Chapter 14Psychological Disorders

©2013 W. W. Norton & Company, Inc.

Gazzaniga • Heatherton • Halpern

FOURTH EDITION

Psychological Science

14.1 How Are Psychological Disorders Conceptualized and Classified?

• Describe the multiaxial classification system of the Diagnostic and Statistical Manual of Mental Disorders.

• Identify assessment methods for psychological disorders.

• Describe the diathesis-stress model.

• Identify biological, psychological, and cognitive-behavioral causes of psychological disorders.

• Discuss sex differences and cultural differences in psychological disorders.

How Are Psychological Disorders Conceptualized and Classified?

• People have long struggled with how best to understand psychopathology

• Earliest views of psychopathology explained apparent “madness” as resulting from possession by demons or evil spirits

• During the last 200 years, recognition has grown that psychopathology reflects dysfunction of the body, particularly of the brain

Psychopathology Is Different from Everyday Problems

• Psychological disorders are common and account for the greatest proportion of disability in developed countries (Centers for Disease Control and Prevention, 2011)

• Mental disorders range in severity and there are enormous sex differences in psychopathology

• Drawing the line between a normal emotional experience and a mental disorder can be difficult

• When a psychological problem disrupts a person’s life and causes significant distress over a long period, the problem is considered a disorder rather than the normal low points of everyday life

Psychological Disorders Are Maladaptive

• How do you know if someone has a psychological disorder?

• Many behaviors considered normal in one setting may be considered deviant in other settings

• In determining whether behavior represents psychopathology, it is important to consider certain criteria: – Does the person act in a way that deviates from cultural norms for

acceptable behavior? – Is the behavior maladaptive? – Is the behavior self-destructive?– Does the behavior cause discomfort and concern to others, thus

impairing a person’s social relationships?

Psychological Disorders Are Classified into Categories

• 1800s: Psychiatrist Emil Kraepelin identified mental disorders on the basis of groups of symptoms that occur together

• In 1952, the American Psychiatric Association published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)

• Disorders are described in terms of observable symptoms; patients must meet specific criteria to receive a particular diagnosis

• Multiaxial system: assessment along five axes that describe important mental health factors

• Categorical versus dimensional approach

Psychological Disorders Must Be Assessed

• Determining whether a person has a mental disorder is not as straightforward as most medical diagnoses

• Assessment: examination of a person’s mental state to diagnose possible psychological disorders; typically involves a mental status exam or clinical interview

• The primary goal of assessment is to make a diagnosis so that appropriate treatment can be provided. The course and probable outcome, or prognosis, will depend on the particular mental disorder that is diagnosed.

• Assessment does not stop with initial diagnosis but rather is ongoing

Structured Versus Unstructured Interviews

• Since the beginning of modern psychology most interviews have been unstructured– No two unstructured interviews are likely to elicit identical

information from the same patient; unstructured interviews are overly dependent on the interviewer’s skills

• In structured interviews, clinicians ask standardized questions in the same order each time. Patients’ answers are coded according to a predetermined formula and the diagnosis is based on the specific patterns of responses.– The most commonly used structured interview is the

Structured Clinical Interview for DSM (SCID), through which diagnoses are made according to DSM criteria

Observation and Types of Testing

• A psychological assessor often can gain valuable information simply by observing the client’s behavior

• Thousands of psychological tests are available to clinicians

• Some are for specific mental disorders, such as the widely used Beck Depression Inventory

• The most widely used questionnaire for psychological assessment is the Minnesota Multiphasic Personality Inventory (MMPI)

• Another assessment method is neuropsychological testing

Evidence-Based Assessment• A key question is whether psychological assessments

provide information that is useful for treating psychological disorders– Popular methods of assessment, such as projective tests,

have not been shown to be helpful in predicting the kinds of treatments that are useful

– Individual clinicians often choose assessment procedures based on their subjective beliefs and training rather than based on scientific studies

• Evidence-based assessment is an approach to clinical evaluation in which research guides evaluation– Example: Evidence-based assessment approach would

indicate that people found to be depressed should also be assessed for co-morbid conditions such as substance abuse

Psychological Disorders Have Many Causes

• Biological and environmental factors are thought to play important developmental roles in psychopathology

