210 CHAPTER 14

CHAPTER 14PSYCHOLOGICAL DISORDERS

LEARNING OBJECTIVES

Abnormal Behavior: Concepts and Controversies (APA Goals 1, 5)• Describe and evaluate the medical model of abnormal behavior.• Identify the most commonly used criteria of abnormality.• Describe the five axes of DSM-IV and controversies surrounding the DSM system.• Summarize data on the prevalence of various psychological disorders.

Anxiety Disorders (APA Goals 1, 4)• List and describe four types of anxiety disorders.• Discuss the contribution of biological factors and conditioning to the etiology of anxiety

disorders.• Explain the contribution of cognitive factors and stress to the etiology of anxiety

disorders.

Somatoform Disorders (APA Goals 1, 4)• Distinguish among the three types of somatoform disorders.• Summarize what is known about the causes of somatoform disorders.

Dissociative Disorders (APA Goals 1, 4)• Distinguish among the three types of dissociative disorders.• Summarize what is known about the causes of dissociative disorders.

Mood Disorders (APA Goals 1, 4)• Describe the two major mood disorders and discuss their prevalence.• Evaluate the degree to which mood disorders elevate the probability of suicide. • Clarify how genetic and neurochemical factors may be related to the development of

mood disorders.• Discuss how cognitive processes may contribute to mood disorders.• Outline the role of interpersonal factors and stress in the development of mood disorders.

Schizophrenic Disorders (APA Goals 1, 4)• Describe the prevalence and general symptoms of schizophrenia.• Identify the subtypes of schizophrenia and distinguish between positive and negative

symptoms.• Outline the course and outcome of schizophrenia. • Summarize how genetic vulnerability and neurochemical factors may contribute to the

etiology of schizophrenia.• Discuss evidence relating schizophrenia to structural abnormalities in the brain and

neurodevelopmental insults to the brain.• Analyze how expressed emotion and stress may contribute to schizophrenia.

APPLICATION: Understanding Eating Disorders (APA Goals 1, 4)• Describe the symptoms of anorexia nervosa, bulimia nervosa, and binge-eating disorder.

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• Discuss the history, prevalence, and gender distribution of eating disorders.• Explain how genetic factors, personality, and culture may contribute to eating disorders.• Clarify how family dynamics and disturbed thinking may contribute to eating disorders.

CHAPTER OUTLINE

I. Abnormal Behavior: Concepts and Controversies

A. The medical model applied to abnormal behavior1. Medical model proposes that it is useful to think of abnormal behavior as a disease2. Basis for many of the terms used to refer to abnormal behavior (e.g., mental illness,

psychological disorder, psychopathology)3. Rise of medical model (in 18th, 19th centuries) brought improvements in treatment4. Problems with model

a. Thomas Szasz suggests that abnormal behavior usually involves a deviation from social norms rather than an illness

b. Results in derogatory labels being applied to people with disorders5. Putting the model in perspective

a. Model is useful as an analogyb. Diagnosis involves distinguishing one illness from anotherc. Etiology refers to the apparent causation and developmental history of an illnessd. Prognosis is a forecast about the probable course of an illness

B. Criteria of abnormal behavior1. Three criteria most frequently used

a. Deviance (e.g., transvestic fetishism: a sexual disorder in which a man achieves sexual arousal by dressing in women's clothing)

b. Maladaptive behaviorc. Personal distress

2. Judgments about mental illness reflect prevailing cultural values, social trends, and political forces

3. Normality and abnormality exist on a continuum

C. Psychodiagnosis: The classification of disorders1. First version of Diagnostic and Statistical Manual of Mental Disorders (DSM)

published in 1952 by American Psychiatric Association2. Current version, DSM-IV introduced in 1994, revised 20003. The multiaxial system

a. Axis I: clinical syndromesb. Axis II: personality disordersc. Axis III: general medical conditionsd. Axis IV: psychological and environmental problemse. Axis V: global assessment of functioning

4. Work currently underway for next edition, DSM-V a. Scheduled for 2011 publication

b. Decisions whether various syndromes should be added, eliminated, or renamed5. Controversies surrounding the DSM

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a. There is enormous overlap among various disorders in symptoms, and people often qualify for more than one diagnosis; the current categorical approach should be replaced by a dimensional approach

c. It medicalizes everyday problems

D. The prevalence of psychological disorders1. Epidemiology is the study of the distribution of mental or physical disorders in a

population2. Prevalence refers to the percentage of a population that exhibits a disorder during a

specified time period3. Estimates suggest that psychological disorders are more common than most people

realize (33-51% lifetime prevalence)

II. Anxiety Disorders

A. Anxiety disorders are a class of disorders marked by feelings of excessive apprehension and anxiety

B. Generalized anxiety disorder is marked by a chronic, high level of anxiety that is not tied to any specific threat1. Worry excessively about minor matters2. Worry about how much they worry3. Frequently accompanied by physical symptoms (e.g., trembling, muscle tension, etc.)4. Tends to have a gradual onset

C. Phobic disorders are marked by a persistent and irrational fear of an object or situation that presents no realistic danger1. Fears seriously interfere with everyday behavior2. Tends to be accompanied by physical symptoms of anxiety3. Common phobias include acrophobia (fear of heights), claustrophobia (fear of small,

enclosed places), brontophobia (fear of storms), hydrophobia (fear of water), and various animal and insect phobias

