Understanding Psychological Disorders: Theoretical Approaches and Abnormal Behavior

Psychological Disorders
Chapter 15
AP Psychology
Alice F. Short
Hilliard Davidson High School
Chapter Preview
Defining/Explaining Abnormal Behavior
Anxiety Disorders
Mood Disorders
Dissociative Disorders
Schizophrenia
Personality Disorders
Psychological Disorders and Health and
Wellness
Abnormal Behavior
abnormal behavior 
- behavior that is…
deviant (atypical)
example: washing hands 4x an hour
maladaptive (dysfunctional)
example: believing that you can hurt people by breathing
and hiding away and avoiding people
personally distressing (despair)
example: feeling extreme shame or guilt
… over a relatively long period of time
NOTE: context matters!
Theoretical Approaches
Biological Approach: Medical Model
disorders with biological origins
Psychological Approach
experiences, thoughts, emotions, personality
Sociocultural Approach
social context
Biopsychosocial Model
interaction of biological, psychological and
sociocultural factors
Theoretical Approaches
Biological Approach: Medical Model
medical model
 – the view that psychological
disorers are medical diseases with biological
origin
disorders with biological origins
abnormalities
 = mental illnesses
patients
 = afflicted individuals
doctors = people who treat the patients
Theoretical Approaches:
Psychological Approach
psychological approach 
– focuses on
experiences, thoughts, emotions, personality
in the development and course of psychological
disorders
Theoretical Approaches:
Sociocultural Approach
Sociocultural Approach
social context
includes
: gender, ethnicity, socioeconomic status,
family relationships, culture, technological aspects of
culture, religious aspects of culture
socioeconomic status 
= greater impact than ethnicity
living conditions of 
poverty
 = 
stressful
Theoretical Approaches:
Biopsychosocial Model
Biopsychosocial Model
interaction of biological, psychological and
sociocultural factors
biological factors 
(such as genes)
psychological factors 
(such as childhood
experiences)
sociocultural factors 
(such as gender)
DSM-V Classification System
Advantages
provides a common basis for communication
helps clinicians make predictions
naming the disorder can provide comfort
Disadvantages
stigma (shame, negative reputation)
medical terminology implies internal cause
focus on weaknesses ignores strength
DISUCSSION
: Which do you think is more
significant—the advantages or disadvantages?
Critical Controversy:
Psychological Disorders –
Real or Myth?
Szasz & Cruise
phrase “mental illness” is presumptuous
medication of mental illnesses is presumptuous
Response of Medical Professionals
mental illnesses are real medical conditions
drugs effectively alleviate symptoms
ADHD: over-diagnosed or non-medical?
should prescription drugs be used to treat ADHD?
Critical Controversy:
A 
SHORT
 Time to Ponder
When do you think it is appropriate to label
someone as having a psychological disorder?
When do you think medical treatments for
psychological disorders are appropriate?
If a teacher suggested that your child be
tested for ADHD, what do you think you would
do? Why?
DSM-V-TR Axes
Multiaxial System
Axis I and II: Psychological Disorders
Axis III: 
Another 
Medical Conditions
Axis IV: Psychosocial/Environmental Problems
Axis V: Current Level of Functioning
Axis I
Disorders
Major Categories
:
disorders usually first diagnosed in infancy,
childhood, or adolescence and
communication disorders
anxiety disorders
somatoform disorders
factitious disorders
dissociative disorders
delirium, dementia, amnesia, and other
cognitive disorders
mood disorders
schizophrenia and other psychotic
disorders
substance-related disorders
sexual and gender identity disorders
eating disorders
sleep disorders
impulse control disorders not elsewhere
classified
adjustment disorders
Axis II Disorders
Major Categories
:
intellectual disability
personality disorders
other conditions that may be a focus of clinical
attention
Anxiety Disorders
anxiety disorders 
- uncontrollable fears that are
disproportionate to the actual danger and disruptive to
ordinary life (Axis I)
generalized anxiety disorder
panic disorder
phobic disorder
separation anxiety disorder
selective mutism
obsessive-compulsive disorder
now in the 
obsessive-compulsive and related disorders
post-traumatic stress disorder
now in the 
trauma- and stressor-related disorders
sequential order of chapter reflects close relationship
Generalized Anxiety Disorder
Diagnosis and Symptoms
persistent anxiety for at least 6 months
inability to specify reasons for the anxiety
Etiology 
– the causes or significant preceding
conditions
biological factors
genetic predisposition, GABA deficiency, sympathetic
nervous system activity, respiration
psychological and sociocultural factors
 harsh self-standards, critical parents, automatic negative
thoughts, history of uncontrollable trauma (like an abusive
parent)
Panic Disorder
Diagnosis and Symptoms
recurrent, sudden onsets of intense terror that often occur
without warning
panic attacks
: can produce sever palpitations, extreme
shortness of breath, chest pains, trembling, sweating,
dizziness and a feeling of helplessness
types changed to 
unexpected panic attack 
and 
expected panic
attack
panic disorder and agoraphobia are unlinked
Etiology
biological factors: genetic predisposition
psychological factors: misinterpret arousal
sociocultural factors: gender differences
American women = 2x as likely to suffer from a panic disorder
FUN FACT: Charles Darwin had a panic disorder
Phobic Disorder
Diagnosis and Symptoms
an irrational, overwhelming, persistent fear of a particular
object or situation
social anxiety disorder 
social phobia 
– an intense fear of being
humiliated or embarrassed in social situations
deletion of requirement that individuals over age 18 years
recognize that their anxiety is excessive or unreasonable
6-month duration expanded to include all ages
panic disorder and agoraphobia are unlinked
“generalized” specifier has been deleted and replaced with a
“performance only” specifier (fear of speaking/performing in
