Course material

1. 300 words and please cite from the document
8 Mental Health Disorders Asiseeit/E+/Getty Learning Outcomes After reading this chapter,
you should be able to • Explain the history of mental health disorders. • Discuss the
interaction between genetics and environment in the development of mental health
disorders. • Differentiate the symptoms and expression of the mental health disorders
discussed in this chapter. • Use Bronfenbrenner’s ecological model to illustrate the micro-,
meso-, and macro-level impact of mental health disorders. • Discuss mental health disorder
development through the life span. • Identify three basic approaches for the treatment of
major mental disorders. • Explain social issues as they relate to mental disorders. • Describe
how stigma affects the treatment of mental disorders. • Explain mental health care
disparities and discuss strategies to fix them. © 2019 Bridgepoint Education, Inc. All rights
reserved. Not for resale or redistribution. Introduction to Mental Health Disorders Section
8.1 8.1 Introduction to Mental Health Disorders Mental health is not just the absence of
mental disorders. The World Health Organization (WHO) defined mental health as “a state
of well-being in which every individual realizes his or her own potential, can cope with the
normal stresses of life, can work productively and fruitfully, and is able to make a
contribution to her or his community” (WHO, 2014, para. 1). Characteristics of people who
are mentally healthy include the following: • They show appropriate emotions related to the
circumstances. • They have the ability to be flexible and easily adjust their responses to
unexpected occurrences. • They have a sense of self-worth. • They have the ability to
identify and accept their own shortcomings and the sense of humor to laugh at those
shortcomings. • They are able to make decisions and learn from failure. • They have a sense
of satisfaction in life (e.g., for work well done and with their relationships, level of success,
and overall happiness). • They demonstrate socially acceptable and considerate behaviors. •
They have a sense of values (e.g., they know right from wrong). • They use wisdom and
experience to make judgments and decisions. • They are able to set realistic goals and plans.
• They have the ability to think independently. • They have respect for others. • They have
personal relationships that are fulfilling and long-lasting. • They have normal attitudes
toward sex and relationships. • They are interested in a variety of activities and are able to
balance their responsibilities with personal interests (Selvam, n.d.). Mental health disorders
always occur within a social context, and how dysfunctional an individual is may be
determined by the support they receive and the responses of people in their environment.
For a short video produced by the WHO about the global reach of mental illness, go to:
(https://www.youtube.com/watch?v=L8iRjEOH41c). In the following sections, we examine

2. the history of mental illness and common mental health disorders in the chronological
order that they are likely to appear through the life span. History Mental disorders have
existed from the beginning of human society. In some periods and cultures, people with
mental disorders had recognized roles: for example, as a shaman or fortune-teller. In other
periods and cultures, people with mental disorders were ostracized by society because the
disorder was believed to be caused by evil spirits. Evidence shows that prehistoric people
treated mental disorders by cutting a hole in the skull of the afflicted person, a process
called trepanation, to allow evil spirits to escape (Clower & Finger, 2001). Written accounts
of mental disorders were found as early as 1550 BCE in Egyptian manuscripts (Nasser,
1987). Greek physicians Pythagoras (sixth century BCE) and Hippocrates (mid-fifth century
to late fourth century BCE) understood that the brain was the center of thought,
intelligence, and emotions (Millon, Grossman, & Meagher, 2004). © 2019 Bridgepoint
Education, Inc. All rights reserved. Not for resale or redistribution. Introduction to Mental
Health Disorders Section 8.1 The first known psychiatric hospital was built in Bagdad, Iraq,
in 705 CE (Murad & Gordon, 2002). In Europe, a famous example is Bethlem Royal Hospital,
which is universally known as Bedlam. The hospital, founded in 1247 as the Priory of St.
Mary of Bethlehem, served people who were indigent (people who are poor or needy). In
the 1300s, it transformed into an asylum for people with mental disorders. In 1547, daily
operations of the hospital were granted to the City of London by King Henry VIII. In 1598,
an inspection of the hospital by Governors of Bridewell found that the roof was caving in,
sewage was backed up, patients were starving, and hospital keepers were paid for doing
little to no work to care for the patients or the building. Bedlam became notorious for the
poor treatment of patients and the practice of allowing fee-paying spectators, though the
latter was discontinued in 1770 (Encyclopaedia Britannica, 2018). Bedlam became a
synonym for mental hospitals and generally for confusion or uproar. Philippe Pinel (1745–
1826), who was the head physician of Bicêtre, the public asylum for men near Paris, and
later authored Memoir on Madness, played a large part in reforming the treatment of people
with severe mental disorders in France. Pinel believed it possible to cure mental illness, and
that to do so it was necessary to first diagnose the patient by careful observation, gain an
understanding of the events precipitating the illness, and write an accurate case history.
Pinel believed that humane treatment was the key to curing mental illness, instead of
treating the mentally ill as criminals or animals (Weiner, 1992). Benjamin Rush (1745–
1813) played a similar role in psychiatric reform in the United States, where he is known as
the father of American psychiatry. Rush believed that mental disorders should be
diagnosed, classified, and treated humanely. His Observations and Inquiries Upon the
Diseases of the Mind, published in 1812, was the first psychiatric textbook printed in the
United States (Penn Medicine, n.d.a). Rush improved patients’ living conditions and
removed their cuffs and chains (Penn Medicine, n.d.b). Nellie Bly, who was an investigative
journalist for New York World newspaper in 1887, wrote an exposé about the conditions at
Blackwell Island Asylum in New York City. She had heard stories of abuse at the asylum and
deliberately acted in a manner that led to her admittance to the Bellevue hospital and then
her transfer to Blackwell Island, where she spent 10 days (Biography, 2018). At the end of
the 10-day period, her editor arranged for her release from the asylum. The New York

3. World published her reports about the circumstances in the asylum and how brutal the
treatment and conditions were. The attention Bly brought to Blackwell Island and the many
people held there—even though they did not have any form of mental illness—initiated an
investigation that led to regular inspections and greater funding for mental illness
treatment in New York (Winchester, 2016). While her articles brought attention to the
treatment of people held in asylums, it would take many years to see improvements across
the country (Winchester, 2016). We still have a great deal of room for improvement in the
care and treatment of people with mental illness. You can read Bly’s original exposé here:
(http://digital.library.upenn.edu/women/bly/madhouse/madhouse.html). Additional
information regarding Bly’s impact on mental illness treatment can be read here: (https://
medium.com/legendary-women/what-nellie-bly-exposed-at-blackwells-asylum-and-why -
it-s-still-important-4591203b9dc7). In 1917, the American Medico-Psychological
Association, later the American Psychiatric Association (APA), called for uniform
classification of mental diseases. Interest gradually shifted away from studying exclusively
those with mental illness who were confined to institutions, and by the late 1930s, interest
in the contribution of social and environmental factors © 2019 Bridgepoint Education, Inc.
All rights reserved. Not for resale or redistribution. Definitions and Familial and Biological
Basis Section 8.2 to mental illness in the community was rising (Faris & Dunham, 1939).
World Wars I and II brought more data. The mental disorders that appeared in soldiers
exposed to combat convinced mental health practitioners that social and environmental
factors play a significant role in the development of mental disorders (Horwitz & Grob,
2011). During the period after WWII, the newly formed National Institute of Mental Health
(NIMH) had the responsibility for funding research into the connection between social and
environmental variables and mental disorders. The movement to establish a uniform
classification of mental diseases resulted in the publication of the first edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952. The first version
(DSM-I) used the term reaction to refer to diagnoses, which reflected the theoretical beliefs
of Adolf Meyers, the first president of the APA, that mental disorders were reactions of the
personality to psychological, social, and biological factors. Later editions of the DSM
dropped this terminology (APA, 2018a). Development of antipsychotic medications for
treating severe mental disturbance meant that, for the first time, people who previously had
to be confined to an institution could be treated in a community setting. The release of
people with mental disorders from institutions, known as deinstitutionalization, started in
the mid-1950s and grew dramatically in the 1960s and 1970s. The idea was that people
with mental disorders were better off in their communities. The assumption was that
sufficient funding for community mental health centers to deal with those who needed
guidance and treatment would be available. However, funding for community centers and
treatment specialists has fallen short of needs ever since, leaving many vulnerable people to
depend on their families or the social service system, or worse, the prison system. Concepts
of causality made an about-face during the late 1960s and early 1970s, when the Nixon
administration together with Congress decided that NIMH should not fund research on
social problems such as poverty, racism, and violence (Horwitz & Grob, 2011). Focus
instead turned to how disturbance within the individual affected society. We can see how,

