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Psychological Disorders


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Title: Psychological Disorders

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

Psychological Disorders
  • To study the abnormal is the best way of
    understanding the normal.

William James (1842-1910)
  1. There are 450 million people suffering from
    psychological disorders (WHO, 2004).
  2. Depression and schizophrenia exist in all
    cultures of the world.

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 (Comer, 2004).
Deviant, Distressful Dysfunctional
  1. Deviant behavior (going naked) in one culture may
    be considered normal, while in others it may lead
    to arrest.
  2. Deviant behavior must accompany distress.
  3. If a behavior is dysfunctional it is clearly a

Carol Beckwith
In the Wodaabe tribe men wear costumes to attract
women. In Western society this would be
considered abnormal.
Psychological Disorders
  • Psychological Disorder
  • a harmful dysfunction in which behavior is
    judged to be
  • atypical--not enough in itself
  • disturbing--varies with time and culture
  • maladaptive--harmful
  • unjustifiable--sometimes theres a good reason

Defining Abnormal
  • Textbook
  • Atypical
  • Behavior is different, unusual
  • Disturbing
  • Behavior is upsetting to self and others
  • Maladaptive
  • Interferes with normal functioning (social, work,
  • Unjustifiable
  • Diagnostic and Statistical Manual of Mental
  • Published by the American Psychiatric Association
  • Lists, categorizes, describes mental disorders
  • Diagnostic criteria

Classifying Psychological Disorders
  • The American Psychiatric Association rendered a
    Diagnostic and Statistical Manual of Mental
    Disorders (DSM) to describe psychological

The most recent edition, DSM-IV-TR (Text
Revision, 2000), describes 400 psychological
disorders compared to 60 in the 1950s.
Multiaxial Classification
Is a Clinical Syndrome (cognitive, anxiety, mood
disorders 16 syndromes) present?
Axis I
Is a Personality Disorder or Mental Retardation
Axis II
Is a General Medical Condition (diabetes,
hypertension or arthritis etc) also present?
Axis III
Are Psychosocial or Environmental Problems
(school or housing issues) also present?
Axis IV
What is the Global Assessment of the persons
Axis V
Multiaxial Classification
Note 16 syndromes in Axis I
Multiaxial Classification
Note Global Assessment for Axis V
Goals of DSM
  1. Describe (400) disorders.
  2. Determine how prevalent the disorder is.

Disorders outlined by DSM-IV are reliable.
Therefore, diagnoses by different professionals
are similar.
Others criticize DSM-IV for putting any kind of
behavior within the compass of psychiatry.
Labeling Psychological Disorders
  1. Critics of the DSM-IV argue that labels may
    stigmatize individuals.

Asylum baseball team (labeling)
Labeling Psychological Disorders
  • 2. Labels may be helpful for healthcare
    professionals when communicating with one another
    and establishing therapy.

Labeling Psychological Disorders
  • 3. Insanity labels raise moral and ethical
    questions about how society should treat people
    who have disorders and have committed crimes.

Elaine Thompson/ AP Photo
Theodore Kaczynski (Unabomber)
Labeling Psychological Disorders (David Rosenhan)
  • David Rosenhan and seven others went to mental
    hospital admissions offices, complaining of
    hearing voices that were saying empty,
    hollow, and thud. Apart from this complaint
    and giving false names and occupations, they
    answered all the questions truthfully. All eight
    were diagnosed as mentally ill.

David Rosenhan Pseudo-Patient Experiment
  • Investigated reliability of psychiatric diagnoses
  • Eight healthy people entered psychiatric
    hospitals complaining of hearing strange voices
  • Once admitted to the hospital, they behaved
    normally and claimed that the voices had

Rosenhan Results
  • Staff treated patients as if they were really ill
  • Staff noted abnormal symptoms
  • Kept patients for an average of 19 days
  • Discharged with diagnosis of schizophrenia in

Rosenhan Nonexistent Impostor Experiment
  • Told hospital staff to expect pseudo-patients
  • No pseudo-patients were actually sent, but staff
    identified 41 anyway (these were, in fact, real

Pros of the DSM System
  • Provides a common language for mental health
  • Describes symptoms and diagnostic criteria
  • Improves diagnostic reliability and validity
  • Better labeling can lead to better treatment
  • A-theoretical
  • does not take sides among the different
    perspectives (cognitive, behaviorist,
    psychoanalytic, etc.)

