Chapter 16

1. Chapter 16 Psychological Disorders

2. What is Normal? • Psychopathology: Scientific study of mental, emotional, and behavioral disorders • Subjective Discomfort: Feelings of anxiety, depression, or emotional distress • Statistical Abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depression • Social Nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior

3. What is Normal? (cont.) • Situational Context: Social situation, behavioral setting, or general circumstances in which an action takes place • Is it normal to walk around strangers naked? If you are in a locker room and in the shower area, yes! • Cultural Relativity: Judgments are made relative to the values of one’s culture

4. Fig. 16.1 The number of people displaying a personal characteristic may help define what is statistically abnormal. Social non-conformity does not automatically indicate psychopathology.

5. Fig. 16.2 This MRI scan of a human brain (viewed from the top) reveals a tumor (dark spot). Mental disorders sometimes have organic causes of this sort. However, in many instances no organic damage can be found. © Scott Camazine/Photo Researchers

6. Clarifying and Defining Abnormal Behavior (Mental Illness) • Maladaptive Behavior: Behavior that makes it difficult to function, to adapt to the environment, and to meet everyday demands • Mental Disorder: Significant impairment in psychological functioning • Those with mental illness lose the ability to adequately control thoughts, behaviors, or feelings

7. Clarifying and Defining Abnormal Behavior (Mental Illness)(cont.) • Psychotic Disorder: Severe psychiatric disorder characterized by hallucinations and delusions, social withdrawal, and a move away from reality • Organic Mental Disorder: Mental or emotional problem caused by brain pathology (i.e., brain injuries or diseases) • Substance Related Disorders: Abuse or dependence on a mind- or mood-altering drug, like alcohol or cocaine • Person cannot stop using the substance and may suffer withdrawal symptoms if they do

8. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.) • Mood Disorder: Disturbances in mood or emotions, like depression or mania • Anxiety Disorder: Feelings of fear, apprehension, anxiety, and behavior distortions

9. Fig. 16.5 The Mad Hatter, from Lewis Carroll’s Alice’s Adventures in Wonderland. History provides numerous examples of psychosis caused by toxic chemicals. Carroll’s Mad Hatter character is modeled after an occupational disease of the eighteenth and nineteenth centuries. In that era, hatmakers were heavily exposed to mercury used in the preparation of felt. Consequently, many suffered brain damage and became psychotic, or “mad” (Kety, 1979). © Bettmann/CORBIS

10. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.) • Somatoform Disorder: Physical symptoms that mimic disease or injury (blindness, anesthesia) for which there is no identifiable physical cause • Dissociative Disorder: Temporary amnesia, multiple identity, or depersonalization (like being in a dream world, feeling like a robot, feeling like you are outside of your body) • Personality Disorder: Deeply ingrained, unhealthy, maladaptive personality patterns

11. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.) • Sexual and Gender Identity Disorder: Problems with sexual identity, deviant sexual behavior, or sexual adjustment • Neurosis: Archaic; once used to refer to anxiety, somatoform, and dissociative disorders, also used to refer to some kinds of depression

12. General Risk Factors for Contracting Mental Illness • Social Conditions: Poverty, homelessness, overcrowding, stressful living conditions • Family Factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problems • Psychological Factors: Low intelligence, stress, learning disorders • Biological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability

13. Insanity • Definition: A legal term; refers to an inability to manage one’s affairs or to be aware of the consequences of one’s actions • Those judged insane (by a court of law) are not held legally accountable for their actions • Can be involuntarily committed to a psychiatric hospital • Some movements today are trying to abolish the insanity plea and defense; desire to make everyone accountable for their actions • How accurate is the judgment of insanity? • Expert Witness: Person recognized by a court of law as being qualified to give expert testimony on a specific topic • May be psychologist, psychiatrist, and so on

14. Personality Disorders: Antisocial Personality Disorder (APD) • Definition: A person who lacks a conscience (superego?); typically emotionally shallow, impulsive, selfish, and manipulative toward others • Oftentimes called psychopaths or sociopaths • Many are delinquents or criminals, but many are NOT crazed murderers displayed on television • Create a good first impression and are often charming • Cheat their way through life (e.g., Dr. Michael Swango, Scott Peterson)

15. APD: Causes and Treatments • Possible Causes: • Childhood history of emotional deprivation, neglect, and physical abuse • Underarousal of the brain • Very difficult to effectively treat; will likely lie, charm, and manipulate their way through therapy

16. Fig. 16.3 Using PET scans, Canadian psychologist Robert Hare found that the normally functioning brain (left) lights up with activity when a person sees emotion-laden words such as “maggot” or “cancer.” But the brain of a psychopath (right) remains inactive, especially in areas associated with feelings and self-control. When Dr. Hare showed the bottom image to several neurologists, one asked, “Is this person from Mars?” (Images courtesy of Robert Hare.) © Robert Hare