4. through the ages, responsibility and blame for mental disorders has shifted from evil spirits
to social conditions and experience to the individual. Now let’s look at definitions for many
of the major mental disorders. 8.2 Definitions and Familial and Biological Basis One of the
difficulties in studying mental health and treating mental disorders is finding a common
language. Without a common language, it is impossible to answer questions about how
disorders arise, how they are related, and how they are best treated. This section discusses
current definitions of some of the major mental disorders and lists short descriptions of
some of the others. It also discusses the role that family environment, genetic makeup,
personal resilience, environment, and supportive social interactions—particularly within
the family—play in various mental disorders. Only recently have researchers begun to
examine what accounts for people having grown up or who are still growing up in
particularly difficult circumstances but nonetheless doing very well in life—people who are
particularly resilient. For instance, some scientists have looked at children who experienced
extreme neglect or abuse yet appeared to function well (Cicchetti, 2010). © 2019
Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Definitions
and Familial and Biological Basis Section 8.2 Case Study: The Diagnostic and Statistical
Manual of Mental Disorders Our understanding is constantly changing, and the DSM reflects
changes in society. For instance, the DSM considered homosexuality to be a mental disorder
until 1973. Another cultural shift came in 2013, when the fifth edition, DSM-5, replaced the
term gender identity disorder with gender dysphoria, suggesting that the problem is not
one of gender mismatch but rather of the resulting emotional distress. Exactly how
disorders are defined may depend on the particular work environment, as well as the
norms and values of society, which are always changing. The definitions in this chapter are
a general guide rather than a dictionary. The DSM, published by the APA, provides criteria
for mental disorder codes and definitions used by clinicians, insurance companies, policy
makers, and researchers around the world. The DSM-5 received approval in December 2012
and was formally adopted on May 18, 2013, at the 166th annual meeting of the APA with
much fanfare and controversy. The DSM-5 is the first major update since the DSM-IV was
published in 1994. According to Dr. Thomas Insel, the then director (2002–2015) of the
NIMH, the problem with the DSM is that it classifies mental disorders by clinical symptoms,
which he thinks are not sufficient for diagnosing disease: While DSM has been described as
a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each.
The strength of each of the editions of DSM has been “reliability”—each edition has ensured
that clinicians use the same terms in the same ways. The weakness is its lack of validity.
Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are
based on a consensus about clusters of clinical symptoms, not any objective laboratory
measure. In the rest of medicine, this would be equivalent to creating diagnostic systems
based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis,
once common in other areas of medicine, has been largely replaced in the past half century
as we have understood that symptoms alone rarely indicate the best choice of treatment.
(Insel, 2013, para. 2) Dr. Insel pointed out the difference between having a shared definition
so that various people are talking about the same thing, which is reliability, and being
logically or factually correct (i.e., evidence-based), which is validity. The NIMH is the major

5. funding source for research in mental health and mental illness for the entire United States
and much of the world. An important goal of the NIMH is to transform diagnosis of mental
illness so that it is based on biology, not on symptoms or subjective criteria. This goal is
achieved by incorporating cognitive science, genetics, imaging, and other information into
the Research Domain Criteria, estimated to be a 10-year project (Insel & Lieberman, 2013).
In other words, DSM-5 may be flawed when applied to research, but it is still the best tool
available for diagnosing mental disorders. The DSM-5 updated terminology to remove
language that had negative social implications of conditions. For example, attention deficit
hyperactivity disorder (ADHD) is now termed a neurodevelopmental disorder instead of a
disruptive disorder. This change removes the negative implication of the word disruptive
and places ADHD in a more neutral, developmental context. Also, several criteria within
posttraumatic stress disorder (PTSD), trauma, and stress-related disorder evaluations are
now more explicit about what constitutes a traumatic event and specifically include sexual
assault and a new, preschool PTSD subtype. By recognizing that sexual assault is a traumatic
event, the DSM-5 validates the impact of such events on people’s lives. © 2019 Bridgepoint
Education, Inc. All rights reserved. Not for resale or redistribution. Definitions and Familial
and Biological Basis Section 8.2 Neurodevelopmental Disorders Neurodevelopmental
disorders are changes in the normal growth and development of the nervous system,
resulting in a slowed maturity or developmental delays in behavior, verbal communication,
or the ability to focus. According to the DSM-5: neurodevelopmental disorders are a group
of conditions with onset in the developmental period. The disorders typically manifest early
in development, often before the child enters grade school, and are characterized by
developmental deficits that produce impairments of personal, social, academic, or
occupational functioning. The range of developmental deficits varies from very specific
limitations of learning or control of executive functions to global impairments of social skills
or intelligence. (DSM Library, 2018, para. 1) This subsection concentrates on three
neurodevelopmental disorders: intellectual disability, autism spectrum disorders (ASD),
and ADHD. These are the three most common neurodevelopmental disorders. Intellectual
Disability The definition of intellectual disability is “impairments in life skills such as
communication, self-care, home living, and social or interpersonal skills” (Environmental
Protection Agency [EPA], 2015, p. 9). Generally, the IQ is less than 70. Causes can be from
“genetic disorders, traumatic injuries, and prenatal events such as maternal infection or
exposure to alcohol” (EPA, 2015, p. 9). Additionally, exposure to lead or mercury and
certain chemicals, such as pesticides, can be the cause of intellectual disabilities in a child.
The levels are classified by severity: mild, moderate, and severe. The higher an individual’s
level of disability, the lower their IQ and the less their ability to care for themselves
independently (EPA, 2015). Autism Spectrum Disorders Children with ASD have unusual
ways of communicating with people and their environment. They may have trouble with
social interactions and communication and may be unusually interested in a specific
subject; they also may show restricted, repetitive patterns of behavior. These problems are
thought to be caused by differences in the way the brains of children with ASD process
information. When the symptoms of ASD begin, when the symptoms are first noticed, and
how much the symptoms affect a child’s functioning vary widely. There is also wide

6. variation in how the families and social systems surrounding these children accept them,
which has profound effects on their functioning. The CDC has sponsored the Autism and
Developmental Disabilities Monitoring (ADDM) Network to estimate the number of U.S.
children who have shown ASD symptoms at any time between birth and the end of the
child’s eighth year. In the year 2000, one in every 150 children had been diagnosed with
ASD. By 2014, the prevalence, or rate of occurrence, of ASD was 1 in 59 or 17 out of 1,000
children. The graph in Figure 8.1 illustrates this rise in prevalence. © 2019 Bridgepoint
Education, Inc. All rights reserved. Not for resale or redistribution. Definitions and Familial
and Biological Basis Section 8.2 Figure 8.1: Autism prevalence per 1,000 children, 2014
Nearly seven out of 1,000 children had ASD in 2000. By 2014, the diagnosis rate had jumped
to approximately 17 out of 1,000 children. This is a significant increase. Per 1,000 children
20 16.8 15 14.7 14.7 2010 2012 11.3 10 6.7 6.7 2000 2002 8.0 9.0 5 0 2004 2006 2008 2014
Source: Centers for Disease Control and Prevention. (2018f). Autism spectrum disorder
(ASD): Data & statistics. Retrieved from https:// www.cdc.gov/ncbddd/autism/data.html
The CDC indicates that ASD occurs four times as often in boys as in girls (2018f). More than
half (62%) of children identified with ASD do not have an intellectual disability. According
to a report on the prevalence of ASD, many children are identified as having ASD by age
three, but most are not identified until they are at least four years old (ADDM Network,
2012). The cause of the increase in the prevalence of ASD is currently unclear. ASD is
thought to be caused by a combination of genetics and environmental factors, but further
research is required. In the past, doctors diagnosed ASD through symptoms, which become
apparent at approximately two years of age (Southers, 2017). Current diagnostic tests
include functional magnetic resonance imaging (fMRI), which shows changes in the blood
flow to the brain. The fMRI allows for earlier diagnosis—as early as six months old—and
earlier therapeutic interventions to assist the child in developing better language and social
skills (Southers, 2017). Signs that a child might have ASD include the following: • • • • • •
does not respond to their name by 12 months of age; avoids eye contact; is not interested in
social interaction; gets upset by minor changes in routine; does not engage in make-believe
or pretend games by 18 months of age; and shows repetitive body movements (e.g.,
spinning, rocking, and flapping hands) (Autism Speaks, 2018). Early identification is
important, because evidence shows that it can improve outcomes for both children and
their families. However, ASD goes undetected in many children until later in childhood
because of limited social demands and inadequate support from parents and caregivers in
early life. The resulting lack of early intervention can affect the child’s functioning
throughout life. © 2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or
redistribution. Definitions and Familial and Biological Basis Section 8.2 Attention Deficit
Hyperactivity Disorder Characteristics of ADHD are age-inappropriate levels of inattention
and hyperactivity/impulsivity, or a combination of the two. People with ADHD can have the
disorder without having impulsivity, and this disorder is still called ADHD even without the
presence of both hyperactive and impulsive behavior. These behaviors impair functioning
in multiple settings and cause problems in school, in relationships with other children, and
in the family. The disorder frequently begins in childhood and often continues into
adulthood. There is no cure for ADHD, but it is manageable. ADHD is the most common

