Exploring 9e

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Transcript Exploring 9e

Chapter 14
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
 Schizophrenia
 Sample of other disorders:
 Dissociative disorders
 Eating disorders
 Personality disorders
 Rates of Diagnosis with Disorders
Why Learn about Psychological Disorders?
Reasons for curiosity:
 personal familiarity with
psychological symptoms
 knowing someone else
with the disorder
 hearing about how
prevalent and socially
devastating some
disorders have become in
 wanting to learn more
about mental health and
human nature
Perspectives on Psychological Disorders
 Defining psychological
 Thinking critically about
 Understanding
psychological disorders
 Classifying
psychological disorders
 Labeling psychological
 Insanity and
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
behavior/mental state?
Can we use our diagnostic labels to
guide treatment rather than to
stigmatize people?
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
about disorders:
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
Is Attention-Deficit/Hyperactivity
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
Psychological Disorders
 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,
caging/restraint, and
Pinel’s New Approach
 Philippe Pinel (1745-1826) proposed that
mental disorders were not caused by
demonic possession, but by stress and
inhumane conditions.
 Pinel’s “moral treatment” involved
gentleness, nature, and social interaction.
Pinel’s interventions
improved lives but
often did not
effectively treat mental
The Medical
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
the mind.
 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
mental health.
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
a disorder.
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
associated symptoms.
2. Diagnoses allow us to
statistically study
many similar cases,
learning to predict
3. Diagnoses can guide
treatment choices.
The Diagnostic and
Statistical Manual
It’s easier to count
cases of autism if we
have a clear
Versions: DSM-IV-TR,
DSM-V (May 2013)
The DSM is used to
justify payment for
It’s consistent with
diagnoses used by
medical doctors
The Five “Axes” of Diagnosis
The DSM suggests describing someone not just with a label
but with a five-part picture.
Axis I:
Axis II:
Axis III:
Axis IV:
Axis V:
Is a clinical Is a personality Is a general
What is the
disorder or
assessment of
such as
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
or more
select one of
these two
Categories of
Categories 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
necessarily deviant?
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.
 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
increased violence.
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
 Generalized Anxiety
Disorder: Painful
 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
help it
 PTSD: Stuck Reexperiencing Trauma
Causes of Anxiety
 Fear Conditioning
 Observational
 Genetic/Evolutionary
 Brain involvement
GAD: Generalized
Anxiety Disorder
 Emotional-cognitive
symptoms include worrying,
having anxious feelings and
thoughts about many
subjects, and sometimes
“free-floating” anxiety with
no attachment to any subject.
Anxious anticipation
interferes with concentration.
 Physical symptoms include
autonomic arousal,
trembling, sweating,
fidgeting, agitation, and sleep
Panic Disorder:
“I’m Dying”
A panic attack is not just an
“anxiety attack.” It may include:
 many minutes of intense dread
or terror.
 chest pains, choking,
numbness, or other frightening
physical sensations.
 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.
Specific Phobia
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
ME!!!”--the uncontrollable,
irrational, intense desire to avoid
the object of the phobia.
Some Fears and Phobias
Which varies
more, fear or
What does
this imply?
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.
Post-Traumatic Stress
Disorder [PTSD]
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
those memories.
 nightmares and other reexperiencing.
 social withdrawal or phobic
 jumpy anxiety or
 insomnia or sleep problems.
Which people develop PTSD?
 Those with sensitive
emotion-processing limbic
 Those who are asked to
relive their trauma as they
report it
 Those previously
Understanding Anxiety Disorders:
Explanations from Different Perspectives
a conditioned
predisposed to
some fears
The Brain:
active anxiety
uncertainty is
surviving by
avoiding danger
Classical Conditioning
and Anxiety
Operant Conditioning
and Anxiety
 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
conditioned response
becomes overgeneralized.
We may begin to fear all
animals, everything fluffy,
all experimenters.
 The result is a phobia or
generalized anxiety.
 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
Learning and
 Experiments with humans
and monkeys show that
anxiety can be acquired
through observational
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 and
 Cognition includes worried
thoughts, as well as
interpretations, appraisals,
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
raised separately,
develop similar phobias
(more similar than two
unrelated people).
 Some people seem to
have an inborn highstrung temperament,
while others are more
 Temperament may be
encoded in our genes.
Genes and
 Genes regulate levels of
 People with anxiety have
problems with a gene
associated with levels of
serotonin, a neurotransmitter
involved in regulating sleep
and mood.
