第93章
He just operates a little different from the
rest of us. Who’s to say who’s wrong?” (Keats, 1966).
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CHAPTER 15
Psychological Disorders
LEARNING OBJECTIVES
On completion of this chapter, students should be able to:
1. Define “normal” and “abnormal”
2. Identify distinguishing differences between normal and abnormal behavior
3. Explain current methods of studying and assessing abnormal behavior
4. Describe the goals of psychological assessment and classification of disorders
5. Explain the use of each axis of DSM-IV-TR
6. Demonstrate a basic understanding of the major types of psychological disorders
7. Explain the theoretical positions from which abnormal behavior is studied
8. Describe the evidence that some abnormal behaviors have a genetic component
9. Name and discuss the types of schizophrenic disorders
10. Suggest some factors that may play causal roles in the development of mental illness
CHAPTER OUTLINE
I. The Nature of Psychological Disorders
A. Definitions
1. Psychopathological functioning involves disruptions in emotional,
behavioral, or thought processes that lead to personal distress or that
block one’s ability to achieve important goals
2. Abnormal psychology is the area of psychological investigation most
directly concerned with understanding the nature of individual
pathologies of mind, mood, and behavior
B. Deciding What Is Abnormal
1. DSM-IV-TR provides seven criteria for determining behavior as
abnormal
a) Distress or disability: An individual experiences personal
distress of disabled functioning, producing risk of physical
and/or psychological deterioration or loss of freedom of
action
b) Maladaptiveness: An individual behaves in a fashion that
hinders goal attainment, does not contribute to personal
well-being, or often interferes significantly with the goals of
others and needs of society
c) Irrationality: An individual acts or speaks in ways that are
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irrational or incomprehensible to others
d) Unpredictability: An individual behaviors unpredictably from
situation to situation, as though experiencing loss of control
e) Unconventionality and statistical rarity: An individual violates
norms of socially acceptable behavior in a manner that is
statistically rare
f) Observer discomfort: An individual behaviors such that it
makes others uncomfortable by feeling threatened or
distressed
g) Violation of moral and ideal standards: An individual violates
expectations for how one ought to behave, according to
societal norms
2. No single DSM-IV-TR criteria is, by itself, a sufficient condition to
distinguish all instances of abnormal behavior from normal
variations in behavior
3. Mental disorder is a continuum, that ranges from mental health at
one extreme and mental illness at the other
C. The Problem of Objectivity
1. The decision to declare an individual as psychologically disordered
or abnormal is a judgment about behavior. The goal is to make these
judgments as objective as possible, without bias.
2. Following assignment of the label “abnormal,” others tend to
interpret the individual so designated in a manner that confirms the
judgment as demonstrated by Rosenhan’s “sane in an insane place”
experience
3. Laing posits that labeling as “mad” suppresses the creative, unique
probing of reality by individuals who are questioning their social
context
4. Some psychologists advocate a contextual or ecological model of
schizophrenia
5. Ecological models view abnormality not as the result of a disease
within the person, but as a product of interaction between
individuals and society
6. Abnormality is viewed as a mismatch between the individual’s
abilities and the needs and norms of society
D. Historical Perspectives
1. Historically, people have feared psychological disorders, often
associating them with evil, and imprisoning and subjecting those
affected to radical treatment
a) Hysteria was originally thought to affect only women and to
be caused by a wandering uterus under the devil’s control
2. Emergence of the medical model occurred in the late 1700s, when society
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began perceiving those with psychological disorders as suffering
from illness, rather than as possessed or immoral
a) Pinel was an early developer of a classification system for
psychological difficulties, based on the premise that
disorders of thought, mood, and behavior were somewhat
similar to physical, organic illnesses
b) The first comprehensive classification system of
psychological disorders was created by Kraepelin in 1896
3. Emergence of psychological models, an alternative to the medical model,
focusing on the psychological causes and treatment of abnormal
behavior, emerged from the late 1700s through the 1800s
a) Mesmer proposed that some disorders were due to
disruptions in the flow of a force he called animal magnetism,
and pioneered new techniques eventually to become known
as hypnotism
b) Mesmer’s techniques were adopted by Jean Charcot, who
passed that knowledge to his student, Sigmund Freud
E. The Etiology of Psychopathology
1. Etiology refers to the causal or contributory factors in the
development of psychological and medical problems
2. Two general categories of causal factors:
a) Biological approaches assume that psychological disturbances
are directly attributable to underlying biological factors such
as structural abnormalities in the brain
b) Psychological approaches focus on the causal role of
psychological or social factors as contributing to the
development of psychopathology. Three models
predominate.
