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Psychological Disorders
People are fascinated by the exceptional, theunusual, and the abnormal. This fascination
may be caused by two reasons:
During various moments we feel, think, and actlike an abnormal individual.
Psychological disorders may bring unexplainedphysical symptoms, irrational fears, and suicidalthoughts.
Psychological Disorders
To study the abnormal is the best way ofunderstanding the normal.
There are 450 million people suffering frompsychological disorders (WHO, 2004).
Depression and schizophrenia exist in all culturesof the world.
William James (1842-1910)
Defining Psychological Disorders
Mental health workers view psychologicaldisorders as persistently harmful thoughts,
feelings, and actions.
When behavior is deviant, distressful, anddysfunctional psychiatrists and psychologists
label it as disordered (Comer, 2004).
Deviant, Distressful & Dysfunctional
Deviant behavior(going naked) in oneculture may beconsidered normal,while in others it maylead to arrest.
Deviant behavior mustaccompany distress.
If a behavior isdysfunctional it isclearly a disorder.
In the Wodaabe tribe menwear costumes to attract
women. In Western societythis would be considered
abnormal.
Carol B
eckwith
Understanding PsychologicalDisorders
Ancient Treatments of psychological disordersinclude 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
2
The Medical ModelPhilippe 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 The A
rt Institute of Chicago
Medical ModelWhen physicians discovered that syphilis led to
mental disorders, they started using medical modelsto review the physical causes of these disorders.
1. Etiology: Cause and development of thedisorder.
2. Diagnosis: Identifying (symptoms) anddistinguishing one disease from another.
3. Treatment: Treating a disorder in a psychiatrichospital.
4. Prognosis: Forecast about the disorder.
*Fails to recognize the effect of social and psychological factors!
The Biopsychosocial ApproachAssumes that biological, socio-cultural, and
psychological factors combine and interact toproduce psychological disorders.
Classifying Psychological Disorders
The American Psychiatric Association rendereda Diagnostic and Statistical Manual of Mental
Disorders (DSM) to describe psychologicaldisorders.
The most recent edition, DSM-IV-TR (TextRevision, 2000), describes 400 psychological
disorders compared to 60 in the 1950s.
Goals of DSM
1. Describe (400) disorders so they may beidentified in affected individuals .
2. Determine how prevalent the disorder is.
Disorders outlined by DSM-IV are reliable.Therefore, diagnoses by different professionalsare similar.
Others criticize DSM-IV for “putting any kindof behavior within the compass of psychiatry.”
Multiaxial Classification
Are Psychosocial or Environmental Problems(school or housing issues) also present?Axis IV
What is the Global Assessment of the person’sfunctioning?Axis V
Is a General Medical Condition (diabetes,hypertension or arthritis etc) also present?Axis III
Is a Personality Disorder or Mental Retardationpresent?Axis II
Is a Clinical Syndrome (cognitive, anxiety,mood disorders [16 syndromes]) present?Axis I
3
Multiaxial ClassificationNote 16 syndromes in Axis I
Multiaxial ClassificationNote Global Assessment for Axis V
Fig. 14-3, p. 555 Fig. 14-4, p. 556
Labeling Psychological Disorders:
Some psychologists criticize the use of labeling.• Critics of the DSM-IV argue that labels may
stigmatize individuals.• Labels may become self-fulfilling.
Some psychologists find diagnostic labels useful.• Labels may be helpful for healthcare professionals
when communicating with one another andestablishing therapy.
Labeling Psychological Disorders
“Insanity” labelsraise moral and
ethical questionsabout how society
should treat peoplewho have
disorders and havecommitted crimes.
Theodore Kaczynski(Unabomber)
Elaine Thompson/ A
P Photo
4
Anxiety Disorders
Feelings of excessive apprehension and anxiety.
1. Generalized anxiety disorder2. Panic disorder3. Phobias4. Obsessive-compulsive disorder5. Post-traumatic stress disorder
Generalized Anxiety Disorder
1. Persistent and uncontrollable tenseness andapprehension.
2. Autonomic arousal.3. Inability to identify or avoid the cause of
certain feelings, this is an anxiety whichFreud labeled free floating.