D. Panic disorder and agoraphobia1. Panic disorder is characterized by recurrent attacks of overwhelming anxiety that

usually occur suddenly and unexpectedly2. Agoraphobia is a fear of going out to public places

E. Obsessive-compulsive disorder (OCD) is marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions)1. Obsessions can center on fear of contamination, inflicting harm on others, suicide, or

sexual acts2. Compulsions usually involve stereotyped rituals that temporarily relieve anxiety3. Specific types of obsessions tend to be associated with specific types of compulsions 4. Can be a particularly severe disorder, associated with social and occupational

impairments

F. Etiology of anxiety disorders1. Biological factors

a. May be weak-to-moderate genetic predisposition

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b. Associated with inhibited temperament in infantsc. Anxiety sensitivity may make people vulnerable to anxiety disordersd. Has been linked to neurochemical activity in brain

1) Neurotransmitters are chemicals that carry signals from one neuron to another

2) Disturbances in neural circuits using GABA may play role2. Conditioning and learning

a. Many anxiety responses may be acquired through classical conditioning, maintained through operant conditioning

b. Martin Seligman's concept of preparedness helps explain the tendency to develop phobias of certain objects

c. Ohman and Mineka propose that the evolved module for fear learning is automatically activated by stimuli related to survival threats in evolutionary history and is resistant to intentional efforts to suppress the resulting fears

3. Cognitive factorsa. Certain styles of thinking may make some people vulnerable to anxiety disordersb. Theorists suggest these people tend to

1) Misinterpret harmless situations as threatening2) Focus excessive attention on perceived threats3) Selectively recall information that seems threatening

4. Stress: anxiety disorders may be stress related

III. Somatoform Disorders

A. Somatoform disorders are physical ailments that cannot be fully explained by organic conditions and are largely due to psychological factors1. Symptoms are more imaginary than real, although people are not simply faking2. Deliberate feigning of illness, malingering, is another matter altogether3. Making accurate diagnoses of somatoform disorders can be difficult

a) In some cases, a problem is misdiagnosed as a somatoform disorder when a genuine organic cause for a person’s physical symptoms goes undetected

b) Diagnostic ambiguities have led some theorists to argue that the category of somatoform disorders should be eliminated in upcoming DSM-V

B. Somatization disorder is marked by a history of diverse physical complaints that appear to be psychological in origin1. Occur mostly in women, often coexisting with depression or anxiety disorders2. Endless succession of minor physical ailments that correlate with stress in life3. Diversity of victims' complaints is distinguishing feature (cardiovascular,

gastrointestinal, pulmonary, neurological, genitourinary)4. Resistant to the suggestion that their symptoms might be the result of psychological

distress

C. Conversion disorder is characterized by a significant loss of physical function, with no apparent organic basis, usually in a single organ system1. Common symptoms include loss of vision, hearing; paralysis, loss of feeling2. People with conversion disorders usually troubled by more severe ailments than

people with somatization disorders3. Symptoms may be inconsistent with medical knowledge about the apparent disease

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D. Hypochondriasis (hypochondria) is characterized by excessive preoccupation with health concerns and incessant worry about developing physical illnesses1. People tend to overinterpret every conceivable sign of illness2. Frequently coexists with other psychological disorders, especially anxiety disorders,

depression

E. Etiology of somatoform disorders1. Inherited aspects of physiological functioning may predispose some people to

somatoform disorders2. Personality factors

a. Often associated with histrionic personality characteristicsb. Neuroticism may also play a rolec. Pathological care-seeking behavior may be caused by insecure attachment style

3. Cognitive factorsa. Focusing excessive attention on physiological processes and amplifying normal

bodily sensations into symptoms of distressb. Drawing catastrophic conclusions about minor bodily complaintsc. Unrealistic standard of good health

4. The sick rolea. Some people grow fond of role associated with being sickb. Benefits of role include being able to avoid life's challenges, convenient excuse

for failure, attention from others

IV. Dissociative Disorders are a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity

A. Dissociative amnesia and fugue1. Dissociative amnesia is a sudden loss of memory for important personal information

that is too extensive to be due to normal forgettinga. Memory loss may occur for single traumatic event or for extended period of time

surrounding the eventb. Cases have been observed as a result of disasters, accidents, combat stress,

physical abuse, etc.2. In dissociative fugue, people experience extensive amnesia and confusion about their

identity and typically wander away from their home area

B. Dissociative identity disorder involves the coexistence in one person of two or more largely complete, and usually very different, personalities1. Former name was multiple personality disorder, still used informally2. A rare disorder but frequently portrayed in media and mislabeled as schizophrenia3. Various personalities often unaware of each other, often with great discrepancies 4. Appears that a handful of clinicians were overdiagnosing the disorder

C. Etiology of dissociative disorders1. Dissociative amnesia, fugue usually attributed to excessive stress

a. Relatively little is known about why such an extreme reaction occurs in tiny minority of people

b. Speculation that certain personality traits may make some people more susceptible (e.g., fantasy proneness)

2. Causes of dissociative identity disorder are obscure

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a. Some believe that individuals engage in intentional role-playing to use mental illness as a face-saving excuse

b. A small minority of therapists help create multiple personalities by subtle encouragement

c. Other explanations argue that DID is rooted in severe childhood trauma

V. Mood Disorders are a class of disorders marked by emotional disturbances that may spill over to disrupt physical, perceptual, social, and thought processes