• Diathesis-stress model: a diagnostic model that proposes that a disorder may develop when an underlying vulnerability is coupled with a precipitating event

Biological Factors • The biological perspective focuses on how physiological factors

contribute to psychological disorders:– Genetics– Some disorders may arise from prenatal problems, such as malnutrition,

exposure to toxins, and maternal illness– During childhood and adolescence, environmental toxins and

malnutrition can put an individual at risk for mental disorders

• Biological factors may contribute to mental disorders because of their effects on the central nervous system

• Functional neuroimaging is currently at the forefront of research into the neurological components of mental disorders

• PET and fMRI have revealed brain regions that may function differently in individuals with mental disorders

Psychological Factors• Psychological factors play an important role in the

expression and treatment of mental disorders

• Family systems model: An individual’s behavior must be considered within a social context, particularly within the family; problems that arise within an individual are manifestations of problems within the family

• Sociocultural model: Psychopathology is the result of the interaction between individuals and their cultures; differences in occurrence of disorders are due to differences in lifestyles, in expectations, and in opportunities between classes

Cognitive-Behavioral Factors• The central principle of the cognitive-behavioral

approach is that abnormal behavior is learned

• Proponents of strict behaviorism argue that mental disorders result from classical and operant conditioning

• According to the revised cognitive-behavioral perspective, thoughts and beliefs are types of behavior and can be studied empirically

• The premise of this approach is that thoughts can become distorted and produce maladaptive behaviors and maladaptive emotions

Sex Differences in Mental Disorders

• Some mental disorders, such as schizophrenia and bipolar disorder, are equally likely in the sexes, whereas other disorders vary between the sexes (e.g., anorexia, depression)

• One way of categorizing mental disorders is to divide them into two major groups: – Internalizing disorders: characterized by negative emotions (e.g.,

major depression, generalized anxiety disorder, panic disorder)– Externalizing disorders: characterized by disinhibition (e.g., alcoholism,

conduct disorders, antisocial behavior)

• In general, the disorders associated with internalizing are more prevalent in females, and those associated with externalizing are more prevalent in males (Krueger & Markon, 2006)

“Dying to Be Thin” Many Americans have made New Year’s resolutions to eat less, exercise more, and lose weight. But people with anorexia nervosa do these things to such an extreme that they endanger their health—or even their lives. As this ScienCentral News video reports, doctors believe the reason may be genetic.

“Virtual Alcohol Control” Scientists are using virtual reality to help alcoholics cope with situations that might get them in trouble. This ScienCentral News video explains.

Culture and Mental Disorders• Most mental disorders show both universal and culture-specific

symptoms– Disorders with a strong biological component will tend to be more similar

across cultures.– A disorder heavily influenced by learning, context, or both is more likely

to differ across cultures (e.g., depression is a major mental health problem around the world, but the manifestations of depression differ by culture)

• The DSM includes a section on culture-bound syndromes that occur mainly in specific cultures or regions

• Clinicians and researchers need to be sensitive to cultural issues to avoid making mistakes in their diagnoses and treatments

14.2 Can Anxiety Be the Root of Seemingly Different Disorders?

• Distinguish between anxiety disorders.

• Identify cognitive, situational, and biological factors that contribute to anxiety disorders.

Can Anxiety Be the Root of Seemingly Different Disorders?

• Anxiety itself is normal and even useful; it can prepare us for upcoming events and motivate us to learn new ways of coping with life’s challenges

• Anxiety can become debilitating and can interfere with every aspect of life

• Anxiety disorders are characterized by excessive anxiety in the absence of true danger

There Are Different Types of Anxiety Disorders

• More than 1 in 4 Americans will have some type of anxiety disorder during their lifetimes (Kessler & Wang, 2008)

• Different anxiety disorders share some emotional, cognitive, somatic, and motor symptoms, even though the behavioral manifestations of these disorders are quite different (Barlow, 2002)

• Because chronic stress can damage the body, including the brain, it is very important to identify and effectively treat disorders that involve chronic anxiety

Phobic Disorder• A phobia is a fear of a specific object or situation

• Specific phobias affect about 1 in 8 people and involve particular objects and situations

• Social phobia is a fear of being negatively evaluated by others; includes fears of public speaking, speaking up in class, meeting new people, and eating in front of others

