Psychological Disorders

What Is Abnormality?
Changing Conceptions of Abnormality
Models of Abnormality
Diagnosing and Classifying Disorders
Disorders of Anxiety, Trauma, and Stress: What,

Psychology Me Worry?
Anxiety Disorders
Other Disorders Related to Anxiety
Causes of Anxiety, Trauma, and Stress Disorders
Dissociative Disorders: Altered Identities
Types of Dissociative Disorders
Causes of Dissociative Disorders
z Disorders of Mood: The Effect of Affect
Major Depressive Disorder and Bipolar Disorders
Causes of Disordered Mood
Eating Disorders and Sexual Dysfunction
Eating Disorders
Sexual Dysfunctions and Problems
Schizophrenia: Altered Reality
Symptoms of Schizophrenia
Causes of Schizophrenia
Personality Disorders: I’m Okay, It’s Everyone
Categories of Personality Disorders
Causes of Personality Disorders
APA Goal 2: Scientific Inquiry and Critical
Fifth Edition Thinking: Learning More: Psychological Disorders
Saundra K. Ciccarelli
J. Noland White

Copyright © 2018, 2015, 2012 Pearson Education, Inc. All Rights Reserved
Psychology
Fifth Edition

Chapter 14
Psychological Disorders
Changing Conceptions of Abnormality

• In ancient times holes were cut in an ill person’s

head to let out evil spirits in a process called
trephining
• Hippocrates believed that mental illness came
from an imbalance in the body’s four humors
– Phlegm, black bile, blood, and yellow bile

• In the Middle Ages, the mentally ill were labeled

as witches
Changing Conceptions of Abnormality

• Psychopathology: the study of abnormal behavior

• Psychological disorders: any pattern of behavior
that causes people significant distress, causes
them to harm others, or harms their ability to
function in daily life
– Statistically rare
– Deviant from social norms
Changing Conceptions of Abnormality

• Situational context: the social or environmental

setting of a person’s behavior
– Subjective discomfort: emotional distress or discomfort
– Maladaptive thinking or behavior: anything that does
not allow a person to function within or adapt to the
stresses and everyday demands of life
Changing Conceptions of Abnormality

• Psychological disorder: any pattern of behavior

that causes people significant distress, causes
them to harm themselves or others, or harms their
ability to function in daily life
– Note that abnormality differs from insanity
– Insanity considered a legal term in United States
Models of Abnormality

• Biological model: psychological disorders have

biological or medical causes
– Biological changes in the chemical, structural, or
genetic systems of the body
Models of Abnormality

• Psychodynamic view: abnormal behavior stems

from repressed conflicts and urges that are
fighting to become conscious
• Behaviorism: abnormal behavior is learned
• Cognitive perspective: abnormal behavior comes
from irrational beliefs and illogical patterns of
thought
Models of Abnormality

• Sociocultural perspective: abnormal behavior is

the product of family, social, and cultural
influences
– Cultural relativity: need to consider unique
characteristics of culture in which behavior takes place
– Culture-bound syndromes: disorders found only in
particular cultures

• Biopsychosocial perspective: incorporates biology,

psychology, and culture into a single explanation
of abnormal behavior
Diagnosing and Classifying Disorders

• Diagnostic and Statistical Manual, Fifth Edition,

(DSM-5): manual of psychological disorders and
their symptoms
• International Classification of Diseases (ICD): an
international resource published by the World
Health Organization (WHO)
– Currently in its tenth edition
Diagnosing and Classifying Disorders

• The DSM-5 describes about 250 different

psychological disorders
• In a given year, about 26.2 percent of American
adults over age 18 suffer from a mental disorder
– Only about 5.8 percent suffer from a severe mental
disorder
– More than one disorder at a time is common
Table 14.1 Yearly Occurrence of Psychological
Disorders in the United States
Category of Disorder Specific Disorder Percentage of U.S. Population
and Number Affected*
Biopolar and All Types 9.5% or 22.3 million
Depressive Major depressive disorder 6.7% or 15.7 million
disorders Persistent depressive disorder 1.5% or 3.5 million
(dysthymia)
Bipolar disorder 2.6% or 6.1 million
Anxiety, Obsessive- All types 18.1% or 42.5 million
Compulsive, and Specific phobia 8.7% or 20.4 million
Trauma-Related Social anxiety disorder (social phobia) 6.8% or 16 million
disorders Panic disorder 2.7% or 6.3 million
Agoraphobia 0.8% or 1.9 million
Generalized anxiety disorder 3.1% or 7.3 million
Obsessive-compulsive disorder 1% or 2.3 million
Posttraumatic stress disorder 3.5% or 8.2 million

