2. What we’ll seek to understand...
What does it mean to have a mental
Defining and classifying disorders
Anxiety disorders, including GAD,
Panic, Phobias, OCD and PTSD
Mood disorders, including depression
and bipolar disorder
Sample of other disorders:
Rates of Diagnosis with Disorders
3. Why Learn about Psychological Disorders?
Reasons for curiosity:
personal familiarity with
knowing someone else
with the disorder
hearing about how
prevalent and socially
disorders have become in
wanting to learn more
about mental health and
4. Perspectives on Psychological Disorders
Thinking critically about
Questions to Keep in Mind
How do we decide when a set of
symptoms are severe enough to be
called a disorder that needs
Can we define specific disorders
clearly enough so that we can know
that we’re all referring to the same
Can we use our diagnostic labels to
guide treatment rather than to
5. A Psychological disorder is:
A significant dysfunction in an individual’s
cognitions, emotions, or behaviors.
Disorders are diagnosed when there
is dysfunction, behaviors which are
considered maladaptive because
they interfere with one’s daily life
Disorders are diagnosed when the
symptoms and behaviors are
accompanied by Distress, suffering.
New definition (DSM 5): “a
disturbance in the psychological,
biological, or developmental
processes underlying mental
6. Is Attention-Deficit/Hyperactivity
Disorder (ADHD) a real disorder?
ADHD: Impulsivity mixed with Inattention and/or
hyperactivity. Can include distractibility, disorganization,
fidgeting, difficulty suppressing impulses, and impaired
working memory. Is this a disorder?
Is it deviant? Do some people have a level of
inattentiveness, impulsiveness, or restlessness that goes
beyond laziness or immaturity?
Is it distressful? Is the person enjoying being energetic, or
are they frustrated that they can’t sustain focus?
Is there dysfunction? Are the symptoms harmless fun, or
do they negatively impact work and relationships?
7. Understanding the Nature of
One reason to diagnose a disorder is to make decisions about
treating the problem.
Based on older understanding of
psychological disorders, treatments have
included: exorcising evil spirits, beatings,
Pinel’s New Approach
Philippe Pinel (1745-1826) proposed that
mental disorders were not caused by
demonic possession, but by stress and
Pinel’s “moral treatment” involved
gentleness, nature, and social interaction.
improved lives but
often did not
effectively treat mental
8. The Medical
The discovery that the disease of
syphilis causes mental symptoms
(by infecting the brain) suggested a
medical model for mental illness.
Psychological disorders can be seen
as psychopathology, an illness of
Disorders can be diagnosed,
labeled as a collection of symptoms
that tend to go together.
People with disorders can be
treated, attended to, given
therapy, all with a goal of restoring
10. Cultural Influences on Disorders
Culture-bound syndromes are
disorders which only seem to exist
within certain cultures; they
demonstrate how culture can play
a role in both causing and defining
Bulimia Nervosa: binging/purging, in the United States
Running amok: violent outbursts, in Malaysia
Hikikomori: social withdrawal, in Japan
11. Classifying Psychological Disorders
Why create classifications
of mental illness? What is
the value of talking about
diagnoses instead of just
talking about individuals?
1. Diagnoses create a
verbal shorthand for
referring to a list of
2. Diagnoses allow us to
many similar cases,
learning to predict
3. Diagnoses can guide
The Diagnostic and
It’s easier to count
cases of autism if we
have a clear
DSM-V (May 2013)
The DSM is used to
justify payment for
It’s consistent with
diagnoses used by
12. The Five “Axes” of Diagnosis
The DSM suggests describing someone not just with a label
but with a five-part picture.
Is a clinical Is a personality Is a general
What is the
environmental this person’s
problems, such functioning?
developmental arthritis, or
as school or
hypertension housing issues, assign a code
also present? also present?
may select Clinicians may
none, one, or may not also
select one of
15. Critiques of Diagnosing with the DSM
1. The DSM calls too many people
2. The border between diagnoses, or
between disorder and normal, seems
3. Decisions about what is a disorder seem
to include value judgments; is depression
4. Diagnostic labels direct how we view and
interpret the world, telling us which
behavior and mental states to see as
16. Stigma and Stereotypes
Many people think a diagnostic
label means being seen as tainted,
weak, and weird.
these negative views/stigma
come from popular cultural views
of mental illness, and not from
the DSM may contain the
information to correct inaccurate
perceptions of mental illness.
17. Insanity and Responsibility
Jared Loughner shot many
people, including a U.S.
Representative, in 2011.
Loughner had schizophrenia and
substance abuse problems, a
combination associated with
To what degree, if any,
should he be held
responsible for his actions?
What is the appropriate
18. Anxiety Disorders: Our self-protective,
risk-reduction instincts in overdrive
Panic Disorder: Fear of
the next attack
Phobias: Don’t even
show me a picture
OCD: I know it doesn’t
make sense, but I can’t
PTSD: Stuck Reexperiencing Trauma
Causes of Anxiety
19. GAD: Generalized
worrying, having anxious
feelings and thoughts about
many subjects, and
anxiety with no attachment to
any subject. Anxious
anticipation interferes with
Physical symptoms include
arousal, trembling, sweating,
fidgeting, agitation, and sleep
20. Panic Disorder:
A panic attack is not just an
“anxiety attack.” It may include:
many minutes of intense dread
chest pains, choking,
numbness, or other frightening
a feeling of a need to escape.
