15.1 What Are Psychological Disorders?

Definition of a Psychological Disorder

• The simplest approach to conceptualizing psychological disorders is to label behaviors, thoughts, and inner experiences that are atypical, distressful, dysfunctional, and sometimes even dangerous, as signs of a disorder.

• Just because something is atypical does not necessarily mean it is disordered.

• Psychological disorder: a condition characterized by abnormal thoughts, feelings, and behaviors.

• Psychopathology: the study of psychological disorders, including their symptoms, their causes, and treatment.

Cultural Expectations

• Violating cultural expectations is not, in and of itself, a satisfactory means of identifying the presence of a psychological disorder.

• Since behavior varies from one culture to another, what may be expected and considered appropriate in one culture may not be viewed as such in other cultures.

• It’s important to recognize that cultural norms change over time.

Harmful Dysfunction

• Wakefield argued that natural internal mechanisms (psychological processes honed by evolution) have important functions, such as enabling us to experience the world the way others do and to engage in rational thought, problem solving, and communication

• Harmful dysfunction: when a natural internal mechanism breaks down and can no longer perform its normal function, and leads to negative consequences for the individual or for others, as judged by the standards of the individual’s culture. bl

The American Psychiatric Association (APA) Definition

• According to the APA (2013), a psychological disorder is a condition that is said to consist of the following:

  • There are significant disturbances in thoughts, feelings, and behaviors.

  • The disturbances reflect some kind of biological, psychological, or developmental dysfunction.

  • The disturbances lead to significant distress or disability in one’s life.

  • The disturbances do not reflect expected or culturally approved responses to certain events.

• No single approach to defining a psychological disorder is adequate by itself, nor is there universal agreement on where the boundary is between disordered and not disordered.

15.2 Diagnosing and Classifying Psychological Disorders

• Diagnosis: appropriately identifying and labeling a set of defined symptoms

• A proper diagnosis is an essential element to guide proper and successful treatment.

The Diagnostic and Statistical Manual of Mental Disorders

• The DSM-5 includes many categories of disorders.

• Each disorder is described in detail, including an overview of the disorder, specific symptoms required for diagnosis, prevalence information, and risk factors associated with the disorder

• The DSM-5 provides information about comorbidity: the co-occurrence of two disorders.

The International Classification of Diseases

• The categories of psychological disorders in both the DSM and ICD are similar, as are the criteria for specific disorders.

• Although the ICD is used for clinical purposes, this tool is also used to examine the general health of populations and to monitor the prevalence of diseases and other health problems internationally

• Worldwide the ICD is more frequently used for clinical diagnosis, whereas the DSM is more valued for research

The Compassionate View of Psychological Disorders

• Psychological disorders represent extremes of inner experience and behavior.

• People with psychological disorders are far more than just embodiments of their disorders.

  • A psychological disorder is not what a person is; it is something that a person has—through no fault of his or her own. These individuals deserve to be viewed and treated with compassion, understanding, and dignity.

15.3 Perspectives on Psychological Disorders

Supernatural Perspectives of Psychological Disorders

• Supernatural perspective: attributed to a force beyond scientific understanding.

• This view was held for centuries but has mostly disappeared.

• Those afflicted were thought to be practitioners of black magic or possessed by spirits

• Such beliefs in supernatural causes of mental illness are still held in some societies today.

Biological Perspectives of Psychological Disorders

• Biological perspective: views psychological disorders as linked to biological phenomena.

• Evidence from many sources indicates that most psychological disorders have a genetic component

• Many of today’s researchers to search for specific genes and genetic mutations that contribute to mental disorders.

• The biological perspective is currently thriving in the study of psychological disorders.

The Diathesis-Stress Model of Psychological Disorders

• Psychosocial perspective: emphasizes the importance of learning, stress, faulty and self-defeating thinking patterns, and environmental factors.

• Diathesis-stress model: integrates biological and psychosocial factors to predict the likelihood of a disorder.

  • Suggests that people with an underlying predisposition for a disorder are more likely than others to develop a disorder when faced with adverse environmental or psychological events.

  • A diathesis is not always a biological vulnerability to an illness; some diatheses may be psychological.

  • The key assumption of the diathesis-stress model is that both factors, diathesis and stress, are necessary in the development of a disorder.

