Psychology G12

h.:q*,*r-*G : *- *;ffi,,-g*=***
'\-- "
W,ruexperience U -.* *::::*li'"
s,il'.:.#.,
(lttPttt!7
*.-';*.'&\
Stress and Health

$trPl[il!8

Psychological Disorders
Methods of Therapy

,f',l,r I. ti,r,l:iil iitii iitiililliliili

,';lt ii ,titi;;rl i il.i li

l",, ,r ;i ,illr.r r:t,ll

How would you like to eat all the fatty, soon debunked Renaud's theory. No one,
butter-rich foods you'd like and not gain however, denied that the French managed
weight? That seemed to be what the French
diet promised. In spite of consuming meals to stay slimmer than Americans.
heavy in cheese, pastries, and chocolate,
the French appeared to remain slimmer So how do they do it? Today some
than the average American. They also researchers think they know the answer:
reported a lower incidence ofheart dis- The French simply take the time to enjoy
ease. This maddening phenomenon became their food. The average American bolts
known as the French paradox. down a hamburger, eats in the car, or
gobbles a sandwich while writing e-mails
The paradox came to the public's atten-
or watching television. By contrast, the
tion in 1991 on the television program French typically spend two hours eating
60 Minutes. During the program, French lunch. They set their forks down between
scientist Serge Renaud claimed that an bites and savor their food. And eating is
ingredient in red wine, which the French
a social activity-a time to talk and relax
consumed regularly, somehow reduced
with friends and family.
drinkers' cholesterol levels. By extension, it Paradoxically, although the French

also protected them from heart disease. spend more time eating than Americans,
Renaud's assertion was a boon to wine-
they actually consume less food. They may
makers around the world. Wine consump- eat several courses, but the portions are
tion in the United States immediately smaller. And while the French eat three
soared by 44 percent. But other research
meals a day, they don't typically snack in
470 cHnprrn rz
between. They also don't reach for seconds.

Watch theYideo $THH$$*ffir*

Explore topics on stress and health, 3tffi&xxf;

In addition, the French emphasize SEffl0l'l 1: Understanding Stress
quality over quantity. Foods tend to be
unprocessed and fresh. While it's true that r Stress is the arousal of one's mind and body in response
they consume a diet rich in fat, the fats are
found mostly in dairy products. Dairy fats, to demands made upon them.
it turns out, are healthier and make you
feel full longer. l Sources of stress include frustration, daily hassles, and

Yet what may separate the French life changes.
from us the most is their relaxed attitude
toward food and eating. The French eat r Different types of conflict contribute t0 stress.
what they want and don't feel guilty about r Some people create their own stress through their personality
it. Psychologist PauI Rozin surveyed people
of several different nationalities, including type.
American and French, on their attitudes
toward food. The Americans, he found, SECIl0ll 2: Stress: Responses and Effects
were much more likely than the French
to worry about food and obsess over diets. r Maintaining a positive attitude and a sense of humor are
Revealingly, in a word-association test,
"chocolate cake" prompted Americans to among the ways that people can reduce the effects of stress.
respond with "guilt"; the French, with "cel-
ebration." The Americans associated "heavy r Stressful situations produce the three stages 0f the general
cream" with "unhealthy," while the French
linked the confection with "whipped." adaptation syndrome.

Thus it would seem that our eating hab- r (hronic stress can suppress the activity of the body's immune
its are not only unhealthy, they are adding
to our overall stress levels. There again we system.
might imitate the French. Their custom of
making a meal a social occasion may foster St(TIOl{ 3: Psychological Factors and Health
peace of mind, which relieves stress and
can lower the risk ofheart disease. r Both biological and psychologicalfactors play important roles

So the next time you sit down to dinner, in health problems.

try turning off the television and talking to r Headaches are among the most common stress-related health

your dinner companions. Enjoy a leisurely problems.
meal and the conversation. At the end of the
dinner, indulge in a few small bites of choc- r People can make behavioral changesto help reducethe risks
olate cake and try not to feel guilty about
of heart disease.
it. Your stress-free attitude-and even the
cake-may be good for your health. r People with cancer must cope with the biological aspects of

1. What are some 0f the key factors that might explain their illness as well as with its psychological effects.
the French paradox?
SECTION 4: Ways of Coping with Stress
2. Do you think Americans are ever likely to change
r Defensive coping methods as a means of handling stress are
their eating habits and adopt the French diet? Why
or why not? self-defeating and usually harmful.

r Effective active coping methods for dealing with stress include

changing stressful thoughts, relaxing, and exercising.

STRESS AND HEALTH 471

Understamdins $tre$s

Before You Read Reading Focus Uorabulary Bt'"$s;*ffi Use a sraphic
1. What are the two different A.;tJ H-fuH organizer like
Main ldea stress
Many different situations kinds of stress? eustress this one to take notes on
and events can produce distress the sources of stress.
both good and bad 2. What are the main sources stressor
stress. Some personality of stress? approach-approach conflict
types may even create avoidance-avoidance conflict
their own stress. 3. Why does conflict cause approach-avoidance conflict
multiple approach-avoidance
stress?
conflict
4. How does personality type
affect stress?

B@MThe SfRmS$ of t

Are you o slave to success? Does this sh

description sound like anyone you know:
She has to get all A's, be presldent of the
debate club, get the lead role in the school play, and win at
everything. lfyou do know such a person, you know a per-
fectionist, and he or she is probably living with severe stress.
Perfectionism actually dooms those who pursue it. The
drive to be perfect creates an unending source of negative
emotions because perfectionists focus on mistakes and
failures. So instead of feeling free to try new experiences
and learn new tasks, they rigidly control their behavior. As
a result, perfectionists may never discover what they really
want to do or who they really are.
Unfortunately, perfectionism seems to be on the rise,
and psychologists think they know why: pushy parents.
Many parents today micromanage their children's lives and
demand perfection. They may think they are doing their
children a favor by setting high goals for them, but these
parents are actually raising a generation that is liable to
become increasingly frustrated, anxious, and depressed.
lronically, the strive for perfection results in just the
opposite. lt stifles creativity and prevents real success. 5o
if your parents are stressing you out by refusing to accept
second-best, ask them if they got all A's in school. lf they

didn't-and even if they did-give yourself a break, and

start looking at failure as another chance to learn. II

472 cHnprcn rz

Different Kinds of Stress $teti+tiealIy

In physics, stress is defined as pressure, or a UPCAtsI.ng+ t a
force. Examples ofphysical stress include rocks
crushing the earth or water pressing against Stress and Other Pressures
a dam. Psychological stresses can also "crush"
and "press" people. People may feel crushed by This bar graph shows some of the reasons college students give
the burden of making an important decision, for seeking counseling.
or they may feel pressed by a lack of time in
which to complete a major task. Stress, anxiety, nervousness

In psychology, stress is the arousal of Romantic relationships

one's mind and body in response to demands Low self-esteem, self-con6dence
made upon them. Stress forces an organism
to adapt, to cope, to adjust. The word stress g! Depressron
is used differently by different psychologists. ig Family relationships
Some psychologists describe stress as an event E Substanceabuse
that causes tension. Others describe stress as -[E Academic problems, grades
a person's response to a disturbing event. Still
others defrne stress as a person's perception Loneliness
of an event. Financial problems
Alcohol-related problems
Not all stress is bad. Stress can increase
sharpness and motivation and can keep peo- 01020304050
ple alert and involved. This kind of positive
Percent reporting reason
stress is called eustress. Positive stress can be
IiITERPRETING GRAPHS Which of the reasons shown
a sign that a person is taking on a challenge might add to students'stress?
or trying to reach a goal. For example, you
might experience eustress as you participate 5ources: "College Youth Haunted by lncreased Pressures" by B. Mwtay,1996, APA
in a classroom activity, whether you are lead- Monitor,26 (41,47; "College students and Alcohol Abuse Statistics," American Psychiatric
ing or following the activity. Association, HealthyMinds.org.

Negative stress-called disuess-is linked a relaxing vacation, while for another person
to intense pressure or anxiety that can have it could be stressful and unpleasant. However,
severe psychological and physical effects. some stressors are common to most people.
When stress becomes too severe or prolonged, For example, a loud, continuous drilling noise
it can strain people's ability to adjust to vari-
ous situations. Negative stress can dampen outside one's window would be irritating to
people's moods, impair their ability to experi- just about everyone.
ence pleasure, and even harm the body.
When stressors and stresses pile up on
High school and college students often each other, we can reach a point where we
experience stress that is related to family have difficulty coping. To avoid reaching that
problems, relationships, pressures at school, point, it is important to recognize some of the
loneliness, and general nervousness. In fact, causes ofstress.
stress is one of the main reasons that college Frustration One ofthe most common sources
students seek help at counseling centers. of stress is frustration-being blocked from
obtaining a goal. Examples include being
@Urc ldentify Supporting Details Why delayed from keeping an appointment,lack-
ing enough money to buy an item we need or
isn't all stress bad? want, or forgetting something important.

Sources of Stress

The event or situation that produces stress is
called a stressor. However, what is a stressor for
one person may not be a stressor for another.
For example, two people might react to a long
bus trip quite differently. For one it might be

STRESS AND HEALTH 473

Sometimes life seems full of frustrations. . time-pressure hassles, including the feel-
Although many frustrations are minor, the
more serious ones can be extremely stress- ing that there are too many things to do,
too many responsibilities, and not
ful-for example, working for weeks on an enough time to do what needs to be done

important project, only to lose it and have to . inner-concern hassles, including feelings
create it all over again.
oflow self-esteem and loneliness
Daily Hassles The everyday frustrations
we all experience are called daily hassles. . environmental hassles, including noise,
They come in different forms, but they have
one thing in common-they all create stress. crowding, pollution, traffic, and crime
When daily hassles become severe or frequent . frnancial hassles, including concerns
enough, they can threaten a person's well-
being. Psychologist Richard Lazarus and his about paying current bills, repaying
colleagues found that there are eight main loans, and saving for the future
. work hassles, including unhappiness with
types ofhassles: one's job and problems with co-workers

. household hassles, including preparing . future-security hassles, including con-

meals, cleaning, and shopping cerns aboutjob security, taxes, invest-
ments, and retirement income
. health hassles, including illness, anxiety
These hassles can result in feelings of tension,
about medical or dental treatment, and nervousness, worry, and sadness.
the side effects of medications
Life Changes Life changes-such as moving,
toThis scale ranks various life changes according : serious illness, or a death in the family-are
another source of stress. Life changes differ
the amount ofstress each produces. : from daily hassles in two important ways: (1)
Many life changes are positive and desirable;
Rank Life Event Q) Life changes tend to happen less often.

1 Death ofspouse Researchers Thomas Holmes and Richard
Rahe attempted to rank various life changes
2 Divorce according to the amount of stress each pro-
duced. The researchers asked people to rate
3 Marital separation each ofthe life changes on a scale of1 to 100 in
terms ofhow much stress they experienced and
. ... i ... .. how much adjustment they needed to make.
Holmes and Rahe used the figures to create
4 i Jailterm the Social Readjustment Rating Scale.

5 , Death of close family member Even life changes that are enjoyable can
produce stress because they require a certain
6 , t:':,oi:|l'j'y "r ill":': amount of adjustment. According to Holmes
and Rahe, too many life changes, even good
7 ; Marriage ones, can cause stress that leads to high blood
pressure and other health problems.
8 ,]
Fired at work Daily hassles and life changes-especially
unpleasant ones-influence the quality of a
9 : Marital reconciliation person's life. They can cause a person to worry
excessively and can dampen his or her spirits.
10 Retirement Stressors can also lead to health problems that
range from minor athletic injuries to serious
Sources: Reprinted with permission from T. H. Holmes and R. illnesses. Holmes and Rahe found that people
H. Rahe (1967).The social readjustment rating scale.Journalof who experienced many life changes within a
year's time were much more likely to develop
Psychoso mot ic R esea rch, 1 1, 21 3 -2'l 8. medical problems than those who did not.

ffiEg* Make Generalizations How can

sources of stress influence a person's life?

474 cHnptR rz

Psychologists have identified four types of conflict, a source of stress.

Example

i,

A choice between two equally attractive alternatives Choosing between cake and ice cream for dessert :

unattractiveA choice between two equally 1 Coing to the dentist or letting a toothache get
alternatives
worse

when I thatA choice of whether or not to do something
Deciding whether to buy a new DVD player l

rA choice between alternatives that have both good Deciding whether to stay at home to study for a

(onflict the decision is made, the person may still

Another source of stress is conflict, being have persistent self-doubts about whether he
pulled in two or more directions by opposing or she has made the right decision. The deci-
forces or motives. Conflict can be frustrating,
especially when a person is facing a difficult sion maker may not feel settled until he or
decision, such as choosing which college to she is in the new situation and knows that
attend. The pressure to make the right choice things are working out. For example, even
only adds to the stress involved in making after you decide which college you will attend,
you may still feel uncertain until you settle
such a major decision. into your dorm, meet your roommates, and
A person thinking about going to college or
begin classes.
entering the armed services may feel conflict-
ing emotions. He or she may be excited about Avoidance-Avoidance Conflict Anavoidance-
the prospect of learning new information and avoidance conflict is more stressful. People in
developing new skills for the future. However, this type of conflict are forced to choose "the
college is expensive, and a person who plans lesser of two evils"-that is, to choose between
to attend college must think about how to pay two unsatisfactory alternatives. People are
for it. The person may also have mixed feel- motivated to avoid each of two negative goals,
ings about leaving home. but the problem is that avoiding one requires
approaching the other. For example, suppose
Psychologists have identified four types you were faced with the choice of dropping
of conflict. These are approach-approach
conflicts, avoidance-avoidance conflicts, a course in which you were doing poorly
approach-avoidance conflicts, and multiple
and risked receiving a poor grade. However,
approach-avoidance confl icts. by dropping the course, you would not have
enough credits to gr:aduate. Both alternatives
Approach-Approach fonflict An approach- have a negative side.

approach conflict is the least stressful type of Approach-Avoidance Confliet A single goal
conflict because the choices are positive. In can produce both approach and avoidance
this situation, each ofthe goals is both desir-
motives. This is called an approach-avoidance
able and within reach. For example, sup- conflict. People face an approach-avoidance
conflict when a choice is both good and bad at
pose you were accepted by several colleges. the same time. For instance, you might want
You would then be faced with an approach- to attend a college that has an excellent repu-
approach conflict because you would have to tation and exactly the program you are look-
choose which college to attend.
ing for, but the college is very far away and
An approach-approach conflict is usually visiting home would be difficult and costly.
resolved by making a decision. However, after

STRESS AND HEALTH 475

ACAilEftEIC Multiple Approach-Avoidance Conflict The Personality Types
Vf,CABULAilY most complex form of conflict is a multiple
approach-avoidance conflict. In this kind of Some people actually create their own stress.
dilemma situation conflict, each of several alternative courses of Psychologists have classified people into two
action has its advantages and disadvantages. basic personality types: type A (intense) and
requiring a choice type B (Iaid-back). Type A people are always
between options You face this type of conflict when you have on the go; they put pressure on themselves
that are equally to decide which college courses to take. The and thus are constantly under stress. They
undesirable factors to consider may include your level of are highly driven, competitive, and impa-
interest in the subject, the reputation ofthe tient. Type A people always feel rushed and
teacher, the usefulness ofthe course to your pressured because they operate at full speed
overall plan, and the diffrculty of the course. and become annoyed when there is even the
slightest delay. Type A people never seem to
When decidingwhat to eat in a restaurant, have enough time, especially since they often
you might have to choose between food that is try to do several things at once. They walk,
healthful but not very tasty, tasty food that is eat, and talk faster than other people, and
not very healthful, and food that is both tasty they are generally quick to become angry.
and healthful but is too expensive. In such a
dilemma, you would be faced with a multiple Type B people, in contrast, are more
approach-avoidance confl ict.
relaxed. They are more patient, do not become
When conflicting motives are strong, people angry as easily, and are typically less driven
may encounter high levels of stress and con- than type A people. While type A people often
fusion about what course ofaction to choose.
They need to make a decision to reduce the earn more money than type B people do, type
stress, yet decision-making itself can be quite
stressful, especially when there is no clear A people pay a high price for their success.
They must live with the heightened stress
right choice. Some people cope with such dif- they create for themselves. Research shows
frcult decisions by making a two-column list, that type A personalities run a much greater
jotting down all the reasons for and against health risk than type B people. Ifthey do not
a particular choice. The thought that goes loosen up and relax, but instead continue their
into making the list sometimes helps people type A behavior, they are in greater danger of
decide what to do.
suffering coronary heart disease.
[!!!ffi!ffi Analyze Which type of conflict
[ll!@!ffi Contrast Howdoesthebehavior
might cause the most amount of stress?
of type A and type B people differ?

