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Psychological Disorders
Chapter 13
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Chapter 13: Psychological Disorders
I.
II.
III.
IV.
V.
VI.
Perspectives on Psych Disorders
Anxiety Disorders
Dissociative and Personalityh
Mood Disorders
Schizophrenia
Rates of Psychological Disorders
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Chapter 13Objectives
1. Identify the criteria for judging whether behavior is
psychologically disordered.
2. Contrast the medical model w/ the biopsychological
approach to disordered behavior.
3. Describe the goals and content of the DSM-IV; discuss
dangers and benefits of labels.
4. Describe the symptoms of generalized anxiety disorder,
panic disorder, phobias, OCD, and PTSD.
5. Discuss the contributions of learning and biological
perspectives to understanding the development of anxiety
disorders.
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Objectives
6. Describe the symptoms of dissociative disorders and the
controversy regarding the diagnosis of dissociative
identity disorder.
7. Contrast the three clusters of personality disorders.
8. Define mood disorders; contrast major depressive and
bipolar disorders.
9. Explain the development of mood disorders, using
biological and social-cognitive perspectives.
10. Describe the symptoms of schizophrenia, and contrast
chronic and acute schizophrenia.
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I.
Perspectives on Psychological
Disorders
Where should we draw the line b/w normality &
disorder?
• Behavior is disordered when it is deviant, distressful, and
dysfunctional. (psych disorder)
• Definition of defiant varies w/ context and culture.
• Varies w/ time… children who might have been judged
rambunctious now are being diagnosed w/ attention deficit
hyperactivity disorder.
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I.
Perspectives
People are fascinated by the exceptional, the
unusual, and the abnormal. This fascination
may be caused by two reasons:
1.
During various moments we feel, think, and act
like an abnormal individual.
2.
Psychological disorders may bring unexplained
physical symptoms, irrational fears, and suicidal
thoughts.
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I.
Perspectives
To study the abnormal is the best way of
understanding the normal.
William James (1842-1910)
1.
There are 450 million people suffering from
psychological disorders (WHO, 2004).
2.
Depression and schizophrenia exist in all cultures
of the world.
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I.
Perspectives… Defining
Psychological Disorders
•Mental health workers view psychological
disorders as persistently harmful thoughts,
feelings, and actions.
•When behavior is deviant, distressful, and
dysfunctional psychiatrists and psychologists
label it as disordered.
I. Perspectives… Deviant,
Distressful & Dysfunctional
Carol Beckwith
1. Deviant behavior
(going naked) in one
culture may be
considered normal,
while in others it may
lead to arrest.
2. Deviant behavior must
accompany distress.
3. If a behavior is
dysfunctional it is
clearly a disorder.
In the Wodaabe tribe men
wear costumes to attract
women. In Western society
this would be considered
abnormal.
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I.
Perspectives… Understanding
Psychological Disorders
•Ancient Treatments of psychological disorders
include trephination, exorcism, being caged like
animals, being beaten, burned, castrated,
mutilated, or transfused with animal’s blood.
John W. Verano
Trephination (boring holes in the skull to remove evil forces)
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I.
Perspectives… The Medical
Model
Philippe Pinel (1745-1826) from France, insisted
that madness was not due to demonic possession,
but an ailment of the mind.
George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago
Dance in the madhouse.
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I. Perspectives… Medical Model
•When physicians discovered that syphilis led to mental
disorders, they started using medical models to review the
physical causes of these disorders.
•The concept that diseases, like psych disorders, have
physical causes that can be diagnosed, treated, and cured in a
hospital.
1. Etiology: Cause and development of the
disorder.
2. Diagnosis: Identifying (symptoms) and
distinguishing one disease from another.
3. Treatment: Treating a disorder in a psychiatric
hospital.
4. Prognosis: Forecast about the disorder.
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I. Perspectives… The
Biopsychosocial Approach
Assumes that biological, socio-cultural, and
psychological factors combine and interact to
produce psychological disorders.
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I.
Perspectives… Biopsychological
Approach
• Assumes that disordered behavior, like
other behavior, arises from genetic
predispositions and physiological states,
inner psychological dynamics, and socialcultural circumstances.
I.
Perspectives… Classifying
Psychological Disorders
•Many psychiatrists and psychologists use the
American Psychiatric Association’s Diagnostic &
Statistical Manual of Mental Disorders (DSM-IV).
•This names and describes psych disorders in treatment
and research.
•Diagnostic labels aid mental health professionals by
providing a common language and shard concepts for
communications & research.
•US health insurances require DSM-IV diagnoses
before they pay for therapy.
•Describes 400 psychological disorders compared to 60
in the 1950s.
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I.
