PSYCHOLOGICAL DISORDERS
Psychological Disorders
• “To study the abnormal is
the best way of
understanding the normal.”
– William James (1842-1910)
• World Health Organization
(2008) estimates 450 million
people worldwide suffer
from mental or behavioral
disorders
Psychological Disorders
• No known society is free of
two terrible maladies:
– Depression
– Schizophrenia
• Psychological Disorder –
deviant, distressful, and
dysfunctional behavior
patterns
– Deviant = different from
others
PSYCHOLOGICAL DISORDERS
Defining Psychological Disorders
Defining Psychological Disorders
• Standards for deviant
behavior vary by context
and culture
• After 1973, the APA no
longer viewed
homosexuality as an illness
• However…
– Mass killing of people
– Talking with the dead
• From 1952 to 1973,
homosexuality was
classified as an illness by
the American Psychiatric
Association
– The stigma and stresses
associated with being
homosexual increase the risk
of mental health problems
(Meyer, 2003)
PSYCHOLOGICAL DISORDERS
Defining Psychological Disorders
Defining Psychological Disorders
• Attention-deficit
hyperactivity disorder
(ADHD) – a psychological
disorder marked by the
appearance by age 7 of one
or more of three key
symptoms:
• To be considered
disordered:
– Extreme inattention
– Hyperactivity
– Impulsivity
– Deviant behavior usually
causes the person distress
– When behaviors are judged as
“harmful dysfunction”
• Interferes with work or
leisure
– When behaviors become
disabling
• Dysfunction is the key
descriptor for a disorder
PSYCHOLOGICAL DISORDERS
Understanding Psychological
Disorders
Understanding Psychological
Disorders
• Yesterday’s Therapy:
• Medical model – the
concept that diseases, in
this case psychological
disorders, have physical
causes that can be
diagnosed, treated, and, in
most cases, cured, often
through treatment in a
hospital
– “devil made him do it”
– Beatings, burning, castration
– Trephination (drilling holes in
skull to release evil)
– Pulling teeth
– Removing lengths of
intestines
– Etc.
PSYCHOLOGICAL DISORDERS
Understanding Psychological
Disorders
Understanding Psychological
Disorders
• Philippe Pinel (1745-1826) –
reformer who insisted that
madness is NOT demon
possession, but a sickness
of the mind caused by
severe stresses and
inhumane conditions
• Support for medical model:
– Supported “moral treatment”
such as gentleness, activity,
clean air and sunshine, and
boosting morale
– Genetically influenced
abnormalities in brain
structure and biochemistry
contribute to many disorders
• Eating disorders are
primarily phenomena of
Western cultures
• Depression and
Schizophrenia occur
worldwide
PSYCHOLOGICAL DISORDERS
Classifying Psychological
Disorders
Classifying Psychological
Disorders
• Schizophrenia
characteristics
• DSM-IV-TR – the American
Psychiatric Association’s
Diagnostic and Statistical
Manual of Mental
Disorders, Fourth Edition,
with an updated “text
revision”; a widely used
system for classifying
psychological disorders
– Talks incoherently
– Hallucinates or has delusions
(bizarre beliefs)
– Shows little emotion or
inappropriate emotion
– Socially withdrawn
PSYCHOLOGICAL DISORDERS
Classifying Psychological
Disorders
• ICD-10 – International
Classification of Diseases
– Covers both mental and
psychological disorders
• Using the DSM-IV-TR
– Clinicians answer a series of
objective questions about
observable behaviors
– This process makes diagnosis
very reliable and replicable
Labeling Psychological Disorders
• How are psychological
disorders diagnosed?
• Critics claim that as the
number of disorder
categories has grown, so
too has the number of
adults who meet that
criteria – more and more
disordered people
PSYCHOLOGICAL DISORDERS
Labeling Psychological Disorders
• Critics more fundamental
claim is that labels are
arbitrary and are value
judgments pretending to be
science
• Rosenhan study (1977)
– 8 healthy people intentionally
claimed of “hearing voices”
– They proceeded to answer all
questions truthfully
– All 8 normal people were
misdiagnosed with disorders
Labeling Psychological Disorders
• Labels matter
– When we attach a label to a
person, we perceive them as
being different
– Labels such as gifted, hostile,
and extraverted encourage us
to look for those traits
• Mental disorders seldom
lead to violence
– Media portrays disorders to
the extremes
PSYCHOLOGICAL DISORDERS
Labeling Psychological Disorders
• Benefits of labels include:
– Communication about cases
– Comprehension of underlying
causes
– Discernment of effective
treatment
• John Hinckley, Jeffrey Dahmer,
Kip Kinkel, and Andrea Yates
– Each either killed or attempted
to kill others, and were
imprisoned rather than
hospitalized
Labeling Psychological Disorders
• When should we – and
should we not – hold
people accountable for their
actions?
