Chapter 15: Psychological Disorders Multiple Choice Questions 1. What is the branch of psychology that is concerned with the study of abnormal behaviour? A. Psychobiology B. Developmental psychology C. Psychopathology D. Health psychology Answer: C 2. Ellie is a graduate student in psychology at the local university. She is interested in one day specializing in the study of abnormal behaviour. What area of psychology should she focus on in school? A. Psychobiology B. Developmental psychology C. Psychopathology D. Health psychology Answer: C 3. The failure analysis approach to understanding mental disorders involves A. evaluation of failures in treatments for mental illness in relation to its causes. B. examining breakdowns in adaptation to understand healthy functioning. C. a focus on early identification of people that have an increased susceptibility to develop mental disorders. D. a recognition that mental disorders can be adaptive and treatment should only be applied when behaviours become disruptive. Answer: B 4. Suppose you are a psychologist who is evaluating the behaviour of a new client. The client tells you that he does not like to wear clothing and that he walks around nude most of the time. In addition, he tells you that he lives in a society in which clothing is required and nudity is seen as abnormal. Which of the following is not a criterion by which you evaluate your client’s behaviour as abnormal? A. Societal disapproval B. Impairment C. Subjective distress D. Statistical rarity Answer: C 5. Maria is a retired factory worker who lives with anxiety. Due to the fear of having anxiety attacks, she does not leave her house. This makes her feel trapped in her home, which creates distress. Which criterion would be most appropriate in deciding whether Maria’s case represents an example of abnormality? A. Societal disapproval B. Social context C. Subjective distress D. Statistical rarity Answer: C 6. One sign of abnormality is when a person engages in behaviour that creates a great deal of emotional distress or A. societal disapproval. B. social context. C. subjective distress. D. statistical rarity. Answer: C 7. Any behaviour that does not allow a person to function within or adapt to the stresses and everyday demands of life is considered A. qualitatively rare. B. socially disapproved of. C. impairing and maladaptive. D. statistically rare. Answer: C 8. Dave, a graduate student, has difficulty talking to groups. Unfortunately, he has chosen a career in which he must speak to large groups of people. The night before a presentation he tosses and turns, and the resulting lack of sleep makes the situation worse. When he makes a presentation, he often becomes confused and stumbles over his words. As a result, he feels worthless and miserable. Which two criteria of abnormal behaviour are most useful in analyzing this case? A. Inability to function normally and statistical rarity B. Statistical rarity and deviance from social norms C. Subjective discomfort and inability to function normally D. Deviance from social norms and subjective discomfort Answer: C 9. Which of the following is one definition of abnormal behaviour? A. Behaviour that does not create distress B. Behaviour that is consistent with societal norms C. Behaviour that is rare D. Behaviour that is adaptive Answer: C 10. Which criterion would designate a person who never talks to anyone as abnormal? A. Societal disapproval B. Impairment C. Subjective distress D. Statistical rarity Answer: D 11. What psychiatrist has claimed that mental illness is “a myth” and that the labels used to identify the various forms of mental illness are nothing more than a means of social control? A. Sigmund Freud B. B. F. Skinner C. Carl Rogers D. Thomas Szasz Answer: D 12. Which of the following is not a criterion for defining mental disorders? A. Subjective distress B. Societal disapproval C. Bizarre behaviour D. Impairment Answer: C 13. Which of the following behaviours used to be considered a mental illness, and was used to support the view that mental illness is nothing more than conditions that society dislikes? A. Pedophilia B. Homosexuality C. Racism D. Sexual addictions Answer: B 14. The perspective that mental disorders don’t all have one thing in common, but rather share a loose set of features is called the _______________. A. failure analysis approach B. family resemblance view C. medical model D. multimodal approach Answer: B 15. It is not unreasonable to assume that, in ancient times, signs of mental illness were believed to be caused by A. imbalance of body fluids. B. social forces. C. demons. D. improper diet. Answer: C 16. The _______________ model is to evil spirits as the _______________ model is to physical disorder. A. demonic; medical B. medical; demonic C. institutional; asylum D. asylum; institutional Answer: A 17. The development of modern psychiatric treatments, such as medications like Thorazine, was associated with A. the hospitalization and humane treatment of mental patients rather than imprisonment. B. a movement towards deinstitutionalization which released patients and closed mental hospitals. C. a push towards moral treatment of mental patients and the provision of better care in asylums. D. the closure of community mental health centres and halfway houses as disorders were treated with medication. Answer: B 18. Bloodletting was a treatment associated with which model of mental illness? A. Demonic model B. Medical model C. Societal model D. Biological model Answer: B 19. Insane asylums were often considered synonymous with _______________ due to some of their questionable treatment methods. A. witch burning B. exorcists C. snake pits D. placebos Answer: C 20. In a condition called _______________, some Malaysian residents report episodes of intense sadness and brooding, followed by uncontrolled behaviour and unprovoked attacks on people or animals. A. Windigo B. Amok C. Ataque de nervios D. Mal de Ojo Answer: B 21. Some residents in Latin America refer to _______________ as the cause of disease, misfortune, and social disruption. A. Windigo B. Gururumba C. Saora disorder D. Mal de Ojo Answer: D 22. In a condition called _______________, some residents in Central Canada report a morbid fear of becoming a cannibal. A. Windigo B. Latah C. Brain fog D. Mal de Ojo Answer: A 23. In a condition called _______________, some residents in New Guinea report episodes where they steal and later deposit their neighbours’ possessions in the forest, but remember nothing of the entire episode. A. Windigo B. Arctic hysteria C. Gururumba D. Mal de Ojo Answer: C 24. In a condition called _______________, Indian residents report episodes of inappropriate laughing or crying, fainting, memory loss, and the sensation of being bitten by ants. A. Windigo B. Saora disorder C. Arctic hysteria D. Mal de Ojo Answer: B 25. Some parts of Malaysia and several other Asian countries have witnessed periodic outbreaks of a strange condition known as _______________. The victims, most of whom are male, typically believe that their penis and testicles are disappearing and receding into their abdomen. A. Windigo B. Hwa-byung C. Koro D. Mal de Ojo Answer: C 26. In a condition called _______________, Inuit persons may experience abrupt episodes accompanied by extreme excitement and then followed by convulsive seizures. A. Windigo B. Gururumba C. Arctic hysteria D. Mal de Ojo Answer: C 27. _______________ is a culture-bound disorder whereas _______________ is a disorder that has cultural universality. A. kunlangeta; bulimia nervosa B. mal de ojo; apotemnophilia C. anorexia nervosa; psychopathy D. schizophrenia; windigo Answer: C 28. The disorder or culture-bound syndrome in which men fear that their penis is shrinking is primarily found in which country? A. China B. Sri Lanka C. Malaysia D. Subarctic Canada Answer: A 29. What is the name of the culture-bound syndrome that results from a perceived insult and is followed by a period of brooding and then a violent outburst during which the person may attack others and not remember doing so? A. Amok B. Ghost sickness C. Susto D. Kyofu Answer: A 30. A key idea in the discussion on the universality versus diversity in psychiatric diagnoses was that A. all disorders are found throughout all cultures of the world. B. most psychiatric disorders are unique to specific cultures and relatively unknown in others. C. many psychiatric disorders are similar across cultures. D. psychiatric disorders found in North America and Europe are often unknown in many African and Asian cultures. Answer: C 31. Which of the following is a diagnosis rather than a label? A. Depersonalization disorder B. Drapetomania C. Road rage disorder D. Codependency Answer: A 32. Which of the following is not a criterion for determining whether a psychiatric diagnosis is valid? A. It distinguishes that diagnosis from other, similar diagnoses. B. It predicts an individual’s performance on laboratory tests. C. It relies on self-reported behaviours and not observations. D. It predicts an individual’s response to treatment. Answer: C 33. Jenny's son received his mumps, measles, and rubella vaccine approximately six months ago. Shortly after his 2nd birthday, she noted that he is showing many of the classic signs of autism. Her belief that the vaccine caused his autism is A. an example of illusory correlation. B. supported by several scientific studies. C. an example of confirmation bias. D. an example of hindsight bias. Answer: A 34. Dr. Brown has been invited to speak at a prestigious psychological conference on the topic of autism. He will talk on the current scientific knowledge regarding this disorder. What is a key point you would expect him to make based on the authors' discussion of the disorder in the chapter? A. The dramatic increase in diagnoses of autism is directly related to the mumps, measles, and rubella vaccine. B. There is an autism epidemic and psychologists have no real insights into the dramatic increase. C. The dramatic increase in autism diagnoses is a result of overdiagnosis rather than a real increase and epidemic. D. The apparent surge in diagnoses of autism is linked to important changes in the diagnostic criteria. Answer: D 35. _______________ are concerned with the possibility that psychiatric diagnoses exert powerful negative effects on people’s perceptions and behaviour, and can lead them to act differently and be treated differently by others. A. Psychoanalysts B. Humanists C. Behaviourists D. Labelling theorists Answer: D 36. _______________ is used to help psychological professionals diagnose psychological disorders. A. The Textbook of Mental Illness B. The Textbook of Psychological Disorders C. The Physician’s Reference Checklist D. The Diagnostic and Statistical Manual Answer: D 37. Which of the following statements is true about the DSM-IV? A. It is used to diagnose all kinds of medical conditions. B. It is used to diagnose medical conditions that may have an impact on mental health. C. It lists information regarding symptoms but does not include a checklist of criteria that must be met for diagnosis. D. It describes symptoms and includes a checklist of specific criteria for diagnosis. Answer: D 38. The primary purpose of the DSM-IV is to A. help psychologists assess only normal behaviour. B. keep the number of diagnostic categories of mental disorders to a minimum. C. describe the causes of common physiological disorders. D. help psychological professionals diagnose psychological disorders. Answer: D 39. Dr. Nwoambi is a psychologist who is currently evaluating a new client. Dr. Nwoambi would most likely refer to the _______________ to assist her in diagnosing her client’s psychological disorder. A. Textbook of Mental Illness B. Textbook of Psychological Disorders C. Physician’s Reference Checklist D. Diagnostic and Statistical Manual Answer: D 40. The DSM-IV has 17 different classes of disorders, and includes all of the following except A. somatoform disorders. B. factitious disorders. C. insanity disorders. D. adjustment disorders. Answer: C 41. The prevalence of a disorder refers to A. the percentage of persons who exhibit the symptoms of a particular disorder. B. its accuracy or correctness as a diagnosis of a real mental illness. C. the agreement among professional about a diagnosis for a specific patient or client. D. the popularity of a diagnosis among different types of mental health professionals. Answer: A 42. The diagnostic criteria in the DSM-IV is based on a _______________ approach. A. biological B. psychological C. social and cultural D. biopsychosocial Answer: D 43. Which model of abnormality holds that physical, mental, and cultural factors are intertwined and that they must all be considered when dealing with psychology disorders? A. Biological B. Psychological C. Social and cultural D. Biopsychosocial Answer: D 44. When a psychologist or psychiatrist is using the DSM-IV-TR as a guide to evaluating a client, he or she would assess the client on each of five A. steps. B. phases. C. stages. D. axes. Answer: D 45. _______________ refers to the overlap between diagnoses, where