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Here is a list of mental disorders.
1. Disorders of Infancy, Childhood and Adolescence:
Freud once stated that the child is the parent of the adult, and where mental disorders are concerned, he was correct: The problems people experience as adults are often visible much earlier in life.
Recognition of this basic fact is one reason behind the increasing importance of a developmental perspective on mental disorders the view that problems and difficulties experienced during childhood or adolescence can play an important role in the emergence of various disorders during adulthood.
The DSM-IV takes note of this fact, and lists many disorders that first emerge during childhood or adolescence. Many psychologists believe that childhood problems can be described in terms of two basic dimensions- Externalizing problems are disruptive behaviors that are often a nuisance to others, such as aggression, hyperactivity, impulsivity, and inattention; in contrast, internalizing problems are ones in which children show deficits in desired behaviors, such as difficulty in interacting with peers or problems with expressing their wishes and needs to others. Children show these difficulties to varying degrees, so considering where a child falls along these dimensions can be very revealing. For purposes of this discussion, however, we’ll stick closely to the disorders described by the DSM-IV.
Srinath and Girimaji (1999) in their review of research on childhood psychiatric and emotional problems report that in India the prevalence ranges from 25 to 356/1000 in field studies. Bhola and Kapur (2003), however, note the range to be 5/1000 to 294/1000. Mental retardation, epilepsy, and enuresis are reported as highly prevalent disorders in community-based studies.
The 23 school-based studies listed during the period 1978-2002 identified enuresis, MR, conduct disorders, and attention deficit hyperactivity disorder (ADHD) as being the most prevalent.
In general, it has been realized that school-going children report higher psychological disturbances; urban children report more problems compared to rural children; boys report more problems than girls. Scholastic backwardness has been a major problem in the Indian region. It was thus concluded that scholastic and learning-related problems of children need to be examined simultaneously with mental health problems.
i. Disruptive Behavior:
Disruptive behaviors are the most common single reason why children are referred to psychologists for diagnosis and treatment. And in fact disruptive behaviors are quite common. As many as 10 percent of children may show such problems at some time or other. Disruptive behaviors are divided by the DSM- IV into two major categories- oppositional defiant disorder and conduct disorder.
Oppositional defiant disorder involves a pattern of behavior in which children have poor control of their emotions or have repeated conflicts with parents, teachers, and other adults.
What are the causes of these disruptive patterns of behavior? Biological factors appear to play a role. Boys show such problems much more often than girls, a pattern that suggests a role for sex hormones. Also, some findings suggest that children who develop CD have unusually low levels of general arousal and thus seem to crave the excitement that accompanies their disruptive behaviors. But psychological factors, too, play a role.
Children with conduct disorder often show insecure attachment to their parents and often live in negative environments that may involve poverty, large family size, and being placed in foster care. In addition, their parents often use coercive child-rearing practices, which may actually encourage disruptive behavior. Whatever the precise causes, it is clear that CD is a serious problem that can well pave the way to additional problems during adulthood.
ii. Attention-Deficit/Hyperactivity Disorder (ADHD):
When you were in school, you must have seen a classmate who couldn’t sit still and who interrupted the class repeatedly by getting up and wandering around? A teacher has to make extra effort get such children stay in his seat and pay attention to the lesson. Such children suffer from attention-deficit/hyperactivity disorder (ADHD).
Actually, three patterns of ADHD exist: one in which children simply can’t pay attention; another in which they show hyperactivity or impulsivity they really can’t sit still and can’t restrain their impulses; and a third pattern that combines the two. Unfortunately, ADHD is not a problem that fades with the passage of time: Seventy percent of children diagnosed with ADHD in elementary school still show signs of it when they are sixteen. Moreover, by this time it is often accompanied by conduct disorder.
The causes of ADHD appear, again, to be both biological and psychological. For instance, such factors as low birth weight, oxygen deprivation at birth, and alcohol consumption by expectant mothers have all been associated with ADHD. In addition, deficits in the reticular activating system and in the frontal lobes may be linked to ADHD. With respect to psychological factors, risk factors seem to include parental intrusiveness and overstimulation parents who just can’t seem to let their infants alone.
Fortunately, ADHD can be treated successfully with several drugs, all of which act as stimulants. Ritalin is the most frequently used, and it amplifies the impact of two neurotransmitters norepinephrine and dopamine in the brain. While taking this drug, children are better able to pay attention and often become calmer and more in control of their own behavior.
