PsychScich14

Report
Gazzaniga • Heatherton • Halpern
Psychological Science
FOURTH EDITION
Chapter 14
Psychological Disorders
©2013 W. W. Norton & Company, Inc.
14.1 How Are Psychological Disorders
Conceptualized and Classified?
• Describe the multiaxial classification system of the
Diagnostic and Statistical Manual of Mental Disorders.
• Identify assessment methods for psychological disorders.
• Describe the diathesis-stress model.
• Identify biological, psychological, and cognitivebehavioral causes of psychological disorders.
• Discuss sex differences and cultural differences in
psychological disorders.
How Are Psychological Disorders
Conceptualized and Classified?
• People have long struggled with how best to
understand psychopathology
• Earliest views of psychopathology explained
apparent “madness” as resulting from possession by
demons or evil spirits
• During the last 200 years, recognition has grown that
psychopathology reflects dysfunction of the body,
particularly of the brain
Psychopathology Is Different
from Everyday Problems
• Psychological disorders are common and account for the
greatest proportion of disability in developed countries
(Centers for Disease Control and Prevention, 2011)
• Mental disorders range in severity and there are
enormous sex differences in psychopathology
• Drawing the line between a normal emotional
experience and a mental disorder can be difficult
• When a psychological problem disrupts a person’s life
and causes significant distress over a long period, the
problem is considered a disorder rather than the
normal low points of everyday life
Psychological Disorders
Are Maladaptive
• How do you know if someone has a psychological disorder?
• Many behaviors considered normal in one setting may be
considered deviant in other settings
• In determining whether behavior represents
psychopathology, it is important to consider certain criteria:
– Does the person act in a way that deviates from cultural norms for
acceptable behavior?
– Is the behavior maladaptive?
– Is the behavior self-destructive?
– Does the behavior cause discomfort and concern to others, thus
impairing a person’s social relationships?
Psychological Disorders
Are Classified into Categories
• 1800s: Psychiatrist Emil Kraepelin identified mental
disorders on the basis of groups of symptoms that
occur together
• In 1952, the American Psychiatric Association
published the first edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM)
• Disorders are described in terms of observable
symptoms; patients must meet specific criteria to
receive a particular diagnosis
• Multiaxial system: assessment along five axes that
describe important mental health factors
• Categorical versus dimensional approach
Psychological Disorders
Must Be Assessed
• Determining whether a person has a mental disorder is
not as straightforward as most medical diagnoses
• Assessment: examination of a person’s mental state to
diagnose possible psychological disorders; typically
involves a mental status exam or clinical interview
• The primary goal of assessment is to make a diagnosis so
that appropriate treatment can be provided. The course
and probable outcome, or prognosis, will depend on the
particular mental disorder that is diagnosed.
• Assessment does not stop with initial diagnosis but
rather is ongoing
Structured Versus
Unstructured Interviews
• Since the beginning of modern psychology most
interviews have been unstructured
– No two unstructured interviews are likely to elicit identical
information from the same patient; unstructured interviews are
overly dependent on the interviewer’s skills
• In structured interviews, clinicians ask standardized
questions in the same order each time. Patients’ answers
are coded according to a predetermined formula and the
diagnosis is based on the specific patterns of responses.