individuals with one diagnosis also may meet the criteria for one or more other diagnoses. A. Labelling B. Pathologizing C. Exclusivity D. Comorbidity Answer: D 46. The DSM-IV has been criticized on the basis of all of the following points except that A. not all diagnoses meet the criteria for diagnostic validity (e.g., Mathematics Disorder). B. the DSM-IV exclusively relies on a dimensional model of understanding disorders. C. there is a high level of comorbidity among many of its diagnoses. D. the DSM-IV is vulnerable to political and social influences. Answer: B 47. The idea that a person may be determined to be sane or insane is an issue that is most relevant to A. medicine and psychiatry. B. all mental health professionals. C. the legal system. D. psychiatrists, psychologists, and trial judges. Answer: C 48. Although most individuals with mental disorders are not at an increased risk for violence, a subset of those with _______________ or _______________ may be more likely to act violently. A. obsessive-compulsive disorder; schizophrenia B. substance abuse disorders; beliefs of persecution C. mood disorders; anxiety disorders D. personality disorders; sleep disorders Answer: B 49. The legal system is to _______________ as scientific psychology is to _______________. A. determinism; free will B. free will; determinism C. psychoanalysis; behaviourism D. behaviourism; psychoanalysis Answer: B 50. The erroneous belief that many criminals are acquitted on the basis of the insanity verdict is most likely due to A. the confirmation bias. B. logical fallacies. C. representativeness heuristic. D. the availability heuristic. Answer: D 51. All of the following are myths about the insanity defence except A. a large proportion of criminals escape criminal responsibility by using the insanity defence. B. most people who use the insanity defence are faking mental illness. C. the determination of insanity rests on a the person’s mental state at the time of the crime. D. insanity is a psychological or psychiatric term. Answer: C 52. A mentally ill individual can be involuntarily committed to a psychiatric hospital against their will if A. they pose a clear and present threat to themselves or others. B. they are so psychologically impaired that they can’t care for themselves. C. psychiatrists or physicians place an emergency “hold” on the patient or it is ordered by a judge. D. All of the above are criteria of involuntary commitment. Answer: D 53. The likelihood of experiencing an anxiety disorder at some point in your lifetime is roughly A. 55%. B. 48%. C. 35%. D. 29%. Answer: D 54. Dikeshia is giving a presentation in her abnormal psychology class on the prevalence of psychological disorders. If you were a student in that class, what general category of disorders would you expect her to mention as one of the most prevalent psychological disorders? A. Dissociative disorders B. Anxiety disorders C. Personality disorders D. Schizophrenia Answer: B 55. The most prevalent of all mental disorders is/are A. dissociative disorders. B. anxiety disorders. C. personality disorders. D. schizophrenia. Answer: B 56. Which of the following is an anxiety disorder? A. Conversion disorder B. Phobic disorder C. Bipolar disorder D. Schizophrenia Answer: B 57. Which of the following statements is true about anxiety? A. It is never considered realistic or normal. B. Some anxiety is realistic when its source is understandable. C. It always manifests itself as a disorder. D. It is unusual for a mentally healthy person to experience anxiety. Answer: B 58. Excessive or unrealistic fearfulness and worry are characteristic of A. dissociative disorders. B. anxiety disorders. C. personality disorders. D. schizophrenia. Answer: B 59. Which of the following is a disorder that takes the form of a bodily ailment that has no physical cause? A. Dissociative disorder B. Somatoform disorder C. Personality disorder D. Schizophrenia Answer: B 60. In the last six months Shelly has visited her physician ten times to complain of numerous physical symptoms. The physician has been unable to find a physical cause for her symptoms. What category of psychological disorders is the physician likely to suspect Shelly exhibits? A. Dissociative disorder B. Somatoform disorder C. Personality disorder D. Schizophrenia Answer: B 61. When Bob noticed a pain in his thigh, he was convinced it was a sign of bone cancer. Although X-rays revealed no sign of cancer, Bob sought the opinions of a dozen other physicians who agreed with the original opinion. What psychological disorder might Bob’s behaviour indicate? A. Dissociative disorder B. Hypochondriasis C. Conversion disorder D. Schizophrenia Answer: B 62. Hypocondriasis is to _______________ disorders as obsessive-compulsive disorder is to _______________ disorders. A. anxiety; personality B. somatoform; anxiety C. personality; mood D. factitious; somatoform Answer: B 63. A person who is preoccupied with every sensation of her body, worries excessively about getting ill, and continuously goes to doctors who never find anything physically wrong with her is likely to be diagnosed with A. somatoform disorder. B. hypochondriasis. C. personality disorder. D. conversion disorder. Answer: B 64. Shantae constantly complains of physical symptoms such as nausea and trouble catching her breath. After finding no medical explanation for her symptoms, a physician suspects Shantae suffers from A. dissociative disorder. B. hypochondriasis. C. conversion disorder. D. somatization disorder. Answer: B 65. Shelby is concerned that she is spending too much of her day worrying about things that are out of her control. She often experiences disturbances in sleep and often feels tense, even in situations where there is nothing that is directly threatening her safety. If you were a clinical psychologist, you would be trying to determine if Shelby meets the criteria for A. agoraphobia. B. major depressive disorder. C. social phobia. D. generalized anxiety disorder. Answer: D 66. A disorder in which excessive anxiety and worry occur more days than not for at least six months is called A. agoraphobia. B. major depressive disorder. C. social phobia. D. generalized anxiety disorder. Answer: D 67. Leo worries all of the time. He worries about his money, his children, and his dog. His muscles are always tense and sore; he has trouble sleeping, is often irritable, and has difficulty concentrating. Leo’s symptoms sound most like A. agoraphobia. B. major depressive disorder. C. social phobia. D. generalized anxiety disorder. Answer: D 68. Some scholars believe that _______________ may be the core anxiety disorder out of which all other anxiety disorders develop. A. obsessive-compulsive disorder B. posttraumatic stress disorder C. panic disorder D. generalized anxiety disorder Answer: D 69. Generalized anxiety disorder would be more likely to occur in which of the following persons? A. A divorced 60 year old Hispanic man B. A widowed low-income Caucasian female C. A married, poor, Asian couple D. A 19 year old African Canadian woman Answer: B 70. The symptoms of _______________ are often mistaken for those of a heart attack. A. obsessive-compulsive disorder B. generalized anxiety disorder C. a panic attack D. posttraumatic stress disorder Answer: C 71. An anxiety disorder characterized by frequent panic disorder that affect the person’s ability to function in day-to-day living is called A. obsessive-compulsive disorder. B. generalized anxiety disorder. C. panic disorder. D. posttraumatic stress disorder. Answer: C 72. Which of the following is the term used to describe a sudden onset of extreme panic with various symptoms including racing heart, rapid breathing, and sweating? A. Obsessive-compulsive disorder B. Generalized anxiety disorder C. Panic attack D. Posttraumatic stress disorder Answer: C 73. Darcy is sitting at her desk in her office one day when, without warning, her heart begins racing rapidly, she has a sensation of being “out of her body,” and she experiences dulled vision and hearing, rapid breathing, and sweating. She thinks she is having a heart attack. Nothing she is doing seems to have caused such an episode. Her symptoms most resemble A. obsessive-compulsive disorder. B. generalized anxiety disorder. C. those of a panic attack. D. posttraumatic stress disorder. Answer: C 74. Demetri is walking down the street and suddenly experiences a bout of intense fear, sweating, dizziness, shortness of breath, and a pounding heart. He goes to the emergency room and is told that his symptoms were “all in his head”. This is the seventh time that Demetri has experienced these unexpected symptoms within the past few months. Based on what you know about psychological disorders, Demetri most likely would be diagnosed with A. panic disorder. B. generalized anxiety disorder. C. agoraphobia. D. obsessive-compulsive disorder. Answer: A 75. Davis has such an intense, irrational fear of clowns that he cannot take his daughters to see the circus when it is in town. Davis would be most correctly diagnosed as suffering from A. obsessive-compulsive disorder. B. posttraumatic stress disorder. C. panic disorder. D. a phobia. Answer: D 76. Which type of anxiety disorder is the most common? A. Panic disorder B. Phobias C. Posttraumatic stress disorder D. Generalized anxiety disorder Answer: B 77. Which type of phobia is the most debilitating of all phobias? A. Social phobias B. Arachnophobia C. Agoraphobia D. Hydrophobia Answer: C 78. Most people with panic disorder also develop what other anxiety disorder? A. Posttraumatic stress disorder B. Obsessive-compulsive disorder C. Agoraphobia D. Generalized anxiety disorder Answer: C 79. Fear of being in a place or situation from which escape is difficult or impossible if something should go wrong is called A. agoraphobia. B. trypanophobia. C. acrophobia. D. pantaphobia. Answer: A 80. Fear of snakes, thunderstorms, darkness, and water are classified as _______________ phobias. A. specific B. social C. nonspecific D. nonsocial Answer: A 81. An irrational fear of some object or specific situation is called A. a specific phobia. B. an interactive phobia. C. acrophobia. D. pantaphobia. Answer: A 82. Arlene has an irrational fear of flying in airplanes. She is probably suffering from a A. phobia. B. generalized anxiety disorder. C. panic attack. D. panic disorder. Answer: A 83. A strong intense fear of being in public or performing behaviours in public is characteristic of A. social phobia. B. panic disorder. C. obsessive-compulsive disorder. D. agoraphobia. Answer: A 84. Which of the following types of anxiety disorders is related to a history of shyness in childhood? A. Social phobia B. Panic disorder C. Obsessive-compulsive disorder D. Agoraphobia Answer: A 85. People who have a(n) _______________ are afraid of being evaluated in some negative way by others, so they tend to avoid situations that can be embarrassing. A. social phobia B. panic disorder C. specific phobia D. agoraphobia Answer: A 86. An anxiety disorder that involves a fear of interacting with others or being in a social situation is called A. social phobia. B. panic disorder. C. a specific phobia. D. agoraphobia. Answer: A 87. Fear of public speaking and stage fright are both examples of A. social phobias. B. panic. C. specific phobias. D. nonspecific phobias. Answer: A 88. Most people with _______________ also develop agoraphobia. A. generalized anxiety disorder B. post-traumatic stress disorder C. panic disorder D. obsessive-compulsive disorder Answer: C 89. Victims of sexual assault may experience strong stress reactions, intense anxiety, and flashbacks to their attacks from environmental cues that remind them of being attacked and helpless. If these become frequent, intense, and debilitating, the person may be diagnosed as suffering from A. generalized anxiety disorder. B. panic disorder. C. social phobia. D. posttraumatic stress disorder. Answer: D 90. What anxiety disorder became a psychological disorder shortly after veterans, returning from Vietnam, began to experience intense anxiety and flashbacks from stimuli that reminded them of the war zones where they were deployed? A. Posttraumatic stress disorder B. Obsessive-compulsive disorder C. Panic disorder D. Generalized anxiety disorder Answer: A 91. Which type of anxiety disorder is most commonly associated with malingering for some type of external gain? A. Phobias B. Obsessive-compulsive disorder C. Posttraumatic stress disorder D. Panic disorder Answer: C 92. During the day, Barb suffers from frequent, unwanted thoughts that she has left her front door unlocked and recurrent images that all her belongings have been taken. These thoughts and images are what psychologists refer to as a(n) A. obsession. B. compulsion. C. delusion. D. hallucination. Answer: A 93. A disorder in which intruding thoughts that occur again and again are followed by repetitive, ritualistic behaviour meant to lower the anxiety caused by the thoughts is called A. obsessive-compulsive disorder. B. social phobia. C. paranoid schizophrenia. D. clinical depression. Answer: A 94. Intruding