1. Comer, Abnormal Psychology, 6e – Chapter 14 1 Chapter 14 Schizophrenia Slides & Handouts by Karen Clay Rhines, Ph.D. Seton Hall University

2. 2Comer, Abnormal Psychology, 6e – Chapter 14 Psychosis Psychosis is a state defined by a loss of contact with reality Psychosis is a state defined by a loss of contact with reality The ability to perceive and respond to the environment is significantly disturbed; functioning is impaired The ability to perceive and respond to the environment is significantly disturbed; functioning is impaired Symptoms may include hallucinations (false sensory perceptions) and/or delusions (false beliefs) Symptoms may include hallucinations (false sensory perceptions) and/or delusions (false beliefs) Psychosis may be substance-induced or caused by brain injury, but most psychoses appear in the form of schizophrenia Psychosis may be substance-induced or caused by brain injury, but most psychoses appear in the form of schizophrenia

3. 3Comer, Abnormal Psychology, 6e – Chapter 14 Schizophrenia Schizophrenia appears to have been present in humans throughout history Schizophrenia appears to have been present in humans throughout history The disorder has a severe impact on people’s functioning and on the health care system The disorder has a severe impact on people’s functioning and on the health care system

4. 4Comer, Abnormal Psychology, 6e – Chapter 14 Schizophrenia Schizophrenia affects approximately 1 in 100 people in the world Schizophrenia affects approximately 1 in 100 people in the world About 2.5 million Americans currently have the disorder About 2.5 million Americans currently have the disorder The financial and emotional costs are enormous The financial and emotional costs are enormous One estimate is greater than $100 billion per year One estimate is greater than $100 billion per year Sufferers have an increased risk of suicide and illness Sufferers have an increased risk of suicide and illness

5. 5Comer, Abnormal Psychology, 6e – Chapter 14 Schizophrenia Schizophrenia appears in all socioeconomic groups, but is found more frequently in the lower levels Schizophrenia appears in all socioeconomic groups, but is found more frequently in the lower levels Leading theorists argue that the stress of poverty causes the disorder Leading theorists argue that the stress of poverty causes the disorder Other theorists argue that the disorder causes victims from higher social levels to fall to lower social levels and remain at lower levels Other theorists argue that the disorder causes victims from higher social levels to fall to lower social levels and remain at lower levels This is called the “downward drift” theory This is called the “downward drift” theory

6. 6Comer, Abnormal Psychology, 6e – Chapter 14 Schizophrenia Equal numbers of men are women are diagnosed Equal numbers of men are women are diagnosed In men, symptoms begin earlier and are more severe In men, symptoms begin earlier and are more severe Rates of diagnosis differ by marital status Rates of diagnosis differ by marital status 3% of divorced or separated people 3% of divorced or separated people 2% of single people 2% of single people 1% of married people 1% of married people It is unclear whether marital problems are a cause or a result It is unclear whether marital problems are a cause or a result

7. 7Comer, Abnormal Psychology, 6e – Chapter 14 Schizophrenia Rates of the disorder differ by ethnicity and race Rates of the disorder differ by ethnicity and race About 2% of African Americans are diagnosed, compared with 1.4% of Caucasians About 2% of African Americans are diagnosed, compared with 1.4% of Caucasians According to the census, however, African Americans are also more likely to be poor and to experience marital separation According to the census, however, African Americans are also more likely to be poor and to experience marital separation When controlling for these factors, rates of schizophrenia become closer between the two racial groups When controlling for these factors, rates of schizophrenia become closer between the two racial groups Rates also differ between countries, as do the course and outcome of the disorder Rates also differ between countries, as do the course and outcome of the disorder

