Chapter 14 Psychological Disorders PowerPoint® Presentation by Jim Foley What we’ll seek to understand... What does it mean to have a mental disorder? Defining and classifying disorders Anxiety disorders, including GAD, Panic, Phobias, OCD and PTSD Mood disorders, including depression and bipolar disorder Schizophrenia Sample of other disorders: Dissociative disorders Eating disorders Personality disorders Rates of Diagnosis with Disorders Why Learn about Psychological Disorders? Reasons for curiosity: personal familiarity with psychological symptoms knowing someone else with the disorder hearing about how prevalent and socially devastating some disorders have become in society wanting to learn more about mental health and human nature Perspectives on Psychological Disorders Defining psychological disorders Thinking critically about ADHD Understanding psychological disorders Classifying psychological disorders Labeling psychological disorders Insanity and responsibility Questions to Keep in Mind How do we decide when a set of symptoms are severe enough to be called a disorder that needs treatment? Can we define specific disorders clearly enough so that we can know that we’re all referring to the same behavior/mental state? Can we use our diagnostic labels to guide treatment rather than to stigmatize people? A Psychological disorder is: A significant dysfunction in an individual’s cognitions, emotions, or behaviors. More Disorders are diagnosed when there Understandings is dysfunction, behaviors which are considered maladaptive because about disorders: they interfere with one’s daily life Disorders are diagnosed when the symptoms and behaviors are accompanied by Distress, suffering. New definition (DSM 5): “a disturbance in the psychological, biological, or developmental processes underlying mental functioning.” Is Attention-Deficit/Hyperactivity Disorder (ADHD) a real disorder? ADHD: Impulsivity mixed with Inattention and/or hyperactivity. Can include distractibility, disorganization, fidgeting, difficulty suppressing impulses, and impaired working memory. Is this a disorder? Is it deviant? Do some people have a level of inattentiveness, impulsiveness, or restlessness that goes beyond laziness or immaturity? Is it distressful? Is the person enjoying being energetic, or are they frustrated that they can’t sustain focus? Is there dysfunction? Are the symptoms harmless fun, or do they negatively impact work and relationships? Understanding the Nature of Psychological Disorders One reason to diagnose a disorder is to make decisions about treating the problem. Based on older understanding of psychological disorders, treatments have included: exorcising evil spirits, beatings, caging/restraint, and Pinel’s New Approach Philippe Pinel (1745-1826) proposed that mental disorders were not caused by demonic possession, but by stress and inhumane conditions. Pinel’s “moral treatment” involved gentleness, nature, and social interaction. Pinel’s interventions improved lives but often did not effectively treat mental illness. But then… The Medical Model The discovery that the disease of syphilis causes mental symptoms (by infecting the brain) suggested a medical model for mental illness. Psychological disorders can be seen as psychopathology, an illness of the mind. Disorders can be diagnosed, labeled as a collection of symptoms that tend to go together. People with disorders can be treated, attended to, given therapy, all with a goal of restoring mental health. The Biopsychosocial Approach Cultural Influences on Disorders Culture-bound syndromes are disorders which only seem to exist within certain cultures; they demonstrate how culture can play a role in both causing and defining a disorder. Examples: Bulimia Nervosa: binging/purging, in the United States Running amok: violent outbursts, in Malaysia Hikikomori: social withdrawal, in Japan Classifying Psychological Disorders Why create classifications of mental illness? What is the value of talking about diagnoses instead of just talking about individuals? 1. Diagnoses create a verbal shorthand for referring to a list of associated symptoms. 2. Diagnoses allow us to statistically study many similar cases, learning to predict outcomes. 