PSYCHOLOGICAL

DISORDERS
A Unit Lesson Plan for
High School Psychology Teachers

Richard Seefeldt, EdD

University of Wisconsin–River Falls
Teacher Reviewers
Nancy Diehl, PhD, Hong Kong International School,
Tai Tam, Hong Kong, and R. Scott Reed, MEd,
Hamilton High School, Chandler, AZ

Developed and Produced by the Teachers of Psychology in Secondary Schools

(TOPSS) of the American Psychological Association, September 2014

BACK TO CONTENTS
PSYCHOLOGICAL DISORDERS
A Unit Lesson Plan for High School Psychology Teachers.

This unit is aligned to the following content and performance standards of the National Standards for High
School Psychology Curricula (APA, 2011):

DOMAiN: iNDiViDUAL VARiATiON

STANDARD AREA: PSYCHOLOGiCAL DiSORDERS

CONTENT STANDARDS

After concluding this unit, students understand:

1. Perspectives on abnormal behavior

2. Categories of psychological disorders

CONTENT STANDARDS WiTH PERFORMANCE STANDARDS

CONTENT STANDARD 1: Perspectives on abnormal behavior

Students are able to (performance standards):

1.1 Define psychologically abnormal behavior
1.2 Describe historical and cross-cultural views of abnormality
1.3 Describe major models of abnormality
1.4 Discuss how stigma relates to abnormal behavior
1.5 Discuss the impact of psychological disorders on the individual, family, and society

CONTENT STANDARD 2: Categories of psychological disorders

Students are able to (performance standards):

2.1 Describe the classification of psychological disorders
2.2 Discuss the challenges associated with diagnosis
2.3 Describe symptoms and causes of major categories of psychological disorders (including schizophrenic,
mood, anxiety, and personality disorders)
2.4 Evaluate how different factors influence an individual’s experience of psychological disorders

DOMAiN: APPLiCATiONS OF PSYCHOLOGiCAL SCiENCE

STANDARD AREA: TREATMENT OF PSYCHOLOGiCAL DiSORDERS

CONTENT STANDARD

After concluding this unit, students understand:

Perspectives on treatment

CONTENT STANDARDS WiTH PERFORMANCE STANDARDS

CONTENT STANDARD 1: Perspectives on treatment

Students are able to (performance standards):

1.1 Explain how psychological treatments have changed over time and among cultures
1.2 Match methods of treatment to psychological perspectives

TOPSS thanks Christie P. Karpiak, PhD, of The University of Scranton and Jyh-Hann Chang, PhD, of East
Stroudsburg University for their reviews of this unit plan.

This project was supported by a grant from the American Psychological Foundation.
 Copyright (C) 2014 American Psychological Association.

ii PSYCHOLOGiCAL DiSORDERS

CONTENTS iNTRODUCTiON V

PROCEDURAL TiMELiNE
1

CONTENT OUTLiNE
3

ACTiViTiES 31

CRiTiCAL THiNKiNG AND DiSCUSSiON QUESTiONS 43

A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS
 REFERENCES AND OTHER RESOURCES
47

iii
INTRODUCTION

I t is common to find students new to psychology who believe the study

of psychological disorders is psychology. These students are often
disappointed to find out that it is only a small piece of what psychologists
study and that they usually have to wait until the very end of the class to
begin studying it.

Moreover, once they get to this unit, students bring with them
preconceived notions regarding psychological disorders. More and more,
these notions have been shaped by a student’s own experience. Most all
students know at least one person whose problem has been classified as
a mental disorder and who is taking some sort of psychotropic medication
to change the problem. Television advertisements, shows, their doctors,
and other people they know have provided them with a lot of information,
and for the most part they tend to believe what they have been told.

Unfortunately, much of what students have learned from these sources is

not scientifically accurate. For example, most students believe “having a
mental disorder” is a clear-cut thing. They believe you are either someone
who “has one,” or you are someone who “doesn’t have one.” They also
tend to believe that explaining psychological disorders is far simpler than
explaining any other kind of behavior. For example, they find it easy to
accept it is impossible for us to determine with absolute certainty why
someone would play basketball, but at the same time believe when
someone acts depressed it is simply because of some neurochemical
imbalance.

The facts of the matter are that people’s problems are typically not
categorical, but dimensional. People experience problems more or less
over the duration of their lives. Sometimes and in some situations these
problems interfere more than at other times and situations. Sometimes
these problems get classified as “mental disorders,” and sometimes they
don’t. In addition, the reasons why people experience problems are highly
complex. Indeed, psychological disorders are at least as complex as why
people experience or do anything else. It is important for students to
 understand the complexity of psychological disorders. There
are many biological, psycho-

logical, and sociocultural factors involved in

the development of psychological disorders.
Understanding these different factors and
their complexities is just as (if not more)
important than memorizing the categorical
names (diagnoses) of different problems. For
this reason, it is important to emphasize the
different models of abnormality and to avoid
oversimplifying the complex nature of human
problems.

The following Content Outline provides an

overview of the history of understanding
psychological disorders, followed by a
summary of the major theoretical models
used to explain them. The final section is a
sampling of the major categorical
descriptions of psychological disorders from
the Diagnostic and Statistical Manual of
Mental Disorders (Fifth Edition) (DSM-5) and
the International Classification of Diseases,
Ninth Revision (ICD-9-CM).

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS
Vi PSYCHOLOGICAL DISORDERS

BACK TO CONTENTS
 PROCEDURAL
TIMELINE
LESSON 1: INTRODUCTION AND HISTORY
Activity 1: What is Abnormal Behavior?

LESSON 2: CURRENT PERSPECTIVES

Activity 2.1: Psychological Disorders and
Perspectives in Psychology

Activity 2.2: On Being Sane in insane Places

LESSON 3: CLASSIFICATION OF PSYCHOLOGICAL

DISORDERS

LESSON 4: PSYCHOLOGICAL DISORDERS

Activity 4: An Assignment With Vignettes

LESSON 5: PSYCHOLOGICAL DISORDERS, CONTINUED

Activity 5.1: Connecting Media and Psychology

Activity 5.2: interesting Psychology information

PROCEDURAL TIMELINE

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 1
 CONTENT OUTLINE

LESSON 1
introduction and History
i. General
“Psychologically abnormal behavior” has been described as many things
over the course of history including madness, insanity, craziness, lunacy,
mental disorders, mental illnesses, psychopathology, maladjustment,
behavioral disturbances, emotional disturbances, personal problems, etc.
All of these descriptions are colored by the culture in which they arise and
by the particular ideas people have for why people exhibit these problems.

There are at least as many definitions of psychological abnormality as there

have been names for it. Because behaviors, emotions, cognitions, and
adaptation are best described dimensionally, and because psychological
abnormality is defined in most cases by these processes, it is very difficult
to have a definition we can apply absolutely. It should come as no surprise,
then, that there are no universally accepted definitions of psychological
abnormality.

A. Comer (2014) states that most current definitions of abnormality

include the ideas of deviance, distress, dysfunction, and
dangerousness.