8. 8Comer, Abnormal Psychology, 6e – Chapter 14 The Clinical Picture of Schizophrenia Schizophrenia produces many “clinical pictures” Schizophrenia produces many “clinical pictures” The symptoms, triggers, and course of schizophrenia vary greatly The symptoms, triggers, and course of schizophrenia vary greatly Some clinicians have argued that schizophrenia is actually a group of distinct disorders that share common features Some clinicians have argued that schizophrenia is actually a group of distinct disorders that share common features

9. 9Comer, Abnormal Psychology, 6e – Chapter 14 What Are the Symptoms of Schizophrenia? Symptoms can be grouped into three categories: Symptoms can be grouped into three categories: Positive symptoms Positive symptoms Negative symptoms Negative symptoms Psychomotor symptoms Psychomotor symptoms

10. 10Comer, Abnormal Psychology, 6e – Chapter 14 What Are the Symptoms of Schizophrenia? Positive symptoms Positive symptoms These “pathological excesses” are bizarre additions to a person’s behavior These “pathological excesses” are bizarre additions to a person’s behavior Positive symptoms include: Positive symptoms include: Delusions – faulty interpretations of reality Delusions – faulty interpretations of reality Delusions may have a variety of bizarre content: being controlled by others; persecution; reference; grandeur; control Delusions may have a variety of bizarre content: being controlled by others; persecution; reference; grandeur; control Disordered thinking and speech Disordered thinking and speech May include loose associations; neologisms; perseverations; and clang May include loose associations; neologisms; perseverations; and clang

11. 11Comer, Abnormal Psychology, 6e – Chapter 14 What Are the Symptoms of Schizophrenia? Examples of positive symptoms Examples of positive symptoms Loose associations: Loose associations: “The problem is insects. My brother used to collect insects. He’s now a man 5 foot 10 inches. You know, 10 is my favorite number; I also like to dance, draw, and watch TV.” “The problem is insects. My brother used to collect insects. He’s now a man 5 foot 10 inches. You know, 10 is my favorite number; I also like to dance, draw, and watch TV.” Neologisms: Neologisms: “This desk is a cramstile”; “He’s an easterhorned head” “This desk is a cramstile”; “He’s an easterhorned head” Clang: Clang: How are you? “Well, hell, it’s well to tell” How are you? “Well, hell, it’s well to tell” How’s the weather? “So hot, you know it runs on a cot” How’s the weather? “So hot, you know it runs on a cot”

12. 12Comer, Abnormal Psychology, 6e – Chapter 14 What Are the Symptoms of Schizophrenia? Examples of positive symptoms Examples of positive symptoms Heightened perceptions Heightened perceptions People may feel that their senses are being flooded by sights and sounds, making it impossible to attend to anything important People may feel that their senses are being flooded by sights and sounds, making it impossible to attend to anything important Hallucinations – faulty sensory perceptions Hallucinations – faulty sensory perceptions Most common are auditory Most common are auditory Generally involve a running commentary and/or accusations Generally involve a running commentary and/or accusations Spoken directly to or overheard by the hallucinator Spoken directly to or overheard by the hallucinator Hallucinations can involve any of the other senses: tactile, somatic, visual, gustatory, or olfactory Hallucinations can involve any of the other senses: tactile, somatic, visual, gustatory, or olfactory Inappropriate affect Inappropriate affect

13. 13Comer, Abnormal Psychology, 6e – Chapter 14 What Are the Symptoms of Schizophrenia? Negative symptoms Negative symptoms These “pathological deficits” are characteristics that are lacking in an individual These “pathological deficits” are characteristics that are lacking in an individual Negative symptoms include: Negative symptoms include: Poverty of speech (alogia) Poverty of speech (alogia) Long lapses before responding to questions, or failure to answer Long lapses before responding to questions, or failure to answer Reduction of quantity of speech Reduction of quantity of speech Slow speech Slow speech Blunted and flat affect Blunted and flat affect

