a problem or disorder. This can be inherited
(genetic factors), acquired (biological, physiological,
psychosocial, sociocultural factors), or a combination
of both.
How are mental disorders viewed by
mental health professionals in this clip?
Write one piece of evidence to support
your opinion.
 How did the schizophrenic patients view
their own disorders in this clip? Why?
 What do you think qualifies a cognitive
or behavioral pattern as “a mental
disorder”? Think of schizophrenia as an
example.

The medical model
--proposes that it is useful to think of abnormal behavior as a
disease, like the flu or cancer.
--Philippe Pinel (18th century) of France was the first to
propose that madness is a sickness of the mind.
--The illness that caused the turning point: syphilis. A disease
with BOTH mental and physical repercussions.
Parts of the Medical Model
--diagnosis: distinguishing one illness from another
--etiology: causes and history of an illness
--prognosis: a forecast about the probable course of an
illness
Another important term
---diathesis: vulnerability toward a disorder that results
from a combination of stress and genetic vulnerability
Q: What are some of the advantages of considering mental
disorders “illnesses.” Disadvantages?


What is abnormal behavior? Here are
some accepted criteria that answer this
question:
› Deviant: deviates from what society deems
“acceptable.” EX. Cross dressing is a
“disorder.”
› Maladaptive: everyday adaptive behavior is
impaired or counterproductive. EX. Alcohol
use is maladaptive in some circumstance
and isn’t in others.
› Personal distress: individual’s report of
personal distress. EX. Depression and anxiety
disorders

Mental illness (psychopathology) arises
from the interaction of nature and
nurture.
Broken Bone








Finding out
Scheduling an
appointment
Doctor’s questions
Doctor’s actions
Diagnosis
Doc’s prediction
Treatment
Reevaluation
Free-floating Anxiety








Finding out
Scheduling an
appointment
Therapist’s questions
Therapist’s actions
Diagnosis
Therapist’s
prediction
Treatment
Reevaluation



American Psychiatric Association
Diagnostic and Statistical Manual of Mental
Disorders – 4th ed. (DSM - IV)
DSM-V will be released in May 2013!
Figure 14.5 Lifetime prevalence of
psychological disorders
Axis I – Clinical Syndromes
Axis II – Personality Disorders or Mental
Retardation
 Axis III – General Medical Conditions
 Axis IV – Psychosocial and Environmental
Problems
 Axis V – Global Assessment of
Functioning



DSM-V revisions:
http://www.dsm5.org/Documents/1203%20Autism%20Spectrum%20Disorders%
20-%20DSM5.pdf
You will have to read, think, infer, and reference Myers
Module 48 to complete this activity.
 Google “Psych Central.” Click on the diseases along the
left side.
 Click on 3 disorders and for each
 (1) write the name,
 (2) axis (I, II, III, IV),
 (3) criteria that the disease matches (deviant,
maladaptive, personal distress),
 (4) an explanation of why the disease matches the criteria
 (5) Use the Internet to research treatments and write a
five-point summary of treatment for each of the three
disorders you chose. Please include insight/talk treatments,
behavioral treatments, and biomedical treatments if
possible.
Anxiety Disorders
 Somatoform Disorders
 Dissociative Disorders
 Mood Disorders
 Schizophrenic Disorders

Read aloud with a group of 2-3 Module
50 (pgs. 618-623) on dissociative,
personality, and somatoform disorders.
 Then write three paragraph-long stories
characterizing fictional people who could
serve as “the poster child” for each of
the three categories of disorder and their
subtypes. You may think of the stories
together, but each group member must
serve as scribe in his/her own spiral for at
least one story.

Objective: Now let’s get specific. Learn the following (1) disorders by name,
(2) their symptoms, and (3) their etiologies (causes of disease).
 Copy these down leaving a few spaces between each.

1.
2.
3.
1.
2.
1.
2.
3.
•
Dissociative amnesia
Dissociative fugue
Dissociative identity disorder
Antisocial Personality Disorder
Borderline Personality Disorder
Somatization disorder
Hypochondriasis
Conversion Disorder
You will create a group of 3 and choose one of the above categories to
study. Find and write down the 3 key parts of the objective for each
disease in your category. You may use other text books and the Internet
in addition to Myers.