B. Rosenhan & Seligman (1995) also include ideas of observer CONTENT OUTLINE
discomfort, irrationality (to others), and violation of ideal standards. C.
The American Psychiatric Association’s Diagnostic and Statistical
Manual (DSM-5) describes some specific abnormal psychiatric
conditions and defines these “mental disorders” as “… syndrome[s]
characterized by clinically significant disturbance[s] in an individual’s
cognition, emotion regulation, or behavior that reflects a dysfunction
in psychological, biological, or developmental processes underlying
mental functioning. Mental disorders are usually associated with

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 3
 significant distress or disability in social, occupational, or other
important activities. An expectable or culturally approved response to
a common stressor or loss, such as the death of a loved one, is not a
mental disorder. Socially deviant behavior (e.g. political, religious, or
sexual) and conflicts that are primarily between the individual and
society are not mental disorders unless the deviance or conflict
results from a dysfunction in the individual, as described above”
(American Psychiatric Association, 2013, p. 20).

ii. Historical views of abnormality

A. Ancient times

Supernatural causes

The primary explanation for psychological disturbances in ancient

times seems to have been supernatural causes. Egyptian, Chinese,
and Hebrew writings all describe psychological disturbances as being
caused by demons, and some of the earliest known treatments for the
disorders were exorcisms, starvation, and maybe even trephination
(Comer, 2014; Maher & Maher, 1985; Porter, 2003). Early
explanations of abnormality in Indian, Chinese, and Egyptian cultures
all refer to some sort of supernatural causes, along with imbalances in
some sort of bodily fluids or forces. B. Greece and Rome (500 BC
to 500 AD)

Imbalances

Though Greeks such as Socrates and Homer were not immune

from citing “the gods” as a potential source of madness,
Hippocrates (460-377 BC) taught that illnesses had natural causes
and that abnormality was the result of some sort of disease
process resulting from imbalances of the four humours: black bile,
yellow bile, blood, and phlegm (Porter, 2003).

C. Middle Ages (500 AD to 1350)

1. Europe

Supernatural explanations for problems again became very

popular across Europe. This popularity was accompanied by
a return to exorcisms and witch hunting as methods of
eliminating problems. Dominican monks by the names of
Kramer and Sprenger published the Malleus Maleficarum in

4 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 1486 (see Mackay, 2009) as a sort of manual describing in
dramatic detail the methods of identifying, examining, trying,
and “treating” witches.

2. Middle East

The first hospital ward to treat madness was founded in Baghdad

in the year 705. Some of the treatments at this hospital
anticipated the development of “moral therapy” in Europe some
1,100 years later. In 1025, a Persian by the name of Ibn-Sina
(Avicenna) completed a five-book encyclopedia of medicine
known as The Canon of Medicine that takes a scientific
approach to disease and whose descriptions and treatments of
abnormality include but go far beyond the humoral explanations.
This document has been cited as one of the most influential in
the history of science (Sarton, 1952).

D. Renaissance (1400–1700)

1. Scientific thinking

Throughout Europe, scientific thinking gained momentum over

supernatural explanations. Johannes Weyer (1515-1588)
published a rebuttal to the Malleus Maleficarum and supernatural
explanations of abnormality that makes the case that
abnormalities might be considered diseases with natural causes.
Because some of his work refuted supernatural causes, the
church banned the book for centuries.

2. De velopment of asylums

Asylums, designed to house the “mad,” began to develop

across Europe. One of the earliest of these was St. Mary of
Bethlehem (“Bethlem” or “Bedlam”) in London. Bethlem is
known to have housed people considered “mad” since the late
14th century. During that time, the ability to reason was the
one faculty believed to differentiate people from other animals.
Because people who were “mad” were considered to have lost
their ability to reason, they were considered to be less than
human and more like animals. Thus, institutions during these
times were largely places that “maintained” patients by holding
them away from the larger community. When attempts were
made to actually treat people, the treatments were limited
mostly to those focused on humoural imbalances (bleeding,
purging, etc.). Patients were often chained in rooms and

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 5
 otherwise treated inhumanely (Andrews, Briggs, Porter,
Tucker, & Waddington, 1997).

E. Late 18th century–mid-19th century

1. Moral therapy

Philippe Pinel is credited with developing what he called

“traitement morale.” This idea was actually developed by one
of Bicetre’s former scrofula patients turned superintendent—
Jean-Baptiste Pussin. The idea was essentially a switch from
treating people like animals in chains to releasing them from
their chains and treating them humanely and with respect.
Pussin and Pinel first implemented this treatment at La Bicetre
in Paris in 1793 and soon after instituted the change at the
even larger La Salpetriere hospital for women also in Paris
(Porter, 2003).

2. Moral therapy applied to asylums

William Tuke is credited with establishing one of the first

institutions based on the idea of moral therapy in York,
England, in 1796. This institution, called The Retreat and
commonly known as the “York Retreat,” was built to be very
much like a large Quaker home where patients would be
treated with a combination of rest, talk, prayer, and manual
work (Tuke, 1964).

3. Spread of moral therapy

This sort of treatment spread throughout Europe and the

United States, with many institutions developing along the
lines of the York Retreat and moral therapy. Benjamin Rush
(1745-1813) and Dorothea Dix (1802-1887) are two Americans
known for the establishment of institutions (Rush) and the
development of laws and reforms (Dix) in line with the notions
of moral therapy.

F. Mid-19th century–early 20th century

1. Continued growth of mental hospitals

Institutions for people exhibiting psychological abnormalities

became increasingly large and increasingly unable to take
good care of the people housed in them. The ideals of moral
therapy gave way to the practicalities of treating large numbers

6 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 of people in large institutions with relatively small numbers of
staff. Once again individuals were not so much treated in these
large “hospitals” as they were maintained (Scull, 1993).

2. Medical breakthroughs

(a) New discoveries made in France and Germany linking

syphilis to the development of general paresis (a
devastating brain disease that was quite prevalent and
considered a form of madness until the early 20th
century) led the way to a resurgence for the idea that
biological factors played an important role in the
development of psychological abnormalities.

(b) The development of arsphenamine and later penicillin in

the treatment of syphilis drastically reduced the numbers
of individuals developing general paresis. This success
paved the way for other biological treatments of
abnormalities, including removal of body parts (Cotton,
1921), insulin shock therapy (Sakel, 1927; see Shorter,
1997), electric convulsive therapy (Cerletti, 1956), and
lobotomy (Moniz, 1935; see Tierney, 2000) and
prescribing of chemicals like chlorpromazine (Laborit,
1949; see Swazey, 1974).

3. Psychological adv ances

Meanwhile in psychology, progress was being made in

understanding all behavior, including abnormality. Individuals
such as Freud (1933, psychoanalysis), Pavlov (1927,
respondent conditioning), Skinner (1938, operant
conditioning), Kelly (1955, role of cognition), Binswanger
(1963, existentialism), Frankl (1958, role of meaning), and
Rogers (1951, humanistic therapy) laid the foundations for
modern psychological explanations of abnormality.

G. Mid-20th century–present

Developments continued in biomedical and psychological understanding

and treatment of abnormality.

1. Biomedical advances

(a) Biological research to e xplain abnormality

lagged far behind the use of biological
treatments to treat it.

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 7
 (b) Biological treatments contin ued to
evolve largely through serendipitous discoveries
of how medications (developed for altogether
different purposes) seemed to affect behavior,
affect, and cognition. Thus, in addition to
treating problems like schizophrenia, drugs
were developed to treat problems like mood
disorders (tricyclic antidepressants for
depression and lithium for bipolarity), anxiety
disorders (benzodiazepines), and even
childhood disorders like attention-deficit
hyperactivity (methylphenidate).

