Psychology in Your Life

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1 Sarah Grison Todd Heatherton Michael Gazzaniga Psychology in Your Life SECOND EDITION Chapter 14 Psychological Disorders W. W. Norton & Company, Inc.

2 14.1 What Is a Psychological Psychopathology Disorder? (1) Sickness or disorder of the mind Drawing the line between normal emotions, thoughts, and behaviors and a psychological disorder can be difficult When a psychological problem disrupts a person s life and causes significant distress over a long period, the problem is considered a disorder 2

3 Disorders Interfere With Our Lives (3) Whether something is psychopathology, it is important to consider four criteria 1. Does it deviate from cultural norms? 2. Is it maladaptive? 3. Is it self-destructive? 4. Does it cause discomfort and concern to others? Psychologists investigate disorders from four perspectives 1. Identify the etiology: Factors that contribute to the development of a disorder 2. Assess the symptoms 3. Group symptoms into categories to make a diagnosis 4. Identify possible treatments 3

4 There Are Several Causes of Disorders (1) Diathesis-stress model Proposes that a disorder may develop when an underlying vulnerability is coupled with a precipitating event According to this model, the onset of mental disorders occurs due to both vulnerability for the disorder and the presence of stressful events 4

5 There Are Several Causes of Disorders (3) Biopsychosocial approach States that most psychological disorders are influenced by biological, psychological, and sociocultural factors The biological aspect of this approach focuses on how physiological factors, such as brain function, neurotransmitter imbalances, and genetics, contribute to psychological disorders 5

6 There Are Several Causes of Disorders (4) The psychological aspect of the approach states that thoughts, emotions, personality, and learned experiences all influence the development of psychological disorders Sociocultural factors include family relationships, socioeconomic status, and the cultural context 6

7 Disordered Thoughts and Behavior Can Be Assessed and Categorized (1) Assessment of a person s mental functions and actions allows psychologists To categorize the individual s thoughts, emotions, and behaviors in order to make a diagnosis so that appropriate treatment can be provided To understand the course of the condition and its probable outcome, or prognosis 7

8 Disordered Thoughts and Behavior Can Be Assessed and Categorized (3) Assessment of symptoms The first step in an assessment is often to conduct an interview People s self-reports can reveal a great deal A psychological assessor can also gain information through observations of the client s behavior Another source of information regarding psychopathology is psychological testing 8

9 Disordered Thoughts and Behavior Can Be Assessed and Categorized (5) Categorizing disordered thoughts and behavior In ancient time madness was believed to be caused by the gods, witches, or some sort of evil spirits The idea of systematically categorizing mental disorders was pioneered by Dr. Emil Kraepelin, and was officially adopted in 1952 when the American Psychiatric Association published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) 9

10 Disordered Thoughts and Behavior Can Be Assessed and Categorized (7) In the current Diagnostic and Statistical Manual, DSM-5 (released in 2013), disorders are described in terms of observable symptoms A person must meet specific criteria to receive a particular diagnosis The DSM-5 consists of three sections 1. An introduction with instructions for using the manual 2.Diagnostic criteria for all disorders, which are grouped so that similar disorders are located near each other 3.A guide for future psychopathology research that describes conditions not yet officially recognized as disorders 10

11 Disordered Thoughts and Behavior Can Be Assessed and Categorized (9) The dimensional approach considers mental disorders along a continuum on which people vary in degree rather than in kind 11

12 Disordered Thoughts and Behavior Can Be Assessed and Categorized (11) Categorizing disordered thoughts and behavior Many mental disorders may occur together (comorbidity) even though the DSM-5 treats them as separate disorders for example, depression and anxiety, or depression and substance abuse. This state is known as comorbidity DSM-5 describes 19 major categories of disorder, each of which has several variations or types 12

13 14.2 How Do People Experience Disorders of Emotion? Anxiety disorders are characterized by excessive anxiety in the absence of true danger People who experience anxiety disorders feel anxious, tense, and worried about the future By continually arousing the autonomic nervous system, chronic anxiety also causes bodily symptoms such as sweating, dry mouth, rapid pulse, shallow breathing, and increased muscular tension 13

14 Anxiety Disorders Make People Fearful and Tense (3) Symptoms of two types of phobias Phobia: Fear of a specific object or situation that is out of proportion with an actual threat Specific phobias affect about 1 in 8 people, involve particular objects and situations, and can be less disruptive because people may be able to avoid the object or situation that triggers their reaction Social anxiety disorder, also called social phobia, is a fear of being negatively evaluated by others; around 1 in 14 people experience social phobia People suffering from social phobia are also more likely to develop depression 14

15 Anxiety Disorders Make People Fearful and Tense (5) Symptoms of generalized anxiety disorder A diffuse state of constant anxiety not associated with any specific object or event People with this disorder are constantly anxious and worry incessantly about even minor matters 15