• Insanity Defense in today’s
U.S. Court System
PSYCHOLOGICAL DISORDERS
Anxiety Disorders
• Anxiety Disorders –
psychological disorders
characterized by distressing,
persistent anxiety or
maladaptive behaviors that
reduce anxiety
Anxiety Disorders
• Generalized Anxiety
Disorder
• Panic Disorder
• Phobias
• Obsessive-Compulsive
Disorder
• Post-Traumatic Stress
Disorder
PSYCHOLOGICAL DISORDERS
Anxiety Disorders
• Generalized Anxiety Disorder –
an anxiety disorder in which a
person is continually tense,
apprehensive, and in a state of
autonomic nervous system
arousal
– 2/3 of cases are women
– Person cannot identify cause
– May lead to ulcers and high
blood pressure
– Rare for those age 50+
Anxiety Disorders
• Panic Disorder – an anxiety
disorder marked by
unpredictable minutes-long
episodes of intense dread in
which a person terror and
accompanying chest pain,
choking, or other
frightening sensations
– 1 in 75 with disorder
experience panic attacks
– Smokers have double the risk
due to stimulant nicotine
PSYCHOLOGICAL DISORDERS
Anxiety Disorders
• Phobia – an anxiety disorder
marked by a persistent,
irrational fear and
avoidance of a specific
object or situation
– A strong fear becomes a
phobia if it provokes a
compelling but irrational
desire to avoid the dreaded
object or situation
Anxiety Disorders
– Social phobia is shyness taken
to the extreme
– Agoraphobia is fear or
avoidance of situations in
which escape might be
difficult or help unavailable
when panic strikes
– Those who experience panic
attacks learn to fear “fear
itself”
PSYCHOLOGICAL DISORDERS
Anxiety Disorders
• Obsessive-Compulsive
Disorder – an anxiety
disorder characterized by
unwanted repetitive
thoughts (obsessions)
and/or actions
(compulsions)
– Behaviors cross the line from
normal to OCD when they
persistently interfere with
everyday living and cause the
person distress
Anxiety Disorders
• OCD is more common
among teens and young
adults
– Obsessions and compulsions
tend to lessen as one gets
older
PSYCHOLOGICAL DISORDERS
Anxiety Disorders
• Common Obsessions
(repetitive thoughts)
– Concern with dirt, germs,
toxins
– Something terrible happening
(fire, death, illness)
– Symmetry, order, or exactness
Anxiety Disorders
• Common Compulsions
(repetitive behaviors)
– Excessive hand washing,
bathing, tooth brushing, or
grooming
– Repeating rituals (in/out of a
door, up/down from a chair)
– Checking doors, locks,
appliances, car brakes,
homework
PSYCHOLOGICAL DISORDERS
Anxiety Disorders
• Post-Traumatic Stress
Disorder (PTSD) – an anxiety
disorder characterized by
haunting memories,
nightmares, social
withdrawal, jumpy anxiety,
and/or insomnia that lingers
for four weeks or more after
a traumatic experience
– Once called “shell shock” or
“battle fatigue”
Anxiety Disorders
• Approximately 19% of
Vietnam War veterans
experienced PTSD
– About same % for Iraq War
veterans
• The greater one’s emotional
distress during trauma, the
higher the risk for PTSD
PSYCHOLOGICAL DISORDERS
Anxiety Disorders
• Sensitive limbic system
continues to flood body
with stress hormones over
and over again in PTSD
• Symptoms of PTSD may be
genetically predisposed
• “Debriefing” survivors
immediately after a trauma
in an attempt to get them to
relive it and vent tends to
be ineffective and harmful
Anxiety Disorders
• Twice as many women as
men develop PTSD
• Holocaust survivors
– “What doesn’t kill you may
make you stronger.”