14. 14Comer, Abnormal Psychology, 6e – Chapter 14 What Are the Symptoms of Schizophrenia? Examples of negative symptoms Examples of negative symptoms Blunted and flat affect Blunted and flat affect Avoidance of eye contact Avoidance of eye contact Immobile, expressionless face Immobile, expressionless face Lack of emotion when discussing emotional material Lack of emotion when discussing emotional material Apathetic and uninterested Apathetic and uninterested Monotonous voice, low and difficult to hear Monotonous voice, low and difficult to hear

15. 15Comer, Abnormal Psychology, 6e – Chapter 14 What Are the Symptoms of Schizophrenia? Examples of negative symptoms Examples of negative symptoms Loss of volition (motivation or directedness) Loss of volition (motivation or directedness) Feeling drained of energy and interest in normal goals Feeling drained of energy and interest in normal goals Inability to start or follow through on a course of action Inability to start or follow through on a course of action Social withdrawal Social withdrawal Withdrawal from social environment Withdrawal from social environment Seems to lead to a breakdown of social skills, including the ability to accurately recognize other people’s needs and emotions Seems to lead to a breakdown of social skills, including the ability to accurately recognize other people’s needs and emotions

16. 16Comer, Abnormal Psychology, 6e – Chapter 14 What Are the Symptoms of Schizophrenia? Psychomotor symptoms Psychomotor symptoms People with schizophrenia sometimes experience psychomotor symptoms People with schizophrenia sometimes experience psychomotor symptoms Awkward movements, repeated grimaces, odd gestures Awkward movements, repeated grimaces, odd gestures The movements seem to have a magical quality The movements seem to have a magical quality These symptoms may take extreme forms, collectively called catatonia These symptoms may take extreme forms, collectively called catatonia Includes stupor, rigidity, posturing, and excitement Includes stupor, rigidity, posturing, and excitement

17. 17Comer, Abnormal Psychology, 6e – Chapter 14 What Is the Course of Schizophrenia? Schizophrenia usually first appears between the late teens and mid-30s Schizophrenia usually first appears between the late teens and mid-30s Many sufferers experience three phases: Many sufferers experience three phases: Prodromal – beginning of deterioration; mild symptoms Prodromal – beginning of deterioration; mild symptoms Active – symptoms become increasingly apparent Active – symptoms become increasingly apparent Residual – a return to prodromal levels Residual – a return to prodromal levels One-quarter of patients fully recover; three-quarters continue to have residual problems One-quarter of patients fully recover; three-quarters continue to have residual problems

18. 18Comer, Abnormal Psychology, 6e – Chapter 14 What Is the Course of Schizophrenia? Each phase of the disorder may last for days or years Each phase of the disorder may last for days or years A fuller recovery from the disorder is more likely in people: A fuller recovery from the disorder is more likely in people: With high premorbid functioning With high premorbid functioning Whose disorder was triggered by stress Whose disorder was triggered by stress With rapid onset With rapid onset With later onset With later onset

19. 19Comer, Abnormal Psychology, 6e – Chapter 14 Diagnosing Schizophrenia The DSM-IV-TR calls for a diagnosis only after signs of the disorder continue for six months or more The DSM-IV-TR calls for a diagnosis only after signs of the disorder continue for six months or more People must also show a deterioration in their work, social relations, and ability to care for themselves People must also show a deterioration in their work, social relations, and ability to care for themselves

20. 20Comer, Abnormal Psychology, 6e – Chapter 14 Diagnosing Schizophrenia The DSM-IV-TR distinguishes five subtypes: The DSM-IV-TR distinguishes five subtypes: Disorganized – characterized by confusion, incoherence, and flat or inappropriate affect Disorganized – characterized by confusion, incoherence, and flat or inappropriate affect Catatonic – characterized by psychomotor disturbance of some sort Catatonic – characterized by psychomotor disturbance of some sort Paranoid – characterized by an organized system of delusions and auditory hallucinations Paranoid – characterized by an organized system of delusions and auditory hallucinations Undifferentiated – characterized by symptoms which fit no subtype; vague category Undifferentiated – characterized by symptoms which fit no subtype; vague category Residual – characterized by symptoms which have lessened in strength and number; person may continue to display blunted or inappropriate emotions Residual – characterized by symptoms which have lessened in strength and number; person may continue to display blunted or inappropriate emotions

