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

 

DEFINING PSYCHOLOGICAL DISORDERS

·         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.

  • A major tool for diagnosing psychological disorders is the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association.
  • Beginning with the third edition of the DSM and continuing to the current fourth edition, the DSM-IV-TR (for “Text Revised”; APA, 2000), disorders are placed on one of two different branches of information, or axes.
  • Axis I disorders: major clinical syndromes or clusters of related symptoms that cause significant impairment: e.g., anxiety, depression, bipolar disorder, and schizophrenia. These disorders tend to develop after adolescence, can wax and wane, and are not permanent. There are more than 250 Axis I disorders
  • Axis II disorders: long-standing personality disorders as well as mental retardation. They tend to develop in childhood or adolescence and are permanent. There are more than 100 Axis II disorders.
  • One final difference between Axis I and Axis II disorders is the Axis I disorders tend to be viewed by the person suffering from them as inconsistent with their personality and therefore cause some degree of guilt. Axis II or personality disorders are viewed as consistent with and part of the person’s personality and therefore do not cause much guilt. They are simply part of the person.
  • Almost half of U.S. adults will suffer from at least some Axis I or Axis II disorder at some point in their lives, and more than half of those will suffer from two or more disorders.
  • Comorbidity: two or more co-occurring disorders.
  • 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.

 

ANXIETY DISORDERS

  • Although fear and anxiety are normal affective responses, for about 29% of the United States population, anxiety becomes disordered: It is out of proportion to the situation and interferes with everyday functioning.

Generalized Anxiety Disorder

  • Generalized anxiety disorder (GAD) is a common anxiety disorder, characterized by a pervasive and excessive state of anxiety lasting at least six months. More women than men experience GAD. And unlike those suffering from other anxiety disorders, people with GAD often have been anxious throughout their lives and cannot recall a specific time when they began to feel that way.

 

Panic Disorder with or without Agoraphobia

  • 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. Attacks usually last about 10 minutes but sometimes come and go for over an hour or more. They are characterized by an overwhelming sense of impending doom, accompanied by heart palpitations, trembling, dizziness, intense dread, and even fear of dying.
  • Panic disorder: repeated panic attacks and concern about having more attacks. Preoccupation with the threat of another attack creates an anxious mood, which increases the likelihood of more worrisome thoughts. Panic disorder hijacks the body’s emergency response system and catapults it out of control.
  • Approximately 10% of the U.S. population has experienced a panic attack in the past 12 months, whereas only about 2% to 5% of the population has panic disorder (Grant et al., 2006).
  • Agoraphobia: related to panic attacks is agoraphobia, or 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. The primary “fear” in agoraphobia is not of being out in public but rather of being in an inescapable situation. Panic attacks lead to agoraphobia in about one-third of those who suffer from them.

 

Post-Traumatic Stress Disorder

  • Post-Traumatic Stress Disorder (PTSD): an anxiety disorder that is triggered by exposure to a catastrophic or horrifying event that posed serious harm or threat to the person – such as experiences of war, attempted murder, rape, natural disasters, sudden death of a loved one, or physical or sexual abuse.
  • Symptoms of PTSD are grouped into three categories: 1) re-experiencing the trauma; 2) avoiding of thoughts, feelings, and activities associated with the trauma; emotional numbing and distancing from loved ones; and 3) increased arousal, irritability, difficulty sleeping, or exaggerated startle response.
  • War veterans are at increased risk, not only for PTSD but also for depression, drug abuse, and suicide after returning home.

 

Social Phobia (Social Anxiety Disorder)

  • Phobia: a persistent and unreasonable fear of a particular object, situation, or activity.
  • Social phobia: extreme anxiety associated with interacting with other people.
  • Social anxiety disorder: a pronounced fear of humiliation in the presence of others.
  • Both are marked by severe self-consciousness about appearance or behavior or both. People with social phobia are afraid of acting in ways that would be embarrassing or humiliating. They fear being evaluated negatively by others and think that everyone is continually observing their faults.
  • Unfortunately, the high degree of anxious arousal produced by social phobia may lead the person to act very nervously and thus, in a self-fulfilling way, create behaviors that do indeed attract other people’s attention.

