by Jim Foley
What we’ll seek to understand...
What does it mean to have a mental
Defining and classifying disorders
Anxiety disorders, including GAD,
Panic, Phobias, OCD and PTSD
Mood disorders, including depression
and bipolar disorder
Sample of other disorders:
Rates of Diagnosis with Disorders
Why Learn about Psychological Disorders?
Reasons for curiosity:
personal familiarity with
knowing someone else
with the disorder
hearing about how
prevalent and socially
disorders have become in
wanting to learn more
about mental health and
Perspectives on Psychological Disorders
Thinking critically about
Questions to Keep in Mind
How do we decide when a set of
symptoms are severe enough to be
called a disorder that needs
Can we define specific disorders
clearly enough so that we can know
that we’re all referring to the same
Can we use our diagnostic labels to
guide treatment rather than to
A Psychological disorder is:
A significant dysfunction in an individual’s
cognitions, emotions, or behaviors.
Disorders are diagnosed when there
is dysfunction, behaviors which are
considered maladaptive because
they interfere with one’s daily life
Disorders are diagnosed when the
symptoms and behaviors are
accompanied by Distress, suffering.
New definition (DSM 5): “a
disturbance in the psychological,
biological, or developmental
processes underlying mental
Disorder (ADHD) a real disorder?
ADHD: Impulsivity mixed with Inattention and/or
hyperactivity. Can include distractibility, disorganization,
fidgeting, difficulty suppressing impulses, and impaired
working memory. Is this a disorder?
Is it deviant? Do some people have a level of
inattentiveness, impulsiveness, or restlessness that goes
beyond laziness or immaturity?
Is it distressful? Is the person enjoying being energetic, or
are they frustrated that they can’t sustain focus?
Is there dysfunction? Are the symptoms harmless fun, or
do they negatively impact work and relationships?
Understanding the Nature of
One reason to diagnose a disorder is to make decisions about
treating the problem.
Based on older understanding of
psychological disorders, treatments have
included: exorcising evil spirits, beatings,
Pinel’s New Approach
Philippe Pinel (1745-1826) proposed that
mental disorders were not caused by
demonic possession, but by stress and
Pinel’s “moral treatment” involved
gentleness, nature, and social interaction.
improved lives but
often did not
effectively treat mental
The discovery that the disease of
syphilis causes mental symptoms
(by infecting the brain) suggested a
medical model for mental illness.
Psychological disorders can be seen
as psychopathology, an illness of
Disorders can be diagnosed,
labeled as a collection of symptoms
that tend to go together.
People with disorders can be
treated, attended to, given
therapy, all with a goal of restoring
The Biopsychosocial Approach
Cultural Influences on Disorders
Culture-bound syndromes are
disorders which only seem to exist
within certain cultures; they
demonstrate how culture can play
a role in both causing and defining
Bulimia Nervosa: binging/purging, in the United States
Running amok: violent outbursts, in Malaysia
Hikikomori: social withdrawal, in Japan
Classifying Psychological Disorders
Why create classifications
of mental illness? What is
the value of talking about
diagnoses instead of just
talking about individuals?
1. Diagnoses create a
verbal shorthand for
referring to a list of
2. Diagnoses allow us to
many similar cases,
learning to predict
3. Diagnoses can guide
The Diagnostic and
It’s easier to count
cases of autism if we
have a clear
DSM-V (May 2013)
The DSM is used to
justify payment for
It’s consistent with
diagnoses used by
The Five “Axes” of Diagnosis
The DSM suggests describing someone not just with a label
but with a five-part picture.
Is a clinical Is a personality Is a general
What is the
environmental this person’s
problems, such functioning?
developmental arthritis, or
as school or
hypertension housing issues, assign a code
also present? also present?
may select Clinicians may
none, one, or may not also
select one of
The 5 Axes
Critiques of Diagnosing with the DSM
1. The DSM calls too many people
2. The border between diagnoses, or
between disorder and normal, seems
3. Decisions about what is a disorder seem
to include value judgments; is depression
4. Diagnostic labels direct how we view and
interpret the world, telling us which
behavior and mental states to see as
Stigma and Stereotypes
Many people think a diagnostic
label means being seen as tainted,
weak, and weird.
these negative views/stigma
come from popular cultural views
of mental illness, and not from
the DSM may contain the
information to correct inaccurate
perceptions of mental illness.
Insanity and Responsibility
Jared Loughner shot many
people, including a U.S.
Representative, in 2011.
Loughner had schizophrenia and
substance abuse problems, a
combination associated with
To what degree, if any,
should he be held
responsible for his actions?
