Psychological DisordersChapter 15

AP PsychologyAlice F. Short

Hilliard Davidson High School

Chapter Preview

• Defining/Explaining Abnormal Behavior• Anxiety Disorders• Mood Disorders• Dissociative Disorders• Schizophrenia• Personality Disorders• Psychological Disorders and Health and

Wellness

Abnormal Behavior

• abnormal behavior - behavior that is…– deviant (atypical)

• example: washing hands 4x an hour– maladaptive (dysfunctional)

• example: believing that you can hurt people by breathing and hiding away and avoiding people

– personally distressing (despair)• example: feeling extreme shame or guilt… over a relatively long period of time

NOTE: context matters!

Theoretical Approaches

• Biological Approach: Medical Model– disorders with biological origins

• Psychological Approach– experiences, thoughts, emotions, personality

• Sociocultural Approach– social context

• Biopsychosocial Model– interaction of biological, psychological and

sociocultural factors

Theoretical ApproachesBiological Approach: Medical Model

• medical model – the view that psychological disorers are medical diseases with biological origin– disorders with biological origins – abnormalities = mental illnesses– patients = afflicted individuals– doctors = people who treat the patients

Theoretical Approaches:Psychological Approach

• psychological approach – focuses on experiences, thoughts, emotions, personality– in the development and course of psychological

disorders

Theoretical Approaches:Sociocultural Approach

• Sociocultural Approach– social context• includes: gender, ethnicity, socioeconomic status,

family relationships, culture, technological aspects of culture, religious aspects of culture• socioeconomic status = greater impact than ethnicity

– living conditions of poverty = stressful

Theoretical Approaches:Biopsychosocial Model

• Biopsychosocial Model– interaction of biological, psychological and

sociocultural factors– biological factors (such as genes)– psychological factors (such as childhood

experiences)– sociocultural factors (such as gender)

DSM-V Classification System

• Advantages– provides a common basis for communication– helps clinicians make predictions– naming the disorder can provide comfort

• Disadvantages– stigma (shame, negative reputation)– medical terminology implies internal cause– focus on weaknesses ignores strength

• DISUCSSION: Which do you think is more significant—the advantages or disadvantages?

Critical Controversy: Psychological Disorders –

Real or Myth?

• Szasz & Cruise– phrase “mental illness” is presumptuous– medication of mental illnesses is presumptuous

• Response of Medical Professionals– mental illnesses are real medical conditions– drugs effectively alleviate symptoms

• ADHD: over-diagnosed or non-medical?– should prescription drugs be used to treat ADHD?

Critical Controversy:A SHORT Time to Ponder

• When do you think it is appropriate to label someone as having a psychological disorder?

• When do you think medical treatments for psychological disorders are appropriate?

• If a teacher suggested that your child be tested for ADHD, what do you think you would do? Why?

DSM-V-TR Axes

• Multiaxial System– Axis I and II: Psychological Disorders– Axis III: Another Medical Conditions– Axis IV: Psychosocial/Environmental Problems– Axis V: Current Level of Functioning

Axis I Disorders• Major Categories:

– disorders usually first diagnosed in infancy, childhood, or adolescence and communication disorders

– anxiety disorders– somatoform disorders– factitious disorders– dissociative disorders– delirium, dementia, amnesia, and other

cognitive disorders– mood disorders– schizophrenia and other psychotic disorders– substance-related disorders– sexual and gender identity disorders– eating disorders– sleep disorders– impulse control disorders not elsewhere

classified– adjustment disorders

Axis II Disorders

• Major Categories:– intellectual disability– personality disorders– other conditions that may be a focus of clinical

attention

Anxiety Disorders• anxiety disorders - uncontrollable fears that are

disproportionate to the actual danger and disruptive to ordinary life (Axis I) – generalized anxiety disorder– panic disorder– phobic disorder– separation anxiety disorder– selective mutism – obsessive-compulsive disorder

• now in the obsessive-compulsive and related disorders– post-traumatic stress disorder

• now in the trauma- and stressor-related disorders– sequential order of chapter reflects close relationship

Generalized Anxiety Disorder• Diagnosis and Symptoms– persistent anxiety for at least 6 months– inability to specify reasons for the anxiety

• Etiology – the causes or significant preceding conditions– biological factors

• genetic predisposition, GABA deficiency, sympathetic nervous system activity, respiration

– psychological and sociocultural factors• harsh self-standards, critical parents, automatic negative thoughts,

history of uncontrollable trauma (like an abusive parent)

Panic Disorder• Diagnosis and Symptoms

– recurrent, sudden onsets of intense terror that often occur without warning

– panic attacks: can produce sever palpitations, extreme shortness of breath, chest pains, trembling, sweating, dizziness and a feeling of helplessness• types changed to unexpected panic attack and expected panic attack

