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Psychological
Disorders
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Presentation
by Jim Foley
© 2013 Worth
Publishers
Module 39: Basic Concepts of Psychological
Disorders, and Mood Disorders
Topics deserving our
understanding and contemplation
 Defining Psychological
Disorders
 Case study: ADHD
 Biopsychosocial and
Medical models
 Classifying Disorders
 The effects of labeling
 Responsibility for one’s
actions
 Rates of various Disorders
 Major Depressive
Disorder
 Bipolar Disorder
 Prevalence and Course of
mood disorders
 Biological Influences on
Depression
 Suicide and Self-Injury
 Social- Cognitive Factors:
Explanatory style
 Depression’s vicious selfreinforcing cycle
Why Learn about Psychological Disorders?
Reasons for curiosity:
 personal familiarity with
psychological symptoms
 knowing someone else
with the disorder
 hearing about how
prevalent and socially
devastating some
disorders have become in
society
 wanting to learn more
about mental health and
human nature
Perspectives on Psychological Disorders
 Defining psychological
disorders
 Thinking critically about
ADHD
 Understanding
psychological disorders
 Classifying
psychological disorders
 Labeling psychological
disorders
 Insanity and
responsibility
Questions to Keep in Mind
How do we decide when a set of
symptoms are severe enough to be
called a disorder that needs
treatment?
Can we define specific disorders
clearly enough so that we can know
that we’re all referring to the same
behavior/mental state?
Can we use our diagnostic labels to
guide treatment rather than to
stigmatize people?
A Psychological disorder is:
A significant dysfunction in an individual’s
cognitions, emotions, or behaviors.
More
 Disorders are diagnosed when there
Understandings
is dysfunction, behaviors which are
considered maladaptive because
about disorders:
they interfere with one’s daily life
 Disorders are diagnosed when the
symptoms and behaviors are
accompanied by Distress, suffering.
 New definition (DSM 5): “a
disturbance in the psychological,
biological, or developmental
processes underlying mental
functioning.”
Is Attention-Deficit/Hyperactivity
Disorder (ADHD) a real disorder?
ADHD: Impulsivity mixed with Inattention and/or
hyperactivity. Can include distractibility, disorganization,
fidgeting, difficulty suppressing impulses, and impaired
working memory. Is this a disorder?
 Is it deviant? Do some people have a level of
inattentiveness, impulsiveness, or restlessness that goes
beyond laziness or immaturity?
 Is it distressful? Is the person enjoying being energetic, or
are they frustrated that they can’t sustain focus?
 Is there dysfunction? Are the symptoms harmless fun, or
do they negatively impact work and relationships?
Understanding the Nature of
Psychological Disorders
 One reason to diagnose a disorder is to make decisions about
treating the problem.
 Based on older understanding of
psychological disorders, treatments have
included: exorcising evil spirits, beatings,
caging/restraint, and
Pinel’s New Approach
 Philippe Pinel (1745-1826) proposed that
mental disorders were not caused by
demonic possession, but by stress and
inhumane conditions.
 Pinel’s “moral treatment” involved
gentleness, nature, and social interaction.
Pinel’s interventions
improved lives but
often did not
effectively treat mental
illness.
But
then…
The Medical
Model
The discovery that the disease of
syphilis causes mental symptoms
(by infecting the brain) suggested a
medical model for mental illness.
 Psychological disorders can be seen
as psychopathology, an illness of
the mind.
 Disorders can be diagnosed,
labeled as a collection of symptoms
that tend to go together.
 People with disorders can be
treated, attended to, given
therapy, all with a goal of restoring
mental health.
The Biopsychosocial Approach
Cultural Influences on Disorders
Culture-bound syndromes are
disorders which only seem to exist
within certain cultures; they
demonstrate how culture can play
a role in both causing and defining
a disorder.
Examples:
Bulimia Nervosa: binging/purging, in the United States
Running amok: violent outbursts, in Malaysia
Hikikomori: social withdrawal, in Japan
Classifying Psychological Disorders
Why create classifications
of mental illness? What is
the value of talking about
diagnoses instead of just
talking about individuals?
1. Diagnoses create a
verbal shorthand for
referring to a list of
associated symptoms.
2. Diagnoses allow us to
statistically study
many similar cases,
learning to predict
outcomes.
3. Diagnoses can guide
treatment choices.




The Diagnostic and
Statistical Manual
It’s easier to count
cases of autism if we
have a clear
definition.
Versions: DSM-IV-TR,
DSM-V (May 2013)
The DSM is used to
justify payment for
treatment.
It’s consistent with
diagnoses used by
medical doctors
worldwide.
