Chapter 13: Psychological Disorders

Chapter 13 Overview
 Introducing Psychological Disorders
 Depressive Disorders
 Bipolar Disorders
 Anxiety Disorders
 Obsessive-Compulsive and Related Disorders
 Dissociative Disorders
 Schizophrenia
 Personality Disorders
 Special Topics Related to Mental Illness

Introducing Psychological Disorders

 Defining Abnormality
 Abnormal psychology: subfield of psychology concerned with assessment, treatment, &
prevention of abnormal behavior (also called psychopathology)
 Three criteria include (1) personal distress, (2) harmful dysfunction, and (3) violation of
social norms
 Lifetime prevalence of ____% (2005)
 ______________: having two or more disorders
o 45% of those with one disorder also met criteria for one or more additional disorders.
 Rates of diagnosis are higher today than in the past. What are some possible reasons for
this trend?

 Theoretical Models

 No single model is sufficient to explain all types of mental illness.

o Medical-biological model
o Psychodynamic model
o Behavioral model
o Humanistic model
o Cognitive model
o Sociocultural model
o Evolutionary model

 Many mental health professionals use an ______________ approach to explain and treat
mental illness.
 The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

 Contains 20 chapters (19 disorder groupings and 1 “other” category) that provide specific
criteria and duration requirements for more than 300 specific disorders, as well as
prevalence rates, demographic information, developmental course, risk factors, and
differential diagnosis
 Several criticisms remain relating to over-pathologizing normal behaviors, medicalizing
mental illness, and relaxed criteria that may lead to over-diagnosis for some disorders

Depressive Disorders

 Major depressive disorder

 a period of at least ____ weeks with sad mood or loss of interest in regular activities, along
with at least ____ additional symptoms:
o changes in sleep habits
o changes in appetite/weight
o fatigue
o feelings of worthlessness or excessive guilt
o difficulties with concentration or decision making
o thoughts of death or suicide

 Lifetime prevalence rate: ____% (2005)

 Median age of onset has declined (late adolescence to early 20s), and women are
diagnosed twice as often as men.

 CAUSES?
o Biological factors include genetics, neurotransmitter dysfunction (serotonin &
dopamine), and brain abnormalities
 Vulnerability: a person’s diminished ability to deal with the demands of life
 ** genetic vulnerability combined with stressful life events
o Cognitive theories (Beck) emphasize negative thoughts.
o Seligman’s theory emphasizes learned helplessness.
o An eclectic biopsychosocial model is most useful for explaining depression (and other
types of mental illness)…

 Persistent depressive disorder

 a less severe but more chronic form of depression, with depressed mood plus two other
symptoms lasting at least two years
 lifetime prevalence: _____% (2005)
 gender differences and causal factors similar to major depressive disorder
Bipolar Disorders

 episodes of the polar extremes of depression (see above) and mania (Table 13.2)

 Bipolar I disorder: person meets the criteria for a full-blown manic episode, typically with one or
more episodes of major depression (though not always)

 Bipolar II disorder: person meets criteria for a major depressive episode but instead of a full manic
episode only has episodes of hypomania (similar but milder symptoms)

 Cyclothymic disorder: a milder form of bipolar disorder involving episodes of hypomanic

symptoms and mild depressive symptoms (no major depression/mania)

 __________: abnormally elevated mood and increased energy or activity lasting at least one
week and causing impaired functioning (or requiring hospitalization), including at least
_____ of the following:
o inflated self-esteem or grandiosity
o pressured/rapid speech
o racing thoughts
o distractibility
o decreased need for sleep
o increased goal-directed behaviors
o excessive involvement in impulsive/risky behaviors

 Bipolar I disorder is more debilitating.

 Those with ____ or more episodes within a year are diagnosed with a rapid cycling specifier
and typically have worse prognosis

 Sequencing, length, and spacing of episodes vary across individuals.

 sometimes misdiagnosed as major depressive disorder (when patients seek help)
 average age of onset: _____
 life-time prevalence: Bipolar 1&2 (2%) and Cyclothymia (up to 1%)
 gender differences???

 _____________ biological component, including substantial genetic influences (60 to 80%

heritability estimate)
 medication is usually necessary, though 50% of patients fail to comply due to side effects,
feeling better, or missing the “highs” of mania
o How might noncompliance be risky?
Anxiety Disorders

 Anxiety: generalized feeling of fear that may be linked to a situation or object and accompanied by
increased physiological arousal; can be helpful but also can become debilitating
 Anxiety disorders are the most common type of mental illness (lifetime prevalence: 31%).
 Examples include specific phobias, social anxiety disorder, agoraphobia, panic disorder, and
generalized anxiety disorder.
 more common in ____________

 Contributing factors include:

o biological factors, such as
 genetics (heritability of ____ to ____%)
 neurochemistry (GABA, serotonin)
 brain structures (“fear circuit” and heightened activity of the amygdala)
o behavioral factors, such as classical and operant conditioning and observational/social
learning
o cognitive factors such as negative/distorted thoughts, perceived lack of control, and
catastrophizing

 Specific phobias: irrational and persistent fear of a particular object or situation, along with a
compelling desire to avoid it
 Lifetime prevalence: >____%
 Common examples?

