Disturbances and emotions and thoughts that cause prolonged, serious distress or impairment of functioning are referred to as mental disorders. The American Psychiatric Association has developed an exclusive manual, DSM-IV, for classifying and diagnosing categories of mental disorders. Because the criteria specified by DSM-IV are relatively objective, the diagnostic system is relatively reliable.

Categorization and Diagnosis of Mental Disorders

Symptom: any characteristic of a person’s actions, thoughts or feelings that could be a potential indicator of a mental disorder.

Syndrome: a constellation of interrelated symptoms manifested by a given individual; evidence of a mental disorder if it satisfies specific criteria:

Operationalizing the definition is finally a matter of human judgment tinged by social values and pragmatic concerns.

Perspectives on Mental Disorders

Mental disorders are described and studied from a variety of perspectives. The biological perspective focuses on the roles of genes and observable abnormalities in the brain.

Biological: diseases of the brain. Measured by correlations between brain abnormalities and observed disorders.

Treated with drugs meant to alter the brain.

Causes: genes, environmental assaults, birth difficulties, viruses, bacteria. Genetic kin of people with a mental disorder have a higher-than average probability of developing the same disorder.

The psychodynamic perspective focuses on the rules of unconscious mental conflicts and drives that interfere with the person's ability to function adaptively.

Psychodynamic, cognitive and behavioral perspectives: disturbances in emotions, thoughts and behaviors may be evidence of the disorder and the cause of the disorder.

Psychodynamic (Freud): unresolved mental conflicts generate anxiety resulting in maladaptive ways of thinking and behaving. Caused by traumatic childhood experiences.

The cognitive and behavioral perspectives focus on learned habits of thought and action that interfere with adaptive functioning in the person's current environment.

The sociocultural perspective focuses on the influences that a culture's believes and practices can have on the mental disorders that people develop within that culture.

Sociocultural perspective: disorders are products of the larger culture in which a person develops.

Cultures produce different kinds of psychological distress. Cultures affect the ways in which distress is expressed. Culture affects the way others respond to a distressed person. Culture-bound syndromes: expressions of mental distress that are almost completely limited to specific cultural groups.

(Example) Koro: fear that the penis will withdraw into the abdomen and cause death (exclusive to Southwest Asia).

(Example) Anorexia nervosa: most prevalent in North America and Western Europe, adolescent women of mid to upper SES.

A useful framework for thinking about the multiple causation of any given instance of mental disorder distinguishes among predisposing causes, precipitating causes, and maintaining causes.

Women are much more likely than men to be diagnosed with anxiety and mood disorders; men are much more likely than women to be diagnosed with alcohol or drug use disorders and antisocial personality disorder. Attempts to explain these gender differences from the sociocultural perspective have focused on sex differences in the willingness to report psychological distress, on possible bias in diagnosis, and on differences in daily experiences of men and women.

Anxiety Disorders

Anxiety disorders entail feelings of fear or worry that are disproportionate to the realistic dangers of the person's current environment. DSM-IV identifies five main categories of such disorders.

Generalized Anxiety Disorder

Generalized anxiety disorder involves more or less continuous worry about daily life experiences; it seems to involve a state of hypervigilance that may have been brought on by dramatic events suffered in childhood or by a generally unpredictable environment.

Evolutionary history: "fight or flight response."

Generalized anxiety disorder: continuous worry about multiple issues, real or imagined. Criteria for diagnosis: serious impairment of daily function for at least 6 months independent from other diagnosable mental disorders. Symptoms: muscle tension, irritability, difficulty sleeping, upset stomach. Hypervigilance: persistent scanning of the environment for signs of impending danger. Prevalence: 5% in North America. Moderately heritable and may be linked to major depression. Predisposition correlates with frequent, unpredictable traumatic childhood experiences. May be brought on in adulthood by the occurrence of a major life change.

Phobias

Phobias - including specific phobias and social phobias - or intense, irrational fears of particular types of objects or events. The feared objects or events are typically those that would pose some realistic threat to evolutionary ancestors. Specific phobias (simple phobias): fear of a specific object or situation. More commonly diagnosed in women. Social phobias: fear of scrutinization. (Example: public speaking.) Diagnosed equally in men and women.

