Chapter 12
Psychological Disorders
Module 12.1: Learning Objectives
Normality and Psychopathology
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Indicate the magnitude of mental health problems in the U.S.
and Canada
Define psychopathology
Describe the following ways of viewing normality: subjective
discomfort, statistical abnormality, social nonconformity,
situational context, and cultural relativity
Give examples of how race, gender, and social class continue to
affect the diagnosis of various disorders
Indicate the two core features of abnormal behavior
Explain how the DSM-IV-TR is used
Define mental disorder
Module 12.1: Learning Objectives
Normality and Psychopathology (Continued)
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Briefly describe each of the following categories of mental
disorders: psychotic disorders, organic mental disorders, mood
disorders, anxiety disorders, somatoform disorders, dissociative
disorders, personality disorders, sexual and gender identity
disorders, and substance related disorders
Define the term neurosis and explain why it was dropped from
use
Describe examples of culture-bound syndromes from around the
world
List the four general risk factors that contribute to
psychopathology
Define insanity and explain how it is established in court
Describe the “medical student’s disease”
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Defining What Is Normal
Psychopathology:
– Scientific study of mental, emotional, and
behavioral disorders
Subjective Discomfort:
– Private feelings of anxiety, depression, or
emotional distress
Statistical Abnormality:
– Having extreme scores on some dimension, such
as intelligence, anxiety, or depression
Social Nonconformity:
– Disobeying societal standards for normal conduct;
may lead to destructive or self-destructive
behavior
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Defining What Is Normal
(Continued)
Situational Context:
– Social situation, behavioral setting, or
general circumstances in which an action
takes place
• Is it normal to walk naked around
strangers? If you are in a locker room
and in the shower area, yes!
Cultural Relativity:
– Judgments are made relative to the values
of one’s culture
Features of Disordered Behavior
• Abnormal behavior has two core features:
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– Maladaptive Behavior:
• Behavior that makes it difficult to
function, to adapt to the environment,
and to meet everyday demands
– Loss of ability to adequately control
thoughts, behaviors, or feelings
Mental Disorder:
– Significant impairment in psychological
functioning
Features of Disordered Behavior
(Continued)
• Psychotic Disorder:
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– Severe psychiatric disorder characterized
by hallucinations and delusions, social
withdrawal, and a movement away from
reality
Organic Mental Disorder:
– Mental or emotional problem caused by
brain pathology (e.g., brain injuries or
diseases)
Classifications of Major Disorders
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Mood Disorder:
– Disturbances in affect (emotions or moods), like
depression or mania
Anxiety Disorder:
– Disruptive feelings of fear, apprehension, anxiety,
or behavior distortions that are anxiety-related
Somatoform Disorders:
– Physical symptoms that mimic disease or injury for
which there is no identifiable cause
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Classifications of Major Disorders
(Continued)
Dissociative Disorder:
– Temporary amnesia, multiple identity, or
depersonalization (like being in a dream
world, feeling like a robot, feeling like you
are outside of your body)
Personality Disorder:
– Deeply ingrained, unhealthy, maladaptive
personality patterns
Classifications of Major Disorders
(Continued)
• Sexual and Gender Identity Disorder:
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– Problems with sexual identity, deviant
sexual behavior, or sexual adjustment
Substance Related Disorders:
– Abuse or dependence on a mind or moodaltering drug, like alcohol or cocaine
– Person cannot stop using the substance
and may suffer withdrawal symptoms if
they do
Neurosis
• Archaic term
• Once used to refer to excessive anxiety,
somatoform, dissociative disorders, and
some kinds of depression
Cultural Maladies
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Amok:
– Men from Malaysia, Laos, Philippines, and
Polynesia who feel they have been insulted will
brood then erupt violently
Susto:
– Insomnia, irritability, phobias, and an increase in
sweating and heart rate affecting Latin Americans
who are frightened by a black magic curse
Ghost Sickness:
– American Indians who become preoccupied with
death and the deceased
– Symptoms include bad dreams, confusion,
feelings of futility, and a sense of suffocation
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Cultural Maladies
(Continued)
Koro:
– A fear of the genitals receding into the body
experienced by people in southern and eastern
Asia
Zar:
– When spirits posses an individual resulting in
shouting, laughing, weeping, or singing
– Seen in North Africa and Middle East
Dhat:
– In Indian society, dhat is the fear of the loss of
semen during nocturnal emissions
General Risk Factors for Contracting Mental
Illness
• Social Conditions:
