Introduction To Psychology Chapter 12 Notes

lOMoARcPSD|23780900 Abnormal behavior may also be defined by three criteria that distinguish it from normal behavior: Abnormal behavior is deviant, maladaptive, or personally distressful over a relatively long period of time. Only one of these criteria needs to be present for a behavior to be labeled “abnormal,” but typically two or all three are present. Abnormal behavior is deviant. -Abnormal behavior is certainly atypical or statistically unusual. - However, Alicia Keys, Tim Howard, and Mark Zuckerberg are atypical in many of their behaviors, and yet we do not categorize them as abnormal. -We do often consider atypical behavior abnormal, though, when it deviates from what is acceptable in a culture. A woman who washes her hands three or four times an hour and takes seven showers a day is abnormal because her behavior deviates from culturally acceptable norms. Abnormal behavior is maladaptive. -Maladaptive behavior interferes with one's ability to function effectively in the world. - A man who believes that he can endanger others through his breathing may go to great lengths to isolate himself from people for what he believes is their own good. -His belief negatively affects his everyday functioning; thus, his behavior is maladaptive. Behavior that presents a danger to the person or those around him or her is also considered maladaptive (and abnormal). Abnormal behavior is personally distressful over a long period of time. -The person engaging in the behavior finds it troubling. -A woman who secretly makes herself vomit after every meal may never be seen by others as deviant (because they do not know about it), but this pattern of behavior may cause her to feel intense shame, guilt, and despair. -Because culture establishes the norms by which people evaluate their own and others’ behaviors, culture is at the core of what it means to be normal or abnormal -In evaluating behavior as normal or abnormal, culture matters in complex ways -Cultural norms provide guidance about how people should behave and what behavior is healthy or unhealthy. Importantly, however, cultural norms can be mistaken. -One only has to watch an episode of Mad Men to recognize that at one time cigarette smoking was not only judged to be an acceptable habit but also promoted as a healthy way to relax. The point is, definitions of normal change as society changes. -is the fact that cultural norms can be limiting, oppressive, and prejudicial -Individuals who fight to change the established social order sometimes face the possibility of being labeled deviant—and even mentally ill. - In the late nineteenth and early twentieth centuries, for instance, women in Britain who demonstrated for women's right to vote were widely viewed to be mentally ill. -When a person's or a group's behavior challenges social expectations, we must open our minds to the possibility that such actions are in fact an adaptive response to injustice. lOMoARcPSD|23780900 -People may justifiably challenge what everyone thinks is true and may express ideas that seem strange. -They should be able to make others feel uncomfortable without being labeled abnormal. The biological approach- attributes psychological disorders to organic, internal causes. ---This perspective primarily focuses on the brain, genetic factors, and neurotransmitter functioning as the sources of abnormality. -The biological approach is evident in the medical model- which describes psychological disorders as medical diseases with a biological origin. From the perspective of the medical model, abnormalities are called “mental illnesses,” the afflicted individuals are “patients,” and they are treated by “doctors.” The psychological approach emphasizes the contributions of experiences, thoughts, emotions, and personality characteristics in explaining psychological disorders. -Psychologists might focus, for example, on the influence of childhood experiences, personality traits, learning experiences, or cognitions in the development and course of psychological disorders. The sociocultural approach emphasizes the social contexts in which a person lives, including gender, ethnicity, socioeconomic status, family relationships, and culture. For instance, poverty is related to rates of psychological disorders (Moitra & others, 2014). -The sociocultural perspective stresses the ways that cultures influence the understanding and treatment of psychological disorders. -The frequency and intensity of psychological disorders vary and depend on social, economic, technological, and religious aspects of cultures (Matsumoto & Juang, 2013). - Some disorders are culture-related, such as windigo, a disorder recognized by northern Algonquian Native American groups that involves fear of being bewitched and turned into a cannibal. Abnormal behavior can be influenced by biological factors (such as genes), psychological factors (such as childhood experiences), and sociocultural factors (such as gender). These factors can operate alone, but they often act in combination with one another. -Sometimes this approach is called biopsychosocial. - From the biopsychosocial perspective, none of the factors considered is necessarily viewed as more important than another; rather, biological, psychological, and social factors are all significant ingredients in producing both normal and abnormal behavior. - Furthermore, these ingredients may combine in unique ways, so that one depressed person might differ from another in terms of the key factors associated with the development of the disorder. An important concept that has helped psychologists understand the ways different factors influence the development of psychological disorders is the vulnerability-stress hypothesis(also called the diathesis-stress model). ----The vulnerability-stress hypothesis suggests that preexisting conditions (such as genetic characteristics, personality dispositions, or experiences) may put a person at risk of developing a psychological disorder. -This vulnerability in combination with stressful experiences can lead to a psychological disorder. In 1952, the American Psychiatric Association (APA) published the first major classification of psychological disorders in the United States, the Diagnostic and Statistical Manual of Mental Disorders. Its current version, DSM-5, was published in 2013. --This edition of the DSM is the product of a 14-year revision process. lOMoARcPSD|23780900 - DSM-5 differs in many ways from its predecessors. Throughout the history of the DSM, the number of diagnosable disorders has increased dramatically. For example, DSM-5 includes new diagnoses such as binge-eating disorder and gambling addiction. -The DSM is not the only diagnostic system. The World Health Organization devised the International Classification of Diseases and Related Problems (ICD-10), which includes a chapter on mental and behavioral disorders. One of the goals of the authors of DSM-5 was to bring diagnoses closer to the ICD-10, although the two manuals remain different in important ways. CRITIQUES OF THE DSM -DSM-5 has been criticized on a number of bases -A central criticism that applies to all versions of the DSM is that it treats psychological disorders as if they are medical illnesses, taking an overly