Psychological Disorders

Chapter 14
Psy12000.003
Spring, 2010
Rita Sampers

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Psychological Disorders Psychological Disorders

I felt the need to clean my room … spent four to five hour at People are fascinated by the exceptional, the
it … At the time I loved it but then didn't want to do it any unusual, and the abnormal. This fascination may be
more, but could not stop … The clothes hung … two fingers
caused by two reasons:
apart …I touched my bedroom wall before leaving the house
… I had constant anxiety … I thought I might be nuts.
  During various moments we feel, think, and act like an
Marc, diagnosed with abnormal individual.
obsessive-compulsive disorder
(from Summers, 1996)   Psychological disorders may bring unexplained physical
symptoms, irrational fears, and suicidal thoughts.
http://www.youtube.com/watch?v=Rn1OYlYzgm8&feature=related

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Psychological Disorders Defining Psychological Disorders

To study the abnormal is the best way of Mental health workers view psychological disorders
understanding the normal. as persistently harmful thoughts, feelings, and
William James (1842-1910) actions.

  There are 450 million people suffering from
psychological disorders (WHO, 2004).
  Depression and schizophrenia exist in all cultures of the
world.
When behavior is deviant, distressful, and
dysfunctional psychiatrists and psychologists label it
as disordered (Comer, 2004).

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 Deviant, Distressful & Dysfunctional Understanding Psychological Disorders

  Deviant behavior (going Ancient Treatments of psychological disorders include

naked) in one culture may
be considered normal, trephination, exorcism, being caged like animals,
while in others it may lead being beaten, burned, castrated, mutilated, or
to arrest. transfused with animal’s blood.
  Deviant behavior must
accompany distress to be

Carol Beckwith
a disorder.

  If a behavior is
dysfunctional it is clearly
a disorder.
John W. Verano
In the Wodaabe tribe men wear
costumes to attract women. In
Western society this would be
considered abnormal.
7 Trephination (boring holes in the skull to remove evil forces) 8

Medical Perspective Medical Model

Philippe Pinel (1745-1826) from France, insisted that When physicians discovered that syphilis led to mental
madness was not due to demonic possession, but an disorders, they started using medical models to review the
ailment of the mind. physical causes of these disorders.
George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago

1.  Etiology: Cause and development of the disorder.

2.  Diagnosis: Identifying (symptoms) and
distinguishing one disease from another.
3.  Treatment: Treating a disorder in a psychiatric
hospital.
4.  Prognosis: Forecast about the disorder.

Dance in the madhouse. 9 10

Biopsychosocial Perspective Classifying Psychological Disorders

Assumes that biological, socio-cultural, and The American Psychiatric Association rendered a
psychological factors combine and interact to Diagnostic and Statistical Manual of Mental
produce psychological disorders. Disorders (DSM) to describe psychological
disorders.
The most recent edition,
DSM-IV-TR (Text Revision,
2000), describes 400
psychological disorders
compared to 60 in the 1950s.

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 Multiaxial Classification Multiaxial Classification
Is a Clinical Syndrome (cognitive, anxiety, mood Note 16 syndromes in Axis I
Axis I
disorders [16 syndromes]) present?
Is a Personality Disorder or Mental Retardation
Axis II
present?
Is a General Medical Condition (diabetes,
Axis III
hypertension or arthritis etc) also present?
Are Psychosocial or Environmental Problems
Axis IV
(school or housing issues) also present?
What is the Global Assessment of the person’s
Axis V functioning?
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Multiaxial Classification Goals of DSM

Note Global Assessment for Axis V 1.  Describe (400) disorders.
2.  Determine how prevalent the disorder
is.

Disorders outlined by DSM-IV are reliable.

Therefore, diagnoses by different professionals are
similar.

Others criticize DSM-IV for “putting any kind of

behavior within the compass of psychiatry.”

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Labeling Psychological Disorders Labeling Psychological Disorders

1.  Critics of the DSM-IV argue that labels may 2. Labels may be helpful for healthcare
stigmatize individuals. professionals when communicating with one
another and establishing therapy.
N. Tomes, Madness in America, 1995. Cornell University Press.
Elizabeth Eckert, Middletown, NY. From L. Gamwell and

BUT, Rosenhan’s “study” - self-

perpetuating aspects of labels

Graduate students, during psychiatric

assessment, claimed to be hearing voices
that were often unclear, but which seemed
to pronounce the words "hollow",
"empty", and "thud."
Asylum baseball team (although comprised of hospital staff, observers saw psychological 17 18
symptoms in these players)

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 Labeling Psychological Disorders Anxiety Disorders
3.  “Insanity” labels Feelings of excessive apprehension and anxiety.
raise moral and
ethical questions
about how society 1.  Generalized anxiety disorders
should treat people
2.  Phobias
who have disorders
and have committed 3.  Panic disorders

Elaine Thompson/ AP Photo

crimes. 4.  Obsessive-compulsive disorders
NGRI, GBI??

