4/24-4/26: Psychological Disorders

• Psychological Disorder = ongoing pattern of thoughts, feelings and actions that are deviant, distressful and/or dysfunctional
• has to be: deviant--------------> distressful
• has to be: deviant------->distressful-------->dysfunctional
• behavior judged to be atypical, disturbing, maladaptive and unjustifiable
• DSM-IV = classifies psychological disorders
• describes disorders
• no explanations of causes
• Defines Diagnostic process and 16 clinical syndromes
• DSM-IV Axes
• Axis 1: Clinical syndrome present?
• 16 clusters
• bigger motivator than 2 or 3
• Axis 2: Personality Disorder or Mental Retardation?
• Axis 3: General Medical Condition?
• Axis 4: Psychosocial or Environmental problems?
• Axis 5: Global Assessment of person's Functioning
• 0-100
• Axis 1: Clinical Disorders
• 16 Clusters of Syndromes
• Anxiety Disorders: distressing persistent anxiety or maladaptive anxiety-reducing behavior
• Generalized anxiety disorder: Continually tense and apprehensive but can't ID cause
• higher autonomic nervous system arousal
• tough sleep
• 2/3 women
• mistreated as children
• typically accompanied by depression
• not over age 50
• Panic disorder: Episodes of intense dread
• 1/75 people escalate into Panic Attacks = terror, chest pain, choking, trembling, dizziness
• Mistaken for heart attack
• Phobia: persistent, irrational fear and avoidance of specific object
• Specific phobias
• Social phobia: intense fear of being scrutinized by others
• Agoraphobia: fear of inescapable situations w/ no immediate help
• avoid elevators, outside home, crowds
• Obsessive-Compulsive Disorder (OCD): unwanted obsessions and/or compulsions
• Obsessions
• Persistent thoughts, ideas that invade person's consciousness
• Compulsions
• Repeated and rigid behaviors or mental acts people feel must perform to prevent/reduce anxiety
• Obsessions-------> Anxiety; Compulsions Reduce anxiety
• Anxiety rises if obsessions and compulsions avoided
• Typical Small scale Obsessions = Normal people
• Minor obsessions = adaptive
• rituals relieve stress
• Disorder = Interferes with normal social Functioning
• Time-consuming = rituals and obsessions
• Obsessions that something Terrible will happen
• excessive hand-washing
• Post-Traumatic Stress Disorder (PTSD): reliving traumatic event repeatedly via:
• Symptoms
• Haunting Memories
• Nightmares
• Social withdrawal
• Anxiety 
• Insomnia 
• Symptoms present-  >= 4 Weeks
• How do Anxiety disorders Develop?
• Learning
• Classical conditioning- unpredictable and uncontrollable bad events
• ex: attacked on street. associate street with bad. fear elicited on streets
• Observational Learning brings about fears
• Operant Conditioning and OCD
• associate fear with stimuli- rituals
• Biology
• Genetic Predisposition - particular fears and anxiety
• Identical twins develop Similar Phobias together or apart
• Dissociative Disorders
• Dissociation: significant aspects of experiences are kept separate and distinct
• Individual experiences disruptions- typically response to traumatic event
• pretend happened someone else, get rid of stress
• Dissociative Identity Disorder (DID): 2 or more distinct and alternating Personalities
• each personality = own Voice and Mannerisms
• Alters = Dramatically Different characteristics
• Vital statistics:
• e.g. age, sex, race, and family history
• Abilities and Preferences: Encyclopedic knowledge affected in DID
• alters have different areas of expertise
• Unique set of memories, behaviors, thoughts, and emotions = Alters
• One dominates at a time
• Primary/host personality = appear more often, who you are
• Transition = sudden and dramatic
• 100 Alters maximum
• Typical types of Alters:
•  Host- Exhausted and Depressed
• Protector - Strong, Angry
• Child - Scared, Hurt
• Helper
• Persecutor blaming one or more of the alters
• Used to think 2 or 3 alters
• now 15 = women 8= men
• Late Adolescence or Early Adulthood = Cases
• Symptoms begin = before age 5
• How Common?
