Chapter 12

1. Chapter 12 Psychological Disorders

2. Chapter Preview • This chapter covers a lot of the material that you probably thought of when you signed up for a psychology class. In this chapter you’ll learn about the challenge of defining abnormality, the tools used to do so, and the different categories and symptoms of psychological disorders. • As usual, this is just a study guide; be sure to use this to focus your attention on your reading of the textbook

3. Abnormal Behavior • Abnormality can be difficult to define • For our purposes, your book is focused on mental illness that affects or is manifested in the brain and can affect thinking, behavior, and interaction with others • May be deviant - atypical and culturally unacceptable • May be maladaptive - interfering with effective functioning • May be personally distressful

4. Theoretical Approaches • Biological approach • Attributes psychological disorders to organic, internal causes • Medical model • Describes psychological disorders as medical diseases • Mental illnesses of patients treated by doctors • Psychological approach • Emphasizes contributions of experiences, thoughts, emotions, and personality

5. Theoretical Approaches • Sociocultural approach • Emphasizes social contexts in which person lives • Stresses cultural influences on understanding and treatment of psychological disorders • Biopsychosocial approach • Mental illness represents a unique combination of biological, psychological, and sociocultural factors

6. Classification Systems • The Diagnostic & Statistical Manual of Mental Disorders (DSM-IV) is a book published by American Psychiatric Association and used as the primary classification system for psychological disorders in U.S. • It provides a common basis for communicating • Can help make predictions • May benefit person suffering from symptoms • But, by providing labels it may also create stigma

7. DSM-IV Classification • Disorders in the DSM are classified along five axes, or dimensions • Axis I  Most diagnostic categories • Axis II  Personality disorders & mentalretardation • Axis III  General medical conditions • Axis IV  Psychosocial and environmental problems • Axis V  Current level of functioning

8. DSM-IV: Critiques • Classifies individuals based on symptoms, without regard to theories behind them • Uses medical terminology based on the medical model • Thus, it assumes mental disorders are a form of disease, a point on which not all people agree regarding all disorders • Implies internal cause, relatively independent of environmental factors • Focuses strictly on pathology and problems

9. DSM-V • A new edition of the DSM, DSM-V, is due out in 2013, and it’s subject to much controversy • Switch to dimensional approach – where disorders will be graded on a scale rather than an either/or set of symptoms • Some disorders will be dropped, others added • Changes in some disorders are unpopular • Implementation of “Risk syndromes” may help identify people at risk for disorders, but may lead to overdiagnosis • Some divisions of the American Psychological Association have started petitions to stop the American Psychiatric Association from moving ahead with DSM-V, but this is unlikely to prevent its publication and usage

10. Disorders • The bulk of this study guide will focus on the major disorder categories, and major disorders within those categories

11. Anxiety Disorders • Involve fears that are: • Uncontrollable • Disproportionate to actual danger • Disruptive of ordinary life • Feature anxiety symptoms, including: • Motor tension • Hyperactivity • Apprehensive expectations and thoughts

12. Anxiety Disorders • Generalized anxiety disorder • Panic disorder • Phobic disorder • Obsessive-compulsive disorder • Post-traumatic stress disorder

13. Generalized Anxiety Disorder • Persistent anxiety for at least 6 months • Unable to specify reasons for the anxiety • Etiology (cause) may include a combination of biological, psychological and sociocultural factors

14. Panic Disorder • Recurrent, sudden onsets of intense apprehension or terror • Often occur without warning and no specific cause • Etiology may include a combination of biological, psychological and cognitive factors, but primary focus in research is understanding how alert systems in the brain and body may overreact to environmental threat cues

15. Phobic Disorder • Irrational, overwhelming, persistent fear of particular object or situation • More than just a strong fear, it’s typically manifested in panic-type symptoms • Social phobia • Intense fear of being humiliated or embarrassed in social situations • Etiology, like other anxiety disorders, is both biological and psychological

