Psychological Disorders Lecture Notes

Abnormal Behavior
 Term "abnormal behavior" is preferable to terms like mental illness
or psychotic because psychologists typically agree that not all
disorders have purely physical causes. Learning often contributes
to behavioral problems (such as phobias and stress).

 The public understanding of abnormal behavior is fairly limited.

Most people tend to be wary or even frightened when they
encounter behavior which seems very atypical. Stigma behind
mental illness.

 Because the boundary between normal and abnormal is so

subjective, psychologists have developed diagnostic criteria.

DSM IV
 Diagnostic and Statistical Manual of Mental Disorders
 Used to diagnose mental illnesses

Anxiety Disorders
Anxiety is an emotion in which there is an unpleasant emotional state,
which is characterized by physical arousal and feelings or tension,
apprehension, and worry
Anxiety Disorders are a category of mental disorders in which extreme
anxiety and cause significant disruptions in the person’s cognitive,
behavioral or interpersonal functioning
The anxiety is not within a “normal” range is often irrational (there is
nothing to worry about), it is uncontrollable (even if the person doesn’t
want to worry), and it is disruptive (it interferes with relationships, a
job, or school)

Generalized Anxiety Disorder

What is it?
Generalized anxiety disorder is the name for excessive worry and fear
about common activities or things, such as work, money, or health.
Often, this anxiety is not linked to a specific cause or situation. Anxiety
can become so overwhelming that it is difficult to carry on with normal
daily activities.
Diagnostic Criteria:
 Excessive anxiety and worry (apprehensive expectation), occurring
more days than not for at least 6 months, about a number of events
or activities (such as work or school performance
 The person finds it difficult to control the worry
 The anxiety and worry are associated with three (or more) of the
following six symptoms (with at least some symptoms present for
more days than not for the past 6 months)
1. restlessness or feeling keyed up or on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance (difficulty falling or staying asleep, or
restless unsatisfying sleep)
What are the symptoms?
The symptoms of generalized anxiety disorder range from feelings of
being tense, constantly tired, afraid, and being unable to make
decisions, to feeling restless and irritable. Physical symptoms include
nausea, vomiting, diarrhea, stomach pain, lack of appetite, shortness
of breath, chest pain, shaking, sweating, or muscle tension. Symptoms
can cause difficulty with concentration, loss of sleep, missed work, and
avoidance of social activities.
Who gets it?
 3 to 4% of the population has during the course of a year
 Usually begins in childhood or adolescence
 Affects more women than men
What causes it?
A number of events can cause generalized anxiety disorder, although it
is believed that some people are genetically predisposed to developing
it. Other causes can include childhood psychological traumas, moving,
changing jobs, divorce, or the death of a loved one. People who grow
up in a family where constant worrying is the norm may learn this
behavior. Sometimes a chemical imbalance in the brain cause
problems with two neurotransmitters called dopamine and serotonin.
Neurotransmitters are the brains chemical message carriers, but
sometimes their messages can’t get through because the nerve cells
they talk to can’t answer for some reason. This causes an imbalance,
and an imbalance of dopamine and serotonin can cause anxiety.
What is the treatment?
Generalized anxiety disorder can be treated very effectively with drugs
and psychotherapy. Anti-anxiety drugs called benzodiazepinescan help
ease the anxiety very quickly but are generally prescribed for only a
short time, then tapered off slowly to prevent addiction.
Antidepressant drugs may also be used. Psychotherapy can be very
effective because it helps people look to the source of the anxiety and
solve their underlying problems.

Panic Disorder
What is it?
Panic attacks are usually 2 to 10 minute periods of intense feelings of
fear, anxiety and physical discomfort that often seem to occur out of
the blue. People often mistake these attacks for heart attacks or
strokes. Common physical symptoms experienced are increased heart
rate, sweating, nausea, and dizziness. Additionally people may feel as
if they are losing self-control or may feel disconnected from their
environment.
First panic attacks are unexpected. This means that they happen in the
absence of a stress or anxiety-provoking situation. Feeling anxiety
during stressful times such as finals week is natural. However, when
one has attacks of extreme anxiety during normal, non-stressful
everyday activities, it might be a panic attack.
Diagnostic Criteria:
 Recurrent unexpected Panic Attacks
o (Criteria for Panic Attack: A discrete period of intense
fear or discomfort, in which four (or more) of the following
symptoms developed abruptly and reached a peak within 10
minutes: palpitations, pounding heart, or accelerated heart
rate, sweating, trembling or shaking, sensations of shortness
of breath or smothering, feeling of choking, chest pain or
discomfort etc.)
 At least one of the attacks has been followed by 1 month (or
more) of one (or more) of the following:
A. persistent concern about having additional attacks
B. worry about the implications of the attack or its
consequences (e.g., losing control, having a heart attack,
"going crazy")
C. a significant change in behavior related to the attacks
  The Panic Attacks are not due to the direct physiological
effects of a substance (e.g., a drug of abuse, a medication) or a
general medical condition (e.g., hyperthyroidism) or another
disorder