– Altruism born of suffering
– Greater than usual sensitivity
to suffering and empathy for
others who suffer, an
increased sense of
responsibility, and an
enlarged capacity for caring
PSYCHOLOGICAL DISORDERS
Anxiety Disorders
Understanding Anxiety Disorders
• Post-Traumatic Growth –
positive psychological changes
as a result of struggling with
extremely challenging
circumstances and life crises
• 2 Perspectives:
– Idea that out of our worst
experiences some good can
come
– Cancer patient may develop
increased appreciation for life,
more meaningful relationships,
etc.
– Learning Perspective
– Biological Perspective
• Learning Perspective
– Link between conditioned
fear and general anxiety
keeps people hyperattentive
to possible threats
– Generalization – when a
person attacked by a dog
comes to fear all dogs
PSYCHOLOGICAL DISORDERS
Understanding Anxiety Disorders
Understanding Anxiety Disorders
• Learning (cont’d)
• Biological Perspective
– Reinforcement – helps
maintain our phobias and
compulsions after they arise
• Observational Learning
– We learn some fears by
observing others
• Parents transmit their fears
to their children
• Monkeys transmit fear of
snakes to other monkeys
– Natural Selection
• Biological preparedness to
fear threats faced by our
ancestors
• Easy to condition fear, but
difficult to extinguish
PSYCHOLOGICAL DISORDERS
Understanding Anxiety Disorders
– Genes
• Identical twins may develop
similar phobias even when
raised separately
• Genes influence disorders by
regulating neurotransmitters
– Serotonin – influences
sleep and mood
– Glutamate – too much of
this results in brain’s alarm
centers to become
overactive
Understanding Anxiety Disorders
– Brain
• Anterior Cingulate Cortex –
brain region that monitors our
actions and checks for errors
– Hyperactive region in
someone with OCD
• Fear circuits within the
amygdala may be a result of
fear-learning experiences
– A sharp increase in anxiety
levels of both children and
college students in last 50 years
may be more the result of
fraying social support
accompanying family break-up
PSYCHOLOGICAL DISORDERS
Somatoform Disorders
• Somatoform Disorders –
psychological disorder in
which the symptoms take a
somatic (bodily) form without
apparent physical cause
– Conversion Disorder – a rare
somatoform disorder in which
a person experiences very
specific genuine physical
symptoms for which no
physiological basis can be
found
Somatoform Disorders
– Hypochondriasis – a
somatoform disorder in which
a person interprets normal
physical sensations as
symptoms of a disease
• A stomach cramp or a
headache is interpreted as
some dreaded disease
• People suffering from this
tend to move from doctor to
doctor as there is nothing
serious wrong with them
PSYCHOLOGICAL DISORDERS
Dissociative Disorder
• Dissociative Disorders –
disorders in which conscious
awareness becomes separated
(dissociated) from previous
memories, thoughts, and
feelings
• Dissociative Identity Disorder –
a rare dissociative disorder in
which a person exhibits two or
more distinct and alternating
personalities. Formerly called
multiple personality disorder.
