©2001 Prentice Hall Psychological Disorders I. General Overview II. Specific Disorders.

©2001 Prentice Hall

Psychological DisordersPsychological Disorders

I. General OverviewI. General Overview

II. Specific DisordersII. Specific Disorders

Defining AbnormalDefining Abnormal What it is …What it is …

Low statistical frequencyLow statistical frequency Social deviationSocial deviation

40 years ago, if men wore earrings . . .40 years ago, if men wore earrings . . . Maladaptive behavior Maladaptive behavior

Disrupted functioning at home, work, and in Disrupted functioning at home, work, and in social lifesocial life

Personal distressPersonal distress Source of the problem lies within the personSource of the problem lies within the person

What it’s not …What it’s not … A response to specific life eventsA response to specific life events A deliberate reaction to a societal conditionA deliberate reaction to a societal condition

Culture and PsychopathologyCulture and Psychopathology

Psychological disorders are Psychological disorders are somewhat culturally relativesomewhat culturally relative In Roman Catholic rural Ireland, In Roman Catholic rural Ireland,

schizophrenics have more bizarre schizophrenics have more bizarre religious beliefsreligious beliefs

Alaskan Eskimos define someone as Alaskan Eskimos define someone as “crazy” when they drink urine or kill “crazy” when they drink urine or kill dogsdogs

Anorexia and bulimia nervosaAnorexia and bulimia nervosa

DSM-IVDSM-IV DSM-IV: Diagnostic and Statistical Manual of DSM-IV: Diagnostic and Statistical Manual of

Mental Disorders, 4Mental Disorders, 4thth edition edition Multiaxial (multidimensional) system of Multiaxial (multidimensional) system of

diagnosisdiagnosis• Axis I - the clinical syndrome for which a Axis I - the clinical syndrome for which a

patient seeks treatmentpatient seeks treatment• Axis II - an enduring personality disorder that Axis II - an enduring personality disorder that

may contribute to axis Imay contribute to axis I• Axis III – medical conditionAxis III – medical condition• Axis IV – stressorsAxis IV – stressors• Axis V – global assessment of functioningAxis V – global assessment of functioning

Traditional classification schemeTraditional classification scheme NeurosesNeuroses

• Has conflicts in relationships, competitivenessHas conflicts in relationships, competitiveness• Rigid, defensive, under-confident at workRigid, defensive, under-confident at work• Reality is slightly distortedReality is slightly distorted

Personality disordersPersonality disorders• Begins and ends relationships too quicklyBegins and ends relationships too quickly• Underemployed, drifting from job to jobUnderemployed, drifting from job to job• Misinterprets interpersonal eventsMisinterprets interpersonal events

Psychoses: Psychoses: biological etiologybiological etiology• Cannot maintain relationships; socially peculiarCannot maintain relationships; socially peculiar• Chronically unemployedChronically unemployed• Has delusions, hallucinations, etc.Has delusions, hallucinations, etc.

Assessment for Assessment for Psychological DisordersPsychological Disorders

AssessmentAssessment• Examining a person’s mental, emotional, and Examining a person’s mental, emotional, and

behavioral functionsbehavioral functions– The goal is to make a The goal is to make a diagnosisdiagnosis and, from there, and, from there,

form a form a prognosisprognosis

Mental Status ExamMental Status Exam Clinical InterviewClinical Interview

• Unstructured vs. structured (e.g., SCID)Unstructured vs. structured (e.g., SCID) Neuropsychological testingNeuropsychological testing

• Is there some specific brain insult involved?Is there some specific brain insult involved? Psychological testing (see next slide)Psychological testing (see next slide)

Psychological TestingPsychological Testing Minnesota Multiphasic Personality Inventory – Minnesota Multiphasic Personality Inventory –

2 (MMPI –2)2 (MMPI –2)• Most widely used personality/psychological Most widely used personality/psychological

disorders instrumentdisorders instrument• Measures aspects of personality that, if extreme, Measures aspects of personality that, if extreme,

suggest a psychological problem suggest a psychological problem • Long test ‑ 567 questionsLong test ‑ 567 questions• Has ten different diagnostic scales (“multiphasic”; Has ten different diagnostic scales (“multiphasic”;

see next slide)see next slide)• Scale scores indicate how you compare with Scale scores indicate how you compare with

othersothers• Yields a personality profile (see next slide)Yields a personality profile (see next slide)

MMPI Score Profile MMPI Score Profile (across the 10 diagnostic scales)(across the 10 diagnostic scales)

MMPI Validity ScalesMMPI Validity Scales

Four additional scales are designed to Four additional scales are designed to determine whether respondent is determine whether respondent is presenting self accurately. presenting self accurately.

