General Psychology 100

Instructor: Ilona Pitkanen

PSYCHOLOGICAL DISORDERS LECTURE NOTES

Psychological disorder is defined as a pattern of behavioral and psychological

symptoms that cause significant personal distress and/or impair the ability to
function in important areas of life (e.g. social, occupational). Additionally, the
behaviors depart from social and cultural norms.
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is a book that
describes and categorizes psychological disorders with specific diagnostic
criteria. The current version was published by the American Psychiatric
Association in 2013, and the first edition was in 1952. (If you have an earlier
edition of our textbook, it discusses DSM-IV-TR [Text Revision]. There are some
differences between these DSM editions). Many disorders have been added in
newer editions over the years, such as eating disorders, ADHD (attention deficit
hyperactivity disorder), and social anxiety disorder.

Anxiety disorders and related disorders

Anxiety disorders are a group of disorders in which some form of anxiety is the
main symptom. Anxiety refers to feelings of dread, uneasiness and even panic.
Anxiety is quite normal in a dangerous or an unfamiliar situation and maybe
adaptive in certain circumstances. However, individuals with anxiety disorders
feel anxiety that is detached from any actual danger, or their anxiety continues
abnormally long after an uncertain or dangerous event. Anxiety disorders are
common (25% lifetime prevalence estimate), and they are typically more
common in women.

There are a number of different anxiety disorders.

Generalized anxiety disorder involves excessive, persistent anxiety that can be

attached to many sources of worry, but it can also be “free floating” which means
that it’s not associated with any clear source. The symptoms can include
sweating, fast heartbeat, clammy hands, upset stomach, irritability, sleep
problems and difficulty concentrating. More than twice as many women as men
are diagnosed with it. There seem to be a genetic component to it, and there may
be a genetic relation to depression. Stressful life situations and childhood abuse
are sometimes associated with it.
General Psychology 100
Instructor: Ilona Pitkanen

Panic disorder involves intense, unpredictable attacks of overwhelming anxiety

or terror that are called panic attacks. They are sudden episodes of terrifying
physiological symptoms (increased heart rate, shortness of breath, sweating,
feelings of choking and chest pain) that are accompanied by feelings of terror. A
person may feel that he/she is dying. Panic attacks often occur after a stressful
period.
Panic disorder can lead to Agoraphobia, which involves a fear of having a panic
attack in a situation which one cannot escape from. This leads to avoidance of
places that are public or frightening in some way. Panic disorder seems to
involve a biological predisposition toward anxiety, oversensitivity to physical
arousal, and catastrophizing the meaning of experiences (for example, a person
interprets an increased heart rate as signifying a heart attack).

Anxiety disorders include Phobias. It’s common to have fears of things like
spiders, closed spaces, and stressful social situations. Fear is only considered a
phobia if it’s persistent, overwhelming and difficult or impossible to control. The
fear must disrupt the person’s daily life to be considered a true phobia.

1. Specific Phobias involve a persistent, irrational fear of a specific object or

situation (13% of people, more common in women). Common categories
of Specific phobias include 1) situational (elevators, bridges); 2)
nature/environment (fear of storms, water, natural heights), 3) animal
phobias (spiders, snakes, dogs), 4) fear of blood, medical procedures
such as injections, and injuries.

2. Social anxiety disorder involves avoidance of social situations due to

extreme fear of being embarrassed or judged by others. The person can
avoid eating in public, meeting people, speaking in public, etc. When
avoidance of these situations is impossible, people with social anxiety
disorder experience intense anxiety and distress along with physical
symptoms like shaking hands, sweating and increased heart rate. The
onset of the disorder is often in adolescence.

Phobias can be learned through conditioning or observational learning. Rate of

phobias increases in people whose family member has a phobia. Some
researchers argue that there may be a biological preparedness to develop
phobias to certain animals or situations (spiders, snakes, heights, maggots).

