Psychological Disorders

Chapter Fourteen

Lecture Slides

By Glenn MeyerTrinity University

Introduction: Understanding Psychological Disorders

Area of psychology and medicine that focuses on these questions is called

psychopathology

• Dividing line between normal and abnormal behavior often determined by social or cultural context

• People whose behavior strikes us as weird easily dismissed as “crazy”

• Strong social stigma attached to suffering from a psychological disorder

What is a Psychological Disorder?

• Pattern of behavioral or psychological symptoms must represent a serious departure from the prevailing social and cultural norms

• Standard descriptions of disorders found today in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) published by American Psychiatric Association

Psychological disorder or mental disorder can be defined as a pattern of behavioral or psychological symptoms that causes significant personal distress, impairs the ability to

function in one or more important areas of life, or both

DSM-IV-TR

• Describes more than 300 specific psychological disorders

• Includes symptoms, criteria that must be met to make a diagnosis, and typical course for each mental disorder

• Number of disorders has increased over the years

• Currently under revision for DSM-V

Critiques:

• Includes some conditions that are too “normal” to be considered disorders

• Uses arbitrary cutoffs

• Gender bias

• Insufficient sensitivity to cultural diversity

DSM-IV-TR

Are People with a Mental Illness as Violent as the Media Portray Them?

• People with a major mental illness belong to one of the most stigmatized groups

• More likely to be portrayed as violent

• Overall, former mental patients do not have a higher rate of violence

• Those with symptoms of substance abuse were most likely to engage in violent behavior

• Those with severe mental disorder symptoms display slightly higher levels of violence

The Prevalence of Psychological DisordersA 50-50 Chance?

• National Comorbidity Survey Replication (NCS-R): One out of four respondents (26 percent) reported experiencing symptoms of a psychological disorder during previous year

• NCS-R found one out of two adults (46 percent) experienced symptoms of a psychological disorder at some point in lives

• Different categories of mental disorders vary significantly in the median age of onset

• NCS-R found that most people with the symptoms of a mental disorder (59 percent) received no treatment during the past year

• Approximately 80 percent who experienced symptoms in the last year did not seek treatment

• Most people seem to deal with symptoms without complete debilitation

Anxiety DisordersIntense Apprehension and Worry

• The main symptom of anxiety disorders is intense anxiety that disrupts normal functioning

• Anxiety puts you on mental and physical alert

• Anxiety is maladaptive

• Anxiety disorders are among most common disorders; they affect about one in four people in the United States during their lifetimes

Pathological anxiety is…

irrational

uncontrollable

disruptive

Generalized Anxiety DisorderWorrying About Anything and Everything

Explaining Generalized Anxiety Disorder (GAD)

• Environmental, psychological, and genetic factors, as well as other biological factors, are probably involved in GAD

• Problematic anxiety can be evident from a very early age

• Early stressful experiences may contribute

• Anxiety disorder characterized by excessive, global, and persistent symptoms of anxiety; also called free-floating anxiety

• In generalized anxiety disorder, when one source of worry is removed, another moves in to take its place

Panic Attacks and Panic DisordersSudden Episodes of Extreme Anxiety

Pounding heart

Rapid breathing

Breathlessness

Choking sensation

Sweating, trembling, and experiencing light-headedness

Chills or hot flashes

Escalating surge of physical arousal

Feelings of terror and belief that one is about to die, go crazy, or lose control

Panic attack

Sudden episode of extreme anxiety that rapidly escalates in

intensity

Symptoms:

Typically peaks within 10 minutes of onset and then gradually subsides

Panic Disorder

An anxiety disorder in which the person experiences

frequent and unexpected panic attacks

• Frequency of panic attacks is highly variable and quite unpredictable

• Very frightening—sufferers live in fear of having them• Agoraphobia often develops as a result• gradually subsides

Explaining Panic Disorder

Barlow: Triple vulnerabilities model of panic based on combination of• Biological predisposition toward anxiety• Low sense of control over potentially life-

threatening events• Oversensitivity to physical sensations

Catastrophic cognitions theoryPeople with panic disorder are not only oversensitive to physical sensations—they also tend to catastrophizemeaning of their experience

