PSYCHOLOGICAL

DISORDERS

CHAPTER 16

1
2
WHAT DISORDER DO YOU
THINK IS HERE?
• antisocial personality disorder

3
4
WHAT DISORDER DO YOU
THINK IS HERE?
• Obsessive compulsive disorder

5
6
WHAT DISORDER DO YOU
THINK IS HERE?
• Agoraphobia

7
8
WHAT DISORDER DO YOU
THINK IS HERE?
• dissociative identity disorder

9
PAGES 639-
649

10
 PSYCHOLOGICAL
DISORDERS
I felt the need to clean my room … spent four to five
hour at it … At the time I loved it but then didn't want
to do it any more, but could not stop … The clothes
hung … two fingers apart …I touched my bedroom
wall before leaving the house … I had constant anxiety
… I thought I might be nuts.
Marc, diagnosed with
obsessive-compulsive disorder
(from Summers, 1996)

11
WHAT IS ABNORMAL?

• Deciding what is normal and what is abnormal is a value

judgment. Mental illness judgments are based on cultural
values, social trends, political forces, as well as scientific
knowledge.
Four criteria for defining abnormal behavior:
• Statistical infrequency
• Disability or dysfunction
• Personal distress
• Violation of norms

12
 PSYCHOLOGICAL
DISORDERS
People are fascinated by the exceptional, the unusual, and the
abnormal. This fascination may be caused by two reasons:

1. During various moments we feel, think, and act

like an abnormal individual. (so we are fascinated
with why)

2. Psychological disorders may bring unexplained

physical symptoms, irrational fears, and suicidal
thoughts.

13
 PSYCHOLOGICAL
DISORDERS
To study the abnormal is the best way of understanding the
normal.

William James (1842-1910)

1. There are 450 million people suffering from

psychological disorders (WHO, 2004).

2. Depression and schizophrenia exist in all cultures

of the world in some form or fashion, but may be
caused by different factors (some may not be diagnosed so it
may appear as though they don’t exist in all societies.)

14
 DEFINING PSYCHOLOGICAL
DISORDERS
Mental health workers view psychological disorders as persistently
harmful thoughts, feelings, and actions.

When behavior is deviant, distressful, and

dysfunctional psychiatrists and psychologists
label it as disordered (Comer, 2004).

15
 DEVIANT, DISTRESSFUL &
DYSFUNCTIONAL
1. Deviant behavior
(going naked) in one
culture may be
considered normal,
while in others it may
lead to arrest.

Carol Beckwith
2. Deviant behavior must
accompany distress.
3. If a behavior is In the Wodaabe tribe men
dysfunctional it is wear costumes to attract
clearly a disorder. women. In Western society
this would be considered
abnormal.
16
 OTHER CULTURE-BOUND
DISORDERS
• Susto is most likely to occur in infants and young children. In addition to anxiety and
restlessness, the disorder is often marked by depression, loss of weight, weakness,
and rapid heartbeat. Those within the culture claim that the susto is caused by
contact with supernatural beings or with frightening strangers, or even by bad air
from cemeteries. Treatment involves rubbing certain plants and animals against the
skin.
• Latah occurs among uneducated middle-aged or elderly women in Malaya.
Unusual circumstances (such as hearing someone say “snake” or even being
tickled) produce a fear response that is characterized by repeating the words and
actions of other people, uttering obscenities, and acting the opposite of what other
people ask.
• Koro is a pattern of anxiety found in Southeast Asian men. It involves the intense fear
that one’s penis will withdraw into one’s abdomen, causing death. Tradition holds
that koro is caused by an imbalance of “yin” and “yang,” two natural forces
thought to be the fundamental components of life. In one form of treatment, the
individual keeps a firm hold on his penis (often with the assistance of family
members) until the fear subsides. Another is to clamp the penis to a wooden box
• Amok, a disorder found in the Philippines, Java, and certain parts of Africa. It occurs
more often in men than in women. Those suffering the affliction jump around
violently, yell loudly, and attack objects and other people. These symptoms are
often preceded by social withdrawal and a loss of contact with reality. The outburst
is often followed by depression, then amnesia regarding the symptomatic behavior.
Within the culture, it is thought that stress, shortage of sleep, alcohol consumption,
and extreme heat are the primary causes.

17
UNDERSTANDING
PSYCHOLOGICAL DISORDERS
Ancient Treatments of psychological disorders include trephination,
exorcism, being caged like animals, being beaten, burned, castrated,
mutilated, or transfused with animal’s blood.

John W. Verano

Trephination (boring holes in the skull to remove evil forces) 18

 MEDICAL PERSPECTIVE
Philippe Pinel (1745-1826) from France, insisted that madness was not
due to demonic possession, but an ailment of the mind.

George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago
Dance in the madhouse. 19
 MEDICAL MODEL
When physicians discovered that syphilis led to mental disorders, they
started using medical models to review the physical causes of these
disorders.

