1
PsychologicalDisorders
2
PsychologicalDisorders
PerspectivesonPsychologicalDisorders
DefiningPsychologicalDisorders
UnderstandingPsychologicalDisorders
ClassifyingPsychologicalDisorders
LabelingPsychologicalDisorders
3
PsychologicalDisorders
AnxietyDisorders GeneralizedAnxietyDisorderandPanicDisorder
Phobias
ObsessiveCompulsiveDisorders
PostTraumaticStressDisorders
AnxietyDisorderExplanation
4
PsychologicalDisorders
MoodDisorders MajorDepressiveDisorders
BipolarDisorder
MoodDisorderExplanation
Schizophrenia SymptomsofSchizophrenia
SubtypesofSchizophrenia
5
PsychologicalDisorders
Schizophrenia UnderstandingSchizophrenia
PersonalityDisorders
RatesofPsychologicalDisorders
6
PsychologicalDisorders
IfelttheneedtocleanmyroomspentfourtofivehoursatitAtthetimeIloveditbutthendidntwanttodoitanymore,butcouldnotstopTheclotheshungtwofingersapartItouchedmybedroom
wallbeforeleavingthehouseIhadconstantanxietyIthoughtImightbenuts.
Marc,diagnosedwithobsessivecompulsivedisorder
(fromSummers,1996)
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PsychologicalDisorders
Peoplearefascinatedbytheexceptional,theunusual,andtheabnormal.Thisfascination
maybecausedbytworeasons:
1.
Duringvariousmomentswefeel,think,andactlikeanabnormalindividual.
2.
Psychologicaldisordersmaybringunexplainedphysicalsymptoms,irrationalfears,andsuicidalthoughts.
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PsychologicalDisorders
Tostudytheabnormalisthebestwayofunderstandingthenormal.
1.
Thereare450millionpeoplesufferingfrompsychologicaldisorders(WHO,2004).
2. Depressionandschizophreniaexistinallculturesoftheworld.
WilliamJames(18421910)
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DefiningPsychologicalDisorders
Mentalhealthworkersviewpsychologicaldisorders
aspersistentlyharmfulthoughts,
feelings,andactions.
Whenbehaviorisdeviant,distressful,anddysfunctional
psychiatristsandpsychologists
labelitasdisordered(Comer,2004).
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Deviant,Distressful&Dysfunctional
1. Deviant
behavior(goingnaked)inoneculturemaybeconsiderednormal,whileinothersitmayleadtoarrest.
2. Deviantbehaviormustaccompanydistress.
3. Ifabehaviorisdysfunctional itisclearlyadisorder.
IntheWodaabetribemenwearcostumestoattract
women.InWesternsocietythiswouldbeconsidered
abnormal.
Carol B
eckwith
11
UnderstandingPsychologicalDisorders
AncientTreatmentsofpsychologicaldisordersincludetrephination,exorcism,beingcagedlike
animals,beingbeaten,burned,castrated,mutilated,ortransfusedwithanimalsblood.
Trephination(boringholesintheskulltoremoveevilforces)
John W. V
erano
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MedicalPerspective
PhilippePinel(17451826)fromFrance,insistedthatmadnesswasnotduetodemonicpossession,
butanailmentofthemind.
Danceinthemadhouse.
George W
esley Bellow
s, Dancer in a M
adhouse, 1907. 1997 The A
rt Institute of Chicago
13
MedicalModel
Whenphysiciansdiscoveredthatsyphilisledtomentaldisorders,theystartedusingmedicalmodelstoreviewthephysicalcausesofthesedisorders.
1. Etiology: Causeanddevelopmentofthedisorder.
2. Diagnosis:
Identifying(symptoms)anddistinguishingonediseasefromanother.
3. Treatment: Treatingadisorderinapsychiatrichospital.
4. Prognosis: Forecastaboutthedisorder.
14
BiopsychosocialPerspective
Assumesthatbiological,sociocultural,andpsychologicalfactorscombineandinteractto
producepsychologicaldisorders.
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ClassifyingPsychologicalDisorders
TheAmericanPsychiatricAssociationrenderedaDiagnosticandStatisticalManualofMentalDisorders(DSM)todescribepsychological
disorders.
Themostrecentedition,DSMIVTR(TextRevision,2000),describes400psychological
disorderscomparedto60inthe1950s.