– The most commonly used structured interview is the
Structured Clinical Interview for DSM (SCID), through which
diagnoses are made according to DSM criteria
Observation and Types of Testing
• A psychological assessor often can gain valuable
information simply by observing the client’s behavior
• Thousands of psychological tests are available to
clinicians
• Some are for specific mental disorders, such as the
widely used Beck Depression Inventory
• The most widely used questionnaire for psychological
assessment is the Minnesota Multiphasic Personality
Inventory (MMPI)
• Another assessment method is neuropsychological
testing
Evidence-Based Assessment
• A key question is whether psychological assessments
provide information that is useful for treating
psychological disorders
– Popular methods of assessment, such as projective tests,
have not been shown to be helpful in predicting the kinds
of treatments that are useful
– Individual clinicians often choose assessment procedures
based on their subjective beliefs and training rather than
based on scientific studies
• Evidence-based assessment is an approach to clinical
evaluation in which research guides evaluation
– Example: Evidence-based assessment approach would
indicate that people found to be depressed should also be
assessed for co-morbid conditions such as substance abuse
Psychological Disorders
Have Many Causes
• Biological and environmental factors are
thought to play important developmental
roles in psychopathology
• Diathesis-stress model: a diagnostic model
that proposes that a disorder may develop
when an underlying vulnerability is coupled
with a precipitating event
Biological Factors
• The biological perspective focuses on how physiological factors
contribute to psychological disorders:
– Genetics
– Some disorders may arise from prenatal problems, such as malnutrition,
exposure to toxins, and maternal illness
– During childhood and adolescence, environmental toxins and
malnutrition can put an individual at risk for mental disorders
• Biological factors may contribute to mental disorders because of
their effects on the central nervous system
• Functional neuroimaging is currently at the forefront of
research into the neurological components of mental disorders
• PET and fMRI have revealed brain regions that may function
differently in individuals with mental disorders
Psychological Factors
• Psychological factors play an important role in the
expression and treatment of mental disorders
• Family systems model: An individual’s behavior must
be considered within a social context, particularly
within the family; problems that arise within an
individual are manifestations of problems within the
family
• Sociocultural model: Psychopathology is the result of
the interaction between individuals and their cultures;
differences in occurrence of disorders are due to
differences in lifestyles, in expectations, and in
opportunities between classes
Cognitive-Behavioral Factors
• The central principle of the cognitive-behavioral
approach is that abnormal behavior is learned
• Proponents of strict behaviorism argue that mental
disorders result from classical and operant
conditioning
• According to the revised cognitive-behavioral
perspective, thoughts and beliefs are types of
behavior and can be studied empirically
• The premise of this approach is that thoughts can
become distorted and produce maladaptive
behaviors and maladaptive emotions
Sex Differences in Mental Disorders
• Some mental disorders, such as schizophrenia and bipolar
disorder, are equally likely in the sexes, whereas other
disorders vary between the sexes (e.g., anorexia, depression)
• One way of categorizing mental disorders is to divide them
into two major groups:
– Internalizing disorders: characterized by negative emotions (e.g.,
major depression, generalized anxiety disorder, panic disorder)
– Externalizing disorders: characterized by disinhibition (e.g., alcoholism,
conduct disorders, antisocial behavior)
• In general, the disorders associated with internalizing are
more prevalent in females, and those associated with
externalizing are more prevalent in males (Krueger & Markon,
2006)
“Dying to Be Thin”
Many Americans have made New Year’s resolutions to eat less,
exercise more, and lose weight. But people with anorexia
nervosa do these things to such an extreme that they endanger
their health—or even their lives. As this ScienCentral News video
reports, doctors believe the reason may be genetic.
“Virtual Alcohol Control”
Scientists are using virtual reality to help alcoholics cope with
situations that might get them in trouble. This ScienCentral
News video explains.
Culture and Mental Disorders
• Most mental disorders show both universal and culture-specific
symptoms
– Disorders with a strong biological component will tend to be more similar
across cultures.
– A disorder heavily influenced by learning, context, or both is more likely
to differ across cultures (e.g., depression is a major mental health
problem around the world, but the manifestations of depression differ by
culture)
• The DSM includes a section on culture-bound syndromes that
occur mainly in specific cultures or regions
• Clinicians and researchers need to be sensitive to cultural issues
to avoid making mistakes in their diagnoses and treatments
14.2 Can Anxiety Be the Root of
Seemingly Different Disorders?
• Distinguish between anxiety disorders.
• Identify cognitive, situational, and biological
factors that contribute to anxiety disorders.
