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Unit 12 Abnormal Psychology

 

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Mental health workers label behavior psychologically disordered when it is deviant, distressful, and dysfunctional. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) provides an authoritative classification scheme. Although diagnostic labels may facilitate communication and research, they can also bias our perception of people’s past and present behavior and unfairly stigmatize these individuals.

Those who suffer from an anxiety disorder may for no reason feel uncontrollably tense (generalized anxiety disorder), may suffer a brief episode of intense dread (panic disorder), may have a persistent irrational fear (phobia), or may be troubled by repetitive thoughts and actions (obsessive-compulsive disorder). Symptoms may also follow the experience of some traumatic
event (post-traumatic stress disorder).

Somatoform disorders are psychological disorders in which the symptoms take a bodily form without apparent physical cause. In dissociative disorders, conscious awareness becomes separated from previous memories, thoughts, and feelings. Those afflicted with a dissociative disorder may even have two or more distinct personalities.

Mood disorders include major depressive disorder and bipolar disorder. Current research on depression is exploring (1) genetic and biochemical influences and (2) cyclic self-defeating beliefs, learned helplessness, negative attributions, and aversive experiences.

The symptoms of schizophrenia include disorganized thinking, disturbed perceptions, and inappropriate emotions. Researchers have linked certain forms of schizophrenia to brain abnormalities. Studies also point to a genetic predisposition that may work in conjunction with environmental factors.

Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. The most common is the remorseless and fearless antisocial personality. The U.S. National Institute of Mental Health estimates that 26 percent of adult Americans suffer from a diagnosable mental disorder in a given year. National population surveys indicate that the rates of disorder vary across the world. Most who suffer from a disorder show the first symptoms by early adulthood. Poverty is clearly a predictor of mental illness.

 


 

Perspectives on Psychological Disorders

 

Psychological disorders consist of deviant, distressful, and dysfunctional behavior patterns. Mental health workers view psychological disorders as persistently harmful thoughts, feelings, and actions. Standards of deviant behavior vary by culture, context, and even time. For example, children once regarded as fidgety, distractible, and impulsive are now being diagnosed with attention deficit
hyperactivity disorder (ADHD). Critics question whether the label is being applied to healthy schoolchildren who, in more natural outdoor environments, would seem perfectly normal.

Although the proportion of children treated for the disorder has increased dramatically, the pervasiveness of the diagnosis depends in part on teacher referrals. Others counterargue that the more frequent diagnoses of ADHD reflect increased awareness of the disorder, particularly in those areas where the rates are highest.

The medical model assumes that psychological disorders are mental illnesses that need to be diagnosed on the basis of their symptoms and cured through therapy. Critics argue that psychological disorders may not reflect a deep internal problem but instead a difficulty in the person’s environment, in the person’s current interpretation of events, or in the person’s bad habits and poor social
skills.

Psychologists who reject the “sickness” idea typically contend that all behavior arises from the interaction of nature (genetic and physiological factors) and nurture (past and present experiences). The biopsychosocial approach assumes that disorders are influenced by genetic predispositions and physiological states, inner psychological dynamics, and social and cultural circumstances.

DSM-V-TR is a current authoritative scheme for classifying psychological disorders.  DSM diagnoses were developed in coordination with the International Classification of Diseases (ICD-10). Most health insurance policies in North America require an ICD diagnosis before they will pay for therapy. The DSM describes various disorders and has high reliability. For example, two clinicians who are working independently and applying the guidelines are likely to reach the same diagnosis. As a complement to the DSM, some psychologists are offering a manual of human strengths and virtues (the “un-DSM”).

Critics point out that labels can create preconceptions that bias our perceptions of people’s past and present behavior and unfairly stigmatize these individuals. Labels can also serve as selffulfilling prophecies. However, diagnostic labels help not only to describe a psychological disorder but also to enable mental health professionals to communicate about their cases, to comprehend
the underlying causes, and to discern effective treatment programs. The label insanity raises moral and ethical questions about how society should treat people who have disorders and have committed crimes.

 

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Anxiety Disorders

 

Many everyday experiences—public speaking, preparing to play in a big game, looking down from a high ledge—may elicit anxiety. In contrast, anxiety disorders are characterized by distressing, persistent anxiety or dysfunctional anxiety-reducing behaviors.

Generalized anxiety disorder is an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal. Panic disorder is an anxiety disorder in which the anxiety suddenly escalates at times into a terrifying panic attack, a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking,
or other frightening sensations.

A phobia is an anxiety disorder marked by a persistent, irrational fear of a specific object, activity, or situation. In contrast to the normal fears we all experience, phobias can be so severe that they are incapacitating. For example, social phobia, an intense fear of being scrutinized by others, is shyness taken to an extreme. The anxious person may avoid speaking up, eating out, or going to
parties. If the fear is intense enough, it can lead to agoraphobia. Other specific phobias focus on animals, insects, heights, blood, or close spaces.

An obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions). The obsessions may be concerned with dirt, germs, or toxins. The compulsions may involve excessive hand washing or checking doors, locks, or appliances. The repetitive thoughts and behaviors become so persistent that they interfere
with everyday living and cause the person distress.

Post-traumatic stress disorder (PTSD) is characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and insomnia that last for four weeks or more following a traumatic experience. Many combat veterans, accident and disaster survivors, and sexual assault victims have experienced the symptoms of PTSD. Some researchers are interested in the impressive survivor resiliency of those who do not develop PTSD. About half of adults experience at least one traumatic experience in their lifetime, but only about 1 in 10 women and 1 in 20 men develop PTSD symptoms. For some, suffering can lead to post-traumatic growth, including an increased appreciation of life, more meaningful relationships, changed priorities, and a richer spiritual life.

The learning perspective views anxiety disorders as a product of fear conditioning, stimulus generalization, reinforcement of fearful behaviors, and observational learning of others’ fears. The biological perspective helps explain why we learn some fears more readily and why some individuals are more vulnerable. It emphasizes evolutionary, genetic, and neural influences. For example, phobias may focus on fears faced by our ancestors, genetic inheritance of a high level of emotional reactivity predisposes some to anxiety, and elevated activity in the anterior cingulate cortex appears to be linked to OCD.

 

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Somatoform Disorders

 

Somatoform disorders are psychological disorders in which the symptoms take a bodily (somatic) form without apparent physical cause. One person may have complaints ranging from dizziness to blurred vision. Another may experience severe and prolonged pain. Conversion disorder is a rare somatoform disorder in which anxiety is presumably converted into a physical symptom. A person experiences very specific genuine symptoms for which no physiological basis is found. These may include unexplained paralysis, blindness, or an inability to swallow. In hypochondriasis, which is relatively common, a person interprets normal physical sensations as symptoms of a disease. For
example, a stomach cramp or a headache may be viewed as evidence of a dreaded disease.

 


 

Dissociative Disorders

 

In dissociative disorders, a person appears to experience a sudden loss of memory or change in identity, often in response to an overwhelmingly stressful situation. A person may have no memory of his identity or family. Conscious awareness is said to dissociate or become separated from painful memories, thoughts, and feelings. Dissociation itself is not uncommon. On occasion, many
people may have a sense of being unreal, of being separated from their body, or of watching themselves as if in a movie. Facing trauma, detachment may protect a person from being overwhelmed by anxiety.

Dissociative identity disorder (DID) is a rare disorder in which a person exhibits two or more distinct and alternating personalities, with the original personality typically denying awareness of the other(s). Skeptics question whether DID is a genuine disorder or an extension of our normal capacity for personality shifts. Or is it merely role-playing by fantasy-prone individuals? They find it suspicious that the disorder became so popular in the late twentieth century and that outside North America it is much less prevalent. (In Britain, it is rare, and in India and Japan, it is essentially nonexistent.) Some argue that the condition is either contrived by fantasy-prone, emotionally variable people or constructed out of the therapist-patient interaction. Other psychologists disagree and find support for DID as a genuine disorder in the distinct brain and body states associated with differing personalities. Even handedness sometimes switches with personality.

From psychoanalytic and learning perspectives, the symptoms of DID are ways of dealing with anxiety. Other clinicians include dissociative disorders under the umbrella of post-traumatic stress disorders—a natural, protective response to “histories of childhood trauma.”

 


 

Mood Disorders

 

Mood disorders are psychological disorders characterized by emotional extremes. Major depressive disorder occurs when at least five signs of depression (including lethargy, feelings of worthlessness, or loss of interest in family, friends, and activities) last two or more weeks and are not caused by drugs or a medical conditions. Bipolar disorder is a mood disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania (a hyperactive, wildly optimistic states). Major depressive disorder is much more common than is bipolar disorder.

Peter Lewinsohn and his colleagues have suggested that any theory of depression must explain the many behavioral and cognitive changes that accompany the disorder, its widespread occurrence, women’s greater vulnerability to depression, the tendency for most major depressive episodes to self-terminate, the link between stressful events and the onset of depression, and the disorder’s increasing rate and earlier age of onset.

 

The biological perspective emphasizes the importance of genetic, neural, and biochemical influences. Mood disorders run in families, and linkage analysis is being used to search for genes that put people at risk. In addition, the brains of depressed people have been found to be less active. The left frontal lobe, which is active during positive emotions, is likely to be inactive during depressed states. Also, studies show that the hippocampus, a memory-processing center linked to the brain’s emotional circuitry, is vulnerable to stress-related damage. Finally, certain neurotransmitters, including norepinephrine and serotonin, seem to be scarce in depression.

