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Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Chapter 16
Specific Disorders and Treatments
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Progress in Abnormal Psychology


The growth of understanding of mental disorders and their
treatment has paralleled the progress of medical science.
Although we have much yet to learn, we now can make
accurate distinctions between a wide range of disorders
and we can tailor treatments to meet the needs of those
suffering from specific disorders.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Psychological Disorders




Psychopathology—scientific study of the origins,
symptoms, and development of psychological disorders
What is a psychological disorder?
What are common characteristics of people with mental
disorders?
How do we as a culture view mental illness?
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Stigmas and Misconceptions


Most people have some experience with mental illness

through personal experience or

through illness of someone they are close to
However there is still a stigma associated with mental illness in the U.S.
(e.g., people are more
likely to talk openly about other forms of disease)

Media--People with mental disorders are the most stigmatized group on television

Portrayed as helpless victims or evil villains who are unpredictable, dangerous,
and violent.

One study found 70% of characters labeled as mentally ill on TV were violent. In
the real world this is not the case- Steadman et. al. (1998) -- overall, former mental patients did not have a
higher rate of violence than a matched comparison group.
 People with severe mental disorders who are experiencing bizarre delusional
ideas and hallucinated voices do have a slightly higher level of violent and
illegal behavior than do “normal” people.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Psychological Disorder


A pattern of behavioral and psychological symptoms that
causes significant personal distress, impairs the ability to
function in one or more important areas of daily life, or both.
Patterns of behaviors or psychological symptoms must
represent a serious departure from the norm.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
4 common DSM categories

Anxiety and Avoidance Disorders

Substance-Related Disorders

Mood Disorders

Schizophrenia
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Anxiety and Avoidance Disorders
Anxiety refers to a certain amount of fear and caution in the
face of potential hazards.
 Normal Anxiety -- A certain amount of anxiety is normal.
 puts us on physical alert, preparing us to defensively
“fight” or “flee” potential dangers, and on mental alert,
making us focus our attention squarely on the threatening
situation.
 Anxiety disorders -- considered pathological when it
interferes with daily functioning.
 maladaptive, disrupting everyday activities, moods, and
thought processes or maladaptive behaviors that reduce
anxiety
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Overview of Anxiety Disorders
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Anxiety

Generalized anxiety disorder (GAD) is the experience of
almost constant and exaggerated worry.
 No basis for worries but the person is tense, irritable
and tired.
 Free-floating anxiety--when one source of worry is
removed another quickly takes its place
 Physical symptoms: headaches, stomach aches,
muscle tension, irritability
 About 5% of the general population will experience
GAD.
 Often it is co-diagnosed with other mood disorders
such as depression.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Anxiety

Panic disorder
 Panic disorder (PD) is characterized by frequent
periods of anxiety and occasional attacks of panic.
 Panic attacks involve rapid breathing, increased heart
rate, chest pains, sweating, trembling and faintness.
 Panic attacks usually last just a few minutes, but can
be much longer.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Panic Attacks
My heart was pounding. It was intense. It felt
like I was having a heart attack, like a mad man
was on a rampage through my body.
Thoughts were racing through my mind -spinning, confusion, jumping. It was almost as if
lightning bolts were catapulting my thoughts,
twisting them without focus.
In less than a minute, I went from a peaceful,
restful state into an attack. Imaginary hands
were choking my throat. Cutting off air.
Smothering me. I thought I was dying.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Anxiety

Panic disorder
 1-3% of adults
 in many cultures.
 More women than men
 Hyperventilation, or rapid deep breathing, is a key
symptom.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Anxiety

Panic disorder
 Hyperventilation causes the body to react as if
suffocation were occurring.
 The person’s subjective interpretation of the symptoms
of hyperventilation can cause an increase in panic or a
calming down.
 People with panic disorder tend to interpret these
episodes as uncontrollable and life threatening.
 The constant anxiety they experience increases the
likelihood of further panic attacks. (cycle of panic)
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Causes of Panic Disorder



Biological -- genetics--tends to run in families
Psychological -- people with panic disorder seem to be unusually
sensitive to signs of physical arousal
Cognitive-behavioral Theory of Panic Disorder
 Sufferers tend to misinterpret the physical signs of arousal as
catastrophic and dangerous
 This interpretation leads to further physical arousal, tending toward a
vicious cycle
 After the attack the person becomes very apprehensive of another
attack, more aware of the signals, and more likely to have another
attack as a result
 Person become behaviorally conditioned

physical symptoms of arousal -> fear
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Anxiety

