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Chapter 16: Psychological Disorders
Chapter Outline
1. Defining, classifying, and diagnosing psychological abnormality
2. Models of abnormality3. Mood disorders4. Anxiety disorders5. Schizophrenia6. Other disorders
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Defining, Classifying, and Diagnosing Psychological Abnormality
Abnormal psychology—scientific study of psychological disorders No universal definition of what is abnormal
behaviour Agreed-upon features (the four Ds):
Deviance—behaviour, thoughts, or emotions are unusual
Distress—to the person or close others Dysfunction—interference with daily functioning Danger—most people with disorders are not a
danger to themselves or others, but people who put themselves or others at risk may have a disorder
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Does Dysfunction Equal Abnormality?
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Classifying and Diagnosing Psychological Disorders
International Classification of Diseases (ICD) System used by most countries to classify
psychological disorders; published by the World Health Organization and currently in its tenth edition
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR): o Manual used to diagnose mental disorders in North
Americao Provides a categorical list of symptoms for all 400
mental disordersDiagnosis—identifying a disorder by its symptoms
and other evidenceComorbidity—two or more disorders are present
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Five Dimensions or Axes of the DSM-IV-TR
Axis I contains the detailed criteria for the principal disorders
Axis II includes criteria relating to longer-term disorders (personality disorders, learning disabilities, etc.)
Axis III lists any medical or neurological problems that may be important in relation to current or past psychiatric problems
Axis IV records any recent major psychosocial stressors (divorce, death of loved one, loss of job, etc.)
Axis V uses a 0 to 100 point detailed general functioning scale that the clinician uses to assess the client’s current level of functioning, as well as his or her highest level of functioning in the past year
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Models of Abnormality
Explanations for why or how disorders occur
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The Neuroscience Model
Views disorders as illnesses caused by a malfunctioning brain Factors contributing to biological dysfunction
Genetic inheritance Mood disorders, schizophrenia, mental retardation,
Alzheimer’s Too few or too many of certain types of neurotransmitters
Insufficient norepinephrine and serotonin in depression Viral infection
Fetal or childhood exposure and schizophrenia Hormones
Excess cortisol in depression Specific brain structures
Huntington’s disease and loss of cells in the striatum Does not take into account additional factors such as stress,
experiences
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Antisocial Disorders and the Brain
Extreme antisocial disorders and the brain—forensic psychiatrist Helen Morrison displays slices of the brain of John Wayne Gacy, who murdered at least 33 boys and young men between 1972 and 1978
Postmortem examinations have not revealed clear links between abnormal brain structure and the extreme antisocial patterns exhibited by Gacy and other serial killers
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The Cognitive-Behavioural Model
Disorders are the result of maladaptive learned behaviours and problematic thinking Behaviour and thinking interact and
influence each other Acknowledge that emotions and biological
factors also interact with behaviour and cognition
Behavioural perspective—based on learning principles from classical conditioning, operant conditioning, and modelling
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The Cognitive-Behavioural Model
Cognitive perspective—maladaptive beliefs and illogical thinking processes cause distress Beliefs about the self and the world
Arbitrary inferences—negative conclusions based on little evidence
Selective perception—seeing negative features of events
Magnification—exaggerating the importance of negative events
Overgeneralization—broad, negative conclusions
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The Psychodynamic Model
Underlying, perhaps unconscious psychological forces cause conflict Rooted in Freudian theory Fixation—being trapped at an early stage of
development due to traumatic childhood experiences
Object relations theorists—believe people’s primary motivation is to form relationships
Problems in early relationships result in psychological problems
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The Socio-cultural Model
A society’s characteristics create stressors for some of its members Widespread social change Socio-economic class Cultural factors Social networks and supports Family systems
Family systems theory—a theory holding that each family has its own implicit rules, relationship structure, and communication patterns that shape the behaviour of the individual members
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The Developmental Psychopathology Model
Study how problem behaviours evolve as a function of a person’s genes and early experiences and how these early issues affect the person at later life stages Risk factors—biological and environmental factors that
contribute to problem outcomes Equifinality—the idea that different children can start
from different points and wind up at the same outcome Multifinality—the idea that children can start from the
same point and wind up at any number of different outcomes