(c) Though these treatments are popular today, the

explanations for why these medications often
work (and often don’t work!) are still lacking.

(d) Technological advances in assessing brain

structures and functions (e.g., EEG, PET, fMRI)
have led to a better understanding of some of
the brain correlates of abnormality.

2. Psychological advances

The psychological theories and therapies developed in the

late 19th and early 20th centuries have continued to evolve
with research to the present day. One major advance in the
last half-century has been the connection of the cognitive and
behavioral approaches to problems. This theoretical
connection was made by psychologists such as Bandura (via
social learning and social–cognitive theories), Rotter, and
Mischel. In addition to those individuals, people such as Beck
and Ellis were early leaders in developing treatments
consistent with these ideas.

3. Adv ances in psychotherapies

In general, psychotherapies continued to evolve during the last

half of the 20th century and continue to evolve to the present.
Eysenck’s (1952) landmark study of the ineffectiveness of
psychoanalysis led to a massive increase in the research of
the effectiveness of not only psychoanalysis but of all
therapies. Thirty years later, Smith & Glass (1977) did a meta-
analysis that supported the overall effectiveness of therapies
across treatments and problems. Research also progressed in
the domain of the “process” of therapy. This research was less

8 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 concerned about which technique “worked the best” and more
focused on the common factors all psychotherapies contain
that make them all relatively effective. Though there is much
support that common factors are more important than
technique in predicting a successful outcome in therapy, this
has not stopped research to determine “which therapy works
best for which problems.” This more prescriptive research has
led to the notion of empirically supported treatments for
various problems. Therapies whose stated treatment
outcomes are more easily described objectively (e.g., cognitive
behavior therapy) typically fare better than others (e.g.
psychodynamic therapies) in these analyses.

4. All theories make contributions to understanding problems

Because all theoretical models and treatments seem to account

for some problems in significant ways better than others, all
theoretical perspectives along with their treatments and
associated research are alive today.

GO TO ACTIVITY 1
What Is Abnormal Behavior?

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 9
 LESSON 2
Current Perspectives
i. Biomedical model

The biomedical model presumes that (like general paresis) all forms
of abnormality are best understood as illnesses or diseases.

A. Causes of problems

1. Germs: Such as the bacterium causing syphilis and general

paresis

2. Genes: Genetic mutations that cause illnesses either directly

or by creating a biological vulnerability

3. Biochemistry: Imbalances in neurotransmitters

4. Neuroanatomy: Abnormal brain structures

B. Treatments

Treatments based on this model are mostly drug therapies that

either kill the germs or theoretically restore the balance of
neurotransmitters that are producing the illness.

C. Current status

This model is more prominent than other models today largely

due to the availability of medical treatments, the ease of chemical
treatment, and the idea that considering people exhibiting
abnormality to be ill may reduce the stigma often associated with
abnormality.

ii. Psychodynamic model

This model presumes unconscious psychological processes are
responsible for abnormality.

A. Causes of problems

1. In the traditional Freudian sense, abnormality is a compromise

between the structures of the personality. Individuals have
unconscious needs or desires that have been repressed
because they are unacceptable to the super ego. When too
much of this instinctual desire is repressed, problems occur that
symbolically represent these unexpressed desires.

10 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 2. In more recent terms, abnormality is the result of dissociated
trauma. Individuals who experience severe emotional traumas
that overwhelm their ability to handle them “dissociate” (mentally
compartmentalize) the memory and emotion that would
otherwise be overwhelming. This dissociated emotion seeks
expression throughout the person’s life, creating problems
associated symbolically and experientially with the original
traumas.

B. Treatments

With either explanation, treatments focus on making the

unconscious conscious, or, as Freud said, “where id is, there shall
ego be” (Freud, 1953), either by having the person experience the
repressed instinctual desires or re-experience the traumas at the
source of the repression/dissociation. In recent years, these
treatments have been implicated in the development of “false
memories” of childhood abuse. Though the legal implications of
these false memories are recent, the issue of whether memories
regained in therapy are historically true has been arduously
debated since Freud’s time.

C. Current status

The psychodynamic model is not nearly as pervasive in the

understanding and treatment of abnormality as it was in the first
half of the 20th century. However, psychodynamic explanations of
problems like dissociative, somatoform, and personality disorders
remain important, and similar explanations for other disorders,
such as mood and anxiety disorders, are still relevant.

iii. Existential–humanistic model

A. General

These models hold that each individual has his/her own idiosyncratic
experience of the world and that each person lives his/her life “as if”
(Vaihinger, 1925) that experience is reality. There are many
experiences of reality, and, therefore, there is no universal or
culturally agreed-upon view that specific behaviors are a problem.

B. Causes of problems

Humanistic theories discuss this basic experience as based on a

force of self-actualization that is an “instinctual drive to maintain
and enhance the organism” (Rogers, 1951). They hold that

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 11
 abnormality is caused when an individual makes choices in life
based on being accepted and approved of by significant others,
rather than basing those choices on their own experience. Rather
than taking responsibility for their own life course, abnormal
individuals blame other people or external factors for their
unhappiness and poor choices. This discrepancy is referred to as
incongruence or inauthenticity. Additionally, abnormality can be
caused when a person’s life loses a sense of meaning based on
the person’s own experience (Frankl, 1958).

C. Treatments

Treatments focus on providing “empathy, genuineness and

unconditional positive regard” so a person develops self-regard
and can therefore learn to trust his/her own experience and
develop his/her own sense of meaning. Rather than having their
choices based on what will be most acceptable to others, people
will then live their lives based on their own experience (authentic
living).

D. Current status

This model is the least scientific of all the theoretical models and is
thus the most prone to criticism. One of the major problems for
supporters of this model has been finding a way of operationalizing
concepts such as “experience” in a way that can be measured. In
spite of this major problem, “current status” remains a legitimate
model because it seems to explain some common problems
(depression, anxiety, low self-esteem) in a way that seems most
meaningful to many (Comer, 2014). Additionally, treatments based
on this model have been successfully applied as an aspect of most
all forms of psychotherapy.

iV. Cognitive–behavioral model

A. General

This model combines the traditional behavioral model with the

cognitive model.

B. Causes of problems

1. The behavioral model views abnormal behavior the same way

it views any other behavior, as being determined by the
environment via classical and operant conditioning. Problems

12 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 are not viewed as symptoms of some other more basic difficulty,
but as problems in and of themselves.

2. The cognitive model is based on a view similar to that of the

philosopher Epictetus (84 AD), who said men are not disturbed
by things, but by the way they think of them. In this view, it is
irrational and/or maladaptive thinking that creates abnormality.
This thinking can be in the form of more short-term cognitions
such as expectations, appraisals, attributions or more long-term
cognitions such as beliefs or life philosophies.

3. The social cognitive model is based largely on Bandura’s

work in observational learning and social cognitive theory and
was one of the major efforts to unite and expand upon the
behavioral and cognitive perspectives. His idea is that behavior
(abnormal and otherwise) is reciprocally determined by
combinations of environment, behavior, and person variables
that are mostly cognitive in nature. The idea of reciprocal
determinism along with concepts such as self-regulation and
self-efficacy have led to many advances in the understanding
and treatment of abnormality.

C. Treatments

1. Behavioral: Treatment of problems involves extinguishing

unwanted behaviors and shaping and reinforcing desired
behaviors via classical and operant conditioning.

