1

1

Psychological Disorders

Chapter 16

2

Psychological Disorders

I felt the need to clean my room … spent four to fivehour at it … At the time I loved it but then didn't want

to do it any more, but could not stop … The clotheshung … two fingers apart …I touched my bedroom

wall before leaving the house … I had constant anxiety… I thought I might be nuts.

Marc, diagnosed withobsessive-compulsive disorder

(from Summers, 1996)

http://www.youtube.com/watch?v=Rn1OYlYzgm8&feature=related

3

Psychological Disorders

People are fascinated by the exceptional, theunusual, and the abnormal. This fascination

may be caused by two reasons:

During various moments we feel, think, and actlike an abnormal individual.

Psychological disorders may bring unexplainedphysical symptoms, irrational fears, and suicidalthoughts.

4

Psychological Disorders

To study the abnormal is the best way ofunderstanding the normal.

There are 450 million people suffering frompsychological disorders (WHO, 2004).

Depression and schizophrenia exist in all culturesof the world.

William James (1842-1910)

5

Defining Psychological Disorders

Mental health workers view psychologicaldisorders as persistently harmful thoughts,

feelings, and actions.

When behavior is deviant, distressful, anddysfunctional psychiatrists and psychologists

label it as disordered (Comer, 2004).

6

Deviant, Distressful & Dysfunctional

Deviant behavior(going naked) in oneculture may beconsidered normal,while in others it maylead to arrest.

Deviant behavior mustaccompany distress.

If a behavior isdysfunctional it isclearly a disorder.

In the Wodaabe tribe menwear costumes to attract

women. In Western societythis would be considered

abnormal.

Carol Beckwith

2

7

Understanding PsychologicalDisorders

Ancient Treatments of psychological disordersinclude trephination, exorcism, being caged like

animals, being beaten, burned, castrated,mutilated, or transfused with animal’s blood.

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

John W. V

erano

8

Medical Perspective

Philippe Pinel (1745-1826) from France, insistedthat madness was not due to demonic possession,

but an ailment of the mind.

Dance in the madhouse.

George W

esley Bellow

s, Dancer in a M

adhouse, 1907. © 1997 The A

rt Institute of Chicago

9

Medical Model

When physicians discovered that syphilis led tomental disorders, they started using medical models

to review the physical causes of these disorders.

1. Etiology: Cause and development of thedisorder.

2. Diagnosis: Identifying (symptoms) anddistinguishing one disease from another.

3. Treatment: Treating a disorder in a psychiatrichospital.

4. Prognosis: Forecast about the disorder.10

Biopsychosocial Perspective

Assumes that biological, socio-cultural, andpsychological factors combine and interact to

produce psychological disorders.

11

Classifying Psychological Disorders

The American Psychiatric Association rendereda Diagnostic and Statistical Manual of Mental

Disorders (DSM) to describe psychologicaldisorders.

The most recent edition, DSM-IV-TR (TextRevision, 2000), describes 400 psychological

disorders compared to 60 in the 1950s.

12

Multiaxial Classification

Are Psychosocial or Environmental Problems(school or housing issues) also present?Axis IV

What is the Global Assessment of the person’sfunctioning?Axis V

Is a General Medical Condition (diabetes,hypertension or arthritis etc) also present?Axis III

Is a Personality Disorder or Mental Retardationpresent?Axis II

Is a Clinical Syndrome (cognitive, anxiety,mood disorders [16 syndromes]) present?Axis I

3

13

Multiaxial ClassificationNote 16 syndromes in Axis I

14

Multiaxial ClassificationNote Global Assessment for Axis V

15

Goals of DSM1. Describe (400) disorders.2. Determine how prevalent the

disorder is.

Disorders outlined by DSM-IV are reliable.Therefore, diagnoses by different professionalsare similar.

Others criticize DSM-IV for “putting any kindof behavior within the compass of psychiatry.”

16

Labeling Psychological Disorders

1. Critics of the DSM-IV argue that labels maystigmatize individuals.

Asylum baseball team (labeling)

Elizabeth Eckert, Middletow

n, NY

. From L. G

amw

ell and N

. Tomes, M

adness in America, 1995. Cornell U

niversity Press.

17

Labeling Psychological Disorders

2. Labels may be helpful for healthcareprofessionals when communicating withone another and establishing therapy.

Rosenhan’s “study” - self-perpetuating aspects of labels

18

Labeling Psychological Disorders

3. “Insanity” labelsraise moral andethical questionsabout how societyshould treat peoplewho havedisorders and havecommitted crimes.

