PSYCHOLOGICAL DISORDERS AND TREATMENTS
8-10% and 7-9% (A combined 15-19% of the exam)
QUESTIONS TO CONSIDER
How should we define psychological disorders?
How should we understand disorders?
 Do underlying biological factors contribute to
disorders?
 How do troubling environments influence our wellbeing?
 How do nature and nurture interact?
How should we classify psychological
disorders? And can we do so in a way that
allows us to help people without stigmatizing
them with labels?
DEFINING PSYCHOLOGICAL DISORDERS
According to the American Psychiatric Association….
Psychological Disorder- a syndrome
marked by a clinically significant
disturbance in an individual’s cognition,
emotion regulation, or behavior
Disturbed behaviors are maladaptive—
they interfere with everyday life
RISK FACTORS- NATURE OR NURTURE
THE DIATHESIS STRESS MODEL
NO STRESS
NO GENETIC
PREDISPOSITION
GENETIC PREDISPOSITION
STRESS
PREVALENCE OF PSYCHOLOGICAL
DISORDERS
26% of American Adults
 Immigrants experience better mental health than their native US
counterparts
75% Experience Symptoms before Age 24
Poverty plays a large role in psychological disorders,
why?
THE MEDICAL MODEL
Psychological disorders are diseases that have
physical causes that can be diagnoses, treated,
and in most cases, cured, often through
hospitalization
Does not account for environmental factors
THE BIOPHYCHOSOCIAL APPROACH
Includes the influences of both nature and
nurture
Bio- psycho- social
Biological Influences
Evolution
Genetics
Brain structure and chemistry
Psychological
Disorder
Psychological Influences
Stress
Trauma
Learned helplessness
Mood-related perception
and memory
Social-Cultural Influences
Roles
Expectations
Definitions of normality and
disorder
CLASSIFYING PSYCHOLOGICAL
DISORDERS
American Psychiatric Association’s Diagnostic and
Statistical Manual for Mental Disorders (5th
Edition)
DSM-V
Guides medical diagnoses and defines who is
eligible for treatments, including medication
CLEARING UP SOME TERMINOLOGY
Psychologist vs. Psychiatrist
People with psychological disorders vs. insanity
PERSON FIRST LANGUAGE
PSYCHOLOGICAL DISORDERS PROJECT
THE PROS AND CONS OF DIAGNOSTIC
LABELS
The Rosenhan Study
Pros
Cons
PSYCHOLOGICAL DISORDERS AND
TREATMENTS
Organization:
 Name and classification (when applicable) of the
disorder (How is it classified in the DSM-V?)
 Diagnostic criteria (How is it diagnosed? What are the
common symptoms?
 Understanding the disorder (how do the different
perspectives contribute to the understanding of the
disorder and how it is formed?)
Anxiety Disorders
ANXIETY DISORDERS- CLASSIFICATION
Generalized
Anxiety Disorder
Panic Disorders
Specific Phobias
Social Anxiety
Disorder
Agoraphobia
ANXIETY DISORDERS- DIAGNOSTIC
CRITERIA
Distressing, persistent anxiety or
maladaptive behaviors that reduce quality
of life
Duration of 6 months or more
GENERALIZED ANXIETY DISORDERDIAGNOSTIC CRITERIA
Continually tense, apprehensive, and in a state of
autonomic nervous system arousal
Worry continuously, jittery, agitated, and sleepdeprived
May cause a depressed mood and lead to
physical problems such as high blood pressure
Debilitating- interferes with normal functioning
PANIC DISORDERS- DIAGNOSTIC
CRITERIA
Marked by unpredictable, minutes-long episodes
of intense dread in which a person experiences
terror, accompanying chest pain, choking , or
other frightening sensations
SPECIFIC PHOBIA- DIAGNOSTIC CRITERIA
Irrational fears cause the person to avoid
some object
Individual become incapacitated by their
efforts to avoid the fearful situation
SOCIAL ANXIETY DISORDER- DIAGNOSTIC
CRITERIA
Intense fear of being scrutinized by others,
avoiding potentially embarrassing social
situations, such as speaking up, eating out, or
going to parties
Fear of performance situations is a specialized
subset
AGORAPHOBIA- DIAGNOSTIC CRITERIA
Fear or avoidance of situations, such as
crowds or wide open places, where one has
felt loss of control or panic
OBSESSIVE COMPULSIVE DISORDERDIAGNOSTIC CRITERIA
Characterized by unwanted repetitive thoughts
(obsessions) and or actions (compulsions)
Persistently interfere with everyday living and
causes distress
Onset occurs in the late teens or 20s; effects 2-3
percent of the population
OCD IN MRS. LALLEMAND’S FAVORITE MOVIE 
CRASH COURSE- ANXIETY AND OCD
POSTTRAUMATIC STRESS DISORDERDIAGNOSTIC CRITERIA
Classified under Trauma and Stress Related Disorders
4 Diagnostic Criteria
 Re-experience (through dreams or thoughts)
 Avoidance (of situations or people)
 Persistent Negative Alterations in Cognition and
Mood (numbing of mood, persistent negative
emotional state)
 Alteration in Arousal and Reactivity (includes
irritability, aggressive behavior, reckless or selfdestructive behavior)
ANALYSIS OF ANXIETY DISORDERS, OCD, AND PTSD
HOW DO THEY FORM?
