Chapter 18—Chapter 18—Psychological DisordersPsychological Disorders

Are these statements true or false?Are these statements true or false?1.1. Abnormal behaviors are always bizarre.Abnormal behaviors are always bizarre.

2.2. A clear distinction can be drawn between A clear distinction can be drawn between “normal” and “abnormal” behaviors.“normal” and “abnormal” behaviors.

3.3. As a group, former mental patients are As a group, former mental patients are unpredictable and dangerous.unpredictable and dangerous.

4.4. Mental disorders indicate a fundamental Mental disorders indicate a fundamental deficiency in personality, and are thus shameful.deficiency in personality, and are thus shameful.

5.5. Because mental illness is so common, there is Because mental illness is so common, there is reason to be fearful of one’s own vulnerability.reason to be fearful of one’s own vulnerability.

6.6. Geniuses are particularly prone to emotional Geniuses are particularly prone to emotional disorders.disorders.

7.7. Most mental disorders are incurable.Most mental disorders are incurable.

Using your group’s definition of Using your group’s definition of abnormal, decide if these are abnormal, decide if these are

examples of psychological disorders.examples of psychological disorders.

Z has a hard time getting out of bed three or four days every week. She has lost interest in playing basketball and seeing her friends, two activities

that she used to really enjoy.

X hears voices in her head telling her to do dangerous things.

R has a house that is neon green, a car that is olive green, and a mailbox that is forest

green. She wears only green clothing. When asked why she replies, “I like green.”

INTRODUCTION TO INTRODUCTION TO PSYCHOLOGICAL PSYCHOLOGICAL DISORDERSDISORDERS

Section 1Section 1

We will discuss the following We will discuss the following disorders…disorders…anxiety disordersanxiety disorderssomotoform disorderssomotoform disordersdissociative disordersdissociative disordersmood disordersmood disordersschizophreniaschizophreniapersonality disorderspersonality disorders

What is a psychological What is a psychological disorder?disorder?

behavior patterns or mental processes behavior patterns or mental processes that cause serious personal suffering or that cause serious personal suffering or interfere with a person’s ability to cope interfere with a person’s ability to cope with everyday lifewith everyday life

““normal” often means what is average normal” often means what is average for most people, therefore, “abnormal” for most people, therefore, “abnormal” is usually a deviation from the majorityis usually a deviation from the majority

How do we determine if a How do we determine if a psychological disorder is psychological disorder is

present?present?typicality- normality of a behavior or

mental process

maladaptivity-a maladaptive behavior is one that impairs

an individual’s ability to function in everyday life or is hazardous to oneself/others

emotional discomfort- feelings of helplessness, hopelessness and extreme sadness. Lose interest in everything

socially unacceptable behavior- violates a society’s accepted norms might indicate a psychological disorder

Culture-Bound Syndromes: Clusters of symptoms that define or describe an illness.

Does this man have a Does this man have a psychological disorder?psychological disorder?

Alan’s performance at work has suffered Alan’s performance at work has suffered because he has been drinking alcohol to because he has been drinking alcohol to excess. Several co-workers have suggested excess. Several co-workers have suggested that he seek help for his problem, but he that he seek help for his problem, but he thinks that they’re getting alarmed over thinks that they’re getting alarmed over nothing. “I just enjoy a good time once in a nothing. “I just enjoy a good time once in a while,” he says. while,” he says.

Monica has gone away to college and feels Monica has gone away to college and feels lonely, sad, and dejected. Her grades are lonely, sad, and dejected. Her grades are fine, and she gets along okay with the other fine, and she gets along okay with the other students in the dormitory, but inside she’s students in the dormitory, but inside she’s choked with gloom, hopelessness, and choked with gloom, hopelessness, and despair.despair.

Boris believes that he’s Napoleon reborn. Boris believes that he’s Napoleon reborn. He believes that he is destined to lead the He believes that he is destined to lead the U.S. military forces into a great battle to U.S. military forces into a great battle to recover California from space aliens.recover California from space aliens.

