Clinical Psychology: Disorders
Part V: Content Review for the AP Psychology Exam
DEFINITIONS OF DISORDER
When is behavior disordered? The definition of disordered behavior is composed of four components. First, disordered behavior is unusual—it deviates statistically from typical behavior. Second, disordered behavior is maladaptive: that is, it interferes with a person’s ability to function in a particular situation. Third, disordered behavior is labeled as abnormal by the society in which it occurs. Finally, disordered behavior is characterized by perceptual or cognitive dysfunction. In order for behavior to be disordered, it should meet all of these criteria. Behavior must be compared with the behavior of the society in which it occurs. So, for example, self-mutilation in this country is behavior that stands apart from what society considers normal. In other parts of the world, however, scarring is an important part of certain rituals.
THEORIES OF PSYCHOPATHOLOGY
Different schools of psychology have attempted to understand the causes of disordered behavior in different ways. Sigmund Freud engaged in careful observation and analysis of people with varying degrees of behavioral abnormalities. Freud and the psychoanalytic school hypothesized that the interactions among conscious and especially unconscious parts of the mind were responsible for a great deal of disordered behavior. The power of unconscious motives drives behavior. To protect the ego, painful or threatening impulses are repressed into the unconscious. The source of this repression stems from issues that arose during childhood. Generally speaking, if intrapsychic conflicts are not resolved, they may lead us to act abnormally. Much of Freud’s writing described his analyses of maladaptive behavior.
The humanistic school of psychology suggests that disordered behavior is, in part, a result of people being too sensitive to the criticisms and judgments of others. This tendency is related to people being unable to accept their own nature and having low self-esteem. This lack of acceptance may result, according to the humanistic view, from feelings of isolation due to a lack of unconditional positive regard received as a child.
The cognitive perspective views disordered behavior as the result of faulty or illogical thoughts. Distortions in the cognitive process, according to this point of view, lead to misperceptions and misinterpretations of the world, which in turn lead to disordered behavior. The cognitive approach to treatment involves changing the contents of thought or changing the ways in which those contents are processed.
The behavioral approach to disordered behavior is based on the notion that all behavior, including disordered behavior, is learned. Disordered behavior has, at some point, been rewarded or reinforced, and has now been established as a pattern of behavior. Treatment involves the unlearning of the maladaptive behavior, or the modification of the learned responses to certain stimuli.
The biological view of disordered behavior, which is a popular one in the United States at the present time, views disordered behavior as a manifestation of abnormal brain function, due to either structural or chemical abnormalities in the brain. This point of view supports medication as providing appropriate treatment for various types of disordered behavior.
The sociocultural approach holds that society and culture help define what is acceptable behavior.
There are commonalities among theories on psychopathology, though. Psychologists of all perspectives realize that disorders have multiple causes. One part of explaining a disorder is to look at the predisposing causes, which are the environmental or genetic influences that exist before the disorder begins and makes people vulnerable to the disorder. The next factors to consider are the precipitating causes, which are the triggering events that bring about the disorder. Lastly, psychologists consider the maintaining causes, which are the factors that make the disorder more likely to continue.
DIAGNOSIS OF PSYCHOPATHOLOGY
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the American Psychiatric Association’s handbook for the identification and classification of behavioral disorders. The DSM-5 calls for the separate notation of important social factors and physical disabilities, in addition to the diagnosis of mental disorder. There are overarching categories in which a specific disorder will be classified. Below are some of the major categories, though be sure to do some extra research, as this list does not cover all.
The term neurodevelopmental refers to the developing brain. Related disorders manifest early in development, and may be due to genetic issues, trauma in the womb, or brain damage acquired at birth or in the first years of life. These disorders can range from very specific learning deficits to very global impairments to social skills or intelligence.
Intellectual disability (formerly known as mental retardation) is characterized by delayed development in general mental abilities (reasoning, problem-solving, judgment, academic learning, etc.). These delays translate into an impairment of adaptive functioning in aspects of daily life such as self-care, communication, or occupation. The severity can range from mild to moderate to severe to profound.
