Psychological Disorders
Psychopathology-the scientific study of the origins,
symptoms, and development of psychological
disorders.
Psychological disorder- a pattern of behavior or
psychological symptoms that causes significant
personal distress, and impairs one’s ability to
function in an important area of life.
DSM-IV, Diagnostic and Statistical Manual of
Mental Disorders is published by the American
Psychiatric Association. It describes with diagnostic
criteria, 250 specific psychological disorders.
48% of Americans describe symptoms of a mental
disorder at some point in their lives, and 80% who
had symptoms had not sought help. Unfortunately,
mental illness is still stigmatized, particularly in the
media, as characters to be frightened by or threatened
by. This is a myth, as violence is no more common to
the mentally ill than to other people. Only
hallucinating sufferers have a slightly higher rate of
violence. There is a much higher rate of violence
with people in substance abuse than mental illness.
Prevalence of certain disorders differs according to
gender. Women have more mood disorders, and
anxiety. Men have more substance abuse and
antisocial personality disorder. This is largely due to
different socialization patterns, as well as hormonal
differences.
A. Anxiety Disorders are marked by feelings of
excessive apprehension and anxiety. More common
for females.
1) Generalized anxiety disorder-chronic,
high level of anxiety that is not tied to a
specific threat. Free-floating anxiety.
There is rumination, obsessive worrying,
tension, heart palpitations. Gradual onset.
2) Phobic Disorder-persistent, irrational
fear of an object/ situation that offers no
real danger. Only pathological if it
interferes with normal behavior. Common
sources are heights, enclosed places,
crossing bridges, storms, water, snakes,
spiders.
3) Panic Disorder-recurring attacks of
overwhelming anxiety that occur
suddenly and unexpectedly. Often there’s
no definable trigger.
Agoraphobia- fear of going out to public
places. Sufferers often stay at home all the
time or only leave with one trusted friend.
4) Obsessive-Compulsive Disorderpersistent, uncontrollable intrusive,
unwanted thoughts (obsessions) and
urges to engage in pointless rituals
(compulsions) which relieve the anxiety.
Howard Hughes. Often center on fears of
contamination (thus the repetitive
cleaning, handwashing), inflicting harm
on others, suicide, sexual acts. 2.5%
Common obsessions are contamination,
feelings of uncertainty about having
performed a task, violent/ sexual
thoughts. Common compulsions are
washing, checking, counting, symmetry.
5) Posttraumatic Stress Disorder- disorder
in which chronic and persistent symptoms of
anxiety develop following an extreme
physical or psychological trauma. Originally
studied by the military in combat survivors.
The core symptoms:
1) frequent recall of the eventintrusive thoughts
2) person avoids any stimuli that tend
to trigger memories of the experience,
and they experience numbing of
emotionality
3) person experiences increased
physical arousal- easily startled,
insomnia, problems with concentration,
memory, irritable, with angry outbursts.
Many self-medicate into substance
abuse to ease the emotional awareness,
guilt. Multiple traumas put one at higher
risk of PTSD.
Etiology: deficiency of serotonin (so SSRIs do
help with symptoms), dysfunction in frontal lobes,
especially the caudate nucleus (It’s overactive)
which regulates movement.
B. Mood Disorders-marked by emotional
disturbances that may spill over to disrupt physical,
perceptual, social and thought processes. Often
associated with creativity, particularly Bipolar
disorder. Called the “common cold” of psychological
disorders.
1) Major Depressive Disorder-Unipolar
disorders experience extremes at one pole-
depression. There is persistent feelings of
sadness, despair and loss of interest in
previously interesting activities for at least 2-3
weeks. Apathy, loss of appetite, insomnia,
brooding. Loss of self-esteem and feelings of
worthlessness. Hopelessness and guilt.
Common duration is 5 months. Often recurs.
7-17% of Americans suffer at least once.
2X greater in women.
2) Dysthymic Disorder- chronic, low-grade
feelings of depression that produce discomfort
but don’t impair the ability to function. Less
intense than major depression.
3) Seasonal Affective Disorder (SAD)
depression occurring in the fall and winter in
response to the lessening of sunlight. Can be
treated with light.