15.4 Anxiety Disorders

• Anxiety involves apprehension, avoidance, and cautiousness regarding a potential threat, danger, or other negative event

• Anxiety motivates us to take actions that enable us to avert potential future problems and to avoid certain things that could lead to future trouble.

• Most individuals’ level and duration of anxiety approximates the magnitude of the potential threat they face.

• Anxiety disorders: characterized by excessive and persistent fear and anxiety, and by related disturbances in behavior

• Anxiety disorders are the most frequently occurring class of mental disorders and are often comorbid with each other and with other mental disorders.

Specific Phobia

• Specific phobia: causes an individual to experience excessive, distressing, and persistent fear or anxiety about a specific object or situation.

• Even though people realize their level of fear and anxiety in relation to the phobic stimulus is irrational, some people with a specific phobia may go to great lengths to avoid the phobic stimulus.

• Typically, the fear and anxiety a phobic stimulus elicits is disruptive to the person’s life.

Acquisition of Phobias Through Learning

• Many theories suggest that phobias develop through learning.

• Rachman proposed that phobias can be acquired through three major learning pathways: classical conditioning, vicarious learning (ie modeling), and verbal transmission of information

• People are more likely to develop phobias of things that do not represent much actual danger to themselves and are less likely to develop phobias toward things that present legitimate danger in contemporary society

  • One theory suggests that this happens because the human brain is evolutionarily predisposed to more readily associate certain objects or situations with fear

Social Anxiety Disorder

• Social anxiety disorder: characterized by extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others

• The heart of the fear and anxiety in social anxiety disorder is the person’s concern that he may act in a humiliating or embarrassing way.

• When people with social anxiety disorder are unable to avoid situations that provoke anxiety, they typically perform safety behaviors

• Safety behaviors: mental or behavioral acts that reduce anxiety in social situations by reducing the chance of negative social outcomes.

• People with social anxiety disorder may resort to self-medication as a means to avert the anxiety symptoms they experience in social situations

• As with specific phobias, it is highly probable that the fears inherent to social anxiety disorder can develop through conditioning experiences.

• One of the most well-established risk factors for developing social anxiety disorder is behavioral inhibition.

  • Behavioral inhibition: thought to be an inherited trait and is characterized by a consistent tendency to show fear and restraint when presented with unfamiliar people or situations

Panic Disorder

• Panic disorder: when an individual experiences recurrent and unexpected panic attacks, along with at least one month of persistent concern about additional panic attacks, worry over the consequences of the attacks, or self-defeating changes in behavior related to the attacks

• Panic attack: a period of extreme fear or discomfort that develops abruptly and reaches a peak within 10 minutes.

  • Its symptoms include accelerated heart rate, sweating, trembling, choking sensations, hot flashes or chills, dizziness or lightheadedness, fears of losing control or going crazy, and fears of dying

  • Sometimes panic attacks are expected, occurring in response to specific environmental triggers, other times these episodes are unexpected and emerge randomly.

  • According to the DSM-5, the person must experience unexpected panic attacks to qualify for a diagnosis of panic disorder.

• Individuals with panic disorder often misinterpret them as a sign that something is intensely wrong internally.

• Panic attacks can occasionally precipitate trips to the emergency room because several symptoms of panic attacks are similar to those associated with heart problem.

• Panic attacks themselves are not mental disorders.

• Researchers are not entirely sure what causes panic disorder.

• Neurobiological theories of panic disorder suggest that a region of the brain called the locus coeruleus may play a role in this disorder.

  • Locus coeruleus: located in the brainstem; the brain’s major source of norepinephrine, a neurotransmitter that triggers the body’s fight-or-flight response.

    • Activation of the locus coeruleus is associated with anxiety and fear

• Conditioning theories of panic disorder propose that panic attacks are classical conditioning responses to subtle bodily sensations resembling those normally occurring when one is anxious or frightened

• Cognitive theories argue that those with panic disorder are prone to interpret ordinary bodily sensations catastrophically, and these fearful interpretations set the stage for panic attacks.

Generalized Anxiety Disorder

• Generalized anxiety disorder: a relatively continuous state of excessive, uncontrollable, and pointless worry and apprehension.

