PSY-150/Withrow
November
23, 2003
Chapter
Twelve Notes:
Psychological
Disorders
Society,
mental health professionals, and the individual all use different standards to
distinguish normal behavior from psychological disorders. Society’s standards
is the orderly world in which people assume responsibility for their assigned
societal roles, conform to prevailing mores, and meet situational requirements.
Society’s standards are measured through observations of behavior, extent to
which a person fulfills society’s expectations and measures up to prevailing
standards. An individual’s standards and values are based on happiness and
gratification of needs. These standards are measured by subjective perceptions
of self-esteem, acceptance, and well being. Standards of the mental health
professional are sound personality structure characterized by growth,
development, autonomy, environmental mastery, ability to cope, and adaptation.
This is measured by clinical judgment, aided by behavioral observations and
psychological tests of such variables as self-concept, sense of identity,
balance of psychic forces, unified outlook on life, resistance to stress,
self-regulation, the ability to cope with reality, the absence of mental and
behavioral, adequacy in love, work, and play, and adequacy in interpersonal
relationships. Mental health professionals define a psychological disorder as a
condition that either seriously impairs a person’s ability to function in life
or creates a high level of inner distress or sometimes both. This view does not
mean that the category “disordered” is always easy to distinguish from the
category “normal.” In fact, it may be more accurate to view abnormal behavior
as merely quantitatively different from normal behavior. Individuals, society,
and the mental health profession do not always view abnormality from the sane
viewpoint.
Thousands
of years ago, mysterious behaviors were probably attributed to supernatural
powers and madness as a form of possession by spirits. Greek physician
Hippocrates maintained that madness was like any other sickness, a natural
event arising from natural causes. During the Middle Ages, people reverted to a
supernatural point of view rather than Hippocrate’s naturalistic view.
Europeans of the Middle Ages thought an emotionally disturbed person to be a
witch or possessed by the devil and they were exorcised, tortured, and even put
to death. In the eighteenth century, the naturalistic approach resurfaces. The
basic reason for the failed and sometimes abusive treatment of mentally
disturbed people throughout history has been the lack of understanding of the
nature and the causes of psychological disorders.
In the late
nineteenth and early twentieth centuries, three influential but conflicting
models of abnormal behavior emerged: the biological model, the psychoanalytic
model, and the cognitive-behavioral model.
The
biological model holds that psychological disorders are caused by physiological
or biochemical malfunctions. Often these disorders stem from hereditary
factors. Freud and his followers developed the psychoanalytic method in end of
the nineteenth century. The view of this model is that psychological disorders
result from unconscious internal conflicts that can usually be traced to
childhood. The cognitive-behavioral model suggests that psychological disorders
result from learning maladaptive ways of thinking and behaving. This model
stresses both internal and external learning processes in the development of
psychological disorders. This model has also led to innovations in treatment
but has also been criticized for its limited perspective, especially in its
emphasis on environmental causes and treatments.
The
diatheses-stress model integrates the various models to discover specific
causes and treatment of different mental disorders. This model suggests that
people biologically disposed to a mental disorder will tend to exhibit that
disorder when particularly affected by stress. Diathesis is a biological
predisposition. The systems approach examines how biological, psychological,
and social risk factors combine to produce psychological disorders. It is also
known as the biopsychosocial model of psychological disorders. With this model,
emotional problems are “lifestyle diseases” that result from a combination of
biological risks, psychological stresses, and social pressures and
expectations.
For nearly
forty years the American Psychiatric Association has issued a manual describing
and classifying the various kinds of psychological disorders. It is called the
Diagnostic and Statistical Manual of Mental Disorders (DSM). This publication
provides careful descriptions if the symptoms of different disorders so that
diagnoses based on them will be reliable from one mental health professional to
another.
A study by
the National Institute of Mental Health revealed that 32% of Americans suffer
from one of more serious mental disorders during their lifetime and that at any
given time, more than 15% of the population are experiencing a mental disorder.
The most common problem is drug abuse, alcohol abuse being the most prevalent.
Mood
disorders are disturbances in mood or prolonged emotional state. Most people
have a wide emotional range while some people with mood disorders have a
restricted emotional range. Depression is a mood disorder characterized by
overwhelming feelings of sadness, lack of interest in activities, and perhaps
excessive guilt or feelings of worthlessness. Major depressive disorder is an
episode of intense sadness that may last for several months. Dysthymia involves
less intense sadness but persist with little relief for a period of two years
or more. Depression is more prevalent in women than in men. More women than men
attempt suicide but more men succeed. Suicide is the third leading cause of
death among teenagers. A common feeling associated with suicide is
hopelessness, which is also typical of depression.
