NOT GUILTY by Reason Of

CASE STUDY

NOT GUILTY by Reason of

The majority of people with serious psychological disorders are not dangerous to others. Some, however, do commit violent crimes. Of these, some are found not guilty of the crimes of which they are accused “by reason of insanity.” Typically, these people are sent to psychiatric institutions instead of prison. They may be released when they are John Hinckley Jr. was arrested immediately after his judged no longer to be a threat to others. attempted assassination of President Reagan on March 30, 1981. A well-known use of the insanity plea occurred in the case of John Hinckley Jr., who tried to assassinate President Ronald from which she hoped to save them. When Reagan in 1981. Not only did Hinckley Yates went to trial, the jury rejected the attempt to murder the president, but he did insanity defense and convicted her of first- so in front of millions of television witnesses. degree murder. However, Yates won a new Nevertheless, Hinckley was found not guilty trial in 2006, and this time was found not by reason of insanity after expert witnesses guilty by reason of insanity. testified that he had the serious psychologi- In using an insanity defense, lawyers cal disorder called schizophrenia. apply a modified version of the M’Naghten Another famous case is that of Andrea Rule, which states that if it can be proved Yates, who on June 20, 2001, drowned all that at the time of committing a criminal act five of her young children. Yates freely a person either did not understand the nature confessed to the murders. She told a psy- of the act or did not know that it was wrong, chiatrist that she feared her children were then the person is insane and not responsible “doomed to perish in the fires of hell”—a fate for the act. The M’Naghten Rule goes back to 1843, when a Scot named Daniel M’Naghten tried to kill the British prime minister, Sir Robert Peel. M’Naghten believed that he was the target of an international conspiracy that included Sir Robert and the pope. In the assassination attempt, M’Naghten killed Peel’s secretary instead of the prime minister. M’Naghten was arrested and tried but was judged not guilty. The jury declared that M’Naghten was insane and thus not responsible for the crime. At her second trial, Andrea Yates was found not guilty Typically, when an accused person pleads by reason of insanity. insanity, prosecuting attorneys try to show

496 CHAPTER 18 Watch the Video HAPTER 1188 Explore topics on psychological disorders in CCHAPTE the United States. PPSYCHOLOGICALSYCHOLOGICAL that the accused was sane at the time of the crime, while the defense tries to prove that the accused was not. Both rely on the testi- DDISORDERSISORDERS mony of expert witnesses, usually psychologists or psychiatrists. Many people claim that the insanity defense allows criminals literally to “get Chapter at a Glance away with murder.” However, the defense is actually used rarely and is often unsuccess- SECTION 1: Understanding Psychological ful. Recent changes have made it more diffi- Disorders cult to use the insanity plea successfully. For ■ Psychological disorders are behavior patterns or mental processes example, it is now up to the defense to prove that cause serious personal suffering or interfere with a person’s that the defendant’s mental illness is one ability to cope with everyday life. that qualifies under the insanity plea. ■ Psychological disorders are classified in the Diagnostic and “Insanity” is a legal concept, not a psy- Statistical Manual of Mental Disorders, also known as the DSM. chological one, and to be legally usable, it must be all or nothing—one is either sane or SECTION 2: Anxiety and Mood Disorders insane. In reality, most psychological disor- ■ Anxiety disorders occur when people feel fear or nervousness out ders are a matter of degree. The distinction of proportion to the actual threat. is important. One can be mildly depressed, ■ Mood disorders are characterized by mood changes that are inap- for example, but according to the law, one propriate for the situation to which they are responding. cannot be mildly insane. Because of the insanity plea’s all-or-nothing nature, decid- SECTION 3: Dissociative and Somatoform ing on someone’s sanity can be a very diffi- Disorders cult decision for judges and juries. ■ Dissociative disorders are characterized by the separation of cer- Our legal system requires a wide range tain personality components or mental processes from conscious of people to make decisions about the mental thought. health of others. How equipped are jurors ■ Somatoform disorders are expressed in the form of actual physi- to make these decisions? How informed are cal symptoms. we about what separates mental illness SECTION 4: Schizophrenia from mental health? For example, the case ■ Schizophrenia is usually considered the most serious psychologi- of Andrea Yates poses some basic questions cal disorder and can be very disabling. that are not easily answered: Is a woman who drowns all her children to “save” them ■ Schizophrenia is characterized by a loss of contact with reality. automatically insane, even though she knew ■ The three types of schizophrenia are paranoid, disorganized, and that her action was wrong in the eyes of the catatonic schizophrenia. law? Just what is mental illness? SECTION 5: Personality Disorders ■ Personality disorders are patterns of inflexible traits that disrupt What do you think? social life or work and may distress the affected individual. ■ Four common personality disorders are paranoid, schizoid, anti- 1. In general, what criteria must a defendant meet to be social, and avoidant. ruled legally insane? 2. Do you support the use of the insanity defense? Why or why not?

PSYCHOLOGICAL DISORDERS 497 SSEECCTIONTION 1 UUnderstandingnderstanding PPsychologicalsychological DisordersDisorders Before You Read Use a graphic Main Idea Reading Focus Vocabulary organizer like Psychological disorders are 1. What are psychological psychological disorders this one to take notes on relatively common. They disorders, and how common culture-bound psychological disorders. cause personal suffering are they? syndromes Psychological to millions of people and 2. What are the four major symp- Disorders interfere with their ability to toms that can help identify cope with everyday life. psychological disorders? Identifying Classifying What they are 3. How do psychologists classify disorders disorders psychological disorders?

Misunderstanding Mental Illness

Why were people with mental illnesses seen as criminals? Until about a century ago, mental illness was a mystery. To both the public and to the medical profession, people who behaved strangely were often seen as evil or cursed, not ill. Doctors sometimes proposed causes for the illnesses that we now consider absurd, such as reading too many novels. Because they did not understand mental disorders, doctors and other officials often treated mental patients very harshly, severely restricting their freedom and even punishing them as if they were criminals. One common method of control was the straitjacket, which is a garment with extra-long sleeves that wrap around the patient’s body. The straitjacket was actually more humane than the ropes and metal chains with which some patients were shackled. Now we know that psychological disorders are indeed illnesses. Mental health professionals have described almost 400 such disorders. Their causes, however, are sometimes disputed. You will read more about psychological disorders in this section.

This straitjacketed mental patient was photographed in 1946.

498 CHAPTER 18 What Are Psychological Disorders? important here, because diagnosing an individual with a psychological disorder is often You have already learned that psychology is difficult, and reaching a correct diagnosis is the scientific study of behavior and mental not always a simple process. processes. PPsychologicalsychological disordersdisorders are behav- Understanding However, psychologists generally use sev- ior patterns or mental processes that cause eral criteria to determine whether a person’s serious personal suffering or interfere with a behavior indicates the presence of a psycho- ACADEMIC person’s ability to cope with everyday life. Psychological Disorders logical disorder. These criteria include how VOCABULARY Many people believe that psychological dis- typical the behavior is of people in general, criteria the stan- orders are uncommon, affecting relatively few whether the behavior is maladaptive, whether dards on which a individuals. It is true that the great majority judgment or deci- the behavior causes the individual emotional of people are never admitted to mental hospi- sion may be based discomfort, and whether the behavior is tals, and most people never seek the help of socially unacceptable. psychologists or psychiatrists. And although many people have relatives they consider INTERACTIVE eccentric, few people have family members they consider to be truly abnormal. Statistically Estimates suggest, however, that about one in four adults in the United States have Sp ea k i n g... experienced some type of psychological disorder. In addition to the many people with substance abuse problems, 26 percent of people in the United States experience some type of psychological disorder in a given year. In any given month, the figure is approximately 13 percent. For people aged 15–44, psychological disorders are the leading cause of disability in the United States. Reading Check Summarize What is a common misconception about psychological disorders? Psychological Disorders in the United States Drug and alcohol addiction, depression, and anxiety disorders are Identifying Psychological Disorders the most common psychological disorders. Deciding whether particular behaviors, thoughts, or feelings are “normal” or “abnor- 26.2% Percentage of American adults who suffer mal” can be difficult. What is normal is often from a diagnosable mental disorder in a given year equated with what is average for the majority 6% Percentage of Americans who suffer from a seri- of people. Using this definition of normality, ous psychological disorder deviation from the majority becomes the primary criterion for abnormality. 47.1 m illion Annual number of visits People with psychological disorders usu- to office-based physicians due to psychological disor- ally do not differ much from so-called normal ders in the United States people. In fact, the primary difference is the simple exaggeration of certain behaviors or 6.9 days Average hospital stay for patients mental processes. For example, laughing is with psychological disorders in the United States a normal and healthy response to humorous situations. However, someone who laughs all 90% Percentage of people that kill themselves who the time, even in a tragic situation where suffer from a diagnosable psychological disorder everyone else is sad might be considered Skills Focus abnormal. INTERPRETING DATA What is one possible result of Certain behavior patterns and mental pro- not diagnosing and treating a serious mental disorder? cesses may suggest that an individual has a Sources: National Institute of Mental Health; National Center for Health Statistics psychological disorder. The word suggest is Interactive Feature thinkcentral.com

PSYCHOLOGICAL DISORDERS 499 Typicality The normality of a behavior or For example, people who are depressed often mental process is often determined by the suffer feelings of helplessness, hopelessness, degree to which it is average, or typical, of the worthlessness, guilt, and extreme sadness. behavior or mental processes of the majority They may lose interest in virtually every- of people. There are, however, problems with thing they once enjoyed and believe that life defining normality in terms of what is typi- is no longer worth living. Such feelings are cal of most people. The fact that a behavior so stressful that they may lead the affected is not typical of most people does not mean it individual to consider suicide. Thus, severe is abnormal. Scientific and artistic geniuses, emotional discomfort may be a sign of a psy- such as Marie Curie and Pablo Picasso, cer- chological disorder. tainly are not typical of people in general. That Socially Unacceptable Behavior Behavior does not mean, however, that such people are that violates a society’s accepted norms may abnormal. In addition, people who are quite also be an indication of a psychological disor- normal may have lifestyles that differ widely der. However, whether a behavior is socially from the rest of the community. Additional unacceptable may depend on the particular measurements must be taken into account culture in which it occurs. What is considered to assess people with different styles and normal behavior in one culture may be con- habits. sidered not normal in another. Therefore, the Maladaptivity Many psychologists believe cultural context of a behavior must be taken that what makes a behavior abnormal is into account before deciding that the behavior the fact that it is maladaptive. That is, the indicates a psychological disorder. behavior impairs an individual’s ability to The importance of culture is demonstrated function adequately in everyday life. Behavior by cculture-boundulture-bound syndromes,syndromes, which are clusters that causes misery and distress rather than of symptoms that are considered recognizable happiness and fulfillment may be considered diseases only within specific cultures or soci- maladaptive. Alcohol abuse is one such behav- eties. Many behaviors associated with cul- ior. Alcohol abuse often has strong negative ture-bound syndromes would be considered effects on the drinker’s health, work, and fam- abnormal by people who were unaware of the ily life. Abuse of alcohol may discourage the cultural context. For example, many people in drinker from seeking healthier solutions to Middle Eastern cultures believe that certain the problem of anxiety as well as create addi- unusual behaviors, such as head-banging, are tional problems of its own. due to possession of the body by a spirit. In Behavior that is hazardous to oneself or the local cultural context, spirit possession is to others may also be considered maladap- considered to be a rational explanation for the tive. This type of maladaptive behavior may behavior, and the affected individual is not include threatening or attempting suicide as thought to have a mental illness. However, in well as threatening or attacking other people. the United States, such an unusual behavior Maladaptive behaviors can put the person might be considered a sign of a psychological with a disorder on the wrong side of the law. disorder. It is important to note, however, that most On the other hand, there are some culture- people who commit violent crimes do not have bound syndromes that are clearly disorders, diagnosable psychological disorders. This is as interpreted both by the home culture and because most criminals are fully aware of by mainstream Western society. Their causes what they are doing. That is, they know that may be unique to the culture, though. Some their behavior is illegal and that they can be culture-bound syndromes have serious phys- held responsible for it. Equally important, the ical symptoms and results. There are many majority of people with psychological disor- types of culture-bound syndromes, some of ders, even severe psychological disorders, are which are described in the feature at the end not violent or dangerous. of this section. Emotional Discomfort Psychological disor- Reading Check Find the Main Idea What are four ders such as anxiety and depression cause features that might indicate a psychological most people serious emotional discomfort. disorder?

