Psychological Disorders
Psychology 12
What is Normal?
• What are examples of “normal” adolescent
behaviour?
• Imagine the following four settings:
1) a rural village in India
2) a formal dinner with the Queen
3) a funeral
4) a city courtyard in the city of Beijing, China
• Defining “normal” is not simple. It depends upon
such variables as behavioural setting, cutural
perspective, public expectation, and so on…
“Giraffe Women” of
Thailand
• Have you heard of the “giraffe women” of the Kenyan
tribe in Thailand who wear heavy copper coils around
their necks to push their faces up and make their necks
look longer? At the age of 5, the first coil is normally
added, but some little girls are “coiled” at the age of 2.
Year after year, new coils are added. Once fastened, the
rings are worn for life because the neck muscles weaken
and deteriorate to the point they can no longer support
the weight of the head. These coils weigh up to 12
pounds and depress the clavicle and the ribs about 45
degrees from their normal position.
• Would you consider this behaviour abnormal? What
about the following cases taken from our own culture…
Abnormal Behaviour?
• “Mary’s troubles first began in adolescence. She
began to miss curfew, was frequently truant, and
her grades declined sharply. Mary later became
promiscuous and prostituted herself several times
to get drug money…She also quickly fell in love
and overly idealized new friends. But when they
quickly (and inevitably) disappointed her, she
would angrily cast them aside…Mary’s problems,
coupled with a preoccupation with inflicting pain
on herself (by cutting and burning) and persistent
thoughts of suicide, eventually led to her
admittance to a psychiatric hospital at age 26”
(Kring et. al., 2007, pp 386-387)
Abnormal Behaviour?
• “Rain or shine, day in and day out, 43-year-old
Joshua occupies his “post” on a busy street corner
wearing his standard outfit—a Red Sox baseball cap,
yellow T-shirt, worn-out hiking shorts, and orange
sneakers. Sometimes he can be seen, “conversing”
with imaginary people. Without apparent cause, he
also frequently explodes into shrieks of laughter or
breaks down into miserable sobs. Police and social
workers keep taking him to shelters for homeless,
but Joshua manages to get back on the street before
he can be treated. He has repeatedly insisted that
these people have no right to keep bothering him.
• (Halgin & Whitbourne, 2008, p. 283)
Abnormal Behaviour?
Both Mary and Joshua have severe psychological
problems, and both of their stories raise
interesting questions.
What caused their difficulties?
Was there something in their early backgrounds to
explain their later behaviours?
Is their something medically wrong with them?
What about the “giraffe women”? What is the
difference between being culturally different and
being disordered?
Do you recognize these myths?
Myth #1
• People with psychological disorders act in
bizarre ways and are very different from normal
people.
Do you recognize these myths?
Fact #1
• This is true for only a small minority of
individuals and during a relatively small portion
of their lives. In fact, sometimes even mental
health professionals find it difficult to
distinguish normal from abnormal individuals
without formal screening.
Do you recognize these myths?
Myth #2
• Mental disorders are a sign of personal
weakness.
Do you recognize these myths?
Fact #2
• Psychological disorders are a function of many
factors, such as exposure to stress, genetic
disposition, family background, and so on.
• Mentally disturbed individuals can’t be blamed
for their illness any more than we blame people
who develop Alzheimer’s or other physical
illness
Do you recognize these myths?
Myth #3
• Mentally ill people are often dangerous and
unpredictable.
Do you recognize these myths?
Fact #3
• Only a few disorders, such as some psychotic
and antisocial personalities, are associated
with violence.
• The stereotype that connects mental illness and
violence persists because of prejudice and
selective media attention
Do you recognize these myths?
Myth #4
• A person who has been mentally ill never fully
recovers.
Do you recognize these myths?
Fact #4
• With therapy, the vast majority of people who
are diagnosed as mentally ill eventually improve
and lead normal productive lives.
• Moreover, mental disorders are generally only
temporary. A person may have an episode that
lasts for days, weeks or months. Afterwards,
they may go for years—even a lifetime—without
further difficulty.
Do you recognize these myths?
Myth #5
• Most mentally ill individuals can work at only
low-level jobs.
Do you recognize these myths?
Fact #5
• Mentally disturbed people are individuals. As such, their
career potentials depend on their particular talents,
abilities and experience, and motivation, as well as their
current state of physical and mental health. Many creative
and successful people have suffered serious mental
disorders. For example, John Forbes Nash Jr., a nobel
prize winner has a lifetime history of schizophrenia (but he
is doing well as has been documented in the book and
movie—A Beautiful Mind
• British PM, Winston Churchill, comedian Stephen Fry,
poet Edgar Allen Poe, Pink Floyd band member Syd
Barrett, painter Vincent Van Gogh, billionaire Howard
Hughes, former PM’s wife Margaret Trudeau are all
believed to have suffered from a serious mental disorder
Uppy-Downy Mood-Swing Kind of Guy
http://bigthink.com/ideas/17869
Normal or Not? The difficulty
with drawing the line…
“A man living in the Ozark Mountains has a vision in which God
speaks to him. He begins preaching to his relatives and
neighbours, and soon he has the whole town in a state of
religious fervor. People say he has a “calling.” His
reputation as a prophet and healer spreads, and in time he
is drawing large audiences everywhere he goes. However,
when he ventures into St. Louis and attempts to hold a
prayer meeting, blocking traffic on a main street at rush
hour, and he is arrested. He tells the police officers about
his conversations with God, and they hurry him off to the
nearest mental hospital.”
--from Understanding Psychology, Richard A. Kasschau, 1995
How can a person be viewed as normal in one
community and abnormal in the next?
Studying Psychological
Disorders
• Like personality, consciousness, and intelligence,
abnormal behaviour is difficult to define.
