copyright © 2010 pearson education canada16-1 psychological disorders chapter 16

Copyright © 2010 Pearson Education Canada 16-1

Psychological DisordersPsychological Disorders

Chapter 16Chapter 16


Chapter OutlineChapter Outline

• Defining and Diagnosing DisorderDefining and Diagnosing Disorder

• Anxiety DisordersAnxiety Disorders

• Mood DisordersMood Disorders

• Personality DisordersPersonality Disorders

• Drug Abuse and AddictionDrug Abuse and Addiction

• Dissociative Identity DisorderDissociative Identity Disorder

• SchizophreniaSchizophrenia

• Mental Disorder and Personal ResponsibilityMental Disorder and Personal Responsibility


Defining Mental DisorderDefining Mental Disorder

• Mental disorderMental disorder

– Any behaviour or emotional state that causes an Any behaviour or emotional state that causes an individual great suffering, is self-destructive, seriously individual great suffering, is self-destructive, seriously impairs the person’s ability to work or get along with impairs the person’s ability to work or get along with others, or endangers others or the communityothers, or endangers others or the community

• NotNot the same as the same as insanityinsanity

– Legal term only involving mental illness and whether Legal term only involving mental illness and whether person is aware of consequences and can control their person is aware of consequences and can control their behaviourbehaviour


Dilemmas of DefinitionDilemmas of Definition

• Varying definitions of mental disorders:Varying definitions of mental disorders:

– Mental disorder as a violation of cultural Mental disorder as a violation of cultural standardsstandards

– Mental disorder as emotional distressMental disorder as emotional distress– Mental disorder as behaviour that is self-Mental disorder as behaviour that is self-

destructive or harmful to othersdestructive or harmful to others

• In Canada, mental disorders the leading In Canada, mental disorders the leading cause of disability in those aged 15-44cause of disability in those aged 15-44


Dilemmas of DiagnosisDilemmas of Diagnosis

• Disorders typically classified using the Disorders typically classified using the Diagnostic Diagnostic and Statistical Manual of Mental Disorders (DSM)and Statistical Manual of Mental Disorders (DSM)

• Primary goal of DSM is to be descriptive and to Primary goal of DSM is to be descriptive and to provide clear diagnostic categories (see Table provide clear diagnostic categories (see Table 16.1 in text)16.1 in text)

• Lists symptoms, onset, predisposing factors, Lists symptoms, onset, predisposing factors, course of disorder, prevalence, sex ratio, and course of disorder, prevalence, sex ratio, and cultural issues in diagnosis cultural issues in diagnosis


DSM CategoriesDSM Categories

• Five dimensions (axes) clients are evaluated on:Five dimensions (axes) clients are evaluated on:

• Axis I: Primary clinical problemAxis I: Primary clinical problem

• Axis II: Personality factors/disordersAxis II: Personality factors/disorders

• Axis III: General medical conditionsAxis III: General medical conditions

• Axis IV: Social and environmental stressorsAxis IV: Social and environmental stressors

• Axis V: Global assessment of functioningAxis V: Global assessment of functioning


Increasing DSM Disorders?Increasing DSM Disorders?

• Supporters of new Supporters of new categories answer that is categories answer that is important to distinguish important to distinguish disorders preciselydisorders precisely

• Critics point to economic Critics point to economic reasons: diagnoses are reasons: diagnoses are needed for insurance needed for insurance reasons so therapists will reasons so therapists will be compensatedbe compensated


Problems with the DSMProblems with the DSM

• It is important to be aware of limitations & It is important to be aware of limitations & problems present in attempts to classify mental problems present in attempts to classify mental disorders:disorders:

1.1. The danger of overdiagnosis (e.g., ADHD)The danger of overdiagnosis (e.g., ADHD)

2.2. The power of diagnostic labelsThe power of diagnostic labels

3.3. The confusion of serious mental disorders with The confusion of serious mental disorders with normal problemsnormal problems

4.4. The illusion of objectivity and universality The illusion of objectivity and universality (e.g., drapetomania, reflect cultural & social (e.g., drapetomania, reflect cultural & social prejudices) prejudices)


