College of Education

School of Continuing and Distance Education 2014/2015 – 2016/2017

PSYC 221 Introduction to General Psychology

Session 9 – Abnormal psychology

Lecturer: Dr. Joana Salifu Yendork, Psychology Department Contact Information: jyendork@ug.edu.gh

Session Overview

• There is a thin line between what is normal and what is abnormal. Abnormal psychology is the branch of psychology that specializes in understanding abnormal behaviours, factors that contribute to psychopathology and ways of treating psychological disorders. You will notice that I have used three new concepts in describing the focus of this session, abnormal behaviours, psychopathology and disorders. In this session, we will focus on understanding these new concepts.

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Session Outline

The key topics to be covered in the session are as follows:

• Perspectives on psychological disorders

• Anxiety disorders

• Mood disorders

• Dissociative, eating and personality disorders

• Schizophrenia

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Reading List

• Chapter 12 of Feldman (2007), Essentials of understanding psychology

• Chapter 13 of Myers (2008), Exploring psychology

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PERSPECTIVES ON PSYCHOLOGICAL DISORDERS

Topic One

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Perspectives on psychological disorders

• Psychological disorders are persistent patterns of thoughts, feelings, or actions that are deviant, distressful, and dysfunctional.

• Key terms

• Disorder refers to a state of mental/behavioral ill health.

• Persistent means the pattern of thought, feeling or action should be continuous

• Patterns refers to finding a collection of symptoms that tend to go together, and not just seeing a single symptom.

• For there to be distress and dysfunction, symptoms must be sufficiently severe to interfere with individual’s daily life and well being.

• Deviant means differing from the norm as defined by culture, context or typical developmental pathway.

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Understanding psychopathology

• In the past, it was believed that mental illnesses were caused by demons • Based on this belief, treatments used included: exorcising evil spirits,

beatings, caging/restraint, and trephination (drilling holes in the skull to release evil spirits)

• Philippe Pinel (1745-1826) was among the reformers who opposed this notion and sought to reform brutal treatment.

• He promoted a new understanding of the nature of mental disorders by proposing that mental disorders were not caused by demonic possession, but by environmental factors such as stress and inhumane conditions.

• Pinel’s “moral treatment” involved improving the environment and replacing the asylum beatings with boosting patients’ morale by unchaining them and talking with them, and by replacing brutality with gentleness, isolation with activity, and filth with clean air and sunshine

• Pinel’s approach helped to improve live but did not led to effective treatment of mental illness

• His ideas also led to the discovery that syphilis causes mental symptoms by infecting the brain. This discovery led to the medical model for mental illness

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The medical model

• Psychological disorders can be seen as psychopathology, an illness of the mind.

• Disorders can be diagnosed, labeled as a collection of symptoms that tend to go together.

• People with disorders can be treated, attended to, given therapy in a psychiatric hospital, all with a goal of restoring mental health.

• The medical model also implies ideas about etiology, the cause of mental disorders.

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The biopsychosocial approach

• This perspective suggests that mental disorders can arise in the interaction between nature and nurture caused by biology, thoughts, and the sociocultural environment.

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Classifying psychological disorders

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• Classification of disorders is important because: – Diagnoses create a verbal shorthand for referring to a list

of associated symptoms.

– Diagnostic classification helps to describe a disorder, predict its future course, imply appropriate treatment, and stimulate research into its causes

• The two commonly used diagnostic manuals are The Diagnostic and Statistical Manual (DSM; by the American Psychiatric Association) and the International Classification of Diseases (ICD; by the World Health Organisation)

The DSM suggests describing someone not just with a label but with a five-part picture.

Axis I: Is a clinical syndrome present?

Using specifically

defined criteria,

clinicians may select none, one,

or more syndromes.

Axis II: Is a personality

disorder or mental

retardation (intellectual

developmental disorder) present?

Clinicians may or may not also

select one of these two conditions.

Axis III: Is a general

medical condition,

such as diabetes,

arthritis, or hypertension also present?

Axis IV: Are

psychosocial or

environmental problems, such

as school or housing issues, also present?

Axis V: What is the

global assessment of this person’s functioning?

