INTRODUCTION TO

PSYCHOLOGY

Chapter 16
Psychopathology
At the end of this Chapter you
should be able to:

 Learn about Psychodynamic approach

 Learn different conceptions of Mental Disorder
 Difference between psychosis and neurosis
 Psychodynamic approach
 Defense Mechanisms
 Learn about Schizophrenia
 Learn about Mood Disorders
 Learn about Anxiety Disorders
 Learn about Dissociative Disorders
History of Mental Illnesses
The psychodynamic approach:
Probing the depths

 Examines motives underlying our behavior

– Motives can be conscious
But…
– Motives may also be poorly understood
– May be completely hidden from our own
view/comprehension
Models of mind

 Levels of processing:
– Conscious: currently being thought about
– Preconscious: easily available to us
– Unconscious: unavailable to our (willed)
thought
 Structures of personality:
– Id
– Ego
– Super-ego
Structures of Personality

Id: all other aspects of personality

emerge from this basic, primitive,
pleasure seeking part of our personality
Ego: deals with reality and its demands;
copes with demands from Id and …
Superego: society’s rules and parents’
rules, internalized and imposed on the
ego
Conflict and defense

 Interplay of the three structures and the

three levels of processing: the
dynamics of this theory
 Avoiding anxiety is prime directive
 Defense mechanisms are in place to
protect the personality from anxiety that
may feel overwhelming
Defense mechanisms

 Defense mechanisms work in two ways:

 helps to maintain our self respect

 Helps to overcome big traumas with less
damage
Defense mechanisms

Repression: Keeping distressing thoughts &

feelings buried in the unconscious
Example: A child who witnessed a parent
being shot has no recollection of the event.
Denial: Refusing to recognize some anxiety
arousing event/piece of information.
Example: although her husband keeps
beating her, his wife doesn’t accept it.
3.
Defense mechanisms, cont’d..

Rationalization: Creating false but plausible

excuses to justify unacceptable behavior
Example: A student watches TV instead of
studying, claiming "additional studying won’t help
anyway".

Displacement: Diverting emotional feelings from

their original course to a safer substitute target.
Example: After getting a speeding ticket you take
your anger out on your passenger rather than
the state trooper.
Defense mechanisms, cont’d..

Reaction Formation: Behaving in a way that

is exactly opposite of one’s true feelings
Example: A parent who unconsciously resents
a child spoiling that child with lavish gifts.

Projection: Attributing one’s own thoughts,

feelings or desires to someone else
Example: Deep down you hate your brother
(but are unaware of this) - instead you feel
your brother hates you.
Defense mechanisms, cont’d..

Regression: Reverting to immature

patterns of behavior.
Example: A six year old renews his
thumb-sucking when a new sibling is
born.
MENTAL ILLNESSES
PSYCOPATHOLOGY
“Normal” versus “Abnormal”

 Concept of “abnormal” not sufficient or necessary

to be mentally disordered
- It is not “normal” to be very joyous, but this
mental state, while “not normal,” is not
mentally ill either
On the other hand…
- It is “normal” to have cavities in teeth
occasionally, but doesn’t mean that’s healthy /
preferred
The term “normal” therefore is very problematic
The modern conception
of mental disorder

 What best explains the cause, or source, of

mental disorders?
– Psychological sources
– Biological sources
– Learning sources
… all contribute important explanatory
power
Diathesis-Stress Models

 Two factor model

 An event + a diathesis
– Event occurs which is stressful
– Combines with a genetic, biological, or other
structural/physical factor
– When both occur, depression, for example,
may result
 Helps address why some identical events do
not produce same outcome in different people
Classification

Neurosis

vs

Psychosis
Neurosis

 A term no longer used medically.

Nowadays, “disorder” is used

 Diagnosis for a relatively mild mental or

emotional disorder that may involve
anxiety or phobias but does not involve
losing touch with reality.
Neurosis

 Neurotic disorder can be

– any mental imbalance that causes or results in
distress.
– not interfere with normal day to day functions,
– create very common symptoms of depression,
anxiety, or stress.
 It is believed that most people suffer from some
sort of neurosis as a part of human nature.
Neurosis

 One with a neurosis is aware of his disorder

 Can differentiate between what is real and

what is not
Types of Neurosis

 According to DSM classificationthere are four

types of Neurosis:
 Anxiety Disorders
– Panic attacks
– Phobias
– Obsessive Compulsive
– Generalized Anxiety
– Post Traumatic Stress Disorders
Neurosis

