AP Psychology Notes
Topic XI: Psychological Disorders
I. Overview
A. At various moments, all of feel, think, or act the way disturbed people do much of the time.
1. We get anxious, depressed, withdrawn, suspicious, deluded, or antisocial, just less intensely and more briefly.
2. The study of psychological disorders may at times evoke an eerie sense of self-recognition.
B. Many of us have felt, either personally or through friends or family members, the bewilderment and pain of a psychological disorder.
1. Some 400 million people worldwide suffer psychological disorders, according to the World Health Organization.
2. As members of the human family, few of us go through life unacquainted with the reality of psychological disturbance.
II. Perspective on Psychological Disorders
A. Defining Psychological Disorders – a "harmful dysfunction" in which behavior is judged to be atypical, disturbing, maladaptive, and unjustifiable.
1. Standards of acceptability for behavior vary.
i. One person’s homicidal "terrorist" is another person’s "freedom fighter."
ii. Standards of acceptability also vary over time.
a. A sex expert in the late 1800’s referred to a women’s orgasm as a disorder, where as a sex expert in the late 1900’s referred to a lack of orgasm as a disorder.
b. On December 9, 1973, homosexuality was an illness. On the next day, it was not.
2. Atypical and disturbing behaviors are more likely to be considered disorders when harmful to others, disabling, or maladaptive.
3. Abnormal behavior is most likely to be considered disordered when others find it rationally unjustifiable.
B. Understanding Psychological Disorders
1. Past History
i. Puzzling behavior in earlier times where explained by the movement of the stars, godlike powers, or evil spirits.
ii. Therapies involved beatings, burning, castration, pulling teeth, removing lengths of intestines, cauterizing the clitoris and transfusions of animal blood.
2. The Medical Perspective
i. Reformer, such as Philippe Pinel (1745-1826) in France insisted madness was not demon possession but a sickness caused by severe stresses and inhumane conditions.
a. His, and other reformers, treatment included boosting patients’ morale, talking, gentleness, activity, clean air and sun.
ii. When physicians discovered that syphilis infects the brain, medical worker began to focus on physical causes for disorders and treatments that would cure them.
iii. Medical Model – the concept that diseases have physical causes that can be diagnosed, treated, and, in most cases cured. When applied to psychological disorders, the medical model assumes that these "mental" illnesses can be diagnosed on the basis of their symptoms and cured through therapy, which may include treatment in a psychiatric hospital.
3. The Bio-Psycho-Social Perspective
i. Today’s psychologists contend that all behavior, whether called normal or disordered, arises from the interaction of nature (genetic and physiological factors) and nurture (past and present experiences).
ii. Evidence of environmental effects comes from links between disorder and culture.
a. Different cultures have different sources of stress and produce different ways of coping.
b. Examples – anorexia nervosa (Western cultures), a fear of black magic (Latin America), social anxiety (Japan).
C. Classifying Psychological Disorders
1. In psychiatry and psychology, classification both orders and describes clusters of symptoms.
2. The diagnostic term simply provides a handy shorthand for describing a complex disorder.
3. Diagnostic classification ideally aims to describe a disorder, predict its future course, imply appropriate treatment, and stimulate research into its causes.
4. The current authoritative scheme for classifying psychological disorders is the American Psychiatric Association’s Diagnostic and Statistical Manual of mental Disorders, nicknamed DSM-IV.
i. DSM-IV defines 17 major categories of "mental disorder," describing the disorder and listing their prevalence without presuming to explain their causes.
ii. Two main categories:
a. Neurotic Disorder – is usually distressing but allows one to think rationally and function socially.
b. Psychotic Disorder – a person loses contact with reality, experiencing irrational ideas and distorted perceptions.
iii. For a DSM-IV category to be valid, it must first be reliable.
a. If one psychologist diagnoses someone, the chances are another mental health worker will independently give the same diagnosis.
iv. Some critics fault the manual for casting too wide a net and bringing "almost any kind of behavior within the compass of psychiatry."
v. The number of disorder categories has swelled from 60 in the 1950’s to 400 today.
a. The number of adults who meet the criteria for at least one psychiatric ailment is nearly 30 percent.