• 1000s
• Reasons:
• Clinicians Willing to make diagnosis
• Diagnostic----->Accurate
• Cons: All Cases = Iatrogenic (Artificial)
• unintentionally produced by Practitioners
• DID cases surfaced After treatment
• Legitimacy = ??  Reluctant to Diagnose
• Support for DID
• Different Personalities = Different Memories
• Test Differently
• Differ Physiologically
• voice, facial expressions, handwriting, allergies, 
• Handedness differentiation
• Criticisms for DID
• 50% Denial
• 2 per decade 1930-1960------> 20,000 in 1980s
• # Alters: 3 to 12
• Twin studies = No Genetic link
• Mood Disorders
• Emotional Extremes
• Major Depressive disorder = 2 or more Weeks of Irrational Depression
• feelings of worthlessness, diminished interest 
• Bipolar disorder: Alternating between Depression and Mania
• Mania: state of euphoria and great energy with grandiose optimism and self-esteem
• Depression
• common
• Women = 2x Likely
• Internalized response
• ~50% recover = 6 weeks, 90% = year
• most 1 other episode at some point
• Symptoms differ dramatically for individuals
• other aspects than sadness
• 5 main areas of Functioning affected:
• Emotional symptoms
• Motivational symptoms
• Everything requires Effort
• Behavioral symptoms
• exceedingly Negative self-view
• Cognitive symptoms
• Distracted Easily
• Physical symptoms
• Arm hurts but not physical cause
• Symptoms Exacerbate each other
• Stress = Trigger
• More stressful events genereal predate depression
• focus: Situation and Internal aspects
• Genetic factors
• Biological Predisposition
• Relatives = 20%
• General Population = 10%
• Neurotransmitters: Serotonin and Norepinephrine
• Serotonin = feel good
• Norepinephrine = energizer
• 1950s blood pressure medications caused depression
• lowered serotonin, lowered norepinephrine
• Socio-Cognitive factors
• Learned Helplessness
• Thinking of Event = Crucial
• depressed when think that:
• No Control over Reinforcements in lives
• Responsible for Helpless state
• Attribution theory focus (Explanatory style)
•  Negative events attributes---> Internal, Global and Stable 
• Negative Explanatory style = Blame Self 
• Positive Explanatory style = Blame Others
• = Helplessness and possibly Depression
• positive = blame environment
• No Hopelessness = No Depression
• Socio-Cultural Causes
• Social Support = Key
• Perceived Availability of Social Support
• Marital status
• Isolation and Lack of Intimacy 
• Cycle of Depression
• #1 Stressful Experience
• #2 Negative Explanatory Style
• #3 Depressed mood
• #4 Cognitive and Behavioral changes------> #1 again
• Bipolar disorder
• Onset = 15 to 44 years of age
• Episodes Subside eventually but Recur later
• Equally Common
• Mania Symptoms (5)
• Emotional
• Active, powerful search of outlet
• Motivational
• Need for Excitement, Involvement, Companionship
• Behavioral
• Very Active - Move and Talk Rapidly
• Cognitive
• Overly Optimistic and prone to Poor Judgment/ No Planning
• Physical
• High Energy - little to no rest
• Causes of Depression v Bipolar
• Originally thought relationship b/w high Norepinephrine levels and mania
• Low Serotonin may permit Norepinephrine activity to define form disorder will take
• Low Serotonin + Low Norepinephrine = Depression
• Low Serotonin + High Norepinephrine = Bipolar
• Schizophrenia
• Misconceptions:
• NOT Dissociative Identity disorder
• DO NOT tend to be Violent toward self or others
• Not all cases = Chronic
• 1/3 Chronic 1/3 Episodes 1/3 Complete Remission
• 10% = Hospitalized Life
• Prevalence
• 1/100 people world
• Equal across Gender
• Men get symptoms = Earlier
• Lower levels = More Frequently
• Previously "catachall" diagnosis
• much more refined today's DSM