1. Myers’ PSYCHOLOGY (7th Ed)
Chapter 16
Psychological Disorders
James A. McCubbin, PhD
Clemson University
Worth Publishers

2. Good AP Psy website for review!
Good AP Psy website for review!
Ch. 16: Psy Disorders: “harmful dysfunction” in which behavior is judged to be…
Atypical (violates social-norms): goes against accepted behaviors; but not enough by itself to be a mental disorder… Varies w/ era & culture
Disturbing: causes distress to you or those around you--
Maladaptive—harmful; keeps you from functioning well in your world
Unjustifiable: no apparent reason….sometimes there’s a good reason

3. Defining Psychological Disorders
Deviant behavior
Distressful behavior
Harmful dysfunctional behavior
Definition varies by context/culture
Attention deficit hyperactivity disorder (ADHD)

4. Historical Perspective
Formerly Perceived Causes
movements of sun or moon
lunacy--full moon
evil spirits; demons ; witches
Ancient Treatments
exorcism, caged like animals, beaten, burned, castrated, mutilated, blood replaced w/ animal’s blood
Lock into attics…chain them up
Changing from “demons” to illness:
-Paris: Philippe Pinel: became head of a mental hospital in 1700’s & saw horrid ways patients were treated…unchained the people & demanded humane treatment BEGAN the MEDICAL MODEL

5. Psychological Disorders
Medical Model
concept that diseases have physical causes
can be diagnosed, treated, (& in most cases) cured
assumes “mental” illnesses can be diagnosed on the basis of their symptoms & cured through therapy…& may include treatment in a psychiatric hospital
Used to use psych. hospitals a lot but now most is on out-patient basis
Bio-Psycho-Social Perspective: assumes that biological, socio-cultural, & psychological factors combine & interact to produce psychological disorders
--a combination of causes in a cycle  

6. Psychological Disorders

7. Psychological Disorders--Etiology
Etiology: the causes of a disorder or condition (where it comes from…)
DSM-IV: classifies a disorder…mainly the symptoms that define that disorder
American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (4th Edition) = DSM-IV-TR (text revision...this is latest)
a widely used system for classifying & defining what constitutes a particular psychological disorders
It does NOT tell you how to treat a disorder

9. Classifying Psychological Disorders

10. Labeling Psychological Disorders
Rosenhan’s study
Power of labels
Preconception can stigmatize
Insanity label
Stereotypes of the mentally ill
Self-fulfilling prophecy

11. Match the Famous ppl w/ mental disorder http://health. discovery
Match the Famous ppl w/ mental disorder NOTE: Some may have more than 1 disorder, some disorders have more than one person affected
ADHD Joan Baez
Agoraphobia Craig Ferguson
Bipolar Disorder Paula Deen
Bulimia Howard Hughes
Depression Brooke Shields
DID (Dissociative identity disorder) Vincent van Gogh
OCD (obsessive compulsive disorder) Emma Thompson
Panic Attacks Michael Phelps
Post-partum depression Elton John
Schizophrenia Herschel Walker
Social Anxiety Carrie Fisher
Substance Abuse John Nash
(answers on LAST slide)

12. Psychological Disorders- Etiology
When Revisions are made in the DSM :
EX: used to classify homosexuality as a mental disorder but when they did the last major revisions (late ’70’s) it was changed & is no longer considered a disorder
Neurotic Disorder: usually distressing/upsetting but… allows one to think rationally & function socially
(this term is seldom used now)
Psychotic disorder
Person loses contact w/ reality, experiencing irrational ideas & distorted perceptions
Commonly seen in schizophrenia & more severe bipolar
disorders as well as others
Major divisions of mental disorders (there are others):
*anxiety disord. *schizophrenia *dissociative disord.
*mood disorders *personality disord. *somatoform

13. More clarification of psychosis vs
More clarification of psychosis vs. neurosis: Psychosis: A loss of contact with reality, usually including delusions & hallucinations. Can be caused by drugs (using & withdrawal), brain tumors, dementia & other brain diseases..plus certain psychiatric disorders Neurosis: a relatively mild mental illness that is not caused by physical disease, involving symptoms of stress (EX: depression, anxiety, obsessive behavior, hypochondria) but not a radical loss of touch with reality. This term was taken out of DSM in 1980 & is not used much today in true diagnoses…used more as a descriptive term if at all.

