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PSY 190: General Psychology
Chapters 15:
Psychological Disorders & Treatment
What Behaviors Are Abnormal?

How do we define what is abnormal?
 The culture’s perspective
 The generation’s perspective
 The individual’s perspective
The Culture’s Perspective

Deviance

Here, we are looking at the degree in which an
individual’s behavior differs from cultural norms


Standards of acceptability vary from culture to culture
But to be considered disordered, the atypical
behavior must also be disturbing to other people
The Generation’s Perspective

Standards of acceptability also vary from
generation to generation
The Individual’s Perspective



Distress
 Does the individual feel psychological pain?
Disability
 Does the behavior interfere with the person’s ability
to function personally, socially, or occupationally?
Many psychologists believe this is the best
criterion for determining the normality of behavior
– does it foster individual and group well-being?
Traditional Views of Abnormality

Demonological Model
 Some mentally ill individuals were considered
witches…
 Submerged into water – if they drowned it was felt
they weren’t really witches
 Thousands of women were killed in this manner
during 13th-16th century
A Little History of Mental Illness…

Physiological Treatment

Bleeding


Fear


Excessive blood in the brain
Put in coffin-like box and submerged in water until
bubbles from the patient’s breathing had ceased to come
to the surface at which point the person was revived…
Drugs

The use of alcohol, opium, and marijuana were used to try
to cure these individuals
A Little History of Mental Illness…

Asylums
During this time (late 1300’s), places where the
mentally ill were cared for began to surface
 Before this, these people were treated as criminals
and put in jails or prisons
 A medical model where psychological disorders were
considered to be sicknesses that could be cured
through therapy at a psychiatric hospital became the
prevailing viewpoint

Bedlam

Hospital of St. Mary of Bethlehem (established
officially in 1500’s)
 Bedlam – “lunatics” were treated cruelly…if they
became too excited they were chained out of harm’s
way and often beaten or doused with water
 Visitors would pay a small fee to be allowed to go in
and ridicule the patients for entertainment purposes
 The crowds would often become very noisy and
disorderly themselves – hence, the name
Removing the chains…

Medical Model
 Philippe Pinel institutes a medical model – that
psychological disorders were sicknesses
 That psychopathology needs to be diagnosed on the
basis of its symptoms and cured through therapy
Biopsychosocial Model

Mental disorders are seen as caused by the combination
and interaction of:
 Biological Factors: Includes physical illnesses and
disruptions of bodily processes that may in part be due
to genetic predispositions
 Psychological Factors: Includes psychological
processes such as our wants, needs, and emotions; our
learning experiences; and our way of looking at the
world
 Sociocultural Factors: Includes the social and cultural
context that form the background of the abnormal
behavior
Classifying Psychological Disorders

Diagnostic and Statistical Manual Of Mental
Disorders (DSM-5)
The behavior pattern of all psychological disorders were
not clearly described until the publication of the APA’s
first diagnostic and statistical manual (DSM-I) in 1952
 DSM-5 recently published in 2013; defines 17 major
categories of mental disorder

Classifying Psychological Disorders

Advantages of DSM-5 classification:
– No longer the communication problems of the pre1950’s
– Allows us to figure out how many people are suffering
from these disorders (statistics are now available)
– Specific symptoms for each diagnosis are clearly listed
– Decision trees: Set of questions leading to correct
diagnosis
– The distinctive categories in the DSM-5 contribute to
the planning of treatment programs and facilities
Criticisms & Weaknesses of DSM


DSM labels too many conditions are “mental
illnesses”
 The number of disorders listed has been increased
 Research indicates that almost half (a recent report says
46.4%, see my website) of our population will suffer
from a mental disorder at some time during their lives
Diagnostic categories are imperfect
 Differences in clinical judgments
Anxiety Disorders

Deciding when anxiety is so severe that it is a disorder
depends on several variables, and physicians differ in
making the diagnosis…
 If anxiety is very distressing, interferes with
functioning, and does not stop spontaneously within
a few days, an anxiety disorder is present and merits
treatment
Anxiety Disorders




Generalized Anxiety Disorder
Panic Disorder
Phobic Disorders
Obsessive-Compulsive Disorder
Generalized Anxiety Disorder

Symptoms and Issues
Anxiety that is constantly present
 Distractibility, fatigue, muscle tension, sleep disturbances
 Chronic unrealistic or excessive worry
 To be diagnosed, the worry must last six months and
not be limited to a single life circumstance
 Always apprehensive even when things seem to be going
well