• Rather than being fixed categories (i.e.,
normal/abnormal), both “abnormal” and
“normal” behaviours exist along a continuum
(i.e., from “rare” to “common” or “low” to
“high”…)
Abnormality can be viewed as an inability
to adjust to getting along in the world—
physically, emotionally, and socially.
Studying Psychological
Disorders
Identifying Abnormal Behaviour:
Four Basic Standards
1. Statistical Infrequency
2. Disability or Dysfunction
3. Personal Distress
4. Violation of Norms
Identifying Abnormal
Behaviour: Standards
1. Statistical Infrequency (e.g., believing others
are plotting against you)
A behaviour may be judged abnormal if it occurs
infrequently in a given population.
Statistical infrequency alone does not determine
what is normal. For example, no one would
classify Albert Einstein’s great intelligence as
abnormal
Rare (Normal)
(Abnormal) Common
Identifying Abnormal
Behaviour: Standards
2. Disability or Dysfunction (e.g., being unable
to go to work due to alcohol abuse)
• People who suffer from psychological disorders
may be unable to get along with others, hold a
job, eat properly, or clean themselves.
• Their ability to think clearly and make rational
decisions also may be impaired
Low (Normal)
(Abnormal) High
Identifying Abnormal Behaviour:
Standards
3. Personal Distress (e.g. having thoughts of suicide)
The personal distress criterion focuses on the
individual’s judgment of his or her level of
functioning.
Yet many people with psychological disorders (such as
antisocial personality disorder) have little or no
personal emotional discomfort.
The personal distress criterion by itself is not sufficient
for identifying all forms of abnormal behaviour
Low (Normal)
(Abnormal) High
Identifying Abnormal Behaviour:
Standards
4. Violation of Norms (e.g. shouting at
strangers)
The fourth approach to identifying abnormal behaviour is
violation of social norms, or cultural rules that guide
behaviour in particular situations.
A major problem with this criterion, however, is that
cultural diversity can affect what people consider a
violation of cultural norms
Rare (Normal)
(Abnormal) Common
Cultural Diversity
• Culture has a strong effect on mental disorders—
studying the similarities and differences can lead to better
diagnosis and understanding
• Even strongly biological mental disorders, like schizophrenia,
can differ greatly between cultures—fortunately, crosscultural researchers have devised ways to identify disorders
across cultures (culture-general symptoms and culture bound
symptoms).
• Research shows that certain symptoms of depression
seem to exist across all cultures: (1) frequent and intense
sad affect (emotion), (2) decreased enjoyment, (3) anxiety, (4)
difficulty in concentrating, and (5) lack of energy.
• Culture-bound symptoms—symptoms that only occur
within a culture. For example—a headache: Chinese report a
“fullness in my head,” Mexican respondents report a “problem
with memory”
Cultural Diversity
Culture Bound Symptoms
Latin America: “attack of the nerves” Symptoms: trembling,
palpitations, and seizure-like episodes
Southeast Asia: “running amok” Symptoms: Wild, out-of-control,
aggressive, attempting to kill others
West Africa: “brain tiredness” Symptoms: ‘brain tiredness’ a mental
and physical response to challenges of schooling
Ethiopia: “possession by the zat” Symptoms: involuntary movements,
an incomprehensible language
South China: “koro” Symptoms: belief that the penis is retracting into
the abdomen and that when it is fully retracted, death will result;
attempts to prevent retraction may lead to severe physical damage
Western Nations: “anorexia nervosa” Symptoms: severe loss of
weight resulting from self-imposed starvation and obsessive fear of
obesity
Gender & Cultural Diversity
12 Culture-General Symptoms of Mental Health
Difficulties
(1) Nervous
(2) trouble sleeping
(3) Low spirits
(4) Weak, all over
(5) Personal worries
(6) Restlessness
(7) feel apart, alone
(8) can’t get along
(9) Hot all over
(10) worry all the time
(11) can’t do anything worthwhile
(12) nothing turns out right
Explaining Abnormality:
Superstition to Science
How do we explain it?
Historically, evil spirits and witchcraft have been the primary suspects
• Stone Age people, believed that abnormal behaviour stemmed from
demonic possession—the therapy was to bore a hole in the skull so
that evil spirits could escape.
• Middle Ages: a troubled person was sometimes treated with
exorcism; an effort to drive the Devil out through prayer, fasting,
noise-making, beating, and drinking terrible-tasting brews.
• 15th Century: many believed that some individuals chose to consort
with the Devil—many of these supposed witches were tortured,
imprisoned for life, or executed.
• As the Middle Ages ended, special mental hospitals, called asylums,
began to appear in Europe—they eventually became overcrowded and
inhumane prisons.
An example of the
“Historical Model” of
Abnormal Behaviour
--An early Catch 22:
(Catch 22: is a paradoxical situation in which an individual is
incapable of avoiding a problem because situations are such that solving one part of a problem only creates
another problem)
In the Middle Ages, “dunking tests” were used
to determine whether people who behaved
abnormally were possessed by demons.
Individuals who did not drown while being
dunked were believed to be guilty of possession
and then punished (usually by hanging).
Those who did drown were judged as innocent.--the ultimate no-win situation!
Classifying Abnormal Behaviour
The Diagnostic and Statistical Manual IV-TR
• This is a classification system developed by the
American Psychological Association used to describe
abnormal behaviours; the “IV-TR” indicates it is
the text revision (TR) of the fourth major revision
(IV)
• Each revision of the DSM has expanded the list of
disorders and changed the descriptions and
categories to reflect both the latest advances in
scientific research and changes in the way abnormal
behaviours are viewed within our social context
Classifying Abnormal Behaviour
For example, take the terms “neurosis” and “psychosis”
• In previous editions, neurosis reflected Freud’s belief that all
neurotic conditions arise from unconscious conflicts—now
conditions that were previously grouped under the heading
“neurosis” have been redistributed as anxiety disorders,
somatoform disorders, and dissociative disorders
• Unlike “neurosis” the term “psychosis” is still listed in the
DSM because it helps distinguish the most severe
mental disorders, such as schizophrenia and some
mood disorders.
