Chapter 14: Psychological Disorders

Psychopathology

• Maladaptive, disruptive, or uncomfortable patterns of thinking, feeling, and behaving – Affect individuals– Affect the people with whom they interact

Sorrowing Old Man ('At Eternity's Gate') Vincent van Gogh, 1890

Abnormal Behavior

• What is abnormal?– Deviant– Dysfunction– Distress

• A continuum of normal/abnormal

A Practical Approach forDefining Abnormal Behavior

• Content of the behavior• Sociocultural context in

which it occurs• Consequences for that

person and others

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Biopsychosocial ApproachExplaining Psychological Disorders

• Most common viewpoint today• Mental disorders are the result of combination

& interaction among– Biological factors– Psychological factors– Sociocultural factors

The Medical Model(aka Neurobiological Model)

• Disorders stem primarily from an underlying illness that can be diagnosed, treated, and cured

• Biological factors cause mental illness– Physical illnesses– Disruptions or imbalances in bodily

processes– Genetic influences

The Psychological Model

• Emphasizes psychological factors:– Wants– Needs– Emotions– Learning experiences– Attachment history– World view Ψ

Multiple Approaches of The Psychological Model:

• Sigmund Freud’s psychodynamic explanation:– Unresolved, mostly unconscious conflicts between inborn

impulses and the limits placed on those impulses by society

• Social-cognitive (social learning) explanation:– Interaction of past learning and current situations– Emphasizes the roles of learned expectations, schemas,

and other mental processes

• Humanistic psychology explanation:– Natural tendency toward healthy growth is blocked and

perceptions of reality become distorted

The Sociocultural Perspective:Effects of Sociocultural Factors

• Create differing stressors, social roles, opportunities, experiences, and avenues of expression for different groups of people

• Help shape the disorders and symptoms to which certain categories of people are prone

• Affect responses to treatment

The Sociocultural Perspective: Culture-General Disorders

• Culture can influenced symptoms of disorders that appear virtually everywhere in the world

• e.g., Depression– Western cultures, emotional/physical

components viewed separately, so symptoms appear as despair/distress

– Asian cultures, emotional/physical components seen as one, so symptoms may appear as stomach/back pain

The Sociocultural Perspective: Culture-Specific Disorders

• Ataques de nervios (attacks of nerves) among Puerto Rican, Guatemalan, Mexican, and Dominican women

• Kyol goeu among Khmer refugees• Koro among Southeast Asian, southern

Chinese, and Malaysian men• Anorexia nervosa among North American &

European young women

The Diathesis-Stress Model:An Integrative Explanation

• Biological, psychological, and sociocultural factors can predispose us toward a disorder

• A certain amount of stress is needed to trigger that disorder – If major stressors don’t occur—or if the

person has adequate coping skills—symptoms may never appear, or may be relatively mild

Perspectives on Diagnosis: José

Consider the following case:• José is a 55-year-old electronics technician, a

healthy and vigorous father of two adult children.

• He was forced to take medical leave because of a series of sudden panic attacks in which he experienced dizziness, heart palpitations, sweating, and a sense of impending death.

• The attacks also kept him from his favorite pastime, scuba diving.

• He has been able to maintain a part-time computer business out of his home.

Diagnosing José

How would these diagnosticians diagnose José?

• Medical (neurobiological) • Psychodynamic• Social-cognitive• Humanistic• Sociocultural• Diathesis-stress

Diagnosing José

• Medical (neurobiological): José may have organic disorders (e.g., genetic tendency toward anxiety, brain tumor, endocrine dysfunction, neurotransmitter imbalance).

• Psychodynamic: José has unconscious conflicts and desires. Instinctual impulses are breaking through his ego defenses into consciousness, causing panic.

Diagnosing José

• Social-cognitive: José interprets physical stress symptoms as signs of serious illness or impending death. Panic is rewarded by reduction in work stress when he stays home.

• Humanistic: José fails to recognize his genuine feelings about work and his place in life, and he fears expressing himself.

Diagnosing José

• Sociocultural: A culturally based belief that “a man should not show weakness” amplifies the intensity of stress reactions.