Dissociative amnesia: sudden loss of
personal memory “involv[ing] a specific
event or series of events—usually a
threatening experience in childhood”
[Zimbardo, 503)
Dissociative fugue: people lose memory
of entire lives and personal identity
Dissociative identity disorder: coexistence
in one person of two or more largely
complete, and usually very different,
personalities.
› Etiology
 severe emotional trauma during childhood
› Controversy
 Media creation? Since the advent of books like
Sybil (1973), the average number of personalities
has climbed from 2-3 to 15.
Key Word: Inflexible
Fonagy, etc. (1996): People with personality disorders seem to lack a highly
necessary skill called "mentalization." Mentalization refers to the ability to reflect upon
the behaviors, internal states, and motivations of both ourselves and other people.
Clarkin (2006) “Personality disorders are long-standing ways of behaving that are not
so much severe mental disorders as dysfunctional styles of living” (Bernstein 628)

Anxious-fearful cluster
› Avoidant, dependent, obsessive-compulsive
› Anxious-fearful cluster:
› Avoidant – excessively sensitive to potential rejection, humiliation or
shame, avoids forming social relationships
› Dependent – excessively lacking in self-reliance and self-esteem,
› Obsessive-compulsive – preoccupied with organization, rules,
schedules, lists, and trivial details.

Dramatic-impulsive cluster
› Histrionic, narcissistic, borderline, antisocial
› Histrionic – overly dramatic, tending to exaggerate
expressions of emotion,
› Narcissistic – grandiosely self-important, lacking
interpersonal empathy,
› Borderline – unstable in self-image, mood, and
interpersonal relationships, angry outbursts, impulsivity
› Antisocial – chronically violating the rights of others,
non-accepting of social norms, inability to form
attachments.
vs.

Odd-eccentric cluster
› Schizoid, schizotypal, paranoid
› Schizoid – defective in capacity for forming social relationships,
› Schizotypal – social deficits and oddities in thinking, perception,
and communication, “illusions” of sights and sounds, “magical
thinking,” strange superstitions (Bernstein 628)
› Paranoid – pervasive and unwarranted suspiciousness and
mistrust.

Etiology
› Genetic predispositions, inadequate
socialization in dysfunctional families

Diagnostic Problem: There is a large overlap between
personality disorders with each other and with Axis I disorders.
Are they even real?
Somatization Disorder
 Conversion Disorder
 Hypochondriasis

› Etiology
 Reactive autonomic nervous system
 Personality factors
 Cognitive factors
 The sick role
Smeagol often argues with his other personality, Gollum,
about his future plans. Many times, however, these two
personalities are out-of-touch with each other. He
alternates between possessing a benign, pitiable outlook
on his past/ future and an alternate murderous
perspective regarding his possession of the Ring of Power.
1. Diagnose his disorder and explain its etiology.
2. Interpret Smeagol’s disordered behavior and/or its origin
using the following psychological perspectives.
1. humanistic,
2. behavioral
3. psychoanalytic
4. cognitive,
5. biological,
6. sociocultural
Terms or THEIR ROOTS
EXAMPLES of Explanations
Diagnosis
Dissociative identity
disorder
Development of two or more personalities that are largely unaware of each
other
Humanistic
2 of the following: free
will, potential; growth;
unique; self
Gollum feels he cannot reach his potential/growth, etc. with one personality
alone. He can no longer progress as “Smeagol” after being evicted from his
society. So, he develops “Gollum” to progress in his current circumstances.
When he meets Frodo, he exercises his free will to renew his potential to
progress beyond the dismal character, Gollum, in an environment of
acceptance and loyalty, so “Smeagol” remerges.
Behavioral
Environment,
condition
Gollum has been conditioned through his punitive environment to have two
personalities. His society punishes “Smeagol,” so he develops “Gollum,” a
resilient and antisocial being who is reinforced by the Ring of Power with a
sense of importance. A lot of conditioning examples possible. Pick one.
Psychoana
ytic
unconscious
The identity and childhood being, Smeagol, is repressed in Gollum’s
unconscious until he meets Frodo. At this point, Smeagol is reborn into
consciousness and challenges Gollum’s control over Smeagol’s behaviors.
Repressing Gollum’s identity ultimately fails as traumatic events continue to
befall Smeagol.
Cognitive
You must refer to
thought processes in
some way! Here are
some options:
catastrophic view,
unrealistic view,
cognitive restructuring
Gollum interprets his not having the Ring as catastrophic. He begins to
restructure his thought processes when Frodo offers him companionship and
meaning in life. Perhaps, he thinks, the Ring is not so important after all. He
temporarily abandons his quest for the Ring and perceives friendship with
Frodo as more important.
Biological
Brain OR
genetics/DNA
Gollum was predisposed because of his genetics to dissociate under very
traumatic and stressful circumstances (i.e. exile, meeting Frodo, trauma with
Boromir).
Sociocultur
al
Culture OR society OR
Ingroup/Outgroup
Gollum belonged to a simple, idealistic culture, so when he committed the
hideous crime of murder, he was cast out of his society. No longer being a
part of the ingroup caused him stress, so he developed an alternate persona
Read Modules 49 (pg. 610) and 51 (pg.
625) in Myers.
 With a partner, write a quiz with 10
questions on anxiety disorders and 10
questions on mood disorders. The
questions should focus on identifying
specific kinds of these disorders within
these categories, their symptoms, and
etiologies.
 You will have 1 hour to read through the
material and write the quiz!

