chapter 14: psychological disorders. abnormal behavior the medical model proposes that it is useful...

Chapter 14: Psychological Disorders

Abnormal Behavior

• 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 medical problems

Abnormal Behavior

• In determining whether a behavior is abnormal, clinicians rely on the following criteria:– Deviant: (does it violate societal norms)– Maladaptive (does it impair a person’s

everyday behavior)– Causing personal distress

• 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.

Figure 14.2 Normality and abnormality as a continuum

Prevalence, Causes, and Course

• Diagnosis: means of distinguishing one illness from another

• Etiology: the apparent causation and developmental history of an illness

• Prognosis: a forecast about the probable course of an illness

Figure 14.5 Lifetime prevalence of psychological disorders

Stereotypes

• Disorders are Incurable? – Most psyc. Disorders are treatable and

patients do get “better”• People with Disorders are Violent or

Dangerous?– There is only a modest association

• People with Disorders behave in Strange and Bizarre Ways?– Only true in a minority of cases, very easy

to fake and even mental health experts can be fooled

Psychodiagnosis:The Classification of 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 5th

revision, which uses a multiaxial system for classifying mental disorders (there are 5 criteria that must be met for a mental disorder)

Five Axis

• Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - 4)– Axis I – Clinical Syndromes– Axis II – Personality Disorders or Mental

Retardation• diagnoses of disorders are made on Axis I and

II, with most falling on Axis I

Five Axes

• Axis III – General Medical Conditions– person’s physical disorders are listed

• Axis IV – Psychosocial and Environmental Problems– the types of stress they have experienced

in the past year• Axis V – Global Assessment of Functioning

– estimates the individual’s current level of adaptive functioning

• remaining axes are used to record supplemental information

• The goal of this multiaxial system is to impart information beyond a traditional diagnostic label

Prevalence, Causes, and Course

• Epidemiology: the study of the distribution of mental or physical disorders in the population

• Prevalence: the percentage of a population that exhibits a disorder during a specified time period

• Lifetime prevalence: the percentage of people who have been diagnosed with a specific disorder at any time in their lives. – Current research suggests that about 44% of the

adult population will have some sort of psychological disorder at some point in their lives

Axis I Clinical Syndromes

• Anywhere from 1/3 to 51% of the population is said to experience a Psyc. Disorder at one point in their lives according to DSM-III– Most Common:

• 1) Substance Abuse• 2) Anxiety Disorder• 3) Mood Disorder

Clinical Syndromes: Anxiety Disorders

• anxiety disorders are a class of disorders marked by feelings of excessive apprehension and anxiety

• Generalized anxiety disorder– “marked by a chronic, high level of anxiety

that is not tied to any specific threat…” free-floating anxiety.

– People worry about yesterday’s mistakes and tomorrow’s problems

– Usually accompanied by physical symptoms


• Phobic disorder– Specific focus of fear– 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, • various animal and insect phobias.


• Panic disorder and agoraphobia– characterized by recurrent attacks of

overwhelming anxiety that usually occur suddenly and unexpectedly

– 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

– About 2/3 are women


• Obsessive compulsive disorder– 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.

– 2.5% of the pop.


• Posttraumatic Stress Disorder– 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

Etiology of Anxiety Disorders

• Biological factors– Genetic predisposition, anxiety sensitivity

• abnormalities in neurotransmitter activity at GABA synapses have been implicated in some types of anxiety disorders

• abnormalities in serotonin synapses have been implicated in panic and obsessive-compulsive disorders

• Conditioning and learning• Acquired through classical conditioning or

observational learning (especially phobias)– Maintained through operant conditioning

• Parents who model anxiety may promote the development of these disorders through observational learning.

Etiology of Anxiety Disorders

• Cognitive factors– Judgments of perceived threat– overinterpreting harmless situations as

threatening, for example, make some people more vulnerable to anxiety disorders

• Personality– trait of neuroticism has been linked to

anxiety disorders• Stress—appears to precipitate the onset of

anxiety disorders.

