Psychology AP Exam Abnormal Psychology

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PsychologyAP ExamAbnormal Psychology

• Instructor Roberta M. Diddel, Ph.D.
• diddel_at_psychologyworks.com

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Content Covered

• Defining abnormality
• Assessment Diagnosis
• Causal factors
• Approaches to treatment
• Information on depression, ADD, schizophrenia
  panic disorder woven into the topics above

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What determines whether a behavior or experience
is abnormal?
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Are these people abnormal?
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Or these?
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Or this person?
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What are the criteria for being a subject of
study in Abnormal Psychology?
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The 4 Ds of Abnormal Psychology

• Deviance
• Distress
• Dysfunction
• Dangerousness

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Deviance Psychopathology

• Unusualness of behavior
• How do we know if somethings uncommon?
• Is uncommonness enough?

If over half of American women have poor body
image, does that put it beyond the scope of our
subject of study?
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Deviance Cultural Relativism

• No universal standards or rules for labeling a
  behavior as abnormal.
• Behaviors can only be abnormal relative to
  cultural norms.

Example Should a baby sleep in its own bed?
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Distress

• What if the person experiences no distress but
  causes problems for others?
• Is subjective distress an adequate criterion for
  abnormality?

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Should these causes of distress have a diagnosis?

• Bereavement
• Disability
• Cross dressing
• Marital discord / Divorce

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Dysfunction

• Psychological /Emotional
• Vocational (work, school)
• Cognitive
• Social

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Dangerousness

• To oneself
• Suicide
• Euthanasia?
• Drug abuse?
• To others
• Homocide
• Abuse / neglect?
• Euthanasia?

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Assessment
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Types of Assessment

• IQ
• Aptitude
• Personality
• Projective
• Objective
• Psychological state

• Clinical interview
• Neuropsychological
• Medical testing

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Intelligence TestingExample Wechsler (WAIS)
These pictures tell a story but they are in the
wrong order. Put them in the right order so they
tell a story.
PICTURE ARRANGMENT
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WAIS performance task
BLOCK DESIGN
Put the block together To make this picture.
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What do you see?
Personality Testing
Projective Tests e.g., Rorschach
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Personality TestingObjective Tests, e.g., MMPI

• Items similar to those on the MMPI
• Hypochondriasis
• My stomach frequently bothers me. At times, my
  body seems to ache all over.
• Depression
• Nothing seems to interest me any more. My sleep
  is often disturbed by worrisome thoughts.
• Schizophrenia
• Things seem unreal to me at times. I sometimes
  hear things that other people cant hear.

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Sample MMPI Profile
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Neuropsychological Assessment
Bender Gestalt
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Medical Assessmentof Neurological Functioning

• Computerized Tomography (CT) scan
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET and SPECT) scans

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SPECT scan (type of PET scan)
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ADD before after treatment
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Assessment can indicate levels of progress for
both therapist patient
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The Diagnostic and Statistical Manual of Mental
Disorders IV (DSM-IV-TR)
Clinical disorders
Axis I
Personality disorders Mental retardation
Axis II
General medical conditions
Axis III
Psychosocial and environmental problems
Axis IV
Global assessment of functioning
Axis V
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Define a box.
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Presenting Symptoms
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Causal Factors in Psychopathology
Biological Factors e.g., genetics,
temperament neurochemistry
Psychological Factors e.g., early childhood
experience, trauma and self-esteem
Feedback Loops
Social Factors Interpersonal stress, family, work
social environment
Feedback Loops
Feedback Loops
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Current Models of Causation

• Biopsychosocial Model (Engels)
• Diathesis-Stress Model

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Biological Factors in Abnormality

• Biochemical factors
• Neurotransmitters / receptors
• Endocrine / hormonal factors / HPA Axis
• Structural factors
• Brain injury or congenital malformations
• Brain pathways implicated in specific disorders
• Genetic factors
• Chromosomes, temperament, susceptibility

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How we discovered that the brain affects behavior

• Phineas Gage
• 1848

From Damasio, 1997
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The Triune Brain
Cortex Higher level thinking (reasoning,
language, self-control)
Hind Brain Basic survival (arousal, heart rate,
breathing, movement)
Limbic System Emotion, memory (conditioned
learning)
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Neurotransmitters
The Brains Chemical Messengers
They carry signals from one nerve cell to the
next.
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Synaptic Cleft
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What Different Neurotransmitters Do

• Serotonin
• Mood, hunger, sleep, arousal
• Facilitates or dampens responses
• Norepinephrine alertness arousal
• Dopamine
• Movement, learning, attention, emotion
• Facilitates or dampens responses

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Sample of how different neurotransmitters affect
different parts of the brain
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Abnormalities in Depression

• Anterior cingulate
• Stress response, emotional
• expression, social behavior
• Less activity
• Prefrontal cortex
• Approach-related goals
• Less metabolic activity
• Less gray matter
• Hippocampus (Memory fear-related learning)
• Less volume and lower metabolic rate
• Associated w/ rumination?
• Amygdala chronic hyperactivity high cortisone
  levels

