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Chapter 14

Atypical (Deviation from
Average):

› causes distress or anxiety in
› Behavior is statistically rare
that individual
› Problem is that people may
not be feeling stress about
their bizarre behaviors
› Problem is that not all rare
behaviors (e.g. genius) are
abnormal

Socially unacceptable
(Deviation from Ideal):
› Behavior violates social
norms
› Problem is that norms change
over time and people do not
agree on “ideal behavior”
Distressing (Subjective
Discomfort):

Dysfunction
› Inability to function
effectively and adapt to the
demands of society
› Problem is that this definition
does not consider personal
choice

Insanity
› Legal term for mentally disturbed people
who are not considered responsible for their
criminal actions

Competency
› Is the individual fit to stand trial?

Those found insane often spend more
time in mental institutions than they
would have in prison




Supernatural view, where mysterious behavior
was attributed to supernatural powers, likely
dominated early societies
Naturalistic View, where abnormality is
attributed to medical problems.
Mental hospitals and asylums were used more
like prisons to keep the afflicted away from
society
Church dominance over culture in Middle
Ages and lack of scientific knowledge caused
the supernatural view to dominate through the
17th century.

Enlightenment and the Triumph of Human
Rights: ALL PEOPLE HAVE RIGHTS!
› Philippe Pinel: Used more humane approaches
to treating patients in France.
› Dorothea Dix: Brought these humane ideas
about mental healthcare to the U.S.

Deinstitutionalization of the mid-20th
century:
› Advent of Drug Therapies allowed people to be
more functional in the real world.
› Rosenhan Study (1973): institutionalization not
necessarily effective!

Brief Film Clip tracing the history of
understanding mental illness

Biological model (Medical)
› Underlying cause (etiology) of
mental disorders is biological
› Medication or medical therapies
are used as treatments

Learning model
› Abnormal behaviors are learned
the same way as normal ones,
through conditioning,
 Humanistic-Existential
Model
› Abnormal behaviors result from
failure to fulfill one’s self-potential;
and faulty self-image
› Client-centered and Gestalt
therapies are used to increase self
acceptance.
 Cognitive
Model
› Faulty or negative thinking can
cause depression or anxiety.
reinforcements, imitation, etc.
› Focus of treatment is on changing
and are not considered symptoms
faulty/irrational thinking
of some underlying disease – the
behaviors themselves are the
 Diathesis-Stress model
problem.
› Biological predisposition to disorder
› Treatments consist of retraining
which is triggered by stress
and reconditioning

Psychodynamic Model
› Abnormal behaviors represent
unconscious motives and conflicts
› Psychoanalysis is used as
treatment
 Systems
model)
theory (biopsychosocial
› Model in which biological,
psychological, and social risk
factors combine to produce
psychological disorders
Diagnostic and Statistical Manual of Mental
Disorders published by the American
Psychiatric Association
 Describes more than 300 specific mental
disorders and is used by most professionals

› DSM: First edition published in 1952
› DSM-II: Revised in 1968 to reflect changing culture
› DSM-III: Revised in 1977 to describe mental disorders
in greater detail
› DSM-III-R: clarified and updated DSM-III
› DSM-IV: Published in 1994 with revisions
› DSM-IV-TR: Released in 2000, text revision

Criticisms
› Disorders classified as diseases
› Many of the symptoms have nothing to do with
mental illness
› Stereotypes and expectations based on labels can
be damaging

DSM-IV evaluates individuals according to five
dimensions or axes, thus rendering it a multiaxial
system of classification.
› Axis I: Mental disorder or learned disorder that might be
›
›
›
›
present (Anxiety Disorders)
Axis II: Personality disorder or mental retardation that
might be present
Axis III: Physical or medical disorders that might be
present, such as diabetes, hypertension, or arthritis
Axis IV: Rates the severity of psychosocial stressors such as
school or housing issues in the individual’s life during the
past year
Axis V: Assess the level of adaptive functioning currently
and during the past year on Global Assessment of
Functioning Scale (GAF) 0-100.
In a 2001 survey, 14.9% of respondents
reported experiencing some type of
clinically significant mental disorder
 Six percent were suffering from
substance abuse
 Most common disorders were anxiety,
phobias, and mood disorders

Anxiety Disorders
Defining Anxiety:
Anxiety is a general
feeling of fear and
apprehension that may be
related to an object or
event and is often
accompanied by increased
physiological arousal.

