Psychological  Disorders    

Dysfunctional  Behavior  • Dysfunctional  or  abnormal  behavior  is  any  behavior  judged  to  be  disturbing,  atypical,  maladaptive  

or  unjustifiable  • It  can  be  irrational,  unpredictable  and  unconventional  • The  person  can  feel  distress  and  discomfort  from  their  behaviors  • It  is  different  from  insanity  which  is  a  legal  defense  

• insanity  means  that  the  individual  could  understanding  the  difference  between  right  and  wrong,  and  is  unable  to  control  their  actions  

• confidentiality—patient  confidentiality  can  come  into  play  in  legal  investigations  • insanity  defense—not  understanding  the  difference  between  right  and  wrong  

 Major  Perspectives  

• There  are  four  perspectives  on  psychopathology  or  the  study  of  dysfunctional  behavior:  • medical  (or  biological)  model:  dysfunctional  behavior  is  the  result  of  an  organic  cause  

• Philippe  Pinel  and  Emil  Kraepelin  created  two  of  the  first  medical  classification  systems  for  psychological  disorders    

• behavioral  model:  abnormal  behavior  is  the  result  of  maladaptive  learning  (reinforcement)    • cognitive  model:  dysfunctional  behavior  is  the  result  of  irrational  or  distorted  thinking  that  leads  to  emotional  problems  and  maladaptive  behaviors    

• psychodynamic  model:  dysfunctional  behavior  is  the  result  of  internal,  unconscious  conflicts  and  motives    

 Other  Perspectives  

• Also  considered  are  these  perspectives:  – humanistic  model:  abnormal  behavior  is  the  result  of  roadblocks  that  people  encounter  on  the  path  to  self-­‐actualization  whereby  people  become  detached  from  their  true  selves  and  adopt  a  distorted  self-­‐image  which  leads  to  emotional  problems    

– ethical  model:  dysfunctional  behavior  is  the  result  of  a  lack  of  or  improper  ethical  values    – sociocultural  model:  abnormal  behavior  is  the  result  the  stress  involved  in  coping  with  poverty  and  other  social  ills  such  as  unemployment  and  racism    

– interactionist  (or  biopsychosocial)  perspective:  dysfunctional  behavior  is  the  result  of  a  complex  interaction  between  biological  processes  and  genetic  predispositions,  psychological  dynamics  and  social  influences  

– evolutionary  perspective—dysfunctional  behavior  is  a  result  of  any  or  all  of  a  variety  of  factors:  psychological  defenses,  side  effects  of  genetics,  the  frequency  by  which  behaviors  are  carried  out  by  existing  genetic  codes,  absence  or  malfunctioning  of  a  particular  biological  system,  a  mismatch  between  the  current  environment  and  other  environments  one  has  previously  mastered,  or  extremes  in  the  distribution  of  traits  influenced  by  more  than  one  gene  

 

Reasons  for  Classification  • Psychological  disorders  have  been  classified  for  four  main  reasons:    

1. describe  the  disorder  2. predict  the  course  it  will  take  in  the  future  3.  render  appropriate  treatment  4. prompt  further  research  into  its  causes  and  treatments  

 DSM-­‐V  

• In  the  United  States,  the  DSM-­‐V  (or  Diagnostic  and  Statistical  Manual  for  Mental  Disorders,  5th  edition)  is  considered  the  authoritative  source  on  diagnosing  and  treating  psychological  disorders    

Neurosis  versus  Psychosis  • neurotic  disorders  which  are  affective  (or  emotional)  disorders  • psychotic  disorders  which  are  affective  and  cognitive  (or  thinking)  disorders  

Medical  Student  Syndrome  

• One  caution  in  examining  both  mental  and  physical  disorders  is  a  phenomenon  called  medical  student  syndrome  

• In  this,  students  who  study  specific  disorders  begin  to  convince  themselves  that  they  are  suffering  from  that  disorder  because  they  may  have  one  or  more  general  symptoms  

• Typically  this  is  not  the  case  and  worry  shifts  from  the  current  disorder  being  studied  to  the  next    

Determining  “Normal”  • Who  determines  what's  "normal?"  

