Psychological Disorders

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Chapter 16

• Psychological Disorders

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What is Normal?

• Psychopathology Scientific study of mental,
  emotional, and behavioral disorders
• Subjective Discomfort Feelings of anxiety,
  depression, 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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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 ones culture

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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.
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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.

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

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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 reality
• Organic 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

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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

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Fig. 16.5 The Mad Hatter, from Lewis Carrolls
Alices Adventures in Wonderland. History
provides numerous examples of psychosis caused by
toxic chemicals. Carrolls 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).
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Clarifying and Defining Abnormal Behavior (Mental
Illness) (cont.)

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

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

• 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

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General Risk Factors for Contracting Mental
Illness

• 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
• Psychological Factors Low intelligence, stress,
  learning disorders
• Biological Factors Genetic defects or inherited
  vulnerabilities poor prenatal care, head
  injuries, exposure to toxins, chronic physical
  illness, or disability

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Insanity

• Definition A legal term refers to an inability
  to manage ones affairs or to be aware of the
  consequences of ones 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

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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
  charming
• Cheat their way through life (e.g., Dr. Michael
  Swango, Scott Peterson)

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APD Causes and Treatments

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

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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.)

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CNN Serial Killer Motives
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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

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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

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CNN Anxiety Disorders in Kids
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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)
• Barbra Streisand, Woody Allen perhaps?

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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, 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

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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 stimuli associated with the event, and
  numbing of emotions
• Acute Stress Disorder Psychological disturbance
  lasting up to one month following stresses from a
  traumatic event
• Post 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

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CNN Mental Health and Traumatic Events

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CNN - Prostitution
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Dissociative Disorders

• Dissociative Amnesia Inability to recall ones
  name, address, or past
• 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 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

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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

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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 disability
• Caused by anxiety or emotional distress but not
  by physical causes

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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.)

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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 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 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)

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Some More Psychotic Symptoms

• Flat Affect Lack of emotional responsiveness
  face is frozen in blank expression
• Disturbed Verbal Communication Garbled and
  chaotic speech word salad
• Personality Disintegration When an individuals
  thoughts, actions, and emotions are uncoordinated

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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
• Archaically known as senility
• Alzheimers Disease 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)
• May involve delusions of grandeur, persecution,
  jealousy, or somatic delusions
• Experiences could really occur!
• 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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The Four Subtypes of Schizophrenia

• Disorganized (Hebephrenic) Type Incoherence,
  grossly disorganized behavior, bizarre thinking,
  and flat or inappropriate emotions
• Catatonic 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
  persecution
• Undifferentiated Type Any type of schizophrenia
  that does not have specific paranoid, catatonic,
  or disorganized features or symptoms

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CNN Schizophrenic Reality
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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

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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
Unabombera reclusive loner who deeply
mistrusted other people and modern technology.
After his arrest, Kaczynski was judged to be
suffering from paranoid schizophrenia.

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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

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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.)
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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 persons
agitation and psychotic symptoms.
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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

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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 Hinkleys brain. (right) CT
scan of a normal 25-year-olds 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.
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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.
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CNN Schizophrenia Gene
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Stress-Vulnerability Model

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

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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.
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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
• 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

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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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Major Mood Disorders (cont.)

• 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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Maternity Blues

• Maternity Blues Mild depression that lasts for
  one to two days after childbirth
• Marked by crying, fitful sleep, tension, anger,
  and irritability
• Brief and not too severe

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Postpartum Depression

• Postpartum Depression Moderately severe
  depression that begins within three months
  following childbirth
• Marked by mood swings, despondency, feelings of
  inadequacy, and an inability to cope with the new
  baby
• May last from two months to one year
• Part of the problem may be hormonal

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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
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 (Booker Hellekson, 1992).
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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).

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Therapeutic Interventions

• Psychotherapy Any psychological treatment for
  behavioral or emotional problems
• Typically involves two people talking about ones
  personal problems
• Medical Therapies Drug therapy, hospitalization,
  or psychosurgery

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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.)

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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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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.
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CNN Suicidal Tendencies
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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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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).
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Insanity

• Insanity Defense Person was incapable of knowing
  right from wrong while committing a crime
• MNaghten 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 act
• Diminished Capacity Temporary loss of ability to
  control actions or to know right from wrong