Panic disorder refers to repeated
and unexpected panic attacks, as
well as a fear of the next attack.
21. Specific Phobia
A specific phobia is more than just
a strong fear or dislike. A specific
phobia is diagnosed when there is
an uncontrollable, irrational,
intense desire to avoid the some
object or situation. Even an image
of the object can trigger a
reaction--“GET IT AWAY FROM
irrational, intense desire to avoid
the object of the phobia.
22. Some Fears and Phobias
more, fear or
Some Other Phobias
Agoraphobia is the avoidance
of situations in which one will
fear having a panic attack.
Social phobia: an intense fear of
being watched and judged by others,
often showing as a fear of possibly
embarrassing public appearances.
23. Obsessive-Compulsive Disorder [OCD]
Obsessions are intense, unwanted
worries, ideas, and images that
repeatedly pop up in the mind.
A compulsion is a repeatedly strong
feeling of “needing” to carry out an
action, even though it doesn’t feel like
it makes sense.
When is it a “disorder”?
Distress: when you are deeply
frustrated with not being able to
control the behaviors
Dysfunction: when the time and
mental energy spent on these
thoughts and behaviors interfere
with everyday life
24. Common OCD Behaviors
Percentage of children and adolescents with OCD reporting
these obsessions or compulsions:
Common pattern: RECHECKING
Although you know that you’ve already
made sure the door is locked, you feel
you must check again. And again.
25. Post-Traumatic Stress
About 10 to 35 percent of
people who experience
trauma not only have
burned-in memories, but also
four weeks to a lifetime of:
repeated intrusive recall of
nightmares and other reexperiencing.
social withdrawal or phobic
jumpy anxiety or
insomnia or sleep problems.
Which people develop PTSD?
Those with sensitive
Those who are asked to
relive their trauma as they
26. Understanding Anxiety Disorders:
Explanations from Different Perspectives
27. Classical Conditioning
In the experiment by
Watson in 1920, Little
Albert learned to feel fear
around a rabbit because he
had been conditioned to
associate the bunny with a
loud scary noise.
Sometimes, such a
We may begin to fear all
animals, everything fluffy,
The result is a phobia or
We may feel anxious in a
situation and make a
decision to leave. This makes
us feel better and our
anxious avoidance was just
If we know we have locked a
door but feel anxious and
compelled to re-check,
rechecking will help us
temporarily feel better.
The result is an increase in
anxious thoughts and
Experiments with humans
and monkeys show that
anxiety can be acquired
learning. If you see
someone else avoiding or
fearing some object or
creature, you might pick up
that fear and adopt it even
after the original scared
person is not around.
In this way, fears get passed
down in families.
29. Cognition and
Cognition includes worried
thoughts, as well as
beliefs, predictions, and
Cognition includes mental
habits such as hypervigilance
(persistently watching out for
danger). This accompanies
anxiety in PTSD.
In anxiety disorders, such
cognitions appear repeatedly
and make anxiety worse.
30. Biology and Anxiety: Genes
Studies show that
identical twins, even
develop similar phobias
(more similar than two
Some people seem to
have an inborn highstrung temperament,
while others are more
Temperament may be
encoded in our genes.
Genes regulate levels of
People with anxiety have
problems with a gene
associated with levels of
serotonin, a neurotransmitter
involved in regulating sleep
People with anxiety also have
a gene that triggers high levels
of glutamate, an excitatory
neurotransmitter involved in
the brain’s alarm centers.
31. Biology and Anxiety: The Brain
experiences can burn
fear circuits into the
circuits are later
of brain areas
involved in impulse
control and habitual
The OCD brain shows extra
activity in the ACC, which
monitors our actions and checks
ACC = anterior cingulate gyrus
32. Biology and Anxiety:
An Evolutionary Perspective
1. Human phobic objects: 2. Similar but non-phobic objects:
Heights Low places
Closed spaces Open spaces
Darkness Bright light
3. Dangerous yet non-phobic subjects:
We are likely to become cautious about, but not phobic about:
Evolutionary psychologists believe that ancestors
prone to fear the items on list #1 were less likely to
die before reproducing.
There has not been time for the innate fear of list #3
(the gun list) to spread in the population.
33. Mood Disorders: Not just feeling
“down;” not just sad about something
Major Depressive Disorder: Stuck in dark withdrawal
Bipolar Disorder: sometimes fleeing depression into
Prevalence and Course of depression: Common, but
for many it goes away
Genetic Influences on Depression
Suicide and Self-Injury
Negative Moods and Negative thoughts: Explanatory
The vicious cycle: Interaction of bad experiences
depressive thoughts mood changes behavior
changes more sad days
34. Mood Disorders
Major depressive disorder [MDD] is:
more than just feeling “down.”
more than just feeling sad
Bipolar disorder is:
more than “mood swings.”
depression plus the problematic
overly “up” mood called “mania.”
35. Criteria of Major Depressive Disorders
Major depressive disorder is not just one of these symptoms.
