Abnormal Psychology. Unit Overview Perspectives on Psychological Disorders Anxiety Disorders...

Abnormal PsychologyAbnormal Psychology

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Psychological DisordersPsychological Disorders

I felt the need to clean my room … would spend four to five hours at it… At the time I loved doing it. Then I didn't want to do it any more, but I couldn’t stop… The clothes hung… two fingers apart… I touched my

bedroom wall before leaving the house… I had constant anxiety… I thought I might be nuts.

Marc, diagnosed withobsessive-compulsive disorder

(from Summers, 1996)

IntroductionIntroduction

• How should we define psychological disorders?

• How should we understand disorders?

• How should we classify psychological disorders?

Perspectives on Perspectives on Psychological DisordersPsychological Disorders

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Psychological DisordersPsychological Disorders

People are fascinated by the exceptional, the unusual, & the abnormal. This fascination may be caused by two reasons:

1. During various moments we feel, think, & act like an abnormal individual.

2. Psychological disorders may bring unexplained physical symptoms, irrational fears, & suicidal thoughts.

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Psychological DisordersPsychological Disorders

To study the abnormal is the best way of understanding the normal.

1. There are 450 million people suffering from psychological disorders (WHO, 2004).

2. Depression & schizophrenia exist in all cultures of the world.

William James (1842-1910)

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Defining Psychological Defining Psychological DisordersDisorders

Definition of Disorders - Free Intro to Psychology VideoPsychological Disorders - persistently harmful thoughts, feelings, & actions.behavior that is deviant, distressful, & dysfunctional

Varies between cultures, over time, & must be more than just deviant, must be harmful (distressful)

1.Deviant behavior (going naked) in one culture may be considered normal, while in others it may lead to arrest.

2.Deviant behavior must accompany distress.3.Behavior is harmful & dysfunctional it is clearly a

disorder.

Controversial & unclear at times: Attention deficit hyperactivity disorder (ADHD) a

psychological disorder marked by the appearance by age 7 of one or more of three key symptoms; extreme inattention, hyperactivity, and impulsivity.

Understanding Psychological DisordersUnderstanding Psychological DisordersThe Medical Model

• Until early 1800s mental illness- largely viewed as possession, evil, godly intervention

• Philippe Pinel- French, late 17–early 1800s REFORMER. Insisted these behaviors were a “sickness of the mind” often caused by severe stress & inhumane conditions

• Medical model–Mental illness (psychopathology)

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Medical ModelMedical Model

When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders.

1. Etiology: Cause & development of the disorder.

2. Diagnosis: Identifying (symptoms) & distinguishing one disease from another.

3. Treatment: Treating a disorder in a psychiatric hospital.

4. Prognosis: Forecast about the disorder.

Understanding Psychological DisordersUnderstanding Psychological DisordersThe Biopsychosocial Approach

Today, psychologist contend that ALL behavior (normal/abnormal) arises from Interaction of nature & nurture

But “mental illness” implies an internal problem or sickness.

Current psychology considers the problem may be a growth-blocking difficulty in the person’s environment, current interpretation of events, or bad habits & poor social skills

• Influence of culture on disorders- may share underlying dynamic while differing in symptoms– Bulimia, Susto ,Taijain-kyofusho Definition of Disorders - Free Intro to Psychology Video

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The Biopsychosocial The Biopsychosocial ApproachApproach

Assumes that biological, socio-cultural, & psychological factors combine & interact to produce psychological disorders.

Classifying Psychological Disorders Classifying Psychological Disorders Classification and Diagnosis - Free Intro to Psychology Video• Diagnostic & Statistical Manual of Mental

Disorders (DSM) video\_Advanced Assessment & Diagnosis Using the DSM-IV-TR®..._ Seminar with Brooks Baer, MA, LCPC, CMHP.mp4

– DSM-IV-TR

– DSM-V - will appear in 2014

– Reliable across practitioners

• International Classification of Diseases (ICD-10) coordinated to develop DSM classifications used as diagnosis codes for insurance companies

• Criticisms of the DSM- creates labels that bias people / may lead to stigmatizing people

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How are Psychological Disorders Diagnosed?

