DEFINITIONS OF DISORDER

• The definition of disordered behavior is composed of four components.

  • First, disordered behavior is unusual—it deviates statistically from typical behavior.

  • Second, disordered behavior is maladaptive: that is, it interferes with a person’s ability to function in a particular situation.

  • Third, disordered behavior is labeled as abnormal by the society in which it occurs.

  • Finally, disordered behavior is characterized by perceptual or cognitive dysfunction.

THEORIES OF PSYCHOPATHOLOGY

• Sigmund Freud engaged in careful observation and analysis of people with varying degrees of behavioral abnormalities.

• Freud and the psychoanalytic school hypothesized that the interactions among conscious and especially unconscious parts of the mind were responsible for a great deal of disordered behavior.

• The humanistic school of psychology suggests that disordered behavior is, in part, a result of people being too sensitive to the criticisms and judgments of others.

• The cognitive perspective views disordered behavior as the result of faulty or illogical thoughts.

• The behavioral approach to disordered behavior is based on the notion that all behavior, including disordered behavior, is learned.

• The biological view of disordered behavior, which is a popular one in the United States at the present time, views disordered behavior as a manifestation of abnormal brain function, due to either structural or chemical abnormalities in the brain.

• The sociocultural approach holds that society and culture help define what is acceptable behavior.

DIAGNOSIS OF PSYCHOPATHOLOGY

• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the American Psychiatric Association’s handbook for the identification and classification of behavioral disorders.

  • The DSM-5 calls for the separate notation of important social factors and physical disabilities, in addition to the diagnosis of mental disorders.

NEURODEVELOPMENTAL DISORDERS

• The term neurodevelopmental refers to the developing brain.

• Related disorders manifest early in development, and may be due to genetic issues, trauma in the womb, or brain damage acquired at birth or in the first years of life.

• Intellectual disability (formerly known as mental retardation) is characterized by delayed development in general mental abilities (reasoning, problem-solving, judgment, academic learning, etc.).

• Autism spectrum disorder is a neurodevelopmental disorder that often manifests early on in childhood development.

• Attention-deficit hyperactivity disorder (ADHD) is described as patterned inattention and/or hyperactivity-impulsivity.

• Other neurodevelopmental disorders include communication disorders such as language disorder, speech sound disorder, and fluency disorder (stuttering); motor disorders such as developmental coordination disorder, stereotypic movement disorder, and tics; and specific learning disorders.

SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS

• Although the term schizophrenia literally means “split brain,” these disorders have nothing to do with what used to be called Multiple Personality Disorder.

• Delusions are beliefs that are not based in reality, such as believing that one can fly, that one is the president of a country, or that one is being pursued by the CIA (assuming that these things are not true).

• Hallucinations are perceptions that are not based in reality, such as seeing things or hearing voices that are not there, or feeling spiders on one’s skin (assuming they are not really there).

• Disorganized thinking and disorganized speech are typical.

• It is important to distinguish between positive symptoms and negative symptoms.

  • A positive symptom of schizophrenic disorders refers to something that a person has that typical people do not.

  • A negative symptom refers to something that typical people do have, but that one does not have.

BIPOLAR AND RELATED DISORDERS

• Bipolar disorders, as the name suggests, involves movement between two poles: depressive states on the one hand, and manic states on the other hand.

• Because manic states often have psychotic features, the DSM-5 now regards bipolar disorders as a bridge between the psychoses and the major depressive disorders.

DEPRESSIVE DISORDERS

• Unlike the everyday-language use of the term (“I’m so depressed about that test”), depressive disorders involve the presence of a sad, empty, or irritable mood, combined with changes in thinking and bodily functioning that significantly impair one’s ability to function.

ANXIETY DISORDERS

• Fear is an emotional response to something present; anxiety is a related emotional response, but to a future threat or a possibility of danger.

• Physical effects of anxiety may include but are not limited to muscle tension, hyperalertness for danger signs, and avoidance behaviors.

• Panic disorder is an anxiety disorder characterized by recurring panic attacks, as well as the constant worry of another panic attack occurring.

• Generalized anxiety disorder (GAD) is an anxiety disorder characterized by an almost constant state of autonomic nervous system arousal and feelings of dread and worry.

• Phobias, or persistent, irrational fears of common events or objects, are also anxiety disorders.

• Agoraphobia, for example, is the fear of being in open spaces, public places, or other places from which escape is perceived to be difficult.

OBSESSIVE-COMPULSIVE AND RELATED DISORDERS

• As the name suggests, these disorders involve obsessions and/or compulsions.

  • Obsessions are intrusive (unwanted) thoughts, urges, or images that plague the individual.

