Psychological Disorders

PowerPoint® Presentation by Jim Foley

Chapter 14

What we’ll seek to understand... What does it mean to have a mental

disorder? Defining and classifying disorders Anxiety disorders, including GAD, Panic,

Phobias, OCD and PTSD Mood disorders, including depression and

bipolar disorder Schizophrenia Sample of other disorders:

Dissociative disorders Eating disorders Personality disorders

Rates of Diagnosis with Disorders

Why Learn about Psychological Disorders?

Reasons for curiosity: personal familiarity with

psychological symptoms knowing someone else

with the disorder hearing about how

prevalent and socially devastating some disorders have become in society

wanting to learn more about mental health and human nature

Questions to Keep in Mind

Perspectives on Psychological Disorders

Defining psychological disorders

Thinking critically about ADHD

Understanding psychological disorders

Classifying psychological disorders

Labeling psychological disorders

Insanity and responsibility

How do we decide when a set of symptoms are severe enough to be

called a disorder that needs treatment?

Can we define specific disorders clearly enough so that we can know that we’re all referring to the same

behavior/mental state?

Can we use our diagnostic labels to guide treatment rather than to

stigmatize people?

A Psychological disorder is: A significant dysfunction in an individual’s cognitions, emotions, or behaviors.

Disorders are diagnosed when there is dysfunction, behaviors which are considered maladaptive because they interfere with one’s daily life

Disorders are diagnosed when the symptoms and behaviors are accompanied by Distress, suffering.

New definition (DSM 5): “a disturbance in the psychological, biological, or developmental processes underlying mental functioning.”

More Understandings about disorders:

Is Attention-Deficit/Hyperactivity Disorder (ADHD) a real disorder?

ADHD: Impulsivity mixed with Inattention and/or hyperactivity. Can include distractibility, disorganization, fidgeting, difficulty suppressing impulses, and impaired working memory. Is this a disorder? Is it deviant? Do some people have a level of

inattentiveness, impulsiveness, or restlessness that goes beyond laziness or immaturity?

Is it distressful? Is the person enjoying being energetic, or are they frustrated that they can’t sustain focus?

Is there dysfunction? Are the symptoms harmless fun, or do they negatively impact work and relationships?

Understanding the Nature of Psychological Disorders One reason to diagnose a disorder is to make decisions about

treating the problem. Based on older understanding of

psychological disorders, treatments have included: exorcising evil spirits, beatings, caging/restraint, and

Pinel’s New Approach Philippe Pinel (1745-1826) proposed that

mental disorders were not caused by demonic possession, but by stress and inhumane conditions.

Pinel’s “moral treatment” involved gentleness, nature, and social interaction.

Pinel’s interventions improved lives but often did not effectively treat mental illness.

But then…

The Medical Model

Psychological disorders can be seen as psychopathology, an illness of the mind.

Disorders can be diagnosed, labeled as a collection of symptoms that tend to go together.

People with disorders can be treated, attended to, given therapy, all with a goal of restoring mental health.

The discovery that the disease of syphilis causes mental symptoms (by infecting the brain) suggested a medical model for mental illness.

The Biopsychosocial Approach

Cultural Influences on Disorders

Examples: Bulimia Nervosa: binging/purging, in the United StatesRunning amok: violent outbursts, in MalaysiaHikikomori: social withdrawal, in Japan

Culture-bound syndromes are disorders which only seem to exist

within certain cultures; they demonstrate how culture can play a role in both causing and defining

a disorder.

Classifying Psychological Disorders

Why create classifications of mental illness? What is the value of talking about diagnoses instead of just talking about individuals?1. Diagnoses create a

verbal shorthand for referring to a list of associated symptoms.

2. Diagnoses allow us to statistically study many similar cases, learning to predict outcomes.

3. Diagnoses can guide treatment choices.

The Diagnostic and Statistical Manual

It’s easier to count cases of autism if we have a clear definition.

Versions: DSM-IV-TR, DSM-V (May 2013)

The DSM is used to justify payment for treatment.

It’s consistent with diagnoses used by medical doctors worldwide.

The DSM suggests describing someone not just with a label but with a five-part picture.