A. Major depressive disorder is marked by persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure1. Negative emotions form the heart of the depressive syndrome (hopelessness,

dejection, guilt, anxiety, irritability, brooding)2. Other symptoms may include

a. Giving up enjoyable activitiesb. Lack of energy, moving sluggishly, talking slowly c. Lowered self-esteem, feelings of worthlessness

3. The severity of abnormal depression varies considerably4. Depression is common (16%) and appears to be increasing5. Depression is about twice as high in woman as in men

B. Bipolar disorder (formerly known as manic-depressive disorders) is marked by the experience of both depressed and manic periods1. Manic episodes include various symptoms

a. Emotional: elation, euphoria, sociable, impatienceb. Cognitive: racing thoughts, flight of ideas, desire for action, impulsive behavior,

talkative, self-confident, delusions of grandeur, impaired judgmentc. Motor: hyperactive, tireless, require less sleep, increased sex drive, fluctuating

appetite2. Milder forms of manic episodes can seem attractive but often escalate into higher

levels that are scary and disturbing3. Affects about 1-2.5% of the population

C. Mood disorders and suicide1. About 90% of the people who complete suicide suffer from some type of

psychological disorder2. Both bipolar disorder and depression are associated with dramatic elevations in

suicide rates

D. Etiology of mood disorders1. Genetic vulnerability

a. Evidence indicates genetic factors influence likelihood of developing disorderb. A concordance rate is the percentage of twin pairs or other pairs of relatives that

exhibit the same disorder1) Twin studies, which compare identical and fraternal twins, suggest that

genetic factors are involved2) Concordance rates average 65-72% for identical twins, 14-19% for fraternal

twins

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c. Evidence suggests that heredity can create a predisposition to mood disorders, with environmental factors determining whether the predisposition is converted into a disorder

2. Neurochemical and neuroanatomical factorsa. Correlations found between mood disorders and levels of two neurotransmitters

in brain (norepinephrine, serotonin)b. Drug therapies are fairly effective in treatmentc. Correlations exist between mood disorders and a variety of structural

abnormalities in the brain, such as depression and reduced hippocampal volumed. Depression appears to occur when major life stress causes neurochemical

reactions that suppress neurogenesis, resulting in reduced hippocampal volume3. Cognitive factors

a. Learned helplessness and a pessimistic explanatory style are tied to vulnerability to depression

b. Depressed people who ruminate about their depression tend to stay depressed longer

c. Difficulty with cognitive theories is their inability to separate cause from effect: does negative thinking cause depression, or vice versa?

4. Interpersonal rootsa. Researchers have indeed found correlations between poor social skills and

depressionb. Depressed people tend to be depressing, resulting in more rejection and less

social support5. Precipitating stress

a. Evidence indicates moderately strong link between stress and onset of mood disorders

b. Stress may also affect how people with mood disorders respond to treatmentc. Stress may trigger mood disorders in people who are vulnerable

VI. Schizophrenic Disorders are a class of disorders marked by disturbances in thought that spill over to affect perceptual, social, and emotional processes

A. General symptoms1. Irrational thought

a. Delusions are false beliefs that are maintained even though they clearly are out of touch with reality

b. Thinking becomes chaotic2. Deterioration of adaptive behavior3. Distorted perception

a. Hallucinations are sensory perceptions that occur in the absence of a real, external stimulus or that represent gross distortions of perceptual input

b. Auditory hallucinations are most common4. Disturbed emotion

a. Some victims show flattening of emotions b. Others show inappropriate emotional responsesc. Some become emotionally volatile

B. Subtypes

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1. Paranoid schizophrenia is dominated by delusions of persecution, along with delusions of grandeur

2. Catatonic schizophrenia is marked by striking motor disturbances, ranging from muscular rigidity to random motor activity

3. Disorganized schizophrenia is marked by a particularly severe deterioration of adaptive behavior

4. Undifferentiated schizophrenia is marked by idiosyncratic mixtures of schizophrenic symptoms

C. Positive versus negative symptoms1. Alternative to subtyping in above fashion

a. Negative symptoms involve behavior deficits (e.g., flattened emotions, social withdrawal)

b. Positive symptoms involve behavioral excesses or peculiarities (e.g., hallucinations, delusions)

2. Most patients exhibit both types of symptoms and vary only in the degree to which positive or negative symptoms dominate

D. Course and outcome1. Disorders usually emerge during adolescence, early adulthood2. About 75% of cases manifest by age 303. Emergence may be sudden, but is more often gradual4. A patient has a relatively favorable prognosis depending on several factors

a) Onset is sudden rather than gradualb) Onset at later agec) Social and work adjustment were relatively good prior to onsetd) Proportion of negative symptoms is relatively low e) Cognitive functioning is relatively preserved f) Good adherence to treatment interventionsg) Healthy and supportive family situation to return to

E. Etiology of schizophrenia1. Genetic vulnerability

a. Much evidence for role of hereditary factorsb. People seem to inherit genetically transmitted vulnerability

2. Neurochemical factorsa. Associated with changes in neurotransmitter activity in brainb. Current research exploring roles of dopamine, serotonin, and glutamatec. Marijuana use during adolescence may help to precipitate schizophrenia in young

people who have a genetic vulnerability 3. Structural abnormalities in brain

a. Cognitive deficits suggest that disorders may be caused by neurological defectsb. Association with enlarged brain ventriclesc. Conclusions are controversial because the structural deterioration in the brain

could be a contributing cause or a consequence of schizophrenia.4. The neurodevelopmental hypothesis

a. This hypothesis proposes that schizophrenia is produced by a series of disruptions in the normal development of the brain

b. The suspected causes of these disruptions are exposure to viruses during prenatal development, malnutrition, and obstetrical complications

