Psychological Disorders
Chapter 15
AP Psychology
Alice F. Short
Hilliard Davidson High School
Chapter Preview
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Defining/Explaining Abnormal Behavior
Anxiety Disorders
Mood Disorders
Dissociative Disorders
Schizophrenia
Personality Disorders
Psychological Disorders and Health and
Wellness
Abnormal Behavior
• abnormal behavior - behavior that is…
– deviant (atypical)
• example: washing hands 4x an hour
– maladaptive (dysfunctional)
• example: believing that you can hurt people by breathing
and hiding away and avoiding people
– personally distressing (despair)
• example: feeling extreme shame or guilt
… over a relatively long period of time
NOTE: context matters!
Theoretical Approaches
• Biological Approach: Medical Model
– disorders with biological origins
• Psychological Approach
– experiences, thoughts, emotions, personality
• Sociocultural Approach
– social context
• Biopsychosocial Model
– interaction of biological, psychological and
sociocultural factors
Theoretical Approaches
Biological Approach: Medical Model
• medical model – the view that psychological
disorers are medical diseases with biological
origin
– disorders with biological origins
– abnormalities = mental illnesses
– patients = afflicted individuals
– doctors = people who treat the patients
Theoretical Approaches:
Psychological Approach
• psychological approach – focuses on
experiences, thoughts, emotions, personality
– in the development and course of psychological
disorders
Theoretical Approaches:
Sociocultural Approach
• Sociocultural Approach
– social context
• includes: gender, ethnicity, socioeconomic status,
family relationships, culture, technological aspects of
culture, religious aspects of culture
• socioeconomic status = greater impact than ethnicity
– living conditions of poverty = stressful
Theoretical Approaches:
Biopsychosocial Model
• Biopsychosocial Model
– interaction of biological, psychological and
sociocultural factors
– biological factors (such as genes)
– psychological factors (such as childhood
experiences)
– sociocultural factors (such as gender)
DSM-V Classification System
• Advantages
– provides a common basis for communication
– helps clinicians make predictions
– naming the disorder can provide comfort
• Disadvantages
– stigma (shame, negative reputation)
– medical terminology implies internal cause
– focus on weaknesses ignores strength
• DISUCSSION: Which do you think is more
significant—the advantages or disadvantages?
Critical Controversy:
Psychological Disorders –
Real or Myth?
• Szasz & Cruise
– phrase “mental illness” is presumptuous
– medication of mental illnesses is presumptuous
• Response of Medical Professionals
– mental illnesses are real medical conditions
– drugs effectively alleviate symptoms
• ADHD: over-diagnosed or non-medical?
– should prescription drugs be used to treat ADHD?
Critical Controversy:
A SHORT Time to Ponder
• When do you think it is appropriate to label
someone as having a psychological disorder?
• When do you think medical treatments for
psychological disorders are appropriate?
• If a teacher suggested that your child be
tested for ADHD, what do you think you would
do? Why?
