CHAPTER 14: WHAT ARE PSYCHOLOGICAL DISORDERS AND HOW CAN WE UNDERSTAND THEM?

CHAPTER 14:WHAT ARE PSYCHOLOGICAL

DISORDERS AND HOW CAN WE UNDERSTAND THEM?

Pastorino/Doyle-PortilloEssentials of What Is Psychology? 1st edition

© 2010 Cengage Learning

WHAT IS ABNORMAL BEHAVIOR?

• Four criteria help distinguish normal from abnormal behavior:• Statistical infrequency• Violation of social norms

• Problematic criterion on its own

• Personal distress• Level of impairment

• Interferes with ability to function



PREVALENCE OF ABNORMAL BEHAVIORS

• 26% of Americans over 18 have diagnosable psychological disorders within a given year; 46% lifetime prevalence

• Psychological disorders are leading cause of disability in U.S. and Canada for individuals between 15 and 44



EXPLAINING PSYCHOLOGICAL DISORDERS: PERSPECTIVES REVISITED

• Western cultures explain abnormal behavior through three perspectives:

• Biological theories• Psychological theories• Social or cultural theories



BIOLOGICAL THEORIES: THE MEDICAL MODEL

• Abnormal behavior attributable to physical processes: • Genetics, hormone/neurotransmitter

imbalance, brain/bodily dysfunction

• Also called the medical model• Emphasizes diagnosis, treatment, and

cure, in similar manner to physical illnesses



PSYCHOLOGICAL THEORIES: HUMANE TREATMENT AND PSYCHOLOGICAL

PROCESSES

• Internal & external stressors result in abnormal behavior

• Four predominant perspectives• Psychoanalytic: unconscious conflicts• Social-learning: past learning and

modeling• Cognitive: ineffective mental processes• Humanistic: distorted perception of self

and reality



SOCIOCULTURAL THEORIES:

• Internal biological and psychological processes can only be understood in context of social factors

• Culture, age, race, sex, gender-identity, sexual orientation, religion/spirituality, socioeconomic status, and social conditions must be taken into consideration in evaluating abnormal behavior



A BIOPSYCHOSOCIAL MODEL: INTEGRATING PERSPECTIVES

• No one perspective is “correct”

• Most disorders are a result of biological psychological, & social factors

• No one single “cause”



THE DSM MODEL FOR CLASSIFYING ABNORMAL BEHAVIOR

• Ability to describe behavior is more advanced than understanding of causes

• Diagnostic and Statistical Manual of Mental Disorders, now in fourth revision (DSM-IV-TR)• Lists specific, concrete criteria for diagnosis

• Atheoretical: does not address causes of mental illness



A MULTIDIMENSIONAL EVALUATION

• Five dimensions for evaluation, known as axes

• Axis I: clinical disorders• 15 major categories

• Axis II: personality disorders; mental retardation

• Axis III: general medical conditions• Axis IV: psychosocial and environmental

problems• Axis V: global assessment of functioning



ANXIETY DISORDERS: NOT JUST “NERVES”

Four components:• Physical: activation of sympathetic

nervous system and hormonal system (fight-or-flight)

• Cognitive: unrealistic thoughts (exaggerated danger, fear losing control, paranoia)

• Emotional: terror, panic, irritability• Behavioral: coping (freezing, aggression)



PANIC ATTACK

• Discrete period of intense fear or discomfort, which usually peaks within 10 minutes.

• And… 4 of the following:

• Racing Heart Sweating• Trembling Shortness of breath• Choking Chest discomfort• Nausea Dizziness/lightheadedness



PANIC ATTACK

• Discrete period of intense fear or discomfort, which usually peaks within 10 minutes.

• And… 4 of the following:

• Derealization Depersonalization (detached from self)

• Fear of dying Fear of losing control/going crazy

• Numbness Chills or hot flashes



PANIC DISORDER W/O AGORAPHOBIA

• Recurrent Panic attacks, followed by one or more (for at least 1 month):

• Persistent concern about future attacks• Worry About implications of attack (heart

attack; “crazy”)• Significant change in behavior

*30 - 40% of young Americans report occasional attacks



PANIC DISORDER WITH AGORAPHOBIA

• Panic Disorder AND…

• Agoraphobia: “fear of the marketplace”

• Anxiety & avoidance of places/situations where help may not be available if panic occurs.



