Chapter 15: Psychological
Disorders
BRIEF CHAPTER OUTLINE
Defining Psychological Disorders
Anxiety Disorders
Generalized Anxiety Disorder
Panic Disorder with or without Agoraphobia
Post-Traumatic Stress Disorder
Social Phobia (Social Anxiety Disorder)
Specific Phobias
Obsessive-Compulsive Disorder
Psychology in the Real World:
Can Internet Behavior Become an Addiction?
What Causes Anxiety Disorders? Nature and Nurture Explanations
Mood Disorders
Depression and its Causes
Bipolar Disorder and its Causes
Schizophrenia
Major Symptoms of Schizophrenia
Subtypes of Schizophrenia
Nature and Nurture Explanations of Schizophrenia
Maternal Infections and Schizophrenia
Schizophrenia and the Brain
Neurochemistry of Schizophrenia
Dissociative Disorders
Dissociative Identity Disorder
Causes of Dissociative Disorders
Breaking New Ground: Abuse,
Disorders, and the Dynamic Brain
Personality Disorders
Odd-Eccentric Personality Disorders
Dramatic-Emotional Personality Disorders
Anxious-Fearful Personality Disorders
Nature and Nurture Explanations of Personality Disorders
Childhood Disorders
Subtypes of Childhood Disorders
Causes of Childhood Disorders
Making Connections in Psychological Disorders: Creativity and Mental Health
Chapter Review
EXTENDED CHAPTER OUTLINE
·
Generally, the behavior must meet three criteria:
deviant, distressing, and dysfunctional.
·
Deviant: literally
means “different from the norm” or different from what most people do. This
criterion allows for the fact that behavior that is considered deviant in one
culture might be considered normal in others.
·
Distressing: the behavior leads to real discomfort or anguish,
either in the person directly or in others.
·
Dysfunctional: the behavior interferes with everyday functioning
and occasionally can be a risk to oneself or others. Dysfunctional also implies
that it prevents the person from participating in everyday social
relationships, holding a regular job, or being productive in other ways.
Generalized Anxiety Disorder
Panic Disorder with or without
Agoraphobia
Post-Traumatic Stress Disorder
Social Phobia (Social Anxiety
Disorder)
Specific Phobias
Obsessive-Compulsive Disorder
Psychology in the Real World:
Can Internet Behavior Become an Addiction?
What Causes Anxiety Disorders?
Nature and Nurture Explanations
1. Deficiencies in the neurotransmitter GABA: Deficiencies in GABA lead to excessive activation in certain brain regions, especially the limbic areas associated with fear. Moreover, the fact major medications for treating anxiety disorders work on GABA receptors is further evidence for GABA’s role in anxiety.
2. Genes: Heritability estimates for generalized anxiety, panic disorder, and agoraphobia range from 30% to 40%
3. Personality: people who are high in neuroticism—prone to worry, anxiety, and nervousness—are more likely to develop anxiety disorders than are people who are low in neuroticism.
Depression and its Causes
·
Caspi et al.
followed a group of nearly 1,000 people from age 3 years until age 26. They
found that if people experience few major stressful events (0 – 2),
their risk of having a major depressive episode does not increase, regardless
of which form of the serotonin gene they carry. But if they experience 3 or 4
stressful events, the likelihood that they will have a major depressive episode
nearly doubles or triples in those with the short form compared to those with
the long form.
·
In short,
depression is most likely in individuals who carry the short form of the gene and experience many severe life
stressors. Either condition by itself is unlikely to lead to depression.
Nature-Nurture Pointer: The
serotonin gene and stressful events work together to increase the odds of
depression.
Bipolar Disorder and its
Causes
D = Distractibility
I = Indiscretion
G = Grandiosity
F = Flight of ideas
A = Activity increased
S = Sleep (decreased need for)
T = Talkativeness
·
Bipolar disorder
affects men and women in roughly equal proportions. The manic episodes are less
frequent than the depressive episodes, and the nature and frequency of the
manic episodes varies considerably.
