psychological disorders chapter 15 copyright 2003 allyn & bacon this multimedia product and its...
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Psychological Disorders
Chapter 15
Copyright 2003 Allyn & Bacon
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Slide authors:
Larry D. Thomas
Landon O. Thomas
Book authors:
R. H. Ettinger
Copyright © 2007 Horizon Textbook Publishing All rights reserved
What Is Abnormal?
Defining mental disorders– Several questions can help determine what behavior
is abnormal: Is the behavior considered strange within the person’s own
culture Does the behavior cause personal distress Is the behavior maladaptive Is the person a danger to self of others Is the person legally responsible for his or her acts
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What Is Abnormal?
Prevalence of psychological disorders– Mental disorders have a lifetime prevalence rate of
nearly 50%– Mental disorders represent a significant source of
personal misery for individuals and lost productivity for society
Explaining psychological disorders– Biological perspective
Views abnormal behavior as arising from a physical cause, such as genetic inheritance, biochemical abnormalities or imbalances, structural abnormalities within the brain, and/or infections
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What Is Abnormal?
Explaining psychological disorders (continued)– Biopsychosocial perspective
Agrees that physical causes are of central importance but also recognizes the influence of biological, psychological, and social factors in the study, identification, and treatment of psychological disorders
– Psychodynamic perspective Originally proposed by Feud Maintains that psychological disorders stem from early
childhood experiences and unresolved, unconscious conflicts, usually of a sexual or aggressive nature
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Psychological Disorders
Bio-psycho-social Perspective
– assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders
Biological(Evolution, individual
genes, brain structures
and chemistry)
Psychological(Stress, trauma,
learned helplessness, mood-related perceptions
and memories)
Sociocultural(Roles, expectations, definition of normality
and disorder)
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What Is Abnormal?
Explaining psychological disorders (continued)– Learning perspective
Psychological disorders are thought to be learned and sustained in the same way as any other behavior
– Cognitive perspective suggests that faulty thinking or distorted perceptions can
contribute to some types of psychological disorders
– Irrespective of theoretical perspective, all clinicians and researchers use the same set of criteria to classify psychological disorders
– The American Psychiatric Association publishes a manual (DSM-IV-TR) listing these criteria
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Anxiety Disorders
Generalized anxiety disorder– An anxiety disorder in which people experience
excessive anxiety or worry that they find difficult to control
– These people expect the worst– Their excessive anxiety may cause them to feel
tense, tired, and irritable, and to have difficulty concentrating and sleeping
– This disorder affects twice as many women as men and leads to considerable distress and impairment
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Anxiety Disorders
Panic disorder– An anxiety disorder in which a person experiences
recurrent unpredictable attacks of overwhelming anxiety, fear, or terror
– Panic attacks An attack of overwhelming anxiety, fear, or terror
– Panic-disorder patients tend to overuse the health care system and are at increased risk for abuse of alcohol and other drugs
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Anxiety Disorders
Phobias– An intense fear of being in a situation form which
immediate escape is not possible or in which help is not immediately available in case of incapacitating anxiety
– Agoraphobia A persistent, irrational fear of an object, situation, or activity
that the person feels compelled to avoid An agoraphobic often will not leave home unless
accompanied by a friend or family member and, in severe cases, not even then
Women are four times more likely than men to be diagnosed with agoraphobia
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Anxiety Disorders
Phobias (continued)– Social phobia
An irrational fear and avoidance of social situations in which one might embarrass or humiliate oneself by appearing clumsy, foolish, or incompetent
About one-third of social phobics fear only speaking in public
In its extreme form, it can seriously affect people’s performance at work, prevent them from advancing in their careers or pursuing an education, and severely restrict their social lives
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Anxiety Disorders
Phobias (continued)– Specific phobia
A marked fear of a specific object or situation The categories of specific phobias, in order of frequency of
occurrence, are (1) situational phobias (2) fear of the natural environment (3) animal phobias and (4) blood-injection-injury phobia
– A person has three times the risk of developing a phobia if a close relative suffers form one
– A therapist my use classical conditioning principles to teach patients to associate pleasant emotions with feared objects or situations
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Anxiety Disorders
Common and uncommon fears
Afraid of it Bothers slightly Not at all afraid of it
Beingclosed in,
in a smallplace
Being alone
In a house
at night
Percentageof peoplesurveyed
100
90
80
70
60
50
40
30
20
10
0Snakes Being
in high,exposedplaces
Mice Flyingon an
airplane
Spidersand
insects
Thunderand
lightning
Dogs Drivinga car
Being In a
crowdof people
Cats
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Anxiety Disorders
Obsessive compulsive disorder (OCD)– An anxiety disorder in which a person suffers form
obsessions and/or compulsions– Obsessions
A persistent, recurring, involuntary though, image, or impulse that invades consciousness and causes great distress
– People with obsessions might worry about contamination or about whether they performed a a certain act, such as turning off the stove or locking the door
