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Introduction to Psychological Science
Research Methods in Psychology
Thinking Critically about Psychology
Science vs. Pseudoscience
Evolution and Psychology
The Biology of Psychology
Principles of Learning
States of Consciousness
Intelligence and Cognitive Abilities
Motivation and Emotion
Gender and Sexuality
Stress and Health
Abnormal Behavior and Psychological Disorders
Treatment of Psychological Disorders
Evaluating Psychology in the Media
Abnormal Behavior and Psychological Disorders
Distinguishing between Normal and Abnormal Behavior: Criteria for Abnormal Behavior
A common notion of what constitutes abnormal behavior is simply that it is behavior that deviates from what is typical or average. Psychological assessments such as the Minnesota Multiphasic Personality Inventory (MMPI) are based on this concept of statistical deviance. For instance, persons diagnosed as depressed using the MMPI are given such a diagnosis based on how rare their score is within the normal population.
Maladaptive or dysfunctional behavior is behavior that does not help a person deal with challenges, cope with stress, or accomplish his or her goals but makes a problem or situation worse. Alcohol consumption, for example, is not a maladaptive behavior in itself. However, when a person’s alcohol consumption interferes with his or her role at work or within the family, it is considered maladaptive.
Personal distress refers to the subjective pain and suffering such as sadness, anxiety, and anger that are often associated with abnormal behavior. Depression, for example, causes a great deal of personal distress although it may not result in maladaptive behavior or statistically deviant scores on a scale testing for depression.
Behavior that deviates from what a society considers acceptable is often labeled as abnormal. Disorders such as
, in which a man achieves sexual arousal by dressing in women’s clothing, are only considered abnormal because they deviate from the expectations of our culture.
Models of Abnormal Behavior
From ancient times up through the Middle Ages, abnormal behavior was believed to be caused by supernatural forces or demonic spirits. Remedies such as exorcism and torture were common practices used to treat people who exhibited abnormal behavior.
The Medical Model.
The medical model, which developed in the eighteenth and nineteenth centuries, is based on the belief that abnormal behavior is a result of mental illnesses that have a biological basis and can be classified by their symptoms, much the same way medical diseases are. This model represented a major shift from religious dogma to a more scientific way of viewing disorders.
Psychological models focus on the psychological roots of abnormal behavior.
Sigmund Freud developed the first major model of abnormal behavior known as the psychodynamic model. Freud theorized than abnormal behavior was the result of unresolved unconscious conflicts from childhood. For instance, an oral fixation (which might be manifested in overeating or smoking) in adulthood might be the result of improper weaning from breastfeeding as an infant.
Ivan Pavlov is credited for having discovered the conditioned response, which paved the way for behaviorists to study how maladaptive behaviors can be learned. The behavioral model holds that most maladaptive or abnormal behaviors are learned in the same ways that adaptive behaviors are. One of the most famous examples of a learned abnormal behavior is John B. Watson’s conditioning of “Little Albert” to fear white rats by making a loud banging sound every time a rat was introduced to the child.
Humanistic theorists, such as Carl Rogers and Abraham Maslow, argue that humans are completely capable of making conscious choices and striving toward self-actualization. Humanistic models see abnormal behavior as the result of obstacles toward self-actualization. People who behave abnormally have become detached from themselves in an attempt to satisfy others, and this detachment leads to a distorted self-image that results in emotional problems.
Cognitive theorists, such as Albert Ellis and Aaron Beck, argue that emotional problems and maladaptive behaviors are the result of irrational or distorted thinking. For example, a person who has a phobia of riding in a car because they are scared of being in an accident has an exaggerated idea of the likelihood of being involved in an automobile accident.
The sociocultural model views abnormal behavior in terms of the social and cultural contexts in which it occurs. This model holds that abnormal behavior has more to do with social problems, such as poverty, racism, and prolonged unemployment, than with an individual’s problems. The stress of dealing with poverty, for example, plays a huge role in a person’s mental well-being. This model is supported by the fact that severe mental disorders occur more frequently among the poor.
