1. Psychological Disorders Chapter 13

2. Chapter 13: Psychological Disorders
Perspectives on Psych Disorders
Anxiety Disorders
Dissociative and Personalityh
Mood Disorders
Schizophrenia
Rates of Psychological Disorders

3. Chapter 13Objectives
Identify the criteria for judging whether behavior is psychologically disordered.
Contrast the medical model w/ the biopsychological approach to disordered behavior.
Describe the goals and content of the DSM-IV; discuss dangers and benefits of labels.
Describe the symptoms of generalized anxiety disorder, panic disorder, phobias, OCD, and PTSD.
Discuss the contributions of learning and biological perspectives to understanding the development of anxiety disorders.

4. Objectives
Describe the symptoms of dissociative disorders and the controversy regarding the diagnosis of dissociative identity disorder.
Contrast the three clusters of personality disorders.
Define mood disorders; contrast major depressive and bipolar disorders.
Explain the development of mood disorders, using biological and social-cognitive perspectives.
Describe the symptoms of schizophrenia, and contrast chronic and acute schizophrenia.

5. I. Perspectives on Psychological Disorders
Where should we draw the line b/w normality & disorder?
Behavior is disordered when it is deviant, distressful, and dysfunctional. (psych disorder)
Definition of defiant varies w/ context and culture.
Varies w/ time… children who might have been judged rambunctious now are being diagnosed w/ attention deficit hyperactivity disorder.

6. I. Perspectives
People are fascinated by the exceptional, the unusual, and the abnormal. This fascination may be caused by two reasons:
During various moments we feel, think, and act like an abnormal individual.
Psychological disorders may bring unexplained physical symptoms, irrational fears, and suicidal thoughts.

7. To study the abnormal is the best way of understanding the normal.
I. Perspectives
To study the abnormal is the best way of understanding the normal.
William James ( )
There are 450 million people suffering from psychological disorders (WHO, 2004).
Depression and schizophrenia exist in all cultures of the world.

8. I. Perspectives… Defining Psychological Disorders
Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions.
When behavior is deviant, distressful, and dysfunctional psychiatrists and psychologists label it as disordered.
Preview Question 1: Where should we draw the line between normality and disorder?

9. I. Perspectives… Deviant, Distressful & Dysfunctional
Deviant behavior (going naked) in one culture may be considered normal, while in others it may lead to arrest.
Deviant behavior must accompany distress.
If a behavior is dysfunctional it is clearly a disorder.
Carol Beckwith
In the Wodaabe tribe men wear costumes to attract women. In Western society this would be considered abnormal.

10. I. Perspectives… Understanding Psychological Disorders
Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood.
Preview Question 2: What theoretical models or perspectives can help us understand psychological disorders?
John W. Verano
Trephination (boring holes in the skull to remove evil forces)

11. I. Perspectives… The Medical Model
Philippe Pinel ( ) from France, insisted that madness was not due to demonic possession, but an ailment of the mind.
George Wesley Bellows, Dancer in a Madhouse, © 1997 The Art Institute of Chicago
Dance in the madhouse.

12. I. Perspectives… Medical Model
When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders.
The concept that diseases, like psych disorders, have physical causes that can be diagnosed, treated, and cured in a hospital.
Etiology: Cause and development of the disorder.
Diagnosis: Identifying (symptoms) and distinguishing one disease from another.
Treatment: Treating a disorder in a psychiatric hospital.
Prognosis: Forecast about the disorder.

13. I. Perspectives… The Biopsychosocial Approach
Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders.

14. I. Perspectives… Biopsychological Approach
Assumes that disordered behavior, like other behavior, arises from genetic predispositions and physiological states, inner psychological dynamics, and social-cultural circumstances.

15. I. Perspectives… Classifying Psychological Disorders
Many psychiatrists and psychologists use the American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (DSM-IV).
This names and describes psych disorders in treatment and research.
Diagnostic labels aid mental health professionals by providing a common language and shard concepts for communications & research.
US health insurances require DSM-IV diagnoses before they pay for therapy.
Preview Question 3: How and why do clinicians classify psychological disorders?
Describes 400 psychological disorders compared to 60 in the 1950s.