Autism spectrum disorder is a neurodevelopmental disorder that often manifests early on in childhood development. This may manifest itself in social communication deficits, both verbal and nonverbal, in which the individual has difficulty noticing social cues and has difficulty engaging others. ASD can also manifest itself in the form of restrictive or repetitive behaviors, difficulty coping with change, or difficulty with accepting change in activity. The spectrum varies widely from person to person, ranging from mild to severe. The term Asperger’s disorder is no longer used.
Attention-deficit hyperactivity disorder (ADHD) is described as patterned inattention and/or hyperactivity-impulsivity. While everyone experiences spurts of inattention or impulsivity, ADHD interferes with an individual’s ability to function at home, work, school, activities, etc. It may sometimes interfere with friends and relationships, and at least some symptoms must have been present before the age of 12 for diagnosis.
Other neurodevelopmental disorders include communication disorders such as language disorder, speech sound disorder, and fluency disorder (stuttering); motor disorders such as developmental coordination disorder, stereotypic movement disorder, and tics; and specific learning disorders.
SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS
Although the term schizophrenia literally means “split brain,” these disorders have nothing to do with what used to be called Multiple Personality Disorder. Rather, these disorders are marked by disturbances in thought, perception and speech, as well as motor behavior and emotional experience.
It is important to distinguish between delusions and hallucinations. Delusions are beliefs that are not based in reality, such as believing that one can fly, that one is the president of a country, or that one is being pursued by the CIA (assuming that these things are not true). Hallucinations are perceptions that are not based in reality, such as seeing things or hearing voices that are not there, or feeling spiders on one’s skin (assuming they are not really there).
Disorganized thinking and disorganized speech are typical. A person with such a disorder may switch from one topic to another in illogical fashion, may respond to questions with irrelevant answers, and may produce streams of speech that have little or no coherence (“word salad”).
It is important to distinguish between positive symptoms and negative symptoms. Just like with Skinner’s learning theory, the terms positive and negative here have nothing to do with good or bad, but rather they refer to adding and subtracting. A positive symptom of schizophrenic disorders refers to something that a person has, which typical people do not. Thus, delusions and hallucinations are positive symptoms. A negative symptom refers to something that typical people do have, but that one does not have. In schizophrenic disorders, a limited range of emotion and the lack of desire to initiate activities are both particularly noticeable. A number of antipsychotic medications can alleviate the positive symptoms of schizophrenia spectrum disorders.
BIPOLAR AND RELATED DISORDERS
Bipolar disorders, as the name suggests, involves movement between two poles: depressive states on the one hand, and manic states on the other hand. Because manic states often have psychotic features, the DSM-5 now regards bipolar disorders as a bridge between the psychoses and the major depressive disorders.
Unlike the everyday-language use of the term (“I’m so depressed about that test”), depressive disorders involve the presence of a sad, empty, or irritable mood, combined with changes in thinking and bodily functioning that significantly impair one’s ability to function. These disorders go far beyond normal sadness or grief, and last longer than usual periods of sadness. Separate or combined treatments such as psychotherapy (in particular cognitive-behavioral therapy) and anti-depressant medications may assist in recovery.
Fear is an emotional response to something present; anxiety is a related emotional response, but to a future threat or a possibility of danger. In a state of anxiety, the nervous system wants to get into fight-or-flight mode, but there is nothing there to fight and nothing to flee from. Physical effects of anxiety may include but are not limited to muscle tension, hyperalertness for danger signs, and avoidance behaviors. Sleep disturbances, irritability, and inability to concentrate are common related symptoms.
Treatments vary from behavioral modification in the case of specific phobias to cognitive-behavioral therapy to psychotherapy to medical treatment through anxiolytics, anti-anxiety medications.
Panic disorder is an anxiety disorder characterized by recurring panic attacks, as well as the constant worry of another panic attack occurring. While panic attacks last only a few minutes, they are debilitating. They are accompanied by sweating, increased heart rate, and a general feeling of being paralyzed with fright.
Generalized anxiety disorder (GAD) is an anxiety disorder characterized by an almost constant state of autonomic nervous system arousal and feelings of dread and worry.
