12 Psychological Disorders

Learning Objectives Learning Objectives 12.1 What criteria do psychologists use to classify behavior as abnormal? 12.2 How do clinicians use the DSM—5? 12.3 What are the five perspectives that psychologists use to explain psychological disorders? 12.4 What are the characteristics of panic attacks, agoraphobia, and panic disorder? 12.5 How do generalized anxiety disorder, social anxiety disorder, and specific phobia differ? 2

Learning Objectives Learning Objectives 12.6 What are the symptoms of obsessive-compulsive disorder? 12.7 What are the characteristics of major depressive disorder? 12.8 What kinds of mood changes do people with bipolar disorder experience? 12.9 What are some risk factors for depressive and bipolar disorders? 12.10 What are some of the risk factors for suicide? 12.11 What are the positive and negative symptoms of schizophrenia? 3

Learning Objectives Learning Objectives 12.12 What factors increase the risk of developing schizophrenia? 12.13 What are somatic disorders? 12.14 How do dissociative disorders affect behavior? 12.15 What are the characteristics of the various sexual dysfunctions? 12.16 What are the similarities and differences among the various personality disorders? 12.17 What kinds of problem behaviors do children with disruptive mood dysregulation disorder exhibit? 4

Learning Objectives Learning Objectives 12.18 How do autism spectrum disorders affect children's development? 12.19 What are the features of attention-deficit hyperactivity disorder? 5

Overview Defining Psychological Disorders Anxiety Disorders Depressive and Bipolar Disorders Schizophrenia Somatic, Dissociative, Sexual, and Personality Disorders Childhood Disorders

Defining Psychological Disorders: What Is Abnormal Behavior? mental processes and/or behavior patterns that cause emotional distress and/or substantial impairment in functioning 12.1 What criteria do psychologists use to classify behavior as abnormal?

Defining Psychological Disorders: What Is Abnormal Behavior? Questions Help Determine Abnormality Is the behavior considered strange within the person's own culture? Does the behavior cause personal distress? Is the behavior maladaptive? Is the person a danger to self or others? Is the person legally responsible for his or her acts? 12.1 What criteria do psychologists use to classify behavior as abnormal?

Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Defining Psychological Disorders: Classifying and Tracking Psychological Disorders LO 12.2 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) new (5th) edition to be released in 2013 contains descriptions of about 300 specific psychological disorders lists criteria that must be met in order to make a particular diagnosis organizes these disorders into categories 12.2 How do clinicians use the DSM-5

Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Defining Psychological Disorders: Classifying and Tracking Psychological Disorders LO 12.2 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) used by researchers, therapists, mental health workers, and most insurance companies has enabled public health officials to keep track of the frequency with which the various categories and individual disorders are diagnosed 12.2 How do clinicians use the DSM-5

Insert Table 12.2 Here TABLE 12.2 Guidelines for the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders

Defining Psychological Disorders: Classifying and Tracking Psychological Disorders Each year, 26 percent, or more than 44 million adults, are diagnosed with a mental disorder. About 50 percent of Americans will be diagnosed with a mental disorder sometime in their lives. Mental disorders represent personal misery for individuals and lost productivity for society. 12.2 How do clinicians use the DSM-5

12.2 How do clinicians use the DSM-5 FIGURE 12.1 Lifetime Prevalence of Psychological Disorders The percentages of people in the United States who suffer from various psychological disorders during their lifetime are based on the findings of the National Comorbidity Survey. Source: Data from Bhugra (2005) & Freeman et al. (2010). 12.2 How do clinicians use the DSM-5

Defining Psychological Disorders: Explaining Psychological Disorders Biological Perspective Abnormal behavior arises from a physical cause. Biological treatments, such as drug therapy, are favored. 12.3 What are the five perspectives that psychologists use to explain psychological disorders?

Defining Psychological Disorders: Explaining Psychological Disorders Biopsychosocial Perspective Disorders result from a combination of biological, psychological, and social causes. Drug and psychotherapy are employed as treatment. 12.3 What are the five perspectives that psychologists use to explain psychological disorders?

Defining Psychological Disorders: Explaining Psychological Disorders Psychodynamic Perspective Disorders stem from childhood and unresolved, unconscious conflicts. Treatment involves psychoanalysis. 12.3 What are the five perspectives that psychologists use to explain psychological disorders?