·
Cyclothymia: a milder form of bipolar disorder where both the manic and depressive episodes
are less severe than they are in bipolar disorder.
· If one identical twin develops bipolar disorder, there is a 40-70% chance that the other twin will also develop the disorder. But even if the chance is 70% that both twins have the disorder, that still suggests that life events, such as stress and trauma, also play a role in the development of bipolar disorder.
Nature-Nurture Pointer: The chance that if one identical twin has bipolar disorder so will the other is 40-70%, indicating that life events, such as stress and trauma, also play a role in the development of this disorder.
·
Psychotic disorders are disorders of thought and perception and are
characterized by an inability to distinguish real from imagined perceptions.
·
Schizophrenia: involves profound changes in thought and emotion; in
particular, impairments in perception such as hallucinations.
·
Approximately 1% of the American population is
afflicted with this disorder at any given time, making schizophrenia much less
common than depression. However, if a first-degree relative has the disorder,
the odds of a person having the disorder rises to 10%.
Major Symptoms of
Schizophrenia
·
For a diagnosis of schizophrenia, at least one of the
following symptoms must persist for six months and at least two must be present
sometime during those six months:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior (immobile and unresponsive, though awake)
Negative symptoms (such as not speaking or being unable to experience emotion)
Subtypes of Schizophrenia
Nature and Nurture
Explanations of Schizophrenia
·
Some researchers describe the diathesis-stress
interaction between biological dispositions and environmental forces as a two-stage model. Stage one is the biological-genetic
foundation or disposition, and stage two is an environmental event that occurs
at some point after conception, such as maternal infection, chronic stress, or
using certain drugs at certain critical points in development.
· The heritability rates are 80% to 85%, suggesting the disorder is due largely to genetic influences.
Maternal
Infections and Schizophrenia
·
If a woman contracts an infection during pregnancy,
the risk of the child developing schizophrenia later in life increases
dramatically; prenatal exposure to infections and diseases such as influenza,
rubella, toxoplasmosis, and herpes has been linked to increased risk of
schizophrenia.
·
CONNECTION: The brain undergoes explosive growth during the first
six months of in-utero development. During this time, the fetal brain is most
vulnerable to all kinds of toxins and the most serious neurological disorders
can happen. (See Chapter 5, Figure 5.2.)
· In working with people with schizophrenia, researchers have found neurons in parts of their brains where they do not belong – that is, the neurons took a wrong turn during prenatal migration.
Schizophrenia and the Brain
Neurochemistry
of Schizophrenia
·
Dopamine hypothesis: states that people with
schizophrenia have an excess of dopamine in certain areas of the brain.
DISSOCIATIVE DISORDERS
Causes of Dissociative Disorders
·
People who suffer from dissociative disorders have
one characteristic in common: having gone through a highly traumatic
experience. Most explanations of dissociative disorder view it as a coping
strategy that has gone awry.
Breaking New Ground: Abuse,
Disorders, and the Dynamic Brain
·
See Breaking New Ground section for detailed
explanation.
PERSONALITY DISORDERS
Odd-Eccentric Personality
Disorders
Dramatic-Emotional Personality
Disorders
Anxious or Fearful Personality
Disorders
Nature and Nurture
Explanations of Personality Disorders
Subtypes
of Childhood Disorders
· Conduct disorder: children may behave aggressively toward people and animals, destroy property, lie and steal, and seriously violate basic rules. A child who is constantly bullying and threatening others, getting into physical fights, setting fires, lying and “conning” others, and destroying property most likely has this disorder.
·
Autism
is a range or spectrum of disorders, ranging from severe disability to high
functioning.
· Asperger’s syndrome: impaired social interest and skills, restricted interests, and most have above-average intelligence.
Causes
of Childhood Disorders
Making
Connections in Psychological Disorders: Creativity and Mental Health
KEY TERMS
agoraphobia: an intense anxiety and panic about being in places from which escape might be difficult or in which help might not be available should a panic attack occur.