Theodore Kaczynski(Unabomber)

Elaine Thompson/ A

P Photo

4

19

Anxiety Disorders

Feelings of excessive apprehension and anxiety.

1. Generalized anxiety disorders2. Phobias3. Panic disorders4. Obsessive-compulsive disorders

20

Generalized Anxiety Disorder

1. Persistent and uncontrollable tenseness andapprehension.

2. Autonomic arousal.3. Inability to identify or avoid the cause of

certain feelings.

Symptoms

21

Panic Disorder

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

Anxiety is a component of both disorders. Itoccurs more in the panic disorder, making

people avoid situations that cause it.

Symptoms

22

Phobia

Marked by a persistent and irrational fear of anobject or situation that disrupts behavior.

23

Kinds of Phobias

Phobia of blood.Hemophobia

Phobia of closed spaces.Claustrophobia

Phobia of heights.Acrophobia

Phobia of open places.Agoraphobia

24

Obsessive-Compulsive Disorder

Persistence of unwanted thoughts (obsessions)and urges to engage in senseless rituals

(compulsions) that cause distress.

5

25

A PET scan of the brainof a person with

Obsessive-CompulsiveDisorder (OCD). Highmetabolic activity (red)in the frontal lobe areas

are involved withdirecting attention.

Brain Imaging

Brain image of an OCD26

Post-Traumatic Stress Disorder

Four or more weeks of the following symptomsconstitute post-traumatic stress disorder

(PTSD):

1. Haunting memories2. Nightmares3. Social withdrawal4. Jumpy anxiety5. Sleep problems

Bettmann/ Corbis

27

Resilience to PTSD

Only about 10% of women and 20% of menreact to traumatic situations and develop PTSD.

Holocaust survivors show remarkable resilienceagainst traumatic situations.

All major religions of the world suggest thatsurviving a trauma leads to the growth of an

individual.

28

Explaining Anxiety Disorders

Freud suggested that we repress our painfuland intolerable ideas, feelings, and thoughts,

resulting in anxiety.

29

The Learning Perspective

Learning theoristssuggest that fear

conditioning leads toanxiety. This anxiety

then becomesassociated with other

objects or events(stimulus

generalization) and isreinforced.

John Coletti/ Stock, Boston

30

The Learning Perspective

Investigators believe that fear responses areinculcated through observational learning.

Young monkeys develop fear when they watchother monkeys who are afraid of snakes.

6

31

The Biological Perspective

Natural Selection has led our ancestors to learnto fear snakes, spiders, and other animals.

Therefore, fear preserves the species.

Twin studies suggest that our genes may bepartly responsible for developing fears and

anxiety. Twins are more likely to sharephobias.

32

The Biological Perspective

Generalized anxiety,panic attacks, and even

OCD are linked withbrain circuits like the

anterior cingulate cortex.

Anterior Cingulate Cortexof an OCD patient.

S. Ursu, V

.A. Stenger, M

.K. Shear, M

.R. Jones, &

C.S. C

arter (2003). Overactive action

monitoring in obsessive-com

pulsive disorder. Psychological Science, 14, 347-353.

33

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.

34

Dissociative Identity Disorder (DID)

Is a disorder in which a person exhibits two ormore distinct and alternating personalities,

formerly called multiple personality disorder.

Chris Sizemore (DID)

Lois Bernstein/ Gam

ma L

iason

Herschel Walker (DID)

35

DID Critics

Critics argue that the diagnosis of DIDincreased in the late 20th century. DID has

not been found in other countries.

Critics’ Arguments

1. Role-playing by people open to atherapist’s suggestion.

2. Learned response that reinforcesreductions in anxiety.

36

Mood Disorders

Emotional extremes of mood disorders come intwo principal forms.

1. Major depressive disorder2. Bipolar disorder

7

37

Major Depressive Disorder

Depression is the “common cold” ofpsychological disorders. In a year, 5.8% of men

and 9.5% of women report depressionworldwide (WHO, 2002).

Chronic shortness ofbreath

Gasping for air after ahard run

Major Depressive DisorderBlue mood

38

Major Depressive Disorder

Major depressive disorder occurs when signs ofdepression last two weeks or more and are not

caused by drugs or medical conditions.