Natasha panics with anxiety whenever she Natasha panics with anxiety whenever she leaves her home. Her problem escalated leaves her home. Her problem escalated gradually until she was absent from work so gradually until she was absent from work so often that she was fired. She hasn’t been often that she was fired. She hasn’t been out of her house in nine months and is out of her house in nine months and is deeply troubled by her problem.deeply troubled by her problem.

The DSM IV (1994)The DSM IV (1994)

Diagnostic and Statistical Manual of Mental Diagnostic and Statistical Manual of Mental DisordersDisorders

18 different categories18 different categories categorized by observable signs and symptoms.categorized by observable signs and symptoms.

TYPES OF ANXIETY TYPES OF ANXIETY DISORDERSDISORDERS

Section 2Section 2

AnxietyAnxiety refers to a general state of dread or refers to a general state of dread or

uneasiness that occurs in response to a vague uneasiness that occurs in response to a vague or imagined dangeror imagined danger

different from fear, which is different from fear, which is a response to a a response to a real danger or threatreal danger or threat

Anxiety disorders are characterized by…Anxiety disorders are characterized by…1.1. nervousnessnervousness

2.2. inability to relaxinability to relax

3.3. concern about losing controlconcern about losing control

4.4. physical signs or symptomsphysical signs or symptoms such as: trembling; sweating; rapid heart rate; such as: trembling; sweating; rapid heart rate;

shortness of breath; increased blood pressure; shortness of breath; increased blood pressure; flushed face; feelings of faintness/light-flushed face; feelings of faintness/light-headednessheadedness

**Anxiety based disorders are among the most **Anxiety based disorders are among the most common.**common.**

Types of Anxiety DisordersTypes of Anxiety Disorders1.1. Phobic Disorders-Phobic Disorders-

a.a. phobiaphobia— “fear”— “fear”

b.b. simple phobiasimple phobia- persistent excessive or irrational - persistent excessive or irrational fear of a particular object or situation; most fear of a particular object or situation; most common of all anxiety disorderscommon of all anxiety disorders

to be diagnosed, the fear must to be diagnosed, the fear must lead to avoidance lead to avoidance behaviorbehavior that interferes with the affected person’s normal that interferes with the affected person’s normal lifelife

c.c. social phobiasocial phobia—characterized by persistent fear of —characterized by persistent fear of social situations in which one might be exposed to social situations in which one might be exposed to the close scrutiny of others and therefore might be the close scrutiny of others and therefore might be observed doing something embarrassing or observed doing something embarrassing or humiliatinghumiliating

Most common types of phobic Most common types of phobic disorders:disorders:

~zoophobia~zoophobia

(fear of animals)(fear of animals)

~claustrophobia~claustrophobia

(fear of enclosed spaces)(fear of enclosed spaces)

~acrophobia~acrophobia

(fear of heights)(fear of heights)

~arachnophobia~arachnophobia

(fear of spiders)(fear of spiders)

What do people fear?What do people fear?

MenMen

1.1. Fear of being Fear of being buried aliveburied alive

2.2. Fear of heightsFear of heights

3.3. Fear of snakesFear of snakes

4.4. Fear of drowningFear of drowning

5.5. Fear of public Fear of public speakingspeaking

WomenWomen

1.1. Fear of snakesFear of snakes

2.2. Fear of being Fear of being bound or tied upbound or tied up

3.3. Fear of being Fear of being buried aliveburied alive

4.4. Fear of heightsFear of heights

5.5. Fear of public Fear of public speakingspeaking

Do you experience…Do you experience…

acrophobia?acrophobia?mikrophobia?mikrophobia?aquaphobia?aquaphobia?ophidiophobia?ophidiophobia?arachnophobia?arachnophobia?claustrophobia?claustrophobia?

triskaidekaphobiatriskaidekaphobia??

uxoriphobia?uxoriphobia?Santa Santa

Claustrophobia?Claustrophobia?panaphobia?panaphobia?phobophobia?phobophobia?

