Chapter 12 Psychological Disorders

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Chapter 12Psychological Disorders
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What is Normal?

• Psychopathology Scientific study of mental,
  emotional, and behavioral disorders
• Subjective Discomfort Feelings of discomfort,
  unhappiness, or emotional distress
• Statistical Abnormality Having extreme scores on
  some dimension, such as intelligence, anxiety, or
  depression
• Social Nonconformity Disobeying societal
  standards for normal conduct usually leads to
  destructive or self-destructive behavior

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Figure 12.1
FIGURE 12.1 The number of people displaying a
personal characteristic may help define what is
statistically abnormal.
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What Is Normal? (cont'd)

• Situational Context Social situation, behavioral
  setting, or general circumstances in which
  behavior 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 ones culture

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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

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Clarifying and Defining Abnormal Behavior (Mental
Illness)

• Psychotic Disorder Severe psychiatric disorder
  characterized by hallucinations and delusions,
  social withdrawal, and a move away from reality
• Organic Mental Disorder Mental or emotional
  problem caused by brain pathology (i.e., brain
  injuries or diseases)
• Mood Disorder Disturbances in affect (emotions),
  like depression or mania
• Anxiety Disorder Feelings of fear, apprehension,
  anxiety, and distorted behavior

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Clarifying and Defining Abnormal Behavior (Mental
Illness)

• Somatoform Disorder Physical symptoms that mimic
  disease or injury (blindness, anesthesia) for
  which there is no identifiable physical cause
• Dissociative Disorder Temporary amnesia,
  multiple personality, 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

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Clarifying and Defining Abnormal Behavior (Mental
Illness)

• 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
• Neurosis Archaic once used to refer to
  excessive anxiety, somatoform, dissociative
  disorders, and some kinds of depression

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General Risk Factors for Contracting Mental
Illness

• Biological Factors Genetic defects or inherited
  vulnerabilities poor prenatal care, head
  injuries, exposure to toxins, chronic physical
  illness, or disability
• Psychological Factors Low intelligence, stress,
  learning disorders________________
• Social Conditions Poverty, homelessness,
  overcrowding, stressful living conditions
• Family Factors Parents who are immature,
  mentally ill, abusive, or criminal poor child
  discipline severe marital or relationship
  problems
• Other sources of psychological stress

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Figure 12.11
FIGURE 12.11 A combination 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.
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Personality Disorders Antisocial Personality
Disorder (ASPD)

• 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
  charming
• Cheat their way through life (e.g., Dr. Michael
  Swango)
• Blind to signs of disgust in other people

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ASPD Causes and Treatments

• Possible Causes
• Childhood history of emotional deprivation,
  neglect, and physical abuse
• Underarousal of the brain
• Very difficult to effectively treat will lie,
  charm, and manipulate their way through therapy

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Anxiety-Based Disorders

• Anxiety Feelings of apprehension, dread, or
  uneasiness
• Adjustment Disorders When ongoing stressors
  cause emotional disturbance and push people
  beyond their ability to effectively cope
• Usually suffer sleep disturbances, irritability,
  and depression
• Examples Grief reactions, lengthy physical
  illness, unemployment can be some triggers for
  anxiety

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Anxiety-Based Disorders (cont'd)

• Anxiety Disorders When stress seems greatly out
  of proportion to the situation at hand usually
  accompanied by some form of avoidance
• 3 Main Types
• Generalized Anxiety Disorder (GAD) Duration of
  at least six months of chronic, unrealistic, or
  excessive anxiety
• Panic Disorder (w/ or w/o agoraphobia)
• Phobia

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Generalized Anxiety Disorder

• Extreme anxiousness and worry for at least 6
  months
• Anxiousness/anxiety do not fade when life
  circumstances get better
• Multiple topics of worry

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Panic Disorders

• Panic 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

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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.

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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.