Assessment 7. ldentify Cause and Effect Using your notes and a

Reviewing Main ldeas and Vocabulary graphic organizer like the one below, identify possible
effects of the stress shown.
l. ldentify What is a stressor?
8. Descriptive Describe a time you faced a multiple approach-
2. Summarize What are the eight main types of daily hassles?
3. Explain Why is an approach-approach conflict the least avoidance conflict. What different courses of action did you
have to consider? How did you resolve the conflict?
stressful type of conflict?

Thinking Critically
4. Draw Conclusions Suppose you won the lottery. Why

might that event cause you stress?
5. Predict Do you think the stress level of a person with a type

A personality might decrease or increase if he or she were
forced to retire? Explain your answer.
6. Support a Position Parents report high stress levels for
their children-even very young children. What steps do
you think parents could take to alleviate this stress?

476 cunptrav

s: Respwttses

*wd Ef&ets

ffi*fareYaM ffiead :1,... " UseagraPhic
Bi
Main ldea Reading focus Uocahulary organrzer
People respond to stress in 1. What factors influence self-efficacy expectation bddE6re*n
different ways, but stressful general adaptation syndrome
situations produce similar our response to stress? like this one to take notes
responses in the body. (GAS)
Stress-especially chronic 2. What is the general on the responses to and
stress-can even compro- adaptation syndrome?
mise the body's immune effects of stress.
3. How does stress affect
system. the immune system?

A HedtW nos.e of Src$SiffifiS$#

Can you ever betoo optimistic? The glass on the left represents the view of optimists, who
It turns out you can. Too much opti- would describe it as half full. The glass on the right represents

mism and good fortune can actually the view of pessimists, who would describe it as half empty.
overtax the immune system. Furthermore, stress can
actually strengthen it.

Does all this seem counterintuitive? After all, positive
emotions and events are supposed to be healthy, and
stress is supposed to suppress the immune system-but
apparently not always. Consider the case of Brian. A
gifted writer, Brian fulfilled a lifelong dream when a book
he wrote was accepted by a major publishing company.
lnstead of being thrilled, however, Brian went into a
tailspin: depression, followed by alcoholism, obesity,
and heart disease. Brian suffered from low self-esteem.
Although he had optimistically dreamed of such suc-
cess, he probably never really expected to achieve it.
Psychologists believe that only emotionally healthy peo-
ple can handle enormous success. For the Brians among
us, stress-in the form of disappointment and unfulfilled
dreams-may actually be healthier.

A daily dose of stress may also help us fight disease.
ln a study, rats that received electric shocks to their
tails every day were better able to fight off a bacterial
infection than rats that did not receive the shocks.The
researchers concluded that short-term stress can actually
boost immunity.

Psychologists do distinguish between short-term
stress and chronic stress, however. ln this section, you will
find out what prolonged stress can do to your body and
your health. lt isn't pretty. hl

STRESS AND HEALTH 477

Responses to Stress result, people are less likely to experience
panic and nervousness. People with more self-
Psychological factors play an important role confidence-a strong belief that they can
in people's responses to stress. People with handle difficult situations-are also less
different types of personalities respond to Iikely than those with less self-confidence
stress in different ways. People who are more to be upset by stress. In other words, a self-
relaxed and free of conflict are less likely than confident person is more likely to keep cool
others to become sick when they do experi-
ence prolonged stress. under pressure.

The stress ofan event depends largely on Psychological Hardiness Psychological har-
what the event means to the person involved. diness is a personality characteristic that
Going to college may be important to you, but helps people withstand stress. The research
leaving home and being away from your fam- on psychological hardiness is based on the
pioneering work of Suzanne Kobasa and her
ily and friends may also mean a great deal colleagues. They studied business executives
who were able to resist illness despite heavy
to you. Moving can be a positive or a nega-
tive event, depending on whether one moves workloads and stress on thejob. The research-
to where one wants to be and on the difficul-
ties ofpacking, unpacking, and paylng for the ers found that these psychologically hardy
move. Even a positive move, such as moving to executives differed from other executives in
a larger house, creates some stress. However, three important ways.
a negative move, such as being evicted from
. Commitment. The hardy executives
one's home, is much more stressful because
were highly committed to their jobs; they
ofthe fear, anxiety, anger, and depression it believed that their work was meaningful,
though it was also demanding and stress-
can trigger. ful; they regarded their stress as a source
Biological factors also account for some of of motivation rather than as something
that was victimizing them.
the differences in people's responses to stress.
. Challenge. The hardy executives
Research suggests that some people inherit
the tendency to develop certain health prob- sought out challenges; they preferred
lems under stress. Yet most people can do change to stability even though the
things to influence or reduce the effects of changes often required great adjustment;
their stress. Factors that influence the effects they regarded change as interesting and
of stress include self-efficacy expectations, rewarding rather than threatening.
psychological hardiness, a sense of humor,
predictability, and social support. . Control. The hardy executives viewed
themselves as being in control of their
Self-Efficacy Expe(tations Do you remem-
ber the children's story "The Little Engine Iives and able to influence and control
That Could"? In an effort to pull a heavy load the rewards and punishments they
up a great hi1l, the engine repeated to itself, received;they did not feel helpless in the
"I think I can, I think I can." The engine suc- face of the forces that were involved in
ceeded because ofits self-efficacy expectations. shaping their lives.

Self-efficacy expectations are the beliefs people Other researchers have also found that believ-
have that they can accomplish goals that they ing that one is in control of a situation tends
set for themselves. The goal might be to write
a persuasive essay, dunk a basketball, or learn to enhance the body's ability to withstand
to solve math problems. Believing one can do
stressful events.
it helps one reach the goal.
Self-efficacy expectations are closely Sense of Humor Do you know the old saying
"Laughter is the best medicine"? The idea that
related to self-confidence. Self-confidence humor lightens the burdens of life is one that
affects people's abilities to withstand stress. dates back to ancient times. One study found
For example, when people are in frighten- that students who had a sense of humor and
ing situations, self-confidence reduces the saw humor in diffrcult situations experienced
level of adrenaline in the bloodstream. As a Iess stress than students who were not able to
find humor in the same situations.

478 cHRprrR rz

Some research suggests that emotional When writer Norman Cousins was diagnosed with
a painful illness that is similar to arthritis, his doctor
responses, such as happiness and even anger, prescribed high doses of painkillers. But Cousins came
may have beneficial effects on the immune up with rnedication of a different kind: He watched
Marx Brothers movies. He found that laughing at the
system as well. Since humor and laughter movies eased his pain and helped him sleep better. ln
are connected with feelings of happiness, very little time, he was able to get offthe painkillers.
they probably really are good "medicine" for Why do you think laughter can reduce pain?

the body. than others to stay with the activity. Social

Fredictahility Having the ability to predict support also appears to shield people and help
them recover from feelings ofdepression.
a stressor seems to reduce the amount of stress
Social support helps many immigrants to
it causes. Predictability allows people to brace cope with the stresses of adapting to life in the
United States.It helped Midwest families cope
themselves for an event and, in many cases, to with the stresses of severe flooding in 2008
and enabled Chinese villagers to deal with a
plan various ways to cope with it. Since hav- major earthquake that same year. Social sup-
port also helps people remain healthy and in
ing control ofthe situation helps reduce stress, good spirits when caring for other people who
having prior information about the expected have serious health problems.

stressor gives people a feeling that they will [ll[lEIEffi Draw Conclusions What role
be able to deal with it. For example, ill people
who ask about the medical procedures they might attitude play in responding to stress?
will undergo and the pain they will experience

tend to cope with the stress better than ill

people who do not know what to expect.

Social Support The presence and interest of
other people provide the social support that
helps people cope with stress. Like psychologi-
cal hardiness, social support helps insulate
people from the effects of stress. People who
lack social skills and spend most of their time
alone seem more likely to develop infectious
diseases when they are under stress.

There are several ways to provide social

support to people who are under stress.

. Express your concern by listening to peo-

ple's problems and offering sympathy,
understanding, and reassurance.

. Provide physical relief by offering the

material support and services that help
people adjust to stress-for example,
financial assistance, food, and shelter.

. Offer information, including advice, that
helps people cope with stress.

. Provide feedback to help people under-

stand or make sense of what they have

experienced.

. Socialize, which includes talking, playing,
or just being with the people who are

under stress.

Research clearly suggests the value of

social support. For example, older people who
have social support recover more rapidly from
physical problems than older people who have
no support. People who have buddies who join
them on an exercise program are more likely

STRESS AND HEALTH 479

[,.&{da l} fr: F*? [ The SerceraE &daptatisE Syndrourue During the alarm reaction, the syrnpathetic
{1{*,ii*ffil=l-.+!: nervous system is activated. This produces a
How is it that daily hassles, Iife changes, con-
secrete to release flict, and other sources of stress often make flood of stress hormones that act to prepare
a liquid substance people ill? Stress researcher Hans Selye sug- the body to deal with the stressor. Adrenaline
gested that the body under stress is like a
clock with an alarm that does not shut off. and noradrenaline arouse the body to help it

Selye observed that different stressful cope with threats and stress. Corticosteroids
situations each produced similar responses and ACTH protect the body from allergic
reactions (such as difficulty breathing). Once
by the body. Whether the source of stress was the stressor or threat is removed, the body
a financial problem, a physical threat, or a returns to its previous state.
bacterial invasion, the body's response was
always the same. Selye labeled this response The Resistan{e Stage Ifthe alarm reaction
the general adaptation syndrome (GAS). The mobilizes the body and the stressor is not
GAS has three stages: an alarm reaction, a
removed, people enter the resistance stage of
resistance stage, and an exhaustion stage. the GAS. During this stage, people attempt to
find a way to cope with the stressor to avoid
The Alarm Reaction The alarm reaction is being overwhelmed by their negative reac-
initiated when a stressor is perceived. This tions. The body tries to regain its lost energ"y,
reaction mobilizes the body for defensive repair damage, and restore balance. However,
action. In the early 1900s, physiologist Walter people may still feel enough of a strain to con-
Cannon described this alarm system as the tinue to experience some physical symptoms.
frght-or-fl ight re action.
The €xhaustion Stage If the stressor is still
Animals and human beings experience not removed, people may enter the exhaus-
this fight-or-flight reaction in similar ways. tion stage of the GAS. At this stage, the
Consider an animal's reaction when a stranger adrenal and other glands activated by the
approaches or when the animal notices some fight-or-flight reaction can no longer secrete
other change in its environment that signals
possible danger. A person might react the hormones. People's muscles become worn out.
same way. Imagine that as you are about to Their heart and breathing rates slow down.
go to sleep, you hear a loud noise in another
room. Like the animal, you also become alert As the resources available to combat stress
to your environment and sensitive to any become depleted, people reach a breaking
sight, sound, or other stimulus around you point. Continued stress during the exhaus-
that might indicate danger.Your body is in the tion stage may cause people to develop health
fight-or-flight mode that occurs when danger problems ranging from allergies and hives to
ulcers and heart disease-and even death.
is perceived to be present.
ffi summarize what are the three

stages of the general adaptation syndrome?

Fight-or- Flight Reaction

Definitiox: an alarm reaction that mobilizes the body for defensive
action when a person first perceives a stressor

Characteristirs: air passages widen to allow more air intake; hair stands
on end; level of blood sugar increases; heart rate increases; muscles
tighten up; blood pressure rises; senses sharpen and become more
alert; steroids and adrenaline are secreted

Effee*: blood flows away from surface areas to major muscle groups,
flooding them with energy; body receives a burst of energy; person is
ready to "fight"-confront the stressor-or take "flight"-run away
from the stressor

480 csRpreR rz

Effects af Stress on suggests that social support may have been a aComplete j
factor in insulating some students from the atWebquest I
the lmmune System detrimental effects of stress. thinkcentral.com i
sotnrehngothwenttohe
Stress also affects our ability to cope with Other studies have found that the stress .\immune svstem. I I
disease. Research shows that chronic stress of examinations weakens the capacity of the l
immune system to combat certain viruses,
suppresses the body's immune system. such as the Epstein-Barr virus, which causes , .-,,. '*-*-j
fatigue and other health problems. In another
The lmmune System You might think that study, researchers found that training aimed
some people are not exposed to the kinds of at improving coping skills and relaxation
organisms that cause serious health prob- techniques improved the functioning of the
lems. But actually, that is not true. Most immune systems of the participants.
people are exposed to a great variety of
disease-causing organisms. However, an intact These studies indicate that stress causes

immune system fights off most of them. the immune system to function less effectively.
How does the immune system frght against
They also indicate that social support, which
disease?The immune system prevents disease reduces stress, makes the immune system
function better.
by producing white blood cells that destroy
disease-causing microorganisms (bacteria, [!EG![B Analyze How doesthe immune
fungi, and viruses), worn-out body cells, and
system protect people against disease?
cells that have become malignant (cancerous).
Reviewing Main ldeas and Vocabulary
White blood cells first recognize and then
1. Recall How does self-confidence affect people's ability to
destroy foreign bodies and unhealthy cells. withstand stress?
Some white blood cells produce antibodies.
2. Summarize What are five ways to provide social support
Others destroy the foreign bodies by surround- to those under stress?
ing and digesting them. The immune system
"remembers" these invaders and maintains 3. ldentify Causeand Effect What may be the result of continued
stress during the exhaustion stage?
antibodies in the bloodstream to fight them,
Thinking Critically
often for years. 4. Explain What might happen to the immune system after stress

Stress and the Immune System One of the becomes prolonged?
reasons that stress eventually exhausts peo- 5. Evaluate Why do you think that a person's stress can be alleviated

ple is that it stimulates their bodies to pro- simply by being in contact with other people?
6. Develop What advice for maintaining his or her immune system
duce steroids, which suppress the functioning
of the immune system. Persistent secretion of would you give to a student who is in a high-stress situation?
steroids interferes with the formation of anti- 7. Sequence Using your notes and a graphic organizer like the one

bodies, which are crucial in fighting germs. below identify the events that might occur when someone is under
In the case of some serious diseases, such as extreme stress.

cancer, the added stress that results from hav- [*]*[-]*[-]*f*]--[:]*[:]
ing a life-threatening disease contributes to
the suppression of the immune system, thus 8. Narrative Write a short, fictional scene in which you tell what hap-
leading to further health problems. pens when a camper hears a noise outside his tent. Be sure to describe
the camper's fight-or-flight reaction.
A study of dental students showed the
effects of stress on the immune system. To

test the functioning of each student's immune
system, researchers measured the level of

antibodies in the students' saliva at differ-
ent times during the school year. The lower
the level of antibodies, the lower a person's

immune-system functioning.
Students showed lower immune-system

functioning during more stressful school peri-
ods. The study also showed that students with

many friends had healthier immune systems
than students with fewer friends. The study

STRESS AND HEALTH 481

Pgychol,osical Faetors

and Health

Befora You Read Reading locus Vocabulary Use a graphic
health psychology organizer like
Main ldea l. How do biological and psycho- migraine headache this one to take notes on
Both biological and psy- the role played by biologi-
chological factors play an logical factors affect health? cal and psychological fac-
important role in medical tors in headaches, heart
problems, including head- 2. What are the most common disease, and cancer.
aches, heart disease, and types of headaches?
BiologicalFactors PsychologicalFactors
cancer. 3. What factors contribute to
heart disease?
Headaches
4. How is cancer linked to stress? Heart disease

Cancer

ffitrffiffitrffiNffiARr

Can you see my poin? Migraine sufferers describe their

pain as agonizing and nightmarish. One man said that he
felt like he was "being beaten up" during an attack. And
the punishment must seem endless-the headaches can last 72 hours.
lnstead of just talking about their pain, however, some sufferers trans-
late what they feel onto a canvas. Some artists focus on what they see just
before the onset of a migraine, during the so-called aura phase. Many see
zigzag lines or lose visual perspective-people and objects become fuzzy
and indistinct. Above all, these artists try to convey the head-exploding pain

of a migraine.
Although migraine art has become increasingly popular, experts believe

it is nothing new. Some of the mystical"visions"conveyed in paintings from
the medieval period may actually represent the hallucinations experienced
during a migraine attack. The German abbess Hildegard of Bingen is prob-
ably the most famous of these mystical artists. Born in 1098, Hildegard
claimed at a young age to have had visions of God. ln time, she described
and illustrated what she saw. Neurologist Oliver Sacks believes that the rep-
resentations of her visions reflect classic migraine symptoms.

ln many respects, of course, we have come a long way since the Middle
Ages. But there is still no cure for migraines. Sufferers hope that the inter-
est in migraine art will help researchers learn more about headaches and

migraines and so result in better understanding and treatment. E

During the aura phase, migraine sufferers often see shim-
mering lights that move across their field of vision. Here,
Hildegard illustrates the light as a multitude of falling stars

that shine brightly before burning out.

