Psych 1 clinical disorders

CHAPTER 14:
WHAT ARE PSYCHOLOGICAL
DISORDERS AND HOW CAN WE
UNDERSTAND THEM?

Pastorino/Doyle-Portillo
Essentials of What Is Psychology? 1st
edition
© 2010 Cengage Learning
WHAT IS ABNORMAL BEHAVIOR?
• Four criteria help distinguish normal from
abnormal behavior:
• Statistical infrequency
• Violation of social norms
• Problematic criterion on its own
• Personal distress
• Level of impairment
• Interferes with ability to function

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PREVALENCE OF ABNORMAL BEHAVIORS
• 26% of Americans over 18 have diagnosable
psychological disorders within a given year;
46% lifetime prevalence
• Psychological disorders are leading cause of
disability in U.S. and Canada for individuals
between 15 and 44

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EXPLAINING PSYCHOLOGICAL DISORDERS:
PERSPECTIVES REVISITED
• Western cultures explain abnormal behavior
through three perspectives:
•Biological theories
•Psychological theories
•Social or cultural theories

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BIOLOGICAL THEORIES: THE MEDICAL
MODEL
• Abnormal behavior attributable to physical
processes:
• Genetics, hormone/neurotransmitter
imbalance, brain/bodily dysfunction
• Also called the medical model
• Emphasizes diagnosis, treatment, and
cure, in similar manner to physical illnesses

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PSYCHOLOGICAL THEORIES: HUMANE
TREATMENT AND PSYCHOLOGICAL PROCESSES
• Internal & external stressors result in
abnormal behavior
• Four predominant perspectives
• Psychoanalytic: unconscious conflicts
• Social-learning: past learning and
modeling
• Cognitive: ineffective mental processes
• Humanistic: distorted perception of self
and reality

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SOCIOCULTURAL THEORIES:
• Internal biological and psychological
processes can only be understood in
context of social factors
• Culture, age, race, sex, gender-
identity, sexual orientation,
religion/spirituality, socioeconomic
status, and social conditions must be
taken into consideration in evaluating
abnormal behavior

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A BIOPSYCHOSOCIAL MODEL:
INTEGRATING PERSPECTIVES
• No one perspective is “correct”
• Most disorders are a result of biological
psychological, & social factors
• No one single “cause”

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THE DSM MODEL FOR CLASSIFYING
ABNORMAL BEHAVIOR
• Ability to describe behavior is more
advanced than understanding of causes
• Diagnostic and Statistical Manual of Mental
Disorders, now in fourth revision (DSM-IV-TR)
• Lists specific, concrete criteria for diagnosis
• Atheoretical: does not address causes of
mental illness

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A MULTIDIMENSIONAL EVALUATION
• Five dimensions for evaluation, known as
axes
• Axis I: clinical disorders
• 15 major categories
• Axis II: personality disorders; mental
retardation
• Axis III: general medical conditions
• Axis IV: psychosocial and environmental
problems
• Axis V: global assessment of functioning

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ANXIETY DISORDERS: NOT JUST “NERVES”
Four components:
• Physical: activation of sympathetic
nervous system and hormonal system
(fight-or-flight)
• Cognitive: unrealistic thoughts
(exaggerated danger, fear losing control,
paranoia)
• Emotional: terror, panic, irritability
• Behavioral: coping (freezing, aggression)

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PANIC ATTACK
• Discrete period of intense fear or discomfort, which
usually peaks within 10 minutes.
• And… 4 of the following:
• Racing Heart Sweating
• Trembling Shortness of breath
• Choking Chest discomfort
• Nausea Dizziness/lightheadedness

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PANIC ATTACK
• Discrete period of intense fear or discomfort, which
usually peaks within 10 minutes.
• And… 4 of the following:
• Derealization Depersonalization (detached from self)
• Fear of dying Fear of losing control/going crazy
• Numbness Chills or hot flashes

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PANIC DISORDER W/O AGORAPHOBIA
• Recurrent Panic attacks, followed by one or more
(for at least 1 month):
• Persistent concern about future attacks
• Worry About implications of attack (heart attack;
“crazy”)
• Significant change in behavior
*30 - 40% of young Americans report occasional attacks

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PANIC DISORDER WITH AGORAPHOBIA
• Panic Disorder AND…
• Agoraphobia: “fear of the marketplace”
• Anxiety & avoidance of
places/situations where help may not
be available if panic occurs.

