Chapter 12

Psychological Disorders

LECTURE OUTLINE

I. What Are Psychological Disorders?

A. Psychological disorders are behaviors or mental processes that are connected with various kinds of distress or disability.

B. Disorders are characterized on the following criteria:

1. They are unusual.

2. They suggest faulty perception or interpretation of reality.

a. Hearing voices, seeing things, hallucinations, ideas of persecution.

3. The person’s emotional response is inappropriate to the situation.

4. They are self-defeating.

5. They are dangerous.

6. The individual’s behavior is socially unacceptable.

C. Classifying Psychological Disorders.

1. The most widely used classification scheme for psychological disorders is the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association.

a. The current edition of the DSM is the DSM-IV-TR.

2. Concerns with the DSM-IV-TR

a. Reliability: different interviewers make the same diagnosis when they evaluate the same people.

b. Validity: diagnosis in the manual corresponds to clusters of behaviors seen in the real world.

i. Predictive validity: if the diagnosis is valid then we should be able to predict what will happen to the person over time.

D. Explaining Psychological Disorders

1. Biological Perspective: explains psychological disorders in terms of factors such as

a. Genetics

b. Evolution

c. Brain

d. Neurotransmitters

e. Hormones

2. Psychological Perspectives: focuses on behavior and mental processes in the description, origins, and treatment of psychological disorders.

a. Psychodynamic theory views disorders as symptoms of underlying unconscious processes that stem from childhood conflict

b. Behavioral perspective views disorders as reflecting the learning of maladaptive responses.

c. Cognitive perspective is deeply involved in the description and treatment of disorders by focusing on ways in which people develop or worsen their situation by blowing things out of proportion or blaming themselves

d. Humanistic theory believes that people can develop a variety of disorders when their tendency towards self-actualization is frustrated

e. Sociocultural perspective suggests that social ills such as poverty, racism and unemployment can contribute to the development of disorders.

3. Biopsychosocial Perspective combines various perspectives

E. Prevalence of Psychological Disorders

1. About half of us will meet the criteria for a DSM-IV disorder at some time or another in our lives

2. Slightly more than one-quarter will experience a disorder in a given year.

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II. Schizophrenia: When Thinking Runs Astray.

A. Schizophrenia is a severe psychological disorder that touches every aspect of a person’s life.

B. Positive Versus Negative Symptoms

1. Positive Symptoms are the excessive and bizarre symptoms including:

a. Hallucinations

b. Delusions

c. Looseness of association

2. Negative Symptoms are the deficiencies we find including:

a. Lack of emotional expression

b. Lack of motivation

c. Loss of pleasure in activities

d. Social withdrawal

e. Poverty of speech

3. Three dimensional Model

a. Psychotic dimension: delusions and hallucinations

b. Negative dimensions: flat affect, poverty in speech and thought

c. Disorganized dimension: inappropriate affect and disorganized thought and speech

C. Types of Schizophrenia: paranoid, disorganized, and catatonic.

1. Paranoid type: have systematized delusions and frequently related auditory hallucinations.

a. Usually the delusions are of grandeur and persecution including jealousy.

2. Disorganized type show incoherence, loosening of associations, disorganized behavior, disorganized delusions, fragmentary delusions or hallucinations, and flat or highly inappropriate emotional responses.

3. Catatonic type show striking impairment in motor activity.

a. Slowing of activity into a stupor that may suddenly change into an agitated phase.

b. Waxy flexibility in which the person maintains positions into which he or she has been manipulated by others.

D. Explaining Schizophrenia.

1. Biological Perspectives:

a. Schizophrenia appears to be a brain disorder.

i. Less gray matter

ii. Size of the ventricles in the brain.

iii. Smaller prefrontal regions of the cortex

iv. Activity levels in the brain.

v. Brain chemistry.

b. Heredity

i. Children with two schizophrenic parents have about a 35-40% chance of being diagnosed

ii. Twin studies found a 45% matching rate for identical twins; 17% among fraternal twins

c. Other contributors

i. Complications during pregnancy and birth

ii. Poor nutrition

iii. Born during the winter months

iv. Increased dopamine and increased numbers of dopamine receptors

2. Psychological Perspectives:

a. Learning theorists explain schizophrenia in terms of conditioning and observational learning.

i. Inner fantasies become more reinforcing than social realities.

b. Hospital staff pay more attention to patients who behave bizarrely.