Theodore Kaczynski
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(Unabomber)

Generalized Anxiety Disorder Panic Disorder

Symptoms Symptoms

1.  Persistent and uncontrollable tenseness and Minute-long episodes of intense dread which may
apprehension. include feelings of terror, chest pains, choking, or
2. Autonomic arousal. other frightening sensations.
3. Inability to identify or avoid the cause of certain
feelings. Anxiety is a component of both disorders. It occurs
more in the panic disorder, making people avoid
situations that cause it.

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Phobia Kinds of Phobias

Marked by a persistent and irrational fear of an object Agoraphobia Phobia of open places.
or situation that disrupts behavior.

Acrophobia Phobia of heights.

Claustrophobia Phobia of closed spaces.

Hemophobia Phobia of blood.

http://phobialist.com/
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 Obsessive-Compulsive Disorder Brain Imaging
Persistence of unwanted thoughts (obsessions) and A PET scan of the brain of
urges to engage in senseless rituals (compulsions) a person with Obsessive-
that cause distress. Compulsive Disorder
(OCD). High metabolic
activity (red) in the frontal
lobe areas are involved with
directing attention.

Red means a difference between the group in

question (in this case, those with OCD) and a
control or comparison group. (yellow does, too,
but to a lesser extent)
Brain image of an OCD
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Post-Traumatic Stress Disorder Resilience to PTSD

Four or more weeks of the following symptoms • Only about 10% of women and 20% of men react to
constitute post-traumatic stress disorder (PTSD): traumatic situations and develop PTSD.

• Holocaust survivors show remarkable resilience against

traumatic situations.
1.  Haunting memories
2. Nightmares • All major religions of the world suggest that surviving a
trauma leads to the growth of an individual.
3. Social withdrawal –  Does this expectation help or hurt individuals?
4. Jumpy anxiety
Bettmann/ Corbis

5. Sleep problems
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Explaining Anxiety Disorders The Learning Perspective

Freud suggested that we repress our painful and Learning theorists
intolerable ideas, feelings, and thoughts, resulting in suggest that fear
anxiety. conditioning leads to
anxiety. This anxiety then
becomes associated with
other objects or events
(stimulus generalization)
and is reinforced.
John Coletti/ Stock, Boston

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 The Learning Perspective The Biological Perspective
Investigators believe that fear responses can also be Natural Selection has led our ancestors to learn to
acquired through observational learning. Young fear snakes, spiders, and other animals. Therefore,
monkeys develop fear when they watch other fear preserves the species.
monkeys who are afraid of snakes.

Hmm, maybe I Twin studies suggest that our genes may be partly
should be
frightened of
snakes…
responsible for developing fears and anxiety. Twins
are more likely to share phobias.

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The Biological Perspective Dissociative Disorder

monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353.
S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action

Generalized anxiety, Conscious awareness becomes separated

panic attacks, and even (dissociated) from previous memories, thoughts, and
OCD are linked with feelings.
brain circuits like the
anterior cingulate cortex.
Symptoms
1.  Having a sense of being unreal.
Maybe Jung would say
these genes that make us 2. Being separated from the body.
Anterior Cingulate Cortex
naturally fearful are part of an OCD patient. 3. Watching yourself as if in a movie.
of our “collective
unconscious?”
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Dissociative Identity Disorder (DID) DID Critics

Is a disorder in which a person exhibits two or more Critics argue that the diagnosis of DID increased in
distinct and alternating personalities, formerly called the late 20th century. And, DID has not been found in
multiple personality disorder. other countries.

Critics’ Arguments
1.  Role-playing by people open to a
therapist’s suggestion.
Lois Bernstein/ Gamma Liason

2. Learned response that reinforces

reductions in anxiety and avoidance
Chris Sizemore (DID)
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of responsibility. 36
On whom “Three Faces of Eve” was based. Herschel Walker (DID)

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 Mood Disorders Major Depressive Disorder
Emotional extremes of mood disorders come in two In terms of frequency, depression is the “common
principal forms. cold” of psychological disorders. In a year, 5.8% of
men and 9.5% of women report depression
worldwide (WHO, 2002).
1.  Major depressive disorder An Analogy:
2.  Bipolar disorder Blue mood Major Depressive Disorder

Is to: as Is to:
Gasping for air after a Chronic shortness of
hard run breath
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Major Depressive Disorder Dysthymic Disorder

Major depressive disorder occurs when signs of Dysthymic disorder lies between a blue mood and
depression last two weeks or more and are not major depressive disorder. It is a disorder
caused by drugs or medical conditions. characterized by daily depression lasting two years
or more.

