Download AP Psychological Disorders

Psychopathology
 What was formerly known as mental illness or mental
disorder is now often referred to as psychopathology.
 Some feel “mental illness” puts the basis for the illness on
biology, even though psychologists have shown that
environment is often the cause of the disorder.
 Psychopathology is any pattern of emotions, behavior, or
thoughts inappropriate to the situation and leading to
personal distress or the inability to achieve important
goals.
Prevalence of Psychopathology
 In America, mental illness is far more common than most
people realize.
 Over 15% of the population suffers from diagnosable
mental health problems.
 Another study found that during any given year, the
behaviors of over 56 million Americans meet the criteria
for a diagnosable psychological disorder (Carson et al.
1996).
 Over the lifespan, as many as 32% of Americans suffer
from some psychological disorder (Regier et al., 1988).
What is Psychological Disorder?
 How do we discern what is normal and abnormal?
Consider eccentric personalities like Robin Williams, Dave
Chapelle, Madonna, Marilyn Manson.
 What about a soldier who risks his life in war? A grief
stricken mother who cannot return to her normal routines
three months after losing her son?
3 Classical Symptoms of
Severe Mental Illness
 The more extreme a disorder is, the more easily it
is detected. When trying to diagnose a patient,
doctors look for three classic symptoms of sever
psychopathology:
 Hallucinations-false sensory experiences.
 Delusions-extreme disorders that involve persistent false
beliefs.
 Affect (emotion)-characteristically depressed, anxious, manic,
or no emotional response.
Psychological Disorders as a Continuum
No Disorder
Mild Disorder
Moderate
Disorder
Severe
Disorder
Absence of signs of
psychological
disorder
Few signs of distress
or other indicators of
psychological
disorder
Indicators of
disorders are more
pronounced and
occur more frequently
Clear signs of
psychological
disorder, which
dominate the
person’s life
Absence of
behavioral problems
Few behavior
problems; responses
usually appropriate to
the situation
More distinct
behavior is often
inappropriate to the
situation
Severe and frequent
behavior problems;
behavior is usually
inappropriate to the
situation
No problems with
interpersonal
relationships
Few difficulties with
relationships
More frequent
difficulties with
relationships
Many poor
relationships or lack
of relationships
Disorders are exaggerations of normal behavior and responses.
Two Contrasting Views
 As with most topics in psychology, there are
multiple perspectives on psychological
disorders.
 The medical model takes a “disease” view.
Psychology, on the other hand, sees
psychological disorders as an interaction of
biological, mental, social and behavioral
factors.
Historical Roots
 In the ancient world, psychopathology was thought to be
caused by demons and spirits that had taken possession of
the person’s mind and body.
 Part of daily life in ancient worlds was spent doing rituals
aimed at outwitting or placating these supernatural beings.
Hippocrates
 In 400 B.C. the Greek physician Hippocrates took the
first step toward a scientific view of mental illness when
he said that abnormal behavior had physical causes.
 He taught his disciples to interpret the symptoms of
psychopathology as an imbalance among our body
fluids called “humors.”
Humors
Origins
Temperament
Blood
Heart
Sanguine (cheerful)
Choler (yellow bile)
Liver
Choleric (angry)
Melancholer (black bile)
Spleen
Melancholy (depressed)
Phlegm
Brain
Phlegmatic (sluggish)
Regression in Thought
 Then in the Middle Ages, superstition eclipsed the
Hippocratic model. Under the influence of the
medieval Church, physicians and clergy reverted
to the old ways of explaining abnormal behavior.
Hippocrates
Salem Witch Trials
 As a result of erroneous thinking, thousands of mentally
disturbed people were executed.
 In Salem Massachusetts, was one example of the problems
with this type of thinking.
 A modern analysis of the Salem witch trials has concluded
that the girls were probably suffering from poisoning by a
fungus growing on rye grain-the same fungus that produces
the hallucinogenic drug LSD.