Example: L scale (‘Fake Good’) - Trying Example: L scale (‘Fake Good’) - Trying too hard to present self in a positive light.too hard to present self in a positive light.• ““I smile at everyone I meet” (T) I smile at everyone I meet” (T) • ““I read every editorial every day” (T)I read every editorial every day” (T)

Pros and cons of diagnosisPros and cons of diagnosis ProsPros

Diagnosis is the first step towards Diagnosis is the first step towards treatment and researchtreatment and research

Cons (“labeling”)Cons (“labeling”) Can be used to mark an individual that Can be used to mark an individual that

society considers deviantsociety considers deviant StigmatizationStigmatization Stereotyping Stereotyping DiscriminationDiscrimination Rosenhan (1973)Rosenhan (1973)

Models of AbnormalityModels of Abnormality Psychological ModelPsychological Model: M: Mental disorders ental disorders

are caused and maintained by life experienceare caused and maintained by life experience.. Psychodynamic Psychodynamic Cognitive and/or behavioralCognitive and/or behavioral Family systems (see notes page)Family systems (see notes page)

Biological (Medical) ModelBiological (Medical) Model: M: Mental ental disorders are caused by biological conditions disorders are caused by biological conditions and can be treated through medical and can be treated through medical interventionintervention..

Diathesis-Stress ModelDiathesis-Stress Model: : Mental disorders Mental disorders occur whenoccur when people with an underlying people with an underlying vulnerability (genetically or environmentally vulnerability (genetically or environmentally caused) are under a great deal of stress.caused) are under a great deal of stress.

The case of CharlieThe case of Charlie

24-year old business student with an 24-year old business student with an intense fear of being in groups (anxiety intense fear of being in groups (anxiety disorder: social phobia)disorder: social phobia) He is most anxious when talking about He is most anxious when talking about

businessbusiness This disorder is disruptive of work and This disorder is disruptive of work and

social life and is a cause of personal social life and is a cause of personal distressdistress

Problem has intensified since his father, Problem has intensified since his father, who did not go to college, ridiculed him for who did not go to college, ridiculed him for going to business schoolgoing to business school

Charlie viewed by different Charlie viewed by different psychological modelspsychological models

Psychodynamic: conflictPsychodynamic: conflict• Consciously, Charlie wants to succeed but Consciously, Charlie wants to succeed but

unconsciously this evokes father’s ridicule unconsciously this evokes father’s ridicule and guilt feelings about outdoing his fatherand guilt feelings about outdoing his father

Behavioral: learningBehavioral: learning• Phobia is a conditioned emotional response; Phobia is a conditioned emotional response;

anxiety -> social incompetence -> avoidance -> anxiety -> social incompetence -> avoidance -> negative reinforcement of avoidance -> further negative reinforcement of avoidance -> further erosion of social skillserosion of social skills

Cognitive: dysfunctional cognitionsCognitive: dysfunctional cognitions• Low self-efficacy expectancies, learned Low self-efficacy expectancies, learned

helplessness, negative cognitions regarding helplessness, negative cognitions regarding selfself

Psychological disordersPsychological disorders Anxiety disordersAnxiety disorders Mood disordersMood disorders Schizophrenic disordersSchizophrenic disorders Personality disordersPersonality disorders Childhood disordersChildhood disorders Some othersSome others

⁉ Substance abuseSubstance abuse⁉ Somatoform disordersSomatoform disorders⁉ Dissociative disordersDissociative disorders⁉ Sexual and gender-identity disordersSexual and gender-identity disorders⁉ Eating disordersEating disorders

Understanding psychological disordersUnderstanding psychological disorders Prevalence ratesPrevalence rates Types: Major types and subtypesTypes: Major types and subtypes

Anxiety disorders is one example of a Anxiety disorders is one example of a major type of disordermajor type of disorder Anxiety disorder subtypesAnxiety disorder subtypes

PhobicPhobic GeneralizedGeneralized PanicPanic Obsessive-compulsiveObsessive-compulsive Post-traumatic stressPost-traumatic stress

SymptomsSymptoms Theories/CausesTheories/Causes

Nature vs. NurtureNature vs. Nurture

Comorbidity of DisordersComorbidity of Disorders

Many people who have psychological Many people who have psychological disorders experience more than one disorders experience more than one diagnosable disorder at the same time.diagnosable disorder at the same time.

