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Background on Psychological Disorders No clear-cut boundary divides psychologically well-adjusted people from those with disorders. In general, psychologists describe peoples emotions, thoughts, and behaviors as disordered if they keep people from performing normal functions, cause personal suffering, and deviate from accepted social norms. The diagnosis of a psychological disorder typically involves the use of resources such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). Several approaches are proposed as explanations for psychological disorders: The biological approach emphasizes brain structure and chemistry or genetic factors. The psychodynamic approach focuses on childhood problems and unconscious conflicts. The cognitive-behavioral approach emphasizes observational learning and cognitive interpretations of the world. Finally, the sociocultural approach examines the social and cultural factors that influence mental health. How common are psychological disorders? Some studies indicate that the lifetime prevalence of some type of psychological disorder--that is, the likelihood that someone will experience a problem at some time within his or her lifetime--is about 48%. The most likely problems are alcohol abuse (27% lifetime prevalence), anxiety disorders (25%), and mood disorders (19%). Disorders Based on Anxiety Anxiety disorders are those that involve persistent worry or fear without any clear explanation. People with generalized anxiety disorders suffer continuous, long-lasting anxiety and tension, but they cannot identify a specific cause of their uneasiness. Panic disorders are characterized by fear that is not constant but occurs in recurrent attacks of overwhelming anxiety. Concern over the possibility of having a panic attack in public may lead to agoraphobia, the fear of being in situations where escape would be difficult. Phobic disorders involve excessive fear of a specific object or situation. Whereas we all fear some things, a phobics fears are out of proportion to any true danger. For example, an excessive fear of social situations is the hallmark of social phobia. Another type of anxiety disorder, obsessivecompulsive disorder, involves recurrent, unwanted thoughts (obsessions) coupled with repetitive

behaviors (compulsions). Another type of anxiety disorder, posttraumatic stress disorder, is a pattern of disordered reactions following a traumatic event such as wartime combat, rape, or natural disaster. Rather than developing physical symptoms, people with dissociative disorders lose a portion of their memory or identity. Dissociative amnesia involves forgetting of past experiences following a stressful event. Even more intriguing is dissociative identity disorder (formerly known as multiple personality disorder), which occurs when a person has two or more distinct, well-developed personalities that are usually dramatically different from one another. We do not know how often the dissociative identity disorder really occurs; some theorists argue that multiple-personality is actually a social phenomenon in which a person plays several roles, rather than a genuine psychological disorder. How can we explain anxiety-based disorders? The biological approach argues that there may be a genetic component to certain anxiety disorders such as panic disorders. Freud argued that anxiety is a signal of unconscious conflicts. The cognitive-behavioral approach points to the importance of observational learning and attentional bias. The sociocultural approach suggests that stereotypes encourage certain groups (particularly women) to be passive and dependent; this approach receives support from the fact that many anxiety disorders are more common for women than for men. Mood Disorders People with mood disorders have persistent, extreme disturbances of emotional state. The most common type, major depression, is characterized by frequent episodes of intense hopelessness and low self-esteem. A second type, bipolar disorder, involves mood swings between episodes of depression and episodes of mania, an abnormally positive and overexcited state. Major depression will affect an estimated 17% of the United States population during their lifetime. Depressed people feel discouraged and hopeless. In a severe depression, ones speed of performance decreases, and one may have trouble doing even routine chores. The social interactions of depressed people can serve to reinforce their feelings of isolation. The most alarming behavior of some depressed people is suicide; about 15% of people with a major mood disorder commit suicide. Suicide threats should always be taken seriously by friends and relatives, who can help by suggesting alternative responses and encouraging consultation with professionals. Cognitively, depressed people experience difficulty concentrating and remembering. They remember much more negative material than positive material, whereas nondepressed people usually remember positive material best. They have negative views of themselves, and have a pessimistic explanatory style. 2

Women are 1.7 to 3.0 times more likely than men to experience depression. There does not seem to be a satisfactory biological explanation for this gender difference. Women may be more likely to have certain negative experiences in their lives. Women may also be more likely to derive their identity from another person, which can lead to depression. Also, women may be more likely to worry about their depressed feelings, whereas men may be more likely to distract themselves. In a bipolar disorder, an individual experiences periods of depression alternating with periods of mania. In a manic period, one may experience inflated self-esteem, extreme talkativeness, and poor judgment. People with bipolar disorder report exhilarating bursts of creativity during their manic phases. When the manic phase ends, however, mood may crash back into depression. Genetic factors clearly influence a persons chances of developing a mood disorder; the heritability of depression is over 50%. At least two neurotransmitters, norepinephrine and serotonin, are thought to play a role in mood disorders. In contrast, the psychodynamic approach argues for a nonbiological cause for mood disorders: Feelings of anger or shame, perhaps due to childhood relationships, surface in adulthood when one is faced with loss. The cognitivebehavioral approach connects depression to maladaptive cognitive responses to life events. The sociocultural approach points out that life is more stressful for certain groups in the United States, and these groups do tend to experience more emotional disturbances. A combined approach favored by many theorists is the diathesis-stress model, which argues that some people are born with a predisposition toward a mood disorder; these people are more likely to develop that disorder if placed in stressful circumstances. Schizophrenic Disorders Schizophrenia is characterized by severely disordered thoughts. People with schizophrenia often experience hallucinations (strong mental images that seem like actual physical sensations). Commonly, they experience delusions, which are false beliefs that will continue to be held despite all evidence to the contrary. The term paranoid schizophrenic applies to people with one or more long-lasting delusions. People with schizophrenia also have trouble focusing their speech, sometimes showing more interest in the sound of language than in its meaning. Those with schizophrenia have trouble paying attention, and are very easily distracted. Emotionally, people with schizophrenia often show flat affect, or little sign of either positive or negative emotions. When emotion is shown, it may be inappropriate to the situation. Not surprisingly, individuals with schizophrenia usually have trouble with social relationships. They may also show motor disturbances such as repeated, purposeless gestures or facial grimaces, or they may stand immobile in a catatonic stupor.

