14 Psychological Disorders

Thinking Critically

Have you ever questioned if someone’s way of thinking or acting was normal? How do you know if a behavior is normal or
abnormal?

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Why study abnormal behavior and mental

processes?
Because it is all around us, which raises many questions: How should one react? What should be done to help?
What kind of person develops a mental illness? Could this happen to someone close to you? The key to answering
these questions is to develop an understanding of just what is meant by abnormal behavior and thinking and the
different ways in which thinking and behavior can depart from the “normal” path.

582
Learning Objectives

14.1 Explain how our definition of 14.10 Compare and contrast behavioral,
abnormal behavior and thinking has social cognitive, and biological
changed over time. explanations for depression and
other disorders of mood.
14.2 Identify models used to explain
psychological disorders. 14.11 Identify the symptoms and risk
factors associated with anorexia
14.3 Describe how psychological nervosa, bulimia nervosa, and ­
disorders are diagnosed and binge-eating disorder.
classified.
14.12 Describe types of sexual dysfunction
14.4 Identify different types of anxiety and explain how they may develop.
disorders and their symptoms.
14.13 Distinguish between the positive
14.5 Describe obsessive-compulsive and negative symptoms of
disorder and stress-related disorders. schizophrenia.
14.6 Identify potential causes of anxiety, 14.14 Evaluate the biological and
trauma, and stress disorders. environmental influences on
14.7 Differentiate among dissociative schizophrenia.
amnesia, dissociative fugue, and 14.15 Classify different types of personality
dissociative identity disorder. disorders.
14.8 Summarize explanations for 14.16 Identify potential causes of
dissociative disorders. personality disorders.
14.9 Describe different disorders of mood, 14.17 Identify some ways to overcome test
including major depressive disorder anxiety.
and bipolar disorders.

583
584  Chapter 14

What Is Abnormality?
I’ve heard people call the different things other people do
“crazy” or “weird.” How do psychologists decide when people are
really mentally ill and not just a little odd?

Exactly what is meant by the term abnormal behavior? When is thinking or a mental pro-
cess maladaptive? Abnormal or maladaptive as compared to what? Who gets to decide
what is normal and what is not? Has the term always meant what it means now?

Changing Conceptions of Abnormality

14.1 Explain how our definition of abnormal behavior and thinking has
changed over time.
The study of abnormal behavior and psychological dysfunction is called p
­ sychopathology.
Defining abnormality is a complicated process, and our view of what is abnormal has
changed significantly over time.
A Very Brief History of Psychological Disorders Dating from as early as
3000 bce, archaeologists have found human skulls with small holes cut into them, holes
made while the person was still alive. Many of the holes show evidence of healing,
meaning that the person survived the process. Although trephining, or cutting holes into
the skull of a living person, is still done today to relieve pressure of fluids on the brain,
in ancient times the reason may have had more to do with releasing the “demons” pos-
sessing the poor victim (Gross, 1999).
A Greek physician named Hippocrates (460–377 bce) challenged that belief with
his assertion that illnesses of both the body and the mind were the result of imbalances in
the body’s vital fluids, or humors. Although he was not correct, his was the first recorded
attempt to explain abnormal thinking or behavior as due to some biological process.
Moving forward in time, people of the Middle Ages believed in spirit possession
as one cause of abnormality. The treatment of choice was a religious one: exorcism, or
the formal casting out of the demon through a religious ritual (Lewis, 1995). During the
Renaissance, belief in demonic possession (in which the possessed person was seen as
a victim) gave way to a belief in witchcraft, and mentally ill persons were most likely
called witches and put to death.

These human skull casts show signs of trephining, a process in

which holes were cut into the skulls of a living person, perhaps
to release “demons” that were making the person’s behavior or
psychopathology thinking odd or disturbed. Some who were treated in this way must
the study of abnormal behavior and have survived, as some of the holes show evidence of healing.
psychological dysfunction. Source: New York Public Library/Science Source.
Psychological Disorders   585

Fast forward to the present day, where psychological disorders are often viewed
from a medical model, in that they can be diagnosed according to various symptoms and
have an etiology*, course, and prognosis (Kihlstrom, 2002). In turn, psychological disor-
ders can be treated, and like many physical ailments, some may be “cured,” whereas
other psychological disorders will require lifelong attention. And while numerous per-
spectives in psychology are not medical in nature, the idea of diagnosis and treatment
of symptoms bridges many of them. This chapter will focus on the types of psycholog-
ical disorders and some of their possible causes. We will focus more on psychological
treatment and therapies in the next chapter, to Chapter Fifteen: Psychological
Therapies.
How Can We Define What Is Abnormal? Defining abnormal behavior, abnormal
thinking, or abnormality is not as simple as it might seem at first. The easy way out
is to say that abnormal behavior is behavior that is not normal, abnormal thinking is
thinking that is not normal, but what does that mean? It’s complicated, as you’ll see
by considering different criteria for determining abnormality. Before we explore differ-
ent criteria for identifying abnormality and mental illness, take a moment to reflect on
your own beliefs in the survey Are You Normal?
STATIsTICAL OR SOCIAL NORM DEVIAnCE One way to define normal and abnormal is to
use a statistical definition. Frequently occurring behavior would be considered normal,
and behavior that is rare would be abnormal. Or how much behavior or thinking devi-
ates from the norms of a society. For example, refusing to wear clothing in a society that
does not permit nudity would likely be rare and be seen as abnormal. But deviance (vari-
ation) from social norms is not always labeled as negative or abnormal. For instance,
a person who decides to become a monk and live in a monastery in the United States
would be exhibiting unusual behavior, and certainly not what the society considers a
standard behavior, but it wouldn’t be a sign of abnormality.
The situational context (the social or environmental setting of a person’s behavior)
can also make a difference in how behavior or thinking is labeled. For example, if a man
comes to a therapist complaining of people listening in on his phone conversations and
spying on all his activities, the therapist’s first thought might be that the man is suffer-
ing from thoughts of persecution. But if the man then explains that he is in a witness
­protection program, the complaints take on an entirely different and quite understand-
able tone.
SUBJECTIVE DIsCOMFORT One sign of abnormality is when the person experiences a great
deal of subjective discomfort, or emotional distress while engaging in a particular behav-
Have you ever questioned if someone
ior or thought process. A woman who suffers from a fear of going outside her house, for was talking to himself or herself and then
example, would experience a great deal of anxiety when trying to leave home and dis- discovered they were on the phone? What
tress over being unable to leave. However, all thoughts or behavior that might be consid- are some other public behaviors than may
ered abnormal do not necessarily create subjective discomfort in the person having them vary by context or situation?
or committing the act—a serial killer, for example, does not experience emotional distress
after taking someone’s life, and some forms of disordered behavior involve showing no
emotions at all. situational context
InABILITY TO FUnCTIOn NORMALLY Thinking or behavior that does not allow a person to the social or environmental setting
fit into society or function normally can also be labeled abnormal. These may be termed of a person’s behavior.
maladaptive, meaning that the person finds it hard to adapt to the demands of day-to-
day living. Maladaptive thinking or behavior may initially help a person cope but has subjective discomfort
harmful or damaging effects. For example, a woman who cuts herself to relieve anxi- emotional distress or emotional pain.
ety does experience initial relief but is harmed by the action. Maladaptive thinking and
behavior are key elements in the definition of abnormality. maladaptive
anything that does not allow a ­person
to function within or adapt to the
*etiology—the origin, cause, or set of causes for a disorder. stresses and everyday demands of life.
586  Chapter 14

Thinking Critically

In today’s growing technological age, can you think of any new criteria that should be considered in
defining abnormal behavior or thinking?

A Working Definition of Abnormality

So how do psychologists decide what is abnormal?

To get a clear picture of abnormality, it is often necessary to take all of the factors
just discussed into account. Psychologists and other psychological professionals must
consider several different criteria when determining whether psychological functioning
or behavior is abnormal (at least two of these criteria must be met to form a diagnosis of
abnormality):
1. Is the thinking or behavior unusual, such as experiencing severe panic when faced
with a stranger or being severely depressed in the absence of any stressful life
situations?
2. Does the thinking or behavior go against social norms? (And keep in mind that
social norms change over time—e.g., homosexuality was once considered a psy-
chological disorder rather than a variation in sexual orientation.)
3. Does the behavior or psychological function cause the person significant subjective
discomfort?
4. Is the thought process or behavior maladaptive, or does it result in an inability to
function?
5. Does the thought process or behavior cause the person to be dangerous to self or
others, as in the case of someone who tries to commit suicide or who attacks other
people without reason?
Abnormal thinking or behavior that includes at least two of these five criteria is
perhaps best classified by the term psychological disorder, which is defined as any
pattern of behavior or psychological functioning that causes people significant dis-
tress, causes them to harm themselves or others, or harms their ability to function in
daily life.
Before moving on, it is important to clarify how the term abnormality is different from
the term insanity. Only psychological professionals can diagnose disorders and determine
the best course of treatment for someone who suffers from mental illness. Lawyers and
judges are sometimes charged with determining how the law should address crimes com-
mitted under the influence of mental illness. Psychologists and psychiatrists determine
whether certain thinking or behavior is abnormal, but they do not decide whether a cer-
tain person is insane. In the United States, insanity is not a psychological term; it is a legal
term used to argue that a mentally ill person who has committed a crime should not be
held responsible for his or her actions because that person was unable to understand the
difference between right and wrong at the time of the offense. This argument is called the
insanity defense.

Models of Abnormality
14.2 Identify models used to explain psychological disorders.
psychological disorder
any pattern of behavior or thinking
What causes psychological disorders?
that causes people significant distress,
causes them to harm others, or harms Recognition of abnormal behavior and thinking depends on the “lens,” or perspective,
their ability to function in daily life. from which it is viewed. Different perspectives determine how the disordered behavior
Psychological Disorders   587

or thinking is explained. And as we will see in Chapter Fifteen, those same perspectives
influence how psychological disorders are treated.

The Biological Model: Medical Causes for Psychological Disorders The

biological model proposes that psychological disorders have a biological or med-
ical cause (Gamwell & Tomes, 1995). This model explains disorders such as anxiety,
depression, and schizophrenia as caused by faulty neurotransmitter systems, genetic
problems, brain damage and dysfunction, or some combination of those causes. For
example, as you may recall from the discussion of trait theory and the five-factor the-
ory of personality traits, to Learning Objectives 13.10, 13.11, a growing body
of evidence suggests that basic personality traits are as much influenced by genetic
inheritance as they are by experience and upbringing, even across cultures (Bouchard,
1994; Herbst et al., 2000; Jang et al., 1996; Loehlin, 1992; Loehlin et al., 1998). One of the
Big Five factors was neuroticism, for example, and it is easy to see how someone who
scores high in neuroticism would be at greater risk for anxiety-based disorders.

The Psychological Models Although biological explanations of psychological dis-

orders are influential, they are not the only ways or even the first ways in which disorders
are explained. Several different theories of personality were discussed in Chapter Thir-
teen. These theories of personality can be used to describe and explain the formation of
not only personality but disordered thinking, behavior, and abnormal personality as well.

Psychodynamic View: Hiding Problems  For instance, the psychodynamic model,

based on the work of Freud and his followers, to Learning Objectives 13.3, 13.4,
explains disordered thinking and behavior as the result of repressing one’s threaten-
ing thoughts, memories, and concerns in the unconscious mind (Carducci, 1998). These
repressed thoughts and urges try to resurface, and disordered functioning develops as
a way of keeping the thoughts repressed. According to this view, a woman who has
unacceptable thoughts of sleeping with her brother-in-law might feel “dirty” and be biological model
compelled to wash her hands every time those thoughts threaten to become conscious, model of explaining thinking or
ridding herself symbolically of the “dirty” thoughts. ­behavior as caused by biological
changes in the chemical, structural, or
Behaviorism: Learning Problems  Behaviorists, who define personality as a set of
genetic ­systems of the body.
learned responses, have no trouble explaining disordered behavior as being learned just
like normal behavior (Skinner, 1971; Watson, 1913). For example, when Emma was a cognitive psychologists
small child, a spider dropped onto her leg, causing her to scream and react with fear. Her psychologists who study the way
mother made a big fuss over her, giving her lots of attention. Each time Emma saw a spi- ­people think, remember, and mentally
der after this, she screamed again, drawing attention to herself. Behaviorists would say organize information.
that Emma’s fear of the spider was classically conditioned, and her screaming reaction
was positively reinforced by all the attention. to Learning Objectives 5.2 and 5.5. sociocultural perspective
perspective that focuses on the
Cognitive Perspective: Thinking Problems  Cognitive psychologists, who study the
­relationship between social ­behavior
way people think, remember, and mentally organize information, see maladaptive func- and culture; in psychopathology,
tioning as resulting from illogical thinking patterns (Mora, 1985). A cognitive psycholo- ­perspective in which abnormal
gist might explain Emma’s fear of spiders as distorted thinking: “All spiders are vicious ­thinking and behavior (as well as
and will bite me, and I will die!” Emma’s particular thinking patterns put her at a higher ­normal) is seen as the product of
risk of depression and anxiety than those of a person who thinks more logically. learning and shaping within the
­context of the family, the social group
The Sociocultural Perspective What’s normal in one culture may be abnormal in
to which one belongs, and the culture
another culture. In the sociocultural perspective of abnormality, abnormal thinking or within which the family and social
behavior (as well as normal) is seen as the product of behavioral shaping within the con- group exist.
text of family influences, the social group to which one belongs, and the culture within
which the family and social group exist. In particular, cultural differences in abnormal cultural relativity
thoughts or actions must be addressed when psychological professionals are attempting the need to consider the unique
to assess and treat members of a culture different from that of the professional. Cultural ­characteristics of the culture in which
relativity is a term that refers to the need to consider the unique characteristics of the behavior takes place.
588  Chapter 14

culture in which the person with a disorder was nurtured to be able to correctly diagnose
and treat the disorder (Castillo, 1997). For example, in most traditional Asian cultures,
mental illness is often seen as a shameful thing that brings disgrace to one’s family. It may
be seen as something inherited and, therefore, something that would hurt the marriage
chances of other family members, or it may be seen as stemming from something the
family’s ancestors did wrong in the past (Ritts, 1999; Ying, 1990). This leads many Asian
people suffering from disorders that would be labeled as depression or even schizophre-
nia to report bodily symptoms rather than emotional or mental ones, because bodily ail-
ments are more socially acceptable (­Fedoroff & McFarlane, 1998; Lee, 1995; Ritts, 1999).
The conceptualization of culture and its influences on psychological function and dis-
orders has been explained by three concepts: cultural syndromes, cultural idioms of ­distress,
and cultural explanations or perceived cause (American Psychiatric Association, 2013). Cultural
syndromes may or may not be recognized as an illness within the culture but are nonetheless
recognizable as a distinct set of symptoms or characteristics of distress. Cultural idioms of
distress refer to terms or phrases used to describe suffering or distress within a given cultural
context. And cultural explanations or perceived cause are culturally defined ways of explain-
ing the source or cause of symptoms or illness (­American Psychiatric Association, 2013).
It is important to take into account other background and influential factors such as
socioeconomic status and education level. Another area of awareness should be primary lan-
guage and, if applicable, degree of acculturation (adapting to or merging with another culture).
Psychosocial functioning has been part of the diagnostic process for some time now, but tra-
ditionally, greater attention has been paid to specifically identifying symptoms of pathology
rather than focusing on the environmental factors that influence an individual’s overall level of
functioning (Ro & Clark, 2009). For example, in one study, college students of Mexican heritage
with migrant farming backgrounds reported more symptoms of anxiety and depression as
compared to nonmigrant college students of Mexican heritage (Mejía & McCarthy, 2010). The
nature of migrant farming poses different stressors than those faced by nonmigrant families.
Biopsychosocial Perspective: All of the Above In recent years, the biological, psy-
chological, and sociocultural influences on abnormality are no longer seen as independent
causes. Instead, these influences interact with one another to cause the various forms of dis-
orders. For example, a person may have a genetically inherited tendency for a type of disor-
der, such as anxiety, but may not develop a full-blown disorder unless the family and social
environments produce the right stressors at the right time in development. We will see later
how this idea specifically applies to a theory of schizophrenia. How accepting a particular
culture is of a specific disorder will also play a part in determining the exact degree and
A migrant farming background has been
form that disorder might take. This is known as the biopsychosocial model of disorder,
found to be related to increased symptoms which has become a very influential way to view the connection between mind and body.
of anxiety and depression among college
students of Mexican heritage when Diagnosing and Classifying Disorders
compared to those without a migrant 14.3 Describe how psychological disorders are diagnosed and classified.
background.
Have you ever asked a young child, or remember from being one yourself, “what’s wrong?”
cultural syndromes when they reported not feeling well? If so, you likely received a variety of answers describ-
sets of particular symptoms of distress ing their tummy ache, ouchie, or booboo. And in turn, you may have not known exactly
found in particular cultures, which what was wrong due to differences in their descriptive language and yours, especially when
may or may not be recognized as an you could not see where or why they were hurting. The same applies to understanding
illness within the culture. and treating psychological disorders. Having a common set of terms and systematic way of
describing psychological and behavioral symptoms is vital to not only correct identification
biopsychosocial model
and diagnosis but also in communication among and between psychological professionals
perspective in which abnormal think-
and other health-care providers.
ing or behavior is seen as the result of
the combined and interacting forces The DSM-5 One international resource is the World Health Organization’s (WHO’s) Inter-
of biological, psychological, social, and national Classification of Diseases (ICD), currently in its tenth edition (ICD-10). In the United
cultural influences. States, the prevalent resource to help psychological professionals diagnose psychologi-
Psychological Disorders   589

cal disorders has been the Diagnostic and Statistical Manual of Mental ­Disorders (DSM), first
published in 1952. The DSM has been revised multiple times as our knowledge and ways
of thinking about psychological disorders have changed. The most recent version, which
was released in 2013, is the Diagnostic and Statistical ­Manual of Mental Disorders, Fifth Edition
(DSM-5; American Psychiatric Association, 2013). It also includes changes in organization of
disorders, modifications in terminology used to describe disorders and their symptoms, and
discusses the possibility of dimensional assessments for some disorders in future ­versions
of the manual. The DSM has been useful in providing clinicians with descriptions and crite-
ria for diagnosing mental disorders, but it has not been without its share of controversy, as
the video Diagnosing and Classifying Disorders: The DSM-5 explains.

