10. ABNORMAL PSYCHOLOGY

8/7/2019 10. ABNORMAL PSYCHOLOGY

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Psychological Disorders

General Psychology47.101

Psychopathology Conceptions of psychopathology

What is Abnormal?

Diagnostic system: DSM IV

Causes

Types of Disorders Dissociative

Anxiety

Schizophrenia

Mood

Personality

Body Ritual of the Naricema

What is Abnormal?

How can abnormal be differentiated from

normal?

How is abnormal diagnosed?

What is Abnormality? Criteria

Infrequent in the population

Socially deviant

Maladaptive

Personal distress

Psychologically disorganized

No sharp boundaries Continuum is more reasonable

Abnormal behaviors often = normal behaviortaken to the extreme


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Diagnosing Disorders Use diagnostic interview

Performance on Psychological Tests

e.g., MMPI, Projective tests

Interviews with Family & Friends

Compare patient information to pre-establishedpsychological disorders

Diagnostic and Statistical Manual of MentalDisorders (DSM-IV)

DSM IV: Agreed-upon criteria for diagnosingpsychological disorders

DSM IV Axes

Axis I: Primary Diagnosis

Axis II: Developmental & Personality Disorders

Axis III: Physical disorders

Axis IV: Stressors in last year, situational

contributors

Axis V: How well the person has coped with

stress in the past

Axes refer to different major diagnostic categories

of psychological disorders

Classification Systems & Labeling:Advantages

Advantages:

grouping of similar symptoms may help

to identify underlying causes

facilitates communication

May seem dehumanizing for patients

Better to apply diagnostic labels to the disorder

and NOT to the people themselves

May lead clinicians to overlook unique

aspects of each case

Label becomes a lens through which we see

and evaluate a persons behavior

Classification Systems & Labeling:Disadvantages

Disadvantages:

Labeling

How important is it really?

Demo

On being sane in insane placesInvestigation by Rosenhan, Seligman, et al.

Discovering Psychology#21: Psychopathology

6:49 9:55


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Causation1. Predisposition

In place before onset of disorder

genetic characteristics, learned beliefs, sociocultural factors2. Precipitating causes

Immediate events that bring on the disorder

Stress, Negative or positive life changes

Diathesis-stress model

People may have predisposition for disorder

that is only brought out under stress

Low HighPredisposition

Low

High

Stress

manifested

Not manifested

Causation1. Predisposition

In place before onset of disorder

genetic characteristics, learned beliefs, sociocultural factors

2. Precipitating causes

Immediate events that bring on the disorder

Stress, Negative or positive life changes

3. Maintaining causes

Effects of disorder that serve to perpetuate it

depressed person may withdraw from social interactions

Schizophrenics are reacted to strangely or violently, enhancingtheir stress, which enhances the disorder

Major Classes of Disorders

Anxiety disorders Generalized anxiety disorder (GAD)

Panic disorder

Phobias

Obsessive compulsive disorder (OCD)

Post- traumatic stress disorder (PTSD)

Dissociative Disorders Dissociative Identity Disorder

Dissociative Amnesia

Dissociative Fugue

Mood Disorders Depression

Bipolar

Dysthymia

Psychotic disorders Schizophrenia Schizoaffective disorder

Somatoform Disorders Hypochondriasis

Body Dysmorphia

Conversion Disorder

Eating Disorders Anorexia

Bulimia

Substance Disorders Substance abuse

Substance dependence

Personality Disorders Antisocial personality disorder

Borderline personality disorder

Narcissistic personality disorder

Major Classes of Disorders

Anxiety disorders Generalized anxiety disorder (GAD)

Panic disorder

Phobias

Obsessive compulsive disorder (OCD)

Post- traumatic stress disorder (PTSD)

Dissociative Disorders Dissociative Identity Disorder

Dissociative Amnesia

Dissociative Fugue

Mood Disorders Depression

Bipolar

Dysthymia

Psychotic disorders Schizophrenia

Schizoaffective disorder

Somatoform Disorders Hypochondriasis

Body Dysmorphia

Conversion Disorder

Eating Disorders Anorexia

Bulimia

Substance Disorders Substance abuse

Substance dependence

Personality Disorders Antisocial personality disorder

Borderline personality disorder

Narcissistic personality disorder

Prevalence of mental disorders


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Before we start

A word of caution: Do not develop

medical student syndrome

But, if some of the things that we discussring true

If ~ 10-15min left jump to #32

Dissociative Disorders

Ever forget the passage of time?

Driving a car, spacing out (certainly not in this class!)

