15.1 Introduction to Psychological Disorders

Most people would agree that someone who is too depressed to get out of bed for weeks at a time has a psychological disorder. But what about those who, having experienced a loss, are unable to resume their usual social activities? Where should we draw the line between sadness and depression? Between zany creativity and bizarre irrationality? Between normality and abnormality? Let’s start with these questions:

“Who in the rainbow can draw the line where the violet tint ends and the orange tint begins? Distinctly we see the difference of the colors, but where exactly does the one first blendingly enter into the other? So with sanity and insanity.”

Herman Melville, Billy Budd, Sailor, 1924

Defining Psychological Disorders

psychological disorder a syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior.

15-1 How should we draw the line between normality and disorder?

A psychological disorder is a syndrome (collection of symptoms) marked by a “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior” (American Psychiatric Association, 2013). Disturbed, or dysfunctional thoughts, emotions, or behaviors are maladaptive—they interfere with normal day-to-day life. Believing your home must be thoroughly cleaned every weekend is not a disorder. But if cleaning rituals interfere with work and leisure, as Marc’s did in this chapter’s opening, they may be signs of a disorder. And occasional sad moods that persist and become disabling may likewise signal a psychological disorder.

Distress often accompanies dysfunctional behaviors. Marc, Greta, and Stuart were all distressed by their behaviors or emotions.

Culture and normality Young men of the West African Wodaabe tribe put on elaborate makeup and costumes to attract women. Young American men may buy flashy cars with loud stereos to do the same. Each culture may view the other’s behavior as abnormal.

Over time, definitions of what makes for a “significant disturbance” have varied. From 1952 through December 9, 1973, homosexuality was classified as a psychological disorder. By day’s end on December 10, it was not. The American Psychiatric Association made this change because more and more of its members no longer viewed same-sex attraction as a psychological problem. Such is the power of shifting societal beliefs. (Later research revealed, however, that the stigma and stresses that gay, lesbian, and transsexual people often experience can increase the risk of mental health problems [Hatzenbuehler et al., 2009; Meyer, 2003].) In the twenty-first century, other controversies swirl over new or altered diagnoses (such as attention-deficit/hyperactivity disorder) in the most recent classification tool for describing disorders. (You’ll hear more about this later.)

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RETRIEVAL PRACTICE

  • A lawyer is distressed by feeling the need to wash his hands 100 times a day. He has no time left to meet with clients, and his colleagues are wondering about his competence. His behavior would probably be labeled disordered, because it is ______________ that is, it interferes with his day-to-day life.

maladaptive

Understanding Psychological Disorders

Yesterday’s “therapy” Through the ages, psychologically disordered people have received brutal treatments, including the trephination evident in this Stone Age skull. Drilling skull holes like these may have been an attempt to release evil spirits and cure those with mental disorders. Did this patient survive the “cure”?

15-2 How do the medical model and the biopsychosocial approach influence our understanding of psychological disorders?

The way we view a problem influences how we try to solve it. In earlier times, people often viewed strange behaviors as evidence that strange forces—the movements of the stars, godlike powers, or evil spirits—were at work. Had you lived during the Middle Ages, you might have said “The devil made him do it.” Believing that, you might have approved of a cure that would drive out the evil demon. Thus, people considered “mad” were sometimes caged or given “therapies” such as genital mutilation, beatings, removal of teeth or lengths of intestines, or transfusions of animal blood (Farina, 1982). Barbaric treatments for mental illness linger even today. In some places, people are chained to a bed, locked in their rooms, or even locked in a room with wild hyenas, in the belief that the animals will see and attack evil spirits (Hooper, 2013). Noting the physical and emotional damage of such restraint, the World Health Organization launched a “chain-free initiative” that aims to reform hospitals “into patient-friendly and humane places with minimum restraints” (WHO, 2014).

The Medical Model

Brutal treatments may worsen, rather than improve, mental health. Reformers, such as Philippe Pinel (1745–1826) in France, opposed such brutal treatments. Madness is not demon possession, he insisted, but a sickness of the mind caused by severe stress and inhumane conditions. Curing the illness, he said, requires “moral treatment,” including boosting patients’ morale by unchaining them and talking with them. He and others worked to replace brutality with gentleness, isolation with activity, and filth with clean air and sunshine.

