Chapter 12:
Psychological Disorders
I. Perspectives on Psychological Disorders
A. Defining abnormality
1. Deviates from statistical norm
2. Deviates from social norm
3. Maladaptive or even injurious
4. Personally distressful
5. Interferes with normal social, academic, or occupational functioning
B. Normality (see Table 12-1)
1. Efficient perception of reality
2. High degree of self-knowledge
3. High degree of voluntary control
4. High degree of self-esteem and self-acceptance
5. Ability to form interpersonal relationships
6. Productive and constructive, not just reactive
C. Quantitative not qualitative judgment
Difference in degree
D. The terms “mentally ill” and “insane”
Mentally ill = clinical term
Insane = legal term
II. Historical Views of Psychological Disorders
A. Hippocrates, Galen:
1. The 4 humors
a. Blood
b. Phlegm
c. Yellow Bile
d. Black Bile
2. Imbalance of these fluids caused disorders.
Blood: excessively cheerful
Phlegm: fiery
Yellow bile: slow
Black bile: melancholy, depressed
B. Middle-ages: work of the devil
C. Reform
1. Philippe Pinel (1745-1826)
2. Dorothea Dix (1802-1887)
III. Conflicting Theories of the Nature, Causes, and Treatment of Psychological Disorders
A. The Biological Model
1. Maintains that psychological disorders have a biochemical or physiological
basis.
2. Idea came from general paresis related to the late stages of syphilis with its
severe cognitive impairments and progressive paralysis
B. The Psychoanalytic Model
1. Fixation, Anxiety, and the defense mechanisms
2. Maintains that psychological disorders result from unconscious internal
conflicts among personality structures.
C. The Cognitive-Behavioral Model
Maintains that psychological disorders result from learning maladaptive ways of
thinking and behaving--cognitive distortions, faulty cognitive perceptions
D. Interactive models
1. The Diathesis-Stress Model
Biological predisposition (diathesis) interacts with stressful life
circumstances to produce behavioral disorder.
2. Systems Theory : the bio-psycho-social model
biological
predisposition
psychological
coping skills
social stress
E. "Medical model" of abnormality
1. A general orientation to the problem of abnormality in which:
(a) unusual behaviors (bizarre, extreme, disturbing) are viewed as symptoms
(b) of an underlying mental pathology (some category from DSM-V)
(c) caused by an underlying internal/mental entity or condition (biological: chemical
imbalance, brain injury; psychological: weak ego, defective personality, faulty cognitive
perception, etc.)
2. In the same way that:
(a) unusual medical conditions (cough/fever/sore throat) are viewed as symptoms
(b) of an underlying medical pathology (cold, flu, pneumonia)
(c) caused by an underlying medical entity or condition (bacteria, virus)
3. In each case, the task of the specialist is to infer the nature of the underlying
pathology and the underlying cause on the basis of the evidence provided by the
symptoms.
IV. Classifying Psychological Disorders
A.
Benefits vs. drawbacks
B.
Diagnostic categories of DSM V (see Table 12-2)
C. Making a diagnosis under DSM V
1. Specify diagnostic category -- clinical disorders, focus of clinical attention
2. For the category, include
a. any current medical conditions that may be relevant to the mental
disorder
b. recent psychological, social and environmental events that cause
stress, create problems, and tax an individual’s coping skills
c. overall level of current functioning
D. Historical
Emil Kraeplin (1855-1925)
DSM I:
1952
DSM II:
1968
DSM III:
1980
DSM III-R:
1987
DSM IV:
1994
DSM IV-TR:
2000
DSM V:
2013
E. The terms "neurosis" and "psychosis"
V. Mood disorders
A. Categories
1. Depressive disorders:
Major depressive disorder
Persistent depressive disorder
2. Bi-polar disorder
(mania + depression)
B. Causes of Mood Disorders
1. Biological factors: genetics, neurotransmitters
2. Psychological factors
Beck's "cognitive distortions": arbitrary inference, selective abstraction,
overgeneralized labeling, mind-reading, magnification/minimization, all-ornothing thinking, personalization, and “tyranny of the shoulds”
