Chapter 15

Psychological Disorders

Historical Perspective

• Perceived Causes– movements of sun or moon

• lunacy- full moon

– evil spirits

• Ancient Treatments– exorcism, caged like animals,

beaten, burned, castrated, mutilated, blood replaced with animal’s blood

Psychological Disorders

•Psychological Disorder– a “harmful dysfunction” in which

behavior is judged to be:•atypical- not enough in itself•disturbing- varies with time & culture•maladaptive- harmful•unjustifiable- sometimes there’s a good

reason

Insane• Legal Definitions:

• Not “Crazy”

Normal vs. Abnormal•The 3 D’s

–Distress (to self or others)–Disfunction (for person or society)

–Deviance (violates social norms)

Psychological Disorders• Medical Model

– concept that diseases have physical causes

– can be diagnosed, treated, and in most cases, cured

– assumes that these “mental” illnesses can be diagnosed on the basis of their symptoms and cured through therapy, which may include treatment in a psychiatric hospital

Psychological Disorders

• Bio-psycho-social Perspective– assumes that biological,

sociocultural, and psychological factors combine and interact to produce psychological disorders

– Need to also look at causes from each separate perspective as well!

Psychological Disorders- Etiology

• DSM-IV – TR (most recent version 2000)– American Psychiatric

Association’s Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)

– a widely used system for classifying psychological disorders

DSM IV-TR• Multi-axial

• Over 350 diagnostic categories classified along 5 dimensions or axes that take both the person and his/her life situation

DSM IV-TR• Axis I = primary diagnosis including patients

primary clinical symptoms present at the time• Axis 2 = reflect longstanding personality

disorders or retardation• Axis 3 = notes any medical conditions that

might be relevant (i.e. high blood pressure, concussion…)

• Axis 4 = rates intensity of psychosocial or environmental problems of patient’s life

• Axis 5 = patient’s coping resources/adaptive functioning

DSM IV-TR• Axis I = Panic disorder• Axis 2 = dependent personality disorder• Axis 3 = high blood pressure,

hypertension• Axis 4 = severe stressors: divorce, job

loss• Axis 5 = serious symptoms; fair overall

functioning

DSM IV

• Reliabilty clinicians using the system should show high levels of agreement in their diagnostic decisions

• Validity – diagnostic categories should accurately capture the essential features of various disorders

Vulnerability Stress Model• Vulnerability in all people toward

developing a psychological disorder, given sufficient stress.

• Diasthesis-Stress hypothesis - proposes that genetic factors place a person at risk while environmental stress factors transform the potential into an actual disorder

Psychological Disorders- Etiology

• Neurotic disorder (term seldom used now)

– usually distressing but that allows one to think rationally and function socially

– Freud saw the neurotic disorders as ways of dealing with anxiety

• Psychotic disorder– person loses contact with

reality– experiences irrational ideas

and distorted perceptions

Disorders vs. Psychosis• Disorders - for the most part, are

considered “transient situation disorders” (problems in everyday living) and have a generally positive prognosis.

• Psychosis - typically no cure, treatment often helps, but often requires hospitalization.

Anxiety Disorders

• General Characteristics

• Not just symptom, but depth and breadth of a collection of systems (syndrome)

Anxiety Disorders

• Anxiety Disorders – distressing, persistent anxiety

or maladaptive behaviors that reduce anxiety

• Generalized Anxiety Disorder– person is tense, apprehensive,

and in a state of autonomic nervous system arousal

• Phobia– persistent, irrational fear of a

specific object or situation

Anxiety Disorders

• Obsessive-Compulsive Disorder– characterized by unwanted repetitive thoughts

(obsessions) and/or actions (compulsions)• Panic Disorder

– marked by a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensation

• PTSD– Severe anxiety disorder that can occur in

people who have been exposed to traumatic life events

Anxiety Disorders

• PET Scan of brain of person with Obsessive/ Compulsive disorder

• High metabolic activity (red) in frontal lobe areas involved with directing attention

Somatoform & Dissociative Disorders

• Involve physical complaints or disabilities that suggest a medical problem but have no known biological cause and are not voluntarily produced by the person

• Soma = body– Body manifestations– Hypochondriasis– Pain disorders– Conversion disorders

• Malingering - faking it to escape responsibility

Dissociative Disorders

• Dissociative Disorders– conscious awareness becomes separated

(dissociated) from previous memories, thoughts, and feelings •psychogenic amnesia•psychogenic fuge

