Psychopathology
8 December 2015
Overview of Mental Disorders
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Conceptions and definitions
Incidence, prevalence and causes
Major categories
Relationship to personality theories
Closing thoughts
Some Things to Consider…
• Psychopathologies have biological/medical
and psychological/experiential causes
• Complexity of causes and symptoms
complicates diagnoses and treatment
• Perceptions and stigmatization can affect
diagnosis and treatment seeking
Mental Disorders Aren’t from Evil Spirits
• Early theory: Possession  mental disorders
• Somatogenic hypothesis (bodily)
– General paresis (Kraft-Ebing)
• Syphilis  delusions, depression, paralysis, and death
• Psychogenic hypothesis (psychological)
– Hysteria (Charcot; Freud; Breuer)
• Paralysis or emotional fits with no neurological damage
Modern Views: Diathesis-Stress Model
• Diathesis
– Predisposition (e.g.,
genetic) for disorder
• Stress
– Triggers disorder
• Both diathesis (risk)
and stress must be
present for disorder
Modern Views: Multicausal Models
• Expands diathesis-stress models
– Multiple diatheses
• E.g., genetics, styles of thinking
– Multiple stresses
• E.g., relationship problems, victim of a crime
• Biopsychosocial perspective
– All three can contribute to mental disorders
Diagnosis Guidelines: DSM-V
DSM-IV-TR (2000-2012)
DSM-V (2013-Present)
• Previously, 5 major axes
• Revised, nonaxial
I.
Clinical syndromes and
disorders
II. Personality disorders and
mental retardation
III. Medical conditions
IV. Psychosocial and
environmental stressors
V. Global assessment of
functioning
– Biopsychosocial diagnosis
and risk factors (Axes I-III)
– Psychosocial and
environmental stressors
(Axis IV)
– Disability (Axis V)
• Better aligned with
international standards
(WHO, ICD)
Mental Disorders are Functionally-Defined
• Behavioral or psychological syndrome or pattern that occurs in a
person and that is associated with present distress (e.g., a painful
symptom) or disability (i.e., impairment in one or more important
areas of functioning) or with a significantly increased risk of
suffering death, pain, disability, or an important loss of
freedom. In addition, this syndrome or pattern must not be merely
an expectable and culturally sanctioned response to a
particular event, for example, the death of a loved one. Whatever
its original cause, it must currently be considered a
manifestation of a behavioral, psychological, or biological
dysfunction in the individual.
– DSM-IV-TR (American Psychiatric Association, 2000)
Functional Focus of Diagnosis
• DSM focuses definitions of mental disorders on
impaired function within social/cultural context
– Biological/psychological symptoms of distress
• E.g., chronic pain, hallucinations
– Disability
• E.g., motor impairment or learning deficits
– Social/cultural context
• E.g., Crying, fear, and anger are culturally universal
emotional responses to death, but may be suppressed in
Western cultures (Parkes, Laungani, & Young, 2003)
Mental Illness Is a Major Social Issue
• Each year, 1 in 5
American adults are or
have been diagnosed
with a mental illness
• Not drug/alcohol-related
• Does not include ADHD,
autism spectrum disorder,
schizophrenia or other
psychotic disorders
Risk of Mental Illness Is Widespread
• Point prevalence
– How many people live with
a disorder at a given time
• Lifetime prevalence
– How many people will
experience a given
disorder at any point in life
• Lifetime prevalence
among US adults = 46%
Assessing Mental Disorders
• Assessment is critical for understanding
reasons for symptoms and developing a
treatment plan
• 3 primary methods of assessment
– Clinical interviews
– Self-report measures
– Projective tests
Assessment: Clinical Interviews
• Semistructured interview
– Specific sequence of questions to identify certain
diagnostic content
• Symptoms
– Patient report of physical or mental condition
• Signs
– Clinician’s observations of physical or mental
condition
Assessment: Self-Report Measures
• Inventory of items to target symptoms or
profile patients
• Beck Depression Inventory
– 21 items, specific to depression
• Minnesota Multiphasic Personality
Inventory (MMPI-2)
– 567 items, broad profile of personality
Methods of Assessment: Projective Tests
• Projective test types
– Thematic Apperception Test (TAT)
– Rorschach (inkblot) Test
• Meant to indirectly reveal
unconscious wishes or conflicts
• Though popular, weak
correlations with mental health
Thought Question…
• Considering biopsychosocial factors…
