1. Chapter 12 The Psychological Disorders
General Psychology
Chapter 12
The Psychological Disorders
Bring 140 copies of “Is this normal?”. Bring copies of “What’s the diagnosis?”. The brain teaching module--- Multiple Personality Disorder-- #

2. What is “Abnormal”?
Abnormal refers to maladaptive affects, behaviors, and/or cognitions that are at odds with social expectations and result in distress or discomfort
What may be abnormal and disordered in one culture or social situation may be viewed as normal and commonplace in another.

3. Classifying Abnormal Reactions
Diagnosis – act of recognizing a disorder on the basis of a specified set of symptoms
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
DSM-IV lists 297 different diagnostic categories
1883, Emil Kraepelin –first classifications scheme for “mental disturbances.”
The APA published its system for classifying psychological disorders “The Diagnostic and Statistical Manual of Mental Disorders (DSM).” Except for known biological factors, the manual attempts to avoid reference to etiology (or causes) of disorders. The system is important for adequate communication concerning disorders.

4. Table 12.1: The multiaxial classification system of the DSM-IV-TR.

5. Problems with Classification & Labeling
Comorbidity – occurrence of two or more disorders in the same individual
Nearly 80% will have 2 or more disorders
Many psychological disorders are also comorbid with physical illness
The DSM-IV refers only to disordered behaviors, not to disordered people!
Labels do not explain behavior and may stick long after the symptoms have gone. For those suffering any disorder in his or her lifetime, nearly 80% will have two or more disorders.

6. A Word on “Insanity” Insanity:
One did not know or fully understand the consequences of his or her actions at a given time
Could not discern the difference between right and wrong
And was unable to exercise control over his or her actions at the time a crime was committed
FIRST–Insanity is a legal term NOT a psychological one.

7. A Word on “Insanity”
Competence – whether one is in control of his or her mental and intellectual functions to understand courtroom procedures and aid in his or her own defense
A related issue is competence.

8. A Few Cautions… “Abnormal” and “normal” are not 2 distinct categories!
Abnormal does not mean dangerous
People jailed for violent crimes are no more likely to have a psychological disorder than not-jailed persons
Persons with psychological disorders are more likely (than persons without) to be victims of violent crimes
Abnormal also does not mean BAD!
Also, psychological disorders may occur in mild and moderate forms.

9. Anxiety Disorders
Anxiety – feeling of general apprehension or dread accompanied by predictable physiological changes
Anxiety disorders are the most common of all the psychological disorders affecting 13.3% (19.1 million persons) in the U.S. aged They are diagnosed 2-3 times more in women than men.

10. Anxiety Disorders
Generalized anxiety disorder – major symptom is distressing, felt anxiety
Anxiety may be intense or diffuse
Anxiety can cause substantial interference
People with this disorder may be prone to drug and alcohol abuse.

11. Anxiety Disorders
Panic Disorder – major symptom is more acute: a recurrent, unpredictable, unprovoked onset of sudden, intense anxiety, or a “panic attack”
Comorbid with depression = higher rate of suicide
Onset is usually between adolescence and the mid-twenties. A comorbid diagnosis of depression significantly increases the rate of suicide and suicide attempts.

12. Anxiety Disorders
Phobic disorder – persistent and excessive fear of some object, activity, or situation that consistently leads a person to avoid that object, activity, or situation
Specific phobia
Social phobia
Agoraphobia
Specific phobias include fear of animals, the physical environment, blood, injection, injury, or a specific situation. Social phobias are significant and persistent fears of social or performance situations in which embarrassment might occur. The prognosis (prediction of the future course of the disorder) is good for phobic disorders, but few seek professional assistance. Agoraphobia–fear of open places–is exaggerated fear of venturing out into the world alone.

13. Table 12.2: A sample of phobias.
Some are relatively common (agoraphobia, claustrophobia, pathopobia, nyctophobia, zoohobia), the others are quite rare.
Table 12.2: A sample of phobias.

14. Obsessive-Compulsive Disorder
OCD – anxiety disorder characterized by a pattern of recurrent obsessions and compulsions
Obsessions – ideas or thoughts that involuntarily and constantly intrude into awareness
Compulsions – constantly intruding, repetitive, behaviors
As many as 5 million Americans are affected. The most commonly reported obsessions are primarily about pointless thoughts, such as cleanliness, violence, and disease. Most common compulsions are hand-washing, grooming, and counting or checking behaviors (such as checking to see whether the door is really locked). People with OCD KNOW that their behaviors are senseless and unreasonable, but they cannot stop them!