16. I. Perspectives… Labeling
Disorders outlined by DSM-IV are reliable; therefore, diagnoses by different professionals are similar.
Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy.

17. I. Perspectives…. Labeling Psychological Disorders
Critics of the DSM-IV argue that labels may stigmatize individual.
Can create preconceptions that unfairly stigmatize people and can bias our perceptions of their past and present behavior.
Preview Question 4: Why do some psychologists criticize the use of diagnostic labels?
Elizabeth Eckert, Middletown, NY. From L. Gamwell and
N. Tomes, Madness in America, Cornell University Press.
Asylum baseball team (labeling)

18. Labeling Psychological Disorders
“Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes.
Current Examples?
Elaine Thompson/ AP Photo
Theodore Kaczynski
(Unabomber)

19. II. Anxiety Disorders Generalized anxiety disorder Panic disorder
What are anxiety disorders; how differ from ordinary worries and fears we all experience?
Our uneasiness is not intense and persistent
Anxiety Disorder: characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.
Five Anxiety Disorders:
Generalized anxiety disorder
Panic disorder
Phobias
Obsessive-compulsive disorder
Post-traumatic stress disorder
Preview Question 5: What are anxiety disorders, and how do they differ from ordinary worries and fears we all experience?

20. II. Generalized Anxiety Disorder
Persistent and uncontrollable tenseness and apprehension; jittery, agitated, sleep-deprived; concentration is difficult.
2. Inability to identify or avoid the cause of certain feelings so difficult to deal w/ or avoid.
2/3s of whom are women.
May lead to physical problems: ulcers or high blood pressure.
Def: An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.

21. II. Panic Disorder
Def: Disorder marked by unpredictable minutes-long episodes of intense dread; person experiences terror, chest pains, choking, or other frightening sensations.
Strikes suddenly, wreaks havoc, and disappears.
Other symptoms: heart palpitations; shortness of breath, trembling, dizziness
Anxiety is a component of both disorders. It occurs more in the panic disorder, making people avoid situations that cause it.

22. II. Anxieties… Phobias
Marked by a persistent and irrational fear of an object or situation that disrupts behavior.
Usually leads to avoidance of a specific object or situation.

23. II. Kinds of Phobias Agoraphobia Phobia of open places. Acrophobia
Phobia of heights.
Claustrophobia
Phobia of closed spaces.
Hemophobia
Phobia of blood.

24. II. Anxieties: Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress.
Characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)
Effective functioning can become impossible

25. II. Anxieties: Post-Traumatic Stress Disorder
Four or more weeks of the following symptoms constitute post-traumatic stress disorder (PTSD):
Haunting memories
2. Nightmares
3. Social withdrawal
4. Jumpy anxiety
5. Sleep problems
Bettmann/ Corbis

26. II. Anxieties… Resilience to PTSD
Only about 10% of women and 20% of men react to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience against traumatic situations.
All major religions of the world suggest that surviving a trauma leads to the growth of an individual.
Current Issues or Concerns?

27. II. Anxieties… Explaining Anxiety Disorders
What are the sources of the anxious feelings and thoughts that characterize anxiety disorders?
Psychoanalytic perspective (Freud) viewed anxiety disorders as the discharging of repressed impulses.
Freud’s theory proposed that, beginning in childhood, people repress intolerable impulses, ideas, and feelings and that this submerged mental energy sometimes produces mystifying symptoms such as anxiety.
Today’s psychologists turned toward two contemporary perspectives: learning and biological.
Preview Question 6: What are the sources of the anxious feelings and thoughts that characterize anxiety disorders?

28. II. Anxieties: The Learning Perspective
Psychologists working from the learning perspective view anxiety disorders as a product of fear conditioning, stimulus generalization, reinforcement of fearful behaviors, and observational learning.
Fear conditioning: ex: rats subjected to unpredictable shocks become anxious
Stimulus Generalization: person fears heights after a fall and is afraid to go on airplane.
Reinforcement: helps maintain anxieties.
Observational Learning: observing other’s fears.

