Chapter 15 - Psychological Disorders

Section 1 - Normal Versus Abnormal: Making the Distinction

MAIN IDEA QUESTIONS

How can we distinguish normal from abnormal behavior?

What are the major perspectives on psychological disorders used by mental health professionals?

What are the major categories of psychological disorders?

VOCABULARY

abnormal behavior - behavior that causes people to experience distress and prevents them from functioning in their daily lives

medical perspective - the perspective that suggests that when an individual displays symptoms of abnormal behavior, the root cause will be found in a physical examination of the individual, which may reveal a hormonal imbalance, a chemical deficiency, or a brain injury

psychoanalytic perspective - the perspective that suggests that abnormal behavior stems from childhood conflicts over opposing wishes regarding sex and aggression

behavioral perspective - the perspective that looks at the behavior itself as the problem

cognitive perspective - the perspective that suggests people's thoughts and beliefs are a central component of abnormal behavior

humanistic perspective - the perspective that emphasizes the responsibility people have for their own behavior, even when such behavior is abnormal

sociocultural perspective - the perspective that assumes that people's behavior - both normal and abnormal - is shaped by the kind of family group, society, and culture in which they live

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) - a system, devised by the American Psychiatric Association, used by most professionals to diagnose and classify abnormal behavior

DEFINING ABNORMALITY

Psychologists have struggled to devise a precise, scientific definition of "abnormal behavior." Consider the following example definitions, all containing advantages and disadvantages;

-Abnormality as deviation from the average. What behaviors are rare or occur infrequently in a specific society or culture?

Problem --- EX: If most people prefer to have corn flakes for breakfast but you prefer raisin bran, this deviation hardly makes your behavior abnormal. Similarly, a person who has an unusually high IQ could be labeled as abnormal.

-Abnormality as a deviation from the ideal. The standard toward which most people are striving - the ideal.

Problem --- Society has few standards for which people universally agree. EX: We would be hard-pressed to find agreement on whether the New Testament, the Koran, the Talmud, or the Book of Mormon provides the most reasonable standards.

-Abnormality as a sense of personal discomfort. The psychological consequences of the behavior on the individual.

Problem --- Even in cases of mental disturbance, people report feeling wonderful even though their behavior seems bizarre to others.

-Abnormality as the inability to function effectively. People who cannot feed themselves, hold a job, get along with others, or live as productive members of society.

Problem --- A homeless woman living in the street would be considered "abnormal," even if she chose to live that way.

-Abnormality as a legal concept. A jury convicts a woman who drowned her five children in a bathtub. The initial verdict reflected the way in which the law defines abnormal behavior.

Problem --- The definition of insanity and its legal use varies from state to state.

Given the difficulty in defining abnormal behavior, psychologists have defined it broadly as behavior that causes people to experience distress and prevents them from functioning in their daily lives.

PERSPECTIVES ON ABNORMALITY: FROM SUPERSTITION TO SCIENCE

Throughout much of human history, people linked abnormal behavior to superstition and witchcraft. People were possessed by the devil or some demonic god. Contemporary approaches have a more enlightened view. Six major perspectives are used to understand psychological disorders.

CLASSIFYING ABNORMAL BEHAVIOR: THE ABCs OF DSM

Crazy. Whacked. Mental. Loony. Insane. Neurotic. Psycho. Strange. Demented. Odd. Possessed. Society has long placed labels on people who display abnormal behavior. Most of the time these labels have reflected intolerance and have been used with little thought as to what each label signifies.

DSM-IV-TR: Determining Diagnostic Distinctions

Most professionals today use this classification system, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to diagnose and classify abnormal behavior.

~It includes five types of information, known as axes, which have to be considered in assessing a patient.

    • Axis I: Clinical Disorders. Disorders that produce distress and impair functioning.

    • Axis II: Personality Disorders and Mental Retardation. Enduring, rigid behavior patterns.

    • Axis III: General Medical Conditions. Physical disorders that may be related to psychological disorders.

