Chapter 13: Psychological Disorders

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Chapter 13 Psychological Disorders
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What is Normal?

• Psychopathology Scientific study of mental,
  emotional, and behavioral disorders
  
• Subjective Discomfort Private feelings of
  anxiety, depression, or emotional distress
  
• Statistical Abnormality Having extreme scores on
  some dimension, such as intelligence, anxiety, or
  depression
  
• Social Nonconformity Disobeying societal
  standards for normal conduct may lead to
  destructive or self-destructive behavior

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What Is Normal? (cont.)

• 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 Judgments are made relative
  to the values of ones culture

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Figure 13.1
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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
  control thoughts, behaviors, or feelings
  adequately

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Clarifying and Defining Abnormal Behavior (Mental
Illness) (cont.)

• Psychotic Disorder Severe psychiatric disorder
  characterized by hallucinations and delusions,
  social withdrawal, and a move away from reality
  
• Organic Mental Disorder Mental or emotional
  problem caused by brain pathology (i.e., brain
  injuries or diseases)

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Clarifying and Defining Abnormal Behavior (Mental
Illness) (cont.)

• Mood Disorder Disturbances in affect (emotions
  or moods), like depression or mania
  
• Anxiety Disorder Disruptive feelings of fear,
  apprehension, anxiety, or behavior distortions
  that are anxiety-related

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Clarifying and Defining Abnormal Behavior (Mental
Illness) (cont.)

• 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
  

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Clarifying and Defining Abnormal Behavior (Mental
Illness) (cont.)

• Somatoform Disorder Physical symptoms that mimic
  disease or injury (blindness, anesthesia) for
  which there is no identifiable physical cause
  
• Dissociative Disorder Temporary amnesia,
  multiple identity, or depersonalization (like
  being in a dream world, feeling like a robot,
  feeling like you are outside of your body)
• Personality Disorder Deeply ingrained,
  unhealthy, maladaptive personality patterns

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Clarifying and Defining Abnormal Behavior (Mental
Illness) (cont.)

• Sexual and Gender Identity Disorder Problems
  with sexual identity, deviant sexual behavior, or
  sexual adjustment
  
• Neurosis Archaic once used to refer to
  excessive anxiety, somatoform, dissociative
  disorders, and some kinds of depression

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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

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General Risk Factors for Contracting Mental
Illness (cont.)

• 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

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Insanity

• Definition A legal term refers to an inability
  to manage ones affairs or to be aware of the
  consequences of ones actions

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More on Insanity

• 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?

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Expert Witness

• Person recognized by a court of law as being
  qualified to give expert testimony on a specific
  topic
  
• May be psychologist, psychiatrist, and so on

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Personality Disorders Antisocial Personality
Disorder (APD)

• Definition A person who lacks a conscience
  (superego?) typically emotionally shallow,
  impulsive, selfish, and manipulative toward
  others
• Oftentimes called psychopaths or sociopaths

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APD Characteristics

• 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
• May be blind to signs of disgust in others

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APD Causes and Treatments

• Possible Causes
• Childhood history of emotional deprivation,
  neglect, and physical abuse
  
• Tend to be thrill-seekers
• Underarousal of the brain
• Very difficult to effectively treat will likely
  lie, charm, and manipulate their way through
  therapy

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Anxiety-Based Disorders

• Anxiety Feelings of apprehension, dread, or
  uneasiness
  
• Adjustment Disorders When ongoing stressors
  within the range of normal experience cause
  emotional disturbance and push people beyond
  their ability to effectively cope

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More on Anxiety-Based Disorders

• Usually suffer sleep disturbances, irritability,
  and depression
  
• Examples of Stresses Grief reactions, lengthy
  physical illness, unemployment
  

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Anxiety-Based Disorders Concluded

• Anxiety Disorders When distress seems greatly
  out of proportion to the situation at hand
  
• Generalized Anxiety Disorder (GAD) Duration of
  at least six months of chronic, unrealistic, or
  excessive anxiety worries about work,
  relationships, ability, or impending disaster

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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

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Panic Disorder (with Agoraphobia)

• Panic attacks and sudden anxiety still occur, but
  with agoraphobia

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Agoraphobia Characteristics

• Intense, irrational fear that a panic attack will
  occur in a public place or in an unfamiliar
  situation
  
• Intense fear of leaving the house or entering
  unfamiliar situations
  
• Can be very crippling
• Literally means fear of open places or market
  (agora)

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Agoraphobia (without Panic Disorder)

• Fear that something extremely embarrassing will
  happen away from home or in an unfamiliar
  situation

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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
  

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Social Phobia

• Intense, irrational fear of being observed,
  evaluated, humiliated, or embarrassed by others
  (e.g., shyness, not eating or speaking in public)
  in social situations
• Barbara Streisand, Woody Allen perhaps?

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Obsessive-Compulsive Disorder (OCD)

• Extreme preoccupation with certain thoughts and
  compulsive performance of certain behaviors

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Obsession

• Recurring images or thoughts that a person cannot
  prevent
  
• Cause anxiety and extreme discomfort
• Enter into consciousness against the persons
  will
  
• Most common Being dirty, wondering if you
  performed an action (turned off the stove), or
  violence (hit by a car)
  

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Compulsion

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

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Obsessive Compulsive Disorder
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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 and that would produce anxiety in
  anyone who experienced them

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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.)
  
