1. Chapter 14: Psychological Disorders

2. Psychopathology
Maladaptive, disruptive, or uncomfortable patterns of thinking, feeling, and behaving
Affect individuals
Affect the people with whom they interact
Sorrowing Old Man ('At Eternity's Gate') Vincent van Gogh, 1890

3. A continuum of normal/abnormal
Abnormal Behavior
What is abnormal?
Deviant
Dysfunction
Distress
A continuum of normal/abnormal
The medical model proposes that it is useful to think of abnormal behavior as a disease…Thomas Szasz and others argue against this model, contending that psychological problems are “problems in living,” rather than psychological problems.
In determining whether a behavior is abnormal, clinicians rely on the following criteria: 1. Is it deviant, or does it violate societal norms, 2. Is it maladaptive, (dysfunction) that is, does it impair a person’s everyday behavior, and 3. Does it cause them personal distress?
All three criteria do not have to be met for a person to be diagnosed with a psychological disorder…diagnoses involve value judgments.
Antonyms such as normal vs. abnormal imply that people can be divided into two distinct groups, when in reality, it is hard to know when to draw the line.

4. A Practical Approach for Defining Abnormal Behavior
Content of the behavior
Sociocultural context in which it occurs
Consequences for that person and others
Back to TOC

5. Biopsychosocial Approach Explaining Psychological Disorders
Most common viewpoint today
Mental disorders are the result of combination & interaction among
Biological factors
Psychological factors
Sociocultural factors

6. The Medical Model (aka Neurobiological Model)
Disorders stem primarily from an underlying illness that can be diagnosed, treated, and cured
Biological factors cause mental illness
Physical illnesses
Disruptions or imbalances in bodily processes
Genetic influences
The medical model proposes that it is useful to think of abnormal behavior as a disease…Thomas Szasz and others argue against this model, contending that psychological problems are “problems in living,” rather than psychological problems.

7. The Psychological Model
Emphasizes psychological factors:
Wants
Needs
Emotions
Learning experiences
Attachment history
World view Ψ

8. Multiple Approaches of The Psychological Model:
Sigmund Freud’s psychodynamic explanation:
Unresolved, mostly unconscious conflicts between inborn impulses and the limits placed on those impulses by society
Social-cognitive (social learning) explanation:
Interaction of past learning and current situations
Emphasizes the roles of learned expectations, schemas, and other mental processes
Humanistic psychology explanation:
Natural tendency toward healthy growth is blocked and perceptions of reality become distorted

9. The Sociocultural Perspective: Effects of Sociocultural Factors
Create differing stressors, social roles, opportunities, experiences, and avenues of expression for different groups of people
Help shape the disorders and symptoms to which certain categories of people are prone
Affect responses to treatment
Sociocultural factors – gender, age, marital status; physical , social & economic situation; cultural values, traditions & expectation in which they are immersed
Not only influences what is/is not labeled “abnormal” but who displays what king odisorder and how likely people are to receive treatment for it

10. The Sociocultural Perspective: Culture-General Disorders
Culture can influenced symptoms of disorders that appear virtually everywhere in the world
e.g., Depression
Western cultures, emotional/physical components viewed separately, so symptoms appear as despair/distress
Asian cultures, emotional/physical components seen as one, so symptoms may appear as stomach/back pain
For next slide
The symptoms of ataque de nervios are transient in nature and typically occur suddenly in response to a severe psychosocial stressor. Symptoms include impulsive, dramatic behaviors such as screaming uncontrollably, crying, trembling and nervousness, anger and violence, and breaking things. Less common symptoms include seizure-like behavior, fainting, suicidal behavior, and dissociative experiences such as localized amnesia of events. Finally, brief psychotic symptoms such as incoherence, auditory hallucinations, and visual hallucinations have been documented during ataque de nervios episodes.

