PSY 451A

Psychological Dr. Ark Verma

Disorders
 “ A clear and complete insight into the nature of
madness, a correct & distinct conception of what
constitutes the difference between the sane and the
insane has, as far as I know, not been found.”
–Shopenhauer
 So what is, “Insanity”?

❖ First, insanity may not be the right word.

❖ Psychological disorders are also ‘disorders’, let’s say like
many other health conditions.
❖ Though, they may have slightly different, sometimes
more complex causes & likewise more difficult
diagnoses & treatment.
“ The government of the United States was overthrown more
than a year ago! I’m the president if the USA and Bob Dylan is
vice president.” So said Ed, the author of a prominent book on
journalism, while speaking to a college journalism class, as
guest lecturer. Ed also informed the class that he had killed both
John & Robert Kennedy, as well as Charles de Gaulle, the former
president of France….The student… expectant calm was
shattered when Ed pulled a hatchet that he had brought with
him & hurled it at the class…”
❖ That…is certainly an example of ABNORMAL
BEHAVIOR!!!
❖ But what is not?
❖ & what have thought of ABNORMAL BEHAVIOUR
historically?
 Let’s begin with Definitions…

❖ psychological disorder: it is a psychological dysfunction

within an individual that is associated with distress or
impairment in functioning and a response that is not
typical or culturally expected.
❖ psychological dysfunction: refers to a breakdown in
cognitive, emotional or behavioral functioning.
❖ cognitive dysfunction: if an individual displays
psychotic behavior, i.e. hallucinating & totally out of
touch with reality, as in Schizophrenia. e.g. remember
Ed!
❖ aside*: most psychological functions are often
considered to be on a continuum or as a dimension,
rather than as categories, that are either present or
absent.
❖ distress: if the individual is extremely upset. e.g.
remember ,Ed was actually very upset. but defining a
disorder by stress alone shall not work, it has to be
qualified by accompanying symptoms & also by the
degree of experience.
❖ impairment: it is a useful concept, but again
qualification is necessary. some people are impaired at
simple things like working in a team, or meeting people
socially. but they are NOT abnormal; though if they
can’t stand even a single person around, that may be
considered abnormal.
❖ atypical response/culturally unexpected response:
again not a criteria in itself. e.g. take homosexuality.
cultures define certain norms for themselves, &
behaviour is often adjudged against these norms, but
deviation of norms is not entirely abnormal!
❖ Let’s attempt a synthesis:
❖ “behavioral, emotional, or cognitive dysfunctions that
are unexpected in their cultural context and
associated with personal distress or substantial
impairment in functioning are abnormal.”
 Concepts