7. childhood mental disorder, followed by anxiety (Association for Children’s Mental Health
[ACMH], 2018). Childhood mental disorders are described as “serious deviations from
expected cognitive, social and emotional development” (Perou et al., 2013, p. 1). The Perou
et al. article emphasizes how important childhood mental disorders are “because of their
prevalence, early onset, and impact on the child, the family, and the community, with an
estimated total annual cost of $247 billion” (Perou et al., 2013, p. 1). The prevalence of
ADHD has steadily increased between 1997 and 2014, and it is higher among children
whose household income is low. More than 6.4 million children have been diagnosed with
ADHD (ADD Resource Center, 2018). White children are most likely to be diagnosed with
ADHD; Hispanic children are much less likely to be diagnosed with ADHD (see Figure 8.2)
(CDC, 2018e). Boys are twice as likely to have ADHD as girls (CDC, 2018j). The number of
diagnoses per year increases as children age (CDC, 2018e). For example, in year five of the
cohort, a certain number of children will be diagnosed with ADHD. In year six, new
diagnoses are added to those earlier numbers, and so on for each additional year. Cases of
severe ADHD are commonly diagnosed by the age of five. Cases of moderate ADHD are
diagnosed by the age of seven. Cases of mild ADHD are commonly diagnosed by the age of
eight (ADD Resource Center, 2018). However, many people with mild ADHD are diagnosed
as adults. See Table 8.1 for details regarding the prevalence of mental disorders in
childhood. Table 8.1: Prevalence of mental disorders in childhood (aged 3–17 years) Mental
disorder Prevalence (%) Attention deficit hyperactivity disorder 6.8 Anxiety 3.0 Behavioral
or conduct problems Depression Autism spectrum disorders Tourette syndrome 3.5 2.1 1.1
0.2 (children aged 6–17 years) Source: Centers for Disease Control and Prevention. (2018j).
Children’s mental health: Data & statistics. Retrieved from https://
www.cdc.gov/childrensmentalhealth/data.html © 2019 Bridgepoint Education, Inc. All
rights reserved. Not for resale or redistribution. Definitions and Familial and Biological
Basis Section 8.2 Figure 8.2: Attention deficit hyperactivity disorder among children aged
5–17 years in the United States, 1997–2014 White children are more likely to be diagnosed
with ADHD. 14 Total Hispanic White, non-Hispanic Black, non-Hispanic 12 Percentage 10 8
6 4 2 0 1997–1999 2000–2002 2003–2005 2006–2008 2009–2011 2012–2014 Period
Source: Centers for Disease Control and Prevention. (2015). Morbidity and Mortality
Weekly Report: QuickStats: Percentage of children and adolescents aged 5–17 years with
diagnosed attention-deficit/hyperactivity disorder (ADHD) by race and Hispanic ethnicity –
National Health Interview Survey, United States, 1997–2014. Morbidity and Mortality
Weekly Report, 64(33), 925. Retrieved from
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a11.htm Mood Disorders One
in five adults experiences a mood disorder (also termed affective disorder) sometime
during their life (see Figure 8.3). Major mood disorders include depression, bipolar
disorder, seasonal affective disorder (SAD), and premenstrual dysphoric disorder (Mayo
Clinic, 2018b). Each year, 9.7% of adults experience a mood disorder, and in almost half
(4.3%) of those adults, the experience is termed severe (NIMH, n.d.a). Mood disorders affect
how people feel over time. Some are slow cycling, which means that a person experiences
long periods of a certain mood. Others are rapid cycling, meaning the person may move
through several mood cycles throughout a single day. Most people have days in which they

8. feel particularly sad or happy, but mood disorders are more persistent and affect how
people function in everyday life. Although we don’t yet understand why, people with mood
disorders are also at increased risk for comorbidities (other diseases or conditions
occurring alongside the primary condition) such as heart disease and diabetes (Wahlqvist et
al., 2012). More generally, people with mental disorders, including mood disorders, anxiety
disorders, and PTSD, have a higher prevalence of cardiovascular disease and higher
mortality compared with people without mental disorders (Fiedorowicz, He, & Merikangas,
2011). © 2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or
redistribution. Definitions and Familial and Biological Basis Section 8.2 Figure 8.3:
Prevalence of mental illness by diagnosis, 2015 In the United States, 18.1% of adults live
with anxiety, and 6.9% of adults live with major depression. 45 42 Millions of people 40 35
30 25 20 16 15 10 5 0 6.1 2.4 Schizophrenia Bipolar disorder Major depression Anxiety
disorder (PTSD, OCD, phobia) Source: National Alliance on Mental Illness. (2018c). Mental
health by the numbers. Retrieved from https://www.nami.org/Learn-More /Mental-Health-
By-the-Numbers Web Field Trip View the Synthesis Project’s online policy brief Mental
Disorders and Medical Comorbidity (Goodell, Druss, & Walker, 2011) at
(https://www.rwjf.org/content/dam/farm/reports /issue_briefs/2011/rwjf69438). After
looking at the graphic on page one and reading the commentary, consider why the overlap
between mental disorders and physical illnesses is so great. Critical-Thinking Questions 1. 2.
How is care coordinated for these patients to achieve better health outcomes? What are
some of the pressing, unmet needs in this area of public health? Depression According to the
WHO (2008), depression is the most significant cause of loss of healthy life years due to
disabling disease, or burden of disease, in middle- and high-income countries. In the United
States during 2007–2010, depression had a nearly 8% prevalence among people 12 years
and older (see Figure 8.4 for major depressive episode statistics from 2016 for U.S. adults
aged 18 years and older). Significantly more women (10%) than men (6%) reported
experiencing depression (CDC, 2012), and because it is influenced by social factors such as
overcrowding, family turmoil, and violence, depression was more prevalent among people
with lower income (Freeman et al., 2016). © 2019 Bridgepoint Education, Inc. All rights
reserved. Not for resale or redistribution. Definitions and Familial and Biological Basis
Section 8.2 Figure 8.4: Prevalence of current depression among persons 18 years and older
For all adult age groups in the United States, more women than men report experiencing
depression. 14 12 10.9 Percent 10 8 10.5 8.7 8.5 7.4 6.7 6 7.4 4.8 4.8 5.6 7.3 5.0 3.9 4 2 0
Overall Female Male Sex 18–25 26–49 Age 50+ Hispanic White Black Asian NH/ OPI** AI/
AN*** 2 or more Race/ethnicity Source: National Institute of Mental Health. (2017). Major
depression. Retrieved from https://www.nimh.nih.gov/health/statistics /major-
depression.shtml Depression is seen in children as young as three years old, although the
prevalence appears to be lower (see Table 8.1). In young children, there does not appear to
be a difference in the prevalence of depression between girls and boys (Perou et al., 2013).
When people are depressed, they have less interest in activities that they used to enjoy,
have difficulty concentrating, may lose or gain weight, and may have trouble sleeping or
sleep too much. Interpersonal relationships at home and at work are likely to suffer. In
addition, people who are depressed are more likely to smoke, overuse alcohol, and neglect

9. their health. Although people usually experience episodes of depression, if the first signs of
depression are neglected, they are more likely to recur and to become chronic. Untreated
depression can lead to serious problems in functioning and even suicide (APA, 2018b).
Bipolar Disorder Bipolar disorder is characterized by dramatic shifts in mood, energy, and
activity levels. During a manic phase, someone might • • • • be overly silly or joyful; have a
very short temper; not sleep much but not be tired, either; or engage in risky behavior, such
as extreme shopping sprees, gambling, and inappropriate sexual behaviors (ACMH, 2018).
© 2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution.
Definitions and Familial and Biological Basis Section 8.2 During a depressive phase, a
person with bipolar disorder might resemble someone who is depressed but with
symptoms of mania. People with bipolar disorder are commonly misdiagnosed as having
depression, which can be a problem, because treatments for the two disorders differ. In
2015, it was estimated that 6.1 million adults, or 2.6% of the U.S. population, are affected by
bipolar disorder each year (National Alliance on Mental Illness [NAMI], 2018c). Bipolar
disorder is classified as existing along a spectrum, with the severity of the manic component
ranging from bipolar I (most severe, with episodes of full-fledged mania) to bipolar II
(episodes of mania that are not severe enough to qualify as full mania but still affect
functioning) to subthreshold bipolar (least severe; fewer episodes with a shorter duration).
Although both mania and depression increase from subthreshold bipolar through bipolar I,
difficulties in patterns of behavior in social or work situations, also known as role
impairment, are similar across subtypes (Merikangas et al., 2011). Bipolar disorder is
associated with serious difficulties in social interaction and high economic costs. In 2015,
the estimated economic burden of bipolar disorder was $202.1 billion, or $81,559 per
person (Cloutier, Greene, Guerin, Touya, & Wu, 2018). “The largest contributors to excess
costs were caregiving (36%), direct healthcare costs (21%), and unemployment (20%)”
(Cloutier et al., 2018, para. 3). Despite its severity, bipolar disorder has received less
research attention than depression or schizophrenia. Bipolar disorder that starts in
childhood or early adolescence is known as early-onset bipolar disorder. It is associated
with more severe disease. The prevalence of early-onset bipolar disorder has been a subject
of controversy as the definitions are not yet clear. Celebrities with bipolar disorder include
Demi Lovato, Mariah Carey, Catherine Zeta-Jones, Russell Brand, and Jean-Claude Van
Damme. Anxiety Disorders Anxiety disorders comprise panic disorder, obsessive-
compulsive disorder, phobias, generalized anxiety disorder, and social anxiety disorder (or
social phobia). Although PTSD is classified as an anxiety disorder, we will address it
separately as it shares a common causal agent (etiology) with other trauma- and stress-
related disorders. Anxiety disorders are the most common mental disorders in the U.S.
population, with 42 million people in America diagnosed in 2015 (NAMI, 2018c). However,
compared with mood disorders, a smaller percentage of anxiety disorders are considered to
be serious mental illness. There appear to be some sex differences, with more women than
men experiencing anxiety and women finding it more disabling than men (McLean, Asnaani,
Litz, & Hofmann, 2011). Anxiety disorders cause people to have “persistent, excessive fear
or worry in situations that are not threatening” (NAMI, 2018a, para. 3). Approximately 18%
of adults and 8% of children have anxiety disorder that is debilitating (NAMI, 2018a).