11. The Sociocultural Perspective: Culture-Specific Disorders
Ataques de nervios (attacks of nerves) among Puerto Rican, Guatemalan, Mexican, and Dominican women
Kyol goeu among Khmer refugees
Koro among Southeast Asian, southern Chinese, and Malaysian men
Anorexia nervosa among North American & European young women
As detailed in the previous article in this journal (Hinton, 2001a), Khmer consider kyol goeu to be a potentially fatal fainting episode. According to the Khmer conception, prior to an episode, despite some accumulation of wind in the body (e.g., in the limb vessels, belly, chest, neck vessels, and head), the person may feel just some malaise. One day, most often upon standing, the individual will suddenly feel dizzy while concurrently experiencing other panic-like symptoms (e.g., palpitations, shortness of breath, and blurred vision) and then fall to the ground. In the supine position, the sufferer normally retains conscious awareness but can not move or speak. Family members and friends must quickly administer various emergency treatments that aim to directly remove excessive wind from the body (e.g., by ‘coining’), cause the wind to move normally in its course through the vessels (e.g., by massaging the limbs), and rouse to consciousness (e.g., by biting the ankle). Khmer believe that if these interventions are not implemented quickly, the sufferer will either permanently lose the use of a limb, such as an arm, or die. Although Khmer sometimes suffer kyol goeu episodes, near-kyol goeu episodes occur much more frequently, in which the person feels multiple symptoms upon standing, such as dizziness, often staggering, or even falling to the ground, but remains in control of self-movement.1
ko·ro
  <a noun Psychiatry . a culture-specific syndrome, occurring chiefly in China and southeastern Asia, characterized by anxiety and the fear of retraction of the penis or breasts and labia into the body.

12. The Diathesis-Stress Model: An Integrative Explanation
Biological, psychological, and sociocultural factors can predispose us toward a disorder
A certain amount of stress is needed to trigger that disorder
If major stressors don’t occur—or if the person has adequate coping skills—symptoms may never appear, or may be relatively mild
Diathesis = genetic vulnerability or predisposition

13. Perspectives on Diagnosis: José
Consider the following case:
José is a 55-year-old electronics technician, a healthy and vigorous father of two adult children.
He was forced to take medical leave because of a series of sudden panic attacks in which he experienced dizziness, heart palpitations, sweating, and a sense of impending death.
The attacks also kept him from his favorite pastime, scuba diving.
He has been able to maintain a part-time computer business out of his home.

14. Diagnosing José How would these diagnosticians diagnose José?
Medical (neurobiological)
Psychodynamic
Social-cognitive
Humanistic
Sociocultural
Diathesis-stress
After reading the previous slide, have students write down the models/perspectives and answer this question. Break it up and have partners do 1 together and share answers with class.

15. Diagnosing José
Medical (neurobiological): José may have organic disorders (e.g., genetic tendency toward anxiety, brain tumor, endocrine dysfunction, neurotransmitter imbalance).
Psychodynamic: José has unconscious conflicts and desires. Instinctual impulses are breaking through his ego defenses into consciousness, causing panic.

16. Diagnosing José
Social-cognitive: José interprets physical stress symptoms as signs of serious illness or impending death. Panic is rewarded by reduction in work stress when he stays home.
Humanistic: José fails to recognize his genuine feelings about work and his place in life, and he fears expressing himself.

17. Diagnosing José
Sociocultural: A culturally based belief that “a man should not show weakness” amplifies the intensity of stress reactions.
Diathesis-stress: José has a biological (possibly genetic) predisposition to be overly responsive to stressors. The stress of work and extra activity exceeds his capacity to cope and triggers panic as a stress response.
Back to TOC

18. Psychodiagnosis: Classifying Psychological Disorders
Reasons for classification:
Determine the nature of a problem
Choose the most appropriate method of treatment
Study the causes of mental disorders
A taxonomy of mental disorders was first published in 1952 by the American Psychiatric Association - the DSM. This classification scheme is now in its 4th revision, which uses a multiaxial system for classifying mental disorders.
Published by APA
Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-4 or DSM-IV-TR)

19. DSM-IV Classification System Five Axes
Axis I: Diagnosed mental disorder
Axis II: Personality disorders/ intellectual disability
Axis III: Relevant medical conditions
Axis IV: Psychosocial and environmental problems
Axis V: Current level of psychological, social, and occupational functioning - Global Assessment of Functioning(GAF) rating scale (100=good)
The goal of this multiaxial system is to impart information beyond a traditional diagnostic label.
100 – Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, no symptoms, etc.
60 - Moderate symptoms or moderate impairment in functioning (conflicts with coworkers, some panic attacks)
20 - Some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene or gross impairment in communication (suicide, violent, smears feces, mute, etc.)

