CHAPTER 13
Psychological Disorders
MODULE 13.1 WHAT IS ABNORMAL BEHAVIOR?
LECTURE OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
II.
Charting the Boundaries Between Normal and Abnormal Behavior LB 13.1, LB 13.2
A. Unusualness—experienced by only a few (See Reality Check, LB 13.3) (Figure 13.2)
B. Social deviance—violates social norms
C. Emotional distress—states of negative emotions when inappropriate, excessive, or
prolonged
D. Maladaptive behavior—self-defeating actions
E. Dangerousness—dangerous to oneself or others
F. Faulty perceptions or interpretations of reality
1. Hallucinations—distorted perceptions of reality
2. Delusions—unfounded beliefs
G. Cultural bases of abnormal behavior LB 13.4
1. Cultural context important in making judgments about abnormality
2. Culture-bound disorders–disorders that occur only in one culture
a.
Dhat syndrome—India, excessive fear of loss of semen during nighttime
emissions
H. Applying the criteria to examples in chapter
Models of Abnormal Behaviors (Concept Chart 13.1) LB 13.5
A. Early beliefs—supernatural and demonic forces
1. Exorcism
B. The medical model—eighteenth–nineteenth centuries, abnormal behavior represents
mental illness
C. Psychological models
1. Psychodynamic model (Freud)—abnormal behavior arises from unresolved
unconscious conflict
2. Behavioral model (Pavlov)—abnormal behavior arises from learning
3. Humanistic model (Rogers and Maslow)—abnormal behavior results from
people experiencing obstacles on their path to self-actualization
4. Cognitive models (Ellis and Beck)—abnormal behavior results from irrational
and distorted thinking
D. The sociocultural model—abnormality is caused by broader social and cultural factors
1. Factors such as poverty, ethnic and cultural background important
2. Effects of labeling people as mentally ill
E. The biopsychosocial model—emphasizes complex interactions of biological,
psychological, and social factors
1.
Diathesis-stress model—vulnerability (diathesis) toward particular diseases
increases under stress (Figure 13.1)
III. What Are Psychological Disorders?
A. How many are affected?
1. One in two adults has diagnosable mental disorder in lifetime (Figure 13.2)
B. How are psychological disorders classified?—DSM-IV-TR
1. Multiaxial system (Table 13.1)
2. First two axes are diagnostic conditions. Major groupings include anxiety
disorders, mood disorders, eating disorders, and personality disorders
3. Axis III is medical conditions and diseases
4. Axis IV is psychosocial and environmental problems
5. Axis V is global assessment
6. Critics of DSM concerned with reliability and validity of diagnostic
classifications
MODULE 13.2 ANXIETY DISORDERS LECTURE OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
II.
Types of Anxiety Disorders (Concept Chart 13.2)
A. Most commonly experienced disorders, characterized by excessive or inappropriate
anxiety reactions
B. Phobias—an irrational or excessive fear of some object or situation LB 13.6
1. Social phobia
2. Specific phobia (e.g., acrophobia, claustrophobia)
3. Agoraphobia
C. Panic disorder—sudden episodes of sheer terror
D. Generalized anxiety disorder (GAD)—persistent anxiety not tied to any particular
object or situation
E. Obsessive-compulsive disorder (OCD)
1. Obsessions—nagging intrusive thoughts
2. Compulsions—repetitive behaviors or rituals compelled to perform
Causes of Anxiety Disorders LB 13.7
A. Biological factors
1. Imbalances in activity of neurotransmitters
2. Genetic predisposition toward anxiety disorders
3. Biochemical changes in brain trigger internal alarm system
B. Psychological factors
1. Phobias learned through classical conditioning
2. Operant conditioning may account for avoidance behaviors
3. Cognitive model of panic disorder suggests panic may occur when people
misinterpret minor changes in bodily sensations as signs of catastrophe (anxiety
sensitivity is a fear of fear itself) (Figure 13.3)
MODULE 13.3 DISSOCIATIVE AND SOMATOFORM
DISORDERS LECTURE OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
Dissociative Disorders (Concept Chart 13.3) LB 13.8
A. Involve problems with memory or changes in consciousness or self-identity
B. Dissociative identity disorder (DID)
1. Two or more distinct personalities exist within the same individual
2. Some have a core personality with hidden alternate personalities
3. Personalities can range in age, gender, sexual orientation, responses to
medication, distinctive traits, etc.
4. Women with DID average 15 personalities, men average 8
C. Dissociative amnesia
1. Loss of memory of information about themselves and their life experiences
without a physical cause for loss
2. Typically memory loss limited to time surrounding traumatic event
II. Causes of Dissociative Disorders
A. Associated with traumatic events (dissociative amnesia) or severe physical or sexual
abuse at an early age (dissociative identity disorder)
B. Controversy over DID
1. Rare but genuine disorder or form of attention-seeking role-playing behavior?
III. Somatoform Disorders (Concept Chart 13.3)
A. People with physical ailments or complaints that cannot be explained medically
B. Conversion disorder
1. Person suffers loss of physical function, such as loss of limb movement without
physical cause
2. Patient may appear indifferent to the loss of functioning
3. Many cases turn out to be undiagnosed medical conditions
C. Hypochondriasis LB 13.9
1. Preoccupation with idea that there is something terribly wrong with their health
2. Attribute physical complaints to underlying serious disease
IV. Causes of Somatoform Disorders
A. Freud suggested due to struggle between id and ego, also the symptom provides
secondary gains (avoid some undesired task or event)
B. Learning theorists emphasize way for people to adopt a “sick role” and avoid anxietyprovoking situations
C. Cognitive theorists focus on how cognitive biases and misinterpretations contribute
MODULE 13.4 MOOD DISORDERS LECTURE OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
Types of Mood Disorders (Concept Chart 13.4)
A.
