CHAPTER 12

Psychological Disorders

Psychopathology

What was formerly known as mental illness or mental disorder is now often referred to as psychopathology. Some feel “mental illness” puts the basis for the

illness on biology, even though psychologists have shown that environment is often the cause of the disorder.

Psychopathology is any pattern of emotions, behavior, or thoughts inappropriate to the situation and leading to personal distress or the inability to achieve important goals.

Prevalence of Psychopathology

In America, mental illness is far more common than most people realize.

Another study found that during any given year, the behaviors of over 56 million Americans meet the criteria for a diagnosable psychological disorder (Carson et al. 1996).

Over the lifespan, as many as 32% of Americans suffer from some psychological disorder (Regier et al., 1988).

What is Psychological Disorder?

How do we discern what is normal and abnormal? Consider eccentric personalities:

What about a soldier who risks his life in war? A grief stricken mother who cannot return to her normal routines three months after losing her son?

3 Classical Symptoms of Severe Mental Illness

The more extreme a disorder is, the more easily it is detected. When trying to diagnose a patient, doctors look for three classic symptoms of sever psychopathology:

Hallucinations-false sensory experiences. Delusions-extreme disorders that involve persistent

false beliefs. Affect (emotion)-characteristically depressed, anxious,

manic, or no emotional response.

Psychological Disorders as a Continuum

No Disorder Mild Disorder Moderate Disorder

Severe Disorder

Absence of signs of psychological disorder

Few signs of distress or other indicators of psychological disorder

Indicators of disorders are more pronounced and occur more frequently

Clear signs of psychological disorder, which dominate the person’s life

Absence of behavioral problems

Few behavior problems; responses usually appropriate to the situation

More distinct behavior is often inappropriate to the situation

Severe and frequent behavior problems; behavior is usually inappropriate to the situation

No problems with interpersonal relationships

Few difficulties with relationships

More frequent difficulties with relationships

Many poor relationships or lack of relationships

Disorders are exaggerations of normal behavior and responses.

Two Contrasting Views

As with most topics in psychology, there are multiple perspectives on psychological disorders.

The medical model takes a “disease” view. Psychology, on the other hand, sees psychological disorders as an interaction of biological, mental, social and behavioral factors.

Historical RootsIn the ancient world, psychopathology was

thought to be caused by demons and spirits that had taken possession of the person’s mind and body.

Part of daily life in ancient worlds was spent doing rituals aimed at outwitting or placating these supernatural beings.

HippocratesIn 400 B.C. the Greek physician Hippocrates

took the first step toward a scientific view of mental illness when he said that abnormal behavior had physical causes.

He taught his disciples to interpret the symptoms of psychopathology as an imbalance among our body fluids called “humors.”

Humors Origins TemperamentBlood Heart Sanguine (cheerful)

Choler (yellow bile) Liver Choleric (angry)

Melancholer (black bile) Spleen Melancholy (depressed)

Phlegm Brain Phlegmatic (sluggish)

Regression in Thought

Then in the Middle Ages, superstition eclipsed the Hippocratic model. Under the influence of the medieval Church, physicians and clergy reverted to the old ways of explaining abnormal behavior.

Hippocrates

Salem Witch TrialsAs a result of erroneous thinking, thousands

of mentally disturbed people were executed.In Salem Massachusetts, was one example

of the problems with this type of thinking. A modern analysis of the Salem witch trials

has concluded that the girls were probably suffering from poisoning by a fungus growing on rye grain-the same fungus that produces the hallucinogenic drug LSD.

The Medical Model

In the late 18th century, the “disease view” reemerged.

The result was the medical model, a view that mental disorders are diseases of the mind that, like ordinary physical diseases, have objective causes and require specific treatment.

Medical Model in Practice

The medical model led to mental hospitals or “asylums.” In this supportive atmosphere, many patients actually improved, even thrived, on rest, contemplation and simple but useful work.

Problems with the Medical Model

Despite its success, modern psychologists find fault with relying solely on the medical model.

They suggest that treating the disorder as a “disease” leads to a doctor-knows-best approach in which the therapist takes all the responsibility for diagnosing and correcting the problem.

In this model, the patient becomes a passive recipient of medication and advice.

Psychologists vs. Psychiatrists

The other problem psychologists have with the medical model (doctor-knows-best), is that it takes responsibility away from psychologists and gives it to psychiatrists.

According to our authors, it assigns psychologists to second-class professional status.