• It is one of the earliest forms of anxiety disorder to develop, often beginning around age 13

• The more social fears a person has, the more likely he or she is to develop other disorders, particularly depression and substance abuse problems

Generalized Anxiety Disorder• Generalized anxiety disorder (GAD): a diffuse state

of constant anxiety not associated with any specific object or event

• People with this disorder are constantly anxious and worry incessantly about even minor matters

• Hypervigilance results in distractibility, fatigue, irritability, and sleep problems, as well as headaches, restlessness, light-headedness, muscle pain

• Just under 6 percent of the United States population is affected by this disorder at some point in their lives; women are diagnosed more often than men

“Sleep and Brain Chemistry” Sleep disorders affect not only the nighttime slumber and daytime behavior of millions of Americans, but also their overall health. As this ScienCentral News video reports, some neuroscientists say sleep disorders could be associated with chemical imbalances in the brain.

Post Traumatic Stress Disorder (PTSD)

• Posttraumatic stress disorder (PTSD): involves frequent nightmares, intrusive thoughts, and flashbacks related to an earlier trauma– At Northern Illinois University in 2008 a lone gunman killed five people

and wounded 21. Among a sample of female students, those with certain genetic markers related to serotonin functioning were much more likely to show PTSD symptoms in the weeks after the shooting (Mercer et al., 2011).

– Those with PTSD often have chronic tension, anxiety, and health problems, and they may experience memory and attention problems in their daily lives. PTSD involves an unusual problem in memory—the inability to forget.

• The lifetime prevalence of PTSD is around 7 percent; women are more likely to develop the disorder

Panic Disorder• Panic disorder: consists of sudden, overwhelming

attacks of terror– Panic attacks typically last for several minutes. Victims sweat,

tremble, feel their hearts racing; experience shortness of breath, chest pain; feel dizziness and light-headedness with numbness and tingling in their hands and feet.

– People feel that they are going crazy or that they are dying, and those who suffer from persistent panic attacks attempt suicide much more frequently than those in the general population (Fawcett, 1992; Korn et al., 1992; Noyes, 1991).

• Affects an estimated 3 percent of the population; women are twice as likely to be diagnosed as men (Kessler & Wang, 2008)

• Clear link between panic attacks and agoraphobia

Obsessive-Compulsive Disorder• Obsessive-compulsive disorder (OCD): characterized

by frequent intrusive thoughts and compulsive action

• Obsessions: recurrent, intrusive, and unwanted thoughts or ideas or mental images; they often include fear of contamination, of accidents, or of one’s own aggression.

• Compulsions: particular acts that the OCD patient feels driven to perform over and over again

• Generally begins in early adulthood, affecting 1 percent to 2 percent of the population; more common among women

Anxiety Disorders Have Cognitive, Situational,

and Biological Components

• Anxiety disorders share some causal factors (Barlow, 2002)

• The factors can be divided into three groups: cognitive, situational, and biological

Cognitive Components

• When presented with ambiguous or neutral situations, anxious individuals tend to perceive them as threatening, whereas nonanxious individuals assume they are nonthreatening

• Anxious individuals also focus excessive attention on perceived threats, recall threatening events more easily than nonthreatening events, and exaggerate their perceived magnitude and frequency

Situational Components

• Through social learning, a person could develop a fear of flying by observing another person’s fearful reaction to the closing of cabin doors

• Once learned, a fear might then generalize to other enclosed spaces, resulting in claustrophobia

Biological Components• Children who have an inhibited temperamental style are

usually shy and tend to avoid unfamiliar people and novel objects

• Inhibited children are more likely to develop anxiety disorders later in life– Adults received brain scans while viewing pictures of familiar faces

and of novel faces– One group of these adults had been categorized as inhibited before

age 2; the other group had been categorized as uninhibited before age 2

– Compared with the uninhibited group, the inhibited group showed greater activation of the amygdala while viewing the novel faces

– Study suggests that some aspects of childhood temperament are preserved in the adult brain (Schwartz, Wright, Shin, Kagan, & Rauch, 2003)

“Panic Disorder” Patients suffering from panic attacks brought on by hard-to define fear may soon have better treatment options. As this ScienCentral News video reports, researchers are a step closer to understanding how this disorder alters the brain’s biology.