What Is The Difference Between A Panic Attack and Panic

Disorder?
Approximately 15% of the population will experience panic attacks at
some time in their lives, but these are not all considered panic
disorder. According to the American Psychiatric Association, people are
diagnosed with a panic disorder if they have reoccurring unexpected
panic attacks and experience psychological distress as a result.
Persons with panic disorders often continually worry about when their
next attack will occur. They may fear that they have a life-threatening
illness that has not been diagnosed. Some people feel as if they are
"going crazy." Others will make significant life changes, such as
quitting a job. Most people develop this condition between late
adolescence and the mid thirties.
When and Where Do Panic Attacks Occur?
Panic attacks usually occur during waking hours, but they may also
happen while asleep. These episodes may be unexpected or may occur
in specific situations. Most often the person’s first attacks happen
unexpectedly, but then become associated with the context in which
they occurred. For example if a person had a panic attack in a grocery
store, that individual might develop a fear of being in that store. When
in the same situation, that person might anticipate a panic attack,
which might then trigger one. This often leads to phobias or irrational
fears of certain places or objects.
Are There Different Types?
Panic disorder can be divided into two types: panic disorder with
agoraphobia and panic disorder without agoraphobia. This phobia
refers to anxiety about being in places where escape would be difficult.
As a result, individuals with agoraphobia avoid situations such as being
in a crowd, traveling by airplane, or even leaving the house by
themselves. If they attempt to be in these situations, they do so with
considerable distress. In panic disorder without agoraphobia, the
individual has panic attacks, without any specific phobias.
Who has it?
 About 1.7% of the population in a given year
 Women twice as likely to have disorder
 Usually presents in young adulthood
  Between one-third to one-half are also agoraphobic
What are the causes?
The precise causes of panic disorders are unknown. However, there is
some evidence that panic disorders may be genetic. There have been
speculations about different biological causes for panic disorder such
as an over-excited nervous system or carbon dioxide levels in the
body.

What is the treatment?

Psychotherapy may be helpful for treating panic disorder by helping to
develop coping and relaxation skills. In panic disorder with
agoraphobia, therapy can help reduce anxiety about the feared
situation and help the person to function better. Some anti-anxiety
medications such as benzodiazepines (Xanax and Valium) may also
help treat panic disorder.