The effects of Ritalin and other medications last only four to five hours, however, so the drugs must be taken quite frequently. Also, Ritalin and other drugs produce potentially harmful side effects (e.g., decreased appetite, insomnia, headaches, increased blood pressure); they are definitely not an unmixed blessing.
For this reason, many psychologists recommend treating ADHD not just with drugs (a purely medical approach), but with behavioral management programs in which children are taught to listen to directions, to continue with tasks, to stay in their seat while in class, and other important skills.
iii. Feeding and Eating Disorders:
Over the past few decades, that feeding and eating disorders disturbances in eating behavior that involve maladaptive and unhealthy efforts to control body weight are becoming increasingly common. The trend in recent decades has been for these disturbing disorders to start at earlier and earlier ages as young as age eight. Two eating disorders, anorexia nervosa and bulimia nervosa, have received most attention.
a. Anorexia Nervosa: Proof That You Can Be Too Slim:
Anorexia nervosa involves an intense and excessive fear of gaining weight coupled with refusal to maintain a normal body weight. In other words, people with this disorder relentlessly pursue the goal of being thin, no matter what this does to their health. They often have distorted perceptions of their own bodies, believing that they are much heavier than they really are. As a result of such fears and distorted perceptions, they starve themselves to the point where their weight drops to dangerously low levels.
Why do persons with this disorder have such an intense fear of becoming fat? Important clues are provided by the fact that anorexia nervosa is far more common among females than males. Research findings indicate that few men prefer the extremely thin figures that anorexics believe men admire; rather, men find a fuller- figured, more rounded appearance much more attractive.
That intense social pressures do indeed play a role in anorexia nervosa is suggested by the findings of a recent study by Paxton and her colleagues (1999). These researchers found that among fifteen-year-old girls, the greater the pressure from their friends to be thin, the more likely the teens was to be unhappy with their current bodies and to be greatly restricting their food intake. Whatever its precise origins, anorexia nervosa poses a serious threat to the physical as well as the psychological health of the persons who experience it.
b. Bulimia: The Binge-Purge Cycle:
If you found anorexia nervosa disturbing, you may find a second eating disorder, bulimia nervosa, even more unsettling. In this disorder individuals engage in recurrent episodes of binge eating eating huge amounts of food within short periods of time followed by some kind of compensatory behavior designed to prevent weight gain. This can involve self-induced vomiting, the misuse of laxatives, fasting, or exercise so excessive that it is potentially harmful to the person’s health.
The causes of bulimia nervosa appear to be similar to those of anorexia nervosa: Once again, the “thin is beautiful” ideal seems to play an important role. Another, and related, factor is the desire to be perfect in all respects, including those relating to physical beauty. Research findings indicate that women who are high on this trait are at risk for developing bulimia, especially if they perceive themselves to be overweight.
And, in fact, bulimics like anorexics do tend to perceive themselves as much heavier than they really are. This fact is illustrated clearly by a study conducted by Williamson, Cubic, and Gleaves (1993).
These researchers noted that when current body size was held constant statistically, both bulimic and anorexic persons rated their current body size as larger than did control participants, and both rated their ideal as smaller than did controls. Both groups with eating disorders viewed themselves as farther from their ideal than did persons who did not suffer from an eating disorder.
Fortunately, it appears that the frequency of eating disorders tends to decrease with age, at least for women. Men, in contrast, may be more at risk for such problems as they get older: The percentage of men who diet increases somewhat with age, and dieting can sometimes lead to excessive efforts to reduce one’s weight.
iv. Autism: A Pervasive Developmental Disorder:
Of all the childhood disorders, the ones that may be most disturbing of all are those described in the DSM-IV as pervasive developmental disorders. Such disorders involve lifelong impairment in mental or physical functioning; among these, the one that has received most attention is autistic disorder, or autism. This term is derived from the Greek word autos (self) and is an apt description for children with this disorder, for they seem to be preoccupied with themselves and to live in an almost totally private world.
Children with autism show three major characteristics: marked impairments in establishing social interactions with others (e.g., they don’t use nonverbal behaviors such as eye contact, don’t develop peer relationships, and don’t seem to be interested in other people); nonexistent or poor language skills; and stereotyped, repetitive patterns of behavior.