The biopsychosocial model provides an integrative explanation for abnormal behavior in terms of the interactions of biological, psychological, and sociocultural factors. The diathesis-stress model is a biopsychosocial model which says that certain people have a genetic predisposition (diathesis) that increases their likelihood of developing a disorder if exposed to certain environmental stressors. For example, if two people have the same genetic predisposition for depression, but one experiences the unexpected deaths of several loved ones, the one who experiences the deaths is more likely to suffer from depression. Although, the stress need not be traumatic if the person’s diathesis is strong. The stronger the diathesis, the less stress is necessary to produce the disorder.
Jerome Wakefield proposed a harmful dysfunction model in the early 1990s in which dysfunction is a failure of an internal mechanism to perform a naturally selected function and harm is the value judgment that the design failure is harmful to the individual. For example, someone with antisocial personality disorder is unable to experience feelings of guilt (the dysfunction), and he or she fails to learn from past mistakes, resulting in repeated punishments, arrests, loss of employment, and eventual impoverishment (the harm).
What Are Psychological Disorders?
Psychological disorders, also referred to as mental disorders or mental illnesses, are abnormal behavior patterns characterized by disturbances in behavior, thinking, perceptions, or emotions that are associated with significant personal distress or impaired functioning. Almost half of adult Americans will develop a diagnosable psychological disorder at some point in his or her lifetime, and roughly one in four adults will experience a mental disorder in any given year.
Classification of Psychological Disorders.
International Statistical Classification of Diseases, Injuries, and Causes of Death
(ICD), produced by the World Health Organization (WHO), and the
Diagnostic and Statistical Manual of Mental Disorders
(DSM), produced by the American Psychiatric Association, are the two major sources of standardized diagnostic definitions today. The ICD-6 of 1948 was the first edition to include a section about mental illnesses. The United States initially adopted the use of the ICD-6, but they later modified it to better suit their purposes and released the DSM-I in 1952. The ICD is now in its tenth edition, and the DSM is in its fourth, revised. Both manuals base their classifications on empirically supported evidence and provide a common language and diagnosis criteria for those working in the mental health field.
The DSM-IV-TR is the most widely used diagnostic system for classifying psychological disorders. Classifications are based on symptoms, and disorders are assessed on five dimensions or axes of evaluation.
Type of Information
Mental disorders that impair functioning or cause distress, including anxiety disorders, mood disorders, dissociative and somatoform disorders, schizophrenia, eating disorders, sleep disorders, and disorders usually first diagnosed in infancy, childhood, or adolescence
Other conditions that may be a focus of clinical attention
Problems that may warrant attention but do not represent diagnosable mental disorders, such as academic, vocational, or social problems affecting daily functioning
A class of mental disorders characterized by excessively rigid, enduring, and maladaptive ways of relating to others and adjusting to external demands
A generalized delay or impairment in the development of intellectual and adaptive skills or abilities
General medical conditions
Illnesses and other medical conditions that may be important to the understanding or treatment of the person’s psychological disorder
Psychosocial and environmental problems
Problems in the person’s social or physical environment that may affect the diagnosis, treatment, and outcome of mental disorders
Global assessment of functioning
Overall judgment of the person’s level of functioning in meeting the responsibilities of daily life
Anxiety disorders, the most commonly experienced psychological disorders among adults, are characterized by physiological signs of anxiety (such as heart palpitations) and subjective feelings of tension, apprehension, or fear.
Generalized Anxiety Disorder.
Generalized anxiety disorder is marked by a chronic, high level of anxiety, also known as “free-floating anxiety,” that is not tied to any specific threat. People with this disorder constantly worry about yesterday’s mistakes and tomorrow’s problems, particularly minor family matters, finances, work, and personal illness. They often dread decisions and brood over them endlessly. Common physical symptoms of this illness include trembling, muscle tension, diarrhea, dizziness, faintness, sweating, and heart palpitations. This disorder is more common in females than males.