• you:  individuals  constantly  assess  the  normalcy  of  their  behaviors    • society:  society  imposes  labels  of  normal  and  abnormal  behavior    • the  experts:  applying  their  skill  and  knowledge  in  diagnosing  and  treating  psychological  

disorders    • Psychologists  have  established  six  criteria  in  determining  the  distinction  between  normal  and  

abnormal  behavior:    • unusualness  • social  deviance  • emotional  distress  • maladaptive  behavior  • dangerousness  • faulty  perceptions  or  interpretations  of  reality.  

 Labeling  

• Experts  caution  that  labeling  individuals  with  certain  disorders  can  predispose  them  to  certain  self-­‐fulfilling  prophesies  and  cause  those  around  them  to  perceive  them  differently  based  on  stereotypical  beliefs  

 Anxiety  Disorders  

• Anxiety  disorders  involve:  • behaviors  the  surround  overwhelming  anxiety  • attempts  to  reduce  this  anxiety  through  maladaptive  means  

• Anxiety  disorders  are  among  the  most  common  psychological  disorders  treated  by  professionals    

Generalized  Anxiety  Disorder  • Generalized  anxiety  disorder  (GAD)  is  one  in  which  the  individual  feels  continually  and  

unexplainable  tense  or  anxious,  worries  that  bad  things  might  happen  • This  anxiety  occurs  consistently  for  at  least  six  months  • The  individual  typically  can  hide  these  symptoms  but  physical  symptoms  such  as  insomnia  or  

racing  heart)  may  occur  • Freud  called  this  a  "free-­‐floating"  anxiety  because  the  individual  cannot  identify  what's  causing  

their  anxiety;  this  makes  it  hard  to  control  it  • Lifetime  prevalence:  5%  

 

Panic  Attack  

• A  panic  attack  or  panic  disorder  is  a  condition  in  which  a  person  suffers  a  period  of  intense  anxiety  

• Physical  reactions  include  disorientation,  tunnel  vision,  a  feeling  a  disconnectedness,  increased  blood  pressure,  increase  heart  rate,  shortness  of  breath  

• Panic  attacks  typically  begin  in  the  mid-­‐20s  • Agoraphobia  is  an  intense  fear  of  situations  with  no  escape  or  help  in  the  event  of  a  panic  attack  • panic  attacks  are  acute  and  short  in  duration,  whereas  GAD  is  less  intense  for  a  longer  period  of  

time  • Lifetime  prevalence:  1-­‐4%  

 Phobias  

• A  phobia  is  an  intense  irrational  fear  • The  individual  usually  actively  avoids  the  situation  or  object  of  their  phobia  • Specific  phobias  involve  fear  and  avoidance  of  specific  objects  or  situations  • Social  phobias  involve  fear  and  avoidance  of  social  situations  or  performance  situations  • Lifetime  prevalence:  specific  phobia  7-­‐11%,  social  phobia  3-­‐13%.  

 Obsessive-­‐Compulsive  Disorder  

• An  obsession  is  an  uncontrollable  thought  • A  compulsion  is  an  uncontrollable  act  • These  frequently  go  together  in  the  form  of  an  obsessive-­‐compulsive  disorder  (OCD)  • This  disorder  is  characterized  by  a  combination  of  repetitive  thoughts  and  uncontrollable  acts  • The  onset  of  this  disorder  occurs  in  childhood  or  adolescence  • Research  now  indicates  that  there  is  a  biological  link  to  OCD  • Part  of  the  problem  lies  in  the  pathway  between  the  basal  ganglia  and  the  frontal  lobe  • Research  indicates  that  four  structures  in  the  brain  are  linked  along  a  circuit  to  promote  OCD  

behaviors:  • the  amygdala  • the  orbital  frontal  cortex  • the  caudate  nucleus  • the  thalamus  