    • Axis IV: Psychosocial and Environmental Problems. Problems in a person's life such as stressors or life events that may affect the diagnosis, treatment, and outcome of psychological disorders.

    • Axis V: Global Assessment of Functioning. Overall level of mental, social, occupational, and leisure functioning.

By following the criteria above, diagnosticians can identify the specific problem an individual is experiencing - but not the underlying cause of the individual's behavior and problems.

Conning the Classifiers: The Shortcomings of DSM-IV-TR

Problem #1 - Labeling (Rosenhan study, 1973)

Problem #2 - The test relies too much on the medical perspective (underlying physiological problems)

Problem #3 - Fails to incorporate modern neuroscience which has determined the genetic underpinnings of certain psychological disorders.

Problem #4 - Compartmentalizes people into inflexible, all-or-none categories rather than recognizing the degree of the disorder.

Section 2 - The Major Psychological Disorders

MAIN IDEA QUESTION

What are the major psychological disorders?

VOCABULARY

anxiety disorder - the occurrence of anxiety without an obvious external cause that affects daily functioning

phobias - Intense, irrational fears of specific objects or situations

panic disorder - Anxiety disorder that takes the form of panic attacks lasting from a few seconds to several hours

generalized anxiety disorder - The experience of long-term, persistent anxiety and worry

obsessive-compulsive disorder (OCD) - A disorder characterized by obsessions or compulsions

obsession - A persistent, unwanted thought or idea that keeps recurring

compulsion - An irresistible urge to repeatedly carry out some act that seems strange and unreasonable

somatoform disorders - Psychological difficulties that take on a physical (somatic) form, but for which there is no medical cause

hypochondriasis - A disorder in which people have a constant fear of illness and a preoccupation with their health

conversion disorder - A major somatoform disorder that involves an actual physical disturbance, such as the inability to use a sensory organ or the complete or partial inability to move an arm or leg

dissociative disorders - Psychological dysfunctions characterized by the separation of different facets of a person's personality that are normally integrated

dissociative identity disorder (DID) - A disorder in which a person displays characteristics of two or more distinct personalities

dissociative amnesia - A disorder in which a signifcant, selective memory loss occurs

dissociative fugue - A form of amnesia in which the individual leaves home and sometimes assumes a new identity

mood disorder - A disturbance in emotional experience that is strong enough to intrude on everyday living

major depression - A severe form of depression that interferes with concentration, decision making, and sociability

mania - An extended state of intense, wild elation

bipolar disorder - A disorder in which a person alternates between periods of euphoric feelings of mania and periods of depression

schizophrenia - A class of disorders in which severe distortion of reality occurs

personality disorder - A disorder characterized by a set of inflexible, maladaptive behavior patterns that keep a person from functioning appropriately in society

antisocial personality disorder - A disorder in which individuals show no regard for the moral and ethical rules of society or the rights of others

borderline personality disorder - A disorder in which individuals have difficulty developing a secure sense of who they are

narcissistic personality disorder - A personality disturbance characterized by an exaggerated sense of self-importance

attention-deficit hyperactivity disorder (ADHD) - A disorder marked by inattention, impulsiveness, a low tolerance for frustration, and a great deal of inappropriate activity

autism - A severe developmental disability that impairs children's ability to communicate and relate to others

ANXIETY DISORDERS

Some people experience anxiety in situations in which there is no external reason or cause for such distress. When anxiety occurs without external justification and begins to affect people's daily functioning, mental health professionals consider it a psychological problem known as anxiety disorder. The four major types of anxiety disorders; phobic, panic, generalized anxiety, and obsessive-compulsive.

Phobic Disorder

A phobia is an intense, irrational fear of a specific object or situation. For example, claustrophobia is a fear of enclosed places, acrophobia is a fear of high places, xenophobia is a fear of strangers, and electrophobia is a fear of electricity.