It is one or both of the first two, PLUS three or more of the
Depressed mood most of the day, and/or
Markedly diminished interest or pleasure in activities
Significant increase or decrease in appetite or weight
Insomnia, sleeping too much, or disrupted sleep
Lethargy, or physical agitation
Fatigue or loss of energy nearly every day
Worthlessness, or excessive/inappropriate guilt
Daily problems in thinking, concentrating, and/or
Recurring thoughts of death and suicide
36. Depression is Everywhere
Depression shows up in people
Phobias are the most
experienced) disorder, but
depression is the #1 reason
people seek mental health
Depression appears worldwide:
Per year, depressive
episodes happen to about 6
percent of men and about 9
percent of women.
Over the course of a
lifetime, 12 percent of
Canadians and 17 percent of
USA residents experience
Depression: The “Common Cold” of
Although both are “common”
(occurring frequently and pervasively),
comparing depression to a cold doesn’t
is more dangerous because of
has fewer observable symptoms.
is more lasting than a cold, and is
less likely to go away just with time.
is much less contagious.
And…depressive pain is beyond sniffles.
37. Seasonal Affective Disorder [SAD]
Seasonal affective disorder is more than simply
Seasonal affective disorder involves a recurring
seasonal pattern of depression, usually during
winter’s short, dark, cold days.
Survey: “Have you cried today”? Result: More
people answer “yes” in winter.
Percentage who cried
38. Bipolar Disorder
Bipolar disorder was once
Bipolar disorder’s two
polar opposite moods are
depression and mania.
Mania refers to a period of
hyper-elevated mood that
is euphoric, giddy, easily
impulsive, overly optimistic,
and even grandiose.
Depressed mood: stuck feeling
Mania: euphoric, giddy, easily
hypersociality and sexuality
lack of felt pleasure
delight in everything
inactivity and no initiative
impulsivity and overactivity
racing thoughts; the mind
fatigue and excessive desire to
won’t settle down
little desire for sleep
39. Bipolar Disorder and Creative Success
Many famous and successful people have lived with the
ups and downs of bipolar disorder. Some speculate that
the depressive periods gave them ideas, and the manic
episodes gave them creative energy. Any evidence of
mood swings here?
40. Bipolar Disorder in Children and
Does bipolar disorder
show up before
adulthood, and even
Many young people have
cycles from depression
to extended rage rather
The DSM-V may have a
new diagnosis for some
of these kids: disruptive
41. Understanding Mood Disorders
Why are mood disorders so pervasive,
especially among women?
Women, starting in adolescence, appear to ruminate
more, have deeper sadness then men, encounter more
stressors, and report their depression more readily.
42. Understanding Mood Disorders
Can we explain…
Why does depression often go
away on its own?
the course/development of
Often, time heals a mood
disorder, especially when the
mood issue is in reaction to a
stressful event. However, a
significant proportion of
people with major depressive
disorder do not automatically
or easily get better with time.
43. Understanding Mood Disorders
Biological aspects and
Negative thoughts and
The vicious cycle
44. An Evolutionary Perspective on the
Biology of Depression
Depression, in its milder, nondisordered form, may have
had survival value.
Under stress, depression is
It allows humans to:
avoid conflicts and other
let go of unattainable
take time to contemplate.
45. Biology of Depression: Genetics
Evidence of genetic influence on depression:
1. DNA linkage analysis reveals depressed gene regions
2. twin/adoption heritability studies
46. Biology of Depression: The Brain
Brain activity is diminished in depression and increased in mania.
Brain structure: smaller frontal lobes in depression and fewer
axons in bipolar disorder
Brain cell communication (neurotransmitters):
more norepinephrine (arousing) in mania, less in depression
reduced serotonin in depression
47. Suicide and Self-Injury
Every year, 1 million people commit suicide, giving up
on the process of trying to cope and improve their
This can happen when people feel frustrated,
trapped, isolated, ineffective, and see no end to
Non-suicidal self-injury has other functions such as
sending a message, distracting from emotional pain,
giving oneself permission to feel, or self-punishment.
48. Understanding Mood Disorders:
The Social-Cognitive Perspective
information and assuming the
worst about self, situation,
and the future
beliefs such as
one (self) is
unable to cope,
or be happy
Stuck focusing on
49. Depressive Explanatory Style
How we analyze bad news predicts mood.
The problem is:
The problem is:
The problem is:
goes along with
50. Depression’s Vicious Cycle
A depressed mood may develop when a person with a
negative outlook experiences repeated stress.
a person’s style
of thinking and
interacting in a
way that makes
Split from reality and from self
Unusual emotions and
actions, including flat
affect, and catatonia
Onset and course
Causes of symptoms:
anatomy and activity
Maternal virus during
to a mental split
from reality and
the mind is split from reality, e.g.
a split from one’s own thoughts
so that they appear as
53. Positive and Negative Symptoms of
Disorganized thought and
Negative absence of
Flat affect (no emotion
showing in the face)
Reduced social interaction
Anhedonia (no feeling of
Avolition (less motivation,
initiative, focus on tasks)
Alogia (speaking less)
Catatonia (moving less)
54. Schizophrenia Symptoms:
Problems in Thinking and Speaking
including the “word salad”
of loosely associated
Delusions (illusory beliefs),
often bizarre and not just
mistaken; most common
are delusions of grandeur
and of persecution
Problems with selective
filtering thoughts and
choosing which thoughts to
believe and to say out loud
55. Schizophrenia Symptoms:
People with schizophrenia often
experience hallucinations, that
is, perceptual experiences not
shared by others.