Clinicians assign a code

from

0-100.

The Five “Axes” of Diagnosis

Critiques of Diagnosing with the DSM

• Criticisms leveled against the DSM include: – The DSM calls too many people “disordered.”

– The border between diagnoses, or between disorder and normal, seems arbitrary.

– Decisions about what is a disorder seem to include value judgments; is depression necessarily deviant?

– Diagnostic labels direct how we view and interpret the world, telling us which behavior and mental states to see as disordered.

ANXIETY DISORDERS Topic Two

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Anxiety disorders

• Generalized anxiety disorder: the experience of unexplainably and continually tension and uneasiness

• Panic disorder: experiences of sudden episodes of intense terror

• Phobias: irrationally and intensely fear of a specific object or situation

• Obsessive-compulsive disorder: concerned by repetitive thoughts or actions

• Post-traumatic stress disorder in which a person has lingering memories, nightmares, and other symptoms for weeks after a severely threatening, uncontrollable event.

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GAD: Generalized Anxiety Disorder

Emotional-cognitive symptoms include worrying, having anxious feelings and thoughts about many subjects, and sometimes “free-floating” anxiety with no attachment to any subject.

Anxious anticipation interferes with concentration. Physical symptoms include autonomic arousal, trembling,

sweating, fidgeting, agitation, and sleep disruption.

• Other physical symptoms included furrowed brows, twitching eyelids and perspiration.

• GAD is often accompanied by depressed mood, but even without depression it tends to be disabling

• May lead to physical problems, such as ulcers and high blood pressure

Panic disorder (PD)

PD refers to repeated and unexpected panic attacks, as well as a fear of the next attack, and a change in behavior to avoid panic attacks.

Symptoms include: many minutes of intense dread or terror. Heart palpitation, dizziness, chest pains, choking,

numbness, or other frightening physical sensations. Patients may feel certain that it’s a heart attack.

a feeling of a need to escape.

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Specific Phobia •A specific phobia is more than just a strong fear or dislike.

• A specific phobia is diagnosed when there is an uncontrollable, irrational, intense desire to avoid the some object or situation.

•Even an image of the object can trigger a reaction--“GET IT AWAY FROM ME!!!”--the uncontrollable, irrational, intense desire to avoid the object of the phobia.

•E.g. Agoraphobia is the avoidance of situations in which one will fear having a panic attack, especially a situation in which it is difficult to get help, and from which it difficult to escape.

•Social phobia refers to an intense fear of being watched and judged by others. It is visible as a fear of public appearances in which embarrassment or humiliation is possible, such as public speaking, eating, or performing.

Obsessive-Compulsive Disorder [OCD]

Obsessions are intense, unwanted worries, ideas, and images that repeatedly pop up in the mind.

A compulsion is a repeatedly strong feeling of “needing” to carry out an action, even though it doesn’t feel like it makes sense.

Typically, the compulsions decrease anxiety only temporarily

When is it a “disorder”?

Distress: when you are deeply frustrated with not being able to control the behaviors

or

Dysfunction: when the time and mental energy spent on these thoughts and behaviors interfere with everyday life

Common OCD behaviors

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•About 10 to 35 percent of people who experience trauma not only have burned-in memories, but also four weeks to a lifetime of:

•repeated intrusive recall of those memories. •nightmares and other re-experiencing. •social withdrawal or phobic avoidance. •jumpy anxiety or hypervigilance. •insomnia or sleep problems.

•Most people experiencing trauma do NOT develop PTSD. •Those who develop PTSD have less control over the situation, those traumatized more frequently or get re-traumatized, have less resilience and those with sensitive amygdala, or difficulty controlling attention

Post-Traumatic Stress Disorder [PTSD]

Understanding Anxiety Disorders:

Explanations from Different Perspectives

Psychodynamic/ Freudian: repressed impulses

Classical conditioning:

overgeneralizing a conditioned

response

Operant conditioning:

rewarding avoidance

Observational learning:

worrying like mom

Cognitive appraisals:

uncertainty is danger

Evolutionary: surviving by

avoiding danger

MOOD DISORDERS Topic Three

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Mood disorders

•Mood disorders are psychological disorders characterized by emotional extremes. •Mood disorders include:

–Major depressive disorders

–Bipolar disorder

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Major depressive disorders (MDD)

• Major depressive disorder [MDD] is: more than just feeling “down.” more than just feeling sad about something

• Major depressive disorder occurs when at least five signs of depression including: – lethargy, – feelings of worthlessness, – loss of interest in family, friends, and activities – Recurring thoughts of death and suicide – Significant increase or decrease in appetite or weight

• Last two or more weeks and are not caused by drugs or a medical condition

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Bipolar

Bipolar disorder was once called “manic-depressive disorder.”