Advantages of the DSMAdvantages of the DSM

• When DSM used correctly, in conjunction When DSM used correctly, in conjunction with valid objective tests, improves reliability with valid objective tests, improves reliability of diagnosisof diagnosis

• Recent inclusion of Recent inclusion of culture-bound culture-bound syndromes:syndromes: disorders that are specific to a disorders that are specific to a particular culture context (see Table 16.2)particular culture context (see Table 16.2)

– E.g., ghost sickness: preoccupation with death E.g., ghost sickness: preoccupation with death and the dead, bad dreams, fainting, etc.and the dead, bad dreams, fainting, etc.


Dilemmas of MeasurementDilemmas of Measurement

• Diagnosis usually made by combination of clinical Diagnosis usually made by combination of clinical interview and psychological testsinterview and psychological tests

– Projective tests:Projective tests: tests used to infer a person’s motives, tests used to infer a person’s motives, conflicts, and unconscious dynamics on the basis of the conflicts, and unconscious dynamics on the basis of the person’s interpretations of ambiguous stimuliperson’s interpretations of ambiguous stimuli

– Objective tests:Objective tests: standardized objective questionnaires standardized objective questionnaires requiring written responses; typically include scales that requiring written responses; typically include scales that people rate themselves onpeople rate themselves on


Projective TestsProjective Tests

• Can help establish rapport Can help establish rapport with clientwith client

• Tests lack reliability and Tests lack reliability and validity (although some validity (although some have tried to develop have tried to develop comprehensive scoring comprehensive scoring systems for responses)systems for responses)

• Sometimes used Sometimes used inappropriatelyinappropriately

• Most popular is Most popular is Rorschach Inkblot TestRorschach Inkblot Test


Objective TestsObjective Tests

• Popular personality assessment is the Popular personality assessment is the Minnesota Minnesota Multiphasic Personality Inventory (MMPI)Multiphasic Personality Inventory (MMPI)

– Contains 10 clinical scales for problems such as Contains 10 clinical scales for problems such as depression, paranoia, schizophrenia, introversiondepression, paranoia, schizophrenia, introversion

– Contains 4 validity scales to indicate whether responder Contains 4 validity scales to indicate whether responder is lying, defensive, or evasiveis lying, defensive, or evasive

– Has been revised but still some cultural differences in Has been revised but still some cultural differences in scores on certain subscalesscores on certain subscales


Anxiety DisordersAnxiety Disorders

• Generalized Anxiety DisorderGeneralized Anxiety Disorder

– A continuous state of anxiety marked by feelings A continuous state of anxiety marked by feelings of worry and dread, apprehension, difficulties in of worry and dread, apprehension, difficulties in concentration, and signs of motor tensionconcentration, and signs of motor tension

– Symptoms experienced in challenging or Symptoms experienced in challenging or uncontrollable situationsuncontrollable situations

– No specific anxiety-producing eventNo specific anxiety-producing event

– Develop habits that foster their worryDevelop habits that foster their worry



• Posttraumatic Stress Disorder (PTSD)Posttraumatic Stress Disorder (PTSD)

– Person who has experienced a traumatic or life-Person who has experienced a traumatic or life-threatening event has symptoms such as threatening event has symptoms such as psychic numbing, reliving of the trauma, and psychic numbing, reliving of the trauma, and increased physiological arousalincreased physiological arousal

– Not all who experience trauma develop PTSDNot all who experience trauma develop PTSD

• May involve a genetic predisposition, history of prior May involve a genetic predisposition, history of prior psychological problems, poor emotional adjustment & psychological problems, poor emotional adjustment & catastrophizing, smaller hippocampus than averagecatastrophizing, smaller hippocampus than average



• Panic DisorderPanic Disorder– An anxiety disorder An anxiety disorder

in which a person in which a person experiences experiences recurring panic recurring panic attacks, feelings of attacks, feelings of impending doom or impending doom or death, accompanied death, accompanied by physiological by physiological symptoms such as symptoms such as rapid breathing and rapid breathing and dizzinessdizziness

