copyright © 2010 by worth publishers dsm-iv-tr the diagnostic and statistical manual iv-text...

Copyright © 2010 by Worth Publishers

DSM-IV-TR The Diagnostic and Statistical Manual IV-Text Revision was revised in 2000 with updated research. Since then, the lengthy process of assembling DSM-V has begun. It is a collaborative effort involving several mental health organizations, including the American Psychiatric Association and the World Health Organization. One key goal of DSM-V is to incorporate the multidisciplinary Research advances in mental health that have occurred worldwide in recent years. DSM-V is scheduled to be published in 2012 (Fink & Taylor, 2008).


Hollywood Versus Reality In The Dark Knight, the Joker takes the image of the insane killer to new heights. As a plot device, the deranged, evil killer on the loose is standard fare in television dramas like CSI and film thrillers like the Halloween and the Friday the 13th movies. Such media depictions foster the stereotype that people with a mental illness are evil, threatening, and prone to violence—an image that is not supported by psychological research.


Figure 14.2 NCS-R Prevalence and Severity of Mental Disorders Shown here are the most commonly reported mental disorders in the National Comorbidity Survey Replication (NCS-R). The 12-month prevalence is indicated by the percentage below each category. The color bars indicate the severity of symptoms reported in each category. Although anxiety disorders were most prevalent (18%), manyrespondents reported experiencing mild symptoms (green bar). But of the 10% of the respondents whoreported symptoms of a mood disorder, almost half indicated experiencing serious symptoms (red bar).Source: Kessler & others, 2005b, 2005c.


How Prevalent Are Psychological Disorders? Psychological disorders are far more common than most people think. According to the findings of the National Comorbidity Survey Replication (NCS-R), every year about one in four American adults experiences the symptoms of some type of psychological disorder. However,most people who experience such symptoms do not receive treatment (Wang &others, 2005).


Panic Attack! The rapidly escalating physical arousal of a panic attack results in a constellation of frightening symptoms: pounding heart, breathlessness, sweating, trembling, and choking sensations. In panic disorder, panic attacks are frequent and unpredictable, often seeming to happen for no apparent reason. How do psychologists explain the development of panic disorder?


Social Phobia About one out of eight adults in the United States have experienced social phobia at some point in their lives (Kessler& others, 2005a). Social phobia is far more debilitating than everyday shyness. People with social phobia are intensely fearful of being watched or judged by others. Even ordinary activities, such as eating with friends in a shopping mall food court, can cause unbearable anxiety.


A Half-Century of Psychological Pain The symptoms of posttraumatic stress disorder can apparently last a lifetime. More than 60 years after the close of World War II, thousands of veterans, now in their eighties, still suffer from nightmares, anxiety, and other PTSD symptoms (Lee & others,1995). Some experts estimate that as many as 200,000 World War II veterans may continue to suffer from the symptoms of post-traumatic stress disorder.


The Ravages of War: Child Soldiers An estimated quarter-million children serve as unwilling combatants in wars today, most of them kidnapped from their families and forced to serve as soldiers. Child soldiers not only suffer torture and violence, they are also often forced to commit atrocities against others. Not surprisingly, These children suffer from a very high rate of posttraumatic stress disorder (Bayer &others, 2007; Kohrt & others, 2008). One survey of former child soldiers in refugee camps in Uganda found that 97 percent of the children suffered from PTSD symptoms (see Dawson, 2007; Derluyn & others, 2004). Rehabilitation centers have been established throughout Uganda and the Democratic Republic of Congo, where many of these children live, but more assistance is desperately needed (Ursano & Shaw, 2007).


Figure 14.3 The Symptoms of Major Depression The experience of major depression can permeate every aspect of life. This figure shows some of the most common emotional, behavioral, cognitive, and physical symptoms of that disorder.