front of an audience)
Etiology
biological factors: genetic disposition
neural circuit: thalamus, amygdala and cerebral cortex
psychological factors: learned
classical conditioning / learned associations
Examples of Phobic Disorders
phobic disorders 
– it is no longer a
requirement that individuals over age 18 years
must recognize that their fear and anxiety are
excessive or unreasonable
Social Anxiety
Disorders in the US
social anxiety
disorder 
(formerly
called 
social
phobias
)
Obsessive Compulsive 
and Related
Disorders
Diagnosis and Symptoms
persistent anxiety-provoking thoughts and/or urges to
perform repetitive, ritualistic behaviors to prevent or
produce a situation
cognitive perspective: inability to turn off negative,
intrusive thoughts by ignoring or effectively dismissing
them
obsession 
– recurrent thoughts
compulsions 
– recurrent behaviors
most common: excessive checking, cleansing, counting
Etiology
biological factors: genetic predisposition
more activity in frontal cortex, basal ganglia, thalamus
smaller amygdala (counter-intuitive)
lower levels of serotonin and dopamine
psychological factors: life stress
Obsessive-Compulsive
and Related Disorders
new disorders:
hoarding disorder
excoriation 
(skin-picking) 
disorder
substance-/medication induced obsessive-compulsive
and related disorder
obsessive-compulsive related disorder due to another
medical condition
from impulse-control disorders
trichotillomania 
(hair-pulling) 
disorder
new specifiers
“with poor insight”… “fair”… “good”… “absent
insight/delusional”
Post-Traumatic Stress Disorder 
(
PTSD
)
Diagnosis and Symptoms
Symptoms develop as a result of exposure to a traumatic
event--oppressive situation, natural or unnatural disasters—
that have overwhelmed the person’s abilities to cope
flashbacks 
 reliving event
avoidance of emotional experiences/talking with others
constricted ability to feel emotions
excessive arousal 
 inability to sleep, exaggerated startle response
difficulties with memory and concentration
feelings of apprehension
impulsive outbursts
4 major symptom clusters: 
reexperiencing
, 
avoidance
,
persistent negative alteration in cognitions and mood
,
arousal 
Post-Traumatic Stress Disorder
Etiology
stressor criterion: 
requires being explicit to whether
qualifying traumatic events were experienced directly,
witnessed, or experienced indirectly
subjective reaction 
(removed) 
trauma
combat and war-related
sexual abuse and assault
natural and unnatural disasters (plane crashes, terrorists
attacks)
vulnerability
previous history of trauma
conditions: abuse, psychological disorders
genetic predispositions
Mood Disorders
mood disorder 
- disturbance of mood that affects
entire emotional state (Axis I Disorder)
1.
depressive disorders
major depressive disorder
dysthymic disorder
2.
bipolar disorders
o
correlate: suicide
Symptoms may include
cognitive, behavioral, or physical symptoms
interpersonal difficulties
Diagnosis and Symptoms
significant depressive episode that lasts for at least two weeks
defined by presence of at least 5 out of 9
symptoms
depressed mood most of the day
reduced interest or pleasure in all or most activities
significant weight loss or gain or significant decrease or
increase in appetite
trouble sleeping or sleeping too much
psychological and physical agitation, or, in contrast, lethargy
fatigue or loss of energy
feeling worthless or guilty in an excessive or inappropriate manner
problems thinking, concentrating, or making decisions
recurrent thoughts of death and suicide
no history of manic episodes (periods of euphoric moods)
daily functioning is impaired
the coexistence of within a major depressive episode of at least three
manic symptoms (insufficient to satisfy criteria for a manic episode) is
now acknowledged by the specifier “with mixed feature” 
 increases
likelihood illness exists in bipolar spectrum
bereavement exclusion 
removed 
- was an exclusion applied to
depressive symptoms lasting less than 2 months following the death of a
loved one
Major
Depressive
Disorder
(
MDD
)
Persistent Depressive Disorder:
Dysthymic Disorder 
(
DD
)
Diagnosis and Symptoms
chronic depression
unbroken depressed mood lasting at least two years (adult) or one
year (child)
adult: less than two months regular mood still = diagnosis
fewer symptoms than MDD
defined by presence of 2 out of 6 symptoms
poor appetite or overeating
sleep problems
low energy or fatigue
low self-esteem
poor concentration or difficulty making decisions
feelings of hopelessness
dysthymic disorder now falls in category of persistent
depressive disorder (along with chronic major depressive
disorder) 
Major Depressive Disorder 
(
MDD
)
Etiology
biological factors: genetic disposition
underactive prefrontal cortex
regulation of neurotransmitters
serotonin
norepinephrine
psychological factors:
learned helplessness
ruminating on negative, self-defeating thoughts
pessimistic attribution
sociocultural factors
poverty
women head of households
minorities
gender differences (women = 2x likely)
Childhood Depression
Developmental Psychopathology
risk factors for depression
parental psychopathology
genetics
protective factors
supportive adult role model, or strong extended family
genetics
Mood Disorder: Bipolar Disorder
Characterized by extreme mood swings
Bipolar I 
(more severe)
hallucinations 
– seeing or hearing things that are not there
mania 
– an overexcited, unrealistically optimistic state
new specifier of “
with mixed features
” (meeting 
full criteria for both 
has been
removed
)
Bipolar II
less extreme level of euphoria
manic and hypomanic episodes now include an emphasis on changes
in activity and energy as well as mood
Frequency and separation of episodes
usually separated by 6 months to a year
Etiology
strong 
genetic component
swings in metabolic activity in cerebral cortex
levels of neurotransmitters
high levels of norepinephrine, glutamate
low levels of serotonin
Suicide
Prevalence
over 32,000 in year 2004
one completion for every 8 to 25 attempts
3rd leading cause of death in early adolescence
10-14
13-19
Suicide
Biological factors
low levels of serotonin
 