 

Specific Phobias

  • Specific phobias: undue anxiety about particular objects or situations, such as spiders (arachnophobia), heights, flying, enclosed spaces (claustrophobia), doctors and dentists, or snakes. Specific phobias are marked by an intense and immediate fear, even panic, when confronted with very particular situations or objects; even thinking about those situations or objects can set off the fear reaction.

 

Obsessive-Compulsive Disorder

  • Obsessive-compulsive disorder (OCD): an anxiety disorder that is manifested in both thought and behavior.
  • Obsession: an unwanted thought, word, phrase, or image that persistently and repeatedly comes into a person’s mind and causes distress.
  • Compulsion: a repetitive behavior performed in response to uncontrollable urges or according to a ritualistic set of rules. In short, obsessions are thought disturbances, whereas compulsions are repetitive behaviors.
  • Obsessive-compulsive disorder most often involves cleaning, checking, or counting behaviors that interfere with everyday functioning. People with OCD often know that their thoughts are irrational, or at least that their compulsive behaviors are excessive, but they cannot stop themselves. In some cases, compulsive behaviors stem from superstitions.
  • IImpulse control disorder: , that behaviors that people cannot control and feel an intense, repetitive desire to perform. Moreover, the behavior must interfere with normal everyday functioning. Behaviors that develop into impulse control disorders in some individuals include gambling, shopping, hair pulling, and substance abuse.

 

Psychology in the Real World: Can Internet Behavior Become an Addiction?

  • In some cases, people are online all day, cannot continue their work or activities around the home without logging on, and think about the Internet whenever they are not online. That is, it has become problematic.
  • Mental health professionals do not agree on whether Internet abuse is an addiction, a compulsion, or an impulse disorder. The word addiction is problematic, as it suggests a physiological dependence in which the body cannot function without a particular substance, such as heroin or nicotine.
  • It is more likely that problems of Internet use are compulsions or impulse disorders. As explained in the text, compulsions are uncontrollable behaviors that serve to control the anxiety created by the obsessions. The possibility that it is a problem of impulse control has received the most empirical support.
  • A broad survey found that 1% of folks surveyed met proposed diagnostic criteria for Internet-based impulse disorder. And that number climbs in teenagers to about 5%.
  • Why is this problematic? Well, most Internet abuse in adults happens in the workplace, decreasing productivity. Also, in a study of Internet use in college students, those who spend excessive amounts of time online are more likely to report depressive symptoms and engage in less face-to-face social interaction.

 

What Causes Anxiety Disorders? Nature and Nurture Explanations

  • Diathesis-stress model: argues that people inherit a predisposition (or Diathesis) for a disorder and then environmental stressors select the disorder.
  • The diathesis-stress model is becoming more fully developed and refined, based on the findings of research in such areas as behavioral genetics, epigenetics, and brain plasticity. Research in epigenetics shows us that genes do not simply turn on at predetermined times in our lives. They can and do respond to experience.
  • CONNECTION: How does our first environment—the womb—shape the expression of our genes? Read more about epigenetics in Chapter 3.
  • Three biological factors that make people vulnerable to anxiety disorders:

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.

  • Panic disorder provides an example of how biological predispositions interact with learning and experience in the development of anxiety disorders. Not everyone who is exposed to certain environmental conditions will develop panic disorder. Panic attacks tend to occur in people who are predisposed toward anxiety and experience extreme internal physiological changes during panic, most likely due to their genetic inheritance and brain chemistry.
  • CONNECTION: Do you remember that classical conditioning is how Pavlov’s dogs learned to salivate to a tone? (See Chapter 8.)
  • Another kind of biological predisposition may be present in OCD. The repetitive links between thought and behavior in OCD have been linked to hyperactivity in certain brain structures, including the anterior cingulate cortex (ACC) and the caudate nucleus. The caudate nucleus is part of the basal ganglia, which controls voluntary behavior. The ACC plays an important role in monitoring conflicting information or detecting errors.
  • Some scientists argue that the brain circuit that connects the caudate, the ACC, and limbic structures is working overtime in OCD.
  • Research on cognitive performance in people with OCD reveals a preoccupation with conscious thinking; it is hard for people with this disorder to keep certain ideas or information out of awareness. As such, people with OCD have trouble on implicit but not explicit learning tasks.
  • 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.)