What is the appropriate
Anxiety Disorders: Our self-protective,
risk-reduction instincts in overdrive
Panic Disorder: Fear of
the next attack
Phobias: Don’t even
show me a picture
OCD: I know it doesn’t
make sense, but I can’t
PTSD: Stuck Reexperiencing Trauma
Causes of Anxiety
symptoms include worrying,
having anxious feelings and
thoughts about many
subjects, and sometimes
“free-floating” anxiety with
no attachment to any subject.
interferes with concentration.
Physical symptoms include
fidgeting, agitation, and sleep
A panic attack is not just an
“anxiety attack.” It may include:
many minutes of intense dread
chest pains, choking,
numbness, or other frightening
a feeling of a need to escape.
Panic disorder refers to repeated
and unexpected panic attacks, as
well as a fear of the next attack.
A specific phobia is more than just
a strong fear or dislike. A specific
phobia is diagnosed when there is
an uncontrollable, irrational,
intense desire to avoid the some
object or situation. Even an image
of the object can trigger a
reaction--“GET IT AWAY FROM
irrational, intense desire to avoid
the object of the phobia.
Some Fears and Phobias
more, fear or
Some Other Phobias
Agoraphobia is the avoidance
of situations in which one will
fear having a panic attack.
Social phobia: an intense fear of
being watched and judged by others,
often showing as a fear of possibly
embarrassing public appearances.
Obsessive-Compulsive Disorder [OCD]
Obsessions are intense, unwanted
worries, ideas, and images that
repeatedly pop up in the mind.
A compulsion is a repeatedly strong
feeling of “needing” to carry out an
action, even though it doesn’t feel like
it makes sense.
When is it a “disorder”?
Distress: when you are deeply
frustrated with not being able to
control the behaviors
Dysfunction: when the time and
mental energy spent on these
thoughts and behaviors interfere
with everyday life
Common OCD Behaviors
Percentage of children and adolescents with OCD reporting
these obsessions or compulsions:
Common pattern: RECHECKING
Although you know that you’ve already
made sure the door is locked, you feel
you must check again. And again.
About 10 to 35 percent of
people who experience
trauma not only have
burned-in memories, but also
four weeks to a lifetime of:
repeated intrusive recall of
nightmares and other reexperiencing.
social withdrawal or phobic
jumpy anxiety or
insomnia or sleep problems.
Which people develop PTSD?
Those with sensitive
Those who are asked to
relive their trauma as they
Understanding Anxiety Disorders:
Explanations from Different Perspectives
In the experiment by
Watson in 1920, Little
Albert learned to feel fear
around a rabbit because he
had been conditioned to
associate the bunny with a
loud scary noise.
Sometimes, such a
We may begin to fear all
animals, everything fluffy,
The result is a phobia or
We may feel anxious in a
situation and make a
decision to leave. This makes
us feel better and our
anxious avoidance was just
If we know we have locked a
door but feel anxious and
compelled to re-check,
rechecking will help us
temporarily feel better.
The result is an increase in
anxious thoughts and
Experiments with humans
and monkeys show that
anxiety can be acquired
learning. If you see
someone else avoiding or
fearing some object or
creature, you might pick up
that fear and adopt it even
after the original scared
person is not around.
In this way, fears get passed
down in families.
Cognition includes worried
thoughts, as well as
beliefs, predictions, and
Cognition includes mental
habits such as hypervigilance
(persistently watching out for
danger). This accompanies
anxiety in PTSD.
In anxiety disorders, such
cognitions appear repeatedly
and make anxiety worse.
Biology and Anxiety: Genes
Studies show that
identical twins, even
develop similar phobias
(more similar than two
Some people seem to
have an inborn highstrung temperament,
while others are more
Temperament may be
encoded in our genes.
Genes regulate levels of
People with anxiety have
problems with a gene
associated with levels of
serotonin, a neurotransmitter
involved in regulating sleep
People with anxiety also have
a gene that triggers high levels
of glutamate, an excitatory
neurotransmitter involved in
the brain’s alarm centers.
Biology and Anxiety: The Brain
experiences can burn
fear circuits into the
circuits are later
of brain areas
involved in impulse
control and habitual
The OCD brain shows extra
activity in the ACC, which
monitors our actions and checks
ACC = anterior cingulate gyrus
Biology and Anxiety:
An Evolutionary Perspective
1. Human phobic objects: 2. Similar but non-phobic objects:
Heights Low places
Closed spaces Open spaces
Darkness Bright light
3. Dangerous yet non-phobic subjects:
We are likely to become cautious about, but not phobic about:
Evolutionary psychologists believe that ancestors
prone to fear the items on list #1 were less likely to
die before reproducing.