biological view of disorders that may have their roots in social experience (Blashfield & others, 2014). -Even as research has shed light on the complex interaction of genetic, neurobiological, cognitive, social, and environmental factors in psychological disorders, DSM-5 continues to reflect the medical model (British Psychological Society, 2011), neglecting factors such as poverty, unemployment, and trauma. -Another general criticism of the DSM is that it focuses strictly on problems. - Critics argue that emphasizing strengths as well as weaknesses might help to destigmatize psychological disorders. -Identifying a person's strengths can be an important step toward maximizing his or her ability to contribute to society (Roten, 2007). -An example of a change that occurred in DSM-5 that has inspired some controversy is the diagnosis of Somatic Symptom and Related Disorder -Somatic Symptom and Related Disorders- are defined as bodily symptoms that are either very distressing or that interfere with a person's functioning along with excessive thoughts, feelings, and behaviors about those symptoms (Rief, & Martin, 2014). - In previous versions of the DSM, for these symptoms to be classified as a psychological disorder, it was required that the physical symptoms lacked a medical explanation. -Now, it is possible for a person to be diagnosed with somatic symptom disorder even if they have an actual physical illness that is causing them distress. anxiety disorders- involve fears that are uncontrollable, disproportionate to the actual danger the person might be in, and disruptive of ordinary life. -They feature motor tension (jumpiness, trembling), hyperactivity (dizziness, a racing heart), and apprehensive expectations and thoughts Generalized anxiety disorder- is different from such everyday feelings of anxiety in that sufferers experience persistent anxiety for at least six months and are unable to specify the reasons for the anxiety (Freeman & Freeman, 2012). -People with generalized anxiety disorder are nervous most of the time. -They may worry about their work, relationships, or health. -That worry can also take a physical toll and cause fatigue, muscle tension, stomach problems, and lOMoARcPSD|23780900 difficulty sleeping. -What is the etiology of generalized anxiety disorder? (Etiology means the causes or significant preceding conditions.) -Among the biological factors are genetic predisposition, deficiency in the neurotransmitter GABA, and respiratory system abnormalities (Boschen, 2012). -The psychological and sociocultural factors include having harsh (or even impossible) self-standards, overly strict and critical parents, automatic negative thoughts when feeling stressed, and a history of uncontrollable traumas or stressors (such as an abusive parent). In a panic disorder- however, a person experiences recurrent, sudden onsets of intense terror, often without warning and with no specific cause. - Panic attacks can produce severe palpitations, extreme shortness of breath, chest pains, trembling, sweating, dizziness, and a feeling of helplessness (Oral & others, 2012). -People with panic disorder may feel that they are having a heart attack or going to die. What is the etiology of panic disorder? -Theories of the origins of panic attack take into account biological, psychological, and sociocultural factors. -In terms of biological factors, individuals may have a genetic predisposition to the disorder (Jensen & others, 2014). -Of particular interest to researchers are genes that direct the action of neurotransmitters such as norepinephrine (Buttenschøn & others, 2011), GABA (Hodges & others, 2014), and serotonin (Paul & others, 2014). -Another brain chemical, lactate, which plays a role in brain metabolism, has been found to be elevated in individuals with panic disorder (Maddock & others, 2009). -Further, experimental research has shown that increasing lactate levels can produce panic attacks (Reiman & others, 1989). -Other research points to the involvement of a wider range of genes and bodily systems, implicating genes involved in hormone regulation and responses to stress (Esler & others, 2008). -It is not uncommon to be afraid of particular objects or specific environments such as extreme heights. - For most of us, these fears do not interfere with daily life. -A fear becomes a phobia when a situation is so dreaded that an individual goes to almost any length to avoid it. -A snake phobia that keeps a city-dweller from leaving his apartment is clearly disproportionate to the actual chances of encountering a snake. -Specific phobia- is a psychological disorder in which an individual has an irrational, overwhelming, persistent fear of a particular object or situation. -Many explanations of specific phobias view these disorders as based on experiences, memories, and learned associations (Veale & others, 2013). -For example, the individual with a fear of heights perhaps experienced a fall from a high place earlier in life and therefore associates heights with pain (a classical conditioning explanation). -Alternatively, he or she may have heard about or watched others who demonstrated terror of high places lOMoARcPSD|23780900 (an observational learning explanation), as when a little girl develops a fear of heights after sitting next to her terrified mother and observing her clutch the handrails, white-knuckled, as the roller coaster creeps steeply uphill. - Not all people who have a specific phobia can easily identify experiences that explain these, so other factors may also be at play (Coelho & Purkis, 2009). -Each specific phobia may have its own neural correlates (Lueken & others, 2011), and some people may be especially prone to develop phobias (Burstein & others, 2012). -Social anxiety disorder (also called social phobia)- is an intense fear of being humiliated or embarrassed in social situations like these (Lampe & Sunderland, 2013; Morrison & Heimberg, 2013). -Singers Carly Simon and Barbra Streisand have dealt with social phobia. -Where does social anxiety disorder come from? Genes appear to play a role (Sakolsky, McCracken, & Nurmi, 2012), along with neural circuitry involving the thalamus, amygdala, and cerebral cortex (Damsa, Kosel, & Moussally, 2009). -A number of neurotransmitters also may be involved, especially serotonin (Christensen & others, 2010). -Social anxiety disorder may involve vulnerabilities, such as genetic characteristics or parenting styles that lay a foundation of risk, combined with learning experiences in a social context obsessive-compulsive disorder (OCD)- features anxiety-provoking thoughts that will not go away and/or urges to perform repetitive, ritualistic behaviors to prevent or produce some future situation. -Obsessions are recurrent thoughts, and compulsions are recurrent behaviors. -Individuals with OCD dwell on their doubts and repeat their routines sometimes hundreds of times a day. -The most common compulsions are excessive checking, cleansing, and counting. -Game show host Howie Mandel has coped with OCD, as have soccer star David Beckham, singer-actor Justin Timberlake, and actor Jessica Alba. -Obsessive-compulsive symptoms have been found in many cultures, and culture plays a role in the content of obsessive thoughts or compulsive behaviors (Matsunaga & Seedat, 2011) -What is the etiology of obsessive-compulsive disorder? In terms of biological factors, there seems to be a genetic component (Tang & others, 2014). - Also, brain-imaging studies have suggested neurological links for OCD (Bokor & Anderson, 2014). - One neuroscientific analysis is that the frontal cortex or basal ganglia are so active in OCD that numerous impulses reach the thalamus, generating obsessive thoughts or compulsive actions (Rotge & others, 2009). -Low levels of the neurotransmitters serotonin, dopamine, and glutamate likely are involved in the brain pathways linked with OCD (Pauls & others, 2014). -In one study, fMRI was used to examine the brain activity of individuals with OCD before and after treatment (Nakao & others, 2005). -Following effective treatment, a number of areas in the frontal cortex showed decreased activation. - The limbic system appears to be hyperactivated in those with OCD, even when situations have no uncertainty (Stern & others, 2013). -The amygdala, that part of the limbic system that is most involved in alerting us to dangers, would seem most relevant to OCD, but its role remains controversial (Via & others, 2014). -Low levels of the neurotransmitters serotonin and dopamine likely are involved in the brain pathways linked with OCD (Goljevscek & Carvalho, 2011; Soomro, 2012). lOMoARcPSD|23780900 -In terms of psychological factors, OCD sometimes occurs during a period of life stress such as that surrounding the birth of a child or a change in occupational or marital status (Uguz & others, 2007). -According to the cognitive perspective, what differentiates individuals with OCD from those who do not have it is the ability to turn off negative, intrusive thoughts by ignoring or effectively dismissing them The DSM-5 includes other disorders that are thought to be related to OCD (Abramowitz & Jacoby, 2015). All of these involve repetitive behavior and often anxiety. Here are some examples: ● Hoarding disorder involves compulsive collecting, poor organization skills, and difficulty discarding things, along with cognitive deficits in information processing speed, problems with decision making, and procrastination (Frost, Steketee, & Tolin, 2012). Individuals with hoarding disorder find it difficult to throw things away and are troubled by the feeling that they might need items like old newspapers at a later time (Bloch & others, 2014; Dimauro & others, 2013). post-traumatic stress disorder (PTSD)- a disorder that develops through exposure to a traumatic event that overwhelms the person's abilities to cope. DSM-5 has expanded the kinds of experiences that might foster PTSD, recognizing that the disorder can occur not only in individuals who directly experience a trauma but also in those who witness it and those who only hear about it (APA, 2013). The symptoms of PTSD vary but include: ● ● ● ● ● ● Flashbacks in which the individual relives the event. A flashback can make the person lose touch with reality and reenact the event for seconds, hours, or, very rarely, days. A person having a flashback—which can come in the form of images, sounds, smells, and/or feelings—usually believes that the traumatic event is happening all over again. Avoiding emotional experiences and avoiding talking about emotions with others. Emotional numbness and a reduced ability to feel emotions. Excessive arousal, resulting in an exaggerated startle response or an inability to sleep. Difficulties with memory and concentration. Impulsive behavior. Clearly, one cause of PTSD is the traumatic event itself. -However, because not everyone who experiences the same traumatic life event develops PTSD, other factors, aside from the event, must influence a person's vulnerability to the disorder (Abramowitz & Jacoby, 2015). -These include a history of previous traumatic events and conditions, such as abuse and psychological disorders (Soylu, Ayaz, & Yüksel, 2014), cultural background as in the case of traumatized refugees (Slewa-Younan & others, 2014), and genetic predisposition (Wolf & others, 2014). Depressive disorders- are disorders in which the individual suffers from depression, an unrelenting lack of pleasure in life. - representative U.S. survey including individuals aged 13 and up found that approximately 30 percent reported a depressive episode or diagnosis in the last 12 months Major depressive disorder (MDD)- involves a significant depressive episode and depressed lOMoARcPSD|23780900 characteristics, such as lethargy and hopelessness, for at least two weeks. -MDD impairs daily functioning, and the National Institute of Mental Health (NIMH) has called it the leading cause of disability in the United States (NIMH, 2014a). The symptoms of major depressive disorder may include: ● ● ● ● ● ● ● ● ● Depressed mood most of the day Reduced interest or pleasure in activities that were once enjoyable Significant weight loss or gain or significant decrease or interest in appetite Trouble sleeping or sleeping too much Fatigue or loss of energy Feeling worthless or guilty in an excessive or inappropriate manner Problems in thinking, concentrating, or making decisions Recurrent thoughts of death and suicide No history of manic episodes (periods of euphoric mood) Individuals who experience less extreme depressive mood for more than two months may be diagnosed with persistent depressive disorder. This disorder includes symptoms such as hopelessness, lack of energy, poor concentration, and sleep problems. - The biological factors implicated in depressive disorders include genes, brain structure and function, and neurotransmitters. -Genes appear to play a role in depression (Chou & others, 2013; Pishva & others, 2014), but they likely do so in conjunction with experiences. -That means that genetic characteristics can make a person vulnerable to develop depression. -For instance, depression has been linked to particular features of the serotonin transporter gene (Albert, Vahid-Ansari, & Luckhart, 2014; Vinberg & others, 2010). - Importantly, research shows that these features do not lead directly to depression. -Rather, they are associated with depression only if the person's social environment was stressful (Ignácio & others, 2014). -In fact, individuals who possess these genetic features are at a decreased risk for depression if they experience a warm, positive social environment (Eley & others, 2004). -In addition, specific brain structures are involved in depression. -For example, depressed individuals show lower levels of brain activity in a section of the prefrontal cortex that is involved in generating actions (Duman & others, 2012) and in regions of the brain associated with the perception of rewards in the environment (Howland, 2012). -A depressed person's brain may not recognize opportunities for pleasurable experiences. -Depression also likely involves problems in neurotransmitter regulation. -Individuals with depressive disorder appear to have too few receptors for the neurotransmitters serotonin and norepinephrine (Hamon & Blier, 2013; Houston & others, 2012). -Psychological explanations of depression have drawn on behavioral learning theories and cognitive theories. -One behavioral view of depression focuses on learned helplessness, which involves an individual's