ABNORMAL PSYCHOLOGY

Dr. Reem Al-Sabah

Faculty of Medicine

Psychology 220

TRUE OF FALSE?

People who are mentally ill are violent. False

Geniuses are particularly prone to emotional disorders. False

Children can have serious mental disorders. True

Depression results from a personality weakness or character flaw. False

Most mental disorders are treatable. True

What is abnormal psychology?

The field devoted to the scientific study of

abnormal behavior to describe, predict,

explain, and change abnormal patterns of

functioning.

ANCIENT VIEWS AND TREATMENT

Most of our knowledge of prehistoric societies has

been acquired indirectly, is based on inferences

from archaeological findings, and is limited.

Most historians believe that prehistoric societies

regarded abnormal behavior as the work of evil

spirits

May have begun as far back as the Stone Age

The cure for abnormality was to force the demons

from the body through trephination and exorcism

Ancient skull with holes from trephination

WHAT IS ABNORMALITY?

Deviation from cultural norms

Every culture has certain standard, or norms, for

acceptable behavior.

Cultural relativist perspective: we should respect

each culture’s definitions of abnormality for the

members of that culture.

Opponents of this position:

Historically, societies have labeled

individuals as abnormal to justify

controlling or silencing them.

The concept of abnormality changes

over time within the same society.

Deviation from statistical norms

Abnormal: away from the norm.

Abnormal behavior is statistically infrequent or

deviant from the norm.

E.g., very tall or very short

E.g., extremenly intelligent

Definition of abnormality is more than statistical

frequency.

THE NORMAL DISTRIBUTION

Maladaptive behavior

Whether a person’s abnormal behavior is

maladaptive, that is if it has adverse effects on

the individual or on society.

Deviant behavior harmful to the individual.

e.g., a mother with severe depression who

can’t adequately fulfill her role.

Deviant behavior harmful to society

e.g., A teenager with violent and aggressive

outbursts.

Personal distress

Distress: feelings of anxiety, depression, or

agitation, or experiences such as insomnia,

loss of appetite, or numerous aches and pains.

Most people diagnosed with a mental disorder

feel extremely miserable.

Sometimes, personal distress may be the only

symptom of abnormality.

DEFINING NORMALITY

The following are traits that a normal person

possesses to a greater degree than an

individual who is diagnosed as abnormal:

Appropriate perceptions of reality.

Realistic in appraising one’s own reactions and

capabilities and in interpreting their surroundings.

Ability to exercise voluntary control

over behavior.

Feeling confident about the ability to control

one’s behavior.

Self-esteem and acceptance.

Having some appreciation for one’s own worth

and feeling accepted by those around you.

Ability to form affectionate relationships.

Able to form close and satisfying relationships with

other people.

Productivity.

Able to channel one’s abilities into productive

activity.

MENTAL ILLNESS

medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning.

Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.

Biologically based brain disorders. They cannot be overcome through "will power" and are not related to a person's "character" or intelligence.

NEUROSIS VS. PSYCHOSIS

Neurosis refers to mental distress that, unlike

psychosis, does not prevent rational thought or

daily functioning.

Neurotic conditions do not interfere with daily

functions

Most people suffer from some sort of neurosis as

a part of human nature.

Psychosis is a mental state involving the loss of

contact with reality, causing the deterioration of

normal social functioning.

Any mental state that impairs thought,

perception, and judgment.

A person experiencing a psychotic episode

might hallucinate, become paranoid, or

experience a change in personality.

CLASSIFYING ABNORMAL BEHAVIOR

DSM: The Diagnostic and Statistical Manual of

Mental Disorders.

The DSM was introduced in 1952.

The DSM has been widely adopted by mental health

professionals

The latest version, published in 2000, is the

DSM IV-TR, the Text Revision (TR) of the Fourth

Edition (DSM-IV).

DSM-5 is scheduled for release in May 2013

ICD: The International Statistical Classification of

Diseases and Related Health Problems.

A classification, published by the World Health

Organization.

Used mainly for compiling statistics on the

worldwide occurrence of disorders.

Now in its tenth revision (the ICD-10).

The DSM-IV is compatible with the ICD, so that

DSM diagnoses could be coded in the ICD system

as well.

ADVANTAGES OF THE DSM

CLASSIFICATION SYSTEM

Diagnostic codes are fundamental to medical

record keeping.

Diagnostic coding facilitates data collection

and retrieval and compilation of statistical

information.

Facilitates communication between clinicians.