Can Anxiety Be the Root
of Seemingly Different Disorders?
• Anxiety itself is normal and even useful; it can
prepare us for upcoming events and motivate us to
learn new ways of coping with life’s challenges
• Anxiety can become debilitating and can interfere
with every aspect of life
• Anxiety disorders are characterized by excessive
anxiety in the absence of true danger
There Are Different Types
of Anxiety Disorders
• More than 1 in 4 Americans will have some type of
anxiety disorder during their lifetimes (Kessler &
Wang, 2008)
• Different anxiety disorders share some emotional,
cognitive, somatic, and motor symptoms, even
though the behavioral manifestations of these
disorders are quite different (Barlow, 2002)
• Because chronic stress can damage the body,
including the brain, it is very important to identify
and effectively treat disorders that involve chronic
anxiety
Phobic Disorder
• A phobia is a fear of a specific object or situation
• Specific phobias affect about 1 in 8 people and involve
particular objects and situations
• Social phobia is a fear of being negatively evaluated by
others; includes fears of public speaking, speaking up in
class, meeting new people, and eating in front of others
• It is one of the earliest forms of anxiety disorder to
develop, often beginning around age 13
• The more social fears a person has, the more likely he or
she is to develop other disorders, particularly depression
and substance abuse problems
Generalized Anxiety Disorder
• Generalized anxiety disorder (GAD): a diffuse state
of constant anxiety not associated with any specific
object or event
• People with this disorder are constantly anxious and
worry incessantly about even minor matters
• Hypervigilance results in distractibility, fatigue,
irritability, and sleep problems, as well as headaches,
restlessness, light-headedness, muscle pain
• Just under 6 percent of the United States population
is affected by this disorder at some point in their
lives; women are diagnosed more often than men
“Sleep and Brain Chemistry”
Sleep disorders affect not only the nighttime slumber and
daytime behavior of millions of Americans, but also their overall
health. As this ScienCentral News video reports, some
neuroscientists say sleep disorders could be associated with
chemical imbalances in the brain.
Post Traumatic Stress Disorder (PTSD)
• Posttraumatic stress disorder (PTSD): involves frequent
nightmares, intrusive thoughts, and flashbacks related to an
earlier trauma
– At Northern Illinois University in 2008 a lone gunman killed five people
and wounded 21. Among a sample of female students, those with
certain genetic markers related to serotonin functioning were much
more likely to show PTSD symptoms in the weeks after the shooting
(Mercer et al., 2011).
– Those with PTSD often have chronic tension, anxiety, and health
problems, and they may experience memory and attention problems in
their daily lives. PTSD involves an unusual problem in memory—the
inability to forget.
• The lifetime prevalence of PTSD is around 7 percent; women
are more likely to develop the disorder
Panic Disorder
• Panic disorder: consists of sudden, overwhelming
attacks of terror
– Panic attacks typically last for several minutes. Victims sweat,
tremble, feel their hearts racing; experience shortness of
breath, chest pain; feel dizziness and light-headedness with
numbness and tingling in their hands and feet.
– People feel that they are going crazy or that they are dying,
and those who suffer from persistent panic attacks attempt
suicide much more frequently than those in the general
population (Fawcett, 1992; Korn et al., 1992; Noyes, 1991).
• Affects an estimated 3 percent of the population;
women are twice as likely to be diagnosed as men
(Kessler & Wang, 2008)
• Clear link between panic attacks and agoraphobia
Obsessive-Compulsive Disorder
• Obsessive-compulsive disorder (OCD): characterized
by frequent intrusive thoughts and compulsive action
• Obsessions: recurrent, intrusive, and unwanted
thoughts or ideas or mental images; they often include
fear of contamination, of accidents, or of one’s own
aggression.