“Moral treatment” Under Philippe Pinel’s influence, hospitals sometimes sponsored patient dances, often called “lunatic balls,” depicted in this painting by George Bellows (Dance in a Madhouse).

medical model the concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured, often through treatment in a hospital.

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By the 1800s, the discovery that syphilis infects the brain and distorts the mind drove further gradual reform. Hospitals replaced asylums, and the medical model of mental disorders was born. This model is reflected in the terms we still use today. We speak of the mental health movement: A mental illness (also called a psychopathology) needs to be diagnosed on the basis of its symptoms. It needs to be treated through therapy, which may include time in a psychiatric hospital.

The medical perspective has gained credibility from recent discoveries that genetically influenced abnormalities in brain structure and biochemistry contribute to many disorders. But as we will see, psychological factors, such as chronic or traumatic stress, also play an important role.

The Biopsychosocial Approach

To call psychological disorders “sicknesses” tilts research heavily toward the influence of biology and away from the influence of our personal histories and social and cultural surroundings. But in the study of disorders, as in so many other areas, we must remember that our behaviors, our thoughts, and our feelings are formed by the interaction of biological, psychological, and social-cultural influences. As individuals, we differ in the amount of stress we experience and in the ways we cope with stressors. Cultures also differ in their sources of stress and in traditional ways of coping.

Increasingly, North America’s disorders, along with McDonald’s and MTV, have spread across the globe (Watters, 2010).

Some disorders, such as depression and schizophrenia, occur worldwide. From Asia to Africa and across the Americas, schizophrenia’s symptoms often include irrationality and incoherent speech. Other disorders tend to be associated with specific cultures. In Malaysia, amok describes a sudden outburst of violent behavior (thus the English phrase “run amok”). Latin America lays claim to susto, a condition marked by severe anxiety, restlessness, and a fear of black magic. In Japanese culture, people may experience taijin kyofusho—social anxiety about their appearance, combined with a readiness to blush and a fear of eye contact. The eating disorders anorexia nervosa and bulimia nervosa occur mostly in food-abundant Western cultures. Such disorders may share an underlying dynamic (such as anxiety) while differing in the symptoms (an eating problem or a type of fear) manifested in a particular culture.

Disorders reflect genetic predispositions and physiological states, inner psychological dynamics, and social and cultural circumstances. The biopsychosocial approach emphasizes that mind and body are inseparable (FIGURE 15.1). Negative emotions contribute to physical illness, and physical abnormalities contribute to negative emotions. Epigenetics, the study of how nurture shapes nature, also informs our understanding of disorders (Powledge, 2011). Genes and environment are not the whole story, as we’ve seen in other chapters. It turns out our environment can affect whether a gene is expressed or not, and thus affect the development of various psychological disorders.

Figure 15.1
The biopsychosocial approach to psychological disorders Today’s psychology studies how biological, psychological, and social-cultural factors interact to produce specific psychological disorders.

epigenetics the study of environmental influences on gene expression that occur without a DNA change.

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For example, even identical twins (with identical genes) do not share the same risks of developing psychological disorders. They are more likely, but not always destined, to develop the same disorders. Their varying environmental factors influence whether certain culprit genes are expressed.

RETRIEVAL PRACTICE

  • Are psychological disorders universal, or are they culture-specific? Explain with examples.

Some psychological disorders are culture-specific. For example, anorexia nervosa occurs mostly in North American cultures, and taijin-kyofusho appears largely in Japan. Other disorders, such as schizophrenia, are universal—occurring in all cultures.

  • What is the biopsychosocial approach, and why is it important in our understanding of psychological disorders?

Biological, psychological, and social-cultural influences combine to produce psychological disorders. This broad perspective helps us understand that our well-being is affected by our genes, brain functioning, inner thoughts and feelings, and the influences of our social and cultural environment.

Classifying Disorders—and Labeling People

15-3 How and why do clinicians classify psychological disorders, and why do some psychologists criticize the use of diagnostic labels?