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MultiaxialClassification
ArePsychosocial
orEnvironmentalProblems(schoolorhousingissues)alsopresent?AxisIV
WhatistheGlobalAssessment ofthepersonsfunctioning?AxisV
IsaGeneralMedicalCondition
(diabetes,hypertensionorarthritisetc)alsopresent?AxisIII
IsaPersonalityDisorder orMentalRetardationpresent?AxisII
IsaClinicalSyndrome
(cognitive,anxiety,mooddisorders[16syndromes])present?AxisI
17
MultiaxialClassificationNote16syndromesinAxisI
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MultiaxialClassificationNoteGlobalAssessmentforAxisV
19
GoalsofDSM1. Describe(400)disorders.2.
Determinehowprevalentthe
disorderis.
DisordersoutlinedbyDSMIVarereliable.Therefore,diagnosesbydifferentprofessionalsaresimilar.
OtherscriticizeDSMIVforputtinganykindofbehaviorwithinthecompassofpsychiatry.
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LabelingPsychologicalDisorders
1. CriticsoftheDSMIVarguethatlabelsmaystigmatizeindividuals.
Asylumbaseballteam(labeling)
Elizabeth Eckert, Middletow
n, NY
. From L. G
amw
ell and N
. Tomes, M
adness in America, 1995. C
ornell University Press.
21
LabelingPsychologicalDisorders
2.
Labelsmaybehelpfulforhealthcareprofessionalswhencommunicatingwithoneanotherandestablishingtherapy.
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LabelingPsychologicalDisorders
3. Insanity
labelsraisemoralandethicalquestionsabouthowsocietyshouldtreatpeoplewhohavedisordersandhavecommittedcrimes.
TheodoreKaczynski(Unabomber)
Elaine Thompson/ A
P Photo
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AnxietyDisorders
Feelingsofexcessiveapprehensionandanxiety.
1. Generalizedanxietydisorders2. Phobias3. Panicdisorders4.
Obsessivecompulsivedisorders
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GeneralizedAnxietyDisorder
1. Persistentanduncontrollabletensenessandapprehension.
2. Autonomicarousal.3. Inabilitytoidentifyoravoidthecauseof
certainfeelings.
Symptoms
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PanicDisorder
Minutelongepisodesofintensedreadwhichmayincludefeelingsofterror,chestpains,choking,orotherfrighteningsensations.
Anxietyisacomponentofbothdisorders.Itoccursmoreinthepanicdisorder,making
peopleavoidsituationsthatcauseit.
Symptoms
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Phobia
Markedbyapersistentandirrationalfearofanobjectorsituationthatdisruptsbehavior.
27
KindsofPhobias
Phobiaofblood.Hemophobia
Phobiaofclosedspaces.Claustrophobia
Phobiaofheights.Acrophobia
Phobiaofopenplaces.Agoraphobia
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ObsessiveCompulsiveDisorder
Persistenceofunwantedthoughts(obsessions)andurgestoengageinsenselessrituals
(compulsions)thatcausedistress.
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APETscanofthebrainofapersonwith
ObsessiveCompulsiveDisorder(OCD).Highmetabolicactivity(red)inthefrontallobeareas
areinvolvedwithdirectingattention.
BrainImaging
BrainimageofanOCD
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PostTraumaticStressDisorder
Fourormoreweeksofthefollowingsymptomsconstituteposttraumaticstressdisorder
(PTSD):
1. Hauntingmemories2. Nightmares3. Socialwithdrawal4.
Jumpyanxiety
5. Sleepproblems
Bettm
ann/ Corbis
31
ResiliencetoPTSD
Onlyabout10%ofwomenand20%ofmenreacttotraumaticsituationsanddevelopPTSD.
Holocaustsurvivorsshowremarkableresilienceagainsttraumaticsituations.
Allmajorreligionsoftheworldsuggestthatsurvivingatraumaleadstothegrowthofan
individual.
32
ExplainingAnxietyDisorders
Freudsuggestedthatwerepressourpainfulandintolerableideas,feelings,andthoughts,
resultinginanxiety.
33
TheLearningPerspective
Learningtheoristssuggestthatfear
conditioning leadstoanxiety.Thisanxiety
thenbecomesassociatedwithotherobjectsorevents
(stimulusgeneralization)andis
reinforced.