Axis I: Is a clinical syndrome present?

Using specifically

defined criteria,

clinicians may select none, one,

or more syndromes.

Axis II: Is a personality

disorder or mental

retardation (intellectual

developmental disorder) present?

Clinicians may or may not also

select one of these two conditions.

Axis III: Is a general

medical condition,

such as diabetes,

arthritis, or hypertension also present?

Axis IV: Are

psychosocial or

environmental problems, such

as school or housing issues, also present?

Axis V: What is the

global assessment of this person’s functioning?

Clinicians assign a code

from 0-100.

The Five “Axes” of Diagnosis

Categories of Diagnoses

Categories of Diagnoses:

The 5 Axes

Critiques of Diagnosing with the DSM

1. The DSM calls too many people “disordered.”

2. The border between diagnoses, or between disorder and normal, seems arbitrary.

3. Decisions about what is a disorder seem to include value judgments; is depression necessarily deviant?

4. Diagnostic labels direct how we view and interpret the world, telling us which behavior and mental states to see as disordered.

Stigma and Stereotypes

Many people think a diagnostic label means being seen as tainted, weak, and weird.

However: these negative views/stigma

come from popular cultural views of mental illness, and not from the DSM.

the DSM may contain the information to correct inaccurate perceptions of mental illness.

Insanity and Responsibility

Jared Loughner shot many people, including a U.S. Representative, in 2011.

Loughner had schizophrenia and substance abuse problems, a combination associated with increased violence.

What is the appropriate consequence?

To what degree, if any, should he be held responsible for his actions?

Anxiety Disorders: Our self-protective, risk-reduction instincts in overdrive

Generalized Anxiety Disorder: Painful worrying

Panic Disorder: Fear of the next attack

Phobias: Don’t even show me a picture

OCD: I know it doesn’t make sense, but I can’t help it

PTSD: Stuck Re-experiencing Trauma

Causes of Anxiety Disorders: Fear Conditioning Observational

Learning Genetic/Evolutionary

Predispositions Brain involvement

GAD: Generalized Anxiety Disorder

Emotional-cognitive symptoms include worrying, having anxious feelings and thoughts about many subjects, and sometimes “free-floating” anxiety with no attachment to any subject. Anxious anticipation interferes with concentration.

Physical symptoms include autonomic arousal, trembling, sweating, fidgeting, agitation, and sleep disruption.

Panic Disorder: “I’m Dying”

A panic attack is not just an “anxiety attack.” It may include: many minutes of intense dread

or terror. chest pains, choking,

numbness, or other frightening physical sensations.

a feeling of a need to escape.

Panic disorder refers to repeated and unexpected panic attacks, as well as a fear of the next attack.

Specific PhobiaA specific phobia is more than just a strong fear or dislike. A specific phobia is diagnosed when there is an uncontrollable, irrational, intense desire to avoid the some object or situation. Even an image of the object can trigger a reaction--“GET IT AWAY FROM ME!!!”--the uncontrollable, irrational, intense desire to avoid the object of the phobia.

Some Fears and PhobiasWhich varies more, fear or phobias? What does this imply?

Agoraphobia is the avoidance of situations in which one will fear having a panic attack.

Social phobia: an intense fear of being watched and judged by others, often showing as a fear of possibly embarrassing public appearances.

Some Other Phobias

Obsessive-Compulsive Disorder [OCD] Obsessions are intense, unwanted

worries, ideas, and images that repeatedly pop up in the mind.

A compulsion is a repeatedly strong feeling of “needing” to carry out an action, even though it doesn’t feel like it makes sense.

When is it a “disorder”? Distress: when you are deeply

frustrated with not being able to control the behaviors

or Dysfunction: when the time and

mental energy spent on these thoughts and behaviors interfere with everyday life

Common OCD Behaviors

Common pattern: RECHECKING Although you know that you’ve already made sure the door is locked, you feel you must check again. And again.

Percentage of children and adolescents with OCD reporting these obsessions or compulsions:

Post-Traumatic Stress Disorder [PTSD]

About 10 to 35 percent of people who experience trauma not only have burned-in memories, but also four weeks to a lifetime of:

repeated intrusive recall of those memories.

nightmares and other re-experiencing.

social withdrawal or phobic avoidance.

jumpy anxiety or hypervigilance.

insomnia or sleep problems.