A phobic disorder is characterized by a persistent and irrational fear of an object or situation that presents no realistic danger. This fear must get in the way of everyday activities in order to be considered a phobia. Reactions to phobias are usually accompanied by physical symptoms of anxiety, like trembling and heart palpitations. For many people with this disorder, even imagining the phobic object or situation can bring about a phobic response.
Panic Disorder and Agoraphobia.
Panic disorder is marked by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly. Panic attacks are characterized by physical symptoms of anxiety, often described as feeling like a heart attack to persons who suffer from them. Apprehension of when and where the next panic attack will strike can sometimes lead to agoraphobia. Agoraphobia is a fear of going out to public places. People with agoraphobia are so concerned about having a panic attack in public that they are afraid to leave their homes. About two-thirds of panic disorder sufferers are female, and onset usually occurs in late adolescence or early adulthood.
Obsessions are thoughts that repeatedly intrude on a person in a distressing way. Compulsions are the actions that person feels forced to carry out. Obsessive-compulsive disorder (OCD) is characterized by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions). People troubled by obsessions often feel that they have lost control of their minds. Compulsions usually involve stereotyped rituals which act to temporarily relieve anxiety. Common compulsions include repetitive hand-washing, constant cleaning, and checking and rechecking of locks. OCD occurs in about 2.5% of the population.
Etiology of Anxiety Disorders
There appears to be a moderate genetic predisposition to anxiety disorders, as evidenced by studies looking at concordance rates (percentages of twin pairs or other pairs of relatives who exhibit the same disorder). Alternate research has shown that anxiety sensitivity may make people vulnerable to anxiety disorders. This theory says that some people are highly sensitive to the internal physiological symptoms of anxiety and are prone to overreact to these symptoms with fear, which in turn breeds more anxiety and fear, and so on. Other research has shown that anxiety disorders may be the result of neurochemical activity in the brain. Anti-anxiety drugs (such as Valium) seem to alter neurotransmitter activity at GABA synapses. Also, abnormalities in neural circuits using serotonin have recently been found to be related to panic and obsessive-compulsive disorders.
Conditioning and Learning.
Many anxiety responses may be developed through classical conditioning and maintained through operant conditioning. An originally neutral stimulus (the rat in the “Little Albert” example above) may be paired with a frightening event (loud banging sound) so that it becomes a conditioned stimulus bringing about anxiety. Once this fear is acquired through classical conditioning, the person may begin avoiding the anxiety-producing stimulus. This avoidance is negatively reinforced by a reduction in anxiety. Operant conditioning maintains this cycle because every time the anxiety-producing stimulus is avoided, the person’s fear is reduced. Many people suffering from phobias can identify a traumatic event that led to the conditioning of a fear and, in turn, their anxiety disorder. Some problems with this theory are that not everyone with a phobia can recall a traumatic event that caused it, and not everyone who experiences a traumatic event develops a phobia. Observational learning, acquiring a response by watching someone else’s behavior, can also lead to phobias. For example, if a child watches her mother become anxious every time she sees a dog, the child might acquire her mother’s fear of dogs.
Cognitive theorists hold that a person’s style of thinking may make him or her particularly vulnerable to anxiety disorders. People are more likely to suffer from anxiety when they (a) misinterpret harmless situations as threatening, (b) focus excessive attention on perceived threats, and (c) selectively recall information that seems threatening.
High levels of stress are often associated with the development of an anxiety disorder.
Dissociative disorders are a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity.
Dissociative Amnesia and Fugue.
Dissociative amnesia is a sudden loss of memory for important personal information that is too extensive to be due to normal forgetting. This memory loss may occur for an isolated traumatic event (such as an accident, physical abuse, or witnessing a murder) or for an extended period of time surrounding the event. The more severe dissociative fugue causes people to lose their memory for their entire lives, along with their sense of personal identity.
Dissociative Identity Disorder.
Dissociative identity disorder (DID), formerly known as multiple personality disorder, involves the co-existence in one person of two or more largely complete, and usually very different, personalities. Each personality has its own name, memories, traits, and physical mannerisms and is usually completely unaware of any other personalities. Developed personalities are often extremely different from the original personality. This disorder is very rare, and most people who have it also have a history of anxiety, mood, or personality disorders.
