Copyright © 2007 Pearson Education Canada 1 Psychological Disorders Chapter 16

Copyright © 2007 Pearson Education Canada

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Psychological DisordersPsychological Disorders

Chapter 16Chapter 16


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Chapter OutlineChapter Outline

• Defining and diagnosing disorderDefining and diagnosing disorder

• Anxiety disordersAnxiety disorders

• Mood disordersMood disorders

• Personality disordersPersonality disorders

• Drug abuse and addictionDrug abuse and addiction

• Dissociative identity disorderDissociative identity disorder

• SchizophreniaSchizophrenia


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Defining and Diagnosing Defining and Diagnosing DisorderDisorder

• Dilemmas of definitionDilemmas of definition

• Dilemmas of diagnosisDilemmas of diagnosis

• Dilemmas of measurementDilemmas of measurement


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Dilemmas of DefinitionDilemmas of Definition

• Possible Models for Defining Disorders:Possible Models for Defining Disorders:– Mental disorder as a violation of cultural Mental disorder as a violation of cultural

standardsstandards– Mental disorder as maladaptive or harmful Mental disorder as maladaptive or harmful

behaviourbehaviour– Mental disorder as emotional distressMental disorder as emotional distress


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Mental DisorderMental Disorder

• Any behaviour or emotional state that causes Any behaviour or emotional state that causes an individual great suffering or worry, is self-an individual great suffering or worry, is self-defeating or self-destructive, or is defeating or self-destructive, or is maladaptive and disrupts the person’s maladaptive and disrupts the person’s relationships or the larger communityrelationships or the larger community


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Diagnostic and Statistical ManualDiagnostic and Statistical Manual

• Axis I: Primary clinical problem Axis I: Primary clinical problem

• Axis II: Personality disorders Axis II: Personality disorders

• Axis III: General medical conditions Axis III: General medical conditions

• Axis IV: Social and environmental Axis IV: Social and environmental stressors stressors

• Axis V: Global assessment of overall Axis V: Global assessment of overall functioning functioning


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Explosion of Mental DisordersExplosion of Mental Disorders

• Supporters of new Supporters of new categories answer that categories answer that is important to is important to distinguish disorders distinguish disorders preciselyprecisely

• Critics point to an Critics point to an economic reason: economic reason: diagnoses are needed diagnoses are needed for insurance reasons for insurance reasons so therapists will be so therapists will be compensatedcompensated


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Problems with DSMProblems with DSM• The danger of overdiagnosisThe danger of overdiagnosis

• The power of diagnostic labelsThe power of diagnostic labels

• Confusion of serious mental disorders Confusion of serious mental disorders with normal problemswith normal problems

• The illusion of objectivity and The illusion of objectivity and universalityuniversality


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Advantages of the DSMAdvantages of the DSM

• When the manual is used correctly and When the manual is used correctly and diagnoses are made with valid objective diagnoses are made with valid objective tests, the DSM improves the reliability of tests, the DSM improves the reliability of and agreement among cliniciansand agreement among clinicians

• The DSM-IV included for the first time a The DSM-IV included for the first time a list of culture-bound syndromes, list of culture-bound syndromes, disorders specific to a particular culturedisorders specific to a particular culture


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Anxiety DisordersAnxiety Disorders

• Generalized Anxiety Disorder Generalized Anxiety Disorder – A continuous state of anxiety marked by feelings A continuous state of anxiety marked by feelings

of worry and dread, apprehension, difficulties in of worry and dread, apprehension, difficulties in concentration, and signs of motor tensionconcentration, and signs of motor tension

• Panic DisorderPanic Disorder– An anxiety disorder in which a person experiences An anxiety disorder in which a person experiences

recurring panic attacks, feelings of impending recurring panic attacks, feelings of impending doom or death, accompanied by physiological doom or death, accompanied by physiological symptoms such as rapid breathing and dizzinesssymptoms such as rapid breathing and dizziness


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Posttraumatic Stress Disorder (PTSD)Posttraumatic Stress Disorder (PTSD)

• An anxiety disorder in which a person who has An anxiety disorder in which a person who has experienced a traumatic or life-threatening experienced a traumatic or life-threatening event has symptoms such as psychic numbing, event has symptoms such as psychic numbing, reliving the trauma, and increased physiological reliving the trauma, and increased physiological arousalarousal

