Introduction to Psychology

- Defining abnormal behaviour

- Diagnosis

- Mental Disorders

What is abnormal behaviour?• Amy hasn’t been to work in two weeks. She has no physical

problems but has trouble getting out of bed. She has little appetite and has lost 10 pounds in two weeks. She has no interest in things that she used to enjoy.

• Mary masturbates in public on a regular basis. She does it so all can see.

• Terry is a successful accountant in a good marriage. He wears silk panties to work. He dresses up in female attire when having sex with his wife. Both enjoy their lovemaking.

• Lloyd appears to be in an altered state of consciousness. His eyes don’t focus and he is unresponsive. He is repeating the same statement over and over.

Diagnosis

Cons:- Reliability- Validity- Uniqueness of person is overlooked- StigmatizationPros: - facilitates communication among practitioners and

researchers- key to further knowledge in terms of treatment and

prevention

DSM Multi-axial Diagnosis

Axis I: all mental disorders (except)

Axis II: personality disorders & mental retardation

Axis III: physical disorders

Axis IV: psychosocial and environmental problems

Axis V: global assessment of functioning scale

DSM Diagnosis

Axis I: Bulimia Nervosa, purging subtype

Axis II: Borderline personality disorder

Axis III: Diabetes

Axis IV: unemployment, social isolation

ongoing family difficulties

Axis V: GAF: 40 (over last three months)

Anxiety Disorders

• When is anxiety abnormal?

• What is the difference between anxiety and fear?

• future-oriented

• mood state

• feeling that one cannot predict or control upcoming events

• present-oriented

• emotional alarm reaction to present danger

• emergency “fight or flight” response

Anxiety vs. Fear

Discrete period of intense fear/discomfort in which at least 4 symptoms developed abruptly and reached a peak within 10 minutes

• palpitations, pounding/racing heart

• sweating

• trembling/shaking

• shortness of breath/smothering sensations

• feeling of choking

• chest pain/discomfort

• nausea or abdominal distress

• feeling dizzy, unsteady, faint or lightheaded

• derealization or depersonalization

• fear of losing control or going crazy

• fear of dying

• paresthesias (numbness or tingling sensations)

• chills or hot flushes

Criteria for a Panic Attack

Panic Disorder with/without Agoraphobia

Specific Phobia

Social Phobia

Obsessive Compulsive Disorder (OCD)

Generalized Anxiety Disorder (GAD)

Post Traumatic Stress Disorder (PTSD)

The DSM-IV Anxiety Disorders

• recurrent, unexpected panic attacks

• AND one month of concern about additional attacks

• OR... worry about the implications of the attack or its consequences

• OR... a significant change in behaviour related to the attacks

Panic Disorder

• anxiety about being in places/situations from which escape might be difficult or embarrassing in the event of a panic attack

• situations are avoided or endured with marked distress or anxiety about having a panic attack OR require the presence of a companion

Agoraphobia

Typical Agoraphobic Situations

• Shopping malls• Cars• Trains• Buses• Subways• Wide streets• Tunnels• Restaurants• Theatres

• Supermarkets• Stores• Crowds• Planes• Elevators• Escalators• Waiting in line• Being far from home

“out of safe zone”

Specific Phobia

• marked and persistent fear that is excessive or unreasonable, cued by a specific object or situation

• exposure to the phobic stimulus almost invariably provokes an immediate anxiety response (e.g., a panic attack)

• phobic situation/object is avoided or endured with intense anxiety and distress

Specific Phobia - Types

1. Animal

2. Natural Environment (e.g., heights, water)

3. Blood-Injection-Injury Type

4. Situational (e.g., planes, elevators, driving)

5. Other (e.g., choking, vomiting)

Social Phobia

• marked and persistent fear of social or performance situations

• situations involve exposure to unfamiliar people or to possible evaluation by others

• individual fears that he/she may do something humiliating or embarrassing.

• recurrent and persistent obsessions and/or compulsions • symptoms cause marked distress• time consuming (more than 1 hour/day)• interfere significantly with person’s normal routine

Obsessive-Compulsive Disorder

OBSESSIONS

• persistent and intrusive thoughts, impulses, images • inappropriate, cause marked anxiety or distress• person usually attempts to ignore or suppress them • ...OR neutralize them with some other thought or action

COMPULSIONS

• repetitive behaviors or mental acts • performed to prevent or reduce anxiety/distress, not to provide pleasure or gratification

Mood Disorders

Lifetime prevalence rates of depressive disorders:

13% men

25% women

Lifetime prevalence rates of bipolar disorders:

less than 1% for men and women

15% complete suicide

Mood Episodes

1. Major Depressive Episode

2. Manic Episode

3. Hypomanic Episode

4. Mixed Episode

1. Major Depressive Episode

- Depressed mood- Loss of interest (anhedonia)- Significant weight loss or gain- Insomnia or hypersomnia- Psychomotor agitation or retardation- Fatigue or loss of energy- Worthlessness or guilt- Diminished ability to concentrate, indecisiveness

