MAJOR CONCEPTS: UNIT 4 EXAM Chapter 11 Psychological Disorders (If its in BOLD TYPE, then KNOW IT) NOTE:

Compare and contrast means to define and explain similarities and differences between terms/concepts Chapter 11 1. Define psychological (mental) disorder. As discussed in class, what is the approximate lifetime prevalence for any psychological disorder? What is the current prevalence of any psychological disorder?

A mental condition characterized by cognitive, emotional, and behavioral symptoms that create significant distress, impair work, school, family, relationships, or daily living, or lead to significant risk or harm.

2. Be familiar with the three factors of distress, disability/impairment, and danger/risk of harm that make up psychological disorders. Consider examples of each. Consider social and cultural influences on the classification of mental disorders. An example of distress is someone who repeatedly bursts into tears and expresses hopelessness about the future for no apparent reason. An example of disability/impairment may be a police officer who becomes so anxious that he cannot perform his job. Danger or risk of harm can occur when symptoms of a disorder cause an individual to put his or her or someone elses life at risk, either purposefully or accidentally. For example, depression may lead to a suicide attempt, and extreme paranoia may provoke someone to attack other people. 3. Describe some historical myths and misassumptions about symptoms of mental illness as discussed in class. 4. Describe the medical model for the classification of psychological disorders as discussed in class. Consider advantages and disadvantages of this model. Define diagnosis, symptoms, etiology, and prognosis as discussed in class. Consider examples of each. medical model - the conceptualization of psychological abnormalities as diseases that, like biological diseases, have symptoms and causes and possible cures. Etiology - refers to the apparent causation and developmental history of an illness. So a specifiable pattern of causes may exist for different mental disorders. The medical model also suggests that each category of mental disorder is likely to have a common prognosis - a typical course over time and susceptibility to treatment and cure (forecast about the probable course of an illness). 5. Describe the Diagnostic and Statistical Manual for Mental Disorders (DSM). Be familiar with the primary advantages and disadvantages of the DSM. Consider the continuum of normality and abnormality. Describe the DSM multiaxial system and the Global Assessment of Functioning (GAF) as discussed in class. Describe comorbidity as discussed in class. DSM - A classification system that describes the features used to diagnose each recognized mental disorder and indicates how the disorder can be distinguished from other, similar problems.

Clinical disorders are noted on Axis I. Personality disorders and mental retardation are noted on Axis II. Axis III notes any general medical conditions that might be relevant to a diagnosis on Axis I or II. Psychosocial and environmental problems are identified on Axis IV. Axis V records the patients GAF (highest level of functioning in major areas of life within the
past year). Axis V is the Global Assessment of Functioning (GAF) Scale - a 0 to 100 rating of the person, with more severe disorders indicated by lower numbers and more effective functioning by higher numbers. Can be thought of as an exam score for quality of functioning in life. Comorbidity - the co-occurrence of two or more disorders in a single individual. This is

relatively common and raises further confusion. Diagnosticians try hard to solve the problem of comorbidity because understanding the underlying basis for a persons disorder may suggest methods of treatment. 6. As discussed in class, 70% of individuals with a diagnosable mental disorder never seek treatment. Discuss how the stigma of mental illness, including false beliefs and the effects of those beliefs, keeps disordered individuals from getting help or even telling those closest to them. Be familiar with David Rosenhans social experiment related to psychiatric labels. 7. Describe the biopsychosocial model and the diathesis-stress model. Consider how these models relate to biological, psychological, and environmental factors in the development of mental illness. Reflecting a growing body of research findings, most psychologists today believe that psychological disorders can be explained by considering factors at all three levels of analysis- the level of the brain, the level of the person, and the level of the group- both separately and by understanding their influences on each other. This approach is generally called the biopsychosocial model. Diathesisstress model - This model states that for a given disorder, there is both a biological predisposition to the disorder (a diathesis) and specific environmental factors (stress) that combine to trigger the disorder. The diathesis is the internal predisposition, and the stress is the external trigger. According to this model, some people may be more vulnerable to developing a particular disorder but without the environmental stressors, the disorder is not triggered. 8. Be familiar with the three levels of analysis related to the etiology of disorders: level of the brain, level of the person, level of the group. At the level of the brain, psychologists consider genetic and biological factors, such as genes, neurotransmitters, hormones, and abnormalities in the structure and function of the brain, that contribute to the development of some disorders. However, thoughts, feelings, and behaviors, as well as interactions with others and the environment, can affect the workings of the brain. Several factors at the level of the person, such as classical conditioning, operant conditioning, observational learning, the content of mental processes (e.g., biases in what a person tends to pay attention to, the pattern of a persons thoughts, and the attributions that he or she makes), dysfunctional attitudes, and feelings, play a role in psychological disorders. Factors at the level of the group play a role in triggering psychological disorders, as well as in increasing the risk of a disorders recurrence. This includes poor socialization, stressful life circumstances, and cultural and social inequities. For example, the stress part of posttraumatic stress disorder is caused by other people (e.g., a terrorist or rapist) or the physical environment (e.g., a natural disaster). 9. Describe cultural variations with regard to the experience of psychological disorders as discussed in class. How might a culture create a disorder? Be generally familiar with the culture bound disorders of koro, windigo, mal de ojo, and anorexia nervosa. Koro is an obsessive fear that ones penis will withdraw into ones abdomen and possibly cause death, seen only in Malaysia and other regions of southern Asia. Windigo involves intense craving for human flesh and fear that one will turn into a cannibal (a form of spirit possession), seen only among Algonquin Indian cultures (ancient Indians of Northeast United States). Mal de Ojo (evil eye) is a disorder resulting from looking at a child with envy in Mediterranean cultures (Italy, Spain) and involves a variety of symptoms in

