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DSM-IV-TR The Diagnostic and Statistical Manual IV-Text
Revision was revised in 2000 with updated research. Since
then, the lengthy process of assembling DSM-V has begun.
It is a collaborative effort involving several mental health
organizations, including the American Psychiatric
Association and the World Health Organization. One key
goal of DSM-V is to incorporate the multidisciplinary
Research advances in mental health that have occurred
worldwide in recent years. DSM-V is scheduled to be
published in 2012 (Fink & Taylor, 2008).
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Hollywood Versus Reality In The Dark Knight, the Joker takes the image of the insane killer to new heights.
As a plot device, the deranged, evil killer on the loose is standard fare in television dramas like CSI and film
thrillers like the Halloween and the Friday the 13th movies. Such media depictions foster the stereotype that
people with a mental illness are evil, threatening, and prone to violence—an image that is not supported by
psychological research.
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Figure 14.2 NCS-R Prevalence and Severity of Mental Disorders Shown here are the most commonly
reported mental disorders in the National Comorbidity Survey Replication (NCS-R). The 12-month
prevalence is indicated by the percentage below each category. The color bars indicate the severity of
symptoms reported in each category. Although anxiety disorders were most prevalent (18%), many
respondents reported experiencing mild symptoms (green bar). But of the 10% of the respondents who
reported symptoms of a mood disorder, almost half indicated experiencing serious symptoms (red bar).
Source: Kessler & others, 2005b, 2005c.
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How Prevalent Are Psychological Disorders? Psychological disorders are far more common than most
people think. According to the findings of the National Comorbidity Survey Replication (NCS-R), every year
about one in four American adults experiences the symptoms of some type of psychological disorder. However,
most people who experience such symptoms do not receive treatment (Wang &others, 2005).
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Copyright © 2010 by Worth Publishers
Panic Attack! The rapidly escalating physical arousal of a panic attack results in a constellation of frightening
symptoms: pounding heart, breathlessness, sweating, trembling, and choking sensations. In panic disorder,
panic attacks are frequent and unpredictable, often seeming to happen for no apparent reason. How do
psychologists explain the development of panic disorder?
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Copyright © 2010 by Worth Publishers
Social Phobia About one out of eight adults in the United States have experienced social phobia at some
point in their lives (Kessler& others, 2005a). Social phobia is far more debilitating than everyday shyness.
People with social phobia are intensely fearful of being watched or judged by others. Even ordinary activities,
such as eating with friends in a shopping mall food court, can cause unbearable anxiety.
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A Half-Century of Psychological Pain The symptoms of posttraumatic stress disorder can apparently last a
lifetime. More than 60 years after the close of World War II, thousands of veterans, now in their eighties, still
suffer from nightmares, anxiety, and other PTSD symptoms (Lee & others,1995). Some experts estimate that
as many as 200,000 World War II veterans may continue to suffer from the symptoms of post-traumatic
stress disorder.
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The Ravages of War: Child Soldiers An estimated quarter-million children serve as unwilling combatants in
wars today, most of them kidnapped from their families and forced to serve as soldiers. Child soldiers not only
suffer torture and violence, they are also often forced to commit atrocities against others. Not surprisingly,
These children suffer from a very high rate of posttraumatic stress disorder (Bayer &others, 2007; Kohrt &
others, 2008). One survey of former child soldiers in refugee camps in Uganda found that 97 percent of the
children suffered from PTSD symptoms (see Dawson, 2007; Derluyn & others, 2004). Rehabilitation centers
have been established throughout Uganda and the Democratic Republic of Congo, where many of these
children live, but more assistance is desperately needed (Ursano & Shaw, 2007).
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Copyright © 2010 by Worth Publishers
Copyright © 2010 by Worth Publishers
Figure 14.3 The Symptoms of Major Depression The experience of major depression can
permeate every aspect of life. This figure shows some of the most common emotional, behavioral,
cognitive, and physical symptoms of that disorder.