Which people develop PTSD? Those with sensitive

emotion-processing limbic systems

Those who are asked to relive their trauma as they report it

Those previously traumatized

Understanding Anxiety Disorders: Explanations from Different Perspectives

Genes: predisposed to

some fears

Classical conditioning:

overgeneralizing a conditioned

response

Operant conditioning:

rewarding avoidance

The Brain: active anxiety

pathways

Cognitive appraisals:

uncertainty is danger

Natural Selection:

surviving by avoiding danger

Operant Conditioning and Anxiety

Classical Conditioning and Anxiety

We may feel anxious in a situation and make a decision to leave. This makes us feel better and our anxious avoidance was just reinforced.

If we know we have locked a door but feel anxious and compelled to re-check, rechecking will help us temporarily feel better.

The result is an increase in anxious thoughts and behaviors.

In the experiment by Watson in 1920, Little Albert learned to feel fear around a rabbit because he had been conditioned to associate the bunny with a loud scary noise.

Sometimes, such a conditioned response becomes overgeneralized. We may begin to fear all animals, everything fluffy, all experimenters.

The result is a phobia or generalized anxiety.

Observational Learning and Anxiety

Experiments with humans and monkeys show that anxiety can be acquired through observational learning. If you see someone else avoiding or fearing some object or creature, you might pick up that fear and adopt it even after the original scared person is not around.

In this way, fears get passed down in families.

Cognition and Anxiety Cognition includes worried

thoughts, as well as interpretations, appraisals, beliefs, predictions, and ruminations.

Cognition includes mental habits such as hypervigilance (persistently watching out for danger). This accompanies anxiety in PTSD.

In anxiety disorders, such cognitions appear repeatedly and make anxiety worse.

Biology and Anxiety: Genes

Studies show that identical twins, even raised separately, develop similar phobias (more similar than two unrelated people).

Some people seem to have an inborn high-strung temperament, while others are more easygoing.

Temperament may be encoded in our genes.

Genes and Neurotransmitters

Genes regulate levels of neurotransmitters.

People with anxiety have problems with a gene associated with levels of serotonin, a neurotransmitter involved in regulating sleep and mood.

People with anxiety also have a gene that triggers high levels of glutamate, an excitatory neurotransmitter involved in the brain’s alarm centers.

Biology and Anxiety: The Brain

Traumatic experiences can burn fear circuits into the amygdala; these circuits are later triggered and activated.

Anxiety disorders include overarousal of brain areas involved in impulse control and habitual behaviors.

The OCD brain shows extra activity in the ACC, which monitors our actions and checks for errors.

ACC = anterior cingulate gyrus

Biology and Anxiety: An Evolutionary Perspective

3. Dangerous yet non-phobic subjects: We are likely to become cautious about, but not phobic about:

GunsElectric wiring

Cars Evolutionary psychologists believe that ancestors

prone to fear the items on list #1 were less likely to die before reproducing.

There has not been time for the innate fear of list #3 (the gun list) to spread in the population.

1. Human phobic objects: Snakes

HeightsClosed spaces

Darkness

2. Similar but non-phobic objects: FishLow placesOpen spacesBright light

Mood Disorders: Not just feeling “down;” not just sad about something Major Depressive Disorder: Stuck in dark withdrawal Bipolar Disorder: sometimes fleeing depression into

mania Prevalence and Course of depression: Common, but

for many it goes away Genetic Influences on Depression Suicide and Self-Injury Negative Moods and Negative thoughts: Explanatory

style The vicious cycle: Interaction of bad experiences

depressive thoughts mood changes behavior changes more sad days

Mood Disorders

Major depressive disorder [MDD] is: more than just feeling “down.” more than just feeling sad

about something.

Bipolar disorder is: more than “mood swings.” depression plus the problematic

overly “up” mood called “mania.”