Dissociative Disorder
– Dissociation is not so rare;
sometimes we may say “I was
not myself at the time”
– Facing trauma, detachment
may protect us from
overwhelming emotions
– In D.I.D. the original
personality typically denies
any awareness of the others
PSYCHOLOGICAL DISORDERS
Understanding Dissociative
Identity Disorder
• In D.I.D.:
– Each person has own voice
and mannerisms
– Person is usually not violent
• Nicholas Spanos questions
existence of D.I.D.:
– From 1930-1960, # of
diagnoses was 2/decade
– In 1980s with new DSM
classification the # grew to
20,000+
Understanding Dissociative
Identity Disorder
– In other cultures D.I.D. is
explained as being
“possessed” by an alien spirit
– D.I.D. is rare in Britain, where
they call it a “wacky American
fad”
– In India & Japan it is virtually
nonexistent
PSYCHOLOGICAL DISORDERS
Understanding Dissociative
Identity Disorder
Understanding Dissociative
Identity Disorder
• There is evidence that
handedness sometimes switches
with personality in D.I.D. patient
• Two Possibilities:
• D.I.D. patients exhibit heightened
brain activity in areas associated
with control and inhibition of
traumatic memories
– D.I.D. is a result of desperate
efforts of the traumatized to
detach from a horrific
existence
– D.I.D. is contrived by fantasyprone, emotionally vulnerable
people, and constructed out
of therapist-patient
interaction
PSYCHOLOGICAL DISORDERS
Mood Disorders
• Mood Disorders –
psychological disorders
characterized by emotional
extremes
– Major Depressive Disorder
• Prolonged hopelessness and
lethargy
– Bipolar Disorder (formerly
manic depressive disorder)
• Person alternates between
depression and mania
Mood Disorders
• Major Depressive Disorder –
a mood disorder in which a
person experiences, in the
absence of drugs or a
medical condition, two or
more weeks of significantly
depressed moods, feelings
of worthlessness, and
diminished interest or
pleasure in most activities
PSYCHOLOGICAL DISORDERS
Mood Disorders
• Mania – a mood disorder
marked by a hyperactive,
wildly optimistic state
• Bipolar Disorder (formerly
Manic-Depressive Disorder)
– a mood disorder in which
the person alternates
between the hopelessness
and lethargy of depression
and the overexcited state of
mania
Mood Disorders
– Prolonged adolescent mood
swings produce a bipolar
diagnosis
– Mania may cause the person to
take more risks
– A racing mind arouses an
upbeat mood
– Those who rely on emotional
expression and vivid imagery
are more prone: composers,
artists, poets, novelists,
entertainers
– It afflicts men and women
equally
PSYCHOLOGICAL DISORDERS
Understanding Mood Disorders
Understanding Mood Disorders
• Many behavioral and cognitive
changes accompany depression
• Most major depressive episodes
self-terminate
– Inactive; feel unmotivated
– More sensitive to negative things,
recall negative info, expect negative
outcomes
• Depression is widespread
• Women are twice as likely as men
to suffer major depression
– Gap begins in adolescence
– Men’s disorders are more external;
women’s internal
– Women get more sad; men get more
mad
– Professional help is good, but
episodes will end on their own
– Half of those who recover will suffer
another episode within 2 years
• Stressful events related to work,
marriage, and close relationships
often precede depression
– Not usually caused by 1 event
PSYCHOLOGICAL DISORDERS
Understanding Mood Disorders
Biological Perspective
• Depression striking earlier and
affecting more people with each
new generation
• Risk of major depression and
bipolar disorder increases if you
have a parent or sibling with the
disorder
• One estimate is the heritability of
major depression is 35-40%
• Linkage Analysis – when
geneticists examine DNA from
affected and unaffected family
members, looking for differences
• Many genes probably work
together to cause depression
– Onset now is early as the late teens
– Most parents of don’t recognize
depression in their children
PSYCHOLOGICAL DISORDERS
Depressed Brain
Depressed Brain
• Neurotransmitters influence
depressed and manic states
• Norepinephrine
• Drugs that relieve depression
– Increases arousal & boosts mood
– Scarce during depression and
abundant during mania
– Drugs that alleviate mania reduce
norepinephrine
• Serotonin
– Scarce during depression
– Increases with physical exercise
– Stimulates hippocampus neuron
growth
– Increase Norepinephrine or
Serotonin by blocking reuptake
– Slows their chemical breakdown
• Left Frontal Lobe
– Active during positive emotions
– Inactive during depressed states
• Hippocampus
– Memory-processing center
• Vulnerable to stress-related damage
PSYCHOLOGICAL DISORDERS
Social-Cognitive Perspective
Social-Cognitive Perspective
• Self-defeating beliefs and
negative explanatory style feed
depression’s vicious cycle
• Learned helplessness may be
cause of self-defeating beliefs
• Explanatory Style – who or what a
person blames for their failures
– Comes after experiencing
uncontrollable painful events
• Women more often than men:
– Tend to overthink or ruminate
– Tend to feel “frequently
overwhelmed by all they do”
– Are twice as vulnerable to depression
during early teenage years
– Internal vs External
• Depressed people see negative
events as:
– Stable – going to last forever
– Global – going to affect everything
– Internal – it’s all my fault
• Depressed people:
– Often exhibit a pessimistic thinking
style
• Optimistic people tend to find more
social support
PSYCHOLOGICAL DISORDERS
Social-Cognitive Perspective
• Depression is common:
– Among individualist cultures
• Less commitment to religion
• Less commitment to family
• Self-blame over personal
failure
• Depression is a vicious cycle:
– “Depressed persons induced
hostility, depression, and
anxiety in others, and got
rejected.”
