13-1 * Chapter 13 Psychological Disorders

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Chapter 13Chapter 13

Psychological Disorders

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Defining and ClassifyingDefining and Classifying

Historical Explanations of Abnormal Behaviors• Demonic possession• Physical diseases• Products of psychological

conflicts• Learned maladaptive behaviors• Distorted perceptions of the world

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Vulnerability-Stress Model

• Each of us has vulnerability for developing a psychological disorder• Stress plays a role in

development

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Criteria for “abnormality”

•Distress•Dysfunction•Deviance

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Distress

• Judgments of abnormality most likely when distress is disproportionately acute or long-lasting

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Dysfunctionality

• Either for individual or for society

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Deviance

• From cultural norms

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What is Abnormal Behavior?• Behavior that is so:•Personally distressful•Personally dysfunctional•Culturally deviant

that others judge it as inappropriate or maladaptive

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Diagnosing Psychological Disorders

• Reliability•Clinicians should show high levels of agreement in their diagnostic decisions

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Diagnosing Psychological Disorders

• Validity

•Diagnostic categories should accurately capture essential features of disorders

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DSM-IV

• Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition• Most widely used classification

system in U.S.

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DSM-IV Axes• Axis I: Primary clinical

symptoms• Axis II: Long-standing

personality or developmental disorders• Axis III: Relevant physical

conditions

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DSM-IV Axes cont.

• Axis IV: Intensity of environmental stressors• Axis V: Coping resources as

reflected in recent adaptive functioning

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Consequences of Diagnostic Labeling

• Social• Personal• Legal

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Social Consequences of Diagnostic Labeling

•Becomes too easy to accept label as description of the individual

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Personal Consequences of Diagnostic Labeling

• May accept the new identity implied by the label• May develop the expected role

and outlook

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Legal Consequences of Diagnostic Labeling

• Involuntary commitment to mental institutions• Loss of civil rights• Indefinite detainment

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Legal Concepts• Competency•Defendant’s state of mind at the time of a judicial hearing

• Insanity•Presumed state of mind of defendant at time crime was committed

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Anxiety DisordersAnxiety Disorders

Definition

• Frequency and intensity of anxiety responses are out of proportion to the situations that trigger them • Anxiety interferes with daily

life

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Components of Anxiety Responses

• Subjective-emotional• Cognitive• Physiological• Behavioral

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Phobias

• Strong and irrational fears of certain objects or situations

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Agoraphobia: Fear of open and public spaces from which escape would be difficult

Social phobias: Fear of situations in which evaluation might occur

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Specific phobias: Fear of specific objects such as animals or situations

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Generalized Anxiety Disorder

• Chronic state of diffuse, “free-floating” anxiety• Anxiety not attached to

specific objects or situations

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Panic Disorder

• Panic occurs suddenly and unpredictably•Much more intense than

typical anxiety

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Obsessive-Compulsive Disorder• Obsessions•Repetitive and unwelcome thoughts, images, or impulses

• Compulsions•Repetitive behavioral responses

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Posttraumatic Stress Disorder

• Severe anxiety disorder•Can occur in people

exposed to extreme trauma

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Symptoms of PTSD• Severe symptoms of anxiety,

arousal, and distress• Reliving of trauma in

flashbacks• Numb to world and avoidance

of reminders• Intense “survivor guilt”

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Biological Factors in Anxiety• Overreactive autonomic

nervous system• Overreactive neurotransmitter

systems involved in emotional responses• Overreactive right hemisphere

sites involved in emotions

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Evolutionary Explanations

• Biological preparedness

•Makes it easier for us to learn to fear certain stimuli

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Psychodynamic Theory

• Neurotic anxiety

•Occurs when unacceptable impulses threaten to overwhelm the ego’s defenses

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Cognitive Factors

•Maladaptive thought patterns and beliefs• Exaggerated

misinterpretations of stimuli

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Learned Responses

• Result of “emotional conditioning” (Öhman, 2000; Rachman, 1998)• Classically conditioned fear• Observational learning

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Culture-Bound Disorders

•Occur only in certain locales•e.g., Anorexia Nervosa, Taijin Kyofushu

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Somatoform DisordersSomatoform Disorders

Involve physical complaints that suggest a medical problem

But no biological cause

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Hypochondriasis

•Great alarm about physical symptoms•Convinced of serious

illness

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Pain Disorder

• Experience of intense pain out of proportion to medical conditions• No physical basis for

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Conversion Disorder

• Serious neurological disorders suddenly occur• e.g., paralysis, loss of

sensation, blindness

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Glove Actual nerve anethesia innervation

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Predispositions

• May involve combinations of biological and psychological vulnerabilities• Genetics, environmental

learning, and social reinforcement for bodily symptoms (Trimble, 2003)

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Incidence (Tanaka-Matsumi & Draguns, 1997)

• Higher in cultures that:

•Discourage open discussion of emotions•Stigmatize psychological disorders

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Dissociative DisordersDissociative Disorders

Breakdown of normal personality integration

• Results in alterations to memory or identity

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Psychogenic Amnesia

•Response to stressful event with extensive but selective memory loss

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Psychogenic Fugue

• Loss of all sense of personal identity• Establishment of new

identity in a new location

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Dissociative Identity Disorder (DID)

• Formerly called multiple personality disorder• Two or more separate

personalities coexist in the same person

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Causes of DID

• Trauma-Dissociation Theory

•Development of personalities is a response to severe stress

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Criticisms of DID

• Large increase in cases in recent years•Are personalities

unintentionally implanted by overzealous therapists?