3. Diagnoses can guide treatment choices. The Diagnostic and Statistical Manual It’s easier to count cases of autism if we have a clear definition. Versions: DSM-IV-TR, DSM-V (May 2013) The DSM is used to justify payment for treatment. It’s consistent with diagnoses used by medical doctors worldwide. The Five “Axes” of Diagnosis The DSM suggests describing someone not just with a label but with a five-part picture. Axis I: Axis II: Axis III: Axis IV: Axis V: Is a clinical Is a personality Is a general Are What is the syndrome disorder or medical psychosocial global present? mental condition, or assessment of retardation such as environmental this person’s Using (intellectual diabetes, problems, such functioning? specifically developmental arthritis, or as school or defined Clinicians disorder) hypertension housing issues, assign a code criteria, present? also present? also present? clinicians from may select Clinicians may 0-100. none, one, or may not also or more select one of syndromes. these two conditions. Categories of Diagnoses Categories of Diagnoses: The 5 Axes Critiques of Diagnosing with the DSM 1. The DSM calls too many people “disordered.” 2. The border between diagnoses, or between disorder and normal, seems arbitrary. 3. Decisions about what is a disorder seem to include value judgments; is depression necessarily deviant? 4. Diagnostic labels direct how we view and interpret the world, telling us which behavior and mental states to see as disordered. Stigma and Stereotypes Many people think a diagnostic label means being seen as tainted, weak, and weird. However: these negative views/stigma come from popular cultural views of mental illness, and not from the DSM. the DSM may contain the information to correct inaccurate perceptions of mental illness. Insanity and Responsibility Jared Loughner shot many people, including a U.S. Representative, in 2011. Loughner had schizophrenia and substance abuse problems, a combination associated with increased violence. To what degree, if any, should he be held responsible for his actions? What is the appropriate consequence? Anxiety Disorders: Our self-protective, risk-reduction instincts in overdrive Generalized Anxiety Disorder: Painful worrying Panic Disorder: Fear of the next attack Phobias: Don’t even show me a picture OCD: I know it doesn’t make sense, but I can’t help it PTSD: Stuck Reexperiencing Trauma Causes of Anxiety Disorders: Fear Conditioning Observational Learning Genetic/Evolutionary Predispositions Brain involvement GAD: Generalized Anxiety Disorder Emotional-cognitive symptoms include worrying, having anxious feelings and thoughts about many subjects, and sometimes “free-floating” anxiety with no attachment to any subject. Anxious anticipation interferes with concentration. Physical symptoms include autonomic arousal, trembling, sweating, fidgeting, agitation, and sleep disruption. Panic Disorder: “I’m Dying” A panic attack is not just an “anxiety attack.” It may include: many minutes of intense dread or terror. chest pains, choking, numbness, or other frightening physical sensations. a feeling of a need to escape. Panic disorder refers to repeated and unexpected panic attacks, as well as a fear of the next attack. Specific Phobia A specific phobia is more than just a strong fear or dislike. A specific phobia is diagnosed when there is an uncontrollable, irrational, intense desire to avoid the some object or situation. Even an image of the object can trigger a reaction--“GET IT AWAY FROM ME!!!”--the uncontrollable, irrational, intense desire to avoid the object of the phobia. Some Fears and Phobias Which varies more, fear or phobias? What does this imply? Some Other Phobias Agoraphobia is the avoidance of situations in which one will fear having a panic attack. Social phobia: an intense fear of being watched and judged by others, often showing as a fear of possibly embarrassing public appearances. Obsessive-Compulsive Disorder [OCD] Obsessions are intense, unwanted worries, ideas, and images that repeatedly pop up in the mind. A compulsion is a repeatedly strong feeling of “needing” to carry out an action, even though it doesn’t feel like it makes sense. When is it a “disorder”? Distress: when you are deeply frustrated with not being able to control the behaviors or Dysfunction: when the time and mental energy spent on these thoughts and behaviors interfere with everyday life Common OCD Behaviors Percentage of children and adolescents with OCD reporting these obsessions or compulsions: Common pattern: RECHECKING Although you know that you’ve already made sure the door is locked, you feel you must check again. And again. Post-Traumatic Stress Disorder [PTSD] About 10 to 35 percent of people who experience trauma not only have burned-in memories, but also four weeks to a lifetime of: repeated intrusive recall of those memories. nightmares and other reexperiencing. social withdrawal or phobic avoidance. jumpy