 

MOOD DISORDERS

  • Anxiety and depression often go together in the same individual – they are comorbid. Approximately half of those who suffer from an anxiety disorder also suffer from a mood disorder.
  • Mood Disorders: Disturbances in emotional behavior that prevent people from functioning effectively in everyday life. The two major forms of mood disorder are depression and bipolar disorder.

 

Depression and its Causes

  • The clinical form of depression occurs in about 10% of adults in the United States at some point in their lives.
  • Major depressive disorder: often referred to as depression for short is characterized by pervasive low mood, lack of motivation, low energy, and feelings of worthlessness and guilt that last for at least two consecutive weeks.
  • Major depressive disorder sometimes is a single event in a person’s life, but more often than not it is recurring.
  • Dysthymia: a milder form of depression; most of the symptoms are the same as in a major depressive disorder, only they are less intense in dysthymia.

·         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.

  • 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.)
  • The role of stress in the development of depression is not trivial. Animal research shows that stress kills neurons in the hippocampus, which can lead to symptoms of depression.
  • Medications that make more serotonin available in the brain stimulate neural growth, which lessens the symptoms of depression.

 

Bipolar Disorder and its Causes

  • Bipolar disorder: substantial mood fluctuations, cycling between very low (depressive) and very high (manic) episodes, which is why it was formerly called “manic-depression.”
  • Manic episodes: typically involve increased energy, sleeplessness, euphoria, irritability, delusions of grandeur, increased sex drive, and “racing” thoughts. A useful mnemonic for remembering the symptoms of mania is D-I-G-F-A-S-T (Carlat, 1998):

D = Distractibility

I = Indiscretion

G = Grandiosity

F = Flight of ideas

A = Activity increased

S = Sleep (decreased need for)

T = Talkativeness

  • People with bipolar disorder often find the initial onset of the manic phase pleasant, especially compared to the dullness and despair of the depressive phase. Unfortunately, soon the symptoms become quite unpleasant and frightening: the manic upswing spirals out of control, often leading to frenetic activity, excessive energy, and grandiose thinking, in which the person thinks he or she has relationships with important people or has expertise in areas where he or she has none. 

·         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.

  • Fetuses that are exposed to large amounts of alcohol suffer permanent effects, including increased risks for bipolar disorder as well as depression, schizophrenia, alcoholism, mental retardation, and drug abuse.

·         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.

  • Many brain regions consistently seem to malfunction in people who suffer from bipolar disorder: the prefrontal cortex, the amygdala, the hippocampus, and the basal ganglia.
  • Neurochemistry is also important to bipolar disorder. In both the manic and depressed phases, serotonin levels are low, but low serotonin may be coupled with high levels of norepinephrine in the manic phase and with low levels in the depressed phase.
  • In addition, thyroid hormones, which control metabolism, contribute. Low levels of thyroid hormones produce sluggishness. High levels of thyroid hormone speed up metabolism and thus can mimic mania.

