Download Psychological Disorders

XII. Abnormal Behavior (7–9%)
Myers book- Chapter 15
In this portion of the course, students examine the nature of common challenges to adaptive functioning. This section
emphasizes formal conventions that guide psychologists’ judgments about diagnosis and problem severity.
AP students in psychology should be able to do the following:
• Describe contemporary and historical conceptions of what constitutes psychological disorders.
• Recognize the use of the Diagnostic and Statistical Manual of Mental Disorders
(DSM) published by the American Psychiatric Association as the primary reference for making diagnostic judgments.
• Discuss the major diagnostic categories, including anxiety and somatoform disorders, mood disorders, schizophrenia,
organic disturbance, personality disorders, and dissociative disorders, and their corresponding symptoms.
• Evaluate the strengths and limitations of various approaches to explaining psychological disorders: medical model,
psychoanalytic, humanistic, cognitive, biological, and sociocultural.
• Identify the positive and negative consequences of diagnostic labels (e.g., the Rosenhan study).
• Discuss the intersection between psychology and the legal system (e.g., confidentiality, insanity defense).
XIII. Treatment of Abnormal Behavior (5–7%)
This section of the course provides students with an understanding of empirically based treatments of psychological
disorders. The topic emphasizes descriptions of treatment modalities based on various orientations in psychology.
AP students in psychology should be able to do the following:
• Describe the central characteristics of psychotherapeutic intervention.
• Describe major treatment orientations used in therapy (e.g., behavioral, cognitive, humanistic) and how those
orientations influence therapeutic planning.
• Compare and contrast different treatment formats (e.g., individual, group).
• Summarize effectiveness of specific treatments used to address specific problems.
• Discuss how cultural and ethnic context influence choice and success of treatment (e.g., factors that lead to premature
termination of treatment).
• Describe prevention strategies that build resilience and promote competence.
• Identify major figures in psychological treatment (e.g., Aaron Beck, Albert Ellis,
Sigmund Freud, Mary Cover Jones, Carl Rogers, B. F. Skinner, Joseph Wolpe).
Lesson 1: Psychological Disorders: Historical Perspectives, Classification
Systems and Models
I.
There is no one absolute definition of psychological disorders; moreover, a continuum exists
between mental health on the one hand and pathology on the other. Some proposed definitions include:
A.
A psychological disorder can be defined as a pattern of behavioral or psychological symptoms
that causes significant personal distress and impairs the ability to function in one or more important
areas of life, or both. (American Psychiatric Association, 1994)
B.
A psychological disorder may exist when behavior is atypical, disturbing, maladaptive and
unjustifiable. (Myers, 1998)
C.
A psychological abnormality involves the presence of at least two of the following: distress,
maladaptiveness, irrationality, unpredictability, unconventional and statistical rarity, and observer
discomfort.
D.
Sanity and insanity are legal rather than psychological terms. In most states the legal definition
of insanity relates to the ability of the defendant to distinguish right from wrong. This requires an
either/or determination on the part of the court.
II.
Historical perspectives on abnormal behavior
A.
The ancient world
1.
Greece
a)
Hippocrates (460-377 BC) believed mental illness was the result of natural, as
opposed to supernatural, causes
b)
Galen (130-200 AD) divided the causes of mental disorders into physical and
psychological explanations.
2.
In China in 200 AD, Chung Ching stated that both organ pathologies and stressful
psychological situations were causes of mental disorders.
B.
The Middle Ages (500-1500 AD)
1.
In Europe, abnormal behavior was most frequently viewed as demonic possession.
Treatment performed by the clergy involved prayer, laying on of hands, and exorcism.
2.
Islamic countries
a)
Humane mental hospitals (for example, in Baghdad in 792 AD) were established .
b)
The Persian physician Ibn Sina (Avicenna, 980-1037) wrote The Canon of
Medicine, perhaps the most widely studied medical work ever written. The principles he
set-out for testing the effectiveness of new drugs and medications still form the basis of
modern clinical drug trials.
C.