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5. Expressed emotiona. Expressed emotion is degree to which relatives are highly critical, emotionally

overinvolvedb. Relapse rates are much greater for patients returning to families high in expressed

emotion6. Precipitating stress may trigger a schizophrenic disorder in someone who is

vulnerable

VII. Eating Disorders are severe disturbances in eating behavior characterized by

preoccupation with weight and unhealthy efforts to control weight

A. Anorexia nervosa involves intense fear of gaining weight, disturbed body image, refusalto maintain normal weight, and dangerous measures to lose weight1. Two subtypes

a. Restricting type characterized by tendency to drastically reduce intake of food,sometimes to point of starvation

b. Binge-eating/purging type involves attempts to lose weight by deliberatelyvomiting after meals, misusing laxatives and diuretics, and engaging inexcessive exercise

2. Both types entail a disturbed body image, which results in relentless decline in bodyweight

3. Leads to variety of medical problems, including amenorrhea (loss of menstrual cyclesin women), gastrointestinal problems, low blood pressure, etc.

4. Leads to death in 5-10% of patients

B. Bulimia nervosa involves habitually engaging in out-of-control overeating followed byunhealthy compensatory efforts, such as self-induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise1. Eating binges usually carried out in secret, followed by intense guilt

a. Feelings motivate ill-advised strategies to undo the effects of overeatingb. People suffering from bulimia nervosa typically maintain reasonably normal

body weight2. Medical problems include cardiac arrhythmias, dental problems, metabolic

Deficiencies, and gastrointestinal problems 3. Often coexists with other psychological disturbances, including depression, anxiety

disorders, and substance abuse 4. Shares many features with anorexia nervosa (e.g., morbid fear of becoming obese)5. Different than anorexia nervosa in crucial ways

a. Bulimia is less life-threateningb. Bulimics are more likely to recognize that eating behavior is pathological,

cooperate with treatment

C. Binge-eating disorder involves distress-inducing eating binges that are not accompaniedby the purging, fasting, and excessive exercise seen in bulimia 1. Resembles bulimia, but is a less severe disorder2. Individuals tend to be disgusted by their bodies and distraught about their overeating3. Excessive eating is often triggered by stress

D. History and prevalence

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1. Although disorder is not new, it did not become a common affliction until middlepart of 20th century

2. Anorexia, bulimia are products of modern, affluent Western culture3. Technology and communications have exported Western culture, with eating

disorders appearing in many non-Western societies, especially affluent Asian4. About 90-95% of sufferers are female

a. Appears to be result of cultural pressuresb. Prevalence of disorders also elevated in groups that place undue emphasis on

thinness (e.g., fashion models, dancers, actresses, athletes)

E. Etiology of eating disorders1. Genetic vulnerability

a. Evidence not as strong as it is for other types of psychopathologyb. But genetic predisposition may exist

2. Personality factorsa. Most victims of anorexia tend to be obsessive, rigid, neurotic, emotionally

restrained b. Victims of bulimia tend to be impulsive, overly sensitive, low in self-esteemc. Most of these personality traits are influenced by genetics

3. Cultural valuesa. Contribution can hardly be overestimatedb. Western society’s emphasis on thinness, attractiveness in women plays a role

4. The role of the familya. Some theorists suggest overly involved parents may have an influence b. Other theorists argue that parents of adolescents with eating disorders tend to

define their children’s needs for them5. Cognitive factors

a. Cognitive theorists emphasize role of disturbed thinkingb. Additional research is needed to determine whether disturbed thinking is a cause

or merely a symptom of eating disorders

DISCUSSION QUESTIONS

1. What do you think of Thomas Szasz’s criticisms of the medical model of psychological disorders? Do you think it makes sense to treat psychological disorders the same way we treat diseases? Why or why not?

2. What do you think of the process of "labeling" people with psychological disorders? Do you think pinning a potentially derogatory label on a person may do more harm than good? Why do you think psychiatrists and psychologists generally support the use of some classification system for psychological disorders?

3. Recent editions of the DSM include everyday problems that are not traditionally thought of as mental illnesses (e.g., developmental coordination disorder, nicotine dependence disorder). Do you think it's appropriate for these kinds of problems to be included among severe psychological disorders such as multiple personality disorder and schizophrenia?

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4. The textbook mentions transvestic fetishism as an example of a deviant behavior. Why do you think it's acceptable in our society for a woman to dress in men's clothing, but not vice versa?

5. If a person does not pose a threat to anyone else and is not unhappy with his or her behavior, but is socially deviant (e.g., a transvestite), should that person be considered abnormal and mentally ill?

6. What do you think of the notion that normality and abnormality exist on a continuum of behavior? Do you think most people view abnormal behavior as quantitatively or qualitatively different from normal behavior?

7. Many people experience some degree of anxiety when they see a snake or a spider, or when they find themselves in high places. What distinguishes this kind of anxiety from a full-fledged phobia?

8. According to your textbook, the vast majority of people who suffer from panic disorder or agoraphobia are women. Why do you think this is the case? How might an evolutionary psychologist explain this difference? How would a behavioral or cognitive-learning psychologist explain the gender difference?