The objective danger posed by an anxiety-producing stimulus is typically small or nonexistent. However, to someone suffering the phobia, the danger is great, and a full-blown panic attack may follow exposure to the stimulus. Avoiding the stimuli that triggers the fear is key to lessening the impact of one's phobia. In one extreme case, a Washington woman left her home just three times in 30 years - once to visit her family, once for an operation, and once to purchase ice cream for a dying companion (she had a social phobia).

Panic Disorder

In a panic disorder, panic attacks occur that last from a few seconds to several hours. Panic disorders do not have any identifiable stimuli. Instead, anxiety suddenly - and often without warning - rises to a peak, and an individual feels a sense of impending, unavoidable doom. Although the physical symptoms differ from person to person, they may include heart palpitations, shortness of breath, unusual amounts of sweating, faintness and dizziness, gastric sensations, and sometimes a sense of imminent death. After an attack, people feel exhausted.

People with panic disorder have reduced reactions in the anterior cingulate cortex to stimuli (such as viewing a fearful face) that normally produce a strong reaction in those without the disorder.

Generalized Anxiety Disorder

People with generalized anxiety disorder experience long-term, persistent anxiety and uncontrollable worry. Sometimes their concerns are about identifiable issues involving family, money, work, or health. In other cases, people feel that something dreadful is about to happen but can't identify the reason and thus experience "free-floating" anxiety.

Due to persistent anxiety, people cannot concentrate or set their worry and fears aside; their lives become centered on their worry. The anxiety is often accompanied by muscle tension, headaches, dizziness, heart palpitations, or insomnia.

Obsessive-Compulsive Disorder. In obsessive-compulsive disorder (OCD), people are plagued by unwanted thoughts, called obsessions, or feel that they must carry out behaviors, termed compulsions, which they feel driven to perform.

An obsession is a persistent, unwanted thought or idea that keeps recurring. People may also experience compulsions, irresistible urges to repeatedly carry out some act that seems strange and unreasonable to them. Whatever the action, people experience extreme anxiety if they cannot carry it out even if it is something they want to stop.

The Causes of Anxiety Disorders

Genetic factors clearly are part of the equation. There is a 30% chance that twins will share a panic disorder. Furthermore, a person's characteristic level of anxiety is related to a specific gene involved in the production of the neurotransmitter serotonin. Several more genetic factors have been discovered to also be at play.

Behavioral psychologists emphasize anxiety as a learned response to stress. EX: A fear of dogs after having been bitten as a child.

Cognitive psychologists assume anxiety grows out of inaccurate thoughts and beliefs about circumstances in a person's world. EX: One may view a friendly puppy as a ferocious and savage pit bull, or they may see an air disaster looming every moment they are in the vicinity of an airplane.

SOMATOFORM DISORDERS

Somatoform disorders are psychological difficulties that take on a physical (somatic) form but for which there is no medical cause. Even though there are physical symptoms, no biological cause exists - or, if there is a medical problem, the person's reaction is greatly exaggerated.

One type of somatoform disorder is hypochondriasis in which people have a constant fear of illness and a preoccupation with their health. These individuals believe that everyday aches and pains are symptoms of a dread disease. The "symptoms" are not faked; rather, they are misinterpreted as evidence of some serious illness - often in the face of inarguable medical evidence to the contrary.

Another somatoform disorder is conversion disorder, which involves an actual physical disturbance, such as the inability to see or hear or to move an arm or leg. The cause of such a disturbance is purely psychological; there is no biological reason for the problem.

Conversion disorders often begin suddenly. People wake up one morning blind or deaf, or experience numbness that is restricted to a certain part of the body.

DISSOCIATIVE DISORDERS

Dissociative disorders are characterized by the separation (or dissociation) of different facets of a person's personality. By dissociating key parts of who they are, people are able to keep disturbing memories or perceptions from reaching conscious awareness and thereby reduce their anxiety.

