1. Chapter 12 Psychological Disorders

2. What is Normal?
Psychopathology: Scientific study of mental, emotional, and behavioral disorders
Subjective Discomfort: Feelings of discomfort, unhappiness, or emotional distress
Statistical Abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depression
Social Nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior

3. Figure 12.1
FIGURE 12.1 The number of people displaying a personal characteristic may help define what is statistically abnormal.

4. What Is Normal? (cont'd)
Situational Context: Social situation, behavioral setting, or general circumstances in which behavior takes place
Is it normal to walk around strangers naked? 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

5. 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

6. Clarifying and Defining Abnormal Behavior (Mental Illness)
Psychotic Disorder: Severe psychiatric 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)
Mood Disorder: Disturbances in affect (emotions), like depression or mania
Anxiety Disorder: Feelings of fear, apprehension, anxiety, and distorted behavior

7. Clarifying and Defining Abnormal Behavior (Mental Illness)
Somatoform Disorder: Physical symptoms that mimic disease or injury (blindness, anesthesia) for which there is no identifiable physical cause
Dissociative Disorder: Temporary amnesia, multiple personality, 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
Sexual and Gender Identity Disorder: Problems with sexual identity, deviant sexual behavior, or sexual adjustment

8. Clarifying and Defining Abnormal Behavior (Mental Illness)
Substance Related Disorders: 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
Neurosis: Archaic; once used to refer to excessive anxiety, somatoform, dissociative disorders, and some kinds of depression

9. 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 ________________
Social Conditions: Poverty, homelessness, overcrowding, stressful living conditions
Family Factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problems
Other sources of psychological stress

10. Figure 12.11
FIGURE A combination of vulnerability and stress may produce psychological problems. The top bar shows low vulnerability and low stress. The result? No problem. The same is true of the next bar down, where low vulnerability is combined with moderate stress. Even high vulnerability (third bar) may not lead to problems if stress levels remain low. However, when high vulnerability combines with moderate or high stress (bottom two bars) the person “crosses the line” and suffers from psychopathology.

11. Personality Disorders: Antisocial Personality Disorder (ASPD)
Definition: A person who lacks a conscience (superego?); typically emotionally shallow, impulsive, selfish, and manipulative toward others
Oftentimes 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., Dr. Michael Swango)
Blind to signs of disgust in other people

12. ASPD: Causes and Treatments
Possible Causes:
Childhood history of emotional deprivation, neglect, and physical abuse
Underarousal of the brain
Very difficult to effectively treat; will lie, charm, and manipulate their way through therapy

13. Anxiety-Based Disorders
Anxiety: Feelings of apprehension, dread, or uneasiness
Adjustment Disorders: When ongoing stressors cause emotional disturbance and push people beyond their ability to effectively cope
Usually suffer sleep disturbances, irritability, and depression
Examples: Grief reactions, lengthy physical illness, unemployment can be some triggers for anxiety

14. Anxiety-Based Disorders (cont'd)
Anxiety Disorders: When stress seems greatly out of proportion to the situation at hand …usually accompanied by some form of avoidance
3 Main Types
Generalized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety
Panic Disorder (w/ or w/o agoraphobia)
Phobia

15. Generalized Anxiety Disorder
Extreme anxiousness and worry for at least 6 months
Anxiousness/anxiety do not fade when life circumstances get better
Multiple topics of worry

16. Panic Disorders
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

17. 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.

18. 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.

19. Social Phobia
Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public)

20. Review: 3 Anxiety Disorders
1. Phobia—objects, situation, social
Causes: not only experience…also inherit tendencies (prepared fears)
2. Generalized Anxiety—constant anxiety and worry
3. Panic Disorder—discrete panicky episodes

21. 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: Being dirty or wondering if you performed an action (turned off the stove)

22. Compulsions
Compulsion: Irrational acts that person feels compelled to repeat against his/her will
Help to control anxiety created by obsessions
Checkers and cleaners

23. Table 16.2
Obsessive-Compulsive Tendencies

24. Anxiety
Feelings of tension, uneasiness, apprehension, worry, and vulnerability
We are motivated to avoid experiencing anxiety

25. Figure 10.6
FIGURE 10.6 The approximate relationship between the id, ego, and superego, and the levels of awareness.

26. Theoretical Causes of Anxiety Disorders: Psychodynamic
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.

27. Other Theoretical Causes of Anxiety Disorders
Humanistic-Existential: Unrealistic self-image conflicts with true self