Social-Cognitive-Behavioral Approach

As psychology has evolved, theories which were originally at odds, have now been combined to offer more thorough explanations, for example, cognitive psychology and behaviorism.

Cognitive psychology looks inward, emphasizing mental processes. Behaviorism looks outward and emphasizes the influences of the environment.

Psychologists from these perspectives see these two as complementary, and add that cognitions and behavior usually happen in social context, requiring social perspective.

Combining Perspectives

The behavioral perspective tells us that abnormal behaviors can be acquired in the same fashion as healthy behaviors-- through behavioral learning.

The cognitive perspective suggests that we must consider how people think about themselves and their relations with other people.

Social-cognitive-behavioral approach, then, is an alternative to the medical model combining all three of psychology’s major perspectives.

The Biopsychology of Mental Disorder

Modern biopsychology assumes that some mental disturbances involve the brain or nervous system in some way.

Subtle changes in the brain’s tissue or its chemical messengers- the neurotransmitters- can profoundly alter thoughts and behaviors.

Genetic factors, brain injury, infection, and learning are some of the factors that can tip the balance towards psychopathology.

Indicators of Abnormality

While psychologists look for the three classical symptoms, not all disorders have such sever symptoms. A few others are: Distress: Does the individual show unusual or prolonged

levels of anxiety? Maladaptiveness: Does the person act in ways that

make others fearful? Irrationality: Does the person act or talk in ways that

are irrational or incomprehensible to others? Unpredictability: Does the individual behave erratically

and inconsistently at different times? Unconventional/undesirable behavior: Does the

person act in ways that are statistically rare and violate social norms?

The More the Better

Clinicians are more confident in labeling behavior as “abnormal” when two or more of the indicators are present. Extremes and prevalence = greater confidence in

diagnosis

DSM-IV-TR

The American Psychological Association developed the most widely used classification system for psychological disorders.

The book is called the Diagnostic and Statistical Manuel of Mental Disorders.

*IV=4th edition**TR=Text revised

DSM-IV-TR

The DSM-IV-TR offers practitioners a common and concise language for the description of psychopathology.

The DSM also contains language for diagnosing each of the disorders.

Experiment in a Mental Hospital

A young psychologist, David Rosenhan, set up an experiment to see if mental hospitals could really detect someone with mental illness.

He felt that terms like “sanity,” “insanity,” “schizophrenia,” “mental illness” and “abnormal” might have fuzzier boundaries and more fluid definitions than those in the medical world were giving them credit for.

Rosenhan Experiment

Rosenhan also suspected that some strange behaviors seen in mental patients might originate in the abnormal atmosphere mental hospitals, rather than in the patients themselves.

To test these theories, Rosenhan and seven collogues conducted the Rosenhan Experiment in the early 1970s.

David Rosenhan

Explaining Rosenhan

Rosenhan said that the mistaken diagnosis were most likely a result of the lack of time the doctors spent with the patients.

Surprisingly, the other hospital patients readily detected the experiment. The pseudo-patients reported that the other patients regularly voiced their suspicions.

After the Experiment

All of the people who served in the original study were eventually discharged from the hospital with the label of "schizophrenic in remission."

To put it another way, they were still considered schizophrenic, but they were temporarily free of symptoms.

Mood Disorders

Mood disorders are abnormal disturbances in emotion or mood. They are also referred to as affective disorders.

The two most common are major depression and bipolar disorder.

Major Depression

Major depression is a form of depression that does not alternate with mania (happiness).

It is normal to become depressed after a sad or unfortunate even but if a person remains depressed weeks or months after that event, it may be classified as major depression.

Major depression does not give way to manic episodes.

Major DepressionBy many accounts,

depression is under diagnosed and under treated.

Globally speaking, studies indicate that depression is the single most prevalent disability.

While some differences may be a result of reporting, other factors seem to be at work too: Taiwan/Korea = low divorce rate Lebanon = war in Middle East

Taiwan 1.5%

Korea 2.9%

Puerto Rico 4.3%

U.S. 5.2%

Germany 9.2%

Canada 9.6%

New Zealand 11.6%

France 16.4%

Lebanon 19%

Lifetime Risk of a Depressive Episode

lasting a Year or More

Causes of Depression

Some causes of major depression involve genetic predisposition. Severe bouts of depression often run in families. Further indication of a biological basis for

depression are that drugs that affect the brains levels of certain neurotransmitters are very effective.

However, biology alone cannot account for everything.

Cognitive Explanations

Probably because of low self-esteem, depression-prone people are more likely to perpetuate the depression cycle by attributing negative events to their own personal flaws or external conditions they feel helpless to change.