❖ psychopathology: the scientific study of psychological

disorders.
❖ clinical & counselling psychologists, psychiatrists,
psychiatric social workers, & psychiatric nurses.
❖ Clinical Description: a manner of describing a patients symptoms,
problems or a set of problems.
❖ e.g. “the patient A presents a set of problems.” (basically why the
patient came to the clinic).
❖ clinical description represents the unique combination of
behaviours, thoughts, feelings that make up a specific disorder.
❖ is to specify what makes the disorder different from normal
behavior or from other disorders.
❖ prevalence: how many people in population as a whole have the
disorder.
❖ incidence: how many cases have come up during a particular time
period.
❖ course: most disorders have a particular pattern.
❖ e.g. schizophrenia follows a chronic course, meaning
that it could take a long time to get cured.
❖ other disorders like mood disorders, follow an
episodic course, i.e. they occur periodically & the
affected individual may get recover within a short
period of time.
❖ further, some disorders might follow a time-limited
course, i.e. the disorder will improve without
treatment in a relatively short period of time.
❖ onset:
❖ some disorders have acute onset, i.e. they begin
suddenly.
❖ others develop gradually over an extended period of
time, & have an insidious onset.
❖ prognosis: the anticipated course of a disorder. e.g. “the
prognosis is good”, i.e. the individual will probably
recover soon. or “the prognosis is bad”, i.e. the outcome
does not look good.
❖ etiology: the study of the origins of a disorder, i.e. why
a disorder begins (causes) & includes biological,
psychological and social dimensions.
❖ treatment: treatment is an important part of studying
psychological disorders. e.g. often treatments & how the
patients respond to these tell us about the nature of
disorders & their causes.
Historical Perspectives
 The Supernatural Tradition
❖ deviant behaviour has traditionally been viewed as the
battle between good & evil.
❖ when people confronted with unexplainable,
irrational behaviour & by suffering with upheaval,
people perceived evil.
❖ mostly, people referred to abnormal behaviour as
“supernatural” & took recourse to exorcism, sorcery
& magic.
❖ people were thought to be, “possessed” by spirits.
whether the possession involved “good” or “evil”
spirits depended on the person’s symptoms.
❖ possessions were also considered to be the work of an
angry God or an evil spirit.
❖ the primary treatment for demonic possession was
exorcism, which included various techniques for casting
an evil spirit out the afflicted person. also, use of magic,
prayers, incantations, horrible concoctions etc.
 The Biological Tradition
❖ The Greek physician Hippocrates (460-377 B.C.) :
❖ denied that deities & demons intervened in
development of illnesses, & suggested that mental
disorders had natural causes & required proper
treatment like other diseases.
❖ believed that the brain was the central organ of
intellectual activity & mental disorders mainly arise
out of brain pathology.
❖ he classified mental disorders into three classes:
❖ mania, melancholia & phrenitis and gave detailed
descriptions of the specific disorders included in each
category.
❖ he relied heavily on clinical observation & descriptions
derived from patients records were thorough.
❖ his treatments were much advanced in comparison to the
exorcist practices prevalent at the time. e.g. for the
treatment of melancholia he prescribed a regular & tranquil
life, sobriety & abstinence from all excess, a vegetable diet,
celibacy & exercise.
❖ later, the Roman physician Galen (129-128 A.D.) adopted
the ideas of Hippocrates & developed them further.
❖ Later, the biological tradition flourished in the Western
world til the 19th century.
❖ John Grey, an American psychiatrist posited that insanity
was always due to physical causes & the mentally ill
patient should be treated as the physically ill patients
only.
❖ treatment routines included rest, diet, proper room
temperature & ventilation etc.
❖ Emil Kraeplin (1856-1926) was one of the first to
distinguish among various psychological disorders,
seeing that each may have a different age of onset &
time - course, with somewhat different clusters of
symptoms etc.
❖ During the 1950s, the first effective drugs for
psychological disorders were developed systematically.
❖ drugs like reserpines, neuroleptics (major tranquilizers),
contributed to control hallucinatory & delusional
thought processes & also agitation and aggression.
 The Psychological Tradition

