Myers’ PSYCHOLOGY

(7th Ed)

Chapter 16

Psychological Disorders

James A. McCubbin, PhDClemson University

Worth Publishers

Psychological Disorders

Psychological Disordera “harmful dysfunction” in which behavior is judged to be:atypical--not enough in itselfdisturbing--varies with time and culture

maladaptive--harmfulunjustifiable--sometimes there’s a good reason

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

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 Perspectiveassumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders

Psychological Disorders

Psychological Disorders--Etiology

DSM-IV American Psychiatric Association’s

Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)

a widely used system for classifying psychological disorders

presently distributed as DSM-IV-TR (text revision)

Psychological Disorders- Etiology

Neurotic Disorder (term seldom used now) usually distressing but that allows

one to think rationally and function socially

Psychotic Disorder person loses contact with reality experiences irrational ideas and

distorted perceptions

What is abnormal behavior?

Psychologists typically identify abnormal behavior based on a combination of the following criteria:

UnusualnessSocial devianceEmotional DistressMaladaptive BehaviorDangerousnessFaulty perceptions/interpretations of

reality

Unusualness

Behavior that is experienced by only a few people may be abnormal, but not in all cases.

Unusualness, by itself, is not enough to be called abnormal.

Social Deviance

All societies establish social norms that define socially acceptable behaviors.

Deviation from these norms is often used as a criterion for labeling behavior as abnormal.

The same behavior might be considered abnormal in some contexts but acceptable in others.

Emotional DistressStates of emotional distress, such

as anxiety or depression are considered abnormal when: Inappropriate Excessive Prolonged

(relative to the person’s situation)

Maladaptive Behavior

Behavior is maladaptive when: it causes personal distress is self-defeating is associated with significant health or

social problems (alcohol or drug abuse)

Dangerousness

Violent or dangerous behavior needs to be looked at in context

Faulty perceptions or interpretations of reality

Hallucinations: distorted perceptions of reality (seeing or hearing things that are not real)

Delusions: Fixed but unfounded beliefs are also distortions of reality (believing people are plotting against you)

Cultural context must be considered

The cultural context in which behavior occurs must also be evaluated when making judgments about whether behavior is abnormal.

Is this abnormal behavior?

Psychological Disorders

Anxiety Disorders: Generalized Anxiety Disorder Panic Disorder Phobic Disorder Post-traumatic Stress Disorder Obsessive Compulsive Disorder

Generalized Anxiety Disorder:

GAD is characterized by persistent anxiety, unrelated to a specific event.

People suffering from GAD cannot help worrying about anything and everything, even in calm situations.

They have difficulty relaxing, falling asleep, and/or concentrating, and tend to be impatient and irritable.

Physical symptoms accompanying GAD include: sweating; an upset stomach; diarrhea;

frequent urination; cold, clammy hands; a lump in the throat; a dry mouth; shortness of breath; headaches; and dizziness.

Managing the normal demands of a job, relationships, and everyday life can become more and more difficult for people with this disorder.

GAD appears in four percent of the general population.

Panic DisorderPanic attacks are sudden, unexplainable

waves of panic that seem to come out of the blue.

The body responds with the "fight-or-flight" response, anticipating clear and immediate danger.

Often, these attacks subside as mysteriously as they occur.

A person who has experienced one or more panic attacks often develops a fear of having one again.

Some professionals call this a "fear of fear."

The individual may even try to stay away from anything that reminds him or her of the last attack to avoid having another one.

People can have panic attacks with or without agoraphobia.

These attacks include symptoms such as heart palpitations, shortness of breath, chest pain, feelings of choking or smothering, nausea, dizziness, sweating, and trembling.

An afflicted person might also be overwhelmed by a fear of dying, going crazy, or losing control.

Phobias:

Phobias are attempts to compartmentalize fear into a few situations that can be avoided.

By attaching all the panicky feelings onto a few situations, the person can avoid those situations and go on with life.

Unfortunately, phobias can take on a life of their own and take over more and more of a person's life.

A fear of dogs can, for example, be fairly easy to manage, just don't go near dogs.

But a fear of flying may limit social and business opportunities.

Some of the more common phobias include claustrophobia (fear of closed spaces), agoraphobia (fear of public places, sometimes related to panic attacks), and acrophobia (fear of heights).

Posttraumatic Stress Disorder:

Posttraumatic stress disorder (PTSD) can develop in the wake of a traumatic event that is outside the usual human experience.

A person either experiences direct or threatened injury, or witnesses the serious injury or death of another.

In some cases, learning of the unexpected death or injury of a loved one can also bring on symptoms of PTSD.

For a diagnosis of PTSD to be made, there must be both an identifiable terrifying event and a response of intense fear, helplessness and horror, as well as one or more characteristic symptoms.