9. Given that instances of dissociative identity disorder (multiple personality disorder) are relatively rare, why do you think it is that this disorder is so frequently portrayed in books and movies?

10. Researchers have suggested that the prevalence of depression is about twice as high in women as it is in men. Why do you think this is the case? Do you think it’s possible that women are simply more likely than men to report instances of depression?

11. According to your textbook, some theorists suggest that inadequate social skills can lead to the development of depression. Do you think it’s possible that poor social skills may be a symptom of depression, rather than a cause? Can you think of a study that could be done that would help resolve this issue? [This question could also be framed in terms of the cognitive patterns associated with depression]

12. There is a common misconception that multiple personality disorder is the same thing as schizophrenia. Can you think of any explanations for this misconception?

13. Eating disorders appear to be particularly common among college women. Why do you think this is the case? Could a psychological disorder be "contagious"?

14. Given that cultural values play a major role in the prevalence of eating disorders, what steps could we take as a society to reduce the likelihood of young women developing these disorders?

15. In what ways might eating disorders [or somatoform disorders] actually be depression or an anxiety disorder taking on a form particular to our culture?

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16. It is not uncommon for students in abnormal psychology classes to begin to feel that they have signs of many of the disorders themselves. Did you experience this feeling as you read the material in this chapter? Why do you think students tend to have this reaction?

DEMONSTRATIONS AND ACTIVITIES

Defining Abnormal Behavior (APA Goals 1, 5) Before you begin discussing the criteria for abnormal behavior presented in the textbook, you might want to ask your students to come up with their own criteria. You could assign groups of 3-5 people to formulate the criteria for (or a definition of) abnormal behavior. After the groups spend 10-15 minutes discussing their criteria, have each group present their conclusions to the class. In a class with at least three groups, you will probably find that the class will formulate definitions that reflect most, if not all, of the criteria discussed in the textbook.

Culture and Mental Health (APA Goal 8) In this activity, students will explore aspects of mental health across cultures. Possible references are included below. Each student (or small group of students) will complete the research necessary to make a brief presentation following these steps:1. Gather information about mental health care, disorders, and beliefs across a multicultural context2. Create a series of 10 objective questions (matching, multiple-choice, or true-false) that will be presented as a quiz to the class. Be prepared to provide answers as well as further discussion of the answers.3. Present the quiz and supplemental information to the class. The quiz questions can be provided as a handout or via presentation technology as available in the classroom.

On the day of the presentations/quizzes, instruct the students to use a single sheet of paper to attempt to answer each group's questions. Emphasize that participation rather than getting the correct answers is the focus of this activity. Before you start, give each group a number, and remind students to label each of their quizzes with the correct group number. (Students will not mark answers for their own quizzes.) As the students present their information in the quiz format, you will need to guide the discussion to make this into a meaningful activity, with prompts such as, "That disorder is from another culture, but how might it be similar to disorders that we see in the United States? How might our own approaches to mental health be similar to those from the other culture? Are we being careful to avoid assumptions or overgeneralization? Do you think that this phenomenon is common to all individuals within the cultural group? What are psychological disorders or mental health practices from our culture that might seem odd or strange to outsiders?"

Possible online content for this activityhttp://152.46.7.80/pub/electronic-publications/stay-free/archives/21/mental_illness.htmlhttp://rjg42.tripod.com/culturebound_syndromes.htmTseng, W.S. (2006). From peculiar psychiatric disorders through culture-bound syndromes to culture-related specific syndromes. Transcultural Psychiatry, 43, 554-576 http://tps.sagepub.com/cgi/content/refs/43/4/554

Searchable websiteshttp://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMedhttp://www.nimh.nih.gov/

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Students may also be encouraged to use library collections, including electronic journal access.

Guest Speakers (APA Goals 4, 9) Assuming that there is a Counseling Center (or its equivalent) on your campus, you could invite a member of the staff to your class to discuss some of the behavioral and/or psychological problems he or she has encountered over the years. Given the relative prevalence of suicide (and suicide attempts) among college-age individuals, one of the staff members will probably have some expertise in this area and could describe some of their experiences with college students who have threatened or attempted suicide. A number of your students probably have contemplated suicide themselves or know someone who has. You could have a discussion focusing on the danger signals associated with suicide and guidelines for preventing it. Alternatively (for a different perspective), you could invite a professional who works in community mental health, an advocate for the mentally ill, an occupational therapist, or clinical social worker to explain his or her work with the mentally ill, and be interviewed by the class.

The Myth of Mental Illness Game (APA Goals 4, 5) James Gardner (1976) developed this activity to demonstrate how easily a person can be labeled as mentally ill even when there is no disorder present. Recruit six student volunteers who are willing to role play a part in front of the class. Take these students out of the class, explain the game to them, and have them select from index cards the following roles:

1. An escaped convict, previously convicted of murder.2. A successful business executive whose spouse has just announced the existence of a

love affair, whose child is in the hospital, and whose car just broke down this morning.3. An unemployed person who is married with two children, desperately needs a job, and

is on the way to an interview.4. A person on the way to a sale.5. A lonely person who has few friends, is depressed, became bored watching TV, and is

going somewhere just to have "something to do."6. The sixth card reads as follows: You are waiting at the bus stop for the Valley bus.

Your role is to try to engage each of the waiting passengers in conversation so that the class can observe how they act. Some helpful questions: Is this the bus to the Valley? Do you have the right time? Does the bus usually run late? Do you have change for a dollar?