482 cHnpruR r z

Biologicaland Headaches

Psychological Factors Among the most common stress-related health
problems are headaches. People under stress
Why do some people develop cancer or have
heart attacks?Why do others seem immune to will sometimes get a headache as a direct
these health problems? Why do some people result of feeling tense. It is estimated that
seem to fall prey tojust about everything that
is going around, while others ride out the lon- 20 percent of Americans experience intense
gest winters with hardly a sniffle?
stress-induced headaches.
Biological factors play an important role in
physical illness. For example, family history Types of Headaches There are several types
of a particular disease can certainly increase of headaches. The most frequent kind is the
muscle-tension headache. When people are
a person's susceptibility to that disease. under stress, the muscles in their shoulders,
neck, forehead, and scalp tend to tighten up.
Other biological factors that are involved in Prolonged stress can lead to prolonged mus-
the development of illness include exposure
to disease-causing microorganisms, inocula- cle contraction, which causes muscle-tension

tions against certain diseases, accidents and headaches. Such headaches are characterized
injuries, and age. by duII, steady pain on both sides ofthe head
and by feelings oftightness or pressure.
A family history of health problems, such
as heart disease and cancer, may tempt some The next most common kind of headache
people to assume there is little they can do to is the migraine headache. Migraine headaches
influence their health. But one's family his- usually have a sudden onset and are identi-
tory (or genetic inheritance) merely suggests fied by severe throbbing pain on one side of
a potential for developing an illness. Health
writer Jane Brody noted that a bad family the head. Migraines affect l American in 10.
medical history should not be considered a
sign of doom. She noted that, instead, it should They may last for hours or days. Some people
be welcomed as an opportunity to keep the have warning "auras" before attacks. These
harmful genes from expressing themselves. warnings include visual distortions or the
perception of unusual odors. The migraines
While biological factors are important, themselves may be accompanied by sensitiv-
ity to light, Ioss of appetite, nausea, vomiting,
many health problems are affected by psycho- Ioss of balance, and changes in mood.

logical factors, such as one's attitudes and pat- Brain imaging suggests that when some-
thing triggers a migraine, neurons at the back
terns ofbehavior. Psychological states of anxi- of the brain fire in waves that ripple across the
ety and depression can impair the functioning top of the head and then down to the brain-
stem, which has many pain centers. Triggers
of the immune system and make people more for migraines include barometric pressure,
vulnerable to physical health problems. pollen, and some drugs. Other triggers are

Health psychology is concerned with the aged cheese and the hormonal changes con-
relationship between psychological factors nected with menstruation.

and the prevention and treatment of physical Psychological factors also trigger or worsen
illness. In recent years, health psychologists migraines. For example, the type A behavior
have been exploring the various ways in which pattern apparently contributes to migraines.
states of mind influence physical well-being.
In one study,53 percent ofpeople who had
Because of the growing recognition of the link
migraine headaches showed the typeA behav-
between psychological factors and health, an ior pattern, compared with 23 percent of peo-
estimated 3,500 health psychologists are now
ple who had muscle-tension headaches.
on the faculties of medical schools. Health psy-
Regardless ofthe source ofthe headache,
chologists have made important contributions people can unwittingly propel themselves into
to the understanding and treatment of many a vicious cycle. Headache pain is a stressor
different kinds of medical problems, including that can lead to an increase in, rather than a
headaches, heart disease, and cancer. relaxing of, muscle tension in the neck, shoul-

ffil} Analyze How can a bad family ders, scalp, and face,

medical history be a positive opportunity?

STRESS AND HEALTH 483

coililEcTtoil Treatment Aspirin, acetaminophen, and . Physical conditions. Obesity, high
many prescription drugs are used to fight
TheSlow-Foo4 headache pain. Some inhibit the production serum cholesterol levels, and hyperten-
low-Stress Diet sion all contribute to heart disease. About
About 33 percent of ofthe prostaglandins that help initiate trans- one American in five has hypertension, or
mission of pain messages to the brain. Newer abnormally high blood pressure.
American adults are prescription drugs can help prevent many Aithough there appears to be a genetic
obese, as opposed to migraines. Behavioral methods can also help. component to hypertension, many other
about 10 percent of Progressive relaxation focuses on decreas-
the [rench. ing muscle tension and has been shown to be factors are also involved. These factors
highly effective in relieving muscle-tension include smoking, obesity, and excessive
headaches. Biofeedback training has also salt in one's diet. Blood pressure also

helped many people with migraine head- rises when people become angry or are
on guard against threats.
aches. However, these methods should only be
attempted under the supervision of a trained . Patterns of consumption. Heavy
health-care professional.
drinking, smoking, overeating, and eating
ffi ldentify Cause and Effect How food high in cholesterol can also contrib-
ute to heart disease. Americans'typically
can headache pain result in a vicious cycle? stressful attitude toward food and eat-
ing-unlike that of the French-contrib-
Heari Disease utes to the risk ofheart disease.

Researchers are not certain how stress . Type A behavion People who exhibit
increases the risk ofheart disease. Chronic
type A behavior are more likely than peo-
stress can be a contributing factor by caus- ple who exhibit type B behavior to
ing blood pressure and cholesterol to rise. develop heart disease.
Prolonged stress may also lower the immune
system's response to harmful hormones. . Anger and hostility. A constant need

Risk Factors Nearly half the deaths in the to control angry and hostile impulses
United States each year are caused by heart increases the risk of developing heart

disease, making it a major national health disease.

problem. There are many risk factors associ- . Job strain. Overtime work, assembly-
ated with heart disease.
line labor, and exposure to conflicting
. Family history (genetics). People with demands on the job can all contribute to
heart disease.
a family history of heart disease are
more likely than others to develop heart . Lack ofexercise. People who do not get
disease themselves. regular exercise are more likely to suffer

from coronary heart disease than those
who exercise regularly.

Alternative Medicine t::,
it:
tlerbal Remedies: plant extracts used as medicine; popular remedies
include ginseng (to increase energy) and ginkgo (to improve memory); lt:
not regulated by the Food and Drug Administration .ti)
1i
Aeupuntture: ancient Chinese medical procedure involving the inser- :t:
tion of hair-thin needles in the skin (shown ot right); used to ease ',1
post-surgery pain as well as pain of arthritis, backache, headache, and
asthma; usually safe when applied by licensed practitioners :t:l
I
Reflexology: massage technique usually applied to feet and hands;
areas ofthe feet and hands supposed to correspond to other areas of iil
the body; pressure believed to reduce stress and improve health
ii
484 CHAPTER 17
\,

Behavioral Changes Various medical treat- Perconality Type and Grdiac Risk ',
ments, such as surgery and medication, are
available for heart disease. However, people Typn D: a personality type that is prone to distress;"D"stands
can also benefit from behavioral changes
that reduce its risks. Among these behavioral for "distressed"
changes are the following:
fharaceristirs: emotiona I profi I e-a n g ry, hosti le, worried,
. Quitting smoking. The links between
depressed, gloomy; psychological profile-negative view of
smoking and heart disease (and Iung self, suppresses feelings, pessimistic, overreacts to stressful
cancer) make quitting smoking the single
situations, lonely, isolated
best way to reduce the risks of serious
health problems. (ardiac &islc greater risk of dying once heart disease devel-

. Controlling weight. Maintaining a ops; about four times more likely than non-D personality types

healthy weight appropriate to one's body f
proportions can help reduce the risk of
heart disease. il

. Reducing hypertension. Relaxation Risk Factors People may inherit a tendency
to develop certain kinds ofcancer. The genes
training, meditation, exercise, weight involved may remove the normal controls on
control, and a reduction in the intake of cell division, allowing cancer cells to multiply
salt all help control blood pressure. wildly. Certain kinds ofbehavior also increase
the risk of cancer. These behaviors include
. Lowering serum cholesterol levels. smoking, sunbathing (ultraviolet light can
cause skin cancer), and eating animal fats.
Behavioral methods for lowering choles- Substances in cigarette smoke may damage
terol include cutting down on foods high genes that would otherwise block the develop-
in cholesterol and saturated fats and ment of many types of cancers. Psychological
problems such as prolonged anxiety and
exercising regularly. depression may also heighten the risk.

. Changing type A behavior patterns. Research suggests that stress may be an
additional risk factor for the development of
Learning to slow down and relax can cancer. In one study, researchers separated
decrease the risk ofheart attacks. This is mice into two groups. One group was regu-
especially true for people who exhibit larly subjected to stressful conditions, while
type A behavior and who have had previ-
the other group was not. The immune systems
ous heart attacks. of the mice in the group that were exposed to
stressful conditions showed a reduced ability
. Exercising regularly. A moderate pro-
to kill cancer cells compared to the mice that
gram ofexercise can help protect people
from heart disease. were not exposed to stressful conditions. Other
experiments with animals have suggested that
ffim summarize what can people do once cancer has taken root, stress can affect
the course of its development.
to help reduce the risk of heart disease?
Psychological Aspects People with can-
(anrer cer must cope with the biological aspects of

Cancer is a disease that involves the rapid their illness, ranging from possible weakness
and abnormal growth of malignant cells. and pain to the side effects of their medica-
Cancerous cells can take root anywhere-for tions. They also face many psychological
example, in the blood, skin, digestive tract, effects of cancer, such as anxiety about the
lungs, or reproductive organs. Ifnot controlled medical treatment itself and about the pos-
sible approach of death. Additionally, seyere
early, cancer cells can spread and establish depression and feelings of vulnerability often
accompany the diagnosis of cancer.
masses, or tumors, elsewhere in the body.

People actually develop cancer cells frequently,

but the immune system normally succeeds in
destroying them. Individuals whose immune

systems are weakened by physical or psycho-
logical factors appear to be more likely candi-
dates than others for getting cancer.

STRESS AND HEALTH 485

&(&EHr40{ Unfortunately, many people who are diag- spirit" rather than with resignation. A desire
u&ffiryufl-A$uY nosed with cancer are also burdened by the to fight the illness is apparently a key compo-
necessity of dealing with the insensitivity of
chemotherapy others. Some people may actually criticize the nent of successful treatment. Social support
treatment of disease
using chemicals to person with the illness for feeling sorry for also increases the survival rate ofpeople who
kill cells himself or herself or for "giving up" the fight
have cancer.
against the disease. Psychologists have found that the feelings
Painful side effects sometimes accompany
of hopelessness that sometimes accompany
the treatment for certain types of cancer. For the diagnosis of cancer may hinder recov-
example, nausea frequently occurs during ery because they can suppress the person's
immune system. In addition, hospitalization
chemotherapy. People receiving chemotherapy
itself is stressful because it removes people
are sometimes taught relaxation and guided
imagery techniques, which have been shown from the familiar surroundings of home and
to significantly reduce the nausea and vomit- the sources of social support. Furthermore,
ing associated with chemotherapy. being in the hospital and subject to hospi-
tal routines-for any reason-reduces one's
Studies of children and adolescents sense ofcontrol.
with cancer have found that playing video
In some cases, there may not be a great
games also reduces the discomfort of che- deal that a person with cancer can do to affect
motherapy. By allowing the children to
focus their attention on battling computer- the eventual outcome of the disease. However,
generated enemies, such games help keep
the children distracted from the discomfort there are numerous ways to reduce the risk of
developing cancer in the first place. The most
caused by the treatment. effective way is to avoid behavioral risk factors
for cancer by reducing the intake offats and
Positive Attitude Cancer requires medical increasing the intake offruits and vegetables.
treatment, and in some cases there are too Limiting the amount of stress one is exposed
to and having regular medical checkups are
few available treatment options. However, the also vital factors in the reduction ofthe risk
attitudes people have about their cancer do of developing cancer.
seem to make a difference. A l0-year follow-
up of women with breast cancer found a sig- ffiffi ldentify Supporting Details

nificantly higher survival rate among women What psychological effects might those with

who met their diagnosis with a "fighting cancer face?

Reviewing Main ldeas and Vocabulary 7. ldentify Cause and Effect Using your notes and a graphic

1. Recall What is health psychology concerned with? organizer like the one beloW list some of the biological and
psychological effects of stress.
2. ldentify What is the most frequent type of headache?
3. Explain How can one deal with the side effects of cancer? Stress

Thinking Critically 8. Persuasive Write a short letter in which you encourage
4. Draw Conclusions Who is more likely to suffer from head- someone who is at risk for cancer or heart disease to make
behavioral changes and have a positive attitude. Explain
aches: the type A personality or the type B personality? how the person can benefit from these adjustments.
Explain your answer.
5. Evaluate How can psychological methods be used to help
people prevent or deal effectlvely with health problems?

6. Support a Position Do you think that companies that pro-
vide health and Iife insurance should be allowed to charge
higher rates to people under high levels of stress? Support

your answer.

486 cHRptn rz

Ways d CeSinS

urith Stress

BeforeYou Read Reading Iocus Uocabulary Use a graphic
1. What are some defensive defensive coping organizer
Main ldea active coping like this one to compare
People handle stress using coping methods? defensive and active cop-
both defensive and active ing methods.
coping methods. Defensive 2. How do active coping methods
coping methods are often help ease stress?
self-defeating, wh ile active
coping methods are far
more effective.

Why won't loponese business- However, Japanese men are literally working themselves
men toke a break? You may think to death. About 10,000 die every year as a result of stress,
Americans are stressed out by work, called karoshi in Japan. Concerned wives call crisis hot-
but compared with Japanese businessmen, we're pretty lines for help, but their efforts have little effect.

laid-back. Known as "business samurai" in Japan, these To cope with and reduce their stress, many business
men maintain an extreme work ethic. Like the feudal samurai drink alcohol, but this only masks the problem.
soldiers they are named for, the businessmen pledge As a result, some Japanese psychologists report that rates
unwavering loyalty to their employers-their modern-day ofanxiety, depression, and even suicide have skyrocketed
among middle-aged men.
lords-and literally work until they drop.
About 59 percent of Japanese businessmen admit to These men need a mental health break, As you will
learn in this section, there are coping methods Japanese
severe fatigue as a result of work, but they refuse to seek businessmen-or anyone-can use to alleviate stress. But
first they have to be willing to lay down their swords. lil
help. Work obsession is considered a virtue in Japanese
culture; asking for help is considered a weakness.

STRESS AND HEALTH 487

A{AtrTFlII{ Defensive (oping has become, for them, an unpleasant reality.
Ug(ABIJTARY That dependence only makes a problem worse
Because stress harms people's physical and
interpersonal because it makes people less able and less
relating to the psychological well-being, it is important to
willing to deal with it.
interactions know how to cope with or reduce the stress in
between individuals one's life. Defensive coping is one way to han- Aggression Some people use aggression and
dle stress and reduce the immediate effects violence to cope with stressful situations, such
of a stressor, but it is probably not the most as those that involve feelings of frustration
desirable way. Defensive coping may involve or a difference of opinion with another per-
socially unacceptable behavior (substance son. However, violence rarely, if ever, provides
abuse or aggression), running away from one's solutions to people's problems. In fact, aggres-
problems (withdrawal), or self-deception (use sive behavior often heightens interpersonal

of defense mechanisms). conflict because it may motivate an injured
Defensive coping may give people time to
party to seek revenge.
gather their resources, but it does not elimi-
Withdrawal Some people withdraw from a
nate the source of stress or improve the effec- stressful situation because they are fright-
ened, feel helpless, or believe that any deci-
tiveness of one's response to stress. In fact, sion they make will be a mistake. Withdrawal
in the long run, defensive methods are self- can be emotional (loss of interest in life, turn-
defeating and usually harmful. ing away from friends and family), or it can

Substance Abuse Some adolescents and be physical (moving to a new location to avoid
adults use alcohol, tranquilizers, and other
drugs to try to reduce feelings ofstress. People dealing with an old problem).
may become psychologically dependent on Suicide is the ultimate form ofwithdrawal.

these substances as they try to decrease Some people experience so much stress and

their awareness of stress or to disguise what feel so hopeless about ever solving their
problems that they believe the only way out
This chart identifies and provides examples of some common is to commit suicide. Of course, suieide does
defense mechanisms. not solve or reduce problems. It usually only

Type Definition Example increases the pain ofthose who are left to deal
with its aftermath.
Denial The refusal to accept An overworked employee
the reality of some- is unwilling to admit to Defense Mechanisms Sigmund Freud
thing that is bad or feeling stressed by his job
upsetting out of a fear of appearing believed that defense mechanisms protect the
weak or incompetent. ego from anxiety that may be produced by an
iRepression The removalof anxiety- awareness of unacceptable ideas or impulses.
A soldier squashes his Defense mechanisms become problematic
when they are the only means used to cope
with stress.

ffi Findthe Main ldea whyare

defensive coping strategies not the most desir-
able ways to deal with stress?

thought, or feeling to in class and unable to ii Active Coping
other people think of herself as angry,
accuses her classmates Active coping involves changing the envi-
i ronment or situation (in socially acceptable
: of behaving angrily.
ways) to remove stressors, or changing one's
m* mightlNTERpRETttttG cHARTs tn each example, what i response to stress so that stressors are no lon-
ger harmful. Methods of active coping include
mi:::::::::-'li:::::":::::':l- "------' changing stressful thoughts, relaxing, and
withstanding stress through exercise and
deep breathing. These methods are far more

effective than defensive coping strategies.