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GAD
• Excessive worry, most days, at least 6 months
• Difficulty controlling the worry
• 3 or more of 6 symptoms, most days:
• Restless/”on edge” Easily fatigued
• Difficulty concentrating Irritability
• Muscle tension Sleep
disturbance
• “clinically significant distress” or impaired
functioning

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OCD
• A. Obsessions Or compulsions that cause marked
distress or impairment in functioning.
• Obsessions: persistent, intrusive thoughts, images
and impulses.
• Product of own mind (e.g., not hallucinations)
• Difficulty ignoring or suppressing obsessions
• Compulsions: Repetitive behaviors or mental acts
(to reduce distress and anxiety…attempt to prevent
fear from occurring in an unrealistic way).

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PTSD
• Exposure to traumatic event
• “actual or threatened death, serious injury, or physical
integrity”
• Response involved intense fear, helplessness
• Reexperience event: images, dreams, reliving, or
intense distress from triggers of event
• Persistent avoidance of stimuli associated with
trauma
• Avoid: thoughts, feelings, activities, loss of recall,
detachment form others, restricted affect, etc

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PTSD
• Duration is more than 1 month
• Less than 1 month= acute distress disorder
• Acute or chronic
• Duration of symptoms less than 3 months, or longer

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PHOBIC DISORDERS
• Intense fears vs. normal fears
• intense fears causing anxiety, possibly panic
attacks, that interfere with functioning
• Specific phobias: persistent fear and
avoidance of object or situation
• Most common, 8% lifetime
• Usually begin in childhood
• Social phobias
• Irrational fear of being negatively evaluated by
others in social situations

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EXPLAINING ANXIETY DISORDERS:
PSYCHOLOGICAL FACTORS
• Social learning
• Phobias develop through
• classical conditioning
• observational learning
• behaviors reinforced by avoidance of
fears (operant conditioning)
• Reinforcement in compulsions
• Cognitive
• Misinterpretation of bodily sensations in panic
• Negative and catastrophic thinking heighten
anxiety

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ANXIETY DISORDERS
• Common Disorders: Panic Disorder, Specific Phobia,
Social Phobia, GAD, PTSD, OCD
• Panic Disorder: 20% have attempted suicide
• Similar suicide rates as depression
• Suicide risk highest when comorbid with depression
• ~50% with an anxiety disorder have another disorder

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SUICIDE: RATES & FACTS
• 32,000 Americans complete suicide a year
(12 people per 100,000; 85 per day).
• A person is more likely to die by suicide than
to be murdered in the U.S.
• Suicide is the 11th leading cause of death
overall in the U.S., yet 2nd for college
students.
• Guns are used in more than half of
completed suicides.
• Females 3x attempts; Males 4x completions
Source: (Granello & Granello, 2007)

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SUICIDE: INCREASED RISK
• Abuse and Assault (Granello & Granello, 2007).
• Women with a history of sexual assault during childhood or
adulthood have a higher risk for suicide attempts (Ullman &
Brucklin, 2002).
• The more types of abuse, the higher the risk (Ullman & Brucklin, 2002).
• Family History of Suicide
• 11 times the risk (AAS, 2009).
• Eating Disorders
• Over 20x Suicide Mortality (Death) rate (AAS, 2009; Harris &
Barraclough,1997)
• HIghest Mortality rate for Anorexia Nervosa (AAS, 2009).

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EXPLAINING MOOD DISORDERS:
BIOLOGICAL FACTORS
• Genetics
• Family, twin and adoption studies show genetic transmission
(clearer for bipolar than major depression)
• Neurotransmitters
• Serotonin and norepinephrine abnormalities
• Hormones
• Repeated activation of hormonal stress system may lay
ground for depression

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PSYCHOLOGICAL FACTORS
• Psychoanalytic: unresolved childhood issues,
symbolic expression of anger
• Attachment: insecure attachments,
separations, losses increase vulnerability
• Behavioral/learning: reduction in positive
reinforcers from others
• Learned helplessness
• Ruminative coping style
• Cognitive research: cognitive distortions and
attributions of events

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SOCIOCULTURAL FACTORS
• Depression more likely among people of
lower social status
• Cross-culturally, more women than men
• Biological: hormonal imbalance
• Psychological: ruminative coping, relational style
• Social: less power, more victimized, gender-role
socialization

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UNIPOLAR DEPRESSIVE DISORDERS
• Depression is leading cause of disability in
U.S. and worldwide
• 17% acute episode in lifetime; 6% chronic
• Average age of onset is 32
• 15 to 24 years at highest risk for major depressive episode
• Women more likely to experience than men
• European American have highest risk, but
African and Hispanic American more severe