500 CHAPTER 18 Classifying Psychological Disorders with it. It is also important to classify psychological disorders so that individuals can Most psychologists believe that it is impor- be correctly diagnosed and treated. tant to have a widely agreed upon classifica- The most widely used classification sys- tion of psychological disorders. Unless there tem for psychological disorders is the DSM, is agreement about how to classify psychologi- or Diagnostic and Statistical Manual of cal disorders, it is difficult to know how many Mental Disorders, published by the American people have a given disorder or what other Psychiatric Association. The most recent ver- factors, such as socioeconomic status, hered- sion of the manual, the DSM-IV-TR™, was ity, or gender differences, may be associated published in 2000.

Major Categories of Psychological Disorders The DSM-IV-TR™ lists 16 basic categories of psychological disorders, of which 13 are described here. You will learn about six of these general categories: anxiety, mood, dissociative, somatoform, and personality disorders; and schizophrenia.

Disorders usually first diagnosed in infancy, child- Somatoform disorders involve physical symptoms hood, or adolescence include mental retardation, for which no biological cause can be found. attention deficit disorders, and autism spectrum Sexual and gender identity disorders disorders. include sexual dysfunctions and the need for unusual or bizarre Delirium, dementia, and amnesia, and other cogni- acts to achieve sexual satisfaction. tive disorders result from brain damage, degenera- Eating disorders tive diseases such as Alzheimer’s disease, or expo- are characterized by abnormal sure to toxic substances or drugs. eating patterns, including anorexia nervosa (self- starvation caused by an irrational fear of becoming Substance-related disorders are associated with the overweight) and bulimia nervosa (episodes of binge excessive use of or withdrawal from drugs such as eating and vomiting). alcohol, nicotine, amphetamines, cocaine, hallucino- Sleep disorders gens, opiates, or caffeine. include disorders associated with sleeping patterns, including insomnia and sleep- Schizophrenia and other psychotic disorders are walking. characterized by delusions, hallucinations, and Impulse control disorders severe disruptions in thoughts and emotions. not elsewhere classified are characterized by an inability to resist an impulse Anxiety disorders include phobias, generalized to perform actions that are harmful to the individual anxiety disorder, panic attacks, post-traumatic stress or to others, including compulsive gambling, steal- disorder, and obsessive-compulsive disorder. ing (kleptomania), and setting fires (pyromania).

Mood disorders include major depression, bipolar Personality disorders are characterized by mal- disorder, postpartum depression, and chronically adaptive patterns that cause distress or interfere depressed mood. with one’s ability to function, including antisocial and paranoid personality disorders. Dissociative disorders are characterized by the separation of certain mental processes or personal- Skills Focus INTERPRETING CHARTS ity traits from conscious thoughts, including dis- What kinds of disorders are typically diagnosed early sociative amnesia and dissociative identity disorder in one’s life? (multiple personality disorder).

PSYCHOLOGICAL DISORDERS 501

py10se_DIS_sect1.indd 501 5/8/09 12:02:47 PM People use the DSM for various purposes. only after the Vietnam War, when many sol- Psychiatrists and other mental health profes- diers were found to suffer from the disorder. sionals use its terminology to communicate More recent research into PTSD in Iraq war about patient needs and treatment. Insurance veterans may be included in the revision of companies may require that patients match the DSM text that is scheduled for 2012. DSM diagnoses to cover treatment costs. With each new revision of the DSM, the Researchers investigating certain disorders number of psychological disorders has grown. or specific diseases may recruit patients Currently, the manual contains almost 400 whose symptoms match the DSM criteria for types of disorders. Critics worry that some of that disease. the disorders being added are simply every- The way psychological disorders are clas- day problems, as opposed to the more serious sified has changed significantly from earlier disorders such as schizophrenia and PTSD. DSM systems. Until 1980, when the third edi- The remainder of this chapter focuses on tion of the DSM was published, psychological six major types of psychological disorders: disorders were classified on the basis of their anxiety disorders, mood disorders, dissocia- presumed causes. For many decades, the most tive disorders, somatoform disorders, schizo- widely accepted causes were those suggested phrenia, and personality disorders. Many of by Freud’s psychoanalytic theory. the symptoms of these disorders are simply Many psychologists criticized early ver- exaggerations of normal thoughts, feelings, sions of the DSM because very diverse psy- or behaviors. As a result, as you read about chological disorders were grouped together the different symptoms, you may feel that under the labels “neuroses” and “psychoses.” you have one or more of the disorders being As a result, beginning with the DSM-III in described. Such a feeling is common among 1980, psychological disorders have been cat- most people who read about psychological dis- egorized on the basis of observable signs and orders for the first time. Keep in mind that symptoms rather than presumed causes. only trained professionals can diagnose psy- The DSM is subject to ongoing revision. chological disorders, and they can do so only New categories are added and old ones after careful evaluation. removed as knowledge of psychological disor- Reading Check Summarize What are some ways ders increases. For example, post-traumatic in which the DSM has been revised? stress disorder (PTSD) was added to the DSM

Online Quiz thinkcentral.com SSECTIONECTION 1 AAssessmentssessment Reviewing Main Ideas and Vocabulary 6. Analyze Using your notes and a graphic organizer like the 1. Define What are psychological disorders? one below, explain the problems that can arise when using the following criteria to determine the presence of a psycho- 2. Summarize How did the arrangement of the criteria for the logical disorder. classification of psychological disorders change in 1980? Criteria Problems Thinking Critically 1. Typicality 3. Elaborate Why must psychologists be aware of culture- 2. Maladaptivity bound syndromes when determining what is abnormal? 3. Emotional discomfort 4. Categorize Give an example of a feeling or a behavior that would be considered normal in one circumstance but might 4. Social unacceptability of behavior be considered a sign of a psychological disorder in another circumstance. FOCUS ON WRITING 5. Predict What are the common pitfalls that students of 7. Persuasive In a paragraph, explain why the changes made psychology may face when learning about psychological in the organization of the DSM in 1980 were a benefit to disorders? psychologists and their patients.

502 CHAPTER 18 Cultural Diversity and Psychology Culture-Bound Syndromes

In certainn cuulltures, one cann find combinationns of psyychiatric and phyysi- cal symptomo s recognized as diseasees only in that culture. Some of thee sys mpttoms off theh see maladies coinciide with dissorders in thee DDSM. Othherss, howew ver, are quite specific to the indiividual culture. These culturee-bound Sufferers of susto may seek help from a syndromes are often treateedd witth folk reemedies. curandero in a healing ritual.

HikikomoriHiikikomorikoo o i Hikikomoorii are Japaneese GhostGhost sicknesssiccknk ess Ghost sickness has Susto Hispanic groups in the United people who have withdh rawn from occurred among the Navajo of thee States and parts off Latin America social life. Thee Jaapanese Ministry of AAmerican Souuthwest. The symptoms report a disorder called susto. Health, Labour and Weelfare has defined include bad dreams, losss off appetite, Sufferers experience acute unhappi- the affliction,, also called hikikomoori, as a feelinng of suffocaation, hallucina- ness following a frightening event. refusing to leeave one’s parentss’ house tiions, faintinng, and a pervasive feeeling The victim believes that her soul has and isolating one’s self from society off terror. A preeoccupationn wiith death left her body. Physical symptoms, for sixx months or longeer. The extreme and thee dead is blameed for the symp- such as muscle pain and insomnia, competitiveness of Jaapanese educa- tomms. Ghosts, called chindi, or witches may accompany the misery. A curan- tion and societyy hava e been cited as aare believed to cause the fixation. dero, or healer, may be called to per- contributing to hih kikomori. form a ceremony that will return the Hwa-byung In Korea, some people soul to its rightful place. Susto may suffer from hwa-byung, which means be similar to post-traumatic stress “aannger illness”or“fire illness.””Many didisordersorder (PTSD). physical symptoms result from the panic and depression believed to Zar There is a religious custom and be due to the suppression off anger. a syndrome in the Middle East and These physical symptoms may North Africa known as Zar. During include a heavy feeling in the chest, a Zar ritual, off which music is an insomnia, fatigue, or indigestion. important aspect, a person (usually a Western psychiatrists would probably woman) is supposedly possessed by a diagnose a hwa-byung patient as suf- spirit. The “possessed””person shouts, This 19-year-old hikikomori has shut fering from anxiety or depression. laughs, bangs her head, and displays himself away in his parents’ tiny other odd behaviors. The Zar custom Amok apartment since he was 11 years old. In Malaysia, a previously may offer an emotional release for peaceful man who suddenly tries to women in male-dominated societies. LatahLaatah In Malaysia and some other kill or injure others is said to be struck arreeas, latah is thhe name both for a by amok, from a Malay word that coc ndition andd someone who suffers means“rushing in a frenzy.””Men who Thinking Critically from it. Thee conndid tion is characterized “run amok”—the syndrome does 1. Summarize What are some of the by havinng a severe reaction to being not occur in women—may be over- whelmed by some kind off shame and physical symptoms associated with startlleed. When surprised, latahss, usu- culture-bound syndromes? allly womo en, may mimic the speech feel they can no longer live with such 2. Discuss Do you thinkk Western medi- off people around them and obey dishonor. A person in the grips off this syndrome may continue to attack cal schools should include culture- ana y order. If a latah does something bound syndromes in their psychiatry until he is restrained, exhausted, or wrong during such an episode, she is programs? Why or why not? ordinarily not held responsible. killed by bystanders.

PSYCHOLOGICAL DISORDERS 503

py10se_DIS_sect1.indd 503 5/8/09 12:03:28 PM SSEECCTIONTION 2 AAnxietynxiety aandnd MoodMood DisordersDisorders Before You Read As you read, Main Idea Reading Focus Vocabulary take notes on Anxiety disorders cause 1. What are some characteristics phobia the types and characteris- people to experience irra- of anxiety? social phobia tics of anxiety and mood disorders. tional or excessive fear. 2. What are five major types of panic attack Mood disorders cause anxiety disorders? agoraphobia Type of Characteristics people to experience mood obsessive-compulsive Disorder 3. How do psychologists explain changes that are inappro- disorder (OCD) anxiety disorders? 1. priate to the situation. post-traumatic stress 2. 4. How do the two main types of disorder (PTSD) 3. mood disorders compare? depression 5. Which theories explain the bipolar disorder origins of mood disorders? mania

A Footballer’s FFixationsixations Why does an English soccer star need three refrigerators? When David Beckham joined the Los Angeles Galaxy, many American sports fans knew of his phenomenal talent on the soccer field, his prominent place on the fashion scene, and his glamorous wife. What they did not know is that Beckham suffers from obsessive-compulsive disorder, often abbreviated as OCD. This mental condition drives Beckham to require his surroundings be arranged just so. For example, when he stays in a hotel room, he cannot rest until all the leaflets and books are stowed out of sight. At home, he has three refrigerators, so that drinks, salad fixings, and other foods are stored separately. If there are three soft drink cans in the fridge, he has to put one away so that an even number of cans remains. Beckham has said “I have to have everything in a straight line or everything has to be in pairs.” OCD is one of the anxiety disorders that afflict millions of people. For many of these people, their disorders go undiagnosed and untreated. Before the 2006 World Cup, soccer star David Beckham disclosed that he suffers from obsessive-compulsive disorder (OCD).

504 CHAPTER 18 Quick Lab Does Public Speaking Make You Nervous? One of the most common phobias that people have is the fear of public speaking. Standing and speaking in front of a group is not a strenuous activity, so why does it cause so much anxiety? PROCEDURE ANALYSIS 1 While seated calmly at your desk, take your pulse for 1. Calculate the number of beats per minute for your resting ten seconds. heart rate. 2 Stand up at the front of the class and read the following 2. Calculate the number of beats per minute after your speech. statement: 3. Compare the two heart rates. People who experience obsessions are usually 4. Describe any other changes that you noticed as your body aware that the obsessions are unjustified. This dealt with the stress of speaking in front of the class. distinguishes obsessions from delusions. 5. Discuss with the rest of the class how the anticipation of pub- 3 Return to your desk and immediately take your pulse for lic speaking affected you, what physical responses you felt ten seconds. during the exercise, and why you think public speaking can cause so much anxiety.