 

SCHIZOPHRENIA

·         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:

Ÿ Delusions

Ÿ Hallucinations

Ÿ Disorganized speech

Ÿ Grossly disorganized or catatonic behavior (immobile and unresponsive, though awake)

Ÿ Negative symptoms (such as not speaking or being unable to experience emotion)

  • Symptoms of schizophrenia:
  • Positive symptoms: bizarre perceptual experiences associated with schizophrenia include hallucinations, delusional thinking, and disorganized thought and speech.
    • Hallucinations: convincing sensory experiences that occur in the absence of an external stimulus – in other words, the brain receives false sensory input. Auditory hallucinations are the most common form of hallucination in schizophrenia, typically taking the form of hearing voices in one’s head. Next most common are visual hallucinations, and then tactile hallucinations.
    • Delusion: a false belief; often exaggerated claims that a person holds in spite of evidence to the contrary.
  • Negative symptoms: nonresponsiveness, being emotionally flat, immobility or striking strange poses (catatonia), reduction of speaking, and inability to complete tasks.
  • Cognitive symptoms: problems with working memory, attention, verbal and visual learning and memory, reasoning and problem solving, speed of processing, and disordered speech.
    • Word salad: follows grammatical rules, but the content makes little sense

 

Subtypes of Schizophrenia

  • Paranoid schizophrenia: persistent preoccupation with one or more delusions or frequent auditory hallucinations, but the person must be free of disorganized speech, catatonic behavior, and flat and inappropriate affect.
  • Catatonic schizophrenia: the person exhibits at least two of the following symptoms: extreme immobility, excessive activity, peculiar posturing, mutism, or parroting what other people say.
  • Undifferentiated schizophrenia: the person exhibits the general symptoms discussed at the beginning of the section (delusions, hallucinations, disorganized speech, and so on), but does not fit any of the specific subtypes.
  • Disorganized schizophrenia: the person shows no signs of catatonia but exhibits both disorganized speech and behavior, and flat or inappropriate affect.

 

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 BrainBrain   

  • One of the most widely recognized brain abnormalities is a dysfunctional prefrontal cortex; there is evidence of both reduced and excessive activity in that area.
  • Considerable research has found that the hippocampus is smaller in people with schizophrenia than in normal individuals.
  • One of the oldest findings on the brain and schizophrenia is the tendency of people with schizophrenia to have enlarged ventricles (the fluid-filled spaces in the brain). Enlarged ventricles can be a result of abnormalities in other brain structures, however, so it is unclear whether enlarged ventricles are a cause or an effect of schizophrenia.

Neurochemistry of Schizophrenia

·         Dopamine hypothesis: states that people with schizophrenia have an excess of dopamine in certain areas of the brain.

  • Although the leading theory, currently there are some challenges to this. Dopamine-specific medications (major tranquilizers) effectively treat only positive symptoms and are not entirely effective. In addition, only a minority of the people who receive the traditional drug treatment find it effective in managing their symptoms.
  • Studies of people on recreational drugs like PCP have shown schizophrenic-type symptoms and these drugs block the action of glutamate, important for learning, memory, and neural processing. Thus, it may be due to glutamate deficiencies rather than dopamine excesses.

 

DISSOCIATIVE DISORDERS

  • Dissociative disorders: produce extreme splits or gaps in memory, identity, or consciousness. 
  • These disorders lack a clear physical cause, such as brain injury, and often stem from extreme stress or abusive experiences, especially during childhood. Three major kinds:

 

Dissociative Identity Disorder

  • Dissociative identity disorder (DID): the person develops at least two distinct personalities, each of whom has a unique set of memories, behaviors, thoughts, and emotions.
  • Childhood abuse is the most frequent cause of dissociative identity disorder. It first develops in childhood, and women are about three times more likely to suffer from DID than are men.
  • Symptoms include amnesia, self-destructive behaviors, and hearing voices.
  • The diagnosis of DID is somewhat controversial, with some psychiatrists even claiming the diagnosis is not real but rather unintentionally produced by therapists themselves.
  • Discussion: Ask students what they think about this diagnosis. Do they think it’s possible? This is a good time to remind students about Loftus’s work on repressed memories.
  • Activity: You may want to show part or all of Sybil (1976) here as well.

 

Dissociative Amnesia and Fugue

  • Dissociative amnesia: extensive form of stunned amnesia.
  • Dissociative fugue: individual not only forgets his or her identity and past but also flees to a new location and may establish a new identity there.