1. Etiology: Cause and development of the

disorder.
2. Diagnosis: Identifying (symptoms) and
distinguishing one disease from another.
3. Treatment: Treating a disorder in a psychiatric
hospital.
4. Prognosis: Forecast about the disorder.
20
WHAT CAUSES ABNORMAL BEHAVIOR?
There are seven major perspectives that emphasize different
factors believed to contribute to abnormal behavior / They are
combined differently in your text so that there are 3

• 1. Biological : problems with brain function, genetic

predisposition, or biochemistry
– Evolutionary: exaggerated form of an adaptive reaction
– 2. Sociocultural: problems reflect cultural values and beliefs
• Humanistic: blocked personal growth
• Behavioral: inappropriate conditioning or modeling
• 3. Cognitive: faulty thinking
– Psychoanalytic/Psychodynamic: unconscious, unresolved conflict

21
22
BIOPSYCHOSOCIAL
PERSPECTIVE
Assumes that biological, socio-cultural, and psychological factors
combine and interact to produce psychological disorders.

23
 WHAT IS THE VULNERABILITY–STRESS
(OR DIATHESIS-STRESS) MODEL?

The biopsychosocial approach gave rise to the stress

vulnerability model (also called the diathesis-stress
model).

This model suggests that genetic predispositions

combine with environmental stressors to increase or
decrease the likelihood of developing a psychological
disorder.
(Monroe & Simons, 1991; Zuckerman, 1999)
 WHAT IS EPIGENETICS?

the study of environmental influences on gene

expression that occur without a DNA change

Research on epigenetics (literally, “in addition to genetic”)

supports the vulnerability-stress model by showing how
our DNA and our environment interact.
In one environment, a gene will be expressed, but in
another, it may lie dormant.
For some, that will be the difference between developing
a disorder or not developing it.
1. WHAT WOULD YOU ANSWER?
Which of the following describes the general idea
that psychological disorders result from an
interplay of a variety of factors?

A. the diathesis-stress model

B. the DSM–5
C. the biopsychosocial approach
D. the psychoanalytic model
E. the medical model
 CLASSIFYING
PSYCHOLOGICAL DISORDERS
The American Psychiatric Association rendered a Diagnostic and
Statistical Manual of Mental Disorders (DSM) to describe
psychological disorders.
The last edition, DSM-IV-TR (Text
Revision, 2000), describes 400
psychological disorders compared
to 60 in the 1950s.

• The new 5th edition was

published in 2013

27
 WHY DO CLINICIANS CLASSIFY
PSYCHOLOGICAL DISORDERS?

In biology, classification creates order. To classify

an animal as a “mammal” says a great deal—
that it is warm-blooded, has hair or fur, and
produces milk to nourish its young.
In psychiatry and psychology, too, classification
orders and describes symptoms.

For instance, to classify a person’s disorder as

“schizophrenia” suggests that the person talks
incoherently, has bizarre beliefs, shows either little
emotion or inappropriate emotion, or is socially
withdrawn.
 WHAT, BEYOND DESCRIBING SYMPTOMS, IS THE
PURPOSE OF DIAGNOSING DISORDERS?

But diagnostic classification gives more than a

thumbnail sketch of a person’s disordered
behavior, thoughts, or feelings.

In psychiatry and psychology, classification also aims

to predict a disorder’s future course, suggest
appropriate treatment, and prompt research into its
causes.

To study a disorder, we must first name and describe it.

 CLASSIFYING
PSYCHOLOGICAL DISORDERS:
• Diagnostic and Statistical Manual of Mental
Disorders – Fourth Edition – Text Revision (DSM-IV-TR)
/ 5th edition is now out
o Lists all the acceptable labels for all psychological
disorders with descriptions for each disorder and
explanations of how to distinguish them from similar
disorders
• o Five axes of the DSM-V
– Axis I: Clinical Disorders
– Axis II: Personality Disorders and Mental Retardation
(Intellectual disability (intellectual developmental disorder)
as a DSM-5 diagnostic term replaces “mental retardation”
used in previous editions of the manuals.
– Axis III: General Medical Conditions
– Axis IV: Psychosocial and Environmental Problems
– Axis V: Global Assessment of Functioning

30
 TYPES OF AXIS I - CLINICAL
DISORDERS
• Anxiety Disorders: A class of disorders marked by feelings of excessive
apprehension and anxiety
• Mood Disorders: A class of disorders marked by emotional disturbance of
varied kinds that may spill over to disrupt physical, perceptual, social,
and thought processes
• Schizophrenic Disorders: A class of disorders marked by delusions,
hallucinations, disorganized speech, and deterioration of adaptive
behavior
• Dissociative Disorders: A class of disorders in which people lose contact
with portions of their consciousness or memory, resulting in disruption in
their sense of identity
• Somatoform Disorders: Physical ailments that cannot be fully explained
by organic conditions and are largely due to psychological factors
(these disorders are not on the exam)

31
MULTIAXIAL
CLASSIFICATION
Is a Clinical Syndrome (cognitive, anxiety,
Axis I

Axis II
GONE –
mood disorders [16 syndromes]) present?
Is a Personality Disorder or Mental Retardation
present?
NO MORE
Axis III
Is a General Medical Condition (diabetes,
hypertension or arthritis etc) also present?
MULTIAXIAL
Axis IV
Are Psychosocial or Environmental Problems
(school or housing issues) also present?

