Abnormal Psychology

PSY 120Prof. South

11/21/08

1. What is abnormal?

2. Categories and Causes

3. Mood Disorders

4. Anxiety Disorders

Social Cognitive Theory

Approach to personality that suggests it is human human experiencesexperiences

and interpretationsinterpretations of these experiences, that determine growth and development of personality

Social-Cognitive Perspective

Culture

Kind of culture you Kind of culture you are from will greatly are from will greatly affect your affect your personalitypersonality

different cultures value different things

If you have what the culture values, life will be less stressful

Defining Abnormal Behavior

A clinically significant behavioral or psychological syndrome with:

1. Present distress

2. Disability

3. An increased risk of suffering pain, death, disability, or loss of freedom

DSM-IV-TR200+ diagnostic categories18 primary headings

Not included

1. Expected & culturally sanctioned response

2. Deviant behavior

3. Conflicts between individual & society

Difficulties in Diagnosis

• Is this person’s behavior abnormal?

– Example: A woman does not like to throw away plastic bags and religiously cleans them and stores them away. She has hundreds of plastic bags but rarely uses them. She gets very angry if anyone suggests she should get rid of them.

Difficulties in Diagnosis

• If a relative or friend:

– No.

• If a stranger:

– Yes.

“Uncle George’s Pancakes Fallacy” (Meehl, 1973)

• People tend to compare the patient’s behavior to that of a friend or relative (e.g., good ole Uncle George)

– The assumption is: your friend or relative is not mentally ill (because you couldn’t have any crazy friends or relatives…)

– Proper conclusion is that your friend or relative also evidences abnormal behaviors

The Five DSM-IV Axes

Axis I Most major disorders

Axis II Stable, enduring problems; personality disorders

Axis III Medical conditions

Axis IV Psychosocial problems/stressors

Axis V Global clinician rating of adaptive functioning

Axis I• Mood Disorders• Anxiety Disorders• Substance-Related Disorders• Schizophrenia and Other Psychotic Disorders• Eating Disorders• Somatoform Disorders• Dissociative Disorders• Sexual and Gender Identity Disorders• Sleep Disorders• Impulsive-Control Disorders• Adjustment Disorders• Factitious Disorders• Delirium, Dementia, and Amnestic and other Cognitive Disorders

Axis II

• Disorders usually first diagnosed in infancy, childhood, or adolescence

• Personality Disorders

Current System of Classification• Disorders grouped together under broader categories

– E.g. Mood Disorders• Depressive Disorders

– Depressive Disorder– Dysthymic Disorder– Depressive Disorder NOS

• Bipolar Disorders– Bipolar I– Bipolar II– Cyclothymic Disorder– Bipolar Disorder NOs

• To qualify for a diagnosis, meet certain number of criteria for each disorder• Thus, a “categorical” system of diagnosis• Is this the best way?

Major Depression1 or more Major

Depressive Episodes

SymptomsBehavior

Affective

Cognitive

Physiological

Anhedonia

Episodic Course

Major Depressive Episode(5 or more for 2 weeks)

#1. depressed mood most of day (sad, empty)

#2 loss of interest or pleasure

#3 weight

#4 sleep

#5 body

#6 fatigue

#7 worthless/ guilt

#8 thinking

#9 recurrent thoughts of death, suicide

Bipolar I Disorder

Bipolar II• Alternates between depressive episodes

and hypomanic episodes

• Alternates between full manic episodes and depressive episodes

• Average age of onset is 18 years, but can begin in childhood

• Tends to be chronic

Elevated, expansive, or irritable mood (>1 Elevated, expansive, or irritable mood (>1 week), plus 3 or more of:week), plus 3 or more of:

Grandiosity/inflated self-esteemGrandiosity/inflated self-esteem

Decreased need for sleepDecreased need for sleep

Pressured speech Pressured speech

Flight of ideasFlight of ideas

Easily distracted to irrelevant stimuliEasily distracted to irrelevant stimuli

Increase in goal-directed activityIncrease in goal-directed activity

Excessive involvement in activities with potential Excessive involvement in activities with potential for harmful consequencefor harmful consequence