John Coletti/ Stock, B
oston
34
TheLearningPerspective
Investigatorsbelievethatfearresponsesareinculcatedthroughobservationallearning.
Youngmonkeysdevelopfearwhentheywatchothermonkeyswhoareafraidofsnakes.
35
TheBiologicalPerspective
NaturalSelection
hasledourancestorstolearntofearsnakes,spiders,andotheranimals.
Therefore,fearpreservesthespecies.
Twinstudiessuggestthatourgenes
maybepartlyresponsiblefordevelopingfearsand
anxiety.Twinsaremorelikelytosharephobias.
36
TheBiologicalPerspective
Generalizedanxiety,panicattacks,andevenOCDarelinkedwithbrain
circuitsliketheanteriorcingulatecortex.
AnteriorCingulateCortexofanOCDpatient.
S. Ursu, V
.A. Stenger, M
.K. Shear, M
.R. Jones, &
C.S. C
arter (2003). Overactive action
monitoring in obsessive-com
pulsive disorder. Psychological Science, 14, 347-353.
37
DissociativeDisorder
Consciousawarenessbecomesseparated(dissociated)frompreviousmemories,
thoughts,andfeelings.
Symptoms
1. Havingasenseofbeingunreal.2. Beingseparatedfromthebody.3.
Watchingyourselfasifinamovie.
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DissociativeIdentityDisorder(DID)
Isadisorderinwhichapersonexhibitstwoormoredistinctandalternatingpersonalities,
formerlycalledmultiplepersonalitydisorder.
ChrisSizemore(DID)
Lois Bernstein/ G
amm
a Liason
39
DIDCritics
CriticsarguethatthediagnosisofDIDincreasedinthelate20th
century.DIDhas
notbeenfoundinothercountries.
CriticsArguments
1. Roleplayingbypeopleopentoatherapistssuggestion.
2. Learnedresponsethatreinforcesreductionsinanxiety.
40
MoodDisorders
Emotionalextremesofmooddisorders comeintwoprincipalforms.
1. Majordepressivedisorder2. Bipolardisorder
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MajorDepressiveDisorder
Depressionisthecommoncold
ofpsychologicaldisorders.Inayear,5.8%ofmen
and9.5%ofwomenreportdepressionworldwide(WHO,2002).
Chronicshortnessofbreath
Gaspingforairafterahardrun
MajorDepressiveDisorderBluemood
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MajorDepressiveDisorder
Majordepressivedisorderoccurswhensigns
ofdepressionlasttwoweeksormoreandarenot
causedbydrugsormedicalconditions.
1. Lethargyandfatigue2. Feelingsofworthlessness3.
Lossofinterestinfamily&friends4. Lossofinterestinactivities
Signsinclude:
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DysthymicDisorder
Dysthymicdisorderliesbetweenabluemoodandmajordepressivedisorder.Itisadisordercharacterizedbydailydepressionlastingtwo
yearsormore.
MajorDepressiveDisorder
BlueMood
DysthymicDisorder
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BipolarDisorder
Formerlycalledmanicdepressivedisorder.Analternationbetweendepressionandmania
signalsbipolardisorder.
MultipleideasHyperactive
DesireforactionEuphoriaElation
ManicSymptoms
SlownessofthoughtTired
InabilitytomakedecisionsWithdrawnGloomy
DepressiveSymptoms
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BipolarDisorder
Manygreatwriters,poets,andcomposerssufferedfrombipolardisorder.Duringtheirmanicphasecreativitysurged,butnotduring
theirdepressedphase.
Whitman Wolfe Clemens Hemingway
Bettm
ann/ Corbis
George C
. Beresford/ H
ulton Getty Pictures Library
The Granger C
ollection
Earl Theissen/ Hulton G
etty Pictures Library
46
ExplainingMoodDisorders
Sincedepressionissoprevalentworldwide,investigatorswanttodevelopatheoryof
depressionthatwillsuggestwaystotreatit.
Lewinsohnetal.,(1985,1995)notethatatheoryofdepressionshouldexplainthefollowing:
1. Behavioralandcognitivechanges2. Commoncausesofdepression
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TheoryofDepression
3. Genderdifferences
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TheoryofDepression
4. Depressiveepisodesselfterminate.5.
Depressionisincreasing,especiallyin
theteens.
Postpartumdepression
Desiree N
avarro/ Getty Im
ages
49
Suicide
Themostsevereformofbehavioralresponsetodepressionissuicide.Eachyearsome1million
peoplecommitsuicideworldwide.