 Social anxiety disorder: fear of, and desire to avoid, social situations involving possible scrutiny,
embarrassment or humiliation
 Lifetime prevalence: almost ____%

 Agoraphobia: marked fear and avoidance of being alone in a place from which escape might be
difficult or embarrassing, relating to at least two situations (e.g., public transportation, open
spaces, crowds, etc.)
 lifetime prevalence: ___ to ___%
 List of “safe” places may gradually decrease until the person cannot leave home at all or
without a trusted companion.
 About ____ also have panic attacks (often before developing agoraphobia).

 Panic disorder: repetitive attacks of acute anxiety with a sharp increase of autonomic nervous
system arousal not triggered by a specific event, including at least four symptoms and followed by
a one-month period of persistent anxiety or avoidance
 lifetime prevalence: ___ to ___%
 Generalized anxiety disorder: persistent anxiety including at least three symptoms that last for at
least 6 months; worry is generalized (non-specific) and without obvious cause or trigger
 lifetime prevalence: ___ to ___%

Obsessive-Compulsive & Related Disorders

 Obsessive-compulsive disorder (OCD): persistent and uncontrollable thoughts and beliefs that
often trigger performance of compulsive rituals that interfere with daily life
 previously classified as an anxiety disorder
 12-month prevalence rate: ____% (U.S.)
 no gender difference (thought _____________ develop it earlier)
 Compulsive rituals serve to reduce anxiety produced by obsessive thoughts.
o Examples?

 OCD has a strong biological basis

o heritability estimate: almost ____%
o involvement of frontal/temporal lobes, amygdala, and basal ganglia

 Cognitive models focus on irrational thoughts and inability to suppress these thoughts
(which increases anxiety).
 Behavioral/learning models emphasize negative reinforcement (e.g., handwashing reduces
anxiety about germs).

 In DSM-5, OCD was combined with related disorders such as:

o Hoarding disorder: persistent problems discarding possessions resulting in accumulation
that impacts normal use of space and causes distress/impairment
 lifetime prevalence rate: 1.5%

o Body dysmorphic disorder: chronic preoccupation with imagined or exaggerated defect

in one’s appearance (not verified by others)
 lifetime prevalence rate: 2.5% (much higher in plastic surgery practices

Dissociative Disorders

 Dissociative disorders: disorders characterized by sudden but temporary alteration in

consciousness, identity, sensorimotor behavior, or memory

 Dissociative amnesia: sudden and extensive inability to recall important personal information,
usually of a stressful or traumatic nature
 not due to head injury; too extensive to be due to ordinary forgetfulness
 often disappears suddenly, with full recovery
 prevalence difficult to determine (12-mo: 1.8%)
 Dissociative amnesia with __________ (subtype)
 includes more extensive memory loss, wandering away from home, often beginning a new
identity/life; lasts days or weeks
 extremely rare, with full recovery (but no memory of fugue state)

 Dissociative identity disorder (DID): existence of two or more personalities within one individual,
which alternate control and exhibit different personalities, behaviors, and appearance
 alters may be different ages and genders
 may have different medical conditions, motor skills, and/or competencies
 not included in DSM until 1980, but reports date back to the 1800s
 prevalence estimates range from ___ to ___%, but believed to be rare (diagnosis tends to
increase after popular media portrayals, e.g., Sybil)
 controversial due to disagreement about validity of diagnosis and prevalence; may be
influenced by:
o iatrogenesis…

o drastic increase observed in 1980s (after media portrayals)

 overdiagnosed, or even faked?
 misdiagnosed in the past?

Schizophrenia

 Schizophrenic disorders: disorders characterized by lack of reality testing (psychosis) and

deteriorating social and cognitive functioning
 considered the most severe type of mental illness**
 typically begins in late adolescence or early adulthood
 must have some disturbance in behavior for at least ____ months, and persistent psychotic
symptoms for at least ___ month
 affects about ___% of the general population
 ____________ rates across cultures; almost equal rates in men and women, though slightly
higher in ______ and they have earlier onset and greater impairment
 higher rates in lower-SES groups

 positive symptoms: the presence of abnormal behavior (e.g., hallucinations, delusions)

 negative symptoms: the absence of normal behaviors (e.g., social withdrawal, flat affect)
o hallucinations: perceptual experiences without sensory stimulation
 can occur in all 5 senses, but hearing voices is most common
o delusions: beliefs that are firmly held despite contradictory evidence
 may include delusions of grandeur, reference, or persecution
o social withdrawal – often the first symptom
 o impaired speech: alogia (lack of speech), or disorganized speech such as word salad,
tangential responses, perseveration, or loose associations
o impaired emotional expression and movement: inappropriate emotions or flat/blunted
affect; catatonia or hyperactivity
o avolition: lack of motivation for planned activities