488 cunptR rz

Calming Stressful Thoughts QuicA frAb

Stressful thoughts can make an already stressful situation worse. ;$
People can actively cope with stress by becoming aware of these
thought patterns and changing them. ln this lab, you will practice t'
changing stressful thoughts to calming ones.

PROCEDURE ANALYSIS

O Get together with a partner. 1. With your partner, study the possible answers. Were the
O Read the stressfulthoughts below and discuss the calming calming thoughts you came up with similar to these?

thoughts you might replace them with. For example, you 2. What do all of the calming thoughts have in common?
might change "l feel like l'm losing control" to "This is painful Do you think they would really ease someone's stress?
and upsetting, but I don't have to go to pieces."
3. Take turns discussing the stressful thoughts you have
a. "This will never end." experienced when you have been under stress. Suggest
calming thoughts that might replace them.
b."How can I go out there? l'll look like a fool."
4. Consider the benefits of changing stressful thoughts.
c. "My heart feels like it could leap out of my chest;" What effect do you think the practice could have on your
emotional and physical well-being?
d."There's nothing lcan do!"

@ Ask your teacher for some possible answers.

Changing Stressful Thoughts Have you anywhere and does not require any special
ever thought to yourself, "I feel like I'm los-
ing control"? Such thoughts can actually equipment. Many people find that meditation
decreases their stress and brings real peace of
increase the amount ofstress you experience. mind. Research has also shown that medita-
However, people who have stressfuI thoughts tion can improve the emotional and physical
well-being of patients who suffer from condi-
can learn to recognize and change them before tions that may be worsened by stress, such as
asthma, chronic pain, and depression.
becoming overwhelmed by them. Through
careful study, people can learn to identify Some people have difficulty recognizing
self-defeating thoughts. Whenever a person their bodies'responses to stress. A form of
feels tense or anxious, he or she should pay mind-body therapy called biofeedback can
close attention to such thoughts and trans- help. During a biofeedback session, a thera-
form them into calming ones. A sign that this pist applies sensors to the patient's body that
is working is evident when the person begins monitor responses to stress. For example, a
to automatically have calming thoughts
rather than stressful ones. sensor may signal when the patient's muscles
contract during a headache. This information
Relaxation Techniques Stress can cause can help the patient recognize the physical
strong bodily reactions, such as muscle ten-
sion, rapid breathing, high blood pressure, cues that accompany a headache so that he or
sweating, and a rapid heart rate. These reac- she can then focus on relaxing the muscles.
tions are signs that something is wrong. They
should prompt people to survey the situation Progressive relaxationhelps lower stress in
and try to make things right. Psychologists
and other researchers have developed a the body byreducing muscle tension. Reducing
number of techniques for reducing the bodily tension also affects the heart and breathing
changes that are brought on by stress. These rates. Progressive relaxation teaches people
techniques include meditation, biofeedback,
and progressive relaxation. how to relax by having them purposely tense
a specific muscle group and then relax it. You
Meditation is a form of relaxation that
involves focusing one's attention on a single can practice this technique while sitting in
point of reference and eliminating all other a chair by first tightening one fist, then the
other, and gradually releasing the pressure.
thoughts from the mind. It can be practiced This process of tightening and then releas-

ing muscles helps people distinguish between

feelings of tension and feelings of relaxation.

STRESS AND HEALTH 489

Changing stressful thoughts and low- Breathing When people are under stress,
ering the level of bodily reactions to stress their breathing tends to become quick and
reduce the effects of stressors and give the shallow. By practicing controlled, regulated
person more time to develop a plan for effec-
tive action. When there is no way to reduce breathing techniques, people can calm them-
or eliminate the stressors, thinking calming selves and reduce the physical symptoms of
thoughts and relaxing the body will increase stress. Controlled breathing can even help
the ability to endure stress. relieve some stress-related health problems,
including panic attacks and digestive disor-
Exerrise Exercise fosters physical health,
enhances people's psychological well-being, ders. The next time you are stressed out, try
and helps people cope with stress. Stress-
reducing exercise includes activities such as the following breathing exercise.
running and jogging, running in place, brisk
walking, swimming, bicycle riding, jumping . Sit with your back straight.
. Place your tongue against the back of
rope, and playrng team sports.
your teeth.
Sustained physical activity reduces the
incidence ofheart attacks. In one long-term . Keeping your mouth closed, slowly inhale
research project, Ralph Paffenbarger and his
colleagues studied 17,000 people. They exam- through your nose and mentally count to
ined the relationship between the incidence of frve.
heart attacks and the levels ofphysical activ-
ity in the people they studied. The incidence of . HoId your breath while you count to
heart attacks began decliningwhen the physi-
cal activity level rose to that ofburning as few seven in your head.

as 500 calories a week. . Exhale making a whooshing sound

Inactive people run the highest risk of through your opened mouth for a count
of eight. You should feel your lungs
heart attacks. People who burn at least 2,000 release the air.
calories a week through sustained physical
. Repeat the exercise three more times.
activity live two years longer, on average,
than less active people. Sustained exercise This breathing exercise can actually calm the
also appears to strengthen the functioning of
nervous system. You can use it whenever you
the immune system. are faced with a stressful situation. You can
also use it to help you fall asleep.

ffi tdentify Supporting Details

How can active coping methods relieve some

health problems?

Reviewing Main ldeas and Vocabulary 6. Compare Using your notes and a graphic organizer like
the one below, list the characteristics that the active coping
i 1. Identify When might someone use withdrawal as a way of methods have in common.

coping with a stressful situation? 7. Descriptive Write a paragraph about a time when you used
2. Contrast What is the difference between defensive and an active coping method to deal with a stressful situation.

active coping methods?
3. Summarize What are some examples of effective active

coping methods?

Thinking Critically
4. Predict What do you think might happen when a person

lashes out physically during a confrontation? What might be
a better response?
5. Make Judgments Do you think only people with certain
personality traits use defensive coping methods, or do you
think anyone might use them from time to time? Support
your answer.

490 cHnpruR r z

€ MWe

On September 11, 2001, Americans and people all over the world watched ;1i',iii,ii1ffiif::f,ft,Hre
as the unthinkable happened. Of course, the tragedy most affected those
who lost family members and friends. But even people who only wit- ::r0nSaOtem,beirl2;.2 ih:::r
nessed the attacks on television suffered real symptoms of stress-what
,',Gexish.owes,tleiit,$r,m,paltirlfoi:thelglJtti:rt:i
some psychologists call "second-hand stress."

ln a study led by psychologist Roxane viewing to a half hour or so a day. But rubble and generally lend a hand.
Si lver, researchers discovered that other psychologists say that turning ln fact, so many volunteers flooded
many of these people experienced away and ignoring the horrific news the areas that local authorities had to
symptoms similar to post-traumatic is just a form of denial and has limited
stress disorder (Silver, et al., 2002). close some of the roads.
Weeks after the attacks, they con- value in really reducing stress.
tinued to replay in their minds the ln her study, Silver found that The Chinese people also coped
images they had seen on television. with the tragedy by making dona-
And these images still inspired strong active coping strategies were most tions. Millions lined streets to donate
feelings of fear and anxiety. effective in coming to terms with blood, money, and clothes. Private
9/11. Those who donated blood or citizens and companies contributed
Comparable reactions occurred in money to help the victims reportedly hundreds of billions of dollars. ln fact,
the aftermath of Hurricane Katrina in felt less helpless. Actively coping with
2005. Many people who compulsively the tragedy helped these peoPle the disaster galvanized the Chinese
followed the coverage of the trag- overcome their symptoms of post- people, and their response to it
edy experienced the fight-or-flight traumatic stress disorder or avoid helped them heal. Their active coping
reaction, which causes blood Pres- them altogether. not only decreased their stress but
sure and heart rate to rise. For some also brought them closer together.
with impaired immune systems, the Silver's findings seem to have Some believed that the massive relief
response does not turn off. Serious been supported by the experience effort gave China a renewed sense of
health problems can occur as a result. unity (Elegant, 2008).
in China following its devastating
So how can we reduce this sec- May 2008 earthquake. PeoPle from Just about a month after the
ond-hand stress? Some psychologists all over the countrY demonstrated earthquake in China, areas ofseveral
suggest that we simPlY take a break great compassion and charity. Shortly midwestern states were ravaged
from the news, by either avoiding it after the earthquake, Chinese volun- when record floods hit the region.
entirely for a few days or by limiting teers traveled long distances to the Again, people not directly affected
small towns and villages affected to by the disaster generously offered
help dig their compatriots out of the their help. Some came to the areas to
fill sandbags; others sent food, cloth-
ing, and money to families who lost
everything in the floods. "ljust felt
better doing something," said one
volunteer. And that about sums it up.

Wtteapait1oii 'ttoc*ea]in:*noz0oa; volunteerrtilled,.san'dbagito helrp hold 1. Analyze How does helping disastet
victims reduce second-hand stress?
back the water.
2. Discuss Think of a time when You
helped someone overcome difficul-
ties. What did you do? How did it

make you feel?

STRESS AND HEALTH 491

|I{}.I,

Stress and Active Use the workbook to
Coping Methods complete this simulation.

What is the most effective way to cope with
a stressful situation?

'1. lntroduction 2. Prepare the Simulation

We deal with stress every day. As you have learned in this With your group, discuss the source of stress or type of
chapter, stress can result from minor, everyday problems' or it conflict that you have been assigned. Review what you
can be tied to a major, life-changing event' ln this simulation' learned about this stressor or conflict in the chapter' Then
you will get together with a group of classmates to develop discuss and develop the situation you are going to role-play'
and perform a simulation in which you role-play a stressful Follow these steps as you develop your simulation:
situation. ln your simulation, you will also demonstrate how
to deal with the situation by using effective coping methods' Decide what role each member of the group will play' You
To complete the simulation, follow the steps below' might have one student play the role of the person dealing
with the stress, several others play the roles of friends and
Following your teacher's instructions, organize the class into advisers, and one play the role of a narrator'
six student grouPs.
Talk about how the person at the center of the situation
Your teacher will assign each group one of the following six should react to the stress. For example, he or she might
stressful situations: reduce the stress by demonstrating a sense of humor or

O Frustration: You are delayed in traffic and miss an taking deep breaths.

important aPPointment. Agree on how the friends and advisers will react' What active
cJping methods willthey suggest? Be sure the methods are
O Oaity hassle:The wheels of your car have been stolen' effective and suitable for the situation'

O Life change:You are about to move to a new state' lf you have a narrator, discuss how he or she will introduce

@ Avoidance-avoidance conflict: You dread going to the and set uP the situation.

dentist, but your toothache is getting worse' Work together to write dialogue for the simulation' The
dialogue should sound natural and realistic' lnclude stage
@ Approach-avoidance conflict:You want to buy a new directions that indicate how each speaker should act and
move throughout the simulation' Note that the performance
DVD player, but it will cost a lot of money' of the simulition should be about five minutes in length'

@ nnuttiple approach-avoidance conflict: You need to stay Make a photocopy of the simulation for each actor'

at home to study for a test, but your friends have invited Practice the simulation a couple of times' The first time' do
You to go to a movie with them' a read-through while sitting in your chairs' The second time'
try enacting the simulation. You might want to continue
Work with your group to write the simulation for the piacticing until all group members feel confident with
situation You have been assigned'
their roles.
Student groups will take turns performing their simulations
before the rest of the class. During each performance' the
audience will take notes.

Take part in a group discussion on the simulations' and then
apply what you have learned to create a list of tips
on coPing with stress'

492 cHRPrrntz

*rA lrt ; ry{ ,

3. Perform the Simulation 4. Discussion

0nce all the groups have prepared their simulations, After all of the simulations have been performed, join in a
they willtake turns performing them. During your group's class discussion. Talk about the performances, focusing on
performance, keep the following in mind: the following questions:

You can read from your photocopy of the simulation, but What did you think of the performances?
try to look at the other role-players from time to time for
realism. Did each one represent a stressful situation realistically?

Speak loudly enough so that audience members do not What were some of the effective coping methods the
have to strain to hear you. groups presented?

Act your role in a serious manner. What, if anything, would you have done differently?

Be supportive of your group members if they falter. Which coping methods do you find most effective in your
daily life?
As an audience member, be attentive and courteous.
Take notes on the following as you watch each Can you think of a time in which you or someone you
performance: know effectively coped with a situation similar to one of
those presented?
The stressor or conflict being demonstrated
Can you think of a time in which you or someone you
The depiction of the stressful situation know could have coped more effectively with a stressful
situation?
The effectiveness of the coping methods used to dealwith
the situation Do you think you can apply what you have seen to dealing
with some of the stressful situations in your daily life?
Some different ways the situation might have been
handled Finally, as a class, come up with a list of tips on coping
with stress. Your list might include the following:
Whether the situation seemed familiar and what other
situations it reminded you of The coping methods used in the stressful situations
performed
How you reacted in a similar situation
The coping methods you have used successfully in other
stressful situations

Other ideas on defusing or avoiding stressors

-,g Comprehension and Critical Thinking Reviewing Vocahulary
:#:f.f'i: SECTION | @p. 422426)
For each of the following questions, choose the letter
1. a. Describe What contributes to the stress of the best answer.
experienced by many high school students?
5. Which of the following refers to an event or
b. Explain Why can positive iife changes produce situation that produces stress?

stress? A. dilemma C. distress

c. Elaborate Think of a character-in television, B. eustress D. stressor
movies, or fiction-who exemplifies the type B
personality. How does this character demon- 6. Which type of conflict forces people to choose
strate type B behavior? between the lesser of two evils?

SECTION 2 (pp. a77a8D A.approach-approach C. approach-avoidance
2. a. Recall How does the body react during the B. avoidance-avoidance D. multiple approach-

alarm reaction stage ofthe general adaptation avoidance

syndrome? 7. Which response to stress is closely related to
b. Summarize How do self-efficacy expectations self-confidence?

affect the way a person responds to stress? A. self-efficacy C. sense of humor
c. Evaluate Why might a diagnosis of cancer expectations D. predictability

further impair a person's immune system? B. psychological
SECTION 3 (pp.482486) hardiness
3. a. ldentify What are some behavioral methods
8. What is the name for the body's response to a
for reducing the pain ofheadache? stressful situation?
b. Make Generalizations What generalizations
A. self-efficacy C. defensive coping
can you make about the risk factors for heart
expectations
disease?
B. general adaptation D. active coping
c. Make Judgments Why do you think some
syndrome
people criticize cancer patients for feeling sorry
for themselves? Do you think they are trying to 9. Research to find out how stress in the workplace,
help? Explain your answer. along with other stress, can affect a person's
SECTION 4 (pp. a874e0) health and well-being. What kinds of situations
4. a. ldentify Main ldeas Why do some defensive contribute to job stress? How do employers try to
coping methods only make a problem worse? deal with job stress? Write a report summarizing
b. ldentify Cause and Effect How does changing your findings.
stressful thoughts help increase the ability to
endure stress? Psychology in Your life
c. Predict What do you think might happen to a
high school student whose only means of coping 10. The Social Readjustment Rating Scale focuses
with a problem is to lock herself in her room? primarily on life changes experienced by adults.
Get together with a small group of classmates
494 cnnpmR rz and create a social readjustment scale for teens.
Make a list of 10 events and assign a rating to
each item on the basis ofa consensus ofgroup
members. For example, you might list excessive
homework or parental restrictions on your scale.
Once you have compiled your list, share and dis-

cuss it with your class. Do your classmates agree
with your scale?