14. Anxiety Disorders: distressing, persistent anxiety or maladaptive behaviors that reduce anxiety for no apparent or rational reason (these are not rare…)
Panic Disorder (panic attacks): marked by a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensation
Often diagnosed in ER…why?
Generalized Anxiety Disorder: person is tense, apprehensive, and in a state of autonomic nervous system arousal
Phobia: persistent, irrational fear of a specific object or situation
Agoraphobia: fear of unfamiliar places…fear of being away from home
Obsessive-Compulsive Disorder: unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

15. Obsessive-Compulsive Disorder
An obsession versus a compulsion
Checkers
Hand washers

16. PTSD: Post Traumatic

17. Anxiety Disorders: NOTE: There are many more than just those most common ones on the previous slide…
Common & uncommon fears: extremes = phobias

18. Anxiety Disorders: OCD obsessions & compulsions: Kids & adolescents

19. Explaining anxiety disorders: etiology– cause?
fear conditioning: bad uncontrollable events can cause these (rape victim?)
EX: PTSD: post-traumatic stress disorder
stimulus generalization: person falls…then fears airplanes…
reinforcement: becomes cyclic: anxiety, so do something to relieve it (run away, stay home, etc.), feel better, so you will do this the next time
observational learning: parents, siblings, etc. teach fears to the young
genetic: thru natural selection (many are heritable)
physiological: folks w/ overactive limbic system can be prone to these disorders…& anti-depressants help them

20. Anxiety Disorders PET Scan of brain of
obsessive/ compulsive disorder (OCD)
High metabolic activity (red) in frontal lobe areas involved with directing attention
Over-active amygdala &/or limbic system can affect this
** b/c it’s a stimulant, nicotine increases risk of a 1st episode of anxiety disorders

21. Mood Disorders: Emotional extremes (ups OR downs)
Mild or moderate Depression (aka dysthymic disor.): “common cold” of mental disorders…
Related to lack of N-T’s serotonin & nor-epinephrine
(both affect mood)
Women more prone to depression…probably b/c of ... **Hormones **Lack of self-esteem
**Lack of a a sense of efficacy ( “I have control, etc.)
Major Depressive Disorder
For no apparent reason, person experiences 2 or more wks of depressed moods, feelings of worthlessness, & diminished interest or pleasure in most activities
Possibility of suicide is major concern
If drugs & cognitive/behavioral therapy don’t work, this is 1 of few disorders Dr’s. may still use shock (ECT-electroconvulsive) therapy on b/c of fear of suicide

22. Mood Disorders Manic Episodes (“Mania”)
Marked by a hyperactive, wildly optimistic state
Biological influence seems to be excess of what 2 neurotransmitters? ( ___ & especially ___ )
EX’s of manic behaviors: Could be 1, some, or all (or some other…) of the following:
-grandiose ideas euphoric optimism
-spending sprees reckless, aggressive
-long periods of no sleep speech becomes loud
-excessive self-esteem poor judgment, egocentric
-increased chances of unprotected sex

23. Bipolar Disorder
Mood disorder in which the person alternates betwn. the hopelessness & lethargy of depression… & the overexcited state of mania
way up…then way down…& back again…
formerly called manic-depressive disorder

24. Types of bipolar disorder:
Bipolar disorder: a lifelong illness. Episodes of mania and depression eventually can occur again, if you don't get treatment.
Many continue to have symptoms, even after getting treatment
Types of bipolar disorder:
Bipolar I disorder: involves periods of severe mood episodes from mania to depression.
Bipolar II disorder: a milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression.
Cyclothymic disorder: periods of hypomania with brief periods of depression that are not as extensive or long-lasting as seen in full depressive episodes.
Mixed bipolar: periods that simultaneously involve the full symptoms of both a manic and a full depressive episode. It's marked by grandiose feelings with racing thoughts. At the same time, the person is irritable, angry, moody, and feeling bad.

25. Rapid-cycling bipolar disorder:
Characterized by 4 or more mood episodes that occur within a 12-month period. Episodes must last for some minimum number of days in order to be considered distinct episodes. 
MAY experience changes in polarity (high  low or vice-versa) within a single week, or even within a single day -- the full symptom profile that defines distinct, separate episodes may not be present (EX: the person may not have a decreased need for sleep), making such "ultra-rapid" cycling a more controversial phenomenon.
Rapid cycling can occur at any time in the course of illness, although some researchers believe that it may be more common at later points in the lifetime duration of illness.
Women appear more likely than men to have rapid cycling. A rapid-cycling pattern increases risk for severe depression and suicide attempts. Antidepressants are thought to trigger and prolong rapid cycling in bipolar disorder. However, that theory is controversial and is still being studied.

26. Mood Disorders-Bipolar
PET scans show that brain energy consumption rises and falls with emotional switches
May 17 May 18 May27
Depressed state
Manic state

27. Manic Chocolate deliveries..

28. READ!! P.638 Suicides & differing groups:
National: see #’s: where’s US?
Racial: Euro.-Amer.(W) more than Afr. Amer. (B)
Gender: Which try? Which succeed? Why?
Age: most = older men; increase in older male teens
Other groups:
religious vs. non-relig.
heterosexual/homosexual?
married, single, widowed, divorced?
drug usage?
The Depressed brain:
How do serotonin & norepinephrine affect depression vs. mania??

