General PsychologyGeneral Psychology

Chapter 12

The Psychological Disorders

Chapter 12

The Psychological Disorders

What is “Abnormal”?What is “Abnormal”?

Abnormal refers to maladaptive affects, behaviors, and/or cognitions that are at odds with social expectations and result in distress or discomfort

Abnormal refers to maladaptive affects, behaviors, and/or cognitions that are at odds with social expectations and result in distress or discomfort

Classifying Abnormal ReactionsClassifying Abnormal Reactions

Diagnosis – act of recognizing a disorder on the basis of a specified set of symptoms

The Diagnostic and Statistical Manual of Mental Disorders (DSM)

DSM-IV lists 297 different diagnostic categories

Diagnosis – act of recognizing a disorder on the basis of a specified set of symptoms

The Diagnostic and Statistical Manual of Mental Disorders (DSM)

DSM-IV lists 297 different diagnostic categories

Table 12.1: The multiaxial classification system of the DSM-IV-TR.Table 12.1: The multiaxial classification system of the DSM-IV-TR.

Problems with Classification & Labeling

Problems with Classification & Labeling

Comorbidity – occurrence of two or more disorders in the same individual Nearly 80% will have 2 or more disorders Many psychological disorders are also

comorbid with physical illness

Comorbidity – occurrence of two or more disorders in the same individual Nearly 80% will have 2 or more disorders Many psychological disorders are also

comorbid with physical illness

A Word on “Insanity”A Word on “Insanity”

Insanity: One did not know or fully understand the

consequences of his or her actions at a given time

Could not discern the difference between right and wrong

And was unable to exercise control over his or her actions at the time a crime was committed

Insanity: One did not know or fully understand the

consequences of his or her actions at a given time

Could not discern the difference between right and wrong

And was unable to exercise control over his or her actions at the time a crime was committed

A Word on “Insanity”A Word on “Insanity”

Competence – whether one is in control of his or her mental and intellectual functions to understand courtroom procedures and aid in his or her own defense

Competence – whether one is in control of his or her mental and intellectual functions to understand courtroom procedures and aid in his or her own defense

A Few Cautions…A Few Cautions…

“Abnormal” and “normal” are not 2 distinct categories!

Abnormal does not mean dangerous People jailed for violent crimes are no more likely to

have a psychological disorder than not-jailed persons Persons with psychological disorders are more likely

(than persons without) to be victims of violent crimes

Abnormal also does not mean BAD!

“Abnormal” and “normal” are not 2 distinct categories!

Abnormal does not mean dangerous People jailed for violent crimes are no more likely to

have a psychological disorder than not-jailed persons Persons with psychological disorders are more likely

(than persons without) to be victims of violent crimes

Abnormal also does not mean BAD!

Anxiety DisordersAnxiety Disorders

Anxiety – feeling of general apprehension or dread accompanied by predictable physiological changes

Anxiety – feeling of general apprehension or dread accompanied by predictable physiological changes

Anxiety DisordersAnxiety Disorders

Generalized anxiety disorder – major symptom is distressing, felt anxiety Anxiety may be intense or diffuse Anxiety can cause substantial interference

Generalized anxiety disorder – major symptom is distressing, felt anxiety Anxiety may be intense or diffuse Anxiety can cause substantial interference

Anxiety DisordersAnxiety Disorders

Panic Disorder – major symptom is more acute: a recurrent, unpredictable, unprovoked onset of sudden, intense anxiety, or a “panic attack” Comorbid with depression = higher rate of

suicide

Panic Disorder – major symptom is more acute: a recurrent, unpredictable, unprovoked onset of sudden, intense anxiety, or a “panic attack” Comorbid with depression = higher rate of

suicide

Anxiety DisordersAnxiety Disorders

Phobic disorder – persistent and excessive fear of some object, activity, or situation that consistently leads a person to avoid that object, activity, or situation Specific phobia Social phobia Agoraphobia

Phobic disorder – persistent and excessive fear of some object, activity, or situation that consistently leads a person to avoid that object, activity, or situation Specific phobia Social phobia Agoraphobia

Table 12.2: A sample of phobias.Table 12.2: A sample of phobias.