Causes of Obsessive-Compulsive Disorder

• Biological and cognitive-behavioral factors interact to produce the symptoms of OCD:– Anxiety is paired to a specific event through classical conditioning;

the person then engages in behavior to reduce the anxiety and the behavior is reinforced through operant conditioning

– OCD runs in families. OCD-related genes control glutamate, the major excitatory neurotransmitter in the brain causing increased neural firing (Pauls, 2008)

– The caudate, a structure involved in suppressing impulses, is smaller and has structural abnormalities in people with OCD (Baxter, 2000)

– OCD can be triggered by environmental factors; a streptococcal infection apparently can cause a severe form of OCD in some young children

“Hoarding” Research suggests that compulsive hoarders have distinct brain abnormalities. This ScienCentral News video has more.

14.3 Are Mood Disorders Extreme Manifestations of Normal Moods?

• Distinguish between major depression and bipolar disorder.

• Discuss cultural and sex differences in depression.

Are Mood Disorders Extreme Manifestations of Normal Moods?

• Moods color every aspect of our lives

• When we are happy we are filled with boundless energy; when sad, we view the world in a decidedly less rosy light

• Some people experience mood fluctuations that disrupt their ability to work, learn, and play

There Are Two Categories of Mood Disorders

• Mood/affective disorders are classified into two categories: – Depressive disorders feature persistent and

pervasive feelings of sadness– Bipolar disorders involve radical fluctuations in

mood

Depressive Disorders • Major depression: a disorder characterized by severe negative

moods or a lack of interest in normally pleasurable activities – Affects about 6 percent to 7 percent of Americans in a given 12-month

period– Sufferers are highly impaired by the condition and it tends to persist over

several months, often lasting for years; affects women nearly twice as much as men

• Dysthymia: a form of depression that is not severe enough to be diagnosed as major depression– Affects approximately 2 percent to 3 percent of the population– Lasts from 2 to 20 or more years, although the typical duration is about 5

to 10 years– Because the depressed mood is so long-lasting, some psychologists

consider it a personality disorder

The Role of Culture and Gender in Depressive Disorders

• In its most severe form, depression is the leading cause of disability in the United States and also worldwide, and is the leading risk factor for suicide

• The stigma associated with this disorder has especially dire consequences in developing countries:– Suicide is the leading cause of death among young women in India

and China (Khan, 2005)– The highest rates of depression are found in women in developing

countries, with especially high rates reported for women in rural Pakistan

• Women respond to stressful events by internalizing their feelings, which leads to depression and anxiety, whereas men externalize with alcohol, drugs, and violence

“Addicted Brain Changes” New research is overturning previous thought about how addiction permanently changes the brain. Researchers hope these new insights may lead to new ways of treating addicts.

Bipolar Disorder• Bipolar disorder: a mood disorder characterized by

alternating periods of depression and mania– Manic episodes: characterized by elevated mood,

increased activity, diminished need for sleep, grandiose ideas, racing thoughts, and extreme distractibility, excessive involvement in pleasurable but foolish activities

– Hypomanic episodes: less extreme mood elevations characterized by heightened creativity and productivity

• Lifetime prevalence for any type is estimated at around 4 percent; equally prevalent in women and men and emerges most commonly during late adolescence or early adulthood

A Case Study of Bipolar Disorder

• Psychology professor Kay Redfield Jamison acknowledged her own struggles with bipolar disorder in her award-winning memoir, An Unquiet Mind (1995)

• Her work helped shape the study of the disorder, and her textbook, coauthored with Frederick Goodwin, is considered the standard for the field (Goodwin & Jamison, 1990)

Mood Disorders Have Biological, Situational, and Cognitive Components

• Mood disorders can be devastating

• Because of their profound effects, much research has focused on understanding what causes mood disorders and in developing treatments

Biological Components• Studies of twins, of families, and of adoptions support the

notion that depression has a genetic component– Concordance rates between identical twins are generally around

two to three times higher than rates between fraternal twins– Evidence suggests that major depression involves a deficiency of

one or more monoamines. Medications that increase the availability of norepinephrine and serotonin may help alleviate depression

– Biological rhythms and damage to the left prefrontal cortex have been implicated in depression

• Concordance for bipolar disorder in identical twins is more than 70 percent

• In bipolar disorder, successive generations have more-severe disorders and earlier ages of onset

Situational Components

• A number of studies have implicated life stressors in many cases of depression (Hammen, 2005).