Major Depression and . . . Kurt Cobain As leader of the alternative rock band Nirvana, Kurt Cobain seemed to have everything: fame, artistic recognition, wealth, and adulation from both fans and music critics. But Cobain also had a history of troubling episodes of deep depression and had attempted suicide several times. Like other people gripped by depression, Cobain focused on the negative during his dark episodes. This negative outlook was sometimes reflected in his lyrics. Just before the release of In Utero, the group’s last album, Cobain pulled a song he had written titled “I Hate Myself and I Want to Die.” Not long after the release of that album, Cobain committed suicide by shooting himself in the head with a shotgun. In his suicide note, Cobain described himself as a “miserable, self-destructive death rocker.”


Major Depression and . . . Sheryl Crow Grammy award-winning singer Sheryl Crow has struggled with depression since she was a young child. Of her chronic depression, she has said “I grew up in the presence of melancholy, a feeling of loss… It is a shadow for me. It's part of who I am. It is constantly there. I just know how, at this point, to sort of manage it.”


Brain Activity During the Extremes of Bipolar Disorder These PET scans record the brain activity of an individual with bipolar disorder as he cycled rapidly from depression to mania and back to depression over a 10-day period. In the top and bottom PET scans, the blue and green colors clearly showthe sharp reduction in overall brain activity that coincided with the episodes of depression. In the Center PET scans, the bright red, orange, and yellow colors indicate high levels of activity in diverse brain regions during the intervening episodes of mania.Source: Lewis Baxter and Michael E. Phelps, UCLA School of Medicine.


Carrie Fisher and Bipolar DisorderBest known for her role as Princess Leiain the Star Wars movie trilogy, Carrie Fisher was first diagnosed with bipolar disorder when she was 24 years old. She struggled with drug addiction for several years before finally accepting her diagnosis. “Maybe I was taking drugs to keep the monster in the box,” Fisher (2001) speculates, referring to her bouts of uncontrollable mania. Today, Fisher takes lithium and other medications to maintain an even keel but still sometimes feels tempted to forgo her medications to “ride the white lightning again.” A successful actress in the 1980s, Fishertoday focuses on her writing. She has written novels and screenplays, and she works behind the scenes as a Hollywood script doctor. Other famous people with bipolar disorder include media mogul Ted Turner, actress Patty Duke, and rockmusicians Peter Gabriel and Axl Rose.


Creativity and Mood Disorders Mood Disorders occur more frequently among creative writers and artists than among the general population, leading Some researchers to propose a biochemical or genetic link between mood disorders and the artistic temperament (Jamison, 1993).Writer Mark Twain, novelist Ernest Hemingway, and poet Sylvia Plath all suffered from severe boutsof depression throughout their lives. Both Plath and Hemingway committed suicide, as did Hemingway’s father, brother, and sister. In 1996, Hemingway’s granddaughter, actress Margaux Hemingway, also committed suicide Just one day before the 35th anniversary Of her famous grandfather’s death.


Smoking Rates Compared to the Number of Lifetime Mental Disorder Diagnoses Source: Lasser & others (2000).


Nicotine’s Effects in the Brain After cigarette smokers were injected with up to two milligrams of nicotine, researchers used functional magnetic resonance imaging to track the brain areas activated, which included the nucleus accumbens, the amygdala, and the thalamus. Previous research has shown That these brain structures produce the reinforcing, mood-elevating properties of other abused drugs, including cocaine, amphetamines, and opiates (Stein & others, 1998).


An Ordinary Family Man: The Dangers of Antisocial Personality Disorder President of his church council, and a very active church member, Dennis Rader had been a Scout leader and worked for the Wichita,Kansas, animal control department. Married for 34 years, Rader had been very involved in the lives of his two children. But Rader was also the sadistic killer Who called himself “BTK,” which stood for “Bind, torture, kill.” In court, Rader shocked even seasoned police officers with his matter-of-fact, emotionless recital of the details of his ten murders. Like Rader,people with antisocial personality disorder wear a “mask of sanity” (Lynam & Gudonis,2005). Because they are socially skilled, their crimes often escape detection. Because they lack empathy, they see other people only as objects for their gratification.


