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Chapter 14: Psychological
Disorders
Abnormal Behavior
 The medical model
 Think of abnormal behavior as a disease
 Combats stereotypes associated with mental illness
 What is abnormal behavior?
 Deviant

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Maladaptive


from social norms
prevents normal functioning
Causing personal distress
Figure 14.2 Normality and abnormality as a continuum
Understanding Mental Illness
 Epidemiology


Prevalence
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Distinguishing features
Etiology
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Percent of population
Diagnosis

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The study of a disorder in a population. Includes the
following:
Causes
Prognosis

Predictable outcome
Problems with Diagnostic Labeling
 Rosenhan Study
 Stigma associated with being labeled as
“mentally ill”
Figure 14.5 Lifetime prevalence of psychological disorders
Psychodiagnosis:
The Classification of Disorders
 American Psychiatric Association
 Diagnostic and Statistical Manual of Mental
Disorders – 4th ed. (DSM - 4)
Five Axes
 Axis I – Clinical Syndromes
 Axis II – Personality Disorders or Mental
Retardation
 Axis III – General Medical Conditions
 Axis IV – Psychosocial and Environmental
Problems
 Axis V – Global Assessment of Functioning
Axis I Clinical Syndromes
 Anxiety Disorders
 Somatoform Disorders
 Dissociative Disorders
 Mood Disorders
 Schizophrenic Disorders
Anxiety Disorders
 Prevalence = 19% of pop.
 Generalized anxiety disorder
 “free-floating anxiety”
 Phobic disorder
 Specific focus of fear
 Panic disorder and agoraphobia
 Obsessive compulsive disorder (2.5%)
 Obsessions – intrusive thoughts (ex. I must check the
stove)
 Compulsions –rituals to reduce anxiety (ex. checking
stove)
 Posttraumatic Stress Disorder
Agoraphobia
Agoraphobia gave us Paula Deen!
 Married at 18, pregnant at 19, and orphaned at 23, she became
depressed and then severely agoraphobic for the next two decades.
For 20 years, she focused on cooking for her family because it was
something she could do without leaving the house. “I could
concentrate on what was in my pots and block out what was in my
head,” she said. Shame and bewilderment prevented her from seeking
help, she said, and no one except her husband knew the depth of her
illness. “Some days I could get to the supermarket, but I could never go
too far inside,” Ms. Deen said. “I learned to cook with the ingredients
they kept close to the door.” – NY Times 2.28.2007
Etiology of Anxiety Disorders
 Biological factors
 Genetic predisposition, anxiety sensitivity
 GABA circuits in the brain (drugs to reduce anxiety)
 Concordance Rates - %age of relatives with same
disorder
 Conditioning and learning
 Acquired through classical conditioning or observational
learning
 Maintained through operant conditioning
 Cognitive factors
 Judgments of perceived threat
 Personality
 Neuroticism
 Stress—a precipitator
Figure 14.6 Twin studies of anxiety disorders
Figure 14.7 Conditioning as an explanation for phobias
Prompt: The doctor examined little Emma’s growth.
Figure 14.8 Cognitive factors in anxiety disorders
Somatoform Disorders
 Somatization Disorder
 Feels real, not faking
 Conversion Disorder
 Impairment of specific organ
 Glove Anesthesia 
 Hypochondriasis
 Preoccupation with illness/medicine
 Feels their disease is too rare for doctors to properly diagnose
 Etiology
Reactive autonomic nervous system
 Personality factors
 Cognitive factors
 The sick role

Factitious disorders
 Made up or self inflicted physical symptoms
 Munchausen
Being ill on purpose
 Consciously aware that they are not ill, however they fake
symptoms for sympathy

 Munchausen By Proxy
 Keeping someone else ill for sympathy
 Usually involves a parent harming a child
Dissociative Disorders
 Dissociative amnesia
Forgetting personal information for a brief episode
 No physical cause for the amnesia, is a reaction to stress

 Dissociative fugue (.2%)

Sudden, unexpected travel away from home or one's customary
place of work, with inability to recall one's past
 Dissociative identity disorder (.01%)
Formerly Multiple Personality Disorder
 Three Faces of Eve (1957)
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Etiology

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severe emotional trauma during childhood
Controversy
Sybil
 Media creation?

