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AP® Psychology:
Disorders and Treatments
I. Historical Perspectives on Disorders
A. Hippocrates and the Humors
• The “father of medicine” diagnosed
personality and psychological dysfunction
by estimating humor level.
• Humors were chemical substances (black
bile, yellow bile, blood, and phlegm) that
supposedly determined health and
personality.
B. Demonological Model
view that abnormal behavior
was caused by the invasion
of evil spirits or demons.
Trephining
In the Stone Age when a person
was thought to have a mental
disorder, a hole was chiseled into
the skull to allow the evil spirits
to escape.
**Significant because it shows
that mental disorders have
existed as long as humans have.
The Float Test
• The Middle Ages.
• The belief was that people were either involuntarily
possessed by the devil or had voluntarily made a pact with
the devil.
• A “test” for witches was devised based on the concept that
impurities tend to float in water. Suspected witches would
have their hands and feet tied, and then they would be
thrown into a lake.
• If they sank, they were innocent because they had no evil
impurities to keep them afloat.
• If they floated, they were guilty and tortured.
• During the 15 and 1600s, over 100,000 people with mental
disorders were identified as witches, tested, and killed.
C. The Medical Model
• abnormal behavior is
symptomatic of an
underlying illness.
1. Organic Version
• behavior/thought is caused by a
biological or biochemical problem.
2. Psychodynamic Version
• Disorders are caused by
unconscious conflicts.
D. The Learning Model
• believe that the behavior itself is
the problem.
E. The Cognitive Model
• Focus on “errors” in the thought
process.
• Information processing theorists
see processes of the mind similar
to those of a computer.
Albert Ellis
• views anxiety problems stem
from irrational beliefs and
attitudes.
Aaron Beck
• attributes depression to cognitive
errors.
Bandura and Mischel
• see encoding strategies, selfregulatory systems, and
expectancies important in
predicting and explaining behavior.
AP® Psychology:
Disorders and Treatments
II. Defining and Classifying Disorders
Crazy
• a general layman’s term that
communicates little to the
professional. Do not use it.
Insane
• Is a legal definition for somebody
suffering from a debilitating
psychological disorder.
• It, too, has no place in a
psychological discussion.
Normal Behavior
• What is considered average
behavior/statistically common behavior.
• Societal influences must be taken into
account.
1. Abnormal Behavior
• We define abnormal in terms that
transcend time, place, and society’s current
value judgments: distress, dysfunction, and
deviance.
Distress
• How upsetting is the condition to the
individual?
• However, cannot base diagnosis on this
alone.
• Some people are so out of touch with
reality that they exhibit no distress, but their
behaviors are so outlandish that they are
labeled abnormal.
Dysfunction
• Behaviors that interfere with a person’s
ability to function within society (work, build
relationships, etc.) or behaviors that interfere
with the well-being of society (murders,
bombings, etc.).
Deviance
• Describes how far a person’s behavior
varies from society’s expectations for
behavior.
• Usually the behavior is considered
maladaptive and/or inappropriate.
• Like facing forward in an elevator and not
making eye contact. Although, some norms
are codified by law, like murder.
Typical indications that a behavior causes
distress/dysfunction:
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1.
2.
3.
4.
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6.
Unusual
Socially unacceptable
Faulty perception of reality
Severe personal distress
Self-defeating
Dangerous
Disorder
• For the most part, these are considered
“transient situational disorders” or
problems in everyday living.
• Generally, these have fairly good
prognosis for treatment.
Characteristics of Disorders
1. In touch with reality
2. Functions in society; may be minimal
3. More likely to be cured or controlled
Psychosis
Characteristics of Psychosis
1. Out of touch with reality
2. Can't function in society
3. Often needs hospitalization
4. Often cannot be cured
• The most serious dysfunctions that include
schizophrenia and organic brain syndromes (like
brain damage, senile dementia, dementia from
syphilis, and Alzheimer’s) that show breaks with
reality and seriously disordered thinking.
Vulnerability-Stress Model
• Vulnerability in all people toward
developing a psychological disorder
given sufficient stress.
Diasthesis-Stress Model
• Genetic factors place the individual at
risk for a psychological disorder, but
environmental factors transform the
potential into an actual disorder.
DSM-IV-TR
Diagnostic and Statistical Manual of Mental
Disorders. 4th ed. Text Revision. (2000)
• The most widely used diagnostic classification
system in the U.S. It has more than 350 diagnostic
categories and contains detailed lists of observable
behaviors that must be present in order for a
diagnosis to be made.
• Recently replaced by the DSM-V
DSM-V
*Axis I—the primary diagnosis—represents the
person’s clinical symptoms (the deviant
behavior/thoughts occurring at that time).