– Poverty, homelessness, overcrowding,
stressful living conditions
• Family Factors:
– Parents who are immature, mentally ill,
abusive, or criminal
– Poor child discipline
– Severe marital or relationship problems
General Risk Factors for Contracting Mental
Illness (Continued)
• Psychological Factors:
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– Stress, learning disorders, and low
intelligence
Biological Factors:
– Genetic defects or inherited vulnerabilities
– Poor prenatal care, head injuries, exposure
to toxins, chronic physical illness, or
disability
Insanity
• A legal term referring to an inability to
manage one’s affairs or to be aware of the
consequences of one’s actions
Expert Witness
• Person recognized by a court of law as being
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qualified to give expert testimony on a
specific topic
– May be psychologist, psychiatrist, and so
on
Insanity is established by testimony from an
expert witness
Module 12.2: Learning Objectives
Personality Disorders and Anxiety-Based Disorders
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Describe the ten different types of personality disorders and
include an in-depth discussion of the distinctive characteristics
and causes of the antisocial personality
Define anxiety and describe the characteristics of anxietyrelated disorders
Explain why the term nervous breakdown has no formal
meaning and how it may be related to adjustment disorders
Describe an adjustment disorder, including its characteristics,
causes, treatment, and how it differs from anxiety disorders
Describe the following anxiety disorders: generalized anxiety
disorder, panic disorder (without agoraphobia), panic disorder
(with agoraphobia), agoraphobia (without panic), specific
phobia, social phobia, obsessive-compulsive disorder, acute
stress disorder, and post-traumatic stress disorder
Module 12.2: Learning Objectives
Personality Disorders and Anxiety-Based Disorders
(Continued)
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Discuss the following dissociative disorders: dissociative
amnesia, dissociative fugue, and dissociative identity disorder
Discuss the following somatoform disorders: hypochondriasis,
somatization disorder, pain disorder, and conversion disorder,
including “glove anesthesia
Describe the related disorders known as Munchausen syndrome
and Munchausen by proxy
Define the term comorbid
Describe the heritability of anxiety-based disorders
Explain how each of the major perspectives in psychology view
the causes of anxiety disorders: psychodynamic, humanistic
(Rogers) existential, behavioral, including the terms avoidance
learning and anxiety reduction hypothesis, and the cognitive
view
Personality Disorders
• Patterns usually begin during adolescence or
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childhood
Deeply rooted
Span many years
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Personality Disorders:
Antisocial Personality Disorder (APD)
Definition:
– A person who lacks a conscience
– Typically emotionally shallow, impulsive,
selfish, and manipulative toward others
• Oftentimes called psychopaths or
sociopaths
APD Characteristics
• Many are delinquents or criminals, but many
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are NOT crazed murderers as displayed on
television
Create a good first impression and are often
charming
Cheat their way through life
May be blind to signs of disgust in others
Tend to be thrill-seekers
APD: Causes and Treatments
• Possible Causes:
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– Childhood history of emotional deprivation,
neglect, and physical abuse
– Underarousal of the brain
Very difficult to effectively treat
– Will likely lie, charm, and manipulate their
way through therapy
Anxiety-Based Disorders
• Anxiety:
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– Feelings of apprehension, dread, or
uneasiness
Adjustment Disorders:
– When ongoing stressors within the range
of normal experience cause emotional
disturbance and push people beyond their
ability to effectively cope
More on Anxiety-Based Disorders
• Usually suffer sleep disturbances, irritability,
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and depression
Examples of Stresses:
– Grief reactions, lengthy physical illness,
unemployment
Anxiety-Based Disorders
• Anxiety Disorders:
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– When distress seems greatly out of
proportion to the situation at hand
Generalized Anxiety Disorder (GAD):
– Duration of at least six months of chronic,
unrealistic, or excessive anxiety
– Worries about work, relationships, ability,
or impending disaster
Panic Disorder (without Agoraphobia)
• A chronic state of anxiety with brief moments
of sudden, intense, unexpected panic (panic
attack)
– Panic Attack:
• Feels like one is having a heart attack,
going to die, or is going insane
– Symptoms include vertigo, chest pain,
choking, fear of losing control
Panic Disorder: Symptoms
PLAY VIDEO
Panic Disorder (with Agoraphobia)
• Panic attacks and sudden anxiety still occur,
but with agoraphobia
Agoraphobia Characteristics
• Intense, irrational fear that a panic attack will
occur in a public place or in an unfamiliar
situation
– Intense fear of leaving the house or
entering unfamiliar situations
– Can be very crippling