 

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

  • Personality disorders generally start in childhood and are more stable than clinical disorders such as schizophrenia, depression, and bipolar disorder.
  • The DSM places the personality disorders on Axis II, meaning they are relatively permanent, may show up in childhood, and are viewed by the person as consistent with their personality and therefore do not cause guilt.
  • Three clusters:

 

Odd-Eccentric Personality Disorders

  • Schizoid personality disorder: does not want close relationships, is emotionally aloof, reclusive, humorless, and wants to live a solitary life.
  • Schizotypal personality disorder: isolated and asocial, but in addition has very odd thoughts and beliefs.
  • Paranoid personality disorder: extremely suspicious and mistrustful of other people, in ways that are both unwarranted and not adaptive.

 

Dramatic-Emotional Personality Disorders

  • Histrionic personality disorder: wants very much to be the center of attention and often behaves in very dramatic, seductive, flamboyant, and exaggerated ways.
  • Borderline personality disorder: has out-of-control emotions, is very afraid of being abandoned by others, and vacillates between idealizing and despising those who are close to them.
  • Narcissistic personality disorder: the person has an extremely positive and arrogant self-image, and most of their time and attention is self-focused.
  • Antisocial personality disorder: marked by extremely impulsive, deceptive, violent, ruthless, and callous behaviors. In fact, people with antisocial personality disorder are most likely to engage in criminal, deceptive, and violent behaviors. Indeed, although only about 3% of the population has this disorder, between 45% and 75% of male prison inmates are diagnosed with the disorder, and 20% of the female prisoners are diagnosed with it.

 

Anxious or Fearful Personality Disorders

  • Avoidant personality disorder: the person is so afraid of being criticized that they avoid interacting with others and become socially isolated.
  • Dependent personality disorder: the person fears being rejected and has such a strong need to be cared for that they form clingy and dependent relationships with others.
  • Obsessive-compulsive personality disorder: rigid in their habits and extremely perfectionistic. This personality disorder is similar to the clinical disorder with the same name but is more general.

 

Nature and Nurture Explanations of Personality Disorders

  • Research on people who kill have identified a cluster of traits possessed by most of these violent criminals: being male, coming from abusive and neglectful households, having at least one psychological disorder, and having suffered some kind of injury to the head or brain.
  • The psychological disorder that is most closely associated with committing murder is usually antisocial personality, but it may be substance abuse, anxiety, or attention deficit disorder.
  • Being male, however, is the single strongest predictor of violent behavior. In 2004, for instance, males accounted for 90.1% of all arrests for murder. Keep in mind, these traits do not cause the disorder, but rather they make it more likely.
  • Moreover, as a result of head injuries or living in a constant state of fear and abuse, or both, murderers almost always have moderate to severe problems of impulse control, social intelligence, working memory, and attention.

 

CHILDHOOD 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.

  • Attention-deficit/hyperactivity disorder (ADHD): can’t work for more than a few minutes on a task, constantly fidgets, frequently disrupts others, makes careless mistakes at school. Symptoms must be present before age 7.
    • Between 5% and 10% of American school-age children and 3% to 5% of children worldwide meet the diagnostic criteria of ADHD.
  • Autistic syndrome disorder or autism: characterized by rather severe language and social impairment combined with repetitive habits and inward-focused behaviors.  Evidence suggests that people with autism have an oversensitivity to sensory stimulation or trouble integrating multiple sources of sensory information, such as sight, sound, and touch.

·         Autism is a range or spectrum of disorders, ranging from severe disability to high functioning.

    • Researchers unaware of diagnoses who closely examined eye contact made by autistic and non-autistic children on their first birthday home videos were able to correctly classify children as autistic or not 77% of the time.
  • When three other social behaviors were added (responding to name, pointing, and showing) researchers again without knowledge of diagnoses could accurately classify children as autistic or not 91% of the time.
  • Historically, approximately 5 to 6 children in 1,000 met the criteria for autism, but during the 1990s and 2000s the rate has increased at least 10 times to 60 per 1,000 (Rice, 2007). Some researchers believe the disorder may be overdiagnosed, and yet the evidence suggests the rise is mostly due to increased awareness of the disorder.