• People with generalized anxiety disorder often worry about routine, everyday things, even though their concerns are unjustified

• A diagnosis of generalized anxiety disorder requires that the diffuse worrying and apprehension characteristic of this disorder is not part of another disorder, occurs more days than not for at least six months, and is accompanied by any three of the following symptoms: restlessness, difficulty concentrating, being easily fatigued, muscle tension, irritability, and sleep difficulties.

• Generalized anxiety disorder is highly comorbid with mood disorders and other anxiety disorders, and it tends to be chronic.

• Generalized anxiety disorder appears to increase the risk for heart attacks and strokes, especially in people with preexisting heart conditions.

• Cognitive theories of generalized anxiety disorder suggest that worry represents a mental strategy to avoid more powerful negative emotions, perhaps stemming from earlier unpleasant or traumatic experiences.

15.5 Obsessive-Compulsive and Related Disorders

• Obsessive-compulsive and related disorders: a group of overlapping disorders that generally involve intrusive, unpleasant thoughts and repetitive behaviors.

  • They elevate the unwanted thoughts and repetitive behaviors to a status so intense that these cognitions and activities disrupt daily life.

Obsessive-Compulsive Disorder

• Obsessive-compulsive disorder (OCD): when an individual experiences thoughts and urges that are intrusive and unwanted (obsessions) and/or the need to engage in repetitive behaviors or mental acts (compulsions).

• Obsessions: characterized as persistent, unintentional, and unwanted thoughts and urges that are highly intrusive, unpleasant, and distressing

• Compulsions: repetitive and ritualistic acts that are typically carried out primarily as a means to minimize the distress that obsessions trigger or to reduce the likelihood of a feared event

• Compulsions characteristic of OCD are not performed out of pleasure, nor are they connected in a realistic way to the source of the distress or feared event.

Body Dysmorphic Disorder

• Body dysmorphic disorder: when an individual is preoccupied with a perceived flaw in their physical appearance that is either nonexistent or barely noticeable to other people.

• These perceived physical defects cause the person to think they’re unattractive, ugly, hideous, or deformed.

• These preoccupations can focus on any bodily area, but they typically involve the skin, face, or hair.

• The preoccupation with imagined physical flaws drives the person to engage in repetitive and ritualistic behavioral and mental acts

Hoarding Disorder

• Hoarding disorder: when an individual cannot bear to part with personal possessions, regardless of how valueless or useless these possessions are.

• These individuals accumulate excessive amounts of usually worthless items that clutter their living areas

• People who suffer from this disorder have great difficulty parting with items because they believe the items might be of some later use, or because they form a sentimental attachment to the items

• A diagnosis of hoarding disorder is made only if the hoarding is not caused by another medical condition and if the hoarding is not a symptom of another disorder.

Causes of OCD

• A brain region that is believed to play a critical role in OCD is the orbitofrontal cortex, an area of the frontal lobe involved in learning and decision-making.

• In people with OCD, the orbitofrontal cortex becomes especially hyperactive when they are provoked with tasks in which.

• The orbitofrontal cortex is part of a series of brain regions that, collectively, is called the OCD circuit

• OCD circuit: consists of several interconnected regions that influence the perceived emotional value of stimuli and the selection of both behavioral and cognitive responses

  • Abnormalities in these regions may produce the symptoms of OCD

15.6 Posttraumatic Stress Disorder

A Broader Definition of PTSD

• For a person to be diagnosed with PTSD, they must be exposed to, witness, or experience the details of a traumatic experience.

• Symptoms of PTSD include intrusive and distressing memories of the event, flashbacks, avoidance of stimuli connected to the event, persistently negative emotional states, feelings of detachment from others, irritability, proneness toward outbursts, and an exaggerated startle response.

  • For PTSD to be diagnosed, these symptoms must occur for at least one month.

Risk Factors for PTSD

• Not everyone who experiences a traumatic event will go on to develop PTSD

• Several factors strongly predict the development of PTSD: trauma experience, greater trauma severity, lack of immediate social support, and more subsequent life stress.

• Traumatic events that involve harm by others carry greater risk than do other traumas.

• Factors that increase the risk of PTSD include female gender, low socioeconomic status, low intelligence, personal history of mental disorders, history of childhood adversity, and family history of mental disorders.

Support for Sufferers of PTSD

• Social support following a traumatic event can reduce the likelihood of PTSD.

