table of contents exit chapter 16 psychological disorders

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Chapter 16

Psychological Disorders


What is Normal?

Psychopathology: Scientific study of mental, emotional, and behavioral disordersSubjective Discomfort: Feelings of anxiety, depression, or emotional distressStatistical Abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depressionSocial Nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior


What is Normal? (cont.)

Situational Context: Social situation, behavioral setting, or general circumstances in which an action takes place Is it normal to walk around strangers

naked? If you are in a locker room and in the shower area, yes!

Cultural Relativity: Judgments are made relative to the values of one’s culture


Fig. 16.1 The number of people displaying a personal characteristic may help define what is statistically abnormal. Social non-conformity does not automatically indicate psychopathology.


Fig. 16.2 This MRI scan of a human brain (viewed from the top) reveals a tumor (dark spot). Mental disorders sometimes have organic causes of this sort. However, in many instances no organic damage can be found.

© Scott Camazine/Photo Researchers


Clarifying and Defining Abnormal Behavior (Mental Illness)

Maladaptive Behavior: Behavior that makes it difficult to function, to adapt to the environment, and to meet everyday demands

Mental Disorder: Significant impairment in psychological functioning

Those with mental illness lose the ability to adequately control thoughts, behaviors, or feelings


Clarifying and Defining Abnormal Behavior

(Mental Illness) (cont.)Psychotic Disorder: Severe psychiatric disorder characterized by hallucinations and delusions, social withdrawal, and a move away from realityOrganic Mental Disorder: Mental or emotional problem caused by brain pathology (i.e., brain injuries or diseases)Substance Related Disorders: Abuse or dependence on a mind- or mood-altering drug, like alcohol or cocaine Person cannot stop using the substance and may suffer

withdrawal symptoms if they do


Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)

Mood Disorder: Disturbances in mood or emotions, like depression or mania

Anxiety Disorder: Feelings of fear, apprehension, anxiety, and behavior distortions


Fig. 16.5 The Mad Hatter, from Lewis Carroll’s Alice’s Adventures in Wonderland. History provides numerous examples of psychosis caused by toxic chemicals. Carroll’s Mad Hatter character is modeled after an occupational disease of the eighteenth and nineteenth centuries. In that era, hatmakers were heavily exposed to mercury used in the preparation of felt. Consequently, many suffered brain damage and became psychotic, or “mad” (Kety, 1979).

© Bettmann/CORBIS



Somatoform Disorder: Physical symptoms that mimic disease or injury (blindness, anesthesia) for which there is no identifiable physical causeDissociative Disorder: Temporary amnesia, multiple identity, or depersonalization (like being in a dream world, feeling like a robot, feeling like you are outside of your body)Personality Disorder: Deeply ingrained, unhealthy, maladaptive personality patterns



Sexual and Gender Identity Disorder: Problems with sexual identity, deviant sexual behavior, or sexual adjustment

Neurosis: Archaic; once used to refer to anxiety, somatoform, and dissociative disorders, also used to refer to some kinds of depression


General Risk Factors for Contracting Mental Illness

Social Conditions: Poverty, homelessness, overcrowding, stressful living conditionsFamily Factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problemsPsychological Factors: Low intelligence, stress, learning disordersBiological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability


InsanityDefinition: A legal term; refers to an inability to manage one’s affairs or to be aware of the consequences of one’s actions Those judged insane (by a court of law) are not held legally

accountable for their actions Can be involuntarily committed to a psychiatric hospital Some movements today are trying to abolish the insanity plea

and defense; desire to make everyone accountable for their actions

How accurate is the judgment of insanity?