1. Specific Phobia
What is it?
Specific phobia is characterized by extreme fear of an object or
situation that is not harmful under general conditions.
Examples include a fear of:
• flying (fearing the plane will crash)
• dogs (fearing the dog will bite/attack)
• closed-in places (fear of being trapped)
• tunnels (fearing a collapse)
• heights (fear of falling)
Diagnostic Criteria:
 Marked and persistent fear that is excessive or unreasonable,
cued by the presence or anticipation of a specific object or
situation (e.g., flying, heights, animals, receiving an injection,
seeing blood).
 Exposure to the phobic stimulus almost invariably provokes an
immediate anxiety response, which may take the form of a
situationally bound or situationally predisposed Panic Attack.
 The person recognizes that the fear is excessive or
unreasonable.
 The phobic situation(s) is avoided or else is endured with intense
anxiety or distress.
  The avoidance, anxious anticipation, or distress in the feared
situation(s) interferes significantly with the person's normal
routine, occupational (or academic) functioning, or social
activities or relationships, or there is marked distress about
having the phobia.
 In individuals under age 18 years, the duration is at least 6
months.
What are the symptoms?
People with specific phobias know that their fear is excessive, but are
unable to overcome their emotion. The disorder is diagnosed only
when the specific fear interferes with daily activities of school, work, or
home life.
Who gets it?
Specific phobias strike more than 1 in 10 people. There is no known
cause, although they seem to run in families and are slightly more
prevalent in women.
If the object of the fear is easy to avoid, people with phobias may not
feel the need to seek treatment.
Treatment for specific phobia:
There is currently no proven drug treatment for specific phobias, but
sometimes certain medications may be prescribed to help reduce
anxiety symptoms before someone faces a phobic situation.
When phobias interfere with a person's life, treatment can help, and
usually involves a kind of cognitive-behavioral therapy called
desensitization or exposure therapy. In this, patients are gradually
exposed to what frightens them until the fear begins to fade.
Relaxation and breathing exercises also help to reduce anxiety
symptoms.
Unusual Phobias: SLIDE
Amathophobia – fear of dust
Anemophobia – fear of wind
Ergophobia – fear of work or responsibility
Erythrophobia – fear of red objects
Phobophobia – fear of acquiring a phobia
Triskaidekaphobia – fear of the number 13
2. Obsessive-Compulsive Disorder (OCD)
What is it?
Obsessive-Compulsive Disorder (OCD) is a type of anxiety disorder.
People with OCD have repeated unwanted thoughts, ideas, images, or
impulses, called obsessions, over which they feel they have no control.
To make these thoughts or images go away and to relieve the anxiety
they cause, people with OCD perform some action over and over again.
This is called a compulsion. For example, people with an obsession
about germs might wash their hands over and over again to relieve
their anxiety.
Diagnostic Criteria:
 Either obsessions or compulsions:
 Obsessions as defined by (1), (2), (3), and (4):
1. recurrent and persistent thoughts, impulses, or images
that are experienced, at some time during the disturbance, as
intrusive and inappropriate and that cause marked anxiety or
distress
2. the thoughts, impulses, or images are not simply excessive
worries about real-life problems
3. the person attempts to ignore or suppress such thoughts,
impulses, or images, or to neutralize them with some other
thought or action
4. The person recognizes that the obsessive thoughts,
impulses, or images are a product of his or her own mind (not
imposed from without as in thought insertion)
 Compulsions as defined by (1) and (2):
1. repetitive behaviors (e.g., hand washing, ordering,
checking) or mental acts (e.g., praying, counting, repeating
words silently) that the person feels driven to perform in
response to an obsession, or according to rules that must be
applied rigidly
2. the behaviors or mental acts are aimed at preventing or
reducing distress or preventing some dreaded event or situation;
however, these behaviors or mental acts either are not
connected in a realistic way with what they are designed to
neutralize or prevent or are clearly excessive
 At some point during the course of the disorder, the person has
recognized that the obsessions or compulsions are excessive or
unreasonable.
  The obsessions or compulsions cause marked distress, are time
consuming (take more than 1 hour a day), or significantly interfere
with the person's normal routine, occupational (or academic)
functioning, or usual social activities or relationships.
Who gets it?
Obsessive-Compulsive Disorder (OCD) occurs equally in men and
women. OCD usually starts during childhood or the teenage years, and
can last a lifetime. Approximately 2.3% of adult Americans have OCD.
This condition can run in families.
What causes it?
The tendency toward OCD appears be inherited because, in
approximately 25% of all cases of OCD, another family member also
has the disorder. Other research has found that some parts of the
brain work differently in people with OCD. This could be caused by a
chemical imbalance or an overactive portion of the brain responsible
for repetitive behavior. Because certain drugs that affect the levels of
serotonin in the brain are effective in treating OCD, there also appears
to be a link between OCD and serotonin.
What are the symptoms?
Symptoms of OCD can range from mild to severe. In most cases,
people know their obsessions do not represent true dangers and
realize their compulsive behavior is strange or bizarre. However, deep
down they are afraid that their fears might be real, and that something
bad might happen if they don't act on them. People with mild OCD may
check repeatedly whether they've locked the door or turned off the
light. Their symptoms do not interfere with everyday life, however, and
they may even successfully hide them from others. In severe cases,
people with OCD may spend hours on compulsive behaviors. Their
symptoms prevent them from living their lives fully and from having
normal relationships with others. The most common obsessions and
compulsions of people with OCD include checking repeatedly, which
usually results from a fear of harm to self or others; cleaning, due to a
fear of germs; hoarding items that are repeatedly counted or arranged;
repeating a name or phrase or touching something a certain number of
times to reduce anxiety; and performing a series of steps in a certain
order or doing them over and over until perfect, again to reduce
anxiety or protect the person from some unfounded fear. People may
have obsessions without compulsions, and vice versa. People with OCD
may also be preoccupied with religious feelings, sexual thoughts, and
the need for order and symmetry.
What is the treatment?
A combination of medication and therapy are used to help symptoms.
Certain medications called serotonin reuptake inhibitors (SSRIs)
regulate the brain's serotonin levels, which can help control obsessive-
compulsive behaviors. These medications include fluoxetine,
fluvoxamine, paroxetine, and sertraline. Therapy involves talking with
someone who is trained in techniques for coping with stress and
anxiety. A technique called exposure and response prevention is often
effective. The patient is exposed to the obsessive thought, then taught
ways to prevent the body's response to the anxiety.
Mood Disorders
Category of mental disorders in which a person has significant and
chronic disruption in mood which cause impaired cognitive, behavioral,
and physical functioning
Treated with antidepressant medication
Causes include genetic predisposition, chemical imbalance or stress
1. Major Depression
What is it?
Depression is a strong feeling of sadness. Many people experience
depression in response to a loss or sad event. In these cases, an
episode of depression usually lasts for six to nine months. However,
when depression lasts longer, and the depressive symptoms go away
for a short time only to return again, it is termed chronic depression.
While everyone experiences sadness at one time or another, these
feelings are generally temporary. Chronic depression is long-lasting,
interferes with daily activities, and causes a loss of interest in things
that were normally pleasurable to the patient.
Diagnostic Criteria:
 At least one of the following three abnormal moods which
significantly interfered with the person's life:
1. Abnormal depressed mood most of the day, nearly
every day, for at least 2 weeks.
2. Abnormal loss of all interest and pleasure most of the
day, nearly every day, for at least 2 weeks.
3. If 18 or younger, abnormal irritable mood most of the
day, nearly every day, for at least 2 weeks.
 At least five of the following symptoms have been present
during the same 2 week depressed period.
1. Abnormal depressed mood (or irritable mood if a child or
adolescent) [as defined in criterion A].
2. Abnormal loss of all interest and pleasure [as defined in
criterion A2].
 3. Appetite or weight disturbance, either:
4. Abnormal weight loss (when not dieting) or decrease in
appetite.
5. Abnormal weight gain or increase in appetite.
6. Sleep disturbance, either abnormal insomnia or abnormal
hypersomnia.
7. Activity disturbance, either abnormal agitation or abnormal
slowing (observable by others).
8. Abnormal fatigue or loss of energy.
9. Abnormal self-reproach or inappropriate guilt.
10. Abnormal poor concentration or indecisiveness.
11. Abnormal morbid thoughts of death (not just fear of
dying) or suicide.
Who gets it?
 People who have a family history of anxiety, depression, or bipolar
disorder
 10% of adult Americans, more than 19 million people in a given
year
 Twice as many women as men
What causes it?
While depression is frequently a response to a sad or traumatic event,
the cause of chronic depression is often not known. Factors that are
known to contribute to depression are heredity, a chemical imbalance
in the brain, and significant levels of stress. Heredity refers to the fact
that people who have family members with any type of depressive
disorder are more likely to also experience depression. Studies of brain
functioning have revealed a complex system of neurotransmitters that
produce chemicals that transfer signals from nerve cell to nerve cell.
Some of these neurotransmitters, such as serotonin, are responsible
for feelings of well-being.
What are the symptoms?
The symptoms of chronic depression may come and go, with periods of
depression alternating with periods of no symptoms at all. Chronic
depression usually begins gradually, with vague feelings of sadness
that gradually build in intensity. The individual may begin to have
difficulty sleeping, or want to sleep more than usual. He or she may
experience changes in eating habits, feelings of hopelessness, low self-
esteem, low energy levels, restlessness, loss of interest in normal
activities, decreased sex drive, feelings of guilt for no reason, difficulty
maintaining relationships, and difficulty concentrating. In severe cases,
the individual may have thoughts of death, or may attempt suicide.
People with chronic depression have at least two of these symptoms
for a period of two years or more. People with chronic depression are
generally gloomy and extremely critical of themselves and others.
They are usually seen as extremely negative people, who seem to
expect failure and take no pleasure in anything.
What is the treatment?
Chronic depression is commonly treated with a combination of drug
and psychotherapy. Drugs are used to treat the symptoms of sadness
and to correct any chemical imbalances in the brain that contribute to
depression. Therapy helps to resolve any personal issues that may
have caused the depression.