Symptoms
Panic Disorder
Minutes-long episodes of intense dread which mayinclude feelings of terror, chest pains, choking, or
other frightening sensations.
Anxiety is a component of both disorders. Itoccurs more in the panic disorder, making
people avoid situations that cause it.
Smokers have at least doubled risk of panicdisorder.
Symptoms
PhobiasMarked by a persistent and irrational fear of an
object or situation that disrupts behavior.
Kinds of Phobias
Phobia of blood.Hemophobia
Phobia of closed spaces.Claustrophobia
Phobia of heights.Acrophobia
Phobia of open places.Agoraphobia
Social phobia Shyness to an extreme
Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions)and urges to engage in senseless rituals
(compulsions) that cause distress.
5
A PET scan of the brain of a person withObsessive-Compulsive Disorder (OCD). High
metabolic activity (red) in the frontal lobe areas areinvolved with directing attention.
Brain Imaging Post-Traumatic Stress DisorderFour or more weeks of the following symptoms
constitute post-traumatic stress disorder(PTSD):
1. Haunting memories2. Nightmares3. Social withdrawal4. Jumpy anxiety5. Sleep problems
Bettm
ann/ Corbis
Resilience to PTSD
Only about 10% of women and 20% of menreact to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilienceagainst traumatic situations.
All major religions of the world suggest thatsurviving a trauma leads to the growth of an
individual. Post-traumatic growth is a theory inwhich challenging crises or traumatic experiences
increases personal strength, positively shiftspriorities and promotes spirituality.
Explaining Anxiety Disorders
Freud suggested that we repress our painfuland intolerable ideas, feelings, and thoughts,
resulting in anxiety.
The Learning PerspectiveLearning theorists suggest two specific learning
processes which contribute to anxiety:1. Fear conditioning leads to
anxiety. This anxiety thenbecomes associated with otherobjects or events (stimulusgeneralization).
2. Reinforcement maintains ourphobias and compulsions whenwe avoid or escape the fearedsituation to reduce anxiety.
The Learning Perspective
Investigators believe that fear responses arereinforced through observational learning.
Young monkeys develop fear when they watchother monkeys who are afraid of snakes.
6
The Biological Perspective
Natural Selection has led our ancestors to learnto fear snakes, spiders, and other animals.
Therefore, fear preserves the species.
Twin studies suggest that our genes may bepartly responsible for developing fears and
anxiety. Twins are more likely to sharephobias.
The Biological Perspective
Generalized anxiety,panic attacks, and even
OCD are linked withbrain circuits like the
anterior cingulate cortex.
Anterior Cingulate Cortexof an OCD patient.
S. Ursu, V
.A. Stenger, M
.K. Shear, M
.R. Jones, & C.S. Carter (2003). O
veractive action m
onitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353.
When givenchallenging, cognitivetasks, these patients
show elevated activityin the anterior cingulate
cortex.
Somatoform Disorders• Symptoms mimic a physical disease or injury.• Medical test results are either normal or do not
explain the person’s symptoms.• One type of somatoform disorder is conversion
disorder in which very specific genuine physicalsymptoms exist for which no physiological basiscan be found.
• Hypochondriasis is a somatoform disorder inwhich a person interprets normal physicalsensations as symptoms of a disease.
Dissociative DisordersConscious awareness becomes separated
(dissociated) from previous memories, thoughts, andfeelings.
Symptoms1. Having a sense of
being unreal.2. Being separated from
the body.3. Watching yourself as
if in a movie.
Dissociative Identity Disorder (DID)
A disorder in which a person exhibits two ormore distinct and alternating personalities,
formerly called multiple personality disorder.
Chris Sizemore (DID)
Lois Bernstein/ G
amm
a Liason
DID Critics
Critics argue that the diagnosis of DIDincreased in the late 20th century. DID has
not been found in other countries.