D. Labeling Psychological Disorders
1. Labels create preconceptions that can bias our perceptions and our interpretations.
i. A controversial demonstration was David Rosenhan and his seven friends from Stanford University.
a. They went to a mental hospital complaining of "hearing voices." Apart from this complain, they answered all questions truthfully. All eight were diagnosed as mentally ill.
2. The media stereotype mental health patients. Most are depicted as violent and dangerous.
i. At least 9 in 10 people with disorders are notdangerous, they are anxious, depressed, or withdrawn.
3. Labels not only can bias perceptions, they can also change reality.
i. Someone who was led to think you are nasty may treat you coldly, leading you to respond as a mean-spirited person would. Labels can be self-fulfilling prophecies.
4. There are definite benefits to diagnostic labels. They enable mental health professionals to:
i. Communicate with each other about the subject matter of their concern.
ii. Comprehend the pathological process involved in psychiatric illness
iii. Control psychiatric outcomes.
III. Anxiety Disorders
A. Defining Anxiety Disorders – psychological disorders characterized by distressing persistent anxiety or maladaptive behaviors that reduce anxiety.
B. Focus on Four of the most common of these disorders:
1. Generalized anxiety Disorder
2. Panic Disorder
3. Phobias
4. Obsessive-Compulsive Disorder
C. Generalized Anxiety Disorder (continually tense and uneasy)
1. The symptoms of this disorder are commonplace; their persistence is not.
2. One of the worst characteristics of this disorder is that the person cannot identify, and therefore cannot deal with or avoid, its cause.
i. To use Freud’s term, the anxiety is "free-floating."
D. Panic Attack – experience sudden episode of intense dread.
1. The experience is unpredictable and so frightening that the sufferer often comes to fear the fear itself and to avoid situations where the panic has struck before.
i. Smokers have a fourfold risk of a first-time panic attack.
2. Agoraphobia – fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes.
i. Given such fear, people may avoid leaving their home or being in a crowd
E. Phobia – irrationally afraid of a specific object or situation.
1. They are a common psychological disorder that many people accept and live with.
2. Some specific phobias are incapacitating.
3. A social phobia is an intense fear of being scrutinized by others.
i. A person may avoid speaking up, eating out, or going to parties – or will sweat, tremble, or have diarrhea when doing so.
ii. Social phobia is shyness taken to an extreme.
F. Obsessive-Compulsive Disorder – troubled by repetitive thoughts and actions.
1. We can see aspects of our own behavior in obsessive-compulsive disorder.
2. Obsessive thoughts and compulsive behaviors cross the fine line between normality and disorder when they become so persistent that they interfere with the way we live or when they cause distress.
i. The obsessive thoughts become so haunting, the compulsive rituals so senselessly time-consuming, that effective functioning becomes impossible.
ii. Older people are less often plagued by obsessive-compulsive disorder than teens and young adults.
a. Anxiety disorders all engage our anticipation of future event, about which older adults, it seems, are less apprehensive.
G. Posttraumatic Stress Disorder- usually involves flashbacks or nightmares following a person’s involvement in or observation of an extremely troubling event such as war or natural disaster. Memories of the events cause anxiety.
H. Explaining Anxiety Disorders
1. Overview
i. Anxiety is both a feeling and a condition – a doubt-laden appraisal of one’s safety or social skill
ii. Two contemporary perspectives – learning and biological.