Schizophrenia All types 1.1% or 2.6 million

• *Percentage of adults over age 18 affected annually and approximate number within the population based on 2010
United States Census data. Adapted from National Institute of Mental Health (2013). Table uses terminology from both
the DSM-IV and DSM-5 (American Psychiatric Association, 2000, 2013).
Diagnosing and Classifying Disorders

• Pros
– Provide a common language to professionals
– Establish distinct categories of diagnosis for treatment
and understanding

• Cons
– Overly prejudicial
– “Psychology student’s syndrome”
Anxiety Disorders

• Anxiety disorders: the main symptom is excessive

or unrealistic worry and fearfulness
– Free-floating anxiety: anxiety unrelated to any realistic,
known source
Anxiety Disorders

• Phobia: an irrational, persistent fear of an object,

situation, or social activity
– Social phobia (social anxiety disorder): fear of
interacting with others or being in social situations that
might lead to a negative evaluation
– Specific phobia: fear of objects or specific situations or
events
Anxiety Disorders

• Claustrophobia: fear of being in a small, enclosed

space
• Acrophobia: fear of heights
• Agoraphobia: fear of being in a place or situation
from which escape is difficult or impossible
– Diagnosis requires that one feels anxiety in at least two
of five situations
Anxiety Disorders

• Panic disorder: panic attacks occur frequently

enough to cause the person difficulty in adjusting
to daily life
– Panic attack: sudden onset of intense panic in which
multiple physical symptoms of stress occur, often with
feelings that one is dying
Anxiety Disorders

• Generalized anxiety disorder: excessive anxieties

and worries occur more days than not for at least
6 months
Table 14.2 Anxiety Disorders and their Symptoms
z
Anxiety Disorder Definition Examples/Symptoms
Social Anxiety Fear of interacting with others or Stage fright, fear of public
Disorder being in social situations that might speaking, fear of urinating in public,
lead to a negative fear of eating with other people
evaluation

Specific Phobias Fear of objects or specific situations Fears of animals, the natural
or events environment such as thunder
storms, blood injections/injury,
specific situations such as flying
Agoraphobia Fear of being in a place or situation Using public transportation, open
from which escape is difficult or spaces, enclosed spaces, being in a
impossible crowd

Panic Disorder Disorder in which panic attacks Various physical symptoms: racing
occur more than once or repeatedly heart, dizziness, rapid breathing,
and cause persistent worry or dulled senses, along with
changes in behavior uncontrollable feelings of terror

Generalized Disorder in which a person has Tendency to worry about situations,

Anxiety feelings of dread and impending people, or objects that are not really
Disorder doom along with physical symptoms problems, tension, muscle aches,
of stress, which lasts 6 months or sleeping problems,
more problems concentrating
Other Disorders Related to Anxiety

• Obsessive-compulsive disorder: intruding,

recurring thoughts or obsessions create anxiety
that is relieved by performing a repetitive,
ritualistic behavior (compulsion)
Other Disorders Related to Anxiety

• Acute stress disorder (ASD): a disorder resulting

from exposure to a major, traumatic stressor
– Symptoms include anxiety, dissociation, recurring
nightmares, sleep disturbances, problems in
concentration, and moments in which people seem to
relive the event in dreams and flashbacks
– Lasting as long as one month after the event
Other Disorders Related to Anxiety

• Posttraumatic stress disorder (PTSD): the

symptoms associated with acute stress disorder
last for more than one month
– Symptoms of PTSD may not develop until more than 6
months after a traumatic event
– Women at higher risk
Causes of Anxiety, Trauma, and Stress
Disorders