*Axis II—reflects long-standing personality disorders
or mental retardation which can influence a person’s
behavior and response to treatment.
Axis III—relevant medical history, such as
hypertension or recent concussions.
Axis IV—rates the person’s psychosocial and
environmental problems in the person’s recent past.
Axis V—rates the person’s coping resources, such
as recent adaptive functioning.
Sample DSM-V Diagnosis
Axis I
Panic Disorder
Axis II
Dependent Personality
Disorder
Hypertension
(high blood pressure)
Severe Stressors:
• Job Loss
• Divorce
Serious Symptoms:
Fair overall functioning
Axis III
Axis IV
Axis V
The Rosenhan Study (1973)
• Showed that psychiatric labels cause
mistaken diagnoses.
• Once a label has been applied, doctors
tend to fit all behaviors into the
framework of that disorder.
AP® Psychology:
Disorders and Treatments
III. Some Common Disorders
I. Anxiety Disorders
A. Characteristics:
1. persistent & irrational feelings of dread,
apprehension, ANS arousal, or tension
2. feelings out of proportion to the threat
perceived
3. anxiety interferes with daily life.
4. total lack of anxiety is also abnormal
a. Phobias
• Phobias are strong and irrational fears of certain
objects or situations. Examples:
• Agoraphobia--fear of open or public places from
which escape would be difficult.
• Social phobia--excessive fear of situations in
which the person might be evaluated and possibly
embarrassed.
• Specific Phobia--a fear of specific things: e.g.
dogs, cats, spiders, planes, elevators, enclosed
spaces, etc.
b. Generalized Anxiety Disorder
• Chronic state of diffuse or flee-floating,
anxiety that is not attached to specific
situations or objects.
c. Panic Disorder
• Tension and anxiety occur suddenly
and unpredictably and are much more
intense than with a generalized anxiety
disorder. Not usually tied to
environmental problems. Can occur day
or night.
• People with panic disorders often
develop agoraphobia b/c they fear having
a panic attack in public.
d. Obsessive-Compulsive Disorder (OCD)
• Obsessions are repetitive and unwelcomed
thoughts, images or impulses that invade
consciousness, are often abhorrent to the person and
very difficulty to dismiss or control.
• Compulsions are repetitive behavioral responses that
can be resisted only with great difficulty. A person will
repeat behaviors endlessly and if they don't, they may
suffer high anxiety or even a panic attack.
• The obsession often results in the compulsion
because the compulsive behavior eases the anxiety
associated with the obsessive thoughts.
e. Post Traumatic Stress Disorder (PTSD)
• A severe anxiety disorder that can occur in people
who have been exposed to traumatic life events.
• Four common major symptoms:
• 1) severe symptoms of anxiety, arousal, or distress
that were not present before the trauma.
• 2) recurrent flashbacks or reliving the event.
• 3) person becomes numb to the world and avoids
stimuli that serve as reminders of the trauma.
• 4) the person experiences intense survivor guilt if
others had died during the trauma.
• Soldiers, natural disaster survivors, civilian war
victims, refugees, etc. often develop PTSD.
II. Mood Disorders
A. Characteristics:
1. emotion-based disorders
2. includes depression and mania
3. often occurs in conjunction with other disorders
a. Depression
• Frequent, persistent and intense feelings of sadness,
hopelessness, and apathy that are out of proportion to
a person's situation.
• Symptoms can include an inability to concentrate,
withdrawal from activities that used to bring pleasure,
increased sleeping, lack of motivation, procrastination,
and a change in body language and movement
(slower, lethargic, slouchy, etc.).
b. Bipolar Disorder
• Depression (usually the dominant state) alternates
with periods of mania (a state of highly excited mood
and behavior.)
• In the manic state, mood is euphoric and cognitions
are grandiose.
• During the manic phase, the person will begin to
speak more quickly, enact plans without regard to
negative consequences, and become highly productive
in many areas of life: work, sex, etc.
• Robert Schumann produced 27 works during a oneyear manic phase, but he ground to halt when he
•swung back into the depressive state again.
III. Somatoform Disorders
A. Characteristics:
1. involves physical complaints or disabilities that
suggest a medical problem
2. but there is no identifiable or known biological
cause
3. the complaint/disability is not produced
voluntarily
Note: In short, there is no physical basis for the
pain.
a. Hypochondriasis
• A person becomes unduly alarmed about any
physical symptom they detect and are convinced that
they have or are about to have a serious illness.
b. Pain disorder
• A person experiences intense pain that is either out
of proportion to whatever medical condition they have
or for which there is no physical basis for the pain.
• E.g. phantom pains in amputees.
c. Conversion Disorder
• A serious neurological symptoms, such as paralysis,
loss of sensation, blindness, suddenly occur.
