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Psychological Disorders

Chapter 13

Chapter 13: Psychological Disorders

I. Perspectives on Psych Disorders

II. Anxiety Disorders

III. Dissociative and Personalityh

IV. Mood Disorders

V. Schizophrenia

VI. Rates of Psychological Disorders

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Chapter 13Objectives

1. Identify the criteria for judging whether behavior is psychologically disordered.

2. Contrast the medical model w/ the biopsychological approach to disordered behavior.

3. Describe the goals and content of the DSM-IV; discuss dangers and benefits of labels.

4. Describe the symptoms of generalized anxiety disorder, panic disorder, phobias, OCD, and PTSD.

5. Discuss the contributions of learning and biological perspectives to understanding the development of anxiety disorders.

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Objectives

6. Describe the symptoms of dissociative disorders and the controversy regarding the diagnosis of dissociative identity disorder.

7. Contrast the three clusters of personality disorders.

8. Define mood disorders; contrast major depressive and bipolar disorders.

9. Explain the development of mood disorders, using biological and social-cognitive perspectives.

10. Describe the symptoms of schizophrenia, and contrast chronic and acute schizophrenia.

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I. Perspectives on Psychological Disorders

Where should we draw the line b/w normality & disorder?

• Behavior is disordered when it is deviant, distressful, and dysfunctional. (psych disorder)

• Definition of defiant varies w/ context and culture.

• Varies w/ time… children who might have been judged rambunctious now are being diagnosed w/ attention deficit hyperactivity disorder.

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I. Perspectives

People are fascinated by the exceptional, the unusual, and the abnormal. This fascination

may be caused by two reasons:

1. During various moments we feel, think, and act like an abnormal individual.

2. Psychological disorders may bring unexplained physical symptoms, irrational fears, and suicidal thoughts.

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I. Perspectives To study the abnormal is the best way of

understanding the normal.

1. There are 450 million people suffering from psychological disorders (WHO, 2004).

2. Depression and schizophrenia exist in all cultures of the world.

William James (1842-1910)

I. Perspectives… Defining Psychological Disorders

•Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions.•When behavior is deviant, distressful, and dysfunctional psychiatrists and psychologists label it as disordered.

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I. Perspectives… Deviant, Distressful & Dysfunctional

1.Deviant behavior (going naked) in one culture may be considered normal, while in others it may lead to arrest.

2.Deviant behavior must accompany distress.

3. If a behavior is dysfunctional it is clearly a disorder.

In the Wodaabe tribe men wear costumes to

attract women. In Western society this would be considered

abnormal.

Carol B

eckwith

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I. Perspectives… Understanding Psychological

Disorders•Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood.

Trephination (boring holes in the skull to remove evil forces)

John W. V

erano

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I. Perspectives… The Medical Model

Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic

possession, but an ailment of the mind.

Dance in the madhouse.

George W

esley Bellow

s, Dancer in a M

adhouse, 1907. © 1997 T

he Art Institute of C

hicago

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I. Perspectives… Medical Model

•When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders.•The concept that diseases, like psych disorders, have physical causes that can be diagnosed, treated, and cured in a hospital.

1. Etiology: Cause and development of the disorder.

2. Diagnosis: Identifying (symptoms) and distinguishing one disease from another.

3. Treatment: Treating a disorder in a psychiatric hospital.

4. Prognosis: Forecast about the disorder.

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I. Perspectives… The Biopsychosocial Approach

Assumes that biological, socio-cultural, and psychological factors combine and interact to

produce psychological disorders.

I. Perspectives… Biopsychological Approach

• Assumes that disordered behavior, like other behavior, arises from genetic predispositions and physiological states, inner psychological dynamics, and social-cultural circumstances.

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I. Perspectives… Classifying Psychological Disorders

•Many psychiatrists and psychologists use the American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (DSM-IV).•This names and describes psych disorders in treatment and research.•Diagnostic labels aid mental health professionals by providing a common language and shard concepts for communications & research.•US health insurances require DSM-IV diagnoses before they pay for therapy.

•Describes 400 psychological disorders compared to 60 in the 1950s.

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I. Perspectives… Labeling• Disorders outlined by DSM-IV are reliable; therefore, diagnoses by different professionals are

similar.

• Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy.

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I. Perspectives…. Labeling Psychological Disorders

Critics of the DSM-IV argue that labels may stigmatize individual.

Can create preconceptions that unfairly stigmatize people and can bias our perceptions of their past and present behavior.

Asylum baseball team (labeling)

Elizabeth E

ckert, Middletow

n, NY

. From

L. G

amw

ell and N

. Tom

es, Madness in A

merica, 1995. C

ornell University P

ress.

