ABNORMAL PSYCHOLOGY

WHAT QUALIFIES AS A DISORDER?

•Unjustifiable (no real and sensible explanation can be given)•Maladaptive (prevents individual from living a normal life)•Atypical (for the culture a person is in)•Disturbing (causes individual or others distress)

THINKING ABOUT LABELS

•What is the difference between calling someone “a schizophrenic” and calling them “a person with schizophrenia”? Which one would you prefer to be called?• If students qualify for a label such as “learning disability” or “ADHD,” at what age should they be told about it? Should teachers be told?

CULTURE-BOUND DISORDERS

• Anorexia nervosa and bulimia nervosa are found mostly in Western cultures

• Susto (anxiety and fear of black magic) is found in children in Latin America

• Latah causes uneducated middle-age and elderly women in Malaysia to repeat others, swear, and do the opposite of what people ask in response to fear brought on by a specific circumstance

• Amok primarily affects men in the Philippines and parts of Africa. Symptoms begin with social withdrawal and disconnect from reality, followed by jumping violently, yelling, and attacking objects and people, and ending with a period of depression and amnesia of the episode

• Winigo, intense fear of becoming a cannibal, was common among Algonquin Indian hunters who returned from a hunt empty-handed. Symptoms included depression, loss of appetite and sleep, and occasionally cannibalism.

ANXIETY DISORDERSIntense and persistent uneasiness and/or dysfunctional anxiety-reducing

behaviors

GENERALIZED ANXIETY DISORDER

• Symptoms: worry, sleep deprivation, agitation, trouble concentrating, trembling, twitching, perspiring, fidgeting•No identifiable cause for anxiety (difficult to deal with)• Affects women more often than men, usually below age 50, 3.1% of Americans

•Often occurs with depression• Both can be treated with Effexor and Paxil, a serotonin reuptake inhibitor

PANIC DISORDER

• Symptoms: panic attacks – episodes of intense fear accompanied by heart palpitations, shortness of breath, choking sensations, trembling, or dizziness • 1.3% of population, smokers have double the risk of non-smokers•Often accompanied by agoraphobia (fear of public spaces) because people fear having a panic attack in public

PHOBIAS

• Specific phobias (of spiders, clowns, thunderstorms, etc) may cause maladaptive avoidant behaviors • Social phobia is a fear of acting awkward or anxious in front of others, often causes people to avoid social situations such as eating in public• Phobias may be learned through conditioning and are often successfully treated with counterconditioning or exposure therapy• Affects 6.8% of population

OBSESSIVE-COMPULSIVE DISORDERAnd related disorders: A new category for DSM V, formerly included in

anxiety disorders

OCD

• Symptoms: obsessive thoughts compel repetitive behavior• Person generally has insight – recognize that they have a problem, may feel overwhelmed by symptoms• 2-3% of Americans have this, most often develops in teens and young adults but may be present in children; lessens with age

COMMON EXAMPLES OF OCD SYMPTOMS

Obsession• Concern with

dirt/germs/toxins• Something terrible

happening• Symmetry, order, or

exactness

Compulsion (often done a certain number of times)

• Excessive hand-washing, bathing, cleaning• Repeating rituals (checking

locks, stoves, going through a door)• Counting things such as

steps taken or words said

OTHER DISORDERS RELATED TO OCD

•Hoarding disorder (new for DSM-V!) – people feel the need to save everything and great distress parting from possessions • 2-5% population

• Trichotillomania – hair-pulling disorder• Excoriation – skin-picking disorder

TRAUMA- AND STRESSOR-RELATED DISORDERS

New category for DSM V!

POSTTRAUMATIC STRESS DISORDER

•DSM IV-TR categorizes it as an anxiety disorder• Causes: “Exposure to actual or threatened death, serious injury, or sexual violation” through direct experience, witnessing an event in person, learning that it happened to a loved one, or repeated encounters with details (not through media) of the event

PTSD

• Symptoms:• Re-experiencing event in memories or dreams• Avoidance of memories, thoughts, or similar situations• Negative cognitions and moods (depression, social isolation,

etc.)• Arousal (aggression, hyperviligance, etc.)• 3.5% Americans, up to 25% of those who have seen combat• Most people who survive a trauma do NOT develop PTSD

LEARNING PERSPECTIVE ON ANXIETY DISORDERS

•We learn fears through conditioning: people may overgeneralize a stimulus (fear all storms instead of just tornadoes) • Anxiety-reducing behaviors are reinforcing: someone with a germ obsession may feel calmer after washing hands and thus wash more frequently

BIOLOGICAL PERSPECTIVE ON ANXIETY DISORDERS

• Many common phobias and compulsions may be adaptive in mild form• Genes may make some predisposed to be anxious/fearful,

sometimes by regulating NTs• Brain circuits in amygdala influence fear, those in anterior

cingulate cortex, which checks actions for errors, are especially active in those with OCD

SOMATOFORM DISORDERSNow called “Somatic Symptom and Related Disorders”

SOMATOFORM DISORDERS

• Soma = body• People experience physical symptoms (anything from dizziness or nausea to extreme pain) with no apparent physical cause•Generalized complaints such as exhaustion are more common in cultures where expressing psychological distress is not the norm

CONVERSION DISORDER

• not as common today as in Freud’s time; patients “convert” anxiety into a real physical symptom (including numbness, paralysis, or blindness)

HYPOCHONDRIASIS

• Symptoms: interpret normal physical sensations (headache or cramp) as signs of terrible disease (not the same as faking illness!)•May be reinforced by sympathy/attention from others•Many patients try doctor after doctor and refuse to believe that nothing is wrong

