Chapter 11: Psychological Disorders

1. Chapter 11: Psychological Disorders Michael L. Farris Psychology 101

2. What is “Normal”? • Normal Curve (Coon, p. 495): A bell-shaped curve with a large number of scores in the middle, tapering to very few extremely high and low scores (please see the illustration on page 495). • Situational Context (Coon, p. 495): The social situation, behavioral setting, or general circumstances in which an action takes place. • Before any behavior can be defined as abnormal, we must consider the situational CONTEXT in which it occurs. • Is it normal to stand outside and water a lawn? It depends on whether it is raining. Is it abnormal for a grown man to remove his pants and expose himself to another man or woman in a place of business? It depends on whether the other person is a bank clerk or a doctor! • Almost any imaginable behavior can be considered normal in some contexts, as the example on Coon, p. 495 (about the rugby team whose airplane crashed in the Andes in 1972, forcing the survivors to eat the bodies of those who died in the crash. Yum!).

3. Cultural Relativity • Perceptions and judgments made relative to the value of one’s culture. • Culture is one of the most influential contexts in which any behavior is judged. • In some cultures it is considered normal to defecate or urinate in public or to appear naked in public. • In our culture such behaviors would be considered unusual or abnormal. Thus, cultural relativity can affect the diagnosis of mental disorders (Coon, p. 495).

4. Disorders • Mental Disorder (Nevid, Pgs. 386-387; Coon pg. 496): A significant impairment in psychological functioning. A list of “DSM-IV” categories of disorders is listed on page 499, in Table 14.4. • Organic Mental Disorder (Coon p. 498): A mental or emotional problem caused by malfunction of the brain. Brain pathology includes drug damage, diseases of the brain, injuries, poisons, and so on (please refer to Table 14.2 on Coon, page 497).

5. Mood Disorder Mood disorder (Nevid pages 400-403, Coon pages 500-501): A major disturbance in mood or emotion, such as depression or mania. Mood disorders primarily involve disturbances in affect, or emotion. Afflicted persons may be manic, which means agitated, euphoric, and hyperactive, or they may be depressed. Some cycle between mania and depression (manic depression, or bipolar disorder). In each case, extremes of mood are intense or long lasting. In addition, depressed individuals run a high risk of suicide. Mood disorders may include psychotic symptoms, and they are sometimes caused by mental conditions or drug abuse.

6. Anxiety disorder (Nevid Pgs. 389-393, Coon Pgs. 500-501) • Disruptive feelings of fear, apprehension, or anxiety, or distortions in behavior that are anxiety related. Anxiety disorders may take the form of panic (in which the person suffers sudden unexplainable feelings of panic), phobias (excessive, irrational fears), or generalized anxiety (chronic and persistent anxiety). Other anxiety disorders are post traumatic stress disorder (high anxiety that persists long after an extremely distressing event, such as military combat) and acute stress disorder (high anxiety that occurs immediately after a highly distressing event, such as an airliner crash). • A pattern known as obsessive-compulsivebehavior is also associated with anxiety.

7. Somatoform and Dissociative • Somatoform disorder (Nevid Pgs. 394, 396-397; Coon, Pgs. 500-501): Physical symptoms that mimic disease or injury (paralysis, blindness, illness, or chronic pain, for example) for which there is no identifiable physical cause. In such cases it is assumed that psychological factors underlie the symptoms. • Dissociative disorder (Nevid Pgs. 394, 396-397 Coon, Pgs. 500-501): Temporary amnesia, multiple personality, or depersonalization (feelings of being outside one’s body, of behaving like a robot, or of being in a dream world).

8. Neurosis and Insanity • Neurosis (Nevid pg. 389, Coon pg. 501): An outdated term once used to refer, as a group, to anxiety disorders, somatoform disorders, dissociative disorders, and some forms of depression. The term neurosis is fading from use because it tends to lump together too many separate problems. Even so, you may sometimes hear the term neurosis used to loosely refer to problems involving excessive anxiety. • Insanity(Coon, p. 501): A legal term that refers to a mental inability to manage one’s affairs or to be aware of the consequences of one’s actions. Persons who are declared legally insane are not legally responsible for their actions. If necessary, they can be involuntarily committed to a mental hospital. An example from page 501 in our text is Mark David Chapman, who was declared insane after he killed former Beatle John Lennon. Chapman claimed that devils forced him to kill Lennon. • Legally, insanity is established by testimony from expert witnesses (psychologists and psychiatrists). An expert witness is a person recognized by a court of law as being qualified to give opinions on a specific topic. In practice, those who are involuntarily committed are usually judged to be a danger to themselves or to others, or they are severely mentally disabled.

9. Antisocial Personality Antisocial personality (Nevid, Pgs. 410-412; Coon, Pg. 503): A person who lacks a conscience, is emotionally shallow, impulsive, selfish, and tends to manipulate others. Such people, who are sometimes referred to as sociopaths or psychopaths, typically have a long history of conflict with society. Antisocial persons are irresponsible, lacking in judgment and morals, and unable to learn from experience. They are also incapable of deep feelings, including guilt, shame, fear, loyalty, and love. In short, the sociopath is poorly socialized and has a general disregard for the truth (DSM-IV, 1994).

