CHAPTER 14—PSYCHOLOGICAL DISORDERS

I. Identifying Psychological Disorders: What Is Abnormal?

A. Medical Model – conceptualization of psychological disorders as diseases that have biological

causes, defined symptoms, and possible cures

B. Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition, Text Revision] (DSM-IV-TR)

– classification system used for diagnosis of recognized mental disorders and indicates how the disorder can be distinguished from other, similar problems

C. Classification of Disorders

1. Key elements for a cluster of symptoms to qualify as a potential disorder:

a. Disturbances in behavior, thoughts, or emotion

b. Personal distress or impairment

c. Internal dysfunction (biological, psychological, or both)

2. Global Assessment of Functioning (GAF) Scale provides a 0-100 rating where more severe

disorders are indicated by lower numbers

3. Early versions of DSM were unreliable

4. 17 main categories of mental disorders in DSM-IV-TR

5. Comorbidity – co-occurrence of two or more disorders in one person

D. Causation of Disorders

1. Etiology – specifiable pattern of causes

2. Prognosis – typical course over time and susceptibility to treatment and cure

3. Diathesis-Stress Model – individual may be predisposed for a psychological disorder that is

unexpressed until triggered by stress

4. Intervention-Causation Fallacy – fallacy involving the assumption that if treatment is effective

it must address the cause of the problem

E. Dangers of Labeling

1. Stigma prevents people from seeking treatment (~70%)

2. Labeling may affect how the person views him or herself; may see themselves not just as

mentally disordered, but also hopeless or worthless

II. Anxiety Disorders: When Fears Take Over

A. Generalized Anxiety Disorder (GAD)

1. Symptoms (3 or more): Restlessness, fatigue, concentration problems, irritability, muscle

tension, and sleep disturbance

2. Treated with benzodiazepines (increase GABA)

B. Phobic Disorders

1. Symptoms: Marked, persistent, and excessive fear and avoidance of specific objects,

activities, or situations

2. Specific Phobia – irrational fear of a particular subject or situation that interferes with the

ability to function

a. Five categories: Animals; natural environments; situations; blood, injections, injury; other

 

 

phobias (illness, death)

3. Social Phobia – irrational fear of being publicly humiliated or embarrassed

4. Preparedness Theory – people are instinctively predisposed toward certain fears

C. Panic Disorder

1. Symptoms: Sudden occurrence of multiple psychological and physiological symptoms that

contribute to a feeling of stark terror

2. Agoraphobia – extreme fear of venturing out into public places (often for fear of having a

panic attack)

D. Obsessive-Compulsive Disorder (OCD)

1. Symptoms: Repetitive, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions)

that are intended to fend off those thoughts, result in significant interference into person’s ability to function

2. Increased serotonin inhibits the caudate nucleus and reduces symptoms of OCD

III. Mood Disorders: At the Mercy of Emotions

A. Depressive Disorders

1. Major Depressive Disorder

a. Symptoms: Severely depressed mood (> 2 weeks) with feelings of worthlessness and

lack of pleasure, lethargy, sleep and appetite disturbances

2. Dysthymia – similar to major depression but less severe and lasting for at least 2 years

3. Double Depression – moderately depressed mood that persists for at least 2 years,

punctuated with severe depression

4. Seasonal Affective Disorder (SAD) – recurring depressive episodes in a seasonal pattern

5. Postpartum Depression – depression following childbirth

6. Biological Factors

a. Increases in norepinephrine and serotonin reduce depression (Prozac and Zoloft)

b. Reduced activity in left dorsolateral prefrontal cortex and increased activity in right

dorsolateral prefrontal cortex

7. Psychological Factors

a. Helplessness Theory – individuals prone to depression automatically attribute negative

experiences to causes that are internal, stable, and global

b. Negative thinking can contribute to relapses and is often heightened in depressed people.

B. Bipolar Disorder

1. Symptoms: Unstable emotional condition characterized by cycles of abnormal, persistent

high mood (mania) and low mood (depression)

2. Rapid cycling bipolar disorder has at least 4 mood episodes per year and is difficult to treat

3. Biological Factors

a. high heritability (40-70% monozygotic twins)

b. Lithium reduces symptoms

4. Psychological Factors

a. Episodes triggered by stressful events

 

 

IV. Dissociative Disorders: Going to Pieces

A. Dissociative Disorder – condition in which normal cognitive processes are severely disjointed and

fragmented, creating significant disruptions in memory, awareness, or personality that can vary in length from a matter of minutes to many years.