 
10x likely to try again
poor health
Psychological Factors
mental disorders
90 percent
trauma (recent/immediate and highly stressful)
sexual abuse
loss of a job/flunking out of school/unwanted pregnancy
substance abuse
Sociocultural Factors
chronic economic hardship
cultural and religious norms
norms against suicide = lower rates
eastern Europe, Japan, South Korea
gender differences
When Someone is Threatening Suicide
attempters: connection to others
women 3x morel likely to attempt
completers: disconnected / burden on others
men 4x more likely to complete suicide; more likely to use a firearm
highest suicide rate is among non-Latino men aged 85+
Dissociative Disorder
dissociative disorder 
- sudden loss of memory or
change in identity due to the dissociation (separation)
of the individual’s conscious awareness from previous
memories and thoughts
Dissociation
protection from extreme stress or shock
problems integrating emotional memories
Types
dissociative amnesia
dissociative fugue
 * is now a specifier of dissociative
amnesia rather than a separate diagnosis 
dissociative identity disorder (DID)
Dissociative Disorders
Dissociative Amnesia
individuals experience extreme memory loss caused
by extensive psychological stress
only aspects of their own identity and
autobiographical experiences are forgotten
Example: sodium pentathol “truth serum” 
 stress
Dissociative Fugue
dissociative fugue
 * is now a specifier of dissociative
amnesia rather than a separate diagnosis 
individuals experience amnesia, unexpectedly travel away,
and sometimes assume a new identity
tendency to run away*
Dissociative Identity Disorder (DID)
formerly known as multiple personality disorder
most dramatic, least common, most controversial dissociative disorder
Diagnosis and Symptoms
the same individual possesses two or more distinct personalities
symptoms of disruption may be reported as well as observed
each personality has unique memories, behaviors, and relationships
only one personality is dominant at a time
personality shifts (and gaps in recall) occur under distress 
and everyday
(not just traumatic events)
* 
“experiences of pathological possession in some cultures are included in
the description of identity disruption”
Etiology
extraordinarily severe abuse in early childhood (70%)
social contagion
mostly women
runs in families
individual compartmentalizes different aspects of the self into
independent identities
Schizophrenia
highly disordered thought
thought disorder 
– refers to the unusual, sometimes bizarre
thought processes that are characteristic positive symptoms of
schizophrenia
split from reality (psychotic)
typically diagnosed in early adulthood
high suicide risk (8x general population)
categories of symptoms:
positive symptoms
hallucinations
delusions
thought disorders
disorders of movement
negative symptoms
Symptoms of
Schizophrenia
Positive Symptoms
hallucinations 
– sensory experiences in the
absence of real stimuli
auditory and visual = more common
smells or tastes = less common
delusions 
– false, unusual, and sometimes magical beliefs that are not part of an
individual’s culture
believing you’re Jesus Christ, Muhammad, etc.
that your thoughts are being broadcast over the radio, etc.
disorganized speech * in DSM-V must have one of these core positive symptoms
thought disorder
“word salad”; neologisms
 – making up new words
referential thinking 
– ascribing personal meaning to completely random events – traffic light
turned red because YOU’RE in a hurry
disorders of movement
 – unusual mannerisms, body movements, facial expressions,
may repeat certain motions over and over
catatonia 
– state of immobility and unresponsiveness lasting for long periods of time (
all contexts
require 3 catatonic symptoms (of 12); may be diagnosed as specifier for depressive, bipolar,
psychotic disorders)
Negative Symptoms
flat affect 
– the display of little or no emotion (common)
Cognitive Symptoms
attention difficulties and memory problems
impaired ability to interpret information and make decisions
subtypes 
of schizophrenia are 
removed 
in DSM-V (paranoid, disorganized,
catatonic, undifferentiated, residual, etc.)
Etiology of
Schizophrenia
Biological Factors
genetic predisposition
structural brain abnormalities
(no glial cells 
 prenatal)
enlarged 
ventricles 
(fluid-filled spaces) in brain