feelings of powerlessness after exposure to aversive circumstances over which the person has no control. lOMoARcPSD|23780900 -Martin Seligman (1975) proposed that learned helplessness is a reason that some people become depressed. -When individuals cannot control their stress, they eventually feel helpless and stop trying to change their situations. This helplessness spirals into hopelessness (Becker-Weidman & others, 2009). -Cognitive explanations of depression focus on the thoughts and beliefs that contribute to this sense of hopelessness (Beck & Haigh, 2014; Jarrett & others, 2012). -Psychiatrist Aaron Beck (1967) proposed that negative thoughts reflect self-defeating beliefs that shape depressed individuals’ experiences. -These habitual negative thoughts magnify and expand depressed persons’ negative experiences (Lam, 2012). -For example, a depressed individual might overgeneralize about a minor occurrence—say, turning in a work assignment late—and think that he or she is worthless. -A depressed person might view a minor setback such as getting a D on a paper as the end of the world. The accumulation of such cognitive distortions can lead to depression (Lee & others, 2011). -Another cognitive view of depression focuses on people's attributions—their attempts to explain what caused something to happen (Seidel & others, 2012). -Depression is thought to be related to a pessimistic attributional style. -In this style, individuals regularly explain negative events as having internal causes (“It is my fault I failed the exam”), stable causes (“I'm going to fail again and again”), and global causes (“Failing this exam shows that I won't do well in any of my courses”). -Pessimistic attributional style means blaming oneself for negative events and expecting the negative events to recur (Abramson, Seligman, & Teasdale, 1978). -This pessimistic style can be contrasted with an optimistic attributional style, which is essentially its opposite. -Optimists make external attributions for bad things that happen (“I did badly on the test because it's hard to know what a professor wants on the first exam”). - They also recognize that these causes can change (“I'll do better on the next one”) and that they are specific (“It was only one test”). -Optimistic attributional style has been related to lowered depression and decreased suicide risk in a variety of samples Individuals with a low socioeconomic status (SES), especially people living in poverty, are more likely to develop depression than their higher-SES counterparts (Wittayanukorn, Qian, & Hansen, 2014). -A longitudinal study of adults revealed that depression increased as one's standard of living and employment circumstances worsened (Lorant & others, 2007). -Studies have found very high rates of depression in Native American groups, among whom poverty, hopelessness, and alcoholism are widespread (Teesson & Vogl, 2006). -Women are nearly twice as likely as men to develop depression (Nolen-Hoeksema, 2014). For individuals with bipolar disorder, the ups and downs of life take on an extreme and often harmful tone. lOMoARcPSD|23780900 -Bipolar disorder- is a disorder characterized by extreme mood swings that include one or more episodes of mania, an overexcited, unrealistically optimistic state. -A manic episode is like the flipside of a depressive episode. -The person who experiences mania feels on top of the world. She has tremendous energy and might sleep very little. A manic state also features an impulsivity that can get the individual in trouble. For example, the sufferer might spend his life savings on a foolish business ventur What factors play a role in the development of bipolar disorder? Genetic influences are stronger predictors of bipolar disorder than of depressive disorders (Kaminsky & others, 2014). -An individual with an identical twin who has bipolar disorder has a 70 percent probability of also having the disorder, and a fraternal twin has a more than 10 percent probability Other biological processes are also a factor. - Like depression, bipolar disorder is associated with differences in brain activity. - Figure 5 shows the metabolic activity in the cerebral cortex of an individual cycling through depressive and manic phases. - Notice the decrease in metabolic activity in the brain during depression and the increase in metabolic activity during mania (Baxter & others, 1985). -In addition to high levels of norepinephrine and low levels of serotonin, studies link high levels of the neurotransmitter glutamate to bipolar disorder =Psychologists and psychiatrists have noted cases of children who appear to suffer from bipolar disorder (Cosgrove, Roybal, & Chang, 2013; DeFilippis & Wagner, 2013). -A key dilemma in such cases is that treating bipolar disorder in adults involves administering psychoactive drugs that have not been approved for children's use. -The side effects of these drugs could put children's health and development at risk. -To address this issue, the DSM-5 includes a new diagnosis, disruptive mood dysregulation disorder, which is considered a depressive disorder in children who show persistent irritability and recurrent episodes of out-of-control behavior (APA, 2013). -This decision is not without controversy. As we saw with ADHD, some children who are perceived to be prone to wild mood swings may be simply behaving like children. Eating disorders are characterized by extreme disturbances in eating behavior—from eating very, very little to eating a great deal. In this section we examine three eating disorders—anorexia nervosa, bulimia nervosa, and binge-eating disorder. Anorexia nervosa- is an eating disorder that involves the relentless pursuit of thinness through starvation. Anorexia nervosa is much more common in girls and women than boys and men and affects between 0.5 and 3.7 percent of young women (NIMH, 2014b). The American Psychiatric Association (2013) lists these main characteristics of anorexia nervosa: ● Weight less than 85 percent of what is considered normal for age and height, and refusal to maintain weight at a healthy level. lOMoARcPSD|23780900 ● ● An intense fear of gaining weight that does not decrease with weight loss. A distorted body image (Stewart & others, 2012). Even when individuals with anorexia nervosa are extremely thin, they never think they are thin enough. Bulimia nervosa- is an eating disorder in which an individual (typically female) consistently follows a binge-and-purge eating pattern - The individual goes on an eating binge and then purges by self-induced vomiting or the use of laxatives. -Most people with bulimia nervosa are preoccupied with food, have a strong fear of becoming overweight, and are depressed or anxious (Cuzzolaro, 2014). - One recent study found that bulimics have difficulty controlling their emotions (Lavender & others, 2014). -Because bulimia nervosa occurs within a normal weight range, the disorder is often difficult to detect. A person with bulimia nervosa usually keeps the disorder a secret and experiences a great deal of selfdisgust and shame. -Bulimia nervosa can lead to complications such as a chronic sore throat, kidney problems, dehydration, and gastrointestinal disorders (NIMH, 2014b). The disorder is also related to dental problems, as persistent