Chapter 18: Case Study: Not Guilty by Reason of Insanity Section 1: Understanding Section 2: Anxiety and Mood Disorders Section 3: Dissociative and Somatoform Disorders Section 4: Schizophrenia Section 5: Personality Disorders Lab: Applying What You ve Learned Case Study: Not Guilty by Reason of Insanity The majority of people with serious psychological disorders are not dangerous to others. Some, however, commit violent crimes. Of these, some are found not guilty by reason of insanity and are sent to psychiatric institutions instead of prison. When an accused person pleads insanity, the prosecutor tries to prove that the person was sane at the time of the crime and the defense tries to prove he or she was not. Under law, one must be either all or nothing, but in reality most psychological disorders are a matter of degree. 1
What do you think? In general, what criteria must a defendant meet to be ruled legally insane? Do you support the use of the insanity defense? Why or why not? Section 1 at a Glance Understanding Psychological disorders are behavior patterns or mental processes that cause serious personal suffering or interfere with a person s ability to cope with everyday life. Psychological disorders are classified in the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM. Understanding Main Idea Psychological disorders are relatively common. They cause personal suffering to millions of people and interfere with their ability to cope with everyday life. Reading Focus What are psychological disorders, and how common are they? What are the four major symptoms that can help identify psychological disorders? How do psychologists classify psychological disorders? 2
Why were people with mental illnesses seen as criminals? What Are? Psychological disorders are behavior patterns or mental processes that cause serious personal suffering or interfere with a person s ability to cope with everyday life. The great majority of people are never admitted to mental hospitals and most people never seek the help of psychologists or psychiatrists. Estimates suggest that one in four American adults have experienced some type of psychological disorder. For people aged 15 to 44, psychological disorders are the leading cause of disability in the United States. Reading Check Summarize What is a common misconception about psychological disorders? Answer: Psychological disorders are uncommon. 3
Click on the image to play the Interactive. Identifying People with psychological disorders usually do not differ much form so-called normal people. Certain behavior patterns and mental processes may suggest that an individual has a psychological disorder. Psychologists use several criteria to determine whether a person s behavior indicates the presence of a psychological disorder. Typicality Normality is determined by the degree to which a behavior is average, or typical, of the majority of people. Scientific and artistic geniuses are not typical, but are not abnormal. People who are quite normal may have lifestyles that differ widely from the rest of the community. Additional measurements must be taken into account. Maladaptivity Maladaptivity is a behavior that impairs an individual s ability to function adequately in everyday life. Behavior that causes misery and distress rather than happiness and fulfillment, or that is dangerous Emotional Discomfort Depression and anxiety cause extreme emotional discomfort. Helplessness, hopelessness, worthlessness, guilt, extreme sadness, and withdrawal Socially Unacceptable Behavior Cultural context of a behavior must be taken into account. Culture-bound syndromes: clusters of symptoms 4
Reading Check Find the Main Idea What are four features that might indicate a psychological disorder? Answer: The four features are typicality, maladaptivity, emotional discomfort, and socially unacceptable behavior. Classifying Classification helps to determine: How many people have a given disorder What factors may be associated with a disorder Diagnosis and treatment DSM APA's classification system Used to communicate needs and treatment Modern categories based on observable signs and symptoms Major Types of Disorders Anxiety Mood Dissociative Somatoform Schizophrenic Personality 5
Section 2 at a Glance Anxiety and Mood Disorders Anxiety disorders occur when people feel fear or nervousness out of proportion to the actual threat. Mood disorders are characterized by mood changes that are inappropriate for the situation to which they are responding. Anxiety and Mood Disorders Main Idea Anxiety disorders cause people to experience irrational or excessive fear. Mood disorders cause people to experience mood changes that are inappropriate to the situation. Reading Focus What are some characteristics of anxiety? What are five major types of anxiety disorders? How do psychologists explain anxiety disorders? How do the two main types of mood disorders compare? Which theories explain the origins of mood disorders? What Is Anxiety? Anxiety refers to a generalized state of dread or uneasiness that occurs in response to a vague or imagined danger, as opposed to fear, which is a response to a real danger or threat. Characterized by Nervousness Inability to relax Concern about losing control Trembling Sweating Rapid heart rate Shortness of breath Increased blood pressure Everyone feels anxious at times, but constant anxiety can interfere with effective living. 6
Reading Check Analyze How are anxiety disorders different from normal anxious reactions? Answer: constant anxiety, out of proportion to event, interferes with normal effective living 7
