in review 474 Chapter 12 Psychological Disorders ANXIET Y, SOMATOFORM, AND DISSOCIATIVE DISORDERS Disorder Subtypes Major Symptoms Anxiety disorders Phobias Intense, irrational fear of objectively nondangerous situations or things, leading to disruptions of behavior. Excessive anxiety not focused on a speciﬁc situation or object; free-ﬂoating anxiety. Repeated attacks of intense fear involving physical symptoms such as faintness, dizziness, and nausea. Persistent ideas or worries accompanied by ritualistic behaviors performed to neutralize the anxiety-driven thoughts. Generalized anxiety disorder Panic disorder Obsessive-compulsive disorder Somatoform disorders Conversion disorder Hypochondriasis Somatization disorder Pain disorder Dissociative disorders Dissociative amnesia/fugue Dissociative identity disorder (multiple personality disorder) ? A loss of physical ability (e.g., sight, hearing) that is related to psychological factors. Preoccupation with, or belief that one has, serious illness in the absence of any physical evidence. Wide variety of somatic complaints that occur over several years and are not the result of a known physical disorder. Preoccupation with pain in the absence of physical reasons for the pain. Sudden, unexpected loss of memory, which may result in relocation and the assumption of a new identity. Appearance within the same person for two or more distinct identities, each with a unique way of thinking and behaving. 1. Concern that it may be triggered by media stories or therapists’ suggestions has made dissociative disorders. 2. A person who sleepwalks but is not able to walk when awake is showing signs of 3. Panic disorder sometimes leads to another anxiety disorder called . the most controversial of the . Depressive Disorders major depressive disorder A condition in which a person feels sad and hopeless for weeks or months, often losing interest in all activities and taking pleasure in nothing. delusions False beliefs, such as those experienced by people suffering from schizophrenia or severe depression. Depression can range from occasional, normal “down” periods to episodes severe enough to require hospitalization. A person suffering major depressive disorder feels sad and overwhelmed for weeks or months, typically losing interest in activities and relationships and taking pleasure in nothing (Coryell et al., 1993; Rapaport et al., 2005; Sloan, Strauss, & Wisner, 2001). Exaggerated feelings of inadequacy, worthlessness, hopelessness, or guilt are common. Despite the person’s best efforts, anything from conversation to bathing can become an unbearable, exhausting task (Solomon, 1998). Changes in eating habits resulting in weight loss or weight gain often accompany major depressive disorder. So does disturbed sleeping or, sometimes, excessive sleeping. Problems in working, concentrating, making decisions, and thinking clearly are also common, as are symptoms of an accompanying anxiety disorder (Zimmerman, McDermut, & Mattia, 2000). In extreme cases, depressed people may express false beliefs, or delusions—worrying, for example, that government agents are planning to punish them. Major depressive disorder may come on suddenly or gradually. It may consist of a single episode or, more commonly, repeated depressive periods. Here is a case example: Mr. J. was a ﬁfty-one-year-old industrial engineer …. Since the death of his wife ﬁve years earlier, he had been suffering from continuing episodes of depression marked by extreme social withdrawal and occasional thoughts of suicide …. He drank, and when Mood Disorders 475 thoroughly intoxicated would plead to his deceased wife for forgiveness. He lost all capacity for joy. … Once a gourmet, he now had no interest in food and good wine … and could barely manage to engage in small talk. As might be expected, his work record deteriorated markedly. Appointments were missed and projects haphazardly started and left unﬁnished. (Davison & Neale, 1990, p. 221) Depression is not always so extreme. In a less severe pattern of depression, called dysthymic disorder, the person shows the sad mood, lack of interest, and loss of pleas- ure associated with major depression but less intensely and for a longer period. (The duration must be at least two years to qualify as dysthymic disorder.) Mental and behavioral disruptions are also less severe. People exhibiting dysthymic disorder rarely require hospitalization. Major depressive disorder occurs sometime in the lives of about 13 to 17 percent of people in North America and Europe (Hasin et al., 2005; Kessler et al., 1994, 2003; U.S. Surgeon General, 1999). The incidence of the disorder varies considerably across cultures and subcultures, however. For example, it occurs at much higher rates in urban Ireland than in urban Spain (Judd et al., 2002). There are gender differences in some cultures, too. North American and European women are two to three times more likely than men to experience major depressive disorder (American Psychiatric Association, 2000; Weissman et al., 1993), but this difference does not appear in the less economically developed countries of the Middle East, Africa, and Asia (Ayuso-Mateos et al., 2001; Culbertson, 1997). Depression can occur at any age, but it frequently ﬁrst appears in late adolescence or young adulthood. Increased rates of depression are also found among the elderly (Cross-National Collaborative Group, 2002; Fassler & Dumas, 1997; Sowdon, 2001). dysthymic disorder A pattern of depression in which the person shows the sad mood, lack of interest, and loss of pleasure associated with major depressive disorder but to a lesser degree and for a longer period. Suicide and Depression Suicide is associated with a variety of psychological disorders, but it is most closely tied to depression. Some form of depression has been implicated in 40 to 60 percent of all suicides (Angst, Angst, & Stassen, 1999; Oquendo & Mann, 2001; Rihmer, 2001). In fact, thinking about suicide is a symptom of depressive disorders. Hopelessness about the future—another depressive symptom—and a desire to seek instant escape from problems are also related to suicide attempts (Beck et al., 1990; Brown et al., 2000). About 31,000 people in the United States commit suicide each year, and 10 to 20 times that many people attempt it (Centers for Disease Control and Prevention, 2004). This puts the U.S. suicide rate at about 11 per 100,000 individuals, making suicide the eleventh leading cause of death. Worldwide, the suicide rate is as high as 25 per 100,000 in some northern European countries, China, and Japan and as low as 6 per 100,000 in countries with stronger religious prohibitions against suicide, such as Greece, Italy, Ireland, and the nations of the Middle East (Lamar, 2000; Phillips, Li, & Zhang, 2002). Suicide rates differ considerably depending on sociocultural factors such as age, gender, and ethnicity (Centers for Disease Control and Prevention, 2002b; Oquendo et al., 2001). In the United States, suicide is most common among people sixty-ﬁve and older, especially males (Centers for Disease Control and Prevention, 2004). However, since 1950, suicide among adolescents has tripled, making it the third leading cause of death, after accidents and homicides, among ﬁfteen- to twenty-four-year-olds (Centers for Disease Control and Prevention, 2002a). Suicide is the second leading cause of death among college students; about 10,000 try to kill themselves each year, and about 1,000 succeed. These ﬁgures are much higher than for young people in general, but much lower than for the elderly. Women attempt suicide three times as often as men, but men are four times as likely to actually kill themselves (Centers for Disease Control and Prevention, 2002b). Suicide rates also differ across ethnic groups (see Figure 12.4). Among males in the United States, for example, the overall rate for American Indians is 19.1 per 100,000, compared with 19.4 for European Americans, 9.7 for Asian Americans, 10.7 for Hispanic Americans, and 10.4 for African Americans. The same pattern of ethnic differences appears among women, though the actual rates are much lower (Centers for Disease Control and Prevention, 2002a).