Perspectives… Labeling
• Disorders outlined by DSM-IV are reliable;
therefore, diagnoses by different professionals are
similar.
• Labels may be helpful for healthcare
professionals when communicating with one
another and establishing therapy.
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I.
Perspectives…. Labeling
Psychological Disorders
Elizabeth Eckert, Middletown, NY. From L. Gamwell and
N. Tomes, Madness in America, 1995. Cornell University Press.
Critics of the DSM-IV argue that labels may stigmatize
individual.
Can create preconceptions that unfairly stigmatize
people and can bias our perceptions of their past
and present behavior.
Asylum baseball team (labeling)
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Labeling Psychological Disorders
Elaine Thompson/ AP Photo
“Insanity” labels raise
moral and ethical
questions about
how society should
treat people who
have disorders and
have committed
crimes.
Current Examples?
Theodore Kaczynski
(Unabomber)
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II.
Anxiety Disorders
What are anxiety disorders; how differ from ordinary worries
and fears we all experience?
•Our uneasiness is not intense and persistent
•Anxiety Disorder: characterized by distressing,
persistent anxiety or maladaptive behaviors that reduce
anxiety.
•Five Anxiety Disorders:
1.
2.
3.
4.
5.
Generalized anxiety disorder
Panic disorder
Phobias
Obsessive-compulsive disorder
Post-traumatic stress disorder
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II.
Generalized Anxiety Disorder
1.
Persistent and uncontrollable tenseness and
apprehension; jittery, agitated, sleep-deprived;
concentration is difficult.
2.
Inability to identify or avoid the cause of certain
feelings so difficult to deal w/ or avoid.
2/3s of whom are women.
May lead to physical problems: ulcers or high
blood pressure.
Def: An anxiety disorder in which a person is
continually tense, apprehensive, and in a state of
autonomic nervous system arousal.
3.
4.
5.
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II.
Panic Disorder
•Def: Disorder marked by unpredictable minutes-long
episodes of intense dread; person experiences terror,
chest pains, choking, or other frightening sensations.
•Strikes suddenly, wreaks havoc, and disappears.
•Other symptoms: heart palpitations; shortness of
breath, trembling, dizziness
•Anxiety is a component of both disorders. It occurs
more in the panic disorder, making people avoid
situations that cause it.
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II.
Anxieties… Phobias
•Marked by a persistent and irrational fear of an object or
situation that disrupts behavior.
•Usually leads to avoidance of a specific object or
situation.
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II. Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Hemophobia
Phobia of open places.
Phobia of heights.
Phobia of closed spaces.
Phobia of blood.
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II.
Anxieties: ObsessiveCompulsive Disorder
•Persistence of unwanted thoughts (obsessions) and
urges to engage in senseless rituals (compulsions) that
cause distress.
•Characterized by unwanted repetitive thoughts
(obsessions) and/or actions (compulsions)
•Effective functioning can become impossible
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II.
Anxieties: Post-Traumatic Stress
Disorder
Four or more weeks of the following symptoms
constitute post-traumatic stress disorder
(PTSD):
1. Haunting memories
2. Nightmares
3. Social withdrawal
Bettmann/ Corbis
4. Jumpy anxiety
5. Sleep problems
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II.
Anxieties… Resilience to PTSD
•Only about 10% of women and 20% of men
react to traumatic situations and develop PTSD.
•Holocaust survivors show remarkable
resilience against traumatic situations.
•All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
•Current Issues or Concerns?
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II.
Anxieties… Explaining Anxiety
Disorders
What are the sources of the anxious feelings and thoughts
that characterize anxiety disorders?
•Psychoanalytic perspective (Freud) viewed anxiety
disorders as the discharging of repressed impulses.
•Freud’s theory proposed that, beginning in childhood,
people repress intolerable impulses, ideas, and feelings
and that this submerged mental energy sometimes
produces mystifying symptoms such as anxiety.
•Today’s psychologists turned toward two
contemporary perspectives: learning and biological.
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II.
Anxieties: The Learning
Perspective
• Psychologists working from the learning perspective view
anxiety disorders as a product of fear conditioning,
stimulus generalization, reinforcement of fearful behaviors,
and observational learning.
• Fear conditioning: ex: rats subjected to unpredictable
shocks become anxious
• Stimulus Generalization: person fears heights after a fall
and is afraid to go on airplane.
• Reinforcement: helps maintain anxieties.
• Observational Learning: observing other’s fears.
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II. Anxieties: The Biological
Perspective
• This perspective considers the evolutionary survival value
of fears of life-threatening animals, objects, or situations;
inherited predispositions; and abnormal responses in the
brain.
• Natural Selection: many of our modern fears come have
an evolutionary explanation.