Phobias, or persistent, irrational fears of common events or objects, are also anxiety disorders. Phobias include fear of objects, such as snakes, and fear of situations. Agoraphobia, for example, is the fear of being in open spaces, public places, or other places from which escape is perceived to be difficult.
OBSESSIVE-COMPULSIVE AND RELATED DISORDERS
As the name suggests, these disorders involve obsessions and/or compulsions. Be clear on the difference between these terms: obsessions are thoughts; compulsions are actions. Specifically, obsessions are intrusive (unwanted) thoughts, urges, or images that plague the individual. Compulsions are repetitive behaviors (or mental acts) that one feels compelled to perform, often in relation to an obsession. For example, intrusive thoughts about germs could lead to repeated hand-washing. This is the textbook example for obsessive-compulsive disorder (OCD). OCD is characterized by involuntary, persistent thoughts or obsessions, as well as compulsions, or repetitive behaviors that are time consuming and maladaptive, that an individual believes will prevent a particular (usually unrelated) outcome. Related disorders include body dysmorphic disorder and hoarding disorder, which involve obsessive thoughts about bodily defects or the need to save possessions. Some specific disorders involve hair-pulling and skin-picking.
TRAUMA- AND STRESSOR-RELATED DISORDERS
By definition, these disorders follow a particularly disturbing event or set of events (the trauma or the stressor), like war or violence. Although it is completely normal for people to respond to a stressful event with stress symptoms, some people recover naturally, whereas others develop symptoms. The best-known such disorder is post-traumatic stress disorder (PTSD), which can involve intrusive thoughts or dreams related to the trauma, irritability, avoidance of situations that might recall the traumatic event, sleep disturbances, diminished interest in formerly pleasurable activities, and social withdrawal. These PTSD symptoms, in turn, lead to a decreased ability to function as well as to a general detachment from reality. Other disorders include reactive attachment disorder, which can occur in seriously neglected children who are unable to form attachments to their adult caregivers, and adjustment disorders, or maladaptive responses to particular stressors.
What gets dissociated in dissociative disorders is primarily consciousness or identity. In many cases, these disorders appear following a trauma, and may be seen as the mind’s attempt to protect itself by splitting itself into parts. Thus, one might experience derealization, the sense that “this is not really happening,” or depersonalization, the sense that “this is not happening to me.” Significant gaps in memory may be related to dissociative amnesia, an inability to recall life events that goes far beyond normal forgetting. Perhaps the most extreme of these disorders is dissociative identity disorder (formerly known as multiple personality disorder), in which one may not only “lose time,” but also manifest a separate personality during that lost time. This disorder is most often associated with significant trauma or abuse in childhood.
SOMATIC SYMPTOM AND RELATED DISORDERS
Soma means “body.” Somatic symptom disorder involves, as one might expect, bodily symptoms combined with disordered thoughts, feelings, and/or behaviors connected to these symptoms. It is not the symptoms themselves, but how the individual experiences them, that is striking and seems maladaptive. That is, the level of worry seems out of proportion to the symptom itself. Related worries appear in illness anxiety disorder, in which one worries excessively about the possibility of falling ill. Conversion disorder (formerly known as hysteria) involves bodily symptoms like changed motor function or changed sensory function that are incompatible with neurological explanations. There may be a suspicion that the symptoms are psychogenic, meaning created by the mind. This may prompt some people to say, “It’s all in your mind.” However, a symptom can originate from the mind but actually end up in the body. According to an old joke, the difference between Americans and Russians is that if an American doesn’t want to go to a dinner, he or she will pretend to have a headache; the Russian has to actually have the headache. In conversion disorder, the individual may be completely unaware of the mental origin of the physical symptoms. Finally, there is also factitious disorder, in which an individual knowingly falsifies symptoms in order to get medical care, or sympathy or aid from others. This disorder differs from simple lying in that the deception occurs even when there are no obvious rewards.
