Psychological Disorders

Understanding Abnormal Behavior

✔Medical Model– Useful to think about abnormal behavior as a

disease– Prior to medical model in 18th century:

• Abnormal behavior was based on superstition:– possessed by demons, witches, victims of God’s

punishment

– Medical model resulted in more sympathy and better treatment

– Criticism of Szasz - abnormal behaviors are “problems of living” not disease processes

Medical Model Today

✔Medical concepts have remained prominent– Diagnosis

• distinguishing one illness from another

– Etiology• refers to the apparent causation and developmental

history of an illness

– Prognosis• a forecast about the probable course of an illness

What is “Abnormal” Behavior✔General criteria for abnormal behavior

– Deviance• the behavior is different from societal norms of what

is acceptable and normal

– Maladaptive Behavior• when the behavior interferes with one’s social or

occupational functioning

– Personal Distress• many may not exhibit deviant or maladaptive

behavior, but experience personal discomfort associated with symptoms

Psychodiagnosis: The Classification of Disorders

✔Diagnostic and Statistical Manual of Mental Disorders (DSM)– Classification system published by the

American Psychiatric Association– First published in 1952– Currently in 4th edition

• DSM-IV-TR (Text Revision)

– Criteria and research has improved with each edition

Multiaxial System of Classification

✔ Axis I– Clinical syndromes, psychological disorders

✔ Axis II– Personality disorders, mental retardation

✔ Axis III– General medical disorders/conditions

✔ Axis IV– Psychosocial/Environmental Stressors

✔ Axis V– Global Assessment of Functioning (1-100 rating)

Anxiety Disorders✔Generalized Anxiety Disorder

– marked by a chronic, high level of anxiety that is not tied to any specific event

– “free-floating” anxiety– ruminative over decisions and minor matters

✔Phobic Disorder– marked by persistent and irrational fear of an

object or situation that presents no realistic danger

– most recognize their own phobias are irrational

Anxiety Disorders

✔Panic Disorder– characterized by recurrent panic attacks

• panic attack – rush of overwhelming anxiety, thoughts that one is dying/

going crazy, increased heart rate, numbing in hands

– typically occurs suddenly and unexpectedly

– after experiencing multiple panic attacks, patient may worry about where they will be when “next one hits”

– agoraphobia - fear of going into public places

Anxiety Disorders

✔Obsessive-Compulsive Disorder (OCD)– obsessions

• thoughts that repeatedly intrude one’s consciousness in a distressing way

– compulsions• actions that one feels forced to carry out; typically

to reduce anxiety brought on by obsessions

– OCD is marked by persistent, uncontrollable intrusions of unwanted thoughts and urges to engage in senseless rituals

Anxiety Disorders

✔Posttraumatic Stress Disorder– person experienced, witnessed, or was

confronted with an event that involved actual or threatened death/injury, or threat to physical integrity of self/others

– response marked by intense fear, helplessness– Symptoms:

• reexperiencing the event • persistent avoidance/numbing • hyperarousal

Anxiety Disorders: Etiology

✔ Biological Factors– Rates are highest among identical twins– Anxiety sensitivity - some are “tuned” to respond to

lower levels of physical anxiety

✔ Conditioning and Learning– a stimulus may be paired with a frightening event

resulting in an learned anxiety response

✔ Cognitive Factors– people misinterpret threat (internal or external), focus

excessive attention on threat, and tend to recall information that seems threatening

Anxiety Disorders: Etiology✔Personality

– Certain personality traits are positively correlated with anxiety disorders

• Neuroticism: – self-conscious, nervous, jittery, insecure, guilt-prone

– This finding may be related to third variable:• genetic predisposition

✔Stress– Those with anxiety disorder tend to experience

more stressors in prior month

Somatoform Disorders

✔Somatoform vs. Psychosomatic– Somatoform Disorders

• physical ailments that cannot be fully explained by organic conditions and are largely due to psychological factors