10. Paraphilias (Coon, pgs. 504-505) Compulsive or destructive deviations in sexual preferences or behavior. Typically, they cause guilt, anxiety, or discomfort for one or both participants. The paraphilias cover a wide variety of behaviors, including: Pedophilia – sex with children, or child molesting. Child molesters, who are usually males, are often depicted as despicable perverts lurking in dark alleys. In fact, most are married and two thirds are fathers. Many are rigid, passive, puritanical, or religious. In one half to two thirds of all cases of pedophilia, the offender is a friend, acquaintance, or relative of the child. Molesters are also often thought of as child rapists. However, most molestations rarely exceed fondling (Sue et al., 1996).

11. Paraphilias • Fetishism – sexual arousal associated with inanimate objects. • Exhibitionism – “flashing”, or displaying the genitals to unwilling viewers. This is a common problem. Roughly 35% of all sexual arrests are for “flashing”. Exhibitionists are typically male and married and most come from strict or repressive backgrounds. They typically feel a deep sense of inadequacy. This leads to a compulsive need to prove their “manhood” by frightening women. Exhibitionists have the highest repeat rate among sexual offenders. While they are usually harmless, those who approach closer than arm’s reach may be dangerous. In general, a woman confronted by an exhibitionist can assume that his goal is to shock and alarm her. By becoming visibly upset she actually encourages him (Hyde, 1996). • Voyeurism – “peeping”, or viewing the genitals of others without their permission.

12. Paraphilias • Transvestic fetishism – achieving sexual arousal by wearing clothing of the opposite sex. • Sexual sadism – deriving sexual pleasure from inflicting pain. • Sexual masochism – desiring pain as part of the sex act. • Frotteurism – sexually touching or rubbing against a non-consenting person, usually in a public place such as a subway.

13. Agoraphobia Agoraphobia (Nevid, Pg. 390): The person fears that something extremely embarrassing will happen to them if they leave the house or enter unfamiliar situations. For example, an agoraphobic person may refuse to go outside because she fears having a sudden attack of dizziness, or diarrhea, or shortness of breath. Being outside the home alone, being in a crowd, standing in line, being on a bridge, or in a car, bus, or train can be impossible for an agoraphobic. About 7% of all adults suffer from agoraphobia during their lifetime.

14. Obsessive-Compulsive Disorder • Obsessive-Compulsive Disorder (Nevid, Pg. 391): an extreme preoccupation with certain thoughts and compulsive performance of certain behaviors. You have probably experienced a mild obsessional thought, such as a song or stupid commercial jingle that repeats over and over in your mind. This may be irritating, but it’s usually not terribly disturbing. True obsessions are images or thoughts that intrude into consciousness against a person’s will. They are so disturbing that they can cause anxiety or extreme discomfort. • The most common obsessions are about violence or harm (such as poisoning one’s spouse or being hit by a car), about being “dirty” or “unclean”, about whether one has performed some action (such as turning off the stove), and about committing immoral acts. • Obsessions usually give rise to compulsions. These are irrational acts a person feels driven to repeat. Often, the compulsive act (for example, washing one’s hands repeatedly) helps control or block out anxiety caused by an obsession (the feeling of being “dirty” or “unclean”). Compulsive attention to detail and rigidly following procedures and rules makes the highly anxious person feel more secure. Doing so helps keep activities totally under control.

15. Psychosis and Delusion • Psychosis (Nevid, p.407; Coon pgs. 514-515): A withdrawal from reality marked by hallucinations and delusions, disturbed thought and emotions, and by personality disorganization. Psychosis reflects a loss of contact with shared views of reality. Paranoid psychosis (Nevid, p. 408; Coon, p. 517) is a delusional disorder centered especially on delusions of persecution (an example is a UFO “abductee”). • Delusion (Nevid, p. 383; Coon pgs. 514-515): A false belief held against all contrary evidence. Disturbed persons insist their delusions are true, even when the facts contradict them. An example is a 43 year old schizophrenic man who was convinced he was pregnant (Mansouri & Adityanjee, 1995).

16. Hallucination and Dementia Hallucination (Nevid, p.383; Coon, pgs. 514-515): An imaginary sensation, such as seeing, hearing, or smelling things that don’t exist in the real world. The most common psychotic hallucination is hearing voices. Sometimes these voices command patients to hurt themselves. Unfortunately, many obey. Dementia (Nevid, p.334; Coon, pgs. 516-517): Serious mental impairment caused by physical deterioration of the brain. In dementia, we see major disturbances in memory, reasoning, judgment, impulse control, and personality. This combination usually leaves the person confused, suspicious, apathetic, or withdrawn. The most common cause of dementia is Alzheimer’s disease (an age related disease characterized by memory loss, mental confusion, and in its later stages, by a nearly total loss of mental abilities). Other common causes include circulatory problems, repeated strokes, or general shrinkage and atrophy of the brain.

17. Schizophrenia, S.A.D., & Psychotherapy • Schizophrenia (Nevid, p.406; Coon, pgs. 518-519): A psychosis characterized by delusions, hallucinations, apathy, and a “split” between thought and emotion. One person in 100 will become schizophrenic, and roughly half of all the people admitted to mental hospitals are diagnosed as schizophrenic. Most are young adults (remember the film in class about the adolescent brain?), but schizophrenia can occur at any age. • Seasonal Affective Disorder (Coon, p. 527): Depression that occurs only during fall and winter; presumably related to decreased exposure to sunlight. Phototherapy involves exposing SAD patients to one or more hours of very bright fluorescent light each day. Light therapy works best when it is used early in the morning. • Psychotherapy (Nevid, p. 418; Coon, p. 529): Any psychological treatment for behavioral or emotional problems.