In biology, classification creates order. To classify an animal as a “mammal” says a great deal—that it is warm-blooded, has hair or fur, and produces milk to nourish its young. In psychiatry and psychology, too, classification orders and describes symptoms. To classify a person’s disorder as “schizophrenia” suggests that the person talks incoherently, has bizarre beliefs, shows either little emotion or inappropriate emotion, or is socially withdrawn. “Schizophrenia” is a quick way to describe a complex disorder.

But diagnostic classification gives more than a thumbnail sketch of a person’s disordered behavior, thoughts, or feelings. In psychiatry and psychology, classification also aims to

To study a disorder, we must first name and describe it.

A book of case illustrations accompanying the previous DSM edition provided several examples for this chapter.

DSM-5 the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders.

The most common tool for describing disorders and estimating how often they occur is the American Psychiatric Association’s 2013 Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition (DSM-5). Physicians and mental health workers use the detailed “diagnostic criteria and codes” in the DSM-5 to guide medical diagnoses and treatment. For example, a person may be diagnosed with and treated for “insomnia disorder” if he or she meets all of the criteria in TABLE 15.1.

Table 15.1
Insomnia Disorder

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In the DSM-5, some diagnostic labels have changed. The conditions formerly called “autism” and “Asperger’s syndrome” have now been combined under the label autism spectrum disorder. “Mental retardation” has become intellectual disability. New categories, such as hoarding disorder and binge-eating disorder, have been added.

Some of the new or altered diagnoses are controversial. Disruptive mood dysregulation disorder is a new DSM-5 diagnosis for children “who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year.” Will this diagnosis assist parents who struggle with unstable children, or will it “turn temper tantrums into a mental disorder” and lead to overmedication, as the chair of the previous DSM edition has warned (Frances, 2012)?

Real-world tests (field trials) have assessed clinician agreement when using the new DSM-5 categories (Freedman et al., 2013). Some diagnoses, such as adult posttraumatic stress disorder and childhood autism spectrum disorder fared well—with agreement near 70 percent. (If one psychiatrist or psychologist diagnosed someone with one of these disorders, there was a 70 percent chance that another mental health worker would independently give the same diagnosis.) Others, such as antisocial personality disorder and generalized anxiety disorder, fared poorly.

Critics have long faulted the DSM for casting too wide a net and bringing “almost any kind of behavior within the compass of psychiatry” (Eysenck et al., 1983). Some now worry that the DSM-5’s even wider net will extend the pathologizing of everyday life—for example, by turning childish rambunctiousness into ADHD, and bereavement grief into a depressive disorder (Frances, 2013). (See Thinking Critically About: ADHD.) Others respond that hyperactivity and depression, though needing careful definition, are genuine disorders—even when the depression was triggered by a major life stress such as a death when the grief does not go away (Kendler, 2011; Kupfer, 2012).

Other critics register a more basic complaint—that these labels are at best subjective and at worst value judgments masquerading as science. Once we label a person, we view that person differently (Bathje & Pryor, 2011; Farina, 1982; Sadler et al., 2012). Labels can change reality by putting us on alert for evidence that confirms our view. When teachers were told certain students were “gifted,” they acted in ways that elicited the behaviors they expected (Snyder, 1984). Someone who was led to think you are nasty may treat you coldly, leading you to respond as a mean-spirited person would. Labels can be self-fulfilling. They create expectations that guide how we perceive and interpret people.

Struggles and recovery Boston Mayor Martin Walsh spoke openly about his struggles with alcohol. His story of recovery helped him win the closest Boston mayoral election in decades.

The biasing power of labels was clear in a now-classic study. David Rosenhan (1973) and seven others went to hospital admissions offices, complaining (falsely) of “hearing voices” saying empty, hollow, and thud. Apart from this complaint and giving false names and occupations, they answered questions truthfully. All eight healthy people were misdiagnosed with disorders.