Consider the following description of one such child:
“A mother is watching her three year old son play. For the last hour, he has been sitting on the floor staring at his right hand, which he holds over his head as he opens and closes his fingers. The child is looking at changes in the lighting that he makes by waving his fingers in front of the ceiling light. He has been doing this every day for months……. Before he was a year old, the mother had begun to notice all sorts of problems. He would never reach out for toys or babble like other babies. He wouldn’t even splash around in the water when she gave him a bath…….. Perhaps most upsetting of all, he didn’t use language and didn’t seem to notice other people. If another child walked over to him, he would shrink back and begin to cry. If his mother called his name, he would ignore her…. The only time he seemed to notice other people was when he got upset…”
Truly, children with autistic disorder seem to live in a world of their own. They make little contact with others, either through words or nonverbal gestures; show little interest in others; and, when they do notice them, often seem to treat them as objects rather than people. How truly sad.
Autistic disorder seems to have important biological and genetic causes. Twin studies, for instance, show a higher concordance rate for identical than for fraternal twins. Similarly, other studies suggest that the brains of children with autistic disorder have structural or functional abnormalities, such as frontal lobes that are less well developed than in normal children.
Psychological factors that play a role in autistic disorder include attentional deficits. Autistic children fail to attend to social stimuli such as their mother’s face and voice, or to others’ calling their names. Perhaps the most intriguing findings of all are that autistic children have deficits in their theory of mind, refers to children’s understanding of their own and others’ mental states.
Apparently, autistic children show serious deficits in this respect. They are unable to realize that other people can have access to different sources of information than themselves, and they are unable to predict the beliefs of others from information that should allow them to make such predictions.
Evidence that deficits with respect to theory of mind do play an important role in autism is provided by research conducted by Peterson and Siegal (1999). These psychologists reasoned that in order to develop an adequate theory of mind, children require social interactions with others in which they communicate about their own and others’ mental states. Because autistic children show marked deficits in the use of language and in interacting with others, they would be expected to experience deficits in their theory of mind.
Peterson and Siegal (1999) reasoned that this would also be true, to a degree, for deaf children living in homes where no one else knew the sign language they used to communicate. Such children would be deprived of opportunities to develop their theory of mind adequately. In contrast, deaf children living in homes where others knew sign language would have such opportunities and would not experience these deficits.
To test these predictions, Peterson and Siegal had autistic children and several groups of deaf children (ones who could use sign language at home and ones who could not) perform tasks that measure children’s theory of mind. In one task, for instance, children were shown a box that usually contained candy but in this case contained pencils. After discovering the unexpected contents, the children were asked what another child would expect to find in the box.
A correct reply was that this other child would expect candy, because she or he wouldn’t know, as the child did, that the box contained pencils. Results confirmed the prediction that both autistic children and deaf children who did not have an opportunity to converse with others about mental states would perform more poorly than would non-deaf children or deaf children who did have the opportunity to converse. These findings suggest that deficits with respect to theory of mind do indeed play a role in autistic disorder.
2. Mood Disorders:
Have you ever felt truly “down in the dumps” sad, blue, and dejected? How about “up in the clouds” happy, elated, excited? Probably you can easily bring such experiences to mind, for everyone has swings in mood or emotional state. For most of us, these swings are usually moderate in scope; periods of deep despair and wild elation are rare.
Some persons, however, experience swings in their emotional states that are much more extreme and prolonged. Their highs are higher, their lows are lower, and they spend more time in these states than most people. Such persons are described as suffering from mood disorders. Among the most important of these are depressive disorders and bipolar disorders.
i. Depressive Disorders: Probing the Depths of Despair:
Unless we lead a truly charmed existence, our daily lives bring some events that make us feel sad or disappointed. A poor grade, breaking up with one’s romantic partner, failure to get a promotion these and many other events tip our emotional balance toward sadness. When do such reactions constitute depression? Most psychologists agree that several criteria are useful for reaching this decision.
First, persons suffering from depression experience truly profound unhappiness, and they experience it much of the time. Second, persons experiencing depression report that they have lost interest in all the usual pleasures of life (e.g., eating, sex, sports, hobbies). Third, persons suffering from depression often experience significant weight loss (when not dieting) or gain.
Depression may also involve fatigue, insomnia, feelings of worthlessness, a recurrent inability to think or concentrate, and recurrent thoughts of death or suicide. An individual who experiences five or more of these symptoms at once during the same two-week period is classified by the DSM-IV as undergoing a major depressive episode.
