Defining and Classifying Psychological Disorders
Vulnerability-stress model, each of us has some degree of vulnerability
(ranging from very low to very high) for developing a psychological disorder,
given sufficient stress.
- Vulnerability (predisposition) can have a biological basis, such as genotype,
over/under activity of neurotransmitter, hormone. Or due to personality factor,
such as low self-esteem, extreme pessimism. Or due to previous
environmental factors, such as poverty or extreme trauma. Cultural factors
can also create vulnerability to certain kinds of disorders.
- A predisposition creates a disorder only when stressor (some event that
requires person to cope) combines with a vulnerability to trigger the disorder.
First, we’re likely to label behaviors as abnormal if they intensely distressing to
Second, most behaviors judged abnormal are dysfunctional either for the
individual or for society.
Third criterion for abnormality is society’s judgements concerning the deviance
of a given behavior.
We may define abnormal behavior as behavior that is personally distressing,
personally dysfunctional, and/or so culturally deviant (violation of norms) that
other people judge it to be inappropriate or maladaptive.
Reliability means that clinicians using the system should show high levels of
agreement in their diagnostic decisions.
Validity means that the diagnostic categories should accurately capture the
essential features of the various disorders.
DSM allows diagnostic information to be represented along 5 dimensions/axes,
that take both the person and his life situation into account.
1. Axis I, primary diagnosis, represents the person’s primary clinical
symptoms, that is, the deviant behaviors or thought processes that are
occurring at present time.
2. Axis II reflects longstanding personality disorders/mental retardation, both
of which can influence person’s behavior/response to treatment.
3. Axis III notes any medical conditions that might be relevant, such as high
blood pressure or a recent concussion.
4. Axis IV, reflecting the vulnerability-stress model, the clinician also rates
intensity of psychosocial/environmental problems in person’s recent life.
5. Axis V, global assessment of level of functioning.
One trade-off, is that the criteria are so detailed/specific that many people don't fit
neatly into the categories.
Once a diagnostic label is attached to a person, it becomes all too easy to accept
the label as an accurate description of the individual rather than of the behavior.
Diagnostic labels may also play a role in creating or worsening psychological
disorders, self-fulfilling prophecy, in which expectation becomes reality. Two particularly important legal concepts are competency and insanity.
- Competency refers to defendant’s state of mind at the time of a judicial
- Insanity relates to the presumed state of mind of the defendant at the time
when crime was committed.
Anxiety, the state of tension and apprehension that is a natural response to
In anxiety disorders, the frequency and intensity of anxiety responses are out of
proportion to the situations that trigger them, and the anxiety interferes with daily
Anxiety responses have 4 components:
1. Subjective-emotional component, including feelings of tension and
2. Cognitive component, including worrisome thoughts and a sense of inability
3. Physiological responses, including increased heart rate/blood pressure.
Muscle tension, etc.
4. Behavioral responses, such as avoidance or certain situations and impaired
Phobias are strong and irrational fears of certain objects or situations.
People with phobias realize their fears are out of proportion to the danger
involved, but they feel helpless to deal with these fears.
Agoraphobia, excessive fear of situations in which the person might be
evaluated and possibly embarrassed.
Specific phobias, such as a fear of dogs, snakes, spiders, elevators. etc.
Once phobias develop, they seldom go away on their own, and they may
broaden/intensify over time.
The degree of impairment produced by a phobia depends in part on how often
the phobic stimulus is encountered in the individual’s normal activities.
Generalized Anxiety Disorder
Generalized anxiety disorder is a chronic (ongoing) state of diffuse, or free-
floating, anxiety that is not attached to specific situations or objects.
May last for months, with signs almost continually present. Panic Disorder
In contrast to generalized anxiety disorder, which involved chronic (ongoing)
tension and anxiety.
Panic disorders occur suddenly and unpredictably, and they are much more
Many people who suffer recurrent panic attacks develop agoraphobia.
Formal diagnosis of a panic disorder requires recurrent attacks that do not seem
tied to environmental stimuli, followed by psychological or behavioral problems.
Such disorders usually consist of two components, one cognitive, the other
behavioral, although either can occur alone.
Obsessions are repetitive and unwelcome thoughts, images, or impulses that
invade consciousness, are often abhorrent to the person, and are very difficult
to dismiss or control.
Compulsions are repetitive behavioral responses that can be resisted only
with great difficulty.
Compulsions are often responses that function to reduce the anxiety associated
with the intrusive thoughts
Like phobic avoidance responses, compulsions are strengthened through
negative reinforcement because they allow the person to avoid anxiety.
Posttraumatic Stress Disorder
PTSD is a severe anxiety disorder that can occur in people who have been
exposed to traumatic life events.
4 major symptoms commonly occur in this anxiety disorder
1. The person experiences severe symptoms of anxiety, arousal, and distress
that were not present before the trauma.
2. The victim relives the trauma recurrently in flashbacks, dreams, fantasy.
3. The person becomes numb to the word and avoids stimuli that serve as
reminders of the trauma
4. The individual experiences intense survivor guilt in instances where others
were killed and individual was somehow spared.
Traumas caused by human actions, such as war, rape, torture, are 5-10 times
more likely to precipitate PTSD than are natural disasters. Women exhibit twice
the rate of PTSD.
Causal Factors in Anxiety Disorders
Genetic factors may create a vulnerability to anxiety disorders.
David Barlow, suggests that genetically caused vulnerability may take the form of
an autonomic nervous system that overreacts to perceived threat, creating high
levels of physiological arousal. GABA, inhibitory transmitter that reduces neural activity in amygdala, and other
brain structures that trigger emotional arousal. Individual with low concentration
of GABA in these areas may be more susceptible to anxiety disorder.
According to Freud, neurotic anxiety occurs when unacceptable impulses
threaten to overwhelm the ego’s defenses and explode into consciousness or
How the ego’s defense mechanisms deal with neurotic anxiety determines the
form of anxiety disorder.
- Freud believed that in phobic disorders, neurotic anxiety is displaced onto
some external stimulus that has symbolic significance in relation to the
- Generalized anxiety and panic attacks are thought to occur when one’s
defenses are not strong enough to control or contain neurotic anxiety but are
strong enough to hide the underlying conflict.
Cognitive theorists stress the role of maladaptive though patterns and beliefs in
anxiety disorders. People with anxiety disorders catastrophize about demands
and magnify them into threats.
Panic attacks can be triggered by exaggerated misinterpretations of normal
anxiety symptoms such as heart palpitations, dizzinesss, and breathlessness.
Culture-bound disorders that occur only in certain locales
Somatoform disorders involve physical complaints or disabilities that suggest a
medical problem but that have no known biological causes and are not produced
voluntarily by the person
In hypochondriasis, people become unduly alarmed about any physical
symptom they detect and are convinced that they have or are about to have a
People with pain disorder experience intense pain that either is out of proportion
to whatever medical condition they might have or for which no physical basis can
Somatoform disorders differ from psychophysiological disorders, in which
psychological factors cause or contribute to a r