29. II. Anxieties: The Biological Perspective
This perspective considers the evolutionary survival value of fears of life-threatening animals, objects, or situations; inherited predispositions; and abnormal responses in the brain.
Natural Selection: many of our modern fears come have an evolutionary explanation.
Genes: Some may be predisposed to anxiety
Brain: generalized anxiety, panic attacks, and even obsessions are biologically measureable in the brain.

30. The Biological Perspective
Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex.
S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action
monitoring in obsessive-compulsive disorder. Psychological Science, 14,
Anterior Cingulate Cortex
of an OCD patient.

31. IV. Dissociative Disorders
Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings.
Symptoms
Preview Question 7: What are dissociative disorders, and why are they controversial?
Having a sense of being unreal.
2. Being separated from the body.
3. Watching yourself as if in a movie.

32. III. Dissociative Identity Disorder (DID)
A disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder.
Lois Bernstein/ Gamma Liason
Chris Sizemore (DID)

33. III. DID Critics
Critics argue that the diagnosis of DID increased in the late 20th century. DID has not been found in other countries.
Critics’ Arguments
Role-playing by people open to a therapist’s suggestion.
2. Learned response that reinforces reductions in anxiety.

34. III. Personality Disorders
Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions.
“BTK Killer”
Preview Question 8: What characteristics are typical of personality disorders?

35. III. Antisocial Personality Disorder
A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, even toward friends and family members. Formerly, this person was called a sociopath or psychopath.
Genetic Predispositions may interact with environment to produce this disorder.

36. III. Understanding Antisocial Personality Disorder
Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological reasons. Youngsters, before committing a crime, respond with lower levels of stress hormones than others do at their age.

37. Understanding Antisocial Personality Disorder
PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study, repeat offenders had 11% less frontal lobe activity (Raine et al., 1999; 2000).
Courtesy of Adrian Raine,
University of Southern California
Normal
Murderer

38. Emotional extremes of mood disorders come in two principal forms.
IV. Mood Disorders
Characterized by emotional extremes
Emotional extremes of mood disorders come in two principal forms.
Major depressive disorder
Bipolar disorder
Preview Question 9: What are mood disorders, and what forms do they take?

39. IV. MD… Major Depressive Disorder
Depression is the “common cold” of psychological disorders. In a year, 5.8% of men and 9.5% of women report depression worldwide (WHO, 2002).
Blue mood
Major Depressive Disorder
Gasping for air after a hard run
Chronic shortness of breath

40. IV. MD…. Major Depressive Disorder
Major depressive disorder occurs when signs of depression last two weeks or more and are not caused by drugs or medical conditions.
Signs include:
Lethargy and fatigue
Feelings of worthlessness
Loss of interest in family & friends
Loss of interest in activities

41. IV. MD…. Bipolar Disorder
Formerly called manic-depressive disorder. An alternation between depression and mania(hyperactivity) signals bipolar disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Desire for action
Tired
Hyperactive
Slowness of thought
Multiple ideas

42. IV. Bipolar Disorder
Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase.
Whitman
Wolfe
Clemens
Hemingway
George C. Beresford/ Hulton Getty Pictures Library
Earl Theissen/ Hulton Getty Pictures Library
The Granger Collection
Bettmann/ Corbis

43. IV. Mood Disorders: What causes mood disorders and what explains its increase?
Depression researchers are exploring two sets of influences.
One: genetic predispositions and on abnormalities in brain structures and functions.
Second: social-cognitive perspective, examining the influence of cyclic self-defeating beliefs, learned helplessness, negative attributions, and stressful experiences.
Biopsychosocial: considers influences on many levels.
Increased rates of depression among young Westerners may be due to rise of individualism and decline of commitment to religion and family.

44. IV. Explaining Mood Disorders
Many behavorial and cognitive changes accompany depression… trapped in depressed mood; also exhibit anxiety or substance abuse.
Women are nearly twice as vulnerable to depression. Men tend to be more external.
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.