CLASSIFICATION
What is the Global Assessment of the person’s
Axis V functioning?

32
 GOALS OF DSM
1. Describe (400) disorders.
2. Determine how prevalent the
disorder is.

Disorders outlined by DSM-5 are reliable.

Therefore, diagnoses by different professionals
are similar.

Others criticize DSM-5 for “putting any kind

of behavior within the compass of
psychiatry.”
33
WHAT ARE SOME CHANGES TO
DIAGNOSTIC LABELS IN THE 5 TH
EDITION OF THE DSM?
The conditions formerly called “autism” and
“Asperger’s syndrome” were combined under the
label autism spectrum disorder.

“Mental retardation” became intellectual disability.

New disorders, such as hoarding

disorder and binge-eating disorder, were added.
2. WHAT WOULD YOU ANSWER?
Which of the following is the primary purpose of the
DSM–5?

A. describing mental disorders

B. selecting appropriate psychological therapies for
mental disorders
C. placing mental disorders in their appropriate cultural
context
D. selecting appropriate medicines to treat mental
disorders
E. understanding the causes of mental disorders
LABELING PSYCHOLOGICAL
DISORDERS
1. Critics of the DSM-IV argue that labels may stigmatize
individuals.

N. Tomes, Madness in America, 1995. Cornell University Press.

Elizabeth Eckert, Middletown, NY. From L. Gamwell and
Asylum baseball team (labeling) 36
LABELING PSYCHOLOGICAL
DISORDERS
2. Labels may be helpful for healthcare professionals when
communicating with one another and establishing therapy.

37
LABELING PSYCHOLOGICAL DISORDERS

3. “Insanity” labels raise

moral and ethical
questions about how
society should treat people
who have disorders and
have committed crimes.

Elaine Thompson/ AP Photo

Theodore Kaczynski
(Unabomber) 38
 ARE SOME DIAGNOSES
CONTROVERSIAL?
• Yes. For instance, disruptive mood dysregulation disorder is a
new DSM-5 diagnosis for children “who exhibit persistent
irritability and frequent episodes of behavior outbursts three or
more times a week for more than a year.”

• Will this diagnosis assist parents who struggle with unstable

children, or will it “turn temper tantrums into a mental disorder”
and lead to overmedication, as the chair of the previous DSM
edition warned?
• (Frances, 2012)
 WHAT IS ONE CRITICISM OF
THE DSM-5 ?
• Critics have long faulted the DSM for casting too wide a
net and bringing “almost any kind of behavior within the
compass of psychiatry”
• (Eysenck et al., 1983)

• Some psychologists believe the DSM-5’s even wider net

will extend the pathologizing of everyday life.
 WHAT IS ANOTHER CRITICISM OF THE DSM-5 ?

Another concern critics of the DSM-5 raise is the over-

labeling of what might be common everyday
feelings and practical responses to traumatic events.

For example, The DSM also now classifies severe grief

following the death of a loved one as a possible
depressive disorder.

Critics suggest that such

grief could instead simply be considered a “normal”
reaction to tragic life events.
WHAT IS A BENEFIT OF LABELING DISORDERS WITH
THE DSM-5?

For those who experience these challenging

symptoms, diagnosis and treatment
can be a relief and bring improved functioning.
(Kupfer, 2012; Maciejewski et al., 2016)

In psychiatry and psychology, classification also aims to

predict a disorder’s future course, suggest appropriate
treatment, and prompt research into its causes.

To study a disorder, we must first name and describe it.

 HOW CAN DIAGNOSTIC
LABELS BE MISLEADING?
• Once labeling a person, we view that person differently.
(Bathje & Pryor, 2011; Farina, 1982; Sadler et al., 2012)

• Labels can change reality by putting us on alert for evidence

that confirms our view.

• In a classic study, teachers who were told certain students

were “gifted” then acted in ways that elicited the behaviors
they expected. (Snyder, 1984)

• Labels can be self-fulfilling.

WHAT RESEARCH HAS BEEN
CONDUCTED ON MISLABELING
OF BEHAVIORS?
• David Rosenhan and seven of his graduate students went to
hospital admissions offices, complaining (falsely) of “hearing
voices” saying empty, hollow, and thud.

• Apart from this complaint and giving false names and

occupations, they answered questions truthfully.

• All eight healthy people were misdiagnosed with disorders.

 HOW DID BEING LABELED AS
“ILL” IMPACT HOW OTHERS
VIEWED THE GRAD STUDENTS?
• Until being released an average of 19 days later, those eight
“patients” showed no other symptoms.

• Yet after analyzing their (quite normal) life histories, clinicians

were able to “discover” the causes of their disorders, such as
having mixed emotions about a parent.

• Even routine note-taking behavior was

• misinterpreted as a symptom.
 HOW DO LABELS HAVE POWER IN
EVERYDAY LIFE?
Getting a job or finding a place to rent can be a
challenge for people recently released from a
psychiatric hospital.

Label someone as “mentally ill” and people may

fear them as potentially violent.