Quick Lab thinkcentral.com

What Is Anxiety? Types of Anxiety Disorders Anxiety refers to a generalized state of dread or Anxiety disorders classified in the DSM-IV uneasiness that occurs in response to a vague include phobic disorder, panic disorder, gener- or imagined danger. It differs from fear, which is alized anxiety disorder, obsessive-compulsive a response to a real danger or threat. Anxiety is disorder, and stress disorders. A description typically characterized by nervousness, inabil- of each follows. ity to relax, and concern about losing control. Phobic Disorder The word pphobiahobia derives Physical signs and symptoms of anxiety may from the Greek root phobos, which means include trembling, sweating, rapid heart rate, “fear.” Specific phobia, which is the most Complete a shortness of breath, increased blood pressure, common of all the anxiety disorders, refers Webquest at flushed face, and feelings of faintness or light- thinkcentral.com to a persistent excessive or irrational fear of headedness. All are the result of overactivity on phobic a particular object or situation. To be diag- disorders. of the sympathetic branch of the autonomic nosed as a phobic disorder, the fear must lead nervous system. to avoidance behavior that interferes with the Everyone feels anxious at times—for affected person’s normal life. example, before a big game. In such situations, Almost any object or situation may lead to feeling anxious or worried is an appropriate a phobic reaction. Several phobias, however, response that does not indicate a psychologi- are especially common. The most common cal disorder. However, some people feel anx- include: ious all or most of the time, or their anxiety is out of proportion to the situation provoking • zoophobia: fear of animals it. Such anxiety may interfere with effective • claustrophobia: fear of enclosed spaces living, the achievement of desired goals, life • acrophobia: fear of heights satisfaction, and emotional comfort. When • arachnophobia: fear of spiders these problems occur, anxiety is considered a Other relatively common phobias include sign of a psychological disorder. Anxiety-based fear of thunderstorms, blood, snakes, dental disorders are among the most common of all procedures, driving, and air travel. psychological disorders in the United States. When people with specific phobias are Reading Check Analyze How are anxiety disor- confronted with the object or situation they ders different from normal anxious reactions? fear, they are likely to feel extremely anxious.

PSYCHOLOGICAL DISORDERS 505 As a result, they tend to avoid what they avoidance is impossible, the situations are fear. Someone with hematophobia (a fear of likely to cause great anxiety. In addition, the blood) might avoid needed medical treatment. avoidance behavior itself may greatly inter- Someone with aviaphobia (a fear of air travel) fere with work and social life. might turn down a job promotion because the Panic Disorder and Agoraphobia People new position involves air travel. For exam- with panic disorder have recurring and ple, an aviaphobic businesswoman panicked unexpected panic attacks. A ppanicanic attackattack is a before a flight to an important meeting in relatively short period of intense fear or dis- Philadelphia. She got off the plane, rented a comfort characterized by shortness of breath, car, and drove to Philadelphia, but she still dizziness, rapid heart rate, trembling or shak- missed the meeting. She later resigned from ing, sweating, choking, nausea, and other dis- her job as a result. Thus, although most people tressing physical symptoms. It may last from with specific phobias never seek treatment for a few minutes to a few hours. People having their disorders, a specific phobia can seriously a panic attack may believe they are dying or disrupt a person’s life. “going crazy.” Not surprisingly, they usually SSocialocial phobiaphobia is characterized by persistent have persistent fears of another attack. fear of social situations in which one might For most people who suffer panic disorder, be exposed to the close scrutiny of others and attacks have no apparent cause. However, thus be observed doing something embarrass- many people with panic disorder also have ing or humiliating. Some people with social agoraphobia. AAgoraphobiagoraphobia is a fear of being in phobias fear all social situations; others fear places or situations in which escape may be specific situations, such as public speaking, difficult or impossible. People with agorapho- eating in public, or dating. bia may be especially afraid of crowded pub- People with social phobias generally try lic places such as movie theaters, shopping to avoid the situations they fear. They may malls, buses, or trains. invent excuses to avoid going to parties or Agoraphobia is a common phobia among other social gatherings, for example. If such adults. In fact, according to the DSM-IV, people with one or both disorders make up from 50 to 80 percent of the phobic patients seen in clinical practice. Most people with agoraphobia have panic attacks when they cannot avoid the stressful situations they fear. They are afraid they will

Other Specific Phobias Arachnophobia Amaxophobia Microphobia fear of riding in a car fear of small things Definition: a simple phobia characterized by an Astraphobia Octophobia irrational, excessive, and persistent fear of spiders fear of thunder, lightning, and fear of the number 8 Symptoms: may include feelings of panic, excessive storms Paraskavedekatriaphobia sweating, rapid breathing, a quickened heartbeat, Chromophobia fear of Friday the 13th nausea, or dizziness fear of colors Selenophobia Coulrophobia fear of the moon Impact on daily life: avoiding encounters with spiders fear of clowns Taphophobia by refusing to go barefoot, checking when showering Gephyrophobia fear of being buried alive or getting into and out of bed, fumigating the home, fear of bridges Trypanophobia or sealing windows with tape fear of needles or injections

506 CHAPTER 18 OCD: Compulsive Hoarding

Definition: a type of obsessive-compulsive disorder characterized by the compulsive acquiring and keeping of a large number of possessions, leading to significant distress or impairment in daily living

Symptoms: may include compulsive need to acquire more possessions, inability to discard possessions, deep shame and embarrassment

Impact on daily life: saving items that are broken or useless, buying and storing large amounts of items but never using them, pulling useful materials from the trash on a regular basis but never putting them to use, acquiring huge numbers of small animals (such as cats) and being unable to keep them in clean conditions

have a panic attack in a public place where checking or cleaning something. Compulsive they will be humiliated or unable to obtain acts may reduce the anxiety the the obses- help. Panic disorder and agoraphobia both sions produce. lead to avoidance behaviors. These behaviors The following examples are typical of can range from avoiding crowded places to people with OCD. One person is obsessed never leaving home at all. Thus, these disor- every night with doubts that he has locked ders can be very serious. the doors and windows before going to bed. He feels driven to compulsively check and Generalized Anxiety Disorder According recheck every door and window in the house, to the DSM-IV, generalized anxiety disorder perhaps dozens of times. Only then can he (GAD) is an excessive or unrealistic worry relax and go to sleep. In another example, about life circumstances that lasts for at least a team of researchers reported the case of a six months. The worries must be present most woman who was obsessed with the idea that of that time in order to warrant a diagnosis of she would pick up germs from nearly every- GAD. Typically, the worries focus on finances, thing she touched. She compulsively washed employment, interpersonal problems, acci- her hands over and over again, sometimes as dents, or illness. many as 500 times a day. GAD is one of the most common anxiety People who experience obsessions are usu- disorders, yet few people seek psychological ally aware that the obsessions are unjustified. treatment for it because it does not differ, This distinguishes obsessions from delusions. except in intensity and duration, from the Although obsessions are a sign of a less serious normal worries of everyday life. It is difficult psychological disorder than delusions, they to distinguish GAD from other anxiety disor- still can make people feel extremely anxious, ders, and many people with GAD have other and they can seriously interfere with daily anxiety disorders as well, most often phobic life. Compulsions may alleviate some of the disorders. anxiety associated with obsessions, but the Obsessive-Compulsive Disorder Among compulsions themselves are time-consuming ACADEMIC the more debilitating of the anxiety disor- and usually create additional interference VOCABULARY ders is oobsessive-compulsivebsessive-compulsive ddisorderisorder ((OCD).OCD). with daily life. debilitating Obsessions are unwanted thoughts, ideas, weakening, making Stress Disorders Stress disorders include life much more or mental images that occur over and over post-traumatic stress disorder (PTSD) and difficult. again. They are often senseless or repulsive, acute stress disorder. The two disorders have and most people with obsessions try to ignore similar symptoms, but they differ in how or suppress them. The majority of people with quickly the symptoms appear after the trau- obsessions also practice compulsions, which matic event that triggers the disorder. They are repetitive ritual behaviors, often involving also differ in how long they last.

PSYCHOLOGICAL DISORDERS 507 TYPES OF ANXIETY DISORDERS The symptoms may occur six months or more after the traumatic event, and they may last Anxiety is a state of dread or uneasiness that occurs in response to for years or even decades. The more severe the danger. A person with an anxiety disorder experiences anxiety out of trauma, the worse the symptoms tend to be. proportion to the actual or perceived threat. Acute stress disorder is a short-term disor- Phobic Disorder der with symptoms similar to those of PTSD. A persistent, excessive, or irrational fear of an object or a situation. Also like PTSD, acute stress disorder follows a Acrophobia is a fear of heights; claustrophobia is a fear of enclosed traumatic event. However, unlike with PTSD, spaces. Fear of public speaking is an example of a social phobia. the symptoms occur immediately or at most within a month of the event. The anxiety also Panic Disorder and Agoraphobia lasts a shorter time—from a few days to a Recurring, unexpected panic attacks characterized by rapid heart rate. few weeks. Not everyone who experiences a Agoraphobia is a phobic disorder in which people fear they will be trauma, however, will develop PTSD or acute caught in crowded, public places when they have an attack. stress disorder. Generalized Anxiety Disorder Reading Check Summarize What are the five Excessive or unrealistic worry that appears to be present nearly all the types of anxiety disorders? time. Obsessive-Compulsive Disorder Explaining Anxiety Disorders Unwanted thoughts or ideas, combined with impulses that are difficult Several different explanations for anxiety or impossible to resist, such as repeated hand washing, connected with disorders have been suggested. As is true for the idea that one’s hands remain unclean. most of the psychological disorders discussed in this chapter, the explanations fall into two Stress Disorders general categories: psychological views and Intense, persistent feelings of anxiety that follow traumatic events. biological views. PTSD may be accompanied by flashbacks, nightmares, and avoidance of stimuli connected with the traumatic event. Psychological Views For anxiety disorders and the other disorders discussed in this chapter, psychoanalytic views are presented even though they are no longer widely accepted. PPost-traumaticost-traumatic stressstress disorderdisorder (PTSD)(PTSD) refers These views are included because they influ- to intense, persistent feelings of anxiety that enced later theories and had a major impact are caused by an experience so traumatic that on the classification of psychological disorders it would produce stress in almost anyone. until recently, as discussed earlier. Experiences that may produce PTSD include According to psychoanalytic theory, anxiety rape, child abuse, assault, severe accident, is the result of “forbidden” childhood urges that airplane crash, natural disasters, and war have been repressed, or hidden from conscious- atrocities. It appears to be a common result ness. If repressed urges do surface, psycho- of extensive trauma. For example, up to one analysts argue, they may do so as obsessions fourth of the people in areas hit by Hurricane and eventually lead to compulsive behaviors. Katrina in 2005 suffered some symptoms of For example, if one is trying to repress “dirty” PTSD. sexual thoughts, repetitive hand washing may People who suffer from PTSD may exhibit help relieve some of the anxiety. any or all of the following symptoms: Learning theorists believe that phobias are conditioned, or learned, in childhood. This may • flashbacks, which are mental reexperi- occur when a child experiences a traumatic ences of the actual trauma event—such as being lost in a crowd or fright- • nightmares or other unwelcome thoughts ened by a bad storm—or when a child observes about the trauma phobic behavior in other people. If a parent ACADEMIC • numbness of feelings screams or faints when a child climbs onto a VOCABULARY • avoidance of stimuli associated with the large box, for example, the child may learn an stimuli outside factors that directly trauma unreasonable fear of heights—even moderate influence a person • tension, irritability, poor concentration heights. Or if a parent warns a child that all