There has not been time for the innate fear of list #3
(the gun list) to spread in the population.
Mood Disorders: Not just feeling
“down;” not just sad about something
Major Depressive Disorder: Stuck in dark withdrawal
Bipolar Disorder: sometimes fleeing depression into
Prevalence and Course of depression: Common, but
for many it goes away
Genetic Influences on Depression
Suicide and Self-Injury
Negative Moods and Negative thoughts: Explanatory
The vicious cycle: Interaction of bad experiences
depressive thoughts mood changes behavior
changes more sad days
Major depressive disorder [MDD] is:
more than just feeling “down.”
more than just feeling sad
Bipolar disorder is:
more than “mood swings.”
depression plus the problematic
overly “up” mood called “mania.”
Criteria of Major Depressive Disorders
Major depressive disorder is not just one of these symptoms.
It is one or both of the first two, PLUS three or more of the
Depressed mood most of the day, and/or
Markedly diminished interest or pleasure in activities
Significant increase or decrease in appetite or weight
Insomnia, sleeping too much, or disrupted sleep
Lethargy, or physical agitation
Fatigue or loss of energy nearly every day
Worthlessness, or excessive/inappropriate guilt
Daily problems in thinking, concentrating, and/or
Recurring thoughts of death and suicide
Depression is Everywhere
Depression shows up in people
Phobias are the most
experienced) disorder, but
depression is the #1 reason
people seek mental health
Depression appears worldwide:
Per year, depressive
episodes happen to about 6
percent of men and about 9
percent of women.
Over the course of a
lifetime, 12 percent of
Canadians and 17 percent of
USA residents experience
Depression: The “Common Cold” of
Although both are “common”
(occurring frequently and pervasively),
comparing depression to a cold doesn’t
is more dangerous because of
has fewer observable symptoms.
is more lasting than a cold, and is
less likely to go away just with time.
is much less contagious.
And…depressive pain is beyond sniffles.
Seasonal Affective Disorder [SAD]
Seasonal affective disorder is more than simply
Seasonal affective disorder involves a recurring
seasonal pattern of depression, usually during
winter’s short, dark, cold days.
Survey: “Have you cried today”? Result: More
people answer “yes” in winter.
Percentage who cried
Bipolar disorder was once
Bipolar disorder’s two
polar opposite moods are
depression and mania.
Mania refers to a period of
hyper-elevated mood that
is euphoric, giddy, easily
impulsive, overly optimistic,
and even grandiose.
Depressed mood: stuck feeling
Mania: euphoric, giddy, easily
hypersociality and sexuality
lack of felt pleasure
delight in everything
inactivity and no initiative
impulsivity and overactivity
racing thoughts; the mind
fatigue and excessive desire to
won’t settle down
little desire for sleep
Bipolar Disorder and Creative Success
Many famous and successful people have lived with the
ups and downs of bipolar disorder. Some speculate that
the depressive periods gave them ideas, and the manic
episodes gave them creative energy. Any evidence of
mood swings here?
Bipolar Disorder in Children and
Does bipolar disorder
show up before
adulthood, and even
Many young people have
cycles from depression
to extended rage rather
The DSM-V may have a
new diagnosis for some
of these kids: disruptive
Understanding Mood Disorders
Why are mood disorders so pervasive,
especially among women?
Women, starting in adolescence, appear to ruminate
more, have deeper sadness then men, encounter more
stressors, and report their depression more readily.
Understanding Mood Disorders
Can we explain…
Why does depression often go
away on its own?
the course/development of
Often, time heals a mood
disorder, especially when the
mood issue is in reaction to a
stressful event. However, a
significant proportion of
people with major depressive
disorder do not automatically
or easily get better with time.
Understanding Mood Disorders
Biological aspects and
Negative thoughts and
The vicious cycle
An Evolutionary Perspective on the
Biology of Depression
Depression, in its milder, nondisordered form, may have
had survival value.
Under stress, depression is
It allows humans to:
avoid conflicts and other
let go of unattainable
take time to contemplate.
Biology of Depression: Genetics
Evidence of genetic influence on depression:
1. DNA linkage analysis reveals depressed gene regions
2. twin/adoption heritability studies
Biology of Depression: The Brain
Brain activity is diminished in depression and increased in mania.
Brain structure: smaller frontal lobes in depression and fewer
axons in bipolar disorder
Brain cell communication (neurotransmitters):
more norepinephrine (arousing) in mania, less in depression
reduced serotonin in depression
Suicide and Self-Injury
Every year, 1 million people commit suicide, giving up
on the process of trying to cope and improve their
This can happen when people feel frustrated,
trapped, isolated, ineffective, and see no end to
Non-suicidal self-injury has other functions such as
sending a message, distracting from emotional pain,
giving oneself permission to feel, or self-punishment.