That reaction may fade as people better

understand that many psychological disorders
involve diseases of the brain, not failures of
character.
 SPEAKIN
G OUT

Public figures have

helped foster
During his campaign, Boston Mayor
understanding by
speaking openly about Martin Walsh spoke openly about his
their own struggles with past struggles with alcohol.
disorders such as His story of recovery helped him win
depression and in 2014—the closest Boston mayoral
substance abuse.
election in decades.
MENTAL ILLNESS
IN HOLLYWOOD

Old stereotypes are slowly being

replaced in media portrayals of
psychological disorders.

Recent films offer fairly realistic

depictions.

Iron Man 3 portrayed a main

character, shown at right, with
posttraumatic stress disorder.
 HOW HAS BROADENING THE DIAGNOSTIC
CRITERIA OF ADHD CREATED A CONTROVERSY?

For example, the DSM has broadened the diagnostic

criteria for attention-deficit/hyperactivity
disorder (ADHD).

For those who experience these challenging symptoms,

diagnosis and treatment can be a relief and bring
improved functioning.
(Kupfer, 2012; Maciejewski et al., 2016)

However, critics suggest that the criteria are now too

broad and may turn normal, childish rambunctiousness
into a disorder.
(Frances, 2013, 2014)
HOW FREQUENTLY IS ATTENTION
DEFICIT HYPERACTIVITY
DISORDER (ADHS) DIAGNOSED?
WHAT ARE THE SYMPTOMS OF ADHD?

inattention and distractibility

hyperactivity
impulsivity
 WHAT ARE THE ARGUMENTS
REGARDING THE DIAGNOSING
OF ADHD?
• Energetic child + boring school = ADHD over diagnosis

 Children are not meant to sit inside for hours in chairs.

 The youngest children in a class tend to be more fidgety
and more often diagnosed.
 Older students may seek out stimulant ADHD prescription
drugs–“good-grade pills.”
 What are the long-term effects of drug treatment?
 Why the increased diagnoses worldwide?
 WHAT DO THE SUPPORTERS
OF ADHD
DIAGNOSES NOTE?
• More diagnoses reflect increased awareness.

 ADHD is a real neurobiological disorder whose existence

should no longer be debated.”

 ADHD is associated with abnormal brain structure, abnormal

brain activity patterns, and future risky or antisocial behavior.
 HOW CAN ADHD BE TREATED?

• Extreme inattention, hyperactivity, and impulsivity can

derail social, academic, and work achievements.

• The symptoms can be treated with stimulant

medication, behavior therapy and aerobic exercise.

• The debate continues over whether normal high energy

is too often diagnosed as a psychiatric disorder, and
whether there is a cost to the long-term use of stimulant
drugs in treating ADHD.
 DO DISORDERS INCREASE
THE
RISK OF VIOLENCE?
• No. Most violent criminals are not mentally ill, and most
mentally ill people are not violent. (Fazel & Grann, 2006; Skeem et
al., 2016)

• The few people with disorders who commit violent acts tend
to be either those who experience threatening delusions
and hallucinated voices that command them to act, who
have suffered a financial crisis or lost relationship, or who
abuse substances. (Douglas et al., 2009; Elbogen et al., 2016; Fazel et
al., 2009, 2010)
RECAP PGS. 639-649
• What is Abnormal?
– Deciding what is normal and
what is abnormal is a value
judgment.
– Mental illness judgments are
based on cultural values, social
trends, political forces, as well
as scientific knowledge.
• Four criteria for defining
abnormal behavior:
– Statistical infrequency
– Disability or dysfunctional
– Personal distressing
– Deviates from norms (Violation
of norms)
• Classifying Psychological
Disorders: Diagnostic and
Statistical Manual of Mental
Disorders – Fifth Edition (2013)
• Lists all the acceptable labels
for all psychological disorders
with descriptions for each
disorder and explanations of
how to distinguish them from
similar disorders
• Five axes of the DSM-5
– Axis I: Clinical Disorders
– Axis II: Personality Disorders
and Mental Retardation
– Axis III: General Medical
Conditions
– Axis IV: Psychosocial and
Environmental Problems
– Axis V: Global Assessment of
Functioning
56
 RECAP PGS. 639-649
CONTINUED
Types of Axis I - Clinical Disorders:
• Anxiety Disorders: A class of disorders
marked by feelings of excessive
apprehension and anxiety
• Mood Disorders: A class of disorders marked
by emotional disturbance of varied kinds that
may spill over to disrupt physical, perceptual,
social, and thought processes
• Schizophrenic Disorders: A class of disorders
marked by delusions, hallucinations,
disorganized speech, and deterioration of
adaptive behavior
• Dissociative Disorders: A class of disorders in
which people lose contact with portions of
their consciousness or memory, resulting in
disruption in their sense of identity
• Somatoform Disorders: Physical ailments that
cannot be fully explained by organic
conditions and are largely due to
psychological factors
What Causes Abnormal Behavior?
• There are seven major perspectives
that emphasize different factors
believed to contribute to abnormal
behavior
• 1. Biological: problems with brain
function, genetic predisposition, or
biochemistry
• 2. Sociocultural: problems reflect
cultural values and beliefs
• 3. Behavioral: inappropriate
conditioning or modeling
• 4. Cognitive: faulty thinking
• 5. Humanistic: blocked personal
growth
• 6. Psychoanalytic/Psychodynamic:
unconscious, unresolved conflict
• 7. Evolutionary: exaggerated form of
an adaptive reaction 57
 AP ® EXAM TIP
• Notice that the term insanity comes out of the
• legal system.

