psychology
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Chapter14PowerPointSlidesExploringPsychology10e.pptxPsychological
Disorders
Chapter 14
Josef F. Steufer/Getty Images
Basic Concepts of Psychological Disorders
Anxiety Disorders, OCD, and PTSD
Major Depressive Disorder and Bipolar Disorder
Schizophrenia and Other Disorders
Chapter Overview
14-1: HOW SHOULD WE DRAW THE LINE BETWEEN NORMALITY AND DISORDER?
According to psychologists and psychiatrists, psychological disorders are marked by a “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior” (American Psychiatric Association, 2013).
Such thoughts, emotions, or behaviors are dysfunctional or maladaptive.
They interfere with normal day-to-day life.
The dysfunctional person is often distressed.
Basic Concepts of Psychological Disorders
14-2: HOW DO THE MEDICAL MODEL AND THE BIOPSYCHOSOCIAL APPROACH INFLUENCE OUR UNDERSTANDING OF PSYCHOLOGICAL DISORDERS?
In earlier times, abnormal behavior attributed to strange forces (movement of the stars, godlike powers, evil spirits).
During the Middle Ages, it was commonly believed that abnormal people were possessed by devils.
“Therapy” often involved physical and mental torture.
Philippe Pinel (1745–1826) recognized abnormal behavior as sickness of the mind.
Opposed barbaric treatments of patients.
Introduced and encouraged reforms and humane treatments.
Basic Concepts of Psychological Disorders Understanding Psychological Disorders
Through the ages, psychologically disordered people have received brutal treatments, including the trephination evident in this Stone Age skull.
Drilling skull holes like these may have been an attempt to release evil spirits and cure those with mental disorders.
It looks doubtful that this patient would have survived the “cure.”
YESTERDAY’S “THERAPY”
The Medical Model
By the 1800s the search began for physical causes of mental disorders and for curative treatments.
With the medical model of mental disorders, mental illness is to be diagnosed on the basis of symptoms and treated through therapy, often in a psychiatric hospital.
Reinvigoration of the medical model has come from recent research in genetically influenced brain abnormalities in brain structure and biochemistry.
Basic Concepts of Psychological Disorders Understanding Psychological Disorders
Medical model: The concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured, often through treatment in a hospital.
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The Biopsychosocial Approach
General approach positing that biological, psychological, and social-cultural factors all play a significant role in human functioning in the context of disease or illness.
Some symptoms of disorders are culture-related, which points to environmental influences.
For example, the eating disorders anorexia nervosa and bulimia nervosa occur mostly in food-abundant cultures.
Depression and schizophrenia occur worldwide.
Basic Concepts of Psychological Disorders Understanding Psychological Disorders
The Biopsychosocial Approach
Disorders reflect
Genetic predispositions and physiological states
Psychological dynamics
Social and cultural circumstances
The biopsychosocial approach emphasizes that mind and body are inseparable.
Epigenetics: The study of environmental influences on gene expression that occur without a DNA change.
Epigenetics shows that our environment can affect the expression (or not) of a gene, thus affecting the development of psychological disorders.
Basic Concepts of Psychological Disorders Understanding Psychological Disorders
BIOPSYCHOSOCIAL APPROACH TO PSYCHOLOGICAL DISORDERS
Figure 14.1 Today’s psychology studies how biological, psychological, and social-cultural factors interact to produce specific psychological disorders.
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14-3: HOW AND WHY DO CLINICIANS CLASSIFY PSYCHOLOGICAL DISORDERS, AND WHY DO SOME PSYCHOLOGISTS CRITICIZE THE USE OF DIAGNOSTIC LABELS?