• Compulsions: particular acts that the OCD patient feels
driven to perform over and over again
• Generally begins in early adulthood, affecting 1 percent
to 2 percent of the population; more common among
women
Anxiety Disorders Have
Cognitive, Situational,
and Biological Components
• Anxiety disorders share some causal factors
(Barlow, 2002)
• The factors can be divided into three groups:
cognitive, situational, and biological
Cognitive Components
• When presented with ambiguous or neutral
situations, anxious individuals tend to
perceive them as threatening, whereas
nonanxious individuals assume they are
nonthreatening
• Anxious individuals also focus excessive
attention on perceived threats, recall
threatening events more easily than
nonthreatening events, and exaggerate their
perceived magnitude and frequency
Situational Components
• Through social learning, a person could
develop a fear of flying by observing another
person’s fearful reaction to the closing of
cabin doors
• Once learned, a fear might then generalize to
other enclosed spaces, resulting in
claustrophobia
Biological Components
• Children who have an inhibited temperamental style are
usually shy and tend to avoid unfamiliar people and novel
objects
• Inhibited children are more likely to develop anxiety
disorders later in life
– Adults received brain scans while viewing pictures of familiar faces
and of novel faces
– One group of these adults had been categorized as inhibited before
age 2; the other group had been categorized as uninhibited before
age 2
– Compared with the uninhibited group, the inhibited group showed
greater activation of the amygdala while viewing the novel faces
– Study suggests that some aspects of childhood temperament are
preserved in the adult brain (Schwartz, Wright, Shin, Kagan, & Rauch,
2003)
“Panic Disorder”
Patients suffering from panic attacks brought on by hard-to
define fear may soon have better treatment options. As this
ScienCentral News video reports, researchers are a step closer
to understanding how this disorder alters the brain’s biology.
Causes of
Obsessive-Compulsive Disorder
• Biological and cognitive-behavioral factors interact to
produce the symptoms of OCD:
– Anxiety is paired to a specific event through classical conditioning;
the person then engages in behavior to reduce the anxiety and
the behavior is reinforced through operant conditioning
– OCD runs in families. OCD-related genes control glutamate, the
major excitatory neurotransmitter in the brain causing increased
neural firing (Pauls, 2008)
– The caudate, a structure involved in suppressing impulses, is
smaller and has structural abnormalities in people with OCD
(Baxter, 2000)
– OCD can be triggered by environmental factors; a streptococcal
infection apparently can cause a severe form of OCD in some
young children
“Hoarding”
Research suggests that compulsive hoarders have distinct brain
abnormalities. This ScienCentral News video has more.
14.3 Are Mood Disorders Extreme
Manifestations of Normal Moods?
• Distinguish between major depression and
bipolar disorder.
• Discuss cultural and sex differences in
depression.
Are Mood Disorders Extreme
Manifestations of Normal Moods?
• Moods color every aspect of our lives
• When we are happy we are filled with
boundless energy; when sad, we view the
world in a decidedly less rosy light
• Some people experience mood fluctuations
that disrupt their ability to work, learn, and
play
There Are Two Categories
of Mood Disorders
• Mood/affective disorders are classified into
two categories:
– Depressive disorders feature persistent and
pervasive feelings of sadness
– Bipolar disorders involve radical fluctuations in
mood
Depressive Disorders
• Major depression: a disorder characterized by severe negative
moods or a lack of interest in normally pleasurable activities
– Affects about 6 percent to 7 percent of Americans in a given 12-month
period
– Sufferers are highly impaired by the condition and it tends to persist over
several months, often lasting for years; affects women nearly twice as
much as men
• Dysthymia: a form of depression that is not severe enough to
be diagnosed as major depression
– Affects approximately 2 percent to 3 percent of the population
– Lasts from 2 to 20 or more years, although the typical duration is about 5
to 10 years
– Because the depressed mood is so long-lasting, some psychologists
consider it a personality disorder
The Role of Culture and Gender
in Depressive Disorders
• In its most severe form, depression is the leading cause of
disability in the United States and also worldwide, and is the
leading risk factor for suicide
• The stigma associated with this disorder has especially dire
consequences in developing countries:
– Suicide is the leading cause of death among young women in India
and China (Khan, 2005)
– The highest rates of depression are found in women in developing
countries, with especially high rates reported for women in rural
Pakistan
• Women respond to stressful events by internalizing their
feelings, which leads to depression and anxiety, whereas men
externalize with alcohol, drugs, and violence
“Addicted Brain Changes”
New research is overturning previous thought about how
addiction permanently changes the brain. Researchers hope these
new insights may lead to new ways of treating addicts.