Critics’ Arguments
1. Role-playing by people open to atherapist’s suggestion.
2. Learned response that reinforcesreductions in anxiety.
7
Mood DisordersEmotional extremes of mood disorders come in
two principal forms.
1. Major depressive disorder2. Bipolar disorder
Major Depressive Disorder
Depression is the “common cold” ofpsychological disorders. In a year, 5.8% of men
and 9.5% of women report depressionworldwide (WHO, 2002).
Chronic shortness ofbreath
Gasping for air after ahard run
Major Depressive DisorderBlue mood
Major Depressive Disorder
Major depressive disorder occurs when signs ofdepression 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:
Bipolar DisorderFormerly called manic-depressive disorder. An
alternation between depression and maniasignals bipolar disorder.
Multiple ideasHyperactive
Desire for actionEuphoriaElation
Manic Symptoms
Slowness of thoughtTired
Inability to make decisionsWithdrawn
Gloomy
Depressive Symptoms
Bipolar Disorder
Many great writers, poets, and composerssuffered from bipolar disorder. During their
manic phase creativity surged, but not duringtheir depressed phase.
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
Explaining Mood Disorders
Since depression is so prevalent worldwide,investigators want to develop a theory of
depression that will suggest ways to treat it.
Lewinsohn et al., (1985, 1998) note that a theoryof depression should explain the following:
1. Behavioral and cognitive changes2. Common causes of depression
8
Theory of Depression
3. Gender differences
Theory of Depression
4. Depressive episodes self-terminate.5. Stressful events often precede depression.6. Depression is increasing, especially in the
teens.
Post-partum depression
Desiree N
avarro/ Getty Im
ages
Suicide
The most severe form of behavioral response todepression is suicide. Each year some 1 million
people commit suicide worldwide.
1. National differences2. Racial differences3. Gender differences4. Age differences5. Other differences
Suicide Statistics
Comparative Suicide Rates• National Differences: Britain, Italy & Spain’s rates are
little more than half that of the US, Canada andAustralia. Austria & Finland are double.
• Racial Differences: In the US, whites are 2x as likelythan blacks.
• Gender Differences: Women are more likely to attempt,men are more likely to succeed.
• Age Differences: Rates increase dramatically in lateadulthood, especially among men.
• Other: Rates are higher among the rich, nonreligiousand those who are single, widowed or divorced. In thelast 60 years, the global rate of annual suicide rose from10 to 18 per 100,000. In 2006 in the US, suicide per100,000: 11.1 (or 33,300 people).
Biological Perspective
Genetic Influences: Mood disorders run infamilies. The rate of depression is higher inidentical (50%) than fraternal twins (20%).
Linkage analysis andassociation studies link
possible genes anddispositions for depression.
Jerry Irwin Photography
The Depressed Brain
PET scans show that brain energy consumptionrises and falls with manic and depressive
episodes.
Courtesy of Lew
is Baxter an M
ichael E. Phelps, U
CLA
School of Medicine
9
Social-Cognitive Perspective
The social-cognitive perspective suggests thatdepression arises partly from self-defeating
beliefs and negative explanatory styles.
Negative Thoughts and Moods
Explanatory style plays a major role in becoming depressed.
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.
SchizophreniaThe literal translation is “split mind” which
refers to a split from reality. A group of severedisorders characterized by the following:
Disorganized and delusionalthinking.
Disturbed perceptions.Inappropriate emotions and
actions.
Symptoms of Schizophrenia
Positive symptoms: thepresence of inappropriatebehaviors (hallucinations,disorganized or delusionaltalking)
Negative symptoms: theabsence of appropriatebehaviors (expressionlessfaces, rigid bodies)
Other forms of delusions include, delusions ofpersecution (“someone is following me”) or
grandeur (“I am a king”).
Disorganized & Delusional Thinking
This morning when I was at Hillside [Hospital], I wasmaking a movie. I was surrounded by movie stars …I’m Mary Poppins. Is this room painted blue to get meupset? My grandmother died four weeks after myeighteenth birthday.”
(Sheehan, 1982)
This monologue illustrates fragmented, bizarrethinking with distorted beliefs called delusions
(“I’m Mary Poppins”).