Classification orders and describes symptoms
Diagnostic classification in psychiatry and psychology attempts to:
Predict the disorder’s future course
Suggest appropriate treatment
Prompt research into its causes
Basic Concepts of Psychological Disorders Classifying Disorders—and Labeling People
The most common tool for system for classifying disorders is the Diagnostic and Statistical Manual of Mental Disorders now in its fifth edition (DSM-5), 2013
Published by the American Psychiatric Association
Describes disorders and estimates their occurrence
In the new DSM-5, some changes include:
Some label changes (e.g., autism spectrum disorder; intellectual disability)
New categories: Hoarding disorder, binge-eating disorder
New or altered diagnoses—some controversial (e.g., concern that simple bereavement may be too quickly diagnosed as a depressive disorder)
Basic Concepts of Psychological Disorders Classifying Disorders—and Labeling People
DSM criticisms include:
Critics have long faulted the DSM for casting too wide a net
Antisocial personality disorder and generalized anxiety disorder did poorly on field trials for the new DSM-5.
DSM-5 continues the path of potentially pathologizing everyday life
Labels are or may act as society’s subjective value judgments
DSM benefits include:
Helping mental health professionals communicate
It is useful in research
Clients often relieved to identify suffering
Basic Concepts of Psychological Disorders Classifying Disorders—and Labeling People
14-4: WHY IS THERE CONTROVERSY OVER ATTENTION-DEFICIT HYPERACTIVITY DISORDER?
Attention-deficit/hyperactivity disorder (ADHD): Marked by extreme inattention and/or hyperactivity and impulsivity
11 percent American 4- to 17-year-olds receive this diagnosis after displaying its key symptoms; 2.5 percent adults have ADHD symptoms.
Critics fear this disorder is overdiagnosed, leading to overuse of prescription drugs.
Those who say ADHD is overdiagnosed argue:
Symptoms displayed sound like the “disorder” of having a Y chromosome; ADHD is three times more prevalent in boys than girls.
ADHD may in effect be marketed by companies that offer drugs for its treatment (Thomas, 2015).
Energetic child + boring school = ADHD diagnoses?
ADHD—Normal High Energy or Disordered Behavior?
Alternate view of those arguing that ADHD is not overdiagnosed:
More frequent diagnoses due to increased awareness of disorder
Scientific community agrees ADHD is a real neurobiological disorder
Coexists with learning disorders
Is heritable
It is treatable with medications
There is debate over the safety of long-term use of these stimulant medications in treating ADHD.
ADHD—Normal High Energy or Disordered Behavior?
14-5: DO PSYCHOLOGICAL DISORDERS PREDICT VIOLENT BEHAVIOR?
Mental disorders seldom lead to violence and clinical prediction of violence is unreliable.
Most people with disorders are nonviolent and are more likely to be victims than perpetrators of violence.
When they are violent, moral and ethical questions about whether society should hold people with disorders responsible for their violent actions are raised.
Triggers for violence acts by people with mental disorders, in addition to disordered thinking, include substance abuse.
Basic Concepts of Psychological Disorders Are People With Psychological Disorders Dangerous?
14-6: HOW MANY PEOPLE HAVE, OR HAVE HAD, A PSYCHOLOGICAL DISORDER? IS POVERTY A RISK FACTOR?
The U.S. National institute of Mental Health estimates just over 1 in 4 adult Americans “suffer from a diagnosable mental disorder in a given year” (Kessler et al., 2008).
Psychological disorder rates vary by time and place.
Immigrant paradox: Those born to immigrants to the United States at greater risk of mental disorder than the immigrants (for example, Mexican-Americans born in the U.S.).
Poverty is a risk factor:
Incidence of serious psychological disorders is doubled.
Conditions and experiences associated with poverty contribute to the development of psychological disorders.
But some disorders, such as schizophrenia, can drive people into poverty; correlation goes both ways.
Basic Concepts of Psychological Disorders Rates of Psychological Disorders
Psychological disorders usually strike by early adulthood (first symptoms by age 24 in most cases)
Symptoms arrive at the following median ages:
Antisocial personality disorder (age 8)
Phobias (age 10)
Alcohol use disorder (near age 20)
Obsessive-compulsive disorder (near age 20)
Schizophrenia (near age 20)
Major depressive disorder (age 25)
Basic Concepts of Psychological Disorders Rates of Psychological Disorders
PERCENTAGE OF AMERICANS REPORTING SELECTED PSYCHOLOGICAL DISORDERS IN THE PAST YEAR
Table 14.2
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What Increases Vulnerability to Mental Disorders?