❖ moral therapy: here moral meant “emotional” or

“psychological”.
❖ it basically involved treating patients as normally as
possible, in a setting that encouraged & reinforced
normal social interaction, thus providing them with
many opportunities for appropriate social &
interpersonal contact.
❖ a larger number of mental asylums established under
moral therapy, became overcrowded & a decline of
humane treatment was observed due to multiple reasons.
❖ Dorothea Dix, a school teacher who had worked in
several such institutions & had first hand knowledge of
their deplorable conditions; made it her life’s work to
inform the American public & leaders about the same. Her
work came to be known as mental hygiene movement.
❖ Later, the psychological movement re-emerged in form of
different schools of thought who had different
perspectives of mental illness.
❖ Psychoanalysis:
❖ Anton Mesmer (1734-1815), had his patients sit in a
dark room around a large vat of chemicals with rods
extending from it & touching them. He suggested
strongly, that they are being cured.
❖ Jean Charcot (1825-1893) later demonstrated that
some of Mesmer’s techniques were effective with a
number of psychological disorders & legitimised the
practice of hypnotism in treatment of psychological
disorders.
❖ In, 1885 a young man named Sigmund Frued teamed up with Josef
Breuer (1842-1925) & began his unique way of treatment.
❖ while their patients were under hypnosis or in a highly suggestible
state, Breuer asked them to describe their problems, conflicts and
fears in as much detail as possible.
❖ they observed two things:
❖ patients often became extremely emotional as they talked, and felt
quite relieved and improved after emerging from the hypnotic state.
❖ seldom would patiens have gained an understanding of the
relationship between their emotional problems & psychological
disorder. some of them even did not recall their own descriptions.
this lead to the discovery of, “the unconscious”.
❖ and so it all began..from Freud’s psychoanalytic model,
to Jung, to humanistic approached of Maslow &
learning & condition of Skinner & Watson.
Contemporary Perspectives…
 The Medical Model
❖ the medical model proposes that it is useful to think of abnormal
behaviour as a disease.
❖ hence the terms: mental illness, psychological disorder or
psychopathology.
❖ the medical model represents progress made over earlier
models of abnormal behaviour.
❖ the rise of the medical model brought improvements in the
treatment of those who exhibited abnormal behaviour.
❖ e.g. more sympathy, less hatred & fear.
❖ however, some critics suggest that the medical model has by
now outlived its usefulness.
❖ Szasz (1974,1993) suggests that, “strictly speaking, disease or
illness can affect only the body; hence there can be no mental
illness…”
❖ he argues that abnormal behaviour usually involves a deviation
from social norms rather than an illness, and that such deviations
are “problems in living” rather than medical problems.
❖ importantly, Szasz points out that the medical model’s disease
analogy converts moral & social questions of acceptable
behaviour into medical questions.
❖ Other critics point out that medical diagnoses of
abnormal behaviour pin potentially derogatory labels
on people (Hinshaw, 2007).
❖ e.g. being labeled as psychotic, schizophrenic or
mentally ill, carries a social stigma that can be
difficult to shake.
❖ those characterized as mentally ill are viewed as
erratic, dangerous, incompetent & inferior (Corrigan
& Larson, 2008).
❖ However, the medical model has some useful concepts
to offer. e.g. diagnosis, etiology, and prognosis.
❖ diagnosis involves distinguishing one illness from
another.
❖ etiology refers to the apparent causation &
developmental history of the illness.
❖ prognosis is a forecast about the probable course of an
illness.
 Criteria of Abnormal Behavior

❖ deviance:
❖ maladaptive behavior:
❖ personal distress:
❖ concept of continuum!
Classification of the Psychological Disorders