• THIS IS NOT DELIBERATE FAKING

– Psychosomatic Diseases• genuine physical ailments caused in part by

psychological factors, especially emotional distress• ulcers, asthma, high blood pressure

Somatoform Disorders✔Somatization Disorder

– marked by a history of diverse physical complaints that appear to be psychological in origin

– unlikely combination of symptoms (gastrointestinal, pulmonary, neurological)

✔Conversion Disorder– significant loss of physical function (with no

apparent organic basis)– loss of sight/hearing, mutism, paralysis

Somatoform Disorders

✔Hypochondriasis– characterized by excessive preoccupation with

one’s health and worry about developing physical illness

– tend to “doctor shop” and think professionals are incompetent

– over-interpret ANY sign of illness

Somatoform Disorders: Etiology

✔Personality– Histrionic - self-centered, suggestible, overly

dramatic, highly emotional, thrive on attention

✔Cognitive Factors– “amplify” normal bodily sensations and draw

catastrophic conclusions

✔Sick Role– some grow fond of “perks” of being sick (avoid

responsibility, attention from others)

Dissociative Disorders✔ Loss of contact with portions of memory or

consciousness resulting in disruption of one’s sense of identity

✔ Dissociative Amnesia– sudden loss of memory for important personal

information– common after disasters, accidents, combat stress,

physical abuse, rape, witnessing a violent death

✔ Dissociative Fugue– People lose their memory for their entire lives along

with their sense of personal identity

Dissociative Disorders

✔Dissociative Identity Disorder (DID)– “multiple personality disorder”– NOT schizophrenia– coexistence in one person of two or more

largely complete, and usually very different, personalities

– experiences of one “personality” are typically not known by others

Dissociative Disorders: Etiology

✔Psychogenic amnesia and fugue:– excessive stress

✔DID– SEVERE emotional trauma during childhood– Criticisms:

• intentional role playing• therapist subtly “create” DID in patients through

suggestion

Mood Disorders

✔Major Depressive Disorder– persistent feelings of sadness/despair and a loss

of interest in previous sources of pleasure, lack of energy, hopelessness, suicidal ideation

– in adolescents, may manifest as agitation– average duration: 5 months– 75%-95% who suffer one episode of depression

will suffer another– affects 7% of population at some point

Mood Disorders

✔Bipolar Disorder– “manic-depressive disorder”– marked by experience of both depressed and

manic periods• mania

– marked by euphoria, hyperactivity, impaired judgement, extravagance, impulsivity, insomnia

– may have uneasiness, irritability that may be disturbing

– affects about 1% of the population

Mood Disorders: Etiology✔Genetic Vulnerability

– heredity may create a predisposition to mood disorders

✔Neurochemical Factors– Norepinephrine and serotonin appear important

in development of depression

✔Cognitive Factors– “Learned helplessness” Martin Seligman

• passive “giving up” response to uncontrollable situations

Mood Disorders: Etiology✔Cognitive Factors

– Pessimistic explanatory style• attribute setbacks to personal flaws instead of

situational factors• draw global generalizations about their inadequacies

– Rumination• those who continue to worry about their depression

tend to remain depressed longer than those who distract themselves

✔Interpersonal Roots– lack social “finesse,” tend to be depressing

Mood Disorders: Etiology

✔Stress-vulnerability models– vulnerability to a disorder is influenced by

heredity– stress from one’s environment results in

potential manifestation of vulnerability– If a person has a genetic predisposition to

develop a disorder, stress from the environment may increase the likelihood that the disorder will appear

Schizophrenic Disorders✔Term meaning “split mind” was coined by

Eugen Bleuler in 1911– refers to fragmentation of thought processes– not “split personality” associated with MPD

✔Class of disorders marked by delusions, hallucinations, disorganized speech, and deterioration of adaptive behavior

✔1% - 1.5% of population – 3-4 million people in U.S.