15. (From the website of the Obsessive-Compulsive Foundation, www
(From the website of the Obsessive-Compulsive Foundation, retrieved July, 2003.)
Table 12.3: A few of the more common obsessions and compulsions found in patients with OCR.

16. Posttraumatic Stress Disorder
PTSD – distressing symptoms that arise some time after the experience of a highly traumatic event
Must have experienced, witnessed, or been confronted with an event that involves actual or threatened death or serious injury
Responses involve fear, helplessness, and horror
Flashbacks, Avoidance, Increased Arousal
Three additional clusters of symptoms include re-experiencing the event via flashbacks or nightmares, avoidance of possible reminders of the event, and increased arousal or hyper-alertness. Estimates of the lifetime prevalence of PTSD range from about 2-8% of the population.

17. Somatoform Disorders
Somatoform disorders – involve physical, bodily symptoms or complaints with no known medical or biological cause for the symptoms

18. Somatoform Disorders
Hypochondriasis – preoccupied with the fear of a serious disease
Somatization disorder – several, recurrent, long-lasting complaints about physical symptoms for which there is no cause
Conversion disorder – loss or altering of physical functioning that suggests a physical disorder, but without medical explanation. La belle indifference
Hypochondriasis–persons with this disorder are unusually aware of every ache and pain. It affects men and women equally.
Conversion disorder is very rare. Usually, there is paralysis, blindness, or deafness. One remarkable symptom of conversion disorder (which occurs in some patients) is known as la belle indifference, a seemingly inappropriate lack of concern over one’s condition. The Greeks knew this disorder and they called it Hysteria. This disorder intrigued Freud and it led him to develop a new method of therapy.

19. Dissociative Disorders
Dissociative disorders – person seeks to escape from some aspect of life or personality seen as the source of stress, discomfort, or anxiety

20. Dissociative Disorders
Dissociative amnesia – inability to recall important personal information too extensive to be explained by ordinary forgetfulness
Dissociative fugue – amnesic forgetfulness is accompanied by a change of location
What is forgotten is often a traumatic incident and some or all of the experiences that led up to it. There is no medical explanation for the loss of memory. These cases tend to be more common in wartime.

21. Dissociative Identity Disorder
Major symptom is the existence within the same person of two or more distinct personalities or traits
Dramatic and extreme personality changes
Take place without warning or provocation
Which personality will be dominant cannot be predicted or controlled
Child/sexual abuse
Commonly known as multiple personality disorder. People with this disorder often have been the victims of child or sexual abuse.
Diagnosis is rarely made in other countries.

22. Personality Disorders
Long-lasting patterns of perceiving, relating to, and thinking about the environment and oneself that are maladaptive and inflexible and cause either impaired functioning or distress

23. Personality Disorders
Cluster I – includes disorders of odd or eccentric reactions, such as:
Paranoid personality disorder – extreme sensitivity, unjustified suspiciousness, envy, and mistrust of others
Schizoid personality disorder – inability to form, and an indifference to, personal relationships

24. Personality Disorders
Cluster II – disorders of dramatic, emotional, or erratic reactions, such as:
Histrionic personality disorder – someone who is overly dramatic, reactive, and demonstrates intensely expressed behavior
Narcissistic personality disorder – reflects a grandiose exaggeration of self-importance, a need for attention or admiration, and a tendency to set unrealistic goals

25. Personality Disorders
Cluster III – disorders involving anxiety and fearfulness, such as:
Avoidant personality disorder – an over-sensitivity to the possibility of being rejected by others and an unwillingness to enter into relationships for fear of being rejected
Dependent personality disorder – allowing and seeking others to dominate and assume responsibility for action; has poor self-image and lacks self-confidence
Unfortunately, the prognosis for the personality disorders is poor! In this case, prognosis is unlikelihood to recover!

26. Personality Disorder
Antisocial personality disorder – an exceptional lack of regard for the rights and properties of others, accompanied by impulsive, often criminal, behaviors
Psychopaths/Sociopaths
Symptoms include deceit and manipulation of others without guilt or regret
More common among persons of low-SES
When someone says “sociopath,” they are communicating the same sentiment. People with this disorder used to be called that. More common in low-SES where people live in an urban setting and have a history of symptoms dating back to childhood. Although the disorder is very resistant to treatment, there is evidence of a burnout factor when these people reach their 40s.

