CHAPTER 12- Psychological Disorder- part 1

Dr. Alhanof Aldabaibeh

Psychological Disorder: What Makes a Behavior Abnormal?
Abnormal psychology — the application of psychological science to understanding and
treating mental disorders.
People with psychological disorders are also stigmatized by the people around them, resulting
in shame and embarrassment, as well as prejudice and discrimination against them. Thus the
understanding and treatment of psychological disorders have broad implications for the everyday
life of many people.
A psychological disorder is an ongoing dysfunctional pattern of thought, emotion, and
behavior that causes significant distress, and that is considered deviant in that person’s culture or
society.
Psychological disorders have much in common with other medical disorders. They are out of
the patient’s control, they may in some cases be treated with drugs. Like medical problems,
psychological disorders have both biological (nature) as well as environmental (nurture)
influences. These causal influences are reflected in the bio-psycho-social model of illness.

The bio-psycho-social model of

illness is a way of understanding disorder
that assumes that disorder is caused by
biological, psychological, and social. The
biological component of the bio-psycho-
social model refers to the influences on
disorder that come from the functioning
of the individual’s body. Particularly
important are genetic characteristics that
make some people more vulnerable to a
disorder than others and the influence of
neurotransmitters. The psychological
component of the bio-psycho-social
model refers to the influences that come
from the individual, such as patterns of
negative thinking and stress responses. The social component of the bio-psycho-social model
refers to the influences on disorder due to social and cultural factors such as socioeconomic status,
homelessness, abuse, and discrimination.

To consider one example, mood and anxiety disorders are caused in part by genetic factors
such as hormones and neurotransmitters, in part by the individual’s particular thought patterns,
and in part by the ways that other people in the social environment treat the person with the
disorder.

Who can diagnose psychological disorders, and what makes the diagnostic process
difficult?

1. Because there are no clear biological diagnoses, psychological disorders are instead diagnosed on
the basis of clinical observations of the behaviors that the individual engages in. These
observations find that emotional states and behaviors operate on a continuum, ranging from more
normal and accepted to more deviant, abnormal, and unaccepted. The behaviors that are associated
with disorder are in many cases the same behaviors that we engage in during our normal everyday
life. Washing one’s hands is a normal healthy activity, but it can be overdone by those with an
obsessive-compulsive disorder (OCD).
2. Whether a given behavior is considered a psychological disorder is determined not only by whether
a behavior is unusual (e.g., whether it is mild anxiety versus extreme anxiety) but also by whether
a behavior is maladaptive — that is, the extent to which it causes distress (e.g., pain and suffering)
and dysfunction (impairment in one or more important areas of functioning) to the individual.

An intense fear of spiders, for example, would not be considered a psychological disorder
unless it has a significant negative impact on the sufferer’s life, for instance by causing him or her
to be unable to step outside the house. The focus on distress and dysfunction means that behaviors
that are simply unusual (such as some political, religious, or sexual practices) are not classified as
disorders.

3. Another difficulty in diagnosing psychological disorders is that they frequently occur together. For
instance, people diagnosed with anxiety disorders also often have mood disorders, and people
diagnosed with one personality disorder frequently suffer from other personality disorders as well.
Comorbidity occurs when people who suffer from one disorder also suffer at the same time from
other disorders. Because many psychological disorders are comorbid, most severe mental
disorders are concentrated in a small group of people (about 6% of the population) who have more
than three of them.

Despite the progress made since the 1800s in public attitudes about those who suffer from
psychological disorders, people, including police, coworkers, and even friends and family
members, still stigmatize people with psychological disorders. A stigma refers to a disgrace or
defect that indicates that person belongs to a culturally devalued social group. In some cases the
stigma of mental illness is accompanied by the use of disrespectful and dehumanizing labels,
including names such as crazy, nuts, mental, schizo, and retard.
The stigma of mental disorder affects people while they are ill, while they are healing, and
even after they have healed. On a community level, stigma can affect the kinds of services social
service agencies give to people with mental illness, and the treatment provided to them and their
families by schools, workplaces, places of worship, and health-care providers. Stigma about
mental illness also leads to employment discrimination, despite the fact that with appropriate
support, even people with severe psychological disorders are able to hold a job.

The mass media has a significant influence on society’s attitude toward mental illness. While
media portrayal of mental illness is often sympathetic, negative stereotypes still remain in
newspapers, magazines, film, and television.