The six students are given a couple of minutes to prepare for their roles (known only to each student). Caution them not to say anything that directly indicates their particular role (such as "I'm feeling really lonely and depressed"). The catalyst (person #6) comes into the room and interacts with each of the other students individually for a minute or two.

After the five students have all interacted with the catalyst, list all six students' names on the board, and tell the class that they are to vote on whom they think played which role. Record the vote total on the board. After the vote, announce another role, and have the class vote on that one. The roles should be announced in the order in which they appear on the list of six, with the exception that the fourth role you announce is that of "a mentally ill person." Continue through the last role (catalyst) in the same manner. After you have finished recording the votes for all the roles, choose the student and role that was closest to unanimous selection and discuss the reasons for that selection. Continue to discuss each role and the class's criteria for decisions. Then have

223 CHAPTER 14

the actors stand in front of the class and reveal their roles. It will then become clear to the class that no one played the role of a mentally ill person.

This activity shows how easy it is for labeling to occur, even in the absence of pathology. You can engage the class in a discussion of the problems that would likely have been created for each individual if that person had been pinned with the label of mentally ill.

Gardner, J.M. (1976). The myth of mental illness game: Sick is just a four letter word. Teaching of Psychology, 3, 141-142.

Normal Forms of Dissociation (APA Goal 4) Even after hearing about the idea of a continuum of normal/abnormal behavior, many students believe that some disorders, particularly the dissociative disorders, are clearly distinct from any normal behavior pattern. Bernstein and Putnam (1986) developed the Dissociative Experiences Scale (DES) to measure dissociative experiences in both normal and abnormal populations. According to Rathus and Nevid (1991), normal people frequently report some types of dissociative experiences, but they tend to report fewer and less varied experiences than people who have been diagnosed with dissociative disorders. Examples of "normal" dissociative experiences provided by Rathus and Nevid (1991, p. 234) include the following:

Suddenly realizing, when you are driving the car, that you don't remember what has happened during all or part of the trip.

Finding that you cannot remember whether or not you have just done something or perhaps had just thought about doing it.

Suddenly realizing when you are listening to someone talk and you didn't hear part or all of what the person said.

Give your students several minutes to record anonymously any similar experiences that they have had. You can then use these experiences to create a scale similar to the DES. Rathus and Nevid suggest that you then administer this scale to your students and have them rate the frequency of occurrence of each experience (e.g., often, occasionally, rarely). You can use this information to determine which experiences are least and most common. You can ask your students how they feel when they experience these dissociations and become aware of them. A class discussion can focus on whether these dissociations are part of normal experience, illustrating the continuum notion of normal and abnormal behavior.

Bernstein, E.M., & Putnam, F.W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727-735.

Rathus, S.A., & Nevid, J.S. (1991). Abnormal psychology. Englewood Cliffs, NJ: Prentice-Hall.

Self-Assessment of Depression (APA Goal 9) There are a number of depression inventories available, but many are one-dimensional and others are difficult to administer and interpret. Zung (1965) developed the Self-Rating Depression Scale (SDS) to measure both the typical feelings associated with depression and the physical aspects that accompany it (e.g., loss of appetite, sleep disturbances). Zung's scale can be administered in just a few minutes.

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Items 1, 3, 4, 7-10, 13, 15, and 19 are scored by assigning 1 point to an "N/L" answer, 2 points to "S," 3 points to "GP," and 4 points to "M/A." The remaining items are scored in reverse order. An overall score is found by adding the scores on the individual items. The results should fall between 20 and 80. Zung reported that a group of 31 depressed patients had a mean score of 59, with a range from 50 to 72. A control group of 100 people had a mean score of 26, with a range from 20 to 34.

Zung, W.W.K. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63-70.

Demonstrating the Symptoms of Schizophrenia (APA Goal 1) Timothy Osberg (1992) developed what he called "the disordered monologue" to illustrate the disordered thought and speech of a person with schizophrenia. Before discussing schizophrenia and without any prior warning, Osberg (1992, p. 47) engages in the following monologue:

Okay, class, we've finished our discussion of mood disorders. Before I go on, I'd like to tell you about some personal experiences I've been having lately. You see I've [pause] been involved in highly abstract [pause] type of contract [pause] which I might try to distract [pause] from your gaze [pause] if it were a new craze [pause] but the sun god has put me into it [pause] the planet of the lost star [pause] is before you now [pause] and so you'd better not try to be as if you were one with him [pause] because no one is one with him [pause] anyone who tries to be one with him [pause] always fails because one and one makes three [pause] and that is the word for thee [pause] which must be like the tiger after his prey [pause] and the zommon is not common [pause] it is a zommon's zommon. [pause] But really class, [holding your head and pausing] what do you think about what I'm thinking right now? You can hear my thoughts can't you? I'm thinking I'm crazy, and I know you [point to a student] put that thought in my mind. You put that thought there! Or could it be that the dentist did, as I thought? She did! I thought she put that radio transmitter in my brain when I had the Novocain! She's making me think this way, and she's stealing my thoughts!

The effectiveness of this demonstration probably depends on how much of a "ham" you are. If you feel uncomfortable acting this out, you can always distribute copies of the monologue and read through it with the class, although I'm sure this approach is not as compelling as actually engaging in the monologue without any warning.