10. Anxiety often presents in the form of “feelings of apprehension or dread, feeling tense and
jumpy, restlessness or irritability, or anticipating the worst and being watchful for signs of
danger” (NAMI, 2018a, para. 3). Despite the prevalence of anxiety disorders, much less
attention has been paid to them, even though anxiety can result in as much impairment as,
and is often comorbid with, depression (NAMI, 2018a). © 2019 Bridgepoint Education, Inc.
All rights reserved. Not for resale or redistribution. Definitions and Familial and Biological
Basis Section 8.2 Panic Disorder People with panic disorder experience sudden attacks of
terror, usually with physical symptoms such as a pounding heart, sweatiness, and weakness
or dizziness. Panic attacks can happen repeatedly and without warning, often producing a
sense of unreality and a fear of dying. Twice as many women as men experience panic
disorder. It can become very disabling because people might avoid leaving their home (and
develop agoraphobia) for fear they will have a panic attack (NIMH, 2016a). Obsessive-
Compulsive Disorder People experiencing obsessive-compulsive disorder (OCD) have
persistent, upsetting, and unwanted thoughts (obsessions) and react with a set of repetitive
activities or rituals (compulsions) to control the anxiety produced by these thoughts. For
example, those with OCD might have to check that the stove is turned off several times
before leaving the house or wash their hands 25 times each day to make sure they are free
from germs. Although checking that the stove is turned off is a normal routine, for people
with OCD these obsessions and compulsions interfere with normal activities and begin
controlling their lives. Research suggests that approximately one-third of adults with OCD
experienced symptoms as children and that the disorder may run in families (NIMH,
2016a). Children whose parents have OCD face challenges and burdens in dealing with their
parents’ mental health problems (Griffiths, Norris, Stallard, & Matthews, 2012). Typical
family reactions and responses to children with OCD do not make the rituals go away and
can even strengthen the children’s need to perform the rituals (Bond & Guastello, 2013). In
contrast, an accepting and autonomy-granting parental style protects children with OCD
from comorbid anxiety and depression (Cohen, Sade, Benarroch, Pollak, & Gross-Tsur,
2008). Phobias Phobias are intense, irrational fears of something that poses little or no
threat. Common phobias are the fear of heights, spiders, public speaking, highway driving,
and tunnels, as in claustrophobia, which is the fear of enclosed spaces. People with phobias
often acknowledge that their fear is irrational, but it doesn’t stop their fear from causing
them terror or panic. Phobias are twice as common in women as in men and often begin in
childhood or adolescence (NIMH, 2016a). Generalized Anxiety Disorder Generalized anxiety
disorder (GAD) is excessive worry about everyday problems and events. Symptoms last for
at least six months and make it difficult to concentrate and carry out everyday activities.
Like people with phobias, people with GAD are often aware that their concerns are
excessive, but that “head knowledge” does not stop them from experiencing disturbing
thoughts and reacting to them. GAD is often accompanied by other anxiety disorders,
depression, or substance abuse (NIMH, 2016a). © 2019 Bridgepoint Education, Inc. All
rights reserved. Not for resale or redistribution. Definitions and Familial and Biological
Basis Section 8.2 Social Anxiety Disorder People with social anxiety disorder or social
phobia are excessively anxious and self-conscious in everyday social situations, leading to
difficulties in work and personal relationships (NIMH, 2016a). Social anxiety usually begins

11. in childhood or early adolescence and, unlike many other anxiety disorders, it is found at
the same rate in women and men (NIMH, 2016a). Trauma- and Stress-Related Disorders
When people experience traumatic or stressful events, many respond with an acute stress
reaction, which may lead to depression, irritability, sleep disturbances, decreased
concentration, and anxiety. The symptoms may last from a few days to a few weeks. Some,
but not all, who experience an acute stress reaction may go on to develop a more chronic
reaction, such as PTSD. Approximately 18% to 36% of those experiencing trauma develop
PTSD (Heinzelmann & Gill, 2013). Posttraumatic Stress Disorder Trauma consists of
different things for different people. Initiating events for posttraumatic stress disorder
(PTSD) can be abuse or assault, combat experience, natural disasters, serious accidents,
sudden and major emotional losses, or terrorist attacks (NIMH, 2010). A child experiencing
neglect or abuse, a rape survivor, a marriage partner subjected to spousal abuse, or a
veteran who has been in combat are all likely candidates for PTSD. The severity of the
traumatic event and length of exposure to it are critical risk factors for developing PTSD but
don’t tell the whole story. Depending on their genetic makeup and early experiences, people
can be more or less resilient—that is, able to bounce back from traumatic events
(Heinzelmann & Gill, 2013). PTSD is associated with changes in parts of the brain involved
with fear and stress. Symptoms include strong memories of the event; nightmares; difficulty
sleeping; emotional numbness; edginess or hyperarousal (or hypervigilance) during
ordinary events; and an aversion to thoughts and situations that might remind the person of
the event. Approximately 8.7 million people in the United States aged 18 years or older, or
3.5% of the U.S. population, experience PTSD (Greaves & Hunt, 2010). Web Field Trip Visit
the National Center for PTSD’s website AboutFace, and view video excerpts of veterans who
have suffered from PTSD after their military service: (https://www.ptsd.va.gov/apps
/AboutFace/). Critical-Thinking Questions 1. 2. How were the veterans suffering from PTSD
helped by medication and other forms of therapy? In what ways are PTSD therapies tailored
to individual cases? © 2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or
redistribution. Definitions and Familial and Biological Basis Section 8.2 We are beginning to
understand some of the biology of PTSD. Long-term studies of people, following their
encounter with natural disasters, have been able to look at those who do and do not develop
PTSD. In addition, there is a large body of literature on the short- and long-term effects of
stress on animals. Stress and trauma may have direct effects on brain structures, including
those structures involved with fear, emotional reactivity, and cognition (Sherin & Nemeroff,
2011). Children may be particularly vulnerable to these effects. Children who develop PTSD
are usually those who have experienced a catastrophic event firsthand. They likely “directly
witnessed a traumatic event, or . . . suffered directly as a result of it, for example, [loss of] a
family member during a fire or tornado. . . . Violence at home also increases a child’s risk for
developing PTSD after a traumatic event” (ACMH, 2018, para. 17). Children who developed
PTSD showed slower and less effective learning capabilities and skills. Children exposed to
violence but who did not develop PTSD also showed below-average skills in executive
functioning (the ability to organize and prioritize tasks and information; associated with the
frontal cortex of the brain), ability to pay attention, and intellectual ability. Schizophrenia
Schizophrenia is a serious and complex, chronic mental disorder that “interferes with a

12. person’s ability to think clearly, manage emotions, make decisions and relate to others”
(NAMI, 2018d). An estimated 1.1% of the U.S. population aged 18 years and older is
diagnosed with schizophrenia (NIMH, n.d.b). Although some studies have found that men
and women are equally affected by schizophrenia (NIMH, n.d.b), other studies have found
more men than women affected by this disorder, with a 1.4:1 ratio (McGrath, Saha, Chant, &
Welham, 2008). Symptoms Diagnosis for schizophrenia often occurs when a person is in
their teen years. This is challenging as many early schizophrenia symptoms are commonly
viewed as teen angst. For example, “the first signs can include a change of friends, a drop in
grades, sleep problems, and irritability – common and nonspecific adolescent behaviors”
(NAMI, 2018d, para. 2). The symptoms described in Table 8.2 must be present for six
months for a diagnosis of schizophrenia. Table 8.2: The variety of symptoms in
schizophrenia Positive symptoms Negative symptoms Cognitive symptoms Delusions
(belief in things that are not real or are outside of the person’s culture) Flat affect (lack of
facial or vocal expressiveness) Poor executive function (inability to organize and prioritize
tasks or information) Disorganized thought; incoherent speech (not making sense when
talking) Inability to start or follow through on activities Problems with working memory
(inability to use information immediately after learning it) Hallucinations (hearing, seeing,
smelling, or feeling things others cannot sense) Agitated or repetitive body movements;
movement disorders Anhedonia (lack of pleasure or interest in everyday life) Withdrawal
(speaking little, even when forced to interact) Trouble focusing and paying attention
Source: National Alliance on Mental Illness. (2018d). Schizophrenia. Retrieved from
https://www.nami.org/Learn-More/Mental -Health-Conditions/Schizophrenia © 2019
Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Definitions
and Familial and Biological Basis Section 8.2 The preceding table identifies both positive
(the presence of something abnormal) and negative (the lack of something normally
present) symptoms of schizophrenia. It is important to understand the cognitive deficits
that are commonly associated with this diagnosis. According to Bowie and Harvey (2006),
“deficits are moderate to severe across several domains, including attention, working
memory, verbal learning and memory, and executive functions. These deficits pre-date the
onset of frank psychosis and are stable throughout the course of the illness in most
patients” (para. 1). The impaired ability to maintain attention is one of the deficits that can
“interfere significantly with successful social and occupational function in individuals with
schizophrenia” (Harris, Minassian, & Perry, 2007, para. 1). Verbal fluency, which is impaired
by schizophrenia, is the ability to remember and use language appropriately, and this
function is handled by the temporal and parietal lobes of the brain (see Figure 8.5).
Executive function, which is also impaired by schizophrenia, takes place in the frontal lobe
of the brain, which is the part of the brain responsible for behavior, memory, logic, and
decision-making. The symptoms of schizophrenia “remain relatively stable within the same
patient over time; they are generally consistent in severity” (Bowie & Harvey, 2006, para.
5). Schizophrenia is a chronic disease, but symptoms may cycle through phases, fluctuating
with time. People with schizophrenia often have difficulty taking care of themselves and so
must rely on family or institutions for help. Many people with schizophrenia manage their
lives better with age, particularly if they have access to social support systems, and a

