What is a Psychological Disorder?
 Defining Psychological Disorders
 Understanding Psychological Disorders
 Classifying Psychological Disorders – and
Labeling People

Anxiety Disorders
 Generalized Anxiety Disorder
 Panic Disorder
 Phobias
 Obsessive-Compulsive Disorder (OCD)
 Post-Traumatic Stress Disorder (PTSD)
 Understanding Anxiety Disorders

Dissociative and Personality
Disorders
 Dissociative Disorders
 Personality Disorders
Substance-Related Disorders
 Tolerance, Addiction, and Dependence
 Types of Psychoactive Drugs
 Understanding Substance Abuse

Mood Disorders
 Major Depressive Disorder
 Bipolar Disorder
 Suicide
 Understanding Mood Disorders

Schizophrenia
 Symptoms of Schizophrenia
 Onset and Development of Schizophrenia
 Understanding Schizophrenia

• Worldwide, 450 million people suffer from mental or behavioral disorders
• 26% of adult Americans suffer from a diagnosable mental disorder at some point during a given year

An ongoing pattern of thoughts, feelings, or actions that are:
• Deviant . Different from most other people who share one’s culture.
• Distressful. Causing distress to the person or to others.
• Dysfunctional . Behaviors interfere with normal day-to-day life.

• Phillipe Pinel (1745-1826)
– Madness is not a demon possession, but a sickness of the mind
• Pinel and others unchained patients, talked with them, used gentleness, gave them activity and fresh air and sunshine

• In the 1800s, it was discovered that syphillis could invade the brain and distort the mind.
• Gave rise to the medical model of mental disorders – diseases (including psychological disorders) have physical causes that can be diagnosed, treated, and often cured

• Psychological disorders are influenced by the interaction of our biology, our psychology, and our socio-cultural environment
• Some disorders are linked with specific cultures
– Anxiety related to a fear of black magic in Latin
America
– Anorexia and bulimia in Western cultures
• Some disorders occur worldwide
– Depression and schizophrenia

• Diagnostic classification gives us a quick description of patient’s behavior, predicts future course, suggests treatment, and prompts research into causes.
• Guidebook is the American Psychiatric
Association’s Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV-TR)
– Categories and guidelines are fairly reliable, resulting in the same diagnosis being made by different clinicians

• Casts too wide a net
– 400 disorder categories
• Labels trigger society’s value judgments
– Can cause us to view a person differently
• Labels can be selffulfilling
Mental illness is portrayed as dangerous

• Study: David Rosenhan and 7 others went to a hospital admissions office, complaining of “hearing voices” (1973)
• Answered all other questions truthfully
• All were misdiagnosed with mental disorders
• Doctors were able to “discover” the causes of their disorders

Help mental health professionals
• Communicate about their cases
• Pinpoint underlying causes
• Share information about effective treatments

• Psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety
– Generalized anxiety disorder
– Panic disorder
– Phobias
– Obsessive-compulsive disorder
– Post-traumatic stress disorder
Anxiety: Basket Case?

• Disorder in which a person is continually tense, fearful, and in a state of autonomic nervous system arousal
• Free-floating anxiety – person cannot identify the cause of the tension
• Often coupled with depression, physical problems such as high blood pressure
• Gender bias: 2/3 of those with GAD are women

• An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and chest pain, choking, or other frightening sensations
• Panic attack symptoms often misread as a heart attack or similar
• Smokers have at least doubled risk of panic attack

• A phobia is an anxiety disorder marked by a persistent, irrational fear or avoidance of a specific object or situation
• Can trigger a panic attack
• Social phobia : fear of being judged by others
• Agoraphobia : fear or avoidance of situations in which panic may strike, escape may be difficult, and help unavailable

• A strong fear may become a phobia if it provokes a compelling but irrational desire to avoid the dreaded object or situation

• Characterized by unwanted repetitive thoughts (obsessions) and/or actions
(compulsions)
• Effective functioning may become impossible