1. Nationaldifferences2. Racialdifferences3. Genderdifferences4.
Agedifferences5. Otherdifferences
SuicideStatistics
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BiologicalPerspective
GeneticInfluences:
Mooddisordersruninfamilies.Therateofdepressionishigherinidentical(50%)thanfraternaltwins(20%).
Linkageanalysis andassociationstudies linkpossiblegenesand
dispositionsfordepression.
Jerry Irwin Photography
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Neurotransmitters&Depression
PostsynapticNeuron
PresynapticNeuron
Norepinephrine Serotonin
Areductionofnorepinephrine andserotonin
hasbeenfoundindepression.
Drugsthatalleviatemaniareduce
norepinephrine.
52
TheDepressedBrain
PETscansshowthatbrainenergyconsumptionrisesandfallswithmanicanddepressive
episodes.
Courtesy of Lew
is Baxter an M
ichael E.Phelps, U
CLA
School of Medicine
53
SocialCognitivePerspective
Thesocialcognitiveperspectivesuggeststhatdepressionarisespartlyfromselfdefeatingbeliefs
andnegativeexplanatorystyles.
54
DepressionCycle
1. Negativestressfulevents.2. Pessimisticexplanatory
style.3. Hopelessdepressedstate.4. Thesehamperthewaythe
individualthinksandacts,fuelingpersonalrejection.
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Example
Explanatorystyleplaysamajorroleinbecomingdepressed.
56
Schizophrenia
Ifdepressionisthecommoncoldofpsychologicaldisorders,schizophreniaisthe
cancer.
Nearly1ina100sufferfromschizophrenia,andthroughouttheworldover24millionpeople
sufferfromthisdisease(WHO,2002).
Schizophreniastrikesyoungpeopleastheymatureintoadults.Itaffectsmenandwomenequally,butmensufferfromitmoreseverely
thanwomen.
57
SymptomsofSchizophreniaTheliteraltranslationissplitmind.Agroup
ofseveredisorderscharacterizedbythefollowing:
1. Disorganizedanddelusionalthinking.
2. Disturbedperceptions.3. Inappropriateemotionsand
actions.
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Otherformsofdelusionsinclude,delusionsofpersecution(someoneisfollowingme)or
grandeur(Iamaking).
Disorganized&DelusionalThinking
ThismorningwhenIwasatHillside[Hospital],Iwasmakingamovie.IwassurroundedbymoviestarsImMarryPoppins.Isthisroompaintedbluetogetmeupset?Mygrandmotherdiedfourweeksaftermyeighteenthbirthday.
(Sheehan,1982)
Thismonologueillustratesfragmented,bizarrethinkingwithdistortedbeliefscalleddelusions
(ImMaryPoppins).
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Disorganized&DelusionalThinking
Manypsychologistsbelievedisorganizedthoughtsoccurbecauseofselectiveattentionfailure(fragmentedandbizarrethoughts).
60
DisturbedPerceptionsAschizophrenicpersonmayperceivethingsthatarenotthere(hallucinations).Frequentlysuchhallucinationsareauditoryandlesser
visual,somatosensory,olfactory,orgustatory.
L. Berthold, U
ntitled.The Prinzhorn Collection, U
niversity of Heidelberg
August N
atter, Witches H
ead.The Prinzhorn Collection, U
niversity of Heidelberg
Photos of paintings by Krannert M
useum, U
niversity of Illinois at Urbana-C
hampaign
61
InappropriateEmotions&Actions
Aschizophrenicpersonmaylaughatthenewsofsomeonedyingorshownoemotionatall
(apathy).
Patientswithschizophreniamaycontinuallyrubanarm,rockachair,orremainmotionless
forhours(catatonia).
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SubtypesofSchizophrenia
Schizophreniaisaclusterofdisorders.Thesesubtypessharesomefeatures,butthereareothersymptomsthatdifferentiatethese
subtypes.
63
PositiveandNegativeSymptoms
Schizophrenicshaveinappropriatesymptoms(hallucinations,disorganizedthinking,deluded
ways)thatarenotpresentinnormalindividuals(positivesymptoms).
Schizophrenicsalsohaveanabsenceofappropriatesymptoms(apathy,expressionlessfaces,rigidbodies)thatarepresentinnormal
individuals(negativesymptoms).