• Diagnosed only if symptoms persist for 6 Diagnosed only if symptoms persist for 6 months or longermonths or longer

• May immediately follow event or occur laterMay immediately follow event or occur later


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Panic DisorderPanic Disorder

• An anxiety disorder in An anxiety disorder in which a person which a person experiences recurring experiences recurring panic attacks, feelings panic attacks, feelings of impending doom or of impending doom or death, accompanied death, accompanied by physiological by physiological symptoms such as symptoms such as rapid breathing and rapid breathing and dizzinessdizziness


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Fears and PhobiasFears and Phobias

• PhobiaPhobia– An exaggerated, unrealistic fear of a An exaggerated, unrealistic fear of a

specific situation, activity, or objectspecific situation, activity, or object


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AgoraphobiaAgoraphobia

• A set of phobias, often set off by a panic A set of phobias, often set off by a panic attack, involving the basic fear of being attack, involving the basic fear of being away from a safe place or personaway from a safe place or person


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Obsessive-Compulsive Disorder (OCD)Obsessive-Compulsive Disorder (OCD)

• An anxiety disorder in which a person An anxiety disorder in which a person feels trapped in repetitive, persistent feels trapped in repetitive, persistent thoughts (thoughts (obsessionsobsessions) and repetitive, ) and repetitive, ritualized behaviours (ritualized behaviours (compulsionscompulsions) ) designed to reduce anxietydesigned to reduce anxiety

• Person understands that the ritual Person understands that the ritual behaviour is senseless but guilt mounts behaviour is senseless but guilt mounts if not performedif not performed


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Mood DisordersMood Disorders

• Depression Depression

• Bipolar DisorderBipolar Disorder

• Theories of DepressionTheories of Depression


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DepressionDepression

• Major Depression Major Depression – A mood disorder involving disturbances in A mood disorder involving disturbances in

emotion (excessive sadness), behaviour emotion (excessive sadness), behaviour (loss of interest in one’s usual activities), (loss of interest in one’s usual activities), cognition (thoughts of hopelessness), and cognition (thoughts of hopelessness), and body function (fatigue and loss of appetite)body function (fatigue and loss of appetite)


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Symptoms of DepressionSymptoms of Depression• Depressed moodDepressed mood• Reduced interest in almost all activitiesReduced interest in almost all activities• Significant weight gain or loss, without dietingSignificant weight gain or loss, without dieting• Sleep disturbance (insomnia or too much sleep)Sleep disturbance (insomnia or too much sleep)• Change in motor activity (too much or too little)Change in motor activity (too much or too little)• Fatigue or loss of energyFatigue or loss of energy• Feelings of worthlessness or guiltFeelings of worthlessness or guilt• Reduced ability to think or concentrateReduced ability to think or concentrate• Recurrent thoughts of deathRecurrent thoughts of death DSM IV Requires 5 of these

within the past 2 weeks


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Gender, Age, & DepressionGender, Age, & Depression

• Women are about twice Women are about twice as likely as men to be as likely as men to be diagnosed with diagnosed with depressiondepression– True around the worldTrue around the world

• After age 65, rates of After age 65, rates of depression drops depression drops sharply in both sexessharply in both sexes


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Bipolar DisorderBipolar Disorder

• A mood disorder in which episodes of A mood disorder in which episodes of depression and mania (excessive euphoria) depression and mania (excessive euphoria) occuroccur


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The Bipolar BrainThe Bipolar Brain

• Bipolar disorder can Bipolar disorder can have rapid mood have rapid mood swingsswings

• These wild changes These wild changes are shown in brain are shown in brain activity (right)activity (right)


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Biological Theories of DepressionBiological Theories of Depression

• Studies of adopted children support genetic Studies of adopted children support genetic explanations of depressionexplanations of depression

• 5-HTT is a gene that is present in either a long or 5-HTT is a gene that is present in either a long or short formshort form– 17% of individuals with the long form become severely 17% of individuals with the long form become severely

depresseddepressed– 43% of Individuals with 2 copies of the short form 43% of Individuals with 2 copies of the short form

become depressedbecome depressed

• Genetics may also influence levels of serotonin Genetics may also influence levels of serotonin and other neurotransmittersand other neurotransmitters


