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Chapter 10Abnormal Psychology
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Topics to Explore
1. Defining & Classifying Disorders
2. Three Categories of Disorders
3. Treatment of Mental Disorders
Part 1Defining & Classifying
Mental Disorders
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Abnormal Psychology: the scientific study of mental
disorders and their treatment
What is Abnormal Psychology?
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Subjective Discomfort: Feelings of anxiety, depression, or emotional distress. But people we would consider definitely abnormal may not feel subjective discomfort.
Social Nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior. But it doesn’t always. Is being a nonconformist always a disorder? 1984!
Statistical Abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depression. But having a numerically rare characteristic isn’t always a disorder (e.g., having an IQ of 180)
Ways of Defining “Abnormal”
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Statistically Abnormal
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Situational Context: Social situation, behavioral setting, or general circumstances in which an action takes place
Is it normal to walk around strangers naked? If you are in a locker room and in the shower area, yes!
Cultural Relativity: Judgments are made relative to the values of one’s culture
Two Considerations
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Maladaptive Behavior: Behavior that makes it difficult to function, to adapt to the environment, and to meet everyday demands
Significant impairment in psychological functioning: Those with mental illness lose the ability to control thoughts, behaviors, or feelings adequately
Atypical behavior: behavior that is not typical of the majority of the population
Three Criteria for Abnormality
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DSM-IV
DSM-IV: Diagnostic and Statistical Manual of Mental Disorders.
Published by the American Psychiatric Association.
Provides a classification system of mental disorders.
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Some DSM-IV Categories
• Mood Disorders
• Anxiety Disorders
• Somatoform Disorders
• Factitious Disorders
• Dissociative Disorders
• Sexual & Gender Identity Disorders
• Eating Disorders
• Sleep Disorders
• Adjustment Disorders
• Personality Disorders
• Disorders First Diagnosed in Childhood
• Organic Mental Disorders
• Substance Related Disorders
• Schizoprenia Disorders
• Paranoid Disorders
• Impulse Control Disorders
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Social Conditions: Poverty, homelessness, overcrowding, stressful living conditions
Family Factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problems
Psychological Factors: Low intelligence, stress, learning disorders
Biological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability
General Risk Factors for Mental Illness
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Incidence of Mental Disorders
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Insanity: A legal term; refers to an inability to manage one’s affairs or to be aware of the consequences of one’s actions
• Those judged insane (by a court of law) are not held legally accountable for their actions
• Can be involuntarily committed to a psychiatric hospital
• Some movements today are trying to abolish the insanity plea and defense; desire to make everyone accountable for their actions
Neurosis: Archaic; once used to refer to excessive anxiety, somatoform, dissociative disorders, and some kinds of depression
Clarifying Some Terms
Part 2Three Major Categories
of Mental Disorders
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Anxiety: Feelings of apprehension, dread, or uneasiness
Anxiety Disorder: a disorder in which excessive anxiety leads to personal distress and atypical, maladaptive, and irrational behavior
Anxiety Disorders
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Specific Phobias: Irrational, persistent fears, anxiety, and avoidance that focus on specific objects, activities, or situations
People with phobias realize that their fears are unreasonable and excessive, but they cannot control them
Specific Phobias
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Social Phobia: Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public)
Those with social phobia avoid social situations, such as eating, writing, or speaking in public.
Social phobias impair functioning at work, at school, and in personal relationships.
Estimate that 13% of all adults affected by social phobias at some time. Examples: Barbra Streisand, Woody Allen perhaps?
Social Phobia
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Agoraphobia: Intense, irrational fear that a panic attack will occur in a public place or in an unfamiliar situation
• Intense fear of leaving the house or entering unfamiliar situations
• Can be very crippling
• Literally means fear of open places or market (agora)
• Can occur with or without accompany panic disorder.
Agoraphobia
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Panic Disorder: A chronic state of anxiety with brief moments of sudden, intense, unexpected panic (panic attack)
Panic Attack: Feels like one is having a heart attack, going to die, or is going insane. Symptoms include vertigo, chest pain, choking, fear of losing control
Panic Disorder
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Generalized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety
Symptoms: sweating, racing heart, clammy hands, dizziness, upset stomach, rapid breathing, irritability, poor concentration.
More common in women than in men.
Generalized Anxiety Disorder
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Obsessive-Compulsive Disorder (OCD): Extreme preoccupation with certain thoughts and compulsive performance of certain behaviors
Obsession: Recurring images or thoughts that a person cannot prevent.
• Cause anxiety and extreme discomfort
• Enter into consciousness against the person’s will
•Most common: Being dirty, wondering if you performed an action (turned off the stove), or worrying about violence (being hit by a car)
Compulsion: Irrational acts that person feels compelled to repeat against his/her will
•Help to control anxiety created by obsessions
•Most compulsions involve either checking or cleaning something.