Substance abuse: AlcoholismSubstance abuse: Alcoholism 33rdrd largest health problem, following heart largest health problem, following heart

disease and cancerdisease and cancer• Prevalence rate ~ 5%Prevalence rate ~ 5%

Children of alcoholics are 4x as likely to Children of alcoholics are 4x as likely to develop alcoholism as children of develop alcoholism as children of nonalcoholicsnonalcoholics

Environmental causesEnvironmental causes• Parents model alcoholic behaviorParents model alcoholic behavior• Parenting style leads to low self-esteem in Parenting style leads to low self-esteem in

children, who then self-medicatechildren, who then self-medicate

Alcoholism and heredityAlcoholism and heredity

Genetic predispositions may causeGenetic predispositions may cause Liking the taste of alcohol or finding Liking the taste of alcohol or finding

the effects of alcohol soothingthe effects of alcohol soothing Depression or anxiety, which then Depression or anxiety, which then

leads to self-medicationleads to self-medication Antisocial or delinquent personality Antisocial or delinquent personality

and behaviors, which in turn may and behaviors, which in turn may include alcohol abuse given the include alcohol abuse given the appropriate social environmentappropriate social environment

©2001 Prentice Hall

Anxiety DisordersAnxiety Disorders

Phobic Disorder Phobic Disorder

Generalized Anxiety DisorderGeneralized Anxiety Disorder

Panic DisorderPanic Disorder

Obsessive-Compulsive DisorderObsessive-Compulsive Disorder

Phobic DisorderPhobic Disorder A phobia is an irrational fear of an object A phobia is an irrational fear of an object

or situation.or situation. Most common subtype of anxiety Most common subtype of anxiety

disorder disorder This anxiety disorder subtype itself This anxiety disorder subtype itself

includes three subtypesincludes three subtypes• Simple (specific) phobia (10%)Simple (specific) phobia (10%)• Social phobia (5%)Social phobia (5%)• Agoraphobia (1-2%)Agoraphobia (1-2%)

Panic AttackPanic Attack Panic: Sudden and Panic: Sudden and

intense physiological intense physiological reactions that occur reactions that occur in the absence of an in the absence of an emergencyemergency

Frequent attacks Frequent attacks diagnosed as diagnosed as panic panic disorderdisorder

In many cases, the In many cases, the first attack comes first attack comes soon after illness, soon after illness, miscarriage, or other miscarriage, or other traumatic event.traumatic event.

Obsessive-Compulsive DisorderObsessive-Compulsive Disorder ObsessionsObsessions

• Persistent thoughts that cannot be controlledPersistent thoughts that cannot be controlled– Terrible accident involving a loved one is about to Terrible accident involving a loved one is about to

occuroccur– Underwear is filled with germsUnderwear is filled with germs

CompulsionsCompulsions• Intentional behaviors or mental acts (that often Intentional behaviors or mental acts (that often

become ritualistic) that are performed in the become ritualistic) that are performed in the hope of warding off the obsessionhope of warding off the obsession

– Washing one’s underwear 22 timesWashing one’s underwear 22 times If the compulsion is prevented, anxiety occurs.If the compulsion is prevented, anxiety occurs. Two-thirds of Obsessive-Compulsive patients Two-thirds of Obsessive-Compulsive patients

improved after 10 years (w/o treatment), but very improved after 10 years (w/o treatment), but very few were symptom-freefew were symptom-free

Causes of anxiety disorders ICauses of anxiety disorders I CognitiveCognitive

• Anxious individuals perceive Anxious individuals perceive ambiguous stimuli as threateningambiguous stimuli as threatening

BiologicalBiological• Children with inhibited temperaments Children with inhibited temperaments

are more likely to have anxiety are more likely to have anxiety disorders as adultsdisorders as adults

• OCD has been linked to an under-OCD has been linked to an under-active caudate nucleus and an active caudate nucleus and an overactive prefrontal cortexoveractive prefrontal cortex

