Ch11PsychologicalDisorders

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Chapter 11

psychological disorders

Chapter Outline
I. DEFINING AND DIAGNOSING DISORDER
A. Mental disorders are not the same as abnormal behavior
B. Insanity is a legal term that depends on whether the person is aware of the
consequences of behavior and is able to control it
C. Several criteria for defining mental disorders are currently in use
1. Violation of cultural standards--behavior that conforms to norms in one culture
might be seen as abnormal in another setting
2. Emotional distress--when people suffer from anxiety, fear, anger, depression, or
guilt
3. Maladaptive or harmful behavior--either for the individual or for the community
D. Mental disorder (text definition) = any behavior or emotional state that causes an
individual great suffering or worry; is self-defeating or self-destructive; or is maladaptive
and disrupts the persons relationships or the larger community
E. Diagnosis: Art or science?
1. Cultural factors and subjective interpretations still affect the process of diagnosis
2. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the bible
of psychological and psychiatric diagnosis
a. Primary aim of the DSM is descriptive--to provide clear criteria for diagnostic
categories
b. Classifies each disorder on five axes or factors
(1) Primary clinical problem
(2) Ingrained aspects of the individuals personality
(3) General medical conditions relevant to the disorder
(4) Social and environmental problems that can make the disorder worse
(5) Global assessment of the clients overall functioning
3. Limitations of the DSM
a. It may foster overdiagnosis
b. It may increase the risk of creating self-fulfilling prophecies
c. It may confuse serious mental disorders with normal problems in living
d. Diagnoses reflect prevailing attitudes and prejudice
F. Psychological tests
1. Projective tests
a. Rely on the projection of unconscious conflicts and motivations onto
ambiguous
stimulus materials
b. Good for establishing rapport with clients
c. These tests have low reliability and validity
2. Objective tests or inventories

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a. Standardized questionnaires--typically multiple-choice or true-false

b. Have better reliability and validity than projective tests, but remain far from
perfect
3. Conclusions concerning diagnoses and testing
a. Advocates say when the DSM is used correctly, diagnoses are more accurate
b. Correct labeling of a disorder may help people identify the source of their
unhappiness and lead to a proper treatment
c. Some disorders are recognized as such in all societies; the fact that some
diagnoses
reflect cultural biases does not mean that they all do
II. ANXIETY DISORDERS
A. Anxiety is adaptive in certain situations, but some individuals are prone to irrational
fears or chronic states of anxiety
B. Anxiety states and panic
1. Generalized anxiety disorder
a. Symptoms
(1) Continuous, uncontrollable anxiety or worry
(2) Feelings of foreboding and dread
(3) Duration of at least 6 months
(4) Restlessness, difficulty concentrating, irritability, and jitteriness
b. Predisposing factors
(1) Physiological tendency
(2) Unpredictable environment in childhood
c. Have mental habits that produce anxiety and keep it going
2. Posttraumatic stress disorder (PTSD)
a. Can occur as a result of uncontrollable and unpredictable danger such as rape,
war,
or natural disasters such as earthquakes or hurricanes
b. Symptoms
(1) Reliving the trauma in thoughts or dreams
(2) Psychic numbing
(3) Increased physiological arousal
c. Reaction may be immediate or delayed with PTSD
d. Symptoms of PTSD may recur for 10 years or more
3. Panic disorder
a. Characterized by sudden attacks of intense fear, with feelings of impending
doom
b. Symptoms of panic attacks include heart palpitations, dizziness, and faintness
c. Panic attacks are often related to stress, prolonged emotion, exercise, or
traumatic
experiences
d. Panic attacks are not uncommon; whether it develops into a disorder depends on
how the bodily reactions are interpreted
e. Culture influences the particular symptoms of a panic attack
C. Fears and phobias
1. Unrealistic fear of a specific situation, activity, or thing

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2. Social phobia--persistent, irrational fear of situations in which one will be observed