3. Social factors
a. real/symbolic loss when close personal relationship becomes troubled
b. inadequate coping repertoire
C. More about Suicide
1. As many as 30,000 people in US commit suicide each year.
2. Adolescents account for 12% of all suicide attempts.
3. Refer to Suicide Statistics and Risk Factors Handout
VI. Anxiety disorders
A. Categories
1. Anxiety disorders:
Phobias (Specific or Social)
Social anxiety
Panic
Generalized anxiety disorder
2. Obsessive-compulsive disorders (OCD)
a. obsessions: persistent intrusions of unwelcome thoughts, images, or
impulses that cause anxiety
b. compulsions: irresistible urges to carry out certain acts or rituals
c. Body-dysmorphic disorder
3. Trauma–stress related disorders
Post-Traumatic Stress Disorder (PTSD)
B. Causes of Anxiety Disorders
1. Phobias-learning theory, predispositions
2. Biological factors
3. Psychoanalytic: displacement
VII. Psychosomatic Disorders
Real physical conditions linked to psychosocial stress: ulcers, high blood pressure,
asthma, immune disorders, tension headaches, but no separate DSM-V category
VIII. Somatic Symptom Disorders
A. Examples
1. Somatic symptom disorder
2. Conversion disorder
3. Illness anxiety disorder
4. Hypochondriasis
B. Causes
1. Psychodynamic interpretation: unconscious, secondary gain
2. Negative reinforcement
3. Undiagnosed but nevertheless real biological disorders
IX.
Dissociative Disorders
A. Examples
1. Dissociative Amnesia
2. Dissociative Fugue
3. Dissociative Identity Disorder (multiple personality disorder)
4. Depersonalization Disorder
B. Causes
1. Psychodynamic interpretation: unconscious, secondary gain
2. Negative reinforcement
3. Intense social, physical, or sexual trauma
X. Sexual Dysfunction
A. Categories
1. Sexual Dysfunction
Erectile disorder, female orgasmic disorder, female interest-arousal disorder,
premature ejaculation
2. Paraphilic Disorders
voyeuristic, exhibitionistic, masochism-sadism, pedophilic, fetishistic
3. Gender dysphoria
B. Causes
1. Hormonal imbalances
2. Family dynamics (e.g., early sexualization)
3. Learning experiences (e.g., physical/sexual/emotional abuse)
XI. Personality Disorders
A. Examples
1. Paranoid
2. Schizoid
3. Schizotypal
4. Anti-social
5. Borderline
6. Histrionic
7. Narcissistic
8. Avoidant
9. Dependent
10. Obsessive-Compulsive
B. Causes: combination of biological predisposition, adverse psychological experiences,
unhealthy social/family environment
C. Antisocial Personality Disorder most studied of all. Also referred to as psychopathy
or sociopathy. No responsibility, no empathy, and no sense of shame.
1. Lack of Affection and severe parental rejection
2. Parental inconsistencies in child-rearing
3. More males than females
4. Often physically attractive and highly intelligent
XII. Schizophrenic Spectrum Disorders
A. Symptoms
1. Positive
Symptoms
Hallucinations
Delusions
Thought/
language disorders
Bizarre behavior
Percent
Reporting
69%
84%
43%
26%
2. Negative
Symptoms
Apathy
Flattened affect
Social withdrawal
Inattention
Slowed or no speech
90%
88%
88%
66%
53%
3. Social/occupational dysfunction
4. Duration: 6 months
5. Not medical condition and not developmental
B. Causes
1. Biological perspective: family links, dopamine imbalance
2. Bio-psycho-social model: vulnerability, coping, stress
XIII. Neurodevelopmental Disorders
A. Examples
1. ADHD
2. Autism spectrum disorder (ASD)
B. Causes: assumed to be biological/genetic or environmental/social and familial or a
combination or both
XIV. Substance abuse (pp. 136-150)
A. Terms
1. Tolerance, withdrawal
2. Dependence = addiction
Physical vs Psychological dependence?
3. Criteria for defining dependence (Table 4-1, p. 137): tolerance, withdrawal,
increasing use over time, persistent and repeated efforts to quit, time spent
using/obtaining substance, giving up activities as a result of use, continuing to
use despite problems
B. Classifications of psychoactive drugs (p. 138)
1. Depressants (sedatives), alcohol, barbiturates, tranquilizers, inhalants
2. Opiates (narcotics): codeine, heroin, morphine, methadone
3. Stimulants: amphetamine, cocaine, nicotine, caffeine
4. Hallucinogens: LSD, mescaline, peyote, psilocybin, PCP
5. Cannabis: marijuana, hashish
C. Alcohol abuse
XV. Gender and Cultural Differences in Psychological Disorders
A. Incidence and gender
1. Overall women are reported to have a higher rate of psychological disorders
a. Due to gender or ability to admit and externalize problems?
b. Perhaps better statement is more women are TREATED for
psychological disorders.
2. Equal
bi-polar, schizophrenia
3. Men: higher incidence of anti-social, substance abuse
4. Women: higher incidence of anxiety, mood disorders
5. Some statistics: Fig 12-1
B. Marital status
1. married women > married men
2. sep/div men > sep/div women, married men
C. Cultural differences
Presenting symptoms
Client expression of symptoms