21. 21Comer, Abnormal Psychology, 6e – Chapter 14 How Do Theorists Explain Schizophrenia? While there is no known cause, research has focused on: While there is no known cause, research has focused on: Biological factors (most promising) Biological factors (most promising) Psychological factors Psychological factors Sociocultural factors Sociocultural factors A diathesis-stress relationship may be at work A diathesis-stress relationship may be at work People with a biological predisposition will develop schizophrenia only if certain kinds of stressors or events are also present People with a biological predisposition will develop schizophrenia only if certain kinds of stressors or events are also present

22. 22Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Genetic and biological studies of schizophrenia have dominated clinical research in the last several decades Genetic and biological studies of schizophrenia have dominated clinical research in the last several decades These studies have revealed the key roles of inheritance and brain activity and have opened the door for changes in treatment These studies have revealed the key roles of inheritance and brain activity and have opened the door for changes in treatment

23. 23Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Genetic factors Genetic factors Following the principles of a diathesis-stress approach, genetic researchers believe that some people inherit a biological predisposition to schizophrenia Following the principles of a diathesis-stress approach, genetic researchers believe that some people inherit a biological predisposition to schizophrenia This disposition (and disorder) are triggered by later exposure to stress This disposition (and disorder) are triggered by later exposure to stress This theory has been supported by studies of relatives, twins, and adoptees, and by genetic linkage studies This theory has been supported by studies of relatives, twins, and adoptees, and by genetic linkage studies

24. 24Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Genetic factors Genetic factors Family pedigree studies have repeatedly shown that schizophrenia is more common among relatives of people with the disorder Family pedigree studies have repeatedly shown that schizophrenia is more common among relatives of people with the disorder The more closely related they are to the person with schizophrenia, the greater their likelihood for developing the disorder The more closely related they are to the person with schizophrenia, the greater their likelihood for developing the disorder General population: 1% General population: 1% Second-degree relatives: 3% Second-degree relatives: 3% First-degree relatives: 10% First-degree relatives: 10% Factors other than genetics may explain these findings Factors other than genetics may explain these findings

25. 25Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Genetic factors Genetic factors Twins have received particular research study Twins have received particular research study Studies of identical twins have found that if one twin develops the disorder, there is a 48% chance that the other twin will do so as well Studies of identical twins have found that if one twin develops the disorder, there is a 48% chance that the other twin will do so as well If the twins are fraternal, the second twin has a 17% chance of developing the disorder If the twins are fraternal, the second twin has a 17% chance of developing the disorder Again, factors other than genetics may explain these findings Again, factors other than genetics may explain these findings

26. 26Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Genetic factors Genetic factors Adoption studies have compared adults with schizophrenia who were adopted as infants with both their biological and adoptive relatives Adoption studies have compared adults with schizophrenia who were adopted as infants with both their biological and adoptive relatives Because they were reared apart from their biological relatives, similar symptoms in those relatives would indicate genetic influences; similarities to their adoptive relatives would suggest environmental influences Because they were reared apart from their biological relatives, similar symptoms in those relatives would indicate genetic influences; similarities to their adoptive relatives would suggest environmental influences Researchers have repeatedly found that the biological relatives of adoptees with schizophrenia are more likely to display schizophrenic symptoms than are their adoptive relatives Researchers have repeatedly found that the biological relatives of adoptees with schizophrenia are more likely to display schizophrenic symptoms than are their adoptive relatives