Axis I disorders: disorders in the Diagnostic and Statistical Manual-IV (DSM-IV) consisting of the major clinical syndromes that cause significant impairment, such as the anxiety disorders, depression, bipolar disorder, and the psychotic disorders. These disorders tend to develop after adolescence, and are perceived by the person suffering from them as not consistent with their view of themselves and therefore cause guilt.
Axis II disorders: the more long-standing personality disorders as well as mental retardation in the DSM-IV. They are viewed as consistent with and part of the person’s personality, and therefore do not cause much guilt.
bipolar disorder: when substantial mood fluctuations occur, which cycle between very low (depressive) and very high (manic) episodes.
comorbidity: when two or more disorders co-occur.
compulsion: a repetitive
behavior performed in response to uncontrollable urges or according to a
ritualistic set of rules.
deviant: “different from the norm” or different from what most people do.
diathesis-stress model: biological predispositions (diathesis) plus stress or abusive environments are usually needed to produce psychological disorders.
distressing: behavior that leads to real discomfort or anguish, either in the person directly or in others.
dysfunctional: behavior that interferes with everyday functioning and occasionally can be a risk to oneself or others.
dysthymia: a milder form of depression.
generalized anxiety disorder (GAD): pervasive and excessive state of anxiety lasting at least six months.
impulse control disorder: behavior that the person cannot control and
feels an intense, repetitive desire to perform.
major depressive disorder: often referred to as depression for short, it is a disorder characterized by pervasive low mood, lack of motivation, low energy, and feelings of worthlessness and guilt that last for at least two consecutive weeks.
manic episodes: typically involve increased energy, sleeplessness, euphoria, irritability, delusions of grandeur, increased sex drive, and “racing” thoughts.
obsession: an unwanted thought, word, phrase, or image that persistently and
repeatedly comes into a person’s mind and causes distress.
obsessive-compulsive disorder
(OCD): an anxiety disorder
that is manifested in both thought and behavior.
panic attacks: associated with perceptions of threat and can occur for a number of reasons: fear of danger, inability to escape, embarrassment, or specific objects.
panic disorder: involves panic attacks and the persistent worry, embarrassment, and concern about having more attacks.
phobia :a persistent and unreasonable fear of a particular object, situation, or activity.
Post-Traumatic Stress Disorder (PTSD): a type of anxiety disorder that is triggered by exposure to a catastrophic or horrifying event that posed serious harm or threat to the person and consists of three main symptoms: 1) re-experiencing the trauma; 2) avoidance of thoughts, feelings, and activities associated with the trauma; emotional numbing and distancing from loved ones; and 3) increased arousal (irritability, difficulty sleeping, exaggerated startle response).
social phobia or social anxiety disorder: a pronounced fear of humiliation in the presence of others; marked by severe self-consciousness about appearance or behavior or both.
specific phobias: anxiety about particular objects or situations, such as spiders (arachnophobia), heights, flying, enclosed spaces (claustrophobia), doctors and dentists, or snakes.
syndromes: clusters of related symptoms.
MAKING
THE CONNECTIONS
CONNECTION: Some cognitive disorders are related to age, such as dementia and Alzheimer’s disease. These are discussed in Chapter 5. Other disorders, however, such as the sleep disorders of insomnia, narcolepsy, and sleepwalking, can occur at any time in a person’s life and are discussed in Chapter 6.
What Causes Anxiety Disorders?
Nature and Nurture Explanations
CONNECTION: How does our first environment—the womb—shape the expression of our genes? Read more about epigenetics in Chapter 3.
Nature and Nurture
CONNECTION: Do you remember that classical conditioning is how Pavlov’s dogs learned to salivate to a tone? (See Chapter 8.)
CONNECTION: Implicit memory differs from explicit memory in terms of whether we are consciously aware of remembering. Similarly, implicit learning is learning without deliberate conscious attention to learning. (See Chapters 7 and 8.)
Depression and its Causes
CONNECTION: Alleles
exist when genes vary in the population and a person can inherit one form from
one parent and another from the other parent. For more details, see Chapter 3.
Nature and Nurture
Explanations of Schizophrenia
CONNECTION: The brain
undergoes explosive growth during the first six months of in-utero development.