Mania is a mood
disorder characterized by euphoric states, extreme physical activity, excessive
talkativeness, distractedness, and sometimes grandiosity. They typically have
unlimited hopes and schemes but little interest in carrying them out. At the
extreme, people going through a manic episode may be come wild,
incomprehensible, or violent until they collapse from exhaustion. Bipolar
disorder is a mood disorder in which periods of mania and depression alternate,
sometimes with periods of normal mood intervening. Bipolar disorder is equally
found among men and women, is less common than depression, is more strongly
linked to heredity, and is most often treated with drugs. Most psychologists
believe that mood disorders result from a combination of risk factors: biological,
psychological, and social. In the development of depression and bipolar
disorder, genes and biology play an important role. Psychological factors
include cognitive distortions defined as an illogical and maladaptive response
to early negative life events that leads to feelings of incompetence and
unworthiness that are reactivated whenever a new situation arises. It is
uncertain whether these distortions cause depression or are caused by it.
Social factors, such as difficulties in interpersonal relationships, can be
linked to depression and mood disorders.
Anxiety
disorders are disorders in which anxiety is a characteristic feature or the
avoidance of anxiety seems to motivate abnormal behavior. With anxiety
disorder, the person does not know why they are afraid or the anxiety is
inappropriate to the circumstances. Regardless, the person’s fear and anxiety
does not seem to make sense. Anxiety disorders are more common than any other
form of mental disorder. Anxiety disorders can be subdivided into several
categories. Specific phobias are anxiety disorders characterized by an intense
paralyzing fear of something that it is unreasonable to fear so excessively. A
social phobia is an anxiety disorder characterized excessive, inappropriate
fears connected with social situations or performances in front of other
people. An example of a social phobia is a fear of public speaking. Agoraphobia
is much more debilitating than social phobia. Agoraphobia is an anxiety
disorder that involves multiple, intense fears of crowds, public places, and
other situations that require separation from a source of security such as the
home. Panic disorder is an anxiety disorder characterized by recurrent panic
attacks in which the person suddenly experiences intense fear of terror without
any reasonable cause. A generalized anxiety disorder is characterized by
prolonged vague but intense fears that are not attached to any particular
object or circumstance. This disorder perhaps come closest to the everyday
meaning attached to the term neurotic. Obsessive-compulsive disorder is an
anxiety disorder in which a person feels driven to think disturbing thoughts or
to perform senseless rituals. Two other types of anxiety disorder are caused by
highly stressful events. If the anxiety reaction occurs soon after the event,
the diagnosis is acute stress disorder; if it occurs long after the event is
over, the diagnosis is posttraumatic stress disorder. Psychologists with a
biological perspective propose that a tendency to anxiety disorders may be inherited,
as these types of disorders tend to run in families. Cognitive psychologists
suggest that people who believe that they have no control over stressful events
in their lives are more likely to suffer anxiety disorders than others.
Evolutionary psychologists believe that we are predisposed by evolution to
associate certain stimuli with intense fears and that this is the origin of
many phobias. Psychoanalytic thinkers focus on inner psychological conflicts
and the defense mechanisms they trigger as the sources of anxiety disorders.
The term
psychosomatic perfectly captures the interplay of psyche and soma, which
characterize these disorders. Psychosomatic disorders are disorders in which
there is real physical illness that is largely caused by psychological factors
such as stress and anxiety. Tension headaches are an example of a psychosomatic
disorder. In contrast, somatoform disorders are disorders in which there is an
apparent physical illness for which there is no identifiable physical cause. Conversion
disorders are somatoform disorders in which a dramatic specific disability had
no physical cause but instead seems related to psychological problems.
Hypochondriasis is a somatoform disorder in which a person interprets
insignificant symptoms as signs of serious illness in the absence of any
organic evidence of such illness. Body dysmorphic disorder, or imagined
ugliness, is a recently diagnosed and poorly misunderstood type of somatoform
disorder in which a person becomes so preoccupied with his or her imagined
ugliness that normal life is impossible. Somatoform disorders, especially
conversion disorders, present a challenge for psychological theorists because
they seem to involve some kind of unconscious process. People who suffer from
somatoform disorders do not consciously seek to mislead others about their
physical condition. Research has shown that at least some diagnosed somatoform
disorders actually were real physical illnesses that were overlooked or
misdiagnosed.