exposure to the stomach acids in vomit can wear away tooth enamel. -In recent years, researchers have increasingly probed the potential biological underpinnings of these disorders, examining in particular the interplay of social and biological factors. - Genes play a substantial role in both anorexia nervosa and bulimia nervosa (Boraska & others, 2014; Mas & others, 2013; Trace & others, 2013). -In fact, genes influence many psychological characteristics (for example, perfectionism, impulsivity, obsessive-compulsive tendencies, and thinness drive) and behaviors (restrained eating, binge eating, self-induced vomiting) that are associated with anorexia nervosa and bulimia nervosa (Laplana & others, 2014; Tang & others, 2014). - These genes are also factors in the regulation of serotonin, and problems in regulating serotonin are related to both anorexia nervosa and bulimia nervosa (Capasso, Putrella, & Milano, 2009). -Even as biological factors play a role in the emergence of eating disorders, eating disorders themselves affect the body, including the brain. -Most psychologists believe that while social factors and experiences may play a role in triggering dieting, the physical effects of dieting, bingeing, and purging may change the neural networks that then sustain the disordered pattern, in a kind of vicious cycle (Fuglset & others, 2014; Kaye & others, 2013). -Although anorexia and bulimia nervosa are serious disorders, recovery is possible (Fitzpatrick, 2012; Treasure, Claudino, & Zucker, 2010). -The first target of intervention is promoting weight gain, in extreme cases through the use of a feeding tube. -A common obstacle in the treatment of anorexia nervosa is that individuals with the disorder deny that anything is wrong. -They maintain their belief that thinness and restrictive dieting are correct and not a sign of mental illness (Wilson, Grilo, & Vitousek, 2007). - Still, drug therapies and psychotherapy (especially cognitive therapy and family therapy) have been shown to be effective in treating anorexia nervosa, as well as bulimia nervosa lOMoARcPSD|23780900 Binge-eating disorder (BED)- is characterized by recurrent episodes of consuming large amounts of food during which the person feels a lack of control over eating (APA, 2013). -Unlike an individual with bulimia nervosa, someone with BED does not try to purge. Most individuals with BED are overweight or obese (Carrard, Van der Linden, & Golay, 2012). -Individuals with BED often eat quickly, eat a great deal when they are not hungry, and eat until they are uncomfortably full. -They frequently eat alone because of embarrassment or guilt, and they feel ashamed and disgusted with themselves after overeating. -BED is the most common of all eating disorders—affecting men, women, and ethnic groups within the -United States more similarly than anorexia nervosa or bulimia nervosa (Azarbad & others, 2010). An estimated 2 to 5 percent of Americans will suffer from BED in their lifetime Researchers are examining the role of biological and psychological factors in BED. -Genes play a role (Akkermann & others, 2012), as does dopamine, the neurotransmitter related to reward pathways in the brain (Davis & others, 2010). = The fact that binge eating often occurs after stressful events suggests that binge eaters use food to regulate their emotions (Wilson, Grilo, & Vitousek, 2007). -The areas of the brain and endocrine system that respond to stress are overactive in individuals with BED (Lo Sauro & others, 2008), and this overactivity leads to high levels of circulating cortisol, the hormone most associated with stress. - Individuals with BED may be more likely to perceive events as stressful and then seek to manage that stress by binge eating. Dissociative disorder- are psychological disorders that involve a sudden loss of memory or change in identity. -Under extreme stress or shock, the individual's conscious awareness becomes dissociated (separated or split) from previous memories and thoughts (Stein & others, 2014). -Individuals who develop dissociative disorders may have problems putting together different aspects of consciousness, so that experiences at different levels of awareness might be felt as if they are happening to someone else. -Psychologists believe that dissociation is a way of dealing with extreme stress (Frewen & Lanius, 2014). -Through dissociation individuals mentally protect their conscious self from the traumatic event. -Dissociative disorders often occur in people who also show signs of PTSD (Dorahy & van der Hart, 2014). -Both psychological disorders are thought to be rooted, in part, in extremely traumatic life events (Elklit, Hyland, & Shevlin, 2014). -The notion that dissociative disorders are related to problems in pulling together emotional memories is supported by findings showing lower volume in the hippocampus and amygdala in individuals with dissociative disorders (McDonald & White, 2013; Vermetten & others, 2006). -The hippocampus is especially involved in consolidating memory and organizing life experience into a coherent whole (Xu & others, 2014). Dissociative amnesia- is a type of amnesia characterized by extreme memory loss that stems from lOMoARcPSD|23780900 extensive psychological stress (Granacher, 2014). - People experiencing dissociative amnesia remember everyday tasks like how to hail a cab and use a phone. They forget only aspects of their own identity and autobiographical experiences. Dissociative identity disorder (DID)-, formerly called multiple personality disorder, is the most dramatic, least common, and most controversial dissociative disorder. -Individuals with this disorder have two or more distinct personalities or identities (Brand, Lowenstein, & Spiegel, 2014). - Each identity has its own memories, behaviors, and relationships - One identity dominates at one time, another takes over at another time. I -individuals sometimes report that a wall of amnesia separates their different identities (Dale & others, 2009); -however, research suggests that memory does transfer across these identities, even if the person believes it does not (Huntjens & others, 2014; Kong, Allen, & Glisky, 2008). -The shift between identities usually occurs under distress (Sar, Akyuz, & Dogan, 2007) but sometimes can also be controlled by the person (Kong, Allen, & Glisky, 2008). -Research on dissociative identity disorder links a high rate of extraordinarily severe sexual or physical abuse during early childhood to the condition (Ross & Ness, 2010). -Some psychologists believe that a child can cope with intense trauma by dissociating from the experience and developing other alternate selves as protectors. -Sexual abuse has occurred in as many as 70 percent or more of dissociative identity disorder cases (Foote & others, 2006); however, the majority of individuals who have been sexually abused do not develop dissociative identity disorder. -The vast majority of individuals with dissociative identity disorder are women. A genetic predisposition might also exist, as the disorder tends to run in families (Dell & Eisenhower, 1990). -Until the 1980s, only about 300 cases of dissociative identity disorder had ever been reported (Suinn, 1984). - In the past 30 years, hundreds more cases have been diagnosed (Dorahy & others, 