2. The Learning Perspective
i. Fear Conditioning
a. When bad things happen unpredictably and uncontrollably, anxiety often develops.
b. Researchers have linked general anxiety with classical conditioning of fear.
c. Anxious people are hyperattentive to possible threats. 58 percent of those with social phobia experience their disorder after a traumatic event.
d. When experimental shocks become predictable – when preceded by a particular conditioned stimulus – the animals’ fear focuses on thatstimulus and when it is absent, they relax.
ii. Stimulus generalization
a. Conditioned fears may remain long after we have forgotten the experience that produced them.
b. Some fear result from stimulus generalization – a person who fears heights after a fall may be afraid of airplanes without ever having flown.
iii. Reinforcement
a. Once phobias and compulsions arise, reinforcement helps maintain them.
b. Avoiding or escaping the feared situation reduces anxiety, thus reinforcing the phobic behavior.
c. Compulsive behaviors similarly reduce anxiety – washing your hands relieves your feelings of unease, you will likely wash your hands again when the feelings return.
iv. Observational Learning
a. We learn fears by observing others fears
b. Parents transmit their fears to their children.
3. The Biological Perspective
i. Evolution
a. We humans seem biologically prepared to fear dangers faced by our ancestors, and most phobias focus on such objects: spiders, snakes, closed spaces, heights, and storms.
b. Consider what people tend not to fear: During WWII, the British and German populations tended to be rather indifferent to planes not in their immediate neighborhood. Evolution had not prepared the to learn to fear bombs dropping from the sky.
c. Our compulsive acts typically exaggerate behaviors that contribute to our species’ survival.
ii. Genes
a. Some people more than others seem genetically predisposed to particular fears and high anxiety.
b. Identical twins often develop similar phobias, in some cases, even when raised separately.
c. Among monkeys, fearlessness runs in families.
iii. Physiology
a. General anxiety, panic attacks, and even obsessions and compulsions are biologically measurable as an overarousal of brain areas involved in impulsive control and habitual habits.
b. Some antidepressant drugs dampen this fear-circuit activity, and the associated obsessive-compulsive behavior, by increasing the neurotransmitter serotonin.
IV. Mood Disorders – characterized by emotional extremes.
A. Major Depressive Disorder
1. Depression is the "common cold" of psychological disorders – an expression that effectively describes it pervasiveness but certainly not its seriousness.
a. Although phobias are more common, depression is the number one reason people seek mental health services.
2. Depression is often a response to past or current loss.
3. Depression is a sort of psychic hibernation; It slows us down, avoids attracting predators, and evokes support.
4. The lines separating life’s normal "downs" from major depression is difficult to draw.
a. On the continuum between temporary blue moods and the crushing impact of major depression is a condition called dysthymic disorder.
- A down in the dumps mood that fills most of the day, nearly every day, for two years or more.
5. Major Depressive Disorder – a mood disorder in which a person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities.
B. Bipolar Disorder – a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.
1. Manic episode – marked by hyperactive, widely optimistic state.
2. Bipolar disorder is much less common, occurring in about 1 percent of the population. Unlike major depression, it afflicts as many men as women.
C. Explaining Mood Disorders
1. The following are a summery of facts that any theory of depression must explain:
i. Many behavioral and cognitive changes that accompany depression.
ii. Depression is widespread
iii. Compared with men, women are twice as vulnerable to major depression.
iv. Most major depressive episodes last less than six months.
v. Stressful events related to work, marriage, and close relationships often precede depression.
2. With each new generation, the rate of depression is increasing and the disorder is striking earlier.
3. Researchers understand and interpret the facts about depression in ways that reflect their own perspective: biological or social-cognitive.
4. The Biological Perspective of Depression
i. Depression is a whole-body disorder.
a. It involves genetic predispositions, biochemical imbalances, melancholy mood, and negative thoughts.
ii. Genetic Influences
a. We have long known that mood disorders run in families.
iii. The Depressed Brain
a. Genes act by directing biochemical events that, down the line, influence behavior. The biochemical key is the neurotransmitter.
b. Norepinephrine increases arousal and boosts mood, and is overabundant during mania and scarce during depression.
c. Serotonin – appears to be scarce during depression.
d. Drugs can alleviate these effects, as can repetitive exercise.
e. Scanning machines can spot neurological signs of depression. Brains of depressed people are less active, indicating a slow-down state.
f. MRI scans have even shown the frontal lobes to be 7 percent smaller in severely depressed patients.