• Genes: Some may be predisposed to anxiety
• Brain: generalized anxiety, panic attacks, and even
obsessions are biologically measureable in the brain.
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The Biological Perspective
S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action
monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353.
Generalized anxiety,
panic attacks, and even
OCD are linked with
brain circuits like the
anterior cingulate cortex.
Anterior Cingulate Cortex
of an OCD patient.
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IV. Dissociative Disorders
•Disorders in which conscious awareness
becomes separated (dissociated) from previous
memories, thoughts, and feelings.
Symptoms
1. Having a sense of being unreal.
2. Being separated from the body.
3. Watching yourself as if in a movie.
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III. Dissociative Identity Disorder
(DID)
A disorder in which a person exhibits two or
more distinct and alternating personalities,
formerly called multiple personality disorder.
Lois Bernstein/ Gamma Liason
Chris Sizemore (DID)
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III. DID Critics
Critics argue that the diagnosis of DID
increased in the late 20th century. DID has
not been found in other countries.
Critics’ Arguments
1. Role-playing by people open to a
therapist’s suggestion.
2. Learned response that reinforces
reductions in anxiety.
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III. Personality Disorders
•Personality disorders
are characterized by
inflexible and
enduring behavior
patterns that impair
social functioning.
They are usually
without anxiety,
depression, or
delusions.
•“BTK Killer”
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III. Antisocial Personality Disorder
•A disorder in which the person (usually men)
exhibits a lack of conscience for wrongdoing, even
toward friends and family members. Formerly,
this person was called a sociopath or psychopath.
•Genetic Predispositions may interact with
environment to produce this disorder.
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III. Understanding Antisocial
Personality Disorder
Like mood disorders
and schizophrenia,
antisocial personality
disorder has biological
and psychological
reasons. Youngsters,
before committing a
crime, respond with
lower levels of stress
hormones than others
do at their age.
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Understanding Antisocial
Personality Disorder
PET scans of 41 murderers revealed reduced
activity in the frontal lobes. In a follow-up study,
repeat offenders had 11% less frontal lobe activity
(Raine et al., 1999; 2000).
Courtesy of Adrian Raine,
University of Southern California
Normal
Murderer
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IV. Mood Disorders
•Characterized by emotional extremes
•Emotional extremes of mood disorders come
in two principal forms.
1. Major depressive disorder
2. Bipolar disorder
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IV. MD… Major Depressive
Disorder
•Depression is the “common cold” of
psychological disorders. In a year, 5.8% of men
and 9.5% of women report depression
worldwide (WHO, 2002).
Blue mood
Major Depressive Disorder
Gasping for air after a
hard run
Chronic shortness of
breath
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IV. MD…. Major Depressive
Disorder
Major depressive disorder occurs when signs of
depression last two weeks or more and are not
caused by drugs or medical conditions.
1.
2.
3.
4.
Signs include:
Lethargy and fatigue
Feelings of worthlessness
Loss of interest in family & friends
Loss of interest in activities
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IV. MD…. Bipolar Disorder
Formerly called manic-depressive disorder. An
alternation between depression and
mania(hyperactivity) signals bipolar disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Tired
Slowness of thought
Desire for action
Hyperactive
Multiple ideas
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IV. Bipolar Disorder
Many great writers, poets, and composers
suffered from bipolar disorder. During their
manic phase creativity surged, but not during
their depressed phase.
Earl Theissen/ Hulton Getty Pictures Library
The Granger Collection
Wolfe
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
Clemens
Hemingway
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IV. Mood Disorders: What causes mood
disorders and what explains its increase?
• Depression researchers are exploring two sets of
influences.
• One: genetic predispositions and on abnormalities in brain
structures and functions.
• Second: social-cognitive perspective, examining the
influence of cyclic self-defeating beliefs, learned
helplessness, negative attributions, and stressful
experiences.
• Biopsychosocial: considers influences on many levels.
• Increased rates of depression among young Westerners
may be due to rise of individualism and decline of
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commitment to religion and family.
IV. Explaining Mood Disorders
1. Many behavorial and cognitive changes accompany
depression… trapped in depressed mood; also exhibit
anxiety or substance abuse.
2. Women are nearly twice as vulnerable to depression.
Men tend to be more external.
3. Most major depressive episodes self-terminate.
4. Stressful events related to work, marriage, and close
relationships often precede depression.
5. With each new generation, depression is striking earlier.
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IV. Theory of Depression
Gender differences
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IV. Suicide
The most severe form of behavioral response to
depression is suicide. Each year some 1 million
people commit suicide worldwide.
1.
2.
3.
4.
5.
Suicide Statistics
National differences
Racial differences
Gender differences
Age differences
Other differences
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IV. MD… Biological Perspective
Genetic Influences: Mood disorders run in
families. The rate of depression is higher in
identical (50%) than fraternal twins (20%).