  • Over-generalizes de-emphasizes individual
  • Knowing diagnostic criteria can lead to
    misattribution of symptoms
  • Confirmation bias
  • Diagnostic labels can lead to negative
    consequences stigmatizes people
  • Controversy over what disorders get labeled in
    the DSM
  • Insurance companies vs. therapists/patients

Sane or Insane?
  • The MNaghten Rule (1843)
  • at the time of the committing of the act, the
    party accused was labouring under such a defect
    of reason, from a disease of the mind, as not to
    know the nature and quality of the act he was
    doing or, if he did know it, that he did not
    know he was doing what was wrong. (Queen v.
    M'Naghten, 8 Eng. Rep. 718 1843)
  • Origin of the insanity defense
  • Sane and Insane are legal terms not used by
    psychologists when diagnosing patients

Myths of Insanity Defense
  • People fake insanity to avoid punishment
  • Too risky lose chance to plea bargain and
    contest facts of case
  • Allows killers to go free
  • Less than 0.5 plead insanity for felonies 1 in
    21,012 successful (1979)
  • Less than 15 of those charged with murder
  • Those successful spend more time in mental
    hospital than average for those found guilty and
    sent to jail.

Biopsychosocial Perspective
  • Assumes that biological, socio-cultural, and
    psychological factors combine and interact to
    produce psychological disorders.

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Generalized Anxiety Disorder (GAD)
  • More or less constant worry about many issues
  • The worry seriously interferes with functioning
  • Physical symptoms
  • headaches
  • stomach aches
  • muscle tension
  • irritability

Generalized Anxiety Disorder
  • 1. Persistent and uncontrollable tenseness and

2. Autonomic arousal.
3. Inability to identify or avoid the cause of
certain feelings.
Model of Development of GAD
  • GAD has some genetic component
  • Related genetically to major depression
  • Childhood trauma also related to GAD

Panic Disorder
  • Minute-long episodes of intense dread which may
    include feelings of terror, chest pains, choking,
    or other frightening sensations.

Anxiety is a component of both disorders. It
occurs more in the panic disorder, making people
avoid situations that cause it.
Anxiety Disorders
  • Common and uncommon fears

Anxiety Disorders
  • Obsessive-Compulsive Disorder
  • unwanted repetitive thoughts (obsessions) and/or
    actions (compulsions)

Anxiety Disorders
Post-Traumatic Stress Disorder
  • Four or more weeks of the following symptoms
    constitute post-traumatic stress disorder (PTSD)
  1. Haunting memories

2. Nightmares
3. Social withdrawal
4. Jumpy anxiety
5. Sleep problems
Bettmann/ Corbis
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
Explaining Anxiety Disorders
Psychoanalytic Perspective Freud suggested that
we repress our painful and intolerable ideas,
feelings, and thoughts, resulting in anxiety.
The Learning Perspective
Learning theorists suggest that fear conditioning
leads to anxiety. This anxiety then becomes
associated with other objects or events (stimulus
generalization) and is reinforced.
John Coletti/ Stock, Boston
The Learning Perspective
  • Stimulus Generalization
  • Conditioned fears may remain long after we
    have forgotten the experiences that produced
  • Stimulus generalization may occur when a
    person who fears heights after a fall may be
    afraid of airplanes without ever having flown.

The Learning Perspective
  • Reinforcement
  • Once phobias and compulsions arise,
    reinforcement helps maintain them. Avoiding or
    escaping the feared situation reduces anxiety,
    thus reinforcing the phobic behavior.

The Learning Perspective
Investigators believe that fear responses are
inculcated through observational learning. Young
monkeys develop fear when they watch other
monkeys who are afraid of snakes.
Parents transmit their fears to their children.
The Biological Perspective
Natural Selection has led our ancestors to learn
to fear snakes, spiders, and other animals.
Therefore, fear preserves the species.
Twin studies suggest that our genes may be partly
responsible for developing fears and anxiety.
Twins are more likely to share phobias.
The Biological Perspective
General anxiety, panic attacks, and even
obsessions and compulsions are biologically
measurable as an overarousal of brain areas
involved in impulse control and habitual
behaviors. (PET scans)
Anterior Cingulate Cortex of an OCD patient.
Somatoform Disorders
  • Somatoform Disorders
  • psychological disorders in which the symptoms
    take a somatic (bodily) form without apparent
    physical cause.