·         Asperger’s syndrome: impaired social interest and skills, restricted interests, and most have above-average intelligence.

 

 

 

Causes of Childhood Disorders

  • For ADHD and conduct disorder, one of the environmental factors is whether the mother smokes while pregnant. Yet, even smoking while pregnant only leads to conduct and impulse problems if the child has one form of a dopamine gene but not another.
  • One consistent finding regarding brain activity of those with ADHD is low levels of activation. Brain activity in general is less pronounced in people with ADHD compared with those without. An understimulated brain explains the “paradoxical” effects of giving children with ADHD a stimulant to calm them down. The stimulant elevates their abnormally low nervous system activity and they require less stimulation and activity from the outside.
  • In autism, the brain is smaller than normal at birth but grows much faster during the first few years of life than the brains of nonautistic children. The brain of a 5-year-old with autism is the same size as that of a typical 13-year-old. Head size, therefore, is a marker of possible autism. In addition, the frontal lobes, where much processing of social information occurs, are less well connected in autistic children than in normal children (Belmonte et al., 2004).
  • A promising theory about the origins of autism is based on the mirror neurons. Mirror neurons fire both when a person performs a particular behavior (such as reaching for an object) and when he or she simply watches someone else performing the same behavior.
  • Mirror neurons are thought to be involved in many, if not most, social behaviors, such as observational learning, imitation, and even language learning. Because autistic children are deficient in these skills, neuroscientists predicted that mirror neurons malfunction in autistic children.

 

Making Connections in Psychological Disorders: Creativity and Mental Health

  • See Making the Connections section for detailed explanation.

 

 

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:, that  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

 

Defining Psychological Disorders

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.

  • Discussion: Ask students what they think about the diathesis stress model. It indeed explains why some veterans seemingly have no difficulty and others have significant difficulty, or why some victims of trauma seem to bounce back more quickly.

 

Nature and Nurture

CONNECTION: Do you remember that classical conditioning is how Pavlov’s dogs learned to salivate to a tone? (See Chapter 8.)

  • Discussion: You may want to tie in learning theory here. This is a great example of classical conditioning. For example, say you were mugged in a parking lot. You get mugged (UCS) and have a fear response (UCR). Now you may develop a fear or anxiety response (CR) to being in dark, enclosed spaces or to persons who look like your attacker (CR). That is, now the environment acts as a stimulus to trigger the sympathetic nervous system.
  • Example: An example of how learning theory partially explains the perpetuation of anxiety problems could be the following: You are at the mall and have a panic attack. Now you are concerned with going to the mall because of a fear of having another attack. That is, the mall becomes a CS for the fear response or CR. It is also easy to see how this could develop in some persons to agoraphobia.  
  • Discussion: Learning theory also explains OCD. The obsession creates anxiety, and compulsions decrease anxiety and thus act as a negative reinforcer. You may want to discuss with students that this is one reason it becomes so hard for people to stop.

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.

  • Discussion: This is also evidence for the diathesis stress model. You may also want to point out to students that this is one of the limitations of co-relational designs. That is, there could also be a third factor variable here in terms of the kinds of parents who abuse. Ask students what kinds of factors or stressors may lead to abuse.

 

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

  • Creative figures throughout history have experienced some psychological condition so often that many people think the two are connected. The term “mad genius” reflects this belief.

Evidence for a Relationship Between Creativity and Psychological Disorders

  • Arnold Ludwig (1995) produced perhaps the most impressive study of creativity and psychological disorder. Ludwig (1995) examined the lifetime rates of psychological disorder across the professions and over lifetimes.
  • Lifetime rates for any psychiatric illness are remarkably high for people in the arts: 87% of poets, 77% of fiction writers, 74% of actors, 73% of visual artists, 72% of nonfiction writers, 68% of musical performers, and 60% of musical composers are affected by some type of psychiatric disorder.  Keep in mind that the rate in the general population for any disorder is 46%. This study clearly indicates a higher prevalence of disorder in creative artists than in people in the general population.