Depression is very common. In fact, it is experienced by 21.3 percent of women and 12.7 percent of men at some time during their lives. This nearly two-to-one gender difference in depression rates has been reported in many studies, especially in studies conducted in wealthy, developed countries; so it appears to be a real one. Why does it exist? As noted by Strickland (1992), several factors account for this finding, including the fact that females have traditionally had lower status, power, and income than males; must worry more than males about their personal safety; and are the victims of sexual harassment and assaults much more often than males.
Gender differences in rates of depression may also stem, at least to a degree, from the fact that females are more willing to admit to such feelings than males, or from the fact that women are more likely than men to remember such episodes.
Unfortunately, episodes of major depression are not isolated events; most people who experience one such episode also experience others during their lives an average of five or six. And others experience what is known as double depression they recover from major depression but continue to experience a depressed mood (dysthymic disorder) or, in some cases, unusual irritability.
ii. Bipolar Disorders: Riding the Emotional Roller Coaster:
If depression is the emotional sinkhole of life, bipolar disorder is life’s emotional roller coaster. People suffering from bipolar disorder experience wide swings in mood. They move, over varying periods of time, between deep depression and an emotional state known as mania, in which they are extremely excited, elated, and energetic.
During manic periods such persons speak rapidly, show a sharply decreased need for sleep, jump from one idea or activity to another, and show excessive involvement in pleasurable activities that have a high potential for harmful consequences.
For example, they may engage in wild buying sprees or make extremely risky investments. Clearly, bipolar disorders are very disruptive not only to the individuals who experience them but to other people in their lives as well.
3. Anxiety Disorders:
At one time or another, we all experience anxiety a diffuse or vague concern that something unpleasant will soon occur. If such feelings become intense and persist for long periods of time, however, they can constitute another important form of mental disorder. Such anxiety disorders take several different forms, and we’ll consider the most important of these here.
i. Phobias: Excessive Fear of Specific Objects or Situations:
Most people express some fear of snakes, heights, violent storms, and buzzing insects such as bees or wasps. Because all of these can pose real threats to our safety, such reactions are adaptive, up to a point. But if such fears become excessive, in that they cause intense emotional distress and interfere significantly with everyday activities, they constitute phobias, one important type of anxiety disorder.
The effects of one type of phobia are vividly illustrated by the following case:
“At nine years old, Ritika’s fear of heights was so strong she was unable to attend schools with more than one story. She panicked when her class went on field trips where there were steps. She was both frightened and embarrassed in front of her classmates on their trip to a museum; she was able to climb the stairs to the second floor, but then she had to lie down and slide on her stomach to get back down.”
While many different phobias exist, most seem to involve fear of animals (e.g., bees, spiders, snakes); the natural environment (e.g., thunder, darkness, wind); illness and injections (e.g., blood, needles, pain, contamination); and various specific situations (e.g., enclosed places, travel, empty rooms). The most common phobia of all is social phobia excessive fear of situations in which a person might be evaluated and perhaps embarrassed.
It is estimated that fully 13 percent of people living in the United States have had a social phobia at some time in their lives, and almost 8 percent report having experienced such fears during the past year. Social phobias appear to exist all around the world, but they take different forms in different cultures.
In collectivistic cultures such as Japan, social phobias seem to focus on individuals’ fear that they will do something to offend other members of their social group (e.g., say something offensive, have a displeasing appearance, emit an offensive odor). In individualistic cultures such as those in Europe or North America, social phobias tend to focus on the fear of being evaluated negatively by others in public situations.
What are the causes of phobias? Through such learning, stimuli that do not initially elicit strong emotional reactions can often come to do so. For example, an individual may acquire an intense fear of buzzing sounds such as those made by bees after being stung by a bee or wasp. In the past, the buzzing sound was a neutral stimulus that produced little or no reaction.
The pain of being stung, however, is an unconditioned stimulus; and as a result of being closely paired with the pain, the buzzing sound acquires the capacity to evoke strong fear. Genetic factors, too, may play a role. Some findings suggest that persons who develop phobias are prone to excessive physiological arousal in certain situations, perhaps because portions of their brain (e.g., the limbic system, the amygdala) are overactive. This intense arousal can serve as the basis for classical conditioning and other forms of learning, and so can result in phobias.
ii. Panic Disorder and Agoraphobia:
The intense fears associated with phobias are triggered by specific objects or situations. Some individuals, in contrast, experience intense, terrifying anxiety that is not activated by a specific event or situation. Such panic attacks are the hallmark of panic disorder, a condition characterized by periodic, unexpected attacks of intense, terrifying anxiety. Panic attacks come on suddenly, reach peak intensity within a few minutes, and may last for hours.
