Chapter twelve
Psychological
Disorders
•
•
•
•
•
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Studying
Psychological
Disorders
Studying PsychologicalAnxiety
Disorders
Disorders
Anxiety Disorders
Depressive and
Depressive and BipolarBipolar
Disorders
Disorders
Schizophrenia
Schizophrenia
Other Disorders
Other Disorders
Gender and
Gender and Cultural Effects
Cultural Effects
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realworldpsychology
Things You’ll Learn in Chapter 12
Q1
How can media coverage of shootings increase
negative attitudes about people with mental illness?
Q2
Why do people with a phobia see the object that
frightens them as larger than it really is?
Q3
Can eating fast food lead to depression later on?
Q4
Why are children who experience trauma at increased
risk of developing schizophrenia later in life?
Q5
How do changes in the brain help explain severe
antisocial personality disorder?
Q6
Are symptoms of depression easier to recognize in
women than in men?
© 2014 John Wiley & Sons, Inc. All rights reserved.
STUDYING PSYCHOLOGICAL
DISORDERS
© 2014 John Wiley & Sons, Inc. All rights reserved.
Identifying and Explaining Disorders
• Abnormal behavior = patterns of behaviors,
thoughts, or emotions considered pathological
(diseased or disordered)
• Four criteria for diagnosing abnormal behavior:
1.
2.
3.
4.
Deviance
Dysfunction
Distress
Danger
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Identifying and Explaining Disorders
• Our understanding of the cause of abnormal
behavior has changed over time:
• Stone Age: demon possession
– bore a hole in the skull (trephining) to release evil spirits
• Middle Ages: demon possession
– Exorcism
• Renaissance: witchcraft
– Torture, imprisonment, death
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Identifying and Explaining Disorders
• Asylums were created after Middle Ages as a quiet retreat for
the ill (and to protect society), but they became inhumane
prisons
• Philipp Pinel (1792) created medical model = the diagnostic
perspective that assumes that diseases have physical causes
that can be diagnosed, treated, and possibly cured
• This gave rise to psychiatry = the branch of medicine that
deals with diagnosis, treatment, and prevention of mental
disorders
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Identifying and Explaining Disorders
• Modern psychology
offers multifaceted
approach for
explaining abnormal
behavior
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Identifying and Explaining Disorders
• Labeling people “mentally ill” creates problems:
– Removes responsibility for their actions
– Labels can become self-perpetuating, encouraging
abnormal behavior
– Public may develop negative attitudes
Q1
How can media coverage of shootings increase
negative attitudes about people with mental illness?
• The public reports more negative attitudes about
mental illness after intense media coverage of a
mass shooting, despite the fact that most people
with mental illness are not violent (McGinty et al., 2013)
© 2014 John Wiley & Sons, Inc. All rights reserved.
Classifying Psychological Disorders
• Diagnostic and Statistical Manual of Mental
Disorders (DSM) = a classification system developed
by the American Psychiatric Association that is used
to describe abnormal behaviors
• Most recent revision in 2013
• Insanity = the legal (not clinical) designation for the
state of an individual judged to be legally
irresponsible or incompetent to manage his/her own
affairs because of mental illness
© 2014 John Wiley & Sons, Inc. All rights reserved.
Understanding and Evaluating the DSM
• Groups 400 disorders into 22 categories
• Comorbidity = the co-occurrence of two or more
disorders in the same person at the same time, as
when a person suffers from both depression and
alcoholism
Benefits:
• Scientific study of disorders
• Communication among
mental health professionals
• Education
Criticisms:
• Overdiagnosis
• Cultural bias
• Reinforces use of labels
© 2014 John Wiley & Sons, Inc. All rights reserved.
ANXIETY DISORDERS
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Anxiety Disorders
• Anxiety disorder = a mental disorder
characterized by overwhelming tension and
irrational fear accompanied by psychological
arousal
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Describing Anxiety Disorders
• Generalized anxiety disorder (GAD) = an anxiety
disorder characterized by persistent, uncontrollable,
and free-floating, nonspecified anxiety
– Not focused on any specific threat; chronic and
uncontrollable
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Describing Anxiety Disorders
• Panic disorder = an anxiety disorder in which sufferers
experience sudden and inexplicable panic attacks;
symptoms include difficulty breathing, heart
palpitations, dizziness, trembling, terror, and feelings of
impending doom
– May be caused by frightening experiences, prolonged stress,
and even exercise; persistent concern about future attacks
© 2014 John Wiley & Sons, Inc. All rights reserved.