– Give one pro AND one con of labeling
mental disorders…
• Please, write your name and section on
slips
Section
Time
TA Name
A
9:30 AM
Josh
C
11:30 AM
Jing
D
11:30 AM
Matthew
E
9:30 AM
Sophie
F
12:30 PM
Sophie
G
10:30 AM
Josh
H
1:30 PM
Kevin
I
1:30 PM
Matthew
J
2:30 PM
Kevin
L
3:30 PM
Muhammad
M
3:30 PM
Charlotte
N
6:30 PM
Anna
Major Categories of Mental Disorders
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Anxiety disorders
Mood disorders
Schizophrenia
Other “Axis I & II” disorders
Anxiety: Coping with Intense Emotions
• Characterized by feelings of intense
distress or worry
• Disruptive and unsuccessful attempts at
coping with those feelings
Phobias = Fear + Avoidance
• Specific phobias
– E.g., acrophobia (heights), claustrophobia
(enclosed places), arachnophobia (spiders)
• Social phobia (social anxiety disorder)
• Avoidance may exacerbate psychological or
physical harm
– E.g., more extreme avoidance of related fears,
resorting to substance abuse  dependence
Panic Disorder As Physical Anxiety
• Panic attacks
– Sudden onset of
terrifying bodily
symptoms
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Labored breathing
Choking
Dizziness
Tingling hands & feet
Sweating
Trembling
Heart palpitations
Chest pain
Anxiety Can Be Continuous & Pervasive
• Phobias need a stimulus
• Panic attacks are not constant
• Generalized Anxiety Disorder
– Visibly worried nearly all the time
– Anxiety is not specific to any stimulus
– Physical symptoms (e.g., rapid heart rate,
irregular breathing, sweating) can accompany
psychological symptoms
Obsessive-Compulsive Disorder (OCD)
• Obsessions
– Recurrent, unwanted or disturbing thoughts
• Compulsions
– Repetitive or ritualistic acts that may help cope
with obsessions
• OCD symptoms may defend against anxiety
• “3 minutes in the mind of someone with OCD”
Acute and Post-Traumatic Stress Disorders
• Triggered abruptly by identifiable, horrific event
• Dissociation
– “Numbness” to traumatic event
• Reactions include intense, intrusive recurrent
nightmares and flashbacks
• Affects women and men equally, with different causes
– Women: rape or assault
– Men: combat-related
Specific Differences in PTSD
• Major clusters of symptoms persist >1 month
– Re-experience
• Nightmares, flashbacks
– Arousal
• Difficulty sleeping, concentrating
– Avoidance
• Avoid anything related to trauma
• 7% lifetime prevalence
• More likely in women
Roots of Anxiety
• Predisposition is heritable
– Meta-analysis of siblings
– Identical twins have higher chance of having same
diagnosis than fraternal twins or non-twins
• Hettema, Neale, Kendler, 2011
• Anxiety can be conditioned
– Classical (Pavlovian) – exposure to stimulus in context of
fear or anxiety
– Vicarious – observing another person’s anxiety
Roots of Anxiety
• Similar brain areas
(amygdala, insula) are
hyperactive (red)
across phobias, social
anxiety, and PTSD
• Hypoactivation (blue)
may be related to
blunted affect in PTSD
– Etkin & Wager, 2007
Mood: Persistent Ups and/or Downs
• Depression
– Extremely common lifetime prevalence
• 1 in 4 women, 1 in 10 men
– Global deficits or disruption in…
• Affect (sadness, loss of pleasure)
• Behavior (sleep, diet, bodily functions)
• Cognition (attention, working memory)
– Severe symptoms persist for > 2 weeks
– Common in adolescence through middle adulthood,
but not specific to any age in life
Mood: Persistent Ups and/or Downs
• Bipolar Disorder
– Depressive & manic episodes (hours-months in
duration)
• Mania – racing thoughts and speech, irritability or euphoria,
impaired judgment
– Hypomania  Mania  Acute/Psychotic Mania
• Short-lived periods, particularly insidious progression
– Switching doesn’t always happen, but there can be
mixed states (signs of both depression and mania)
– Lifetime prevalence of 4%...
Roots of Mood Disorders
• High concordance rate
– For bipolar disorder, 60% in twins (Kelsoe, 1997)
• Neurotransmitter response and/or reuptake have
complex, unclear effects on mood
– Norepinephrine, dopamine, serotonin
• Personal experiences, environment, and social/cultural
factors can increase vulnerability to depression
– Family/job problems; low SES neighborhood; social
support structure; norms for expressing emotion
Developing Vulnerability to Mood Disorders
• Negative cognitive schema (Beck)
– Automatic, negative interpretations about self, future, world
• Explanatory style (Peterson & Seligman)
– Internal, global, stable characterization of bad experiences
• Since the above both predate depression, how might
personality be involved?