children, such as fitful sleep, crying without cause, diarrhea, vomiting, and fever. Anorexia nervosa is an eating disorder characterized by intentional selfstarvation possibly up to death as a result of an intense fear of gaining weight, until recently seen only in affluent Western cultures, but is catching as our cultural ideals of beauty spread. 10.What defines mood disorders? Describe the episodic and polar nature of these disorders as discussed in class. Mood disorders are conditions marked by persistent or episodic disturbances in emotion that interfere with normal functioning in at least one realm of life. Moods are relatively long-lasting, nonspecific emotional states. Mood disorders are disorders of emotional extremes- they are polar in nature- either on the extremely low end of emotional spectrum (e.g., depression) or on the extremely high end of emotional spectrum (e.g., mania). The emotional extremes are so intense that it regularly affects cognition and behavior as well. 11.Define and describe major depressive disorder. Consider examples. Be familiar with cultural variations in this disorder. Be familiar with the suicide risk related to major depression and recognize suicide myths. Major depressive disorder (MDD) is characterized by at least two weeks of depressed mood or loss of interest in nearly all activities, along with at least five symptoms of depression (sleep or eating disturbances, loss of energy, restlessness or sluggishness, feelings of worthlessness and guilt, thoughts of suicide- see textbook for full list of symptoms). It is also called unipolar mood disorder as it involves only one emotional extreme. 12.Describe seasonal affective disorder. Consider examples. Seasonal affective disorder (SAD) - recurrent depressive episodes in a seasonal pattern, beginning in fall or winter, due to reduced levels of daylight. 13.Describe bipolar disorder. What other name does this disorder go by? Compare and contrast manic and depressed phases. Consider examples of each. Be familiar with the time frame of bipolar cycles. Bipolar disorder is a mood disorder marked by one or more episodes of mania, or the less intense hypomania, often alternating between periods of depression. 14.Know the following general etiological (causal) factors for mood disorders at the different levels of analysis and consider examples of each genetics, neurochemistry, cognitive distortions, negative triad of depression, attributional style, environmental stress, social isolation and rejection. Aaron Beck proposes that people with depression commit cognitive distortions (systematic errors in thinking about events and people, including the self) that lead to a negative triad of depression in their thoughts. The negative triad consists of a negative view of the world (e.g., Everybody hates me), self (e.g., Im worthless), and future (e.g., Things will never get better). These errors in logic act to maintain an outlook on life that perpetuates depressing feelings and behaviors. When people feel they have no control over negative aspects of their environment, they are at an increased risk of developing depression. A persons attributional style, or their characteristic way of explaining life events, affects his or her risk of developing depression. For people who attribute blame to themselves (versus external factors), the risk of depression increases, especially after a stressful event. Patterns of attributing blame to external causes (e.g., the self-serving bias) are less likely to lead to depression.