16. Obsessive-Compulsive Disorder • An anxiety disorder including: • Obsessions • Recurrent, anxiety-provoking thoughts • Compulsions • Repetitive, ritualistic behaviors • Checking, cleansing, counting • Typically the compulsions are used to try to alleviate anxiety caused by the obsessions • Etiology – biological and psychological

17. Post-Traumatic Stress Disorder • Long-term anxiety disorder in which anxiety develops because of exposure to a traumatic event that overwhelms abilities to cope (usually with potential threat to one’s life) • Symptoms may include: • Flashbacks • Avoiding emotional experiences • Reduced ability to feel emotions • Excessive arousal • Difficulties with memory and concentration • Feelings of apprehension • Impulsive outbursts of behavior

18. Post-Traumatic Stress Disorder • Can follow trauma immediately or be delayed • Common causes of PTSD include: • Combat and war-related traumas • Sexual abuse and assault • Natural disasters • Unnatural disasters • Etiology focuses on trauma experienced and psychological/biological responses to it

19. Mood Disorders • Primary disturbance of mood, or prolonged emotion that colors emotional state • Depressive disorders • Major depressive disorder • Dysthymic disorder • Bipolar disorder • Can include cognitive, behavioral, and somatic (physical) symptoms • Note: different from anxiety disorders, which will trigger heightened levels of arousal

20. Depressive Disorders • Depression • Unrelenting lack of pleasure in life • Majordepressive disorder • Significant depressive episode (five of nine symptoms) and depressed characteristics for at least two weeks • Impaired daily functioning • Dysthymic disorder • More chronic and with fewer (two of six) symptoms than major depression

21. Depressive Disorders: Etiology • Biological factors • Genetic influences. brain structures, neurotransmitters • Psychological factors • Learned helplessness – a self-fulfilling cycle in which a person learns that they are helpless to change the bad circumstances of life, so they stop trying, which in turn guarantees things get worse • Cognitive explanations – how we mentally frame the things that happen in life • Sociocultural factors • Socioeconomic status (SES) • Social expectations vary by gender

22. Bipolar Disorder • Extreme mood swings, including one or more episodes of mania • Overexcited, unrealistically optimistic state • Multiple cycles of depression interspersed with mania • Etiology • Genetic influences and biological processes play a major role

23. Eating Disorders • Characterized by extreme disturbances in eating behavior • Anorexia nervosa • Bulimia nervosa • Binge eating disorder

24. Anorexia Nervosa • Relentless pursuit of thinness through starvation • Weighing less than 85% of normal weight • Intense fear of gaining weight • Distorted body image – may not perceive themselves the way others do • Very difficult to treat, as those who have it may be in denial, and see it as a pursuit of perfection • Can lead to physical changes, serious complications (e.g. organ failure), and death

25. Bulimia Nervosa • Binge-and-purge eating pattern • Preoccupation with food • Strong fear of becoming overweight • Depression or anxiety • Differs from anorexia in that the person may not be underweight • Difficult to detect • People may engage in this because of a high level of perfectionism coupled with low self-efficacy; thus, the bulimia gives a sense of control

26. Anorexia & Bulimia: Etiology • Sociocultural factors (e.g. media emphasis on weight) • Previously believed to be central determinants • No longer sole focus • Biological factors • Of increasing focus in research • Genes and regulation of serotonin are suspected to be important

27. Binge-Eating Disorder • Recurrent episodes of eating large amounts of food • Lack of control over eating • Symptomology – typically overweight or obese • Experience of guilt and shame after binge episodes • Biological factors • Genes and dopamine (typically tied to pleasure) • Psychological factors • Stress

28. Dissociative Disorders • Dissociation • Psychological states of disconnection from immediate experience • Dissociative disorders • Involve sudden loss of memory or changes in identity, under extreme stress or shock • Dissociative amnesia • Dissociative fugue • Dissociative identity disorder

29. Dissociative Amnesia & Fugue • Amnesia • Inability to recall important events • Dissociative amnesia • Extreme memory loss caused by extensive psychological stress • These differ from psychogenic amnesia, which has a known biological cause. • Dissociative fugue • Amnesia, plus traveling away from home and assuming new identity