 Somatoform Disorders
– Conversion Disorders
– Hipocondria
 Dissociative Disorders
– Dissociative Amnesia
– Dissociative Identity Disorder
 Stress Disorders
– Post Traumatic Syndrome Disorder
Anxiety Disorders

 “Mood” here is anxiety

 Overwhelming feelings of fear/ anxiety/
apprehension and incomplete or
unsuccessful attempts to deal with this
 Most common clinical diagnosis
 Found in both genders; but, higher
prevalence overall in women compared to
men
Phobias

 Social phobia: fear of public scrutiny or public

judgment, emerges most commonly in adolescence
– Avoid many common social/public experiences
– Common to use/abuse substances to manage
fear

 Specific phobia: irrational fear of some object,

situation, event: bridges, heights, spiders
Panic disorder and agoraphobia

 Panic attacks: sudden onset of full fight/flight

symptoms, including …
– feelings of choking, dizziness,
lightheadedness
– heart pounding, sweating,
– dread, “need” to run or escape
– Panic attacks not uncommon in general
public!
 In panic disorder, one experiences panic attacks
either out of the blue, or unpredictably in
response to certain stressors/events
Panic Disorder, cont.

 Attempts to avoid any further panic

attacks are hallmark of the disorder
– the “fear of fear”
 Over time, increased attention to
symptoms develops; this increases
number of attacks
– “Agoraphobia” then may result
Generalized Anxiety Disorder

 Continuous anxious feeling

 No real trigger; trivial worries can intensify
– Symptoms: constant sense of dread;
gut/intestinal upset; inability to focus;
increased heart rate; excessive sweating;
constant worry
 Common disorder; around 3% of population
Obsessive-Compulsive Disorder

 Obsessions: unwanted, intrusive thoughts (“If I

step on this crack I will cause my mother to die”)
 Compulsions: irresistible urges to engage in
certain behaviors (“I must repeat this phrase 20
times to keep my mother from dying”)
Checking,
Doing, undoing
– Typically, compulsions decrease anxiety only
temporarily
Predispositions for OCD?

 Again, genetic: CR higher for identical

than fraternal twins
– Seperate inheritance paths for
different types of OCD: e.g., cleaning
may be uniquely transmitted, but not
other forms (checking or washing)
Stress disorders

 Occur in response to events that threatened

one’s life directly, or threatened integrity of
one’s life (or someone else’s life)
 Often marked by acute feelings of
distance/estrangement from – “dissociation”
 Alternates with intense “reliving” of the event:
nightmares, flashbacks, intrusive thoughts
Post-traumatic stress disorder

 Diagnosed only after one month has passed

 Other symptoms:
– increased startle reflex,
– inability to focus/concentrate;
– problems with memory and attention;
– intense irritability;
– avoidance of memories of event;
– continued problems with flashbacks and
nightmares
 However… of those who experience trauma, only
about 5 – 12% develop PTSD
Better prognosis if…

 Trauma less severe

 “Preparation” or training was in place (so, police
and firefighters trained to deal with frightening
situations less likely to develop PTSD than
ordinary citizens facing same situation)
 Better social support prior to trauma
 No adverse/traumatic experiences in childhood
 Lack of PTSD in parent’s background
Dissociative Disorders

 Dissociation: distancing of the self from what

is occurring; dissociation between an on-
going event from one’s sense that one is
experiencing it; sense of “watching from a
distance”
– As a defense mechanism: effective in
many ways
– Over the long term: dissociation
associated with poorer outcomes
 This response is the defining feature of
dissociative disorders
Dissociative disorders

 Dissociative amnesia
– Inability to remember discrete period of
one’s life, one’s identity, aspects of one’s
biography
Or
– One wanders away from home for a time,
then suddenly “comes back to one’s
senses” with no memory for that period of
time
Dissociative disorders, cont’d..

 Dissociative identity disorder

– Two or more distinct personalities can be
identified or take action in one’s life
– Can differ by gender, age, SES, interests, etc.
– Controversial diagnosis; given with caution
 Factors underlying Dissociative Disorders:
– Ability to dissociate: trait aspects, some
easily able to dissociate, others unable to
dissociate
– Intense/abusive/traumatic stress as a trigger?
Somatoform Disorders

 Hypochondriasis: Hypochondriasis is
preoccupation with the fear of having, or with
the idea that one has, a serious disease,
based on misinterpretation of nonpathologic
physical symptoms or normal bodily
functions
 Treatment is difficult because patients
believe that something is seriously wrong
and that the physician has failed to find the
real cause.
Psychosis

 As a psychiatric term, psychosis refers

to any mental state that impairs
thought, perception, and judgement.