The most common form of
hallucination is hearing voices
that no one else hears, often with
upsetting (e.g. shaming) content.
Hallucinations can also be
visual, olfactory/smells, tactile/to
uch, or gustatory/taste.
Am I evil?
56. Schizophrenia Symptoms:
Inappropriate Emotions and Actions
Odd and socially inappropriate
responses such as looking bored or
amused while hearing of a death
Flat affect: facial/body expression is
“flat” with no visible emotional
Impaired perception of emotions,
including not “reading” others’
intentions and feelings
The schizophrenic body exhibits
symptoms such as:
repetitive behaviors such as rocking
catatonia, such as sitting motionless
and unresponsive for hours.
57. Onset and
appear at the end of
adolescence and in early
adulthood, later for women
than for men.
Prevalence: Nearly 1 in 100
more men than women.
Development: The course
of schizophrenia can be
acute/reactive or chronic.
In reaction to stress, some
people develop positive
symptoms such as
– Recovery is likely.
develops slowly, with more
negative symptoms .
– With treatment and
support, there may be
periods of a normal life,
but not a cure.
– Without treatment, this
type of schizophrenia
often leads to poverty and
58. Subtypes of Schizophrenia
• Plagued by hallucinations, often with negative
messages, and delusions, both grandiose and
• Primary symptoms are flat affect, incoherent speech,
and random behavior
• Rarely initiating or controlling movement; copies
others’ speech and actions
• Many varied symptoms
• Withdrawal continues after positive symptoms have
59. Understanding Schizophrenia
What’s going on in
the brain in
structure and activity
Too many dopamine/D4 receptors
help to explain paranoia and
hallucinations; it’s like taking
amphetamine overdoses all the time.
Poor coordination of neural firing in
the frontal lobes impairs judgment
The thalamus fires during
hallucinations as if real sensations
were being received.
There is general shrinking of many
brain areas and connections between
60. Understanding Schizophrenia
Are there biological risk factors
affecting early development?
Biological Risk Factors
Schizophrenia is somewhat more likely
to develop when one or more of these
factors is present:
low birth weight
older paternal age
oxygen deprivation during delivery
maternal virus during mid-pregnancy
impairing brain development
Schizophrenia is more
likely to develop in
during and after flu
in densely populated
a few months after
after mothers had
the flu during the
second trimester, or
The lesson is to:
get flu shots
with early fall
61. Understanding Schizophrenia
Are there genetic risk factors? If
so, we would see more similar
schizophrenia risk shared
between identical twins than
fraternal twins (graph below). Do
If one twin has
chance of the other one
also having it are much
greater if the twins are
Having adoptive siblings
(or parents) with
schizophrenia does not
increase the likelihood
62. Understanding Schizophrenia
Genetic and Prenatal Causes
Even in quadruplets, genetics do not
fully predict schizophrenia.
This could be because of
First difference: twins in separate
Only one of two twins has the enlarged
ventricles seen in schizophrenia.
genes and all have
at different levels
of severity: genes
may interact with
63. Other Disorders, Including
Dissociative, Personality, and Eating
A sample of a few of theDisorders
many other psychological disorders
Disorder: Is it real?
How could it happen?
problems relating to
Focus on Antisocial
Overlap with criminal
Genes and social causes
Anorexia and Bulimia
Genes and social causes
Dissociation: a separation of
conscious awareness from
thoughts, memory, bodily
sensations, feelings, or even
dysfunction and distress caused
by chronic and severe
Fugue = “Running away”; wandering away from one’s
life, memory, and identity, with no memory of them
Development of separate personalities
65. Dissociative Identity Disorder (D.I.D.)
formerly “Multiple Personality Disorder”
In the rare actual cases of
D.I.D., the personalities:
are distinct, and not
present in consciousness
at the same time.
may or may not appear to
be aware of each other.
might just be an extreme
form of playing a role.
D.I.D. in North America
might be a recent cultural
construction, similar to the
idea of being possessed by
Cases of D.I.D. might be
created or worsened by
people to think of different
parts of themselves.
66. D.I.D., or DID Not?
Evidence that D.I.D. is Real
Different personalities have
different brain wave
different visual acuity and
eye muscle balance
Patients with D.I.D. also show
heightened activity in areas of
the brain associated with
managing and inhibiting
of personality from
coping with abuse
These may involve:
unrealistic body image and
extreme body ideal.
a desire to control food and the
body when one’s situation can’t
cycles of depression.
