Abnormal Psychology

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Abnormal Psychology

• Chapter 14

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Abnormal Psychology

• Part I How do we define abnormal?
• Part II What is the DSM IV?
• Part III Disorders

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Criteria for Abnormal Behavior

• Deviant
• Statistical Deviance, Cultural Deviance
• Distressing
• Causes distress to individual or those around
  individual
• Dysfunctional
• Causes disruption in social, occupational, day to
  day functioning
• (Dangerous)
• Be careful with this label!!
• Risk of harm to self

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Explaining Psychological Disorders

• Medical Model
• Useful to think of abnormal behavior as a disease
• mental illness psychological disorder
• Rise of medical model brought improvement in
  treatment
• Viewed with more sympathy, less fear
• Criticisms
• Thomas Szasz problems in living
• Labelling
• Encourages passivity

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Explaining Psychological Disorders

• Sociocultural Perspective
• Mental disorders products of person, immediate
  environment, larger culture in which person
  develops
• Concerned with ways in which people respond to
  and express distress
• Also concerned with how culture labels and reacts
  to manifestations of distress

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What is the DSMIV?

• Diagnostic Statistical Manual of Mental
  Disorders, 4th Edition
• Published by American Psychiatric Association
• Used for the diagnosis and classification of
  psychological disorders
• First edition published in 1952

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What is the DSM-IV?

• Current edition describes over 200 disorders
• Uses five axes to describe clients
• Does not make suggestions regarding causes of
  disorders
• Does not make suggestions for treatment/therapy

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Multiaxial System

• Axis I Clinical Disorders
• Axis II Personality Disorders MR
• Axis III General Medical Condition
• Axis IV Psychosocial Functioning
• Axis V Global Assessment of
• Functioning

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Anxiety Disorders

• We all experience anxiety from time to time
• Anxiety disorders marked by excessive feelings of
  apprehension and anxiety
• Generalized Anxiety Disorder
• Specific and Social Phobias
• Panic Disorder Agoraphobia
• Obsessive Compulsive Disorder
• Post Traumatic Stress Disorder

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Generalized Anxiety Disorder

• Marked by a chronic, high level of anxiety that
  is not tied to any specific threat
• Free-floating anxiety
• Worry constantly about yesterday's mistakes,
  tomorrows problems
• Worry about family, finances, work, personal
  illness more than others
• May see muscle tension, poor concentration,
  irritability, sleep disturbance, feeling on edge

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Generalized Anxiety Disorder

• Moderately heritable
• If it begins later in life, typically follows a
  stressful life event (e.g., having baby, new job)
• See in about 5 of population

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Simple Phobias

• A phobic disorder is marked by a persistent and
  irrational fear of an object or situation that
  presents no realistic danger
• Suffer from fear itself and
• knowing it is irrational
• Common phobias
• Fear of animals/insects
• Fear of heights
• Fear water
• Fear of small, enclosed spaces

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Social Phobia

• Anxiety provoked by social or
• performance situations
• Feared situations are avoided or
• endured with marked anxiety
• E.g., public speaking, going to parties, meeting
  new people, eating in public
• Person fears will act in a way that will be
  humiliating or embarrassing
• See in 10 of individuals (most common)

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Panic Disorder

• Characterized by recurrent attacks of
  overwhelming anxiety that usually occur suddenly
  and unexpectedly
• Last several minutes, often accompanied by high
  physiological arousal (rapid heart rate,
  shortness of breath) and fear of losing control
• Become apprehensive about when next attack will
  occur
• See in 1-2 of population

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Panic Disorder

• May lead to agoraphobia fear of going out in
  public places
• Fear may be general or limited
• to certain situations
• Public transportation
• Tunnels or bridges
• Crowds
• Going out by oneself
• 1/3 1/2 of individuals with PD develop
  agoraphobia

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Obsessive Compulsive Disorder

• Consists of 2 components cognitive, behavioral
• Obsessions
• Persistent, uncontrollable thoughts, images or
  impulses
• Compulsions
• Urges to engage in senseless
• repetitive rituals that can only
• be resisted with great difficulty

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Obsessive Compulsive Disorder

• Compulsions are responses to obsessions and often
  reduce anxiety associated with the thoughts in
  the short term
• Common compulsions cleaning, counting, checking,
  asking for reassurance, ordering
• Usually has onset during adolescence
• See in about 2.5 of population

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Post-Traumatic Stress Disorder

• Unlike other anxiety disorders, PTSD is directly
  tied to a traumatic incident
• E.g., Torture victims, accident survivors,
  assault victims
• May see onset immediately after traumatic event,
  or may be delayed onset
• Seems to be particularly likely to occur if a
  person cannot make sense of a trauma

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Post Traumatic Stress Disorder

• In order to meet the diagnosis, clients must meet
  the following criteria
• (1) Person relives the event
• Distressing dreams, flashbacks
• (2) Person becomes numb to world and avoids
  reminders of trauma
• Avoid thoughts, activities related trauma, show
  feelings of detachment
• (3) Person shows symptoms of increased arousal
• E.g., irritability, difficulty concentrating,
  difficulting falling/staying asleep

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What causes Anxiety Disorders?

