1

Psychological Psychological DisordersDisorders

2

Psychological DisordersPsychological Disorders

To study the abnormal is the best way of To study the abnormal is the best way of understanding the normal.understanding the normal.

1.1. There are 450 million people suffering from There are 450 million people suffering from psychological disorders (WHO, 2004).psychological disorders (WHO, 2004).

2.2. Depression and schizophrenia exist in all Depression and schizophrenia exist in all cultures of the world.cultures of the world.

William James (1842-1910)William James (1842-1910)

3

Deviant, Distressful & Deviant, Distressful & DysfunctionalDysfunctional

1.1. DeviantDeviant behavior behavior (going naked) in one (going naked) in one culture may be culture may be considered normal, considered normal, while in others it while in others it may lead to arrest.may lead to arrest.

2.2. DistressDistress must must accompany the accompany the deviant behaviordeviant behavior

3.3. If a behavior is If a behavior is dysfunctionaldysfunctional it is it is clearly a disorder.clearly a disorder.

In the Wodaabe tribe men wear costumes to

attract women. In Western society this would be considered

abnormal.

Carol B

eckwith

4

Defining Psychological Defining Psychological DisordersDisorders

Mental health workers view Mental health workers view psychological disorders as persistently psychological disorders as persistently harmful thoughts, feelings, and actions.harmful thoughts, feelings, and actions.

When behavior is When behavior is deviant, distressing, deviant, distressing, and dysfunctionaland dysfunctional psychiatrists and psychiatrists and psychologists label it as disordered psychologists label it as disordered

(Comer, 2004).(Comer, 2004).

5

Philippe Pinel (1745-1826) from France, insisted Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic that madness was not due to demonic

possession, but an ailment of the mind.possession, but an ailment of the mind.

Dance in the madhouse.

George W

esley Bellow

s, Dancer in a M

adhouse, 1907. © 1997 T

he Art Institute of C

hicago

6

Medical ModelMedical Model

When physicians discovered that syphilis led to When physicians discovered that syphilis led to mental disorders, they started using mental disorders, they started using medical modelsmedical models

to review the physical causes of these disorders.to review the physical causes of these disorders.

1.1. Etiology: Cause and development of the Etiology: Cause and development of the disorder.disorder.

2.2. Diagnosis: Identifying (symptoms) and Diagnosis: Identifying (symptoms) and distinguishing one disease from another.distinguishing one disease from another.

3.3. Treatment: Treating a disorder in a Treatment: Treating a disorder in a psychiatric hospital.psychiatric hospital.

4.4. Prognosis:Prognosis: Forecast about the disorder.Forecast about the disorder.

7

Biopsychosocial Biopsychosocial PerspectivePerspective

Assumes that biological, socio-cultural, and Assumes that biological, socio-cultural, and psychological factors combine and interact psychological factors combine and interact

to produce psychological disorders.to produce psychological disorders.

Classifying Psychological Classifying Psychological DisordersDisorders

Why do it?Why do it?

plus/minus plus/minus

8

9

Labeling Psychological Labeling Psychological DisordersDisorders

Labels may be helpful for healthcare Labels may be helpful for healthcare professionals and researchers when professionals and researchers when communicating with one another and communicating with one another and establishing therapiesestablishing therapies

10

Labeling Psychological Labeling Psychological DisordersDisorders

Critics of the DSM-IV argue that labels Critics of the DSM-IV argue that labels may stigmatize individuals.may stigmatize individuals.

Asylum baseball team (labeling)

Elizabeth E

ckert, Middletow

n, NY

. From

L. G

amw

ell and N

. Tom

es, Madness in A

merica, 1995. C

ornell University P

ress.

11

Labeling Psychological Labeling Psychological DisordersDisorders

““InsanityInsanity”” labels labels raise moral and raise moral and ethical questions ethical questions about how about how society should society should treat people who treat people who have disorders have disorders and have and have committed committed crimes.crimes.

