Psychological Disorders
Specific Disorders for our
BIG “Landscape” Notes
Created by Andy Filipowicz
Ocean Lakes High School, 2008
Definitions of Mental Disorder
1- Mental disorders as a violation of
cultural standards or atypical
2- Mental disorder as maladaptive or
harmful behavior
3- Mental disorder as a disturbing
emotional distress.
4- Mental disorder as unjustifiable
Psychological
Disorders
According to the Law
M’Naghten Rule 
1) must not know what you are doing is
wrong OR
2) must not understand the nature of the
act
Stats on “legal insanity”…
Discuss: Are the mentally insane
more dangerous?
Several articles on “legal
insanity” and more
Discussion Day 59
• Why do we diagnose people with
psychological disorders? What exactly is
the purpose of this anyway?
• What might be some potential benefits?
Potential negatives/side effects of such
a diagnostic system?
Let’s discuss a few ideas…
Diagnostic & Statistical
Manual of Mental Disorders
• DSM-IV (1994) contains more than
300 mental disorders. (DSM-V to
be released in May 2012)
• Provides diagnostic categories
• Does not provide information on
causes
• Does not provide information on
treatment
• It is organized in 5 axes
The Five Axes
• I = Categories of Psychological Disorders
• II = Personality & Developmental
Disorders
• III = Medical Conditions
• IV = Rating of Recent Social &
Environmental Stress
• V = Global Assessment of Functioning
(GAF) from 1-100 (1 = severe dysfunction)
Discussion
• What are some remaining issues stemming from
this system of classification?
• Boundary btwn normal / abnormal
• Cut-offs for number of symptoms seems random
and arbitrary
• How are specific time periods for symptom
duration chosen?
• Auxiliary axes (premorbid history, quality of
relationships, work and family functioning)
Understanding
Psychological Disorders
The Biomedical Model
Psychological disorders are sicknesses
and can be diagnosed, treated, and
even cured.
The Bio-Psycho-Social Model
How biological, psychological, and social
factors interact to produce specific
psychological disorders.
Anxiety Disorders
• 1- Panic Disorder
• 2- Generalized Anxiety Disorder (GAD)
• 3- Posttraumatic Stress Disorder
(PTSD)
• 4- Phobias (fears)
• 5- Obsessive-Compulsive Disorder
(OCD)
1 – Panic Disorder
• Symptoms
Panic Attack
– “recurrent, unexpected”
– acute episode of intense anxiety without any apparent provocation
• Can’t breathe, heart pounding ,sweat, shake, feel like you’re losing your
mind
– Additional anxiety comes from anticipating future attacks  this
is actually what the disorder is (panic attacks are actually separate
from the disorder; can have 1 without the other! (Abnormal book
Pg. 117  Gretchen  Attacked by Panic)
• Cause – based on perspective
– NOT caused by a stressful event
– LIKELY original cause  physiological event (out of breath) and
then an unrelated troublesome thought (death of mother)
– Increase in frequency following 1st panic attack
– Low levels of GABA = inc anxiety
– Genes  tendency to be tense/uptight
– Smoking incs likelihood of developing anxiety disorders
1 – Panic Disorder –
Stats and Treatment
• With or without agoraphobia (5.3% have this by itself)?
– Fear and avoidance of situations in which they would feel
unsafe in the event of a panic attack or symptoms
– Abnormal book pg. 126 (Mrs. M – Self-Imprisoned)
• 3.5% some point in their lives
• 2/3 women
– Men drink
– Women develop this agoraphobia
• Onset mid-teens to 40
– Puberty is best predictor
• Less pervasive in elderly
• Benzodiazepines/SSRIs = Prozac, Paxil, Xanax
2 – Generalized Anxiety
Disorder (GAD)
• (abnormal book pg. 121 – Irene)
• A general feeling of impending doom
• Continually tense / jittery (from constant high-levels of
anxiety)
– Muscle fatigue, tension common
• Worried that bad, horrible things might happen
• Autonomic System Arousal
– racing heart, clammy hands, stomach butterflies, sleeplessness,
twitching eyelids, fidgeting
• Cause: no specific cause
– Genes: tendency to be tense
– Learning: important events in life are uncontrollable/dangerous
– Stress makes them apprehensive, vigilant
2 – GAD Stats
• 5% at some point
• 2/3 female
• Gradual onset, though first appears following a major life
change beginning in early adulthood (leaving home, getting a
new job, having a baby, etc.)