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Labeling Psychological Disorders

“Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes.

Current Examples?

Theodore Kaczynski(Unabomber)

Elaine T

hompson/ A

P Photo

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II. Anxiety DisordersWhat are anxiety disorders; how differ from ordinary worries and fears we all experience?•Our uneasiness is not intense and persistent•Anxiety Disorder: characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.•Five Anxiety Disorders:

1. Generalized anxiety disorder

2. Panic disorder3. Phobias4. Obsessive-compulsive

disorder5. Post-traumatic stress

disorder

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II. Generalized Anxiety Disorder

1. Persistent and uncontrollable tenseness and apprehension; jittery, agitated, sleep-deprived; concentration is difficult.

2. Inability to identify or avoid the cause of certain feelings so difficult to deal w/ or avoid.

3. 2/3s of whom are women.4. May lead to physical problems: ulcers or

high blood pressure.5. Def: An anxiety disorder in which a person

is continually tense, apprehensive, and in a state of autonomic nervous system arousal.

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II. Panic Disorder•Def: Disorder marked by unpredictable minutes-long episodes of intense dread; person experiences terror, chest pains, choking, or other frightening sensations. •Strikes suddenly, wreaks havoc, and disappears. •Other symptoms: heart palpitations; shortness of breath, trembling, dizziness•Anxiety is a component of both disorders. It occurs more in the panic disorder, making people avoid situations that cause it.

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II. Anxieties… Phobias•Marked by a persistent and irrational fear of an object or situation that disrupts behavior.•Usually leads to avoidance of a specific object or situation.

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II. Kinds of Phobias

Phobia of blood.Hemophobia

Phobia of closed spaces.

Claustrophobia

Phobia of heights.Acrophobia

Phobia of open places.

Agoraphobia

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II. Anxieties: Obsessive-Compulsive Disorder

•Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress.•Characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)•Effective functioning can become impossible

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II. Anxieties: Post-Traumatic Stress Disorder

Four or more weeks of the following symptoms constitute post-traumatic

stress disorder (PTSD):

1. Haunting memories2. Nightmares

3. Social withdrawal4. Jumpy anxiety5. Sleep problems

Bettm

ann/ Corbis

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II. Anxieties… Resilience to PTSD

•Only about 10% of women and 20% of men react to traumatic situations and develop PTSD.

•Holocaust survivors show remarkable resilience against traumatic situations.

•All major religions of the world suggest that surviving a trauma leads to the growth of an individual.•Current Issues or Concerns?

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II. Anxieties… Explaining Anxiety Disorders

What are the sources of the anxious feelings and thoughts that characterize anxiety disorders?•Psychoanalytic perspective (Freud) viewed anxiety disorders as the discharging of repressed impulses. •Freud’s theory proposed that, beginning in childhood, people repress intolerable impulses, ideas, and feelings and that this submerged mental energy sometimes produces mystifying symptoms such as anxiety.•Today’s psychologists turned toward two contemporary perspectives: learning and biological.

II. Anxieties: The Learning Perspective

• Psychologists working from the learning perspective view anxiety disorders as a product of fear conditioning, stimulus generalization, reinforcement of fearful behaviors, and observational learning.

• Fear conditioning: ex: rats subjected to unpredictable shocks become anxious

• Stimulus Generalization: person fears heights after a fall and is afraid to go on airplane.

• Reinforcement: helps maintain anxieties.

• Observational Learning: observing other’s fears.

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II. Anxieties: The Biological Perspective

• This perspective considers the evolutionary survival value of fears of life-threatening animals, objects, or situations; inherited predispositions; and abnormal responses in the brain.

• Natural Selection: many of our modern fears come have an evolutionary explanation.

• Genes: Some may be predisposed to anxiety

• Brain: generalized anxiety, panic attacks, and even obsessions are biologically measureable in the brain.

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The Biological Perspective

Generalized anxiety, panic attacks, and

even OCD are linked with brain circuits like the

anterior cingulate cortex.

Anterior Cingulate Cortexof an OCD patient.

S. U

rsu, V.A

. Stenger, M

.K. S

hear, M.R

. Jones, & C

.S. Carter (2003). O

veractive action m

onitoring in obsessive-compulsive disorder. P

sychological Science, 14, 347-353.

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IV. Dissociative Disorders

•Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings.

Symptoms

1. Having a sense of being unreal.2. Being separated from the body.3. Watching yourself as if in a movie.

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III. Dissociative Identity Disorder (DID)

A disorder in which a person exhibits two or more distinct and alternating personalities,

formerly called multiple personality disorder.