4)Bipolar Disorder-marked by both depressive
and manic periods. Manic symptoms include
euphoric mood, high self-esteem, creative, optimistic,
energetic, not much sleeping, elaborate plans, racing
thoughts, self-confidence, hyperactivity, high libido,
judgment is impaired, high risk-taking. Leads people
to do things that threaten their financial and relational
well-being. Generally treated with lithium, but
patients are notoriously uncompliant.
5) Cyclothymic Disorder- milder form of
bipolar disorder, lasts as long as two years, but
doesn’t disrupt life as seriously. Symptoms are
moodiness, unpredictability, inconsistency of
behavior.
Etiology:
Genetic predisposition seen in twin studies.
(70% concordance in twin of sufferer, compared to
10-20% of average population).
Deficiency of neurotransmitters serotonin and
norepinephrine. Antidepressants are effective once
you find the right one in the right dosage. Lithium
stabilizes glutamate which is an excitatory
neurotransmitter.
Stress often triggers depression. Caregivers for
those with dementia were found to have a 30%
chance of depression, compared to 1% of those in a
control group who were not caring for a sick person.
Suicide-30,000 known suicides/year, many suicides
are reported as accidents. Women attempt 3x more
than men, but Men complete 4x more than women.
Adolescent suicide has increased 200% in last 30
years. Highest rate of suicide is in the elderly.
These people have developed a hopeless and
pessimistic view of life and their own ability to
overcome adversity. Some do it to avoid the pain of a
terminal or chronic illness. Others do because of
feelings of failure, humiliation, or shame. They begin
to see suicide as a means of escape from pain. Their
thinking has become rigid and constricted, seeing
only one way to solve the problem. Other possible
solutions are seen as inadequate.
If a friend indicates s/he is thinking in this way (and
some of their signs are subtle- giving away precious
possessions, saying they are going away for a long
time), you cannot ignore it thinking it is just a plea
for attention- it is, and they need serious treatment,
not just talking to a friend. It’s not enough to suggest
therapy- you need to call 911 or other family to help.
Don’t try to talk them out of their feelings. This may
be the first and only time someone has truly heard
them and responded effectively. Let them vent their
feelings, although usually by the time they are
actively planning the act, they feel peaceful and no
longer angry or sad. Ask them exactly what their
plan is and if they have the means to complete it.
While waiting for professional help, suggest solutions
that the person may not have been able to consider. If
the person has ever attempted in the past, it puts them
at much higher risk of doing it again.
Personality Disorders-inflexible and maladaptive
personality traits. They are stable over time and
across situations, and deviate from the expectations
of the individual’s culture. They compose 15% of the
population. Some people have more than one.
They fall into three clusters:
1) Odd, eccentric
a. Paranoid
b. Schizoid
c. Schizotypal
2) Dramatic, emotional, erratic
a. Antisocial
b. Borderline
c. Histrionic
d. Narcissistic
3) Anxious, fearful
a. Avoidant
b. Dependent
c. Obsessive-compulsive
Paranoid Personality Disorder- 3% of the
population, most often in Men. Their world view is
that others are out to exploit, harm or dupe them.
They misinterpret even benign behaviors as
threatening. It makes it hard for them to form
intimate relationships, they would have to reveal
themselves, and they feel that vulnerability would be
intolerable. Blaming and critical of others, sarcastic
and hostile. Pathological jealousy of a partner.
Antisocial Personality Disorder- also called a
sociopath or psychopath, these people have no
conscience about lying, cheating, stealing or
manipulating others to get what they want. They
show little or no remorse when caught, displaying no
empathy toward victims or guilt. 6%M, 1% F. During
youth the signs are cruelty to animals, arson, theft,
bullying others- diagnosed as Conduct disorder.
There is a consistent failure to conform to social
norms. They are good at con games, because they can
lie so effectively, they have no guilt about it. They
even blame their victims for being gullible/ naïve.
Substance abuse is also common to this type.
Etiology:
Childhood stress or abuse
Substance abuse during youth
Disturbed brain chemistry
Pathological family
Models Parental traits
Genetic factors
Treatment is not effective, since there is no sincere
desire for change on the part of the person.
