Psychological
Disorders and
Diagnosis
An Introduction
What are the Boundaries between Normal and Abnormal Behavior??
• Unconventional and Unusual
– behavior that is so different that it violates a
norm or cultural standard AND experienced by
only a few
• Disturbing
– behavior that is troublesome to other people
• Maladaptive
– behavior that is destructive or harmful to
oneself or others
• Unpredictable and Irrational
– Does not make sense to the average person
May only need to meet one to
be diagnosed with a disorder
What fits the description for abnormal
behavior depends on a few things…

Culture Bases of Abnormal Behavior

Psychologists take into account the cultural context when
making judgments about abnormal behavior
• The same behavior may be considered normal in one culture but
abnormal in another



Examples of Cultural Bound Disorders:
Susto – Latin America – anxiety and fear of black magic
Koro – Southeast Asian Men
Time Period and Social Conditions
 ADHD
• Is it a real problem or just kids being active kids??
• Energetic child + boring school = ADHD overdiagnosis?
 Homosexuality
How do we classify and learn about
Psychological Disorders???
We use the DSM
• DSM-IV-TR:
– the big book of disorders
– Classifies disorders on the basis
of their distinctive features or
symptoms
Classifies and describes the disorders
but does NOT NOT NOT discus
their causes or treatments…WHY??
Two Major Classifications in the
DSM
Neurotic Disorders
• Distressing but one can
still function in society
and act rationally.
Psychotic Disorders
• Person loses contact
with reality,
experiences distorted
perceptions.
John Wayne Gacy
So How does the DSM work??
• Uses a system of Axes or Dimensions (5 in total)
that help the examiner conduct a comprehensive
evaluation of a person’s mental health
• Axis I and Axis II
– Contains lists of disorders
• Axis III
– Contains general medial conditions and diseases
• Axis IV
– Any psychosocial and environmental problems that may
impair function
• Axis V
– Global assessment of functioning (GAF)
– A numerical value that indicates overall level of mental
health
A Sample DSM Evaluation
The Clinical Picture of Angela Savanti
•
Angela was rarely reinforced for any of her accomplishments at
school, but she gained her mother’s negative attention for what Mrs.
Savanti judged to be poor performance at school or at home. Mrs.
Savanti repeatedly told her daughter that she was incompetent, and any
mishaps that happened to her were her own fault.......When Mr. Savanti
deserted the family, Angela’s first response was that somehow she was
responsible. From her mother’s past behavior, Angela had learned to
expect that in some way she would be blamed. At the time that Angela
broke up with her boyfriend, she did not blame Jerry for his behavior,
but interpreted this event as a failing solely on her part. As a result,
her level of self-esteem was lowered still more.
•
Angela’s uncertainties intensified when she was deprived of the
major source of gratification she had, her relationship with Jerry.
Despite the fact that she was overwhelmed with doubts about whether
to marry him or not, she had gained a great deal of pleasure through
being with Jerry. Whatever feelings she had been able to express, she
had shared with him and no one else. Angela labeled Jerry’s termination
of their relationship as proof that she was not worthy of another
person’s interest. She viewed her present unhappiness as likely to
continue, and she attributed it to some failing on her part. As a result,
she became quite depressed.
The Clinical Picture of
Angela Savanti
• Axis I
The Diagnosis
– Major Depressive Disorder
• Axis II
– Dependent personality Disorder
• Axis III
– Diabetes
• Axis IV
– Problems related to social environment (termination of
relationship – Jerry and Father)
• Axis V
– GAF = 55
A Cautionary Note…
• The DSM-IV provides an invaluable tool to
psychologists, but it doesn’t come without
its criticisms
• Some believe it can turn normal problems
of living into “diseases” – i.e. ADHD or
the argument over PMS
• Also, some believe the DSM-IV makes
diagnosis of disorders scientific when they
are actually highly subjective
• The problem of Labeling…
The Influence of Labels
Should people who were once diagnosed with a
psychological problem carry that diagnosis
for the rest of their lives?