• Depression is especially likely in the face of multiple negative events. Patients with depression often have experienced negative life events during the year before the onset of their depression.

• How an individual reacts to stress, however, can be influenced by interpersonal relationships, which play an extremely important role in depression (Joiner, Coyne, & Blalock, 1999).

Cognitive Components• Aaron Beck has hypothesized that people with

depression think negatively about themselves, about their situations, and about the future

• Beck refers to these negative thoughts about self, situation, and the future as the cognitive triad

• A second cognitive model of depression is based on learned helplessness, where people come to see themselves as unable to have any effect on events in their lives

• The attributions they make for negative events are stable and global rather than situational, temporary and specific, which leads them to feel hopeless about making positive changes

14.4 What Are Dissociative Disorders?

• Describe dissociative amnesia, dissociative fugue, and dissociative identity disorder.

• Identify possible causes of dissociative identity disorder.

• Discuss the current controversy regarding dissociative identity disorder.

What Are Dissociative Disorders?

• Our thoughts and experiences can become dissociated, or split, from the external world

• Dissociative disorders involve disruptions of identity, of memory, or of conscious awareness

• These disorders are believed to result from extreme stress

Dissociative Amnesia and Fugue Involve Loss of Memory

• Dissociative amnesia: A person forgets that an event happened or loses awareness of a substantial block of time

• Dissociative fugue: The rarest and most extreme form of dissociative amnesia that involves a loss of identity; involves travel to another location and sometimes the assumption of a new identity

Dissociative Identity Disorder is a Controversial Diagnosis

• Dissociative identity disorder (DID): formerly called multiple personality disorder; consists of the occurrence of two or more distinct identities in the same individual– Most people with DID are women who report being severely abused

as children– Children cope with abuse by pretending it is happening to someone

else. Over time, this dissociated state takes on its own identity– The separate identities usually differ substantially, such as in gender

identity, sexual orientation, age, language spoken, interests, physiological profiles, and patterns of brain activation

• Many researchers remain skeptical about whether DID is a genuine mental disorder or whether it exists at all (Kihlstrom, 2005)

14.5 What is Schizophrenia?

• Distinguish between positive and negative symptoms of schizophrenia.

• Identify biological and environmental factors that contribute to schizophrenia.

What is Schizophrenia?

• Schizophrenia: a psychological disorder characterized by a split between thought and emotion; involves alterations in thoughts, in perceptions, or in consciousness

• It is a psychotic disorder, the essence of which is a disconnection from reality referred to as psychosis

• Current estimates state between 0.5 percent and 1.0 percent of the population has schizophrenia; effects women and men similarly

• The disorder has distinct subtypes

Schizophrenia Has Positive and Negative Symptoms

• Positive symptoms: excesses in functioning, such as delusions, hallucinations, and disorganized speech or behavior

• Negative symptoms: deficits in functioning, such as apathy, lack of emotion, and slowed speech and movement

Positive Symptoms of Schizophrenia• Common positive (i.e., excessive) symptoms associated

with schizophrenia include: – Delusions: false beliefs based on incorrect inferences about

reality– Hallucinations: false sensory perceptions that are

experienced without an external source. Frequently auditory, they can also be visual, olfactory, or somatosensory.

– Loosening of associations: Individual shifts between seemingly unrelated topics as he or she speaks, making it difficult or impossible for a listener to follow the speaker’s train of thought

– Disorganized behavior: Person might walk along muttering to himself, alternate between anger and laughter

Negative Symptoms of Schizophrenia• A number of behavioral deficits associated with schizophrenia

result in patients’ becoming isolated and withdrawn:– People with schizophrenia often avoid eye contact and seem

apathetic– They do not express emotion– Speech is slowed and they use a monotonous tone of voice, long

pauses before answering, failure to respond to a question, inability to complete an utterance after initiating it

– Movements may be slowed and the overall amount of movement reduced, with little initiation of behavior and no interest in social participation

• Negative symptoms are more resistant to medications. Researchers have speculated that positive and negative symptoms have different organic causes