Multiaxial Classification pg 645

Are Psychosocial or Environmental Problems (school or housing issues) also present?Axis IV

What is the Global Assessment of the person’s functioning?Axis V

Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present?Axis III

Is a Personality Disorder or Mental Retardation present?Axis II

Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present?Axis I

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Labeling Psychological Labeling Psychological DisordersDisorders

1. Critics of the DSM-IV argue that labels may stigmatize individuals.

Rosenhan’s study Rosenhan’s study – “hearing voices,” saying “empty,” “hollow,” or “thud.” Otherwise gave good info…. All 8 diagnosed mentally ill.

2. Labels may be helpful for healthcare professionals when communicating with one another & establishing therapy.

3. “Insanity” labels raise moral & ethical questions about how society should treat people who have disorders & have committed crimes.

Labeling Psychological DisordersLabeling Psychological Disorders• Rosenhan’s study – “hearing voices,” saying

“empty,” “hollow,” or “thud.” Otherwise gave good info…. All 8 diagnosed mentally ill.

• Power of labels–Preconception can stigmatize

• Insanity label• Stereotypes of the mentally ill• Self-fulfilling prophecy

Anxiety DisordersAnxiety Disorders

Anxiety Disorders Anxiety Disorders video\217_Experiencing_Anxiety.mp4

• Anxiety disorders- psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety Anxiety Disorders -

Free Intro to Psychology Video

–Generalized anxiety disorder–Panic disorder–Phobia–Obsessive-compulsive disorder–Post-traumatic stress disorder

Generalized Anxiety DisorderGeneralized Anxiety Disorder• Generalized anxiety disorder - an anxiety disorder

in which a person is continually tense, apprehensive, & in a state of autonomic nervous system arousal. (persistent)– Unexplainably & continually tense, jittery & uneasy, muscle

tension, sleeplessness & agitation, Feeling unfocused, out of control & negative

– Physical symptoms (dizziness, sweating palms, heart palpitations, High BP, ulcers, etc) w/o any physical problem video\216_Anxiety_Disorders.mp4

– 2/3 women– Cause not Identifiable thus can not be dealt with

»Free floating anxiety

Panic DisorderPanic Disorder

• Panic disorder- an anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror & accompanying chest pain, choking, or other frightening sensations.–Panic attacks- minutes long episode of

intense fear that something horrible is about to happen. Usually involves physical symptoms. Smokers have a 2-4 X higher risk

PhobiasPhobias• Phobias an anxiety disorder marked by a

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

–Specific phobia – can lead to incapacitating efforts to avoid the feared situation

–Social phobia – intense fear of being scrutinized by others

–Agoraphobia- fear/avoidance of a situation in which escape might be difficult or help unavailable when panic strikes

Phobias

Phobias

Obsessive-Compulsive DisorderObsessive-Compulsive Disorder

• Obsessive-compulsive disorder - an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions). video\219_OCD_Young Mother.mp4

–An obsession versus a compulsion

–Checkers

–Hand washers

Obsessive-Compulsive Disorder

Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder• Post-traumatic stress disorder - an anxiety

disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a

traumatic experience. video\THIS EMOTIONAL LIFE _ PTSD _ Treatment _ PBS.flv

–AKA: PTSD, “shellshock” or “battle fatigue”

–Not just due to a war situation

• Post-traumatic growth

UnderstandingUnderstanding Anxiety Disorders Anxiety DisordersThe Learning PerspectiveThe Learning Perspective

• Fear conditioning- general anxiety has been linked with classical conditioning of fear

–Stimulus generalization–Reinforcement- avoidance, compulsions

• Observational learning–We can learn fear thru

observing other’s fears

Understanding Anxiety DisordersUnderstanding Anxiety DisordersThe Biological PerspectiveThe Biological Perspective

• Natural selection

• Genes– Anxiety gene

– Twin studies support

• The Brain– scans reveal specific brain activity in OCD &

depressed people

–Anterior cingulate cortex- monitors our actions & checks for errors. Extremely active in OCD patients

Dissociative DisordersDissociative Disorders

Dissociative Disorders Dissociative Disorders Dissociative Disorders - Free Intro to Psychology Video

• Dissociative disorders- disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts,& feelings.