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Hypothalamus-Pituitary-Adrenal(HPA) Axis
Physiology of Stress
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Neuroendocrine Dysregulation

• Chronic high levels of cortisol may be the result
  of the failure of the HPA feedback loop to shut
  off stimulation
• Oversensitivity to stress
• Exhaustion / Depression

HPA Axis
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Heredity as a Risk Factor for Depression
Risk of MDD
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Is mental illness really an illness?
(like diabetes, heart disease or cancer)
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Positive Symptoms Type I

• Delusions
• Persecutory
• Delusions of reference
• Grandiose delusions
• Delusions of thought insertion
• Hallucinations
• Disorganized Thought and Speech
• Disorganized or Catatonic Behavior

Painting by schizophrenic patient
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Negative Symptoms Type II

• Flattened/Blunted affect
• Severe reduction or absence of affect
• Alogia
• Severe reduction or absence of speech
• Avolition
• Inability to persist at common, goal-oriented
  tasks

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Role of Dopamine in Schizophrenia

• Excess number of dopamine receptors
• related to positive symptoms
• Less dopamine activity in prefrontal cortex
• associated with negative symptoms
• Receptors in mesolimbic pathway
• Atypical antipsychotics (e.g. clozapine) block
  action of dopamine in this system

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Poorer connections between

• Prefrontal cortex
• Language, emotional expression, planning
  producing new ideas, social interactions
• Limbic system
• Emotion, cognition (working memory)
• Basal ganglia
• Motor control, movement

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Glutamate Theory in Schizophrenia

• PCP patients often experience psychosis
• blocks glutamate receptors
• Suggests that schizophrenia results from
  under-activity of glutamate
• Better explains negative symptoms cognitive
  deficits
• LY2140023 may help by increasing action at
  NMDA/glutamate receptor sites

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Treatment - Medications

• Neuroleptics
• Most function as dopamine blockers
• Work best for Type I symptoms
• Serious side effects
• sedation, akinesia, akathesis, tardive dyskinesia
• Atypical anti-psychotics
• Type II symptoms (as well as Type I)
• Dopamine receptors as well as serotonin
• Avoids side effects of neuroleptics
• Better at preventing relapse

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Psychological, Social Cultural Factors
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Psychoanalysis Psychodynamic Theory Therapies
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Psychodynamic Therapies
Therapeutic Alliance
Free Association
Concepts
Working Through
Resistance the defenses
Transference
Counter-Transference
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Personality DisordersDramatic Erratic Cluster

• Histrionic
• Narcissistic Attachment difficulties?
• Borderline
• Longstanding pattern of behaviors developed as a
  defense against fear of attachment.

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Classical Conditioning Pairing an event or
object with a naturally occurring response leads
to a persistent connection between the two
US
CS
UR
CR
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Panic Disorder with Agoraphobia
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Biological Theories of Panic Disorder

• Biological
• Genetic
• Norepinephrin, serotonin, GABA, CCK
• Locus ceruleus
• Suffocation false alarm
• Hypersensitivity to CO2
• Kindling

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Producing Change Based onOperant Conditioning
Increase Behavior
Decrease Behavior
Add
Remove
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The naughty stool(aka time out from
reinforcement)
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Controversial Issue

• Should kids with behavioral disorders like ADHD
  be medicated? (And, if so, when?)
• Should parents teachers be required to learn
  behavioral techniques before using medication?

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Medication ADHD

• Improvement in 3 out of 4 children in
• Reduced impulsivity anti-social behavior
• Improved attention
• No significant improvement in school performance,
  unless paired with a behavioral program
• Improvements generally lost once the drug is
  discontinued

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Cognitive Theories
What are the unspoken rules in your family of
origin?

• Core beliefs
• Schema
• Rule of Laws
• Cognitive distortions
• Internal dialogue (self-talk)

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Spiral of Self-Esteem(from M. Basch,
Understanding Psychotherapy)
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Drugs Combined with Therapy Work Best
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Socio-cultural Factors

• Culture - Norms, gender roles, marginalization
• Socioeconomic factors
• Political environment
• Social systems

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Erik Erikson
We are shaped by our social interactions.
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Family Systems

• Social group as an eco-system
• Operational rules patterns of interaction
• Alliances, coalitions, triangulation,
  scapegoating
• Homeostasis - tendency of system is to remain
  stable (even if unhappy dysfunctional)
• Roots of disorder are within the family, not the
  individual.

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The Hunter Family
Janie 39
Ed 38

Erin 16
Jimmy 13
Sammy 9
School phobic
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Dad 75
Mom 72
Chronic pain/ obese
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Ed 38
Janie 39
Chronic pain / Obese
Erin 16
Jimmy 13
Sammy 9
Obese / Somatizing
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Individual Choice Self-Determination
How much does our personal history determine who
we are?