Psychology 2e Chapter 13 Psychological Disorders

Module 31 Defining Abnormal Behavior

Learning Objectives 31.1 Discuss historical and cross-cultural views of abnormality. 31.2 Explain psychologically abnormal behavior. 31.3 Describe the challenges associated with diagnosis. 31.4 Explain major models of abnormality. 31.5 Explain the classification of psychological disorders. 31.6 Explain how stigma relates to abnormal behavior. 31.7 Describe the impact of psychological disorders on the individual, family, and society.

History of Psychological Disorders (1 of 3) Learning Objective 31.1 Discuss historical and cross-cultural views of abnormality. Psychopathology: the study of abnormal behavior and psychological dysfunction Trephining (3000 B.C.E.): cutting holes into the skull of a living person Done in ancient times to release the “demons” possessing a victim Is still done today to relieve pressure of fluids on the brain

History of Psychological Disorders (2 of 3) Learning Objective 31.1 Discuss historical and cross-cultural views of abnormality. Hippocrates (460–377 B.C.E.), Greek physician: considered the “Father of Medicine” First recorded attempt to explain abnormal thinking or behavior as due to some biological process Believed that mental illness came from an imbalance in the body’s four humors Middle Ages: believed in spirit possession as cause of abnormality Exorcism: possessed person was seen as a victim

History of Psychological Disorders (3 of 3) Learning Objective 31.1 Discuss historical and cross-cultural views of abnormality. Renaissance: Witchcraft: mentally ill persons were called witches and put to death Present day: psychological disorders are often viewed from a medical model in that they can be diagnosed according to various symptoms and have an etiology, course, and prognosis

Statistical or Social Norm Deviance Learning Objective 31.2 Explain psychologically abnormal behavior. Normal: frequently occurring behavior Abnormal: behavior that is rare or deviates from the norms of a society Situational context (the social or environmental setting of a person’s behavior) can also make a difference in how behavior or thinking is labeled

Subjective Discomfort Learning Objective 31.2 Explain psychologically abnormal behavior. Subjective discomfort: emotional distress while engaging in a particular behavior or thought process All thoughts or behavior that might be considered abnormal do not necessarily create subjective discomfort For example, a serial killer Some forms of disordered behavior involve showing no emotions at all

Inability to Function Normally Learning Objective 31.2 Explain psychologically abnormal behavior. Maladaptive: person finds it hard to adapt to the demands of day-to-day living

Working Definition of Abnormality (1 of 3) Learning Objective 31.3 Describe the challenges associated with diagnosis. Psychological disorder: any pattern of behavior or thinking that causes people significant distress, causes them to harm others, or harms their ability to function in daily life

Working Definition of Abnormality (2 of 3) Learning Objective 31.3 Describe the challenges associated with diagnosis. Abnormal thinking or behavior that includes at least two of the following five criteria, is perhaps best classified by the term psychological disorder: Is the thinking or behavior unusual? Does the thinking or behavior go against social norms? Does the behavior or psychological function cause the person significant subjective discomfort? Is the thought process or behavior maladaptive, or does it result in an inability to function? Does the thought process or behavior cause the person to be dangerous to self or others?

Working Definition of Abnormality (3 of 3) Learning Objective 31.3 Describe the challenges associated with diagnosis. Abnormality is different from the term insanity Insanity: a legal term used in the United States, to argue that a mentally ill person who has committed a crime should not be held responsible for his or her actions (insanity defense)

Biological Model Learning Objective 31.4 Explain major models of abnormality. Biological model: model of explaining behavior as caused by biological changes in the chemical, structural, or genetic systems of the body Proposes that psychological disorders have a biological or medical cause Explains disorders such as anxiety, depression, and schizophrenia as caused by faulty neurotransmitter systems, genetic problems, brain damage and dysfunction

Psychological Models Learning Objective 31.4 Explain major models of abnormality. Theories of personality can be used to describe and explain the formation of not only personality but disordered thinking, behavior, and abnormal personality as well