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BIPOLAR DEPRESSIVE DISORDERS:
THE PRESENCE OF MANIA
• 2.6% lifetime, late adolescence, early
adulthood
• Bipolar disorder
• Shift in mood between two states (poles)
• Depression to mania characterized by high energy,
impulsiveness, euphoria
• Cyclothymic disorder
• Less severe, but more chronic, form of bipolar
• Alternates between milder periods of mania and moderate
depression

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MOOD DISORDERS: BEYOND THE BLUES
• Significant change in one’s emotional state
• 9.5% per year
• Although most experience some depression,
clinical depression is related to length of
time symptoms exist and interference with
functioning
• Symptoms exist even in absence of
triggering events

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UNIPOLAR DEPRESSIVE DISORDERS:
A CHANGE TO SADNESS
• Major depression
• Extreme sadness (dysphoria) or extreme apathy (loss of
interest in activities) plus four other symptoms for at least
two weeks
• May be single or repeated episodes
• Dysthymic disorder
• Less severe, more chronic form of depression
• Depressed mood plus two other symptoms lasting at least
two years

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DEPRESSIVE DISORDER NOS
• NOS means “Not Otherwise Specified”
• This is a “catch all” category for those who do not fit
neatly into the other categories

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MOOD DISORDERS & SUICIDE
• Double Depression: MDD & Dysthymic Disorder
• “Dual Diagnosis”: Mental Disorder and Substance
Abuse or Dependence Disorder

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MANIA
• A distinct period of abnormally elevated, expansive, or
irritable mood, lasting at least 1 week (or hospitalization
required)
• 3 criteria must be met
• 4 if mood is irritable instead of elevated

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MANIA
• Criteria 3 must be met “to a significant degree”
• Inflated self-esteem or grandiosity
• Decreased need for sleep (rested after 3 hours a night)
• More talkative/ “Pressured speech”
• Racing Thoughts for “Flight of ideas”
• Distractibility
• Increased goal-directed activity or psychomotor agitation
• Excessive involvement in pleasurable activities with high
chance of painful consequences

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HYPOMANIC EPISODE
• A distinct period of abnormally elevated, expansive, or
irritable mood, lasting at least 4 days
• 3 criteria must be met
• 4 if mood is irritable instead of elevated
• Not severe enough to hospitalize; no psychotic features

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HYPOMANIA
• Criteria 3 must be met “to a significant degree”
• Inflated self-esteem or grandiosity
• Decreased need for sleep (rested after 3 hours a night)
• More talkative/ “Pressured speech”
• Racing Thoughts for “Flight of ideas”
• Distractibility
• Increased goal-directed activity or psychomotor agitation
• Excessive involvement in pleasurable activities with high
chance of painful consequences

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BIPOLAR I DISORDER
• Presence of a Manic Episode
• Bipolar II: One or more depressive episodes with at least
one Hypomanic Episode (No full manic episode)

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SCHIZOPHRENIA
• From Greek…“split mind” is a misnomer
• Affects approximately 1-2% of population in lifetime
• Strong biological component
• Identical (monozygotic) twin ~ 50%
• Schizophrenia or Mood disorder with psychotic
features?.. often difficult to determine
• Many call this disorder “the schizophrenias”

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SCHIZOPHRENIA
A. 2 or more of these criteria:
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized, or catatonic behavior
• Negative symptoms (affective flattening, alogia, or
avolition)
•Only 1 criteria needed if: bizaare delusions, voice
keeping commentary of person’s behaviors and
thoughts, two or more voices conversing together.

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TYPES OF SCHIZOPHRENIA: POSITIVE AND
NEGATIVE SYMPTOMS
• Positive and negative symptoms exist in
schizophrenia
• Positive: increase in behaviors (i.e.unusual perceptions,
thoughts, behaviors)
• Negative: loss of behaviors (i.e. motor movements, social
withdrawal, etc.)
• Some show both positive and negative
• Better outcome for treatment in cases
where predominantly positive symptoms

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SCHIZOPHRENIA:
2 TYPES OF SYMPTOMS
• Between 50-70% experience positive symptoms
Positive Symptoms:
• Hallucinations (auditory most common)
• Delusions
Delusion of grandeur: “I can save the world by sacrificing
myself”
Delusion of persecution: “The FBI and CIA are out ot get me
and have bugged all of my electronic devices”