Somatoform Disorders
  • Conversion Disorders
  • a rare somatoform disorder in which a person
    experiences very specific genuine physical
    symptoms for which no physiological basis can be

Somatoform Disorders
  • Hypochondriasis
  • a somatoform disorder in which a person
    misinterprets normal physical sensations as
    symptoms of a disease.

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Mood Disorders
  • Mood Disorders
  • characterized by emotional extremes
  • Major Depressive Disorder
  • a mood disorder in which a person, for no
    apparent reason, experiences two or more weeks of
    depressed moods, feelings of worthlessness, and
    diminished interest or pleasure in most activities

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).
Major Depressive Disorder
Blue mood
Chronic shortness of breath
Gasping for air after a hard run
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
  1. Lethargy and fatigue
  2. Feelings of worthlessness
  3. Loss of interest in family friends
  4. Loss of interest in activities

Symptoms of Major Depression
Dysthymic Disorder
Dysthymic disorder lies between a blue mood and
major depressive disorder. It is a disorder
characterized by daily depression lasting two
years or more.
Dysthymic Disorder
  • Chronic, low-grade depressed feelings that are
    not severe enough to be major depression
  • May develop in response to trauma, but does not
    decrease with time
  • Can have co-existing major depression

Seasonal Affective Disorder
  • Cyclic severe depression and elevated mood
  • Seasonal regularity
  • Unique cluster of symptoms
  • intense hunger
  • gain weight in winter
  • sleep more than usual
  • depressed more in evening than morning

Prevalence and Course
  • Most common of psychological disorders
  • Women are twice as likely as men to be diagnosed
    with major depression
  • Untreated episodes can become recurring and more
  • Seasonal affective disorder (SAD)onset with
    changing seasons

Mood Disorders
  • Bipolar Disorder
  • a mood disorder in which the person alternates
    between the hopelessness and lethargy of
    depression and the overexcited state of mania
  • formerly called manic-depressive disorder
  • Manic Episode
  • a mood disorder marked by a hyperactive, wildly
    optimistic state

Bipolar Disorder
  • Formerly called manic-depressive disorder. An
    alternation between depression and mania signals
    bipolar disorder.

Manic Symptoms
Depressive Symptoms
Desire for action
Inability to make decisions
Multiple ideas
Slowness of thought
Prevalence and Course
  • Bipolar Disorder
  • Onset usually in young adulthood
  • (early twenties)
  • Mood changes more abrupt than in major
  • No sex differences in rate of bipolar disorder
  • Commonly recurs every few years
  • Can often be controlled by medication (lithium)

The most severe form of behavioral response to
depression is suicide. Each year some 1 million
people commit suicide worldwide.
Explaining Mood Disorders
Since depression is so prevalent worldwide,
investigators want to develop a theory of
depression that will suggest ways to treat it.
Lewinsohn et al., (1985, 1995) note that a theory
of depression should explain the following
  1. Behavioral and cognitive changes
  2. Common causes of depression

Theory of Depression
  1. Gender differences

Theory of Depression
  1. Depressive episodes self-terminate.
  2. Depression is increasing, especially in the teens.

Desiree Navarro/ Getty Images
Post-partum depression
Neurotransmitters Depression
A reduction of norepinephrine and serotonin has
been found in depression. Drugs that alleviate
mania reduce norepinephrine.
Pre-synaptic Neuron
Post-synaptic Neuron
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
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
Cognitive Bases for Depression
  • A.T. Beck depressed people hold pessimistic
    views of
  • themselves
  • the world
  • the future
  • Depressed people distort their experiences in
    negative ways
  • exaggerate bad experiences
  • minimize good experiences

Cognitive Bases for Depression
  • Hopelessness theory
  • depression results from a pattern of thinking
  • person loses hope that life will get better
  • negative experiences are due to stable, global
  • e.g., I didnt get the job because Im stupid
    and inept vs. I didnt get the job because the
    interview didnt go well

Depression Cycle
  1. Negative stressful events.
  2. Pessimistic explanatory style.
  3. Hopeless depressed state.
  4. These hamper the way the individual thinks and
    acts, fueling personal rejection.

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Dissociative Amnesia
  • Also known as psychogenic amnesia
  • Memory loss the only symptom
  • Often selective loss surrounding traumatic events
  • person still knows identity and most of their
  • Can also be global
  • loss of identity without replacement with a new

Dissociative Amnesia
  • Margie and her brother were recently victims of a
    robbery. Margie was not injured, but her brother
    was killed when he resisted the robbers. Margie
    was unable to recall any details from the time of
    the accident until four days later.

