1. Chapter 13: Psychological Disorders

2. What is Normal?
Psychopathology: Scientific study of mental, emotional, and behavioral disorders
Subjective Discomfort: Private feelings of anxiety, depression, 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; may lead to destructive or self-destructive behavior

3. What Is Normal? (cont.)
Situational Context: Social situation, behavioral setting, or general circumstances in which an action 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

4. Figure 13.1 The number of people displaying a personal characteristic may help define what is statistically abnormal.
Figure 13.1

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
Those with mental illness lose the ability to control thoughts, behaviors, or feelings adequately

6. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)
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)

7. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)
Mood Disorder: Disturbances in affect (emotions or moods), like depression or mania
Anxiety Disorder: Disruptive feelings of fear, apprehension, anxiety, or behavior distortions that are anxiety-related

8. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)
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

9. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)
Somatoform Disorder: Physical symptoms that mimic disease or injury (blindness, anesthesia) for which there is no identifiable physical cause
Dissociative Disorder: Temporary amnesia, multiple identity, 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

10. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)
Sexual and Gender Identity Disorder: Problems with sexual identity, deviant sexual behavior, or sexual adjustment
Neurosis: Archaic; once used to refer to excessive anxiety, somatoform, dissociative disorders, and some kinds of depression

11. General Risk Factors for Contracting Mental Illness
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

12. General Risk Factors for Contracting Mental Illness (cont.)
Psychological Factors: Low intelligence, stress, learning disorders
Biological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability

13. Insanity
Definition: A legal term; refers to an inability to manage one’s affairs or to be aware of the consequences of one’s actions

14. More on Insanity
Those judged insane (by a court of law) are not held legally accountable for their actions
Can be involuntarily committed to a psychiatric hospital
Some movements today are trying to abolish the insanity plea and defense; desire to make everyone accountable for their actions
How accurate is the judgment of insanity?

15. Expert Witness
Person recognized by a court of law as being qualified to give expert testimony on a specific topic
May be psychologist, psychiatrist, and so on

16. Personality Disorders: Antisocial Personality Disorder (APD)
Definition: A person who lacks a conscience (superego?); typically emotionally shallow, impulsive, selfish, and manipulative toward others
Oftentimes called psychopaths or sociopaths

17. APD Characteristics
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
May be blind to signs of disgust in others

18. APD: Causes and Treatments
Possible Causes:
Childhood history of emotional deprivation, neglect, and physical abuse
Tend to be thrill-seekers
Underarousal of the brain
Very difficult to effectively treat; will likely lie, charm, and manipulate their way through therapy

19. Anxiety-Based Disorders
Anxiety: Feelings of apprehension, dread, or uneasiness
Adjustment Disorders: When ongoing stressors within the range of normal experience cause emotional disturbance and push people beyond their ability to effectively cope

20. More on Anxiety-Based Disorders
Usually suffer sleep disturbances, irritability, and depression
Examples of Stresses: Grief reactions, lengthy physical illness, unemployment

21. Anxiety-Based Disorders Concluded
Anxiety Disorders: When distress seems greatly out of proportion to the situation at hand
Generalized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety; worries about work, relationships, ability, or impending disaster

22. 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

23. Panic Disorder (with Agoraphobia)
Panic attacks and sudden anxiety still occur, but with agoraphobia

24. Agoraphobia Characteristics
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)

25. Agoraphobia (without Panic Disorder)
Fear that something extremely embarrassing will happen away from home or in an unfamiliar situation

26. 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

27. Social Phobia
Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, not eating or speaking in public) in social situations
Barbara Streisand, Woody Allen perhaps?

28. Obsessive-Compulsive Disorder (OCD)
Extreme preoccupation with certain thoughts and compulsive performance of certain behaviors

29. 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, wondering if you performed an action (turned off the stove), or violence (hit by a car)

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

31. Obsessive Compulsive Disorder

32. Stress Disorders
Occur when stresses outside range of normal human experience cause major emotional disturbance
Symptoms: Reliving traumatic event repeatedly, avoiding stimuli associated with the event, and numbing of emotions
Acute Stress Disorder: Psychological disturbance lasting up to one month following stresses from a traumatic event and that would produce anxiety in anyone who experienced them

33. Post Traumatic Stress Disorder (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.)
The “War” in Iraq will likely lead to an increase of PTSD

34. Dissociative Disorders
Dissociative Amnesia: Inability to recall one’s name, address, or past
Dissociative Fugue: Sudden travel away from home and confusion about personal identity

35. 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
Goal: Integrate and fuse identities into single, balanced personality