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ChronicandAcuteSchizophrenia
Whenschizophreniaisslowtodevelop(chronic/process)recoveryisdoubtful.Suchschizophrenicsusuallydisplaynegative
symptoms.
Whenschizophreniarapidlydevelops(acute/reactive)recoveryisbetter.Suchschizophrenicsusuallyshowpositive
symptoms.
65
Subtypes
66
UnderstandingSchizophrenia
Schizophreniaisadiseaseofthebrainexhibitedbythesymptomsofthemind.
DopamineOveractivity:Researchersfoundthatschizophrenicpatientsexpresshigherlevelsof
dopamineD4receptorsinthebrain.
BrainAbnormalities
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AbnormalBrainActivity
Brainscansshowabnormalactivityinthefrontalcortex,thalamus,and
amygdala of
schizophrenicpatients.Adolescentschizophrenicpatientsalsohavebrainlesions.
Paul Thompson and A
rthur W. Toga, U
CLA
Laboratory of Neuro
Imaging and Judith L. R
apport, National Institute of M
ental Health
68
AbnormalBrainMorphology
Schizophreniapatientsmayexhibitmorphologicalchangesinthebrainlikeenlargementoffluidfilledventricles.
Both Photos: C
ourtesy of Daniel R
. Weinberger, M
.D., N
IH-N
IMH
/ NSC
69
ViralInfection
Schizophreniahasalsobeenobservedinindividualswhocontractedaviralinfection
(flu)duringthemiddleoftheirfetaldevelopment.
70
GeneticFactors
Thelikelihoodofanindividualsufferingfromschizophreniais50%iftheiridenticaltwinhas
thedisease(Gottesman,1991).
01020304050Identical
BothparentsFraternal
OneparentSibling
NephewornieceUnrelated
71
GeneticFactors
Thefollowingshowstheprevalenceofschizophreniainidenticaltwinsasseenin
differentcountries.
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PsychologicalFactors
Psychologicalandenvironmentalfactorscantriggerschizophreniaiftheindividualis
geneticallypredisposed(Nicols&Gottesman,1983).
GenainSisters
ThegeneticallyidenticalGenain
sisterssufferfromschizophrenia.Twomorethan
others,thustherearecontributingenvironmental
factors.
Courtesy of G
enain Family
73
WarningSigns
Earlywarningsignsofschizophreniainclude:
Birthcomplications,oxygendeprivationandlowbirthweight.
2.
Shortattentionspanandpoormusclecoordination.
3.
Poorpeerrelationsandsoloplay.6.Emotionalunpredictability.5.
Disruptiveandwithdrawnbehavior.4.
Amotherslonglastingschizophrenia.1.
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PersonalityDisorders
Personalitydisordersarecharacterizedby
inflexibleandenduringbehaviorpatternsthatimpairsocialfunctioning.Theyareusuallywithoutanxiety,depression,ordelusions.
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AntisocialPersonalityDisorder
Adisorderinwhichtheperson(usuallymen)exhibitsalackofconscienceforwrongdoing,eventowardfriendsandfamilymembers.Formerly,thispersonwascalledasociopath
orpsychopath.
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UnderstandingAntisocialPersonalityDisorder
Likemooddisordersandschizophrenia,antisocialpersonalitydisorderhasbiologicalandpsychological
reasons.Youngsters,beforecommittingacrime,respondwithlowerlevelsofstresshormonesthanothers
doattheirage.
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UnderstandingAntisocialPersonalityDisorder
PETscansof41murderersrevealedreducedactivityinthefrontallobes.Inafollowupstudyrepeatoffendershad11%lessfrontallobeactivitycomparedtonormals(Raineetal.,1999;2000).
Normal Murderer
Courtesy of A
drian Raine,
University of Southern C
alifornia
78
UnderstandingAntisocialPersonalityDisorder
Thelikelihoodthatonewillcommitacrimedoubleswhenchildhoodpovertyiscompoundedwith
obstetricalcomplications(Raineetal.,1999;2000).
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RatesofPsychologicalDisorders
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RatesofPsychologicalDisorders
Theprevalenceofpsychologicaldisordersduringthepreviousyearisshownbelow(WHO,2004).
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RiskandProtectiveFactors
Riskandprotectivefactorsformentaldisorders(WHO,2004).
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RiskandProtectiveFactors
