Download Chapter 2: Psychology As a Science

Chapter 16: Psychological Disorders
Chapter Outline
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Defining, classifying, and diagnosing psychological
abnormality
Models of abnormality
Mood disorders
Anxiety disorders
Schizophrenia
Other disorders
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Defining, Classifying, and Diagnosing
Psychological Abnormality
 Abnormal psychology—scientific study of
psychological disorders
No universal definition of what is abnormal behaviour
 Agreed-upon features (the four Ds):
 Deviance—behaviour, thoughts, or emotions are
unusual
 Distress—to the person or close others
 Dysfunction—interference with daily functioning
 Danger—most people with disorders are not a danger to
themselves or others, but people who put themselves or
others at risk may have a disorder
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Does Dysfunction Equal Abnormality?
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Classifying and Diagnosing
Psychological Disorders
 International Classification of Diseases (ICD)
System used by most countries to classify psychological
disorders; published by the World Health Organization
and currently in its tenth edition
 Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR):
o Manual used to diagnose mental disorders in North
America
o Provides a categorical list of symptoms for all 400 mental
disorders
 Diagnosis—identifying a disorder by its symptoms and
other evidence
 Comorbidity—two or more disorders are present
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Five Dimensions or Axes of the DSM-IV-TR
 Axis I contains the detailed criteria for the principal disorders
 Axis II includes criteria relating to longer-term disorders
(personality disorders, learning disabilities, etc.)
 Axis III lists any medical or neurological problems that may be
important in relation to current or past psychiatric problems
 Axis IV records any recent major psychosocial stressors
(divorce, death of loved one, loss of job, etc.)
 Axis V uses a 0 to 100 point detailed general functioning scale
that the clinician uses to assess the client’s current level of
functioning, as well as his or her highest level of functioning in
the past year
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Models of Abnormality
 Explanations for why or how disorders occur
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The Neuroscience Model
 Views disorders as illnesses caused by a malfunctioning
brain
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Factors contributing to biological dysfunction
 Genetic inheritance
 Mood disorders, schizophrenia, mental retardation,
Alzheimer’s
 Too few or too many of certain types of neurotransmitters
 Insufficient norepinephrine and serotonin in depression
 Viral infection
 Fetal or childhood exposure and schizophrenia
 Hormones
 Excess cortisol in depression
 Specific brain structures
 Huntington’s disease and loss of cells in the striatum
Does not take into account additional factors such as stress,
experiences
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Antisocial Disorders and the Brain
 Extreme antisocial disorders and
the brain—forensic psychiatrist
Helen Morrison displays slices
of the brain of John Wayne
Gacy, who murdered at least 33
boys and young men between
1972 and 1978
 Postmortem examinations have
not revealed clear links between
abnormal brain structure and
the extreme antisocial patterns
exhibited by Gacy and other
serial killers
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The Cognitive-Behavioural Model
 Disorders are the result of maladaptive learned
behaviours and problematic thinking
 Behaviour and thinking interact and influence each
other
 Acknowledge that emotions and biological factors
also interact with behaviour and cognition
 Behavioural perspective—based on learning
principles from classical conditioning, operant
conditioning, and modelling
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The Cognitive-Behavioural Model
 Cognitive
perspective—maladaptive beliefs and
illogical thinking processes cause distress
Beliefs about the self and the world
 Arbitrary inferences—negative conclusions
based on little evidence
 Selective perception—seeing negative
features of events
 Magnification—exaggerating the
importance of negative events
 Overgeneralization—broad, negative
conclusions
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The Psychodynamic Model
 Underlying, perhaps unconscious psychological forces
cause conflict
 Rooted in Freudian theory
 Fixation—being trapped at an early stage of
development due to traumatic childhood experiences
 Object relations theorists—believe people’s primary
motivation is to form relationships
Problems in early relationships result in
psychological problems
 Unsupported by research
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The Socio-cultural Model
 A society’s characteristics create stressors for some of
its members
Widespread social change
 Socio-economic class
 Cultural factors
 Social networks and supports
 Family systems
 Family systems theory—a theory holding that
each family has its own implicit rules, relationship
structure, and communication patterns that shape
the behaviour of the individual members
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The Developmental Psychopathology Model
 Study how problem behaviours evolve as a function
of a person’s genes and early experiences and how
these early issues affect the person at later life stages
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Risk factors—biological and environmental factors that
contribute to problem outcomes
Equifinality—the idea that different children can start
from different points and wind up at the same outcome
Multifinality—the idea that children can start from the
same point and wind up at any number of different
outcomes
Resilience—the ability to recover from or avoid the serious
effects of negative circumstances
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Mood Disorders
 Depression—low, sad state in which people feel
overwhelmed
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Most people with a mood disorder suffer only from depression
Major depressive disorder is more severe than dysthymic
disorder
 Mania—elation and frenzied energy
 People with bipolar disorder or the less severe cyclothymic
disorder also experience mania
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Mood Disorders
 Major depressive disorder—a disorder
characterized by a depressed mood that is
significantly disabling and is not caused by such
