Psychological Disorders

General Psychology
47.101

Psychopathology
• Conceptions of psychopathology
• What is Abnormal?
• Diagnostic system: DSM IV Body Ritual of the Naricema…
• Causes
• Types of Disorders
– Dissociative
– Anxiety
– Schizophrenia
– Mood
– Personality

What is Abnormality?
What is Abnormal? • Criteria
• How can abnormal be differentiated from – Infrequent in the population
normal? – Socially deviant
• How is abnormal diagnosed? – Maladaptive
• Personal distress
– Psychologically disorganized
• No sharp boundaries
– Continuum is more reasonable
• Abnormal behaviors often = normal behavior
taken to the extreme

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 Diagnosing Disorders
• Use diagnostic interview
• Performance on Psychological Tests
– e.g., MMPI, Projective tests
• Interviews with Family & Friends
• Compare patient information to pre-established
psychological disorders
– Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV)
– DSM IV: Agreed-upon criteria for diagnosing
psychological disorders
Classification Systems & Labeling:
Advantages
Advantages:
• grouping of similar symptoms may help
to identify underlying causes
• facilitates communication
Labeling…
How important is it really?
Demo…
DSM IV Axes
“Axes” refer to different major diagnostic categories
of psychological disorders
• Axis I: Primary Diagnosis
• Axis II: Developmental & Personality Disorders
• Axis III: Physical disorders
• Axis IV: Stressors in last year, situational
contributors
• Axis V: How well the person has coped with
stress in the past
Classification Systems & Labeling:
Disadvantages
Disadvantages:
• May seem dehumanizing for patients
– Better to apply diagnostic labels to the disorder
and NOT to the people themselves
• May lead clinicians to overlook unique
aspects of each case
– Label becomes a lens through which we see
and evaluate a person’s behavior
“On being sane in insane places”
Investigation by Rosenhan, Seligman, et al.
Discovering Psychology
#21: Psychopathology
6:49 – 9:55
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 Causation Diathesis-stress model
1. Predisposition
• In place before onset of disorder • People may have predisposition for disorder
• genetic characteristics, learned beliefs, sociocultural factors that is only brought out under stress
2. Precipitating causes
• Immediate events that bring on the disorder

High
• Stress, Negative or positive life changes manifested

Stress
Not manifested

Low
Low High
Predisposition

Causation Major Classes of Disorders

1. Predisposition
• In place before onset of disorder • Anxiety disorders • Somatoform Disorders
– Generalized anxiety disorder (GAD) – Hypochondriasis
• genetic characteristics, learned beliefs, sociocultural factors – Panic disorder – Body Dysmorphia
– Phobias – Conversion Disorder

2. Precipitating causes –
–
Obsessive compulsive disorder (OCD)
Post- traumatic stress disorder (PTSD)
• Immediate events that bring on the disorder • Dissociative Disorders • Eating Disorders
• Stress, Negative or positive life changes – Dissociative Identity Disorder – Anorexia
– Dissociative Amnesia – Bulimia

3. Maintaining causes – Dissociative Fugue

• Effects of disorder that serve to perpetuate it • Mood Disorders • Substance Disorders

– Depression – Substance abuse
– depressed person may withdraw from social interactions – Bipolar – Substance dependence
– Dysthymia
– Schizophrenics are reacted to strangely or violently, enhancing • Personality Disorders
their stress, which enhances the disorder • Psychotic disorders – Antisocial personality disorder
– Schizophrenia – Borderline personality disorder
– Schizoaffective disorder – Narcissistic personality disorder

Major Classes of Disorders Prevalence of mental disorders

• Anxiety disorders • Somatoform Disorders

– Hypochondriasis
– Generalized anxiety disorder (GAD)
– Body Dysmorphia
– Panic disorder
– Phobias – Conversion Disorder
– Obsessive compulsive disorder (OCD)
– Post- traumatic stress disorder (PTSD)

• Dissociative Disorders • Eating Disorders

– Dissociative Identity Disorder – Anorexia
– Dissociative Amnesia – Bulimia
– Dissociative Fugue

• Mood Disorders • Substance Disorders

– Depression – Substance abuse
– Bipolar – Substance dependence
– Dysthymia
• Personality Disorders
• Psychotic disorders – Antisocial personality disorder
– Schizophrenia – Borderline personality disorder
– Schizoaffective disorder – Narcissistic personality disorder

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 Before we start… Dissociative Disorders
• A word of caution: Do not develop • Ever forget the passage of time?
“medical student syndrome” – Driving a car, spacing out (certainly not in this class!)

• Dissociation: “out of body experience”,

• But, if some of the things that we discuss disconnect form self
ring true…
• Dissociation is part of other disorders as well
• Ex: BPD…
• But in dissociative disorders it is the primary symptom
If ~ 10-15min left jump to #32

Dissociative Identity Disorder (DID) DID

• Previously known as Multiple personality
disorder (MPD)
– Characterized by multiple identities

• Causes…
– Often severe trauma in childhood
– Means of escape

• Controversial

What does anxiety feel like???

