1. Psychological Disorders
Chapter 15

2. Abnormal Behavior Historical aspects of mental disorders
The medical model
What is abnormal behavior?
3 criteria
Deviant
Maladaptive
Causing personal 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, 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. Prevalence, Causes, and Course
Epidemiology
Prevalence
Lifetime prevalence
Diagnosis
Etiology Prognosis
Epidemiology: study of the distribution of mental or physical disorders in the population
Prevalence: % of population that displays the disorder during a specific period
Lifetime: % of people who have ben diagnosed w/ a disorder at any point in their lives
Diagnosis: distinguishing one disease form another
Etiology: apparent causation and development history of illness

6. Psychodiagnosis: The Classification of Disorders
American Psychiatric Association – published first taxonomy in 1952
Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV)
Multiaxial system
5 axes or dimensions – F 14.3
Axis I – Clinical Syndromes
Axis II – Personality Disorders or Developmental Disorders
Axis III – General Medical Conditions
Axis IV – Psychosocial and Environmental Problems
Axis V – Global Assessment of Functioning
DSM
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.
The remaining axes are used to record supplemental information. A person’s physical disorders are listed on Axis III, and the types of stress they have experienced in the past year on Axis IV. Axis V estimates the individual’s current level of adaptive functioning.
The goal of this multiaxial system is to impart information beyond a traditional diagnostic label.

8. Figure 14.4 – Example multiaxial evaluation

9. Two Major Classifications in the DSM
Neurotic Disorders
Psychotic Disorders
Distressing but one can still function in society and act rationally.
Person loses contact with reality, experiences distorted perceptions.

10. Axis I Clinical Syndromes and Axis II Personality Disorders
Anxiety Disorders
Somatoform Disorders
Dissociative Disorders
Mood Disorders
Schizophrenic Disorders
Eating Disorders
Axis II – Personality Disorders

11. Clinical Syndromes: Anxiety Disorders
Generalized anxiety disorder
“free-floating anxiety”
Phobic disorder
Specific focus of fear
Panic disorder and agoraphobia
Physical symptoms of anxiety/leading to agoraphobia
Obsessive compulsive disorder
Obsessions
Compulsions
PTSD
A group of conditions where the primary symptoms are anxiety or defenses against anxiety
The patient fears something awful will happen to them
They are in a state of intense apprehension, uneasiness, uncertainty, or fear
GAD: high level of anxiety not tied to anything
Phobia: no realistic danger ( hydrophobia, claustrophobia and acrophobia)
Panic disorder: recurrent attacks of overwhelming anxiety that occur suddenly and unexpectedly
- physical symptoms (chest pain, choking)
- may eventually be afraid of going out in public
- studies show that patients had experienced a traumatic increase in stress in the past month
D) OCD: persistent, uncontrolled
E) PTSD: flashbacks or nightmares following a persons involvement in or observation of an extremely stressful event. Memories of the event cause anxiety
-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

12. Etiology of Anxiety Disorders
Biological factors
Genetic predisposition, anxiety sensitivity
GABA circuits in the brain
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.

16. Clinical Syndromes: Somatoform Disorders
Somatization Disorder
Conversion Disorder
Hypochondriasis
Etiology
Reactive autonomic nervous system
Personality factors
Cognitive factors
The sick role
Occur when a person manifests a psychological problem through a physiological symptom.
No physical explanation
Not just faking that would be malingering
They occur mostly in women and often coexist with depression and anxiety disorders.
Report the existence of severe physical problems with no biological reason. Ex. Blindness or paralysis
Excessive preoccupation w/ health concerns and worry about developing physical illness. Usually believe that the minor issues (headache, upset stomach) are indicative are more severe illnesses.
- Etiology: 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.