–Fugue state- a patient completely forgets their personal identity (only temporarily)

–Dissociate (become separated)

Dissociative Identity DisorderDissociative Identity Disorder

• Dissociative identity disorder (DID) a rare dissociative disorder in which a person exhibits two or more distinct & alternating

personalities. Formerly called multiple

personality disorde– video\232_Multiple_Personality_Disorder.mp4

Understanding Dissociative Identity Disorder

• Genuine disorder or not?• DID rates 1930 2 cases a year to > 20,000 in the

1980s

• Therapist’s creation – shows up most with therapist who utilize hypnosis

Mood Disorders

•Phobias more commonBUT….

•Depression is the #1 reason to seek help & it’s the leading cause of disability

Mood DisordersMood Disorders• Mood disorders psychological disorders characterized

by emotional extremes. Mood Disorders - Free Intro to Psychology Video

– Major depressive disorder mood disorder in which a person experiences, in the absence of drugs or a medical condition, 2 or more weeks of significantly depressed moods, feelings of worthlessness, & diminished interest or pleasure in most activities.

– Bipolar disorder a mood disorder in which the person alternates btwn the hopelessness & lethargy of depression & the overexcited state of mania. (formerly called manic-depressive disorder.)

Major Depressive DisorderMajor Depressive Disorder• Major depressive disorder

– Lethargy– Discouraged, dissatisfied, isolated– Unable to concentrate, eat or sleep– Feelings of worthlessness– Loss of interest in family & friends– Loss of interest in activities

Dysthymic disorder- btwn normal sadness & major depression. Everyday > than 2 yrs

Major Depressive Disorder

Major Depressive Disorder

Major Depressive Disorder

Bipolar DisorderBipolar Disorder• Bipolar Disorder - a mood disorder in which

the person alternates between the hopelessness & lethargy of depression & the overexcited state of mania. (formerly named manic-depressive disorder)

–Mania (manic) Overtalkative, overactive, elated, little need for sleep, loud, flighty, reckless, poor judgement, etc.

–Bipolar disorder & creativity

Understanding Mood DisordersUnderstanding Mood Disorders• Many behavioral & cognitive changes accompany

depression• Depression is widespread, nearly ½ of depressed

people have other disorders (anxiety, substance abuse)

• Compared with men, women are nearly twice as vulnerable to major depression

• Most major depressive episodes self-terminate• Stressful events related to work, marriage & close

relationships often precede depression• With each new generation, depression is striking

earlier & affecting more people

Understanding Mood DisordersUnderstanding Mood Disorders

• Genetic Influences• Heritability- mood disorders run in families

• Linkage analysis- process of elimination

• Association studies- correlation btwn more specific DNA variation & population traits

The depressed brain- Left Frontal Lobe. Genes act by directing biochemicals that down the line, influence behavior

– Biochemical influences (key)• Norepinephrine -increases arousal, boosts mood. scarce during

depression, in overabundance during Mania

• Serotonin-scarce during Depression

Understanding Mood DisordersUnderstanding Mood DisordersThe Biological Perspective The Biological Perspective

video\225_Mood_Disorders.mp4 11 mvideo\225_Mood_Disorders.mp4 11 m

Understanding Mood DisordersThe Biological Perspective

Understanding Mood DisordersThe Biological Perspective

Understanding Mood DisordersThe Biological Perspective

Understanding Mood DisordersUnderstanding Mood DisordersThe Social-Cognitive Perspective