Obsessive-Compulsive Disorder
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Mood Disorders: Major disturbances in emotion, such as depression or mania
Depressive Disorders: Sadness or despondency that are prolonged, exaggerated, or unreasonable
Bipolar Disorders: Involve both depression and mania or hypomania
Mood Disorders
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Maternity Blues: Mild depression that lasts for one to two days after childbirth
•Marked by crying, fitful sleep, tension, anger, and irritability
•Brief and not too severe
Postpartum Depression: Moderately severe depression that begins within three months following childbirth
•Marked by mood swings, despondency, feelings of inadequacy, and an inability to cope with the new baby
•May last from two months to one year
•Part of the problem may be hormonal
Childbirth-related Mood Disorders
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Psychosis: Loss of contact with shared views of reality
Delusions: False beliefs that psychotic individuals insist are true, regardless of overwhelming evidence against them
Hallucinations: Imaginary sensations, such as seeing, hearing, or smelling things that do not exist in the real world
•Most common psychotic hallucination is hearing voices
•Note that olfactory hallucinations sometimes occur with seizure disorder (epilepsy)
Psychotic Disorders
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Flat Affect: Lack of emotional responsiveness; face is frozen in blank expression
Disturbed Verbal Communication: Garbled and chaotic speech; word salad
Personality Disintegration: Uncoordinated thoughts, actions, and emotions
Other Psychotic Symptoms
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The Mad Hatter
In Lewis Carroll’s time, hatmakers were heavily exposed to mercury used in making felt. Many suffered brain damage and became psychotic; thus, the Mad Hatter.
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Schizophrenia: Psychotic disorder characterized by hallucinations, delusions, apathy, thinking abnormalities, and “split” between thoughts and emotions
Does NOT refer to having split or multiple personalities
Schizophrenia: The Most Severe Disorder
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Disorganized Type: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or inappropriate emotions
Catatonic Type: Marked by stupor, unresponsiveness, posturing, and mutism
Paranoid Type: Preoccupation with delusions; also involves hallucinations that are related to a single theme, especially grandeur or persecution
Undifferentiated Type: Any type of schizophrenia that does not have paranoid, catatonic, or disorganized features or symptoms
Four Types of Schizophrenia
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Psychological Trauma: Psychological injury or shock, often caused by violence, abuse, or neglect
Disturbed Family Environment: Stressful or unhealthy family relationships, communication patterns, and emotional atmosphere
Deviant Communication Patterns: Cause guilt, anxiety, anger, confusion, and turmoil
Stress-Vulnerability Hypothesis: Combination of environmental stress and inherited susceptibility cause schizophrenic disorders
Causes of Schizophrenia
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Biochemical Abnormality: Disturbance in brain’s chemical systems or in the brain’s neurotransmitters
Dopamine: Neurotransmitter involved with emotions and muscle movement. Works in limbic system
Dopamine overactivity in brain may be related to schizophrenia
Biochemical Causes
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Genetic Predisposition
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PET Scans of Normal & Schizophrenic Brains
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Schizophrenic Patients 10 Years Later
Part 3Treatment of Mental Disorders
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Types of Therapists
• Clinical psychologist: has doctoral degree in clinical psychology; provides therapy for people with mental disorders
• Counseling psychologist: has doctoral degree in psychological or educational counseling; counsels people with milder problems
• Psychiatrist: has medical degree with residency in mental health, provides therapy for people with mental disorders and is only type of therapist who can prescribe drugs or other biomedical treatment
• Psychoanalyst: Any of the above types of credential, but with training in psychoanalysis from a psychoanalytic institute
• Clinical social worker: has master’s or doctoral degree in social work with specialized training in counseling; provides help with social problems, such as family problems.
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Biomedical Therapies
Biomedical therapies: medical treatment for mental disorders; includes drug therapy and medical procedures treating the brain
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Pharmacotherapy: Use of drugs to alleviate emotional disturbance; three classes:
Antianxiety (Minor Tranquilizers): Produce relaxation or reduce anxiety (Valium, Lithium, Zanax)
Antidepressants: Elevate mood and combat depression (Elavil, Paxil, Prozac, Zoloft)
Antipsychotics (Major Tranquilizers): Tranquilize and also reduce hallucinations and delusions in larger dosages (Thorazine, Clozaril)
Pharmacotherapy
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Problems with Drug Therapy
• There can be serious side-effects (tranquilizers can cause neurological disorders; Clozaril associated with a fatal blood disorder)
• Drugs do not cure the disorder; they only ameliorate the symptoms.
