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Chapter 14
Psychological Disorders
Psychological Disorders
Perspectives on Psychological
Disorders
 Defining Psychological Disorders
 Understanding Psychological Disorders
 Classifying Psychological Disorders
 Labeling Psychological Disorders
2
Anxiety Disorders
 Generalized Anxiety Disorder
 Panic Disorder
 Phobias
 Obsessive-Compulsive Disorder
 Post-Traumatic Stress Disorder
 Understanding Anxiety Disorders
Somatoform Disorders
3
Dissociative Disorders
 Dissociative Identity Disorder
 Understanding Dissociative Identity
Disorder
Mood Disorders
 Major Depressive Disorder
 Bipolar Disorder
 Understanding Mood Disorders
4
Schizophrenia
 Symptoms of Schizophrenia
 Onset and Development of Schizophrenia
 Understanding Schizophrenia
Personality Disorders
 Antisocial Personality Disorder
 Understanding Antisocial Personality
Disorder
Rates of Psychological Disorders
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WARNING
SOME OF THE TOPICS AND SYMPTOMS
COVERED IN THIS CHAPTER YOU MAY HAVE
FELT OR EXPERIENCED AT ONE TIME
HOWEVER, IT IS NOT LIKELY THAT YOU HAVE A
PSYCHOLOGICAL DISORDER!!
Remember…
Psychological Disorders
People are fascinated by the exceptional, the
unusual, and the abnormal. This fascination
may be caused by two reasons:
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1.
During various moments we feel, think, and act
like an abnormal individual.
2.
Psychological disorders may bring unexplained
physical symptoms, irrational fears, and suicidal
thoughts.
Psychological Disorders
To study the abnormal is the best way of
understanding the normal.
William James (1842-1910)
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1.
There are 450 million people suffering from
psychological disorders (WHO, 2004).
2.
Depression and schizophrenia exist in all cultures
of the world.
Psychological Disorders
 About 26.2 percent of Americans ages 18 and older —
about one in four adults — suffer from a diagnosable mental
disorder in a given year
 About 6 percent of American adults suffer from a serious
mental illness such as bipolar disorder, schizophrenia, and
clinical depression.
Defining Psychological Disorders
Mental health workers view psychological
disorders as persistently harmful thoughts,
feelings, and actions.
When behavior is deviant, distressful, and
dysfunctional psychiatrists and psychologists
label it as disordered (Comer, 2004).
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What is Abnormal?
 What is the content of the behavior?
 I stop bathing
 I shower 37 times every day
 What is the sociocultural context in which the behavior
occurs?
 We are expected to not smell
 We are expected to show up to work on time
 What are the consequences of the behavior for that
person and for others?
 People avoid me
 I get fired from my job
Deviant, Distressful & Dysfunctional
1. Deviant behavior
Carol Beckwith
(going naked) in one
culture may be
considered normal,
while in others it may
lead to arrest.
2. Deviant behavior must
accompany distress.
3. If a behavior is
dysfunctional it is
clearly a disorder.
In the Wodaabe tribe men
wear costumes to attract
women. In Western society
this would be considered
abnormal.
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Handout Out 12-2
 Defining Psychological disorder (back of Ch. 12 Facts &
falsehoods)
Understanding Psychological Disorders
Ancient Treatments of psychological disorders
include trephination, exorcism, being caged like
animals, being beaten, burned, castrated,
mutilated, or transfused with animal’s blood.
John W. Verano
Trephination (boring holes in the skull to remove evil forces)
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The Medical Model
Philippe Pinel (1745-1826) from France, insisted
that madness was not due to demonic possession,
but an ailment of the mind.
George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago
Dance in the madhouse.
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Medical Model
When physicians discovered that syphilis led to
mental disorders, they started using medical models
to review the physical causes of these disorders.
1.
2.
3.
4.
Etiology: Cause and development of the
disorder.
Diagnosis: Identifying (symptoms) and
distinguishing one disease from another.
Treatment: Treating a disorder in a psychiatric
hospital.
Prognosis: Forecast about the disorder.
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The Biopsychosocial Approach
Assumes that biological, socio-cultural, and
psychological factors combine and interact to
produce psychological disorders.
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Classifying Psychological Disorders
The American Psychiatric Association rendered
a Diagnostic and Statistical Manual of Mental
Disorders (DSM) to describe psychological
disorders.
The most recent edition, DSM-IV-TR (Text
Revision, 2000), describes 400 psychological
disorders compared to 60 in the 1950s.
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Multiaxial Classification
Axis I
Axis II
Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16
syndromes]) present?
Is a Personality Disorder or Mental Retardation present?
Axis III
Is a General Medical Condition (diabetes, hypertension or
arthritis etc) also present?
