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Chapter 13Chapter 13
Psychological Disorders
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Defining and ClassifyingDefining and Classifying
Historical Explanations of Abnormal Behaviors• Demonic possession• Physical diseases• Products of psychological
conflicts• Learned maladaptive behaviors• Distorted perceptions of the world
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Defining and ClassifyingDefining and Classifying
Vulnerability-Stress Model
• Each of us has vulnerability for developing a psychological disorder• Stress plays a role in
development
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13-5
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Defining and ClassifyingDefining and Classifying
Criteria for “abnormality”
•Distress•Dysfunction•Deviance
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Defining and ClassifyingDefining and Classifying
Distress
• Judgments of abnormality most likely when distress is disproportionately acute or long-lasting
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Defining and ClassifyingDefining and Classifying
Dysfunctionality
• Either for individual or for society
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Defining and ClassifyingDefining and Classifying
Deviance
• From cultural norms
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Defining and ClassifyingDefining and Classifying
What is Abnormal Behavior?• Behavior that is so:•Personally distressful•Personally dysfunctional•Culturally deviant
that others judge it as inappropriate or maladaptive
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13-11
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Defining and ClassifyingDefining and Classifying
Diagnosing Psychological Disorders
• Reliability•Clinicians should show high levels of agreement in their diagnostic decisions
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Defining and ClassifyingDefining and Classifying
Diagnosing Psychological Disorders
• Validity
•Diagnostic categories should accurately capture essential features of disorders
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Defining and ClassifyingDefining and Classifying
DSM-IV
• Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition• Most widely used classification
system in U.S.
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Defining and ClassifyingDefining and Classifying
DSM-IV Axes• Axis I: Primary clinical
symptoms• Axis II: Long-standing
personality or developmental disorders• Axis III: Relevant physical
conditions
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Defining and ClassifyingDefining and Classifying
DSM-IV Axes cont.
• Axis IV: Intensity of environmental stressors• Axis V: Coping resources as
reflected in recent adaptive functioning
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Defining and ClassifyingDefining and Classifying
Consequences of Diagnostic Labeling
• Social• Personal• Legal
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Defining and ClassifyingDefining and Classifying
Social Consequences of Diagnostic Labeling
•Becomes too easy to accept label as description of the individual
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Defining and ClassifyingDefining and Classifying
Personal Consequences of Diagnostic Labeling
• May accept the new identity implied by the label• May develop the expected role
and outlook
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Defining and ClassifyingDefining and Classifying
Legal Consequences of Diagnostic Labeling
• Involuntary commitment to mental institutions• Loss of civil rights• Indefinite detainment
13-20
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Defining and ClassifyingDefining and Classifying
Legal Concepts• Competency•Defendant’s state of mind at the time of a judicial hearing
• Insanity•Presumed state of mind of defendant at time crime was committed
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Anxiety DisordersAnxiety Disorders
Definition
• Frequency and intensity of anxiety responses are out of proportion to the situations that trigger them • Anxiety interferes with daily
life
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Anxiety DisordersAnxiety Disorders
Components of Anxiety Responses
• Subjective-emotional• Cognitive• Physiological• Behavioral
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13-24
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Anxiety DisordersAnxiety Disorders
Phobias
• Strong and irrational fears of certain objects or situations
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Anxiety DisordersAnxiety Disorders
Agoraphobia: Fear of open and public spaces from which escape would be difficult
Social phobias: Fear of situations in which evaluation might occur
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Anxiety DisordersAnxiety Disorders
Specific phobias: Fear of specific objects such as animals or situations
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Anxiety DisordersAnxiety Disorders