 indicates deterioration in other brain tissue
smaller and less active 
prefrontal cortex
regulation of neurotransmitters
excess dopamine production (or overactivation of pathways)
bizarre beliefs continue after dopamine regulation 
 may disappear only
after experience demonstrates that such schemas no longer carry their
explanatory power
Psychological Factors
diathesis-stress model 
– view of schizophrenia emphasizing that
a combination of biogenetic disposition and stress causes the
disorder
diathesis 
– physical vulnerability or predisposition to a particular
disorder
Sociocultural Factors
influence how disorder progresses (course)
developing, non-industrialized countries have better results
Personality
Disorders
personality disorder 
- chronic
maladaptive cognitive-behavioral
patterns
antisocial personality disorder
borderline personality disorder
Antisocial Personality Disorder
Diagnosis and Symptoms
guiltless lawbreaking, violence, deceit
impulsive, irritable, reckless, irresponsible
exploitative, lacks empathy
psychopaths – remorseless predators who engage in violence to
get what they want (examples: John Wayne Gacy, Ted Bundy)
“successful psychopaths” and “unsuccessful psychopaths”
Etiology
biological factors
genetic heritable
brain: less prefrontal activation, structural abnormalities in amygdala and
hippocampus
underaroused ANS (autonomic nervous system) differences
testosterone – hormone most associated with aggressive behavior
more common in men
Personality
Disorders
Borderline Personality Disorder
Diagnosis and Symptoms
instability in interpersonal relationships &
self-image
impulsive, insecure, unstable & extreme emotions
very sensitive to treatment of others
paranoia 
– a pattern of disturbed thought featuring delusion of grandeur
or persecution
dissociative symptoms
recurrent suicidal behavior, gestures, or threats or self-mutilating
behaviors
cutting 
– insuring oneself with a sharp object but without suicidal attempt
splitting 
– thinking style of seeing things in black or white
Etiology
genetic (40% heritability)
childhood abuse, neglect – suggests diathesis-stress explanation
irrational belief one is powerless, unacceptable, and that others are hostile
hypervigilance 
– the tendency to be constantly on the alert, looking for
threatening information in the environment
75% women
Psychological Disorders
and Health and Wellness
Stereotypes and Stigma
Rosenhan’s study 
- fake psychiatric patients
3-52 days hospitalization for (FAKE) schizophrenia
negative attitudes toward mentally ill
physical health risk
successfully functioning individuals with mental
illness reluctant to “come out”
Chapter Summary
Discuss the characteristics, explanations, and
classifications of abnormal behavior.
Distinguish among the various anxiety disorders.
Compare the mood disorders and specify risk factors
for depression and suicide.
Describe the dissociative disorders.
Characterize schizophrenia.
Identify behavior patterns typical of personality
disorders.
Explain the impact of the stigma associated with
mental illness.
Chapter Summary
Abnormal Behavior
deviant, maladaptive, or personally distressing
Theoretical Approaches
biological, psychological, and sociocultural
biopsychosocial
Classifying Abnormal Behavior
DSM-IV-TR Axes
advantages and disadvantages
Chapter Summary
Anxiety Disorders
generalized anxiety disorder
panic disorder
phobic disorder
obsessive-compulsive disorder
post-traumatic stress disorder
Chapter Summary
Mood Disorders
major depressive disorder
dysthymic disorder
bipolar disorder
suicide
Dissociative Disorders
dissociative amnesia
dissociative fugue
dissociative identity disorder
Chapter Summary
Schizophrenia
positive, negative and cognitive symptoms
etiology (biological, psychological, sociocultural)
Personality Disorders
antisocial personality disorder
borderline personality disorder
Psychological Disorders and Health & Wellness
stigmas and stereotypes
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Explore the realm of psychological disorders through theoretical approaches such as the Biological, Psychological, and Sociocultural models. Delve into the complexities of abnormal behavior, including definitions and examples. Gain insights into the impact of biological, psychological, and sociocultural factors on mental health and wellness.