Possible causes:

Acquired through classical conditioning. People are genetically prepared by evolution.

Cultural differences:

Taijin kyofusho: fear of offending others with awkward social behavior (exclusive to Japan).

Obsessive Compulsive Disorder

People who suffer from obsessive-compulsive disorder regularly experience an obsessive, fearful thought that can be temporary relieved by engaging in some compulsive action such as handwashing. The disorder seems to be associated with an abnormality in the basal ganglia of the brain.

Obsession: a disturbing thought that intrudes repeatedly on a person’s consciousness even though it is recognized as irrational. Common obsessions: disease, disfigurement, death.

Compulsion: repetitive action performed in response to an obsession. Common compulsions: checking and cleaning.

Diagnosis criteria: the disturbing thoughts or actions are:

Severe, prolonged and disruptive of normal life.

Consumes more than an hour per day of the person’s time interfering with work or social relationships.

Correlates with heightened neural activity in the caudate nucleus (portion of brain known to be involved in the initiation of learned, habitual motor activities).

Treatments: Drugs that increase serotonin activity which reduces neural activity in the caudate nucleus. Behavioral and cognitive therapy procedures.

Panic Disorder

Panic disorder involves a repeated experience of a sense of terror that comes at unpredictable times, unprovoked by specific environmental threats. People with this disorder often suffer chronically from an intense fear of their next attack and for this reason are often afraid to leave their homes. Accompanied high physiological arousal (i.e., rapid heart rate, etc.). Constant anxiety between attacks about the next one. Moderately heritable.

Cause: learned tendency to interpret physiological arousal as catastrophic.

Treatment: cognitive therapy to help the person learn to interpret attacks temporary.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder involves a painful, uncontrollable reliving of one or more traumatic experiences, along with such additional symptoms as sleeplessness, high arousal, irritability, and guilt. Genetic predisposition plays a role in all five categories of anxiety disorders, and the same genes that predispose a person for generalized anxiety also predispose a person for depression.

Post-traumatic stress disorder (PTSD): anxiety directly and explicitly tied to a traumatic incident(s). May begin immediately after the traumatic event or later. Symptoms: sleeplessness, high arousal, irritability, guilt, emotional numbing, depression. Genes may partially determine who develops PTSD

Mood Disorders

Mood: prolonged emotional state that colors aspects of thoughts and behavior.

Mood disorders include depressive and bipolar disorders. Major depression is characterized by intense sadness, feelings of worthlessness, and absence of pleasure that lasts for at least two weeks. Dysthymia is characterized by less severe symptoms that last for at least two years.

Biological Bases for Depression

Antidepressant drugs typically raise the level of monoamine neurotransmitters (particularly norepinephrine and serotonin) in the brain. This fact lead, early on, to the theory-now doubted-that depression is caused by an undersupply of one or more of the monoamine neurotransmitters. Genes that predispose a person for depression appear to work largely by increasing one sensitivity to stressful life events.

Situational Bases for Depression

Major depression is especially likely to be triggered by serious losses, such as the death of a spouse or a permanent decline in health. From an evolutionary perspective, depression may be an exaggerated response that in less extreme form helps one reassess one's goals the following a major setback.

Cognitive Bases for Depression

Cognitively, people who are most prone to depression are those who attribute their failures and losses to causes that are stable (unlikely to change) and global (widespread). Changing one's way of interpreting such events has been shown to reduce the occurrence of depression.

Hopelessness theory (Seligman & Abramson, 1989): depression results from patterns of thinking about negative experiences that reduces or eliminates any hope that life will get better.

Depression Breeds Depression

Major depression, unlike normal low mood, traps a person in a vicious cycle in which negative thoughts, depressed action (withdrawal from enjoyable activities), and depressed mood all reinforce one another.

Seasonal affective disorder (SAD): severe depression every fall and winter followed by normal or elevated mood in the spring. Symptoms: intense hunger, weight gain during the winter, sleeping more. Treatment: sunlight.

