Chapter 14 Psychological Disorders
What is Normal?
• Psychopathology: Scientific study of mental, emotional, and behavioral disorders; abnormal or maladaptive behavior
• Subjective discomfort: Private feelings of pain, unhappiness, or emotional distress
• Statistical abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depression
What is Normal? (cont)
• Social nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior
• Situational context: Social situation, behavioral setting, or general circumstances in which an action takes place– Is it normal to walk around naked among
strangers? If you are in a locker room and in the shower area, yes!
Cultural Relativity
• Judgments are made relative to the values of one’s culture
Fig. 14-2, p. 464
Fig. 14-1, p. 461
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
Insanity
• Definition: A legal term; refers to an inability to manage one’s affairs or to be unaware of the consequences of one’s 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– How accurate is the judgment of insanity?
p. 461
Some Psychological Disorders
• Psychotic disorder: Severe mental 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)
p. 465
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Some More Psychological Disorders
• Mood disorder: Major disturbances in mood or emotions, like depression or mania
• Anxiety disorder: Disruptive feelings of fear, apprehension, anxiety, and behavior distortions
Table 14-4, p. 468
More Psychological Disorders
• 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
A Final Few Psychological Disorders
• Substance-related disorder: 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• Sexual and gender identity disorders: Problems
with sexual identity, deviant sexual behavior, or sexual adjustment
• Neurosis: Archaic; once used to refer to, as a group, anxiety, somatoform, and dissociative disorders, and to some forms of depression
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
• Family factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problems
• Social conditions: Poverty, homelessness, overcrowding, stressful living conditions
Fig. 14-3, p. 469
Psychosis
• Loss of contact with shared views of reality• Typically marked by delusions and
hallucinations, and personality disintegration
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)
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 individual’s thoughts, actions, and emotions are no longer coordinated
Other Psychotic Disorders
• Organic psychosis: Psychosis caused by brain injury or disease– Dementia: Most common organic problem;
serious mental impairment in old age caused by brain deterioration
Alzheimer’s Disease
• Symptoms include memory loss, mental confusion, and progressive loss of mental abilities– Ronald Reagan most famous Alzheimer’s
victim
p. 469
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
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
Video: Schizophrenia: Common Symptoms
The Four Subtypes of Schizophrenia
Disorganized Type
• Incoherence, grossly disorganized behavior, bizarre thinking, and flat or grossly inappropriate emotions
p. 471
Catatonic Type
• Marked by stupor, unresponsiveness, posturing, mutism, and sometimes, by agitated, purposeless behavior
p. 472
Paranoid Type
• Preoccupation with delusions; also involves auditory hallucinations that are related to a single theme, especially grandeur or persecution
• Most common schizophrenic disorder
Fig. 14-4, p. 472
Undifferentiated Type
• Any type of schizophrenia that does not have specific paranoid, catatonic, or disorganized features or symptoms
Video: Schizophrenia: Distortion of Reality
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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Biochemical Causes of Schizophrenia
• Biochemical abnormality: Disturbance in brain’s chemical systems or in the brain’s neurotransmitters
• Dopamine: Neurotransmitter involved with emotions and muscle movement– Works in limbic system
• Dopamine overactivity in brain may be related to schizophrenia
• Glutamate: A neurotransmitter; may also be involved
Fig. 14-6, p. 474
Schizophrenic Brain Images
• 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
Fig. 14-7a, p. 475
Fig. 14-7b, p. 475
Fig. 14-8, p. 475
Stress-Vulnerability Model
• Combination of environmental stress and inherited susceptibility cause psychotic disorders
Mood Disorders
• Major disturbances in mood or 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
More Mood Disorders
• 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
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 Disorders
• Bipolar I disorder: Person experiences extreme mania and deep depression– Mania: Excited, hyperactive, energetic,
grandiose behavior• Bipolar II disorder: Person is mainly sad but has
one or more hypomanic episodes (mild mania)
Video: Bipolar Disorder: Delusional Thinking
Endogenous Depression
• Depression that seems to be produced from inside the body and not from reaction to life events
Table 14-5, p. 477
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
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
More on Postpartum Depression
– Part of the problem may be hormonal– Unlike other depressions, features unusually
high levels of restlessness and difficulty concentrating
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,
full-spectrum light to treat SAD
Fig. 14-11, p. 480
Video: Bipolar Disorder: Expression of Mood
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
Generalized Anxiety Disorder (GAD)
• Duration of at least six months of chronic, unrealistic, or excessive anxiety about work, relationships, ability, or impending disaster
Video: Panic Disorder: Symptoms
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
• 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
Video: Panic Disorder: Coping
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
p. 482
Video: Snake Phobia
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?
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 person’s
will– Most common: About 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– Help to control or block out anxiety created by
obsessions– Checkers and cleaners
Video: Obsessive-Compulsive Disorder
p. 483
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
Posttraumatic 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 11, 2001,
likely led to an increase of PTSD– Many cases of PTSD come from Iraq war
Table 14-6, p. 481
Munchausen Syndrome by Proxy
• Person fakes the medical problems of someone in his or her care in order to gain attention
Munchausen Syndrome
• Person fakes his or her own medical problems in order to gain attention
Dissociative Disorders
• Dissociative amnesia: Inability to recall one’s name, address, or past
• Dissociative fugue: Sudden travel away from home and confusion about personal identity– Usually triggered by highly traumatic events
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
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
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 skin sensitivity in areas normally covered by a glove
Fig. 14-12, p. 485
Theoretical Causes of Anxiety Disorders: 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
Other Theoretical Causes of Anxiety Disorders
• Humanistic: Unrealistic self-image conflicts with real self-image
• Existential: Anxiety reflects loss of meaning in one’s life
• Behavioristic: Anxiety symptoms and behaviors are learned, like everything else– Conditioned emotional responses that
generalize to new situations
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
Antisocial Personality Disorder (APD)
• A person who lacks a conscience (superego?); typically emotionally shallow, impulsive, selfish, and manipulative toward others– Often 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., Scott Peterson)
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
Fig. 14-3, p. 469
Fig. 14-7a, p. 475
Fig. 14-7b, p. 475
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
Fig. 14-14, p. 491
Common Characteristics of Suicidal Thoughts and Feelings (Shneidman, 1987)
• 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
Fig. 14-15, p. 492
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