• Diathesis-stress: José has a biological (possibly genetic) predisposition to be overly responsive to stressors. The stress of work and extra activity exceeds his capacity to cope and triggers panic as a stress response.

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Psychodiagnosis:Classifying Psychological Disorders

• Published by APA• Diagnostic and Statistical Manual of

Mental Disorders, 4th ed. (DSM-4 or DSM-IV-TR)

• Reasons for classification:– Determine the nature of

a problem– Choose the most

appropriate method of treatment

– Study the causes of mental disorders

DSM-IV Classification SystemFive Axes

• Axis I: Diagnosed mental disorder• Axis II: Personality disorders/

intellectual disability• Axis III: Relevant medical conditions• Axis IV: Psychosocial and environmental

problems• Axis V: Current level of psychological, social,

and occupational functioning - Global Assessment of Functioning(GAF) 1-100 rating scale (100=good)

Global Assessment of Functioning(GAF)

100 – Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, no symptoms, etc.

60 - Moderate symptoms or moderate impairment in functioning (conflicts with coworkers, some panic attacks)

20 - Some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene or gross impairment in communication (suicide, violent, smears feces, mute, etc.)

Problems with the Diagnostic System

• Mixed disorders are common• Same symptoms seen in different disorders• Subjective nature of criteria judgments• Possibility of bias in diagnosis• Insufficient attention to sociocultural variables• Labeling can be dehumanizing

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Example #1

Axis I: Major Depressive Disorder Alcohol Abuse

Axis II: Dependent Personality DisorderAxis III: NoneAxis IV: UnemploymentAxis V: GAF = 35 (on admission)

GAF = 57 (at discharge)

What does this tell us about this person?What does this not tell us about this person?

Axis I Clinical Syndromes

• Anxiety Disorders• Somatoform Disorders• Dissociative Disorders• Mood Disorders• Schizophrenic Disorders

Clinical Syndromes: Anxiety Disorders

• Generalized anxiety disorder– “free-floating anxiety”

• Phobic disorder– Specific focus of fear

• Panic disorder • Obsessive compulsive disorder (OCD)• Posttraumatic Stress Disorder (PTSD)

Obsessive-Compulsive Disorder(OCD)

• Obsessions—persistent, upsetting, unwanted thoughts• Compulsions—ritualistic, repetitive behaviors

– e.g., checking locks; repeating words, images, or numbers; counting things; or arranging objects “just so”

• Prevalence:– Affects about 1% of the population in any given year– Equally common in males and females

• Many sufferers know that their thoughts and actions are irrational, but are severely upset or anxious if they try to interrupt obsessions or stop compulsive behaviors

Jump to Linkages

Etiology of Anxiety Disorders

• Biological factors– Genetic predisposition, anxiety sensitivity– Neurotransmitter system abnormalities

• Conditioning and learning– Acquired through classical conditioning or

observational learning– Maintained through operant conditioning

• Cognitive factors– Judgments of perceived threat,

• Personality– Neuroticism

• Stress—a precipitator

Clinical Syndromes: Somatoform Disorders

• Somatization Disorder• Conversion Disorder• Hypochondriasis

• Etiology of Somatoform Disorders– Some cases related to:

• Childhood experiences• Severe stressors as triggers• Cognitive factors

– Explained by diathesis-stress approach– Sociocultural factors affect manifestation

Somatoform Disorders: Conversion Disorder

• Apparent blindness, deafness, paralysis, or insensitivity to pain

• Appears in teens or early adulthood

• Tends to appear under severe stress

• Reduces stress by allowing avoidance of unpleasant or threatening situations

• Sufferer may show little concern

• Symptoms may be neurologically impossible or improbable– e.g., glove anesthesia

• People can actually see, hear, or move

• E.g. Glove anesthesia• Anesthesia stops at wrist• But hand and arm nerves

blend• If nerves were actually

impaired, part of the arm would also lose sensitivity

Somatoform Disorders: Hypochondriasis

• Strong, unjustified fear that one has a serious physical problem

• Hypochondriasis resembles an anxiety disorder—involves health concerns; includes elements of phobia, panic, and obsessive-compulsive disorder