Schizophrenia: The “Split Mind” (Blueler)
• Group of severe mental disorders
– Disturbance of thought, withdrawal,
inappropriate or flat emotions, delusions,
hallucinations
• Lifetime prevalence = 1%
• Commonly diagnosed in adolescence or
early adulthood; more often in men
Signs and Symptoms of Schizophrenia
• Positive or negative symptoms based on
presence or absence in healthy people
• Cognitive symptoms reflect impaired
attention, working memory, inhibitory control,
and even early sensory processing
– Psychosis is a “cognitive break” from reality
• Bizarre beliefs and perceptions
Positive Symptoms of Schizophrenia
• Not typically present in healthy individuals
• Delusions
– Systematized false beliefs of grandeur or persecution
(delusions of reference)
• Hallucinations
– Sensory experience without actual external stimulation
– Anderson Cooper tries a schizophrenia simulator
• Disorganized behavior
– Strangely dressed, violent or nonsensical behavior
Negative Symptoms of Schizophrenia
• Not typically absent or low in healthy individuals
• Flat affect
– Little to no display of emotion
– Catatonic behavior
• Anhedonia
– No interest in pleasurable activities
• Withdrawal
– Isolation from social interactions
– Development of idiosyncratic thoughts and behavior
Genetics & Development in Schizophrenia
• Risk increases with
closer relations
• Potential developmental
risk factors
– Influenza exposure
• Brown et al., 2001
– Maternal malnutrition
• St. Clair et al, 2005
– Oxygen deprivation
• Cannon et al., 2000
Neural Bases of Schizophrenia
• Dopamine Hypothesis
– Oversensitivity to
dopamine
– Classic antipsychotics
block dopaminergic
signaling
– Amphetamines increase
dopamine activity 
schizophrenia-like
symptoms
Neural Bases of Schizophrenia
• Enlarged ventricles
– Decreased white and
gray matter volume
– Shenton et al., 2001
• Decreased gray matter
in prefrontal cortex
– Impaired executive
control
Poverty: Diathesis & Stress in Schizophrenia
• Prevalence in Chicago (19221934)
– Low SES closer to center 
High incidence
– High SES moving outward 
Low incidence
• Poverty increases
vulnerability to schizophrenia,
schizophrenia increases
vulnerability to poverty
Overview of Other “Axis I & II” Disorders
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Developmental
Eating
Dissociative
Personality
Developmental Disorders
• Autism
– Language deficits: late
onset, pronoun
difficulties
– Motor impairments:
peculiar repetitive
actions
– Apparently have little
understanding of or
interest in other people’s
emotions or goals
• Attentiondeficit/hyperactivity
disorder (ADHD)
– Impulsivity, attentional
deficits, behavioral
problems
– Controversy in diagnosis
– Development of
prefrontal cortex is
implicated
Eating Disorders
• Either may arise from genetic factors, as well
as sociocultural norms of attractiveness
• Anorexia nervosa
– Appear underweight
– Preoccupation with food, eating, gaining weight
– Incredibly strict dieting and/or exercise; purging
• Bulimia nervosa
– Appear “normal” weight
– Binging and compensatory behavior
Dissociative Disorders
• Psychological distancing to cope with
ongoing traumatic or distressing events
– Dissociative amnesia
• Sudden inability to remember a period of life
– Dissociative fugue
• Wandering from home for extended period of time
– Dissociative identity disorder (DID)
• Creation of “multiple personalities”
Personality Disorders
• Some aspects of different personality dimensions can be
socially or culturally maladaptive
• The associated maladaptive behaviors and cognitions can
lead to distress or impairments
• Since personality is relatively stable within an individual and
across time, such issues can then be pervasive and persistent
10 Types of Personality Disorders
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Paranoid
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– Mistrust of others
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Schizoid
– Detachment from others
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Antisocial
– Disregard & violation of other’s rights
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– Excessive attention-seeking and
emotionality
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Borderline
– Impulsive behavior; unstable
relationships, self-concept, affect
Narcissistic
– Grandiose, lacks empathy, attentionand validation-seeking
Schizotypal
– Discomfort with relationships; cognitive
& perceptual distortions; odd behavior
Histrionic
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Avoidant
– Social inhibition & insecurity
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Dependent
– Excessive need to be cared for
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Obsessive-Compulsive
– Preoccupation with order,
cleanliness, and control
Take Home Messages
• There is a high prevalence of mental illness
• Mental illnesses have biological, psychological,
and social underpinnings
• Social factors can influence illnesses and their
characterization/stigmatization
• Complexity of mental illnesses (e.g., symptoms,
signs, comorbidity) make diagnosis and
treatment extremely challenging
Some Thoughts before We Cover Treatment
• 1 in 5 people you see may live with a mental illness…
– Consider how biological, psychological, and social factors
influence our perceptions of people who live with mental illness
– How do these factors guide our assessment and treatment?
– How do these factors help or hinder the decision to seek
treatment?
• Be compassionate!!!
– Even though you see people every day, you may never know
what it’s like live a day in their mind…