2014). -Social cognitive approaches point out that diagnoses have tended to increase whenever the popular media present a case, as in the miniseries Sybil and the Showtime drama United States of Tara. -From this perspective, individuals develop multiple identities through social contagion. -After exposure to these examples, people may be more likely to view multiple identities as a real condition. -Some experts believe, in fact, that dissociative identity disorder is a social construction—that it represents a category some people adopt to make sense of their experiences (Spanos, 1996). -Rather than being a single person with many conflicting feelings, wishes, and potentially awful experiences, the individual compartmentalizes different aspects of the self into independent identities. -In some cases, therapists have been accused of creating alternate personalities. -Encountering an individual who appears to have a fragmented sense of self, the therapist may begin to treat each fragment as its own “personality” (Spiegel, 2006). Psychosis- refers to a state in which a person's perceptions and thoughts are fundamentally removed from reality. lOMoARcPSD|23780900 -The DSM-5 recognizes a class of disorders called Schizophrenia Spectrum and Other Psychotic Disorders. Within this group is one of the most debilitating psychological disorders (and our focus in this section), schizophrenia. Schizophrenia- is a severe psychological disorder that is characterized by highly disordered thought processes. These disordered thoughts are referred to as psychotic because they are far removed from reality. The world of the person with schizophrenia is deeply frightening and chaotic. It is difficult to imagine the ordeal of people living with schizophrenia, who comprise about half of the patients in psychiatric hospitals. -Although schizophrenia is less common than disorders like depression, those with schizophrenia are more likely to require hospitalization. -The suicide risk for individuals with schizophrenia is eight times that for the general population (Pompili & others, 2007). - For many with the disorder, controlling it means using powerful medications to combat symptoms. -the most common cause of relapse is that individuals stop taking their medication. They might do so because they feel better and believe they no longer need the drugs, they do not realize that their thoughts are disordered, or the side effects of the medications are too unpleasant. POSITIVE SYMPTOMS -The positive symptoms of schizophrenia are marked by a distortion or an excess of normal function. -They are “positive” because they reflect something added above and beyond normal behavior. -Positive symptoms of schizophrenia include hallucinations, delusions, thought disorders, and disorders of movement. Hallucinations -are sensory experiences that occur in the absence of real stimuli. -Hallucinations are usually auditory—the person might complain of hearing voices—or visual, and much less commonly they can be experienced as smells or tastes (Bhatia & others, 2009; Galderisi & others, 2014). -Culture affects the form hallucinations take, as well as their content and sensory modality—that is, whether the hallucinations are visual, auditory, or manifest as smells or tastes (Bauer & others, 2011). -Visual hallucinations involve seeing things that are not there, as in the case of Moe Armstrong. -At the age of 21, while serving in Vietnam as a Marine medical corpsman, Armstrong experienced a psychotic break. -Dead Vietcong soldiers appeared to talk to him and beg him for help and did not seem to realize that they were dead. -Armstrong, now a successful businessman and a sought-after public speaker who holds two master's degrees, relies on medication to keep such experiences at bay (Bonfatti, 2005). Delusions- are false, unusual, and sometimes magical beliefs that are not part of an individual's culture. -A delusional person might think that he is Jesus Christ or Muhammad; another might imagine that her thoughts are being broadcast over the radio. -It is crucial to distinguish delusions from cultural ideas such as the religious belief that a person can have divine visions or communicate personally with a deity. -Generally, psychology and psychiatry do not treat these ideas as delusional. -For individuals with schizophrenia, delusional beliefs that might seem completely illogical to the outsider are experienced as all too real. lOMoARcPSD|23780900 -At one point in his life, Bill Garrett, a college student diagnosed with schizophrenia, was convinced that a blister on his hand was a sign of gangrene. So strong was his belief that he tried to cut off his hand with a knife, before being stopped by his family (Park, 2009). Thought disorder- refers to the unusual, sometimes bizarre thought processes that are characteristic positive symptoms of schizophrenia. -The thoughts of persons with schizophrenia can be disorganized and confused. -Often individuals with schizophrenia do not make sense when they talk or write. -For example, someone with schizophrenia might say, “Well, Rocky, babe, happening, but where, when, up, top, side, over, you know, out of the way, that's it. Sign off.” -These incoherent, loose word associations, called word salad, have no meaning for the listener. -The individual might also make up new words (Kerns & others, 1999). -In addition, a person with schizophrenia can show referential thinking- which means giving personal meaning to completely random events. For instance, the individual might believe that a traffic light has turned red because he or she is in a hurry. -A final type of positive symptom is disorders of movement. -A person with schizophrenia may show unusual mannerisms, body movements, and facial expressions. -The individual may repeat certain motions over and over or, in extreme cases, may become catatonic. -Catatonia- is a state of immobility and unresponsiveness that lasts for long periods of time Whereas schizophrenia's positive symptoms are characterized by a distortion or an excess of normal functions, schizophrenia's negative symptoms reflect social withdrawal, behavioral deficits, and the loss or decrease of normal functions. -One negative symptom is flat affect- which means the display of little or no emotion (Lepage & others, 2011). - Individuals with schizophrenia also may be lacking in the ability to read the emotions of others (Chambon, Baudouin, & Franck, 2006). -They may experience a lack of positive emotional experience in daily life and show a deficient ability to plan, initiate, and engage in goal-directed behavior. -Cognitive symptoms of schizophrenia include difficulty sustaining attention, problems holding information in memory, deficits in the ability to self-reflect, and inability to interpret information and make decisions (Garety & others, 2014; Sitnikova, Goff, & Kuperberg, 2009; Tas & others, 2014; Torniainen & others, 2012). -These symptoms may be subtle and are often detected only through neuropsychological tests. - Researchers now recognize that to understand schizophrenia's cognitive symptoms fully, measures of these symptoms must be tailored to particular cultural contexts (Mehta & others, 2011). -Research provides strong support for biological explanations of schizophrenia. -Especially