17. CNN – Serial Killer Motives

18. Anxiety-Based Disorders • Anxiety: Feelings of apprehension, dread, or uneasiness • Adjustment Disorders: When ordinary stress causes emotional disturbance and pushes people beyond their ability to effectively cope • Usually suffer sleep disturbances, irritability, and depression • Examples: Grief reactions, lengthy physical illness, unemployment

19. Anxiety-Based Disorders (cont.) • Generalized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety • Free-Floating Anxiety: Anxiety that is very general and persuasive

20. CNN – Anxiety Disorders in Kids

21. Panic Disorders • Panic Disorder (without Agoraphobia): A chronic state of anxiety with brief moments of sudden, intense, unexpected panic (panic attack) • Panic Attack: Feels like one is having a heart attack, going to die, or is going insane • Symptoms include vertigo, chest pain, choking, fear of losing control • Panic Disorder (with Agoraphobia): Panic attacks and sudden anxiety still occur, but with agoraphobia

22. Agoraphobia • Agoraphobia (with Panic Disorder): Intense, irrational fear that a panic attack will occur in a public place or in an unfamiliar situation • Intense fear of leaving the house or entering unfamiliar situations • Can be very crippling • Literally means fear of open places or market (agora) • Agoraphobia (without Panic Disorder): Fear that something extremely embarrassing will happen away from home or in an unfamiliar situation

23. Specific Phobias • Irrational, persistent fears, anxiety, and avoidance that focus on specific objects, activities, or situations • People with phobias realize that their fears are unreasonable and excessive, but they cannot control them

24. Social Phobia • Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public) • Barbra Streisand, Woody Allen perhaps?

25. Obsessive-Compulsive Disorder (OCD) • Extreme preoccupation with certain thoughts and compulsive performance of certain behaviors • Obsession: Recurring images or thoughts that a person cannot prevent • Cause anxiety and extreme discomfort • Enter into consciousness against the person’s will • Most common: Being dirty, wondering if you performed an action (turned off the stove), or violence (hit by a car) • Compulsion: Irrational acts that person feels compelled to repeat against his/her will • Help to control anxiety created by obsessions • Checkers and cleaners

26. Stress Disorders • Occur when stresses outside range of normal human experience cause major emotional disturbance • Symptoms: Reliving traumatic event repeatedly, avoiding stimuli associated with the event, and numbing of emotions • Acute Stress Disorder: Psychological disturbance lasting up to one month following stresses from a traumatic event • Post Traumatic Stress Disorder (PTSD): Lasts more than one month after the traumatic event has occurred; may last for years • Typically associated with combat and violent crimes (rape, assault, etc.) • Terrorist attacks on September 11th, 2001, likely led to an increase of PTSD

27. CNN – Mental Health and Traumatic Events

28. CNN - Prostitution

29. Dissociative Disorders • Dissociative Amnesia: Inability to recall one’s name, address, or past • Dissociative Fugue: Sudden travel away from home and confusion about personal identity

30. Dissociative Identity Disorder (DID) • Person has two or more distinct, separate identities or personality states; previously known as Multiple Personality Disorder • “Sybil” or “The Three Faces of Eve” are good examples • Often begins with horrific childhood experiences (e.g., abuse, molestation, etc.) • Therapy often makes use of hypnosis • Goal: Integrate and fuse identities into single, stable personality

31. Somatoform Disorders • Hypochondriasis: Person is preoccupied with having a serious illness or disease • Interpret normal sensations and bodily signs as proof that they have a terrible disease • No physical disorder can be found • Somatization Disorder: Person expresses anxieties through numerous physical complaints • Many doctors are consulted but no organic or physical causes are found

32. Somatoform Disorders (cont.) • Pain Disorder: Pain that has no identifiable organic, physical cause • Appears to have psychological origin • Conversion Disorder: Severe emotional conflicts are “converted” into physical symptoms or a physical disability • Caused by anxiety or emotional distress but not by physical causes

33. Fig. 16.4 (left) “Glove” anesthesia is a conversion reaction involving loss of feeling in areas of the hand that would be covered by a glove (a). If the anesthesia were physically caused, it would follow the pattern shown in (b). (right) To test for organic paralysis of the arm, an examiner can suddenly extend the arm, stretching the muscles. A conversion reaction is indicated if the arm pulls back involuntarily. (Adapted from Weintraub, 1983.)

