Chapter 14 Psychological Disorders

What is Normal?

• Psychopathology: Scientific study of mental, emotional, and behavioral disorders; abnormal or maladaptive behavior

• Subjective discomfort: Private feelings of pain, unhappiness, or emotional distress

• Statistical abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depression

What is Normal? (cont)

• Social nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior

• Situational context: Social situation, behavioral setting, or general circumstances in which an action takes place– Is it normal to walk around naked among

strangers? If you are in a locker room and in the shower area, yes!

Cultural Relativity

• Judgments are made relative to the values of one’s culture

Fig. 14-2, p. 464

Fig. 14-1, p. 461

Clarifying and Defining Abnormal Behavior (Mental Illness)

• Maladaptive behavior: Behavior that makes it difficult to function, to adapt to the environment, and to meet everyday demands

• Mental disorder: Significant impairment in psychological functioning

• Those with mental illness lose the ability to adequately control thoughts, behaviors, or feelings

Insanity

• Definition: A legal term; refers to an inability to manage one’s affairs or to be unaware of the consequences of one’s actions– Those judged insane (by a court of law) are

not held legally accountable for their actions– Can be involuntarily committed to a

psychiatric hospital– How accurate is the judgment of insanity?

p. 461

Some Psychological Disorders

• Psychotic disorder: Severe mental disorder characterized by hallucinations and delusions, social withdrawal, and a move away from reality

• Organic mental disorder: Mental or emotional problem caused by brain pathology (i.e., brain injuries or diseases)

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Some More Psychological Disorders

• Mood disorder: Major disturbances in mood or emotions, like depression or mania

• Anxiety disorder: Disruptive feelings of fear, apprehension, anxiety, and behavior distortions

Table 14-4, p. 468

More Psychological Disorders

• Somatoform disorder: Physical symptoms that mimic disease or injury (blindness, anesthesia) for which there is no identifiable physical cause

• Dissociative disorder: Temporary amnesia, multiple identity, or depersonalization (like being in a dream world, feeling like a robot, feeling like you are outside of your body)

• Personality disorder: Deeply ingrained, unhealthy, maladaptive personality patterns

A Final Few Psychological Disorders

• Substance-related disorder: Abuse or dependence on a mind- or mood-altering drug, like alcohol or cocaine– Person cannot stop using the substance and

may suffer withdrawal symptoms if they do• Sexual and gender identity disorders: Problems

with sexual identity, deviant sexual behavior, or sexual adjustment

• Neurosis: Archaic; once used to refer to, as a group, anxiety, somatoform, and dissociative disorders, and to some forms of depression

General Risk Factors for Contracting Mental Illness

• Biological factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability

• Psychological factors: Low intelligence, stress, learning disorders

• Family factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problems

• Social conditions: Poverty, homelessness, overcrowding, stressful living conditions

Fig. 14-3, p. 469

Psychosis

• Loss of contact with shared views of reality• Typically marked by delusions and

hallucinations, and personality disintegration

Delusions

• False beliefs that individuals insist are true, regardless of overwhelming evidence against them

Hallucinations

• Imaginary sensations, such as seeing, hearing, or smelling things that do not exist in the real world– Most common psychotic hallucination is

hearing voices– Note that olfactory hallucinations sometimes

occur with seizure disorder (epilepsy)

Some More Psychotic Symptoms

• Flat affect: Lack of emotional responsiveness; face is frozen in blank expression

• Disturbed verbal communication: Garbled and chaotic speech; word salad

• Personality disintegration: When an individual’s thoughts, actions, and emotions are no longer coordinated

Other Psychotic Disorders

• Organic psychosis: Psychosis caused by brain injury or disease– Dementia: Most common organic problem;

serious mental impairment in old age caused by brain deterioration

Alzheimer’s Disease

• Symptoms include memory loss, mental confusion, and progressive loss of mental abilities– Ronald Reagan most famous Alzheimer’s

victim

p. 469

Delusional Disorders

• Marked by presence of deeply held false beliefs (delusions)– May involve delusions of grandeur,

persecution, jealousy, or somatic delusions– Experiences could really occur!

• Paranoid psychosis: Most common delusional disorder– Centers on delusions of persecution

Schizophrenia: The Most Severe Mental Illness

• Psychotic disorder characterized by hallucinations, delusions, apathy, thinking abnormalities, and “split” between thoughts and emotions– Does NOT refer to having split or multiple

personalities

Video: Schizophrenia: Common Symptoms

The Four Subtypes of Schizophrenia

Disorganized Type

• Incoherence, grossly disorganized behavior, bizarre thinking, and flat or grossly inappropriate emotions

p. 471

Catatonic Type

• Marked by stupor, unresponsiveness, posturing, mutism, and sometimes, by agitated, purposeless behavior

p. 472

Paranoid Type

• Preoccupation with delusions; also involves auditory hallucinations that are related to a single theme, especially grandeur or persecution

• Most common schizophrenic disorder

Fig. 14-4, p. 472

Undifferentiated Type

• Any type of schizophrenia that does not have specific paranoid, catatonic, or disorganized features or symptoms

