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Chapter 13

Psychological
Disorders
13-1

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Defining and Classifying

13-2

Historical Explanations of
Abnormal Behaviors
Demonic possession
Physical diseases
Products of psychological
conflicts
Learned maladaptive behaviors
Distorted perceptions of the
world

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Defining and Classifying

Vulnerability-Stress Model
Each of us has vulnerability for
developing a psychological
disorder
Stress plays a role in
development
13-3

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13-4

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Defining and Classifying

Criteria for abnormality

Distress
Dysfunction
Deviance
13-5

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Defining and Classifying

Distress
Judgments of abnormality
most likely when distress is
disproportionately acute or
long-lasting
13-6

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Defining and Classifying

Dysfunctionality
Either for individual or for
society

13-7

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Defining and Classifying

Deviance
From cultural norms

13-8

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Defining and Classifying

What is Abnormal Behavior?
Behavior that is so:
Personally distressful
Personally dysfunctional
Culturally deviant
that others judge it as
inappropriate or maladaptive
13-9

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13-10

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Defining and Classifying

Diagnosing Psychological
Disorders
Reliability
Clinicians should show high
levels of agreement in their
diagnostic decisions
13-11

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Defining and Classifying

Diagnosing Psychological
Disorders
Validity
Diagnostic categories should
accurately capture essential
features of disorders
13-12

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Defining and Classifying

DSM-IV
Diagnostic and Statistical
Manual of Mental Disorders,
Fourth Edition
Most widely used classification
system in U.S.
13-13

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Defining and Classifying

DSM-IV Axes
Axis I: Primary clinical
symptoms
Axis II: Long-standing
personality or developmental
disorders
Axis III: Relevant physical
conditions
13-14

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Defining and Classifying

DSM-IV Axes cont.
Axis IV: Intensity of
environmental stressors
Axis V: Coping resources as
reflected in recent adaptive
functioning
13-15

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Defining and Classifying

Consequences of Diagnostic
Labeling
Social
Personal
Legal
13-16

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Defining and Classifying

Social Consequences of
Diagnostic Labeling
Becomes too easy to accept
label as description of the
individual
13-17

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Defining and Classifying

Personal Consequences of
Diagnostic Labeling
May accept the new identity
implied by the label
May develop the expected role
and outlook
13-18

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Defining and Classifying

Legal Consequences of
Diagnostic Labeling
Involuntary commitment to
mental institutions
Loss of civil rights
Indefinite detainment
13-19

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Defining and Classifying

Legal Concepts
Competency
Defendants state of mind at
the time of a judicial hearing
Insanity
Presumed state of mind of
defendant at time crime was
committed
13-20

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Anxiety Disorders
Definition
Frequency and intensity of
anxiety responses are out of
proportion to the situations
that trigger them
Anxiety interferes with daily
life
13-21

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Anxiety Disorders
Components of Anxiety
Responses
Subjective-emotional
Cognitive
Physiological
Behavioral
13-22

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13-23

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Anxiety Disorders
Phobias
Strong and irrational fears
of certain objects or
situations
13-24

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Anxiety Disorders
Agoraphobia: Fear of open and
public spaces from which
escape would be difficult
Social phobias: Fear of
situations in which evaluation
might occur
13-25

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Anxiety Disorders

Specific phobias: Fear of

specific objects such as
animals or situations

13-26

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Anxiety Disorders
Generalized Anxiety Disorder
Chronic state of diffuse, freefloating anxiety
Anxiety not attached to
specific objects or situations

13-27

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Anxiety Disorders
Panic Disorder
Panic occurs suddenly and
unpredictably
Much more intense than
typical anxiety
13-28

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13-29

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13-30

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13-31

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Anxiety Disorders
Obsessive-Compulsive Disorder
Obsessions
Repetitive and unwelcome
thoughts, images, or
impulses
Compulsions
Repetitive behavioral
responses
13-32

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Anxiety Disorders
Posttraumatic Stress
Disorder
Severe anxiety disorder
Can occur in people
exposed to extreme trauma
13-33

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Anxiety Disorders
Symptoms of PTSD
Severe symptoms of anxiety,
arousal, and distress
Reliving of trauma in
flashbacks
Numb to world and avoidance
of reminders
Intense survivor guilt
13-34

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Anxiety Disorders
Biological Factors in Anxiety
Overreactive autonomic
nervous system
Overreactive neurotransmitter
systems involved in emotional
responses
Overreactive right hemisphere
sites involved in emotions
13-35