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The DSM-5 describes about 250 different psychological disorders. Each disorder is
described in terms of its symptoms, the typical path the disorder takes as it progresses,
and a checklist of specific criteria that must be met in order for the diagnosis of that dis-
order to be made. Whereas previous editions of the manual divided disorders and rele-
vant facts about the person being diagnosed along five different categories, or axes, the
DSM-5 uses a single axis for all disorders, with provisions for also noting significant and
relevant facts about the individual (American Psychiatric Association, 2013).
A few of the 20 categories of disorders that can be diagnosed include depressive disor-
ders, anxiety disorders, schizophrenia spectrum and other psychotic disorders, feeding and
eating disorders, and neurodevelopmental disorders such as ADHD (­American Psychiat-
ric Association, 2013). Other categories include personality disorders, intellectual disability,
trauma- and stressor-related disorders, and obsessive-compulsive and related disorders.
While the diagnosis of psychological disorders into categories, based on signs and
symptoms, has been the prevalent approach for many years, it is not the only way to think
about psychological disorders. In fact, continuing advances in neuroimaging, genetics,
and cognitive science have led the National Institute of Mental Health (NIMH) to call for a
change in the way we think about and study disorders through the launch of their Research
Domain Criteria (RDoC) project. This project promotes research that incorporates all of
these advances, as well as other types of information, to provide a knowledge base for a
new system of classifying psychological disorders (Insel, 2013). The RDoC research matrix
is a framework consisting of several domains, each containing certain measurable and
related ideas or constructs. For example, one domain is “negative valence systems” and
590  Chapter 14

Figure 14.1 RDoC Research Matrix Example

Hypothetical application of the RDoC approach. Individuals with a variety of symptom-based anxiety disorders are
examined with different methods, and across different areas of investigation, to identify specific data-based clusters and categories for diagnosis.

Symptom-based categories Integrated data Data-driven categories

Generalized Cluster 1
anxiety disorder Genetic risk
polygenic risk score

Brain activity
ventromedial PFC
dorsal ACC Cluster 2
Panic disorder medial amygdala
Data-driven diagnostic categories
Physiology can lead to improved
average cortisol levels replication studies and
Cluster 3 better-defined clinical trials.
Behaviors
avoidance
Social anxiety
disorder facial expressions
(social phobia)
Personal experience Cluster 4
social, cultural, and
environmental factors

Figure 14.1 RDoC Research Matrix Example

Source: Based on and adapted from Insel & Cuthbert, 2015, and information from the RDoC Matrix,
[Link]

contains the constructs fear, anxiety, and loss, among others. The purpose of the matrix is
to provide a means by which disorders may be better conceptualized and measured, based
on more modern research approaches in genetics and neuroscience in addition to those of
the behavioral sciences (Cuthbert, 2014; Insel & Cuthbert, 2015; see Figure 14.1).

How Common Are Psychological Disorders?

That sounds like a lot of possible disorders, but most people

don’t get these problems, right?
Actually, psychological disorders are more common than most people might think.
Estimates of prevalence can vary based on the survey methodology, groups used, and the
questions being asked. For example, different analyses of data from the same survey sug-
gest that anywhere from 26.2 to 32.4 percent of American adults over age 18 suffer from a
mental disorder (Harvard Medical School, Department of Health Care Policy, 2007; Kessler
et al., 2005). More recently, data from the National Survey on Drug Use and Health reveals
about 43.6 million American adults over age 18, or 18.1 percent, experienced some kind of
mental illness in 2014 (excluding developmental and substance use disorders). Fortunately,
the same survey revealed only about 4.1 percent of American adults had a serious mental
disorder (Center for Behavioral Health Statistics and Quality, 2015). Overall, it
appears that more than 1 in 5 American adults experience a psychological dis-
order in any given year.
Statistically, mental disorders are one of the leading causes of disability in
the United States and Canada (National Institute of Mental Health, 2010). In fact,
it is quite common for people to suffer from more than one mental disorder at a
time, such as a person with depression who also has a substance-abuse disorder
or a person with an anxiety disorder who also suffers from sleep disorders. For
example, in 2014, of the 20.2 million American adults that had a substance use
disorder, approximately 39.1 percent met criteria for another psychological dis-
order (Center for Behavioral Health Statistics and Quality, 2015). Table 14.1 has
percentages of selected psychological disorders in the United States. Please note
Statistically speaking, about one out of every five of the people
the most recent National Survey on Drug Use and Health data does not provide
in this crowd probably suffers from some form of psychological prevalence information for all of the different disorders. The data in this table is
disorder. based on earlier estimates.
Psychological Disorders   591

Table 14.1 Yearly Occurrence of Psychological Disorders in the United States

CATEGORY OF DISORDER SPECIFIC DISORDER PERCENTAGE OF U.S. POPULATION AND NUMBER AFFECTED*

Bipolar and Depressive All types 9.5% or 22.3 million

disorders Major depressive disorder 6.7% or 15.7 million
Persistent depressive disorder (dysthymia) 1.5% or 3.5 million
Bipolar disorder 2.6% or 6.1 million

Anxiety, Obsessive- All types 18.1% or 42.5 million

Compulsive, and Trauma- Specific phobia 8.7% or 20.4 million
Related disorders
Social anxiety disorder (social phobia) 6.8% or 16 million
Panic disorder 2.7% or 6.3 million
Agoraphobia 0.8% or 1.9 million
Generalized anxiety disorder 3.1% or 7.3 million
Obsessive-compulsive 1% or 2.3 million
disorder 3.5% or 8.2 million
Posttraumatic stress disorder

Schizophrenia All types 1.1% or 2.6 million

*
Percentage of adults over age 18 affected annually and approximate number within the population based on 2010 United States Census data.
Adapted from National Institute of Mental Health (2016). Table uses terminology from both the DSM-IV and DSM-5 (American Psychiatric Association, 2000, 2013).

The Pros and Cons of Labels With its lists of disorders and their corresponding
symptoms, the DSM-5 helps psychological professionals diagnose patients and provide
those patients with labels that explain their conditions. In the world of psychological
diagnosis and treatment, labels like depression, anxiety, and schizophrenia can be very help-
ful: They make up a common language in the mental health community, allowing psy-
chological professionals to communicate with each other clearly and efficiently. Labels
establish distinct diagnostic categories that all professionals recognize and understand,
and they help patients receive effective treatment.
However, labels can also be dangerous—or, at the very least, overly prejudicial. In
1972, researcher David Rosenhan asked healthy participants to enter psychiatric hospi-
tals and complain that they were hearing voices. All of the participants, whom Rosenhan
called “pseudopatients,” were admitted into the hospitals and diagnosed with either schizo-
phrenia or manic depression (now called bipolar disorder). Once the pseudopatients were
admitted, they stopped pretending to be ill and acted as they normally would, but the hos-
pital staff’s interpretation of the pseudopatients’ normal behavior was skewed by the label
of mental illness. For example, hospital workers described one pseudopatient’s relatively
normal relationships with family and friends as evidence of a psychological disorder, and
another pseudopatient’s note-taking habits were considered to be a pathological behavior.
The pseudopatients had been diagnosed and labeled, and those labels stuck, even when
actual symptoms of mental illness disappeared. ­Rosenhan concluded that psychologi-
cal labels are long-lasting and powerful, affecting not only how other people see mental
patients but how patients see themselves (Rosenhan, 1973).
Before describing the various categories and types of disorders, here is a word of cau-
tion: It’s very easy to see oneself in these disorders. Medical students often become convinced
that they have every one of the symptoms for some rare, exotic disease they have been study-
ing. Psychology students studying abnormal behavior can also become convinced that they
have some mental disorder, a problem that can be called “psychology student’s syndrome.”
The problem is that so many psychological disorders are really ordinary variations in human
behavior taken to an extreme. For example, some people are natural-born worriers. They
look for things that can go wrong around every corner. That doesn’t make them disordered—
it makes them pessimistic worriers. Remember, it doesn’t become a disorder until the worry-
ing causes them significant distress, causes them to harm themselves or others, or harms their
ability to function in everyday life. So if you start “seeing” yourself or even your friends and
family in any of the following discussions, don’t panic—all of you are probably okay.
592  Chapter 14

Concept Map L.O. 14.1, 14.2, 14.3

psychopathology is the study of abnormal behavior and

psychological dysfunction; mental illness has been defined in
statistical or social norm
various ways throughout history (e.g., possession, evil spirits,
deviance
bodily imbalances)
subjective discomfort
what is abnormality? current definitions of abnormality are based on several factors
inability to function normally
disorders vary according to culture; cultural sensitivity and
relativity are necessary in diagnosing and treating psychological disorders
overall, psychological disorders are any pattern of behavior or thinking that causes significant
distress, causes people to harm themselves or others, or harms their ability to function in daily life

Psychological Disorders diagnosing and classifying disorders

ICD-10
models of abnormality the Diagnostic and Statistical Manual
explanations for disordered thinking or of Mental Disorders (DSM) was first
behavior depend on theoretical model DSM-5 published in 1952, current version
used to explain personality in general (DSM-5) published in 2013
biological model: proposes that psychological describes and provides diagnostic criteria
disorders have a biological or medical cause; for approximately 250 different psychological
the medical model also influences approaches disorders
to diagnosis, treatment, and possible outcomes
for a given disorder potential new system of classifying
RDoC disorders using advances in
psychodynamic
psychological models: propose neuroimaging, genetics, and
that disorders are the result of behavioral cognitive science
various forms of emotional, cognitive estimates may vary but it appears
behavioral, or thought-related
more than 1 in 5 adults over age
malfunctioning
18 in the United States suffer from
prevalence and impact a mental disorder in a given year
sociocultural perspective: thinking and behavior (see Table 14.1); similar rates exist
are the products of family, social, and cultural worldwide and lifetime prevalence
influences; what is normal in one culture may be as high as 36%
may be abnormal in another
biopsychosocial perspective: worldwide, many people do not
incorporates biological, psychological, receive treatment; mental disorders
and sociocultural factors are one of the leading causes of
disability in the United States and
Canada

Practice Quiz How much do you remember?

Pick the best answer.
1. How would the Greek physician Hippocrates have typically dealt 3. In the United States, “insanity” is a term typically used by
with someone suffering from mental illness? a. psychologists. c. the social work system.
a. He would have made a hole in the patient’s skull to release the b. psychiatrists. d. the legal system.
pressure, a process known today as trephining. 4. Elliot became widowed after nearly 40 years of marriage. He has
b. He would focus on correcting the imbalance of bodily fluids, or convinced himself that no one will ever love him again. His irrational
humors. thinking has caused him to suffer from depression, and he rarely
c. He would have someone conduct the religious ritual known as leaves his house. What perspective might best explain his behavior?
an exorcism. a. psychodynamic c. behavioral
d. He would have tried to understand the person’s unconscious b. cognitive d. biological
and the forces at work there.
5. Which of the following concepts is not specifically associated with
2. Lisa has just been fired from her new job for consistently arriving the DSM-5 examination of culture-related disorders?
2 hours late for work. Lisa tries to explain that she must often drive a. cultural syndrome
back home to ensure that all the doors are locked and that no b. cultural idioms of distress
appliances have been left on. Lisa’s condition is abnormal from the c. cultural explanations or perceived cause
__________ definition. d. cultural binding
a. maladaptive c. social deviance
b. situational context d. subjective discomfort
Psychological Disorders   593

Disorders of Anxiety, Trauma, and Stress:

What, Me Worry? anxiety disorders
class of disorders in which the primary
In this section, we will examine disorders in which the most dominant symptom is excessive or symptom is excessive or unrealistic
unrealistic anxiety. In addition to anxiety disorders, we will also address disorders that many anxiety.
people associate with anxiety symptoms, including obsessive-­compulsive disorder, posttrau-
matic stress disorder, and acute stress disorders. These were classified as anxiety disorders in free-floating anxiety
previous editions of the DSM. However, they now fall under different categories in the DSM- anxiety that is unrelated to any
5. Obsessive-compulsive disorder now falls in the category of “Obsessive-Compulsive and ­specific and known cause.
Related Disorders,” while posttraumatic stress disorder and acute stress disorder are found
under “Trauma- and Stressor-Related Disorders” (­American Psychiatric Association, 2013). phobia
an irrational, persistent fear of an
Anxiety Disorders object, situation, or social activity.
14.4 Identify different types of anxiety disorders and their symptoms.
social anxiety disorder (social
The category of anxiety disorders includes disorders in which the most dominant symp- phobia)
tom is excessive or unrealistic anxiety. Anxiety can take very specific forms, such as a fear fear of interacting with others or being
of a specific object, or it can be a very general emotion, such as that experienced by some- in social situations that might lead to
one who is worried and doesn’t know why. a negative evaluation.

specific phobia
But doesn’t everybody have anxiety sometimes? What makes it
fear of objects or specific situations or
a disorder? events.

Everyone does have anxiety, and some people have a great deal of anxiety at times. claustrophobia
When talking about anxiety disorders, the anxiety is either excessive—greater than it
fear of being in a small, enclosed
should be given the circumstances—or unrealistic. If final exams are coming up and a stu- space.
dent hasn’t studied enough, that student’s anxiety is understandable and realistic. But a
student who has studied, has done well in all the exams, and is very prepared and still acrophobia
worries excessively about passing is showing an unrealistic amount of anxiety. For more fear of heights.
about test anxiety, see the Applying Psychology to Everyday Life section in this chapter.
Free-floating anxiety is the term given to anxiety that seems to be unrelated to any realistic
and specific, known factor, and it is often a symptom of an anxiety disorder (Freud, 1977).
Phobic Disorders: When Fears Get Out of Hand One of the more specific anxi-
ety disorders is a phobia, an irrational, persistent fear of something. The “something”
might be an object or a situation or may involve social interactions. For example, many
people would feel fear if they suddenly came upon a live snake as they were walking
and would take steps to avoid the snake. Although those same people would not nec-
essarily avoid a picture of a snake in a book, a person with a phobia of snakes would.
Avoiding a live snake is rational; avoiding a picture of a snake is not.
Social Anxiety Disorder (Social Phobia) Social anxiety disorder (also called social
phobia) involves a fear of interacting with others or being in a social situation and is one
of the most common phobias people experience (Kessler et al., 2012). People with social
anxiety disorder are afraid of being evaluated in some negative way by others, so they
tend to avoid situations that could lead to something embarrassing or humiliating. They
are very self-conscious as a result. Common types of social phobia are stage fright, fear
of public speaking, and fear of urinating in a public restroom. Not surprisingly, people
with social phobias often have a history of being shy as children (Sternberger et al., 1995).
Specific Phobias  A specific phobia is an irrational fear of some object or specific situ-
Many people get nervous when they have to
ation, such as a fear of dogs or a fear of being in small, enclosed spaces (claustrophobia).
speak in front of an audience. Fear of public
Other specific phobias include a fear of injections (trypanophobia), fear of dental work (odon- speaking is a common social phobia. Can
tophobia), fear of blood (hematophobia), fear of washing and bathing (ablutophobia), and fear you remember a time when you experienced
of heights (acrophobia). a fear like this?
594  Chapter 14

Agoraphobia A third type of phobia is agoraphobia, a Greek name that literally means
“fear of the marketplace.” It is the fear of being in a place or situation from which escape
is difficult or impossible if something should go wrong (American Psychiatric Associa-
tion, 2013). Furthermore, the anxiety is present in more than one ­situation. Someone is
diagnosed with agoraphobia if they feel anxiety in at least two of five possible situations
such as using public transportation like a bus or plane, being out in an open space such
as on a bridge or in a parking lot, being in an enclosed space such as a grocery store or
movie theatre, standing in line or being in a crowd like at a concert, or being out of the
home alone (American Psychiatric Association, 2013).