Generalized Anxiety Disorder
• Chronic state of diffuse, “free-floating” anxiety• Anxiety not attached to
specific objects or situations
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Anxiety DisordersAnxiety Disorders
Panic Disorder
• Panic occurs suddenly and unpredictably•Much more intense than
typical anxiety
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13-30
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13-31
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13-32
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Anxiety DisordersAnxiety Disorders
Obsessive-Compulsive Disorder• Obsessions•Repetitive and unwelcome thoughts, images, or impulses
• Compulsions•Repetitive behavioral responses
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Anxiety DisordersAnxiety Disorders
Posttraumatic Stress Disorder
• Severe anxiety disorder•Can occur in people
exposed to extreme trauma
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Anxiety DisordersAnxiety Disorders
Symptoms of PTSD• Severe symptoms of anxiety,
arousal, and distress• Reliving of trauma in
flashbacks• Numb to world and avoidance
of reminders• Intense “survivor guilt”
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Anxiety DisordersAnxiety Disorders
Biological Factors in Anxiety• Overreactive autonomic
nervous system• Overreactive neurotransmitter
systems involved in emotional responses• Overreactive right hemisphere
sites involved in emotions
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Anxiety DisordersAnxiety Disorders
Evolutionary Explanations
• Biological preparedness
•Makes it easier for us to learn to fear certain stimuli
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Anxiety DisordersAnxiety Disorders
Psychodynamic Theory
• Neurotic anxiety
•Occurs when unacceptable impulses threaten to overwhelm the ego’s defenses
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Anxiety DisordersAnxiety Disorders
Cognitive Factors
•Maladaptive thought patterns and beliefs• Exaggerated
misinterpretations of stimuli
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Anxiety DisordersAnxiety Disorders
Learned Responses
• Result of “emotional conditioning” (Öhman, 2000; Rachman, 1998)• Classically conditioned fear• Observational learning
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Anxiety DisordersAnxiety Disorders
Culture-Bound Disorders
•Occur only in certain locales•e.g., Anorexia Nervosa, Taijin Kyofushu
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Somatoform DisordersSomatoform Disorders
Involve physical complaints that suggest a medical problem
But no biological cause
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Somatoform DisordersSomatoform Disorders
Hypochondriasis
•Great alarm about physical symptoms•Convinced of serious
illness
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Somatoform DisordersSomatoform Disorders
Pain Disorder
• Experience of intense pain out of proportion to medical conditions• No physical basis for
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Somatoform DisordersSomatoform Disorders
Conversion Disorder
• Serious neurological disorders suddenly occur• e.g., paralysis, loss of
sensation, blindness
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Glove Actual nerve anethesia innervation
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Somatoform DisordersSomatoform Disorders
Predispositions
• May involve combinations of biological and psychological vulnerabilities• Genetics, environmental
learning, and social reinforcement for bodily symptoms (Trimble, 2003)
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Somatoform DisordersSomatoform Disorders
Incidence (Tanaka-Matsumi & Draguns, 1997)
• Higher in cultures that:
•Discourage open discussion of emotions•Stigmatize psychological disorders
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Dissociative DisordersDissociative Disorders
Breakdown of normal personality integration
• Results in alterations to memory or identity
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Dissociative DisordersDissociative Disorders
Psychogenic Amnesia
•Response to stressful event with extensive but selective memory loss
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Dissociative DisordersDissociative Disorders
Psychogenic Fugue
• Loss of all sense of personal identity• Establishment of new
identity in a new location
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Dissociative DisordersDissociative Disorders
Dissociative Identity Disorder (DID)
• Formerly called multiple personality disorder• Two or more separate
personalities coexist in the same person
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Dissociative DisordersDissociative Disorders
Causes of DID
• Trauma-Dissociation Theory
•Development of personalities is a response to severe stress
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Dissociative DisordersDissociative Disorders
Criticisms of DID
• Large increase in cases in recent years•Are personalities
unintentionally implanted by overzealous therapists?