– panic disorder and agoraphobia are unlinked• Etiology

– biological factors: genetic predisposition– psychological factors: misinterpret arousal– sociocultural factors: gender differences

• American women = 2x as likely to suffer from a panic disorder

• FUN FACT: Charles Darwin had a panic disorder

Phobic Disorder• Diagnosis and Symptoms

– an irrational, overwhelming, persistent fear of a particular object or situation • social anxiety disorder social phobia – an intense fear of being humiliated or

embarrassed in social situations– deletion of requirement that individuals over age 18 years recognize that

their anxiety is excessive or unreasonable– 6-month duration expanded to include all ages– panic disorder and agoraphobia are unlinked– “generalized” specifier has been deleted and replaced with a “performance

only” specifier (fear of speaking/performing in front of an audience)• Etiology

– biological factors: genetic disposition• neural circuit: thalamus, amygdala and cerebral cortex

– psychological factors: learned • classical conditioning / learned associations

Examples of Phobic Disorders• phobic disorders – it is no longer a requirement

that individuals over age 18 years must recognize that their fear and anxiety are excessive or unreasonable

Social Anxiety Disorders in the US

• social anxiety disorder (formerly called social phobias)

Obsessive Compulsive and Related Disorders

• Diagnosis and Symptoms– persistent anxiety-provoking thoughts and/or urges to perform

repetitive, ritualistic behaviors to prevent or produce a situation– cognitive perspective: inability to turn off negative, intrusive

thoughts by ignoring or effectively dismissing them– obsession – recurrent thoughts– compulsions – recurrent behaviors– most common: excessive checking, cleansing, counting

• Etiology– biological factors: genetic predisposition

• more activity in frontal cortex, basal ganglia, thalamus• smaller amygdala (counter-intuitive)• lower levels of serotonin and dopamine

– psychological factors: life stress

Obsessive-Compulsive and Related Disorders

• new disorders:– hoarding disorder– excoriation (skin-picking) disorder– substance-/medication induced obsessive-compulsive and

related disorder– obsessive-compulsive related disorder due to another medical

condition• from impulse-control disorders

– trichotillomania (hair-pulling) disorder• new specifiers

– “with poor insight”… “fair”… “good”… “absent insight/delusional”

Post-Traumatic Stress Disorder (PTSD)

• Diagnosis and Symptoms– Symptoms develop as a result of exposure to a traumatic

event--oppressive situation, natural or unnatural disasters—that have overwhelmed the person’s abilities to cope• flashbacks reliving event• avoidance of emotional experiences/talking with others• constricted ability to feel emotions• excessive arousal inability to sleep, exaggerated startle response• difficulties with memory and concentration• feelings of apprehension• impulsive outbursts

– 4 major symptom clusters: reexperiencing, avoidance, persistent negative alteration in cognitions and mood, arousal

Post-Traumatic Stress Disorder• Etiology– stressor criterion: requires being explicit to whether

qualifying traumatic events were experienced directly, witnessed, or experienced indirectly• subjective reaction (removed)

– trauma• combat and war-related• sexual abuse and assault• natural and unnatural disasters (plane crashes, terrorists attacks)

– vulnerability• previous history of trauma• conditions: abuse, psychological disorders• genetic predispositions

Mood Disorders• mood disorder - disturbance of mood that affects entire

emotional state (Axis I Disorder)1. depressive disorders– major depressive disorder– dysthymic disorder

2. bipolar disorderso correlate: suicide

• Symptoms may include– cognitive, behavioral, or physical symptoms– interpersonal difficulties

• Diagnosis and Symptoms– significant depressive episode that lasts for at least two weeks– defined by presence of at least 5 out of 9

symptoms• depressed mood most of the day• reduced interest or pleasure in all or most activities• significant weight loss or gain or significant decrease or

increase in appetite• trouble sleeping or sleeping too much• psychological and physical agitation, or, in contrast, lethargy• fatigue or loss of energy• feeling worthless or guilty in an excessive or inappropriate manner• problems thinking, concentrating, or making decisions• recurrent thoughts of death and suicide• no history of manic episodes (periods of euphoric moods)

– daily functioning is impaired– the coexistence of within a major depressive episode of at least three manic

symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier “with mixed feature” increases likelihood illness exists in bipolar spectrum

– bereavement exclusion removed - was an exclusion applied to depressive symptoms lasting less than 2 months following the death of a loved one

Major Depressive

Disorder (MDD)

Persistent Depressive Disorder:Dysthymic Disorder (DD)

• Diagnosis and Symptoms– chronic depression

• unbroken depressed mood lasting at least two years (adult) or one year (child)– adult: less than two months regular mood still = diagnosis