Panic disorder
 Treatments for panic disorder include:
 Psychotherapy
 Anti-depressant drugs
 Advice: “Don’t worry about panic attacks; they won’t
kill you.”
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Anxiety

Panic disorder
 Common co-existing disorders include:
 Social phobia – severe avoidance of other people
and fear of doing anything in public.
 Agoraphobia – an intense fear of open or public
places.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Anxiety

Phobias
 Avoidance behaviors are highly resistant to extinction.
 Phobia is the most common type disorder involving
avoidance behaviors.
 A phobia is strong and persistent fear of a specific object
or situation – so strong it interferes with daily living.
 May focus on
 Natural environment—heights, water, lightening
 Situation—flying, tunnels, crowds, social gathering
 Injury—needles, blood, dentist, doctor
 Animals or insects—insects, snakes, bats, dogs
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
It is not phobic to simply be anxious about something
Study of normal anxieties
100
Percentage 90
of people 80
surveyed 70
60
50
40
30
20
10
0
Snakes Being Mice Flying Being Spiders Thunder Being Dogs Driving Being Cats
in high,
on an closed in, and
a car
and alone
in
exposed
airplane in a
insectslightning in
a crowd
places
a house
small
of people
at night
place
Afraid of it
Bothers slightly
Not at all afraid of it
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Anxiety

Phobias
 The Prevalence of Phobias
 Not all extreme fears qualify as phobias.
 About 11% of U.S. adults suffer from a phobia at
some point in their lives.
 About 5-6% are experiencing a phobia at any given
time.
 Phobia usually does not persist across the lifetime –
many young adults lose them by middle age.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Figure 16.2 Most phobias do not last a lifetime. Young people with phobias often
lose them by middle age.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Some Unusual Phobias
Ailurophobia
—fear of cats
Algobphobia
—fear of pain
Anthropophobia
—fear of men
Monophobia
—fear of being alone
Pyrophobia
—fear of fire
Scolionophobia
-- Fear of school.
Testophobia
—fear of taking tests
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Avoidance

Phobias
 Acquiring a phobia:
 Some fears are innate but many are learned.
 Some phobias can be traced to a specific event.
 The early behaviorists were the first to demonstrate
how fears might be learned.
 This does not account for the fact that:
 some phobias are much more common and
easily acquired than others.
 Some phobias are towards objects that have
never injured
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Avoidance

Phobias
 The most common phobias include:
 Open spaces
 Closed spaces
 Heights
 Lightening and thunder
 Certain animals – (snakes, spiders, dogs)
 Illnesses/germs
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Can phobias be socially learned?
Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared
monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared
monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Figure 16.4 Interpretation -- to develop fear of snakes lab-reared monkey needs to see that the
other monkey was afraid and what caused the fear
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Avoidance

Phobias
 Behavior therapy for phobias
 Systematic desensitization – reduces fear by
gradually exposing people to the object under
controlled conditions. Virtual reality is now being
employed for this kind of therapy.
 Flooding or implosion – a sudden and large-scale
exposure to the object under controlled conditions.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Avoidance

Phobias
 Drug therapies for phobias and anxieties
 Benzodiazepines, a common type of tranquilizer, are
often prescribed for anxiety disorders.
 They suppress symptoms only temporarily and can
be addictive.
 Anti-depressants, which are not likely to be taken
habitually, are used more effectively.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Avoidance




Obsessions—irrational, disturbing thoughts that intrude
into consciousness
Compulsions—repetitive actions performed to alleviate
obsessions
Checking and cleaning most common compulsions
 Not done out of joy of being clean but to relieve
extreme anxiety if not done
Magical thinking -- e.g., “If I don’t get dressed according to a strict
pattern my husband will die”
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Disorders Characterized by Excessive Avoidance

Obsessive-compulsive disorder
 Therapies for obsessive-compulsive disorder:
 Exposure therapy is very similar to systematic
desensitization.
 The patient is exposed to the situation that brings on
the compulsive behavior, but is prevented from
engaging in it.
 The most common drug treatments for this disorder
utilize clomipramine and other serotonin reuptake
inhibiters.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Anxieties and Avoidance

Phobias and anxiety disorders involve the interaction and
influence of cognition and emotion upon each other.

