psychological disorders chapter 15 copyright 2003 allyn & bacon this multimedia product and its...

Psychological Disorders

Chapter 15

Copyright 2003 Allyn & Bacon

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Slide authors:

Larry D. Thomas

Landon O. Thomas

Book authors:

R. H. Ettinger

Copyright © 2007 Horizon Textbook Publishing All rights reserved

What Is Abnormal?

Defining mental disorders– Several questions can help determine what behavior

is abnormal: Is the behavior considered strange within the person’s own

culture Does the behavior cause personal distress Is the behavior maladaptive Is the person a danger to self of others Is the person legally responsible for his or her acts


What Is Abnormal?

Prevalence of psychological disorders– Mental disorders have a lifetime prevalence rate of

nearly 50%– Mental disorders represent a significant source of

personal misery for individuals and lost productivity for society

Explaining psychological disorders– Biological perspective

Views abnormal behavior as arising from a physical cause, such as genetic inheritance, biochemical abnormalities or imbalances, structural abnormalities within the brain, and/or infections


What Is Abnormal?

Explaining psychological disorders (continued)– Biopsychosocial perspective

Agrees that physical causes are of central importance but also recognizes the influence of biological, psychological, and social factors in the study, identification, and treatment of psychological disorders

– Psychodynamic perspective Originally proposed by Feud Maintains that psychological disorders stem from early

childhood experiences and unresolved, unconscious conflicts, usually of a sexual or aggressive nature


Psychological Disorders

Bio-psycho-social Perspective

– assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders

Biological(Evolution, individual

genes, brain structures

and chemistry)

Psychological(Stress, trauma,

learned helplessness, mood-related perceptions

and memories)

Sociocultural(Roles, expectations, definition of normality

and disorder)


What Is Abnormal?

Explaining psychological disorders (continued)– Learning perspective

Psychological disorders are thought to be learned and sustained in the same way as any other behavior

– Cognitive perspective suggests that faulty thinking or distorted perceptions can

contribute to some types of psychological disorders

– Irrespective of theoretical perspective, all clinicians and researchers use the same set of criteria to classify psychological disorders

– The American Psychiatric Association publishes a manual (DSM-IV-TR) listing these criteria


Anxiety Disorders

Generalized anxiety disorder– An anxiety disorder in which people experience

excessive anxiety or worry that they find difficult to control

– These people expect the worst– Their excessive anxiety may cause them to feel

tense, tired, and irritable, and to have difficulty concentrating and sleeping

– This disorder affects twice as many women as men and leads to considerable distress and impairment


Anxiety Disorders

Panic disorder– An anxiety disorder in which a person experiences

recurrent unpredictable attacks of overwhelming anxiety, fear, or terror

– Panic attacks An attack of overwhelming anxiety, fear, or terror

– Panic-disorder patients tend to overuse the health care system and are at increased risk for abuse of alcohol and other drugs


Anxiety Disorders

Phobias– An intense fear of being in a situation form which

immediate escape is not possible or in which help is not immediately available in case of incapacitating anxiety

– Agoraphobia A persistent, irrational fear of an object, situation, or activity

that the person feels compelled to avoid An agoraphobic often will not leave home unless

accompanied by a friend or family member and, in severe cases, not even then

Women are four times more likely than men to be diagnosed with agoraphobia


Anxiety Disorders

Phobias (continued)– Social phobia

An irrational fear and avoidance of social situations in which one might embarrass or humiliate oneself by appearing clumsy, foolish, or incompetent

About one-third of social phobics fear only speaking in public

In its extreme form, it can seriously affect people’s performance at work, prevent them from advancing in their careers or pursuing an education, and severely restrict their social lives


Anxiety Disorders

Phobias (continued)– Specific phobia

A marked fear of a specific object or situation The categories of specific phobias, in order of frequency of

occurrence, are (1) situational phobias (2) fear of the natural environment (3) animal phobias and (4) blood-injection-injury phobia

– A person has three times the risk of developing a phobia if a close relative suffers form one

– A therapist my use classical conditioning principles to teach patients to associate pleasant emotions with feared objects or situations


Anxiety Disorders

Common and uncommon fears

Afraid of it Bothers slightly Not at all afraid of it

Beingclosed in,

in a smallplace

Being alone

In a house

at night

Percentageof peoplesurveyed

100

90

80

70

60

50

40

30

20

10

0Snakes Being

in high,exposedplaces

Mice Flyingon an

airplane

Spidersand

insects

Thunderand

lightning

Dogs Drivinga car

Being In a

crowdof people

Cats


Anxiety Disorders

Obsessive compulsive disorder (OCD)– An anxiety disorder in which a person suffers form

obsessions and/or compulsions– Obsessions

A persistent, recurring, involuntary though, image, or impulse that invades consciousness and causes great distress