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Major Depression and . . . Kurt Cobain As leader of the alternative rock band Nirvana, Kurt Cobain
seemed to have everything: fame, artistic recognition, wealth, and adulation from both fans and music
critics. But Cobain also had a history of troubling episodes of deep depression and had attempted suicide
several times. Like other people gripped by depression, Cobain focused on the negative during his dark
episodes. This negative outlook was sometimes reflected in his lyrics. Just before the release of In Utero,
the group’s last album, Cobain pulled a song he had written titled “I Hate Myself and I Want to Die.” Not long
after the release of that album, Cobain committed suicide by shooting himself in the head with a shotgun. In
his suicide note, Cobain described himself as a “miserable, self-destructive death rocker.”
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Major Depression and . . . Sheryl Crow Grammy
award-winning singer Sheryl Crow has struggled with
depression since she was a young child. Of her chronic
depression, she has said “I grew up in the presence of
melancholy, a feeling of loss… It is a shadow for me.
It's part of who I am. It is constantly there. I just know
how, at this point, to sort of manage it.”
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Brain Activity During the Extremes of
Bipolar Disorder These PET scans record the brain
activity of an individual with bipolar disorder as he
cycled rapidly from depression to mania and back to
depression over a 10-day period. In the top and bottom
PET scans, the blue and green colors clearly show
the sharp reduction in overall brain activity that
coincided with the episodes of depression. In the
Center PET scans, the bright red, orange, and yellow
colors indicate high levels of activity in diverse brain
regions during the intervening episodes of mania.
Source: Lewis Baxter and Michael E. Phelps,
UCLA School of Medicine.
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Carrie Fisher and Bipolar Disorder
Best known for her role as Princess Leia
in the Star Wars movie trilogy, Carrie
Fisher was first diagnosed with bipolar
disorder when she was 24 years old.
She struggled with drug addiction for
several years before finally accepting
her diagnosis. “Maybe I was taking drugs
to keep the monster in the box,” Fisher
(2001) speculates, referring to her bouts
of uncontrollable mania. Today, Fisher
takes lithium and other medications to
maintain an even keel but still sometimes
feels tempted to forgo her medications
to “ride the white lightning again.” A
successful actress in the 1980s, Fisher
today focuses on her writing. She has
written novels and screenplays, and she
works behind the scenes as a Hollywood
script doctor. Other famous people with
bipolar disorder include media mogul
Ted Turner, actress Patty Duke, and rock
musicians Peter Gabriel and Axl Rose.
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Creativity and Mood Disorders Mood Disorders
occur more frequently among creative writers and
artists than among the general population, leading
Some researchers to propose a biochemical or
genetic link between mood disorders and the
artistic temperament (Jamison, 1993).Writer
Mark Twain, novelist Ernest Hemingway, and
poet Sylvia Plath all suffered from severe bouts
of depression throughout their lives. Both Plath
and Hemingway committed suicide, as did
Hemingway’s father, brother, and sister.
In 1996, Hemingway’s granddaughter, actress
Margaux Hemingway, also committed suicide
Just one day before the 35th anniversary
Of her famous grandfather’s death.
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Smoking Rates Compared to the Number of Lifetime Mental Disorder Diagnoses
Source: Lasser & others (2000).
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Nicotine’s Effects in the Brain After cigarette smokers were injected with up to two milligrams of
nicotine, researchers used functional magnetic resonance imaging to track the brain areas activated,
which included the nucleus accumbens, the amygdala, and the thalamus. Previous research has shown
That these brain structures produce the reinforcing, mood-elevating properties of other abused drugs,
including cocaine, amphetamines, and opiates (Stein & others, 1998).
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Copyright © 2010 by Worth Publishers
An Ordinary Family Man: The Dangers of Antisocial
Personality Disorder President of his church council,
and a very active church member, Dennis Rader had
been a Scout leader and worked for the Wichita,
Kansas, animal control department. Married for 34
years, Rader had been very involved in the lives of
his two children. But Rader was also the sadistic killer
Who called himself “BTK,” which stood for “Bind,
torture, kill.” In court, Rader shocked even seasoned
police officers with his matter-of-fact, emotionless
recital of the details of his ten murders. Like Rader,
people with antisocial personality disorder wear a
“mask of sanity” (Lynam & Gudonis,2005). Because
they are socially skilled, their crimes often escape
detection. Because they lack empathy, they see
other people only as objects for their gratification.