Panic Disorder and AgoraphobiaPanic Disorder and Agoraphobia1.1. those with a panic disorder have those with a panic disorder have recurring/ recurring/

unexpectedunexpected panic attacks panic attacks

2.2. panic attackpanic attack—relatively short period of intense —relatively short period of intense fear or discomfort, characterized by fear or discomfort, characterized by

shortness of breath, dizziness, rapid heart rate, shortness of breath, dizziness, rapid heart rate, trembling, shaking, sweating, choking, nauseatrembling, shaking, sweating, choking, nausea

3.3. many who suffer from panic disorder also many who suffer from panic disorder also have have agoraphobiaagoraphobia, or the fear of , or the fear of places/ places/ situations where escape may be situations where escape may be difficultdifficult

Generalized Anxiety DisorderGeneralized Anxiety Disorderexcessive or unrealistic worry about life excessive or unrealistic worry about life

circumstances, for 6 or more monthscircumstances, for 6 or more monthsworries tend to focus on worries tend to focus on

finances,work, interpersonal problems, finances,work, interpersonal problems, accidents, illnessaccidents, illness

Obsessive-Compulsive Disorder Obsessive-Compulsive Disorder (OCD)(OCD)a.a. obsessions-obsessions- unwanted thoughts, unwanted thoughts,

ideas or mental images that occur over ideas or mental images that occur over and over; often senselessand over; often senseless

b.b. compulsions-compulsions- repetitive ritual repetitive ritual behaviors; often involve checking or behaviors; often involve checking or cleaningcleaning

c.c. people are usually aware that people are usually aware that obsessions are obsessions are unjustifiedunjustified which which distinguishes them from distinguishes them from delusionsdelusions

Obsessive-Compulsive Obsessive-Compulsive BehaviorsBehaviorscheckingchecking

““Did I lock the door? I know I checked, but I better check Did I lock the door? I know I checked, but I better check one more time. OK, it’s locked. I’m satisfied. But maybe I one more time. OK, it’s locked. I’m satisfied. But maybe I better open the door and start over. Lock it again.”better open the door and start over. Lock it again.”

washingwashing ““My hands are a little raw, but I can’t help feeling that My hands are a little raw, but I can’t help feeling that

they could be a little cleaner, that I might have missed a they could be a little cleaner, that I might have missed a spot where bacteria can grow.”spot where bacteria can grow.”

hoardinghoarding ““I don’t need the things that I save, I know that. But I don’t need the things that I save, I know that. But

what if I throw something away that I’ll need later? Of what if I throw something away that I’ll need later? Of course there are some things I know I won’t need. For course there are some things I know I won’t need. For instance, I’ve been giving myself haircuts lately so that I instance, I’ve been giving myself haircuts lately so that I can save the hair.”can save the hair.”

harmingharming ““I used to enjoy smoking, but I can’t help thinking that I used to enjoy smoking, but I can’t help thinking that

the matches I throw out will start a fire and hurt the matches I throw out will start a fire and hurt someone. Or when I’m in a car and I hit a bump, I someone. Or when I’m in a car and I hit a bump, I sometimes worry that I’ve hit someone.”sometimes worry that I’ve hit someone.”

countingcounting ““I do it mainly when I’m bored: I count ceiling tiles, I do it mainly when I’m bored: I count ceiling tiles,

floor tiles, letters on billboards and street signs. floor tiles, letters on billboards and street signs. Sometimes I’ll even divide the letters into groups of Sometimes I’ll even divide the letters into groups of three or four. I try to stop, but I can’t help myself.”three or four. I try to stop, but I can’t help myself.”

performing ritualsperforming rituals ““When I walk through a doorway, I need to make sure When I walk through a doorway, I need to make sure

that there are six inches between each shoulder and that there are six inches between each shoulder and the door jamb. If I walk through and I don’t think I’ve the door jamb. If I walk through and I don’t think I’ve accomplished this, I’ll walk out and try again.”accomplished this, I’ll walk out and try again.”