29. Mood Disorders - Depression & Gender cross-culturally: Females more susceptible

30. Mood Disorders-Depression
Canadian depression rates: M vs F in varying ages

31. Mood Disorders- Suicide

32. Mood Disorders-Depression
Altering any one component of the chemistry-cognition-mood circuit can alter the others
Genetic: there is a strong genetic link in mood disorders
Physiological (638)
brains differences: lobes, NT’s, activity levels
Social-cognitive: self-defeating beliefs; negative thoughts
-”stable, global,
internal” (b-640)

33. Mood Disorders-Depression
The vicious cycle of depression can be broken at any point
Rumination: dwelling on something
P. 643: Loneliness: “aloneness often breeds loneliness”:
-excluded
-unloved
-constricted
-alienated

34. Major Depressive Disorder

35. Bipolar Disorder Bipolar Disorder Mania (manic)
Overtalkative, overactive, elated, little need for sleep, etc.
Bipolar disorder and creativity

36. 2 other Mood disorders: Post-Partum Depression:
“baby blues”…comes after
birth of a baby…linked to
hormonal changes
(Brooks Shield, Andrea Yates)
SAD: seasonal Affective Disorder:
“Winter Blues”—lack of light
usually the trigger
-hormone melatonin linked
to this it also helps
w/ jetlag, shift work—
i.e., disruption of sleep cycles

37. Understanding Mood Disorders
Many behavioral and cognitive changes accompany depression
Depression is widespread
Compared with men, women are nearly twice as vulnerable to major depression
Most major depressive episodes self-terminate
Stressful events related to work, marriage and close relationships often precede depression
With each new generation, depression is striking earlier and affecting more people

38. Understanding Mood Disorders The Biological Perspective
Genetic Influences
Mood disorders run in families
Heritability
Linkage analysis
The depressed brain
Biochemical influences
Norepinephrine and serotonin

39. Understanding Mood Disorders The Social-Cognitive Perspective
Negative Thoughts & Moods Interact
Self-defeating beliefs
Learned helplessness
Overthinking
Explanatory style
Stable, global, internal explanations
Cause versus indictor of depression?

40. Understanding Mood Disorders:
Explanatory Styles

41. Understanding Mood Disorders The Social-Cognitive Perspective
Depression’s Vicious Cycle
Stressful experience
Negative explanatory style
Depressed mood
Cognitive and behavioral changes

42. Understanding Mood Disorders The Vicious Cycle of Depression

43. Biopsychosocial Approach to Depression

44. Dissociative Disorders (Read 644-5)
conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings
Dissociative amnesia: blocking of information regarding a very stressful event; just go on w/ life like it never happened (Freud’s repression)
Dissociative Fugue: go to new place & take up new life after some traumatic event
Dissociative Identity Disorder (DID)
rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities
formerly called multiple personality disorder
Some psychologists disbelieve this, say it’s role-playing
It is NOT schizophrenia (though you’ll hear it called that)
V. rare & disputed by most psychologists
Virtually always related to long-term childhood sexual abuse

45. Dissociative Identity Disorder
Dissociative identity disorder (DID)
Multiple personality disorder

46. Understanding Dissociative Identity Disorder
Genuine disorder or not?
DID rates…v. small: .01%
Therapist’s creation? Ppl do not come “with” the disorder—often comes after therapist begins to ask specifically about it
Differences from culture to culture are too great…it is NOT cross-cultural & seems specific mainly to USA
DID and other disorders

47. Schizophrenia: This one IS real…& v. sad…
literal translation “split mind” which is why may hear schiz. called multi. personality
a group of severe disorders characterized by:
disorganized and delusional thinking
disturbed perceptions
inappropriate emotions and actions
Delusions
false beliefs, often of persecution or grandeur, that may accompany psychotic disorders
Hallucinations
sensory experiences without sensory stimulation

48. Schizophrenic Art: also 

50. 5 subtypes of schizophrenia: Also… Acute vs. chronic?