During this time, the fetal brain is most vulnerable to all kinds of toxins,
and the most serious neurological disorders can happen. (See Chapter 5, Figure
5.2.)
o
Discussion: You may want to introduce students to the
neurodevelopmental hypothesis, which argues that early brain development gone
awry may be causal in the development of schizophrenia. See biology online for
a brief overview: http://www.biology-online.org/articles/advances_neurobiology_schizophrenia/neurodevelopmental_hypothesis_schizophrenia.html.
Abuse
and Neglect Changes the Brain
CONNECTION: Critical periods occur when individuals are biologically most receptive to a particular kind of input from the environment. They exist most noticeably for brain and language development. See Chapter 5 for critical periods in brain development and Chapter 9 for critical periods in language development.
Psychotic Symptoms and Creativity
CONNECTION: Psychoticism
can be measured in degrees. Normal people vary considerably in their scores on
psychoticism measures (see Chapter 13). Creative thinking requires novelty and
connections among ideas (see Chapter 10).
o
Discussion: See http://www.trans4mind.com/personality/EPQ.html for an overview of traits Eysenk argued were
parts of psychoticism. Eysenk has done considerable research on creativity and
psychoticism and may be one of the leaders in this area.
Making
Connections in Psychological Disorders: Creativity and Mental Health
Evidence for a Relationship Between Creativity and Psychological
Disorders
Which Disorders Affect Creative Artists?
Psychotic
Symptoms and Creativity
·
17% of
poets experienced schizophrenia at one point in their lifetime, compared to the
population norm of 1.5%.
·
Composers
and athletes were next most likely, at 10% and 11% each.
·
Immediate
relatives of individuals with schizophrenia, people with schizotypal
personality disorder, and those who score high on the normal personality
dimension of psychoticism are all conditions that create unusual thought
processes that are milder than those of schizophrenia.
·
People
in these groups are more likely to have unusual thought processes that develop
into creative achievements that other people recognize to be important and
significant.
CONNECTION: Psychoticism
can be measured in degrees. Normal people vary considerably in their scores on
psychoticism measures (see Chapter 13). Creative thinking requires novelty and
connections among ideas (see Chapter 10).
Depression and Creativity
Bipolar Disorder and Creativity d
Anxiety Disorders and Creativity
CONNECTION: As discussed in Chapter 10, some people who have autism or Asperger’s syndrome are called savants for their extreme giftedness in one domain, such as music or math.
Autism and Creativity
·
Asperger’s
syndrome has been associated with creative ability in science, math, and
engineering.
· Children with Asperger’s are more than twice as likely as normal children to have a father or grandfather who was an engineer (Baron-Cohen et al., 2001; Baron-Cohen et al., 1997; Baron-Cohen et al., 1998).
NATURE-NURTURE
POINTERS
Depression and its Causes
Nature-Nurture Pointer: The
serotonin gene and stressful events work together to increase the odds of
depression.
·
Discussion: This again is evidence for the diathesis stress model.
That is, biology (nature) must interact with environmental stressors (nurture)
for the trait to appear.
·
Discussion: Point out to students that many people are under great
stress and undergo myriad traumas, yet very few ever develop a dissociative
state. You may also want to reiterate that many argue that there is no real
science to back these claims up. However, if it did, would some folks be more
inclined to develop a dissociative state than others?
Bipolar Disorder and its
Causes
Nature-Nurture Pointer: The chance that if one identical twin has bipolar disorder so will the other is 40-70%, indicating that life events, such as stress and trauma, also play a role in the development of this disorder.
Breaking New Ground:
Abuse, Disorders, and the Dynamic Brain
·
Childhood physical
and sexual abuses are horrible, not only because of the short-term trauma, but
because they inflict lasting effects. Early adverse experiences may increase
the likelihood of developing psychological disorders by fundamentally altering
the structure and function of the brain. Research in this area has changed the
way psychologists have looked at the causes of psychological disorders.
