Psychology applied to modern life adjustment in the 21st century, 11e chapter 14

Anxiety Disorders, continued • Anxiety disorders “are a class of disorders marked by feelings of excessive apprehension and anxiety”.. Anxiety Disorders, continued • Panic disorder “is

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Chapter 14

Psychological Disorders

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Abnormal Behavior, continued

• The medical model applied to abnormal behavior

behavior as a disease” and has become the main way of thinking about mental illness today

(see Figure 14.1)

patient care

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Figure 14.1 Historical conceptions of mental illness Throughout most of history, psychological disorders were thought to be caused by demonic possession, and the mentally ill

were candidates for chains and torture.

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The medical model, continued

– Diagnosis – “involves distinguishing one illness from another”.

– Etiology – “refers to the apparent causation and developmental history of

an illness”

– Prognosis – “is a forecast about the probable course of an illness”.

Abnormal Behavior, continued

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Criteria of Abnormal Behavior

1. Deviance – the behavior must be significantly different from what society

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Psychodiagnosis: The Classification of Disorders

Statistical Manual (now in its fourth revision and referred to as the DSM-IV)

to classify disorders

clinicians to make more consistent diagnoses

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Classification of Disorders, continued

• The multiaxial system

– The DSM has five “axes” or components

1. Axis I: criteria for diagnosing most disorders.

2. Axis II: specific to personality disorders.

3. Axis III: patient’s general medical condition.

4. Axis IV: psychosocial and environmental problems.

5. Axis V: global assessment of functioning.

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Classification of Disorders, continued

• Controversies surrounding the DSM

dimensional approach.

disorder”

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Prevalence of Psychological Disorders

• Epidemiology is “the study of the distribution of mental or physical disorders in a

population”

• Prevalence “refers to the percentage of the population that exhibits a disorder

during a specified time period”

disorder (see Figure 14.4)

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Figure 14.4 Lifetime prevalence of psychological disorders The estimated percentage of people who have, at any time in their life, suffered from one of four types of psychological

disorders or from a disorder of any kind (top bar) is shown here Prevalence estimates vary somewhat from one study to the next, depending on the exact methods used in sampling and assessment The estimates shown here are based on pooling data from Wave 1 and 2 of the Epidemiological Catchment Area studies and the National Comorbidity Study, as

summarized by Regier and Burke (2000) and Dew, Bromet, and Switzer (2000) These studies, which collectively evaluated over 28,000 subjects, provide the best data to date on the prevalence of mental illness in the United States.

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Anxiety Disorders, continued

• Anxiety disorders “are a class of disorders marked by feelings of excessive

apprehension and anxiety”

• Generalized anxiety disorder “is marked by a chronic, high level of anxiety

that is not tied to any specific threat”

• Phobic disorder “is marked by a persistent and irrational fear of an object of

situation that presents no realistic danger”

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• Panic disorder “is characterized by recurrent attacks of overwhelming anxiety that

usually occur suddenly and unexpectedly” (see following animation sequence)

• Agoraphobia “is a fear of going out to public places”.

their homes out of fear of the outside world

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• Obsessive-compulsive disorder (OCD) “is marked by persistent,

uncontrollable intrusions of unwanted thoughts (obsessions) and urges to

engage in senseless rituals (compulsions)”

sexual acts

on by obsessions

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Obsessive -compulsive disorder, continued

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• Etiology of anxiety disorders

– Biological factors

sensitive to internal physiological symptoms of anxiety and overreact with fear when they occur

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Etiology of anxiety disorders, continued

one neuron to another”, may underlie anxiety

Valium) suggest that these chemical circuits may be involved in anxiety disorders

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• Conditioning and learning

scenario

conditioning, by making the person feel less anxious

more than others, however

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• Cognitive factors

they

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• Stress as a factor

disorders were more likely to have experienced severe stress one month prior to the onset of their disorder

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Somatoform Disorders, continued