Table 14.3 Risk and Protective Factors for Mental Disorders
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Anxiety is a part of life for all of us.
Some of us are more prone to notice and remember information perceived as threatening, and the brain’s danger-detection system becomes hyperactive.
When this occurs, we are at greater risk for an anxiety disorder, or for two other disorders that involve anxiety:
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Anxiety Disorders, OCD, and PTSD
OCD and PTSD were formerly classified as anxiety disorders, but the DSM-5 now classifies them separately.
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14-7: HOW DO GENERALIZED ANXIETY DISORDER, PANIC DISORDER, AND PHOBIAS DIFFER?
Anxiety disorders are marked by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety; include:
Generalized anxiety disorder: Person is unexplainably and continually tense and uneasy.
Panic disorder: Person experiences panic attacks, sudden episodes of intense dread, and fears the next episode’s unpredictable onset.
Phobia: Person is intensely and irrationally afraid of a specific object, activity, or situation.
Anxiety Disorders, OCD, and PTSD Anxiety Disorders
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Generalized anxiety disorder: Person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.
Worry continually, often jittery, on edge, and sleep deprived
Lack of concentration on a task
Two-thirds women
Anxiety is free-floating (not linked to a specific stressor or threat)
Often seen with depression, but usually debilitating even on its own
May lead to physical problems (high blood pressure)
Anxiety Disorders Generalized Anxiety Disorder
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Panic disorder: An anxiety disorder marked by unpredictable, minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Often followed by worry over a possible next attack.
Panic attacks: Sudden episodes of intense dread
Physical symptoms accompany the attack:
Irregular heartbeat, chest pains, shortness of breath, choking, trembling, dizziness
Agoraphobia: Fear or avoidance of public situations from which escape may be difficult (should a panic attack occur).
Anxiety Disorders Panic Disorder
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Phobia: Anxiety disorder marked by a persistent and irrational fear of a specific object, activity, or situation.
Specific phobias include a fear of particular animals, insects, heights, blood, or closed spaces.
Social anxiety disorder (formerly called “social phobia”) is an intense fear of other people’s negative judgments.
People with this disorder avoid social situations (speaking up in a group, eating out, going to parties), and if unable to avoid them, may experience strong symptoms of their anxiety.
Anxiety Disorders Phobias
See Figure 14.3 for some common and uncommon specific fears.
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14-8: WHAT IS OCD?
Obsessive-compulsive disorder (OCD)
Characterized by persistent and repetitive thoughts (obsessions), actions (compulsions), or both
Occurs when obsessive thoughts and compulsive behaviors persistently interfere with everyday life and cause distress
Is more common among teens and young adults than older people
Twin studies reveal that OCD has a strong genetic basis
Anxiety Disorders, OCD, and PTSD Obsessive-Compulsive Disorder (OCD)
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COMMON OBSESSIONS AND COMPULSIONS AMONG CHILDREN AND ADOLESCENTS WITH OBSESSIVE-COMPULSIVE DISORDER
Table 14.4
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14-9: WHAT IS PTSD?
Post traumatic stress disorder (PTSD)
Is characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia lingering for four weeks or more after a traumatic experience.
Often involves military veterans (7.6 percent of combatants; 1.4 of noncombatants among American military personnel in Afghanistan) and survivors of accidents, disasters, and violent and sexual assaults (including an estimated two-thirds of prostitutes).
Women at higher risk (1 in 10) than men (1 in 20) of developing this disorder, following a traumatic event.
Most men and women display impressive survivor resiliency.