Psychodynamic View: Hiding Problems Learning Objective 31.4 Explain major models of abnormality. Based on the work of Freud and his followers Explains disordered thinking and behavior as the result of repressing one’s threatening thoughts, memories, and concerns in the unconscious mind

Behaviorism: Learning Problems Learning Objective 31.4 Explain major models of abnormality. Behaviorists define personality as a set of learned responses; have no trouble explaining disordered behavior as being learned just like normal behavior (Skinner, 1971; Watson, 1913)

Cognitive Perspective: Thinking Problems Learning Objective 31.4 Explain major models of abnormality. Cognitive psychologists study the way people think, remember, and mentally organize information; they see maladaptive functioning as resulting from illogical thinking patterns

Sociocultural Perspective (1 of 3) Learning Objective 31.4 Explain major models of abnormality. Abnormal thinking or behavior (as well as normal) is seen as the product of behavioral shaping within the context of family influences, the social group to which one belongs, and the culture within which the family and social group exist Cultural relativity: the need to consider the unique characteristics of the culture in which behavior takes place

Sociocultural Perspective (2 of 3) Learning Objective 31.4 Explain major models of abnormality. Culture-bound syndromes: disorders unique to specific cultures For example, anorexia nervosa and bulimia nervosa have traditionally been most often found in Western societies The idea of “culturebound” has been replaced by three concepts: Cultural syndromes Cultural idioms of distress Cultural explanations or perceived cause

Sociocultural Perspective (3 of 3) Learning Objective 31.4 Explain major models of abnormality. The idea of “culturebound” has been replaced by three concepts: Cultural syndromes Recognizable as a distinct set of symptoms or characteristics of distress Cultural idioms of distress Terms or phrases used to describe suffering or distress within a given cultural context Cultural explanations or perceived cause Culturally defined ways of explaining the source or cause of symptoms or illness

Biopsychosocial Perspective Learning Objective 31.4 Explain major models of abnormality. Biological, psychological, and sociocultural influences on abnormality interact with one another to cause the various forms of disorders

The DSM-5 Learning Objective 31.5 Explain the classification of psychological disorders. Diagnostic and Statistical Manual of Mental Disorders (DSM), first published in 1952: the prevalent resource in the United States, to help psychological professionals diagnose psychological disorders DSM-5 combines all disorders and diagnoses into a single list, therefore eliminating the multiaxis system

How Common Are Psychological Disorders? Learning Objective 31.5 Explain the classification of psychological disorders. It is quite common for people to suffer from more than one mental disorder at a time In any given year, about 26.2 percent of American adults over age 18 suffer from a mental disorder Only about 5.8 percent of the U.S. population, or 1 in 17 adults, suffers from a severe mental disorder Statistically, mental disorders are the leading cause of disability in the United States and Canada

Table 31.1 Yearly Occurrence of Psychological Disorders in the United States *Percentage of adults over age 18 affected annually and approximate number within the population based on 2010 United States Census data. Adapted from National Institute of Mental Health (2013). Table uses terminology from both the DSM-IV and DSM-5 (American Psychiatric Association, 2000, 2013).

Stigma Learning Objective 31.6 Explain how stigma relates to abnormal behavior. Labels (like depression, anxiety, and schizophrenia) are very helpful Allow psychological professionals to communicate with each other Establish distinct diagnostic categories that all professionals recognize and understand Help patients receive effective treatment Can be overly prejudicial Rosenhan Study Psychological labels long lasting and powerful

Impact of Psychological Disorders Learning Objective 31.7 Describe the impact of psychological disorders on the individual, family, and society. Individuals People diagnosed with psychological disorders may feel judged or labeled by others around them May lead to a loss of friendships, family support, and even employment Side effects of treatment Families and friends Often time-consuming and expensive to look after mentally ill Stress can lead to mental illness in caretaker

Module 32 Types of Psychological Disorders

Learning Objectives 32.1 Describe symptoms and causes of anxiety disorders. 32.2 Describe symptoms and causes of dissociative disorders. 32.3 Describe symptoms and causes of mood disorders. 32.4 Describe symptoms and causes of eating disorders. 32.5 Describe symptoms and causes of schizophrenia. 32.6 Describe symptoms and causes of personality disorders. 32.7 Discuss how different factors influence an individual’s experience of psychological disorders.