51. Schizophrenia

52. Schizophrenia in ID Twins: 1 w/ & 1 w/o Indicates some other cause other than ____? FLUID FILLED areas are “ventricles”…larger ventricles associated w/ schizophrenia

53. Positive vs. negative symptoms …
These do NOT relate to good or bad…
Positive: something added…
EX: hallucinations; delusions; excessive emotion….etc.
Negative: something taken away…
EX: -flat affect (no emotion)
-no movement (catatonic)
Onset of schiz.: those predisposed to schiz. have their 1st episode typically between about ages 17 – 35
--some possible warning signs…
EX: poor selective attention

54. Understanding Schizophrenia: Psychological Factors
Possible warning signs
Mother severely schizophrenic
Birth complications (low weight/oxygen deprivation)
Separation from parents
Short attention span
Poor muscle coordination
Disruptive or withdrawn behavior
Emotional unpredictability
Poor peer relations and solo play

55. Clarification: Positive vs. Negative Schiz. symptoms
Positive symptoms are things that are present in schizophrenics which are absent in normal people, such as delusions, hallucinations, or word salad. 
Negative symptoms are things which are absent in schizophrenics which are present in normal people, such as flat affect, avolition (lack of motivation, etc.) or catatonia.

56. Etiology of schizophrenia:
Environment: Other disorders have effects from from the environment, BUT schiz. very much physiological
…BUT stress can bring on episodes in those who have physiological tendencies already
EX: family interaction & communication can have an
effect (Hi-risk factors RE: schiz.: p. 652)
Dopamine over-activity: too much dopamine in brains of schiz. during autopsies
Brain anatomy: low activity in frontal lobes; enlarged brain cavities (ventricles)
Maternal viruses during mid-pregnancy: is it the virus, or the medications, etc.?
But only 2% of schiz. seem affected this way…
Genetic factors: there is a genetic link …so if you have a close family member w/ schiz., risk is up

57. Personality Disorders: inflexible, long-lasting behavior patterns that impair social functioning usually without anxiety, depression, or delusions
(SOME below......BUT are others!)
Borderline Personality Disorder: manipulative; can be sexually promiscuous; defensive; high-risk; may threaten suicide for attention
Co-dependent Persn. Disor.: over-dependent on another; will allow another to abuse verbally, emotionally, etc., & tend to make excuses for him/her
-usually women; “passive-aggressive”
Narcissistic Persn. Disor.: It’s ALL about MEEEE!!!
Antisocial Persn. Disor. (aka “sociopaths”)
person (usually male) exhibits a lack of conscience for wrongdoing, even toward friends & family
may be aggressive and ruthless or a clever con artist
Early signs? (See “ppl who abuse animals…”)

58. Dimensional Models for Personality Disorders
A personality disorder : Enduring pattern of inner experience & behavior that deviates markedly from the expectations of the individual’s culture, is pervasive & inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. From DSM-5
Dimensional Models for Personality Disorders 
General Personality Disorder  Paranoid Personality Disorder 
Schizoid Personality Disorder  Schizotypal Personality Disorder  
Antisocial Personality Disorder   Borderline Personality Disorder  
Histrionic Personality Disorder   Narcissistic Personality Disorder  
Avoidant Personality Disorder  Dependent Personality Disorder  
Obsessive-Compulsive Personality Disorder  
Other Specified Personality Disorder 
Unspecified Personality Disorder
Personality Change Due to Another Medical Condition   

59. Anti-social personality disorder: little guilt or effect
Boys who were later convicted of a crime showed relatively low arousal during stress situations

60. Antisocial-Personality Disorders
PET scans illustrate reduced activation in a murderer’s frontal cortex…lacks guilt, etc.
Less related to genetics, more environ.
Normal
Murderer

61. Personality Disorders: Do seem to have an environmental etiology
Personality Disorders: Do seem to have an environmental etiology...often abusive, poor, neglectful parents are involved + birth problems

62. Rates of Psychological Disorders: Highest. Lowest
Rates of Psychological Disorders: Highest? Lowest? Cultural /gender aspects?

63. Rates of Disorders
Mental health statistics
Influence of poverty
Other factors

64. Somatoform disorders: (Not in bk!)
-Preoccupation w/ health…or showing physical symptoms w/ NO true physical problems
Conversion disorder: used to be called “hysterical ___”, i.e., hysterical blindness or hysterical paralysis
Hypochodriasis: hypochondria…preoccupied w/ your health, worried you have everything
Munchausen’s Syndrome or Munchausen by proxy: actually poison or otherwise hurt yourself (or another= proxy) in order to get sympathetic attention (any movie you remember?)

66. Answers to Match the famous ppl w/ mental disorders
ADHD : Michael Phelps
Agoraphobia: Paula Deen
Bipolar Disorder: Carrie Fisher, Vincent van Gogh
Bulimia: Elton John
Depression: Emma Thompson
Dissociative identity disorder (DID): Herschel Walker
OCD: Howard Hughes
Panic Attacks: Paula Deen
Post-partum depression: Brooke Shields
Schizophrenia: John Nash
Social Anxiety: Joan Baez
Substance Abuse: Craig Ferguson, Elton John