Theodore Kaczynski(Unabomber)

Elaine T

hompson/ A

P Photo

12

Classifying Psychological Classifying Psychological DisordersDisorders

The American Psychiatric Association The American Psychiatric Association rendered a Diagnostic and Statistical rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to Manual of Mental Disorders (DSM) to

describe psychological disorders.describe psychological disorders.

The most recent edition, DSM-IV-TR The most recent edition, DSM-IV-TR (Text Revision, 2000), describes 400 (Text Revision, 2000), describes 400

psychological disorders compared to 60 psychological disorders compared to 60 in the 1950s.in the 1950s.

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DSM Multiaxial DSM Multiaxial ClassificationClassification

Are Are PsychosocialPsychosocial or or Environmental Environmental ProblemsProblems (school or housing issues) (school or housing issues) also present?also present?

Axis IVAxis IV

What is the What is the Global AssessmentGlobal Assessment of the of the personperson’’s functioning?s functioning?Axis VAxis V

Is a Is a General Medical ConditionGeneral Medical Condition (diabetes, hypertension or arthritis etc) (diabetes, hypertension or arthritis etc) also present?also present?

Axis IIIAxis III

Is a Is a Personality DisorderPersonality Disorder or or Mental Mental RetardationRetardation present? present?Axis IIAxis II

Is a Is a Clinical SyndromeClinical Syndrome (cognitive, (cognitive, anxiety, mood disorders [16 anxiety, mood disorders [16 syndromes]) present?syndromes]) present?

Axis IAxis I

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Multiaxial ClassificationMultiaxial Classification

Note 16 syndromes in Axis INote 16 syndromes in Axis I

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Multiaxial ClassificationMultiaxial ClassificationNote Global Assessment for Axis VNote Global Assessment for Axis V

16

Anxiety DisordersAnxiety Disorders

Feelings of excessive apprehension and anxiety.Feelings of excessive apprehension and anxiety.physiological, cognitive and behavioral symptomsphysiological, cognitive and behavioral symptoms

1.1. Generalized anxiety Generalized anxiety

disordersdisorders

2.2. PhobiasPhobias

3.3. Panic disordersPanic disorders

4.4. Obsessive-compulsive Obsessive-compulsive

disordersdisorders

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Generalized Anxiety Generalized Anxiety DisorderDisorder

1. Persistent and uncontrollable 1. Persistent and uncontrollable tenseness and apprehension.tenseness and apprehension.

2.2. Autonomic arousal. (e.g., heart Autonomic arousal. (e.g., heart racing, shortness of breath, sweating, racing, shortness of breath, sweating, etc.)etc.)

3.3. Inability to identify or avoid the cause Inability to identify or avoid the cause of certain feelings.of certain feelings.

SymptomsSymptoms

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Panic DisorderPanic Disorder

Episodes of intense dread which may Episodes of intense dread which may include feelings of terror, chest pains, include feelings of terror, chest pains,

choking, or other frightening sensationschoking, or other frightening sensations..

SymptomSymptomss

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PhobiaPhobia

Marked by a persistent and Marked by a persistent and irrational fearirrational fear of an of an object or situation accompanied by object or situation accompanied by avoidanceavoidance..

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Kinds of PhobiasKinds of Phobias

Phobia of blood.Phobia of blood.HemophobiaHemophobia

Phobia of closed Phobia of closed spaces.spaces.

ClaustrophobiClaustrophobiaa

Phobia of heights.Phobia of heights.AcrophobiaAcrophobia

Phobia of open Phobia of open places.places.AgoraphobiaAgoraphobia

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Post-Traumatic Stress Post-Traumatic Stress DisorderDisorder

Four or more weeks of the following Four or more weeks of the following symptoms constitute post-traumatic symptoms constitute post-traumatic

stress disorder (PTSD):stress disorder (PTSD):

1. Flashbacks1. Flashbacks

2.2. NightmaresNightmares

3.3. Social Social withdrawalwithdrawal4.4. Jumpy Jumpy anxietyanxiety5.5. Sleep problemsSleep problems

Bettm

ann/ Corbis

22

Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder

Persistence of unwanted thoughts (Persistence of unwanted thoughts (obsessionsobsessions) ) and urges to engage in senseless, ritualistic and urges to engage in senseless, ritualistic behavior (behavior (compulsionscompulsions) that cause distress.) that cause distress.

