Chapter 18: Psychological Disorders Case Study: Not Guilty by Reason of Insanity

1. Chapter 18: Psychological Disorders Case Study:Not Guilty by Reason of Insanity Section 1:Understanding Psychological Disorders Section 2:Anxiety and Mood Disorders Section 3:Dissociative and Somatoform Disorders Section 4:Schizophrenia Section 5:Personality Disorders Lab:Applying What You’ve Learned

2. Case Study: Not Guilty by Reason of Insanity The majority of people with serious psychological disorders are not dangerous to others. Some, however, commit violent crimes. Of these, some are found not guilty by reason of insanity and are sent to psychiatric institutions instead of prison. When an accused person pleads insanity, the prosecutor tries to prove that the person was sane at the time of the crime and the defense tries to prove he or she was not. Under law, one must be either all or nothing, but in reality most psychological disorders are a matter of degree.

4. What do you think? • In general, what criteria must a defendant meet to be ruled legally insane? • Do you support the use of the insanity defense? Why or why not?

5. Section 1 at a Glance • Understanding Psychological Disorders • Psychological disorders are behavior patterns or mental processes that cause serious personal suffering or interfere with a person’s ability to cope with everyday life. • Psychological disorders are classified in the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM.

6. Understanding Psychological Disorders Main Idea Psychological disorders are relatively common. They cause personal suffering to millions of people and interfere with their ability to cope with everyday life. • Reading Focus • What are psychological disorders, and how common are they? • What are the four major symptoms that can help identify psychological disorders? • How do psychologists classify psychological disorders?

7. Why were people with mental illnesses seen as criminals?

8. What Are Psychological Disorders? • Psychological disorders are behavior patterns or mental processes that cause serious personal suffering or interfere with a person’s ability to cope with everyday life. • The great majority of people are never admitted to mental hospitals and most people never seek the help of psychologists or psychiatrists. • Estimates suggest that one in four American adults have experienced some type of psychological disorder. • For people aged 15 to 44, psychological disorders are the leading cause of disability in the United States.

9. Reading Check Summarize What is a common misconception about psychological disorders? Answer: Psychological disorders are uncommon.

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11. Identifying Psychological Disorders • People with psychological disorders usually do not differ much form so-called normal people. • Certain behavior patterns and mental processes may suggest that an individual has a psychological disorder. • Psychologists use several criteria to determine whether a person’s behavior indicates the presence of a psychological disorder. • Typicality • Normality is determined by the degree to which a behavior is average, or typical, of the majority of people. • Scientific and artistic geniuses are not typical, but are not abnormal. • People who are quite normal may have lifestyles that differ widely from the rest of the community. • Additional measurements must be taken into account.

12. Maladaptivity • Maladaptivity is a behavior that impairs an individual’s ability to function adequately in everyday life. • Behavior that causes misery and distress rather than happiness and fulfillment, or that is dangerous • Emotional Discomfort • Depression and anxiety cause extreme emotional discomfort. • Helplessness, hopelessness, worthlessness, guilt, extreme sadness, and withdrawal • Socially Unacceptable Behavior • Cultural context of a behavior must be taken into account. • Culture-bound syndromes: clusters of symptoms

13. Reading Check Find the Main Idea What are four features that might indicate a psychological disorder? Answer: The four features are typicality, maladaptivity, emotional discomfort, and socially unacceptable behavior.

14. DSM Major Types of Disorders • APA's classification system • Used to communicate needs and treatment • Modern categories based on observable signs and symptoms • Anxiety • Mood • Dissociative • Somatoform • Schizophrenic • Personality Classifying Psychological Disorders • Classification helps to determine: • How many people have a given disorder • What factors may be associated with a disorder • Diagnosis and treatment

16. Reading Check Summarize What are some ways in which the DSM has been revised? Answer: disorders are no longer organized by presumed causes, categories have been added and removed, and the number of psychological disorders has grown

17. Cultural Diversity and Psychology Culture-Bound Syndromes In certain cultures, one can find combinations of psychiatric and physical symptoms recognized as disease only in that culture. These are often treated with folk remedies. • Hikikomori: Japanese people who have withdrawn from social life • Latah: In Malaysia, a person who has a severe reaction to being startled. When surprised, latahs mimic the speech of those around them and obey any order • Ghostsickness: Navajo illness with symptoms of bad dreams, loss of appetite, feeling of suffocation, hallucinations, fainting, and terror • Hwa-byung: In Korea, a name for physical symptoms that arise from the suppression of anger • Amok: In Malaysia, a previously peaceful man who suddenly tries to kill or injure others • Susto: some Hispanics; the experience of acute unhappiness following a frightening event • Zar: Middle East and North Africa, women laugh and bang heads

19. Thinking Critically • What are some of the physical symptoms associated with culture-bound syndromes? • Do you think Western medical schools should include culture-bound syndromes in their psychiatry programs? Why or why not?