Depressive disorders
1. Major depression—persistent downcast mood for at least 2 weeks
a.
Lethargy, changes in sleep, appetite, inability to make decisions, etc.
b. Women twice as likely as men to develop it, due to hormonal, stress, and
coping factors LB 13.10
2. Seasonal affective disorder (SAD)
3. Dysthymic disorder—mild but chronic form of depression
B. Bipolar disorders—alternating mood states from euphoric feelings to depression
1. Bipolar disorder (manic-depression) shifts between elevated moods (manic
episodes) and depressed states
2. Cyclothymic disorder—marked by milder mood swings
II. Causes of Mood Disorders
A. Psychological factors
1. Freud—depression involves inwardly-turned anger
2. Behavior model—emphasizes changes in reinforcement levels
a.
Loss of reinforcement saps motivation and induces depression
3. Cognitive models focus on the way people interpret events as contributors to
depression
a.
Beck—those who adopt negatively biased thinking prone to depression,
cognitive distortions (Table 13.2) LB 13.11
b. Learned helplessness model (people become depressed whey they feel
helpless)
c.
Depressive attributional style (internal, global, stable) LB 13.12
d. Stress linked to depression
B. Biological factors
1. Linked to chemical imbalances in the brain (serotonin)
2. Genetic predisposition, especially for bipolar disorder
III. (See Exploring Psychology—The Personal Tragedy of Suicide) LB 13.13
A. Who is most at risk?
1. Age—older adults have greater rates (Figure 13.4)
2. Gender—women attempt more, men complete act more
3. Race/ethnicity—White non-Hispanics and Native Americans are more likely
(Figure 13.5)
B. Why do people commit suicide? (Table 13.3)
1. Closely linked to mood disorders
2. Lack of serotonin may lead to a disinhibition effect—removal of inhibitions that
normally constrain behavior
3. Drug and alcohol dependence
4. Exit events—linked to losses of supportive persons
5. Copycat suicides—particularly in teenagers
MODULE 13.5 SCHIZOPHRENIA LECTURE OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
Schizophrenia—Greek roots meaning split brain (Concept Chart 13.5)
A. Affects 1 in 100 adults
B. Treatment accounts for 75% of mental health expenditures
C.
Slightly more common in men than women, men develop earlier and more severe
forms than women
II. Symptoms of Schizophrenia
A. Psychotic disorder
1. Confuse reality with fantasy
2. Hallucinations—perceptions occurring in absence of external stimuli (auditory or
visual)
3. Delusions—irrational persistent beliefs
B. Thought disorder
1. Breakdown in logical thinking and speech characterized by loose associations
2. May form meaningless words or mindless rhymes LB 13.14
C. Positive symptoms—behavioral excesses; acute episodes
D. Negative symptoms—behavioral withdrawal, apathy; enduring
III. Types of Schizophrenia LB 13.15
A. Disorganized
1. Characterized by confused behavior, thought, hallucinations
2. Significant problems relating to others
B. Catatonic
1. Bizarre movements, postures, gestures; episodes of noncommunication
2. Waxy flexibility—being able to be “molded” into positions that they will hold
for hours
C. Paranoid
1. Most common form
2. Delusions of grandeur, persecution, jealousy accompanied by auditory
hallucinations
IV. Causes of Schizophrenia
A. Genetic factors—twin and adoptee studies demonstrate strong genetic component
B. Biochemical factors—imbalance in nerve pathways using dopamine; may be overly
sensitive to dopamine or have high number of dopamine receptors
C. Brain abnormalities—prefrontal cortex and limbic system (Figure 13.6)
D. Psychosocial influences
1. Diathesis-stress model—stress component may come from brain trauma, abusive
family environment, negative life events, etc.
MODULE 13.6 PERSONALITY DISORDERS LECTURE
OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
Personality Disorders (Concept Chart 13.6)
A. Cluster of psychological disorders characterized by rigid patterns of behavior, which
become self-defeating LB 13.16
B. Types identified in DSM include:
1. Narcissistic personality disorder—inflated, grandiose sense of self
2. Paranoid personality disorder—extreme degree of mistrust and suspicion of
others
3.
Schizoid personality disorder—limited range of emotions, distant, aloof, little
social relationships
4. Borderline personality disorder—stormy relationships, dramatic mood swings,
unstable self-image
II. Symptoms of Antisocial Personality Disorder (APD) LB 13.17
A. Marked by flagrant disregard for social rules, lack of concern for others
B. Psychopaths—impulsive, irresponsible, take advantage of others, lack of remorse and
anxiety
C. Most are law-abiding although some are criminals
D. Higher rates in men than women
III. Causes of Antisocial Personality Disorder (APD)
A. Brain abnormality—men with APD may have low levels of activity in frontal lobes,
making it difficult to restrain their impulses and aggressive behaviors
B. Genetic contribution
C. Exaggerated need for stimulation to maintain optimal state of arousal
D. Environmental contributions—family relationships characterized by lack of parental
warmth, neglect, harsh punishment, abuse
MODULE 13.7 APPLICATION: SUICIDE PREVENTION
LECTURE OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
Facing the Threat LB 13.18 (Table 13.3)
A. Recognize the seriousness of the situation
B. Take implied threats seriously
C. Express understanding
D. Focus on alternatives
E. Assess the immediate danger
F. Enlist the person’s agreement to seek help
G. Accompany the person to seek help