Conditioning
› For example, phobias can be learned through
classical conditioning
Feelings of not being in control can lead to
anxiety
 Predisposition to anxiety disorders may be
inherited (genetic)
 Displacement or repression of
unacceptable thoughts or impulses can
lead to anxiety

Prolonged vague but intense fears not
attached to any particular object or
circumstance
 Often results from Free-Floating Anxiety –
anxiety not attached to any particular
event or object
 Difficult to treat

Recurrent panic attacks in which the
person experiences intense terror without
cause
 Person is often left with fear of having
another panic attack
 Can lead to agoraphobia



Intense fear of specific
situations or objects
Agoraphobia
› Intense fear of crowds and public
places or other situations that
require separation from source of
security, such as the home

Social phobia
› Excessive fear of social situations
› Fear of scrutiny of others

Specific Phobia
› Common phobias include
animals, heights, closed places,
needles
Driven to disturbing
thoughts (obsessions)
and/or performing
senseless rituals
(compulsions)
 Individual recognizes
behavior is excessive but
cannot stop without
experiencing anxiety.
 “Washers” and “Checkers”
 Hoarding; Touching

Psychologically distressing
experience continues to
plague individual after the
fact and causes anxiety.
 Could result from either
personally experiencing or
witnessing a lifethreatening situation
 Often linked with combat
or rape


Somatoform Disorders
› Physical symptoms without any physical
cause
› Person experiences symptoms as real

Contrast with Psychosomatic Disorders…
› Real physical illness with psychological
causes such as stress or anxiety
› Tension headaches, for example
› Research indicates that most, if not all,
illnesses may have a psychosomatic
component

Freud
› Symptoms related to traumatic experience
in the past

Cognitive-behavioral
› Examines ways in which the behavior is
being rewarded, either tangibly or mentally

Biological perspective
› May be real physical illnesses that are
misdiagnosed or overlooked

Somatization Disorder– vague, recurrent physical
symptoms; plentiful and unrelated and
unresponsive to medical treatment (back pain, dizziness,
stomach pains, etc.)
Conversion Disorder – sudden but temporary loss of
physical functions triggered by psychological
factors.
› La belle indifference – apathy over loss of
functioning.
› Glove anesthesia – lack of feeling in hand only –
neurologically impossible.
 Hypochondriasis – without physical evidence,
individual believes they have a serious illness
 Body Dysmorphic Disorder – preoccupation with a
minor physical anomaly to the point of dysfunction.

Dissociative Disorders
Disorders in which conscious awareness
becomes separated from previous
memories, thoughts and feelings.
 Dissociative disorders are characterized
by a sudden but temporary alteration in
consciousness, identity, sensory/motor
behavior, or memory.
 These disorders are relatively rare, but
quite noticeable.

Seems to involve unconscious processes
 Memory impairments may also include
biological factors such as normal aging
and Alzheimer’s disease
 Dissociation is common with use of some
drugs such as LSD
 Trauma is often involved


Dissociative amnesia
› Loss of memory without a
physical cause

Dissociative fugue
› Involves flight from home and
adoption of a new identity
and amnesia for past events

Depersonalization disorder
› Person suddenly feels
strangely changed or
different; “outside self”

Dissociative identity disorder
› Person has several distinct
personalities that emerge at
different times
› Previously called multiple
personality disorder
Sexual Disorders

Include a range of sexual problems typically divided
into two categories
› sexual dysfunctions
› sexual desire disorders, known as paraphilias.

Difficult to diagnose!
› Sexuality is a private thing
› Difficult to label acts as “abnormal” or “normal”
› Kinsey’s research?
Additionally, must people be diagnosed for desire
or for acts or both?
 Key factor in definition of sexual disorders: it causes
the individual stress and anxiety. This is a sign that
something is wrong, no matter how acceptable or
unacceptable the desire or behavior may be to the
rest of society.

Sexual dysfunctions involve an impairment
of “normal” sexual functioning.
 This can refer to an inability to perform or
reach an orgasm, painful sexual
intercourse, a strong repulsion of sexual
activity, or an exaggerated sexual response
cycle or sexual interest.
 A medical cause must be ruled out prior to
making any sexual dysfunction diagnosis
and the symptoms must be hindering the
person's everyday functioning.


Erectile disorder

› Inability of a man to
› Inability to reach
achieve or maintain an
erection

Female sexual arousal
disorder
orgasm in a person who
has sexual desire and
can maintain arousal


Sexual aversion
disorders
› Lack of sexual interest or
active distaste for sex
Premature ejaculation
› Male’s inability to inhibit
› Inability of a woman to
become sexually
aroused or reach
orgasm
Orgasmic disorders
orgasm as long as
desired

Vaginismus
› Involuntary muscle
spasms in the outer part
of the vagina making
intercourse impossible




Paraphilias all have in
common distressing and
repetitive sexual fantasies,
urges, or behaviors.
Must occur for a significant
period of time
Must interfere with either
satisfactory sexual relations or
everyday functioning if the
diagnosis is to be made.
There is also a sense of
distress within these
individuals
› Typically recognize the
symptoms as negatively
impacting their life
› Feel as if they are unable to
control the symptoms