Bipolar Disorders

Bipolar disorders-including the less extreme cyclothymia- involve alternating episodes of depression and mania (or the milder hypomania). During manic episodes people typically experience inordinately high levels of energy and unrealistic, often dangerous feelings of power and confidence. Some creative people have done their best work during periods of hypomania. Bipolar disorder is quite strongly heritable, but the initiation of episodes of depression and mania in predisposed individuals may be triggered by stressful life experiences.

Psychological Influences on Physical Symptoms and Diseases

Our thoughts and emotions can affect our bodily functions.

Somatoform Disorders

Somatoform disorders-including conversion disorder and somatization disorder- are manifested as bodily ailments in the absence of any physical disease that can cause them. Such disorders are relatively common in cultures that do not distinguish between medical and psychological problems as sharply as do modern Western cultures.

(Example: blindness in Cambodian women.)

Freud’s explanation: symptoms were products of the patients’ unconscious minds that serve to protect them from anxiety-producing activities and experiences.

Psychological Factors Affecting Medical Condition

Psychological factors can also affect the onset and maintenance of actual medical conditions, and these influences are apparently as common in the West as elsewhere.

Personality, Negative Emotions and Cardiovascular Disease

Traumatic grief predisposes people for a variety of life-threatening diseases; chronic anger, anxiety, and oppression increase the risk of cardiovascular diseases; and emotional distress interferes with the immune response, increasing People's chance of developing colds and other infectious diseases.

Psychoactive-Substance-Use Disorders

Issues of drug abuse and dependence are illustrated here with examples concerning alcohol, which is the most abused substance.

The Biological Perspective

Biologically, alcohol alters mood, thought, and behavior through its intoxicating effects (including alcohol myopia), withdrawal effects, and permanent effects (including Korsakoff's syndrome and fetal alcohol syndrome). Susceptibility to alcohol dependence is strongly affected by genes.

Effects of alcohol: anxiety relief, slowed thinking, poor judgment, slurred speech, uncoordinated movements, stronger reaction to emotional-arousal cues.

Withdrawal effects: occur after the drug is removed from the system after along period of continuous or frequent use.

Delirium tremens: extraordinarily overactive brain; autonomic arousal; 15% to 50% of instances result in death.

Hallucinations, panic, muscle tremors, sweating, high heart rate.

Permanent effects: irreversible forms of brain damage Alcohol amnesic disorder (Korsakoff’s syndrome): memory impairment, poor motor coordination, brain damage. Fetal alcohol syndrome: mental retardation, physical abnormalities.

Genes contribute to susceptibility to alcohol dependence. . More than one type of alcohol dependence; each have different degrees of heritability. (Example: predisposition to heightened pleasure and reduced unpleasant effects.) Alcohol abuse without dependence is less heritable than dependence.

The Behavioral and Cognitive Perspective

From a behavioral perspective, alcoholism is partly explained as operant conditioning reinforced by the pleasure or relief that alcohol offers and the classical conditioning of counteractive responses that induced alcohol craving.

Behavioral perspective: abuse and dependence are learned, voluntary behaviors. Short-term pleasure or relief is reinforcing. Conditioned environmental cues can counteract the drug effect.

From a cognitive perspective, alcoholism is partly explained in terms of learned alcoholic expectancies and an avoiding style of coping with negative emotions. Valued effects: more sociable, powerful, sexually vital. Fear of and tendency to avoid negative emotions.

The Sociocultural Perspective

From a sociocultural perspective, differences in alcohol use and abuse are understood in terms of varying cultural traditions and mores.

Peer pressure.

Cultural traditions: negative sanctions against drunkenness.

Sex expectations: drunkenness is less acceptable in women than men.

Dissociative Disorders

Dissociation, which can be reduced by hypnosis, is the process in which a period of a person's life is separated from the rest of his or her conscious experience in such a way that cannot later be recalled or can recalled only under special conditions. People who suffer from dissociative disorders experience such dissociations in their everyday lives in a manner that interferes with their ability to function effectively.

