Chapter 14
Psychological Disorders
The system used by psychologists to classify psychological disorders is the:
a. APA Clinical Handbook
b. Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV)
c. Physician's Desk Reference (PDR)
d. Encyclopedia of Psychological Disorders
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Posttraumatic stress disorder is characterized by
a
.
b
.
recurrent, sudden and unexpected attacks of
overwhelming anxiety
enduring psychological disturbances
attributed to the experience of a major
traumatic event
c a chronic high level of anxiety
.
d persistent and irrational fear of an object or
. situation
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Your friend's mother is afraid of squirrels. While she knows squirrels are
basically harmless, she cannot control her anxiety when she sees either a
real squirrel or a picture of a squirrel. She never took your friend to the
local park when he was a child because of the numerous squirrels.
Your friend's mother has:
a
.
b
.
c
.
d
.
panic disorder
conversion disorder
generalized anxiety disorder
phobic disorder
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ANSWERS:



B
B
D
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Rate this person using the following scale:
1= Basically OK Psychotherapy is not necessary
2=Mild Disturbance. Psychotherapy should be considered
3= Significant disturbance. Psychotherapy is definitely required
4= Severe disturbance. Hospitalize!

Larry, a homosexual who has lived for three
years with a man he met in graduate school,
works as a psychologist in a large hospital.
Although competent in his work, he often
feels strained by the pressures of his
demanding position. An added source of
tension on the job is his not being able to
confide in all his co workers about his private
life. Most of his leisure activities are with good
friends who belong to the gay subculture.
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Rate this person using the following scale:
1= Basically OK Psychotherapy is not necessary
2=Mild Disturbance. Psychotherapy should be considered
3= Significant disturbance. Psychotherapy is definitely required
4= Severe disturbance. Hospitalize!

Bob is a very intelligent, 25 year old member of a
religious organization that is based on Buddhism.
Bob’s working for this organization caused
considerable conflict between him and his parents,
who are devout Catholics. Recently Bob experiences
acute spells of nausea and fatigue that prevent him
from working and which have forced him to return
home to live with his parents. Various medical tests
are being conducted, but as yet no physical causes
of his problems have been found.
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Rate this person using the following scale:
1= Basically OK Psychotherapy is not necessary
2=Mild Disturbance. Psychotherapy should be considered
3= Significant disturbance. Psychotherapy is definitely required
4= Severe disturbance. Hospitalize!

Jim was vice president of the freshman class at a
local college and played on the school’s football
team. Later that year he dropped out of these
activities and gradually became more and more
withdrawn from friends and family. Neglecting to
shave and shower, he began to look dirty and
unhealthy. He spent most of his time alone in his
room and sometimes complained to his parents that
he heard voices in the curtains and in the closet. In
his sophomore year he dropped out of school
entirely. With increasing anxiety and agitation, he
began to worry that the “Nazis” were plotting to kill his
family and kidnap him.
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Rate this person using the following scale:
1= Basically OK Psychotherapy is not necessary
2=Mild Disturbance. Psychotherapy should be considered
3= Significant disturbance. Psychotherapy is definitely required
4= Severe disturbance. Hospitalize!

Mary is a 30 year old musician who is very dedicated
and successful in her work as a teacher in a local
high school and as a part time member of local
musical groups. Since her marriage five years ago,
which ended in divorce after six months, she has
dated very few men. She often worries that her time
is “running out” for establishing a good relationship
with a man, getting married, and raising a family. Her
friends tell her that she gets way too anxious around
men, and that she needs to relax a little in general.
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Abnormal Behavior


The medical model
What is abnormal behavior?
– 3 criteria
• Deviant
• Maladaptive
• Causing personal distress


A continuum of normal/abnormal
diathesis-stress model
– genetic predisposition to a disorder, and
– poor environment (learning) in childhood, and
– severe stress
• explains causality for disorders
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Prevalence, Causes, and Course

Epidemiology - study of the distribution of mental or physical
disorders in the population




Prevalence
Lifetime prevalence
Diagnosis
Etiology - refers to the apparent causation and developmental
history of an illness