• FYI: Psychosis is: serious mental disorder characterized by extreme mental
disruption and defective or lost contact with reality
• Somatoform disorder, is a mental disorder characterized by physical symptoms
that suggest physical illness or injury - symptoms that cannot be explained
• Dissociative disorders are defined as conditions that involve disruptions or
breakdowns of memory, awareness, identity and/or perception
What about the term “insanity”
where does it fit in?
• Insanity is a legal term indicating that a person
cannot be held responsible for his/her actions,
or is judged incompetent to manage his/her own
affairs, because of a mental illness.
• In law, the definition of mental illness rests
primarily on a person’s inability to tell right
from wrong.
• For psychologists, insanity is not the same as
abnormal behaviour---see the next example…
What about the term
“insanity” where does it fit
in?
• The insanity plea—guilty of a crime or mentally ill?
• On the morning of June 20, 2001, Texas mother Andrea Yates
drowned her five children in the bathtub, then calmly called
her husband to tell him he should come home. At Yates’s
trail, both the defense and the prosecution agreed that Yates
was mentally ill at the time of the murders, yet the jury still
found her guilty and sentenced her to life in prison.
• In 2006, this was overturned and was found not guilty by
reason of insanity. How could two courts come to such
opposite conclusions?
• Insanity is a complicated legal term—despite cases like this
one, it is important to keep in mind that the insanity plea is
used in less than 1% of all cases that reach trial, and when
used, it is rarely successful.
Understanding the DSM
The DSM is organized into five major dimensions, called axes,
which serve as guidelines for making decisions about
symptoms.
• Axis I describes clinical disorders that reflect a patient’s current
condition. Depression and anxiety disorders are examples
• Axis II describes trait disorders, which are long-running personality
disturbances (like antisocial personality disorder) and mental
retardation
The other three axes are used to record important supplemental
information.
• Axis III lists general medical conditions that may be important to a
person’s psychopathology (such as diabetes or hypothyroidism, which
can affect mood)
• Axis IV is reserved for psychosocial and environmental stressors that
could be contributing to emotional problems (job or housing issues)
• Axis V evaluates a person’s overall level of functioning, on a scale from 1
(serious attempt at suicide or complete inability to take care of oneself)
to 100 (happy, productive, with many interests)
Understanding the DSM
• The DSM offers a comprehensive, well-defined
system intended for the diagnosis and
classification of psychological disorders. It does
not suggest therapies or treatment.
• The current DSM-IV-TR contains more than
200 diagnostic categories grouped into 17
subcategories.
• Also, note that the DSM classifies disorders,
not people. Accordingly, we use the terms
such as a persons with schizophrenia, rather
than describing people as schizophrenic
Anxiety Disorders
I was 9 years old and sitting alone in the back of a cab as it rumbled
over New York City’s 59th St. Bridge. I noticed the driver was
watching me curiously. My feet began tapping and then shaking,
and slowly my chest grew tight and I couldn’t get enough air in my
lungs. I tried to disguise the little screams I made as throat
clearings, but the noises began to rattle the driver. I knew a panic
attack was coming on, but I had to hold on, get to the studio, and get
through the audition. Still, if I kept riding in that car I was certain I
was going to die. The black water was just a few hundred feet below.
“Stop!” I screamed at the driver. “Stop right here, please! I have to
get out!”
“Young miss, I can’t stop here.”
“Stop!” I must have looked like I meant it because he squealed to a halt
in the middle of traffic. I got out and began to run. I ran the entire
length of the bridge and kept going. Death would never catch me as
long as my small legs kept propelling me forward.
◦
Adapted from Pearce & Scanlon, 2002, p. 69 (words of actress Patty Duke)
Anxiety Disorders
These are the words of actress Patty Duke describing an
episode around the time she was starring as Helen
Keller, the deaf and blind child in “The Miracle Worker.”
• Patty’s flight from the cab and other cases of ANXIETY
DISORDER share one central defining
characteristic—unreasonable, often paralyzing,
anxiety or fear.
• The person feels threatened, unable to cope, unhappy,
insecure in a world that seems dangerous and hostile.
• Anxiety Disorders (diagnosed twice as often in women as
in men) are the most frequently occurring category of
mental disorders in the general population.
• They are also the easiest to treat and have one of the best
chances of recovery.
Anxiety Disorders
Anxiety disorders are marked by excessive
fear, caution, and avoidance.
5 Major Types:
1) Generalized Anxiety Disorder
2) Panic Disorder
3) Phobias
4) Obsessive-Compulsive Disorder
5) PTSD
Five Major Anxiety Disorders
Symptoms of anxiety such as rapid breathing and
increased heart rate, plague most of us at
different times in our lives (final exams,
important job interviews, public speaking).
But some people experience unreasonable anxiety
that is do intense and chronic it seriously
disrupts their lives.
5 Major Anxiety Disorders: Generalized Anxiety Disorder
1) Generalized Anxiety Disorder
• This disorder affects twice as many women as it does men
• It is characterized with chronic, uncontrollable, and excessive
fear and worry that lasts at least six months and that is not
focused on any particular object or situation.
• As the name implies, the anxiety is generalized and
nonspecific or free-floating. Victims feel afraid of something,
but are unable to identify and articulate the specific fear.
