Chapter Eleven Psychological Disorders. Copyright © Houghton Mifflin Company. All rights reserved....

Chapter Eleven

Psychological Disorders

Copyright © Houghton Mifflin Company. All rights reserved. 11-2

Did You Know That…

• Behavior considered abnormal in one culture may be deemed perfectly normal in another?

• Psychological disorders affect nearly everyone in one way or another?

• Some people have such fear of leaving the house that they literally are unable to go out to buy a quart of milk?


Did You Know That… (Cont’d)

• Some people have lost all feeling in an arm or leg but remain unconcerned about their ailments?

• Some health professionals use bright light to treat depression – and it works?

• Some people with schizophrenia sit motionless for hours as though they were statues?


Did You Know That… (Cont’d)

• People who receive the label of psychopath are not psychotic?

• Despite popular beliefs to the contrary, people who threaten suicide are quite likely serious about taking their lives?

Module 11.1

What Is Abnormal Behavior?


Module 11.1 Preview Questions

• What criteria are used to determine whether behavior is abnormal?

• What are the major models of abnormal behavior?

• What are psychological disorders?


Criteria Typically Used to Identify Abnormal Behavior

• Unusualness

• Social deviance

• Emotional distress

• Maladaptive behavior

• Dangerousness

• Faulty perceptions or interpretations of reality


Cultural Bases of Abnormal Behavior

• Cultural context important when making judgments about abnormal behavior

• Abnormal behavior patterns may be expressed differently in different cultures.

• Judgments of what is abnormal behavior can change over time.


Early Beliefs About Abnormal Behavior

• Abnormal behaviors caused by supernatural forces

• Doctrine of demonic possession• Treatment was exorcism


Medical Model of Abnormal Behavior

• Result of the rapid advances in medical science during 18th and 19th centuries

• Abnormal behavior patterns represent mental illnesses that have a biological basis.• Can be classified by their particular

characteristics or symptoms


Psychological Models of Abnormal Behavior

• Psychodynamic Model: Abnormal behaviors arise from unconscious conflicts.• Psychological symptoms are the outward

expressions of inner turmoil.

• Behavioral Model: Abnormal behaviors are learned.


Psychological Models of Abnormal Behavior (Cont’d)

• Humanistic Model: Abnormal behaviors result from roadblocks on the path toward self-actualization.

• Cognitive Model: Irrational or distorted thinking leads to emotional problems and maladaptive behaviors.


Sociocultural Model of Abnormal Behavior

• Views causes of abnormal behavior within a broader social and cultural context• Abnormal behavior may have more to do with

social ills or failures of society.

• Focus also on the effects of labeling people as mentally ill


Biopsychosocial Model of Abnormal Behavior

• Abnormal behavior results from the complex interactions of biological, psychological, and sociocultural factors.

• Example: Diathesis-Stress Model• Diathesis: What is the person’s vulnerability or

predisposition to developing a disorder?• Stress: What level of stress is the person

experiencing?


Figure 11.1: The Diathesis-Stress Model

From Abnormal Psychology in a Changing World 4/e by Nevid/Rathus/Greene, pp.35-36 Reprinted by adaption of Prentice-Hall Inc, Upper Saddle River, NJ.


Psychological Disorders

• Distinctive patterns of abnormal behavior• Also known as “mental disorders” or “mental

illnesses”

• Involve disturbances of mood, behavior, thought processes, or perceptions that result in significant personal distress or impaired functioning


Classification of Psychological Disorders

• Diagnostic and Statistical Manual of Mental Disorders (DSM) now in a 4th, text revised edition (DSM-IV-TR).

• Multiaxial system• Axis I: Clinical disorders• Axis II: Personality disorders• Axis III: General medical conditions• Axis IV: Psychosocial and environmental problems• Axis V: Global assessment of functioning

Module 11.2

Anxiety Disorders



• What are anxiety disorders?

• What causal factors are implicated in anxiety disorders?


What is an Anxiety Disorder?

• Anxiety can be an adaptive response.• But can become abnormal when excessive or

when interferes with ability to function

• “Fear” is used to describe anxiety experienced in specific situations.


Phobias

• An irrational or excessive fear of some object or situation

• Three types of phobic disorders:• Social Phobia• Specific Phobia• Agoraphobia


Panic Disorder

• Person experiences sudden episodes of sheer terror called panic attacks.

