Download Psychology 10th Edition David Myers

Chapter 15
Psychological
Disorders
PowerPoint®
Presentation
by Jim Foley
© 2013 Worth Publishers
What we’ll seek to understand...
 What does it mean to have a mental
disorder?
 Defining and classifying disorders
 Anxiety disorders, including OCD and
PTSD
 Mood disorders, including depression
and bipolar disorder
 Schizophrenia
 Sample of other disorders:
 Dissociative disorders
 Eating disorders
 Personality disorders
 Rates, vulnerability, and protective
factors
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?
Psychological disorders are:
patterns of thoughts, feelings, or actions
that are deviant, distressful, and
dysfunctional.
Terms from the Definition
 Disorder refers to a state of
mental/behavioral ill health.
 Patterns refers to finding a collection
of symptoms that tend to go together,
and not just seeing a single
symptom.
 For there to be distress and
dysfunction, symptoms must be
sufficiently severe to interfere with
one’s daily life and well being.
 Deviant means differing from the
norm.
“Deviant”?
 To deviate, in general,
means to vary from
what typically would
happen.
 In psychology, a
behavior or mental
state is considered
deviant by a culture
when it is different from
what would be
expected in that culture.
 A disorder may also be
a deviation from a
typical developmental
pathway.
Defining Deviance:
The Role of Context and
Culture
 Context: whether a behavior
varies from expectation
depends on the situation in
which the behavior occurs
Yelling for hours is not
deviant when it happens at a
football game.
 Culture: these painted faces
might seem deviant when
viewed from a different culture
Is Attention-Deficit/
Hyperactivity Disorder (ADHD)
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.
 To treat a disorder, it helps to understand the
nature/cause of the psychological symptoms.
 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) and others
sought to reform brutal treatment by
promoting a new understanding of the
nature of mental disorders.
 Pinel proposed that mental disorders
were not caused by demonic possession,
but by environmental factors such as
stress and inhumane conditions.
 Pinel’s “moral treatment” involved
improving the environment and
replacing the asylum beatings with
patient dances.
From the humane view
to the scientific view of
the mentally ill:
Pinel’s humane
environmental
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
Mental disorders
can arise in the
interaction between
nature and nurture
caused by biology,
thoughts, and the
sociocultural
environment.
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
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.
Because of this, many psychologists
believe we should use extreme
caution in diagnosing and labeling.
However:
 these negative views/stigma
come from popular cultural views
of mental illness, and not from
the DSM. [Does a diabetes
diagnosis create stigma? No.
Bipolar diagnosis? Yes.]
 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?
Anxiety Disorders
GAD: Generalized anxiety disorder
Panic disorder
Phobias
OCD: Obsessive-compulsive disorder
PTSD: Post-traumatic stress disorder
GAD: Generalized
Anxiety Disorder
 Emotional-cognitive
symptoms include
worrying, having anxious
feelings and thoughts about
many subjects, and
sometimes “free-floating”
anxiety with no attachment
to any subject. Anxious
anticipation interferes with
concentration.
 Physical symptoms include
autonomic arousal,
trembling, sweating,
fidgeting, agitation, and
sleep disruption.
Panic Disorder:
“I’m Dying”
A panic attack is not just an
“anxiety attack.” It may include:
 many minutes of intense dread
or terror.
 chest pains, choking,
numbness, or other frightening
physical sensations. Patients
may feel certain that it’s a
heart attack.
 a feeling of a need to escape.
Panic disorder refers to repeated
and unexpected panic attacks, as
well as a fear of the next attack,
and a change in behavior to avoid
panic attacks.
Specific Phobia
A specific phobia is more than just
a strong fear or dislike. A specific
phobia is diagnosed when there is
an uncontrollable, irrational,
intense desire to avoid the some
object or situation. Even an image
of the object can trigger a
reaction--“GET IT AWAY FROM
ME!!!”--the uncontrollable,
irrational, intense desire to avoid
the object of the phobia.