Dissociative Fugue
  • Also known as psychogenic fugue
  • Global amnesia with identity replacement
  • leaves home
  • develops a new identity
  • apparently no recollection of former life
  • called a fugue state
  • If fugue wears off
  • old identity recovers
  • new identity is totally forgotten

Dissociative Identity Disorder
  • Dissociative Identity Disorder
  • rare dissociative disorder in which a person
    exhibits two or more distinct and alternating
  • formerly called multiple personality disorder

Dissociative Identity Disorder
  • Pattern typically starts prior to age 10
  • Most people with disorder are women
  • Most report recall of torture or sexual abuse as
    children and show symptoms of PTSD

Dissociative Disorder
  • Conscious awareness becomes separated
    (dissociated) from previous memories, thoughts,
    and feelings.

  1. Having a sense of being unreal.

2. Being separated from the body.
3. Watching yourself as if in a movie.
Dissociative Identity Disorder (DID)
  • Norma has frequent memory gaps and cannot
    account for her whereabouts during certain
    periods of time. While being interviewed by a
    clinical psychologist, she began speaking in a
    childlike voice. She claimed that her name was
    Donna and that she was only six years old.
    Moments later, she seemed to revert to her adult
    voice and had no recollection of speaking in a
    childlike voice or claiming that her name was

Causes of Dissociative Disorders?
  • Repeated, severe sexual or physical abuse
  • However, many abused people do not develop DID
  • Combine abuse with biological predisposition
    toward dissociation?
  • people with DID are easier to hypnotize than
  • may begin as series of hypnotic trances to cope
    with abusive situations

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
  1. Role-playing by people open to a therapists

2. Learned response that reinforces reductions in
The DID Controversy
  • Some curious statistics
  • 193060 2 cases per decade in USA
  • 1980s 20,000 cases reported
  • many more cases in US than elsewhere
  • varies by therapistsome see none, others see a
  • Is DID the result of suggestion by therapist and
    acting by patient?

  • If depression is the common cold of psychological
    disorders, schizophrenia is the cancer.

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.
  • Schizophrenia
  • literal translation split mind
  • a group of severe disorders characterized by
  • disorganized and delusional thinking
  • disturbed perceptions
  • inappropriate emotions and actions

What is Schizophrenia?
  • Comes from Greek meaning split and mind
  • split refers to loss of touch with reality
  • not dissociative state
  • not split personality
  • Equally split between genders, males have
    earlier onset
  • 18 to 25 for men
  • 26 to 45 for women

  • Delusions
  • false beliefs, often of persecution or grandeur,
    that may accompany psychotic disorders
  • In a psychiatrist's waiting room two patients
    are having a conversation. One says to the other,
    "Why are you here?" The second answers, "I'm
    Napoleon, so the doctor told me to come
    here." The first is curious and asks, "How do you
    know that you're Napoleon?" The second responds,
    "God told me I was." At this point, a patient on
    the other side of the room shouts, "NO I DIDN'T!"

Disorganized Delusional Thinking
  • Many psychologists believe disorganized thoughts
    occur because of selective attention failure
    (fragmented and bizarre thoughts).

Symptoms of Schizophrenia
  • Delusions of persecution
  • theyre out to get me
  • paranoia
  • Delusions of grandeur
  • God complex
  • megalomania
  • Delusions of being controlled
  • the CIA is controlling my brain with a radio

Disorganized Thinking
  • Word Salad
  • jumping from one idea to another even within
  • Clang Associations
  • rhyming the last word of a sentence.

Symptoms of Schizophrenia
  • Hallucinations
  • hearing or seeing things that arent there
  • contributes to delusions
  • command hallucinations voices giving orders
  • Disorganized speech
  • Over-inclusionjumping from idea to idea without
    the benefit of logical association
  • Paralogicon the surface, seems logical, but
    seriously flawed
  • e.g., Jesus was a man with a beard, I am a man
    with a beard, therefore I am Jesus

Inappropriate Emotions Actions
  • A schizophrenic person may laugh at the news of
    someone dying or show no emotion at all (apathy).

Patients with schizophrenia may continually rub
an arm, rock a chair, or remain motionless for
hours (catatonia).
Positive and Negative Symptoms
  • Schizophrenics have inappropriate symptoms
    (hallucinations, disorganized thinking, deluded
    ways) that are not present in normal individuals
    (positive symptoms).