Defining Psychological Disorders: Explaining Psychological Disorders Learning Perspective Abnormal thoughts and behaviors are learned and sustained like any other behaviors. Treatment uses classical and operant conditioning and modeling to extinguish maladaptive behavior and increase adaptive behavior. 12.3 What are the five perspectives that psychologists use to explain psychological disorders?

Defining Psychological Disorders: Explaining Psychological Disorders Cognitive Perspective Faulty thinking and distorted perceptions can cause psychological disorders. Treatment tries to change faulty, irrational, and/or negative thinking. 12.3 What are the five perspectives that psychologists use to explain psychological disorders?

Five Perspectives on Psychological Disorders 19

Anxiety Disorders LO 12.4 Disorders characterized by frequent, fearful thoughts about what might happen in the future The most common category of psychological disorders Anxiety disorders account for more than 4 million visits to doctors' offices in the US each year. 12.4 What are the characteristics of panic attacks, agoraphobia, and panic disorder?

Anxiety Disorders LO 12.4 Two types of anxious feelings for which people often seek professional help: Panic attacks Agoraphobia 12.4 What are the characteristics of panic attacks, agoraphobia, and panic disorder?

Anxiety Disorders: Panic Attacks and Agoraphobia LO 12.4 Panic Attack an episode of overwhelming anxiety, fear, or terror The brain responds to normal changes in the body as if they were life-threatening. Uncued attacks appear to be brought about by a dysfunction in the autonomic nervous system's fight-or-flight system. 12.4 What are the characteristics of panic attacks, agoraphobia, and panic disorder?

Anxiety Disorders: Panic Attacks and Agoraphobia LO 12.4 Agoraphobia intense fear of being in a situation from which escape is not possible often begins with repeated panic attacks People with agoraphobia sometimes plan their entire lives around avoiding feared situations. 12.4 What are the characteristics of panic attacks, agoraphobia, and panic disorder?

Anxiety Disorders: Panic Disorder LO 12.4 Panic Disorder The person experiences recurring, unpredictable episodes of overwhelming anxiety, fear, or terror. 12.4 What are the characteristics of panic attacks, agoraphobia, and panic disorder?

Anxiety Disorders: Panic Disorder LO 12.4 Panic Disorder can lead to the development of agoraphobia Agoraphobia complicates clinicians' efforts to help people who have panic disorder. Panic disorder with agoraphobia is among the most debilitating of all psychological disorders. 12.4 What are the characteristics of panic attacks, agoraphobia, and panic disorder?

Anxiety Disorders: Panic Disorder LO 12.4 Explaining Panic Disorder Avoidance behavior is reinforced because it enables the individual to escape from the unpleasant sensations that are associated with anxiety. 12.4 What are the characteristics of panic attacks, agoraphobia, and panic disorder?

Anxiety Disorders: Generalized Anxiety Disorder and Phobias LO 12.5 Generalized Anxiety Disorder disorder involving chronic, excessive worry for 6 months or more The worry is either unfounded or greatly exaggerated: difficult to control. affects twice as many women as men 12.5 How do generalized anxiety disorder, social phobia, and specific phobia differ?

Anxiety Disorders: Generalized Anxiety Disorder and Phobias LO 12.5 Social Phobia irrational fear and avoidance of any social or performance situation fear of embarrassing or humiliating oneself in front of others by appearing clumsy, foolish, or incompetent may take the specific form of performance anxiety 12.5 How do generalized anxiety disorder, social phobia, and specific phobia differ?

Anxiety Disorders: Generalized Anxiety Disorder and Phobias LO 12.5 Specific Phobia fear of a specific object or situation general label for any phobia other than agoraphobia or social phobia categories of specific phobias: Situational phobias Fear of the natural environment Animal phobias Blood, injection, injury phobias 12.5 How do generalized anxiety disorder, social phobia, and specific phobia differ?

Anxiety Disorders: Generalized Anxiety Disorder and Phobias LO 12.5 Explaining Generalized Anxiety Disorder and Phobias Brown (2007) argues that GAD and social phobia are manifestations of the Big Five personality trait of neuroticism. Neuroticism is also a risk factor for the development of specific phobias (Bienvenu et al., 2007). 12.5 How do generalized anxiety disorder, social phobia, and specific phobia differ?