• Chronic
• Very prevalent in elderly
• Treatment: Hardest of the Anxiety Disorders to treat
– Valium, Librium
– Cognitive Behavioral Therapy  purposefully confront anxietyprovoking images and thoughts…develop strategies for dealing
with these
3 – Posttraumatic
Stress Disorder (PTSD)
• SYMPTOMS: flashbacks, nightmares, intrusive thoughts, intense
physiological reactivity
• CAUSES:
• When people are in danger, they produce high levels of natural opiates,
which can temporarily mask pain. They also produce stress hormones.
• People with PTSD tend to continue producing these hormones.
• Norepinephrine is higher than normal. It activates the hippocampus,
which is involved with memory and long term memory.
• At high levels, stress hormones can become toxic and can damage the
brain.
• Triggered by a life threatening trauma
– Men: War
– Women: Rape
• 25% of those experiencing a life threatening event develop PTSD
3—PTSD – Stats /
Treatment
• Group therapy  helps us to mimic
normal relationships again
• Behavioral therapy  experience the
conditioned stim/response as NOT
always together or anxiety will always
persists
– Systematic Desensitization
•
•
•
•
•
•
•
•
•
4 – Phobias
Acrophobia: fear of heights
Brontophobia: fear of thunder
Astraphobia: fear of lightning
Claustrophobia: fear of closed places
Porphyrophobia: fear of the color purple
Mysophobia: fear of dirt and germs
Agoraphobia: fear of being away from a safe place.
Triskaidekaphobia: fear of number 13
Phobophobia
4 – Phobias – 3 Classes
• Specific (over 700, but not in DSM)
– Search for Phobias
• Social – avoidance of social situations
– 13.3% of pop at some point (35mil)
– 1.4F: 1M
– Peak onset = 15yrs
• Agoraphobia
• Cause:
– Inherited = falling, loud noises, social  seen in infants
4 months old
– Behavioral = observation, vicarious (latent) experience
Moving Images: 24:
Intensive Exposure Therapy
5 – Obsessive-Compulsive
Disorder (OCD)
• Obsessions = Recurrent, persistent,
unwished-for thoughts or images.
– Example: repetitive thoughts about killing a
child or becoming contaminated by shaking
hands.
• Compulsions = Repetitive, ritualized
behaviors that the person feels must be
carried out to avoid disaster.
– Example: hand washing, counting, & checking
(door locked, curling iron off)
•
•
•
•
•
•
•
•
•
•
•
5 – OCD – Causes
Video  Moving Images: 22 OCD or OCD VHS
2.6% at some point
55-60% female (in kids though, ratio is reversed)
Onset around 20, doesn’t show up past 30
– Boys develop OCD earlier
Article  Strep throat!
High activity in front lobe just above the eyes
Freud = Anal Retentive
NT = lack of serotonin
Link to Tourette syndrome and Dopamine
Organic = brain tumors, injuries, stress, viruses
1918 flu epidemic spiked encephalitis also
increased OCD cases
• Brain = abnormally high levels of activity in the
caudate nucleus, part of the basal ganglia known to
be involved in initiation of learned behavior
Somatoform Disorders
• Defined = psychological problem
manifested in a physiological symptom
(see overhead slides)
• A - Conversion Disorder
• B - Hypochondriasis
• C – Body Dysmorphic Disorder
•
•
•
•
•
•
Conversion Disorder
NOT FAKING IT
Paralysis of a limb (most common)
Total paralysis
Weakness
Insomnia
Blurred vision, deafness, other
sensory effects
• Pain – back, abdominal
• Peak onset = mid-late 30s
• “Shell shock” during WWI/II
• The patient has one or more symptoms or deficits affecting the
senses or voluntary movement that suggest a neurological or
general medical disorder.
• The onset or worsening of the symptoms was preceded by
conflicts or stressors in the patient's life.
• The symptom is not faked or produced intentionally.
• The symptom cannot be fully explained as the result of a general
medical disorder, substance intake, or a behavior related to the
patient's culture.