Schizophrenics also have an absence of
appropriate symptoms (apathy, expressionless
faces, rigid bodies) that are present in normal
individuals (negative symptoms).
Frequency of positive and negative symptoms in
individuals at the time they were hospitalized
for schizophrenia. Source Based on data
reported in Andreasen Flaum, 1991.
Disorganized Symptoms
  • Disorganized behavior and affect
  • behavior is inappropriate for the situation
  • e.g., wearing sweaters and overcoats on hot days
  • affect is inappropriately expressed
  • flat affectno emotion at all in face or speech
  • inappropriate affectlaughing at very serious
    things, crying at funny things
  • catatonic behavior
  • unresponsiveness to environment, usually marked
    by immobility for extended periods

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.
Subtypes of Schizophrenia
  • Schizophrenia is a cluster of disorders. These
    subtypes share some features, but there are other
    symptoms that differentiate these subtypes.

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

Brain Abnormalities
Chemical Factors Dopamine Overactivity
Researchers found that schizophrenic patients
express higher levels of dopamine D4 receptors in
the brain.
Genetic Factors
  • Genetic Factors
  • 1 in 100 odds of any person being diagnosed
    with schizophrenia.
  • 1 in 10 chance among those who have an
    afflicted sibling or parent.
  • 1 in 2 chance among those who have an
    afflicted identical twin.

Genetic Factors
  • The likelihood of an individual suffering from
    schizophrenia is 50 if their identical twin has
    the disease (Gottesman, 1991).

Environmental Factors Viral Infection
  • Schizophrenia has also been observed in
    individuals who contracted a viral infection
    (flu) during the middle of their fetal

Family Influences on Schizophrenia
  • Family variables
  • parental communication that is disorganized,
    hard-to-follow, or highly emotional
  • expressed emotion
  • highly critical, over-enmeshed families

Cultural Differences in Schizophrenia
  • Prevalence of symptoms is similar no matter what
    the culture
  • Less industrialized countries have better rates
    of recovery than industrialized countries
  • families tend to be less critical of the patients
  • less use of antipsychotic medications, which may
    impair full recovery
  • think of it as transient, rather than chronic and
    lasting disorder

Summary of Schizophrenia
  • Many biological factors seem involved
  • heredity
  • neurotransmitters
  • brain structure abnormalities
  • Family and cultural factors also important
  • Combined model of schizophrenia
  • biological predisposition combined with
    psychosocial stressors leads to disorder
  • Is schizophrenia the maladaptive coping behavior
    of a biologically vulnerable person?

Personality Disorders
  • These people have unstable and intense
    relationships with others.
  • They are dependent on others and yet, sabotage
    those relationships.
  • They have problems controlling their impulses
    their perceptions and
  • thoughts are distorted.

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.

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.

Understanding Antisocial Personality Disorder
  • The likelihood that one will commit a crime
    doubles when childhood poverty is compounded with
    obstetrical complications (Raine et al., 1999

Borderline Personality Disorder
  • Chronic instability of emotions, self-image,
  • Self-destructive behaviors
  • Intense fear of abandonment and emptiness
  • Possible history of childhood physical,
    emotional, or sexual abuse
  • 75 of diagnosed cases are women

Paranoid Personality Disorder
  • Pervasive mistrust and suspiciousness of others
    are the main characteristic
  • Distrustful even of close family and friends
  • Reluctant to form close relationships
  • Tend to blame others for their own shortcomings

Histrionic Personality Disorder
  • Histrionic Personality Disorder displays a
    shallow, attention-getting emotionality.
  • Histrionic individuals go to great length to
    gain others praise and reassurance.

Narcissistic Personality Disorder
  • Narcissistic Personality Disorder exaggerate
    their own importance, aided by success fantasies.
  • They find criticism hard to accept, often
    reacting with rage or shame.

Risk and Protective Factors
Risk and protective factors for mental disorders
(WHO, 2004).
Rates of Psychological Disorders
Medical Model
  • When physicians discovered that syphilis led to
    mental disorders, they started using medical
    models to review the physical causes of these
  1. Etiology Cause and development of the disorder.
  2. Diagnosis Identifying (symptoms) and
    distinguishing one disease from another.
  3. Treatment Treating a disorder in a psychiatric
  4. Prognosis Forecast about the disorder.