DISADVANTAGES OF THE DSM

CLASSIFICATION SYSTEM

Some symptoms requirement (e.g., major depression be

present for 2 weeks before a diagnosis is reached) .

Medical model does not pay attention to external social

influences on behavior.

Categorical structure (a disorder is either present or not)

too rigid. Abnormal behavior occurs along a continuum

(dimensional approach ).

Stigmatizes people by labeling them with psychiatric

diagnoses.

PERSPECTIVES ON MENTAL HEALTH PROBLEMS

Biological perspective (medical or disease model):

due to brain disorders, genetic problems, brain

dysfunction.

Psychological perspective : due to problems in the

functioning of the mind.

Psychoanalytic perspective: defense mechanisms

are used to handle the anxiety of unconscious

conflicts (usually originating from childhood).

Behavioral perspective: fears become conditioned

to specific situations; reinforcement of inappropriate

behaviors; learning theory.

Cognitive perspective: maladaptive cognitive

processes.

Cultural/sociological perspective: social context in

which a person lives (e.g., poverty, discrimination).

Vulnerability-stress model

Interaction between predisposition & stressful

environmental conditions (need both to develop a

mental health problem).

DEFENSE MECHANISMS

Defense mechanisms protect us from being

consciously aware of a thought or feeling

which we cannot tolerate.

The defense only allows the unconscious

thought or feeling to be expressed indirectly

in a disguised form.

EXAMPLES OF DEFENSE MECHANISMS

Denial: You completely reject the thought or feeling. "I'm not angry with him!"

Suppression: You are vaguely aware of the thought or feeling, but try to hide it. "I'm going to try to be nice to him."

Reaction Formation: You turn the feeling into its opposite. "I think he's really great!“

Projection: You project your thoughts and feelings onto someone else. "That professor hates me.” "That student hates the prof.“

CATEGORIES OF MENTAL DISORDERS

1. Disorders usually first evident in infancy, childhood,

or adolescence.

2. Delirium, dementia, amnestic, and other cognitive

disorders.

3. Mental Disorders Due to a General Medical

Condition.

4. Substance-Related Disorders.

5. Schizophrenia and Other Psychotic Disorders

6. Mood Disorders.

7. Anxiety Disorders.

8. Somatoform Disorders.

9. Factitious Disorders

10. Dissociative Disorders

11. Sexual and Gender Identity Disorders

12. Eating Disorders

13. Sleep disorders

14. Impulse-Control Disorders Not Elsewhere Classified

15. Adjustment Disorders

16. Personality Disorders

17. Other Conditions That May Be a Focus of Clinical

Attention

PERVASIVE DEVELOPMENTAL DISORDERS

Pervasive developmental disorders

Set of disorders characterised by severe & lasting

impairment in several areas of development.

Diagnosis of autism

Involves three types of deficits:

Social interaction – lack of connection with others

Communication – difficulties in communication & speech

Activities & interests – preoccupation/routines/rituals

Autistic boys outnumber autistic girls three to one

PERVASIVE DEVELOPMENTAL DISORDERS

Asperger’s syndrome & other pervasive

developmental disorders (PDDs)

Rett’s disorder & childhood disintegrative disorder

Children appear to develop normally for while & then show

apparent permanent loss of basic skills in social interaction,

language, and/or movement

Asperger’s syndrome

Characterized by deficits in social interactions & in activities

and interests that similar to autism but different from autism in

that no significant delays or deviance in language

PDDs viewed as falling along continuum with autism most

severe & others lower on continuum

PERVASIVE DEVELOPMENTAL DISORDERS

Understanding pervasive developmental

disorders

Biological factors – several have been implicated in

development of PDDs

Family & twin studies suggest genetics play a role

Neurological factors also likely – disruption in normal

development & organization of the brain

Studies suggest that PDD sufferers lack theory of

mind which may make it impossible for these

children to understand & operate in the social world

5. ANXIETY DISORDERS

Includes disorders in which anxiety is the

main symptom (generalized anxiety or panic

disorders).

Or anxiety is experienced unless the

individual avoids feared situations (phobic

disorders) or tries to resist performing certain

rituals.

ANXIETY DISORDERS (CONT.)

Anxiety is only considered unhealthy when occurs in

situations that most people can handle with little

difficulty.

Four types of symptoms:

Physiological, cognitive, behavioral & emotional

symptoms.

Generalised anxiety disorder

Person experiences constant sense of tension &

dread, and continuously worries about potential

problems and has difficulty concentrating or

making decisions.