From the behavioral perspective
 Classical conditioning
 Operant conditioning
 Observational learning
Biological perspective
 Natural selection
 Genes
 The brain
Mood Disorders
(Not a DSM-V Term)
MOOD DISORDERS-CLASSIFICATION
Major Depressive
Disorder
Bipolar Disorder
MAJOR DEPRESSIVE DISORDERDIAGNOSIS
The presence of at least five of the following
symptoms over a two week period of time
 Depressed mood most of the day
 Markedly diminished interest or pleasure in activity most of
the day
 Significant weight loss or gain when not dieting, or significant
decrease or increase in appetite
 Insomnia or sleeping too much
MAJOR DEPRESSIVE DISORDERDIAGNOSIS
The presence of at least five of the following
symptoms over a two week period of time
 Physical agitation or lethargy
 Fatigue or loss of energy
 Feeling worthless, or excessive or inappropriate guilt
 Problems in thinking, concentrating, or making decisions
 Recurrent thoughts of death or suicide
BIPOLAR DISORDER- DIAGNOSTIC
CRITERIA
Mania- a mood disorder marked by hyperactive, widely optimistic
state
Individuals with bipolar disorder alternate between depression and
mania (from week to week, not day to day)
UNDERSTANDING MOOD DISORDERS
Some facts about depression….
 Many behavioral and cognitive changes accompany
depression
 Depression is widespread
 Women’s risk of major depression is double that of men’s
 Most major depressive episodes self-terminate
UNDERSTANDING MOOD DISORDERS
Some facts about depression…
 Stressful events related to work, marriage, or
relationships often precede depression
 With each new generation, depression is striking earlier,
affection more people, with the highest rates in
developed countries
 Depression has 37% heritability, bipolar disorder 80%
UNDERSTANDING MOOD DISORDERS
THE BIOLOGICAL PERSPECTIVE
Mood disorders run in families
 Heritability of depression is 37%
 Heritability of bipolar disorder is 80%
THE BIOLOGICAL PERSPECTIVE
The Depressed Brain
Lower levels of serotonin and
dopamine
PET SCAN OF DEPRESSED VS. BIPOLAR
BRAIN
Review: How does a PET scan work? What can it show us?
PET scans show that energy consumption in the brain goes up during manic
episodes of bipolar disorder
THE SOCIAL-COGNITIVE PERSPECTIVE
Learned helplessness- when faced with adverse events, an individual
(animal or human) may begin to believe that they have no control over
situations and begin to feel hopeless
Rumination- staying focused on a problem
 Adaptive when trying to solve an external problem or
overcome a challenge
 Problematic when self-focused
THE SOCIAL-COGNITIVE PERSPECTIVE
Depression prone people tend to respond to bad events in an
especially self-focused, self-blaming way
Think about it from a mindset perspective…
CRASH COURSE- DEPRESSION AND
BIPOLAR DISORDER
SCHIZOPHRENIA-CLASSIFICATION
Means “split mind”
 NOT THE SAME AS MULTIPLE PERSONALITY DISORDER
OR SPLIT BRAIN RESEARCH!!