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Life Experiences and CircumstancesLife Experiences and Circumstances

• Social explanations emphasize the Social explanations emphasize the stressful circumstances of people’s stressful circumstances of people’s lives. Examples include:lives. Examples include: – Loss of or problems with important Loss of or problems with important

relationships throughout liferelationships throughout life– Psychologists investigating sex Psychologists investigating sex

differences for depression have ruled out differences for depression have ruled out hormones and genetics and are now hormones and genetics and are now investigating life circumstancesinvestigating life circumstances• Women are less satisfied with work and Women are less satisfied with work and

family and more likely to live in povertyfamily and more likely to live in poverty


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Cognitive HabitsCognitive Habits

• Cognitive explanations Cognitive explanations emphasize particular emphasize particular habits of thinking and habits of thinking and ways of interpreting ways of interpreting eventsevents

• Depressed people believe Depressed people believe their situation is their situation is permanent and permanent and uncontrollableuncontrollable

• Rumination involves Rumination involves brooding about negative brooding about negative aspects of one’s lifeaspects of one’s life


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Vulnerability-Stress Vulnerability-Stress ModelModel

• ““Vulnerability-Stress” Vulnerability-Stress” explanations draw on explanations draw on all four explanations all four explanations described abovedescribed above


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Personality DisordersPersonality Disorders

• Problem PersonalitiesProblem Personalities

• Antisocial Personality DisorderAntisocial Personality Disorder


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Problem PersonalitiesProblem Personalities

• Personality DisorderPersonality Disorder– Rigid, maladaptive patterns that cause personal Rigid, maladaptive patterns that cause personal

distress or an inability to get along with othersdistress or an inability to get along with others

• Narcissistic Personality DisorderNarcissistic Personality Disorder– A disorder characterized by an exaggerated sense A disorder characterized by an exaggerated sense

of self-importance and self-absorptionof self-importance and self-absorption

• Paranoid Personality DisorderParanoid Personality Disorder– A disorder characterized by habitually A disorder characterized by habitually

unreasonable and excessive suspiciousness and unreasonable and excessive suspiciousness and jealousyjealousy


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Problem PersonalitiesProblem Personalities

• Borderline Personality DisorderBorderline Personality Disorder– A disorder characterized by intense but A disorder characterized by intense but

unstable relationships, a fear of unstable relationships, a fear of abandonment by others, an unrealistic self-abandonment by others, an unrealistic self-image, and emotional volatility image, and emotional volatility


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Antisocial Personality Disorder (APD)Antisocial Personality Disorder (APD)

• A disorder characterized by antisocial A disorder characterized by antisocial behaviour such as lying, stealing, behaviour such as lying, stealing, manipulating others, and sometimes manipulating others, and sometimes violence; and a lack of guilt, shame and violence; and a lack of guilt, shame and empathyempathy– Sometimes called psychopathy or Sometimes called psychopathy or

sociopathysociopathy

• Occurs in 3% of all males and 1% of all Occurs in 3% of all males and 1% of all femalesfemales


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Emotions and Emotions and Antisocial Personality DisorderAntisocial Personality Disorder

• People with APD were People with APD were slow to develop slow to develop classically conditioned classically conditioned responses to anger, responses to anger, pain, or shockpain, or shock

• Such responses Such responses indicate normal indicate normal anxietyanxiety


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DSM Criteria for APDDSM Criteria for APD• Must have 3 of these criteria and a history of Must have 3 of these criteria and a history of

behavioursbehaviours– Repeatedly break the lawRepeatedly break the law– They are deceitful, using aliases and lies to con othersThey are deceitful, using aliases and lies to con others– They are impulsive and unable to plan aheadThey are impulsive and unable to plan ahead– They repeatedly get into physical fights or assaultsThey repeatedly get into physical fights or assaults– They show reckless disregard for own safety or that of They show reckless disregard for own safety or that of

othersothers– They are irresponsible, failing to meet obligations to They are irresponsible, failing to meet obligations to

othersothers– They lack remorse for actions that harm othersThey lack remorse for actions that harm others