Etiology of Dissociative Disorders.
Dissociative amnesia and fugue are usually seen as the result of excessive stress, although the exact link is still unclear. Very little is known about the cause of dissociative identity disorder. Some theorists who are doubtful that DID is a real disorder believe that people who have the disorder are intentionally role playing so they can use a mental illness as a face-saving excuse for their personal failings. Clinicians who do not doubt the authenticity of the disease commonly hold that the disorder is likely a psychological defense against emotional trauma (resulting from abuse or torture, for example) that occurred during childhood.
People have a history of diverse physical complaints that appear to be psychological in origin. People normally have a complicated history of medical treatment from many doctors. The person has many complaints that are diverse in their nature. They may complain of cardiovascular, gastrointestinal, pulmonary, neurological, and genitourinary symptoms.
Conversion disorder is characterized by a person losing physical function such as loss of movement in a limb, loss of blindness, or loss of feeling in a hand or arm without there being any physical cause for this loss. Often the symptoms are not consistent with their medical knowledge about their apparent disease.
People with hypochondrasis are constantly occupied with the idea that they are terribly sick. They believe their complaints or symptoms are due to a more serious condition such as cancer or heart disease. Even when the person receives medical attention and is assured they do not have a real illness, they are skeptical and believe the doctor is wrong. They believe the doctor is incompetent so they go doctor shopping for a new doctor. Hypochondriasis is often seen with other psychological disorders such as anxiety and depression.
Etiology of Somatoform Disorders
People may be predisposed to somatoform disorders through inherited aspects of physiological functioning. However, evidence has shown that personality and learning factors may be a large contributor to these disorders.
It appears that people with certain personality types are more prone to develop somatoform disorders. An example of a personality disorder that would be more acceptable to developing a somatoform disorder would be histrionic. People with a histrionic personality type are typically self-centered, highly emotional, overly dramatic, suggestible, and excitable. They tend to thrive on the attention they receive when they become ill. People with the personality trait of neuroticism also are prone to somatoform disorders.
Some people put such an extreme amount of focus on their internal physiological processes that they magnify their normal bodily sensations into being symptoms of distress which leads them to seek unnecessary medical treatment. Evidence has shown that people with somatoform disorders show a tendency to draw catastrophic conclusions about minor bodily problems. It has also been shown that they underemphasize their problems by giving the impression that they are healthy. They do this by associating their health status as having no symptoms and discomfort, which is unrealistic.
The Sick Role
As bizarre as it may seem, some people enjoy playing the sick role. These people associate their physical complaints with having indirect benefits from being sick. One benefit that is commonly associated with being sick is being able to avoid life’s challenges. Some of these challenges could be marital problems, career frustrations, and family responsibilities. They might come to the conclusion that if they are sick then others can not place demands on them or expect much from them. Another benefit is attention from others. When people are sick, they receive attention from spouses, family members, co-workers, neighbors, doctors, and friends. The tendency for people to feel sick may be strengthen by the sympathy they receive from others. Sick people receive support, comfort, attention, and assistance for their illness.
Mood disorders are classified as disorders that are apparent through emotional disturbances that may disturb one’s physical, perceptual, social, and thought processes. Mood disorders are divided into two basic types: unipolar and bipolar. People with unipolar disorder only experience an emotional disturbance on what end of the mood spectrum, depression. People with bipolar disorder experience emotional disturbances on both ends of the mood spectrum, having periods of both depression and mania.
Major Depressive Disorder (MDD)
Considering everyone gets depressed from time to time, determining what it normal and abnormal depression can be difficult. One should take into consideration the length of depression and the impairment of everyday behavior when deciding the significance of depression. If impairment of everyday behavior and tasks is affected for more than 2 weeks there is reason for concern. People with major depressive disorder show symptoms such as a persistent feeling of sadness, despair, and loss of interest in activities once enjoyed. Common symptoms of major depressive disorder are lack of energy, insomnia, loss of appetite, anxiety, irritability, sluggish body movements, and talking slowly. A person’s self-esteem is also affected as the person begins to feel worthless, dejected, and guilty. People can become depressed at any time during their lifetime. Research has shown that the median extent of depression is five months. It has been found that 75%-90% of people that experience depression have more than one episode during their lifetime. Research has shown that depression occurs in 7% and as many as 17% of Americans. The prevalence of depression is increasing although the reasoning behind it is not known. Researchers have also found that depression is twice as common in women as it is in men. The many explanations for this give rise to debate.