Bipolar disorder’s two polar opposite moods are depression and mania and the patient alternate between the two mood states

A typical pattern is three to seven weeks of depression, followed by three to seven days of mania.

Mania refers to a period of hyper-elevated mood that is euphoric, giddy, easily irritated, hyperactive, impulsive, overly optimistic, and even grandiose.

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Bipolar Disorder

Contrasting Symptoms

Depressed mood: stuck feeling “down,” with:

Mania: euphoric, giddy, easily irritated, with:

exaggerated pessimism social withdrawal lack of felt pleasure inactivity and no initiative difficulty focusing fatigue and excessive desire to

sleep

exaggerated optimism hypersociality and sexuality delight in everything impulsivity and overactivity racing thoughts; the mind

won’t settle down little desire for sleep

Understanding Mood Disorders

Biological aspects and explanations

Social-cognitive aspects and explanations

Evolutionary

Genetic

Brain /Body

Negative thoughts and negative mood

Explanatory style

The vicious cycle

Biology of Depression: Genetics

Evidence of genetic influence on depression:

1. DNA linkage analysis reveals depressed gene regions

2. twin/adoption heritability studies

Biology of Depression: The Brain

Brain activity is diminished in depression and increased in mania.

Brain structure: smaller frontal lobes in depression and fewer axons in bipolar disorder

Brain cell communication (neurotransmitters): more norepinephrine (arousing) in mania, less in depression

reduced serotonin in depression

Depressive Explanatory

Style

Low Self-Esteem

Learned Helplessness

Rumination

Discounting positive information and assuming the worst about self, situation, and the future

Self-defeating beliefs such as assuming that one (self) is unable to cope, improve, achieve, or be happy

Depression is associated with:

Stuck focusing on what’s bad

Understanding Mood Disorders: The Social-Cognitive Perspective

Depression’s Vicious Cycle

A depressed mood may develop when a person with a negative outlook experiences repeated stress.

The depressed mood changes a person’s style of thinking and interacting in a way that makes stressful experience more likely.

DISSOCIATIVE, EATING AND PERSONALITY DISORDERS

Topic Four

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Dissociative disorders

Dissociation refers to a separation of conscious awareness from thoughts, memory, bodily sensations, feelings, or even from identity.

Dissociation can serve as a psychological escape from an overwhelmingly stressful situation.

A dissociative disorder refers to dysfunction and distress caused by chronic and severe dissociation.

Examples include: Dissociative amnesia: Loss of memory with no known physical cause;

inability to recall selected memories or any memories

Dissociative fugue: “Running away” state; wandering away from one’s life, memory, and identity, with no memory of these

Dissociative identity disorder (DID): development of separate personalities

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Eating disorders

• These may involve: – unrealistic body image and extreme body ideal

– a desire to control food and the body when one’s situation can’t be controlled

– cycles of depression

– health problems, e.g. malnutrition, death

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Types Definition Prevalence

Anorexia Nervosa

Compulsion to lose weight, coupled with certainty about

being fat despite being 15 percent or more underweight

0.6 percent meet criteria at

some time during lifetime

Bulimia Nervosa

Compulsion to binge, eating large amounts fast, then purge by losing

the food through vomiting, laxatives, and extreme exercise

1.0 percent

Binge-Eating Disorder

Compulsion to binge, followed by guilt and depression 2.8 percent

Eating disorders

• Factors linked to eating disorders include: Family factors:

having a mother focused on her weight, and on child’s appearance and weight

negative self-evaluation in the family

for bulimia, if childhood obesity runs in the family

for anorexia, if families are competitive, high-achieving, and protective

Cultural factors:

unrealistic ideals of body appearance

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Personality disorders

• Personality disorders are enduring patterns of social and other behavior that impair social functioning.