2. Cognitive: Treatment of problems involves exposing the

maladaptive and irrational patterns of thinking and replacing
them with “the ironclad logic of rational thinking” (Ellis, Harper, &
Powers, 1975).

3. Social cognitive: Treatments include modeling, building self-

efficacy, and facilitating self-regulation of behavior.

D. Current status

The cognitive–behavioral perspective has many strengths. Among

these are its basis in rigorous experimental science and the fact
that therapies based on this theoretical model are relatively
economical and very successful. For many of the most prevalent
sorts of human problems (depression and anxiety disorders),
cognitive behavior therapy has been shown to be as effective or
superior to other forms of treatment (e.g., Hollon & Ponniah, 2010).

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 13
 V. Sociocultural model
A. General

The sociocultural model looks at how greater sociological forces

such as institutions, economies, and cultures shape individuals’
behaviors, including their problems.

B. Causes of prob lems

The sociocultural model contends that individual problems are

caused by the larger systems in which the individual is living.
According to this model, nothing is wrong with the individual, per
se. Abnormality is an outcome of an individual’s living within
systems that create problems. Individual problems are produced by
factors such as poor family communication, racism, poverty,
societal change, oppression, and dysfunctional institutions such as
schools, governments, housing, churches, etc.

C. Treatment

Because the source of individual problems is beyond the individual

level, individual therapy is of little use. Treatment from this
perspective involves family therapies, work to eliminate societal ills
such as poverty and racism, or initiatives to change how institutions
such as schools and governments operate.

D. Current status

The main strength of this model is that it is the only theoretical

model to view societal and cultural factors as causes of
abnormality in and of themselves. The problems with this view are
that it is based too heavily on case studies and epidemiological
studies, and it does not explain well why only a minority of
individuals living within the same problematic system develop
abnormally.

Vi. Meta-theoretical models

A. General

Meta-theoretical models allow for research within all theoretical

models to fit into the overall understanding and treatment of
abnormality. Because psychological problems are complex, and
because all theoretical models make substantial contributions to our
understanding of problems, these meta-theoretical models are

14 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 gaining in popularity. Two of the most prominent of them are the
biopsychosocial model and the diathesis-stress model.

B. The biopsychosocial model suggests significant biological, psychological, and

sociocultural factors are involved in the development and maintenance of
abnormality. Though the relative role played by each set of factors may be more
or less, depending on the problem and the individual, none of these factors
should be overlooked when someone is trying to understand a person’s
problems.

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 15
 C. The diathesis-stress model states that different biological factors produce a
vulnerability to different forms of abnormality (diathesis) and that disorders
develop when an individual experiences environmental stress exceeding that
threshold of vulnerability.

GO TO ACTIVITY 2.1
Psychological Disorders and Perspectives in
Psychology

Vii. Stigma and abnormal behavior

Stigma is when individuals with a certain characteristic or attribute become
discredited and/or rejected by society as a result of that characteristic or
attribute. When individuals’ behaviors become classified as “mental
disorders,” this classification often discredits the individuals in the eyes of
society and leads to their being rejected as individuals.

A. Ho w does stigma relate to psychological problems?

An individual’s abnormality or “having a mental disorder” or being

“mentally ill” or “crazy,” etc., can be one of those attributes that
affects others’ perception of that individual as well as the
individual’s own self-schema and can lead to rejection by those
considered to not “have a mental disorder.” One’s cultural or ethnic
background plays a major role in the stigmatization of mental
illness and seeking help (e.g., African American, Latino/a, and
Asian populations).

B. Consequences of having a problem classified

Being labeled with a mental disorder can affect how individuals

view themselves and how others view them. Through social
cognitive processes such as confirmation bias (Wason, 1960),
self-serving bias (Miller, D. T., & Ross, 1975), and self-fulfilling
prophecy (Merton, 1957), individuals can come to act more like the
label that has been used to describe their problems.

C. Examples of uncovering and dealing with stigmas

1. Rosenhan’ s (1973) classic study “On Being Sane

in Insane Places” supports how these processes
occur even within professional mental health
service communities.

16 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 2. One of the critiques of the Diagnostic and
Statistical Manual
(discussed more in depth later) is that its categorical system of
classification promotes applying categorical descriptions to
individuals that promote the labeling and stigmatizing of people
exhibiting mental disorders.

3. Throughout history different sorts of efforts have

been made to eliminate the stigmatic nature of
diagnostic labels. One example is the viewing of
everyone as mad in one way or another (Porter,
2003). The idea of the “wise fool” was another
(Porter, 2003). Currently, groups such as “Mad
Pride” encourage individuals to take pride in their
madness and promote a removal of the stigmas
associated with it.

GO TO ACTIVITY 2.2
On Being Sane in Insane Places

Viii. Prevalence of mental disorders

A. According to the World Health Organization, more than 450 million
people exhibit some sort of mental disorder.

B. The 12-month prevalence rate of mental disorders of all kinds for adults
in the U.S. is 26.2%. The comparative figure in Europe is 27%.

C. The 12-month prevalence rate of mental disorders of all kinds for

children in the U.S. is 13.1% (8.6% classified as ADHD).

D. In 2007, there were about 35,000 suicides in the U.S. About 95% of
these suicides were committed by individuals age 19 and over (CDC
statistics).

iX. Financial impact of mental disorders

A. Mental illness is the leading cause of disability in children
(Whitaker, 2010).

B. Mental disorders constitute more than 28% of the burden of

disability in the U.S. and Canada (WHO statistics).

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 17
 C. Expenditures for mental disorders constitute 6.2% of all health care
expenditures ($100 billion in 2002) (NIMH statistics).

D. The average amount spent for mental health care in the U.S. is
about $1,500 per person (NIMH statistics).

18 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 LESSON 3
Classification of
Psychological Disorders
I. Classification systems
The DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders
(Fifth Edition) (American Psychiatric Association, 2013). It is currently the
most common means of classifying mental disorders used in the United
States and, along with the International Classification of Diseases, 10th
Revision (ICD-10) (World Health Organization, 1992), one of the most
widely used classification systems for mental disorders around the world.

A. Contents of DSM

The DSM-5 contains diagnostic criteria and codes for 19 specific

categories of mental disorders and additional codes for conditions
(often called V-codes) that may be a focus of clinical attention not
considered mental disorders. These would include problems such
as sibling relational problems, religious or spiritual problems, or
extreme poverty.

B. Organization of DSM

The categories of the DSM are laid out in a general

developmental fashion, with categories of disorders typically seen
early in the lifespan described first, and those usually expressed
later in the lifespan later. Likewise, disorders within categories are
also presented in a somewhat developmental sequence. C. The
International Classification of Diseases

The International Classification of Diseases (ICD) is published by

the World Health Organization. This manual is the most commonly
used system for the classification of all diseases. It has a chapter
devoted to the classification of mental and behavioral disorders.
The current DSM uses coding from the current ICD-9-CM and the
upcoming ICD-10-CM, and it has an organizational structure that
reflects the anticipated structure of the ICD-11, due to be published
sometime in 2017. Though the DSM and ICD organizational

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 19
 systems are not identical, there is and will continue to be a great
deal of correspondence between the two systems.

II. Understanding classification

The classification of problems is difficult because the ways humans may
experience and express problems are nearly limitless. Thus, classification
provides descriptions of the most common ways humans express
problems. These descriptions are best understood as prototypes (best
examples of problems).

iii. Criticisms of the DSM

A. Biomedical orientation

There are many criticisms of the DSM as a classification tool. First

among them is that the system is based on a biomedical model of
problems (e.g., the term diagnostic).