thoughts that occur again and again are called A. obsessions. B. compulsions. C. checklists. D. rituals. Answer: A 95. Repetitive, ritualistic behaviours are called A. obsessions. B. compulsions. C. checklists. D. phobias. Answer: B 96. George is suffering from an obsessive-compulsive disorder. If he tries to stop his compulsive behaviours, he is likely to experience A. anxiety. B. depression. C. amnesia. D. hypochondrias. Answer: A 97. Each day, while Sid is sitting at his desk at work, he continually thinks about germs. Each time this occurs, he washes his hands. Sid probably suffers from A. obsessive-compulsive disorder. B. social phobia. C. paranoid schizophrenia. D. clinical depression. Answer: A 98. Sierra is constantly worried that everyone whom she comes in contact with is full of germs so she is constantly rushing off to wash her hands. Sierra suffers from what psychological disorder? A. Obsessive-compulsive disorder B. Social phobia C. Paranoid schizophrenia D. Clinical depression Answer: A 99. Mr. Carpenter is constantly afraid that he is going to oversleep and be late for work. As a result, he spends nearly an hour total each night making certain that his alarm clock is correctly set and saying, “It's set, it's set, it's set” each of the times he checks it. This repetitive action is what clinical psychologists refer to as a(n) A. hallucination. B. obsession. C. compulsion. D. delusion. Answer: C 100. _______________ are repetitive behaviours or mental acts initiated to reduce anxiety caused by _______________. A. Obsessions; compulsions B. Compulsions; obsessions C. Panic attacks; generalized anxiety D. Generalized anxiety; panic attacks Answer: B 101. Jeff collects books, paperclips, pennies, empty soda cans, and old trophies. He has so many objects in his collection that it interferes with his daily life and he cannot stop collecting things no matter how hard he tries. Jeff would most likely be diagnosed with what psychological disorder? A. Agoraphobia B. Generalized anxiety disorder C. Panic disorder D. Obsessive-compulsive disorder Answer: D 102. The phenomenon of getting a song stuck in your head is referred to as _______________. A. catastrophizing B. ruminating C. an earworm D. a homophone Answer: C 103. Behavioural theorists argue that anxiety disorders are conditioned through the process of A. negative reinforcement. B. positive punishment. C. positive reinforcement. D. negative punishment. Answer: A 104. The behavioural perspective views anxiety as A. a learned reaction. B. a danger signal that repressed conflicts are threatening to surface. C. the result of illogical, irrational thought processes. D. linked to an imbalance in several neurotransmitters in the nervous system. Answer: A 105. According to the biological perspective, anxiety disorders are A. learned reactions. B. danger signals that repressed conflicts are threatening to surface. C. the result of illogical, irrational thought processes. D. genetic in origin. Answer: D 106. Sandy has the tendency to make everything seem so much worse than it actually is. A cognitive therapist might say that Sandy has a tendency to engage in A. catastrophizing. B. minimizing. C. all-or-nothing thinking. D. overgeneralizing. Answer: A 107. Brian is the bassist and vocalist for a band with his two brothers, cousin, and a college friend. Recently, he has begun to experience more and more intense anxiety as he sings in front of crowds. As a result, he has begun to ask his bandmates to sing the songs for him. Brian's anxiety lessens when the focus of the crowd is not on him, demonstrating that Brian's avoidance of singing is being A. positively reinforced. B. positively punished. C. negatively punished. D. negatively reinforced. Answer: D 108. Which of the following is an example of the catastrophizing that sometimes accompanies anxiety disorders? A. “If I make a mistake during our routine, no one else in the band will ever speak with me again.” B. “If she doesn't want to go to the dance with me, I'll just ask someone else.” C. “I sure hope that this storm isn't strong enough for there to be a tornado.” D. “I've never had to work so hard in my life just to make a C in a class.” Answer: A 109. Individuals with anxiety disorders also may display high levels of _______________ and tend to interpret ambiguous situations in a negative light or as dangerous. A. depression B. anxiety sensitivity C. delusions D. schizophrenia Answer: B 110. High levels of _______________ tend to be associated with excessive worry, generalized anxiety disorder, and depression, suggesting a shared genetic pathway for these disorders. A. neuroticism B. anxiety sensitivity C. introversion D. self-monitoring Answer: A 111. Research has shown that persons who suffer from obsessive-compulsive disorder have more active _______________ lobes than persons without the disorder. A. frontal B. temporal C. occipital D. parietal Answer: A 112. Which of the following is not a strongly supported finding in research into the causes of the various anxiety disorders? A. People's irrational and unrealistic thoughts often reinforce their avoidance of situations they believe will cause anxiety. B. A person observes others experiencing anxiety and distress in certain situations and can imagine the same reactions for themselves. C. Difficult interactions with one's parents during childhood lead people to develop compulsive rituals to exert control over their life. D. If one identical twin suffers from an anxiety disorder, the other is more likely to experience an anxiety disorder. Answer: C 112. Family studies have demonstrated that people with obsessive-compulsive disorder are more likely to inherit a specific overactive gene that is related to the transport of which neurotransmitter? A. Dopamine B. Serotonin C. Acetylcholine D. Glutamate Answer: B 113. Research using _______________ has demonstrated that anxiety leads us to interpret ambiguous stimuli negatively. A. homophones B. inkblots C. earworms D. negative reinforcement Answer: A 114. Major changes in sleep patterns, weight level, and feelings about one's self-worth characterize A. major depressive disorder. B. social anxiety. C. schizophrenia. D. agoraphobia. Answer: A 115. Andrea is a new mother and constantly worries about her daughter, checking her all the time, hiding knives and objects for fear of stabbing the child, excessive cleaning, and is sometimes afraid to take care of her for fear of hurting her. Andrea would most likely be diagnosed with what psychological disorder? A. Posttraumatic stress disorder B. Bipolar disorder C. Postpartum obsessive-compulsive disorder D. Postpartum depression Answer: C 116. _______________ is associated with moods that alternate between numerous periods of hypomanic symptoms and numerous periods of depressive symptoms. A. Bipolar disorder B. Dysthymic disorder C. Seasonal affective disorder D. Cyclothymia Answer: D 117. The most frequently diagnosed psychological disorder is A. schizophrenia. B. alcohol abuse. C. depression. D. social phobia. Answer: C 118. Research into demographic differences in the rates of major depressive disorder, or clinical depression as it is often called, suggests that A. there are no age, gender, or racial differences in the prevalence of the disorder in North America. B. men are more likely than women to be diagnosed with the disorder in North America. C. men are less likely than women to be diagnosed with the disorder in North America. D. adults are less likely than children to be diagnosed with the disorder in North America. Answer: C 119. Which of the following forms of depression, which develops within a month of childbirth, has become more widely discussed in recent years? A. Postpartum depression B. Major depressive disorder C. Seasonal affective disorder D. Bipolar disorder Answer: A 120. Suppose that the treatment recommended for a patient at the mental health clinic is phototherapy. What is the likely diagnosis? A. Bipolar disorder B. Seasonal affective disorder C. Major depressive disorder D. Cyclothymia Answer: B 121. _______________ is a mood disorder that is caused by the body’s reaction to low levels of light present in the winter months. A. Bipolar disorder B. Seasonal affective disorder C. Major depressive disorder D. Cyclothymia Answer: B 122. For some people, their depression lasts only from December to February but returns at the same time each year. This is what psychologists call A. bipolar disorder. B. seasonal affective disorder. C. major depressive disorder. D. cyclothymia. Answer: B 123. Which disorder are the following symptoms associated with—Low-level depression of at least two years’ duration; feelings of inadequacy, sadness, low energy, poor appetite, decreased pleasure and productivity, and hopelessness? A. Bipolar disorder II B. Dysthymic disorder C. Cyclothymic disorder D. Seasonal affective disorder Answer: B 124. To remember _______________, think of “cycles” of up and down moods. A. major depressive disorder B. dysthymic disorder C. cyclothymia D. seasonal affective disorder Answer: C 125. Excessive spending, reckless driving, and unprotected sex are all characteristics of what mood disorder? A. Manic episode B. Hypomanic episode C. Cyclothymic disorder D. Bipolar disorder I Answer: A 126. According to the authors, which of the following statements is true? A. Gender differences in depression are not universal. B. Men in North America are more likely than women to be diagnosed with depression. C. Men are more likely than women to be diagnosed with depression. D. Gender differences in depression are found throughout all cultures. Answer: A 127. Which of the following losses might serve as a starting point for one's experience of major depressive disorder? A. Losing $1.25 in a vending machine and not getting it refunded B. A fellow student from your high school class moves away C. The loss of a grandparent who had been sick for many years D. Getting fired from one's job and having difficulty getting a new job Answer: D 128. According to the _______________ model of depression, when people become depressed they seek excessive reassurance, which, in turn, leads others to dislike and reject them, which can maintain or worsen their depression. A. behavioural B. cognitive C. interpersonal D. learned helplessness Answer: C 129. Kevan used to study diligently for exams in all of his high school classes and begin working on writing projects immediately after they were assigned. However, no matter what he did, he could never score higher than C or C+. What prediction would the behavioural model make about Kevan's behaviour today as a college student? A. Kevan may begin to give up working so hard because of the lack of a payoff for his efforts. B. Kevan will eventually drop out of college because of his poor performance. C. Kevan will continue to study diligently and work hard in his classes. D. Kevan's behaviour cannot be adequately predicted from his past experiences. Answer: A 130. One suggestion for overcoming depression is given by the behavioural model. What is it? A. Stop thinking negative, irrational thoughts all of the time. B. Look at how your actions are creating a negative impression on others and change your behaviour to create a more positive impression. C. Engage in pleasurable activities, even when you do not want to, to create reinforcers for your behaviour. D. Don't get too close to people because they might die or move away and leave you all alone. Answer: C 131. According to Aaron Beck, depression is often caused by A. poor interpersonal skills. B. negative beliefs and expectations. C. a lack of positive reinforcement for one's behaviour. D. biological or genetic influences. Answer: B 132. Which of the following is not part of Beck’s cognitive triad of depressed thinking? A. Negative views of oneself B. Negative views of others C. Negative views of one’s experiences D. Negative views of the future Answer: B 133. Russell has had bouts of mild depression for years, yet tends to display a more accurate view of his circumstances and recognizes factors such as job stress, rejection, and change, which lead to his depressive episodes. Russell’s thoughts represent a phenomenon called A. illusory control. B. overgeneralization. C. learned helplessness. D. depressive realism. Answer: D 134. Which of the following examples demonstrates what the cognitive model means when it discusses selective abstraction? A. Nicholette who believes that she will be more likely to win a gamble if she tosses the dice than if someone else does B. Manuel who believes that it is better to be overly modest than appear to be a braggart C. Ruth who chooses to focus on one instance where she gave an incorrect answer in class as the reason why she feels alienated and like an outsider in all her classes D. Rick who believes that if his girlfriend breaks up with him, there is nothing he will be able to do to make himself feel better Answer: C 135. According to the cognitive model of depression, one's negative beliefs develop as the result of A. failure and rejection. B. deficient levels of certain neurotransmitters