Types of Anxiety Disorders Phobic Disorder Phobia: derives from the Greek root phobos, which means fear Specific phobia is the most common of all anxiety disorders and refers to a persistent excessive fear of a particular object or situation. Most common include Zoophobia: fear of animals Claustrophobia: fear of enclosed spaces Acrophobia: fear of heights Arachnophobia: fear of spiders Social phobia is characterized by persistent fear of social situations in which one might be exposed to the scrutiny of others. Panic Disorder and Agoraphobia People with panic disorder have recurring and unexpected panic attacks, or relatively short periods of intense fear or discomfort characterized by shortness of breath, dizziness, rapid heart rate, trembling, choking, etc. Agoraphobia: the fear of being in places or situations in which escape may be difficult or impossible such as crowded public places. Many people with agoraphobia develop panic attacks when in public. Generalized Anxiety Disorder An excessive or unrealistic worry about life circumstances that lasts for at least six months. Few people seek treatment because it does not differ, except in intensity and duration, from the normal worries of everyday life. 8
Obsessive-Compulsive Disorder (OCD) Obsessions are unwanted thoughts, ideas, or mental images that occur over and over again, and most people try to ignore or suppress them. Compulsions are repetitive ritual behaviors, often involving checking or cleaning something. People are usually aware that the obsessions are unjustified, which distinguishes obsessions from delusions. Stress Disorders Include post-traumatic stress disorder (PTSD) and acute stress disorder Similar symptoms, but PTSD is more severe and longer-lasting PTSD occurs after rape, abuse, severe accident, natural disasters, and war atrocities. Explaining Anxiety Disorders Psychological Views Biological Views Psychoanalytic views are no longer Heredity may play a role widely accepted, but have affected Studies of twins indicate that the classification of psychological having a parent or sibling with a disorders. disorder increases the chance an Learning theorists believe that individual will have a disorder. phobias are learned in childhood. Some psychologists believe that Cognitive theorists believe that people who rapidly acquired strong people make themselves feel fears of real dangers would be anxious by responding negatively more likely to live and reproduce. to most situations. Interaction of Factors: some cases reflect the interaction of biological and psychological factors. 9
Types of Mood Disorders Most people have mood changes Major Depression that reflect the normal ups and downs of life, but mood changes Feelings of helplessness, that are inappropriate to a situation hopelessness, worthlessness, guilt, can signal a mood disorder. and great sadness Two types: depression and The DSM-IV contains a list of bipolar disorder symptoms to help diagnose Bipolar Disorder A cycle of mood changes from depression to wild elation and back again Period of mania, or extreme excitement characterized by hyperactivity and chaotic behavior Postpartum Depression Some women suffer symptoms of depression after giving birth Can harm both mother and child Reading Check Analyze What are some ways that mood disorders can disrupt one s daily life? Answer: persistent depressed mood, loss of interest in activities, significant weight loss or gain, sleeping more or less, fatigue, reduced ability to concentrate or make meaningful decisions, recurrent thoughts of death or suicide 10
Current Research in Psychology Post-Traumatic Stress Disorder and Iraq War Veterans For those who survive the horrors of war, the trauma of combat may not be left behind on the battlefield. Some veterans report vivid flashbacks and nightmares. A high incidence of PTSD has been reported among soldiers returning from war in Iraq and Afghanistan. Researchers are seeking reasons for what some call a PTSD epidemic. Younger veterans are more likely to be diagnosed. Those with traumatic head injuries more likely to be diagnosed. Currently veterans can receive five years of free health care for any mental disorder related to combat. Because PTSD shows up long after the trauma, increased mental health services will be necessary. 11
Section 3 at a Glance Dissociative and Somatoform Disorders Dissociative disorders are characterized by the separation of certain personality components or mental processes from conscious thought. Somatoform disorders are expressed in the form of actual physical symptoms. Dissociative Disorders Dissociation: the separation of certain personality components or mental processes from conscious thought In some situations, it is normal (becoming engrossed in a book). If dissociation occurs as a way to avoid stressful events or feelings, it can signal a disorder. Dissociative Amnesia Characterized by a sudden loss of memory, usually following a particularly stressful or traumatic event. It cannot be explained biologically. The incidence of dissociative amnesia rises markedly during wartime and natural disasters. Dissociative Fugue Characterized by not only forgetting personal information and past events but also by suddenly relocating from home or work and taking on a new identity. Individuals may appear healthy until the fugue ends, when they will not remember anything that happened during the fugue. Dissociative Identity Disorder Involves the existence of two or more personalities within a single individual. The various personalities may or may not be aware of the other. Depersonalization Disorder Depersonalization: feelings of detachment from one s mental processes or body People describe being outside their bodies. 12