FEEDING AND EATING DISORDERS
Anorexia nervosa (commonly called anorexia) involves not only restriction of food intake, but also intense fear of gaining weight and disturbances in self-perception, such as thinking one looks fat, when one does not. The self-starvation behavior associated with this disorder can lead to life-threatening medical conditions. Bulimia nervosa (commonly called bulimia) involves recurrent episodes of binge-eating: eating large amounts of food in short amounts of time, followed by inappropriate behaviors to prevent weight gain, such as self-induced vomiting (purging), using laxatives, or intense exercising. There is usually a heightened sense of shame in connection with both binging and purging. Self-image is also unduly affected by body shape and weight. Binge-eating disorder might be thought of as bulimia without purging. But this occurs in both normal-weight and overweight/obese people. There is a loss of control associated with the binge-eating in this disorder. Finally, pica refers to regular consumption of non-nutritive substances (plastic, paper, dirt, string, chalk, etc.). This occurs more often in children, but can occur in adults. Pica is occasionally seen in pregnant women and individuals with iron deficiency. While it is not clear why this occurs, it is most likely a result of biochemical, physiological, and cultural factors.
Consider data that suggests that 15% of U.S. adults have at least one personality disorder. This is roughly one in seven people. While we do not encourage you to start diagnosing people without training, you might think about the people you have met as you study personality disorders.
A personality disorder refers to a stable (and inflexible) way of experiencing and acting in the world, one that is at variance with the person’s culture, that starts in adolescence or adulthood, and leads to either personal distress or impairment of social functioning. (It is important to note that, by definition, children cannot have personality disorders. Think of it this way: children are still developing their personalities.) Ten personality disorders are organized into three clusters. You might think of them as the three Ws: the weird, the wild, and the worried.
Cluster A includes paranoid, schizoid, and schizotypal personality disorders. These individuals appear to be markedly odd or eccentric. With paranoid personality disorder, there may be a pattern of general distrust of others that is not justified by real circumstances. Schizoid personality disorder is marked by disturbances in feeling (detachment from social relationships, flat affect, does not enjoy close relationships with people), whereas schizotypal personality disorder is marked by disturbances in thought (odd beliefs that do not quite qualify as delusions, such as superstitions, belief in a “sixth sense,” etc.; odd speech; eccentric behavior or appearance).
Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. These individuals appear to be dramatic, emotional, or erratic. Terms like psychopath or sociopath have been used to describe people with antisocial personality disorder, which is characterized by a persistent pattern of disregard for, and violation of, the rights of others. Lying, cheating, stealing, and having no remorse are common. Borderline personality disorder involves a very stormy relationship with the world, with others, and with one’s own feelings. People with this disorder have a regular pattern of instability in relationships, often involving frantic efforts to avoid abandonment (imagined or real), alternating between extremes of idealization and devaluation (“You’re the best ever!” → “I hate you!”) with the same person, identity disturbance, impulsivity, chronic feelings of emptiness, and anger control issues. Histrionic personality disorder involves a pattern of excessive emotionality and attention-seeking, beyond what might be considered normal (even in a “culture of selfies”). Narcissistic personality disorder involves an overinflated sense of self-importance, fantasies of success, beliefs that one is special, a sense of entitlement, a lack of empathy for others, and a display of arrogant behaviors or attitudes.
Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. These individuals appear to be anxious or fearful. Avoidant personality disorder involves an enduring pattern of social inhibition, feelings of inadequacy, and hypersensitivity to real or perceived criticism, which lead to avoidance behavior in relation to social, personal, and intimate relationships. Dependent personality disorder is marked by an excessive need to be cared for, leading to clingy and submissive behavior and fears of separation. People with this disorder may feel unable to make everyday decisions without constantly consulting others and getting their advice and approval. Finally, obsessive-compulsive personality disorder (OCPD) is marked by a rigid concern with order, perfectionism, control, and work, at the expense of flexibility, spontaneity, openness, and play. These people may be described using Freud’s term “anal.” In distinction to OCD, which involves unwanted or intrusive thoughts along with unwanted or intrusive compulsions, OCPD can involve similar thoughts and compulsions, but they are not seen by the person as intrusive. Rather, the person with OCPD may think that the problem lies with other people, who do not see the need for things to be ordered in a certain way.