20. Global Assessment of Functioning (GAF)
100 – Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, no symptoms, etc.
60 - Moderate symptoms or moderate impairment in functioning (conflicts with coworkers, some panic attacks)
20 - Some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene or gross impairment in communication (suicide, violent, smears feces, mute, etc.)

21. Problems with the Diagnostic System
Mixed disorders are common
Same symptoms seen in different disorders
Subjective nature of criteria judgments
Possibility of bias in diagnosis
Insufficient attention to sociocultural variables
Labeling can be dehumanizing
Back to TOC

22. Example #1 Axis I: Major Depressive Disorder Alcohol Abuse
Axis II: Dependent Personality Disorder
Axis III: None
Axis IV: Unemployment
Axis V: GAF = 35 (on admission)
GAF = 57 (at discharge)
What does this tell us about this person?
What does this not tell us about this person?
What does this tell us about this person?
What does this not tell us about this person?
Gender, age, race/ethnicity

23. Example #2 Axis I: Post-Traumatic Stress Disorder Social Phobia
Axis II: None
Axis III: Hypothyroidism
Axis IV: Victim of child abuse
Axis V: GAF = 65 (current)
What does this tell us about this person?
What does this not tell us about this person?

24. Axis I Clinical Syndromes
Anxiety Disorders
Somatoform Disorders
Dissociative Disorders
Mood Disorders
Schizophrenic Disorders
The clinical syndromes discussed at length in the text are listed on this slide as an overview and are covered individually on the following slides.
syndrome /syn·drome/ (sin´drōm) a set of symptoms occurring together

25. Clinical Syndromes: Anxiety Disorders
Generalized anxiety disorder
“free-floating anxiety”
Phobic disorder
Specific focus of fear
Panic disorder
Obsessive compulsive disorder (OCD)
Posttraumatic Stress Disorder (PTSD)
The anxiety disorders are a class of disorders marked by feelings of excessive apprehension and anxiety.
Generalized anxiety disorder is marked by a chronic, high level of anxiety that is not tied to any specific threat…”free-floating anxiety.”
Phobic disorder is marked by a persistent and irrational fear of an object or situation that presents no realistic danger. Particularly common are acrophobia – fear of heights, claustrophobia – fear of small, enclosed places, brontophobia – fear of storms, hydrophobia – fear of water, and various animal and insect phobias.
Panic disorder is characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly. These paralyzing attacks have physical symptoms. After a number of these attacks, victims may become so concerned about exhibiting panic in public that they may be afraid to leave home, developing agoraphobia or a fear of going out in public.
Obsessive-compulsive disorder (OCD) is marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions). Obsessions often center on inflicting harm on others, personal failures, suicide, or sexual acts. Common examples of compulsions include constant handwashing, repetitive cleaning of things that are already clean, and endless checking and rechecking of locks, etc.
PTSD involves enduring psychological disturbance attributed to the experience of a major traumatic event…seen after war, rape, major disasters, etc. Symptoms include re-experiencing the traumatic event in the form of nightmares and flashbacks, emotional numbing, alienation, problems in social relations, and elevated arousal, anxiety, and guilt.