in the brain. C. excessive levels of certain neurotransmitters in the brain. D. the loss of positive reinforcement. Answer: A 136. A counterintuitive research finding involving depression is that A. depressed people assume they have more control over the outcome of events than do nondepressed people. B. depressed people have a more accurate view of circumstances than do nondepressed people. C. nondepressed people are less attentive to reality than are depressed people. D. nondepressed people have a more accurate view of circumstances than do depressed people. Answer: B 137. Lily is concerned that her roommate Sachie is feeling overwhelmed by being a first- year student at a large university. Sachie often explains her academic difficulties and failures as being due to _______________ factors. A. internal, specific, and unstable B. internal, global, and unstable C. internal, global, and stable D. external, specific, and unstable Answer: C 138. Mr. Evans feels that no matter what he does, he will be unable to convince his boss that he deserves a promotion. He also feels that it doesn't matter who his boss is, he still would not receive a promotion. These feelings represent what Martin Seligmann called A. learned helplessness. B. depressive realism. C. illusory control. D. overgeneralization. Answer: A 139. In class, a psychology professor states that learned helplessness causes persons to make attributions that are internally focused, global in nature, and stable. A student who demonstrates critical thinking would raise his or her hand and remind the professor that A. such a claim is unfalsifiable. B. the research needs to still be replicated. C. correlation does not equal causation. D. extraordinary claims require extraordinary evidence. Answer: C 140. The results of studies investigating the role of biological factors suggest that depression is caused by A. decreased levels of various neurotransmitters. B. exposure to stressful life events. C. both A and B. D. neither A nor B. Answer: C 141. Depression has been associated with low levels of which two neurotransmitters? A. Serotonin and dopamine B. Norepinephrine and acetylcholine C. Dopamine and norepinephrine D. Acetylcholine and serotonin Answer: C 142. Kayla has experienced a decrease in the need for sleep for the past three nights, is extremely talkative and creative, and has been very irresponsible with money during this time. Kayla is in the midst of a(n) A. dissociated amnesiac episode. B. manic episode. C. major depressive episode. D. obsessive episode. Answer: B 143. A person who suffers from bipolar disorder alternates between _______________. A. mania and schizophrenia B. depression and manic episodes C. anxiety and mania D. depression and schizophrenia Answer: B 144. When a patient arrives in the emergency room, he is restless and irritable with unlimited energy and a rapid rate of speech. The attending psychiatrist believes the patient has taken cocaine or amphetamines and admits him for observation. The next day the symptoms are the same. What condition with symptoms that are similar to those associated with amphetamine use might the psychiatrist now consider as a condition that is relevant to the diagnosis? A. Dissociated amnesiac episode B. Mania C. Major depressive episode D. Obsessive episode Answer: B 145. What specific psychological disorder is marked by cycles of extreme activity and inactivity? A. Catatonic schizophrenia B. Obsessive-compulsive disorder C. Bipolar disorder D. Major depressive disorder Answer: C 146. Which psychological disorder has the strongest evidence for a genetic link? A. Schizophrenia B. Antisocial personality disorder C. Bipolar disorder D. Obsessive-compulsive disorder Answer: C 147. Evidence of a biological influence in bipolar disorder comes from brain imaging studies, which have found that activity is increased in the _______________ and decreased in the _______________. A. hippocampus and thalamus; temporal lobes B. amygdala and emotion-related structures; temporal lobes C. amygdala and emotion-related structures; prefrontal cortex D. amygdala and emotion-related structures; occipital cortex Answer: C 148. Unlike many other psychological disorders, manic episodes may be triggered by A. failures and rejection. B. stressful life events. C. negative life events. D. positive life events. Answer: D 149. In relation to its prevalence, bipolar disorder is A. more common in men than women. B. more common in women than men. C. equally common in men and women. D. extremely rare in both men and women. Answer: C 150. Genetic research suggests that individuals are at an increased risk of developing bipolar disorder if they have genes that increase the sensitivity of _______________ receptors and decrease the sensitivity of _______________ receptors. A. dopamine; serotonin B. serotonin; norepinephrine C. norepinephrine; dopamine D. serotonin; dopamine Answer: A 151. A concern for researchers interested in the topic of suicide prevention is that the number of suicides is A. hopelessly out of date. B. underestimated. C. overestimated. D. much greater for adults than adolescents. Answer: B 152. Jessie is giving a class presentation on suicide. Which of the following is a point you are likely to hear her make? A. People who talk about committing suicide are just looking for attention. B. One must be careful when talking with a depressed person about suicide because you might make them more likely to take their own life. C. As depression lifts, the risk of suicide may increase rather than decrease. D. There is seldom any warning given by those who commit suicide. Answer: C 153. Which of the following is not a major risk factor for suicide? A. Schizophrenia B. Depression C. Dissociative disorder D. Borderline personality disorder Answer: C 154. According to the data, the single best predictor of suicide is A. a previous attempt. B. loss of a loved one. C. recent discharge from the hospital. D. unemployment. Answer: A 155. Which of the following statements is true regarding suicide? A. More women than men attempt suicide. B. There is no relationship between age and attempting suicide. C. Depression is a better predictor of suicide than are feelings of hopelessness. D. More men than women attempt suicide. Answer: A 156. The suicide rate of people with bipolar disorder is about _______________ than that of the general population. A. 5 times lower B. 7 times higher C. 10 times higher D. 15 times higher Answer: D 157. What category of psychological disorders is characterized by inflexible and maladaptive behavioural patterns? A. Personality disorders B. Schizophrenia C. Dissociative disorders D. Anxiety disorders Answer: A 158. On what Axis of the DSM-IV are personality disorders coded? A. Axis I B. Axis II C. Axis III D. Axis IV Answer: B 159. A person who has been diagnosed with borderline personality disorder is most likely to exhibit A. intense discomfort in most social situations and odd thinking and behaviour patterns. B. impulsivity and unpredictability in his or her interactions with others. C. a strong need to be the centre of attention in all social situations. D. a charming, self-centred, and manipulative interpersonal style. Answer: B 160. Marty is moody, manipulative, and unstable, and he lacks a clear sense of identity, and often clings to others. He wants to have close relationships but is unable to do so because he is untrusting of others. Marty is suffering from _______________ personality disorder. A. antisocial B. borderline C. bipolar D. dependent Answer: B 161. Recent research at the Centre for Addiction and Mental Health has suggested that higher prevalence rates of borderline personality disorders are often found in groups of individuals that engage in what problem behaviour? A. Alcohol abuse B. Gambling C. Hypochondriasis D. Manic episodes Answer: B 162. According to the sociobiological model, individuals with borderline personality disorder A. are likely to have experienced childhood sexual abuse and have poor coping skills. B. inherit a tendency to overreact to stress and experience difficulty with emotional regulation. C. have low levels of serotonin that increase responsivity to emotional stimuli resulting in oversensitivity. D. were lacking in key childhood experiences involved in developing a sense of self and emotionally bonding to others. Answer: B 163. Randy has a grandiose sense of self, lacks empathy for others, and is dishonest, manipulative, and callous. What type of personality disorder is Randy most likely to have? A. Psychopathic personality B. Antisocial personality C. Borderline personality D. Depersonalized personality Answer: A 164. Serial killers Paul Bernardo, Ted Bundy, and Aileen Wuornos each are prototypical examples of A. histrionic personality. B. schizotypal personality. C. psychopathic personality. D. borderline personality. Answer: C 165. Individuals with a psychopathic personality may have a history of what childhood disorder? A. Autism B. Conduct disorder C. ADHD D. Bipolar disorder Answer: B 166. What general category of psychological disorders is characterized by a disruption in one's unified sense of identity? A. Anxiety disorders B. Dissociative disorders C. Schizophrenia D. Personality disorders Answer: B 167. _______________ disorder involves frequent experiences where you feel detached from yourself, as though you are living in a movie or a dream, or observing your body from the perspective of an outsider. A. Dissociative amnesia B. Depersonalization C. Dissociative fugue D. Dissociative identity Answer: B 168. Disorders in which there is a break in conscious awareness, memory, the sense of identity, or some combination are called A. anxiety disorders. B. dissociative disorders. C. schizophrenia. D. personality disorders. Answer: B 169. Which of the types of psychological disorders is marked by disruptions in one's sense of consciousness and/or memory? A. Schizophrenia B. Dissociative disorders C. Anxiety disorders D. Personality disorders Answer: B 170. The single most controversial psychological disorder is A. antisocial personality disorder. B. dissociative identity disorder. C. autism. D. attention deficit hyperactivity disorder (ADHD). Answer: B 171. The presence of at least two distinct personalities is characteristic of A. antisocial personality disorder. B. dissociative amnesia. C. schizophrenia. D. dissociative identity disorder. Answer: D 172. In which disorder does a person seem to experience at least two or more distinct personalities existing in one body? A. Antisocial personality disorder B. Dissociative amnesia C. Schizophrenia D. Dissociative identity disorder Answer: D 173. After being passed up for a promotion and then getting into a heated argument with his son, a man disappears. He shows up two weeks later in another town with no memory of who he is or how he got there. He appears to be suffering from A. antisocial personality disorder. B. conversion disorder. C. schizophrenia. D. dissociative disorder. Answer: D 174. A dissociative disorder characterized by a partial or complete loss of memory for personal information that is usually associated with a stressful or emotionally traumatic experience is known as A. dissociative fugue. B. dissociative amnesia. C. schizophrenia. D. dissociative identity disorder. Answer: B 175. Ned seeks therapy after having recurrent episodes of feeling “detached from himself” for several months, but he has not lost his self-awareness or memory. He notes that he feels like a robot, disconnected from his movements and actions. He is most likely suffering from A. dissociative fugue. B. dissociative amnesia. C. depersonalization disorder. D. dissociative identity disorder. Answer: C 176. The police find a man who is dishevelled and in a daze wandering through the downtown area. When the police ask him for his name, he seems bewildered. A search of missing persons photographs reveals that this man was reported missing three months ago in a town more than 1000 kilometres away. The man is most likely suffering from A. dissociative fugue. B. dissociative amnesia. C. schizophrenia. D. dissociative identity disorder. Answer: A 177. A dissociative disorder that involves sudden travel from home, the taking on of a new identity, and amnesia regarding the trip and one’s actual personal information is called A. antisocial personality disorder. B. dissociative amnesia. C. depersonalization disorder D. dissociative fugue. Answer: D 178. Eve seeks treatment to learn how to relax. When her therapist hypnotizes her, her voice changes and someone claiming her name is “Joan” begins to speak. During therapy, 23 separate entities, each with its own name, personal style, and memories emerge. Eve appears to be suffering from A. antisocial personality disorder. B. dissociative amnesia. C. schizophrenia. D. dissociative identity disorder. Answer: D 179. The preponderance of the available data suggests that dissociative identity disorder is A. one's expectancies and beliefs rather than a true disorder in nearly all instances. B. the result of early childhood sexual abuse experiences. C. unconscious and