Symptoms and Issues



Trouble making decisions – agonize over them –
then once they finally make the decision…
Sex difference: Women 6.6% Men 3.6%
Onset: anytime
Complications

High risk for development of substance abuse
or dependence

Self-medicating
Physiological Explanation: Chemical imbalances



Serotonin
 low levels
GABA
 low levels
Norepinephrine
 high levels
Medications


Antidepressants and anti-anxiety drugs
 Valium, Xanax, etc.
 These fast-acting drugs increase GABA activity
Minor Tranquilizers
 These increase the activity of the inhibitory neurons so
that the excitatory neurons will be less active
Prognosis

Not very good…can be long-standing and
difficult to treat
Panic Disorder


Usually brief periods of intense anxiety
Usually unexpected and do not appear to be
provoked by the situation the person is
responding to
Prevalence and Onset

Lifetime prevalence:


Approximately 1 to 3% of adults
Sex difference:
Females 4%
 Males 2%


Onset

Usually before age 25
Symptoms

Rapid deep breathing






Hyperventilation
Racing heart rate
Chest pain
Excessive sweating
Dizziness and Nausea
Chills, shaking, etc.
Physiological Explanation

It appears that these people have an overly
sensitive respiratory control center (RCC) in
their brain:
RCC detects small increases in carbon dioxide
 Because of oversensitivity it sends false alarms
 Higher brain structures think we are suffocating
 We panic

Physiological Explanation

Genetics seems to play a role:
 Biological relatives: 25%
 Non-Biological relatives: 2-4%
 MZ twins higher concordance than DZ twins
 About 5 times more than likely
Treatments

Medication
 Anti-anxiety and antidepressants have been
successful…


Xanax
Zoloft
Prognosis

Bad news
 This illness can be chronic and difficult to treat


One study found 80% of patients were still symptomatic
at a 20 year follow-up evaluation
Good news

Although, disorder may not be cured…nearly all can
expect improvement with a drug/psychotherapy combo
Phobias




Fear that interferes with normal living
Fear has no justification in reality
Fear is greater than is justified
Individual is aware of irrationality of fear
Phobias
Social phobia
 Agoraphobia
 Specific phobias

What is Social Phobia?




Irrational fear that they will behave in an embarrassing
way
Is limited to situations in which the scrutiny of others is
likely
Extreme form of shyness that interferes significantly
with an individual’s functioning
These individuals avoid all social situations
Prevalence/Onset


Most studies say its about 4%
Sex difference:


Slightly more women than men
Average onset

Early adolescence
Symptoms



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Avoidance of all social situations
High anxiety if ever placed in a social situation
Rapid heart rate
Elevated blood pressure
History of phobia
What causes social phobia?

Basically unknown but…
 Possible biological reasons: scarcity of
serotonin
 Possible environmental factors…
Agoraphobia



These people suffer from intense anxiety when
in a place where escape would be difficult or
embarrassing if they were to experience a panic
attack
Fear being in a place where they can’t get help
In extreme cases, they may not leave their house
Prevalence and Onset

Prevalence


Sex difference



Estimated 5% of general population will suffer from
agoraphobia
Women 7%
Men 3.5%
Onset

Usually occurs in their 20’s
Prognosis

Very good – 90% improve
Specific Phobias

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DSM-IV classifies all other phobias (besides social phobia and
agoraphobia) as “specific phobias”
We’re talking about specific objects or situations here
Sex difference:
 Women 16%
 Men 7%
Associated features: depressed mood and dependent personality
Exposure to the phobic stimulus may lead to a panic attack
As with other phobias, the person recognizes that the fear is
excessive and unreasonable
Explanations for Phobias

Evolutionary

Psychodynamic


Behavioral


Symbolically expressed conflicts and stress
Classically conditioned fears
Physiological

Neurological arousal and genetics
Treatment for Phobias


Fear-Reduction Methods
 Systematic Desensitization
 Breathing and relaxation techniques are sometimes
used in conjunction with systematic desensitization
 Virtual Therapy
 Flooding
Physiological Approach
 Drug treatment
 Commonly anti-depressants and anti-anxiety meds
are used:
 Prozac, Paxil, Zoloft, Elavil, etc.
 Xanax, Klonipin, etc.
Prognosis

Very good – 90% improve
Obsessive-Compulsive Disorder
(OCD)

To be diagnosed with OCD, a person must have
recurrent obsessions and compulsions that are
disabling

Significantly interfere with a person’s routine,
making it difficult to work, or to have a normal
social life or relationships
Prevalence and Onset