• Social support can help individuals cope during difficult times by allowing them to discuss feelings and experiences and providing a sense of being loved and appreciated.

Learning and the Development of PTSD

• PTSD learning models suggest that some symptoms are developed and maintained through classical conditioning.

  • The traumatic event may act as an unconditioned stimulus that elicits an unconditioned response characterized by extreme fear and anxiety.

  • Cognitive, emotional, physiological, and environmental cues accompanying or related to the event are conditioned stimuli.

  • These traumatic reminders evoke conditioned responses similar to those caused by the event itself.

• One model suggests that two key processes are crucial: disturbances in memory for the event, and negative appraisals of the trauma and its aftermath.

  • According to this theory, some people who experience traumas do not form coherent memories of the trauma causing them to be to unable remember the event in a way that gives it meaning and context.

  • Proposes that negative appraisals of the event may lead to dysfunctional behavioral strategies that maintain PTSD symptoms by preventing both a change in the nature of the memory and a change in the problematic appraisals.

15.7 Mood Disorders

• Mood disorders: characterized by severe disturbances in mood and emotions.

• Depressive disorders: a group of disorders in which depression is the main feature.

  • Depression: a heterogeneous mood state that consists of a broad spectrum of symptoms that range in severity; intense an persistent sadness

• Bipolar and related disorders: a group of disorders in which mania is the defining feature.

  • Mania: a state of extreme elation and agitation.

Major Depressive Disorder

• The defining symptoms of major depressive disorder include feeling sad, empty, hopeless, or appearing tearful to others, and loss of interest and pleasure in usual activities most of each day

• To receive a diagnosis of major depressive disorder, one must experience a total of five symptoms for at least a two-week period; these symptoms must cause significant distress or impair normal functioning, and they must not be caused by substances or a medical condition.

• Other symptoms of major depressive disorder

  • significant weight loss or weight gain and/or significant decrease or increase in appetite

  • difficulty falling asleep or sleeping too much

  • psychomotor agitation (the person is noticeably fidgety and jittery) or psychomotor retardation (the person talks and moves slowly)

  • fatigue or loss of energy

  • feelings of worthlessness or guilt

  • difficulty concentrating and indecisiveness

  • suicidal ideation: thoughts of death, thinking about or planning suicide, or making an actual suicide attempt.

• Major depressive disorder is considered episodic: its symptoms are typically present at their full magnitude for a certain period of time and then gradually abate.

• Major depressive disorder can have a devastating effect on the quality of one’s life.

• Comorbid disorders include anxiety disorders and substance abuse disorders.

Subtypes of Depression

• Seasonal pattern: a person experiences the symptoms of major depressive disorder only during a particular time of year

• Peripartum onset: women who experience major depression during pregnancy or in the four weeks following the birth of their child

• Persistent depressive disorder: individuals experience depressed moods most of the day nearly every day for at least two years, as well as at least two of the other symptoms of major depressive disorder.

Bipolar Disorder

• Bipolar disorder: the person’s mood is said to alternate from one emotional extreme to the other.

• To be diagnosed with bipolar disorder, a person must have experienced a manic episode at least once in their life

• Manic episode symptoms:

  • Experience a mood that is almost euphoric

  • Become excessively talkative

  • Become excessively irritable and complain or make hostile comments.

  • May talk loudly and rapidly, exhibiting flight of ideas, abruptly switching from one topic to another.

  • Easily distracted

  • Exhibit grandiosity, in which they experience inflated but unjustified self-esteem and self-confidence.

• During a manic episode, individuals usually feel as though they are not ill and do not need treatment. However, the reckless behaviors that often accompany these episodes may require involuntary hospitalization.

• Some patients with bipolar disorder will experience a rapid-cycling subtype, which is characterized by at least four manic episodes within one year.

• Bipolar disorder is considerably less frequent than major depressive disorder.

The Biological Basis of Mood Disorders

• Mood disorders have been shown to have a strong genetic and biological basis.

• People with mood disorders often have imbalances in certain neurotransmitters, particularly norepinephrine and serotonin.

  • These neurotransmitters are important regulators of the bodily functions that are disrupted in mood disorders.

• Medications that are used to treat major depressive disorder typically boost serotonin and norepinephrine activity, whereas lithium—used in the treatment of bipolar disorder—blocks norepinephrine activity at the synapses.

