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Psychological Disorders
Chapter 16
Psychological Disorders
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Defining and diagnosing disorder
Anxiety disorders
Mood disorders
Personality disorders
Drug abuse and addiction
Dissociative identity disorder
Schizophrenia
Defining and Diagnosing Disorder
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Dilemmas of definition
Dilemmas of diagnosis
Dilemmas of measurement
Dilemmas of Definition
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Possible Models for Defining Disorders:
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Mental disorder as a violation of cultural standards.
Mental disorder as maladaptive or harmful behaviour.
Mental disorder as emotional distress.
Mental Disorder
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Any behaviour or emotional state that causes an
individual great suffering or worry, is self-defeating
or self-destructive, or is maladaptive and disrupts the
person’s relationships or the larger community.
Diagnostic and Statistical Manual
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Axis I: Primary clinical problem
Axis II: Personality disorders
Axis III: General medical conditions
Axis IV: Social and environmental stressors
Axis V: Global assessment of overall
functioning
Explosion of Mental Disorders
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Supporters of new
categories answer that
is important to
distinguish disorders
precisely.
Critics point to an
economic reason:
diagnoses are needed
for insurance reasons
so therapists will be
compensated.
Concerns About Diagnostic System
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The danger of over-diagnosis
The power of diagnostic labels
Confusion of serious mental disorders with
normal problems
The illusion of objectivity and universality
Advantages of the DSM
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When the manual is used correctly and
diagnoses are made with valid objective
tests, the DSM improves the reliability of
and agreement among clinicians.
The DSM-IV included for the first time a
list of culture-bound syndromes, disorders
specific to a particular culture.
Projective Tests
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Projective Tests
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Psychological tests used to
infer a person’s motives,
conflicts, and unconscious
dynamics on the basis of
the person’s interpretations
of ambiguous stimuli.
Rorschach Inkblot Test
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A projective personality
test that asks respondents
to interpret abstract,
symmetrical inkblots.
A sample inkblot
Objective Tests
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Inventories
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Standardized objective questionnaires
requiring written responses; they typically
include scales on which people are asked to
rate themselves.
Minnesota Multiphasic Personality
Inventory (MMPI)
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A widely used objective personality test.
Anxiety Disorders
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Anxiety and panic
Fears and phobias
Obsessions and compulsions
Anxiety and Panic
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Generalized Anxiety Disorder
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A continuous state of anxiety marked by feelings of
worry and dread, apprehension, difficulties in
concentration, and signs of motor tension.
Some people suffer from generalized anxiety disorder
without having lived through any specific anxietyproducing event.
Other chronically anxious people may have a history,
starting in childhood, of being unable to control or
predict their environments.
Posttraumatic Stress Disorder
(PTSD)
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An anxiety disorder in which a person who
has experienced a traumatic or lifethreatening event has symptoms such as
psychic numbing, reliving the the trauma,
and increased physiological arousal.
Diagnosed only if symptoms persist for 6
months or longer.
May immediately follow event or occur later.
Panic Disorder
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An anxiety disorder in
which a person
experiences:
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recurring panic attacks,
periods of intense fear,
and
feelings of impending
doom or death,
accompanied by
physiological symptoms
such as rapid heart rate
and dizziness.
Fears and Phobias
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Phobia
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An exaggerated, unrealistic fear of a specific
situation, activity, or object.
Agorophobia
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A set of phobias, often set off by a panic
attack, involving the basic fear of being
away from a safe place or person.
Obsessions and Compulsions
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Obsessive-Compulsive Disorder (OCD)
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An anxiety disorder in which a person feels
trapped in repetitive, persistent thoughts
(obsessions) and repetitive, ritualized
behaviours (compulsions) designed to reduce
anxiety.
Person understands that the ritual behaviour
is senseless but guilt mounts if not performed.
Mood Disorders
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Depression and Bipolar Disorder
Theories of Depression
Depression
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Major Depression
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A mood disorder involving disturbances in
emotion (excessive sadness), behaviour (loss
of interest in one’s usual activities), cognition
(thoughts of hopelessness), and body function
(fatigue and loss of appetite).
Symptoms of Depression
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DSM IV Requires 5 of these
within the past 2 weeks
Depressed mood
Reduced interest in almost all activities
Significant weight gain or loss, without dieting
Sleep disturbance (insomnia or too much sleep)
Change in motor activity (too much or too little)
Fatigue or loss of energy
Feelings of worthlessness or guilt
Reduced ability to think or concentrate
Recurrent thoughts of death
Gender, Age, & Depression
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Women are about
twice as likely as men
to be diagnosed with
depression.
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True around the
world
After age 65, rates of
depression drop
sharply in both sexes.
Bipolar Disorder
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Bipolar Disorder: A
mood disorder in
which episodes of
depression and mania
(excessive euphoria)
occur.
Mood
The Bipolar Brain
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Bipolar disorder can
have rapid mood
swings
These wild changes
are shown in brain
activity (right)
Theories of Depression
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Biological explanations emphasize genetics and brain
chemistry.
Social explanations emphasize the stressful
circumstances of people’s lives.
Attachment explanations emphasize problems with
close relationships.
Cognitive explanations emphasize particular habits of
thinking and ways of interpreting events.
“Vulnerability-Stress” explanations draw on all four
explanations described above.
Vulnerability-Stress
Model
Personality Disorders
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Problem Personalities
Antisocial Personality Disorder
Problem Personalities
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Personality Disorder
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Narcissistic Personality Disorder
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Rigid, maladaptive patterns that cause personal
distress or an inability to get along with others.
A disorder characterized by an exaggerated sense of
self-importance and self-absorption.