Should we be surprised? As one psychiatrist noted, if someone swallows blood, goes to an emergency room, and spits it up, should we fault the doctor for diagnosing a bleeding ulcer? Surely not. But what followed the Rosenhan study diagnoses was startling. Until being released an average of 19 days later, those eight “patients” showed no other symptoms. Yet after analyzing their (quite normal) life histories, clinicians were able to “discover” the causes of their disorders, such as having mixed emotions about a parent. Even routine note-taking behavior was misinterpreted as a symptom.

Labels matter. In another study, people watched videotaped interviews. If told the interviewees were job applicants, the viewers perceived them as normal (Langer et al., 1974, 1980). Other viewers who were told they were watching psychiatric or cancer patients perceived the same interviewees as “different from most people.” Therapists who thought they were watching an interview of a psychiatric patient perceived him as “frightened of his own aggressive impulses,” a “passive, dependent type,” and so forth. A label can, as Rosenhan discovered, have “a life and an influence of its own.”

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THINKING CRITICALLY ABOUT

ADHD—Normal High Energy or Disordered Behavior?

15-4 Why is there controversy over attention-deficit/hyperactivity disorder?

attention-deficit/hyperactivity disorder (ADHD) a psychological disorder marked by extreme inattention and/or hyperactivity and impulsivity.

Eight-year-old Todd has always been energetic. At home, he chatters away and darts from one activity to the next, rarely settling down to read a book or focus on a game. At play, he is reckless and overreacts when playmates bump into him or take one of his toys. At school, Todd fidgets, and his exasperated teacher complains that he doesn’t listen, follow instructions, or stay in his seat and do his lessons. As Todd matures to adulthood, his hyperactivity likely will subside, but his inattentiveness may persist (Kessler et al., 2010).

If taken for a psychological evaluation, Todd may be diagnosed with attention-deficit/hyperactivity disorder (ADHD). Some 11 percent of American 4- to 17-year-olds receive the diagnosis after displaying its key symptoms (extreme inattention, hyperactivity, and impulsivity) (Schwarz & Cohen, 2013). Studies also find 2.5 percent of adults—though the number diminishes with age—exhibit ADHD symptoms (Simon et al., 2009). The looser criteria for adult ADHD in the DSM-5 has led critics to fear increased diagnosis and overuse of prescription drugs (Frances, 2012).

To skeptics, being distractible, fidgety, and impulsive sounds like a “disorder” caused by a single genetic variation: a Y chromosome (the male sex chromosome). And sure enough, ADHD is diagnosed three times more often in boys than in girls. Children who are “a persistent pain in the neck in school” are often diagnosed with ADHD and given powerful prescription drugs (Gray, 2010). Minority youth less often receive an ADHD diagnosis than do Caucasian youth, but this difference has shrunk as minority ADHD diagnoses have increased (Getahun et al., 2013).

The problem may reside less in the child than in today’s abnormal environment that forces children to do what evolution has not prepared them to do—to sit for long hours in chairs. In more natural outdoor environments, these children might seem perfectly healthy.

Rates of medication for presumed ADHD vary by age, sex, and location. Prescription drugs are more often given to teens than to younger children. Boys are nearly three times more likely to receive them than are girls. And location matters. Among 4- to 17-year-olds, prescription rates have varied from 1 percent in Nevada to 9 percent in North Carolina (CDC, 2013). Some students seek out the stimulant drugs—calling them the “good-grade pills.” They hope to increase their focus and achievement, but the risks include the development of addiction, depressive disorders, or bipolar disorder (Schwarz, 2012).

Not everyone agrees that ADHD is being overdiagnosed. Some argue that today’s more frequent diagnoses reflect increased awareness of the disorder, especially in those areas where rates are highest. They also note that diagnoses can be inconsistent—ADHD is not as clearly defined as a broken arm. Nevertheless, declared the World Federation for Mental Health (2005), “there is strong agreement among the international scientific community that ADHD is a real neurobiological disorder whose existence should no longer be debated.” A consensus statement by 75 neuroimaging researchers noted that abnormal brain activity often accompanies ADHD (Barkley et al., 2002).

