CHAPTERS 14-15

DISORDERS/TREATMENT

PSYCHOLOGICAL DISORDERS

I. What is abnormal behavior?

a. Atypical- not enough in itself
b. Disturbing- varies with time and culture
c. Maladaptive- harmful
d. Unjustifiable- there isn’t a good reason

II. Explaining Psychological Disorders

a. Medical Model
i. assumes that these “mental” illnesses can be diagnosed on the basis of their
symptoms and cured through therapy, may include treatment in a psychiatric hospital
ii. Limitations- critics argue that psychological problems are not illnesses, but rather
behaviors and experiences that are morally or socially deviant
b. Bio-Psycho-Social Model
i. assumes that biological, socio-cultural, & psychological factors combine & interact to
produce psychological disorders
c. Predisposition
i. inherited biological characteristics and early experiences can create a predisposition,
or diathesis, to develop a disorder, but the actual appearance of the disorder depends on
what stressors are encountered in life
d. Psychoanalytic
i. abnormal behavior was due to unresolved, mostly unconscious clashes between
desires of the id and the demands of society; such conflicts were presumed to have begin
in childhood
e. Humanistic
i. suggests that behavior disorders appear when a person is too sensitive to criticisms
and judgments of others; unable to accept their own nature; when this happens, the
persons perceptions or reality become distorted
f. Cognitive
i. views abnormal behavior as the result of faulty or illogical thoughts; distortions in
cognitive process lead to misconceptions or misinterpretations of the world; lead to
abnormal behavior
g. Behavioral
i. based on the notion that all behavior, including abnormal behavior, is learned;
abnormal behavior has been rewarded or reinforced at some point
h. Biological
i. views abnormal behavior as a manifestation of abnormal brain function, due to either
structural or chemical abnormalities in the brain; supports medication as treatment
i. Socio-cultural
i. holds that society and culture help define what is acceptable behavior
j. Labeling
i. Positives- most clinicians believe that diagnostic labels help in prescribing, treating
and researching the causes of psychological disorders
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ii. Negatives- critics says that these labels are arbitrary value judgments that create
preconceptions that can bias our perceptions and interpretations; labels can also affect
people’s self-images; labels can serve as self-fulfilling prophecies

III. Classifying Psychological Disorders

a. The Diagnostic and Statistical Manual (DSM- IV) is what psychologists and psychiatrists use
to diagnose psychological disorders
b. Uses multi-axial system of classification, there are five axes
i. Axis I records patient’s primary diagnosis
1. major disorders such as schizophrenia, mood disorders, delirium, dementia,
eating disorders, sleeping disorders, substance-related disorders
ii. Axis II includes personality problems or mental retardation
iii. Axis III is concerned with physical disorders that have an impact on behavior
iv. Axis IV assesses the level of psychosocial and environmental stress the person is
experiencing
v. Axis V represents an overall assessment of the person’s level of functioning; includes
rating from 1-100 of person’s psychological, social and occupational functioning
c. Serves as a guide to psychologists as they attempt to classify abnormal behavior patterns
d. Major criticisms: overly reliant on medical aspect; reliability and validity; labeling people
instead of describing problems

IV. Anxiety Disorders

a. Types
i. Generalized Anxiety Disorder- persistent and excessive anxiety, worry or dread that
lasts at least six months
ii. Panic disorder- recurring, unexpected panic attacks, as well as the constant worry of
another panic attack occurring
1. During panic attacks, a person has symptoms such as heart palpitations,
sweating, trembling, dizziness, etc
iii. Phobia- persistent, irrational fears of common objects or events
1. Agoraphobia is the fear of being in open spaces or public places or other
places from which escape is perceived to be difficult
iv. OCD- anxiety disorder characterized by involuntary persistent thoughts or repetitive
behaviors
1. Obsessions are ideas, thoughts, impulses, or images that are persistent and
cause anxiety or distress
2. Compulsions are repetitive behaviors that help to prevent or relieve anxiety
v. PTSD- caused by exposure to trauma, leads to recurring thoughts and anxiety linked
to the trauma
b. Causes
i. Biological- hereditary; evolutionary factors
ii. Psychological- poor stress-coping techniques, Type A personality; catastrophic
thinking
iii. Social- observational learning; high levels of pressure and responsibility
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V. Somatoform Disorders
a. Psychological disorders characterized by physical symptoms without any actual physical
causes
b. Types
i. Conversion Disorder- a psychological problem manifests itself as a deficit in
physiological function; the person appears to be, but is not, blind, dead, paralyzed, or
insensitive to pain in parts of the body; also called hysteria
ii. Hypochondriasis- the person is irrationally concerned with having a serious disease
iii. Pain Disorder- involves complaints of severe, often constant pain with no physical
cause (typically in neck, chest or back)
c. Causes
i. Biological- none
ii. Psychological- pay too much attention to bodily sensations
iii. Social- enjoy being center of attention, reinforced for being sick