26. Some Phobias Acrophobia: Heights Claustrophobia: Enclosed spaces
Hematophobia: Blood
Gephyrophobia: Crossing a bridge
Kenophobia: Empty rooms
Cynophobia: Dogs
Aerophobia: Flying
Entomophobia: Insects
Gamophobia: Marriage
Ophdophobia: Snakes
Xenophobia: Strangers
Melissophobia: Bees

27. Obsessive-Compulsive Disorder (OCD)
Obsessions—persistent, upsetting, unwanted thoughts
Compulsions—ritualistic, repetitive behaviors
e.g., checking locks; repeating words, images, or numbers; counting things; or arranging objects “just so”
Prevalence:
Affects about 1% of the population in any given year
Equally common in males and females
Many sufferers know that their thoughts and actions are irrational, but are severely upset or anxious if they try to interrupt obsessions or stop compulsive behaviors
Jump to Linkages

28. Etiology of Anxiety Disorders
Biological factors
Genetic predisposition, anxiety sensitivity
Neurotransmitter system abnormalities
Conditioning and learning
Acquired through classical conditioning or observational learning
Maintained through operant conditioning
Cognitive factors
Judgments of perceived threat,
Personality
Neuroticism
Stress—a precipitator
Twin studies suggest a moderate genetic predisposition to anxiety disorders. They may be more likely in people who are especially sensitive to the physiological symptoms of anxiety. Abnormalities in neurotransmitter activity at GABA synapses have been implicated in some types of anxiety disorders, and abnormalities in serotonin synapses have been implicated in panic and obsessive-compulsive disorders.
Many anxiety responses, especially phobias, may be caused by classical conditioning and maintained by operant conditioning. Parents who model anxiety may promote the development of these disorders through observational learning.
Cognitive theories hold that certain styles of thinking, overinterpreting harmless situations as threatening, for example, make some people more vulnerable to anxiety disorders. The personality trait of neuroticism has been linked to anxiety disorders, and stress appears to precipitate the onset of anxiety disorders.

29. Clinical Syndromes: Somatoform Disorders
Somatization Disorder
Conversion Disorder
Hypochondriasis
Etiology of Somatoform Disorders
Some cases related to:
Childhood experiences
Severe stressors as triggers
Cognitive factors
Explained by diathesis-stress approach
Sociocultural factors affect manifestation
Somatoform disorders are physical ailments that cannot be explained by organic conditions. They are not psychosomatic diseases, which are real physical ailments caused in part by psychological factors. (Recall from chapter 13 that psychosomatic disease as a category has fallen into disuse). Individuals with somatoform disorders are not simply faking an illness, which would be termed malingering.
Somatization disorder is marked by a history of diverse physical complaints that appear to be psychological in origin. They occur mostly in women and often coexist with depression and anxiety disorders.
Conversion disorder is characterized by a significant loss of physical function (with no apparent organic basis), usually in a single organ system…loss of vision, partial paralysis, mutism, etc…glove anesthesia, for example, is neurologically impossible.
Hypochondriasis is characterized by excessive preoccupation with health concerns and incessant worry about developing physical illnesses.
Somatoform disorders often emerge in people with highly suggestible, histrionic personalities and in people who focus excess attention on their physiological processes. They may be learned avoidance strategies, reinforced by attention and sympathy.

30. Somatoform Disorders: Conversion Disorder
Apparent blindness, deafness, paralysis, or insensitivity to pain
Appears in teens or early adulthood
Tends to appear under severe stress
Reduces stress by allowing avoidance of unpleasant or threatening situations
Sufferer may show little concern
Symptoms may be neurologically impossible or improbable
e.g., glove anesthesia
People can actually see, hear, or move
E.g. Glove anesthesia
Anesthesia stops at wrist
But hand and arm nerves blend
If nerves were actually impaired, part of the arm would also lose sensitivity

31. Somatoform Disorders: Hypochondriasis
Strong, unjustified fear that one has a serious physical problem
Hypochondriasis resembles an anxiety disorder—involves health concerns; includes elements of phobia, panic, and obsessive-compulsive disorder
Sufferers make frequent doctor visits to report symptoms & request unnecessary treatment
They may even become “experts” by endlessly searching health-related Web sites