Compulsion to lose weight,
coupled with certainty about being meet criteria at
fat despite being 15 percent or
Compulsion to binge, eating large
amounts fast, then purge by losing
the food through vomiting,
laxatives, and extreme exercise
Compulsion to binge, followed by
guilt and depression
68. Eating Disorders: Associated Factors
having a mother focused on her
weight, and on child’s appearance
negative self-evaluation in the family
for bulimia, if childhood obesity runs
in the family
for anorexia, if families are
competitive, high-achieving, and
unrealistic ideals of body appearance
are enduring patterns of
social and other
behavior that impair
There are three “clusters”/categories of personality
Anxious: e.g., Avoidant P.D., ruled by fear of social
Eccentric/Odd: e.g. Schizoid P.D., with flat affect,
no social attachments
Dramatic: e.g. Histrionic, attention-seeking;
narcissistic, self-centered; antisocial, amoral
70. Antisocial Personality Disorder [APD]
conscience, without a
sense of guilt for harm
done to others
(strangers and family
The diagnostic criteria
include a pattern of
violating the rights of
others since age 15,
including three of these:
Disregard for safety of self or
Failure to conform to social
Lack of remorse
Impulsivity and failure to plan
Irresponsibility regarding jobs,
family, and money
71. Which Kids May Develop APD as Adults?
About half of children with
behavior develop lifelong
Which kids are at risk?
those who in preschool
unconcerned with social
rewards, and low in
those who endured
child abuse, and/or
Biological APD Risk Factors
Antisocial or unemotional
biological relatives increases risk.
Some associated genes have
Lower levels of stress hormones
and low physiological arousal in
Fear conditioning is impaired.
Reduced prefrontal cortex tissue
leads to impulsivity.
Substance dependence is more
72. Antisocial PD ≠ Criminality
Many career criminals do show empathy and
selflessness with family and friends.
Many people with A.P.D. do not commit crimes.
73. Antisocial Crime: Associated factors
personality disorder is
not a full picture of most
criminal activity, what
can we say about people
who commit crime,
especially violent crime?
Lower levels of
(measured here as
adrenaline levels) under
stress may enable taking
violent action without
feeling anxiety or panic.
74. Biosocial Roots of Crime: The Brain
seem to have
less tissue and
activity in the
part of the
Other differences include:
less amygdala response when viewing violence.
an overactive dopamine reward-seeking system.
77. Vulnerable factors and ages for
developing Mental Disorders
Who is vulnerable to
• Poverty increases the risk
of many mental disorders
including aggression and
anxiety. Disorders decrease
when poverty is lifted.
• “Immigrant paradox”:
Despite the stress of
immigrating, those who
immigrate to the U.S.A.
have a lower risk of
disorders than their
children born in the U.S.A.
Age of vulnerability:
• Many disorders begin to show
symptoms by early
• Developing on average
around age 20: OCD,
• Showing some signs earlier:
Phobias (median age 10) and
antisocial personality disorder
(some symptoms by age 8)
• Developing later than 20:
Major Depressive Disorder.
78. Outcomes for People with Psychological
There are risks to be watchful of, obstacles
to be overcome, and improvements to be
made, often with the help of with
Some people with psychological
disorders do not recover.
Some achieve greatness, even with a
Hinweis der Redaktion
Click to reveal bullets.
Click to reveal bullets. Optional slide, material not in the book.Instructor: you might add to the last point, “Just as our understanding of the brain has been increased by studies of damage to the brain, our understanding of the mind may be improved by studying problems in psychological functioning. As William James said, ‘To study the abnormal is the best way of understanding the normal.’”
Click to reveal bullets and questions. Questions are optional, not in the book.
Click to reveal bullets.The term“disorder” is used instead of “disease” because the latter term typically implies a known cause of the symptoms. In naming a disorder, you’re not naming a cause such as a virus. Instead, you are naming the collection of symptoms that tend to go together. More on the issue of pattern vs. single symptom: one of the symptoms of brain cancer is a headache. If you have a headache, though, it would be a mistake to assume that you have brain cancer. Similarly, one of the symptoms of major depression may be that you feel sad. If you feel sad, though, this is not enough to qualify for diagnosis of major depressive disorder. Keep this in mind when we discuss ADHD. More about deviance coming up. Another common term is “ abnormal,” which more literally means varying from the norm. Both of these terms have acquired an unnecessarily negative connotation outside the field of psychology. Image from the text.
Click to reveal bullets.The answer to all three questions is, “yes.” For some people, ADHD is a disorder, deviating greatly from the norm, and causing significant distress and dysfunction.ADHD is overdiagnosed when the label is applied to children whose behavior may be a function of immaturity, culture, sleep deprivation, or other learning problems. ADHD is underdiagnosed, most frequently in girls with the primarily inattentive type of ADHD, when children are quietly trying to sustain focus but can’t do it.
Click to reveal bullets.The term for drilling holes in the skull to release evil spirits is “trephination.” When you click the drill will bounce and to demonstrate the old medical technique, although the equipment may be anachronistic.
Click to reveal bullets.The medical model also implies ideas about etiology, the cause of mental disorders. It is not always possible to determine the cause of a specific mental disorder, but in general, the assumption here is that the cause is physical and mental, and not spiritual.
Automatic animation.Some disorders, such as depression and schizophrenia, appear to be found in the same form across all cultures.
Click to reveal bullets and sidebar.In order to make the definitions clear, each diagnosis in the DSM includes lists of symptoms, often in groups. The DSM includes criteria about how many symptoms must be present in each category to justify a label.
No animation.Usually Axis V is in two parts: the highest GAF in the past year, and the current GAF.