ANXIETY DISORDERS (CONT.)

Panic disorders

Panic attack – episode of acute & overwhelming apprehension or terror (approx. 28% have them occasionally).

Panic disorder is rare (approx. 2%). When panic attacks become frequent and person worries about having attacks.

Agoraphobia: anxiety about being in places where escape might be difficult or embarrassing or in which help may not be available should a panic attack develop

About 20% people with panic disorder develop agoraphobia.

UNDERSTANDING PANIC DISORDER &

AGORAPHOBIA

Panic disorders likely to have biological component

May have over-reactive fight-or-flight response

Cognitive factors play strong role in panic attacks & agoraphobic behavior may be conditioned through learning experiences

Interoceptive conditioning

Misinterpret bodily sensations

Catastophic thinking

ANXIETY DISORDERS

ANXIETY DISORDERS (CONT.)

Phobias

Intense fear of stimulus/situation most do not find particularly dangerous & it interferes with person’s life

Specific phobia

fear of specific object/animal/situation

Common about 8%

Social phobia

extreme insecurity in social situations (fear of public speaking, fear of eating in public)

2.4%

UNDERSTANDING PHOBIAS

Freud argued – phobias result of people

displacing anxiety over unconscious motives

onto symbolic objects

Behaviorists – phobias develop from

classical & operant conditioning.

Many phobias emerge after a traumatic

experience (classical conditioning).

Phobias are maintained through operant

conditioning.

ANXIETY DISORDERS (CONT.)

Obsessive-Compulsive Disorder: repetitive acts

or thoughts.

central feature is subjective loss of control (sufferers

don’t trust senses/judgements)

Obsessions: persistent intrusions of unwelcome

thoughts, images, or impulses that elicit anxiety

Compulsions: irresistible urges to carry out

certain acts or rituals that reduce anxiety

UNDERSTANDING OBSESSIVE-

COMPULSIVE DISORDER

Cognitive & behavioral theorists – those with obsessive-

compulsive disorder have more trouble “turning off”

intrusive thoughts due to more rigid thinking.

OCD begins at a young age.

Prevalence 1-3%.

May also have biological causes – possible deficiencies

in serotonin in areas of the brain that regulates primitive

impulses.

MOOD DISORDERS

Disturbances of normal mood; the person may be

extremely depressed, abnormally elated, or may

alternate between periods of elation and

depression.

Depressive disorders: one or more periods of

depression.

Common, about 13%.

Depression becomes a disorder when the symptoms

become so severe they interfere with normal

functioning & continue for weeks at a time

Women twice as likely to suffer depression as men

MOOD DISORDERS (CONT.)

Depression is a disorder of the whole person, affecting bodily

functions, behaviors, thoughts, and emotions).

Emotional symptoms:

Unrelenting pain and despair

Anhedonia: loss of ability to experience joy even in

response to the most joyous occasions

Cognitive Symptoms:

Negative thoughts (hopelessness, worthlessness, guilt)

Physical Symptoms:

changes in appetite and sleep, very fatigued, drained

MOOD DISORDERS

MOOD DISORDERS (CONT.)

Bipolar disorders: person alternates between

periods of depression & mania

individual alternates between depression &

extreme elation

Manic symptoms often change from joyful

exuberance to hostile agitation & equally found

in men & women

Uncommon, <2%

Occur equally in men and women

UNDERSTANDING MOOD DISORDERS

The biological perspective

Tendency to develop mood disorders, especially

bipolar disorders, appears to be inherited

1st degree relatives 5-10 times as likely

Twins 45-75 times as likely

Recurrent depression

1st relatives 2-4 times as likely

Structural & functional brain abnormalities could

be precursors & causes of mood disorders or

result of biochemical processes in mood

disorders which are toxic for brain

UNDERSTANDING MOOD DISORDERS

The cognitive perspective

Depressed people interpret life in pessimistic, hopeless

ways

Beck developed the cognitive triad: negative thoughts

about the self, present experiences and the future

Depression also affected by maladaptive attributional

styles

Interpersonal perspectives

Depressed people often too dependent on opinions &

support of others, e.g. through excessive reassurance

seeking

Psychosocial factors in bipolar disorders

Stressful life events can trigger new bipolar episodes

SCHIZOPHRENIA

SCHIZOPHRENIA

Schizophrenia is a chronic, severe, and disabling brain disease.

Schizophrenia occurs in all cultures.