If a person has agoraphobia, it might be difficult to even go to

work or to the store, right?

Exactly. People with specific phobias can usually avoid the object or situation with-
out too much difficulty, and people with social phobias may simply avoid jobs and situa-
tions that involve meeting people face to face. But people with agoraphobia cannot avoid
their phobia’s source because it is simply being outside in the real world. A severe case of
agoraphobia can make a person’s home a prison, leaving the person trapped inside unable
to go to work, shop, or engage in any kind of activity that requires going out of the home.

Panic Disorder Fourteen-year-old Dariya was sitting in science class watching a film. All
of a sudden, she started feeling really strange. Her ears seemed to be stuffed with cotton and
her vision was very dim. She was cold, had broken out in a sweat, and felt extremely afraid
for no good reason. Her heart was racing, and she immediately became convinced that she
was dying. A friend sitting behind her saw how pale she had become and tried to ask her
what was wrong, but Dariya couldn’t speak. She was in a state of panic and couldn’t move.
Dariya’s symptoms are the classic symptoms of a panic attack, a sudden onset of
extreme panic with various physical symptoms: racing heart, rapid breathing, a sensa-
tion of being “out of one’s body,” dulled hearing and vision, sweating, and dry mouth
(Kumar & Oakley-Browne, 2002). Many people who have a panic attack think that they
are having a heart attack and can experience pain as well as panic, but the symptoms
are caused by the panic, not by any actual physical disorder. Psychologically, the person
having a panic attack is in a state of terror, thinking that this is it, death is happening, and
agoraphobia many people may feel a need to escape. The attack happens without warning and quite
suddenly. Although some panic attacks can last as long as half an hour, some last only a
fear of being in a place or situation
from which escape is difficult or
few minutes, with most attacks peaking within 10 to 15 minutes.
impossible. Having a panic attack is not that unusual, especially for adolescent girls and young
adult women (Eaton et al., 1994; Hayward et al., 1989, 2000; Kessler et al., 2007). Research-
panic attack ers have also found evidence that cigarette smoking greatly increases the risk of panic
sudden onset of intense panic in attacks in adolescence, young adulthood, and middle adulthood (Bakhshaie et al., 2016;
which multiple physical symptoms Johnson et al., 2000; Zvolensky et al., 2003). Regardless, it is only when panic attacks occur
of stress occur, often with feelings more than once or repeatedly and cause persistent worry or changes in behavior that they
that one is dying. become a panic disorder. Many people try to figure out what triggers a panic attack and
then do their best to avoid the situation if possible. If driving a car sets off an attack, they
panic disorder don’t drive. If being in a crowd sets off an attack, they don’t go where crowds are.
disorder in which panic attacks occur
more than once or repeatedly, and Generalized Anxiety Disorder
cause persistent worry or changes in
behavior.
What about people who are just worriers? Can that become
generalized anxiety disorder a disorder?
disorder in which a person has
­feelings of dread and impending doom Remember free-floating anxiety? That’s the kind of anxiety that has no known spe-
along with physical symptoms of cific source and may be experienced by people with generalized anxiety disorder, in which
stress, which lasts 6 months or more. excessive anxiety and worries (apprehensive expectations) occur more days than not for at
Psychological Disorders   595

Table 14.2 Anxiety Disorders and their Symptoms

Anxiety Disorder Definition Examples/Symptoms

Social Anxiety Fear of interacting with others Stage fright, fear of public speaking,
Disorder or being in social situations fear of urinating in public, fear of eating
that might lead to a negative with other people
evaluation

Specific Phobias Fear of objects or specific Fears of animals, the natural

situations or events environment such as thunder storms,
blood injections/injury, specific
situations such as flying

Agoraphobia Fear of being in a place or Using public transportation, open

situation from which escape is spaces, enclosed spaces, being in a
difficult or impossible crowd

Panic Disorder Disorder in which panic attacks Various physical symptoms: racing
occur more than once or heart, dizziness, rapid breathing, dulled
repeatedly and cause persistent senses, along with uncontrollable
worry or changes in behavior feelings of terror

Generalized Disorder in which a person has Tendency to worry about situations,

Anxiety Disorder feelings of dread and impending people, or objects that are not
doom along with physical really problems, tension, muscle
symptoms of stress, which lasts aches, sleeping problems, problems
6 months or more concentrating

least 6 months. People with this disorder may also experience anxiety about a number of
events or activities (such as work or school performance). These feelings of anxiety have no
particular source that can be pinpointed, nor can the person control the feelings even if an
effort is made to do so.
People with this disorder are just plain worriers (Ruscio et al., 2001). They worry
excessively about money, their children, their lives, their friends, the dog, as well as things
no one else would see as a reason to worry. They feel tense, edgy, get tired easily, and
may have trouble concentrating. They have muscle aches, they experience sleeping prob-
lems, and they are often irritable—all signs of stress. Generalized anxiety disorder is
often found occurring with other anxiety disorders and depression.

Other Disorders Related to Anxiety

14.5 Describe obsessive-compulsive disorder and stress-related disorders.
As discussed earlier, despite anxiety being a common symptom, the following dis-
orders are no longer classified as anxiety disorders in the DSM-5. Obsessive-compulsive
disorder now falls in the category of “Obsessive-Compulsive and Related Disorders,”
while ­posttraumatic stress disorder and acute stress disorder are found under “Trauma- and
­Stressor-Related Disorders” (American Psychiatric Association, 2013).
Obsessive-Compulsive Disorder Sometimes people get a thought running through
their head that just won’t go away, like when a song gets stuck in one’s mind. If that particu-
lar thought causes a lot of anxiety, it can become the basis for an ­obsessive-compulsive dis-
order, or OCD. OCD is a disorder in which intruding* thoughts that occur again and again
(obsessions, such as a fear that germs are on one’s hands) are followed by some repetitive,
ritualistic behavior or mental acts (compulsions, such as repeated hand washing, counting,
etc.). The compulsions are meant to lower the anxiety caused by the thought (Soomro, 2001).

I knew someone who had just had a baby, and she spent the obsessive-compulsive disorder
first few nights home with the baby checking it to see if it was disorder in which intruding, ­recurring
thoughts or obsessions create ­anxiety
breathing—is that an obsessive-compulsive disorder?
that is relieved by performing a
­repetitive, ritualistic behavior or
*intruding: forcing one’s way in; referring to something undesirable that enters awareness. ­mental act (compulsion).
596  Chapter 14

No, many parents check their baby’s breathing often at first. Everyone has a lit-
tle obsessive thinking on occasion or some small ritual that makes them feel better. The
difference is whether a person likes to perform the ritual (but doesn’t have to) or feels
­compelled to perform the ritual and feels extreme anxiety if unable to do so. You may
wash your hands a time or two after picking up garbage, but it is entirely different if you
must wash them a thousand times to prevent getting sick. The distress caused by a failure
or an inability to successfully complete the compulsion is a defining feature of OCD.
Acute Stress Disorder (Asd) and Posttraumatic Stress Disorder (PTSD)
Both general and specific stressors were discussed in Chapter Eleven: Stress and Health.
Two trauma- and stressor-related disorders—acute stress disorder and posttraumatic stress dis-
order—are related to exposure to significant and traumatic stressors. The trauma, severe
stress, and anxiety experienced by people after 9/11, Hurricane Katrina, the April 2013 Bos-
ton Marathon bombings, the 2015 terrorist attacks in Paris and earthquake in Nepal, and
the 2016 attacks in Brussels, Orlando, and Nice can lead to acute stress disorder (ASD).
The symptoms of ASD often occur immediately after the traumatic event and include anxi-
ety, dissociative symptoms (such as emotional numbness/lack of responsiveness, not being
What stressors and types of trauma
might refugees fleeing war-torn countries
aware of surroundings, dissociative amnesia), recurring nightmares, sleep disturbances,
experience? problems in concentration, and moments in which people seem to “relive” the event in
dreams and flashbacks for as long as 1 month following the event. One published study
gathered survey information from Katrina evacuees at a major emergency shelter and
found that 62 percent of those sampled met the criteria for having acute stress disorder
(Mills et al., 2007).
When the symptoms associated with ASD last for more than 1 month, the disorder
is then called posttraumatic stress disorder (PTSD). In the same study (Mills et al., 2007),
researchers concluded that it was likely that anywhere from 38 to 49 percent of all the evac-
uees sampled were at risk of developing PTSD that would still be present 2 years after the
disaster. Furthermore, whereas the onset of ASD often occurs immediately after the trau-
matic event, the symptoms of PTSD may not occur until 6 months or later after the event
(American Psychiatric Association, 2013). Treatment of these stress disorders may involve
psychotherapy and the use of drugs to control anxiety. to Learning Objectives 15.10,
15.13. The video PTSD: The Memories We Don’t Want describes PTSD in more detail.

acute stress disorder (ASD)

a disorder resulting from exposure
to a major stressor, with symptoms
of anxiety, dissociation, recurring
­nightmares, sleep disturbances,
­problems in concentration, and
moments in which people seem to
“relive” the event in dreams and
­flashbacks for as long as 1 month
­following the event.

posttraumatic stress disorder

(PTSD)
a disorder resulting from exposure
to a major stressor, with symptoms
of anxiety, dissociation, nightmares,
poor sleep, reliving the event, and
­concentration problems, lasting for
more than 1 month; symptoms may
appear immediately, or not occur CC
until 6 months or later after the
­traumatic event. Watch the Video PTSD: The Memories We Don’t Want on MyPsychLab
Psychological Disorders   597

Researchers have found that women have almost twice

the risk of developing PTSD as do men and that the likelihood
increases if the traumatic experience took place before the woman
was 15 years old (Breslau et al., 1997, 1999). However, female and
male veterans tend to have similar symptoms of PTSD, at least for
military-related stressors (King et al., 2013). Children may also suf-
fer different effects from stress than do adults. Severe PTSD has
been linked to a decrease in the size of the hippocampus in chil-
dren with the disorder (Carrion et al., 2007). The hippocampus is
important in the formation of new long-term declarative memories
( to Learning Objectives 2.11, 6.5, 6.12), and this may have
a detrimental effect on learning and the effectiveness of treatments
for these children. Changes in the connections between different
brain areas, especially those involved in regulating fear, also likely
impair possible recovery efforts (Keding & Herringa, 2015).
Some life experiences lend themselves to people experienc-
ing traumatic events. For example, the rate of PTSD (self-reported)
among combat-exposed military personnel has tripled since 2001
(Smith et al., 2008). One study of older veterans over a 7-year period
(Yaffe et al., 2010) found that those with PTSD were also more likely
to develop dementia (10.6 percent risk) when compared to those
Anxiety disorders affect children as well as adults.
without PTSD (only 6.6 percent risk). Increased levels of stress can
make things worse. The risk of developing dementia appears to be
more than 75 percent higher for veterans that were prisoners of war (POWs) than veter-
ans that were not (Meziab et al., 2014).
Last, individuals with ASD and PTSD likely perceive the world around them
differently. A study of assault and motor vehicle accident survivors treated in a South
London, UK, emergency room suggested individuals with ASD or PTSD were more
likely to identify trauma-related pictures than neutral pictures, as compared to trauma
survivors not diagnosed with ASD or PTSD. Furthermore, such preferential process-
ing of trauma-related information may be more strongly primed in individuals with
PTSD (Kleim et al., 2012) and is supported by fMRI studies demonstrating heightened
brain processing in areas associated with associative learning and priming in individ-
uals with PTSD (Sartory et al., 2013). to Learning Objective 6.5.

Causes of Anxiety, Trauma, and Stress Disorders

14.6 Identify potential causes of anxiety, trauma, and stress disorders.
Different perspectives on how personality develops offer different explanations for these
disorders. For example, the psychodynamic model sees anxiety as a kind of danger sig-
nal that repressed urges or conflicts are threatening to surface (Freud, 1977). A phobia is
seen as a kind of displacement, in which the phobic object is actually only a symbol of
whatever the person has buried deep in his or her unconscious mind—the true source of
the fear. A fear of knives might mean a fear of one’s own aggressive tendencies, or a fear
of heights may hide a suicidal desire to jump.
Behavioral and Cognitive Factors Behaviorists believe that anxious behavioral
reactions are learned. They see phobias, for example, as nothing more than classi-
cally conditioned fear responses, as was the case with “Little Albert” (Rachman, 1990;
­Watson & Rayner, 1920). to Learning Objective 5.3. Cognitive psychologists
see anxiety disorders as the result of illogical, irrational thought processes. One way magnification
in which people with anxiety disorders show irrational thinking (Beck, 1976, 1984) is the tendency to interpret situations
through magnification, or the tendency to “make mountains out of molehills” by inter- as far more dangerous, harmful, or
preting situations as being far more harmful, dangerous, or embarrassing than they important than they actually are.
598  Chapter 14

actually are. In panic disorder, for example, a person might interpret a racing heartbeat
as a sign of a heart attack instead of just a momentary arousal.
Cognitive-behavioral psychologists may see anxiety as related to another distorted
thought process called all-or-nothing thinking, in which a person believes that his or
her performance must be perfect or the result will be a total failure. Overgeneralization
(a single negative event interpreted as a never-ending pattern of defeat), jumping to con-
clusions without facts to support that conclusion, and minimization (giving little or no
emphasis to one’s successes or positive events and traits) are other examples of irratio-
nal thinking. In a recent study with firefighters, a profession with repeated exposure to
trauma, research suggests cognitive flexibility in regulating emotions according to the
demands of particular situations can protect someone from developing PTSD symptoms
(Levy-Gigi et al., 2016).

Biological Factors Growing evidence exists that biological factors contribute to

anxiety disorders. Several disorders, including generalized anxiety disorder, panic
disorders, phobias, and OCD, tend to run in families, pointing to a genetic basis for
these disorders. Furthermore, genetic factors in PTSD seem to influence both the risk
of developing the disorder and the likelihood individuals may be involved in poten-
tially dangerous situations (Hyman & Cohen, 2013). Functional neuroimaging stud-
ies, to Learning Objective 2.9, have revealed that the amygdala, an area of
the limbic system, is more active in phobic people responding to pictures of spiders
than in nonphobic people (LeDoux, 2003; Rauch et al., 2003) and also more active in
individuals with PTSD and social anxiety disorder, suggesting excessive condition-
ing and exaggerated responses to stimuli that would typically elicit minimal fear­-
related responses (Hyman & Cohen, 2013). to Learning Objectives 2.11, 6.12,
and 9.8. Structural neuroimaging studies have also been helpful, to ­Learning
­Objective 2.9, in that specific brain areas have been associated with a variety of anx-
iety disorders, namely reductions of gray matter in the parts of the right ventral
­anterior cingulate gyrus (at the bottom and front of the right cingulate gyrus) and left
inferior frontal gyrus (Shang et al., 2014). In a study of individuals across six different
psychological disorders, reductions in gray matter were found in the dorsal anterior
(at the top and front) cingulate gyrus and both the left and right insula (Goodkind
et al., 2015).
all-or-nothing thinking
the tendency to believe that one’s Cultural Variations Anxiety disorders are found around the world, although the
­performance must be perfect or the particular form the disorder takes might be different in various cultures. For exam-
result will be a total failure. ple, in some Latin American cultures, anxiety can take the form of ataque de nervios,
or “attack of nerves,” in which the person may have fits of crying, shout uncontrol-
overgeneralization lably, experience sensations of heat, and become very aggressive, either verbally or
distortion of thinking in which a physically. These attacks usually come after some stressful event such as the death
­person draws sweeping conclusions of a loved one (American Psychiatric Association, 2013). Several syndromes that are
based on only one incident or event essentially types of phobias are specific to certain cultures. For example, koro, found
and applies those conclusions to primarily in China and a few other South Asian and East Asian countries, involves a
events that are unrelated to the fear that one’s genitals are shrinking (Pfeiffer, 1982), and taijin kyofusho (TKS), found
­original; the tendency to interpret a
primarily in Japan, involves excessive fear and anxiety, but in this case it is the fear
single negative event as a neverending
that one will do something in public that is socially inappropriate or embarrassing,
pattern of defeat and failure.
such as blushing, staring, or having an offensive body odor (Kirmayer, 1991). Panic
minimization disorder occurs at similar rates in adolescents and adults in the United States and
distortions of thinking in which a
parts of Europe but is found less often in Asian, African, and Latin American coun-
person blows a negative event out tries. Within the United States, Native Americans have significantly higher rates,
of proportion to its importance whereas Latinos, African Americans, Caribbean blacks, and Asian Americans have
(­magnification) while ignoring relevant significantly lower rates as compared to non-Latino whites (American Psychiatric
positive events (minimization). Association, 2013).
Psychological Disorders   599

Concept Map L.O. 14.4, 14.5, 14.6

social anxiety disorder (social

phobia)

(e.g., claustrophobia,
acrophobia)
agoraphobia
panic disorder consists of an individual having recurrent panic attacks that
cause ongoing worry and concern
Disorders of generalized anxiety disorder involves excessive worry about lots of things and occurs
Anxiety, Trauma, more days than not

and Stress obsessive-compulsive disorder (OCD) consists of recurring anxiety-provoking thoughts

(most dominant or obsessions that are only relieved through ritualistic or repetitive behaviors or mental events
symptom is excessive or acute stress disorder (ASD)
unrealistic anxiety, or posttraumatic stress stressors; diagnosis differs according
related to traumatic stress) disorder (PTSD) to duration and onset of symptoms,
including dissociation, nightmares,
and reliving the event. magnification
all-or-none thinking
behavioral: anxious behavioral reactions are learned
causes overgeneralization
cognitive: anxiety is result of illogical,
irrational thought processes minimization

biological: anxiety is due to dysfunction in several neurotransmitter systems (e.g.,

serotonin, GABA) and/or difference in brain activation; panic disorder is also hereditary
cultural: anxiety disorders found around the world but particular forms
vary across cultures

Practice Quiz How much do you remember?