unresolved motivational conflicts from adolescence. D. an attempt to malinger symptoms to avoid imprisonment for one's crimes. Answer: A 180. Kat is giving a report on dissociative identity disorder (DID) in her psychopathology seminar. A main conclusion that you would expect to hear from her talk is that A. most clinical psychologists agree that DID is a valid psychological disorder. B. most claims of sexual abuse as a precursor to DID have been proven with corroborating evidence. C. DID is most often created by questionable therapeutic practices rather than being a true disorder. D. the diagnosis of DID has dropped nearly a hundredfold since 1979. Answer: C 181. Dissociative identity disorder is caused by a history of severe abuse according to the _______________ model, and by expectancies and beliefs about the therapeutic process according to the _______________ model. A. posttraumatic; sociocognitive B. behavioural; humanistic C. psychoanalytic; behavioural D. humanistic; behavioural Answer: A 182. The most severe psychological disorder is A. depression. B. dissociative identity disorder. C. schizophrenia. D. autism. Answer: C 183. A person who is suffering from disordered thinking, bizarre behaviour, and hallucinations and who is unable to distinguish between fantasy and reality is likely suffering from A. depression. B. dissociative identity disorder. C. schizophrenia. D. autism. Answer: C 184. A patient in a psychiatric hospital exhibits disordered thinking, bizarre behaviour, and hallucinations. This person is probably suffering from A. depression. B. dissociative identity disorder. C. schizophrenia. D. autism. Answer: C 185. According to the authors, schizophrenia is most often confused with which other psychological disorder? A. Dementia B. Bipolar disorder C. Dissociative identity disorder D. Autism Answer: C 186. The idea of “split mind” contributed to the popular myth that the symptoms of _______________ stemmed from a split-personality. A. schizophrenia B. borderline personality disorder C. dissociative identity disorder D. bipolar disorder Answer: A 187. Schizophrenia is a disorder that results from disturbances in _______________ that spill into other areas of the person's life. A. memory B. personality C. thought D. mood Answer: C 188. Believing that other people or the government is out to get you is a way in which sufferers of schizophrenia experience their A. hallucinations. B. delusions. C. obsessions. D. compulsions. Answer: B 189. False beliefs held by a person who refuses to accept evidence of their falseness are known as A. hallucinations. B. delusions. C. obsessions. D. compulsions. Answer: B 190. Shareen is diagnosed with schizophrenia. She believes that she is a powerful person who can save the world. Shareen is experiencing A. hallucinations. B. delusions of grandeur. C. delusions of reference. D. compulsions. Answer: B 191. The belief that one is Abraham Lincoln is an example of what schizophrenic symptom? A. Disorganized thinking B. Delusion C. Obsession D. Hallucination Answer: B 192. Shannon believes that her boss has inserted microelectrodes in the water at work because he wants to be able to track the movement of all of his staff. She has “evidence” of this because her fish died when she brought them into work, and she feels compelled to work non-stop every time she has drank the water. Shannon’s experience reflects what symptom of schizophrenia? A. Hallucinations B. Obsessions C. Compulsions D. Delusions Answer: D 193. Trevor has schizophrenia and often hears a voice that tells him “Meat eaters are the devil. They will force you to eat the beef and implant you with brain tumours. Go and stop the meat eaters”. Trevor’s experience reflects what symptom of schizophrenia? A. Delusions of grandeur B. Disorganized speech C. Command hallucinations D. Persecutory delusions Answer: C 194. The most frequent type of hallucinations involves A. experiencing taste in the absence of the appropriate food. B. hearing voices or sounds that are not real. C. seeing objects or persons that are not real. D. feeling objects on one's body that are not really present. Answer: B 195. Feeling insects crawling on your skin (when none are really there) or hearing voices (when no one is around or no one is talking to you) would be examples of what symptom of schizophrenia? A. Hallucinations B. Obsessions C. Compulsions D. Delusions Answer: A 196. Nick is admitted to a mental institution because he hears voices talking to him that no one else can hear, and he sees demons attacking him, though no one else could see anything near him. Nick’s symptoms are known as A. hallucinations. B. obsessions. C. compulsions. D. delusions. Answer: A 197. Experiencing extremes in motor behaviour or repeating phrases over and over are two symptoms associated with A. paranoid schizophrenia. B. disorganized schizophrenia. C. catatonic schizophrenia. D. undifferentiated schizophrenia. Answer: C 198. Repeating the word “maaaaah” repetitively and in a parrot-like fashion reflects what symptom of schizophrenia? A. Delusions B. Hallucinations C. Echolalia D. Disorganized speech Answer: C 199. Monte often displays either flat or inappropriate affect, giggles unpredictably, speaks in a manner that reflects “word salad” and experiences only short-lived and incoherent delusions. What subtype of schizophrenia does Monte have? A. Paranoid type B. Disorganized type C. Catatonic type D. Undifferentiated type Answer: B 200. A person with schizophrenia who displays bizarre or rigid postures, often seeming to get “stuck” in certain positions for hours, is displaying what symptom of schizophrenia? A. Delusions B. Disorganization C. Catatonia D. Echolalia Answer: C 201. Which familial factor increases the risk of relapse in patients with schizophrenia? A. Schizophrenogenic mothers B. Authoritarian parenting C. Childhood sexual abuse D. High levels of expressed emotion Answer: D 202. The research data suggest that schizophrenia results from A. biological/genetic causes. B. difficulties in learning. C. troubles in filtering information from one's social world. D. poor mother–child relationships. Answer: A 203. What part of the brain is typically enlarged in persons with schizophrenia? A. Frontal lobes B. Ventricles C. Amygdala D. Thalamus Answer: B 204. Delusions are to _______________ as flat affect is to _______________. A. positive symptoms; negative symptoms B. negative symptoms; positive symptoms C. excess dopamine; excess serotonin D. diminished serotonin; diminished dopamine Answer: A 205. Research indicates that some people's schizophrenia may result from abnormalities in the brain's receptor sites for what neurotransmitter? A. Dopamine B. Acetylcholine C. Epinephrine D. GABA Answer: A 206. The risk of developing schizophrenia increases to approximately _______________ percent if we have an identical twin with schizophrenia. A. 25 B. 50 C. 75 D. 100 Answer: B 207. The risk of developing schizophrenia is approximately _______________ percent if we have a parent with schizophrenia. A. 6 B. 13 C. 17 D. 48 Answer: A 208. The diathesis-stress model suggests that schizophrenia develops from A. exposure to stress. B. genetic influences entirely. C. environmental influences entirely. D. a combination of a genetic predisposition to schizophrenia and exposure to significant stressors in their life. Answer: D 209. Which of the following is not an “early warning sign” of a vulnerability to schizophrenia or related conditions such as schizotypal personality disorder? A. Learning and memory deficits B. High neuroticism C. Increased sociability D. Impaired attention Answer: C 210. Research has found that more people with schizophrenia are born in which two seasons? A. Spring and summer B. Summer and fall C. Fall and winter D. Winter and spring Answer: D 211. Children who display severe deficits in language, social bonding, and imagination would be diagnosed as having what disorder? A. Conduct disorder B. Autism C. ADHD D. Bipolar disorder Answer: B 212. The widespread belief in an autism epidemic resulting from childhood vaccines has been perpetuated in the media, and the autism-vaccine link represents _______________. A. one causal factor in the development of this disorder B. an illusory correlation C. how environmental factors can “onset” a disorder D. preliminary findings that are slowly gaining research support Answer: B 213. The dramatic increase in the rate of autism over the last decade is most likely due to A. childhood vaccines. B. changes in diagnostic procedures. C. poor diets and nutrition. D. genetic mutations. Answer: B 214. Asperger’s disorder appears to be a mild form of what disorder? A. Autism B. Schizophrenia C. Bipolar disorder D. Depression Answer: A 215. Which of the following statements is true concerning attention-deficit/hyperactivity disorder? A. Approximately 10-15% of children are diagnosed with ADHD. B. ADHD is more prevalent in young boys than in young girls. C. Children with ADHD are unable to concentrate on tasks. D. ADHD is caused by environmental and parenting factors. Answer: B 216. Genetic and biological research has reported that ADHD patients display decreased activation in what area of the brain? A. Temporal lobe B. Parietal lobe C. Frontal lobe D. Occipital lobe Answer: C 217. What type of medication is used, with success, to treat children with ADHD? A. Anxiolytics B. Stimulants C. Depressants D. Antipsychotics Answer: B 218. What other childhood disorder is ADHD often confused with (and possibly misdiagnosed as)? A. Autism B. Asperger’s disorder C. Early-onset bipolar disorder D. Conduct disorder Answer: C 219. The authors of your text suggest that the increase in diagnosis of early-onset bipolar disorder may come from the fact that many children diagnosed with bipolar disorder could merely be those with severe symptoms of _______________. A. Autism B. Asperger’s disorder C. ADHD D. Conduct disorder Answer: C Critical Thinking Questions 1. Describe the four prevalent misconceptions regarding psychiatric diagnosis. For each, explain how the media or the criminal justice system have contributed to these erroneous perceptions. Answer: Answers will vary but a full credit answer should contain the following points. Misconception 1: Psychiatric diagnosis is nothing more than pigeonholing—that is, sorting people into different “boxes.” According to this criticism, when we diagnose people with a mental disorder, we deprive them of their uniqueness: We imply that all people within the same diagnostic category are alike in all important respects. Misconception 2: Psychiatric diagnoses are unreliable. As we learned in Chapter 2, reliability refers to consistency of measurement. In the case of psychiatric diagnoses, the form of reliability that matters most is interrater reliability: the extent to which different raters (such as different psychologists) agree on patients’ diagnoses. The widespread perception that psychiatric diagnosis is unreliable is probably fuelled by high-profile media coverage of “duelling expert witnesses” in criminal trials, in which one expert witness diagnoses a defendant as experiencing schizophrenia and another diagnoses him as free of this disorder. Misconception 3: Psychiatric diagnoses are invalid. From the standpoint of Thomas Szasz (1960) and other critics, psychiatric diagnoses are largely useless because they don’t provide us with much, if any, new information. They’re merely descriptive labels for behaviours we don’t like. When it comes to some popular psychology labels, Szasz probably has a point. Consider the explosion of diagnostic labels that are devoid of scientific support, such as codependency, sexual addiction, Internet addiction, road rage disorder, and compulsive shopping disorder. Misconception 4: Psychiatric diagnoses stigmatize people. According to labelling theorists, psychiatric diagnoses exert powerful negative effects on people’s perceptions and behaviours (Scheff, 1984; Slater, 2004). Labelling theorists argue that once a mental health professional diagnoses us, others perceive us differently. Suddenly, we’re “weird,” “strange,” even “crazy.” This diagnosis leads others to treat us differently, in turn often leading us to behave in weird, strange, or crazy ways. The diagnosis thereby becomes a self-fulfilling prophecy. Four prevalent misconceptions regarding psychiatric diagnosis are: 1. Over-simplification of Disorders: Media often portrays psychiatric disorders in a stereotypical and exaggerated manner, simplifying complex conditions like schizophrenia or bipolar disorder into caricatures. 2. Stigmatization and Misrepresentation: Criminal cases sometimes sensationalize mental illness as a cause of violent behavior, perpetuating the misconception that all individuals with mental disorders are dangerous. 3. Neglect of Treatment Success Stories: Media coverage tends to focus on negative outcomes or rare extreme cases, overshadowing successful treatment stories and recovery journeys. 4. Lack of Understanding of Diagnostic Criteria: The media and even the criminal justice system may misinterpret or oversimplify diagnostic criteria, leading to misunderstandings about the nature and severity of psychiatric disorders. 