10
Disorganized & Delusional Thinking
Many psychologists believe disorganizedthoughts occur because of selective attention
failure (fragmented and bizarre thoughts).
Disturbed PerceptionsA schizophrenic person may perceive thingsthat are not there (hallucinations). Frequently
such hallucinations are auditory and lesservisual, somatosensory, olfactory, or gustatory.
L. Berthold, Untitled. The Prinzhorn Collection, U
niversity of Heidelberg
August N
atter, Witches H
ead. The Prinzhorn Collection, University of H
eidelberg
Photos of paintings by Krannert M
useum, U
niversity of Illinois at Urbana-C
hampaign
Inappropriate Emotions & Actions
A schizophrenic person may laugh at the newsof someone dying or show no emotion at all
(flat affect).
Patients with schizophrenia may continuallyrub an arm, rock a chair, or remain motionless
for hours (catatonia).
Onset and Development ofSchizophrenia
Nearly 1 in a 100 suffer from schizophrenia, andthroughout the world over 24 million people
suffer from this disease (WHO, 2002).
Schizophrenia strikes young people as theymature into adults. It affects men and womenequally, but men suffer from it more severely
than women.
Chronic and Acute Schizophrenia
When schizophrenia is slow to develop(chronic/process) recovery is doubtful. Such
schizophrenics usually display negativesymptoms.
When schizophrenia rapidly develops(acute/reactive) recovery is better. Such
schizophrenics usually show positivesymptoms.
Understanding Schizophrenia
Schizophrenia is a disease of the brain exhibitedby the symptoms of the mind.
Dopamine Overactivity: Researchers found thatschizophrenic patients express higher levels of
dopamine D4 receptors in the brain.
Brain Abnormalities
11
Abnormal Brain Activity
Brain scans show abnormal activity in thefrontal cortex, thalamus, and amygdala of
schizophrenic patients.
Paul Thompson and A
rthur W. Toga, U
CLA Laboratory of N
euro Im
aging and Judith L. Rapport, National Institute of M
ental Health
Abnormal Brain Morphology
Schizophrenia patients may exhibitmorphological changes in the brain like
enlargement of fluid-filled ventricles.
Both Photos: Courtesy of Daniel R. W
einberger, M.D
., NIH
-NIM
H/ N
SC
Viral Infection
Schizophrenia has also been observed inindividuals who contracted a viral infection
(flu) during the middle of their fetaldevelopment.
Genetic Factors
The likelihood of an individual suffering fromschizophrenia is 50% if their identical twin has
the disease (Gottesman, 2001).
0 10 20 30 40 50Identical
Both parentsFraternal
One parentSibling
Nephew or nieceUnrelated
Genetic Factors
The following shows the prevalence ofschizophrenia in identical twins as seen in
different countries.
Psychological Factors
Psychological and environmental factors cantrigger schizophrenia if the individual is
genetically predisposed (Nicol & Gottesman,1983).
Genain Sisters
The genetically identicalGenain
sisters suffer fromschizophrenia. Two more than
others, thus there arecontributing environmental
factors.
Courtesy of G
enain Family
12
Personality Disorders
Personality disordersare characterized by
inflexible andenduring behavior
patterns that impairsocial functioning.They are usuallywithout anxiety,
depression, ordelusions.
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.
Symptoms May Include:
• Lack of empathy or affection.
• No regard for right and wrong.
• Using charm or wit to manipulate others.
• Intimidation of others.
•Violent or aggressive behavior.
Antisocial Personality Disorder Some have troublefunctioning normally insociety: trouble with
relationships and withthe law.
Others are very successful andmimicking emotion and general
deception.
Understanding AntisocialPersonality Disorder
Like mood disordersand schizophrenia,
antisocial personalitydisorder has biological
and psychologicalreasons. Youngsters,before committing acrime, respond withlower levels of stresshormones than others
do at their age.
Understanding AntisocialPersonality Disorder
PET scans of 41 murderers revealed reducedactivity 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
Rates of Psychological Disorders