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  1. Psychological Disorders Chapter 15 AP Psychology Alice F. Short Hilliard Davidson High School

  2. Chapter Preview Defining/Explaining Abnormal Behavior Anxiety Disorders Mood Disorders Dissociative Disorders Schizophrenia Personality Disorders Psychological Disorders and Health and Wellness

  3. Abnormal Behavior abnormal behavior - behavior that is deviant (atypical) example: washing hands 4x an hour maladaptive (dysfunctional) example: believing that you can hurt people by breathing and hiding away and avoiding people personally distressing (despair) example: feeling extreme shame or guilt over a relatively long period of time NOTE: context matters!

  4. Theoretical Approaches Biological Approach: Medical Model disorders with biological origins Psychological Approach experiences, thoughts, emotions, personality Sociocultural Approach social context Biopsychosocial Model interaction of biological, psychological and sociocultural factors

  5. Theoretical Approaches Biological Approach: Medical Model medical model the view that psychological disorers are medical diseases with biological origin disorders with biological origins abnormalities = mental illnesses patients = afflicted individuals doctors = people who treat the patients

  6. Theoretical Approaches: Psychological Approach psychological approach focuses on experiences, thoughts, emotions, personality in the development and course of psychological disorders

  7. Theoretical Approaches: Sociocultural Approach Sociocultural Approach social context includes: gender, ethnicity, socioeconomic status, family relationships, culture, technological aspects of culture, religious aspects of culture socioeconomic status = greater impact than ethnicity living conditions of poverty = stressful

  8. Theoretical Approaches: Biopsychosocial Model Biopsychosocial Model interaction of biological, psychological and sociocultural factors biological factors (such as genes) psychological factors (such as childhood experiences) sociocultural factors (such as gender)

  9. DSM-V Classification System Advantages provides a common basis for communication helps clinicians make predictions naming the disorder can provide comfort Disadvantages stigma (shame, negative reputation) medical terminology implies internal cause focus on weaknesses ignores strength DISUCSSION: Which do you think is more significant the advantages or disadvantages?

  10. Critical Controversy: Psychological Disorders Real or Myth? Szasz & Cruise phrase mental illness is presumptuous medication of mental illnesses is presumptuous Response of Medical Professionals mental illnesses are real medical conditions drugs effectively alleviate symptoms ADHD: over-diagnosed or non-medical? should prescription drugs be used to treat ADHD?

  11. Critical Controversy: A SHORT Time to Ponder When do you think it is appropriate to label someone as having a psychological disorder? When do you think medical treatments for psychological disorders are appropriate? If a teacher suggested that your child be tested for ADHD, what do you think you would do? Why?

  12. DSM-V-TR Axes Multiaxial System Axis I and II: Psychological Disorders Axis III: Another Medical Conditions Axis IV: Psychosocial/Environmental Problems Axis V: Current Level of Functioning

  13. Major Categories: disorders usually first diagnosed in infancy, childhood, or adolescence and communication disorders anxiety disorders somatoform disorders factitious disorders dissociative disorders delirium, dementia, amnesia, and other cognitive disorders mood disorders schizophrenia and other psychotic disorders substance-related disorders sexual and gender identity disorders eating disorders sleep disorders impulse control disorders not elsewhere classified adjustment disorders Axis I Disorders

  14. Axis II Disorders Major Categories: intellectual disability personality disorders other conditions that may be a focus of clinical attention

