Psychopathology involves patterns of thinking and behaving that are maladaptive, disruptive, or uncomfortable either for the person affected or for others.

Outline

I. UNDERSTANDING PSYCHOLOGICAL DISORDERS: SOME BASIC ISSUES

A. What Is Abnormal?

There are several approaches to defining normality, but none is perfect. No behavior is universally abnormal.

  1. Infrequency. Those behaviors displayed by the greatest number of people are considered normal. Statistical infrequency considers behavior that is atypical or rare to be abnormal. However, some behavior that is rare, such as creative genius, extraordinary language skills, or world-class athletic ability, is valued; therefore, statistical infrequency alone is not an adequate criterion.
  2. Personal Suffering. Psychological problems causing distress require treatment. Because some people with disorders may not experience distress, personal suffering cannot be the only criterion for abnormality.
  3. Norm Violation. People who behave in ways that are bizarre, unusual, or disturbing enough to violate social norms or cultural rules are termed abnormal.
  4. Behavior in Context: A Practical Approach. The content of behavior (whether behavior is bizarre, dysfunctional, or harmful), the sociocultural context in which the behavior occurs (where and when behavior occurs), and the consequences of behavior are all taken into consideration when judging whether behavior is abnormal. A practical approach also considers whether behavior causes impaired functioning. Cultures and subcultures determine which behaviors are appropriate for a given situation.

B. Explaining Psychological Disorders

For centuries, people believed abnormal behavior was due to supernatural influences—actions of gods or demons. Today, Western cultures look to other causes to explain psychopathology.

  1. Biological Factors. The ancient Greek physician Hippocrates introduced the medical model, in which he explained that psychological disorders resulted from imbalances among four humors. The medical model eventually evolved into the concept of mental illness. The medical model is now termed the neurobiological model because it looks at problems in anatomy and physiology of the brain and other areas.
  2. Psychological Processes. Mental disorders are caused by inner turmoil or other psychological events. Psychological models include the psychodynamic, cognitive-behavioral, and phenomenological approaches.
  3. Sociocultural Context. Sociocultural explanations rely on factors such as gender and age, physical and social situations, cultural values and expectations, and historical eras. Culture-general disorders appear in most societies, while culture-specific forms appear only in certain ones.
  4. Diathesis-Stress as an Integrative Approach. According to the diathesis-stress model, genetics, early learning, and biological processes may all contribute to psychological disorders.

Classifying Psychological Disorders

A. A Classification System: DSM-IV

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes each form of disorder and provides criteria for diagnosis. DSM-IV consists of a series of evaluations on five dimensions called axes. Every person is rated on each axis. Axis I comprises descriptive criteria of sixteen major mental disorders. Axis II contains personality disorders and mental retardation. Axis III comprises physical conditions or disorders. Axis IV has types and levels of stress. Axis V has a rating of the highest level of functioning. (Neurosis, characterized by anxiety, and psychosis, whose symptoms include a break with reality, are no longer major diagnostic categories in DSM.)

B. Purposes and Problems of Diagnosis

The major goals of diagnosis are to help identify appropriate treatment for clients and to accurately and consistently group patients with similar disorders so that research efforts can more easily identify underlying causes of mental illness. Two limitations of diagnosis are validity and interrater reliability. Interrater reliability is the degree to which different diagnosticians give the same label to one patient.

C. Thinking Critically: Is Psychodiagnosis Biased?

What am I being asked to believe or accept?
Clinicians' diagnoses are biased by, for example, racial stereotypes.

What evidence is available to support the assertion?
African-American people are more frequently diagnosed as schizophrenic than are European-Americans. In addition, African-Americans are overrepresented in facilities noted for higher incidences of more serious disorders (public mental health hospitals).

Are there alternative ways of interpreting the evidence?
Diagnostic differences by race may not reflect bias. There could very well be physiological or cultural differences that cause mental illness.

What additional evidence would help to evaluate the alternatives?
Studies that ask physicians to diagnose pairs of potentially mentally ill people with identical symptoms but different races could detect bias in diagnoses. Other studies that have examined diagnostic practices (examining notes and interviews) and controlled the research for the type and severity of symptoms have shown that African-Americans are more frequently diagnosed as schizophrenic. Therefore, ethnic bias is a factor in some diagnoses.

What conclusions are most reasonable?
Clinicians, because they are human, are prone to bias when diagnosing the mentally ill. However, bias can be minimized by becoming educated about a prospective patient's cultural background and its effect on behavior and mental processes.