1. Lethargy and fatigue2. Feelings of worthlessness3. Loss of interest in family & friends4. Loss of interest in activities

Signs include:

39

Dysthymic Disorder

Dysthymic disorder lies between a blue moodand major depressive disorder. It is a disordercharacterized by daily depression lasting two

years or more.

Major DepressiveDisorder

BlueMood

DysthymicDisorder

40

Bipolar Disorder

Formerly called manic-depressive disorder. Analternation between depression and mania

signals bipolar disorder.

Multiple ideasHyperactive

Desire for actionEuphoriaElation

Manic Symptoms

Slowness of thoughtTired

Inability to make decisionsWithdrawn

Gloomy

Depressive Symptoms

41

Bipolar Disorder

Many great writers, poets, and composerssuffered from bipolar disorder. During their

manic phase creativity surged, but not duringtheir depressed phase.

Whitman Wolfe Clemens Hemingway

Bettmann/ Corbis

George C

. Beresford/ H

ulton Getty Pictures Library

The Granger Collection

Earl Theissen/ Hulton G

etty Pictures Library

42

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 theoryof depression should explain the following:

1. Behavioral and cognitive changes2. Common causes of depression

8

43

Theory of Depression

3. Gender differences

44

Theory of Depression

4. Depressive episodes self-terminate.5. Depression is increasing, especially in

the teens.

Post-partum depression

Desiree N

avarro/ Getty Im

ages

45

Suicide

The most severe form of behavioral response todepression is suicide. Each year some 1 million

people commit suicide worldwide.

1. National differences2. Racial differences3. Gender differences4. Age differences5. Other differences

Suicide Statistics

46

Biological Perspective

Genetic Influences: Mood disorders run infamilies. The rate of depression is higher inidentical (50%) than fraternal twins (20%).

Linkage analysis andassociation studies link

possible genes anddispositions for depression.

Jerry Irwin Photography

47

Neurotransmitters & Depression

Post-synapticNeuron

Pre-synapticNeuron

Norepinephrine Serotonin

A reduction ofnorepinephrine andserotonin has been

found in depression.

Drugs that alleviatemania reduce

norepinephrine.

48

The Depressed Brain

PET scans show that brain energy consumptionrises and falls with manic and depressive

episodes.

Courtesy of Lewis Baxter an M

ichael E. Phelps, U

CLA School of M

edicine

9

49

Social-Cognitive Perspective

The social-cognitive perspective suggests thatdepression arises partly from self-defeating

beliefs and negative explanatory styles.

50

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.

51

Example

Explanatory style plays a major role in becoming depressed.52

Schizophrenia

If depression is the common cold ofpsychological disorders, schizophrenia is the

cancer.

Nearly 1 in a 100 suffer from schizophrenia, andthroughout the world over 24 million people

suffer from this disease (WHO, 2002).

Schizophrenia strikes young people as theymature into adults. It affects men and womenequally, but men suffer from it more severely

than women.

53

Symptoms of SchizophreniaThe literal translation is “split mind.” A group

of severe disorders characterized by thefollowing:

Disorganized and delusionalthinking.

Disturbed perceptions. Inappropriate emotions and

actions.

54

Other forms of delusions include, delusions ofpersecution (“someone is following me”) or

grandeur (“I am a king”).

Disorganized & Delusional Thinking

This morning when I was at Hillside [Hospital], I wasmaking a movie. I was surrounded by movie stars …I’m Marry Poppins. Is this room painted blue to get meupset? My grandmother died four weeks after myeighteenth birthday.”

(Sheehan, 1982)

This monologue illustrates fragmented, bizarrethinking with distorted beliefs called delusions

(“I’m Mary Poppins”).

10

55

Disorganized & Delusional Thinking

Many psychologists believe disorganizedthoughts occur because of selective attention

failure (fragmented and bizarre thoughts).

56

Disturbed Perceptions

A schizophrenic person may perceive thingsthat are not there (hallucinations). Frequently

such hallucinations are auditory and lesservisual, somatosensory, olfactory, or gustatory.

L. Berthold, U

ntitled. The Prinzhorn Collection, U

niversity of Heidelberg

August N

atter, Witches H

ead. The Prinzhorn C

ollection, University of H

eidelberg

Photos of paintings by Krannert M

useum, U

niversity of Illinois at Urbana-C

hampaign

57

Inappropriate Emotions & Actions

A schizophrenic person may laugh at the newsof someone dying or show no emotion at all

(apathy).