3. Sociocultural Perspective

a. Social and cultural factors such as poverty, discrimination and overcrowding contribute to schizophrenia

b. Especially true among people with a genetic predisposition

c. Rates were twice as high among those of the low socio-economic level

i. Poor quality housing

d. Controversy in downward drift: is the schizophrenic patient influenced by these issues or because they have schizophrenia they experience these situations?

e. Quality of parenting

4. Biopsychosocial Perspective

a. Genetic factors create the predisposition which then interacts with other factors (complications at birth, stress, quality of parenting, etc.).

III. Mood Disorders: Up, Down, and Around.

A. Mood disorders are characterized by disturbance in expressed emotions generally involving sadness or elation.

B. Types of Mood Disorders.

1. Major depression is the common cold of psychological problems. Characteristics include:

a. Lack of energy.

b. Loss of self-esteem.

c. Difficulty concentrating.

d. Loss of interest in activities and other people.

e. Pessimism, crying, and thoughts of suicide.

f. Poor appetite and serious weight loss.

g. Psychomotor retardation.

h. Faulty perception including delusions of unworthiness, guilt for imagined wrong doings and possible hallucinations of strange bodily sensations.

i. More intense with people experiencing Major Depressive Disorder (MDD)

2. Bipolar Disorder is formerly known as manic-depressive disorder and is characterized by:

a. Mood swings from ecstatic elation to deep depression.

i. In the manic phase the person may show excessive excitement, silliness, show poor judgment, destroying property and giving away expensive possessions. They are too restless to sit still or sleep restfully.

ii. Rapid flight of ideas.

iii. Depression often includes sleeping more than usual and being lethargic. Individuals also tend to withdraw and experience irritability.

C. Explaining Mood Disorders.

1. Biological Perspective.

a. Depression is heritable.

b. Genetic factors appear to be involved.

i. Bipolar disorder may be connected with genetic material found on Chromosome 18.

c. Depression research focuses on the underutilization of the neurotransmitter serotonin in the brain.

2. Psychological Perspectives:

a. Learning theorists suggest that depressed people behave as though they cannot obtain reinforcement.

i. They have an external locus of control.

ii. Researchers have found links between depression and learned helplessness.

b. Cognitive factors contributing to depression include making irrational demands on themselves.

i. Depressed people tend to ruminate about feelings of depression.

ii. Attribution styles include: internal vs. external; stable vs. unstable; and global vs. specific. People who are depressed tend to think of their situation as internal, stable, and global. They are powerless to change.

iii. Self-blame for negative events is connected with poorer functioning of the immune system.

c. Biopsychosocial Perspective

i. Biological predispositions

ii. Attitudes

iii. Situations

Ø Reactions to stress

Ø Chronic strain

D. Suicide: When the Psychache Becomes Impossible to Bear

1. About 31,000 people each year take their lives in the U.S.

a. 3% of the American population considers suicide

b. Third or fourth leading cause of death among older teenagers

2. Risk Factors in Suicide:

a. Linked to feelings of depression and hopelessness.

b. Highly achieving.

c. Rigid perfectionists.

d. Set impossibly high expectations for themselves.

e. Compare themselves negatively with others.

f. Suicidal Adolescents experience four psychological problems:

i. Confusion about self.

ii. Impulsiveness.

iii. Emotional instability.

iv. Interpersonal problems.

g. Suicide attempts are more common following stressful life events.

i. Exit events are events that entail a loss of social support.

Ø Death of a parent or friend.

Ø Divorce.

ii. Result in psychological pain or psychache.

h. People who consider suicide are less capable of solving problems.

i. Suicide tends to run in families.

3. Sociocultural Factors in Suicide.

a. Suicide is the third leading cause of death among people aged 15-24.

b. Suicide is more common among college students than among people of the same age who do not attend college.

i. Each year about 10,000 college students attempt suicide

c. Older people are more likely to commit suicide.

d. One in six Native Americans has attempted suicide

e. One in eight Latino and Latina Americans

f. Three times as many females as males attempt

g. Four times as many males “succeed”

4. Myths about Suicide.

a. Most people who commit suicide give warnings about their intentions, they aren’t just seeking attention.

b. Many people who commit suicide have made prior attempts.

c. Discussing suicide with a person does not prompt the person to attempt suicide.

d. Suicidal thinking is not necessarily a sign of psychosis, neurosis, or a personality disorder.