No animation.The text describes this table as a list of syndromes. However, this is a table of contents of the DSM, a list of the categories under which other diagnoses fall.
No animation. This slide can be used in place of the previous two slides. The text describes this table as a list of syndromes. However, this is a table of contents of the DSM, a list of the categories under which other diagnoses fall.
No animation.More comments about each of these points:The first critique has been raised about the DSM 5 in particular, including the possibility that some depression that is part of a grieving process may be more likely to be called a disorder (implying that it needs to be treated).Valid, reliable criteria might address this concern.In an older DSM, homosexuality was considered a disorder. In the current and future versions, there are more adult labels for symptoms more likely to be evident in females, such as anxiety and depression, and fewer “male” diagnoses (such as diagnoses that relate to the emotion of anger). See if students can connect the impact of diagnoses to the general impact of having schema, concepts and categories that organize and influence our perceptions.
Click to reveal bullets.Some of the stigma of labels is not the DSM’s fault; notice how “deviant” and “retarded” and other once-neutral terms have acquired a negative connotation.Having schizophrenia is not about having a “split personality” (that’s D.I.D.) and does not mean you are not dangerous or “crazy.” Having mood swings does not mean you have bipolar disorder or a split personality.
Click to reveal bullets and questions.Note: schizophrenia alone is not associate with increased risk of violence. However, schizophrenia plus substance abuse increases the risk of violent behavior.Both people who see him as NOT responsible for his actions and those who see his mental illness as part of who he is, and thus making him responsible, might agree that the appropriate consequence might be confinement with mandatory treatment rather than simply imprisonment.
Click to reveal bullets.GAD tends to occur along with mild but persistent depression. GAD becomes more rare after age 50. Why might that be? Perhaps experience shows that things usually don’t turn out as badly as those with Generalized Anxiety Disorder think they will.
Click to reveal bullets.Panic disorder includes the fight or flight system, and easy triggering of the autonomic nervous system.In a panic attack, the mind fills in an explanation: “If I’m feeling terror and a physical response to a threat, there must be some danger here.” People sometimes attribute the panic to whatever situation was present when the attack occurred.Extreme avoidance of possible panic triggers agoraphobia, an anxiety disorder characterized by anxiety in situations where the sufferer perceives the environment to be difficult or embarrassing to escape, such as wide-open spaces.
Automatic animation.“Irrational” means the fear and the avoidance compulsion are out of proportion to the actual threat (e.g. triggered by even a photograph) and the phobia occurs even when the person knows that the fear doesn’t make sense.Some phobias may make evolutionary sense. More on this later, but in case you decide to delete the biological perspective slide, there are some fears more likely to form phobias. These seem to be part of our biological heritage to avoid (for example, clowns may trigger a fear of baboons and mandrills bred into our ancestors). People reasonably fear handguns, but are not likely to panic and run away from a mere photograph of a gun unless they had a personal traumatic experience with one. However, people fear heights, snakes and spiders with no previous bad experience with these, because those that didn’t fear these 100,000 years ago might have not lived to reproduce.I suggest asking students, before viewing the next slide with its list of phobias and fears, about their own fears. You might ask, “is anyone getting an irrational fear reaction triggered by this slide?” and “do any of you have a fear that meets the criteria to be called a phobia?”This diagnosis is known in the DSM as “specific phobia,” although agoraphobia is in a separate category because it is so closely and frequently associated with panic disorder. Social phobia is also a separate diagnosis.
Click to reveal two additional phobias.The number of people with the specific FEAR varies more widely than the number of people with that specific PHOBIA. This implies that what we are really seeing in the lighter color is the number of people prone to a phobic-level fear. Not clear why clowns were not part of the survey, since this is a phobia mentioned often in the popular culture and by Intro Psych students.
Click to reveal bullets.Why is OCD considered an anxiety disorder? Because obsessions can be a distraction from underlying anxiety, and compulsions worsen through a cycle of negative reinforcement related to anxiety. The OCD sufferer resists carrying out a compulsion, feels anxious, and ultimately relieves the anxiety by giving in to the compulsion.
Click to show bottom text box and start animation.Emphasize the concept of “again.” Doing one of these behaviors does not mean that you have OCD. You are more likely to get a higher level of distress or dysfunction when you keep having these thoughts or behaviors, even when it makes no sense to you and you want to stop, but feel too much anxiety when you try to stop the compulsions and feel that the obsessions are outside of your control.
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Click to show bullets under each heading.If you want to remind students of operant conditioning ideas, you can point out that the anxious, avoidant behavior was negatively reinforced (rewarded by the removal of aversive feelings).See if students can connect the second bullet point to OCD. “Compelled” = compulsion; see if they can see pattern of reinforcement (once again, negative). One more example to insert before the last bullet, though this type of example is not in the text. You can ask, “what happens if we reassure a friend who is worrying?” If we verbalize a worry and a friend reassures us, worrying just got positively reinforced.
Click to reveal bullets.Could this method of developing anxiety help explain the acquisition of prejudices? Subtle behaviors like avoiding certain types of people on a dark street might be acquired through watching the behavior of parents and friends even when we espouse believing in equal treatment and worth of all groups.