• An anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia lingering for four weeks or more after a traumatic experience
• Odds of getting PTSD after a trauma are higher for women (10%) than for men
(5%)
• Most people display survivor resilience – the ability to recover after severe stress
– Some people may have more sensitive emotion-processing limbic systems than others

How do anxious thoughts and feelings arise?
• The Learning Perspective
– Fear Conditioning
– Observational Learning
• The Biological Perspective
– Genes
– The Brain
– Natural Selection

• Fear Conditioning
– Classical conditioning can produce fear and anxiety
– Stimulus generalization : a person experiences a fearful event and later fears similar events
– Feeling relief by escaping a feared situation can reinforce phobic behavior
• Observational Learning
– We may learn fear by observing others’ fears
– Parents may transmit fears to children

• Genes
– Fearfulness runs in families
• The Brain
– Fear-learning experiences cause new brain pathways  easy inroads for more fearful experiences
– Brain scans of OCD patients reveal higherthan-normal activity in regions involved in impulse control and habitual behaviors

• Natural Selection
– Our ancestors evolved to fear snakes, confinements, toxins, and heights
– Our phobias focus on dangers our ancestors face
– Compulsive acts typically exaggerate behaviors that helped them survive
(grooming, cleaning)

• Dissociative disorders involve a separation of conscious awareness from previous memories, thoughts, and feelings

• Dissociative identity disorder (DID) is a rare dissociative disorder in which a person exhibits two or more alternating personalities

• A short history
– Between 1930 and 1960, 2 cases per year.
By they 1980s there were 20,000 cases
• Much less common outside North America
– May be a cultural phenomenon
• May be an extension of the way we vary the “selves” we present

• Disorders characterized by inflexible and enduring behavior patterns that impair social functioning

• Antisocial personality disorder is a personality disorder in which the person exhibits a lack of conscience for wrong-doing, even toward friends and family
– More common in men
– May be aggressive and ruthless or a clever con artist
Dennis Rader, the “BTK killer”

• Lack of conscience manifests before age 15
• Most criminals do not have this disorder
• There is a genetic component – appears as low arousal
– Lower stress hormones than average as children
– Slower to develop conditioned fears
• Combined with childhood abuse, can wire the brain for antisocial behavior

• The frontal lobes help brake impulsive, aggressive behavior are less active in this disorder.

• Maladaptive patterns of substance use can lead to significant impairment or distress
• Substances are often psychoactive drugs , chemical substances that alter perceptions or moods.
• A drug’s effect depends on the biological effects and the user’s psychological expectations, which vary with cultures

Tolerance, Addiction, and Dependence
• Tolerance : diminishing effects with regular use, requiring larger doses to experience effect
• Addiction: compulsive drug craving and use
• Withdrawal : discomfort and distress following discontinuing drug use
• Physical dependence: A physiological need for a drug, marked by withdrawal symptoms
• Psychological dependence: a psychological need for a drug, to relieve negative emotions

• Depressants
• Stimulants
• Hallucinogens
• Work at the brain’s synapses
• Stimulate, inhibit, or mimic the activity of neurotransmitters

• Calm neural activity and slow body functions
• Alcohol
• Barbiturates
• Opiates

• Slowed neural processing . Slow sympathetic nervous system activity.
• Memory disruption . Suppresses REM sleep, which helps to consolidate memories
• Effects of expectations . User’s expectations influence behavior:
– People who think they have been drinking alcohol are more likely to feel uninhibited and sexually interested

• Chronic alcohol abuse shrinks the brain

• Barbiturates , or tranquilizers, depress activity of the central nervous system, reducing anxiety but impairing memory and judgment
• Sometimes prescribed to induce sleep or reduce anxiety

• Opium and its derivatives, morphine and heroin
• Depress neural activity, lessening pain and anxiety
• Mimic the effects of endorphins , the body’s natural painkillers
• Highly addictive

• Stimulants excite neural activity and speed up body functions
– Caffeine
– Nicotine
– Amphetamines
– Cocaine
– Ecstasy
Is smoking really this cool?