Borderline Personality Disorder
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A disorder characterized by intense but unstable
relationships, a fear of abandonment by others, an
unrealistic self-image, and emotional volatility.
Antisocial Personality Disorder (APD)
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A disorder characterized by antisocial
behaviour such as lying, stealing,
manipulating others, and sometimes
violence; and a lack of guilt, shame and
empathy.
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Sometimes called psychopathy or sociopathy
Occurs in 3% of all males and less than 1%
of all females.
DSM Criteria for APD
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Must have 3 of these criteria and a history of
behaviours
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Repeatedly break the law.
They are deceitful, using aliases and lies to con others.
They are impulsive and unable to plan ahead.
They repeatedly get into physical fights or assaults.
They show reckless disregard for own safety or that of
others.
They are irresponsible, failing to meet obligations to
others.
They lack remorse for actions that harm others.
Causes of APD
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Abnormalities in central nervous system.
Genetically influenced problems with impulse
control.
Brain damage.
Emotions and
Antisocial Personality Disorder
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People with APD were
slow to develop
classically conditioned
responses to anger, pain,
or shock.
Such responses indicate
normal anxiety.
Drug Abuse and Addiction
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Biology and addiction
Learning, culture, and addiction
Debating the causes of addiction
Biology and Addiction
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The biological model holds that addiction,
whether to alcohol or other drugs is due
primarily to:
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a person’s biochemistry,
metabolism, and
genetic predisposition.
Most evidence comes from twin and family
studies of alcoholism.
Learning, Culture, and Addiction
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Addiction patterns vary according to cultural
practices and the social environment.
Policies of total abstinence tend to increase
addiction rates rather than reduce them.
Not all addicts have withdrawal symptoms when
they stop taking a drug.
Addiction does not depend on the properties of
the drug alone, but also on the reason for taking
it.
Failure of the Addiction Prediction
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75% of US Soldiers who
tested “drug positive”
reported being addicted
during their tour.
Fewer reported postVietnam drug use (blue bar).
Even fewer still showed
dependency(green bar).
This contradicts what the
biomedical model of
addiction would predict.
Debating the Causes of Addiction
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Problems with drugs are more likely when:
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A person has a physiological vulnerability to a drug.
A person believes she or he has no control over the
drug.
Laws or customs encourage people to take the drug
in binges, and moderate use is neither tolerated nor
taught.
A person comes to rely on a drug as a method of
coping with problems, suppressing anger or fear, or
relieving pain.
Members of a person’s peer group use drugs or drink
heavily, forcing the person to choose between using
drugs or losing friends.
Dissociative Identity Disorder
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Defining identity disorders
The MPD controversy
The sociocognitive explanation
Dissociative Identity Disorders
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A controversial disorder marked by the
appearance within one person of two or
more distinct personalities, each with its
own name and traits; commonly known as
“Multiple Personality Disorder (MPD).”
The MPD Controversy
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First view
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MPD is common but often unrecognized or
misdiagnosed.
The disorder starts in childhood as means of
coping.
Trauma produced a mental splitting.
2nd view
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Created through pressure and suggestions by
clinicians.
Handful of cases to tens of thousands since
1980.
Sociocognitive Explanation
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MPD is an extreme form of our ability to
present many aspects of our personalities to
others.
MPD is a culturally acceptable way for
some troubled people to make sense of
their problems.
Therapists looking for MPD may reward
patients with attention and praise for
revealing more and more personalities.
Schizophrenia
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Symptoms of schizophrenia
Theories of schizophrenia
Symptoms of Schizophrenia
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Bizarre delusions
Hallucinations and heightened sensory
awareness
Disorganized, incoherent speech
Grossly disorganized and inappropriate
behaviour
Delusions and Hallucinations
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Delusions
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False beliefs that often accompany
schizophrenia and other psychotic disorders.
Hallucinations
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Sensory experiences that occur in the absence
of actual stimulation.
Positive Symptoms
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Cognitive, emotional, and behavioural
excesses
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Examples of Positive Symptoms
 Hallucinations
 Bizarre delusions
 Incoherent speech
 Inappropriate/Disorganized behaviours
Negative Symptoms
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Cognitive, emotional, and behavioural
deficits
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Examples of Negative Symptoms
 Loss of motivation
 Emotional flatness
 Social withdrawal
 Slowed speech or no speech
Theories of Schizophrenia
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Genetic predispositions
Structural brain abnormalities
Neurotransmitter abnormalities
Prenatal abnormalities
Adolescent abnormalities in brain
development
Genetic Vulnerability to
Schizophrenia
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The risk of developing
schizophrenia (i.e.,
prevalence) in one’s
lifetime increases as the
genetic relatedness with
a diagnosed
schizophrenic increases.
Structural Brain Abnormalities
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Several abnormalities exist, especially when
schizophrenia is characterized by primarily
negative symptoms:
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Decreased brain weight.
Decreased volume in temporal lobe or
hippocampus.
Enlargement of ventricles.
About 25% do not have these observable
brain deficiencies
Neurotransmitter Abnormalities
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Include serotonin, glutamate, and
dopamine.
Many schizophrenics have high levels of
brain activity in brain areas served by
dopamine as well as greater numbers of
particular dopamine receptors.
Similar neurotransmitter abnormalities are
also found in depression and alcoholism.
Prenatal Problems or Birth
Complications
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Damage to the fetal brain increases chances
of schizophrenia and other mental
disorders.
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May occur as a function of maternal
malnutrition, maternal illness.
May also occur if brain injury or oxygen
deprivation occurs at birth.
Adolescent Abnormalities in Brain
Development
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Normal pruning of excessive synapses in
the brain occurs during adolescence.
In schizophrenics, a greater number of
synapses are pruned away.
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May explain why first episode occurs in
adolescence or early adulthood.