Stress DisordersStress Disorderspost-traumatic stress disorder-post-traumatic stress disorder- intense, intense,

persistent feelings of anxiety caused by persistent feelings of anxiety caused by traumatic experiencestraumatic experiences

Examples of traumatic events: rape, severe Examples of traumatic events: rape, severe childhood abuse, assault, accidents, nautral childhood abuse, assault, accidents, nautral disasters, wardisasters, war

Symptoms: flashbacks, nightmares, numbness or Symptoms: flashbacks, nightmares, numbness or feeling, avoidance, increased tensionfeeling, avoidance, increased tension

can occur can occur 6 or more months6 or more months after the event after the event and tend to last for and tend to last for years/decadesyears/decades

acute stress disorder-acute stress disorder- short-term symptoms short-term symptoms similar to PTSD; follows a traumatic eventsimilar to PTSD; follows a traumatic event

differs from PTSD because symptoms occur differs from PTSD because symptoms occur immediatelyimmediately and they last for and they last for a few days to a a few days to a few weeksfew weeks

DISSOCIATIVE DISORDERSDISSOCIATIVE DISORDERSSection 3Section 3

dissociationdissociation- separation of certain - separation of certain personality components or mental personality components or mental processes from conscious thoughtprocesses from conscious thought

ex: daydreamingex: daydreaming

When is it considered to be a sign of When is it considered to be a sign of a psychological disorder?a psychological disorder?when it occurs as a way to avoid when it occurs as a way to avoid

stressful events or feelingsstressful events or feelings

Have you ever experienced Have you ever experienced these dissociative these dissociative

experiences?experiences? Suddenly realizing, when you are driving Suddenly realizing, when you are driving

the car, that you don’t remember what the car, that you don’t remember what has happened during all or part of the has happened during all or part of the trip.trip.

Suddenly realizing, when you are Suddenly realizing, when you are listening to someone talk, that you did listening to someone talk, that you did not hear part or all of what the person not hear part or all of what the person said.said.

Having the experience of being in a Having the experience of being in a familiar place but finding it strange and familiar place but finding it strange and unfamiliar.unfamiliar.

Becoming so absorbed in watching Becoming so absorbed in watching television or a movie that you are television or a movie that you are unaware of other events happening unaware of other events happening around you.around you.

Talking out loud to yourself when you are Talking out loud to yourself when you are alone.alone.

Finding that you cannot remember Finding that you cannot remember whether or not you have just done whether or not you have just done something or perhaps had just thought something or perhaps had just thought about doing it.about doing it.

Feeling sometimes as if you were looking Feeling sometimes as if you were looking at the world through a fog such that at the world through a fog such that people and objects appear faraway or people and objects appear faraway or unclear.unclear.

SOMATOFORM SOMATOFORM DISORDERSDISORDERS

Section 4Section 4

somatizationsomatization- expression of - expression of psychological distress through psychological distress through physical symptomsphysical symptoms

What are the symptoms?What are the symptoms?psychological problems and unexplainable psychological problems and unexplainable

physical symptomsphysical symptoms

MOOD DISORDERSMOOD DISORDERSSection 5Section 5

What do all these people What do all these people have in common?have in common?

True or False?????True or False????? Every year more than 32,000 Americans Every year more than 32,000 Americans

commit suicide.commit suicide. Approximately once every 16 minutes a Approximately once every 16 minutes a

suicide occurs in the United States.suicide occurs in the United States. More women than men attempt suicide.More women than men attempt suicide. Of those who attempt suicide, more men Of those who attempt suicide, more men

than women succeed.than women succeed. Suicide is most common among the elderly.Suicide is most common among the elderly. Suicide is the second most common cause Suicide is the second most common cause

of death among college students.of death among college students. Individuals who threaten suicide or make an Individuals who threaten suicide or make an

unsuccessful attempt usually are serious.unsuccessful attempt usually are serious.

Approximately 70% of suicide victims threaten to Approximately 70% of suicide victims threaten to kill themselves sometime during the three kill themselves sometime during the three months preceding the suicide.months preceding the suicide.

Suicide rates among youth have nearly tripled Suicide rates among youth have nearly tripled since the 1950’s.since the 1950’s.

A firearm is used in over 60% of all suicides.A firearm is used in over 60% of all suicides. Fewer than 5% of elderly suicide victims had Fewer than 5% of elderly suicide victims had

been diagnosed with a terminal illness when they been diagnosed with a terminal illness when they committed suicide.committed suicide.

Nevada consistently has the highest suicide rate Nevada consistently has the highest suicide rate in the United States.in the United States.