The Five “Axes” of Diagnosis
The DSM suggests describing someone not just with a label
but with a five-part picture.
Axis I:
Axis II:
Axis III:
Axis IV:
Axis V:
Is a clinical Is a personality Is a general
Are
What is the
syndrome
disorder or
medical
psychosocial
global
present?
mental
condition,
or
assessment of
retardation
such as
environmental this person’s
Using
(intellectual
diabetes,
problems, such functioning?
specifically
developmental arthritis, or
as school or
defined
Clinicians
disorder)
hypertension housing issues, assign a code
criteria,
present?
also present? also present?
clinicians
from
may select Clinicians may
0-100.
none, one, or may not also
or more
select one of
syndromes.
these two
conditions.
Categories of
Diagnoses
Categories of
Diagnoses:
The 5 Axes
Critiques of Diagnosing with the DSM
1. The DSM calls too many people
“disordered.”
2. The border between diagnoses, or
between disorder and normal, seems
arbitrary.
3. Decisions about what is a disorder seem
to include value judgments; is depression
necessarily deviant?
4. Diagnostic labels direct how we view and
interpret the world, telling us which
behavior and mental states to see as
disordered.
Stigma and Stereotypes
Many people think a diagnostic
label means being seen as tainted,
weak, and weird.
However:
 these negative views/stigma
come from popular cultural views
of mental illness, and not from
the DSM.
 the DSM may contain the
information to correct inaccurate
perceptions of mental illness.
Insanity and Responsibility
 Jared Loughner shot many
people, including a U.S.
Representative, in 2011.
 Loughner had schizophrenia and
substance abuse problems, a
combination associated with
increased violence.
To what degree, if any,
should he be held
responsible for his actions?
What is the appropriate
consequence?
How common are
psychological disorders?
Countries vary greatly in the percentage of people reporting
mental health issues in the past year.
Vulnerable factors and ages for
developing Mental Disorders
Who is vulnerable to
mental disorders?
 Poverty increases the risk
of many mental disorders
including aggression and
anxiety. Disorders
decrease when poverty is
lifted.
 “Immigrant paradox”:
Despite the stress of
immigrating, those who
immigrate to the U.S.A.
have a lower risk of
disorders than their
children born in the
U.S.A.
Age of
vulnerability:
 Many disorders begin to
show symptoms by early
adulthood.
 Developing on average
around age 20: OCD,
Schizophrenia, Bipolar,
Alcohol Dependence.
 Showing some signs earlier:
Phobias (median age 10)
and antisocial personality
disorder (some symptoms
by age 8)
 Developing later than 20:
Major Depressive Disorder.
Rates of
Psychological
Disorders
This list takes a closer
look at the past-year
prevalence of various
mental health diagnoses
in the United States.
Mood Disorders: Not just feeling
“down;” not just sad about something
 Major Depressive Disorder: Stuck in dark withdrawal
 Bipolar Disorder: sometimes fleeing depression into
mania
 Prevalence and Course of depression: Common, but
for many it goes away
 Genetic Influences on Depression
 Suicide and Self-Injury
 Negative Moods and Negative thoughts: Explanatory
style
 The vicious cycle: Interaction of bad experiences 
depressive thoughts  mood changes  behavior
changes  more sad days
Mood Disorders
Major depressive disorder [MDD] is:
 more than just feeling “down.”
 more than just feeling sad
about something.
Bipolar disorder is:
 more than “mood swings.”
 depression plus the problematic
overly “up” mood called “mania.”
Criteria of Major Depressive Disorders
Major depressive disorder is not just one of these symptoms.
It is one or both of the first two, PLUS three or more of the
rest.








Depressed mood most of the day, and/or
Markedly diminished interest or pleasure in activities
Significant increase or decrease in appetite or weight
Insomnia, sleeping too much, or disrupted sleep
Lethargy, or physical agitation
Fatigue or loss of energy nearly every day
Worthlessness, or excessive/inappropriate guilt
Daily problems in thinking, concentrating, and/or
making decisions
 Recurring thoughts of death and suicide
Depression is Everywhere
Depression shows up in people
seeking treatment:
 Phobias are the most
common (frequently
experienced) disorder, but
depression is the #1 reason
people seek mental health
services.
Depression appears worldwide:
 Per year, depressive
episodes happen to about 6
percent of men and about 9
percent of women.
 Over the course of a
lifetime, 12 percent of
Canadians and 17 percent of
USA residents experience
depression.
Depression: The “Common Cold” of
Disorders?
Although both are “common”
(occurring frequently and pervasively),
comparing depression to a cold doesn’t
work.