What, then, is known about ADHD’s causes? It is not caused by too much sugar or poor schools. There is mixed evidence suggesting that extensive TV watching and video gaming are associated with reduced cognitive self-regulation and ADHD (Bailey et al., 2011; Courage & Setliff, 2010; Ferguson et al., 2011). ADHD often coexists with a learning disorder or with defiant and temper-prone behavior. ADHD is heritable, and research teams are sleuthing the culprit genes and abnormal neural pathways (Lionel et al., 2014; Poelmans et al., 2011; Volkow et al., 2009; Williams et al., 2010). It is treatable with medications such as Ritalin and Adderall, which are considered stimulants but help calm hyperactivity and increase one’s ability to sit and focus on a task—and to progress normally in school (Barbaresi et al., 2007). Psychological therapies, such as those focused on shaping classroom and at-home behaviors, also help address the distress of ADHD (Fabiano et al., 2008).

The bottom line: Extreme inattention, hyperactivity, and impulsivity can derail social, academic, and vocational achievements, and these symptoms can be treated with medication and other therapies. But the debate continues over whether normal high energy is too often diagnosed as a psychiatric disorder, and whether there is a cost to the long-term use of stimulant drugs in treating ADHD.

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“My sister suffers from a bipolar disorder and my nephew from schizoaffective disorder. There has, in fact, been a lot of depression and alcoholism in my family and, traditionally, no one ever spoke about it. It just wasn’t done. The stigma is toxic.”

Actress Glenn Close, “Mental Illness: The Stigma of Silence,” 2009

Labels also have power outside the laboratory. Getting a job or finding a place to rent can be a challenge for people recently released from a mental hospital. Label someone as “mentally ill” and people may fear them as potentially violent (see Thinking Critically About: Are People With Psychological Disorders Dangerous?) Such negative reactions may fade as people better understand that many psychological disorders involve diseases of the brain, not failures of character (Solomon, 1996). Public figures have helped foster this new understanding by speaking openly about their own struggles with disorders such as depression and substance abuse. The more contact we have with people with disorders, the more accepting our attitudes are (Kolodziej & Johnson, 1996).

THINKING CRITICALLY ABOUT

Are People With Psychological Disorders Dangerous?

15-5 Do psychological disorders predict violent behavior?

September 16, 2013, started like any other Monday at Washington, DC’s, Navy Yard, with people arriving early to begin work. Then government contractor Aaron Alexis parked his car, entered the building, and began shooting people. An hour later, 13 people were dead, including Alexis. Reports later confirmed that Alexis had a history of mental illness. Before the shooting, he had stated that an “ultra low frequency attack is what I’ve been subject to for the last three months. And to be perfectly honest, that is what has driven me to this.” This devastating mass shooting, like the one in a Connecticut elementary school in 2012 and many others since then, reinforced public perceptions that people with psychological disorders pose a threat (Jorm et al., 2012). After the 2012 slaughter, New York’s governor declared, “People who have mental issues should not have guns” (Kaplan & Hakim, 2013).

Does scientific evidence support the governor’s statement? If disorders actually increase the risk of violence, then denying people with psychological disorders the right to bear arms might reduce violent crimes. But real life tells a different story. The vast majority of violent crimes are committed by people with no diagnosed disorder (Fazel & Grann, 2006; Walkup & Rubin, 2013).

People with disorders are more likely to be victims than perpetrators of violence (Marley & Bulia, 2001). According to the U.S. Surgeon General’s Office (1999, p. 7), “There is very little risk of violence or harm to a stranger from casual contact with an individual who has a mental disorder.” People with mental illness commit proportionately little gun violence. The bottom line: Focusing gun restrictions only on mentally ill people will likely not reduce gun violence (Friedman, 2012).

If mental illness is not a good predictor of violence, what is? Better predictors are a history of violence, use of alcohol or drugs, and access to a gun. The mass-killing shooters have one more thing in common: They tend to be young males. “We could avoid two-thirds of all crime simply by putting all able-bodied young men in cryogenic sleep from the age of 12 through 28,” said one psychologist (Lykken, 1995).