 Split, as in split from reality
Classified under Schizophrenia Spectrum and Other Psychotic
Disorders
Psychosis- a psychological disorder in which a person loses contact
with reality, experiencing irrational ideas and distorted perceptions
SCHIZOPHRENIA- DIAGNOSIS AND
SYMPTOMS
Individual exhibits two of the following symptoms
 Delusions
 Hallucinations
 Disorganized speech and behavior
 Other symptoms that cause social and occupational
dysfunction (often diminished or inappropriate emotion)
Symptoms present for 6 months with at least 1
month of active symptoms
DELUSIONS VS. HALLUCINATIONS
Delusions- false thoughts
Often about grandeur or persecution
Can manifest as paranoia- fear based delusions
Hallucinations- false sensory experiences
Seeing, hearing, smelling, or tasting something
that is not actually there
Auditory hallucinations are common, hearing
voices, often persecuting or ordering
ANDERSON COOPER SCHIZOPHRENIA SIMULATION
INAPPROPRIATE EMOTIONS AND
DISORGANIZED BEHAVIORS
Emotions
 Expressed emotions are utterly inappropriate
 Anger for no reason, laughing when others are crying
 May exhibit flat affect- expressing no emotions at all
 Most have difficulty perceiving facial emotions and
exhibiting empathy
Behaviors
 Senseless, compulsive acts such as continually rocking or
rubbing arms
 Catatonic (motionless for hours), followed by becoming
agitated
ONSET AND DEVELOPMENT
Strikes as young people are maturing into adulthood
Affects 1 in 100 people
All cultures are susceptible
Effects both men and women, thought men seem to get
it earlier and it strikes more severely
ONSET AND DEVELOPMENT
Can appear suddenly in reaction to stress (easier to treat)
Can develop gradually- typically individuals with a history of social
inadequacy and poor school performance (harder to treat)
Positive Symptoms- hallucinations, disorganized talking, inappropriate
emotions
Negative Symptoms- toneless voice, expressionless faces, mute rigid
bodies
UNDERSTANDING SCHIZOPHRENIABIOLOGICAL PERSPECTIVE
NEUROTRANSMITTERS
Dopamine over activity
Brains of deceased
schizophrenics show a six
fold increase in
dopamine receptors
Intensified hallucinations
and paranoia
ABNORMAL BRAIN ANATOMY AND
ACTIVITY
Review…what are the functions of the following brain structures?
Thalamus-
AmygdalaCorpus callosumCerebrum/ cortex/ cerebral cortexFrontal Lobe (a portion of the cortex)-
ABNORMAL BRAIN ANATOMY AND
ACTIVITY
Review…what are the functions of the following brain structures?
Thalamus- filters incoming sensory information and relays it to the proper area of
the cortex for processing and storage
Amygdala- fear processing center
Corpus callosum- connection between the two hemispheres of the brain
Cerebrum/ cortex/ cerebral cortex- where sensory information is processed,
memories are stored, and higher order thinking occurs
Frontal Lobe (a portion of the cortex)- reasoning, planning, and problem solving
ABNORMAL BRAIN ANATOMY AND
ACTIVITY
Considering the function of each part of the brain and the symptoms of
schizophrenia, try to predict how the brains of schizophrenic patients may differ
from a nonschizophrenic individual.