While several disorders exist, all of them are rare. A person with dissociative identity disorder (DID) (once called multiple personality disorder) displays characteristics of two or more distinct personalities, identities, or personality fragments. Individual personalities often have a unique set of likes and dislikes and their own reactions to situations. Some people with the disorder carry multiple sets of glasses because their vision changes with each personality. The classic movie The Three Faces of Eve and the book Sybil represent the highly dramatic, rare, and controversial dissociative disorders.

The diagnosis of DID is controversial. It was rarely diagnosed before 1980, when it was added as a category to the DSM for the first time. After that, the number of cases increased significantly. Some claim the increase was due to proper identification now available, while others contend the increase was because of overreadiness to use the classification.

Dissociative amnesia is another disorder in which a significant, selective memory loss occurs. Unlike traditional amnesia, the "forgotten" material is still present in memory - it simply cannot be recalled. The term repressed memories is sometimes used to describe lost memories of people with dissociative amnesia. In some cases, the memory loss is profound.

A more unusual form is a condition known as dissociative fugue. In this state, people take sudden, impulsive trips and sometimes assume a new identity. After a period of time (days, months, even years), they suddenly realize they are in a strange place and completely forget the time they have spent wandering. Their last memories are those from the time just before they entered the fugue state.

The common thread among dissociative disorders is that they allow people to escape from some anxiety-producing situation. Either a person produces a new personality to deal with stress, or the individual forgets or leaves behind the situation that caused the stress as he or she journeys to some new - and perhaps less anxiety-ridden - environment.

MOOD DISORDERS

We all experience mood swings. Sometimes we are happy, perhaps even euphoric; at other times we feel upset, saddened, or depressed. Such changes in mood are a normal part of everyday life. Sometimes, however, moods are so pronounced and lingering that they interfere with the ability to function effectively. In extreme cases, a mood may become life threatening; in other cases, it may cause a person to lose touch with reality. Situations such as these represent mood disorders, disturbances in emotional experience that are strong enough to intrude on everyday living.

Major Depression

Major depression is a severe form of depression that interferes with concentration, decision making, and sociability. It is one of the more common forms of mood disorders, affecting some 15 million people in the United States. At any one time, 6-10% of the U.S. population is clinically depressed. One in five people experiences major depression at some point in their life, and 15% of college students have received a diagnosis of depression. The cost of depression of $80 billion a year in lost productivity.

Women are twice as likely to experience major depression as men, with one-fourth of all females apt to encounter it at some point during their lives.

People who suffer from major depression become depressed from experiencing life disappointment just as anyone else. However, the severity tends to be considerably greater. They may feel useless, worthless, and lonely, viewing the future as hopeless accompanied by a loss of appetite and energy. They may cry uncontrollably, have sleep disturbances, and be at risk for suicide.

Mania And Bipolar Disorder

While depression leads to the depths of despair, mania leads to emotional heights. Mania is an extended state of intense, wild elation. People experience intense happiness, power, invulnerability, and energy.

Typically, people sequentially experience periods of mania and depression. This alternation of mania and depression is called bipolar disorder (a condition previously known as manic-depressive disorder). The swings between high and low may occur days apart or may alternate over a period of years. Periods of depression are usually longer than periods of mania.

Despite the creative fires that may be lit by mania, persons who experience this disorder often show a recklessness that produces emotional and sometimes physical self-injury. They may alienate people with their talkativeness, inflated self-esteem, and indifference to the needs of others.

Causes Of Mood Disorders

Some mood disorders clearly have genetic and biochemical roots. Most evidence suggests that bipolar disorder is caused primarily by genetic factors. Other explanations for depression involve psychological factors - such as feelings of loss or anger directed at oneself. Behavioral theories argues that stressors of life reduce positive reinforcement. Cognitive psychologists suggest that depression is largely a response to learned helplessness.

Clinical psychologist Aaron Beck has proposed that faulty cognitions underlie people's depressed feelings. For example, according to Beck, individuals typically view themselves as life's losers and blame themselves whenever anything goes wrong. The negative cognitions lead to feelings of depression.

According to evolutionary psychology, depression is an adaptive response to unattainable goals.