Prognosis - is a forecast about the probable course of an
illness
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Psychodiagnosis: The Classification
of Disorders




American Psychiatric Association
Diagnostic and Statistical Manual of Mental
Disorders – 4th ed. (DSM - 4)
Multiaxial system
5 axes or dimensions
–
–
–
–
–
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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The DSM multiaxial system
Figure 14.4 –
Example multiaxial
evaluation
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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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Post-Traumatic Stress
Disorder

Post-Traumatic Stress Disorder Traumatic stress
(experiencing or witnessing severely
threatening, uncontrollable events with a
sense of fear, helplessness, or horror) can
produce PTSD, symptoms of which include haunting
memories and nightmares, numbed social
withdrawal, jumpy anxiety, and insomnia.
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Anxiety Disorders

Common and uncommon fears
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Anxiety Disorders
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Anxiety Disorders


PET Scan of brain of
person with Obsessive/
Compulsive disorder
High metabolic activity
(red) in frontal lobe
areas involved with
directing attention
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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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Somatoform disorders are a class of psychological disorders characterized by
a emotional disturbances of varied kinds that
. may spill over to disrupt physical, perceptual,
social, and thought processes
b delusions, hallucinations, disorganized
. speech, and deterioration of adaptive
behavior
c physical ailments that cannot be fully
. explained by organic conditions
d feelings of excessive apprehension and
. worry
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The psychological disorder that involves the coexistence in one person of
two or more largely complete, and usually very different, personalities is
a
.
b
.
c
.
d
.
schizophrenic disorder
dissociative identity disorder
dissociative fugue
dissociative amnesia
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The psychological disorder characterized by separate episodes of
depression and mania is
a
.
b
.
c
.
d
.
bipolar disorder
posttraumatic stress disorder
schizophrenic disorder
major depressive disorder
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ANSWERS:



C
B
A
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Clinical Syndromes: Somatoform
Disorders

Somatization Disorder - is marked by a history of diverse physical
complaints that appear to be psychological in origin. They occur mostly
in women and often coexist with depression and anxiety disorders.


Conversion Disorder - significant loss of physical function (with
no apparent organic basis), usually in a single organ
system…loss of vision, partial paralysis, mutism, etc…glove
anesthesia, for example, is neurologically impossible.
Hypochondriasis - excessive preoccupation with health
concerns and incessant worry about developing physical
illnesses.
– Etiology
•
•
•
•
Reactive autonomic nervous system
Personality factors
Cognitive factors
The sick role
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Clinical Syndromes: Dissociative
Disorders

Dissociative amnesia - sudden loss of memory for
important personal information that is too extensive to be due to
normal forgetting. Memory loss may be for a single traumatic
event or for an extended time period around the event

Dissociative fugue - is when people lose their memory for
their entire lives along with their sense of personal
identity…forget their name, family, where they live, etc., but still
know how to do math and drive a car

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 disorder)
– Cyclothymic disorder

Etiology
– Genetic vulnerability
– Neurochemical factors - norepinephrine and serotonin
synapses
– Cognitive factors - pessimistic explanatory
– Interpersonal roots - poor social skills
– Precipitating stress
– 2X as high in women
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Larry frequently hears his daughter's stuffed animals talking about him when
he is in the hallway outside his daughter's bedroom; Larry is experiencing
a
.
b
.
c
.
d
.
delusions
hallucinations
disturbed emotions
irrational thought
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The presence of structural abnormalities in the brain that are assumed
to reflect deterioration of brain tissue has been associated with
a
.
b
.
c
.
d
.
mood disorders
schizophrenic disorders
anxiety disorders
somatoform disorders
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Which of the following has not been proposed as a factor associated
with the development of schizophrenic disorders?
a
.
b
.
c
.
d
.
neurological damage during prenatal
development
excessive levels of the neurotransmitter
dopamine
structural abnormalities in the brain
inadequate social skills
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ANSWERS:



B
B
D
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Clinical Syndromes: Schizophrenia