Criteria of Major Depressive Disorders

Depressed mood most of the day, and/or Markedly diminished interest or pleasure in activities Significant increase or decrease in appetite or weight Insomnia, sleeping too much, or disrupted sleep Lethargy, or physical agitation Fatigue or loss of energy nearly every day Worthlessness, or excessive/inappropriate guilt Daily problems in thinking, concentrating, and/or

making decisions Recurring thoughts of death and suicide

Major depressive disorder is not just one of these symptoms.It is one or both of the first two, PLUS three or more of the rest.

Depression is EverywhereDepression shows up in people seeking treatment: Phobias are the most

common (frequently experienced) disorder, but depression is the #1 reason people seek mental health services.

Depression appears worldwide: Per year, depressive

episodes happen to about 6 percent of men and about 9 percent of women.

Over the course of a lifetime, 12 percent of Canadians and 17 percent of USA residents experience depression.

Depression: The “Common Cold” of Disorders?Although both are “common” (occurring frequently and pervasively), comparing depression to a cold doesn’t work. Depression: is more dangerous because of

suicide risk. has fewer observable symptoms. is more lasting than a cold, and is

less likely to go away just with time. is much less contagious.And…depressive pain is beyond sniffles.

Seasonal Affective Disorder [SAD] Seasonal affective disorder is more than simply

disliking winter. Seasonal affective disorder involves a recurring

seasonal pattern of depression, usually during winter’s short, dark, cold days.

Survey: “Have you cried today”? Result: More people answer “yes” in winter.

Percentage who cried

Men Women

August 4 7

December 8 21

Bipolar Disorder Bipolar disorder was once

called “manic-depressive disorder.”

Bipolar disorder’s two polar opposite moods are depression and mania.

Mania refers to a period of hyper-elevated mood that is euphoric, giddy, easily irritated, hyperactive, impulsive, overly optimistic, and even grandiose.

Contrasting SymptomsDepressed mood: stuck feeling

“down,” with:Mania: euphoric, giddy, easily

irritated, with: exaggerated pessimism social withdrawal lack of felt pleasure inactivity and no initiative difficulty focusing fatigue and excessive desire to

sleep

exaggerated optimism hypersociality and sexuality delight in everything impulsivity and overactivity racing thoughts; the mind

won’t settle down little desire for sleep

Many famous and successful people have lived with the ups and downs of bipolar disorder. Some speculate that the depressive periods gave them ideas, and the manic episodes gave them creative energy. Any evidence of mood swings here?

Bipolar Disorder and Creative Success

Bipolar Disorder in Children and Adolescents Does bipolar disorder

show up before adulthood, and even before puberty?

Many young people have cycles from depression to extended rage rather than mania.

The DSM-V may have a new diagnosis for some of these kids: disruptive mood dysregulation disorder.

Understanding Mood DisordersWhy are mood disorders so pervasive, especially among women?

Women, starting in adolescence, appear to ruminate more, have deeper sadness then men, encounter more stressors, and report their depression more readily.

Understanding Mood DisordersCan we explain…

Why does depression often go away on its own?

the course/development of reactive depression? Often, time heals a mood disorder, especially when the mood issue is in reaction to a stressful event. However, a significant proportion of people with major depressive disorder do not automatically or easily get better with time.

Understanding Mood Disorders

Biological aspects and explanations

Social-cognitive aspects and explanations

EvolutionaryGenetic

Brain /Body

Negative thoughts and negative mood

Explanatory style The vicious cycle

An Evolutionary Perspective on the Biology of Depression

Depression, in its milder, non-disordered form, may have had survival value.

Under stress, depression is social-emotional hibernation. It allows humans to: conserve energy. avoid conflicts and other

risks. let go of unattainable

goals. take time to contemplate.

Biology of Depression: GeneticsEvidence of genetic influence on depression:1. DNA linkage analysis reveals depressed gene regions2. twin/adoption heritability studies

Biology of Depression: The Brain Brain activity is diminished in depression and increased in mania. Brain structure: smaller frontal lobes in depression and fewer

axons in bipolar disorder Brain cell communication (neurotransmitters):

more norepinephrine (arousing) in mania, less in depression reduced serotonin in depression

Suicide and Self-Injury

Every year, 1 million people commit suicide, giving up on the process of trying to cope and improve their emotional well-being.