Pick the best answer.
1. Who is most likely to be diagnosed with a phobic disorder? 3. Sandy took part in the April 2013 Boston Marathon, where two
a. Brianne, who is afraid of snakes after nearly being bitten while bombs were detonated near the finish line, killing three spectators.
running For approximately 2 weeks after the marathon, Sandy was unable
b. Calista, who is afraid of snakes after watching a documentary on to sleep or concentrate and often found herself reliving the moment
poisonous snakes found in her region she heard the bombs explode. What disorder might Sandy be
c. Jennifer, who is morbidly afraid of snakes and refuses to even ­diagnosed with?
look at a picture of a snake a. acute stress disorder
d. Both Calista and Jennifer’s behavior would qualify as a phobic b. posttraumatic stress disorder
disorder. c. phobic disorder
2. Amelia has recently given birth to her first child. She mentions d. panic disorder
that she often goes into her baby’s bedroom to check if he is 4. Melanie has just received an exam grade in her psychology class.
still breathing. Would this qualify as an obsessive-compulsive She earned a grade of 89 percent, which is a B. All of her work
disorder (OCD)? during the semester thus far has earned A grades, and she is
a. If Amelia continues to carry out this behavior for more than 1 or very upset about the exam score. “This is the worst thing that
2 days, this would qualify as an OCD. could possibly have happened,” she laments to her best friend,
b. If Amelia and her husband both carry out this behavior, then it Keesha, who just rolls her eyes. A cognitive psychologist would
would qualify as an OCD. suggest that Melanie is employing the cognitive distortion called
c. If Amelia enjoys frequently checking to see that her baby is _________.
breathing, then this would qualify as an OCD. a. all-or-nothing thinking
d. As long as Amelia is not compelled to check on her baby and b. overgeneralization
does not suffer from severe anxiety if she is unable to do so, c. magnification
then this is not an OCD. d. minimization
600  Chapter 14

Dissociative Disorders: Altered Identities

Just as there is sometimes overlap of symptoms between different diagnoses, various
disorders can be related to similar circumstances or phenomena. As already discussed,
exposure to trauma is a key component to ASD and PTSD, and both may include symp-
toms of dissociation. Dissociation plays a more prominent role in the dissociative disor-
ders, where the dissociative symptoms encompass many aspects of everyday life and not
just memories of the traumatic events themselves or the time around them (American
Psychiatric Association, 2013).

dissociative disorders
Types of Dissociative Disorders
disorders in which there is a break
in conscious awareness, ­memory,
14.7 Differentiate among dissociative amnesia, dissociative fugue, and
the sense of identity, or some
­dissociative identity disorder.
combination. Dissociative disorders involve a break, or dissociation, in consciousness, memory, or
a person’s sense of identity. This “split” is easier to understand when thinking about
dissociative identity disorder how people sometimes drive somewhere and then wonder how they got there—they
(DID) don’t remember the trip at all. This sort of “automatic pilot” driving happens when the
disorder occurring when a person route is familiar and frequently traveled. One part of the conscious mind was think-
seems to have two or more distinct ing about work, school, or whatever was uppermost in the mind, while lower centers
personalities within one body. of consciousness were driving the car, stopping at signs and lights, and turning when
needed. This split in conscious attention is very similar to what happens in dissociative
disorders. The difference is that in these disorders, the dissociation is much more pro-
nounced and involuntary.

Dissociative Amnesia and Fugue: Who Am I and How Did I Get Here? In
­d issociative amnesia, the individual cannot remember personal information such as
one’s own name or specific personal events—the kind of information contained in
episodic long-term memory. to Learning Objective 6.5. Dissociative amnesia
may sound like retrograde amnesia, but it differs in its cause. In retrograde amnesia,
the memory loss is typically caused by a physical injury, such as a blow to the head.
In dissociative amnesia, the cause is psychological rather than physical. The “blow”
is a mental one, not a physical one. The reported memory loss is usually
associated with a stressful or emotionally traumatic experience, such as
rape or childhood abuse (Chu et al., 1999; Kirby et al., 1993), and cannot
be easily explained by simple forgetfulness. It can be a loss of memory for
only one small segment of time, or it can involve a total loss of one’s past
personal memories. For example, a soldier might be able to remember
being in combat but cannot remember witnessing a friend get killed, or a
person might forget his or her entire life. These memories usually resur-
face, sometimes quickly and sometimes after a long delay. Dissociative
amnesia can occur with or without fugue. The Latin word fugere means
“flight” and is the word from which the term fugue is taken. A dissociative
fugue occurs when a person suddenly travels away from home (the flight)
An apparent case of dissociative amnesia and fugue. Edward and afterwards cannot remember the trip or even personal information
Lighthart, or as he preferred, John Doe, was found in Seattle, such as identity. The individual may become confused about identity,
Washington in 2009. During the interview when this photo sometimes even taking on a whole new identity in the new place (Nijen-
was taken, Doe reported memories were slowly trickling back
huis, 2000). Such flights usually take place after an emotional trauma and
during the nearly seven weeks since he walked out of a Seattle
park with no idea of who he was and how he got there. News
are more common in times of disasters or war.
reports indicated he was found later that same year in Las
Vegas, New Mexico, again without knowing who he was or Dissociative Identity Disorder: How Many Am I? Perhaps the
how he got there. most controversial dissociative disorder is dissociative identity disorder
Psychological Disorders   601

(DID), formerly known as multiple personality d ­ isorder. In this disorder, a person

seems to experience at least two or more distinct personalities existing in one body.
There may be a “core” personality, who usually knows nothing about the other per-
sonalities and is the one who experiences “blackouts” or losses of memory and time.
Fugues are common in dissociative identity ­disorder, with the core personality expe-
riencing unsettling moments of “awakening” in an unfamiliar place or with people
who call the person by another name (Kluft, 1984).
With the publication of several famous books and movies made from those books,
dissociative identity disorder became well known to the public. Throughout the 1980s,
psychological professionals began to diagnose this condition at an alarming rate—
”multiple personality,” as it was then known, had become the “fad” disorder of the
late twentieth century, according to some researchers (Aldridge-Morris, 1989; Boor,
1982; Cormier & Thelen, 1998; Showalter, 1997). Although the diagnosis of disso-
ciative identity disorder has been a point of controversy and scrutiny, with many
(but not all) professionals doubting the validity of previous diagnoses, some believe
otherwise.
Some research suggests DID is not only a valid diagnostic category, it may co-­occur
in other disorders, such as individuals with borderline personality disorder, and may pos-
sibly be characterized by specific variations in brain functioning (Dorahy et al., 2014;
Ross et al., 2014; Schlumpf et al., 2014). Dissociative symptoms and features can also
be found in other cultures. The trancelike state known as amok in which a person sud-
denly becomes highly agitated and violent (found in Southeast Asia and Pacific Island
cultures) is usually associated with no memory for the period during which the “trance”
lasts (Hagan et al., 2015; Suryani & Jensen, 1993). However, despite their occurrence, in
some cultures dissociative symptoms in and of themselves are not always perceived as a
source of stress or a problem (van Duijl et al., 2010).

Causes of Dissociative Disorders

14.8 Summarize explanations for dissociative disorders.
Psychodynamic theory sees the repression of threatening or unacceptable thoughts and
behavior as a defense mechanism at the heart of all disorders, and the dissociative dis-
orders in particular seem to have a large element of repression—motivated forgetting—
in them. In the psychodynamic view, loss of memory or disconnecting one’s awareness
from a stressful or traumatic event is adaptive in that it reduces the emotional pain
(Dorahy, 2001).
Cognitive and behavioral explanations for dissociative disorders are con-
nected: The person may feel guilt, shame, or anxiety when thinking about disturb-
ing experiences or thoughts and start to avoid thinking about them. This “thought
avoidance” is negatively reinforced by the reduction of the anxiety and unpleasant
feelings and eventually will become a habit of “not thinking about” these things.
This is similar to what many people do when faced with something unpleasant, such
as an injection or a painful procedure such as having a root canal. They “think about
something else.” In doing that, they are deliberately not thinking about what is hap-
pening to them at the moment, and the experience of pain is decreased. People with
dissociative disorders may simply be better at doing this sort of “not thinking” than
other people are.
Also, consider the positive reinforcement possibilities for a person with a disso-
ciative disorder: attention from others and help from professionals. Shaping may also
play a role in the development of some cases of dissociative identity disorder. The ther-
apist may unintentionally pay more attention to a client who talks about “feeling like
602  Chapter 14

someone else,” which may encourage the client to report more such feelings and even
elaborate on them.
There are some possible biological sources for dissociations as well. Researchers
have found that people with depersonalization/derealization disorder (a dissociative disorder
in which people feel detached and disconnected from themselves, their bodies, and their
surroundings) have lower brain activity in the areas responsible for their sense of body
awareness than do people without the disorder (Simeon et al., 2000). Others have found
evidence that people with dissociative identity disorders show significant differences in
brain activity, as evidenced by PET and fMRI, when different “personalities” are present
(Reinders et al., 2001; Schlumpf et al., 2014; Tsai et al., 1999). It is also possible individuals
with DID may be more elaborative when forming memories and are better at memory
recall as a result (García-Campayo et al., 2009).

Concept Map L.O. 14.7, 14.8

dissociative amnesia: one cannot remember personal information; may involve

a dissociative fugue in that the person takes a sudden trip and also cannot
remember the trip
dissociative identity disorder: person seems to experience at least two or more
distinct personalities; validity of actual disorder has been topic of debate
Dissociative Disorders
(involve a dissociation psychodynamic: repressed thoughts and behavior is
in consciousness, memory, causes primary defense mechanism and reduces emotional pain
or sense of identity, often cognitive and behavioral: trauma-related thought avoidance
associated with extreme is negatively reinforced by reduction in anxiety and emotional pain
stress or trauma)
biological: support for brain activity differences in body awareness has
been found in individuals with depersonalization/derealization disorder

Practice Quiz How much do you remember?

Pick the best answer.
1. What is the major difference between dissociative amnesia and 3. Dr. Cowden believes that Jamison’s dissociation disorder may be
­retrograde amnesia? due to his apparent enhanced ability to think about things other than
a. Retrograde amnesia patients often suffer from some form of those associated with his traumatic childhood. What psychological
physical brain trauma. perspective is Dr. Cowden applying?
b. Individuals suffering from dissociative amnesia often have a. psychodynamic perspective
a ­history of memory loss that seems to be hereditary. b. biological perspective
c. Those suffering from dissociative amnesia have prior damage to c. cognitive/behavioral perspective
the brain, which in turn causes memory loss. d. evolutionary perspective
d. Retrograde amnesia patients often have suffered from painful 4. Dissociative symptoms and features can be found in many ­different
psychological trauma. cultures. For example, in Southeast Asian and Pacific Islander
2. Franklin wakes up on a cot in a homeless shelter in another town. cultures, people sometimes experience a trancelike state called
He doesn’t know where he is or how he got there, and he’s ___________ that is associated with increased agitation and violent
­confused when people say he has been calling himself Anthony. tendencies.
This is most likely an episode of dissociative a. “TKS” c. amok
a. amnesia. c. identity disorder. b. koro d. susto
b. amnesia with fugue. d. multiple personality.
Psychological Disorders   603

Disorders of Mood: The Effect of Affect

When was the last time you felt down and sad? Or maybe a period of excitement or
­jubilation? Did these come about as the result of normal, day-to-day events or circum-
stances and change accordingly? Imagine how the experience of such feelings would
impact your life if they lasted for much longer periods of time, were much more per-
sistent across life events, and if you were unable to identify the source or cause for such
emotions. That is often the case when someone experiences a disordered mood.

Major Depressive Disorder and Bipolar Disorders

14.9 Describe different disorders of mood, including major depressive d
­ isorder
and bipolar disorders.
In psychological terms, the word affect is used to mean “emotion” or “mood.” Mood
disorders are disturbances in emotion and are also referred to as affective disorders.
Although the range of human emotions runs from deep, intense sadness and despair
to extreme happiness and elation, under normal circumstances people stay in between
those extremes—neither too sad nor too happy but content (see Figure 14.1). It is when
stress or some other factor pushes a person to one extreme or the other that mood disor-
ders can result. Mood disorders can be relatively mild or moderate (straying only a short
distance from the “average”), or they can be extreme (existing at either end of the full
range). While we will examine disorders of mood together here, note that in the DSM-5,
disorders of mood can be found under “Bipolar and Related Disorders” or “Depressive
Disorders.”
Major Depressive Disorder When a deeply depressed mood comes on fairly sud-
denly and either seems to be too severe for the circumstances or exists without any
external cause for sadness, it is called major depressive disorder. Major depression
would fall at the far extreme of sadness on Figure 14.1. People suffering from major
depressive disorder are depressed for most of every day, take little or no pleasure in
any activities, feel tired, have trouble sleeping or sleep too much, experience changes
in appetite and significant weight changes, experience excessive guilt or feelings of
worthlessness, and have trouble concentrating. Some people with this disorder also suf-
fer from delusional thinking and may experience hallucinations. Most of these symp-
toms occur on a daily basis, lasting for the better part of the day (American ­Psychiatric
­Association, 2013).
Some people with depression may have thoughts of death or suicide, including
suicide attempts. Death by suicide is the most serious negative outcome for the person
with depression. It is now the second leading cause of death among young people from
15 to 34 years of age in the United States, and more than 90 percent of suicides are associ-
ated with a psychological disorder, with depression being the most likely cause (Centers
for Disease Control and Prevention, 2015; Hyman & Cohen, 2013). If you or someone affect
you know is thinking about suicide, confidential assistance is available from the National
in psychology, a term indicating
­Suicide Prevention Lifeline, 1-800-273-TALK (8255). “­emotion” or “mood.”

mood disorders
disorders in which mood is severely
disturbed.
Extreme Mild Normal Mild Extreme
sadness sadness emotions elation elation
major depressive disorder
Figure 14.2 The Range of Emotions severe depression that comes on
Most people experience a range of emotions over the course of a day or several days, such as ­suddenly and seems to have no
mild sadness, calm contentment, or mild elation and happiness. A person with a disorder of mood ­external cause, or is too severe for
experiences emotions that are extreme and, therefore, abnormal. ­current circumstances.
604  Chapter 14