13. surprising number can hold jobs and have regular family contact. Biological Basis
Schizophrenia, like so many disorders, is a result of a combination of genetic and
environmental influences. Many theories and much evidence exists about the biological
basis of schizophrenia, but there is little consensus as to the mechanisms involved. As the
onset of schizophrenia is usually seen between late adolescence and early adulthood,
coinciding with major changes in the brain, one suggestion posits that something about this
process goes amiss. The density of nerve cell connections, or synapses (the space in which
the nervous impulse passes between neurons), in the cerebral cortex reaches a maximum
when children are between two and four years old and then declines to adult levels during
adolescence. The process of eliminating excess connections is known as synaptic pruning.
Though the data suggest that problems in synaptic pruning are a possible trigger of
schizophrenia, the process is far from being proven responsible (Boksa, 2012). Another
long-held hypothesis about schizophrenia is that disruptions during early brain
development increase risk for the disorder. Again, some data have correlated maternal
infection, nutritional stresses, and obstetric complications with heightened risk for
schizophrenia, but the findings are not definitive. Comorbidities Comorbidity makes it more
difficult to determine which disease or disorder is responsible for any specific sign or
symptom. Using Swedish national health care records, a recent study examined what might
cause the increase in cardiovascular mortality among people with schizophrenia (Crump,
Winkleby, Sundquist, & Sundquist, 2013). Sweden has universal health care and collects
extensive data on diseases and treatments. Crump et al. (2013) © 2019 Bridgepoint
Education, Inc. All rights reserved. Not for resale or redistribution. Definitions and Familial
and Biological Basis Section 8.2 Figure 8.5 Brain areas and their functions Schizophrenia
affects the frontal lobe, which controls many of our cognitive functions, and the
hippocampus, which controls many of our emotions and long-term memories. Source:
Sunshine_Art/iStock/Getty Images Plus followed a cohort of more than six million adults
from 2003 to 2009 to detect mortality and illness. Among the 8,277 people with
schizophrenia, men died 15 years earlier and women died 12 years earlier than the average
life expectancy of the rest of the population. Contrary to expectations, these deaths were not
from suicide but mostly from cardiovascular disease and cancer, which were
underdiagnosed in this population despite their having twice as many contacts with the
health system as people without schizophrenia. These findings underscore the importance
of integrating medical care with mental health care tailored to the needs of people with
mental disorders. © 2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or
redistribution. Using Bronfenbrenner’s Model to Better Understand Mental Health and
Mental Disorders Section 8.3 8.3 Using Bronfenbrenner’s Model to Better Understand
Mental Health and Mental Disorders Bronfenbrenner’s ecological model places the
individual within several concentric circles of the larger environment: the micro
perspective of the family; the meso perspective of the immediate community, including
school or work; and the macro perspective of the larger world, including race, ethnicity,
socioeconomic status, national origin, and political systems. Micro Perspectives In
Bronfenbrenner’s model, interaction is a two-way phenomenon. For example, because a
child with ASD requires so much attention as a toddler, one parent probably spends a lot of

14. time tending to and interacting with the child and is less able to hold a demanding, full-time
job. In turn, the extent to which the parents understand and are willing to cope with the
child’s demands does play a role in helping the child learn to interact with the environment.
Some parents resist having their children evaluated, even when they suspect serious
developmental delays. They may be afraid that having their child labeled will be a problem
in the future. In doing so, they pass up services that can help their children develop. They
also are not learning how to interact with their child in ways that might benefit both the
child and the family. Other factors that may prevent children or adults from getting services
for autism or other mental health problems include language barriers, lack of trust in
providers, competing family demands, problems with transportation to a service provider,
lack of integrated services, and the need for the parent to earn an income. Meso
Perspectives Mental disorders affect how a person functions in school, at work, and in their
immediate community. A mental disorder in a child, such as autism, affects how family
members interact with the larger community. For example, children with autism are
abnormally sensitive to sensory input and can become overwhelmed when they are in a
grocery store, with its array of colors, patterns, and smells. When overstimulated, which is a
state they may experience in a grocery store, these children are likely to exhibit what is
often termed a temper tantrum. Sometimes people with mental disorders receive
accommodations in their various environments. How well the outside community (e.g.,
daycare facilities, schools) understands the problems of such children and makes
allowances for them determines how the meso-level environment influences that child’s
development, for good or ill. Macro Perspectives The macro perspective looks at how the
disorder affects the person within the culture and the larger society and, conversely, how
the larger society affects the person with the disorder. Possibly more significantly, as a
matter of public policy, the Americans with Disabilities Act (ADA) requires such employers
to make reasonable accommodations for a person’s disability, if doing so will allow them to
function well in their job. (For more discussion of the ADA, see Chapter 2.) © 2019
Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Mental
Disorders Through the Life Span Section 8.4 8.4 Mental Disorders Through the Life Span
The onset of mental disorders occurs at differing points in a person’s life and, depending on
age and stage in life, has different effects on those with the disorder and their families.
Mental disorders are typically diagnosed during childhood and adolescence. “Half of mental
health conditions begin by age 14, [and 75%] of mental health conditions develop by age
24” (NAMI, 2018c, para. 5). However, typical age of onset differs for various mental
disorders. Childhood ASDs are among the first mental illnesses to be diagnosed. More
severe forms of the disorder are typically diagnosed earlier. For instance, children with
autistic disorder are usually diagnosed by age four, but children with Asperger syndrome (a
somewhat less severe ASD) are not diagnosed until an average age of 6 years, 3 months
(CDC, 2018g). The CDC has an active campaign to urge early diagnosis of ASD: “Learn the
Signs. Act Early” (CDC, n.d.). Although age at diagnosis is getting younger, many children
with ASD are missing out on early intervention programs that could address specific
developmental concerns and help them catch up with their peers. These early intervention
programs are important because they are effective for young children, and all public school

15. systems across the country are required by federal law to provide appropriate educational
opportunities for all enrolled children, no matter their disability. Sometimes the symptoms
exhibited by a child with a mental disorder are different from those seen in an adult with
the same disorder. For instance, children with bipolar disorder often have continuous
symptoms of cycling through the depressive and manic phases, whereas adults have shorter
KatarzynaBialasiewicz/iStock/Getty Images Plus durations of depressive and manic phases
with long Early detection of ASD allows children periods of remission of those symptoms
(NIMH, to be placed in programs that address n.d.c). Children with bipolar disorder
sometimes their specific developmental concerns. have an extremely short temper and
show unusual irritability when they are in a manic state, and they complain about pain
when they are in a depressed state, which are symptoms similar to or the same as those
experienced by adults with bipolar disorder (NIMH, 2018). Information about early
intervention programs across the country are found by visiting this web page:
(https://www.parentcenterhub.org /ei-history/). Adolescence The peak period of onset for
bipolar disorder occurs during adolescence (Merikangas et al., 2012). As previously noted,
“half of all chronic mental illness begins by age 14” (NAMI, 2018c, para. 15). Unfortunately,
only half of those in need of mental health services actually receive those services (NAMI,
2018c). Further, the child’s educational experience is affected by the disorder. © 2019
Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Mental
Disorders Through the Life Span Section 8.4 Mainstreaming, which refers to placing the
child with ASD on the same educational path as other children, has many proponents and
many detractors. Some people think that children with ASD, particularly those who are
higher functioning, can learn communication skills by interacting with more typical children
in a mixed classroom. Others think that children with ASD, particularly those who are not so
high functioning, learn social skills best from specially trained teachers. Most parents of
children with ASD think it is most important to match the individual child with the school
situation that best fits the child’s needs, whether that is a special needs school, a special
needs class within a regular school, some mix of special needs classes and mainstreaming,
or all mainstreaming. For a more extensive discussion of mainstreaming, see the article
“Supporting students with autism in the classroom: what teachers need to know” at
(http://theconversation.com/supporting-students-with-autism -in-the-classroom-what-
teachers-need-to-know-64814). For a list of helpful websites for parents and caregivers of
children with ASD, visit this web page: (https://autismaction.org /resource-center/helpful-
websites/helpful-websites-for-parents-and-caregivers/). What happens to children with
ASD as they get older? Once graduated from high school, those with ASD have limited
opportunities. One study of 1,900 youths found that fewer people with ASD, as compared to
people with other disabilities, are either employed or undergoing further education two
years after graduating from high school. It also found that youths from low-income families
were much more likely to become disengaged, regardless of the severity of their disability.
More impaired youths were also at greater risk of disengagement (Shattuck et al., 2012).
Adulthood ADHD, while thought of as a childhood disorder, is typically diagnosed in
preschool or during early-elementary school years (Kessler, Chiu, Demler, Merikangas, &
Walters, 2005). Although many people diagnosed with ADHD as children seem to grow out