anxiety or hypervigilance. insomnia or sleep problems. Which people develop PTSD? Those with sensitive emotion-processing limbic systems Those who are asked to relive their trauma as they report it Those previously traumatized Understanding Anxiety Disorders: Explanations from Different Perspectives Classical conditioning: overgeneralizing a conditioned response Genes: predisposed to some fears Operant conditioning: rewarding avoidance The Brain: active anxiety pathways Cognitive appraisals: uncertainty is danger Natural Selection: surviving by avoiding danger Classical Conditioning and Anxiety Operant Conditioning and Anxiety In the experiment by Watson in 1920, Little Albert learned to feel fear around a rabbit because he had been conditioned to associate the bunny with a loud scary noise. Sometimes, such a conditioned response becomes overgeneralized. We may begin to fear all animals, everything fluffy, all experimenters. The result is a phobia or generalized anxiety. We may feel anxious in a situation and make a decision to leave. This makes us feel better and our anxious avoidance was just reinforced. If we know we have locked a door but feel anxious and compelled to re-check, rechecking will help us temporarily feel better. The result is an increase in anxious thoughts and behaviors. Observational Learning and Anxiety Experiments with humans and monkeys show that anxiety can be acquired through observational learning. If you see someone else avoiding or fearing some object or creature, you might pick up that fear and adopt it even after the original scared person is not around. In this way, fears get passed down in families. Cognition and Anxiety Cognition includes worried thoughts, as well as interpretations, appraisals, beliefs, predictions, and ruminations. Cognition includes mental habits such as hypervigilance (persistently watching out for danger). This accompanies anxiety in PTSD. In anxiety disorders, such cognitions appear repeatedly and make anxiety worse. Biology and Anxiety: Genes Studies show that identical twins, even raised separately, develop similar phobias (more similar than two unrelated people). Some people seem to have an inborn highstrung temperament, while others are more easygoing. Temperament may be encoded in our genes. Genes and Neurotransmitters Genes regulate levels of neurotransmitters. People with anxiety have problems with a gene associated with levels of serotonin, a neurotransmitter involved in regulating sleep and mood. People with anxiety also have a gene that triggers high levels of glutamate, an excitatory neurotransmitter involved in the brain’s alarm centers. Biology and Anxiety: The Brain Traumatic experiences can burn fear circuits into the amygdala; these circuits are later triggered and activated. Anxiety disorders include overarousal of brain areas involved in impulse control and habitual behaviors. The OCD brain shows extra activity in the ACC, which monitors our actions and checks for errors. ACC = anterior cingulate gyrus Biology and Anxiety: An Evolutionary Perspective 1. Human phobic objects: 2. Similar but non-phobic objects: Snakes Fish Heights Low places Closed spaces Open spaces Darkness Bright light 3. Dangerous yet non-phobic subjects: We are likely to become cautious about, but not phobic about: Guns Electric wiring Cars Evolutionary psychologists believe that ancestors prone to fear the items on list #1 were less likely to die before reproducing. There has not been time for the innate fear of list #3 (the gun list) to spread in the population. Mood Disorders: Not just feeling “down;” not just sad about something Major Depressive Disorder: Stuck in dark withdrawal Bipolar Disorder: sometimes fleeing depression into mania Prevalence and Course of depression: Common, but for many it goes away Genetic Influences on Depression Suicide and Self-Injury Negative Moods and Negative thoughts: Explanatory style The vicious cycle: Interaction of bad experiences depressive thoughts mood changes behavior changes more sad days Mood Disorders Major depressive disorder [MDD] is: more than just feeling “down.” more than just feeling sad about something. Bipolar disorder is: more than “mood swings.” depression plus the problematic overly “up” mood called “mania.” Criteria of Major Depressive Disorders Major depressive disorder is not just one of these symptoms. It is one or both of the first two, PLUS three or more of the rest. Depressed mood most of the day, and/or Markedly diminished interest or pleasure in activities Significant increase or decrease in appetite or