• Depression is linked to abnormal activity in several regions of the brain including those important in assessing the emotional significance of stimuli and experiencing emotions (amygdala) and in regulating and controlling emotions.

  • Depressed individuals show elevated amygdala activity and less activation in the prefrontal, particularly on the left side

• Depressed individuals have abnormal levels of cortisol, a stress hormone released into the blood by the neuroendocrine system during times of stress

• High levels of cortisol are a risk factor for future depression

• Cortisol activates activity in the amygdala while deactivating activity in the PFC

• High cortisol levels may have a causal effect on depression, as well as on its brain function abnormalities

• Exit events: instances in which an important person departs; often occurs prior to an episode

• Exit events are especially likely to trigger depression if these happenings occur in a way that humiliates or devalues the individual.

• Individuals who are exposed to traumatic stress during childhood are at a heightened risk of developing depression at any point in their lives

• Not everyone who experiences stressful life events or childhood adversities succumbs to depression

• Genetic vulnerability may be one mechanism through which stress potentially leads to depression.

• Cognitive theories of depression: view that depression is triggered by negative thoughts, interpretations, self-evaluations, and expectations.

  • These diathesis-stress models propose that depression is triggered by a negative and maladaptive thinking, and by precipitating stressful life events.

  • Aaron Beck theorized that depression-prone people possess depressive schemas, or mental predispositions to think about most things in a negative way. He believed this thinking is maintained by errors in how we process information about ourselves, which lead us to focus on negative aspects of experiences, interpret things negatively, and block positive memories

  • Hopelessness theory: a particular style of negative thinking leads to a sense of hopelessness, which then leads to depression

  • Rumination: the repetitive and passive focus on the fact that one is depressed and dwelling on depressed symptoms, rather that distracting one’s self from the symptoms or attempting to address them in an active, problem-solving manner.

Suicide

• Suicide: death caused by self-directed injuries with the intent to die as the result of the behavior.

• The person must be biologically or psychologically vulnerable to suicide, have the means to perform the suicidal act, and lack the necessary protective factors that provide comfort and enable one to cope during times of crisis or great psychological pain.

• Suffering from a mental disorder—especially a mood disorder—poses the greatest risk for suicide.

• Suicidal risk is especially high among people with substance abuse problems.

• Suicidal individuals may be at high risk for terminating their life if they have a lethal means in which to act.

• Withdrawal from social relationships, feeling as though one is a burden to others, and engaging in reckless and risk-taking behaviors may be precursors to suicidal behavior.

• A sense of entrapment or feeling unable to escape one’s miserable feelings or external circumstances predicts suicidal behavior.

• Suicides can have a contagious effect on people.

• Widely-publicized suicides tend to trigger copycat suicides in some individuals.

15.8 Schizophrenia

• Schizophrenia: a psychological/psychotic disorder characterized by major disturbances in thought, perception, emotion, and behavior that prevent them from functioning normally in life

• Most people with schizophrenia experience significant difficulties in many day-to-day activities

• Many with schizophrenia will experience serious social and occupational impairment throughout their lives.

Symptoms of Schizophrenia

• The main symptoms of schizophrenia include hallucinations, delusions, disorganized thinking, disorganized or abnormal motor behavior, and negative symptoms.

• Hallucination: a perceptual experience that occurs in the absence of external stimulation.

  • Auditory hallucinations: hearing voices; the most common form of hallucination.

  • Visual hallucinations: seeing things that are not there

  • Olfactory hallucinations: smelling odors that are not actually present

• Delusions: beliefs that are contrary to reality and are firmly held even in the face of contradictory evidence.

  • Paranoid delusions: the (false) belief that other people or agencies are plotting to harm the person.

  • Grandiose delusions: beliefs that one holds special power, unique knowledge, or is extremely important.

  • Thought withdrawal: the belief that one’s thoughts are being removed

  • Thought insertion: the belief that thoughts have been placed inside one’s head

  • Somatic delusion: the belief that something highly abnormal is happening to one’s body.

• Disorganized thinking: disjointed and incoherent thought processes—usually detected by what a person says.