2. Bipolar Disorder
What is it?
Bipolar disorder is a serious mental illness marked by mood shifts and
episodes of depression and mania. The Diagnostic and Statistical
Manual of Mental Disorders lists four separate categories of bipolar
disorder: bipolar I, bipolar II, cyclothymia, and bipolar not-otherwise-
specified (NOS).
Bipolar I is marked by manic episodes followed by periods of
depression that may not be severe. In contrast, Bipolar II is marked by
major depressive episodes and hypomanic periods, or milder episodes
of mania. Cyclothymia is defined as episodes of hypomania and
depressive periods that do not reach major depressive proportions.
Bipolar NOS means that the bipolar state does not fit into the other
categories.
Diagnostic Criteria:
 Combination of Depressive and Manic episodes
Manic Episodes:
 A distinct period of abnormally and persistently elevated,
expansive, or irritable mood, lasting at least 1 week (or any duration
if hospitalization is necessary).
 During the period of mood disturbance, three (or more) of the
following symptoms have persisted (four if the mood is only
irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours
of sleep)
 3. more talkative than usual or pressure to keep talking
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day
(observable by others, not merely subjective feelings of
restlessness or being slowed down)
6. flight of ideas or subjective experience that thoughts are
racing
7. distractibility (i.e., attention too easily drawn to unimportant
or irrelevant external stimuli)
8. increase in goal-directed activity (either socially, at work or
school, or sexually) or psychomotor agitation
9. excessive involvement in pleasurable activities that have a
high potential for painful consequences (e.g., engaging in
unrestrained buying sprees, sexual indiscretions, or foolish
business investments)
 The mood disturbance is sufficiently severe to cause marked
impairment in occupational functioning or in usual social activities
or relationships with others, or to necessitate hospitalization to
prevent harm to self or others, or there are psychotic features.
 The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication, or other treatment)
or a general medical condition (e.g., hyperthyroidism).
What are the symptoms?
An adult with bipolar disorder will have unusual or extreme shifts in
mood, energy and behavior that could interfere significantly with
normal life.
Manic symptoms include: extreme irritability or silliness, very high self-
esteem, increased energy, decreased need for sleep, talking quickly
and allowing no interruptions, hypersexuality, increased goal-directed
activity, risk-taking, and distraction.
Depressive symptoms include: persistent sadness or irritability, loss of
interest, significant change in appetite or body weight, difficulty
sleeping or excessive sleeping, loss of energy, feelings of
worthlessness or inappropriate guilt, difficulty concentrating, suicidal
thoughts.
Some bipolar patients’ episodes may coincide with seasonal changes,
having manic episodes in spring and summer months and depressive
episodes in fall and winter.
Who gets it?
 1% of the population – about 2.3 million adults
 Men and women are equally likely to develop disorder
 Commonly develops from adolescence through the early twenties
 People who have family members with emotional disorders may be
more susceptible to bipolar disorder
 Many patients with bipolar disorder have a history of substance
abuse
What causes it?
There is no clear cause of bipolar disorder. It may be genetic, the result
of substance abuse – especially cocaine – or caused by the presence of
calcium build-up in the cells.
Treatment
Bipolar disorder is treated with medications including a combination of
mood stabilizing agents, anti-depressants, anti-psychotics and
anticonvulsants. An individualized combination of the medications is
determined in order to regulate the patient’s manic and depressive
episodes. Psychotherapy and counseling may be used in combination
with medications.

Psychotic Disorders
1. Schizophrenia
What is it?
Schizophrenia is a serious brain disorder. It is a disease that makes it
difficult for a person to tell the difference between real and unreal
experiences, to think logically, to have normal emotional responses to
others, and to behave normally in social situations.
Diagnostic Criteria:
 Characteristic symptoms: Two (or more) of the following, each
present for a significant portion of time during a 1-month period (or
less if successfully treated):
1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or
incoherence)
4. grossly disorganized or catatonic behavior
5. negative symptoms (i.e., affective flattening, alogia, or
avolition)
 Social/occupational dysfunction: For a significant portion of the time
since the onset of the disturbance, one or more major areas of
 functioning such as work, interpersonal relations, or self-care are
markedly below the level achieved prior to the onset (or when the
onset is in childhood or adolescence, failure to achieve expected
level of interpersonal, academic, or occupational achievement).
What are the symptoms?
People with schizophrenia can have a variety of symptoms. Usually the
illness develops slowly over months or even years. At first, the
symptoms may not be noticed. For example, people may feel tense,
may have trouble sleeping, or have trouble concentrating. They
become isolated and withdrawn, and they do not make or keep friends.
As the illness progresses, psychotic symptoms develop:
Delusions -- false beliefs or thoughts with no basis in reality
Hallucinations -- hearing, seeing, or feeling things that are not there
Disordered thinking -- thoughts "jump" between completely
unrelated topics (the person may talk nonsense)
Catatonic behavior -- bizarre motor behavior marked by a decrease
in reactivity to the environment, or hyperactivity that is unrelated to
stimulus
Flat affect -- an appearance or mood that shows no emotion
No single characteristic is present in all types of schizophrenia. The risk
factors include a family history of schizophrenia.
How many people have it?
Schizophrenia is thought to affect about 1% of the population
worldwide.
What causes it?
Causes of schizophrenia:
1. Genetic Inheritance
Closer the family member is to you that has the disease the
more likely you are to develop it. It usually develops in
adolescence. However, this is not the sole cause because
even if both of your parents have the disease, you only have a
46% chance of developing it
 2. Environmental Factors
Often if a person has a predisposition for the disease and they
are presented a life situation that is more stress than they can
handle, they may develop the disease
3. Excessive Dopamine
In excessive amounts may cause an increased chance of
developing the disease. Drugs such as cocaine can cause too
much dopamine to be produced or released in the brain. The
drugs that are used to treat schizophrenia actually work by
blocking the dopamine action in the brain
What are the different types? SLIDE
1. Paranoid Schizophrenia
 Preoccupation with one or more delusions or frequent
auditory hallucinations.
 None of the following is prominent: disorganized speech,
disorganized or catatonic behavior, or flat or inappropriate
affect.
2. Disorganized Schizophrenia
 All of the following are prominent:
 disorganized speech
 disorganized behavior
 flat or inappropriate affect
 The criteria are not met for Catatonic Type.
3. Catatonic Schizophrenics
A type of Schizophrenia in which the clinical picture is
dominated by at least two of the following:
 motoric immobility as evidenced by catalepsy (including
waxy flexibility) or stupor
 excessive motor activity (that is apparently purposeless
and not influenced by external stimuli)
 extreme negativism (an apparently motiveless
resistance to all instructions or maintenance of a rigid
posture against attempts to be moved) or mutism
 peculiarities of voluntary movement as evidenced by
posturing (voluntary assumption of inappropriate or
bizarre postures)
  stereotyped movements, prominent mannerisms, or
prominent grimacing
 echolalia or echopraxia
4. Undifferentiated Schizophrenia
Catch all category
Show symptoms of schizophrenia, but won’t fit in one
category
Who gets it?
 Between 1/3 and half of all homeless people have disorder
 About 1% of population
 Far more likely to be victims of violence and crime than to commit
the acts themselves
 Only have an increased risk of violent behavior when untreated or
engaging in substance abuse