Expert Witness: Person recognized by a court of law as being qualified to give expert testimony on a specific topic May be psychologist, psychiatrist, and so on


Personality Disorders: Antisocial Personality Disorder (APD)

Definition: A person who lacks a conscience (superego?); typically emotionally shallow, impulsive, selfish, and manipulative toward others Oftentimes called psychopaths or sociopaths

Many are delinquents or criminals, but many are NOT crazed murderers displayed on television Create a good first impression and are often charmingCheat their way through life (e.g., Dr. Michael Swango, Scott Peterson)


APD: Causes and Treatments

Possible Causes:Childhood history of emotional deprivation,

neglect, and physical abuseUnderarousal of the brain

Very difficult to effectively treat; will likely lie, charm, and manipulate their way through therapy


Fig. 16.3 Using PET scans, Canadian psychologist Robert Hare found that the normally functioning brain (left) lights up with activity when a person sees emotion-laden words such as “maggot” or “cancer.” But the brain of a psychopath (right) remains inactive, especially in areas associated with feelings and self-control. When Dr. Hare showed the bottom image to several neurologists, one asked, “Is this person from Mars?” (Images courtesy of Robert Hare.)

© Robert Hare


CNN – Serial Killer Motives


Anxiety-Based Disorders

Anxiety: Feelings of apprehension, dread, or uneasiness

Adjustment Disorders: When ordinary stress causes emotional disturbance and pushes people beyond their ability to effectively cope Usually suffer sleep disturbances, irritability, and

depression Examples: Grief reactions, lengthy physical illness,

unemployment


Anxiety-Based Disorders (cont.)

Generalized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety

Free-Floating Anxiety: Anxiety that is very general and persuasive


CNN – Anxiety Disorders in Kids


Panic DisordersPanic Disorder (without Agoraphobia): A chronic state of anxiety with brief moments of sudden, intense, unexpected panic (panic attack) Panic Attack: Feels like one is having a heart

attack, going to die, or is going insane Symptoms include vertigo, chest pain, choking,

fear of losing control

Panic Disorder (with Agoraphobia): Panic attacks and sudden anxiety still occur, but with agoraphobia


Agoraphobia

Agoraphobia (with Panic Disorder): Intense, irrational fear that a panic attack will occur in a public place or in an unfamiliar situation Intense fear of leaving the house or entering unfamiliar

situations Can be very crippling Literally means fear of open places or market (agora)

Agoraphobia (without Panic Disorder): Fear that something extremely embarrassing will happen away from home or in an unfamiliar situation


Specific Phobias

Irrational, persistent fears, anxiety, and avoidance that focus on specific objects, activities, or situations

People with phobias realize that their fears are unreasonable and excessive, but they cannot control them


Social Phobia

Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public)Barbra Streisand, Woody Allen perhaps?


Obsessive-Compulsive Disorder (OCD)

Extreme preoccupation with certain thoughts and compulsive performance of certain behaviorsObsession: Recurring images or thoughts that a person cannot prevent Cause anxiety and extreme discomfort Enter into consciousness against the person’s will Most common: Being dirty, wondering if you performed an

action (turned off the stove), or violence (hit by a car)

Compulsion: Irrational acts that person feels compelled to repeat against his/her will Help to control anxiety created by obsessions Checkers and cleaners


Stress DisordersOccur when stresses outside range of normal human experience cause major emotional disturbance Symptoms: Reliving traumatic event repeatedly, avoiding stimuli

associated with the event, and numbing of emotions

Acute Stress Disorder: Psychological disturbance lasting up to one month following stresses from a traumatic eventPost Traumatic Stress Disorder (PTSD): Lasts more than one month after the traumatic event has occurred; may last for years Typically associated with combat and violent crimes (rape,

assault, etc.) Terrorist attacks on September 11th, 2001, likely led to an

increase of PTSD


CNN – Mental Health and Traumatic Events


CNN - Prostitution


Dissociative Disorders

Dissociative Amnesia: Inability to recall one’s name, address, or past

Dissociative Fugue: Sudden travel away from home and confusion about personal identity


Dissociative Identity Disorder (DID)

Person has two or more distinct, separate identities or personality states; previously known as Multiple Personality Disorder “Sybil” or “The Three Faces of Eve” are good

examples Often begins with horrific childhood experiences

(e.g., abuse, molestation, etc.) Therapy often makes use of hypnosis Goal: Integrate and fuse identities into single,

stable personality


Somatoform Disorders

Hypochondriasis: Person is preoccupied with having a serious illness or disease Interpret normal sensations and bodily signs as

proof that they have a terrible disease No physical disorder can be found

Somatization Disorder: Person expresses anxieties through numerous physical complaints Many doctors are consulted but no organic or

physical causes are found


Somatoform Disorders (cont.)