Major depressive disorder is the most common of the diagnosed disorders of

mood and is 1.5 to 3 times more likely in women than it is in men (American Psychiatric
Association, 2013). This is true even across various cultures (Kessler et al., 2012; Seedat
et al., 2009). Many possible explanations have been proposed for this gender difference,
including the different hormonal structure of the female system (menstruation, hormonal
changes during and after pregnancy, menopause, etc.) and different social roles played
by women in the culture (Blehar & Oren, 1997). Research has found little support for hor-
monal influences in general, instead finding that the role of hormones and other biological
factors in depression is unclear. Furthermore, studies have found that the degree of dif-
ferences between male and female rates of depression is decreasing and is nonexistent in
college students and single adults, leading some to conclude that gender roles and social
factors such as marital status, career type, and number of children may have more impor-
tance in creating the gender difference than biological differences do (McGrath et al., 1992;
Nolen-Hoeksema, 1990; Seedat et al., 2009; Weissman & Klerman, 1977). Women also tend
to ruminate, or repeatedly focus more on negative emotions, more than men, and this
may also be a contributing factor for reported gender differences in prevalence rates for
both depression and anxiety (Krueger & Eaton, 2015; Nolen-Hoeksema, 2012).
Some people find that they only get depressed at certain times of the year. In partic-
ular, depression seems to set in during the winter months and goes away with the coming
of spring and summer. Seasonal affective disorder (SAD) is a mood disorder that is caused
by the body’s reaction to low levels of light present in the winter months (­Partonen &
Lonnqvist, 1998). Despite the use of this term, recent research suggests there may not be
a valid category of depression that varies by season and raise questions about the contin-
ued use of this diagnosis (Traffanstedt et al., 2016).
Bipolar Disorders Major depressive disorder is sometimes referred to as a unipolar
disorder because the emotional problem exists at only one end, or “pole,” of the emo-
tional range. When a person experiences periods of mood that can range from severe
depression to manic episodes (excessive excitement, energy, and elation), that person is
said to suffer from a type of bipolar disorder (American Psychiatric Association, 2013).
However, while an individual may experience periods of mood at the two extremes, in
some instances the individual may only experience mood that spans from normal to
manic and may or may not experience episodes of depression, called bipolar I disorder.
In the manic episodes, the person is extremely happy or euphoric* without any real
cause to be so happy. Restlessness, irritability, an inability to sit still or remain inac-
tive, and seemingly unlimited energy are also common. The person may seem silly
to others and can become aggressive when not allowed to carry out the grand (and
sometimes delusional) plans that may occur in mania. Speech may be rapid and jump
from one topic to another. Oddly, people in the manic state are often very creative until
their lack of organization renders their attempts at being creative useless (Blumer, 2002;
McDermott, 2001; Rothenberg, 2001). In bipolar II disorder, spans of normal mood are
manic interspersed with episodes of major depression and episodes of hypomania, a level of
having the quality of excessive
mood that is elevated but at a level below or less severe than full mania (American
excitement, energy, and elation or Psychiatric Association, 2013).
irritability.
That sounds almost like a description of an overactive child—
bipolar disorder can’t sit still, can’t concentrate—are the two disorders related?
periods of mood that may range from
normal to manic, with or ­without The answer to that question is actually part of an ongoing controversy. There
episodes of depression (bipolar I
does seem to be a connection between attention-deficit/hyperactivity disorder (ADHD)
disorder), or spans of normal mood
and the onset of bipolar disorder in adolescence (Carlson et al., 1998), but only a small
interspersed with episodes of major
depression and episodes of hypomania
(bipolar II disorder). *euphoric: having a feeling of vigor, well-being, or high spirits.
Psychological Disorders   605

percentage of children with ADHD go on to develop bipolar disorder. Recent evidence

has found significantly higher rates of ADHD among relatives of individuals with ­bipolar
disorder and a higher prevalence of bipolar disorder among relatives of individuals with
ADHD (Faraone et al., 2012). The symptoms of bipolar disorder include irrational think-
ing and other manic symptoms that are not present in ADHD (Geller et al., 1998). Confu-
sion between the two disorders arises because hyperactivity (excessive movement and an
inability to concentrate) is a symptom of both disorders. In one study, researchers com-
pared children diagnosed with both bipolar disorder and ADHD to children diagnosed
with ADHD only on measures of academic performance and a series of neurological tests
(Henin et al., 2007). They found that the two groups responded in very similar ways,
showing the same deficits in information-processing abilities, with only one exception:
The children with both disorders performed more poorly on one measure of processing
speed when compared to children with only ADHD. The researchers concluded that the
neurological deficits often observed in children with bipolar disorder are more likely to
be due to the ADHD than to the bipolar disorder itself. Children with bipolar disorder
also seem to suffer from far more severe emotional and behavioral problems than those
with ADHD (Ferguson-Noyes, 2005; McDougall, 2009).

Causes of Disordered Mood

14.10 Compare and contrast behavioral, social cognitive, and biological
­explanations for depression and other disorders of mood.
Explanations of depression and other disorders of mood come from the perspectives
of behavioral, social cognitive, and biological theories as well as genetics.
Behavioral theorists link depression to learned helplessness (Seligman, 1975,
1989), whereas social cognitive theorists point to distortions of thinking such as
blowing negative events out of proportion and minimizing positive, good events
(Beck, 1976, 1984). to Learning Objective 5.12. In the social cognitive view,
depressed people continually have negative, self-defeating thoughts about them-
selves, which depress them further in a downward spiral of despair. Learned helpless-
ness has been linked to an increase in such self-defeating thinking and depression in
studies with people who have experienced uncontrollable, painful events (Abramson
et al., 1978, 1980). This link does not necessarily mean that negative thoughts cause
depression; it may be that depression increases the likelihood of negative thoughts
(Gotlib et al., 2001). One study found that when comparing adolescents who were
depressed to those who were not, the depressed group faced risk factors specifically
associated with the social cognitive environment, such as being female or a mem-
ber of an ethnic minority, living in poverty, regular use of drugs (including tobacco
and alcohol), and engaging in delinquent behavior (Costello et al., 2008). In con-
trast, those in the nondepressed group of adolescents were more likely to come from
two-parent households; had higher self-esteem; and felt connected to parents, peers,
and school. Clearly, learned helplessness in the face of discrimination, prejudice, and
poverty may be associated with depression in these adolescents. Research has also
found that when therapists focus on helping clients change their way of thinking,
depression improves significantly when compared to therapy that focuses only on
changing behavior; these results lend support to the cognitive explanation of dis-
torted thinking as the source of depression (Strunk et al., 2010).
Biological explanations of disordered mood focus on the effects of brain chemi-
cals such as serotonin, norepinephrine, and dopamine; drugs used to treat depression
and mania typically affect the levels of these three neurotransmitters, either alone
or in combination (Cohen, 1997; Cummings & Coffey, 1994; Ruhe et al., 2007). And
as with other psychological disorders, neuroimaging continues to provide informa-
tion regarding possible brain areas associated with mood. Gray matter loss has been
606  Chapter 14

found in individuals with a history of neglect or physical, emotional, or sexual abuse,

in brain areas associated with mood, regulation of emotional behaviors, and attention
(Lim et al., 2014). One recent investigation across different psychological disorders
found variations in gray matter loss in several brain regions. Think back to the cov-
erage of different brain areas in ­Chapter Two. In addition to the reductions found in
the dorsal anterior cingulate and bilateral insular cortex across disorders, there was
greater loss in the hippocampus and amygdala in depressed individuals (Goodkind,
et al., 2015). Another investigation has found that baseline thickness of cortical gray
matter in the right medial orbitofrontal and right precentral areas of the frontal lobe,
the left anterior cingulate, and bilateral areas of insular cortex predicted future onset
of major depression in a group of 33 ­adolescent females (Foland-Ross et al., 2015). For
subcortical structures, researchers have found smaller volumes in the caudate, part of
the basal ganglia, for individuals with major depressive disorder (MDD) and bipolar
disorder (BD) as compared to controls, but individuals with MDD had greater vol-
ume in the ventral diencephalon, an area that includes the hypothalamus, than both
controls and individuals with BD (Sacchet et al., 2015). Functional neuroimaging has
also found dysfunction in many of these brain areas, with some being more active
and others less active as compared to controls, and to complicate it even further, the
direction of altered activity may be different in youth than in adults with depression
(Miller et al., 2015; Su et al., 2014).
Genes also play a part in these disorders. The fact that the more severe mood dis-
orders are not a reaction to some outside source of stress or anxiety but rather seem to
come from within the person’s own body, together with the tendency of mood disorders
to appear in genetically related individuals at a higher rate, suggests rather strongly that
inheritance may play a significant part in these disorders (Barondes, 1998; Farmer, 1996).
It is possible that some mood disorders share a common gene, but actual rates vary. For
example, genetic risks are higher in bipolar disorder as compared to unipolar depression
(Hyman & Cohen, 2013; McMahon et al., 2010). More than 65 percent of people with
bipolar disorder have at least one close relative with either bipolar disorder or major
depression (Craddock et al., 2005; National Institute of Mental Health Genetics Work-
group, 1998; Sullivan et al., 2000). Twin studies have shown that if one identical twin
has either major depression or bipolar disorder, the chances that the other twin will also
develop a mood disorder are about 40 to 70 percent (Muller-Oerlinghausen et al., 2002).

Concept Map L.O. 14.9, 14.10

major depressive disorder: deeply depressed mood; most commonly diagnosed mood disorder,
Disorders of Mood twice as common in women
(involve a disturbance bipolar disorders: experience of mood from normal to manic, possibly with episodes of depression,
in mood or emotion; or the experience of normal mood interrupted by episodes of depression and
can be mild or severe) hypomania
psychodynamic: depression is repressed anger originally aimed at parents
causes

behavioral: depression is linked to learned helplessness

social cognitive: distorted thinking and negative, self-defeating thoughts
biological: variation in neurotransmitter systems (e.g., serotonin, norepinephrine,
Psychological Disorders   607

Practice Quiz How much do you remember?

Pick the best answer.
1. Jorge finds himself feeling depressed most of the day. He 3. What disorder seems to hold an association with bipolar disorder?
is ­constantly tired yet he sleeps very little. He has feelings a. dysthymia c. phobic disorder
of ­worthlessness that have come on suddenly and seemingly have b. cyclothymia d. ADHD
no basis in reality. What might Jorge be diagnosed with? 4. Biological explanations of disordered mood have focused on the
a. seasonal affective disorder c. major depressive disorder effects of several different brain chemicals, and medications used
b. acute depressive disorder d. bipolar disorder to treat these disorders are designed to work on these various
2. Studies have suggested the increased rates of major depressive neurotransmitter systems. Which of the following is not one of the
disorder in women may have a basis in __________ chemicals that has been implicated in mood disorders?
a. gender roles, social factors, and emotional processing. a. serotonin
b. hormonal differences. b. dopamine
c. biological differences. c. norepinephrine
d. heredity. d. melatonin

Eating Disorders and Sexual Dysfunction

Thus far we have talked about disorders that have primarily focused on mood, anxiety,
stress, and trauma. We will now shift to disorders of a slightly different type and will first
examine eating disorders and then sexual dysfunction.

Eating Disorders
14.11 Identify the symptoms and risk factors associated with anorexia nervosa,
bulimia nervosa, and binge-eating disorder.
There are a variety of disorders that relate to the intake of food, or in some cases non-­
nutritive substances, or in the elimination of bodily waste. These are found in the DSM-5
under “Feeding and Eating Disorders.”
Types of Eating Disorders We will specifically examine three eating disorders:
anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Anorexia Nervosa Anorexia nervosa, often called anorexia, is a condition in which a
person (typically young and female) reduces eating to the point that their body weight is
significantly low, or less than minimally expected. For adults, this is likely a body mass
index (BMI; weight in kilograms/height in meters2) less than 18.5 (American P ­ sychiatric
Association, 2013). Hormone secretion becomes abnormal, especially in the thyroid and
adrenal glands. The heart muscles become weak and heart rhythms may alter. Other
physical effects of anorexia may include diarrhea, loss of muscle tissue, loss of sleep, low
blood pressure, and lack of menstruation in females.
Some individuals with anorexia will eat in front of others (whereas individuals
anorexia nervosa (anorexia)
with bulimia tend to binge eat as secretly as possible) but then force themselves to throw
up or take large doses of laxatives. They are often obsessed with exercising and with a condition in which a person reduces
eating to the point that their body
food—cooking elaborate meals for others while eating nothing themselves. They have
weight is significantly low, or less than
extremely distorted body images, seeing fat where others see only skin and bones.
minimally expected. In adults, this is
Bulimia Nervosa Bulimia nervosa, often called bulimia, is a condition in which a likely associated with a BMI 18.5.
person develops a cycle of “binging,” or overeating enormous amounts of food at one
sitting, and then using inappropriate methods for avoiding weight gain (­American bulimia nervosa (bulimia)
­P sychiatric Association, 2013). Most individuals with bulimia engage in “purging” a condition in which a person d ­ evelops
behaviors, such as deliberately vomiting after the binge or misuse of laxatives, but a cycle of “binging,” or ­overeating
some may not, using other inappropriate methods to avoid weight gain such as fasting enormous amounts of food at one
the day or two after the binge or engaging in excessive exercise (American ­Psychiatric ­sitting, and then using unhealthy
Association, 2013). There are some similarities to anorexia: The victims are usually methods to avoid weight gain.
608  Chapter 14

female, are obsessed with their appearance, diet excessively, and believe themselves
to be fat even when they are quite obviously not fat. But individuals with bulimia are
typically a little older than individuals with anorexia at the onset of the disorder—
early 20s rather than early puberty. Individuals with bulimia often maintain a normal
weight, making the disorder difficult to detect. The most obvious difference between
the two conditions is that the individual with bulimia will eat, and eat to excess, bing-
ing on huge amounts of food—an average of 3,500 calories in a single binge and as
much as 50,000 calories in one day (Humphries, 1987; Mitchell et al., 1981; Oster, 1987).
A typical binge may include a gallon of ice cream, a package of cookies, and a gallon of
milk—all consumed as quickly as possible.

But wait a minute—if individuals with bulimia are so concerned

about gaining weight, why do they binge at all?

The binge itself may be prompted by an anxious or depressed mood, social stress-
ors, feelings about body weight or image, or intense hunger after attempts to diet. The
binge continues due to a lack of or impairment in self-control once the binge begins.
This young model is not merely thin; The individual is unable to control when to stop eating or how much to eat. Eating one
by medical standards, she is probably cookie while trying to control weight can lead to a binge—after all, since the diet is com-
at a weight that would allow her to be pletely blown, why not go all out? This kind of thought process is another example of the
labeled as having anorexia. The “thin
cognitive distortion of all-or-nothing thinking.
is in” mentality that dominates the field
of fashion design models is a major
One might think that bulimia is not as damaging to the health as anorexia. After
contributor to the Western cultural all, the individual with bulimia is in no danger of starving to death. But bulimia comes
concept of very thin women as beautiful with many serious health consequences: severe tooth decay and erosion of the lining of
and desirable. The model pictured here the esophagus from the acidity of the vomiting, enlarged salivary glands, potassium,
is a far cry from the days of sex symbol ­calcium, and sodium imbalances that can be very dangerous, damage to the intestinal
Marilyn Monroe, who was rumored to be
tract from overuse of laxatives, heart problems, fatigue, and seizures (Berg, 1999).
a size 12.
Binge-Eating Disorder Binge-eating disorder also involves uncontrolled binge eat-
ing but differs from bulimia primarily in that individuals with binge-eating disorder
do not purge or use other inappropriate methods for avoiding weight gain (American
­Psychiatric Association, 2013).
Causes of Eating Disorders The causes of anorexia, bulimia, and binge-eating
disorder are not yet fully understood, but the greatest risk factor appears to be someone
being an adolescent or young adult female (Keel & Forney, 2013). Increased sensitivity
to food and its reward value may play a role in bulimia and binge-eating disorder,
while fear and anxiety may become associated with food in anorexia nervosa, with
altered activity or functioning of associated brain structures in each (­Friedrich et al.,
2013; Kaye et al., 2009; Kaye et al., 2013). Research continues to investigate genetic
components for eating disorders, as they account for 40 to 60 percent of the risk for
anorexia, bulimia, and binge-eating disorder, and although several genes have been
implicated, the exact ones to focus on have not yet been identified (Trace et al., 2013;
Wade et al., 2013).
binge-eating disorder Although many researchers have believed eating disorders, especially anorexia,
are cultural syndromes that only show up in cultures obsessed with being thin (as
a condition in which a person ­overeats,
or binges, on enormous amounts
many Western cultures are), eating disorders are also found in non-Western cultures
of food at one sitting, but unlike (Miller & Pumariega, 1999). What differs between Western and non-Western cultures is
­bulimia nervosa, the ­individual does the rate at which such disorders appear. For example, Chinese and Chinese American
not then purge or use other unhealthy women are far less likely to suffer from eating disorders than are non-Hispanic white
methods to avoid weight gain. women (Pan, 2000). Why wouldn’t Chinese American women be more likely to have
Psychological Disorders   609

eating disorders after being exposed to the Western cultural obsession with thinness?
Pan (2000) assumes that whatever Chinese cultural factors “protect” Chinese women
from developing eating disorders may also still have a powerful influence on Chinese
American women.
One problem with studying anorexia and bulimia in other cultures is that the
behavior of starving oneself may be seen in other cultures as having an entirely differ-
ent purpose than in Western cultures. One key component of anorexia, for example, is a
fear of being fat, a fear that is missing in many other cultures. Yet women in those cul-
tures have starved themselves for other socially recognized reasons: religious fasting or
unusual ideas about nutrition (Castillo, 1997).
Anorexia and bulimia have also been thought to occur only rarely in African
­American women, but that characterization seems to be changing. Researchers are seeing
an increase in anorexia and bulimia among young African American women of all socio-
economic levels (Crago et al., 1996; Mintz & Betz, 1988; Pumariega & Gustavson, 1994).
Eating disorders are present in males, and as compared to females, adolescent males may
be more likely to be diagnosed with anorexia than with bulimia. They may also be more
likely to have had a previous diagnosis of ADHD (Welch et al., 2015). There is also a high
rate of eating disorders among transgender individuals (Diemer et al., 2015; Haas et al.,
2014). If clinicians and doctors are not aware that these disorders can affect more than
the typical white, young, middle-class to upper-middle-class woman, important signs
and symptoms of eating disorders in non-white or non-Western people may allow these
disorders to go untreated until it is too late.