Seasonal Affective Disorder (SAD) Seasonal Affective Disorder is a type of major depression in which people experience depression during the months of fall and winter and then during the months of spring and summer they experience elevated moods. Effective treatment of SAD has been found in people being exposed to artificial light as a substitute for natural light.
Dysthymic Disorder Dysthymic Disorder is a mild but chronic form of depression. The symptoms of dysthymia are less severe than major depression, but people feel depressed for long periods of time, usually for five years or longer. Dysthymia is more common in women than in men.
Bipolar disorder is apparent by the experience of both depressed and manic episodes. The symptoms seen in depressive and manic episodes are normally opposite from each other. While a person is in a manic episode their mood is elevated, their self-esteem is extremely high, and they are full of energy as well as being optimistic. They may become hyperactive, go for days without rest, and make extravagant plans. They can have racing thoughts, flight of ideas and may have impulsive behavior such as gambling excessively, spending money recklessly, and be sexually irresponsible. The manic episodes to some are enticing because there are increases in energy, self-esteem, and optimism. These periods may allow for more creativity and productivity to be present. Bipolar disorder can create many problems for its victims. During the manic episodes there are negative consequences such as being anxious or irritable. The manic episodes can worsen into higher levels that can be scary and disturbing. The impaired judgment during a manic episode can lead many people to do things they regret greatly. Bipolar disorder is less common than unipolar disorder, occurring in a little over 1% of the population. Bipolar disorder is seen equally in males and females. The age of vulnerability is between the ages of 20-29.
Cyclothymic Disorder Cyclothymia is a milder form of bipolar disorder which is apparent in the less severe mood swings a person experiences. The development of cyclothymia occurs in late adolescence or early adulthood. It is also likely to affect as many men as women. Etiology of Mood Disorders Psychological Factors The behavioral model attempts to explain depression in terms of a breakdown in the reinforcement process. The reinforcement process includes the effort that one exerts and the reinforcement they receive. If the reinforcement or feedback stops due to a number of reasons such as lost of a loved one, meeting new friends, or a disabling injury the motivation is diminished this then induces depression. As one becomes more depressed they feel less motivated to search out that reinforcement, so they withdraw more so. Cognitive theorists believe that depression develops from people having a negative or distorted way of thinking about disappointing or unfortunate life events. People develop a distorted way of interpreting life’s events. A minor disappointment is blown out of proportion and becomes a major letdown. The learned helplessness model views the development of depression stemming from people believing they have no control over the reinforcement in their lives. People that feel helpless may see depression as the “final pathway” and may develop a pessimistic attitude that includes low self-esteem and high stress. Research has shown that people that ruminate about their depression are depressed for longer periods of time than those that try to distract themselves. A person that ruminates about their depression puts a lot of focus and attention on how sad, exhausted, and unmotivated they feel. This type of thinking can make the length and the intensity of depression worse. Biological Factors Evidence has shown that genetic vulnerability greatly influences the probability of one developing major depression. Research conducted between identical and fraternal twins have shown that the concordance rate for depression is much higher for identical twins than fraternal. Having a genetic vulnerability may predispose one to having neurochemical imbalances in the brain. The neurotransmitters norepinephrine and serotonin are believed to be associated with the prevalence of mood disorders. Serotonin is a key brain chemical that regulates mood. Treatment for depression involves antidepressants which increase the availability of serotonin and norepinephrine to the brain. Childhood Disorders Attention-Deficit Hyperactive Disorder (ADHD) ADHD is characterized by children who have significant levels of inattention, hyperactivity, and impulsivity. Children with ADHD are different from children without ADHD in that there is a persistent pattern of inattention, hyperactivity, and impulsivity that is more severe than what is typical behavior for a child at the same development level. The Diagnostic Statistical Manual-IV (DSM-IV) specifies the criteria for ADHD to be six or more symptoms, persists for 6 months and evident before age 7, impairment present in two or more settings, and impairment in a social, academic, or occupational setting. Oppositional Defiant Disorder (ODD) The DSM-IV defines ODD as a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four or more symptoms are present. Some of the symptoms include often loses temper, often argues with adults, often deliberately annoys people, is often spiteful and vindictive, or is often angry and resentful. A criterion should only be considered if the behavior occurs more frequently than what is typically observed in individuals of comparable age and developmental level. ODD is diagnosed if there is significant impairment in a social, academic, or occupational setting. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder. Conduct Disorder (CD) CD is defined by the DSM-IV as a repetitive and persistent pattern of behavior in which the basic rights of others or major-age appropriate societal norms or rules are violated, as shown by the presence of three or more symptoms in the past 12 months, with at least one criterion present in the past 6 months. There are four main groupings that these behaviors can fall into. These groupings are aggression to people and animals, destruction of property, deceitfulness or theft, serious violation of rules. Research has shown that ODD is a milder form of CD. Children typically begin to show ODD behavior between the ages of 3 and 8 and then gradually progress into showing more severe CD behavior. Autistic Disorder The DSM-IV defines autism as having 6 or more symptoms from several different areas. There is impairment in social interaction which is obvious by marked impairment in the use of nonverbal behaviors such as eye-to-eye gaze, facial expression, or body gestures. There is also impairment by a lack of wanting to share enjoyment, interests, or achievements with other people. There are impairments in communication by the delay or total lack of the development of spoken language, inability to sustain a conversation, repetitive use of language, and lack of varied, spontaneous make-believe appropriate to developmental level. Impairment is also seen in preoccupation with stereotyped patterns of interest, inflexibility in nonfunctional routines or rituals, repetitive motor mannerisms, and
occupation with parts of objects. Delays or abnormal functioning occurs in at least one of the following areas before the age of 3: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. Childhood Mood Disorders
Major Depressive Disorder (MDD)
MDD has the same diagnostic criteria in children as it does in adults. To diagnose MDD in children, one needs to be aware that a child’s external behavior (e.g., disruptiveness) is sometimes more easily expressed than his or her internal emotions, so internalizing problems such as depression can often be overlooked and instead attention is focused on disruptive behavior. Another diagnostic concern is some characteristics of depression, such as irritable mood, are seen more frequently in children, a fact one has to keep in mind that fact when assessing for MDD.
Dsythmic Disorder (DD)
DD is, along with MDD, the other depressive disorder recognized by the DSM-IV-TR. In children, it is defined as a chronically depressed or irritable mood that occurs most days and persists for most of the day for at least one year. In conjunction with the depressed mood, two or more of the following symptoms are present: appetite disturbance, sleep disturbance, fatigue, low self-esteem, inability to concentrate, and hopelessness. For DD to be diagnosed, the youth cannot be without the above symptoms for more than two months at a time during the previous one year, and there cannot be a major depressive episode during that time. DD is often considered a low-grade depression, where the symptoms of MDD are present, but in fewer numbers and with less severity.
Bipolar disorder is characterized by mood swings from extremely low (depression) to extremely high (mania). Manic episodes are characterized by a period of at least one week where the person’s mood is abnormally and constantly elevated, unrestrained, or irritable. There must be at least three of the following symptoms present during the mood disturbance (four if the mood is only irritable): grandiosity, decreased need for sleep, more talkative or pressure to keep talking, having flights of ideas, easily distracted, increase in goal-directed activity, and involvement in activities that could have serious negative consequences. For both manic and mixed episodes, the performance of the person must be so impaired that his or her occupational or social functioning is compromised or they require hospitalization, and the symptoms are not due to the effects of drug abuse, medication, or other treatment. In children, diagnosis of bipolar disorder is often complicated by the high comorbidity rates, particularly the disruptive behavior disorders, substance abuse, and anxiety.