• The neural and physical pathways are intact, but the
function ceases.
• For example, during the Vietnam war, survivors of
the "killing fields" of the Khmer Rouge saw
unspeakable horror and more than 150 became
functionally blind after their experience, even though
their eyes and neural pathways were perfectly fine.
IV. Dissociative Disorder
A. Characteristics:
1. involves a breakdown of normal personality
integration
2. results in significant alterations in identity or
memory
a. Psychogenic Amnesia
A person responds to stressful events with extensive
but selective memory loss some can recall nothing
about large portions of their past; others cannot
remember specific events, people, or places, although
the other contents of memory are in tact.
b. Psychogenic Fugue
• A person loses all sense of personal identity, gives up
their customary life wanders to a new faraway location,
and establishes a new identity.
• Generally, triggered by a stressful event or trauma.
Can last from a few hours or days to several years.
c. Dissociative Identity Disorder
AKA: Multiple Personality Disorder--two or more
separate identities exist within the same individual. A
primary personality will appear more than others, but
the alternates have their own integrated memories and
behaviors. They may or may not know of the existence
of the other personalities and can vary in age or
gender. Physiology can change with each personality.
Ine one case, a female had different menstrual cycles
for each personality--3 in a month with the 3 different
personalities! One patient nearly died from a bee sting
allergy, but when a different personality was present a
week later, no reaction occurred to the sting.
V. Personality Disorders
A. Characteristics:
1. exhibits stable, ingrained, inflexible, and
maladaptive ways of thinking, feeling, or behaving
2. distinct enough to have their own category in the
DSM and are not considered in the same class as
depression, anxiety disorders, or even
schizophrenia.
3. main characteristic is the entrenched, enduring,
and patterns of maladaptive behaviors
a. Antisocial Personality Disorder
• A person seems to lack a conscience; they exhibit little
or no anxiety or guilt and tend to be impulsive and
unable to delay gratification of their needs.
• They exhibit a lack of emotional attachment to others.
This lack of caring about others can make these
individuals dangerous.
• Serial killers like Jeffrey Dahmer or Ted Bundy exhibit
no remorse for their actions.
• They can make the most sincere and charming
statements but not mean a word of it.
• They are typically highly intelligent and rational; they
can logically justify their unacceptable behaviors and are
masters of manipulation.
b. Borderline Personality Disorder
• A collection of symptoms characterized primarily by
serious instability in behavior, emotion, identity, and
interpersonal relationships.
• Chaos marks their lives as they engage in selfdestructive behaviors: running away, promiscuity, binge
eating, drugs, self-mutilation and suicide attempts.
• Hard to diagnose because it is usually in conjunction
with mood disorders, PTSD, and substance abuse
disorders.
• They also experience chronic bouts of depression,
loneliness, anger, and emptiness.
VI. Childhood Disorders
A. Characteristics:
1. psyc disorders that begin in childhood, and can encompass
the other categories we have covered.
2. studies indicate that only about 40% of children with PDs
receive treatment.
3. Failure to treat the disorders early can result in needless
distress for children and families, as well as continuing (and
sometimes worsening) problems through adulthood.
a. Attention Deficit/Hyperactivity Disorder
• Problems take the form of inattention,
hyperactivity/impulsivity or a combination of the two.
• This is the most common childhood disorder. 4x more
often in boys.
• Boys tend to be more on the hyper side while girls
tend to be on the inattentive side.
• Causes: linked to diet, brain chemistry, inconsistent
parenting.
a. Attention Deficit/Hyperactivity Disorder
• A long-term disorder characterized by extreme
unresponsiveness to others, poor communication skills
and highly repetitive and rigid behavior.
•Typically forms in the first 3 years of life in the form of
lack of interest in others.
• Autistic children often do not make eye contact, don't
reach for their mothers, don‘t care who is around them,
do not engage in normal play activities, don't include
others in their play or even acknowledge the presence of
others.
• Language develops slowly and often what does
develop is strange.
Echolalia
• The exact echoing of phrases spoken by others.
Savant
Some exhibit extraordinary abilities, such as calendar
calculation or the ability to repeat a song
or paragraph after hearing it only once.
VII. Schizophrenia
A. Characteristics:
1. severe disturbances in thinking, speech, perception,
emotion, motivation, and behavior
2. involves loss of contact with reality--often associated with
delusions, hallucinations and disordered thinking
3. characterized by "pieces of personality" and an "absence of
wholeness"; in most people, language, thought and emotion are
integrated, but with schizophrenia these things become split or
disconnected
****NOTE: This is the true "split personality"; the lay public
confuses schizophrenia with DID; people with DID are not split
from reality, but people with schizophrenia are split from reality.