B. Categorical vs. dimensional

Another major criticism concerns the categorical nature of

classification. Though in reality individual problems are best
described dimensionally (more or less) (Markon, Chmielewski, &
Miller, 2011), the DSM is a categorical system (in or out). This
categorical system is maintained because it is a traditional form of
classification in medicine and because it is easier for clinicians to
understand and use (American Psychiatric Association, 2013;
Widiger & Shea, 1991).

The categorical nature of the DSM tends to increase inter-rater

reliability, but is more questionable with regard to issues of validity.
Further, it creates problems such as reification of the categories
(making the categories seem like real entities), exacerbates
problems such as secondary labeling, and increases the likelihood
that a diagnostic label becomes integrated into the schemas of
others and an individual’s own self-schema becomes stigmatic.

Categories are descriptions of problems and not explanations

for them. For example, bulimia nervosa describes a problem in
which an individual binge eats and is involved in compensatory
behavior. It does not mean that a person acts that way because of
bulimia nervosa. Psychological disorders are complex and (as
outlined previously) are explained in different ways by various
theoretical approaches.

20 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 C. Modifications

The DSM-5 attempts to address some of these issues by

incorporating more dimensional aspects. This has been done in a
variety of ways, for example by broadening some categories of
disorders (e.g., autism spectrum disorder) and allowing for coding
of severity of many problems along with the use of specifiers (e.g.,
major depressive disorder). Despite these additions, the DSM has
essentially maintained its categorical nature (American Psychiatric
Association, 2013).

IV. Important things to remember about the classification of

psychological problems
A. Psychological disorders are classified only if the problems interfere
with the person’s life in some “clinically significant” (American
Psychiatric Association, 2013) way. Typically, a mental health
professional determines this clinical significance based on the
degree of the individual’s suffering and/or the reports of others close
to the individual.

B. Psychological problems are complex and have biological,

psychological, and sociocultural aspects. Thus, questions like “Is
schizophrenia genetic?” denote an oversimplification of the
complexities of the problems that together are known as
schizophrenia.

C. Problems exist at different levels of severity, and the combinations of

factors that might produce a problem for one person could be
different from the factors that might produce similar problems in
others.

D. There are also different factors that influence an individual’s

experience of psychological disorders.

1. The American Psychiatric Association (2013) makes it clear

that psychological disorders “are defined in relation to culture,
social and familial norms and values” (p. 14). Thus, it is
important to understand the particular cultural background of
an individual to understand the type and severity of the
problem a person may be experiencing. Matsumoto & van de
Vijver’s (2011) description of “multicultural psychology” in part
addresses the need to understand the impact culture may have
on all behavior, including psychological disorders.

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 21
 2. Additionally, people’s different ages, cultural/ethnic
backgrounds, and sexual orientation can relate to issues of
mental health.

3. Factors such as culture and gender can have an impact on the

way individuals experience problems. For example, a person’s
particular culture can influence how that person exhibits the
problems they do. Examples of this may be the increase in
numbers of people exhibiting dissociative identity disorders,
eating disorders, or attention-deficit hyperactivity disorders in
the United States (e.g. Hacking, 1999; Toro, et. al., 2005) or
the existence of even more culture-specific disorders such as
susto. Susto is an anxiety disorder found among people in
Central and South America that is supposedly caused by
having contact with supernatural beings or being the victim of
black magic (Tan, 1980). It is important to remember that
culture and gender are not specific single causes of
psychological problems, but they can play a role in the
development, experience, and expression of psychological
disorders (American Psychiatric Association, 2013).

4. Social relationships and support have been shown to be

protective factors against the development of psychological
disorders (Cobb, 1976) and in the treatment of psychological
disorders (Bryant, 2010).

22 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 LESSON 4
Psychological Disorders
i. Anxiety disorders
An underlying issue with all anxiety disorders is a normal fear response
gone awry. Anxiety disorders are classified when the fear response
triggered is out of proportion to the reality of the danger of a situation.
Typically, individuals who experience this anxiety understand their fear is
irrational but have a difficult time controlling this response. This irrational
fear often leads to avoidance of situations or objects that interrupts a
person’s life in a significant way.

A. Examples of anxiety disorders

1. Specific phobia is an irrational fear of some specific object or

situation.

2. Agoraphobia is literally “fear of the marketplace”; this is a

person’s fear of being out in some situation away from safety and
being unable to escape should they experience overwhelming
panic or in some other way become suddenly incapacitated.

3. Social anxiety is fear of being humiliated in front of others in one

or more social situations.

4. Panic disorder is the experience of a sudden severe fear

response in the absence of any sort of realistic threat. These
“panic attacks” occur suddenly, are of brief duration, can be
incapacitating, and lead to worry about experiencing more of
them.

5. Generalized anxiety disorder is being worried and fearful of

many different things, including health, finances, weather, family,
etc. The worry is persistent and interferes significantly with the
person’s life.

B. Causes of anxiety disorders

1. Psychological: Classically conditioned fear responses and

negatively reinforced avoidance (or other fear reducing)
behaviors; irrational thinking, low self-efficacy, irrational
appraisals, fear of negative evaluation, anxious apprehension;
unresolved unconscious conflicts or traumas; incongruence,
inauthenticity

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 23
 2. Biological: Gamma-aminobutyric acid (GABA) inactivity;
dysfunctional amygdala-hypothalamus-central grey matter-locus
ceruleus circuit (Comer, 2014) ii. Obsessive–compulsive
and related disorders
A. Examples of obsessive–compulsive and related disorders 1.
Obsessive-compulsive disorder: The key aspects of this
disorder are repetitive thoughts; images or impulses that are
unwelcome, produce anxiety, and are difficult to control
(obsessions); and repetitive and often meaningless behaviors that
are also difficult to control and that reduce anxiety associated with
the obsessions (compulsions).

2. Hoarding disorder: A person with this disorder has

persistent difficulty discarding possessions, regardless of their
actual value, that leads to an accumulation of items that
interfere with functioning.

3. Body dysmorphic disorder: This is a person’s

preoccupation with a perceived defect or flaw in physical
appearance that seems insignificant to others. The person
responds to this preoccupation by performing repetitive
behaviors (such as checking, grooming, or comparing
themselves to others).

B. Causes of obsessive–compulsive and related disorders

1. Psychological: Negative reinforcement of compulsive

behaviors (for example, washing hands repeatedly is
negatively reinforcing since it removes the anxiety of thinking
about germs); ego-defense mechanisms of isolation, undoing,
and reaction formation; irrational and negative thinking
regarding undesired thoughts

2. Biological: Overactive orbitofrontal cortex-caudate nuclei-

thalamic circuit

Serotonin, glutamate, and dopamine appear to be the

neurotransmitters most correlated with these disorders. iii.
Depressive disorders
A. Examples of depressive disorders1. Major depressive disorder (MDD):
Sad mood, loss of pleasure in activities, feelings of worthlessness,

24 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 sleeping difficulties, lack of motivation lasting at least 2 weeks (This
disorder

tends to be recurrent. Rather than being separate diagnostic

entities, aspects of this disorder such as “with peripartum onset”
and “with seasonal pattern” are now used as specifiers in the
coding of major depressive disorder. )

2. Persistent depressive disorder (PDD, formerly

dysthymia): Chronic depressive symptoms that have
been experienced for at least 2 years (Because criteria
for MDD are not contained in PDD, it is possible for
someone to be classified as exhibiting both disorders.)