❖ A formal attempt at a systematic classification of

psychological disorders began in 1952 when the
American Psychiatric Association unveiled its
Diagnostic and Statistical Manual of Mental Disorders
(DSM n).
❖ the classification scheme described about 100 disorders.
❖ consequent revisions happened in order to improve the
system of classifications, definitions & symptoms.
❖ it helps lay out specific & explicit diagnostic criteria for
mental disorders & helps clear ambiguity regarding
definition and clinical practices.
❖ Most recent edition is the DSM - IV TR.
❖ It follows a multi-axial system of classification, which
asks clinicians to organize information about
individuals on 5 separate dimensions or axes.
❖ the diagnoses of the disorders are made on AXIS I &
AXIS II.
❖ while most disorders are already found under AXIS I,
clinicians use AXIS II to list long running disorders or
mental retartdation. People may receive diagnoses on
both AXES I & II.
❖ the remaining axes are used to collect supplementary
information.
❖ AXIS III (General Medical Conditions): person’s
physical disorders are listed under this axis.
❖ Axis I (Clinical Syndromes):
❖ disorders usually diagnosed in infancy, childhood or
adolescence: includes disorders that arise before adolescence
such as attention deficit disorders, autism, mental retardation, etc.
❖ organic mental disorders: includes disorders that are
temporary or permanent dysfunctions of the brain tissues
caused by diseases or chemicals. e.g. delirium, dementia, &
amnesia.
❖ substance related disorders: refers to maladaptive use of
drugs & alcohol. e.g. alcohol dependance, cocaine
dependence etc.
❖ schizophrenia & psychoses: schizophrenias are characterised by
psychotic symptoms (e.g. grossly disorganized behaviour,
delusions, & hallucinations) and by over 6 months of behaviour
deterioration. also includes delusional disorder & schizoaffective
disorder.
❖ mood disorders: cardinal feature of these disorders is emotional
disturbance. patients may or may not, have psychotic symptoms.
these disorders include major depression, bipolar disorder etc.
❖ anxiety disorders: these disorders are characterised by
physiological signs of anxiety (e.g. palpitations) and subjective
feelings of tension, apprehension, or fear. anxiety may be acute
and focused (panic disorder) or continual & diffused (generalized
anxiety disorder).
❖ somatoform disorders: these disorders are dominated by
somatic symptoms that resemble physical illnesses.
symptoms cannot be accounted for by organic damage. also
there must be strong evidence that these symptoms are
caused psychological factors. e.g hypochondriasis.
❖ dissociative disorders: these disorders feature a sudden,
temporary alteration or dysfunction of memory,
consciousness, identity, and behavior. e.g. dissociative
amnesia & multiple personality disorder.
❖ sexual & gender identity disorders: there are three basic
types of disorders here: gender identity, paraphilia and
sexual functioning.
❖ Axis II (Personality Disorders): these disorders are
patterns of personality traits that are longstanding,
maladaptive, and inflexible and involve impaired
functioning or subjective distress. e.g. antisocial
personality disorder.
❖ Axis III (General Medical Conditions): Physical
disorders or conditions. e.g. hypertension, diabetes etc.
❖ Axis IV (Psychosocial & Environmental Problems): the
clinician makes notes regarding the types of stress
experienced by the individual in the past year. e.g. any
significant happenings like (loss of job, death of spouse
etc.)
❖ Axis V (Global Assessment of Functioning): the clinician
estimates the individuals current levels of functioning
(as in social and occupational behaviour) and compares
it to the individual peak levels performance at an earlier
time.
Disorders
 Anxiety Disorders
❖ anxiety disorders: are a class of disorders marked by
feelings of excessive apprehension & anxiety.
❖ four principal disorders: generalised anxiety disorder,
phobic disorder, obsessive compulsive disorder & panic
disorder.
❖ they are not mutually exclusive, as individual may
experience symptoms that are common to more than
one of these disorders.
❖ Generalized Anxiety Disorder: it is marked by a chronically high level of
anxiety that is not tied to any specific threat.
❖ tends to have a gradual onset, a lifetime prevalence of about 5%, and is
seen more frequently in females than males (Brown & Lawrence, 2009).
❖ patients tend to worry constantly about yesterday’s mistakes and
tomorrow’s problems.
❖ they worry excessively about minor matters related to family, finances,
work & personal illness.
❖ they hop that their worrying will help ward off negative events (Beidel
& Stipelman, 2007).
❖ their anxiety is frequently accompanied by physical symptoms as muscle