People who suffer from these conditions are aware that
their reactions are exaggerated, but this awareness doesn’t
cure the problem.

These disorders are challenging but psychologists continue
to improve the efficacy of available treatments.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Module 16.3

Mood Disorders
A category of mental disorders in which significant and
chronic disruption in mood is the predominant symptom,
causing impaired cognitive, behavioral, and physical
functioning

Two common mood Disorders
 Major depression
 Bipolar disorder
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Major depression--A mood disorder characterized by
extreme and persistent feelings of despondency,
worthlessness and hopelessness
 Major depression is an extreme prolonged condition.
 Severe symptoms for at least 2 weeks (usually
persists for months).
 The person experiences little interest in anything,
little pleasure, and little motivation to be
productive.
 Global negativity and pessimism
 Very low self-esteem
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Major depression
 Loss of interest in food and sex are common.
 The person has feelings of worthlessness, guilt and
powerlessness over their lives.
 Sleep abnormalities are associated with depression
(there is a characteristic rapid onset of REM sleep).
 The person may attempt suicide.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Symptoms of Depression
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Figure 16.9 When most people go to sleep at their usual time, they progress slowly to
stage 4 and then back through stages 3 and 2, reaching REM sleep toward the end of
their first 90-minute cycle. Depressed people, however, reach REM more rapidly,
generally in less than 45 minutes. They also tend to awaken frequently during the
night.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments

Mood Disorders
Depression
 Seasonal affective disorder (SAD)
 Cyclic severe depression and elevated mood
 Seasonal regularity -- onset with changing seasons
 most common in areas that have little sunlight in
winter
 Unique cluster of symptoms
 intense hunger
 gain weight in winter
 sleep more than usual
 depressed more in evening than morning
 It can be relieved by light therapy, which requires the
depressed person to sit in front of a bright light for a few
hours each day.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Genetic predisposition to depression
 Having close biological relatives who were diagnosed
with depression increases one’s probability of
becoming depressed.
 Having adoptive relatives who were depressed also
increases that probability, but not as much.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Sex differences in depression
 Before adolescence, depression is about equally
common in boys and girls.
 From adolescence onward, women are about twice
as likely to experience depression as men.
 Why?




estrogen cycle has been linked to mood changes
puberty brings on low self-esteem related to body image -- may
lead to prolonged feelings of dissatisfaction resulting in
depression
explanatory style -- girls tend to look within to explain failures
and problems
micro-aggressions from society that convey girls as less
important and competent may lead to feelings of worthlessness
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Events that precipitate depression
 Exposure to recent stressful events is one of the best
predictors of major depression




spouse or companion
long-term job
health
income
There is little relationship between the scale of the
event and the intensity and duration of the
subsequent depression.
 Severe losses early in life may make people more
vulnerable to depression later on in life.

Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Events that precipitate depression
 Lack of social support also increases vulnerability to
depression.
 Person’s interpretation of the event’s significance
influences degree of depression.
 The way people think about their lives, as well as the
course of the events, is a factor to consider.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Cognitive aspects of depression
 Every person has an explanatory style in accounting
for successes and failures.
 Internal attributions cite causes within the person.
 External attributions identify causes outside the
person.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Cognitive aspects of depression
 more consistent in attributions for their failures.
 pessimistic explanatory style--blame themselves for
all failures, regardless of the circumstances,
 negative experiences are due to stable, global
reasons
e.g., “I didn’t get the job because I’m stupid
and inept” vs. “I didn’t get the job because the
interview didn’t go well”

“Depressed people believe that every silver lining has a
cloud.”
-- Kalat
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Treatments for depression
 Cognitive therapy helps the individual develop more
positive beliefs.
 Drug therapies use anti-depressant medications
including the tricyclics, selective serotonin
reuptake inhibitors, monoamine oxidase
inhibitors, and atypical antidepressants.
 St. John’s Wort is a naturally occurring herb that has
antidepressant effects. It should not be used with
other medications.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Figure 16.13 Antidepressant drugs prolong the activity of the neurotransmitters
dopamine, norepinephrine, and serotonin. (a) Ordinarily, after the release of one of the
neurotransmitters, some of the molecules are reabsorbed by the terminal button, and
other molecules are broken down by the enzyme monoamine oxidase (MAO). (b)
Selective serotonin reuptake inhibitors (SSRIs) prevent reabsorption of serotonin.
Tricyclic drugs prevent reabsorption of dopamine, norepinephrine, and serotonin. (c)
MAO inhibitors (MAOIs) block the enzyme monoamine oxidase and thereby prolong
the effects of the neurotransmitters.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Treatments for depression
 Electroconvulsive shock therapy (ECT) is a wellknown but controversial treatment.
 A brief electrical shock is administered to the patient’s
head.
 It induces a convulsion similar to an epileptic seizure.
 How it works is not fully understood.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Depression
 Treatments for depression
 It is an effective treatment, although the benefits are
temporary. Other treatments must be offered also.
 ECT fell out of favor because it was widely abused
(administered without patient consent, given too
often, used as a threat).
 It is now used only for patients who have treatmentresistant depressions or who are strongly suicidal.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders



Bipolar disorder
 Cyclic disorder (manic-depressive disorder)
Mood levels swing from severe depression to extreme
euphoria (mania)
Must have at least one manic episode
 extreme euphoria, excitement,
 physical energy,
 Supreme self-confidence
 Grandiose ideas and movements
 Flight of ideas(rapid thoughts and speech)
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Bipolar Disorder
 Bipolar Disorder: types
 Psychologists diagnose two types of bipolar disorder.
 Bipolar I disorder involves the experience of at least
one episode of mania.
 Bipolar II disorder involves alternation between
major depression and hypomania, which is a milder
form of mania.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
prevalence and course of bipolar disorder




Onset -- typically in person’s early twenties.
Differences with depression
 tends to start and stop more abruptly than major depression.
 tends to be shorter -- a few days to a couple months
Affects about 2 million Americans annually.
 no gender differences --for both men and women, the lifetime risk is
about 1 percent.
in majority of cases, a recurring mental disorder;
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Bipolar disorder
 Drug therapies for bipolar disorder
 Lithium is a naturally occurring chemical that is used
to treat mania.
 How lithium relieves mania is not well understood.
Often recurs when the individual stops taking lithium.
Lithium is toxic at high doses, so a patient who takes
it must be carefully monitored.
 Valproate and anticonvulsant drugs are also used
to treat bipolar disorders.

Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Suicide
 Mood disorders and suicide
 People who suffer from depression and bipolar
disorders consider suicide. Some make attempts.
 It is hard to know the true rate of suicide because
some suicides are disguised to look like accidents.
 Suicide rates vary as a function of gender, culture and
age
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Figure 16.15 Suicide rates differ as a function of age, gender, and culture. The rates shown
here are for 1988; the rate has dropped since then for Hungary, presumably because of
economic and social changes within the country. (Based on data of Lester, 1996)
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Table 16.5 People most
likely to attempt suicide
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Mood Disorders

Suicide
 Mood disorders and suicide
 If someone you know is thinking of suicide, try to treat
the person as you would any other person who is in
distress.
 Offer support and friendship, and don’t be afraid to
ask him or her to talk about feelings.
 Encourage the person to seek professional help if you
sense that they are open to the suggestion.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Module 16.4

Schizophrenia
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
What is Schizophrenia?

Comes from Greek meaning “split” and “mind”




‘split’ refers to loss of touch with reality
not dissociative state
not ‘split personality’
Equally split between genders, males have
earlier onset


18 to 25 for men
26 to 45 for women
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Symptoms of Schizophrenia

Positive symptoms



Negative symptoms


hallucinations
delusions
absence of normal cognition or affect (e.g., flat affect, poverty of
speech)
Disorganized symptoms


disorganized speech (e.g., word salad)
disorganized behaviors
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Symptoms of Schizophrenia

Delusions of persecution



Delusions of grandeur



‘they’re out to get me’
paranoia
“God” complex
megalomania
Delusions of being controlled

the CIA is controlling my brain with a radio signal
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Symptoms of Schizophrenia

Hallucinations




hearing or seeing things that aren’t there
contributes to delusions
command hallucinations: voices giving orders
Disorganized speech


Over-inclusion—jumping from idea to idea without the benefit of
logical association
Paralogic—on the surface, seems logical, but seriously flawed
 e.g., Jesus was a man with a beard, I am a man with a beard,
therefore I am Jesus
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Symptoms of Schizophrenia