Personality Disorders
Characterized with inflexible, maladaptive patterns of thoughts,
emotions, or behaviors that go across a range of personal and social
situations
Behaviors and emotions are constant over time
Are different or odd compared to the person’s culture
Usually these disorders show up during adolescence or early adulthood
1. Antisocial Personality Disorder
Alternative names
Psychopathic personality; Sociopathic personality; Personality disorder
- antisocial
What is it?
Antisocial personality disorder is a psychiatric condition characterized
by chronic behavior that manipulates, exploits, or violates the rights of
others. This behavior is often criminal.
Personality disorders are chronic behavioral and relationship patterns
that interfere with a person's life over many years. To receive a
diagnosis of antisocial personality disorder, a person must have first
had behavior that qualifies for a diagnosis of conduct disorder during
childhood.
Diagnostic Criteria:
 There is a pervasive pattern of disregard for and violation of the
rights of others occurring since age 18 years, as indicated by three
(or more) of the following:
1. failure to conform to social norms with respect to lawful
behaviors as indicated by repeatedly performing acts that are
grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases,
or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated
physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to
sustain consistent work behavior or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or
rationalizing having hurt, mistreated, or stolen from another
What are the symptoms?
A person with antisocial personality disorder:
Breaks the law repeatedly
Lies, steals, and fights often
Disregards the safety of self and others
Demonstrates a lack of guilt
Had a childhood diagnosis (or symptoms consistent with) conduct
disorder
Individuals with antisocial personality disorder are often angry and
arrogant but may be capable of superficial wit and charm. They may
be adept at flattery and at manipulating the emotions of others. People
with antisocial personality disorder often have extensive substance
abuse and legal problems.
What causes it?
The cause of antisocial personality disorder is unknown, but genetic
factors and child abuse are believed to contribute to the development
of this condition. People with an antisocial or alcoholic parent are
increased risk.
Who gets it?
 About 3% of the male population and 1% of women
 Far more men than women are affected, and unsurprisingly, the
condition is common in prison populations.
How is it treated?
Antisocial personality disorder is considered one of the most difficult of
all personality disorders to treat. Individuals rarely seek treatment on
their own and may only initiate therapy when mandated by a court.
The efficacy of treatment for antisocial personality disorder is largely
unknown.
What is the prognosis?
Symptoms tend to peak during the late teenage years and early 20's
and may improve on their own by a person's 40's.

2. Borderline Personality Disorder

What is it?
Borderline personality disorder is a condition characterized by
impulsive actions, mood instability, and chaotic relationships.
Personality disorders are chronic patterns of behavior that impair
relationships and work. People with BPD are impulsive in areas that
have a potential for self-harm, such as drug use, drinking, and other
risk-taking behaviors.
Diagnostic Criteria:
 A pervasive pattern of instability of interpersonal relationships, self-
image, and affects, and marked impulsivity beginning by early
adulthood and present in a variety of contexts, as indicated by five
(or more) of the following:
1. frantic efforts to avoid real or imagined abandonment.
2. a pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization
and devaluation
3. identity disturbance: markedly and persistently unstable self-
image or sense of self
4. impulsivity in at least two areas that are potentially self-
damaging (e.g., spending, sex, substance abuse, reckless
driving, binge eating).
5. recurrent suicidal behavior, gestures, or threats, or self-
mutilating behavior
6. affective instability due to a marked reactivity of mood (e.g.,
intense episodic dysphoria, irritability, or anxiety usually
lasting a few hours and only rarely more than a few days)
7. chronic feelings of emptiness
 8. inappropriate, intense anger or difficulty controlling anger
(e.g., frequent displays of temper, constant anger, recurrent
physical fights)
9. transient, stress-related paranoid ideation or severe
dissociative symptoms
What are the symptoms?
Relationships with others are intense and unstable, swinging wildly
from love to hate and back again. People with BPD will engage in
frantic efforts to avoid real or imagined abandonment.
BPD patients may also have uncertainties about their identity or self-
image. They tend to see things in terms of extremes, either all good or
all bad. Such people also typically view themselves as victims of
circumstance and take little responsibility for themselves or their
problems.
Other symptoms include:
Frequent displays of inappropriate anger
Recurrent suicidal gestures such as wrist cutting, overdosing, or
self-mutilation
Feelings of emptiness and boredom
Intolerance of being alone
Impulsiveness with money, substance abuse, sexual relationships,
binge eating, or shoplifting
What causes it?
The cause of borderline personality disorder (BPD) is unknown.
Risk factors for BPD include abandonment issues in childhood or
adolescence, sexual abuse, disrupted family life, and poor
communication within the family.
Who gets it?
 About 2% of the population
 Women are 2 to 4 times more likely to develop disorder
What is the treatment?
Self-destructive behavior can be changed in social and therapeutic
environments such as group therapy. Peer reinforcement of
appropriate behavior may be more successful than one-on-one
counseling because difficulties with authority figures often prevent
learning in such situations. Group therapy can also be helpful in
modifying specific impulsive behaviors.
Medications can help to level mood swings and to treat depression or
other disorders which may accompany this condition.