• Insanity in criminal law means that defendants

cannot
• be held accountable for their actions at the time
of the crime, typically due to mental disorder.

• It is not a psychological or medical diagnosis

and
 ANXIETY
DISORDERS
PAGES 649-658

59
ANXIETY DISORDERS
Feelings of excessive apprehension and anxiety.

Text focuses on 4:
1. Generalized anxiety disorders
2. Phobias
3. Panic disorders
4. Obsessive-compulsive disorders

60
GENERALIZED ANXIETY DISORDER
Anxiety: A generalized feeling of fear and apprehension that may be related to
a particular situation or object and is often accompanied by increased
physiological arousal
Symptoms
1. Persistent and uncontrollable tenseness and
apprehension.
2. Autonomic arousal.
3. Inability to identify or avoid the cause of
certain feelings.
Anxiety disorders are quite common – occurring in roughly 15% of the population in the
United State and about 15% of Europe. They are more prevalent in women than in men.

Generalized anxiety disorder (GAD): Chronic, high level of anxiety that is not tied to
any specific threat (not focused on any particular object or situation)
61
 PANIC DISORDER:
RECURRENT ATTACKS OF OVERWHELMING
ANXIETY (PANIC ATTACKS) THAT USUALLY
OCCURS SUDDENLY AND UNEXPECTEDLY

Symptoms
Minute-long episodes of intense dread
which may include feelings of terror, chest
pains, choking, or other frightening
sensations.

Panic attack – acute anxiety accompanied by sharp increases in

autonomic nervous system arousal that is not triggered by a specific
event

62
PHOBIA
Marked by a persistent and irrational fear of an object or situation
that disrupts behavior.

63
 THREE BASIC KINDS:
• Agoraphobia: Anxiety characterized by
marked fear and avoidance of being alone
in a place from which escape might be
difficult or embarrassing (such as airplanes,
tunnels, being in crowds)

• Social phobia: Fear of, and desire to avoid,

situations in which one might be exposed to
scrutiny by others and might behave in an
embarrassing or humiliating way - Irrational
fear of embarrassing self in social situations

• Specific phobia: Anxiety disorder

characterized by irrational and persistent
fear of a particular object or situation, along
with a compelling desire to avoid it
64
KINDS OF PHOBIAS
Cacophobia- Fear of ugliness

Acrophobia Phobia of heights.

Claustrophobia Phobia of closed spaces.

Hemophobia Phobia of blood.

65
 OBSESSIVE-COMPULSIVE
DISORDER
Persistence of unwanted thoughts (obsessions) and urges to engage
in senseless rituals (compulsions) that cause distress.

66
• Most people with OCD have multiple
obsessions and compulsions
• Research shows that OCD suffers
constantly check, doubt, wash, hoard, order,
obsess, and mentally neutralize their
unacceptable thoughts and behaviors.
• People with OCD usually experience
intense anxiety or panic attacks if they are
prevented from performing their rituals

67
 BRAIN IMAGING
A PET scan of the brain of a person
with Obsessive-Compulsive
Disorder (OCD). High metabolic
activity (red) in the frontal lobe
areas are involved with directing
attention.

Brain image of an OCD

68
 POST-TRAUMATIC STRESS
DISORDER
Four or more weeks of the following symptoms constitute post-
traumatic stress disorder (PTSD):

1. Haunting memories
2. Nightmares
3. Social withdrawal
4. Jumpy anxiety

Bettmann/ Corbis
5. Sleep problems
69
RESILIENCE TO PTSD
Only about 10% of women and 20% of men react to traumatic
situations and develop PTSD.

Holocaust survivors show remarkable resilience

against traumatic situations.

All major religions of the world suggest that

surviving a trauma leads to the growth of an
individual.

70
EXPLAINING ANXIETY
DISORDERS
Freud suggested that we repress our painful
and intolerable ideas, feelings, and thoughts,
resulting in anxiety.

71
 THE LEARNING
PERSPECTIVE
Learning theorists
suggest that fear
conditioning leads to
anxiety. This anxiety
then becomes
associated with other
objects or events

John Coletti/ Stock, Boston

(stimulus
generalization) and is
reinforced.

72
 THE LEARNING
PERSPECTIVE
Investigators believe that fear responses are
inculcated through observational learning.
Young monkeys develop fear when they watch
other monkeys who are afraid of snakes.

73
 THE BIOLOGICAL
PERSPECTIVE
Natural Selection has led our ancestors to learn
to fear snakes, spiders, and other animals.
Therefore, fear preserves the species.

Twin studies suggest that our genes may be

partly responsible for developing fears and
anxiety. Twins are more likely to share phobias.

74
 THE BIOLOGICAL
PERSPECTIVE

monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353.

S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action
Generalized
anxiety, panic
attacks, and even
OCD are linked
with brain circuits
like the anterior
cingulate cortex.

Anterior Cingulate Cortex

of an OCD patient.