34. Theoretical Causes of Anxiety Disorders: Psychodynamic • Psychodynamic (Freud): Anxiety caused by conflicts among id, ego, and superego • Forbidden id impulses for sex or aggression are trying to break into consciousness and thus influence behavior; person fears doing something crazy or forbidden • Superego creates guilt in response to these impulses • Ego gets overwhelmed and uses defense mechanisms to cope

35. Other Theoretical Causes of Anxiety Disorders • Humanistic: Unrealistic self-image conflicts with real self-image • Existential: Anxiety reflects loss of meaning in one’s life • Behavioristic: Anxiety symptoms and behaviors are learned, like everything else • Conditioned emotional responses that generalize to new situations

36. More Theoretical Causes of Anxiety Disorders • Avoidance Learning: When making a particular response delays or prevents the onset of a painful or unpleasant stimulus • Anxiety Reduction Hypothesis: When reward of immediate relief from anxiety perpetuates self-defeating avoidance behaviors • Cognitive: When distorted thinking causes people to magnify ordinary threats and failures, leading to anxiety and distress

37. Psychosis and Hallucinations • Psychosis: Loss of contact with shared views of reality • Delusions: False beliefs that individuals insist are true, regardless of overwhelming evidence against them • Hallucinations: Imaginary sensations, such as seeing, hearing, or smelling things that do not exist in the real world • Most common psychotic hallucination is hearing voices • Note that olfactory hallucinations sometimes occur with seizure disorder (epilepsy)

38. Some More Psychotic Symptoms • Flat Affect: Lack of emotional responsiveness; face is frozen in blank expression • Disturbed Verbal Communication: Garbled and chaotic speech; word salad • Personality Disintegration: When an individual’s thoughts, actions, and emotions are uncoordinated

39. Other Psychotic Disorders • Organic Psychosis: Psychosis caused by brain injury or disease • Dementia: Most common organic psychosis; serious mental impairment in old age caused by brain deterioration • Archaically known as senility • Alzheimer’s Disease: Symptoms include impaired memory, confusion, and progressive loss of mental abilities • Ronald Reagan most famous Alzheimer’s victim

40. Delusional Disorders • Marked by presence of deeply held false beliefs (delusions) • May involve delusions of grandeur, persecution, jealousy, or somatic delusions • Experiences could really occur! • Paranoid Psychosis: Most common delusional disorder • Centers on delusions of persecution

41. Schizophrenia: The Most Severe Mental Illness • Psychotic disorder characterized by hallucinations, delusions, apathy, thinking abnormalities, and “split” between thoughts and emotions • Does NOT refer to having split or multiple personalities

42. The Four Subtypes of Schizophrenia • Disorganized (Hebephrenic) Type: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or inappropriate emotions • Catatonic Type: Marked by stupor, unresponsiveness, posturing, and mutism • Paranoid Type: Preoccupation with delusions; also involves auditory hallucinations that are related to a single theme, especially grandeur or persecution • Undifferentiated Type: Any type of schizophrenia that does not have specific paranoid, catatonic, or disorganized features or symptoms

43. CNN – Schizophrenic Reality

44. Causes of Schizophrenia • Psychological Trauma: Psychological injury or shock, often caused by violence, abuse, or neglect • Disturbed Family Environment: Stressful or unhealthy family relationships, communication patterns, and emotional atmosphere • Deviant Communication Patterns: Cause guilt, anxiety, anger, confusion, and turmoil

45. Fig. 16.6 Over a period of years, Theodore Kaczynski mailed bombs to unsuspecting victims, many of whom were maimed or killed. As a young adult, Kaczynski was a brilliant mathematician. At the time of his arrest, he had become the Unabomber—a reclusive “loner” who deeply mistrusted other people and modern technology. After his arrest, Kaczynski was judged to be suffering from paranoid schizophrenia. © Bruce Ely/Getty Images

46. Biochemical Causes of Schizophrenia • Biochemical Abnormality: Disturbance in brain’s chemical systems or in the brain’s neurotransmitters • Dopamine: Neurotransmitter involved with emotions and muscle movement • Works in limbic system • Dopamine overactivity in brain may be related to schizophrenia

47. Fig. 16.7 Lifetime risk of developing schizophrenia is associated with how closely a person is genetically related to a schizophrenic person. A shared environment also increases the risk. (Estimates from Lenzenweger & Gottesman, 1994.)

48. Fig. 16.8 Dopamine normally crosses the synapse between two neurons, activating the second cell. Antipsychotic drugs bind to the same receptor sites as dopamine does, blocking its action. In people suffering from schizophrenia, a reduction in dopamine activity can quiet a person’s agitation and psychotic symptoms.

49. Schizophrenic Brain • Computed Tomography (CT) Scan: Computer enhanced X-ray of brain or body • Magnetic Resonance Imaging (MRI) Scan: Computer enhanced three-dimensional image of brain or body; based on magnetic field • MRIs show schizophrenic brains as having enlarged ventricles • Positron Emission Tomography (PET) Scan: Computer-generated color image of brain activity; radioactive sugar solution is injected into a vein, eventually reaching the brain • Activity is abnormally low in frontal lobes of schizophrenics

50. Fig. 16.9 (left) CT scan of would-be presidential assassin John Hinkley, Jr., taken when he was 25. The X-ray image shows widened fissures in the wrinkled surface of Hinkley’s brain. (right) CT scan of a normal 25-year-old’s brain. In most young adults the surface folds of the brain are pressed together too tightly to be seen. As a person ages, surface folds of the brain normally become more visible. Pronounced brain fissuring in young adults may be a sign of schizophrenia, chronic alcoholism, or other problems. © Dennis Brack/Stockphoto.com76