tension, diarrhoea, dizziness, faintness, sweating & heart palpitations.
❖ Phobic Disorder: is marked by a persistent & irrational
fear of an object or situation that presents no realistic
danger.
❖ people are said to have phobic disorders when their fears
seriously interfere with normal everyday functioning.
❖ phobic reactions are often accompanied by physical
symptoms as trembling & palpitations (Rapee & Barlow,
2001). e.g. claustrophobia (fear of small enclosed places),
hydrophobia (fear of water), acrophobia (fear of heights)
etc.
❖ Panic Disorder and Agoraphobia: is characterized by
recurrent attacks of overwhelming anxiety that usually
occurs suddenly and unexpectedly.
❖ these paralysing attacks are accompanied by physical
symptoms of anxiety.
❖ victims become apprehensive & think about when the
next attack will occur.
❖ sometimes patients become so concerned that are afraid
to leave home, agoraphobia.
❖ agoraphobia (fear of the marketplace or open places) is
a fear of going out to public places.
❖ some patients become confined to their homes,
although many can venture out in company of a
trusted individual (Hollander & Simeon, 2008).
❖ Obsessive Compulsive Disorder (OCD): marked by persistent,
uncontrollable intrusions of unwanted thoughts (obsessions) and
urges to engage in senseless rituals or compulsions. e.g. Howard
Hughes.
❖ obsessions often center on fears of contamination, inflicting harm
on others, suicide or sexual acts.
❖ compulsions usually involve rituals that temporarily relieve
anxiety.
❖ examples: constant handwashing, repetitive cleanings of things
that are already clean, endless rechecking of locks, faucets ,
excessive arranging, counting & hoarding of things (Pato, Eisen &
Philips, 2003).
❖ Etiology of Anxiety Disorders:
❖ Biological Factors: recent studies suggest that there may be a
weak to moderate genetic predisposition to anxiety disorders,
depending upon the specific type of disorder (Fyer, 2009;
McMahon & Kassem, 2005).
❖ Kagan et al (1992) have found that 15-20% of infants display
and inhibited temperament, characterised by shyness, timidity &
wariness, which appears to have a strong genetic basis.
❖ another theory holds that, anxiety sensitivity may make people
vulnerable to anxiety disorders.
❖ a neurotransmitter GABA (gamma aminobutyric acid) has
been linked to OCD & panic disorders.
❖ Conditioning & Learning: many anxiety responses
may be acquired through classical conditioning and
maintained through operant conditioning.
❖ According to Mowrer (1947) an originally neutral
stimulus may be paired with a frightening event to
become a conditioned stimulus to elicit anxiety.
❖ once this happens individual tend to avoid, where
avoidance becomes negative reinforcement and
contributed in maintaining that behavior.
❖ tendency to develop phobias of certain types of objects
& situations can be explained by Martin Seligman’s
concept of preparedness.
❖ people are biologically prepared by their evolutionary
history to acquire some fears more easily than others.
e.g. fear of snakes & spiders.
❖ Cognitive Factors: styles of thinking & interpretation.
❖ a) misinterpret harmless situations as threatening.
❖ b) focus excessive attention on perceived threats.
❖ c) selectively recall information that seems
threatening.
❖ Stress: some anxiety disorders are stress related.
❖ e.g. Farvelli & Pallanti (1989) found that patients with
panic disorder had experienced dramatic increase in
stress in prior month.
 Somatoform Disorders
❖ Somatoform Disorders are physical ailments that cannot be fully
explained by organic conditions and are largely due to
psychological factors.
❖ although the symptoms are largely imaginary than real, patients
are actually not faking illness.
❖ patients typically seek treatments from physicians practicing
neurology, internal medicine, or family medicine, instead from
psychologists or psychiatrists.
❖ It is however, very difficult to correctly diagnose a somatoform
disorders.
❖ Somatization Disorder: marked by a history of diverse
physical complaints that appear to be psychological in origin.
❖ appears to occur mostly in women with depression or
anxiety disorders (Yutzy & Parish, 2008).
❖ victims report an endless succession of minor physical
ailments that seem to was & wane in response to stress in
their lives (Servan-Shcreiber, Kolb & Tabas, 1999).
❖ victims usually have a long history of medical treatment
from many doctors.
❖ problems can range from a cardiovascular, gastrointestinal,
pulmonary, neurological & genitourinary symptoms.
❖ Conversion Disorder: characterised by a significant loss
of physical function with no apparent organic basis,
usually in a single organ system.
❖ common symptoms include partial or complete loss
of vision, or hearing, partial paralysis, severe
laryngitis, seizures, vomiting etc.