Figure 14.6 Twin studies of anxiety disorders

Figure 14.7 Conditioning as an explanation for phobias

Figure 14.8 Cognitive factors in anxiety disorders

Clinical Syndromes: Somatoform Disorders

• physical ailments that cannot be explained by organic conditions. (occur mostly in women)– They are not psychosomatic diseases,

which are real physical ailments caused in part by psychological factors.

– Individuals with somatoform disorders are not simply faking an illness, which would be termed malingering (Recorded on Axis 3 of the DSM)

– Actual Somatoform Disorder are recorded on Axis 1 of the DSM


• Somatization Disorder– marked by a history of diverse physical

complaints that appear to be psychological in origin

– often coexist with depression and anxiety disorders, occur mostly in women

– Come and go with the level of stress– Marked difference is the huge diversity of

victim complaints


• Conversion Disorder– 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

– Usually more severe ailments than somatization disorders


• Hypochondriasis– characterized by excessive preoccupation

with health concerns and incessant worry about developing physical illnesses

– Personality factors: often emerge in people with highly suggestible histrionic personalities and in people who focus excess attention on their physiological processes (Cognitive factors)

– Over interpretation of every sign of illness


• Etiology– Personality: histrionic personality types,

neurotic personality types, insecure attachment styles rooted in early experiences

– Cognitive: the mind amplifies common process into symptoms of distress

– The Sick Role: reinforcement of “sick behavior” through the care and nurturing they receive. (attention, lack of responsibility, and consolation)

Figure 14.10 Glove anesthesia

Clinical Syndromes: Dissociative Disorders

• 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: 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: 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– Etiology

• 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 Controversy


• D.I.D. (cont.)– Media creation? 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

Clinical Syndromes: Mood Disorders

• 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– marked by profound sadness, slowed thought

processes, low self-esteem, and loss of interest in previous sources of pleasure (also called unipolar depression)

– 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

• 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

– Cyclothymic disorder: People are given the diagnosis of cyclothymic disorder when they exhibit chronic but relatively mild symptoms of bipolar disturbance


• Etiology– Evidence suggests genetic vulnerability – Neurochemical factors: disorders are

accompanied by changes in neurochemical activity in the brain, particularly at norepinephrine and serotonin synapses

– Interpersonal inadequacies and poor social skills may lead to a paucity of life’s reinforcers and frequent rejection• Depressed people are depressing


• Etiology– Stress has also been implicated in the

development of depressive disorders– Reduced hippocampal volume: plays a

major role in memory consolidation and tends to be 8-10% smaller


– Cognitive factors: 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

• high stress, low self-esteem, and other factors combine in the development of depression

• ruminating over one’s problems

Figure 14.11 Episodic patterns in mood disorders

Figure 14.13 Twin studies of mood disorders

Figure 14.15 Negative thinking and prediction of depression

Figure 14.16 Interpersonal factors in depression

Clinical Syndromes: Schizophrenia

• Schizophrenic disorders are a class of disorders marked by delusions, hallucinations, disorganized speech, and disorganized behavior.

• Disturbed thought lies at the core of schizophrenia, whereas disturbed emotion lies at the core of mood disorders.

• General symptoms– Delusions: 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

• Delusions of grandeur occur when people think they are famous or important


• General symptoms (cont.)– Irrational thought: chaotic thinking, or loose

associations, 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, and personal care

– Hallucinations: sensory perceptions that occur in the absence of a real, external stimulus or are gross distortions of perceptual input…hearing voices


• General symptoms (cont.)– Disturbed emotions: may manifest as little

emotional responsiveness (blunted or flat affect) or inappropriate emotional responses (laughing at a story of a child’s death).