Dissociation: out of body experience,disconnect form self

Dissociation is part of other disorders as well Ex: BPD

But in dissociative disorders it is the primarysymptom

Dissociative Identity Disorder (DID)

Previously known as Multiple personalitydisorder (MPD)

Characterized by multiple identities

Causes

Often severe trauma in childhood

Means of escape

Controversial

DID

Anxiety Disorders

What does anxiety feel like???


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Anxiety Feeling of dread, apprehension or fear

Accompanied by physiological arousal

Can make it hard to think clearly

Anxiety Disorders Generalized anxiety disorder

Panic attacks

Phobias Obsessive-compulsive disorder

PTSD

As a category, easiest to treat and best long-termprognosis

GAD

Tom, a 37 year old electrician, complains ofdizziness, sweating palms, heart palpitations

and ringing in the ears. He feels edgy andsometimes finds himself shaking. Withreasonable success he hides his symptomsfrom his family and co-workers. Never theless, he has few social contacts since thesymptoms began two years ago. Heoccasionally has to leave work. His family

doctor and a neurologist can find no physicalproblem.

Generalized Anxiety Disorder (GAD)

Symptoms are commonit is there persistencethat is uncommon

Unfocused anxiety

feels vaguely uneasy

overreacts to mild stressors

inability to relax, disturbed sleep

rapid heart rate,

fatigue, headaches, dizziness

Hard to treat because there is no obvious source ofthe anxiety

Panic attack

I felt hot as though I couldn't breath. Myheart was racing and I started to sweat andtremble and I was sure I was going to faint.

Then my fingers felt numb and tingly andthings seemed unreal. It was so bad I

wondered if I was dying and asked myhusband to take me to the emergency room.By the time we got there the worst of theattack was over and I just felt washed out

Panic Attack

Sudden episodes of overwhelming terror

Over-activity of sympathetic nervous system heart palpitations

shortness of breath

perspiration muscle tremors

faintness

nausea

fear of dying or going crazy

Can start to fear the fear itself


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Persistent and irrational fear of an object or situation thatpresents no realistic danger

Anxiety experienced in response to a specific stimulus Specific (simple) phobias Animals (snakes, spiders, rats) Situations (high places, enclosed spaces, doctors office) Things (blood, waters, clowns)

Social phobia - fear of public scrutiny Public speaking

Agoraphobia - fear of being in public places Fear is that something bad might happen and youll be

trapped

Not labeled a phobia unless it disrupts a persons daily life

Example of panic/agoraphobia (DVD - Clip)

Phobia

How do phobias develop?

Classical Conditioning Remember Little Albert

Social Learning Principles E.g., modeling

Phobias often persist because of avoidance Cannot learn that anxiety response is unnecessary

Usually treated with exposure therapy Expose the person to the object that arouses fear

When nothing bad happens the phobia fades

OCD

(Howard Hughes)

Hughes compulsively dictated the samephrases over and over again. Under stress,he developed a phobic fear of germs, which

led to compulsive behaviors. Hughes becamereclusive and insisted his assistants carry outelaborate hand-washing rituals and wearwhite gloves when handling any document hewould later touch. He ordered tape arounddoors and windows and forbade his staff totouch or even look at him.

Obsessive - Compulsive Disorder

Obsessions persistent and irrational intrusions or

unwelcome thoughts or images

Try it - The white bear

Compulsions irresistible urges to carry out certain acts or

rituals DVD example


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OCD: Cleaners vs. Checkers

Sex Distribution:

Dominant Emotion:

Speed of onset:

Length of behavior:

Feel better after?

Cleaners Checkers

Mostly female

Anxiety

Usually rapid

Less 1 hour at a time

Yes

Equal

Guilt and Shame

More often gradual

Some go on indefinitely

Usually not

Causes of OCD

Operant conditioning

anxiety paired to event and to behavior to reduce

anxiety

Biological

Abnormalities of the frontal lobes

organizing behaviors and planning.

Abnormality of the basal ganglia

involved in routine behaviors, like grooming, and thefrontal lobes

PTSD

During the Iraq war, Jacks platoon wasrepeatedly under fire. In one ambush, I closestfriends as killed while Jack stood a few feet away.Jack himself killed someone in an assault. Yearslater, images of theses event still intrude on his asflashbacks and nightmare. He still jumps at thesound of a firecracker or the backfire of a car.When annoyed by his family or friends, he lashesout in ways he seldom did before Iraq. To calmhis continuing anxiety, he drinks more than heshould.