– People with obsessions might worry about contamination or about whether they performed a a certain act, such as turning off the stove or locking the door


Anxiety Disorders

Obsessive compulsive disorder (continued)– Compulsion

A persistent, irresistible, irrational urge to perform an act or ritual repeatedly

– The individual knows such acts are irrational and senseless but cannot resist performing them without experiencing an intolerable buildup of anxiety-anxiety that can be relieved only by yielding to the compulsion

– People with OCD realize their behavior is not normal; but they simply cannot help themselves


Anxiety Disorders


Anxiety Disorders

PET Scan of brain of person with Obsessive/ Compulsive disorder

High metabolic activity (red) in frontal lobe areas involved with directing attention


Anxiety Disorders

Common Obsessions and Compulsions AmongPeople With Obsessive-Compulsive Disorder

Thought or Behavior

Percentage*Reporting Symptom

Obsessions (repetitive thoughts)

Concern with dirt, germs, or toxins 40

Something terrible happening (fire, death, illness) 40

Symmetry order, or exactness 24

Excessive hand washing, bathing, tooth brushing, 85or grooming

Compulsions (repetitive behaviors)

Repeating rituals (in/out of a door, 51up/down from a chair)Checking doors, locks, appliances, 46 car brake, homework


Identifying Anxiety DisordersRead each of the four descriptions below and place a checkmark beside

each description that sounds like you or someone you know.1. You are always worried about things, even when there are

no signs of trouble. You have frequent aches and pains that can’t be traced to physical illness or injury. You tire easily, and yet you have trouble sleeping. Your body is constantly tense.

2. Out of the blue, your heart starts pounding. You feel dizzy. You can’t breathe. You feel like you are about to die. You’ve had these symptoms over and over again.

3. Every day you fear you will do something embarrassing. You’ve stopped going to parties because you’re afraid to meet new people. When other people look at you, you break out in a sweat and shake uncontrollably. You stay home from work because you’re terrified of being called on in a staff meeting

4. You are so afraid of germs that you wash you hands repeatedly until they are raw and sore. You can’t leave the house until you check the locks on every window and door over and over again. You are terrified that you will harm someone you care about. You just can’t get those thoughts out of your head

Generalized Anxiety Disorder

Panic Disorder

Agoraphobia

Obsessive/ Compulsive Disorder

(From NIMH, 1999.)

Copyright © 2004 Allyn & Bacon All rights reserved


Mood Disorders

Disorders characterized by extreme and unwarranted disturbances in feeling or mood

Depressive disorders– Major depressive disorder

A mood disorder marked by feelings of great sadness, despair, guilt, worthlessness, and hopelessness

Key symptoms of major depressive disorder are psychomotor disturbances

– Depression can be so severe tat its victims suffer form delusions or hallucinations, which are symptoms of psychotic depression


Mood Disorders

Culture, gender, and depression– One large study involving participants form ten

countries revealed that the lifetime risk for developing depression varied greatly around the world

– Before boys reach puberty, they are more likely than girls to be depressed, but at adolescence a dramatic reversal in the gender-related depression rates takes place

– Not only are women more likely to suffer form depression, they are also more likely to be affected by negative consequences as a result


Mood Disorders-Depression

Percentageof

populationaged 18-84

experiencingmajor

depressionat some

point In life

20

15

10

5

0

USA Edmonton Puerto Paris West Florence Beirut Taiwan Korea New Rico Germany Zealand

Around the worldwomen are more

susceptible todepression



12-17 18-24 25-34 35-44 45-54 55-64 65-74 75+

Age in Years

10%

8

6

4

2

0

Percentagedepressed

Females

Males


Mood Disorders

Bipolar disorder– A mood disorder in which manic episodes alternate

with periods of depression, usually with relatively normal periods in between

– Manic episode A period of extreme elation, euphoria, and hyperactivity,

often accompanied by delusions of grandeur and by hostility if activity is blocked

Such episodes are marked by excessive euphoria, inflated self-esteem, wild optimism, and hyperactivity

People in a manic state have temporarily lost touch with reality and frequently have delusions of grandeur along with their euphoric highs


Mood Disorders

Bipolar disorder (continued)– Bipolar disorder is much less common than major

depressive disorder– Bipolar disorder tends to appear in late adolescence

or early childhood, and, unfortunately, about 90% of those with the disorder have recurrences, and half experiences another episode within a year of recovering form a previous one