– High risk for divorce, job loss,
and other stressful life events
Social-Cognitive Perspective
• The Depression Cycle
– 1. negative stressful events
interpreted through
– 2. a ruminating, pessimistic
explanatory style create
– 3. a hopeless, depressed state
that
– 4. hampers the way the
person thinks and acts.
– This in turn, fuels (back to 1.)
negative experiences such as
rejection
PSYCHOLOGICAL DISORDERS
Social-Cognitive Perspective
• Depression related to
sports:
– Many fans see a team’s
performance as an extension
of themselves
• After a loss, fans offer
bleaker assessments about
their own performance on
various tasks
Social-Cognitive Perspective
• When we feel down, we
think negatively and
remember bad experiences
– Mood-congruent memories
• We can break the cycle by:
– Moving to a different
environment
– Reversing self-blame
– Turning attention outward
– Engaging in more pleasant
activities
PSYCHOLOGICAL DISORDERS
Schizophrenia
• Nearly 1 in 100 people will
suffer schizophrenia
• Schizophrenia – a group of
severe disorders
characterized by
disorganized and delusional
thinking, disturbed
perceptions, and
inappropriate emotions and
actions; literally means
“split mind”
Schizophrenia
• Schizophrenia is a split from
reality
• Delusions = false beliefs
such as “I’m Mary Poppins”
• Paranoid = prone to
delusions of persecution
• Part of schizophrenia is a
breakdown in selective
attention
– There is NO filter – it ALL
comes in
PSYCHOLOGICAL DISORDERS
Schizophrenia
• Hallucinations – sensory
experiences without
sensory stimulation
– Seeing, feeling, hearing,
tasting, or smelling things
– Most common is hearing
voices that aren’t there
Schizophrenia
• Inappropriate Emotions and
Actions
– Laughing during a typically
sad moment
– Flat effect – emotionless state
– Catatonia – being motionless
for sometimes hours followed
by agitation
– Social relations are difficult to
maintain
PSYCHOLOGICAL DISORDERS
Schizophrenia
• Disorder typically strikes
young people maturing into
adulthood
– Men are affected earlier,
more severely, and more
often
– Sometimes develops
suddenly and appears as a
response to stress
– Sometimes develops
gradually from a long history
of social inadequacy
Schizophrenia
• Positive Symptoms
– Presence of inappropriate
behaviors
• Hallucinations, disorganized
and delusional talk,
inappropriate laughter, tears,
or rage
• Negative Symptoms
– Absence of appropriate
behaviors
• Toneless voices,
expressionless faces, mute
or rigid bodies
PSYCHOLOGICAL DISORDERS
Schizophrenia
• Subtypes of Schizophrenia
– Paranoid
• Preoccupation with
delusions or hallucinations,
often with themes of
persecution or grandiosity
– Disorganized
• Disorganized speech or
behavior, or flat or
inappropriate emotion
Schizophrenia
– Catatonic
• Immobility (or excessive,
purposeless movement),
extreme negativism, and/or
parrotlike repeating of
another’s speech or
movements
– Undifferentiated
• Many and varied symptoms
– Residual
• Withdrawal, after
hallucinations and delusions
have disappeared
PSYCHOLOGICAL DISORDERS
Schizophrenia
• Chronic/Process
Schizophrenia
– Slow-developing
– Recovery is doubtful
• Acute/Reactive
Schizophrenia
– When a well-adjusted person
develops schizophrenia
rapidly following stress
– Recovery is much more likely
Understanding Schizophrenia
• “About 60% of
schizophrenia patients
smoke, often heavily.
Nicotine apparently
stimulates certain brain
receptors, which helps focus
attention.”