 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
 Traumatic
experiences can burn
fear circuits into the
amygdala; these
circuits are later
triggered and
 Anxiety disorders
include overarousal
of brain areas
involved in impulse
control and habitual
The OCD brain shows extra
activity in the ACC, which
monitors our actions and checks
for errors.
ACC = anterior cingulate gyrus
Biology and Anxiety:
An Evolutionary Perspective
1. Human phobic objects: 2. Similar but non-phobic objects:
Snakes Fish
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:
Electric wiring
 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
Mood Disorders
Major depressive disorder [MDD] is:
 more than just feeling “down.”
 more than just feeling sad
about something.
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
making decisions
 Recurring thoughts of death and suicide
Depression is Everywhere
Depression shows up in people
seeking treatment:
 Phobias are the most
common (frequently
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
suicide risk.
 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
disliking winter.
 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
 Bipolar disorder was once
called “manic-depressive
 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
irritated, hyperactive,
impulsive, overly optimistic,
and even grandiose.
Contrasting Symptoms
Depressed mood: stuck feeling
Mania: euphoric, giddy, easily
“down,” with:
irritated, with:
 exaggerated pessimism
 exaggerated optimism
 social withdrawal
 hypersociality and sexuality
 lack of felt pleasure
 delight in everything
 inactivity and no initiative
 impulsivity and overactivity
 difficulty focusing
 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
before puberty?
 Many young people have
cycles from depression
to extended rage rather
than mania.
 The DSM-V may have a
new diagnosis for some
of these kids: disruptive
mood dysregulation
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
reactive depression?
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
Social-cognitive aspects
and explanations
Brain /Body
Negative thoughts and
negative mood
Explanatory style
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
social-emotional hibernation.
It allows humans to:
 conserve energy.
 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
emotional well-being.
 This can happen when people feel frustrated,
trapped, isolated, ineffective, and see no end to
these feelings.
 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
Low SelfEsteem
Discounting positive
information and assuming the
worst about self, situation,
and the future
beliefs such as
assuming that
one (self) is
unable to cope,
improve, achieve,
or be happy
Depression is
associated with:
Stuck focusing on
what’s bad
Depressive Explanatory Style
How we analyze bad news predicts mood.
Problematic event:
Assumptions about
the problem
The problem is:
The problem is:
The problem is:
Mood/result that
goes along with
these views:
Depression’s Vicious Cycle
A depressed mood may develop when a person with a
negative outlook experiences repeated stress.
The depressed
mood changes
a person’s style
of thinking and
interacting in a
way that makes
more likely.
Split from reality and from self
Schizophrenia symptoms:
 Disorganized thinking,
 Disturbed perceptions:
 Unusual emotions and
actions, including flat
affect, and catatonia
 Subtypes
 Onset and course
Causes of symptoms:
 Brain: Dopamine
 Abnormal brain
anatomy and activity
 Maternal virus during
 Associated genes
Psychosis refers
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
symptoms include:
 disorganized
 disturbed
 inappropriate
emotions and
Positive and Negative Symptoms of
Positive +
presence of
Hallucinations (illusory
perceptions), especially
Delusions (illusory
beliefs), especially
Disorganized thought and
nonsensical speech
Bizarre behaviors
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)
Schizophrenia Symptoms:
Problems in Thinking and Speaking
 Disorganized speech,
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
attention, difficulty
filtering thoughts and
choosing which thoughts to
believe and to say out loud
Schizophrenia Symptoms:
Disturbed Perceptions
 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?
You’re evil!
Schizophrenia Symptoms:
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
and rubbing.
 catatonia, such as sitting motionless
and unresponsive for hours.
Onset and
Development of
 Onset: Typically,
schizophrenic symptoms
appear at the end of
adolescence and in early
adulthood, later for women
than for men.
 Prevalence: Nearly 1 in 100
people develop
schizophrenia, slightly
more men than women.
 Development: The course
of schizophrenia can be
acute/reactive or chronic.
Course of
Acute/Reactive Schizophrenia
In reaction to stress, some
people develop positive
symptoms such as
– Recovery is likely.
Chronic/Process Schizophrenia
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
social problems.
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
Understanding Schizophrenia
What’s going on in
the brain in
Abnormal brain
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
and self-control.
 The thalamus fires during
hallucinations as if real sensations
were being received.