States with stricter gun control laws have lower States with stricter gun control laws have lower suicide rates.suicide rates.

The suicide rate for children ages 10 to 14 more The suicide rate for children ages 10 to 14 more than doubled between 1985 and 2000.than doubled between 1985 and 2000.

Edvard MunchEdvard Munch

born December 12, 1863—Loten, Norway born December 12, 1863—Loten, Norway Norwegian painter and printmakerNorwegian painter and printmaker played an important role in the played an important role in the

development of German expressionismdevelopment of German expressionism parents, brother and sister died when he parents, brother and sister died when he

was youngwas young his work often displayed themes such as his work often displayed themes such as

misery, sickness, deathmisery, sickness, death

““Sickness and Sickness and insanity and death insanity and death

were the black angels were the black angels that hovered over my that hovered over my cradle and have since cradle and have since

followed me followed me throughout my life.”throughout my life.”

Self-Portrait with Burning Cigarette,

1895

The Scream (or The Cry),

1893

Death in the Sickroom, 1895

Two categories of mood disorders:

•depression-typically involves feelings of helplessness, hopelessness, worthlessness, guilt, great sadness

•bipolar disorder-involves a cycle of mood changes from depression to wild elation and back again

Types of Mood Disorder:Types of Mood Disorder:Major Depression Major Depression To be diagnosed, you must exhibit 5 of the To be diagnosed, you must exhibit 5 of the

following 9 symptoms for at least 2 weeks, nearly following 9 symptoms for at least 2 weeks, nearly every day.every day.

One of the 5 symptoms must be #1 or #2One of the 5 symptoms must be #1 or #21.1. persistent depressed mood for most of the daypersistent depressed mood for most of the day

2.2. loss of interest or pleasure in all, or almost all loss of interest or pleasure in all, or almost all

activitiesactivities

The remaining 4 symptoms can be any The remaining 4 symptoms can be any of these…of these…

3. significant weight loss/gain due to changes in 3. significant weight loss/gain due to changes in

appetiteappetite

4. sleeping more or less than usual4. sleeping more or less than usual

5. speeding up or slowing down of physical and 5. speeding up or slowing down of physical and

emotional reactionsemotional reactions

6. fatigue or loss of energy6. fatigue or loss of energy

7. feelings of worthlessness or unfounded guilt7. feelings of worthlessness or unfounded guilt

8. reduced ability to concentrate or make meaningful 8. reduced ability to concentrate or make meaningful

decisionsdecisions

9. recurrent thoughts of death or suicide9. recurrent thoughts of death or suicide

Bipolar DisorderBipolar Disorder Characterized by dramatic ups and downs in Characterized by dramatic ups and downs in

moodmood

manic phasemanic phase- characterized by a mood that is - characterized by a mood that is persistently and abnormally elevated and by persistently and abnormally elevated and by some of the following: some of the following: inflated self-esteem; inability to sit still or sleep inflated self-esteem; inability to sit still or sleep

restfully; pressure to keep talking and switching restfully; pressure to keep talking and switching from topic to topic; racing thoughts; difficulty from topic to topic; racing thoughts; difficulty concentratingconcentrating

Robert, a dentist, awoke one morning with the idea that he was the most gifted dental surgeon in his tristate area.

He decided that he should try to provide services to as many people as possible, so that more people could

benefit from his talents. Thus, he decided to remodel his two-chair dental office, installing 20 booths so that he could simultaneously attend to 20 patients. That same

day he drew up plans for this arrangement, telephoned a number of remodelers, and invited bids for the work.

Later that day, impatient to get rolling on his remodeling, he rolled up his sleeves, got himself a sledgehammer, and

began to knock down the walls In his office. Annoyed when that didn’t go so well, he smashed his dental tools, washbasins, and X-ray equipment. Later, Robert’s wife became concerned about his behavior and summoned

two of her adult daughters for assistance. The daughters responded quickly, arriving at the family home with their

husbands. In the ensuing discussion, Robert—after bragging about his sexual prowess—made advances toward his daughters. He had to be subdued by their

husbands. (Adapted from Kleinmuntz, 1980, p. 309)

