Chapter 14
Psychological Disorders
Abnormal Behavior
The
medical model
What is abnormal behavior?
– 3 criteria
• Deviant
• Maladaptive
• Causing personal distress
A continuum
of normal/abnormal
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Fig 14.2 – Normality and abnormality as a continuum. There isn’t a
sharp boundary between normal and abnormal behavior. Behavior is
normal or abnormal in degree, depending on the extent to which one’s
behavior is deviant, personally distressing, or maladaptive.
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Prevalence, Causes, and Course
 Epidemiology
 Prevalence
 Lifetime
prevalence
 Diagnosis
 Etiology
 Prognosis
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Fig 14.5 – Lifetime prevalence of psychological disorders. The estimated percentage of people who
have, at any time in their life, suffered from one of four types of psychological disorders or from a disorder
of any kind (top bar) is shown here. Prevalence estimates vary somewhat from one study to the next,
depending on the exact methods used in sampling and assessment. The estimates shown here are based
on pooling data from Wave 1 and 2 of the Epidemiological Catchment Area studies and the National
Comorbidity Study, as summarized by Regier and Burke (2000) and Dew, Bromet, and Switzer (2000).
These studies, which collectively evaluated over 28,000 subjects, provide the best
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data to date on the prevalence of mental illness in the United States.
Psychodiagnosis: The Classification of
Disorders
 American Psychiatric Association
 Diagnostic and Statistical Manual of
Disorders – 4th ed. (DSM - 4)
 Multiaxial system
 5 axes or dimensions
–
–
–
–
–
Mental
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
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Axis I Clinical Syndromes Discussed in Text
 Anxiety
Disorders
 Somatoform Disorders
 Dissociative Disorders
 Mood Disorders
 Schizophrenic Disorders
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Clinical Syndromes: Anxiety Disorders
 Generalized
anxiety disorder
– “free-floating anxiety”
 Phobic
disorder
– Specific focus of fear
 Panic
disorder and agoraphobia
– Physical symptoms of anxiety/leading to
agoraphobia
 Obsessive
compulsive disorder
– Obsessions
– Compulsions
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Etiology of Anxiety Disorders
 Biological factors
– Genetic predisposition, anxiety sensitivity
– GABA circuits in the brain
 Conditioning and learning
– Acquired through classical conditioning or observational
learning
– Maintained through operant conditioning
 Cognitive factors
– Judgments of perceived threat
 Personality
– Neuroticism
 Stress
– A precipitator
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Fig 14.6 - Twin studies of anxiety disorders. The concordance rate for anxiety
disorders in identical twins is higher than that for fraternal twins, who share less
genetic overlap. These results suggest that there is a genetic predisposition to
anxiety disorders. (Data based on Noyes et al., 1987; Slater & Shields, 1969;
Torgersen, 1979, 1983)
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Fig 14.7 - Conditioning as an explanation for phobias. (a) Many phobias appear to be
acquired through classical conditioning when a neutral stimulus is paired with an anxietyarousing stimulus. (b) Once acquired, a phobia may be maintained through operant
conditioning. Avoidance of the phobic stimulus reduces anxiety, resulting in
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negative reinforcement.
Fig 14.8 - Cognitive factors in anxiety disorders. Eysenck and his colleagues
(1991) compared how subjects with anxiety problems and nonanxious subjects
tended to interpret sentences that could be viewed as threatening or nonthreatening.
Consistent with cognitive models of anxiety disorders, anxious subjects were more
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likely to interpret the sentences in a threatening light.
Clinical Syndromes: Somatoform Disorders
 Somatization
Disorder
 Conversion Disorder
 Hypochondriasis
– Etiology
•
•
•
•
Reactive autonomic nervous system
Personality factors
Cognitive factors
The sick role
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Fig 14.10 - Glove anesthesia. In
conversion disorders, the physical
complaints are sometimes
inconsistent with the known facts of
physiology. For instance, given the
patterns of nerve distribution in the
arm shown in (a), it is impossible
that a loss of feeling in the hand
exclusively, as shown in (b), has a
physical cause, indicating that the
patient’s problem is psychological
in origin.
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Clinical Syndromes: Dissociative Disorders
 Dissociative
amnesia
 Dissociative fugue
 Dissociative identity disorder
– Etiology
• severe emotional trauma during childhood
– Controversy
• Media creation?
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Clinical Syndromes: Mood Disorders
 Major depressive disorder
– Dysthymic disorder
 Bipolar disorder (manic-depressive
– Cyclothymic disorder
disorder)
 Etiology
– Genetic vulnerability
– Neurochemical factors
– Cognitive factors
– Interpersonal roots
– Precipitating stress
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Fig 14.11 - Episodic patterns in mood disorders. Time-limited episodes of emotional
disturbance come and go unpredictably in mood disorders. People with unipolar disorders
suffer from bouts of depression only, whereas people with bipolar disorders experience both
manic and depressive episodes. The time between episodes of disturbance varies greatly
with the individual and the type of disorder.