• This  circuit  is  abnormally  active  in  individuals  with  OCD    • Research  also  indicates  genetic  markers  on  six  sites  in  five  chromosomes  in  children  of  family  

members  with  OCD  • A  seventh  gene,  located  on  the  ninth  chromosome,  appears  to  regulate  the  brain  chemical  

glutamate  • Excessive  amounts  of  glutamate  stimulate  the  alarm  centers  in  the  brain  which  facilitates  the  

obsessive-­‐compulsive  behavior    • Drug  medication  that  regulates  an  individual's  serotonin  level  has  shown  great  success  in  two-­‐

thirds  of  patients  • The  most  common  obsessions  are  dirt  or  germs  (40%),  that  something  terrible  will  happen  

(24%),  symmetry  or  order  (17%)  and  religious  obsessions  (13%)  • The  most  common  compulsions  are  ritualized  hand  washing  and  showering  (85%),  repeating  

rituals  (51%),  checking  (46%),  removing  contaminants  from  contacts  (23%)  and  touching  (20%)  • Lifetime  prevalence:  2-­‐3%.              

• The  most  common  expressions  of  OCD:  • Relationship  substantiation—searching  for  tiny  but  disqualifying  flaws  in  someone  else  • Fear  of  injuring  others-­‐-­‐a  preoccupation  of  losing  control  and  injuring  or  killing  someone  else  • Responsibility  anxiety-­‐-­‐a  fear  of  negligently  hurting  others  • Scrupulosity-­‐-­‐intolerance  of  disorder  or  asymmetry  • Contamination  anxiety-­‐-­‐compulsive  hand-­‐washing  and  fear  of  contamination  from  other  objects  

• Sexual-­‐orientation  fears-­‐-­‐fear  of  homosexual  stirrings  in  people  who  have  no  moral  or  social  objections  to  it  

• Obsessive  hypochondria-­‐-­‐fear  of  illness  in  the  face  of  evidence  to  the  contrary  and  the  tendency  to  reject  that  opinion  of  experts  

• Hoarding  disorder—persistent  difficulty  in  getting  rid  of  or  parting  with  possessions  • There  is  a  perceived  need  to  save  them  • Individuals  feel  distress  at  parting  with  these  possessions  

Post-­‐Traumatic  Stress  Disorder  • Posttraumatic  stress  disorder  (PTSD)  involves  overwhelming  anxiety,  flashbacks  and  troubling  

recollections  of  a  highly  traumatic  event  • veterans  who  have  seen  heavy  combat  duty  and  women  who  have  been  raped  or  assaulted  may  suffer  from  this  

• The  individual  attempts  to  avoid  situations  or  objects  that  might  trigger  the  disorder  • Other  symptoms  include  reduced  involvement  in  the  external  world,  hyperaltertness,  and  

concentration  difficulties  • Success  of  treatment  depends  on:    

• whether  the  individual  had  any  psychological  disorders  prior  to  PTSD  • their  social  support  group  • whether  the  individual  is  currently  experiencing  any  other  psychological  disorders.  

 Causes  of  Anxiety  Disorders  

• The  causes  of  anxiety  disorders  depend  on  the  model  of  psychopathology:  – biological:  disorders  are  the  result  of  organic  causes;  neurotransmitter  imbalances  (anxiety,  mood  and  schizophrenic  disorders)  and  hereditary  genetics  (schizophrenia)  cause  the  disorder;  GAD  is  treated  with  benzodiazepines  because  it’s  associated  with  too  little  inhibitory  neurotransmitters  in  the  brain;  OCD  and  panic  disorders  are  treated  with  antidepressants  associated  with  low  levels  of  serotonin  

– behavioral:  behaviors  result  from  prior  reinforcement  or  conditioning  of  the  maladaptive  behavior:  rewarding  avoidance  behaviors  can  contribute  to  phobias;  relieve  from  anxiety  (negative  reinforcement)  reinforces  OCD  ;  anxiety  disorders  are  acquired  through  classical  conditioning  and  maintained  through  operant  conditioning  

– cognitive:  anxiety  is  based  on  incorrect  reasoning,  a  distortion  of  real  events  and  unrealistic  expectations;  misinterpretation  of  minor  changes  in  bodily  sensations  promotes  anxiety  and  panic  attacks;  social  phobias  may  occur  because  of  an  obsessive  fear  of  social  embarrassment  or  negative  judgments  