 Because of specific muscle tension and autonomic fear
reactions, people with this disorder may develop headaches,
heart palpitations, dizziness, and insomnia, making it ever
harder to cope with daily activities
5 Major Anxiety Disorders: Panic
2) Panic Disorder is marked by sudden, but
brief, attacks of intense apprehension that
causes trembling, dizziness, and difficulty
breathing. (Patty Duke suffered from this)
• Panic attacks (in the DSM) are classified with or
without agoraphobia
• Agoraphobia is an anxiety disorder
characterized by anxiety in situations where the
sufferer perceives the environment as being
difficult to escape or get help.
5 Major Anxiety Disorders: Phobias
3) Phobias involve a strong, irrational fear and
avoidance of objects or situations that are usually
considered harmless (fear of elevators, fear of going
to the dentist, for example).
• Although the person recognizes that the fear is
irrational, the experience is still one of
overwhelming anxiety, and a full-blown panic attack
may follow.
• The DSM divides phobic disorders into three
broad categories: agoraphobia, specific phobias,
and social problems
5 Major Anxiety Disorders: Phobias
A) Agoraphobia:
• People with agoraphobia restrict their normal
activities because they fear having panic attacks
in crowded, enclosed, or wide-open places where
they would be unable to receive help in an
emergency.
• In severe cases, people with agoraphobia may
refuse to leave the safety of their homes.
5 Major Anxiety Disorders: Phobias
B) Specific Phobias:
• A specific phobia is a fear of a specific object or
situation, such as needles, heights, rats, spiders…
• Claustrophobia (fear of closed spaces) and
acrophobia (fear of heights) are the specific
phobias most often treated by therapists.
• People with specific phobias generally recognize that
their fears are excessive and unreasonable, but they
are unable to control their anxiety and will go to
great lengths to avoid the feared stimulus.
5 Major Anxiety Disorders: Phobias
C) Social Phobias:
• People with social phobias are irrationally
fearful of embarrassing themselves in social
situations.
• Fear of public speaking and of eating in public
are the most common social phobias.
• The fear of public scrutiny and potential
humiliation may become so pervasive that
normal life is severely restricted.
5 Major Anxiety Disorders:
4) Obsessive-Compulsive Disorder
Do you remember the movie The Aviator? The main
character, Howard Hughes, was endlessly counting,
checking, and repeatedly washing his hands in a seemingly
senseless, ritualistic pattern. What drives this behaviour?
The answer is Obsessive-Compulsive Disorder (OCD)
• This disorder involves persistent, unwanted fearful thoughts
(obsessions) or irresistible urges to perform an act or
repeated ritual (compulsion), which help relieve the anxiety
created by the obsession.
• Common examples of obsessions are fear of germs, of being
hurt or of hurting others, and troubling religious or sexual
thoughts.
OCD
• Examples of compulsions are repeatedly checking,
counting, cleaning, washing the body or parts of it,
or putting things in certain order.
• While everyone worries, and sometimes doublechecks, people with OCD have these thoughts and
do these rituals for at least an hour or more each
day, often longer
• Most suffers of OCD realize that their actions are
senseless, but when they try to stop the behaviour,
they experience mounting anxiety, which is relieved
only by giving in to the urges.
5 Major Anxiety Disorders: PTSD
5) PTSD: anxiety disorder following exposure to a
life-threatening or other extreme event that
evoked great horror or helplessness;
characterized by flashbacks, nightmares, and
impaired functioning
• Children as well as adults may suffer
Explaining Anxiety Disorders
Psychological: Faulty cognition and maladaptive
learning
• Faulty Cognition: People with certain thinking, or
cognitive habits that make them vulnerable or prone
to fear. They tend to be hyper vigilant.
• They constantly scan their environment for danger
and seem to ignore signs of safety.
• They also tend to magnify ordinary threats and
failures.
Explaining Anxiety Disorders
Maladaptive Learning:
• They may have learned these behaviours. Through classical
conditioning, for example: a stimulus that is originally neutral (e.g. harmless
spider) becomes paired with a frightening event (a sudden panic attack)so that
it becomes a conditions stimulus and brings about anxiety. The person then
begins to avoid spiders in order to reduce anxiety.
• Social learning theorists propose that some phobias are the result of
modeling and imitation, or learned indirectly.
• Example of vicarious (indirect learning): Monkeys who watch
artificially created videos of other monkeys being afraid of a toy snake, toy
crocodile toy rabbit, or toy flower, will develop their own set of phobias. The
fact that the “viewing” monkeys only develop fears of snakes and crocodiles,
but not flowers or rabbits, demonstrates that phobias are both learned and
biological
Explaining Anxiety Disorders
• Biological:
• Phobias may develop from a genetic and
evolutionary predisposition to fear that was
dangerous to our ancestors.
• In addition, studies show that anxiety disorders may
be due to a disrupted biochemistry ,or unusual brain
activity.
Explaining Anxiety Disorders
• Sociocultural: There has been a sharp rise in anxiety
disorders in the past 50 years, particularly in Western
culture.
• Can you see how our increasingly fast-paced lives—along
with our increased mobility, decreased job security and
decreased family support—might contribute to anxiety?
• Further support to this theory is that anxiety disorders
have dramatically different forms in other cultures.
• For example, in a collectivist twist on anxiety, the
Japanese have a type of social phobia call taijin kyofusho
(TKS) which involves morbid dread of doing something
to embarrass others.
Dissociative Disorder
There are several types of dissociative disorders, but all involve
splitting apart (a dis-association) of significant aspects of
experience from memory or consciousness.
• Individuals dissociate from the core of their personality by
failing to recall or identify past experiences (dissociative
amnesia)
• Individuals may leave home and wander off (dissociative
fugue)
• May lose the sense of reality and feeling estranged from self
(depersonalization disorder)
• May develop completely different personalities (dissociative
identity disorder, DID—recall Shutter Island)
Dissociative-Identity Disorder
• Previously known as “multiple personality
disorder”
• Two or more distinct personalities exist within
the same person at different times
• Each personality has unique memories,
behaviours and social relationships.