Thinking Critically

How might the proliferation of various media and the Internet affect the development of eating
disorders in cultures not previously impacted by them?

Treatment of Eating Disorders What can be done to treat eating disorders?

If the weight loss due to anorexia is severe (40 percent or more below expected nor-
mal weight), dehydration, severe chemical imbalances, and possibly organ damage
may result. Hospitalization should occur before this dangerous point is reached.
In the ­h ospital the individual ’s physical needs will be treated, even to the point
of force-feeding in extreme cases. Psychological counseling will also be part of the
hospital treatment, which may last from 2 to 4 months. Those individuals with
anorexia who are not so severely malnourished as to be in immediate danger can
be treated outside of the hospital setting. Psychological treatment strategies might
include supportive clinical management, interpersonal therapy, cognitive-behavioral
therapy, group therapy, or family-based therapy (Hay, 2013). to Learning
Objective 15.6. The prognosis for full recovery is not as hopeful as it should be; only
40 to 60 percent of all individuals with anorexia who receive treatment will make
a recovery. For some individuals with anorexia who do gain weight, the damage
already done to the heart and other body systems may still be so great that an early
death is a possibility (Neumarker, 1997). Overall, the estimated mortality rate in
anorexia is highest among all of the eating disorders and much higher than any other
psychological disorder (Arcelus et al., 2011).
Treatment of bulimia can involve many of the same measures taken to treat anorexia.
In addition, the use of antidepressant medications can be helpful, especially those that
affect serotonin levels such as the SSRIs (Mitchell et al., 2013). The prognosis for recov-
ery of the individual with bulimia is somewhat more hopeful than that of anorexia. Ther-
apist-led cognitive-behavioral therapy is the best empirically supported therapy, and
610  Chapter 14

there is developing evidence for some guided self-help approaches (Hay, 2013). A cogni-
tive therapist is very direct, forcing clients to see how their beliefs do not stand up when
considered in “the light of day” and helping them form new, more constructive ways of
thinking about themselves and their behavior. to Learning Objective 15.5. Treat-
ment of binge-eating disorder may use some of the same strategies used for anorexia and
bulimia, with the added issue of weight loss management in those with obesity.

Sexual Dysfunctions and Problems

14.12 Describe types of sexual dysfunction and explain how they may
develop.
A sexual dysfunction is a problem with sexual functioning, or with the actual physical
workings of the sex act. Sexual dysfunctions involve problems in three possible areas
of sexual activity: sexual interest, arousal, and response.

How common are problems like these—aren’t they pretty rare?

Results of surveys from around the globe suggest that about 40 to 45 percent of
women and 20 to 30 percent of men have at least one sexual dysfunction, and the rate
increases as we age (Lewis et al., 2010). In fact, the figures may actually be higher than
those reported. As stated in Chapter One, one of the hazards of doing survey research is
that people don’t always tell the truth ( to Learning Objective 1.6). If a person is
going to lie about sexual problems, the most likely lie (or distorted truth) would probably
be to deny or minimize such problems.
There are a variety of physical sexual dysfunctions included in the DSM-5. ­Sexual
desire or arousal disorders include female sexual interest/arousal disorder and male hypo-
active sexual desire disorder. Disorders related to the physical act of intercourse include
erectile disorder and genito-pelvic pain/penetration disorder. And last, disorders related to
the timing or inability to reach orgasm include premature (early) ejaculation, female orgas-
mic disorder, and delayed ejaculation (American Psychiatric ­Association, 2013). Watch the
video Sexual Problems and Dysfunction for more ­information on some of these disorders.

CC
sexual dysfunction
a problem in sexual functioning. Watch the Video Sexual Problems and Dysfunction on MyPsychLab
Psychological Disorders   611

Some sexual dysfunctions stem from physical sources, known organic factors. Others
can be caused by purely sociocultural factors, or psychological factors. However, body and
mind influence each other’s functioning, and these categories are not mutually exclusive
(Lewis et al., 2010).
Organic factors include physical problems such as illnesses, side effects from med-
ication, the effects of surgeries, physical disabilities, and even the use of illegal and legal
drugs, such as cocaine, alcohol, and nicotine. Chronic illnesses such as diabetes, cancer,
or strokes also belong in this category of factors.
Sociocultural influences on sexual attitudes and behavior also exist and may be a
source of psychological stress leading to sexual dysfunction. In the United States and
some other Western cultures, people may have experienced instruction from their par-
ents (both direct and indirect teaching) that actually influenced them to form negative
attitudes toward sex and sexual activities, such as masturbation.
Psychological stressors also include individual psychological problems, such as low
self-esteem, anxiety over performance of the sex act, depression, self-consciousness about
one’s body image, anxiety disorders, or a history of previous sexual abuse or assault.
Another source of psychological stress leading to sexual dysfunctions is the relationship
between the two sexual partners. The sexual dysfunction may be only an outward symp-
tom of an underlying problem with the relationship.
For all of the sexual dysfunctions, treatment can include medication, psychother-
apy, hormone therapy, stress reduction, sex therapy, and behavioral training. Still com-
monly used today, Masters and Johnson (1970) recommended a technique called sensate
focus for treatment of premature ejaculation, in which each member of a couple engages
in a series of exercises meant to focus attention on his or her own sensual experiences
during various stages of sexual arousal and activity. Male erectile disorder is now com- There are a variety of drugs aimed at
monly treated with drug therapy (Kukula et al., 2014). treating male erectile disorder.

Concept Map L.O. 14.11, 14.12

anorexia nervosa is disordered eating that

eating disorders results in significantly low body weight typically female, obsessed
bulimia nervosa involves cycles of binging and use of with appearance, diet
unhealthy methods to avoid weight gain; unlike anorexia, excessively, and have
those with bulimia will tend to maintain a normal body weight distorted body images;
biological, psychological,
binge-eating disorder involves binge-eating similar to bulimia and cultural factors are likely
but individuals do not purge afterwards; weight gain and
related issues may result

prevalence rates across various cultures

Eating Disorders and Sexual Dysfunction

sexual dysfunctions are problems with sexual functioning

or physical aspects of the sex act
sexual dysfunctions
causes may be organic (i.e., physical sources or disorders)
or psychogenic (i.e., worry and anxiety)
612  Chapter 14

Practice Quiz How much do you remember?

Pick the best answer.
1. Olivia is a teenager who has been diagnosed with anorexia nervosa. 3. Researchers believe that 40 to 60 percent of the risk for anorexia,
What percentage of individuals with anorexia that receive treatment bulimia, and binge-eating disorder is due to
make a recovery? a. genetic factors. c. environmental factors.
a. 40 to 60 percent c. 80 to 90 percent b. hormonal factors. d. psychological factors.
b. 70 to 80 percent d. approximately 95 percent 4. What is a major cause of sexual dysfunction?
2. Which of the following characteristics best describes differences a. stress c. heredity
between bulimia nervosa and anorexia nervosa? b. paraphilias d. economic status
a. Individuals with anorexia do not have as severe health risks as 5. Surveys suggest that about _________ percent of women
individuals with bulimia have. and _________ percent of men have at least one sexual
b. Individuals with bulimia may have a normal body weight, dysfunction.
whereas those with anorexia tend to be severely under their a. 10; 25
expected body weight. b. 40 to 45; 20 to 30
c. Individuals with anorexia have been known to binge like those c. 80; 50
with bulimia on occasion. d. 10 to 20; 30 to 40
d. Anorexia tends to occur in early adulthood, while bulimia often
starts in early adolescence.

Schizophrenia: Altered Reality

Once known as dementia praecox, a Latin-based term meaning “out of one’s mind before
one’s time,” schizophrenia was renamed by Eugen Bleuler, a Swiss psychiatrist, to bet-
ter illustrate the division (schizo-) within the brain (phren) among thoughts, feelings, and
behavior that seems to take place in people with this disorder (Bleuler, 1911; Möller &
Hell, 2002). Because the term literally means “split mind,” it has often been confused
with dissociative identity disorder, which was at one time called “split personality.”

Symptoms of Schizophrenia
14.13 Distinguish between the positive and negative symptoms
of ­schizophrenia.
Today, schizophrenia is described as a long-lasting psychotic disorder (involving a
severe break with reality), in which there is an inability to distinguish what is real from
fantasy as well as disturbances in thinking, emotions, behavior, and perception. The dis-
order typically arises in the late teens or early 20s, affects both males and females, and is
consistent across cultures.
schizophrenia Schizophrenia includes several different kinds of symptoms. Disorders in thinking
severe disorder in which the person are a common symptom and are called delusions. Although delusions are not prominent
suffers from disordered thinking,
in everyone with schizophrenia, they are the symptom that most people associate with
bizarre behavior, hallucinations,
this disorder. Delusions are false beliefs about the world that the person holds and that
and inability to distinguish between
tend to remain fixed and unshakable even in the face of evidence that disproves the delu-
­fantasy and reality.
sions. Common schizophrenic delusions include delusions of persecution, in which people
psychotic believe that others are trying to hurt them in some way; delusions of reference, in which peo-
refers to an individual’s inability to
ple believe that other people, television characters, and even books are specifically talking
separate what is real and what is to them; delusions of influence, in which people believe that they are being controlled by
fantasy. external forces, such as the devil, aliens, or cosmic forces; and delusions of grandeur (or
grandiose delusions), in which people are convinced that they are powerful people who can
delusions save the world or have a special mission (American Psychiatric Association, 2013).
false beliefs held by a person who Delusional thinking alone is not enough to merit a diagnosis of schizophrenia, as
refuses to accept evidence of their other symptoms must be present (American Psychiatric Association, 2013). Speech dis-
falseness. turbances are common: People with schizophrenia will make up words, repeat words or
Psychological Disorders   613

sentences persistently, string words together on the basis of sounds (called ­clanging,
such as “come into house, louse, mouse, mouse and cheese, please, sneeze”), and
experience sudden interruptions in speech or thought. Thoughts are significantly
disturbed as well, with individuals with schizophrenia having a hard time link-
ing their thoughts together in a logical fashion, and in advanced ­schizophrenia,
they may express themselves in a meaningless and jumbled mixture of words and
phrases sometimes referred to as a word salad. Attention is also a problem for many
people with schizophrenia. They seem to have trouble “screening out” information
and stimulation that they don’t really need, causing them to be unable to focus on
information that is relevant (Asarnow et al., 1991; Luck & Gold, 2008).
People with schizophrenia may also have hallucinations, in which they hear
voices or see things or people that are not really there. Hearing voices is actually Dr. John Nash is a famous mathematician who won
more common and one of the key symptoms in making a diagnosis of ­schizophrenia the Nobel Prize for mathematics in 1994. His fame,
(Kuhn & Nasar, 2001; Nasar, 1998). Hallucinations involving touch, smell, and taste however, is more due to the fact that Nash once
are less common but also possible. Emotional disturbances are also a key feature of suffered from a form of schizophrenia in which he
experienced delusions of persecution. He at one time
schizophrenia. Flat affect is a condition in which the person shows little or no emotion.
believed that aliens were trying to contact him through
Emotions can also be excessive and/or inappropriate—a person might laugh when it the newspaper (delusions of reference). His life story
would be more appropriate to cry or show sorrow, for example. The person’s behavior and remarkable recovery from schizophrenia are
may also become disorganized and extremely odd. The person may not respond to the portrayed in the 2001 movie A Beautiful Mind, which
outside world and either doesn’t move at all, maintaining often odd-looking postures starred Russell Crowe as Nash.
for hours on end, or moves about wildly in great agitation. Both extremes, either wildly
excessive movement or total lack thereof, are referred to as catatonia.
Another way of describing symptoms in schizophrenia is to group them by the way
they relate to normal functioning. Positive symptoms appear to reflect an excess or distortion
of normal functions, such as hallucinations and delusions. Negative ­symptoms appear to
reflect a decrease of normal functions, such as poor attention or lack of affect (American Psy-
chiatric Association, 2013). According to the American ­Psychiatric ­Association (2013), at least
two or more of the following symptoms must be present frequently for at least 1 month to
diagnose schizophrenia: delusions, hallucinations, disorganized speech, negative symptoms, hallucinations
and grossly disorganized or catatonic behavior, and at least one of the two symptoms has to false sensory perceptions, such as
hearing voices that do not really exist.
be delusions, hallucinations, or disorganized speech. The video Positive and Negative Symp-
toms of Schizophrenia summarizes the key positive and negative symptoms of the disorder.
flat affect
a lack of emotional responsiveness.

catatonia
disturbed behavior ranging from
­statue-like immobility to bursts
of energetic, frantic movement, and
talking.

positive symptoms
symptoms of schizophrenia that
are excesses of behavior or occur
in addition to normal behavior;
­hallucinations, delusions, and
­distorted thinking.

negative symptoms
symptoms of schizophrenia that
are less than normal behavior or an
CC absence of normal behavior; poor
attention, flat affect, and poor speech
Watch the Video Positive and Negative Symptoms of Schizophrenia on MyPsychLab production.
614  Chapter 14

Causes of Schizophrenia
14.14 Evaluate the biological and environmental influences on schizophrenia.
When trying to explain the cause or causes of schizophrenia, biological models and theories
prevail, as it appears to be most likely caused by a combination of genetic and environmental
factors. This is captured by the neurodevelopmental model, or neurodevelopmental hypothesis,
of schizophrenia (Rapoport et al., 2005; Rapoport et al., 2012). Biological explanations of schizo-
phrenia have generated a significant amount of research pointing to genetic origins, prenatal
influences such as the mother experiencing viral infections during pregnancy, inflammation in
the brain, chemical influences (dopamine, GABA, glutamate, and other neurotransmitters), and
brain structural defects (frontal lobe defects, deterioration of neurons, and reduction in white
matter integrity) as the causes of schizophrenia (Brown & Derkits, 2010; Cardno & Gottesman,
2000; Gottesman & Shields, 1982; Harrison, 1999; Kety et al., 1994; Nestor et al., 2008; Rijsdijk
et al., 2011; Söderlund et al., 2009). Dopamine was first suspected when amphetamine users
began to show schizophrenia-like psychotic symptoms. One of the side effects of amphetamine
usage is to increase the release of dopamine in the brain. Drugs used to treat schizophrenia
decrease the activity of dopamine in areas of the brain responsible for some of the positive
symptoms. However, it is not that simple. The prefrontal cortex (an area of the brain involved
Schizophrenia and depression have been in planning and organization of information) of people with schizophrenia has been shown to
suggested as possible diagnoses that
produce lower levels of dopamine than normal (Harrison, 1999), resulting in attention deficits
may have been applicable for Mary Todd
(Luck & Gold, 2008) and poor organization of thought, negative symptoms of the disorder.
Lincoln, the wife and widow of President
Abraham Lincoln. However, she reportedly Further support for a biological explanation of schizophrenia comes from studies
experienced a variety of medical conditions of the incidence of the disorder across different cultures. If schizophrenia were caused
that could also explain aspects of her mainly by environmental factors, the expectation would be that rates of ­schizophrenia
eccentric behavior, personality, and mood would vary widely from culture to culture. There is some variation for immigrants
changes.
and children of immigrants, but about 7 to 8 individuals out of 1,000 will develop
­schizophrenia in their lifetime, regardless of the culture (Saha et al., 2005).
Family, twin, and adoption studies have provided strong evidence that genes are a
major means of transmitting schizophrenia. The highest risk for developing ­schizophrenia
if one has a blood relative with the disorder is faced by monozygotic (identical) twins, who
share 100 percent of their genetic material, with a risk factor of about 50 ­percent (Cardno &
Gottesman, 2000; Gottesman & Shields, 1976, 1982; ­Gottesman et al., 1987). Dizygotic twins,
who share about 50 percent of their genetic material, have about a 17 percent risk, the same
as a child with one parent with schizophrenia. As genetic relatedness decreases, so does the
risk (see Figure 14.3). Twin studies are not perfect tools, however; identical twins share the
same womb but are not necessarily exposed to the same exact prenatal or postnatal environ-
ments, causing some to urge caution in interpreting the 50 percent figure; and even twins
reared apart are often raised in similar childhood environments (Davis et al., 1995).
Adoption studies also support the genetic basis of schizophrenia (Sullivan, 2005;
Tienari et al., 2004). In one study, the biological and adoptive relatives of adoptees
with schizophrenia were compared to a control group of adoptees without schizophre-
nia but from similar backgrounds and conditions (Kety et al., 1994). The adoptees with
­schizophrenia had relatives with schizophrenia but only among their biological relatives.
When the prevalence of schizophrenia was compared between the biological relatives of
the adoptees with schizophrenia and the biological relatives of the control group, the rate
of the disorder in the relatives of the group with schizophrenia was 10 times higher than in
the control group (Kety et al., 1994). It appears the strongest genetic risk may be associated
with a gene that plays a role in synaptic pruning during development. In individuals with
schizophrenia that have this gene, this process appears to go awry during adolescence,
leading to the removal of too many connections between neurons (Sekar et al., 2016).