Subtyping of Schizophrenia

• 4 subtypes in the DSM-IV– Paranoid type: dominated by delusions of

persecution, along with delusions of grandeur– Catatonic type: striking motor disturbances,

ranging from muscular rigidity to random motor activity

– Disorganized type: particularly severe deterioration of adaptive behavior is seen

• incoherence, complete social withdrawal, delusions centering on bodily functions

– Undifferentiated type: People who clearly have schizophrenia, but cannot be placed in any of the above subtypes

Subtyping of Schizophrenia

• There are many critics of the current subtyping system for schizophrenia

• New model for classification– Positive: behavioral excesses or

peculiarities, such as hallucinations, delusions, bizarre behavior, and wild flights of ideas

– Negative symptoms: behavioral deficits, such as flattened emotions, social withdrawal, apathy, impaired attention, and poverty of speech

Schizophrenia Prognosis

• Prognostic factors (more favorable prognosis exists when): – the onset of the disorder is sudden and at

a later age – the individual’s social and work adjustment

was good prior to onset– the proportion of negative symptoms is

low, – the patient has a good social support

system– 15- 20% make full recovery

Etiology of Schizophrenia

• Genetic vulnerability: positive correlation (46% parents- 1% parents do not)

• Neurochemical factors: neurotransmitter activity at dopamine, and perhaps serotonin, receptors

• Structural abnormalities of the brain: such as enlarged ventricles, are associated with schizophrenia, as are metabolic abnormalities in the prefrontal and temporal lobes– Theories are that positive symptoms are related to

prefrontal abnormalities and negative symptoms to temporal abnormalities.

– The question remains to be answered re: do these abnormalities cause or are the consequence of schizophrenia

Etiology of Schizophrenia

• The neurodevelopmental hypothesis: 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

• Expressed emotion: the degree to which a relative of a person with schizophrenia displays highly critical or emotionally overinvolved attitudes toward the patient– 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

Figure 14.18 The dopamine hypothesis as an explanation for schizophrenia

Figure 14.20 The neurodevelopmental hypothesis of schizophrenia

Personality Disorders

• Personality disorders are a class of disorders marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning.

• 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


• 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.


• 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


• 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– Etiology

• Genetic predispositions , along with autonomic reactivity

• Inadequate socialization in dysfunctional families and observational learning

Table 14.2 Personality Disorders

Psychological Disorders and the Law

• Insanity– 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

– M’naghten rule: holds that insanity exists when a mental disorder makes a person unable to distinguish right from wrong.


• Involuntary commitment– occurs when people are hospitalized in

psychiatric facilities against their will.– Rules vary from state to state– Generally, people are subject to

involuntary commitment when:• danger to self• danger to others• in need of treatment


• In emergency situations, psychiatrists and psychologists can authorize temporary commitment only for a period of 24-72 hours.

• Long-term commitments must go through the courts and are usually set up for renewable six-month periods

Figure 14.22 The insanity defense: public perceptions and actual realities

Culture and Pathology

• The principal categories of psychological disturbance are identifiable in all cultures, but milder disorders may go unrecognized in some societies

Culture and Pathology

• Culture bound disorders: illustrate the diversity of abnormal behavior around the world, as well as cultural influence– Koro: an obsessive fear that one’s penis will

withdraw into one’s abdomen, seen only in Malaya and other regions of southern Asia

– Windigo: intense craving for human flesh and fear that one will turn into a cannibal, seen only among Algonquin Indian cultures

– Anorexia nervosa: eating disorder characterized by intentional self-starvation, until recently seen only in affluent Western cultures

Eating Disorders

• Anorexia Nervosa– Intense fear of gaining weight, disturbed

body image, refusal to maintain normal body weight, and dangerous measures to lose weight• Restricting Type: people reduce their

intake of food (literally starve themselves)

• Binge-eating/ Purging: vomiting, laxatives, diuretics, excessive exercise

Eating Disorders

• Bulimia Nervosa– Out-of-control overeating followed by

unhealthy compensatory efforts (vomiting, fasting, etc)

– They usually maintain a normal body weight

– Med. Problems include: cardiac arrhythmias, dental problems, metabolic deficiencies, gastrointestinal problems

Eating Disorders

• Similarities:– Morbid fear of obesity, preoccupation with

food and maladaptive processes to control weight (if you have one it is easy to cross over from one to another)

• Differences:– Bulimia is much less life threatening and

people’s appearances are more normal looking, people with bulimia are much more likely to cooperate with treatment

chapter 14: psychological disorders. abnormal behavior the medical model proposes that it is useful...

Documents

mental disorder slide

classification of disorders

continuum slide

mood disorder slide

personality disorders

stereotypes disorders

taxonomy of mental disorders

axis diagnostic