Schizophrenia is Primarily a Brain Disorder

• Genetics plays a role in the development of the disorder– If one identical twin develops schizophrenia, the likelihood of the

other twin’s succumbing is almost 50 percent; 14 percent if the twins are fraternal

– Genetic component of schizophrenia represents a predisposition rather than destiny

• Ventricles in the brain are enlarged and there are abnormalities throughout many brain regions

• Schizophrenia may result from abnormality in neurotransmitters (e.g., dopamine)

• There is evidence that some neurological signs of schizophrenia can be observed long before the disorder is diagnosed

Environmental Factors Influence Schizophrenia

• Environmental stress seems to contribute to the development of schizophrenia:– Being born or raised in an urban area approximately doubles

the risk of developing schizophrenia later in life (Torrey, 1999)– Speculation that a schizovirus exists– People with schizophrenia are more likely to have been born

during late winter and early spring– Mothers of children born in late winter and early spring were in

their second trimester of pregnancy during flu season; mothers of people with schizophrenia are more likely than other mothers to have contracted influenza during this critical period

– Growing up in a dysfunctional family may increase the risk of developing schizophrenia for those who are genetically at risk

“Schizophrenia Gene Puzzle” Scientists are trying to decode the genetic causes of schizophrenia. But as this ScienCentral News video explains, new research suggests that nearly every person with the illness has a different genetic defect.

14.6 Are Personality Disorders Truly Mental Disorders?

• Distinguish between personality disorders.

• Identify the symptoms and possible causes of borderline personality disorder and antisocial personality disorder.

Are Personality Disorders Truly Mental Disorders?

• Although individuals change somewhat over time, the ways they interact with the world and cope with events are fairly fixed by the end of adolescence

• Some people interact with the world in maladaptive and inflexible ways

• When this style of interaction is long-lasting and causes problems in work and in social situations, it becomes a personality disorder

• People with personality disorders consistently behave in maladaptive ways, show a more extreme level of maladaptive behavior, and experience more personal distress and more problems as a result of their behavior

Personality Disorders Are Maladaptive Ways of Relating to the World

• Personality disorders are classified on Axis II in the DSM, along with mental retardation

• Personality disorders and mental retardation are grouped together because they usually last throughout the life span, with no expectation of significant change

• Personality disorders generally are divided into three groups: – Odd or Eccentric Behavior: paranoid, schizoid, and schizotypal– Anxious or Fearful Behavior: avoidant, dependent, and obsessive-

compulsive– Dramatic, Emotional, or Erratic Behavior: histrionic, narcissistic,

borderline, and antisocial

Borderline Personality Disorder Is Associated with Poor Self-Control

• Borderline personality disorder: characterized by disturbances in identity, in affect, and in impulse control

• Officially recognized as a diagnosis in 1980, the term borderline was initially used because these patients were considered on the border between normal and psychotic (Knight, 1953)

• Characterized by problems with identity, affective disturbances, impulsivity, sleep abnormalities

• Approximately 1 percent to 2 percent of adults meet the criteria for borderline personality disorder; more than twice as common in women as in men

• Possible causes: low serotonin, trauma or abuse

Antisocial Personality Disorder Is Associated with a Lack of Empathy

• In 1980, the DSM dropped the former label psychopath and adopted the term antisocial personality disorder (APD)

• Antisocial personality disorder (APD): a personality disorder marked by a lack of empathy and remorse

• APD is the catchall diagnosis for individuals who behave in socially undesirable ways, seeking immediate gratification of wants and needs without any thought of others

Assessment and Consequences • APD estimated at between 1 percent and 4 percent of the

population; more common in men than in women– Most apparent in late adolescence and early adulthood, it

generally improves around age 40. Cannot be diagnosed before age 18, but the person must have displayed antisocial conduct before age 15.

– Must meet criteria such as repeatedly performing illegal acts, repeatedly lying or using aliases, and showing reckless disregard for one’s own safety or the safety of others.