75
 DISSOCIATIVE
DISORDER
Conscious awareness becomes separated (dissociated) from
previous memories, thoughts, and feelings.

Symptoms
1. Having a sense of being unreal.
2. Being separated from the body.
3. Watching yourself as if in a movie.

76
DISSOCIATIVE IDENTITY
DISORDER (DID)
Is a disorder in which a person exhibits two or more distinct and
alternating personalities, formerly called multiple personality
disorder.

Lois Bernstein/ Gamma Liason

Chris Sizemore (DID) 77
 DID CRITICS
Critics argue that the diagnosis of DID increased in the late 20th
century. DID has not been found in other countries.

Critics’ Arguments
1. Role-playing by people open to a
therapist’s suggestion.
2. Learned response that reinforces
reductions in anxiety.
78
 TO BE CLINICALLY DIAGNOSED WITH DID, THE
FOLLOWING SYMPTOMS MUST BE IDENTIFIED:

• • The presence of at least two distinct personalities with

their own relatively enduring pattern of sensing, thinking
about, and relating to self and environment
• • At least two of these personalities assume control of
behavior repeatedly
• • Extensive inability to recall major personal information
cannot be attributed to common forgetfulness
• • This behavior is not caused directly by substance abuse
or a general medical condition

79
PG. 658-668

80
 MOOD DISORDERS
Emotional extremes of mood disorders come in two principal
forms.

1. Major depressive disorder - unipolar

2. Bipolar disorder

81
82
MAJOR DEPRESSIVE
DISORDER
Depression is the “common cold” of
psychological disorders. In a year, 5.8% of men
and 9.5% of women report depression
worldwide (WHO, 2002).

Blue mood Major Depressive Disorder

Gasping for air after a Chronic shortness of

hard run breath

83
 MAJOR DEPRESSIVE
DISORDER
Major depressive disorder occurs when signs of depression last
two weeks or more and are not caused by drugs or medical
conditions.

Signs include:
1. Lethargy and fatigue
2. Feelings of worthlessness
3. Loss of interest in family & friends
4. Loss of interest in activities

84
DYSTHYMIC DISORDER

Dysthymic disorder lies between a blue mood

and major depressive disorder. It is a disorder
characterized by daily depression lasting two
years or more.

Blue Dysthymic Major Depressive

Mood Disorder Disorder

85
BIPOLAR DISORDER
Formerly called manic-depressive disorder. An alternation between
depression and mania signals bipolar disorder.

Depressive Symptoms Manic Symptoms

Gloomy Elation
Withdrawn Euphoria
Inability to make decisions Desire for action
Tired Hyperactive
Slowness of thought Multiple ideas
86
 BIPOLAR DISORDER
Many great writers, poets, and composers
suffered from bipolar disorder. During their
manic phase creativity surged, but not during
their depressed phase.

George C. Beresford/ Hulton Getty Pictures Library

Earl Theissen/ Hulton Getty Pictures Library

The Granger Collection
Bettmann/ Corbis

Whitman Wolfe Clemens Hemingway

87
EXPLAINING MOOD
DISORDERS
Since depression is so prevalent worldwide,
investigators want to develop a theory of
depression that will suggest ways to treat it.

Lewinsohn et al., (1985, 1995) note that a theory

of depression should explain the following:

1. Behavioral and cognitive changes

2. Common causes of depression

88
THEORY OF
DEPRESSION
3. Gender differences

89
 THEORY OF
DEPRESSION
4. Depressive episodes
self-terminate.
5. Depression is
increasing,
especially in the
teens.

Post-partum depression
90
 SUICIDE
The most severe form of behavioral response to
depression is suicide. Each year some 1 million
people commit suicide worldwide.

91
 BIOLOGICAL
PERSPECTIVE
Genetic Influences: Mood disorders run in
families. The rate of depression is higher in
identical (50%) than fraternal twins (20%).

Linkage analysis and

association studies link
possible genes and

Jerry Irwin Photography

dispositions for depression.

92
 NEUROTRANSMITTERS
& DEPRESSION
A reduction of
norepinephrine and
serotonin has been Pre-synaptic
found in depression. Neuron
Serotonin
Norepinephrine

Drugs that alleviate

Post-synaptic
mania reduce Neuron

norepinephrine.

93
THE DEPRESSED BRAIN
PET scans show that brain energy consumption rises and falls with
manic and depressive episodes.

Courtesy of Lewis Baxter an Michael E.

Phelps, UCLA School of Medicine
94
 SOCIAL-COGNITIVE
PERSPECTIVE
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.

95
 DEPRESSION CYCLE
1. Negative stressful events.
2. Pessimistic explanatory
style.
3. Hopeless depressed state.
4. These hamper the way the
individual thinks and acts,
fueling personal rejection.

96
 EXAMPLE

Explanatory style plays a major role in becoming depressed.