by
others
3. Agoraphobia--fear of being alone in a public place from which escape might be
difficult
or help unavailable
a. The most disabling phobia--most common phobia for which people seek
treatment
b. May begin with panic attacks--sudden onset of intense fear, then avoiding
situations
that might provoke another attack
D. Obsessions and compulsions
1. Obsessions
a. Recurrent, persistent, unwished-for thoughts
b. May be frightening or repugnant
2. Compulsions
a. Repetitive, ritualized behaviors that the person feels must be carried out to avoid
disaster
b. People feel a lack of control over the compulsion
c. Common compulsions include repeated hand washing, counting, touching and
checking things
3. Most OCD sufferers do not enjoy the rituals and realize the behavior is senseless,
but if
they try to break off the ritual, they feel mounting anxiety
4. Several parts of the brain are overactive in OCD sufferers, resulting in the person
experiencing a constant state of danger
III. MOOD DISORDERS
A. Clinical depression is more severe than normal sadness over lifes problems, however,
serious depression is so widespread that it is referred to as the common cold of psychiatric
disturbances
B. Depression and mania
1. Major depression--disrupts ordinary functioning for at least six months;symptoms
include emotional, behavioral, and cognitive changes
a. Despair and hopelessness: thoughts of death or suicide, loss of pleasure in usual
activities
b. Unable to do everyday activities (e.g., takes tremendous effort to get up and get
dressed)
c. Exaggerate minor failings, discount positive events, interpret things that go
wrong as
evidence that nothing will ever go right, low self-esteem, losses interpreted as
sign of
personal failure
d. Person may stop eating or overeat, have difficulty falling asleep or staying
asleep,
have trouble concentrating, feel tired all the time
2. Mania--the opposite of depression; an abnormally high state of exhilaration
3. Bipolar disorder--depression alternates with mania
C. Theories of depression
1. Biological explanations--focus on genetics and brain chemistry
a. Low norepinephrine and/or serotonin levels implicated in depression

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b. Mania may be caused by excessive production of norepinephrine

c. Drugs help to bring the levels of neurotransmitter into balance
d. Brain scans show reduced frontal lobe activity in depressed people
2. Social explanations--focus on stressful conditions of peoples lives; may explain
gender
differences in depression rates
a. Marriage and employment associated with lower rates of depression
b. In women, having more children is associated with higher rates of depression
c. A history of exposure to violence is related to depression
3. Attachment explanations--focus on disturbed relationships and separations and a
history of insecure attachments
a. Disruption of a primary relationship most often sets off a depressive episode
b. Direction of cause and effect is not clear
4. Cognitive explanations--propose that depression results from particular habits of
thinking and interpreting events
a. Depression involves three negative habits of thinking
(1) Internality
(2) Stability
(3) Lack of control
b. Learned helplessness theory held that people become depressed when their
efforts
to avoid pain or control the environment fail--however, not all depressed
people have
actually experienced failure
c. Ruminating response style may also lead to longer, more intense periods of
depression
(1) Women more likely to adopt this style than men
(2) May account for sex differences in depression
d. Negative thinking may be both a cause and a result of depression
IV. PERSONALITY DISORDERS
A. Personality disorders--characterized by rigid, maladaptive traits that cause great
distress or inability to get along with others or (DSM-IV definition) an enduring pattern of
inner experience and behavior that deviates markedly from the expectations of the
individuals culture
B. Problem personalities
1. Narcissistic personality disorder--exaggerated sense of self-importance,
preoccupation
with fantasies of unlimited success; demands for constant attention
and admiration
2. Paranoid personality disorder--pervasive, unfounded suspiciousness and mistrust of
others; irrational jealousy and secretiveness
C. Criminals and psychopaths - Antisocial personality disorder
1. Characterized by a lack of conscience, morality, emotional attachments, empathy,
and
guilt
2. Individuals may be superficially charming, but form no emotional connections to
others
and do not feel guilt about wrongdoing
3. Occurs in 3 percent of males, less than 1 percent of females

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4. May account for more than half of serious crimes committed in the U.S.
5. Begin with serious problem behaviors in childhood which continue through
adulthood
D. Biological and social factors
1. Do not respond physiologically to punishments that would affect other people
2. Show a lack of emotional arousal which may suggest a central nervous system
abnormality
3. Problems with impulse control--an inherited characteristic shared by those who are
antisocial, hyperactive, addicted, or impulsive
4. Vulnerability-stress model--holds that brain damage can interact with social
deprivation
and other experiences to produce individuals who are impulsive or violent
V. DRUG ABUSE AND ADDICTION
A. Substance abuse (DSM-IV definition) = maladaptive pattern of substance use leading to
clinically significant impairment or distress
B. The biological model
1. Jellinek argued that alcoholism is a disease over which people have no control-complete abstinence is the only solution
2. Biological model of addiction--when alcoholism begins in adolescence, linked to
impulsivity, antisocial behavior, and violent criminality; does seem to have a hereditary
component
3. It may be that consumption of alcohol causes biological dependence, inability to
metabolize alcohol, and psychological problems
C. Learning, culture, and addiction
1. Learning model says that addiction is not a disease, but a central activity of an
individuals life
2. Arguments in support of the learning model include:
a. Addiction patterns vary according to cultural practices and the social
environment
(1) Alcoholism more likely to occur in societies that forbid children to drink but
condone drunkenness in adults
(a) In cultures with low rates of alcoholism, adults demonstrate correct
drinking
to children, gradually introducing them to alcohol in safe family
settings
(b) In cultures with low rates of alcoholism, alcohol is not used as a rite of
passage into adulthood
(2) Rates of alcoholism may increase when people move from culture of origin
into
a culture that has different drinking rules
b. Policies of total abstinence tend to increase rates of addiction rather than
reducing
them, perhaps by denying people the opportunity to learn to drink
moderately
c. Not all addicts go through withdrawal symptoms when they stop taking a drug
d. Addiction does not depend on the drug alone, but also on the reason the person
is
taking the drug