• Perhaps as much as 50 percent of the prison population meets the criteria for APD

• Affected individuals are often charming and intelligent, lacking remorse, willing to lie or cheat, and lacking empathy. Some with APD manage to be successful professionals

The Etiology of Antisocial Personality Disorder

• Genetic and environmental factors appear to play roles in antisocial personality disorder

• Individuals do not seem to feel fear or anxiety (Lykken, 1995)

• Electroencephalogram (EEG) examinations show criminals who meet the criteria for antisocial personality disorder have slower alpha-wave activity (Raine, 1989)

• Pattern of reduced psychophysiological response in the face of punishment also occurs in adolescents at risk for developing psychopathy (Fung et al., 2005)

• Evidence of amygdala abnormalities

• Factors such as low socioeconomic status, dysfunctional families, childhood abuse, and malnutrition may also be important

14.7 Should Childhood Disorders Be Considered a Unique Category?

• Identify the symptoms and possible causes of autism.

• Identify the symptoms and possible causes of attention deficit hyperactivity disorder.

Should Childhood Disorders Be Considered a Unique Category?

• The current DSM has a category in Axis I called “disorders usually first diagnosed in infancy, childhood, or adolescence”

• Conditions such as autistic disorder and attention deficit hyperactivity disorder affect every aspect of a child’s life

• All of the disorders in this category should be considered within the context of normal childhood development

Autistic Disorder Involves Social Deficits

• Autistic disorder, or autism, is characterized by deficits in social interaction, by impaired communication, and by restricted interests– Approximately 3 to 6 children out of 1,000 show signs of autistic

disorder. Males with autism outnumber females with autism 3 to 1– The notion that autism is epidemic overstates reality. There are

several serious problems with studies that claim huge increases in cases of autism (Gernsbacher, Dawson, & Goldsmith, 2005)

• Autism varies in severity, from mild social impairments to severe social and intellectual impairments

• As a result, some psychologists prefer the term autism spectrum disorders, which covers the range of symptoms of autistic disorder

Core Symptoms of Autism

• Children with severe autism are seemingly unaware of others.– As babies, they do not smile at their caregivers, do not respond

to vocalizations, may actively reject physical contact with others, do not establish eye contact, and do not use their gazes to gain or direct the attention of those around them

• Deficits in communication are the second major cluster of behaviors characteristic of autism

• A third category of deficits includes restricted activities and interests

Autism is Primarily a Biological Disorder• It is now well established that autism is the result of

biological factors– There is evidence for a genetic component to autism:

Concordance rates in twins are estimated to be as high as 90 percent for identical twins and 10 percent for dizygotic twins

– Gene mutations may play a role. An international study compared 996 children with autism to 1,287 control children and found a number of rare gene abnormalities (Pinto et al., 2010)

– Prenatal and/or neonatal events may result in brain dysfunction– Exposure to antibodies in the womb may affect brain

development– The brains of people with autism have faulty wiring in a large

number of areas

“Autism and Older Dads” New research suggests that children of older fathers are at higher risk of having autism. This ScienCentral News video has more.

Attention Deficit Hyperactivity Disorder Is a Disruptive Impulse Control Disorder

• Attention deficit hyperactivity disorder (ADHD): characterized by restlessness, inattentiveness, and impulsivity– Children are often friendly and talkative, but they can have

trouble making and keeping friends because they miss subtle social cues and make unintentional social mistakes

– The line between normal and abnormal behavior is hard to draw – The best available evidence for children in the United States

suggests that 11 percent of boys and 4 percent of girls have the disorder (Bloom & Cohen, 2007)

The Etiology of ADHD• The causes of this disorder are unknown

• One of the difficulties in pinpointing the etiology is that ADHD is most likely a heterogeneous disorder

• What is known: – Children with ADHD may be more likely than other children

to come from disturbed families– ADHD clearly has a genetic component: Concordance is

estimated at 55 percent in identical twins and 32 percent in dizygotic twins

– Adults with ADHD in childhood had reduced metabolism in brain regions involved in the self-regulation of motor functions and of the attentional system

– Researchers have also demonstrated differences in the basal ganglia in the brains of some ADHD patients

ADHD Across the Life Span• Children generally are not given diagnoses of ADHD until

they enter structured settings in which they must conform to rules, get along with peers, and sit in their seats for long periods

• Longitudinal studies show that children do not outgrow ADHD by the time they enter adulthood (McGough & Barkley, 2004)

• Adults with ADHD symptoms, about 4 percent of the population (Kessler et al., 2006), may struggle academically and vocationally

• Many adults with ADHD learn how to adapt to their condition, such as by reducing distractions while they work