Describing Anxiety Disorders
• Phobia = a persistent and intense, irrational fear and
avoidance of a specific object or situation
– Agoraphobia – restricts normal activities due to fear of a
panic attack in crowded, enclosed, or wide-open places
– Specific phobia – fear of a specific object or situation
(needles, rats, spiders, heights…)
– Social phobia (or social anxiety disorder) – irrational fear of
embarrassing oneself; fear of
public speaking and eating in public
© 2014 John Wiley & Sons, Inc. All rights reserved.
realworldpsychology
Q2
Why do people with a phobia see the object that
frightens them as larger than it really is?
• Participants viewed five different
tarantulas in a glass tank and
estimated their size by drawing a
line on an index card – those with
spider phobia drew the longest
lines (Vasey et al., 2012)
© 2014 John Wiley & Sons, Inc. All rights reserved.
Explaining Anxiety Disorders
• The biopsychosocial model acknowledges the
roles of psychological, biological and
sociocultural processes
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Explaining Anxiety Disorders
• Psychological Factors:
– Faulty cognition – habits of thinking that make
them prone to fear; hypervigilant; magnify
ordinary threats
– Maladaptive learning – inadvertent and improper
conditioning (remember Little Albert?) and social
learning
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Explaining Anxiety Disorders
• Biological Factors:
– Evolutionary predisposition – fear things that were
dangerous to ancestors
– Overreaction of the autonomic nervous system
– Drugs, caffeine, and nicotine can trigger anxiety
attack
© 2014 John Wiley & Sons, Inc. All rights reserved.
Explaining Anxiety Disorders
• Sociocultural Factors:
– Sharp rise in past 50 years in anxiety disorders
corresponds with increased mobility, decreased
job security, and decreased family support
– Anxiety disorders have different forms in different
cultures
• In Japan, social phobia is fear of embarrassing others,
not self
© 2014 John Wiley & Sons, Inc. All rights reserved.
DEPRESSIVE AND BIPOLAR
DISORDER
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Describing Depressive & Bipolar
• Depressive disorders = a group of mental disorders, including
disruptive mood dysregulation disorder and major depressive
disorder, characterized by sad, empty, or irritable moods that
interfere with the ability to function
• Symptoms may include trouble sleeping, weight gain or loss,
fatigue, problems concentrating, profound feelings of sadness
or guilt, suicidal thoughts
• Unipolar depression – depressive episode ends and person
returns to normal emotional level
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Describing Depressive & Bipolar
• Bipolar disorder = a mental disorder characterized by
repeated episodes of mania (unreasonable elation,
often with hyperactivity) alternating with depression
– Manic episodes include: unrealistically high self-esteem,
inflated sense of importance, poor judgment,
hyperactivity, lack of sleep, rapid thoughts and speech
© 2014 John Wiley & Sons, Inc. All rights reserved.
Describing Depressive & Bipolar
• Manic episodes may last a few
days or even months;
depressive episodes generally
last three times longer
• Low risk for bipolar disorder
(0.5 to 1.6%), but among the
most debilitating and lethal
disorders with 10 to 20%
suicide rate
© 2014 John Wiley & Sons, Inc. All rights reserved.
Explaining Depressive & Bipolar
• Biological factors play a significant role in
depressive and bipolar disorders
– Changes to brain structure implicated in study of
former NFL players with concussions: 24% show
clinical depression
– Depression and bipolar show genetic links
– Moderate depression may be a normal and
healthy response to a very real loss; clinical
depression is an extreme version
© 2014 John Wiley & Sons, Inc. All rights reserved.
Explaining Depressive & Bipolar
• Negative thinking, demanding perfection, feelings of rejection can
contribute to depression
• Learned helplessness = Seligman’s term for a state of
helplessness or resignation, in which human or nonhuman
animals learn that escape from something painful is impossible;
the organism stops responding and may become depressed
• Attributing failure to causes that are internal, stable, and global
make depression worse
• Suicide is a major danger of depressive and bipolar disorder;
many people suffering with the disorder fail to recognize their
own symptoms and need for help
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SCHIZOPHRENIA
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Schizophrenia
• Schizophrenia = a group of severe disorders
involving major disturbances in perception,
language, thought, emotion, and behavior
– 1 out of 100 people; half of people admitted to
mental hospitals are diagnosed with schizophrenia
– Emerges in late teens to mid-30s; rarely prior to
adolescence or after age 45
– Equally prevalent in men and women, but strikes
men earlier and more severely
© 2014 John Wiley & Sons, Inc. All rights reserved.