3. Premenstrual dysphoric disorder: Significant mood

swings or depressive symptoms that occur in the week
prior to the
onset of menses and are greatly reduced or absent in the week
postmenses

B. Causes of depressive disorders

1. Psychological: Negative schemas for self, ongoing experience,

and future (cognitive triad); lack of reinforcement; regression and
introjection after actual or symbolic loss of loved one; loss of
meaning; incongruence

2. Biological: Some sort of dysfunction of a neurological circuit that

includes the prefrontal cortex, hippocampus, amygdala, and
Brodmann Area 25 (This circuit is rich in serotonin. Abnormal
serotonin gene has been targeted as a potential predisposing
factor.) iV. Bipolar and related disorders

A. Examples of bipolar disorders1. Bipolar disorder: For a person to

be classified as exhibiting this disorder, the person must have
exhibited a manic episode. A manic episode is characterized by
persistently elevated, expansive, or irritable mood and includes
such problems as inflated self-esteem, decreased need for sleep,
flight of ideas, and distractibility that lasts for at least 1 week. 2.
Manic episodes may include hallucinations and delusions.
Depressive episodes may or may not be present.

B. Causes of bipolar disorder

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 25
 1. Psychological: Manic-defense hypothesis—underlying
processes similar to depression, but person denies and
defends against them by acting in a manic way, perhaps due
to need for approval by others

2. Biological: May be related somewhat to norepinephrine,

serotonin, or GABA; abnormal ion activity within neurons;
abnormal basal ganglia and cerebellum (Genes seem to play
some role in creating vulnerability to these problems.)

V. Schizophrenia spectrum and other psychotic disorders

A. Examples of schizophrenia spectrum and other psychotic disorders 1.
Schizophrenia: Schizophrenia consists of several problems associated
with several psychological processes including delusions, hallucinations,
disorganized speech, grossly disorganized behavior, and negative
symptoms. These problems must persist for at least 6 months and be a
significant negative change in the person’s functioning.

2. Delusional disorder: The presence of one or more delusions

(false beliefs a person holds in spite of evidence to the
contrary and in spite of what others believe) (These delusions
may be described in many ways, including erotomanic,
grandiose, jealous, persecutory, or somatic. )

B. Causes of schizophrenia spectrum and other psychotic disorders

1. Psychological: External-personal attributions for negative

events, operant conditioning of peculiar behaviors, attempting
to make sense out of peculiar perceptual experiences, family
stress and dysfunction

2. Biological: Biochemical abnormalities (dopamine and perhaps

serotonin); abnormalities in frontal and temporal lobes and in
brain structures such as the hippocampus, amygdala, and
thalamus

GO TO ACTIVITY 4
An Assignment With Vignettes

26 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 LESSON 5
Psychological Disorders, Continued
i. Personality disorders
Personality disorders involve life-long patterns of maladaptive cognitions,
thoughts, and behaviors that are both consistent (similar across situations)
and stable (similar over time). These maladaptive patterns of behavior
begin in childhood or early adolescence.

A. Examples of personality disorders1. Antisocial personality disorder

(includes problems also known as psychopathy and sociopathy): A
pattern of disregarding and violating the rights of others that includes such
problems as deceitfulness, impulsivity, aggressive behavior,
recklessness, lack of conscience, irresponsibility, viewing others as prey

2. Borderline personality disorder: Instability with regard to identity,

mood, relationships and includes problems such as
impulsivity, feelings of emptiness, suicidal ideation, self-injurious
behaviors

B. Causes of personality disorders

1. Psychological: Mistreatment in childhood and failure to establish

positive loving relationships with parents, childhood trauma, lack of
empathy, operant and classical conditioning, failure to learn from
punishment, modeling, irrational beliefs, nonadaptive attributions

2. Biological: Genetic predispositions for maladaptive personality

traits, slow autonomic arousal, abnormal frontal lobe activity ii.
Trauma and stressor-related disorders
A. Examples of trauma and stressor-related disorders 1.
Posttraumatic stress disorder: A maladaptive reaction to actual
or threatened death, serious injury, or sexual violence
characterized by problems such as recurrent intrusive memories of
the event, flashbacks, fear of stimuli associated with the event,
negative changes in mood and ability to concentrate, irritability,
and feelings of detachment

2. Adjustment disorder: A person’s development of emotional

or behavioral problems within 3 months after experiencing a
stressful event

B. Causes of trauma and stress-related disorders

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 27
 1. Psychological: Negative appraisals, fatalistic beliefs,
apprehension, early childhood traumas, lack of social support,
poor coping skills, low efficacy, limited self-capacities

2. Biological: Abnormal activity of cortisol and norepinephrine;

abnormal activity in a circuit involving the hypothalamus and
amygdala iii. Dissociative and somatic symptom
disorders
A. Examples of dissociative and somatic symptom disorders

1. Dissociative identity disorder (formerly multiple

personality disorder): Presence of two or more distinct
personality states, each present at different times and having
their own cognitions, affect, and behavior

2. Somatic symptom disorder: Experiencing of somatic

symptoms that are distressing and/or result in disruption of a
person’s life

3. illness anxiety disorder: Preoccupation with having or

acquiring a specific illness, without experiencing somatic
symptoms

4. Conversion disorder: Physical symptoms resulting in the

loss of functioning not due to physical causes

5. Factitious disorder (formerly Munchausen’s syndrome):

Production of physical problems for the purpose of receiving
medical attention

B. Causes of dissociative and somatic symptom disorders

1. Psychological: Keeping internal conflicts out of awareness

(primary gain) and removing self from aversive
events/activities (secondary gain), suggestion, self-hypnosis,
repression of traumatic events, state-dependent learning

2. Biological: Some unspecified neurological predisposition

iV. Feeding and eating disorders

A. Examples of feeding and eating disorders1. Anorexia nervosa: Refusal
to maintain minimally normal body weight accompanied by an irrational
fear of becoming obese

28 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 2. Bulimia nervosa: Binge eating accompanied by
compensatory behavior that is either purging or nonpurging in
nature 3. Binge-eating disorder: Binge eating without
compensatory behavior

B. Causes of feeding and eating disorders

1. Psychological: Ego-deficiencies, perceptual disturbances, irrational

beliefs, cognitive distortions

2. Biological: Dysfunctional hypothalamus

3. Sociological: Unreasonable societal standards, family environment,

and communication

V. Neurodevelopmental disorders
These are disorders that develop early in the lifespan and are most often
classified early in childhood.

A. Examples of neurodevelopmental disorders

1. intellectual disability (formerly mental retardation): Intellectual

and adaptive functioning deficits

2. Autism spectrum disorder (this disorder now includes what

was formerly Asperger’s disorder): Significant problems with
social communication and social interaction across many different
social situations; small numbers of interests and activities

3. Attention-deficit/hyperactivity disorder: Significant and

consistent pattern of inattention and impulsive behavior. This may
be primarily an inattention problem, a hyperactivity/impulsivity
problem, or a combination of both.