97
MOOD DISORDER RECAP

*Also called Major Depressive

Disorder

Mania: A condition in which people are constantly active,

uninhibited, and either happy or irritable

Depression: A condition in which people are slow, inactive,

and inhibited – they feel helpless, guilt-ridden, and sad

98
MOOD DISORDER RECAP
• Bipolar Disorder: Formerly known as manic-depressive
disorder; People alternate between the extremes of mania
and depression The depressive episode generally lasts three
times as long as the manic episode

• Three Categories of Bipolar Disorder:

– Bipolar I Disorder: Characterized by one or more manic
episodes alternating with major depressive episodes
– Bipolar II Disorder: Characterized by at least one major
depressive episode and at least one hypomanic episode
– Cyclothymia: Characterized by experiences of mild depression
and hypomania

99
MOOD DISORDER RECAP
Symptoms and Signs of Mania:
• Increased energy, activity, and restlessness
• Excessively “high,” overly good, euphoric mood
• Extreme irritability
• Flight of ideas
• Distractibility
• Little sleep needed
• Unrealistic beliefs in one’s abilities and powers
• Poor judgment
• Spending sprees
• A lasting period of behavior that is different from usual
• Increased sexual drive
• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
• Provocative, intrusive, or aggressive behavior
• Denial that anything is wrong

100
MOOD DISORDER RECAP
Symptoms and Signs of Depression:
• Lasting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities once enjoyed – including sex
• Decreased energy, a feeling of fatigue or of being “slowed down”
• Sleeping too much or can’t sleep
• Difficulty concentrating, remembering, making decisions
• Restlessness or irritability
• Change in appetite and/or unintended weight loss or gain
• Chronic pain or other persistent bodily symptoms that are not
caused by physical illness or injury
• Thoughts of death or suicide, or suicide attempts

101
 SCHIZOPHRENIA
If depression is the common cold of psychological disorders,
schizophrenia is the cancer.

Nearly 1 in a 100 suffer from schizophrenia, and

throughout the world over 24 million people
suffer from this disease (WHO, 2002).

Schizophrenia strikes young people as they

mature into adults. It affects men and women
equally, but men suffer from it more severely
than women. 102
 SYMPTOMS OF
SCHIZOPHRENIA
The literal translation is “split mind.” A group of severe disorders
characterized by the following:

1. Disorganized and delusional

thinking.
2. Disturbed perceptions.
3. Inappropriate emotions and
actions.

103
DISORGANIZED &
DELUSIONAL THINKING
This morning when I was at Hillside [Hospital], I was
making a movie. I was surrounded by movie stars …
I’m Marry Poppins. Is this room painted blue to get me
upset? My grandmother died four weeks after my
eighteenth birthday.”
(Sheehan, 1982)

Other
This forms of delusions
monologue illustratesinclude, delusions
fragmented, of
bizarre
persecution
thinking with (“someone is following
distorted beliefs me”) or
called delusions
grandeur
(“I’m Mary(“I am a king”).
Poppins”).

104
DISORGANIZED &
DELUSIONAL THINKING
Many psychologists believe disorganized thoughts occur because
of selective attention failure (fragmented and bizarre thoughts).

105
 106
(hallucinations). Frequently such hallucinations are auditory and
A schizophrenic person may perceive things that are not there

L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg

lesser visual, somatosensory, olfactory, or gustatory.
DISTURBED PERCEPTIONS

August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg

Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
INAPPROPRIATE EMOTIONS &
ACTIONS
A schizophrenic person may laugh at the news of someone dying
or show no emotion at all (apathy).

Patients with schizophrenia may continually

rub an arm, rock a chair, or remain motionless
for hours (catatonia).

107
 SUBTYPES OF
SCHIZOPHRENIA
Schizophrenia is a cluster of disorders. These subtypes share some
features, but there are other symptoms that differentiate these
subtypes.

108
POSITIVE AND NEGATIVE
SYMPTOMS
Schizophrenics have inappropriate symptoms (hallucinations,
disorganized thinking, deluded ways) that are not present in
normal individuals (positive symptoms).

Schizophrenics also have an absence of

appropriate symptoms (apathy, expressionless
faces, rigid bodies) that are present in normal
individuals (negative symptoms).

109
 CHRONIC AND ACUTE
SCHIZOPHRENIA
When schizophrenia is slow to develop (chronic/process) recovery
is doubtful. Such schizophrenics usually display negative
symptoms.

When schizophrenia rapidly develops

(acute/reactive) recovery is better. Such
schizophrenics usually show positive
symptoms.

110
SUBTYPES

111
 UNDERSTANDING
SCHIZOPHRENIA
Schizophrenia is a disease of the brain exhibited by the symptoms
of the mind.

Brain Abnormalities
Dopamine Overactivity: Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain.

112
ABNORMAL BRAIN
ACTIVITY
Brain scans show abnormal activity in the frontal cortex, thalamus,
and amygdala of schizophrenic patients. Adolescent schizophrenic
patients also have brain lesions.

Imaging and Judith L. Rapport, National Institute of Mental Health

Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
113
ABNORMAL BRAIN
MORPHOLOGY
Schizophrenia patients may exhibit morphological changes in the
brain like enlargement of fluid-filled ventricles.

Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC

114
VIRAL INFECTION
Schizophrenia has also been observed in individuals who
contracted a viral infection (flu) during the middle of their fetal
development.

115
GENETIC FACTORS
The likelihood of an individual suffering from schizophrenia is
50% if their identical twin has the disease (Gottesman, 1991).