The most significant problem of the stigmatization of those with psychological disorder is that
it slows their recovery. People with mental problems internalize societal attitudes about mental
illness, often becoming so embarrassed or ashamed that they conceal their difficulties and fail to
seek treatment. Stigma leads to lowered self-esteem, increased isolation, and hopelessness, and it
may negatively influence the individual’s family and professional life

Despite all of these challenges, however, many people overcome psychological disorders and
go on to lead productive lives. It is up to all of us who are informed about the causes of
psychological disorder and the impact of these conditions on people to understand, first, that
mental illness is not a “fault” any more than is cancer. People do not choose to have a mental
illness. Second, we must all work to help overcome the stigma associated with disorder.
Organizations such as the Canadian Mental Health Association (CMHA) help by working to
reduce the negative impact of stigma through education, community action, and individual support.

Diagnosing Disorder: The DSM

Psychologists have developed criteria that help them determine whether behavior should be
considered a psychological disorder and which of the many disorders particular behaviors indicate.
These criteria are laid out in a 1,000-page manual known as the Diagnostic and Statistical
Manual of Mental Disorders (DSM), a document that provides a common language and
standard criteria for the classification of mental disorders (American Psychiatric Association,
2013). The DSM is used by therapists, researchers, drug companies, health insurance companies,
and policymakers in Canada and the United States to determine what services are appropriately
provided for treating patients with given symptoms.

The DSM does not attempt to specify the exact symptoms that are required for a diagnosis.
Rather, the DSM uses categories, and patients whose symptoms are similar to the description of
the category are said to have that disorder. The DSM frequently uses qualifiers to indicate different
levels of severity within a category. For instance, the disorder of intellectual disability can be
classified as mild, moderate, or severe. The current version of the DSM lists about 400 disorders.
1.Anxiety and Dissociative Disorders: Fearing the World Around Us
Anxiety, the nervousness, or agitation that we sometimes experience, often about something that is going to happen, is a natural part of life. We all feel
anxious at times, maybe when we think about our upcoming visit to the dentist. Anxiety is an important and useful human emotion; it is associated with the
activation of the sympathetic nervous system and the physiological and behavioral responses that help protect us from danger. But too much anxiety can be
debilitating, and every year millions of people suffer from anxiety disorders, which are psychological disturbances marked by irrational fears, often of
everyday objects and situations.

Definition Example
a psychological disorder For a few months now I’ve had a - may also experience a variety of physical symptoms, including irritability,
really bad feeling inside of me. The best
diagnosed in situations in sleep troubles, difficulty concentrating, muscle aches, trembling,
a) Generalized Anxiety

way to describe it is like a really bad

which a person has been feeling of negative inevitability, like perspiration, and hot flashes.
Disorder

excessively worrying about something really bad is impending, but I - The sufferer cannot deal with what is causing the anxiety, nor avoid it,
don’t know what. It’s like I’m on trial for
money, health, work, family murder or I’m just waiting to be sent because there is no clear cause for anxiety. The sufferer frequently knows, at
life, or relationships for at down for something. I have it all of the least cognitively, that there is nothing to worry about.
least six months, even time but it gets worse in waves that come - About 3% of the general population suffer from GAD, and about two-thirds
from nowhere with no apparent triggers. I
though he or she knows that used to get it before going out for nights are women. Generalized anxiety disorder is most likely to develop between
the concerns are out with friends, and it kinda stopped me the ages of seven and 40 years, but its influence may in some cases lessen
exaggerated, and when the from doing it as I’d rather not go out and with age.
stress about the feeling, but now I have it
anxiety causes significant all the time so it doesn’t really make a
distress and dysfunction. difference anymore.
a psychological disorder When I was about 30 I had my first - Symptoms of a panic attack include shortness of breath, heart palpitations,
panic attack. I was driving home, my
characterized by sudden trembling, dizziness, choking sensations, nausea, and an intense feeling of
B. Panic Disorder