Some Fears and Phobias
What trends are
evident here?
Which varies more,
fear or phobias?
What does this
imply?
Some Other Phobias
Agoraphobia is the
avoidance of situations in
which one will fear having a
panic attack, especially a
situation in which it is
difficult to get help, and from
which it difficult to escape.
Social phobia refers to an intense
fear of being watched and judged by
others. It is visible as a fear of public
appearances in which
embarrassment or humiliation is
possible, such as public speaking,
eating, or performing.
Obsessive-Compulsive Disorder [OCD]
 Obsessions are intense,
unwanted worries, ideas, and
images that repeatedly pop up in
the mind.
 A compulsion is a repeatedly
strong feeling of “needing” to
carry out an action, even though
it doesn’t feel like it makes sense.
 When is it a “disorder”?
 Distress: when you are deeply
frustrated with not being able
to control the behaviors
or
 Dysfunction: when the time
and mental energy spent on
these thoughts and behaviors
interfere with everyday life
Common OCD Behaviors
Percentage of children and adolescents with OCD reporting
these obsessions or compulsions:
Common pattern: RECHECKING
Although you know that you’ve
already made sure the door is
locked, you feel you must check
again. And again.
Post-Traumatic
Stress Disorder
[PTSD]
About 10 to 35 percent of
people who experience
trauma not only have
burned-in memories, but also
four weeks to a lifetime of:
 repeated intrusive recall of
those memories.
 nightmares and other reexperiencing.
 social withdrawal or phobic
avoidance.
 jumpy anxiety or
hypervigilance.
 insomnia or sleep problems.
Which People get PTSD?
 Those with less control in the
situation
 Those traumatized more frequently
 Those with brain differences
 Those who have less resiliency
 Those who get re-traumatized
Resilience and PostTraumatic Growth
Resilience/recovery
after trauma may
include:
 some lingering,
but not
overwhelming,
stress.
 finding strengths
in yourself.
 finding connection
with others.
 finding hope.
 seeing the trauma
as a challenge that
can be overcome.
 seeing yourself as
a survivor.
Understanding Anxiety Disorders:
Explanations from Different Perspectives
Psychodynamic/
Freudian:
repressed
impulses
Observational
learning:
worrying like
mom
Classical
conditioning:
overgeneralizing
a conditioned
response
Cognitive
appraisals:
uncertainty is
danger
Operant
conditioning:
rewarding
avoidance
Evolutionary:
surviving by
avoiding danger
Understanding Anxiety Disorders:
Freudian/Psychodynamic Perspective
 Sigmund Freud felt that
anxiety stems from
repressed childhood
impulses, socially
inappropriate desires, and
emotional conflicts.
 We repress/bury these
issues in the unconscious
mind, but they still come
up, as anxiety.
Classical Conditioning
and Anxiety
 In the experiment by John B.
Watson and Rosalie Rayner in
1920, Little Albert learned to
feel fear around a rabbit
because he had been
conditioned to associate the
bunny with a loud scary noise.
 Sometimes, such a conditioned
response becomes
overgeneralized. We may begin
to fear all animals, everything
fluffy, and any location where
we had seen those, or even fear
that those items could appear
soon along with the noise.
 The result is a phobia or
generalized anxiety.
Operant Conditioning
and Anxiety
 We may feel anxious in a
situation and make a decision
to leave. This makes us feel
better and our anxious
avoidance was just reinforced.
 If we know we have locked a
door but feel anxious and
compelled to re-check,
rechecking will help us
temporarily feel better.
 The result is an increase in
anxious thoughts and
behaviors.
Observational
Learning and
Anxiety
 Experiments with humans
and monkeys show that
anxiety can be acquired
through observational
learning. If you see
someone else avoiding or
fearing some object or
creature, you might pick
up that fear and adopt it
even after the original
scared person is not
around.
 In this way, fears get
passed down in families.