This can happen when people feel frustrated, trapped, isolated, ineffective, and see no end to these feelings.

Non-suicidal self-injury has other functions such as sending a message, distracting from emotional pain, giving oneself permission to feel, or self-punishment.

Depressive Explanatory

Style

Low Self-Esteem

Learned Helplessness

Rumination

Discounting positive information and assuming the worst about self, situation, and the future Self-defeating

beliefs such as assuming that one (self) is unable to cope, improve, achieve, or be happy

Depression is associated with:

Stuck focusing on what’s bad

Understanding Mood Disorders: The Social-Cognitive Perspective

Depressive Explanatory Style

Mood/result that goes along with

these views:

How we analyze bad news predicts mood.

Assumptions about the problem

The problem is:

The problem is:

The problem is:

Problematic event:

Depression’s Vicious CycleA depressed mood may develop when a person with a

negative outlook experiences repeated stress.

The depressed mood changes a person’s style of thinking and interacting in a way that makes stressful experience more likely.

Schizophrenia

Causes of symptoms: Brain: Dopamine

overactivity Abnormal brain

anatomy and activity Maternal virus during

pregnancy Associated genes

Schizophrenia symptoms: Disorganized thinking,

Delusions Disturbed perceptions:

Hallucinations Unusual emotions and

actions, including flat affect, and catatonia

Subtypes Onset and course

Split from reality and from self

Schizophrenia:the mind is split from reality, e.g. a split from one’s own thoughts so that they appear as hallucinations.

Psychosis refers to a mental split from reality and

rationality.Schizophrenia symptoms include: disorganized

and/or delusional thinking.

disturbed perceptions.

inappropriate emotions and actions.

Positive + presence of problematic behaviors

Negative - absence of

healthy behaviors

Hallucinations (illusory perceptions), especially auditory

Delusions (illusory beliefs), especially persecutory

Disorganized thought and nonsensical speech

Bizarre behaviors

Flat affect (no emotion showing in the face)

Reduced social interaction

Anhedonia (no feeling of enjoyment)

Avolition (less motivation, initiative, focus on tasks)

Alogia (speaking less) Catatonia (moving less)

Positive and Negative Symptoms of Schizophrenia

Schizophrenia Symptoms:Problems in Thinking and Speaking Disorganized speech,

including the “word salad” of loosely associated phrases

Delusions (illusory beliefs), often bizarre and not just mistaken; most common are delusions of grandeur and of persecution

Problems with selective attention, difficulty filtering thoughts and choosing which thoughts to believe and to say out loud

? ! ? !

? ! ? !

People with schizophrenia often experience hallucinations, that is, perceptual experiences not shared by others.

The most common form of hallucination is hearing voices that no one else hears, often with upsetting (e.g. shaming) content.

Hallucinations can also be visual, olfactory/smells, tactile/touch, or gustatory/taste.

You’re evil!Am I evil?

Schizophrenia Symptoms:Disturbed Perceptions

Odd and socially inappropriate responses such as looking bored or amused while hearing of a death

Flat affect: facial/body expression is “flat” with no visible emotional content

Impaired perception of emotions, including not “reading” others’ intentions and feelings

The schizophrenic body exhibits symptoms such as: repetitive behaviors such as rocking

and rubbing. catatonia, such as sitting motionless

and unresponsive for hours.

Schizophrenia Symptoms:Inappropriate Emotions and Actions

Onset and Development of Schizophrenia Onset: Typically,

schizophrenic symptoms appear at the end of adolescence and in early adulthood, later for women than for men.

Prevalence: Nearly 1 in 100 people develop schizophrenia, slightly more men than women.

Development: The course of schizophrenia can be acute/reactive or chronic.

Course of Schizophrenia

Acute/Reactive Schizophrenia In reaction to stress, some people develop positive symptoms such as hallucinations.

– Recovery is likely.Chronic/Process Schizophrenia develops slowly, with more negative symptoms .

– With treatment and support, there may be periods of a normal life, but not a cure.

– Without treatment, this type of schizophrenia often leads to poverty and social problems.