• Interpretation of bodily reactions Interpretation of bodily reactions key in development of disorderkey in development of disorder


Fears & PhobiasFears & Phobias

• Phobia:Phobia: an exaggerated, unrealistic fear of a specific an exaggerated, unrealistic fear of a specific situation, activity, or objectsituation, activity, or object

• Social phobia:Social phobia: irrational fear where sufferers become irrational fear where sufferers become extremely anxious in situations in which they will be extremely anxious in situations in which they will be observed by others, worrying that they will do or say observed by others, worrying that they will do or say something that will be excruciatingly humiliating or something that will be excruciatingly humiliating or embarrassing embarrassing

• Agoraphobia:Agoraphobia: set of phobias, often set off by a panic set of phobias, often set off by a panic attack, involving the basic fear of being away from a attack, involving the basic fear of being away from a safe place or personsafe place or person



• Obsessive-compulsive disorder (OCD)Obsessive-compulsive disorder (OCD)

– An anxiety disorder in which a person feels An anxiety disorder in which a person feels trapped in repetitive, persistent thoughts trapped in repetitive, persistent thoughts ((obsessionsobsessions) and repetitive, ritualized ) and repetitive, ritualized behaviours (behaviours (compulsionscompulsions) designed to reduce ) designed to reduce anxietyanxiety

– May involve depletion of serotonin from May involve depletion of serotonin from prefrontal cortex (may create cognitive rigidity)prefrontal cortex (may create cognitive rigidity)


Mood DisordersMood Disorders

• Mood disordersMood disorders– Disturbances in mood ranging from extreme Disturbances in mood ranging from extreme

depression to extreme maniadepression to extreme mania

– Major depression:Major depression: mood disorder involving mood disorder involving disturbances in emotion, behaviour, cognition, disturbances in emotion, behaviour, cognition, and body functionand body function

– Bipolar disorder:Bipolar disorder: mood disorder in which mood disorder in which episodes of both depression and episodes of both depression and maniamania (excessive euphoria) occur(excessive euphoria) occur


Vulnerability-Stress ModelVulnerability-Stress Model

• Vulnerability-stress model:Vulnerability-stress model:

– Approaches that Approaches that emphasize how emphasize how individual vulnerabilities individual vulnerabilities interact with external interact with external stresses or circumstances stresses or circumstances to produce mental to produce mental disordersdisorders

– Not just related to Not just related to depressiondepression


Origins of DepressionOrigins of Depression

1.1. Genetic factorsGenetic factors– Adoption studies, 5-HTT gene, levels of serotonin & Adoption studies, 5-HTT gene, levels of serotonin &

cortisolcortisol

2.2. Life experiences and circumstancesLife experiences and circumstances– Experience of violence/domestic violenceExperience of violence/domestic violence

3.3. Losses of important relationshipsLosses of important relationships

4.4. Cognitive habitsCognitive habits– Permanent & uncontrollable attributions, ruminationPermanent & uncontrollable attributions, rumination


Personality DisordersPersonality Disorders

• Personality disordersPersonality disorders

– A pattern in the personality that involves A pattern in the personality that involves unchanging, maladaptive traits that cause great unchanging, maladaptive traits that cause great distress or an inability to get along with othersdistress or an inability to get along with others

– Not caused by medical conditions, stress, or Not caused by medical conditions, stress, or situations that involve temporary changes in situations that involve temporary changes in behaviourbehaviour


Problem PersonalitiesProblem Personalities

• Paranoid personality disorder:Paranoid personality disorder: characterized by characterized by unreasonable, excessive suspiciousness and mistrust, unreasonable, excessive suspiciousness and mistrust, and irrational feelings of being persecuted by othersand irrational feelings of being persecuted by others

• Narcissistic personality disorder:Narcissistic personality disorder: characterized by an characterized by an exaggerated sense of self-importance and self-exaggerated sense of self-importance and self-absorptionabsorption