In many cases, people do not seek treatment for their personality disorders. But if their disorder leads them to become depressed or anxious, due to social or occupational impairments, they may seek help for depression or anxiety, and may become diagnosed in that way.
We have only given an overview and selection of the disorders listed in the DSM-5. Other disorders include the following: elimination disorders; sleep-wake disorders; sexual dysfunctions; gender dysphoria; disruptive, impulse-control and conduct disorders; substance-related and addictive disorders; neurocognitive disorders; paraphilic disorders; and others.
Definitions of Disorder
Theories of Psychopathology
Diagnosis of Psychopathology
autism spectrum disorder
attention-deficit hyperactivity disorder (ADHD)
specific learning disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and Related Disorders
generalized anxiety disorder (GAD)
Obsessive-Compulsive and Related Disorders
obsessive-compulsive disorder (OCD)
body dysmorphic disorder
Trauma- and Stressor-Related Disorders
post-traumatic stress disorder (PTSD)
reactive attachment disorder
dissociative identity disorder (DID)
Somatic Symptom and Related Disorders
somatic symptom disorder
illness anxiety disorder
Feeding and Eating Disorders
paranoid personality disorder
schizoid personality disorder
schizotypal personality disorder
antisocial personality disorder
borderline personality disorder
histrionic personality disorder
narcissistic personality disorder
avoidant personality disorder
dependent personality disorder
obsessive-compulsive personality disorder (OCPD)
Chapter 16 Drill
See Chapter 19 for answers and explanations.
1.A man claims to hear voices telling him to run for president. He is most likely experiencing
2.The disorder characterized by psychological difficulties that manifest themselves as physical symptoms is
3.Which of the following are most characteristic of a dissociative disorder?
(A)A persistent, irrational fear of objects or situations
(B)Difficulties in forming lasting personal relationships
(C)Involuntary and persistent thoughts that interfere with daily activity
(D)Auditory and tactile hallucinations
(E)Memory dysfunction and/or altered perceptions of identity
4.Depression has been associated with low levels of the neurotransmitter
5.Which of the following is NOT characterized by the DSM-5 as an anxiety disorder?
(C)Anxious personality disorder
(E)Generalized anxiety disorder
6.A high-school girl goes missing, and when she is found in a town 100 miles away a week later, she has assumed a new personality and has no apparent recollection of her life at home. Which category of disorder is she most likely suffering from?
7.Conversion disorder is best characterized by
(A)a constant fear of being ill
(B)panic attacks and severe anxiety
(C)frequent vague complaints about physical symptoms
(D)functional impairment of a limb or sensory ability with no apparent physical cause
8.All of the following are Cluster B personality disorders EXCEPT
(A)borderline personality disorder
(B)schizoid personality disorder
(C)histrionic behavior disorder
(D)narcissistic personality disorder
(E)antisocial personality disorder
9.A child shows difficulty engaging with other children and needs to follow a very strict routine every day to function properly. If the routine is broken, he cries and has a very difficult time adjusting. These symptoms may satisfy which of the following diagnoses?
(A)Attention-deficit hyperactivity disorder
(B)Reactive attachment disorder
(E)Autism spectrum disorder
10.All of the following are classified as feeding and eating disorders EXCEPT
(D)body dysmorphic disorder
Respond to the following questions:
· Which topics in this chapter do you hope to see on the multiple-choice section or essay?
· Which topics in this chapter do you hope not to see on the multiple-choice section or essay?
· Regarding any psychologists mentioned, can you pair the psychologists with their contributions to the field? Did they contribute significant experiments, theories, or both?
· Regarding any theories mentioned, can you distinguish between differing theories well enough to recognize them on the multiple-choice section? Can you distinguish them well enough to write a fluent essay on them?
· Regarding any figures given, if you were given a labeled figure from within this chapter, would you be able to give the significance of each part of the figure?
· Can you define the key terms at the end of the chapter?
· Which parts of the chapter will you review?
· Will you seek further help, outside of this book (such as a teacher, Princeton Review tutor, or AP Students), on any of the content in this chapter—and, if so, on what content?