Chris Sizemore (DID)

Lois B

ernstein/ Gam

ma L

iason

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III. DID Critics

Critics argue that the diagnosis of DID increased in the late 20th century. DID has not been found in other countries.

Critics’ Arguments

1. Role-playing by people open to a therapist’s suggestion.

2. Learned response that reinforces reductions in anxiety.

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III. Personality Disorders

•Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions.•“BTK Killer”

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III. Antisocial Personality Disorder

•A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends and family members. Formerly, this person was called a sociopath or psychopath.•Genetic Predispositions may interact with environment to produce this disorder.

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III. Understanding Antisocial Personality Disorder

Like mood disorders and schizophrenia,

antisocial personality disorder has biological

and psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress hormones than others

do at their age.

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Understanding Antisocial Personality Disorder

PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up

study, repeat offenders had 11% less frontal lobe activity (Raine et al., 1999; 2000).

Normal Murderer

Courtesy of A

drian Raine,

University of Southern C

alifornia

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IV. Mood Disorders

•Characterized by emotional extremes

•Emotional extremes of mood disorders come in two principal forms.

1. Major depressive disorder

2. Bipolar disorder

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IV. MD… Major Depressive Disorder

•Depression is the “common cold” of psychological disorders. In a year, 5.8% of men and 9.5% of women report depression worldwide (WHO, 2002).

Chronic shortness of breath

Gasping for air after a hard run

Major Depressive Disorder

Blue mood

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IV. MD…. Major Depressive Disorder

Major depressive disorder occurs when signs of depression last two weeks or more and are

not caused by drugs or medical conditions.

1. Lethargy and fatigue2. Feelings of worthlessness3. Loss of interest in family &

friends4. Loss of interest in activities

Signs include:

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IV. MD…. Bipolar Disorder

Formerly called manic-depressive disorder. An alternation between depression and

mania(hyperactivity) signals bipolar disorder.

Multiple ideas

Hyperactive

Desire for action

Euphoria

Elation

Manic Symptoms

Slowness of thought

Tired

Inability to make decisions

Withdrawn

Gloomy

Depressive Symptoms

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IV. Bipolar Disorder

Many great writers, poets, and composers suffered from bipolar disorder.

During their manic phase creativity surged, but not during their depressed

phase.

Whitman Wolfe Clemens Hemingway

Bettm

ann/ Corbis

George C

. Beresford/ H

ulton Getty Pictures L

ibrary

The G

ranger Collection

Earl T

heissen/ Hulton G

etty Pictures L

ibrary

IV. Mood Disorders: What causes mood disorders and what explains its increase?

• Depression researchers are exploring two sets of influences.• One: genetic predispositions and on abnormalities in brain

structures and functions.• Second: social-cognitive perspective, examining the

influence of cyclic self-defeating beliefs, learned helplessness, negative attributions, and stressful experiences.

• Biopsychosocial: considers influences on many levels.• Increased rates of depression among young Westerners may

be due to rise of individualism and decline of commitment to religion and family.

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IV. Explaining Mood Disorders

1. Many behavorial and cognitive changes accompany depression… trapped in depressed mood; also exhibit anxiety or substance abuse.

2. Women are nearly twice as vulnerable to depression. Men tend to be more external.

3. Most major depressive episodes self-terminate.

4. Stressful events related to work, marriage, and close relationships often precede depression.

5. With each new generation, depression is striking earlier.

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IV. Theory of Depression

Gender differences

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IV. Suicide

The most severe form of behavioral response to depression is suicide. Each

year some 1 million people commit suicide worldwide.

1. National differences

2. Racial differences3. Gender

differences4. Age differences5. Other differences

Suicide Statistics

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IV. MD… Biological Perspective

Genetic Influences: Mood disorders run in families. The rate of depression is

higher in identical (50%) than fraternal twins (20%).

Linkage analysis and association studies link

possible genes and dispositions for

depression.

Jerry Irwin Photography

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IV. The Depressed Brain

PET scans show that brain energy consumption rises and falls with manic

and depressive episodes.

Courtesy of L

ewis B

axter an Michael E

. P

helps, UC

LA

School of M

edicine

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IV. MD & Social-Cognitive Perspective

The social-cognitive perspective suggests that depression arises partly from self-

defeating beliefs and negative explanatory styles.

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IV. MD… Negative Thoughts and Moods

Explanatory style plays a major role in becoming depressed.