Post-traumatic stress disorder (PTSD) is caused by an extreme physical or

psychological traumatic event. (NOTE: It was an anxiety disorder in DSM-IV but
is now under a separate category in DSM-5. I will not test you on this
categorization difference between the different DSM versions). Such events
include military combat, natural disasters, terrorist attacks, crimes and personal
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Instructor: Ilona Pitkanen

tragedies. Rescue workers and witnesses to atrocities may also acquire PTSD.
It’s more common in women, and involves frequent, intrusive recalls of the
traumatic event and avoidance of situations that trigger memories of the event.
Various physical symptoms are associated with PTSD, including physical
arousal, startle response, sleep problems, concentration problems, irritability and
anger.

Obsessive-compulsive disorder (OCD) involves Obsessions (repeating,

uncontrollable, irrational thoughts that cause anxiety) and Compulsions (the
need to perform an overt or covert action or ritual repeatedly). (NOTE: It was an
anxiety disorder in DSM-IV but is now under a separate category in DSM-5. I will
not test you on this categorization difference between the different DSM
versions). Performing the ritualistic actions temporarily reduces the anxiety
caused by the obsession. Mild obsessions are common in most people (such as
an annoying song repeating in your head over and over again, or having to check
that the stove was switched off). In OCD, the obsessions and compulsions
become overwhelming, intense and disruptive to normal life.
Common categories of OCD:
• Fear of contamination: common compulsions include cleaning and hand
washing
• Pathological doubt: repeatedly checking things associated with harm or
danger
• Obsession with order and symmetry: repeatedly counting and arranging
things

OCD may involve abnormalities in the brain. Brain scans have shown abnormally
high activation in the limbic system. There may also be a dysfunction in the
orbital frontal cortex-caudate nucleus-thalamus pathway. OCD may involve
insufficient levels of serotonin and norepinephrine, because antidepressant
medications that increase levels of these neurotransmitters (by blocking reuptake
of them) often help with OCD symptoms.

Depressive disorders (formerly called Mood disorders in

DSMIV)
Depressive disorders involve disturbances in emotion. Most people occasionally
feel sad, or intensely happy, but in depressive disorders, these feelings are taken
to the extreme and are often paired with various physiological symptoms.

Major depressive disorder (formerly major depression) is the most common

depressive disorder. Symptoms include overwhelming sadness, hopelessness,
worthlessness, and feeling disconnected from other people. Many physical
symptoms accompany the mood disturbances, including changes in appetite that
can lead to weight loss or gain, insomnia or oversleeping, abnormal REM sleep
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Instructor: Ilona Pitkanen

and low energy. Cognitive symptoms include difficulty thinking and concentrating,
pessimism, and sometimes suicidal thoughts. Behavioral symptoms often include
less smiling and eye contact, slower movements, crying, and loss of interest in
sex and social activities. These symptoms must not be caused by substance use
(such as alcohol, drugs, or medication), or be the result of normal grief over the
death of a loved one. Approximately twice as many women than men suffer from
major depression (this sex difference is seen in many cultures).

Seasonal affective disorder (SAD) is characterized by depression that comes

and goes with the seasons. It is most common to have depressive episodes
during the fall and winter months. The depression is not usually very severe but it
is persistent and affects the ability to function normally. Common symptoms
include oversleeping, fatigue, food craving and social withdrawal. It’s more
prevalent in northern latitudes that experience longer winters and less light during
the day. SAD is thought to be triggered by light deficiency. Common treatment is
light therapy in which the person is exposed to one or more hours of very bright
fluorescent light each day. This is most effective in the early morning.

Bipolar disorder (now under Bipolar and related disorders in DSM-5, previously
a mood disorder) involves longer depression episodes and occasional manic
episodes, with normal periods in between. During a manic episode, the person
experiences extreme euphoria and excitement, may show grandiose delusions,
and a rush of creativity and imagination. People with mania often exhibit reckless
behaviors (gambling, risky sexual behaviors, spontaneous trips and money
spending). Often manic people sleep very little. Mania typically has a sudden
onset and escalates quickly. Bipolar disorder is rare, about 1% prevalence, and
affects men and women equally.