Reading Check Compare What is the basic feature that dissociative disorders have in common? Answer: involve separation of personality components or mental processes from conscious thought Explaining Dissociative Disorders Psychoanalytic theory suggests people dissociate in order to repress unacceptable urges. Learning theorists claim individuals have learned not to think about disturbing events in order to avoid feelings, of guilt, shame, or pain. Cognitive and biological theorists have not offered a complete explanation of dissociative disorders. Somatoform Disorders Somatization: the expression of psychological distress through physical symptoms. People with somatoform disorders have psychological problems (such as depression) but experience inexplicable physical symptoms (such as paralysis). Conversion Disorder Patients experience a change in or loss of physical functioning in a major part of the body for which there is no known medical explanation Patients often show a lack of concern for their symptoms. Hypochondriasis A person s unrealistic preoccupation with thoughts that he or she has a serious disease. Patients may become absorbed by minor physical symptoms and sensations. 13
Section 4 at a Glance Schizophrenia Schizophrenia is usually considered the most serious psychological disorder and can be very disabling. Schizophrenia is characterized by a loss of contact with reality. The three types of schizophrenia are paranoid, disorganized, and catatonic schizophrenia. What Is Schizophrenia? Schizophrenia: characterized by loss of contact with reality. Can be very disabling and can lead to the affected person s inability to function independently First appears in young adulthood Usually develops gradually, but can also appear suddenly Most striking symptoms are: Hallucinations Delusions Thought disorders Other symptoms include social withdrawal, impaired social skills, loss of normal emotional responses. Occasionally, may go into a catatonic stupor: an immobile, expressionless, comalike state. Reading Check Summarize What is the basic characteristic of schizophrenia? Answer: loss of contact with reality 14
Types of Schizophrenia Paranoid Schizophrenia Delusions or frequent auditory hallucinations that center on one theme, often a theme of persecution Disorganized Schizophrenia Incoherent in their thought and speech and disorganized in their behavior; delusions and hallucinations are unconnected Emotionless or show inappropriate emotions Catatonic Schizophrenia Activity may slow to a stupor and then suddenly switch to agitation May hold unusual, uncomfortable body positions for long periods of time, even after their arms and legs swell and stiffen Reading Check Analyze What are some indications that schizophrenia has a physical basis? Answer: evidence of differences in size and structure of the brain, more dopamine use, genetic factors Section 5 at a Glance Personality Disorders Personality disorders are patterns of inflexible traits that disrupt social life or work and may distress the affected individual. Four common personality disorders are paranoid, schizoid, antisocial, and avoidant. 15
Personality Disorders Main Idea Personality disorders are characterized by patterns of unchanging personality traits that disrupt people s social lives and work lives. Reading Focus What are personality disorders, and how do they differ from other psychological disorders? What are ten types of personality disorders? How do psychological and biological views explain the origins of antisocial personality disorder? What Are Personality Disorders? Personality disorders: patterns of inflexible traits that disrupt social life or work and may distress the affected individual An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it Usually show up by late adolescence Psychological disorders are illnesses that an individual experiences as episodes. In contrast, personality disorders are enduring traits that are major components of the individual s personality. Reading Check Contrast How are personality disorders different from other disorders that they may resemble? Answer: Personality disorders are patterns of inflexible, enduring traits, not episodes of illness. 16
Reading Check Analyze What are some ways that personality disorders can make life difficult? Answer: Individuals with personality disorders have great difficulty making friends and developing lasting relationships with others, and it is difficult for them to retain or achieve success in a job, which can lead to further isolation or financial hardship. Explaining Personality Disorders Both psychological and biological theories have been suggested to explain some of them. Psychological Views Biological Views Psychoanalytic theory suggests a lack of guilt underlies the antisocial personality. Learning theorists suggest children who are not reinforced for good behavior learn antisocial behavior. Cognitive theorists argue antisocial teens use a faulty view of others actions. Antisocial personality disorder appears to run in families. Some evidence suggests that antisocial people have less developed emotional centers in their brains. Biological factor by itself is unlikely to cause the development of antisocial personality disorder. 17
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