Anxiety Disorders, OCD, and PTSD Posttraumatic Stress Disorder (PTSD)
Symptoms of posttraumatic stress disorder (PTSD) include four or more weeks of haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or sleep problems following some traumatic experience.
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14-10: HOW DO CONDITIONING, COGNITION, AND BIOLOGY CONTRIBUTE TO THE FEELINGS AND THOUGHTS THAT MARK ANXIETY DISORDERS, OCD, AND PTSD?
Conditioning research helps explain how panic-prone people associate anxiety with certain cues. Learning may magnify a single painful and frightening event into a full-blown phobia through two conditioning processes:
Stimulus generalization: Research demonstrates how a fearful event can later become a fear of similar events.
Reinforcement can help maintain a developed and generalized phobia.
Understanding Anxiety Disorders, OCD, and PTSD Conditioning
Conditioning influences our feelings of anxiety, but so does cognition—our thoughts, memories, interpretations, and expectations.
Observing others can contribute to development of some fears.
Olsson and colleagues: Wild monkey research findings
Our interpretations and expectations also shape our reactions.
Hypervigilance
Understanding Anxiety Disorders, OCD, and PTSD Cognition
Genes
Genetic predisposition to anxiety, OCD, and PTSD
Researchers have identifies 17 gene variations associated with typical anxiety disorder symptoms
Genes influence levels of neurotransmitters:
Serotonin: Influences sleep, mood, attending to threat
Glutamate: Heightens activity in the brain’s alarm centers
Experience affects gene expression. Epigenetic marks are often organic molecules that attach to chromosomes and turn certain genes on or off
Understanding Anxiety Disorders, OCD, and PTSD Biology
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The Brain
Traumatic fear-learning experiences can leave tracks in the brain
Fear circuits created within the amygdala result in easy inroads for more fear experiences
Brain scans show higher-than-normal activity in the amygdala of brain scans of people with PTSD when they view traumatic images
Anterior cingulate cortex, a brain region that monitors our actions and checks for errors, is especially likely to be hyperactive in people with OCD
Understanding Anxiety Disorders, OCD, and PTSD Biology
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Natural Selection
We seem biologically prepared to fear certain threats—these are easily conditioned and difficult to extinguish.
Some modern fears may have an evolutionary explanation
Fear of flying may be rooted in our biological predisposition to fear heights and confinement
Our phobias focus on dangers our ancestors faced. Our compulsive acts typically exaggerate behaviors that helped them survive.
Understanding Anxiety Disorders, OCD, and PTSD Biology
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14-11: HOW DO MAJOR DEPRESSIVE DISORDER AND BIPOLAR DISORDER DIFFER?
Major depressive disorder is a prolonged state of hopeless depression
Bipolar disorder (formerly called “manic-depressive disorder”) alternates between depression and overexcited hyperactivity
Symptoms for these disorders may have a seasonal pattern
Depression protects us from dangerous thoughts and feelings, letting us slow down
Reassessing life may redirect our energy in promising ways, and even mild sadness can be helpful sometimes
Depression can be seriously maladaptive and disabling
Major Depressive Disorder and Bipolar Disorder
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Major depressive disorder: A disorder in which a person experiences two or more weeks with five or more symptoms, at least one of which must be:
Depressed mood or
Loss of interest or pleasure
These symptoms present themselves in the absence of drugs or another medical condition
Phobias are more common, but depression is the number one reason people seek mental health services
United States: 7.6% experience moderate or severe depression (CDC, 2014)
Worldwide: 3.95% men and 7.2% women have a depressive episode (Global, 2015)
Major Depressive Disorder and Bipolar Disorder Major Depressive Disorder
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DIAGNOSING MAJOR DEPRESSIVE DISORDER
Table 14.6
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Bipolar disorder: A disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania
Formerly called “manic-depressive disorder”
Mania: A hyperactive, wildly optimistic state in which dangerously poor judgment is common
Mild mania fuels creativity
Strikes more often among those who rely on emotional expression and vivid imagery
Much less common than major depressive disorder, but often more dysfunctional
Americans twice as likely as people elsewhere to be diagnosed with this disorder
New to DSM-5: Disruptive mood dysregulation disorder
Major Depressive Disorder and Bipolar Disorder Bipolar Disorder
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14-12: HOW CAN THE BIOLOGICAL AND SOCIAL-COGNITIVE PERSPECTIVES HELP US UNDERSTAND MAJOR DEPRESSIVE DISORDER AND BIPOLAR DISORDER?