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

  • Across 18 professions, the lifetime rate of depression was 30%, with poets (77%), fiction writers (59%), and visual artists (50%) having the highest rates.
  • Poets are 20 times more likely to commit suicide, a key indicator for depression, than most people (20% to 1%).
  • Although highly creative artists and writers may suffer from depression more than most people, depressive episodes themselves do not generate much creative output. Recall that a complete lack of motivation is a common symptom of depression, so lower productivity would follow. However, the experiences one has while depressed might inspire and motivate the creation of works of art.

Bipolar Disorder and Creativity d

  • Actors (17%), poets (13%), architects (13%), and nonfiction writers (11%) all exceeded the 10% rate of lifetime prevalence of bipolar disorder – 10 times the rate in the general population.
  • Some studies have shown that highly creative people are more likely than noncreative people to have bipolar disorder. The manic stage is particularly associated with creativity.

Anxiety Disorders and Creativity

  • There is some evidence that anxiety disorders are more common in creative people, but the evidence for a link with creativity is not as compelling as it is for other disorders. Nonfiction writers (16%), actors (14%), visual artists (14%), poets (13%), and fiction writers (11%) were most likely to experience some kind of anxiety disorder over their lifetime.

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.

  • Discussion: At this point, most students are thinking that this sounds great. Students tend to idolize actors, writers, musicians, and artists. Remind students that although they show great creativity, the data overall supports that these increases in ability in one area are tied to severe deficits in other areas. For example, although it may sound to them that savants have these great spikes, they often cannot complete many aspects of independent living without help. That is, depressive stages and autism are severely debilitating. You may also want to remind them that most schizophrenics are not like John Nash; they are homeless and in a vicious cycle of non-treatment and severe symptoms.

Autism and Creativity

  • Most autistic savants do not produce great works of original genius because their amazing feats of calculation and recall are not original, nor do they create something significant. Some savant prodigies do produce truly creative works of art, usually math analyses, musical compositions, drawings, or painting.

·         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.

  • An ambitious study that is changing the way psychologists view the interaction between biology and environment in the development of psychological disorders is the Adverse Childhood Experiences (ACE) study, which began in the mid to late 1990s. They are looking at more than 17,000 participants who have been interviewed about 8 “adverse childhood experiences,” including abuse, domestic violence, and serious household dysfunction. Researchers then correlated their adverse childhood experiences with health and mental health outcomes in adulthood.
  • Results indicate that for every additional adverse childhood experience participants reported, psychological outcomes deteriorated.
  • Neglect: the absence of basic stimulation during the critical periods of growth and development.
  • Brain scans have shown that in cases of extreme neglect, the overall size of the brain is smaller and often you see enlarged ventricles (butterfly shapes) in the middle of the brain. These two brain characteristics are among the major brain abnormalities characteristic of schizophrenia.
  • Researchers have found that when children were removed from neglectful home environments at age 1 or 2 and placed in caring foster homes, the size of their brains increased dramatically. For a child’s brain size to be anywhere near normal, the child needs normal environmental stimulation by about age 4.
  • Researchers have also found that an increased incidence of a brief psychotic disorder at age 26 occurred in people who had undergone birth complications (such as lack of oxygen), shown childhood difficulties in understanding speech, had motor-movement problems, and had lower IQ.

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.

  • It is now widely recognized that the interaction of genetic factors with exposure to abusive or neglectful environments plays a major role in the development of psychological disorders. Separating nature and nurture influences is impossible

 

 

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 Readings

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., & Marshall, T. (2002) The APA classification of mental disorders: future perspectives. Psychopathology. Mar-Jun;35(2-3):166-70.

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). Washington, DC: American Psychiatric Press, 1994.

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.