factors as drugs or a general medical condition
 Bipolar disorder—periods of mania alternate with
periods of depression
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Major Depressive Disorder
 Symptoms in these areas of functioning
Emotional—depressed mood
 Motivational—loss of desire to do usual activities, lack
of drive
 Behavioural—less active and productive, may move
and speak slowly or seem physically agitated
 Cognitive—negative self-evaluation, self-blame,
pessimism, guilt, indecisiveness, difficulty
concentrating, thoughts of death or suicide
 Physical—headaches, indigestion, constipation, dizzy
spells, pain, sleep and eating disturbance, fatigue
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Explanations for Major Depressive Disorder
 Neuroscientists
 Genetic
predisposition—low norepinephrine and
serotonin activity
 High cortisol
 Socio-cultural theorists
 Social support
 Stressors
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Explanations for Major Depressive Disorder
 Cognitive-behavioural
theorists
 Learned helplessness
 Attribution-helplessness
theory—global, stable,
internal causes
 Negative
thinking/dysfunctional
attitudes
 Illogical thinking
processes
 Automatic thoughts
 The cognitive triad
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Bipolar Disorder
 Bipolar disorder—extreme highs and lows
Mania—inappropriate, dramatic positive mood
 Symptoms of mania in five areas of functioning
(alternating with depressive symptoms)
 Emotional—powerful highs and lows
 Motivational—seek excitement and companionship
 Behavioural—may move and speak quickly
 Cognitive—poor judgment and planning, optimism,
grandiosity
 Physical—energetic, require little sleep
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Explanations for Bipolar Disorder
 Neuroscientists
 Gene
abnormalities
 Irregularities in ions that allow neurons to
communicate
 Other causes
 Stress plus biological predisposition
 Life events—striving, failures
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Anxiety Disorders
 Most common group of disorders in Canada
 About
12 percent of the adult population suffer
from an anxiety disorder in any year
 Key features
 Disabling levels of fear or anxiety that are frequent,
severe, persistent, or easily triggered
 Most people with one anxiety disorder experience
another one as well
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Generalized Anxiety Disorder
 Key features
 Anxiety
under most life circumstances; diffuse
worry
 Restlessness, edginess, easily tired
 Difficulty concentrating
 Sleep problems
 4% of the North American population have
symptoms of this disorder in any given year
 Women outnumber men 2 to 1
© John Wiley & Sons Canada, Ltd.
Explanations for Generalized
Anxiety Disorder
 Cognitive-behavioural theorists
Dysfunctional assumptions
 Assumption that one is in danger
 Intolerance of uncertainty theory—unwilling to accept
negative events
 Neuroscientists
 Malfunctioning GABA feedback system
 Malfunctioning emotional brain circuit
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© John Wiley & Sons Canada, Ltd.
Social Anxiety Disorder
 More women than men, more poor people than
wealthier people
 12% of population develop this at some time in their
life
 Often begins in late childhood or adolescence
 Key features
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Severe, persistent fear of embarrassment in social situations
May be narrow or broad
 Fear of talking in public
 General fear of functioning poorly in front of others
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Explanations for Social Anxiety Disorder
 Cognitive-behavioural theorists
 Dysfunctional
cognitions about social situations
Unrealistically high social standards
View oneself as socially unattractive
View oneself as socially unskilled
Belief that one is in danger of behaving clumsily
Expect negative consequences for clumsy
behaviour
Belief that one has no control over anxious
feelings
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Phobias
 7.7 % of people in Canada suffer from at least one
specific phobia in any year
 Key features
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Persistent, irrational fear of a specific object, activity, or
situation
 Explanations
Classically conditioned fear
 Avoidance behaviours are reinforced through operant
conditioning
 Modelling of fearful behaviour
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Ten Most Common Phobias
 Spiders—arachnophobia
 Heights—acrophobia
 Public, social places—
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agoraphobia
Social situations—social phobia
Flying—aerophobia
Enclosed spaces—
claustrophobia
Thunder—brontophobia
Germs—mysophobia
Cancer—carcinophobia
Death—necrophobia
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Panic Disorder
 Key features
Panic attacks—periodic sudden bouts of panic
 Panic disorder—panic attack plus changes in thinking or
behaviour
 May misinterpret panic as a sign of medical emergency
 Often accompanied by agoraphobia
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 Explanations
Malfunctioning brain circuit and excess norepinephrine
 Misinterpretation of bodily sensations
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 21% of Canadians over 15 years old have suffered
from a panic attack at some point
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Obsessive-Compulsive Disorder
 Key features
 Obsessions—persistent
unwanted thoughts
Wishes, impulses, doubts, or images
 Compulsions—repetitive, rigid behaviours or
mental acts
Are often responses to obsessive thoughts,
performed to reduce or prevent anxiety
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Obsessive-Compulsive Disorder
 Explanations
Neuroscientists
 Low serotonin activity
 Overactive orbitofrontal cortex and caudate nuclei
 Cingulate cortex and hypothalamus activate the OCD
impulses
 Amygdala drives the fear and anxiety components of
the OCD response
 Cognitive-behavioural theorists
 Learning that compulsive behaviour relieves distress
 2% of Canadians suffer from obsessive-compulsive
disorder
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Posttraumatic Stress Disorder
 Key features
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Persistent depression, anxiety after a traumatic event
 Acute stress disorder (ASD)—lasts less than a month and
begins within four weeks of the event
 Posttraumatic stress disorder (PTSD)—lasts more than a
month, may begin shortly after or years after the event
Hyperalertness
Easily startled
Sleep disturbance
Guilt, anxiety, depression, difficulty with concentration
 What events cause PTSD?