Any theory of depression must explain at least the following six phenomena:
Behaviors and Thoughts Change With Depression
Negative aspects on environment consume the depressed
Nearly half of people diagnosed with depression also display symptoms of another disorder (anxiety or substance abuse)
Depression Is Widespread
Found worldwide; causes must also be common
Major Depressive Disorder and Bipolar Disorder Understanding Major Depressive Disorder and Bipolar Disorder
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Women’s Risk of Major Depressive Disorder Is Nearly Double Men’s
Women experience depression 1.7 times more often than men (CDC, 2014)
Women’s disorders are generally more internal (depression, anxiety, inhibited sexual desire)
Men’s disorders are more external (alcohol use disorder, antisocial conduct, lack of impulse control)
Most Major Depressive Episodes End on Their Own
Therapy often helps and tends to speed recovery, but even without most people recover
Recovery more likely if first episode strikes later in life, there were few previous episodes, and there is minimal stress and a strong social support system
Understanding Major Depressive Disorder and Bipolar Disorder
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Stressful Events Often Precede Depression
About one in four diagnosed with depression have experienced an emotional, financial, or professional trauma within the past month
Moving to a new culture may also lead to depression
With Each New Generation, Depression Strikes Earlier (Now Often in the Late Teens) and Affects More People, With the Highest Rates Among Young Adults in Developed Countries
In North America, young adults three times more likely than their grandparents to suffer—recently or ever—from depression
Some generational affect; young people now more willing to talk openly about their depression
Understanding Major Depressive Disorder and Bipolar Disorder
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Genes and Depression
Risk for major depressive disorder and bipolar disorder increases if family member has disorder.
Twin studies data estimated heritability (the extent to which individual differences are attributable to genes) of major depression at 37 percent.
Linkage analysis points to “chromosome neighborhood” to help researchers tease out the genes that put people at risk of depression.
Many genes work together and produce interacting small effects that increase risk for depression.
Understanding Major Depressive Disorder and Bipolar Disorder The Biological Perspective
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Understanding Major Depressive Disorder and Bipolar Disorder The Biological Perspective
THE HERITABILITY OF VARIOUS
PSYCHOLOGICAL DISORDERS
Figure 14.6 Researchers used data from studies of identical and fraternal twins to estimate the heritability of bipolar disorder, schizophrenia, anorexia nervosa, major depressive disorder, and generalized anxiety disorder (Bienvenu et al., 2011).
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The Depressed Brain
Brain activity slows during depression, increases during mania
Left frontal lobe and adjacent reward center become more active during positive emotions
Neurotransmitter norepinephrine scarce during depression; overabundant during mania
Neurotransmitter serotonin scarce/inactive during depression
Depression-relieving drugs increase serotonin supplies
Repetitive physical exercise decreases depression by increasing serotonin
Understanding Major Depressive Disorder and Bipolar Disorder The Biological Perspective
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Nutritional Effects
What’s good for the heart is also good for the brain and mind
People who eat heart-healthy “Mediterranean diet” (heavy on vegetables, fish, and olive oil) have a comparatively low risk of depression as well as lower risk for many other ailments
Excessive alcohol use correlates with depression
Alcohol misuse in fact leads to depression
Understanding Major Depressive Disorder and Bipolar Disorder The Biological Perspective
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Biological influences contribute to depression, but our life experiences also play a part.
Thinking matters: People’s assumptions and expectations influence what they perceive.
Many depressed people have low self-esteem, holding negative views of themselves, their situation, and their future.