Martin Seligman calls this learned helplessness.

Cognitive-Behavioral Cycle of Depression

Low self-esteemand negative

interpretations

Social rejectionand loneliness

Negativeevents

Depression

Negativebehaviors

Fred decides to be more sociable, but when he asks Teresa for a date she already has plans.

Fred concludes that he is not very interesting or attractive and that people don’t like him.

Fred feels completely alone and unhappy

Fred avoids people, skips school and neglects personal hygiene

Because of Fred’s negative behaviors, people avoid him-reinforcing his symptoms.

The Cognitive Approach

The cognitive approach to depression points out that negative thinking styles are learned and modifiable.

*Think classical and operant conditioning.

Beck’s Basics

Aaron Beck suggests that depression is a result of negative thinking which he called ‘cognitive errors’ (errors in logic)

Beck identified three negative thoughts that seemed to be really automatic and occurred without delay in depressed patients. The “Cognitive Triad:”

Self External World Future

Beck believes that faulty thinking leads to depression. The question remains though, which came first, the depression or the faulty thoughts.

WHO BECOMES DEPRESSED?

Studies show that depression rates are higher in women. The difference may be in the way men and women handle emotional situations.

Women tend to be introspective: Think about their feelings and what may be causing

them.

Men, on the other hand, try to distract themselves from the depressed feelings.

This suggests the more ruminative response of women increases their vulnerability to depression. Depression breeds depression

Increasing Rates of DepressionRates of depression have increased 10-20

times what they were 50 years ago. The average age of people experiencing

depression has gone down.

Seligman identifies three causes for this trend:

1.Out-of-control individualism/self-centeredness-focuses on individual successes and failures rather than group accomplishments.

Increasing Rates of Depression

2. The self-esteem movement- teaching a generation of children they should feel good about themselves, irrespective of their efforts and achievements.

3. A culture of victimology- reflexively pointing the finger of blame at someone or something else.

Bipolar Disorder

Formerly known as manic-depressive disorder, bipolar disorder is a mental abnormality involving swings of mood from mania to depression.

A strong genetic component is well established, although the exact genes involved are not known. 1% of the population has bipolar attacks, having an identical twin

with the problem inflates a person’s chances to about 70%

Anxiety Disorders

Everyone has experienced some level of anxiety in their life. For some people, a spider, or a tall ladder are enough to send chills down the spine.

Psychopathology anxiety is far more sever than the anxiety associated with normal life challenges.

Prevalence of Mental Disorders

=Anxiety Disorder

Generalized Anxiety Disorder

Generalized anxiety disorder is a psychological problem characterized by persistent and pervasive feelings of anxiety, without any external cause.

May experience times when your worries don't completely consume you, but you still feel rather anxious

May feel on edge about many or all aspects of your life May have a general sense that something bad is about to

happen, even when there's no apparent danger. May not remember when you last felt relaxed or at ease.

GAD often begins at an early age, and the signs and symptoms may develop slowly.

Panic Disorder

Panic disorder is a disturbance marked by sudden and severe anxiety attacks that have no obvious connections with events in the person’s life. Usually free of anxiety between panic attacks

Panic attack symptoms:

* Rapid heart rate * Sweating * Trembling * Shortness of breath * Hyperventilation * Chills * Hot flashes * Nausea * Abdominal cramping

* Chest pain * Headache * Dizziness * Faintness * Trouble swallowing * A sense of impending death

Panic Disorder

Many people who suffer from panic disorder also have agoraphobia. A condition which involves panic that develops when people find themselves in situations from which they cannot easily escape: crowed places, open spaces, etc. Occurs in about 2% of Americans and affect

women more than men.

Phobic DisordersIn contrast to panic disorder, phobias

involve persistent and irrational fear associated with a specific object, activity or situation.

While many of us have fears, or dislikes of specific objects or situations, these only become psychopathology when they have a cause substantial disruptions in our lives.

Preparedness Hypothesis

This theory suggests that we carry an innate biological tendency, acquired through natural selection, to respond quickly and automatically to stimuli that posed a survival threat to our ancestors. May explain why we develop phobias for snakes and

lightening much more easily than automobiles and electrical outlets

Obsessive-Compulsive Disorder

OCD is a condition characterized by patterns of persistent, unwanted thoughts and behaviors.

The obsessive component consists of thoughts, images or impulses that recur or persist despite a person’s efforts to suppress them.