These include re-experiencing of the event through: nightmares daytime flashbacks physical sensations that recall the feelings

present during the event.

PTSD Symptoms continuedShutting down feelings and memory. Feeling detached from others. Dissociating from the distressing memories

and feelings.Hyperalertness to danger. The individual

often has difficulty shutting down the fight-or-flight response that was activated during the event. This causes sleeplessness, irritability, difficulty concentrating, restlessness, and sometimes the development of an exaggerated startle.

Hypervigilance and avoidance of any situation associated with the event. These symptoms significantly disrupt an afflicted

person’s daily life.

Obsessive-Compulsive DisorderAlthough classified as an anxiety disorder,

obsessive-compulsive disorder (OCD) differs from these disorders in significant ways.

It is the one anxiety diagnosis that seems to have a clear biological cause. Unlike the other kinds of anxiety disorders, therapy alone isn't much help. Medication is also necessary.

OCD is a disorder in which the mind is flooded with involuntary thoughts, or in which an individual feels compelled to repeat certain acts over and over again (for example, hand washing).

This disorder can interfere significantly with everyday living, and usually leads to concern and/or resentment among friends, family, and co-workers.

A person who suffers from OCD doesn't want the thoughts and doesn't want to do the behaviors. Unfortunately, he or she really can't help it.

About half the people with OCD report that it began in childhood; most others start in adolescence or early adulthood. OCD affects approximately two percent of the general population.

Anxiety Disorders Common and uncommon fears

Anxiety Disorders

Anxiety Disorders

PET Scan of brain of person with Obsessive/ Compulsive disorder

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

Two Broad Categories of Mood Disorders

Depressive DisordersBipolar Disorders

Depressive Disorders

(1) Major Depressive Disorder (major depression) The most common type of depressive

disorder. Characterized by periods of downcast

mood, feelings of worthlessness, and loss of interest in pleasurable activities.

Is more common in women

Depressive Disorders Continued

(2) Seasonal Affective Disorder (SAD) A type of major depression that

involves a recurring pattern of Winter depressions followed by elevations in mood in the Spring and Summer.

More common in extreme northern climates

Depressive Disorders Continued

(3) Dysthymic Disorder A relatively mild but chronic form of

depression Can last for months or years More common in women

Bipolar Disorders

Characterized by alternating moods that shift between euphoric feelings and depression.

There are two major types: (1) Bipolar disorder (2) Cyclothymic disorder

Bipolar Disorder

Formerly called manic depressionInvolves mood swings that shift between

elevated moods or “euphoria” “manic” episodes and depression.

People with this disorder experience normal moods also. Examples of manic behavior:

Extreme restlessness argumentativenessExcitability lavish spendingTalkativeness reckless drivingTaking on tasks beyond a person’s ability

Bipolar Continued

Mania eventually gives way to depression: Feelings of hopelessness and despair Suicidal feelings

About 1% of the adult population in the U.S. suffers from bipolar disorder.

Cyclothymic Disorder

A mood disorder characterized by milder mood swings than bipolar disorder.

It is about as common as bipolar disorder.

Causes of Mood Disorders

There are several possible causes which may occur separately or together to cause mood disorders:

Biological Causes

Brain chemicals: Neurotransmitters serotonin and norepinephrine may be too low in depressed people.

Genetic factors: There is a family connection

Faulty brain structure and function: Research is being done in this area to see if the structures responsible for emotions, etc. are different in depressed people.

Psychological Factors

Each approach to psychology has a theory of what causes depression. Psychodynamic Theory (Freud) says

depression is the result of anger turned inward against the self.

Learning Theory (Behaviorist) Depression is the result of changes in reinforcement levels.

Cognitive Theory: Says the way people interpret events, and distorted thinking can cause depression.

Learned Helplessness Theory: Says people become depressed when they feel powerless to control aspects of their lives

Mood Disorders-Depression

Mood Disorders-Depression

Canadian depression rates

Mood Disorders- Suicide

Mood Disorders-Bipolar

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

Depressed state Manic state Depressed state

Mood Disorders-Depression

Altering any one component of the chemistry-cognition-mood circuit can alter the others

Mood Disorders-Depression

The vicious cycle of depression can be broken at any point

Somatoform Disorders

Somatoform Disorders

Physical symptoms for which there is no apparent physical cause.

Sick Role

Have you ever “played sick” in order to get out of something? How did that work out (did you get what you wanted)?

Sick attention (friends, family, medical) = secondary gains

Likely link between secondary gains and somatoform disorders

Some medical condition may actually exist

Types of Somatoform Disorders

1. Somatization Disorder Known as “Hysteria,” “hypochondriasis,” and

“melancholia” until 1800’s Term “somatization disorder” was first used in

DSM-III (1980)

Diagnosis

DSM-IV criteria History of many physical complaints beginning before age 30 occurring over several years resulting in treatment being sought or significant impairment in functioning.