508 CHAPTER 18 dogs are dangerous and must not be touched, Interaction of Factors As with many other the child may learn to fear all dogs. Learning disorders, the causes of anxiety disorder may theorists argue that such conditioned phobias be mixed. Some cases of anxiety disorder may remain long after the experiences that probably reflect the interaction of biological produced them have been forgotten. and psychological factors. People with panic Learning theorists also assert that people disorder, for example, may have a biologically will learn to reduce their anxiety by avoiding based tendency to overreact psychologically the situations that make them anxious. For to physical sensations. The initial physical example, a student who feels anxious speak- symptoms of panic—such as rapid heart rate ing in front of others in class may learn to keep and shortness of breath—cause these people quiet because it reduces his or her feelings of to react with fear, leading to even worse panic anxiety. However, by intentionally avoiding the symptoms. They may think they are having a anxiety-producing behavior, the student has no heart attack and experience severe psycho- chance to learn other ways of coping with or logical stress. Anxiety about having another unlearning the anxiety. As a result, the anxiety panic attack becomes a psychological disor- may worsen or be generalized to other situa- der itself—one that originated in a biological tions that involve speaking in front of others. reaction. Cognitive theorists, on the other hand, Regardless of their cause, anxiety disor- believe that people make themselves feel anx- ders are both common and disabling. In seri- ious by responding negatively to most situa- ous cases, they lead to tremendous restrictions tions and coming to believe they are helpless and limitations in lifestyle, relationships, and to control what happens to them. This creates work. They can also lead to great personal dis- great anxiety. tress. In extreme cases, the sufferer can be practically paralyzed with fear. Fortunately, Biological Views Research indicates that most people who suffer from anxiety disorder heredity may play a role in most psychologi- respond well to treatment, which is covered in cal disorders, including anxiety disorders. For the next chapter. example, one study showed that if one of a pair of identical twins exhibited an anxiety Reading Check Find the Main Idea How do disorder, there was a 45 percent chance that learning theorists explain anxiety disorders? the other twin would also exhibit the disorder. This was true even of twins raised in different families. By contrast, the chance of fraternal twins both developing anxiety disorders Perspectives on was only about 15 percent. Similarly, adopted children are more likely to have an anxiety Anxiety Disorders disorder if a biological parent has one than if an adoptive parent does. Both types of studies Psychoanalytic View Anxiety represents the suggest that genetics plays at least some role “leakage” of forbidden aggressive or sexual ideas in the development of anxiety disorders. or urges that were repressed during childhood. How did genes get involved? Some psychologists believe that people are genetically Learning View Phobias are conditioned, or inclined to fear things that were threats to learned in childhood, either through direct their ancestors. These psychologists argue experience or observation. People avoid threaten- that people who rapidly acquired strong ing situations to reduce anxiety. fears of real dangers—such as large animals, snakes, heights, and sharp objects—would be Biological View Anxiety disorders tend to run more likely to survive and reproduce. To the in families, suggesting a role for genetic factors. extent that the tendency to develop such fears Anxiety disorders may be the exaggerated remains of adaptive fears. is controlled by genes, they conclude, the tendency would be passed on to future genera- Cognitive View tions, causing the disorders to be relatively People exaggerate threats and believe they are helpless to deal with them. common today.

PSYCHOLOGICAL DISORDERS 509 Types of Mood Disorders According to the DSM-IV, major depression is diagnosed when an individual experiences Most people have mood changes that reflect at least five of the following symptoms: the normal ups and downs of daily life. They 1. persistent depressed mood for most of feel down when things go wrong, such as fail- the day ing an important test, and they feel up when good things happen, such as when their team 2. loss of interest or pleasure in all, or wins a championship. almost all, activities Some people, however, experience mood 3. significant weight loss or gain due to changes that seem inappropriate for or incon- changes in appetite sistent with the situations to which they are 4. sleeping more or less than usual responding. They feel sad when things are 5. speeding up or slowing down of physical going well, or they feel elated for no appar- and emotional reactions ent reason. People who have abnormal moods 6. fatigue or loss of energy such as these may have a mood disorder. 7. feelings of worthlessness or unfounded Mood disorders fall into two general cat- guilt egories. DDepressionepression typically involves feelings of helplessness, hopelessness, worthlessness, 8. reduced ability to concentrate or make meaningful decisions guilt, and great sadness. BBipolaripolar disorderdisorder involves a cycle of mood changes from depres- 9. recurrent thoughts of death or suicide sion to wild elation and back again. For a diagnosis of major depression to Mood disorders—particularly depres- be made, at least one of the individual’s five sion—are very common psychological disor- symptoms must be one of the first two symp- ders. In any six-month period, about 8 percent toms in the list. Also, the symptoms must of women and 4 percent of men are likely to be be present for at least two weeks and occur diagnosed with some form of depression. The nearly every day during that period. DSM-IV classifies mood disorders into sev- Severely depressed individuals may eral different types of depressive and bipolar become consumed by feelings of worthless- disorders. ness or guilt. Severe depression calls for immediate treatment—as many as 15 percent Major Depression Major depression is by far of severely depressed individuals eventually the most common of all psychological disor- commit suicide. ders. Depression may affect more than 100 million people worldwide. Some 8 to 18 percent of the general population will experience major depression in their lifetime.

Major Depression

Definition: a disorder characterized by persistent sad, anxious, or “empty” feelings that interfere with daily living

Symptoms: may include feelings of hopelessness or worthlessness, irritability, restlessness, loss of interest in once-pleasurable activities, fatigue, difficulty concentrating, changes in appetite, persistent aches or pains

Behaviors: may include withdrawal from social activities, insomnia or excessive sleeping

510 CHAPTER 18 Bipolar Disorder Once called manic depres- behaviors, such as going on spending sprees, sion, bipolar disorder is characterized by quitting their jobs to pursue wild dreams, or dramatic ups and downs in mood. Periods of making foolish business investments. Thus, mmania,ania, or extreme excitement characterized the manic phase of bipolar disorder can be by hyperactivity and chaotic behavior, can very disruptive to an individual’s life. change into depression quickly and for no Postpartum Depression Some women suffer apparent reason. a type of depression, called postpartum depres- The manic phase is characterized by a sion (PPD), after giving birth. Symptoms may mood that is persistently and abnormally include feelings of hopelessness and inad- elevated. In some people, however, this phase equacy in childcare skills. This condition can may be characterized by irritability instead of have a negative effect not just on the woman’s elation. Manic moods are also characterized health, but also on parent-infant bonding. Not by at least some of the following traits: long ago, PPD was kept hidden and consid- • inflated self-esteem ered a source of shame. Now, however, doctors • inability to sit still or sleep restfully and hospitals act aggressively to prevent and • pressure to keep talking and switching treat PPD. from topic to topic Reading Check Analyze What are some ways that • racing thoughts (referred to as “flight of mood disorders can disrupt one’s daily life? ideas”) • difficulty concentrating. Explaining Mood Disorders Individuals in the manic phase may appear Psychological and biological theories have highly excited and act silly or argumentative. been proposed to explain why such a large In severe cases, they may have delusions number of people experience mood disorders. (beliefs that have no basis in reality) about These theories are explained here. their own superior abilities. They may also experience hallucinations (sensory percep- Psychological Views The psychoanalytic tions that occur in the absence of sensory view of depression connects past events stimuli) such as hearing imaginary voices or to the present. It says that people prone to seeing things that are not really there. These depression suffered a real or imagined loss individuals may also engage in impulsive of a beloved object or person in childhood.

Thoughts and Depression

Psychologists note that many people create or worsen feelings of depression through irrational thoughts. In this way, they make it seem as if they cannot change things for the better. This chart shows the kinds of thoughts that can increase depression, along with more realistic thoughts that can help people take control of their lives.

A depressed person might think . . . A rational alternative would be . . . “There’s nothing I can do.” “I can’t think of anything to do right now, but if I work at it, I may.” “I’m no good.” “I did something I regret, but that doesn’t make me evil or worthless as a person.” “This is absolutely awful.” “This is pretty bad, but it’s not the end of the world.” “I just don’t have the brains for this course.” “I guess I really need to go back over the basics in the course. Whom can I turn to for help?” “I just can’t believe I did something so terrible!” “That was a bad experience. Well, I won’t be likely to try that again soon.” “I can’t imagine ever feeling right.” “This is painful, but if I try to work it through step by step, I’ll probably see my way out of it eventually.”

PSYCHOLOGICAL DISORDERS 511 Explaining Depression there was nothing they could do to prevent the pain. This learned helplessness has been com- pared to the helplessness often seen in people who are depressed. Learning theorists argue that people prone to depression have learned through experience to believe that previous events in their lives were out of their control. This leads them to expect that future events will be out of their control as well. As a result, whenever a negative event occurs, these people feel helpless, and this leads to depression. In contrast, cognitive theorists have suggested that some people are prone to depression because of their habitual style of explaining life events. According to attribution theory, people assign different types of explanations to events—internal or external, stable or unstable, and global or specific. These attributional styles affect people’s self-esteem and self- efficacy. These styles also relate to expectancy— what people expect based on prior experiences. Suppose, for example, that someone goes on a date that does not work out. Different ways Skills Focus INTERPRETING CARTOONS to explain the uncomfortable evening might What does this cartoon imply about the include the following: causes of depression? • “I really messed up” (internal explanation, places blame on self). • “Some people just don’t get along” (external explanation, places the blame elsewhere). According to this view, the child feels anger • “It’s just my personality” (stable explana- toward the lost object or person but, instead tion, suggests problem cannot be of expressing the anger, internalizes it and changed). directs it toward himself or herself. This leads • “It was that lousy head cold I’ve had all to feelings of guilt and loss of self-esteem, week” (unstable explanation, suggests which in turn lead to depression. problem is temporary). Learning theorists have suggested other • “I have no idea what to do when I’m with explanations for depression. Some believe other people” (global explanation, sug- that learned helplessness makes people prone gests problem is too large to deal with). to depression. Psychologist Martin Seligman demonstrated the concept of learned help- • “I have difficulty making small talk” lessness in a classic but now widely criticized (specific explanation, suggests problem experiment. In his experiment, Seligman is small enough to be manageable). taught dogs that they were helpless to escape Research shows that people who are depressed from electric shock. First, he placed a barrier are more likely than other people to blame in the dogs’ cage to prevent them from leav- their failures on internal, stable, and global ing when shocks were administered. Later the causes—causes they feel helpless to change. barrier was removed. However, when shocks Cognitive theorists argue that such expla- were again administered, the dogs made no nations give rise to feelings of helplessness, effort to escape. They had apparently learned which in turn lead to depression.

512 CHAPTER 18 Another cognitive theory was proposed by or deficiencies, off serotonin may create a Aaron Beck, who suggested that people who tendency toward mood disorders in general. are depressed have a negative view off them- Deficiencies off serotonin combined with defi- selves, their experiences, and their future. ciencies off noradrenaline, however, may be Accordingg to Beck, this is because people who linked to depression specifically. These find- are depressed have negative self-schemas— ings have been important in the development self-judgments developed from negative expe- off a wide range off drugg therapies for the treat- riences in early childhood. This leads them to ment off mood disorders. filter out positive information and perceive Biological and Psychological Factors As negative information as more negative than it we have seen before, a combination off factors really is. Such negativity, Beck argued, makes may be at work in the explanation off mood people prone to depression. disorders. Many cases off depression may Biological Views Other researchers have reflect the interaction off biological factors investigated biological factors in mood disor- such as neurotransmitter levels and psycho- ders. Mood disorders, like anxiety disorders, logical factors such as learned helplessness. tend to occur more often in theclose rela- This has been demonstrated with laboratory tives off affected individuals than they do in animals. Seligman and Weiss found that dogs the general population. Between 20 and 25 that learned they were helpless to escape percent off people with mood disorders have electric shocks also had less noradrenaline a family memberwho is affected by a similar activity in their brains. Helplessness is thus disorder. Moreover, identical twins off affected linked to specific neurotransmitter deficien- individuals are more likely to be affected cies. The relationship may result in a vicious than fraternal twins. These studies seem to cycle. A depressingg situation may slow down indicate that mood disorders have a genetic the activity off noradrenaline in the brain; in component. turn, the chemical changes may then worsen Scientists believe that two neurotransmit- the depression. Breaking that cycle may be ters, or chemical messengers, in the brain— the key to successful treatment. serotonin and noradrenaline—may at least Reading Check Explain How was Martin partly explain the connection between genes Seligman’s experiment with dogs related to and mood. Serotonin and noradrenaline both theories about mood disorders? play a role in mood regulation. Low levels,

Online Quiz thinkcentral.com SECTION 2 AssessmentAssessment

Reviewing Main Ideas and Vocabulary 7. Analyze Using your Theories Explanation Explain How does anxiety differ from fear? notes and a graphic Psychoanalytic organizer like the one Learning 2. Describe What is the relationship between panic disorder here, explain why such Cognitive and agoraphobia? a large number off peo- Biological 3. Recall What are five symptoms off major depression? ple experience mood disorders, particularly Biological and 4. Contrast What is the difference between depression and Psychological bipolar disorder? depression.

