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.

• 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.

• Cognitive perspective: views disordered behavior as the result of faulty or illogical thoughts.

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

• 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.

• 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 Disorder

• 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.

Disassociative 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.

Psychoanalysis

• Psychoanalysis: or psychoanalytic therapy, as it is sometimes called, was first developed by Freud and focuses on probing past defense mechanisms of repression and rationalization to understand the unconscious cause of a problem.

• Countertransference: may occur if the therapist transfers his or her own feelings onto the patient.

Humanistic Therapy

• The humanistic school of psychology takes a related, yet different approach to the treatment of disordered behavior.

• Client-centered therapy: was invented by Carl Rogers and involves the assumption that clients can be understood only in terms of their own realities.

  • The client-centered therapist approaches this differently from the Freudian.

• The therapist is honest, open, and emotional with the client (an active listener).

  • Rogers called this client-relationship genuineness.

• The next key for successful client-centered therapy, according to Rogers, is unconditional positive regard.

  • Unconditional positive regard: is a term used in psychology to refer to an attitude of acceptance and warmth towards another person, regardless of their behavior or beliefs.

  • The therapist provides this unconditional positive regard to help the client reach a state of unconditional self-worth.

• The final key to successful therapy is accurate empathic understanding.

  • Accurate empathic understanding: is the ability to accurately understand and identify what someone else is feeling.

• Rogers used this term to describe the therapist’s ability to view the world from the eyes of the client.

• This empathy is critical to successful communication between the therapist and client.

• A different type of approach toward treatment is Gestalt therapy, which combines both physical and mental therapies.

• Fritz Perls: developed this approach to blend an awareness of unconscious tensions with the belief that one must become aware of and deal with those tensions by taking personal responsibility.

Behavioral Therapy

• Behavioral therapy: stands in dramatic contrast to the insight therapies.

• Counterconditioning: is a technique in which a response to a given stimulus is replaced by a different response.

• Counterconditioning can be accomplished in a few ways.

  • One is to use aversion therapy, in which an aversive stimulus is repeatedly paired with the behavior that the client wishes to stop.

  • Another method used for counterconditioning is systematic desensitization.

  • This technique involves replacing one response, such as anxiety, with another response, such as relaxation.

• Other forms of behavioral therapy involve extinction procedures, which are designed to weaken maladaptive responses.

  • One way of trying to extinguish a behavior is called flooding.

  • Flooding involves exposing a client to the stimulus that causes the undesirable response.

• Implosion: is a similar technique, in which the client imagines the disruptive stimuli rather than actually confronting them.

• Operant conditioning: is a behavior-control technique that we discussed in the chapter on learning.

  • A related approach is behavioral contracting, in which the therapist and the client draw up a contract by which they both agree to abide.

• Modeling: is a therapeutic approach based on Bandura’s social learning theory.

  • This technique is based on the principle of vicarious learning.

Cognitive Therapy

• Cognitive approaches to the treatment of disordered behavior rely on changing cognitions, or the ways people think about situations, in order to change behavior.

• One such approach is rational-emotive behavior therapy (REBT) (sometimes called simply RET, for rational-emotive therapy), formulated by Albert Ellis.

• Another cognitive approach is cognitive therapy, formulated by Aaron Beck, in which the focus is on maladaptive schemas.

• Maladaptive schemas: include arbitrary inference, in which a person draws conclusions without evidence, and dichotomous thinking, which involves all-or-none conceptions of situations.

Biological Therapies

• Biological therapies are medical approaches to behavioral problems.

• Biological therapies are typically used in conjunction with one of the previously mentioned forms of treatment.

• Electroconvulsive therapy (ECT): is a form of treatment in which fairly high voltages of electricity are passed across a patient’s head.

  • This treatment causes temporary amnesia and can result in seizures.

• Another form of biological treatment is psychosurgery.

  • Perhaps the most well-known form of psychosurgery is the prefrontal lobotomy, in which parts of the frontal lobes are cut off from the rest of the brain.

• Psychopharmacology: is the treatment of psychological and behavioral maladaptations with drugs.

  • There are four broad classes of psychotropic, or psychologically active drugs: antipsychotics, antidepressants, anxiolytics, and lithium salts.

• Antipsychotics: like Clozapine, Thorazine, and Haldol reduce the symptoms of schizophrenia by blocking the neural receptors for dopamine.

• Antidepressants: can be grouped into three types: monoamine oxidase (MAO) inhibitors, tricyclics, and selective reuptake inhibitors.

• MAO inhibitors: like Eutron, work by increasing the amount of serotonin and norepinephrine in the synaptic cleft.

• Tricyclics: like Norpramin, Amitriptyline, and Imipramine increase the amount of serotonin and norepinephrine.

• The third class of antidepressants, selective reuptake inhibitors (often called the selective serotonin reuptake inhibitors, or SSRIs, for the neurotransmitter most affected by them) also work by increasing the amount of neurotransmitter at the synaptic cleft, in this case by blocking the reuptake mechanism of the cell that released the neurotransmitters.

• Anxiolytics depress the central nervous system and reduce anxiety while increasing feelings of well-being and reducing insomnia.

• Benzodiazepines: which also include Valium (Diazepam) and Librium (Chlordiazepoxide), cause muscle relaxation and a feeling of tranquility.

• Lithium carbonate:a salt, is effective in the treatment of bipolar disorder.

Modes Of Therapy

• Group therapy: in which clients meet together with a therapist as an interactive group, has some advantages over individual therapy.

• Twelve-step programs: are one form of group therapy, although they are usually not moderated by professional psychotherapists.

• Another form of therapy in which there is more than a single client is couples or family therapy.

  • This type of treatment arose out of the simple observation that some dysfunctional behavior affects the afflicted person’s loved ones.