27. 27Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Genetic factors Genetic factors Genetic linkage and molecular biology studies indicate that possible gene defects on numerous chromosomes may predispose individuals to develop schizophrenia Genetic linkage and molecular biology studies indicate that possible gene defects on numerous chromosomes may predispose individuals to develop schizophrenia These varied findings may indicate: These varied findings may indicate: A case of “mistaken identity” -- that is, some of these gene sites do not contribute to the disorder; A case of “mistaken identity” -- that is, some of these gene sites do not contribute to the disorder; Various types of schizophrenia are linked to different genes; or Various types of schizophrenia are linked to different genes; or Schizophrenia, like many disorders, is a polygenic disorder, caused by a combination of gene defects Schizophrenia, like many disorders, is a polygenic disorder, caused by a combination of gene defects

28. 28Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Genetic factors Genetic factors Genetic factors may lead to the development of schizophrenia through two kinds of (potentially inherited) biological abnormalities: Genetic factors may lead to the development of schizophrenia through two kinds of (potentially inherited) biological abnormalities: Biochemical abnormalities Biochemical abnormalities Abnormal brain structure Abnormal brain structure

29. 29Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Biochemical abnormalities Biochemical abnormalities One promising theory is the dopamine hypothesis: One promising theory is the dopamine hypothesis: Neurons using dopamine fire too often, producing symptoms of schizophrenia Neurons using dopamine fire too often, producing symptoms of schizophrenia This theory is based on the effectiveness of antipsychotic medications (dopamine antagonists) This theory is based on the effectiveness of antipsychotic medications (dopamine antagonists)

30. 30Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Biochemical abnormalities Biochemical abnormalities Originally developed for treatment of allergies, antipsychotic drugs were found to cause a Parkinson’s disease-like tremor response in patients Originally developed for treatment of allergies, antipsychotic drugs were found to cause a Parkinson’s disease-like tremor response in patients Scientists knew that Parkinson’s patients had abnormally low levels of dopamine which caused their shaking Scientists knew that Parkinson’s patients had abnormally low levels of dopamine which caused their shaking This relationship between symptoms suggested that symptoms of schizophrenia were related to excess dopamine This relationship between symptoms suggested that symptoms of schizophrenia were related to excess dopamine

31. 31Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Biochemical abnormalities Biochemical abnormalities Research since the 1960s has supported and clarified this hypothesis Research since the 1960s has supported and clarified this hypothesis Example: patients with Parkinson’s develop schizophrenic symptoms if they take too much L-dopa, a medication that raises dopamine levels Example: patients with Parkinson’s develop schizophrenic symptoms if they take too much L-dopa, a medication that raises dopamine levels Example: people who take high doses of amphetamines, which increase dopamine activity in the brain, may develop amphetamine psychosis – a syndrome similar to schizophrenia Example: people who take high doses of amphetamines, which increase dopamine activity in the brain, may develop amphetamine psychosis – a syndrome similar to schizophrenia

32. 32Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Biochemical abnormalities Biochemical abnormalities Investigators have also located the dopamine receptors to which antipsychotic drugs bind Investigators have also located the dopamine receptors to which antipsychotic drugs bind The drugs are apparently dopamine antagonists which bind to the receptors, preventing further dopamine binding and neuron firing The drugs are apparently dopamine antagonists which bind to the receptors, preventing further dopamine binding and neuron firing These findings suggest that, in schizophrenia, messages traveling from dopamine-sending neurons to dopamine- receptors (particularly D-2) may be transmitted too easily or too often These findings suggest that, in schizophrenia, messages traveling from dopamine-sending neurons to dopamine- receptors (particularly D-2) may be transmitted too easily or too often An appealing theory because certain dopamine receptors are known to play a role in guiding attention An appealing theory because certain dopamine receptors are known to play a role in guiding attention

33. 33Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Biochemical abnormalities Biochemical abnormalities Dopamine may be overactive in people with schizophrenia because of a larger-than-usual number of dopamine receptors (particularly D-2) Dopamine may be overactive in people with schizophrenia because of a larger-than-usual number of dopamine receptors (particularly D-2) Autopsy findings have found an unusually large number of dopamine receptors in people with schizophrenia Autopsy findings have found an unusually large number of dopamine receptors in people with schizophrenia