Thinking Critically FOCUS ON WRITING 5. Evaluate Why are studies off twins important for determin- 8. Narrative Review the information about anxiety disorders ing whether a disorder has a biological basis? in this section. Then try to imagine what life is like for a per- 6. Develop Describe and explain self-esteem, self-efficacy, son who suffers from obsessive-compulsive disorder. Write and expectancy from the perspective off attribution theory. a diary entry from that person’s point off view, in which you describe how the disorder affects tasks and events off daily life. Or, select a different anxiety disorder and write a similar diary entry.

PSYCHOLOGICAL DISORDERS 513

py10se_DIS_sect2.indd 513 5/8/09 12:06:06 PM Current Research in Psychology Post-Traumatic Stress Disorder and Iraq War Veterans

Few of us will ever experience the horrors of war directly—the physical agony, the fear, the grief of seeing friends killed, the moral dilemmas that soldiers face. For those who survive these ordeals, the trauma of combat may not be left behind on the battlefield. Instead, some veterans experience vivid flashbacks and nightmares that replay the wartime shocks In Iraq and Afghanistan, dangers could wait over and over. Many of these vets are diagnosed with post-traumatic behind any doorway. Such uncertainties have stress disorder (PTSD). added to soldiers’ stress.

A high incidence of PTSD has been PTSD epidemic. One study focused including memory loss, irritability, reported among soldiers returning on more than 100,000 veterans and insomnia, are actually the result from the war in Iraq and Afghanistan. who sought medical care at U.S. of PTSD—a welcome conclusion, Added to the usual stress of com- Department of Veterans Affairs (VA) because PTSD is more treatable than bat are various factors that have facilities. About one fourth were diag- brain injury (Hoge et al., 2008). increased the disorder’s appearance. nosed with a mental disorder. The Other researchers have exam- Some of those factors are the dif- study found that younger vets, from ined the overwhelming impact of ficulty of distinguishing between 18 to 24 years old, are more likely to so many PTSD cases on the armed enemies and allies and the threat of be diagnosed with PTSD than older forces’ mental health facilities. unseen improvised explosive devices veterans (Seal et al., 2007). More than 300,000 servicemen and (IEDs). In addition, many of the vet- The connection between women have returned from Iraq and erans are members of the National increased PTSD risk and combat- Afghanistan. A survey indicates that Guard and military reserves. Being related head injuries was the sub- about 20 percent of those involved called into combat has already dis- ject of another study. Of particular in combat suffer from severe men- rupted their previously civilian lives, concern were the soldiers who had tal disorders (Tanielian and Jaycox, and the extra stress of PTSD adds dra- lost consciousness during the injury 2008). Currently, they can receive up matically to their troubles. episode. They were especially prone to five years of free health care from Researchers are attempting to to post-traumatic stress. The study’s the VA for any mental disorder related understand the reasons and implica- authors found that many symptoms to combat. Since PTSD often shows tions of what some observers call a previously ascribed to brain injury, up long after the end of the trauma, increased mental healthcare for veterans will be necessary for many years to come.

Thinking Critically

1. Draw Conclusions Why do you think younger veterans are more likely to be diagnosed with PTSD? 2. Discuss Given the current research on PTSD, what steps do you think the U.S. Department of Veterans Affairs Some veterans hesitate to seek help for PTSD, thinking that having the disorder should take to deal with the effects of means they are weak. PTSD is treatable, especially through early intervention. PTSD in returning soldiers?

Current Research thinkcentral.com 514 CHAPTER 18 SSEECCTIONTION 3 DDissociativeissociative aandnd SSomatoformomatoform DisordersDisorders Before You Read Use a graphic Main Idea Reading Focus Vocabulary organizer like Dissociative disorders cause 1. What is dissociation, and dissociation this one to take notes on people to lose their mem- what are the four dissociative depersonalization the types and character- ory or identity. Somatoform disorders? somatization istics of dissociative and somatoform disorders. disorders cause people 2. How do theorists explain the to express psychological origins of dissociative disorders? Dissociative Disorders Somatoform Disorders distress through physical 3. What is somatization, and what symptoms. are the most common types of somatoform disorders? 4. How do theorists explain the origins of somatoform disorders?

LOST in New York City

How could a man forget his entire life? On July 3, 2003, a man with bumps and cuts on his head woke up on a train near Coney Island, at the edge of New York City. He did not know where he was, why he was on the train, or how he became injured. He had no idea who he was. Eventually, a police officer helped identify the frightened man as Doug Bruce, a British resident of New York who years before had abandoned a successful career as a stockbroker to become a photographer. No clues emerged, however, about how Bruce lost his memory to a condition called total retrograde amnesia. Bruce experienced things as if for the first time that we take for granted—rain, fireworks, the ocean, sports, re-runs of TV cop shows. Doug Bruce’s story was filmed for a documentary titled Unknown White Male. Some observers doubt that his amnesia is real. To date, however, the “old” Doug Bruce has not reappeared, and the source of “new” Bruce’s amnesia remains a mystery.

PSYCHOLOGICAL DISORDERS 515 Dissociative Disorders injury, for example. Most often, a traumatic event, such as witnessing a serious accident, The term ddissociationissociation refers to the separation precedes the amnesia. The incidence of dis- of certain personality components or mental sociative amnesia rises markedly during war- processes from conscious thought. In some time and crises such as natural disasters. ACADEMIC situations, dissociation is normal. Someone VOCABULARY may be so engrossed in reading a book or Dissociative Fugue Dissociative fugue—pre- fugue disturbed watching a television program, for example, viously called psychogenic fugue—is charac- state of conscious- that he is unaware that his name is being terized not only by forgetting personal infor- ness in which mation and past events but also by suddenly someone performs called. Someone else may become so involved acts in full aware- in watching the road that she misses the relocating from home or work and taking on ness but later sign for her exit on the freeway. Perhaps the a new identity. Like dissociative amnesia, dis- cannot remember most common form of normal dissociation is sociative fugue usually follows a traumatic daydreaming, in which the person’s thoughts event that is psychologically very stressful. It may be “a million miles away.” In each of these is reported most frequently during wartime cases, dissociation usually does not indicate a and natural disasters. psychological disorder. When individuals with dissociative fugue However, when dissociation occurs as a travel away from their home or workplace, way to avoid stressful events or feelings, it can they may take on a new name, residence, and be a sign of a psychological disorder. People occupation. They may become socially active with dissociative (di-SOH-shee-uh-tiv) disor- in their new identity and not appear to be ill ders may lose their memory of an event or in any way. When the fugue comes to an end, even forget their identity. A common theory is they no longer remember what happened dur- that dissociation occurs when individuals are ing the fugue state. faced with urges or experiences that are very Dissociative Identity Disorder Formerly stressful. By dissociating, they are able to called multiple personality disorder, dissocia- remove themselves from the source of stress tive identity disorder involves the existence and lessen their feelings of anxiety. of two or more personalities within a single There are no current statistics on the prev- individual. The various personalities may or alence of dissociative disorders. In part, this may not be aware of the others, and at least is because the DSM-IV classifies them some- two of the personalities take turns controlling what differently than they were classified in the individual’s behavior. the past. However, dissociation is a common Each personality is likely to be different psychological symptom. from the others in several ways, including in Dissociative Amnesia Formerly called psy- such observable traits as voice, facial expres- chogenic amnesia, dissociative amnesia is sion, and handedness, as well as self-perceived characterized by a sudden loss of memory, age, gender, and physical characteristics. The usually following a particularly stressful or personalities may even have different aller- traumatic event. A person experiencing dis- gies and eyeglass prescriptions. They may also sociative amnesia typically cannot remember behave very differently from one another. any events that occurred for a certain period People who are diagnosed with dissocia- of time surrounding the traumatic event. tive identity disorder usually were severely Less commonly, a person may forget all prior abused in childhood. They typically suffered experiences and may be unable to remember severe physical, sexual, or psychological his or her name, recognize friends and fam- abuse. Less often, dissociative identity disor- ily, or recall important personal information. der is preceded by other types of trauma. Dissociative amnesia may last for just a few Depersonalization Disorder A condition hours, or it may persist for years. Memory is called ddepersonalizationepersonalization refers to feelings of likely to return just as suddenly as it was lost, detachment from one’s mental processes or and the amnesia rarely recurs. body. People with this disorder describe feel- The term psychogenic means “psychologi- ing as though they are outside their bodies, cal in origin.” Dissociative amnesia cannot be observing themselves at a distance. explained biologically—as the result of a head

516 CHAPTER 18 Depersonalization is a common symptom of other psychological disorders in addition The Three Faces of Eve to being a disorder in its own right. After depression and anxiety, it is the most common complaint among psychiatric patients. Like the other dissociative disorders, depersonalization disorder is likely to be preceded by a stressful event. Reading Check Compare What is the basic feature that dissociative disorders have in common? Explaining Dissociative Disorders Dissociative disorders have been explained primarily by psychological views. According to psychoanalytic theory, people dissociate in order to repress unacceptable urges. In dissociative amnesia or fugue, for example, the person forgets the disturbing urges. In dissociative identity disorder, the person expresses “Inside this demure young woman undesirable urges by developing other personalities that can take responsibility for them. two very vivid and different In depersonalization, the person goes outside the self, away from the turmoil within. personalities were battling According to learning theorists, individuals with dissociative disorders have learned for the mastery of her character.” not to think about disturbing events in order to avoid feelings of guilt, shame, or pain. So begins the 1957 film The Three Faces of Eve, which They dissociate themselves from the stress- was based on a real case of dissociative identity ful events by selectively forgetting them. This is reinforced by the reduced anxiety they feel disorder. As the story progresses, a third personality when the trauma is forgotten. emerges. In fact, the woman whose case inspired the Neither cognitive nor biological theorists film experienced 21 different personalities. have offered a complete explanation of dis- Do you think Hollywood accurately portrays serious sociative disorders. At present, there is no psychological disorders such as dissociative identity convincing evidence that either biological or disorder? Why or why not? genetic factors play a role in the development of dissociative disorders. Reading Check Summarize Which type of theo- order to avoid work, school, or other respon- ries can explain dissociative disorders? sibilities. People with somatoform disorders do not intentionally fake their illnesses. They Somatoform Disorders honestly feel pain, for example, or believe they SSomatization,omatization, which comes from the Greek cannot move their limbs. word for “body,” refers to the expression of Because of the nature of the condition, reli- psychological distress through physical symp- able statistics on the incidence of somatoform toms. People with somatoform disorders have disorders are not available. Many diagnoses psychological problems (such as depression) of somatoform illness later prove to be incor- but experience inexplicable physical symp- rect when patients are found to have actual toms (such as paralysis). medical illnesses. On the other hand, cases It is important to distinguish between of somatoform disorders may go undiagnosed somatoform disorders and malingering, or because of the focus on physical, as opposed the conscious attempt to “fake” an illness in to psychological, symptoms.