• Negative Thoughts & Moods Interact– Mind’s negative thoughts can influence biological events that can be a vicious cycle

amplifying depression

– Self-defeating beliefs• Learned helplessness• Overthinking

– Explanatory style• Stable, global, internal explanations

– Cause versus indictor of depression? • Bad moods feed on themselves

–xxx

Understanding Mood DisordersUnderstanding Mood DisordersExplanatory Style

Understanding Mood DisordersExplanatory Style

Understanding Mood DisordersExplanatory Style

Understanding Mood DisordersExplanatory Style

Understanding Mood DisordersExplanatory Style

Understanding Mood DisordersExplanatory Style

Understanding Mood DisordersExplanatory Style

Understanding Mood DisordersExplanatory Style

Understanding Mood DisordersExplanatory Style

Understanding Mood DisordersExplanatory Style

Understanding Mood DisordersThe Vicious Cycle of Depression

Biopsychosocial Approach to Depression

Biopsychosocial Approach to Depression

Understanding Mood DisordersUnderstanding Mood DisordersThe Social-Cognitive Perspective

• Depression’s Vicious Cycle–Stressful experience

–Negative explanatory style

–Depressed mood

–Cognitive & behavioral changes

SchizophreniaSchizophrenia

SymptomsSymptoms of Schizophrenia of SchizophreniaSchizophrenia - Free Intro to Psychology Video

• Schizophrenia (split mind) a group of severe disorders characterized by disorganized & delusional thinking, disturbed perceptions, &

inappropriate emotions & actions. video\229_Schizophrenia.mp4 -4:20

Not multiple personalities

–Positive symptoms

–Negative symptoms

SymptomsSymptoms of Schizophrenia of SchizophreniaDisorganized Thinking

• Disorganized thinking–Delusions false beliefs, often of persecution or

grandeur, that may accompany psychotic disorders

• Delusions of persecution (paranoid)\Word Salad

–Breakdown in selective attention ability

• Disturbed perceptions–Hallucinations- no stimulus

• hearing voices• Visual, smells, touch hallucinations are rare

SymptomsSymptoms of Schizophrenia of SchizophreniaInappropriate Emotions & Actions

• Inappropriate Emotions–Flat affect – zombielike state of apparent

apathy

• Inappropriate Actions–Catatonia- to remain motionless for hrs on

end & then become agitated

–Disruptive social behavior- disorganized thinking, disturbed perceptions & inappropriate emotions & actions

Types of Schizophrenia

Onset & DevelopmentOnset & Development• Onset of the disease-early adulthood,

• 1 in 100 people • Chronic (process) schizophrenia

develops gradually, emerging from a long history of social inadequacy. Recovery in doubtful

• Acute (reactive) schizophrenia develops rapidly in response to particular life stresses. Recovery is much more likely

Understanding SchizophreniaUnderstanding SchizophreniaBrain Abnormalities video\229_Schizophrenia.mp4 4:20 -

• Dopamine Overactivity–Dopamine – D4 dopamine receptor:

increased receptors for dopamine.

–Dopamine blocking drugs

• Glutamate- impaired glutamate acitivity = another symptom

• Scans indicate abnormal activity in multiple brain areas. Out of sync neurons may disrupt the integrated functioning of t neural ntwks

Understanding SchizophreniaUnderstanding SchizophreniaBrain Abnormalities

• Abnormal Brain Activity & Anatomy– Frontal lobe & core brain activity abnormally low

– Enlarged Fluid filled areas of the brain & a corresponding skrinkage of cerebral tissue

– Thalamus tends to be smaller than normal – filtering sensory input & focusing attention C:\Users\mburt\Desktop\AP Psych\psych disorders\video\231_Schizophrenic_Brain.mp4

Understanding SchizophreniaBrain Abnormalities

• Maternal Virus During Pregnancy–Studies on maternal activity &

schizophrenia

–Influence of the flu during mid pregnancy may impair fetal brain development

Understanding SchizophreniaUnderstanding SchizophreniaGenetic Factors

• Genetic predisposition- risks increases to in if a family member had/s schizophrenia & in 1 in 2 if an identical twin has/d it