Pain Disorder: Pain that has no identifiable organic, physical cause Appears to have psychological origin

Conversion Disorder: Severe emotional conflicts are “converted” into physical symptoms or a physical disabilityCaused by anxiety or emotional distress

but not by physical causes


Fig. 16.4 (left) “Glove” anesthesia is a conversion reaction involving loss of feeling in areas of the hand that would be covered by a glove (a). If the anesthesia were physically caused, it would follow the pattern shown in (b). (right) To test for organic paralysis of the arm, an examiner can suddenly extend the arm, stretching the muscles. A conversion reaction is indicated if the arm pulls back involuntarily. (Adapted from Weintraub, 1983.)


Theoretical Causes of Anxiety Disorders: Psychodynamic

Psychodynamic (Freud): Anxiety caused by conflicts among id, ego, and superego Forbidden id impulses for sex or aggression are

trying to break into consciousness and thus influence behavior; person fears doing something crazy or forbidden

Superego creates guilt in response to these impulses

Ego gets overwhelmed and uses defense mechanisms to cope


Other Theoretical Causes of Anxiety Disorders

Humanistic: Unrealistic self-image conflicts with real self-image

Existential: Anxiety reflects loss of meaning in one’s life

Behavioristic: Anxiety symptoms and behaviors are learned, like everything else Conditioned emotional responses that generalize

to new situations


More Theoretical Causes of Anxiety Disorders

Avoidance Learning: When making a particular response delays or prevents the onset of a painful or unpleasant stimulus

Anxiety Reduction Hypothesis: When reward of immediate relief from anxiety perpetuates self-defeating avoidance behaviors

Cognitive: When distorted thinking causes people to magnify ordinary threats and failures, leading to anxiety and distress


Psychosis and Hallucinations

Psychosis: Loss of contact with shared views of reality

Delusions: False beliefs that individuals insist are true, regardless of overwhelming evidence against them

Hallucinations: Imaginary sensations, such as seeing, hearing, or smelling things that do not exist in the real world Most common psychotic hallucination is hearing voices Note that olfactory hallucinations sometimes occur with

seizure disorder (epilepsy)


Some More Psychotic Symptoms

Flat Affect: Lack of emotional responsiveness; face is frozen in blank expressionDisturbed Verbal Communication: Garbled and chaotic speech; word saladPersonality Disintegration: When an individual’s thoughts, actions, and emotions are uncoordinated


Other Psychotic Disorders

Organic Psychosis: Psychosis caused by brain injury or disease Dementia: Most common organic psychosis;

serious mental impairment in old age caused by brain deterioration

Archaically known as senility Alzheimer’s Disease: Symptoms include impaired

memory, confusion, and progressive loss of mental abilities

Ronald Reagan most famous Alzheimer’s victim


Delusional Disorders

Marked by presence of deeply held false beliefs (delusions)May involve delusions of grandeur,

persecution, jealousy, or somatic delusionsExperiences could really occur!

Paranoid Psychosis: Most common delusional disorderCenters on delusions of persecution


Schizophrenia: The Most Severe Mental Illness

Psychotic disorder characterized by hallucinations, delusions, apathy, thinking abnormalities, and “split” between thoughts and emotionsDoes NOT refer to having split or multiple

personalities


The Four Subtypes of Schizophrenia

Disorganized (Hebephrenic) Type: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or inappropriate emotionsCatatonic Type: Marked by stupor, unresponsiveness, posturing, and mutism Paranoid Type: Preoccupation with delusions; also involves auditory hallucinations that are related to a single theme, especially grandeur or persecutionUndifferentiated Type: Any type of schizophrenia that does not have specific paranoid, catatonic, or disorganized features or symptoms