Anxiety Disorders: Obsessive-Compulsive Disorder LO 12.6 Recurrent obsessions and/or compulsions Obsession persistent, involuntary thought, image, or impulse that causes great distress 12.6 What are the symptoms of obsessive compulsive disorder?

Anxiety Disorders: Obsessive-Compulsive Disorder LO 12.6 Compulsion persistent, irresistible, and irrational urge to perform an act or ritual repeatedly Compulsions often involve cleaning and washing, counting, checking, touching objects, hoarding, or excessive organizing. 12.6 What are the symptoms of obsessive compulsive disorder?

Anxiety Disorders: Obsessive-Compulsive Disorder LO 12.6 Explaining Obsessive-Compulsive Disorder Autoimmune system diseases, strep infection, and brain changes caused by infection may predispose development of OCD (Swedo & Grant, 2004). Genes affecting serotonin functioning are suspected of causing OCD in some people. 12.6 What are the symptoms of obsessive compulsive disorder?

Mood Disorders: Major Depressive Disorder LO 12.7 Mood Disorders disorders characterized by extreme and unwarranted disturbances in emotion Major Depressive Disorder Sufferers feel an overwhelming sadness, despair, and hopelessness. usually lose their ability to experience pleasure 12.7 What are the characteristics of major depressive disorder?

Mood Disorders: Major Depressive Disorder LO 12.7 Major Depressive Disorder one year after initial diagnosis: Forty percent are without symptoms Forty percent still suffering from a disorder Twenty percent are depressed The risk of recurrence is greatest for females (Winokur et al., 1993) and for individuals with an onset of depression before age 15. 12.7 What are the characteristics of major depressive disorder?

Mood Disorders: Bipolar Disorder LO 12.8 Manic episodes alternate with periods of depression, usually with relatively normal periods in between. Manic Episodes periods of excessive euphoria, inflated self-esteem, wild optimism, and hyperactivity often accompanied by delusions of grandeur and by hostility if activity is blocked 12.8 What kinds of mood changes do people with bipolar disorder experience?

Mood Disorders: Bipolar Disorder LO 12.8 Much less common than major depressive disorder affects about 1 percent of the U.S. population in any given year Seventy to eighty percent of those diagnosed return to a state of emotional stability (American Psychiatric Association, 2000a). 12.8 What kinds of mood changes do people with bipolar disorder experience?

Mood Disorders: Bipolar Disorder LO 12.8 Symptoms can be managed with lithium and divalproex. 12.8 What kinds of mood changes do people with bipolar disorder experience?

Explaining Mood Disorders LO 12.9 Neurological Correlates of Mood Disorders PET scans have revealed abnormal patterns of brain activity in people with mood disorders. Area of brain tissue in lower prefrontal cortex is 40 to 50 percent smaller in people with major depression. 12.9 What are some risk factors for mood disorders?

Explaining Mood Disorders LO 12.9 Neurological Correlates of Mood Disorders Neuroticism is associated with depression and abnormal serotonin levels. abnormal production, transport, and reuptake patterns for dopamine, GABA, and norepinephrine 12.9 What are some risk factors for mood disorders?

Explaining Mood Disorders LO 12.9 Heredity Fifty percent of the identical twins of bipolar sufferers have also been diagnosed with a mood disorder (compared to only seven percent of fraternal twins). 12.9 What are some risk factors for mood disorders?

Explaining Mood Disorders LO 12.9 Stressors The majority of first episodes of depression strike after major life stress. Culture Lifetime risk for developing depression varies greatly around the world. Depression in individuals in non-Asian cultures appears to be influenced by cultures' ideas about how people ought to feel. 12.9 What are some risk factors for mood disorders?

Explaining Mood Disorders LO 12.9 Gender In most countries, the rate of depression for females is about twice that for males. Early-onset major depressive disorder adversely affects educational attainment and earning power of women, but not men. 12.9 What are some risk factors for mood disorders?

Explaining Mood Disorders LO 12.9 The prevalence of depression varies greatly across cultures. Prevalence rates also differ between men and women. In most countries, the rate of depression in females is about twice that for males. 12.9 What are some risk factors for mood disorders?

LO 12.9 12.9 What are some risk factors for mood disorders? FIGURE 12.2 As you can see, rates of depressive and bipolar disorders vary widely across nations. Source: Kessler et al., 2007. 12.9 What are some risk factors for mood disorders?