The Renaissance led to the re-emergence of the scientific approach in Europe.
1.
The Spanish nun Teresa of Avila (1515-1582) established the conceptual framework that
the mind can be sick.
2.
Both Johann Weyer (1515-1588) of Germany and Reginald Scot (1538-1599) of England
used scientific skepticism to refute the concept of demonic possession.
D.
Humanitarian reforms of the 18th and 19th century
1.
In France, Philippe Pinel (1745-1826) pioneered a compassionate medical model for the
treatment of the mentally ill and established a humane hospital in Paris.
2.
In England, William Tuke (1732-1822) introduced trained nurses for the mentally ill and
helped to change public attitudes regarding their treatment.
3.
In the United States, Benjamin Rush (1745-1813), the founder of American psychiatry,
encouraged humane treatment of the mentally ill and the establishment of hospitals for their care.
E.
Scientific advances of the 20th century
1.
Developments in technology such as MRI and PET scans have added to our knowledge
of the biological bases of psychological disorders.
2.
Developments in psychopharmacology have provided effective treatments for many
psychological disorders.
III.
Models (or perspectives) of psychological disorders
Models of Psychological Disorders
Biopsychological Model
Psychoanalytic Model
Behavioral Model
Cognitive Model
Definition
Type of T
Biopsychosocial Model
IV.
The Diagnostic and Statistical Manual of Mental Disorders, 4th edition
A.
Published by the American Psychiatric Association, the DSM-IV, as it is known, is a widely used
diagnostic classification system. It provides a set of criteria which allows diagnosticians to make
assessments.
B.
The diagnostic system is based on five axes that are used by clinicians to provide a complete
diagnosis.
1.
2.
An example of how a therapist might
make a complete DSM multiaxial diagnosis is:
a)
Axis 1: alcohol dependence
b)
Axis 2: dependent personality
disorder
c)
d)
Axis 3: diabetes
Axis 4: death of spouse; unemployment
e)
GAF = 60 (moderate symptoms, e.g., occasional panic attacks or moderate
difficulty in social, occupational, or school functioning)
C.
Criticisms of classification
1.
The system relies heavily on the medical perspective.
2.
Reliability in diagnosis remains a problem; psychological disorders have "fuzzy borders."
Different disorders share certain characteristics, for example, and a person might exhibit some,
but not all, characteristics of a particular disorder.
3.
Controversy exists regarding the existence of some disorders, such as dissociative
identity disorder and premenstrual syndrome.
Lesson 3: Dissociative and Personality Disorders
I. Dissociative disorders are
A. Specific dissociative disorders
1. Dissociative amnesia involves partial or total loss
2. Dissociative fugue occurs when the individual suffers
3. Depersonalization disorder is the most common dissociative disorder and is characterized by
4. Dissociative identity disorder (formerly called multiple personality disorder) is a rare, dramatic,
and controversial disorder characterized by
B. Explaining dissociative disorders. Amnesia and fugue are usually attributed to
1. Dissociation is a relatively common response to traumatic experience. People report feeling
detached from their surroundings and their own bodies. Most are rooted in severe emotional
trauma that occurred during childhood like because of a disturbed home, sexual abuse and
beatings).
2.
In those persons with dissociative disorders the dissociative experiences are more extreme
and frequent, and the symptoms severely disrupt everyday functioning.
3. The learning perspective views dissociation as rewarding and thus highly reinforcing.
4. Some psychologists suggest that dissociative identity disorder is a diagnostic fad. Some
think that DID is the result of modern North American culture (Sybil affected the # of
personality disorder people)
II. Personality disorders (these make up a separate axis of the DSM-IV)
A. In general, personality disorders are
1. Characterized by long-standing chronic, inflexible, maladaptive patterns of
2. Usually recognizable by the time the person reaches adolescence.
3. As a group, among the least reliably judged and are questioned as to their existence
independent of the social and cultural factors in which they develop.
