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PSYCHOLOGY
Third Edition
by
Drew Westen
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C h a p t e r 15
PSYCHOLOGICAL
DISORDERS
John Wiley & Sons, Inc.
Lecture Outline
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Definitions of Psychopathology
Perspectives on Psychopathology
Diagnostic Systems
© 2002 John Wiley & Sons, Inc.
Psychopathology
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Psychopathology refers to problematic
patterns of thought, feeling, and behavior
 Disrupted functioning at home, work, and in
the person’s social life
 Patterns that cause distress in the person or
in others
 Psychopathology literally means sickness of
the mind
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Psychopathology varies between and
within cultures
© 2002 John Wiley & Sons, Inc.
Labeling of Mental Illness
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The notion of abnormality carries with it
the presumption that we can define what
is and in not abnormal
 Labeling theory argues that diagnoses of
abnormality are but labels we use for people
who we consider deviant
 Rosenhan study: “Pseudo”-patients claimed
to hear voices and were admitted to various
psychiatric hospitals. Rosenhan noted that
no hospital detected them as fakes. The
study suggests support for labeling theory.
© 2002 John Wiley & Sons, Inc.
Psychodynamic Perspective
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The psychodynamic perspective
recognizes three classes of pathology:
 Neuroses refer to issues in living that involve
anxiety (phobias) or interpersonal conflict
 Personality disorders are chronic and severe
disturbances that alter the capacity to work
and to love
 Psychoses refer to marked disturbances of
contact with reality
 These classes form a continuum of functioning
from minimal to serious disturbance
© 2002 John Wiley & Sons, Inc.
Psychodynamic View of
Psychopathology
© 2002 John Wiley & Sons, Inc.
Biological Perspective on
Psychopathology
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The biological perspective seeks the roots
of abnormal behavior within the brain
The biological view holds that brain
disturbance results in mental changes
 Gross pathology of the brain: damage to the
frontal lobes associated with syphilis
 Disturbance of neurotransmitter function
• Schizophrenia as too much dopamine
• Depression as too little serotonin
© 2002 John Wiley & Sons, Inc.
Systems Perspective
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The systems perspective seeks the roots
of abnormality in the broad social context
 Each person is a member of a social group
 The group functions as a system and the
system parts are interdependent
• A change in one member may influence other
members
• A father may show evidence of anxiety that is
traced to his children: Father is the symptom
bearer
– Son arrested for driving while intoxicated
– Daughter runs away from home
© 2002 John Wiley & Sons, Inc.
Descriptive Diagnosis
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The current diagnostic system assumes
that we can distinguish normal from
abnormal
 Abnormality is reflected in discrete symptoms
 As in physical illness, symptoms fall into
discrete clusters called syndromes
 Syndromes are assumed to have discrete
causes and are to be treated using different
therapies
 This system is based on the medical model
© 2002 John Wiley & Sons, Inc.
DSM-IV
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The American Psychiatric Association published a
diagnostic manual that attempts to classify signs
and symptoms into syndromes
 Signs are observable phenomena (temperature)
 Symptoms are reports from patients (headache)
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The current edition is termed the DSM-IV
 The DSM-IV uses a multi-axial system of diagnosis
• The axes cover symptoms as well as medical conditions, stress,
and current level of function
© 2002 John Wiley & Sons, Inc.
The Axes of DSM-IV
Axis Description
I
II
III
IV
V
Symptoms that cause distress
Personality disorders and mental retardation
Medical conditions that may be relevant to understanding
or treating a psychological disorder
Psychosocial and environmental problems
Global assessment of functioning
(Source: DSM-IV, American Psychiatric Association, 1994)
© 2002 John Wiley & Sons, Inc.
Childhood Disorders
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Attention-Deficit Hyperactivity Disorder is
characterized by inattention, impulsiveness,
and hyperactivity
 Prevalence of ADHD is likely 3-5% of schoolaged children, more common in boys
 ADHD is often treated with Ritalin
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Conduct Disorder refers to the child who
persistently violates rules and norms
 Prevalence is larger in boys than girls
 Conduct disorder may reflect a problem in
conditioning
© 2002 John Wiley & Sons, Inc.
Substance-Related Disorders
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Substance-Related Disorders refer to continued
use of a substance (alcohol) that impairs social
and physical functioning
Alcoholism is a common substance-related
disorder
 Some 13 million in the USA are alcoholic
 Alcoholism is the 3rd largest cause of death
 Heredity plays a large role in alcoholism
• Children of alcoholics are prone to developing alcoholism
• Male children are more likely than female children to develop
alcoholism
© 2002 John Wiley & Sons, Inc.