DSM-V-TR Axes
• Multiaxial System
– Axis I and II: Psychological Disorders
– Axis III: Another Medical Conditions
– Axis IV: Psychosocial/Environmental Problems
– Axis V: Current Level of Functioning
• Major Categories:
– disorders usually first diagnosed in infancy,
childhood, or adolescence and
communication disorders
– anxiety disorders
– somatoform disorders
– factitious disorders
– dissociative disorders
– delirium, dementia, amnesia, and other
cognitive disorders
– mood disorders
– schizophrenia and other psychotic
disorders
– substance-related disorders
– sexual and gender identity disorders
– eating disorders
– sleep disorders
– impulse control disorders not elsewhere
classified
– adjustment disorders
Axis I
Disorders
Axis II Disorders
• Major Categories:
– intellectual disability
– personality disorders
– other conditions that may be a focus of clinical
attention
Anxiety Disorders
• anxiety disorders - uncontrollable fears that are
disproportionate to the actual danger and disruptive to
ordinary life (Axis I)
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generalized anxiety disorder
panic disorder
phobic disorder
separation anxiety disorder
selective mutism
obsessive-compulsive disorder
• now in the obsessive-compulsive and related disorders
– post-traumatic stress disorder
• now in the trauma- and stressor-related disorders
– sequential order of chapter reflects close relationship
Generalized Anxiety Disorder
• Diagnosis and Symptoms
– persistent anxiety for at least 6 months
– inability to specify reasons for the anxiety
• Etiology – the causes or significant preceding
conditions
– biological factors
• genetic predisposition, GABA deficiency, sympathetic
nervous system activity, respiration
– psychological and sociocultural factors
• harsh self-standards, critical parents, automatic negative
thoughts, history of uncontrollable trauma (like an abusive
parent)
Panic Disorder
• Diagnosis and Symptoms
– recurrent, sudden onsets of intense terror that often occur
without warning
– panic attacks: can produce sever palpitations, extreme
shortness of breath, chest pains, trembling, sweating,
dizziness and a feeling of helplessness
• types changed to unexpected panic attack and expected panic
attack
– panic disorder and agoraphobia are unlinked
• Etiology
– biological factors: genetic predisposition
– psychological factors: misinterpret arousal
– sociocultural factors: gender differences
• American women = 2x as likely to suffer from a panic disorder
• FUN FACT: Charles Darwin had a panic disorder
Phobic Disorder
• Diagnosis and Symptoms
– an irrational, overwhelming, persistent fear of a particular
object or situation
• social anxiety disorder social phobia – an intense fear of being
humiliated or embarrassed in social situations
– deletion of requirement that individuals over age 18 years
recognize that their anxiety is excessive or unreasonable
– 6-month duration expanded to include all ages
– panic disorder and agoraphobia are unlinked
– “generalized” specifier has been deleted and replaced with a
“performance only” specifier (fear of speaking/performing in
front of an audience)
• Etiology
– biological factors: genetic disposition
• neural circuit: thalamus, amygdala and cerebral cortex
– psychological factors: learned
• classical conditioning / learned associations
Examples of Phobic Disorders
• phobic disorders – it is no longer a
requirement that individuals over age 18 years
must recognize that their fear and anxiety are
excessive or unreasonable
Social Anxiety
Disorders in the US
• social anxiety
disorder (formerly
called social
phobias)
Obsessive Compulsive and Related
Disorders
• Diagnosis and Symptoms
– persistent anxiety-provoking thoughts and/or urges to
perform repetitive, ritualistic behaviors to prevent or
produce a situation
– cognitive perspective: inability to turn off negative,
intrusive thoughts by ignoring or effectively dismissing
them
– obsession – recurrent thoughts
– compulsions – recurrent behaviors
– most common: excessive checking, cleansing, counting
• Etiology
– biological factors: genetic predisposition
• more activity in frontal cortex, basal ganglia, thalamus
• smaller amygdala (counter-intuitive)
• lower levels of serotonin and dopamine
– psychological factors: life stress
Obsessive-Compulsive
and Related Disorders
• new disorders:
– hoarding disorder
– excoriation (skin-picking) disorder
– substance-/medication induced obsessive-compulsive
and related disorder
– obsessive-compulsive related disorder due to another
medical condition
• from impulse-control disorders
– trichotillomania (hair-pulling) disorder
• new specifiers
– “with poor insight”… “fair”… “good”… “absent