 There is general shrinking of many
brain areas and connections between
Understanding Schizophrenia
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
 maternal diabetes
 older paternal age
 famine
 oxygen deprivation during delivery
 maternal virus during mid-pregnancy
impairing brain development
Schizophrenia is more
likely to develop in
babies born:
 during and after flu
 in densely populated
 a few months after
flu season.
 after mothers had
the flu during the
second trimester, or
had antibodies
showing viral
 The lesson is to:
get flu shots
with early fall
Understanding Schizophrenia
Are there genetic risk factors? If
so, we would see more similar
schizophrenia risk shared
between identical twins than
fraternal twins (graph below). Do
Genetic Factors
If one twin has
schizophrenia, the
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
of developing
Understanding Schizophrenia
Genetic and Prenatal Causes
 Even in quadruplets, genetics do not
fully predict schizophrenia.
 This could be because of
environmental differences.
 First difference: twins in separate
Only one of two twins has the enlarged
ventricles seen in schizophrenia.
 The Genain
quadruplets share
genes and all have
schizophrenia but
at different levels
of severity: genes
may interact with
environment to
produce this
Other Disorders, Including Dissociative,
Personality, and Eating Disorders
A sample of a few of the many other psychological disorders
 Dissociative Disorders:
Separation of
 Dissociative Identity
Disorder: Is it real?
How could it happen?
 Personality Disorders:
Severe, enduring
problems relating to
Focus on Antisocial
Personality Disorder
 Overlap with criminal
 Brain differences
 Genes and social causes
Eating Disorders
 Anorexia and Bulimia
 Genes and social causes
 Dissociation: a separation of
conscious awareness from
thoughts, memory, bodily
sensations, feelings, or even
from identity.
 Dissociative disorder:
dysfunction and distress caused
by chronic and severe
Fugue state
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.
Alternative Explanations
for D.I.D.
 Dissociative “identities”
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
evil spirits.
 Cases of D.I.D. might be
created or worsened by
therapists encouraging
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 left-right
 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
traumatic memories.
Explaining fragmentation
of personality from
different perspectives
Psychoanalytic perspective:
diverting id
Cognitive perspective:
coping with abuse
Learning perspective:
dissociation pays
Social influence:
therapists encourage
Anorexia nervosa
Bulimia nervosa
Binge-eating disorder
These may involve:
 unrealistic body image and
extreme body ideal.
 a desire to control food and the
body when one’s situation can’t
be controlled.
 cycles of depression.
 health problems.
Compulsion to lose weight,
0.6 percent
coupled with certainty about being meet criteria at
fat despite being 15 percent or
some time
more underweight
during lifetime
Compulsion to binge, eating large
amounts fast, then purge by losing
1.0 percent
the food through vomiting,
laxatives, and extreme exercise
Compulsion to binge, followed by
2.8 percent
guilt and depression
Eating Disorders: Associated Factors
Family factors:
 having a mother focused on her
weight, and on child’s appearance
and weight
 negative self-evaluation in the family
 for bulimia, if childhood obesity runs
in the family
 for anorexia, if families are
competitive, high-achieving, and
Cultural factors:
 unrealistic ideals of body appearance
Personality disorders
are enduring patterns of
social and other
behavior that impair
social functioning.
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]
Antisocial personality
disorder: Persistently
acting without
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
persistent antisocial
behavior develop lifelong
Which kids are at risk?
Psychological factors:
 those who in preschool
were impulsive,
unconcerned with social
rewards, and low in
 those who endured
child abuse, and/or
inconsistent, unavailable
Biological APD Risk Factors
Antisocial or unemotional
biological relatives increases risk.
 Some associated genes have
been identified.
Lower levels of stress hormones
and low physiological arousal in
stressful situations
Fear conditioning is impaired.
Reduced prefrontal cortex tissue
leads to impulsivity.
Substance dependence is more
Antisocial PD ≠ Criminality
Criminals: people
who repeatedly
commit crimes
People with
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
Though antisocial
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
physiological arousal
(measured here as
adrenaline levels) under
stress may enable taking
violent action without
feeling anxiety or panic.
Biosocial Roots of Crime: The Brain
People who
commit murder
seem to have
less tissue and
activity in the
part of the
brain that
Other differences include:
 less amygdala response when viewing violence.
 an overactive dopamine reward-seeking system.
How common are
psychological disorders?
Countries vary greatly in the percentage of people reporting
mental health issues in the past year.
Rates of
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
mental disorders?
• 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,
Schizophrenia, Bipolar,
Alcohol Dependence.
• 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
psychological disorder.