compelling is the evidence for a genetic predisposition (Dai & others, 2014). -However, structural brain abnormalities and neurotransmitters also are linked to this severe psychological disorder Heredity -Research supports the notion that schizophrenia is at least partially due to genetic factors (Warnica & lOMoARcPSD|23780900 others, 2014). -As genetic similarity to a person with schizophrenia increases, so does a person's risk of developing schizophrenia, as Figure 8 shows (Cardno & Gottesman, 2000). -Such data strongly suggest that genetic factors play a role in schizophrenia. -Researchers are seeking to pinpoint the chromosomal location of genes involved in susceptibility to schizophrenia (Collins & others, 2014; Rampino & others, 2014). -Studies have found structural brain abnormalities in people with schizophrenia. I -maging techniques such as MRI scans clearly show enlarged ventricles in the brain (Rais & others, 2012). -Ventricles are fluid-filled spaces, and enlargement of the ventricles indicates the deterioration in other brain tissue. -Individuals with schizophrenia also have a small frontal cortex (the area in which thinking, planning, and decision making take place) and show less activity in this area than individuals who do not have schizophrenia - Whether it is differences in amount of dopamine, its production, or its uptake, there is good evidence that problems regulating the neurotransmitter dopamine play a role in schizophrenia (Brito-Melo & others, 2012; Howes & others, 2012). -A link between dopamine and psychotic symptoms was first noticed when the drug L-dopa (which increases dopamine levels) was given to individuals as a treatment for Parkinson disease. -In addition to relieving Parkinson symptoms, L-dopa caused some to experience psychosis (Janowsky, Addario, & Risch, 1987; Madras, 2013). -Further, drugs that reduce psychotic symptoms often block dopamine -Psychologists used to explain schizophrenia as rooted in childhood experiences with unresponsive parents. -Such explanations have fallen by the wayside. - Contemporary theorists do recognize that stress may contribute to the development of this disorder. -Experiences are now viewed through the lens of the vulnerability-stress hypothesis, described earlier, suggesting that individuals with schizophrenia may have biological risk factors that interact with experience to produce the disorder. personality disorders- which are chronic, maladaptive cognitive-behavioral patterns that are thoroughly integrated into an individual's personality. -Personality disorders are relatively common. -In one study of a representative U.S. sample, researchers found that 15 percent had a personality disorder (Grant & others, 2004). Antisocial personality disorder (ASPD- is a psychological disorder characterized by guiltlessness, lawbreaking, exploitation of others, irresponsibility, and deceit. Although they may be superficially charming, individuals with ASPD do not play by the rules, and they often lead a life of crime and violence. -ASPD is far more common in men than in women (a 3 to 1 ratio) and is related to criminal behavior, vandalism, substance abuse, and alcoholism (Alegria & others, 2013). ASPD is characterized by: lOMoARcPSD|23780900 ● ● ● ● ● ● ● Failure to conform to social norms or obey the law Deceitfulness, lying, using aliases, or conning others for personal profit or pleasure Impulsivity Irritability and aggressiveness; getting into physical fights or perpetrating assaults Reckless disregard for the safety of self or others Consistent irresponsibility, inconsistent work behavior; not paying bills Lack of remorse, indifference to the pain of others, or rationalizing; hurting or mistreating another person -A number of factors intertwine to produce ASPD. -Research has linked ASPD to low levels of activation in the prefrontal cortex and has related these brain differences to poor decision making and problems in learning (Yang & Raine, 2009). -Both genetic factors (Garcia & others, 2010) and childhood abuse are associated with ASPD, but there is evidence that genetic differences may distinguish abused children who go on to commit violent acts from those who do not -Individuals with ASPD show lower levels of autonomic nervous system arousal and are less stressed than others by aversive circumstances, including punishment (Fung & others, 2005). -They have the ability to keep their cool while engaging in deception (Verschuere & others, 2005), suggesting that those with ASPD might be able to fool a polygraph. -The underaroused autonomic nervous system may be a key difference between adolescents who become antisocial adults and those whose behavior improves during adulthood psychopath is sometimes used to refer to a subgroup of individuals with ASPD (Crego & Widiger, 2014). Psychopaths are remorseless predators who engage in violence to get what they want. -Examples of psychopaths include serial killers John Wayne Gacy, who murdered 33 boys and young men, and Ted Bundy, who confessed to murdering at least 30 young women. - Psychopaths tend to show less prefrontal activation than normal individuals and to have structural abnormalities in the amygdala, as well as the hippocampus, the brain structure most closely associated with memory (Seara-Cardoso & Viding, 2014; Weber & others, 2008). -Importantly, these brain differences are most pronounced in “unsuccessful psychopaths”—individuals who have been arrested for their behaviors (Yang & others, 2005). -In contrast, “successful psychopaths”—individuals who have engaged in antisocial behavior but have not gotten caught—are more similar to healthy controls in terms of brain structure and function. -However, in their behavior, successful psychopaths demonstrate a lack of empathy and a willingness to act immorally; they victimize others to enrich their own lives. -Psychopaths show deficiencies in learning about fear and have difficulty processing information related to the distress of others, such as sad or fearful faces (Dolan & Fullam, 2006). Borderline personality disorder (BPD)- is a pervasive pattern of instability in interpersonal relationships, self-image, and emotions, and of marked impulsivity beginning by early adulthood and present in various contexts. -Individuals with BPD are insecure, impulsive, and emotional (Wehbe-Alamah & Wolgamott, 2014) lOMoARcPSD|23780900 -. BPD is related to self-harming behaviors such as cutting (injuring oneself with a sharp object but without suicidal intent) and also to suicide (Latalova, Kamaradova, & Prasko, 2014; Turnbull & others, 2013). At the very core of BPD is profound instability in mood, in sense of self, and in relationships. BPD is characterized by four essential features (Trull & Brown, 2013): ● ● ● ● Unstable affect Unstable sense of self and identity, including self-destructive impulsive behavior and chronic feelings of emptiness Negative interpersonal relationships that are unstable, intense, and characterized by extreme shifts between idealization and devaluation Self-harm, including recurrent suicidal behavior, gestures, or threats or self-mutilating behavior. In 2012, 40,600 people in the United States committed suicide, and suicide was the 10th-highest cause of death in the country (American Foundation for Suicide