– Literally means fear of open places or
market (agora)
Agoraphobia (without Panic Disorder)
• Fear that something extremely embarrassing
will happen away from home or in an
unfamiliar situation
Specific Phobias
• Irrational, persistent fears; anxiety; and
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avoidance that focus on specific objects,
activities, or situations
People with phobias realize that their fears
are unreasonable and excessive, but they
cannot control them
Social Phobia
• Intense, irrational fear of being observed,
evaluated, humiliated, or embarrassed by
others in social situations
– Examples: shyness, not eating or speaking
in public
Obsessive-Compulsive Disorder (OCD)
• Extreme preoccupation with certain thoughts
and compulsive performance of certain
behaviors
Obsession
• Recurring images or thoughts that a person
cannot prevent
– Cause anxiety and extreme discomfort
– Enter into consciousness against the
person’s will
– Most common:
• Being dirty, wondering if you performed
an action (turned off the stove), or
violence (hit by a car)
Compulsion
• Irrational acts that person feels compelled to
repeat against his/her will
– Help to control anxiety created by
obsessions
– Checkers and cleaners
Obsessive Compulsive Disorder
PLAY VIDEO
Stress Disorders
• Occur when stresses outside range of normal
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human experience cause major emotional
disturbance
Symptoms:
– Reliving traumatic event repeatedly,
avoiding stimuli associated with the event,
and numbing of emotions
Acute Stress Disorder
• Psychological disturbance, lasting up to one
month following stresses from a traumatic
event , that would produce anxiety in anyone
who experienced them
Post Traumatic Stress Disorder (PTSD)
• Lasts more than one month after the
traumatic event has occurred; may last for
years
– Typically associated with combat and
violent crimes (rape, assault, etc.)
• Example: the “war” in Iraq
Dissociative Disorders
• Dissociative Amnesia:
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– Inability to recall one’s name, address, or
past
Dissociative Fugue:
– Sudden travel away from home and
confusion about personal identity
Dissociative Identity Disorder (DID)
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Person has two or more distinct, separate identities
or personality traits
Previously known as Multiple Personality Disorder
– “Sybil” or “The Three Faces of Eve” are good
examples
– Often begins with horrific childhood experiences
(e.g., abuse, molestation, etc.)
– Therapy often makes use of hypnosis
– Goal: Integrate and fuse identities into single,
balanced personality
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Somatoform Disorders:
Hypochondriasis
Person is preoccupied with having a serious
illness or disease
– Interpret normal sensations and bodily
signs as proof that they have a terrible
disease
– No organic cause can be found
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Somatoform Disorders:
Somatization Disorder
Person expresses anxieties through
numerous physical complaints
– Many doctors are consulted but no organic
or physical causes are found
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Somatoform Disorders:
Pain Disorder
Pain that has no identifiable organic, physical
cause
– Appears to have psychological origin
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Somatoform Disorders:
Conversion Disorder
Severe emotional conflicts are “converted”
into physical symptoms or a physical disability
– Caused by anxiety or emotional distress
but not by physical causes
Munchausen Syndrome by Proxy
• When a person fakes the medical problems
of someone in his or her care
Theoretical Causes of Anxiety Disorders
• Psychodynamic Approach
• Humanistic-Existential Approach
• Behavioral Approach
• Cognitive Approach
Theoretical Causes of Anxiety Disorders:
Psychodynamic
• Freud: anxiety caused by conflicts among id,
ego, and superego
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Some of Freud’s Concepts Regarding
Anxiety
Forbidden id impulses for sex or aggression
are trying to break into consciousness and
thus influence behavior
Person fears doing something crazy or
forbidden
Superego creates guilt in response to these
impulses
Ego gets overwhelmed and uses defense
mechanisms to cope
Theoretical Causes of Anxiety Disorders:
Humanistic
• Unrealistic self-image conflicts with real selfimage
• Emphasize subjective experience, human
problems, and personal potentials
• Existentialism focuses on elemental problems
of existence, such as death, meaning, choice,
and responsibility
Theoretical Causes of Anxiety Disorders:
Behavioral
• Anxiety symptoms and behaviors are learned,
like everything else
– Conditioned emotional responses that
generalize to new situations
• Avoidance Learning:
– When making a particular response delays
or prevents the onset of a painful or
unpleasant stimulus
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Theoretical Causes of Anxiety Disorders:
Behavioral (Continued)
Anxiety Reduction Hypothesis:
– When reward of immediate relief from
anxiety perpetuates self-defeating
avoidance behaviors
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Theoretical Causes of Anxiety Disorders:
Cognitive
When distorted thinking causes people to