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(1) Persons taking drugs for chronic pain may be able to discontinue their use
without any problems
(2) People who drink to cope with uncomfortable feelings are more likely to
become
addicted than those who take drugs to enhance positive feelings
D. Debating solutions to addiction
1. A central issue in the debate between biological and learning theories of
alcoholism has been the debate over controlled drinking
a. According to the disease model, total abstinence is the only way to manage the
disease of addiction
b. According to learning theory, controlled drinking is possible
2. Alcoholics Anonymous (disease) model has helped many people, but does not work
for
everyone
3. Best predictors of an addicts ability to learn to control excessive drug use are:
a. Previous severity of dependence on drug,
b. Social stability
c. Beliefs about the necessity of maintaining abstinence
4. Drug abuse and addiction appear to reflect interactions of physiology and
psychology,
person, and culture
VI. DISSOCIATIVE IDENTITY DISORDER
A. Dissociative disorders--disorders in which consciousness, behavior, and identity are
severely split or altered
1. Dissociative states are intense, long lasting, and seem out of ones control
2. Often occur in response to shocking events
B. Dissociative identity disorder (Multiple personalityor MPD)
1. The appearance of two or more identities within one person
2. Two opposing views of MPD exist among mental health professionals
a. A real disorder, common but often underdiagnosed or misdiagnosed--believed to
develop in childhood as a response to trauma
b. A creation of mental health clinicians who believe in it
(1) Research used to support the diagnosis, including claims of physiological
differences between personalities, is seriously flawed
(2) Clinicians are creating it through the power of suggestion--MPD may be the
result of unwitting collusion between clinicians and suggestible clients
(3) The influence of the media
3. Alternative sociocognitive explanation
a. Seen as an extreme form of a normal human process: the ability to present
different
aspects of our personalities to others
b. May be a way for troubled people to understand and legitimize their problems
c. Rewarded by clinicians with attention
VII. SCHIZOPHRENIA
A. Schizophrenia--a psychosis or mental condition involving distorted perceptions of reality
and an inability to function in most aspects of life
B. Symptoms of schizophrenia

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1. Active or positive symptoms--involve exaggerations or distortions of normal

processes
and behavior
a. Bizarre delusions--false beliefs about reality
b. Hallucinations and heightened sensory awareness
c. Disorganized, incoherent speech--illogical jumble of ideas
d. Grossly disorganized and inappropriate behavior ranging from childlike silliness
to
violent agitation
2. Negative symptoms--involve loss of former traits and abilities
a. Loss of motivation
b. Poverty of speech--brief, empty replies reflecting diminished thought
c. Emotional flatness--unresponsive facial expressions, poor eye contact,
diminished
emotionality
d. Tend to occur before and last after positive symptoms
3. Severity and duration of symptoms vary; onset can be abrupt or gradual
4. Prognosis is unpredictable when onset is gradual
C. Origins of schizophrenia
1. Biological factors that have been studied
a. Genetic predispositions
(1) Risk of schizophrenia for general population is 1-2%
(a) Risk is about 50% if identical twin has schizophrenia
(b) Risk is 12% for people with one schizophrenic parent
(c) Risk is 35-46% for people with two schizophrenic parents
(2) No specific genes for schizophrenia have been identified
(3) 88% of people with a schizophrenic parent do not develop schizophrenia
b. Structural brain abnormalities
(1) May have decreased brain weight, reduced volume in specific brain areas, or
reduced number of neurons in certain brain areas
(2) May have enlarged ventricles
(3) Schizophrenics are more likely to have abnormalities in the thalamus
(4) Antipsychotic medications might affect the brain
c. Neurotransmitter abnormalities--schizophrenics may have low levels of serotonin
and high levels of dopamine activity
d. Prenatal abnormalities--damage to fetal brain may increase likelihood of
schizophrenia--possible causes of prenatal damage include:
(1) Severe malnutrition during pregnancy
(2) Infectious viruses, such as influenza, especially during second trimester of
gestation
e. Adolescent abnormalities
(1) Too much synaptic pruning may be implicated