“ Mildred was a rancher’s daughter, who lost the use of both of her legs
in adolescence. She was at home alone one afternoon when a male
relative attempted to assault her. She screamed for help, and her legs
gave way as she slipped to the floor. She was later found on the floor after
her mother came home. She could not get up…”
“Jeff is a middle-aged man who works as clerk in drug store. He spends long hours
describing his health problems to anyone who will listen. Jeff is an avid reader of
popular magazine articles on medicine. He can tell you about the latest medical
discoveries. He takes all sorts of pills and vitamins to ward off possible illnesses…
Jeff is constantly afflicted by new symptoms of illness…”

❖ Hypochondriasis: characterised by excessive preoccupation with

health concerns and incessant worry about developing physical illness.
❖ when hypochondriacs are assured by their physicians that they do
not have any real illness they often are skeptical & disbelieving
(Starcevic, 2001).
❖ hypochondriacs don’t subjectively suffer from physical distress as
much as they over interpret every conceivable sign of illness.
❖ Etiology of Somatoform disorders
❖ inherited aspects of physiological functioning, such as an
elevated sensitivity to bodily sensations, may predispose some
people to somatform disorders (Kirmayer & Looper, 2007).
❖ Personality factors:
❖ people with histrionic personality characteristics tend to be
prone to develop somatoform disorders.
❖ typically they tend to be self-centred, suggestible, excitable,
highly emotional & overly dramatic.
❖ such people thrive on the attention they get, when they
become ill.
 ❖ also people having personality trait of neuroticism are
susceptible to somatoform disorders (Noyes et al., 2005).
❖ pathological care-seeking behaviour seen in these disorders
may be caused by insecure attachment styles (Noyes et al.,
2003).
❖ Cognitive Factors:
❖ Barsky (2001) asserts that some people focus excessive
attention on their internal physiological processes and amplify
normal bodily sensations into symptoms of distress.
❖ Evidence suggests that people with somatoform disorders
tend to draw catastrophic conclusions about minor bodily
complains (Bouman & Eifert, 2000).
❖ The Sick Role:
❖ Some people grow fond of the role associated with
being sick (Hotopf, 2004)
❖ their complaints of physical symptoms may be
reinforced by indirect benefits obtained from their
illness (Schwartz, Slater, & Birchler, 1994).
❖ One simple payoff is that being ill is a superb way
of avoiding to confront life’s challenges.
❖ attention from others is another payoff. sympathy
from others may be rewarding for some.
 Dissociative Disorders.