Approximately 1 % of the population develops schizophrenia during their lifetime.

men (late teens or early twenties)

women (twenties to early thirties)

The first signs of schizophrenia often appear as

confusing, or even shocking, changes in

behavior.

Coping with the symptoms of schizophrenia can

be especially difficult for family members who

remember how involved or vivacious a person

was before they became ill.

One of the most stigmatized disorders.

CHARACTERISTICS OF SCHIZOPHRENIA

DISTURBANCES OF THOUGHT AND

ATTENTION

Process of thinking

difficulty focusing attention and filtering out

irrelevant stimuli

(‘world salad’, loosening of associations)

Content of thought

Lack of insight into their condition

delusions

Thoughts may come and go rapidly; the person

may not be able to concentrate on one thought for

very long and may be easily distracted .

Delusions: are false beliefs that usually involve a

misinterpretation of perceptions or experiences.

Most common: delusion of persecution

Least common: delusion of grandeur

Types of Delusions:

Persecutory delusions

Most common

Person believes he is being tormented, followed, tricked, spied on, or subjected to ridicule.

Referential delusions

Person believes that certain gestures, comments, passages from books, newspapers, song lyrics..etc are specifically directed at him or her.

Delusion of control: a false belief that another

person, group of people, or external force

controls one's thoughts, feelings, impulses, or

behavior.

Thought broadcasting, Thought insertion

Nihilistic delusion: A delusion whose theme

centers on the nonexistence of self or parts of

self, others, or the world. A person with this type

of delusion may have the false belief that the

world is ending.

Delusion of guilt or sin

A false feeling of remorse or guilt of delusional

intensity.

A person may believe that he or she has committed

some horrible crime and should be punished

severely, or that he or she is responsible for some

disaster (such as fire, flood, or earthquake) with

which there can be no possible connection.

Religious delusion:

Any delusion with a religious or spiritual content.

Beliefs that would be considered normal for an

individual's religious or cultural background are not

delusions.

Erotomania:

A belief that another person (of higher status) is in love with him or her.

Individuals may attempt to contact the other person (through phone calls, letters, gifts, and sometimes stalking).

Grandiose delusion:

Exaggerating one’s sense of self-importance and being convinced that one has special powers, talents, or abilities.

Person may actually believe he or she is a famous person (for example, a rock star or religious /political figure).

Somatic delusion:

A delusion whose content pertains to bodily

functioning, bodily sensations, or physical

appearance.

Usually the false belief is that the body is

somehow diseased, abnormal, or changed.

(e.g. a person who believes that his or her

body is infested with parasites. Or a belief that

one emits a foul odor ).

DISTURBANCES OF PERCEPTION

Hallucinations

sensory experiences in the absence of

relevant or adequate external stimulation.

Hallucinations can occur in any sensory

form: auditory (sound), visual (sight),

tactile (touch), gustatory (taste), and

olfactory (smell).

Most common: auditory hallucination

Auditory hallucinations

A false perception of sound/noise.

most common type of hallucination

"running commentary" on the person's behavior as

it occurs or “command hallucinations” or telling the

person to do something.

Visual hallucination

A false perception of sight.

The content of the hallucination may be anything

(such as shapes, colors, and flashes of light) but are

typically people or human-like figures.

Tactile hallucination:

A false perception or sensation of touch or

something happening in or on the body.

A common tactile hallucination is feeling like

something is crawling under or on the skin.

Actual physical sensations stemming from

medical disorders (perhaps not yet diagnosed)

and hypochondriasis with normal physical

sensations are not thought of as somatic

hallucinations.

Gustatory hallucination

A false perception of taste. Usually, the

experience is unpleasant (e.g. a persistent

taste of metal).

Olfactory hallucination

A false perception of odor or smell. Typically,

the experience is very unpleasant (e.g. the

person may smell decaying fish, dead bodies,

or burning rubber).

DISTURBANCES OF EMOTIONAL

EXPRESSION

Exhibit unusual emotional reactions.

Express emotions that are inappropriate to

the situation or to the thought being

expressed.

MOTOR SYMPTOMS AND

WITHDRAWAL OF REALITY

Sometimes exhibit bizarre motor activity.

Examples:

Strange facial expressions

Very agitated and move about in continual

activity

Totally unresponsive or immobile for extended

periods of time (catatonic immobility).

DECREASED ABILITY TO FUNCTION

Impaired ability to carry out the daily routines of living.

School, job, personal hygiene, grooming.

Person avoids company of others.