23

Explaining Anxiety Explaining Anxiety DisordersDisorders

Freud suggested that we repress our Freud suggested that we repress our painful and intolerable ideas, feelings, painful and intolerable ideas, feelings,

and thoughts, resulting in anxiety.and thoughts, resulting in anxiety.

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The Learning PerspectiveThe Learning Perspective

Learning theorists Learning theorists suggest that fear suggest that fear

conditioning leads conditioning leads to anxiety. This to anxiety. This

anxiety then anxiety then becomes associated becomes associated with other objects with other objects or events (stimulus or events (stimulus generalization) and generalization) and

is reinforced.is reinforced.

John Coletti/ Stock, B

oston

25

The Learning PerspectiveThe Learning Perspective

Investigators believe that fear responses Investigators believe that fear responses are inculcated through are inculcated through observational observational

learninglearning. Young monkeys develop fear . Young monkeys develop fear when they watch other monkeys who are when they watch other monkeys who are

afraid of snakes.afraid of snakes.

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The Biological PerspectiveThe Biological Perspective

Natural Selection has led our ancestors to Natural Selection has led our ancestors to learn to fear snakes, spiders, and other learn to fear snakes, spiders, and other animals. Therefore, fear preserves the animals. Therefore, fear preserves the

species.species.

Twin studies suggest that our Twin studies suggest that our genesgenes may may be partly responsible for developing fears be partly responsible for developing fears

and anxiety. Twins are more likely to and anxiety. Twins are more likely to share phobias.share phobias.

27

The Biological PerspectiveThe Biological Perspective

Generalized anxiety, Generalized anxiety, panic attacks, and panic attacks, and

even OCD are even OCD are linked with linked with brain brain

circuitscircuits..

Anterior Cingulate Cortexof an OCD patient.

S. U

rsu, V.A

. Stenger, M

.K. S

hear, M.R

. Jones, & C

.S. Carter (2003). O

veractive action m

onitoring in obsessive-compulsive disorder. P

sychological Science, 14, 347-353.

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A PET scan of the A PET scan of the brain of a person with brain of a person with Obsessive-Compulsive Obsessive-Compulsive Disorder (OCD). High Disorder (OCD). High

metabolic activity metabolic activity (red) in the frontal (red) in the frontal

lobe areas are lobe areas are involved with involved with

directing attention.directing attention.

Brain ImagingBrain Imaging

Brain image of an OCD

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Mood DisordersMood Disorders

Emotional extremes of mood disorders Emotional extremes of mood disorders come in two principal forms.come in two principal forms.

1.1. Major depressive Major depressive

disorderdisorder

2.2. Bipolar disorderBipolar disorder

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Major Depressive Major Depressive DisorderDisorder

Depression is the Depression is the ““common coldcommon cold”” of of psychological disorders. In a year, 5.8% psychological disorders. In a year, 5.8%

of men and 9.5% of women report of men and 9.5% of women report depression worldwide (WHO, 2002).depression worldwide (WHO, 2002).

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Major Depressive Major Depressive DisorderDisorder

Major depressive disorder occurs when signs Major depressive disorder occurs when signs of depression last two weeks or more and are of depression last two weeks or more and are

not caused by drugs or medical conditionsnot caused by drugs or medical conditions..

1.1. Lethargy and fatigueLethargy and fatigue

2.2. Feelings of worthlessnessFeelings of worthlessness

3.3. Loss of interest or pleasureLoss of interest or pleasure

4.4. Loss of motivationLoss of motivation

5.5. Sleep or appetite disturbanceSleep or appetite disturbance

Signs include:Signs include:

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Dysthymic DisorderDysthymic Disorder

Dysthymic disorder lies between a blue Dysthymic disorder lies between a blue mood and major depressive disorder. It is mood and major depressive disorder. It is

a disorder characterized by daily a disorder characterized by daily depression lasting two years or more.depression lasting two years or more.