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Click to reveal bullets and sidebar.Even if natural selection explains some things about humans as a whole, why are some people more prone to anxiety than others? Part of the answer is in a person’s experience, but part is in the genes.This association with a serotonin-related gene may be why some people with worrying-style anxiety respond to the SSRIs which increase serotonin at the synapse.A third major type of neurotransmitter involvement related to anxiety is GABA (gamma-aminobutyric acid), the inhibitory and “calming” neurotransmitter. GABA is not mentioned in this section of the text, probably because there is not a related gene that has been identified as being different in people with anxiety.
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Evolutionary psychology question: why is anxiety part of our biological repertoire? Perhaps panic, when functioning as fight, flight, or freeze, helped our ancestors stay safe when encountering danger. Perhaps worrying helps us plan how to face future danger.The book suggests that compulsions are exaggerations of natural survival strategies, e.g. hair pulling stems from grooming, rechecking stems from territory management, compulsive washing stems from a healthy practice. Click to reveal answer.
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Click to reveal bullets.Diagnosing major depressive disorder, as with making other diagnoses, requires seeing the whole pattern rather than just one or two symptoms. Depression crosses the line into a disorder when it impairs daily functioning and/or causes significant distress.With this list, the pattern is one or both of the first two symptoms and three to four of the rest of the symptoms, lasting more than two weeks.The criteria related to weight loss does not include weight loss caused by deliberate dieting.
Click to reveal bullets and sidebar.Instructor: the information in the sidebar is included for your optional use. Although it is a minor issue in the text, this analogy was a major complaint for a few of my students each semester. They reacted to the connotation of the word “common” as “no big deal,” and did not notice Myers’ sympathetic disclaimer that comparing depression to the common cold “effectively describes its pervasiveness but not its seriousness.” If you do some form of pre-class feedback, hopefully you’ll know in advance if you need this slide.This analogy will come up again soon when discussing schizophrenia, so we may as well clarify it now.
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Click to reveal bullets and table of contrasting symptoms.A typical pattern is three to seven weeks of depression, followed by three to seven DAYS of mania. People enjoying their mania often forget or deny that the manic phase leads back into depression.Like depression, this euphoria is self-sustaining; in mania, it’s not that you’re happy about something.
Animation: after a click from the instructor, the pictures will move up and down at different rates to simulate up and down swings of mood.
Click to reveal bullets.Many have questioned whether children and adolescents who have swings in mood have bipolar disorder or something else. The 2013 edition of the diagnostic manual, the DSM-V, may have a new diagnosis which is designed to describe many of these kids: “Disruptive mood dysregulation disorder.” This awkward diagnoses has gone through a few name changes between 2010 and 2012, and in earlier versions including the inclusion of the word “dysphoric” (depressed mood) and “temper” (as in, temper tantrum).
No animation.You might remind students that the evolutionary perspective has difficulty with mood disorders; it is unlikely that they helped our ancestors survive in any way.Instructor: warn students that we may not answer this question in this section.
Click to reveal bullets.Depression in reaction to life events often results in a temporary period of withdrawal, worrying, and feeling down.
Click to reveal text boxes and examples.
Click to reveal bullets.This information is presented in the book earlier in the chapter, but it also fits here.However, students might consider that from an evolutionary perspective, it seems just as likely that depression serves no survival purpose, as evidenced by suicide, and is in the process of being eliminated by natural selection.
No animation.DNA linkage analysis shows that regions of chromosomes are similar across generations of people in depressed families Another genetic factor to mention here, though it doesn’t come up in the text until the discussion of neurotransmitters (p. 629): people with depression had a variation of a serotonin-controlling gene, although the text notes that this result may not be reliable.Regarding the chart, see if students can recall the definition of heritability from the chapter on intelligence. Remind them that 80 percent heritability does NOT mean that genes are 80 percent of the cause of schizophrenia, as we shall soon see; it means that 80 percent of the variation among people is caused by genes.
Click to reveal bullets.Fewer axons, less white matter, and larger ventricles (fluid filled areas in the center of the brain) point to a problem in having different parts of the brain work together smoothly.
Click to reveal bullets.Beyond the 1 million who succeed, many more attempt suicide or make suicidal gestures, acts that look like suicide attempts, without clear intent to succeed. The numbers get much larger if we consider those who have had thoughtsabout suicide or wanting to be dead.Other purposes of NSSI besides the ones above mentioned in the text: distracting from emotional pain, giving themselves an excuse to cry when emotional pain doesn’t feel justified, or eventually to get the endorphin response which can come especially with repeated self-cutting. I mention these because students might speak up to comment that the reasons given in the text are inadequate.
Click to reveal bubbles.Discounting the positive: “You’re only spending time with me because you feel sorry for me.”Depression is also associated with cognitive errors, such as assuming one can know the future or the thoughts of others.
Click through to animate the chart.This chart implies that the negative explanatory style leads to depression. However, as the next chart will show, depression makes it more likely to make cognitive problems such as this negative attributional style. As Martin Seligman has suggested (quote in the text), depression can be caused by “preexisting pessimism encountering failure.”