• Twin studies & adoption studies confirm genetic connection

• Genetics & environmental influences- work together

Understanding SchizophreniaPsychological Factors

video\227_Schizophrenia_Case_Study.mp4

• Possible warning signs– Mother severely schizophrenic– Birth complications (low weight/oxygen deprivation)– Separation from parents– Short attention span– Poor muscle coordination– Disruptive or withdrawn behavior – Emotional unpredictability– Poor peer relations and solo play

Personality DisordersPersonality Disorders

Personality DisordersPersonality Disorders• Personality disorders psychological disorders

characterized by inflexible & enduring behavior patterns that impair social functioning

–Anxiety cluster- avoidant–Eccentric cluster- schizoid–Dramatic/impulsive cluster- histrionic & narcissistic– Personality Disorders - Free Intro to Psychology Video

Most troubling of Personality Disorders:

Antisocial Personality Disorder

Antisocial Personality DisorderAntisocial Personality Disorder• Antisocial personality disorder a

personality disorder in which the person (usually male) exhibits a lack of conscience for wrongdoing, even toward friends & family members. May be aggressive & ruthless or a clever con artist.

-AKA Sociopath or psychopath

• Understanding antisocial personality disorder- brain scans reveal reduced activity in the frontal lobes (controls impulses)

• A genetic predisposition may interact with environ-mental influences to produce this disorder

Rates of DisorderRates of Disorder

• Mental health statistics

• 1 in 6 or 7 consistently in studies. – Lowest rates –

Shanghai

– Highest rates- US

Rates of DisorderRates of Disorder•Poverty is a predictor

•Serious psychological disorders are doubly high among those below the poverty line• Chicken or egg? Both

•Schizophrenia leads to poverty•Kids in poverty exhibit more deviant & aggressive behavior

•When people move out of poverty these rates drop 40%•Women in poverty= higher rates of substance abuse & depression

•Other factors•Age –antisocial & phobias appear the earliest 8-10•OCD, alcohol abuse, bipolar, schizophrenia median 20•Major Depression median age 25

The End

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Definition Slides

Psychological Disorder

= deviant, distressful, and dysfunctional patterns of thoughts, feelings, or behaviors.

Attention-deficit Hyperactivity Disorder (ADHD)

= a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms; extreme inattention, hyperactivity, and impulsivity.

Medical Model

= the concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured often through treatment in a hospital.

DSM-IV-TR

= the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, updated as of 2000 “text revision”; a widely used system for classifying psychological disorders.

describes 400 psychological disorders compared to 60 in the 1950s.

Anxiety Disorders

= psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.

Generalized Anxiety Disorder

= an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.

Panic Disorder

= an anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations.

Phobia

= an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation.

Obsessive-compulsive Disorder (OCD)

= an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions).

Post-traumatic Stress Disorder (PTSD)

= an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience.

Post-traumatic Growth

= positive psychological changes as a result of struggling with extremely challenging circumstances and life crises.

Somatoform Disorder

= psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause.

Conversion Disorder

= a rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no psychological basis can be found.

Hypochondriasis

= a somatoform disorder in which a person interprets normal physical sensations as symptoms of the disease.

Dissociative Disorders

= disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings.

Dissociative Identity Disorder (DID)

= a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Formerly called multiple personality disorder.

Mood Disorders

= psychological disorders characterized by emotional extremes.

Major Depressive Disorder

= a mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities.

Mania

= a mood disorder marked by a hyperactive, wildly optimistic state.

Bipolar Disorder

= a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. (formerly called manic-depressive disorder.)

Schizophrenia

= a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions.

Delusions

= false beliefs, often of persecution or grandeur, that may accompany psychotic disorders.

Personality Disorders

= psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning.

Antisocial Personality Disorder

= a personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist.