Chapter Summary
Psychological Disorders
1. Several criteria may be used to define abnormal behavior. By the standard of statistical rarity, behavior is abnormal when it is infrequent. Behavior is dysfunctional when it interferes with the person’s ability to function in day -to-day life. The criterion of personal distress is frequently used in identifying the presence of a psychological disorder. Departures from social norms are used to define deviant, and therefore abnormal, behaviors; however, social norms can change over time and vary across cultures.
2. Insanity is a legal ruling that an accused individual will not be held responsible for a crime. The public’s perceptions of insanity pleas are not consistent with data showing that such pleas are infrequently used and rarely successful. The most frequently used definition of insanity is the M’Naughton or “right-wrong” rule.
3. Models of behavior are like road maps that help us understand what we investigate. The medical model views abnormal behaviors as no different from illnesses and seeks to identify symptoms and prescribe medical treatments. Several psychological models exist. The psychodynamic model considers abnormal behavior as the result of unconscious conflicts, often dating from childhood. The behavioral model views abnormal behaviors as learned through classical conditioning, operant conditioning, and modeling. The cognitive model suggests that our interpretation of events and our beliefs influence our behavior. The sociocultural model emphasizes the importance of social and cultural factors in the frequency, diagnosis, and conception of disorders. For example, the emphasis on thinness in Western countries seems to affect the rate of anorexia nervosa. Culture-bound syndromes such as taijin kyofusho and ataque de nervios reveal how culture influences the development of symptoms of disorders. Growing evidence suggests that many disorders have multiple causes. The biopsychosocial model combines biological (medical-model) factors with psychological and sociocultural factors to provide a comprehensive understanding of the development of abnormal behaviors.
4. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) of Mental Disorders provides rules for diagnosing psychological disorders without specifying a model of abnormal behavior. The emphasis on diagnostic rules has increased reliability—the degree to which mental health professionals agree that a person suffers from a particular disorder.
5. Rosenhan’s pseudopatient study raises questions about our ability to identify normal and abnormal behaviors and shows how labels affect the perception of behavior.
6. Epidemiologists study the prevalence and incidence of accidents, diseases, and psychological disorders. Two major surveys of the prevalence of psychological disorders indicate that phobias, alcohol and drug abuse or dependence, and major depressive episodes are among the most common psychological disorders. Many individuals suffer from more than one psychological disorder (comorbidity).
7. Anxiety may involve behavioral, cognitive, and physiological elements.
Phobias are excessive, irrational fears of activities, objects, or situations. The most frequently diagnosed phobia is agoraphobia. The DSM-IV also lists social phobia and specific phobia. Classical conditioning and modeling have been offered as explanations for the development of phobias.
8. Frequent panic attacks (which resemble heart attacks) are the main symptom of panic disorder. Biological and cognitive explanations for this disorder have been proposed. A person with a chronically high level of anxiety may suffer from generalized anxiety disorder.
9. Most individuals who have the diagnosis of obsessive-compulsive disorder have both obsessions and compulsions. Obsessions are senseless thoughts, images, or impulses that occur repeatedly; they are often accompanied by compulsions, which are irresistible, repetitive acts. Low levels of serotonin and elevated activity in the frontal lobes and basal ganglia have been proposed as possible causes.
10. Somatoform disorders involve the presentation of physical symptoms that have no medical causes, but psychological factors are involved. Among these disorders are hypochondriasis, somatization disorder, and conversion disorder. People with hypochondriasis present physical symptoms that they believe reflect a serious disease; individuals with somatization disorder present a range of unrelated symptoms. Conversion disorders may involve anatomically impossible losses of motor or sensory ability in response to stressful situations. Modeling appears to play a role in some cases of conversion disorder.
11. Dissociative disorders involve a disruption in some function of the mind. In dissociative amnesia, important memories cannot be recalled; in dissociative fugue, memory loss is accompanied by travel. Dissociative identity disorder (multiple personality) is characterized by the presence of two or more personalities in the same individual. Many cases of multiple personality occur in persons who report sexual or physical abuse in childhood. The recent increase in reports of this disorder is controversial; some experts believe the increase is real, whereas others suggest that therapists may unwittingly encourage patients to present these symptoms.
12. Depression affects almost all facets of an individual’s life; the symptoms include sadness, reduced pleasure and energy levels, feelings of guilt, sleep disturbances, and suicidal thinking. The lifetime prevalence of depression is twice as high among women as among men; prevalence rates throughout the world have increased over the past century. Reductions in family and community support may account for this increase.
13. Suicide, which is often associated with depression, is one of the leading causes of death in the United States. Rates of suicide are higher among men than among women, although women make more suicide attempts. The risk factors for suicide include being male, being unmarried, and being depressed. Contrary to popular belief, most suicides are preceded by some type of warning.
14. Because the effects of depression can be seen in the workplace, efforts are being made to educate supervisors about their role in helping employees suffering from this disorder.
15. Bipolar disorder involves swings between depression and mania. The symptoms of mania include euphoria, increased energy, and poor judgment.
16. Mood disorders tend to run in families, which suggests genetic transmission. Mood disorders may involve lower than normal levels of norepinephrine or serotonin. According to the learned helplessness model, depression can also be brought on when people believe that they cannot control outcomes. A refinement of this model suggests that typical ways of explaining negative events may be at the root of depression. This model, known as the hopelessness model, is similar to the cognitive model of depression.
17. Schizophrenia affects about 1.5 percent of the population. It is often confused with dissociative identity disorder; however, the two are different disorders. Schizophrenia is characterized by a split between thoughts and emotions and a separation from reality.
18. The symptoms of schizophrenia can be classified as positive (excesses) or negative (deficits). Positive symptoms include fluent but disorganized speech, delusions, and hallucinations. Negative symptoms include disturbances in emotional expression such as blunt or flat affect along with disturbances in volition.
19. The DSM-IV lists five subtypes of schizophrenia: catatonic, disorganized, paranoid, residual, and undifferentiated.
20. Schizophrenia tends to run in families; the risk of developing the disorder increases with the degree of genetic relatedness between an individual and a family member who has schizophrenia.
21. Evidence of various brain abnormalities, including larger ventricles, smaller limbic structures, and a smaller thalamus, in schizophrenic patients suggests a possible cause for the disorder. Several sources also point to the importance of the neurotransmitter dopamine in explaining schizophrenia.
22. Environmental influences on schizophrenia include stress and hostile family communication. A predisposition to schizophrenia may be inherited, with the actual development of the disorder requiring the presence of other factors such as poverty or family conflict.
23. Personality disorders are long-standing dysfunctional patterns of behavior.
A person with antisocial personality disorder displays few of the signs usually associated with psychological disorders, such as anxiety. They are often described as deceitful, impulsive, and remorseless. Low levels of arousal may play a role in the development of this disorder.
24. Gender identity disorder (transsexualism) is a sexual disorder in which a person believes that he or she should have been a member of the opposite sex. The only effective treatment is sex reassignment surgery.
25. Paraphilias are disorders involving sexual arousal in unusual situations or in response to unusual objects. Fetishism is a paraphilia in which a male is sexually aroused by an object such as boots. One of the explanations for fetishism and perhaps other paraphilias is classical conditioning.