The Medical Model
 In the late 18th century, the “disease view”
reemerged.
 The result was the medical model, a view that
mental disorders are diseases of the mind that,
like ordinary physical diseases, have objective
causes and require specific treatment.
Medical Model in Practice
 The medical model led to mental hospitals or
“asylums.” In this supportive atmosphere, many
patients actually improved, even thrived, on rest,
contemplation and simple but useful work.
Problems with the Medical Model
 Despite its success, modern psychologists find
fault with relying solely on the medical model.
 They suggest that treating the disorder as a
“disease” leads to a doctor-knows-best approach
in which the therapist takes all the responsibility
for diagnosing and correcting the problem.
 In this model, the patient becomes a passive
recipient of medication and advice.
Psychologists vs. Psychiatrists
 The other problem psychologists have with the medical
model (doctor-knows-best), is that it takes responsibility
away from psychologists and gives it to psychiatrists.
 According to our authors, it assigns psychologists to
second-class professional status.
Social-Cognitive-Behavioral Approach
 As psychology has evolved, theories which were originally
at odds, have now been combined to offer more thorough
explanations, for example, cognitive psychology and
behaviorism.
 Cognitive psychology looks inward, emphasizing mental
processes. Behaviorism looks outward and emphasizes
the influences of the environment.
 Psychologist from these perspectives see these two as
complementary, and add that cognitions and behavior
usually happen in social context, requiring social
perspective.
Combining Perspectives
 The behavioral perspective tells us that abnormal
behaviors can be acquired in the same fashion as healthy
behaviors-- through behavioral learning.
 The cognitive perspective suggests that we must consider
how people think about themselves and their relations
with other people.
 Social-cognitive-behavioral approach, then, is an
alternative to the medical model combining all three of
psychology’s major perspectives.
The Biopsychology of Mental Disorder
 Modern biopsychology assumes that some
mental disturbances involve the brain or nervous
system in some way.
 Subtle changes in the brain’s tissue or its chemical
messengers- the neurotransmitters- can
profoundly alter thoughts and behaviors.
 Genetic factors, brain injury, infection, and
learning are some of the factors that can tip the
balance towards psychopathology.
Indicators of Abnormality
 While psychologists look for the three classical
symptoms, not all disorders have such sever symptoms.
A few others are:
 Distress: Does the individual show unusual or prolonged levels of
anxiety?
 Maladaptiveness: Does the person act in ways that make others
fearful?
 Irrationality: Does the person act or talk in ways that are irrational or
incomprehensible to others?
 Unpredictability: Does the individual behave erratically and
inconsistently at different times?
 Unconventional/undesirable behavior: Does the person act in ways
that are statistically rare and violate social norms?
The More the Better
 Clinicians are more confident in labeling behavior as
“abnormal” when two or more of the indicators are
present.
 Extremes and prevalence = greater confidence in diagnosis
DSM-IV
 The American Psychological Association developed
the most widely used classification system for
psychological disorders.
 The book is called the Diagnostic and Statistical
Manuel of Mental Disorders.
*IV=4th edition
DSM-IV-TR
 The DSM-IV-TR offers practitioners a common and
concise language for the description of
psychopathology.
 The DSM also contains language for diagnosing
each of the disorders.
Mood Disorders
 Mood disorders are abnormal disturbances in emotion or
mood. They are also referred to as affective disorders.
 The two most common are major depression and bipolar
disorder.
See if you can
identify which
disorder Ms.
Spears has.
Major Depression
 Major depression is a form of depression that
does not alternate with mania (happiness).
 It is normal to become depressed after a sad or
unfortunate even but if a person remains
depressed weeks or months after that event, it
may be classified as major depression.
 Major depression does not give way to manic
episodes.
Major Depression
 By many accounts, depression is
under diagnosed and under
treated.
 Globally speaking, studies indicate
that depression is the single most
prevalent disability.