B. Examples of specific personality disorders
1. Narcissistic personality disorder is marked by a grandiose
2. Antisocial personality disorder is marked by a long-standing pattern of irresponsible behavior
that hurts others without causing feelings of guilt for oneself. The individual often does not
C. Explaining antisocial personality disorders
1. The biological perspective suggests that a genetic vulnerability (related to little or low level
autonomic system arousal) may contribute to the antisocial personality disorder. This is
correlated with a fearless approach to life.
2. The biopsychosocial perspective suggests that, in the case of antisocial personality disorder,
if fearlessness is channeled in productive directions, heroism or adventurism may result.
Lacking a sense of social responsibility, the same disposition produces, for example, a con
artist or killer.
3. Some studies have detected early signs of antisocial behavior in children as young as 3 to 6
years old.
Lesson 4: Mood (Affective) Disorders
I.
Mood disorders in general
A.
This category of mental disorders has significant and chronic disruption in mood as the
predominant symptom. This causes impaired cognitive, behavioral, and physical functioning.
B.
Mood disorders are differentiated from normal moods on the basis of
C.
Prevalence of mood disorders
1.
Mood disorders are among the most common of all psychological disorders, affecting
about 12 million Americans in any given year.
2.
Mood disorders are more common in women than in men.
3.
The greatest risk of developing major depression occurs between the ages of 15- 24 and
35-44.
4.
Episodes recur in one half of all cases and last at least two weeks.
II.
Major depression aka Major Depressive Disorder- persistent feelings of
III.
Other depressed mood disorders
A.
Dysthymic disorder involves chronic, low-grade feelings of
B.
IV.
Seasonal affective disorder (SAD) involves
Bipolar disorder is characterized by alternating episodes of
A.
B.
V.
Cyclothymic disorder, a milder, but chronic form of bipolar disorder,
Explaining affective disorders
A.
The biopsychological perspective
1.
Family, twin, and adoption studies indicate that some people inherit a genetic
predisposition for mood disorders. Concordance rate in identical twins higher (65%-68%)
compare to 15% for fraternal twins. Recent studies show that this genetic role may be higher in
females.
2.
Indirect evidence indicates that two neurotransmitters, seratonin and norepinephrine, are
implicated in major depression.
3.
Symptoms of major depression are alleviated in about 80% of people for whom
antidepressant medication is prescribed. These medications increase the availability of seratonin
and norepinephrine in the brain.
4.
B.
Continued use of antidepressants can prevent recurrences of major depression.
The behavioral perspective stresses the role of reinforcement.
1.
Depressed people may lack the social skills needed to gain normal social reinforcement
from others.
2.
Thus, a vicious cycle develops in which reduced social reinforcement leads to depression,
and depressed behavior further reduces social reinforcement.
C.
The cognitive perspective stresses that the way people think can result in depression.
1.
Perfectionists set themselves up for depression through irrational self-demands they may
not be able to meet.
2.
Paying attention to negative information, being highly self-critical, being pessimistic
about the future, and focusing on the cause of the negative mood all contribute to depression.
3.
Making attributions that are internal ("it's all my fault"), stable ("nothing can change to
improve the situation") and global ("it is a major, all-encompassing problem") may cause
depression.
4.
Martin Seligman’s learned helplessness- depression is based on passive giving up.
D.
The biopsychosocial perspective recognizes the roles played by an individual's biochemistry,
behavior and mood (along with environmental stress factors), thus acknowledging that depression is an
ailing mind in an ailing body. It also acknowledges that altering any one of the components of the
chemistry-cognition-mood circuit can affect the others.
Lesson 5: Schizophrenia and the Impact of Psychological Disorders
I.
Description and symptoms of schizophrenia
A.
Schizophrenia is a group of severe disorders characterized by the breakdown of personality
functioning, withdrawal from reality, distorted emotions, and disturbed thought
B.
Originally, the vague, general description of the disorder led to its over diagnosis. Bipolar
disorder, for example, was mistaken for schizophrenia.
C.
The Diagnostic and Statistical Manual, 4th Edition (DSM-IV), tightens the standards to be used
for positive diagnosis. Organic and affective disorders are ruled out as possible causes. DSM-IV
indicates that the following symptoms must be manifested:
1.