Cyclothymia is the second class of bipolar disorders. The symptoms for cyclothymia in children and adolescents include periods of hypomania and depressive symptoms for at least one year that do not meet the criteria for a major depressive episode, during the year’s time the symptoms have not been absent for more than two months, and that there has not been a major depressive, manic, or mixed episode during the first year of the disturbance, and it is not better accounted for by another disorder or medical condition. In addition, the symptoms cause severe functional difficulty in social, occupational, or other areas of importance.
Mental Retardation Mental retardation is defined as significant limitations in intellectual functioning, significant limitations in adaptive behavior, and the appearance of these limitations before the age of 18. Limitations in intellectual functioning include and IQ of approximately 70 or below on an individually administered IQ test. Limitations in adaptive functioning include the person effectively meeting the standards expected for his or her age by his or her cultural group such as communication, self-care, home living, social/interpersonal skills, academic skills, work, leisure, health, and safety. Substance Use Disorders Addiction is seen as a behavior pattern that involves biological, psychological, and sociological components.
An addict’s behavior is different from others in the individual’s involvement or attachment to it, compulsion to continue it, and reduced ability to have control over it. The individual will continue to use despite the negative impact and associations it has on their psychological, physical, and social functioning. There are two general subcategories of substance use: abuse and dependence. To meet diagnostic criteria for substance abuse the individual must display three of the following symptoms:
Larger amounts of the substance is taken than intended
Unsuccessful attempts to control substance use
A great amount of time is spent using the substances
Less time is spent in important social, occupational, or recreational activities
Use of the substance is continued despite knowledge of physical or psychological problems that are caused or made worse by the substance.
Substance Dependence is marked by a pattern of significant impairment or distress by one or more of the following, occurring within a 12-month period:
Failure to fulfill obligations at home, school, or work.
Recurrent substance use in situations that are physically dangerous.
Recurrent substance-related legal problems.
Continued use despite persistent or recurrent social or interpersonal problems caused or made worse by the substance.
The biological model states that addiction is due primarily to one’s biochemistry, metabolism, and genetic predisposition. Research about twins has shown that alcoholism may involve an inherited vulnerability. Believing biological factors cause addiction is one way of looking at the situation. Another way of viewing it is addictions come about from the abuse of drugs.
Some believe that substance use is a result of one’s culture and learning model. Depending on what culture one comes from can affect their behavior towards substance use. Some cultures allow drinking at an early age while others are opposed to it. Cultures that view drinking as an acceptable behavior will teach children how to drink responsibly. If a culture views substance use as wrong, one may not learn how to drink in moderation. If one moves into a new culture they would have to learn new drinking rules.
Schizophrenia and Psychotic Disorders
Schizophrenic disorders are marked by delusions, hallucinations, disorganized speech, and deterioration of adaptive behavior. A central feature of schizophrenia is disturbed, irrational thought processes. Delusions are a common in schizophrenia. Delusions are false beliefs that are maintained even though they clearly are out of touch with reality. Affected persons believe their thoughts are being broadcasted to the world. They also believe that their thoughts are being inserted into their mind against their will. A person’s behavior can deteriorate considerably. This deterioration can affect the person’s quality of functioning in work, social relations, and personal care. Hallucinations are also a common occurrence in schizophrenia. Hallucinations are sensory perceptions that occur in the absence of real stimulus or are distortions of perceptual input. Affected person’s frequently report that they hear voices talking to them. The voices can be insulting, argumentative, or commanding. There are several subtypes of schizophrenia that include paranoid type, catatonic type, disorganized type, and undifferentiated type.
People believe that others are out to get them so they may become suspicious of their friends and relatives. They believe they are being watched and manipulated. To make sense of this they take on the view of themselves being very important.
Catatonic schizophrenia is marked by motor disturbances, ranging from muscular rigidity to random motor activity. Individuals may remain motionless and seem oblivious to their environment for long periods of time. They may also become hyperactive and incoherent.