  • Compulsions are repetitive behaviors (or mental acts) that one feels compelled to perform, often in relation to an obsession.

• OCD is characterized by involuntary, persistent thoughts or obsessions, as well as compulsions, or repetitive behaviors that are time consuming and maladaptive, that an individual believes will prevent a particular (usually unrelated) outcome.

TRAUMA-AND STRESSOR-RELATED DISORDERS

• By definition, these disorders follow a particularly disturbing event or set of events (the trauma or the stressor), like war or violence.

• The best-known such disorder is post-traumatic stress disorder (PTSD), which can involve intrusive thoughts or dreams related to the trauma, irritability, avoidance of situations that might recall the traumatic event, sleep disturbances, diminished interest in formerly pleasurable activities, and social withdrawal.

• Other disorders include reactive attachment disorder, which can occur in seriously neglected children who are unable to form attachments to their adult caregivers, and adjustment disorders, or maladaptive responses to particular stressors.

DISSOCIATIVE DISORDERS

• In many cases, these disorders appear following a trauma, and may be seen as the mind’s attempt to protect itself by splitting itself into parts.

  • Thus, one might experience derealization, the sense that “this is not really happening,” or depersonalization, the sense that “this is not happening to me.”

• Significant gaps in memory may be related to dissociative amnesia, an inability to recall life events that goes far beyond normal forgetting.

  • Perhaps the most extreme of these disorders is dissociative identity disorder (formerly known as multiple personality disorder), in which one may not only “lose time,” but also manifest a separate personality during that lost time.

SOMATIC SYMPTOM AND RELATED DISORDERS

• Soma means “body.”

• Somatic symptom disorder involves, as one might expect, bodily symptoms combined with disordered thoughts, feelings, and/or behaviors connected to these symptoms.

• Related worries appear in illness anxiety disorder, in which one worries excessively about the possibility of falling ill.

• Conversion disorder (formerly known as hysteria) involves bodily symptoms like changed motor function or changed sensory function that are incompatible with neurological explanations.

• Factitious disorder, in which an individual knowingly falsified symptoms in order to get medical care, or sympathy or aid from others.

FEEDING AND EATING DISORDERS

• Anorexia nervosa (commonly called anorexia) involves not only restriction of food intake, but also intense fear of gaining weight and disturbances in self-perception, such as thinking one looks fat, when one does not.

• Bulimia nervosa (commonly called bulimia) involves recurrent episodes of binge-eating: eating large amounts of food in short amounts of time, followed by inappropriate behaviors to prevent weight gain, such as self-induced vomiting (purging), using laxatives, or intense exercising.

• Binge-eating disorder might be thought of as bulimia without purging.

• Pica refers to regular consumption of non-nutritive substances (plastic, paper, dirt, string, chalk, etc.).

PERSONALITY DISORDERS

• A personality disorder refers to a stable (and inflexible) way of experiencing and acting in the world, one that is at variance with the person’s culture, that starts in adolescence or adulthood, and leads to either personal distress or impairment of social functioning.

• Cluster A includes paranoid, schizoid, and schizotypal personality disorders.

  • Schizoid personality disorder is marked by disturbances in feeling (detachment from social relationships, flat affect, does not enjoy close relationships with people), whereas schizotypal personality disorder is marked by disturbances in thought (odd beliefs that do not quite qualify as delusions, such as superstitions, belief in a “sixth sense,” etc.; odd speech; eccentric behavior or appearance).

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

  • Terms like psychopath or sociopath have been used to describe people with antisocial personality disorder, which is characterized by a persistent pattern of disregard for, and violation of, the rights of others.

  • Borderline personality disorder involves a very stormy relationship with the world, with others, and with one’s own feelings.

  • Histrionic personality disorder involves a pattern of excessive emotionality and attention-seeking, beyond what might be considered normal (even in a “culture of selfies”).

  • Narcissistic personality disorder involves an overinflated sense of self-importance, fantasies of success, beliefs that one is special, a sense of entitlement, a lack of empathy for others, and a display of arrogant behaviors or attitudes.

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

  • Avoidant personality disorder involves an enduring pattern of social inhibition, feelings of inadequacy, and hypersensitivity to real or perceived criticism, which lead to avoidance behavior in relation to social, personal, and intimate relationships.

  • Dependent personality disorder is marked by an excessive need to be cared for, leading to clingy and submissive behavior and fears of separation.

  • Obsessive-compulsive personality disorder (OCPD) is marked by a rigid concern with order, perfectionism, control, and work, at the expense of flexibility, spontaneity, openness, and play.

Next Chapter: Chapter 17: Clinical Psychology: Treatment