Mood Disorders-Bipolar

PET scans show that brain energy consumption rises and falls with emotional swings

Depressed state Manic state Depressed state


Mood Disorders



Altering any one component of the chemistry-cognition-mood circuit can alter the others

Brainchemistry

Cognition

Mood



The vicious cycle of depression can be broken at any point

1Stressful

experiences

4Cognitive and

behavioral changes

2Negative

explanatory style

3Depressed

mood



A happy or depressed mood strongly influences people’s ratings of their own behavior

Negative Positivebehaviors behaviors

Self-ratings

35%

30

25

20

15

Percentage ofobservations


Mood Disorders

Causes of mood disorders– Biological factors such as genetic inheritance and

abnormal brain chemistry play a major role in bipolar disorder and major depressive disorder

– Drevets and others Located a brain area that may trigger both the sadness of

major depression and the mania of bipolar disorder A small, thimble-size patch of brain tissue in the lower

prefrontal cortex hereditary depression

– Researchers have found that patterns of dopamine, GABA, and norepinephrine production, transport, and reuptake in people suffering from mood disorders differ from those of normal individuals


Mood Disorders

Causes of mood disorders (continued)– In one twin study, researchers found that 50% of the

identical twins of bipolar sufferers had also been diagnosed with a mood disorder, compared to only 7% of fraternal twins

– Depressed individuals view themselves, their world, and their future all in negative ways

– Depressed persons believe they are deficient, unworthy, and inadequate, and they attribute their perceived failures to their own physical, mental, or moral inadequancies


Mood Disorders

Causes of mood disorders (continued)– The vast majority of first episodes of depression

strike after major life stress– Cui and Vaillant

Found that negative life events as well as family history played significant roles in the development of mood disorders


Mood Disorders

Suicide and race, gender, and age– Whites are more likely to commit suicide than

African Americans– Native American suicide rates are similar to those of

whites; rates for Hispanic Americans are similar to those of African Americans

– Suicide rates are far lower for both White and African American women than for men

– Older Americans are at far greater risk for suicide than younger people


Mood Disorders

Suicide and race, gender, and age (continued)– Poor general health, serious illness, loneliness, and

decline in social and economic status are conditions that may push many older Americans, especially those aged 75 and over, to commit suicide


Mood Disorders- Suicide

15-24 25-34 35-44 45-44 55-64 65-74 75-84 85+

Suicides per100,000 people

70

60

50

40

30

20

10

0

Males Females

The higher suicide rateamong men greatly increases in late adulthood


Mood Disorders-Suicide

Increasing rates of teen suicide

1960 1970 1980 1990 2000Year

12%

10

8

6

4

2

0

Suicide rate,

ages 15 to 19

(per 100,000)


Schizophrenia

A severe psychological disorder characterized by loss of contact with reality, hallucinations, delusions, inappropriate or flat affect, some disturbance in thinking, social withdrawal, and/or other bizarre behavior

Positive symptoms of schizophrenia– Positive symptoms are the abnormal behaviors that

are present in people with schizophrenia– Hallucinations

A sensory perception in the absence of any external sensory stimulus; an imaginary sensation


Schizophrenia

Positive symptoms of schizophrenia (continued)– Schizophrenic patients may see, hear, feel, taste, or

smell strange things in the absence of any stimulus in the environment, but hearing voices is the most common type of hallucinations

– Delusions A false believe, not generally shared by other in the

culture, that cannot be changed despite strong evidence to the contrary

– Delusions of grandeur A false belief that one is a famous person or a person who

has some great knowledge, ability, or authority


Schizophrenia

Positive symptoms of schizophrenia (continued)

– Delusions of persecutions A false belief that a person or group is trying in some way

to harm one– Another positive symptom is the loosening of associations, or

derailment, when a schizophrenic does not follow one line of though to completion, but on the basis of vague connections shifts from one subject to another in conversation or writing

– Schizophrenics may also display inappropriate affect; that is, their facial expressions, tone of voice, and gestures ma not reflect the emotion that would be expected under the circumstances


Schizophrenia

Negative symptoms of schizophrenia– A negative symptom of schizophrenia is a loss of or

deficiency in thoughts and behaviors that are characteristic of normal functioning

– Negative symptoms include social withdrawal, apathy, loss of motivation, lack of goal-directed activity, very limited speech, slowed movements, poor hygiene and grooming, poor problem-solving abilities, and a distorted sense of time