Anxiety Disorders

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 Anxiety Anxiety Disorders
– Generalized anxiety disorder
• Feeling of dread, apprehension or fear – Panic attacks
• Accompanied by physiological arousal – Phobias
• Can make it hard to think clearly – Obsessive-compulsive disorder
– PTSD

• As a category, easiest to treat and best long-term

prognosis

GAD Generalized Anxiety Disorder (GAD)

“Tom, a 37 year old electrician, complains of
dizziness, sweating palms, heart palpitations
and ringing in the ears. He feels edgy and
sometimes finds himself shaking. With
reasonable success he hides his symptoms
from his family and co-workers. Never the
less, he has few social contacts since the
symptoms began two years ago. He
occasionally has to leave work. His family
doctor and a neurologist can find no physical
problem.”
• Symptoms are common…it is there persistence
that is uncommon
• Unfocused anxiety
– feels vaguely uneasy
– overreacts to mild stressors
– inability to relax, disturbed sleep
– rapid heart rate,
– fatigue, headaches, dizziness
• Hard to treat because there is no obvious source of
the anxiety

Panic attack Panic Attack

• Sudden episodes of overwhelming terror
“I felt hot as though I couldn't breath. My
heart was racing and I started to sweat and • Over-activity of sympathetic nervous system
tremble and I was sure I was going to faint. – heart palpitations
– shortness of breath
Then my fingers felt numb and tingly and
– perspiration
things seemed unreal. It was so bad I – muscle tremors
wondered if I was dying and asked my – faintness
husband to take me to the emergency room. – nausea
By the time we got there the worst of the – fear of dying or going crazy
attack was over and I just felt washed out” • Can start to fear the fear itself…

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 Phobia
• Persistent and irrational fear of an object or situation that
presents no realistic danger
• Anxiety experienced in response to a specific stimulus
– Specific (simple) phobias
• Animals (snakes, spiders, rats)
• Situations (high places, enclosed spaces, doctor’s office)
• Things (blood, waters, clowns)
– Social phobia - fear of public scrutiny
• Public speaking
– Agoraphobia - fear of being in public places
• Fear is that something bad might happen and you’ll be
trapped

• Not labeled a phobia unless it disrupts a person’s daily life

• Example of panic/agoraphobia (DVD - Clip)

How do phobias develop?

• Classical Conditioning
– Remember Little Albert…

• Social Learning Principles

– E.g., modeling

• Phobias often persist because of avoidance

– Cannot learn that anxiety response is unnecessary

• Usually treated with exposure therapy

– Expose the person to the object that arouses fear
– When nothing bad happens the phobia fades

OCD Obsessive - Compulsive Disorder

(Howard Hughes) • Obsessions
“Hughes compulsively dictated the same – persistent and irrational intrusions or
phrases over and over again. Under stress, unwelcome thoughts or images
he developed a phobic fear of germs, which
led to compulsive behaviors. Hughes became – Try it - The white bear…
reclusive and insisted his assistants carry out
elaborate hand-washing rituals and wear • Compulsions
white gloves when handling any document he – irresistible urges to carry out certain acts or
would later touch. He ordered tape around rituals
doors and windows and forbade his staff to – DVD example
touch or even look at him.”

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 OCD: Cleaners vs. Checkers

Cleaners Checkers
Sex Distribution: Mostly female Equal
Dominant Emotion: Anxiety Guilt and Shame
Speed of onset: Usually rapid More often gradual
Length of behavior: Less 1 hour at a time Some go on indefinitely
Feel better after? Yes Usually not

Causes of OCD PTSD

• Operant conditioning
– anxiety paired to event and to behavior to reduce
anxiety
• Biological
– Abnormalities of the frontal lobes
• organizing behaviors and planning.
– Abnormality of the basal ganglia
• involved in routine behaviors, like grooming, and the
frontal lobes
During the Iraq war, Jack’s platoon was
repeatedly under fire. In one ambush, I closest
friends as killed while Jack stood a few feet away.
Jack himself killed someone in an assault. Years
later, images of theses event still intrude on his as
flashbacks and nightmare. He still jumps at the
sound of a firecracker or the backfire of a car.
When annoyed by his family or friends, he lashes
out in ways he seldom did before Iraq. To calm
his continuing anxiety, he drinks more than he
should.