 While some differences may be a
result of reporting, other factors
seem to be at work too:
 Taiwan/Korea = low divorce rate
 Lebanon = war in Middle East
Lifetime Risk of a
Depressive Episode
lasting a Year or More
Taiwan
1.5%
Korea
2.9%
Puerto Rico
4.3%
U.S.
5.2%
Germany
9.2%
Canada
9.6%
New Zealand
11.6%
France
16.4%
Lebanon
19%
Causes of Depression
 Some causes of major depression involve genetic
predisposition. Severe bouts of depression often run
in families.
 Further indication of a biological basis for depression
are that drugs that affect the brains levels of certain
neurotransmitters are very effective.
 However, biology alone cannot account for
everything.
Cognitive Explanations
 Probably because of low self-esteem, depressionprone people are more likely to perpetuate the
depression cycle by attributing negative events to
their own personal flaws or external conditions they
feel helpless to change.
 Martin Seligman calls this learned helplessness.
Cognitive-Behavioral Cycle of Depression
Fred decides to be more
sociable, but when he
asks Teresa for a date she
already has plans.
Fred concludes that he is
not very interesting or
attractive and that people
don’t like him.
Low self-esteem
and negative
interpretations
Negative
events
Because of Fred’s
negative behaviors,
people avoid himreinforcing his symptoms.
Fred feels completely
alone and unhappy
Social rejection
and loneliness
Depression
Negative
behaviors
Fred avoids people, skips
school and neglects
personal hygiene
The Cognitive Approach
 The cognitive approach to depression points out that
negative thinking styles are learned and modifiable.
*Think classical and operant conditioning.
Beck’s Basics
 Aaron Beck suggests that depression is a result of negative
thinking which he called ‘cognitive errors’ (errors in logic)
 Beck identified three negative thoughts that seemed to be
really automatic and occurred without delay in depressed
patients. The “Cognitive Triad:”
 Self
 External World
 Future
 Beck believes that faulty thinking leads to depression. The
question remains though, which came first, the depression or
the faulty thoughts.
WHO BECOMES DEPRESSED?
 Studies show that depression rates are higher in women.
The difference may be in the way men and women
handle emotional situations.
 Women tend to be introspective:
 Think about their feelings and what may be causing them.
 Men, on the other hand, try to distract themselves from
the depressed feelings.
 This suggests the more ruminative response of women
increases their vulnerability to depression.
 Depression breeds depression
Increasing Rates of Depression
 Rates of depression have increased 10-20 times
what they were 50 years ago.
 The average age of people experiencing depression
has gone down.
 Seligman identifies three causes for this trend:
1. Out-of-control individualism/self-centeredness-focuses on
individual successes and failures rather than group
accomplishments.
Increasing Rates of Depression
2. The self-esteem movement- teaching a generation
of children they should feel good about themselves,
irrespective of their efforts and achievements.
3. A culture of victimology- reflexively pointing the
finger of blame at someone or something else.
Bipolar Disorder
 Formerly known as manic-depressive disorder, bipolar
disorder is a mental abnormality involving swings of
mood from mania to depression.
 A strong genetic component is well established,
although the exact genes involved are not known.
 1% of the population has bipolar attacks, having an identical
twin with the problem inflates a person’s chances to about 70%
Anxiety Disorders
 Everyone has experienced
some level of anxiety in their
life. For some people, a
spider, or a tall ladder are
enough to send chills down
the spine.
 Psychopathology anxiety is
far more sever than the
anxiety associated with
normal life challenges.
Prevalence of Mental Disorders
=Anxiety
Disorder
Generalized Anxiety Disorder
 Generalized anxiety disorder is a psychological problem
characterized by persistent and pervasive feelings of
anxiety, without any external cause.
 May experience times when your worries don't completely
consume you, but you still feel rather anxious
 May feel on edge about many or all aspects of your life
 May have a general sense that something bad is about to
happen, even when there's no apparent danger.