*No true/false or yes/no questions!
1.
2.
3.
4.
5.
Generalized anxiety disorder
1. “free-floating anxiety”
2. Continually tense, apprehensive, and experiencing
constant autonomic arousal
Panic disorder
1. Sometimes unpredictable episodes of dread and terror
accompanied by physical anxiety symptoms (chest pains,
vomiting, increased pulse)
Phobic disorder
1. Specific, usually irrational fear and avoidance of an object
or situation
Obsessive compulsive disorder
1. Obsessions: unwanted repetitive thoughts
2. Compulsions: actions to assuage the repetitive thoughts
Posttraumatic Stress Disorder
1. Haunting memories, nightmares, social withdrawal, jumpy
anxiety, and or insomnia that lingers four weeks or more
•
•
•
•
•
Conditioning and learning
– Fear conditioning:
– CC establishes conditioning and OC maintains it
– stimulus generalization and reinforcement
– Observational learning: Mineka (1985) demonstrated that wild
monkeys transmit fear of snakes to watchful offspring
Biological factors
– Natural selection: fear has kept us alive as a species; it is easy to
condition and difficult to extinguish
– Genetic predisposition, anxiety sensitivity runs in families and
correlates to personality
– EX. Twins have high correlation to anxiety disorder
– “Anxiety gene” impacts brain level of serotonin (Canli, 2008) which
regulates sleep and mood.
– Glutamate (Lafleur et al., 2006) which causes the brain’s alarm
centers to become overactive. GABA counterbalances glutamate,
and anxiety patients have GABA irregularities
– Brain circuitry irregularities in PTSD and OCD patients
Cognitive factors
– Judgments of perceived threat
Personality
– Neuroticism
Stress—a precipitator
Figure 14.7 Conditioning as an explanation for phobias
Anxious and non-anxious
subjects are asked to
interpret a benign
statement made by the
experiment such as (to a
child), “You need to cut it
out and start behaving.”
Subjects are then asked
to interpret the
statements on a scale of
threatening to nonthreatening. Anxious
subjects much more likely
to find the statement
threatening.
-Eyesenck, 1991
Figure 14.8 Cognitive factors in anxiety disorders
1.
Major depressive disorder:
a person experiences two or
more weeks of persistent feelings of sadness, worthlessness, and/or despair
and a loss of interest in previous sources of pleasure
1. Dysthymic disorder: chronic depression that isn’t severe
enough to be diagnosed as a depressive episode
2.
Bipolar disorder:
the experience of one or more manic
episodes as well as periods of depression.
1. Bipolar 1:
at least one full-blown manic episode lasting at least
one week or any duration if hospitalization is required. Symptoms:
inflated self-esteem or grandiosity, decreased need for sleep, being
more talkative than usual, flight of ideas, distractibility, increase in goaloriented activity and excessive involvement in risky activities.
2. Bipolar II:
at least one major depressive episode, plus at least
one hypomanic episode over at least four days. The same
characteristics as mania are evident, with the disturbance of mood
observable by others; but, the episode is not enough to disrupt
normal functioning or necessitate hospitalization and there are no
psychotic features.
3. Cyclothymic disorder: people exhibit mild symptoms of
bipolar
•
Etiology
– Behavioral Origins:
– People react to their environment, and when their
environment changes, their mood stabilizes.
– Precipitating stress: Moderate link between stress and the
onset of mood disorders
– Interpersonal roots: People with inadequate social skills are
often depressed
– Genetic vulnerability
– Monozygotic Twin Studies: depression (4 in 10) (Kendler, 2006),
bipolar (7 in 10) (Tsuang & Faraone, 1990)
– Linkage analysis: look at family which has many depressed
members, find non-depressed members in that family, and
analyze genes. Conclusion is that depression is polygenic (Hu
and McMahon and Paddock et al., 2007)
– Genetic predisposition for neurochemical
abnormalities in the brain
– Less brain activity during depressive episodes and more brain
activity during manic episodes
– Left frontal lobe interprets positive emotions and is 7% smaller in
depressed patients (Cofey et al., 1993).
– Emotional information coming from the primitive brain is not
interpreted in the cerebra cortex (the thinking part of the brain)
due to the cortex's inactivity during depression (Discovery Ed)
– Hippocampus, which processes memories and is linked with
emotion, is vulnerable to stress-related damage.
– Norepinephrine, which increases arousal and boosts mood, is
scarce during depression and abundant during mania (HMHL,
2002).
– Serotonin, which soothes, is scarce during depression due to
genes for a protein that controls serotonin activity (combined
with stress) (Plomin & McGuffin, 2003)
– Cognitive factors:
– How do people explain setbacks and other negative events? Pessimistic
people likely to be depressed because negative thoughts and negative
moods interact
#27 Who’s Crazy Here, Anyway?
› Experimenter
› Hypothesis
› Experimental Design: variables, groups, set-up
› Results
 #28 You’re Getting Defensive Again
› Scientist
› Hypothesis
› Results and Discussion
› Implications
 #29 Learning to Be Depressed
› Experimenter
› Hypothesis
› Experimental Design: variables, groups, set-up
› Results