VI. Dissociative Disorders

a. Disorders that involve dysfunction or memory or an altered state of identity
b. Types
i. Dissociative Amnesia- sudden loss of memory, usually precipitated by a traumatic
event
ii. Dissociative Fugue- sudden and complete loss of identity, sometimes caused by
severe stress, followed by assumption of a new identity
iii. Dissociative Identity Disorder- formerly known as multiple personality disorder, is
the appearance of two or more distinct identities in one individual
c. Causes
i. Biological- none
ii. Psychological- poor coping with childhood abuse (overuse of defense mechanisms);
inability to unite id, ego, and superego; fantasy prone personality
iii. Social- psychologist’s suggestions; media hype

VII. Mood disorders

a. Extreme disturbances of emotional balance
b. Types
i. Major Depressive Disorder- characterized by depressed mood, general lack of interest
in things that were once enjoyable, low sense of self-worth, low energy and possibly
thoughts of death or suicide
1. symptoms last at least two weeks
ii. Bipolar Disorder- can appear in a number of forms:
1. the most common form exhibits severe depression similar to major depression
but with infrequent manic episodes
2. primarily manic-characterized by extreme talkativeness, increased self-esteem,
excessive pleasure seeking, and lack of sleep; this form is quite rare
3. this form cycles from normal to manic to depressive
c. Causes
i. Biological- hereditary, low levels of Serotonin
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ii. Psychological- pessimistic explanatory style, learned helplessness, catastrophic

thinking
iii. Social- few or no friends, series of bad events with which one has no control of

VIII. Schizophrenia
a. A family of disorders of thought and behavior
b. Symptoms
i. Delusions are false beliefs that are strongly held despite contradictory evidence
ii. Hallucinations are sensory or perceptual experiences that happen without any external
stimulus
1. Auditory
2. Visual
iii. Inappropriate or disturbed emotional responses and behaviors
c. Types
i. Paranoid- characterized by auditory hallucinations and feelings of persecution,
delusions are grandeur
ii. Catatonic- is marked by stupor and rigid body postures for extended periods of time;
unnatural speech patterns like absence of speech or parroting of other people’s speech
iii. Disorganized- characterized by incoherent speech and flat or inappropriate emotional
affect
1. World salads
iv. Undifferentiated- schizophrenics who do not fit easily into one category
d. Causes
i. Biological- hereditary, viral infection during pregnancy, high levels of dopamine
ii. Psychological- poor stress-coping techniques
iii. Social- disturbed communication in family

IX. Personality Disorders

a. Characterized by pervasive expression of extreme, abnormal personality constructs which
interfere with normal social functioning
b. Types
i. Narcissistic- characterized by self-preoccupation and the need for other to focus on
oneself
ii. Dependent- characterized by a need to be cared for
iii. Paranoid- characterized by extreme distrust and suspicion of others
iv. Borderline- characterized by impulsive behavior and unstable relationships, emotions,
and self-image
v. Anti-social (Psychopathic)- characterized by disregard for the rights or interests of
others
vi. Histrionic- characterized by attention-seeking behavior, excessive emotional reactions
and excitability

X. Organic Disorders
a. caused by damage to brain tissue; most are result of disease or chemicals
b. Dementia, Alzheimer’s disease, drug/alcohol dependence
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XI. Behavior Disorders

a. Types
i. Attention Deficit Hyperactivity Disorder- a condition in which there is evidence of
inattentiveness, which includes difficulty paying attention in class, trouble listening,
difficulties in organization, forgetfulness and distractability. Fidgeting, constant
movement, constant need for attention characterize hyperactivity and impulsivity
ii. Autism- children have severe deficits in communication, impaired social relationships
and often, repetitive behaviors or ticks
iii. Oppositional Defiance Disorder- affects student performance at home and at school

XII. Intersection between Psychology and the Legal System

a. Confidentiality- laws and rules protect people with severe psychological disorders in two
ways:
i. They may be protected from persecution if they cannot understand the charges against
them; they are declared mentally unstable to stand trial
ii. Severe mental illnesses can sometimes shield one from punishment for a crime even
if brought to trial; not guilty by reason of insanity
b. Insanity rules have been criticized on many grounds:
i. Some critics argue that everyone should be held accountable for their actions
ii. There are significant problems in the implementation of insanity rules
iii. Even severely impaired people have some rational decision making and control some
aspects of their behavior