Schizophrenia usually develops between the ages of 17 and 40. It often begins with social withdrawal and peculiar behavior, followed by major symptoms such as delusions and hallucinations. About one fourth of those with schizophrenia will recover substantially. About half remain the same for the rest of their lives, and about one fourth become more disturbed. Explaining schizophrenia is difficult. Biological psychologists have noted a strong support for a genetic contribution to schizophrenia. Neurotransmitter activity and the structure of the brain also seem to be somewhat different in those with schizophrenia. According to the dopamine hypothesis, the schizophrenic brain has too much dopamine at critical synapses. PET scans indicate that the frontal lobe of the cortex is under-active in people with schizophrenia. The cognitive-behavioral approach focuses on family dynamics, arguing that the risk of schizophrenia is greater in families with communication problems or high levels of criticism. The sociocultural approach notes that schizophrenia is found more often in lower social classes, in which long-term stress is common. At present, however, the most likely explanation of schizophrenia seems to be some variation of the diathesis-stress model. Personality Disorders When personality traits become inflexible and maladaptive, they are called personality disorders. People with personality disorders typically share an inflexible response to stress, problems at work and in social relationships, and frequent interpersonal conflicts. Obsessivecompulsive personality disorder involves overemphasis of details and rigid compliance with rules. Borderline personality disorder is characterized by unstable moods and interpersonal relationships, inappropriate anger, and impulsiveness. Although there are many types of personality disorders, the antisocial personality has attracted the most attention. People with this disorder may exhibit aggressiveness, lack of guilt, and exploitation of others. Antisocial personality disorder seems to have a hereditary component, and it may be related to frontal lobe problems. Psychological explanations emphasize inappropriate parenting. Antisocial personality disorder is extremely difficult to treat, because individuals who suffer from antisocial personality disorder do not believe that they have a problem at all.

Demonstration 14.1: What is "normal" behavior? Halgin and Whitbourne

(1994) suggest the following exercise regarding the identification of "abnormal" behavior. Read the following examples out loud to your students, and ask the students to jot down whether they believe each person is exhibiting "normal" or "abnormal" behavior: 1. A person who takes a "lucky" pencil to an exam 2. A person who is unable to sleep, eat, study, or talk to anyone else for days after her lover says, "It's over between us" 3. A person who breaks into a cold sweat at the thought of being trapped in an elevator

4. A person who swears, throws pillows, and pounds his fist on the wall in the middle of an argument with a roommate 5. A person who refuses to eat solid food for days at a time in order to stay thin 6. A person who has to engage in a thorough hand-washing after coming home from a ride on public transportation 7. A person who believes that the government has agents who are listening in to her telephone conversations 8. A person who drinks a six-pack of beer in order to be "sociable" with his friends after work 9. A person who has AIDS and is experiencing pain from some of the symptoms, and is contemplating suicide because of his disease. 10. A college student who has episodes of binge drinking 3 times a week, along with the majority of her friends. The drinking interferes with her schoolwork and her parttime job You may wish to ask for a show of hands from people who decided that each behavior was "abnormal." There will probably be clear disagreements over some of the items. Use these disagreements to begin a discussion of the difficulty in defining abnormality. A behavior like taking a lucky pencil to exams may be seen as "normal" by many people, but could be abnormal if it begins to interfere with normal functioning--for example, if the loss of the lucky pencil renders the person completely unable to take the exam. Likewise, contemplating suicide may be seen as abnormal for a physically healthy teenager but may be more understandable for an AIDS victim. RATIONALE: Most students think that they can tell the difference between "normal" and "abnormal." However, a few specific examples should make it clear that the line between normal and abnormal is often difficult to define.
Halgin, R. P., & Whitbourne, S. K. (1994). Abnormal psychology: The human experience of psychological disorders. Fort Worth, TX: Harcourt.

Critical Thinking 14.1: Does misery love company? Give a copy of

Handout 14.3 to each of your students. Give students a few minutes to think about their answers to the question, then discuss why misery loves company is not necessarily an appropriate conclusion here. The key point to note is that this study is correlational and thus cannot be used to infer cause and effect. It is possible that being depressed causes a person to seek out others who are similarly depressed. However, it is also plausible that these participants and their friends were close for many years, and as one became depressed, the other came to share his or her sadness. 5

Being around a depressed person could be depressing in itself! Or, shared environmental factors may cause both the participant and the participant's friends to become depressed. For example, they both may share a stressful housing situation.
Rosenblatt, A., & Greenberg, J. (1991). Examining the world of the depressed: Do depressed people prefer others who are depressed? Journal of Personality and Social Psychology, 60, 620-629.

Handout 14.3 Critical Thinking: Does Misery Love Company? As your textbook notes, depressed people often behave in ways that elicit negative reactions from others. Depressed people thus may feel "out of place" or "different" among groups of nondepressed people. Some research suggests that depressed people actively seek out other depressed persons, preferring the company of people who are more similar to themselves. Rosenblatt and Greenberg (1991) asked depressed and nondepressed students to bring their best friend to a study of personality and compatibility. The depression level of the best friends was measured by a standardized depression test, which had also been given to the original group of students. Depressed subjects' best friends scored significantly higher on the depression test than did the best friends of nondepressed subjects.

Can we conclude that misery loves company? That is, is it reasonable to conclude that depression causes one to seek out others who are similarly depressed? If not, think of an alternative explanation for these findings.