ABNORMAL BRAIN ANATOMY AND
ACTIVITY
Thalamus- PET scans show increased activity during hallucinations
Amygdala- PET scans show increased activity during paranoid
episodes
Increased fluid and smaller brain regions (cortex, thalamus, and
corpus callosum) slows neural firing and interrupts coordination of
neural signaling
Frontal Lobe (a portion of the cortex)- a noticeable decline in the
brain waves
GENETIC FACTORS
Twin studies show an increased risk 60-70% of identical twins both
being diagnosed with schizophrenia vs. 10-30% for fraternal twins
NATURE VIA NURTURE
Low birth weights, maternal diabetes, older paternal age, and oxygen
deprivation during delivery
Brain fully develops during midpregancy (2nd trimester)
Viral infections during pregnancy
 Increased risk if the country experiences a flue epidemic
 Increased risk if you are born in more densely populated
area
 Increased risk if you were born in the spring or summer
 Increased risk if your mother was sick while pregnant
NURTURE- RISK FACTORS
A mother whose schizophrenia was severe or long-lasting
Birth complication, often involving oxygen deprivation and low birth weight
Short attention span and poor muscle coordination
Disruptive or withdrawn behavior
Emotional unpredictability
Poor peer relations and solo play
OTHER DISORDERS
Other Disorders
Somatic Symptom and
Related Disorders
Dissociative Disorders
Somatic Symptom
Disorder
Illness Anxiety
Disorder
Dissociative Identity
Disorder
Anorexia nervosa
Eating Disorders
Bulimia nervosa
Binge Eating Disorder
Personality Disorders
Antisocial Personality
Disorder
SOMATIC SYMPTOM DISORDER
Psychological disorder in which the symptoms take a somatic (bodily) form
without apparent physical cause
Vomiting, dizziness, blurred vision, difficulty in swallowing, prolonged pain
Can be strongly influenced by culture
Diagnostic Criteria:
 Persistently symptomatic (at least 6 months)
 Significantly distressing or disruptive to daily life and must be
accompanied by excessive thoughts, feelings, or behaviors
ILLNESS ANXIETY DISORDER
Formerly known as hypochondria
Disorder in which the individual interprets normal physical sensations
as symptoms of a serious disease
Diagnostic Criteria: heightened bodily sensations, are intensely
anxious about the possibility of an undiagnosed illness, or devote
excessive time and energy to health concerns, often obsessively
researching them
DISSOCIATIVE IDENTITY DISORDER
A rare disorder in which a person has two or more distinct and
alternating personalities
Diagnostic Criteria
 Two or more distinct personality states must be present,
each with their own way of being
 Recurrent gaps in the recall of everyday events,
important personal information, and/or traumatic events
that are inconsistent with ordinary forgetting
 No substance abuse problems
DISSOCIATIVE DISORDER CONTROVERSYIS IT A REAL DISORDER?
Disorder is localized in time and
space
We are all capable of
presenting a different version of
ourselves
Hillside strangler case
Individuals diagnosed show
heightened brain activity in brain
areas associated with the control
and inhibition of traumatic
memories
Psychodynamic theory and
learning theory support a
possible mechanism
CRASH COURSE!
EATING DISORDERS
You have notes about this! Look in the motivation and emotion unit!
ANOREXIA NERVOSA- DIAGNOSIS
1. Significantly low body weight for their developmental stage
(85% of what is considered normal in previous additions) and
restrictive calorie intake.
2. An overtly expressed fear of weight gain AND persistent
behavior that interferes with weight gain.
3. Distorted body image.
ANOREXIA NERVOSA
Associated problems
Growth of fine hair on the
body
White
Thinning of bones and hair
Female
Severe constipation
Middle or higher income
family
Low blood pressure
Damage to heart and thyroid
Risk indicators
Perfectionist
Traumatic event
BULIMIA NERVOSA- DIAGNOSIS
1. Bing eating and inappropriate purging (via induced
vomiting or laxative use) behavior once weekly
BULIMIA NERVOSA
Associated problems
Chronic soar throat
Kidney problems
Dehydration
Gastrointestinal disorders
Dental problems
Risk indicators
Highly perfectionistic
Secretive
Low self-efficacy
Impulsiveness
Depression
Sexual and physical abuse in
childhood
CAUSES AND TREATMENTS
Causes
Susceptibility to social pressure
treatments
Psychotherapy
Genetic influence on psychological
Hospitalization
characteristics (perfectionism,
impulsivity, serotonin regulation)
A combination of both
Changes in the brain due to the
disorder
BINGE-EATING DISORDER- DIAGNOSIS
1. Bing eating once weekly over the last 3 months
Characteristics
Most are overweight
Eat quickly, a great deal when not hungry, or until they
are uncomfortably full
Experience disgust or shame after binging
Often eat alone
BINGE-EATING DISORDER
Associated problems
Diabetes
Risk indicators
Overweight already
Hypertension
Cardiovascular disease
Likely to place emphasis on
physical appearance, weight,
and body shape
Emotional eaters
CAUSES AND TREATMENTS
Causes
Emotional eating/stressful events
treatments
Psychotherapy
Areas of the brain and endocrine
system that respond to stress are
overactive- more likely to see
events as stressful
Weight loss
Changing relationship with food
PERSONALITY DISORDERS
A collection of psychological disorders characterized by inflexible
and enduring behavior patterns that impair social functioning
Divided into three “clusters” with key characteristics
PERSONALITY DISORDERS
Cluster A- Eccentric or odd behaviors
 Paranoid
 Schizoid
 Schizotypal
Cluster B- dramatic or impulsive behaviors




Antisocial
Borderline (I love you, I hate you, Please don’t leave me)
Histrionic (attention seeking)
Narcissistic (intense love of self)
Cluster C- Fearful sensitivity to rejection
 Avoidant
 Dependent
 Obsessive-compulsive
ANTISOCIAL PERSONALITY DISORDERDIAGNOSIS
Significant impairments in personality functioning manifest by impairments in
self-functioning and interpersonal functioning.