20. Section 2 at a Glance • Anxiety and Mood Disorders • Anxiety disorders occur when people feel fear or nervousness out of proportion to the actual threat. • Mood disorders are characterized by mood changes that are inappropriate for the situation to which they are responding.

21. Anxiety and Mood Disorders Main Idea Anxiety disorders cause people to experience irrational or excessive fear. Mood disorders cause people to experience mood changes that are inappropriate to the situation. • Reading Focus • What are some characteristics of anxiety? • What are five major types of anxiety disorders? • How do psychologists explain anxiety disorders? • How do the two main types of mood disorders compare? • Which theories explain the origins of mood disorders?

22. Why does an English soccer star need three refrigerators?

23. What Is Anxiety? • Anxiety refers to a generalized state of dread or uneasiness that occurs in response to a vague or imagined danger, as opposed to fear, which is a response to a real danger or threat. • Characterized by • Nervousness • Inability to relax • Concern about losing control • Trembling • Sweating • Rapid heart rate • Shortness of breath • Increased blood pressure • Everyone feels anxious at times, but constant anxiety can interfere with effective living.

24. Reading Check Analyze How are anxiety disorders different from normal anxious reactions? Answer: constant anxiety, out of proportion to event, interferes with normal effective living

26. Types of Anxiety Disorders • Phobic Disorder • Phobia: derives from the Greek root phobos, which means “fear” • Specific phobia is the most common of all anxiety disorders and refers to a persistent excessive fear of a particular object or situation. • Most common include • Zoophobia: fear of animals • Claustrophobia: fear of enclosed spaces • Acrophobia: fear of heights • Arachnophobia: fear of spiders • Social phobia is characterized by persistent fear of social situations in which one might be exposed to the scrutiny of others.

28. Panic Disorder and Agoraphobia • People with panic disorder have recurring and unexpected panic attacks, or relatively short periods of intense fear or discomfort characterized by shortness of breath, dizziness, rapid heart rate, trembling, choking, etc. • Agoraphobia: the fear of being in places or situations in which escape may be difficult or impossible such as crowded public places. • Many people with agoraphobia develop panic attacks when in public. • Generalized Anxiety Disorder • An excessive or unrealistic worry about life circumstances that lasts for at least six months. • Few people seek treatment because it does not differ, except in intensity and duration, from the normal worries of everyday life.

29. Obsessive-Compulsive Disorder (OCD) • Obsessions are unwanted thoughts, ideas, or mental images that occur over and over again, and most people try to ignore or suppress them. • Compulsions are repetitive ritual behaviors, often involving checking or cleaning something. • People are usually aware that the obsessions are unjustified, which distinguishes obsessions from delusions. • Stress Disorders • Include post-traumatic stress disorder (PTSD) and acute stress disorder • Similar symptoms, but PTSD is more severe and longer-lasting • PTSD occurs after rape, abuse, severe accident, natural disasters, and war atrocities.

32. Reading Check Summarize What are the five types of anxiety disorders? Answer: phobic, panic, generalized anxiety, obsessive-compulsive, stress

33. Explaining Anxiety Disorders • Psychological Views • Psychoanalytic views are no longer widely accepted, but have affected the classification of psychological disorders. • Learning theorists believe that phobias are learned in childhood. • Cognitive theorists believe that people make themselves feel anxious by responding negatively to most situations. • Biological Views • Heredity may play a role • Studies of twins indicate that having a parent or sibling with a disorder increases the chance an individual will have a disorder. • Some psychologists believe that people who rapidly acquired strong fears of real dangers would be more likely to live and reproduce. Interaction of Factors: some cases reflect the interaction of biological and psychological factors.

35. Reading Check Find the Main Idea How do learning theorists explain anxiety disorders? Answer: Phobias are learned in childhood, conditioned phobias remain; people avoid situations that lead to anxiety related to the phobia.