❖ dissociative disorders are a class of disorders in which

people lose contact with portions of their consciousness
or memory, resulting in disruptions in their sense of
identity.
❖ Dissociative Amnesia & Fugue: sudden loss of memory
for important personal information that is too extensive
to be due to normal forgetting.
❖ memory losses may occur for a single traumatic event (
such as an automobile accident), or for an extended
period of time surrounding the event.
❖ cases of amnesia have been observed after people have
experienced disasters, accidents, excess stress, physical
abuse, rape or after they have witnessed violent death
of a parent etc. (Cardena & Gleaves, 2007).
❖ Dissociative Identity Disorder: involves the existence of two or more
largely complete, & usually very different, personalities, in one person.
❖ people with multiple personalities feel that they have more than one
identity.
❖ each personality has his or her own name, memories, traits &
physical mannerisms,
❖ however, in the various personalities generally report that they are
unaware of each other (Eich et al., 1997), although doubts have been
raised about the accuracy of this assertion.
❖ alternate personalities commonly display traits that are quite
foreign to the original personality. e.g. a shy inhibited person might
develop a flamboyant, extreverted alternate personality.
❖ transitions between identities happens suddenly, & alternate
personalities may assert different age, race, gender & sexual
orientation (Kluft, 1996).
❖ Etiology of Dissociative Disorders:
❖ usually attributed to excessive stress, though little is know of how
exactly.
❖ some theorists speculate that certain personality traits e.g. fantasy
proneness may make people to more susceptible to dissociative
disorders.
❖ Theorists like Nicholas Spanos (1994,1996) etc. believe that patients
are engaging in intentional “role playing” to use mental illness as a
face saving excuse for their personal feelings.
❖ he even says that some therapists help create multiple personalities
by subtly encouraging the emergence of multiple personalities.
❖ However, other believe that DID is an authentic disorder caused by
excessive trauma or abuse (Maldonando & Spiegel, 2008).
 Mood Disorders
❖ Mood disorders are a class of disorders marked by emotional
disturbances that may spill over to disrupt physical, perceptual,
social & thought processes.
❖ mood disorders typically included tow basic types: unipolar &
bipolar.
❖ people with unipolar disorders experience emotional extremes at
just one end of the continuum - depression.
❖ people with bipolar disorders experience emotional extremes at
both ends of the continuum, going through both depression &
mania (excitement & elation).
❖ Major Depressive Disorder: people show persistent feelings of
sadness and despair and a loss of interest in previous sources of
pleasure.
❖ negative emotions form the heart of the depressive syndrome.
❖ depressed people often give up activities they used to find
enjoyable. e.g. a depressed person might give up a favorite hobby.
❖ reduced apetite & insomnia are common, as is lack of energy.
❖ they tend to move sluggishly & talk slowly.
❖ anxiety, irritability & brooding are frequently observed.
❖ lack of self-esteem, feelings of hopelessness, dejection &
boundless guilt.
❖ the onset of unipolar disorder can occur at any point in the
lifespan, but a substantial majority of cases emerge before age
40 (Hammen, 2003).
❖ depression occurs in children as well as adolescents & adults
(Gruenberg & Goldstein, 2003).
❖ a majority of people often suffer more than one episode over
the course of lifetime (Joska & Stein, 2008). the average number
is 5 to 6 while the length of the episode could be about 6
months.
❖ the lifetime prevalence of depression was reported to be
around 16.2% (Kessler et al., 2003) & is about twice as high in
women as it is in men (Rihmer & Angst, 2005).
❖ Bipolar Disorder (also known as manic-depressive disorder) :
marked by the experience of both depressive & manic periods.
❖ symptoms seen in manic periods are generally the opposite
of those in depressive episodes.
❖ a person’s mood becomes elevated to the point of euphoria,
self-esteem skyrockets, over-optimism, energy, &
extravagant planning.
❖ people become hyperactive & can go on for days without
sleep.
❖ talk rapidly, shift topics wildly, have impaired judgment &
may gamble impulsively & become reckless.
❖ interestingly, in milder forms such an euphoria can be attractive. many
bipolar patients report temporary surges of productivity & creativity
(Godwin & Jamison, 2007).
❖ bipolar disorder ultimately proves to be troublesome for most victims.
❖ manic episodes often have a paradoxical negative underflow of
uneasiness & irritability (Dilsaver et al., 1999).
❖ often mild manic episodes usually escalate to high levels & can
become disturbing. e.g. the case of the Dentist.
❖ bipolar disorders are much less frequent than unipolar disorders,
affect around 1-2.5% of the population (Dubovsky, Davies &
Dubovsky, 2003).
❖ & seen equally in men and women (Rihmer & Angst, 2009).
❖ Mood disorders & Suicide: a tragic outcome of mood disorders is
suicide, accounting for almost 30, 000 deaths annually in the U.S.
❖ about 90% of the people who commit suicide suffer from some
type of psychological disorder, although in some cases this
disorder might not be apparent (Dawkins, Golden & Fawcett,
2003).
❖ suicide rates are higher for people with mood disorders, about
60% of suicides (Mann & Currier, 2006).
❖ a lifetime risk of suicide is around 15-20% in people with
bipolar disorder & around 10-15% in people with depression
(Sudak, 2009).
❖ Etiology of Mood disorders
❖ Genetic Vulnerability: genetic factors influence the likelihood of
developing major depression or a bipolar mood disorder (Lohoff
& Berttini, 2009).
❖ a concordance rate indicates the percentage of twin pairs or
other pairs of relatives that exhibit the same disorder. a higher
concordance supports the genetic hypothesis.
❖ twin studies suggest that genetic factors are involved in mood
disorders (Kelsoe, 2009), concordance rates average around 65
- 72% for identical twins, but only 14 - 19% for fraternal twins.
❖ however, it is clear that heredity can create a predisposition to
mood disorders.
❖ correlations have been found between mood
disorders & abnormal levels of two neurotransmitters
in the brain: norepinephrine & serotonin (Sher &
Mann, 2003).
❖ studies have also found correlations between
depression & reduced hippocampal volume
(Davidson, Pizzagalli, & Nitschke, 2009),
❖ the hippocampus tends to be about 8-10% smaller in
depressed subjects than normal subjects (Videbech &
Ravnkilde, 2004).
❖ Cognitive Factors:
❖ Seligman (1874) proposed that depression is caused by learned
helplessness, produced by exposure to unavoidable aversive events.
❖ postulates that LH is rooted in how people explain setbacks &
other negative events they experience (Abramson, Seligman &
Teasdale, 1978).
❖ acc. to Seligman (1990) people who exhibit a pessimistic
explanatory style are especially vulnerable to depression.
❖ Similarly, Susan Nolen-Hoeksema (1991,2000) has found that
people who ruminate have elevated rates of depression & tend to
remain depressed longer than those who don’t.
❖ Excessive rumination tends to foster and amplify episodes of
depression by increasing negative thinking, impairing problem
solving, and undermining social support (Nolen-Hoeksema et al.,
2008).
❖ Interpersonal Roots:
❖ acc. to this notion, depression prone people lack the
social finesse to acquire many important kinds of
reinforcers, such as good friends, top jobs, & desirable
spouses; which could lead to negative emotions and
depression (Ingram, Scott & Hamill, 2009).
❖ researchers have found correlations between poor
social skills & depression (Petty et al., 2004).
❖ Precipitating Stress:
❖ evidence available today suggests a moderately
strong link between stress & the onset of mood
disorders (Hammen, 2005), and also their response to
treatment & possibility of relapse (Monroe &
Hadjiyannakis, 2002).
 Schizophrenic Disorders
❖ Schizophrenic disorders: are a class of disorders marked
by disturbances in thought that spill over to affect
perceptual, social, and emotional processes.
❖ about 1% of the population suffers from sd. (Lauriello
et al., 2005).
❖ schizophrenia is an extremely costly disorder for the
society, as it is a severe, debilitating illness that has a
early onset & requires lengthy hospital care
(Samnaliev & Clark , 2008).
Sylvia was first diagnosed as schizophrenic at age 15. She has been in & out of
many types of psychiatric facilities since then. during flare ups of her disorder,
her personal hygiene deteriorates. She rarely washes, wears clothes that neither
fit nor match, smears makeup on heavily but randomly & slops food all over
herself. Sylvia occasionally hears voices talking to her. She tends to be
argumentative, aggressive & emotionally volatile. over the years she has been
involved in innumerable fights with people.