weight Insomnia, sleeping too much, or disrupted sleep Lethargy, or physical agitation Fatigue or loss of energy nearly every day Worthlessness, or excessive/inappropriate guilt Daily problems in thinking, concentrating, and/or making decisions Recurring thoughts of death and suicide Depression is Everywhere Depression shows up in people seeking treatment: Phobias are the most common (frequently experienced) disorder, but depression is the #1 reason people seek mental health services. Depression appears worldwide: Per year, depressive episodes happen to about 6 percent of men and about 9 percent of women. Over the course of a lifetime, 12 percent of Canadians and 17 percent of USA residents experience depression. Depression: The “Common Cold” of Disorders? Although both are “common” (occurring frequently and pervasively), comparing depression to a cold doesn’t work. Depression: is more dangerous because of suicide risk. has fewer observable symptoms. is more lasting than a cold, and is less likely to go away just with time. is much less contagious. And…depressive pain is beyond sniffles. Seasonal Affective Disorder [SAD] Seasonal affective disorder is more than simply disliking winter. Seasonal affective disorder involves a recurring seasonal pattern of depression, usually during winter’s short, dark, cold days. Survey: “Have you cried today”? Result: More people answer “yes” in winter. Percentage who cried Men Women August 4 7 December 8 21 Bipolar Disorder Bipolar disorder was once called “manic-depressive disorder.” Bipolar disorder’s two polar opposite moods are depression and mania. Mania refers to a period of hyper-elevated mood that is euphoric, giddy, easily irritated, hyperactive, impulsive, overly optimistic, and even grandiose. Contrasting Symptoms Depressed mood: stuck feeling Mania: euphoric, giddy, easily “down,” with: irritated, with: exaggerated pessimism exaggerated optimism social withdrawal hypersociality and sexuality lack of felt pleasure delight in everything inactivity and no initiative impulsivity and overactivity difficulty focusing racing thoughts; the mind fatigue and excessive desire to won’t settle down sleep little desire for sleep Bipolar Disorder and Creative Success Many famous and successful people have lived with the ups and downs of bipolar disorder. Some speculate that the depressive periods gave them ideas, and the manic episodes gave them creative energy. Any evidence of mood swings here? Bipolar Disorder in Children and Adolescents Does bipolar disorder show up before adulthood, and even before puberty? Many young people have cycles from depression to extended rage rather than mania. The DSM-V may have a new diagnosis for some of these kids: disruptive mood dysregulation disorder. Understanding Mood Disorders Why are mood disorders so pervasive, especially among women? Women, starting in adolescence, appear to ruminate more, have deeper sadness then men, encounter more stressors, and report their depression more readily. Understanding Mood Disorders Can we explain… Why does depression often go away on its own? the course/development of reactive depression? Often, time heals a mood disorder, especially when the mood issue is in reaction to a stressful event. However, a significant proportion of people with major depressive disorder do not automatically or easily get better with time. Understanding Mood Disorders Biological aspects and explanations Social-cognitive aspects and explanations Evolutionary Genetic Brain /Body Negative thoughts and negative mood Explanatory style The vicious cycle An Evolutionary Perspective on the Biology of Depression Depression, in its milder, nondisordered form, may have had survival value. Under stress, depression is social-emotional hibernation. It allows humans to: conserve energy. avoid conflicts and other risks. let go of unattainable goals. take time to contemplate. Biology of Depression: Genetics Evidence of genetic influence on depression: 1. DNA linkage analysis reveals depressed gene regions 2. twin/adoption heritability studies Biology of Depression: The Brain Brain activity is diminished in depression and increased in mania. Brain structure: smaller frontal lobes in depression and fewer axons in bipolar disorder Brain cell communication (neurotransmitters): more norepinephrine (arousing) in mania, less in depression reduced serotonin in depression Suicide and Self-Injury Every year, 1 million people commit suicide, giving up on the process of trying to cope and improve their emotional well-being. This can happen when people feel