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Anxiety Disorders
Evolutionary Explanations
Biological preparedness
Makes it easier for us to learn
to fear certain stimuli
13-36

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Anxiety Disorders
Psychodynamic Theory
Neurotic anxiety
Occurs when unacceptable
impulses threaten to
overwhelm the egos
defenses
13-37

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Anxiety Disorders
Cognitive Factors
Maladaptive thought
patterns and beliefs
Exaggerated
misinterpretations of stimuli
13-38

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Anxiety Disorders
Learned Responses
Result of emotional
conditioning (hman, 2000;
Rachman, 1998)
Classically conditioned fear
Observational learning
13-39

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Anxiety Disorders
Culture-Bound Disorders
Occur only in certain
locales
e.g., Anorexia Nervosa,
Taijin Kyofushu
13-40

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Somatoform Disorders
Involve physical complaints
that suggest a medical
problem

But no biological cause

13-41

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Somatoform Disorders
Hypochondriasis
Great alarm about physical
symptoms
Convinced of serious
illness
13-42

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Somatoform Disorders
Pain Disorder
Experience of intense pain out
of proportion to medical
conditions
No physical basis for

13-43

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Somatoform Disorders
Conversion Disorder
Serious neurological
disorders suddenly occur
e.g., paralysis, loss of
sensation, blindness
13-44

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13-45

Glove
anethesia

Actual nerve
innervation

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Somatoform Disorders
Predispositions
May involve combinations of
biological and psychological
vulnerabilities
Genetics, environmental
learning, and social
reinforcement for bodily
symptoms (Trimble, 2003)
13-46

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Somatoform Disorders
Incidence (Tanaka-Matsumi &
Draguns, 1997)
Higher in cultures that:

13-47

Discourage open discussion

of emotions
Stigmatize psychological
disorders

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Dissociative Disorders
Breakdown of normal personality
integration
Results in alterations to
memory or identity

13-48

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Dissociative Disorders

Psychogenic Amnesia
Response to stressful event
with extensive but selective
memory loss
13-49

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Dissociative Disorders
Psychogenic Fugue
Loss of all sense of
personal identity
Establishment of new
identity in a new location
13-50

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Dissociative Disorders
Dissociative Identity Disorder
(DID)
Formerly called multiple
personality disorder
Two or more separate
personalities coexist in the
same person
13-51

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Dissociative Disorders
Causes of DID
Trauma-Dissociation Theory
Development of personalities
is a response to severe
stress
13-52

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Dissociative Disorders
Criticisms of DID
Large increase in cases in
recent years
Are personalities
unintentionally implanted
by overzealous therapists?
13-53

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Mood (Affective) Disorders

Involve depression and
mania
Most frequently experienced
(with anxiety disorders)
psychological disorders
13-54

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Mood (Affective) Disorders

Major Depression
Intense depressed state
Leaves people unable to
function effectively in their
lives
13-55

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Mood (Affective) Disorders

Dysthymia
Intense form of depression
Less dramatic effects on
personal and occupational
functioning
More chronic than major
depression
13-56

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Mood (Affective) Disorders

Symptoms of Depression
Negative mood
Cognitive symptoms
Motivational symptoms
Somatic (physical)
symptoms
13-57

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13-58

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13-59

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Mood (Affective) Disorders

Negative Mood in Depression
Sadness, misery, loneliness
Loss of capacity for
psychological, biological
pleasures
13-60

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Mood (Affective) Disorders

Cognitive Symptoms of
Depression

13-61

Difficulty concentrating and

making decisions
Low self-esteem
Feelings of inferiority
Blame selves for failures
Pessimism and hopelessness

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Mood (Affective) Disorders

Motivational Symptoms of
Depression
Inability to get started on task
Inability to perform behaviors
leading to pleasure or
accomplishment
13-62

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Mood (Affective) Disorders

Somatic (Bodily) Symptoms of
Depression
Loss of appetite and weight
loss in moderate and severe
depression
Weight gain in mild depression
13-63

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Mood (Affective) Disorders

Bipolar Disorder
Depression alternates with
periods of mania
Mania = Highly excited
mood and behavior
13-64

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Mood (Affective) Disorders

Prevalence of Mood Disorders
1 in 20 Americans is severely
depressed (Narrow et al., 2002)
1 in 5 Americans will have a
depressive episode of clinical
proportions during lifetime
(Hamilton, 1989)
13-65

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Mood (Affective) Disorders

Gender Differences
Women about twice as
likely to suffer from
unipolar depression
13-66

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Mood (Affective) Disorders

Biological Explanations for
Gender Differences in
Depression
Genetic factors
Biochemical differences
Premenstrual depression
13-67

