Abnormal PsychologyA.K.A. Psychological Disorders

Psychological Disorder1.unusual (deviant from typical behavior in that culture)2.causes distress in the person experiencing the symptoms3.harmful dysfunction : interferes with life

Early Theories• Abnormal behavior was evil

spirits trying to get out• Beatings, burnings,

castration, pulling teeth, removing parts of intestines, caged like animals, animal blood transfusions, & trephining were often used

Medical Model• 1800s medical model emerges, replaces

“evil” cause of mental illness• Medical Model: A mental illness needs

to be diagnosed on the basis of its symptoms and can be treated

• Biopsychosocial approach: today’s psychologists say that all behavior (normal or disordered) arises from interaction of nature & nurture– Nature: depression & schizophrenia…– Nurture: eating disorders, phobias…

Perspectives and DisordersPsychological

School/PerspectiveCause of the Disorder

Psychoanalytic/Psychodynamic Internal, unconscious drives, root in childhood

Humanistic Failure to strive to one’s potential or being out of touch with one’s feelings, being too sensitive to others’ criticisms/judgments, lack of positive regard as a child

Behavioral Reinforcement history, the environment. At some point the abnormal behavior has been rewarded or reinforced & is now an established pattern of behavior

Cognitive Irrational, illogical, dysfunctional thoughts or ways of thinking lead us to misperceive the world (leading to abnormal behavior)

Sociocultural Society & culture help define what is acceptable behavior

Biological/Neuroscience Organic problems, biochemical imbalances, genetic predispositions (very popular in US right now)

DSM IV (V is coming…)• Diagnostic and

Statistical Manual of Mental Disorders: the big book of disorders

• DSM will classify disorders and describe the symptoms

• DSM will NOT explain the causes or possible cures

DSM IV• Axis I

– major disorders (schizophrenia, depression, dementia, mood, eating, sleep…)

• Axis II– Developmental & Personality disorders

(antisocial, narcissism, autism, mental retardation…)

• Axis III– Physical disorders (brain injury, HIV/AIDS…)

• Axis IV– Assesses the level of psychosocial &

environmental stress the person is experiencing • Axis V

– Overall assessment of the person’s level of functioning

Two Major Classifications in the DSM

Neurotic Disorders• Distressing but one

can still function in society and act rationally.

Psychotic Disorders• Person loses contact

with reality, experiences distorted perceptions.

John Wayne Gacy

Anxiety Disorders• Anxiety Disorders:

characterized by distressing, persistent anxiety or dysfunctional behaviors to reduce anxiety

• the patient fears something awful will happen to them

• They are in a state of intense apprehension, uneasiness, uncertainty, or fear

Generalized Anxiety DisorderGAD

• An anxiety disorder in which a person is continuously tense, apprehensive, & in a state of autonomic nervous system arousal

• The patient is constantly tense and worried, can’t concentrate, switch from worry to worry and sleep deprived

• Cannot identify a cause• 2/3 are women

Phobias• An anxiety disorder marked by

a persistent, irrational fear and avoidance of a specific object, activity, or situation

• Social phobia: intense fear of being scrutinized by others, avoid potentially embarrassing situations (speaking up, going to parties…)

• Agoraphobia: fear of situations/places where escape is difficult when panic strikes

• Phobia List

PhobiasTop 10 phobias

•Fear of snakes•Fear of being buried alive•Fear of heights•Fear of being bound/tied up•Fear of drowning•Fear of public speaking•Fear of hell•Fear of cancer•Fear of tornadoes/hurricanes•Fear of fire

What are the following phobias?

•Uxoriphobia•Mikrophobia•Xenophobia•Trichophobia•Nyctophobia•Triskadekaphobia

Panic Disorder• 1 in 75 people• An anxiety disorder marked

by a minutes-long episode of intense dread in which a person experiences terror

• Will have chest pain, heart palpitations, dizziness, choking and other frightening sensations

• Those who smoke have double risk of panic disorder

Obsessive-Compulsive Disorder

• Persistent unwanted thoughts (obsessions, ex: germs, death…) cause someone to feel the need (compulsion, ex: checking locks, in/out of a door…) to engage in a particular action

• Obsessive thoughts, compulsive behavior/rituals

• Ex: Obsession about dirt and germs may lead to compulsive hand washing

• 2-3%, often in late teens/early twenties

Post-Traumatic Stress Disorder (PTSD)• Flashbacks/nightmares following a

person’s involvement in or observation of an extremely stressful event (accident, disaster, sexual assault, violence…)