The PhobiasFear and Loathing

• Encountering feared situation or object can provoke a full-fledged panic attack

• About 13 percent of the general population experiences a specific phobia

• More than twice as many women as men suffer from specific phobia

PhobiaPersistent and irrational fear of a specific object,

situation, or activity

Specific PhobiaExcessive, intense, and irrational fear of a specific

object, situation, or activity that is actively avoided or endured with marked anxiety

Four Primary Categories of Specific Phobias

Fear of particular situations

Fear of features of the natural environment

Fear of injury or blood

Fear of animals and insects

Also called social anxiety disorder• One of the most common

psychological disorders• More prevalent among women than

men• Core of social phobia seems to be

an irrational fear of being embarrassed, judged, or critically evaluated by others

• Can vary by culture: • Japanese men suffer from taijin

kyofusho• Fear that their own appearance

or smell, facial expression, or body language will offend, insult, or embarrass other people

Social PhobiaFear of Social Situations

Explaining PhobiasLearning Theories

Classical Conditioning

as seen in the Watson and Rayner

demonstration with Little Albert

Operant Conditioning

we are rewarded by reducing our

conditioned fear by avoidance of the

conditioned stimulus, an example of

negative reinforcement

Observational Learning

we model and imitate the fears we see in

others

Biological Preparation – certain fears, such as to spiders or heights, have an evolutionary history; may represent a fear of contamination: spoiled foods, infection, parasites

Post-Traumatic Stress DisorderRe-Experiencing the Trauma

• Originally associated with military combat, can develop in survivors of other extreme trauma

• 5 million Americans may suffer from PTSD in a given year

• Twice as many women as men suffer from PTSD

An anxiety disorder in which

chronic and persistent

symptoms of anxiety develop

in response to an extreme physical or psychological

trauma

Three Core Symptoms of PTSD According to the DSM-IV-TR

Core symptoms include

• Frequent recollection of traumatic event, often intrusive and interfering with normal thoughts

• Avoidance of stimuli or situations that trigger recall of the event

• Increased physical arousal associated with anxiety

Greater Likelihood of Developing PTSD

• Personal or family history of psychological disorders

• Greater magnitude of trauma

• Multiple trauma

CompulsionsRepetitive behaviors or

mental acts that are performed to prevent or

reduce anxiety

May be overt or covert

ObsessionsRepeated, intrusive, and uncontrollable irrational

thoughts or mental images that cause extreme anxiety

and distress

Common – fear of dirt, germs; pathological doubt about having completed a

task

Obsessive–Compulsive DisorderChecking It Again and Again

• Often accompanied by an irrational belief that failure to perform ritual action will lead to catastrophe

• Usually both obsessions and compulsions are present and the sufferer can’t resist them even though they know they are absurd

• Content mirrors cultural beliefs

• United States – fear of germs

• India – concerns about religious purity

An anxiety disorder in

which symptoms of anxiety are triggered by

intrusive, repetitive

thoughts and urges to perform certain actions.

Dysfunction in specific brain areas

Areas involved in the fight-or-flight

response

Frontal lobes, which play a key role in our

ability to think and plan ahead

Heightened neural activity in caudate

nucleus involved in regulating

movements

Deficiency in serotonin,

norepinephrine implicated

Drugs that increase the availability of

these neurotransmitters

decrease symptoms

Explaining Obsessive–Compulsive Disorder

• DSM-IV-TR: Serious, persistent disturbance in a person’s emotions that causes psychological discomfort or impairs the ability to function, or both

• Mood disorders are also often called affective disorders

• Results in impaired cognitive, behavioral, and physical functioning

Mood DisordersEmotions Gone Awry

Major DepressionMore than Ordinary Sadness

Darkness Visible, William Styron (1990): All sense of hope had vanished, along with the idea of a futurity; my brain, in thrall to its outlaw hormones, had become less an organ of thought than an instrument registering, minute by minute, varying degrees of its own suffering. The mornings themselves were becoming bad now as I wandered about lethargic, following my synthetic sleep, but afternoons were still the worst, beginning at about three o’clock, when I’d feel the horror, like some poisonous fogbank, roll in upon my mind, forcing me into bed. There I would lie for as long as six hours, stuporous and virtually paralyzed, gazing at the ceiling.