The various theories of depression have not provided a complete answer to an elusive question: Why does depression occur in approximately twice as many women as men - a pattern that is similar across a variety of cultures?

One explanation suggests that the stress women experience may be greater than the stress men experience at certain points in their lives - such as when a woman must simultaneously earn a living and be the primary caregiver for her children. Women have a higher risk for physical and sexual abuse, typically earn lower wages than men, report greater unhappiness with their marriages, and generally experience chronic negative circumstances. Women and men may respond to stress with different coping mechanisms - men may abuse drugs, while women respond with depression.

Biologically, female depression begins to rise during puberty and some psychologists believe that hormones make women more vulnerable to the disorder. 25-50% of women who take oral contraceptives report symptoms of depression, and depression that occurs after the birth of a child is linked to hormonal changes. Structural differences in male and female brains may also be at play.

SCHIZOPHRENIA

People with schizophrenia represent the largest the largest percentage of those hospitalized for psychological disorders. They are also the least likely to recover from their difficulties.

Schizophrenia refers to a class of disorders in which severe distortion of reality occurs. Thinking, perception, and emotion may deteriorate; the individual may withdraw from social interaction; and the person may display bizarre behavior. A number of characteristics reliably distinguish schizophrenia from other disorders. They include the following:

  • Decline from a previous level of functioning.

  • Disturbances of thought and speech.

  • Delusions.

  • Hallucinations and perceptual disorders.

  • Emotional disturbances.

  • Withdrawal.

Furthermore, there are different classifications of schizophrenia, which include the following;

    • Disorganized (hebephrenic) schizophrenia - inappropriate laughter and giggling, silliness, incoherent speech, infantile behavior, strange and sometimes obscene behavior.

    • Paranoid schizophrenic - delusions and hallucinations of persecution or of greatness, loss of judgment, erratic and unpredictable behavior

    • Catatonic schizophrenic - major disturbances in movement; in some phases, loss of all motion, with patient frozen into a single position, remaining that way for hours and sometimes even days; in other phases, hyperactivity and wild, sometimes violent, movement

    • Undifferentiated schizophrenia - variable mixture of major symptoms of schizophrenia; classification used for patients who cannot be typed into any of the more specific categories

    • Residual schizophrenia - minor signs of schizophrenia after a more serious episode

The onset of schizophrenia usually occurs in early adulthood. In process schizophrenia, the symptoms develop slowly and subtly. In reactive schizophrenia, the onset of symptoms is sudden and conspicuous.

DSM-IV-TR classifies schizophrenia into two types; positive-symptom and negative symptom. Positive is indicated by the presence of disordered behavior such as hallucinations, delusions, and emotional extremes. Negative shows and absence or loss of normal functioning, such as social withdrawal or blunted emotions.

In Type I schizophrenia, positive symptoms are dominant, while in Type II schizophrenia, negative symptoms are dominant. These classifications are important for understanding the different processes that might trigger schizophrenia and has implications for predicting treatment outcomes.

Solving The Puzzle Of Schizophrenia: Biological Causes

It is apparent that schizophrenia has both biological and environmental causes. Schizophrenia is more common in some families than in others. The closer the genetic link, the greater the likelihood of sharing schizophrenia.

One hypothesis suggests that brains of people with the disorder may harbor either a biochemical imbalance or a structural abnormality. For example, the discovery of drugs that block dopamine action in brain pathways can be highly effective in reducing the symptoms of schizophrenia. Other research suggests that glutamate - another neurotransmitter - may be a major contributor to the disorder.

Structural abnormalities may exist as a result of exposure to a virus during prenatal development. These abnormalities are observed in the neural circuits of the cortex and the limbic systems of individuals with schizophrenia.

Furthermore, when people with the disorder hear voices during hallucinations, the parts of the brain responsible for hearing and language processing become active. When they have visual hallucinations, the parts of the brain involved in movement and color are active. Those with the disorder also have unusually low activity in the frontal lobes - the parts of the brain involved with emotional regulation, insight, and the evaluation of sensory stimuli.