Borderline Personality Disorder-instability of
relationships, self-image, and emotions. Marked
impulsivity. 75% F. Mood swings are violent, as well
as attitudes toward self and others. Pervasive feelings
of emptiness, fears of abandonment which leads to
clinging behavior. Then there are perceived slights by
the lover, and the sufferer turns on the lover and
rejects him with contempt. Needs constant assurance
of the lover’s fidelity and love. Sees life in black and
white, no shades of grey. Self-destructive, acting out
with suicide attempts, as well as gambling, reckless
driving, substance abuse, promiscuity. May be linked
to early attachment disorder. Also related to early
abuse or severe neglect.
Dissociative Disorders- disorder where people lose
contact with memory and identity.
1) Dissociative Amnesia- sudden loss of
memory of personal information, often for a
single traumatic event and time around the
event. Follows abuse, disaster, accident,
combat, or witnessing violence.
Fugue- loss of memory for their own identity.
They wander away from family and home, but
often keep memories for vocational skills,
driving, etc.
2) Dissociative Identity Disorder- formerly
called multiple personality disorder, where
there are distinct, recognizable personalities
within a single person. The personalities have
different names, memories, traits, illnesses.
Usually only the host personality knows about
the other personalities. There is loss of time,
as people don’t know how they got places, did
things they are accused of doing. The
personalities serve emotional purposes for an
inhibited, anxious person who can’t act
authentically in many areas of life.
Etiology of Dissociative Disorders- usually
attributed to excessive stress. May be used for facesaving over perceived failures. May be a factor of
culture, as these cases are presented in intriguing
media. Victims often report chaotic, violent home
life, sexual abuse. Dissociation was a way to protect
the psyche from an event the child couldn’t stop.
(Rape case, with testimony of multiples.)
Schizophrenic Disorders-defined by disturbances of
thought that affect perceptions, social and emotional
processes. 1.5% of population, but it is so debilitating
that treatment costs ¾ of US budget for mental
illness.
1) Symptomology
Positive vs. Negative symptoms-an alternative
way of defining types- based on whether
negative or positive symptoms predominate.
Negative- behavioral deficits, flat emotion,
social withdrawal, apathy, poverty of speech.
Positive- behavioral excesses, hallucinations,
delusions, bizarre behavior, flights of ideas. A
third category looks at the disorganization of
behavior.
a. Irrational thought- so disturbed that
verbalizations are described as “word
salad”. Delusions are false beliefs that are
maintained even though there is no reality
to support them. Delusions of grandeurpeople think they are famous, important.
Thought is chaotic, not linear or logicalloosening of associations as they shift
topics in mysterious ways.
b. Deterioration of adaptive behavior-no
longer take care of hygiene, work.
c. Distorted perception-most common is
auditory hallucinations- sensory
perceptions in the absence of real stimuli.
Often insulting, humiliating to the
sufferer. Gross distortions of sensory
input.
d. Disturbed emotion-either flat affect or
volatile emotion with no trigger.
2) Types
a. Paranoid Type-dominated by delusions
of persecution, and grandeur. They fear
many enemies, become suspicious of
friends, feel like they’re being watched. If
they feel persecuted, it’s because they feel
so special. Grandiose thought.
b. Catatonic Type-major motor
disturbances, muscular rigidity, random
motor activity. Waxy Flexibility is when
the person can be moved, manipulated and
they will hold the position indefinitely.
(Robin Williams film Awakenings
described tx with L-dopa)
c. Disorganized Type-deterioration of
adaptive behavior, incoherence, social
withdrawal.
d. Undifferentiated Type- idiosyncratic
mixtures of symptoms.
4)Course and Outcome- generally emerges
during adolescence or early adulthood. Sudden
or gradual onset. Some can be treated and they
can return to independent life. Most relapse. Half
are so chronically ill they remain in hospitals
most of their lives (if they can…) Males have a
worse outcome. 1% of the population
5)Etiology
a. Genetic Vulnerability-concordance rate
is higher for identical twins. Chances of
getting it from 2 schizophrenic parents is
46% (as opposed to 1% of general
population). There is a genetic
predisposition to this disease.
b. Neurochemical factors- excess dopamine
activity, so drugs slow dopamine
production in the brain.
c. Structural abnormalities in brain- may
be problems filtering distracting stimuliproblems in the attentional part of the
brain.
d. Neurodevelopmental hypothesis- due to
disruptions in normal development of the
brain at or before birth. Possibly viral
complications prenatally or malnutrition.