CNN – Schizophrenic Reality


Causes of Schizophrenia

Psychological Trauma: Psychological injury or shock, often caused by violence, abuse, or neglect

Disturbed Family Environment: Stressful or unhealthy family relationships, communication patterns, and emotional atmosphere

Deviant Communication Patterns: Cause guilt, anxiety, anger, confusion, and turmoil


Fig. 16.6 Over a period of years, Theodore Kaczynski mailed bombs to unsuspecting victims, many of whom were maimed or killed. As a young adult, Kaczynski was a brilliant mathematician. At the time of his arrest, he had become the Unabomber—a reclusive “loner” who deeply mistrusted other people and modern technology. After his arrest, Kaczynski was judged to be suffering from paranoid schizophrenia.

© Bruce Ely/Getty Images


Biochemical Causes of Schizophrenia

Biochemical Abnormality: Disturbance in brain’s chemical systems or in the brain’s neurotransmittersDopamine: Neurotransmitter involved with emotions and muscle movementWorks in limbic system

Dopamine overactivity in brain may be related to schizophrenia


Fig. 16.7 Lifetime risk of developing schizophrenia is associated with how closely a person is genetically related to a schizophrenic person. A shared environment also increases the risk. (Estimates from Lenzenweger & Gottesman, 1994.)


Fig. 16.8 Dopamine normally crosses the synapse between two neurons, activating the second cell. Antipsychotic drugs bind to the same receptor sites as dopamine does, blocking its action. In people suffering from schizophrenia, a reduction in dopamine activity can quiet a person’s agitation and psychotic symptoms.


Schizophrenic Brain

Computed Tomography (CT) Scan: Computer enhanced X-ray of brain or body

Magnetic Resonance Imaging (MRI) Scan: Computer enhanced three-dimensional image of brain or body; based on magnetic field MRIs show schizophrenic brains as having enlarged ventricles

Positron Emission Tomography (PET) Scan: Computer-generated color image of brain activity; radioactive sugar solution is injected into a vein, eventually reaching the brain Activity is abnormally low in frontal lobes of schizophrenics


Fig. 16.9 (left) CT scan of would-be presidential assassin John Hinkley, Jr., taken when he was 25. The X-ray image shows widened fissures in the wrinkled surface of Hinkley’s brain. (right) CT scan of a normal 25-year-old’s brain. In most young adults the surface folds of the brain are pressed together too tightly to be seen. As a person ages, surface folds of the brain normally become more visible. Pronounced brain fissuring in young adults may be a sign of schizophrenia, chronic alcoholism, or other problems.

© Dennis Brack/Stockphoto.com76


Fig. 16.10 Positron emission tomography produces PET scans of the human brain. In the scans shown here, red, pink, and orange indicate lower levels of brain activity; white and blue indicate higher activity levels. Notice that activity in the schizophrenic brain is quite low in the frontal lobes (top area of each scan) (Velakoulis & Pantelis, 1996). Activity in the manic-depressive brain is low in the left brain hemisphere and high in the right brain hemisphere. The reverse is more often true of the schizophrenic brain. Researchers are trying to identify consistent patterns like these to aid diagnosis of mental disorders.


CNN – Schizophrenia Gene


Stress-Vulnerability Model

Stress-Vulnerability Hypothesis: Combination of environmental stress and inherited susceptibility cause schizophrenic disorders


Fig. 16.11 Various combinations of vulnerability and stress may produce psychological problems. The top bar shows low vulnerability and low stress. The result? No problem. The same is true of the next bar down, where low vulnerability is combined with moderate stress. Even high vulnerability (third bar) may not lead to problems if stress levels remain low. However, when high vulnerability combines with moderate or high stress (bottom two bars) the person “crosses the line” and suffers from psychopathology.