– evolutionary:  enhanced  vigilance  occurs  even  in  the  absence  of  a  real  threat  – psychodynamic:  anxiety  disorders  are  the  result  of  an  unconscious  conflict  or  fear;  desire  to  avoid  a  previously  abrasive  experience  can  generate  ritualistic  behaviors  to  reduce  anxiety  (OCD);  phobias  may  be  a  result  of  childhood  traumas  that  have  been  repressed  

Psychosomatic  Disorders  • Psychosomatic  (or  psychophysiological)  disorders  are  where  there  are  real  physical  disorders  but  

no  organic  or  biological  cause  • These  illnesses  are  brought  on  by  psychological  not  physiological  factors  • The  two  most  common  types  of  psychosomatic  disorders  are  migraine  headaches  and  stomach  

ulcers  • These  are  usually  brought  on  by  overwhelming  stress  

 Somatoform  Disorders  

• Somatoform  disorders  are  where  there  is  an  apparent  physical  illness  but  no  organic  or  biological  cause.  

• Individuals  are  usually  seen  in  medical  settings  and  complain  of  a  variety  of  physical  symptoms • Those  afflicted  complain  of  anxiety,  and  maladaptive  feelings,  thoughts  and  behaviors.    

Somatoform  Disorders  • Somatic  symptom  disorder  (SSD)  is  a  disorder  where  the  person  has  vague  physical  symptoms  and  

repeatedly  seeks  medical  treatment  but  no  organic  cause  is  found  for  the  illness  – The  individual  has  repeatedly  seen  physicians,  taken  medicine  and  changed  his  or  her  

lifestyle  – Duration  of  symptoms:  6  months  

• Conversion  disorder  is  a  disorder  where  the  person  suffers  from  paralysis,  blindness,  deafness,  seizures.  loss  of  feeling  or  false  pregnancy  but  with  no  physiological  reason  for  it  

• Symptoms  persist  as  long  as  the  anxiety  exists  – in  about  80%  of  suspected  cases,  the  cause  turns  out  to  be  medical  – this  disorder  is  rare  

• Illness  anxiety  disorder  (IAD)  is  a  disorder  where  a  person  takes  insignificant  physical  symptoms  

and  interprets  them  as  a  sign  of  a  serious  illness  despite  a  lack  of  evidence  of  any  organic  cause.    • Formerly  called  hypochondriasis  • Duration  of  symptoms:  6  months   • Body  dysmorphic  disorder  is  a  disorder  in  which  a  person  become  preoccupied  with  his  or  her  

imagined  physical  ugliness  that  makes  normal  life  impossible    

Causes  of  Somatoform  Disorders  • The  causes  of  somatoform  disorders  depend  on  the  model:  

• biological:  there  is  no  biological  argument  since  there  are  no  biological  reasons  for  these  disorders    

• behavior:  believe  the  disorder  allows  the  person  to  avoid  the  anxiety-­‐producing  situation  (see  psychodynamic  explanation);  further  reinforcement  for  the  disorder  comes  in  the  form  of  sympathy  and  support  from  others  for  having  the  physical  ailment  

• cognitive:  people  are  misinterpreting  and  exaggerating  minor  bodily  sensations  as  signs  of  serious  illness    

• psychodynamic:  these  disorders  are  an  outward  sign  of  an  unconscious  conflict;  in  stopping  the  expressions  of  the  id  by  the  ego,  leftover  sexual  or  aggressive  energy  is  converted  into  a  physical  symptom  • the  symptom  itself  is  symbolic  of  the  underlying  struggle  (e.g.  immobilization  of  the  arm  would  prevent  the  person  from  carrying  out  a  violent  act)  

• the  symptom  has  the  secondary  gain  of  preventing  the  person  from  having  to  confront  the  conflict  

• socio-­‐cognitive:  SSD  patients  focus  too  much  on  internal  rather  than  external  experiences  which  leads  to  incorrect  cognitive  conclusions    

 

Organic/Neurocognitive  Disorders  • The  DSM-­‐V  calls  these  neurocognitive  disorders  • The  World  Health  Organization’s  International  Statistical  Classification  of  Diseases  and  Related  

