Chapter 11Chapter 11Psychological DisordersPsychological Disorders

Prevalence of Psychological Disorders In a year in the U.S.:

20% of persons experience psychological problems severe enough to adversely affect their daily living.

40% of persons experience at least mild mental health problems.

About 2.1 million people are admitted to hospitals due to serious psychological problems.

Worldwide: About 400 million people are afflicted with

psychological disorders.

How Should We Understand Psychological Disorders?

The medical model proposes that psychological disorders have a biological basis and can be classified into discrete categories and are analogous to physical diseases.

How Should We Understand Psychological Disorders?

Although not agreeing that all mental health problems have a biological basis, mainstream psychology has adopted the medical model’s terminology.Symptom: a sign of a disorderDiagnosis: distinguishing one disorder from anotherEtiology: a disorder’s apparent causes and

developmental historyPrognosis: prediction about the likely course of a

disorder

Defining Psychological Disorders

A pattern of atypical behavior

Results in personal distress or

Significant impairment in a person’s social or occupational functioning

Numerous Theoretical Explanations

Five primary perspectives to understand mental illness:

Psychodynamic: Disordered behavior is controlled by unconscious forces shaped by childhood experiences.

Behavioral: Disordered behavior is caused by identifiable factors in the person’s environment and results from learning.

Cognitive: ineffective or inaccurate thinking is the root cause of mental illness

Numerous Theoretical Explanations

Five primary perspectives to understand mental illness:

Sociocultural: Mental illness is the product of broad social and cultural forces .

Biological: Disordered behavior is caused by biological conditions, such as genetics, hormone levels, or neurotransmitter activity in the brain.

Combined Models

Diathesis-stress model: a predisposition to a given disorder (diathesis) that combines with environmental stressors to trigger a psychological disorder

Bio-psycho-social model. Takes into account predispositions, personal experience, and life circumstances.

The Diathesis-Stress Model

Psychological DisordersBio-psycho-social

Perspectiveassumes that

biological, sociocultural, and psychological factors combine and interact to produce psychological disorders

Biological(Evolution, individual

genes, brain structures

and chemistry)

Psychological(Stress, trauma,

learned helplessness, mood-related perceptions

and memories)

Sociocultural(Roles, expectations, definition of normality

and disorder)

Models from Outside Psychology

Spirit PossessionTrephiningLunacy

CursesFamily/generationalOccult (voodoo, witchcraft)

SinGuiltUnforgiveness, bitterness

Risks of Using Diagnostic Labels

David Rosenhan demonstrated diagnostic labels’ biasing effects.

Misdiagnosis of insanity by hospital personnel due to their bias toward calling a healthy person sick

Diagnostic labels can harm patients in several ways.

Label may “dehumanize” patients by encouraging mental health practitioners to treat them as labels rather than as unique individuals with problems.

Labeled individuals may experience discrimination and may cause people to expect those labeled to behave abnormally and thus to misperceive normal behavior as disordered.

Benefits of Using Diagnostic Labels

Despite ethical concerns, diagnostic labels are used because they serve several important functions:

Summarize patient’s symptoms or problems, and thus, communicate great deal of information with a single word

Convey information about possible causes of the disorder

Convey information about the patient’s prognosis

DSM Classification System

Diagnostic and Statistical Manual of Mental Disorders (DSM) use to diagnose mental disorders

Published by the American Psychiatric Association.

Since 1980, DSM has been updated several times and is now in its fourth edition, text revision, or DSM-IV-TR.

DSM Classification System

DSM classification system is descriptive rather than explanatory, meaning that:it is not based on a particular theory concerning the

cause(s) of psychological disorders. diagnoses are based mainly on observable symptoms.

DSM provides clearer directions concerning number, duration, and severity of symptoms necessary to assign a diagnosis. By recognizing that two patients with same disorder may

substantially differ from one another, clinicians much more likely to acknowledge uniqueness of all patients.

Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior

Characterized by distressing, persistent anxiety or maladaptive behavior

About 25 percent of the population will experience this disorder in our lifetime.