Manic EpisodeManic Episode

Mood Disorders Among Twins

Causes of Mood Disorders

Biological

Stress

Learned Helplessness

Social and Cultural

Cognitive Theory

Beck’s Cognitive Triad for Depression

An Integrative Model of Mood Disorders

Anxiety Disorders

• Panic Disorder

• Agoraphobia

• Specific Phobia

• Social Phobia

• Obsessive-Compulsive Disorder

• Post-traumatic Stress Disorder

• Acute Stress Disorder

• Generalized Anxiety Disorder

Difference between “Normal & Abnormal” Anxiety

Normal

–Everyone experiences anxiety from time to time

–Often important to have low to moderate levels of anxiety for optimal performance

–A little anxiety motivates you to “go the extra mile

Abnormal– intense

anxiety where there is no danger

–Overwhelmed with anxiety is not adaptive

Generalized Anxiety Disorder

Defining Features– Excessive uncontrollable worry about life events– Strong, persistent anxiety – Somatic symptoms – Persists for 6 months or more

Panic DisordersEpisode in which intense anxiety &

physiological symptoms are suddenly experienced… recurrent, unpredictable

Panic attack symptoms include:

–Shortness of breath–Chest pain & discomfort– heart palpitations–Feeling of choking–Numbness or tingling–Chills or hot flushes–Sweating –Shaking

PanicMisappraisal of what’s happening

–Catastrophic conclusion

•I feel flush, fast heart beat.. I must be having a heart attack vs. I am a little over excited today

Defining Features– Extreme and irrational fear of specific

object/situation– Interferes with one's ability to function– Recognize fears are unreasonable, but avoids

phobic objects

Specific Phobias

Social Phobia

Defining Features

– Fear of being scrutinized by others

– Interferes with functioning

– Avoids social situations

Obsessive-Compulsive Disorder• Recurrent obsessions and/or compulsions that are

severe enough to be time consuming or cause marked distress and/or significant impairment.

• At some point, person has recognized that the obsessions or compulsions are excessive or unreasonable.

• Common: cleaning or checking rituals

Obsessions

#1 Violence is MOST common theme

#2 Contamination, 2nd common theme

– shaking hands – touching a public door

knob– or toilet

Compulsions

• Most common manifestations:

• Hand washing (cleaning)• Checking behavior

• Counters & Perfectionists

Post Traumatic Stress Disorder• WW II military gave greater recognition to the

condition they termed "shell shock“ (PTSD)• PTSD follows a

traumatic event• Symptoms:

Re-experiencing

Avoidance

Arousal

Summary of Anxiety Disorders

One of the largest domains of psychopathology

From normal to disordered – Multiple factors– Fear & anxiety persist to non-

dangerous cues– Significant distress

Addictive Disorders: one of country’s major mental and

health problem

Substance Use Disorders

• Abuse– Interference with ability to fulfill major role

obligations and/or legal difficulties associated with use

• Dependence– Pattern of use that results in tolerance,

withdrawal, and compulsive drug-taking behavior

Types of psychoactive substances

• Alcohol• Amphetamines• Caffeine• Marijuana/hashish• Cocaine• Hallucinogens• Inhalants• Nicotine• Opiates• Phencyclidine• Sedatives, hypnotics, anxiolytics

midbrain: nucleus accumbens

All drugs which All drugs which people become people become dependent upon act dependent upon act on theon the

“ “pleasure pathways”pleasure pathways”

internal reward internal reward centers, made up of centers, made up of dopamine-sensitive dopamine-sensitive neuronsneurons

Ethnic DifferencesRates of alcoholism among Rates of alcoholism among Asian populations are lower Asian populations are lower than among European than among European peoplepeople

This fact may be related to a This fact may be related to a mutant enzyme that leads to mutant enzyme that leads to hypersensitive reactions to hypersensitive reactions to alcohol in Asiansalcohol in Asians

Mental health resources

• Center for Counseling and Psychological Services (CAPS) – 494-6995. Offices at PUSH and in Psychological Sciences Building.

• Urgent care after hours at PUSH 494-1724.• Crisis Center 742-0244• Mental Health American of Tippecanoe County 742-1800,

http://www.mhalafayette.org/• NAMI West Central Indiana 423-6939, http://www.nami-wci.org/