Mental disorders seldom lead to violence, and clinical prediction of violence is unreliable. What, then, are the triggers for the few people with psychological disorders who do commit violent acts? For some, the trigger is substance abuse. For others, like the Navy Yard shooter, it’s threatening delusions and hallucinated voices that command them to act (Douglas et al., 2009; Elbogen & Johnson, 2009; Fazel et al., 2009, 2010). Whether people with mental disorders who turn violent should be held responsible for their behavior remains controversial. U.S. President Ronald Reagan’s near-assassin, John Hinckley, was sent to a hospital rather than to prison. The public was outraged. “Hinkley insane. Public mad,” declared one headline. They were outraged again in 2011, when Jared Lee Loughner killed six people and injured several others, including U.S. Representative Gabrielle Giffords. Loughner was diagnosed with schizophrenia and twice found incompetent to stand trial. He was later judged competent to stand trial, pled guilty to 19 charges of murder and attempted murder, and was sentenced to life in prison without parole.

How to prevent mass shootings? Following the Newtown, Connecticut, slaughter of 20 young children and 6 adults, people wondered: Could those at risk for violence be identified in advance by mental health workers and reported to police? Would laws that require such reporting discourage disturbed gun owners from seeking mental health treatment?

Which decision was correct? The first two, which blamed Loughner’s “madness” for clouding his judgment? Or the final one, which decided that he should be held responsible for the acts he committed? As we come to better understand the biological and environmental bases for all human behavior, from generosity to vandalism, when should we—and should we not—hold people accountable for their actions?

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Better portrayals Old stereotypes are slowly being replaced in media portrayals of psychological disorders. Recent films offer fairly realistic depictions. Iron Man 3 (2013) portrayed a main character, shown here, with posttraumatic stress disorder. Black Swan (2010) dramatized a lead character suffering a delusional disorder. A Single Man (2009) depicted depression.

“What’s the use of their having names,” the Gnat said, “if they won’t answer to them?”

“No use to them,” said Alice; “but it’s useful to the people that name them, I suppose.”

Lewis Carroll, Through the Looking-Glass, 1871

Despite their risks, diagnostic labels have benefits. Mental health professionals use labels to communicate about their cases, to comprehend the underlying causes, and to discern effective treatment programs. Researchers use labels when discussing work that explores the causes and treatments of disorders. Clients are often relieved to learn that the nature of their suffering has a name, and that they are not alone in experiencing this collection of symptoms.

To test your ability to form diagnoses, visit LaunchPad’s PsychSim 6: Classifying Disorders.

RETRIEVAL PRACTICE

  • What is the value, and what are the dangers, of labeling individuals with disorders?

Therapists and others use disorder labels to communicate with one another using a common language, and to share concepts during research. Clients may benefit from knowing that they are not the only ones with these symptoms. The dangers of labeling people are that (1) people may begin to act as they have been labeled, and (2) the labels can trigger assumptions that will change our behavior toward those we label.

Rates of Psychological Disorders

15-6 How many people have, or have had, a psychological disorder? Is poverty a risk factor?

Who is most vulnerable to psychological disorders? At what times of life? To answer such questions, various countries have conducted lengthy structured interviews with representative samples of thousands of their citizens. After asking hundreds of questions that probed for symptoms—“Has there ever been a period of two weeks or more when you felt like you wanted to die?”—the researchers have estimated the current, prior-year, and lifetime prevalence of various disorders.

How many people have, or have had, a psychological disorder? More than most of us suppose:

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What increases vulnerability to mental disorders? As TABLE 15.3 indicates, there is a wide range of risk and protective factors for mental disorders. But one predictor of mental disorder, poverty, crosses ethnic and gender lines. The incidence of serious psychological disorders has been doubly high among those below the poverty line (CDC, 1992). Like so many other correlations, the poverty-disorder association raises further questions: Does poverty cause disorders? Or do disorders cause poverty? It is both, though the answer varies with the disorder. Schizophrenia understandably leads to poverty. Yet the stresses and demoralization of poverty can also precipitate disorders, especially depression in women and substance abuse in men (Dohrenwend et al., 1992).