frustrated, trapped, isolated, ineffective, and see no end to these feelings. Non-suicidal self-injury has other functions such as sending a message, distracting from emotional pain, giving oneself permission to feel, or self-punishment. Understanding Mood Disorders: The Social-Cognitive Perspective Low SelfEsteem Discounting positive information and assuming the worst about self, situation, and the future Self-defeating beliefs such as assuming that one (self) is Learned unable to cope, Helplessness improve, achieve, or be happy Depression is associated with: Depressive Explanatory Style Rumination Stuck focusing on what’s bad Depressive Explanatory Style How we analyze bad news predicts mood. Problematic event: Assumptions about the problem The problem is: The problem is: The problem is: Mood/result that goes along with these views: Depression’s Vicious Cycle A depressed mood may develop when a person with a negative outlook experiences repeated stress. The depressed mood changes a person’s style of thinking and interacting in a way that makes stressful experience more likely. Schizophrenia Split from reality and from self Schizophrenia symptoms: Disorganized thinking, Delusions Disturbed perceptions: Hallucinations Unusual emotions and actions, including flat affect, and catatonia Subtypes Onset and course Causes of symptoms: Brain: Dopamine overactivity Abnormal brain anatomy and activity Maternal virus during pregnancy Associated genes Schizophrenia: Psychosis refers to a mental split from reality and rationality. the mind is split from reality, e.g. a split from one’s own thoughts so that they appear as hallucinations. Schizophrenia symptoms include: disorganized and/or delusional thinking. disturbed perceptions. inappropriate emotions and actions. Positive and Negative Symptoms of Schizophrenia Positive + presence of problematic behaviors Hallucinations (illusory perceptions), especially auditory Delusions (illusory beliefs), especially persecutory Disorganized thought and nonsensical speech Bizarre behaviors Negative absence of healthy behaviors Flat affect (no emotion showing in the face) Reduced social interaction Anhedonia (no feeling of enjoyment) Avolition (less motivation, initiative, focus on tasks) Alogia (speaking less) Catatonia (moving less) Schizophrenia Symptoms: Problems in Thinking and Speaking Disorganized speech, including the “word salad” of loosely associated phrases Delusions (illusory beliefs), often bizarre and not just mistaken; most common are delusions of grandeur and of persecution Problems with selective attention, difficulty filtering thoughts and choosing which thoughts to believe and to say out loud ?!?! ?!?! Schizophrenia Symptoms: Disturbed Perceptions People with schizophrenia often experience hallucinations, that is, perceptual experiences not shared by others. The most common form of hallucination is hearing voices that no one else hears, often with upsetting (e.g. shaming) content. Hallucinations can also be visual, olfactory/smells, tactile/touch, or gustatory/taste. Am I evil? You’re evil! Schizophrenia Symptoms: Inappropriate Emotions and Actions Odd and socially inappropriate responses such as looking bored or amused while hearing of a death Flat affect: facial/body expression is “flat” with no visible emotional content Impaired perception of emotions, including not “reading” others’ intentions and feelings The schizophrenic body exhibits symptoms such as: repetitive behaviors such as rocking and rubbing. catatonia, such as sitting motionless and unresponsive for hours. Onset and Development of Schizophrenia Onset: Typically, schizophrenic symptoms appear at the end of adolescence and in early adulthood, later for women than for men. Prevalence: Nearly 1 in 100 people develop schizophrenia, slightly more men than women. Development: The course of schizophrenia can be acute/reactive or chronic. Course of Schizophrenia Acute/Reactive Schizophrenia In reaction to stress, some people develop positive symptoms such as hallucinations. – Recovery is likely. Chronic/Process Schizophrenia develops slowly, with more negative symptoms . – With treatment and support, there may be periods of a normal life, but not a cure. – Without treatment, this type of schizophrenia often leads to poverty and social problems. Subtypes of Schizophrenia Paranoid • Plagued by hallucinations, often with negative messages, and delusions, both grandiose and persecutory Disorganized • Primary symptoms are flat affect, incoherent speech, and random behavior Catatonic • Rarely initiating or controlling movement; copies