5. The Social-Cognitive Perspective
i. The mind’s negative thoughts somehow influence biochemical events that in a vicious cycle amplify depressing thoughts.
ii. Self-defeating beliefs feed the vicious cycle.
iii. Self-defeating beliefs may arise from learned helplessness.
a. Women, more often than men, are abused or made to feel helpless.
iv. Negative Thoughts Feed negative moods
a. Attribution of Blame – we have some choice of whom or what to blame for our failures.
- Depressed people tend to explain bad events in terms that are stable, global, and internal.
- The result of these pessimistic, overgeneralized, self-blaming attributions is a depressing sense of hopelessness.
b. Martin Seligman argues that depression is common among young Westerners because of epidemic hopelessness stemming from the rise of individualism and the decline of commitment to religion and family.
c. The self-focused individual takes on personal responsibility for problems and has nothing to fall back on for hope.
v. Negative Moods Feed Negative Thoughts – a chicken/egg problem with the social-cognitive explanation of depression.
vi. Misery may love company, but company does not love another’s misery.
vii. The assembled pieces of the depression puzzle’ – (1) Negative, stressful events interpreted through (2) a ruminating, pessimistic explanatory style cycle creates (3) a hopeless, depressed state that (4) hampers the way the person thinks and acts. This, in turn, fuels (1) more negative experiences.
viii. We can break the cycle of depression at any of these points – by moving to a different environment, by reversing our self-blame and negative attributions, by turning our attention outward, or by engaging in more pleasant activities and more competent behavior.
V. Schizophrenia – a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions. (literally means "split mind")
A. Overview
1. If depression is the common cold of psychological disorders, chronic schizophrenia is the cancer.
2. It affects males and females about equally often.
B. Symptoms of Schizophrenia
1. Disorganized thinking
i. The thinking of a person with schizophrenia is fragmented, bizarre, and distorted by false beliefs, called delusions.
a. Delusions – false beliefs, often of persecution or grandeur, that may accompany psychotic disorders.
b. Those with paranoid tendencies are particularly prone to delusions of persecution.
ii. Many psychologists believe disorganized thoughts result from a breakdown in selective attention.
a. Recall from chapter 6 that we normally have a remarkable capacity for selective attention – for, say, giving our undivided attention to one voice at a party while filtering out competing sensory stimuli. Schizophrenia suffers cannot do this.
2. Disturbed Perception
i. A person with schizophrenia may perceive things that are not there. Such hallucinations (sensory experiences without sensory stimulation) are usually auditory.
ii. Less commonly, people see, feel, taste, or smell things that are not there.
iii. When the unreal seems real, the resulting perceptions are at best bizarre, at worst terrifying.
3. Inappropriate Emotions and Actions
i. The emotions of schizophrenia are often utterly inappropriate.
ii. Some victims of schizophrenia sometimes lapse into flat affect, a zombielike state of appaent apathy.
iii. Motor behavior may also be inappropriate.
a. May perform senseless or compulsive acts.
b. Those who exhibit catatonia may remain motionless for hours on end and then become agitated.
iv. During their most severe periods, people with schizophrenia live in a private inner world, preoccupied with illogical ideas and unreal images.
v. Given a supportive environment, some recover to enjoy a normal life or experience bouts of schizophrenia only intermittently. Others remain socially withdrawn and isolated throughout much of their lives.
vi. Rarely is schizophrenia a one-time episode that is "cured," never to return.
4. Types of Schizophrenia
i. Schizophrenia is a cluster of disorders with subtypes that share common features, but also have some distinguishing symptoms.
ii. Positive Symptoms (presence of inappropriate behaviors)– may experience hallucinations, are often disorganized and deluded in their talk, and may exhibit inappropriate laughter, tears, or rage.
iii. Negative Symptoms (absence of inappropriate behaviors) – have toneless voices, expressionless faces, or mute and rigid bodies.
iv. One rule holds true around the world: when the schizophrenia is a slow-developing process (called chronic, or process, schizophrenia), recovery is doubtful. When, in reaction to particular life stresses, a previously well adjusted person develops schizophrenia rapidly (acute, or reactive, schizophrenia), recovery is much more likely.