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Mood (Affective) DisordersMood (Affective) Disorders

Involve depression and mania

Most frequently experienced (with anxiety disorders) psychological disorders

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Major Depression

• Intense depressed state• Leaves people unable to

function effectively in their lives

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Dysthymia

• Intense form of depression• Less dramatic effects on

personal and occupational functioning• More chronic than major

depression

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Symptoms of Depression

•Negative mood•Cognitive symptoms•Motivational symptoms• Somatic (physical)

symptoms

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Negative Mood in Depression

• Sadness, misery, loneliness

• Loss of capacity for psychological, biological pleasures

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Cognitive Symptoms of Depression

• Difficulty concentrating and making decisions• Low self-esteem• Feelings of inferiority• Blame selves for failures• Pessimism and hopelessness

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Motivational Symptoms of Depression

• Inability to get started on task• Inability to perform behaviors

leading to pleasure or accomplishment

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Somatic (Bodily) Symptoms of Depression

• Loss of appetite and weight loss in moderate and severe depression• Weight gain in mild depression

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Bipolar Disorder

•Depression alternates with periods of mania•Mania = Highly excited

mood and behavior

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Prevalence of Mood Disorders

• 1 in 20 Americans is severely depressed (Narrow et al., 2002)• 1 in 5 Americans will have a

depressive episode of clinical proportions during lifetime (Hamilton, 1989)

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Gender Differences

•Women about twice as likely to suffer from unipolar depression

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Biological Explanations for Gender Differences in Depression

• Genetic factors• Biochemical differences• Premenstrual depression

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Environmental Explanations for Gender Differences in Depression (Nolen-Hoeksma, 1990)

• Female passivity and dependency•Distraction by physical activity

and drinking in males

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Patterns After Depressive Episodes

• No recurrence of clinical depression• Recovery with recurrence• No recovery

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Genetic Factors

• 67% concordance rate for identical twins; only 15% for fraternal twins (Gershon et al., 1989)• Genetic predisposition to

mood disorder

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Brain Chemistry Factors

• Underactivity of norepinephrine, dopamine, and serotonin in depression (Davidson, 1998)• Overactivity of

neurotransmitters in mania?

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Psychological Factors

• Early traumatic losses or rejections create vulnerability (e.g. Abraham, 1911; Freud, 1917, Brown and Harris, 1978)

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Humanistic Factors• Definition of self-worth in

terms of individual attainment • React more strongly to

failures; view failures as due to inadequacies• Experience of

meaninglessness

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Depressive Cognitive Triad (Wenzlaff et al., 1988)

• Negative thoughts concerning:•The world•Oneself•The future

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Depressive Attributional Pattern

• Attributing success to factors outside self• Attributing negative outcomes

to personal factors

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Learned Helplessness Theory (Abramson et al., 1978; Seligman & Isaacowitz, 2000)

• Depression occurs when people expect that bad events will occur and they think that they can’t cope with them

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Environmental Factors (Hammen, 1991)• Poor parenting• Many stressful experiences• Failure to develop good coping

skills• Failure to develop positive self-

concept

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Sociocultural Factors• Prevalence of depressive

disorders less in Hong Kong and Taiwan than in the West• Feelings of guilt and

inadequacy are highest in North America and Western Europe

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Sociocultural Factors cont.

•Gender difference not found in developing countries

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SuicideSuicide

Willful taking of one’s life

Second most frequent cause of death among high school and college students

Women attempt more suicides; men are more likely to kill selves

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SuicideSuicide

Motives for Suicide (Beck et al., 1979)

• Desire to end one’s life

• Manipulation of others

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SuicideSuicide

Warning Signs of Suicide

• Verbal or behavioral threat to kill self• History of previous attempts• Detailed plan that involves a

lethal method

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SuicideSuicide

Suicide Prevention

• Talk about it with the person

• Provide social support and empathy

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SuicideSuicide

Suicide Prevention cont.