 May not remember when you last felt relaxed or at ease.
 GAD often begins at an early age, and the signs and
symptoms may develop slowly.
Panic Disorder
 Panic disorder is a disturbance marked by sudden and severe
anxiety attacks that have no obvious connections with events in
the person’s life.
 Usually free of anxiety between panic attacks
Panic attack symptoms:
* Rapid heart rate
* Chest pain
* Sweating
* Headache
* Trembling
* Dizziness
* Shortness of breath
* Faintness
* Hyperventilation
* Trouble swallowing
* Chills
* A sense of
* Hot flashes
impending death
* Nausea
* Abdominal cramping
Panic Disorder
 Many people who suffer from panic disorder also have
agoraphobia. A condition which involves panic that
develops when people find themselves in situations
from which they cannot easily escape: crowed places,
open spaces, etc.
 Occurs in about 2% of Americans and affect women
more than men.
Phobic Disorders
 In contrast to panic disorder, phobias involve persistent and
irrational fear associated with a specific object, activity or
situation.
 While many of us have fears, or dislikes of specific objects or
situations, these only become psychopathology when they
have a cause substantial disruptions in our lives.
Preparedness Hypothesis
 This theory suggests that we carry an innate biological
tendency, acquired through natural selection, to respond
quickly and automatically to stimuli that posed a survival
threat to our ancestors.
 May explain why we develop phobias for snakes and
lightening much more easily than automobiles and electrical
outlets
Obsessive-Compulsive Disorder
 OCD is a condition characterized by patterns of persistent,
unwanted thoughts and behaviors.
 The obsessive component consists of thoughts, images or
impulses that recur or persist despite a person’s efforts to
suppress them.
Obsessive-Compulsive Disorder
 The compulsive component are repetitive, purposeful acts
performed according to certain private “rules,” in response
to an obsession.
 Many characters on TV and in movies have OCD: Jack
Nicolson in As Good As It Gets; Monica on Friends; Monk
 Others?
Obsessive-Compulsive Disorder
 When they are calm, people with obsessivecompulsive disorder view their compulsions as
senseless. However, when anxiety arises, they cannot
resist performing the compulsive behavior rituals to
relieve tension.
 OCD has a tendency to run in families
 A clear genetic connection
 Environment seems to play a factor
 Behavioral therapy helps many OCD sufferers
Somatoform Disorders
 Somatoform disorders are psychological problems
appearing in the form of bodily symptoms or physical
complaints such as weakness or excessive worry
about disease.
 Conversion Disorder: A disorder marked by paralysis,
weakness or loss of sensation but with no discernable
physical cause.
 Hypochondriasis: A disorder involving excessive worry
about health and disease.
How a hypochondriac might see himself
Dissociative Disorders
 Dissociative disorders are a group of pathologies
involving the “fragmentation” of the personality, in which
some parts of the personality have become detached from
other parts.
 Dissociative Amnesia: A psychologically induced loss of
memory for personal information, like one’s identity.
 Usually the result of a stressful situation, it is often
associated with Post Traumatic Stress Disorder (PTSD).
PTSD
 Post Traumatic Stress Disorder dates back to 6 B.C. where
reports of battlefield stress had an adverse affect on
soldiers.
 In the past PTSD has been referred to as railway spine,
shell shock, battle fatigue, traumatic war neurosis, or
post-traumatic stress syndrome.
 Today treatment involves therapy and anti-anxiety drugs.
During WWI treatment looked much different:
 Shell Shock/Shock Therapy
 New PTSD Therapy
Dissociative Fugue
 Dissociative fugue is a combination of fugue, or “flight,
and amnesia. Sufferers not only suffer from a lost sense of
identity, they also flee their homes, jobs and families.
 While most episodes last only a few hours or days, it can
last longer.
 Heavy use of alcohol may predispose a person to
dissociative fugue. While this suggest that some brain
impairment may be involved, no specific cause has been
identified.