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Psychologically traumatic events like rape, combat, natural
disasters
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Explanations for PTSD
 9.2% of Canadians experience PTSD in their lifetime
 Twice as common in women than men
 20%
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of women who experience a traumatic event
 8% of men who experience a traumatic event
Biological factors
 Increased cortisol and norepinephrine
 Damaged hippocampus, amygdala
Personality—external locus of control, anxious
Childhood experiences
Social and family support
Cultural factors
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Many Events Can Produce PTSD
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Schizophrenia
 Key features
Positive symptoms—pathological excesses
 Delusions—false beliefs
 Hallucinations—false sensory perceptions
 Disorganized thinking and speech, loose associations or
derailment
 Inappropriate affect
 Negative symptoms—pathological deficits
 Poverty of speech
 Flat affect
 Loss of volition
 Social withdrawal
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© John Wiley & Sons Canada, Ltd.
Schizophrenia
 Key features (continued)
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Psychomotor symptoms
 Strange movements
 Catatonia—extreme psychomotor symptoms
 Stupor
 Rigidity
 Posturing
 Waxy flexibility
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Catatonic Posturing
 Some people struggling
with schizophrenia
demonstrate catatonic
posturing, where they
strike and hold bizarre
positions, sometimes for
hours
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Schizophrenia: Subtypes
 Paranoid type—the main symptoms in this type are
delusions and possibly auditory hallucinations; there
is no thought disorder and the delusions centre on
being persecuted or jealousy
 Disorganized type (also called hebephrenic
schizophrenia)—the combination of disordered
thoughts and flat affect characterize this subtype
© John Wiley & Sons Canada, Ltd.
Schizophrenia: Subtypes
 Catatonic type—this subtype is characterized by
immobility or by agitated, purposeless movements
 Undifferentiated type—symptoms of schizophrenia
are present but not in a combination that allows for
categorization in any of the previous other subtypes
 Residual type—symptoms are present but at a low
level of intensity
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Explanations for Schizophrenia
 Neuroscientists
Genetic predisposition
 Identical twins—48% concordance rate
 Fraternal twins—17% concordance rate
 Biochemical abnormalities—excessive dopamine
activity
 Brain structure—enlarged ventricles, small temporal
lobes and frontal lobes, structural abnormalities of the
hippocampus, amygdala, and thalamus
 Diathesis-stress model
 Biological predisposition plus negative event
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© John Wiley & Sons Canada, Ltd.
Other Disorders
 Somatoform disorders—physical complaint that
is psychological in origin
Conversion disorder—conflict or need converted into
physical symptom; paralysis, blindness, or loss of feeling
 Somatization disorder—long-term physical ailments that
have no organic basis; pain, neurological, gastrointestinal
 Hypochondriasis—interpret bodily symptoms as signs of a
serious illness
 Body dysmorphic disorder—deeply concerned about some
imagined or minor defect in their appearance
 Explanations
 Classical conditioning and modelling
 Misinterpretation of bodily cues
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© John Wiley & Sons Canada, Ltd.
Other Disorders
 Dissociative disorders—major disruptions in
memory
Dissociative amnesia—unable to remember important
information about a traumatic event; wartime, natural
disaster
 Dissociative fugue—forget one’s personal identity and flee
 Dissociative identity disorder—two or more distinct
personalities
 Explanations
 Psychodynamic theorists—repression
 Neuroscience—smaller hippocampus and amygdala,
changes in the level of activity in the sensory cortex
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© John Wiley & Sons Canada, Ltd.
Other Disorders
 Personality disorders—rigid patterns of
experience and behaviour causing distress or
difficulty
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Antisocial personality disorder:
 Disregards and violates the rights of others, impulsive,
reckless, self-centred; linked to criminal behaviour
 Explanations: Modelling, operant conditioning; low
serotonin activity, deficient functioning in the frontal lobes,
lower arousal to stress and less anxiety
Borderline personality disorder:
 Unstable mood, self-image, high volatility
 Explanation: Biosocial theory—child has difficulty
identifying and controlling emotions, and the emotions are
punished or disregarded
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