• BIOLOGICAL FACTORS
• Most anxiety disorders appear to run in families
• May be due in part to shared environmental
  factors, but likely inherit a predisposition
• Strongest evidence for panic disorder and
  generalized anxiety disorder

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What causes Anxiety Disorders?

• PSYCHOLOGICAL/COGNITIVE FACTORS
• Impact of learning
• E.g., parents who do not socialize much
• Abuse or traumatic childhood experiences increase
  risk
• Those with anxiety disorders tend to be
  hypervigilent
• Overestimate risk, underestimate safety

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Mood Disorders

• Class of disorders marked by emotional
  disturbances
• Major Depressive Disorder
• Dysthymia
• Bipolar Disorder

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Major Depressive Disorder

• Persistent feelings of sadness and despair, loss
  of interest in sources of pleasure
• There are four main types of symptoms
• (1) Mood
• (2) Cognitive
• (3) Motivational
• (4) Somatic (Bodily)

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Major Depression

• Must show 5 or more symptoms for at least 2
  weeks, 1 symptom must be depressed mood or loss
  of pleasure
• Depressed Mood
• Loss of interest/pleasure activities
• Significant weight loss/gain
• Insomnia/hypersomnia
• Psychomotor agitation/retardation
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Reduced ability to concentrate
• Recurrent thoughts of death / suicidal ideation
• See in 5-12 men, 10-25 women

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Dysthymia

• Chronic depression that is insufficient in
  severity to merit diagnosis of a major depressive
  episode
• Must show symptoms for at least 2 years
• Diagnosed 2-3x more often in women
• See in about 6 of population
• May see double depression
• Major depression superimposed over previous state
  of chronic dysthymia

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Bipolar Disorder

• Depression (usually dominant state) alternates
  with periods of mania (must be at least 1 week
  long)
• Main features of manic states include feelings of
  power, confidence, energy, enhanced creativity
• Not all individuals with BD experience manic
  states as euphoric some find them times of
  paranoia
• See in lt2 of population

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Suicide

• Best predictors are prior suicide attempts and
  suicidal thoughts
• Alcohol and drug use increases risk
• Impulsive decision making
• Females attempt more, males more successful
• Men use more lethal means
• Three myths
• People who talk about suicide dont commit
  suicide
• Suicide usually takes place with little or no
  warning
• People who attempt suicide are fully intent on
  dying

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What causes Depression/Bipolar disorder?

• BIOLOGICAL PERSPECTIVE
• Heredity can create predisposition to depression
• Influence of genetic factors slightly stronger in
  bipolar disorders than in depressive disorders
• Role of seratonin, norepinephrine, and dopamine
• Seratonin important promiting calm, sleep
• Nor. dop important motivation pleasure
• enhancing

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What causes Depression/Bipolar disorder?

• Psychological/Cognitive Factors
• Attributions are inferences we draw about causes
  of events, others behavior, own behavior
• Hopelessness Theory of Depression
• People who are depressed tend to make
• Internal, stable, global attributions for
  negative experiences
• and
• External, unstable, and specific attributions
• for positive experiences

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Maladaptive Thoughts in Depression
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Schizophrenia

• Disturbances in thought that affect perceptual,
  social, and emotional processes
• Onset tends earlier in males (18-25) and later
  for females (26-45)
• See in 1 of population

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Schizophrenia Symptoms

• Delusions
• False beliefs held in face of compelling evidence
  to the contrary
• Delusions Persecution
• Belief others plotting against you
• Delusions of grandeur
• Belief in own extraordinary competence
• Hallucinations
• False sensory perceptionsseeing or hearing
  things that are not there.
• Most common hallucinations are auditory (hearing
  voices)

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Schizophrenia Symptoms

• Positive Symptoms
• Hallucinations, delusions, disordered thinking,
  bizarre/disorganized behavior
• Negative Symptoms
• Absence of, or reduction in expected behaviors,
  thoughts, feelings, drives
• Lack of motivation, inability to experience
  pleasure

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Schizophrenia Subtypes

• Paranoid Type
• Characterized mainly by delusions of persecution
  and grandeur
• Believe have enemies who want to harass you
• Catatonic Type
• Striking motor disturbances, ranging from
  muscular rigidity to random motor activity
• Disorganized Type
• Incoherence speech, inappropriate flattened
  affect
• Particularly severe
• Undifferentiated Type
• Catch all category
• Idiosyncratic mixtures of schizophrenic symptoms

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What causes Schizophrenia?