Health  Problems  (ICD-­‐10)  calls  these  organic  disorders  • These  are  disorders  in  which  medical  conditions  produce  a  psychological  disorder   • There  can  be  a  loss  of  attention  ability,  learning,  memory  impairments,  deficits  in  language,  motor  

skills  or  social  skills  • Specific  diseases  or  brain  damage  an  be  the  cause  • For  example,  a  brain  injury  or  thyroid  disorder  may  directly  produce  a  mood  disturbance  • All  of  these  can  result  in  dementia—the  loss  of  mental  ability   • Alzheimer’s  disease—degenerative  neurological  disease  that  is  ultimately  fatal  

– characterized  by  loss  of  memory,  loss  of  control  of  bodily  movements,  and  learning  and  memory  impairment  

• Delirium—impaired  attention  and  lack  of  awareness  of  the  surrounding  environment  – characterized  by  memory  loss,  and  disturbances  in  language  and  perception  

Dissociative  Disorders  • Dissociative  disorders  involve  a  separation  (or  dissociation)  of  conscious  awareness  of  the  world  

around  the  individual  and  previous  thoughts  and  memories  • This  can  cause  a  sudden  memory  loss  or  even  the  person  may  not  be  able  to  remember  their  own  

identity  • Stress  is  so  extreme  that  the  individual  blocks  out  part  of  their  memory  to  reduce  their  anxiety  • The  causes  of  dissociative  disorders  may  involve  an  attempt  to  disconnect  from  consciousness  to  

avoid  awareness  of  traumatic  or  painful  experiences  • It  may  be  an  attempt  to  protect  the  self  from  this  trauma  • Severe  and  continual  physical  or  sexual  abuse  as  a  child  is  a  prominent  precursor  to  dissociative  

identity  disorders.      

Major  Dissociative  Disorders  • Major  dissociative  disorders  include  the  following:  

• Dissociative  amnesia  involves  partial  or  total  memory  loss  • This  is  usually  caused  by  overwhelming  stress  • Amnesia  is  usually  limited  to  memories  associated  with  anxiety-­‐producing  or  traumatic  events  that  result  in  a  strong,  negative  emotional  reaction  

• This  disorder  is  rare  • Dissociative  fugue  (or  generalized  amnesia)  involves  memory  and  identity  loss  

• The  individual  may  forget  their  home  and  past  life  for  days  to  years  • This  is  extremely  rare  

• Dissociative  identity  disorder  (DID)  was  previously  called  multiple  personality  disorder  or  MPD  • This  involves  the  two  or  more  distinct  personalities  inhabiting  the  same  body  • Identities  can  be  either  sex  and  handedness  sometimes  switches  • Brain  studies  indicate  that  eye-­‐muscle  balance  and  visual  acuity  are  different  in  the  different  personalities  • this  study  was  compared  to  subjects  pretending  to  be  have  multiple  identities  in  which  there  were  no  differences  in  these  factors  

• This  disorder  is  extremely  rare    

Opinions  on  DID  • There  is  still  some  skepticism  regarding  the  existence  of  DID  • Only  a  few  cases  were  reported  prior  to  1970;  thousands  have  been  reported  in  the  1990s  • Some  psychologists  believe  DID  is  a  legitimate  disorder;  others  believe  it  is  a  form  of  attention-­‐

seeking  role  playing  • Others  believe  these  alternate  personalities  are  a  result  of  therapy  • To  help  deal  with  a  history  of  abuse,  therapists  promote  the  enactment  of  alternate  personalities  

to  cope  with  these  feelings;  patients  identify  too  closely  with  this  role  and  it  becomes  reality  to  them  

 Depressive  Disorders  

• Depressive  disorders  (also  called  affective  or  mood  disorders)  involve  extremes  in  emotion.    

