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Chapter 12

Psychological Disorders

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

Flick – “A Bug’s Life” was “deviant”; behavior was “abnormal”
The role of culture in determining behavior
Suffragettes were considered “mentally ill”

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

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

Classification Systems

The Diagnostic & Statistical Manual of Mental Disorders (DSM-5) 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

DSM-5: 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, and takes a biological view of disorders that may have social or experiential causes

These are points on which not all people agree

Implies internal cause, relatively independent of environmental factors
Focuses strictly on pathology and problems

DSM-5: Critiques

DSM-5 was released in 2013, and has been subject to much criticism

Some have argued that it relies too much on social norms and subjective judgments

Many new categories of disorders have been added, but some lack consistent research support

Standards for some existing diagnoses have been loosened, leading to concerns about potential for overdiagnosis of these disorders

Some Changes in DSM-5

Disorders

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

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

Anxiety Disorders

Generalized anxiety disorder
Panic disorder
Phobic disorder
Social Anxiety Disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder

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

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

Specific Phobia Disorder and Social Anxiety Disorder

Specific Phobia 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 Anxiety Disorder

Intense fear of being humiliated or embarrassed in social situations

Etiology, like other anxiety disorders, is both biological and psychological

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

With DSM-5, category now includes related disorders, such as Hoarding Disorder and Body Dysmorphic Disorder

Etiology – biological and psychological

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

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

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

Depressive Disorders

Depression

Unrelenting lack of pleasure in life

Major depressive 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

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

Bipolar Disorder

Extreme mood swings, including one or more episodes of mania

Overexcited, unrealistically optimistic state

Multiple cycles of depression interspersed with mania

As shown on next slide, levels of brain activity can vary dramatically between cycles of mania and depression

Etiology

Genetic influences and biological processes play a major role

Bipolar Disorder

Eating Disorders

Characterized by extreme disturbances in eating behavior

Anorexia nervosa

Bulimia nervosa

Binge eating disorder

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

The debate over DSM-5 focused on elimination of some personality disorders, but ultimately all were kept.

Here we’ll focus on two of the most common:

Antisocial personality disorder

Borderline personality disorder

Personality Disorders Included in DSM-5

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

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

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.

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

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