0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
116
GENETIC FACTORS
The following shows the prevalence of schizophrenia in identical
twins as seen in different countries.

117
PSYCHOLOGICAL
FACTORS
Psychological and environmental factors can trigger schizophrenia
if the individual is genetically predisposed (Nicols & Gottesman,
1983).

The genetically identical

Genain
sisters suffer from
schizophrenia. Two more than
Courtesy of Genain Family

others, thus there are

contributing environmental
factors.
Genain Sisters 118
WARNING SIGNS
Early warning signs of schizophrenia include:

1. A mother’s long lasting schizophrenia.

2. Birth complications, oxygen deprivation and
low-birth weight.
3. Short attention span and poor muscle
coordination.
4. Disruptive and withdrawn behavior.
5. Emotional unpredictability.
6. Poor peer relations and solo play.
119
SCHIZOPHRENIA RECAP

120
 www.psychlotron.org.uk
SCHIZOPHRENIA

• Clinical description
• Biological explanations
• Psychological explanations
 www.psychlotron.org.uk
SCHIZOPHRENIA

• Schizophrenia is not a multiple personality

• A psychotic disorder involving a break

with reality
• Many different manifestations with a few
shared features
 www.psychlotron.org.uk
SCHIZOPHRENIA DIAGNOSIS
• At least two of the following:
– Hallucinations (us. auditory or somatic)
– Delusions (oft. linked to hallucinations)
– Disorganized speech
– Disorganized or catatonic behavior
– Negative symptoms
• Social & occupational dysfunction
• Duration of several months
 www.psychlotron.org.uk
SCHIZOPHRENIA DIAGNOSIS
• Diagnostic subtypes
– Paranoid
– Catatonic
– Disorganized
– Undifferentiated
• Type 1 - Episodic, mainly
positive symptoms
• Type 2 - Chronic, mainly
negative symptoms
 www.psychlotron.org.uk
SCHIZOPHRENIA
PREVALENCE
• 1% lifetime risk in general
population
• Holds true for most geographical
areas although rates do vary
– Abnormally high in Southern Ireland,
Croatia; significantly lower rates in
Italy, Spain (Torrey, 2002)
• Risk factors include low SES, minority
ethnicity, urban residence
 Hospitalizations per 100,000

Age Groups
SCHIZOPHRENIA ONSET

Source: CIHI (2001)

www.psychlotron.org.uk
 www.psychlotron.org.uk
SCHIZOPHRENIA
PROGNOSIS
• ‘Rule of the thirds’ (rule of thumb):
– 1/3 recover more or less completely
– 1/3 episodic impairment
– 1/3 chronic decline
• Confirmed in US & UK (Stevens, 1978)
• With treatment about 60% of patients
manage a relatively normal life
• Prognosis better in non-industrialised
societies
 www.psychlotron.org.uk
SCHIZOPHRENIA
EXPLANATIONS
• Biological
– Genetics
– Neurochemicals & hormones
– Structural brain abnormalities
• Psychological
– Family dynamics
– Life stress
– Urbanicity
PERSONALITY
DISORDERS
Personality disorders are
characterized by inflexible and
enduring behavior patterns that
impair social functioning. They
are usually without anxiety,
depression, or delusions.

129
 ANTISOCIAL PERSONALITY
DISORDER
A disorder in which the person (usually men) exhibits a lack of
conscience for wrongdoing, even toward friends and family members.
Formerly, this person was called a sociopath or psychopath.

130
 UNDERSTANDING ANTISOCIAL
PERSONALITY DISORDER
Like mood disorders and
schizophrenia, antisocial
personality disorder has biological
and psychological reasons.
Youngsters, before committing a
crime, respond with lower levels
of stress hormones than others do
at their age.

131
UNDERSTANDING ANTISOCIAL
PERSONALITY DISORDER
PET scans of 41 murderers revealed reduced activity in the frontal
lobes (area responsible for reasoning and planning). In a follow-up
study repeat offenders had 11% less frontal lobe activity compared to
normal (Raine et al., 1999; 2000).

University of Southern California

Courtesy of Adrian Raine,
132
Normal Murderer
UNDERSTANDING ANTISOCIAL
PERSONALITY DISORDER
The likelihood that one will commit a crime doubles when
childhood poverty is compounded with obstetrical complications
(Raine et al., 1999; 2000).

133
RATES OF PSYCHOLOGICAL DISORDERS

134
WHAT DISORDERS ARE MOST PREVALENT IN
AMERICA?
HOW PREVALENT ARE
DISORDERS ACROSS
THE GLOBE?
A WorldHealth Organization study—
based on 90-minute interviews with
thousands of
people who were representative of their
country’s population—estimated the
number
of prior-year mental disorders in 28
countries.
(Kessler et al., 2009)
WHAT ARE RISK
FACTORS FOR
MENTAL
ILLNESS?
One example of a risk factor for a
psychological disorder—poverty—crosses
ethnic and gender lines.

The incidence of serious psychological

disorders is 2.5 times higher among those

below the poverty line. (CDC, 2014)

WHAT ARE
PROTECTIVE
FACTORS FOR
MENTAL
ILLNESS?
There are many factors that can
help shield people against mental
illness.