Depressive  Disorders  • Major  mood  disorders  include  the  following:  

• Major  depressive  disorder  involves  feelings  of  worthlessness,  a  depressed  mood  and  a  reduction  in  pleasure  from  most  activities  for  a  period  of  at  least  two  weeks  

• There  is  typically  a  change  in  eating  and  sleeping  patterns  • Low  self-­‐esteem,  pessimism,  negativity  and  slow  thought  processes  are  also  accompanying  

symptoms  – this  is  an  extreme  depression,  not  to  be  confused  with  feeling  blue  from  time  to  time.    – Lifetime  prevalence:  10-­‐25%  for  women  and  5-­‐12%  for  men  

• Seasonal  affective  disorder  (SAD)  is  a  pattern  of  severe  depression  in  the  fall  and  winter,  and  elevated  moods  in  the  spring  and  summer  – this  has  been  successfully  treated  with  artificial  light  therapy  

• Dysthymic  disorder  is  a  mild,  chronic  depression  for  long  period  of  time,  typically  five  years  or  more  – Lifetime  prevalence:  6%  

• Premenstrual  dysphoric  disorder—occurs  in  women  who  are  between  menarche  and  menopause  – Symptoms  include  (must  have  at  least  five  of  these)  mood  swings,  sensitivity  to  rejection,  

increased  irritability,  increased  interpersonal  conflicts,  a  depressed  mood,  marked  anxiety,  decrease  in  energy,  changes  in  appetite,  insomnia,  and  feelings  of  being  “out  of  control”  

Causes  of  Depressive  Disorders  

• The  causes  of  depression  are  explained  from  different  perspectives:  • biological:  disorders  are  the  result  of  organic  causes,  particularly  levels  of  serotonin  and  

norepinephrine    • behavioral:  feelings  result  from  lack  of  positive  reinforcement  and  an  overabundance  on  

punishment  – this  is  an  imbalance  between  behavioral  output  and  reinforcement  input  – this  becomes  a  viscous  cycle  as  behavior  diminishes  and  reinforcement  is  consequently  absent    

• cognitive:  feelings  are  caused  by  negative  thinking,  pessimistic  views  of  self  and  the  world  – this  becomes  a  distorted  thinking  pattern  and  a  mental  filter  that  bias  people  toward  

exaggerating  events  and  conflicts    • psychodynamic:  anxiety  disorders  are  the  result  of  an  unresolved  childhood  emotions  and  

unconscious  conflicts  – Freud  believed  depression  was  anger  turned  inward  against  one's  self    

Additional  Causes  • Additionally,  the  learned  helplessness  model  believes  that  people  become  depressed  when  they  

believe  they  cannot  control  the  reinforcement  in  their  lives  • This  is  combined  with  attributional  style  which  refers  to  where  people  place  the  cause  of  events:  

internal  or  external  factors,  global  or  specific  factors,  and  stable  or  unstable  factors  • Depressive  attributional  style  consists  of  internal,  global  and  stable  attributions;  this  means  the  

person  thinks  that  negative  situation  are  because:    – they  are  at  fault  (internal)  – they  don't  possess  the  abilities  to  deal  with  the  issue  (global)  – they'll  never  learn  to  cope  with  them  (stable)  

Bipolar  and  Related  Disorders  

• Mania  is  a  period  of  hyperactivity  where  the  individual  has  unrealistic  hope  and  dreams  – it  is  an  wildly  optimistic,  euphoric  state  

• When  this  manic  behavior  is  coupled  with  depression,  the  individual  experiences  bipolar  disorder  – this  is  extreme  mood  swings  between  both  mania  and  depression  – bipolar  disorder  is  rare    – lifetime  prevalence:  .4-­‐1.6%  

 • Cyclothymic  disorder  is  a  milder  form  of  bipolar  disorder,  with  less  severe  swings  in  mood  

– unlike  unipolar  depression  which  is  more  common  in  women,  bipolar  and  cyclothymic  disorder  are  equally  common  among  both  men  and  women  

Schizophrenia  

• Schizophrenia  is  a  collection  of  several  disorders  that  are  characterized  by:    – disorganized  thinking  and  language  – delusions  (or  false  beliefs)  – hallucinations  (or  false  sensory  experiences)  – grossly  inappropriate  behavior  

• Schizophrenic  has  a  flattened  affect  (or  lack  of  emotional  dynamic)  and  tend  to  become  withdrawn  from  social  settings  

• Life  prevalence:  1%    

Causes  of  Schizophrenia  • The  causes  of  schizophrenia  fall  predominantly  around  the  biological  model  • Freud  did  not  have  any  good  explanation  for  schizophrenia  