(i) Psychodynamic. This model, as developed by Freud,
posited the causes of psychopathology as located
inside the person, holding those factors to be
psychological, rather than physiological
(a) Symptoms are rooted in unconscious conflict,
much of which derives from conflict between id
and superego
(b) Defense mechanisms (repression, denial) can be
effected to avoid pain resulting from conflicting
motives and anxieties
(ii) Behavioral theorists posit abnormal behaviors as
being acquired in the same manner as normal
behaviors-through learning and reinforcement
(a) Focus is on current behavior and current
conditions that may be reinforcing the behavior
(b) Both classical and operant conditioning models
are used to understand the processes that can
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result in maladaptive behavior
(iii) Cognitive perspectives may be used to supplement
behavioristic views
(a) How the individual perceives and thinks about
him- or herself, and his/her relations with others
in the environment are important issues
(b) This approach suggests problems are the result of
distortions in perceptions of the reality of a
situation
(iv) The sociocultural perspective emphasizes the role
culture plays in both the diagnosis and etiology of
abnormal behavior
c) Most recently, the interactionist perspective is becoming
increasingly popular, and is viewed as a product of the
complex interactions between a number of biological and
psychological factors
II.Classifying Psychological Disorders
A. Psychological Diagnosis: The label given to an abnormality by classifying and
categorizing the observed behavior pattern into an approved diagnostic system
B. Goals of Classification
1. A useful diagnostic system provides the following three benefits:
a) Common shorthand language: A common set of agreed-upon
meanings, given that it is imperative that researchers
studying different aspects of psychopathology, or evaluating
treatment programs, can agree on the disorder they are
observing
b) Understanding etiology: Under ideal circumstances, a
diagnosis of a specific disorder should make clear the
cause(s) of the symptoms; this is not always possible with
psychological disorders
c) Treatment plan: Diagnosis should suggest types of treatment
to consider for particular disorders
C. DSM-IV-TR
1. The 4th revision of the Diagnostic and Statistical Manual of Mental
Disorders (DSM) classifies, defines, and describes more than 200
mental disorders
2. DSM-IV-TR emphasizes the description of patterns of symptoms and
courses of disorders, rather than etiological theories or treatment
strategies
3. DSM-IV-TR uses dimensions or axes that portray information about
the psychological, social, and physical factors that may be associated
with a psychological disorder
4. Current DSM-IV-TR categories or axes are:
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a) Axis I: Clinical Disorders
(i) These disorders present symptoms of patterns of
behavioral or psychological problems that typically
are painful or impair an area of functioning.
Included are disorders that emerge in infancy,
childhood, or adolescence
b) Axis II. Personality Disorders & Mental Retardation
(ii) Details mental retardation and personality
disorders, i.e., dysfunctional patterns of perceiving
and responding to the world
c) Axis III. General Medical Conditions
(iii) Codes physical problems that are relevant to
understanding or treating an individual’s
psychological disorders, as detailed on Axes I and II
d) Axis IV. Psychosocial and Environmental Problems
(iv) Codes psychosocial and environmental stressors
that may impact diagnosis and treatment of an
individual’s disorder and his or her likelihood of
recovery
e) Axis V: Global Assessment of Functioning
(v) Codes the individual’s overall level of current
functioning in the psychological, social, and
occupational domains
5. Full diagnosis, in accordance with the DSM system, involves
consideration of each axis
6. Methods used to organize and present categories have shifted with
each revision of the DSM. DSM-III-R felt neurotic disorders and
psychotic disorders had become too generalized in meaning to
remain useful as diagnostic categories.