• Transition from one personality to the next
occurs suddenly and is often triggered by stress
• Usually, the other personality has no awareness
of the other
Mood Disorders
• Anne had been divorced for eight months when she called a
psychologist for an emergency appointment. Although her
husband had verbally and physically abused her for years, she
had mixed feelings about staying on in the marriage. She had
anticipated feeling good after the divorce, but she became
increasingly depressed. She had trouble sleeping, had little
appetite, felt very fatigued, and showed no interest in her
usual activities. She stayed home from work for two days
because she “just didn’t feel like going in.” Late one afternoon,
she went straight to bed, leaving her two small children to
fend for themselves. Then, the night before calling for an
emergency therapy appointment, she took five sleeping
tablets and a couple of stiff drinks. As she said, “ I don’t think
I wanted to kill myself; I just wanted to forget everything for
awhile.” (Meyer & Salmon, 1988)
Mood Disorders
• Anne’s case is a good example of a mood
disorder (also known as affective disorder).
• This category encompasses not only excessive
sadness, like Anne’s, but also unreasonable
elation and hyperactivity.
Mood Disorders
• Mood Disorders are characterized by extreme
disturbances in emotional states that may
include psychotic distortions of reality.
• There are two main types of mood
disorders—major depressive disorder
and bipolar disorder
Mood Disorders: Major Depressive
Disorder
• Depression has been recorded as far back as
ancient Egypt, when the condition was called
melancholia and was treated by priests.
• We all feel “blue” sometimes, especially when
we’ve suffered some kind of loss
Mood Disorders: Major Depressive
Disorder
• People suffering from major depressive disorder,
however, may experience a lasting and
continuously depressed mood without a
clear trigger or precipitating event.
• In addition, their sadness is far more intense,
interfering with their basic ability to function, feel
pleasure or maintain interest in life.
• When depression is unipolar, the depressive
episode eventually ends and people return to a
“normal” emotional level.
Mood Disorders: Major Depressive
Disorder
Signs of Clinical Depression:
• trouble sleeping
• lose (or gain) weight
• may feel so fatigued that they cannot go to work or
school or even comb their hair and brush their teeth.
• may sleep both day and night
• have problems concentrating
• feel so profoundly sand and guilty that they consider
suicide.
These feelings have no apparent cause and may
be so severe that the individual loses contact
with reality.
Mood Disorders: Bipolar
Disorderer
With bipolar disorder, the person
experiences periods of depression
as well as mania (an excessive and
unreasonable state of overexcitement
and impulsive behaviour)
Mood Disorders: Bipolar
Disorder
During a manic episode:
• person is overly excited
• extremely active
• easily distracted
• the person exhibits unrealistically high self-esteem
• an inflated sense of importance or even delusions of
grandeur (He/she often makes elaborate plans for
becoming rich and famous. )
• this individual is hyperactive and may not sleep for days at
a time, yet does not become fatigued.
• thinking is speeded up and can change abruptly to new
topics, showing “rapid flight of ideas.”
• speech is also rapid (“pressured speech”), and it is difficult
for others to get a word in edgewise.
• poor judgment is common: a person may give away
valuable possessions or go on wild spending sprees.
Mood Disorders: Bipolar Disorder
Cycle of Behaviour:
Manic episodes may last a few days to a few months
and generally end abruptly.
The person’s previous manic mood, rapid thinking
and speaking style, and hyperactivity are reversed.
The following depressive episode generally lasts
three times as long as the manic disorder.
Risk:
The lifetime risk for developing bipolar disorder is
low, between 0.5 and 1.6 %, unfortunately, it can
be one of the most debilitating and lethal
disorders, with a high suicide rate.
Mood Disorders: An Explanation
Biological Factors:
• Biological factors play a significant role in
both major depression and bipolar disorder.
• Evidence suggest that major depressive
disorders and bipolar disorder may be
inherited.
• For example, when one identical twin has a
mood disorder, there is a 50% chance that the
other will also develop the illness.
Mood Disorders: An Explanation
• Research shows that some patients with
bipolar disorder and depression show
decreased grey matter and decreased
overall functioning in the frontal lobes.
• These areas of the brain are associated
with memory and coordination.
• This suggests structural brain
changes may contribute (or cause) these
mood disorders.
• http://www.nature.com/news/2007/070720/full/ne
ws070716-16.html
Mood Disorders: An Explanation
• Other research points to an imbalance of several
neurotransmitters, including serotonin,
norepinephrine, and dopamine.
▫ these same neurotransmitters are involved in the
capacity to be aroused or energized and in the
control of other functions affected by depression,
(i.e., sleep cycles and hunger)
▫ drugs that alter the activity of these
neurotransmitters also decrease symptoms of
depression (antidepressants).
▫ The drug lithium reduces or prevents manic
episodes by preventing norepinephrine and
serotonin-sensitive neurons from being overstimulated
Mood Disorders: An Explanation
Psychosocial Theories:
• These theories focus on environmental stressors
and disturbances in the person’s interpersonal
relationships, thought processes, self-concept,
and learning history.
• The psychoanalytic explanation of depression is
anger turned inward against oneself when an
important relationship or attachment is lost.
Mood Disorders: An
Explanationtion
Psychosocial Theories:
• Another important contributor may be explained by
the “learned helplessness” theory of depression
(Martin Seligman).
• Seligman demonstrated that when humans are
repeatedly subjected to pain that they cannot escape,
they develop such as strong sense of helplessness
or resignation that they do not attempt to escape
future painful experiences.
• In other words, when people learn they are unable to
change things for the better, they’re more likely to
give up—this may explain why people stay in abusive
relationships.
