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General Psychology Chapter 12 The Psychological Disorders What is “Abnormal”? Abnormal refers to maladaptive affects, behaviors, and/or cognitions that are at odds with social expectations and result in distress or discomfort Classifying Abnormal Reactions Diagnosis – act of recognizing a disorder on the basis of a specified set of symptoms The Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM-IV lists 297 different diagnostic categories Table 12.1: The multiaxial classification system of the DSM-IV-TR. Problems with Classification & Labeling Comorbidity – occurrence of two or more disorders in the same individual Nearly 80% will have 2 or more disorders Many psychological disorders are also comorbid with physical illness A Word on “Insanity” Insanity: One did not know or fully understand the consequences of his or her actions at a given time Could not discern the difference between right and wrong And was unable to exercise control over his or her actions at the time a crime was committed A Word on “Insanity” Competence – whether one is in control of his or her mental and intellectual functions to understand courtroom procedures and aid in his or her own defense A Few Cautions… “Abnormal” and “normal” are not 2 distinct categories! Abnormal does not mean dangerous People jailed for violent crimes are no more likely to have a psychological disorder than not-jailed persons Persons with psychological disorders are more likely (than persons without) to be victims of violent crimes Abnormal also does not mean BAD! Anxiety Disorders Anxiety – feeling of general apprehension or dread accompanied by predictable physiological changes Anxiety Disorders Generalized anxiety disorder – major symptom is distressing, felt anxiety Anxiety may be intense or diffuse Anxiety can cause substantial interference Anxiety Disorders Panic Disorder – major symptom is more acute: a recurrent, unpredictable, unprovoked onset of sudden, intense anxiety, or a “panic attack” Comorbid with depression = higher rate of suicide Anxiety Disorders Phobic disorder – persistent and excessive fear of some object, activity, or situation that consistently leads a person to avoid that object, activity, or situation Specific phobia Social phobia Agoraphobia Table 12.2: A sample of phobias. Obsessive-Compulsive Disorder OCD – anxiety disorder characterized by a pattern of recurrent obsessions and compulsions Obsessions – ideas or thoughts that involuntarily and constantly intrude into awareness Compulsions – constantly intruding, repetitive, behaviors Table 12.3: A few of the more common obsessions and compulsions found in patients with OCR. Posttraumatic Stress Disorder PTSD – distressing symptoms that arise some time after the experience of a highly traumatic event Must have experienced, witnessed, or been confronted with an event that involves actual or threatened death or serious injury Responses involve fear, helplessness, and horror Flashbacks, Avoidance, Increased Arousal Somatoform Disorders Somatoform disorders – involve physical, bodily symptoms or complaints with no known medical or biological cause for the symptoms Somatoform Disorders Hypochondriasis – preoccupied with the fear of a serious disease Somatization disorder – several, recurrent, longlasting complaints about physical symptoms for which there is no cause Conversion disorder – loss or altering of physical functioning that suggests a physical disorder, but without medical explanation. La belle indifference Dissociative Disorders Dissociative disorders – person seeks to escape from some aspect of life or personality seen as the source of stress, discomfort, or anxiety Dissociative Disorders Dissociative amnesia – inability to recall important personal information too extensive to be explained by ordinary forgetfulness Dissociative fugue – amnesic forgetfulness is accompanied by a change of location Dissociative Identity Disorder Major symptom is the existence within the same person of two or more distinct personalities or traits Dramatic and extreme personality changes Take place without warning or provocation Which personality will be dominant cannot be predicted or controlled Child/sexual abuse Personality Disorders Long-lasting patterns of perceiving, relating to, and thinking about the environment and oneself that are maladaptive and inflexible and cause either impaired functioning or distress Personality Disorders Cluster I – includes disorders of odd or eccentric reactions, such as: Paranoid personality disorder – extreme sensitivity, unjustified suspiciousness, envy, and mistrust of others Schizoid personality disorder – inability to form, and an indifference to, personal relationships Personality Disorders Cluster II – disorders of dramatic, emotional, or erratic reactions, such