insight/delusional”
Post-Traumatic Stress Disorder (PTSD)
• Diagnosis and Symptoms
– Symptoms develop as a result of exposure to a traumatic
event--oppressive situation, natural or unnatural disasters—
that have overwhelmed the person’s abilities to cope
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flashbacks  reliving event
avoidance of emotional experiences/talking with others
constricted ability to feel emotions
excessive arousal  inability to sleep, exaggerated startle response
difficulties with memory and concentration
feelings of apprehension
impulsive outbursts
– 4 major symptom clusters: reexperiencing, avoidance,
persistent negative alteration in cognitions and mood,
arousal
Post-Traumatic Stress Disorder
• Etiology
– stressor criterion: requires being explicit to whether
qualifying traumatic events were experienced directly,
witnessed, or experienced indirectly
• subjective reaction (removed)
– trauma
• combat and war-related
• sexual abuse and assault
• natural and unnatural disasters (plane crashes, terrorists
attacks)
– vulnerability
• previous history of trauma
• conditions: abuse, psychological disorders
• genetic predispositions
Mood Disorders
• mood disorder - disturbance of mood that affects
entire emotional state (Axis I Disorder)
1. depressive disorders
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major depressive disorder
dysthymic disorder
2. bipolar disorders
o correlate: suicide
• Symptoms may include
– cognitive, behavioral, or physical symptoms
– interpersonal difficulties
• Diagnosis and Symptoms
– significant depressive episode that lasts for at least two weeks
– defined by presence of at least 5 out of 9
symptoms
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Major
depressed mood most of the day
Depressive
reduced interest or pleasure in all or most activities
significant weight loss or gain or significant decrease or
Disorder
increase in appetite
trouble sleeping or sleeping too much
(MDD)
psychological and physical agitation, or, in contrast, lethargy
fatigue or loss of energy
feeling worthless or guilty in an excessive or inappropriate manner
problems thinking, concentrating, or making decisions
recurrent thoughts of death and suicide
no history of manic episodes (periods of euphoric moods)
– daily functioning is impaired
– the coexistence of within a major depressive episode of at least three
manic symptoms (insufficient to satisfy criteria for a manic episode) is
now acknowledged by the specifier “with mixed feature”  increases
likelihood illness exists in bipolar spectrum
– bereavement exclusion removed - was an exclusion applied to
depressive symptoms lasting less than 2 months following the death of a
loved one
Persistent Depressive Disorder:
Dysthymic Disorder (DD)
• Diagnosis and Symptoms
– chronic depression
• unbroken depressed mood lasting at least two years (adult) or one
year (child)
– adult: less than two months regular mood still = diagnosis
– fewer symptoms than MDD
• defined by presence of 2 out of 6 symptoms
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poor appetite or overeating
sleep problems
low energy or fatigue
low self-esteem
poor concentration or difficulty making decisions
feelings of hopelessness
– dysthymic disorder now falls in category of persistent
depressive disorder (along with chronic major depressive
disorder)
Major Depressive Disorder (MDD)
• Etiology
– biological factors: genetic disposition
• underactive prefrontal cortex
• regulation of neurotransmitters
– serotonin
– norepinephrine
– psychological factors:
• learned helplessness
• ruminating on negative, self-defeating thoughts
• pessimistic attribution
– sociocultural factors
• poverty
– women head of households
– minorities
• gender differences (women = 2x likely)
Childhood Depression
• Developmental Psychopathology
– risk factors for depression
• parental psychopathology
• genetics
– protective factors
• supportive adult role model, or strong extended family
• genetics
Mood Disorder: Bipolar Disorder
• Characterized by extreme mood swings
– Bipolar I (more severe)
• hallucinations – seeing or hearing things that are not there
• mania – an overexcited, unrealistically optimistic state
• new specifier of “with mixed features” (meeting full criteria for both has been
removed)
– Bipolar II
• less extreme level of euphoria
– manic and hypomanic episodes now include an emphasis on changes
in activity and energy as well as mood
• Frequency and separation of episodes
– usually separated by 6 months to a year
• Etiology
– strong genetic component
– swings in metabolic activity in cerebral cortex
– levels of neurotransmitters
• high levels of norepinephrine, glutamate