Other Disorders
1. Attention Deficit Disorder
What is it?
ADD is a problem with inattentiveness, over-activity, impulsivity, or a
combination. For these problems to be diagnosed as ADD, they must
be out of the normal range for the child's age and development. ADD
affects school performance and relationships with others. Parents of
children with ADD are often exhausted and frustrated. Depression,
sleep deprivation, learning disabilities, tic disorders, and behavior
problems may be confused with, or appear along with, ADD. Every
child suspected of having ADD deserves a careful evaluation to sort out
exactly what is contributing to the concerning behaviors.
Diagnostic Criteria:
 Either (1) or (2):
 Six (or more) of the following symptoms of inattention have
persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level:
1. often fails to give close attention to details or makes
careless mistakes in schoolwork, work, or other activities
2. often has difficulty sustaining attention in tasks or play
activities
3. often does not seem to listen when spoken to directly
4. often does not follow through on instructions and fails to
finish schoolwork, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions)
5. often has difficulty organizing tasks and activities
6. often avoids, dislikes, or is reluctant to engage in tasks
that require sustained mental effort (such as schoolwork or
homework)
7. often loses things necessary for tasks or activities (e.g.,
toys, school assignments, pencils, books, or tools)
8. is often easily distracted by extraneous stimuli
9. is often forgetful in daily activities
 Six (or more) of the following symptoms of hyperactivity-
impulsivity have persisted for at least 6 months to a degree that is
maladaptive and inconsistent with developmental level:
Hyperactivity
1. often fidgets with hands or feet or squirms in seat
 2. often leaves seat in classroom or in other situations in
which remaining seated is expected
3. often runs about or climbs excessively in situations in
which it is inappropriate (in adolescents or adults, may be
limited to subjective feelings of restlessness)
4. often has difficulty playing or engaging in leisure activities
quietly
5. is often "on the go" or often acts as if "driven by a motor"
6. often talks excessively
Impulsivity
1. often blurts out answers before questions have been
completed
2. often has difficulty awaiting turn
3. often interrupts or intrudes on others (e.g., butts into
conversations or games)
 Some hyperactive-impulsive or inattentive symptoms that
caused impairment were present before age 7 years.
 Some impairment from the symptoms is present in two or more
settings (e.g., at school [or work] and at home).
 There must be clear evidence of clinically significant impairment
in social, academic, or occupational functioning.
What causes it?
Scientific studies, using advanced neuroimaging techniques of brain
structure and function, show that the brains of children with ADD are
different from those of other children. These children handle
neurotransmitters (including dopamine, serotonin, and adrenalin)
differently from their peers.
ADD is often genetic. Whatever the specific cause may be, it seems to
be set in motion early in life as the brain is developing.
Who gets it?
Attention Deficit Disorder (ADD) is the most commonly diagnosed
behavioral disorder of childhood, affecting an estimated 3 - 5% of
school aged children. It is diagnosed much more often in boys than in
girls.
What is the treatment?
Alternative remedies have become quite popular, including herbs,
supplements, and chiropractic manipulation. However, there is little or
no solid evidence for many remedies marketed to parents.
Children who receive both behavioral treatment and medication often
do the best. Medications should not be used just to make life easier for
the parents or the school. There are now several different classes of
ADD medications that may be used alone or in combination. The
following may also help:
Limit distractions in the child's environment.
Provide one-on-one instruction with teacher.
Make sure the child gets enough sleep.
Make sure the child gets a healthy, varied diet, with plenty of
fiber and basic nutrients.

2. Autism
What is it?
Autism is a complex developmental disorder that appears in the first 3
years of life, though it is some times diagnosed much later. It affects
the brain's normal development of social and communication skills.

Autism is a spectrum that encompasses a wide continuum of behavior.