Obsessive-Compulsive DisorderObsessive-Compulsive Disorder

OCD – anxiety disorder characterized by a pattern of recurrent obsessions and compulsions Obsessions – ideas or thoughts that

involuntarily and constantly intrude into awareness

Compulsions – constantly intruding, repetitive, behaviors

OCD – anxiety disorder characterized by a pattern of recurrent obsessions and compulsions Obsessions – ideas or thoughts that

involuntarily and constantly intrude into awareness

Compulsions – constantly intruding, repetitive, behaviors

Table 12.3: A few of the more common obsessions and compulsions found in patients with OCR. Table 12.3: A few of the more common obsessions and compulsions found in patients with OCR.

Posttraumatic Stress DisorderPosttraumatic Stress Disorder

PTSD – distressing symptoms that arise some time after the experience of a highly traumatic event Must have experienced, witnessed, or been

confronted with an event that involves actual or threatened death or serious injury

Responses involve fear, helplessness, and horror

Flashbacks, Avoidance, Increased Arousal

PTSD – distressing symptoms that arise some time after the experience of a highly traumatic event Must have experienced, witnessed, or been

confronted with an event that involves actual or threatened death or serious injury

Responses involve fear, helplessness, and horror

Flashbacks, Avoidance, Increased Arousal

Somatoform DisordersSomatoform Disorders

Somatoform disorders – involve physical, bodily symptoms or complaints with no known medical or biological cause for the symptoms

Somatoform disorders – involve physical, bodily symptoms or complaints with no known medical or biological cause for the symptoms

Somatoform DisordersSomatoform Disorders

Hypochondriasis – preoccupied with the fear of a serious disease

Somatization disorder – several, recurrent, long-lasting complaints about physical symptoms for which there is no cause

Conversion disorder – loss or altering of physical functioning that suggests a physical disorder, but without medical explanation. La belle indifference

Hypochondriasis – preoccupied with the fear of a serious disease

Somatization disorder – several, recurrent, long-lasting complaints about physical symptoms for which there is no cause

Conversion disorder – loss or altering of physical functioning that suggests a physical disorder, but without medical explanation. La belle indifference

Dissociative DisordersDissociative Disorders

Dissociative disorders – person seeks to escape from some aspect of life or personality seen as the source of stress, discomfort, or anxiety

Dissociative disorders – person seeks to escape from some aspect of life or personality seen as the source of stress, discomfort, or anxiety

Dissociative DisordersDissociative Disorders

Dissociative amnesia – inability to recall important personal information too extensive to be explained by ordinary forgetfulness Dissociative fugue – amnesic forgetfulness is

accompanied by a change of location

Dissociative amnesia – inability to recall important personal information too extensive to be explained by ordinary forgetfulness Dissociative fugue – amnesic forgetfulness is

accompanied by a change of location

Dissociative Identity DisorderDissociative Identity Disorder

Major symptom is the existence within the same person of two or more distinct personalities or traits Dramatic and extreme personality changes Take place without warning or provocation Which personality will be dominant cannot be

predicted or controlled Child/sexual abuse

Major symptom is the existence within the same person of two or more distinct personalities or traits Dramatic and extreme personality changes Take place without warning or provocation Which personality will be dominant cannot be

predicted or controlled Child/sexual abuse

Personality DisordersPersonality Disorders

Long-lasting patterns of perceiving, relating to, and thinking about the environment and oneself that are maladaptive and inflexible and cause either impaired functioning or distress

Long-lasting patterns of perceiving, relating to, and thinking about the environment and oneself that are maladaptive and inflexible and cause either impaired functioning or distress

Personality DisordersPersonality Disorders

Cluster I – includes disorders of odd or eccentric reactions, such as: Paranoid personality disorder – extreme

sensitivity, unjustified suspiciousness, envy, and mistrust of others

Schizoid personality disorder – inability to form, and an indifference to, personal relationships

Cluster I – includes disorders of odd or eccentric reactions, such as: Paranoid personality disorder – extreme

sensitivity, unjustified suspiciousness, envy, and mistrust of others

Schizoid personality disorder – inability to form, and an indifference to, personal relationships

Personality DisordersPersonality Disorders

Cluster II – disorders of dramatic, emotional, or erratic reactions, such as: Histrionic personality disorder – someone

who is overly dramatic, reactive, and demonstrates intensely expressed behavior

Narcissistic personality disorder – reflects a grandiose exaggeration of self-importance, a need for attention or admiration, and a tendency to set unrealistic goals