Environmental Perspectives On Schizophrenia

Psychoanalytic approaches suggest that schizophrenia is a form of regression to earlier experiences and stages of life. Freud believed people with the disorder lack egos that are strong enough to cope with their unacceptable impulses. They regress to the oral stage - a time when the id and the ego are not yet separated, therefore, acting out impulses without concern for reality. Although plausible, there is little evidence in support of this approach.

Some researchers suggest that schizophrenia results from high levels of expressed emotion - an interaction style characterized by family members' criticism, hostility, and emotional intrusiveness. Others suggest that faulty communication patterns lie at the heart of schizophrenia.

The cognitive perspective suggests that schizophrenia results from overattention to stimuli in the environment. People with schizophrenia may be excessively receptive to virtually everything in their environment. Information-processing capabilities become overloaded and break down. Others suggests that schizophrenia results from underattention to certain stimuli. These individuals fail to focus sufficiently on important stimuli and pay attention to other, less important information in their surroundings.

These approaches - like other environmental explanations - do not sufficiently explain the origins of such information-processing disorders.

The Multiple Causes of Schizophrenia

The predominant approach to explaining schizophrenia today is the predisposition model of schizophrenia which incorporates a number of biological and environmental factors. The model suggests that individuals may inherit a predisposition or an inborn sensitivity to schizophrenia that makes them particularly vulnerable to stressful factors in the environment, such as social rejection or dysfunctional family communication patterns.

PERSONALITY DISORDERS

A personality disorder is characterized by a set of inflexible, maladaptive behavior patterns that keep a person from functioning appropriately in society. Unlike the above disorders, those affected with personality disorders often have little sense of personal distress associated with the psychological maladjustment. In fact, they frequently lead normal lives.

The best-known type of personality disorder is the antisocial personality disorder (sometimes known as a sociopathic personality). Individuals with this disorder show no regard for the moral and ethical rules or society or the rights of others. Although they can appear intelligent and quite likable (at first), upon closer examination they turn out to be manipulative and deceptive. They lack any guilt or anxiety over their wrongdoing. They are often impulsive and lack the ability to withstand frustration. They may also have excellent social skills; they can be charming, engaging, and highly persuasive.

A variety of factors have been suggested as causes, ranging from an inability to experience emotions appropriately to problems in family relationships. In many cases, the individual has come from a home in which a parent has died or left or in one in which there is a lack of affection, a lack of consistency in discipline, or outright rejection. Often, antisocial individuals come from lower socioeconomic groups.

People with borderline personality disorder have difficulty developing a secure sense of who they are. They tend to rely on relationships with others to define their identity. Under such circumstances, rejection is devastating. People with the disorder distrust others and have difficulty controlling their anger. Their emotional volatility can often lead to self-destructive behavior. They often feel alone and have difficulty cooperating with others. They may form intense, sudden, one-sided relationships in which they demand the attention of another person and then feel angry when they don't receive it.

One reason for this behavior is they may have a background in which others discounted or criticized their emotional reactions, and they may not have learned to regulate their emotions effectively.

Another personality disturbance is narcissistic personality disorder, which is characterized by an exaggerated sense of self-importance. Those affected expect special treatment from others while at the same time disregarding others' feelings. The main attribute is an inability to experience empathy for other people.

There are several categories of personality disorder that range in severity from individuals who may simply be regarded by others as eccentric, obnoxious, or difficult to people who act in a manner that is criminal and dangerous to others. Although they are not out of touch with reality, they lead lives that put them on the fringes of society.

CHILDHOOD DISORDERS

Almost 20% of children and 40% of adolescents experience significant emotional or behavioral disorders. Around 2.5% of children and more than 8% of adolescents suffer from major depression. By the time they reach age 20, between 15-20% of children and adolescents will experience an episode of major depression.