as: Histrionic personality disorder – someone who is overly dramatic, reactive, and demonstrates intensely expressed behavior Narcissistic personality disorder – reflects a grandiose exaggeration of self-importance, a need for attention or admiration, and a tendency to set unrealistic goals Personality Disorders Cluster III – disorders involving anxiety and fearfulness, such as: Avoidant personality disorder – an over-sensitivity to the possibility of being rejected by others and an unwillingness to enter into relationships for fear of being rejected Dependent personality disorder – allowing and seeking others to dominate and assume responsibility for action; has poor self-image and lacks selfconfidence Personality Disorder Antisocial personality disorder – an exceptional lack of regard for the rights and properties of others, accompanied by impulsive, often criminal, behaviors Psychopaths/Sociopaths Symptoms include deceit and manipulation of others without guilt or regret More common among persons of low-SES Alzheimer’s Dementia Dementia – condition characterized by the marked loss of intellectual abilities Alzheimer’s disease – slow deterioration of intellectual functioning accompanied by personality changes Physical disease Abnormal changes in brain tissue Table 12.4: Ten warning signs of Alzheimer’s disease. Alzheimer’s Dementia Risk Factors for Alzheimer’s: There is a genetic predisposition! Obesity Receiving a head injury Alzheimer’s Dementia Possibly reduces chances of Alzheimer’s: Using folic acid in one’s diet Engaging in cognitively challenging activities in old age Mood Disorders Major depression – diagnosis for a constellation of symptoms that includes feeling sad, low, and hopeless, coupled with a loss of pleasure or interest in most normal activities Dysthymia – mild case of major depression, but it tends to be more chronic, or continuous Mood Disorders Bipolar Disorder – episodes of depression are occasionally interspersed with episodes of mania Mania – elevated mood with feelings of euphoria or irritability and increased levels of activity The Roots of Depression There is evidence for a genetic, or inherited, predisposition to bipolar mood disorder Researchers suspect that there is a genetic basis for major depression, as well The Roots of Depression Diathesis-stress model – the expression of disordered behaviors (particularly depression) results from the interaction of an inherited predisposition and the experience of stress or trauma Biogenic amines Brain anatomy The Roots of Depression Psychological Factors These could include learning experiences, situational stress, and cognitive factors Freud believed that depression was a reflection of early childhood experiences that leads to anger directed inwardly Schizophrenia Involves a distortion of reality and a retreat from other people. Three dimensions of symptoms: 1. Negative symptoms – emotional and social withdrawal, reduced energy and motivation, apathy and poor attention Schizophrenia 2. Positive symptoms: a. Hallucinations – false perceptions b. Delusions – false beliefs 3. Positive disorganized symptoms – disorders of thinking and speech, bizarre behaviors, inappropriate affect Schizophrenia: Correlates of Negative Symptoms Structural abnormalities in the brain Clearer genetic basis More severe complications at birth A lower educational level Poorer adjustment patterns before onset Poorer prognosis Schizophrenia: Correlates of Positive Symptoms Excesses of the neurotransmitter dopamine Relatively normal brain configuration Severe disruptions in early family life Overactivity and aggressiveness in adolescence Relatively good response to treatment Table 12.5: Classifying schizophrenia on the basis of negative and positive symptoms. Schizophrenia DSM-IV Subtypes: Catatonic Disorganized Paranoid Undifferentiated Table 12.6: Types of schizophrenia described in the DSM-IV-TR. What Causes Schizophrenia? It has a genetic basis It is a disease of the brain Excess dopamine Diathesis-stress model Consensus that it is a complex disease of the brain, not a “disorder of living” Spotlight: Disorder, Race, and Gender African Americans are: More likely to suffer from phobias and somatoform disorders than are Caucasian Americans Less likely to suffer from depression, dysthymia, obsessive-compulsive, and antisocial personality disorder Less likely to seek professional help Spotlight: Disorder, Race, and Gender Asian Americans report higher incidents of social anxiety and social phobias When Native Americans experience a psychological disturbance, it is usually depression, posttraumatic stress disorder, or alcohol-related. Spotlight: Disorder, Race, and Gender Gender: Women are significantly more likely to be diagnosed with depression Men are more likely to be diagnosed with antisocial personality disorder