Bipolar Disorder
• Bipolar disorder: a mood disorder characterized by
alternating periods of depression and mania
– Manic episodes: characterized by elevated mood,
increased activity, diminished need for sleep, grandiose
ideas, racing thoughts, and extreme distractibility,
excessive involvement in pleasurable but foolish activities
– Hypomanic episodes: less extreme mood elevations
characterized by heightened creativity and productivity
• Lifetime prevalence for any type is estimated at
around 4 percent; equally prevalent in women and
men and emerges most commonly during late
adolescence or early adulthood
A Case Study of Bipolar Disorder
• Psychology professor Kay Redfield Jamison
acknowledged her own struggles with bipolar
disorder in her award-winning memoir, An
Unquiet Mind (1995)
• Her work helped shape the study of the disorder,
and her textbook, coauthored with Frederick
Goodwin, is considered the standard for the field
(Goodwin & Jamison, 1990)
Mood Disorders Have Biological,
Situational, and Cognitive Components
• Mood disorders can be devastating
• Because of their profound effects, much
research has focused on understanding what
causes mood disorders and in developing
treatments
Biological Components
• Studies of twins, of families, and of adoptions support the
notion that depression has a genetic component
– Concordance rates between identical twins are generally around
two to three times higher than rates between fraternal twins
– Evidence suggests that major depression involves a deficiency of
one or more monoamines. Medications that increase the
availability of norepinephrine and serotonin may help alleviate
depression
– Biological rhythms and damage to the left prefrontal cortex have
been implicated in depression
• Concordance for bipolar disorder in identical twins is more
than 70 percent
• In bipolar disorder, successive generations have more-severe
disorders and earlier ages of onset
Situational Components
• A number of studies have implicated life stressors in
many cases of depression (Hammen, 2005).
• Depression is especially likely in the face of multiple
negative events. Patients with depression often have
experienced negative life events during the year before
the onset of their depression.
• How an individual reacts to stress, however, can be
influenced by interpersonal relationships, which play
an extremely important role in depression (Joiner,
Coyne, & Blalock, 1999).
Cognitive Components
• Aaron Beck has hypothesized that people with
depression think negatively about themselves, about
their situations, and about the future
• Beck refers to these negative thoughts about self,
situation, and the future as the cognitive triad
• A second cognitive model of depression is based on
learned helplessness, where people come to see
themselves as unable to have any effect on events in
their lives
• The attributions they make for negative events are
stable and global rather than situational, temporary
and specific, which leads them to feel hopeless about
making positive changes
14.4 What Are Dissociative Disorders?
• Describe dissociative amnesia, dissociative
fugue, and dissociative identity disorder.
• Identify possible causes of dissociative identity
disorder.
• Discuss the current controversy regarding
dissociative identity disorder.
What Are Dissociative Disorders?