DISSOCIATIVE DISORDERS “Dissociate” = separate from reality

DISSOCIATIVE DISORDERS

• Very rare•Difficult to prove•May develop as a way to protect oneself from trauma - detach from situation and emotions

DISSOCIATIVE IDENTITY DISORDER (DID)

• Former called multiple/split personality• Symptoms: A person’s thoughts, behavior, and actions are alternately controlled by at least two different identities with distinct personalities and mannerisms•Original personality usually claims to be unaware of others•Usually not violent

DISSOCIATIVE AMNESIA

• Complete identity loss due to trauma

DISSOCIATIVE FUGE

• Complete loss of identity• Patients travel far from home and may turn up in a faraway city as “John Doe”

CRITICISM OF DISSOCIATIVE DISORDERS

• DID may be inadvertently manufactured by therapists: most DID patients are highly susceptible to hypnosis, so if a therapist asks to speak to a different part of them, they may invent one

• Patient may get so into acting like someone else that they convince themselves

• Number of reported cases increased from 2 per decade to 20,000 per decade after it was officially coded a disorder in the DSM

• DID is found almost exclusively in North America

• However, many DID patients do report suffering intense trauma or abuse as children

MOOD DISORDERS

MAJOR DEPRESSIVE DISORDER

• Affects roughly 6% of men and 10% of women worldwide in a given year• Person must have 5 signs of depression that last at least 2 weeks (not caused by drugs/medical condition)•May end on its own or with therapy

• Signs may include• Lethargy• Feeling worthless• Loss of interest in social interaction or previously enjoyed activities • Insomnia or hypersomnia• Poor appetite or overeating•Difficulty concentrating or making decisions

BIPOLAR DISORDER

• Switching from back and forth from depression to mania• Symptoms of mania:• Hyperactivity • Feel little need for sleep• Overconfidence (may lead to poor judgement)• Creativity/energy

•Generally life-long, can be regulated with medication

SEASONAL AFFECTIVE DISORDER

• Change in seasons causes change in brain chemistry • People experience symptoms of depression in the winter

PERSONALITY DISORDERSInflexible and enduring behavior patterns that impair social functioning

3 CLUSTERS OF PERSONALITY DISORDERS

• Cluster A: exhibits odd or eccentric behavior; schizoid, paranoid, schizotypal• Cluster B: demonstrates impulsive or dramatic behavior; antisocial, borderline, histrionic, narcissistic• Cluster C: anxiety-related behaviors; avoidant, dependent, obsessive-compulsive personality disorder (different from OCD)

ANTISOCIAL PERSONALITY DISORDER

• Formerly called psychopaths or sociopaths•Usually affects men, symptoms show before age 15• Antisocial individuals: • Lack regret for actions and compassion for others•May be highly intelligent and charming• Often exhibit criminal behavior such as lying, stealing, or unrestrained sexual behavior

BIOLOGICAL CAUSES OF ANTISOCIAL BEHAVIOR

•Genetic predisposition to have lower levels of stress hormones may cause risky and irresponsible behavior•Murders have smaller-than-average frontal lobes• Environmental factors also influence behavior

SCHIZOPHRENIA“Split mind”, as in “split from reality”

SYMPTOMS

•Delusions – false beliefs; in people with paranoid tendencies, especially belief that others are out to get them•Disorganized thinking – “word salad” describes sentences that don’t make sense, often including made-up words (neologisms) • perhaps because of lack of selective attention

SYMPTOMS

•Hallucinations – false perceptions, most often auditory and insulting or commanding• Inappropriate emotions – opposite of what others display or flat affect – no emotions at all• Strange actions – excessive, unnecessary movement or catatonia, no movement for long periods of time

SYMPTOMS

• Symptoms may be positive (something is added – hallucinations or active emotions) or negative (something is absent –flat affect or catatonia) • Symptoms may develop over time: chronic or process schizophrenia, less likely to be cured• Symptoms may begin suddenly after a stressor: acute or reactive schizophrenia, much more likely to respond to medication

5 TYPES OF SCHIZOPHRENIA

• Paranoid – concerned with delusions or hallucinations•Disorganized – disorganized speech/behavior, inappropriate emotions• Catatonic – lack of movement or excessive meaningless movement, repetition of others’ speech•Undifferentiated – shows a variety of symptoms• Residual – social withdrawal, after hallucinations or delusions are gone

CAUSES: CHEMICAL

•Unusually high levels of dopamine causes positive symptoms•Dopamine-blocking drugs help with hallucinations/delusions and attention•May cause symptoms similar to Parkinson’s disease such as hand tremors (Parkinson’s patients do not have enough dopamine)•Negative symptoms may be caused by lack of glutamate

CAUSES

•Neurons in frontal lobe fire out of sync• Sensory areas light up with hallucinations • Smaller-than-average thalamus (explains difficulty filtering sensory input) and cortex, larger-than-average fluid filled areas

RISK FACTORS

•Maternal virus during first half of pregnancy can double or triple risk (1% to 2 or 3%)•Genetics – if a sibling or parent has schizophrenia, person has a 10% chance of also having it (60% if an identical twin that shared the placenta also has it)• Low birth weight or oxygen deprivation at birth

ORGANIC DISTURBANCE

ORGANIC DISTURBANCE

•Decrease in brain function due to a physical or biological cause such as head injury, disease, or substance abuse• Can be permanent or temporary