Understanding Mood Disorders:
The Social-Cognitive Perspective
information and assuming the
worst about self, situation,
and the future
beliefs such as
one (self) is
unable to cope,
or be happy
Stuck focusing on
Depressive Explanatory Style
How we analyze bad news predicts mood.
The problem is:
The problem is:
The problem is:
goes along with
Depression’s Vicious Cycle
A depressed mood may develop when a person with a
negative outlook experiences repeated stress.
a person’s style
of thinking and
interacting in a
way that makes
Split from reality and from self
Unusual emotions and
actions, including flat
affect, and catatonia
Onset and course
Causes of symptoms:
anatomy and activity
Maternal virus during
to a mental split
from reality and
the mind is split from reality, e.g.
a split from one’s own thoughts
so that they appear as
Positive and Negative Symptoms of
Disorganized thought and
Negative absence of
Flat affect (no emotion
showing in the face)
Reduced social interaction
Anhedonia (no feeling of
Avolition (less motivation,
initiative, focus on tasks)
Alogia (speaking less)
Catatonia (moving less)
Problems in Thinking and Speaking
including the “word salad”
of loosely associated
Delusions (illusory beliefs),
often bizarre and not just
mistaken; most common
are delusions of grandeur
and of persecution
Problems with selective
filtering thoughts and
choosing which thoughts to
believe and to say out loud
People with schizophrenia often
experience hallucinations, that is,
perceptual experiences not
shared by others.
The most common form of
hallucination is hearing voices
that no one else hears, often with
upsetting (e.g. shaming) content.
Hallucinations can also be visual,
olfactory/smells, tactile/touch, or
Am I evil?
Inappropriate Emotions and Actions
Odd and socially inappropriate
responses such as looking bored or
amused while hearing of a death
Flat affect: facial/body expression is
“flat” with no visible emotional
Impaired perception of emotions,
including not “reading” others’
intentions and feelings
The schizophrenic body exhibits
symptoms such as:
repetitive behaviors such as rocking
catatonia, such as sitting motionless
and unresponsive for hours.
appear at the end of
adolescence and in early
adulthood, later for women
than for men.
Prevalence: Nearly 1 in 100
more men than women.
Development: The course
of schizophrenia can be
acute/reactive or chronic.
In reaction to stress, some
people develop positive
symptoms such as
– Recovery is likely.
develops slowly, with more
negative symptoms .
– With treatment and
support, there may be
periods of a normal life,
but not a cure.
– Without treatment, this
type of schizophrenia
often leads to poverty and
Subtypes of Schizophrenia
• Plagued by hallucinations, often with negative
messages, and delusions, both grandiose and
• Primary symptoms are flat affect, incoherent speech,
and random behavior
• Rarely initiating or controlling movement; copies
others’ speech and actions
• Many varied symptoms
• Withdrawal continues after positive symptoms have
What’s going on in
the brain in
structure and activity
Too many dopamine/D4 receptors
help to explain paranoia and
hallucinations; it’s like taking
amphetamine overdoses all the time.
Poor coordination of neural firing in
the frontal lobes impairs judgment
The thalamus fires during
hallucinations as if real sensations
were being received.
There is general shrinking of many
brain areas and connections between
Are there biological risk factors
affecting early development?
Biological Risk Factors
Schizophrenia is somewhat more likely
to develop when one or more of these
factors is present:
low birth weight
older paternal age
oxygen deprivation during delivery
maternal virus during mid-pregnancy
impairing brain development
Schizophrenia is more
likely to develop in
during and after flu
in densely populated
a few months after
after mothers had
the flu during the
second trimester, or
The lesson is to:
get flu shots
with early fall
Are there genetic risk factors? If
so, we would see more similar
schizophrenia risk shared
between identical twins than
fraternal twins (graph below). Do
If one twin has
chance of the other one
also having it are much
greater if the twins are
Having adoptive siblings
(or parents) with
schizophrenia does not
increase the likelihood
Genetic and Prenatal Causes
Even in quadruplets, genetics do not
fully predict schizophrenia.
This could be because of
First difference: twins in separate
Only one of two twins has the enlarged
ventricles seen in schizophrenia.
genes and all have
at different levels
of severity: genes
may interact with
Other Disorders, Including Dissociative,
Personality, and Eating Disorders
A sample of a few of the many other psychological disorders
Disorder: Is it real?