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SCHIZOPHRENIA:
2 TYPES OF SYMPTOMS
• Negative:
• Avolition: inability to persist in daily activities (unable to
groom, shower, etc).
• Alogia: Relative absence of speech (brief replies, with little
content; for example, one word answers).
• Anhedonia: Loss of pleasure / interest
• Affective flattening: show almost no emotion, even when
you’d expect strong emotional display.
• Disorganized:
• Disorganized speech, thought process
• Tangential thought process

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SYMPTOMS OF SCHIZOPHRENIA
• Disordered thoughts
• Thought disorder: lack of association between ideas and
events
• Loose associations, poverty of content,
word salad
• Delusions: thoughts and beliefs the person believes to be
true, while having no basis in reality
• Persecutory, grandiose, delusions of
reference, delusions of thought control

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SYMPTOMS OF SCHIZOPHRENIA (CONT.)
• Disordered perceptions: hallucinations
• Perceiving sensations that others don’t
• Auditory hallucinations most common
• Visual hallucinations
• Hallucinations may “tell” person to perform certain acts
• Disordered affect: distorted emotional
expression
• Blunted, flat affect
• Inappropriate affect

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EXPLAINING SCHIZOPHRENIA: THE BRAIN
• Neurotransmitters
• Dopamine: reducing dopamine activity can help in
reducing positive symptoms
• Glutamate: drugs that block can cause cognitive
impairments and negative symptoms
• What is role of interaction?
• Brain abnormalities
• Enlarged ventricles
• Brain dysfunction in temporal and frontal lobes

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SCHIZOPHRENIA: THE ROLE OF FAMILY
AND ENVIRONMENT
• Two psychological factors involved in onset
and course of disorder
• Family support
• Quality of family communication and interaction; may
encourage/discourage development of disorder, also
trigger future episodes
• Exposure to chronic stress
• High-risk, low-income lifestyle may increase susceptibility

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DISSOCIATIVE DISORDERS: FLIGHT OR
MULTIPLE PERSONALITIES
• Relatively rare disorders
• Dissociation: to break or pull apart
• Mild dissociative experiences are common
• Extreme dissociation typically linked to
severe stress or emotional trauma
• Dissociative fugue
• Episodes of amnesia with inability to recall or confusion
about identity; new identity may be established
• Return to original identity causes distress

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DISSOCIATIVE DISORDERS: FLIGHT OR
MULTIPLE PERSONALITIES (CONT.)
• Dissociative identity disorder
• Existence of 2 or more separate personalities in same
individual
• Separate personalities (alters) may not be known to “host”
personality
• Frequent blackouts or amnesia episodes common
• Chronic childhood physical/sexual abuse
may be causal factor
• Validity of DID? May be extreme PTSD

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SOMATOFORM DISORDER:
“DOCTOR, I’M SURE I’M SICK”
• Somatoform disorders
• Physical complaints for which no physical causes can be
found
• Hypochondriasis: person believes there is a
serious medical disease, despite no
confirmation by medical tests
• Often have family history of depression or anxiety
• May be related to panic disorder and OCD

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PERSONALITY DISORDERS: MALADAPTIVE
PATTERNS OF BEHAVIOR
• Coded on Axis II of DSM-IV-TR
• Life-long or long-standing patterns of
malfunctioning
• Behavior is maladaptive to self or others
• Behavior is seen across many situations, for long periods of
time
• Often don’t see there’s a problem; seldom
seek treatment on own

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ANTISOCIAL PERSONALITY DISORDER:
CHARMING AND DANGEROUS
• Impulsive, disregard rights of others without
remorse or guilt; psychopath or sociopath
• Correlated with criminal behavior/ incarceration
• May be charming and manipulative
• One of most common personality disorders;
many more men than women
• Biological factors: genetic, lower serotonin,
higher testosterone
• Psychological/social: conflict-filled
childhood

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BORDERLINE PERSONALITY DISORDER:
LIVING ON YOUR FAULT LINE
• Instability in moods, interpersonal
relationships, self-image, and behavior
• Disrupts relationships, careers, and identity
• Higher risk of self-injury and suicide
• Often diagnosed with other disorders
• 2%; more in young women
• Biological: low serotonin, abnormal brain
functioning
• Psychological/social; family history of abuse
or neglect

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HOW GOOD IS THE DSM MODEL?
• Reliability (consistency) and validity
(accuracy) good for Axis I, but not Axis II
• Standard criteria do not necessarily mean
accurate diagnoses will be made
• Judgments of clinicians can be skewed by gender, race, or
culture, consciously and unconsciously
• Some feel the DSM model of labeling may
lead to negative effects - self-fulfilling
prophecy

Psych 1 clinical disorders

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