Mood Disorders
 Major depressive disorder
 Unipolar
 2x more women
 Bipolar disorder (formerly manic-depressive disorder) (2.6%)
 One or more manic episodes with periods of depression

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Lasting *at least* one week
Cyclothymic disorder – chronic but mild symptoms
 Etiology
 Genetic vulnerability – more for unipolar
 Neurochemical factors- low levels of seratonin & norepinephrine
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Smaller hippocampus (8-10% smaller)
Cognitive factors – pessimistic
Interpersonal roots – hard to make friends when you act like
Eeyore.
Bipolar Disorder
Manic Episode
Depressive Episode
 Euphoric
 Gloomy
 Impatient
 Hopeless
 Delusions of grandeur
 Obsessive worrying
 Hyperactive
 Withdrawn
 Increased sex drive
 Delusions of guilt &
 Impulsive behavior
disease
 Decreased sex drive
 Irritable
 Tired
 Requiring less sleep
 Talkative
 Racing thoughts
Discussion Questions
 What is schizophrenia?
 Do you know of any real life examples of schizophrenia?
 How does Hollywood depict schizophrenia?
Schizophrenic Disorders (Psychotic Disorders)
 General symptoms
 Delusions and irrational thought
 Deterioration of adaptive behavior
 Hallucinations
 Disturbed emotions
 Prognostic factors
 Rule of quarters
25% will live independently with medication
 25% will live require in patient care
 25% will end up homeless
 25% will commit suicide

Subtyping of Schizophrenia
 Four Patient Examples
 4 subtypes
 Paranoid type
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Catatonic type
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Marked by stupor, unresponsiveness, posturing, mutism,
and sometimes, by agitated, purposeless behavior
Disorganized type
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Preoccupation with delusions; also involves auditory
hallucinations that are related to a single theme, especially
grandeur or persecution
Incoherence, grossly disorganized behavior, bizarre
thinking, and flat or grossly inappropriate emotions
Undifferentiated type

Any type of schizophrenia that does not have specific
paranoid, catatonic, or disorganized features or symptoms
Examples of Catatonic Schizophrenia
Schizophrenia Symptom Classification
Positive Symptoms
Negative Symptoms
 Disorganized Speech
 Avolution (apathy)
 Delusions
 Alogia (poverty of speech)
 Hallucinations/disorders of  Anhedonia (lack of
perception
pleasure)
 Catatonia/catatonic
immobility
 Flat or inappropriate affect
(emotional response)
 Echolalia
 Asociality
Etiology of Schizophrenia
 Genetic vulnerability
 Neurochemical factors
 Structural abnormalities of the brain
 The neurodevelopmental hypothesis
 Expressed emotion
 Precipitating stress
Figure 14.18 The dopamine hypothesis as an explanation for schizophrenia
Figure 14.20 The neurodevelopmental hypothesis of schizophrenia
Personality Disorders
 Anxious-fearful cluster
 Avoidant, dependent, obsessive-compulsive
 Dramatic-impulsive cluster
 Histrionic, narcissistic, borderline, antisocial
 Odd-eccentric cluster
 Schizoid, schizotypal, paranoid
 Etiology
 Genetic predispositions, inadequate socialization in
dysfunctional families
Table 14.2 Personality Disorders
Psychological Disorders and the Law
 Insanity
 M’naghten rule
 Involuntary commitment
 danger to self
 danger to others
 in need of treatment
Figure 14.22 The insanity defense: public perceptions and actual realities
Culture and Pathology
 Cultural variations
 Culture bound disorders
 Koro
 Windigo
 Anorexia nervosa