Abnormal psychology

ABNORMAL PSYCHOLOGY

HISTORY OF UNDERSTANDING PSYCHOLOGICAL DISORDERS In Ancient times, disorders were thought

to have been caused by movements of the sun and moon (lunacy is full moon) or by evil spirits.

Treatments for people with mental illness were very inhumane even up until the mid 1900’s. Patients were often chained like animals, beaten, burned, castrated, etc.

CONDITIONS FOR PSYCHOLOGICALLY DISABLED

European Trephines “released evil spirits.”

Ancient Greek Trephines

CONDITIONS FOR PSYCHOLOGICALLY DISABLED

MEDICAL MODEL IMPROVES CONDITIONS Eventually the medical model came to

dominate understandings of mental illness.

The medical model assumes that diseases have physical causes that can be diagnosed based on their symptoms and be treated and in most cases cured.

Assumption of medical model drastically improves conditions in mental hospitals.

BUT, the medical model often times promotes the myth that disorders are brought on by single causes.

HISTORICAL TREND OF DEINSTITUTIONALIZATION Starting in the 1950s and 1960s more

and more drugs began being used to “cure” psychological disorders.

Because of this there was a policy of deinstitutionalization instituted where patients were removed from mental institutions to live in family based or community based environments.

PSYCHOLOGICAL DISORDERSPSYCHOLOGICAL BEHAVIORS RUN A CONTINUUM FROM VERY MILD TO EXTREME. EVERYONE HAS THESE BEHAVIORS TO ONE DEGREE OR ANOTHER. IT IS NOT UNTIL A BEHAVIOR OR FEELING INTERFERES WITH YOUR QUALITY OF LIFE THAT THEY BECOME A DISORDER.

PSYCHOLOGICAL DISORDERS ARE:

Atypical (deviant)Disturbing (distressing)

Maladaptive (dysfunctional)Unjustifiable

What is “insane”?Insanity is a legal definition, not a psychological one. The

term of insanity is applied to someone who is incapable of determining if an act is wrong and cannot control their behavior.

The insanity defense is rarely used – just 0.9% of the time (9 times in 1000). The success rate is less than 20% of the time it is used. People who are declared not guilty by reason of insanity generally spend more time institutionalized than they would have been imprisoned.

Being declared insane is not the same as being declared not competent to stand trial – this simply means you are unable to understand the charges against you and the proceedings of the court (could apply to very young children, for example).

Defining DisordersDSM IV-Diagnostic and statistical manual vol. 4.: attempts to describe psychological disorders, without explaining the causes, predicts the future course, and suggests treatments. It focuses on observable behaviors to make diagnoses.

Categorizes 400+ disorders, in 17 categories.

Axis I: refers to clinical disorders which need clinical attention. Includes most mental disorders Ex: Depression, Schizophrenia, Phobia, etc.

Axis II: Includes personality disorders and mental retardation. Ex: Antisocial, Narcissistic, Avoidant, etc.

Axis III: relates to physical conditions which may contribute to mental illness. Ex: brain injury, cancer, HIV, etc.

Axis IV: relates to psycho-social events in a persons life which may contribute to mental illness. Ex: death of a loved one, divorce, new job, etc.

Axis V: relates to a rating clinician gives patient on how well they are functioning in life presently and within the last year.

Advantages of Diagnosis and the DSM-IV Diagnosis can facilitate communication Diagnosis can provide etiology (study of

causation) clues Diagnosis provides prognosis (likely outcome) Diagnosis can give direction for treatment plans Disadvantages of Diagnosis and the DSM-IV Diagnosis is not theoretically neutral No clear line between normal and abnormal in

many cases Reliability is still a problem (if 5 psychologists

examine a patient will they all come up with the same diagnosis?)

Diagnostic labels may take on a life of their own and are hard to remove – LABELING THEORY – Rosenhan – this can lead to self-fulfilling prophecy.

DAVID ROSENHAN TESTS POWER OF LABELING AND ITS RELIABILITYDescription of Rosenhan’s study:

He had colleagues attempt to fake symptoms to get into mental hospitals. Each pseudopatient told the hospitals they had been hearing voices. Apart from that they told no lies other than fake names, addresses, etc.