Resilience—the ability to recover from or avoid the serious effects of negative circumstances
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Mood Disorders
Depression—low, sad state in which people feel overwhelmed Most people with a mood disorder suffer only from
depression Major depressive disorder is more severe than
dysthymic disorderMania—elation and frenzied energy
People with bipolar disorder or the less severe cyclothymic disorder also experience mania
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Mood Disorders
Major depressive disorder—a disorder characterized by a depressed mood that is significantly disabling and is not caused by such factors as drugs or a general medical condition
Bipolar disorder—periods of mania alternate with periods of depression
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Major Depressive Disorder
Symptoms in these areas of functioning Emotional—depressed mood Motivational—loss of desire to do usual activities,
lack of drive Behavioural—less active and productive, may move
and speak slowly or seem physically agitated Cognitive—negative self-evaluation, self-blame,
pessimism, guilt, indecisiveness, difficulty concentrating, thoughts of death or suicide
Physical—headaches, indigestion, constipation, dizzy spells, pain, sleep and eating disturbance, fatigue
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Explanations for Major Depressive Disorder
Neuroscientists Genetic predisposition—low norepinephrine
and serotonin activity High cortisol
Socio-cultural theorists Social support Stressors
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Explanations for Major Depressive Disorder
Cognitive-behavioural theorists Learned helplessness Attribution-helplessness
theory—global, stable, internal causes
Negative thinking/dysfunctional attitudes Illogical thinking
processes Automatic thoughts The cognitive triad
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Bipolar Disorder
Bipolar disorder—extreme highs and lows Mania—inappropriate, dramatic positive mood Symptoms of mania in five areas of functioning
(alternating with depressive symptoms) Emotional—powerful highs and lows Motivational—seek excitement and
companionship Behavioural—may move and speak quickly Cognitive—poor judgment and planning,
optimism, grandiosity Physical—energetic, require little sleep
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Explanations for Bipolar Disorder
Neuroscientists Gene abnormalities Irregularities in ions that allow neurons to
communicateOther causes
Stress plus biological predisposition Life events—striving, failures
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Anxiety Disorders
Most common group of disorders in Canada About 12 percent of the adult population
suffer from an anxiety disorder in any yearKey features
Disabling levels of fear or anxiety that are frequent, severe, persistent, or easily triggered
Most people with one anxiety disorder experience another one as well
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Generalized Anxiety Disorder
Key features Anxiety under most life circumstances;
diffuse worry Restlessness, edginess, easily tired Difficulty concentrating Sleep problems
4% of the North American population have symptoms of this disorder in any given year
Women outnumber men 2 to 1
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Explanations for Generalized Anxiety Disorder
Cognitive-behavioural theorists Dysfunctional assumptions
Assumption that one is in danger Intolerance of uncertainty theory—unwilling to
accept negative eventsNeuroscientists
Malfunctioning GABA feedback system Malfunctioning emotional brain circuit
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Social Anxiety Disorder
More women than men, more poor people than wealthier people
12% of population develop this at some time in their life
Often begins in late childhood or adolescenceKey features
Severe, persistent fear of embarrassment in social situations
May be narrow or broad Fear of talking in public General fear of functioning poorly in front of others
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Explanations for Social Anxiety Disorder
Cognitive-behavioural theorists Dysfunctional cognitions about social situations
Unrealistically high social standards View oneself as socially unattractive View oneself as socially unskilled Belief that one is in danger of behaving clumsily Expect negative consequences for clumsy
behaviour Belief that one has no control over anxious
feelings
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Phobias
7.7 % of people in Canada suffer from at least one specific phobia in any year
Key features Persistent, irrational fear of a specific object,
activity, or situationExplanations
Classically conditioned fear Avoidance behaviours are reinforced through
operant conditioning Modelling of fearful behaviour
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Ten Most Common Phobias
Spiders—arachnophobia Heights—acrophobia Public, social places—
agoraphobia Social situations—social
phobia Flying—aerophobia Enclosed spaces—
claustrophobia Thunder—brontophobia Germs—mysophobia Cancer—carcinophobia Death—necrophobia
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Panic Disorder
Key features Panic attacks—periodic sudden bouts of panic Panic disorder—panic attack plus changes in thinking
or behaviour May misinterpret panic as a sign of medical
emergency Often accompanied by agoraphobia
Explanations Malfunctioning brain circuit and excess norepinephrine Misinterpretation of bodily sensations
21% of Canadians over 15 years old have suffered from a panic attack at some point
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Obsessive-Compulsive Disorder