• Panic attacks are characterized by intense physical symptoms.

• Over time, panic attacks can become associated with specific situations.


Generalized Anxiety Disorder

• Persistent anxiety not tied to any particular object or situation

• Anxiety has a “free-floating” quality

• Key feature is excessive worry

• Other characteristics include shakiness, inability to relax, fidgeting, and feelings of dread and foreboding.


Obsessive-Compulsive Disorder

• Person experiences persistent obsessions and/or compulsions• Obsessions: Nagging, intrusive thoughts

person feels unable to control• Compulsions: Repetitive behaviors or rituals

the person feels compelled to perform repeatedly


Causes of Anxiety Disorders

• Biological factors:• Heredity• Disturbances in brain biochemistry or circuits

• Psychological factors:• Classical conditioning• Operant conditioning• Cognitive factors


Figure 11.2: Cognitive Model of Panic

Module 11.3

Dissociative and Somatoform Disorders



• What are dissociative disorders and somatoform disorders?

• What causal factors are implicated in dissociative and somatoform disorders?


Dissociative Disorders

• Involve problems with memory or changes in consciousness or self-identity

• Inability to maintain a cohesive sense of self or unity of consciousness• Results in unusual or bizarre behavior


Dissociative Identity Disorder

• Dissociative Identity Disorder (DID): Two or more distinct personalities exist within same individual• Commonly called “multiple” or “split

personality”

• Women tend to have 15+ identities; men tend to have 8+ identities.


Dissociative Amnesia

• Loss of memory about self or life experiences

• No physical cause for amnesia

• Memory lost usually involves a stressful or traumatic event.• Generalized amnesia is much less common.


Causes of Dissociative Disorders

• Role of traumatic experiences:• Childhood sexual abuse• Psychological pain or conflict

• Is DID a genuine disorder?• A form of attention-seeking role playing?• Inadvertently cued by therapists?


Somatoform Disorders

• Person has physical ailments or complaints that cannot be explained medically• Or may have belief that gravely ill despite

reassurances to the contrary


Conversion Disorder

• Loss of functioning, feeling, or movement in specific body part• But no physical cause for the symptoms.

• Lack of concern with symptoms• La belle indifférence

• May be a way of avoiding anxiety associated with painful or stressful conflicts or situations

• Many cases turn out to be unrecognized medical conditions.


Hypochondriasis

• Preoccupied with idea of health problems• Attribute physical complaints or symptoms to

a serious underlying disease

• Rejects reassurances that concerns are groundless

• May not realize how their anxiety may be causing the symptoms being experienced


Causes of Somatoform Disorders

• Freud: Hysterical symptom an indication of unconscious conflicts

• Learning Theories: Symptoms help person avoid painful or anxiety-evoking situations• Reinforcement for “sick role”

• Cognitive Theories: Cognitive biases lead to misinterpreting bodily symptoms.

Module 11.4

Mood Disorders



• What are mood disorders?

• What causal factors are implicated in mood disorders?

• Who is at risk for suicide?

• Why do people commit suicide?


Mood Disorders

• Severe or persistent disturbances of mood that limit one’s ability to function

• Will focus on two major forms of mood disorder:• Major Depressive Disorder• Bipolar Disorder


Major Depressive Disorder

• Symptoms:• Depressed mood for at least two weeks• Sadness• Worthlessness• Changes in sleep, appetite• Lethargy• Loss of interest, concentration


Prevalence of Major Depression

• About 16% of adult U.S. population develop major depression at some point.

• Women twice as likely as men to develop disorder• Possibly due to hormonal or other biological

differences one possible explanation• But also may be due to differences in levels of stress

experienced

• Gender differences in how one copes with depression


Bipolar Disorder

• Person shifts between manic episodes and periods of depression with intervening periods of normal mood• Formerly called manic-depression

• About 1% of adult U.S. population suffers from a bipolar disorder.


Psychological Models of Depression

• Classic Psychodynamic Theory: Depression involves anger turned inward against self.

• Behavioral Model: Depression results from changes in reinforcement levels.

• Cognitive Model: How people interpret events contributes to emotional disorders.• Aaron Beck: One is prone depression if adopt a

negatively biased or distorted way of thinking.