45. IV. Theory of Depression
Gender differences

46. IV. Suicide
The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide.
National differences
Racial differences
Gender differences
Age differences
Other differences
Suicide Statistics

47. IV. MD… Biological Perspective
Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%).
Linkage analysis and association studies link possible genes and dispositions for depression.
Jerry Irwin Photography

48. IV. The Depressed Brain
PET scans show that brain energy consumption rises and falls with manic and depressive episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine

49. IV. MD & Social-Cognitive Perspective
The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles.

50. IV. MD… Negative Thoughts and Moods
Explanatory style plays a major role in becoming depressed.

51. IV. MD… Depression Cycle
Negative stressful events.
Pessimistic explanatory style.
Hopeless depressed state.
These hamper the way the individual thinks and acts, fueling personal rejection.
Therapists try to break this cycle by changing the way depressed people process events.

52. V. Schizophrenia
The literal translation is “split mind” which refers to a split from reality. A group of severe disorders characterized by the following:
Disorganized and delusional thinking.
Disturbed perceptions.
Inappropriate emotions and actions.

53. V. Schizophrenia
What patterns of thinking, perceiving, feeling, and behaving characterize schizophrenia?
A group of disorders that typically strike during late adolescence, affect men very slightly more than women, and seem to occur in all cultures.
Symptoms: disorganized and delusional thinking (which may stem from selective attention), disturbed perceptions, and inappropriate emotions and actions.
Delusions are false beliefs; hallucinations are sensory experiences w/o sensory stimulations.

54. V. Schizophrenia What forms does schizophrenia take?
May emerge gradually from a chronic history of social inadequacies (recovery is dim) or suddenly in reaction to stress (recovery is brighter).
Positive symptoms are defined as the presence of inappropriate behaviors.
Negative symptoms: as the absence of appropriate behaviors.

55. IV. What causes Schizophrenia?
May have increased receptors for the neurotransmitter dopamine, which may intensify the positive symptoms of schizophrenia.
Brain abnormalities include enlarged, fluid-filled cerebral cavities and corresponding decreases in the cortex.
Brain scans reveal abnormal activity in the frontal lobes, thalamus, and amygdala.
Malfunctions in the brain regions and their connections apparently interact to produce symptoms of schizophrenia.
Twin/Adoptive studies also point to genetic disposition that interact w/ environmental factors .

56. Disturbed Perceptions
A schizophrenic person may perceive things that are not there (hallucinations). Frequently such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory.
Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg
L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg

57. Inappropriate Emotions & Actions
A schizophrenic person may laugh at the news of someone dying or show no emotion at all (flat affect).
Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia).

58. Onset and Development of Schizophrenia
Nearly 1 in a 100 suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (WHO, 2002).
Schizophrenia strikes young people as they mature into adults. It affects men and women equally, but men suffer from it more severely than women.
Preview Question 12: What forms does schizophrenia take?

59. Chronic and Acute Schizophrenia
When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative symptoms.
When schizophrenia rapidly develops (acute/reactive) recovery is better. Such schizophrenics usually show positive symptoms.

60. Understanding Schizophrenia
Schizophrenia is a disease of the brain exhibited by the symptoms of the mind.
Brain Abnormalities
Dopamine Overactivity: Researchers found that schizophrenic patients express higher levels of dopamine D4 receptors in the brain.
Preview Question 13: What causes schizophrenia?

61. Abnormal Brain Activity
Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients.
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health

62. Abnormal Brain Morphology
Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC

63. Viral Infection
Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development.

64. Genetic Factors
The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 2001).
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated

65. Genetic Factors
The following shows the prevalence of schizophrenia in identical twins as seen in different countries.

66. VI. Rates of Psychological Disorders
Research: 1 in 7 US adults has, or has have, a psychological disorder, usually by early adulthood.
Poverty is a predictor of mental illness.
Conditions and experiences associated w/ poverty contribute to the development of mental disorders, but some, like schizophrenia, can drive people into poverty.
Among Americans who have ever experienced a psychological disorder, the three most common were phobias, alcohol abuse, and mood disorder.

67. Rates of Psychological Disorders
Preview Question 14: How many people suffer, or have suffered, from a psychological disorder?

68. Rates of Psychological Disorders
The prevalence of psychological disorders during the previous year is shown below (WHO, 2004).