Post-Traumatic Stress Disorder

• Experiencing or witnessing severely threatening and
traumatic experiences
– Eg. War veterans, rape victims, accident survivors
• Symptoms include:
– Flashbulb memories
Schizophrenia
– Hypervigilance
– Intrusive thoughts
– Startle response
– Nightmares
– Insomnia
– Social withdrawal

(Example: Carl Vietnam Vet if there is time…)

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 Schizophrenia Schizophrenia Symptoms
• Dysfunction in social, emotional, cognitive, and
perceptual processes • Thought and attention
• Afflicts 1% of the general population – inability to filter out irrelevant stimuli
• Account for 30% of all hospital beds – loose associations (word salad); easily
• Peak incidence occurs adolescence or early adulthood distracted
• Onset can be sudden or gradual – delusions
• Course of schizophrenia is variable
• Delusions of grandeur
• Effects may wax and wane across time
• 40% successfully treated
• Thought broadcasting
• Best predictor Æ pre-morbid functioning • Thought blocking or withdrawal
• Thought insertion

Schizophrenia Symptoms (continued)

Example
• Perceptual
– Hallucinations
• Generally auditory
– Difficulty distinguishing reality from Discovering Psychology
imagination 20:19 – 22-30
• Affective
– dysregulated emotion
• Flat; inappropriate tears, laughter or anger
• Motor
– deficit in motor processes

Schizophrenia and Biology

• Dopamine hypothesis
– high levels of activity at dopamine receptors in brain
– only known treatment are neuroleptic drugs
• Block receptor sites
• Basically a tranquilizer
• Enlarged cerebral ventricles (fluid-filled spaces)
– continue to enlarge as the disorder progresses,
signifying brain atrophy (loss of brain tissue)

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 Somatoform Disorders
• Mental disorders expressed in bodily symptoms
– No apparent physical cause
– Difficult to diagnose – any physical cause must be ruled out
• Hyphochondriasis: belief one has specific disease; Mood Disorders
continually seeks treatment despite no physical evidence
for illness
• Somatization disorder: aches and pains inconsistent with
any illness
• Somatoform pain disorder: chronic pain with no apparent
physical cause
• Conversion disorder: dramatic loss of function (numbness
of hand, paralysis) with no physical cause.
– Referred to as “hysteria” by Freud
– Not commonly diagnosed today

Affective (mood) disorders Mood Continuum

• Extreme disturbances of mood
• Can disrupt physical, perceptual, social, and thought
processes
“Normal” Range

• Two major types

• Unipolar – extreme at one end of mood continuum Extreme Positive
Extreme Negative
• Depression
• Bipolar – extremes at both ends of the mood Unipolar Depression
continuum
• Major swings between depression and mania
– Note each episode (dep or mania last for some time) Bipolar Disorder
» NOT Rapid cycling….

Depressive Disorder
• Persistent feelings of sadness and despair
• Loss of interest in previous sources of pleasure
• Symptoms also include:
– feelings of worthlessness or guilt; low self-esteem
– reduced motivation
– disturbances of sleep, appetite, sex drive
– reduced energy; move sluggishly/talk slowly
– difficulties in thinking
– recurrent thoughts of suicide

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 Major Depression and Suicide Myths about Suicide
• Of suicides, majority had suffered a major depression
Myth 1:
• 250, 000 suicide attempts per year • Failed attempts indicate the person is not serious
– 1 in 8 are “successful”
– 8th leading cause of death
about dying
Age: – 75% of those who succeed in committing suicide
– highest attempts: 24-44 have made at least one previous attempt
– highest success: 55-65
– adolescents: rate tripled in last several decades
– college students: almost twice the rate of non-college peers
• Usually has to do with social relationships
Gender:
– women 3 times more likely to attempt suicide than men
– of those who attempt, men 4 times more successful
• Men tend to use more effective means

Myths about Suicide Myths about Suicide

Myth 2: Myth 3:
• Those who talk about suicide seldom make • Depressed people should be steered away from
attempts talking about suicide for fear it will only
– 70% of suicide victims had communicated their strengthen their resolve
intention to others – letting despondent people talk may actually help
– percentage is similar among college students them to overcome those thoughts

Mania
Important to get professional • State of exaggerated elation
help! Often accompanied by:
– feverish activity
• Risk of suicide may actually rise for a period – great distractibility
during recovery process – emotional high
• Greater risk during recovery than during depths of – inflated self-esteem
depressive episode – hyperactivity
• Person may have more energy and control to carry – reckless behavior
the suicide out – decreased need for sleep
– constant talkativeness
– flight of ideas

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 Bipolar Disorder
• Cycling between manic and depressive episodes
• Tied to biological causes
Changes in brain’s approach system: Personality Disorders
• Highly activated during mania
• Low activation during depression
• Most often treated with lithium carbonate
• Requires careful monitoring of toxicity

Personality Disorders
Class of disorder marked by inflexible and maladaptive
ways of interacting with the world
• Persistent…

Antisocial Personality: Typical

attributes

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 Antisocial Personality
• Often called “sociopaths” or
“psychopaths”
• Show lower physiological
arousal
• Less sensitive to peripheral
informational cues

• Subjects received a shock at number 8

– sociopaths show lower overall skin
conductance response and smaller
Ted Bundy responses in anticipation of shock

Practice your understanding…

Name that disorder…

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