They leave the persons who experience them feeling as if they are about to die or are losing their minds. Among the specific symptoms of panic attacks are a racing heart, sweating, dizziness, nausea, trembling, palpitations, pounding heart, feelings of unreality, fear of losing control, fear of dying, numbness or tingling sensations, and chills or hot flashes.
Although panic attacks often seem to occur out of the blue, in the absence of any specific triggering event, they often take place in specific situations. In such cases panic disorder is said to be associated with agoraphobia, or fear of situations in which the individual suspects that help will not be available if needed.
It often takes the form of intense fear of open spaces, fear of being in public, fear of traveling or, commonly, fear of having a panic attack while away from home! Persons suffering from panic disorder with agoraphobia often experience anticipatory anxiety; they are terrified of becoming afraid.
What causes panic attacks? Existing evidence indicates that both biological factors and cognitive factors play a role. With respect to biological factors, it has been found that there is a genetic component in this disorder. About 50 percent of people with panic disorder have relatives who have it too. In addition, PET scans of the brains of persons who suffer from panic attacks suggest that even in the non-panic state, their brains may be functioning differently from those of other persons.
A portion of the brain stem, the locus coeruleus (LC), may play a key role in panic experiences. This area seems to function as a primitive “alarm system,” and stimulating it artificially in animals results in panic like behavior. It seems possible that in persons who experience panic attacks, the LC may be hypersensitive to certain stimuli (e.g., lactic acid, a natural by-product of exercise); as a result, these persons may experience intense fear in situations in which others do not. No conclusive evidence on this possible mechanism yet exists, but it seems worthy of further study.
With respect to cognitive factors, persons suffering from panic disorder tend to show a pattern of interpreting bodily sensations as being more dangerous than they really are for instance, they perceive palpitations as a sign of a heart attack and so experience anxiety, which itself induces further bodily changes and sensations.
A diathesis-stress model proposed by Barlow (1988, 1993) suggests that panic disorder combines biological vulnerability with cognitive factors such as the tendency to perceive relatively harmless stressors as signs of mortal danger and the tendency to then remain vigilant and “on guard” against such imagined dangers.
iii. Obsessive-Compulsive Disorder: Behaviors and Thoughts outside One’s Control:
Have you ever left your home, gotten halfway down the street, and then returned to see if you really locked the door or turned off the stove? And have you ever worried about catching a disease by touching infected people or objects? Most of us have had these experiences, and they are completely normal. But some persons experience intense anxiety about such concerns.
These individuals have disturbing thoughts or images that they cannot get out of their minds (obsessions) unless they perform some action or ritual that somehow reassures them and helps to break the cycle (compulsions). Persons who have such experiences may be experiencing obsessive compulsive disorder, another important type of anxiety disorder.
Common compulsions actions people perform to neutralize their obsessions include repetitive hand washing, checking doors, windows, water, or gas repeatedly; counting objects a precise number of times or repeating an action a specific number of times; and hoarding old mail, newspapers, and other useless objects.
What is the cause of such reactions? We all have repetitious thoughts occasionally, for example, after watching a film containing disturbing scenes of violence, we may find ourselves thinking about these over and over again. Most of us soon manage to distract ourselves from such unpleasant thoughts. But individuals who develop obsessive-compulsive disorder are unable to do so.
They are made anxious by their obsessive thoughts, yet they can’t dismiss them readily from their minds. Moreover, they have had past experiences for instance, embarrassments that suggest to them that some thoughts are so dangerous they must be avoided at all costs. As a result, they become even more anxious, and the cycle builds. Only by performing specific actions can these individuals ensure their “safety” and reduce their anxiety.
Therefore, they engage in complex repetitive rituals that can gradually grow to fill most of their day. Because these rituals do help reduce anxiety, the tendency to perform them grows stronger. Unless such persons receive effective outside help, they have little chance of escaping from their self-constructed, anxiety-ridden prisons.
Some intriguing gender differences exist with respect to obsessive-compulsive disorder. Although the rate of this disorder is about equal for females and males, females are much more likely to be compulsive “washers” than males.