Disorganized behavior and affect



behavior is inappropriate for the situation
 e.g., wearing sweaters and overcoats on hot days
affect is inappropriately expressed
 flat affect—no emotion at all in face or speech
 inappropriate affect—laughing at very serious
things,
crying at funny things
catatonic behavior
 unresponsiveness to environment, usually marked
by
immobility for extended periods
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Frequency of positive and negative symptoms in individuals at the time they were
hospitalized for schizophrenia. Source: Based on data reported in Andreasen &
Flaum, 1991.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Subtypes of Schizophrenia

Paranoid type




delusions of persecution
 believes others are spying and plotting
delusions of grandeur
 believes others are jealous, inferior, subservient
Catatonic type—unresponsive to surroundings,
purposeless movement, parrot-like speech
Disorganized type


delusions and hallucinations with little meaning
disorganized speech, behavior, and flat affect
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Schizophrenia and Genetics
Risk increases with genetic similarity
50
40
40
Lifetime risk
of developing
schizophrenia
for relatives of
a schizophrenic
30
30
20
20
10
10
0
0
Fraternal Children
Identical
of two
twin
General
Siblings
twin
Children
schizophrenia
population
victims
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
The Dopamine Theory




Drugs that reduce dopamine reduce symptoms
Drugs that increase dopamine produce symptoms even
in people without the disorder
Theory: Schizophrenia is caused by excess dopamine
Dopamine theory not enough; other neurotransmitters
involved as well
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Biological Bases of Schizophrenia

Other congenital influences



difficult birth (e.g., oxygen deprivation)
prenatal viral infection
Brain chemistry


neurotransmitter excesses or deficits
dopamine theory
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Other Biological Factors

Brain structure and function



Early warning signs



enlarged cerebral ventricles and reduced neural tissue around
the ventricles
PET scans show reduced frontal lobe activity
nothing very reliable has been found yet
certain attention deficits can be found in children who are at risk
for the disorder
Father’s age—older men are at higher risk for fathering
a child with schizophrenia
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Family Influences on Schizophrenia
Family variables


parental communication that is disorganized,
hard-to-follow, or highly emotional
expressed emotion
• highly critical, over-enmeshed families
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Cultural Differences in Schizophrenia


Prevalence of symptoms is similar no matter what the
culture
Less industrialized countries have better rates of
recovery than industrialized countries



families tend to be less critical of the patients
less use of antipsychotic medications, which may impair full
recovery
think of it as transient, rather than chronic and lasting disorder
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Summary of Schizophrenia

Many biological factors seem involved





heredity
neurotransmitters
brain structure abnormalities
Family and cultural factors also important
Combined model of schizophrenia


biological predisposition combined with psychosocial stressors
leads to disorder
Is schizophrenia the maladaptive coping behavior of a
biologically vulnerable person?
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Module 16.2

Substance-Related Disorders
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Dependence or addiction refers to an inability to quit using
a self-destructive substance.

Addiction varies in degree, and different people react in
various ways.


E.g., range of how it affects their daily functioning.
Any substance can be addictive, however, some are more
likely than others to be addictive.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)



Dependence (Psychological) vs. Addiction (Physical)
There are two symptoms involved in the development of a
drug addiction.
 Tolerance – decreased effects of a given dose.
 Withdrawal – unpleasant sensations when the drug is
not used (or too little is used).
Dependence vs. Addiction: a difficult distinction
 Not just based on the substance being used
 Activities and substances that are not drugs can
produce addictions – suggesting that addiction is a
function of the person, not the drug alone.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
What Makes a Substance Addictive?



Substances tend to be
addictive to the degree
that they enter the brain
rapidly.
Nearly all addictive drugs
stimulate the dopamine
receptors in the nucleus
accumbens.
Activation of these
synapses causes
increased attention
accompanied by feelings
of great pleasure.
Nucleus accumbens - the key structure of
the brain responsible for reward, motivation
and addiction. Dependent drugs such as
cocaine and nicotine trigger the release of
dopamine from its shell.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Which Came First?