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Anxiety Disorders
Obsessive compulsive disorder (continued)– Compulsion
A persistent, irresistible, irrational urge to perform an act or ritual repeatedly
– The individual knows such acts are irrational and senseless but cannot resist performing them without experiencing an intolerable buildup of anxiety-anxiety that can be relieved only by yielding to the compulsion
– People with OCD realize their behavior is not normal; but they simply cannot help themselves
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Anxiety Disorders
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Anxiety Disorders
PET Scan of brain of person with Obsessive/ Compulsive disorder
High metabolic activity (red) in frontal lobe areas involved with directing attention
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Anxiety Disorders
Common Obsessions and Compulsions AmongPeople With Obsessive-Compulsive Disorder
Thought or Behavior
Percentage*Reporting Symptom
Obsessions (repetitive thoughts)
Concern with dirt, germs, or toxins 40
Something terrible happening (fire, death, illness) 40
Symmetry order, or exactness 24
Excessive hand washing, bathing, tooth brushing, 85or grooming
Compulsions (repetitive behaviors)
Repeating rituals (in/out of a door, 51up/down from a chair)Checking doors, locks, appliances, 46 car brake, homework
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Identifying Anxiety DisordersRead each of the four descriptions below and place a checkmark beside
each description that sounds like you or someone you know.1. You are always worried about things, even when there are
no signs of trouble. You have frequent aches and pains that can’t be traced to physical illness or injury. You tire easily, and yet you have trouble sleeping. Your body is constantly tense.
2. Out of the blue, your heart starts pounding. You feel dizzy. You can’t breathe. You feel like you are about to die. You’ve had these symptoms over and over again.
3. Every day you fear you will do something embarrassing. You’ve stopped going to parties because you’re afraid to meet new people. When other people look at you, you break out in a sweat and shake uncontrollably. You stay home from work because you’re terrified of being called on in a staff meeting
4. You are so afraid of germs that you wash you hands repeatedly until they are raw and sore. You can’t leave the house until you check the locks on every window and door over and over again. You are terrified that you will harm someone you care about. You just can’t get those thoughts out of your head
Generalized Anxiety Disorder
Panic Disorder
Agoraphobia
Obsessive/ Compulsive Disorder
(From NIMH, 1999.)
Copyright © 2004 Allyn & Bacon All rights reserved
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Mood Disorders
Disorders characterized by extreme and unwarranted disturbances in feeling or mood
Depressive disorders– Major depressive disorder
A mood disorder marked by feelings of great sadness, despair, guilt, worthlessness, and hopelessness
Key symptoms of major depressive disorder are psychomotor disturbances
– Depression can be so severe tat its victims suffer form delusions or hallucinations, which are symptoms of psychotic depression
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Mood Disorders
Culture, gender, and depression– One large study involving participants form ten
countries revealed that the lifetime risk for developing depression varied greatly around the world
– Before boys reach puberty, they are more likely than girls to be depressed, but at adolescence a dramatic reversal in the gender-related depression rates takes place
– Not only are women more likely to suffer form depression, they are also more likely to be affected by negative consequences as a result
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Mood Disorders-Depression
Percentageof
populationaged 18-84
experiencingmajor
depressionat some
point In life
20
15
10
5
0
USA Edmonton Puerto Paris West Florence Beirut Taiwan Korea New Rico Germany Zealand
Around the worldwomen are more
susceptible todepression
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Mood Disorders-Depression
12-17 18-24 25-34 35-44 45-54 55-64 65-74 75+
Age in Years
10%
8
6
4
2
0
Percentagedepressed
Females
Males
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Mood Disorders
Bipolar disorder– A mood disorder in which manic episodes alternate
with periods of depression, usually with relatively normal periods in between
– Manic episode A period of extreme elation, euphoria, and hyperactivity,
often accompanied by delusions of grandeur and by hostility if activity is blocked
Such episodes are marked by excessive euphoria, inflated self-esteem, wild optimism, and hyperactivity
People in a manic state have temporarily lost touch with reality and frequently have delusions of grandeur along with their euphoric highs
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Mood Disorders
Bipolar disorder (continued)– Bipolar disorder is much less common than major
depressive disorder– Bipolar disorder tends to appear in late adolescence
or early childhood, and, unfortunately, about 90% of those with the disorder have recurrences, and half experiences another episode within a year of recovering form a previous one
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Mood Disorders-Bipolar
PET scans show that brain energy consumption rises and falls with emotional swings
Depressed state Manic state Depressed state
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Mood Disorders
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Mood Disorders-Depression
Altering any one component of the chemistry-cognition-mood circuit can alter the others
Brainchemistry
Cognition
Mood
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Mood Disorders-Depression
The vicious cycle of depression can be broken at any point
1Stressful
experiences
4Cognitive and
behavioral changes
2Negative
explanatory style
3Depressed
mood
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Mood Disorders-Depression
A happy or depressed mood strongly influences people’s ratings of their own behavior