In contrast, there are no gender differences with respect to other compulsive behaviors such as checking items repeatedly or counting. These findings emphasize the fact that sociocultural factors often influence not only the incidence of mental disorders, but their specific form as well.
iv. Posttraumatic Stress Disorder (PTSD):
Imagine that you are sleeping peacefully in your own bed when suddenly the ground under your home heaves and shakes and you are thrown to the floor. Once awakened, you find yourself surrounded by the sounds of objects, walls, and even entire buildings crashing to the ground accompanied by shrieks of fear and pain from your neighbors or perhaps even your own family. This is precisely the kind of experience reported by many persons following earthquakes.
Such experiences are described as traumatic by psychologists because they are extraordinary in nature and extraordinarily disturbing. It is not surprising, then, that some persons exposed to them experience PTSD a disorder in which people persistently re-experience the traumatic event in their thoughts or dreams; feel as if they are reliving the event from time to time; persistently avoid stimuli associated with the traumatic event (places, people, thoughts); and persistently experience symptoms of increased arousal such as difficulty falling asleep, irritability, outbursts of anger, or difficulty in concentrating. PTSD can stem from a wide range of traumatic events natural disasters, accidents, rape and other assaults, torture, or the horrors of wartime combat.
PTSD is classified as an anxiety disorder, characterized by aversive anxiety-related experiences, behaviors, and physiological responses that develop after exposure to a psychologically traumatic event (sometimes months after). Its features persist for longer than 30 days, which distinguishes it from the briefer acute stress disorder. These persisting post-traumatic stress symptoms cause significant disruptions of one or more important areas of life function. It has three sub-forms: acute, chronic, and delayed-onset.
In India, the impact of the Orissa Super Cyclone on survivors’ locus of control (LOC), depression and stress were assessed through interviews and it was found that those who were closer to the epicenter of super cyclone experienced more anxiety, depression, and stress; the magnitude of loss experienced by the survivors significantly increased external LOC than the unaffected.
Symptoms of PTSD fall into the following three main categories:
1. “Reliving” the event, which disturbs day-to-day activity, i.e., flashback episodes, where the event seems to be happening again and again, repeated upsetting memories of the event, repeated nightmares of the event and strong, uncomfortable reactions to situations reminiscent of the event.
2. Avoidance which includes emotional “numbing” or feeling as though you don’t care about anything, feeling detached, being unable to remember important aspects of the trauma, having lack of interest in normal activities, avoiding places, people, or thoughts reminding the event, and lacking hope of future.
3. Arousal which includes difficulty in concentration, becoming upset easily, having an exaggerated response to things, feeling more aware (hyper-vigilance), feeling irritable or having outbursts of anger, and having trouble in falling or staying asleep.
Not all persons exposed to traumatic events experience PTSD, so a key question is this- What factors lead to PTSD’s occurrence? Research on this question suggests that many factors play a role. The amount of social support trauma victims receives after the traumatic event seems crucial. The more support, the less likely are such persons to develop PTSD.
Similarly, the coping strategies chosen by trauma victims are important. Effective strategies such as trying to see the good side of things (e.g., “I survived!”) help to prevent PTSD from developing, whereas ineffective strategies such as blaming oneself for the traumatic event (“I should have moved away from here!”) increase its likelihood.
Individual differences, too, play a role; PTSD is more likely among persons who are passive, inner-directed, and highly sensitive to criticism and who exhibited social maladjustment before the trauma (e.g., legal difficulties, irresponsibility) than among persons who don’t show these traits. In sum, it appears that whether individuals experience posttraumatic stress disorder after exposure to a frightening event depends on several different factors.
4. Dissociative and Somatoform Disorders:
Traumatic events sometimes result in PTSD. This is not the only mental disorder that can result from such events, however. Two other major types of disorder seem to involve dramatic, unexpected, and involuntary reactions to traumatic experiences; dissociative disorders and somatoform disorders. Dissociative disorders involve disruptions in a person’s memory, consciousness, or identity processes that are normally integrated.
In contrast, somatoform disorders involve physical symptoms for which there is no apparent physical cause. Although these disorders are classified separately in the DSM-IV, I’ll cover them together here, because historically they have been viewed as stemming from similar causes and involving similar symptoms. As will soon be apparent, though, they are distinct in many ways.
i. Dissociative Disorders:
Have you ever awakened during the night and, just for a moment, been uncertain about where you were or even who you were? Such temporary disruptions in our normal cognitive functioning are far from rare; many persons experience them from time to time as a result of fatigue, illness, or the use of alcohol or other drugs.