GAD

• Excessive worry, most days, at least 6 months• Difficulty controlling the worry• 3 or more of 6 symptoms, most days:

• Restless/”on edge” Easily fatigued• Difficulty concentrating Irritability• Muscle tension Sleep

disturbance

• “clinically significant distress” or impaired functioning



OCD

• A. Obsessions Or compulsions that cause marked distress or impairment in functioning.

• Obsessions: persistent, intrusive thoughts, images and impulses.• Product of own mind (e.g., not hallucinations)• Difficulty ignoring or suppressing obsessions

• Compulsions: Repetitive behaviors or mental acts (to reduce distress and anxiety…attempt to prevent fear from occurring in an unrealistic way).



PTSD

• Exposure to traumatic event• “actual or threatened death, serious injury, or physical

integrity”• Response involved intense fear, helplessness

• Reexperience event: images, dreams, reliving, or intense distress from triggers of event

• Persistent avoidance of stimuli associated with trauma• Avoid: thoughts, feelings, activities, loss of recall,

detachment form others, restricted affect, etc



PTSD

• Duration is more than 1 month• Less than 1 month= acute distress disorder

• Acute or chronic• Duration of symptoms less than 3 months, or longer



PHOBIC DISORDERS• Intense fears vs. normal fears

• intense fears causing anxiety, possibly panic attacks, that interfere with functioning

• Specific phobias: persistent fear and avoidance of object or situation• Most common, 8% lifetime• Usually begin in childhood

• Social phobias• Irrational fear of being negatively evaluated by

others in social situations



EXPLAINING ANXIETY DISORDERS: PSYCHOLOGICAL FACTORS

• Social learning• Phobias develop through• classical conditioning• observational learning• behaviors reinforced by avoidance of

fears (operant conditioning)• Reinforcement in compulsions

• Cognitive• Misinterpretation of bodily sensations in panic• Negative and catastrophic thinking heighten

anxiety



ANXIETY DISORDERS

• Common Disorders: Panic Disorder, Specific Phobia, Social Phobia, GAD, PTSD, OCD

• Panic Disorder: 20% have attempted suicide• Similar suicide rates as depression

• Suicide risk highest when comorbid with depression• ~50% with an anxiety disorder have another disorder



SUICIDE: RATES & FACTS

• 32,000 Americans complete suicide a year (12 people per 100,000; 85 per day).

• A person is more likely to die by suicide than to be murdered in the U.S.

• Suicide is the 11th leading cause of death overall in the U.S., yet 2nd for college students.

• Guns are used in more than half of completed suicides.

• Females 3x attempts; Males 4x completions Source: (Granello & Granello, 2007)



SUICIDE: INCREASED RISK

• Abuse and Assault (Granello & Granello, 2007).

• Women with a history of sexual assault during childhood or adulthood have a higher risk for suicide attempts (Ullman & Brucklin, 2002).

• The more types of abuse, the higher the risk (Ullman & Brucklin, 2002).

• Family History of Suicide• 11 times the risk (AAS, 2009).

• Eating Disorders • Over 20x Suicide Mortality (Death) rate (AAS, 2009; Harris

& Barraclough,1997)

• HIghest Mortality rate for Anorexia Nervosa (AAS, 2009).



EXPLAINING MOOD DISORDERS: BIOLOGICAL FACTORS

• Genetics• Family, twin and adoption studies show genetic

transmission (clearer for bipolar than major depression)

• Neurotransmitters• Serotonin and norepinephrine abnormalities

• Hormones• Repeated activation of hormonal stress system may lay

ground for depression



EXPLAINING MOOD DISORDERS: PSYCHOLOGICAL FACTORS

• Psychoanalytic: unresolved childhood issues, symbolic expression of anger

• Attachment: insecure attachments, separations, losses increase vulnerability

• Behavioral/learning: reduction in positive reinforcers from others• Learned helplessness• Ruminative coping style

• Cognitive research: cognitive distortions and attributions of events



EXPLAINING MOOD DISORDERS: SOCIOCULTURAL FACTORS

• Depression more likely among people of lower social status

• Cross-culturally, more women than men• Biological: hormonal imbalance• Psychological: ruminative coping, relational style• Social: less power, more victimized, gender-role

socialization



UNIPOLAR DEPRESSIVE DISORDERS

• Depression is leading cause of disability in U.S. and worldwide• 17% acute episode in lifetime; 6% chronic

• Average age of onset is 32• 15 to 24 years at highest risk for major depressive episode

• Women more likely to experience than men• European American have highest risk, but