32. Clinical Syndromes: Dissociative Disorders
Dissociative Fugue (fugue reaction)
Sudden wandering and loss of memory or confusion about personal identity
May adopt an entirely new identity
Dissociative Amnesia
Sudden loss of memory about personal information
Dissociative Identity Disorder (DID)
Also called multiple personality disorder
Etiology
severe emotional trauma during childhood
Controversy
Media creation?
Dissociative disorders are a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity.
Dissociative amnesia is a sudden loss of memory for important personal information that is too extensive to be due to normal forgetting. Memory loss may be for a single traumatic event or for an extended time period around the event.
Dissociative fugue is when people lose their memory for their entire lives along with their sense of personal identity…forget their name, family, where they live, etc., but still know how to do math and drive a car.
Dissociative identity disorder (formerly multiple personality disorder) involves the coexistence in one person of two or more largely complete, and usually very different, personalities.
DID is related to severe emotional trauma that occurred in childhood, although this link is not unique to DID, as a history of child abuse elevates the likelihood of many disorders, especially among females.
Some theorists believe that people with DID are engaging in intentional role playing to use an exotic mental illness as a face-saving excuse for their personal failings and that therapists may play a role in their development of this pattern of behavior, others argue to the contrary. In a recent survey, only ¼ of American psychiatrists in the sample indicated that they felt there was solid evidence for the scientific validity of DID.

33. Clinical Syndromes: Mood (Affective) Disorders
Major depressive disorder
Dysthymic disorder
Bipolar disorder
Cyclothymic disorder
Etiology
Genetic vulnerability
Neurochemical factors
Cognitive factors
Interpersonal roots
Precipitating stress
Mood disorders are a class of disorders marked by emotional disturbances of varied kinds that may spill over to physical, perceptual, social, and thought processes.
Major depressive disorder is marked by profound sadness, slowed thought processes, low self-esteem, and loss of interest in previous sources of pleasure. Major depression is also called unipolar depression. Research suggests that the lifetime prevalence rate of unipolar depression is between 7 and 18%. Evidence suggests that the prevalence of depression is increasing, particularly in more recent age cohorts, and that it is 2X as high in women as in men.
Dysthymic disorder consists of chronic depression that is insufficient in severity to justify diagnosis of major depression; sad mood, lack in interest/pleasure; longer duration >/= 2 years in adults; >/= 1 year in children
Bipolar disorder (formerly known as manic-depressive disorder) is characterized by the experience of one or more manic episodes usually accompanied by periods of depression. In a manic episode, a person’s mood becomes elevated to the point of euphoria.
Bipolar disorder affects a little over 1%-2% of the population and is equally as common in males and females.
People are given the diagnosis of cyclothymic disorder when they exhibit chronic but relatively mild symptoms of bipolar disturbance.
Etiology
Evidence suggests genetic vulnerability to mood disorders. These disorders are accompanied by changes in neurochemical activity in the brain, particularly at norepinephrine and serotonin synapses.
Continued on next slide

34. Etiology of Mood Disorders
Genetics
Malfunctions in brain regions involved in mood
Neurotransmitter system imbalances
Malfunctioning of the endocrine system
Disruption of biological rhythms
Seasonal affective disorder (SAD)
Learned helplessness/hopelessness
Beck’s cognitive theory of depression (self-blame, negativity, pessimistic)
Negative attributional style
Thinking style (ruminative vs distracting)
Stressors
Biological
Continued from previous slide
Cognitive models suggest that negative thinking contributes to depression. Learned helplessness and a pessimistic explanatory style have been proposed by Martin Seligman as predisposing individuals to depression. Hopelessness theory, the most recent descendant of the learned helplessness model of depression, proposes a sense of hopelessness as the “final pathway” leading to depression…not just explanatory style, but also high stress, low self-esteem, and other factors combine in the development of depression. Current research also implicates ruminating over one’s problems as important in the maintenance of depression, extending and amplifying individuals’ episodes of depression.
Interpersonal inadequacies and poor social skills may lead to a paucity of life’s reinforcers and frequent rejection. Stress has also been implicated in the development of depressive disorders.
Psychosocial