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IV. MD… Depression Cycle

1. Negative stressful events.

2. Pessimistic explanatory style.

3. Hopeless depressed state.

4. These hamper the way the individual thinks and acts, fueling personal rejection.

5. Therapists try to break this cycle by changing the way depressed people process events.

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V. Schizophrenia

The literal translation is “split mind” which refers to a split from reality. A group of severe

disorders characterized by the following:

1. Disorganized and delusional thinking.

2. Disturbed perceptions. 3. Inappropriate emotions

and actions.

V. Schizophrenia

What patterns of thinking, perceiving, feeling, and behaving characterize schizophrenia?

• A group of disorders that typically strike during late adolescence, affect men very slightly more than women, and seem to occur in all cultures.

• Symptoms: disorganized and delusional thinking (which may stem from selective attention), disturbed perceptions, and inappropriate emotions and actions.

• Delusions are false beliefs; hallucinations are sensory experiences w/o sensory stimulations.

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V. SchizophreniaWhat forms does schizophrenia take?

• May emerge gradually from a chronic history of social inadequacies (recovery is dim) or suddenly in reaction to stress (recovery is brighter).

• Positive symptoms are defined as the presence of inappropriate behaviors.

• Negative symptoms: as the absence of appropriate behaviors.

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IV. What causes Schizophrenia?

• May have increased receptors for the neurotransmitter dopamine, which may intensify the positive symptoms of schizophrenia.

• Brain abnormalities include enlarged, fluid-filled cerebral cavities and corresponding decreases in the cortex.

• Brain scans reveal abnormal activity in the frontal lobes, thalamus, and amygdala.

• Malfunctions in the brain regions and their connections apparently interact to produce symptoms of schizophrenia.

• Twin/Adoptive studies also point to genetic disposition that interact w/ environmental factors .

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Disturbed Perceptions

A schizophrenic person may perceive things that are not there (hallucinations). Frequently

such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory.

L. B

erthold, Untitled. T

he Prinzhorn Collection, U

niversity of Heidelberg

August N

atter, Witches H

ead. The Prinzhorn C

ollection, University of H

eidelberg

Photos of paintings by K

rannert Museum

, University of Illinois at U

rbana-Cham

paign

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Inappropriate Emotions & Actions

A schizophrenic person may laugh at the news of someone dying or show no

emotion at all (flat affect).

Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia).

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Onset and Development of Schizophrenia

Nearly 1 in a 100 suffer from schizophrenia, and throughout the world

over 24 million people suffer from this disease (WHO, 2002).

Schizophrenia strikes young people as they mature into adults. It affects men

and women equally, but men suffer from it more severely than women.

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Chronic and Acute Schizophrenia

When schizophrenia is slow to develop (chronic/process) recovery is doubtful.

Such schizophrenics usually display negative symptoms.

When schizophrenia rapidly develops (acute/reactive) recovery is better. Such

schizophrenics usually show positive symptoms.

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Understanding Schizophrenia

Schizophrenia is a disease of the brain exhibited by the symptoms of the mind.

Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in

the brain.

Brain Abnormalities

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Abnormal Brain Activity

Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of

schizophrenic patients.

Paul T

hompson and A

rthur W. T

oga, UC

LA

Laboratory of N

euro Im

aging and Judith L. R

apport, National Institute of M

ental Health

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Abnormal Brain Morphology

Schizophrenia patients may exhibit morphological changes in the brain like

enlargement of fluid-filled ventricles.

Both Photos: C

ourtesy of Daniel R

. Weinberger, M

.D., N

IH-N

IMH

/ NSC

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Viral Infection

Schizophrenia has also been observed in individuals who contracted a viral

infection (flu) during the middle of their fetal development.

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Genetic Factors

The likelihood of an individual suffering from schizophrenia is 50% if their identical

twin has the disease (Gottesman, 2001).

0 10 20 30 40 50Identical

Both parents

Fraternal

One parent

Sibling

Nephew or niece

Unrelated

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Genetic Factors

The following shows the prevalence of schizophrenia in identical twins as seen

in different countries.

VI. Rates of Psychological Disorders

• Research: 1 in 7 US adults has, or has have, a psychological disorder, usually by early adulthood.

• Poverty is a predictor of mental illness.

• Conditions and experiences associated w/ poverty contribute to the development of mental disorders, but some, like schizophrenia, can drive people into poverty.

• Among Americans who have ever experienced a psychological disorder, the three most common were phobias, alcohol abuse, and mood disorder.

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Rates of Psychological Disorders

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Rates of Psychological Disorders

The prevalence of psychological disorders during the previous year is shown below

(WHO, 2004).