The Symptoms of Major Depression

• To be diagnosed, a person must display most of the symptoms for two weeks or longer

• In many cases, there’s no external reason for depression

• In other cases, triggered by a negative life event, stressful situation, or chronic stress

• If a person’s ability to function after the death of a loved one is still impaired after two months, major depression is suspected

Major depression is characterized by extreme and persistent feelings of despondency, worthlessness, and hopelessness, causing impaired emotional, cognitive, behavioral, and physical functioning.

Seasonal Affective Disorder

• More common among women and among people who live in the northern latitudes

• Cyclic severe depression and elevated mood

• Seasonal regularity, especially at onset of autumn and winter when there is the least amount of sunlight

• Unique cluster of symptoms

• Intense hunger

• Gain weight in winter

• Sleep more than usual

• Depressed more in evening than morning

Mood disorder in which episodes of depression typically occur during the fall and winter and subside during the spring and

summer

Dysthymic Disorder• Chronic, low-grade

depressed feelings that are not severe enough to be major depression

• May develop in response to trauma, but does not decrease with time

• Can have co-existing major depression

• DSM-IV-TR: Major depression requires symptoms to be present for at least two weeks, while dysthymic disorder requires two years

The Prevalence of Major Depression

• 6 percent to 7 percent of Americans are affected by major depression

• Lifetime prevalence, about 15 percent of Americans at some point in their lives

• Women are about twice as likely as men to be affected by major depression

• Women more vulnerable because

• Experience greater degree of chronic stress in daily life

• Have lesser sense of personal control

• More prone to dwell on their problems

Course of Major Depression

Left untreated, symptoms of

major depression

can easily last six months or

longer

Left untreated, depression may recur

and become progressively more severe

More than half of all people who

have been through one episode of

major depression can expect a

relapse, usually within two years

Symptoms tend to

increase in severity and time between

episodes decreases

Situational Bases for Depression

Positive correlation between stressful life events and onset of depression.

Does life stress cause depression?

Most life events that cause depression are losses (of a spouse or companion, long-term job, health, or income)

Bipolar DisorderAn Emotional Roller Coaster

• Mood disorder involving periods of incapacitating depression alternating with periods of extreme euphoria and excitement

• Formerly called manic depression

By age 24, Carrie Fisher was grappling with drug addiction and bipolar disorder. Today, she is a successful actress and writer. Her critically acclaimed one-woman Broadway show, Wishful Drinking, is a funny yet bluntly honest memoir of her struggles.

The Symptoms of Bipolar Disorder

Involves abnormal moods at both ends

of emotional spectrum

Person experiences

extreme mood swings

Episodes of incapacitating

depression alternate with

shorter periods of extreme euphoria,

called manic episodes

Usually manic episode

immediately precedes or

follows a bout with major depression

Small percentage of people

experience only manic episodes

Manic episode: Sudden,rapidly escalating emotional state characterized by

Extreme euphoria

Excitement

Physical energy

Rapid thoughts and speech

Flight of ideas

Cyclothymic disorder (milder form of bipolar disorder)• People experience moderate

but frequent mood swings for two years or longer

• Mood swings are not severe enough to qualify as either bipolar disorder or major depression

• People with it are perceived as being extremely moody, unpredictable, and inconsistent

The Prevalence and Course of Bipolar Disorder

• Typically occurs in the person’s early 20s

• Lasts from a few days to a couple of months

• Less common than major depression – lifetime risk about 1 percent

• No differences between the sexes

• Children with unstable moods are more likely to be diagnosed in adulthood

• Small percentage disorder display rapid cycling

• Commonly recurs every few years

• Can often be controlled by medication (lithium)

• Family, twin, and adoption studies suggest a genetic predisposition

• Antidepressants lift symptoms of depression by increasing the availability of norepinephrine and serotonin

• Lithium alleviates symptoms of mania and depression regulating availability of glutamate

• Stress is also implicated in the development of mood disorders

• Links between cigarette smoking and development of major depression

Explaining Mood DisordersNicotine’s Effects in the Brain After cigarette smokers were injected with up to two milligrams of nicotine, researchers used functional magnetic resonance imaging to track the brain areas activated, which included the nucleus accumbens, the amygdala, and the thalamus. Previous research has shown that these brain structures produce the reinforcing, mood-elevating properties of other abused drugs, including cocaine, amphetamines, and opiates (Stein & others, 1998).