Signs include:
1.  Lethargy and fatigue Blue Dysthymic Major Depressive
Mood Disorder Disorder
2.  Feelings of worthlessness
3.  Loss of interest in family & friends
4.  Loss of interest in activities
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Bipolar Disorder Bipolar Disorder

Formerly called manic-depressive disorder. An Many great writers, poets, and composers suffered
alternation between depression and mania signals from bipolar disorder. During their manic phase
bipolar disorder. creativity surged, but not during their depressed
phase.
Depressive Symptoms Manic Symptoms
George C. Beresford/ Hulton Getty Pictures Library

Earl Theissen/ Hulton Getty Pictures Library

Gloomy Elation
Withdrawn Euphoria
The Granger Collection
Bettmann/ Corbis

Inability to make decisions Desire for action

Tired Hyperactive
Whitman Wolfe Clemens Hemingway
Slowness of thought Multiple ideas
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 Explaining Mood Disorders Theory of Depression
Since depression is so prevalent worldwide, 3.  Gender differences
investigators want to develop a theory of depression
that will suggest ways to treat it.

Lewinsohn et al., (1985, 1995) note that a theory of

depression should explain the following:

1.  Behavioral and cognitive changes

2.  Common causes of depression

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Theory of Depression
New Theory of Depression
4.  Depressive episodes self-terminate.
•  Allen & Badcock (2003, Psych Bulletin)
5.  Depression is increasing, especially in the –  “Social Risk Hypothesis”
teens. •  Depressive state evolved as alerting mechanism when at risk of
social exclusion, necessary since Pleistocene period, because
social exclusion would equal death.
•  Mechanism works to minimize social exclusion by changing
social perception and social behavior in response to others’
behavior
Desiree Navarro/ Getty Images

–  This theory could address those points, but one problem

with this theory is that the depressive mechanism seems
to shut person down rather than energize them to
improve their inclusionary status.
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Post-partum depression

Suicide Biological Perspective

The most severe form of behavioral response to Genetic Influences: Mood disorders run in families.
depression is suicide. Each year some 1 million The rate of depression is higher in identical (50%)
people commit suicide worldwide. than fraternal twins (20%).

Suicide Statistics
Linkage analysis and
1.  National differences
association studies link
2.  Racial differences possible genes and dispositions
Jerry Irwin Photography

3.  Gender differences for depression.

4.  Age differences
5.  Other differences
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 Neurotransmitters & Depression The Depressed Brain

A reduction of PET scans show that brain energy consumption rises

norepinephrine and and falls with manic and depressive episodes.
serotonin has been Pre-synaptic
Neuron
found in depression.
Serotonin
Norepinephrine

Courtesy of Lewis Baxter an Michael E.

Phelps, UCLA School of Medicine
Drugs that alleviate Post-synaptic
mania reduce Neuron

norepinephrine.

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Social-Cognitive Perspective Depression Cycle

The social-cognitive perspective suggests that 1.  Negative stressful events.
depression arises partly from self-defeating beliefs 2.  Pessimistic explanatory style.
and negative explanatory styles. 3.  Hopeless depressed state.
4.  These hamper the way the
individual thinks and acts,
fueling personal rejection.

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Example Schizophrenia
If depression is the common cold of psychological
disorders, schizophrenia is the cancer.

Nearly 1 in a 100 suffer from schizophrenia, and

throughout the world over 24 million people suffer
from this disease (WHO, 2002).

Schizophrenia strikes young people as they mature

into adults. It affects men and women equally, but
Explanatory style plays a major role in becoming depressed. men suffer from it more severely than women.
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 Symptoms of Schizophrenia Disorganized & Delusional Thinking
The literal translation is “split mind.” A group of This morning when I was at Hillside [Hospital], I was making
severe disorders characterized by the following: a movie. I was surrounded by movie stars … I’m Marry
Poppins. Is this room painted blue to get me upset? My
grandmother died four weeks after my eighteenth birthday.”
  Disorganized and delusional
thinking. (Sheehan, 1982)
  Disturbed perceptions.
  Inappropriate emotions and Othermonologue
This forms of delusions
illustratesinclude, delusions
fragmented, of
bizarre
actions. persecutionthinking
(disorganized) (“someone
withisdistorted
followingbeliefs
me”) called
or
grandeur
delusions (“I Mary
(“I’m am a king”).
Poppins”).
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Disorganized & Delusional Thinking Disturbed Perceptions

Many psychologists believe disorganized thoughts A schizophrenic person may perceive things that are not
occur because of selective attention failure there (hallucinations). Frequently such hallucinations are
(fragmented and bizarre thoughts). auditory and to a lesser extent visual, somatosensory,
olfactory, or gustatory.