Fetishism

› Wearing clothing of the
› Non-human object is
opposite sex to achieve
sexual arousal
preferred method of
sexual excitement

Voyeurism

gratification by
humiliating or physically
harming a sex partner
having sex or undressing
Exhibitionism
› Compulsion to expose
one’s genitals to
achieve sexual arousal


against a nonconsenting person in
public
Sexual masochism
› Inability to enjoy sex
without physical or
emotional pain
Frotteurism
› Touching or rubbing
Sexual sadism
› Obtain sexual
› Desire to watch others

Transvestic fetishism

Pedophilia
› Preferred desire to have
sex with children
Involves a desire to become, or
insistence that one really is, a member of
the other sex
 Usually begins in childhood
 Most develop normal gender identity in
adulthood
 Sex reassignment surgery is an option for
adults who have this disorder
 Causes are not known

Mood Disorders
Woh woh.
Mood disorders are characterized by
ongoing, dysfunctional emotional patterns
 Mood disorders are also referred to as
affective disorders
 An affect is another word for an emotion
 Mood disorders come in two general
categories, depressive disorders and
bipolar disorders


Biological factors
› Twin studies suggest genetic factors play a role
› Mood disorders may be linked to chemical imbalances in
the brain

Psychological factors
› Cognitive distortions: Maladaptive response to early
negative life events that leads to feelings of
incompetence and unworthiness
› These responses are reactivated whenever a new
situation arises that resembles the original events

Social factors
› Depression is linked to troubled close relationships
› May explain greater incidence of depression in women,
who tend to be more relationship-oriented
› Depressed people can evoke anxiety and hostility in
others, who then withdraw, which in turn can intensify
feelings of depression
In most cases, mood disorders are treated
with a combination of drug therapy and
talk therapy.
 In some extreme cases when these
methods do not work, ECT has been
effective.

› used rarely – if all other treatments fail
› Used if suicide is a threat
› Not as heinous as depicted in films
Many more women are diagnosed with
mood disorders than men.
 Psychologists have been researching both
biological and cultural causes for this.

19,000 people commit suicide in the U.S.
every year, the 11th leading cause of
death
 More women than men attempt suicide,
but more men succeed


General Symptoms:
› Overwhelming feelings of sadness
› Lack of interest in activities
› Excessive guilt or feelings of worthlessness

Types:
› Major depressive disorder
 Intense symptoms that may last for several months
› Dysthymic Disorder
 Less intense, but may last for periods of two years or
more
› Seasonal Affective Disorder (SAD)
 symptoms of depression triggered by weather patterns
(melatonin hypersensitivity)
Characterized by alternating between
depression and mania
 Manic-Depressive Disorder (Kelsey and
Chase)

› Periods of normal mood may come between
bouts of depression and mania
› Symptoms of Mania include




Feelings of euphoria
Extreme physical activity
Excessive talkativeness
Grandiosity
› Mania rarely occurs alone – it is typically part of
manic-depressive disorder
› Much less common than depression
› Stronger biological component than depression

Cyclothemia – less intense mood swings





Disorders in which maladaptive ways of
thinking and behaving learned early in life
cause distress in the person and/or conflicts
with others
Axis II in DSM
Rate among prisoners is close to 50%
They are often easy to identify in others, but
difficult to treat
Personality disorders are grouped by the
DSM into three groups or clusters
 Cluster
A: Odd or
Eccentric Behavior
› Paranoid
 Very suspicious of
others
› Schizoid
 Withdrawn and lacks
feelings for others

Cluster B: Dramatic or
Erratic Behavior
› Histrionic (Hysterical)
 Attention-hungry
 “drama-queen”
› Narcissistic
 exaggerated sense of
self-importance
› Antisocial - Ted Bundy
 Violates social norms
 Enjoys harming others
 Conduct Disorder
› Borderline
 Unpredictable, impulsive
and sometimes
destructive behavior
 Chaotic relationships

Cluster C: Anxious or Inhibited Behavior
› Avoidant
 Fearful of social interactions
 Feels inferior
› Dependent
 Uncomfortable being alone
 Uncomfortable making decisions
› Obsessive-Compulsive
 Obsessed with order, lists, organizing
 Need for control over all aspects of life
Combination of biological
predisposition, adverse
psychological experiences,
and an unhealthy social
environment
 Also possible link to damaged
frontal lobe during infancy
 Emotional deprivation during
childhood may lead to
antisocial tendencies

I enjoy long walks on the
beach, soft music, oh,
and killing people.
Schizophrenia
Schizophrenia is the most debilitating and
complex of all the psychological disorders.
 Diverse symptoms; one common
denominator: psychoticism