7. In addition to the diagnoses on the five traditional axes, DSM-IV-TR
provides an appendix that describes about 25 culture-bound
syndromes–recurrent, locality-specific patterns of aberrant behavior
and troubling experience that may or may not be likened to a
particular DSM-IV-TR diagnostic category. Such syndromes include:
a) Boufée delirante: A sudden outburst of agitated and
aggressive behavior, marked confusion, and psychomotor
excitement (West Africa and Haiti)
b) Koro: An episode of sudden and intense anxiety that the
penis will recede into the body and possibly cause death
(South and East Asia)
c) Taijin kyofusho: An individual’s intense fear that his or her
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body, its parts or its functions, displease, embarrass, or are
offensive to other people (Japan)
III. Major Types of Psychological Disorders
A. Important Disorders not Covered in Psychology and Life.
1. Substance-use disorders include both dependence on and abuse of
alcohol and drugs
2. Somatoform disorders involve physical symptoms that arise without a
physical cause
3. Sexual disorders involve problems with sexual inhibition or
dysfunction, and deviant sexual practices
4. Disorders usually first diagnosed in infancy, childhood, or adolescence
include mental retardation, communication disorders (such as
stuttering), and autism
5. Eating disorders, such as anorexia and bulimia.
6. Some individuals experience more than one disorder at some point
in their life span; this is known as comorbidity, the co-occurrence of
diseases
B. Anxiety Disorders: Types
1. Involve the experiencing of fear or anxiety in certain life situations
when that anxiety is problematic enough to interfere with the ability
to function or to enjoy life
2. Generalized Anxiety Disorder: manifests itself as feeling anxious or
worried most of the time, when not faced with any specific danger.
Presenting symptoms must include at least three of the following:
a) Muscle tension
b) Fatigue
c) Restlessness
d) Poor concentration
e) Irritability
f) Sleep difficulties
3. Panic Disorder manifests in unexpected, severe panic attacks that
begin with a feeling of intense apprehension, fear, or terror. Attacks
are unexpected, in the sense that they are not evoked by something
concrete in the situation. One manifestation of panic disorder is
agoraphobia, an extreme fear of being in public places or open spaces
from which escape may be difficult or embarrassing.
4. Phobias are diagnosed when the individual suffers from a persistent
and irrational fear of a specific object, activity, or situation, when
that fear is excessive and unreasonable, given the reality of the
threat. Phobias interfere with adjustment, cause significant distress,
and inhibit necessary action toward goals. DSM-IV-TR defines two
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categories of phobias.
a) Social phobia is a persistent, irrational fear, arising in
anticipation of a public situation in which an individual can
be observed by others
b) Specific phobias occur in response to several different types of
objects or situations
5. Obsessive-Compulsive Disorder is an anxiety disorder in which the
individual becomes locked into specific patterns of thought and
behavior. It may best be defined in terms of its component parts
a) Obsessions are thoughts, images, or impulses that recur or
persist despite the individual’s efforts to suppress them.
They are experienced as an unwanted invasion of
consciousness, seem to be senseless or repugnant, and are
unacceptable to the individual experiencing them.
b) Compulsions are repetitive, purposeful acts performed
according to certain rules, in a ritualized manner, and in
response to an obsession. The behavior is performed to
reduce or prevent the discomfort associated with some
dreaded situation, but it is either unreasonable or clearly
excessive.
6. Posttraumatic stress disorder (PTSD), an anxiety disorder, is
characterized by the persistent reexperiencing of traumatic events
through distressing recollections, dreams, hallucinations, or
flashbacks
C. Anxiety Disorders: Causes
1. Biological: This view posits a predisposition to fear whatever is
related to sources of serious danger in the evolutionary past, thus the
preparedness hypothesis suggests that we carry an evolutionary
tendency to respond quickly and “thoughtlessly” to once-feared
stimuli. Some evidence is available linking this disorder to
abnormalities in the basal ganglia and frontal lobe of the brain.
2. Psychodynamic: This model begins with the assumption that
symptoms of anxiety disorders derive from underlying psychic
conflicts or fears, with the symptoms being attempts to protect the
individual from psychological pain
3. Behavioral explanations of anxiety focus on the way symptoms of
anxiety disorders are reinforced or conditioned
4. Cognitive perspectives concentrate on the perceptual processes or
attitudes that may distort a person’s estimate of the danger he or she
is facing. Individuals suffering from anxiety disorders may interpret
their own distress as a sign of imminent danger
D. Mood Disorders: Types
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1. A mood disorder is an emotional disturbance, such as a severe
depression or depression alternating with manic states
2. Major Depressive Disorder occurs so frequently that it has been called
the “common cold” of psychopathology; virtually everyone has
experienced elements of this disorder at some time during their
lives.