African and Hispanic American more severe



BIPOLAR DEPRESSIVE DISORDERS: THE PRESENCE OF MANIA

• 2.6% lifetime, late adolescence, early adulthood

• Bipolar disorder• Shift in mood between two states (poles)• Depression to mania characterized by high energy,

impulsiveness, euphoria

• Cyclothymic disorder• Less severe, but more chronic, form of bipolar• Alternates between milder periods of mania and

moderate depression



MOOD DISORDERS: BEYOND THE BLUES

• Significant change in one’s emotional state

• 9.5% per year• Although most experience some

depression, clinical depression is related to length of time symptoms exist and interference with functioning

• Symptoms exist even in absence of triggering events



UNIPOLAR DEPRESSIVE DISORDERS: A CHANGE TO SADNESS

• Major depression• Extreme sadness (dysphoria) or extreme apathy (loss of

interest in activities) plus four other symptoms for at least two weeks

• May be single or repeated episodes

• Dysthymic disorder• Less severe, more chronic form of depression• Depressed mood plus two other symptoms lasting at

least two years



DEPRESSIVE DISORDER NOS

• NOS means “Not Otherwise Specified”

• This is a “catch all” category for those who do not fit neatly into the other categories



MOOD DISORDERS & SUICIDE

• Double Depression: MDD & Dysthymic Disorder

• “Dual Diagnosis”: Mental Disorder and Substance Abuse or Dependence Disorder



MANIA

• A distinct period of abnormally elevated, expansive, or irritable mood, lasting at least 1 week (or hospitalization required)

• 3 criteria must be met • 4 if mood is irritable instead of elevated



MANIA

• Criteria 3 must be met “to a significant degree”• Inflated self-esteem or grandiosity• Decreased need for sleep (rested after 3 hours a night)• More talkative/ “Pressured speech”• Racing Thoughts for “Flight of ideas”• Distractibility• Increased goal-directed activity or psychomotor agitation• Excessive involvement in pleasurable activities with high

chance of painful consequences



HYPOMANIC EPISODE

• A distinct period of abnormally elevated, expansive, or irritable mood, lasting at least 4 days

• 3 criteria must be met • 4 if mood is irritable instead of elevated

• Not severe enough to hospitalize; no psychotic features



HYPOMANIA

• Criteria 3 must be met “to a significant degree”• Inflated self-esteem or grandiosity• Decreased need for sleep (rested after 3 hours a night)• More talkative/ “Pressured speech”• Racing Thoughts for “Flight of ideas”• Distractibility• Increased goal-directed activity or psychomotor agitation• Excessive involvement in pleasurable activities with high

chance of painful consequences



BIPOLAR I DISORDER

• Presence of a Manic Episode

• Bipolar II: One or more depressive episodes with at least one Hypomanic Episode (No full manic episode)



SCHIZOPHRENIA

• From Greek…“split mind” is a misnomer • Affects approximately 1-2% of population in

lifetime • Strong biological component

• Identical (monozygotic) twin ~ 50%

• Schizophrenia or Mood disorder with psychotic features?.. often difficult to determine

• Many call this disorder “the schizophrenias”



SCHIZOPHRENIA

A. 2 or more of these criteria:• Delusions• Hallucinations• Disorganized speech• Grossly disorganized, or catatonic behavior• Negative symptoms (affective flattening, alogia, or

avolition)

•Only 1 criteria needed if: bizaare delusions, voice keeping commentary of person’s behaviors and thoughts, two or more voices conversing together.



TYPES OF SCHIZOPHRENIA: POSITIVE AND NEGATIVE SYMPTOMS

• Positive and negative symptoms exist in schizophrenia• Positive: increase in behaviors (i.e.unusual perceptions,

thoughts, behaviors)• Negative: loss of behaviors (i.e. motor movements, social

withdrawal, etc.)

• Some show both positive and negative• Better outcome for treatment in cases

where predominantly positive symptoms



SCHIZOPHRENIA: 2 TYPES OF SYMPTOMS

• Between 50-70% experience positive symptoms

Positive Symptoms: • Hallucinations (auditory most common)• Delusions

Delusion of grandeur: “I can save the world by sacrificing myself”Delusion of persecution: “The FBI and CIA are out ot get me and have bugged all of my electronic devices”



SCHIZOPHRENIA: 2 TYPES OF SYMPTOMS

• Negative: • Avolition: inability to persist in daily activities (unable to

groom, shower, etc).• Alogia: Relative absence of speech (brief replies, with

little content; for example, one word answers).• Anhedonia: Loss of pleasure / interest• Affective flattening: show almost no emotion, even when

you’d expect strong emotional display.