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Fig 14.13 - Twin studies of mood disorders. The concordance rate for mood disorders in
identical twins is much higher than that for fraternal twins, who share less genetic overlap.
These results suggest that there must be a genetic predisposition to mood disorders. The
disparity in concordance between the two types of twins is greater for mood disorders than
for either anxiety disorders (see Figure 14.7) or schizophrenic disorders (see Figure
14.19), which suggests that genetic factors may be particularly important in mood
disorders. (Data from Gershon, Berrettini, & Goldin, 1989)
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Fig 14.15 - Negative thinking and prediction of depression. Alloy and colleagues (1999)
measured the explanatory style of first-year college students and characterized them as high
risk or low risk for depression. This graph shows the percentage of these students who
experienced major or minor episodes of depression over the next 2.5 years. As you can see,
the high-risk students who exhibited a negative thinking style proved to be much more
vulnerable to depression. (Data from Alloy et al., 1999)
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Fig 14.16 - Interpersonal factors in depression. Behavioral theories about the etiology of
depression emphasize how inadequate social skills may contribute to the development of the
disorder.
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Clinical Syndromes: Schizophrenia
 General
–
–
–
–
symptoms
Delusions and irrational thought
Deterioration of adaptive behavior
Hallucinations
Disturbed emotions
 Prognostic
factors
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Subtyping of Schizophrenia
4
subtypes
–
–
–
–
Paranoid type
Catatonic type
Disorganized type
Undifferentiated type
 New
model for classification
– Positive vs. negative symptoms
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Etiology of Schizophrenia






Genetic vulnerability
Neurochemical factors
Structural abnormalities of the brain
The neurodevelopmental hypothesis
Expressed emotion
Precipitating stress
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Fig 14.18 – The dopamine hypothesis as an explanation for schizophrenia. Decades of research have
implicated over-activity at dopamine synapses as a key cause of schizophrenic disorders. However, the evidence
on the exact mechanisms underlying this over-activity, which is summarized in the graphic, is complex and open
to debate. Recent hypotheses about the neurochemical bases of schizophrenia go beyond the simple
assumption that dopamine activity is increased. For example, one theory posits that schizophrenia may be
accompanied b decreased dopamine activity in one area of the brain (the prefrontal cortex)
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and increased activity or dysregulation in other areas of the brain (Egan & Hyde, 2000).
Moreover, abnormalities in other neurotransmitter systems may
also contribute to schizophrenia.
Fig 14.20 – The neurodevelopmental hypothesis of schizophrenia. Recent findings have
suggested that insults to the brain sustained during prenatal development or at birth may
disrupt crucial maturational processes in the brain, resulting in subtle neurological damage
that gradually becomes apparent as a youngsters develop. This neurological damage is
believed to increase both vulnerability to schizophrenia and the incidence of minor physical
anomalies (slight anatomical defects of the head, face, hands and feet).
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Personality Disorders
 Anxious-fearful
cluster
– Avoidant, dependent, obsessive-compulsive
 Dramatic-impulsive
cluster
– Histrionic, narcissistic, borderline, antisocial
 Odd-eccentric
cluster
– Schizoid, schizotypal, paranoid
 Etiology
– Genetic predispositions, inadequate socialization in
dysfunctional families
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Psychological Disorders and the Law
 Insanity
– M’naghten rule
 Involuntary
commitment
– danger to self
– danger to others
– in need of treatment
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Fig 14.22 – The insanity defense: Public perceptions and actual realities. Silver,
Cirincione, and Steadman (1994) collected data on the general public’s beliefs about the
insanity defense and the realities of how often it is used and how often it is successful
(based on a large-scale survey of insanity pleas in either states). Because of highly
selective media coverage, there are dramatic disparities between public perceptions and
actual realities, as the insanity defense is used less frequently and less
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successfully than widely assumed.
Culture and Pathology
 Cultural
variations
 Culture bound disorders
– Koro
– Windigo
– Anorexia nervosa
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Fig 14.25 - Weight trends among Playboy centerfolds and Miss America
contestants. This graph charts how the average weight of Playboy centerfolds and
Miss America contestants changed over the course of 30 years (from 1959 to 1989). To
control for age and height, each woman’s weight was compared to the average weight
for a woman of that age and height and expressed as a percentage of the expected
weight. Given the small samples, the figures are a little erratic, but overall, the data
show a clear downward trend. (Data from Garner et al., 1980; Wiseman et al., 1992;
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graphic from Barlow & Durand, 1999)