Characteristics

Manic Episode Depressive Episode

Emotional elated, euphoric, very sociable, impatient at any hindrance

gloomy, hopeless, socially withdrawn, irritable

Cognitive characterized by racing thoughts, flight of ideas, desire for action, and impulsive behavior; talkative, self-confident; experiencing delusions of grandeur

characterized by slowness of thought processes, obsessive worrying, inability to make decisions, negative self-image, self-blame and delusions of guilt and disease

Motor hyperactive, tireless, requiring less sleep than usual, showing increased sex drive and fluctuating appetite

less active, tired, experiencing difficulty in sleeping, showing decreased sex drive and decreased appetite

Personality DisordersPersonality DisordersSection 7Section 7

What is a personality disorder?What is a personality disorder? patterns of inflexible traits that disrupt patterns of inflexible traits that disrupt

social life or work and/or distress the social life or work and/or distress the affected individualaffected individual

What is the difference between personality What is the difference between personality disorders and other psychological disorders and other psychological

disorders?disorders? other disorders are “episodes of illness other disorders are “episodes of illness

that an individual experiences”; P.D. are that an individual experiences”; P.D. are “enduring traits that are major “enduring traits that are major components of the individual’s components of the individual’s personality”personality”

Types of Personality Types of Personality DisordersDisorders

Paranoid Personality Disorder:Paranoid Personality Disorder:

people tend to be distrustful and people tend to be distrustful and suspicious of others; perceive others’ suspicious of others; perceive others’ behavior is threatening/insultingbehavior is threatening/insulting

Schizoid Personality Disorder:Schizoid Personality Disorder:

no interest in relationships with other no interest in relationships with other people; lack normal emotional people; lack normal emotional responsivenessresponsiveness

Antisocial Personality Disorder:Antisocial Personality Disorder:

behavior pattern of disregard for/ behavior pattern of disregard for/ violation of the rights of others; does violation of the rights of others; does not feel guilt or remorsenot feel guilt or remorse

(less than 1% to almost 10% of the (less than 1% to almost 10% of the population)population)

Avoidant Personality Disorder:Avoidant Personality Disorder:

desire relationships, but prevented desire relationships, but prevented from forming them by tremendous from forming them by tremendous fear of disapproval of othersfear of disapproval of others

SchizophreniaSchizophreniaSection 6Section 6

““schism” or “split mind”schism” or “split mind”

usually considered most usually considered most seriousserious

characterized by a loss characterized by a loss of contact with realityof contact with reality

usually first appears in usually first appears in young adulthoodyoung adulthood

often worsens over timeoften worsens over time affects approximately affects approximately

1% of the world’s 1% of the world’s populationpopulation

characterized by characterized by disorganized and delusional disorganized and delusional

thinkingthinkingdisturbed perceptions disturbed perceptions inappropriate emotions and inappropriate emotions and

actionsactions

Paranoid SchizophreniaParanoid Schizophrenia

delusions or hallucinations relating to delusions or hallucinations relating to a single themea single theme

less disordered thoughts and bizarre less disordered thoughts and bizarre behavior, but may be agitated, behavior, but may be agitated, confused, afraidconfused, afraid

Disorganized SchizophreniaDisorganized Schizophrenia

incoherent in their thought and incoherent in their thought and speech; disorganized in their speech; disorganized in their behaviorbehavior

fragmented and unconnected fragmented and unconnected delusions and hallucinationsdelusions and hallucinations

emotionless/inappropriate emotionsemotionless/inappropriate emotionsmay neglect appearance/hygienemay neglect appearance/hygiene

Catatonic SchizophreniaCatatonic Schizophrenia

disturbance of disturbance of movementmovement

may hold unusual, may hold unusual, uncomfortable uncomfortable body positions for body positions for long periods of long periods of timetime

How do we treat How do we treat psychological disorders?psychological disorders?

Two categories of therapy:Two categories of therapy:

1. 1. psychotherapypsychotherapy-involves verbal -involves verbal interactions between a trained interactions between a trained professional and person seeking helpprofessional and person seeking help

2. 2. biologically basedbiologically based- involves using - involves using drugs and other medical procedures to drugs and other medical procedures to treat psychological disorderstreat psychological disorders