B. Causes of neurodevelopmental disorders

1. Psychological: Operant and classical conditioning, modeling, failure

of self-regulatory systems, high levels of stress, family dysfunction,
failure to develop a theory of mind

2. Biological: Neurotransmitter dysfunction (dopamine) in ADHD;

genetic predispositions; abnormal frontal-striatal areas of the brain;
prenatal difficulties; abnormalities in the brain such as in the limbic
system, cerebellum, brain stem nuclei, frontal and temporal lobes

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 29
 Vi. Substance-related and addictive disorders
Substance-related disorders involve the persistent maladaptive use of (a)
specific substance(s). All disorders are substance-specific.

A. Examples of substance related and addictive disorders 1. Alcohol

use disorder: Problematic use of alcohol indicated by behaviors
such as craving, social problems, interference with work/school
responsibilities, inability to stop using, physical problems

2. Gambling disorder: Problematic gambling behavior that leads

to significant disruption of the person’s life

B. Causes of substance-related and addictiv e disorders

1. Psychological: Operant and classical conditioning, modeling,

stress, trauma, low efficacy, lack of coping skills, impulsivity

2. Biological: Genetic predisposition, abnormal GABA

receptors, reward-deficiency syndrome

3. Sociocultur al: Poverty, unemployment; dysfunctional families;

societal value placed on substance use; availability

GO TO ACTIVITY 5.1
Connecting Media and Psychology

GO TO ACTIVITY 5.2
Interesting Psychology Information

ACTIVITY 1
What is Abnormal Behavior?

30 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 ACTIVITIES

From original TOPSS unit lesson plan Procedure

This activity can be used to introduce the idea of abnormal psychology.
BACK
TO
Ask students to individually write down three criteria they believe could CONTEN
T
be used to define abnormal behavior. Tell them they will be using their OUTLINE
criteria to determine the relative mental health of the student described
in the case study (below) you are going to give them. Provide them time
to think critically about the case. Suggest the students use the prompt
“Behavior might be considered psychologically disordered if it is ...”
Discussion
First, ask students to contribute ideas about psychologically disordered
behavior. Write their ideas on the board or overhead with the goal of trying
to develop some sort of class consensus. Your goal is to illustrate how
difficult it is for us to agree on a workable definition of psychologically
disordered. As you cluster contributions from students, try to establish the
general definition as follows.
Most accepted definitions of abnormality include the ideas of deviance,
distress, dysfunction, and dangerousness (Comer, 2014).

Ask students if all these criteria should be involved to determine whether a

behavior is psychologically disordered.

Second, distribute the case study (see below). Ask students to read it
silently, then discuss with a partner whether or not Anne should be
thought of as psychologically disordered. Opinions will differ. Ask several
pairs to share their conclusions with the class and to support their position.
ACTIVITIES

Point out that behaving differently does not necessarily indicate poor
mental health; we also need more information about Anne to make an
informed decision. Students should come to understand the difficulties of
determining abnormal behavior.

Finally, point out that the Diagnostic and Statistical Manual of Mental
Disorders of the American Psychiatric Association, along with the

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 31
 International Classification of Diseases, is an attempt to carefully
categorize and describe mental disorders. DSM-5 is used by
psychologists and psychiatrists to do professionally what the students
have attempted to do in this activity.

A Case Study
Anne is a 16-year-old girl living in a medium-sized city in the Midwest. Her
family includes a mother, father, 14-year-old brother, and a great-aunt,
who has lived with the family since Anne was 4. Anne is a junior at City
High School and is taking a college-preparatory program. Her appearance
is strikingly different from the appearance of the other girls in her class.
She wears blouses which she has made out of various scraps of material.
The blouses are accompanied by the same pair of overalls every day, two
mismatched shoes, and a hat with a blue feather. She is a talented artist,
producing sketches of her fellow classmates that are remarkably accurate.
She draws constantly, even when told that to do so will lower her grade in
classes where she is expected to take lecture notes.

She has no friends at school, but seems undisturbed by the fact that she
eats lunch by herself and walks alone around the campus. Her grades
are erratic; if she likes a class she often receives an A or B, but will do no
work at all in those she dislikes. Anne can occasionally be heard talking
to herself; she is interested in poetry and says she is “composing” if
asked about her poetry. She refuses to watch television, calling it a
“wasteland.” This belief is carried into the classroom, where she refuses
to watch videotapes, saying they are poor excuses for teaching. Her
parents say they don’t understand her; she isn’t like anyone in their
family. She and her brother have very little in common. He is
embarrassed by Anne’s behavior and doesn’t understand her either.
Anne seems blithely unaware of her apparent isolation, except for
occasional outbursts about the meaninglessness of most people’s
activities.

32 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 ACTIVITY 2.1
Psychological Disorders and
Perspectives in Psychology

Developed by

Scott Reed, MEd

Hamilton High School, Chandler, AZ

Review the diagnostic criteria of a particular disorder in the DSM. Select

one of the criteria and relate the behavior to the different perspectives in
psychology. Consider the course of the disorder including the onset,
maintenance, and/or treatment.

Some possible disorders to consider: depression, alcohol use disorder,

phobias, generalized anxiety, schizophrenia, obsessive–compulsive
disorder, eating disorders, bipolar disorder, posttraumatic stress, or
another of your choice.

Try to relate to these perspectives:

Biomedical
•
Psychodyna
BACK TO • mic
CONTENT
OUTLINE • Cognitive

• Behavioral

• Humanistic

• Sociocultural

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 33
 ACTIVITY 2.2
On Being Sane in insane Places

Developed by

Nancy Diehl, PhD

Hong Kong International School, Tai Tam, Hong Kong

The purpose of this activity is to further understand issues related to defining

psychological disorders in context, considering aspects of labeling and
treatment, using Rosenhan’s classic study as a backdrop. This also
addresses contemporary issues of making a referral. Students should work
in small groups of five to seven.

Part 1
Students read the original or a summary of Rosenhan’s classic experiment
(Rosenhan, 1973) “On Being Sane in Insane Places.”

Part 2 Hold a class discussion. Topics may include:

BACK TO

• Research design including selection of participants CONTENT

OUTLINE

• Typical behavior of psychiatric patients

• Confirmation bias

• The long-term impact of labeling

• Historical context (This may affect categories and labeling in early to mid-1970s
America. Of note, the publication date of Rosenhan’s work is the same year
homosexuality was removed from the DSM.)

Part 3
Students discuss the related issue regarding how to refer someone with
disordered behavior to seek evaluation and/or treatment. Using acronym
REFER (Van Raalte & Brewer, 2005), discuss each step:

34 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 R—Recognize a referral is needed.

E—Explain the referral process.

F—Focus on feelings.

E—Exit if emotions are too intense.

R—Repeat and follow up as needed.

Discuss effectiveness of a referral attempt as framed above.

References
Rosenhan, D. L. (1973). On being sane in insane places. Science, 179, 250-258.

Van Raalte, J. L., & Brewer, B. W. (2005). Balancing college, food, and life [CD-ROM].
Wilbraham, MA: Virtual Brands. (Available from Virtual Brands, 10 Echo Hill Rd.,
Wilbraham, MA 01095 or http://www.vbvideo.com.)

ACTIVITY 4
An Assignment With Vignettes

Developed by

Scott Reed, MEd

Hamilton High School, Chandler, AZ

Write a vignette, a short story, about a person who has been diagnosed
with one of the disorders from the lesson. Include the onset of the disorder,
how it is affecting the person’s life, and how the person is coping with the
disorder.

