Chapter 16
Psychological Disorders
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What is Normal?
Psychopathology: Scientific study of mental,
emotional, and behavioral disorders
Subjective Discomfort: 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; usually leads
to destructive or self-destructive behavior
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What is Normal? (cont.)
Situational Context: Social situation,
behavioral setting, or general
circumstances in which an action takes
place

Is it normal to walk around strangers
naked? 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
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Fig. 16.1 The number of people displaying a personal characteristic may help define what is statistically
abnormal. Social non-conformity does not automatically indicate psychopathology.
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Fig. 16.2 This MRI scan of a human
brain (viewed from the top) reveals a
tumor (dark spot). Mental disorders
sometimes have organic causes of this
sort. However, in many instances no
organic damage can be found.
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© Scott Camazine/Photo Researchers
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Clarifying and Defining Abnormal
Behavior (Mental Illness)
Maladaptive Behavior: Behavior that makes it
difficult to function, to adapt to the
environment, and to meet everyday demands
Mental Disorder: Significant impairment in
psychological functioning
Those with mental illness lose the ability to
adequately control thoughts, behaviors, or
feelings
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Clarifying and Defining Abnormal Behavior
(Mental Illness) (cont.)
Psychotic Disorder: Severe psychiatric disorder
characterized by hallucinations and delusions, social
withdrawal, and a move away from reality
Organic Mental Disorder: Mental or emotional problem
caused by brain pathology (i.e., brain injuries or
diseases)
Substance Related Disorders: Abuse or dependence
on a mind- or mood-altering drug, like alcohol or
cocaine

Person cannot stop using the substance and may suffer
withdrawal symptoms if they do
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Clarifying and Defining Abnormal
Behavior (Mental Illness) (cont.)
Mood Disorder: Disturbances in mood
or emotions, like depression or mania
Anxiety Disorder: Feelings of fear,
apprehension, anxiety, and behavior
distortions
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© Bettmann/CORBIS
Fig. 16.5 The Mad Hatter, from Lewis Carroll’s Alice’s Adventures in Wonderland. History provides
numerous examples of psychosis caused by toxic chemicals. Carroll’s Mad Hatter character is modeled
after an occupational disease of the eighteenth and nineteenth centuries. In that era, hatmakers were
heavily exposed to mercury used in the preparation of felt. Consequently, many suffered brain damage and
became psychotic, or “mad” (Kety, 1979).
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Clarifying and Defining Abnormal
Behavior (Mental Illness) (cont.)
Somatoform Disorder: Physical symptoms
that mimic disease or injury (blindness,
anesthesia) for which there is no identifiable
physical cause
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
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Clarifying and Defining Abnormal
Behavior (Mental Illness) (cont.)
Sexual and Gender Identity Disorder:
Problems with sexual identity, deviant
sexual behavior, or sexual adjustment
Neurosis: Archaic; once used to refer to
anxiety, somatoform, and dissociative
disorders, also used to refer to some
kinds of depression
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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
Psychological Factors: Low intelligence, stress,
learning disorders
Biological Factors: Genetic defects or inherited
vulnerabilities; poor prenatal care, head injuries,
exposure to toxins, chronic physical illness, or
disability
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Insanity
Definition: A legal term; refers to an inability to manage
one’s affairs or to be aware of the consequences of
one’s actions

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Those judged insane (by a court of law) are not held legally
accountable for their actions
Can be involuntarily committed to a psychiatric hospital
Some movements today are trying to abolish the insanity plea
and defense; desire to make everyone accountable for their
actions
How accurate is the judgment of insanity?
Expert Witness: Person recognized by a court of law
as being qualified to give expert testimony on a
specific topic

May be psychologist, psychiatrist, and so on
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Personality Disorders: Antisocial
Personality Disorder (APD)
Definition: A person who lacks a conscience
(superego?); typically emotionally shallow,
impulsive, selfish, and manipulative toward others