• Borderline personality disorder:Borderline personality disorder: characterized by characterized by intense but unstable relationships, fear of intense but unstable relationships, fear of abandonment by others, unrealistic self-image, & abandonment by others, unrealistic self-image, & emotional volatilityemotional volatility


Criminals & PsychopathsCriminals & Psychopaths

• PsychopathyPsychopathy

– Characterized by lack of remorse, empathy, anxiety, and Characterized by lack of remorse, empathy, anxiety, and other social emotions, the use of deceit and other social emotions, the use of deceit and manipulation, and impulsive thrill seekingmanipulation, and impulsive thrill seeking

• Antisocial personality disorder (APD)Antisocial personality disorder (APD)

– Characterized by a lifelong pattern of irresponsible, Characterized by a lifelong pattern of irresponsible, antisocial behaviour such as law-breaking, violence, and antisocial behaviour such as law-breaking, violence, and other impulsive, reckless actsother impulsive, reckless acts


APD & Psychopathy FactorsAPD & Psychopathy Factors

• A number of factors may be involved in A number of factors may be involved in these disorders:these disorders:

1.1. Abnormalities in the central nervous systemAbnormalities in the central nervous system

2.2. Impaired frontal lobe functioningImpaired frontal lobe functioning

3.3. Genetic influencesGenetic influences


Emotions & APDEmotions & APD

• Physiological Physiological responses to threat of responses to threat of punishment, empathy, punishment, empathy, and emotions such as and emotions such as anxiety or fear that anxiety or fear that can be classically can be classically conditioned are conditioned are different between APD different between APD & non-APD groups& non-APD groups


Drug Abuse & AddictionDrug Abuse & Addiction

• Substance abuseSubstance abuse

– A maladaptive pattern of substance use leading to A maladaptive pattern of substance use leading to clinically significant impairment or distressclinically significant impairment or distress

– Symptoms of impairment include failure to hold a Symptoms of impairment include failure to hold a job, care for children, complete schoolwork, use of job, care for children, complete schoolwork, use of drug in hazardous situationsdrug in hazardous situations

• Various models of addiction have been Various models of addiction have been proposed to explain how patterns developproposed to explain how patterns develop


Biology & AddictionBiology & Addiction

• Biological model of addictionBiological model of addiction

– Addiction, whether to alcohol or any other drug, is due Addiction, whether to alcohol or any other drug, is due primarily to a person’s biochemistry, metabolism, and primarily to a person’s biochemistry, metabolism, and genetic predispositiongenetic predisposition

• No single “addiction gene” for any type of problem No single “addiction gene” for any type of problem but genes may relate to traits & dispositions linked but genes may relate to traits & dispositions linked to addictionto addiction

• Addictions also can result from the abuse of drugs Addictions also can result from the abuse of drugs (changes brain chemistry)(changes brain chemistry)


The Addicted BrainThe Addicted Brain


Learning, Culture, & AddictionLearning, Culture, & Addiction

• Learning model of addiction Learning model of addiction

– Examines the role of the environment, learning, Examines the role of the environment, learning, and culture in encouraging or discouraging drug and culture in encouraging or discouraging drug abuse and addictionabuse and addiction

• Treatment programs for alcoholics geared Treatment programs for alcoholics geared towards teaching people how to drink in towards teaching people how to drink in moderation & keep it under controlmoderation & keep it under control

– E.g., Harm Reduction, Rational Recovery, E.g., Harm Reduction, Rational Recovery, Moderation Management, DrinkWiseModeration Management, DrinkWise


Learning Model of AddictionLearning Model of Addiction

• Four major findings:Four major findings:

1.1. Addiction patterns vary according to cultural practices Addiction patterns vary according to cultural practices & the social environment& the social environment

2.2. Policies of total abstinence tend to increase rates of Policies of total abstinence tend to increase rates of addiction rather than reduce themaddiction rather than reduce them

3.3. Not all addicts have withdrawal symptoms when they Not all addicts have withdrawal symptoms when they stop taking a drugstop taking a drug

4.4. Addiction depends not on properties of the drug alone Addiction depends not on properties of the drug alone but also the reasons for taking itbut also the reasons for taking it