SKILLS ACTIVITY: INTERPRETING PRIMARY SOURCES Visit thinkcentral.com for
Read the following excerpt, in which Anne Petersen and Ralph Spiga review and enrichment
activities related to this chapter.
look at school as one ofthe sources ofadolescent stress. Then answer
the questions that follow. oNUNE QUTZZES
Take a practice quiz for each
66lndeed, the school may provide major stress during the adolescent years. section in this chapter.
ln early adolescence, young people in our society move from a single class-
room, with one teacher and the same group of classmates, into a middle wEBQUEST
school or junior high school, where they pass from class to class, most often Complete a structured
with different teachers and different students. For many young people, lnternet activity for this
this transition may be smooth, but for others it appears to be untimely and chapter.
stressful. . . . Little research has focused on the transition from eighth or
ninth grade into senior high school. Research with early adolescents, how- QU|CK rAB
ever, would suggest that this change also involves stress.!! Reinforce a key concept
with a short lab activity.
-Anne C. Petersen and Ralph Spiga,
APPTYIIIG II'HAT
}i,",',iffi :#i,::;2:;:;:,2:;:l:::r YOU'UE LEARNED
Review and apply your
11. ldentify Main ldeas According to this excerpt, what is a key source knowledge by completing a
of school-related stress for adolescents? project-based assessment.

12. DrawConclusions Why might the transition into middle school be eAfflUlTlES
"untimely" for some adolescents? Complete chapter lnternet
activities for en richment.
13. Develop How might educators make school transitions less stressful
for adolescents? INTERACTIUE FEATURE
Explore an interactive version
Use your knowledge of the general adaptation syndrome to answer the of a key feature in this chapter.
question below. Do not simply list facts. Present a clear argument based
on your critical analysis ofthe question, using the appropriate psycho- KEEP IT CURRENT
logical terminolory. Link to current news and
research in psychology.
14. Briefly discuss what happens during each stage of the syndrome
listed below. Explain the role stress plays in each stage. Learn more
about key topics
. the alarm reaction in this chapter.
. the resistance stage
. the exhaustion stage STRE5S AND HEALTH 495

NOT GUILTYbyReasonof

ilmsarmnq7

The majority of people with serious psy- from which she hoped to save them. When
chological disorders are not dangerous to
others. Some, however, do commit violent Yates went to trial, the jury rejected the
crimes. Of these, some are found not guilty insanity defense and convicted her offirst-
of the crimes of which they are accused "by
reason of insanity." Typically, these people degree murder. However, Yates won a new
are sent to psychiatric institutions instead of
prison. They may be released when they are trial in 2006, and this time was found not
judged no longer to be a threat to others. guilty by reason of insanity.

A well-known use of the insanity plea In using an insanity defense, lawyers
occurred in the case of John Hinckley Jr.,
who tried to assassinate President Ronald apply a modified version of the M'Naghten
Reagan in 1981. Not only did Hinckley Rule, which states that if it can be proved
attempt to murder the president, but he did
so in front of millions of television witnesses. that at the time of committing a criminal act
Nevertheless, Hinckley was found not guilty a person either did not understand the nature
by reason of insanity after expert witnesses of the act or did not know that it was wrong,
testified that he had the serious psychologi then the person is insane and not responsible
cal disorder called schizophrenia.
for the act. The M'Naghten RuIe goes back to
Another famous case is that of Andrea
Yates, who on June 20,2001, drowned all 1843, when a Scot named Daniel M'Naghten
five of her young children. Yates freely
confessed to the murders. She told a psy- tried to kill the British prime minister, Sir
chiatrist that she feared her children were
Robert Peel. M'Naghten believed that he
"doomed to perish in the fires of hell"-afate was the target ofan international conspiracy
that included Sir Robert and the pope. In
496 cHnprcn re the assassination attempt, M'Naghten killed
Peelt secretary instead of the prime minis-
ter. M'Naghten was arrested and tried but
was judged not guilty. The jury declared that

M'Naghten was insane and thus not respon-

sible for the crime.
Typically, when an accused person pleads

insanity, prosecuting attorneys try to show

Watch the Uideo T$K*X*eSSffi3.

:J Explore topics on psychological disorders in x$ ft Hft$
, the United States.
St(Il0ll ! : Underslanding Psythologkal
that the accused was sane at the time of the
crime, while the defense tries to prove that Disorders
the accused was not. Both rely on the testi-
mony of expert witnesses, usually psycholo- r Psychological disorders are behavior patterns or mental processes
gists or psychiatrists.
that cause serious personal suffering or interfere with a person's
Many people claim that the insanity ability to cope with everyday life.
defense allows criminals literally to "get
away with murder." However, the defense is r Psychological disorders are classified inthe Diognostic and
actually used rarely and is often unsuccess-
ful. Recent changes have made it more diffi- Stotistical Monuolof Mentol Disorders, also known as the DiM.
cult to use the insanity plea successfully. For
example, it is now up to the defense to prove SItTl0l{ 2: Anxiety and }lood Disorders
that the defendant's mental illness is one
that qualifies under the insanity plea. r Anxiety disorders occur when people feel fear or nervousness out

"Insanity" is a legal concept, not a psy- of proportion to the actual threat.

chological one, and to be legally usable, it r Mood disorders are characterized by mood (hanges that are inap-

must be all or nothing-one is either sane or propriate for the situation to which they are responding.
insane. In reality, most psychological disor-
ders are a matter of degree. The distinction SftTl0t{ 3: Dissoriative and Somatoform
is important. One can be mildly depressed, Disorders
for example, but according to the law, one
cannot be mildly insane. Because of the r Dissociative disorders are characterized by the separation of cer-
insanity plea's all-or-nothing nature, decid-
ing on someone's sanity can be a very diffi- tain personality c0mponents or mental processes from conscious
cult decision for judges and juries. thought.

Our legal system requires a wide range r Somatoform disorders are expressed in the form of actual physi-
of people to make decisions about the mental
health ofothers. How equipped arejurors calsymptoms.
to make these decisions? How informed are
we about what separates mental illness 5tffl0l{ 4: Sthizophrenia
from mental health? For example, the case
of Andrea Yates poses some basic questions r Schizophrenia is usually considered the most serious psychologi-
that are not easily answered: Is a woman
who drowns all her children to "save" them cal disorder and can be very disabling.
automatically insane, even though she knew
that her action was wrong in the eyes of the r Schizophrenia is characterized by a loss ofcontact with reality.
Iaw? Just what is mental illness? r The three types of schizophrenia are paranoid, disorganized, and

1. ln general, what criteria must a defendant meetto be catatonic schizophrenia.
ruled legally insane?
5tfil0ll 5: Personality Disorders
2. Do you supportthe use 0f the insanity defense?Why or
r Personality disorders are patterns of infl exible traits that disrupt
why not?
social life or work and may distress the affected individual.

r Four common personality disorders are paranoid, schizoid, anti-

social, and avoidant.

PSYCHOLOGICALDIsORDERs 497

Understandinu

Psychelosieht nisorders

BeforeYou Read Use a graphic
organizer like
Main Idea Reading Focus Uocabulary this one to take notes on
1. What are psychological psychological disorders psychological disorders.
Psychological disorders are culture-bound
relatively com mon. They disorders, and how common Psychological
cause personal suffering are they? syndromes Disorders
to millions of people and
interfere with their ability to 2. What are the four major symp-
cope with everyday life. toms that can help identify
psychological disorders?
\ /hat trey a-e Classifyi nq
3. How do psychologists classify disorcjers
psychologica I disorders?

Why were people with mental ill nesses ffi
seen os criminals? Until about a cen-
tury ago, mental illness was a mystery. To ii'
both the public and to the medical profession, people who
behaved strangely were often seen as evil or cursed, not ill. ''.li ,;,{ 5ffi -,-.. !
Doctors sometimes proposed causes for the illnesses that
ts #r..--,fl"f*€
we now consider absurd, such as reading too many novels.
Because they did not understand mental disorders, doctors ' t,
and other officials often treated mental patients very harshly,
severely restricting their freedom and even punishing them I !qr:T.{11 @il@
as if they were criminals. One common method of control j
was the straitjacket, which is a garment with extra-long :'
sleeves that wrap around the patient's body. The straitjacket ,.1
*i;e1€9ffi
was actually more humane than the ropes and metal chains ln
with which some patients were shackled.
. ,,..f
Now we know that psychological disorders are indeed
illnesses. Mental health professionals have described almost "!1',@ffitr
400 such disorders. Their causes, however, are sometimes
disputed. You will read more about psychological disorders i' :

in this section. E l. t-
::*.::!5e.4

This straitjacketed mental patient was
photographed in 1946.

498 cHRptR ra

What Are Psychological Disorders? important here, because diagnosing an indi- ACADEilIIC
vidual with a psychological disorder is often V$CAEULARY
You have already learned that psycholory is difficult, and reaching a correct diagnosis is
the scientifrc study of behavior and mental not always a simple process. criteria the stan-
processes. Psychological disorders are behav-
ior patterns or mental processes that cause Howeveq psychologists generally use sev- dards on which a
serious personal suffering or interfere with a eral criteria to determine whether a person's judgment or deci-
person's ability to cope with everyday life. behavior indicates the presence of a psycho- sion may be based
Iogical disorder. These criteria include how
Many people believe that psychological dis-
orders are uncommon, affecting relatively few typical the behavior is ofpeople in general,
individuals.It is true that the great majority
of people are never admitted to mental hospi- whether the behavior is maladaptive, whether
tals, and most people never seek the help of the behavior causes the individual emotional
psychologists or psychiatrists. And although
many people have relatives they consider discomfort, and whether the behavior is
eccentric, few people have family members
they consider to be truly abnormal. socially unacceptable.

Estimates suggest, however, that about Psychological Disorders in the United States
one in four adults in the United States have
Drug and alcohol addiction, depression, and anxiety disorders are
experienced some type of psychological disor- the most common psychological disorders.

der. In addition to the many people with sub- .2f"26 Percentage of American adults who suffer
stance abuse problems, 26 percent ofpeople
in the United States experience some type of from a diagnosable mental disorder in a given year
psychological disorder in a given year. In any
given month, the figure is approximately 13 6/, Percentage of Americans who suffer from a seri.
percent. For people aged L544, psychological
disorders are the leading cause ofdisability in ous psychological disorder
the United States.
47 .L mi I I i on Annual number of visits
Effiffi* Summarize What is a common
to office-based physicians due to psychological disor-
misconception about psychological disorders? ders in the United States

ldentifying Psychological Disorders .9 S6 d,ay Average hospital stay for patients

Deciding whether particular behaviors, with psychological disorders in the United States

thoughts, or feelings are "normal" or "abnor- 9O/, Percentage of people that kill themselves who
mal" can be diffrcult. What is normal is often
equated with what is average for the majority suffer from a dia8nosable psychological disorder
of people. Using this defrnition of normality,
deviation from the majority becomes the pri- fffifffi rilTERpRETtlrtc DATA what is one possible result of
mary criterion for abnormality.
not diagnosing and treating a serious mentaldisorder?
People with psychological disorders usu-
ally do not differ much from so-called normal Sources: National lnstitute of Mental Health; National Center for Health Statistics
people. In fact, the primary difference is the
simple exaggeration of certain behaviors or
mental processes. For example, Iaughing is
a normal and healthy response to humorous
situations. However, someone who laughs all
the time, even in a tragic situation where
everyone else is sad might be considered

abnormal.
Certain behavior patterns and mental pro-

cesses may suggest that an individual has a
psychological disorder. The word suggest is

PSYCHOLOGICAL DISORDERS 499

Typicality The normality of a behavior or For example, people who are depressed often
mental process is often determined by the suffer feelings of helplessness, hopelessness,
degree to which it is average, or typical, ofthe
behavior or mental processes of the majority worthlessness, guilt, and extreme sadness.
of people. There are, however, problems with They may lose interest in virtually every-
defining normality in terms of what is typi- thing they once enjoyed and believe that life
cal of most people. The fact that a behavior is no longer worth living. Such feelings are
so stressful that they may lead the affected
is not typical of most people does not mean it individual to consider suicide. Thus, severe

is abnormal. Scientific and artistic geniuses, emotional discomfort may be a sign of a psy-
such as Marie Curie and Pablo Picasso, cer-
tainly are not typical of people in general. That chological disorder.
does not mean, however, that such people are
abnormal. In addition, people who are quite Socially Unacceptable Behavior Behavior
normal may have lifestyles that differ widely that violates a society's accepted norms may
from the rest of the community. Additional also be an indication of a psychological disor-
measurements must be taken into account der. However, whether a behavior is socially
unacceptable may depend on the particular
to assess people with different styles and culture in which it occurs. What is considered
normal behavior in one culture may be con-
habits. sidered not normal in another. Therefore, the
cultural context of a behavior must be taken
Maladaptivity Many psychologists believe into account before deciding that the behavior
that what makes a behavior abnormal is indicates a psychological disorder.

the fact that it is maladaptive. That is, the The importance of culture is demonstrated
by culture-bound syndromes, which are clusters
behavior impairs an individual's ability to of symptoms that are considered recognizable
diseases only within specifrc cultures or soci-
function adequately in everyday life. Behavior
that causes misery and distress rather than eties. Many behaviors associated with cul-
happiness and fulfrllment may be considered
ture-bound syndromes would be considered
maladaptive. Alcohol abuse is one such behav- abnormal by people who were unaware of the
cultural context. For example, manypeople in
ior. Alcohol abuse often has strong negative Middle Eastern cultures believe that certain
unusual behaviors, such as head-banging, are
effects on the drinker's health, work, and fam-
due to possession ofthe body by a spirit. In
ily life. Abuse of alcohol may discourage the the local cultural context, spirit possession is
drinker from seeking healthier solutions to
considered to be a rational explanation for the
the problem of anxiety as well as create addi- behavior, and the affected individual is not
tional problems of its own. thought to have a mental illness. However, in
the United States, such an unusual behavior
Behavior that is hazardous to oneself or might be considered a sign of a psychological
to others may also be considered maladap- disorder.
tive. This type of maladaptive behavior may
include threatening or attempting suicide as On the other hand, there are some culture-
well as threatening or attacking other people. bound syndromes that are clearly disorders,
Maladaptive behaviors can put the person as interpreted both by the home culture and
with a disorder on the wrong side of the law by mainstream Western society. Their causes
may be unique to the culture, though. Some
It is important to note, however, that most culture-bound s;rndromes have serious phys-
people who commit violent crimes do not have ical symptoms and results. There are many
diagnosable psychological disorders. This is types of culture-bound syndromes, some of
because most criminals are fully aware of which are described in the feature at the end
what they are doing. That is, they know that of this section.
their behavior is illegal and that they can be
held responsible for it. EquaIIy important, the EEEEE*E$I Find the Main ldea what are four
majority of people with psychological disor-
features that might indicate a psychological
ders, even severe psychological disorders, are
disorder?
not violent or dangerous.

Emotional Discomfort Psychological disor-
ders such as anxiety and depression cause
most people serious emotional discomfort.

500 cHRprrn ra

Oassifying Psychological Disorders with it. It is also important to classify psy-
Most psychologists believe that it is impor-
chological disorders so that individuals can
tant to have a widely agreed upon classifica-
tion ofpsychological disorders. Unless there be correctly diagnosed and treated.
is agreement about how to classify psychologi-
cal disorders, it is difficult to know how many The most widely used classifrcation sys-
people have a given disorder or what other tem for psychological disorders is the DSM,

factors, such as socioeconomic status, hered- or Diagnostic and Statisticol Manual of
ity, or gender differences, may be associated
Mental Disorders, published by the American

Psychiatric Association. The most recent ver-
sion of the manual, the DSM-IV-TRrM, was
published in 2000.

Major (ategories of Psychological Disorders

The DSM-|V-TR'" lists 1 6 basic categories of psychological disorders, of which I 3 are
described here. You will learn about six of these general categories: anxiety, mood,
dissociative, somatoform, and personality disorders; and schizophrenia.

Ilirodus $$selly first dlagr*os*d in lnfanqr, tkild' fuamtafunn d*so*ers involve physical symptoms

ho*d, ar adal*s*e*te include mental retardation, for which no biological cause can be found.
attention deficit disorders, and autism spectrum
Ssual a*d $nd*r idantity di*ord*rs include sexual
disorders.
dysfunctions and the need for unusual or bizarre
S*lirium" demeRti&, and amaasie, and ottrer tryni- acts to achieve sexual satisfaction.
tiva dts*rdem result from brain damage, degenera-
txting dirorde$ are characterized by abnormal
tive diseases such as Alzheimer's disease, or expo-
sure to toxic substances or drugs. eating patterns, including anorexia nervosa (self-
starvation caused by an irrational fear of becoming
Sahstante-re|at*d $issld*ffi are associated with the overweight) and bulimia nervosa (episodes of binge
eating and vomiting).
excessive use of or withdrawal from drugs such as
alcohol, nicotine, amphetamines, cocaine, hallucino- $lwp dkeders include disorders associated with
gens, opiates, or caffeine.
sleeping patterns, including insomnia and sleep-
$chlxuplrre*ia and o*er psyt*t*$t dlco$er$ are walking.

characterized by delusions, hallucinations, and Impalsa tens*l d*ssrders not elsewhere classified
severe disruptions in thoughts and emotions. are characterized by an inability to resist an impulse
to perform actions that are harmful to the individual
Axxiary dlscrders i ncl ude phobias, genera I ized
anxiety disorder, panic attacks, post-traumatic stress or to others, including compulsive gambling, steal-
d isorder, and obsessive-compulsive disorder. ing (kleptomania), and setting fires (pyromania).