Axis IV
Are Psychosocial or Environmental Problems (school or housing
issues) also present?
What is the Global Assessment of the person’s functioning?
Axis V
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Multiaxial Classification
Note 16 syndromes in Axis I
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Multiaxial Classification
Note Global Assessment for Axis V
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Mnemonic Device
 5 axis of the DSM-IV-TR. They are as
follows: Clinical, Personality, Medical,
Psychosocial, and GAF (Global)
 Can Pretty Molly Please Get Abby Fit?
Goals of DSM
1.
2.
Describe (400) disorders.
Determine how prevalent the
disorder is.
Disorders outlined by DSM-IV are reliable.
Therefore, diagnoses by different professionals
are similar.
Others criticize DSM-IV for “putting any kind
of behavior within the compass of psychiatry.”
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Labeling Psychological Disorders
1.
Critics of the DSM-IV argue that labels may
stigmatize individuals.
Elizabeth Eckert, Middletown, NY. From L. Gamwell and
N. Tomes, Madness in America, 1995. Cornell University Press.
Asylum baseball team (labeling)
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Labeling Psychological Disorders
2. Labels may be helpful for healthcare
professionals when communicating with
one another and establishing therapy.
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DSM-V
 For more information
Labeling Psychological Disorders
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Elaine Thompson/ AP Photo
3. “Insanity” labels
raise moral and
ethical questions
about how society
should treat people
who have
disorders and have
committed crimes.
Theodore Kaczynski
(Unabomber)
Anxiety Disorders
Feelings of excessive apprehension and anxiety.
1.
2.
3.
4.
5.
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Generalized anxiety disorder
Panic disorder
Phobias
Obsessive-compulsive disorder
Post-traumatic stress disorder
Generalized Anxiety Disorder
Symptoms
1.
Persistent and uncontrollable tenseness and
apprehension.
2. Autonomic arousal.
3. Inability to identify or avoid the cause of
certain feelings.
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Panic Disorder
Symptoms
Minutes-long episodes of intense dread which
may include feelings of terror, chest pains,
choking, or other frightening sensations.
Anxiety is a component of both disorders. It
occurs more in the panic disorder, making
people avoid situations that cause it.
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Phobias
Marked by a persistent and irrational fear of an
object or situation that disrupts behavior.
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Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Hemophobia
Phobia of open places.
Phobia of heights.
Phobia of closed spaces.
Phobia of blood.
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Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions)
and urges to engage in senseless rituals
(compulsions) that cause distress.
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Brain Imaging
A PET scan of the brain
of a person with
Obsessive-Compulsive
Disorder (OCD). High
metabolic activity (red)
in the frontal lobe areas
are involved with
directing attention.
Brain image of an OCD
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Howie Mandel
 http://www.youtube.com/watch?v=QtVToi8Cnn8
OCD ACTIVITY
Post-Traumatic Stress Disorder
Four or more weeks of the following symptoms
constitute post-traumatic stress disorder
(PTSD):
1. Haunting memories
2. Nightmares
3. Social withdrawal
Bettmann/ Corbis
4. Jumpy anxiety
5. Sleep problems
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Resilience to PTSD
Only about 10% of women and 20% of men
react to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience
against traumatic situations.
All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
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Explaining Anxiety Disorders
Freud suggested that we repress our painful
and intolerable ideas, feelings, and thoughts,
resulting in anxiety.
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The Learning Perspective
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John Coletti/ Stock, Boston
Learning theorists
suggest that fear
conditioning leads to
anxiety. This anxiety
then becomes
associated with other
objects or events
(stimulus
generalization) and is
reinforced.
The Learning Perspective
Investigators believe that fear responses are
inculcated through observational learning.
Young monkeys develop fear when they watch
other monkeys who are afraid of snakes.
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The Biological Perspective
Natural Selection has led our ancestors to learn
to fear snakes, spiders, and other animals.
Therefore, fear preserves the species.
Twin studies suggest that our genes may be
partly responsible for developing fears and
anxiety. Twins are more likely to share phobias.
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The Biological Perspective
S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action
monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353.
Generalized anxiety,
panic attacks, and even
OCD are linked with
brain circuits like the
anterior cingulate cortex.
Anterior Cingulate Cortex
of an OCD patient.
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Somatoform Disorders
 (somatic) Bodily symptoms without physical cause
 Examples: Conversion Disorder & Hypochondraisis
Dissociative Disorders
Conscious awareness becomes separated
(dissociated) from previous memories,
thoughts, and feelings.
Symptoms
1. Having a sense of being unreal.
2. Being separated from the body.
3. Watching yourself as if in a movie.
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Dissociative Identity Disorder (DID)
A disorder in which a person exhibits two or
more distinct and alternating personalities,
formerly called multiple personality disorder.