Types of Psychological Disorders Learning Objective 32.1 Describe symptoms and causes of anxiety disorders. Anxiety disorders: class of disorders in which the primary symptom is excessive or unrealistic anxiety Free-floating anxiety: anxiety that is unrelated to any specific and known cause

Anxiety Disorders (1 of 4) Learning Objective 32.1 Describe symptoms and causes of anxiety disorders. Phobia: an irrational, persistent fear of an object, situation, or social activity Social anxiety disorder (social phobia): fear of interacting with others or being in social situations that might lead to a negative evaluation For example, stage fright, fear of public speaking, and fear of urinating in a public restroom

Anxiety Disorders (2 of 4) Learning Objective 32.1 Describe symptoms and causes of anxiety disorders. Specific phobia: fear of objects or specific situations or events Such as a fear of dogs, or a fear of being in small, enclosed spaces (claustrophobia) Agoraphobia: fear of being in a place or situation from which escape is difficult or impossible

Anxiety Disorders (3 of 4) Learning Objective 32.1 Describe symptoms and causes of anxiety disorders. Panic disorder: disorder in which panic attacks occur more than once or repeatedly, and cause persistent worry or changes in behavior Panic attack: sudden onset of intense panic in which multiple physical symptoms of stress occur, often with feelings that one is dying Usually experienced by adolescent girls and young adult women When panic attacks occur more than once or repeatedly, and cause persistent worry or changes in behavior, that they become a panic disorder

Anxiety Disorders (4 of 4) Learning Objective 32.1 Describe symptoms and causes of anxiety disorders. Generalized anxiety disorder: disorder in which a person has feelings of dread and impending doom along with physical symptoms of stress, which lasts 6 months or more Excessive anxiety and worries occur more days than not for at least 6 months

Disorders Related to Anxiety (1 of 2) Learning Objective 32.1 Describe symptoms and causes of anxiety disorders. Some disorders are not classified as anxiety disorders in the DSM-5 Obsessive-compulsive disorder: disorder in which intruding, recurring thoughts, or obsessions create anxiety that is relieved by performing a repetitive, ritualistic behavior or mental act (compulsion) Acute stress disorder (ASD): a disorder resulting from exposure to a major stressor, with symptoms of anxiety, dissociation, recurring nightmares, sleep disturbances, problems in concentration, and moments in which people seem to “relive” the event in dreams and flashbacks for as long as 1 month following the event

Disorders Related to Anxiety (2 of 2) Learning Objective 32.1 Describe symptoms and causes of anxiety disorders. Some disorders are not classified as anxiety disorders in the DSM-5 (continued) Posttraumatic stress disorder (PTSD): a disorder resulting from exposure to a major stressor, with symptoms of anxiety, dissociation, nightmares, poor sleep, reliving the event, and concentration problems, lasting for more than 1 month; symptoms may appear immediately, or not occur until 6 months or later after the traumatic event

Causes of Anxiety, Trauma, and Stress Disorders Learning Objective 32.1 Describe symptoms and causes of anxiety disorders. Behavioral and Cognitive Factors Biological Factors Cultural Variations

Behavioral and Cognitive Factors (1 of 2) Learning Objective 32.1 Describe symptoms and causes of anxiety disorders. Behaviorists believe that anxious behavioral reactions are learned For example, see phobias as nothing more than classically conditioned fear responses Case of “Little Albert”

Behavioral and Cognitive Factors (2 of 2) Learning Objective 32.1 Describe symptoms and causes of anxiety disorders. Cognitive psychologists see anxiety disorders as the result of illogical, irrational thought processes Examples of irrational thinking are: Magnification: tendency to interpret situations as being far more harmful, dangerous, or embarrassing than they actually are All-or-nothing thinking: a person believes that his or her performance must be perfect or the result will be a total failure Overgeneralization: a single negative event is interpreted as a never-ending pattern of defeat Jumping to conclusions without facts to support that conclusion Minimization: giving little or no emphasis to one’s successes or positive events and traits