Prevalence



Life-time prevalence
 Afflicts 2%-3% of population some time in their lives
Group differences
 No sex differences
 Knows no geographic, ethnic, or economic
boundaries
Onset
About two-thirds develop the disorder before they are
25 years old and only 15% after the age of 35
 Onset after 40 is very rare

Obsessions

Constant, intrusive, unwanted thoughts causing
distressing emotions such as anxiety or disgust

Examples:
 Thoughts of violence (person feels he/she will hurt
someone)
 Thoughts of contamination (germs)
 Thoughts of uncertainty (did I lock the door?)
They understand yet it doesn’t matter…

They know thoughts are irrational
Compulsions


Compulsions are urges to do something to
lessen discomfort
Rituals are the behaviors in which these people
engage in to accomplish this
Physiological Explanations




Scarcity of serotonin
In certain brain structures there are high levels
of brain activity (orbital frontal, etc.)
Brain damage
Genetics
Common Treatments for OCD


Cognitive-Behavioral Therapy
Antidepressant Medications
Cognitive-Behavioral Therapy

Response prevention


Preventing the person from doing the compulsion or
mental act
Relaxation techniques

Cognitive techniques such as self-talk are often
combined with the above techniques
Cognitive-Behavioral Therapy

Effectiveness:
 60-80% of those using the cognitivebehavioral treatments improve (show at least
a partial reduction in symptoms)
Antidepressant Medications

Drugs that influence (increase) serotonin levels have
been used effectively
 Prozac, Zoloft, Paxil, Anafranil, etc.
 Drawbacks:
 High doses of these drugs may be required in
the treatment of OCD
 It can take several weeks to feel their
beneficial effects
 Additionally, there are potential side effects to
consider
Prognosis

The disease is chronic for most people even with drug
treatment
 Partial reduction of symptoms is seen in most
 Most take medication indefinitely, and about 85% of
people relapse within one or two months after
discontinuing usage
Substance Dependence (Addiction)
Addiction
 A chronic, relapsing brain disease that is characterized by compulsive
drug seeking and use, despite harmful consequences
 Dependence
 Often used interchangeably with addiction
 Substance Abuse
 The use of a drug with serious consequences
 Substance Misuse
 Contemporary term
 The Substance Use and Misuse Journal prefers this term
 Rationale is that Substances are used or misused; living organisms
are and can be abused
Alcoholism




Refers to one’s dependence on alcohol that seriously
interferes with one’s life
Most common and costly form of drug abuse in U.S.
Aproximately 7% of adults 18 and over (10M people)
Traditionally more common (about 2 to 1) among
males but recent research suggests that women are
closing this gap
Detrimental Effects

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Life span of average alcoholic is 12 years shorter than
the norm
Alcoholism ranks as the third leading cause of death in
U.S.
More than one-third suffer at least one coexisting
mental disorder
Organic impairment such as brain shrinkage occurs in a
high proportion of alcoholics
About 20% attempt suicide
About 10% are successful
Symptoms of Alcohol Dependence
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Use alcohol to boost self-confidence and to relax
around others
Drink to forget their problems or to relieve stress
Often are the ones who want “one more” drink even
when their friends have stopped drinking
After friends have left they drink with new
friends…often close the bar…stay past last call
Get drunk without planning to
Have blackouts
Blackouts

Blackouts are much more common among social
drinkers than previously assumed and should be viewed
as a potential consequence of acute intoxication
regardless of age or whether the drinker is clinically
dependent on alcohol
Blackouts
White, Signer, Kraus, & Swartzwelder (2004)

Surveyed 772 college undergraduates about their experiences with
blackouts and asked, “Have you ever awoken after a night of drinking
not able to remember things that you did or places that you went?”
 Of the students who had ever consumed alcohol, 51 percent
reported blacking out at some point in their lives, and 40 percent
reported experiencing a blackout in the year before the survey
 Of those who reported drinking in the 2 weeks before the survey,
9.4 percent said they blacked out during that time
 The students reported learning later that they had participated in a
wide range of potentially dangerous events they could not
remember, including vandalism, unprotected sex, and driving
Symptoms of Alcohol Dependence



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Lie about their drinking, try to hide it, sneak
drinks at work or school
Drink in the morning to cure a hangover
May begin to have financial, work, or family
problems
Complete loss of control
Genetic & Family Background


Six genes have been linked to addiction
Seems to be linked primarily to early-onset
alcoholism
Treatments