After being admitted, the fake patients acted completely normal. Hospital staff failed to identify the fakers and interpreted all of their normal behavior in terms of mental illness. Ex: guy taking notes was said to have “writing behavior” which seemed pathological.

What does this say about the impact of labeling?

Psychological Disorders: Causes

Are not usually caused by a single factor. The bio-psycho-social school argues that most disorders

are caused by a biological predisposition, physiological state, psychological dynamics, and

social circumstances.

+ = DISORDER

The diathesis-stress modelThe model looks at the diathesis or genetic/biologic vulnerability to a disorder/disease and the stress(or)s that may trigger it.  The diathesis-stress model uses the analogy of a "walking time bomb" to help explain why, for example, not 100% of identical twins both get schizophrenia. It also helps to explain why a large percent of people in traumatic situations (post 9/11, rape, etc.) never develop PTSD. The model further talks about a balance -- the greater the diathesis or predisposition, the less the stress required for the disorder to "appear" and visa versa. 

Biological / genetic

predisposition

Stress(environment)

MOST MENTAL HEALTH PROFESSIONALS ASSUME DISORDERS HAVE INTERLOCKING CAUSES

Bio-Psycho-Social Perspective: assume biological, psychological, and socio-cultural factors interact to produce disorders.

Biological(Evolution, individual

genes, brain structures

and chemistry)

Psychological(Stress, trauma,

learned helplessness, mood-related perceptions

and memories)

Sociocultural(Roles, expectations, definition of normality

and disorder)

WHAT ARE THE CATEGORIES DISORDERS FIT INTO?Categories of Disorder:

1. Anxiety2. Mood3. Dissociative4. Schizophrenia (No Need in IB)

5. Personality6. Somatoform (Not in Book)7. Facticious (Not in Book)

ANXIETY DISORDERS

Anxiety Disorders in general refer to disorders that involve persistent and distressing nervousness and apprehension OR maladaptive behaviors which reduce anxiety (defenses against anxiety).

General Characteristics of Anxiety: Constant worrying, fear, or uncertainty Feels inadequate Oversensitive Difficulty concentrating May suffer insomnia

General Anxiety Disorder: person is tense, apprehensive, and in a state of autonomic nervous system arousal (Sympathetic N.S.).

Persistent symptoms: sweating, heart racing, dizziness, shaking accompanied by persistent negative feelings and fear…not triggered by specific events.

ANXIETY DISORDERS

ANXIETY DISORDERSPanic Disorder: unpredictable,

minutes long intense anxiety attack, as if you're going to be killed any second, but no specific, real threat is apparent. “Panic Attacks.” Usually accompanied by chest pain or other frightening sensations.

Obsessive-Compulsive Disorder (OCD): Obsessions: intrusive thoughts or fears.

Compulsions: repetitive behaviors that soothe the fears

example of OCD ritual behavior

“As Good As It Gets”

ANXIETY DISORDERS

Anxiety Disorders

ii. Social: Fear of being embarrassed in public. Example: public speaking

iii. Agoraphobia: Fear of public spacesCopycat – Sigourney Weaver

Phobias:i. Specific: persistent, irrational fear of a specific object of situation. They are fairly common. Spiders, snakes, heights, water, enclosed spaces are all very common phobias.

Anxiety Disorders

Phobias:

SPECIFIC PHOBIAS

Triskaidekaphobia

PHOBIAS

Santa Claustrophobia

PHOBIA

Trichophobia

Post Traumatic Stress Disorder (PTSD): caused by prolonged or intensely stressful situations, like war or rape.

Symptoms: difficulty sleeping, nightmares; anxiety attacks or Generalized Anxiety Disorder (GAD); intrusive memories; Guilt associated with event;

US Military awareness campaign- PTSD & mTBI (mild traumatic brain injury)

ANXIETY DISORDERS

ANXIETY DISORDER (NOT IN BOOK)

Tourette’s Syndrome: involves involuntary twitching and the making of unusual sounds.

dopamine which helps control movement and norepinephrine, which helps body respond to stress seems to be involved in Tourette’s Syndrome.

