Chapter 13
Why should you care...
• An estimated 26.2 percent of Americans ages 18 and
older—about 1 in 4 adults—suffer from a
diagnosable mental disorder in a given year.
• Major depressive disorder affects approximately
14.8 million American adults.
• Nearly twice as many _________as ________ suffer
from major depressive disorder each year.
• In 2006, 33,300 (approximately 11 per 100,000)
people died by suicide in the U.S
• Four times as many men as women die by suicide;
however, women attempt suicide two to three times
as often as men.
What we’ll seek to understand...
 What does it mean to have a mental
 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
Rates of
This list takes a closer
look at the past-year
prevalence of various
mental health diagnoses
in the United States.
Perspectives on Psychological Disorders
 Defining psychological
 Understanding
 Classifying
 Labeling psychological
Questions to Keep in Mind
How do we decide when a set of
symptoms are severe enough to be
called a disorder that needs
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:
 Disorders are diagnosed when there
is dysfunction, behaviors which are
considered maladaptive because
about disorders:
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
The discovery that the disease of
syphilis causes mental symptoms
(by infecting the brain) suggested a
medical model for mental illness.
 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.
A Counter Argument:
The Myth of Mental illness
Thomas ___________
• Not all mental illnesses are diseases as defined by the medical
• There are no objective ways to test or measure behavior
• Diagnoses are not diseases
• A way to classify and control “undesirable behavior”
• Two Historic Examples
• ___________________- “the uncontrollable urge to escape
• Homosexuality- was viewed as a mental illness just 30 years
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
3. Diagnoses can guide
treatment choices.
The Diagnostic and
Statistical Manual
It’s easier to count
cases of autism if we
have a clear
Versions: DSM-IV-TR,
DSM-V (May 2013)
The DSM is used to
justify payment for
It’s consistent with
diagnoses used by
medical doctors
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.
5. Creates distorted view of normalcy in
• ______________ Experiment
Anxiety Disorders: Our self-protective,
risk-reduction instincts in overdrive
 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 Reexperiencing Trauma
Causes of Anxiety
 Fear Conditioning
 Observational
 Genetic/Evolutionary
 Brain involvement
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.
to repeated and unexpected
panic attacks, as well as a fear of
the next attack.
A __________________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.
uncontrollable, irrational, intense
desire to avoid the object of the
Common OCD Behaviors
Percentage of children and adolescents with OCD reporting
these obsessions or compulsions: Howie Mandel Video
Howard Hughes Aviator Clip
Common pattern: RECHECKING
Although you know that you’ve already
made sure the door is locked, you feel
you must check again. And again.
Post-Traumatic Stress
Disorder _________
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 reexperiencing.
 social withdrawal or phobic
 jumpy anxiety or
 insomnia or sleep problems.
Which people develop PTSD?
 Those with sensitive
emotion-processing limbic
 Those who are asked to
relive their trauma as they
report it
 Those previously
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 highstrung temperament,
while others are more
 Temperament may be
encoded in our genes.
Genes and
 Genes regulate levels of
 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
 Anxiety disorders
include overarousal
of brain areas
involved in impulse
control and habitual
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
1. Human phobic objects: 2. Similar but non-phobic objects:
Snakes Fish
Heights Low places
Closed spaces Open spaces
Darkness Bright light
3. Dangerous yet non-phobic subjects:
We are likely to become cautious about, but not phobic about:
Electric wiring
 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.
Criteria of Major Depressive Disorders
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
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
An Evolutionary Perspective on the
Biology of Depression
 Depression, in its milder, nondisordered form, may have
had survival value.
 Under stress, depression is
social-emotional hibernation.
It allows humans to:
 conserve energy.
 avoid conflicts and other
 let go of unattainable
 take time to contemplate.
Biology of Depression: Genetics
Evidence of genetic influence on depression:
1. DNA linkage analysis reveals depressed gene regions
2. twin/adoption heritability studies
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.
 _______________________has other functions such
as sending a message, distracting from emotional
pain, giving oneself permission to feel, or selfpunishment.
Psychosis refers
to a mental split
from reality and
the mind is split from reality, e.g.
a split from one’s own thoughts
so that they appear as
symptoms include:
 disorganized
 disturbed
 inappropriate
emotions and
Positive and Negative Symptoms of
presence of
Hallucinations (illusory
perceptions), especially
Delusions (illusory
beliefs), especially
Disorganized thought and
nonsensical speech
Bizarre behaviors
absence of
Flat affect (no emotion
showing in the face)
Reduced social interaction
Anhedonia (no feeling of
Avolition (less motivation,
initiative, focus on tasks)
Alogia (speaking less)
Catatonia (moving less)
Subtypes of Schizophrenia
• Plagued by hallucinations, often with negative
messages, and delusions, both grandiose and
• Primary symptoms are flat affect, incoherent speech,
and random behavior
• Rarely initiating or controlling movement; copies
others’ speech and actions
• Many varied symptoms
• Withdrawal continues after positive symptoms have
Anorexia nervosa
Bulimia nervosa
Binge-eating disorder
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.
Compulsion to lose weight,
0.6 percent
coupled with certainty about being meet criteria at
fat despite being 15 percent or
some time
more underweight
during lifetime
____________ Compulsion to binge, eating large
____________ amounts fast, then purge by losing
1.0 percent
the food through vomiting,
laxatives, and extreme exercise
Binge-Eating Compulsion to binge, followed by
2.8 percent
guilt and depression
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
Cultural factors:
 unrealistic ideals of body appearance
Persistently acting
without conscience,
without a sense of guilt
for harm done to others
(strangers and family
The diagnostic criteria
include a pattern of
violating the rights of
others since age 15,
including three of these:
Iceman Video Clip
Disregard for safety of self or
Failure to conform to social
Lack of remorse
Impulsivity and failure to plan
Irresponsibility regarding jobs,
family, and money
Biosocial Roots of Crime: The Brain
People who
commit murder
seem to have
less tissue and
activity in the
part of the
brain that
Other differences include:
 less amygdala response when viewing violence.
 an overactive dopamine reward-seeking system.
Case Examples
• Julie, a 24 year old office manager came to see me
complaining that she is constantly fearful that her
home will be robbed. As a result of her fear, Julie
routinely locks all the doors and windows in her
home and checks the locks upwards of twenty times.
Julie reports that even when she is at work she
cannot help but constantly think about her home
being robbed.
• _________________________________
Case Examples
• Maria brought her nine year old son Marcos to my
office last week. Maria is concerned that Marcos has
been constantly arguing with her and openly refusing
to follow her instructions. Marcos has also displayed
this disobedient behavior at school with his teacher.
He is easily angered and purposely tries to spite or
annoy his mother.
• ________________________________
Case Examples
• Joanne is a seventeen year old who was referred to
my clinic for odd eating behaviors. When I
interviewed Joanne I could tell she was very
obsessive about her weight. I noted in my
assessment that her weight fell in the normal range
for a young girl her age. Joanne revealed to me that
she frequently ate excessively large meals to the
point she would feel ill. She would later secretly
induce herself to vomit.
• _________________________________
Case Examples
• A colleague of mine told me about the case of 27
year old Michael. Michael was a former legal clerk
who was convinced that he was under surveillance
by the CIA. He was difficult to understand because
he spoke with no logical organization to his speech.
He reported that the CIA had implanted a device in
his ear which was designed to command him to
reveal secret legal documents. Michael was soon
referred to a psychiatrist for a psychiatric evaluation.
• _________________________________