Rehab Centers
 Treatment centers where the addict is supervised 24/7
 Supervised detoxification period to eliminate drugs from our
bodies system
Alcoholics Anonymous
 Self-help group
 Little research because of members anonymity but indications are
most don’t stick to it
 Need to go to regular meetings for it to work
 90 meetings in first 90 days and then at least once per week after
that
Antabuse
 A type of aversion therapy where usually a pill is taken that will
cause the patient to become sick whenever they drink alcohol
Contingency Management
 Monitor alcohol use by Breathalyzer; reinforcement is given
Dissociative Disorders
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

Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder
Dissociative Amnesia

Prevalence


Very rare (less than 1%)
Symptoms
The sudden inability to remember important
personal information or events
 Usually begins as a response to intolerable
psychological stress

Dissociative Fugue




Formerly termed Psychogenic Fugue
Name of illness also changed in DSM IV
An episode during which an individual leaves his
usual surroundings unexpectedly and forgets
essential details about himself and his lives
It is very rare, with a prevalence rate of about
0.2% in the general population
Etiology


Is usually triggered by traumatic and stressful
events, such as wartime battle, abuse, rape,
accidents, natural disasters, and extreme violence,
etc.
Usually a delay as fugue states may not occur
immediately after the above
Dissociative Amnesia and Dissociative Fugue
Treatment
 Therapy can be useful to help with residual aspects of
the disorder
 Family therapy
 Prognosis is very good
Dissociative Identity Disorder

Symptoms
 The individual may change from one personality to
another in a matter of a few minutes to several years
(shorter time frames are more common)
 A person alternates between two or more distinct
personality systems
 The personalities are often dramatically different
 Usually there is a main or basic personality
Click on picture for video 
Probably the #1
“Hollywood Disorder”
Prevalence

No reliable figures
Nevertheless, appears to be increasing cases
 Why?

Etiology

Unknown

Possibility: Severe physical and sexual abuse
Dissociative Identity Disorder
Treatment
 Psychoanalysis -- try to give therapy to the main
personality who "knows" the others
Prognosis
 Poor
Somatoform Disorders



Physical symptoms with an absence of physical
reasons for the symptoms
No physical damage results from the disorder
These individuals believe that their illnesses
are real
Psychosomatic Disorders


Tension headaches, cardiovascular problems, etc.
which cause physical damage
State of mind appears to be causing the illness
Somatoform Disorders




Somatization Disorder
Hypochondriasis
Body Dysmorphic Disorder
Conversion Disorder
Somatization Disorder

Diagnostic Criteria
 To be diagnosed a person must have reported at least
the following:
 Gastrointestinal symptoms (2)
 Sexual symptoms (1)
 Neurological symptoms (1)
 Pain (4 locations)
 These symptoms cannot be explained by a physical
disorder
Somatization Disorder

Sex difference



Onset


F>M
Primarily a female disorder with about 1% suffering from this
disorder
Usually by age 30 but its seen from childhood on up
Familial tendencies


5 to 10 times more common in female first-degree relatives
Genetic links to antisocial personality and alcoholism
A typical scenario…



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Typically, patients are dramatic and emotional when
recounting their symptoms
They are often described as exhibitionistic and seductive
and self-centered
In an attempt to manipulate others, they may threaten
or attempt suicide
These patients “doctor-shop”…
 Often dissatisfied with their medical care, they go
from one physician to another…
They usually don’t go and further than
their General Practitioner…

Psychologists and psychiatrists rarely manage the
majority of patients with somatoform disorders -this difficult undertaking falls predominantly on
general practitioners
Learning Explanation


A child with an injury quickly learns the benefits of
playing the sick role
Reinforced by increased parental attention and
avoidance of unpleasant responsibilities
Physiological Explanation

Genes
Cognitive Explanation


They do not accept psychologists advice
Therefore treatment is difficult
More research is needed for this one




Treatments
 Not successful
Etiology
We know it tends to run in families but the
cause is unknown at this time
Prognosis
Poor
 Its usually a lifelong disorder

Hypochondrasis




Unrealistic belief that a minor symptom reflects a serious
disease
Excessive anxiety about one or two symptoms
Examination and reassurance by a physician does not
relieve the concerns of the patient
They believe the doctor has missed the real
reason
Hypochondrasis

Gender difference


More common in women than men
Onset
Usually in 30’s
 But seen in all age groups

Treatments

Much research suggests a cognitive-behavioral combo is
best with therapist extremely gentle in his/her questioning
the patient’s incorrect beliefs

Prognosis is poor
Major Differences between Somatization Disorder
and Hypochondrasis




Focus of Complaint
Style of Complaint
Interaction with Clinician
Physical Appearance
Conversion Disorder