Causes of anxiety disorders IICauses of anxiety disorders II Situational (Learning)Situational (Learning)

• In phobias, associations may be learned between In phobias, associations may be learned between previously neutral objects and a traumatic eventpreviously neutral objects and a traumatic event

– And then generalized to other previously neutral objectsAnd then generalized to other previously neutral objects• In OCD, relief is associated with performing an In OCD, relief is associated with performing an

action to escape an aversive stimulus action to escape an aversive stimulus – This can be rewarding and can cause that behavior to be This can be rewarding and can cause that behavior to be

performed with increasing frequencyperformed with increasing frequency• In agoraphobia, embarrassing panic attacks in In agoraphobia, embarrassing panic attacks in

public are avoided by staying at homepublic are avoided by staying at home– Again, the relief from anxiety is rewarding and causes the Again, the relief from anxiety is rewarding and causes the

person to stay home with increasing frequencyperson to stay home with increasing frequency

©2001 Prentice Hall

Mood DisordersMood Disorders

Major DepressionMajor Depression

DysthymiaDysthymia

Bipolar DisorderBipolar Disorder

Mood disorders: Mood disorders: Major depressionMajor depression

Symptoms includeSymptoms include Depressed mood and loss of interest in Depressed mood and loss of interest in

pleasurable activitiespleasurable activities Disturbances in appetite, sleep, energy Disturbances in appetite, sleep, energy

level, and concentrationlevel, and concentration Feelings of guilt and worthlessnessFeelings of guilt and worthlessness Thoughts of suicideThoughts of suicide

15% of depressed people go on to commit 15% of depressed people go on to commit suicide suicide 30,000 people per year in the USA30,000 people per year in the USA

Depression is a progressive disorderDepression is a progressive disorder Lifetime prevalence rate ~ 20%Lifetime prevalence rate ~ 20%

5% in a given year5% in a given year

Major Depression: Major Depression: Theories/CausesTheories/Causes

GeneticsGenetics Fraternal twins: 20%; Identical twins: 50%Fraternal twins: 20%; Identical twins: 50% Heritability is .3 to .5Heritability is .3 to .5 Family history doubles/triples chancesFamily history doubles/triples chances

BiologyBiology Low levels of two neurotransmitters Low levels of two neurotransmitters

(serotonin and norepinephrine) that are (serotonin and norepinephrine) that are involved in arousal and control of sleep involved in arousal and control of sleep cyclescycles

Antidepressants (Prozac) increase the level Antidepressants (Prozac) increase the level of these neurotransmitters in the brain by of these neurotransmitters in the brain by blocking reuptake at synapsesblocking reuptake at synapses

Major Depression: Major Depression: Environmental factorsEnvironmental factors Childhood: Depressed adults are more likely to Childhood: Depressed adults are more likely to

have grown up in disruptive, hostile, and have grown up in disruptive, hostile, and negative home environmentsnegative home environments

Adulthood: Severe stressors (e.g., Adulthood: Severe stressors (e.g., interpersonal loss), high levels of criticism, and interpersonal loss), high levels of criticism, and lack of intimate relationshipslack of intimate relationships

Depressed people themselvesDepressed people themselves Their social behavior leads to social Their social behavior leads to social

rejection which, in turn, worsens depressionrejection which, in turn, worsens depression They tend to seek out others that have They tend to seek out others that have

negative views of themselvesnegative views of themselves

Major Depression: Major Depression: Behavioral/Cognitive TheoriesBehavioral/Cognitive Theories

Beck’s theory of depressionBeck’s theory of depression Interpret events unfavorablyInterpret events unfavorably Do not like themselvesDo not like themselves Regard the future pessimisticallyRegard the future pessimistically These lead to cognitive distortionsThese lead to cognitive distortions

Learned helplessnessLearned helplessness Pessimistic (depressive or negative) Pessimistic (depressive or negative)

explanatory styleexplanatory style Explain failures with internal (personal), stable, Explain failures with internal (personal), stable,

and global attributionsand global attributions

Explanatory Style and Explanatory Style and DepressionDepression

Measured Measured explanatory styles explanatory styles among first-year among first-year college studentscollege students

Two years later, Two years later, those with negative those with negative style were more style were more likely to experience likely to experience a major or minor a major or minor depressive disorderdepressive disorder