• low levels of serotonin
Suicide
• Prevalence
– over 32,000 in year 2004
– one completion for every 8 to 25 attempts
– 3rd leading cause of death in early adolescence
• 10-14
• 13-19
Suicide
• Biological factors
– low levels of serotonin
– 10x likely to try again
– poor health
• Psychological Factors
– mental disorders
• 90 percent
– trauma (recent/immediate and highly stressful)
• sexual abuse
• loss of a job/flunking out of school/unwanted pregnancy
– substance abuse
• Sociocultural Factors
– chronic economic hardship
– cultural and religious norms
• norms against suicide = lower rates
• eastern Europe, Japan, South Korea
– gender differences
When Someone is Threatening Suicide
• attempters: connection to others
– women 3x morel likely to attempt
• completers: disconnected / burden on others
– men 4x more likely to complete suicide; more likely to use a firearm
– highest suicide rate is among non-Latino men aged 85+
Dissociative Disorder
• dissociative disorder - sudden loss of memory or
change in identity due to the dissociation (separation)
of the individual’s conscious awareness from previous
memories and thoughts
• Dissociation
– protection from extreme stress or shock
– problems integrating emotional memories
• Types
– dissociative amnesia
– dissociative fugue * is now a specifier of dissociative
amnesia rather than a separate diagnosis
– dissociative identity disorder (DID)
Dissociative Disorders
• Dissociative Amnesia
– individuals experience extreme memory loss caused
by extensive psychological stress
– only aspects of their own identity and
autobiographical experiences are forgotten
• Example: sodium pentathol “truth serum”  stress
– Dissociative Fugue
• dissociative fugue * is now a specifier of dissociative
amnesia rather than a separate diagnosis
• individuals experience amnesia, unexpectedly travel away,
and sometimes assume a new identity
• tendency to run away*
Dissociative Identity Disorder (DID)
• formerly known as multiple personality disorder
• most dramatic, least common, most controversial dissociative disorder
• Diagnosis and Symptoms
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the same individual possesses two or more distinct personalities
symptoms of disruption may be reported as well as observed
each personality has unique memories, behaviors, and relationships
only one personality is dominant at a time
personality shifts (and gaps in recall) occur under distress and everyday
(not just traumatic events)
– * “experiences of pathological possession in some cultures are included in
the description of identity disruption”
• Etiology
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extraordinarily severe abuse in early childhood (70%)
social contagion
mostly women
runs in families
• individual compartmentalizes different aspects of the self into
independent identities
Schizophrenia
• highly disordered thought
– thought disorder – refers to the unusual, sometimes bizarre
thought processes that are characteristic positive symptoms of
schizophrenia
– split from reality (psychotic)
– typically diagnosed in early adulthood
– high suicide risk (8x general population)
• categories of symptoms:
– positive symptoms
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hallucinations
delusions
thought disorders
disorders of movement
– negative symptoms
• Positive Symptoms
– hallucinations – sensory experiences in the
absence of real stimuli
• auditory and visual = more common
• smells or tastes = less common
Symptoms of
Schizophrenia
– delusions – false, unusual, and sometimes magical beliefs that are not part of an
individual’s culture
• believing you’re Jesus Christ, Muhammad, etc.
• that your thoughts are being broadcast over the radio, etc.
– disorganized speech * in DSM-V must have one of these core positive symptoms
– thought disorder
• “word salad”; neologisms – making up new words
• referential thinking – ascribing personal meaning to completely random events – traffic light
turned red because YOU’RE in a hurry
– disorders of movement – unusual mannerisms, body movements, facial expressions,
may repeat certain motions over and over
• catatonia – state of immobility and unresponsiveness lasting for long periods of time (all contexts
require 3 catatonic symptoms (of 12); may be diagnosed as specifier for depressive, bipolar,
psychotic disorders)
• Negative Symptoms
– flat affect – the display of little or no emotion (common)
• Cognitive Symptoms
– attention difficulties and memory problems
– impaired ability to interpret information and make decisions
• subtypes of schizophrenia are removed in DSM-V (paranoid, disorganized,
catatonic, undifferentiated, residual, etc.)