Self-Functioning:
 Identity: Ego-centrism; self-esteem derived from personal gain, power,
or pleasure.
 Self-direction: Goal-setting based on personal gratification; absence
of prosocial internal standards associated with failure to conform to
lawful or culturally normative ethical behavior.
Impairments in interpersonal functioning:
 Empathy: Lack of concern for feelings, needs, or suffering of others;
lack of remorse after hurting or mistreating another.
 Intimacy: Incapacity for mutually intimate relationships, as exploitation
is a primary means of relating to others, including by deceit and
coercion; use of dominance or intimidation to control others.
ANTISOCIAL PERSONALITY DISORDER
The most troubling and heavily research of the personality disorders
Sociopath/psychopath
Male that shows symptoms before age 15
Criminality is not an essential component, but about 50% participate
in criminal behavior
Behave impulsively and then feel and fear little
UNDERSTANDING ANTISOCIAL
PERSONALITY DISORDER
Specific genes associated with antisocial personality disorder have
been identified
Individuals with the disorder show little fear and little autonomic
nervous system arousal, low levels of stress hormones
If channeled it may lead to adventurousness, heroism, and athleticism
The genes that put individuals at risk for antisocial personality
disorder also put them at risk for substance abuse problems
UNDERSTANDING ANTISOCIAL
PERSONALITY DISORDER
Decreased brain activity in the frontal lobe and the area of the cortex
that helps control impulses
Deficits in frontal lobe functions such as planning, organization, and
inhibition
Respond poorly to the facial displays of those in distress
Inability to feel empathy
CRASH COURSE!
TREATMENTS
PSYCHOTHERAPY MYTH
PSYCHOTHERAPY REALITY
BEHAVIOR THERAPIES
Applies learning principles to the elimination of
unwanted behaviors
View maladaptive behaviors as behaviors that
can be replaced by constructive behaviors
CLASSICAL CONDITIONING REVIEW
CLASSICAL CONDITIONING TECHNIQUES
Work on the principle of counterconditioning- using classical
conditioning to evoke a new response to stimuli that are triggering
unwanted behaviors
Two substitute a positive response for a negative response in a
harmless situation
 Exposure therapies
 Systematic Desensitization
The third substitutes a negative response for a positive response in a
harmful situation
 Aversive Conditioning
EXPOSURE THERAPIES
Expose people to what they normally avoid or escape (behaviors that
are reinforced by reduced anxiety)
“Face your fears”
Allows people to habituate to the fear
HABITUATION
EXPOSURE THERAPY
SYSTEMATIC DESENSITIZATION
if you can repeatedly relax when facing anxiety-providing stimuli,
you can gradually eliminate your anxiety
Must proceed gradually
Involves progressive relaxation
AVERSIVE CONDITIONING
Unwanted behavior is associated with an
unpleasant feeling
 Bitter nail polish for nail biting
 Bitter apple spray for dogs that chew
 Alcohol mixed with drugs that cause vomiting
Not as effective
 Individual outside of treatment has free will
 Once the pairing is terminated there may be
extinction
OPERANT CONDITIONING
Also known as behavioral modification
Reinforcement of desired behaviors while withholding reinforcement
for undesired behaviors
In an institutional setting may take the form of a token economypatients receive tokens for positive behaviors that can be exchanged
for prizes of their choosing
 Will it last?