Suicide and Race Gender and Age LO 12.10 Major risk factors for suicide: Mood disorders Schizophrenia Substance abuse The risk of suicide increases when people are exposed to major life stressors. 12.10 What are some of the risk factors for suicide?

Suicide and Race, Gender, and Age LO 12.10 Older white males commit suicide more often than members of other race or age groups. Women are more likely to attempt suicide; men are more likely to succeed. 12.10 What are some of the risk factors for suicide?

FIGURE 12.3 Differences in Suicide Rates According to Race, Gender, and Age The general conclusion from these data is that males are more likely to commit suicide than females and that White Americans are more likely to do so than are individuals in other groups. Source: National Institute of Mental Health (2013).

Schizophrenia: Symptoms of Schizophrenia LO 12.11 Positive Symptoms abnormal behaviors present in people with schizophrenia hallucinations imaginary symptoms 12.11 What are the positive and negative symptoms of schizophrenia?

Schizophrenia: Symptoms of Schizophrenia LO 12.11 Positive Symptoms delusions delusions of grandeur belief that one is famous or important delusions of persecution false notion that some person or agency is attempting to conspire against the individual 12.11 What are the positive and negative symptoms of schizophrenia?

Schizophrenia: Symptoms of Schizophrenia LO 12.11 Positive Symptoms loosening of associations or derailment grossly disorganized behavior inappropriate affect 12.11 What are the positive and negative symptoms of schizophrenia?

Schizophrenia: Symptoms of Schizophrenia LO 12.11 Negative Symptoms loss or deficiency in thought or behavior that is characteristic of normal functioning Socially withdrawal Apathy/loss of motivation Flat affect showing little or no emotional response Limited speech and slow movements Poor hygiene and grooming 12.11 What are the positive and negative symptoms of schizophrenia?

Schizophrenia: Symptoms of Schizophrenia LO 12.11 Negative Symptoms Negative symptoms are predictors of impaired overall social and vocational functioning. People with negative symptoms tend to withdraw from normal social contacts. 12.11 What are the positive and negative symptoms of schizophrenia?

Explaining Schizophrenia LO 12.13 There is no known single cause of schizophrenia. Risk factors interact in complex ways. An individual might have relevant risk factors but never develop the disorder. 12.13 What factors increase the risk of developing schizophrenia?

Explaining Schizophrenia LO 12.13 Several factors may interact to produce schizophrenia, including: Constitutional vulnerability Stress Neuromaturational processes 12.13 What factors increase the risk of developing schizophrenia?

Explaining Schizophrenia: Constitutional Vulnerability LO 12.13 Individual's congenital risk of developing schizophrenia Attributable to factors of gender and heredity gender Males are more likely than females to develop schizophrenia. 12.13 What factors increase the risk of developing schizophrenia?

Explaining Schizophrenia: Constitutional Vulnerability LO 12.13 Attributable to factors of gender and heredity heredity One's chances of developing schizophrenia are higher if one has a close genetic relative with schizophrenia. 12.13 What factors increase the risk of developing schizophrenia?

LO 12.13 12.13 What factors increase the risk of developing FIGURE 12.4 How Risk Factors Lead to Schizophrenia This diagram shows how many researchers today view the risk factors for schizophrenia. The central concept is “constitutional vulnerability.” Prenatal and postnatal factors derived from both heredity and environmental factors cause some people to be born with a greater sensitivity to stress than others. Stress and neuromaturational processes interact with constitutional vulnerability to produce the symptoms of schizophrenia. Source: Walker et al. (2004). 12.13 What factors increase the risk of developing schizophrenia?

FIGURE 12.5 Genetic Similarity and Probability of Developing Schizophrenia Research strongly indicates a genetic factor associated with schizophrenia. Identical twins have identical genes, and if one twin develops schizophrenia, the other twin has a 46% chance of also developing it. In fraternal twins, the chance is only 14%. A person with one schizophrenic parent has a 13% chance of developing schizophrenia, but a 46% chance if both parents are schizophrenic. Source: Data from Nicol & Gottesman (1983).

Schizophrenia LO 12.13 Stress Stressful events may trigger development of schizophrenia in individuals with constitutional vulnerability. 12.13 What factors increase the risk of developing schizophrenia?