 A psychotic person loses contact with

reality and experiences hallucinations
or delusions.
Psychosis

 The three primary causes of psychosis are:

– Functional (mental illnesses such as
schizophrenia and bipolar disorder),
– Organic (stemming from medical, non-
psychological conditions, such as brain
tumors or sleep deprivation)
– Psychoactive drugs (eg barbituates,
amphetamines, and hallucinogens).
Schizophrenia

“Abnormal disintegration of mental functions” –

Eugene Bleuler
– Problematic description; term still used
 1-2% of population exhibits this disorder
– Higher (or lower) in many populations;
variations not well understood
 Usual onset: late adolescence/early
adulthood
Signs/Symptoms

 “Positive symptoms” (too much of something)

– Delusions (fixed idea or belief, obviously untrue or
unlikely)
– Hallucinations (seeing or hearing something
others don’t)
– Disorganized speech/behaviors
 Negative symptoms (not enough of something)
– Blunted/limited emotion
– Poverty of speech
– Poverty of language
– Unable to persist in tasks
Other symptoms

 Pronounced social withdrawal

– May begin at a very young age, well
before other symptoms
 Idiosyncratic “inner world” – extremely
difficult for others to access / understand
 Difficulty communicating
… all seem to result in less social contact and
fewer friends as years go by
The roots of schizophrenia

 Heredity/genetics: Examined by looking at

concordance rates,
Ex: Consider 100 families, all of whom have identical
twins; one twin of each pair of twins has
schizophrenia
-- the concordance rate tells us how many of the
“co-twins” have it as well
-- Identical twins CR: up to 50%
-- Fraternal twins CR: about 25%
-- Sibling CR: about 8%
As genetic “overlap” increases,
rates of schizophrenia increase
Prenatal environment

 Why is CR not 100%?

 Environment plays an important role;
environment is not identical even if genetic
material is identical
– Birth complications?
– Viral exposure?
– Time of birth (i.e., season)?
 Many environmental factors point to
schizophrenia being a neurodevelopmental
disorder
Social and Psychological
Environment

 Stressors from much later in life  may

play a role
– Stress from poverty, racism,
poor/absent education
– Parent or parents who also suffer
from mental disorder
Mood Disorders

Bipolar and Unipolar

Each pole: a different mood state
 At “manic” pole: feelings of “ease, intensity, power,
well-being, financial omnipotence and euphoria”
(Kay Redfield Jamison, 1995, p. 67)
 Hypomania: milder form of mania; hard to
sustain
 Mania: unable to function, loss of one’s
ability to maintain rationality, or to complete
goal-directed activity, fear/paranoia set in.
At the other pole…

 Depressive states:
– Guilt, shame, dread
– Hopelessness, loss of interest and
pleasure in life
– Sleeping / eating problems (too little or too
much)
– Thoughts of death, dying, suicide; plans or
attempts or completed suicide
 Alternating between Mania and Depression:
Bipolar Disorder (from one pole to the other)
The roots of mood disorders

 Heredity
– Concordance rates (CR) for Depression:
2x higher in identical twins compared to
fraternal twins
– CR for Bipolar Disorder: Identical twins,
CR = 60%; fraternal twins, CR = 12%
– Risk for other aspects (suicide, other
forms of depression) increases as genetic
overlap increases
Case Study 1

 34 year old, male

 Talks to himself loudly
 Lives in the streets, doesn’t have any relatives
 Does not take care of himself / does not clean
himself, dirty
 Looks, talks and laughs at things that does not exist
 Can not identify reality
 Sees hallucinations
 His interpersonal relations are very weak
Case Study 1

 What is the diagnosis?

– PSYCHOTIC?

– NEUROTIC?
Case Study 1

 Probable diagnosis would be;

 PSYCHOTIC

 SCHIZOPHRENIA
Case Study 2

 27 years old, female, housewife

 Very captious since childhood
 Married 6 years ago, has 2 daughters
 Constantly cleans the house
 Whenever guests leave the house, she
cleans the house for hours
 Life becomes unbearable for her family
 Stays in the bathroom for at least 2 hours,
finishing one block of soap
Case Study 2

 She says “I know what I am doing is ridiculous, but I

can’t help it”
 Her relations with people other than her family, are
very positive
 Admits she has a disorder, goes and asks for help from
a doctor, willingly
 Doesn’t lose contact with reality
 Uses reaction formation and rationalization as defence
mechanisms to avoid from anxiety
Case Study 2

 What is the diagnosis?

– PSYCHOTIC?

– NEUROTIC?
Case Study 2

 Probable diagnosis would be;

 NEUROTIC

 Obsessive Compulsive Disorder