Lois Bernstein/ Gamma Liason
Chris Sizemore (DID)
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Dissociative Identity Disorder (DID)
 EXTREMELY RARE! But the number of cases is on the
rise. (Why?)
 In true DID the personalities are distinct people, with
their own names, identities, mannerisms, speaking
voices, and even IQs!
Origins of DID
 Childhood abuse – child copes with the abuse by assigning it
to another person and thus dissociates themselves. 3/4ths of
all MI cases have child abuse.
 Prevalence of child personalities in DID seem to support
this.
 Some believe this is not real and it is an elaborate role play –
but the various personalities have different blood pressure
readings, different responses to medication, different
allergies, different vision problems and different handedness,
and maybe even brainwave patters.
DID Critics
Critics argue that the diagnosis of DID increased in
the late 20th century. DID has not been found in
other countries.
Critics’ Arguments
1. Role-playing by people open to a
therapist’s suggestion.
2. Learned response that reinforces
reductions in anxiety.
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DSM Criteria: DID cont
 A. The presence of two or more distinct identities or personality
states
 B. At least two of these identities or personality states
recurrently take control of the person’s behavior
 C. Inability to recall important personal information that is too
extensive to be explained by ordinary forgetfulness
 D. Not due to a GMC or substance
DID cont
May be seen through:
 Various personalities don’t know they inhabit the same body.
 Sometimes they know of the other people and make
disparaging comments about them.
 They usually are very different as if the various aspects of the
person are represented by various personalities.
 Almost always one of the personalities is a child.
Other Dissociative Disorders
 Dissociative Amnesia
 Key features– loss of memory for past events without a
biological reason. Can be a defense mechanism. Is usual
selective. Total amnesia is very rare.
 One or more episodes of inability to recall important personal
information, usually of a traumatic or stressful nature, that is too
extensive to be explained by ordinary forgetfulness
 Not better explained by a another mental disorder and is not due
the brain or substance
 Symptoms cause clinically significant distress or impairment in
functioning
Other Dissociative Disorders
 Dissociative Fugue
 Extreme and rare, involves flight from home and the assumption




of a new identity, with amnesia for past identity and events.
Sudden, unexpected travel away from home or one’s customary
place of work, with inability to recall one’s past
Confusion about personal identity or assumption of a new identity
(partial or complete)
Not better explained by a another mental disorder and is not due
to the brain or substance
Symptoms cause clinically significant distress or impairment in
functioning
Mood Disorders
Emotional extremes of mood disorders come in
two principal forms.
1. Major depressive disorder
2. Bipolar disorder
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Major Depressive Disorder
Depression is the “common cold” of
psychological disorders. In a year, 5.8% of men
and 9.5% of women report depression
worldwide (WHO, 2002).
Blue mood
Major Depressive Disorder
Gasping for air after a hard run
Chronic shortness of breath
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Major Depressive Disorder
Major depressive disorder occurs when signs of
depression last two weeks or more and are not
caused by drugs or medical conditions.
Signs include:
1.
2.
3.
4.
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Lethargy and fatigue
Feelings of worthlessness
Loss of interest in family & friends
Loss of interest in activities
Bipolar Disorder
Formerly called manic-depressive disorder. An
alternation between depression and mania
signals bipolar disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Desire for action
Tired
Hyperactive
Slowness of thought
Multiple ideas
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Bipolar Disorder
Many great writers, poets, and composers
suffered from bipolar disorder. During their
manic phase creativity surged, but not during
their depressed phase.
Earl Theissen/ Hulton Getty Pictures Library
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Wolfe
The Granger Collection
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
Clemens
Hemingway
Bipolar Self screening
 http://www.aboutdepressionfacts.com/bipolar-disorder-
self-screening-test-infographic.html
Explaining Mood Disorders
Since depression is so prevalent worldwide,
investigators want to develop a theory of
depression that will suggest ways to treat it.
Lewinsohn et al., (1985, 1998) note that a theory
of depression should explain the following:
1. Behavioral and cognitive changes
2. Common causes of depression
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Theory of Depression
3. Gender differences
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Theory of Depression
4. Depressive episodes self-terminate.
5. Stressful events often precede depression.
6. Depression is increasing, especially in the
teens.
Desiree Navarro/ Getty Images
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Post-partum depression
Biological Perspective
Genetic Influences: Mood disorders run in
families. The rate of depression is higher in
identical (50%) than fraternal twins (20%).
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Jerry Irwin Photography
Linkage analysis and
association studies link
possible genes and
dispositions for depression.
The Depressed Brain
PET scans show that brain energy consumption
rises and falls with manic and depressive
episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine
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Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
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Depression Cycle
1. Negative stressful
events.
2. Pessimistic explanatory
style.