• The symptom is severe enough to interfere with the patient's
schooling, employment, or social relationships, or is serious enough
to require a medical evaluation.
• The symptom is not limited to pain or sexual dysfunction, does not
occur only in the context of somatization disorder , and is not
better accounted for by another mental disorder.
Hypochondriasis
Body Dysmorphic
Disorder
• “distorted body image”
– Size, shape, form
– Perception of physical appearance
• 50% get plastic surgery
• Equal gender ratios
• Onset: late childhood, early
adolescence (avg age is 17)
Dissociative
Disorders
• ?- Amnesia
• @- Fugue
• #- Dissociative Identity
Disorder
(Multiple Personality
Disorder)
?- Dissociative
Amnesia
• Unable to recall important personal information or
past events (name, origin, relationships, job, etc.)
– General amnesia is anything at all (procedural stuff is
fine though  ride a bike, how to talk, etc.)
– Selective amnesia is specific traumatic events (war)
• Cause (all Dissociative Disorders): attempt to
escape from traumatic event (past or present)
• Abnormal book: 179: The Woman who Lost Her
Memory
@- Fugue
• Memory loss is accompanied by an
unexpected trip
• Confusion about personal identity
• 0.2% of pop
• Therapy: Psychotherapy to deal with
original traumatic event
• Prognosis: A few months
• Abnormal book: 180: The Misbehaving
Sherif
#- Dissociative Identity Disorder
(Multiple Personality Disorder)
• IT IS NOT SCHIZOPHRENIA; IT’S
TOTALLY DIFFERENT!!!!!!!! THIS WAS AN
AP ESSAY QUESTION!
• Loss of time
• Onset = 2-12 yrs old
• At least 2 personalities, 10 is avg
• Personalities have different names, sexes,
ages, voices, facial expressions, handwriting,
physical problems
– Often at least 1 is quite violent, aggressive
(FIGHT CLUB!)
#- Dissociative Identity Disorder
(Multiple Personality Disorder)
• Almost non-existent outside of North America
•
•
•
•
– India, Japan entirely nonexistent
Self-multilation
EXCELLENT MEMORY!!! (when not in the alter egos)
Some can function in a “normal” life
Cause: physical, sexual, psychological abuse (not all who are
abused will develop it, but it’s a good place to look for a cause
if someone has it)
• Video: Brain 23 Multiple Personality
• May involve role playing as normal subjects under hypnosis will
express 2nd personality if instructed to do so by the
psychologist/hypnotist
• 85% are female (http://skepdic.com/mpd.html)
Mood Disorders
• - Major Depression (think Unipolar)
• &  Bipolar Disorder aka
Manic Depression
MIND 32: Mood Disorders: Hereditary Factors
Symptoms of Depression
Pg. 195 (Katie)
Psychological Symptoms
• Feeling of despair, hopelessness, worthlessness, intense sadness
#1 symptom
• Exaggerating minor failings and ignoring positive events
• Interpreting losses as signs of personal failures and concluding that
happiness is not possible.
Physiological Symptoms
• Insomnia/Hypersomnia, lack of appetite trouble/ overeating, trouble
concentrating, early morning wakeups
• DEBILITATING  can’t go to work/school
VIDEO: Moving Images: 23: Depression
•
•
•
•
•
•
•
•
•
•
Causes
/
Stats
of
Depression
1 more thing about symptoms: to be clinical depression, symptoms must persist for
at least 2 weeks in the absence of a clear reason
If only during winter months (no sunlight = more melatonin = sleepy), SAD =
Seasonal Affective Disorder
Neurotransmitters: lack of serotonin, norepinephrine
Lower activity in left frontal lobe
Freud: “anger turned inward”
Onset: mean = 25-29, though age of onset is going down [3 month olds (207)]
Average duration of 1st episode = 6-9 months
70% are women
Dysthmyic Disorder = chronic, lasting at least 2 years, not episodes, its chronic!
But less severe…(not debilitating) (Double Depression = Dysthymic Disorder with
occasional bouts of depression
+ common than bipolar, - common than phobias
Moving Images 23: Mike Wallace
NT Causes of...