 • In  terms  of  genetic  factors,  one  stands  a  13%  chance  of  developing  schizophrenia  if  one  of  his  or  

her  parents  is  schizophrenic,  and  a  45-­‐  50%  chance  if  his  or  her  identical  twin  suffers  from  the  disorder  

• If  heredity  was  the  sole  factor,  it  would  be  expected  that  fraternal  twins  would  have  a  100%  chance  of  both  being  schizophrenic  

• In  fraternal  twins  there  is  about  a  17%  chance  if  one  has  schizophrenia  that  the  other  will  as  well  • These  statistics  have  been  supported  through  adoption  studies  as  well    • Biochemical  factors  involve  overreactivity  or  overabundance  of  dopamine  levels  in  the  brain  • The  brain  does  not  have  more  dopamine,  rather  schizophrenia  patients  seem  to  have  more  

dopamine  receptors  and  these  may  be  overly  sensitive  • Excess  dopamine  promotes  hallucinations  and  delusional  thinking  • Antipsychotic  drugs  such  as  Thorazine  and  Mellaril  reduce  dopamine  activities   • Tardive  dyskinesia  can  result  from  long-­‐term  use  of  dopaminergic  anatogonist  medications—

muscle  tremors  and  stiffness  can  result  

• Parkinson’s  disease  has  similar  muscle  tremors  and  stiffness  – treated  with  L-­‐dopa  to  increase  dopamine  levels  – excessive  L-­‐dopa  can  cause  schizophrenic-­‐like  symptoms  

 • Brain  abnormalities  also  seem  to  contribute  to  schizophrenia  • These  abnormalities  develop  during  certain  critical  prenatal  periods  • Areas  that  are  most  effected  are  the  prefrontal  cortex  (thought  formation  and  organization)  and  

the  limbic  system  (memory  and  emotion)  • Brain  asymmetries  and  an  abnormality  on  the  fifth  chromosome  may  be  associated  with  

schizophrenia    • The  diathesis-­‐stress  model  suggests  that  stress  works  with  genetic  factors  in  bringing  on  

schizophrenia  in  genetically  vulnerable  individuals  • Sources  of  stress  include  early  brain  trauma,  dysfunctional  family  environments  and  negative  life  

events  • It  is  suggested  that  these  factors  combine  to  produce  brain  abnormalities  and  disturbances  in  

thinking,  memory  and  perception    

Schizophrenia  and  DID  • Schizophrenia  is  frequently  confused  with  dissociative  identity  disorder  because  the  word  

"schizophrenia"  literally  means  "split  mind"    • This  is  because  their  is  a  break  with  reality  and  a  disintegration  of  personality  • Because  of  this,  schizophrenic  disorders  are  considered  psychotic  disorders  

 Characteristics  

• Schizophrenia  is  usually  diagnosed  in  the  late  teens  or  early  twenties  and  occurs  in  only  1%  of  the  population  

• There  is  a  fairly  strong  genetic  link  to  schizophrenia  and  recent  research  believes  the  limbic  system  is  involved  in  the  disorder.  

 • 25%  of  those  who  experience  a  schizophrenic  episode  fully  recover  • 50%  have  reoccurrences  which  can  be  controlled  through  medication  • 25%  show  little  to  no  sign  of  recovery  

 Process  v.  Reactive  

• Schizophrenia  can  be  one  of  two  types:    – process  (or  chronic)  schizophrenia  develops  gradually  over  time    – reactive  (or  acute)  schizophrenia  comes  on  suddenly,  usually  in  response  to  environmental  

cues  • Prognosis  is  worse  for  process  schizophrenia  and  better  for  reactive  schizophrenia.  