2. Manic Episode - Abnormally and persistently elevated, expansive, or

irritable mood- Inflated self-esteem and grandiosity- Requiring very little sleep- Talkativeness- Flight of ideas- Distractibiltiy- Psychomotor agitation- Buying sprees, sexual indiscretions, foolish business

investments

3. Hypomanic EpisodeSymptoms are milder than a Manic Episode

• Less intense and last at least four days

4. Mixed EpisodeBoth a Major Depressive Episode and a

Manic Episode nearly everyday for at least a one week period

Major Depressive Disorder• One or more Major Depressive Episodes• No history of Manic, Hypomanic or Mixed Episodes

Dysthymic Disorder• Less severe but more chronic than Major Depressive Disorder• Symptoms are milder but remain unchanged over long periods of time

Bipolar I Disorder• One or more Manic or Mixed Episodes • Often individuals have also had one or more

Major Depressive Episodes

Bipolar II Disorder• Presence (or history) of one or more Major

Depressive Episodes • Presence (or history) of at least one

Hypomanic Episode• There has never been a Manic Episode or a

Mixed Episode

Cyclothymic Disorder

• Less severe but more chronic than Bipolar Disorder

• Symptoms of hypomania and depression are milder but remain unchanged over long periods of time

DSM-IV Specifiers

1. Chronic2. Psychotic3. Melancholic

1. Atypical

4. Catatonic5. Postpartum Onset6. Seasonal Pattern7. Rapid Cycling Pattern

Somatoform & Dissociative Disorders

• Somatoform Disorders:– Hypochondriasis– Somatization Disorder– Conversion Disorder– Factitious Disorder– Body Dysmorphic Disorder

• Dissociative Identity Disorder

HypochondriasisDSM-IV Criteria

A. Preoccupation with the belief that one has a serious disease

B. The preoccupation persists despite medical evaluation and reassurance

C. Not delusional

D. Distress or impairment

E. Lasts at least 6 months

Somatization Disorder

A. History of many physical complaints beginning before age 30 that result in treatment being sought or significant impairment

B. Each of the following criteria must have been met:1. Four pain symptoms2. Two gastrointestinal symptoms3. One sexual or reproductive symptom4. One neurological symptom

Somatization Disorder

C. Symptoms cannot be fully explained by a known medical condition

D. The symptoms are not intentionally produced or feigned

Causes: unclear, anxiety, secondary gain

Treatment: gatekeeper physician, work, treatment for anxiety and depression

Conversion Disorder

A. One or more symptoms or deficits affecting voluntary motor or sensory function that suggests a neurological or general medical condition

B. Preceded by a conflict or stressorC. Not intentionally producedD. Cannot be fully explained by a medical

conditionE. Significant distress or impairment or warrants

medical evaluation

Body Dysmorphic Disorder

A. Preoccupation with an imagined defect in appearance, or if a slight physical anomaly is present, the person’s concern is excessive

B. Significant distress or impairment

Dissociative Identity Disorder

A. The presence of two or more distinct identities or personality states

B. At least two of these identities recurrently take control of the person’s behaviour

C. Inability to recall important personal information that is too excessive to be explained by forgetfulness

Dissociative Identity Disorder

• Host Identity• Alternate Identities• Switch• Causes: abuse, neglect, iatrogenic, feigned• Treatment: skillful therapist, build a

therapeutic alliance, ground rules, reintegration: process trauma & dissociative defenses, post integration therapy

Eating Disorders

• Females 10 x more likely to develop an eating disorder

• Around 5% of young women will develop an eating disorder

• Course and outcome of eating disorders is highly variable

• Eating disorders are associated with serious complications, and have the highest mortality rate

DSM-IV Diagnostic criteria for Anorexia Nervosa

A. Low body weight

B. Fear of gaining weight or becoming fat

C. Weight-related self-evaluation, or denial of the seriousness of the low body weight

D. Amenorrhea

RESTRICTING TYPE

BINGE EATING/PURGING TYPE

DSM-IV: Diagnostic criteria for Bulimia Nervosa

A. Binge eating

B. Inappropriate compensatory behavior

C. Both occur, at least 2/ week for 3 months

D. Weight-related self-evaluation

PURGING TYPE

NON PURGING TYPE

Physical Complications

• Menstrual Dysfunction

• Hypothermia• Hypotension• Tiredness, Lethargy• Headaches• Hair Loss• Dental Problems

• Electrolyte Abnormalities

• Parathesias• Acute Gastric Dilation• Delayed Gastric

Emptying• Constipation• Swollen salivary gland• Kidney Dysfunction

Psychological Complications

• Depression• Anxiety• Mood swings • Food Preoccupation

• Social Isolation• Sleep Disturbances• Self-Esteem Deficits• Impulsive Behaviors

Schizophrenia

• Delusions and Irrational thought• Deterioration of Adaptive Behaviors• Hallucinations• Disturbed Emotion• Paranoid, Catatonic, Disorganized,

Undifferentiated• Positive vs. Negative symptoms • Chronic, resistant to treatment