Delusions that
2.
Auditory hallucinations
3.
Marked disturbance
4.
Deterioration from former
5.
Symptoms that last at least six months and
D. The symptoms of schizophrenia
1. Positive symptoms (meaning an excess or distortion of normal functioning)
2. Negative symptoms (meaning restriction or reduction of normal functioning)
II. Types of schizophrenia
A. Paranoid schizophrenia involves
1. The onset of symptoms tends to occur later in life (in the 30s) than in other types of
schizophrenia.
2. The individual rarely displays obviously disorganized behavior, but may act upon the
delusions. This may result in behavior which seems reasonable to the individual, but not to
others.
B. Disorganized schizophrenia involves inappropriate behavior and
C. Catatonic schizophrenia involves frozen, rigid or excitable motor behavior. For example, patients
can maintain postures
D. Undifferentiated schizophrenia has a mixed (undifferentiated) set of symptoms. It involves thought
disorders and features from other types of schizophrenia.
III. The course of schizophrenia
A. Onset
1. The disorder typically occurs in men younger than 25 and in women between 25 and 45 years
of age.
a. Men and women are equally affected but males have earlier onset and are more likely
to have hospitalizations and a higher rate of relapse.
b. Schizophrenia occurs in approximately one percent of the world's populations and is
seen in all cultures.
2. Gradual onset
a. Some changes in previous behavior may be noted by others, especially social
withdrawal.
b. The promodal phase (preceding the active phase) involves increased withdrawal with
peculiar actions or talk.
c. During the active phase, full-blown symptoms are present.
d. Residual phase
(1) The symptoms are no longer prominent.
(2) There is some remaining impairment in functioning
e. Generally, one third of patients recover, one third are helped with medication (they
are likely to be in and out of treatment their whole lives, but retain some symptoms,
and one third are not helped by drug therapy. Individuals with chronic symptoms
may be hospitalized permanently. This is sometimes referred to as the "Rule of
Thirds."
3. Sudden onset in a previously symptom-free individual usually occurs early in life (in the 20s)
and presents a better prognosis for recovery with no recurrance. This is not true for gradual onset
schizophrenia.
IV. Long-term outcome studies regarding schizophrenia indicate that recovery may be more rapid in developing
countries than in the U.S., Europe, or Russia. This may be due to greater acceptance or work opportunities
available in third world communities. This has important implications for social policy.
V. Explaining schizophrenia: a biopsychological perspective
A. Studies of families, twins, and adopted individuals have firmly established that genetic factors play a
role in many cases.
B. Abnormal brain chemistry (there is a lot of doubt about this theory)
1. One theory implicates an excess of the neurotransmitter
2. Dopamine blocking drugs often reduce symptoms of schizophrenia, particularly positive ones.
C. In some patients there is evidence of a prenatal viral infection-based cause.
D. Abnormalities in brain structures and functioning are present in some patients with schizophrenia.
1. MRI studies have found abnormalities in the frontal lobes, temporal lobes, and basal ganglia.
2. The fluid-filled ventricles are enlarged in some brains of schizophrenic patients (an effect, not a
cause according to many).
E. Schizophrenia may be viewed as a complex, chronic medical illness, similar to diabetes or cancer,
affecting different people in different ways.
F. Researchers have been unable to find a single psychological factor which emerges consistently as
causing schizophrenia. Rather, it seems that those who are genetically predisposed to developing
schizophrenia may be more vulnerable to such factors as disturbed family environments and stress.
VI. The impact of psychological disorders
A. Frequency of psychological disorders
1. The World Health Organization estimates that 400 million people worldwide suffer from
psychological disorders. Though not all disorders are seen in all cultures, no known culture
anywhere in the world is free of depression or schizophrenia.