• Reliance on drugs increase belief in the “quick fix”; belief that any disorder can be cured with a pill.
• Generally, psychotherapy is needed in addition to medication.
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Electroconvulsive Therapy (ECT): Electric shock is passed through the brain inducing a convulsion.
• Based on belief that seizure alleviates depression by altering brain chemistry
• Used in treatment of depression
• Produces only temporary improvement
• Causes permanent memory loss in many patients
• Should only be used as a last resort
Shock Therapy
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Psychosurgery: Any surgical alteration of the brain
Prefrontal Lobotomy: Frontal lobes in brain are surgically cut from other brain areas
• Supposed to calm people who did not respond to other forms of treatment
• Was not very successful
Deep Lesioning: Small target areas in the brain are destroyed by using an electrode
Psychosurgery
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Psychotherapy: Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment;
Some types of psychotherapy:
Psychoanalysis: therapy based on Freud’s theory
Client-centered therapy: based on Humanism
Behavioral and Cognitive therapies
What is Psychotherapy?
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Main Goal of Psychoanalysis: To resolve internal conflicts that lead to emotional suffering
Free Association: Saying whatever comes to mind, regardless of how embarrassing it is. By doing so without censorship and censure, unconscious material can emerge
Dream Analysis: Dreams express forbidden desires and unconscious feelings
• Latent Content: Hidden, symbolic meaning of dreams
• Manifest Content: Obvious, visible meaning of dreams
• Dream Symbols: Images in dreams that have personal or emotional meanings
Psychoanalytic Techniques
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Analysis of Resistance: analysis of blockage in flow of ideas; topics the client resists thinking about or discussing. Resistances reveal particularly important unconscious conflicts
Analysis of Transference: analysis of tendency to transfer feelings to a therapist that match those the patient has for important people in his or her past. The patient might act like the therapist is a rejecting father, loving mother, etc.
Psychoanalytic Techniques, continued
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Client-Centered Therapy (Rogers): Nondirective and based on insights from conscious thoughts and feelings
Effective therapist must have four basic conditions
• Unconditional Positive Regard: Unshakable acceptance of another person, regardless of what they tell the therapist or how they feel
• Empathy: Ability to feel what another person is feeling; capacity to take another person’s point of view
• Authenticity: Ability of a therapist to be genuine and honest about his or her feelings
• Reflection: Rephrasing or repeating thoughts and feelings of the clients; helps clients become aware of what they are saying
Client-Centered (Humanistic) Therapies
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Existential Therapy: An insight therapy that focuses on
problems of existence, such as meaning, choice, and
responsibility; emphasizes making difficult choices in life
Therapy focuses on death, freedom, isolation, and
meaninglessness
Free Will: Human ability to make choices. You can choose to
be the person you want to be
Confrontation: Clients are challenged to examine their values
and choices
Humanistic Therapies
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Behavior Therapy: Use of learning principles to make constructive changes in behavior
Behavior Modification: Using any classical or operant conditioning principles to directly change human behavior
• Deep insight is often not necessary
• Focus on the present; cannot change the past, and no reason to alter that which has yet to occur
• Can also use classical conditioning techniques
Behavioral Therapies
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Aversion Therapy: Associate a strong aversion to an undesirable habit like smoking, overeating, drinking alcohol, or gambling
Flooding: client is exposed to feared object or situation.
Behavioral Therapies
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Systematic Desensitization: Guided reduction in fear, anxiety, or aversion; attained by approaching a feared stimulus gradually while maintaining relaxation
• Best used to treat phobias: intense, unrealistic fears
• Hierarchy: Rank-ordered series of steps, amounts, or degrees
• Reciprocal Inhibition: One emotional state is used to block another (e.g., impossible to be anxious and relaxed at the same time)
Behavioral Therapies
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Cognitive Therapy: Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions
Selective Perception: The tendency to screen out information with which we aren’t comfortable or what we do not consider relevant.
Overgeneralization: Allowing upsetting events to affect unrelated situations. :
Example: John makes a mistake while speaking in a meeting at work. He thinks to himself, "This always happens to me, I will never be any good in meetings." This defeating thought was an overgeneralization.
All-or-Nothing Thinking: Seeing objects and events as absolutely right or wrong, good or bad, and so on
Cognitive therapy is VERY effective in treating depression, shyness, and stress
Cognitive Therapy
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Rational Emotive Behavior Therapy (Albert Ellis): Attempts to change irrational beliefs that cause emotional problems
Common Sense: Activating Event Consequence (feelings, behavior)
Rational Emotive View:Activating Event Beliefs Consequence (feelings,
behavior)
Rational Emotive Therapy
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Rational Emotive Therapy