Chapter 14

Psychological Disorders

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Abnormal Behavior

Historical aspects of mental disorders

The medical model What is abnormal behavior?

– 3 criteria• Deviant• Maladaptive • Causing personal distress

A continuum of normal/abnormal

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Prevalence, Causes, and Course

Epidemiology Prevalence - % of population that displays the

disorder during a specific period Lifetime prevalence – Diagnosis Etiology – causes Prognosis

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Psychodiagnosis: The Classification of Disorders

American Psychiatric Association – published first taxonomy in 1952

Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV)

Multiaxial system 5 axes or dimensions

– Axis I – Clinical Syndromes– Axis II – Personality Disorders or Mental Retardation– Axis III – General Medical Conditions– Axis IV – Psychosocial and Environmental Problems– Axis V – Global Assessment of Functioning

Example Figure DSM V – to be published in 2011-12

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Fig. 14-3, p. 555Figure 14.3 – DSM-IV overview

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Example multiaxial evaluation

The DSM multiaxial system

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Axis I Clinical Syndromes and Axis II Personality Disorders

Anxiety Disorders – Somatoform Disorders – Dissociative Disorders – Mood Disorders – Schizophrenic Disorders – Eating Disorders –

Axis II – Personality Disorders –

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Clinical Syndromes: Anxiety Disorders

Generalized anxiety disorder– “free-floating anxiety”

Phobic disorder– Specific focus of fear

Panic disorder and agoraphobia (definition issue)– Physical symptoms of anxiety/leading to agoraphobia

Obsessive compulsive disorder– Obsessions– Compulsions

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Etiology of Anxiety Disorders

Biological factors – – Genetic predisposition, anxiety sensitivity– GABA circuits in the brain

Conditioning and learning– Acquired through classical conditioning or observational

learning – – Maintained through operant conditioning

Cognitive factors– Judgments of perceived threat –

Personality– Neuroticism

Stress – – A precipitator

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Clinical Syndromes: Somatoform Disorders

Somatization Disorder Conversion Disorder – Figure Hypochondriasis

– Etiology• Reactive autonomic nervous system

• Personality factors

• Cognitive factors

• The sick role

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Clinical Syndromes: Dissociative Disorders

Dissociative amnesia Dissociative fugue Dissociative identity disorder

– Etiology• severe emotional trauma during childhood

– Controversy• Media creation?

• Sybil

• Repressed memories

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Clinical Syndromes: Mood Disorders

Major depressive disorder– Dysthymic disorder

Bipolar disorder (manic-depressive disorder)– Cyclothymic disorder

Etiology– Age of onset – – Genetic vulnerability – – Neurochemical factors– Cognitive factors – negative thinking – – Interpersonal roots– Precipitating stress

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Clinical Syndromes: Schizophrenia

General symptoms– Delusions and irrational thought– Deterioration of adaptive behavior -

avolition– Hallucinations – any modality but

usually auditory– Disturbed emotions – 66%

Prognostic factor– Gradual onset– Sudden onset

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Subtyping of Schizophrenia

4 subtypes– Paranoid type – most

common subtype - John Nash

– Catatonic type– Disorganized type– Undifferentiated type

New model for classification– Positive vs. negative

symptoms

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Etiology of Schizophrenia

Genetic vulnerability – Neurochemical factors – Dopamine hypothesis – Structural abnormalities of the brain – prefrontal lobe

and ventricles – The neurodevelopmental hypothesis – Expressed emotion – Precipitating stress – stress-vulnerability model –

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– Genetic vulnerability - schizophrenia

Table of ContentsThe dopamine hypothesis as an explanation for schizophrenia

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Neurological Changes in Schizophrenia

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– Neurodevelopment hypothesis of schizophrenia

– Expressed emotion and relapse rates in schizophrenia

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The stress-vulnerability model of schizophrenia

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Personality Disorders

Next slide– description and male/female percents Anxious-fearful cluster

– Avoidant, dependent, obsessive-compulsive

Dramatic-impulsive cluster– Histrionic, narcissistic, borderline, antisocial

Odd-eccentric cluster– Schizoid, schizotypal, paranoid

Etiology– Genetic predispositions, inadequate socialization in

dysfunctional families

Prognosis

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Psychological Disorders and the Law

Insanity– M’naghten rule– The insanity defense –– perception versus actual cases

Involuntary commitment – varies by states– danger to self– danger to others– in need of treatment

Culture and pathology –

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John Hinkley, Jr. – assassination attempt of President Reagan in 1981

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Eating Disorders –

Issues of weight – Anorexia nervosa

– Criteria and subtypes: restrictive and binge/purge Bulimia nervosa Binge eating History and prevalence

– Age onset – Etiology

– Genetics– Personality – perfectionism– Cultural issues - “perfect” body type and digital photograph– Family role– Cognitive factors

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Age of anorexia nervous in the United States – Lucas et al. (1991)

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