Chapter 14
Psychological Disorders
Abnormal Behavior
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Historical aspects of mental
disorders
 The medical model
 What is abnormal behavior?
– 3 criteria
• Deviant
• Maladaptive
• Causing personal distress
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A continuum of
normal/abnormal
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Prevalence, Causes, and Course
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Epidemiology
Prevalence - % of population that displays the
disorder during a specific period
Lifetime prevalence –
Diagnosis
Etiology – causes
Prognosis
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Psychodiagnosis: The Classification
of Disorders
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American Psychiatric Association – published
first taxonomy in 1952
Diagnostic and Statistical Manual of Mental
Disorders – 4th ed. (DSM - IV)
Multiaxial system
5 axes or dimensions
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Axis I – Clinical Syndromes
Axis II – Personality Disorders or Mental Retardation
Axis III – General Medical Conditions
Axis IV – Psychosocial and Environmental Problems
Axis V – Global Assessment of Functioning
Example Figure
DSM V – to be published in 2011-12
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Figure
14.3
– DSM-IV
Fig. 14-3,
p. 555
overview
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The DSM multiaxial system
Example multiaxial
evaluation
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Axis I Clinical Syndromes and Axis II
Personality Disorders
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Anxiety Disorders –
Somatoform Disorders –
Dissociative Disorders –
Mood Disorders –
Schizophrenic Disorders –
Eating Disorders –
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Axis II – Personality Disorders –
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Clinical Syndromes: Anxiety
Disorders
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Generalized anxiety disorder
– “free-floating anxiety”
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Phobic disorder
– Specific focus of fear
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Panic disorder and agoraphobia (definition issue)
– Physical symptoms of anxiety/leading to agoraphobia
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Obsessive compulsive disorder
– Obsessions
– Compulsions
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Etiology of Anxiety Disorders
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Biological factors –
– Genetic predisposition, anxiety sensitivity
– GABA circuits in the brain
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Conditioning and learning
– Acquired through classical conditioning or observational
learning –
– Maintained through operant conditioning
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Cognitive factors
– Judgments of perceived threat –
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Personality
– Neuroticism
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Stress –
– A precipitator
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Clinical Syndromes: Somatoform
Disorders
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Somatization Disorder
Conversion Disorder – Figure
Hypochondriasis
– Etiology
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Reactive autonomic nervous system
Personality factors
Cognitive factors
The sick role
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Clinical Syndromes: Dissociative
Disorders
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Dissociative amnesia
Dissociative fugue
Dissociative identity disorder
– Etiology
• severe emotional trauma during childhood
– Controversy
• Media creation?
• Sybil
• Repressed memories
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Clinical Syndromes: Mood Disorders
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Major depressive disorder
– Dysthymic disorder
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Bipolar disorder (manic-depressive disorder)
– Cyclothymic disorder
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Etiology
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Age of onset –
Genetic vulnerability –
Neurochemical factors
Cognitive factors – negative thinking –
Interpersonal roots
Precipitating stress
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Clinical Syndromes: Schizophrenia
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General symptoms
– Delusions and irrational thought
– Deterioration of adaptive behavior avolition
– Hallucinations – any modality but
usually auditory
– Disturbed emotions – 66%
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Prognostic factor
– Gradual onset
– Sudden onset
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Subtyping of Schizophrenia
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4 subtypes
– Paranoid type – most
common subtype - John
Nash
– Catatonic type
– Disorganized type
– Undifferentiated type
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New model for classification
– Positive vs. negative
symptoms
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Etiology of Schizophrenia
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Genetic vulnerability –
Neurochemical factors – Dopamine hypothesis –
Structural abnormalities of the brain – prefrontal lobe
and ventricles –
The neurodevelopmental hypothesis –
Expressed emotion –
Precipitating stress – stress-vulnerability model –
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– Genetic vulnerability - schizophrenia
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The dopamine hypothesis as an explanation for schizophrenia
Neurological Changes in Schizophrenia
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– Neurodevelopment hypothesis of schizophrenia
– Expressed emotion
and relapse rates in
schizophrenia
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The stress-vulnerability model of schizophrenia
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Personality Disorders
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Next slide– description and male/female percents
Anxious-fearful cluster
– Avoidant, dependent, obsessive-compulsive
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Dramatic-impulsive cluster
– Histrionic, narcissistic, borderline, antisocial
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Odd-eccentric cluster
– Schizoid, schizotypal, paranoid
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Etiology
– Genetic predispositions, inadequate socialization in
dysfunctional families
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Prognosis
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Psychological Disorders and the Law
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Insanity
– M’naghten rule
– The insanity defense –– perception versus actual cases
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Involuntary commitment – varies by states
– danger to self
– danger to others
– in need of treatment
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Culture and pathology –
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John Hinkley, Jr. – assassination attempt of
President Reagan in 1981
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Eating Disorders –
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Issues of weight –
Anorexia nervosa
– Criteria and subtypes: restrictive and binge/purge
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Bulimia nervosa
Binge eating
History and prevalence
– Age onset –
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Etiology
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Genetics
Personality – perfectionism
Cultural issues - “perfect” body type and digital photograph
Family role
Cognitive factors
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Age of anorexia nervous in the United States – Lucas et al. (1991)
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