Table 15.3
Risk and Protective Factors for Mental Disorders

In one natural experiment on the poverty-pathology link, researchers tracked rates of behavior problems in North Carolina Native American children as economic development enabled a dramatic reduction in their community’s poverty rate. As the study began, children of poverty exhibited more deviant and aggressive behaviors. After four years, children whose families had moved above the poverty line exhibited a 40 percent decrease in the behavior problems. Those who continued in their previous positions below or above the poverty line exhibited no change (Costello et al., 2003).

At what times of life do disorders strike? Usually by early adulthood. “Over 75 percent of our sample with any disorder had experienced [their] first symptoms by age 24,” reported Lee Robins and Darrel Regier (1991, p. 331). Among the earliest to appear are the symptoms of antisocial personality disorder (median age 8) and of phobias (median age 10). Alcohol use disorder, obsessive-compulsive disorder, bipolar disorder, and schizophrenia symptoms appear at a median age near 20. Major depressive disorder often hits somewhat later, at a median age of 25.

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RETRIEVAL PRACTICE

  • What is the relationship between poverty and psychological disorders?

Poverty-related stresses can help trigger disorders, but disabling disorders can also contribute to poverty. Thus, poverty and disorder are often a chicken-and-egg situation, and it’s hard to know which came first.

REVIEW: Introduction to Psychological Disorders

REVIEW Introduction to Psychological Disorders

LEARNING OBJECTIVES

RETRIEVAL PRACTICE Take a moment to answer each of these Learning Objective Questions (repeated here from within this section). Then click the 'show answer' button to check your answers. Research suggests that trying to answer these questions on your own will improve your long-term retention (McDaniel et al., 2009).

15-1 How should we draw the line between normality and disorder?

According to psychologists and psychiatrists, psychological disorders are marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior.

15-2 How do the medical model and the biopsychosocial approach influence our understanding of psychological disorders?

The medical model assumes that psychological disorders are mental illnesses with physical causes that can be diagnosed, treated, and, in most cases, cured through therapy, sometimes in a hospital. The biopsychosocial perspective assumes that three sets of influences—biological (evolution, genetics, brain structure and chemistry), psychological (stress, trauma, learned helplessness, mood-related perceptions and memories), and social and cultural circumstances (roles, expectations, definitions of “normality” and “disorder”)—interact to produce specific psychological disorders. Epigenetics also informs our understanding of disorders.

15-3 How and why do clinicians classify psychological disorders, and why do some psychologists criticize the use of diagnostic labels?

The American Psychiatric Association’s DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) contains diagnostic labels and descriptions that provide a common language and shared concepts for communication and research. Most U.S. health insurance organizations require a DSM diagnosis before paying for treatment.
     Some critics believe the DSM editions have become too detailed and extensive. Others view DSM diagnoses as arbitrary labels that create preconceptions, which bias perceptions of the labeled person’s past and present behavior.

15-4 Why is there controversy over attention-deficit/hyperactivity disorder?

A child (or, less commonly, an adult) who displays extreme inattention and/or hyperactivity and impulsivity may be diagnosed with attention-deficit/hyperactivity disorder (ADHD) and treated with medication and other therapy. The controversy centers on whether the growing number of ADHD cases reflects overdiagnosis or increased awareness of the disorder. Long-term effects of stimulant-drug treatment for ADHD are not yet known.

15-5 Do psychological disorders predict violent behavior?

Mental disorders seldom lead to violence, but when they do, they raise moral and ethical questions about whether society should hold people with disorders responsible for their violent actions. Most people with disorders are nonviolent and are more likely to be victims than attackers.

15-6 How many people have, or have had a psychological disorder? Is poverty a risk factor?

Psychological disorder rates vary, depending on the time and place of the survey. In one multinational survey, rates for any disorder ranged from less than 5 percent (Shanghai) to more than 25 percent (the United States). Poverty is a risk factor: Conditions and experiences associated with poverty contribute to the development of psychological disorders. But some disorders, such as schizophrenia, can drive people into poverty.

TERMS AND CONCEPTS TO REMEMBER

RETRIEVAL PRACTICE Match each of the terms on the left with its definition on the right. Click on the term first and then click on the matching definition. As you match them correctly they will move to the bottom of the activity.

Question

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