16 Anxiety Disorders Make People Fearful and Tense (6) Symptoms of panic disorder Panic disorder: An anxiety disorder that consists of sudden, overwhelming attacks of terror Panic attacks typically last for several minutes, during which the person may begin to sweat and tremble; feel the heart racing; feel shortness of breath and chest pain; and feel dizzy and lightheaded, with numbness and tingling in the hands and feet People experiencing frequent panic attacks are at increased risk for committing suicide. 16

17 Anxiety Disorders Make People Fearful and Tense (7) Symptoms of agoraphobia An anxiety disorder marked by fear of being in situations from which escape may be difficult or impossible People who experience agoraphobia avoid going into open spaces or to places that might have crowds 17

18 Anxiety Disorders Make People Fearful and Tense (8) Development of anxiety disorders Although people are anxious about different things, the etiology of various types of anxiety is best explained using a biopsychosocial approach We also know that many fears are learned 18

19 Unwanted Thoughts Create Fear in Obsessive-Compulsive Disorder (1) Symptoms of obsessive-compulsive disorder (OCD) A disorder characterized by frequent intrusive thoughts that create anxiety and compulsive actions that temporarily reduce the anxiety Affecting 1 percent to 2 percent of the population, OCD is more common in women than men and generally begins in early adulthood 19

20 Unwanted Thoughts Create Fear in Obsessive-Compulsive Disorder (2) Obsessions are recurrent, intrusive, and unwanted thoughts, urges, or mental images They often include intense worry and fears of contamination, of accidents, or of one s own aggression Compulsions are particular acts that the person feels driven to perform over and over again The most common compulsive behaviors are cleaning, checking, and counting 20

21 Unwanted Thoughts Create Fear in Obsessive-Compulsive Disorder (3) Development of obsessive-compulsive disorder OCD is another example of how the biopsychosocial approach explains the causes of some mental disorders There is also good evidence that the etiology of OCD is in part biological specifically, genetic in nature Brain imaging has also provided some evidence regarding which brain systems are involved in OCD 21

22 Posttraumatic Stress Disorder Results From Trauma Trauma and stressor-related disorders Posttraumatic stress disorder (PTSD): A mental disorder that involves frequent nightmares, intrusive thoughts, and flashbacks related to an earlier trauma Around 7 percent of the population will experience PTSD at some point, and women are more likely to develop the disorder Adjustment disorder People have difficulty adjusting to the stressors 22

23 Depressive Disorders Are Common (3) Symptoms of depressive disorders Major depressive disorder: Mood disorder, characterized by extremely depressed moods or a lack of interest in normally pleasurable activities, that persists for 2weeks or more Major depressive disorder affects about 6 percent to 7 percent of Americans in any given year, and approximately 16 percent of Americans will experience major depression at some point in their lives 23

24 Depressive Disorders Are Common (4) Persistent depressive disorder: Mood disorder, characterized by mildly or moderately depressed moods, that persists for at least 2 years People with persistent depressive disorder approximately 2 percent to 3 percent of the population may have many of the same symptoms as those with major depression, but the symptoms are less intense 24

25 Depressive Disorders Are Common (5) 25

26 Depressive Disorders Are Common (6) Development of depressive disorders: Biological factors Biopsychosocial factors play a role in the etiology of depression Studies of twins, of families, and of adoptive children support the notion that depression has a genetic component Studies of brain function have suggested that certain neural structures may be involved in mood disorders 26

27 Depressive Disorders Are Common (7) Relationships contribute to the development of depression and alter people s experiences when depressed Aaron Beck believes that a psychological factor associated with depression is how people think of themselves. I am stupid, or I m a failure People who develop depression blame misfortunes on personal defects and see positive occurrences as the result of luck. Cognitive triad. A second cognitive theory of depression is based on learned helplessness People come to see themselves as unable to have any effect on events in their lives 27

28 Depressive Disorders Are Common (10) Development of depressive disorders: Culture and gender Across multiple countries and contexts, twice as many women as men are diagnosed with depression Women in developing nations like Brazil or Chile are more likely to develop depression. One theory is that women respond to stressful events by internalizing their feelings, which leads to depression and anxiety, whereas men externalize their feelings with alcohol, drugs, and violence 28

29 Bipolar Disorders Involve Mania (1) Symptoms of bipolar disorder Bipolar I disorder: Mood disorder characterized by extremely elevated moods during manic episodes Bipolar II disorder: Mood disorder characterized by alternating periods of extremely depressed and mildly elevated moods 29