Cluster II – disorders of dramatic, emotional, or erratic reactions, such as: Histrionic personality disorder – someone

who is overly dramatic, reactive, and demonstrates intensely expressed behavior

Narcissistic personality disorder – reflects a grandiose exaggeration of self-importance, a need for attention or admiration, and a tendency to set unrealistic goals

Personality DisordersPersonality Disorders

Cluster III – disorders involving anxiety and fearfulness, such as: Avoidant personality disorder – an over-sensitivity to

the possibility of being rejected by others and an unwillingness to enter into relationships for fear of being rejected

Dependent personality disorder – allowing and seeking others to dominate and assume responsibility for action; has poor self-image and lacks self-confidence

Cluster III – disorders involving anxiety and fearfulness, such as: Avoidant personality disorder – an over-sensitivity to

the possibility of being rejected by others and an unwillingness to enter into relationships for fear of being rejected

Dependent personality disorder – allowing and seeking others to dominate and assume responsibility for action; has poor self-image and lacks self-confidence

Personality DisorderPersonality Disorder

Antisocial personality disorder – an exceptional lack of regard for the rights and properties of others, accompanied by impulsive, often criminal, behaviors Psychopaths/Sociopaths Symptoms include deceit and manipulation of

others without guilt or regret More common among persons of low-SES

Antisocial personality disorder – an exceptional lack of regard for the rights and properties of others, accompanied by impulsive, often criminal, behaviors Psychopaths/Sociopaths Symptoms include deceit and manipulation of

others without guilt or regret More common among persons of low-SES

Alzheimer’s DementiaAlzheimer’s Dementia

Dementia – condition characterized by the marked loss of intellectual abilities

Alzheimer’s disease – slow deterioration of intellectual functioning accompanied by personality changes Physical disease Abnormal changes in brain tissue

Dementia – condition characterized by the marked loss of intellectual abilities

Alzheimer’s disease – slow deterioration of intellectual functioning accompanied by personality changes Physical disease Abnormal changes in brain tissue

Table 12.4: Ten warning signs of Alzheimer’s disease.Table 12.4: Ten warning signs of Alzheimer’s disease.

Alzheimer’s DementiaAlzheimer’s Dementia

Risk Factors for Alzheimer’s: There is a genetic predisposition! Obesity Receiving a head injury

Risk Factors for Alzheimer’s: There is a genetic predisposition! Obesity Receiving a head injury

Alzheimer’s DementiaAlzheimer’s Dementia

Possibly reduces chances of Alzheimer’s: Using folic acid in one’s diet Engaging in cognitively challenging activities

in old age

Possibly reduces chances of Alzheimer’s: Using folic acid in one’s diet Engaging in cognitively challenging activities

in old age

Mood DisordersMood Disorders

Major depression – diagnosis for a constellation of symptoms that includes feeling sad, low, and hopeless, coupled with a loss of pleasure or interest in most normal activities

Dysthymia – mild case of major depression, but it tends to be more chronic, or continuous

Major depression – diagnosis for a constellation of symptoms that includes feeling sad, low, and hopeless, coupled with a loss of pleasure or interest in most normal activities

Dysthymia – mild case of major depression, but it tends to be more chronic, or continuous

Mood DisordersMood Disorders

Bipolar Disorder – episodes of depression are occasionally interspersed with episodes of mania

Mania – elevated mood with feelings of euphoria or irritability and increased levels of activity

Bipolar Disorder – episodes of depression are occasionally interspersed with episodes of mania

Mania – elevated mood with feelings of euphoria or irritability and increased levels of activity

The Roots of DepressionThe Roots of Depression

There is evidence for a genetic, or inherited, predisposition to bipolar mood disorder

Researchers suspect that there is a genetic basis for major depression, as well

There is evidence for a genetic, or inherited, predisposition to bipolar mood disorder

Researchers suspect that there is a genetic basis for major depression, as well

The Roots of DepressionThe Roots of Depression

Diathesis-stress model – the expression of disordered behaviors (particularly depression) results from the interaction of an inherited predisposition and the experience of stress or trauma Biogenic amines Brain anatomy

Diathesis-stress model – the expression of disordered behaviors (particularly depression) results from the interaction of an inherited predisposition and the experience of stress or trauma Biogenic amines Brain anatomy

The Roots of DepressionThe Roots of Depression

Psychological Factors These could include learning experiences,

situational stress, and cognitive factors

Freud believed that depression was a reflection of early childhood experiences that leads to anger directed inwardly

Psychological Factors These could include learning experiences,

situational stress, and cognitive factors

Freud believed that depression was a reflection of early childhood experiences that leads to anger directed inwardly

SchizophreniaSchizophrenia

Involves a distortion of reality and a retreat from other people.