• Biological Factors
– genetic predisposition
– structural brain abnormalities
(no glial cells  prenatal)
Etiology of
Schizophrenia
• enlarged ventricles (fluid-filled spaces) in brain
 indicates deterioration in other brain tissue
• smaller and less active prefrontal cortex
– regulation of neurotransmitters
• excess dopamine production (or overactivation of pathways)
– bizarre beliefs continue after dopamine regulation  may disappear only
after experience demonstrates that such schemas no longer carry their
explanatory power
• Psychological Factors
– diathesis-stress model – view of schizophrenia emphasizing that
a combination of biogenetic disposition and stress causes the
disorder
– diathesis – physical vulnerability or predisposition to a particular
disorder
• Sociocultural Factors
– influence how disorder progresses (course)
– developing, non-industrialized countries have better results
• personality disorder - chronic
maladaptive cognitive-behavioral
patterns
– antisocial personality disorder
– borderline personality disorder
Personality
Disorders
• Antisocial Personality Disorder
– Diagnosis and Symptoms
• guiltless lawbreaking, violence, deceit
• impulsive, irritable, reckless, irresponsible
• exploitative, lacks empathy
– psychopaths – remorseless predators who engage in violence to
get what they want (examples: John Wayne Gacy, Ted Bundy)
• “successful psychopaths” and “unsuccessful psychopaths”
– Etiology
• biological factors
– genetic heritable
– brain: less prefrontal activation, structural abnormalities in amygdala and
hippocampus
– underaroused ANS (autonomic nervous system) differences
– testosterone – hormone most associated with aggressive behavior
• more common in men
• Borderline Personality Disorder
– Diagnosis and Symptoms
Personality
Disorders
• instability in interpersonal relationships &
self-image
• impulsive, insecure, unstable & extreme emotions
• very sensitive to treatment of others
• paranoia – a pattern of disturbed thought featuring delusion of grandeur
or persecution
• dissociative symptoms
• recurrent suicidal behavior, gestures, or threats or self-mutilating
behaviors
– cutting – insuring oneself with a sharp object but without suicidal attempt
• splitting – thinking style of seeing things in black or white
– Etiology
• genetic (40% heritability)
• childhood abuse, neglect – suggests diathesis-stress explanation
• irrational belief one is powerless, unacceptable, and that others are hostile
– hypervigilance – the tendency to be constantly on the alert, looking for
threatening information in the environment
• 75% women
Psychological Disorders
and Health and Wellness
• Stereotypes and Stigma
– Rosenhan’s study - fake psychiatric patients
• 3-52 days hospitalization for (FAKE) schizophrenia
– negative attitudes toward mentally ill
– physical health risk
– successfully functioning individuals with mental
illness reluctant to “come out”
Chapter Summary
• Discuss the characteristics, explanations, and
classifications of abnormal behavior.
• Distinguish among the various anxiety disorders.
• Compare the mood disorders and specify risk factors
for depression and suicide.
• Describe the dissociative disorders.
• Characterize schizophrenia.
• Identify behavior patterns typical of personality
disorders.
• Explain the impact of the stigma associated with
mental illness.
Chapter Summary
• Abnormal Behavior
– deviant, maladaptive, or personally distressing
• Theoretical Approaches
– biological, psychological, and sociocultural
– biopsychosocial
• Classifying Abnormal Behavior
– DSM-IV-TR Axes
– advantages and disadvantages
Chapter Summary
• Anxiety Disorders
– generalized anxiety disorder
– panic disorder
– phobic disorder
– obsessive-compulsive disorder
– post-traumatic stress disorder
Chapter Summary
• Mood Disorders
– major depressive disorder
– dysthymic disorder
– bipolar disorder
– suicide
• Dissociative Disorders
– dissociative amnesia
– dissociative fugue
– dissociative identity disorder
Chapter Summary
• Schizophrenia
– positive, negative and cognitive symptoms
– etiology (biological, psychological, sociocultural)
• Personality Disorders
– antisocial personality disorder
– borderline personality disorder
• Psychological Disorders and Health & Wellness
– stigmas and stereotypes