• There are three “clusters”/categories of personality disorders.

Anxious: Avoidant, Dependent, and Obsessive-Compulsive Personality Disorder

e.g., Avoidant P.D., ruled by fear of social rejection

Eccentric/Odd: Schizoid, Schizotypal, and Paranoid Personality Disorders

e.g. Schizoid P.D., with flat affect, no social attachments

Dramatic: Histrionic, Narcissistic, Antisocial, and Borderline Personality Disorders

e.g. Histrionic, attention-seeking; narcissistic, self-centered; antisocial, amoral

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Antisocial personality disorder (APD)

• APD refers to acting impulsively or fearlessly without regard for others’ needs and feelings

• To diagnose APD, criteria include: – A pattern of violating the rights of others since age 15 and

– Three of the following • Deceitfulness;

• disregard for safety of self or others;

• aggressiveness;

• failure to conform to social norms;

• lack of remorse;

• impulsivity and failure to plan ahead;

• irritability;

• irresponsibility regarding jobs, family and money Slide 37

Risks factors for APD

•About half of children with persistent antisocial behavior develop lifelong APD. Certain psychological and biological factors have been identified. •Psychological factors:

–History of impulsivity, uninhibition, unconcerned with social rewards, and low in anxiety in preschool. –those who endured child abuse, and/or inconsistent, unavailable caretaking.

• Biological APD – Antisocial or unemotional biological relatives increases risk. – Some associated genes have been identified. – Risk factors include body-based fearlessness, lower levels of stress

hormones, and low physiological arousal in stressful situations such as awaiting receiving a shock.

– Fear conditioning is impaired. – Reduced prefrontal cortex tissue leads to impulsivity. – Substance dependence is more likely.

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Antisocial PD ≠ Criminality

Criminals: people who repeatedly commit crimes

People with antisocial

personality disorder

Many career criminals do show empathy and selflessness with family and friends. Many people with A.P.D. do not commit crimes.

Antisocial Crime

If antisocial personality disorder is not a full picture of most criminal activity, what can we say about people who commit crime, especially violent crime?

Biosocial roots of crime: birth complications and poverty combine to increase risk.

Biosocial Roots of Crime: The Brain

People who commit murder seem to have less tissue and activity in the part of the brain that suppresses impulses.

Other differences include: less amygdala response when viewing violence. an overactive dopamine reward-seeking system.

Rates of Psychological Disorders

This list takes a closer look at the past-year prevalence of various mental health diagnoses in the United States.

Risks and Protective Factors for Mental Disorders

Outcomes for people with psychological disorders

• Some people with psychological disorders do not recover.

• Some achieve greatness, even with a psychological disorder.

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SCHIZOPHRENIA Topic Five

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Schizophrenia

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

• There are positive and negative symptoms include:

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Positive + presence of problematic

behaviors

Negative - absence of

healthy behaviors

Hallucinations (illusory perceptions), especially auditory

Delusions (illusory beliefs), especially persecutory

Disorganized thought and nonsensical speech

Bizarre behaviors

Flat affect (no emotion showing in the face)

Reduced social interaction Anhedonia (no feeling of

enjoyment) Avolition (less motivation,

initiative, focus on tasks) Alogia (speaking less) Catatonia (moving less)

Positive and Negative Symptoms of Schizophrenia

Schizophrenia Symptoms: • Problems in Thinking and Speaking: • Disorganized speech, including the “word salad” of loosely

associated phrases • Delusions (illusory beliefs), often bizarre and not just mistaken;

most common are delusions of grandeur and of persecution • Problems with selective attention, difficulty filtering thoughts

and choosing which thoughts to believe and to say out loud • Disturbed perceptions: • People with schizophrenia often experience hallucinations, that

is, perceptual experiences not shared by others. • The most common form of hallucination is hearing voices that no

one else hears, often with upsetting (e.g. shaming) content.