Three dimensions of symptoms:1. Negative symptoms – emotional and social

withdrawal, reduced energy and motivation, apathy and poor attention

Involves a distortion of reality and a retreat from other people.

Three dimensions of symptoms:1. Negative symptoms – emotional and social

withdrawal, reduced energy and motivation, apathy and poor attention

SchizophreniaSchizophrenia

2. Positive symptoms:a. Hallucinations – false perceptions

b. Delusions – false beliefs

3. Positive disorganized symptoms – disorders of thinking and speech, bizarre behaviors, inappropriate affect

2. Positive symptoms:a. Hallucinations – false perceptions

b. Delusions – false beliefs

3. Positive disorganized symptoms – disorders of thinking and speech, bizarre behaviors, inappropriate affect

Schizophrenia:Correlates of Negative

Symptoms

Schizophrenia:Correlates of Negative

Symptoms Structural abnormalities in the brain Clearer genetic basis More severe complications at birth A lower educational level Poorer adjustment patterns before onset Poorer prognosis

Structural abnormalities in the brain Clearer genetic basis More severe complications at birth A lower educational level Poorer adjustment patterns before onset Poorer prognosis

Schizophrenia:Correlates of Positive Symptoms

Schizophrenia:Correlates of Positive Symptoms

Excesses of the neurotransmitter dopamine Relatively normal brain configuration Severe disruptions in early family life Overactivity and aggressiveness in

adolescence Relatively good response to treatment

Excesses of the neurotransmitter dopamine Relatively normal brain configuration Severe disruptions in early family life Overactivity and aggressiveness in

adolescence Relatively good response to treatment

Table 12.5: Classifying schizophrenia on the basis of negative and positive symptoms.Table 12.5: Classifying schizophrenia on the basis of negative and positive symptoms.

SchizophreniaSchizophrenia

DSM-IV Subtypes: Catatonic Disorganized Paranoid Undifferentiated

DSM-IV Subtypes: Catatonic Disorganized Paranoid Undifferentiated

Table 12.6: Types of schizophrenia described in the DSM-IV-TR.Table 12.6: Types of schizophrenia described in the DSM-IV-TR.

What Causes Schizophrenia?What Causes Schizophrenia?

It has a genetic basis It is a disease of the brain Excess dopamine Diathesis-stress model Consensus that it is a complex disease of

the brain, not a “disorder of living”

It has a genetic basis It is a disease of the brain Excess dopamine Diathesis-stress model Consensus that it is a complex disease of

the brain, not a “disorder of living”

Spotlight: Disorder, Race, and Gender

Spotlight: Disorder, Race, and Gender

African Americans are: More likely to suffer from phobias and

somatoform disorders than are Caucasian Americans

Less likely to suffer from depression, dysthymia, obsessive-compulsive, and anti-social personality disorder

Less likely to seek professional help

African Americans are: More likely to suffer from phobias and

somatoform disorders than are Caucasian Americans

Less likely to suffer from depression, dysthymia, obsessive-compulsive, and anti-social personality disorder

Less likely to seek professional help

Spotlight: Disorder, Race, and Gender

Spotlight: Disorder, Race, and Gender

Asian Americans report higher incidents of social anxiety and social phobias

When Native Americans experience a psychological disturbance, it is usually depression, posttraumatic stress disorder, or alcohol-related.

Asian Americans report higher incidents of social anxiety and social phobias

When Native Americans experience a psychological disturbance, it is usually depression, posttraumatic stress disorder, or alcohol-related.

Spotlight: Disorder, Race, and Gender

Spotlight: Disorder, Race, and Gender

Gender: Women are significantly more likely to be

diagnosed with depression Men are more likely to be diagnosed with

antisocial personality disorder

Gender: Women are significantly more likely to be

diagnosed with depression Men are more likely to be diagnosed with

antisocial personality disorder