3. Bipolar depression is characterized by periods of severe depression,
alternating with manic episodes
E. Mood Disorders: Causes
1. Biological: Growing evidence suggests that the incidence of mood
disorder is influenced by genetic factors
2. Psychodynamic: This approach purports the causal mechanism(s) to
be unconscious conflicts and hostile feelings originating in
childhood. Freud believed the source of depression to be displaced
anger, originally directed at someone else, and now turned inward
against the self
3. Behavioral: This approach focuses on the impact and effects of the
amount of positive reinforcement and punishments the individual
receives. Lacking a sufficient level of reinforcement, the individual
feels sad and withdraws from others.
4. Two Cognitive Theories:
a) Beck argued that depressed people have negative cognitive
sets, which promote a pattern of negative thought that
clouds all experiences and produces the other characteristic
signs of depression. Negative thought patterns include
negative views of (1) themselves; (2) ongoing experiences;
and (3) the future.
b) Seligman’s learned helplessness paradigm, the “explanatory
style view of depression, in which individuals believe
(correctly or not) that they have no control of future
outcomes of importance to them. Learned helplessness is
marked by deficits in three areas: (1) motivational; (2)
emotional; and (3) cognitive.
F. Gender Differences in Depression
1. Women suffer from depression twice as often as men
2. Research suggests differences in response style may originate in
childhood
a) When women experience sadness, they tend to think about
causes and implications of their feelings, a ruminative
response style with an obsessive focus on problems, thus
increasing depression.
b) Men attempt actively to distract themselves from negative
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feelings through physical exercise or by focusing on
something else. Other research has also revealed a
maladaptive tendency for men to distract themselves
through use of alcohol, drugs, or violent behaviors.
G. Suicide
1. Patterns of suicide
a) The 8th leading cause of death in the U. S., 3rd among the
young, and 2nd among college students
b) Five million living Americans have attempted suicide
c) For each completed suicide, there are 8 to 20 attempts
d) Suicide usually affects at least 6 other individuals
2. Every 9 minutes, a teenager attempts suicide; every 90 minutes one
succeeds
3. Suicide rates for African American youths, of both sexes, are roughly
half that for white youths. These racial differences persist across the
life span.
4. Gay and lesbian youth are at higher risk than are other adolescents
5. Youth suicide is not an impulsive act. It typically occurs as the final
stage of a period of inner turmoil and outer distress.
H. Personality Disorders
1. A personality disorder is a chronic, inflexible, maladaptive pattern of
perceiving, thinking, or behaving that can seriously impair the
individual’s ability to function and can cause significant distress.
Examples include:
a) Paranoid personality disorders: Show a consistent pattern of
distrust and suspiciousness about the motives of people with
whom they interact. These individuals believe others are
trying to harm or deceive them they may find unpleasant
meanings in harmless situations, and expect their friends,
spouses, or partners to be disloyal.
b) Histrionic personality disorder: Characterized by patterns of
excessive emotionality and attention seeking. Sufferers offer
strong opinions, with great drama, but with little evidence to
back their claims. They react to minor occasions with
overblown emotional responses.
c) Narcissistic personality disorders: Manifests grandiose sense of
self-importance, preoccupation with fantasies of success or
power, and need for constant admiration. These individuals
often have problems in interpersonal relationships, tending
to feel entitled to special favors without reciprocal
obligation. They exploit others for their own purposes and
experience difficulty in realizing and experiencing how
others feel.
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d) Antisocial personality disorder: Manifested by a long-standing
pattern of irresponsible or unlawful behavior that violates
established social norms. These individuals often do not feel
shame or remorse for their hurtful behaviors. A violation of
social norms begins early in life; the actions are marked by
indifference to the rights of others.
I. Dissociative Disorders
1. Consist of a disturbance in the integration of identity, memory, or
consciousness. Psychologists believe that in dissociative disorders
the individual escapes from his or her conflicts by giving up
consistency and continuity of the self
2. Dissociative amnesia refers to the forgetting of important personal
experiences, caused by psychological factors in the absence of any
organic dysfunction
3. Dissociative identity disorder, formerly known as multiple personality
disorder, is a dissociative mental disorder in which two or more
distinct personalities exist within the same individual. May involve
chronic, severe abuse during childhood.