Dissociative
disorders are disorders in which some aspect of the personality seems separated
from the rest. This disorder usually involves memory loss and a complete,
though generally temporary, change in identity. Dissociative amnesia involves
the loss of at least some significant aspects of memory. When an amnesia victim
leaves home and assumes an entirely new identity, the disorder is known as
dissociative fugue and is very unusual. Dissociative identity disorder also
called multiple personality disorder is characterized by the separation of the
personality into two or more distinct personalities. Most psychologists believe
this disorder to be extremely rare, although in recent years the number of
cases appears to be increasing. A much more common dissociative disorder is
depersonalization disorder whose essential feature is that a person suddenly
feels changed or different in a strange way.
Sexual
dysfunction is the loss or impairment of the ordinary physical responses of
sexual function. In men this usually takes the form of erectile disorder, the
inability to achieve or maintain an erection. In women it often takes the form
of female sexual arousal disorder, the inability to become sexually excited or
to reach an orgasm. A second group of sexual disorders is called paraphilias. Paraphilias
are sexual disorders in which unconventional objects or situations cause sexual
arousal. Fetishism is a paraphilia in which a nonhuman object is the preferred
or exclusive method of achieving sexual excitement. One of the most serious
paraphilias is pedophilia. Pedophilia is the desire to have sexual relations
with children as the preferred or exclusive method of achieving sexual
excitement. Gender-identity disorders involve the desire to become, or the
insistence that one really is, a member of the other biological sex.
Gender-identity disorder in children is the rejection of one’s biological
gender in childhood, along with clothing and behavior that society considers
appropriate to that gender.
Personality
disorders are disorders in which inflexible and maladaptive ways of thinking
and behaving learned early in life cause distress to the person or conflicts
with others. People with personality disorders range from harmless eccentrics
to cold-blooded killers and the disorder may also coexist with other
psychological disorders. Schizoid personality disorders is a personality
disorder in which a person is withdrawn and lacks feeling for others. The
personality disorder in which the person is inappropriately suspicious and
mistrustful of others is called paranoid personality disorder. Dependent
personality disorder is defined as a personality disorder in which the person
is unable to make choices and decisions independently and cannot tolerate being
alone. A personality disorder in which the person’s fears of rejection by
others lead to social isolation is called an avoidant personality disorder.
Narcissistic personality disorder is where the person has an exaggerated sense
of self-importance and needs constant admiration. A personality disorder characterized
by marked instability on self-image, mood, and interpersonal relationships is
called borderline personality disorder. This disorder is both common and
serious. The most widely studied personality disorders is antisocial
personality disorder. This disorder is defined as a personality disorder that
involves a pattern of violent, criminal, or unethical and exploitative behavior
and an inability to feel affection for others. People with antisocial
personality disorder are responsible for a good deal of crime and violence.
It is a
common misconception that schizophrenia means split personality. Defined,
schizophrenic disorders are severe disorders in which there are disturbances of
thoughts, communications, and emotions, including delusions and hallucinations.
People with schizophrenia are out of touch with reality, which is to say that
they are psychotic. Psychosis is sometimes confused with insanity. Insanity is
the legal term for mentally disturbed people who are not considered responsible
for their criminal actions. People with schizophrenia often suffer from
hallucinations, which are sensory experiences in the absence of external
stimulation. They also frequently have delusions, which are false beliefs about
reality that have no basis in fact. Typically, these delusions are paranoid.
Disorganized schizophrenia is a schizophrenic disorder in which bizarre and
childlike behaviors are common. Catatonic schizophrenia is a schizophrenic
disorder in which disturbed motor behavior is prominent. A schizophrenic disorder
marked by extreme suspiciousness and complex, bizarre delusions is called
paranoid schizophrenia. Undifferentiated schizophrenia is a schizophrenic
disorder in which there are clear schizophrenic symptoms that do not meet the
criteria for another subtype of schizophrenia. Genetic factors are universally
acknowledged as a theory to discover its cause, but many theorists believe that
combinations of biological, psychological, and social factors are also
responsible.
Attention-deficit/hyperactivity
disorder or ADHD was once known simply as hyperactivity. ADHD is defined as a
childhood disorder characterized by inattention, impulsiveness, and
hyperactivity. The psychostimulants frequently prescribed for ADHD appear to
slow such children down because they increase the ability to focus attention on
routine tasks therefore decreasing their hyperactivity. Another childhood
disorder is autistic disorder. This disorder is characterized by lack of social
instincts and strange motor behavior. Autistic disorder is a profound problem
identified in the first few years of life. It is characterized by a failure to
form normal social attachments, severe speech impairment, and strange motor
behaviors.
Gender
differences are less likely to be seen in disorders that have a strong
biological component. Gender and cultural differences support the view that
biological, psychological, and social forces interact as causes of abnormal
behavior.