36. Types of Mood Disorders • Most people have mood changes that reflect the normal ups and downs of life, but mood changes that are inappropriate to a situation can signal a mood disorder. • Two types: depression and bipolar disorder • Major Depression • Feelings of helplessness, hopelessness, worthlessness, guilt, and great sadness • The DSM-IV contains a list of symptoms to help diagnose • Bipolar Disorder • A cycle of mood changes from depression to wild elation and back again • Period of mania, or extreme excitement characterized by hyperactivity and chaotic behavior • Postpartum Depression • Some women suffer symptoms of depression after giving birth • Can harm both mother and child

37. Reading Check Analyze What are some ways that mood disorders can disrupt one’s daily life? Answer: persistent depressed mood, loss of interest in activities, significant weight loss or gain, sleeping more or less, fatigue, reduced ability to concentrate or make meaningful decisions, recurrent thoughts of death or suicide

39. Explaining Mood Disorders • Psychological Views • The psychoanalytic view of depression connects the past to the present. • Learning theorists: “learned helplessness” makes people prone. • Cognitive theorists: habitual style of explaining life events. • Attribution theory: people assign different types of explanations to events, which affect self-esteem and self-efficacy. • Beck suggests that people who are depressed have a negative view of themselves, their experiences, and their future. • Biological Views • Mood disorders occur more often in the close relatives of affected individuals than they do in the general population. • Two neurotransmitters in the brain—serotonin and noradrenaline—may partly explain the connection between genes and mood. • Biological and Psychological Factors • A combination of factors is most likely at work.

41. Reading Check Explain How was Martin Seligman’s experiment with dogs related to theories about mood disorders? Answer: Dogs learned that they could not prevent the pain of shocks. Theorists have applied this to human beings, suggesting that once people believe that they cannot change a situation, they will make no effort to do so.

42. Current Research in Psychology Post-Traumatic Stress Disorder and Iraq War Veterans For those who survive the horrors of war, the trauma of combat may not be left behind on the battlefield. Some veterans report vivid flashbacks and nightmares. • A high incidence of PTSD has been reported among soldiers returning from war in Iraq and Afghanistan. • Researchers are seeking reasons for what some call a PTSD epidemic. • Younger veterans are more likely to be diagnosed. • Those with traumatic head injuries more likely to be diagnosed. • Currently veterans can receive five years of free health care for any mental disorder related to combat. • Because PTSD shows up long after the trauma, increased mental health services will be necessary.

44. Thinking Critically • Why do you think younger veterans are more likely to be diagnosed with PTSD? • Given the current research on PTSD, what steps do you think the U.S. Department of Veterans Affairs should take to deal with the effects of PTSD in returning soldiers?

45. Section 3 at a Glance • Dissociative and Somatoform Disorders • Dissociative disorders are characterized by the separation of certain personality components or mental processes from conscious thought. • Somatoform disorders are expressed in the form of actual physical symptoms.

46. Dissociative and Somatoform Disorders Main Idea Dissociative disorders cause people to lose their memory or identity. Somatoform disorders cause people to express psychological distress through physical symptoms. • Reading Focus • What is dissociation, and what are the four dissociative disorders? • How do theorists explain the origins of dissociative disorders? • What is somatization, and what are the most common types of somatoform disorders? • How do theorists explain the origins of somatoform disorders?

47. How could a man forget his entire life?

48. Dissociative Disorders • Dissociation: the separation of certain personality components or mental processes from conscious thought • In some situations, it is normal (becoming engrossed in a book). • If dissociation occurs as a way to avoid stressful events or feelings, it can signal a disorder. • Dissociative Amnesia • Characterized by a sudden loss of memory, usually following a particularly stressful or traumatic event. • It cannot be explained biologically. • The incidence of dissociative amnesia rises markedly during wartime and natural disasters.

49. Dissociative Fugue • Characterized by not only forgetting personal information and past events but also by suddenly relocating from home or work and taking on a new identity. • Individuals may appear healthy until the fugue ends, when they will not remember anything that happened during the fugue. • Dissociative Identity Disorder • Involves the existence of two or more personalities within a single individual. The various personalities may or may not be aware of the other. • Depersonalization Disorder • Depersonalization: feelings of detachment from one’s mental processes or body • People describe being outside their bodies.

50. Reading Check Compare What is the basic feature that dissociative disorders have in common? Answer: involve separation of personality components or mental processes from conscious thought