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Chapter 14. Psychological Disorders. Abnormal Behavior. Historical aspects of mental disorders The medical model What is abnormal behavior? 3 criteria Deviant Maladaptive Causing personal distress A continuum of normal/abnormal. Prevalence, Causes, and Course. Epidemiology

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Chapter 14

Psychological Disorders


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Abnormal Behavior

  • Historical aspects of mental disorders

  • The medical model

  • What is abnormal behavior?

    • 3 criteria

      • Deviant

      • Maladaptive

      • Causing personal distress

  • A continuum of normal/abnormal


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Prevalence, Causes, and Course

  • Epidemiology

  • Prevalence - % of population that displays the disorder during a specific period

  • Lifetime prevalence –

  • Diagnosis

  • Etiology – causes

  • Prognosis


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Psychodiagnosis: The Classification of Disorders

  • American Psychiatric Association – published first taxonomy in 1952

  • Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV)

  • Multiaxial system

  • 5 axes or dimensions

    • Axis I – Clinical Syndromes

    • Axis II – Personality Disorders or Mental Retardation

    • Axis III – General Medical Conditions

    • Axis IV – Psychosocial and Environmental Problems

    • Axis V – Global Assessment of Functioning

  • Example Figure

  • DSM V – to be published in 2011-12



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The DSM multiaxial system

Example multiaxial evaluation


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Axis I Clinical Syndromes and Axis II Personality Disorders

  • Anxiety Disorders –

  • Somatoform Disorders –

  • Dissociative Disorders –

  • Mood Disorders –

  • Schizophrenic Disorders –

  • Eating Disorders –

  • Axis II – Personality Disorders –


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Clinical Syndromes: Anxiety Disorders

  • Generalized anxiety disorder

    • “free-floating anxiety”

  • Phobic disorder

    • Specific focus of fear

  • Panic disorder and agoraphobia (definition issue)

    • Physical symptoms of anxiety/leading to agoraphobia

  • Obsessive compulsive disorder

    • Obsessions

    • Compulsions


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Etiology of Anxiety Disorders

  • Biological factors –

    • Genetic predisposition, anxiety sensitivity

    • GABA circuits in the brain

  • Conditioning and learning

    • Acquired through classical conditioning or observational learning –

    • Maintained through operant conditioning

  • Cognitive factors

    • Judgments of perceived threat –

  • Personality

    • Neuroticism

  • Stress –

    • A precipitator


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Clinical Syndromes: Somatoform Disorders

  • Somatization Disorder

  • Conversion Disorder – Figure

  • Hypochondriasis

    • Etiology

      • Reactive autonomic nervous system

      • Personality factors

      • Cognitive factors

      • The sick role


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Clinical Syndromes: Dissociative Disorders

  • Dissociative amnesia

  • Dissociative fugue

  • Dissociative identity disorder

    • Etiology

      • severe emotional trauma during childhood

    • Controversy

      • Media creation?

      • Sybil

      • Repressed memories


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Clinical Syndromes: Mood Disorders

  • Major depressive disorder

    • Dysthymic disorder

  • Bipolar disorder (manic-depressive disorder)

    • Cyclothymic disorder

  • Etiology

    • Age of onset –

    • Genetic vulnerability –

    • Neurochemical factors

    • Cognitive factors – negative thinking –

    • Interpersonal roots

    • Precipitating stress


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Clinical Syndromes: Schizophrenia

  • General symptoms

    • Delusions and irrational thought

    • Deterioration of adaptive behavior - avolition

    • Hallucinations – any modality but usually auditory

    • Disturbed emotions – 66%

  • Prognostic factor

    • Gradual onset

    • Sudden onset


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Subtyping of Schizophrenia

  • 4 subtypes

    • Paranoid type – most common subtype - John Nash

    • Catatonic type

    • Disorganized type

    • Undifferentiated type

  • New model for classification

    • Positive vs. negative symptoms


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Etiology of Schizophrenia

  • Genetic vulnerability –

  • Neurochemical factors – Dopamine hypothesis –

  • Structural abnormalities of the brain – prefrontal lobe and ventricles –

  • The neurodevelopmental hypothesis –

  • Expressed emotion –

  • Precipitating stress – stress-vulnerability model –





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– Neurodevelopment hypothesis of schizophrenia

– Expressed emotion and relapse rates in schizophrenia



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Personality Disorders

  • Next slide– description and male/female percents

  • Anxious-fearful cluster

    • Avoidant, dependent, obsessive-compulsive

  • Dramatic-impulsive cluster

    • Histrionic, narcissistic, borderline, antisocial

  • Odd-eccentric cluster

    • Schizoid, schizotypal, paranoid

  • Etiology

    • Genetic predispositions, inadequate socialization in dysfunctional families

  • Prognosis


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Psychological Disorders and the Law

  • Insanity

    • M’naghten rule

    • The insanity defense –– perception versus actual cases

  • Involuntary commitment – varies by states

    • danger to self

    • danger to others

    • in need of treatment

  • Culture and pathology –



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Eating Disorders – Reagan in 1981

  • Issues of weight –

  • Anorexia nervosa

    • Criteria and subtypes: restrictive and binge/purge

  • Bulimia nervosa

  • Binge eating

  • History and prevalence

    • Age onset –

  • Etiology

    • Genetics

    • Personality – perfectionism

    • Cultural issues - “perfect” body type and digital photograph

    • Family role

    • Cognitive factors



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