Osberg suggests asking students for their reactions to the monologue, particularly if it made them feel nervous or uncomfortable. Students' answers can lead into a discussion of how people with schizophrenia might feel about the way others react to them.

When you cover the material on schizophrenia, you can refer to the monologue, which contains examples of some of the more common disturbances in the content and form of thought associated with schizophrenia and described in the DSM. Some of these disturbances include loose associations (jumping from topic to unrelated topic), neologisms (creating new words), and clanging (rhyming and punning).

Osberg, T.M. (1992). The disordered monologue: A classroom demonstration of the symptoms of schizophrenia. Teaching of Psychology, 19, 47-48.

Popular Conceptions of Mental Illness (APA Goals 1, 3) Like many mental illnesses, schizophrenia is one that tends to be misunderstood by the general population. In particular, schizophrenia is frequently confused with dissociative identity disorder (multiple personality

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disorder). To explore this confusion, have students interview acquaintances or friends about their understanding of schizophrenia. Handout 14.1 provides a format for organizing and interpreting the interview results. You might provide each student with 3-5 copies of the handout, depending on how many interviewees you require. In addition to completion of the handouts, you might have students write a comprehensive paper summarizing all of the interview results and looking at larger patterns.

Handout 14.2 also allows you to have students complete this activity for any psychological disorder of their choosing. Although the topic of schizophrenia works particularly well for this activity, students might find it interesting to select any one of the wide range of psychological disorders.

Diversity of Mental Illness (APA Goals 3, 5) Students often come into an introductory psychology class with the misconception that people with mental illness are all the same or at least very similar. Help students move beyond this overgeneralization to recognize and appreciate the wide variety of types of symptoms and levels of severity within mental illness.

Handout 14.3 has a list of questions to guide students in investigating the diversity within mental illness. Because each student will come up with different examples, having students share their results in class or small groups can greatly expand the impact of this assignment.

Self-Assessment: Manifest Anxiety Scale (APA Goal 9) The Taylor Manifest Anxiety Scale (1953), as revised by Richard Suinn (1968), can be used to demonstrate the assessment of the tendency to experience anxiety in a wide variety of situations. A copy of the scale appears in the Personal Explorations Workbook. Although the scale is no longer a "state of the art" measure of anxiety, it was widely used for many years and is relatively easy to score. Norms from Suinn's research appear in the Personal Explorations Workbook.

Suinn, R.M. (1968). Removal of social desirability and response set items from the Manifest Anxiety Scale. Educational and Psychological Measurement, 28, 1189-1192.

Taylor, J.A. (1953). A personality scale of manifest anxiety. Journal of Abnormal and Social Psychology, 48, 285-290.

Self-Reflection: What Are Your Attitudes on Mental Illness? (APA Goal 9) These five questions, which appear in the Personal Explorations Workbook, were developed to assess students' attitudes toward mental illness and mentally ill people. Having your students answer these questions is a good way to lead into a discussion of the myths and stereotypes people tend to believe about individuals who have been labeled as "mentally ill."

VIDEOS

Bellevue: Inside Out. Produced for HBO’s America Undercover series, this gripping documentary records the lives and struggles of staff and patients filmed over several months in the famous psychiatric hospital. HBO Video, 2001, 77 minutes.

Case Studies in Childhood Obsessive-Compulsive Disorder. This edition of Primetime tracks the treatment of three children as they attempt to reclaim their lives and overcome the stigma associated with OCD. ABC News, 2009, 38 minutes.

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A Crime of Insanity: Frontline. In 1994, Ralph Tortorici, a student, took a college class hostage. He was charged with assault, kidnapping, and attempted murder. His mental illness, paranoid schizophrenia, was apparent but not how the courts should deal with him. The program examines the controversial case. PBS 60 minutes, 2002

Cry for Help. This program features first-person stories from adolescents who are confronting depression, anxiety, and mental illness. It provides a rare and important look at mental illness among young adults. PBS, 2009, 60 minutes.

Depression: Out of the Shadows. Through the voices and stories of people living with depression and interviews with scientists, this documentary provides a portrait of depression. PBS, 2008, 90 minutes.

Diagnosis Bipolar: Five Families Search for Answers. This documentary takes viewers inside five households ravaged by the illness, revealing painful dilemmas over medication, school, and family dynamics. HBO Productions, 2009, 49 minutes.

Eating Disorders: The Inner Voice. This video dispels the myth that eating disorders are about the desire to be thin. Instead, it shows that eating disorders are severe psychological disorders that can be accompanied by devastating physical side effects. A Cambridge Educational Production. Films for the Humanities and Sciences, 2000, 30 minutes.

This Emotional Life: Facing Our Fears. This episode looks at emotions typically regarded as obstacles to happiness: fear, anxiety, despair, and associated psychological disorders. PBS, 2009, 120 minutes.

Fires of the Mind. This informative four-installment series by Discover Health Channel covers autism, anxiety disorder, depression/mania, and schizophrenia. Discovery Communications, 2000, 52 minutes each installment.

Hidden in Plain Sight: Looking for Mental Illness. With their mental health histories kept secret, 10 adults enter a period of psychiatric observation in an isolated group setting. It is up to a panel of experts to determine who is healthy and who isn’t. BBC/Science Channel, 2008, 50 minutes.