DEPRESSION
• Low levels of 1 of 2
NTs:
• 1-Norepinephrine
–2-Serotonin
MANIA
•Excessive
production of 1
or 2 NTs:
–1Norepinephrine
–2-Serotonin
Mind: 31: Mania & Depression
Mania
• An abnormally high state of exhilaration
• Extreme pleasure in every activity (cleaning,
shopping, etc.)
• Flight of ideas – lots at once
• Excessive energy
• Irrational decisions
• Feeling of excessive hopefulness
• Speaking rapidly and dramatically
• Excessive feeling of ambition / grandiosity
• Inflated self esteem
Pg. 202
abnormal book
– Billy
Stages of Mania
• 1-Hypomania
Patients are energetic, extroverted,
and assertive
• 2-Mania
Loss of judgment
• 3-Delusion with Paranoid Themes
Speech is generally rapid and
hyperactive behavior may lead to
violence.
Bipolar Disorder
Manic-Depressive
• When people alternate between episodes of depression
and one or more episodes of mania.
• Occurs equally in both sexes.
• Mean onset is between 18-22, though 1/3 of cases
actually begin in adolescence
• 50/50 M/F
• Those who have rapid cycling may experience more
episodes of mania and depression that succeed each
other without a period of remission.
• Less common than depression
Bipolar Disorder
Manic-Depressive
• Cyclothymic Disorder =
People Who Had Bipolar
• Abraham Lincoln
• Van Gough
• Vivian Lee
• Charles Dickens
• Isaac Newton
• Mark Twain
Edgar Allan Poe
Virginia Wolf
Walt Whitman
Ernest Hemingway
Mind 34: ECT for Depression
SAD
• Seasonal Affective Disorder
• 5% of North Americans
– 2% of Floridians
– 10% of New Hampshirians
Schizophrenia
• Overall must have at least 2 of the
following 5:
–
–
–
–
Delusions (+)
Hallucinations (+)
Disorganized Speech (mostly +)
Disorganized Behavior (inappropriate or
ineffective behavior) (mostly +)
– Negative Symptoms
Schizophrenia –
General Characteristics
• delusions =
– Delusions of Persecution (CIA watching)
• “the doctor is out to get me” “that picture is meant for me”
Beautiful Mind: codes in the newspaper
– Delusions of Grandeur (God-like, the president, Nobel
Prize winner, savior of the world, etc.)
– Capgras Syndrome: someone you know replaced by a
double
– Cotard’s Syndrome: thinks a part of the body has
changed in some impossible way
Schizophrenia –
General Characteristics
• Disturbed Perceptions = Hallucinations
– Seeing / hearing / feeling usually
• Somatic hallucinations – “snakes are crawling around on me”
• Hearing voices (auditory hallucinations – most common)
– interestingly, we find problems in Broca’s area (NOT wernicke), so
it’s not language composition, but as if one’s own produced language
is repeated in the head as other people’s voices & the person can’t
tell the diff
Schizophrenia –
General Characteristics
• Disorganized speech & Thought
–
–
–
–
Lack insight, awareness of problem
Jump from topic to topic, talk illogically
Tangentiality, loose association
Overinclusion (word associations guide speech “For
dinner we had veal cutlets, tossed salad, and
French fries, with lots of German, Polish, Spanish,
and the United Snakes)
– Paralogic: “President Bush is a Texan. I come
from Houston, TX. I’m the President.”
– Thought insertion or withdrawal
Schizophrenia –
General Characteristics
• Disorganized behavior =
Inappropriate or ineffective behaviors
– Ex: wearing winter clothing on a hot day
– Ex: crying, laughing at inappropriate times
– Catatonia – no movement (- symptom) OR
rigid fixed behaviors
– Flat Affect – no emotion (- symptom)
Negative Symptoms
• Affective Flattening (2/3 have this) = don’t show
emotion in situations where you’d expect it
• Anhedonia = inability to feel pleasure;
indifference
• Alogia = lack of meaningful speech
• Avolition = lack of motivation
• Cessation of personal hygiene
Other symptoms
• Dissociative symptoms
• Anosognosia
• High rates of substance abuse
disorders
• High risk of suicide
• High rate of OCD / Panic Disorder
• Downward drift
Onset of
Schizophrenia
• Chronic / Process schizophrenia
– Slow developing process
– Recovery doubtful
• Acute / reactive schizophrenia
– Previously well-adjusted person, in
reaction to life’s stresses, rapidly
develops schizophrenia; recovery more
likely
Onset statistics
• Average age of onset = 15-30
– Men = usually younger than 25
– Women = 26-45
• 1 % worldwide
• EQUAL M/F
– Men  likelihood of onset decreases with age (possible after even
age 75)
– Women  lower likelihood until age 36, then higher
• Kids do show abnormal signs
– (more -, less +)
• 78% have several episodes, not just 1
• In US, Af-Am are diagnosed at a higher rate than whites.