 Is it ethical?
COGNITIVE THERAPIES
Therapy that teaches people new, more adaptive ways of thinking,
based on the assumption that thoughts intervene between events and
our emotional reactions
Rational-Emotive Behavior Therapy (REBT)
Arron Beck’s Therapy for Depression
Cognitive Behavioral Therapy (CBT)
RATIONAL-EMOTIVE BEHAVIOR THERAPY
Confrontational therapy that vigorously challenges peoples illogical,
self-defeating attitudes and assumptions
Albert Ellis
ALBERT ELLIS AND GLORIA
CARL ROGERS AND GLORIA
AARON BECK’S TREATMENT FOR
DEPRESSION
Cognitive therapist that believes in changing peoples thinking but
emphasis a gentler approach
A good example of the steps taken during cognitive therapy
Aim of Technique
Technique
Reveal Beliefs
Question your interpretations
Rank thoughts and emotions
Test Beliefs
Examine consequences
Decatastrophize thinking
Change Beliefs
Take appropriate responsibility
Resist Extremes
COGNITIVE-BEHAVIORAL THERAPY (CBT)
Popular integrative therapy that combines cognitive therapy with
behavior therapy
Changes both thinking and behavior
Become aware of your negative thinking, replace it with positive
thinking, and practice that more positive approach everyday
Works for anxiety disorders, mood disorders, and may also be helpful
with OCD
BIOMEDICAL THERAPIES
Psychically changing the brain’s functioning by altering its chemistry
with drugs or affecting its circuitry with electroconvulsive shock,
magnetic impulses, or psychosurgery
DRUG THERAPIES
Antagonist
 compete for the receptor sites of neurotransmitters
 used when the neurotransmitter is found in excess
Agonist
 Increase the availability of specific neurotransmitters
 Used when the neurotransmitter is lacking
DRUG THERAPIES
ANTIPSYCHOTIC DRUGS
Drugs used to treat schizophrenia and other severe thought disorders
Dopamine antagonist- they block dopamine receptor sites
Examples:
 Chlorpromazine“Chlor-pro-ma-zine”
 Risperdal and Zyprexa
Side Effects; sluggishness, tremors, twitches similar to those of
Parkinson’s
ANTIANXIETY
DRUGS
Depress the central nervous system to control anxiety and agitation
Examples:
 Xanax
 Ativan
Side Effects: learned response and dependency
DRUG THERAPIES
ANTIDEPRESSANTS
Also known as SSRIs- selective serotonin reuptake inhibitors
Agonists- work by increasing the availability by blocking its reuptake
Also successful in treating anxiety disorders, obsessive-compulsive
disorder, and PTSD
Examples:
 Fluoxitine (Prozac)
 Zoloft
 Paxil
NEURON
SSRI MECHANISM
NATURAL ANTIDEPRESSANTS
Aerobic Exercise
Cognitive Therapy
RECENT RESEARCH
Drugs (bottom-up) + Cognitive-behavioral therapy (top-down)
MOOD STABILIZING MEDICATION
Lithium and Depakote (usually used for epilepsy) are effective in
treating the manic episodes associated with bipolar disorder
BRAIN STIMULATION
Electroconvulsive Therapy (ECT) – used for severely depressed
patients by sending a brief electric current through the brain of an
anesthetized patient
Repetitive Transcranial Magnetic Stimulation (rTMS)- repeated pulses
of magnetic energy to the brain of awake patients
PSYCHOSURGERY
Lobotomy- separating the frontal lobes from the emotion controlling
centers of the brain
 Calmed uncontrollably emotional and violent patients
 Produced permanently lethargic, immature, and
unreactive individuals
 No longer practiced
THERAPEUTIC LIFESTYLE CHANGE
Aerobic exercise (30 min per day, 3 times per week)
Adequate Sleep (7-8 hours per night)
Light Exposure (30 minutes per day)- amplifies arousal and regulates
hormone levels)
Social Connection (allows for human need to belong)
Antirumination (identify and redirect negative thoughts)
Healthy Diet (supports healthy brain and body function)