35. Clinical Syndromes: Schizophrenic Disorders
Perceptual disorders (including hallucinations)
Emotional disturbances
Deterioration of adaptive behavior
Lack of motivation and poor social skills
Deteriorating personal hygiene
Inability to function on a daily basis
Delusions and irrational thought, inability to focus
Disorganized thought & language
Neologisms
Clang associations
Word salad
Schizophrenic disorders -class of disorders marked by delusions, hallucinations, disorganized speech,disorganized behavior.
General symptoms include delusions, which are false beliefs that are maintained even though they clearly are out of touch with reality…belief that you are a tiger, that private thoughts are being broadcasted to others, etc. Delusions of grandeur-people think they are famous or important. Chaotic thinking, or loose associations, is common as well, where a person shifts topics in disjointed ways.
Deterioration of adaptive behavior -noticeable deficits in the quality of a person’s routine functioning in work, social relations, personal care.
Hallucinations -sensory perceptions that occur in the absence of a real, external stimulus or are gross distortions of perceptual input…hearing voices.
Disturbed emotion may manifest as little emotional responsiveness (blunted or flat affect) or inappropriate emotional responses (laughing at a story of a child’s death).
Clang association A word evoked not by logic or meaning but by its similarity in sound to another word.
neologism n. A new word, expression, or usage. The creation or use of new words or senses.
word salad, is confused, and often repetitious, words & phrases
Disturbed thought lies at the core of schizophrenia; disturbed emotion lies at the core of mood disorders.

36. Categorizing Schizophrenia
Paranoid
Catatonic
Disorganized
Undifferentiated
Alternate Categorization by Symptom types:
Positive symptoms
e.g., disorganized thoughts, delusions, hallucinations
Negative symptoms
e.g., absence of pleasure and motivation, lack of emotional reactivity, social withdrawal, reduced speech
Currently, in the DSM-IV, there are 4 subtypes of schizophrenia.
Paranoid schizophrenia is dominated by delusions of persecution, along with delusions of grandeur.
Catatonic schizophrenia is marked by striking motor disturbances, ranging from muscular rigidity to random motor activity.
In disorganized schizophrenia, a particularly severe deterioration of adaptive behavior is seen…incoherence, complete social withdrawal, delusions centering on bodily functions.
Undifferentiated schizophrenia diagnosis given to people who clearly have schizophrenia, but cannot be placed in any of the above subtypes.
There are many critics of the current subtyping system for schizophrenia. Some theorists argue that the disorder should be conceptualized along two categories, positive symptoms – behavioral excesses or peculiarities, such as hallucinations, delusions, bizarre behavior, and wild flights of ideas; and negative symptoms – behavioral deficits, such as flattened emotions, social withdrawal, apathy, impaired attention, and poverty of speech.

37. Etiology of Schizophrenia
Genetic vulnerability
Neurochemical factors
Structural abnormalities of the brain
Neurodevelopmental abnormalities
Expressed emotion
Precipitating stress
Biological
Dysfunctional cognitive habits
Stress of urban living
Being an immigrant
Stressful family communication patterns
Family members’ negative attitudes
Research has linked schizophrenia to a genetic vulnerability and changes in neurotransmitter activity at dopamine, and perhaps serotonin, receptors.
Structural abnormalities in the brain, such as enlarged ventricles, are associated with schizophrenia, as are metabolic abnormalities in the prefrontal and temporal lobes. Researchers theorize that positive symptoms are related to prefrontal abnormalities and negative symptoms to temporal abnormalities. The question remains to be answered re: whether these abnormalities are cause or consequence of schizophrenia.
The neurodevelopmental hypothesis of schizophrenia asserts that it is attributable to disruptions in maturational processes of the brain before or at the time of birth that are caused by prenatal viral infections or malnutrition, obstetrical complications, and other brain insults.
Studies of expressed emotion, or the degree to which a relative of a person with schizophrenia displays highly critical or emotionally overinvolved attitudes toward the patient, suggest that expressed emotion is a good predictor of the course of schizophrenic illness, negatively impacting prognosis.
Precipitating stress and unhealthy family dynamics have also been shown to be related to schizophrenia.
precipitating factor n An element that causes or contributes to the occurrence of a disorder or problem.
Psychosocial