PSYCHOLOGICAL DISORDERS 517 Conversion Disorder People with conver- Explaining Somatoform Disorders sion disorder experience a change in or loss Explanations for somatoform disorders in of physical functioning in a major part of the general, and specifically conversion disorder body for which there is no known medical and hypochondriasis, are primarily psycho- explanation. For example, they may suddenly logical. According to psychoanalytic theory, develop the inability to move their legs, even somatoform disorders occur when individuals though no medical explanation for the dis- repress emotions associated with forbidden ability can be found. These behaviors are not urges and instead express them symbolically intentionally produced. That is, the person is in physical symptoms. The physical symp- not faking it. toms thus represent a compromise between Conversion disorder is complicated because the unconscious need to express feelings and many people who experience the disorder the fear of actually expressing them. show little concern about their symptoms, no More recently, other psychologists have matter how serious or strange they may be. argued that people with conversion disor- This lack of concern may help in the diagnosis der “convert” psychological stress into actual of conversion disorder. medical problems. There may be a direct con- Hypochondriasis Also called hypochondria, nection between the body part affected and hypochondriasis (hy-poh-kahn-DRY-uh-sis) is the cause. For example, a fighter pilot may defined as a person’s unrealistic preoccupa- lose the ability to see at night as a response tion with thoughts that he or she has a serious to great anxiety he felt about flying nighttime disease. People with hypochondriasis become bombing missions. Another individual may absorbed by minor physical symptoms and suffer paralysis of the legs after nearly being sensations, convinced that the symptoms in a car accident. indicate the presence of a serious medical ill- Some behavioral theorists have suggested ness. They maintain their erroneous beliefs that somatoform symptoms can serve as a despite reassurances from doctors that there reinforcer if they successfully allow a person is nothing physically wrong with them. Some to escape from anxiety. There are also some people with hypochondriasis visit doctor after indications that biological or genetic factors doctor, seeking the one physician who will find may play a role in the development of somato- the cause of their symptoms. form disorders. Reading Check Summarize What are the two Reading Check Analyze What does it mean to main types of somatoform disorders? convert psychological stress into an actual physical problem?

Online Quiz thinkcentral.com SSECTIONECTION 3 AAssessmentssessment Reviewing Main Ideas and Vocabulary 5. Analyze Using your notes and a graphic organizer like the 1. Describe What are the four dissociative disorders? one below, explain how conversion disorder and hypochondriasis are different. 2. Contrast How does somatization differ from malingering?

Thinking Critically Conversion Hypochondriasis Disorder 3. Evaluate In some cultures, people are encouraged to go into trancelike states. Should this kind of dissociation be considered a sign of a psychological disorder? Why or why not? FOCUS ON WRITING 4. Infer How do you think learning theorists might explain somatoform disorders? 6. Descriptive How might dissociative disorders cause difficul- ties for law enforcement? Describe a scenario for each of the dissociative disorders in which the disorder complicates a legal case or situation.

518 CHAPTER 18 SSEECCTIONTION 4 SSchizophreniachizophrenia

Before You Read Use a graphic Main Idea Reading Focus Vocabulary organizer like Schizophrenia is the most 1. What are the basic symptoms schizophrenia this one to take notes on serious psychological of schizophrenia? catatonic stupor the characteristics of the disorder, causing thought different types of schizo- 2. What are the three major types phrenia. disruption and a decreased of schizophrenia? ability to function normally. 3. How do psychological and Schizophrenia biological explanations of schizophrenia differ?

An Artist’s Troubled Mind

What can paintings of cats reveal about a human mind? In the late 1800s, Londoners were entranced with Louis As artist Louis Wain Wain’s humorous paintings of pets dressed as people and (center) sank into mimicking human activities. Wain specialized in cats—cats schizophrenia, drinking tea, cats attending the opera, cats playing cards, his painting style cats doing all kinds of funny things. Later, Wain painted cats changed. on their own, just being cats. Gradually, Wain’s cat portraits became more odd, with wild eyes and spiky fur. At the same time, Wain was sinking into schizophrenia, a mental disorder marked by a separation from reality. Wain’s increasing illness is reflected in the growing strangeness of his art. Eventually, his cats became just the starting point for frantic abstract designs. Louis Wain spent his last years in an asylum for the mentally ill, painting the asylum’s flowers and cats. What Is Schizophrenia? SSchizophrenia,chizophrenia, usually considered the most serious of the psychological disorders, is characterized by loss of contact with reality. Schizophrenia can be very disabling and can lead to the affected person’s inability to function independently. Typically, schizophrenia first appears in young adulthood, but it may occur at other ages. Although it usually develops gradually, it can also appear suddenly. Schizophrenia can now be treated more effectively, although if untreated it can worsen over time.

PSYCHOLOGICAL DISORDERS 519 The most striking symptoms of schizo- Thought disorders involve problems in the phrenia include hallucinations, delusions, and organization or the content of mental processes. ACADEMIC thought disorders. In most cases, the halluci- The thoughts of a person with schizophrenia VOCABULARY nations are auditory—voices telling the indi- may skip from topic to topic in an apparently auditory related vidual what to do or commenting on the indi- illogical way. This is reflected in the person’s to hearing vidual’s behavior. Sometimes they may tell the speech, which sounds disorganized and con- individual to harm herself or himself or oth- fused. A person with schizophrenia may also ers. Robert Bayley, a schizophrenia sufferer, repeat the same word or phrase over and over, described his hallucinations this way: “The repeat words or phrases that another person visions are extremely vivid . . . Paving stones has spoken, or invent new words. transform into demonic faces . . . Buildings People with schizophrenia have other and rooms spin and weave and their walls symptoms that affect their ability to function. close in as I look on, paralyzed by fear . . . These symptoms include social withdrawal, The voices either ramble in alien tongues or impaired social skills, and loss of normal emo- scream orders to carry out violent acts. They tional responses. Some people with schizo- also persecute me by way of unwavering com- phrenia may even go into a ccatatonicatatonic sstuportupor— mentary and ridicule to deceive, derange, and an immobile, expressionless, comalike state. force me into a world of crippling paranoia.” Understandably, these symptoms cause Individuals with schizophrenia may expe- tremendous stress to individuals with schizo- rience what are called delusions of grandeur. phrenia and their families. It has been esti- For example, they may believe that they are mated that as many as 20 percent of people historical figures, famous celebrities, or on a with schizophrenia attempt suicide and that special but secret mission to save the world. 10 percent actually do kill themselves. Sometimes the delusions are of persecution. Schizophrenia is found in all cultures, and For example, a person with schizophrenia its symptoms have been recognized for cen- might believe that he is being pursued by turies. A large number of people have schizo- spies or some other shadowy enemy. Other phrenia—an estimated 2.4 million in the delusions may include beliefs that one has United States alone. committed unpardonable sins or even that Reading Check Summarize What is the basic one does not really exist. characteristic of schizophrenia?

Perceptions of Schizophrenia

Descriptions of what we might now The Muslim World call schizophrenia first appeared in an In response to what they read in Egyptian medical document written in the Qur’an, Islamic doctors took about 1550 BC. The ways in which people a clinical and humane approach have viewed and reacted to schizophrenia to mental illnesses such as have varied widely over the centuries. schizophrenia. How has our understanding of the causes of schizophrenia changed over time? The Granger Collection, New York

The Ancient World Mental European Middle Ages disorders were widely seen as Schizophrenia was often viewed as a result of the gods’ anger, and witchcraft or possession by demons. sufferers were treated harshly Many sufferers were tortured and as a result. Some thinkers, such executed. as Hippocrates, viewed such disorders as true illnesses.

520 CHAPTER 18 Types of Schizophrenia Disorganized Schizophrenia People with disorganized schizophrenia are incoherent in Individuals with schizophrenia vary greatly their thought and speech and disorganized in in their symptoms, although virtually all have their behavior. They usually have delusions thought disorders. Most people with schizo- or hallucinations as well, but these tend to phrenia exhibit a combination of symptoms. be fragmentary and unconnected, unlike the The DSM-IV classification of schizophre- more ordered and systematic delusions of nia and other psychotic disorders is based those with paranoid schizophrenia. primarily on the duration and recurrence People with disorganized schizophrenia of symptoms. The types of schizophrenia are also either emotionless or show inap- include paranoid, disorganized, and catatonic propriate emotions. Typically, they act silly schizophrenia. and giddy, and they tend to giggle and speak Paranoid Schizophrenia People with para- nonsense. They may neglect their appearance noid schizophrenia have delusions or frequent and hygiene. Sometimes they may even lose auditory hallucinations, all relating to a sin- control of their bladders and bowels. gle theme. These people may have delusions of The following case description illustrates grandeur, persecution, or jealousy. For exam- several symptoms of disorganized schizo- ple, individuals with paranoid schizophrenia phrenia. A 40-year-old man was brought to may be convinced that people have been plot- the hospital by his distraught mother, who ting against them even when there is no evi- reported that she had become deeply afraid dence of such a plot. of her son. It was the twelfth time he had A person with paranoid schizophrenia may been checked into the hospital. The man was be distrustful of everyone except a spouse or dressed in a dirty, tattered overcoat, a base- a special friend. He or she may even accuse ball cap, and house slippers. He spoke with people who are trying to help of being part a childlike quality and walked with exagger- of a covert conspiracy. Although people with ated movements. His emotions ranged from this type of schizophrenia tend to have less anger (hurling obscenities) to silliness (gig- disordered thoughts and obviously bizarre gling for no apparent reason). behavior than do people with other types of Since stopping his medication about a schizophrenia, they may be agitated, con- month before his hospitalization, the man had fused, and afraid. been hearing voices and acting more strangely.

Early Modern Europe Schizophrenia The Age of Enlightenment Mental and other mental illnesses were still seen illness began to be seen as a disease as afflictions to be punished. The patients instead of a curse. were often kept in chains like criminals. Late 1800s Outsiders paid a penny to watch the Emil Kraepelin was the first patients at Bethlem Hospital in London. psychiatrist to classify schizophrenia as a distinct mental disorder. Sigmund Freud began to develop his theories for analyzing mental illnesses, including schizophrenia.

1930s and 1940s The Granger Many people, Collection, including doctors, saw schizophrenia New York Later 20th Century as a hereditary defect to be removed Schizophrenia was widely from society. Thousands of mental accepted as a disease that can patients were sterilized. In Nazi respond to a range of therapies, Germany, an unknown number of including medication. people with schizophrenia were killed.

PSYCHOLOGICAL DISORDERS 521 He told the interviewer that he had been “eat- of other people. One avenue of brain research ing wires and lighting fires.” His speech was connects the major problems found in schizo- generally incoherent and contained many phrenia—problems in attention, memory, rhyming phrases. abstract thinking, and language—with differences in the frontal part of the brain. There Catatonic Schizophrenia The most obvious is some evidence that there are differences in symptom of catatonic schizophrenia is dis- the size and structure of certain brain areas turbance of movement. Activity may slow to in people with schizophrenia. a stupor and then suddenly switch to agita- At his trial, John Hinckley Jr.’s lawyers tion. Individuals with this disorder may hold CONNECTION fought to introduce a CAT-scan of Hinckley’s unusual, uncomfortable body positions for brain as evidence that he had schizophrenia. The Hinckley Trial long periods of time, even after their arms and The defense lawyers believed that the scan John Hinckley Jr. legs swell and stiffen. They may also exhibit suffers from schizo- would help prove that Hinckley’s brain was waxy flexibility, a condition in which other phrenia, and brain abnormal and show a biological basis for his people can mold them into strange poses that tests showed that schizophrenia. After hearings on the mat- they continue to hold for hours. there may have been a ter, the judge allowed the scan as evidence. biological component Reading Check Summarize What are the three It showed that Hinckley’s brain had widened of the disorder. types of schizophrenia? sulci, the folds and ridges on the brain’s surface. According to psychiatrists, widened sulci Explaining Schizophrenia are far more common in people with schizo- Many different theories have been proposed to phrenia than in other people. explain schizophrenia. These theories include Research also suggests that people with both psychological and biological views. schizophrenia may have experienced a loss of synapses, the structures that connect neurons Psychological Views According to the psy- and make it possible for neurons to communi- choanalytic perspective, schizophrenia is the cate with one another. What might cause these result of the overwhelming of the ego by urges differences in brain structure? Research evi- from the id. The urges threaten the ego and dence suggests that there are three biological cause intense conflict. In response, the indi- risk factors for schizophrenia: heredity, com- vidual regresses to an early phase of the oral plications during pregnancy and birth, and stage of development in which the infant has birth during winter. Schizophrenia, like many not yet learned that it is separate from the other psychological disorders, runs in families. mother. In this condition, fantasies become People with schizophrenia constitute about 1 confused with reality, leading to hallucina- percent of the population. However, children tions and delusions. Like many psychoana- with one parent who has schizophrenia have lytic theories, this one has fallen into disfavor about a 10 percent chance of being diagnosed over the years. as having schizophrenia themselves, and Other psychological views focus on the children with two such parents have about a family environment as the root of schizophre- 35 to 40 percent chance. When one identical nia. One such theory suggests that a family in twin has schizophrenia, the other has about which a parent frequently expresses intense a 40 to 50 percent chance of also being diag- emotions and has a pushy, critical attitude nosed with it. Many studies have been car- puts children at risk of developing schizo- ried out to try to isolate the gene or genes phrenia. While it is possible that such a fam- involved in schizophrenia. Some studies have ily environment may increase the chances found locations for multiple genes on several of onset or relapse in individuals who have chromosomes. Recent research suggests that schizophrenia, family environment does not particular genes may provide a vulnerability actually cause the illness. to schizophrenia. Further advances in genetic Biological Views Schizophrenia appears to research techniques may shed more light on be a brain disorder, and many studies have this possibility. been done to determine how the brains of Many people with schizophrenia experi- people with schizophrenia differ from those enced complications during their mother’s pregnancy and their birth. For example, the