The core features include impaired social interactions, impaired verbal
and nonverbal communication, and restricted and repetitive patterns
of behavior.
Symptoms may vary from quite mild to quite severe. A related, milder
condition is Asperger's syndrome.
Diagnostic Criteria:
 A total of six (or more) items from (1), (2), and (3), with at least two
from (1), and one each from (2) and (3):
1. qualitative impairment in social interaction, as manifested by at
least two of the following:
 marked impairment in the use of multiple nonverbal behaviors
such as eye-to-eye gaze, facial expression, body postures,
and gestures to regulate social interaction
 failure to develop peer relationships appropriate to
developmental level
 a lack of spontaneous seeking to share enjoyment, interests,
or achievements with other people (e.g., by a lack of showing,
bringing, or pointing out objects of interest)
 a lack of spontaneous seeking to share enjoyment, interests,
or achievements with other people (e.g., by a lack of showing,
bringing, or pointing out objects of interest)
2. qualitative impairments in communication as manifested by at
least one of the following:
  delay in, or total lack of, the development of spoken language
(not accompanied by an attempt to compensate through
alternative modes of communication such as gesture or
mime)
 in individuals with adequate speech, marked impairment in
the ability to initiate or sustain a conversation with others
 stereotyped and repetitive use of language or idiosyncratic
language
 lack of varied, spontaneous make-believe play or social
imitative play appropriate to developmental level
3. restricted repetitive and stereotyped patterns of behavior,
interests, and activities, as manifested by at least one of the
following:
 encompassing preoccupation with one or more stereotyped
and restricted patterns of interest that is abnormal either in
intensity or focus
 apparently inflexible adherence to specific, nonfunctional
routines or rituals
 stereotyped and repetitive motor mannerisms (e.g., hand or
finger flapping or twisting, or complex whole-body
movements)
 persistent preoccupation with parts of objects
 Delays or abnormal functioning in at least one of the following
areas, with onset prior to age 3 years: (1) social interaction, (2)
language as used in social communication, or (3) symbolic or
imaginative play.
What are the symptoms?
Most parents of autistic children suspect that something is wrong by
the time the child is 18 months old and seek help by the time the child
is 2 (though the diagnosis is usually not made until long after that).
Children with autism typically have difficulties in verbal and nonverbal
communication, social interactions, and pretend play. In some,
aggression -- toward others or self -- may be present.
Some children with autism appear normal before age 1 or 2 and then
suddenly "regress" and lose language or social skills they had
previously gained. This is called the regressive type of autism.
People with autism may perform repeated body movements, show
unusual attachments to objects or have unusual distress when routines
are changed. Individuals may also experience sensitivities in the
senses of sight, hearing, touch, smell, or taste. Such children, for
example, will refuse to wear "itchy" clothes and become unduly
distressed if forced because of the sensitivity of their skin.
What causes it?
Autism is a physical condition linked to abnormal biology and
neurochemistry in the brain. The exact causes of these abnormalities
remain unknown, but this is a very active area of research.
In the past, autism was thought to be a mental illness caused by bad
parenting. No scientific evidence supports this idea, which has since
been rejected.
Genetic factors seem to be important. Language and cognitive
abnormalities are more common in relatives of autistic children.
Chromosomal abnormalities and other neurological problems are also
more common in families with autism.
Who gets it?
In the general population, autism affects up to 0.2% of children, but
the risk of a couple having a second autistic child increases more than
50 times -- to 10-20%. An identical twin is far more likely to also have
autism than a fraternal twin or another sibling would be -- all of these
facts suggest a strong genetic influence on the condition.
Autism affects boys 3 to 4 times more often than girls. Family income,
education, and lifestyle do not seem to affect the risk of autism.
What is the treatment?
Intensive, appropriate early intervention greatly improves the outcome
for most young children with autism. Most programs will build on the
interests of the child in a highly structured schedule of constructive
activities. Visual aids are often helpful.
Treatment is most successful when geared toward the individual's
particular needs. A variety of effective therapies are available,
including applied behavior analysis, medications, music therapy,
occupational therapy, physical therapy, sensory integration,
speech/language therapy and vision therapy.

Possible Stuff:

Eating Disorders
There are many motivations behind why we eat and drink
Unfortunately, people do not always eat or not eat for the right
reasons Therefore, eating disorders in this country are very
common
1. Anorexia Nervosa
a) Person refuses to maintain normal body weight for age and
height
b) Usually starts with dieting that eventually becomes an
obsession
c) Weighs 85% or less than what is expected for age and height
d) Person denies the dangers of low weight
e) Is terrified of becoming fat
f) Is terrified of gaining weight even though s/he is markedly
underweight
g) Reports feeling fat even when very thin
h) In women, menstrual periods stop, in men levels of sex
hormones fall
i) Often seen with depression, irritability, withdrawal, and
peculiar behaviors such as compulsive rituals, strange eating
habits, and division of foods into "good/safe" and
"bad/dangerous" categories
j) Person may have low tolerance for change and new
situations; may fear growing up and assuming adult
responsibilities and an adult lifestyle. May be overly engaged
with or dependent on parents or family.
k) Dieting may represent avoidance of, or ineffective attempts to
cope with, the demands of a new life stage such as adolescence.

2. Bulimia Nervosa
a) Diet-binge-purge disorder, person binge eats and feels out of
control while eating
b) Vomits, misuses laxatives, exercises, or fasts to get rid of the
calories
c) Diets when not bingeing, becomes hungry and binges again
d) Like anorexia, people with bulimia believe that self-worth
requires being thin
e) Weight may be normal or near normal unless anorexia is also
present
f) Also seen with depression, feelings of loneliness and
emptiness
 g) Feeling unworthy, they have great difficulty talking about
their feelings, which almost always include anxiety, depression,
self-doubt, and deeply buried anger.
h) Impulse control may be a problem; e.g., shoplifting, sexual
adventurousness, alcohol and drug abuse, and other kinds of
risk-taking behavior. Person acts with little consideration of
consequences.

3. Pica
Rare eating disorder that has been documented throughout time
Characterized by a compulsive craving for inedible substances
such as clay, dirt, laundry starch, chalk, buttons, paper, sand,
burnt matches
Most often seen in pregnant or nursing women, also seen in
children and adults with seizer disorders, mental retardation or
psychosis
Cause is not known, not shown to be connected with a specific
deficiency

4. Obesity SLIDE
Person’s that weigh more than 20% above expected weight for
age, height, and body build
Morbid or malignant obesity is weight in excess of 100 pounds
above that expected for age, height, and build
Health reasons may be the cause, but may also be caused by
psychological problems like depression, anxiety etc..
64% of American adults are overweight or obese

Body Image Survey Results

How does America’s obsession with body image contribute to
eating disorders?
Recent study (4,000, not representative) found that 89% of
women want to lose weight and 22% of men say they want to
gain weight
15% of women and 11% of men say they would sacrifice more
than 5 years of their life to be the weight they want
 Some women are choosing not to have children because
pregnancy will make them fat
Sexual abuse is a significant contributor to body dissatisfaction