Dissociation and Possession A Candomble priestess in Brazil holds a woman who is “possessed” by a Christian saint during a religious ceremony. Such dissociative trance and possession states are common in religions around the world (Krippner, 1994).When dissociative experiences take place within a religious ritual context, they are not considered abnormal. In fact, such experiences may be highly valued (Mulhern,1991). One study of Brazilian mediums from Candomble or related Christian “spiritistic” religions found that their dissociative experiences were not associated with mental disorders, childhood abuse, or psychological problems (Moreira-Almeida,2008).


Glimpses of Schizophrenia This drawing was made by a young man hospitalized for schizophrenia. He drew the picture while he was hallucinating and extremely paranoid. The drawing provides glimpses of the distorted perceptions and thoughts that arecharacteristic of a schizophrenic episode. Notice the smaller face that is superimposed on the larger face, which might represent the hallucinated voices that are often heard in schizophrenic episodes.


The Hallucinating Brain

Researcher David Silbersweig and his colleagues (1995) used PET scans to take a “snapshot” of brain activity during schizophrenic hallucinations. The scan shown here was recorded at the exact instant a schizophrenicpatient hallucinated disembodied heads yelling orders at him. The bright orange areas reveal activity in the left Auditory and visual areas of his brain, but not in the frontal lobe, which normally is involved in organized thought processes.


Figure 14.4 Incidence of Different Types of Hallucinations in Schizophrenia Schizophrenia-related hallucinations can occur in any sensory modality. Auditory hallucinations, usually in the form of voices, are the most common type of hallucinations that occur in schizophrenia, followed by visual hallucinations.Source: Adapted from data in Mueser &others (1990) and Bracha & others (1989).


Figure 14.5 Presence of Symptoms in Schizophrenia This graph shows how often specific positive and negative symptoms were present in a study of over 100 individuals at the time they were hospitalized for schizophrenia. Delusions were the most common positive symptom, and a volition, or apathy, was the most common negative symptom.Source: Based on data reported in Andreasen & Flaum (1991).


Figure 14.6 The Risk of Developing Schizophrenia Among Blood Relatives The risk percentages shown here reflect the collective results of about 40 studies investigating the likelihood of developing schizophrenia among blood relatives. As you can see, the greatest risk occurs if you have an identical twin who has schizophrenia (48 percent lifetime risk) or if both of your biological parents have schizophrenia (46 percent lifetime risk). However, environmental factors, as well as genetic ones, are involved in the development ofschizophrenia.Source: Gottesman (1991), p. 96.


Identical Twins but Not Identical Brains David and Steven Elmore are identical twins, but they differ in one Important respect—Steven (right) has schizophrenia. Behind each is a CAT scan, which reveals that Steven’s brain is slightly smaller, with less area devoted to the cortex at the top of the brain. Steven also has larger fluid-filled ventricles, which are circled in red on his brain scan. As researcher Daniel Weinberger (1995) commented, “The part of the cortex that Steven is missing serves as perhaps the most evolved part of the human brain. It performs complicated tasks such as thinking organized thoughts. This might help explain why paranoid Delusions and hallucinations are characteristic of schizophrenia.”


Figure14.7 The Finnish Adoptive Family Study of Schizophrenia In the Finnish Adoptive Family Study, psychiatrist Pekka Tienari and his colleagues (1994, 2006) tracked the mental health of two groups of adopted individuals: one group with biological mothers who had schizophrenia and a control group whose biological mothers did not have schizophrenia. This graph shows the strong influence of the adoptive family environment on the development of serious mental disorders.


How to Help a Friend The majority of those who attempt suicide communicate their intentions to friends or family members (Shneidman, 1998). When a friend is despondent and desperate, you can help by listening, expressing your understanding and compassion, and, if necessary, referring him or her to a professional counselor or suicide prevention specialist.

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