1. Psychological Disorders
Chapter 16
Psychological Disorders

2. What is Normal?
Psychopathology: Scientific study of mental, emotional, and behavioral disorders
Subjective Discomfort: 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; usually leads 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. Fig The number of people displaying a personal characteristic may help define what is statistically abnormal. Social non-conformity does not automatically indicate psychopathology.

5. © Scott Camazine/Photo Researchers
Fig This MRI scan of a human brain (viewed from the top) reveals a tumor (dark spot). Mental disorders sometimes have organic causes of this sort. However, in many instances no organic damage can be found.

6. 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 adequately control thoughts, behaviors, or feelings

7. 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)
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

8. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)
Mood Disorder: Disturbances in mood or emotions, like depression or mania
Anxiety Disorder: Feelings of fear, apprehension, anxiety, and behavior distortions

9. © Bettmann/CORBIS
Fig The Mad Hatter, from Lewis Carroll’s Alice’s Adventures in Wonderland. History provides numerous examples of psychosis caused by toxic chemicals. Carroll’s Mad Hatter character is modeled after an occupational disease of the eighteenth and nineteenth centuries. In that era, hatmakers were heavily exposed to mercury used in the preparation of felt. Consequently, many suffered brain damage and became psychotic, or “mad” (Kety, 1979).

10. 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

11. 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 anxiety, somatoform, and dissociative disorders, also used to refer to some kinds of depression

12. 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
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
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?
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

14. 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
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, Scott Peterson)

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

16. © Robert Hare
Fig Using PET scans, Canadian psychologist Robert Hare found that the normally functioning brain (left) lights up with activity when a person sees emotion-laden words such as “maggot” or “cancer.” But the brain of a psychopath (right) remains inactive, especially in areas associated with feelings and self-control. When Dr. Hare showed the bottom image to several neurologists, one asked, “Is this person from Mars?” (Images courtesy of Robert Hare.)

17. CNN – Serial Killer Motives

18. Anxiety-Based Disorders
Anxiety: Feelings of apprehension, dread, or uneasiness
Adjustment Disorders: When ordinary stress causes emotional disturbance and pushes people beyond their ability to effectively cope
Usually suffer sleep disturbances, irritability, and depression
Examples: Grief reactions, lengthy physical illness, unemployment

19. Anxiety-Based Disorders (cont.)
Generalized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety
Free-Floating Anxiety: Anxiety that is very general and persuasive

20. CNN – Anxiety Disorders in Kids

21. 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

22. 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

23. 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

24. Social Phobia
Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public)
Barbra Streisand, Woody Allen perhaps?

25. 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, wondering if you performed an action (turned off the stove), or violence (hit by a car)
Compulsion: Irrational acts that person feels compelled to repeat against his/her will
Help to control anxiety created by obsessions
Checkers and cleaners

26. 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
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.)
Terrorist attacks on September 11th, 2001, likely led to an increase of PTSD

27. CNN – Mental Health and Traumatic Events

28. CNN - Prostitution

29. 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

30. Dissociative Identity Disorder (DID)
Person has two or more distinct, separate identities or personality states; 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, stable personality

31. 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 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

32. Somatoform Disorders (cont.)
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

33. Fig (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.)

34. 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

35. 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

36. 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

37. Psychosis and Hallucinations
Psychosis: Loss of contact with shared views of reality
Delusions: False beliefs that individuals insist are true, regardless of overwhelming evidence against them
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)

38. 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: When an individual’s thoughts, actions, and emotions are uncoordinated

39. 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
Alzheimer’s Disease: Symptoms include impaired memory, confusion, and progressive loss of mental abilities
Ronald Reagan most famous Alzheimer’s victim

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

41. 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

42. The Four Subtypes of Schizophrenia
Disorganized (Hebephrenic) Type: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or inappropriate emotions
Catatonic Type: Marked by stupor, unresponsiveness, posturing, and mutism
Paranoid Type: Preoccupation with delusions; also involves auditory hallucinations that are related to a single theme, especially grandeur or persecution
Undifferentiated Type: Any type of schizophrenia that does not have specific paranoid, catatonic, or disorganized features or symptoms

43. CNN – Schizophrenic Reality

44. 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

45. © Bruce Ely/Getty Images
Fig Over a period of years, Theodore Kaczynski mailed bombs to unsuspecting victims, many of whom were maimed or killed. As a young adult, Kaczynski was a brilliant mathematician. At the time of his arrest, he had become the Unabomber—a reclusive “loner” who deeply mistrusted other people and modern technology. After his arrest, Kaczynski was judged to be suffering from paranoid schizophrenia.

46. 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

47. Fig 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.)

48. Fig 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.

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

50. © Dennis Brack/Stockphoto.com76
Fig (left) CT scan of would-be presidential assassin John Hinkley, Jr., taken when he was 25. The X-ray image shows widened fissures in the wrinkled surface of Hinkley’s brain. (right) CT scan of a normal 25-year-old’s brain. In most young adults the surface folds of the brain are pressed together too tightly to be seen. As a person ages, surface folds of the brain normally become more visible. Pronounced brain fissuring in young adults may be a sign of schizophrenia, chronic alcoholism, or other problems.

51. Fig Positron emission tomography produces PET scans of the human brain. In the scans shown here, red, pink, and orange indicate lower levels of brain activity; white and blue indicate higher activity levels. Notice that activity in the schizophrenic brain is quite low in the frontal lobes (top area of each scan) (Velakoulis & Pantelis, 1996). Activity in the manic-depressive brain is low in the left brain hemisphere and high in the right brain hemisphere. The reverse is more often true of the schizophrenic brain. Researchers are trying to identify consistent patterns like these to aid diagnosis of mental disorders.

52. CNN – Schizophrenia Gene

53. Stress-Vulnerability Model
Stress-Vulnerability Hypothesis: Combination of environmental stress and inherited susceptibility cause schizophrenic disorders

54. Fig 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.

55. 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
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

56. 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)

57. Major Mood Disorders (cont.)
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

58. Maternity Blues
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

59. Postpartum Depression
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

60. Fig 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).

61. © Dan McCoy/Rainbow
Fig An hour or more of bright light a day can dramatically reduce the symptoms of seasonal affective disorder. Treatment is usually necessary from fall through spring. Light therapy typically works best when it is used early in the morning (Lewy et al., 1998).

62. Therapeutic Interventions
Psychotherapy: Any psychological treatment for behavioral or emotional problems
Typically involves two people talking about one’s personal problems
Medical Therapies: Drug therapy, hospitalization, or psychosurgery

63. Fig At least one schizophrenic patient in four had completely recovered 10 years after being diagnosed. Three out of four had improved. New treatments for schizophrenia and other major mental disorders may improve these odds. (Source: FDA Consumer, 1993.)

64. 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

65. Fig 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.

66. CNN – Suicidal Tendencies

67. 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

68. Fig 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).

69. Insanity
Insanity Defense: Person was incapable of knowing right from wrong while committing a crime
M’Naghten Rule: Standard for judging legal insanity in English common law
Must understand wrongfulness of actions to be held responsible for them
If suffering from mental disease preventing person from knowing right from wrong, can be deemed insane
Taking of a life due to insanity is not murder
Irresistible Impulse: Uncontrollable urge to act
Diminished Capacity: Temporary loss of ability to control actions or to know right from wrong