Additional info

Primary relationships are with doctors; personal relationships usually have problems

Physical symptoms become part of their identity

This disorder is chronic and rarely goes away completely

Causes of Somatization

Genetic Genetic influence (30-50%) on

somatization symptomsSocial learning Parents may reinforce somatic

complaints in children gain attention (sick role)Societal

More acceptance of medical vs. psychological problems

Types of Somatoform Disorders, cont.

2. Conversion Disorder• Changing emotional difficulties into a loss

of a specific voluntary body function.• Loss of function is real, but no physical

damage is present.• Can be persistent, lasting for years.• Examples: paralysis, loss of sight or

hearing, loss of speech• May free the person from dealing with

difficult emotional situations.

Dissociative Disorders

Dissociative Disorders

Involve disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment

What are some “normal” dissociative experiences that people have sometimes? You dissociate sometimes when you “space

out” while driving, reading, watching t.v., etc.

Dissociative Identity Disorder (DID)

Formerly known as multiple personality disorder

DSM-IV criteriaA. presence of 2 or more distinct identities or personality statesB. At least 2 identities/personalities recurrently take control of the person’s behavior

DSM-IV criteria (cont.)

C. Inability to recall important personal information (goes beyond ordinary forgetfulness)D. Not due to effects of a substance; in children, symptoms not attributable to imaginary playmates or fantasy play

Additional descriptive info

Alter = identity or personality in DID Many have at least 1 impulsive alter Alters of the opposite gender are

common

Switch = transition to another identity

DID (cont.)

- more common among women

- number of identities varies:- women average about 15- men average about 8

- dissociation can be spurred by stress

DID (cont.)

Causes- almost every DID case has history of severe sexual or physical abuse dissociation seems to be a defense

- may be extreme form of PTSD- biological influences not clear

- very few twin studies suggest environment is more influential

than genes

Causes (cont.)

Most are highly suggestible; easily hypnotized

DID (cont.)

Treatment- similar to treatment of PTSD

- exposure to traumatic memories; goal is desensitization and prevention of response (dissociation)

Other Dissociative Disorders

Dissociative Amnesia: the inability to recall important personal events or information; is usually associated with stressful events

Dissociative Fugue: a person suddenly travels away from home or work and is unable to recall the past

Summary

Somatoform disorders involve a focus on physical symptoms that are either not real or are exaggerated

Dissociative disorders involve a disturbance in normally integrated functions (memory, identity, etc.)

Course is usually chronicCauses for most are unknown

Dissociative Disorders

Dissociative Disorders conscious awareness becomes separated

(dissociated) from previous memories, thoughts, and feelings

Dissociative Identity Disorder rare dissociative disorder in which a

person exhibits two or more distinct and alternating personalities

formerly called multiple personality disorder

Schizophrenia

Schizophrenia literal translation “split mind” 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 sensory experiences without

sensory stimulation

Schizophrenia

A thought Disorder

Schizophrenia

It is a disease that affects 1% of the world’s population

It has more impact on urban people than rural people

It is a disease that affects men and women equally

It is a disease of the brain

Schizophrenia is not caused by:

Inadequate parenting Overzealous mothers Poor family relations It is not split personality

Schizophrenia and Genetics

70% of persons who develop schizophrenia have a genetic basis for it. Usually, there is a relative who has the disease.

The closer in relation to the ill person, the more likely one is to get the disease.

Schizophrenia and Genetics

If you have an identical twin who has schizophrenia, you have a 50% chance of developing schizophrenia.

Schizophrenia: Three Types

Paranoid typeCatatonic typeDisorganized type

Paranoid Schizophrenia: the affected person may:

Talk to himself Gesture to himself Become preoccupied with idea that he/she is

being followed or watchedHear voices (possibly from “the devil” or “God”)Develop elaborate delusions and believe

outrageous things (such as aliens from another planet have invaded his/her body).

Paranoid Schizophrenia: the affected person may:

See things like dark figures, bugs or spotsFeel people are out to get them Believe in all sorts of conspiracies Have ideas that no amount of evidence to

the contrary can dislodge

Catatonic Schizophrenia: the affected person may:

Seem almost frozen and unable to move at times

Stop talking or greatly reduce conversation Appear lazy, unmotivated and uninterested

“out of it”Become completely detached from reality

and have no sense of anything going on around them.

Disorganized Schizophrenia: the affected person may:

Talk in jumbled sentencesBe essentially incoherent in their

speechSuffer from an inability to keep track

of his/her thought processes and will jump from subject to subject

Become detached from what is happening around them

Schizophrenia is often described in terms of positive (not meaning good) and negative (not meaning bad) symptoms

Positive symptoms include delusions and hallucinations

Negative symptoms are the loss or absence of normal traits or abilities, and include flat affect and emotion, and lack of motivation.