Postpartum Depression
• Postpartum depression is a relatively common
depressive disorder that occurs among new mothers
within three to four weeks after birth of a child.
• Symptoms: similar to other depressive disorders,
plus it often includes anxiety about harming the
baby.
• One possible explanation is the wide hormonal
swings that occur as the mother’s body readjusts to
its non-pregnant state.
• Episodes of postpartum depression increase the risk
for developing other types of depressive disorders
• http://www.globalnews.ca/health/fact+file/644263
9858/story.html
SAD—Seasonal Affective Disorder
• As a result of the dull, dreary, short and often
rainy days of winter, some people may develop a
deep depression
• It is suggested that the hormone melatonin plays
a significant role. The less light available the
more melatonin is secreted by the brain’s pineal
gland
Stephen Fry: The Secret Life of a
Manic Depressive
• http://topdocumentaryfilms.com/stephen-frythe-secret-life-of-the-manic-depressive/
Schizophrenia
Schizophrenia: The Jerusalem
Syndrome
Every year, dozens of tourists to Jerusalem are
hospitalized with symptoms of “Jerusalem
Syndrome,” a psychological disorder in which a
person becomes obsessed with the significance of
Jerusalem and engages in bizarre, deluded
behaviour while visiting the city.
For example, the person might come to believe that he
is Jesus Christ or some biblical character
Although scholars disagree with the explanation for
“religious psychosis,” the symptoms themselves
provide a classic example of delusional thought
disturbances
Schizophrenia: Mental illness in public
view
• What could be more terrifying than performing at a
final audition for American Idol? How about doing
so just moments before announcing—to Simon
Cowell, the celebrity judge—that you have a mental
illness?
• Singer/songwriter Tracey Moore, who was
diagnosed with schizophrenia at 21, felt it was
important to say. Even as she combats paranoid and
delusional thoughts, Moore has worked to raise
awareness and develop support groups for people
with schizophrenia.
Schizophrenia
• Imagine for the moment that your friend has
just left for college and you hear voices inside
your head shouting, “You’ll never see her again!
You have been a bad friend! She’ll die.” Or what
if you saw dinosaurs on the street and live
animals in your refrigerator? These are actual
experiences that have plagued Mrs. T for almost
30 yrs.
Schizophrenia
• Mrs. T suffers from schizophrenia, a disorder
characterized by major disturbances in perception,
language, thought, emotion, and behaviour.
• Mental disorders exist on a continuum and many
people suffering from schizophrenia can still
function in daily life.
• For some people however, schizophrenia is so severe
that it is considered a “psychosis,” meaning that the
person is out of touch with reality.
Schizophrenia
• People with schizophrenia often have difficulty
with:
• Caring for themselves
• Relating to others
• Holding a job
In extreme cases—the individual may withdraw
from others and reality, often into a fantasy life
of delusions and hallucinations—this is when
they may require custodial/institutional care
Schizophrenia: Facts
• It is one of the most widespread and devastating of
all mental disorders
• Approx. 1/100 persons will develop schizophrenia in
his/her lifetime
• Approx. half of those admitted to mental hospitals
are diagnosed with this disorder
• Usually emerges between late teens and mid-thirties
and only rarely prior to adolescence or after age 45
• Equally prevalent in both men and women
• Generally more severe and strikes earlier in men
than women
Schizophrenia: Same as multiple
personalities?
• No. Schizophrenia means “split mind.”
Referring to the fragmented thought processes
and emotions found in schizophrenia
• Multiple personality disorder (known as
dissociative identity disorder) is the rare
condition of having more than one distinct
personality
Symptoms of Schizophrenia: Five Areas
of Disturbance
• All people with anxiety disorders have anxiety. All
people with mood disorders have depression,
and/or mania.
• People who suffer from schizophrenia can have
significantly different symptoms, yet all are given
the same general label. This is because
schizophrenia is a group or class of disorders.
• Each case is identified according to some kind of
basic disturbance in one or more of the following
areas: perception, language, thought,
emotions (affect), and behaviour
Symptoms of Schizophrenia: Five Areas
of Disturbance—Perceptual Symptoms
Perceptual Symptoms
• The senses may be either enhanced (Mrs. T) or
blunted. Sensory stimulation is jumbled and
distorted. One patient reported:
“When people are talking, I just get scraps of it. If it
is just one person who is speaking, that’s not so
bad, but if others join in then I can’t pick it up at all.
I just can’t get in tune with the conversation. It
makes me feel all open—as if things are closing in
on me and I have lost control.”
Symptoms of Schizophrenia: Five Areas
of Disturbance—Perceptual Symptoms
Perceptual Symptoms
• These disruptions in sensations help explain why people with
schizophrenia experience hallucinations—imaginary sensory
perceptions that occur without external stimuli.
• Hallucinations occur in all of the senses (visual, tactile,
olfactory). But auditory hallucinations (hearing voices and
sounds) are most common.
• They hear voices speaking their thoughts aloud, commenting
on their behaviour, or telling them what to do. Voices may
come from inside their heads or from external sources such
as an animal, telephone wires, or a TV set.
• On rare occasions, people with schizophrenia will hurt others
in response to distorted internal experiences or the voices
they hear---in reality these people are more inclined to selfharm/suicide
Symptoms of Schizophrenia—Language
& Thought Disturbances
Language & Thought Disturbances
• “People who live in glass houses should not throw stones.”
When asked to explain its meaning, a patient with
schizophrenia said, “People who live in glass houses shouldn’t
forget people who live in stone houses and shouldn’t throw
glass.”
• You can see how for people with schizophrenia their logic is
sometimes impaired and their thoughts disorganized and
bizarre.
• When language and thought disturbances are mild, an
individual will jump from topic to topic.