Dissociative Fuge
 The DSM-IV-TRlists four criteria for diagnosing
dissociative fugue:
 Unexplained/ unexpected travel from a person's usual place
of living along with partial or complete amnesia.
 Uncertainty and confusion about one's identity, or in rare
instances, the adoption of a new identity.
 The flight and amnesia that characterize the fugue are not
related exclusively to DID, nor is it the result of substance
abuse or a physical illness.
 An episode must result in distress or impairment severe
enough to interfere with the ability of the patient to function
in social, work or home settings.
Depersonalization Disorder
 Depersonalization disorder is an abnormality involving
the sensation that mind and body have separated.
 Often times sufferers explain episodes as out of body
experiences.
 Like all of the other dissociative disorders,
depersonalization disorder occurs far more frequently
following a prolonged period of stress or a traumatic
event.
Dissociative Identity Disorder
 Once called multiple personality
disorder, dissociative identity disorder
is a condition where an individual
displays multiple identities or
personalities.
 Experts say this disorder appears first in
childhood and may be a defensive
response to abusive situations or
terrifying events.
 Most of the emerging personalities
contrast in some significant way with
the original self.
Hershel Walker was recently
diagnosed with DID.
Schizophrenia
 Schizophrenia is a psychological disorder involving
distortions in thoughts, perceptions and/or emotions.
 This is the disorder people are referring to when they use
terms like “madness,” “psychosis,” or “insanity.”
What Does it Look Like
 For sufferers of schizophrenia, the mind can be
twisted in terrible ways.
 May become bleak and devoid of meaning
 Can become very overwhelming and filled with
stimuli, hallucinations and delusions.
 In schizophrenia, emotions become blunted,
thoughts turn bizarre, and language takes a
strange turn. Take the following for example:
Sample Speech From Schizophrenic Patient
 The lion will have to change from dogs into cats until I
can meet my father and mother and we dispart some
rats. I live on the front of Whitton’s head. You have to
work hard if you don’t want to get into bed…It’s all
over for a squab true tray and there ain’t no squabs,
there ain’t no men, there ain’t no music, there ain’t
nothing besides my mother and my father who stand
along upon the Island of Capri where is no ice. Well it’s
my suitcase sir. (Roger, 1982)
Prevalence of Schizophrenia
 One out of every 100 Americans, 2 million people over
the age of 18-will be affected.
 For men, schizophrenia usually shows up before age
25, and between the ages of 25 and 40 for women.
 Currently, schizophrenia is the diagnosis for over 40%
of patients in public mental hospitals. This may be due
to the fact that there is no cure, and often times
patients will need need therapy for the remainder of
their lives.
5 Major Types of Schizophrenia
 Disorganized type: typical image of mental illness with incoherent
speech, hallucinations, delusions and odd behaviors
 Catatonic type: a range of motor dysfunctions
 Stupor: long periods of coma like, motionless state
 Excitement: agitated and hyperactive
 Paranoid type: delusions and hallucinations but no catatonic
symptoms and none of the incoherence of disorganized type
 Undifferentiated type: a catchall term for schizophrenia
symptoms that are erratic and do not it into one of the other
categories, but are clear symptoms of the disorder
 Residual type: the diagnosis for individuals who have suffered
from schizophrenia, but have no major symptoms at the time
Positive and Negative Categories
 Often times, researchers now simply
characterize symptoms of schizophrenia into
positive and negative categories.
 Positive symptoms refer to active process such as
delusions, and hallucinations.
 Negative symptoms refer to passive processes
like social withdrawal.
Causes of Schizophrenia
 Freud originally thought schizophrenia was a result of
defective parenting or repressed childhood trauma.
 Impact of Drugs
 Major tranquilizers which inhibit dopamine, can suppress the
symptoms of schizophrenia
 Drugs that provide excess dopamine can cause schizophrenic
type behaviors in healthy people.