How could it happen?
problems relating to
Focus on Antisocial
Overlap with criminal
Genes and social causes
Anorexia and Bulimia
Genes and social causes
Dissociation: a separation of
conscious awareness from
thoughts, memory, bodily
sensations, feelings, or even
dysfunction and distress caused
by chronic and severe
Fugue = “Running away”; wandering away from one’s
life, memory, and identity, with no memory of them
Development of separate personalities
Dissociative Identity Disorder (D.I.D.)
formerly “Multiple Personality Disorder”
In the rare actual cases of
D.I.D., the personalities:
are distinct, and not
present in consciousness
at the same time.
may or may not appear to
be aware of each other.
might just be an extreme
form of playing a role.
D.I.D. in North America
might be a recent cultural
construction, similar to the
idea of being possessed by
Cases of D.I.D. might be
created or worsened by
people to think of different
parts of themselves.
D.I.D., or DID Not?
Evidence that D.I.D. is Real
Different personalities have
different brain wave
different visual acuity and
eye muscle balance
Patients with D.I.D. also show
heightened activity in areas of
the brain associated with
managing and inhibiting
of personality from
coping with abuse
These may involve:
unrealistic body image and
extreme body ideal.
a desire to control food and the
body when one’s situation can’t
cycles of depression.
Compulsion to lose weight,
coupled with certainty about being meet criteria at
fat despite being 15 percent or
Compulsion to binge, eating large
amounts fast, then purge by losing
the food through vomiting,
laxatives, and extreme exercise
Compulsion to binge, followed by
guilt and depression
Eating Disorders: Associated Factors
having a mother focused on her
weight, and on child’s appearance
negative self-evaluation in the family
for bulimia, if childhood obesity runs
in the family
for anorexia, if families are
competitive, high-achieving, and
unrealistic ideals of body appearance
are enduring patterns of
social and other
behavior that impair
There are three “clusters”/categories of personality
Anxious: e.g., Avoidant P.D., ruled by fear of social
Eccentric/Odd: e.g. Schizoid P.D., with flat affect,
no social attachments
Dramatic: e.g. Histrionic, attention-seeking;
narcissistic, self-centered; antisocial, amoral
Antisocial Personality Disorder [APD]
conscience, without a
sense of guilt for harm
done to others
(strangers and family
The diagnostic criteria
include a pattern of
violating the rights of
others since age 15,
including three of these:
Disregard for safety of self or
Failure to conform to social
Lack of remorse
Impulsivity and failure to plan
Irresponsibility regarding jobs,
family, and money
Which Kids May Develop APD as Adults?
About half of children with
behavior develop lifelong
Which kids are at risk?
those who in preschool
unconcerned with social
rewards, and low in
those who endured
child abuse, and/or
Biological APD Risk Factors
Antisocial or unemotional
biological relatives increases risk.
Some associated genes have
Lower levels of stress hormones
and low physiological arousal in
Fear conditioning is impaired.
Reduced prefrontal cortex tissue
leads to impulsivity.
Substance dependence is more
Antisocial PD ≠ Criminality
Many career criminals do show empathy and
selflessness with family and friends.
Many people with A.P.D. do not commit crimes.
Antisocial Crime: Associated factors
personality disorder is
not a full picture of most
criminal activity, what
can we say about people
who commit crime,
especially violent crime?
Lower levels of
(measured here as
adrenaline levels) under
stress may enable taking
violent action without
feeling anxiety or panic.
Biosocial Roots of Crime: The Brain
seem to have
less tissue and
activity in the
part of the
Other differences include:
less amygdala response when viewing violence.
an overactive dopamine reward-seeking system.
How common are
Countries vary greatly in the percentage of people reporting
mental health issues in the past year.
This list takes a closer
look at the past-year
prevalence of various
mental health diagnoses
in the United States.
Vulnerable factors and ages for
developing Mental Disorders
Who is vulnerable to
• Poverty increases the risk
of many mental disorders
including aggression and
anxiety. Disorders decrease
when poverty is lifted.
• “Immigrant paradox”:
Despite the stress of
immigrating, those who
immigrate to the U.S.A.
have a lower risk of
disorders than their
children born in the U.S.A.
Age of vulnerability:
• Many disorders begin to show
symptoms by early
• Developing on average
around age 20: OCD,
• Showing some signs earlier:
Phobias (median age 10) and
antisocial personality disorder
(some symptoms by age 8)
• Developing later than 20:
Major Depressive Disorder.
Outcomes for People with Psychological
There are risks to be watchful of, obstacles
to be overcome, and improvements to be
made, often with the help of with
Some people with psychological
disorders do not recover.
Some achieve greatness, even with a