5. Warning Signs of Suicide:

a. Changes in eating and sleeping patterns.

b. Difficulty concentrating on school work.

c. A sharp decline in school performance and attendance.

d. Loss of interest in previously enjoyed activities.

e. Giving away prized possessions.

f. Complaints about physical problems when no medical basis for the problem can be found.

g. Withdrawal from social relationships.

h. Personality or mood changes.

i. Talking or writing about death or dying.

j. Abuse of drugs or alcohol

k. An attempted suicide.

l. Availability of a handgun.

m. A precipitating event such as an argument, a broken romantic relationship, academic difficulties, problems on the job, loss of a friend, or trouble with the law.

n. In the case of adolescents, knowing or hearing about another teenager who has committed suicide (cluster suicides).

o. Threatening to commit suicide.

6. Life Connections: Preventing Suicide

a. Keep talking. Encourage the person to talk.

b. Be a good listener.

c. Suggest that something other than suicide might solve the problem.

d. Emphasize as concretely as possible how the person’s suicide would be devastating to you and to other people who care.

e. Ask how the person intends to commit suicide. Individuals with a concrete plan are at a greater risk.

f. Suggest that the person go with you to obtain professional help now.

g. Extract a promise that the person will not commit suicide before seeing you again.

h. Do not tell people threatening suicide that they are silly or crazy.

IV. Anxiety Disorders: Real Life “Fear Factors”?

A. Anxiety has psychological and physical features.

1. Psychological features include:

a. Worrying.

b. Fear of the worst things happening.

c. Fear of losing control.

d. Nervousness.

e. Inability to relax.

2. Physical features include:

a. Arousal of the sympathetic branch of the autonomic nervous system:

i. Trembling.

ii. Sweating.

iii. Pounding heart.

iv. Elevated blood pressure.

v. Faintness.

3. Anxiety is an appropriate response to a real threat.

B. Types of Anxiety Disorders.

1. Phobias.

a. Specific phobias are excessive, irrational fears of specific objects or situations, such as snakes or heights.

b. Social phobias are persistent fears of scrutiny by others or of doing something that will be humiliating or embarrassing.

c. Examples of phobias

i. Agoraphobia: fear of being out in open, busy areas.

ii. Acrophobia: fear of heights

iii. Claustrophobia: fear of tight or enclosed places

2. Panic Disorder is an abrupt attack of acute anxiety that is not triggered by a specific object or situation.

a. Symptoms include:

i. Shortness of breath.

ii. Heavy sweating.

iii. Tremors.

iv. Pounding of heart.

v. Many fear suffocation.

vi. Choking sensations.

vii. Nausea.

viii.Numbness.

ix. Fear of going crazy or losing control.

b. Symptoms may last minutes or hours.

3. Generalized Anxiety Disorder is persistent anxiety that cannot be attributed to a phobic object, situation or activity. It seems to be free-floating.

a. Symptoms include:

i. Autonomic nervous system overarousal.

ii. Feelings of dread and foreboding.

iii. Excessive vigilance.

4. Obsessive-Compulsive Disorder.

a. Obsessions are recurrent, anxiety provoking thoughts or images that seem irrational and disrupt daily life.

b. Compulsions are thought or behaviors that tend to reduce the anxiety connected with obsessions.

5. Stress Disorders.

a. Posttraumatic stress disorder (PTSD) is characterized by a rapid heart rate and feelings of anxiety and helplessness that are caused by a traumatic experience.

i. Traumatic experiences include natural or man-made disasters, threats, or assault, or witnessing a death.

ii. The traumatic event is revisited in the form of intrusive memories, recurrent dreams, and flashbacks.

b. Acute stress disorder is characterized by feelings of anxiety and helplessness that are caused by a traumatic event.

i. Acute stress disorder occurs within a month of the event and lasts from 2 days to 4 weeks.

C. Explaining Anxiety Disorders

1. Biological Views.

a. Anxiety tends to run in families.

i. Twin studies shoe a higher concordance rate for anxiety disorders among identical twins than among fraternal twins.

b. Mineka (1991) suggest that humans are genetically predisposed to fear stimuli that may have posed a threat to their ancestors.

c. The brain may not be sensitive enough to GABA, a neurotransmitter that may help calm anxiety reactions.