Health News and Interviews: Mental Health and the Human Mind Video Clips. This collection of brief clips takes a look at mental health and the human mind. Aspects of chronic stress, sleep disorders, seasonal affective disorder, depression, panic attacks, posttraumatic stress disorder, and schizophrenia are covered. Films for the Humanities and Sciences, 2007, 51 minutes.

Hypochondriacs: Inside Health Anxiety Disorder. This compelling film follows three patients as they undergo an intensive period of cognitive behavioral therapy for health anxiety disorder. Films for the Humanities and Sciences, 2007, 49 minutes.

I'm a Child Anorexic. This film documents the highs and lows of a London clinic’s 12-week program, during which malnourished patients must confront and conquer their fears of eating. BBCW Productions, 2007, 57 minutes.

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It’s Not Me…It’s My OCD. This documentary presents OCD sufferers and experts on the disorder. Insight Media, 2002, 28 minutes.

Men Get Depression. This documentary explores the effects of depression on the self, relationships, and careers through the intimate profiles of several men, featuring revealing scenes of psychotherapy, interviews with therapists, and commentary by leading medical authorities. PBS, 2007, 60 minutes.

Mental Health: The Individual and Society. This program examines mental health at the personal level and in a social context. It discusses key processes for recovering and maintaining mental well-being; helpful information concerning depression and drug and alcohol abuse; and the importance of diet, exercise, meditation, and social support. Films for the Humanities and Sciences, 2009, 28 minutes.

NOVA: Dying to Be Thin. This video explores the misconceptions and distortions that promote anorexia, particularly among dancers, and how some learn to overcome these beliefs and save their lives and careers by learning to eat healthily. WGBH Video, 2004, 60 minutes.

Post-Traumatic Stress and the War. NOW looks at how America's newest crop of returning soldiers is coping with the emotional scars of war and some innovative treatments for them. PBS, 2007, 30 minutes.

PTSD: Post-Traumatic Stress Disorder. This program expands awareness and knowledge of the disorder and explores the latest treatment options available today. Films for the Humanities and Sciences, 2007, 24 minutes.

The Released. Frontline investigates what happens to the mentally ill when they leave prison and why they are re-incarcerated at such alarming rates. PBS, 2009, 60 minutes.

Schizophrenia: Stolen Lives, Stolen Minds. Produced by the Learning Channel, this video focuses on several people who struggle with the illness, including identical twins, one of whom developed it and the other who did not. This is interesting material for examining the neurodevelopmental hypothesis and the issue of genetic vulnerability. Discovery Channel Video, 2000, 60 minutes.

Self-Injury: From Suffering to Solutions. This video shows how abuse, depression, perfectionism, and low self-esteem can lead teens to cut and burn themselves and explores strategies for overcoming the desire to inflict self-injury. Insight Media, 2002, 18 minutes.

Thin. The documentary goes inside the walls of Renfrew Center, a residential facility for the treatment of women with eating disorders, closely following four young women (ages 15-30) who struggle with eating disorders. HBO Productions, 2006, 60 minutes.

Touch Wood: Understanding Obsessive-Compulsive Disorder. Hosted by an individual with OCD, this program includes case studies and information about diagnosis and therapy. Films for the Humanities and Sciences, 2006, 46 minutes.

CENGAGE LEARNING VIDEOS

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Characteristics of Depression, Jeffrey Nevid. Clip 14, Wadsworth Guest Lecture Series.

Exploring the Origins of a Personal Phobia, Rock. E. Diddridge. Clip 72, Wadsworth Guest Lecture Series.

Guided Discovery Using Case Studies, Richard Gorman. Clip15, Wadsworth Guest Lecture Series.

Home Videos and Schizophrenia, Elaine Walker. Psychology: Research in Action Videos (Volume I).

HELPFUL WEBSITES

APA Psychology Topics. From their topical index page, the APA provides information about various disorders, including bipolar, depression, and schizophrenia, among others. http://www.apa.org/topics/index.aspx

BehaveNet Clinical Capsule. This site provides diagnostic information about mental disorders, reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association. http://www.behavenet.com/capsules/disorders/dsm4TRclassification.htm

Help Guide. This site includes information about various mental health topics including anxiety, bipolar disorder, depression, eating disorders, and many others, with the mission to understand, prevent, and resolve challenges. http://helpguide.org/

Mental Health: A Report by the Surgeon General. This report covers various issues concerning mental illness. http://www.surgeongeneral.gov/library/mentalhealth/toc.html

Medline Plus: Mental Health and Behavior. This website provides a wealth of information on a wide range of topics, including mental health and behavior. From the U.S. National Library of Medicine, National Institutes of Health, and the Department of Health & Human Services. http://www.nlm.nih.gov/medlineplus/mentalhealthandbehavior.html

Mental Health America. The website of MHA provides resources and information about mental health and illness. http://www.mentalhealthamerica.net/

Mental Illness. The Mayo clinic provides an overview of the concept of mental illness. You can also search the site for articles about many particular mental illnesses. http://www.mayoclinic.com/health/mental-illness/DS01104

National Alliance for the Mentally Ill. Official homepage of the NAMI, providing information about mental illness, NAMI programs, and support. http://www.nami.org/index.html

National Institute of Mental Health. This site includes a wealth of information about various mental health topics. http://www.nimh.nih.gov/

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The Pendulum. This website features information, support, and education related to bipolar disorder. http://www.pendulum.org/

Substance Abuse & Mental Health Services Administration. SAMHSA provides a wide array of information about mental health, disorders, and treatment. http://www.samhsa.gov/