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Mood (Affective) Disorders

Environmental Explanations for
Gender Differences in Depression
(Nolen-Hoeksma, 1990)
Female passivity and
dependency
Distraction by physical activity
and drinking in males
13-68

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Mood (Affective) Disorders

Patterns After Depressive
Episodes
No recurrence of clinical
depression
Recovery with recurrence
No recovery
13-69

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Mood (Affective) Disorders

Genetic Factors
67% concordance rate for
identical twins; only 15% for
fraternal twins (Gershon et al.,
1989)
Genetic predisposition to
mood disorder
13-70

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13-71

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Mood (Affective) Disorders

Brain Chemistry Factors
Underactivity of
norepinephrine, dopamine, and
serotonin in depression
(Davidson, 1998)
Overactivity of
neurotransmitters in mania?
13-72

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Mood (Affective) Disorders

Psychological Factors
Early traumatic losses or
rejections create vulnerability
(e.g. Abraham, 1911; Freud,
1917, Brown and Harris, 1978)

13-73

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Mood (Affective) Disorders

Humanistic Factors
Definition of self-worth in
terms of individual attainment
React more strongly to
failures; view failures as due to
inadequacies
Experience of
meaninglessness
13-74

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Mood (Affective) Disorders

Depressive Cognitive Triad
(Wenzlaff et al., 1988)
Negative thoughts concerning:
The world
Oneself
The future
13-75

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Mood (Affective) Disorders

Depressive Attributional Pattern
Attributing success to factors
outside self
Attributing negative outcomes
to personal factors

13-76

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13-77

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Mood (Affective) Disorders

Learned Helplessness Theory
(Abramson et al., 1978; Seligman
& Isaacowitz, 2000)
Depression occurs when
people expect that bad events
will occur and they think that
they cant cope with them
13-78

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Mood (Affective) Disorders

Environmental Factors
(Hammen, 1991)
Poor parenting
Many stressful experiences
Failure to develop good coping
skills
Failure to develop positive selfconcept
13-79

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Mood (Affective) Disorders

Sociocultural Factors
Prevalence of depressive
disorders less in Hong Kong
and Taiwan than in the West
Feelings of guilt and
inadequacy are highest in
North America and Western
Europe
13-80

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Mood (Affective) Disorders

Sociocultural Factors cont.

Gender difference not found
in developing countries

13-81

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Suicide
Willful taking of ones life
Second most frequent cause of
death among high school and
college students

Women attempt more suicides;

men are more likely to kill selves
13-82

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13-83

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Suicide
Motives for Suicide (Beck et al.,
1979)
Desire to end ones life
Manipulation of others
13-84

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Suicide
Warning Signs of Suicide
Verbal or behavioral threat to
kill self
History of previous attempts
Detailed plan that involves a
lethal method
13-85

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Suicide
Suicide Prevention
Talk about it with the
person

Provide social support and

empathy
13-86

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Suicide
Suicide Prevention cont.
Help the person to consider
positive future possibilities
Stay with the person and help
him or her to seek professional
assistance
13-87

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Schizophrenia
Severe disturbances in (Herz &
Marder, 2002):
Thinking
Speech
Perception
Emotion
Behavior
13-88

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Schizophrenia
Diagnosis of Schizophrenia
(American Psychiatric
Association, 1994, 2000)
Misinterpretation of reality
Disordered attention, thought,
perception
Withdrawal from social
activities
13-89

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Schizophrenia
Diagnosis of Schizophrenia cont.
Strange or inappropriate
communication
Neglect of personal grooming
Disorganized behavior
13-90

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Schizophrenia
Delusions
False beliefs that are sustained
in the face of contrary
evidence normally sufficient to
destroy them

13-91

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Schizophrenia
Hallucinations
False perceptions that have a
compelling sense of reality

Can be auditory or visual

13-92

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Schizophrenia

Types of Affect
Flat: No emotions at all
Inappropriate
13-93

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Schizophrenia
Subtypes of Schizophrenia
Paranoid
Delusions of persecution
and grandeur
13-94

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Schizophrenia
Subtypes of Schizophrenia
Disorganized
Confusion and incoherence
Severe deterioration of
adaptive behavior
13-95

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Schizophrenia
Subtypes of Schizophrenia
Catatonic
Motor disturbances from
muscular rigidity to random
or repetitive movements
13-96

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Schizophrenia
Subtypes of Schizophrenia
Undifferentiated
Do not show enough specific
criteria to be classified as
paranoid, disorganized, or
catatonic
13-97