Anxiety disorders occur across the life span and commonly co-occur with many other disorders, such as depression and substance abuse.

Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior

Five major anxiety disorders:

Panic disorder: brief episodes of intense anxiety with no apparent reason

Phobic disorder: strong irrational fears of specific objects or situations, called phobias

Generalized anxiety disorder (GAD): a constant state of moderate anxiety

Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior

Five major anxiety disorders:

Obsessive-compulsive disorder: repetitive, unwanted, and distressing actions and/or thoughts

Post-traumatic stress disorder: occurs among individuals who have experienced or witnessed traumatic eventsLater reexperience the event through nightmares, flashbacks, and

avoid situations or persons that trigger flashbacks

Anxiety DisordersCommon Obsessions and Compulsions AmongPeople With Obsessive-Compulsive Disorder

Thought or Behavior Percentage*Reporting Symptom

Obsessions (repetitive thoughts)

Concern with dirt, germs, or toxins 40

Something terrible happening (fire, death, illness) 24

Symmetry order, or exactness 17

Excessive hand washing, bathing, tooth brushing, 85or grooming

Compulsions (repetitive behaviors)

Repeating rituals (in/out of a door, 51up/down from a chair)Checking doors, locks, appliances, 46car brake, homework

Anxiety DisordersPET Scan of brain of

person with obsessive/ compulsive disorder

High metabolic activity (red) in frontal lobe areas involved with directing attention

Etiology of Anxiety Disorders

Genetic and biological factors: Genetic heritage may predispose us to more easily develop

phobic reactions or to respond intensely to stressful events.

Behavioral or conditioning factors: Classical conditioning may instill conditioned emotional

responses, and operant conditioning may reinforce and maintain the person’s avoidance responses.

Cognitive factors: People suffering from panic disorder closely monitor their

physiological reactions, and often exaggerate the significance of their physiological symptoms.

Mood Disorders: Emotional Extremes

Characterized by emotional extremes that cause significant disruption in daily functioning.

To qualify as a mood disorder, emotional extremes must persist for a long time.

Most common mood disorder is depression Characterized by extreme and persistent negative moods

and the inability to experience pleasure by participating in activities one previously enjoyed (Kramlinger, 2001)

Mood Disorders: Emotional Extremes

Depressed individuals:

Often experience physiological problems such as lack of appetite, weight loss, fatigue, and sleep disorders

Often experience behavioral symptoms, such as slowed thinking and acting, social withdrawal, and decreased activity

Exhibit cognitive symptoms, such as low self-esteem, thinking about death and/or suicide, and having little hope for the future

Mood Disorders-Depression

The vicious cycle of depression can be broken at any point

1Stressful

experiences

4Cognitive and

behavioral changes

2Negative

explanatory style

3Depressed

mood

Hostile & Pessimistic Persons Are More Reactive to Stressors

Pessimistic explanatory style:tendency to explain cause of negative uncontrollable events

as one’s own stable personal qualities affecting all aspects of life

Associated with health problems and premature death

Optimistic explanatory style:tendency to explain cause of uncontrollable negative events

as temporary, external factors that do not affect other aspects of one’s life

Associated with good health and longevity

Mood Disorders-Depression

Percentageof population

aged 18-84experiencing

majordepression

at somepoint In life

20

15

10

5

0USA Edmonton Puerto Paris West Florence Beirut Taiwan Korea New Rico Germany Zealand

Around the worldwomen are more

susceptible todepression

Mood Disorders: Emotional Extremes

Bipolar disorder: characterized by swings between the emotional extremes of mania and depression

Less common than major depressive disorder, occurring in about 1 percent of the population

Unlike major depression, this disorder occurs about equally in men and women and tends to occur earlier than major depression

Mood Disorders: Emotional ExtremesBipolar disorder

Bipolar patients’ depressive episodes differ from the depressive episodes in major depression in that they tend to be more severe, are accompanied by higher suicide risks, and have a distinct pattern of brain activity during sleep.

Mood Disorders-BipolarPET scans show that brain energy consumption

rises and falls with emotional swings

Depressed state Manic state Depressed state

Suicide

A major danger of depression is suicide. As many as 30% of people with severe mood disorders

die from suicide.