  15. Anxiety Disorders anxiety disorders - uncontrollable fears that are disproportionate to the actual danger and disruptive to ordinary life (Axis I) generalized anxiety disorder panic disorder phobic disorder separation anxiety disorder selective mutism obsessive-compulsive disorder now in the obsessive-compulsive and related disorders post-traumatic stress disorder now in the trauma- and stressor-related disorders sequential order of chapter reflects close relationship

  16. Generalized Anxiety Disorder Diagnosis and Symptoms persistent anxiety for at least 6 months inability to specify reasons for the anxiety Etiology the causes or significant preceding conditions biological factors genetic predisposition, GABA deficiency, sympathetic nervous system activity, respiration psychological and sociocultural factors harsh self-standards, critical parents, automatic negative thoughts, history of uncontrollable trauma (like an abusive parent)

  17. Panic Disorder Diagnosis and Symptoms recurrent, sudden onsets of intense terror that often occur without warning panic attacks: can produce sever palpitations, extreme shortness of breath, chest pains, trembling, sweating, dizziness and a feeling of helplessness types changed to unexpected panic attack and expected panic attack panic disorder and agoraphobia are unlinked Etiology biological factors: genetic predisposition psychological factors: misinterpret arousal sociocultural factors: gender differences American women = 2x as likely to suffer from a panic disorder FUN FACT: Charles Darwin had a panic disorder

  18. Phobic Disorder Diagnosis and Symptoms an irrational, overwhelming, persistent fear of a particular object or situation social anxiety disorder social phobia an intense fear of being humiliated or embarrassed in social situations deletion of requirement that individuals over age 18 years recognize that their anxiety is excessive or unreasonable 6-month duration expanded to include all ages panic disorder and agoraphobia are unlinked generalized specifier has been deleted and replaced with a performance only specifier (fear of speaking/performing in front of an audience) Etiology biological factors: genetic disposition neural circuit: thalamus, amygdala and cerebral cortex psychological factors: learned classical conditioning / learned associations

  19. Examples of Phobic Disorders phobic disorders it is no longer a requirement that individuals over age 18 years must recognize that their fear and anxiety are excessive or unreasonable

  20. Social Anxiety Disorders in the US social anxiety disorder (formerly called social phobias)

  21. Obsessive Compulsive and Related Disorders Diagnosis and Symptoms persistent anxiety-provoking thoughts and/or urges to perform repetitive, ritualistic behaviors to prevent or produce a situation cognitive perspective: inability to turn off negative, intrusive thoughts by ignoring or effectively dismissing them obsession recurrent thoughts compulsions recurrent behaviors most common: excessive checking, cleansing, counting Etiology biological factors: genetic predisposition more activity in frontal cortex, basal ganglia, thalamus smaller amygdala (counter-intuitive) lower levels of serotonin and dopamine psychological factors: life stress

  22. Obsessive-Compulsive and Related Disorders new disorders: hoarding disorder excoriation (skin-picking) disorder substance-/medication induced obsessive-compulsive and related disorder obsessive-compulsive related disorder due to another medical condition from impulse-control disorders trichotillomania (hair-pulling) disorder new specifiers with poor insight fair good absent insight/delusional

  23. Post-Traumatic Stress Disorder (PTSD) Diagnosis and Symptoms Symptoms develop as a result of exposure to a traumatic event--oppressive situation, natural or unnatural disasters that have overwhelmed the person s abilities to cope flashbacks reliving event avoidance of emotional experiences/talking with others constricted ability to feel emotions excessive arousal inability to sleep, exaggerated startle response difficulties with memory and concentration feelings of apprehension impulsive outbursts 4 major symptom clusters: reexperiencing, avoidance, persistent negative alteration in cognitions and mood, arousal

  24. Post-Traumatic Stress Disorder Etiology stressor criterion: requires being explicit to whether qualifying traumatic events were experienced directly, witnessed, or experienced indirectly subjective reaction (removed) trauma combat and war-related sexual abuse and assault natural and unnatural disasters (plane crashes, terrorists attacks) vulnerability previous history of trauma conditions: abuse, psychological disorders genetic predispositions

  25. Mood Disorders mood disorder - disturbance of mood that affects entire emotional state (Axis I Disorder) 1. depressive disorders major depressive disorder dysthymic disorder 2. bipolar disorders o correlate: suicide Symptoms may include cognitive, behavioral, or physical symptoms interpersonal difficulties