Cognition and
Anxiety
 Cognition includes worried
thoughts, as well as
interpretations, appraisals,
beliefs, predictions, and
ruminations.
 Cognition includes mental
habits such as
hypervigilance (persistently
watching out for danger).
This accompanies anxiety in
PTSD.
 In anxiety disorders, such
cognitions appear
repeatedly and make
anxiety worse.
Examples of Cognitions that can
Worsen Anxiety:
Cognitive errors, such as believing that we
can predict that bad events will happen
Irrational beliefs, such as “bad things don’t
happen to good people, so if I was hurt, I
must be bad”
Mistaken appraisals, such as seeing aches as
diseases, noises as dangers, and strangers as
threats
Misinterpretations of facial expressions and
actions of others, such as thinking “they’re
talking about me”
Biology and Anxiety:
An Evolutionary Perspective
1. Human phobic objects: 2. Similar but non-phobic objects:
Snakes Fish
Heights Low places
Closed spaces Open spaces
Darkness Bright light
3. Dangerous yet non-phobic subjects:
We are likely to become cautious about, but not phobic about:
Guns
Electric wiring
Cars
 Evolutionary psychologists believe that ancestors
prone to fear the items on list #1 were less likely to
die before reproducing.
 There has not been time for the innate fear of list #3
(the gun list) to spread in the population.
Biology and Anxiety: Genes
 Studies show that
identical twins, even
raised separately,
develop similar
phobias (more similar
than two unrelated
people).
 Some people seem to
have an inborn highstrung temperament,
while others are more
easygoing.
 Temperament may be
encoded in our genes.
Genes and
Neurotransmitters
 Genes regulate levels of
neurotransmitters.
 People with anxiety have
problems with a gene
associated with levels of
serotonin, a neurotransmitter
involved in regulating sleep
and mood.
 People with anxiety also have
a gene that triggers high levels
of glutamate, an excitatory
neurotransmitter involved in
the brain’s alarm centers.
Biology and Anxiety: The Brain
 Traumatic
experiences can burn
fear circuits into the
amygdala; these
circuits are later
triggered and
activated.
 Anxiety disorders
include overarousal
of brain areas
involved in impulse
control and habitual
behaviors.
The OCD brain shows extra
activity in the ACC, which
monitors our actions and checks
for errors.
ACC = anterior cingulate gyrus
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
Major Depression:
Not Just a Depressive Reaction
 Some people make an unfair
criticism of themselves or
others with major
depression: “There is nothing
to be depressed about.”
 If someone with asthma has
an attack, do we say, “what
do you have to be gasping
about?”
 It is bad enough to have MDD
that persists even under
“good” circumstances. Don’t
add criticism by implying the
depression is an exaggerated
response.
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
Americans 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
these kids: disruptive
mood dysregulation
disorder.
Understanding Mood Disorders
Why are mood disorders so pervasive,
and more common among the young,
and especially among women?
Why Does Depression Have so
Many Symptoms?
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.
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, or self-punishment.
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
Preventing or Reducing Depression:
Using Knowledge of the Biology of Depression
1. Adjust
neurotransmitters
with medication.
2. Increase serotonin
levels with
exercise.
3. Reduce brain
inflammation with
a healthy diet
(especially olive
and fish oils).
4. Prevent excessive
alcohol use .
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.
Schizophrenia:
Psychosis refers
to a mental split
from reality and
rationality.
the mind is split from reality, e.g.
a split from one’s own thoughts
so that they appear as
hallucinations.
Schizophrenia
symptoms include:
 disorganized
and/or
delusional
thinking.
 disturbed
perceptions.
 inappropriate
emotions and
actions.