• Help the person to consider positive future possibilities

• Stay with the person and help him or her to seek professional assistance

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SchizophreniaSchizophrenia

Severe disturbances in (Herz & Marder, 2002):

• Thinking• Speech• Perception• Emotion• Behavior

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Diagnosis of Schizophrenia (American Psychiatric Association, 1994, 2000)• Misinterpretation of reality• Disordered attention, thought,

perception• Withdrawal from social

activities

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Diagnosis of Schizophrenia cont.

• Strange or inappropriate communication• Neglect of personal grooming• Disorganized behavior

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Delusions

• False beliefs that are sustained in the face of contrary evidence normally sufficient to destroy them

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Hallucinations

• False perceptions that have a compelling sense of reality

• Can be auditory or visual

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Types of Affect

• Flat: No emotions at all

• Inappropriate

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Subtypes of Schizophrenia

• Paranoid

•Delusions of persecution and grandeur

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• Disorganized

•Confusion and incoherence•Severe deterioration of adaptive behavior

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• Catatonic

•Motor disturbances from muscular rigidity to random or repetitive movements

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• Undifferentiated

•Do not show enough specific criteria to be classified as paranoid, disorganized, or catatonic

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Positive Symptoms• Bizarre behaviors such as

delusions, hallucinations, and disordered speech, thinking

Negative Symptoms• Absence of normal reactions• e.g., emotional expression,

motivation, normal speech

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Positive Symptoms

•Better prognosis for later recovery

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Biological Causes

• Genetic predisposition• Destruction of neural tissue

(neurodegenerative hypothesis)•Atrophy in brain regions that influence cognitions, emotions

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Dopamine hypothesis•Overactivity of the dopamine system in brain areas regulating emotions, motivations, and cognitions

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Psychological Factors• Freud: extreme example of

regression• Retreat from painful

intrapersonal world• Chaotic sensory input• Deficits in frontal lobe

executive functions

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Environmental Factors

• Stressful life events• Family dynamics• Home environments high in

expressed emotion (Vaughn & Leff, 1976)

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Expressed Emotion

• High levels of criticism• High levels of hostility• Overinvolvement in person’s

life

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Sociocultural Factors

•Highest in lower socioeconomic populations•Causal or correlational?

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Social Causation Hypothesis• Higher prevalence of

schizophrenia due to higher levels of stress

Social Drift Hypothesis• Deterioration of social and

personal functioning causes drift into poverty

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Personality DisordersPersonality Disorders

Stable, ingrained, inflexible, and maladaptive ways of thinking, feeling, and behaving

Increase likelihood of acquiring, maintaining several Axis I disorders

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Three Clusters:

•Dramatic and impulsive behaviors•Anxiety and fearfulness•Odd and eccentric

behaviors

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Antisocial Personality Disorder• Psychopaths or sociopaths• 3:1 male-female ratio• Lack a conscience• Fail to respond to

punishment

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Biological Causes of Antisocial Personality Disorder

• Genetic predisposition• Dysfunction in brain structures

that govern self-control and emotional arousal?

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Psychological Causes of Antisocial Personality Disorder

• Psychodynamic view: lack of a superego• Inability to develop conditioned

fear responses when punished leads to poor impulse control

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Psychological Causes of Antisocial Personality Disorder cont.

•Modeling of aggression• Parental inattention to

children’s needs (Rutter, 1997)

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Psychological Causes of Antisocial Personality Disorder cont.

• Exposure to deviant peers• Consistent failure to think

about or anticipate long-term negative consequences of acts

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Childhood DisordersChildhood Disorders

Over 20% of children aged 2-5 diagnosed with DSM-IV disorder (Lavigne et al., 1996)

Only about 40% of children with behavior disorders receive professional attention (Satcher, 1999)

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Externalizing Disorders

•Disruptive and aggressive behaviors• e.g., ADHD

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ADHD (Attention Deficit/Hyperactivity Disorder)

• Attentional difficulties• Hyperactivity-impulsivity• Most common childhood

disorder (7-10% of U.S. children)

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Causes of ADHD

• Genetic predispositions• Brain scans show no

differences with “normals”• Environmental factors

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Other Externalizing Disorders• Oppositional Defiant Disorder

(ODD)•Disobedient, defiant, hostile

• Conduct Disorder•Violate social norms and show disregard for others’ rights

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Internalizing Disorders

• Involve maladaptive thoughts and emotions

• Include anxiety and mood disorders

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Dementia in Old AgeDementia in Old Age

Gradual loss of cognitive abilities

Accompanies brain deterioration

e.g., Alzheimer’s, Parkinson’s, Huntington’s, Creutzfeldt-Jakob Diseases

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Senile Dementia

• Dementia that begins after age 65• 2:1 female-male ratio• Onset is typically gradual• Over 1/2 cases resemble

schizophrenia

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Alzheimer’s Disease• 60% of senile dementias• Caused by deterioration in

frontal and temporal lobes of brain• Plaques in brain• Destruction of cells that

produce acetylcholine

13-1 * Chapter 13 Psychological Disorders

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