Schizophrenic Disorders

✔General Symptoms– Irrational Thought

• Delusions - false beliefs that are maintained even though they clearly are out of touch with reality

– thought broadcasting

– ideas being injected into one’s mind against one’s will

– delusions of grandeur

• Train of thought deteriorates– becomes less logical and linear and more chaotic

– loosening of associations

Schizophrenic Disorders✔General Symptoms

– Deterioration of adaptive behavior• impairment of work, social relations, personal care

– Distorted perception• Hallucinations - sensory perceptions that occur in

the absence of a real, external stimulus or gross distortions of perceptual input

– visual or auditory (auditory more common)

– Disturbed emotion• Flattening of emotions (little emotional response)• Emotionally volatile and inapproapriate

Schizophrenic Disorders✔Subtypes

– Paranoid • dominated by delusions of persecution and

delusions of grandeur

– Catatonic• marked by striking motor disturbances, ranging

from muscular rigidity to random motor activity

– Disorganized• severe deterioration of adaptive behavior

– Undifferentiated• marked by a mix of symptoms

Schizophrenic Disorders✔Positive Versus Negative Symptoms

– with criticism of subtype classification, this scheme was devised

– Negative Symptoms• behavioral deficits, such as flattened emotions,

social withdrawal, apathy, impaired attention, poverty of speech

– Positive Symptoms• behavioral excesses or peculiarities, such as

hallucinations, delusions, bizarre behavior, and wild flights of ideas

Schizophrenic Disorders: Etiology✔ Genetic “vulnerability”

– concordance rate for identical twins is 48%

✔ Neurochemical factors– Excess dopamine

✔ Structural abnormalities in the brain– chronic schizophrenic disturbance is associated with

enlarged brain ventricles

✔ Expressed emotion– degree to which family displays highly critical or

emotionally overinvolved attitudes (critical comments, resentment, overprotective)

Schizophrenic Disorders: Etiology✔Neurodevelopmental Hypothesis

– disruptions in normal maturation processes of brain before or at birth

• viral infections during prenatal development– study of 1957 flu epidemic in Finland: Schizophrenia

rates elevated among individuals who were in their second trimester of prenatal development during epidemic

• malnutrition during prenatal development• obstetrical complications during birth process

✔Precipitating Stress– stress can trigger onset or relapses

Eating Disorders✔Severe disturbances in eating behavior

characterized by preoccupation with weight concerns and unhealthy efforts to control it– Anorexia nervosa

• intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and dangerous measures to lose weight

– Bulimia nervosa• habitually engaging in out-of-control overeating

followed by unhealthy compensatory efforts, such as self-induced vomiting, fasting, laxatives

Eating Disorders: Etiology

✔Genetic Vulnerability✔Personality Factors

– anorexia• obsessive, rigid, neurotic, emotionally restrained

– bulemia• impulsive, overly sensitive, low self-esteem

✔Cultural Values– Western society’s emphasis on “attractive”

Eating Disorders: Etiology✔The Role of the Family

– Overly involved parents turn normal adolescent drive for independence into unhealthy struggle

• in response, child may seek extreme control over body and eating behavior

– Parents may endorse society’s messages about body image

✔Cognitive Factors– rigid, all-or-none thinking, maladaptive beliefs,

obsessive, ruminative

Psychology and the Law✔Insanity

– NOT a diagnosis– a legal concept indicating that a person cannot

be held responsible for his/her actions because of mental illness

– used with people that admit they committed the crime but claim that they lacked intent

✔Involuntary commitment– people are hospitalized in psychiatric facilities

against their will

Culture and Psychopathology✔ Relativistic View

– criteria for mental disorders vary across cultures– no universal standards of “normal” or “abnormal”

✔ Pancultural view– basic standards of normality are universal– most serious psychological disorders (schizophrenia,

depression, bipolar disorder) are found in all cultures

✔ Culture-bound disorders– abnormal syndromes found only in a few cultural groups

• koro - obsesive fear that penis will retract into abdomen (Southern Asia)