&fiuad disarders include major depression, bipolar Personalirg disordqt are characterized by mal-
disorder, postpartum depression, and chronically
depressed mood. adaptive patterns that cause distress or interfere
with one's ability to function, including antisocial
Bics**ati$e disordss are characterized by the and paranoid personality disorders.

separation of certain mental processes or personal- What kinds of disorders are typically diagnosed early
ity traits from conscious thoughts, including dis- in onet life?
sociative amnesia and dissociative identity disorder
(multiple personality disorder).

PSYCHOLOGICAL DI5ORDERS 501

People use the DSM for various purposes. only after the Vietnam War, when many sol-
Psychiatrists and other mental health profes- diers were found to suffer from the disorder.
sionals use its terminology to communicate More recent research into PTSD in Iraq war
about patient needs and treatment. Insurance veterans may be inciuded in the revision of
companies may require that patients match the DSM text that is scheduled for 2072.

DSM diagnoses to cover treatment costs. With each new revision of the DSM, t}:e
Researchers investigating certain disorders
or specific diseases may recruit patients number of psychological disorders has grown.
whose symptoms match the DSM criteria for Currently, the manual contains almost 400
that disease. types of disorders. Critics worry that some of
the disorders being added are simply every-
The way psychological disorders are clas- day problems, as opposed to the more serious
sifred has changed significantly from earlier
DSM systems. Until 1980, when the third edi- disorders such as schizophrenia and PTSD.
tion of the DSM was published, psychological
The remainder of this chapter focuses on
disorders were classified on the basis oftheir six major types of psychological disorders:
anxiety disorders, mood disorders, dissocia-
presumed causes. For many decades, the most tive disorders, somatoform disorders, schizo-
widely accepted causes were those suggested phrenia, and personality disorders. Many of
the symptoms of these disorders are simply
by Freud's psychoanalybic theory. exaggerations of normal thoughts, feelings,
Many psychologists criticized early ver- or behaviors. As a result, as you read about
the different symptoms, you may feel that
sions of the DSM because very diverse psy- you have one or more of the disorders being
chological disorders were grouped together described. Such a feeling is common among
under the labels "neuroses" and "psychoses."
As a result, beginning with the DSM-III in most people who read about psychological dis-
1-980, psychological disorders have been cat-
egorized on the basis ofobservable signs and orders for the first time. Keep in mind that
symptoms rather than presumed causes. only trained professionals can diagnose psy-

T}r,e DSM is subject to ongoing revision. chological disorders, and they can do so only
New categories are added and old ones after careful evaluation.

removed as knowledge of psychological disor- ffi summarize what are some ways
ders increases. For example, post-traumatic
stress disorder (PTSD) was added tol}:,e DSM in which the DSM has been revised?

fusessment 6. Analyze Using your notes and a graphic organizer like the
one beloq explain the problems that can arise when using
Reviewing Main ldeas and Vocabulary the following criteria to determine the presence of a psycho-
1. Define What are psychological disorders?
2. Summarize How did the arrangement of the criteria for the logical disorder.

classification of psychological disorders change in 1980? Criteria Problems
1. Typrcality
Thinking Critically 2. Maladaptivity
3. Emotional disiomfor:
3. Elaborate Why must psychologists be aware of culture- 4 Soiial L,nd((eptabrlitr of behav:or
bound syndromes when determining what is abnormal?
7. Persuasive ln a paragraph, explain why the changes made
4. Categorize Give an example of a feeling or a behaviorthat in the organization of the DSM in 1 980 were a benefit to
would be considered normal in one circumstance but might psychologists and their patients.
be considered a sign of a psychological disorder in another

circumstance.

5. Predict What are the common pitfalls that students of
psychology may face when learning about psychological

disorders?

502 cHnprun ra

Syr#srles

ln certain cultures, one can find combinations of psychiatric and physi-
cal symptoms recognized as diseases only in that culture. Some of the
symptoms of these maladies coincide with disorders in the DSM. Others,
however, are quite specific to the individual culture. These culture-bound
syndromes are often treated with folk remedies.

&{i8E*k*ms}rl Hikikomori are Japanese 6ksse si{kfir*ss Ghost sickness has $*rto Hispanic Aroups in the United
people who have withdrawn from occurred among the Navajo of the
social life. The Japanese Ministry of American Southwest. The symptoms States and parts of Latin America
Health, Labour and Welfare has defined include bad dreams, loss of appetite, report a disorder called susto.
the affliction, also called hikikomori, as a feeling of suffocation, hallucina- Sufferers experience acute unhappi-
refusing to leave one's parents'house tions, fainting, and a pervasive feeling ness following a frightening event.
and isolating one's self from society of terror. A preoccupation with death The victim believes that her soul has
for six months or longer.The extreme and the dead is blamed for the symp- left her body. Physicalsymptoms,
competitiveness of Japanese educa- toms. Ghosts, called chindi, or witches such as muscle pain and insomnia,
tion and soclety have been cited as are believed to cause the fixation. may accompany the misery. A curan-
contributing to hikikomori. dero, or healer, may be called to per-
*{wa-bgumg ln Korea, some PeoPle form a ceremony that will return the
suffer from hwa-byung, which means soul to its rightful place. Susfo may
"anger illness" or "fire illness." Many be similar to post-traumatic stress
physical symptoms result from the disorder (PTSD).
panic and depression believed to
be due to the suppression of anger. ffiar There is a religious custom and
These physical symptoms may a syndrome in the Middle East and
include a heavy feeling in the chest, North Africa known as Zar.During
insomnia, fatigue, or indigestion. a Zar ritual, of which music is an
Western psychiatrists would probably important aspect, a person (usually a
diagnose a hwa-byung patient as suf- woman) is supposedly possessed by a
fering from anxiety or depression. spirit. The "possessed" person shouts,
laughs, bangs her head, and disPlays
E;mta** ln Malaysia and some other &mok ln Malaysia, a previouslY other odd behaviors. TheZar custom
areas, latah is the name both for a peaceful man who suddenly tries to may offer an emotional release for
condition and someone who suffers women in male-dominated societies.
from it. The condition is characterized kill or injure others is said to be struck
by having a severe reaction to being by amok, from a Malay word that 1. Summarize What are some of the
startled. When surpris ed, latahs, usu- physical symptoms associated with
ally women, may mimic the speech means "rushing in a frenzy!'Men who culture-bound syndromes?
of people around them and obeY
any order. lf a latah does something "1'g6 3p9["-the syndrome does 2. Discuss Do you thinkWestern medi-
wrong during such an episode, she is
ordinarily not held responsible. not occur in women-maY be over- cal schools should include culture-
bound syndromes in their psychiatry
whelmed by some kind of shame and programs? Why or why not?
feel they can no longer live with such
PSYCHOLOGICALDISORDERS 503
dishonor. A person in the grips of this

syndrome may continue to attack

, until he is restrained, exhausted, or
r killed by bystanders.

kxietv and

Mood-tlisnrders

Main ldea Reading Focus Uocabulary As you read,
Anxiety disorders cause 1. What are some characteristics phobia take notes on
people to experience irra- social phobia the types and characteris-
tional or excessive fear. of anxiety? panic attack tics of anxiety and mood
Mood disorders cause agoraphobia disorders.
people to experience mood 2. What are five major types of obsessive-compulsive
changes that are inappro- anxiety disorders? Type of Characteristics
priate to the situation. disorder (OCD) Disorder
3. How do psychologists explain post-traumatic stress
anxiety disorders? )
disorder (PTSD)
4. How do the two main types of depression 3
mood disorders compare? bipolar disorder
mania
5. Which theories explain the
origins of mood disorders?

A rootballer's ftf1tlOnS

Why does an English soccer
star need three refrigerators?
When David Beckham joined the
Los Angeles Galaxy, many American sports fans
knew of his phenomenal talent on the soccer field,
his prominent place on the fashion scene, and his
glamorous wife. What they did not know is that
Beckham suffers from obsessive-compulsive disor-
der, often abbreviated as OCD.This mental condi-
tion drives Beckham to require his surroundings
be arranged just so. For example, when he stays
in a hotel room, he cannot rest until all the leaflets
and books are stowed out of sight. At home, he has
three refrigerators, so that drinks, salad fixings, and
other foods are stored separately, lf there are three
soft drink cans in the fridge, he has to put one away
so that an even number of cans remains. Beckham
has said "l have to have everything in a straight line
or everythlng has to be in pairsJ'
OCD is one of the anxiety disorders that afflict
millions of people. For many of these people, their
disorders go undiagnosed and untreated. lil

Before the 2006 World Cup, soccer star David Beckham disclosed
that he suffers from obsessive-compulsive disorder (OCD).

504 cHnprun ra

Does Public Speaking _Q.kick f.,ab
Make You Nervous?

One of the most common phobias that people have is the fear of public
speaking. Standing and speaking in front of a group is not a strenuous
activity, so why does it cause so much anxiety?

PROCEDURE ANALYSIS

O White seated calmly at your desk, take your pulse for 1. Calculate the number of beats per minute for your resting
heart rate.
ten seconds.
2. Calculate the number of beats per minute after your speech.
o Stand up at the front of the class and read the following
3. Compare the two heart rates.
statement:
4. Describe any other changes that you noticed as your body
People who experience obsessions are usually dealt with the stress of speaking in front of the class.
aware that the obsessions are unjustified. This
distinguishes obsessions from delusions. 5. Discuss with the rest of the class how the anticipation of pub- I

o Return to your desk and immediately take your pulse for lic speaking affected you, what physical responses you felt

ten seconds. during the exercise, and why you think public speaking can {I
cause so much anxiety.

What ls Anxiety? Types of Anxiety Disorders tqri6t:fkff"ryi*"* ,

Anxiety refers to a generalized state ofdread or Anxiety disorders classified in the DSM-IV aComplete :
uneasiness that occurs in response to a vague atWebquest !
or imagined danger.It differs from fear,which is include phobic disorder, panic disorder, gener- thinkcentral.com i
alized anxiety disorder, obsessive-compulsive
a response to a real danger or threat.Aaxiety is disorder, and stress disorders. A description on phobic
typically char acterized by nervousness, inabil- of each follows.
ity to relax, and concern about losing control. disorders.
Physical signs and s;rmptoms of anxiety may Fhobic Disorder The word phobia derives
include trembling, sweating, rapid heart rate, from the Greek root phobos, which means
shortness of breath, increased blood pressure, "fear." Specific phobia, which is the most
flushed face, and feelings of faintness or light- common of all the anxiety disorders, refers
to a persistent excessive or irrational fear of
headedness. All are the result ofoveractivity a particular object or situation. To be diag-
of the sympathetic branch of the autonomic
nosed as a phobic disorder, the fear must lead
nervous system. to avoidance behavior that interferes with the
affected person's normal life.
Everyone feels anxious at times-for
Almost any object or situation may lead to
example, before a big game. In such situations, a phobic reaction. Several phobias, however,
feeling anxious or worried is an appropriate are especially common. The most common
response that does not indicate a psychologi-
cal disorder. However, some people feel anx- include:
ious all or most of the time, or their anxiety
is out ofproportion to the situation provoking . zoophobia: fear of animals
. claustrophobia: fear ofenclosed spaces
it. Such anxiety may interfere with effective . acrophobia: fear ofheights
living, the achievement of desired goals, life . arachnophobia: fear ofspiders
satisfaction, and emotional comfort. When
Other relatively common phobias include
these problems occur, anxiety is considered a fear of thunderstorms, blood, snakes, dental
sign of a psychological disorder. Anxiety-based procedures, driving, and air travel.
disorders are among the most common of all
psychological disorders in the United States. When people with specific phobias are
confronted with the object or situation they
ElllEElEfil Anatyze How are anxiety disor-
fear, they are likely to feel extremely anxious.
ders different from normal anxious reactions?

PSYCHOLOGICALDISORDERs 505

qEdf # As a result, they tend to avoid what they avoidance is impossible, the situations are
fear. Someone with hematophobia (a fear of likely to cause great anxiety. In addition, the
# avoidance behavior itself may greatly inter-
blood) might avoid needed medical treatment. fere with work and social life.
Someone with aviaphobia (a fear of air travel)
might turn down a job promotion because the Fani< Disorder and Ag6raphobia People
new position involves air travel. For exam- with panic disorder have recurring and
ple, an aviaphobic businesswoman panicked unexpected panic attacks. A panic attack is a
relatively short period ofintense fear or dis-
before a flight to an important meeting in
comfort characterrzed by shortness of breath,
Philadelphia. She got off the plane, rented a dizziness, rapid heart rate, trembling or shak-
ing, sweating, choking, nausea, and other dis-
car, and drove to Philadelphia, but she still
missed the meeting. She later resigned from tressing physical symptoms. It may last from
a few minutes to a few hours. People having
herjob as a result. Thus, although most people
with specifrc phobias never seek treatment for a panic attack may believe they are dying or
their disorders, a specific phobia can seriously "going crazy." Not surprisingly, they usually
disrupt a person's life. have persistent fears of another attack.

Social phobia is characterized by persistent For most people who suffer panic disorder,
fear of social situations in which one might attacks have no apparent cause. However,
be exposed to the close scrutiny ofothers and
thus be observed doing something embarrass- many people with panic disorder also have
agoraphobia. Agoraphobia is a fear ofbeing in
ing or humiliating. Some people with social places or situations in which escape may be
phobias fear all social situations; others fear difficult or impossible. People with agorapho-
specific situations, such as public speaking,
eating in public, or dating. bia may be especially afraid of crowded pub-
lic places such as movie theaters, shopping
People with social phobias generally try malls, buses, or trains.

to avoid the situations they fear. They may Agoraphobia is a common phobia among
invent excuses to avoid going to parties or adults. In fact, according to the DSM-I\ peo-
ple with one or both disorders make up from
other social gatherings, for example. If such 50 to 80 percent ofthe phobic patients seen
in clinical practice.
ry4%ffi x;el't
Most people with agoraphobia have panic
attacks when they cannot avoid the stressful
situations they fear.-They are afraid they will

tArachnofiro,, Other Specific Phobias

Sefinition: a simple phobia characterized by an Amaxophobia Microphobia
irrational, excessive, and persistent fear of spiders fear of riding in a car fear of small things

$yrnptoms: may include feelings of panic, excessive Astraphobia Octophobia
sweating, rapid breathing, a quickened heartbeat, fear ofthunder, lightning, and fear of the number 8
nausea, or dizziness Paraskavedekatriaphohia
storms fear of Friday the 1 3th
lmpact on d*ily life: avoiding encounters with spiders Selenophohia
Chromophobia fear of the moon
by refusing to go barefoot, checking when showering
or getting into and out of bed, fumigating the home, fear of colors Taphophobia
or sealing windows w th tape fear of being buried alive
Coulrophobia
Trypanophobia
fear of clowns fear of needles or injections

Gephyrophobia
fear of bridges

506 cnnprtn ra

OCD: Compulsive Hoarding

Definiticn: a type of obsessive-compulsive disorder characterized by
the compulsive acquiring and keeping of a large number of posses-
sions, leading to significant distress or impairment in daily living

$yrnptoms: may include compulsive need to acquire more possessions,
inability to discard possessions, deep shame and embarrassment

lrmpxct mn daily life: saving items that are broken or useless, buying

and storing large amounts of items but never using them, pulling useful
materials from the trash on a regular basis but never putting them to
use, acquiring huge numbers of small animals (such as cats) and being
unable to keep them in clean conditions

have a panic attack in a public place where checking or cleaning something. Compulsive d&i[d{$"i fiFrtrl;i.
they will be humiliated or unable to obtain acts may reduce the anxiety the the obses-
help. Panic disorder and agoraphobia both sions produce. x,i*i"l\*4C. iii€?
aeuititaiing
Iead to avoidance behaviors. These behaviors The following examples are typical of
can range from avoiding crowded places to people with OCD. One person is obsessed weakening, making
never leaving home at all. Thus, these disor- every night with doubts that he has locked life much more
ders can be very serious. the doors and windows before going to bed. difficult.
He feels driven to compulsively check and
ffieneralieed &mxi*ty #isorder According recheck every door and window in the house,
perhaps dozens of times. Only then can he
to the DSM-IU generalized anxiety disorder relax and go to sleep. In another example,
(GAD) is an excessive or unrealistic worry a team ofresearchers reported the case of a
about life circumstances that lasts for at least woman who was obsessed with the idea that
six months. The worries must be present most she would pick up germs from nearly every-
of that time in order to warrant a diagnosis of thing she touched. She compulsively washed
GAD. Typically, the worries focus on finances,
employment, interpersonal problems, acci- her hands over and over again, sometimes as
dents, or illness.
many as 500 times a day.
GAD is one of the most common anxiety
disorders, yet few people seek psychological People who experience obsessions are usu-
ally aware that the obsessions are unjustified.
treatment for it because it does not differ,
This distinguishes obsessions from delusions.
except in intensity and duration, from the Although obsessions are a sign ofa less serious
normal worries of everyday life. It is difficult psychological disorder than delusions, they
still can make people feel extremely anxious,
to distinguish GAD from other anxiety disor-
ders, and many people with GAD have other and they can seriously interfere with daily
anxiety disorders as well, most often phobic life. Compulsions may alleviate some of the
disorders. anxiety associated with obsessions, but the

Ghselssive-C*mpulsiv* Bi*orden Among compulsions themselves are time-consuming
the more debilitating of the anxiety disor- and usually create additional interference
d.ers is oUsessire-.ornpulsive disorder (OCD). with daily life.
Obsessions are unwanted thoughts, ideas,
or mental images that occur over and over Stress Disurders Stress disorders include
post-traumatic stress disorder (PTSD) and
again. They are often senseless or repulsive,
and most people with obsessions try to ignore acute stress disorder. The two disorders have
or suppress them. The majority of people with
obsessions also practice compulsions, which similar symptoms, but they differ in how
are repetitive ritual behaviors, often involving
quickly the symptoms appear after the trau-
matic event that triggers the disorder. They
also differ in how long they last.