WHY?
• Could be a bias in who is tested
Neurotransmitters 
dopamine
• Over-activity of DA (impaired attention)
• Over-sensitivity of DA receptors
• Drugs mimicking DA (amphetamines,
cocaine intensify symptoms b/c they too
increase DA levels)
• Anti-psychotic drugs reduce symptoms by
blocking receptors for DA
Brain issues
• Thalamus smaller than normal (could
explain hallucinations?)
• Low activity in frontal lobes (judgment,
planning of behavior)
– Major site of Dopamine activity
• Vesicles (fluid filled) larger (mostly only in
men) = shrinkage of brain tissue
Prenatal factors
• Pregnant women:
• Exposed to the influenza virus during
2nd trimester
• Poor nutrition
• Exposed to a variety of teratogens
• Born in winter = greater chance
Genetic factors
• 1% worldwide
• 8% with sibling
• 12% with 1 afflicted parent (30-40% when 2
parents have it)
• 18% with Fraternal Twin
• 50% with afflicted identical twin
• Smooth-pursuit eye movement – watching a
pendulum swing isn’t as smooth for schizos
• Most resistent to treatment of all psych disorders
(more resistant = more of a genetic factor)
Family factors
• Schizophrenogenic Parenting Style – mom
who is cold, dominant, rejecting nature
• Double bind = punish for following
directions OR confusing messages
– Mother responds coolly to a child’s embrace,
then says “Don’t you love me anymore?” when
the child withdraws…child is thinking what the
heck??
• Families with high criticism, hostility, over
emotional involvement
Potential causes
• Big thing to know…
• DIATHESIS-STRESS MODEL
• 1) Genetic predisposition inherited (multiple genes)
– Tendency to exhibit certain traits / behaviors / neurological
makeup, etc.
• ***Prenatal issues*** likely have some effect in here
• 2) Stress (really like a trigger)
– People in war combat display temporary symptoms resembling
schizophrenia
– Family factors
• Schizophrenogenic mother
• Double bind
Brain 27: Etiology
•
•
•
•
Sub-types of schizo
Paranoid
Disorganized
Catatonic
Undifferentiated
• See handout  “Types of
Schizophrenia”
Paranoid
• Delusions of persecution or grandeur.
The individual may trust no one and
may be anxious or angry about
supposed tormenters
• Delusions, hallucinations stand out
• Cognitive skills, affect in tact
Disorganized
• disorganized behavior, disorganized speech, and
flat affect. Involving a disturbance in behavior,
communication, and thought. There is a lacking of
any consistent theme.
• Disruption of speech & behavior, inappropriate
affect
• Self-absorbed
• Delusions
• More likely to be chronic
Catatonic
• Odd mannerisms with bodies, faces
• Echolalia – mimic words of others
• Echopraxia – mimic movement of
others
• Undifferentiated = everything
else
Residual
• Have had 1 episode but now no longer
have any major symptoms
Journal: Day 63
• If you had to pick just 1, which of the
personality disorders best describes
you? Give several general & specific
reasons why you chose this answer.
• DO NOT REVEAL TO ANYONE!
Personality Disorders
• 20% of pop has at least 1
• 50% of those treated for a psychiatric disorder
also have a personality disorder
• 10 PDs…2 ways to learn them…choose what
works best for you
• DAN HAS BOPS
• Or…
• The 3 Cluster Format
NEW STUFF...Look at to Update these!