others’ speech and actions Undifferentiated • Many varied symptoms Residual • Withdrawal continues after positive symptoms have disappeared Understanding Schizophrenia What’s going on in the brain in schizophrenia? Abnormal brain structure and activity Too many dopamine/D4 receptors help to explain paranoia and hallucinations; it’s like taking amphetamine overdoses all the time. Poor coordination of neural firing in the frontal lobes impairs judgment and self-control. The thalamus fires during hallucinations as if real sensations were being received. There is general shrinking of many brain areas and connections between them. Understanding Schizophrenia Are there biological risk factors affecting early development? Biological Risk Factors Schizophrenia is somewhat more likely to develop when one or more of these factors is present: low birth weight maternal diabetes older paternal age famine oxygen deprivation during delivery maternal virus during mid-pregnancy impairing brain development Schizophrenia is more likely to develop in babies born: during and after flu epidemics. in densely populated areas. a few months after flu season. after mothers had the flu during the second trimester, or had antibodies showing viral infection. The lesson is to: get flu shots with early fall pregnancies. Understanding Schizophrenia Are there genetic risk factors? If so, we would see more similar schizophrenia risk shared between identical twins than fraternal twins (graph below). Do we? Genetic Factors If one twin has schizophrenia, the chance of the other one also having it are much greater if the twins are identical. Having adoptive siblings (or parents) with schizophrenia does not increase the likelihood of developing schizophrenia. Understanding Schizophrenia Genetic and Prenatal Causes Even in quadruplets, genetics do not fully predict schizophrenia. This could be because of environmental differences. First difference: twins in separate placentas. Only one of two twins has the enlarged ventricles seen in schizophrenia. The Genain quadruplets share genes and all have schizophrenia but at different levels of severity: genes may interact with environment to produce this pattern. Other Disorders, Including Dissociative, Personality, and Eating Disorders A sample of a few of the many other psychological disorders Dissociative Disorders: Separation of consciousness Dissociative Identity Disorder: Is it real? How could it happen? Personality Disorders: Severe, enduring problems relating to others Focus on Antisocial Personality Disorder Overlap with criminal activity Brain differences Genes and social causes Eating Disorders Anorexia and Bulimia Genes and social causes Dissociative Disorders Dissociation: a separation of conscious awareness from thoughts, memory, bodily sensations, feelings, or even from identity. Dissociative disorder: dysfunction and distress caused by chronic and severe dissociation. Examples: Dissociative Fugue state Fugue = “Running away”; wandering away from one’s life, memory, and identity, with no memory of them Dissociative Identity Disorder (D.I.D.) Development of separate personalities Dissociative Identity Disorder (D.I.D.) formerly “Multiple Personality Disorder” In the rare actual cases of D.I.D., the personalities: are distinct, and not present in consciousness at the same time. may or may not appear to be aware of each other. Alternative Explanations for D.I.D. Dissociative “identities” might just be an extreme form of playing a role. D.I.D. in North America might be a recent cultural construction, similar to the idea of being possessed by evil spirits. Cases of D.I.D. might be created or worsened by therapists encouraging people to think of different parts of themselves. D.I.D., or DID Not? Evidence that D.I.D. is Real Different personalities have involved: different brain wave patterns. different left-right handedness. different visual acuity and eye muscle balance patterns. Patients with D.I.D. also show heightened activity in areas of the brain associated with managing and inhibiting traumatic memories. Explaining fragmentation of personality from different perspectives Psychoanalytic perspective: diverting id Cognitive perspective: coping with abuse Learning perspective: dissociation pays Social influence: therapists encourage Eating Disorders Anorexia nervosa Bulimia nervosa Binge-eating disorder Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder These may involve: unrealistic body image and extreme body ideal. a desire to control food and the body when one’s situation can’t be controlled. cycles