Cyclothymic disorder also involves frequent mood swings that last at least 2
years, but they are milder than the mania and depression in bipolar disorder.

Genetics seems to affect the development of these disorders. People with

relatives that have these disorders are at a higher risk of developing them. Low
levels of norepinephrine and serotonin may contribute to depression, because
antidepressants (e.g. Prozac, Zoloft, Paxil) increase levels of NE and serotonin.
However, alternative theories about the role of the neurotransmitter glutamate
are investigated, because some drugs that affect glutamate seem to rapidly
reduce symptoms of depression (e.g. ketamine). Bipolar disorder is often treated
with lithium which (according to some research) normalizes glutamate levels in
the synapse.

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General Psychology 100
Instructor: Ilona Pitkanen

Dissociative Disorders
Dissociative disorders are an unusual group of disorders in which
consciousness, memory and identity are somehow split or altered. The onset is
typically associated with a shocking or a stressful event or life situation. No
physiological cause can be identified for these disorders; they appear to be
caused by psychological factors.

Dissociative amnesia refers to a temporary memory loss of some personal

information, often in response to stress. In contrast to amnesia caused by a brain
injury or a stroke, dissociative amnesia involves losing personal information, not
general knowledge. Dissociative amnesia may occur after a person experiences
a traumatic event, such as losing a family member in an accident. It can manifest
itself as a loss of memory of the couple of days following the accident.
Dissociative amnesia may also involve a loss of memory of a particular person or
some other aspect of the patient’s life.

Dissociative Fugue refers to a form of dissociative amnesia in which one loses

one’s identity and may travel away from home. In extreme cases one may
assume a new identity in a new place. The person often acts very normally
during the fugue, and may have no memory for this episode afterwards.

Dissociative Identity Disorder (DID, formerly multiple personality disorder) is

a disorder in which two or more distinct personalities occur in the same person.
Each identity has its own memories, traits, and habits, and may have distinct
accents, genders, ages and even physical abilities and illnesses (such as visual
acuity and presence or absence of allergies). Usually there is a primary identity
which is in control most of the time, tends to be unaware of the other identities,
and is often a passive, reserved personality type. The other identities are called
alters or alter egos. Some of these identities are often more aggressive and
active, even destructive.
About 90% of people diagnosed with this disorder report extreme physical and/or
sexual abuse in childhood. Mental health professionals have suggested that DID
has become a coping mechanism for abuse victims who have tried to block the
distressing events by creating alternative identities that don’t experience the
abuse. Incidence of DID surged in the US after prominent media coverage, and
critics believe that DID cases are generated by the clinicians when they interact
with suggestible, disturbed patients. Interviews with patients may last for hours at
a time until an alternative personality appears, and therapists may use
controversial techniques, such as hypnosis. DID (and other dissociative
disorders) remain controversial and have also been used in criminal defense
cases as evidence of reduced responsibility for crimes. DID patients usually have
extensive gaps in their memory which can make it difficult to interview them.
Most DID patients also have a PTSD diagnosis.

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Instructor: Ilona Pitkanen

Schizophrenia
Schizophrenia is a condition that involves distorted beliefs, perceptions and
thoughts.
People with schizophrenia do NOT have a “split personality” or “multiple
personalities” but exhibit bizarre behaviors and thought patterns that prevent
them from functioning normally.
An estimated 1% of the population cross-culturally has schizophrenia, and it is
estimated that half of the patients in mental institutions have it. Schizophrenia
varies a lot in severity, duration, and symptoms.
There are two broad categories of symptoms: Positive symptoms and Negative
symptoms (there’s also a third category, cognitive symptoms, which we are not
covering in this class). Positive symptoms involve abnormal, excessive
distortions of functioning. They are called “positive” because they are additions to
normal behavior and experience. Negative symptoms refer to the absence of
normal behaviors, traits and responses to situations.

Positive symptoms

1. Hallucinations are false or distorted perceptions/sensory experiences that

seem vividly real. Auditory hallucinations (“hearing voices”) are the most
common in adults with schizophrenia, but hallucinations can be
associated with any of the senses (e.g. visual, olfactory, tactile).