34. 34Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Biochemical abnormalities Biochemical abnormalities Though enlightening, the dopamine hypothesis has limitations Though enlightening, the dopamine hypothesis has limitations It has been challenged by the discovery of a new type of antipsychotic drug (“atypical” antipsychotics) that are more effective than traditional antipsychotics and also bind to serotonin receptors It has been challenged by the discovery of a new type of antipsychotic drug (“atypical” antipsychotics) that are more effective than traditional antipsychotics and also bind to serotonin receptors It has also been challenged by theorists who claim that excessive dopamine activity contributes primarily to the positive symptoms of schizophrenia It has also been challenged by theorists who claim that excessive dopamine activity contributes primarily to the positive symptoms of schizophrenia These symptoms respond particularly well to conventional antipsychotic drugs These symptoms respond particularly well to conventional antipsychotic drugs

35. 35Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Abnormal brain structure Abnormal brain structure During the past decade, researchers have also linked schizophrenia (particularly cases dominated by negative symptoms) to abnormalities in brain structure During the past decade, researchers have also linked schizophrenia (particularly cases dominated by negative symptoms) to abnormalities in brain structure For example, brain scans have found that many people with schizophrenia have enlarged ventricles For example, brain scans have found that many people with schizophrenia have enlarged ventricles This enlargement may be a sign of poor development in related brain regions This enlargement may be a sign of poor development in related brain regions People with schizophrenia have also been found to have smaller temporal and frontal lobes, and abnormal blood flow to certain brain areas People with schizophrenia have also been found to have smaller temporal and frontal lobes, and abnormal blood flow to certain brain areas

36. 36Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views Viral problems Viral problems A growing number of researchers suggest that the brain abnormalities seen in schizophrenia result from exposure to viruses before birth A growing number of researchers suggest that the brain abnormalities seen in schizophrenia result from exposure to viruses before birth Circumstantial evidence for this theory comes from the unusually large number of people with schizophrenia born in winter months Circumstantial evidence for this theory comes from the unusually large number of people with schizophrenia born in winter months More direct evidence comes from studies showing that mothers of children with schizophrenia were more often exposed to the influenza virus during pregnancy than mothers of children without schizophrenia More direct evidence comes from studies showing that mothers of children with schizophrenia were more often exposed to the influenza virus during pregnancy than mothers of children without schizophrenia Other studies have found a link between schizophrenia and a particular group of viruses found in animals Other studies have found a link between schizophrenia and a particular group of viruses found in animals

37. 37Comer, Abnormal Psychology, 6e – Chapter 14 Biological Views While the biochemical, brain structure, and viral findings are beginning to shed much light on the mysteries of schizophrenia, they offer only a partial explanation While the biochemical, brain structure, and viral findings are beginning to shed much light on the mysteries of schizophrenia, they offer only a partial explanation Some people who have these biological problems never develop schizophrenia Some people who have these biological problems never develop schizophrenia May be because biology sets the stage for the disorder, but psychological and sociocultural factors must be present for it to appear May be because biology sets the stage for the disorder, but psychological and sociocultural factors must be present for it to appear

38. 38Comer, Abnormal Psychology, 6e – Chapter 14 Psychological Views As schizophrenia investigators began to identify genetic and biological factors of schizophrenia, clinicians largely abandoned psychological theories As schizophrenia investigators began to identify genetic and biological factors of schizophrenia, clinicians largely abandoned psychological theories In the past decade, however, psychological factors are again being considered important In the past decade, however, psychological factors are again being considered important Leading psychological explanations come from the psychodynamic, behavioral, and cognitive perspectives Leading psychological explanations come from the psychodynamic, behavioral, and cognitive perspectives