Their self-defeating beliefs and negative explanatory style often feed depression’s vicious cycle.
Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective
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Negative Thoughts and Negative Moods Interact
Learned helplessness may exist with self-defeating beliefs, self-focused rumination, and self-blaming and pessimistic explanatory style.
Found more often in women than men, who may tend to respond more strongly to stress
Rumination: Compulsive fretting; overthinking about our problems and their causes
Can divert us from thinking about other life tasks
Can increase negative moods
Critics note a chicken-and-egg problem in the social-cognitive explanation of depression. Which comes first, the pessimistic explanatory style or the depressed mood?
Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective
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EXPLANATORY STYLE AND DEPRESSION
Figure 14.8 After a negative experience, a depression-prone person may respond with a negative explanatory style.
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Depression’s vicious cycle—pieces of the depression puzzle:
Stressful events are interpreted through
A brooding, negative explanatory style, that
Creates a hopeless, depressed state, that
Hampers the way the person thinks and acts
These thoughts and actions, in turn, fuel 1), and the cycle continues.
Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective
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Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective
THE VICIOUS CYCLE OF DEPRESSED THINKING
Figure 14.9 Therapists recognize this cycle, and they work to help depressed people break out of it, by changing their negative thinking, turning their attention outward, and engaging them in more pleasant and competent behavior.
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14-13: WHAT FACTORS INCREASE THE RISK OF SUICIDE, AND WHAT DO WE KNOW ABOUT NONSUICIDAL SELF-INJURY?
Worldwide, 800,000 people annually take their own lives.
At least five times higher risk for suicide with diagnosis of depression, and ironically it may especially occur when people are beginning to rebound (when they become capable of following through).
Is more likely to occur when people feel disconnected from or burden to others, or when they feel defeated and trapped by an inescapable situation.
Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury
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Comparing the suicide rates of different groups, researchers have found:
National differences
Racial differences
Gender differences
Age differences and trends
Other group differences
Day of the week differences
Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury
Only 1 in 25 attempts in the United States are successful
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How to help a family member or friend who is talking suicide? Three tips:
Listen, offering sincere empathy (rather than arguments for why suicide is not the answer)
Connect, by doing your best to link those at risk with a helpline or with campus health services
Protect, by seeking help right away (doctor, emergency room, or 911) and removing potential tools for suicide (weapons, medications) for anyone appearing in immediate risk
Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury
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Nonsuicidal Self-Injury
Nonsuicidal self-injury (NSSI) includes cutting, burning, hitting oneself, inserting objects under nails or skin, and self-administered tattooing. These self-injuries are painful but not fatal.
People engage in NSSI to:
gain relief from intense negative thoughts through the distraction of pain
ask for help and gain attention
relieve guilt by self-punishment
get others to change their negative behavior (bullying, criticism)
fit in with a peer group
Typically are suicide gesturers, not suicide attempters.
Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury
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Self-injury rates peak higher for females than for males (CDC, 2009).
RATES OF NONFATAL SELF-INJURY IN THE U.S.
Figure 14.10
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Schizophrenia: A psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression.
The word itself means “split” (schizo) “mind” (phrenia).
Schizophrenia is the chief example of a psychotic disorder, which is marked by irrationality, distorted perceptions, and lost contact with reality.
With treatment and a supportive environment, over 40 percent of people with schizophrenia will have periods of a year or more with normal life experience. But just 1 in 7 of those diagnosed will make a complete and enduring recovery.
Schizophrenia and Other Disorders Schizophrenia
14-14: WHAT PATTERNS OF PERCEIVING, THINKING, AND FEELING CHARACTERIZE SCHIZOPHRENIA?