16. of it, a significant percentage of them continue having symptoms as adults. Some people are
diagnosed with ADHD during their adult years. Prevalence of ADHD among patients aged
18–44 exists in 4.4% of the adult population. These adults were more likely to be
unemployed and have other comorbid disorders than those without ADHD (Kessler et al.,
2006). Adults with ADHD were also more likely to perform poorly in the workplace, with an
excess of 35 lost work days per year compared with those without ADHD (Kessler et al.,
2005). It is not known whether treatment improves the severity of this disorder and its
effects. A recent study compared adults (mean age of 27 years) diagnosed with ADHD as
children with those from the same birth cohort who did not have ADHD. Researchers found
that childhood ADHD persisted in 29.3% of the adults and that, tragically, those adults who
had been diagnosed with ADHD as children were significantly more likely to have one or
more additional mental disorders and to die from suicide (Barbaresi et al., 2013). The
Elderly The most common mental disorders seen among the elderly living in long-term care
facilities are depression and anxiety (Seitz, Purandare, & Conn, 2010). (For a discussion of
dementia and other neurodegenerative disorders, please see Chapter 9.) Depression is quite
prevalent © 2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or
redistribution. Prevention and Treatment Approaches to Mental Disorders Section 8.5
among people in the United States aged 65 and older. Although many experience depression
for most of their lives, others experience its onset late in life—even as late as their eighties
and nineties. Although elderly women are more likely to experience depression, it is a
greater risk factor for suicide among elderly men (NAMI, 2018b). Social factors that may
contribute to late-onset depression include loneliness, loss of a spouse, perceived lack of
support, and feelings of isolation. The effects of GAD do not appear to diminish with age.
Instead, compared with older adults with no mental disorders, older adults with GAD were
found to be more disabled and exhibited worse health-related quality of life (Porensky et al.,
2009). Although we often think of PTSD as occurring in children, young adults, and those
who have served in the military, it exists in older adults, too. A meta-analysis of cognitive
functioning in older adults found that those with PTSD had worse cognitive performance
compared with those of the same age without PTSD (Schuitevoerder et al., 2013). In some
cases, PTSD emerges late in life, years after exposure to trauma. This is termed late-onset
stress symptomatology, and it has been observed in aging combat veterans after years of
functioning well (King, King, Vickers, Davison, & Spiro, 2007). Psychosis is another aspect of
mental illness that affects the elderly; it may be caused by schizophrenia, a mood disorder,
or some form of dementia. When psychosis begins in the elder years of a person’s life, their
functional status is generally poorer than that of similarly aged people who have psychosis
that was diagnosed at an early age. For example, many elderly adults with early-onset
schizophrenia—diagnosed during adolescence or early adulthood—function surprisingly
well, often better than young adults with the disorder. They may live independently, drive,
have been employed, and have a surprising amount of social interaction with family and
friends (Iglewicz, Meeks, & Jeste, 2011). Psychosocial functioning in adults with
schizophrenia appears to improve over time and features better self-management, fewer
psychotic symptoms, and fewer psychiatric hospitalizations (Jeste, Wolkowitz, & Palmer,
2011). For those who experience schizophrenia or other causes of psychosis with an onset

17. between the ages of 40 and 60 years, or even after age 60, the response to medication is
equivalent to that of younger patients (Iglewicz et al., 2011). 8.5 Prevention and Treatment
Approaches to Mental Disorders Three basic approaches are taken to treat the major mental
disorders: (a) medication; (b) psychotherapy, cognitive behavioral therapy or behavioral
therapy, and counseling of several types in both inpatient and outpatient settings; and (c) a
group of instrumental interventions, such as biofeedback, nerve stimulation, and
electroconvulsive therapy (ECT). For most mental disorders, the combination of two or
more treatment types yields the best results. Table 8.3 provides examples of non-
pharmaceutical therapies that are used in the treatment of mental disorders. © 2019
Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution. Prevention
and Treatment Approaches to Mental Disorders Section 8.5 Table 8.3: Examples of non-
pharmaceutical therapies for mental disorders Treatment modality Brief description
Psychodynamic or insight-oriented Focuses on unconscious processes that contribute to
present behavior; goals are self-awareness and understanding how the past influences
present behavior. Family-centered Cognitive behavioral therapy Behavioral therapy
Psychosocial therapy for bipolar disorder Psychosocial rehabilitation Views the individual
in the context of the family and the family’s history; may involve more than one person in
the room with the therapist. Views that feelings are based on maladaptive thinking and that
changing those thought patterns can change the patient’s subjective feelings. Theorizes that
rewarding desirable behavior increases that behavior and that not rewarding unwanted
behavior eliminates it; teaches parents of children with ADHD or ASD techniques to
accomplish this. Umbrella term; may include family therapy, cognitive behavioral therapy,
and other modalities. Goal is to enhance QOL and decrease the frequency of affective
episodes by teaching techniques for medication adherence, social and family problem-
solving, and enhanced communication. Goal is to help clients care for themselves by
developing social, vocational, and other living skills. Neurodevelopmental Disorders
Treatment for ASD is mostly behavioral and should begin as early as possible—as soon as a
child receives the diagnosis. Early intervention services, between birth and three years of
age, help the child learn to talk, walk, and interact with others (CDC, 2018g). These services
greatly improve the child’s development and help the family learn how to help their
children. More information about different early intervention programs is available at the
Autism Society website: (http://www.autism-society.org/living-with-autism/autism -
through-the-lifespan/infants-and-toddlers/early-intervention/). Children with ADHD are
treated with medication as well as behavioral therapy. The American Academy of Pediatrics
recommends that behavioral interventions be the first line of treatment for young children
(Wolraich et al., 2011). Many people think that it is best to try behavioral therapy first for all
children and to prescribe medication only as an adjunct therapy for those who need it.
Behavioral therapy gives the child self-regulatory tools that will be there when medication
ends. In addition, definitive data on the long-term effects of these medications in children
are not yet available. Recommendations for helpful behavioral therapy programs are
available through the CDC. For older children aged 6–11 years, both medication and
behavioral therapy are useful. For adolescents aged 12–18 years, medication can be useful if
they agree to take it (Wolraich et al., 2011). Learn more about evidence-based behavioral

18. treatments for ADHD through this CDC website:
(https://www.cdc.gov/ncbddd/adhd/treatment.html). © 2019 Bridgepoint Education, Inc.
All rights reserved. Not for resale or redistribution. Prevention and Treatment Approaches
to Mental Disorders Section 8.5 Mood Disorders Both major depressive disorder
(depression) and bipolar disorder usually respond well to a combination of medication and
therapy. People with major depressive disorder are treated with more than one modality,
usually antidepressant, anti-anxiety, and/or mood-leveling medications and some form of
psychotherapy or a support group. It often takes several weeks or several months for
antidepressant medication to have a full effect, so people should not expect overnight
changes (Mayo Clinic, 2018a). It is common that a person will need to try different
medications to find the right one for them. It can take months if not a few years of trying
new medications to find a good fit. This trial period for testing different
medicaMonkeybusinessimages/iStock/Getty Images Plus tions to find a good fit can be
frustrating as well as Mood disorders are often effectively very difficult for the person. The
medications affect treated with a combination of and can interfere in every aspect of the
person’s life, medication and therapy. such as personal relationships and work. Anxiety
Disorders Both medication and psychotherapy are effective in treating anxiety disorders in
adults; generally, psychotherapy is considered first, and if not sufficient, then medication
may be prescribed. The most commonly used psychotherapeutic mode is cognitive
behavioral therapy (CBT) (NAMI, 2018a). CBT has been useful for children and adolescents
with anxiety disorders, although a combination of therapy and medication may be needed
for those with moderate to severe disorders. GAD is a common anxiety disorder in adults
aged 55 years and older. Before seeking treatment, a person should see their medical doctor
first to eliminate environmental causes for anxiety. For example, excessive caffeine intake
can cause symptoms like anxiety. Psychotherapy helps the person with GAD learn coping
mechanisms and relaxation skills. Medication therapy is helpful for short periods. Long-
term medications are not advisable, as they can be addictive (Grohol, 2018). Posttraumatic
Stress Disorder People exposed to trauma often undergo an acute stress reaction, which can
lead to PTSD. Acute stress disorder develops within the first 30 days after a traumatic event.
In the absence of treatment, most people exhibiting acute stress disorder develop PTSD
(U.S. Department of Veterans Affairs, 2015). Therefore, it makes sense to treat those who
exhibit an acute stress reaction to prevent, delay, or decrease the severity of PTSD. CBT
appears to be the most effective method for preventing acute stress disorder from
developing into PTSD (U.S. Department of Veterans Affairs, 2015). © 2019 Bridgepoint
Education, Inc. All rights reserved. Not for resale or redistribution. Prevention and
Treatment Approaches to Mental Disorders Section 8.5 CBT for PTSD may contain several
different components, which include the following: • Exposure therapy, also called
prolonged exposure therapy, helps people control and face their fears by having them re-
experience their trauma in a safe environment. • Cognitive restructuring or processing
helps people look at the facts of what happened by challenging and modifying inaccurate
beliefs about the trauma; it often includes a written component. • Stress inoculation training
teaches people to control their own anxiety (U.S. Department of Veterans Affairs, 2017a).
Complementary and alternative medicine (CAM) is gaining acceptance because of research