IV. Schizophrenic Disorders
A. Schizophrenic Disorders are a severe form of psychopathology in which personality
seems to disintegrate, thought and perception are distorted, and emotions are blunted
1. Hallucinations occur often, and are assumed real
2. Delusions, false or irrational beliefs maintained regardless of
evidence to the contrary, are common
3. Other manifestations
a) Incoherent language, word salad
b) Flattened or inappropriate emotions
c) Disorganized psychomotor behavior
4. Categories of symptoms
a) Positive symptoms: hallucinations, delusions, incoherence,
and disorganized behavior are prominent during the acute
or active phases.
b) Negative symptoms: social withdrawal and flattened
emotions become more apparent during the chronic phase.
B. Major Types of Schizophrenia
1. Disorganized type: Individual displays inappropriate behavior and
emotions, incoherent language.
a) Incoherent thought patterns and grossly bizarre and
disorganized behavior
b) Emotions are flattened or situationally inappropriate,
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language may be incoherent, communications with others
break down
c) If present, hallucinations and delusions lack organization
around a central theme
2. Catatonic type: Individual displays frozen, rigid, or excitable motor
behavior
a) Major feature is disruption in motor activity
b) Also characterized by extreme negativism and resistance to
all instructions
3. Paranoid type: Individuals suffer complex and systematized
delusions, focused around a specific theme, often delusions of
grandeur or persecution. Symptom onset is usually later in life than
in other types of schizophrenia. Manifestations include:
a) Delusions of persecution, in which the individual believes
he/she is being constantly spied upon, plotted against, or is
in mortal danger
b) Delusions of grandeur, in which the individual believes
he/she is an important or exalted being, such as Jesus Christ
c) Delusional jealousy, in which the individual becomes
convinced (without due cause) that his or her mate is
unfaithful
4. Undifferentiated type: The schizophrenic “grab-bag,” describing the
individual who exhibits
a) Prominent delusions, hallucinations, incoherent speech, or
grossly disorganized behavior that fit criteria of more than
one type, or of no clear type
b) Hodgepodge of symptoms fails to differentiate clearly
among the schizophrenic reactions.
5. Residual type: Individuals have typically experienced a major episode
within the past, but are currently free of major positive symptoms.
a) Ongoing presence of the disorder is signaled by minor
positive symptoms or negative symptoms, such as flattened
affect
b) Diagnosis of residual type may indicate the individual’s
disorder is entering a stage of remission, becoming dormant
C. Causes of Schizophrenia
1. Genetic Approaches
a) Disorder tends to run in families, with increased risk if both
parents have the disorder
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b) Probability of identical twins both having the disorder is
approximately 3 times greater than is the probability for
fraternal twins
c) Diathesis-stress hypothesis suggests genetic factors place the
individual at risk, but environmental stressors must impinge
for the potential risk to be manifested
2. Brain Function and Biological Markers
a) Magnetic resonance imaging (MRI) may be used to show
brain structures (i.e., ventricles) that are enlarged by up to
50% in individuals with schizophrenia
b) Imaging also reveals that individuals with schizophrenia
may have differing patterns of brain activity than those
found in normal controls
c) The dopamine hypothesis posits an association with an excess
of the neurotransmitter dopamine, at specific receptor sites
in the central nervous system (CNS).
d) A biological marker is a “measurable indicator of disease that
may or may not be causal”; that is, it may correlate with the
disorder. No known marker perfectly predicts, or brings
about, schizophrenia.
3. Family Interaction and Communication
a) Hope remains for identification of an environmental
circumstance that increases the likelihood of schizophrenia
b) Research does offer evidence for theoretical position that
emphasizes the influence of deviations in parental
communications on the subsequent development of
schizophrenia
c) Research indicates family factors do play a role in
influencing functioning after the symptoms appear
V.The Stigma of Mental Illness
A. The Problem of Stigma
1. Individuals with psychological disorders are frequently labeled as
deviant, though this label is not true to prevailing realities
2. Stigma is a mark or brand of disgrace; in the context of psychology, it
is a set of negative attitudes about a person that sets him or her apart
as unacceptable”
3. Negative attitudes toward the psychologically disturbed, which
come from many sources, bias perceptions of and actions toward
these individuals
4. Mental illness can become one of life’s self-fulfilling prophecies
5. Research suggests that people who have contact with individuals
with mental illness hold attitudes less affected by stigma
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DISCUSSION QUESTIONS
1. What if a well-controlled study showed that “crazy” people were more creative, happier,
and lived longer tha