2. Differentiate how learning theorists and cognitive theorists differ in their explanations for the causes of anxiety disorders and major depressive disorder. Answer: Answers will vary but a full credit answer should contain the following points. • Learning theorists believe that anxiety disorders result from our direct (operant conditioning approaches) and indirect experiences (classical conditioning, observational/social learning) with the world around us. For example, we learn via negative reinforcement that our anxiety can be reduced by leaving stressful situations or places, people, or objects that we fear. • Learning theorists explain depression through discussing the loss of positive reinforcement. Without being able to attain desired rewards for our actions, we come to feel that we are incapable of producing desired outcomes in other situations. • Cognitive theorists believe that anxiety disorders result from our thought patterns about events. For example, people overgeneralize or catastrophize the likelihood of a highly improbable event and create needless worries for themselves. • Cognitive theorists explain depression through individuals' negative view of themselves, their experiences, and their future. They view themselves as incapable now and in the future, and engage in cognitive distortions that create problems for themselves rather than see their experiences, abilities, and futures realistically. Learning theorists attribute anxiety disorders and major depressive disorder to conditioning and reinforcement processes. For instance, anxiety might develop through classical conditioning (associating a neutral stimulus with fear) or operant conditioning (avoidance behaviors reinforced by anxiety relief). In contrast, cognitive theorists focus on distorted thinking patterns and maladaptive beliefs as central to these disorders, such as catastrophizing or negative self-perceptions, which perpetuate anxiety and depression. 3. Differentiate how the posttraumatic model and the sociocognitive model differ in their explanations of the causes of Dissociative Identity Disorder (DID). Identify which view has been empirically supported and list several observations that have provided support for this view. Answer: Answers will vary but a full credit answer should contain the following points. According to the posttraumatic model (Gleaves, May, & Cardeña, 2001; Ross, 1997), DID arises from a history of severe abuse—physical, sexual, or both—during childhood. This abuse leads individuals to “compartmentalize” their identity into distinct alters as a means of coping with intense emotional pain. In this way, the person can feel as though the abuse happened to someone else. Advocates of the posttraumatic model claim that 90 percent or more of individuals with DID were severely abused in childhood (Gleaves, 1996). Nevertheless, many studies that reported this association didn’t check the accuracy of abuse claims against objective information, such as court records of abuse (Coons, Bowman, & Milstein, 1988). Moreover, researchers haven’t shown that early abuse is specific to DID, as it is present in many other disorders (Pope & Hudson, 1992). These considerations don’t exclude a role for early trauma in DID, but they suggest that researchers must conduct further controlled studies before drawing strong conclusions (Gleaves, 1996; Gleaves et al., 2001). According to advocates of the competing sociocognitive model (see Chapter 5), the claim that some people have hundreds of personalities is extraordinary, but the evidence for it is unconvincing (Giesbrecht et al., 2008; Lilienfeld et al., 1999; McHugh, 1993; Merskey, 1992; Spanos, 1994, 1996). According to this model, people’s expectancies and beliefs—shaped by certain psychotherapeutic procedures (i.e., hypnosis, repeated prompting of alters), and cultural influences, rather than early traumas—account for the origin and maintenance of DID. Observations in support of latter view: 1. Many or most DID patients show few or no clear-cut signs of this condition, such as alters, prior to psychotherapy (Kluft, 1984). 2. Mainstream treatment techniques for DID reinforce the idea that the person possesses multiple identities. These techniques include using hypnosis to “bring forth” hidden alters, communicating with alters and giving them different names, and encouraging patients to recover repressed memories supposedly housed in dissociated selves (Spanos, 1994, 1996). 3. The number of alters per DID individual tends to increase substantially when therapists use these techniques (Piper, 1997). The posttraumatic model suggests that DID arises from severe childhood trauma, such as abuse, leading to dissociation as a defense mechanism. In contrast, the sociocognitive model proposes that DID emerges from suggestibility, therapist influence, and societal beliefs about dissociation. Empirical support has been stronger for the posttraumatic model, with observations of high rates of childhood trauma among individuals with DID and changes in identity states triggered by trauma-related cues supporting this view. Essay Questions 1. Identify and discuss important considerations in distinguishing between normal and psychologically disordered behaviour. Answer: Answers will vary but the discussion should address at least four of the following six points for full credit. • Psychologically disordered behaviour will occur relatively infrequently. • Psychologically disordered behaviour will often cause the person to experience psychological and/or physical distress or discomfort. • Psychologically disordered behaviour will lead to problems in interpersonal relationships, school/academics, work, or ability to successfully deal with daily living. • Psychologically disordered behaviour often has accompanying physiological problems (e.g., neurotransmitter or receptor site deficiencies). • Psychologically disordered behaviour may involve difficulties in controlling one's behaviour. Important considerations include the impact of behavior on daily functioning, cultural context, duration, and distress caused. Normal behavior typically aligns with cultural norms and does not significantly impair functioning or cause distress, whereas psychologically disordered behavior deviates from these norms and can interfere with daily life. 2. Contrast the demonic and moral treatment approaches of mental illness. Answer: Answers will vary but should contain the following points for full credit. • The demonic model assumed that the primary cause of mental illness was the presence of evil spirits within the body. • The demonic model assumed that the absence of something was indicative of an undesired evil spirit (absence of sinking implied one was a witch). • The demonic model treated mental illness by attempting to remove the evil spirits from the body. • The moral treatment approach addressed the treatment of those with mental illness more than identifying the cause or causes of mental illness. • Rather than treating those with mental illness as a subhuman form, the humane thing to do was to treat them with kindness, dignity, and respect. The demonic approach viewed mental illness as caused by supernatural forces, requiring exorcism or religious rituals. In contrast, moral treatment emphasized humane care, moral guidance, and therapeutic environments to rehabilitate individuals with mental illness, focusing on their moral and social development. 3. What are some important criticisms of the DSM-IV as a diagnostic tool for psychological disorders? Be sure to elaborate on your answers. Answer: Answers will vary but should include the following points, along with appropriate supportive discussion, for full credit. • Some disorders are nothing more than labels for a problem rather than an informative diagnosis that adds to our knowledge about the person. • Some people are diagnosed as suffering from multiple disorders at the same time (comorbidity), which may instead suggest that the disorders are variations on a single condition rather than true, independent diagnoses. • The DSM is a based on a categorical approach—one either has the disorder (meets the diagnostic criteria for a disorder) or does not. This means that one is either normal or abnormal (differences in kind), rather than differing in one's degree of healthy functioning (differences in degree). Critics argue that the DSM-IV's categorical approach oversimplifies complex disorders, neglecting the spectrum and variability of symptoms within disorders. It has been criticized for relying heavily on symptom checklists without sufficient consideration of contextual factors or individual differences. Additionally, concerns about overdiagnosis and diagnostic reliability have been raised, questioning its validity across diverse cultural contexts and its ability to capture the dynamic nature of mental health conditions over time. 4. What are phobias? Describe agoraphobia, specific phobias, and social phobia. Answer: Answers will vary but should contain the following information for full credit. A phobia is an intense fear of an object or situation that’s greatly out of proportion to its actual threat. For a fear to be diagnosed as a phobia, it must restrict our lives, create considerable distress, or both. Phobias are the most common of all anxiety disorders. One in nine of us has a phobia of an animal, blood or injury, or a situation like a thunderstorm. Social fears are just as common (Kessler et al., 1994). Agoraphobia, which we’ll examine next, is the most debilitating of the phobias, and occurs in about one in 20 of us (Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996). Agoraphobia. Some 2700 years ago in the city-states of ancient Greece, agoraphobia acquired its name as a condition in which certain fearful citizens couldn’t pass through the central city’s open-air markets (agoras). A common misconception is that agoraphobia is a fear of crowds or public places. But agoraphobia actually refers to a fear of being in a place or situation in which escape is difficult or embarrassing, or in which help is unavailable in the event of a panic attack (APA, 1994). Most fears originate in childhood, but agoraphobia emerges in the midteens and is typically a direct outgrowth of panic disorder. In fact, most people with panic disorder develop agoraphobia (Cox & Taylor, 1999) and become apprehensive in a host of settings, such as malls, crowded movie theatres, tunnels, bridges, or wide-open spaces. Specific Phobia. Phobias of objects, places, or situations—called specific phobias— commonly arise in response to animals, insects, thunderstorms, water, elevators, and darkness. Many of these fears, especially of animals, are widespread in childhood but disappear with age (APA, 2000). Social Phobia. Surveys show that most people rank public speaking as a greater fear than dying (Wallechinsky, Wallace, & Wallace, 1977). Given that statistic, imagine how people with social phobia must feel. People with this condition—a marked fear of public appearances in which embarrassment or humiliation seems likely—experience anxiety well beyond the stage fright that most of us feel occasionally (Heimberg & Juster, 1995). People with social phobia are often deathly afraid of speaking, eating, or performing in public. Some people with social phobia even fear using public restrooms. Alert to the slightest hint of disapproval, social phobics may misinterpret ambiguous feedback from others as negative (Coles & Heimberg, 2002; Gray & McNaughton, 2000). In some cases they’re so concerned with drawing attention to themselves that they’re afraid to sign their names on cheques or to swim, breathe, or swallow in public (Mellinger & Lynn, 2003). Phobias are intense, irrational fears of specific objects or situations that provoke anxiety and avoidance behavior. Agoraphobia involves fear of situations where escape might be difficult or help unavailable. Specific phobias are fears of particular objects or situations, like heights or spiders. Social phobia, or social anxiety disorder, involves intense fear of social situations where scrutiny or embarrassment may occur, leading to avoidance of social interactions. 