Chapter 14

Psychological Disorders – 8th Edition

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Abnormal Behavior

Historical aspects of mental disorders – F 14.1

The medical model

What is abnormal behavior? – 3 criteria – F 14.2

• Deviant

• Maladaptive

• Causing personal distress

A continuum of normal/abnormal

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Prevalence, Causes, and Course

Epidemiology

Prevalence - % of population that displays the

disorder during a specific period

Lifetime prevalence – F 14.5

Diagnosis

Etiology – causes

Prognosis

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Psychodiagnosis: The Classification of Disorders

American Psychiatric Association – published first taxonomy in 1952

Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV)

Multiaxial system

5 axes or dimensions – F 14.3 – Axis I – Clinical Syndromes

– Axis II – Personality Disorders or Mental Retardation

– Axis III – General Medical Conditions

– Axis IV – Psychosocial and Environmental Problems

– Axis V – Global Assessment of Functioning

Example Figure 14.4

DSM V – to be published in 2011-12

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Fig. 14-3, p. 555 Figure 14.3 – DSM-IV

overview

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Figure 14.4 –

Example multiaxial

evaluation

The DSM multiaxial system

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Axis I Clinical Syndromes and Axis II Personality Disorders

Anxiety Disorders – p. 583

Somatoform Disorders – p. 586

Dissociative Disorders – p. 589

Mood Disorders – p. 590

Schizophrenic Disorders – p. 598

Eating Disorders – p. 613

Axis II – Personality Disorders – p. 604

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Clinical Syndromes: Anxiety Disorders

Generalized anxiety disorder

– “free-floating anxiety”

Phobic disorder

– Specific focus of fear

Panic disorder and agoraphobia (definition issue

– p. 582)

– Physical symptoms of anxiety/leading to agoraphobia

Obsessive compulsive disorder

– Obsessions

– Compulsions

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Etiology of Anxiety Disorders

Biological factors – F 14.6 – Genetic predisposition, anxiety sensitivity

– GABA circuits in the brain

Conditioning and learning – Acquired through classical conditioning or observational

learning – F 14.7

– Maintained through operant conditioning

Cognitive factors – Judgments of perceived threat – F 14.8

Personality – Neuroticism

Stress – F 14.9 – A precipitator

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Clinical Syndromes: Somatoform Disorders

Somatization Disorder

Conversion Disorder – Figure 14.10

Hypochondriasis

– Etiology

• Reactive autonomic nervous system

• Personality factors

• Cognitive factors

• The sick role

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Clinical Syndromes: Dissociative Disorders

Dissociative amnesia

Dissociative fugue

Dissociative identity disorder

– Etiology

• severe emotional trauma during childhood

– Controversy

• Media creation?

• Sybil

• Repressed memories

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Clinical Syndromes: Mood Disorders

Figure 14.11 and Table 14.1

Major depressive disorder – Dysthymic disorder

Bipolar disorder (manic-depressive disorder) – Cyclothymic disorder

Etiology – Age of onset – F 14.12

– Genetic vulnerability – F 14.14

– Neurochemical factors

– Cognitive factors – negative thinking – F 14.15, F 14.16

– Interpersonal roots

– Precipitating stress

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XX 14.14

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XX 14.16

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XX 14.17

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Clinical Syndromes: Schizophrenia

General symptoms

– Delusions and irrational thought

– Deterioration of adaptive behavior -

avolition

– Hallucinations – any modality but

usually auditory

– Disturbed emotions – 66%

Prognostic factor

– Gradual onset

– Sudden onset

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Subtyping of Schizophrenia

4 subtypes

– Paranoid type – most

common subtype - John

Nash

– Catatonic type

– Disorganized type

– Undifferentiated type

New model for classification

– Positive vs. negative

symptoms

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Etiology of Schizophrenia

Genetic vulnerability – F 14.18

Neurochemical factors – Dopamine hypothesis – F 14.19

Structural abnormalities of the brain – prefrontal lobe and ventricles – F 14.20

The neurodevelopmental hypothesis – F 14.21

Expressed emotion – F 14.22

Precipitating stress – stress-vulnerability model – Slide 33

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Figure 14.18 – Genetic vulnerability -

schizophrenia

Table of Contents Figure 14.19 The dopamine hypothesis as an explanation for schizophrenia

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Neurological Changes in Schizophrenia

XXXX Figure 14.20

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Figure 14.21 – Neurodevelopment hypothesis of schizophrenia

Figure 14.22 –

Expressed emotion

and relapse rates in

schizophrenia

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Slide 33 – The stress-vulnerability model of schizophrenia

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Personality Disorders

Table 14.2 – description and male/female percents

Anxious-fearful cluster – Avoidant, dependent, obsessive-compulsive

Dramatic-impulsive cluster – Histrionic, narcissistic, borderline, antisocial

Odd-eccentric cluster – Schizoid, schizotypal, paranoid

Etiology – Genetic predispositions, inadequate socialization in

dysfunctional families

Prognosis

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Psychological Disorders and the Law

Insanity

– M’naghten rule

– The insanity defense – Figure 14.23 – perception versus

actual cases

Involuntary commitment – varies by states

– danger to self

– danger to others

– in need of treatment

Culture and pathology – p. 610 - 611

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XXX 14.23

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John Hinkley, Jr. – assassination attempt of President Reagan in 1981

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Eating Disorders – p. 613-615

Issues of weight – slide 41

Anorexia nervosa – Criteria and subtypes: restrictive and binge/purge

Bulimia nervosa

Binge eating

History and prevalence – Age onset – Figure 14.25

Etiology – Genetics

– Personality – perfectionism

– Cultural issues - “perfect” body type and digital photograph

– Family role

– Cognitive factors

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Figure 14.25 - Age of anorexia nervous in the United States – Lucas et al.

(1991)

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XXXXX Slide 41