Positive and Negative Symptoms of
Schizophrenia
Positive +
presence of
problematic
behaviors




Hallucinations (illusory
perceptions), especially
auditory
Delusions (illusory
beliefs), especially
persecutory
Disorganized thought and
nonsensical speech
Bizarre behaviors
Negative absence of
healthy
behaviors






Flat affect (no emotion
showing in the face)
Reduced social interaction
Anhedonia (no feeling of
enjoyment)
Avolition (less motivation,
initiative, focus on tasks)
Alogia (speaking less)
Catatonia (moving less)
Schizophrenia Symptoms:
Problems in Thinking and Speaking
 Disorganized speech,
including the “word salad”
of loosely associated
phrases
 Delusions (illusory beliefs),
often bizarre and not just
mistaken; most common
are delusions of grandeur
and of persecution
 Problems with selective
attention, difficulty
filtering thoughts and
choosing which thoughts to
believe and to say out loud
?!?!
?!?!
Schizophrenia Symptoms:
Disturbed Perceptions
 People with schizophrenia often
experience hallucinations, that is,
perceptual experiences not
shared by others.
 The most common form of
hallucination is hearing voices
that no one else hears, often with
upsetting (e.g. shaming) content.
 Hallucinations can also be visual,
olfactory/smells, tactile/touch, or
gustatory/taste.
Am I evil?
You’re evil!
Schizophrenia Symptoms:
Inappropriate Emotions
 Odd and socially inappropriate
responses such as looking bored
or amused while hearing of a
death
 Flat affect: facial/body
expression is “flat” with no
visible emotional content
 Impaired perception of
emotions, including not
“reading” others’ intentions and
feelings
Schizophrenia Symptoms:
Inappropriate Actions/Behavior
Odd and socially inappropriate
behavior can be caused by symptoms
such as:
 errors in social perception.
 disorganized, unfiltered thinking.
 delusions and hallucinations.
The schizophrenic body exhibits
symptoms such as:
 repetitive behaviors such as
rocking and rubbing.
 catatonia, such as sitting
motionless and unresponsive for
hours.
Onset and
Development of
Schizophrenia
 Onset: Typically,
schizophrenic symptoms
appear at the end of
adolescence and in early
adulthood, later for women
than for men.
 Prevalence: Nearly 1 in 100
people develop
schizophrenia, slightly
more men than women.
 Development: The course
of schizophrenia can be
acute/reactive or chronic.
Course of
Schizophrenia
Acute/Reactive Schizophrenia
In reaction to stress, some
people develop positive
symptoms such as
hallucinations.
– Recovery is likely.
Chronic/Process Schizophrenia
develops slowly, with more
negative symptoms such as flat
affect and social withdrawal.
– With treatment and
support, there may be
periods of a normal life,
but not a cure.
– Without treatment, this
type of schizophrenia
often leads to poverty and
social problems.
Subtypes of Schizophrenia
Paranoid
• Plagued by hallucinations, often with negative
messages, and delusions, both grandiose and
persecutory
Disorganized
• Primary symptoms are flat affect, incoherent speech,
and random behavior
Catatonic
• Rarely initiating or controlling movement; copies
others’ speech and actions
Undifferentiated
• Many varied symptoms
Residual
• Withdrawal continues after positive symptoms have
disappeared
Understanding Schizophrenia
What’s going on in
the brain in
schizophrenia?
Abnormal brain
structure and
activity
 Too many dopamine/D4 receptors
help to explain paranoia and
hallucinations; it’s like taking
amphetamine overdoses all the time.
 Poor coordination of neural firing in
the frontal lobes impairs judgment
and self-control.
 The thalamus fires during
hallucinations as if real sensations
were being received.
 There is general shrinking of many
brain areas and connections between
them.
Understanding Schizophrenia
Are there biological risk factors
affecting early development?
Biological Risk Factors
Schizophrenia is somewhat more
likely to develop when one or more of
these factors is present:
 low birth weight
 maternal diabetes
 older paternal age
 famine
 oxygen deprivation during delivery
 maternal virus during mid-pregnancy
impairing brain development
Schizophrenia is more
likely to develop in
babies born:
 during and after flu
epidemics.
 in densely
populated areas.
 a few months after
flu season.
 after mothers had
the flu during the
second trimester, or
had antibodies
showing viral
infection.