What was surprising about Rosenhan’s study on mental hospitals?
Who in the hospital could tell the difference between real and
psuedo patients?
How does this study point out the difficulty of psychological
diagnosis?
What is confirmation bais?
How did the homophobic subjects in Anna Freud’s study calm their
anxiety? (what are the mechanisms they used?)
Were the homophobic or non-homophobic subjects in Freud’s
study more reactive to the images on the screen?
Which mechanism were homophobics using to cope with their
feelings, thus openly fearing homosexuals?
Describe the two different experimental environments Seligman
used for his dogs.
Why wouldn’t the “no-escape” dogs fail to escape in the second
environment even when they were not restrained?
What is learned helplessness?
Based on Seligman’s experiment, how do you think depressed
patients can do so as not to fall prey to “learned helplessness?’
Real Patients
Pseudo Patients
Confirmation Bias: accept evidence that
says you’re right. Ignore evidence that
says you’re wrong
Escape group
No Escape group
Learned
Helplessness








Key Points
General Symptoms
Paranoid
Catatonic
Disorganized
Positive symptoms
Negative symptoms
Etiology
Summary:

Notes

Definition and General symptoms
› Delusions and irrational thought
› Deterioration of adaptive behavior
› Hallucinations
› Disorganized speech
› Disturbed thoughts

How is schizophrenia different from a
mood disorder (like bipolar)?


Key question: Disturbed thoughts and
emotions, or just disturbed emotions?
Prognostic factors: early onset and
requires lengthy hospital care.

4 subtypes
› Paranoid type:
 delusions of persecution, argumentativeness, along with
delusions of grandeur, auditory hallucinations
 More easily hidden than other types
 40% of schizophrenics, onset after age 25 and sudden
 Patients more functional than other schizophrenics.
› Catatonic type:
 lack of motivation,
 motor disturbances ranging from muscular rigidity to
waxy flexibility to random motor activity. Sometimes
unable to move at all, sometimes hyperactive.
 Often “pose” in any position.
 Symptoms negative.
 8% of schizophrenics
 Uncommon.
Disorganized type:
 deterioration of adaptive behavior including emotional
indifference or inappropriateness,
 complete social withdrawal,
 frequent incoherence, aimless babbling, giggling
 delusions, hallucinations.
 Neglect hygiene and manifests bladder/bowel control
problems
 Both positive (babbling, etc.) and negative
(emotionlessness, etc.) symptoms
 5 %. Often found in homeless population
 Severe.
› Undifferentiated type: the person’s emotional, behavioral,
and thought patterns are schizophrenic but don’t conform
to any of the other three categories because their
symptoms are mixed. 40%.
New model for classification
› Positive vs. negative symptoms: behavioral excesses vs
behavioral deficiencies.