Childhood depression may produce the expression of exaggerated fears, clinginess, or avoidance of everyday activities. In older children, the symptoms may be sulking, school problems, and even acts of delinquency.

A considerably more common childhood disorder is attention-deficit hyperactivity disorder, or ADHD, a disorder marked by inattention, impulsiveness, a low tolerance for frustration, and generally a great deal of inappropriate activity. Although all children show such behavior some of the time, it is so common in children diagnosed with ADHD that it interferes with their everyday functioning.

ADHD is surprisingly widespread with estimates ranging between 3-5% of the school-age population - or some 3.5 million students under the age of 18 in the United States. These children are often exhausting to parents and teachers, and even their peers find them difficult to deal with.

The cause of ADHD is not known, although most experts feel that it is produced by dysfunctions in the nervous system. One theory suggests that low levels of arousal in the central nervous system cause ADHD. These children seek out stimulation to increase arousal. Still, such theories are speculative. Because many children occasionally show behaviors characteristic of ADHD, it is often misdiagnosed or in some cases overdiagnosed.

Autism, a severe development disability that impairs children's ability to communicate and relate to others, is another childhood disorder that usually appears in the first three years and typically continues throughout life. They have difficulty in both verbal and nonverbal communication, and they may avoid social contact. About one in 110 children are now thought to have the disorder, and its prevalence has risen significantly in the last decade.

OTHER DISORDERS

The DSM-IV-TR covers much more ground that the major disorders discussed in this chapter. Psychoactive substance use disorder relates to problems that arise from the use and abuse of drugs. Alcohol use disorders are among the most serious and widespread problems. Both disorders co-occur with other psychological disorders such as mood disorders, posttraumatic stress disorder, and schizophrenia, which complicates treatment considerably.

Another widespread problem is eating disorders, including anorexia nervosa and bulimia. Furthermore, binge-eating disorder is characterized by binge eating without behaviors designed to prevent weight gain. Finally, there are sexual disorders, in which one's sexual activity is unsatisfactory. They include sexual desire disorders, sexual arousal disorders, and paraphilias, atypical sexual activities that may include nonhuman objects or nonconsenting partners.

Another important class is organic mental disorders. These are problems that have a purely biological basis, such as Alzheimer's disease and some types of mental retardation.

Section 3 - Psychological Disorders in Perspective

MAIN IDEA QUESTIONS

How prevalent are psychological disorders?

What indicators signal a need for the help of a mental health practitioner?

How common are the kinds of psychological disorders we've discussed? Every second person in the United States is likely to suffer at some point during his or her life from a psychological disorder.

The most common disorder reported is depression. The next most common disorder was alcohol dependence, followed by drugs disorders, disorders involving panic, and posttraumatic stress disorder.

According to the World Health Organization, mental health difficulties are also a global concern. Psychological disorders are widespread throughout the world. There are economic disparities in treatment; more affluent people with mild disorders receive more and better treatment than poor people who have more severe disorders. Psychological disorders make up 14% of global illness, and 90% of people in developing countries receive no care at all for their disorders.

THE SOCIAL AND CULTURAL CONTEXT OF PSYCHOLOGICAL DISORDERS

The development of the most recent version of the DSM was a source of great debate, which in part reflects issues that divide society.

Two disorders caused particular controversy. One, known as self-defeating personality disorder was removed from the appendix after having originally been included. The term was applied to cases in which people who were treated unpleasantly or demeaningly in relationships neither left nor took other action. It was typically used to describe people who remained in abusive relationships. The disorder lacked enough research evidence to support its designation as a disorder in DSM.

A second and even more controversial category was premenstrual dysphoric disorder, which is characterized by severe, incapacitating mood changes or depression related to a woman's menstrual cycle. Critics claimed it labels normal female behavior as a disorder. Former U.S. Surgeon General Antonia Novello suggested that what "in women is called PMS [premenstrual syndrome, a similar classification] in men is called healthy aggression and initiative." Advocates for the disorder prevailed, however, and the disorder appears in the appendix of the DSM.