Eating DisordersAnorexia and Bulimia

• Involve serious and maladaptive disturbances in eating behavior, including reducing food intake, severe overeating, obsessive concerns about body shape or weight

• Ninety to 95 percent of the people who experience an eating disorder are female

Anorexia NervosaLife-Threatening Weight Loss

Effects of Anorexia Nervosa

• Very similar to those caused by starvation

• Basal metabolic rate decreases

• Blood levels of glucose, insulin, and leptin decrease

• Hormonal levels drop, including the level of reproductive hormones

• Reduced estrogen results in the menstrual cycle stopping

• Males: decreased testosterone disrupts sex drive and sexual function

• Develop a soft, fine body hair called lanugo to maintain body heat

Eating disorder characterized by excessive weight loss, an irrational fear of gaining weight, and distorted

body self-perception

Key Features

• Refuses to maintain a minimally normal body weight

• Intense fear of gaining weight or becoming fat

• Distorted perception about the size of her body

• Denies the seriousness of her weight loss

Bulimia NervosaBingeing and Purging

Eating disorder characterized by binges of extreme overeating

followed by self-induced vomiting,

misuse of laxatives, or other inappropriate

methods to purge the excessive food and prevent weight gain

Key Features

• Fear gaining weight

• Stay within a normal weight range

• Recognize that they have an eating disorder

• Binges typically occur twice a week

• After bingeing, self-induced vomiting or by misuse of laxatives or enemas

• Repeated purging disrupts the body’s electrolyte balance, which is potentially fatal

• Self-induced vomiting erodes tooth enamel

Causes of Eating Disorders

• Decreases in brain activity of the neurotransmitter serotonin• Genetic factors

implicated in both• Family interaction patterns

• Critical comments by parents

• Parental modeling of disordered eating

• Western cultural attitudes toward thinness

• Perfectionism, rigid thinking, poor peer relations, social isolation, low self-esteem associated with anorexia

Personality DisordersMaladaptive Traits

• Involves pervasive patterns of perceiving, relating to, and thinking about the environment and the self that interfere with long-term functioning

• Becomes evident during adolescence or early adulthood

• May not consider their personality characteristics as being problematic

• Categorized into three basic clusters

• Odd, eccentric

• Dramatic, emotional, erratic

• Anxious, fearful

• 10 distinct personality disorders

Personality disordersInflexible, maladaptive

pattern of thoughts, emotions, behaviors,

and interpersonal functioning that are stable over time and

across situations, and deviate from the

expectations of the individual’s culture

Paranoid Personality DisorderPervasive Distrust and Suspiciousness

• 3 percent of population–most frequently men

• Pervasive mistrust and suspiciousness of others are the main characteristics

• Distrustful even of close family and friends

• Reluctant to form close relationships

• Tend to blame others for their own shortcomings

• Pathological jealousy seen in intimate relationships

• Childhood abuse or neglect may play a role

Characterized by a pervasive distrust and

suspiciousness of the motives of others without sufficient basis

Characterized by a pervasive pattern of disregarding

and violating the rights of others; such individuals

are also often referred to as

psychopaths or sociopaths

Antisocial Personality Disorder Violating the Rights of Others—Without Guilt or Remorse

• Central feature — pattern of blatantly disregarding and violating the rights of others

• 1 percent to 4 percent of population

• Evidence often seen in childhood (conduct disorder)

• Cruelty to animals

• Attacking or harming adults or other children

• Theft

• Setting fires and destroying property

• Deceiving and manipulating others for their own personal gain

• Manipulative; can be charming; can be cruel and destructive

• Seem to lack “conscience”

• More prevalent in men than women

• High rates of alcoholism and other forms of substance abuse

Characterized by instability of interpersonal

relationships, self-image, and

emotions, and marked impulsivity

Borderline Personality Disorder Chaos and Emptiness

• Most serious and disabling of the personality disorders

• 1.2 percent to 6 percent of the population

• Moods and emotions are intense, fluctuating, and extreme, often vastly out of proportion

• Relationships with others are as chaotic, desperately afraid of abandonment

• “Cutting” or other acts of self-mutilation, threats of suicide, and suicide attempts are common

• 10 percent of those who meet the BPD criteria eventually commit suicide

• Highest prevalence among women, people in lower income groups, and Native American men

• Lowest incidence was among women of Asian descent

What Causes Borderline Personality Disorder?