27. Alzheimer’s Dementia
Dementia – condition characterized by the marked loss of intellectual abilities
Alzheimer’s disease – slow deterioration of intellectual functioning accompanied by personality changes
Physical disease
Abnormal changes in brain tissue
It is a disorder that is becoming increasingly more common. About 7 million in North America have been diagnosed with Alzheimer’s. In the year 2000, there were 4.5 million. By the year 2050, that number is estimated to be 13.2 million. Diagnosed with certainty at autopsy.

28. Table 12.4: Ten warning signs of Alzheimer’s disease.

29. Alzheimer’s Dementia Risk Factors for Alzheimer’s:
There is a genetic predisposition!
Obesity
Receiving a head injury

30. Alzheimer’s Dementia Possibly reduces chances of Alzheimer’s:
Using folic acid in one’s diet
Engaging in cognitively challenging activities in old age

31. Mood Disorders
Major depression – diagnosis for a constellation of symptoms that includes feeling sad, low, and hopeless, coupled with a loss of pleasure or interest in most normal activities
Dysthymia – mild case of major depression, but it tends to be more chronic, or continuous
With mood disorders, the intensity or extreme nature of one’s mood is the major symptom.

32. Mood Disorders
Bipolar Disorder – episodes of depression are occasionally interspersed with episodes of mania
Mania – elevated mood with feelings of euphoria or irritability and increased levels of activity
Still referred to as “manic depression.”

33. The Roots of Depression
There is evidence for a genetic, or inherited, predisposition to bipolar mood disorder
Researchers suspect that there is a genetic basis for major depression, as well

34. The Roots of Depression
Diathesis-stress model – the expression of disordered behaviors (particularly depression) results from the interaction of an inherited predisposition and the experience of stress or trauma
Biogenic amines
Brain anatomy
Some neurotransmitters, collectively referred to as biogenic amines, appear to influence mood. Also, brain anatomy appears to be different for some of the individual disorders.

35. The Roots of Depression
Psychological Factors
These could include learning experiences, situational stress, and cognitive factors
Freud believed that depression was a reflection of early childhood experiences that leads to anger directed inwardly
Women are twice as likely as men to be diagnosed with mood disorders.

36. Schizophrenia
Involves a distortion of reality and a retreat from other people.
Three dimensions of symptoms:
Negative symptoms – emotional and social withdrawal, reduced energy and motivation, apathy and poor attention
Around the world it affects the same rate of the population, about 1%. Involves disturbances in affect, behavior, and cognition.

37. Schizophrenia 2. Positive symptoms:
Hallucinations – false perceptions
Delusions – false beliefs
3. Positive disorganized symptoms – disorders of thinking and speech, bizarre behaviors, inappropriate affect

38. Schizophrenia: Correlates of Negative Symptoms
Structural abnormalities in the brain
Clearer genetic basis
More severe complications at birth
A lower educational level
Poorer adjustment patterns before onset
Poorer prognosis

39. Schizophrenia: Correlates of Positive Symptoms
Excesses of the neurotransmitter dopamine
Relatively normal brain configuration
Severe disruptions in early family life
Overactivity and aggressiveness in adolescence
Relatively good response to treatment
However, not all of the data on typing schizophrenia have been supportive.

40. Table 12.5: Classifying schizophrenia on the basis of negative and positive symptoms.

41. Schizophrenia DSM-IV Subtypes: Catatonic Disorganized Paranoid
Undifferentiated

42. Table 12.6: Types of schizophrenia described in the DSM-IV-TR.

43. What Causes Schizophrenia?
It has a genetic basis
It is a disease of the brain
Excess dopamine
Diathesis-stress model
Consensus that it is a complex disease of the brain, not a “disorder of living”
It has a genetic basis (though not as clearly so as mood disorders). The role of excess dopamine in the brain is being investigated.

44. Spotlight: Disorder, Race, and Gender
African Americans are:
More likely to suffer from phobias and somatoform disorders than are Caucasian Americans
Less likely to suffer from depression, dysthymia, obsessive-compulsive, and anti-social personality disorder
Less likely to seek professional help
There are no differences among racial/ethnic groups in the overall incidence of psychological disorders.

45. Spotlight: Disorder, Race, and Gender
Asian Americans report higher incidents of social anxiety and social phobias
When Native Americans experience a psychological disturbance, it is usually depression, posttraumatic stress disorder, or alcohol-related.
D. E.

46. Spotlight: Disorder, Race, and Gender
Women are significantly more likely to be diagnosed with depression
Men are more likely to be diagnosed with antisocial personality disorder