Schizophrenia symptoms: due to disorder, reaction to life in

a mental hospital, or to the effects of medication.

POSITIVE AND NEGATIVE SYMPTOMS OF

SCHIZOPHRENIA

The positive symptoms appear to reflect an

excess or distortion of normal functions. They

include:

Distortion of inferential thinking (delusions).

Distortion of perception (hallucinations).

Distortions in language and thought processes

(Disorganized speech).

Distortions in self-monitoring of behavior (grossly

disorganized or catatonic behavior).

whereas the negative symptoms appear to

reflect a loss of normal functions. They include

restrictions in:

The range and intensity of emotional

expression (affective flattening).

The fluency and productivity of thought and

speech (alogia).

The inability to initiate of goal-directed

behavior (avolition).

CAUTIONARY NOTE At times, normal individuals may feel, think, or act in

ways that resemble schizophrenia.

Normal people may sometimes be unable to think straight, may become extremely anxious, be unable to pull their thoughts together, and forget what they had intended to say. This is not schizophrenia.

Hypnagogic (while falling asleep) and hypnopompic (waking up) hallucinations are considered normal human experiences

People with schizophrenia do not always act

abnormally. They can appear completely normal

and be perfectly responsible, even while they

experience hallucinations or delusions.

An individual’s behavior may change over time,

becoming bizarre if medication is stopped and

returning closer to normal when receiving

appropriate treatment.

WHAT CAUSES SCHIZOPHRENIA?

There is no known single cause of

schizophrenia.

Many diseases, such as heart disease, result

from an interplay of genetic, behavioral, and

other factors; and this may be the case for

schizophrenia as well.

Scientists do not yet understand all of the factors

necessary to produce schizophrenia.

The Path to Schizophrenia - The diagram shows how biological, genetic

and prenatal factors are believed to create a vulnerability to schizophrenia. Additional

environmental exposures (for example, frequent or ongoing social stress and/or isolation

during childhood, drug abuse, etc.) then further increase the risk or trigger the onset of

psychosis and schizophrenia. Early signs of schizophrenia risk include neurocognitive

impairments, social anxiety (shyness) and isolation and "odd ideas". (note: "abuse of DA

drugs" referes to dopamine affecting (DA) drugs).

Dr. Ira Glick (2005)"New Schizophrenia Treatments“

THE BIOLOGICAL PERSPECTIVE

Schizophrenia runs in families (hereditary predisposition for schizophrenia).

First-degree biological relatives have about a 10% chance, whereas the risk of schizophrenia in the general population is about 1%.

A monozygotic twin of a person with schizophrenia has the highest risk (40 to 50%) of developing the illness, while dizygotic twins have approx. 15% risk.

HOW DO GENETIC ABNORMALITIES OF

SCHIZOPHRENIA AFFECT THE BRAIN?

1. Brain structure

Prefrontal cortex is smaller and shows less activity

Enlarged ventricles (cavities inside the brain

containing cerebrospinal fluid).

2. Biochemistry

Imbalance in levels of dopamine in different areas of the

brain.

Excess dopamine in the mesolimbic system (emotion ,

cognition)

Low dopamine activity in the prefrontal area of the

brain (attention, motivation, organization of behavior)

Multiple genes are involved in creating a

predisposition to develop the disorder (the

transmission of this genetic predisposition is not

yet understood).

Prenatal difficulties (e.g., intrauterine starvation,

viral infections, perinatal complications, and

various nonspecific stressors, seem to influence

the development of schizophrenia.

THE PSYCHOSOCIAL PERSPECTIVE

Determine severity of the disorder and may trigger new episodes of psychosis.

Family-related stress: High in expressed emotion.

(hostility, intrusiveness, over-involved in one another, overprotective, critical, hostile, resentful)

but how exactly they interact, or to what degree is not completely understood.

Life stressors may trigger schizophrenia in people

whose genetics leave them susceptible to the illness.

Ending relationships, leaving home, and other life

stressors have been linked to schizophrenia onset in

some cases.

Certain personality traits may predispose individuals to

the disease.

Low levels of social competence and a diminished

ability to experience pleasure have been linked to

schizophrenia, as have pre-existing problems with

cognitive and perceptual distortion.

CONCLUSION

Clinically, schizophrenia is heterogeneous

and this may point to heterogeneous

etiology.

It seems that genetics, neurodevelopmental

problems, neurochemistry and abnormal

connectivity, as well as psychosocial

stressors probably all contribute to

developing the typical clinical pictures of

schizophrenia.