Early views

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Disruption in attachment relationships in early childhood; neglect or physical, sexual, or emotional abuse in childhood

Biosocial developmental theory

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• Combination of biological, psychological, and environmental factors

• Biological temperament characterized by extreme emotional sensitivity, impulsivity, and tendency to experience negative emotions

• Caregivers do not teach control of impulses or regulation of emotions

• Parents or caregivers shape and reinforce pattern of frequent, intense emotional displays

• History of abuse and neglect may be present but is not a necessary ingredient

The Dissociative DisordersFragmentation of the Self

Dissociative experienceBreak or disruption in

consciousness during which awareness, memory, and personal identity become

separated or divided

Three basic disorders

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Dissociative fugue

Dissociative identity disorder

Dissociative amnesia

Dissociative disordersCategory of psychological

disorders in which extreme and frequent disruptions of awareness,

memory, and personal identity impair the ability to function

Dissociative fugue

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Dissociative amnesia

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Dissociative Amnesia and FugueForgetting and Wandering

• Refers to partial or total inability to recall important information that is not due to a medical condition

• Person develops amnesia for personal events and information, rather than for general knowledge or skills

• Suddenly and inexplicably travels away from his home, wandering to other cities or even countries

Dissociative Identity

Disorder

Dissociative Identity DisorderMultiple Personalities

• Dissociative disorder involving extensive memory disruptions along with the presence of two or more distinct identities, or “personalities”; formerly called multiple personality disorder

• Each personality has its own name and is experienced as if it has its own personal history and self-image. These alternate personalities often called alters

• Not all mental health professionals are convinced that dissociative identity disorder is a genuine psychological disorder

• Reported cases sharply increased in the early 1970s after books, films, and television dramas about multiple personality disorder became popular

• Suggest that DID patients learned “how to behave like a multiple”

The DID Controversy: Some curious statistics• 1930–60: Two

cases per decade in United States

• 1980s: 20,000 cases reported

• Many more cases in United States than elsewhere

• Varies by therapist—some see none, others see a lot

Explaining Dissociative Identity Disorder• Extreme form of dissociative coping

• High percentage of DID patients report having suffered extreme physical or sexual Child “dissociates” from it, creating alternate personalities to experience trauma

• Dissociative coping theory is difficult to test empirically

• Opposite effect occurs to most trauma victims

SchizophreniaA Different Reality

Schizophrenia is a psychological disorder that involves severely distorted

beliefs, perceptions, and thought processes

Schizophrenia is diagnosed when two or more of these

characteristic symptoms are actively present for a month

or longer

Comes from Greek meaning “split” and “mind”

“Split” refers to loss of touch with reality

Positive Symptoms

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Hallucinations, or false perceptions; can be

indistinguishable from reality

Can be influenced by cultural references (example: Jerusalem

Syndrome)

100 visitors to Jerusalem per year believe they are Jesus,

Mary, John the Baptist, Moses, Samson, King David, the Mahdi

Usually have a history of disorder, but 10% don’t

Severely disorganized thought processes, speech,

and behavior

Difficult to concentrate, remember, and

integrate important information while ignoring irrelevant

information

Delusions, or false beliefs; can lead to

dangerous behaviors

Delusions of reference

Delusions of grandeur

Delusions of persecution

Delusions of being controlled

Symptoms of Schizophrenia

Negative Symptoms

(Can occur in combination)

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Alogia

or greatly reduced production of speech

Avolition

refers to the inability to initiate or persist in

even simple forms of goal-directed

behaviors

Flat affect

or affective fattening

Symptoms of Schizophrenia

Presence of Symptoms in Schizophrenia This graph shows the incidence of positive and negative symptoms in over 100 people at the time they were hospitalized for schizophrenia. Delusions were the most common positive symptom, and avolition, or apathy, was the most common negative symptom.