Probably not useful to imagine that something becomes
addictive because it stimulates the nucleus accumbens.
It could also be that nucleus accumbens becomes
stimulated when something becomes addictive
Other things that stimulate nucleus accumbens when they
become strong habits include:
 Gambling
 Video games
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Is substance dependence a disease?
 Controversial issue -- depends in part on how we define
“disease.” (medical profession doesn’t have precise
definition)



Arguments for:
 Removes stigma and judgement
Arguments against
 people lie along a continuum from mildly to severely
addicted.
 there isn’t one course of development and deterioration,
 curing addiction does not seem to require medical
intervention. (In fact, research suggests that family therapy
is the most effective treatment).
Psychologists currently favor use of continuum from
“no addiction” to “severe addiction.”
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Nicotine
 Serious addiction or psychological dependence?
 Myth: Because it is legal people often have the
perception that people that nicotine addiction is mild or
“psychological”
 Reality nicotine is one of the most difficult drugs to quit
using



smoking kills more people than all the other drugs combined
(and then some.)
People find it almost impossible to quit smoking without a
replacement source of nicotine (patches or gum, for example.)
Low tar cigarettes are ineffective for use in this effort because
smokers find ways to use them that result in the same
consumption of nicotine, tar and the other deadly substances
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Figure 16.7 “Low-nicotine” cigarettes have a row of small holes in the filter; room air is
supposed to enter through those holes when the smoker inhales and therefore dilute the
tobacco smoke. If people smoke such cigarettes without covering the air holes, little tar
and nicotine pass through the cigarette, as we see from the relatively clean filter tip.
However, if people cover the holes with their fingers or tape, they will
receive about as much tar and nicotine as they would from any other filtered cigarette.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Alcoholism
 Alcoholism is defined as the habitual overuse of alcohol.
 Treatment of chronic alcoholism is very difficult.
 Earlier detection promotes more effective treatment.
 To detect earlier we need better understanding of risk
factors.
 Genetic and family background is one factor
 But it’s role is different depending on type of
alcoholism
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Alcoholism
 Type I (A) alcoholism develops gradually over the
lifespan.
 It is equally prevalent in men and women.
 It is generally less severe in its health consequences.
 Appears to be more environmentally influenced
 Type II (B) alcoholism has an early onset (teens to
early 20s)
 It is much more prevalent in men and more severe.
 more common in families in which there is conflict
between parents, or between parents and children
 Genetic influence seem to play larger role
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Alcoholism: Risk factors
 Research studies indicate that tendency to
addiction is influenced by genetics.
 Type II alcoholism shows a strong genetic
basis.
 Some people with no family history of
alcoholism develop an alcohol problem.
 Exposure to parental conflict, inadequate
supervision, and abuse can increase the
likelihood of alcoholism emerging later in life.
 Culture also has an influence – prevalence
rates vary in different nations and ethnic
groups.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Treatment for alcoholism
 Very difficult to quit--only 10-20% who try on their own
are successful, and relapses are very common.
 Many recovering addicts seek help from mental-health
professionals or self-help groups.
 Such help improves the chances of successful
recovery, but offers no guarantees.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Treatments for alcoholism
 Antabuse is the trade name for disulfiram.
 Alcoholics who take Antabuse daily become very sick
when they drink alcohol.
 This treatment is only moderately effective.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Treatments for alcoholism
 Detoxification is a program of supervised recovery
provided in a hospital setting.
 period in order to remove the alcohol (or whatever
substance was being used) from their bodies.
 Outpatient mental-health treatment has about the same
rate of success as detoxification.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Treatments for alcoholism
 Controlled drinking refers to reducing consumption of
alcohol from dependent/abusive to moderate levels.
 Some psychologists contend that total abstinence is
not the best approach for all alcoholics and believe
this is a viable alternative.

Harm reduction is a similar approach applied to drug
abuse.

These methods are highly controversial
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Treatments for alcoholism
 The most widespread treatment for alcoholism is offered
by Alcoholic Anonymous (AA).
 AA is a self-help group comprised of people who abstain
from alcohol use and offer help and support to each
other.
 The group has a strong spiritual focus, but is not
affiliated with any particular religion.
Introduction to Psychology, 7th Edition, James W. Kalat
Chapter 16: Specific Disorders and Treatments
Substance Dependence (Addiction)

Opiate dependence (e.g., Morphine, Heroin)
 A very difficult withdrawal syndrome complicates
recovery from dependence on opiate drugs (i.e. heroin,
morphine).
 Some opiate addicts go “cold turkey” in order to stop
using.
 Recovery programs commonly offer methadone as a
less dangerous replacement for opiates.
 This is a harm reduction strategy
 reduces craving without serious disruption of
behavior--allows recovering opiate addicts to
remain employed and avoid criminal behavior.
 But can also become addictive