Oftentimes called psychopaths or sociopaths
Many are delinquents or criminals, but many are
NOT crazed murderers displayed on television
Create a good first impression and are often
charming
Cheat their way through life (e.g., Dr. Michael
Swango, Scott Peterson)
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APD: Causes and Treatments
Possible Causes:
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
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© Robert Hare
Fig. 16.3 Using PET scans, Canadian psychologist Robert Hare found that the normally functioning brain
(left) lights up with activity when a person sees emotion-laden words such as “maggot” or “cancer.” But the
brain of a psychopath (right) remains inactive, especially in areas associated with feelings and self-control.
When Dr. Hare showed the bottom image to several neurologists, one asked, “Is this person from Mars?”
(Images courtesy of Robert Hare.)
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CNN – Serial Killer Motives
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Anxiety-Based Disorders
Anxiety: Feelings of apprehension, dread, or
uneasiness
Adjustment Disorders: When ordinary stress
causes emotional disturbance and pushes
people beyond their ability to effectively cope


Usually suffer sleep disturbances, irritability, and
depression
Examples: Grief reactions, lengthy physical
illness, unemployment
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Anxiety-Based Disorders (cont.)
Generalized Anxiety Disorder (GAD):
Duration of at least six months of
chronic, unrealistic, or excessive anxiety
Free-Floating Anxiety: Anxiety that is
very general and persuasive
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CNN – Anxiety Disorders in Kids
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Panic Disorders
Panic Disorder (without Agoraphobia): A
chronic state of anxiety with brief moments of
sudden, intense, unexpected panic (panic
attack)
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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 (with Agoraphobia): Panic
attacks and sudden anxiety still occur, but
with agoraphobia
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Agoraphobia
Agoraphobia (with Panic Disorder): Intense,
irrational fear that a panic attack will occur in a
public place or in an unfamiliar situation

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
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
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Specific Phobias
Irrational, persistent fears, anxiety, and
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
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Social Phobia
Intense, irrational fear of being
observed, evaluated, humiliated, or
embarrassed by others (e.g., shyness,
eating, or speaking in public)

Barbra Streisand, Woody Allen perhaps?
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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
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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
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Help to control anxiety created by obsessions
Checkers and cleaners
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Stress Disorders
Occur when stresses outside range of normal 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
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.)
Terrorist attacks on September 11th, 2001, likely led to an
increase of PTSD
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CNN – Mental Health and
Traumatic Events
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CNN - Prostitution
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Dissociative Disorders
Dissociative Amnesia: Inability to recall
one’s name, address, or past
Dissociative Fugue: Sudden travel away
from home and confusion about
personal identity
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Dissociative Identity Disorder
(DID)
Person has two or more distinct, separate
identities or personality states; previously
known as Multiple Personality Disorder

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“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,
stable 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 physical disorder can be found
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 (cont.)
Pain Disorder: Pain that has no
identifiable organic, physical cause

Appears to have psychological origin
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
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Fig. 16.4 (left) “Glove” anesthesia is a conversion reaction involving loss of feeling in areas of the hand that
would be covered by a glove (a). If the anesthesia were physically caused, it would follow the pattern
shown in (b). (right) To test for organic paralysis of the arm, an examiner can suddenly extend the arm,
stretching the muscles. A conversion reaction is indicated if the arm pulls back involuntarily. (Adapted from
Weintraub, 1983.)
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Theoretical Causes of Anxiety
Disorders: Psychodynamic
Psychodynamic (Freud): Anxiety caused by
conflicts among id, ego, and superego
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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
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Other Theoretical Causes of
Anxiety Disorders
Humanistic: Unrealistic self-image conflicts
with real self-image
Existential: Anxiety reflects loss of meaning in
one’s life
Behavioristic: Anxiety symptoms and
behaviors are learned, like everything else