Comparing Models of AddictionComparing Models of Addiction


Dissociative Identity DisorderDissociative Identity Disorder

• Dissociative Identity DisorderDissociative Identity Disorder

– Controversial disorder marked by apparent Controversial disorder marked by apparent appearance within one person of two or more appearance within one person of two or more distinct personalities, each with its own name distinct personalities, each with its own name and traitsand traits

– Formerly known as multiple personality Formerly known as multiple personality disorder (MPD)disorder (MPD)

– Some psychiatrists and psychologists doubt Some psychiatrists and psychologists doubt its existenceits existence


Roots of MPDRoots of MPD

• Some clinicians argue MPD originates as means of Some clinicians argue MPD originates as means of coping with childhood trauma which produces coping with childhood trauma which produces “splitting”“splitting”

• Others believe many cases may be generated Others believe many cases may be generated unwittingly by clinicians through suggestive unwittingly by clinicians through suggestive techniques/hypnosistechniques/hypnosis

• Socio-cognitive explanation of MPD:Socio-cognitive explanation of MPD: ability of some ability of some troubled, highly imaginative individuals to produce troubled, highly imaginative individuals to produce many different “personalities” is an extreme form of many different “personalities” is an extreme form of ability we all have to present different aspects of our ability we all have to present different aspects of our personalities to otherspersonalities to others


SchizophreniaSchizophrenia

• SchizophreniaSchizophrenia

– Psychotic disorder marked by delusions, Psychotic disorder marked by delusions, hallucinations, disorganized and incoherent speech, hallucinations, disorganized and incoherent speech, inappropriate behaviour, and cognitive impairmentsinappropriate behaviour, and cognitive impairments

– Form of Form of psychosis:psychosis: distorted perceptions of reality distorted perceptions of reality and irrational behaviourand irrational behaviour

• Schizophrenia is Schizophrenia is notnot split or multiple personality split or multiple personality


Symptoms of SchizophreniaSymptoms of Schizophrenia

• Symptoms of schizophrenia include:Symptoms of schizophrenia include:

1.1. Bizarre delusionsBizarre delusions2.2. Hallucinations, false sensory experiences that Hallucinations, false sensory experiences that

feel intensely realfeel intensely real3.3. Disorganized, incoherent speech (involves Disorganized, incoherent speech (involves

word saladword salad))4.4. Grossly disorganized and inappropriate behaviourGrossly disorganized and inappropriate behaviour5.5. Impaired cognitive abilitiesImpaired cognitive abilities

• May also involve being emotionally ‘flat’ or May also involve being emotionally ‘flat’ or catatonic stuporcatatonic stupor


Origins of SchizophreniaOrigins of Schizophrenia

• Early theories argued that schizophrenia Early theories argued that schizophrenia resulted from erratic, cold, rejecting mothersresulted from erratic, cold, rejecting mothers

• Modern contributing factors:Modern contributing factors:

– Genetic predispositionsGenetic predispositions

– Structural brain abnormalitiesStructural brain abnormalities

– Neurotransmitter abnormalitiesNeurotransmitter abnormalities

– Prenatal problems or birth complicationsPrenatal problems or birth complications

– Adolescent abnormalities in brain developmentAdolescent abnormalities in brain development


Genetic PredispositionsGenetic Predispositions


Structural AbnormalitiesStructural Abnormalities


Mental Disorder & ResponsibilityMental Disorder & Responsibility

• Large debate surrounding mental disorders Large debate surrounding mental disorders and personal responsibilityand personal responsibility

– Insanity and diminished-capacity defensesInsanity and diminished-capacity defenses

– Law recognizes that mentally disturbed Law recognizes that mentally disturbed individuals should not be held to same individuals should not be held to same standards of accountabilitystandards of accountability

– Society has obligation to protect citizens & Society has obligation to protect citizens & reject excuses for legal violationsreject excuses for legal violations


End of Chapter 16End of Chapter 16

copyright © 2010 pearson education canada16-1 psychological disorders chapter 16

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