• Our thoughts and experiences can become
dissociated, or split, from the external world
• Dissociative disorders involve disruptions of
identity, of memory, or of conscious
awareness
• These disorders are believed to result from
extreme stress
Dissociative Amnesia and Fugue
Involve Loss of Memory
• Dissociative amnesia: A person forgets that an
event happened or loses awareness of a
substantial block of time
• Dissociative fugue: The rarest and most
extreme form of dissociative amnesia that
involves a loss of identity; involves travel to
another location and sometimes the
assumption of a new identity
Dissociative Identity Disorder
is a Controversial Diagnosis
• Dissociative identity disorder (DID): formerly called multiple
personality disorder; consists of the occurrence of two or
more distinct identities in the same individual
– Most people with DID are women who report being severely abused
as children
– Children cope with abuse by pretending it is happening to someone
else. Over time, this dissociated state takes on its own identity
– The separate identities usually differ substantially, such as in gender
identity, sexual orientation, age, language spoken, interests,
physiological profiles, and patterns of brain activation
• Many researchers remain skeptical about whether DID is a
genuine mental disorder or whether it exists at all (Kihlstrom,
2005)
14.5 What is Schizophrenia?
• Distinguish between positive and negative
symptoms of schizophrenia.
• Identify biological and environmental factors
that contribute to schizophrenia.
What is Schizophrenia?
• Schizophrenia: a psychological disorder characterized
by a split between thought and emotion; involves
alterations in thoughts, in perceptions, or in
consciousness
• It is a psychotic disorder, the essence of which is a
disconnection from reality referred to as psychosis
• Current estimates state between 0.5 percent and 1.0
percent of the population has schizophrenia; effects
women and men similarly
• The disorder has distinct subtypes
Schizophrenia Has Positive
and Negative Symptoms
• Positive symptoms: excesses in functioning,
such as delusions, hallucinations, and
disorganized speech or behavior
• Negative symptoms: deficits in functioning,
such as apathy, lack of emotion, and slowed
speech and movement
Positive Symptoms of Schizophrenia
• Common positive (i.e., excessive) symptoms associated
with schizophrenia include:
– Delusions: false beliefs based on incorrect inferences about
reality
– Hallucinations: false sensory perceptions that are
experienced without an external source. Frequently auditory,
they can also be visual, olfactory, or somatosensory.
– Loosening of associations: Individual shifts between
seemingly unrelated topics as he or she speaks, making it
difficult or impossible for a listener to follow the speaker’s
train of thought
– Disorganized behavior: Person might walk along muttering
to himself, alternate between anger and laughter
Negative Symptoms of Schizophrenia
• A number of behavioral deficits associated with schizophrenia
result in patients’ becoming isolated and withdrawn:
– People with schizophrenia often avoid eye contact and seem
apathetic
– They do not express emotion
– Speech is slowed and they use a monotonous tone of voice, long
pauses before answering, failure to respond to a question, inability
to complete an utterance after initiating it
– Movements may be slowed and the overall amount of movement
reduced, with little initiation of behavior and no interest in social
participation
• Negative symptoms are more resistant to medications.
Researchers have speculated that positive and negative symptoms
have different organic causes
Schizophrenia is Primarily
a Brain Disorder
• Genetics plays a role in the development of the disorder
– If one identical twin develops schizophrenia, the likelihood of the
other twin’s succumbing is almost 50 percent; 14 percent if the
twins are fraternal
– Genetic component of schizophrenia represents a predisposition
rather than destiny
• Ventricles in the brain are enlarged and there are
abnormalities throughout many brain regions
• Schizophrenia may result from abnormality in
neurotransmitters (e.g., dopamine)
• There is evidence that some neurological signs of
schizophrenia can be observed long before the disorder is
diagnosed
Environmental Factors
Influence Schizophrenia
• Environmental stress seems to contribute to the
development of schizophrenia:
– Being born or raised in an urban area approximately doubles
the risk of developing schizophrenia later in life (Torrey, 1999)
– Speculation that a schizovirus exists
– People with schizophrenia are more likely to have been born
during late winter and early spring
– Mothers of children born in late winter and early spring were in
their second trimester of pregnancy during flu season; mothers
of people with schizophrenia are more likely than other
mothers to have contracted influenza during this critical period
– Growing up in a dysfunctional family may increase the risk of
developing schizophrenia for those who are genetically at risk
“Schizophrenia Gene Puzzle”
Scientists are trying to decode the genetic causes of
schizophrenia. But as this ScienCentral News video explains, new
research suggests that nearly every person with the illness has a
different genetic defect.