❖ General Symptoms:
❖ Irrational Thought: Cognitive deficits & disturbed thought
processes are the central, defining feature of sd (Barch, 2003).
Various kinds of delusion are common. e.g tiger delusion.
❖ affected persons believe that their private thoughts are being
broadcasted to other people, that thoughts are being injected in the
ir mind against their will or that their thoughts are being
controlled by some external force (Maher, 2001).
❖ in delusions of grandeur, people maintain that they
are extremely famous or important or powerful.
❖ thinking becomes extremely chaotic rather than
logical and linear, there is like a “flight of ideas” or
“loosening of associations”
❖ Deterioration of adaptive behaviour: a noticeable
deterioration in quality of one’s daily work.
❖ Distorted Perception: a variety of perceptual
distortions are common, auditory hallucinations being
most common (about 75% of patients, Combs &
Meuser, 2007).
❖ Disturbed emotion: normal emotional tone can be
disrupted in schizophrenics. some patients show little
responsiveness, referred to as flat affect.
❖ Subtypes:
❖ Paranoid Type: dominated by delusions of
persecution, along with delusions of grandeur.
❖ Catatonic Type: marked by striking moto
disturbances ranging from striking muscular rigidity
to random motor activity.
❖ Disorganized Type: severe deterioration of adaptive
behaviour is seen.
❖ Undifferentiated Type: mixtures of symptoms.
❖ Symptoms:
❖ Negative symptoms: behavioral deficits, flattened
emotions, social withdrawal, apathy, impaired
attention, & poverty of speech.
❖ Positive symptoms: behavioral excesses such as
hallucinations, delusions, bizarre behaviour & wild
flights of ideas.
❖ Course & outcome:
❖ schizophrenic disorders usually surface during
adolescence or early adulthood, with 75% of cases
surfacing before 30 years of age. (Perkins et al., 2006).
❖ onset is usually gradual & insidous, but may be
sudden rarely.
❖ only about 20% of patients enjoy full recovery
(Perkins et al., 2006).
❖ Etiology of Schizophrenia
❖ Genetic Vulnerability: plenty of evidence indicate that
hereditary factors play a role in the development of sd (Kirov &
Owen, 2009). concordance rates are around 48% for identical
twins & 17% for fraternal twins. a child born to two
schizophrenic patients has a chance of 46% to develop
schizophrenia.
❖ Neurochemical Factors: excessive dopamine activity has been
linked to sd (Javitt & Laru, 2006).
❖ Structural abnormalities in the brain: individuals with sd
exhibit a variety of deficits in perception, attention & information
processing. enlarged ventricles have been associated with sd.
❖ Expressed Emotion: reflects the degree to which a
relative of a schizophrenic patient displays highly
critical or emotionally over involved attitudes
towards the patient.
❖ studies have shown that patients with high EE
families have two to there times higher elapsed
rates than those from low EE families.
❖ Precipitating Stress: stress plays a triggering role in
schizophrenic disorders (Walker & Tessner, 2008), &
in relapse (Walker, Mittal & Tessner, 2008).