• Disorganized or abnormal motor behavior: unusual behaviors and movements

  • Catatonic behaviors: show decreased reactivity to the environment

• Negative symptoms: those that reflect noticeable decreases and absences in certain behaviors, emotions, or drives

  • Diminished emotional expression, avolition, alogia, asociality, social withdrawal, and anhedonia.

Causes of Schizophrenia

• Studies support a diathesis-stress interpretation of schizophrenia—both genetic vulnerability and environmental stress are necessary for schizophrenia to develop, genes alone do not show the complete picture.

• Dopamine hypothesis: proposed that an overabundance of dopamine or too many dopamine receptors are responsible for the onset and maintenance of schizophrenia

  • An overabundance of dopamine in the limbic system may be responsible for some of the symptoms of schizophrenia, such as hallucinations and delusions, whereas low levels of dopamine in the prefrontal cortex might be responsible primarily for the negative symptoms

• Brain imaging studies reveal that people with schizophrenia have enlarged ventricles, and larger than normal ventricles suggests that various brain regions are reduced in size, thus implying that schizophrenia is associated with a loss of brain tissue.

• Many people with schizophrenia display a reduction in cell bodies of neurons in the frontal lobes and less frontal lobe activity when performing cognitive tasks.

  • The frontal lobes are important in a variety of complex cognitive functions

Early Warning Signs

• Identifying people who show minor symptoms of psychosis and following these individuals over time to determine which of them develop a psychotic disorder and which factors best predict such a disorder.

15.9 Dissociative Disorders

• Dissociative disorders: characterized by an individual becoming split off, or dissociated, from her core sense of self.

Dissociative Amnesia

• Dissociative amnesia: when an individual is unable to recall important personal information, usually following an extremely stressful or traumatic experience such as combat, natural disasters, or being the victim of violence.

• Dissociative fugue: they suddenly wander away from their home, experience confusion about their identity, and sometimes even adopt a new identity; sometimes experienced by those with dissociative amnesia

Depersonalization/Derealization Disorder

• Depersonalization/derealization disorder: characterized by recurring episodes of depersonalization, derealization, or both.

• Individuals who experience depersonalization might believe their thoughts and feelings are not their own; they may feel as though they lack control over their movements and speech; they may experience a distorted sense of time

• A person who experiences derealization might feel as though they’re in a fog or a dream, or that the surrounding world is somehow artificial and unreal.

Dissociative Identity Disorder

• Dissociative identity disorder: when an individual exhibits two or more separate personalities or identities, each well-defined and distinct from one another.

• They experience memory gaps for the time during which another identity is in charge

• Dissociative identity disorder (DID) is highly controversial and its validity is often questioned because there are people who fake its symptoms

• People with this disorder tend to report a history of childhood trauma

• Traumatic experiences can cause people to experience states of dissociation, suggesting that dissociative states—including the adoption of multiple personalities—may serve as a psychologically important coping mechanism for threat and danger

15.10 Personality Disorders

• Personality disorders: individuals exhibit a personality style that differs markedly from the expectations of their culture, is pervasive and inflexible, begins in adolescence or early adulthood, and causes distress or impairment

• Their maladaptive personality styles frequently bring them into conflict with others, disrupt their ability to develop and maintain social relationships, and prevent them from accomplishing realistic life goals.

• The DSM-5 recognizes 10 personality disorders, organized into 3 different clusters.

  • Cluster A disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

    • People with these disorders display a personality style that is odd or eccentric.

  • Cluster B disorders include antisocial personality disorder, histrionic personality disorder, narcissistic personality disorder, and borderline personality disorder.

    • People with these disorders usually are impulsive, overly dramatic, highly emotional, and erratic.

  • Cluster C disorders include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder.

    • People with these disorders often appear to be nervous and fearful.

Borderline Personality Disorder

• Borderline personality disorder: characterized chiefly by instability in interpersonal relationships, self-image, and mood, as well as marked impulsivity

• People with borderline personality disorder cannot tolerate the thought of being alone and will make frantic efforts to avoid abandonment or separation and their relationships are intense and unstable

• These individuals have an unstable view of self and might suddenly display a shift in personal attitudes, interests, career plans, and choice of friends.

• People with borderline personality disorder may be highly impulsive and may engage in reckless and self-destructive behaviors

• They sometimes show intense and inappropriate anger that they have difficulty controlling, and they can be moody, sarcastic, bitter, and verbally abusive.