Key features Obsessions—persistent unwanted thoughts
Wishes, impulses, doubts, or images Compulsions—repetitive, rigid behaviours or
mental acts Are often responses to obsessive thoughts,
performed to reduce or prevent anxiety
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Obsessive-Compulsive Disorder
Explanations Neuroscientists
Low serotonin activity Overactive orbitofrontal cortex and caudate nuclei Cingulate cortex and hypothalamus activate the
OCD impulses Amygdala drives the fear and anxiety components
of the OCD response Cognitive-behavioural theorists
Learning that compulsive behaviour relieves distress
2% of Canadians suffer from obsessive-compulsive disorder
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Posttraumatic Stress Disorder
Key features Persistent depression, anxiety after a traumatic event
Acute stress disorder (ASD)—lasts less than a month and begins within four weeks of the event
Posttraumatic stress disorder (PTSD)—lasts more than a month, may begin shortly after or years after the event
Hyperalertness Easily startled Sleep disturbance Guilt, anxiety, depression, difficulty with concentration
What events cause PTSD? Psychologically traumatic events like rape, combat,
natural disasters
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Explanations for PTSD
9.2% of Canadians experience PTSD in their lifetimeTwice as common in women than men
20% of women who experience a traumatic event 8% of men who experience a traumatic event
Biological factors Increased cortisol and norepinephrine Damaged hippocampus, amygdala
Personality—external locus of control, anxiousChildhood experiencesSocial and family supportCultural factors
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Many Events Can Produce PTSD
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Schizophrenia
Key features Positive symptoms—pathological excesses
Delusions—false beliefs Hallucinations—false sensory perceptions Disorganized thinking and speech, loose
associations or derailment Inappropriate affect
Negative symptoms—pathological deficits Poverty of speech Flat affect Loss of volition Social withdrawal
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Schizophrenia
Key features (continued) Psychomotor symptoms
Strange movements Catatonia—extreme psychomotor symptoms
StuporRigidityPosturingWaxy flexibility
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Catatonic Posturing
Some people struggling with schizophrenia demonstrate catatonic posturing, where they strike and hold bizarre positions, sometimes for hours
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Schizophrenia: Subtypes
Paranoid type—the main symptoms in this type are delusions and possibly auditory hallucinations; there is no thought disorder and the delusions centre on being persecuted or jealousy
Disorganized type (also called hebephrenic schizophrenia)—the combination of disordered thoughts and flat affect characterize this subtype
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Schizophrenia: Subtypes
Catatonic type—this subtype is characterized by immobility or by agitated, purposeless movements
Undifferentiated type—symptoms of schizophrenia are present but not in a combination that allows for categorization in any of the previous other subtypes
Residual type—symptoms are present but at a low level of intensity
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Explanations for Schizophrenia
Neuroscientists Genetic predisposition
Identical twins—48% concordance rate Fraternal twins—17% concordance rate
Biochemical abnormalities—excessive dopamine activity
Brain structure—enlarged ventricles, small temporal lobes and frontal lobes, structural abnormalities of the hippocampus, amygdala, and thalamus
Diathesis-stress model Biological predisposition plus negative event
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Other Disorders
Somatoform disorders—physical complaint that is psychological in origin
Conversion disorder—conflict or need converted into physical symptom; paralysis, blindness, or loss of feeling
Somatization disorder—long-term physical ailments that have no organic basis; pain, neurological, gastrointestinal
Hypochondriasis—interpret bodily symptoms as signs of a serious illness
Body dysmorphic disorder—deeply concerned about some imagined or minor defect in their appearance
Explanations Classical conditioning and modelling Misinterpretation of bodily cues
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Other Disorders
Dissociative disorders—major disruptions in memory Dissociative amnesia—unable to remember important
information about a traumatic event; wartime, natural disaster
Dissociative fugue—forget one’s personal identity and flee
Dissociative identity disorder—two or more distinct personalities
Explanations Psychodynamic theorists—repression Neuroscience—smaller hippocampus and amygdala,
changes in the level of activity in the sensory cortex
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Other Disorders
Personality disorders—rigid patterns of experience and behaviour causing distress or difficulty Antisocial personality disorder:
Disregards and violates the rights of others, impulsive, reckless, self-centred; linked to criminal behaviour
Explanations: Modelling, operant conditioning; low serotonin activity, deficient functioning in the frontal lobes, lower arousal to stress and less anxiety
Borderline personality disorder: Unstable mood, self-image, high volatility Explanation: Biosocial theory—child has difficulty
identifying and controlling emotions, and the emotions are punished or disregarded
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