28. Other Theoretical Causes of Anxiety Disorders
Behavioristic: Anxiety symptoms and behaviors are learned, like everything else
Conditioned emotional responses generalize to new situations
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

29. Freudian Defense Mechanisms
Defense Mechanisms: Habitual and unconscious (in most cases) psychological processes designed to reduce anxiety

30. More on Defense Mechanisms
Work by avoiding, denying, or distorting sources of threat or anxiety
If used short term, can help us get through everyday situations
If used long term, we may end up not living in reality
Protect idealized self-image so we can live with ourselves

31. Freudian Defense Mechanisms: Some Examples
Denial: Most primitive; denying reality; usually occurs with death and illness
Repression: When painful memories, anxieties, and so on are held out of our awareness
Reaction Formation: Impulses are repressed and the opposite behavior is exaggerated

32. More Defense Mechanisms
Projection: When one’s own feelings, shortcomings, or unacceptable traits and impulses are seen in others; exaggerating negative traits in others lowers anxiety
Rationalization: Justifying personal actions by giving “rational” but false reasons for them

34. Name that defense mechanism!
Your ex-spouse, who cheated on you, writes a best-selling nonfiction book arguing that human beings are not naturally monogamous and have an instinctive need for variety.
rationalization

35. Name that defense mechanism!
You are in love with your best friend’s new flame. The friendship is an old one and very valuable to you. You tell everybody that your friend’s new love interest is a terrible human being and you don’t understand the attraction at all.

36. Mood Disorders
Major disturbances in 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
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 light to treat SAD

37. 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 I Disorder: Extreme mania and deep depression; one type of manic-depressive illness.
Mania: Excited, hyperactive, energetic, grandiose behavior
Bipolar II Disorder: Person is mainly sad but has one or more hypomanic episodes (mild mania)

38. 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

39. Figure 12.14
FIGURE Adolescent suicide rates vary for different racial and ethnic groups. Higher rates occur among whites than among non-whites. White male adolescents run the highest risk of suicide. Considering gender alone, it is apparent that more male than female adolescents commit suicide. This is the same as the pattern observed for adults.

40. Figure 12.15
FIGURE Suicidal behavior usually progresses from suicidal thoughts, to threats, to attempts. A person is unlikely to make an attempt without first making threats. Thus, suicide threats should be taken seriously

41. Common Characteristics of Suicidal Thoughts and Feelings (Shneidman)
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

42. Stress Disorders
Occur when stresses outside range of normal human experience cause major emotional disturbance
Symptoms: Reliving traumatic event repeatedly, avoiding reminders of the event, and numbing of emotions
Acute Stress Disorder: Psychological disturbance lasting up to one month following stresses from a traumatic event

43. Post-Traumatic Stress Disorder (PTSD)
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.)

44. Dissociative Disorders
Dissociative Amnesia: Inability to recall one’s name, address, or past
Memory loss is partial or complete for personal information
Dissociative Fugue: Sudden travel away from home and confusion about personal identity

45. Dissociative Identity Disorder (DID)
Person has two or more distinct, separate identities or personality traits; 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

46. Somatoform Disorders
Hypochondriasis: Person is preoccupied with fears of 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

47. Somatoform Disorders (cont'd)
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 sensitivity in areas of skin normally covered by a glove

48. Figure 12.4
FIGURE 12.4 (left) “Glove” anesthesia is a conversion reaction involving loss of feeling in areas of the hand that would be covered by a glove (a). If the anesthesia were physically caused, it would follow the pattern shown in (b). (right) To test for organic paralysis of the arm, an examiner can suddenly extend the arm, stretching the muscles. A conversion reaction is indicated if the arm pulls back involuntarily.

49. Other Theoretical Causes of Anxiety Disorders
Humanistic-Existential: 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

50. 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

51. Psychosis
Psychosis: Loss of contact with reality marked by hallucinations, delusions, disturbed thoughts and emotions, and personality disorganization

52. Other Psychotic Disorders
Organic Psychosis: Psychosis caused by brain injury or disease
Dementia: Most common organic psychosis; serious mental impairment in old age caused by brain deterioration
Known as senility at times
Alzheimer’s Disease: Most common cause of dementia; symptoms include impaired memory, confusion, and progressive loss of mental abilities
Ronald Reagan most famous Alzheimer’s victim

53. Delusional Disorders
Marked by presence of deeply held false beliefs (delusions)
Usually involve delusions of grandeur, persecution, or jealousy
Paranoid Psychosis: Most common delusional disorder
Centers on delusions of persecution

54. 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

55. Delusions
Delusions: False beliefs that psychotic individuals insist are true, regardless of overwhelming evidence against them
Common forms:
Erotomanic
Grandiose
Jealous
Persecution
Somatic
Erotomanic: Delusions of love from another person, especially someone famous or of higher status
Grandiose type: In this case, people suffer from the delusion that they have some great, unrecognized talent, knowledge, or insight. They may also believe that they have a special relationship with an important person or with God or that they are a famous person. (If the famous person is alive, the deluded person regards her or him as an imposter.)
Jealous type: An example of this type of delusion would be having an all-consuming, but unfounded, belief that your spouse or lover is unfaithful.
Persecutory type: Delusions of persecution involve belief that you are being conspired against, cheated, spied on, followed, poisoned, maligned, or harassed.
Somatic type: People suffering from somatic delusions typically believe that their bodies are diseased or rotting, or infested with insects or parasites, or that parts of their bodies are defective.
People with delusional disorders usually do not suffer from hallucinations, emotional excesses, or personality disintegration.

56. Hallucinations
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)

57. Some More Psychotic Symptoms
Flat Affect: Lack of emotional responsiveness
Inappropriate emotions:
Disturbed Verbal Communication: Garbled and chaotic speech; word salad
Personality Disintegration: Uncoordinated thoughts, actions, and emotions…a “split” between thought and emotion
Withdrawal and apathy
Breakdown of personal habits
Problems with selective attention
Impaired “sensory filter” –it is hard for people with schizophrenia to focus on one item of info. at a time….overwhelmed by a jumble of thoughts, sensations, images, and feelings

58. The Four Subtypes of Schizophrenia
Disorganized Schizophrenia: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or grossly inappropriate emotions
Catatonic Schizophrenia: Marked by stupor where victim may hold same position for hours or days; also unresponsive
Paranoid Schizophrenia: Preoccupation with delusions of grandeur or persecution; also involves hallucinations that are related to a single theme, especially grandeur or persecution
Undifferentiated Schizophrenia: Any type of schizophrenia that does not have paranoid, catatonic, or disorganized features or symptoms
Disorganized—comes close to matching the stereotypes in the movies—Personality disintegration is almost complete—Emotions, speech, and behavior are all highly disorganized. The result is silliness, laughter, bizare or obscene behavior
Catatonic—seem to be in a total panic and trying desperately to control their inner turmoil…similar to freezing at times of great emergency or panic…Mutism (no speaking) and unresponsive to environment
Paranoid—most common—centers on delusions of grandeur and persecution…also hallucinate…may erupt in violence in attempt to protect themselves

59. Causes of Schizophrenia
Psychological Trauma: Psychological injury or shock, often caused by an environment of 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
Heredity—if one identical twin becomes schizophrenic then the other twin has about 50% chance
Stress-Vulnerability Hypothesis: Combination of environmental stress and inherited susceptibility cause psychotic disorders

60. Figure 12.7
FIGURE 12.7 Lifetime risk of developing schizophrenia is associated with how closely a person is genetically related to a schizophrenic person. A shared environment also increases the risk.

61. 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 may also be related to schizophrenia
Dopamine appears to trigger a flood of unrelated thoughts, feelings, and perceptions, which may account for the voices, hallucinations, and delusions of schizophrenia
Glutamate is implicated as well—glutamate influences brain activity in areas that control emotions and sensory information
Also—stress alters glutamate levels which in turn alter dopamine systems

62. Figure 12.8
FIGURE 12.8 Dopamine normally crosses the synapse between two neurons, activating the second cell. Antipsychotic drugs bind to the same receptor sites as dopamine does, blocking its action. In people suffering from schizophrenia, a reduction in dopamine activity can quiet a person’s agitation and psychotic symptoms.

63. Schizophrenic Brain
Computed Tomography (CT) Scan: Computer enhanced X-ray of brain or body
CT scans show schizophrenic brains as having wider surface fissures
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

64. Schizophrenic Brain (cont'd)
Positron Emission Tomography (PET) Scan: Computer-generated color image of brain activity; radioactive sugar solution is injected into the brain.
Activity is abnormally low in frontal lobes of schizophrenics

65. Major Mood Disorders (cont'd)
Endogenous Depression: Depression that seems to be produced from inside the body (due to chemical imbalances) and NOT from life events
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 light to treat SAD

66. Figure 12.12
FIGURE Seasonal affective disorder appears to be related to reduced exposure to daylight during the winter. SAD affects 1 to 2 percent of Florida’s population, about 6 percent of the people living in Maryland and New York City, and nearly 10 percent of the residents of New Hampshire and Alaska