Conditioned emotional responses that generalize
to new situations
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More Theoretical Causes of
Anxiety Disorders
Avoidance Learning: When making a
particular response delays or prevents the
onset of a painful or unpleasant stimulus
Anxiety Reduction Hypothesis: When reward
of immediate relief from anxiety perpetuates
self-defeating avoidance behaviors
Cognitive: When distorted thinking causes
people to magnify ordinary threats and
failures, leading to anxiety and distress
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Psychosis and Hallucinations
Psychosis: Loss of contact with shared views of
reality
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)
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Some More Psychotic Symptoms
Flat Affect: Lack of emotional
responsiveness; face is frozen in blank
expression
Disturbed Verbal Communication:
Garbled and chaotic speech; word salad
Personality Disintegration: When an
individual’s thoughts, actions, and
emotions are uncoordinated
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Other Psychotic Disorders
Organic Psychosis: Psychosis caused by
brain injury or disease
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Dementia: Most common organic psychosis;
serious mental impairment in old age caused by
brain deterioration
Archaically known as senility
Alzheimer’s Disease: Symptoms include impaired
memory, confusion, and progressive loss of
mental abilities

Ronald Reagan most famous Alzheimer’s victim
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Delusional Disorders
Marked by presence of deeply held
false beliefs (delusions)
May involve delusions of grandeur,
persecution, jealousy, or somatic delusions
 Experiences could really occur!

Paranoid Psychosis: Most common
delusional disorder

Centers on delusions of persecution
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Schizophrenia: The Most Severe
Mental Illness
Psychotic disorder characterized by
hallucinations, delusions, apathy,
thinking abnormalities, and “split”
between thoughts and emotions

Does NOT refer to having split or multiple
personalities
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The Four Subtypes of
Schizophrenia
Disorganized (Hebephrenic) Type: Incoherence, grossly
disorganized behavior, bizarre thinking, and flat or
inappropriate emotions
Catatonic Type: Marked by stupor, unresponsiveness,
posturing, and mutism
Paranoid Type: 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 specific paranoid, catatonic, or
disorganized features or symptoms
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CNN – Schizophrenic Reality
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Causes of Schizophrenia
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
Deviant Communication Patterns: Cause
guilt, anxiety, anger, confusion, and turmoil
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© Bruce Ely/Getty Images
Fig. 16.6 Over a period of years, Theodore Kaczynski mailed bombs to unsuspecting victims, many of
whom were maimed or killed. As a young adult, Kaczynski was a brilliant mathematician. At the time of his
arrest, he had become the Unabomber—a reclusive “loner” who deeply mistrusted other people and
modern technology. After his arrest, Kaczynski was judged to be suffering from paranoid schizophrenia.
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Biochemical Causes of
Schizophrenia
Biochemical Abnormality: 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
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Fig. 16.7 Lifetime risk of developing schizophrenia is associated with how closely a person is genetically
related to a schizophrenic person. A shared environment also increases the risk. (Estimates from
Lenzenweger & Gottesman, 1994.)
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Fig. 16.8 Dopamine normally crosses the synapse between two neurons, activating the second cell.
Antipsychotic drugs bind to the same receptor sites as dopamine does, blocking its action. In people
suffering from schizophrenia, a reduction in dopamine activity can quiet a person’s agitation and psychotic
symptoms.
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Schizophrenic Brain
Computed Tomography (CT) Scan: Computer enhanced
X-ray of brain or body
Magnetic Resonance Imaging (MRI) Scan: Computer
enhanced three-dimensional image of brain or body;
based on magnetic field

MRIs show schizophrenic brains as having enlarged ventricles
Positron Emission Tomography (PET) Scan: Computergenerated color image of brain activity; radioactive sugar
solution is injected into a vein, eventually reaching the
brain