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Causes of APDCauses of APD

• Abnormalities in central nervous systemAbnormalities in central nervous system• Genetically influenced problems with impulse Genetically influenced problems with impulse

controlcontrol• Brain damageBrain damage


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Drug Abuse and AddictionDrug Abuse and Addiction

• Biology and addictionBiology and addiction

• Learning, culture, and addictionLearning, culture, and addiction

• Debating the causes of addictionDebating the causes of addiction


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Biology and AddictionBiology and Addiction

• The biological model holds that The biological model holds that addiction, whether to alcohol or other addiction, whether to alcohol or other drugs is due primarily to:drugs is due primarily to:– a person’s biochemistry, a person’s biochemistry, – metabolism, and metabolism, and – genetic predisposition.genetic predisposition.

• Most evidence comes from twin studiesMost evidence comes from twin studies


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The Addicted BrainThe Addicted Brain


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Learning, Culture, and AddictionLearning, Culture, and Addiction

• Addiction patterns vary according to cultural Addiction patterns vary according to cultural practices and the social environmentpractices and the social environment

• Policies of total abstinence tend to increase Policies of total abstinence tend to increase addiction rates rather than reduce themaddiction rates rather than reduce them

• Not all addicts have withdrawal symptoms Not all addicts have withdrawal symptoms when they stop taking a drugwhen they stop taking a drug

• Addiction does not depend on the properties Addiction does not depend on the properties of the drug alone, but also on the reason for of the drug alone, but also on the reason for taking ittaking it


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Debating the Causes of AddictionDebating the Causes of Addiction

• Has a physiological vulnerability to a drugHas a physiological vulnerability to a drug• Believes she or he has no control over the Believes she or he has no control over the

drugdrug• Is encouraged to take the drug in binges, and Is encouraged to take the drug in binges, and

moderate use is neither tolerated nor taughtmoderate use is neither tolerated nor taught• Comes to rely on the drug as a method of Comes to rely on the drug as a method of

coping with problems, suppressing anger or coping with problems, suppressing anger or fear, or relieving painfear, or relieving pain

• Has a peer group using drugs or drinking Has a peer group using drugs or drinking heavilyheavily


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Dissociative Identity DisorderDissociative Identity Disorder

• Defining identity disordersDefining identity disorders

• The MPD controversyThe MPD controversy

• The sociocognitive explanationThe sociocognitive explanation


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Dissociative Identity DisordersDissociative Identity Disorders

• A controversial disorder marked by the A controversial disorder marked by the appearance within one person of two or appearance within one person of two or more distinct personalities, each with its more distinct personalities, each with its own name and traits; commonly known own name and traits; commonly known as “Multiple Personality Disorder as “Multiple Personality Disorder (MPD)”(MPD)”


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The MPD ControversyThe MPD Controversy• First viewFirst view

– MPD is common but often unrecognized or MPD is common but often unrecognized or misdiagnosedmisdiagnosed

– The disorder starts in childhood as means of The disorder starts in childhood as means of copingcoping

– Trauma produced a mental splittingTrauma produced a mental splitting• Second viewSecond view

– Created through pressure and suggestions by Created through pressure and suggestions by cliniciansclinicians

– Since 1980, diagnoses increased from a handful Since 1980, diagnoses increased from a handful to tens of thousandsto tens of thousands


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Sociocognitive ExplanationSociocognitive Explanation

• MPD is an extreme form of our ability to MPD is an extreme form of our ability to present many aspects of our personalities to present many aspects of our personalities to othersothers

• MPD is a socially acceptable way for some MPD is a socially acceptable way for some troubled people to make sense of their troubled people to make sense of their problemsproblems

• Therapists looking for MPD may reward Therapists looking for MPD may reward patients with attention and praise for patients with attention and praise for revealing more and more personalitiesrevealing more and more personalities


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SchizophreniaSchizophrenia

• Symptoms of schizophreniaSymptoms of schizophrenia

• Theories of schizophreniaTheories of schizophrenia


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Symptoms of SchizophreniaSymptoms of Schizophrenia

• Bizarre delusionsBizarre delusions

• Hallucinations and heightened sensory Hallucinations and heightened sensory awarenessawareness