A third symptom grouping, the disorganization syndrome, includes chaotic speech, thought, and behavior.

Schizophrenia treatment

BiologicalPsychologicalSocial

Schizophrenia Treatment: Biological

Medications called antipsychotic (not “antischizophrenic”) they deal with some of the symptoms

delusions, hallucinations, disorganized behaviorThese drugs work by blocking dopamine receptors

in the brain.

Schizophrenia Treatment: Psychological

Patients will need therapy supportive “digging deep” can help some, but that is the

exception, not the rule

Schizophrenia Treatment: Psychological

Those who have family benefit most from families who: are informed about the illness have support Have skills to deal with the ill family member

Schizophrenia Treatment: Psychological

Family member skills: low key low demand use simple sentences able to ignore the inconsequential features of the

illness are able to respond to dangerous behavior can accept that their ill family member may never

be like he once was

Schizophrenia Treatment: Social

Rehabilitation Social skills training Vocational assistanceEnvironmental modification

reduce stimuli

Schizophrenia

Schizophrenia

PERSONALITY DISORDERS

A class of psychological disorders characterized by rigid personality traits that impair people’s ability to adjust to the demands they face in the environment and that interfere with their relationships with others.

Cluster A (odd, eccentric) personality disorders

PARANOID PERSONALITY DISORDER

High levels of suspiciousness of the motives and intentions of others

No paranoid delusions as in schizophreniaBelief that others are lying, cheating,

exploiting or trying to harm youPerception of hidden, malicious meaning

in benign comments

SCHIZOID PERSONALITY DISORDER

Shallow or blunted emotionsFantasizingExtreme introversionEmotional distance, even from family

membersFixation on your own thoughts and

feelings

SCHIZOTYPAL PERSONALITY DISORDER

Holding beliefs or showing behaviors that are odd or peculiar but not clearly psychotic

"Magical thinking" — the idea that you can influence people and events with your thoughts

Odd, elaborate style of dressing, speaking and interacting with others

Signs and symptoms of cluster B (dramatic, emotional) personality disorders

ANTISOCIAL PERSONALITY DISORDER

Callous treatment of othersLack of remorse for wrongdoingChronic irresponsibility and unreliabilityLack of regard for the law and for others'

rightsPersistent lying and stealingAggressive, often violent behaviorLack of remorse for hurting othersLack of concern for the safety of yourself

and others

BORDERLINE PERSONALITY DISORDER

A failure to develop a stable self- imageDifficulty controlling emotions or

impulsesFrequent, dramatic changes in mood,

opinions and plansStormy relationships involving frequent,

intense anger and possibly physical fights

Feeling of emptiness insideSuicide attempts or self-mutilation

HISTRIONIC PERSONALITY DISORDER

Dramatic and emotional behaviorExcessive demands to be the center of

attentionExcessive needs for reassurance, praise

and approvalAttention-grabbing, often sexually

provocative clothing and behaviorExcessive concern with your physical

appearanceFalse sense of intimacy with others

NARCISSISTIC PERSONALITY DISORDER

Excessive need for admirationInflated sense of — and preoccupation with —

your importance, achievements and talentsConstant attention-grabbing and admiration-

seeking behaviorInability to empathize with othersExcessive anger or shame in response to

criticismManipulation of others to further your own

desires

Signs and symptoms of cluster C (anxious, fearful) personality disorders

AVOIDANT PERSONALITY DISORDER

Pattern of avoiding social relationships out of fear of rejection

Hypersensitivity to criticism or rejection

Self-imposed social isolationExtreme shyness in social situations,

though you strongly desire close relationships

DEPENDENT PERSONALITY DISORDER

Excessive dependence on others to meet your physical and emotional needs

Tolerance of poor, even abusive treatment in order to stay in relationships

Unwillingness to independently voice opinions, make decisions or initiate activities

Intense fear of being aloneUrgent need to start a new relationship when one

has ended

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

Rigid ways of relating to others Excessive concern with order, rules, schedules and lists Perfectionism, often so pronounced that you can't complete

tasks because your standards are impossible to meet Inability to throw out even broken, worthless objects Inability to share responsibility with others Inflexibility about the "right" ethics, ideas and methods Compulsive devotion to work at the expense of recreation and

relationships Financial stinginess Discomfort with emotions and aspects of personal relationships

that you can't control

Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, an anxiety disorder that shares some symptoms but is more extreme and disabling.

Mood Disorders-Depression

Boys who were later convicted of a crime showed relatively low arousal

Personality Disorders PET scans illustrate reduced activation in a

murderer’s frontal cortexNormal Murderer

Rates of Psychological Disorders