PSYCHOLOGICALDISORDERS 507

Anxiety is a state of dread or uneasiness that occurs in response to The symptoms may occur six months or more
danger. A person with an anxiety disorder experiences anxiety out of after the traumatic event, and they may last
proportion to the actual or perceived threat. for years or even decades. The more severe the
trauma, the worse the symptoms tend to be.
Phobic Disorder I
A persistent, excessive, or irrational fear of an object or a situation. Acute stress disorder is a short-term disor-
Acrophobia is a fear of heights; claustrophobia is a fear of enclosed der with s;rmptoms similar to those of PTSD.
Also like PTSD, acute stress disorder follows a
:l::'::l':l :1 !:lln :o'1u1" l"l :'1m{e of a so.:|'l olo!'u: traumatic event. However, unlike with PTSD,
the symptoms occur immediately or at most
Panic Disorder and Agoraphobia within a month of the event. The anxiety also
Recurring, unexpected panic attacks characterized by rapid heart rate.
Agoraphobia is a phobic disorder in which people fear they will be lasts a shorter time-from a few days to a
caught in crowded, public places when they have an attack.
few weeks. Not everyone who experiences a
Generalized Anxiety Disorder trauma, however, will develop PTSD or acute
Excessive or unrealistic worry that appears to be present nearly all the stress disorder.
time.
ffi Summarize What are the five
0bsessive-Compulsive Disorder
types of anxiety disorders?
Unwanted thoughts or ideas, combined with impulses that are difficult ,,
Explaining Anxiety Disorders
or impossible to resist, such as repeated hand washing, connected with ,
Several different explanations for anxiety
:n'luu::lhe ldea'1":::t l'lo_:l'Tuln i disorders have been suggested. As is true for

Stress Disorders most of the psychological disorders discussed
lntense, persistent feelings of anxiety that follow traumatic events. in this chapter, the explanations fall into two
. general categories: psychological views and
biological views.
PT5Dmaybeaccompaniedbyflashbacks,nightmares,andavoidance
PsychotoEical Views For anxiety disorders
of stimuli connected with the traumatic event. . _,
and the other disorders discussed in this chap-
,{!:_*=uarqE{ Post-traumatic stress disorder (PTSD) refers ter, psychoanalytic views are presented even
to intense, persistent feelings ofanxiety that though they are no longer widely accepted.
*\{iry4$?€x"+{c}: are caused by an experience so traumatic that
These views are included because they influ-
stimuli outside it would produce stress in almost anyone. enced later theories and had a major impact

factors that directly Experiences that may produce PTSD include on the classification of psychological disorders
influence a person rape, child abuse, assault, severe accident,
airplane crash, natural disasters, and war until recently, as discussed earlier.
According to psychoanalytic theory, anxiety
atrocities. It appears to be a common result
is the result of"forbidden" childhood urges that
of extensive trauma. For example, up to one have been repressed, or hidden from conscious-
fourth of the people in areas hit by Hurricane
Katrina in 2005 suffered some symptoms of ness. If repressed urges do surface, psycho-

PTSD. analysts argue, they may do so as obsessions
and eventually lead to compulsive behaviors.
People who suffer from PTSD may exhibit For example, if one is trying to repress "dirty"
sexual thoughts, repetitive hand washing may
any or all of the following symptoms: help relieve some of the anxiety.

. flashbacks, which are mental reexperi- Learningtheorists believe that phobias are
conditioned, or learned, in childhood. This may
ences of the actual trauma occur when a child experiences a traumatic
event-such as being lost in a crowd or fright-
. nightmares or other unwelcome thoughts ened by a bad storm-or when a child observes

about the trauma phobic behavior in other people. If a parent

. numbness of feelings screams or faints when a child climbs onto a
. avoidance of stimuli associated with the large box, for example, the child may learn an
unreasonable fear of heights-even moderate
trauma
heights. Or if a parent warns a child that all
. tension, irritability, poor concentration

508 cHnptR r a

dogs are dangerous and must not be touched, lnteraction of Factors As with many other
the child may learn to fear all dogs. Learning disorders, the causes of anxiety disorder may
theorists argue that such conditioned phobias be mixed. Some cases of anxiety disorder
may remain long after the experiences that probably reflect the interaction of biological
and psychological factors. People with panic
produced them have been forgotten. disorder, for example, may have a biologically
Learning theorists also assert that people based tendency to overreact psychologically
to physical sensations. The initial physical
will learn to reduce their anxiety by avoiding symptoms of panic-such as rapid heart rate
the situations that make them anxious. For and shortness of breath-cause these people
example, a student who feels anxious speak- to react with fear, leading to even worse panic
ing in front of others in class may learn to keep symptoms. They may think they are having a
quiet because it reduces his or her feelings of heart attack and experience severe psycho-
anxiety. However, by intentionally avoiding the Iogical stress. Anxiety about having another
panic attack becomes a psychological disor-
anxiety-producing behavior, the student has no der itself-one that originated in a biological

chance to learn other ways of coping with or reaction.
unlearning the anxiety. As a result, the anxiety
may worsen or be generalized to other situa- Regardless of their cause, anxiety disor-
tions that involve speaking in front of others. ders are both common and disabling. In seri-
ous cases, they lead to tremendous restrictions
Cognitive theorists, on the other hand, and limitations in lifestyle, relationships, and

believe that people make themselves feel anx- work. They can also lead to great personal dis-
ious by responding negatively to most situa-
tions and coming to believe they are helpless tress. In extreme cases, the sufferer can be
to control what happens to them. This creates practically paralyzed with fear. Fortunately,
great anxiety.
most people who suffer from anxiety disorder
Biologica! Views Research indicates that respond well to treatment, which is covered in
heredity may play a role in most psychologi- the next chapter.

cal disorders, including anxiety disorders. For mm$} Find the Main tdea How do

example, one study showed that if one of a learning theorists explain anxiety disorders?
pair of identical twins exhibited an anxiety
disorder, there was a 45 percent chance that Psychoanalytic Uiew Anxiety represents the

the other twin would also exhibit the disorder. "leakage"of forbidden aggressive or sexual ideas
This was true even of twins raised in differ- or urges that were repressed during childhood.
ent families. By contrast, the chance of frater-
Learning Uiew Phobias are conditioned, or
nal twins both developing anxiety disorders
was only about 15 percent. Similarly, adopted learned in childhood, either through direct
children are more likely to have an anxiety experience or observation. People avoid threaten-
ing situations to reduce anxiety.
disorder if a biological parent has one than if
Biological Uiew Anxiety disorders tend to run
an adoptive parent does. Both types ofstudies
suggest that genetics plays at least some role in families, suggesting a role for genetic factors.
in the development of anxiety disorders. Anxiety disorders may be the exaggerated
remains of adaptive fears.
How did genes get involved? Some psy-
chologists believe that people are genetically Cognitive Uiew People exaggerate threats and
inclined to fear things that were threats to
their ancestors. These psychologists argue believe they are helpless to dealwith them.

that people who rapidly acquired strong

fears of real dangers-such as large animals,
snakes, heights, and sharp objects-would be
more likely to survive and reproduce. To the
extent that the tendency to develop such fears
is controlled by genes, they conclude, the ten-
dency would be passed on to future genera-
tions, causing the disorders to be relatively

common today.

PSYCHOLOGICAL DISORDERS 509

Types of Mood Fisarders According to the DSM-I{ major depressron
is diagnosed when an individual experiences
Most people have mood changes that reflect
the normal ups and downs of daily life. They at least five of the following symptoms:
feel down when things go wrong, such as fail-
ing an important test, and they feel up when 1. persistent depressed mood for most of
good things happen, such as when their team the day

wins a championship. 2. loss ofinterest or pleasure in all, or
Some people, however, experience mood almost all, activities

changes that seem inappropriate for or incon- 3. significant weight loss or gain due to
sistent with the situations to which they are changes in appetite
responding. They feel sad when things are
going well, or they feel elated for no appar- 4. sleeping more or less than usual
ent reason. People who have abnormal moods
5. speeding up or slowing down of physical
such as these may have a mood disorder. and emotional reactions

Mood disorders fall into two general cat- 6. fatigue or loss ofenergy
egories. Depression typically involves feelings
7. feelings of worthlessness or unfounded
of helplessness, hopelessness, worthlessness,
guilt
guilt, and great sadness. Bipolar disorder
8. reduced ability to concentrate or make
involves a cycle of mood changes from depres- meaningful decisions
sion to wild elation and back again.
9. recurrent thoughts ofdeath or suicide
Mood disorders-particularly depres-
sion-are very common psychological disor- For a diagnosis of major depression to
be made, at least one of the individual's five
ders. In any six-month period, about 8 percent symptoms must be one of the first two symp-
of women and 4 percent of men are likely to be toms in the list. Also, the symptoms must
diagnosed with some form of depression. The be present for at least two weeks and occur
DSM-IV classifies mood disorders into sev- nearly every day during that period.
eral different types ofdepressive and bipolar
Severely depressed individuals may
disorders.
become consumed by feelings of worthless-
Major ilepression Major depression is by far
the most common of all psychological disor- ness or guilt. Severe depression calls for
ders. Depression may affect more than 100 immediate treatment-as many as 15 percent
million people worldwide. Some 8 to 18 per-
cent of the general population will experience of severely depressed individuals eventually
major depression in their lifetime. commit suicide.

Maior Depression \

Sefinition: a disorder characterized by persistent sad, anxious, or
"empty"feelings that interfere with daily living

Symptoms: may include feelings of hopelessness or worthless-
ness, irritability, restlessness, loss of interest in once-pleasurable
activities, fatigue, difficulty concentrating, changes in appetite,
persistent aches or pains

Behaviors: may include withdrawal from social activities, insom-
nia or excessive sleeping

:i/r"te:trili,j.riri, ::.tir,1rr;i,.ri?.ai r,.ii:rrl :rliii::i!!r.,$ili,:: *t:riiri) rr:ii, :.51:. t.:.a.r::irir.*::irr

510 cHRprun ta

Bipolar Disorder Once called manic depres- behaviors, such as going on spending sprees,
sion, bipolar disorder is characterized by
dramatic ups and downs in mood. Periods of quitting their jobs to pursue wild dreams, or
making foolish business investments. Thus,
mania, or extreme excitement characterized the manic phase of bipolar disorder can be
by hyperactivity and chaotic behavior, can very disruptive to an individual's life.

change into depression quickly and for no Pcstpartunr Depression Some women suffer
a type ofdepression, called postpartum depres-
apparent reason. sion (PPD), after givingbirth. Symptoms may
include feelings of hopelessness and inad-
The manic phase is characterized by a equacy in childcare skills. This condition can
mood that is persistently and abnormally have a negative effect not just on the woman's
elevated. In some people, however, this phase health, but also on parent-infant bonding. Not
may be characterized by irritability instead of long ago, PPD was kept hidden and consid-

elation. Manic moods are also characterized ered a source of shame. Now, however, doctors
and hospitals act aggressively to prevent and
by at least some of the following traits:
treat PPD.
. inflated self-esteem
. inability to sit still or sleep restfully ffiflf Analyze What are some ways that

o pressure to keep talking and switching mood disorders can disrupt one's daily life?
from topic to topic
Explaircing Moad Disonders
o racing thoughts (referred to as "flight of
Psychological and biological theories have
ideas") been proposed to explain why such a large
number of people experience mood disorders.
. difficulty concentrating.
These theories are explained here.
Individuals inthe manic phase may appear
highly excited and act silly or argumentative. FsycholoEical Views The psychoanalytic
view of depression connects past events
In severe cases, they may have delusions
to the present. It says that people prone to
(beliefs that have no basis in reality) about
their own superior abilities. They may also depression suffered a real or imagined loss
experience hallucinations (sensory percep-
tions that occur in the absence of sensory of a beloved object or person in childhood.
stimuli) such as hearing imaginary voices or
seeing things that are not really there. These
individuals may also engage in impulsive

Thoughts and Depression

Psychologists note that many people create or worsen feelings of
depression through irrational thoughts. ln this way, they make it
seem as if they cannot change things for the better. This chart shows
the kinds of thoughts that can increase depression, along with more
realistic thoughts that can help people take control of their lives.

A depressed person might think . . . A rational alternative would be . . .

"There's nothing I can do." "I can't think of anything to do right now, but if I work at it, I mayl'

"I'm no $ood," "I did something I reg?et, but that doesn't make me evil or worthless as a person."

"This is absolutely awfulJ' "This is pretty bad, but it's not the end of the world.'

course.""I just don't have the brains for this "I giuess I really need to go back over the basics in the course. Whom can I turn

to for help?"

*I just can't believe I did something so terrible!" "That was a bad experience. Ytleii, I won't be likely to try that again soon."

"I can't imagne ever feeling rightl' "This is painful, but if I try to work it through step by step, I'll probably see my
way out of it eventuallyl'

PSYCHOLOGICAL DISORDERS 51 1

vi there was nothing they could do to prevent
the pain.
I
This learned helplessness has been com-
|, pared to the helplessness often seen in people
€ who are depressed. Learning theorists argue
that people prone to depression have learned
, through experience to believe that previous

k events in their lives were out of their con-
trol. This leads them to expect that future
ett events will be out of their control as well. As
a result, whenever a negative event occurs,
:, these people feel helpless, and this leads to

',I,i depression.

: In contrast, cognitive theorists have sug-
i gested that some people are prone to depres-
sion because of their habitual style of explain-
!
ing life events. According to attribution theory
"Son, it\ im?zrtdnt to runanber that it\ O.K. to be deprmed"
people assign different types ofexplanations to
What does this cartoon imply about the
causes of depression? events-internal or external, stable or unsta-
ble, and global or specific. These attributional
According to this view, the child feels anger styles affect people's self-esteem and self-
toward the lost object or person but, instead efflcacy. These styles also relate to expectancy-
what people expect based on prior experiences.
of expressing the anger, internalizes it and
Suppose, for example, that someone goes on a
directs it toward himself or herself. This leads date that does not work out. Different ways
to explain the uncomfortable evening might
to feelings of guilt and loss of self-esteem, include the following:
which in turn lead to depression.
. "I really messed up" (internal explana-
Learning theorists have suggested other
explanations for depression. Some believe tion, places blame on selfl.
that learned helplessness makes people prone
to depression. Psychologist Martin Seligman . "Some people just don't get along" (exter-
demonstrated the concept of learned help-
Iessness in a classic but now widely criticized nal explanation, places the blame else-
where).
experiment. In his experiment, Seligman
. "It's just my personality" (stable explana-
taught dogs that they were helpless to escape
from electric shock. First, he placed a barrier tion, suggests problem cannot be
in the dogs'cage to prevent them from leav-
ing when shocks were administered. Later the changed).
barrier was removed. However, when shocks
were again administered, the dogs made no . "ft was that lousy head cold I've had all
effort to escape. They had apparently learned
week" (unstable explanation, suggests
problem is temporary).

. "I have no idea what to do when I'm with

other people" (global explanation, sug-
gests problem is too large to deal with).

. "I have difficulty making small talk"

(specifi c explanation, suggests problem
is small enough to be manageable).

Research shows that people who are depressed
are more likely than other people to blame
their failures on internal, stable, and global
causes-causes they feel helpless to change.