In the U.S. suicide rates are higher among: Men than women;Elderly adults than younger adults; Unemployed (& retired) adults than employed persons; Widowed adults than married adults;Native & European Americans than Asian. Hispanic, and

African Americans.

Etiology of mood disorders

Genetic/ biological influence?Bipolar patients show imbalances in neural circuits using

serotonin, norepinephrine, etc.? Enlarged amygdala?Major depressive disorder: Family, twin, and adoption studies

indicate at least a moderate genetic influence on depression.

Cognitive contributions: Depressed persons have negative views and they

misinterpret daily experiences so that their negative outlook is supported.

Behavioral psychologists propose that depression results from low social reinforcement.

Gender & Mood DisordersWhy is depression more common among women?

May due to biological factors. Sociocultural factors: Women have fewer educational and

occupational opportunities, receive less money for their work, and experience more violence due to their gender than men.

Difference in diagnosis?Women may be diagnosed more frequently because they are

more likely to seek help for their problems.Gender bias among mental health professionals may result in

women and men with identical symptoms being diagnosed differently, i.e., women labeled as depressed and men diagnosed with other conditions

Dissociative Disorders: Loss of Contact with Consciousness or MemoryCharacterized by disruptions in

consciousness, memory, sense of identity, or perception

Dissociative amnesia: a sudden loss of memory of one’s identity and other personal information

Dissociative fugue: a sudden departure from home or work, combined with loss of memory of identity and the assumption of a new identity

Dissociative Disorders: Loss of Contact with Consciousness or Memory

Dissociative identity disorder (DID): characterized by the presence of two or more distinct identities or personalities, which take turns controlling the person’s behavior (also known as multiple personality disorder)

Etiology of Dissociative Disorders

Psychodynamic theory: results from the individual’s attempt to repress some troubling event

Biological explanation: patient may have a neurological problem that has not yet been detected

Cognitive perspective: individuals learn to dissociate as a way to cope with intense distress

Schizophrenia: Disturbances in Almost All Areas of Psychological Functioning

Characterized by severe impairment in thinking, including hallucinations, delusions, or loose associations

Diagnosed when symptoms persist for at least six months, are not due to some other condition, and cause significant impairment in daily functioning

Schizophrenics often cannot work, manage a home or apartment successfully, or care for their basic needs.

Schizophrenia

Delusionsfalse beliefs, often of persecution or

grandeur, that may accompany psychotic disorders

Hallucinationsfalse sensory experiences such as seeing something

without any external visual stimulus

Risk of Developing Schizophrenia

Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning

Personality disorders: general styles of living that are ineffective and lead to problems for the person and for others

Ten personality disorders in the DSM-IV-TR.

Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning

Three common personality disorders are:

Paranoid personalities: habitually distrustful and suspicious of others’ motives

Histrionic personalities: excessively emotional and attention seeking, often turning minor incidents into full-blown dramas

Narcissistic personalities: desire constant admiration from others  

Personality Disorders: Inflexible Behavior Patterns That Impair Social Functioning

The personality disorder that receives the most attention is the antisocial personality disorder.

Exhibit a persistent pattern of disregard for and violation of the rights of others

Repeatedly exhibit antisocial behavior across all realms of life, lying, cheating, stealing, and manipulating others

When caught, they take no responsibility and feel no remorse.

Personality Disorders

Adrenalineexcretion(ng/min)

15

10

5

0 Nonstressfulsituation

Stressfulsituation

Those with criminalconvictions have lower

levels of arousal

No criminal convictionCriminal conviction

Personality DisordersPET scans illustrate reduced activation in a murderer’s frontal cortex

Normal Murderer

Etiology of Personality Disorders A genetic component: related to abnormal brain

development or chronic underarousal of both the autonomic and central nervous systems

May be caused by the interaction of both biological and environmental factors.

Children in chaotic households who have a biological predisposition for this disorder may not learn to control their impulses, and so behave in ways to maximize their benefit even if this means violating social rules.