  26. Diagnosis and Symptoms significant depressive episode that lasts for at least two weeks defined by presence of at least 5 out of 9 symptoms depressed mood most of the day reduced interest or pleasure in all or most activities significant weight loss or gain or significant decrease or increase in appetite trouble sleeping or sleeping too much psychological and physical agitation, or, in contrast, lethargy fatigue or loss of energy feeling worthless or guilty in an excessive or inappropriate manner problems thinking, concentrating, or making decisions recurrent thoughts of death and suicide no history of manic episodes (periods of euphoric moods) daily functioning is impaired the coexistence of within a major depressive episode of at least three manic symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier with mixed feature increases likelihood illness exists in bipolar spectrum bereavement exclusion removed - was an exclusion applied to depressive symptoms lasting less than 2 months following the death of a loved one Major Depressive Disorder (MDD)

  27. Persistent Depressive Disorder: Dysthymic Disorder (DD) Diagnosis and Symptoms chronic depression unbroken depressed mood lasting at least two years (adult) or one year (child) adult: less than two months regular mood still = diagnosis fewer symptoms than MDD defined by presence of 2 out of 6 symptoms poor appetite or overeating sleep problems low energy or fatigue low self-esteem poor concentration or difficulty making decisions feelings of hopelessness dysthymic disorder now falls in category of persistent depressive disorder (along with chronic major depressive disorder)

  28. Major Depressive Disorder (MDD) Etiology biological factors: genetic disposition underactive prefrontal cortex regulation of neurotransmitters serotonin norepinephrine psychological factors: learned helplessness ruminating on negative, self-defeating thoughts pessimistic attribution sociocultural factors poverty women head of households minorities gender differences (women = 2x likely)

  29. Childhood Depression Developmental Psychopathology risk factors for depression parental psychopathology genetics protective factors supportive adult role model, or strong extended family genetics

  30. Mood Disorder: Bipolar Disorder Characterized by extreme mood swings Bipolar I (more severe) hallucinations seeing or hearing things that are not there mania an overexcited, unrealistically optimistic state new specifier of with mixed features (meeting full criteria for both has been removed) Bipolar II less extreme level of euphoria manic and hypomanic episodes now include an emphasis on changes in activity and energy as well as mood Frequency and separation of episodes usually separated by 6 months to a year Etiology strong genetic component swings in metabolic activity in cerebral cortex levels of neurotransmitters high levels of norepinephrine, glutamate low levels of serotonin

  31. Suicide Prevalence over 32,000 in year 2004 one completion for every 8 to 25 attempts 3rd leading cause of death in early adolescence 10-14 13-19

  32. Suicide Biological factors low levels of serotonin 10x likely to try again poor health Psychological Factors mental disorders 90 percent trauma (recent/immediate and highly stressful) sexual abuse loss of a job/flunking out of school/unwanted pregnancy substance abuse Sociocultural Factors chronic economic hardship cultural and religious norms norms against suicide = lower rates eastern Europe, Japan, South Korea gender differences

  33. When Someone is Threatening Suicide attempters: connection to others women 3x morel likely to attempt completers: disconnected / burden on others men 4x more likely to complete suicide; more likely to use a firearm highest suicide rate is among non-Latino men aged 85+

  34. Dissociative Disorder dissociative disorder - sudden loss of memory or change in identity due to the dissociation (separation) of the individual s conscious awareness from previous memories and thoughts Dissociation protection from extreme stress or shock problems integrating emotional memories Types dissociative amnesia dissociative fugue * is now a specifier of dissociative amnesia rather than a separate diagnosis dissociative identity disorder (DID)

  35. Dissociative Disorders Dissociative Amnesia individuals experience extreme memory loss caused by extensive psychological stress only aspects of their own identity and autobiographical experiences are forgotten Example: sodium pentathol truth serum stress Dissociative Fugue dissociative fugue * is now a specifier of dissociative amnesia rather than a separate diagnosis individuals experience amnesia, unexpectedly travel away, and sometimes assume a new identity tendency to run away*

  36. Dissociative Identity Disorder (DID) formerly known as multiple personality disorder most dramatic, least common, most controversial dissociative disorder Diagnosis and Symptoms the same individual possesses two or more distinct personalities symptoms of disruption may be reported as well as observed each personality has unique memories, behaviors, and relationships only one personality is dominant at a time personality shifts (and gaps in recall) occur under distress and everyday (not just traumatic events) * experiences of pathological possession in some cultures are included in the description of identity disruption Etiology extraordinarily severe abuse in early childhood (70%) social contagion mostly women runs in families individual compartmentalizes different aspects of the self into independent identities

  37. Schizophrenia highly disordered thought thought disorder refers to the unusual, sometimes bizarre thought processes that are characteristic positive symptoms of schizophrenia split from reality (psychotic) typically diagnosed in early adulthood high suicide risk (8x general population) categories of symptoms: positive symptoms hallucinations delusions thought disorders disorders of movement negative symptoms