Dissociative Disorders (1 of 2) Learning Objective 32.2 Describe symptoms and causes of dissociative disorders. Dissociative disorders: disorders in which there is a break in conscious awareness, memory, the sense of identity, or some combination Dissociative amnesia: loss of memory for personal information, either partial or complete due to psychological causes Dissociative fugue: traveling away from familiar surroundings with amnesia for the trip and possible amnesia for personal information

Dissociative Disorders (2 of 2) Learning Objective 32.2 Describe symptoms and causes of dissociative disorders. Dissociative disorders (continued) Dissociative identity disorder (DID): disorder occurring when a person seems to have two or more distinct personalities within one body Depersonalization/derealization disorder: disorder in which people feel detached and disconnected from themselves, their bodies, and their surroundings

Causes of Dissociative Disorders Learning Objective 32.2 Describe symptoms and causes of dissociative disorders. Psychodynamic theory: sees the repression of threatening or unacceptable thoughts and behavior as a defense mechanism at the heart of all disorders Cognitive and behavioral explanations: the person may feel guilt, shame, or anxiety when thinking about disturbing experiences or thoughts and start to avoid thinking about them Biological sources: lower brain activity in the areas responsible for people’s sense of body awareness

Mood Disorders (1 of 2) Learning Objective 32.3 Describe symptoms and causes of mood disorders. Major Depressive Disorder and Bipolar Disorders Affect (in psychology): a term indicating “emotion” or “mood” Mood disorders: mood is severely disturbed Major depressive disorder: severe depression that comes on suddenly and seems to have no external cause or is too severe for current circumstances More likely in women, across cultures

Mood Disorders (2 of 2) Learning Objective 32.3 Describe symptoms and causes of mood disorders. Bipolar disorders (unipolar disorder): periods of mood that may range from normal to manic, with or without episodes of depression (bipolar disorder), or spans of normal mood interspersed with episodes of major depression and episodes of hypomania (bipolar II disorder) Manic: having the quality of excessive excitement, energy, and elation or irritability

Causes of Mood Disorders Learning Objective 32.3 Describe symptoms and causes of mood disorders. Behavioral theorists link depression to learned helplessness Social cognitive theorists point to distortions of thinking such as blowing negative events out of proportion and minimizing positive, good events Biological explanations focus on the effects of brain chemicals such as serotonin, norepinephrine, and dopamine Genes also play a part: disorders appear in genetically related individuals at a higher rate

Eating Disorders Learning Objective 32.4 Describe symptoms and causes of eating disorders. . Anorexia nervosa (anorexia): causes a person to reduce eating to the point that their body weight is significantly lower or less than minimally expected; in adults, this is likely associated with a BMI < 18.5 Bulimia nervosa (bulimia): causes a person to develop a cycle of “binging,” or overeating enormous amounts of food at one sitting, and then using unhealthy methods to avoid weight gain Binge-eating disorder: involves uncontrolled binge eating, without purging

Causes of Eating Disorders Learning Objective 32.4 Describe symptoms and causes of eating disorders. . Greatest risk factor: someone being an adolescent or young adult female Increased sensitivity to food and its reward value may play a role in bulimia and binge-eating disorder Fear and anxiety may become associated with food in anorexia nervosa

Schizophrenia Learning Objective 32.5 Describe symptoms and causes of schizophrenia. Schizophrenia: severe disorder in which the person suffers from disordered thinking, bizarre behavior, hallucinations, and inability to distinguish between fantasy and reality

Symptoms of Schizophrenia (1 of 4) Learning Objective 32.5 Describe symptoms and causes of schizophrenia. Psychotic disorder: refers to an individual’s inability to separate what is real and what is fantasy Delusions: false beliefs held by a person who refuses to accept evidence of their falseness Delusions of persecution: people believe that others are trying to hurt them in some way Delusions of reference: people believe that other people, television characters, and even books are specifically talking to them