– fewer symptoms than MDD• defined by presence of 2 out of 6 symptoms

– poor appetite or overeating– sleep problems– low energy or fatigue– low self-esteem– poor concentration or difficulty making decisions– feelings of hopelessness

– dysthymic disorder now falls in category of persistent depressive disorder (along with chronic major depressive disorder)

Major Depressive Disorder (MDD)• Etiology– biological factors: genetic disposition

• underactive prefrontal cortex• regulation of neurotransmitters

– serotonin– norepinephrine

– psychological factors: • learned helplessness• ruminating on negative, self-defeating thoughts• pessimistic attribution

– sociocultural factors• poverty

– women head of households– minorities

• gender differences (women = 2x likely)

Childhood Depression

• Developmental Psychopathology– risk factors for depression• parental psychopathology• genetics

– protective factors• supportive adult role model, or strong extended family• genetics

Mood Disorder: Bipolar Disorder• Characterized by extreme mood swings

– Bipolar I (more severe)• hallucinations – seeing or hearing things that are not there• mania – an overexcited, unrealistically optimistic state• new specifier of “with mixed features” (meeting full criteria for both has been

removed) – Bipolar II

• less extreme level of euphoria– manic and hypomanic episodes now include an emphasis on changes in

activity and energy as well as mood• Frequency and separation of episodes

– usually separated by 6 months to a year• Etiology

– strong genetic component– swings in metabolic activity in cerebral cortex– levels of neurotransmitters

• high levels of norepinephrine, glutamate• low levels of serotonin

Suicide

• Prevalence– over 32,000 in year 2004– one completion for every 8 to 25 attempts– 3rd leading cause of death in early adolescence • 10-14• 13-19

Suicide• Biological factors

– low levels of serotonin– 10x likely to try again– poor health

• Psychological Factors– mental disorders

• 90 percent– trauma (recent/immediate and highly stressful)

• sexual abuse• loss of a job/flunking out of school/unwanted pregnancy

– substance abuse• Sociocultural Factors

– chronic economic hardship– cultural and religious norms

• norms against suicide = lower rates• eastern Europe, Japan, South Korea

– gender differences

When Someone is Threatening Suicide• attempters: connection to others

– women 3x morel likely to attempt• completers: disconnected / burden on others

– men 4x more likely to complete suicide; more likely to use a firearm– highest suicide rate is among non-Latino men aged 85+

Dissociative Disorder• dissociative disorder - sudden loss of memory or change in

identity due to the dissociation (separation) of the individual’s conscious awareness from previous memories and thoughts

• Dissociation – protection from extreme stress or shock– problems integrating emotional memories

• Types– dissociative amnesia– dissociative fugue * is now a specifier of dissociative amnesia rather

than a separate diagnosis – dissociative identity disorder (DID)

Dissociative Disorders

• Dissociative Amnesia– individuals experience extreme memory loss caused by

extensive psychological stress– only aspects of their own identity and autobiographical

experiences are forgotten• Example: sodium pentathol “truth serum” stress

– Dissociative Fugue• dissociative fugue * is now a specifier of dissociative amnesia

rather than a separate diagnosis • individuals experience amnesia, unexpectedly travel away, and

sometimes assume a new identity• tendency to run away*

Dissociative Identity Disorder (DID)• formerly known as multiple personality disorder• most dramatic, least common, most controversial dissociative disorder • Diagnosis and Symptoms

– the same individual possesses two or more distinct personalities– symptoms of disruption may be reported as well as observed– each personality has unique memories, behaviors, and relationships– only one personality is dominant at a time– personality shifts (and gaps in recall) occur under distress and everyday (not just

traumatic events)– * “experiences of pathological possession in some cultures are included in the

description of identity disruption”• Etiology

– extraordinarily severe abuse in early childhood (70%)– social contagion– mostly women– runs in families

• individual compartmentalizes different aspects of the self into independent identities

Schizophrenia• highly disordered thought

– thought disorder – refers to the unusual, sometimes bizarre thought processes that are characteristic positive symptoms of schizophrenia

– split from reality (psychotic)– typically diagnosed in early adulthood– high suicide risk (8x general population)

• categories of symptoms:– positive symptoms

• hallucinations• delusions• thought disorders• disorders of movement

– negative symptoms

Symptoms of Schizophrenia

• Positive Symptoms – hallucinations – sensory experiences in the

absence of real stimuli• auditory and visual = more common• smells or tastes = less common

– delusions – false, unusual, and sometimes magical beliefs that are not part of an individual’s culture• believing you’re Jesus Christ, Muhammad, etc.• that your thoughts are being broadcast over the radio, etc.