Helping a suicidal friendHelping a suicidal friend Recognizing the signsRecognizing the signs

Talking about suicideTalking about suicide Preoccupation with deathPreoccupation with death Putting things in order; “saying goodbye”Putting things in order; “saying goodbye”

Changes in behaviorChanges in behavior Outgoing person becomes withdrawnOutgoing person becomes withdrawn Loss of interest in school and usual activitiesLoss of interest in school and usual activities Problems with sleeping, eating, personal hygieneProblems with sleeping, eating, personal hygiene

Taking actionTaking action Talk to your friend; ask about suicidal Talk to your friend; ask about suicidal

thoughts and plansthoughts and plans Stay with your friend; help them help Stay with your friend; help them help

themselves and/or tell others in a position to themselves and/or tell others in a position to helphelp

©2001 Prentice Hall

Schizophrenic DisordersSchizophrenic Disorders

The Symptoms of SchizophreniaThe Symptoms of Schizophrenia

Types of SchizophreniaTypes of Schizophrenia

Theories of SchizophreniaTheories of Schizophrenia

SchizophreniaSchizophrenia Umbrella term for a number of different Umbrella term for a number of different

disorders marked by gross cognitive, disorders marked by gross cognitive, perceptual, emotional, and behavioral perceptual, emotional, and behavioral disturbancedisturbance

Lifetime prevalence rate < 1%Lifetime prevalence rate < 1% Negative symptomsNegative symptoms

Flat affectFlat affect Slowed movement or speechSlowed movement or speech Social withdrawalSocial withdrawal Impoverished thoughtImpoverished thought

Positive symptoms of Positive symptoms of schizophreniaschizophrenia

Delusions: Delusions: firmly held false beliefsfirmly held false beliefs

Influence: thoughts are read or manipulatedInfluence: thoughts are read or manipulated Grandeur: famous or capable of powerful actsGrandeur: famous or capable of powerful acts Persecution: target of secret plotsPersecution: target of secret plots

Hallucinations: Hallucinations: sensory experiences w/o external sensory experiences w/o external stimulation; auditory hallucinations are the most commonstimulation; auditory hallucinations are the most common

Incoherent thinkingIncoherent thinking Loosening of associationsLoosening of associations

Displayed in speech whose direction flows in a freely Displayed in speech whose direction flows in a freely associative mannerassociative manner

Inability to focus on one thing and filter out distractionsInability to focus on one thing and filter out distractions

Bizarre behaviorBizarre behavior

Types of SchizophreniaTypes of Schizophrenia Paranoid: Paranoid: Delusions (especially persecution) Delusions (especially persecution)

and hallucinationsand hallucinations

Disorganized: Disorganized: Illogical thought, incoherent Illogical thought, incoherent speech, and inappropriate affectspeech, and inappropriate affect

Catatonic: Catatonic: Motor immobility, rigid posture or Motor immobility, rigid posture or excessive motor activity, including parrot-like excessive motor activity, including parrot-like repetitionrepetition

Undifferentiated: Undifferentiated: Mixture of the aboveMixture of the above

Residual: Residual: Partial remission after an acute Partial remission after an acute episode, marked by negative symptomsepisode, marked by negative symptoms

Schizophrenia: Schizophrenia: Theories/CausesTheories/Causes

GeneticsGenetics Fraternal twins: 17%; Identical twins: 48%Fraternal twins: 17%; Identical twins: 48% Heritability is .5 to .9Heritability is .5 to .9

BiologyBiology High levels of dopamineHigh levels of dopamine

Antipsychotic medications decrease influence of Antipsychotic medications decrease influence of dopamine by blocking receptor sites at the synapsedopamine by blocking receptor sites at the synapse

Brain atrophy (neuronal loss) reflected in Brain atrophy (neuronal loss) reflected in enlarged ventricles in schizophrenicsenlarged ventricles in schizophrenics

Even though schizophrenia typically emerges in Even though schizophrenia typically emerges in early 20’s, unusual social, emotional, and motor early 20’s, unusual social, emotional, and motor behaviors are evident during childhoodbehaviors are evident during childhood

Schizophrenia: Schizophrenia: Environmental FactorsEnvironmental Factors

Psychological Psychological Patterns of communication within familiesPatterns of communication within families

Confusing communication that involves mixed messagesConfusing communication that involves mixed messages

Expressed emotion in familiesExpressed emotion in families Criticism, hostile interchanges, and emotional intrusivenessCriticism, hostile interchanges, and emotional intrusiveness

BiologicalBiological Schizovirus?Schizovirus?