Obsessive-Compulsive Disorder

The compulsive component are repetitive, purposeful acts performed according to certain private “rules,” in response to an obsession.

Many characters on TV and in movies have OCD: Jack Nicolson in As Good As It Gets; Monica on Friends; Monk

Others?

Obsessive-Compulsive Disorder

When they are calm, people with obsessive-compulsive disorder view their compulsions as senseless. However, when anxiety arises, they cannot resist performing the compulsive behavior rituals to relieve tension.

OCD has a tendency to run in families A clear genetic connection

Environment seems to play a factor Behavioral therapy helps many OCD sufferers

Somatoform Disorders

Somatoform disorders are psychological problems appearing in the form of bodily symptoms or physical complaints such as weakness or excessive worry about disease. Conversion Disorder: A disorder marked by

paralysis, weakness or loss of sensation but with no discernable physical cause.

Hypochondriasis: A disorder involving excessive worry about health and disease.

How a hypochondriac might see himself

Dissociative Disorders

Dissociative disorders are a group of pathologies involving the “fragmentation” of the personality, in which some parts of the personality have become detached from other parts.

Dissociative Amnesia: A psychologically induced loss of memory for personal information, like one’s identity.

Usually the result of a stressful situation, it is often associated with Post Traumatic Stress Disorder (PTSD).

PTSD

Post Traumatic Stress Disorder dates back to 6 B.C. where reports of battlefield stress had an adverse affect on soldiers.

In the past PTSD has been referred to as railway spine, shell shock, battle fatigue, traumatic war neurosis, or post-traumatic stress syndrome.

Today treatment involves therapy and anti-anxiety drugs. During WWI treatment looked much different:

Shell Shock/Shock Therapy New PTSD Therapy

Dissociative Fugue

Dissociative fugue is a combination of fugue, or “flight, and amnesia. Sufferers not only suffer from a lost sense of identity, they also flee their homes, jobs and families.

While most episodes last only a few hours or days, it can last longer.

Heavy use of alcohol may predispose a person to dissociative fugue. While this suggest that some brain impairment may be involved, no specific cause has been identified.

Depersonalization Disorder

Depersonalization disorder is an abnormality involving the sensation that mind and body have separated.

Often times sufferers explain episodes as out of body experiences.

Like all of the other dissociative disorders, depersonalization disorder occurs far more frequently following a prolonged period of stress or a traumatic event.

Dissociative Identity Disorder

Once called multiple personality disorder, dissociative identity disorder is a condition where an individual displays multiple identities or personalities.

Experts say this disorder appears first in childhood and may be a defensive response to abusive situations or terrifying events.

Most of the emerging personalities contrast in some significant way with the original self. http://www.youtube.com/watch?v=YXuG2zI39yA

Hershel Walker was recently diagnosed with DID.

Schizophrenia

http://www.youtube.com/watch?v=gGnl8dqEoPQ

Schizophrenia is a psychological disorder involving distortions in thoughts, perceptions and/or emotions. This is the disorder people are referring to when they

use terms like “madness,” “psychosis,” or “insanity.”

What Does it Look Like

For sufferers of schizophrenia, the mind can be twisted in terrible ways. May become bleak and devoid of meaning Can become very overwhelming and filled

with stimuli, hallucinations and delusions. In schizophrenia, emotions become blunted,

thoughts turn bizarre, and language takes a strange turn. Take the following for example:

Sample Speech From Schizophrenic Patient

The lion will have to change from dogs into cats until I can meet my father and mother and we dispart some rats. I live on the front of Whitton’s head. You have to work hard if you don’t want to get into bed…It’s all over for a squab true tray and there ain’t no squabs, there ain’t no men, there ain’t no music, there ain’t nothing besides my mother and my father who stand along upon the Island of Capri where is no ice. Well it’s my suitcase sir. (Roger, 1982)

Prevalence of Schizophrenia

One out of every 100 Americans, 2 million people over the age of 18-will be affected.

For men, schizophrenia usually shows up before age 25, and between the ages of 25 and 40 for women.

Currently, schizophrenia is the diagnosis for over 40% of patients in public mental hospitals. This may be due to the fact that there is no cure, and often times patients will need need therapy for the remainder of their lives.