5. Understanding Schizophrenia
i. Most of the new research studies link it with brain abnormalities and genetic predisposition.
a. Schizophrenia is a disease of the brain exhibited in symptoms of the mind.
ii. Brain Abnormalities
a. Dopamine Overactivity – when researchers examined patients’ brains after death, they found excess of receptors for dopamine – in fact, a sixfold excess. This may intensify brain signals, creating positive symptoms. Drugs that block these receptors often lessen the symptoms.
b. Brain Anatomy – modern brain scanning techniques reveal that many people with chronic schizophrenia have abnormal brain activity. There are also enlarge, fluid-filled areas and a corresponding shrinkage of the cerebral tissue.
c. The bottom line of various brain studies is that schizophrenia involves not a single brain abnormality but problems with several brain regions and their interconnections.
d. Although it has other causes, the converging lines of evidence suggests that prenatal viral infections play a contributing factor in schizophrenia.
iii. Genetic Factors
a. The nearly 1 in 100 odds of any person’s being diagnosed with schizophrenia become 1 in 10 among those who have an afflicted sibling or parent, and close to 1 in 2 among those who have an afflicted identical twin.
b. Even with identical twins, there may be a prenatal component. Twins who share a placenta are more likely to experience the same prenatal viruses.
c. Several linkage studies have implicated chromosomes 6, 8, and 22 as sites of genes that make some people susceptible.
iv. Psychological Factors
a. No environmental causes have been discovered that will invariably, or even with moderate probability, produce schizophrenia in persons who are not related to a schizophrenic.
b. The psychological triggers of schizophrenia have proved elusive, partly because they may vary with the type of schizophrenia and its speed of onset.
VI. Personality Disorders – psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning.
A. Clusters of personality disorders
1. One cluster of disorders expresses anxiety, such as fearful sensitivity to rejection that predisposes the withdrawn avoidant personality disorder.
2. A second cluster expresses eccentric behaviors, such as the social disengagement of the shhizoid personality disorder.
3. A third cluster exhibits dramatic or impulsive behaviors
i. Histrionic personality disorder – shallow, attention-getting emotions to gain others praise and reassurance.
ii. Narcissistic personality disorder – exaggerate own importance, aided by success fantacies.
iii. Borderline personality disorder – unstable identity, unstable relationships, and unstable emotions.
iv. Antisocial personality disorder – exhibits a lack of conscience for wrongdoing, even towards friends and family members. May be aggressive and ruthless or a clever con artist.
a. If channeled in more productive directions, such fearlessness may lead to courageous heroism or adventurism.
b. Lacking a sense of social responsibility, the same disposition produces a cool con artist or killer.
c. Studies confirm that with antisocial behavior, nature and nurture interact.
VII. Other Disorders
A. Somatoform Disorders – occur when a person manifests a psychological problem through a physiological symptom.
1. Such a person exhibits a physical problem in the absence of physical cause (hypochondriasis).
2. Conversion disorder – will report the existence of a severe physical problem such as paralysis or blindness, and they will, in fact, be unable to move their arms or see. No biological reason for the problem can be identified.
B. Dissociative Disorder – involve a disruption in conscious processes.
1. Amnesia – when no physiological basis for the disruption in memory can be identified.
2. Multiple Personality Disorder (a.k.a. dissociative identity disorder) – a person has several personalities rather than one integrated personality.
i. Commonly have a history of sexual abuse or some other terrible childhood trauma.
VIII. Rates of Psychological Disorders (table 15.3, page 565)
A. A 1980s NIMH survey of nearly 20,000 institutionalized and community residents revealed that one in three U.S. adults had experienced a psychological disorder, and that one in five was currently experiencing a disorder.
B. The three most common disorders are phobic disorder, alcohol abuse or dependence (with men outnumbering women five to one), and mood disorder (with women outnumbering men two to one).