Jerry Irwin Photography
Linkage analysis and
association studies link
possible genes and
dispositions for depression.
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IV. The Depressed Brain
PET scans show that brain energy consumption
rises and falls with manic and depressive
episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine
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IV. MD & Social-Cognitive
Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
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IV. MD… Negative Thoughts and
Moods
Explanatory style plays a major role in becoming depressed.
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IV. MD… Depression Cycle
1. Negative stressful events.
2. Pessimistic explanatory
style.
3. Hopeless depressed state.
4. These hamper the way the
individual thinks and acts,
fueling personal rejection.
5. Therapists try to break
this cycle by changing the
way depressed people
process events.
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V. Schizophrenia
The literal translation is “split mind” which
refers to a split from reality. A group of severe
disorders characterized by the following:
1. Disorganized and delusional
thinking.
2. Disturbed perceptions.
3. Inappropriate emotions and
actions.
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V.
Schizophrenia
What patterns of thinking, perceiving, feeling, and behaving
characterize schizophrenia?
• A group of disorders that typically strike during late
adolescence, affect men very slightly more than women,
and seem to occur in all cultures.
• Symptoms: disorganized and delusional thinking (which
may stem from selective attention), disturbed perceptions,
and inappropriate emotions and actions.
• Delusions are false beliefs; hallucinations are sensory
experiences w/o sensory stimulations.
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V.
Schizophrenia
What forms does schizophrenia take?
• May emerge gradually from a chronic history of social
inadequacies (recovery is dim) or suddenly in reaction to
stress (recovery is brighter).
• Positive symptoms are defined as the presence of
inappropriate behaviors.
• Negative symptoms: as the absence of appropriate
behaviors.
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IV. What causes Schizophrenia?
• May have increased receptors for the neurotransmitter
dopamine, which may intensify the positive symptoms of
schizophrenia.
• Brain abnormalities include enlarged, fluid-filled cerebral
cavities and corresponding decreases in the cortex.
• Brain scans reveal abnormal activity in the frontal lobes,
thalamus, and amygdala.
• Malfunctions in the brain regions and their connections
apparently interact to produce symptoms of schizophrenia.
• Twin/Adoptive studies also point to genetic disposition
that interact w/ environmental factors .
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Disturbed Perceptions
A schizophrenic person may perceive things
that are not there (hallucinations). Frequently
such hallucinations are auditory and lesser
visual, somatosensory, olfactory, or gustatory.
L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg
Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg
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Inappropriate Emotions & Actions
A schizophrenic person may laugh at the news
of someone dying or show no emotion at all
(flat affect).
Patients with schizophrenia may continually
rub an arm, rock a chair, or remain motionless
for hours (catatonia).
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Onset and Development of
Schizophrenia
Nearly 1 in a 100 suffer from schizophrenia, and
throughout the world over 24 million people
suffer from this disease (WHO, 2002).
Schizophrenia strikes young people as they
mature into adults. It affects men and women
equally, but men suffer from it more severely
than women.
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Chronic and Acute Schizophrenia
When schizophrenia is slow to develop
(chronic/process) recovery is doubtful. Such
schizophrenics usually display negative
symptoms.
When schizophrenia rapidly develops
(acute/reactive) recovery is better. Such
schizophrenics usually show positive
symptoms.
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Understanding Schizophrenia
Schizophrenia is a disease of the brain exhibited
by the symptoms of the mind.
Brain Abnormalities
Dopamine Overactivity: Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain.
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Abnormal Brain Activity
Brain scans show abnormal activity in the
frontal cortex, thalamus, and amygdala of
schizophrenic patients.
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
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Abnormal Brain Morphology
Schizophrenia patients may exhibit
morphological changes in the brain like
enlargement of fluid-filled ventricles.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
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Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection
(flu) during the middle of their fetal
development.
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Genetic Factors
The likelihood of an individual suffering from
schizophrenia is 50% if their identical twin has
the disease (Gottesman, 2001).
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
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Genetic Factors
The following shows the prevalence of
schizophrenia in identical twins as seen in
different countries.
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VI. Rates of Psychological Disorders
• Research: 1 in 7 US adults has, or has have, a
psychological disorder, usually by early adulthood.
• Poverty is a predictor of mental illness.
• Conditions and experiences associated w/ poverty
contribute to the development of mental disorders, but
some, like schizophrenia, can drive people into poverty.
• Among Americans who have ever experienced a
psychological disorder, the three most common were
phobias, alcohol abuse, and mood disorder.
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Rates of Psychological Disorders
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Rates of Psychological Disorders
The prevalence of psychological disorders during
the previous year is shown below (WHO, 2004).
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