Dissociative disorders, however, go far beyond such experiences. They involve much more profound losses of identity or memory, intense feelings of unreality, a sense of being depersonalized (i.e., separate from oneself), and uncertainty about one’s own identity.
Dissociative disorders take several different forms. In dissociative amnesia, individuals suddenly experience a loss of memory that does not stem from medical conditions or other mental disorders. Such losses can be localized, involving only a specific period of time, or generalized, involving memory for the person’s entire life.
In another dissociative disorder, dissociative fugue, an individual suddenly leaves home and travels to a new location where he or she has no memory of his or her previous life. In depersonalization disorder the individual retains memory but feels like an actor in a dream or movie.
As dramatic as these disorders are, they pale when compared with the most amazing and controversial dissociative disorder, dissociative identity disorder. This was known as multiple personality disorder in the past, and it involves a shattering of personal identity into at least two and often more separate but coexisting personalities, each possessing different traits, behaviors, memories, and emotions.
Usually, there is one host personality the primary identity that is present most of the time and one or more alters alternative personalities that appear from time to time. Switching, the process of changing from one personality to another, often seems to occur in response to anxiety brought on by thoughts or memories of previous traumatic experiences.
Many mental health professionals believe that this disorder does indeed exist, and it is included in the DSM-IV. Several kinds of evidence offer support for its reality. First, persons with dissociative identity disorder sometimes show distinctive patterns of brain activity when each of their supposedly separate personalities appears.
Similarly, alters sometimes differ in ways that are hard to fake. Some are right-handed and others left-handed; some show allergic reactions to various substances and others do not; and some alters may be color blind while others are not. Findings such as these suggest that this disorder may indeed be real in at least some cases. However, this evidence itself is somewhat controversial; so at present the best approach is one of considerable caution.
This is in no way to suggest that the potentially harmful effects of early traumatic experiences should be ignored if these are severe, many psychologists believe, they may indeed lead to some kind of dissociation (splitting of identity or consciousness). But accepting exaggerated claims about dissociative identity disorder does seem unjustified.
ii. Somatoform Disorders: Physical Symptoms without Physical Causes:
Several of Freud’s early cases, ones that played an important role in his developing theory of personality, involved the following puzzling situation. An individual would show some physical symptom (such as deafness or paralysis of some part of the body); yet careful examination would reveal no underlying physical causes for the problem. Such disorders are known as somatoform disorders – disorders in which individuals have physical symptoms in the absence of identifiable physical causes for these symptoms.
One such disorder is somatization disorder, a condition in which an individual has a history of many physical complaints, beginning before age thirty, that occur over a period of years and result in treatment being sought for significant impairments in social, occupational, or other important areas of life.
The symptoms reported may include pain in various parts of the body (e.g., head, back, abdomen), gastrointestinal problems (e.g., nausea, vomiting, bloating), sexual symptoms (e.g., sexual indifference, excessive menstrual bleeding), and neurological symptoms not related to pain (e.g., impaired coordination or balance, paralysis, blindness).
Another somatoform disorder is hypochondriasis preoccupation with fear of disease. Hypochondriacs do not actually have the diseases they fear, but they persist in worrying about them, despite repeated reassurance by their doctors that they are healthy. Many hypochondriacs are not simply faking; they feel the pain and discomfort they report and are truly afraid that they are sick or will soon become sick.
Other persons who seek medical help are faking. For instance, persons with Munchausen’s syndrome devote their lives to seeking and often obtaining costly and painful medical procedures they realize they don’t need. Why? Perhaps because they relish the attention or because they enjoy fooling physicians and other trained professionals. In any case, such persons waste precious medical resources and often run up huge bills that must be paid by insurance companies or government programs; so Munchausen’s syndrome, no matter how strange, is definitely no laughing matter.
Yet another somatoform disorder is known as conversion disorder. Persons with this disorder actually experience physical problems such as motor deficits (poor balance or coordination, paralysis, or weakness of arms or legs) or sensory deficits (loss of sensitivity to touch or pain, double vision, blindness, deafness). While these disabilities are quite real to the persons involved, there is no medical condition present to account for them.