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Dissociation and Possession A Candomble priestess in Brazil holds a woman who is “possessed” by a
Christian saint during a religious ceremony. Such dissociative trance and possession states are common in
religions around the world (Krippner, 1994).When dissociative experiences take place within a religious ritual
context, they are not considered abnormal. In fact, such experiences may be highly valued (Mulhern,1991). One
study of Brazilian mediums from Candomble or related Christian “spiritistic” religions found that their dissociative
experiences were not associated with mental disorders, childhood abuse, or psychological problems
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(Moreira-Almeida,2008).
“Tell me more about these nine separate and distinct personalities.”
© John Caldwell
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Copyright © 2010 by Worth Publishers
Glimpses of Schizophrenia This drawing was made
by a young man hospitalized for schizophrenia. He
drew the picture while he was hallucinating and
extremely paranoid. The drawing provides glimpses
of the distorted perceptions and thoughts that are
characteristic of a schizophrenic episode. Notice
the smaller face that is superimposed on the larger
face, which might represent the hallucinated voices
that are often heard in schizophrenic episodes.
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The Hallucinating Brain
Researcher David Silbersweig and his colleagues (1995) used PET scans to take a “snapshot” of brain activity
during schizophrenic hallucinations. The scan shown here was recorded at the exact instant a schizophrenic
patient hallucinated disembodied heads yelling orders at him. The bright orange areas reveal activity in the left
Auditory and visual areas of his brain, but not in the frontal lobe, which normally is involved in organized
thought processes.
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Figure 14.4 Incidence of Different Types of Hallucinations in Schizophrenia Schizophrenia-related
hallucinations can occur in any sensory modality. Auditory hallucinations, usually in the form of voices, are
the most common type of hallucinations that occur in schizophrenia, followed by visual hallucinations.
Source: Adapted from data in Mueser &others (1990) and Bracha & others (1989).
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Figure 14.5 Presence of Symptoms in Schizophrenia This graph shows how often specific positive and
negative symptoms were present in a study of over 100 individuals at the time they were hospitalized for
schizophrenia. Delusions were the most common positive symptom, and a volition, or apathy, was the most
common negative symptom.
Source: Based on data reported in Andreasen & Flaum (1991).
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Copyright © 2010 by Worth Publishers
Figure 14.6 The Risk of Developing Schizophrenia Among Blood Relatives The risk percentages shown
here reflect the collective results of about 40 studies investigating the likelihood of developing schizophrenia
among blood relatives. As you can see, the greatest risk occurs if you have an identical twin who has
schizophrenia (48 percent lifetime risk) or if both of your biological parents have schizophrenia (46 percent
lifetime risk). However, environmental factors, as well as genetic ones, are involved in the development of
schizophrenia.
Source: Gottesman (1991), p. 96.
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Identical Twins but Not Identical Brains David and Steven Elmore are identical twins, but they differ in one
Important respect—Steven (right) has schizophrenia. Behind each is a CAT scan, which reveals that Steven’s
brain is slightly smaller, with less area devoted to the cortex at the top of the brain. Steven also has larger
fluid-filled ventricles, which are circled in red on his brain scan. As researcher Daniel Weinberger (1995)
commented, “The part of the cortex that Steven is missing serves as perhaps the most evolved part of the human
brain. It performs complicated tasks such as thinking organized thoughts. This might help explain why paranoid
Delusions and hallucinations are characteristic of schizophrenia.”
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Copyright © 2010 by Worth Publishers
Figure14.7 The Finnish Adoptive Family Study of Schizophrenia In the Finnish Adoptive Family Study,
psychiatrist Pekka Tienari and his colleagues (1994, 2006) tracked the mental health of two groups of adopted
individuals: one group with biological mothers who had schizophrenia and a control group whose biological
mothers did not have schizophrenia. This graph shows the strong influence of the adoptive family environment
on the development of serious mental disorders.
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How to Help a Friend The majority of those who attempt suicide communicate their intentions to friends or
family members (Shneidman, 1998). When a friend is despondent and desperate, you can help by listening,
expressing your understanding and compassion, and, if necessary, referring him or her to a professional
counselor or suicide prevention specialist. Copyright © 2010 by Worth Publishers