39. 39Comer, Abnormal Psychology, 6e – Chapter 14 Psychological Views The psychodynamic explanation The psychodynamic explanation Freud believed that schizophrenia developed from two processes: Freud believed that schizophrenia developed from two processes: Regression to a pre-ego stage Regression to a pre-ego stage Efforts to re-establish ego control Efforts to re-establish ego control He proposed that when their world is extremely harsh, people who develop schizophrenia regress to the earliest points in their development (primary narcissism), in which they recognize and meet only their own needs He proposed that when their world is extremely harsh, people who develop schizophrenia regress to the earliest points in their development (primary narcissism), in which they recognize and meet only their own needs This regression leads to self-centered symptoms such as neologisms, loose associations, and delusions of grandeur This regression leads to self-centered symptoms such as neologisms, loose associations, and delusions of grandeur

40. 40Comer, Abnormal Psychology, 6e – Chapter 14 Psychological Views The psychodynamic explanation The psychodynamic explanation Freud’s theory posits that attempts to reestablish ego control from such a state fail and lead to further schizophrenic symptoms Freud’s theory posits that attempts to reestablish ego control from such a state fail and lead to further schizophrenic symptoms Years later, another psychodynamic theorist elaborated on Freud’s idea of harsh parents Years later, another psychodynamic theorist elaborated on Freud’s idea of harsh parents The theory of schizophrenogenic mothers proposed that mothers of people with schizophrenia were cold, domineering, and uninterested in their children’s needs The theory of schizophrenogenic mothers proposed that mothers of people with schizophrenia were cold, domineering, and uninterested in their children’s needs Both of these theories have received little research support and have been rejected by most psychodynamic theorists Both of these theories have received little research support and have been rejected by most psychodynamic theorists

41. 41Comer, Abnormal Psychology, 6e – Chapter 14 Psychological Views The behavioral view The behavioral view Behaviorists cite operant conditioning and principles of reinforcement as the cause of schizophrenia Behaviorists cite operant conditioning and principles of reinforcement as the cause of schizophrenia They propose that some people are not reinforced for their attention to social cues and, as a result, they stop attending to those cues and focus instead on irrelevant cues (e.g., room lighting) They propose that some people are not reinforced for their attention to social cues and, as a result, they stop attending to those cues and focus instead on irrelevant cues (e.g., room lighting) Their responses become increasingly bizarre Their responses become increasingly bizarre Support for this model has been circumstantial and the view is considered (at best) a partial explanation Support for this model has been circumstantial and the view is considered (at best) a partial explanation

42. 42Comer, Abnormal Psychology, 6e – Chapter 14 Psychological Views The cognitive view The cognitive view Leading cognitive theorists agree that biological factors produce symptoms Leading cognitive theorists agree that biological factors produce symptoms They theorize that further features of the disorder develop because of faulty interpretation and a misunderstanding of symptoms They theorize that further features of the disorder develop because of faulty interpretation and a misunderstanding of symptoms Example: a man experiences auditory hallucinations and approaches his friends for help; they deny the reality of his sensations; he concludes that they are trying to hide the truth from him; he begins to reject all feedback and starts feeling persecuted Example: a man experiences auditory hallucinations and approaches his friends for help; they deny the reality of his sensations; he concludes that they are trying to hide the truth from him; he begins to reject all feedback and starts feeling persecuted There is little direct research support for this view There is little direct research support for this view

43. 43Comer, Abnormal Psychology, 6e – Chapter 14 Sociocultural Views Sociocultural theorists believe that people with mental disorders are victims of two main social forces: Sociocultural theorists believe that people with mental disorders are victims of two main social forces: Social labeling Social labeling Family dysfunction Family dysfunction Although social and family forces are considered important in the development of schizophrenia, research has not yet clarified what their precise relationships might be Although social and family forces are considered important in the development of schizophrenia, research has not yet clarified what their precise relationships might be