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Social Phobia

• Intense, irrational fear of being observed,
  evaluated, humiliated, or embarrassed by others
  (e.g., shyness, eating, or speaking in public)

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Review 3 Anxiety Disorders

• 1. Phobiaobjects, situation, social
• Causes not only experiencealso inherit
  tendencies (prepared fears)
• 2. Generalized Anxietyconstant anxiety and
  worry
• 3. Panic Disorderdiscrete panicky episodes

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Obsessive-Compulsive Disorder (OCD)

• Extreme preoccupation with certain thoughts and
  compulsive performance of certain behaviors
• Obsession Recurring images or thoughts that a
  person cannot prevent
• Cause anxiety and extreme discomfort
• Enter into consciousness against the persons
  will
• Most common Being dirty or wondering if you
  performed an action (turned off the stove)

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Compulsions

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

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• Table 16.2
• Obsessive-Compulsive Tendencies

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Anxiety

• Feelings of tension, uneasiness, apprehension,
  worry, and vulnerability
• We are motivated to avoid experiencing anxiety

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Figure 10.6
FIGURE 10.6 The approximate relationship between
the id, ego, and superego, and the levels of
awareness.
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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.

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Other Theoretical Causes of Anxiety Disorders

• Humanistic-Existential Unrealistic self-image
  conflicts with true self

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Other Theoretical Causes of Anxiety Disorders

• Behavioristic Anxiety symptoms and behaviors are
  learned, like everything else
• Conditioned emotional responses generalize to new
  situations
• 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

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Freudian Defense Mechanisms

• Defense Mechanisms Habitual and unconscious (in
  most cases) psychological processes designed to
  reduce anxiety

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More on Defense Mechanisms

• Work by avoiding, denying, or distorting sources
  of threat or anxiety
• If used short term, can help us get through
  everyday situations
• If used long term, we may end up not living in
  reality
• Protect idealized self-image so we can live with
  ourselves

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Freudian Defense Mechanisms Some Examples

• Denial Most primitive denying reality usually
  occurs with death and illness
• Repression When painful memories, anxieties, and
  so on are held out of our awareness
• Reaction Formation Impulses are repressed and
  the opposite behavior is exaggerated

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More Defense Mechanisms

• Projection When ones own feelings,
  shortcomings, or unacceptable traits and impulses
  are seen in others exaggerating negative traits
  in others lowers anxiety
• Rationalization Justifying personal actions by
  giving rational but false reasons for them

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• Name that defense mechanism!
• Your ex-spouse, who cheated on you, writes a
  best-selling nonfiction book arguing that human
  beings are not naturally monogamous and have an
  instinctive need for variety.

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• Name that defense mechanism!
• You are in love with your best friends new
  flame. The friendship is an old one and very
  valuable to you. You tell everybody that your
  friends new love interest is a terrible human
  being and you dont understand the attraction at
  all.

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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
• Seasonal 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

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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 disorders.
• Bipolar 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)

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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

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Figure 12.14
FIGURE 12.14 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.
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Figure 12.15
FIGURE 12.15 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
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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

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Stress Disorders

• Occur when stresses outside range of normal human
  experience cause major emotional disturbance
• Symptoms Reliving traumatic event repeatedly,
  avoiding reminders of the event, and numbing of
  emotions
• Acute Stress Disorder Psychological disturbance
  lasting up to one month following stresses from a
  traumatic event

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Post-Traumatic Stress Disorder (PTSD)

• 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.)

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Dissociative Disorders

• Dissociative Amnesia Inability to recall ones
  name, address, or past
• Memory loss is partial or complete for personal
  information
• Dissociative Fugue Sudden travel away from home
  and confusion about personal identity

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Dissociative Identity Disorder (DID)

• Person has two or more distinct, separate
  identities or personality traits 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

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Somatoform Disorders

• Hypochondriasis Person is preoccupied with fears
  of 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

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Somatoform Disorders (cont'd)

• 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 disability
• Caused by anxiety or emotional distress but not
  by physical causes
• Glove Anesthesia Loss of sensitivity in areas of
  skin normally covered by a glove

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Figure 12.4
FIGURE 12.4 (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.
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Other Theoretical Causes of Anxiety Disorders