Types of Schizophrenia

The Prevalence and Course of Schizophrenia

• 200,000 new cases are diagnosed in United States per year

• Approximately 1 million Americans are treated annually

• 1 percent of the U.S. population will experience at least one episode during life

• Most cultures correspond very closely to the 1 percent rate

• Onset of schizophrenia typically occurs during young adulthood

• One-quarter of those who experience an episode of schizophrenia recover completely

• One-quarter experience recurrent episodes of schizophrenia but with minimal impairment in ability to function

• For one-half, schizophrenia becomes a chronic mental illness, and the ability to function may be severely impaired

Explaining SchizophreniaGenetic Factors—Family, Twin, Adoption, and Gene Studies• Schizophrenia clusters in certain families

• More closely related a person is to someone who has schizophrenia, the greater the risk of schizophrenia

• Adoption studies: if either biological parent of an adopted individual had schizophrenia, there is a greater risk to develop schizophrenia

• Presence of certain genetic variations increases susceptibility

• Schizophrenia associated with thousands of common gene variations

• No specific pattern of genetic variation can be identified as the genetic “cause” of schizophrenia

• Bipolar disorder and schizophrenia might share some common genetic origins

• Chromosome locations associated with genes that influence brain development, memory, and cognition seem related

• Large number of gene variants involved in the immune response

Twins Again

• 50 percent risk rate for a person whose identical twin has schizophrenia—is evidence that underscores the importance of environmental factors

• Rate not even close to 100 percent as might be expected

The Risk of Developing Schizophrenia among Blood Relatives

Paternal Age

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• Schizophrenia caused by mutations in the sperm of fathers

• Age increases the rate of mutation

• Schizophrenia rate compared with fathers younger than 25 years

• 45 to 49 years: twice as likely

• 50+ years: three times as likely

Mother’s age made no difference

Environmental Factors

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The Viral Infection Theory• Women exposed to flu

virus during the first trimester had a sevenfold increased risk of a child who developed schizophrenia

• Mothers who were exposed to flu virus during the first or second trimester, show an increased rate of schizophrenia

• Schizophrenia occurs more often in those born in the winter and spring months, when upper respiratory infections are most common

Abnormal Brain Structures

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Evidence• 50 percent of people with

schizophrenia show some type of brain structure abnormality

• Most consistent finding: enlargement of the ventricles

• Loss of gray matter tissue and lower overall volume of the brain

Not Conclusive• Some people with

schizophrenia do not show brain structure abnormalities

• Evidence is correlational• Brain abnormalities seen in

other mental disorders

Explaining Schizophrenia

Loss of Gray Matter

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• Teenagers with schizophrenia showed a severe loss of gray matter

• Developed in a specific, wavelike pattern

• Began in the parietal lobes

• Spread forward to the temporal and frontal regions

• Pattern of loss mirrored the progression of neurological and cognitive deficits

• Loss in temporal lobes was associated hallucinations and delusions

• Loss in frontal lobes correlated with negative symptoms, including flat affect and poverty of speech

• Cause not known

Explaining Schizophrenia

Abnormal Brain Chemistry

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The Dopamine HypothesisTheory: schizophrenia is caused by excess dopamine• Drugs that reduce dopamine reduce symptoms

• Haldol, Thorazine, and Stelazine• Drugs that increase dopamine produce symptoms

even in people without the disorder• Amphetamines and cocaine

Critiques• Dopamine theory not enough; other

neurotransmitters involved as well• Antipsychotic drugs that reduce dopamine activity

don’t aid all sufferers• One part of brain (limbic system) may have too

much dopamine but some parts (cortex) may have too little

Psychological Factors

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Unhealthy Families• Those who are

genetically predisposed to develop schizophrenia are more vulnerable to disturbed family environments.

• A Finnish study found adopted children with a biological schizophrenic mother had a higher rate of schizophrenia when raised in a disturbed, adoptive home.

Explaining Schizophrenia