three little girls were in their car seats in

attacks of anxiety and terror the back, and all of a sudden I couldn’t dread or impending doom. Panic attacks can often be mistaken for heart
that have led to significant breathe, I broke out into a sweat, and my attacks or other serious physical illnesses, and they may lead the person
heart began racing and literally beating
behavioral changes in the against my ribs! I thought I was going to experiencing them to go to a hospital emergency room.
person’s life. die. I pulled off the road and put my head - Panic attacks may last as little as one or as much as 20 minutes, but they
on the wheel. I remember songs playing often peak and subside within about 10 minutes.
on the CD for about 15 minutes and my
kids’ voices singing along. I was sure I’d - Sufferers are often anxious because they fear that they will have another
never see them again. And then, it attack. They focus their attention on the thoughts and images of their fears,
passed. I slowly got back on the road and becoming excessively sensitive to cues that signal the possibility of threat.
drove home. I had no idea what it was.
They may also become unsure of the source of their arousal, misattributing it
to situations that are not actually the cause. As a result, they may begin to
avoid places where attacks have occurred in the past, such as driving, using
an elevator, or being in public places.
A phobia is a specific fear of A sufferer of arachnophobia (fear of The fear experience can range from a sense of unease to a full-blown panic attack.
spiders), for example, may refuse to enter
a certain object, situation, or Most people learn to live with their phobias, but for others the fear can be so
b) c. Phobias
a room until it has been checked
activity. thoroughly for spiders or may refuse to debilitating that they go to extremes to avoid the fearful situation.
vacation in the countryside because
spiders may be there.
A person with acrophobia (a fear of Phobias are characterized by their specificity and their irrationality
height) could fearlessly sail around the
world on a sailboat with no concerns yet
refuse to go out onto the balcony on the
fifth floor.
Social phobia may be specific to a certain A common phobia is social phobia, extreme shyness around people or discomfort
event, such as speaking in public or using
a public restroom, or it can be a more
in social situations. They often experience physical symptoms in public, such as
generalized anxiety toward almost all sweating profusely, blushing, stuttering, nausea, and dizziness. They are
people outside of close family and friends. convinced that everybody around them notices these symptoms as they are
occurring. Women are somewhat more likely than men to suffer from social phobia.
Typical places that provoke the panic The most incapacitating phobia is agoraphobia, defined as anxiety about being
attacks are parking lots; crowded streets or
shops; and bridges, tunnels, or
in places or situations from which escape might be difficult or embarrassing, or
expressways. in which help may not be available. People (mostly women) who suffer from
agoraphobia may have great difficulty leaving their homes and interacting with
other people.
Phobias are one of the most common anxiety disorders, are among the most
common psychiatric illnesses, and are about twice as prevalent in women as in
men.
In most cases, phobias first appear in childhood and adolescence and usually
persist into adulthood.
a psychological disorder that is Although he is best known his − OCD is diagnosed when obsessive thoughts are so disturbing and the
diagnosed when an individual perfect shots on the field, the compulsive behaviors are so time-consuming that they cause distress and
continuously experiences British soccer star David significant dysfunction in a person’s everyday life.
c) Obsessive-Compulsive Disorders

distressing or frightening Beckham also suffers from − Washing your hands once or even twice to make sure that they are clean is
thoughts, and engages in obsessive-compulsive disorder normal; washing them 20 times is not. The sufferers know that these rituals are
obsessions (repetitive (OCD). As he describes it, “I senseless, but they cannot bring themselves to stop them, in part because the
thoughts) or compulsions have got this obsessive- relief that they feel after they perform them acts as a reinforcer, making the
(repetitive behaviors) in an compulsive disorder where I behavior more likely to occur again.
attempt to calm these have to have everything in a − Sufferers of OCD may avoid certain places that trigger the obsessive thoughts
thoughts. straight line or everything has or use alcohol or drugs to try to calm themselves down.
to be in pairs. I’ll put my Pepsi − OCD has a low prevalence rate (about 1% of the population in a given year)
cans in the ridge and if there’s in relation to other anxiety disorders and usually develops in adolescence or
one too many then I’ll put it in early adulthood
another cupboard somewhere. − The course of OCD varies from person to person. Symptoms can come and go,
decrease, or worsen over time.
. People with PTSD experience People who have survived a − They may lose interest in things they used to enjoy; startle easily; have
high levels of anxiety along terrible ordeal, such as combat, difficulty feeling affection; and may experience terror, rage, depression, or
d) Post-traumatic

with reexperiencing the torture, sexual assault, insomnia. The symptoms may be felt especially when approaching the area
(PTSD
Stress Disorder

trauma (flashbacks), and a imprisonment, abuse, natural where the event took place or when the anniversary of that event is near.
strong desire to avoid any disasters, or the death of someone − PTSD has affected approximately 8% of the population. Women are more
reminders of the event. close to them may develop post- likely to develop PTSD than men
traumatic stress disorder (PTSD).