Mood Disorders

Major disturbances in emotion, such as depression or mania

Depressive Disorders: Sadness or despondency are prolonged, exaggerated, or unreasonable

Bipolar Disorders: Involve both depression and mania or hypomania

Dysthymic Disorder: Moderate depression that lasts for at least two years

Cyclothymic Disorder: Moderate manic and depressive behavior that lasts for at least two years


Major Mood Disorders

Lasting extremes of mood or emotion and sometimes with psychotic features (hallucinations, delusions)Major Depressive Disorder: A mood disorder where the person has suffered one or more intense episodes of depression; one of the more serious mood disordersBipolar I Disorder: Extreme mania and deep depression; one type of manic-depressive illness Mania: Excited, hyperactive, energetic, grandiose behavior

Bipolar II Disorder: Person is mainly sad but has one or more hypomanic episodes (mild mania)


Major Mood Disorders (cont.)

Endogenous Depression: Depression that seems to be produced from inside the body (due to chemical imbalances) and NOT from life eventsSeasonal Affective Disorder (SAD): Depression that only occurs during fall and winter May be related to reduced exposure to sunlight Phototherapy: Extended exposure to bright light to

treat SAD


Maternity Blues

Maternity Blues: Mild depression that lasts for one to two days after childbirthMarked by crying, fitful sleep, tension,

anger, and irritabilityBrief and not too severe


Postpartum Depression

Postpartum Depression: Moderately severe depression that begins within three months following childbirthMarked by mood swings, despondency,

feelings of inadequacy, and an inability to cope with the new baby

May last from two months to one yearPart of the problem may be hormonal


Fig. 16.12 Seasonal affective disorder appears to be related to reduced exposure to daylight during the winter. SAD affects 1 to 2 percent of Florida’s population, about 6 percent of the people living in Maryland and New York City, and nearly 10 percent of the residents of New Hampshire and Alaska (Booker & Hellekson, 1992).


Fig. 16.13 An hour or more of bright light a day can dramatically reduce the symptoms of seasonal affective disorder. Treatment is usually necessary from fall through spring. Light therapy typically works best when it is used early in the morning (Lewy et al., 1998).

© Dan McCoy/Rainbow


Therapeutic Interventions

Psychotherapy: Any psychological treatment for behavioral or emotional problemsTypically involves two people talking about

one’s personal problems

Medical Therapies: Drug therapy, hospitalization, or psychosurgery


Fig. 16.14 At least one schizophrenic patient in four had completely recovered 10 years after being diagnosed. Three out of four had improved. New treatments for schizophrenia and other major mental disorders may improve these odds. (Source: FDA Consumer, 1993.)


Suicide: Major Risk Factors

Drug or alcohol abuse

Prior suicide attempt

Depression or other mood disorder

Availability of a firearm

Severe anxiety or panic attacks

Family history of suicidal behavior

Shame, humiliation, failure or rejection


Fig. 16.15 Adolescent suicide rates vary for different racial and ethnic groups. Higher rates occur among whites than among non-whites. White male adolescents run the highest risk of suicide. Considering gender alone, it is apparent that more male than female adolescents commit suicide. This is the same as the pattern observed for adults.


CNN – Suicidal Tendencies


Common Characteristics of Suicidal Thoughts and Feelings (Shneidman)

Escape

Unbearable Psychological Pain: Emotional pain that the person wishes to escape

Frustrated Psychological Needs: Such as searching for love, achievement, or security

Constriction of Options: Feeling helpless and hopeless and deciding that death is the only option left


Fig. 16.16 Suicidal behavior usually progresses from suicidal thoughts, to threats, to attempts. A person is unlikely to make an attempt without first making threats. Thus, suicide threats should be taken seriously (Garland & Zigler, 1993).


Insanity

Insanity Defense: Person was incapable of knowing right from wrong while committing a crimeM’Naghten Rule: Standard for judging legal insanity in English common law Must understand wrongfulness of actions to be held

responsible for them If suffering from mental disease preventing person from

knowing right from wrong, can be deemed insane Taking of a life due to insanity is not murder

Irresistible Impulse: Uncontrollable urge to actDiminished Capacity: Temporary loss of ability to control actions or to know right from wrong

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