• Memories of the event cause anxiety– Half of adults will experience at least 1

traumatic event, only 1 in 10 women ptsd, 1 in 20 men

• After 9/11, 8% ptsd, 19% of Vietnam vets• 1 in 6 Iraq vets have symptoms (1 in 4

some psych disorder)• Post-traumatic growth: positive

psychological changes that come from challenging circumstances– Greater appreciation for life,

priorities…– Good can come from our worst

experiences

Explaining Anxiety/Fears• 2 major perspectives to explain anxiety/fear

– Biological, learning (behaviorism)• Learning (classical & operant conditioning)

– Reinforcement (getting away from the dog reduces your anxiety=reinforcement)

– Easy to condition fear, hard to extinguish– Observational Learning (parents transmit fears to

children…)• Biological

– Ancestors passed on fears of spiders, snakes, heights, etc. (fearless people likely died)

– Some studies suggests serotonin & glutamate might influence anxiety

– Brain scans detect elevated activity in certain brain areas

Somatoform Disorders

• Occur when a person manifests a psychological problem through a physiological symptoms

• Two types……

Conversion Disorder

• Anxiety/stressful experience is converted into a physical problem

• Often related to the stress they are under-Ex: blindness, loss of sensation...-Ex: you fall off a horse & you become paralyzed even though you are not physically injured

Hypochondriasis

• A person interprets normal physical sensations as symptoms of a disease

• They usually believe that the minor issues (headache, upset stomach) are indicative are more severe illnesses

Dissociative Disorders

• These disorders involve someone experiencing a sudden loss of memory or change in identity

• Often in response to overwhelming stressful event

• Three types….

Psychogenic (Dissociative) Amnesia

• Mentally blocks out personal information

• Lose memories of distant & recent past

• Lose personal identity• Usually occurs after a

traumatic or stressful event

• Usually temporary• Not physical!

Dissociative Fugue

• Dissociative Amnesia & creating a physical distance from your real life

• Last usually only a few hours or days, rarely months Click above to

watch a real life example

Dissociative Identity Disorder

• Used to be known as Multiple Personality Disorder

• A rare disorder in which a person has 2 or more distinct, alternating personalities

• People with DID commonly have a history of childhood abuse or trauma

• Very controversialClick above to see an explanation of DID

Mood Disorders• Mood Disorders: Characterized by

emotional extremes• Affects 10% of Americans in a given year

Major Depressive Disorder• When at least 5 signs last 2 weeks or more

(not caused by drugs or medical condition)– Lethargic/fatigue/lack of energy– feelings of worthlessness– loss of pleasure/interest in activities– Loss of appetite/overeat– Lack of sleep/too much sleep

• Survey: 29% hs students, 44% college students• 13% of adults at some point, 15 million year • World Health Org- affects 5.8% of men & 9.5%

women in any yr• 1 in 4 w/ depression is struggling w/ a

significant loss (death, job, relationship)• #1 reason people seek mental health services

Seasonal Affective Disorder• Experience symptoms

of depression usually during the winter months– Places with long winter

nights

• Often occurs at the same time each year

• Treatment: light therapy, psychotherapy, medication

Bipolar Disorder• Person alternates b/w

hopelessness of depression & overexcited states of mania (formally manic depression)

• Mania: hyperactive, wildly optimistic state– Overactive, overtalkative,

little sleep, find advice irritating, exhibit poor judgment (unsafe sex, reckless spending…)

• 5.7 million Americans• Many Creatives: Walt Whitman,

Virginia Woolf, Ernest Hemingway, Mark Twain, Emily Dickinson, Vincent Van Gogh, Catherine Zeta-Jones, Jane Pauley

Understanding Mood Disorders• Women twice as likely to suffer depression• Bipolar equal among men & women• Disorders run in families

– More likely if parent or sibling has– Identical twins 1 in 2 depression, 7 in 10 bipolar

• MRI scans found frontal lobes 7% smaller in people w/ severe depression

• Neurotransmitters– Norepinephrine (increases arousal & boosts mood)

• Scarce during depression• Overabundant during mania

– Serotonin • Scarce during depression

Social-Cognitive Perspective• Explanatory Style

– Our way of thinking- how we explain the events in our lives

– Depressed people tend to blame themselves, feeding the negative feelings

– Remember: if you feel down, you think negatively & remember bad experiences

Suicide• Whites twice as likely as African

Americans• Women more likely to attempt, men

4xs more likely to succeed• 3 out of 5 suicides in US are shootings• More likely among rich, nonreligious,

single/widowed/divorced• 5x greater risk for those who been

depressed• Alcoholics 100x more likely• Teen suicides often linked w/ drug and

alcohol abuse• Gay youth & elderly more likely• 33,000 Americans/year• 90% have diagnosable mental disorder