5. Discuss how the interpersonal, behavioural, cognitive, and learned helplessness models of depression differ. Answer: Answers will vary but should contain the following information for full credit. Interpersonal Model: Depression as a Social Disorder. James Coyne (1976; Joiner & Coyne, 1999; Rudolph, Hammen, Burge, Lindberg, Herzberg, & Daley, 2006) hypothesized that depression creates interpersonal problems. When people become depressed, he argued, they seek excessive reassurance, which, in turn, leads others to dislike and reject them. Depression is a vicious cycle. Depressed people often elicit hostility and rejection from others, which, in turn, maintains or worsens their depression. Behavioural Model: Depression as a Loss of Reinforcement. Peter Lewinsohn’s (1974) behavioural model assumes that depression results from a low rate of response- contingent positive reinforcement. Put in simpler terms, when depressed people try different things and receive no payoff for them, they eventually give up. They stop participating in many pleasant activities, leaving them little opportunity to obtain reinforcement from other people. In time, their personal and social worlds shrink, as depression seeps into virtually every nook and cranny of their lives. Lewinsohn later observed that depressed people sometimes lack social skills (Segrin, 2000; Youngren & Lewinsohn, 1980), making it even harder for them to obtain reinforcement from others. To make matters worse, if people respond to depressed individuals with sympathy and concern, they may reinforce and maintain these individuals’ withdrawal. This view implies a straightforward recipe for breaking the grip of depression: pushing ourselves to engage in pleasant activities. Sometimes merely getting out of bed can be the first step toward conquering depression. Cognitive Model: Depression as a Disorder of Thinking. In contrast, Aaron Beck’s influential cognitive model of depression holds that depression is caused by negative beliefs and expectations (Beck, 1987). Beck focused on the cognitive triad, three components of depressed thinking: negative views of oneself, one’s experiences, and the future. These habitual thought patterns, called negative schemas, presumably originate in early experiences of loss, failure, and rejection. Activated by stressful events in later life, these schemas reinforce depressed people’s negative experiences (Scher, Ingram, & Segal, 2005). Depressed people’s view of the world is bleak because they put a decidedly negative mental spin on their experiences. They also suffer from cognitive distortions, that is, skewed ways of thinking. Two examples are overgeneralization and selective abstraction. People engage in overgeneralization when they draw an extremely broad conclusion on the basis of a specific fact or minor event. After receiving a parking ticket, a woman might conclude she’s worthless and that nothing will ever go right for her. People engage in selective abstraction when they draw a negative conclusion based on only an isolated aspect of a situation. A man might consistently single out a trivial error he committed in a softball game and blame himself completely for the loss. It’s as though depressed people were wearing glasses that filtered out all of life’s positive experiences and brought all of life’s negative experiences into sharper focus. Learned Helplessness: Depression as a Consequence of Uncontrollable Events. Bruce Overmier and Seligman (1967) described learned helplessness as the tendency to feel helpless in the face of events we can’t control and argued that it offers an animal model of depression. They noted striking parallels between the effects of learned helplessness and depressive symptoms: passivity, appetite and weight loss, and difficulty learning that one can change circumstances for the better. But we must be cautious in drawing conclusions from animal studies because many psychological conditions, including depression, may differ in animals and humans. The interpersonal model of depression focuses on disrupted relationships and interpersonal conflicts as triggers for depression. The behavioral model emphasizes learned patterns of negative behaviors and reinforcement. Cognitive models highlight distorted thought patterns and negative beliefs about oneself, the world, and the future. Learned helplessness model posits that individuals become depressed when they perceive events as uncontrollable and hopeless, leading to feelings of helplessness. 6. Identify and discuss two important myths as well as the reality of suicide and important risk factors that predict suicide attempts. Answer: Answers will vary but should contain the following information for full credit. • Students should identify and discuss any two of the myths and the real facts that are listed in Table 15.9 on page 622. • Students need to identify that a previous attempt is the best predictor of an attempted suicide. • Students should mention that while depression is a risk factor, it is less predictive than feelings of hopelessness. • Students should also mention either a person's intense agitation or wish to have died in previous attempt as an important predictor. • Students should list at least one more risk factor mentioned in Table 15.9. Optional (may include either as credit or extra credit) • Mention that while more women attempt suicide than men, more men successfully complete suicide attempts. • Mention that suicide is the third leading cause of death for children, adolescents, and young adults. • Mention that data on attempts and suicides may be underreported by relatives for various reasons (e.g., religious beliefs about persons who commit suicide not being allowed into heaven). Two myths about suicide are that people who talk about it won't actually do it and that suicide happens without warning. In reality, many individuals do communicate their intentions beforehand, and warning signs can often be present. Important risk factors include mental illness (especially mood disorders), substance abuse, previous suicide attempts, social isolation, and access to lethal means such as firearms. 7. Differentiate between the psychological disorders of dissociative identity disorder (DID) and schizophrenia. Answer: Answers will vary but should contain at least three of the following points, including the first one for sure, to earn full credit. • DID is one of the dissociative disorders characterised by disruptions in a unified sense of the self (through disruptions in consciousness, memory, identity, or perception) where there are multiple personalities within a single individual. Schizophrenia by contrast deals with disruptions in thought processes/information processes that in turn effect expression of language, emotions, perceptual abilities, and relationships with others. • DID is a highly controversial disorder with many critics doubting its existence as a valid diagnosis. By contrast, schizophrenia has long been recognised as a disorder (going back to Bleuler's coining of the term in 1911). • DID is proposed to arise as a response for dealing with experiences of childhood sexual abuse (in response to environmental factors when it cannot be explained via the sociocognitive model), while schizophrenia is often linked to biological and/or genetic causes. However, many psychologists take the approach that schizophrenia is caused by having a predisposition to schizophrenia along with an exposure to significant stress or multiple stressors in one's life making the disorder more likely to emerge (diathesis- stress model). • DID largely appeared with the use of suggestive therapeutic tools that seem to create the disorder (and fit with the sociocognitive explanation), while schizophrenia is only managed through the use of antipsychotic medications and hospitalisation as necessary for the symptoms. • DID is often marked by the switching between from one's normal personality among the various “alters” that exist. Schizophrenia is often marked by the presence of delusions, hallucinations, disorganized speech, catatonia or other disorganized behaviour. Dissociative Identity Disorder (DID) involves the presence of two or more distinct identities or personality states that recurrently take control of the individual's behavior. These identities may have unique memories and traits. In contrast, schizophrenia is characterized by hallucinations, delusions, disorganized thinking, and impaired emotional responses. DID primarily involves disruptions in identity, while schizophrenia is marked by disturbances in perception, thought processes, and emotional expression. 8. Identify and describe the four main classes of symptoms of schizophrenia. Answer: Answers will vary but should contain the following information for full credit. Delusions: Fixed False Beliefs. Among the hallmark symptoms of schizophrenia are delusions—strongly held fixed beliefs that have no basis in reality. Delusions are called psychotic symptoms because they represent a serious distortion of reality. Delusions commonly involve themes of persecution, delusions of grandeur (greatness), other delusions centre on the body and may include a firm belief that one is infested with brain parasites or even that one is dead (so-called Cotard’s syndrome). Still others involve elaborate themes of sexuality or romance. Hallucinations: False Perceptions. Among the other serious symptoms of schizophrenia are hallucinations: sensory perceptions that occur in the absence of an external stimulus. They can be auditory (involving hearing), olfactory (involving smell), gustatory (involving taste), tactile (involving the sense of feeling), or visual. Most hallucinations in schizophrenia are auditory, usually consisting of voices. In some patients, hallucinated voices express disapproval or carry on a running commentary about the person’s thoughts or actions. Command hallucinations, which tell patients what to do (“Go over to that man and tell him to shut up!”) may be associated with a heightened risk of violence toward others (McNiel, Eisner, & Binder, 2000). Incidentally, visual hallucinations in the absence of auditory hallucinations are usually signs of an organic (medical) disorder or substance abuse rather than schizophrenia (Shea, 1998). Disorganized Speech. We can see that his language skips from topic to topic in a disjointed way. Most researchers believe that this peculiar language results from thought disorder (McGrath, 1991;Meehl, 1962). The usual associations that we forge between two words, such as mother–child, are considerably weakened or highly unusual for schizophrenic individuals (for example, mother–rug). In severe forms, the resulting speech is so jumbled that it’s almost impossible to understand, leading psychologists to describe it as word salad. Grossly Disorganized Behaviour or Catatonia. When people develop schizophrenia, self-care, personal hygiene, and motivation often deteriorate. These individuals may avoid conversation; laugh, cry, or swear inappropriately; or wear a warm coat on a sweltering summer day. Catatonic symptoms involve motor (movement) problems, such as extreme resistance to complying with even simple suggestions, holding the body in bizarre or rigid postures, or curling up in a fetal position. Catatonic individuals’ withdrawal can be so severe that they refuse to speak and move, or they may pace aimlessly. They may also repeat a phrase in conversation in a parrotlike manner, a symptom called echolalia. At the opposite extreme, they may occasionally engage in bouts of frenzied, purposeless motor activity. The four main classes of symptoms of schizophrenia are: 1. Positive Symptoms: Include hallucinations (perceiving things that aren't there) and delusions (false beliefs). 2. Negative Symptoms: Involve deficits in normal emotional responses and behaviors, such as reduced motivation, social withdrawal, and diminished speech. 3. Disorganized Symptoms: Include disorganized thinking, speech, and behavior, manifesting as incoherence and unpredictable or inappropriate actions. 4. Cognitive Symptoms: Involve impairments in memory, attention, and executive functioning, affecting the ability to plan and organize daily activities. 