of depression. health problems. Definition Prevalence Compulsion to lose weight, 0.6 percent coupled with certainty about being meet criteria at fat despite being 15 percent or some time more underweight during lifetime Compulsion to binge, eating large amounts fast, then purge by losing 1.0 percent the food through vomiting, laxatives, and extreme exercise Compulsion to binge, followed by 2.8 percent guilt and depression Eating Disorders: Associated Factors Family factors: having a mother focused on her weight, and on child’s appearance and weight negative self-evaluation in the family for bulimia, if childhood obesity runs in the family for anorexia, if families are competitive, high-achieving, and protective Cultural factors: unrealistic ideals of body appearance Personality Disorders Personality disorders are enduring patterns of social and other behavior that impair social functioning. There are three “clusters”/categories of personality disorders. Anxious: e.g., Avoidant P.D., ruled by fear of social rejection Eccentric/Odd: e.g. Schizoid P.D., with flat affect, no social attachments Dramatic: e.g. Histrionic, attention-seeking; narcissistic, self-centered; antisocial, amoral Antisocial Personality Disorder [APD] Antisocial personality disorder: Persistently acting without conscience, without a sense of guilt for harm done to others (strangers and family alike). The diagnostic criteria include a pattern of violating the rights of others since age 15, including three of these: Deceitfulness Disregard for safety of self or others Aggressiveness Failure to conform to social norms Lack of remorse Impulsivity and failure to plan ahead Irritability Irresponsibility regarding jobs, family, and money Which Kids May Develop APD as Adults? About half of children with persistent antisocial behavior develop lifelong APD. Which kids are at risk? Psychological factors: those who in preschool were impulsive, uninhibited, unconcerned with social rewards, and low in anxiety. those who endured child abuse, and/or inconsistent, unavailable caretaking. Biological APD Risk Factors Antisocial or unemotional biological relatives increases risk. Some associated genes have been identified. Lower levels of stress hormones and low physiological arousal in stressful situations Fear conditioning is impaired. Reduced prefrontal cortex tissue leads to impulsivity. Substance dependence is more likely. Antisocial PD ≠ Criminality Criminals: people who repeatedly commit crimes People with antisocial personality disorder Many career criminals do show empathy and selflessness with family and friends. Many people with A.P.D. do not commit crimes. Antisocial Crime: Associated factors Though antisocial personality disorder is not a full picture of most criminal activity, what can we say about people who commit crime, especially violent crime? Lower levels of physiological arousal (measured here as adrenaline levels) under stress may enable taking violent action without feeling anxiety or panic. Biosocial Roots of Crime: The Brain People who commit murder seem to have less tissue and activity in the part of the brain that suppresses impulses. Other differences include: less amygdala response when viewing violence. an overactive dopamine reward-seeking system. How common are psychological disorders? Countries vary greatly in the percentage of people reporting mental health issues in the past year. Rates of Psychological Disorders This list takes a closer look at the past-year prevalence of various mental health diagnoses in the United States. Vulnerable factors and ages for developing Mental Disorders Who is vulnerable to mental disorders? • Poverty increases the risk of many mental disorders including aggression and anxiety. Disorders decrease when poverty is lifted. • “Immigrant paradox”: Despite the stress of immigrating, those who immigrate to the U.S.A. have a lower risk of disorders than their children born in the U.S.A. Age of vulnerability: • Many disorders begin to show symptoms by early adulthood. • Developing on average around age 20: OCD, Schizophrenia, Bipolar, Alcohol Dependence. • Showing some signs earlier: Phobias (median age 10) and antisocial personality disorder (some symptoms by age 8) • Developing later than 20: Major Depressive Disorder. Outcomes for People with Psychological Disorders There are risks to be watchful of, obstacles to be overcome, and improvements to be made, often with the help of with treatment. Some people with psychological disorders do not recover. Some achieve greatness, even with a psychological disorder.