August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg

L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg

Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign

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Inappropriate Emotions & Actions Subtypes of Schizophrenia

A schizophrenic person may laugh at the news of Schizophrenia is a cluster of disorders. These
someone dying or show no emotion at all (apathy). subtypes share some features, but there are other
symptoms that differentiate these subtypes.

Patients with schizophrenia may

continually rub an arm, rock a
chair, or remain motionless for
hours (catatonia).

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Positive (present) and Negative (absent)
Chronic and Acute Schizophrenia
Symptoms
Schizophrenics have inappropriate symptoms When schizophrenia is slow to develop (chronic/
(hallucinations, disorganized thinking, deluded process) recovery is doubtful. Such schizophrenics
ways) that are not present in normal individuals usually display negative symptoms.
(positive symptoms).

Schizophrenics also have an absence of appropriate When schizophrenia rapidly develops (acute/
symptoms (apathy, expressionless faces, rigid reactive) recovery is better. Such schizophrenics
bodies) that are present in normal individuals usually show positive symptoms.
(negative symptoms).

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Subtypes Understanding Schizophrenia

Schizophrenia is a disease of the brain exhibited by the
symptoms of perception, affect, and cognition.

Brain Abnormalities
Dopamine Overactivity: Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain.

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Abnormal Brain Activity Abnormal Brain Morphology

Brain scans show abnormal activity in the frontal Schizophrenia patients may exhibit morphological
cortex, thalamus, and amygdala of schizophrenic changes in the brain like enlargement of fluid-filled
patients. Adolescent schizophrenic patients also ventricles.
have brain lesions.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
Imaging and Judith L. Rapport, National Institute of Mental Health
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro

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 Viral Infection Genetic Factors
Schizophrenia has also been observed in individuals The likelihood of an individual suffering from
who contracted a viral infection (flu) during the schizophrenia is 50% if their identical twin has the
middle of their fetal development. disease (Gottesman, 1991).
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
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Genetic Factors Psychological Factors

The following shows the prevalence of Psychological and environmental factors can trigger
schizophrenia in identical twins as seen in different schizophrenia if the individual is genetically
countries. predisposed (Nicols & Gottesman, 1983).

The genetically identical Genain

sisters suffer from schizophrenia.
Two of them suffered more than the
Courtesy of Genain Family

other two; thus there are contributing

environmental factors.

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Genain Sisters

Warning Signs Personality Disorders

Early warning signs of schizophrenia include: Personality disorders are
characterized by
1. A mother’s long lasting schizophrenia. inflexible and enduring
behavior patterns that
2. Birth complications, oxygen deprivation and low- impair social
birth weight.
functioning. They are
3. Short attention span and poor muscle coordination. usually without anxiety,
depression, or delusions.
4. Disruptive and withdrawn behavior.
5. Emotional unpredictability.
6. Poor peer relations and solo play.
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 Understanding Antisocial Personality
Antisocial Personality Disorder
Disorder
A disorder in which the person (usually men) exhibits a Like mood disorders and
lack of conscience for wrongdoing, even toward friends schizophrenia, antisocial
and family members. These characteristics are also personality disorder has
referred to as sociopaths or psychopaths. biological and psychological
reasons. Youngsters with
antisocial personality
characteristics, (even before
committing any crimes),
respond with lower levels of
stress hormones than others do
at their age.

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Understanding Antisocial Personality Cultural Influences Matter, Too.

Disorder Understanding Antisocial Personality
PET scans of 41 murderers revealed reduced activity in
Disorder
the frontal lobes. In a follow-up study repeat offenders The likelihood that one will commit a crime doubles when
had 11% less frontal lobe activity compared to normal childhood poverty is compounded with obstetrical complications
(Raine et al., 1999; 2000).
individuals (Raine et al., 1999; 2000).
University of Southern California
Courtesy of Adrian Raine,

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Normal Murderer

Rates of Psychological Disorders Rates of Psychological Disorders

The prevalence of psychological disorders across

different countries (WHO, 2004).

Depression 8% 77 78

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 Risk and Protective Factors Risk and Protective Factors
Risk and protective factors for mental disorders (WHO,
2004).

79 80

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