Marc Elliott – Tourette’s Tolerance

CAUSES OF ANXIETY DISORDERS FROM LEARNING PERSPECTIVE (SOCIO-CULTURAL)

1. Fear Conditioning : ex: rape victim may develop fear of being alone in apartment.

2. Stimulus Generalization: ex: fear of heights leads to fear of flying even without flying.

3. Reinforcement (ENCOURAGES behavior): avoiding places you have phobia about rewards you by lessening your anxiety.

4. Observational Learning/Modeling observing others display symptoms

CAUSES OF ANXIETY DISORDERS FROM BIOLOGICAL PERSPECTIVE

1. Evolution: certain fears help us survive.

2. Genes: correlations with identical twins and phobias.

3. Physiology: brain chemistry. Often see increased brain activities in brain areas involving impulse control. Ex: picture overactive frontal lobe activity involved in directing attention.

CAUSES OF ANXIETY DISORDERS FROM COGNITIVE PERSPECTIVE

An individual interprets (or misinterprets) a harmless situation as a dangerous or threatening situation.

Somatoform Disorders:Various disorders that have no medical cause They must happen before age 30 – rules out aches and pains of aging.

Conversion Disorder: A person develops symptoms such as paralysis, numbness or blindness. Yet, there is no medical reason for the symptoms.Hypochondriasis: Preoccupation or worry about having a serious illness ex. My headache is a sign I have a brain tumor.

Examples:

Somatization Disorder: Repeated complaints about vague and unverifiable medical conditions: dizziness, nausea, conscious awareness of an irregular heartbeat (too fast, too slow, etc).

CAUSES OF SOMATOFORM DISORDERS FROM THE PSYCHOANALYTIC PERSPECTIVE The disorders are repressed emotions

that get transformed into physical symptoms

CAUSES OF SOMATOFORM DISORDERS FROM THE BEHAVIORAL PERSPECTIVE Operant conditioning is responsible

because the patient gets rewarded for his/her complaints (medicine, attention)

CAUSES OF SOMATOFORM DISORDERS FROM THE SOCIAL COGNITIVE PERSPECTIVE Patients pay too much attention to

their health which results in sensations that are more easily perceived (patients notice every little ache or spot on their skin, etc.)

Dissociative DisordersDissociation is the feeling that you are outside of yourself, looking at yourself. That your mind is separate from your body. A person’s memories and emotions are somehow separated from his/her conscious awareness. This is a controversial disorder. Many experts do not believe it is real. Dissociative AmnesiaSelective memory loss of a specific traumatic event (not a brain injury). The amnesia vanishes as abruptly as it begins and rarely reoccurs. Ex. A woman who gives birth to a stillborn baby might not remember that she was even pregnant.

Fugue-stateThis type of dissociation involves a person who just leaves one’s home and starts on new life, with no memory of one’s past life. The memory may reoccur and the person may return home, only to leave again.Dissociative Identity Disorder:This is a disorder wherein your mind partitions itself into two or more distinct personalities that may or may not know about each other. One “personality” emerges to handle stressful situations that the whole psyche or other parts cannot handle.

Caused by traumatic event or events where the mind represses parts of itself that can’t handle the pain. Repressed from a psychoanalytical point of view.The Debate Over Multiple Personalities (DID)

Dissociative Disorders

CAUSES OF DISSOCIATIVE DISORDERS FROM THE PSYCHOANALYTIC PERSPECTIVE Repression of a traumatic event

MOOD DISORDERSPsychotic Period

                                                                                                                                                                                                                      In any given 1-year period, 9.5% of the population, or

about 18.8 million American adults, suffer from a depressive

illness.

DEPRESSION A depressive disorder is an illness that involves the body, mood

and thoughts.

It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things.

Nearly everyone will experience at least some type of mild depression in their life often due to some external sad event.

A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away.