Schizophrenia
• The term schizophrenia
means “split mind”, referring
to the fragmenting of though
processes and emotions
• NOT the same as split
personality or multiple
personality disorder
© 2014 John Wiley & Sons, Inc. All rights reserved.
Symptoms of Schizophrenia
• Perception – senses are either enhanced or blunted;
sensory information is jumbled and distorted
• Hallucinations = a false, imaginary sensory
perception that occurs without an external, objective
source
– Auditory hallucinations – hearing voices and sounds – is
most common
• Rarely, people with schizophrenia hurt others in
response to distorted perception; more likely to be
self-destructive and suicidal
© 2014 John Wiley & Sons, Inc. All rights reserved.
Symptoms of Schizophrenia
• Language and thought – words lose usual meaning
and association, logic is impaired, thoughts are
disorganized and bizarre, conversation jumps from
topic to topic, phrases and words are jumbled in
“word salad”
• Delusions = a false or irrational
belief maintained despite clear
evidence to the contrary
– Delusions of persecution
– Delusions of grandeur
– Delusions of reference
© 2014 John Wiley & Sons, Inc. All rights reserved.
Symptoms of Schizophrenia
• Emotion – emotions are exaggerated and
fluctuate rapidly; some have flattened affect
with almost no emotional response
• Behavior – unusual actions have special
meaning to the sufferer; could become
cataleptic or nearly immobile
© 2014 John Wiley & Sons, Inc. All rights reserved.
Types of Schizophrenia
1. Positive schizophrenia symptoms – additions to or
exaggerations of normal thought processes, including
delusions and hallucinations
–
Develops more rapidly, better prognosis for recovery
2. Negative schizophrenia symptoms – loss or absence of
normal thought processes and behaviors, including
impaired attention, limited/toneless speech, flat affect,
social withdrawal
– Develops more slowly
© 2014 John Wiley & Sons, Inc. All rights reserved.
Explaining Schizophrenia
Biological theories of schizophrenia:
• Genetics – the risk for schizophrenia increases when someone
in family has the disorder
• Neurotransmitters – overactivity in certain dopamine
neurons; drugs that decrease dopamine decrease some
symptoms
• Brain abnormalities – larger cerebral
ventricles (fluid-filled spaces in the
brain); lower level of activity in frontal
lobe
© 2014 John Wiley & Sons, Inc. All rights reserved.
Explaining Schizophrenia
• Heritability of schizophrenia is only 48% for identical twins, so
nongenetic factors must contribute
Psychosocial contributors:
1. Diathesis-stress model = a hypothesis about the cause of
certain disorders, such as schizophrenia, which suggests that
people inherit a predisposition (or “diathesis”) that increases
their risk for mental disorders if they are exposed to certain
extremely stressful life experiences
2. Family communication disorders – unintelligible speech,
contradictory messages; critical and hostile
© 2014 John Wiley & Sons, Inc. All rights reserved.
Explaining Schizophrenia
Q4
Why are children who experience trauma at increased
risk of developing schizophrenia later in life?
• Children who experience severe stress
before age 16 are three times more likely to
develop schizophrenia (Bentall et al., 2012)
© 2014 John Wiley & Sons, Inc. All rights reserved.
OTHER DISORDERS
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Obsessive-Compulsive Disorder (OCD)
• Obsessions - Persistent, unwanted, fearful thoughts
– Fear of germs, fear of being hurt, troubling religious or
sexual thoughts
• Compulsions - irresistible urges to perform an act or
repeated ritual
– Repeatedly checking, counting, cleaning, washing
• Compulsions help relieve anxiety created by the
obsession
© 2014 John Wiley & Sons, Inc. All rights reserved.
Dissociative Disorders
• Dissociative disorder = a personality disorder
marked by a disturbance in the integration of
identity, memory, or consciousness
– In dissociative disorders, significant aspects of
experience are split apart from memory or
consciousness
– Primarily environmental causes; few or no genetic
influence
© 2014 John Wiley & Sons, Inc. All rights reserved.
Dissociative Disorders
• Dissociative identity disorder
(DID) = a mental disorder
characterized by the presence
of two or more distinct
personality systems in the
same individual at different
times; previously known as
multiple personality disorder
© 2014 John Wiley & Sons, Inc. All rights reserved.
Personality Disorders
• Personality disorder = a mental disorder
characterized by chronic, inflexible,
maladaptive personality traits that cause
significant impairment of social and
occupational functioning
© 2014 John Wiley & Sons, Inc. All rights reserved.