Antibodies found in blood of schizophrenics, but not othersAntibodies found in blood of schizophrenics, but not others Schizophrenics more likely to have been born in spring, meaning that Schizophrenics more likely to have been born in spring, meaning that

they were in their 2they were in their 2ndnd trimester during flu season trimester during flu season In late-splitting identical twins that shared the same plancenta, the In late-splitting identical twins that shared the same plancenta, the

concordance rate is 60%concordance rate is 60% 20% in early splitting identical twins20% in early splitting identical twins

©2001 Prentice Hall

Personality DisordersPersonality Disorders

The Borderline PersonalityThe Borderline Personality

The Antisocial PersonalityThe Antisocial Personality

Personality DisordersPersonality Disorders

Marked by persistent (since adolescence), Marked by persistent (since adolescence), extremely maladaptive behaviorextremely maladaptive behavior

Usually lasts throughout the life spanUsually lasts throughout the life span

Seldom seek treatmentSeldom seek treatment

Improvement is uncommonImprovement is uncommon Lifetime prevalence rate ~ 5-10%Lifetime prevalence rate ~ 5-10%

Two subtypes of interestTwo subtypes of interest

Borderline Personality DisorderBorderline Personality Disorder

Antisocial Personality DisorderAntisocial Personality Disorder

Borderline Personality Disorder: Borderline Personality Disorder: SymptomsSymptoms

Unstable personal relationships Unstable personal relationships Lack of a clear identity leads them to . . .Lack of a clear identity leads them to . . .

Seek out dependent relationshipsSeek out dependent relationships

Fear abandonmentFear abandonment Extremely sensitive to rejectionExtremely sensitive to rejection

Be very manipulative about controlling any relationshipBe very manipulative about controlling any relationship

Intense, unstable moodsIntense, unstable moods Chronic angerChronic anger

Impulsive behaviorImpulsive behavior Drug and alcohol abuseDrug and alcohol abuse

Sexual promiscuitySexual promiscuity

Self-mutilationSelf-mutilation

Borderline Personality Disorder: Borderline Personality Disorder: CausesCauses

BiologicalBiological• Evidence for heritabilityEvidence for heritability• Low serotonin levelsLow serotonin levels

– Linked to depressionLinked to depression

SituationalSituational• History of trauma or abuseHistory of trauma or abuse• Hypercritical caregiversHypercritical caregivers• Caregivers that encourage dependenceCaregivers that encourage dependence

Antisocial Personality Disorder: Antisocial Personality Disorder: SymptomsSymptoms

Known pejoratively as “psychopath” or “sociopath”Known pejoratively as “psychopath” or “sociopath” Lack of remorse; lack of empathyLack of remorse; lack of empathy Seeks immediate gratification without any thought of Seeks immediate gratification without any thought of

othersothers Impulsive; sensation-seekingImpulsive; sensation-seeking Many are very intelligent and highly verbalMany are very intelligent and highly verbal Punishment has little effect on themPunishment has little effect on them Different “subtypes”Different “subtypes”

• White collar criminalWhite collar criminal• Con manCon man• Habitually violent offenderHabitually violent offender• Psychopath (e.g., Hannibal Lecter)Psychopath (e.g., Hannibal Lecter)

Antisocial Personality Disorder: Antisocial Personality Disorder: CausesCauses

Feel little fear or anxietyFeel little fear or anxiety Lower overall level of arousalLower overall level of arousal

• Therefore they are sensation-seekersTherefore they are sensation-seekers• Therefore they do not find punishment Therefore they do not find punishment

aversiveaversive Evidence for heritabilityEvidence for heritability

• Adopted male children have a higher Adopted male children have a higher rate of crime if their biological fathers rate of crime if their biological fathers had criminal recordshad criminal records

Low SES, poor nutrition as a childLow SES, poor nutrition as a child

©2001 Prentice Hall

Somatoform DisordersSomatoform Disorders

HypochondriasisHypochondriasis

Conversion DisorderConversion Disorder

Somatoform DisordersSomatoform Disorders

HypochondriasisHypochondriasis: A disorder : A disorder characterized by an unwarranted characterized by an unwarranted preoccupation with one’s physical health.preoccupation with one’s physical health.