5 Major Types of Schizophrenia

Disorganized type: typical image of mental illness with incoherent speech, hallucinations, delusions and odd behaviors http://www.youtube.com/watch?v=avbfd_OkLoU

Catatonic type: a range of motor dysfunctions Stupor: long periods of coma like, motionless state Excitement: agitated and hyperactive

Paranoid type: delusions and hallucinations but no catatonic symptoms and none of the incoherence of disorganized type

Undifferentiated type: a catchall term for schizophrenia symptoms that are erratic and do not it into one of the other categories, but are clear symptoms of the disorder

Residual type: the diagnosis for individuals who have suffered from schizophrenia, but have no major symptoms at the time

Positive and Negative Categories

Often times, researchers now simply characterize symptoms of schizophrenia into positive and negative categories.

Positive symptoms refer to active process such as delusions, and hallucinations.

Negative symptoms refer to passive processes like social withdrawal.

Causes of SchizophreniaFreud originally thought schizophrenia was

a result of defective parenting or repressed childhood trauma.

Impact of Drugs Major tranquilizers which inhibit dopamine, can

suppress the symptoms of schizophrenia Drugs that provide excess dopamine can cause

schizophrenic type behaviors in healthy people.

Causes of Schizophrenia

Loss of grey matter: Magnetic resonance images (MRI scanswere created after repeatedly scanning 12 schizophrenia subjects over five years, and comparing them with 12 healthy controls, scanned at the same ages and intervals.

• Severe loss of gray matter is indicated by red and pink colors, while stable regions are in blue.

• STG =superior temporal gyrus

• DLPFC =dorsolateral prefrontal cortex.

Causes of Schizophrenia

While the exact cause of the disorder still remains somewhat of a mystery, there is very strong evidence that it has a genetic link. People who have an identical twin who suffers from

schizophrenia have a 50% chance of suffering from the disorder too, even if they were raised in separate environments.

Similarly, a child with one parent suffering from schizophrenia has a 13% chance of developing the disorder, but a child of two parents with the disorder has a 46% chance of developing schizophrenia.

Schizophrenia Treatments

Much like the treatment for all psychological disorders, the treatment of schizophrenia has come a long way:

Lobotomies Insulin Shock Therapy

Current treatment for schizophrenia is usually a combination of therapy and medication:

Schizophrenia Medication

LobotomiesOne of the earliest treatments were

lobotomies. This procedure consisted of cutting the connections to and from, or simply destroying, the prefrontal cortex.

The Process

Doctors would access the frontal lobes through the eye sockets, instead of through drilled holes in the scalp. In 1945, he took an ice pick from his own kitchen and began to test the new surgical technique on cadavers.

The Process

The technique involved lifting the upper eyelid and placing the point of a thin surgical instrument under the eyelid and against the top of the eye socket.

• A hammer was used to drive the pick through the bone, into the brain. It was then moved from side to side, severing nerve fibers connecting the frontal lobes to the thalamus.

Other Types of Disorders

Most people get stuck thinking about depression and schizophrenia when they think about psychological disorders. In reality there are far more. Some of the more common, and more studied disorders are:

Eating Disorders: Personality Disorders: Developmental Disorders:

Eating Disorders

Of the eating disorders that exist, two are most prevalent and most studied:

Anorexia nervosa: an eating disorder that causes a persistent loss of appetite that endangers an individuals health Stems from emotional or

psychological reasons rather than natural causes

Usually a distorted view of oneself 1% of population affected 3.4% with partial syndrome anorexia

Eating Disorders

The other common eating disorder is bulimia nervosa.

Bulimia Nervosa: An eating disorder characterized by binges and purges

Induced vomiting, or laxatives .6% of population affected with

bulimia Up to 4.2% of females

The History of Bulimia-Nervosa

It was believed that the ancient Romans used a vomitorium to rid themselves of food.

Bulimia was not established as a psychological disorder until the late 1970’s.

95-85% of cases of anorexia/bulimia are women in the US (National Institute of Mental Health)

Personality Disorders

Personality disorders are conditions involving a chronic, pervasive, inflexible and maladaptive pattern of thinking, emotion, social relationships or impulse control Narcissistic Personality Disorder: Grandiose sense of self

importance and preoccupation with fantasies of success

Antisocial Personality Disorder: Longstanding pattern of irresponsible behavior indicating lack of conscience and responsibility towards others.

Borderline Personality Disorder: Unstable and given to extreme impulses without clear reasoning.

Development Disorders

Developmental disorders are a group of disorders that can appear at any age, but most commonly show signs during childhood. Autism: Marked by disabilities in language, social

interaction and the inability to understand another person’s state of mind 1 in 500 children; recent increase in cases

Dyslexia: A reading disorder where letters words and numbers are perceived out of order, upside down or completely incomprehensible

http://www.mhhe.com/socscience/psychology/faces/#