Positive symptoms: Presence of inappropriate behavior
Negative symptoms: Absence of appropriate behavior
Disturbed Perceptions
Hallucinations: Seeing, feeling, tasting, smelling things that exist only in the mind
Disorganized Thinking and Speech
Delusions: False beliefs
May have paranoid tendencies
Word salad (senseless speech) and a breakdown in selective attention
Schizophrenia and Other Disorders Schizophrenia Symptoms of Schizophrenia
Diminished and Inappropriate Emotions
Flat affect: Emotionless, a state of no apparent feeling
Impaired theory of mind: Difficulty reading other peoples’ facial emotions and states of mind
Emotional deficiencies occur early in illness and have a genetic basis
Inappropriate motor behavior, with motionless catatonia or senseless, compulsive actions
Schizophrenia and Other Disorders Schizophrenia Symptoms of Schizophrenia
14-15: HOW DO CHRONIC AND ACUTE SCHIZOPHRENIA DIFFER?
Chronic schizophrenia (also called process schizophrenia)
Form of schizophrenia in which symptoms usually appear by late adolescence or early adulthood
As people age, psychotic episodes last longer and recovery periods shorten
Acute schizophrenia (also called reactive schizophrenia)
Form of schizophrenia that can begin at any age, frequently occurs in response to an emotionally traumatic event, and has extended recovery periods
Often positive symptoms that respond to drug therapy
Schizophrenia and Other Disorders Schizophrenia Onset and Development of Schizophrenia
14-16: WHAT BRAIN ABNORMALITIES ARE ASSOCIATED WITH SCHIZOPHRENIA?
Brain Abnormalities
Dopamine Overactivity
Resulting hyper-responsive dopamine system could intensify brain signals, creating positive symptoms
Abnormal Brain Activity and Anatomy
Often low activity in frontal lobes
Vigorous activity in thalamus and amygdala when experiencing hallucinations
Enlarged, fluid-filled areas and corresponding shrinkage and thinning of cerebral tissue
Smaller-than-normal cortex and corpus callosum
Schizophrenia and Other Disorders Schizophrenia Understanding Schizophrenia
14-17: WHAT PRENATAL EVENTS ARE ASSOCIATED WITH INCREASED RISK OF DEVELOPING SCHIZOPHRENIA?
Prenatal Environment and Risk
Low birth weight
Maternal diabetes
Older paternal age
Lack of oxygen during delivery
Maternal prenatal nutrition
Midpregnancy viral infection (factors examined include flu incidence, population density, season of birth)
Schizophrenia and Other Disorders Schizophrenia Understanding Schizophrenia
14-18: HOW DO GENES INFLUENCE SCHIZOPHRENIA?
Genetic Influences
Odds of being diagnosed with schizophrenia are nearly 1 in 100; 1 in 10 for those with diagnosed family member
Risk for adopted children is related to biological parent
Schizophrenia influenced by many genes
Some influence the activity of dopamine and other brain neurotransmitters
Others affect the production of myelin
Epigenetic factors influence gene expression
Schizophrenia and Other Disorders Schizophrenia Understanding Schizophrenia
Schizophrenia and Other Disorders Schizophrenia Understanding Schizophrenia
RISK OF DEVELOPING SCHIZOPHRENIA
Figure 14.11 The lifetime risk of developing schizophrenia varies with one’s genetic relatedness to someone having the disorder. Across countries, barely more than 1 in 10 fraternal twins, but some 5 in 10 identical twins, share a schizophrenia diagnosis. (Data from Gottesman, 2001.)
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Schizophrenia and Other Disorders Schizophrenia Understanding Schizophrenia
SCHIZOPHRENIA IN IDENTICAL TWINS
Figure 14.12 When twins differ, only the one afflicted with schizophrenia typically has enlarged, fluid-filled cranial cavities (right) Suddath et at., 1990). The difference between the twins implies some nongenetic factor, such as a virus, is also at work.
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14-19: WHAT ARE DISSOCIATIVE DISORDERS, AND WHY ARE THEY CONTROVERSIAL?