Conversion DisorderConversion Disorder: A disorder in : A disorder in which a person temporarily loses a bodily which a person temporarily loses a bodily function in the absence of a physical function in the absence of a physical cause.cause.

Lifetime prevalence rate of .3%Lifetime prevalence rate of .3%

Sensitivity in HypochondriasisSensitivity in Hypochondriasis Foot put into tub of ice waterFoot put into tub of ice water

• 15 hypochondriac women15 hypochondriac women• 15 control women15 control women

Heart rate and hand Heart rate and hand temperature were recordedtemperature were recorded

Hypochondriacs Hypochondriacs • removed their foot sooner removed their foot sooner • rated cold as more rated cold as more

unpleasantunpleasant Physiological signs of stress Physiological signs of stress

were higher in were higher in hypochondriacshypochondriacs

Conversion DisordersConversion Disorders

In “Glove Anesthesia” In “Glove Anesthesia” (shown), the hand may (shown), the hand may be numb, although four be numb, although four different nerve tracts different nerve tracts provide sensation to provide sensation to the hand and lower armthe hand and lower arm• The physical The physical

symptoms don’t symptoms don’t match what is match what is known about known about physiologyphysiology

Symptoms Neural Wiring

©2001 Prentice Hall

Dissociative DisordersDissociative Disorders

Amnesia and Fugue StatesAmnesia and Fugue States

Dissociative Identity DisorderDissociative Identity Disorder

Dissociative DisordersDissociative Disorders AmnesiaAmnesia: A dissociative disorder involving a : A dissociative disorder involving a

partial or complete loss of memory.partial or complete loss of memory. Fugue StateFugue State: A form of amnesia in which a : A form of amnesia in which a

person “forgets” his or her identity, wanders person “forgets” his or her identity, wanders from home, and starts a new life.from home, and starts a new life.

Dissociative Identity Disorder (DID):Dissociative Identity Disorder (DID): A A condition in which an individual develops two condition in which an individual develops two or more distinct identities.or more distinct identities.• Formerly known as “Multiple Personality Formerly known as “Multiple Personality

Disorder.”Disorder.” Lifetime prevalence rate is “very rare”Lifetime prevalence rate is “very rare”

©2001 Prentice Hall

Childhood DisordersChildhood Disorders

AutismAutism

Attention-Deficit/HyperactivityAttention-Deficit/Hyperactivity

AutismAutism Extreme lack of awareness of othersExtreme lack of awareness of others Deficits in social interaction, impaired Deficits in social interaction, impaired

communication, and restricted interests communication, and restricted interests characterize autismcharacterize autism

3-6 of 1000 children show signs of autism, with 3-6 of 1000 children show signs of autism, with males outnumbering females 3:1males outnumbering females 3:1

Asperger’s syndromeAsperger’s syndrome is high-functioning autism is high-functioning autism Autism is a biological disorderAutism is a biological disorder

• Some evidence for heritabilitySome evidence for heritability• Prenatal or neonatal eventsPrenatal or neonatal events• Some neurochemistry abnormalitiesSome neurochemistry abnormalities

Attention-Deficit/Hyperactive DisorderAttention-Deficit/Hyperactive Disorder

Restlessness, inattentiveness, and Restlessness, inattentiveness, and impulsivity characterize ADHDimpulsivity characterize ADHD• Need to have directions repeatedNeed to have directions repeated• Friendly, but not many friends because Friendly, but not many friends because

they miss social cuesthey miss social cues 50% of mothers of 4-year-old boys believe 50% of mothers of 4-year-old boys believe

their sons are hyperactive, but actual their sons are hyperactive, but actual diagnostic estimates are 3-5%diagnostic estimates are 3-5%

Symptoms often persist into adulthoodSymptoms often persist into adulthood

ADHD CausesADHD Causes Causes are unknown but probably Causes are unknown but probably

heterogeneousheterogeneous• SituationalSituational

– Poor parentingPoor parenting– Dysfunctional familyDysfunctional family

• Chicken and egg problemChicken and egg problem

• BiologicalBiological– Some evidence for heritabilitySome evidence for heritability– Frontal lobe dysfunctionFrontal lobe dysfunction– Basal ganglia dysfunctionBasal ganglia dysfunction