Early Views on Sexual and Physical Abuse
·
Before the 1950s, experts underestimated the
pervasiveness of childhood sexual and physical abuse. Most researchers and clinicians also may have
underestimated the long-term consequences of abuse, as they did not know that
serious abuse could change the brain and interact with genetic variability in
such a way as to make certain psychological disorders more likely.
Abuse and Neglect Change Brains
·
Research in genetics has documented how genes in the
brain are switched on and off epigenetically due to environmental events. When
children are severely abused or neglected, their overall physical and mental
health and well-being are seriously compromised – not just because these
abusive behaviors and their consequences are learned, but also because they
change the brain.
How ACE Research Changed the Course of the Field
·
Abuse and neglect
do shape long-term behavior, and dysfunctional behaviors are modeled and imitated.
But this view does not explain exactly how abuse shapes the brain to produce
disordered states of mind.
INNOVATIVE INSTRUCTION
Additional Discussion Topics
1. Defining Psychopathology: You may want to point out to students that defining a disorder is no easy feat. For example, do you go with statistically unusual? If so, then how do you deal with intelligence? The bottom 2.5% are in the DSM as mentally retarded, but the top 2.5% (the gifted portion) are not. Should they be? And then what do you do about disorders that are high in the general population, like substance abuse?
Students generally have no problem brainstorming ideas about what abnormal is, but it is easy to challenge most of them. For example, let’s use unusual behaviors. Are behaviors you don’t see frequently necessarily abnormal? What if a student took of his or her shirt and started dancing on a table in a bar? It’s not something you see everyday, but as the tabloids show us, it’s not something that people think is necessarily “abnormal.” However, if it happened in class…
Another factor is cultural influences. It is important to remind students that speaking in tongues in a Pentecostal church is fine but in another setting, it’s probably not.
2. PTSD: Ask students about what kinds of events other than war can lead to PTSD. Point out that being a victim of a violent crime, for example, could lead to similar effects. What kinds of effects could this have on everyday life?
3. Phobias: Ask students what they have a phobic response to. You may want to point out that having one phobia in a subtype—say animal types—increases the probability of having another phobia in the same subtype (e.g., fear of spiders and snakes).
4. Abuse and brain damage: Remind students that perhaps being abused as a child may affect the development of the brain increasing activity level. That is, neglect and abuse no doubt affect the way the brain becomes wired. For example, let’s take poor feeding habits. Would poor food choices affect the development of the brain?
Further, witnessing extreme abuse of others or being in an aggression-charged environment would have effects on behavior as well.
5. Autism: You may want to point out that the increase is most likely due to several factors: increased awareness, a broadening of the definition into “spectrum,” a need to “label” a child to procure government-provided services for children with delays, and many others. Ask students to brainstorm other possible reasons for why the numbers have jumped.
Activities
1. Assign students to take a quick quiz at ally dog to test their knowledge: http://www.alleydog.com/quizzes/abnormalquiz.asp
2. Have students do a literature review of the recent supposed “causes” of autism and then write a paragraph. You may want to pick a few and show that research has yet to show any definitive causal factor.
3. Have students watch Girl Interrupted and write a 2-paragraph synopsis of the disorders seen in the film.
4. Have students watch one of the cases on phobias from the McGraw-Hill library and write a brief review of the video: http://highered.mcgraw- hill.com/sites/0073382760/student_view0/videos.html.
5. Have a speaker from the counseling department at your university come and speak to your class. As college students are at the peak age for the development of many disorders, counselors can answer student questions and review the support available at your university. This may also increase students’ awareness of diversity and disability.
6. Students love to talk about dissociative states! Remind them that there is little evidence here but it is also hard to falsify claims. Have them do a little Internet research and bring to class one example they found for either a “pro” or a “con” – this should lead to a lively discussion.
Suggested Films
1. The Aviator, a biography of Howard Hughes.
2. Any episode of “Monk” will demonstrate OCD.
3. Girl Interrupted is based on Susanna Kaysen’s book and real-life experience
as a patient in the mid 1960s.