15.What are the defining symptoms of anxiety disorders? An anxiety disorder is characterized by intense or pervasive fear (a response to an external stimulus) or anxiety (a vague but persistent sense of foreboding or dread), or extreme attempts to avoid these feelings. These experiences create exceptional distress that can interfere with the persons ability to function normally. 16.Compare and contrast generalized anxiety disorder and specific phobias. Consider examples of each. Describe social phobia. Know the following general etiological factors for phobias biological preparedness (evolutionary component), the role of classical and operant conditioning in phobias. Generalized anxiety disorder involves excessive anxiety and worry that is not consistently related to a specific object or situation (e.g., free-floating anxiety). In people suffering from GAD, chronic worry is accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance. A phobia is an exaggerated, irrational fear of an object, activity, or situation accompanied by avoidance of the feared stimulus that is extreme enough to interfere with everyday life. Phobias can be sorted into two types Social phobia (social anxiety disorder) is the fear of public embarrassment or humiliation and the avoidance of social situations likely to arouse this fear. Individuals with social phobia try to avoid situations where unfamiliar people might evaluate them (fear of negative evaluation). Approximately 12 percent of Americans experience social phobia in their lives, and it is one of the most common disorders occurring during the teenage years. Specific phobias focus on a specific object or non-social situation. The fear may occur in the presence of the stimulus or in anticipation of it, despite an intellectual recognition that the fear is excessive or unreasonable. By avoiding the object or situation, the sufferer avoids the fear, anxiety, or panic that it might elicit. 17.Define panic disorder and explain how it relates to agoraphobia. Describe panic attacks and consider examples. Describe the locus coeruleus alarm system and anxiety sensitivity as related to the development of panic disorder. People with panic disorder worry about having more attacks and may change their behavior to attempt to avoid or minimize attacks. This propensity may lead to agoraphobia (fear of the marketplace)- a condition in which people fear or avoid places that might be difficult to leave should panic symptoms occur. People suffering from agoraphobia may completely avoid leaving home or will do so only with a close friend or relative. Etiological factors for panic disorder can be understood by looking at the levels of analysis. At the level of the brain in panic disorders: Panic attacks may arise from a hypersensitivity involving the locus coeruleus, a small group of cells deep in the brainstem. The locus coeruleus is the seat of an alarm system that triggers an increased heart rate, faster breathing, sweating, and other components of the fight-or-flight response. For example, people with anxiety sensitivity, the belief that autonomic arousal (body arousal) can have harmful consequences, are at higher risk of experiencing spontaneous panic attacks. 18.Describe obsessive-compulsive disorder and compare and contrast obsessions and compulsions. Consider examples of each. Obsessions are recurrent and persistent thoughts, impulses, or images that feel intrusive and inappropriate and that are difficult to suppress or ignore. Obsessions are more than

excessive worries about real problems. They may cause significant anxiety and distress. Common obsessions involve thoughts of contamination, repeated doubts, the need to have things in a certain order, and aggressive or horrific impulses. Compulsions are repetitive behaviors or mental acts that some individuals feel driven to perform in response to an obsession. Some examples of compulsive behaviors are washing (in response to thoughts of contamination), checking, ordering, and counting. 19.Describe the conditions that must be met for a diagnosis of posttraumatic stress disorder. Consider examples. How do personality factors and social support relate to the development of PTSD? 1. The person experiences or witnesses an event that involves actual or threatened serious injury or death. 2. The traumatized person responds to the situation with fear and helplessness. 3. The traumatized individual experiences three sets of symptoms, which do not always appear immediately after the traumatic event but can persist for months or even years: persistent reexperiencing of the traumatic event, persistent avoidance of anything associated with the trauma and general emotional numbing, and heightened arousal. Persistent reexperiencing of the traumatic event can take the form of intrusive, unwanted, and distressing recollections, dreams, or nightmares of the event, or may involve flashbacks that can include illusions, hallucinations, and a sense of reliving the experience. Heightened arousal may cause people with PTSD to startle easily, have difficulty sleeping, or be in a constant state of hypervigilance. 20.Define psychosis and consider how it relates to schizophrenia. Psychosis is an obvious impairment in the ability to perceive and comprehend events accurately, combined with a gross disorganization of behavior. Psychosis is the catch-all term for disorders involving unusual symptoms, such as hallucinations and delusions. Schizophrenia represents the primary form of psychotic disorders. Schizophrenia is a psychotic disorder that profoundly alters affect, behavior, and cognition, particularly the pattern or form of thought. 21.Describe dissociative identity disorder. Contrast this disorder with schizophrenia. Dissociative Identity Disorder (formerly called MPD) is characterized by the presence within an individual of two or more distinct identities that at different times take control of the individuals behavior. This is a form of dissociative disorder more similar to amnesia. It is a completely different class of disorder and is NOT a form of psychosis 22.What are the defining symptoms of schizophrenia? Compare and contrast positive symptoms and negative symptoms. Compare and contrast hallucinations and delusions. Describe disorganized speech, disordered behavior, flat affect, alogia, and avolition. Consider examples of each. Positive symptoms involve an excess or distortion of normal functions. They are called positive not because they indicate something desirable, but rather because they mark the presence of certain unusual behaviors. Delusions are entrenched and unshakable false beliefs that are often bizarre (of persecution, grandeur, reference, or control). For example, the belief that a persons thoughts are being controlled by aliens is a delusion. Delusions can be quite complex. Such beliefs however, even if false, should not be considered abnormal if they are an accepted part of the culture. For example, in some religious groups, it is not considered abnormal to hear voices, especially the voice of God. Hallucinations are mental images in any sensory modality (but mostly visual or auditory) that are so vivid that they seem real. Hallucinations are false