If someone confides in you, they are crying out for help

Personality Disorders• Inflexible & continuous

behavior patterns that negatively affect people’s ability to function

• Dominates their personality

• Let’s Group Them: – The Dramatic Ones– The Fearful Ones– The Odd Ones

Antisocial Personality Disorder• Lack of conscience &

empathy• Little regard for

other’s feelings• No remorse• View the world as

hostile and look out only for themselves

• Formerly called sociopath

• 3% males, 1% females

Borderline Personality Disorder • Tries to avoid abandonment (real or imagined)• Pattern of unstable & intense relationships

– Idealize or devalue• Unstable self-image, feelings of emptiness• Impulsive

– Spending, sex, substance abuse…• Recurrent suicidal behavior (threats, cutting…)• Emotional instability• Intense anger & trouble controlling it (fights,

temper)• Paranoid thoughts• 75% are female, 2% of population

Histrionic Personality Disorder

• Needs to be the center of attention & feels uncomfortable when not

• Inappropriate sexual or provocative behavior

• Uses physical appearance to draw attention

• Thinks relationships are closer than they actually are

• Dramatic, theatrical, exaggerated emotions

• 2-3% of population

Narcissistic Personality Disorder• Having an exaggerated sense

of self-importance• Think only other super

important people can understand them

• Overwhelming need for admiration

• Patronizing, snobby• Preoccupied w/ fantasies of

unlimited, success, power, beauty…

• Lacks empathy• Arrogant behaviors &

attitudes• Exploits others• 1% population (more male)

Avoidant Personality Disorder

• Overwhelming feelings of inadequacy• hypersensitive to what others think

about them & rejection• Avoids socializing/interacting with

others• 0.5%-1% of population

Dependent Personality Disorder• Fear of being separated

from important people in their lives, become “clingy”

• Difficulty making everyday decisions

• Feels helpless when alone• Excessive lengths to get

support from others• Difficulty disagreeing with

others• Need others to take charge

in most areas of life

Paranoid Personality Disorder• Distrustful & suspicious of others• Thinks others’ motives are always bad• Affects every relationship they have• Preoccupied w/ doubts about loyalty of

friends• Reluctant to confide in others bc think it will

be used against• Holds grudges• 0.5%-2.5% of population

Schizoid Personality Disorder• Detached from social relationships• Doesn’t enjoy close relationships (even family)• Difficulty expressing emotions• Uninterested in sex, activities, relationships• Seems emotionally cold & detached• More common in males

Schizotypal Personality Disorder

• Odd beliefs that differ from cultural norms– Telepathy, bizarre fantasies

• Unusual perceptual experiences• Suspicious or paranoid• Odd, eccentric, strange behavior/appearance• Lack of close friends• Social anxiety (often associated w/ paranoia)• Less that 3%

Schizophrenic Disorders

• About 1 in every 100 people are diagnosed with schizophrenia (24 million worldwide)

Symptoms of Schizophrenia

1.Disorganized thinking2.Disturbed Perceptions3.Inappropriate Emotions

and Actions

Disorganized Thinking• The thinking of a person

with Schizophrenia is fragmented and bizarre and distorted with false beliefs

• Delusions: false beliefs– Persecution: people are

trying to kill me, watching me, etc.

• Common for those w/ paranoid tendencies

– Grandeur: I am the Wizard of Oz, Jesus, etc.

• Disorganized thinking may come from a breakdown in selective attention- they cannot filter out information & focus on one stimulus

Disturbed Perceptions

• Hallucinations- sensory experiences without sensory stimulation

• They see, hear, smell, feel things that aren’t there

• Most often auditory hallucinations (horrible insults, giving orders)

• They seem real!

Inappropriate Emotions & Actions

• Laugh at inappropriate times, angry for no apparent reason

• Flat Affect (emotionless state)

• Senseless, compulsive acts.

• Catatonia (catatonic state) – motionless for hours then

agitated

Onset of Schizophrenia• Usually as moving into adulthood

– Men: late teens-early 20s– Women: early-mid 20s

• Positive symptoms– Hallucinations, exhibit inappropriate

emotions, disorganized talking– Presence of inappropriate behaviors

• Negative symptoms– Toneless voices, expressionless

faces, catatonic states– Absence of appropriate behaviors

Subtypes of Schizophrenia

Disorganized Schizophrenia

• disorganized speech or behavior

• flat or inappropriate emotion

Paranoid Schizophrenia

• preoccupation with delusions or hallucinations

• Somebody is out to get me!!!!