Subtypes of Schizophrenia

• Plagued by hallucinations, often with negative messages, and delusions, both grandiose and persecutory

Paranoid

• Primary symptoms are flat affect, incoherent speech, and random behavior

Disorganized

• Rarely initiating or controlling movement; copies others’ speech and actions

Catatonic

• Many varied symptomsUndifferentiated

• Withdrawal continues after positive symptoms have disappeared

Residual

What’s going on in the brain in schizophrenia?

Too many dopamine/D4 receptors help to explain paranoia and hallucinations; it’s like taking amphetamine overdoses all the time.

Poor coordination of neural firing in the frontal lobes impairs judgment and self-control.

The thalamus fires during hallucinations as if real sensations were being received.

There is general shrinking of many brain areas and connections between them.

Abnormal brain structure and activity

Understanding Schizophrenia

Understanding Schizophrenia

Are there biological risk factors affecting early development?

low birth weight maternal diabetes older paternal age famine oxygen deprivation during delivery maternal virus during mid-pregnancy

impairing brain development

Biological Risk Factors

Schizophrenia is more likely to develop in babies born: during and after flu

epidemics. in densely populated

areas. a few months after

flu season. after mothers had

the flu during the second trimester, or had antibodies showing viral infection.

The lesson is to:

Schizophrenia is somewhat more likely to develop when one or more of these factors is present:

get flu shots with early fall pregnancies.

Understanding SchizophreniaAre there genetic risk factors? If so, we would see more similar schizophrenia risk shared between identical twins than fraternal twins (graph below). Do we?

Having adoptive siblings (or parents) with schizophrenia does not increase the likelihood of developing schizophrenia.

Genetic FactorsIf one twin has schizophrenia, the chance of the other one also having it are much greater if the twins are identical.

Even in quadruplets, genetics do not fully predict schizophrenia.

This could be because of environmental differences.

First difference: twins in separate placentas.

Genetic and Prenatal Causes

Only one of two twins has the enlarged ventricles seen in schizophrenia.

The Genain quadruplets share genes and all have schizophrenia but at different levels of severity: genes may interact with environment to produce this pattern.

Understanding Schizophrenia

Dissociative Disorders: Separation of consciousness

Dissociative Identity Disorder: Is it real? How could it happen?

Personality Disorders: Severe, enduring problems relating to others

Focus on Antisocial Personality Disorder

Overlap with criminal activity

Brain differences Genes and social causes

Eating Disorders Anorexia and Bulimia Genes and social causes

A sample of a few of the many other psychological disorders

Other Disorders, Including Dissociative, Personality, and Eating Disorders

Dissociation: a separation of conscious awareness from thoughts, memory, bodily sensations, feelings, or even from identity.

Dissociative disorder: dysfunction and distress caused by chronic and severe dissociation.

Dissociative Disorders

Fugue = “Running away”; wandering away from one’s life, memory, and identity, with no memory of them

Development of separate personalities

Dissociative Fugue state

Dissociative Identity Disorder (D.I.D.)

Examples:

Dissociative Identity Disorder (D.I.D.) formerly “Multiple Personality Disorder”

In the rare actual cases of D.I.D., the personalities: are distinct, and not

present in consciousness at the same time.

may or may not appear to be aware of each other.

Alternative Explanations for D.I.D.

Dissociative “identities” might just be an extreme form of playing a role.

D.I.D. in North America might be a recent cultural construction, similar to the idea of being possessed by evil spirits.

Cases of D.I.D. might be created or worsened by therapists encouraging people to think of different parts of themselves.

D.I.D., or DID Not? Evidence that D.I.D. is Real

Different personalities have involved: different brain wave

patterns. different left-right

handedness. different visual acuity and

eye muscle balance patterns.

Patients with D.I.D. also show heightened activity in areas of the brain associated with managing and inhibiting traumatic memories.

Explaining fragmentation of personality from different perspectivesPsychoanalytic perspective:

diverting idCognitive perspective:

coping with abuseLearning perspective:

dissociation paysSocial influence:

therapists encourage

Definition Prevalence

Anorexia Nervosa

Compulsion to lose weight, coupled with certainty about being

fat despite being 15 percent or more underweight

0.6 percent meet criteria at

some time during lifetime

Bulimia Nervosa

Compulsion to binge, eating large amounts fast, then purge by losing

the food through vomiting, laxatives, and extreme exercise

1.0 percent

Binge-Eating Disorder

Compulsion to binge, followed by guilt and depression 2.8 percent

These may involve: unrealistic body image and

extreme body ideal. a desire to control food and the

body when one’s situation can’t be controlled.

cycles of depression. health problems.