Schizophrenia Neuromaturational Processes LO 12.13 Neuromaturational Processes Environmental factors may disrupt normal brain development. causing decreased frontal lobe functioning, destruction of gray matter, and abnormal dopamine activity 12.13 What factors increase the risk of developing schizophrenia?

FIGURE 12.6 Destruction of Gray Matter in the Brains of Adolescents Diagnosed with Schizophrenia This figure dramatically depicts the devastating effects of schizophrenia on gray matter in the brains of people with the disorder. The images on the first line of this figure show the average gray matter deficits in the brains of 15 adolescents who ranged from 12 to 15 years of age who had just been diagnosed with schizophrenia. Those on the second line represent the amount of gray matter they had lost to the disease 5 years later. Source: Thompson, P., Vidal, C., Giedd, J., Gochman, P., Blumenthal, J., Nicolson, R., Toga, A., & Rapoport, J. (2001). Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proceedings of the National Academy of Sciences, 98, 11650-11655.

Other Psychological Disorders: Somatoform Disorders Physical symptoms are present that are due to psychological causes rather than any known medical condition. Conversion Disorder loss of sensory or motor functioning which has no physical cause 12.14 What are somatoform disorders?

Other Psychological Disorders: Dissociative Disorders Consciousness becomes dissociated from a person's identity and/or his or her memories Dissociative Amnesia complete or partial loss of the ability to recall personal information and/or past experiences 12.15 How do dissociative disorders affect behavior?

Other Psychological Disorders: Dissociative Disorders Dissociative Fugue complete loss of memory of one's entire identity and traveling away from home often involves assuming a new identity 12.15 How do dissociative disorders affect behavior?

Other Psychological Disorders: Dissociative Disorders Dissociative Identity Disorder (DID) Two or more distinct personalities occur in the same person. host personality in charge of person most of the time alters alternate personalities 12.15 How do dissociative disorders affect behavior?

Other Psychological Disorders: Dissociative Disorders Dissociative Identity Disorder (DID) Like other dissociative disorders, DID seems to be a response to unbearable stress. Among DID patients, at least 95 percent have history of severe physical and/or sexual abuse. 12.15 How do dissociative disorders affect behavior?

Sexual Disorders Behavior patterns that are: LO 12.16 Behavior patterns that are: Related to sexuality or sexual functioning Destructive, guilt- or anxiety-producing, compulsive Cause of discomfort or harm to one or both parties involved 12.16 What are the characteristics of the various sexual disorders?

Sexual Disorders Sexual Dysfunction LO 12.16 Sexual Dysfunction persistent, recurrent, and distressing problems involving sexual desire, arousal, or the pleasure associated with sex or orgasm 12.16 What are the characteristics of the various sexual disorders?

Sexual Disorders Paraphilias LO 12.16 Paraphilias recurrent sexual urges, fantasies, or behavior involve nonhuman objects, children, other non-consenting persons, or the suffering or humiliation of the person or his or her partner 12.16 What are the characteristics of the various sexual disorders?

Personality Disorders LO 12.16 Long-standing, inflexible, maladaptive pattern of behaving and relating to others Personality disorders usually begin early in childhood or adolescence, and are among the most common mental disorders.

Personality Disorders LO 12.16 9 percent of North Americans have 1 or more personality disorders. Medications have not proved to be very useful in treatment.

Table 12.3 Types of Personality Disorders

Childhood Disorders Disruptive Mood Dysregulation Disorder LO 12.17 Disruptive Mood Dysregulation Disorders (DMDD) a disorder in which children are highly irritable and have frequent outbursts of temper that interfere with social and academic functioning. 12.17 What kinds of problem behaviors do children with Disruptive mood dysregulation disorder exhibit? 74

Childhood Disorders Autism Spectrum Disorder LO 12.18 Autism Spectrum Disorders (ASD) a disorder in which a child lacks the ability to establish and maintain social relationships. 12.18 How do autism spectrum disorders affect children's development? 75

Childhood Disorders Attention-Deficit/Hyperactivity Disorder LO 12.19 Attention-Deficit/Hyperactivity Disorder (ADHD) a disorder characterized by inattention and difficulty completing tasks. 12.19 What are the features of attention-deficit/hyperactivity disorder? 76