 The lesson is to:
get flu shots
with early fall
pregnancies.
Understanding Schizophrenia
Are there genetic risk factors?
If so, we would see more
similar schizophrenia risk
shared between identical twins
than fraternal twins (graph
below). Do we?
Genetic Factors
If one twin has
schizophrenia, the
chance of the other
one also having it are
much greater if the
twins are identical.
Having adoptive
siblings (or parents)
with schizophrenia
does not increase the
likelihood of
developing
schizophrenia.
Understanding Schizophrenia
Genetic and Prenatal Causes
if maternal flu
 Even in identical twins, genetics do  Even
during the second
not fully predict schizophrenia.
trimester doubles the
risk of schizophrenia,
 This could be because of
this means only 2
environmental differences.
percent of these
 First difference: twins in separate
babies develop the
placentas.
disorder.
Only one of two twins has the enlarged
ventricles seen in schizophrenia.
 Genetics may
differentiate these 2
percent.
 Research shows many
genes linked to
schizophrenia, but it
may take
environmental factors
to turn on these
genes.
Understanding Schizophrenia
Are there
psychological
causes?
SocialPsychological
Factors
 Research does not support the idea
that social or psychological factors
(such as parenting) alone can cause
schizophrenia.
 However, there may be factors such
as stress that affect the onset of
schizophrenia.
 Until we find a mechanism of
causation, all we may have is a list of
factors which correlate with
increased risk.
Predicting Schizophrenia:
Early Warning Signs
Social/psychological
factors which tend to
appear before the
onset of
schizophrenia:
 early separation from
parents
 short attention span
 disruptive OR withdrawn
behavior
 emotional unpredictability
 poor peer relations and/or
solitary play
Biological factors
which tend to appear
before the onset of
schizophrenia:
 having a mother with
severe chronic
schizophrenia
 birth complications,
including oxygen
deprivation and low
birth weight
 poor muscle
coordination
Other
Disorders
Eating
Disorders
Dissociative
Disorders
Personality
Disorders
Dissociative
Disorders
Examples:
 Dissociation refers to a separation of
conscious awareness from thoughts,
memory, bodily sensations, feelings,
or even from identity.
 Dissociation can serve as a
psychological escape from an
overwhelmingly stressful situation.
 A dissociative disorder refers to
dysfunction and distress caused by
chronic and severe dissociation.
Dissociative
Amnesia:
Loss of memory with no known physical cause;
inability to recall selected memories or any memories
Dissociative
Fugue
“Running away” state; wandering away from one’s
life, memory, and identity, with no memory of these
Dissociative
Identity
Disorder
(D.I.D.)
Development of separate personalities
Dissociative Identity Disorder (D.I.D.)
formerly “Multiple Personality Disorder”
In the rare actual cases of
D.I.D., the personalities:
 are distinct, and not
present in consciousness
at the same time.
 may or may not appear to
be aware of each other.
Alternative Explanations
for D.I.D.
 Dissociative “identities”
might just be an extreme
form of playing a role.
 D.I.D. in North America
might be a recent cultural
construction, similar to the
idea of being possessed by
evil spirits.
 Cases of D.I.D. might be
created or worsened by
therapists encouraging
people to think of different
parts of themselves.
D.I.D., or DID Not?
Evidence that D.I.D. is Real
Different personalities have
involved:
 different brain wave
patterns.
 different left-right
handedness.
 different visual acuity and
eye muscle balance
patterns.
Patients with D.I.D. also show
heightened activity in areas of
the brain associated with
managing and inhibiting
traumatic memories.
Explaining fragmentation
of personality from
different perspectives
Psychoanalytic perspective:
diverting id
Cognitive perspective:
coping with abuse
Learning perspective:
dissociation pays
Social influence:
therapists encourage
Eating
Disorders
Anorexia nervosa
Bulimia nervosa
Binge-eating disorder
Anorexia
Nervosa
Bulimia
Nervosa
Binge-Eating
Disorder
These may involve:
 unrealistic body image and
extreme body ideal.
 a desire to control food and the
body when one’s situation can’t
be controlled.
 cycles of depression.
 health problems.