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Mood (Affective) DisordersMood (Affective) Disorders
Involve depression and mania
Most frequently experienced (with anxiety disorders) psychological disorders
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Mood (Affective) DisordersMood (Affective) Disorders
Major Depression
• Intense depressed state• Leaves people unable to
function effectively in their lives
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Mood (Affective) DisordersMood (Affective) Disorders
Dysthymia
• Intense form of depression• Less dramatic effects on
personal and occupational functioning• More chronic than major
depression
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Mood (Affective) DisordersMood (Affective) Disorders
Symptoms of Depression
•Negative mood•Cognitive symptoms•Motivational symptoms• Somatic (physical)
symptoms
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13-59
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13-60
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Mood (Affective) DisordersMood (Affective) Disorders
Negative Mood in Depression
• Sadness, misery, loneliness
• Loss of capacity for psychological, biological pleasures
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Mood (Affective) DisordersMood (Affective) Disorders
Cognitive Symptoms of Depression
• Difficulty concentrating and making decisions• Low self-esteem• Feelings of inferiority• Blame selves for failures• Pessimism and hopelessness
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Mood (Affective) DisordersMood (Affective) Disorders
Motivational Symptoms of Depression
• Inability to get started on task• Inability to perform behaviors
leading to pleasure or accomplishment
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Mood (Affective) DisordersMood (Affective) Disorders
Somatic (Bodily) Symptoms of Depression
• Loss of appetite and weight loss in moderate and severe depression• Weight gain in mild depression
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Mood (Affective) DisordersMood (Affective) Disorders
Bipolar Disorder
•Depression alternates with periods of mania•Mania = Highly excited
mood and behavior
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Mood (Affective) DisordersMood (Affective) Disorders
Prevalence of Mood Disorders
• 1 in 20 Americans is severely depressed (Narrow et al., 2002)• 1 in 5 Americans will have a
depressive episode of clinical proportions during lifetime (Hamilton, 1989)
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Mood (Affective) DisordersMood (Affective) Disorders
Gender Differences
•Women about twice as likely to suffer from unipolar depression
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Mood (Affective) DisordersMood (Affective) Disorders
Biological Explanations for Gender Differences in Depression
• Genetic factors• Biochemical differences• Premenstrual depression
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Mood (Affective) DisordersMood (Affective) Disorders
Environmental Explanations for Gender Differences in Depression (Nolen-Hoeksma, 1990)
• Female passivity and dependency•Distraction by physical activity
and drinking in males
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Mood (Affective) DisordersMood (Affective) Disorders
Patterns After Depressive Episodes
• No recurrence of clinical depression• Recovery with recurrence• No recovery
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Mood (Affective) DisordersMood (Affective) Disorders
Genetic Factors
• 67% concordance rate for identical twins; only 15% for fraternal twins (Gershon et al., 1989)• Genetic predisposition to
mood disorder
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Mood (Affective) DisordersMood (Affective) Disorders
Brain Chemistry Factors
• Underactivity of norepinephrine, dopamine, and serotonin in depression (Davidson, 1998)• Overactivity of
neurotransmitters in mania?
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Mood (Affective) DisordersMood (Affective) Disorders
Psychological Factors
• Early traumatic losses or rejections create vulnerability (e.g. Abraham, 1911; Freud, 1917, Brown and Harris, 1978)
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Mood (Affective) DisordersMood (Affective) Disorders
Humanistic Factors• Definition of self-worth in
terms of individual attainment • React more strongly to
failures; view failures as due to inadequacies• Experience of
meaninglessness
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Mood (Affective) DisordersMood (Affective) Disorders
Depressive Cognitive Triad (Wenzlaff et al., 1988)
• Negative thoughts concerning:•The world•Oneself•The future
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Mood (Affective) DisordersMood (Affective) Disorders
Depressive Attributional Pattern
• Attributing success to factors outside self• Attributing negative outcomes
to personal factors
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13-78
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Mood (Affective) DisordersMood (Affective) Disorders
Learned Helplessness Theory (Abramson et al., 1978; Seligman & Isaacowitz, 2000)
• Depression occurs when people expect that bad events will occur and they think that they can’t cope with them
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Mood (Affective) DisordersMood (Affective) Disorders
Environmental Factors (Hammen, 1991)• Poor parenting• Many stressful experiences• Failure to develop good coping
skills• Failure to develop positive self-
concept
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Mood (Affective) DisordersMood (Affective) Disorders
Sociocultural Factors• Prevalence of depressive
disorders less in Hong Kong and Taiwan than in the West• Feelings of guilt and
inadequacy are highest in North America and Western Europe
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Mood (Affective) DisordersMood (Affective) Disorders
Sociocultural Factors cont.