Results are larger ventricles (holes in the
brain) Early brain damage increases
susceptibility to mood disorders, too.
e. Expressed emotion- family members
often show overinvolvement, criticism of
every aspect of the patient. Relapse after
hospitalization is higher when family is
high in expressed emotion. High stress.
f. Precipitating stress- a severe stressor
may trigger breakdown in a vulnerable
person.
Psychological Disorders
Psychopathology-the scientific study of the origins,
symptoms, and development of psychological
disorders.
Psychological disorder- a pattern of behavior or
psychological symptoms that causes significant
personal distress, and impairs one’s ability to
function in an important area of life.
DSM-IV, Diagnostic and Statistical Manual of
Mental Disorders is published by the American
Psychiatric Association. It describes with diagnostic
criteria, 250 specific psychological disorders.
48% of Americans describe symptoms of a mental
disorder at some point in their lives, and 80% who
had symptoms had not sought help.
A. Anxiety Disorders are marked by feelings of
excessive apprehension and anxiety. More common
for females.
Generalized anxiety disorder
Phobic Disorder
Panic Disorder Agoraphobia
Obsessive-Compulsive Disorder
Posttraumatic Stress Disorder
B. Mood Disorders-marked by emotional
disturbances that may spill over to disrupt physical,
perceptual, social and thought processes. Often
associated with creativity, particularly Bipolar
disorder.
Major Depressive Disorder
Dysthymic Disorder
Seasonal Affective Disorder (SAD)
Bipolar Disorder
Cyclothymic Disorder
Etiology:
Genetic predisposition
Deficiency of neurotransmitters serotonin and
norepinephrine. Antidepressants are effective once
you find the right one in the right dosage. Lithium
stabilizes glutamate which is an excitatory
neurotransmitter.
Stress often triggers depression.
Suicide-30,000 known suicides/year, many suicides
are reported as accidents. Women attempt 3x more
than men, but Men complete 4x more than women.
Adolescent suicide has increased 200% in last 30
years. Highest rate of suicide is in the elderly.
Personality Disorders-inflexible and maladaptive
personality traits. They are stable over time and
across situations, and deviate from the expectations
of the individual’s culture. They compose 15% of the
population. Some people have more than one.
They fall into three clusters:
1)Odd, eccentric
a.Paranoid
b.Schizoid
c.Schizotypal
2)Dramatic, emotional, erratic
a.Antisocial
b.Borderline
c.Histrionic
d. Narcissistic
3)Anxious, fearful
a.Avoidant
b.Dependent
c.Obsessive-compulsive
Paranoid Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
Dissociative Disorders- disorder where people lose
contact with memory and identity.
Dissociative Amnesia
Fugue
Dissociative Identity Disorder
Etiology of Dissociative Disorders- usually
attributed to excessive stress.
Schizophrenic Disorders-defined by disturbances of
thought that affect perceptions, social and emotional
processes
1) Symptomology
Positive vs. Negative symptoms-an alternative
way of defining types- based on whether
negative or positive symptoms predominate.
Negative- behavioral deficits, flat emotion,
social withdrawal, apathy, poverty of speech.
Positive- behavioral excesses, hallucinations,
delusions, bizarre behavior, flights of ideas. A
third category looks at the disorganization of
behavior.
a.Irrational thought- Delusions are false beliefs
b.Deterioration of adaptive behavior-no longer
take care of hygiene, work.
c.Distorted perception-most common is auditory
hallucinations- sensory perceptions in the absence of
real stimuli.
d.Disturbed emotion-either flat affect or volatile
emotion with no trigger.
2) Types
a.Paranoid Type
b.Catatonic Type
c.Disorganized Type
d.Undifferentiated Type
3)Course and Outcome- generally emerges during
adolescence or early adulthood-1% of population.
4)Etiology
a.Genetic Vulnerability
b.Neurochemical factors
c.Structural abnormalities in brain
d.Neurodevelopmental hypothesis
e.Expressed emotion
f.Precipitating stress