Video: Schizophrenia: Distortion of Reality

Causes of Schizophrenia

• Psychological trauma: Psychological injury or shock, often caused by violence, abuse, or neglect

• Disturbed family environment: Stressful or unhealthy family relationships, communication patterns, and emotional atmosphere

• Deviant communication patterns: Cause guilt, anxiety, anger, confusion, and turmoil

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Biochemical Causes of Schizophrenia

• Biochemical abnormality: Disturbance in brain’s chemical systems or in the brain’s neurotransmitters

• Dopamine: Neurotransmitter involved with emotions and muscle movement– Works in limbic system

• Dopamine overactivity in brain may be related to schizophrenia

• Glutamate: A neurotransmitter; may also be involved

Fig. 14-6, p. 474

Schizophrenic Brain Images

• Computed tomography (CT) scan: Computer enhanced X-ray of brain or body

• Magnetic resonance imaging (MRI) scan: Computer enhanced three-dimensional image of brain or body; based on magnetic field– MRIs show schizophrenic brains as having

enlarged ventricles

Positron Emission Tomography (PET) Scan

• Computer-generated color image of brain activity; radioactive sugar solution is injected into a vein, eventually reaching the brain– Activity is abnormally low in frontal lobes of

schizophrenics

Fig. 14-7a, p. 475

Fig. 14-7b, p. 475

Fig. 14-8, p. 475

Stress-Vulnerability Model

• Combination of environmental stress and inherited susceptibility cause psychotic disorders

Mood Disorders

• Major disturbances in mood or emotion, such as depression or mania

• Depressive disorders: Sadness or despondency are prolonged, exaggerated, or unreasonable

• Bipolar disorders: Involve both depression and mania or hypomania

More Mood Disorders

• Dysthymic disorder: Moderate depression that lasts for at least two years

• Cyclothymic disorder: Moderate manic and depressive behavior that lasts for at least two years

Major Mood Disorders

• Lasting extremes of mood or emotion and sometimes with psychotic features (hallucinations, delusions)

• Major depressive disorder: A mood disorder where the person has suffered one or more intense episodes of depression; one of the more serious mood disorders

Bipolar Disorders

• Bipolar I disorder: Person experiences extreme mania and deep depression– Mania: Excited, hyperactive, energetic,

grandiose behavior• Bipolar II disorder: Person is mainly sad but has

one or more hypomanic episodes (mild mania)

Video: Bipolar Disorder: Delusional Thinking

Endogenous Depression

• Depression that seems to be produced from inside the body and not from reaction to life events

Table 14-5, p. 477

Maternity Blues

• Mild depression that lasts for one to two days after childbirth– Marked by crying, fitful sleep, tension, anger,

and irritability– Brief and not too severe

Postpartum Depression

• Moderately severe depression that begins within three months following childbirth– Marked by mood swings, despondency,

feelings of inadequacy, and an inability to cope with the new baby

– May last from two months to one year

More on Postpartum Depression

– Part of the problem may be hormonal– Unlike other depressions, features unusually

high levels of restlessness and difficulty concentrating

Seasonal Affective Disorder (SAD)

• Depression that only occurs during fall and winter– May be related to reduced exposure to

sunlight– Phototherapy: Extended exposure to bright,

full-spectrum light to treat SAD

Fig. 14-11, p. 480

Video: Bipolar Disorder: Expression of Mood

Anxiety-Based Disorders

• Anxiety: Feelings of apprehension, dread, or uneasiness

• Adjustment disorders: When ordinary stress causes emotional disturbance and pushes people beyond their ability to effectively cope– Usually suffer sleep disturbances, irritability,

and depression– Examples: Grief reactions, lengthy physical

illness, unemployment

Generalized Anxiety Disorder (GAD)

• Duration of at least six months of chronic, unrealistic, or excessive anxiety about work, relationships, ability, or impending disaster

Video: Panic Disorder: Symptoms

Panic Disorder without Agoraphobia

• A chronic state of anxiety with brief moments of sudden, intense, unexpected panic (panic attack)– Panic attack: Feels like one is having a heart

attack, going to die, or is going insane – Symptoms include vertigo, chest pain,

choking, fear of losing control

Panic Disorder with Agoraphobia

• Panic attacks and sudden anxiety still occur, but with agoraphobia

• Agoraphobia (with panic disorder): Intense, irrational fear that a panic attack will occur in a public place or in an unfamiliar situation– Intense fear of leaving the house or entering

unfamiliar situations– Can be very crippling– Literally means fear of open places or market

(agora)

Agoraphobia without Panic Disorder

• Fear that something extremely embarrassing will happen away from home or in an unfamiliar situation

Video: Panic Disorder: Coping

Specific Phobias

• Irrational, persistent fears, anxiety, and avoidance that focus on specific objects, activities, or situations

• People with phobias realize that their fears are unreasonable and excessive, but they cannot control them

p. 482

Video: Snake Phobia

Social Phobia

• Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public)– Barbra Streisand, Woody Allen perhaps?