– Flat affect Showing practically no emotional response at all, even

though they often report feeling the emotion


Schizophrenia

Brain abnormalities in schizophrenics– Many schizophrenics have defects in the neural

circuitry of the cerebral cortex and limbic system– There is also evidence of reduced volume in the

hippocampus, amygdala, thalamus, frontal lobe gray matter

– Abnormal activity in the brain’s dopamine system is found in many schizophrenics


Schizophrenia

Types of schizophrenia– Paranoid schizophrenia

A type of schizophrenia characterized by delusions of grandeur or persecution

Paranoid schizophrenics often show exaggerated anger and suspiciousness

– Disorganized schizophrenia The most serious type of schizophrenia, marked by

inappropriate affect, silliness, laughter, grotesque mannerisms, and bizarre behavior

Tends to occur at an earlier age than the others types


Schizophrenia

Types of schizophrenia (continued)– Catatonic schizophrenia

A type of schizophrenia characterized by complete stillness or stupor and/or periods of great agitation and excitement; patients may assume an unusual posture and remain in it for long periods

– Undifferentiated schizophrenia A catchall term for people who display symptoms of

schizophrenia but who do not fit into other categories


Schizophrenia

Subtypes of Schizophrenia

Paranoid: Preoccupation with delusions or hallucinations

Disorganized: Disorganized speech or behavior, or flat or inappropriate emotion

Catatonic: Immobility (or excessive, purposeless movement), extreme negativism, and/or parrotlike repeating of

another’s speech or movements

Undifferentiated Schizophrenia symptoms without fitting one of the or residual: above types


Schizophrenia

Risk factors in schizophrenia– Schizophrenia develops when there is both a

genetic predisposition toward the disorder and more stress than a person can handle

– Schizophrenia is more likely to strike men than women

– The earlier age of onset of the disorder among males appears to be independent of culture and socioeconomic variables


Schizophrenia

Lifetime riskof developingschizophrenia

for relatives of a schizophrenic

40

30

20

10

0General

populationSiblings Children Fraternal

twinChildrenof two

schizophrenia victims

Identicaltwin


Somatoform and Dissociative Disorders

Somatoform disorders– Disorders in which physical symptoms are present

that are due to psychological rather than physical causes

– People with somatoform disorders are not consciously faking illness to avoid work or other activities

– Hypochondriasis A somatoform disorder in which persons are preoccupied

with their health and convinced they have some serious disorder despite reassurance from doctors to the contrary



Somatoform disorders (continued)– Conversion disorder

A somatoform disorder in which a person suffers a lost of motor or sensory functioning in some part of the body; the loss has no physical cause but solves some psychological problem

– A person may become blind, deaf, or unable to speak or may develop a paralysis in some part of the body



Dissociative disorders– Dissociation

The loss of one’s ability to integrate all the components of self into a coherent representation of one’s identity

– Dissociative disorder Disorders in which, under stress, one loses the integration

of consciousness, identity, and memories of important personal events

– Dissociative amnesia A dissociative disorder in which there is a lost of memory of

limited periods in one’s life or of one’s entire identity



Dissociative disorders (continued)– Dissociative fugue

A dissociative disorder in which one has a complete loss of memory of one’s entire identity, travels away from home,and may assume a new identity

When people recover from the fugue, they often have no memory of events that occurred during the episode

– Dissociative identity disorder (DID) A dissociative disorder in which tow or more distinct

personalities occur in the same person, each taking over a t different times; also called multiple personality



Dissociative disorders (continued)– Dissociative identity disorder (continued)

The alternate personalities, or alter personalities, may differ radically in intelligence, speech, accent, vocabulary, posture, body language, hairstyle, taste in clothes, manners, and even handwriting and sexual orientation

There is the common complaint of “lot time”-periods for which a given personality has no memory because he or she was not in control of the body


Sexual Disorders

Sexual disorders– Disorders that are destructive, guilt- or anxiety-

producing, compulsive, or cause of discomfort or harm to one or both parties involved

– Perhaps the most common of all of the sexual disorders are the sexual dysfunctions

– Drug treatment for sexual dysfunctions in both men and women have proved successful

– Depression is both a cause and an effect of sexual dysfunctions


Sexual Disorders

Sexual disorders (continued)– Paraphilias

Disorders in which recurrent sexual urges, fantasies, and behaviors involve nonhuman objects, children, other nonconsenting persons, or the suffering or humiliation of the individual or his/her partner