14.6 Are Personality Disorders Truly
Mental Disorders?
• Distinguish between personality disorders.
• Identify the symptoms and possible causes of
borderline personality disorder and antisocial
personality disorder.
Are Personality Disorders
Truly Mental Disorders?
• Although individuals change somewhat over time, the ways
they interact with the world and cope with events are fairly
fixed by the end of adolescence
• Some people interact with the world in maladaptive and
inflexible ways
• When this style of interaction is long-lasting and causes
problems in work and in social situations, it becomes a
personality disorder
• People with personality disorders consistently behave in
maladaptive ways, show a more extreme level of
maladaptive behavior, and experience more personal
distress and more problems as a result of their behavior
Personality Disorders Are Maladaptive
Ways of Relating to the World
• Personality disorders are classified on Axis II in the DSM,
along with mental retardation
• Personality disorders and mental retardation are grouped
together because they usually last throughout the life span,
with no expectation of significant change
• Personality disorders generally are divided into three groups:
– Odd or Eccentric Behavior: paranoid, schizoid, and schizotypal
– Anxious or Fearful Behavior: avoidant, dependent, and obsessivecompulsive
– Dramatic, Emotional, or Erratic Behavior: histrionic, narcissistic,
borderline, and antisocial
Borderline Personality Disorder Is
Associated with Poor Self-Control
• Borderline personality disorder: characterized by
disturbances in identity, in affect, and in impulse control
• Officially recognized as a diagnosis in 1980, the term
borderline was initially used because these patients were
considered on the border between normal and psychotic
(Knight, 1953)
• Characterized by problems with identity, affective
disturbances, impulsivity, sleep abnormalities
• Approximately 1 percent to 2 percent of adults meet the
criteria for borderline personality disorder; more than twice
as common in women as in men
• Possible causes: low serotonin, trauma or abuse
Antisocial Personality Disorder Is
Associated with a Lack of Empathy
• In 1980, the DSM dropped the former label
psychopath and adopted the term antisocial
personality disorder (APD)
• Antisocial personality disorder (APD): a personality
disorder marked by a lack of empathy and remorse
• APD is the catchall diagnosis for individuals who
behave in socially undesirable ways, seeking
immediate gratification of wants and needs without
any thought of others
Assessment and Consequences
• APD estimated at between 1 percent and 4 percent of the
population; more common in men than in women
– Most apparent in late adolescence and early adulthood, it
generally improves around age 40. Cannot be diagnosed
before age 18, but the person must have displayed antisocial
conduct before age 15.
– Must meet criteria such as repeatedly performing illegal acts,
repeatedly lying or using aliases, and showing reckless
disregard for one’s own safety or the safety of others.
• Perhaps as much as 50 percent of the prison population
meets the criteria for APD
• Affected individuals are often charming and intelligent,
lacking remorse, willing to lie or cheat, and lacking empathy.
Some with APD manage to be successful professionals
The Etiology of
Antisocial Personality Disorder
• Genetic and environmental factors appear to play roles in
antisocial personality disorder
• Individuals do not seem to feel fear or anxiety (Lykken, 1995)
• Electroencephalogram (EEG) examinations show criminals who
meet the criteria for antisocial personality disorder have slower
alpha-wave activity (Raine, 1989)
• Pattern of reduced psychophysiological response in the face of
punishment also occurs in adolescents at risk for developing
psychopathy (Fung et al., 2005)
• Evidence of amygdala abnormalities
• Factors such as low socioeconomic status, dysfunctional families,
childhood abuse, and malnutrition may also be important
14.7 Should Childhood Disorders Be
Considered a Unique Category?