TREATMENT OF ABNORMAL BEHAVIOR

I. Treatment Approaches
a. Insight Therapies- insight into the cause of the problem is the primary key to eliminating
the problem
i. Psychoanalysis- focuses on probing past defense mechanisms of repression and
rationalization to understand the unconscious cause of a problem
1. Free association- the patient reports any and all conscious thoughts and
ideas, sometimes while under hypnosis
2. Manifest content- the images and occurrences in dreams; Freud believed
that the manifest content of dreams were actually symbols representing the latent,
or truly meaningful, content of dreams
3. Transference- occurs when the patient shifts thoughts and feelings about
certain people or events onto the therapist because the therapist stayed detached
from the patient; thought to help reveal the nature of the patient’s conflicts
4. Counter-transference- occurs when the therapist transfers his or her own
feelings onto the patient; in order to avoid this, therapists usually undergo
psychoanalysis themselves
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ii. Humanistic- treats the individual as a client instead of a patient

1. Client-centered therapy- invented by Carl Rogers and involves the
assumption that clients can only be understood in terms of their own reality
a. Non-directional approach- allows the focus to be on client’s
perception of the world and how that conception affects them
b. Self-actualization- the goal of therapy is to help the client realize
full potential through this
c. In order to accomplish self-actualization, the therapist is open,
honest, and expressive of feelings with the client, this shows genuineness;
the therapist shows unconditional positive regard; and accurate empathic
understanding is critical to successful communication between the therapist
and client
2. Gestalt Therapy- combines both physical and mental therapies, developed
by Fritz Perls to blend an awareness of unconscious tensions with the belief that
one must become aware of and deal with those tensions by taking personal
responsibility
b. Behavioral Therapy- short-term process, whereas insight approaches are extended over
long periods of time; treats symptoms because in this school of thought, there is no deep
underlying cause of the problem
i. Behavior therapist believe if past learning experiences can produce problems,
systematic new learning experiences can help alleviate them. Based on the works of
Skinner
ii. Counter-conditioning- a technique in which a response to a given stimulus is
replaced by a different response; Mary Cover Jones was the first to demonstrate this; it
can be accomplished in a few ways:
1. Aversion therapy- an aversive stimulus is repeatedly paired with the
behavior that the client whishes to stop
2. Systematic desensitization- involves replacing one response, such as
anxiety, with another response, such as relaxation;
a. Joseph Wolpe believed that if clients remain calm while facing gradually
more intense versions of something they fear, the learned associations between
anxiety and the feared object will be weakened, and the fear will disappear.
iii. Extinction procedures- are designed to weaken maladaptive responses
1. Flooding- involves exposing a client to the stimulus that causes the
undesirable response
2. Implosion- client imagines the disruptive stimuli rather than actually
confronting it
iv. Modeling- a therapeutic approach based on Bandura’s social learning theory;
clients watch someone act in a certain way and then receive a reward
c. Cognitive Therapy- changes the way people think about situations in order to change
behavior
i. RET (rational-emotive therapy)- formulated by Albert Ellis, is based on the idea
that when confronted with situations, people recite statements to themselves that express
maladaptive thoughts; the goal of RET is to change the bad thoughts by confronting the
irrational thoughts
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ii. Cognitive Therapy- formulated by Aaron Beck, focuses on maladaptive schemas;

theses schemas cause the client to experience cognitive distortions, which in turn lead
them to feel worthless or incompetent
1. Negative triad- Beck asserted that there is a negative triad of depression
that involves a negative view of self, world and future
2. Maladaptive schemas include arbitrary inference, in which a person draws
conclusions without evidence, and dichotomous thinking, which involves all-or-
none conceptions of situations
d. Biological Therapy- medical approaches to behavioral problems; usually used in
conjunction with any of the above therapies
i. Electroconvulsive therapy (ECT)- form of treatment in which fairly high voltages
of electricity are passed across a patient’s head
ii. Psychosurgery- brain surgery; best known form is prefrontal lobotomy, in which
parts of the frontal lobes are cut off from the rest of the brain
iii. Psychopharmacology- treatment of psychological and behavioral maladaptations
with drugs
1. Antipsychotics- reduce symptoms of schizophrenia by blocking neural
receptors for dopamine; ex: Clozapine, Thorazine, Haldol
2. Antidepressants- typically prescribed for depression, anziety, phobias, and
ocd; there are three types:
a. Monoamine oxidase inhibitors (MAOIs)
b. Tricyclics
c. Selective serotonin reuptake inhibitors (SSRIs)
3. Anxiolytics- depress the central nervous system and reduce anxiety while
increasing feelings of well-being and reducing insomnia
4. Lithium- effective in the treatment of bipolar disorder

II. Modes of Therapy

a. Group- clients meet together with a therapist as an interactive group
i. Advantages- less expensive than individual therapy; group dynamic may be
therapeutic in itself; clients learn from one another
b. Family- focuses on family problems
i. Advantages- has distinct advantages in that it allows family members to express
their feelings to each other and to the therapist simultaneously; encourages family
members to listen to each other
c. Couples- focuses on communication between partners; sessions revolve around learning
the rules for talking