9. Discuss the biological explanations for schizophrenia, including brain, biochemical, and genetic differences. Answer: Answers will vary but should contain a reflection of the following information for full credit. Brain Abnormalities. Research indicates that one or more of four fluid-filled structures called ventricles (see Chapter 3), which cushion and nourish the brain, are typically enlarged in individuals with schizophrenia. This finding is important for two reasons. First, these brain areas frequently expand when others shrink (Barta, Pearlson, Powers, Richards, & Tune, 1990; Raz & Raz, 1990). Second, deterioration in these areas is associated with thought disorder (Vita et al., 1995). Other brain abnormalities in schizophrenia include increases in the size of the sulci, or spaces between the ridges of the brain (Cannon,Mednick, & Parnas, 1989), and decreases in activation of the amygdala and hippocampus (Hempel,Hempel, Schönknecht, Stippich, & Schröder, 2003) and in the symmetry of the brain’s hemispheres (Luchins,Weinberger, & Wyatt, 1982; Zivotofsky, Edelman, Green, Fostick, & Strous, 2007). Functional brain imaging studies show that the frontal lobes of people with schizophrenia are less active than those of nonpatients when engaged in demanding mental tasks (Andreasen et al., 1992; Carter et al., 1998), a phenomenon called hypofrontality (see Prologue). Still, it’s not clear whether these findings are causes or consequences of the disorder. For example, hypofrontality could be due to the tendency of patients with schizophrenia to concentrate less on tasks compared with other individuals. Researchers also need to rule out alternative explanations for brain underactivity that could arise from patients’ diet, drinking and smoking habits, and medication use (Hanson & Gottesman, 2005). Neurotransmitter Differences. The biochemistry of the brain is one of the keys to unlocking the mystery of schizophrenia. One early explanation was the dopamine hypothesis (Carlsson, 1995; Keith, Gunderson, Reifman, Buchsbaum, & Mosher, 1976; Nicol & Gottesman, 1983). The evidence for the role of dopamine in schizophrenia is mostly indirect. First, most antischizophrenic drugs block dopamine receptor sites. To put it crudely, they “slow down” nerve impulses by partially blocking the action of dopamine (see Chapter 16). Second, amphetamine, a stimulant drug (see Chapter 5) that blocks the reuptake of dopamine, tends to make the symptoms of schizophrenia worse (Lieberman & Koreen, 1993; Snyder, 1975). Nevertheless, the hypothesis that a simple excess of dopamine creates the symptoms of schizophrenia doesn’t seem to fit the data. A better-supported rival hypothesis is that abnormalities in dopamine receptors produce these symptoms. Receptor sites in the brain appear to be highly specific for dopamine transmission. These sites respond uniquely to drugs designed to reduce psychotic symptoms and are associated with difficulties in attention, memory, and motivation (Busatto et al., 1995; Keefe & Harvey, 1994; Reis, Masson, deOliveira, & Brandão, 2004). These findings provide evidence for a direct tie between dopamine pathways and symptoms of schizophrenia, such as paranoia. As we’ve seen, some of the symptoms of schizophrenia represent distortions or excesses of normal functions and include hallucinations, delusions, and disorganised speech and behaviour. We can contrast these so called positive symptoms with negative symptoms, which reflect a decrease or loss of normal functions. These symptoms include social withdrawal and diminished motivations, decreased expression of emotions, and brief and limited speech (Andreasen, Arndt, Alliger, Miller, & Flaum, 1995). People with schizophrenia are less impaired when their symptoms are predominantly positive rather than negative (Harvey, Reichenberg, & Bowie, 2006). There’s evidence that positive symptoms result from dopamine excess in some brain regions and negative symptoms from dopamine deficits in other brain regions (Davis, Kahn, Ko, & Davidson, 1991). However, the cause of negative symptoms can be difficult to pinpoint, because they may arise from prolonged institutionalisation and medication side effects (see Chapter 16). Dopamine is probably only one of several neurotransmitters that play a role in schizophrenia; other likely candidates include norepinephrine, glutamate, and serotonin (Cornblatt et al., 1999; Grace, 1991). Genetic Influences. Still unresolved is the question of which biological deficits are present prior to schizophrenia and which appear after the disorder begins (Seidman et al., 2003). The seeds of schizophrenia are often sown well before birth and lie partly in individuals’ genetic endowment. As we can see in Figure 15.5, being the offspring of someone diagnosed with schizophrenia greatly increases one’s odds of developing the disorder. If we have a sibling with schizophrenia, we have about a one in ten chance of developing the disorder; these odds are about ten times higher than those of the average person. As genetic similarity increases, so does the risk of schizophrenia. If we have an identical twin with schizophrenia, our risk rises to about 50 percent. An identical twin of a person with schizophrenia is about three times as likely as a fraternal twin of a person with schizophrenia to develop the disorder, and about 50 times as likely as an average person (Gottesman & Shields, 1972; Kendler & Diehl, 1993;Meehl, 1962). Adoption data also point to a genetic influence. Even when children who have a biological parent with schizophrenia are adopted by parents with no hint of the disorder, their risk of schizophrenia is greater than that of a person with no biological relative with schizophrenia (Gottesman, 1991). Biological explanations for schizophrenia suggest abnormalities in brain structure and function, such as enlarged ventricles and reduced gray matter volume, particularly in the frontal and temporal lobes. Biochemically, dopamine dysregulation is implicated, with excess dopamine activity linked to positive symptoms. Genetic factors play a significant role, with heritability estimates around 80%; specific genes related to neurotransmitter systems and brain development are under investigation. 10. What is borderline personality disorder (BPD)? Describe the behaviours displayed by someone who has been diagnosed with BPD and discuss what explanations have been given for BPD. Answer: Answers will vary but should contain the following information for full credit. Borderline personality disorder is a condition marked by instability in mood, identity, and impulse control. Individuals with a borderline personality disorder tend to be extremely impulsive and unpredictable, although many are married and hold down good jobs. Their relationships frequently alternate from extremes of worshipping partners one day to hating them the next. Borderline persons’ impulsivity and rapidly fluctuating emotions often have a self-destructive quality: Many engage in drug abuse, sexual promiscuity, overeating, and even self-mutilation, like cutting themselves when upset. They may threaten suicide to manipulate others, reflecting the chaotic nature of their relationships. Because many of them experience intense feelings of abandonment when alone, they may jump frantically from one unhealthy relationship to another. Explanations of Borderline Personality Disorder. Object relations theorist Otto Kernberg (1967, 1975) traced the roots of borderline personality to childhood problems with developing a sense of self and bonding emotionally to others. According to Kernberg, borderline individuals can’t integrate differing perceptions of people, themselves included. This defect supposedly arises from an inborn tendency to experience intense anger and frustration from living with a cold, unempathic mother. Kernberg argued that borderline individuals experience the world and themselves as unstable because they tend to “split” people and experiences into either all good or all bad. Although influential, Kernberg’s model of borderline personality remains inadequately researched. According to Marsha Linehan’s (1993) sociobiological model, individuals with borderline personality disorder inherit a tendency to overreact to stress and experience lifelong difficulties with regulating their emotions. Indeed, twin studies suggest that borderline personality traits are substantially heritable (Torgersen et al., 2000). Difficulties in controlling emotions may be responsible for the rejection many individuals with borderline personality disorder encounter, as well as their concerns about being validated, loved, and accepted. Linehan’s clinical work and research suggest the following recipe for creating a borderline personality: Expose a child to a great deal of trauma and stress, don’t validate the child’s feelings, and don’t provide the child with skills to cope with stress. Needless to say, we don’t recommend that you follow this prescription with your children. Borderline Personality Disorder (BPD) is a mental health disorder characterized by pervasive instability in mood, interpersonal relationships, self-image, and behavior. Individuals with BPD often exhibit intense fear of abandonment, impulsivity, unstable sense of self, frequent mood swings, and recurrent self-harm behaviors. Explanations for BPD include biological factors such as genetic predispositions and abnormalities in brain structure and function, as well as environmental factors such as early life trauma or invalidating environments that contribute to the development of the disorder. Fill in the Blank Questions 1. Most psychologists agree that it is _______________ that any single criterion helps demarcate psychological disorders and abnormal behaviour from normality. Answer: unlikely 2. The conceptualization of psychological troubles as resulting from physical disorders is known as the _______________ Answer: medical model. 3. Persons who suffer from a particular psychological disorder are considered to be alike in at _______________ important respect. Answer: least one 4. Psychiatrist Thomas Szasz would disagree with the majority of psychologists about the _______________ of the various disorders listed in the DSM-IV. Answer: validity 5. According to your authors, one possible explanation for the apparent exponential growth in the diagnosis of _______________ is the change in diagnostic criteria for the disorder from DSM-III to DSM-IV. Answer: autism 6. Before discussing the chapter on Psychological Disorders, Dr. Plummer warned his class against seeing the symptoms in their own everyday behaviour and thus believing that they suffered from the disorder. He was warning them against ____________ Answer: medical students' syndrome. 7. _______________ implies that a person who committed a crime fails to understand that what he or she did was wrong. Answer: Insanity 8. Eddie is unable to help his lawyers as they prepare to defend him against three charges of first- degree murder. It is likely that Eddie will be found ____________ Answer: incompetent to stand trial. 9. Marvel is often anxious and tense, though there is no specific reason for these feelings. As a result she is often irritable with her family, friends, and co-workers without meaning to be. Her family doctor suggests that she meet with a psychiatrist to discuss her ___________________ Answer: generalised anxiety disorder (or anxiety disorder if wishing to differentiate between the major categories of disorder mentioned in the chapter). 10. _______________ involves an intense fear of public situations in which embarrassment or humiliation is likely. Answer: Social phobia 11. Marc is often consumed by the thought that he is unclean despite the fact that he has bathed. He also becomes extremely anxious when other people want to shake hands with him or touch him, because all he can think about is the germs that may get passed from them to him. Marc's continual fears are what psychologists label as a(n) ________________ Answer: obsession (or obsessive- compulsive disorder if wishing students to name the actual disorder). 12. Your authors strongly imply that _______________ is the single most frequently diagnosed psychological disorder. Answer: major depressive disorder (or depression or clinical depression) 13. Felix has a strong feeling of grandiosity, experiences racing thoughts throughout the day, and is much more active and agitated than normal. Felix appears to be experiencing a ___________ Answer: manic episode. 14. An approach to understanding how depression occurs as the result of a combination of genetic factors, psychological difficulties, and the culture in which one lives is known as the _______________ Answer: biopsychosocial approach. 15. According to cognitive theorists such as Aaron Beck and Albert Ellis, some people's depression is the result of _______________ about the self or one's abilities. Answer: negative schemas 16. Scott feels that no matter what he does, he will always be unable to master his French vocabulary terms. He points to the fact that he has received a 5/10, 6/10, and 5/10 despite increasing the amount of time he studied each week. As a result, he has stopped going to class and studying. Scott is demonstrating a phenomenon known as ____________ Answer: learned helplessness. 17. Public health officials and researchers assert that the number of suicides reported each year is likely an ______________ Answer: underestimate. 18. Nicholas's therapist suggests that his inability to recall any specifics from the dozens of times he was sexually abused by his great-uncle results from a second personality that is protecting him. After being hypnotised, a personality called “Biff” emerges that Nicholas is unaware of. This finding is most consistent with the _______________ explanation of dissociative identity disorder. Answer: posttraumatic 19. Tavaris feels that the legal system and his ex-wife are unfairly out to get him and are making him pay more child support than he should. One persistent belief he has is that the police, the judges at the court house, and his ex-wife have all conspired to send the Gnarls Barkley song "Crazy" into his head. Tavaris is clearly suffering from _____________ Answer: delusions (or delusions of persecution). 20. The hallucinations that those with schizophrenia experience are most likely to be _______________ in nature. Answer: auditory 21. Riddick constantly speaks in a manner that is hard to follow because he quickly skips from topic to topic, sometimes even within a single sentence. This is most clearly the schizophrenic symptom of _______________. Answer: disorganized speech. Test Bank for Psychology: From Inquiry to Understanding Scott O. Lilienfeld, Steven J. Lynn, Laura L. Namy, Nancy J. Woolf, Kenneth M. Cramer, Rodney Schmaltz 9780205896110, 9780133793048, 9780133870282
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