4. A great 2-part series from ABC’s 20/20 on schizophrenia: http://www.youtube.com/watch?v=moP_e-gx5hk&feature=related
http://www.youtube.com/watch?v=QPXkwYM9G-s&feature=related
5. A clip from NOVA on epigenisis in identical twins: http://www.pbs.org/wgbh/nova/sciencenow/3411/02.html
6. A brief clip with interviews of people with schizophrenia: http://www.youtube.com/watch?v=f4R6jln_eZg&feature=related’
7. The brain and schizophrenia: http://www.youtube.com/watch?v=NIs-xqtcguw&feature=related
8. Medications and schizophrenia: http://www.youtube.com/watch?v=pyGpa0b9n0Q&feature=user
9. A great 8-minute clip of a woman with autism: http://www.youtube.com/watch?v=pyGpa0b9n0Q&feature=user.
10. Through the Discovery channel in McGraw-Hill’s library, there are several videos you may want to use: bipolar, an interview with John Nash, depression, and phobias. http://highered.mcgraw-hill.com/sites/0073382760/student_view0/videos.html
11. A clip of a doctor living with manic depression at Johns Hopkins: http://www.youtube.com/watch?v=CxRLap9xLag
10. The Learning Resources Organization has free copies of an Abnormal Psychology Video set. You have to register first but then you can play it in the classroom: http://www.learner.org/resources/series60.html
Suggested Websites
1. An Internet dictionary of abnormal terms: http://www.mentalhealth.com/p20-grp.html
2. Links to pages for most of the disorders: http://www.healthyplace.com/site/disorders_list.asp
3. APA definitions of the disorders from the DSM: http://www.behavenet.com/capsules/disorders/dsm4classification.htm
4. Journal of Abnormal Psychology – some free articles: http://www.apa.org/journals/abn/
5. A great overview of psychology (and the abnormal page is great): http://www.psywww.com/index.html
6. NIMH: http://www.nimh.nih.gov/
7. A great general page: http://psychology.about.com/b/2006/01/13/psychology-glossary-abnormal-psychology.htm
8. ICD-10 website – free access: http://www.who.int/classifications/icd/en/
Suggested
American Psychiatric Association APA (1994
& 2000) Diagnostic and Statistical
Manual of Mental Disorders.
Eysenck, H. J.
(1983). The roots of creativity: Cognitive ability or personality trait? Roeper Review, 5, 10-12.
Eysenck, H. J.
(1993). Creativity and personality: Suggestions for a theory. Psychological Inquiry, 4, 147-178.
Glenn, A. L., et
al (2007). Early Temperamental
and Psychophysiological Precursors of Adult Psychopathic Personality. Journal of Abnormal Psychology. 116, 508
– 515
Heath, A.C. & Martin, N.G. (1990). Psychoticism as a dimension of
personality: A multivariate genetic test of Eysenck and Eysenck's psychoticism
construct. Journal of Personality and
Social Psychology, 58, 111-121.
Kendell R, Jablensky A. (2003) Distinguishing between the validity and
utility of psychiatric diagnoses. Am J
Psychiatry. Jan;160 (1):4-12. PMID 12505793.
Krueger, RF., Watson, D., Barlow, DH., et al. (2005) Toward a Dimensionally Based Taxonomy
of Psychopathology. Journal of Abnormal Psychology Vol 114,
Issue 4.
Regier,
D.S., Narrow, W.E., First, MB., &
Schaffer, David. (1996) A Participant's
Observations: Preparing DSM-IV Can J Psychiatry 1996; 41:325–329.
Spitzer R.L. & Wakefield, J.C. (1999) DSM-IV diagnostic criterion
for clinical significance: does it help solve the false positives problem? Am J Psychiatry. 1999 Dec; 156(12):1856-64.
PMID 10588397.
Steinberg, M. Interviewer’s Guide to the Structured
Clinical Interview for DSM-IV Dissociative Disorders (SCID-D).
Viding, E., James R., Blair, R., Moffitt, T.E., & Plomin, R. (2005). Evidence for substantial genetic risk for psychopathy in 7-year-olds. Journal of Child Psychology and Psychiatry, 46, 6.