•Gender difference not found in developing countries
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SuicideSuicide
Willful taking of one’s life
Second most frequent cause of death among high school and college students
Women attempt more suicides; men are more likely to kill selves
13-83
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13-84
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SuicideSuicide
Motives for Suicide (Beck et al., 1979)
• Desire to end one’s life
• Manipulation of others
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SuicideSuicide
Warning Signs of Suicide
• Verbal or behavioral threat to kill self• History of previous attempts• Detailed plan that involves a
lethal method
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SuicideSuicide
Suicide Prevention
• Talk about it with the person
• Provide social support and empathy
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SuicideSuicide
Suicide Prevention cont.
• Help the person to consider positive future possibilities
• Stay with the person and help him or her to seek professional assistance
13-88
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SchizophreniaSchizophrenia
Severe disturbances in (Herz & Marder, 2002):
• Thinking• Speech• Perception• Emotion• Behavior
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SchizophreniaSchizophrenia
Diagnosis of Schizophrenia (American Psychiatric Association, 1994, 2000)• Misinterpretation of reality• Disordered attention, thought,
perception• Withdrawal from social
activities
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SchizophreniaSchizophrenia
Diagnosis of Schizophrenia cont.
• Strange or inappropriate communication• Neglect of personal grooming• Disorganized behavior
13-91
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SchizophreniaSchizophrenia
Delusions
• False beliefs that are sustained in the face of contrary evidence normally sufficient to destroy them
13-92
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SchizophreniaSchizophrenia
Hallucinations
• False perceptions that have a compelling sense of reality
• Can be auditory or visual
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SchizophreniaSchizophrenia
Types of Affect
• Flat: No emotions at all
• Inappropriate
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SchizophreniaSchizophrenia
Subtypes of Schizophrenia
• Paranoid
•Delusions of persecution and grandeur
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SchizophreniaSchizophrenia
Subtypes of Schizophrenia
• Disorganized
•Confusion and incoherence•Severe deterioration of adaptive behavior
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SchizophreniaSchizophrenia
Subtypes of Schizophrenia
• Catatonic
•Motor disturbances from muscular rigidity to random or repetitive movements
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SchizophreniaSchizophrenia
Subtypes of Schizophrenia
• Undifferentiated
•Do not show enough specific criteria to be classified as paranoid, disorganized, or catatonic
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SchizophreniaSchizophrenia
Positive Symptoms• Bizarre behaviors such as
delusions, hallucinations, and disordered speech, thinking
Negative Symptoms• Absence of normal reactions• e.g., emotional expression,
motivation, normal speech
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SchizophreniaSchizophrenia
Positive Symptoms
•Better prognosis for later recovery
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SchizophreniaSchizophrenia
Biological Causes
• Genetic predisposition• Destruction of neural tissue
(neurodegenerative hypothesis)•Atrophy in brain regions that influence cognitions, emotions
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SchizophreniaSchizophrenia
Dopamine hypothesis•Overactivity of the dopamine system in brain areas regulating emotions, motivations, and cognitions
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SchizophreniaSchizophrenia
Psychological Factors• Freud: extreme example of
regression• Retreat from painful
intrapersonal world• Chaotic sensory input• Deficits in frontal lobe
executive functions
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SchizophreniaSchizophrenia
Environmental Factors
• Stressful life events• Family dynamics• Home environments high in
expressed emotion (Vaughn & Leff, 1976)
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SchizophreniaSchizophrenia
Expressed Emotion
• High levels of criticism• High levels of hostility• Overinvolvement in person’s
life
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SchizophreniaSchizophrenia
Sociocultural Factors
•Highest in lower socioeconomic populations•Causal or correlational?