Symptoms of Schizophrenia (2 of 4) Learning Objective 32.5 Describe symptoms and causes of schizophrenia. Delusions: false beliefs held by a person who refuses to accept evidence of their falseness (continued) Delusions of influence: people believe that they are being controlled by external forces, such as the devil, aliens, or cosmic forces Delusions of grandeur (or grandiose delusions): people are convinced that they are powerful people who can save the world or have a special mission

Symptoms of Schizophrenia (3 of 4) Learning Objective 32.5 Describe symptoms and causes of schizophrenia. Speech disturbances Clanging: stringing words together on the basis of sounds Word salad: expressing oneself in a meaningless and jumbled mixture of words and phrases Hallucinations: false sensory perceptions, such as hearing voices that do not really exist Flat affect: a lack of emotional responsiveness

Symptoms of Schizophrenia (4 of 4) Learning Objective 32.5 Describe symptoms and causes of schizophrenia. Catatonia: disturbed behavior ranging from statue- like immobility to bursts of energetic, frantic movement, and talking Positive symptoms: symptoms that are excesses of behavior or occur in addition to normal behavior; hallucinations, delusions, and distorted thinking Negative symptoms: symptoms that are less than normal behavior or an absence of normal behavior; poor attention, flat affect, and poor speech production

Causes of Schizophrenia Learning Objective 32.5 Describe symptoms and causes of schizophrenia. Most likely caused by a combination of genetic and environmental factors Stress-vulnerability model: explanation of disorder that assumes a biological sensitivity, or vulnerability, to a certain disorder will result in the development of that disorder under the right conditions of environmental or emotional stress

Figure 32.1 Genetics and Schizophrenia This chart shows a definite pattern: The greater the degree of genetic relatedness, the higher the risk of schizophrenia in individuals related to each other. The only individual to carry a risk even close to that of identical twins (who share 100 percent of their genes) is a person who is the child of two parents with schizophrenia. Source: Based on Gottesman (1991).

Categories of Personality Disorder (1 of 3) Learning Objective 32.6 Describe symptoms and causes of personality disorders. . Personality disorders: disorders in which a person adopts a persistent, rigid, and maladaptive pattern of behavior that interferes with normal social interactions The behavior of the person is very dramatic, emotional, or erratic The main emotion is anxiety or fearfulness

Categories of Personality Disorder (2 of 3) Learning Objective 32.6 Describe symptoms and causes of personality disorders. . Antisocial personality disorder (ASPD): disorder in which a person uses other people without worrying about their rights or feelings and often behaves in an impulsive or reckless manner without regard for the consequences of that behavior Many more males diagnosed with this disorder than females Majority of individuals with ASPD are not psychopathic

Categories of Personality Disorder (3 of 3) Learning Objective 32.6 Describe symptoms and causes of personality disorders. . Borderline personality disorder (BLPD): maladaptive personality pattern in which the person is moody, unstable, lacks a clear sense of identity, and often clings to others with a pattern of self-destructiveness, chronic loneliness, and disruptive anger in close relationships Extreme swings from idealization to demonization Emotions are often inappropriate and excessive, leading to confusion with histrionic personality disorder The frequency of this disorder in women is nearly three times greater than in men

Causes of Personality Disorders Learning Objective 32.6 Describe symptoms and causes of personality disorders. . Cognitive-behavioral theorists believe specific behavior can be learned over time through the processes of reinforcement, shaping, and modeling Close biological relatives of people with disorders such as antisocial, schizotypal, and borderline are more likely to have these disorders Social relationships, and parenting-related factors, such as childhood abuse, neglect, overly strict parenting, are all possible causes

Factors: Psychological Disorders Learning Objective 32.7 Discuss how different factors influence an individual’s experience of psychological disorders. Environmental influences such as parenting and social relationships Stress and negativity experienced as a result of poverty Other factors: academic failure, family conflict, personal tragedies, child abuse, and neglect