Cognitive Distortions Linked to Depression (see Table 11.2 for more detail)

• All-or-nothing thinking• Misplaced blame• Misfortune telling• Negative focusing• Dismissing the

positive• Jumping to

conclusions

• Catastrophizing• Emotion-based

reasoning• Shouldisms• Name calling• Mistaken

responsibility


Learned Helplessness Model

• Depression results from belief that one is helpless to control reinforcements.

• Reformulated Model: How are negative events explained?• Depressive Attributional Style involves making

internal, global, and stable attributions for disappointments and failures.


Causes of Mood Disorders: Biological Factors

• Chemical imbalances in brain involving the levels or activity of neurotransmitters

• Hereditary influences


Suicide

• Nearly one-half million Americans make serious suicide attempts each year.

• About 30,000 Americans and 1 million people worldwide commit suicide each year.

• Third leading cause of death among 15-24 year olds.

• About 10% of college students seriously thought of committing suicide during preceding year.

• Nearly 1 in 20 adult Americans reported making a prior suicidal attempt.


Figure 11.3: Suicide Rates in Relation to Age


Figure 11.4: Suicide Rates in Relation to Gender and Ethnicity


Factors in Suicide

• Closely linked to mood disorders• Role of biochemical factors?

• Lack of serotonin may lead to a disinhibition effect

• Drugs and alcohol • Lack of coping responses• Exit events or losses of supportive

persons• Teens and copycat suicides


Myths About Suicide(see Table 11.3 for more detail)

• People who threaten suicide are only seeking attention.

• A person must be insane to attempt suicide.• Talking about suicide with a depressed person

may prompt the person to attempt it.• People who attempt suicide and fail aren’t

serious about killing themselves.• If someone threatens suicide, it is best to ignore

it so as not to encourage repeated threats.

Module 11.5

Schizophrenia



• What is schizophrenia?

• What are the three specific types of schizophrenia?

• What causal factors are implicated in schizophrenia?

• What is the diathesis-stress model of schizophrenia?


Schizophrenia

• Most closely corresponds to popular notion of insanity or madness

• Affects about one adult in a hundred• Characterized by bizarre, irrational behavior• Somewhat more common in men than in

women• Follows a lifelong course

• Typically develops in late adolescence or early adulthood


Symptoms of Schizophrenia

• A psychotic disorder:• Confuses fantasy with reality• Experiences hallucinations and delusions

• May exhibit bizarre behavior, incoherent speech, and illogical thinking

• Positive vs. negative symptoms• Behavioral excesses vs. behavioral deficits


Types of Schizophrenia

• Disorganized

• Catatonic

• Paranoid


Causes of Schizophrenia

• Genetic factors

• Biochemical imbalances

• Brain abnormalities

• Psychosocial influences• Stressful life experiences• Diathesis-stress model revisited


Figure 2.20: Familial Risk in Schizophrenia

Return

Module 11.6

Personality Disorders



• What are personality disorders?

• What characteristics are associated with antisocial personality disorder?

• What causal factors are implicated in antisocial personality disorder?


Personality Disorders

• A cluster of psychological disorders characterized by excessively rigid patterns of behavior• Behavioral patterns become self-defeating.

• Person has deeply ingrained maladaptive personality traits


Types of Personality Disorders

• Paranoid• Schizoid• Schizotypal• Antisocial• Borderline

• Histrionic• Narcissistic• Avoidant• Dependent• Obsessive-

compulsive


Symptoms of Antisocial Personality Disorder

• Disregard for rules• Lack of concern for others• Act on selfish impulse• Irresponsible• Take advantage of others for own need or

personal gain.• Lack remorse for mistreatment of others• May be highly intelligent and charming


Causes of Antisocial Personality Disorder

• Brain abnormalities

• Genetic contributions

• Exaggerated cravings for stimulation

• Environmental factors• Family history

Application: Module 11.7

Suicide Prevention


Module 11.7 Preview Question

• What steps can you take to help someone who is threatening suicide?


Facing the Threat of Suicide

• Recognize the seriousness of the situation.

• Take implied threats seriously.

• Express understanding.

• Focus on alternatives.


Facing the Threat of Suicide (Cont’d)

• Assess the immediate danger.

• Enlist the person’s agreement to seek help.

• Accompany the person to seek help.

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