Catatonic Schizophrenia

• Immobility• Extreme

negativism• parrot like

repeating of another’s speech and movements

Undifferentiated Schizophrenia

• Many and varied Symptoms

Understanding Schizophrenia• Excess of dopamine receptors (6x)

– Drugs to treat block, cocaine & amphetamines intensify

• Glutamate research• Brain area activity (several areas, not just 1)

– Low activity in frontal lobes (reasoning, planning, problem solving)

– PET scans while hallucinating: • very active & small thalamus (sensory

relay center), maybe difficult to filter sensory info & focus attention

• very active amygdala (fear) for paranoid schizophrenics

• Pregnancy risk factors– Low birth weight, deprived of oxygen

during delivery, famine– Flu

Treatment of Psychological Disorders

• History of treating mental illness was barbaric• Crusaders like Dorothea Dix changed treatment

(mental hospitals)• 2 main categories of mental health therapies:

1. Psychotherapy (overcome difficulties & achieve personal growth)

2. Biomedical therapy (medication or medical procedure)

• Many psychotherapists say they take an eclectic approach

– blending different types of therapy depending on the client’s problem

Psychotherapy• Psychotherapy: treatment w/

interaction between therapist & someone seeking to overcome psychological difficulties or achieve personal growth

• Freud’s psychoanalysis (repressed childhood trauma, hypnosis, free association, dream interpretation)– Not practiced like Freud anymore

but…• Resistance: blocking memories,

experiences that cause anxiety• The analyst will interpret

behaviors, dreams, events…in order to promote insight

• Transference: patient transfers emotions linked with other relationships on the analyst (+ or -)

Evaluating Psychotherapy

• Clients and therapists say yes! but that in itself cannot prove its effectiveness

• Meta-analysis: procedure for statistically combining results of different studies

• The verdict: those not undergoing therapy often improve, but those undergoing therapy are more likely to improve

Humanistic Therapy• Psychoanalytic & Humanistic

therapies are both insight therapies – providing new insights to help

better understand motives, boost self-fulfillment & self-acceptance)

• Focuses on present & future (not past), conscious motives (not unconscious), taking responsibility for feelings & actions, promoting growth instead of curing illness (clients not patients)

• Therapists exhibit genuineness, acceptance, & empathy b/c clients already have the potential for growth

Humanistic• Client-Centered Therapy (Carl Rogers)

– non-directive therapy and listens w/o judging or interpreting; client is to find own insights

– Active Listening • Paraphrase (summarize in your own

words to check understanding)• Invites clarification (“What might be an

example of that?”)• Reflect feelings (acknowledge their

feelings & mirror what you are sensing)– Self-actualization, free-will and

unconditional positive regard• Gestalt Therapy by Fritz Perls encourage

clients to get in touch with whole self.

Behavioral Therapies• Behavior therapy: applies

learning principles to eliminate unwanted behaviors

• Believe can replace learned behaviors w/ constructive behaviors

• Counterconditioning: uses classical conditioning to generate new responses to stimuli• Exposure Therapy: expose

people to what they normally avoid

Behavior: Exposure Therapies

1. Systematic Desensitization (negative to positive)-associate a nice, relaxed state by exposing people to things they fear & avoid-common in treating phobias

2. Aversive Conditioning (positive to negative) -associates an unpleasant state w/ unwanted

behavior -ex: nausea w/ drinking alcohol, bitter taste w/

nail bitingOperant Conditioning• Behavior modification• Token Economy: get token for desired behavior

& can trade in for privilege or treat

Cognitive Therapy• Aaron Beck• Goal: teach people new,

more constructive ways of thinking– Negative, self-defeating

thinking

• Rational Emotive Behavior Therapy (Albert Ellis)– The way people feel is

largely influenced by how they think

– Change their irrational thinking

Group Therapy• Helps people discover that

other have similar problems – Can be very reassuring

• Family Therapy– Problem: stressful

relationships– Focused on healing

relationships, not 1 person– Resolving conflicts

Biomedical TherapiesPsychopharmacology• Antipsychotics: treats

schizophrenia– Reduce dopamine activity in

brain– Haldol, thorazine

• Anti-anxiety: Increases GABA to decrease brain activity in areas that relate to anxiety– Valium, xanax

• Antidepressants & Mood Elevators: increase serotonin & norepinephrine activity levels– Prozac, MAOIs, SSRIs

Brain Stimulation• ECT (electroconvulsive therapy)

– Extremely effective for those w/ severe depression (80%) drugs have not worked

– Given anesthetic & muscle relaxer, some memory loss during treatment period (3 weeks)

– No one really knows why• Psychosurgery

– Most drastic, least used• Parkinson’s, Epilepsy, OCD

– Lobotomy• Very common in 50s & 60s• not used anymore