Sensory/motor dysfunction in the absence of a physical
basis…
Symptoms develop unconsciously and are limited to those
that suggest a neurological disorder
 Examples: numbness of limbs, paralysis, speech
problems, blindness and hearing loss, difficulty
swallowing, sensation of a lump in your throat,
difficulty speaking, difficulty walking, etc.
 Symptoms are not feigned (as in factitious disorder or
malingering)
Individual is often highly dramatic
Conversion Disorder




History
 Was first studied by the Nancy School of Hypnosis (Nancy,
France) and Freud in examinations of hysteria (1880’s)
Onset
 Tends to be adolescence to adulthood but may occur at any
age
Sex Difference
 Appears to be "somewhat" more common in women
 No stats
Prevalence
 1% - 3% of general population
 Tends to occur in less educated, lower socioeconomic groups
Conversion Disorder:
Important Characteristics

Glove
anesthesia
Conversion Disorder:
Important Characteristics

Doctor Shop


They visit many physicians hoping to find one who will
propose a physical treatment for their non-physical
problems
La Belle Indifference

The tendency of these people to be relatively
unconcerned about their physical problem
More research is needed for this one, too


Explanations
 Pure speculation at this point
Prognosis
 Poor
 No treatment is considered very effective
Body Dysmorphic Disorder




Preoccupation with an imagined or minor defect in
one's physical appearance
It is distinguished from normal concerns about
appearance because it is time-consuming, causes
significant distress, and impairs functioning
Depression, phobias, and OCD may accompany this
disorder
Sex difference: Females > Males
 Females: breasts, legs
 Males: genitals, height, and body hair
Symptoms

Major concerns involving especially the face or head but
may involve any body part and often shifts from one to
another
 Examples: hair thinning, acne, wrinkles, scars, eyes,
mouth, breasts, buttocks, etc.
Case Study: Cindy Jackson



Why would someone want to undergo over 50
operations to try to obtain the “perfect” figure
and face?
What would drive a woman to spend a fortune
to look like a “Barbie”?
Cindy Jackson, the small town Ohio woman
did just that…
Cindy: Before…
Cindy: After…
A total transformation
1979
1990
1994
2003
Once had lunch with Michael Jackson:
What do you think they talked about?
Cindy Jackson: Today
She’s 60 years old 
Click on picture for video 
Treatments

Cognitive-Behavioral
Exposure is used to treat phobia-like symptoms
 Therapy will focus on improving the distorted body
image that these people possess

Again, not much known…


Treatment
 Preliminary evidence that selective serotonin reuptake
inhibitors may be helpful but data on drug treatment
is limited
Prognosis
 Poor
Schizophrenia




A disease of the brain
Changes in neurophysiological function that characterize
schizophrenia have been identified
Exact cause: Unknown
 High levels of dopamine and low levels of serotonin
have been found in these patients
Prevalence


Less than 1% of the general population
Onset

Young adulthood (although late onset is possible)
Risk Factors

Equal numbers of men are women are
diagnosed


In men, symptoms begin earlier and are more severe
Rates of diagnosis differ by marital status
3% of divorced or separated people
 2% of single people
 1% of married people


It is unclear whether marital problems are a cause or a
result
Symptoms of Schizophrenia
Cognitive symptoms
 Hallucinations
Perceptions that do not correspond to anything in
the real world
 Auditory is most common type

Symptoms of Schizophrenia
Cognitive symptoms
 Delusions

Beliefs that are strongly held despite a lack of evidence
for them

Delusions of persecution


Delusions of grandeur


A belief that enemies are out to get you
A belief that you are unusually important
Delusions of reference


A tendency to take all types of messages personally
Newspapers have coded messages of what he or she should do
Symptoms of Schizophrenia
Cognitive symptoms
Disturbed speech and thought processes
Word salad

Mood symptoms


Depression
Inappropriate emotional responses
Professor portrayed in media: “He saw the world in a way no one
could have imagined”
John Nash
Strong genetic link
Genain Quadruplets: 1 in 100,000,000
History of Treatment of Schizophrenia

Psychosurgery
 Prefrontal Lobotomy
(introduced in 1935)
Transorbital Lobotomy (introduced in 1948)
Referred to as “the icepick lobotomy”
Before 
During 
After 
Today’s Treatment

Neuroleptics
 Low-potency Neuroleptics
 Mellaril
 Thorazine
 High-potency Neuroleptics
 Haldol
 Navane
 Atypical Neuroleptics
 Clozaril
 Risperidal
 Zyprexa