18. Quick Write
Ellie, a new student at Skinner High School, is determined to make friends. When she attends the first psychology club meeting she finds herself in the room with twenty strangers who seem to know each other well. She plans to attend a few more meetings before deciding whether she will join.
A. Demonstrate how each of the following could HELP play a role in Ellie’s quest for friendship. You may use a different example for each concept. Definitions will not score.
Operant conditioning
Locus of control
B. Demonstrate how each of the following could HINDER Ellie’s quest for friendship. You may use a different example for each concept. Definitions will not score.
HINDER
 Agorapohia
Circadian rhythm
Narcissitic Personality Disorder

19. Clinical Syndromes: Dissociative Disorders
Dissociative amnesia
Dissociative fugue
Dissociative identity disorder
Etiology
severe emotional trauma during childhood
Controversy
Media creation?
Sybil
Repressed memories
These disorders involve a disruption in the conscious process
Lose contact with portions of their consciousness or memory resulting in disruptions in their sense of identity
Most controversial
Relatively uncommon
Amnesia: sudden loss of memory for important personal info that is too extensive to be due to normal forgetting. Can last for one single traumatic event or for an extended period of time around the vent. ex. Car accident, rape etc
2. 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.
3. 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.

20. Clinical Syndromes: Mood Disorders
Major depressive disorder
Dysthymic disorder
Bipolar disorder (manic-depressive disorder)
Cyclothymic disorder
Seasonal Affective Disorder
Etiology
Age of onset
Genetic vulnerability
Neurochemical factors
Cognitive factors
Interpersonal roots
Precipitating stress
MDD:
Also known as unipolar depression
Unhappy for at least two weeks with no apparent cause
Depression is the common cold of psychological disorders
7-18% of people have this disorder (15 million in the US, this is increasing and is twice as high for women)
Bipolar:
A) fomarlly known as manic depression
Involves periods of depression and manic episodes
Manic episodes involve feelings of high energy but they differ a lot
Engage in risky behavior during the manic episode
Manic episode is followed by a period of depression
1 – 2% of population suffers from this disorder (about 5 million in US, equal among men and women)

25. Clinical Syndromes: Schizophrenia
General symptoms
Delusions and irrational thought
Deterioration of adaptive behavior - avolition
Hallucinations – any modality but usually auditory
Disturbed emotions – 66%
Prognostic factor
Gradual onset
Sudden onset
About 1 in every 100 people are diagnosed with schizophrenia
Disturbed thoughts are the core
In mood disorders its disturbed emotions

26. Subtyping of Schizophrenia
4 subtypes
Paranoid type
Catatonic type
Disorganized type
Undifferentiated type
New model for classification
Positive vs. negative symptoms
paranoid: someone is out to get them
Catatonic: impaired motor movement
Disorganized: comes from a breakdown in selective attention- they cannot filter out info. Fragmented and bizarre thoughts with false beliefs
- delusions of grandeur: when people think they are famous or important
- delusions of prosecution: someone's out to get me.

27. Etiology of Schizophrenia
Genetic vulnerability
Neurochemical factors – Dopamine hypothesis
Structural abnormalities of the brain – prefrontal lobe and ventricles
The neurodevelopmental hypothesis
Expressed emotion
Precipitating stress – stress-vulnerability model

29. Figure 14.19 The dopamine hypothesis as an explanation for schizophrenia

30. Neurological Changes in Schizophrenia

31. Figure 14.21 – Neurodevelopment hypothesis of schizophrenia
Figure – Expressed emotion and relapse rates in schizophrenia

32. Slide 33 – The stress-vulnerability model of schizophrenia

33. Personality Disorders
Anxious-fearful cluster
Avoidant, dependent, obsessive- compulsive
Dramatic-impulsive cluster
Histrionic, narcissistic, borderline, antisocial
Odd-eccentric cluster
Schizoid, schizotypal, paranoid
Etiology
Genetic predispositions, inadequate socialization in dysfunctional families
Prognosis
Personality disorders:
a) Well-established, maladaptive ways of behaving that negatively affect people’s ability to function
b) Dominates their personality. -

35. Psychological Disorders and the Law
Insanity
M’naghten rule
The insanity defense
Involuntary commitment – varies by states
danger to self
danger to others
in need of treatment
Culture and pathology

37. Eating Disorders Issues of weight Anorexia nervosa
Criteria and subtypes: restrictive and binge/purge
Bulimia nervosa
Binge eating
History and prevalence
Age onset
Etiology
Genetics
Personality – perfectionism
Cultural issues - “perfect” body type and digital photograph
Family role
Cognitive factors

39. Figure 14.25 - Age of anorexia nervous in the United States – Lucas et al. (1991)