Negative Positivebehaviors behaviors
Self-ratings
35%
30
25
20
15
Percentage ofobservations
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Mood Disorders
Causes of mood disorders– Biological factors such as genetic inheritance and
abnormal brain chemistry play a major role in bipolar disorder and major depressive disorder
– Drevets and others Located a brain area that may trigger both the sadness of
major depression and the mania of bipolar disorder A small, thimble-size patch of brain tissue in the lower
prefrontal cortex hereditary depression
– Researchers have found that patterns of dopamine, GABA, and norepinephrine production, transport, and reuptake in people suffering from mood disorders differ from those of normal individuals
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Mood Disorders
Causes of mood disorders (continued)– In one twin study, researchers found that 50% of the
identical twins of bipolar sufferers had also been diagnosed with a mood disorder, compared to only 7% of fraternal twins
– Depressed individuals view themselves, their world, and their future all in negative ways
– Depressed persons believe they are deficient, unworthy, and inadequate, and they attribute their perceived failures to their own physical, mental, or moral inadequancies
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Mood Disorders
Causes of mood disorders (continued)– The vast majority of first episodes of depression
strike after major life stress– Cui and Vaillant
Found that negative life events as well as family history played significant roles in the development of mood disorders
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Mood Disorders
Suicide and race, gender, and age– Whites are more likely to commit suicide than
African Americans– Native American suicide rates are similar to those of
whites; rates for Hispanic Americans are similar to those of African Americans
– Suicide rates are far lower for both White and African American women than for men
– Older Americans are at far greater risk for suicide than younger people
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Mood Disorders
Suicide and race, gender, and age (continued)– Poor general health, serious illness, loneliness, and
decline in social and economic status are conditions that may push many older Americans, especially those aged 75 and over, to commit suicide
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Mood Disorders- Suicide
15-24 25-34 35-44 45-44 55-64 65-74 75-84 85+
Suicides per100,000 people
70
60
50
40
30
20
10
0
Males Females
The higher suicide rateamong men greatly increases in late adulthood
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Mood Disorders-Suicide
Increasing rates of teen suicide
1960 1970 1980 1990 2000Year
12%
10
8
6
4
2
0
Suicide rate,
ages 15 to 19
(per 100,000)
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Schizophrenia
A severe psychological disorder characterized by loss of contact with reality, hallucinations, delusions, inappropriate or flat affect, some disturbance in thinking, social withdrawal, and/or other bizarre behavior
Positive symptoms of schizophrenia– Positive symptoms are the abnormal behaviors that
are present in people with schizophrenia– Hallucinations
A sensory perception in the absence of any external sensory stimulus; an imaginary sensation
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Schizophrenia
Positive symptoms of schizophrenia (continued)– Schizophrenic patients may see, hear, feel, taste, or
smell strange things in the absence of any stimulus in the environment, but hearing voices is the most common type of hallucinations
– Delusions A false believe, not generally shared by other in the
culture, that cannot be changed despite strong evidence to the contrary
– Delusions of grandeur A false belief that one is a famous person or a person who
has some great knowledge, ability, or authority
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Schizophrenia
Positive symptoms of schizophrenia (continued)
– Delusions of persecutions A false belief that a person or group is trying in some way
to harm one– Another positive symptom is the loosening of associations, or
derailment, when a schizophrenic does not follow one line of though to completion, but on the basis of vague connections shifts from one subject to another in conversation or writing
– Schizophrenics may also display inappropriate affect; that is, their facial expressions, tone of voice, and gestures ma not reflect the emotion that would be expected under the circumstances
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Schizophrenia
Negative symptoms of schizophrenia– A negative symptom of schizophrenia is a loss of or
deficiency in thoughts and behaviors that are characteristic of normal functioning
– Negative symptoms include social withdrawal, apathy, loss of motivation, lack of goal-directed activity, very limited speech, slowed movements, poor hygiene and grooming, poor problem-solving abilities, and a distorted sense of time
– Flat affect Showing practically no emotional response at all, even
though they often report feeling the emotion
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Schizophrenia
Brain abnormalities in schizophrenics– Many schizophrenics have defects in the neural
circuitry of the cerebral cortex and limbic system– There is also evidence of reduced volume in the
hippocampus, amygdala, thalamus, frontal lobe gray matter
– Abnormal activity in the brain’s dopamine system is found in many schizophrenics
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Schizophrenia
Types of schizophrenia– Paranoid schizophrenia
A type of schizophrenia characterized by delusions of grandeur or persecution
Paranoid schizophrenics often show exaggerated anger and suspiciousness
– Disorganized schizophrenia The most serious type of schizophrenia, marked by
inappropriate affect, silliness, laughter, grotesque mannerisms, and bizarre behavior
Tends to occur at an earlier age than the others types
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Schizophrenia
Types of schizophrenia (continued)– Catatonic schizophrenia