Clusters
• Cluster A = odd, eccentric
– paranoid, schizoid, schizotypal
• Cluster B = dramatic, emotional, erratic
– antisocial, borderline, histrionic, narcissistic
• Cluster C = anxious, fearful
– avoidant, dependent, OCPD
Cluster A = odd, eccentric
paranoid, schizoid, schizotypal
Paranoid
• Suspicious, mistrustful, interprets others
motives as malevolent, don’t pay attention to
facts that contradict thoughts
• Argumentative, complains, hostile
• Refusal to go with the group in debates, doesn’t
like authority figures, fears passive surrender
• Cause: compensating for feelings of weakness
– Think self is weak, so sees threats everywhere
– (2:1 M:F)
• Jake: Abnormal 411
Cluster A = odd, eccentric
•
•
•
•
Schizoid
loner-type, lacks feelings for others, indifferent to others, detached
Dopamine (too much) issues
3.5:1 M:F
Mr. Z: 413
Schizotypal
• socially isolated, behaves in unusual ways,
suspicious, odd beliefs, detached, eccentric
(half-crazy), magical thinking (but not illogical)
• Ideas of reference = insignificant events relate
directly to them
• Dresses strangely/unusually
• A Phenotype of the schizophrenic Genotype
• About even M/F
• Mr. S: 415
paranoid, schizoid, schizotypal
•Cluster B = dramatic, emotional, erratic
Antisocial
• THE MOST COMMON (4:1 M:F; 3%, 1%)
• Sociopath, violates rights of others without
remorse, immoralistic, just don’t care about
hurting others
• frequently breaks the law
Mind 35: Mind of
• irritable, aggressive, manipulative the Psychopath
• charming con-artist
Ryan: 417
• little desire for the truth
• If <18, called “Conduct Disorder”
• Cause:
– low cortical arousal or insufficient development
– cortex is childlike, impulsive
– Higher threshold for experiencing fear
–antisocial, borderline, histrionic, narcissistic
•Cluster B = dramatic, emotional, erratic
•
•
•
•
•
•
•
•
Borderline
Instability in interpersonal relationships, mood,
& self-image
“Girl Interrupted”
Theory = abandonment depression (live in fear
of being abandoned), so they distract themselves
with alternative destructing actions
25% have major depression; 10% have bipolar
disorder (cause = link to mood disorders)
Uses splitting  see others as either awesome or
horrible (idealization vs. devaluation)
2% of pop; (2:1 F:M)
10% of people with this commit suicide by age 30
Claire: 426
–antisocial, borderline, histrionic, narcissistic
•Cluster B = dramatic, emotional, erratic
Histrionic
• Overly dramatic (almost acting) Excessive emotionality, need for attention
• shallow, vain, self-centered, uncomfortable if not in the limelight,
seductive in appearance/behavior
• seeks reassurance/approval constantly
• Angry when others don’t attend to them or praise them
• Impulsive, great difficulty delaying gratification
• Tend to say everything they think
• Focused on repression – while seductive, represses sex/aggression
(disgusted if blatant sex appears in a movie)
• 5:1 F/M
• Pat: 429
–antisocial, borderline, histrionic, narcissistic
•Cluster B = dramatic, emotional, erratic
Narcissistic
• Exaggerated self-regard, self-importance,
needs constant admiration
• Lack sensitivity/compassion for
others
• Grandiosity
• Actually has low self-esteem, insecure,
inferiority complex underlies all
thoughts
• Can be good empathizers (reciprocity
desires)
• 2:1 M:F
–antisocial, borderline, histrionic, narcissistic
•Cluster C = anxious, fearful
Avoidant
Sensitive to rejection, so avoid relationships
•
• Equal M/F
• Jane: 432
Dependent
• Excessive need to be taken care of,
• Unable to make choices and decisions
independently
• Overly cooperative, submissive
• Yield and placate, not assertive, clingy
• Fear of abandonment
• 2.5:1 F:M
• Karen: 434
avoidant, dependent, OCPD
•Cluster C = anxious, fearful
Obsessive-Compulsive
•
•
•
•
Opposite of histrionic
highly focused thinking
attention to details
Cause: fears a lack of control b/c
something bad could happen
• Inflexible
• About even M/F
• Daniel: 435
avoidant, dependent, OCPD
Reactive Attachment
Disorder
• http://www.youtube.com/watch?v=Dc
AuYRp2dJs