• Identify the symptoms and possible causes of
autism.
• Identify the symptoms and possible causes of
attention deficit hyperactivity disorder.
Should Childhood Disorders
Be Considered a Unique Category?
• The current DSM has a category in Axis I called
“disorders usually first diagnosed in infancy,
childhood, or adolescence”
• Conditions such as autistic disorder and
attention deficit hyperactivity disorder affect
every aspect of a child’s life
• All of the disorders in this category should be
considered within the context of normal
childhood development
Autistic Disorder
Involves Social Deficits
• Autistic disorder, or autism, is characterized by deficits in
social interaction, by impaired communication, and by
restricted interests
– Approximately 3 to 6 children out of 1,000 show signs of autistic
disorder. Males with autism outnumber females with autism 3 to 1
– The notion that autism is epidemic overstates reality. There are
several serious problems with studies that claim huge increases in
cases of autism (Gernsbacher, Dawson, & Goldsmith, 2005)
• Autism varies in severity, from mild social impairments to
severe social and intellectual impairments
• As a result, some psychologists prefer the term autism
spectrum disorders, which covers the range of symptoms of
autistic disorder
Core Symptoms of Autism
• Children with severe autism are seemingly unaware of
others.
– As babies, they do not smile at their caregivers, do not respond
to vocalizations, may actively reject physical contact with others,
do not establish eye contact, and do not use their gazes to gain
or direct the attention of those around them
• Deficits in communication are the second major
cluster of behaviors characteristic of autism
• A third category of deficits includes restricted
activities and interests
Autism is Primarily a Biological Disorder
• It is now well established that autism is the result of
biological factors
– There is evidence for a genetic component to autism:
Concordance rates in twins are estimated to be as high as 90
percent for identical twins and 10 percent for dizygotic twins
– Gene mutations may play a role. An international study
compared 996 children with autism to 1,287 control children
and found a number of rare gene abnormalities (Pinto et al.,
2010)
– Prenatal and/or neonatal events may result in brain dysfunction
– Exposure to antibodies in the womb may affect brain
development
– The brains of people with autism have faulty wiring in a large
number of areas
“Autism and Older Dads”
New research suggests that children of older fathers are at
higher risk of having autism. This ScienCentral News video has
more.
Attention Deficit Hyperactivity Disorder Is a
Disruptive Impulse Control Disorder
• Attention deficit hyperactivity disorder (ADHD):
characterized by restlessness, inattentiveness, and
impulsivity
– Children are often friendly and talkative, but they can have
trouble making and keeping friends because they miss subtle
social cues and make unintentional social mistakes
– The line between normal and abnormal behavior is hard to draw
– The best available evidence for children in the United States
suggests that 11 percent of boys and 4 percent of girls have the
disorder (Bloom & Cohen, 2007)
The Etiology of ADHD
• The causes of this disorder are unknown
• One of the difficulties in pinpointing the etiology is
that ADHD is most likely a heterogeneous disorder
• What is known:
– Children with ADHD may be more likely than other children
to come from disturbed families
– ADHD clearly has a genetic component: Concordance is
estimated at 55 percent in identical twins and 32 percent in
dizygotic twins
– Adults with ADHD in childhood had reduced metabolism in
brain regions involved in the self-regulation of motor
functions and of the attentional system
– Researchers have also demonstrated differences in the basal
ganglia in the brains of some ADHD patients
ADHD Across the Life Span
• Children generally are not given diagnoses of ADHD until
they enter structured settings in which they must conform
to rules, get along with peers, and sit in their seats for long
periods
• Longitudinal studies show that children do not outgrow
ADHD by the time they enter adulthood (McGough &
Barkley, 2004)
• Adults with ADHD symptoms, about 4 percent of the
population (Kessler et al., 2006), may struggle academically
and vocationally
• Many adults with ADHD learn how to adapt to their
condition, such as by reducing distractions while they work

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