People experience a deterioration in their behavior that include emotional indifference, social withdrawal, and incoherence.
People that display schizophrenic symptoms but can not be classified into any of the previous categories are said to have undifferentiated schizophrenia.
Schizophrenia can be divided into two categories based on the displaying of negative and positive symptoms. Negative symptoms include flattened emotions, social withdrawal, and impaired attention. Positive symptoms include hallucinations, delusions, bizarre behavior, and flight of ideas.
Etiology of Schizophrenia
Heredity plays a major part in the development of schizophrenia. Twin studies have shown that identical twins are more likely to develop schizophrenia than fraternal twins. High levels of dopamine are believed to be a contributing factor to schizophrenia. Research has shown that brain abnormalities specifically in the brain ventricles may be a significant cause of why individuals with schizophrenia are unable to filter out unimportant stimuli.
Sexual Identity Disorders
The DSM-IV defines sexual identity disorders include that the person must have a strong and persistent cross-gender identification and persistent discomfort with his or her sex. For adolescents and adults symptoms that are present include the desire to be the other sex, frequent passing as the other sex, or desire to live or be treated as the other sex. As individuals get older they develop a need for physical sex-conversion by hormones and surgery. They also begin to express negative feelings about their genitals. Men and women are typically attracted to members of the same biological sex and they adopt occupations and interests typical of the opposite sex.
Personality disorders are characterized by excessive patterns of behavior. These behavioral patterns can make relationships with others difficult because it is hard for others to adapt to the external demands. Personality disorders include narcissistic, paranoid, schizoid, schizotypal, borderline, antisocial, histrionic, avoidant, dependent, and obsessive-compulsive.
Common symptoms are a grandiose self-image and having an excessive need for admiration.
Individuals are highly suspicious of the motives and intentions of others.
Individuals are aloof and distant from others, with shallow or blunted emotions.
Individuals have difficulties in establishing close social relationships. They also have difficulties in holding beliefs or showing behaviors that are odd or psychotic.
These individuals are unable to develop a stable self-image which contributes them being unable to have stable relationships and having a lack of impulse control.
These individuals have a tendency to treat others badly without any remorse for their feelings.
Individuals show symptoms such as dramatic and emotional behavior where they feel the need to be the center of attention, need for reassurance, praise, and approval.
These individuals avoid social relationships out of the fear of rejections.
These individuals exhibit an excessive dependence on others and have difficulty in making independent decisions.
Individuals have an excessive need for orderliness and attention to detail as well as perfectionism and rigid ways of dealing with others.
Eating disorders are characterized by severe disturbances in their concerns over weight and unhealthy efforts to control weight. The two main syndromes of eating disorders are: anorexia nervosa and bulimia nervosa. Individuals in both of these categories have disturbed body images. They have fears of becoming too fat but their methods differ. Anorexia nervosa is a person that has fear of gaining weight, disturbed body image, refusal to maintain normal weight, and dangerous measures to lose weight. Within anorexia nervosa there are two subtypes: restricting type anorexia nervosa and binge-eating/ purging type. In restricting type anorexia nervosa, people significantly reduce their food intake, sometimes to the point of starvation. Individuals with binge-eating/purge type make themselves vomit after eating, misuse laxatives and diuretics, and taking part in excessive exercise. Bulimia nervosa involves overeating and using compensatory means such as self-induced vomiting, fasting, abuse of laxatives and diuretics, and excessive exercise. Individuals normally overeat excessively then have a tremendous amount of guilt and concern about gaining weight.
Etiology of Eating Disorders
There is some evidence to suggest a genetic vulnerability to eating disorders. Studies have shown that relatives of patients with eating disorders have elevated rates of anorexia nervosa and bulimia nervosa. Some has suggested that genetic factors may influence the development of certain personality traits. People with anorexia nervosa tend to be rigid, obsessive, neurotic, and emotionally restrained. People with bulimia nervosa tend to be impulsive, overly sensitive, and having low self-esteem.
Individuals may have a distorted way of viewing themselves. Anorexics believe they are fat when in reality they are wasting away.
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