• Disorganized, incoherent speech Disorganized, incoherent speech

• Grossly disorganized and inappropriate Grossly disorganized and inappropriate behaviourbehaviour


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Delusions and HallucinationsDelusions and Hallucinations

• DelusionsDelusions– False beliefs that often accompany False beliefs that often accompany

schizophrenia and other psychotic schizophrenia and other psychotic disordersdisorders

• HallucinationsHallucinations– Sensory experiences that occur in the Sensory experiences that occur in the

absence of actual stimulationabsence of actual stimulation


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Positive SymptomsPositive Symptoms

• Cognitive, emotional, and behavioural Cognitive, emotional, and behavioural excessesexcesses– Examples of Positive SymptomsExamples of Positive Symptoms

• HallucinationsHallucinations• Bizarre delusionsBizarre delusions• Incoherent speechIncoherent speech• Inappropriate/Disorganized behavioursInappropriate/Disorganized behaviours


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Negative SymptomsNegative Symptoms

• Cognitive, emotional, and behavioural Cognitive, emotional, and behavioural deficitsdeficits

• Examples of Negative SymptomsExamples of Negative Symptoms– Loss of motivationLoss of motivation– Emotional flatnessEmotional flatness– Social withdrawalSocial withdrawal– Slowed speech or no speechSlowed speech or no speech


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Theories of SchizophreniaTheories of Schizophrenia

• Genetic predispositionsGenetic predispositions

• Structural brain abnormalitiesStructural brain abnormalities

• Neurotransmitter abnormalitiesNeurotransmitter abnormalities

• Prenatal abnormalitiesPrenatal abnormalities

• Adolescent abnormalities in brain Adolescent abnormalities in brain developmentdevelopment


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Genetic Vulnerability to SchizophreniaGenetic Vulnerability to Schizophrenia

• The risk of developing The risk of developing schizophrenia (i.e., schizophrenia (i.e., prevalence) in one’s prevalence) in one’s lifetime increases as lifetime increases as the genetic relatedness the genetic relatedness with a diagnosed with a diagnosed schizophrenic schizophrenic increasesincreases


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Structural Brain AbnormalitiesStructural Brain Abnormalities

• Several abnormalities exist, especially when Several abnormalities exist, especially when schizophrenia is characterized by primarily schizophrenia is characterized by primarily negative symptoms:negative symptoms:– Decreased brain weightDecreased brain weight– Decreased volume in temporal lobe or Decreased volume in temporal lobe or

hippocampushippocampus– Enlargement of ventriclesEnlargement of ventricles

• About 25% do not have these observable About 25% do not have these observable brain deficienciesbrain deficiencies


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Schizophrenia and the BrainSchizophrenia and the Brain


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Neurotransmitter AbnormalitiesNeurotransmitter Abnormalities

• Include serotonin, glutamate, and dopamineInclude serotonin, glutamate, and dopamine• Many schizophrenics have high levels of Many schizophrenics have high levels of

brain activity in brain areas served by brain activity in brain areas served by dopamine as well as greater numbers of dopamine as well as greater numbers of particular dopamine receptorsparticular dopamine receptors

• Similar neurotransmitter abnormalities are Similar neurotransmitter abnormalities are also found in depression and alcoholismalso found in depression and alcoholism


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Prenatal or Birth ComplicationsPrenatal or Birth Complications

• Damage to the fetal brain increases Damage to the fetal brain increases chances of schizophrenia and other chances of schizophrenia and other mental disordersmental disorders– May occur as a function of maternal May occur as a function of maternal

malnutrition, maternal illnessmalnutrition, maternal illness– May also occur if brain injury or oxygen May also occur if brain injury or oxygen

deprivation occurs at birthdeprivation occurs at birth


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Adolescent Abnormalities in Brain Adolescent Abnormalities in Brain DevelopmentDevelopment

• Normal pruning of excessive synapses Normal pruning of excessive synapses in the brain occurs during adolescencein the brain occurs during adolescence

• In schizophrenics, a greater number of In schizophrenics, a greater number of synapses are pruned awaysynapses are pruned away– Many explain why first episode occurs in Many explain why first episode occurs in

adolescence or early adulthoodadolescence or early adulthood

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Copyright © 2007 Pearson Education Canada 1 Psychological Disorders Chapter 16