Causes of Schizophrenia
 Loss of grey matter: Magnetic resonance images (MRI
scanswere created after repeatedly scanning 12
schizophrenia subjects over five years, and comparing them
with 12 healthy controls, scanned at the same ages and
intervals.
•Severe loss of gray matter is
indicated by red and pink
colors, while stable regions
are in blue.
•STG =superior temporal
gyrus
•DLPFC =dorsolateral
prefrontal cortex.
Causes of Schizophrenia
 While the exact cause of the disorder still remains somewhat of
a mystery, there is very strong evidence that it has a genetic
link.
 People who have an identical twin who suffers from schizophrenia
have a 50% chance of suffering from the disorder too, even if they
were raised in separate environments.
 Similarly, a child with one parent suffering from schizophrenia has
a 13% chance of developing the disorder, but a child of two parents
with the disorder has a 46% chance of developing schizophrenia.
Schizophrenia Treatments
 Much like the treatment for all psychological disorders, the
treatment of schizophrenia has come a long way:
 Lobotomies
 Insulin Shock Therapy
 Current treatment for schizophrenia is usually a combination of
therapy and medication:
 Schizophrenia Medication
Lobotomies
 One of the earliest treatments were lobotomies. This
procedure consisted of cutting the connections to and from,
or simply destroying, the prefrontal cortex.
The Process
 Doctors would access the frontal lobes through the eye
sockets, instead of through drilled holes in the scalp. In 1945,
he took an ice pick from his own kitchen and began to test
the new surgical technique on cadavers.
The Process
 The technique involved lifting the upper eyelid and placing the
point of a thin surgical instrument under the eyelid and against the
top of the eye socket.
•A hammer was
used to drive the
pick through the
bone, into the brain.
It was then moved
from side to side,
severing nerve
fibers connecting
the frontal lobes to
the thalamus.
Other Types of Disorders
 Most people get stuck thinking about depression and
schizophrenia when they think about psychological
disorders. In reality there are far more. Some of the more
common, and more studied disorders are:
 Eating Disorders:
 Personality Disorders:
 Developmental Disorders:
Eating Disorders
 Of the eating disorders that exist, two
are most prevalent and most studied:
 Anorexia nervosa: an eating disorder
that causes a persistent loss of
appetite that endangers an individuals
health
 Stems from emotional or psychological
reasons rather than natural causes
 Usually a distorted view of oneself
 1% of population affected
 3.4% with partial syndrome anorexia
Eating Disorders
 The other common eating disorder is
bulimia nervosa.
 Bulimia Nervosa: An eating disorder
characterized by binges and purges
 Induced vomiting, or laxatives
 .6% of population affected with bulimia
 Up to 4.2% of females
The History of Bulimia-Nervosa
 It was believed that the
ancient Romans used a
vomitorium to rid
themselves of food.
 Bulimia was not established
as a psychological disorder
until the late 1970’s.
 95-85% of cases of
anorexia/bulimia are women
in the US (National Institute
of Mental Health)
Personality Disorders
 Personality disorders are conditions involving a chronic,
pervasive, inflexible and maladaptive pattern of thinking,
emotion, social relationships or impulse control
 Narcissistic Personality Disorder: Grandiose sense of self
importance and preoccupation with fantasies of success
 Antisocial Personality Disorder: Longstanding pattern of
irresponsible behavior indicating lack of conscience and
responsibility towards others.
 Borderline Personality Disorder: Unstable and given to
extreme impulses without clear reasoning.
Development Disorders
 Developmental disorders are a group of disorders that can
appear at any age, but most commonly show signs during
childhood.
 Autism: Marked by disabilities in language, social interaction
and the inability to understand another person’s state of
mind
 1 in 500 children; recent increase in cases
 Dyslexia: A reading disorder where letters words and
numbers are perceived out of order, upside down or
completely incomprehensible
 True account of dyslexia