Not to know this difference shows great ignorance.
4. often involves withdrawal from social activity, communication
in strange or inappropriate ways, neglect of personal hygiene, and
behaving in a disorganized fashion.
a. Paranoid Schizophrenia
• Most prominent features are delusions of persecution (people
out to get me) and delusions of grandeur (I am enormously
important).
• Suspicion, anxiety, or anger may accompany the delusions, and
hallucinations can occur with this type.
b. Catatonic Schizophrenia
•Characterized by striking motor disturbances ranging from
muscular rigidity to repetitive movements.
•Patients in this type can be in a stupor in which they seem
oblivious to reality and alternate to states of excitability and
agitation in which they can be dangerous to others.
•When in the stupor state, their muscles exhibit waxy flexibility
which means that their limbs can be molded into grotesque
positions that they will maintain for hours.
c. Disorganized Schizophrenia
• Central features are confusion and incoherence, combined with
severe deterioration of adaptive behavior, such as personal
hygiene, social skills, and self-care.
• Their behavior often seems silly and childlike. It is difficult to
communicate with these individuals because of their extreme
mental disorganization, so their responses often seem highly
inappropriate.
• These patients are usually unable to function on their own.
d. Undifferentiated Schizophrenia
Category of schizophrenia assigned to people who exhibit some
of the symptoms and thought disorders of the above categories
but who do not have enough of the specific criteria to be
diagnosed in these categories.
Positive Symptoms
The presence of bizarre behaviors that are not found in normal
persons (such as delusions, hallucinations, speech, bizarre
behavior, disordered speech)
**Pos. Symptoms, especially those associated with paranoid
schizophrenia, often indicate good function prior to breakdown
and a better prognosis for recovery.
Negative Symptoms
Negative Symptoms--the absence of characteristics found in
normal persons (such as loss of motivation, absence of affect
[emotion], or absence of speech).
**Negative symptoms likely indicate a long history of poor
functioning prior to diagnosis and are associated with a poor
prognosis following treatment.
Additional Data/Stats on Schizophrenia
Notes on Schizophrenia: It afflicts only 1 to 2% of the
population, yet schizophrenic patients occupy about half of
all psychiatric hospital beds. Many go undiagnosed and barely
function as homeless people in society.
Stats on Schizophrenia: 10% with it remain permanently
impaired. 65% show intermittent periods of normal functioning.
The other 25% recover from it.
AP® Psychology:
Disorders and Treatments
IV. Treatments
1. Psychodynamic Therapies
• All are rooted in Freud’s theories, but
later psychologists have modified them.
All, however, focus on internal conflicts
and unconscious factors.
1. Psychoanalysis
• Refers not only to Freud’s theory, but to
the approach to treatment that he
developed.
• The goal is achieve insight (conscious
awareness of the dynamics that underlie
their problems).
• Insight allows clients to adjust their
behavior to their current situation rather
than continuing on with the maladaptive
behavior learned in childhood.
Free Association
• Clients verbally report without censorship any thoughts,
feelings, or images that enter their awareness.
• The client will lay on a couch, and the therapist will sit
behind the client (out of sight) so that the client’s thought
processes will directly mostly by internal factors.
• Free association may not lead directly to unconscious
material, but provide clues concerning important events or
themes.
• For example, if a client’s stream of thought suddenly stops
after they mention their father, it could indicate a loaded topic
that activated repressive defenses. In other words, there
could be something there that they don’t want to remember or
talk about.
Interpretation
Any statements made by the therapist
to intended to provide insight to the client
about his/her behavior/thoughts.
•
Resistance
Defensive maneuvers that hinder the
process of therapy.
• Could be difficulty in free-associating,
arriving late, or “forgetting” their
appointment, or avoidance of certain
topics.
• The therapist will attempt to explore the
reasons for resistance to help the client
gain insight and guard against the
ultimate resistance: quitting therapy
altogether prematurely.
•
Transference
Responding irrationally to the therapist
as if the therapist were an important
figure from the client’s past.
• It is an important process because it
brings repressed feelings and
maladaptive behavior patterns into the
open for the client and therapist to
explore.
•
Transference
Positive Transference—when the client
transfers feelings of intense affection,
dependency, or love to the analyst.
Negative Transference—when the client
transfers feelings of intense anger,
animosity, hate, or disappointment onto
the therapist.
Interpersonal Therapy
Focuses almost exclusively on the
client’s current relationships with
important people in their lives. Very
effective for depression.
•
B. Humanistic Therapies
• Focuses on the individual and sees
therapy as an encounter between human
equals. The goal is to create an
environment in which clients can engage
in self-exploration and remove the
barriers that block their natural
tendencies toward personal growth.