I.  Anxiety Disorders

A. Types of Anxiety Disorders

  1. Phobia. A phobia is an anxiety disorder involving a strong, irrational fear of an object or situation that should not cause such a reaction. Specific phobias involve fear of specific physical objects, places, or activities. Social phobias involve fear of being negatively evaluated by others or publicly embarrassed by doing something impulsive, outrageous, or humiliating. Agoraphobia is a strong fear of being separated from a safe place like home or of being trapped in a place from which escape might be difficult.
  2. Generalized Anxiety Disorder. The condition called generalized anxiety disorder involves milder but long-lasting feelings of anxiety, worry, dread, or apprehension that are not focused on any particular object or situation. Free-floating anxiety is a term sometimes used to describe the nonspecific nature of this anxiety.
  3. Panic Disorder. Periodic episodes of extreme terror (panic attacks) without warning or obvious cause are characteristic of people with panic disorder.
  4. Obsessive-Compulsive Disorder. The persistent intrusion of thoughts or images or a compulsive need to perform certain behavior patterns are symptoms of obsessive-compulsive disorder (OCD). When the obsessive thinking or compulsive behaviors are interrupted, severe anxiety results.

B. Causes of Anxiety Disorders

  1. Biological Factors. Biological explanations of anxiety disorders include abnormal levels of particular neurotransmitters and oversensitive brainstem mechanisms.
  2. Cognitive Factors. A person suffering from an anxiety disorder may exaggerate the danger associated with certain stimuli and underestimate his or her coping skills, causing anxiety and depression.

C. Linkages: Psychological Disorders and Learning

Phobias start with distressing thoughts followed by operantly rewarded behaviors. Phobias can also be explained by classical conditioning. People may be biologically prepared to learn certain fears and avoid stimuli that had potential for harm to our evolutionary ancestors. Rare phobias may be a product of classical conditioning, but common ones such as snakes, fire, height, and insects may be due to a biological preparedness to react negatively to certain potentially hazardous things.

II. Somatoform Disorders

Somatoform disorders are characterized by physical symptoms with no physical cause. In conversion disorder, a person appears to be, but is actually not, functionally impaired (for example, blind, deaf, or paralyzed). The physical symptoms often help reduce stress, and the person may seem unconcerned about them. Hypochondriasis involves strong fears of a specific severe illness that are usually accompanied by complaints of many vague symptoms. In somatization disorder, a person makes dramatic but vague reports about a multitude of physical problems rather than any specific illness. Pain disorder is characterized by severe, often constant, pain with no apparent physical cause.

III. Dissociative Disorders

 

A. Focus on Research Methods: Searching for Links Between Child Abuse and Adult Psychopathology

Is it possible for adults to have no memory of a sexual abuse incident that took place during childhood? Linda Meyer Williams (1994) contacted 129 females who had received medical treatment fifteen years earlier for sexual assault. Forty-nine women did not recall the incident. Failure to recall a trauma does not, in and of itself, justify a diagnosis of dissociative amnesia. Other symptoms must also be present. And in some cases there was evidence for normal processes of forgetting. Some cases of psychopathology are associated with abuse in childhood. However, symptoms and disorders reported are varied and not all people abused as children exhibit symptoms later in life.

IV.  Mood Disorders

Mood disorders, or affective disorders, are characterized by persistent extreme mood swings that are inconsistent with environmental events.

A. Depressive Disorders

Major depressive disorder involves feelings of sadness, hopelessness, inadequacy, worthlessness, and guilt that persist for long periods. Also common are changes or disturbances in eating habits, sleep, decision making, and concentration. In extreme cases, depressed people exhibit delusions. A more common pattern of depression is dysthymic disorder, which involves symptoms similar to those of major depressive disorder but to a lesser degree and spread out over a longer time period.

  1. Suicide and Depression. Repeated bouts of depression and suicide are closely linked. Interpersonal crises, intense feelings of frustration, anger or self-hatred, the absence of meaningful life goals, and constant exposure to stress are associated with suicide and depression. Student populations, the elderly, and females have a higher incidence of suicide than the general population. Those who say they are thinking about suicide are much more likely to attempt it than the general population.

B. Bipolar Disorder

Bipolar disorder is characterized by alternating feelings of extreme depression and mania over a period of days, weeks, or years. Bipolar disorder is relatively rare in comparison to major depressive disorder. Cyclothymic disorder is a slightly more common pattern of less extreme mood swings.

C. Causes of Mood Disorders

  1. Biological Factors. Altered levels and possibly dysregulation of norepinephrine and serotonin (neurotransmitters), changes in the control of the stress-related hormone cortisol, abnormal biological rhythms, and genetic influences are causative factors in affective disorders. There is strong evidence that bipolar disorder may be inherited.
  2. Psychological Factors. Traditional psychodynamic theorists believe that people with strong dependency needs turn inward the feelings of worthlessness, guilt, and blame that are really meant for others. Behavioral theorists believe that people become depressed when they lose important reinforcements. Learned helplessness can also play a causative factor in depression. Cognitive theorists believe that negative mental habits (such as focusing on and exaggerating the dark side of events and being generally pessimistic) and attributional style can lead to depression.