• Humanistic-Existential Unrealistic self-image
  conflicts with real self-image
• Existential Anxiety reflects loss of meaning in
  ones life
• Behavioristic Anxiety symptoms and behaviors are
  learned, like everything else
• Conditioned emotional responses that generalize
  to new situations

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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

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Psychosis

• Psychosis Loss of contact with reality marked by
  hallucinations, delusions, disturbed thoughts and
  emotions, and personality disorganization

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Delusions

• Delusions False beliefs that psychotic
  individuals insist are true, regardless of
  overwhelming evidence against them
• Common forms
• Erotomanic
• Grandiose
• Jealous
• Persecution
• Somatic

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Hallucinations

• 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)

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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
• Known as senility at times
• Alzheimers Disease Most common cause of
  dementia symptoms include impaired memory,
  confusion, and progressive loss of mental
  abilities
• Ronald Reagan most famous Alzheimers victim

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Delusional Disorders

• Marked by presence of deeply held false beliefs
  (delusions)
• Usually involve delusions of grandeur,
  persecution, or jealousy
• Paranoid Psychosis Most common delusional
  disorder
• Centers on delusions of persecution

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Schizophrenia The Most Severe Mental Illness

• Psychotic disorder characterized by
  hallucinations, delusions, apathy, thinking
  abnormalities, and split between thoughts and
  emotions
• Does NOT refer to having split or multiple
  personalities

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Some More Psychotic Symptoms

• Flat Affect Lack of emotional responsiveness
• Inappropriate emotions
• Disturbed Verbal Communication Garbled and
  chaotic speech word salad
• Personality Disintegration Uncoordinated
  thoughts, actions, and emotionsa split between
  thought and emotion
• Withdrawal and apathy
• Breakdown of personal habits
• Problems with selective attention

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The Four Subtypes of Schizophrenia

• Disorganized Schizophrenia Incoherence, grossly
  disorganized behavior, bizarre thinking, and flat
  or grossly inappropriate emotions
• Catatonic Schizophrenia Marked by stupor where
  victim may hold same position for hours or days
  also unresponsive
• Paranoid Schizophrenia Preoccupation with
  delusions of grandeur or persecution also
  involves hallucinations that are related to a
  single theme, especially grandeur or persecution
• Undifferentiated Schizophrenia Any type of
  schizophrenia that does not have paranoid,
  catatonic, or disorganized features or symptoms

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Causes of Schizophrenia

• Psychological Trauma Psychological injury or
  shock, often caused by an environment of
  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
• Heredityif one identical twin becomes
  schizophrenic then the other twin has about 50
  chance
• Stress-Vulnerability Hypothesis Combination of
  environmental stress and inherited susceptibility
  cause psychotic disorders

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Figure 12.7
FIGURE 12.7 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.
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Biochemical Causes of Schizophrenia

• Biochemical Abnormality Disturbance in brains
  chemical systems or in the brains
  neurotransmitters
• Dopamine Neurotransmitter involved with emotions
  and muscle movement
• Works in limbic system
• Dopamine overactivity in brain may be related to
  schizophrenia
• Glutamate may also be related to schizophrenia

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Figure 12.8
FIGURE 12.8 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 persons
agitation and psychotic symptoms.
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Schizophrenic Brain

• Computed Tomography (CT) Scan Computer enhanced
  X-ray of brain or body
• CT scans show schizophrenic brains as having
  wider surface fissures
• 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

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Schizophrenic Brain (cont'd)

• Positron Emission Tomography (PET) Scan
  Computer-generated color image of brain activity
  radioactive sugar solution is injected into the
  brain.
• Activity is abnormally low in frontal lobes of
  schizophrenics

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Major Mood Disorders (cont'd)

• Endogenous Depression Depression that seems to
  be produced from inside the body (due to chemical
  imbalances) and NOT from life events
• Seasonal 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

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Figure 12.12
FIGURE 12.12 Seasonal affective disorder appears
to be related to reduced exposure to daylight
during the winter. SAD affects 1 to 2 percent of
Floridas 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