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Click to reveal two more text boxes.Literally, schizophrenia means “split mind,” but NOT split personality. The person who invented the term, Eugen Bleuler (1857-1939), spoke of a splintering of the functions governing thinking, perception, personality, and memory, although I would add emotion to that list. Most noticeable are the perceptual problems such as a split from REALITY.
The column headings appear on click.You can ask first, “which of these are negative symptoms?” Students have experienced this sense of the words “positive” and “negative” when talking about reinforcement, but it’s a difficult shift in word usage so it’s worth testing them on it here. Some of the symptoms, such as disorganized thought and catatonia, could arguably be placed in either column.
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Click to reveal bullets.There is recent evidence that hallucinations in schizophrenia are caused in part because there is dysfunction in the parts of the brain that identify what is self vs. what is external. Thus, the fleeting ideas in the thought balloon might trigger, not just follow, the “heard” words about being evil.
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Click to reveal bullets.“Course” means the development of symptoms over time. Treatment can include not only medication but psychosocial rehabilitation, exercise, psychotherapy, supervised group homes, case management, daily living skills support, and vocational programs. Without real treatment, institutionalization was once the norm, then homelessness and incarceration, now outpatient treatment and “partial hospitalization” (day treatment).
No animation.The previous slide showed two types of course: acute/reactive and chronic/process. This slide differentiates types of schizophrenia by the pattern of symptoms. Paranoid schizophrenia is the most common and the most likely to be known to students. The symptoms go together as the individual experiences brain-generated perceptions that seem as real as sensory experiences. Often the delusions are an attempt to explain these hallucinations; “thoughts are being broadcast into my head so I must have a special power or role in the world.”
Click to reveal bullets.Students may need reminding that the thalamus was referred to earlier in the course as the sensory switchboard.There is also abnormal amygdala functioning in schizophrenia, which could be a result of schizophrenia or could explain the hyper-sensitivity to threat that could feed into paranoid ideas and aggressive reactive behavior.In addition to the shrinkage of the brain tissue, enlargement of the ventricles (fluid-filled areas within and between areas of tissue) can be seen.
Click to reveal bullets.Lesson: even if we do not know how the virus in the mother derails the fetus’s brain development, the statistical results here are enough of a warning. Get a flu inoculation (in the shot form, if you want to avoid nasal mist exposure to live-deactivated virus) if pregnancy will include flu season.
Click to reveal bullets.Questions to raise here: what does this tell us about the role of genes in schizophrenia? They must play some role, because having more genes in common means more similar likelihood of developing schizophrenia.Preview of the next slide, or in place of it: why is the risk not identical for identical twins? It could be environmental factors. Or, it could be a difference beginning even sooner (not sharing a placenta).
Click to reveal bullets.Identical twins who developed in separate placentas in the womb, which happens about a third of the time for identical twins, were less similar in their risk of developing schizophrenia than twins who developed in a shared placenta (60 percent chance of also having the diagnosis with shared placenta, 10 percent risk in separate placentas).
Click to reveal bullets.Dissociation is related to “spacing out” but well beyond it. During a physical assault, people might try to separate themselves from bodily experience, which is functional at the time but can lead to problems in relating to one’s bodily memory and experience later.Click to reveal examples.Question for class: using this definition of dissociation, describe the process of dissociation going on in each of these disorders. Answer: the person is dissociating 1) from memory, 2) from situation and identity, or 3) having dissociations within identity (or among parts of identity). Another question you might ask before the next slide: “what is another, former name for Dissociative Identity Disorder?”
Click to reveal bullets and sidebar.“Identity” is another movie to explore on this topic; it portrays schizophrenia from the inside rather than from the outside. A different way of looking at the cultural issue: could it be that cases of D.I.D. and demonic possession might be two different names for the same phenomenon?
Click to reveal bullets and sidebar.In apparently genuine cases of Dissociative Identity Disorder, the different personalities show differences that are hard to fake.In the sidebar, you can prompt students with the hints to do the work guessing at what different perspectives might say.
Click to reveal bullets, then table.Health problems include malnutrition, shutdown of bodily functions and structures, and death.“Nervosa” is a leftover term related to neurosis or what we would now call anxiety.“Underweight,” like “overweight,” is determined by medical standards, and obviously not by the felt standards of those with anorexia.
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Click to reveal bullets.A full list of the disorders in each category of the DSM, although the list is changing with the DSM-V: Anxious Cluster: Avoidant, Dependent, and Obsessive-Compulsive Personality DisorderEccentric/Odd/Detached cluster: Schizoid, Schizotypal, and Paranoid Personality DisordersDramatic/Erratic/Impulsive cluster: Histrionic, Narcissistic, Antisocial, and Borderline Personality Disorders
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Click to reveal bullets and sidebar.These attributes and experiences increase risk for developing APD, especially in combination with biological factors, discussed on the next slide.
No animation.This chart is not based on any statistics but is an illustrative estimate.
No animation.For a review, you can ask, “what part of the brain are we referring to here?” Hint: These are top-down views of the brain, with people facing up toward the top of the slide. Review challenge: What type of scan is this? (PET Scan).
No animation.Depression and schizophrenia are found all over the world. Bulimia, however appears mostly in the United States and pockets of Americanized culture elsewhere.
No animation.“Mood disorder” includes depressive disorders and bipolar disorders.