Chapter 16 Psychological Disorders

Quiz Social nonconformity is the failure to conform to societal norms or the usual minimum standards for social conduct, culturally specific. Mood disorder is a major disturbance in mood or emotion, such as depression or mania or bipolarity. Schizophrenia means having a split personality Everyone who experiences the same traumatic event will experience PTSD. Once someone is diagnosed with a major mental health disorder, they are considered crazy and there is not much that can be done to help them.

What is Normal? Psychopathology: Scientific study of mental, emotional, and behavioral disorders; abnormal or maladaptive behavior Subjective Discomfort: Subjective feelings of pain, unhappiness, or emotional distress Statistical Abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depression

What is Normal? Continued Social Nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior 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 Prepare a list of normal behaviors that involve interacting with other people Who are they normal or abnormal for? A man? A woman? A culture emphasizing passivity? A culture emphasizing aggression? Judgments are made relative to the values of one’s culture

Figure 16.1: The number of people displaying a personal characteristic may help define what is statistically abnormal. Fig. 16-1, p. 533

Statistical Abnormality Estimate the number of parties you have attended in the last month. Estimate the number of hours you have spent watching TV or using the computer (not for homework) in the last week Estimate the number of hours you have spent with your family in the last week What should define compulsive partying? Or other compulsive behavior? What is the cutoff for being addicted to any of these behaviors?

Figure 16.2: 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. Fig. 16-2, p. 536

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

Social nonconformity does not automatically indicate psychopathology.

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

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?

Insanity How do you define insanity? DSM-IV TR definition: Interferes with daily functioning on the following 2 out of 5 of the following categories. (page 312) Legal Defense: When an accused person in a criminal prosecution to avoid liability for the commission of a crime because, at the time of the crime, the person did not appreciate the nature or quality or wrongfulness of the acts.

Antisocial Personality Disorder (APD) 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., Scott Peterson)

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

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

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

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

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

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

The severe obsessions and compulsions of billionaire Howard Hughes led him to live as a recluse for over 20 years. Hughes had an intense fear of contamination. To avoid infection, he constructed sterile, isolated environments in which his contact with people and objects was strictly limited by complicated rituals. Before handling a spoon, for instance, Hughes had his attendants wrap the handle in tissue paper and seal it with tape. A second piece of tissue was then wrapped around the first before he would touch it (Hodgson & Miller, 1982). A spoon prepared as Hughes required is shown at right.

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 What does a nervous breakdown look like? What has broken down? What nerves are being referred to?

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

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 Usually triggered by highly traumatic events

Split Personality What does split personality mean? What is split? What would it look like? How would you treat it?

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

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

Glove Anesthesia Loss of skin sensitivity in areas normally covered by a glove

Theoretical Causes of Anxiety Disorders: 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

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)

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 no longer connected

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, mental confusion, and progressive loss of mental abilities Ronald Reagan most famous Alzheimer’s victim

Former U.S. President Ronald Reagan was diagnosed with Alzheimer’s disease in 1995. Like many Alzheimer’s victims, Reagan slipped into a slow mental decline. He died in 2004. p. 551

Figure 16.5: 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, hat makers were heavily exposed to mercury used in the preparation of felt. Consequently, many suffered brain damage and became psychotic, or “mad” (Kety, 1979). Fig. 16-5, p. 550

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

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

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

Can the rigid postures and stupor of a person with catatonic schizophrenia be understood in terms of abnormal body chemistry? Environment? Heredity? p. 553

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

This series of paintings by Louis Wain reflects a troubled personality This series of paintings by Louis Wain reflects a troubled personality. Wain was a British illustrator who became schizophrenic in middle age. As Wain’s psychosis progressed, his cat paintings became highly abstract and fragmented. In many ways, Wain’s paintings resemble the perceptual changes caused by psychedelic drugs such as mescaline and LSD. Recent research suggests that psychosis may, in fact, be the result of mind-altering changes in brain chemistry. p. 556

This series of paintings by Louis Wain reflects a troubled personality This series of paintings by Louis Wain reflects a troubled personality. Wain was a British illustrator who became schizophrenic in middle age. As Wain’s psychosis progressed, his cat paintings became highly abstract and fragmented. In many ways, Wain’s paintings resemble the perceptual changes caused by psychedelic drugs such as mescaline and LSD. Recent research suggests that psychosis may, in fact, be the result of mind-altering changes in brain chemistry. p. 556

This series of paintings by Louis Wain reflects a troubled personality This series of paintings by Louis Wain reflects a troubled personality. Wain was a British illustrator who became schizophrenic in middle age. As Wain’s psychosis progressed, his cat paintings became highly abstract and fragmented. In many ways, Wain’s paintings resemble the perceptual changes caused by psychedelic drugs such as mescaline and LSD. Recent research suggests that psychosis may, in fact, be the result of mind-altering changes in brain chemistry. p. 556

This series of paintings by Louis Wain reflects a troubled personality This series of paintings by Louis Wain reflects a troubled personality. Wain was a British illustrator who became schizophrenic in middle age. As Wain’s psychosis progressed, his cat paintings became highly abstract and fragmented. In many ways, Wain’s paintings resemble the perceptual changes caused by psychedelic drugs such as mescaline and LSD. Recent research suggests that psychosis may, in fact, be the result of mind-altering changes in brain chemistry. p. 556

Figure 16.6: 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. Fig. 16-6, p. 554

Biochemical Causes of Schizophrenia Biochemical Abnormality: Disturbance in brain’s chemical systems or in the brain’s neurotransmitters Dopamine: Neurotransmitter involved with emotions and muscle movement Works in limbic system Dopamine overactivity in brain may be related to schizophrenia Glutamate: A neurotransmitter; may also be involved

Figure 16.7: 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.) Fig. 16-7, p. 555

Figure 16.8: 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. Fig. 16-8, p. 556

Schizophrenic Brain Images 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

Stress-Vulnerability Model Combination of environmental stress and inherited susceptibility cause schizophrenic disorders

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

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 Disorders Bipolar I Disorder: Person experiences extreme mania and deep depression Mania: Excited, hyperactive, energetic, grandiose behavior Bipolar II Disorder: Person is mainly sad but has one or more hypomanic episodes (mild mania)

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

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

Figure 16.12: 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). Fig. 16-12, p. 561

Other Psychological Disorders 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 Sexual and Gender Identity Disorder: Problems with sexual identity, deviant sexual behavior, or sexual adjustment Neurosis: Archaic; once used to refer to anxiety, somatoform, dissociative disorders, and to some forms of depression (as a whole group)

Mentally Healthy? What does it mean to be mentally healthy? What are the basic attributes? How can we discuss psychopathology (problems) without a thorough understanding of health? For example: Jahoda’s list: Accurate self concept, self awareness and self acceptance Self actualization, full use of potential Autonomy Integration, a coherent outlook on life Accurate perceptions of reality and social sensitivity Competence and mastery of the environment

Deviant Behavior You get the chance to observe deviant behavior in action. In groups of 3, one of you will be the deviant behaver, and the other 2 will be the observers. Go out in the building, or surrounding areas and do something that is not “normal” The observers will report how your behavior was responded to by other people Don’t do anything entirely inappropriate, offensive or that would get yourself or me into trouble See page 533 in your textbooks for an example

Deviant Discussion Reactions of the unsuspecting to the “deviant” Negative sanctions applied by the subjects Feelings of students before, during and after event What does it mean to be normal or abnormal? Are your thoughts different now than they were in the beginning of class?

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