The students can share the vignettes with class members and see if they
can identify some of the relevant characteristics of the disorder. Disorders
may include: agoraphobia, generalized anxiety disorder, obsessive–
compulsive disorder, major depressive disorder, bipolar disorder,
schizophrenia, antisocial personality disorder, borderline personality
disorder, posttraumatic stress disorder, dissociative identity disorder,

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 35
 factitious disorder, anorexia nervosa, bulimia nervosa, autism spectrum
disorder, attention-deficit/hyperactivity disorder.

Teachers may want to assign the disorders to ensure more of them are covered.

BACK TO
CONTENT

Sources OUTLINE

American Psychological Association

http://www.apa.org

National Institute of Mental Health

http://www.nimh.nih.gov

National Alliance on Mental Illness

http://www.nami.org

ACTIVITY 5.1
Connecting Media and Psychology

Developed by

Judy Van Raalte, PhD

Springfield College

The purpose of this assignment is to help students to find connections

between what they experience in their lives and the field of psychology.
Outcomes may be a class presentation (typically fewer than 5 minutes per
presentation is most effective) or a paper. This may also be an out-of-
class assignment.

Student instructions

(a) Select a newspaper or magazine article, song lyrics, drawrings, or YouTube

video that is meaningful or interesting to you relating, in some meaningful

36 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 way, to a psychological disorder. The article, song, drawing, or video you
select is your “media source.”

(b) Re-read or review your media source and type a paper

BACK TO or create a presentation in which you first describe
CONTENT
your media source. What is your media source about?
OUTLINE
What is interesting or meaningful about it? Why did you
choose this particular media source? Feel free to quote
the essential characteristics with proper citations.
(c) Explain the connection between the media source and relevant terms
covered in the textbook. Be as detailed as possible. You cannot do this from
memory. You must be specific about your media source and the text terms.
Use psychology terms (and underline them) and include their definitions.
Where possible, consider the perspective taken in the article, song, drawing,
or video (e.g., biomedical, psychodynamic, cognitive, behavioral, humanistic,
sociocultural).

(d) Submit your media source (or the web address of your source or movie or
song lyrics) with the paper or on the presentation day.

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 37
 ACTIVITY 5.2
interesting Psychology information

Developed by

Judy Van Raalte, PhD

Springfield College

The purpose of this assignment is to familiarize students with the

American Psychological Association, which has a website that provides
scientifically based, interesting, and important info related to psychology,
including psychological disorders. Students will be directed to the Monitor
on Psychology magazine to select an article.

Student instructions
Go to this website for the Monitor on Psychology monthly magazine
published by APA: http://www.apa.org/monitor/.

(a) Select an article to read focused on issues related to

psychological disorders in general or specifically or
issues that relate to the diagnosis, care, treatment of
people with psychological disorders, family or caregiver
BACK TO concerns, or more generally regarding the
CONTENT
Diagnostic and Statistical Manual of Mental
OUTLINE
Disorders (it can be from a previous issue—see
link at the side of the webpage).
(b) Read your article and type a paper in which you first
summarize the article.

(c) What is the most important idea in the article? Explain

your answer. Be as detailed as you can be.

(d) Explain the connection you see between the most

important idea in the article and concepts in the textbook.
Be as detailed as possible. Use psychology terms (and
underline them) and include their definitions. If a topic
has not yet been covered in class, look it up and read the
relevant section(s). Do not limit your connections to the
chapter on psychological disorders, but make

38 PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

 connections with previous sections on topics such as
research design, stress, biology of the mind, nature–
nurture, etc.

(e) Submit a hard copy of your article along with your

paper.

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 39
 CRITICAL THINKING AND
DISCUSSION QUESTIONS
CRiTiCAL THiNKiNG ON PSYCHOLOGiCAL
DiSORDERS

Critical Thinking Exercise for Lesson 1

As explained in the unit, defining the term mental disorder is complex.

Comer (2014) suggested most accepted definitions include the ideas of
deviance, distress, dysfunction, and dangerousness. Demonstrate your
understanding by giving one example of a behavior that reflects each “D.”

CRITICAL THINKING AND DISCUSSION QUESTIONS

How might historical context and culture affect these decisions?

Critical Thinking Exercise for Lesson 2

Consider the perspectives in psychology: psychodynamic, cognitive,
behavioral, humanistic, sociocultural, and biological. Given what you’ve
learned thus far, does any one or more perspective(s) resonate with you?
Which? Why?

What steps can high school students take to lessen the stigma often
associated with psychological disorders? What steps can be taken by
various community leaders?

Critical Thinking Exercise for Lesson 3

Personality disorders have been a controversial aspect of the DSM.

DSM5 described three clusters, with specific disorders falling under each
of three categories: anxiety related, eccentric, and dramatic/impulsive. In
the development of DSM-5, there was much debate about changing these
categories, but ultimately they remained the same. What are some of the
challenges categorizing these disorders? What changes do you foresee
for next DSM edition?

BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 41
Critical Thinking Exercise for Lesson 4
Apply the learning perspective using concepts in
classical conditioning and operant conditioning
(e.g., unconditioned stimulus, reinforcement,
punishment) to describe how a teenager may have
developed a school phobia. Consider how the
reasons for the initial driving force of the behavior
may be different from the reasons for maintaining
the behavior.

Critical Thinking Exercise for Lesson 5

When exposed to trauma, most people do not
develop posttraumatic stress disorder (PTSD).
Discuss factors that might influence who develops
PTSD and who does not.

DiSCUSSiON QUESTiONS

Discussion Questions for Lesson 1

Changes in the treatment of people with abnormal
behavior have coincided with social change and
medical understanding. What changes do you
think might happen in the next 10–20 years? How
might technological advances inform or shift
current understanding of abnormality?

There is a much smaller percentage of the

population in mental institutions in America since
the philosophy of deinstitutionalization started in
the 1970s. Why do you think so many fewer
people are now institutionalized? What were some
of the problems associated with the release of so
many patients? What are some ways those are
being dealt with now?
 44PSYCHOLOGICAL DISORDERS BACK TO CONTENTS

Discussion Questions for Lesson 2

The biopsychosocial model suggests the interaction of many different
kinds of factors leads to the development of mental disorders. Describe
evidence that emphasizes environmental causes for mental disorders.
Describe evidence for biological causes of mental disorders. How might
these interact?

What might parents of a child with abnormal behavior consider as short-

term or long-term effects of labeling? What might parents consider as
benefits?

From each of the different perspectives, how do early experiences

(e.g., significant levels of stress) contribute to likelihood of developing
a disorder?

Discussion Question for Lesson 3

What are the pros and cons of classifying abnormal behaviors with a
system such as DSM or ICD?

Discussion Questions for Lesson 4

In what ways does major depressive disorder differ from “the blues”?

Compare and contrast the biological and behavioral views of anxiety

disorders and discuss how differences between the two views might
be reconciled.

Discussion Questions for Lesson 5

People unfamiliar with the study of abnormal behavior sometimes
confuse “multiple personality” with schizophrenia. How would you
explain the differences?

In what ways do personality disorders differ from other psychological

disorders? In what ways are they similar?
46

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Bryant, R. A. (2010). Treating the full range of posttraumatic reactions. In G. M. Rosen

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Centers for Disease Control and Prevention. (2014). National suicide statistics at a
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BACK TO CONTENTS A UNIT LESSON PLAN FOR HIGH SCHOOL PSYCHOLOGY TEACHERS 47
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A SSO CIATIO N

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