1. Psychology 2e
Chapter 13
Psychological Disorders

2. Module 31 Defining Abnormal Behavior

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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?

12. 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)

13. 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

14. 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

15. 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

16. 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)

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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).

25. 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

26. 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

27. Module 32 Types of Psychological Disorders

28. Learning Objectives
32.1 Describe symptoms and causes of anxiety disorders Describe symptoms and causes of dissociative disorders Describe symptoms and causes of mood disorders Describe symptoms and causes of eating disorders Describe symptoms and causes of schizophrenia Describe symptoms and causes of personality disorders Discuss how different factors influence an individual’s experience of psychological disorders.

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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”

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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

51. 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

52. 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

53. 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).

54. 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

55. 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

56. 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

57. 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

58. 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