19. studies showing its effectiveness in treating the symptoms of PTSD. One research study
shows that acupuncture has similar outcomes to CBT (U.S. Department of Veterans Affairs,
2017b). Yoga decreased the “re-experiencing and hyperarousal symptoms” in one study
group (U.S. Department of Veterans Affairs, 2017a, para. 22). Other CAM therapies studied
for the treatment of PTSD are chiropractic adjustments, massage therapy, Reiki and other
energy therapies, relaxation, meditation, and Emotional Freedom Techniques (EFT)
Tapping, each of which has outcomes that help the person with PTSD cope with the
condition (Wahbeh, Senders, Neuendorf, & Cayton, 2014). Psychologists at the National
Center for Telehealth and Technology and the U.S. Department of Veterans Affairs’ National
Center for PTSD have been working together to develop mobile apps and other portable
technology that can aid in PTSD treatment. For instance, a mobile app called PE Coach
(short for Prolonged Exposure Coach), available for both Apple and Android mobile devices,
is helping patients practice controlled breathing and other techniques, and it helps them
complete their assigned therapeutic exercises between therapy sessions as well. Although
developed for use by military personnel, the apps are available for civilians, too (U.S.
Department of Veterans Affairs, 2015). Schizophrenia Schizophrenia treatment requires a
combination of medication, psychotherapy, and psychosocial interventions, such as social,
vocational, and illness-management skill training. Treatment for schizophrenia works best
when all aspects—medical, therapeutic, and psychosocial interventions—are well
integrated, but that is an ideal often not met in practice. The treatment combination will
help patients with schizophrenia stay on medication, stay out of the hospital, and function
well in daily life. Despite the severity of the disorder, a surprisingly large proportion of
people with schizophrenia manage to attain good QOL as they get older. Antipsychotic
medication reduces the positive symptoms of hallucinations and delusions but is unlikely to
affect the cognitive problems associated with schizophrenia. There are two major groups of
antipsychotic medications: the so-called typical (conventional or first-generation)
antipsychotics, which gained FDA approval before 1990 and act by almost completely
blocking brain dopamine receptors; and the atypical (or second-generation) antipsychotics,
which act on a subgroup of brain receptors. Typical antipsychotics are more likely to cause
a severe movement disorder known as tardive dyskinesia, although this disorder can also
develop among people with schizophrenia who have never been treated with antipsychotics
(Tenback & van Harten, 2011). Atypical antipsychotics have other safety problems:
clozapine © 2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or
redistribution. Prevention and Treatment Approaches to Mental Disorders Section 8.5 can
cause a severe blood disorder, and others can result in significant weight gain and metabolic
changes. Psychotherapy is an important part of the treatment plan for people with
schizophrenia once they are stabilized on medication. CBT can help people manage
symptoms that persist by developing proactive coping strategies and improving medication
adherence. Because families are often involved in the care of people with schizophrenia,
family therapy can be useful for educating families about coping strategies and problem-
solving skills (NIMH, 2016b). Psychosocial interventions and rehabilitation are often
delivered through local community mental health centers. The aim is to teach people with
schizophrenia skills of everyday living, such as managing money, using public

20. transportation, and communicating effectively with other people. Job training and job
counseling may also be important components of this instructional effort. Gut Microbiota
and Mental Illness There is emerging evidence that gut flora—bacteria in the
gastrointestinal system—may play a role in the onset and persistence of mental illnesses.
Dysbiosis is the microbial imbalance between healthy and harmful bacteria as well as fungi
in the gut. Microbial imbalance “may produce systemic [meaning it affects the entire body]
and/or central nervous system inflammation” (Galland, 2014, para. 1). Systemic or central
nervous system (CNS) inflammation can lead to a variety of health issues, such as
fibromyalgia, chronic fatigue syndrome, and brain function (Galland, 2014). Dysbiosis is
also associated with “different metabolic disorders, including obesity, diabetes and
cardiometabolic disorders . . . [as well as] brain pathologies and neurodegenerative
disorders” (Cani & Knauf, 2016, para. 1). How does this happen? The purpose of the gut is to
break food down to its molecular components for easy absorption. Some molecules help
create hormones and neurotransmitters, which are chemical messengers. Chemical
messengers tell your body what to do. They serve to regulate body functions, which “affect
mood, sleep, concentration, weight, carbohydratecravings, and addictions, and they can
contribute to depression, pain, anxiety, and insomnia when they are not in balance” (Korn,
2016, p. 32). A person’s diet plays a role in the balance of the gut flora. Gut microbes begin
to develop while the baby is in utero. Breast milk, called colostrum, conveys immunity as
well as healthy gut bacteria to the infant (Clapp et al., 2017). Formula alone allows an
increase in growth in harmful bacteria. However, “the implementation of formula food with
prebiotics and probiotics has been demonstrated to be effective in changing microflora
composition toward the desired breast-feeding pattern” (Guaraldi & Salvatori, 2012, para.
15). Diets that consist mostly of fruits, vegetables, legumes (beans), and grains increase the
healthy gut flora. Diets that include mostly animal products, such as meats and cheese and
other dairy products, increase the bacteria associated with an inflammatory reaction
(Pandika, 2017). Another way diet affects the gut microbiome is related to the chemicals in
the air, water, and food. Chemicals used to promote the growth of plants and animals are
persistent in our foods. These chemicals reduce the number of good bacteria, which in turn
allows bad bacteria to proliferate. There are studies suggesting that these chemicals may
cause cancer and interrupt © 2019 Bridgepoint Education, Inc. All rights reserved. Not for
resale or redistribution. Social Issues in Mental Health and Mental Disorders Section 8.6
endocrine (hormone) and nervous system activities. Studies have shown that these
chemicals can cross the placenta, which may cause damage to the growing child (WHO,
2018). Waste products are excreted primarily through urinary and fecal processes.
However, many of the chemicals accumulate in the fat cells and remain in the body. 8.6
Social Issues in Mental Health and Mental Disorders Social issues surrounding mental
health and mental disorders have a tremendous impact on how they get researched,
diagnosed, and treated. Stigma, racial or ethnic diversity and disparities, and treatment
access are just a few related topics that pertain to mental illness. Policy issues become
interwoven throughout these social issues and are especially relevant to treatment access.
Stigma According to NAMI (2018e), stigmatizing means attempting to label a group of
people as less than worthy of respect than others; it is a mark of shame, disgrace, or

21. disapproval that results in discrimination. The WHO (2003) identified stigma as a major
barrier to mental health care access. The history of mental health and mental disabilities
leaves no doubt that people who have mental disabilities have suffered from stigma for
hundreds—if not thousands—of years. As touched on in the beginning of this chapter,
mental illness was once considered to be either a punishment for sin or a sign of demonic
possession. Stigma affects not only the individual with a mental disorder but their whole
family as well. Stigma is a barrier for people who are seeking treatment, finding or keeping a
job, and receiving quality health care. Research presented at the 2013 APA annual meeting
found that physicians and nurses were influenced by stigma (Mittal et al., 2013). In half of
otherwise identical scenarios, a patient was diagnosed with schizophrenia. In these
hypothetical cases, providers were less likely to refer the person for weight loss treatment,
assumed the person was less likely to adhere to medication, and considered the person less
able to make treatment decisions. The researchers concluded that “stigma-reduction
interventions that target all provider groups are needed” (Mittal et al., 2013, p. 266). The
need to campaign against stigma in the mental health field has been acknowledged since at
least the 1990s (Dain, 1994). The WHO (2003) listed stigma eradication as one of the four
core strategies of its Mental Health Global Action Programme, which was launched in 2001.
There are five ongoing approaches to reducing stigma: (a) education to reduce or eliminate
misinformation; (b) mental health literacy programs within health education courses for
school-aged children; (c) peer services, where an individual with a current or prior mental
illness diagnosis works as a service provider and identifies their own experience as part of
the support; (d) advocacy (e.g., through large organizations such as NAMI); and (e)
legislative and policy change (e.g., ADA) (National Academies of Sciences, Engineering, and
Medicine, 2016). © 2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or
redistribution. Social Issues in Mental Health and Mental Disorders Section 8.6 Racial and
Ethnic Diversity and Disparities Attitudes toward mental health and mental disorders differ
among individuals, families, communities, ethnic groups, and cultures. Carpenter-Song et al.
(2010) studied the understanding of mental disorders and the response to mental health
services in Hartford, Connecticut, among Whites, Blacks, and Hispanics diagnosed with
severe mental disorders. They found differences among the three groups in perceived
stigma, interpretation of symptoms and illness, and acceptance of advice given by the
mental health center. Whites accepted the medical model most easily and wanted advice
from mental health professionals. Although they were aware of the stigma of mental illness,
they did not focus on it. In contrast, the stigma of mental illness was a prominent theme for
Blacks and Hispanics, and they were less accepting of mental health care. This type of
information is important to keep in mind when designing community mental-health care
programs. A gap or state of inequality is known as a disparity. Disparities in mental disorder
diagnosis and hospitalization because of race or ethnicity are observed as early as
childhood. In one study, a review of medical records of children and adolescents presenting
to an urban hospital’s psychiatric emergency room in a one-year period occurred. Black or
Hispanic children and adolescents were much more likely to have a psychotic or behavioral
disorder diagnosis than White children. Black children were less likely to receive a
diagnosis of depression or bipolar disorder. Similarly, when disparities in diagnosis and