• In severe disturbances, phrases and words are jumbled
together (word salad). Or the person creates artificial words
(neologisms)—the person might say, “splisters” for splinter
and blisters, or “smever” for smart and clever.
Symptoms of Schizophrenia—Language
& Thought Disturbances
Language & Thought Disturbances
• The most common thought disturbance: lack of
contact with reality (psychosis). Think about
seeing dinosaurs walking down the street--it
would be frightening to no longer separate
hallucinations and delusions from reality
• Another common thought disturbance:
delusions, or mistaken beliefs based on
misrepresentations of reality.
Symptoms of Schizophrenia—Language
& Thought Disturbances
Language & Thought Disturbances
Delusions of persecution: They may believe
others are stalking them or trying to kill them
Delusions of grandeur: believe they are
someone very important (Jesus, queen of
England)
Delusions of reference: unrelated events are
given special significance—when a person believes
a radio program or newspaper is giving him/her a
special message
Symptoms of Schizophrenia—Emotional
Disturbances
“It must look queer to people when I laugh about
something that has got nothing to do with what
I am talking about, but they don’t know what’s
going on inside me and how much of it is
running around in my head. You see, I might
be talking about something quite serious to you
and other things come into my head at the same
time that are funny and this makes me laugh.
If I could only concentrate on one thing at the
same time, I wouldn’t look half so silly.”
Symptoms of Schizophrenia—Emotional
Disturbances
• As you can see from this quote, the emotions of
people suffering from schizophrenia are
sometimes exaggerated and fluctuate rapidly in
inappropriate ways. In other cases, emotions
may become blunted or decreased in intensity.
• Some people have a flattened affect—meaning
there is almost no emotional response of any
kind
Symptoms of Schizophrenia—Behaviour
Disturbances
• Behavioural disturbances may take the form of
social withdrawal and/or unusual actions that have
special meaning
• Examples: one patient shook his head
rhythmically from side to side to try to shake the
excess thoughts out of his mind. Another massaged
his head repeatedly “to help clear it” of unwanted
thoughts. Other cases, the affected person may
grimace and display unusual mannerisms (may also
be related to side effects from medication)
Symptoms of Schizophrenia—Behaviour
Disturbances
• People with schizophrenia may become cataleptic
and assume uncomfortable, nearly immobile stance
for an extended period.
• A few people have symptoms called waxy
flexibility, which is the tendency to maintain
whatever posture is imposed on them
• These abnormal behaviours are often related to
disturbances in perception, thoughts and feelings.
For example, experiencing a flood of sensory
stimuli or overwhelming confusion, a person with
schizophrenia may hallucinate, experience
delusions, and/or withdraw from social contacts
and refuse to communicate.
Types of Schizophrenia: Methods of
Classification
Two groups of symptoms :
1. Positive Symptoms involve additions to or
exaggerations of normal thought, such as
delusions and hallucinations. These symptoms
are more common when schizophrenia
develops rapid (acute). Positve symptoms are
associated with better adjustment before the
onset and better prognosis for recovery.
Types of Schizophrenia: Methods of
Classification
Two groups of symptoms :
1. Negative Symptoms: involve the loss or
absence of normal thought processes and
behaviours. Examples include impaired
attention, limited or toneless speech, flattened
affect (emotions), and social withdrawal
Negative symptoms are more often found in slowdeveloping schizophrenia.
Subtypes of Schizophrenia
Paranoid
Dominated by delusions (persecution and
grandeur) and hallucinations (hearing
voices)
Catatonic
Marked by motor disturbances (immobility or wild
activity) and echo speech (repeating the speech of
others)
Disorganized
Characterized by incoherent speech, flat or
exaggerated emotions, and social withdrawal
Undifferentiated
Varied symptoms that meet the criteria for
schizophrenia but is not any of the other subtypes
Residual
No longer meets the full criteria for schizophrenia
but still shows some symptoms
Explaining Schizophrenia
• Research supports possible biological factors in
schizophrenia.
• Some research suggest prenatal virus infections,
birth complications, immune responses,
maternal malnutrition, and advanced paternal
age
• Biological Theories focus on: genetics,
neurotransmitters, and brain abnormalities
Biological Theories: Genetics
• Most genetic studies focus on twins and
adoptions—research indicates that the risk for
schizophrenia increases with genetic similarity;
that is, people who share more genes with a
person who has schizophrenia are more likely to
develop the disorder
Biological Theories: Neurotransmitters
• It is not fully clear how neurotransmitters
contribute.
• Dopamine hypothesis suggest that overactivity
of certain dopamine neurons in the brain
contribute to some forms of schizophrenia. This
is based on (1) administering amphetamines
increases the amount of dopamine and can
produce (or worsen) some symptoms (2) drugs
that reduce dopamine activity in the brain
reduce or eliminate some symptoms
Biological Theories: Brain
Abnormalities
1) Abnormalities in brain function and structure have
been noted. Researchers have found larger cerebral
ventricles (fluid-filled spaces in the brain) in some
people with schizophrenia
2) Some people with chronic schizophrenia have a
lower level of activity in their frontal and temporal
lobes—areas that are involved in language, attention
and memory. Damage to these areas may explain
the thought and language disturbances that
characterize schizophrenia
Psychosocial Theories
1) Diathesis-Stress Model: stress plays an
essential role in triggering schizophrenic
episodes in people with an inherited
predisposition
2) Communication disorders in family members
may be a predisposing factor—such disorders
include unintelligible speech, fragmented
communication, and parents frequently
sending contradictory messages—this research
is inconclusive.
Biosocial Model
• Takes into account the biological, psychological
and social factors
• John Nash, the Nobel Prize winning
mathematician demonstrated several classic
symptoms of schizophrenia, including
disturbances in perception, language, thought,
behaviour, and emotion. For Nash, as well as
others with schizophrenia, no single factor led to
his illness.