Prevention, 2014). -There are twice as many suicides as homicides in the United States, and the suicide rate increased 13 percent from 1999 to 2010 (Schmitz & others, 2012). -Research indicates that for every completed suicide, 25 attempted suicides occur (American Foundation for Suicide Prevention, 2014). -Suicide is the third-leading cause (after automobile accidents and homicides) of death today among U.S. adolescents 13 through 19 years of age (Murphy, Xu, & Kochanek, 2012). -Approximately 4,400 adolescents commit suicide each year (Eaton & others, 2012). -Even more shocking, in the United States suicide is the third-leading cause of death among children 10 to 14 years of age. - Emerging adults (18 to 25 years of age) have triple the rate of suicide of adolescents (Park & others, 2006). -Genetic factors appear to play a role in suicide, which tends to run in families (Coon & others, 2013). -The Hemingways are one famous family that has been plagued by suicide. -Five Hemingways, spread across generations, committed suicide, including the writer Ernest Hemingway and his granddaughter Margaux, a model and actor. - Similarly, in 2009, Nicholas Hughes—a successful marine biologist and the son of Sylvia Plath, a poet who had killed herself—tragically hanged himself. -Studies have linked suicide with low levels of the neurotransmitter serotonin (Di Narzo & others, 2014). -Individuals who attempt suicide and who have low serotonin levels are 10 times more likely to attempt suicide again than are attempters who have high serotonin levels (Courtet & others, 2004). -Poor physical health, especially when it is chronic, is another risk factor for suicide (Webb & others, 2012). PSYCHOLOGICAL FACTORS -Psychological factors that can contribute to suicide include psychological disorders and traumatic experiences (Miller & others, 2013; Ramberg & others, 2014). -Approximately 90 percent of individuals who commit suicide are estimated to have a diagnosable mental disorder (American Foundation for Suicide Prevention, 2014). -The most common disorders among individuals who commit suicide are depression and anxiety (Blanco lOMoARcPSD|23780900 & others, 2012; Nauta & others, 2012; Parra Uribe & others, 2013). - An immediate and highly stressful circumstance—such as the loss of a loved one, losing one's job, flunking out of school, or an unwanted pregnancy—can lead people to threaten and/or to commit suicide (Kumar & George, 2013; Reeves, McKee, & Stuckler, 2014). -In addition, substance abuse is linked with suicide (Kaplan & others, 2014). -Suicide rates vary worldwide; the lowest rates occur in countries with cultural and religious norms against ending one's own life. - Among the nations with the highest suicide rates are several eastern European nations—including Lithuania, Belarus, and Slovenia—along with Japan and South Korea. -According to the World Health Organization (WHO), among the nations with the lowest rates are Nepal, Haiti, Antigua and Barbuda, and Egypt (WHO, 2011). -Of the 110 nations ranked by the WHO, the United States ranks 30th. -There are gender differences in suicide as well. -Women are three times more likely than men to attempt suicide. - Men, however, are four times more likely than women to complete suicide (American Foundation for Suicide Prevention, 2014). -Men are also more likely than women to use a firearm in a suicide attempt (Maris, 1998). -The highest suicide rate is among non-Latino White men ages 85 and older -A classic and controversial study illustrates that labels of psychological disorder can be “sticky”—hard to remove once they are applied to a person. -David Rosenhan (1973) recruited eight adults (including a stay-at-home mother, a psychology graduate student, a pediatrician, and some psychiatrists), none with a psychological disorder, to see a psychiatrist at various hospitals. -These “pseudo-patients” were instructed to act normally except to complain about hearing voices that said things like “empty” and “thud.” -All eight expressed an interest in leaving the hospital and behaved cooperatively. - Nevertheless, all eight were labeled with schizophrenia and kept in the hospital from 3 to 52 days. -None of the mental health professionals they encountered ever questioned the diagnosis that was given to these individuals, and all were discharged with the label “schizophrenia in remission.” -The label “schizophrenia” had stuck to the pseudo-patients and caused the professionals around them to interpret their quite normal behavior as abnormal. -Clearly, once a person has been labeled with a psychological disorder, that label colors how others perceive everything else he or she does. -The stigma attached to psychological disorders can provoke prejudice and discrimination toward individuals who are struggling with these problems, thus complicating an already difficult situation. -Having a disorder and experiencing the stigma associated with it can also negatively affect the physical health of such individuals. lOMoARcPSD|23780900 Individuals with psychological disorders are often aware of the negative stigma attached to these conditions and may themselves have previously held such negative attitudes. - Seeking the assistance they need may involve accepting a stigmatized identity (Thornicroft & others, 2009; Yen & others, 2009). -Even mental health professionals can fall prey to prejudicial attitudes toward those who are coping with psychological disorders (Nordt, Rossler, & Lauber, 2006). -Improved knowledge about the neurobiological and genetic processes involved in many psychological disorders appears to be a promising direction for interventions to reduce such prejudice. - Research shows that information about the role of genes in these disorders reduces prejudicial attitudes (WonPat-Borja & others, 2012). -Among the most feared aspects of stigma is discrimination, or acting prejudicially toward a person who is a member of a stigmatized group. - In the workplace, discrimination against a person with a psychological disorder violates the law. -The Americans with Disabilities Act (ADA) of 1990 made it illegal to refuse employment or a promotion to someone with a psychological disorder when the person's condition does not prevent performance of the job's essential functions (Cleveland, Barnes-Farrell, & Ratz, 1997). -A person's appearance or behavior may be unusual or irritating, but as long as that individual is able to complete the duties required of a position, employment or promotion cannot be denied. -individuals with psychological disorders are more likely to be physically ill and two times more likely to die than their psychologically healthy counterparts (Gittelman, 2008). -They are also more likely to be obese, to smoke, to drink excessively, and to lead sedentary lives -A critical step toward eliminating stigma is to resist thinking of people with disorders as completely defined by their condition. -Instead, it is vital to recognize that they are still people, who demonstrate considerable strengths both in confronting their disorder and in carrying on despite their problems—and their achievements. - By creating a positive environment for people with disorders, we encourage more of them to become confidently “visible” and empower them to be positive role models.