• Somatoform disorders “are physical ailments that cannot be fully explained

by organic conditions and are largely due to psychological factors”

• Somatization disorder “is marked by a history of diverse physical complaints

that appear to be psychological in origin”

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• Conversion disorder – “is characterized by a significant loss of physical function

with no apparent organic basis, usually in a single organ system”

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• Hypochondriasis (or hypochondria) “is characterized by excessive

preoccupation with health concerns and incessant worry about developing physical illnesses”

often become frustrated with the medical establishment

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Etiology of somatoform disorders

• Personality factors

personalities (those who thrive on the attention that illness brings)

disorders

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Etiology of somatoform disorders, continued

• Cognitive factors

them into perceived symptoms of distress

deviation from perfect health is seen as a sign of illness

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Etiology of somatoform disorders, continued

• The sick role

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Dissociative Disorders, continued

• Dissociative disorders “are a class of disorders in which people lose contact

with portions of their consciousness or memory, resulting in disruptions in their sense of identity”

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• Dissociative amnesia & fugue

– Dissociative amnesia “is a sudden loss of memory for important personal

information that is too extensive to be due to normal forgetting”

severe trauma or stress

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Dissociative amnesia & fugue, continued

• Dissociative fugue is a disorder in which “people lose their memory for their

sense of personal identity”

know who they are, where they live, or who they know

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• Dissociative identity disorder (DID) “involves the coexistence in one person of

two or more largely complete, and usually very different, personalities”

own name, memories, traits, and physical mannerisms

them can be extreme (e.g., different races or genders)

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• Etiology of dissociative disorders

causes are largely unknown

emotional trauma that occurs in childhood

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Mood Disorders, continued

• Mood disorders “are a class of disorders marked by emotional disturbances that

may spill over to disrupt physical, perceptual, social, and thought processes”

• Major depressive disorder is one in which people “show persistent feelings of

sadness and despair and a loss of interest in previous sources of pleasure”

episode

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Major depressive disorder, continued

prevalence is 16.2%)

diagnosed with depression

and women and could result from greater stress and abuse that women experience

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• Bipolar disorder (once known as manic-depressive disorder) “is marked by

the experience of both depressed and manic periods”

feeling of invincibility

of depression (see Figure 14.10)

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Figure 14.10 Common symptoms in manic and depressive episodes The emotional, cognitive, and motor symptoms exhibited in manic and depressive illnesses are largely the

opposite of each other.

Prentice-Hall Reprinted by permission of Prentice-Hall, Inc

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• Mood disorders and suicide

disorder

60% of completed suicides

those who have had depression

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• Etiology of mood disorders

– Genetic vulnerability

• Concordance rates, or “the percentage of twin pairs or other pairs of

relatives that exhibit the same disorder”, suggests there is a genetic basis for mood disorders

14-19% for fraternal twins who share fewer genes but the same environment

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Etiology of mood disorders, continued

– Neurochemical & neuroanatomical factors

brain:

the result, of the onset of mood disorders

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– Neuroanatomical factors, continued

subjects (see Figure 14.12)

regulation of mood and depression

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Figure 14.12 The hippocampus and depression This graphic shows the hippocampus in blue The photo inset shows a brain dissected to reveal the hippocampus in both the right

and left hemispheres It has long been known that the hippocampus plays a key role in memory, but its possible role in depression has only come to light in recent years Research suggests that shrinkage of the hippocampal formation due to suppressed neurogenesis may be a key causal factor underlying depressive disorders

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– Cognitive factors

helplessness”, in which people become passive and “give up” in times of difficulty

style” in which people attribute setbacks to personal flaws

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problems put themselves at risk for depression

Alloy’s (1999) studies (see Figure 14.14)

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Figure 14.14 Negative thinking and prediction of depression Alloy and colleagues (1999) measured the explanatory style of first-year college students and characterized them as

being high risk or low risk for depression This graph shows the percentage of these students who experienced major or minor episodes of depression over the next 2.5 years As you can see, the high-risk students, who exhibited a negative thinking style, proved to be much more vulnerable to depression (Data from Alloy et al., 1999)

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Schizophrenic Disorders, continued

• Schizophrenia literally means “split mind”.