• Sufferers make frequent doctor visits to report symptoms & request unnecessary treatment

• They may even become “experts” by endlessly searching health-related Web sites

Clinical Syndromes: Dissociative Disorders

• Dissociative Fugue (fugue reaction)– Sudden wandering and loss of memory or

confusion about personal identity– May adopt an entirely new identity

• Dissociative Amnesia– Sudden loss of memory about personal

information• Dissociative Identity Disorder (DID)

– Also called multiple personality disorderEtiology

• severe emotional trauma during childhood

Controversy

• Media creation?

Clinical Syndromes: Mood (Affective) Disorders

• Major depressive disorder– Dysthymic disorder

• Bipolar disorder– Cyclothymic disorder

• Etiology– Genetic vulnerability– Neurochemical factors– Cognitive factors– Interpersonal roots– Precipitating stress

Etiology of Mood Disorders• Genetics• Malfunctions in brain regions involved in mood• Neurotransmitter system imbalances• Malfunctioning of the endocrine system• Disruption of biological rhythms

– Seasonal affective disorder (SAD)

• Learned helplessness/hopelessness• Beck’s cognitive theory of depression (self-blame,

negativity, pessimistic)• Negative attributional style• Thinking style (ruminative vs distracting)• Stressors

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Clinical Syndromes: Schizophrenic Disorders

• Perceptual disorders (including hallucinations)• Emotional disturbances• Deterioration of adaptive behavior– Lack of motivation and poor social skills– Deteriorating personal hygiene– Inability to function on a daily basis• Delusions and irrational thought, inability to focus• Disorganized thought & language– Neologisms– Clang associations– Word salad

Disturbed thought lies at the core of schizophrenia; disturbed emotion lies at the core of mood disorders.

Categorizing Schizophrenia

– Paranoid – Catatonic – Disorganized – Undifferentiated • Alternate Categorization by Symptom types:– Positive symptoms

• e.g., disorganized thoughts, delusions, hallucinations

– Negative symptoms• e.g., absence of pleasure and motivation, lack

of emotional reactivity, social withdrawal, reduced speech

Etiology of Schizophrenia• Genetic vulnerability• Neurochemical factors• Structural abnormalities of the brain• Neurodevelopmental abnormalities• Expressed emotion• Precipitating stress

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l • Dysfunctional cognitive habits• Stress of urban living• Being an immigrant• Stressful family communication patterns• Family members’ negative attitudes

Personality Disorders

Etiology– Genetic predispositions, inadequate socialization

in dysfunctional families, observational learning

• Odd-eccentric cluster (cluster A)– Paranoid, schizoid, and schizotypal

• Dramatic-erratic cluster (cluster B)– Histrionic, narcissistic, borderline, and

antisocial• Anxious-fearful cluster (cluster C)

– Dependent, obsessive-compulsive, and avoidant

Psychological Disorders and the Law: Protecting the Accused

Protection for accused people who are:• Mentally incompetent to stand trial• Not guilty by reason of insanity

– M’Naghton rule: Mental illness prevents understanding one’s actions or knowing that the actions were wrong

– American Law Institute (ALI) rule: Mental illness disables the ability to resist the impulse to do wrong • Insanity Defense Reform Act eliminated ALI rule in

federal cases

Criticisms of the Insanity Defense

• Everyone should be held responsible and punished for their crimes

• Jurors must choose between conflicting, highly technical expert testimony about a defendant’s sanity at the time of a crime

• People with mental disorders are still capable of some rational decision making and of controlling some aspects of their behavior

Can Criminals Get Away with Murder?

• Rarely, if ever• The insanity plea is used in fewer than 1 of

200 felony cases in the United States• Insanity plea only successful in 2 of 2000

tries – Defendants found not guilty by reason of

insanity are usually hospitalized 2 to 9 times longer than the time they would have spent in prison if convicted

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Psychological Disorders & the Law

• Involuntary commitment– danger to self– danger to others– in need of treatment

Chapter 14: Psychological Disorders