2. Delusions are false beliefs. These beliefs tend to be very strong and may
control the person’s life, and it’s very difficult to persuade schizophrenics
that their beliefs are false. Delusions can take different forms: Delusions
of reference: false belief that external events are related to oneself (for
example, believing that a person on TV is directly talking to you);
Delusions of grandeur: false belief that one is a famous, important,
powerful person; Delusions of persecution: false belief that one is being
persecuted, followed, etc.

3. Disturbances in thought and speech are also types of positive symptoms.

Many patients show a loosening of associations which means that in their
speech and thinking, they shift from one subject to another without
following any apparent logic. Sometimes their speech is difficult to
understand and involves confused, repetitive language with inappropriate
or invented words (word salad).

4. Disorganized behavior includes inappropriate sexual behaviors, unusual

motor behaviors, and inappropriate emotional responses.

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General Psychology 100
Instructor: Ilona Pitkanen

Negative symptoms

These involve decreases or defects in normal behavioral and emotional

functioning. Examples:
1. Social withdrawal, apathy
2. Reduced production of speech (alogia)
3. Slow movements
4. Flat affect (reduced emotional response)

Causes
Schizophrenia seems to run in families: the more closely related a family member
with the disorder, the greater the risk of schizophrenia.

Some studies have shown that a pregnant woman’s exposure to influenza virus
may be associated with a higher risk of bearing a child who later develops
schizophrenia. Children born in late winter and early spring have higher rates of
schizophrenia (the seasonality effect). Flu rates tend to be higher during critical
time of the pregnancy for those children. Also, age of the father has been
correlated with schizophrenia: the older the father, the more likely the child is to
develop the disorder. It is hypothesized that with age, the risk of mutations in the
sperm-producing cells increases.

Several abnormalities in brain structure and function have been found in

schizophrenic patients. Researchers have found that the ventricles, which are
fluid filled cavities of the brain, are larger in schizophrenic patients than in people
without the disorder. This implies a loss of brain tissue around the ventricles. An
interesting study comparing the loss of gray matter in the brains of teenagers
with and without schizophrenia revealed differences in the rate and amount of
gray matter loss. Healthy teens had gradual, smaller loss of gray matter due to
pruning of unused neuronal connections, but teenagers with schizophrenia
showed severe loss of gray matter starting in the parietal lobes and advancing to
the temporal and frontal lobes. More severe loss in the temporal lobes was
associated with more positive symptoms and more loss of gray matter in the
frontal lobes was associated with more negative symptoms.

Abnormalities in several neurotransmitters, including dopamine and glutamate,

have been associated with schizophrenia. A highly influential dopamine
hypothesis states that the positive symptoms of schizophrenia are due to the
over-activity of dopamine synapses. Antipsychotic drugs block dopamine
receptors, and they decrease positive symptoms of the disorder. In addition,
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drugs such as cocaine and amphetamine increase dopamine activity (by blocking
reuptake of dopamine), and they may produce schizophrenia-like symptoms.
Antipsychotics don’t work on everyone, and other neurotransmitters are
researched as potentially contributing to the disorder. One of those
neurotransmitters is glutamate: some drugs that hamper glutamate seem to
produce schizophrenia-like symptoms (e,g. ketamine and PCP).

Negative symptoms of schizophrenia most likely have a different origin in the

brain: it seems that the prefrontal cortex has reduced activity levels (this is called
hypofrontality). This reduced functionality in the prefrontal cortex may be a
factor that leads to the negative symptoms.

It is commonly thought that a person may inherit a predisposition to develop the

disorder, but may only develop it in certain environmental circumstances.
According to some research, adopted children whose biological mother has
schizophrenia are only vulnerable to serious mental disorders if they grow up in a
disturbed adoptive family environment. If they grow up in a good family
environment, their chances of developing a serious psychological disorder are
the same as children’s whose biological mothers have no schizophrenia. These
findings highlight the interplay of environment and genetics in the development of
psychological disorders.