The stimulating and highly addictive psychoactive drug in tobacco

• A powerfully addictive drug
• Triggers release of dopamine
– Enhances energy and mood
• Aftereffects include irritability, insomnia, high blood pressure, seizures, periods of disorientation, and violent behavior
• Over time, can permanently reduce brain’s normal dopamine output – leading to craving more meth

• MDMA is a synthetic stimulant and mild hallucinogen
– Produces euphoria and social intimacy
– Short-term health risks
– Long-term harm to serotonin-producing neurons and to mood and cognition

• Psychedelic drugs that distort perceptions and evoke sensory images without sensory input
• LSD : a powerful hallucinogen
– Interferes with serotonin transmission
• Near-death experience : altered state of consciousness reported after close brush with death, may be similar to drug-induced hallucinations

• A difficult drug to classify. Effects include:
– Mild hallucinations, increases sensitivity to colors, sounds, tastes and smells
– Also relaxes, disinhibits, produces euphoria
– Impairs motor coordination, perceptual skills, and reaction time
– May help control pain, as well as reduce ability to sense that hunger is satisfied
• Unlike alcohol, THC lingers for a month or so, during which it takes smaller amounts of THC to trigger effects”

Biological Influences
• Adopted persons more likely to have alcohol dependence if a biological parent was alcoholic
• Identical twins have correlated alcohol dependence
• Boys at age 6 who are excitable and fearless are more likely as teens to smoke, drink, and abuse other drugs
• Researchers have bred rats and mice that prefer alcoholic drinks to water

Psychological and Social-Cultural
Influences
• Substance abusers may have experienced significant stress or failure and depression
• Can have social roots – contributions from media and culture
• Location matters – more opportunities and less supervision in cities
• Peer pressure
Peer pressure: To use, or not to use

Psychological disorders characterized by a prolonged state of emotional extremes
– Major depressive disorder
– Mania
– Bipolar disorder

• Anxiety is a response to threat of future loss
• Depressed mood is often a response to past and current loss
• We all feel depressed or anxious sometimes
• Anxiety is a response to threat of future loss;
Depressed mood is often a response to past and current loss
• We all feel depressed or anxious sometimes, but a mood disorder:
– lasts longer,
– sticks around even when there is not something to be depressed about, and
– makes it hard to function

• Recurring depression during the dark months of winter

• Biologically, life’s purpose is survival and reproduction, not happiness
• Depression helps us face and solve problems
– Protects us from dangerous thoughts and feelings
– Gives us time to think and consider our options in the face of trouble

• A person with major depressive disorder experiences two or more weeks of significantly depressed moods
– Lethargy
– Feeling worthless
– Loss of interest in family, friends, and activities
• Leading cause of disability worldwide

• A person with bipolar disorder alternates between depression and mania
– Much more extreme and problematic than simple ‘mood swings’
• During mania, people are overtalkative, overactive, and elated
– Sleep less, sexually uninhibited, easily irritated
– Extreme optimism and self-esteem

• In milder forms, mania’s energy and freeflowing thinking can fuel creative energy
Madonna Mark Twain Virginia Woolf Tim Burton

• Nearly 1 million suicides a year worldwide
• Risk is 5x greater for those who have been depressed
– People may feel most suicidal in the depths of depression, but lack initiative and energy to act on it; they may be more at risk of actually committing suicide when mood and energy seem to be improving
Anyone who threatens suicide is at least sending a signal of feeling desperate or hopeless

• Depression leads to negative thoughts and behaviors, which in turn reinforce depression
• All around the world, Women’s risk of major depression is nearly twice that of men’s.

More Facts about Depression
• Most major depressive episodes end on their own, especially one’s first episode.
• Stressful events often precede depression
• Depression is striking earlier in each generation, and affecting more people
– May reflect cultural differences between generations
– Today’s youth may be more willing to talk openly about depression

Genetics
– Mood disorders run in families
– If one identical twin is diagnosed with major depression, 50% chance the other one will be too
– 70% chance for bipolar disorder

• The Depressed Brain
– Brain activity slows during depression, increases during mania