Definition
Prevalence
Compulsion to lose weight,
0.6 percent
coupled with certainty about
meet criteria at
being fat despite being 15 percent
some time
or more underweight
during lifetime
Compulsion to binge, eating large
amounts fast, then purge by losing
1.0 percent
the food through vomiting,
laxatives, and extreme exercise
Compulsion to binge, followed by
2.8 percent
guilt and depression
Eating Disorders: Associated Factors
Family factors:
 having a mother focused on her
weight, and on child’s appearance
and weight
 negative self-evaluation in the
family
 for bulimia, if childhood obesity
runs in the family
 for anorexia, if families are
competitive, high-achieving, and
protective
Cultural factors:
 unrealistic ideals of body
appearance
Personality
Disorders
Personality disorders
are enduring patterns of
social and other
behavior that impair
social functioning.
There are three “clusters”/categories of personality
disorders.
 Anxious: e.g., Avoidant P.D., ruled by fear of social
rejection
 Eccentric/Odd: e.g. Schizoid P.D., with flat affect,
no social attachments
 Dramatic: e.g. Histrionic, attention-seeking;
narcissistic, self-centered; antisocial, amoral
Antisocial Personality Disorder [APD]
Antisocial personality
disorder refers to acting
impulsively or fearlessly
without regard for
others’ needs and
feelings.
The diagnostic criteria
include a pattern of
violating the rights of
others since age 15,
including three of these:
Deceitfulness
Disregard for safety of self or
others
Aggressiveness
Failure to conform to social
norms
Lack of remorse
Impulsivity and failure to plan
ahead
Irritability
Irresponsibility regarding jobs,
family, and money
Which Kids May Develop APD as Adults?
About half of children
with persistent antisocial
behavior develop lifelong
APD.
Which kids are at risk?
Psychological factors:
 those who in
preschool were
impulsive, uninhibited,
unconcerned with
social rewards, and
low in anxiety.
 those who endured
child abuse, and/or
inconsistent,
unavailable
caretaking.





Biological APD Risk Factors
Antisocial or unemotional
biological relatives increases risk.
 Some associated genes have
been identified.
Risk factors include body-based
fearlessness, lower levels of stress
hormones, and low physiological
arousal in stressful situations such
as awaiting receiving a shock.
Fear conditioning is impaired.
Reduced prefrontal cortex tissue
leads to impulsivity.
Substance dependence is more
likely.
Antisocial PD ≠ Criminality
Criminals: people
who repeatedly
commit crimes
People with
antisocial
personality
disorder
Many career criminals do show empathy and
selflessness with family and friends.
Many people with A.P.D. do not commit crimes.
Antisocial Crime
If antisocial personality disorder is not a full picture of most
criminal activity, what can we say about people who
commit crime, especially violent crime?
Biosocial roots of crime:
birth complications and
poverty combine to
increase risk.
Biosocial Roots of Crime: The Brain
People who
commit murder
seem to have
less tissue and
activity in the
part of the
brain that
suppresses
impulses.
Other differences include:
 less amygdala response when viewing violence.
 an overactive dopamine reward-seeking system.
How common are psychological
disorders?
Countries vary greatly in the percentage of people reporting
mental health issues in the past year.
Rates of
Psychological
Disorders
This list takes a closer look at
the past-year prevalence of
various mental health
diagnoses in the United
States.
Risks and Protective Factors for
Mental Disorders
Who is at risk of mental disorders?
Who is less at risk?
Outcomes for People with
Psychological Disorders
There are risks to be watchful of, obstacles
to be overcome, and improvements to be
made, often with the help of with
treatment.
 Some people with psychological
disorders do not recover.
 Some achieve greatness, even with a
psychological disorder.