36. Somatoform Disorders: Hypochondriasis
Person is preoccupied with having a serious illness or disease
Interpret normal sensations and bodily signs as proof that they have a terrible disease
No organic cause can be found

37. Somatoform Disorders: Somatization Disorder
Person expresses anxieties through numerous physical complaints
Many doctors are consulted but no organic or physical causes are found

38. Somatoform Disorders: Pain Disorder
Pain that has no identifiable organic, physical cause
Appears to have psychological origin

39. Somatoform Disorders: 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

40. Figure 13.4 (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. (Adapted from Weintraub, 1983.)
Figure 13.4

41. Theoretical Causes of Anxiety Disorders: Psychodynamic
Freud: Anxiety caused by conflicts among id, ego, and superego

42. Some of Freud’s Concepts Regarding Anxiety
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

43. Other Theoretical Causes of Anxiety Disorders
Humanistic: 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

44. 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

45. Psychosis and Hallucinations
Psychosis: Loss of contact with shared views of reality

46. Delusions
False beliefs that individuals insist are true, regardless of overwhelming evidence against them

47. 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)

48. Some More Psychotic Symptoms
Flat Affect: Lack of emotional responsiveness; face is frozen in blank expression
Disturbed Verbal Communication: Garbled and chaotic speech; word salad
Personality Disintegration: Uncoordinated thoughts, actions, and emotions

49. 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
Archaically known as senility
Common Causes: Circulatory problems, repeated strokes, shrinkage and atrophy of the brain

50. Alzheimer’s Disease
Symptoms include impaired memory, confusion, and progressive loss of mental abilities
Ronald Reagan was perhaps the most famous Alzheimer’s victim

51. Delusional Disorders
Marked by presence of deeply held false beliefs (delusions)
May involve delusions of grandeur, persecution, jealousy, eroticism, or somatic
Experiences could really occur!
Paranoid Psychosis: Most common delusional disorder
Centers on delusions of persecution

52. 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

53. Schizophrenia: Distortion of Reality

54. The Four Subtypes of Schizophrenia

55. Disorganized Type
Incoherence, grossly disorganized behavior, bizarre thinking, and flat or inappropriate emotions

56. Schizophrenia: Common Symptoms

57. Catatonic Type
Marked by stupor, rigidity, unresponsiveness, posturing, mutism, and sometimes agitated, purposeless behavior

58. Paranoid Type
Preoccupation with delusions; also involves auditory hallucinations that are related to a single theme, especially grandeur or persecution

59. Undifferentiated Type
Any type of schizophrenia that does not have paranoid, catatonic, or disorganized features or symptoms

60. Causes of Schizophrenia
Psychological Trauma: Psychological injury or shock, often caused by 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
Stress-Vulnerability Hypothesis: Combination of environmental stress and inherited susceptibility cause psychoses

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

62. Figure 13.7 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. (Estimates from Lenzenweger & Gottesman, 1994.)
Figure 13.7

63. Figure 13.8 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.
Figure 13.8

64. Figure Various combinations 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.
Figure 13.11

65. Schizophrenic Brain
Computed Tomography (CT) Scan: Computer enhanced X-ray of brain or body

66. 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

67. Positron Emission Tomography (PET) Scan
Computer-generated color image of brain activity; radioactive sugar solution is injected into a vein, eventually reaching the brain
Activity is abnormally low in frontal lobes of schizophrenics

68. Table 13.6
Table 13.6

69. Mood Disorders
Major disturbances in emotion or mood, such as depression or mania
Depressive Disorders: Sadness or despondency are prolonged, exaggerated, or unreasonable
Bipolar Disorders: Involve both depression, and mania or hypomania

70. Bipolar Disorder: Delusional Thinking

71. Milder Mood Disorders
Dysthymic Disorder: Moderate depression that lasts for at least two years
Cyclothymic Disorder: Moderate manic and depressive behavior that lasts for at least two years

72. 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

73. Endogenous Depression
Depression that seems to be produced from inside the body (perhaps due to chemical imbalances) and NOT from reaction to life events

74. 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

75. Bipolar 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)

76. Bipolar Disorder: Expression of Mood

77. Maternity Blues
Mild depression that lasts for one to two days after childbirth
Marked by crying, fitful sleep, tension, anger, and irritability
Brief and not too severe

78. Postpartum Depression
Moderately severe depression that begins within three months following childbirth
Marked by mood swings, despondency, feelings of inadequacy, and an inability to cope with the new baby
May last from two months to one year
Part of the problem may be hormonal

79. 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 (Booker & Hellekson, 1992).
Figure 13.12

80. 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

81. 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.
Figure 13.14

82. 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 (Garland & Zigler, 1993).
Figure 13.15

83. 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