2. A U.S. government survey estimates that 15% of the population are in need of psychological
therapy.
a. 1.9 million people per year are admitted to mental hospitals and psychiatric units in
the U.S.
b. 2.4 million Americans seek out-patient help each year.
c. In any given year, about 5 million adults and 3 million children in the U.S. suffer
from an acute episode of one of five serious disorders: schizophrenia, bipolar
disorder, major depression, obsessive-compulsive disorder and panic disorder.
B. Stigma associated with mental illness
1. Misconceptions about people with psychological disorders often lead to misunderstandings
and discrimination.
2. Examples of misconceptions
a. "People with mental illnesses will never recover." The reality is:
(1) The current success rate for treating schizophrenia is 60%; for bipolar disorder
it is 65%; and for major depression it is 80%.
(2) Mental illnesses can now be diagnosed and treated as precisely and as
effectively as other medical disorders.
b. "All people with mental illnesses are dangerous to society." The reality is:
(1) People with mental illness pose no more of a crime threat than do other
members of the general population.
(2) They are often victims of crime.
c. "Individuals treated for psychological disorders will make poor employees." The
reality is:
(1) People who have been treated for these disorders have been shown to be about
equal to their co-workers in the areas of motivation, quality of work, and length of
time on the job.
(2) Many employers report them to be more punctual and to have better
attendance records than their co-workers.
C. Efforts to combat stigma and misconceptions
1. Some of the organizations that are making efforts to combat the misconceptions and stigma
attached to psychological disorders are
a. The American Psychological Association
b. The National Mental Health Association
c. NAMI, the Family Organization for People with Brain Disorder d. Anxiety Disorders
Association of America
2. Some of the goals of these organizations are
a. to educate the public about mental illness.
b. to confront discrimination in insurance coverage, housing, education, employment
and access to services.
c. to challenge negative stereotypes such as those portrayed in the media
d. to emphasize that treatment works.
e. to ultimately achieve the understanding that serious mental illnesses are no- fault,
biologically based brain diseases which should receive the same attention, concern,
research and care dollars as do other physical diseases.
Treatment of Disorders
I. Introduction and Overview
A. Definition of psychological treatment—
1. Psychotherapy—
2. Biological—
3. Combined treatments—
B. History of treatment—Historically, treatment of people with psychological disorders ranged
from lack of care to extreme and often violent mistreatment of individuals with serious
psychological disorders.
1. Early treatment approaches (circa 1300–1900)—Early psychological treatment
consisted primarily of imprisonment, rather than specific techniques to help people with
mental illness. Bethlam (or the more common name of Bedlam) is located in London
and is considered the oldest hospital caring for people with mental illness. The term
bedlam aptly describes the conditions that were present in hospitals at that time.
Treatment facilities, called asylums or mental hospitals, were built to house people with
mental illness in the mid-1500s. Patients often were chained and mistreated in the early
attempts to treat psychological illness.
a. Phillipe Pinel (1745–1826) was the first physician to remove chains from
seriously mentally ill patients, which resulted in calmer patients. In the 1840s, in
the United States, Dorothea Dix (1802–1887) also initiated freeing the mentally ill
from mistreatment in jails and other locations. She was instrumental in helping to
establish state-funded mental hospitals (Weiten, 1994).
b. The precursor to modern psychotherapy began with a physician, Josef Breuer
(1845–1925), who used hypnosis to get his patients to talk about their problems or
what became known as cathartic therapy.
2. Contemporary treatment approaches (1900–2000)—Early twentieth century treatments
also included harsh medical interventions (e.g. ECT, prefrontal lobotomy), which were
performed in mental hospitals. Although these hospitals remained operational, they
failed to reach their full potential, and in the 1950s, efforts were undertaken to close
many large mental hospitals. Deinstitutionalization of patients resulted in release of
many patients. Treatment of psychological disorders now includes hospital inpatient
treatments and community mental health or outpatient treatments. Several specific
treatments modalities were introduced in the second half of the twentieth century.
Freud’s approach to therapy, or psychoanalysis, is perhaps the most well-known
contemporary approach to therapy. Freud emphasized understanding the unconscious
mind as a central tenet of treating psychological disorders. Freud’s patients would lie
on a couch and talk about heir problems through free association or reporting dreams.