• The War in Iraq will likely lead to an increase
  of PTSD

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Dissociative Disorders

• Dissociative Amnesia Inability to recall ones
  name, address, or past
  
• Dissociative Fugue Sudden travel away from home
  and confusion about personal identity

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Dissociative Identity Disorder (DID)

• Person has two or more distinct, separate
  identities or personality traits 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,
  balanced personality

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Somatoform Disorders 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 organic cause can be found

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Somatoform Disorders Somatization Disorder

• Person expresses anxieties through numerous
  physical complaints
  
• Many doctors are consulted but no organic or
  physical causes are found

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Somatoform Disorders Pain Disorder

• Pain that has no identifiable organic, physical
  cause
  
• Appears to have psychological origin

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Somatoform Disorders Conversion Disorder

• Severe emotional conflicts are converted into
  physical symptoms or a physical disability
  
• Caused by anxiety or emotional distress but not
  by physical causes

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Figure 13.4
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Theoretical Causes of Anxiety Disorders
Psychodynamic

• Freud Anxiety caused by conflicts among id, ego,
  and superego
  

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Some of Freuds Concepts Regarding Anxiety

• 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

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Other Theoretical Causes of Anxiety Disorders

• Humanistic Unrealistic self-image conflicts with
  real self-image
  
• Existential Anxiety reflects loss of meaning in
  ones life
  
• Behavioristic Anxiety symptoms and behaviors are
  learned, like everything else
  
• Conditioned emotional responses that generalize
  to new situations
  

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More Theoretical Causes of Anxiety Disorders

• Avoidance Learning When making a particular
  response delays or prevents the onset of a
  painful or unpleasant stimulus
  
• Anxiety Reduction Hypothesis When reward of
  immediate relief from anxiety perpetuates
  self-defeating avoidance behaviors
  
• Cognitive When distorted thinking causes people
  to magnify ordinary threats and failures, leading
  to anxiety and distress
  

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Psychosis and Hallucinations

• Psychosis Loss of contact with shared views of
  reality

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Delusions

• False beliefs that individuals insist are true,
  regardless of overwhelming evidence against them
  

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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)

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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 Uncoordinated
  thoughts, actions, and emotions

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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
• Common Causes Circulatory problems, repeated
  strokes, shrinkage and atrophy of the brain

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Alzheimers Disease

• Symptoms include impaired memory, confusion, and
  progressive loss of mental abilities
  
• Ronald Reagan was perhaps the most famous
  Alzheimers victim

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Delusional Disorders

• Marked by presence of deeply held false beliefs
  (delusions)
  
• May involve delusions of grandeur, persecution,
  jealousy, eroticism, or somatic
  
• Experiences could really occur!
• Paranoid Psychosis Most common delusional
  disorder
  
• Centers on delusions of persecution

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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

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Schizophrenia Distortion of Reality
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The Four Subtypes of Schizophrenia
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Disorganized Type

• Incoherence, grossly disorganized behavior,
  bizarre thinking, and flat or inappropriate
  emotions

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Schizophrenia Common Symptoms
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Catatonic Type

• Marked by stupor, rigidity, unresponsiveness,
  posturing, mutism, and sometimes agitated,
  purposeless behavior

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Paranoid Type

• Preoccupation with delusions also involves
  auditory hallucinations that are related to a
  single theme, especially grandeur or persecution

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Undifferentiated Type

• Any type of schizophrenia that does not have
  paranoid, catatonic, or disorganized features or
  symptoms

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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
  
• Stress-Vulnerability Hypothesis Combination of
  environmental stress and inherited susceptibility
  cause psychoses

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Biochemical Causes of Schizophrenia

• Biochemical Abnormality Disturbance in brains
  chemical systems or in the brains
  neurotransmitters
  
• Dopamine Neurotransmitter involved with emotions
  and muscle movement
  
• Works in limbic system
• Dopamine overactivity in brain may be related to
  schizophrenia

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Figure 13.7
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Figure 13.8
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Figure 13.11
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Schizophrenic Brain

• Computed Tomography (CT) Scan Computer enhanced
  X-ray of brain or body

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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

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Positron Emission Tomography (PET) Scan

• Computer-generated color image of brain activity
  radioactive sugar solution is injected into a
  vein, eventually reaching the brain
  
• Activity is abnormally low in frontal lobes of
  schizophrenics

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Table 13.6
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Mood Disorders

• Major disturbances in emotion or mood, such as
  depression or mania
  
• Depressive Disorders Sadness or despondency are
  prolonged, exaggerated, or unreasonable
  
• Bipolar Disorders Involve both depression, and
  mania or hypomania

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Bipolar Disorder Delusional Thinking
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Milder Mood Disorders

• 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

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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

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Endogenous Depression

• Depression that seems to be produced from inside
  the body (perhaps due to chemical imbalances) and
  NOT from reaction to life events

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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

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Bipolar Disorders

• Bipolar I Disorder Extreme mania and deep
  depression one type of manic-depressive illness
  
• Mania Excited, hyperactive, energetic, grandiose
  behavior
  
• Bipolar II Disorder Person is mainly sad but has
  one or more hypomanic episodes (mild mania)
  

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Bipolar Disorder Expression of Mood
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Maternity Blues

• Mild depression that lasts for one to two days
  after childbirth
  
• Marked by crying, fitful sleep, tension, anger,
  and irritability
  
• Brief and not too severe

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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

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Figure 13.12
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Suicide Major Risk Factors

• Drug or alcohol abuse
• Prior suicide attempt
• Depression or other mood disorder
• Availability of a firearm
• Severe anxiety or panic attacks
• Family history of suicidal behavior
• Shame, humiliation, failure or rejection

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Figure 13.14
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Figure 13.15
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Common Characteristics of Suicidal Thoughts and
Feelings (Shneidman)

• Escape
• Unbearable Psychological Pain Emotional pain
  that the person wishes to escape
  
• Frustrated Psychological Needs Such as searching
  for love, achievement, or security
  
• Constriction of Options Feeling helpless and
  hopeless and deciding that death is the only
  option left