 Positive  Symptoms  

• Some  schizophrenic  patients  have  positive  symptoms  which  include:    – excessive  laughing  and  emotional  outbursts  – disorganized  speech  and  thinking  

• Those  exhibiting  these  symptoms  tend  to  have:    – normal  brain  structures  – excessive  amounts  of  dopamine  – show  overactivity  and  aggressive  behavior  during  adolescence  – have  a  greater  prognosis  for  treatment  

 

Negative  Symptoms    • Other  patients  have  negative  symptoms  which  include:  

– rigid  bodies  – lack  of  emotional  response  – faces  with  no  expression  

• Those  exhibiting  these  symptoms  tend  to  have:    – more  abnormal  brain  structures  – more  frontal  and  parietal  lobe  deficits    – are  more  clearly  genetically  linked  – have  lower  educational  levels  – have  a  poorer  prognosis  for  treatment  

 Types  of  Schizophrenia  

• The  major  types  of  schizophrenia  are:  – paranoid:  fear  or  persecution  is  present,  as  are  delusions  of  grandeur,  or  feelings  of  extreme  

self-­‐importance  as  the  reason  they  are  being  singled  out  for  persecution    – disorganized:  disorganized  thinking  and  speech  patterns  accompanied  by  flat  emotions  

and/or  grossly  inappropriate  behavior    – catatonic:  a  freezing  up  of  the  body  in  response  to  overwhelming  stress  accompanied  by  

extreme  negativism  and/or  mimicking  of  language  patterns  or  body  movements    – undifferentiated  (residual):  schizophrenic  symptoms  that  do  not  fit  one  of  the  specific  types  

listed  above  Personality  Disorders  

• Personality  disorders  involve  enduring,  inflexible  behavior  patterns  that  impair  social  functioning  • These  are  usually  first  identified  in  adolescence  • 10-­‐20%  of  the  population  has  one  type  of  personality  disorder  • The  DSM-­‐V  classifies  three  types  of  personality  disorder  

 Odd/Eccentric  Disorders  

• paranoid  personality  disorder:  extreme  suspiciousness  and  mistrust  of  others  based  on  unjustified  reasoning    

• schizoid  personality  disorder:  indifference  or  lack  of  interpersonal  relationships    • schizotypal  personality  disorder:  generally  odd  thinking,  showing  suspicion  and  mistrust  

Dramatic/Emotionally  Problematic  • narcissistic  personality  disorder:  an  overexaggeration  of  self-­‐importance  and  love  of  one's  self  

– requires  constant  attention  and  admiration    • antisocial  personality  disorder:  exercises  his  or  her  own  needs  or  wants  over  the  feelings  of  

others  – hedonistic  (seeks  self-­‐gratification);  no  emotional  reaction  to  others'  suffering  – commonly  called  a  psychopath  or  sociopath    

• histrionic  personality  disorder:  over-­‐dramatizes  situations  and  behaviors  – blows  things  out  of  proportion  and  overreacts  to  situations  

• borderline  personality  disorder:  unpredictable  and  impulsive,  irritable  and  emotionally  unstable    

Chronic  Fearfulness/Avoidant  • dependent  personality  disorder:  overly  dependent  on  others  due  to  low  self-­‐esteem  and  lack  of  

confidence    • avoidant  personality  disorder:  avoids  relationships  because  of  an  exaggerated  fear  of  rejection    • obsessive-­‐compulsive  personality  disorder:  too  serious,  emotionally  insensitive,  too  preoccupied  

with  structure  and  rules    

AP  Check  AP  students  in  psychology  should  be  able  to  do  the  following:  – Describe  contemporary  and  historical  conceptions  (p.  642)  of  what  constitutes  psychological  

disorders.  – Recognize  the  use  of  the  Diagnostic  and  Statistical  Manual  of  Mental  Disorders  (DSM)  

published  by  the  American  Psychiatric  Association  as  the  primary  reference  for  making  diagnostic  judgments.  

– Discuss  the  major  diagnostic  categories,  including  anxiety  and  somatoform  disorders,  mood  disorders,  schizophrenia,  organic  disturbance,  personality  disorders,  and  dissociative  disorders,  and  their  corresponding  symptoms.  

– Evaluate  the  strengths  and  limitations  of  various  approaches  to  explaining  psychological  disorders:  medical  model,  psychoanalytic,  humanistic,  cognitive,  biological,  and  sociocultural.  

– Identify  the  positive  and  negative  consequences  of  diagnostic  labels  (e.g.  the  Rosenhan  study).  – Discuss  the  intersection  between  psychology  and  the  legal  system  (e.g.  confidentiality,  

insanity  defense).