Stress And Health In PSY

CHAPTER 14—PSYCHOLOGICAL DISORDERS
I. Identifying Psychological Disorders: What Is Abnormal?
A. Medical Model – conceptualization of psychological disorders as diseases that have biological

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causes, defined symptoms, and possible cures
B. Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition, Text Revision] (DSM-IV-TR)
– classification system used for diagnosis of recognized mental disorders and indicates how the disorder can be distinguished from other, similar problems
C. Classification of Disorders
1. Key elements for a cluster of symptoms to qualify as a potential disorder:
a. Disturbances in behavior, thoughts, or emotion
b. Personal distress or impairment
c. Internal dysfunction (biological, psychological, or both)
2. Global Assessment of Functioning (GAF) Scale provides a 0-100 rating where more severe
disorders are indicated by lower numbers
3. Early versions of DSM were unreliable
4. 17 main categories of mental disorders in DSM-IV-TR
5. Comorbidity – co-occurrence of two or more disorders in one person
D. Causation of Disorders
1. Etiology – specifiable pattern of causes
2. Prognosis – typical course over time and susceptibility to treatment and cure
3. Diathesis-Stress Model – individual may be predisposed for a psychological disorder that is
unexpressed until triggered by stress
4. Intervention-Causation Fallacy – fallacy involving the assumption that if treatment is effective
it must address the cause of the problem
E. Dangers of Labeling
1. Stigma prevents people from seeking treatment (~70%)
2. Labeling may affect how the person views him or herself; may see themselves not just as
mentally disordered, but also hopeless or worthless
II. Anxiety Disorders: When Fears Take Over
A. Generalized Anxiety Disorder (GAD)
1. Symptoms (3 or more): Restlessness, fatigue, concentration problems, irritability, muscle
tension, and sleep disturbance
2. Treated with benzodiazepines (increase GABA)
B. Phobic Disorders
1. Symptoms: Marked, persistent, and excessive fear and avoidance of specific objects,
activities, or situations
2. Specific Phobia – irrational fear of a particular subject or situation that interferes with the
ability to function
a. Five categories: Animals; natural environments; situations; blood, injections, injury; other
 

 
phobias (illness, death)
3. Social Phobia – irrational fear of being publicly humiliated or embarrassed
4. Preparedness Theory – people are instinctively predisposed toward certain fears
C. Panic Disorder
1. Symptoms: Sudden occurrence of multiple psychological and physiological symptoms that
contribute to a feeling of stark terror
2. Agoraphobia – extreme fear of venturing out into public places (often for fear of having a
panic attack)
D. Obsessive-Compulsive Disorder (OCD)
1. Symptoms: Repetitive, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions)
that are intended to fend off those thoughts, result in significant interference into person’s ability to function
2. Increased serotonin inhibits the caudate nucleus and reduces symptoms of OCD
III. Mood Disorders: At the Mercy of Emotions
A. Depressive Disorders
1. Major Depressive Disorder
a. Symptoms: Severely depressed mood (> 2 weeks) with feelings of worthlessness and
lack of pleasure, lethargy, sleep and appetite disturbances
2. Dysthymia – similar to major depression but less severe and lasting for at least 2 years
3. Double Depression – moderately depressed mood that persists for at least 2 years,
punctuated with severe depression
4. Seasonal Affective Disorder (SAD) – recurring depressive episodes in a seasonal pattern
5. Postpartum Depression – depression following childbirth
6. Biological Factors
a. Increases in norepinephrine and serotonin reduce depression (Prozac and Zoloft)
b. Reduced activity in left dorsolateral prefrontal cortex and increased activity in right
dorsolateral prefrontal cortex
7. Psychological Factors
a. Helplessness Theory – individuals prone to depression automatically attribute negative
experiences to causes that are internal, stable, and global
b. Negative thinking can contribute to relapses and is often heightened in depressed people.
B. Bipolar Disorder
1. Symptoms: Unstable emotional condition characterized by cycles of abnormal, persistent
high mood (mania) and low mood (depression)
2. Rapid cycling bipolar disorder has at least 4 mood episodes per year and is difficult to treat
3. Biological Factors
a. high heritability (40-70% monozygotic twins)
b. Lithium reduces symptoms
4. Psychological Factors
a. Episodes triggered by stressful events
 