522 CHAPTER 18 mothers of many people with schizophrenia to the development of schizophrenia. Thus, had influenza during the sixth or seventh people who are not genetically vulnerable are month of pregnancy. People with the disease unlikely to develop the disorder, regardless of are also somewhat more likely to have been the environmental risk factors to which they born during the winter than would be predicted have been exposed. by chance. Maternal starvation has also been Reading Check Analyze What are some indica- related to schizophrenia. These biological risk tions that schizophrenia has a physical basis? factors suggest that schizophrenia involves abnormal prenatal brain development. Problems in the central nervous system may involve neurotransmitters as well as Perspectives on brain structures, and research has focused on one particular neurotransmitter: dopamine. According to the dopamine theory of schizo- Schizophrenia phrenia, the brains of people with schizo- Psychoanalytic View The ego is overwhelm- phrenia use more dopamine than average, ingly threatened by the id. The individual although they may not produce more. Why? regresses to an early phase of the oral stage of They may have more dopamine receptors in development, and fantasies become confused the brain than other people do, or their dopa- with reality. mine receptors may be hyperactive. Other Psychological Views Multifactorial Model The multifactorial A family model of schizophrenia illustrates how bio- environment in which a parent frequently expresses intense emotions and has a pushy, logical and psychological factors may inter- critical attitude puts children at risk for act in the development of the disorder. In this schizophrenia. model, genetic factors create a vulnerability, or susceptibility, to schizophrenia. Among Biological View Loss of synapses in the brain people who are genetically vulnerable, other have been linked to schizophrenia. Other factors factors, such as prenatal problems or trauma include heredity, complications during pregnancy during birth, may lead to brain injury and the and birth, birth during winter, and the brain’s development of schizophrenia. Once the dis- overuse of dopamine. order develops, its course may be negatively affected by a troubled family environment. Multifactorial View Biological and psycho- The multifactorial model also suggests logical factors combine to put people at risk for that even severely dysfunctional environ- schizophrenia. mental factors alone are not enough to lead

Online Quiz thinkcentral.com SSECTIONECTION 4 AAssessmentssessment Reviewing Main Ideas and Vocabulary 6. Draw Conclusions 1. Recall What are four symptoms of schizophrenia? Using your notes and a graphic organizer like this 2. Contrast How does paranoid schizophrenia differ from Schizophrenia one, explain why disorganized schizophrenia? a multifactorial model of 3. Describe How would you describe the varying activity schizophrenia may help in levels of a person experiencing catatonic schizophrenia? explaining the disorder. Thinking Critically FOCUS ON WRITING 4. Summarize What are some biological explanations for the origins of schizophrenia? 7. Persuasive Write a letter to a friend in which you suggest that he or she be examined by a psychiatrist for help with 5. Evaluate What are the major psychological views that symptoms that resemble those of schizophrenia. Include a attempt to explain schizophrenia? description of the friend’s actions and their consequences.

PSYCHOLOGICAL DISORDERS 523 SSEECCTIONTION 5 PPersonalityersonality DDisordersisorders

Before You Read Use a graphic Main Idea Reading Focus Vocabulary organizer like Personality disorders are 1. What are personality disorders, personality disorders this one to take notes on characterized by patterns and how do they differ from personality disorders. of unchanging personality other psychological disorders? traits that disrupt people’s Personality 2. What are ten types of personal- Disorders social lives and work lives. ity disorders? 3. How do psychological and biological views explain the origins of antisocial personality disorder?

It’s all about HER!

Why does Lisa demand so much attention? Perhaps you know someone like Lisa. At parties, she always steers the conversation back to herself. She makes sure everyone knows how important, accom- plished, and intelligent she is. If Lisa doesn’t get the admiration she thinks she deserves, she’ll move on to another group and take over their conversation. She thinks nothing of telling—not asking, telling—someone to get her a plate of food or something to drink. Talking to Lisa after the party, you can see another side of her personality. Even though there were plenty of guys paying attention to her, she still envied Julia for talking to the new Swedish exchange student. What makes Lisa act the way she does? She may actually have a personality disorder named after Narcissus, a youth in a Greek myth who fell in love with his own reflection. That condition is called narcissistic personality disorder.

524 CHAPTER 18 What Are Personality Disorders? PERSONALITY DISORDERS PPersonalityersonality disordersdisorders are patterns of inflexible AND THEIR CHARACTERISTICS traits that disrupt social life or work and may distress the affected individual. The American Personality disorders are inflexible and lasting patterns of behavior that hamper social functioning. Listed here from the DSM-IV-TR are the 10 Psychiatric Association defines a personality specific personality disorders and their main characteristics. disorder as “an enduring pattern of inner experience and behavior that deviates markedly from Personality Main Characteristics the expectations of the culture of the individual Disorder who exhibits it.” These patterns usually show up by late adolescence and affect all aspects of Paranoid Suspiciousness and distrust about others’ motives the individual’s personality, including thought Schizoid Detachment from social relationships processes, emotions, and behavior. It is important to note the distinction Schizotypal Acute discomfort in close relationships; eccentrici- between personality disorders and other psy- ties of behavior chological disorders that they may resemble. Antisocial Disregard for the rights of others Psychological disorders, such as major depression or a phobic disorder, for example, are Borderline Instability in interpersonal relationships and self- illnesses that an individual experiences as image episodes. Such illnesses can be clearly dis- Histrionic Excessive emotionality, need for attention tinguished from the individual’s personality. In contrast, personality disorders are endur- Narcissistic Grandiosity, need for admiration, lack of empathy ing traits that are major components of the Avoidant Social inhibitions, feelings of inadequacy individual’s personality. Dependent Submissive, clinging Reading Check Contrast How are personality disorders different from other disorders that they Obsessive- Obsession with orderliness, perfectionism, and Compulsive control may resemble?

Skills Focus INTERPRETING CHARTS What is one characteristic Types of Personality Disorders that a person with antisocial personality disorder might have in com- The chart on this page shows the DSM-IV mon with someone who has narcissistic personality disorder? classification of personality disorders. They are described here in detail. Paranoid Personality Disorder People with do not have tender feelings for, or become paranoid personality disorder tend to be attached to, other people; spending time with suspicious of others and to interpret others’ others just seems pointless. Thus, people with motives as harmful or evil. They tend to per- schizoid personalities tend to be loners, with ceive other people’s behavior as threatening few if any friends. or insulting, even when it is not. They are dif- These symptoms are similar to some of ficult to get along with—argumentative, yet the symptoms of schizophrenia. Unlike peo- cold and aloof. It is not surprising that people ple with schizophrenia, however, people with with this disorder often lead isolated lives. schizoid personality disorder do not have Unlike individuals with paranoid schizo- delusions or hallucinations. They stay in phrenia, people with paranoid personality dis- touch with reality. order are not confused about reality. However, Schizotypal Personality Disorder Symp- their view of reality is distorted, and they are toms of this disorder include odd behaviors, unlikely to see their mistrust and suspicions unconventional beliefs, and a need for social as unfounded or abnormal. isolation. Although the disorder is similar Schizoid Personality Disorder People with to schizoid personality disorder, people with schizoid personality disorder have no interest the schizotypal disorder avoid relationships in relationships with other people. They also because of a fear of not fitting in, not because lack normal emotional responsiveness. They they are uninterested in others.

PSYCHOLOGICAL DISORDERS 525 Antisocial Personality Disorder People with The symptoms of avoidant personality antisocial personality disorder show a persis- disorder are similar to those of social phobia, tent behavior pattern of disregard for, and vio- and people with avoidant personality disorder lation of, the rights of others. Typically, they do virtually always have social phobias as well. not feel remorse for their antisocial behaviors, However, not all people who have social pho- and they continue the behaviors despite the bias have avoidant personality disorder. The threat of social rejection and punishment. latter seems to be a more severe condition. In childhood and early adolescence, a per- Dependent Personality Disorder This dis- son with antisocial personality disorder may order is characterized by being overly depen- run away from home, hurt other people or ani- dent on other people. Among the symptoms mals, lie, or steal. In adulthood, the person are difficulty in making decisions without may be aggressive and reckless, have a hard extensive advice, reluctance to take responsi- time holding a job, incur large debts, or break bility for one’s own life, difficulty expressing the law. disagreement, lack of initiative, and fear of Borderline Personality Disorder Instability being left to take care of oneself. People with of mood, chaotic personal relationships, and a dependent personality disorder often seek a disturbed sense of self are among the symp- new relationship immediately after the end of toms of borderline personality disorder. Self- another so that they are not left alone. mutilating behaviors, such as cutting, can Obsessive-Compulsive Personality Disorder be evidence of the disorder. The name comes While similar to obsessive-compulsive dis- from an early description of the disorder as order, this personality disorder is different. being on the “borderline” between neurosis Obsessive-compulsive personality disorder and psychosis. is characterized by inflexibility and fixa- Histrionic Personality Disorder People tion on rules, procedures, and orderliness. with this disorder are overly emotional People with the disorder can be particularly and dramatic and seek constant attention. anxious about time, relationships, cleanli- Inappropriate seductiveness and being easily ness, and money. They often work many influenced by other people are also common more hours than their financial situation symptoms. Although people with histrionic demands. They do not, however, perform the personality disorder may be outwardly suc- constant, meaningless rituals that are com- cessful in work and social situations, their mon in obsessive-compulsive disorder. personal relationships are often troubled, Reading Check Analyze What are some ways that partly because the disorder limits one’s abil- personality disorders can make life difficult? ity to cope with loss or failure. Such failures are often blamed on others. Explaining Personality Disorders People Narcissistic Personality Disorder Most personality disorders were not classified with this disorder believe that they deserve until 1980, with the publication of the third excessive admiration. They may be preoccu- edition of the DSM. However, both psychologi- pied with fantasies of their own success, power, cal and biological theories have been suggested intelligence, or beauty. In addition, they show ACADEMIC to explain some of them. Here we will concen- VOCABULARY little empathy toward other people, treating trate on antisocial personality disorder. empathy sympa- them with arrogance and exploiting them. thy; understanding Psychological Views Freud’s psychoanalytic People with of others’ feelings Avoidant Personality Disorder theory regarding the antisocial personality avoidant personality disorder desire rela- type states that a lack of guilt underlies the tionships with other people, but they are pre- antisocial personality. This lack of guilt is vented from forming these relationships by due to a problem in the development of the tremendous fear of the disapproval of others. conscience, or superego. Research has found Thus, they act shy and withdrawn in social that children who are rejected by adults and situations. They are always afraid they will harshly punished rather than treated with say or do something that is foolish or even affection tend to lack a sense of guilt. embarrassing.

526 CHAPTER 18 Some learning theorists have suggested that childhood experiences “teach” children Perspectives on how to relate to other people. Iff children are not reinforced for good behavior and only a Personality Disorder receive attention when they behave badly, they may learn antisocial behaviors. Such Psychoanalytic View Lack off guilt due to a behaviors may persist into adulthood. Other problem in the development off the conscience learning theorists maintain that antisocial causes the antisocial personality. personality disorder develops when a child lacks appropriate role models and when the Other Psychological Views Childhood role models they do have act aggressively. experiences teach children how to relate to other Cognitive theorists argue that antisocial people. Iff children get attention only when they behave badly or don’t have appropriate role adolescents tend to see other people’s behav- models, they may develop antisocial behaviors. ior as threatening, even when it is not. They use this faulty view off other people’s actions Biological View Heredity plays a role in to justify their own antisocial behavior. antisocial disorders, as does having fewer neurons Biological Views Genetic factors are appar- in the frontal part off the brain. ently involved in the disorders. For example, antisocial personality disorder tends to run in families. Adoptee studies reveal higher likely to show guilt for their misdeeds and to incidence off antisocial behavior among the learn to fear punishment. But a biological fac- biological parents than among the adoptive tor by itselff is unlikely to cause the develop- relatives off individuals with the disorder. ment off an antisocial personality. The genetics off antisocial personality Although the origins off personality disor- disorder may involve the frontal part off the ders are still unresolved, treatment off these brain, an area that is connected with emo- disorders is more straightforward. Methods of tional responses. There is some evidence that treatment for psychological disorders are the people with antisocial personality disorder focus off the next chapter. have fewer neurons in the frontal part off the brain than other people. The fewer neurons Reading Check Analyze How may childrearing could make the nervous system less respon- affect the development off antisocial personality sive. As a result, such people would be less disorder?