People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

SYMPTOMS OF DEPRESSION Persistent sad, anxious, or "empty" mood Feelings of hopelessness, pessimism Feelings of guilt, worthlessness, helplessness Loss of interest in hobbies and activities that were once enjoyed Decreased energy, fatigue, being "slowed down” Difficulty concentrating, remembering, making decisions Insomnia, early-morning awakening, or oversleeping Changes in appetite and weight loss or weight gain Thoughts of death or suicide; suicide attempts Restlessness, irritability Persistent physical symptoms that do not respond to treatment,

such as headaches, digestive disorders, and chronic pain

TYPES OF MOOD DISORDERSMajor Depressive DisorderCombination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities.

Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

DysthmiaA less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Less severe than major depressive disorder.

5 (or more) of the symptoms have been present during the same 2-week period

GENDER DIFFERENCES IN RATES OF DEPRESSION Women experience depression about twice as

often as men.

Although men are less likely to suffer from depression than women, 3 to 4 million men in the United States are affected by the illness. Men are less likely to admit to depression, and doctors are less likely to suspect it.

The rate of suicide in men is four times that of women, though more women attempt it. In fact, after age 70, the rate of men's suicide rises, reaching a peak after age 85.

GENDER AND DEPRESSION

0

5

10

15

20

25

Males Females

Percentageof population

aged 18-84experiencing

majordepression

at somepoint In life

20

15

10

5

0

USA Edmonton Puerto Paris West Florence Beirut Taiwan Korea New Rico Germany Zealand

Around the worldwomen are more

susceptible todepression

GENDER AND DEPRESSION

12-17 18-24 25-34 35-44 45-54 55-64 65-74 75+

Age in Years

10%

8

6

4

2

0

Percentage

depressed

Females

Males

EXPLAINING DEPRESSIONPsychoanalyticNegative events that occur in adulthood evoke memories of childhood traumas OR unresolved anger or sadness in your unconscious from your childhood are turned inward.BiologicalNorepinephrineSerotonin(people suffering from depression tend to have low levels of both of these neurotransmitters) •Genetics •(if an identical twin suffers from major depressive disorder or bipolar disorder the chances that the other twin will experience symptoms is higher than those with a fraternal twin who is suffering)

Social-cognitive“attributional theory”

the depressed person tends to think: internal

("it's my fault"),

stable ("things can't

change") global ("this affects

everything")BehavioralLearned helplessness

SYMPTOMS OF BIPOLAR DISORDERCycling mood changes: severe highs (mania) and lows (depression)

Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. Mania, left untreated, may worsen to a psychotic state. Symptoms of Mania:Abnormal or excessive elationOveractive / overtalkative Unusual irritability Decreased need for sleep Grandiose notions Increased talking

Racing thoughts Increased sexual desire Markedly increased energy Poor judgment Inappropriate social behavior

SEASONAL AFFECTIVE DISORDER• regularly occurring symptoms of depression (excessive

eating and sleeping, weight gain) during the fall or winter months

• full remission from depression occur in the spring and summer months• • symptoms have occurred in the past two years, with no

nonseasonal depression episodes

• seasonal episodes substantially outnumber nonseasonal depression episodes.

• a craving for sugary and/or starchy foodsCAUSE OF SAD?Melatonin is normally released by the pineal gland in the evening as sunlight is diminishing. Melatonin causes us to feel tired and withdraw. This helps us to sleep, but if we have to be awake when melatonin is in our system, we become lethargic, disoriented, irritable and moody. Almost everyone with a mood disorder suffers worse in the winter because of excess melatonin in his or her system.

PERSONALITY AND FACTICIOUS DISORDERS

PERSONALITY DISORDERS ARE A DIAGNOSTIC CATEGORY WHICH DESCRIBES INFLEXIBLE BEHAVIOR PATTERNS THAT IMPAIR SOCIAL RELATIONSHIPS AND FUNCTIONING.

Types of Personality Disorders:

Paranoid Personality DisorderHistrionic Personality DisorderBorderline Personality DisorderNarcissistic Personality DisorderAntisocial Personality Disorder

TYPES OF PERSONALITY DISORDERS:

Paranoid Personality Disorder: constant and longstanding mistrust of others; believe others are out to get you. (more common in males)

Histrionic Personality Disorder characterized by excess and extreme emotions and attention seeking behavior. Always need to be center of attention, overly dramatic, and often inappropriately sexually provocative.