• Psychodynamic explanations point to repressed

urges and desires that are trying to surface,
creating anxiety that is controlled by the abnormal
behavior
• Behaviorists believe that disordered behavior is
learned through both positive and negative
reinforcement
Causes of Anxiety, Trauma, and Stress
Disorders

• Cognitive psychologists believe that excessive

anxiety comes from illogical, irrational thought
processes
Causes of Anxiety, Trauma, and Stress
Disorders

• Irrational thinking
– Magnification: the tendency to interpret situations as far
more dangerous, harmful, or important than they
actually are
– All-or-nothing thinking: the belief that one’s performance
must be perfect or the result will be a total failure
– Overgeneralization: the interpretation of a single
negative event as a never-ending pattern of defeat and
failure
– Minimization: the tendency to give little or no importance
to one’s successes or positive events and traits
Causes of Anxiety, Trauma, and Stress
Disorders

• Biological explanations of anxiety disorders

– Chemical imbalances in the nervous system
– Genetics
– More activity in amygdala and limbic system

• Cultural variations
– Ataque de nervios
– Koro
– Taijin kyofusho (TKS)
Types of Dissociative Disorders

• Dissociative disorders: disorders in which there is

a break in conscious awareness, memory, the
sense of identity, or some combination
– Dissociative amnesia: loss of memory for personal
information, either partial or complete
– Dissociative fugue: traveling away from familiar
surroundings with amnesia for the trip and possible
amnesia for personal information
– Dissociative identity disorder (DID): disorder occurring
when a person seems to have two or more distinct
personalities within one body
Causes of Dissociative Disorders

• Psychodynamic explanations point to repression

of memories, seeing dissociation as a defense
mechanism against anxiety
• Cognitive and behavioral explanations see
dissociative disorders as a kind of avoidance
learning
– May also involve shaping
Causes of Dissociative Disorders

• Biological explanations point to lower than normal

activity levels in the areas responsible for body
awareness in people with dissociative disorders
– Depersonalization/derealization disorder: dissociative
disorder in which sufferers feel detached and
disconnected from themselves, their bodies, and their
surroundings
Major Depressive Disorder and Bipolar
Disorders
• Affect: in psychological terms, emotion or mood
• Mood disorders: disorders in which mood is
severely disturbed
– Major depressive disorder: severely depressed mood
that comes on suddenly and has no external cause
– Seasonal affective disorder (SAD): a mood disorder
caused by the body’s reaction to low levels of sunlight
in the winter months
Major Depressive Disorder and Bipolar
Disorders

• Bipolar disorder: periods of mood that may range

from normal to manic, with or without episodes of
depression
– Manic episode: a period of excessive excitement,
energy, and elation or irritability
– Bipolar I: without episodes of depression
– Bipolar II: interspersed with episodes of depression
and hypomania
Figure 14.2 The Range of Emotions

Most people experience a range of emotions over the course of

a day or several days, such as mild sadness, calm contentment,
or mild elation and happiness. A person with a mood disorder
experiences emotions that are extreme and, therefore, abnormal.
Causes of Disordered Mood

• Behavioral theories link depression to learned

helplessness
• Cognitive theories see depression as the result of
distorted, illogical thinking
• Biological explanations of mood disorders look at
the function of serotonin, norepinephrine, and
dopamine systems in the brain
– Genetic origins
Eating Disorders

• Anorexia nervosa (anorexia): a condition in which

a person reduces eating to the point that their
body weight is significantly low, or less than
minimally expected
– In adults, this is likely associated with a BMI <18.5
Eating Disorders

• Bulimia nervosa (bulimia): a condition in which a

person develops a cycle of “binging,” or
overeating enormous amounts of food at one
sitting, and then using unhealthy methods to avoid
weight gain
• Binge-eating disorder also involves uncontrolled
binge eating but differs from bulimia primarily in
that individuals with binge-eating disorder do not
purge
Eating Disorders

• Causes of eating disorders

– Greatest risk factors appear to be someone being an
adolescent or young adult female
– Genetic components appear to be significant

• Treatment of eating disorders

– Hospitalization
– Psychological counseling
– Only 40-60% of those with anorexia make a recovery
Sexual Dysfunctions and Problems

• Sexual dysfunction: problem with sexual

functioning, or with physical workings of sex act
– Sexual interest
– Arousal
– Response

• Prevalence
– About 40 to 45 percent of women
– About 20 to 30 percent of men
– Rate increases as we age
Sexual Dysfunctions and Problems

• Diagnostic and Statistical Manual of Mental

Disorders, DSM-5
– Sexual desire or arousal disorders
– Disorders related to the physical act of intercourse
– Disorders related to the timing or inability to reach
orgasm

• Causes and influences

– Organic factors
– Sociocultural factors
– Psychological factors
Sexual Dysfunctions and Problems

• Treatment options
– Medication
– Psychotherapy
– Hormone therapy
– Stress reduction
– Sex therapy
– Behavioral training
Symptoms of Schizophrenia

• Schizophrenia: severe disorder in which the

person suffers from disordered thinking, bizarre
behavior, and hallucinations, and is unable to
distinguish between fantasy and reality
• Psychotic: the break away from an ability to
perceive what is real and what is fantasy
Symptoms of Schizophrenia

• Delusions: false beliefs held by a person who

refuses to accept evidence of their falseness
– Delusions of persecution
– Delusions of reference
– Delusions of influence
– Delusions of grandeur (or grandiose delusions)

• Speech and thought disturbances

Symptoms of Schizophrenia

• Hallucinations: false sensory perceptions, such as

hearing voices that do not really exist
• Flat affect: a lack of emotional responsiveness
• Catatonia: either wildly excessive movement or
total lack thereof
Symptoms of Schizophrenia

• Positive symptoms: excesses of behavior or occur

in addition to normal behavior
– Hallucinations, delusions, and distorted thinking

• Negative symptoms: less-than-normal behavior or

an absence of normal behavior
– Poor attention, flat affect, and poor speech production
Causes of Schizophrenia

• Biological explanations of schizophrenia focus on

dopamine, structural defects in the brain,
inflammation, and genetic influences
Figure 14.3 Genetics and Schizophrenia

This chart shows a definite pattern: The greater the degree of genetic relatedness, the
higher the risk of schizophrenia in individuals related to each other. The only individual to
carry a risk even close to that of identical twins (who share 100 percent of their genes) is a
person who is the child of two parents with schizophrenia. Based on Gottesman (1991).
Causes of Schizophrenia

• Stress-vulnerability model: assumes a biological

sensitivity, or vulnerability, to a certain disorder
that will develop under the right conditions of
environmental or emotional stress
Categories of Personality Disorders

• Personality disorder: a disorder in which a person

adopts a persistent, rigid, and maladaptive pattern
of behavior that interferes with normal social
interactions
– Cluster A: seen as odd or eccentric (Paranoid,
Schizoid, Schizotypal)
– Cluster B: behavior is dramatic, emotional, or erratic
(Antisocial, Borderline, Histrionic, Narcissistic)
– Cluster C: the main emotion is anxiety or fearfulness
(Avoidant, Dependent, Obsessive-Compulsive)
Categories of Personality Disorders

• Antisocial personality disorder: a person has no

morals or conscience and often behaves in an
impulsive manner without regard for the
consequences of that behavior
• Borderline personality disorder: maladaptive
personality pattern in which the person is moody
and unstable, lacks a clear sense of identity, and
often clings to others
Causes of Personality Disorders

• Cognitive-learning theorists see personality

disorders as a set of learned behavior that has
become maladaptive
– Bad habits learned early on in life
– Belief systems of the personality disordered person are
seen as illogical

• Biological explanations look at genetic factors and

stress hormones
Causes of Personality Disorders

• Other possible causes of personality disorders

may include disturbances in family
communications and relationships, childhood
abuse, neglect, overly strict parenting,
overprotective parenting, and parental rejection
Taking the Worry Out of Exams

• While not yet recognized as a clinical disorder in

the DSM-5, test anxiety has caused countless
students considerable stress over the years
• Overcoming test anxiety
1. Determine why you want to do well on the test in the
first place
2. Develop a strategy for controlling your cognitive state
and behavior, both before and during the exam
3. Focus on using energy; engage in positive self-talk