• Disorganized: • Disorganized speech, thought process• Tangential thought process



SYMPTOMS OF SCHIZOPHRENIA

• Disordered thoughts• Thought disorder: lack of association between ideas and

events

• Loose associations, poverty of content, word salad

• Delusions: thoughts and beliefs the person believes to be true, while having no basis in reality

• Persecutory, grandiose, delusions of reference, delusions of thought control



SYMPTOMS OF SCHIZOPHRENIA (CONT.)

• Disordered perceptions: hallucinations• Perceiving sensations that others don’t

• Auditory hallucinations most common• Visual hallucinations

• Hallucinations may “tell” person to perform certain acts

• Disordered affect: distorted emotional expression• Blunted, flat affect• Inappropriate affect



EXPLAINING SCHIZOPHRENIA: THE BRAIN

• Neurotransmitters• Dopamine: reducing dopamine activity can help in

reducing positive symptoms• Glutamate: drugs that block can cause cognitive

impairments and negative symptoms• What is role of interaction?

• Brain abnormalities• Enlarged ventricles• Brain dysfunction in temporal and frontal lobes



SCHIZOPHRENIA: THE ROLE OF FAMILY AND ENVIRONMENT

• Two psychological factors involved in onset and course of disorder

• Family support• Quality of family communication and interaction; may

encourage/discourage development of disorder, also trigger future episodes

• Exposure to chronic stress• High-risk, low-income lifestyle may increase susceptibility



DISSOCIATIVE DISORDERS: FLIGHT OR MULTIPLE PERSONALITIES

• Relatively rare disorders• Dissociation: to break or pull apart

• Mild dissociative experiences are common

• Extreme dissociation typically linked to severe stress or emotional trauma

• Dissociative fugue• Episodes of amnesia with inability to recall or confusion

about identity; new identity may be established• Return to original identity causes distress



DISSOCIATIVE DISORDERS: FLIGHT OR MULTIPLE PERSONALITIES (CONT.)

• Dissociative identity disorder• Existence of 2 or more separate personalities in same

individual• Separate personalities (alters) may not be known to

“host” personality• Frequent blackouts or amnesia episodes common

• Chronic childhood physical/sexual abuse may be causal factor

• Validity of DID? May be extreme PTSD



SOMATOFORM DISORDER: “DOCTOR, I’M SURE I’M SICK”

• Somatoform disorders• Physical complaints for which no physical causes can be

found

• Hypochondriasis: person believes there is a serious medical disease, despite no confirmation by medical tests• Often have family history of depression or anxiety• May be related to panic disorder and OCD



PERSONALITY DISORDERS: MALADAPTIVE

PATTERNS OF BEHAVIOR

• Coded on Axis II of DSM-IV-TR• Life-long or long-standing patterns of

malfunctioning• Behavior is maladaptive to self or others• Behavior is seen across many situations, for long periods

of time

• Often don’t see there’s a problem; seldom seek treatment on own



ANTISOCIAL PERSONALITY DISORDER: CHARMING AND DANGEROUS

• Impulsive, disregard rights of others without remorse or guilt; psychopath or sociopath• Correlated with criminal behavior/ incarceration• May be charming and manipulative

• One of most common personality disorders; many more men than women

• Biological factors: genetic, lower serotonin, higher testosterone

• Psychological/social: conflict-filled childhood



BORDERLINE PERSONALITY DISORDER: LIVING ON YOUR FAULT LINE

• Instability in moods, interpersonal relationships, self-image, and behavior• Disrupts relationships, careers, and identity• Higher risk of self-injury and suicide

• Often diagnosed with other disorders• 2%; more in young women• Biological: low serotonin, abnormal brain

functioning• Psychological/social; family history of

abuse or neglect



HOW GOOD IS THE DSM MODEL?

• Reliability (consistency) and validity (accuracy) good for Axis I, but not Axis II

• Standard criteria do not necessarily mean accurate diagnoses will be made• Judgments of clinicians can be skewed by gender, race,

or culture, consciously and unconsciously

• Some feel the DSM model of labeling may lead to negative effects - self-fulfilling prophecy

CHAPTER 14: WHAT ARE PSYCHOLOGICAL DISORDERS AND HOW CAN WE UNDERSTAND THEM?

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Transcript of CHAPTER 14: WHAT ARE PSYCHOLOGICAL DISORDERS AND HOW CAN WE UNDERSTAND THEM?