– disorganized speech * in DSM-V must have one of these core positive symptoms– thought disorder

• “word salad”; neologisms – making up new words• referential thinking – ascribing personal meaning to completely random events – traffic light turned red

because YOU’RE in a hurry– disorders of movement – unusual mannerisms, body movements, facial expressions, may

repeat certain motions over and over• catatonia – state of immobility and unresponsiveness lasting for long periods of time (all contexts require 3

catatonic symptoms (of 12); may be diagnosed as specifier for depressive, bipolar, psychotic disorders)

• Negative Symptoms – flat affect – the display of little or no emotion (common)

• Cognitive Symptoms– attention difficulties and memory problems– impaired ability to interpret information and make decisions

• subtypes of schizophrenia are removed in DSM-V (paranoid, disorganized, catatonic, undifferentiated, residual, etc.)

Etiology of Schizophrenia

• Biological Factors– genetic predisposition– structural brain abnormalities

(no glial cells prenatal)• enlarged ventricles (fluid-filled spaces) in brain indicates deterioration in other brain tissue

• smaller and less active prefrontal cortex– regulation of neurotransmitters

• excess dopamine production (or overactivation of pathways)– bizarre beliefs continue after dopamine regulation may disappear only after

experience demonstrates that such schemas no longer carry their explanatory power

• Psychological Factors– diathesis-stress model – view of schizophrenia emphasizing that a

combination of biogenetic disposition and stress causes the disorder– diathesis – physical vulnerability or predisposition to a particular

disorder• Sociocultural Factors

– influence how disorder progresses (course)– developing, non-industrialized countries have better results

Personality Disorders

• personality disorder - chronic maladaptive cognitive-behavioral patterns– antisocial personality disorder– borderline personality disorder

• Antisocial Personality Disorder– Diagnosis and Symptoms

• guiltless lawbreaking, violence, deceit• impulsive, irritable, reckless, irresponsible• exploitative, lacks empathy

– psychopaths – remorseless predators who engage in violence to get what they want (examples: John Wayne Gacy, Ted Bundy)• “successful psychopaths” and “unsuccessful psychopaths”

– Etiology• biological factors

– genetic heritable– brain: less prefrontal activation, structural abnormalities in amygdala and hippocampus – underaroused ANS (autonomic nervous system) differences– testosterone – hormone most associated with aggressive behavior

• more common in men

Personality Disorders

• Borderline Personality Disorder– Diagnosis and Symptoms

• instability in interpersonal relationships & self-image

• impulsive, insecure, unstable & extreme emotions• very sensitive to treatment of others• paranoia – a pattern of disturbed thought featuring delusion of grandeur or

persecution• dissociative symptoms• recurrent suicidal behavior, gestures, or threats or self-mutilating behaviors

– cutting – insuring oneself with a sharp object but without suicidal attempt• splitting – thinking style of seeing things in black or white

– Etiology• genetic (40% heritability)• childhood abuse, neglect – suggests diathesis-stress explanation• irrational belief one is powerless, unacceptable, and that others are hostile

– hypervigilance – the tendency to be constantly on the alert, looking for threatening information in the environment

• 75% women

Psychological Disorders and Health and Wellness

• Stereotypes and Stigma– Rosenhan’s study - fake psychiatric patients• 3-52 days hospitalization for (FAKE) schizophrenia

– negative attitudes toward mentally ill– physical health risk – successfully functioning individuals with mental

illness reluctant to “come out”

Chapter Summary• Discuss the characteristics, explanations, and

classifications of abnormal behavior.• Distinguish among the various anxiety disorders.• Compare the mood disorders and specify risk factors for

depression and suicide.• Describe the dissociative disorders.• Characterize schizophrenia.• Identify behavior patterns typical of personality disorders.• Explain the impact of the stigma associated with mental

illness.

Chapter Summary

• Abnormal Behavior– deviant, maladaptive, or personally distressing

• Theoretical Approaches– biological, psychological, and sociocultural– biopsychosocial

• Classifying Abnormal Behavior– DSM-IV-TR Axes– advantages and disadvantages

Chapter Summary

• Anxiety Disorders– generalized anxiety disorder – panic disorder– phobic disorder– obsessive-compulsive disorder– post-traumatic stress disorder

Chapter Summary

• Mood Disorders– major depressive disorder – dysthymic disorder– bipolar disorder– suicide

• Dissociative Disorders– dissociative amnesia– dissociative fugue– dissociative identity disorder

Chapter Summary

• Schizophrenia– positive, negative and cognitive symptoms– etiology (biological, psychological, sociocultural)

• Personality Disorders– antisocial personality disorder– borderline personality disorder

• Psychological Disorders and Health & Wellness– stigmas and stereotypes