Dissociative disorders
Controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings
Dissociative identity disorder (DID) (formerly called multiple personality disorder)
Rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities
Other Disorders Dissociative Disorders
Skeptics note that dissociative identity disorder, formerly known as multiple personality disorder, increased dramatically in the late twentieth century; is rarely found outside North America; and may reflect role playing by people who are vulnerable to therapists’ suggestions. Others view this disorder as a manifestation of feelings of anxiety, or as a response learned when behaviors are reinforced by anxiety-reduction.
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Understanding Dissociative Identity Disorder
Increased dramatically in the late twentieth century.
Is rarely found outside North America.
DID may reflect role playing by people who are vulnerable to therapists’ suggestions.
Some psychodynamic theorists view this disorder as a manifestation of feelings of anxiety.
Some learning theorists view this disorder as a response learned when behaviors are reinforced by anxiety-reduction.
Some clinicians include dissociative disorders under the umbrella of posttraumatic stress disorder.
Other Disorders Dissociative Disorders
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14-20: WHAT ARE THE THREE CLUSTERS OF PERSONALITY DISORDERS? WHAT BEHAVIORS AND BRAIN ACTIVITY CHARACTERIZE THE ANTISOCIAL PERSONALITY?
Personality disorders: Inflexible and enduring behavior patterns that impair social functioning.
These disorders forms three clusters, characterized by:
anxiety, that predisposes the withdrawn avoidant personality disorder
eccentric or odd behaviors, such as the emotionless disengagement of schizotypal personality disorder
dramatic or impulsive behaviors as seen in borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder
Other Disorders Personality Disorders
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Antisocial Personality Disorder
A person with antisocial personality disorder displays:
Lack of conscience for wrongdoing, even toward friends and family members
Often impulsiveness, fearlessness, irresponsibility
Criminality is not an essential component of antisocial behavior—and many criminals do not fit the description of antisocial personality disorder (since they show responsible concern for their friends and family members).
Other Disorders Personality Disorders
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Other Disorders Personality Disorders
Antisocial Personality Disorder
Understanding Antisocial Personality Disorder
Biological relatives of people with antisocial and unemotional tendencies are at increased risk for antisocial behavior.
Some specific genes identified as more common in those with antisocial personality disorder; these genes also increase the risk for substance use disorder, and these disorders often appear in combination.
Low autonomic nervous system arousal in situations others would find unnerving.
Genetic predispositions may interact with the environment to produce the altered brain activity associated with antisocial personality disorder.
14-21: WHAT ARE THE THREE MAIN EATING DISORDERS, AND HOW DO BIOLOGICAL, PSYCHOLOGICAL, AND SOCIAL-CULTURAL INFLUENCES MAKE PEOPLE MORE VULNERABLE TO THEM?
Anorexia nervosa: Person (usually an adolescent female) maintains a starvation diet despite being significantly underweight
People with anorexia nervosa continue to diet and sometimes exercise excessively because they view themselves as fat.
Bulimia nervosa: Person alternates binge eating (usually of high-calorie foods) with purging (by vomiting or laxative use), sometimes followed by fasting or excessive exercise
Binge-eating disorder: Significant binge eating, followed by distress, disgust, or guilt, but without the compensatory purging or fasting that marks bulimia nervosa
American rates: 0.6% anorexia, 1% bulimia, and 2.8% binge-eating
Other Disorders Eating Disorders
People with bulimia nervosa secretly binge and then compensate by purging, fasting, or excessive exercise.
People with binge-eating disorder have binge-eating episodes but do not follow with purging, fasting, and exercise.
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Understanding Eating Disorders
Family environment for those diagnosed with anorexia is often competitive, high-achieving, protective
Those with eating disorders often have low self-evaluations, set perfectionistic standards, and are intensely concerned with how others perceive them
Heredity: Disorders seen more in identical twins than in fraternal twins
Cultural pressures: Ideal body shapes vary across cultures and time
Other influences: Low self-esteem, and negative emotions interact with stressful life experiences
Prevention programs have had success; especially effective when interactive and focused on girls over age 15
Other Disorders Eating Disorders
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