22. treatment of childhood ADHD were examined, Black and Hispanic children were less likely
to be diagnosed with ADHD, and, when diagnosed, they were less likely to be taking
medication than White children (Morgan, Staff, Hillemeier, Farkas, & Maczuga, 2013).
Morgan et al. ascribed this difference to underdiagnosing of Black and Hispanic children
compared with White children. They hypothesized that clinicians are “disproportionately
responsive to white parents who are more likely to solicit ADHD diagnosis and treatment of
their children” (2013, p. 91). As it appeared that the only treatment offered was medication,
it is also possible that minority parents were wary of medicating their children. Haeri et al.
(2011) found that among adults, Black people are more likely to be diagnosed with
schizophrenia and less likely to be diagnosed with bipolar disorder than White people. The
authors suggested that this disparity might result from how racial or cultural factors affect
behaviors and symptoms and how they are interpreted during diagnosis. Disparities in the
use of mental health service by minority ethnic or racial groups also might result from
attitudes (e.g., thinking that the problems will get better on their own, or fear of stigma),
structural barriers (e.g., inability to get an appointment), and lack of diversity among care
providers. A recent study of beliefs about mental health treatment found that although
some differences in attitudes existed between different racial or ethnic groups, they were
small and could not account for the persistent disparities observed in mental health care
(Hunt et al., 2013). These results illustrate the pervasiveness of disparities in the
accessibility and quality of health care among different racial and ethnic groups (Muroff,
Edelsohn, Joe, & Ford, 2008). For more detail on this topic, refer to the report edited by
Smedley, Stith, and Nelson (2003) on racial and ethnic disparities in health care:
(https://www.ncbi.nlm.nih.gov/pubmed/25032386). © 2019 Bridgepoint Education, Inc.
All rights reserved. Not for resale or redistribution. Social Issues in Mental Health and
Mental Disorders Section 8.6 Treatment Access and Advocacy Parity within the realm of
mental health means that services and medications receive funding at levels equal to other
health services and medications. Although the Mental Health Parity and Addiction Equity
Act of 2008 requires group health insurance plans that offer coverage for mental disorders
to provide benefits that are no more restrictive than all other medical and surgical benefits,
it does not go so far as to require coverage of mental disorders (Substance Abuse and
Mental Health Services Administration [SAMHSA], n.d.). The Patient Protection and
Affordable Care Act of 2010 (PPACA or ACA) expanded mental health insurance coverage
benefits, beyond those offered by group health insurance plans, to include all new small
group and individual market health insurance plans, and it requires these health insurance
plans to cover mental health disorders in compliance with federal parity protections under
law (Sarata, 2011). The Department of Health & Human Services (HHS) explains how the
ACA changes mental health insurance coverage for patients in its brief, which can be read on
this web page: (https://aspe.hhs.gov/report/affordable-care-act-expands -mental-health-
and-substance-use-disorder-benefits-and-federal-parity-protections-62 -million-
americans). Although the ACA expanded access to mental health services for a wider sector
of U.S. society, it is consistently challenged and amended by lawmakers. U.S. citizens should
expect changes, including the possible repeal, without replacement, of the law. If that
happens, it is estimated that between 13 and 30 million people will lose their health

23. insurance coverage because of preexisting conditions (Modern Healthcare, 2017). Mental
health advocacy is alive and well in the United States. Several branches of the federal
government are cooperating with private, nonprofit organizations to promote awareness of
mental health and to increase access to and uptake of mental health services. Some of the
major players are shown in Table 8.4. Table 8.4: Selected mental health advocacy
organizations Organization Website Special focus Depression and Bipolar Support Alliance
http://www.dbsalliance.org Support and advocacy for people with mood disorders National
Alliance on Mental Illness http://www.nami.org Public policy; support for families of the
mentally ill Mental Health America National Center for PTSD (a program of the U.S.
Department of Veterans Affairs) National Institute of Mental Health Outreach Partnership
Program and other outreach activities Substance Abuse and Mental Health Services
Administration http://www.mentalhealth america.net http://www.ptsd.va.gov
http://www.nimh.nih.gov /outreach http://www.samhsa.gov Behavioral health access for
mental illness and substance use Support and clearinghouse for the public and
professionals working with PTSD Liaison between governmentsupported research and
public policy Leading public health efforts to advance the behavioral health of the nation
and reduce the impact of substance abuse and mental illness on America’s communities ©
2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution.
Summary and Resources Chapter Summary Summary and Resources Mental health gives
people the potential to live productive and fulfilling lives and make a positive contribution
to their communities. Most mental disorders are treatable. Hope and help are available but
finding them can be a challenge. In the past, mental disorders were considered character
flaws, retribution for sins, or signs of demonic possession. Definitions of mental disorders
are still influenced by society’s attitudes. Criteria for diagnosing mental disorders are
usually taken from the APA’s DSM-5. Half of all lifetime cases of mental disorders appear by
age 14. Neurodevelopmental disorders (e.g., ASD and ADHD) result in slowed development
and age-inappropriate behavior, communication, or ability to focus. Early intervention is
critical for both the child and the family. Mood disorders, including depression and bipolar
disorder, are among the most severe mental disorders. Anxiety disorders are the most
common mental disorder. Treatment for all three disorders—neurodevelopmental
disorders, mood disorders, and anxiety disorders—usually includes a combination of
psychotherapy and medication, often involving the family. PTSD arises after exposure to
traumatic or stressful events such as abuse, assault, combat, natural disasters, or serious
accidents. Parts of the brain dealing with fear and stress are affected; therapy focuses on
calming these parts. Schizophrenia is generally chronic and serious, although many people
diagnosed with it do manage to live productive lives, particularly as they age. Medication,
psychotherapy, and psychosocial support services are needed to treat this disorder.
Emerging research places emphasis on a healthy gut. The “small brain” of the intestines
starts its development before birth. When unhealthy gut floras are excessive, the
gastrointestinal system does not function properly; nutrients from food are not properly
absorbed. This inhibited uptake of nutrients appears to have a systemic effect. Prebiotics
and probiotics assist in reestablishing healthy gut flora. Disparity of diagnosis and
treatment exists between racial and ethnic cohorts. Many factors, including stigma and

24. racism, drive this problem. The U.S. health care system does not provide adequate support
for either those with mental disorders or their families. This lack of support is shortsighted,
as the cost of providing quality care for people with mental disorders is less than the costs
of dealing with the consequences of inadequate treatment. © 2019 Bridgepoint Education,
Inc. All rights reserved. Not for resale or redistribution. Summary and Resources Key Terms
agoraphobia Fear of leaving one’s home or a safe place, thereby avoiding situations that
cause anxiety, such as public or open spaces. anxiety disorders Category including panic
disorder, OCD, PTSD, phobias, GAD, and social anxiety disorder (or social phobia). These
disorders are marked by excessive feelings of fright, distress, or uneasiness in certain
situations. burden of disease Loss of healthy life years due to disabling disease.
deinstitutionalization The movement in psychiatry that began in the 1950s and 1960s of
removing people with mental disorders from institutions or asylums and treating them in
the community. delusions Persistent beliefs in something that is untrue despite evidence to
the contrary. A symptom of a psychotic mental state: for example, schizophrenia. disparity
Gap or inequality in treatment or outcomes: for example, in health care. The differences are
noted when comparing people of different income levels, race, or ethnicity. Disparity
suggests that the difference is unjust and arises from discrimination. dysbiosis The
microbial imbalance between healthy and harmful bacteria as well as fungi in the gut.
executive functioning The ability to organize and prioritize tasks and information;
associated with the frontal cortex of the brain. generalized anxiety disorder (GAD) A state of
mind characterized by worrying excessively about everyday problems and events that lasts
for at least six months and makes it difficult to concentrate and carry out everyday
activities. gut flora Naturally occurring bacteria and fungi in the gastrointestinal system.
hallucinations Seeing, hearing, or sensing something that is not there. indigent People who
are poor, homeless, or in need. Mental Health Parity and Addiction Equity Act of 2008 A
federal law that requires any group health plan (covering more than 50 employees) that
offers mental health or substance use disorder coverage to provide it on par with medical
and surgical benefits, that is, with no greater financial requirements or treatment
limitations. This law does not mandate that plans cover mental health or substance abuse
treatment. obsessive-compulsive disorder (OCD) A syndrome that involves persistent,
upsetting, and unwanted thoughts (obsessions). These, in turn, trigger a set of activities or
rituals (compulsions) to control the anxiety produced by these thoughts (e.g., needing to
check repeatedly that the stove is off before leaving the house). panic disorder A mental
illness characterized by sudden attacks of terror and physical symptoms such as a pounding
heart, sweatiness, and weakness or dizziness. Panic attacks can happen repeatedly and
without warning, often producing a sense of unreality and a fear of dying. It is a more
common disorder in women. parity In a mental health context, descriptive of a situation
where services and medications are funded at levels equal to other health services and
medications. phobias Irrational fears (e.g., of high places or speaking in public) that can
impair either a person’s ability to function in certain situations or their overall functioning.
© 2019 Bridgepoint Education, Inc. All rights reserved. Not for resale or redistribution.
Summary and Resources posttraumatic stress disorder (PTSD) A type of anxiety disorder
with symptoms that include strong memories of a traumatic event; bad dreams; emotional

25. numbness; edginess or hyperarousal (or hypervigilance) during ordinary events; and the
avoidance of thoughts and situations that might recall the traumatic event. Initiating events
for the disorder include physical, sexual, or mental abuse; assault; combat experience;
natural disasters; serious accidents; sudden and major emotional losses; and terrorist
attacks. psychosis Personality derangement and loss of contact with reality, causing
negative changes in social interaction; usually accompanied by delusions or hallucinations.
resilient Able to recover from a stressful situation or traumatic event without having an
acute stress reaction or other mental problem. schizophrenia A serious chronic mental
disorder that interferes with a person’s ability to think clearly, manage emotions, make
decisions, and relate to others. It includes positive (e.g., psychosis), negative (e.g., flat
affect), and cognitive (e.g., thought disorder) symptoms. social anxiety disorder Also known
as social phobia, this disorder involves excessive nervousness and self-consciousness in
everyday social situations, leading to impairment in work and personal relationships.
synapses The space in which the nervous impulse passes between neurons. Critical-
Thinking and Discussion Questions 1. Many mental disorders are commonly diagnosed
within families. How might genetics contribute to this finding? What other explanations
might there be for this observation? 2. What is the difference between a hallucination and a
delusion? Which do you think might be more difficult for family members to handle? 3. Give
an example of the stigma of mental disorders. How might stigma affect the life of a person
diagnosed with a mental disorder? 4. What is exposure therapy? Do you think it is an
effective method of treating PTSD? © 2019 Bridgepoint Education, Inc. All rights reserved.
Not for resale or redistribution. © 2019 Bridgepoint Education, Inc. All rights reserved. Not
for resale or redistribution.