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Schizophrenia
Positive Symptoms
Bizarre behaviors such as
delusions, hallucinations, and
disordered speech, thinking
Negative Symptoms
Absence of normal reactions
e.g., emotional expression,
motivation, normal speech
13-98

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Schizophrenia
Positive Symptoms
Better prognosis for later
recovery

13-99

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Schizophrenia
Biological Causes

13-100

Genetic predisposition
Destruction of neural tissue
(neurodegenerative
hypothesis)
Atrophy in brain regions that
influence cognitions,
emotions

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Schizophrenia
Dopamine hypothesis
Overactivity of the dopamine
system in brain areas
regulating emotions,
motivations, and cognitions

13-101

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Schizophrenia
Psychological Factors
Freud: extreme example of
regression
Retreat from painful
intrapersonal world
Chaotic sensory input
Deficits in frontal lobe
executive functions
13-102

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Schizophrenia
Environmental Factors
Stressful life events
Family dynamics
Home environments high in
expressed emotion (Vaughn &
Leff, 1976)
13-103

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Schizophrenia
Expressed Emotion
High levels of criticism
High levels of hostility
Overinvolvement in persons
life
13-104

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Schizophrenia
Sociocultural Factors
Highest in lower
socioeconomic populations
Causal or correlational?

13-105

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Schizophrenia
Social Causation Hypothesis
Higher prevalence of
schizophrenia due to higher
levels of stress

13-106

Social Drift Hypothesis

Deterioration of social and
personal functioning causes
drift into poverty

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Personality Disorders
Stable, ingrained, inflexible, and
maladaptive ways of thinking,
feeling, and behaving
Increase likelihood of acquiring,
maintaining several Axis I
disorders
13-107

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Personality Disorders
Three Clusters:
Dramatic and impulsive
behaviors
Anxiety and fearfulness
Odd and eccentric
behaviors
13-108

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Personality Disorders
Antisocial Personality
Disorder
Psychopaths or sociopaths
3:1 male-female ratio
Lack a conscience
Fail to respond to
punishment
13-109

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Personality Disorders
Biological Causes of Antisocial
Personality Disorder
Genetic predisposition
Dysfunction in brain structures
that govern self-control and
emotional arousal?
13-110

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Personality Disorders
Psychological Causes of
Antisocial Personality Disorder
Psychodynamic view: lack of a
superego
Inability to develop
conditioned fear responses
when punished leads to poor
impulse control
13-111

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Personality Disorders
Psychological Causes of
Antisocial Personality
Disorder cont.
Modeling of aggression
Parental inattention to
childrens needs (Rutter,
1997)
13-112

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Personality Disorders
Psychological Causes of
Antisocial Personality Disorder
cont.
Exposure to deviant peers
Consistent failure to think
about or anticipate long-term
negative consequences of acts
13-113

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Childhood Disorders
Over 20% of children aged 2-5
diagnosed with DSM-IV disorder
(Lavigne et al., 1996)
Only about 40% of children with
behavior disorders receive
professional attention (Satcher,
1999)
13-114

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Childhood Disorders
Externalizing Disorders
Disruptive and aggressive
behaviors
e.g., ADHD
13-115

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Childhood Disorders
ADHD (Attention
Deficit/Hyperactivity Disorder)
Attentional difficulties
Hyperactivity-impulsivity
Most common childhood
disorder (7-10% of U.S.
children)
13-116

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Childhood Disorders
Causes of ADHD
Genetic predispositions
Brain scans show no
differences with normals
Environmental factors
13-117

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Childhood Disorders
Other Externalizing Disorders
Oppositional Defiant Disorder
(ODD)
Disobedient, defiant, hostile
Conduct Disorder
Violate social norms and
show disregard for others
rights
13-118

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Childhood Disorders
Internalizing Disorders
Involve maladaptive thoughts
and emotions

Include anxiety and mood

disorders
13-119

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Dementia in Old Age

Gradual loss of cognitive
abilities
Accompanies brain deterioration
e.g., Alzheimers, Parkinsons,
Huntingtons, Creutzfeldt-Jakob
Diseases
13-120

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Dementia in Old Age

Senile Dementia
Dementia that begins after age
65
2:1 female-male ratio
Onset is typically gradual
Over 1/2 cases resemble
schizophrenia
13-121

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Dementia in Old Age

Alzheimers Disease
60% of senile dementias
Caused by deterioration in
frontal and temporal lobes of
brain
Plaques in brain
Destruction of cells that
produce acetylcholine
13-122