There’s something I don’t understand. If one identical twin has

the gene and the disorder, shouldn’t the other one always have it,
too? Why is the rate only 50 percent?
Psychological Disorders   615

General population (1%)

Spouses of patients (2%)
First cousins (2%)
Uncles/aunts (2%)
Nephews/nieces (4%)
Grandchildren (5%)
Half-siblings (6%)
Parents (6%)
Siblings (9%)
Children (12%)
Siblings with
schizophrenic parent (17%)
Dizygotic twins (17%)
Offspring of two
schizophrenic parents (46%)
Monozygotic twins (48%)

Figure 14.3 Genetics and Schizophrenia

This chart shows a definite pattern: The greater the degree of genetic relatedness, the higher the risk of stress-vulnerability model
schizophrenia in individuals related to each other. The only individual to carry a risk even close to that of
explanation of disorder that assumes a
identical twins (who share 100 percent of their genes) is a person who is the child of two parents with
schizophrenia. biological sensitivity, or vulnerability,
to a certain disorder will result in the
Based on Gottesman (1991).
development of that disorder under
the right conditions of environmental
or emotional stress.
If schizophrenia were entirely controlled by genes, identical twins would indeed
both have the disorder at a risk of 100 percent, not merely 50 percent. Obviously,
there is some influence of environment on the development of schizophrenia.
One model that has been proposed is the stress-vulnerability model, which
assumes that persons with the genetic “markers” for schizophrenia have a phys-
ical vulnerability to the disorder but will not develop schizophrenia unless they
are exposed to environmental or emotional stress at critical times in develop-
ment, such as puberty (Harrison, 1999; Weinberger, 1987). That would explain
why only one twin out of a pair might develop the disorder when both carry
the genetic markers for schizophrenia—the life stresses for the affected twin
were different from those of the one who remained healthy. The immune sys-
tem is activated during stress, and one recent study has found that in recent-on-
set schizophrenia (the early stages of the disorder), the brain’s immune system
secretes high levels of an inflammation-fighting substance, indicating a possible
infection (Söderlund et al., 2009). This leads to the possibility that schizophrenia
might one day be treatable with anti-­inflammatory medications.
Both structural and functional neuroimaging have provided information
about how schizophrenia affects the brain, or how the brain operates in an indi- Nestor et al. (2008) used diffusion tensor imaging to
investigate schizophrenia. Two of the brain areas examined
vidual with schizophrenia. In one study, researchers using diffusion tensor imag-
were the cingulum bundle (CB, consisting of fibers
ing (DTI), to Learning Objective 2.9, in addition to other neurological underlying the cingulate gyrus linking parts of the limbic
testing, found that, when compared to healthy control participants, participants system) and the uncinate fasciculus (UF, neural fibers
with schizophrenia showed structural differences in two particular areas of the linking the frontal lobe to the temporal lobe). The cingulum
brain (Nestor et al., 2008). Specifically, a white matter tract called the cingulum bundle is depicted in the image above. For individuals with
schizophrenia, both the CB and UF fiber pathways were
bundle (CB) that lies under the cingulate gyrus and links part of the limbic sys-
found to have neurons with significantly less myelin, making
tem, and another that links the frontal lobe to the temporal lobe, were found them less efficient in information transfer and resulting in
to have significantly less myelin coating on the axons of the neurons within decreased memory and decision-making ability. Image
the bundle. This makes these areas of the brain less efficient in sending neural courtesy of Dr. Paul Nestor.
616  Chapter 14

messages to other cells, resulting in decreased memory and decision-making ability. Exam-
ination of differences in functional connectivity between brain areas is providing new
information about schizophrenia and its symptoms (Schilbach et al., 2016; Shaffer et al.,
2015). Measuring cortical thickness and tracking changes in the volume of gray matter and
white matter is also providing valuable information about the abnormal patterns of brain
development in schizophrenia and other disorders (Gogtay et al., 2008; Gogtay & Thomp-
son, 2010; Goldman et al., 2009; Goodkind et al., 2015).

Concept Map L.O. 14.13, 14.14

delusions: false beliefs about the world (e.g., delusions of

persecution, delusions of grandeur, delusions of reference)
primary symptoms are
disturbed or disorganized thoughts: often lacking structure
(in excess or in addition to or relevance, most often displayed through disorganized speech
normal functions) or negative hallucinations: can occur in any sensory modality
(absence or decrease but auditory hallucinations are most common
in normal functions)
changes in mood:
little or no emotion)
disorganized or odd behavior: ranging from periods of
immobility to odd gesturing or facial grimaces; wildly excessive
movement or total lack thereof is called catatonia
Schizophrenia
(a psychotic disorder positive symptoms appear to be associated with overactivity of dopamine areas
involving a break of brain; negative with lower dopamine activity; related to dopamine hypothesis
with reality and causes
genetics and brain structural defects have been implicated
disturbances in thinking,
emotions, behavior, biological roots supported by universal lifetime prevalence
and perceptions) across cultures of approximately 7–8 people out of 1,000;
genetics supported by twin and adoption studies
stress-vulnerability model: suggests people with genetic markers
for schizophrenia will not develop the disorder unless they are exposed
to environmental or emotional stress at critical times in development

Practice Quiz How much do you remember?

Pick the best answer.
1. David believes that characters in a popular science fiction show ­ ancer for many months, died that morning. Charles has no appre-
c
are secretly sending him messages. This would be an example of a ciable facial reaction, and in a very monotone voice says, “okay.”
delusion of The nurse is not surprised by Charles’s lack of response to the
a. persecution. c. influence. awful news, because she knows that _________ is one ­symptom
b. reference. d. grandeur. often seen in those suffering from schizophrenia.
a. clang associations c. flat affect
2. Dr. Haldol has several patients with schizophrenia who appear to b. echolalia d. perseveration
exhibit excessive or distorted characteristics in relation to what
one might consider normal functioning. Specific symptoms include 4. Neuroimaging studies examining potential causes of s­ chizophrenia
­varied hallucinations and multiple delusions. According to the have discovered that an area of the brain called the ________
DSM-5, these are referred to as appears to have significantly less myelin coating on the axons of its
a. flat affect. c. negative symptoms. neurons in people with schizophrenia compared to those without
b. positive symptoms. d. catatonia. the condition.
a. cingulum bundle
3. Charles has suffered from schizophrenia for many years and now b. striate nuclei
resides in a group treatment facility. One day a nurse approaches c. putamen
him and quietly tells him that his sister, who has been fighting d. lateral geniculate nucleus of the thalamus
Psychological Disorders   617

Personality Disorders: I’m Okay, It’s

Everyone Else Who’s Weird
Personality disorders are a little different from other psychological disorders in that the dis-
order does not affect merely one aspect of the person’s life, such as a higher-than-­normal
level of anxiety or a set of distorted beliefs, but instead affects the entire life adjustment
of the person. The disorder is the personality itself, not one aspect of it. However, despite
personality disorders affecting the entire person, current research suggests they are not
always life-long in nature as once believed.

Categories of Personality Disorders

14.15 Classify different types of personality disorders.
In personality disorder, a person has an excessively rigid, maladaptive pattern
of behavior and ways of relating to others (American Psychiatric Association,
2013). This rigidity and the inability to adapt to social demands and life changes
make it very difficult for the individual with a personality disorder to fit in with
others or have relatively normal social relationships. The DSM-5 lists 10 primary
types of personality disorder across three basic categories (American Psychiatric
Association, 2013): those in which the people are seen as odd or eccentric by oth-
ers (­P aranoid, Schizoid, Schizotypal), those in which the behavior of the person is
very dramatic, emotional, or erratic (Antisocial, Borderline, Histrionic, Narcissistic),
and those in which the main emotion is anxiety or fearfulness (Avoidant, Depen-
dent, ­Obsessive-Compulsive). These categories are labeled Cluster A, Cluster B, and
­Cluster C, respectively.

Antisocial Personality Disorder One of the most well researched of the per-
sonality disorders is antisocial personality disorder (ASPD). People with ASPD
are literally “against society.” The antisocial person may habitually break the law, personality disorders
disobey rules, tell lies, and use other people without worrying about their rights or disorders in which a person adopts
feelings. The person with ASPD may be irritable or aggressive. These individuals a persistent, rigid, and maladaptive
may not keep promises or other obligations and are consistently irresponsible. They ­pattern of behavior that interferes
may also seem indifferent or able to rationalize taking advantage of or hurting oth- with normal social interactions.
ers. ­Typically they borrow money or belongings and don’t bother to repay the debt
or return the items, they are impulsive, they don’t keep their commitments either antisocial personality disorder
(ASPD)
socially or in their jobs, and they tend to be very selfish, self-centered, and manipula-
tive. There is a definite gender difference in ASPD, with many more males diagnosed disorder in which a person uses other
people without worrying about their
with this disorder than females (American Psychiatric Association, 2013).
rights or feelings and often behaves
Borderline Personality Disorder People with borderline personality in an impulsive or reckless manner
­disorder (BLPD) have relationships with other people that are intense and relatively without regard for the consequences
of that behavior.
unstable. They are impulsive, have an unstable sense of self, and are intensely fearful
of abandonment. Life goals, career choices, friendships, and even sexual behavior
borderline personality disorder
may change quickly and dramatically. Close personal and romantic relationships are
(BLPD)
marked by extreme swings from idealization to demonization. Periods of depression
maladaptive personality pattern in
are not unusual, and some may engage in excessive spending, drug abuse, or s­ uicidal
which the person is moody, unstable,
behavior (suicide attempts may be part of the manipulation used against others in lacks a clear sense of identity, and
a relationship). Emotions are often inappropriate and excessive, with a pattern of often clings to others with a p
­ attern
self-­d estructiveness, chronic loneliness, and disruptive anger in close relationships of self-destructiveness, chronic
(­American ­Psychiatric Association, 2013). The frequency of this disorder in women is ­loneliness, and disruptive anger in
nearly three times greater than in men (American Psychiatric Association, 2013). close relationships.
618  Chapter 14

Causes of Personality Disorders

14.16 Identify potential causes of personality disorders.
Cognitive-behavioral theorists talk about how specific behavior can be learned over time
through the processes of reinforcement, shaping, and modeling. More cognitive explana-
tions involve the belief systems formed by the personality disordered persons, such as
the paranoia, extreme self-importance, and fear of being unable to cope by oneself of the
paranoid, narcissistic, and dependent personalities, for example.
There is some evidence of genetic factors in personality disorders (Reichborn-­
Kjennerud, 2008). Close biological relatives of people with disorders such as antisocial,
schizotypal, and borderline are more likely to have these disorders than those who are
not related (American Psychiatric Association, 2013; Kendler et al., 2006; Reichborn-­
Kjennerud et al., 2007; Torgersen et al., 2008). Adoption studies of children whose biolog-
ical parents had antisocial personality disorder show an increased risk for that disorder
in those children, even though raised in a different environment by different people
(­American Psychiatric Association, 2013). A longitudinal study has linked the temper-
aments of children at age 3 to antisocial tendencies in adulthood, finding that those
children with lower fearfulness and inhibitions were more likely to show antisocial per-
sonality characteristics in a follow-up study at age 28 (Glenn et al., 2007).
Other causes of personality disorders have been suggested. Antisocial person-
alities are emotionally unresponsive to stressful or threatening situations when com-
pared to others, which may be one reason that they are not afraid of getting caught
(Arnett et al., 1997; Blair et al., 1995; Lykken, 1995). This unresponsiveness seems to
be linked to lower than normal levels of stress hormones in antisocial persons (Fair-
child et al., 2008; Lykken, 1995).
Disturbances in family relationships and communication have also been linked
to personality disorders and, in particular, to antisocial personality disorder (Benjamin,
1996; Livesley, 1995). Childhood abuse, neglect, overly strict parenting, overprotective
parenting, and parental rejection have all been put forth as possible causes, making the
picture of the development of personality disorders a complicated one. It is safe to say
that many of the same factors (genetics, social relationships, and parenting) that help
create ordinary personalities also create disordered personalities.

Concept Map L.O. 14.15, 14.16

Cluster A: odd or eccentric thinking antisocial personality disorder: minimal to no

and behavior regard for value of others’ rights or feelings;
more common in men
Personality Disorders Cluster B: very dramatic, emotional, or
erratic thinking and behavior
(involve excessively rigid and borderline personality disorder: relationships with
maladaptive patterns of behavior and Cluster C: predominantly anxious or others that are intense and unstable; often moody,
ways of relating to others) fearful thinking and behavior manipulative, and untrusting of others;
more common in women
cognitive-behavioral: specific behaviors
learned over time, associated with
causes maladaptive beliefs
genetic factors play a role, with many showing
increased rates of heritability
variances in stress tolerance and disturbances
in family relationships and communication
have also been linked to personality disorders
Psychological Disorders   619

Practice Quiz How much do you remember?

Pick the best answer.
1. Which of the following is not an accurate portrayal of antisocial 3. One suggested physiological cause of antisocial personality disorder
­personality disorder? is that people with this condition have:
a. Most people with this disorder are female. a. lack of appropriate short-term memory related to ethical and
b. Most people with this disorder are male. moral rules, caused by deficient function in the hippocampus.
c. People with this disorder suffer little or no guilt for their criminal b. lower-than-normal levels of stress hormones.
acts. c. increased synaptic pruning in the prefrontal cortex.
d. People with this disorder are consistently irresponsible and don’t d. heightened sensitivity to external stimuli in the amygdala
keep commitments. 4. Due to the types and degree of emotions often experienced
2. Studies show that _________ personality disorders occur more by ­people with borderline personality disorder, their personal
­frequently in women while ___________ personality disorders ­relationships are often characterized by __________.
­happen more often in men. a. periods of domestic bliss
a. antisocial; borderline b. long-term stability
b. borderline; schizotypal c. intense emotions, impulsivity, and relative instability
c. schizotypal; antisocial d. long periods of boredom
d. borderline; antisocial

APA Goal 2: Scientific Inquiry and

Critical Thinking
Learning More: Psychological Disorders
Addresses APA Learning Objective 2.2: Demonstrate psychology
information literacy.
We have covered several areas of research that have prompted various levels of contro-
versy, and for various reasons. You have read about the possible comorbidity of ADHD and
bipolar disorders in children. You have also read about genetics research in psychological
disorders. How might this knowledge impact your personal behavior or thinking about the
disorders themselves or the people they affect? While these topics can certainly raise mul-
tiple ethical questions, consider each of them from a psychological information and literacy
perspective.
What information would you want to know as the parent of a child with ADHD or ­bipolar
disorder? If you are the spouse or partner of someone with a psychological ­disorder, how
might the knowledge of genetic contributions impact decisions to have c ­ hildren, or what
might you want to be mindful of in the children you already have?
Several research studies have been cited and summarized in this chapter. If you
wanted to look beyond your text, what sources of information would be most useful to you
in trying to learn more about a possible disorder or the contribution of genetics? Where
would you find or obtain those sources? What would you look for in each? What are some
characteristics of objective data, as opposed to personal reports? Do you know how to
interpret a graph or chart? How do you determine if the information is relevant? Can it be
generalized to your current situation?
620  Chapter 14

Thinking Critically

After reviewing the questions raised in the last paragraph above, identify at least two
information sources you would pursue and what data would you want to get from them.