Cognitive theorists argue that such expla-
nations give rise to feelings of helplessness,
which in turn lead to depression.

512 CHAPTER 18

Another cognitive theory was proposed by or deficiencies, of serotonin may create a
Aaron Beck, who suggested that people who tendency toward mood disorders in general.
are depressed have a negative view of them- Deficiencies of serotonin combined with defr-
ciencies of noradrenaline, however, may be
selves, their experiences, and their future. Iinked to depression specifically. These find-

According to Beck, this is because people who ings have been important in the development
are depressed have negative self-schemas- ofa wide range ofdrug therapies for the treat-
ment of mood disorders.
self-judgments developed from negative expe-
riences in early childhood. This leads them to Biological and Psychological Factors As

filter out positive information and perceive we have seen before, a combination of factors
negative information as more negative than it
may be at work in the explanation of mood
really is. Such negativity, Beck argued, makes disorders. Many cases of depression may
reflect the interaction of biological factors
people prone to depression. such as neurotransmitter levels and psycho-

Biological Views Other researchers have logical factors such as learned helplessness.
investigated biological factors in mood disor- This has been demonstrated with laboratory
ders. Mood disorders,like anxiety disorders, animals. Seligman andWeiss found that dogs
tend to occur more often in the close rela-
tives of affected individuals than they do in that learned they were helpless to escape
the general population. Between 20 and 25
percent of people with mood disorders have electric shocks also had less noradrenaline
a family member who is affected by a similar activity in their brains. Helplessness is thus
linked to specific neurotransmitter defrcien-
disorder. Moreover, identical twins of affected cies. The relationship may result in a vicious
cycle. A depressing situation may slow down
individuals are more likely to be affected the activity of noradrenaline in the brain; in
than fraternal twins. These studies seem to turn, the chemical changes may then worsen
indicate that mood disorders have a genetic the depression. Breaking that cycle may be
the key to successful treatment.
component.
Scientists believe that two neurotransmit- Msffi Explain Howwas Martin

ters, or chemical messengers, in the brain- Seligman's experiment with dogs related to

serotonin and noradrenaline-may at least theories about mood disorders?
partly explain the connection between genes
and mood. Serotonin and noradrenaline both
play a role in mood regulation. Low levels,

Assessment 7. Analyze Using your
notes and a graphic
Reviewing Main ldeas and Vocabulary organizer like the one
here, explain why such
I 1. Explain How does anxiety differ from fear? a large number of peo-
ple experience mood
2. Describe What is the relationship between panic disorder disorders, particularly
and agoraphobia?
depression.
3. Recall What are five symptoms of major depression?
4. Contrast What is the difference between depression and 8. Narrative Review the information about anxiety disorders
in this section. Then try to imagine what life is like for a per-
bipolar disorder?
son who suffers from obsessive-compulsive disorder. Write
Thinking Critically a diary entry from that person's point of view, in which you
5. Evaluate Why are studies of twins important for determin- describe how the disorder affects task and events of daily
life. Or, select a different anxiety disorder and write a similar
ing whether a disorder has a biological basis? diary entry.

6. Develop Describe and explain self-esteem, self-efficacy, PSYCHOLOGICAL DISORDERS 513
and expectancy from the perspective of attribution theory.

WMt=Tm**m*,*gSre$$ ff

Few of us will ever experience the horrors of war directly-the physical ri ,+tr:ilt
agony, the fear, the grief of seeing friends killed, the moral dilemmas that .l +r,

soldiers face. For those who survive these ordeals, the trauma of combat ln lraq aild:Afghani-$n, .danierl could:rwait :
may not be left behind on the battlefield. lnstead, some veterans experi- behind:6y66orway.,5uch uncertainties have
ence vivid flashbacks and nightmares that replay the wartime shocks added to soldiers' stress.
over and over. Many of these vets are diagnosed with post-traumatic
stress disorder (PTSD).

A high incidence of PTSD has been PTSD epidemic. One study focused including memory loss, irritability,
reported among soldiers returning on more than 100,000 veterans and insomnia, are actually the result
from the war in lraq and Afghanistan. who sought medical care at U.S. of PTSD-a welcome conclusion,
Added to the usual stress of com- Department of Veterans Affairs (VA) because PTSD is more treatable than
bat are various factors that have facilities. About one fourth were diag- brain injury (Hoge et a1.,2008).
increased the disorder's appearance. nosed with a mental disorder. The
Some of those factors are the dif- study found that younger vets, from Other researchers have exam-
ficulty of distinguishing between 1B to 24 years old, are more likely to
enemies and allies and the threat of be diagnosed with PTSD than older ined the overwhelming impact of
unseen improvised explosive devices veterans (Seal et al.,2007). so many PTSD cases on the armed
(lEDs). ln addition, many of the vet- forces' mental health facilities.
erans are members of the National The connection between More than 300,000 servicemen and
Guard and military reserves. Being increased PTSD risk and combat- women have returned from lraq and
called into combat has already dis- related head injuries was the sub- Afghanistan. A survey indicates that
rupted their previously civilian lives, ject of another study. Of particular about 20 percent of those involved
and the extra stress of PTSD adds dra- concern were the soldiers who had in combat suffer from severe men-
matically to their troubles. lost consciousness during the injury tal disorders (Tanielian and Jaycox,
episode. They were especially prone 2008). Currently, they can receive up
Researchers are attempting to to post-traumatic stress. The study's to five years of free health care from
understand the reasons and implica- authors found that many symptoms the VA for any mental disorder related
tions of what some observers calI a previously ascribed to brain injury, to combat. Since PTSD often shows
up long after the end of the trauma,
increased mental healthcare for
veterans will be necessary for many
years to come.

Some veterans hesitate to ieek help for PTSD, thinking'that having the disordef 1. Draw Conclusions Why do you think
means,they are weak. PTSD,is treatab,le, especially thro:ugh eaily interventidn. younger veterans are more likely to
be diagnosed with PTSD?
.
2. Discuss Given the current research
514 CHAPTER 18 on PTSD, what steps do you thinkthe
U.S. Department of Veterans Affairs
should take to deal with the effects of
PTSD in returning soldiers?

s&eiative amd

Somatafurm Tlt$€)rders

BeforaYeu Bead Reading Focus Uocabulary rfFL..J,r'*.*=jf Use a graphic
dissociation organizer like
Main ldea l. What is dissociation, and depersona lization
somatization this one to take notes on
Dissociative disorders cause what are the four dissociative
people to lose their mem- disorders? the types and character-
ory or identity. Somatoform
disorders cause people 2. How do theorists explain the istics of dissociative and
to express psychological origins of dissociative disorders?
distress through physical somatoform disorders.
symptoms. 3. What is somatization, and what
are the most common types of Di:sociativi: D:so|da:.s :oilralaioil,-i ilis0r*e
somatoform disorders?

4. How do theorists explain the
origins of somatoform disorders?

in Smwkrle fi3ty

How could a mon forget his entire
life? OnJuly 3, 2003, a man with

bumps and cuts on his head woke up
on a train near Coney Island, at the edge of New York City.
He did not know where he was, why he was on the train,
or how he became injured. He had no idea who he was.

Eventually, a police officer helped identifi/ the frightened
man as Doug Bruce, a British resident of New York who years
before had abandoned a successful career as a stockbroker
to become a photographer. No clues emerged, however,
about how Bruce lost his memory to a condition called
total retrograde amnesia. Bruce experienced things as if for
the first time that we take for granted-rain, fireworks, the
ocean, sports, re-runs ofTV cop shows.

Doug Bruce's story was filmed for a documentary
titled UnknownWhite Male. Some observers doubt that his
amnesia is real.To date, however,the'bld"Doug Bruce has
not reappeared, and the source of "new" Bruce's amnesia
remains a mystery. hl

PSYCHOLOGICAL DISORDERS 515

A(AffiE&II€ Dissociative Disorders injury, for example. Most often, a traumatic
gSCASUTARY event, such as witnessing a serious accident,
The term dissociation refers to the separation precedes the amnesia. The incidence of dis-
fugue disturbed of certain personality components or mental sociative amnesia rises markedly duringwar-
time and crises such as natural disasters.
state of conscious- processes from conscious thought. In some
ness in which Dissociative Fugue Dissociative @-0."-
someone performs situations, dissociation is normal. Someone
acts in full aware- viously called psychogenic fugue-is charac-
ness but later may be so engrossed in reading a book or
cannot remember terized not only by forgetting personal infor-
watching a television program, for example, mation and past events but also by suddenly
that he is unaware that his name is being relocating from home or work and taking on
called. Someone else may become so involved a new identity. Like dissociative amnesia, dis-
sociative fugue usually follows a traumatic
in watching the road that she misses the
event that is psychologically very stressful. It
sign for her exit on the freeway. Perhaps the
most common form of normal dissociation is is reported most frequently during wartime
daydreaming, in which the person's thoughts and natural disasters.
may be "a million miles away." In each of these
cases, dissociation usually does not indicate a When individuals with dissociative fugue
psychological disorder. travel away from their home or workplace,
they may take on a new name, residence, and
However, when dissociation occurs as a occupation. They may become socially active
way to avoid stressful events or feelings, it can
be a sign of a psychological disorder. People in their new identity and not appear to be ill
with dissociative (di-SOH-shee-uh-tiv) disor-
ders may lose their memory of an event or in any way. When the fugue comes to an end,
even forget their identity. A common theory is they no longer remember what happened dur-
that dissociation occurs when individuals are ing the fugue state.
faced with urges or experiences that are very
stressful. By dissociating, they are able to Dissociative ldentity Disorder Formerly
remove themselves from the source of stress
and lessen their feelings of anxiety. called multiple personality disorder, dissocia-
tive identity disorder involves the existence
There are no current statistics on the prev- of two or more personalities within a single
alence ofdissociative disorders. In part, this individual. The various personalities may or
is because the DSM-IV classifres them some- may not be aware of the others, and at least
what differently than they were classified in two of the personalities take turns controlling
the past. However, dissociation is a common
the individual's behavior.
psychological symptom. Each personality is likely to be different

Dissociative Amnesia Formerly called psy- from the others in several ways, including in
chogenic amnesia, dissociative amnesia is such observable traits as voice, facial expres-
characterized by a sudden loss of memory,
usually following a particularly stressful or sion, and handedness, as well as self-perceived
traumatic event. A person experiencing dis- age, gender, and physical characteristics. The
sociative amnesia typically cannot remember personalities may even have different aller-
any events that occurred for a certain period gies and eyeglass prescriptions. They may also
of time surrounding the traumatic event. behave very differently fiom one another.
Less commonly, a person may forget all prior
People who are diagnosed with dissocia-
experiences and may be unable to remember tive identity disorder usually were severely
his or her name, recognize friends and fam- abused in childhood. They typically suffered
ily, or recall important personal information. severe physical, sexual, or psychological
abuse. Less often, dissociative identity disor-
Dissociative amnesia may last for just a few
hours, or it may persist for years. Memory is der is preceded by other types of trauma.
likely to return just as suddenly as it was lost,
Depersonalization Disorder A condition
and the amnesia rarely recurs. called depersonalization refers to feelings of
The term psychogenic means "psychologi-
detachment from one's mental processes or
cal in origin." Dissociative amnesia cannot be body. People with this disorder describe feel-
explained biologically-as the result of a head ing as though they are outside their bodies,
observing themselves at a distance.

516 cHnprun ra

Depersonalization is a common symptom
ofother psychological disorders in addition

to being a disorder in its own right. After

depression and anxiety, it is the most common
complaint among psychiatric patients. Like

the other dissociative disorders, depersonal-
ization disorder is likely to be preceded by a

stressful event.

ffiW compare what is the basic fea-

ture that dissociative disorders have in common?

Explaining Dissociative Disorders So begins the 1957 film lhe Three Faces of Eve, which
was based on a real case of dissociative identity
Dissociative disorders have been explained disorder. As the story progresses, a third personality
primarily by psychological views. According emerges. ln fact, the woman whose case inspired the
to psychoanallic theory, people dissociate in film experienced 21 different personalities.
Do you think Hollywood accurately portrays serious
order to repress unacceptable urges. In dis- psychological disorders such os dissociative identity
sociative amnesia or fugue, for example, the disorder? Why or why not?
person forgets the disturbing urges. In disso-
ciative identity disorder, the person expresses order to avoid work, school, or other respon-
sibilities. People with somatoform disorders
undesirable urges by developing other person- do not intentionally fake their illnesses. They
honestly feel pain, for example, or believe they
alities that can take responsibility for them. cannot move their limbs.
In depersonalization, the person goes outside
the self, away from the turmoil within. Because ofthe nature ofthe condition, reli-
able statistics on the incidence of somatoform
According to learning theorists, individu- disorders are not available. Many diagnoses
als with dissociative disorders have learned of somatoform illness later prove to be incor-
not to think about disturbing events in order rect when patients are found to have actual
medical illnesses. On the other hand, cases
to avoid feelings of guilt, shame, or pain. of somatoform disorders may go undiagnosed
because ofthe focus on physical, as opposed
They dissociate themselves from the stress- to psychological, symptoms.
ful events by selectively forgetting them. This
is reinforced by the reduced anxiety they feel
when the trauma is forgotten.

Neither cognitive nor biological theorists
have offered a complete explanation of dis-

sociative disorders. At present, there is no
convincing evidence that either biological or

genetic factors play a role in the development

of dissociative disorders.

Mf summarize which type of theo-

ries can explain dissociative disorders?

Somatoform ilisorders

Somatization, which comes from the Greek
word for "body," refers to the expression of
psychological distress through physical symp-
toms. People with somatoform disorders have
psychological problems (such as depression)
but experience inexplicable physical symp-

toms (such as paralysis).

It is important to distinguish between

somatoform disorders and malingering, or
the conscious attempt to "fake" an illness in

PSYCHOLOGICALDISORDERS 517

Conversion Disorder People with conver- Explain ing Sornatoforrgr Disorders
sion disorder experience a change in or loss
of physical functioning in a major part of the Explanations for somatoform disorders in
body for which there is no known medical
general, and specifically conversion disorder
explanation. For example, they may suddenly and hypochondriasis, are primarily psycho-
logical. According to psychoanalytic theory,
develop the inability to move their legs, even somatoform disorders occur when individuals
though no medical explanation for the dis-
ability can be found. These behaviors are not repress emotions associated with forbidden
intentionally produced. That is, the person is
not faking it. urges and instead express them symbolically

Conversion disorder is complicated because in physical symptoms. The physical symp-

many people who experience the disorder toms thus represent a compromise between
show little concern about their symptoms, no
matter how serious or strange they may be. the unconscious need to express feelings and
This lack of concern may help in the diagnosis the fear of actually expressing them.

of conversion disorder. More recently, other psychologists have

Hypochondriasis Also called hypochondria, argued that people with conversion disor-
hypochondriasis (hy-poh-kahn-DRY-uh-sis) is
defrned as a person's unrealistic preoccupa- der "convert" psychological stress into actual
tion with thoughts that he or she has a serious
disease. People with hypochondriasis become medical problems. There may be a direct con-
absorbed by minor physical symptoms and nection between the body part affected and
the cause. For example, a fighter pilot may
sensations, convinced that the symptoms lose the ability to see at night as a response
indicate the presence of a serious medical ill- to great anxiety he felt about flying nighttime
ness. They maintain their erroneous beliefs bombing missions. Another individual may
suffer paralysis of the legs after nearly being
despite reassurances from doctors that there in a car accident.
is nothing physically wrong with them. Some
people with hypochondriasis visit doctor after Some behavioral theorists have suggested
doctor, seeking the one physician who will find
that somatoform symptoms can serye as a
the cause of their symptoms. reinforcer ifthey successfully allow a person
to escape from anxiety. There are also some
ffiS summarize what are the two indications that biological or genetic factors

main types of somatoform disorders? may play a role in the development of somato-

form disorders.

EE@ffi Analyze what does it mean to

convert psychological stress into an actual physi-

calproblem?

fusessment 5. Analyze Using your notes and a graphic organizer like the

Reviewing Main ldeas and Vocabulary one below, explain how conversion disorder and hypochon-
driasis are different.
1. Describe What are the four dissociative disorders?
2. Contrast How does somatization differ from malingering? Conversion \ IH
Disnrder J
Thinking Critically
--n/
3. Evaluate ln some cultures, people are encouraged to go
into trancelike states. Should this kind of dissociation be con- 6. Descriptive How might dissociative disorders cause difficul-
sidered a sign of a psychological disorder? Why or why not? ties for law enforcement? Describe a scenario for each of the
dissociative disorders in which the disorder complicates a legal
4. lnfer How do you think learning theorists might explain case or situation.

somatoform disorders?

518 cHRprun ra