perceptions that are often repetitive and negative in nature. Disordered behavior- behavior that is inappropriate for the situation or ineffective in attaining goals, often with specific motor disturbances. A patient might exhibit constant childlike silliness, improper sexual behavior, disheveled appearance, or loud unpredictable shouting or swearing. Specific motor disturbances might include strange movements, rigid posturing, odd mannerisms, bizarre grimacing, or hyperactivity. It also may involve a complete lack of hygiene. Disorganized speech- a severe disruption of verbal communication in which ideas shift rapidly and incoherently from one to another unrelated topic. This reflects difficulties in organizing thoughts and focusing attention. Responses to questions are often irrelevant, ideas are loosely associated, and words are used in peculiar ways (word salad). Negative symptoms involve a diminution or loss of normal functions. These symptoms refer to things missing in people with schizophrenia, in contrast to the positive symptoms (such as hallucinations) that appear more in people with schizophrenia than in other people. Flat affect is a general failure to express or respond to emotion. Alogia (poverty of speech) is brief, slow, empty replies to questions. Avolition is an inability to initiate goal-directed behavior. An apparent complete lack of motivation. 23.Compare and contrast the following subtypes of schizophrenia: paranoid, disorganized, catatonic. Consider examples of each. Paranoid schizophrenia is characterized by specific delusional beliefs, which are limited to particular topics. If someone isnt talking about these topics, he or she may seem perfectly normal, which sometimes makes diagnosis difficult. People with this type of schizophrenia are more likely to exhibit aggressive behavior (accounts for most dangerous mentally ill) and have the highest suicide rate. This subtype has the best prognosis or prospect of recovery. Disorganized schizophrenia is marked by severely disorganized speech and behavior, which can be childish, including giggling and a strange style of dress. The person may engage in public urination, defecation, and obscene and babbling speech. This type has the worst prognosis. Catatonic schizophrenia involves bizarre motor disturbances (immobility and/or agitation) and may require constant care. 24.Know the following general etiological (causal) factors for schizophrenia at the different levels of analysis and consider examples of each genetics, brain ventricle size differences and prenatal explanations, cortisol and dopamine differences, perceptual/interpretational problems, stress as a trigger, social selection (social drift), and high expressed emotion. A higher rate of schizophrenia is found in urban areas and among lower socioeconomic classes. Social selection (also called social drift) refers to the drifting to lower socioeconomic classes of people who have become mentally disabled. This often happens to patients who are no longer able to work and lack family support or care. May account for the extremely high rate of schizophrenia among the homeless. Most individuals with schizophrenia in recovery go to live with their families. The way a family expresses emotions can affect the likelihood of a recurrence of acute schizophrenia symptoms, although it does not cause schizophrenia. High expressed emotion families (an emotional style in which family members are

critical, hostile, and overinvolved) are more likely to lead to relapse of symptoms for those in recovery. 25.Compare and contrast anorexia nervosa and bulimia nervosa. Consider examples of each. How do eating disorders relate to body image distortion? Consider cultural influences on the development of eating disorders. 26.What are the defining characteristics of personality disorders? Describe antisocial personality disorder and consider genetic and environmental risk factors. 27.Define insanity and contrast this concept with the concept of mental illness (psychological disorder). How does public perception of the insanity defense and its outcome differ from reality? SEE ONLINE HANDOUT.