**Genetic vulnerability: 48% for identical twin (Weiten). 16% of
children with schizophrenic mothers developed the disorder while
only 2% of children with non-schizophrenic mothers developed the
disorder (Bernstein)
Genes: 5-HT-sub (5A) receptor gene, for example, and about 3
more (Bernstein)

**Neurochemical factors: Excess dopamine? Abnormalities

**Structural abnormalities of the brain: enlarged ventricles

The neurodevelopmental hypothesis: brain

Expressed emotion: Do family members of the patient baby

Precipitating stress: High stress on people who are predisposed
in neural circuits using glutamate?
lead to less brain tissue in thalamic, prefrontal, and subcortical
areas.
maldevelopement before birth, abnormal metabolic activity in the
temporal and frontal lobes
him/her? If yes, the patients symptoms persist.
to suffer from schizophrenia causes its onset.
Write your summary and cite evidence!
Write a 1-paragraph-per-topic
connection between what we’ve
learned in our Abnormal Behavior Unit
and the story of Nathaniel Ayers as
portrayed in The Soloist:
 Onset of schizotypal behavior
 Treatment
 Social Support
 The homeless problem and mental illness
 Deinstitutionalization

Read the article, “Catching Autism
Earlier” from the Oct. 2009 Monitor on
Psychology.
 Pay attention not only to the
breakthroughs in treating autism, but to
the changes in (1) the number of recent
diagnosis and (2) proposed reasons for
those numbers.

1.
2.
3.
-Write your thoughts regarding the increased
number of recent autism diagnoses and
reasons for them (either from the text or from
deductive reasoning) which make the most
sense to you. Cite evidence and explain.
-Review the successful treatments of this
disorder. What do the successful treatments
indicate about the etiology of this disease?
Cite evidence and explain.
-Find one other credible source online
regarding recent breakthroughs in explaining
and treating autism. Summarize it in a
paragraph.
Insanity (criminal)
› A legal status indicating that a person cannot be held
responsible for his/her actions because of mental illness.
› M’naghten rule: insanity exists when a mental disorder
makes a person unable to distinguish right from wrong.
 Involuntary commitment (civil)
› danger to self or others
› in need of treatment

New Mexico is one of a few states whose laws make it difficult to commit
someone involuntarily. There is no involuntary commitment law in NM.
Group Question Minute: Should insanity be a factor in
deciding criminals’ fates? Why and why not?
Group Question Minute: Should civil courts take into
account mental disorder when deciding issues like
custody of children? Why or why not?
"Andrea Yates admitted to drowning her five children in the bathtub
of her Houston, Texas home in 2001. She had twice tried to kill
herself in previous years , and she was reportedly depressed at
the time of the murders. Accordingly, she pleaded not guilty by
reason of insanity. The court's first step in deciding her fate was to
confine her in a mental institution for assessment of her mental
competency to stand trial. Following testimony of psychologists
who examined her, she was found competent, tried, and
sentenced to life in prison. Her conviction was overturned on
appeal, though, and at a second trial in 2006, she was found not
guilty by reason of insanity and committed to a mental hospital”
(Bernstein, 639).
Figure 14.22 The insanity defense:
public perceptions and actual realities
Relativistic view vs universalistic view
 Cultural variations




(1) Are the psychological disorders seen in Western societies
found throughout the world?
(2) Are the symptom patters of mental disorders invariant across
cultures?
Culture bound disorders
› Koro- Present in Chinese males. Fear that a very manly
part of anatomy will disappear into the abdomen
› Windigo- an intense craving for human flesh and the
perpetual fear that one will become a cannibal. Only
happens Algonquin Indian cultures.
› Anorexia nervosa- fear of being fat and abstinence
from food. Only in affluent Western cultures.