• Dissociative Identity Disorder (DID)– VERY rare dissociative disorder in which a

person exhibits two or more distinct and alternating personalities

– formerly called multiple personality disorder

Dissociative Disorder Causes• Frank Putnam’s trauma-

dissociation theory

–The development of new personalities occurs in response to severe stress

Mood Disorders (Affective Disorders)

• AFFECT - deals with mood or emotion

• “Flat Affect” - negative mood state or absence of emotions

• Dysthymia - the common cold of mental illness

Mood Disorders

• Mood Disorders – characterized by emotional

extremes• Major Depressive Disorder

– a mood disorder in which a person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities

Mood Disorders

• Manic Episode– a mood disorder marked by a

hyperactive, wildly optimistic state

• Bipolar Disorder– a mood disorder in which the

person alternates between the hopelessness and lethargy of depression and the overexcited state of mania

– formerly called manic-depressive disorder

Mood Disorders-Depression

Percentageof population

aged 18-84experiencing

majordepression

at somepoint In life

20

15

10

5

0

USA Edmonton Puerto Paris West Florence Beirut Taiwan Korea New Rico Germany Zealand

Around the worldwomen are more

susceptible todepression

Mood Disorders- Suicide

15-24 25-34 35-44 45-44 55-64 65-74 75-84 85+

Suicides per100,000 people

70

60

50

40

30

20

10

0

Males Females

The higher suicide rateamong men greatly increases in late adulthood

Mood Disorders-Suicide

• Increasing rates of teen suicide

1960 1970 1980 1990 2000Year

12%

10

8

6

4

2

0

Suicide rate,ages 15 to 19(per 100,000)

Mood Disorders-Bipolar

• PET scans show that brain energy consumption rises and falls with emotional swings

Depressed state Manic state Depressed state

Schizophrenia• Schizophrenia

– literal translation “split mind”

– Split from reality– Characterized by “pieces of

personality” and absence of “wholeness”

– Lay public’s idea of “split personality - actually DID• ***Not to know this shows

great ignorance!

Schizophrenia

• Schizophrenia

– a group of severe disorders characterized by:•disorganized and

delusional thinking•disturbed perceptions•inappropriate emotions

and actions

Schizophrenia

• Delusions– false beliefs, often of

persecution or grandeur, that may accompany psychotic disorders

• Hallucinations– false sensory

experiences such as seeing something without any external visual stimulus

SchizophreniaSubtypes of Schizophrenia

Paranoid: Preoccupation with delusions or hallucinations

Disorganized: Disorganized speech or behavior, or flat or inappropriate emotion

Catatonic: Immobility (or excessive, purposeless movement), extreme negativism, and/or parrot-like repeating of

another’s speech or movements

Undifferentiated Schizophrenia symptoms without fitting one of the or residual: above types

Schizophrenia

Lifetime riskof developingschizophrenia

for relatives of

a schizophrenic

4

0

3

0

2

0

1

0

0

Generalpopulation

Siblings Children Fraternaltwin

Childrenof two

schizophrenia

victims

Identicaltwin

Personality Disorders• Distinct enough to have their

own category in the DSM• Personality Disorders

– disorders characterized by inflexible and enduring patterns of maladaptive behavior that impair social functioning

– usually without anxiety, depression, or delusions

Personality Disorders• Resistant to change

– “Ingrained Patterns”

Personality Disorders

• Antisocial Personality Disorder– disorder in which the person

(usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members

– may be aggressive and ruthless or a clever con artist

– Not against being social, but against social norms of a culture

– Commonly hear about Serial killers– Tend to be charming, manipulative,

and persistently violate the rights of others

Personality Disorders• PET scans illustrate reduced activation in a

murderer’s frontal cortexNormal Murderer

Childhood Disorders

• Autism– Biological foundations, but no cause

determined

ADD/ADHDSome genetic components possible May not go away in adulthood

Rates of Psychological Disorders

Percentage of Americans Who Have Ever Experienced Psychological Disorders

Disorder White Black Hispanic Men Women Totals

Ethnicity Gender

Alcohol abuse or dependence 13.6% 13.8% 16.7% 23.8% 4.6% 13.8%Generalized anxiety 3.4 6.1 3.7 2.4 5.0 3.8Phobia 9.7 23.4 12.2 10.4 17.7 14.3Obsessive-compulsive disorder 2.6 2.3 1.8 2.0 3.0 2.6Mood disorder 8.0 6.3 7.8 5.2 10.2 7.8Schizophrenic disorder 1.4 2.1 0.8 1.2 1.7 1.5Antisocial personality disorder 2.6 2.3 3.4 4.5 0.8 2.6