30. Dissociative Identity Disorder • Formerly called multiple personality disorder • Two or more distinct personalities or selves • Each has its own memories, behaviors, relationships • One personality dominates at one time • Wall of amnesia separates personalities • Shift between personalities occurs under distress • Exceptionally high rate of sexual or physical abuse during early childhood • Majority are women • Genetic predisposition may exist, but primary theoretical understanding is in Freudian repression

31. Dissociative Disorders • These are very controversial. Dissociative amnesia and fugue states often are found to actually be malingering (faking) in people who are trying to evade responsibility for things in life. • Some argue that Dissociative Identity Disorder may often be a product of bad therapeutic practice, wherein therapist expectations interact with highly suggestible clients to create a situation where the client creates symptoms cued by the therapist.

32. Schizophrenia • Schizophrenia is an umbrella term for a group of disorders characterized by highly disordered thought processes • Psychotic or far removed from reality • Positive symptoms – presence of abnormal behavior • Marked by distortion or excess of normal function • Negative symptoms – absence of normal behavior • Reflect social withdrawal, behavioral deficits, and loss or decrease of normal functions

33. Schizophrenia: Positive Symptoms • Hallucinations • Sensory experiences in absence of real stimuli • Often auditory • Delusions • False, unusual, or magical beliefs • Not part of individual’s culture

34. Schizophrenia: Positive Symptoms • Thought disorder • Unusual, sometimes bizarre thought processes • Word salad - Incoherent, loose word associations • New words • Referential thinking • Ascribing personal meaning to random events • Disorders of movement • Catatonia • State of immobility and unresponsiveness over time

35. Schizophrenia: Symptoms • Negative symptoms • Flat affect • Display of little or no emotion • Lacking ability to read emotions of others • Cognitive symptoms • Difficulty sustaining attention • Problems holding information in memory • Inability to interpret information and make decisions

36. Schizophrenia: Etiology • Biological factors • Heredity plays a strong role • High correlation between incidence in identical twins • Structural brain abnormalities • Problems in neurotransmitter regulation • Psychological factors • Diathesis-stress model • Combination of biogenetic predisposition and stress • Sociocultural factors • Socioeconomic level and other sociocultural factors play a role, but how exactly they contribute is unclear

37. Personality Disorders • Chronic, maladaptive cognitive-behavioral patterns integrate into personality • These are controversial, because some people argue they represent poor choices rather than actual illness • Ten personality disorders listed in DSM-IV; but this will be changed in DSM-V • Here we’ll focus on two of the most common: • Antisocial personality disorder • Borderline personality disorder

38. Antisocial Personality Disorder • Characterized by guiltlessness, law breaking, exploitation of others, irresponsibility, and deceit • Psychopaths • Subgroup of individuals with ASPD • Remorseless predators who engage in violence • More a legal/social term than a clinical one • Biological factors • Genetically heritable • Brain differences • Autonomic nervous system differences lead to differences in arousal levels

39. Borderline Personality Disorder • Pervasive pattern of instability in: • Interpersonal relationships • Self-image • Emotions • Marked impulsivity beginning by early adulthood and present in various contexts • Splitting • Thinking style characterized by seeing the world in black and white terms

40. Borderline Personality Disorder • Potential causes are complex • Biological factors • Genetic heritability • Childhood experiences • Childhood sexual abuse • Cognitive factors • Irrational beliefs • Hypervigilance • Some people believe BPD is very much overdiagnosed, applied as a label to people who are not actually ill, but who frequently make irresponsible choices.

41. Combating Stigma • One of the difficulties in treating mental illness in the US is that mental illness labels carry with them a lot of stigma (potential for social judgment) • For instance, do you think it would help you or hurt you to tell a potential employer that you have a history of schizophrenia? • Consequences of stigma • Prejudice and discrimination • Overcoming stigma • Recognize strengths and achievements

42. Combating Stigma • Rosenhan study (1973) – “On Being Sane in Insane Places” • Be sure to read about this in your book (a link to the original article is provided in the Activity Folder) • Labels of psychological disorders can be very ‘sticky’ • Labels influence perception of everything else person does