– Gender identity disorders Disorders characterized by a problem accepting one’s

identity as male or female An individual may feel so strongly that she or he is

psychologically of the other gender that sex-reassignment surgery is sought


Sexual Motivation

Sex is a physiologically based motive, like hunger, but it is more affected by learning and values


Sexual Motivation

Androgens– A sex hormone, secreted

in greater amounts by males than by females

Estrogen– a sex hormone, secreted

in greater amounts by females than by males


Sexual Motivation

Sexual Response Cycle– the four stages of sexual responding described by

Masters and Johnson Excitement Plateau Orgasm Resolution

Refractory Period– resting period after orgasm, during which a man

cannot achieve another orgasm


The Sexual Response Cycle

Males Females

Orgasm

Plateau

ExcitementResolution

Resolutionwith orgasm


Sexual Motivation

Same drives, different attitudes

Iceland Germany Great Canada Mexico United India Taiwan Singapore Britan States

Country

100%

90

80

70

60

50

40

30

20

10

0

Percentanswering

wrong

“Do you think it is, or is not, wrong for a couple to have a baby if they are not married?”


Sexual Motivation

Changing attitudes

Extramarital sex is “always wrong”

Homosexual sex is “always wrong”

1987 1998Year

100%

80

60

40

20

0Source: National Opinion Research Center(University of Chicago) General Social Survey


Forces Affecting Sexual Motivation

Physiologicalreadiness

Imaginativestimuli

Externalstimuli

Sexual motivation


Sexual Motivation

Births to unwed parents

United States

Canada

Japan

Britain

1960 1970 1980 1990 2000Year

40%

35

30

25

20

15

10

5

0

Percentageof births

to unwedmothers


Sexual Motivation

Sexual Orientation– an enduring sexual attraction toward

members of either one’s own gender (homosexual orientation) or the other gender (heterosexual orientation)


Personality Disorders

Personality disorders– A continuing, inflexible, maladaptive pattern of inner

experience and behavior that causes great distress or impaired functioning and differs significantly form the patterns expected in the person’s culture

– Characteristics of personality disorders People who suffer form other disorders, especially the

mood disorders, are often diagnosed with personality disorders as well

People with personality disorders are extremely difficult to get along with



Personality disorders (continued)– Types of personality disorders

Those who suffer from paranoid personality disorder display extreme suspiciousness, while those with schizoid personality disorder isolate themselves from others and appear to be unable to form emotional bonds

Individuals diagnosed with schizotypal personality disorder are often mistakenly classified as schizophrenic because their odd appearances, magical thinking, and lack of social skills are also often seen in schizophrenics

A pervasive desire to be the center of others’ attention is characteristic of both narcissistic personality disorder and histrionic personality disorder, as is a lack of concern for others



Personality disorders (continued)– Types of personality disorders (continued)

People with borderline personality disorder are highly unstable and fear of abandonment is the primary theme of their social relationships

A significant proportion of borderline personality disorder patients have histories of abuse or other disturbances in childhood attachment relationships

People who suffer from antisocial personality disorder have a “pervasive pattern of disregard for, and violation of, the rights of other that begins in childhood or early adolescence and continues into adulthood”



Personality disorders (continued)– Types of personality disorders (continued)

Individuals diagnosed with obsessive-compulsive personality fear falling short of perfectionistic standards

Avoidant personality disorder and dependent personality disorder, represent opposite approaches to social relationships

The avoidant personality shuns relationships because of excessive sensitivity to criticism and rejection

The dependent personality relies on others to an inappropriate degree



PET scans illustrate reduced activation in a murderer’s frontal cortex

Normal Murderer



Percentageof criminaloffenders

35

30

25

20

15

10

5

0Total crime Thievery Violence

Childhoodpoverty

Obstetricalcomplications

Both poverty and obstetrical complications


Rates of Psychological Disorders

Percentage of Americans Who Have Ever Experienced Psychological Disorders

Disorder White Black Hispanic Men Women Totals

Ethnicity Gender

Alcohol abuse or dependence 13.6% 13.8% 16.7% 23.8% 4.6% 13.8%

Generalized anxiety 3.4 6.1 3.7 2.4 5.0 3.8

Phobia 9.7 23.4 12.2 10.4 17.7 14.3

Obsessive-compulsive disorder 2.6 2.3 1.8 2.0 3.0 2.6

Mood disorder 8.0 6.3 7.8 5.2 10.2 7.8

Schizophrenic disorder 1.4 2.1 0.8 1.2 1.7 1.5

Antisocial personality disorder 2.6 2.3 3.4 4.5 0.8 2.6

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