A type of schizophrenia characterized by complete stillness or stupor and/or periods of great agitation and excitement; patients may assume an unusual posture and remain in it for long periods
– Undifferentiated schizophrenia A catchall term for people who display symptoms of
schizophrenia but who do not fit into other categories
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Schizophrenia
Subtypes of Schizophrenia
Paranoid: Preoccupation with delusions or hallucinations
Disorganized: Disorganized speech or behavior, or flat or inappropriate emotion
Catatonic: Immobility (or excessive, purposeless movement), extreme negativism, and/or parrotlike repeating of
another’s speech or movements
Undifferentiated Schizophrenia symptoms without fitting one of the or residual: above types
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Schizophrenia
Risk factors in schizophrenia– Schizophrenia develops when there is both a
genetic predisposition toward the disorder and more stress than a person can handle
– Schizophrenia is more likely to strike men than women
– The earlier age of onset of the disorder among males appears to be independent of culture and socioeconomic variables
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Schizophrenia
Lifetime riskof developingschizophrenia
for relatives of a schizophrenic
40
30
20
10
0General
populationSiblings Children Fraternal
twinChildrenof two
schizophrenia victims
Identicaltwin
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Somatoform and Dissociative Disorders
Somatoform disorders– Disorders in which physical symptoms are present
that are due to psychological rather than physical causes
– People with somatoform disorders are not consciously faking illness to avoid work or other activities
– Hypochondriasis A somatoform disorder in which persons are preoccupied
with their health and convinced they have some serious disorder despite reassurance from doctors to the contrary
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Somatoform and Dissociative Disorders
Somatoform disorders (continued)– Conversion disorder
A somatoform disorder in which a person suffers a lost of motor or sensory functioning in some part of the body; the loss has no physical cause but solves some psychological problem
– A person may become blind, deaf, or unable to speak or may develop a paralysis in some part of the body
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Somatoform and Dissociative Disorders
Dissociative disorders– Dissociation
The loss of one’s ability to integrate all the components of self into a coherent representation of one’s identity
– Dissociative disorder Disorders in which, under stress, one loses the integration
of consciousness, identity, and memories of important personal events
– Dissociative amnesia A dissociative disorder in which there is a lost of memory of
limited periods in one’s life or of one’s entire identity
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Somatoform and Dissociative Disorders
Dissociative disorders (continued)– Dissociative fugue
A dissociative disorder in which one has a complete loss of memory of one’s entire identity, travels away from home,and may assume a new identity
When people recover from the fugue, they often have no memory of events that occurred during the episode
– Dissociative identity disorder (DID) A dissociative disorder in which tow or more distinct
personalities occur in the same person, each taking over a t different times; also called multiple personality
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Somatoform and Dissociative Disorders
Dissociative disorders (continued)– Dissociative identity disorder (continued)
The alternate personalities, or alter personalities, may differ radically in intelligence, speech, accent, vocabulary, posture, body language, hairstyle, taste in clothes, manners, and even handwriting and sexual orientation
There is the common complaint of “lot time”-periods for which a given personality has no memory because he or she was not in control of the body
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Sexual Disorders
Sexual disorders– Disorders that are destructive, guilt- or anxiety-
producing, compulsive, or cause of discomfort or harm to one or both parties involved
– Perhaps the most common of all of the sexual disorders are the sexual dysfunctions
– Drug treatment for sexual dysfunctions in both men and women have proved successful
– Depression is both a cause and an effect of sexual dysfunctions
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Sexual Disorders
Sexual disorders (continued)– Paraphilias
Disorders in which recurrent sexual urges, fantasies, and behaviors involve nonhuman objects, children, other nonconsenting persons, or the suffering or humiliation of the individual or his/her partner
– Gender identity disorders Disorders characterized by a problem accepting one’s
identity as male or female An individual may feel so strongly that she or he is
psychologically of the other gender that sex-reassignment surgery is sought
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Sexual Motivation
Sex is a physiologically based motive, like hunger, but it is more affected by learning and values
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Sexual Motivation
Androgens– A sex hormone, secreted
in greater amounts by males than by females
Estrogen– a sex hormone, secreted
in greater amounts by females than by males
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Sexual Motivation
Sexual Response Cycle– the four stages of sexual responding described by
Masters and Johnson Excitement Plateau Orgasm Resolution
Refractory Period– resting period after orgasm, during which a man
cannot achieve another orgasm
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The Sexual Response Cycle
Males Females
Orgasm
Plateau
ExcitementResolution
Resolutionwith orgasm
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Sexual Motivation
Same drives, different attitudes
Iceland Germany Great Canada Mexico United India Taiwan Singapore Britan States
Country
100%
90
80
70
60
50
40
30
20
10
0
Percentanswering
wrong
“Do you think it is, or is not, wrong for a couple to have a baby if they are not married?”