Major Major DepressiveDepressive

DisorderDisorder

Blue Blue

MoodMoodDysthymicDysthymic

DisorderDisorder

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Biological PerspectiveBiological Perspective

Genetic Influences: Mood disorders run Genetic Influences: Mood disorders run in families. The rate of depression is in families. The rate of depression is

higher in identical (50%) than fraternal higher in identical (50%) than fraternal twins (20%).twins (20%).

Linkage analysis and Linkage analysis and

association studies link association studies link

possible genes and possible genes and

dispositions for dispositions for

depressiondepression..

Jerry Irwin Photography

34

Neurotransmitters & Neurotransmitters & DepressionDepression

Post-synapticNeuron

Pre-synapticNeuron

Norepinephrine Serotonin

A reduction of A reduction of

norepinephrine norepinephrine

and serotonin has and serotonin has

been found in been found in

depression.depression.

Drugs that Drugs that

alleviate mania alleviate mania

reduce reduce

norepinephrine.norepinephrine.

35

The Depressed BrainThe Depressed Brain

PET scans show that brain energy PET scans show that brain energy consumption rises and falls with manic consumption rises and falls with manic

and depressive episodes.and depressive episodes.

Courtesy of L

ewis B

axter an Michael E

. P

helps, UC

LA

School of M

edicine

36

Social-Cognitive Social-Cognitive PerspectivePerspective

The social-cognitive perspective suggests The social-cognitive perspective suggests that depression arises partly from self-that depression arises partly from self-

defeating beliefs and negative defeating beliefs and negative explanatory styles.explanatory styles.

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Depression CycleDepression Cycle

1.1. Negative stressful Negative stressful

events.events.

2.2. Pessimistic Pessimistic

explanatory style.explanatory style.

3.3. Hopeless depressed Hopeless depressed

state.state.

4.4. These hamper the way These hamper the way

the individual thinks the individual thinks

and acts, fueling and acts, fueling

personal rejection.personal rejection.

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Bipolar DisorderBipolar Disorder

Formerly called manic-depressive disorder. Formerly called manic-depressive disorder. An alternation between depression and An alternation between depression and

mania signals bipolar disorder.mania signals bipolar disorder.

Grandiosity/IrritibilityGrandiosity/IrritibilityHyperactive Hyperactive

Pressured speechPressured speech

Flight of ideasFlight of ideas

Elation/EuphoriaElation/Euphoria

Manic SymptomsManic Symptoms

Slowness of thoughtSlowness of thoughtTiredTired

Inability to make Inability to make decisionsdecisions

WithdrawnWithdrawn

GloomyGloomy

Depressive SymptomsDepressive Symptoms

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Bipolar DisorderBipolar Disorder

Many great writers, poets, and Many great writers, poets, and composers suffered from bipolar disorder. composers suffered from bipolar disorder.

During their manic phase creativity During their manic phase creativity surged, but not during their depressed surged, but not during their depressed

phase.phase.

Whitman Wolfe Clemens Hemingway

Bettm

ann/ Corbis

George C

. Beresford/ H

ulton Getty Pictures L

ibrary

The G

ranger Collection

Earl T

heissen/ Hulton G

etty Pictures L

ibrary

40

SuicideSuicide

Each year some 1 million people commit Each year some 1 million people commit suicide worldwide.suicide worldwide.

1.1. National National

differencesdifferences

2.2. Racial differencesRacial differences

3.3. Gender Gender

differencesdifferences

4.4. Age differencesAge differences

5.5. Other differencesOther differences

Suicide Statistics

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Risk Factors and SignsRisk Factors and Signs

history of attempts/gestureshistory of attempts/gestures feelings of hopelessnessfeelings of hopelessness preoccupation with suicidepreoccupation with suicide giving away possessions giving away possessions recent lossrecent loss physical problemsphysical problems substance usesubstance use etc.etc.

42

SchizophreniaSchizophrenia

Nearly 1 in a 100 suffer from Nearly 1 in a 100 suffer from schizophrenia, and throughout the world schizophrenia, and throughout the world

over 24 million people suffer from this over 24 million people suffer from this disease (WHO, 2002).disease (WHO, 2002).

