CHAPTER 17 The Nature and Causes of Mental Disorders
CLASSIFICATION AND DIAGNOSIS OF MENTAL DISORDERS
To understand, diagnose, and treat psychological disorders, some sort of classification system is needed.
The need for a comprehensive classification system of psychological disorders was first recognized by
What is “Abnormal”?
The term “abnormal” literally refers to any departure from the norm (e.g. a really tall or really
short people, or really smart people like me are considered abnormal). However, the distinction
between normal and abnormal behaviour can be very subjective. Psychologists stress that the
most important feature of mental disorder is not whether behaviour is abnormal but rather if
it’s maladaptive. Mental disorders cause distress or discomfort and interfere with people’s
ability to lead satisfying, productive lives.
Although the diagnosis of mental disorders should be as objective as possible, it may never be
completely free from social and political judgments (i.e. what is thought of as retarded in one
culture may be sacred in another). It is important to note that mental disorders bring pain and
discomfort to these people and to their friends and families.
Perspectives on the Causes of Mental Disorders
There isn’t a single cause of mental disorders but in general, they are cause by the interaction of
hereditary, cognitive and environmental factors. Sometimes, genetics can play a strong role and
the person carrying those genes is likely to develop a mental disorder. To understand mental
disorders, a complete study must be taken deriving all possible factors. There are many
psychology related profession who try to understand mental disorders and each vary their
emphasis on the three given factors. The perspectives differ primarily in their explanation of the
etiology (origin) of mental disorders.
o The Psychodynamic Perspective
This is based on Freud’s early work: mental disorders originate in the intrapsychic
conflict produced by the three components of the mind—id, ego and superego. For
some people the conflicts become so sever the mind’s defence mechanisms fail and
begin to distort reality or the individual may revert to an earlier stage of life (e.g. begin
acting like a kid). Mental disorders may involve extreme anxiety, obsessive thoughts and
compulsive behaviour, depression, and etc.
o The Medical Perspective
The origins of the medical perspective like in the work of the ancient Greek physician
Hippocrates. The medical model is based on the ideas that mental disorders are caused
by specific abnormalities of the brain and nervous system and that they should be
approached for treatment in the same way as physical illnesses. However, not all mental
disorders can be traced so directly.
o The Cognitive-Behavioural Perspective
The cognitive-behavioural perspective holds that mental disorders are learned
maladaptive behaviour patterns that can be best understood by focusing on
environmental factors and a person’s perception of those factors. A mental disorder is
not something that arises spontaneously within a person but caused by the person’s
interaction with his or her environment. o The Humanistic Perspective
Mental disorders arise when people perceive that they must earn the positive regard of
others. They become overly sensitive to the demands and criticisms of others and come
to define their personal value primarily in terms of others’ reaction to them. They lack
confidence in their abilities and fell as though they have no stable, internal value as
persons. They may come to feel that they have no control over the control over the
outcomes of the important events in their lives. The goal of humanistic therapy is to
persuade people that they do have intrinsic value to help them achieve their own
unique, positive potential as human beings.
o The Sociocultural Perspective
Psychologists are paying more attention to the role of sociocultural factors in their
attempts to understand how people thinking and behave and the development of
disorders is the same. Proper treatment requires an understanding of cultural issues
which influence the nature and extent to which people interpret their own behaviours
as normal or abnormal.
o The Diathesis-Stress Model of Mental Disorders
Elements of the previous perspective are often combined to form a different, more
comprehensive, perspective on mental disorders. The diathesis-stress model says a
casual account of mental disorders based on the idea that mental disorders develop
when a person possesses a predisposition for a disorder and faces stressors that exceed
his or her abilities to cope with them.
The DSM-IV Classification Scheme
A system most commonly used in N. America for classifying mental disorders today is the
Diagnostic and Statistical Manual IV (DSM-IV). Axis I contains information on major
psychological conditions. Axis II is where personality disorders are found. Axis III is used to
describe any physical disorders. Axis IV specifies the severity of stress that a person has
experienced and Axis V is to estimate the extent to which a person’s quality of life has been
diminished by the disorder.
Some Problems with DSM-IV Classification
This system is more consistent with the medical perspective on mental disorders than with
other perspectives. It is not very reliable since mental disorders do not have distinct borders and
can one disorder can be a combination of two other disorders.