38. Personality Disorders
Odd-eccentric cluster (cluster A)
Paranoid, schizoid, and schizotypal
Dramatic-erratic cluster (cluster B)
Histrionic, narcissistic, borderline, and antisocial
Anxious-fearful cluster (cluster C)
Dependent, obsessive-compulsive, and avoidant
Personality disorders are a class of disorders marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning.
Odd-eccentric cluster: Schizoid – defective in capacity for forming social relationships, Schizotypal – social deficits and oddities in thinking, perception, and communication, Paranoid – pervasive and unwarranted suspiciousness and mistrust.
Dramatic-impulsive cluster: Histrionic – overly dramatic, tending to exaggerate expressions of emotion, Narcissistic – grandiosely self-important, lacking interpersonal empathy, Borderline – unstable in self-image, mood, and interpersonal relationships, Antisocial – chronically violating the rights of others, non-accepting of social norms, inability to form attachments.
Anxious-fearful cluster: Avoidant – excessively sensitive to potential rejection, humiliation or shame, Dependent – excessively lacking in self-reliance and self-esteem, Obsessive-compulsive – preoccupied with organization, rules, schedules, lists, and trivial details.
Specific personality disorders are poorly defined, and there is much overlap among them…some theorists propose replacing the current categorical approach with a dimensional one.
Research on the etiology of personality disorders has been conducted primarily on antisocial personality disorder. Genetic vulnerability has been suggested, along with autonomic reactivity, inadequate socialization, and observational learning.
Reactivity has been defined as “the deviation of a physiological response parameter from a comparison or control value that results from an individual's response to a discrete, environmental stimulus” (Matthews, 1986).
Etiology
Genetic predispositions, inadequate socialization in dysfunctional families, observational learning

39. Identify how these character/people mght be diagnosed on this chart
Sheldon Cooper (Big Bang Theory) – dramatic/impulsive – narcissistic personality disorder?; odd/eccentric – schizoid personality disorder?

40. Psychological Disorders and the Law: Protecting the Accused
Protection for accused people who are:
Mentally incompetent to stand trial
Not guilty by reason of insanity
M’Naghton rule: Mental illness prevents understanding one’s actions or knowing that the actions were wrong
American Law Institute (ALI) rule: Mental illness disables the ability to resist the impulse to do wrong
Insanity Defense Reform Act eliminated ALI rule in federal cases
Insanity is not a diagnosis, it is a legal concept. Insanity is a legal status indicating that a person cannot be held responsible for his or her actions because of mental illness.
The M’naghten rule holds that insanity exists when a mental disorder makes a person unable to distinguish right from wrong.

41. Criticisms of the Insanity Defense
Everyone should be held responsible and punished for their crimes
Jurors must choose between conflicting, highly technical expert testimony about a defendant’s sanity at the time of a crime
People with mental disorders are still capable of some rational decision making and of controlling some aspects of their behavior
Insanity defense abolished in 4 U.S. states
Juries in 13 states can find defendants guilty but mentally ill
These defendants still serve a sentence
They are supposed to receive treatment while confined
Insanity Defense Reform Act eliminated the ALI rule in federal cases
Burden of proof for insanity shifted to the defense, rather than the prosecution in federal and some state courts

42. Can Criminals Get Away with Murder?
Rarely, if ever
The insanity plea is used in fewer than 1 of 200 felony cases in the United States
Insanity plea only successful in 2 of 2000 tries
Defendants found not guilty by reason of insanity are usually hospitalized 2 to 9 times longer than the time they would have spent in prison if convicted
Back to TOC

43. Psychological Disorders & the Law
Involuntary commitment
danger to self
danger to others
in need of treatment
Involuntary commitment occurs when people are hospitalized in psychiatric facilities against their will. Rules vary from state to state, but generally, people are subject to involuntary commitment when they are a danger to themselves or others or when they are in need of treatment (as in cases of severe disorientation).
In emergency situations, psychiatrists and psychologists can authorize temporary commitment only for a period of hours. Long-term commitments must go through the courts and are usually set up for renewable six-month periods.

44. Chapter 14: Psychological Disorders