Online Quiz thinkcentral.com SECTION 5 AssessmentAssessment Reviewing Main Ideas and Vocabulary 7. Draw Conclusions Using your notes and a graphic organizer Define How would you define a personality disorder? likethis one, explain the major difference between personality disorders and other disorders that they may resemble. 2. Contrast How does paranoid personality disorder differ from paranoid schizophrenia? Disorder Definition 3. Explain What is the difference between schizoid personality Psychological disorders disorder and schizophrenia? (such as schizophrenia or phobic disorders) 4. Describe What are three behaviors off an individual with Personality disorders (such as paranoid personality disorder or antisocial personality disorder? antisocial personality disorder) Thinking Critically 5. Evaluate Why do you thinkk people with antisocial personal- FOCUS ON WRITING ity disorder are often more difficult to treat than people with other types off personality disorders? 8. Narrative Review the Psychology Close Up feature about the girl with narcissistic personality disorder. Write a similar 6. Support a Position Which seems more sound to you—the profile off someone with one off the other personality disor- psychological or biological theory about the origins off anti- ders. Designate which disorder you are describing. social personality disorder? Explain your answer.

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py10se_DIS_sect5.indd 527 5/8/09 12:08:38 PM Reading and Diagnosing Activity Workbook Use the workbook to Psychological Disorders complete this lab. Can you diagnose a psychological disorder based on a written description of someone’s symptoms? 1. Introduction 2. Writing the Case Studies This lab will help you review the major psychological Working as a group, select at least two specific disorders from disorders covered in this chapter. You will work in small your assigned type of psychological disorders. Then, write case groups to review one of the six general types of disorders studies for these disorders. Each case study should be written that you learned about. Then your group will select at on a single sheet of paper and should include each of the least two specific disorders and write fictional case studies items shown in the sample case study below. After your group describing someone who suffers from each disorder. Finally, is finished writing the case studies, give them to your teacher. the entire class will evaluate each case study and try to 1 A fictional name and age; diagnose the disorder being described. To complete this lab, follow the steps below. 2 A description of the person’s physical, mental, or behavioral symptoms, with relevant details; ■ Following your teacher’s instructions, organize the class into six student groups. 3 A description of how the person’s disorder affects his or her life; ■ Your teacher will assign each group one of the six general types of psychological disorders covered in this chapter— 4 An “answer”—the specific psychological disorder that the anxiety disorders, mood disorders, dissociative disorders, case study describes. somatoform disorders, schizophrenia, and personality disorders. Sample Case Study ■ Work with the students in your group to review the chapter material on the general type of disorders that you were 1 Andrew, Age 37 assigned, along with the specific disorders that fall within Andrew Miller was a delivery driver for an office equipment com- that category. (See the chart titled Major Psychological pany. Three years ago Andrew was making a delivery when he was Disorders on the next page.) Write down a few main points involved in a horrific car accident. As he was exiting the highway, a about both the general type of disorders and the specific four-car collision occurred right in front of Andrew’s van that he was disorders. unable to avoid. Andrew smashed into the car in front of him, killing ■ Conduct additional research on your assigned disorders, if one person and rolling his van over. He was thrown out of his vehicle your teacher instructs you to do so. Your group is now ready and suffered a broken arm, three broken vertebrae, and multiple to write the case studies. cuts and lacerations. He was lucky to survive. Immediately after the accident, Andrew ran to the person he hit and tried to help her, but she 2 died at the scene. Andrew spent two weeks in the hospital, where he underwent several surgeries before being discharged. However, Andrew does not remember his time in the hospital. He also cannot remember anything about the accident or even several days before it, despite his best attempts. Six months after the accident, Andrew has 3 almost fully recovered physically, but still says that the time period surrounding his accident is “a complete blank.” What psychological disorder does Andrew suffer from? 4 Answer: Dissociative Amnesia

528 CHAPTER 18 From the classroom of Greg Talberg, Howell High School, Howell, MI

3. Diagnosing the Disorders MAJOR PSYCHOLOGICAL DISORDERS Before you and your classmates try to diagnosis the psychological disorders described in the case studies, briefly review the disorders covered in the Anxiety Disorders chapter. To review the disorders and complete the diagnoses, follow • Specific Phobias these steps: • Panic Disorder ■ Have someone from each group share with the rest of the class the main • Agoraphobia points about the general type of disorder assigned to their group, along with • Generalized Anxiety Disorder information on the specific disorders. This will serve as a quick review for the entire class. • Obsessive-Compulsive Disorder (OCD) • Post-Traumatic Stress Disorder (PTSD) ■ Your teacher will then randomly select the case studies and read them aloud to the class. Mood Disorders ■ After each case study is read, jot down on a piece of paper which psycho- • Major Depression logical disorder you think the case study describes and why. Refer to the • Bipolar Disorder chart titled Major Psychological Disorders on this page for a complete list of • Postpartum Depression the disorders covered in this chapter. ■ Your teacher will then ask the class to vote on which psychological disorder Dissociative Disorders is being described. After the vote, briefly discuss each case study as a group • Dissociative Amnesia to determine the correct answer. (Do not vote on or discuss the case studies • Dissociative Fugue that your group wrote unless your teacher calls on you.) • Dissociative Identity Disorder 4. Discussion • Depersonalization Disorder What did you learn from this lab? Hold a group discussion that focuses on Somatoform Disorders the following questions: • Conversion Disorder ■ Overall, how successful was the class at diagnosing the psychological • Hypochondriasis disorders described in the case studies? Schizophrenia ■ Were some disorders particularly easy to diagnose? If so, which ones, and • Paranoid Schizophrenia why do you think they were easy? • Disorganized Schizophrenia ■ Were some disorders particularly difficult to diagnose? If so, which ones, • Catatonic Schizophrenia and why do you think they were difficult? ■ How do you think this lab would have been different if some of the case Personality Disorders studies described people with multiple psychological disorders? Do you • Paranoid Personality Disorder think that would have made the lab more realistic? • Schizoid Personality Disorder ■ How might being able to personally observe and interview the people • Schizotypal Personality Disorder described in the case studies have helped with a diagnosis? • Antisocial Personality Disorder • Borderline Personality Disorder • Histrionic Personality Disorder • Narcissistic Personality Disorder • Avoidant Personality Disorder • Dependent Personality Disorder • Obsessive-Compulsive Personality Disorder

Applying What You’ve Learned thinkcentral.com PSYCHOLOGICAL DISORDERS 529 CCHAPTEHAPTER 1188 RRevieweview Comprehension and Critical Thinking Reviewing Vocabulary

SECTION 1 (pp. 498–502) Match the terms below with their correct definitions. 1. a. Describe How common are psychological disor- 6. psychological disorder 11. bipolar disorder ders in the United States? 7. criteria 12. schizophrenia b. Summarize What are the four main criteria 8. anxiety 13. catatonic stupor that psychologists use to determine the pres- 9. phobia 14. personality disorder ence of a psychological disorder? 10. depression c. Support a Position Of the four main criteria used to diagnose disorders, which do you think A. feelings of helplessness, hopelessness, worthless- is the most significant? Why? ness, guilt, and great sadness B. an immobile, expressionless, comalike state SECTION 2 (pp. 504–513) C. behavior patterns or mental processes that cause 2. a. Define What is an anxiety disorder? What is a serious personal suffering or interfere with a mood disorder? person’s ability to cope with everyday life b. Analyze Why do you think major depression is D. patterns of inflexible traits that disrupt social life the most common psychological disorder? or work and may distress the affected individual c. Make Judgments In your opinion, when do nor- E. a serious psychological disorder characterized by mal feelings of anxiety and uneasiness about a loss of contact with reality a situation cross the line to become an anxiety F. the standards on which a judgment or decision disorder? may be based G. a cycle of mood changes from depression to wild (pp. 515–518) SECTION 3 elation and back again 3. a. Recall What are dissociative and somatoform H. a general state of dread or uneasiness that occurs disorders? in response to a vague or imagined danger b. Contrast Give an example of a normal form of I. a persistent excessive or irrational fear dissociation in everyday life, and contrast with an example of a dissociative disorder. INTERNET ACTIVITY c. Evaluate Why do you think it is so difficult 15. How do psychological disorders affect teens? to get reliable statistics on the incidence of Choose one disorder covered in this chapter, somatoform disorders? such as depression or phobic disorder, and use SECTION 4 (pp. 519–523) the Internet to research how the disorder affects 4. a. Describe What are some of the causes of teenagers. Look for information on how common schizophrenia? the disorder is among teens, recent statistics b. Infer Why might dissociative identity disorder and data, and common treatments. Write a short be confused with schizophrenia? report that summarizes your findings. c. Make Judgments Do you think the psychological views on the causes of schizophrenia are Psychology in Your Life valid? Support your answer with facts from the 16. What should you do if you encounter someone text. who you suspect suffers from a psychological dis- SECTION 5 (pp. 524–527) order? Should you talk to the person or contact 5. a. Identify Main Ideas How can personality disor- an adult or a mental health professional for help? ders be distinguished from other psychological Think about a realistic situation in which you disorders? might find yourself dealing with someone who has a psychological disorder. Then, write a short b. Contrast What are the differences between paragraph describing the situation and your pos- schizoid personality disorder and avoidant per- sible course of action. sonality disorder?

530 CHAPTER 18 SKILLS ACTIVITY: INTERPRETING GRAPHS Connecting Online The bar graph below shows how some factors, including family history, increase the risk of a child developing schizophrenia later in life. The Visit thinkcentral.com for number 1 represents the norm, and each number above 1 represents a review and enrichment 100 percent increase in the risk. Therefore, a child born in winter has activities related to this chapter. about a 10 percent higher risk of developing schizophrenia than average. Study the graph and answer the questions that follow.

SELECTED RISK FACTORS FOR SCHIZOPHRENIA

Place/Time Winter of Birth Urban Quiz and Review Inﬂuenza ONLINE QUIZZES Illness Rubella of Mother Take a practice quiz for each Poliovirus section in this chapter. Famine WEBQUEST Conditions Bereavement* Complete a structured for Mother Internet activity for this at Time of Flood chapter. Birth Depression Family QUICK LAB History Reinforce a key concept 012345678910 with a short lab activity. * Grief caused by death of spouse or close family member Relative Increase in Risk APPLYING WHAT Source: adapted from Public Library of Science, 2005 YOU’VE LEARNED Review and apply your knowledge by completing a 17. Analyze Of the factors listed, which besides family history increases project-based assessment. the odds the most? 18. Compare Which mother’s illness increases a child’s odds of develop- Activities ing schizophrenia by about 10 percent? by 200 percent? eACTIVITIES 19. Develop How does this graph suggest that events beyond the moth- Complete chapter Internet er’s control can increase the risk of schizophrenia? activities for enrichment. INTERACTIVE FEATURE WRITING FOR AP PSYCHOLOGY Explore an interactive version of a key feature in this chapter. Use your knowledge of psychological disorders to answer the question below. Do not simply list facts. Present a clear description based on your KEEP IT CURRENT critical analysis of the question, using the appropriate terminology. Link to current news and research in psychology. 20. Briefly describe each of the disorders listed below. For each disorder, include a general description of the disorder, a review of the symptoms, and a description of the possible causes. Online Textbook (A) Post-traumatic stress disorder (PTSD) Learn more about key topics (B) Major depression in this chapter. (C) Schizophrenia

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