Eating Disorders

Anorexia nervosaBulimia nervosa

Binge-eating disorder

Eating Disorders: Associated Factors

Family factors: having a mother focused on her

weight, and on child’s appearance and weight

negative self-evaluation in the family

for bulimia, if childhood obesity runs in the family

for anorexia, if families are competitive, high-achieving, and protective

Cultural factors: unrealistic ideals of body

appearance

Personality disorders are enduring patterns of

social and other behavior that impair

social functioning.

There are three “clusters”/categories of personality disorders. Anxious: e.g., Avoidant P.D., ruled by fear of social

rejection Eccentric/Odd: e.g. Schizoid P.D., with flat affect,

no social attachments Dramatic: e.g. Histrionic, attention-seeking;

narcissistic, self-centered; antisocial, amoral

Personality Disorders

Antisocial Personality Disorder [APD]

Antisocial personality disorder: Persistently acting without conscience, without a sense of guilt for harm done to others (strangers and family alike).The diagnostic criteria include a pattern of violating the rights of others since age 15, including three of these:

DeceitfulnessDisregard for safety of self or

othersAggressiveness

Failure to conform to social norms

Lack of remorseImpulsivity and failure to plan

aheadIrritability

Irresponsibility regarding jobs, family, and money

Which Kids May Develop APD as Adults?

About half of children with persistent antisocial behavior develop lifelong APD.Which kids are at risk? Psychological factors: those who in preschool

were impulsive, uninhibited, unconcerned with social rewards, and low in anxiety.

those who endured child abuse, and/or inconsistent, unavailable caretaking.

Biological APD Risk Factors Antisocial or unemotional biological

relatives increases risk. Some associated genes have

been identified. Lower levels of stress hormones

and low physiological arousal in stressful situations

Fear conditioning is impaired. Reduced prefrontal cortex tissue

leads to impulsivity. Substance dependence is more

likely.

Antisocial PD ≠ Criminality

Criminals: people who repeatedly commit crimes

People with antisocial

personality disorder

Many career criminals do show empathy and selflessness with family and friends.Many people with A.P.D. do not commit crimes.

Antisocial Crime: Associated factorsThough antisocial personality disorder is not a full picture of most criminal activity, what can we say about people who commit crime, especially violent crime?Lower levels of physiological arousal (measured here as adrenaline levels) under stress may enable taking violent action without feeling anxiety or panic.

Biosocial Roots of Crime: The BrainPeople who commit murder seem to have less tissue and activity in the part of the brain that suppresses impulses.

Other differences include: less amygdala response when viewing violence. an overactive dopamine reward-seeking system.

How common are psychological disorders?

Countries vary greatly in the percentage of people reporting mental health issues in the past year.

Rates of Psychological

Disorders

This list takes a closer look at the past-year prevalence of various mental health diagnoses in the United States.

Vulnerable factors and ages for developing Mental Disorders

Who is vulnerable to mental disorders?

• Poverty increases the risk of many mental disorders including aggression and anxiety. Disorders decrease when poverty is lifted.

• “Immigrant paradox”: Despite the stress of immigrating, those who immigrate to the U.S.A. have a lower risk of disorders than their children born in the U.S.A.

Age of vulnerability:• Many disorders begin to show

symptoms by early adulthood. • Developing on average around

age 20: OCD, Schizophrenia, Bipolar, Alcohol Dependence.

• Showing some signs earlier: Phobias (median age 10) and antisocial personality disorder (some symptoms by age 8)

• Developing later than 20: Major Depressive Disorder.

Outcomes for People with Psychological Disorders

There are risks to be watchful of, obstacles to be overcome, and improvements to be made, often with the help of with treatment. Some people with psychological

disorders do not recover. Some achieve greatness, even with a

psychological disorder.