Applying Psychology to Everyday Life

Taking the Worry Out of Exams
14.17 Identify some ways to overcome test anxiety.
Imagine this scenario: You sit down to take your midterm exam, feeling that you are pre-
pared and ready. Once you get the test in front of you, well, maybe you start to feel just a
bit more nervous, your hands get sweaty, your stomach may ache; and when you look at
the first question—your mind becomes a complete blank!
These are a few of the common symptoms of test anxiety, the personal experience
of possible negative consequences or poor outcomes on an exam or evaluation, accom-
panied by a cluster of cognitive, affective, and behavioral symptoms (Zeidner & Matthews,
2005). Cognitive symptoms may consist of worrying excessively about an exam, expect-
ing to do poorly no matter how hard you study, or even finding it hard to start studying
in the first place. Then, while taking the test, you might find you do not understand cer-
tain directions or questions, “go blank” when looking at the items, or feel like you cannot
concentrate on the exam in front of you because your mind keeps wandering. Affective
or emotional symptoms may include body tension and heightened physiological arousal
including sweaty palms, upset stomach, difficulty breathing, and the like, prior to and/or
during the exam. Behavioral aspects may include procrastination, deficient study skills, or
avoiding studying altogether.
While not a clinical disorder, test anxiety has caused countless students considerable
stress and agony over the years. Remember “psychology student’s syndrome”? You may
not really have any of the psychological disorders we’ve discussed in this chapter, but
chances are good that you have experienced test anxiety a time or two. It is often easier to
address milder forms of anxiety before they escalate, and the main intent of this section is
to help you achieve that.
Psychological Disorders   621

So what can you do if you experience test anxiety and want to get your worrying
under control? First, determine why you want to do well on the test in the first place. Do
you really want to demonstrate your understanding of the material, or are you hoping just
to pass? Try to find an internal motivation to do well on the exam rather than simply relying
on extrinsic reasons. Even if you are taking a test in a subject you don’t necessarily enjoy,
try to identify something you want to accomplish, and get your focus off the goal of simply
earning a passing grade.
Second, develop some type of strategy for controlling both your cognitive state
and behavior before and during the exam. Review the study tips we presented in the
­Psychology in Action section of this book. to Learning Objective PIA.5. As
mentioned there, if you are well prepared, you are less likely to worry. Avoid cramming
and take advantage of the additive effects of distributed practice. Refer to that informa-
tion and review suggestions that will help you manage your tasks and your time. Sched-
ule regular study sessions and avoid or limit distractions (email, phone, text messages,
television, noisy roommates, and the like may seem to provide welcome escapes from
studying, but they will only keep you from your intended goal). You’ve read the chapter
on memory (or at least you should have!) and now know that spacing out your study and
using meaningful, elaborative rehearsal over multiple study periods is going to yield much
better results than an all-out cramming marathon the night before an exam. to
­Learning ­Objectives 6.5, 6.10 and 6.11.
The way you approach an exam can have a significant impact on the testing expe-
rience and how you manage yourself during that exam (Davis et al., 2008). Instead of
focusing on how nervous you are and how sure you are that you aren’t going to be able to
remember anything, turn that thinking around and recognize how much energy you have
going into the exam (Dundas et al., 2009). Positive self-talk can be very valuable in this kind
of situation (and is a good example of cognitive therapy at work). A recent study demon-
strated that competence-priming (imagining a person who is successful at a related task)
lowered the relationship between test anxiety and test performance (Lang & Lang, 2010).
Additionally, instead of focusing on the whole exam, take control and address one ques-
tion at a time, first answering the questions you know—that will build your confidence and
help you progress through the test. Also control your body; try to stay relaxed and breathe
normally. If you get distracted, consciously redirect yourself back to the next question.
Before you know it, you will have completed the entire exam—whew!

Questions for Further Discussion

1. Have you ever experienced test anxiety? What methods did you use to get your
­worrying under control?
2. What factors, other than the ones listed here, might influence the anxiety one feels
when taking an exam?
622  Chapter 14

Chapter Summary
What Is Abnormality? Disorders of Anxiety, Trauma, and Stress: What,
Me Worry?
14.1 Explain how our definition of abnormal behavior
and thinking has changed over time. 14.4 Identify different types of anxiety disorders and
• Psychopathology is the study of abnormal behavior and psycho- their symptoms.
logical dysfunction. • Anxiety disorders are all disorders in which the most dominant
• In ancient times, holes were cut in an ill person’s head to let out symptom is excessive and unrealistic anxiety.
evil spirits in a process called trephining. Hippocrates believed • Phobias are irrational, persistent fears. Three types of phobias
that mental illness came from an imbalance in the body’s four are social anxiety disorder (social phobia), specific phobias, and
humors, whereas in the early Renaissance period the mentally ill agoraphobia.
were labeled as witches. • Panic disorder is the sudden and recurrent onset of intense panic
• Abnormality can be characterized as thinking or behavior that for no reason, with all the physical symptoms that can occur in
is statistically rare, deviant from social norms, causes subjective sympathetic nervous system arousal.
discomfort, does not allow day-to-day functioning, or causes a • Generalized anxiety disorder is a condition of intense and unre-
person to be dangerous to self or others. alistic anxiety that lasts 6 months or more.
• In the United States, insanity is a legal term, not a psychological
term. 14.5 Describe obsessive-compulsive disorder and
stress-related disorders.
14.2 Identify models used to explain psychological
• Obsessive-compulsive disorder consists of an obsessive, recur-
disorders.
ring thought that creates anxiety and a compulsive, r­ itualistic,
• In biological models of abnormality, the assumption is that men- and repetitive behavior or mental action that reduces that
tal illnesses are caused by chemical or structural malfunctions in anxiety.
the nervous system.
• Significant and traumatic stressors can lead to acute stress dis-
• Psychodynamic theorists assume that abnormal thinking and order or posttraumatic stress disorder. The diagnosis differs
behavior stem from repressed conflicts and urges that are fight- according to duration and onset but includes symptoms of
ing to become conscious. ­anxiety, dissociation, nightmares, and reliving the event.
• Behaviorists see abnormal behavior or thinking as learned.
• Cognitive theorists see abnormal behavior as coming from irra- 14.6 Identify potential causes of anxiety, trauma, and
tional beliefs and illogical patterns of thought. stress disorders.
• The sociocultural perspective conceptualizes all thinking and • Psychodynamic explanations of anxiety and related disorders
behavior as the product of learning and shaping of behavior point to repressed urges and desires that are trying to come into
within the context of family, social group, and culture. consciousness, creating anxiety that is controlled by the abnor-
mal behavior.
• Cultural relativity refers to the need to consider the norms and
customs of another culture when diagnosing a person from that • Behaviorists state that disordered behavior is learned
culture with a disorder. through both operant conditioning and classical conditioning
techniques.
• The biopsychosocial model views abnormal thinking and
behavior as the sum result of biological, psychological, social, • Cognitive psychologists believe that excessive anxiety comes
and cultural influences. from illogical, irrational thought processes.
• Biological explanations of anxiety-related disorders include
14.3 Describe how psychological disorders are chemical imbalances in the nervous system, in particular
diagnosed and classified.
­serotonin and GABA systems.
• The Diagnostic and Statistical Manual of Mental Disorders, Fifth
• Genetic transmission may be responsible for anxiety-related
­Edition (DSM-5) is a manual of psychological disorders and their
­disorders among related persons.
symptoms.
• More than one fifth of all adults over age 18 suffer from a mental
disorder in any given year.
Dissociative Disorders: Altered Identities
• Diagnoses provide a common language for health care provid-
ers, but they may also predispose providers to think about their 14.7 Differentiate among dissociative amnesia,
patients in particular ways. dissociative fugue, and dissociative identity disorder.
• In contrast to categorical approaches to diagnosis, research is • Dissociative disorders involve a break in consciousness,
building related to dimensional assessment of psychopathology ­memory, or both. These disorders include dissociative amnesia,
across brain, behavior, cognitive, and genetic factors. with or without fugue, and dissociative identity disorder.
Psychological Disorders   623

14.8 Summarize explanations for dissociative disorders. Schizophrenia: Altered Reality

• Psychodynamic explanations point to repression of memories,
14.13 Distinguish between the positive and negative
seeing dissociation as a defense mechanism against anxiety.
symptoms of schizophrenia.
• Cognitive and behavioral explanations see dissociative disor-
• Schizophrenia is a split among thoughts, emotions, and behav-
ders as a kind of avoidance learning. Biological explanations
ior. It is a long-lasting psychotic disorder in which reality and
point to lower-than-normal activity levels in the areas of the
fantasy become confused.
brain responsible for body awareness.
• Symptoms of schizophrenia include delusions (false beliefs
about the world), hallucinations, emotional disturbances,
Disorders of Mood: The Effect of Affect attentional difficulties, disturbed speech, and disordered
thinking.
14.9 Describe different disorders of mood, including
major depressive disorder and bipolar disorders. • Positive symptoms are excesses of behavior associated with
increased dopamine activity in some parts of the brain, whereas
• Mood disorders, also called affective disorders, are severe dis-
negative symptoms are deficits in behavior associated with
turbances in emotion.
decreased dopamine activity in other parts of the brain.
• Major depressive disorder has a fairly sudden onset and is
extreme sadness and despair, typically with no obvious external 14.14 Evaluate the biological and environmental
cause. It is the most common of the mood disorders and is more influences on schizophrenia.
common in women than in men. • Biological explanations for schizophrenia focus on dopamine,
• Bipolar disorders are characterized by shifts in mood that may structural defects in the brain, and genetic influences. Rates of
range from normal to manic, with or without episodes of depres- risk of developing schizophrenia increase drastically as genetic
sion (bipolar I disorder) or spans of normal mood interspersed with relatedness increases, with the highest risk faced by an identical
episodes of major depression and hypomania (bipolar II disorder). twin whose twin sibling has schizophrenia.

14.10 Compare and contrast behavioral, social

cognitive, and biological explanations for depression and Personality Disorders: I’m Okay, It’s Everyone Else
other disorders of mood. Who’s Weird
• Learning theories link depression to learned helplessness.
• Cognitive theories see depression as the result of distorted, 14.15 Classify different types of personality disorders.
illogical thinking. • Personality disorders are extremely rigid, maladaptive patterns
• Biological explanations of mood disorders look at the function of of behavior that prevent a person from normal social interac-
serotonin, norepinephrine, and dopamine systems in the brain. tions and relationships.
• Mood disorders are more likely to appear in genetically related • The DSM-5 lists 10 primary types of personality disorders across
people, with higher rates of risk for closer genetic relatives. three broad categories.
• In antisocial personality disorder, a person consistently violates
the rights of others.
Eating Disorders and Sexual Dysfunction
• In borderline personality disorder, a person is clingy, moody,
14.11 Identify the symptoms and risk factors unstable in relationships, and suffers from problems with
associated with anorexia nervosa, bulimia nervosa, and identity.
binge-eating disorder.
14.16 Identify potential causes of personality
• Maladaptive eating problems include anorexia nervosa, bulimia disorders.
nervosa, and binge-eating disorder.
• Cognitive-learning theorists see personality disorders as a set
• Genetics, increased sensitivity to the rewarding value of food, of learned behavior that has become maladaptive—bad hab-
or food-related anxiety, altered brain function, and being female its learned early on in life. Belief systems of the personality-­
contribute to risk of being diagnosed with an eating disorder. disordered person are seen as illogical.
14.12 Describe types of sexual dysfunction and • Biological relatives of people with personality disorders are
explain how they may develop. more likely to develop similar disorders, supporting a genetic
• Sexual dysfunctions are problems with sexual functioning. They basis for such disorders.
may be caused by physical problems, interpersonal or sociocul- • Biological explanations look at the lower-than-normal stress hor-
tural issues, or psychological problems and can affect sexual mones in antisocial personality disordered persons as responsi-
interest, arousal, and response. ble for their low responsiveness to threatening stimuli.
• These dysfunctions include female sexual interest/arousal dis- • Other possible causes of personality disorders may include dis-
order, male hypoactive sexual desire disorder, erectile disorder, turbances in family communications and relationships, child-
genito-pelvic pain/penetration disorder, premature (early) ejac- hood abuse, neglect, overly strict parenting, overprotective
ulation, female orgasmic disorder, and delayed ejaculation. parenting, and parental rejection.
624  Chapter 14

Applying Psychology to Everyday Life: Taking the • Some ways to deal with test anxiety are to find an internal moti-
Worry Out of Exams vation, develop strategies for studying and controlling your
emotional reactions, and focus on the positive rather than the
14.17 Identify some ways to overcome test anxiety. negative.
• Test anxiety is the personal experience of possible negative
­consequences or poor outcomes on an exam or evaluation.

Test Yourself
Pick the best answer.

1. What was the most likely reason that someone would perform an 8. Dr. Kirby has been meeting with 9-year-old Loren, whose family
exorcism? lost everything in a tornado. In her initial visit, Loren was ­diagnosed
a. to relieve fluid pressure on the brain with acute stress disorder. During a 2-month follow-up with
b. to look into the brain to see what was wrong Dr. Kirby, Loren is still exhibiting many of the same symptoms.
c. to release evil spirits What should Dr. Kirby do?
d. to restore balance to the body’s humors a. Dr. Kirby will revise Loren’s diagnosis from ASD to posttraumatic
2. In 1972, a jet carrying a rugby team from Peru crashed high in the stress disorder.
snow-covered Andes Mountains. Many of the players survived b. Dr. Kirby will revise Loren’s diagnosis from ASD to generalized
for more than 2 months by eating the remains of those who died. anxiety disorder.
­Psychologists justified their cannibalism because that was the c. Dr. Kirby will continue treatment for acute stress disorder for at
only way they could have survived so long without food. By what least 6 months.
­definition might their behavior best be classified? d. Dr. Kirby should tell Loren she is cured so as to speed her
a. statistical c. maladaptive recovery.
b. subjective discomfort d. situational context 9. Survivors of natural disasters like Hurricane Sandy in 2012 may
3. Which of the following is an example of cultural relativity? experience higher incidences of
a. Dr. Han believes that the voices his patient is hearing stem from a. bipolar disorder. c. personality disorders.
a biological instead of a psychological cause. b. posttraumatic stress d. schizophrenia.
b. While Dr. Howard believes that hypnosis is the best way to disorder.
understand all disorders, his approach is not shared by his 10. Calvin is terribly worried that his college education was wasted
colleagues. when he doesn’t get his dream job. Furthermore, Calvin believes
c. While Dr. Akido knows that his patient, Aki, believes her anxiety he ruined his future when he did poorly in his job interview. Calvin
has a biological explanation, in learning more about her family explains, “I had to ace the interview. It had to be perfect, and it
of origin, he suspects it has a psychological cause. wasn’t!” How might a cognitive-behavioral psychologist classify this
d. Dr. Roland uses a behavioral approach to treat all his clients distorted thought process?
who are younger than age 10. a. magnification c. all-or-nothing thinking
4. How many axes does the DSM-5 use to aid mental health b. overgeneralization d. minimization
­professionals in making a diagnosis? 11. Dissociative amnesia is different from retrograde amnesia because
a. one c. four a. dissociative amnesia is typically psychological in origin.
b. two d. five b. retrograde amnesia has been shown to not actually exist.
5. Trypanophobia, also known as a fear of receiving an injection, is an c. dissociative amnesia is caused by a physical blow to the head.
example of d. retrograde amnesia is caused by psychological trauma.
a. obsession. c. anxiety attack. 12. Depersonalization/derealization disorder is a type of d
­ issociative
b. social phobia. d. specific phobia. disorder that has been found to have possible __________
6. Aaron hates to go to restaurants for fear that he will be seated in ­foundations for the experience of detachment.
the far back of the restaurant and be unable to get out in case a. biological c. behavioral
of an emergency. This may be a symptom of b. psychodynamic d. cognitive
a. social phobia. c. agoraphobia. 13. Which type of depression is the most common type of mood
b. specific phobia. d. claustrophobia. disorder?
7. Ria experienced a sudden attack of intense fear when she was a. bipolar disorder c. seasonal affective disorder
boarding a plane with her friends to fly to Mexico for spring break. b. mania d. major depressive disorder
Ria’s heart raced, she became dizzy, and she was certain she 14. Behavioral theorists link depression to ___________________,
would die in a plane crash if she boarded the plane. Subsequently whereas social cognitive theorists point to ___________________.
she did not go on her trip, and the plane arrived safely in Mexico a. distortions in thinking; learned helplessness
3 hours later. Ria experienced b. biological abnormalities; distortions in thinking
a. a depressive episode. c. panic disorder. c. unconscious forces; learned helplessness
b. a panic attack. d. agoraphobia. d. learned helplessness; distortions in thinking
Psychological Disorders   625

15. Individuals with bulimia often rationalize that since they have had a 19. Rodney has been diagnosed with schizophrenia. He rarely smiles
single treat, their diet is ruined and therefore they might as well go and often shows little emotion in any situation. Psychologists refer
ahead and eat excessively. Such irrational thinking is an example to this characteristic as
of the cognitive distortion known as a. catatonia. c. positive symptoms.
a. overgeneralization. c. magnification. b. flat affect. d. negative symptoms.
b. all-or-nothing thinking. d. minimization. 20. What neurotransmitter was first believed to be the cause
16. Binge-eating disorder is different from bulimia in that individuals of schizophrenia?
with binge-eating disorder a. GABA c. epinephrine
a. typically eat much smaller portions before purging the food. b. serotonin d. dopamine
b. do not typically purge the food they eat. 21. Colleen found herself attracted to her psychology instructor. She
c. only purge their food after several binge sessions. would frequently go by his office just to be near him. When he
d. often resort to anorexic methods to rid themselves of the food didn’t respond to her advances, Colleen eventually told him that
they have eaten. she had thoughts of killing herself so that he would spend time
17. Sexual dysfunctions and problems can be caused by trying to counsel her. What personality disorder best describes
a. organic factors. ­Colleen’s thinking and behavior?
b. organic and sociocultural factors. a. borderline personality disorder
c. organic, psychological, and sociocultural factors. b. schizoid personality disorder
d. hereditary factors primarily. c. schizotypal personality disorder
18. On your first call as a paramedic, you enter the house of a man d. antisocial personality disorder
who has covered his walls and ceiling in aluminum foil to protect
his brain from the thought-controlling rays of the government. This
is an example of a __________ delusion.
a. persecution c. influence
b. reference d. grandeur