Sexual Behavior
• How would you categorize sexual behavior in terms of
motivation? Psychologists consider the drive to have sex a basic
human motive. But what exactly motivates that drive?
Obviously, there are differences between sex and other basic
motives, such as hunger. Engaging in sex is essential to the
survival of the human species, but it is not essential to the
survival of any specific person. In other words, you’ll die if you
don’t eat, but you won’t die if you don’t have sex (you just might
think you will)
• What motivates sexual behavior?
• In most animals, sex is biologically determined and triggered
by hormonal changes in the female. During the cyclical period
known as estrus, a female animal is fertile and receptive to
male sexual advances. Roughly translated, the Greek word
estrus means “frantic desire.” Indeed, the female animal will
often actively signal her willingness to engage in sex – as the
owner of any unneutered cat or dog that’s “in heat” can testify.
In many, but not all, species, sex takes place only when the
female is in estrus.
• As you go up the evolutionary scale, moving from relatively
simple to more complex animals, sex becomes less biologically
determined and more subject to learning and environmental
influences. Sex also becomes less limited to the goal of
reproduction. For example, in some primate species, such as
monkeys and apes, sex can occur at any time, not just when the
female is fertile. In these species, sex serves important social
functions, defining and cementing relationships among the
members of the primate group.
• One rare species of chimplike apes, the bonobos of the
Congo, exhibit a wide variety of sexual behaviors. For one thing,
they have sex face-to-face which is rare. They also engage in
oral sex, and homosexual encounters.
• Emory University psychology professor Frans de Waal
observes that their frequent and varies sexual behavior seems to
serve important social functions. Sex is not limited to fulfilling
the purpose of reproduction. Among the bonobos, sex is used to
increase group cohesion, avoid conflict, and decrease tension
that might be caused by competition for food. According to de
Wall, the bonobos’ motto seems to be ‘Make love, not war.”
• In humans, of course, sex is not limited to a female’s fertile
period. Nor is the motivational goal of sex limited to
reproduction. Although a woman’s fertility is regulated by
monthly hormonal cycles, these hormonal changes seem to have
only a slight effect on a female’s sex drive. Even when a
woman’s ovaries, which produce the female sex hormone
estrogen, are surgically removed or stop functioning during
menopause, she experiences little or no drop in sex interest. In
many nonhuman female mammals, however, removal of the
ovaries results in a complete loss of sexual activity. If injections
of estrogen and other female sex hormones are given, the
female animals’ sexual interest returns.
• In male animals, removal of the testes (castration) typically
causes a steep drop in sexual activity and interest, although the
decline is more gradual in sexually experienced animals.
Castration causes a significant decrease in levels of testosterone,
the hormone response for male sexual development. When
human males experience lowered levels of testosterone because
of illness or castration, a similar drop in sexual interest tends to
occur, although the effects vary among individuals. Some men
continue to lead a normal sex life for years, but others quickly
lose all interest in sex. In castrated men who experience a loss
of sexual interest, injections of testosterone restore the sex
drive.
• Testosterone is also involved in female sexual motivation.
Most of the testosterone in a woman’s body is produced by her
adrenal glands. If these glands are removed or malfunction,
causing testosterone levels to become abnormally low, sexual
interest often wanes. When supplemental testosterone is
administered, the woman’s sex drive returns. Thus in both men
and women, sexual motivation is biologically influenced by the
levels of the hormone testosterone in the body.
• Of course, sexual behavior is greatly influenced by cultural
and social factors (Culture and Human Behavior reading)
• The Stages of Human Sexual Response
• The human sexual response cycle was first mapped by sex
research pioneers William Masters and Virginia Johnson
during the 1950s and 1960s. Until the 1950s, info about sexual
response had been gathered by observing behavior of different
 animal species. Masters and Johnson felt that a more diret
approach was needed to further the understanding of human
sexual anatomy and physiology. Thus, in the name of science,
Massters and Johnson observed hundreds of people engage in
more than 10,000 episodes of sexual activity in their laboratory.
Their findings, published in 1966, indicated that the human
sexual response could be described as a cycle with four stages.
• Stage 1: Excitement – beginning of sexual arousal, rapid
rise in blood pressure, breathing rates increase, blood shifts to
the genitals, producing an erect penis and swelling of the clitoris
in the female. The female’s vaginal lips expand and open up,
and her vagina becomes lubricated in preparation for
intercourse. Nipples and breast may also become enlarged.
• Stage 2: Plateau – Pulse and Breathing rates continue to
increase; testes increase in size, clitoris withdraws under the
clitoral hood but remains very sensitive to stimulation. Vaginal
entrance tightens, putting pressure on the penis during
intercourse. Vaginal lubrication continues. During Stage 1 & 2,
degree of arousal fluctuates. Majority of actual intercourse
occurs at this stage.
• Stage 3: Orgasm – shortest phase; blood pressure and
heart rate reach their peak, muscles in the vaginal walls and the
uterus contract rhythmically, as do the muscles in and around
the penis as the male ejaculates. Most male and females
describe orgasm as an intensely pleasurable experience. Vast
majority of men experience one intense orgasm. But many
women are capable of experience multiple orgasms. If sexual
stimulation continues following orgasm, women may experience
additional orgasm within a short period of time.
• Stage 4: Resolution – Following orgasm, both sexes tend to
experience a warm physical “glow” and a sense of well-being.
Arousal slowly subsides and returns to normal levels. The male
experiences a refractory period, during which he is incapable of
having another erection or orgasm; this period varies widely, and
tends to increase with age.

Survey of National Health and Social Life (1994) SLIDE

Important findings:
• Half of people 30 to 50 had five or more partners
• By age 30, 90% of Americans have married
 • 1/3 have sex two or more times/week, 1/3 a few times a
month, 1/3 have sex a few times a year or not at all
• 43% of women and 31% of men reported sexual problems (low sex drive, arousal problems, inability to
achieve orgasm, premature ejaculation, problems achieving or maintaining an erection

Sexual Orientation
• Estimated 7 to 15 million Americans are gay
• Evidence suggests that genetics play a role
• Research found a small cluster of neurons in the
hypothalamus is half the size in homosexuals compared to
heterosexuals
• Research also found that homosexuality is not a result of
unpleasant early heterosexual experiences or an abnormal
relationship between the child and parents
• Both men and women homosexuals are less likely then
heterosexuals to engage in gender-specific behaviors in
childhood
• Homosexuality is no longer considered a sexual disorder by
doctors and psychologists