 Diathesis-stress model: schizophrenia likely results from an interaction between

genetic/biological vulnerability and stressful life events

 Biological factors:
o genetic predisposition:
 concordance rates higher for identical than for fraternal twins, and for higher degree
of familial relationship
 heritability estimate: _____%
o neurotransmitters (dopamine theory; glutamate)
o birth complications/head injury during delivery

 Environmental factors:
o early infections, malnutrition, lead exposure
o urban (vs. rural) residence
o poverty/low SES -- **____________
o expressed emotion: family hostility, criticism, over-involvement, lack of boundaries
(contributes to relapse)

Personality Disorders

 Personality disorders: inflexible behavior patterns that occur across situations and persist for many
years; related to stable personality traits traced back to childhood
 must affect several areas of one’s life and persist for years
 ____ disorders, grouped into 3 clusters (A, B, and C)
 Criticisms:
o patterns may be less rigid than previously believed
o blurred line between normal and abnormal
o gender stereotypes may contribute to diagnosis and prevalence rates

 lifetime prevalence: almost ____% (2004)

 high comorbidity, which complicates diagnosis and treatment

 Risk factors for personality disorders:

o genetics, via personality traits (e.g., emotionality, introversion, impulsivity) and/or
alterations to serotonin and dopamine systems
 involved in all 10 personality disorders, more so in some than in others
 o environmental factors: childhood abuse/neglect, parenting styles, insecure attachment
patterns
o Nature and nurture interact.

 Cluster A personality disorders

 Paranoid personality disorder: unwarranted distrust, hypersensitivity to criticism, restricted
emotional expression
 Schizoid personality disorder: detachment, no interest in socializing, restricted emotional
expression, preference for solitude
 Schizotypal personality disorder: bizarre and eccentric behaviors and/or appearance,
strange and magical beliefs; not psychotic, but may be a precursor to schizophrenia

 Cluster B personality disorders

 Antisocial personality disorder: impulsive, destructive and deceitful behaviors, lack of
concern for consequences and lack of remorse; history of conduct disorder in adolescence;
significantly more common in men
 Borderline personality disorder: unstable emotions and relationships, feelings of emptiness,
frantic attempts to avoid abandonment, unstable/insecure self-image; self-injury or suicidal
behaviors; significantly more common in women
 Histrionic personality disorder: attention-seeking, inappropriately seductive, shallow
emotions, overly dramatic and suggestible, needs to be the center of attention
 Narcissistic personality disorder: exaggerated sense of self-importance and sense of
entitlement, require admiration, arrogance and lacking empathy for others

 Cluster C personality disorders

 Avoidant personality disorder: desire for social interaction but avoidance of interpersonal
contact due to fear of rejection, embarrassment, or humiliation, feelings of inferiority and
inadequacy
 Dependent personality disorder: lack of self-confidence producing feelings of helplessness
and over-reliance on others, submissive and clingy, afraid to be alone
 Obsessive-compulsive personality disorder: perfectionism, preoccupation with rules and
details, overly devoted to work, unable to delegate, overly-controlling and rigid, intolerant
and judgmental

Special Topics

 Mental Illness and Violence

 Common stereotype links mental illness and violence, but most individuals with mental
illness are never violent.
  Some disorders are associated with higher risk (e.g., schizophrenia, and especially antisocial
personality disorder)
 ____________ ______ disorders are more commonly linked with violence than other types
of mental illness.
 Only ____% of the violence in the U.S. can be attributed to mental illness (2005); gender,
age, exposure to abuse/violence, poverty, and parenting factors are stronger predictors.
 People with mental illness are more likely to be victims than perpetrators of violence.

 Mental Illness and Suicide

 Individuals with mental illness are more likely to harm themselves than others.
 ____ leading cause of death in the U.S., and ____ leading cause of death for those ages 10
to 34
 Young people and females are most likely to attempt suicide, but older adults and males are
more likely to die from suicide due to lethality of means
 ~____% have a mental disorder (though not all have been diagnosed)
 most common: depression (about 50%), bipolar disorder, schizophrenia, substance use
disorders, and certain personality disorders
 other risk factors include medical conditions, poor social skills, hopelessness,
isolation/loneliness, poverty, poor coping skills, unemployment, media contagion, and
access to lethal means
 _________________ suicide is correlated with impulsivity, childhood maltreatment, recent
humiliation, LGBT status, and family and peer difficulties
 rates increased for all groups in a short period of time, especially for females and younger
ages (10 to 14)
 See Table 13.4: Myths & Facts About Suicide

 Group Differences in Mental Illness

 Prevalence of specific diagnoses are related to gender, ethnicity and culture.

 Some differences appear to be real, though some may be based on stereotypes and role
expectations.
o Example: men vs. women and depression
 Some cultures have a stronger ____________ associated with discussing problems and
seeking help, and different perceptions about efficacy or necessity of treatment.
o culture-specific or culture-bound disorders and behaviors
 Language barriers, insensitivity among mental health professionals, poverty and healthcare
costs are barriers to accessing treatment.