2. Psychological and Social Perspectives.

a. Learning theorists:

i. Phobias are conditioned fears that were acquired in childhood. Observational learning also plays a role.

b. Cognitive theorists:

i. Anxiety is maintained by thinking that one is in a terrible situation and helpless to change it.

c. Biopsychosocial Perspective

i. May reflect the interaction of biological, psychological and social factors

Ø Biological imbalances may initially trigger events with subsequent events being triggered by a combination of all three

V. Somatoform Disorders: When the Body Expresses Stress.

A. Somatoform disorders are characterized by physical problems in people, such as paralysis, pain, or a persistent belief that they have a serious disease. Yet no evidence of a physical abnormality can be found.

B. Types of somatoform disorders include:

1. Conversion disorder which is characterized by a major change in, or loss of, physical functioning although there are no medical findings to explain the loss of functioning.

a. The person is not faking as they seem to be converting a source of stress into a physical difficulty.

b. Some people with this disorder show indifference to their symptoms.

2. Hypochondriasis is characterized by people insisting that they are suffering with a serious physical illness even though no medical evidence of illness can be found.

a. They become preoccupied with minor physical sensations and continue to believe that they are ill despite the reassurance of physicians that they are healthy.

3. Body Dysmorphic Disorder is a disorder where people are preoccupied with a fantasized or exaggerated physical defect in their appearance.

a. They may go to extreme lengths to correct the problem.

C. Explaining Somatoform Disorders.

1. There is research evidence that people who develop hypochondriasis are particularly sensitive to bodily sensations and tend to ruminate about them.

D. Are Somatoform Disorders the special province of women?

1. Hippocrates believed that hysteria was caused by a wandering uterus.

2. Psychodynamic view suggests that conversion disorders protect the individual from feelings of guilt, shame or from another source of stress.

3. Conversion disorders are not the special province of women.

4. Hypochondriasis: people may misinterpret run of the mill physical sensations

5. Social role of personal attractiveness can contribute to dissatisfaction with one’s body

6. Tendencies towards perfectionism may be partly inherited.

VI. Dissociative Disorders: Splitting Consciousness.

A. Dissociative disorders are characterized by a separation of mental processes such as thoughts, emotions, identity, memory, or consciousness.

B. Types of Dissociative Disorders include: dissociative amnesia, dissociative fugue, dissociative identity disorder, and depersonalization.

1. Dissociative amnesia is characterized by the person suddenly being unable to recall important personal information.

2. Dissociative Fugue is characterized by the person abruptly leaving their home or place of work and traveling to another place, having lost all memory of their past. The new personality is often more outgoing than the less inhibited one.

3. Dissociative Identity Disorder (formerly termed multiple personality disorder) is characterized by two or more identities or personalities, each with distinct traits and memories, occupying the same person. Each identity may or may not be aware of the others.

4. Depersonalization Disorder is characterized by persistent feelings that one is detached from one’s own body, as if one is observing one’s thought processes from the outside.

C. Explaining Dissociative Disorders

1. Biopsychosocial factors may be involved.

2. Learning theorists suggest that people have learned not to think about bad memories or disturbing impulses in order to avoid feelings of anxiety, guilt or shame.

3. Biological level, research has shown with abused children that the trauma related dissociation observed may have a neurological basis.

a. Child abuse may lead to permanent neurochemical and structural abnormalities in parts of the brain involved in cognition and memory.

VII. Personality Disorders: Making Oneself or Others Miserable.

A. Personality disorders are characterized by enduring patterns of behavior that are inflexible, and maladaptive. These behaviors typically impair social or personal functioning and are a source of distress to the individual or to other people.

B. Types of Personality Disorders include: paranoid, schizotypal, schizoid, antisocial, and avoidant.

1. Paranoid personality disorder is a tendency to interpret other people’s behavior as threatening or demeaning.

a. Mistrustful of others.

2. Schizotypal personality disorder is characterized by peculiarities of thought, perception, or behavior such as excessive fantasy and suspiciousness, feelings of being unreal, or odd usage of words.

3. Schizoid personality is defined by indifference to relationships and flat emotional response.

a. People with this disorder are loners.

4. Borderline Personality Disorder is characterized by instability in relationships, self image, and mood, with a lack of impulse control

a. Fear of abandonment

b. View others as all good or all bad

c. Destructive behavior including

i. Spending sprees

ii. Binge eating

iii. Shoplifting

iv. Reckless driving