Chapter 16: Psychological Disorders. Chapter Outline 1. Defining, classifying, and diagnosing...

Chapter 16: Psychological Disorders

Chapter Outline

1. Defining, classifying, and diagnosing psychological abnormality

2. Models of abnormality3. Mood disorders4. Anxiety disorders5. Schizophrenia6. Other disorders

© John Wiley & Sons Canada, Ltd.

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


Does Dysfunction Equal Abnormality?


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


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


Models of Abnormality

Explanations for why or how disorders occur


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


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


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


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


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

Unsupported by research© John Wiley & Sons Canada, Ltd.

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


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


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


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


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


Explanations for Major Depressive Disorder

Neuroscientists Genetic predisposition—low norepinephrine

and serotonin activity High cortisol

Socio-cultural theorists Social support Stressors


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


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


Explanations for Bipolar Disorder

Neuroscientists Gene abnormalities Irregularities in ions that allow neurons to

communicateOther causes

Stress plus biological predisposition Life events—striving, failures


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


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


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


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


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


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


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


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


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


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


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


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


Many Events Can Produce PTSD


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


Schizophrenia

Key features (continued) Psychomotor symptoms

Strange movements Catatonia—extreme psychomotor symptoms

StuporRigidityPosturingWaxy flexibility


Catatonic Posturing

Some people struggling with schizophrenia demonstrate catatonic posturing, where they strike and hold bizarre positions, sometimes for hours


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


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


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


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


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


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


Copyright

Copyright © 2012 John Wiley & Sons Canada, Ltd. All rights reserved. Reproduction or translation of this work beyond that permitted by Access Copyright (The Canadian Copyright Licensing Agency) is unlawful. Requests for further information should be addressed to the Permissions Department, John Wiley & Sons Canada, Ltd. The purchaser may make back-up copies for his or her own use only and not for distribution or resale. The author and the publisher assume no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information contained herein.

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