magnify ordinary threats and failures, leading
to anxiety and distress
Module 12.3: Learning Objectives
Psychosis, Delusional Disorders, and Schizophrenia
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Discuss the major features of psychotic disorders, including the
different types of delusions and hallucinations
List the warning signs of psychotic disorders and major mood
disorders
Describe the various types of organic psychoses, including
poisonings and dementia
List the main feature of delusional disorders
Describe the five types of delusional disorders, including the
most common delusional disorder, paranoid psychosis and
explain how it differs from schizophrenia
Discuss schizophrenia, including its frequency, symptoms, and
the problems with selective attention
Module 12.3: Learning Objectives
Psychosis, Delusional Disorders, and Schizophrenia
(Continued)
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List and describe the four major subtypes of schizophrenia,
Explain the general relationship between psychosis and
violence
Discuss the following causes of schizophrenia: the environment,
including the prenatal environment, birth complications, early
psychological trauma, disturbed family environment, and deviant
communication patterns; heredity, including inherited potential
and genetic mutations; brain chemistry, including the roles of
dopamine and glutamate; and brain structure and activity,
including information gained through CT, MRI, and PET scans
Explain the stress-vulnerability model
Psychosis and Hallucinations
• Psychosis: loss of contact with shared views
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of reality
Delusions and hallucinations are core
features of psychosis
– Delusions:
• False beliefs that individuals insist are
true, regardless of overwhelming
evidence against them
Hallucinations
• Imaginary sensations, such as seeing,
hearing, or smelling things that do not exist in
the real world
– Most common psychotic hallucination is
hearing voices
– Note that olfactory hallucinations
sometimes occur with seizure disorder
(epilepsy)
Some More Psychotic Symptoms
• Flat Affect:
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– Lack of emotional responsiveness; face is
frozen in blank expression
Disturbed Verbal Communication:
– Garbled and chaotic speech
– Word salad
Personality Disintegration:
– Uncoordinated thoughts, actions, and
emotions
Other Psychotic Disorders
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Organic Psychosis:
– Psychosis caused by brain injury or disease
• Dementia:
– Most common organic psychosis; serious
mental impairment in old age caused by
brain deterioration
– Archaically known as senility
– Common Causes:
• Circulatory problems, repeated strokes, and
shrinkage and atrophy of the brain
Alzheimer’s Disease
• Symptoms include impaired memory,
confusion, and progressive loss of mental
abilities
– Ronald Reagan was perhaps the most
famous Alzheimer’s victim
Delusional Disorders
• Marked by presence of deeply held false
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beliefs (delusions)
– May involve delusions of grandeur,
persecution, jealousy, or eroticism
– Experiences could really occur!
Paranoid Psychosis: most common
delusional disorder
– Centers on delusions of persecution
Schizophrenia
• Psychotic disorder characterized by
hallucinations, delusions, apathy, thinking
abnormalities, and “split” between thoughts
and emotions
– Does NOT refer to having split or multiple
personalities
Schizophrenia: Distortion of Reality
PLAY VIDEO
The Four Subtypes of Schizophrenia
• Disorganized Type:
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– Incoherence, grossly disorganized
behavior, bizarre thinking, and flat or
inappropriate emotions
Catatonic Type:
– Marked by stupor, rigidity,
unresponsiveness, posturing, mutism, and
sometimes agitated, purposeless behavior
The Four Subtypes of Schizophrenia
• Paranoid Type:
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– Preoccupation with delusions
– Also involves auditory hallucinations that
are related to a single theme, especially
grandeur or persecution
Undifferentiated Type:
– Any type of schizophrenia that does not
have paranoid, catatonic, or disorganized
features or symptoms
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Causes of Schizophrenia
Environment:
– In utero exposure to the flu
– Malnutrition during pregnancy
– Complications during birth
Psychological Trauma:
– Psychological injury or shock, often caused by
violence, abuse, or neglect
Disturbed Family Environment:
– Stressful or unhealthy family relationships,
communication patterns, and emotional
atmosphere
Heredity
Biochemical Causes of Schizophrenia
• Biochemical Abnormality:
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– Disturbance in brain’s chemical systems or
in the brain’s neurotransmitters
Dopamine:
– Neurotransmitter involved with emotions
and muscle movement
– Works in limbic system
Dopamine overactivity in brain may be related
to schizophrenia
Schizophrenic Brain
• Computed Tomography (CT) Scan:
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– Computer enhanced X-ray of brain or body
Images revealed schizophrenic brains have
shrunk
Magnetic Resonance Imaging (MRI) Scan
• Computer enhanced three-dimensional image