• Schizophrenic disorders “are a class of disorders marked by disturbances in

thought that spill over to affect perceptual, social, and emotional processes”

class of disorders

prognosis

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• General symptoms

1. Irrational thought

• Delusions “are false beliefs that are maintained even though they clearly

are out of touch with reality”

by an external source

• Delusions of grandeur are irrational beliefs that one is “extremely

important or famous”

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General symptoms, continued

2. Deterioration of adaptive behavior

3. Distorted perception

of a real external stimulus or that represent gross distortions of perceptual input” are common symptoms

4. Disturbed emotion (either “flat” affect or inappropriate emotions for a

situation)

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• Subtypes

1. Paranoid type

• Paranoid schizophrenia “is dominated by delusions of persecution along

with delusions of grandeur”

against them

2. Catatonic type

• Catatonic schizophrenia “is marked by striking motor disturbances,

ranging from muscular rigidity to random motor activity”

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Subtypes of schizophrenia, continued

3. Disorganized type

adaptive behavior is seen”

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Subtypes of schizophrenia, continued

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• Positive versus negative symptoms

by Andreasen (1990) and others

flat affect)

bizarre behavior)

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• Course and outcome

facilities.

hospitalization.

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Course and outcome, continued

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• Etiology of schizophrenia

– Genetic vulnerability

suggesting a genetic basis for the disease (see Figure 14.17)

– Neurochemical factors

Dopamine

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Figure 14.17 Genetic vulnerability to schizophrenic disorders Relatives of schizophrenic patients have an elevated risk for schizophrenia This risk is greater among closer

relatives Although environment also plays a role in the etiology of schizophrenia, the concordance rates shown here suggest that there must be a genetic vulnerability to the disorder These concordance estimates are based on pooled data from 40 studies.

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Etiology of schizophrenia, continued

– Structural abnormalities in the brain

schizophrenia have enlarged brain ventricles (see Figure 14.18)

of the disorder

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Figure 14.18 Schizophrenia and the ventricles of the brain Cerebrospinal fluid (CSF) circulates around the brain and spinal cord The hollow cavities in the brain filled with CSF are

called ventricles The four ventricles in the human brain are depicted here Studies with modern brain-imaging techniques suggest that an association exists between enlarged ventricles

in the brain and the occurrence of schizophrenic disturbance.

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part by various disruptions in the normal maturational processes of the brain before or at birth” (Brown, 1999)

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– Expressed emotion (EE) is “the degree to which a relative of a schizophrenic

patient displays highly critical or emotionally overinvolved attitudes toward the patient”

to relapse because they add stress

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– Precipitating stress itself may trigger the onset of schizophrenia in someone

who is already vulnerable to the disease

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Application: Eating Disorders, continued

• Types of eating disorders

– Eating disorders “are severe disturbances in eating behavior characterized by

preoccupation with weight and unhealthy efforts to control weight”

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Types of eating disorders, continued

– Anorexia nervosa “involves intense fear of gaining weight, disturbed body

image, refusal to maintain normal weight, and dangerous measure to lose weight”

laxatives and excessive exercise to eliminate food and/or burn calories

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Anorexia nervosa, continued

• Amenorrhea (ceasing of menstrual cycles).

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– Bulimia nervosa “involves habitually engaging in out-of-control overeating

followed by unhealthy compensatory efforts, such as self-induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise”

problems, metabolic, and gastrointestinal problems

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– Binge-eating disorder “involves distress-inducing eating binges that are not

accompanied by the purging, fasting, and excessive exercise seen in bulimia”

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• History and prevalence

middle of the 20th century

gender gap is likely due to the unrealistic cultural standards for weight in Western societies

developing bulimia

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