General symptoms
–
–
–
–
–
–

Delusions and irrational thought
Disorganized speech (word salad) and thinking
Deterioration of adaptive behavior
Hallucinations
Disturbed emotions and reality
Psychomotor disturbances (stupor, rigidity, waxy
flexibility, posturing, ‘parroting’)
Prognostic factors - A more favorable prognosis exists when
the onset of the disorder is sudden and at a later age, the
individual’s social and work adjustment was good prior to onset,
the proportion of negative symptoms is low, and the patient has
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a good social support system
Subtyping of Schizophrenia

4 subtypes
–
–
–
–

Paranoid type - delusions
Catatonic type - muscular rigidity, random activity
Disorganized type - incoherence, social withdrawal
Undifferentiated type – doesn’t fit neatly in one of the
above
New model for classification
– Positive vs. negative symptoms
• Negative means taking away behaviors that were present
– ex. - no emotions (‘flat affect’), inappropriate emotions,
ambivalence
• Positive means adding behaviors that were not already present
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– ex..- hallucinations, delusions
Schizophrenia

Delusions
 false beliefs, often of persecution or grandeur, that
may accompany psychotic disorders
 In a psychiatrist's waiting room two patients are having a
conversation. One says to the other, "Why are you here?"
The second answers, "I'm Napoleon, so the doctor told me to
come here."
The first is curious and asks, "How do you know that you're
Napoleon?"
The second responds, "God told me I was."
At this point, a patient on the other side of the room shouts, "NO
I DIDN'T!"
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Symptoms of Schizophrenia
 Delusions
of persecution
– ‘they’re out to get me’
– paranoia
 Delusions
of grandeur
– “God” complex
– megalomania
 Delusions
of being controlled
– the CIA is controlling my brain with a radio signal
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Etiology of Schizophrenia

Genetic vulnerability – high genetic predisposition - it runs
in families - twin studies show high correlation for identical twins
vs. fraternal

Neurochemical factors – dopamine receptors are
overactive which means an excess of dopamine



Brain structure– enlarged ventricles
The neurodevelopmental hypothesis - asserts that it is
attributable to disruptions in maturational processes of the brain
before or at the time of birth that are caused by prenatal viral
infections or malnutrition, obstetrical complications, and other
brain insults.
Psychoactive medication – work by lowering levels of
dopamine – prolonged use has side effects, ex. tremors,
seizures, restlessness, weight gain, slow mental functioning,
losing sense of self, blurred vision, or tardive dyskinesia - an
incurable neurological disorder marked by involuntary writhing
and ticklike movements of the mouth, tongue, face, hands, or
feet.
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Schizophrenia
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Frequency of positive and negative symptoms in individuals at the time they were
hospitalized for schizophrenia. Source: Based on data reported in Andreasen
&
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Flaum, 1991.
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Disorganized Thinking
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Schizophrenia
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Dissociative Identity Disorder
Originally known as “multiple personality disorder”
 2 or more distinct personalities manifested by the same
person at different times
 VERY rare and controversial disorder
 Examples include Sybil, Trudy Chase, Chris Sizemore
(“Eve”)
 Has been tried as a criminal defense
 Nonpsychotic disorder, do not respond to meds
 memory loss

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Dissociative Identity Disorder
 Pattern
typically starts prior to age
10 (childhood)
 Most people with disorder are
women
 Most report recall of torture or
sexual abuse as children and show
symptoms of PTSD
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Causes of Dissociative
Disorders?


Repeated, severe sexual or physical abuse. However,
many abused people do not develop DID
Combine abuse with biological predisposition toward
dissociation?
– people with DID are easier to hypnotize than others
– may begin as series of hypnotic trances to cope with
abusive situations
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The DID Controversy
 Some
–
–
–
–
curious statistics
1930–60: 2 cases per decade in USA
1980s: 20,000 cases reported
many more cases in US than elsewhere
varies by therapist—some see none, others see a lot
 Is
DID the result of suggestion by
therapist and acting by patient?
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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 - mental disorder makes a person unable to
distinguish right from wrong

Involuntary commitment
– danger to self
– danger to others
– in need of treatment
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Culture and Pathology


Cultural variations
Culture bound disorders
– Koro
– Windigo
– Anorexia nervosa
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