• Core personality traits that characterize this disorder show a high degree of heritability

• Borderline personality disorder may be determined by an interaction between genetic factors and adverse environmental experiences.

Antisocial Personality Disorder

• People with antisocial personality disorder do not seem to have a moral compass.

• Antisocial personality disorder: individual shows no regard at all for other people’s rights or feelings.

• Characteristics of antisocial personality disorder:

  • People with this disorder have no remorse over one’s misdeeds

  • Signs of this disorder can emerge early in life; however, a person must be at least 18 years old to be diagnosed with antisocial personality disorder.

  • People with antisocial personality disorder seem to view the world as self-serving and unkind.

  • They tend to view others not as living, thinking, feeling beings, but rather as pawns to be used or abused for a specific purpose.

  • They often have an over-inflated sense of themselves and can appear extremely arrogant.

  • They frequently display superficial charm

  • They lack empathy

• Three major concepts of antisocial personality disorder: disinhibition, boldness, and meanness.

  • Disinhibition: a propensity toward impulse control problems, lack of planning and forethought, insistence on immediate gratification, and inability to restrain behavior.

  • Boldness: a tendency to remain calm in threatening situations, high self-assurance, a sense of dominance, and a tendency toward thrill-seeking.

  • Meanness: aggressive resource seeking without regard for others; signaled by a lack of empathy, disdain for and lack of close relationships with others, and a tendency to accomplish goals through cruelty

• Genetic and environmental factors influence the development of antisocial personality disorder, as well as general antisocial behavior.

• Those with antisocial tendencies do not seem to experience emotions the way most other people do. These individuals fail to show fear in response to environment cues that signal punishment, pain, or noxious stimulation.

15.11 Disorders in Childhood

• Neurodevelopmental disorders: involve developmental problems in personal, social, academic, and intellectual functioning

Attention Deficit/Hyperactivity Disorder

• Attention deficit/hyperactivity disorder (ADHD): child shows a constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning

• Some of the signs of inattention include great difficulty with and avoidance of tasks that require sustained attention, failure to follow instructions, disorganization, lack of attention to detail, becoming easily distracted, and forgetfulness.

• Hyperactivity: characterized by excessive movement.

• Previously, ADHD was thought to fade away by adolescence. However, longitudinal studies have suggested that ADHD is a chronic problem, one that can persist into adolescence and adulthood

• Genetics play a significant role in the development of ADHD.

• The specific genes involved in ADHD are thought to include at least two that are important in the regulation of the neurotransmitter dopamine, suggesting that dopamine may be important in ADHD.

• People with ADHD show less dopamine activity in key regions of the brain, which provides support to the theory that dopamine deficits may be a vital factor in the development of ADHD.

• Family environment doesn’t play much of a role in the development of ADHD

Autism Spectrum Disorder

• Autism spectrum disorder: children with this disorder show signs of significant disturbances in three main areas: deficits in social interaction, deficits in communication, and repetitive patterns of behavior or interests.

  • These disturbances appear early in life and cause serious impairments in functioning.

  • The child with autism spectrum disorder might exhibit deficits in social interaction by living in a personal and isolated social world others are simply not privy to or able to penetrate.

  • Communication deficits can range from a complete lack of speech, to one word responses, to echoed speech, to difficulty maintaining a conversation because of an inability to reciprocate others’ comments. These deficits can also include problems in using and understanding nonverbal cues that facilitate normal communication.

  • Repetitive patterns of behavior or interests can be exhibited a number of ways. The child might engage in stereotyped, repetitive movements, or they might show great distress at small changes in routine or the environment.

• Autism spectrum disorder is not the same thing as intellectual disability, although these two conditions are often comorbid. The DSM-5 specifies that the symptoms of autism spectrum disorder are not caused or explained by intellectual disability.

• Most individuals with autism don’t live and work independently as adults because the symptoms remain sufficient to cause serious impairment in many realms of life.

• Early theories of autism placed the blame squarely on the shoulders of the child’s parents, particularly the mother.

• Autism appears to be strongly influenced by genetics.

  • Many different genes and gene mutations have been implicated in autism.

    • Among the genes involved are those important in the formation of synaptic circuits that facilitate communication between different areas of the brain.