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of brain or body
Based on magnetic field
– MRIs show schizophrenic brains as having
enlarged ventricles
Positron Emission Tomography (PET) Scan
• Computer-generated color image of brain
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activity
Radioactive sugar solution is injected into a
vein, eventually reaching the brain
– Activity is abnormally low in frontal lobes of
schizophrenics
Implications
• Stress-Vulnerability Hypothesis:
– Combination of environmental stress and
inherited susceptibility cause psychoses
Module 12.4: Learning Objectives
Mood Disorders
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Discuss mood disorders, including the following: the incidence,
the two general types, characteristics of the moderate mood
disorders of dysthymic and cyclothymic disorders, the
characteristics of the three major mood disorders: major
depression, bipolar I and bipolar II, and how major mood
disorders differ from moderate mood disorders, including the
definition of the term endogenous
Discuss the following causes of depression: brain chemicals,
psychoanalytic theory, behavioral theory, cognitive theory, the
social and environmental stresses that cause women to
experience depression more than men, including postpartum
depression, the role of heredity, and the time or season of the
year, including the cause, symptoms, and treatment of seasonal
affective disorder
Module 12.4: Learning Objectives
Mood Disorders (Continued)
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Describe Rosenhan’s pseudo-patient study and his observations
regarding psychiatric labeling
Discuss the dangers of psychiatric labeling, including the social
stigma
Give a general description of the treatment and prognosis for
various mental disorders
Mood Disorders
• Major disturbances in emotion or mood, such
as depression or mania
– Depressive Disorders:
• Sadness or despondency are prolonged,
exaggerated, or unreasonable
– Bipolar Disorders:
• Involve both depression, and mania or
hypomania
Bipolar Disorder: Delusional Thinking
PLAY VIDEO
Milder Mood Disorders
• Dysthymic Disorder:
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– Moderate depression that lasts for at least
two years
Cyclothymic Disorder:
– Moderate manic and depressive behavior
that lasts for at least two years
Major Mood Disorders
• Lasting extremes of mood or emotion and
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sometimes with psychotic features
(hallucinations, delusions)
Major Depressive Disorder:
– A mood disorder where the person has
suffered one or more intense episodes of
depression
– One of the more serious mood disorders
Major Mood Disorders
• Bipolar I Disorder:
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– People who experience extreme mania
and deep depression
• Mania:
–Excited, hyperactive, energetic,
grandiose behavior
Bipolar II Disorder:
– Person is mostly depressed, but has had
one or more hypomanic episodes
• Hypomania is not as severe as mania
Endogenous Depression
• Depression that seems to be produced from
inside the body (perhaps due to chemical
imbalances) and NOT from reaction to life
events
Maternity Blues
• Mild depression that lasts for one to two days
after childbirth
– Marked by crying, fitful sleep, tension,
anger, and irritability
– Brief and not too severe
Postpartum Depression
• Moderately severe depression that begins
within three months following childbirth
– Marked by mood swings, despondency,
feelings of inadequacy, and an inability to
cope with the new baby
– May last from two months to one year
– Part of the problem may be hormonal
Seasonal Affective Disorder (SAD)
• Depression that only occurs during fall and
winter
– May be related to reduced exposure to
sunlight
– Phototherapy:
• Extended exposure to bright light to treat
SAD
Module 12.5: Learning Objectives
Psychology in Action
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Discuss the following aspects of suicide:
– factors that affect suicide rates, including sex, ethnicity, age,
and marital status
– the immediate causes of suicide
– warning signs
– common characteristics of suicidal thoughts and feelings
– how to help someone who is suicidal
– crisis intervention
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Factors Affect Suicide Rate
Gender:
– Men are more likely to complete suicide, but more
women attempt
Ethnicity:
– Rates vary from country to country, but
Caucasians have higher suicide rates
– Native Americans have highest suicide rate in
country
Age:
– Suicide rates increase with age
Marital Status:
– Married individuals have lower suicide rates
Suicide: Major Risk Factors
• Drug or alcohol abuse
• Prior suicide attempt
• Depression or other mood disorder
• Availability of a firearm
• Severe anxiety or panic attacks
• Family history of suicidal behavior
• Shame, humiliation, failure, or rejection
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Common Characteristics of Suicidal
Thoughts and Feelings (Shneidman)
Escape
Unbearable Psychological Pain:
– Emotional pain that the person wishes to
escape
Frustrated Psychological Needs:
– Such as searching for love, achievement,
or security
Constriction of Options:
– Feeling helpless and hopeless and
deciding that death is the only option left