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SchizophreniaSchizophrenia
Social Causation Hypothesis• Higher prevalence of
schizophrenia due to higher levels of stress
Social Drift Hypothesis• Deterioration of social and
personal functioning causes drift into poverty
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Personality DisordersPersonality Disorders
Stable, ingrained, inflexible, and maladaptive ways of thinking, feeling, and behaving
Increase likelihood of acquiring, maintaining several Axis I disorders
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Personality DisordersPersonality Disorders
Three Clusters:
•Dramatic and impulsive behaviors•Anxiety and fearfulness•Odd and eccentric
behaviors
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Personality DisordersPersonality Disorders
Antisocial Personality Disorder• Psychopaths or sociopaths• 3:1 male-female ratio• Lack a conscience• Fail to respond to
punishment
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Personality DisordersPersonality Disorders
Biological Causes of Antisocial Personality Disorder
• Genetic predisposition• Dysfunction in brain structures
that govern self-control and emotional arousal?
13-111
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Personality DisordersPersonality Disorders
Psychological Causes of Antisocial Personality Disorder
• Psychodynamic view: lack of a superego• Inability to develop conditioned
fear responses when punished leads to poor impulse control
13-112
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Personality DisordersPersonality Disorders
Psychological Causes of Antisocial Personality Disorder cont.
•Modeling of aggression• Parental inattention to
children’s needs (Rutter, 1997)
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Personality DisordersPersonality Disorders
Psychological Causes of Antisocial Personality Disorder cont.
• Exposure to deviant peers• Consistent failure to think
about or anticipate long-term negative consequences of acts
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Childhood DisordersChildhood Disorders
Over 20% of children aged 2-5 diagnosed with DSM-IV disorder (Lavigne et al., 1996)
Only about 40% of children with behavior disorders receive professional attention (Satcher, 1999)
13-115
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Childhood DisordersChildhood Disorders
Externalizing Disorders
•Disruptive and aggressive behaviors• e.g., ADHD
13-116
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Childhood DisordersChildhood Disorders
ADHD (Attention Deficit/Hyperactivity Disorder)
• Attentional difficulties• Hyperactivity-impulsivity• Most common childhood
disorder (7-10% of U.S. children)
13-117
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Childhood DisordersChildhood Disorders
Causes of ADHD
• Genetic predispositions• Brain scans show no
differences with “normals”• Environmental factors
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Childhood DisordersChildhood Disorders
Other Externalizing Disorders• Oppositional Defiant Disorder
(ODD)•Disobedient, defiant, hostile
• Conduct Disorder•Violate social norms and show disregard for others’ rights
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Childhood DisordersChildhood Disorders
Internalizing Disorders
• Involve maladaptive thoughts and emotions
• Include anxiety and mood disorders
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Dementia in Old AgeDementia in Old Age
Gradual loss of cognitive abilities
Accompanies brain deterioration
e.g., Alzheimer’s, Parkinson’s, Huntington’s, Creutzfeldt-Jakob Diseases
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Dementia in Old AgeDementia in Old Age
Senile Dementia
• Dementia that begins after age 65• 2:1 female-male ratio• Onset is typically gradual• Over 1/2 cases resemble
schizophrenia
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Dementia in Old AgeDementia in Old Age
Alzheimer’s Disease• 60% of senile dementias• Caused by deterioration in
frontal and temporal lobes of brain• Plaques in brain• Destruction of cells that
produce acetylcholine