  38. Positive Symptoms hallucinations sensory experiences in the absence of real stimuli auditory and visual = more common smells or tastes = less common delusions false, unusual, and sometimes magical beliefs that are not part of an individual s culture believing you re Jesus Christ, Muhammad, etc. that your thoughts are being broadcast over the radio, etc. disorganized speech * in DSM-V must have one of these core positive symptoms thought disorder word salad ; neologisms making up new words referential thinking ascribing personal meaning to completely random events traffic light turned red because YOU RE in a hurry disorders of movement unusual mannerisms, body movements, facial expressions, may repeat certain motions over and over catatonia state of immobility and unresponsiveness lasting for long periods of time (all contexts require 3 catatonic symptoms (of 12); may be diagnosed as specifier for depressive, bipolar, psychotic disorders) Negative Symptoms flat affect the display of little or no emotion (common) Cognitive Symptoms attention difficulties and memory problems impaired ability to interpret information and make decisions subtypes of schizophrenia are removed in DSM-V (paranoid, disorganized, catatonic, undifferentiated, residual, etc.) Symptoms of Schizophrenia

  39. Biological Factors genetic predisposition structural brain abnormalities (no glial cells prenatal) enlarged ventricles (fluid-filled spaces) in brain indicates deterioration in other brain tissue smaller and less active prefrontal cortex regulation of neurotransmitters excess dopamine production (or overactivation of pathways) bizarre beliefs continue after dopamine regulation may disappear only after experience demonstrates that such schemas no longer carry their explanatory power Psychological Factors diathesis-stress model view of schizophrenia emphasizing that a combination of biogenetic disposition and stress causes the disorder diathesis physical vulnerability or predisposition to a particular disorder Sociocultural Factors influence how disorder progresses (course) developing, non-industrialized countries have better results Etiology of Schizophrenia

  40. personality disorder - chronic maladaptive cognitive-behavioral patterns antisocial personality disorder borderline personality disorder Antisocial Personality Disorder Diagnosis and Symptoms guiltless lawbreaking, violence, deceit impulsive, irritable, reckless, irresponsible exploitative, lacks empathy psychopaths remorseless predators who engage in violence to get what they want (examples: John Wayne Gacy, Ted Bundy) successful psychopaths and unsuccessful psychopaths Etiology biological factors genetic heritable brain: less prefrontal activation, structural abnormalities in amygdala and hippocampus underaroused ANS (autonomic nervous system) differences testosterone hormone most associated with aggressive behavior more common in men Personality Disorders

  41. Borderline Personality Disorder Diagnosis and Symptoms instability in interpersonal relationships & self-image impulsive, insecure, unstable & extreme emotions very sensitive to treatment of others paranoia a pattern of disturbed thought featuring delusion of grandeur or persecution dissociative symptoms recurrent suicidal behavior, gestures, or threats or self-mutilating behaviors cutting insuring oneself with a sharp object but without suicidal attempt splitting thinking style of seeing things in black or white Etiology genetic (40% heritability) childhood abuse, neglect suggests diathesis-stress explanation irrational belief one is powerless, unacceptable, and that others are hostile hypervigilance the tendency to be constantly on the alert, looking for threatening information in the environment 75% women Personality Disorders

  42. Psychological Disorders and Health and Wellness Stereotypes and Stigma Rosenhan s study - fake psychiatric patients 3-52 days hospitalization for (FAKE) schizophrenia negative attitudes toward mentally ill physical health risk successfully functioning individuals with mental illness reluctant to come out

  43. Chapter Summary Discuss the characteristics, explanations, and classifications of abnormal behavior. Distinguish among the various anxiety disorders. Compare the mood disorders and specify risk factors for depression and suicide. Describe the dissociative disorders. Characterize schizophrenia. Identify behavior patterns typical of personality disorders. Explain the impact of the stigma associated with mental illness.

  44. Chapter Summary Abnormal Behavior deviant, maladaptive, or personally distressing Theoretical Approaches biological, psychological, and sociocultural biopsychosocial Classifying Abnormal Behavior DSM-IV-TR Axes advantages and disadvantages

  45. Chapter Summary Anxiety Disorders generalized anxiety disorder panic disorder phobic disorder obsessive-compulsive disorder post-traumatic stress disorder

  46. Chapter Summary Mood Disorders major depressive disorder dysthymic disorder bipolar disorder suicide Dissociative Disorders dissociative amnesia dissociative fugue dissociative identity disorder

  47. Chapter Summary Schizophrenia positive, negative and cognitive symptoms etiology (biological, psychological, sociocultural) Personality Disorders antisocial personality disorder borderline personality disorder Psychological Disorders and Health & Wellness stigmas and stereotypes

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