Post-Traumatic Stress Disorder

Experiencing or witnessing severely threatening andtraumatic experiences Eg. War veterans, rape victims, accident survivors

Symptoms include:

Flashbulb memories Hypervigilance

Intrusive thoughts

Startle response

Nightmares

Insomnia

Social withdrawal

(Example: Carl Vietnam Vet if there is time)

Schizophrenia


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Dysfunction in social, emotional, cognitive, and

perceptual processes

Afflicts 1% of the general population Account for 30% of all hospital beds

Peak incidence occurs adolescence or early adulthood Onset can be sudden or gradual

Course of schizophrenia is variable

Effects may wax and wane across time

40% successfully treated

Best predictor pre-morbid functioning

Schizophrenia

Thought and attention

inability to filter out irrelevant stimuli loose associations (word salad); easily

distracted

delusions

Delusions of grandeur

Thought broadcasting

Thought blocking or withdrawal

Thought insertion

Schizophrenia Symptoms

Perceptual

Hallucinations

Generally auditory

Difficulty distinguishing reality from

imagination

Affective

dysregulated emotion

Flat; inappropriate tears, laughter or anger

Motor deficit in motor processes

Schizophrenia Symptoms (continued)Example

Discovering Psychology

20:19 22-30

Schizophrenia and Biology Dopamine hypothesis

high levels of activity at dopamine receptors in brain

only known treatment are neuroleptic drugs Block receptor sites Basically a tranquilizer

Enlarged cerebral ventricles (fluid-filled spaces) continue to enlarge as the disorder progresses,

signifying brain atrophy (loss of brain tissue)


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Mental disorders expressed in bodily symptoms No apparent physical cause Difficult to diagnose any physical cause must be ruled out

Hyphochondriasis: belief one has specific disease;continually seeks treatment despite no physical evidencefor illness

Somatization disorder: aches and pains inconsistent withany illness

Somatoform pain disorder: chronic pain with no apparentphysical cause

Conversion disorder: dramatic loss of function (numbnessof hand, paralysis) with no physical cause. Referred to as hysteria by Freud Not commonly diagnosed today

Somatoform Disorders

Mood Disorders

Affective (mood) disorders

Extreme disturbances of mood Can disrupt physical, perceptual, social, and thought

processes

Two major types Unipolar extreme at one end of mood continuum

Depression

Bipolar extremes at both ends of the moodcontinuum Major swings between depression and mania

Note each episode (dep or mania last for some time)

NOT Rapid cycling.

Mood Continuum

Extreme Negative Extreme Positive

Normal Range

Unipolar Depression

Bipolar Disorder

Depressive Disorder Persistent feelings of sadness and despair

Loss of interest in previous sources of pleasure

Symptoms also include:

feelings of worthlessness or guilt; low self-esteem

reduced motivation

disturbances of sleep, appetite, sex drive

reduced energy; move sluggishly/talk slowly

difficulties in thinking

recurrent thoughts of suicide


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Major Depression and Suicide

Of suicides, majority had suffered a major depression

250, 000 suicide attempts per year

1 in 8 are successful 8th leading cause of death

Age: highest attempts: 24-44 highest success: 55-65 adolescents: rate tripled in last several decades college students: almost twice the rate of non-college peers

Usually has to do with social relationships

Gender: women 3 times more likely to attempt suicide than men of those who attempt, men 4 times more successful

Men tend to use more effective means

Myths about SuicideMyth 1:

Failed attempts indicate the person is not serious

about dying

75% of those who succeed in committing suicide

have made at least one previous attempt

Myth 2:

Those who talk about suicide seldom make

attempts

70% of suicide victims had communicated their

intention to others

percentage is similar among college students

Myths about SuicideMyth 3:

Depressed people should be steered away from

talking about suicide for fear it will only

strengthen their resolve

letting despondent people talk may actually help

them to overcome those thoughts

Myths about Suicide

Important to get professionalhelp!

Risk of suicide may actually rise for a period

during recovery process

Greater risk during recovery than during depths of

depressive episode

Person may have more energy and control to carry

the suicide out

Mania State of exaggerated elation

Often accompanied by:

feverish activity

great distractibility

emotional high

inflated self-esteem

hyperactivity

reckless behavior

decreased need for sleep

constant talkativeness

flight of ideas


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Bipolar Disorder

Cycling between manic and depressive episodes

Tied to biological causes

Changes in brains approach system:

Highly activated during mania

Low activation during depression

Most often treated with lithium carbonate

Requires careful monitoring of toxicity

Personality Disorders

Personality DisordersClass of disorder marked by inflexible and maladaptive

ways of interacting with the world

Persistent

Antisocial Personality: Typicalattributes


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Antisocial Personality Often called sociopaths or

psychopaths

Show lower physiological

arousal

Less sensitive to peripheral

informational cues

Subjects received a shock at number 8

sociopaths show lower overall skin

conductance response and smaller

responses in anticipation of shockTed Bundy

Practice your understanding

Name that disorder

10. ABNORMAL PSYCHOLOGY

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