1. Dissociative Identity Disorder (DID) – presence within an individual of two or more distinct

identities that take over control of the individual’s behavior at different times

a. Host personality is dominant and often unaware of the alters, yet alters are aware of host

personality

b. Usually the result of ritualistic abuse and/or trauma

2. Dissociative Amnesia (sudden loss of personal information) and Dissociative Fugue (sudden

loss of personal history, accompanied by an abrupt departure from home, assumption of new identity)

V. Schizophrenia: Losing the Grasp on Reality

A. Universal symptoms: Profound disruption of psychological processes; distorted perception of

reality; altered or blunted emotion; disturbances in thought, motivation, and behavior

B. Symptoms and Types of Schizophrenia

1. Symptoms

a. Delusion – patently false belief system, often bizarre and grandiose, that is maintained in

spite of its irrationality

b. Hallucination – a false perceptual experience that has a compelling sense of being real

despite the absence of external stimulation

c. Disorganized speech – a severe disruption of verbal communication in which ideas shift

rapidly and incoherently from one to another unrelated topic

d. Grossly disorganized behavior – behavior that is inappropriate for the situation or

ineffective in attaining goals, often with specific motor disturbances

i. Catatonic behavior – a marked decrease in all movement or an increase in muscular

rigidity and overactivity

e. Negative symptoms – emotional and social withdrawal; apathy; poverty of speech; and

other indications of the absence or insufficiency of normal behavior, motivation, and emotion

2. Types and their characteristics

a. Paranoid – absurd, illogical, and changeable delusions; vivid hallucinations; impairment of

critical judgment and erratic, unpredictable and occasionally dangerous behavior

b. Catatonic – alternating periods of extreme withdrawal and extreme excitement

c. Disorganized – usually occurs at an earlier age; emotional distortion and blunting

manifested by inappropriate laughter and silliness, peculiar mannerisms, and bizarre behavior

d. Undifferentiated – rapidly changing mixture of all or most of the primary indicators of

schizophrenia

e. Residual – mild indication of schizophrenia shown by individuals in remission following a

schizophrenic episode

C. Biological Factors

 

 

1. Genetic Factors

a. heritability (~48% monozygotic twins)

2. Prenatal and Perinatal Factors

a. Virus or influenza in second trimester increases risk

3. Biochemical Factors

a. Dopamine hypothesis – the idea that schizophrenia involves an excess of dopamine activity

4. Neuroanatomy

a. Early observations showed enlarged ventricles

b. Progression of “pruning” starting in parietal lobe

D. Psychological Factors

1. Expressed emotion (emotional over involvement and excessive criticism from the family)

VI. Personality Disorders: Going to Extremes

A. Types of Personality Disorders

1. Odd/Eccentric Cluster

a. Schizotypal – eccentric manners of speaking or dressing; strange beliefs; difficulty

forming relationships

b. Paranoid – distrust in others; apt to challenge loyalty of friends; prone to anger and

aggressive outburst; emotionally cold

c. Schizoid – extreme introversion and withdrawal from relationships; little interest in others;

humorless; distant

2. Dramatic/Erratic Cluster

a. Antisocial – impoverished moral sense; history of deception, crime, impulsive behavior;

little emotional empathy or remorse for harming others; high risk for substance abuse

b. Borderline – unstable moods and intense stormy relationships; self-mutilation or suicidal

threats or gestures to get attention; tendency to see others as “all good” or “all bad”

c. Histrionic – constant attention-seeking, grandiose language, provocative dress,

exaggerated illness, all to gain attention; emotional, lively, overly dramatic, enthusiastic; flirtatious

d. Narcissistic – inflated sense of self-importance, absorbed by fantasies or self or success;

poor longer-term relationships; exploitative of others

3. Anxious/Inhibited Cluster

a. Avoidant – socially anxious and uncomfortable unless they are confident of being liked;

fears criticism; avoids social situations due to fear of rejection

b. Dependent – submissive, dependent, requiring excessive approval, reassurance and

advice; clings to people; lacks self-confidence; uncomfortable when alone

c. Obsessive-compulsive (NOT OCD) – conscientious, orderly, perfectionist; excessive need

to do everything right; fear of errors; poor expression of emotions

B. Antisocial Personality Disorder (APD) – pattern of disregard for, and violation of, the rights of

others

1. Usually starts with conduct disorder (aggression, rule violations, etc.) in adolescence

 

 

2. Sociopath and psychopath (coldhearted, manipulative, and ruthless)

3. Less active hippocampus and amygdala when shown negative conditional words, resulting in

less sensitivity to fear