The Need for Classification
Since labelling can have negative effects, some people, such as Thomas Szasz, suggested that we
should abandon all attempts to classify and diagnose mental disorders. However, proper
classification has advantages for a patient. One is that the recognition of a specific diagnostic
category precedes the development of successful treatment for the disordered (e.g. diabetes,
syphilis). To accurately treat a patient, we must accurately identify and diagnose the problem.
Prevalence of Mental Disorders
In Canada, substance use disorders, mood disorders and anxiety disorders have found to be the
most common types of mental disorders.
ANXIETY, SOMATOFORM, AND DISSOCIATIVE MENTAL DISORDERS
Often referred to as neuroses, anxiety, somatoform, and dissociative mental disorders are strategies of
perception and behaviour that have gotten out of hand. People who have neuroses experience anxiety,
fear, and depression, and generally are unhappy. However, unlike people who have psychoses, they do
not suffer from delusions or severely disordered thought processes and hey almost universally realize
that they have a problem. Anxiety Disorders
Fear and anxiety are the most prominent symptoms. Anxiety is a sense of apprehension or
doom that is accompanied by certain physiological reactions (e.g. accelerated heart rate, sweaty
palms, and tightness in the stomach.
o Panic Disorder: Description
Panic is a feeling of extreme fear mixed with hopelessness or helplessness. People with
panic disorder suffer from episodic attacks of acute anxiety—periods of acute and
unremitting terror that grip them for lengths of time lasting from a few seconds to a few
hours. Shortness of breath, clammy sweat, and irregularities in heartbeat, dizziness,
faintness, and feelings of unreality are often symptoms of panic attacks. Between panic
attacks, people with panic disorder tend to suffer from anticipatory anxiety—a fear of
having a panic attack. Anxiety is a normal reaction to many stresses of life and none of
us is completely free from it.
o Panic Disorder: Possible Causes
Genetic and Physiological Causes. A considerable amount of evidence implicates
biological influences in the development of panic disorder. It appears to have a
substantial hereditary component. People with panic disorder show
physiological response patterns that seem to be biological controlled (e.g.
Cognitive Causes. The cognitive approach focuses on expectancies. People who
suffer from panic attacks appear to be extremely sensitive to any element of risk
or danger in their environment: these people expect to be threatened by
environmental stressors and downplay or underestimate their abilities to cope
o Phobic Disorders: Description
Phobias are persistent, irrational fears of specific objects or situations. The term
phobic disorder should be reserved for people whose fear makes their lives
difficult. There are three types of phobia: agoraphobia, social phobia, and
specific phobia. Agoraphobia is a mental disorder characterized by fear of and
avoidance of being alone in public places; this disorder is often accompanied by
panic attacks. Social phobia is a mental disorder characterized by an excessive
and irrational fear of situations in which the person is observed by others.
Specific phobia is an excessive and irrational fear of specific things, such as
snake, darkness, or heights.
o Phobic Disorders: Possible Causes
Environmental Causes—Learning. Not all phobias are learned through classical
conditioning. Most do not remember a specific cause for their phobia.
Genetic Causes. Some suggest that a tendency to develop a fear of certain kinds
of stimuli may have a biological basis that reflects the evolution of our species.
The idea is that because of our ancestors’ history in relatively hostile natural
environments, a capacity evolved for especially efficient fear conditioning to
certain classes of dangerous stimuli.
o Obsessive-Compulsive Disorder: Description
People with an obsessive-compulsive disorder—recurrent, unwanted thoughts or ideas
and compelling urges to engage in repetitive ritual-like behaviour—suffer from
obsessions—thoughts will not leave them—and compulsions—behaviours that repeat
some action over and over even though it serves no useful purpose. Unlike people with
panic disorder, people with obsessive-compulsive disorder have a defence against anxiety—their compulsive behaviour. Obsessions are seen in many mental disorders,
including schizophrenia. However, unlike those with schizophrenia, people with OCD
generally recognize that their thoughts and behaviours are senseless and wish that they
would go away. Most compulsions fall into four categories: counting, checking, cleaning
o Obsessive-Compulsive Disorder: Possible Causes
Cognitive Causes. These people believe they should be competent at all times,
avoid any kinds of criticism at all costs, and worry about being punished by
others for behaviour that is less than perfect.
Genetic Causes. Evidence is beginning to accumulate suggesting that obsessive-
compulsive disorder may have a genetic origin. One example is Tourette’s
syndrome which entails muscular and vocal tics, including mak