Obsessive-Compulsive Disorder (OCD)

• Extreme preoccupation with certain thoughts and compulsive performance of certain behaviors

Obsession

• Recurring images or thoughts that a person cannot prevent – Cause anxiety and extreme discomfort– Enter into consciousness against the person’s

will– Most common: About being dirty, wondering if

you performed an action (turned off the stove), or violence (hit by a car)

Compulsion

• Irrational acts that person feels compelled to repeat– Help to control or block out anxiety created by

obsessions– Checkers and cleaners

Video: Obsessive-Compulsive Disorder

p. 483

Stress Disorders

• Occur when stresses outside range of normal human experience cause major emotional disturbance– Symptoms: Reliving traumatic event

repeatedly, avoiding stimuli associated with the event, and numbing of emotions

Acute Stress Disorder

• Psychological disturbance lasting up to one month following stresses from a traumatic event

Posttraumatic Stress Disorder (PTSD)

• Lasts more than one month after the traumatic event has occurred; may last for years – Typically associated with combat and violent

crimes (rape, assault, etc.)– Terrorist attacks on September 11, 2001,

likely led to an increase of PTSD– Many cases of PTSD come from Iraq war

Table 14-6, p. 481

Munchausen Syndrome by Proxy

• Person fakes the medical problems of someone in his or her care in order to gain attention

Munchausen Syndrome

• Person fakes his or her own medical problems in order to gain attention

Dissociative Disorders

• Dissociative amnesia: Inability to recall one’s name, address, or past

• Dissociative fugue: Sudden travel away from home and confusion about personal identity– Usually triggered by highly traumatic events

Dissociative Identity Disorder (DID)

• Person has two or more distinct, separate identities or personality states; previously known as multiple personality disorder– Sybil or The Three Faces of Eve are good

examples – Often begins with horrific childhood

experiences (e.g., abuse, molestation, etc.)– Therapy often makes use of hypnosis– Goal: Integrate and fuse identities into single,

stable personality

Hypochondriasis

• Person is preoccupied with having a serious illness or disease – Interpret normal sensations and bodily signs

as proof that they have a terrible disease– No physical disorder can be found

Somatization Disorder

• Person expresses anxieties through numerous physical complaints – Many doctors are consulted but no organic or

physical causes are found

Pain Disorder

• Pain that has no identifiable organic, physical cause – Appears to have psychological origin

Conversion Disorder

• Severe emotional conflicts are “converted” into physical symptoms or a physical disability– Caused by anxiety or emotional distress but

not by physical causes

Glove Anesthesia

• Loss of skin sensitivity in areas normally covered by a glove

Fig. 14-12, p. 485

Theoretical Causes of Anxiety Disorders: Psychodynamic (Freud)

• Anxiety caused by conflicts among id, ego, and superego– Forbidden id impulses for sex or aggression

are trying to break into consciousness and thus influence behavior; person fears doing something crazy or forbidden

– Superego creates guilt in response to these impulses

– Ego gets overwhelmed and uses defense mechanisms to cope

Other Theoretical Causes of Anxiety Disorders

• Humanistic: Unrealistic self-image conflicts with real self-image

• Existential: Anxiety reflects loss of meaning in one’s life

• Behavioristic: Anxiety symptoms and behaviors are learned, like everything else– Conditioned emotional responses that

generalize to new situations

More Theoretical Causes of Anxiety Disorders

• Avoidance learning: When making a particular response delays or prevents the onset of a painful or unpleasant stimulus

• Anxiety reduction hypothesis: When reward of immediate relief from anxiety perpetuates self-defeating avoidance behaviors

• Cognitive: When distorted thinking causes people to magnify ordinary threats and failures, leading to anxiety and distress

Antisocial Personality Disorder (APD)

• A person who lacks a conscience (superego?); typically emotionally shallow, impulsive, selfish, and manipulative toward others– Often called psychopaths or sociopaths

• Many are delinquents or criminals, but many are NOT crazed murderers displayed on television

• Create a good first impression and are often charming

• Cheat their way through life (e.g., Scott Peterson)

APD: Causes and Treatments

• Possible causes:– Childhood history of emotional deprivation,

neglect, and physical abuse– Underarousal of the brain

• Very difficult to effectively treat; will likely lie, charm, and manipulate their way through therapy

Fig. 14-3, p. 469

Fig. 14-7a, p. 475

Fig. 14-7b, p. 475

Suicide: Major Risk Factors

• Drug or alcohol abuse• Prior suicide attempt• Depression or other mood disorder• Availability of a firearm• Severe anxiety or panic attacks• Family history of suicidal behavior• Shame, humiliation, failure or rejection

Fig. 14-14, p. 491

Common Characteristics of Suicidal Thoughts and Feelings (Shneidman, 1987)

• Escape• Unbearable psychological pain: Emotional pain

that the person wishes to escape• Frustrated psychological needs: Such as

searching for love, achievement, or security• Constriction of options: Feeling helpless and

hopeless and deciding that death is the only option left

Fig. 14-15, p. 492