Activity is abnormally low in frontal lobes of schizophrenics
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© Dennis Brack/Stockphoto.com76
Fig. 16.9 (left) CT scan of would-be presidential assassin John Hinkley, Jr., taken when he was 25. The
X-ray image shows widened fissures in the wrinkled surface of Hinkley’s brain. (right) CT scan of a
normal 25-year-old’s brain. In most young adults the surface folds of the brain are pressed together too
tightly to be seen. As a person ages, surface folds of the brain normally become more visible.
Pronounced brain fissuring in young adults may be a sign of schizophrenia, chronic alcoholism, or other
problems.
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Fig. 16.10 Positron emission tomography
produces PET scans of the human brain. In the
scans shown here, red, pink, and orange indicate
lower levels of brain activity; white and blue
indicate higher activity levels. Notice that activity
in the schizophrenic brain is quite low in the
frontal lobes (top area of each scan) (Velakoulis &
Pantelis, 1996). Activity in the manic-depressive
brain is low in the left brain hemisphere and high
in the right brain hemisphere. The reverse is more
often true of the schizophrenic brain. Researchers
are trying to identify consistent patterns like these
to aid diagnosis of mental disorders.
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CNN – Schizophrenia Gene
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Stress-Vulnerability Model
Stress-Vulnerability Hypothesis:
Combination of environmental stress
and inherited susceptibility cause
schizophrenic disorders
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Fig. 16.11 Various combinations of vulnerability and stress may produce psychological problems. The top
bar shows low vulnerability and low stress. The result? No problem. The same is true of the next bar down,
where low vulnerability is combined with moderate stress. Even high vulnerability (third bar) may not lead to
problems if stress levels remain low. However, when high vulnerability combines with moderate or high
stress (bottom two bars) the person “crosses the line” and suffers from psychopathology.
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Mood Disorders
Major disturbances in emotion, such as depression or
mania
Depressive Disorders: Sadness or despondency are
prolonged, exaggerated, or unreasonable
Bipolar Disorders: Involve both depression and mania
or hypomania
Dysthymic Disorder: Moderate depression that lasts
for at least two years
Cyclothymic Disorder: Moderate manic and
depressive behavior that lasts for at least two years
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Major Mood Disorders
Lasting extremes of mood or emotion and 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
Bipolar I Disorder: Extreme mania and deep
depression; one type of manic-depressive illness

Mania: Excited, hyperactive, energetic, grandiose behavior
Bipolar II Disorder: Person is mainly sad but has one
or more hypomanic episodes (mild mania)
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Major Mood Disorders (cont.)
Endogenous Depression: Depression that
seems to be produced from inside the body
(due to chemical imbalances) and NOT from
life events
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
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Maternity Blues
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

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Postpartum Depression
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

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Fig. 16.12 Seasonal affective
disorder appears to be
related to reduced exposure
to daylight during the winter.
SAD affects 1 to 2 percent of
Florida’s population, about 6
percent of the people living in
Maryland and New York City,
and nearly 10 percent of the
residents of New Hampshire
and Alaska (Booker &
Hellekson, 1992).
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© Dan McCoy/Rainbow
Fig. 16.13 An hour or more of bright light a day can dramatically reduce the symptoms of seasonal
affective disorder. Treatment is usually necessary from fall through spring. Light therapy typically works
best when it is used early in the morning (Lewy et al., 1998).
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Therapeutic Interventions
Psychotherapy: Any psychological
treatment for behavioral or emotional
problems

Typically involves two people talking about
one’s personal problems
Medical Therapies: Drug therapy,
hospitalization, or psychosurgery
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Fig. 16.14 At least one schizophrenic patient in four had completely recovered 10 years after being
diagnosed. Three out of four had improved. New treatments for schizophrenia and other major mental
disorders may improve these odds. (Source: FDA Consumer, 1993.)
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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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Fig. 16.15 Adolescent suicide rates vary for different racial and ethnic groups. Higher rates occur among
whites than among non-whites. White male adolescents run the highest risk of suicide. Considering
gender alone, it is apparent that more male than female adolescents commit suicide. This is the same as
the pattern observed for adults.
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CNN – Suicidal Tendencies
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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
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Fig. 16.16 Suicidal behavior usually progresses from suicidal thoughts, to threats, to attempts. A
person is unlikely to make an attempt without first making threats. Thus, suicide threats should
be taken seriously (Garland & Zigler, 1993).
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Insanity
Insanity Defense: Person was incapable of knowing
right from wrong while committing a crime
M’Naghten Rule: Standard for judging legal insanity
in English common law
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Must understand wrongfulness of actions to be held
responsible for them
If suffering from mental disease preventing person from
knowing right from wrong, can be deemed insane
Taking of a life due to insanity is not murder
Irresistible Impulse: Uncontrollable urge to act
Diminished Capacity: Temporary loss of ability to
control actions or to know right from wrong
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