30 Bipolar Disorders Involve Mania (2) 30

31 Bipolar Disorders Involve Mania (3) A case study of bipolar disorder Psychology professor Kay Redfield Jamison acknowledged her own struggles with bipolar disorder in her award-winning memoir An Unquiet Mind Lithium is an effective treatment, however many people with the disorder stop taking it because it reduces their positive emotions or feelings (they miss the mania) Major artists and writers who may have had bipolar disorders Michelangelo Vincent van Gogh Georgia O Keeffe Ernest Hemingway 31

32 Bipolar Disorders Involve Mania (4) Development of bipolar disorder Bipolar disorders are much less common than depression Around 3 percent to 4 percent of the population will experience a bipolar disorder in their lifetimes They are equally prevalent in women and men Bipolar disorders emerge most commonly during late adolescence or early adulthood There is a very strong genetic component Genetic research also suggests, however, that the hereditary nature of bipolar disorders is complex and not linked to only one gene 32

33 14.3 How Do People Experience Disorders of Thought? Schizophrenia A psychological disorder characterized by a split between thought and emotion where a person has difficulty distinguishing whether altered thoughts, perceptions, and conscious experiences are real versus what are imagined Less than 1 percent of the population has schizophrenia The rates for men and women are similar 33

34 Schizophrenia Is a Psychotic Disorder (1) Schizophrenia is characterized by a combination of motor, cognitive, behavioral, and perceptual abnormalities These abnormalities result in impaired social, personal, or vocational functioning or in some combination of these impairments Continuous signs of disturbances for at least 6 months 34

35 Schizophrenia Is a Psychotic Schizophrenia Disorder (2) The 5 major symptoms for schizophrenia are 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Disorganized behavior 5. Negative symptoms A diagnosis of schizophrenia requires a person to show two or more of these symptoms, including at least one of the first three symptoms listed 35

36 Schizophrenia Is a Psychotic Disorder (4) Positive symptoms: Symptoms of schizophrenia that are marked by excesses in functioning, such as delusions, hallucinations, and disorganized speech or behavior Negative symptoms: Symptoms of schizophrenia that are marked by deficits in functioning, such as apathy, lack of emotion, and slowed speech and movement 36

37 Schizophrenia Is a Psychotic Delusions Disorder (5) False beliefs based on incorrect inferences about reality Hallucinations False sensory perceptions that are experienced without an external source Hallucinations are frequently auditory but can also be visual, olfactory, or bodily 37

38 Schizophrenia Is a Psychotic Disorder (6) 38

39 Schizophrenia Is a Psychotic Disorder (9) Disorganized speech Speaking in an incoherent way that involves frequently changing topics and saying strange or inappropriate things Loosening of associations Clang associations Disorganized behavior Acting in strange or unusual ways, including strange movement of limbs and inappropriate self-care, such as failing to dress properly or bathe 39

40 Schizophrenia Is a Psychotic Negative symptoms Disorder (11) People with schizophrenia often avoid eye contact and seem apathetic They do not express emotion Their speech is slowed They use a monotonous tone of voice They take long pauses before answering They fail to respond to a question or are unable to complete their sentences Negative symptoms are more common in men 40

41 Schizophrenia Is a Psychotic Biological factors Disorder (12) The etiology of schizophrenia is nt well understood Schizophrenia runs in families, and genetics clearly plays a role in the development of the disorder Twin studies Schizophrenia is primarily a brain disorder. Most show loss of brain tissue, and increased ventricle size. One possibility is that schizophrenia results from an abnormality in neurotransmitters (dopamine levels) Exposure to certain viruses influences prevalence Schizophrenia is most often diagnosed when people are in their 20s or 30s 41

42 Schizophrenia Is a Psychotic Disorder (14) 42

43 Schizophrenia Is a Psychotic Disorder (16) Development of schizophrenia: Environmental factors For people who are genetically at risk for schizophrenia, environmental stress seems to contribute to its development Diathesis-stress model Researchers have also theorized that the increased stress of urban environments can trigger the onset of the disorder 43

44 Schizophrenia Is a Psychotic Disorder (17) 44

45 14.4 How Do People Experience Disorders of Self? Some people s identities cause them to interact with the world in maladaptive and inflexible ways When this style of interaction is long-lasting and causes problems in work and social situations, it becomes a personality disorder 45

46 Personality Disorders Are Maladaptive Ways of Relating to the World (1) The DSM-5 divides personality disorders into three groups 1. Cluster A (characterized by odd or eccentric behavior), paranoid, schizoid, and schizotypal 2. Cluster B (characterized by dramatic, emotional, or erratic behaviors), antisocial, borderline, histrionic, and narcissistic 3. Cluster C (characterized by anxious or fearful behavior), avoidant, dependent, and obsessive-compulsive 46