• Hallucinations can also be visual, olfactory/smells, tactile/touch, or gustatory/taste.

? ! ? !

Schizophrenia Symptoms: • Inappropriate Emotions:

• Odd and socially inappropriate responses such as looking bored or amused while hearing of a death

• Flat affect: facial/body expression is “flat” with no visible emotional content

• Impaired perception of emotions, including not “reading” others’ intentions and feelings

• Inappropriate Actions/Behavior • Odd and socially inappropriate behavior can be caused by

symptoms such as: • errors in social perception. • disorganized, unfiltered thinking. • delusions and hallucinations.

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Schizophrenia Symptoms:

•The schizophrenic body exhibits symptoms such as: •repetitive behaviors such as rocking and rubbing. •Catatonia, such as sitting motionless and unresponsive for hours.

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Onset and developmental schizophrenia

Onset: Typically, schizophrenic symptoms appear at the end of adolescence and in early adulthood, later for women than for men.

Prevalence: Nearly 1 in 100 people develop schizophrenia, slightly more men than women.

Development: The course of schizophrenia can be acute/reactive or chronic

Acute/Reactive Schizophrenia In reaction to stress, some people develop positive

symptoms such as hallucinations.

Recovery is likely.

Chronic/Process Schizophrenia develops slowly, with more negative symptoms such as

flat affect and social withdrawal.

– With treatment and support, there may be periods of a normal life, but not a cure.

– Without treatment, this type of schizophrenia often leads to poverty and social

problems.

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Treatment

• Treatment can include: – medication but

– psychosocial rehabilitation,

– exercise,

– psychotherapy,

– supervised group homes,

– case management,

– daily living skills support, and

– vocational programs.

• Without real treatment, institutionalization was once the norm, then homelessness and incarceration, now outpatient treatment and “partial hospitalization” (day treatment).

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Subtypes of Schizophrenia

• Plagued by hallucinations, often with negative messages, and delusions, both grandiose and persecutory

Paranoid

• Primary symptoms are flat affect, incoherent speech, and random behavior

Disorganized

• Rarely initiating or controlling movement; copies others’ speech and actions

Catatonic

• Many varied symptoms Undifferentiated

• Withdrawal continues after positive symptoms have disappeared

Residual

Causes of schizophrenia

• Abnormal brain structure and activity

• Too many dopamine/D4 receptors help to explain paranoia and hallucinations; it’s like taking amphetamine overdoses all the time.

• Poor coordination of neural firing in the frontal lobes impairs judgment and self-control.

• The thalamus fires during hallucinations as if real sensations were being received.

• There is general shrinking of many brain areas and connections between them.

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Causes of schizophrenia

• Biological Risk Factors

• Schizophrenia is somewhat more likely to develop when one or more of these factors is present:

– low birth weight

– maternal diabetes

– older paternal age

– Famine

– oxygen deprivation during delivery

– maternal virus during mid-pregnancy impairing brain development

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Causes of schizophrenia

• Genetic Factors

• If one twin has schizophrenia, the chance of the other one also having it are much greater if the twins are identical.

• Having adoptive siblings (or parents) with schizophrenia does not increase the likelihood of developing schizophrenia.

• Even in identical twins, genetics do not fully predict schizophrenia.

• This could be because of environmental differences.

• First difference: twins in separate placentas.

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Causes of schizophrenia

• Social-Psychological Factors

• Research does not support the idea that social or psychological factors (such as parenting) alone can cause schizophrenia.

• However, there may be factors such as stress that affect the onset of schizophrenia.

• Until we find a mechanism of causation, all we may have is a list of factors which correlate with increased risk.

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Predicting Schizophrenia: Early Warning Signs

early separation from parents

short attention span disruptive OR withdrawn

behavior emotional unpredictability poor peer relations and/or

solitary play

having a mother with severe chronic schizophrenia

birth complications, including oxygen deprivation and low birth weight

poor muscle coordination

Social/psychological factors which tend to

appear before the onset of schizophrenia:

Biological factors which tend to appear before the onset of

schizophrenia:

Sample Question

• As anxiety is a response to the threat of future loss, depressed mood is often a response to past and current loss. Discuss.

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References

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