– Javitt & Coyle, 2004
PSYCHOLOGICAL DISORDERS
Understanding Schizophrenia
• “Mad as a hatter”
– Gets its meaning from British
hat makers whose brains
were slowly poisoned as they
moistened the brims of
mercury-laden felt hats with
their lips
• Dopamine over activity
– May intensify brain signals
• Impaired glutamate activity
– Leads to schizophrenic
symptoms
Understanding Schizophrenia
• Frontal lobes
– Critical for reasoning,
planning, and problem solving
• During hallucinations
– Core regions of brain such as
thalamus and amygdala are
very active
• Thalamus – sensory
switchboard
• Amygdala – fear-processing
center
PSYCHOLOGICAL DISORDERS
Understanding Schizophrenia
• Brain abnormalities may be
caused by:
– Mishap during prenatal
development or delivery
– Low birth weight
– Oxygen deprivation during
delivery
– Viral infection during midpregnancy fetal brain
development
Understanding Schizophrenia
• Identical twins are 5x more
likely than fraternal twins to
“share” schizophrenia
• 98% of women who get flu
during 2nd trimester do NOT
pass on schizophrenia
• Twins who share a placenta
are likely to share the same
viruses
PSYCHOLOGICAL DISORDERS
Understanding Schizophrenia
• Adopted children have an
elevated risk only if a
biological parent is
diagnosed with
Schizophrenia
• No environmental causes
alone are known to produce
schizophrenia in someone
who isn’t already related to
a person with schizophrenia
Understanding Schizophrenia
• There is some tendency to
socially withdraw and
behave oddly prior to the
onset of the disorder
PSYCHOLOGICAL DISORDERS
Understanding Schizophrenia
Understanding Schizophrenia
• Warnings signs of schizophrenia:
– A mother whose
schizophrenia was severe and
long lasting
– Birth complications, often
involving oxygen deprivation
and low birth weight
– Separation from parents
– Short attention span and poor
muscle coordination
• Warning signs (cont’d):
– Disruptive or withdrawn
behavior
– Emotional unpredictability
– Poor peer relations and solo
play
PSYCHOLOGICAL DISORDERS
Personality Disorders
• Personality Disorders –
psychological disorders
characterized by inflexible
and enduring behavior
patterns that impair social
functioning
1. Avoidant – withdrawal;
fearful sensitivity to
rejection
Personality Disorders
2. Schizoid – eccentric
behaviors; emotionless
disengagement
3. Histrionic – dramatic or
impulsive behaviors;
attention getting
4. Narcissistic – selffocused and self-inflating
PSYCHOLOGICAL DISORDERS
Personality Disorders
• Antisocial Personality
Disorder – a personality
disorder in which the
person (usually a man)
exhibits a lack of conscience
for wrongdoing, even
toward friends and family
members. May be
aggressive and ruthless or a
clever con artist.
Personality Disorders
• Antisocial Personality
Disorder
– Person has been called a
sociopath or psychopath
– Lack of conscience is visible
prior to age 15
– Express little regret over
violating others’ rights
– Show no concern for family
members and friends
PSYCHOLOGICAL DISORDERS
Personality Disorders
• Antisocial (cont’d)
–
–
–
Those with biological
relatives with antisocial and
unemotional tendencies are
more at risk
Stress hormones such as
adrenaline display relatively
low arousal
Early signs of disorder
appear in children as young
as 3-6 years old
Personality Disorders
– Early signs include:
• Impulsivity
• Uninhibited
• Unconcerned with
social rewards
• Low in anxiety
– These signs could lead in
a good or bad direction
PSYCHOLOGICAL DISORDERS
Personality Disorders
• Antisocial murderers have
reduced activity in their
frontal lobes
• 1787 – Britain exiled
160,000 of their criminals to
Australia
– Their offspring managed to
establish an orderly society
Personality Disorders
• Other evidence indicates
childhood maltreatment
and a gene that altered
neurotransmitter balance
predicted antisocial
problems
PSYCHOLOGICAL DISORDERS
Rates of Psychological Disorders
Rates of Psychological Disorders
• Highest estimates of
diagnosable mental
disorders lies in the U.S.
• Symptoms of Disorder (and
age of onset):
– At any given time,
approximately 26% of us may
have a “mental disorder”
• Who is most vulnerable?
– Those in poverty
– Those in early adulthood
– A.P.D. (8-10)
– Alcohol dependency, OCD,
bipolar, schizophrenia (20)
– Major depression (25)
• 18 U.S. Presidents have
suffered from some sort of
psychological disorder