 
IV. Dissociative Disorders: Going to Pieces
A. Dissociative Disorder – condition in which normal cognitive processes are severely disjointed and
fragmented, creating significant disruptions in memory, awareness, or personality that can vary in length from a matter of minutes to many years.
1. Dissociative Identity Disorder (DID) – presence within an individual of two or more distinct
identities that take over control of the individual’s behavior at different times
a. Host personality is dominant and often unaware of the alters, yet alters are aware of host
personality
b. Usually the result of ritualistic abuse and/or trauma
2. Dissociative Amnesia (sudden loss of personal information) and Dissociative Fugue (sudden
loss of personal history, accompanied by an abrupt departure from home, assumption of new identity)
V. Schizophrenia: Losing the Grasp on Reality
A. Universal symptoms: Profound disruption of psychological processes; distorted perception of
reality; altered or blunted emotion; disturbances in thought, motivation, and behavior
B. Symptoms and Types of Schizophrenia
1. Symptoms
a. Delusion – patently false belief system, often bizarre and grandiose, that is maintained in
spite of its irrationality
b. Hallucination – a false perceptual experience that has a compelling sense of being real
despite the absence of external stimulation
c. Disorganized speech – a severe disruption of verbal communication in which ideas shift
rapidly and incoherently from one to another unrelated topic
d. Grossly disorganized behavior – behavior that is inappropriate for the situation or
ineffective in attaining goals, often with specific motor disturbances
i. Catatonic behavior – a marked decrease in all movement or an increase in muscular
rigidity and overactivity
e. Negative symptoms – emotional and social withdrawal; apathy; poverty of speech; and
other indications of the absence or insufficiency of normal behavior, motivation, and emotion
2. Types and their characteristics
a. Paranoid – absurd, illogical, and changeable delusions; vivid hallucinations; impairment of
critical judgment and erratic, unpredictable and occasionally dangerous behavior
b. Catatonic – alternating periods of extreme withdrawal and extreme excitement
c. Disorganized – usually occurs at an earlier age; emotional distortion and blunting
manifested by inappropriate laughter and silliness, peculiar mannerisms, and bizarre behavior
d. Undifferentiated – rapidly changing mixture of all or most of the primary indicators of
schizophrenia
e. Residual – mild indication of schizophrenia shown by individuals in remission following a
schizophrenic episode
C. Biological Factors
 

 
1. Genetic Factors
a. heritability (~48% monozygotic twins)
2. Prenatal and Perinatal Factors
a. Virus or influenza in second trimester increases risk
3. Biochemical Factors
a. Dopamine hypothesis – the idea that schizophrenia involves an excess of dopamine activity
4. Neuroanatomy
a. Early observations showed enlarged ventricles
b. Progression of “pruning” starting in parietal lobe
D. Psychological Factors
1. Expressed emotion (emotional over involvement and excessive criticism from the family)
VI. Personality Disorders: Going to Extremes
A. Types of Personality Disorders
1. Odd/Eccentric Cluster
a. Schizotypal – eccentric manners of speaking or dressing; strange beliefs; difficulty
forming relationships
b. Paranoid – distrust in others; apt to challenge loyalty of friends; prone to anger and
aggressive outburst; emotionally cold
c. Schizoid – extreme introversion and withdrawal from relationships; little interest in others;
humorless; distant
2. Dramatic/Erratic Cluster
a. Antisocial – impoverished moral sense; history of deception, crime, impulsive behavior;
little emotional empathy or remorse for harming others; high risk for substance abuse
b. Borderline – unstable moods and intense stormy relationships; self-mutilation or suicidal
threats or gestures to get attention; tendency to see others as “all good” or “all bad”
c. Histrionic – constant attention-seeking, grandiose language, provocative dress,
exaggerated illness, all to gain attention; emotional, lively, overly dramatic, enthusiastic; flirtatious
d. Narcissistic – inflated sense of self-importance, absorbed by fantasies or self or success;
poor longer-term relationships; exploitative of others
3. Anxious/Inhibited Cluster
a. Avoidant – socially anxious and uncomfortable unless they are confident of being liked;
fears criticism; avoids social situations due to fear of rejection
b. Dependent – submissive, dependent, requiring excessive approval, reassurance and
advice; clings to people; lacks self-confidence; uncomfortable when alone
c. Obsessive-compulsive (NOT OCD) – conscientious, orderly, perfectionist; excessive need
to do everything right; fear of errors; poor expression of emotions
B. Antisocial Personality Disorder (APD) – pattern of disregard for, and violation of, the rights of
others
1. Usually starts with conduct disorder (aggression, rule violations, etc.) in adolescence
 

 
2. Sociopath and psychopath (coldhearted, manipulative, and ruthless)
3. Less active hippocampus and amygdala when shown negative conditional words, resulting in
less sensitivity to fear

 
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