Antisocial Personality Disorder
• Antisocial personality disorder = the pervasive
pattern of disregard for, and violation of, the
rights of others, beginning in childhood or early
adolescence and continuing into adulthood
• Also called psychopath, sociopath, dissocial
personality disorder
© 2014 John Wiley & Sons, Inc. All rights reserved.
Antisocial Personality Disorder
Symptoms:
– Unlawful behaviors, deceitful and manipulative behaviors,
impulsivity, irritability and aggression, consistent
irresponsibility, reckless disregard for self and others, lack of
remorse
– Charming and persuasive
Causes:
– Genetic predisposition: biochemical disturbances, reduced
gray matter, right hemisphere abnormalities
– Environmental causes: abusive parenting styles, emotional
deprivation, harsh and inconsistent discipline, antisocial
parental behavior
© 2014 John Wiley & Sons, Inc. All rights reserved.
Antisocial Personality Disorder
Q5
How do changes in the brain help explain severe
antisocial personality disorder?
• MRI of criminals in prison for violent crimes show
reduced gray matter volume in prefrontal cortex
(Gregory et al., 2012)
© 2014 John Wiley & Sons, Inc. All rights reserved.
Borderline Personality Disorder
• Borderline personality disorder (BPD) = a
mental disorder characterized by severe
instability in emotion and self-concept, along
with impulsive and self-destructive behaviors
• Originally a term for someone on the border
between neurosis and schizophrenia, but no
longer retains that meaning
© 2014 John Wiley & Sons, Inc. All rights reserved.
Borderline Personality Disorder
Symptoms:
• Extreme difficulty in relationships
• Chronic feelings of depression, emptiness, fear of
abandonment
• Engage in destructive, impulsive behaviors, selfmutilation, suicide
• See themselves in absolute terms – perfect or
worthless; constantly seek reassurance from others
© 2014 John Wiley & Sons, Inc. All rights reserved.
Borderline Personality Disorder
Causes:
• Environmental factors: history of neglect in
childhood; emotional deprivation; physical,
sexual, or emotional abuse
• Biological: BPD runs in families; impaired
functioning in frontal lobe and limbic system
© 2014 John Wiley & Sons, Inc. All rights reserved.
GENDER AND CULTURAL
EFFECTS
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Gender and Cultural Effects
• Windigo or wiitiko psychosis appears in Native
American tribes – symptoms start with loss of appetite,
diarrhea, vomiting, and insomnia; sufferers believe
they are possessed by the spirit of a windigo (a
cannibal giant with heart and entrails of ice); victims
become severely depressed, see people turning into
beavers; may become obsessed with cannibalistic
thoughts and even attack and kill loved ones
Does the DSM
help diagnose
this disorder?
© 2014 John Wiley & Sons, Inc. All rights reserved.
Gender Differences
• Gender differences exist in the rates of certain
psychological disorders
• Women experience depression at double the rate for
men, around the world. Why?
– Poverty is a well-known contributor; women are more likely
than men to fall into lowest socioeconomic groups
– Women experience more sexual trauma, partner abuse, and
chronic stress
– Women ruminate more frequently than men; internalize
negative emotions rather than external problem solving
– Men may be better at hiding or redirecting emotions that are
stereotypically feminine (crying, social withdrawal)
© 2014 John Wiley & Sons, Inc. All rights reserved.
realworldpsychology
Q6
Are symptoms of depression easier to recognize in
women than in men?
• Most common signs of depression (crying, low energy,
dejected facial expressions, and withdrawal from social
activities) are more socially acceptable for women than men
• Male depression may be underdiagnosed because men are
raised to better hide and redirect emotions (Fields & Cochran, 2011)
• Instead, men may show aggression, act
Impulsively, and engage in substance abuse
© 2014 John Wiley & Sons, Inc. All rights reserved.
Culture and Schizophrenia
• Rates of schizophrenia differ around the world
• Due to actual difference in prevalence or from
differences in definition, diagnosis, and
reporting?
• In industrialized nations, prognosis for
schizophrenia is worse. Why?
– Core symptoms of schizophrenia make it harder to
survive in industrialized nations
– Reduced social support and responsibility among
family and friends
© 2014 John Wiley & Sons, Inc. All rights reserved.
Avoiding Ethnocentrism
• Most research on disorders is conducted in Western
cultures, which can limit understanding of disorders
• Cultural-general symptom – a group of symptoms
that appear across cultures
• Culture-bound symptoms – a group of symptoms that
appear in only select cultures
– Cultures may have different
names and understanding of
similar experiences
© 2014 John Wiley & Sons, Inc. All rights reserved.
© 2014 John Wiley & Sons, Inc. All rights reserved.