Can lead to stigmatization
– The Rosenhan Study
– rooms for rent story

Can change reality
– a student is “gifted” or “hostile”
What are the Causes of Psychological Disorders??
It depends on your views of psychology
 Medical Perspective
 disorders are sicknesses and can be diagnosed, treated
and often cured.
 Learning or Behavioral Perspective
 disorders result from the reinforcement of abnormal
behavior
 Psychodynamic Perspective
 disorders result from defenses against internal,
unconscious conflicts
 Humanistic Perspective
 disorders result from a failure to strive towards one’s
potential or being out of touch with one’s feelings
 Sociocultural Perspective
 disorders result from a dysfunctional environment
Current Perspectives…cont.
Bio-Psycho-Social Perspective:
• assumes biological, psychological and
sociocultural factors combine to interact
causing disorders.
One Example
The Diathesis-Stress Model
Diathesis = predisposition or
vulnerability
Inherited predisposition
To develop the disorder
Environmental
Stressors
Disorder
Are you Insane??
Mental Illness vs. Insanity

Mental Illness
– A medical decision

Insanity
– A legal decision
– To be insane a person must be unable
to control behavior and be unaware
that behavior is wrong
– Insanity defense is based on the
principle that punishment is justified
only if the person is capable of
understanding and controlling his or
her behavior
Sex and Mental Disorders
Does the gender of a person influence (1)
the type of disorder or (2) the frequency
of various disorders??
Of Course it Does
…but Why??
 Differences
in reporting or suppressing
psychological distress
 Clinicians
expectations
 Differences
 Differences
in social roles and experiences
in ways of responding to
stressful situations
Early Theories on Mental Illness
and Disorders
• Afflicted people
were possessed
by evil spirits.
Early Theories on Treatment
• Music or singing was
often used to chase
away spirits.
•In some cases
trephining was
used:
Cutting a hole in
the head of the
afflicted to let out
the evil spirit.
Early Theories on Treatment
Another theory on treatment was to
make the body extremely
uncomfortable.
Hopefully, this
would drive out
the evil spirits
History of Mental Disorders
In the 1800’s, disturbed people
were no longer thought of as
madmen, but as mentally ill.
They were first put in hospitals.
Did this mean
better
treatment?
Early Mental Hospitals
• They were nothing
more than barbaric
prisons.
•The patients were chained
and locked away.
• Some hospitals even charged admission for the
public to see the “crazies”, just like a zoo.
Philippe Pinel and Dorethea Dix
Moral-treatment Movement
• Doctors who were the
first to take the chains
off and declare that
people are sick and “a
cure must be found!!!”
Out of this movement, large statesupported asylums were built
Good intentions, but poor concept….why??
Deinstitutionalization
New Drugs and a feeling of
optimism – “all could make it if
given a chance” – lead to an
emptying of mental hospitals
Most ended up either homeless or
in prisons
Anxiety Disorders


A group of disorders in which
either fear or anxiety is a major
symptom
fear, phobia and nervous condition,
that come on suddenly and prevent
pursuing normal daily routines
»Includes panic disorder, obsessivecompulsive disorder (ocd), posttraumatic stress disorder, general
anxiety disorder, and phobias
Mood Disorders
 A condition where the
emotional mood is
distorted or
inappropriate to the
circumstances
»Includes major
depression, dysthymic
disorder (mild
depression) and bipolar
disorders
Dissociative Disorders
 A psychological state or
condition in which certain
thoughts, emotions,
sensations, or memories are
separated from the rest of the
conscious identity
»Includes Dissociative Identity
Disorder (DID), formerly
known as Multiple Personality
Disorder (MPD), and different
types of amnesia
Schizophrenia
Mental disorder characterized by
impairments in the perception or
expression of reality and by
significant social or occupational
dysfunction
Personality Disorders
 A class of mental disorders that are
characterized by long-lasting rigid
patterns of thought and behavior that
disrupt social functioning
»Includes paranoid personality disorder,
avoidant personality disorder,
narcissistic personality disorder and
borderline personality disorder
Eating Disorders
A person eats in a way which
disturbs their physical health
»Includes anorexia, bulimia, and
binge-eating