Types of Personality Disorders:

Borderline Personality: characterized by instability in relationships and moods. Tend to have poor self-image and are very impulsive and unpredictable. Black and white thinking.

TYPES OF PERSONALITY DISORDERS:

Narcissistic Personality: characterized by an exaggerated sense of self-importance. Often believes they are overly “special,” and that they are entitled to special treatment. “Don’t you know who I am?” Very self-absorbed.

TYPES OF PERSONALITY DISORDERS:

Don't worry if this sounds a little bit like you. A small amount of narcissism is a healthy thing. It shows you have self-esteem, protects you against others, and allows you to take care of yourself.

It's only when the scales tip too far the other way, when you no longer care about other people or what they need, that could indicate that you may have stepped into the narcissist trap.

5 signs that should alert you to a potential Facebook narcissist:

1. They have an astoundingly high number of Facebook friends and wallposts. Just like in real life narcissists focus on quantity of friends over quality and have many superficial friendships.

2. Their profile photo is posed, glamorous and otherwise artificial. A narcissist will use a glamorous, posed and otherwise artificial picture of themselves while people with a more healthy sense of self are content with an honest snapshot of what they really look like.

3. They have opened profiles on more than one self-promotion site like Facebook, YouTube and MySpace. A narcissist never gets tired of speaking or writing about themselves.

4. They were born after the 1980's. Since the 1980's there has been a wave of overly empathic parenting. "Instead of teaching children and teens to figure things out, accept consequences for their actions, and feel any real pain, parents rush in to rescue, solve and eliminate all struggle for their kids.“

5. They tend to use their site to put other people down.

5 signs that should alert you to a potential Facebook narcissist:

Narcissistic Personality Inventory:Want to check you rate on seven component traits of narcissism? Go to the following website:

http://psychcentral.com/cgibin/narcissisticquiz.cgi

TYPES OF PERSONALITY DISORDERS:

ANTISOCIAL PERSONALITY DOES NOT MEAN SHYNESS/NOT GOOD WITH PEOPLEAnti-Social Personality Disorder: characterized by a lack of conscience for wrong-doing toward anyone. Fail to conform to social norms and laws. Very deceitful, irresponsible, and dangerous. Often aggressive or con artists and fearless. No remorse for wrongdoing. Murderers like Charles Manson.

BIOLOGICAL LINK TO ANTI-SOCIAL BEHAVIOR? PET scans illustrate reduced

activation in a murderer’s frontal cortex Normal Murderer

FACTICIOUS DISORDERSFacticious Disorders: are conditions in

which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms.

Ex. Münchausen syndrome: psychiatric disorder where one fakes physical or psychological illnesses or diseases to gain sympathy for themselves. Münchausen syndrome by proxy: involves inflicting physical symptoms on others usually a child to gain sympathy.

MISCELLANEOUS DISORDERPhenylketonuria (PKU): a genetic

disorder that makes metabolizing certain foods (most proteins for example) impossible.

If undetected or untreated, it can cause mental retardation, seizures and / or brain damage.

Treatment usually consists of a special diet that a person must be on for life.

Percentage of Americans Who Have Ever Experienced Psychological Disorders

Disorder White Black Hispanic Men Women Totals

Ethnicity Gender

Alcohol abuse or dependence 13.6% 13.8% 16.7% 23.8% 4.6% 13.8%Generalized anxiety 3.4 6.1 3.7 2.4 5.0 3.8Phobia 9.7 23.4 12.2 10.4 17.7 14.3Obsessive-compulsive disorder 2.6 2.3 1.8 2.0 3.0 2.6Mood disorder 8.0 6.3 7.8 5.2 10.2 7.8Schizophrenic disorder 1.4 2.1 0.8 1.2 1.7 1.5Antisocial personality disorder 2.6 2.3 3.4 4.5 0.8 2.6