Depression:
 is more dangerous because of
suicide risk.
 has fewer observable symptoms.
 is more lasting than a cold, and is
less likely to go away just with time.
 is much less contagious.
And…depressive pain is beyond sniffles.
Seasonal Affective Disorder [SAD]
 Seasonal affective disorder is more than simply
disliking winter.
 Seasonal affective disorder involves a recurring
seasonal pattern of depression, usually during
winter’s short, dark, cold days.
 Survey: “Have you cried today”? Result: More
people answer “yes” in winter.
Percentage who cried
Men
Women
August
4
7
December
8
21
Bipolar Disorder
 Bipolar disorder was once
called “manic-depressive
disorder.”
 Bipolar disorder’s two
polar opposite moods are
depression and mania.
Mania refers to a period of
hyper-elevated mood that
is euphoric, giddy, easily
irritated, hyperactive,
impulsive, overly optimistic,
and even grandiose.
Contrasting Symptoms
Depressed mood: stuck feeling
Mania: euphoric, giddy, easily
“down,” with:
irritated, with:
 exaggerated pessimism
 exaggerated optimism
 social withdrawal
 hypersociality and sexuality
 lack of felt pleasure
 delight in everything
 inactivity and no initiative
 impulsivity and overactivity
 difficulty focusing
 racing thoughts; the mind
 fatigue and excessive desire to
won’t settle down
sleep
 little desire for sleep
Bipolar Disorder and Creative Success
Many famous and successful people have lived with the
ups and downs of bipolar disorder. Some speculate that
the depressive periods gave them ideas, and the manic
episodes gave them creative energy. Any evidence of
mood swings here?
Bipolar Disorder in Children and
Adolescents
 Does bipolar disorder
show up before
adulthood, and even
before puberty?
 Many young people have
cycles from depression
to extended rage rather
than mania.
 The DSM-V may have a
new diagnosis for some
of these kids: disruptive
mood dysregulation
disorder.
Understanding Mood Disorders
Why are mood disorders so pervasive,
especially among women?
Women, starting in adolescence, appear to ruminate
more, have deeper sadness then men, encounter more
stressors, and report their depression more readily.
Understanding Mood Disorders
Can we explain…
 Why does depression often go
away on its own?
 the course/development of
reactive depression?
Often, time heals a mood
disorder, especially when the
mood issue is in reaction to a
stressful event. However, a
significant proportion of
people with major depressive
disorder do not automatically
or easily get better with time.
Understanding Mood Disorders
Biological aspects and
explanations
Social-cognitive aspects
and explanations
Evolutionary
Genetic
Brain /Body
Negative thoughts and
negative mood
Explanatory style
The vicious cycle
An Evolutionary Perspective on the
Biology of Depression
 Depression, in its milder, nondisordered form, may have
had survival value.
 Under stress, depression is
social-emotional hibernation.
It allows humans to:
 conserve energy.
 avoid conflicts and other
risks.
 let go of unattainable
goals.
 take time to contemplate.
Biology of Depression: Genetics
Evidence of genetic influence on depression:
1. DNA linkage analysis reveals depressed gene regions
2. twin/adoption heritability studies
Biology of Depression: The Brain
 Brain activity is diminished in depression and increased in mania.
 Brain structure: smaller frontal lobes in depression and fewer
axons in bipolar disorder
 Brain cell communication (neurotransmitters):
 more norepinephrine (arousing) in mania, less in depression
 reduced serotonin in depression
Suicide and Self-Injury
 Every year, 1 million people commit suicide, giving up
on the process of trying to cope and improve their
emotional well-being.
 This can happen when people feel frustrated,
trapped, isolated, ineffective, and see no end to
these feelings.
 Non-suicidal self-injury has other functions such as
sending a message, distracting from emotional pain,
giving oneself permission to feel, or self-punishment.
Understanding Mood Disorders:
The Social-Cognitive Perspective
Low SelfEsteem
Discounting positive
information and assuming the
worst about self, situation,
and the future
Self-defeating
beliefs such as
assuming that
one (self) is
Learned
unable to cope,
Helplessness
improve, achieve,
or be happy
Depression is
associated with:
Depressive
Explanatory
Style
Rumination
Stuck focusing on
what’s bad
Depressive Explanatory Style
How we analyze bad news predicts mood.
Problematic event:
Assumptions about
the problem
The problem is:
The problem is:
The problem is:
Mood/result that
goes along with
these views:
Depression’s Vicious Cycle
A depressed mood may develop when a person with a
negative outlook experiences repeated stress.
The depressed
mood changes
a person’s style
of thinking and
interacting in a
way that makes
stressful
experience
more likely.