Nature Versus Nurture in
Substance Abuse
(Figure adapted from Kendler et al., 2000)
© 2002 John Wiley & Sons, Inc.
Schizophrenia
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Schizophrenia refers to a profound disturbance in
human function including:
 Thought: Illogical thought systems (delusions) and
loosening of associations
 Perception: Presence of hallucinations
 Language: Word salad, disconnected ideas
 Affect: Emotion (often flat or absent)
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Symptoms can be viewed as:
 Positive: Delusions are an added function
 Negative: Signal the absence of a function (flat affect)
© 2002 John Wiley & Sons, Inc.
Major Types of Schizophrenia
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Paranoid
Catatonic
Disorganized
Undifferentiated
Residual
© 2002 John Wiley & Sons, Inc.
Biological Basis of Schizophrenia
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Diathesis-stress model proposes that some
persons develop schizophrenia because of a
underlying biological vulnerability(diathesis) that is
compounded by stress
The heritability of schizophrenia is 50-83%
 Risk of schizophrenia is 48% in monozygotic, 17% in
dizygotic twins, and 9% in siblings
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Dopamine hypothesis: schizophrenia reflects
elevated levels of dopamine in brain
 Paranoid schizophrenia is induced by chronic treatment
with amphetamine, a drug that releases dopamine
© 2002 John Wiley & Sons, Inc.
Diathesis-Stress Models of
Schizophrenia
© 2002 John Wiley & Sons, Inc.
Neural Atrophy in Schizophrenia
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Neuron loss in brain results in a diminished
volume of brain tissue
 The fluid-filled ventricles enlarge to take up the
volume
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Enlarged ventricles are a common finding in
schizophrenia
 Atrophy of the frontal, temporal, and prefrontal cortex
has been noted in schizophrenic patients: reflects
brain damage
 Note that negative symptoms induced by brain cell
loss may not respond to drug treatment
© 2002 John Wiley & Sons, Inc.
Mood Disorders
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Mood disorders are characterized by disturbance
of emotion and mood state
 Mania refers to an excessive degree of happiness,
and a belief the person can do anything
 Major Depressive Disorder refers to a long-term
episode of intense sadness, loss of appetite, and
difficulty in sleeping
• Duration may be 5 months or more
• Women are twice as likely to have major depression
(incidence is 2-3% for men and 5-9% for women)
© 2002 John Wiley & Sons, Inc.
Mood Disorders, Continued
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Dysthymia is a less severe type of depression
 Symptoms of dysthymia are evident over longer time
periods (two years) but are not as debilitating as those
of major depression
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Bipolar disorder involved alternating episodes of
mania and depression
 Lifetime risk is low (0.5-1.6%)
 Appears more often in upper classes
 Bipolar patients achieve high levels of education
© 2002 John Wiley & Sons, Inc.
Theories of Depression
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Depression may reflect a biological vulnerability
and an environmental basis
The heritability of depression is about 30%
 Twin studies show a clear role of genetics in
depression
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Effective antidepressant drugs alter serotonin
activity (Prozac blocks the reuptake of serotonin)
Cognitive theories of depression note that
depresses people have negative cognitive
schemas about themselves
© 2002 John Wiley & Sons, Inc.
Beck’s Negative Triad
(Figure adapted from Beck, 1976, p 256)
© 2002 John Wiley & Sons, Inc.
Anxiety Disorders
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Anxiety disorders refer to feelings of
distress, uneasiness, or apprehension
Types of anxiety disorders:
 Phobias refer to an irrational fear of an object
or situation
• Social phobia: a fear of being in a public situation
 Panic Disorders are intense attacks of anxiety
that are justified by the situation
 Agoraphobia refers to anxiety associated with
being in places or situations from which it
might be difficult to escape (e.g. an elevator)
© 2002 John Wiley & Sons, Inc.
Obsessive-Compulsive Disorder
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An obsession is a persistent thought that cannot
be controlled
 “Did I lock the door?”
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A compulsion is an intentional behavior (ritual)
that occurs in response to a thought
 Check the door (22 times)
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Key aspect is that OC persons experience
anxiety if they are unable to complete their ritual
© 2002 John Wiley & Sons, Inc.
Copyright
Copyright 2002 by John Wiley & Sons, Inc., New
York, NY. All rights reserved. No part of the
material protected by this copyright may be
reproduced or utilized in any form or by any means,
electronic or mechanical, including photocopying,
recording, or by any information storage and
retrieval system, without written permission of the
copyright owner.
© 2002 John Wiley & Sons, Inc.