› Being psychotic means that the individual is
suffering from a break with reality that inhibits
their ability to function.
Additionally, there is ongoing evidence of
deteriorating social and intellectual
functioning.
 The diagnosis must be made before age 45
and symptoms must persist for at least 6
months.
 The Schizophrenic Experience


Most cases of schizophrenia are treated with
antipsychotic medication.
› When these medications first were introduced,
they only treated some of the symptoms of the
disorder
› Tardive dyskinesia in long-term patients

Medications used now better treat both the
positive and negative symptoms of the
disease.
› Positive symptoms are symptoms people with
schizophrenia experience, but normal people do not
 Hallucinations, delusions, disorganized thought, movements
› Negative symptoms are behaviors that occur
normally, but do not in schizophrenics
 Flat affect, minimal speech


Symptoms have further been categorized by the effect they
have on functioning: disturbances of thought, perception,
and emotions
Thought Disturbances
Delusions - False beliefs about reality
› Language Disturbances
 Clang – rhyming speech pattern (The run sun done the gun; don't
drink drown down, brown gown." )
 Neologism – making up new words
 Loose Association – words don’t hold together; language does not
make sense ("I need to go to the store to buy some band-aids. I read
an article about how expensive AIDS drugs are. People take too many
street drugs. The streets should be clean from the rain today, etc" )
 Echolalia – repeating words over and over
›

Perceptual Disturbances
›

Hallucinations - Sensory experiences without external stimulation
Emotional Disturbances
Flat Affect – having no emotion
› Ambivalent Affect – having erratic emotional responses
›






Biological predisposition to schizophrenia may be
inherited
Twin studies show genetic link
Excessive levels of dopamine lead to psychotic
symptoms
Abnormalities of brain structures
Abnormal patterns of connections between
brain cells
May involve family relationships and social class

Disorganized
schizophrenia

› Marked by extreme
suspiciousness and
complex delusions
› Bizarre and childlike
behavior
› May engage in
incoherent conversations


Catatonic schizophrenia
Undifferentiated
schizophrenia
› Clear symptoms of
schizophrenia that do not
meet criteria for other
subtypes
› Can alternate between a
catatonic state (mute
and immobile) and an
overly active state (overly
excited and shouting)
Paranoid schizophrenia

Cases
› Gerald 1
› Gerald 2
› Heather
Disorders Usually First Diagnosed in Infancy,
Childhood, or Adolescence
 Example Categories:

› Mental Retardation
› Pervasive Developmental Disorder (Autism,
Asperger’s)
› Disruptive Behavior Disorders (AD/HD, Conduct
Disorder, ODD)
› Tic Disorders (Tourette’s)
› Feeding Disorders (Pica, Rumination Disorder)
› Autistic Disorder
 Qualitative impairment in social interaction
 Qualitative impairments in communication
 Restricted repetitive and stereotyped patterns
of behavior, interests, and activities
› Asperger’s Disorder
 Qualitative impairment in social interaction
 Restricted repetitive and stereotyped patterns
of behavior, interests, and activities
 No language or cognitive limitations –
limitation is mostly social



AD/HD (Attention Deficit/Hyperactivity Disorder)
› 6 month history of behaviors involving multiple symptoms of
inattention, impulsivity and hyperactivity that disrupt normative
development
› Use of psychostimulants for treatment (Ritalin, Adderall)
ODD (Oppositional Defiant Disorder)
› A pattern of negativistic, hostile, and defiant behavior lasting at
least 6 months
› Impairs social, academic, or occupational functioning
Conduct Disorder
› A repetitive and persistent pattern of behavior in which the basic
rights of others or major age-appropriate societal norms or rules
are violated
› Aggression to people and animals
› Destruction of property
› Deceitfulness or theft
› Serious violations of rules
› Antisocial disorder?

Tic Disorders
A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or
vocalization
› The tics occur many times a day (usually in bouts) nearly every day or
intermittently throughout a period of more than 1 year
› Example: Tourette’s Disorder (includes motor and vocal tics)
›

Feeding Disorders
Pica
› Persistent eating of nonnutritive substances for a period of at least 1 month.
› The eating of nonnutritive substances is inappropriate to the developmental
level (older than 18-24 mos)
› clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves,
plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood,
plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches.
› Rumination Disorder
› Repeated regurgitation and rechewing of food for a period of at least 1 month
following a period of normal functioning.
› The behavior is not due to an associated gastrointestinal or other general
medical condition (e.g., esophageal reflux).
›
Trends in Psychological Disorders
More women are in treatment for
psychological disorders
 Men who are divorced or separated, or
who never married, have a higher rate
of mental disorders
 Married women have higher rates than
married men
 Women have higher rates of anxiety
disorders and depression

Many disorders occur only in particular
cultural groups
 Prevalence of some disorders among
males/females/children differs markedly
by culture

Prevalence of Mental Disorders