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Chapter 12 Psychological Disorders

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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

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