• The Depressed Brain: Levels of Activity
– Decreased activity in left frontal lobe, which is active during positive emotions
• The Depressed Brain: Levels of
Neurotransmitters
– Levels of Norepinephrine (which increases arousal and boosts mood) are lower during depression, too high during mania
– Serotonin levels are also lower during depression

• Negative thoughts and negative moods interact
• Self-defeating thoughts can arise from learned helplessness
• Women’s increased vulnerability to depression may be related to tendency to overthink
• Outlook influences whether an event will become depressing

• Which comes first: pessimistic explanatory style, or depressed mood?
• A depressed mood may trigger negative thoughts.
• People put in bad or sad moods tend to become more pessimistic
• These negative thoughts also worsen depression, thus completing a cycle

• Rejection and depression feed each other
• Recognizing the cycle, we can break it
– Each of the 4 points offers an exit

• A group of severe disorders characterized by
– Disorganized and delusional thinking
– Disturbed perceptions
– Inappropriate emotions and actions
• Disrupts social relationships, holding a job is difficult

• Positive symptoms
– Inappropriate behaviors that are present
– Hallucinations, talking in disorganized or deluded ways, laugh or rage at inappropriate times
• Negative symptoms
– Feels or actions that one expects to be present are absent
– Toneless voices, expressionless faces, mute and rigid bodies

• May appear as word salad – jumbled ideas that make no sense
– “A little more allegro in the treatment”
– “Liberationary movement with a view to the widening of the horizon will ergo extort some wit in lectures.”
• Often distorted by delusions (false beliefs, often of persecution or grandeur)

• Hallucinations – people with schizophrenia may hear, see, feel, taste, or smell things that are not there
– Most often take the form of sounds, usually voices giving insults or instructions

• Emotions are often split off from reality
– Laughing at grandmother’s death
– Crying when others laugh
– Becoming angry for no reason
• Others may exhibit flat affect
• Inappropriate motor behaviors may take many forms
– Senseless, compulsive acts
– Remaining motionless for hours ( catatonia )

• Nearly 1 in 100 people develop schizophrenia
• 24 million sufferers worldwide
• Men struck earlier, more severely, and slightly more often
• May appear suddenly, or develop gradually

• When a slow-developing process ( chronic, or process schizophrenia ), recovery is doubtful
– Often characterized by more negative symptoms
– More common in men
• Recovery is more likely when a well-adjusted person develops it rapidly ( acute, or reactive schizophrenia )
– Follows stress
– Often characterized by more positive symptoms that respond to drug therapy

Brain Abnormalities
• By studying the brains of schizophrenic patients, we can gain insight into the causes of this disorder, as well as possible treatments
E. Fuller Torrey

Brain Abnormalities
• Dopamine overactivity
– Schizophrenic patients’ brains have excess number of dopamine receptors
– Drugs that block dopamine receptors often lessen positive symptoms
– Drugs that increase dopamine (e.g., amphetamines, cocaine) sometimes intensify them

Brain Abnormalities
• Abnormal brain activity and anatomy
– Low activity in frontal lobes
– PET study during hallucinations – activation in the thalamus and amygdala
– Areas of the brain fill with fluid, and cerebral tissue shrinks
Schizophrenia involves problems with several brain regions and their interconnections

Prenatal Environment and Risk
• Prenatal viral infections can contribute to the development of schizophrenia
– Increased risk if fetus develops during flu epidemic
– Increased risk if born right after flu season
– Mothers who report being sick with flu during pregnancy more likely to have schizophrenic children

Genetics and Risk
• Predisposition to the disorder may be inherited
– Odds of being diagnosed: 1 in 100
– Odds if sibling or parent has schizophrenia: 1 in 10

• Identical twins also share prenatal environment
– Shared germs PLUS shared genes produce identical twin similarities
– Chances of sharing a diagnosis 6 in 10 if shared placenta, 1 in 10 if separate
• Adoption studies confirm genetic link is real
Only afflicted twin has enlarged cavities. Implies a nongenetic factor.

These mental health disorders and others, from Panic Disorder to Schizophrenia, are the subject of:
• much suffering,
• much research, and
• much effort in the form of mental health treatment, which is also known as:
Therapy.