Personality Disorders
Personality Disorders: Antisocial and Borderline
• Personality is defined as a unique and relatively
stable pattern of thoughts, feelings, and actions.
What would happen if these stable patterns, called
personality , were so inflexible and maladaptive that
they created significant impairment of someone’s
ability to function socially and occupationally?
• This is what happens to personality disorders—
people with PD generally do not feel upset or
anxious about their behaviour and may not be
motivated to change.
Personality Disorder: Types
Disorder
Characteristics
Antisocial
Displays pattern of disregarding and violating
the rights of others without feeling and remorse
Dependent
Displays pattern of submissiveness and
excessive need to be taken care of
Histrionic
Displays excessive emotions; excessively seeks
attention
Obsessive compulsive
Has an intense interest in being orderly, having
control, and achieving perfection
Paranoid
Distrust others; percieves others as having evil
emotions
Schizotypal
Feels intense discomfort in close relationships;
has distorted thinking and eccentric behaviour
Personality Disorders
Media reports that Scott Peterson was more upset about
burning chicken on the barbecue than about the
disappearance of his wife, Laci, who at the time was eight
months pregnant with their child.
Do you remember this case---listening to the audiotapes of
Scott Peterson flirting and lying to his girlfriend while
others were frantically searching for his “missing” wife?
This is a good example of the traits and behaviours of an
antisocial personality disorder
How Do You Recognize Antisocial PD?
• Often labeled psychopaths or sociopaths, people
with this disorder function on an entirely
different plane of existence than the rest of us.
• Official diagnosis in usually not determined until
the affected individual reaches adulthood,
however, there are several telltale signs that
indicate the presence of this disturbing disorder.
Antisocial Personality Disorder
• Term is used interchangeably with terms
sociopath and psychopath.
• These labels describe behaviour that is so far
outside the ethical and legal standards of society
that many consider it the most serious of all
mental disorders.
• People with this diagnosis feel little personal
distress (and may not be motivated to change).
Yet their maladaptive traits generally bring
considerable harm and suffering to others
Antisocial Personality Disorder
Four hallmarks of antisocial personality disorder:
1. Egocentrism: preoccupation with oneself and
insensitivity to the needs of others
2. Lack of conscience
3. Impulsivity
4. Superficial charm
Antisocial Personality Disorder
• Unlike most adults, individuals with APD act
impulsively, without giving thought to their
consequences.
• They are usually poised when confronted with their
destructive behaviour and feel contempt for anyone
they are able to manipulate
• They often change jobs and relationships suddenly
• They often have a history with truancy from school
and of being expelled for destructive behaviour
• They may be charming and persuasive, and have
remarkably good insight into the needs and
weaknesses of others
Antisocial Personality Disorder
• Twin and adoption studies suggest a possible
genetic predisposition to antisocial personality
disorder
• Biological contributions are also suggested by
studies that have found abnormally low
autonomic activity during stress, right
hemisphere abnormalities , reduced grey matter
in the frontal lobes, smaller amygdala, and
biochemical disturbances
Antisocial Personality Disorder
• Evidence also exists for environmental or
psychological causes.
• Antisocial personality disorder is highly correlated
with neglectful and/or abusive parenting styles, and
inappropriate modeling
• They often come from homes characterized by
emotional deprivation, harsh, inconsistent
disciplinary practices, and antisocial parental
behaviour
• Other studies show a strong interaction between
both heredity and environment
How To Recognize Someone with
Borderline Personality Disorder
•People who act out by throwing tantrums, getting
drunk all the time or frequently talking of or
attempting suicide may be having more than a bad
day. They could be suffering from borderline
personality disorder. This mental disorder most
frequently occurs in young adults, although it can hit
at any age. The disorder can be successfully treated
once it's recognized.
Profile of BPD
1. Abandonment Issues
2. Unstable Personal Relationships
3. Self Harm & Impulsivity
4. Mood Swings
5. Poor Self-Image
Borderline Personality Disorder
•BPD is among the most commonly diagnosed
personality disorders.
•The core features are impulsivity and instability in
mood, relationships, and self-image
•Originally, the term implied that the person was on
the borderline between neurosis and schizophrenia—
the modern day take no longer has this connotation,
but BPD remains one of the most complex and
debilitating of all the personality disorders
Borderline Personality Disorders
• People with borderline experience extreme
difficulties in relationships.
• Subject to chronic feelings of depression,
emptiness, and intense fear of abandonment,
they also engage in destructive, impulsive
behaviour, such as sexual promiscuity, drinking,
gambling, and eating sprees.
• In addition, they may attempt suicide and
sometimes engage in self-mutilating behaviour.
Borderline Personality Disorders
• People with BPD tend to see themselves and
everyone else in absolute terms—perfect or
worthless
• They constantly seek reassurance from others
and may quickly erupt in anger at the slightest
sign of disapproval
• This disorder is typically marked by a long
history of broken friendships, divorces, and lost
jobs
Borderline Personality Disorders
• People with BPD frequently have a childhood
history of neglect; emotional deprivation; and
physical, sexual, or emotional abuse.
• The disorder tends to run in families, and some
data suggests it is the result of impaired
functioning of the brain’s frontal lobes and
limbic system, areas that control impulsive
behaviours
Borderline Personality Disorders
• Some therapist have had success in treating BPD
with drug therapy and behaviour therapy, the
prognosis is generally not favourable.
• People with BPD appear to have a deep well of
intense loneliness and a chronic fear of
abandonment.
• Given their troublesome personality traits,
friends, lovers, even family members and
therapists often do “abandon” them—thus
creating a tragic self-fulfilling prophecy.