The social-cognitive perspective suggests that self-defeating beliefs, which arise in part from learned helplessness, and a negative explanatory style feed depression. Depressed people explain bad events in terms that are global, stable, and internal. This perspective sees the disorder as a vicious cycle in which (1) negative, stressful events are interpreted through (2) a ruminating, pessimistic explanatory style, creating (3) a hopeless, depressed state that (4) hampers the way a person thinks and acts. This, in turn, fuels (1) negative experiences such as rejection.

 

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Schizophrenia

 

Schizophrenia is a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions. Literally, schizophrenia means “split mind,” which refers to a split from reality rather than multiple personality. The thinking of people with schizophrenia may be marked by delusions, that is, false beliefs—often of persecution
or grandeur. Sometimes, they also experience hallucinations, sensory experiences without sensory stimulation. Hallucinations are usually auditory and often take the form of voices making insulting statements or giving orders.

Schizophrenia patients who are disorganized and deluded in their talk or prone to inappropriate laughter, tears, or rage are said to have positive symptoms. When appropriate behaviors are absent (for example, the schizophrenia patient has a toneless voice, expressionless face, and a mute or rigid body), the person is showing negative symptoms. The subtypes of schizophrenia include paranoid (preoccupation with delusions or hallucinations, often of persecution or grandiosity), disorganized (disorganized speech or behavior, or flat affect or inappropriate emotions), catatonic (immobility, extreme negativism, and/or parrotlike repetition of another’s speech or movements),
undifferentiated (many and varied symptoms), and residual (withdrawal after hallucinations and delusions have disappeared). Chronic, or process, schizophrenia develops gradually, emerging from a long history of social inadequacy. Recovery is doubtful. Acute, or reactive, schizophrenia develops rapidly in response to particular life stresses. Recovery is much more likely.

Researchers have linked certain forms of schizophrenia with brain abnormalities such as increased receptors for the neurotransmitter dopamine. Impaired glutamate activity appears to be another source of schizophrenia symptoms. Modern brain-scanning techniques indicate that people with chronic schizophrenia have abnormal activity in multiple brain areas. Out-of-sync neurons may
disrupt the integrated functioning of neural networks. Some patients appear to have abnormally low brain activity in the frontal lobes or enlarged, fluid-filled areas and a corresponding shrinkage of cerebral tissue. Another smaller-than-normal area in persons with schizophrenia is the thalamus. A possible cause of these abnormalities is a midpregnancy viral infection that impairs fetal brain
development. For example, people are at increased risk of schizophrenia if, during the middle of their fetal development, their country experienced a flu epidemic. People born in densely populated areas, where viral diseases spread more readily, also seem at greater risk for schizophrenia.

The nearly 1-in-100 odds of any person developing schizophrenia become about 1 in 10 if a family member has it, and close to 1 in 2 if an identical twin has the disorder. Adoption studies confirm the genetic contribution to schizophrenia. An adopted child’s probability of developing the disorder is greater if the biological parents have schizophrenia. A complex disorder such as schizophrenia is surely influenced by multiple genes with small effects, but identifying these genes has proven difficult.

No environmental factors have been discovered that invariably produce schizophrenia in persons who are not related to a person with schizophrenia. However, researchers have pinpointed possible early warning signs of schizophrenia in children. These include a mother whose schizophrenia was severe and long-lasting, birth complications, separation from parents, short attention span and poor
muscle coordination, disruptive or withdrawn behavior, emotional unpredictability, and poor peer relations and solo play.

 

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Personality Disorders

 

Personality disorders are psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning. One cluster expresses anxiety (e.g., avoidant), a second cluster expresses eccentric behaviors (e.g., schizoid), and a third exhibits dramatic or impulsive behaviors (e.g., histrionic and narcissistic). The most troubling of these disorders is the antisocial personality disorder, in which a person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. This person may be aggressive and ruthless or a clever con artist. Brain scans of murderers with this disorder have revealed reduced activity in the
frontal lobes, an area of the cortex that helps control impulses. A genetic predisposition may interact with environmental influences to produce this disorder.

 

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Rates of Psychological Disorders

 

The U.S. National Institute of Mental Health estimates that 26 percent of adult Americans suffer from a diagnosable mental disorder in a given year. The three most common disorders in the United States are mood disorders, phobias of specific objects or situations, and social phobia. A twenty-first-century World Health Organization study of 20 countries found that the lowest rate of reported mental disorders was in Shanghai, whereas the highest rate was found in the United States. One predictor of mental disorder is poverty. Although the stresses and demoralization of poverty can precipitate disorders, especially depression in women and substance abuse in men, some disorders, such as schizophrenia, can also lead to poverty.

 

*Work Cited:  All summary notes come from *Myers Pyschology for AP, Lecture Guides (2011 Worth Publishers)

 

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