Humanistic therapy, which consists of more egalitarian behavioral treatments that
emphasize change in actions; cognitive therapy, designed to change a person’s thought
processes; and biomedical treatments are among the specific techniques that will be
outlined.
.
C. Those who provide treatment—Professionals who treat people with psychological problems
have training as medical doctors (psychiatrists), psychologists, or other professions with
specialized mental health training (e.g., social workers, nurses, counselors).
1. Psychiatrist—A psychiatrist is a medical doctor who specializes in treating
psychological disorders. A psychiatrist can diagnose a mental illness, prescribe
medication, or administer other biomedical treatments.
2. Psychologist—A clinical or counseling psychologist has a doctoral degree (PhD or
PsyD) that includes training in diagnosis and treatment of psychological illnesses.
3. Psychiatric social worker or psychiatric nurse—This social worker or nurse works as
part of a team of people in a hospital setting. Services include monitoring treatments
that are prescribed by a psychiatrist or psychologist.
4. Counselor—A counselor provides limited psychotherapy for individuals who do not
have a serious mental illness.
D. Ethical issues in treatment—Professionals should adhere to a set of ethical standards issued by
their respective organizations. For example, psychologists should adhere to the ethical principles
of the American Psychological Association. In addition to ethical standards, professionals must
adhere to legal stipulations governing the practice of psychology. One example of the nexus of
law and ethical code relates to the right to privacy, which is granted by the U.S. Constitution.
Although this right to privacy is a legal mandate, specific application of this right to privacy is
specified in the ethics code (Koocher & Keith-Speigel, 1998). Essentially, practitioners should
be sure that they keep all information confidential. Information about a client should be released
only under very specific circumstances, and the client has a right to know, in advance, about the
conditions under which information will be released. For example, if a client tells a psychologist
that (s)he plans to hurt someone, the psychologist must break confidentiality.
II. Psychoanalytic Treatment Approaches
A. Introduction and overview—Psychoanalytic, humanistic, and cognitive approaches to therapy
are often called insight therapies. Insight therapy helps
B. Psychoanalytic approaches—Sigmund Freud (1856–1939) pioneered work in psychodynamic
therapies. His particular type of therapy has been labeled psychoanalysis.
1. Psychoanalysis emphasizes the importance of the unconscious mind. Freud attempted
to help people understand, or develop insight, into their unconscious conflicts as a way
to relieve neurotic anxiety.
2. Techniques—Psychoanalysis is an intensive and long-term therapy that may include
several sessions per week over a period of several years. A psychoanalyst helps the
patient to discover unconscious conflicts, yet the therapist remains neutral, does not
reveal personal information, and does not give advice.
a. Free association—During a therapy session, psychoanalysts encourage patients to
verbalize any thoughts or feelings that come into their consciousness. Resistance
occurs when patients unconsciously
b. Dream analysis—According to Freud, dreams reflect symbolic or unconscious
desires. A psychoanalyst asks a patient to describe a dream in as much detail as
possible. Then, the psychoanalyst interprets the underlying meaning of the
dream. Freud believed that unfulfilled desires that are not expressed consciously
during waking hours may be represented in latent content of dreams.
3. Other psychoanalytic therapies—Carl Jung, Erik Erikson, and Karen Horney are neoFreudians who believed that therapy should include conscious and unconscious aspects
of the patient. A neo-Freudian psychoanalyst seeks to understand the patient’s past and
helps to understand the patient’s future. This type of therapy is usually shorter in
duration compared to traditional psychoanalysis. Ego analysis, interpersonal therapy,
and individual analysis are among some of the neo-Freudian therapies that include both
conscious and unconscious aspects. According to the newest neo-Freudian approach,
object relations theory, children should form a secure relationship with a caregiver in
order to feel secure as adults. In this case, the object is the “relationship with the
parent.” If a secure bond is not formed, the child may not be able to form strong social
relationships as an adult. An object relations therapist treats a patient with the
underlying perspective that object relations are influential in the development of the
patient.