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Sexual Motivation
Changing attitudes
Extramarital sex is “always wrong”
Homosexual sex is “always wrong”
1987 1998Year
100%
80
60
40
20
0Source: National Opinion Research Center(University of Chicago) General Social Survey
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Forces Affecting Sexual Motivation
Physiologicalreadiness
Imaginativestimuli
Externalstimuli
Sexual motivation
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Sexual Motivation
Births to unwed parents
United States
Canada
Japan
Britain
1960 1970 1980 1990 2000Year
40%
35
30
25
20
15
10
5
0
Percentageof births
to unwedmothers
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Sexual Motivation
Sexual Orientation– an enduring sexual attraction toward
members of either one’s own gender (homosexual orientation) or the other gender (heterosexual orientation)
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Personality Disorders
Personality disorders– A continuing, inflexible, maladaptive pattern of inner
experience and behavior that causes great distress or impaired functioning and differs significantly form the patterns expected in the person’s culture
– Characteristics of personality disorders People who suffer form other disorders, especially the
mood disorders, are often diagnosed with personality disorders as well
People with personality disorders are extremely difficult to get along with
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Personality Disorders
Personality disorders (continued)– Types of personality disorders
Those who suffer from paranoid personality disorder display extreme suspiciousness, while those with schizoid personality disorder isolate themselves from others and appear to be unable to form emotional bonds
Individuals diagnosed with schizotypal personality disorder are often mistakenly classified as schizophrenic because their odd appearances, magical thinking, and lack of social skills are also often seen in schizophrenics
A pervasive desire to be the center of others’ attention is characteristic of both narcissistic personality disorder and histrionic personality disorder, as is a lack of concern for others
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Personality Disorders
Personality disorders (continued)– Types of personality disorders (continued)
People with borderline personality disorder are highly unstable and fear of abandonment is the primary theme of their social relationships
A significant proportion of borderline personality disorder patients have histories of abuse or other disturbances in childhood attachment relationships
People who suffer from antisocial personality disorder have a “pervasive pattern of disregard for, and violation of, the rights of other that begins in childhood or early adolescence and continues into adulthood”
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Personality Disorders
Personality disorders (continued)– Types of personality disorders (continued)
Individuals diagnosed with obsessive-compulsive personality fear falling short of perfectionistic standards
Avoidant personality disorder and dependent personality disorder, represent opposite approaches to social relationships
The avoidant personality shuns relationships because of excessive sensitivity to criticism and rejection
The dependent personality relies on others to an inappropriate degree
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Personality Disorders
PET scans illustrate reduced activation in a murderer’s frontal cortex
Normal Murderer
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Personality Disorders
Percentageof criminaloffenders
35
30
25
20
15
10
5
0Total crime Thievery Violence
Childhoodpoverty
Obstetricalcomplications
Both poverty and obstetrical complications
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Rates of Psychological Disorders
Percentage of Americans Who Have Ever Experienced Psychological Disorders
Disorder White Black Hispanic Men Women Totals
Ethnicity Gender
Alcohol abuse or dependence 13.6% 13.8% 16.7% 23.8% 4.6% 13.8%
Generalized anxiety 3.4 6.1 3.7 2.4 5.0 3.8
Phobia 9.7 23.4 12.2 10.4 17.7 14.3
Obsessive-compulsive disorder 2.6 2.3 1.8 2.0 3.0 2.6
Mood disorder 8.0 6.3 7.8 5.2 10.2 7.8
Schizophrenic disorder 1.4 2.1 0.8 1.2 1.7 1.5
Antisocial personality disorder 2.6 2.3 3.4 4.5 0.8 2.6