3. Hopeless depressed
state.
4. These hamper the way
the individual thinks
and acts, fueling
personal rejection.
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Schizophrenia
The literal translation is “split mind” which
refers to a split from reality. A group of severe
disorders characterized by the following:
1. Disorganized and delusional
thinking.
2. Disturbed perceptions.
3. Inappropriate emotions and
actions.
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Types
 Paranoid-panic and hallucinations
 Catatonic –stupors, physical immobility
 Disorganized –speech & thought incoherent; loose touch
with reality
 Undifferentiated –does not fit other categories
 Residual –symptoms disappear
Symptoms of Schizophrenia
Positive symptoms: the presence of
inappropriate behaviors (hallucinations,
disorganized or delusional talking)
Negative symptoms: the absence of
appropriate behaviors (expressionless faces,
rigid bodies)
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Disturbed Perceptions
A schizophrenic person may perceive things
that are not there (hallucinations). Frequently
such hallucinations are auditory and lesser
visual, somatosensory, olfactory, or gustatory.
L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg
August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg
Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
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Inappropriate Emotions & Actions
A schizophrenic person may laugh at the news
of someone dying or show no emotion at all
(flat affect).
Patients with schizophrenia may continually
rub an arm, rock a chair, or remain motionless
for hours (catatonia).
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Onset and Development of
Schizophrenia
Nearly 1 in a 100 suffer from schizophrenia, and
throughout the world over 24 million people
suffer from this disease (WHO, 2002).
Schizophrenia strikes young people as they
mature into adults. It affects men and women
equally, but men suffer from it more severely
than women.
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Chronic and Acute Schizophrenia
When schizophrenia is slow to develop
(chronic/process) recovery is doubtful. Such
schizophrenics usually display negative
symptoms.
When schizophrenia rapidly develops
(acute/reactive) recovery is better. Such
schizophrenics usually show positive
symptoms.
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Understanding Schizophrenia
Schizophrenia is a disease of the brain exhibited
by the symptoms of the mind.
Brain Abnormalities
Dopamine Overactivity: Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain.
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Abnormal Brain Activity
Brain scans show abnormal activity in the
frontal cortex, thalamus, and amygdala of
schizophrenic patients.
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
82
Genetic Factors
The likelihood of an individual suffering from
schizophrenia is 50% if their identical twin has
the disease (Gottesman, 2001).
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
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Personality Disorders
Personality disorders
are characterized by
inflexible and
enduring behavior
patterns that impair
social functioning.
They are usually
without anxiety,
depression, or
delusions.
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Personality Disorder Activity
Narcissistic Personality
Antisocial Personality Disorder
A disorder in which the person (usually men)
exhibits a lack of conscience for wrongdoing, even
toward friends and family members. Formerly,
this person was called a sociopath or psychopath.
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COMMON SYMPTOMS OF SOCIOPATHIC
PERSONALITY DISORDER
 1. Pathological lying, can often pass a lie detector test, as
lying is part of the sociopath's innate makeup
 2. Shallow emotions, exhibits outward charm but holds
inward scorn for others.
 3. Overblown ego (total self-centeredness)and sense of
entitlement, feelings that whatever they want is their right to
have regardless of harm done to others to obtain it
 4. Feel their behavior is justified
COMMON SYMPTOMS OF SOCIOPATHIC
PERSONALITY DISORDER
 5. Desire to control and manipulate others, sees others more as




targets to be victimized than as people
6. Vindictive when thwarted
7. Keenly aware of the weaknesses of others and will exploit those
weaknesses to their own advantage, loves to con others for
pleasure or for profit
8. Versatile and chameleon-like, changes image and life story as
needed to attain immediate goals
9. Lack of conscience, no sense of remorse, guilt, or regret"
Borderline Personality Disorder
 Borderline personality disorder (BPD) is an emotional




disorder that causes emotional instability, leading to stress
and other problems.
People with BPD have a distorted image of themselves and
often feel worthless and fundamentally flawed.
They will have outbursts of anger, impulsivity and frequent
mood swings.
Many people withB PD get better with treatment and can
live happy, peaceful lives.
For More information
Understanding Antisocial Personality
Disorder
Like mood disorders
and schizophrenia,
antisocial personality
disorder has biological
and psychological
reasons. Youngsters,
before committing a
crime, respond with
lower levels of stress
hormones than others
do at their age.
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Understanding Antisocial Personality
Disorder
PET scans of 41 murderers revealed reduced
activity in the frontal lobes. In a follow-up study,
repeat offenders had 11% less frontal lobe activity
(Raine et al., 1999; 2000).
Courtesy of Adrian Raine,
University of Southern California
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Normal
Murderer
Rates of Psychological Disorders
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