44. 44Comer, Abnormal Psychology, 6e – Chapter 14 Sociocultural Views Social labeling Social labeling Many sociocultural theorists believe that the features of schizophrenia are influenced by the diagnosis itself Many sociocultural theorists believe that the features of schizophrenia are influenced by the diagnosis itself Society labels people who fail to conform to certain norms of behavior Society labels people who fail to conform to certain norms of behavior Once assigned, the label becomes a self-fulfilling prophecy Once assigned, the label becomes a self-fulfilling prophecy The dangers of social labeling have been well demonstrated The dangers of social labeling have been well demonstrated Example: Rosenhan “pseudo-patient” study Example: Rosenhan “pseudo-patient” study

45. 45Comer, Abnormal Psychology, 6e – Chapter 14 Sociocultural Views Family dysfunctioning Family dysfunctioning One of the best-known family theories of schizophrenia is the double-bind hypothesis: One of the best-known family theories of schizophrenia is the double-bind hypothesis: Some parents repeatedly communicate pairs of mutually contradictory messages that place the child in so-called double-bind situations; the child cannot avoid displeasing the parents because nothing the child does is right Some parents repeatedly communicate pairs of mutually contradictory messages that place the child in so-called double-bind situations; the child cannot avoid displeasing the parents because nothing the child does is right In theory, the symptoms of schizophrenia represent the child’s attempt to deal with the double binds In theory, the symptoms of schizophrenia represent the child’s attempt to deal with the double binds

46. 46Comer, Abnormal Psychology, 6e – Chapter 14 Sociocultural Views Family dysfunctioning Family dysfunctioning Double-bind messages typically consist of a “primary” verbal communication and an accompanying contradictory nonverbal “metacommunication” Double-bind messages typically consist of a “primary” verbal communication and an accompanying contradictory nonverbal “metacommunication” According to the double-bind theory, a child repeatedly exposed to these communications will adopt a special strategy for coping with them and may progress toward paranoid schizophrenia According to the double-bind theory, a child repeatedly exposed to these communications will adopt a special strategy for coping with them and may progress toward paranoid schizophrenia This theory is closely related to the psychodynamic notion of a schizophrenogenic mother This theory is closely related to the psychodynamic notion of a schizophrenogenic mother It has been similarly unsupported by research, but is popular in clinical practice It has been similarly unsupported by research, but is popular in clinical practice

47. 47Comer, Abnormal Psychology, 6e – Chapter 14 Sociocultural Views Family dysfunctioning Family dysfunctioning A number of studies suggest that schizophrenia is often linked to family stress: A number of studies suggest that schizophrenia is often linked to family stress: Parents of people with the disorder often: Parents of people with the disorder often: Display more conflict Display more conflict Have greater difficulty communicating Have greater difficulty communicating Are more critical of and overinvolved with their children than other parents Are more critical of and overinvolved with their children than other parents Family theorists have long recognized that some families are high in “expressed emotion” – family members frequently express criticism and hostility and intrude on each other’s privacy Family theorists have long recognized that some families are high in “expressed emotion” – family members frequently express criticism and hostility and intrude on each other’s privacy Individuals who are trying to recover from schizophrenia are almost four times more likely to relapse if they live with such a family Individuals who are trying to recover from schizophrenia are almost four times more likely to relapse if they live with such a family

48. 48Comer, Abnormal Psychology, 6e – Chapter 14 Sociocultural Views A sociocultural-existential view A sociocultural-existential view Most controversial explanation of schizophrenia Most controversial explanation of schizophrenia Argues that the disorder is actually a constructive process in which people try to cure themselves of the confusion and unhappiness caused by their social environment Argues that the disorder is actually a constructive process in which people try to cure themselves of the confusion and unhappiness caused by their social environment Most theorists reject this notion; research has largely ignored it Most theorists reject this notion; research has largely ignored it