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Chapter 16

Chapter 16: Psychopathology

Chapter Review

CONCEPTIONS OF MENTAL DISORDERS

  • Early views of mental disorders held to the somatogenic hypothesis, which perceives the disorders as the result of a specific injury or infection. Sigmund Freud, in contrast, argued for the psychogenic hypothesis, which considers mental disorders to be rooted in psychological processes.
  • Modern theorists describe mental disorders using a diathesisstress model, with the diathesis creating the predisposition toward mental disorder, and the stress providing a trigger that turns the risk into the actual disorder. However, the fact that multiple factors often give rise to both diathesis and stress has led theorists to propose a multicausal model guided by a biopsychosocial viewpoint.

DEFINING, ASSESSING, AND DIAGNOSING MENTAL DISORDERS

  • A diagnosis is generally made with reference to the categories identified in the Diagnostic and Statistical Manual for Mental Disorders (DSM). The prevalence of a disorder refers to how widespread it is. The Axis I classifications in the DSM include the more familiar categories of mental disorders; Axis II classifications describe various personality disorders.
  • Assessment of any individual may include a semi-structured interview, which is one way in which a clinician evaluates the patient’s symptoms and signs. The assessment may also include self-report measures (such as the Beck Depression Inventory) or projective measures (such as the Thematic Apperception Test).
  • Diagnostic labels have evolved over time and psychiatric labeling has both costs and benefits.

ANXIETY DISORDERS

  • Anxiety disorders are the most common mental disorder. The phobias are characterized by intense and irrational fear, as well as efforts to avoid the feared object or situation. Panic disorder is characterized by the occurrence of panic attacks. Generalized anxiety disorder is characterized by continuous and allpervasive feelings of anxiety. Obsessive-compulsive disorder involves both obsessions (disturbing thoughts) and compulsions (ritualistic behaviors). The stress disorders result from identifiable and horrific events such as rape or military combat.
  • A number of different genes are thought to contribute to the anxiety disorders, and neuroimaging studies reveal that different anxiety disorders have quite different biological bases. Conditioning accounts of the anxiety disorders emphasize the role played by learning.

MOOD DISORDERS

  • Mood disorders—also known as affective disorders—involve disturbances of positive and negative mood. In major depression, patients suffer periods of sadness, apathy, and lack of energy. In bipolar disorder, patients endure manic episodes and episodes of deep depression. Both disorders are associated with a considerable suicide risk.
  • Mood disorders have important hereditary components. A disruption of neurotransmission is also implicated, with norepinephrine, dopamine, and serotonin systems involved.
  • Life crises often trigger depression, although the crises by themselves do not cause the disorder. According to Aaron Beck, depression is more likely to occur if a person interprets life events through a negative cognitive schema rather than a positive one. A related account focuses on explanatory style, or how people explain what happens to them. Individuals who explain bad things that happen to them as the result of internal, global, and stable factors are at elevated risk of depression.

SCHIZOPHRENIA

  • Someone suffering from schizophrenia is likely to suffer from positive symptoms (e.g., delusions, hallucinations, disorganized behavior), negative symptoms (e.g., an absence of emotional expression), and cognitive symptoms (e.g., impairments in working memory and attentional control).
  • Evidence suggests that genetic predisposition, a period of diminished oxygen supply to the newborn, and a variety of prenatal viral infections contribute to schizophrenia. These factors suggest that schizophrenia is a neurodevelopmental disorder, and, consistent with this view, precursors of schizophrenia may be detected in early childhood.
  • Schizophrenia involves problems with neurotransmission, with evidence coming from the efficacy of the classical antipsychotics. There is debate about whether the problem lies in dopamine systems, glutamate systems, or both. People with schizophrenia also have defects in the structure of many areas of the brain.
  • Stress also contributes to schizophrenia, and this factor is one reason schizophrenia is especially prevalent among people with a low socioeconomic status.

OTHER AXIS I AND AXIS II DISORDERS

  • Developmental disorders include autism and attentiondeficit/ hyperactivity disorder. Children with autism show a range of symptoms, including little interest in other people, marked defects in language, and peculiar movement patterns; they are often mentally retarded. Children with attentiondeficit/ hyperactivity disorder are impulsive, fidget constantly, and have difficulty keeping their attention focused
  • Eating disorders include anorexia nervosa and bulimia nervosa. Individuals with anorexia nervosa are preoccupied with food and eating, have an intense fear of gaining weight, and are often severely underweight. Individuals with bulimia nervosa are also very concerned with their weight and appearance, but typically have normal weight, and engage in binge eating followed by compensatory behaviors that include vomiting, laxative use, or extreme levels of exercise.
  • Dissociative disorders involve extreme responses to horrific events. In dissociative amnesia, the person is unable to remember some period of her life; in dissociative fugue, the person wanders away from home, loses track of who he is, and then, months later, realizes that he is in a strange place and does not know how he got there. The diagnosis of dissociative identity disorder—in which a person develops more than one personality—remains highly controversial.
  • Personality disorders involve traits or habits that characterize almost everything a person does. These disorders are difficult to diagnose, in part because the diagnostic manual describes “pure” cases and in part because the same behavior patterns often emerge in less extreme, less disruptive forms in ordinary personalities.
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