• BIOLOGICAL
• Excess of dopamine
• Brains of those with schizophrenia have enlarged
  ventricles
• Not sure if cause or consequence
• Seems to be a strong genetic influence
• Great likelihood of developing disorder

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What causes Schizophrenia?

• SOCIOCULTURAL
• Levels of expressed emotion
• Criticisms and negative attitudes expressed about
  and toward a person with schizophrenia by family
  members
• Greater levels of expressed emotion, lower
  recovery rate
• Those in less industrialized countries tend to
  accept individuals with schizophrenia more
  readily
• Can influence recovery

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Somatoform Disorders

• Somatoform disorders are physical ailments that
  have no authentic organic basis and that are due
  to psychological factors
• Somatization Disorder
• Conversion Disorder
• Hypochondriasis

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Somatization Disorder

• Marked by history of diverse physical complaints
  that appear to be psychological in origin
• Occur mostly in women
• Usually have a long complicated treatment history
  from medical doctors
• Cardiovascular, gastrointestinal, pulmonary,
  genitourinary symptoms

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Conversion Disorder

• Characterized by a significant loss of physical
  function (with no apparent organic basis),
  usually in a single organ system
• Common symptoms
• Partial or complete loss of vision
• Partial or complete loss of hearing
• Partial paralysis
• Mutism
• Loss of feeling in limbs
• Usually more troubled than those with
  somatization disorder

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Hypochondriasis

• Characterized by excessive preoccupation with
  health concerns, and incessant worry about
  developing physical illnesses
• Skeptical and disbelieving when doctor says they
  are healthy
• Overinterpret every conceivable sign of illness
• Often see with anxiety disorders and depression

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What Causes Somatoform Disorders?

• PERSONALITY COGNITVE
• People with histrionic traits
• Excitable, suggestible, self-centered
• Neuroticism
• People who focus excessively on their internal
  physiological processes amplify normal bodily
  sensations
• Sick Role
• Avoid lifes challenges, sympathy, attention

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Personality Disorders

• Marked by extreme, inflexible personality traits
  that cause subjective distress or impaired
  social/occupational functioning
• Long-standing, inflexible ways of behaving
• Usually emerge childhood/adolescence
• Some are mild versions of more severe Axis I
  disorders

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Personality Disorders

• There are three main clusters of personality
  disorders
• (1) Odd/Eccentric Cluster
• (2) Dramatic/Erratic Cluster
• (3) Anxious/Fearful Cluster

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Odd/Eccentric Cluster

• Paranoid
• Shows pervasive and unwarranted suspiciousness
  and mistrust of others overly sensitive prone
  to jealousy
• Schizoid
• Defective capacity in forming social
  relationships absence of warmth and tender
  feelings for others
• Schizotypal
• Social deficits and oddities of thinking,
  perception and communication that resemble
  schizophrenia
• May see odd superstitious beliefs

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Dramatic-Erratic Cluster

• Histrionic
• Overly dramatic tending to exaggerate
  expressions of emotion egocentric attention
  seeking
• Borderline
• Unstable self-image, mood, and interpersonal
  relationships, impulsive, unpredictable
• Narcissistic
• Grandiosely self-important preoccupied with
  success fantasies expecting special treatment
  lacking interpersonal empathy
• Antisocial
• Chronically violating rights of others failing
  to accept social norms or sustain work behavior
  exploitive, reckless

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Anxious-Fearful Cluster

• Dependent
• Excessively lacking in self-reliance and
  self-esteem passively allowing others to make
  all decisions, constantly subordinating own needs
  to others
• Avoidant
• Excessively sensitive to personal rejection,
  humiliation socially withdrawn in spite of
  desire for acceptance from others
• Obsessive-Compulsive
• Preoccupied with organization, rules, schedules,
  lists extremely serious, formal unable to
  express warm emotions

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Problems With Personality Disorders

• Excessive overlap among disorders
• Replace categorical approach with dimensional
  approach
• Big Five
• Circumplex models