Schizophrenia strikes young people as Schizophrenia strikes young people as they mature into adults. It affects men they mature into adults. It affects men

and women equally, but men suffer from and women equally, but men suffer from it more severely than women.it more severely than women.

43

Symptoms of Symptoms of SchizophreniaSchizophrenia

The literal translation is “split mind,” which The literal translation is “split mind,” which is a misnomer. A group of severe disorders is a misnomer. A group of severe disorders

characterized by the following:characterized by the following:

1. Disorganized and delusional thinking.

2. Disturbed perceptions. 3. Inappropriate emotions

and actions.

44

Disordered thinkingDisordered thinking

loose associationsloose associations word saladword salad clang associationsclang associations cognitive flooding/stimulus overloadcognitive flooding/stimulus overload

inability to selectively attendinability to selectively attend

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Other forms of delusions include, Other forms of delusions include, delusions of persecution (“someone is delusions of persecution (“someone is following me”) or grandeur (“I am a following me”) or grandeur (“I am a

king”).king”).

Disorganized & Delusional Disorganized & Delusional ThinkingThinking

This morning when I was at Hillside [Hospital], I This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie was making a movie. I was surrounded by movie stars … I’m Marry Poppins. Is this room painted stars … I’m Marry Poppins. Is this room painted blue to get me upset? My grandmother died four blue to get me upset? My grandmother died four weeks after my eighteenth birthday.”weeks after my eighteenth birthday.”

(Sheehan, 1982)

This monologue illustrates fragmented, This monologue illustrates fragmented, bizarre thinking and distorted beliefs bizarre thinking and distorted beliefs

called called delusionsdelusions (“I’m Mary Poppins”). (“I’m Mary Poppins”).

DelusionsDelusions

Examples:Examples: Delusions of persecutionDelusions of persecution Delusions of grandeurDelusions of grandeur Delusions of referenceDelusions of reference

46

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Disturbed PerceptionsDisturbed Perceptions

A schizophrenic person may perceive things A schizophrenic person may perceive things that are not there (that are not there (hallucinationshallucinations). Frequently ). Frequently

such such hallucinationshallucinations are auditory and lesser are auditory and lesser visual, somatosensory, olfactory, or gustatory.visual, somatosensory, olfactory, or gustatory.

L. B

erthold, Untitled. T

he Prinzhorn Collection, U

niversity of Heidelberg

August N

atter, Witches H

ead. The Prinzhorn C

ollection, University of H

eidelberg

Photos of paintings by K

rannert Museum

, University of Illinois at U

rbana-Cham

paign

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Inappropriate Emotions & Inappropriate Emotions & ActionsActions

A schizophrenic person may laugh at the A schizophrenic person may laugh at the news of someone dying or show no news of someone dying or show no

emotion at all.emotion at all.

Patients with schizophrenia may Patients with schizophrenia may continually rub an arm, rock a chair, or continually rub an arm, rock a chair, or remain motionless for hours (remain motionless for hours (catatoniacatatonia).).

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Subtypes of SchizophreniaSubtypes of Schizophrenia

Schizophrenia is a cluster of disorders. Schizophrenia is a cluster of disorders. These subtypes share some features, but These subtypes share some features, but

there are other symptoms that there are other symptoms that differentiate these subtypes.differentiate these subtypes.

50

SubtypesSubtypes

51

Positive and Negative Positive and Negative SymptomsSymptoms

Schizophrenics have inappropriate symptoms Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, (hallucinations, disorganized thinking,

deluded ways) that are not present in normal deluded ways) that are not present in normal individuals (individuals (positive symptomspositive symptoms).).

Schizophrenics lack appropriate Schizophrenics lack appropriate behaviors (behaviors (negative symptomsnegative symptoms), such as ), such as apathy, anhedonia, blunted or flat affect apathy, anhedonia, blunted or flat affect

poor social relatedness, etc.poor social relatedness, etc.

52

Chronic and Acute Chronic and Acute SchizophreniaSchizophrenia

When schizophrenia is slow to develop When schizophrenia is slow to develop (chronic/process) recovery is doubtful. (chronic/process) recovery is doubtful.