47 Personality Disorders Are Maladaptive Ways of Relating to the World (3) Symptoms and development of Borderline Personality Disorder A personality disorder characterized by disturbances in identity, in moods, and in impulse control 1 percent to 2 percent of adults meet the criteria Borderline personality disorder may have an environmental component because of the strong relationship that exists between the disorder and trauma or abuse Antisocial personality disorder (APD) A personality disorder marked by disregard for and violation of the rights of others and by lack of remorse Psychopaths: Ironically, people with psychopathic traits are often seen as charming and intelligent 47

48 Personality Disorders Are Maladaptive Ways of Relating to the World (5) In the United States, about 1 percent to 4 percent of the population has APD Various physiological abnormalities may play a role in the disorder 48

49 Dissociative Disorders Involve Disruptions in One s Sense of Self (1) Dissociative disorders involve disruptions of Identity, Memory, and/or Conscious Awareness Symptoms and development of dissociative amnesia Mental disorder that involves disruptions of memory for personal facts or loss of conscious awareness for a period of time The rarest and most extreme form of dissociative amnesia is dissociative fugue, which involves traveling to another location (the Latin word fuga means flight ) and sometimes assuming a new identity 49

50 Dissociative Disorders Involve Disruptions in One s Sense of Self (3) Symptoms and development of dissociative identity disorder (DID) The occurrence of two or more distinct identities in the same individual The condition was formerly called multiple personality disorder (MPD) Most people diagnosed with DID are women who report being severely abused as children 50

51 14.5 What Disorders Affect Children? (1) All the neurodevelopmental disorders should be considered within the context of normal childhood development The most common symptoms are problems affecting emotions and/or learning ability. This category includes a wide range of disorders 51

52 Autism Spectrum Disorder Involves Social Deficits (1) Autism spectrum disorder A developmental disorder characterized by deficits in social interaction, impaired communication, and restricted, repetitive behavior and interests Approximately 3 to 6 children out of 1,000 show signs of autism spectrum disorder, and males outnumber females 3 to 1 From 1991 to 1997, there was a dramatic increase (556 percent) in the number of children diagnosed with autism 52

53 Autism Spectrum Disorder Involves Social Deficits (2) Autism spectrum disorder varies in severity, from mild social impairments to severe social and intellectual impairments High-functioning autism is sometimes called Asperger s syndrome 53

54 Autism Spectrum Disorder Involves Social Deficits (3) Symptoms of autism spectrum disorder Children with a severe form of autism spectrum disorder are seemingly unaware of others These children do not establish eye contact and do not use their gaze to gain or direct the attention of those around them Deficits in communication are another characteristic of autism spectrum disorder 54

55 Autism Spectrum Disorder Involves Social Deficits (4) Another set of deficits includes restricted, repetitive behaviors and interests Any changes in daily routine or in the placement of furniture or toys are very upsetting for children with autism spectrum disorder Their behavior also tend to be repetitive and can include strange hand movements, body rocking, and hand flapping Self-injury is common, and some children must be forcibly restrained to keep them from hurting themselves 55

56 Autism Spectrum Disorder Involves Social Deficits (8) Development of autism spectrum disorder It is now well established that autism is the result of biological factors Research into the causes of autism also points to prenatal and/or early childhood events that may result in brain dysfunction There is evidence that the brains of people with autism have faulty wiring in a large number of areas 56

57 Attention-Deficit/Hyperactivity Disorder Is Common in Childhood (1) Symptoms of attentiondeficit/hyperactivity disorder (ADHD) A disorder characterized by excessive activity or fidgeting, inattentiveness, and impulsivity Symptoms before age 12 In the United States, 12.1 percent of boys and 5.5 percent of girls have ADHD 57

58 Attention-Deficit/Hyperactivity Disorder Is Common in Childhood (2) Development of ADHD The causes of ADHD are unknown Possible factors such as poor parenting and social disadvantage may contribute to the onset of symptoms Researchers have theorized that the connection between the frontal lobes and the limbic system is impaired in ADHD patients 58

59 Attention-Deficit/Hyperactivity Disorder Is Common in Childhood (3) 59

60 Attention-Deficit/Hyperactivity Disorder Is Common in Childhood (4) ADHD across the life span First diagnosed between ages 5 and 7 With the development of more structured day care settings, the demands on children to conform are occurring much earlier The DSM-5 recognizes that many of the symptoms of ADHD continue well into adulthood Adults with ADHD symptoms compose about 4 percent of the population 60

Agoraphobia. An anxiety disorder marked by fear of being in situations in which escape may be difficult or impossible.

Agoraphobia. An anxiety disorder marked by fear of being in situations in which escape may be difficult or impossible. Agoraphobia An anxiety disorder marked by fear of being in situations in which escape may be difficult or impossible. (See page 634) Antisocial personality disorder (APD) A personality disorder marked