Patients with schizophrenia may continuallyrub an arm, rock a chair, or remain motionless

for hours (catatonia).

58

Subtypes of Schizophrenia

Schizophrenia is a cluster of disorders. Thesesubtypes share some features, but there are

other symptoms that differentiate thesesubtypes.

59

Positive and Negative Symptoms

Schizophrenics have inappropriate symptoms(hallucinations, disorganized thinking, deluded

ways) that are not present in normalindividuals (positive symptoms).

Schizophrenics also have an absence ofappropriate symptoms (apathy, expressionlessfaces, rigid bodies) that are present in normal

individuals (negative symptoms).

60

Chronic and Acute Schizophrenia

When schizophrenia is slow to develop(chronic/process) recovery is doubtful. Such

schizophrenics usually display negativesymptoms.

When schizophrenia rapidly develops(acute/reactive) recovery is better. Such

schizophrenics usually show positivesymptoms.

11

61

Subtypes

62

Understanding Schizophrenia

Schizophrenia is a disease of the brain exhibitedby the symptoms of the mind.

Dopamine Overactivity: Researchers found thatschizophrenic patients express higher levels of

dopamine D4 receptors in the brain.

Brain Abnormalities

63

Abnormal Brain Activity

Brain scans show abnormal activity in thefrontal cortex, thalamus, and amygdala of

schizophrenic patients. Adolescentschizophrenic patients also have brain lesions.

Paul Thompson and A

rthur W. Toga, U

CLA

Laboratory of Neuro

Imaging and Judith L. R

apport, National Institute of M

ental Health

64

Abnormal Brain Morphology

Schizophrenia patients may exhibitmorphological changes in the brain like

enlargement of fluid-filled ventricles.

Both Photos: C

ourtesy of Daniel R

. Weinberger, M

.D., N

IH-N

IMH

/ NSC

65

Viral Infection

Schizophrenia has also been observed inindividuals who contracted a viral infection

(flu) during the middle of their fetaldevelopment.

66

Genetic Factors

The likelihood of an individual suffering fromschizophrenia is 50% if their identical twin has

the disease (Gottesman, 1991).

0 10 20 30 40 50Identical

Both parentsFraternal

One parentSibling

Nephew or nieceUnrelated

12

67

Genetic Factors

The following shows the prevalence ofschizophrenia in identical twins as seen in

different countries.

68

Psychological Factors

Psychological and environmental factors cantrigger schizophrenia if the individual is

genetically predisposed (Nicols & Gottesman,1983).

Genain Sisters

The genetically identicalGenain

sisters suffer fromschizophrenia. Two more than

others, thus there arecontributing environmental

factors.

Courtesy of Genain Fam

ily

69

Warning Signs

Early warning signs of schizophrenia include:

Birth complications, oxygen deprivation andlow-birth weight.

2.

Short attention span and poor musclecoordination.

3.

Poor peer relations and solo play.6.Emotional unpredictability.5.

Disruptive and withdrawn behavior.4.

A mother’s long lasting schizophrenia.1.

70

Personality Disorders

Personality disordersare characterized by

inflexible andenduring behavior

patterns that impairsocial functioning.They are usuallywithout anxiety,depression, or

delusions.

71

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.

72

Understanding AntisocialPersonality Disorder

Like mood disordersand schizophrenia,

antisocial personalitydisorder has biological

and psychologicalreasons. Youngsters,before committing acrime, respond withlower levels of stresshormones than others

do at their age.

13

73

Understanding AntisocialPersonality Disorder

PET scans of 41 murderers revealed reducedactivity in the frontal lobes. In a follow-up study

repeat offenders had 11% less frontal lobe activitycompared to normals (Raine et al., 1999; 2000).

Normal Murderer

Courtesy of Adrian R

aine, U

niversity of Southern California 74

Understanding AntisocialPersonality Disorder

The likelihood that one will commit a crime doubleswhen childhood poverty is compounded with

obstetrical complications (Raine et al., 1999; 2000).

75

Rates of Psychological Disorders

76

Rates of Psychological Disorders

The prevalence of psychological disorders duringthe previous year is shown below (WHO, 2004).

77

Risk and Protective Factors

Risk and protective factors for mental disorders(WHO, 2004).

78

Risk and Protective Factors