Identifying Dissociative Identity Disorder

The most well known such disorder is dissociative identity disorder, in which the person manifests two or more distinct self identities at different times.

Dissociative identity disorder (multiple-personality disorder): two or more distinct personalities or self-identities are manifested by the same person at different times.

Switch between identities are usually in response to some environmental provocation.

Identifying dissociative identity disorder: difficult to identify; may take years of therapy. Criticisms: Patients may be faking; may be inadvertently created through hypnosis.

Causes of dissociative identity disorder: repeated, severe physical or sexual abuse in childhood.

Abuse usually occurs before the age of 10 (Coons, et al., 1988). More women than men diagnosed. Includes symptoms of posttraumatic stress disorder. Begins in early childhood to cope with repeated abuse. May be a biological predisposition to dissociate. May present as an isolated disorder or in tandem with other mental disorders.

The Childhood Trauma Theory of Dissociative Identity Disorder

According to the childhood trauma theory, the dissociation begins in early childhood as a means of coping with severe physical or sexual abuse.

The Culturally Conditioned Iatrogenic Theory of Dissociative Identity Disorder

According to the culturally conditioned iatrogenic theory, the disorder begins in the therapist's office when a therapist who believes in the childhood, theory and is adjustable patient worked together to construct memories and behaviors in the patient that are consistent with the therapist's belief.

Dissociation: similar to hypnosis; a process by which a period of a person’s life becomes separated from the conscious mind and cannot be recalled except under special conditions.

Dissociative amnesia: memory loss is the only prominent symptom; selective loss of memory for a specific traumatic experience or global including all facts about self.

Dissociative fugue: loss of memory about identity, wandering away from home, development of a new identity. Return to original identity triggers loss of memory of everything during the fugue.

Schizophrenia

Schizophrenia is a debilitating disorder of cognition. A split among such mental processes as attention, perception, emotion, motivation and thought. Processes lead to bizarre and disorganized thoughts and actions. Termed coined by Bleuler; schizo = split; phrenum = mind.

Prevalence: 1% of general population; equal between women and men. Males first symptoms: age 18 to 25. Females first symptoms: age 26 to 45. May recover fully or may take a deteriorating course throughout life.

Symptoms

Its symptoms fall into three broad clusters: (1) positive symptoms (including delusions and hallucinations)

Delusions: false beliefs held in the face of compelling evidence to the contrary.

Delusions of persecution: belief that others are plotting against him/her.

Delusions of grandeur: belief that he/she is extraordinarily important.

Delusions of being controlled: belief that others control his/her thoughts or movements.

(2) disorganized symptoms (disorganized speech, thought, and behavior);

Disorganized speech: speech characteristics that reflect an underlying disorganization of thought.

Overinclusion: inclusion of associated words in a statement that have little to do with the meaning.

Paralogic: reasoning is superficially based on rules of logic, but in fact is flawed in ways that are obvious to others.

Grossly disorganized behavior: behaviors that are strikingly inappropriate for the situation or ineffective in obtaining the apparent goal.

(3) negative symptoms (slow bodily movements, labored speech, lack of emotional expression, and loss of basic drives). People with the disorder can vary greatly in the relative prominence of any of the symptom categories.

Twin and adoption studies show that genes contribute considerably to a person's vulnerability to schizophrenia. Other congenital influences on vulnerability include birth trauma, prenatal undernutrition, and, apparently, prenatal viral infections. The positive symptoms of the disorder can be relieved with drugs that block the release or effects of dopamine, suggesting that these symptoms may be due to overactivity of brain neurons that use dopamine as their neurotransmitter. Newer antipsychotic drugs reduce the negative and disorganized symptoms to some degree, as well as the positive symptoms, by means that are not well understood. Neuroimaging studies indicate that many people with schizophrenia have larger cerebral ventricles and somewhat smaller masses of neural tissue in the frontal and temporal cortical lobes than people without the disorder, and researchers have found that adults to develop schizophrenia often showed some deficits and intention, memory, and behavioral organization and childhood, well before they developed the disorder.