What are the causes of somatoform disorders? As is true with almost all mental disorders, several factors seem to play a role. Individuals who develop such disorders seem to have a tendency to focus on inner sensations they are high in private self-consciousness. In addition, they tend to perceive normal bodily sensations as being more intense and disturbing than do most people.
Finally, they have a high level of negative affectivity they tend to be pessimistic, fear uncertainty, experience guilt, and have low self-esteem. Together, these traits create a predisposition or vulnerability to stressors (e.g., intense conflict with others, severe trauma); operating together, in a diathesis-stress model, these factors then contribute to the emergence of somatoform disorders.
In addition, of course, persons who develop such disorders learn that their symptoms often yield increased attention and better treatment from family members. These persons are reluctant to give the patient a hard time, because he or she is already suffering so much! In short, these patients gain important forms of reinforcement from their disorder.
5. Sexual and Gender Identity Disorders:
Freud believed that many psychological disorders can be traced to disturbances in psychosexual development. While Freud’s theory is not widely accepted by psychologists today, there is little doubt that individuals experience many problems relating to sexuality and gender identity.
Several of these are discussed below:
i. Sexual Dysfunctions: Disturbances in Desire and Arousal:
Sexual dysfunctions include disturbances in sexual desire and/or sexual arousal, disturbances in the ability to attain orgasms, and disorders involving pain during sexual relations.
Sexual desire disorders involve a lack of interest in sex or active aversion to sexual activity. Persons experiencing these disorders report that they rarely have the sexual fantasies most persons generate, that they avoid all or almost all sexual activity, and that these reactions cause them considerable distress.
In contrast, sexual arousal disorders involve the inability to attain or maintain an erection (males) or the absence of vaginal swelling and lubrication (females). Orgasm disorders include the delay or absence of orgasms in both sexes as well as premature ejaculation (reaching orgasm too quickly) in males. Needless to say, these problems cause considerable distress to the persons who experience them.
ii. Paraphilias: Disturbances in Sexual Object or Behavior:
What is sexually arousing? For most people, the answer involves the sight or touch of another human being. But many people find other stimuli arousing, too. The large volume of business done by Victoria’s Secret and other companies specializing in alluring lingerie for women stems, at least in part, from the fact that many men find such garments mildly sexually arousing.
Other persons find that inflicting or receiving some slight pain during lovemaking increases their arousal and sexual pleasure. Do such reactions constitute sexual disorders? According to most psychologists, and the DSM-IV, they do not. Only when unusual or bizarre imagery or acts are necessary for sexual arousal (that is, when arousal cannot occur without them) do such preferences qualify as a disorder. Such disorders are termed paraphilias, and they take many different forms.
In fetishes, individuals become aroused exclusively by inanimate objects. Often these are articles of clothing; in more unusual cases they can involve animals, dead bodies, or even human waste. Frotteurism, another paraphilia, involves fantasies and urges focused on touching or rubbing against a non-consenting person. The touching, not the coercive nature of the act, is what persons with this disorder find sexually arousing.
The most disturbing paraphilia of all is pedophilia, in which individuals experience sexual urges and fantasies involving children, generally ones younger than thirteen. When such urges are translated into overt actions, the effects on the young victims can be devastating. Two other paraphilias are sexual sadism and sexual masochism. In the former, individuals become sexually aroused only by inflicting pain or humiliation on others. In the latter, they are aroused by receiving such treatment. See Table 14.2 for a description of these and other paraphilias.
iii. Gender Identity Disorders:
Have you ever read about a man who altered his gender to become a woman or vice versa? Such individuals feel, often from an early age, that they were born with the wrong sexual identity.
They identify strongly with the other sex and show preferences for cross-dressing (wearing clothing associated with the other gender). They are displeased with their own bodies and request again, often from an early age—that they receive medical treatment to alter their primary and secondary sex characteristics.
In the past, there was little that medicine could do satisfy these desires on the part of persons suffering from gender identity disorder. Advances in surgical techniques, however, have now made it possible for such persons to undergo sex-change operations, in which their sexual organs are actually altered to approximate those of the other gender. Several thousand individuals have undergone such operations, and existing evidence indicates that most report being satisfied with the results and happier than they were before.
However, it is difficult to evaluate such self-reports. Perhaps after waiting years for surgery and spending large amounts of money for their sex-change operations, such persons have little choice but to report positive effects. Clearly, such surgery is a drastic step and should be performed only when the would-be patient fully understands all potential risks.