Such schizophrenics usually display Such schizophrenics usually display negative symptoms.negative symptoms.

When schizophrenia rapidly develops When schizophrenia rapidly develops (acute/reactive) recovery is better. Such (acute/reactive) recovery is better. Such

schizophrenics usually show positive schizophrenics usually show positive symptoms.symptoms.

53

Understanding Understanding SchizophreniaSchizophrenia

Schizophrenia is a disease of the brain Schizophrenia is a disease of the brain exhibited by the symptoms of the mind.exhibited by the symptoms of the mind.

Dopamine Overactivity: Researchers Dopamine Overactivity: Researchers found that schizophrenic patients express found that schizophrenic patients express higher levels of dopamine D4 receptors in higher levels of dopamine D4 receptors in

the brain.the brain.

Brain Abnormalities

54

Abnormal Brain ActivityAbnormal Brain Activity

Brain scans show abnormal activity in the Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdalafrontal cortex, thalamus, and amygdala of of

schizophrenic patients. Adolescent schizophrenic patients. Adolescent schizophrenic patients also have brain lesions.schizophrenic patients also have brain lesions.

Paul T

hompson and A

rthur W. T

oga, UC

LA

Laboratory of N

euro Im

aging and Judith L. R

apport, National Institute of M

ental Health

55

Abnormal Brain Abnormal Brain MorphologyMorphology

Schizophrenia patients may exhibit Schizophrenia patients may exhibit morphological changes in the brain like morphological changes in the brain like

enlargement of fluid-filled ventricles.enlargement of fluid-filled ventricles.

Both Photos: C

ourtesy of Daniel R

. Weinberger, M

.D., N

IH-N

IMH

/ NSC

56

Genetic FactorsGenetic Factors

The likelihood of an individual suffering The likelihood of an individual suffering from schizophrenia is 50% if their identical from schizophrenia is 50% if their identical

twin has the disease (Gottesman, 1991).twin has the disease (Gottesman, 1991).

0 10 20 30 40 50Identical

Both parents

Fraternal

One parent

Sibling

Nephew or niece

Unrelated

57

Genetic FactorsGenetic Factors

The following shows the prevalence of The following shows the prevalence of schizophrenia in identical twins as seen schizophrenia in identical twins as seen

in different countries.in different countries.

58

Psychological FactorsPsychological Factors

Psychological and environmental factors Psychological and environmental factors can trigger schizophrenia if the individual can trigger schizophrenia if the individual

is genetically predisposed (Nicols & is genetically predisposed (Nicols & Gottesman, 1983).Gottesman, 1983).

Genain Sisters

The genetically identical Genain

sisters suffer from schizophrenia. Two more

than others, thus there are contributing environmental

factors.

Courtesy of G

enain Fam

ily

59

Personality DisordersPersonality Disorders

Personality Personality disorders are disorders are

characterized by characterized by inflexible and inflexible and

enduring behavior enduring behavior patterns that patterns that

impair social and impair social and occupational occupational functioning. functioning.

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Antisocial Personality Antisocial Personality DisorderDisorder

A disorder in which the person (usually men) A disorder in which the person (usually men) exhibits a lack of conscience for wrongdoing, exhibits a lack of conscience for wrongdoing,

even toward friends and family members. even toward friends and family members. Formerly, this person was called a Formerly, this person was called a sociopathsociopath

or or psychopath.psychopath.

61

Understanding Antisocial Understanding Antisocial Personality DisorderPersonality Disorder

PET scans of 41 murderers revealed reduced PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up activity in the frontal lobes. In a follow-up

study repeat offenders had 11% less frontal study repeat offenders had 11% less frontal lobe activity compared to normals (Raine et lobe activity compared to normals (Raine et

al., 1999; 2000).al., 1999; 2000).

Normal Murderer

Courtesy of A

drian Raine,

University of Southern C

alifornia

62

Risk and Protective Risk and Protective FactorsFactors

Risk and protective factors for mental Risk and protective factors for mental disorders (WHO, 2004).disorders (WHO, 2004).

63

Risk and Protective Risk and Protective FactorsFactors