Abnormal Psychology

1. Abnormal Psychology

2. What is Normal? • Free from any mental disorder • Sane Abnormal Behavior -inability to behave in ways that further the well being of the individual and society *Discomfort- Psychological/Physiological *Deviance-Bizarre, unusual behavior *Dysfunction-inability to complete tasks or take responsibility -any behavior that interferes with personal growth

3. DSM-IV • DSM-IV: Diagnostic and Statistical Manual of Mental Disorders • Accepted system of classification for mental disorders • Lists symptoms, not why • Assessment is made on five axes to provide a complete picture of the individual

4. DSM-IV Five Axes • Axis 1- Clinical Syndromes-major diagnostic classification • EX: DID, Affective, Psychosis • Axis 2- Developmental and Personality Disorders-gives anunderstanding of the diagnosis in Axis 1. • EX:Childhood, Borderline personality disorder • Axis 3- Medical Conditions – physical problems relevant to the mental disorder • EX: Too much Dopamine=Schizophrenia, dementia

5. DSM-IV Five Axes • Axis 4- Psychosocial Stressors – All potentially stressful events or enduring circumstances that are relevant to your disorder • EX: Death of loved one, loss of job, poverty • Axis 5- Global Assessment of Functioning – Clinician provides a rating of the psychological, social, and occupational functioning of the person • EX: On a scale from 1-100 • 1=Danger to him/herself • 90=Good in all areas

6. Abnormal Psychology • Ideas to consider when looking at abnormality *Social Non-Conformity: failure in socialization They do not follow the rules for social conduct. *Context: Situation and where it takes place ***The most influential context---CULTURE!

7. Culture Bound Syndromes • 1. Amok(Location- Malaysia, Laos, Philippines) Symptoms: brooding, outburst of violent behavior, aggressive, homicidal • 2. Ataque de nervios(Latinos from the Caribbean) Symptoms: uncontrollable shouting, attacks of crying, trembling, verbal and physical aggression

8. Culture Bound Syndrome • 3. Ghost Sickness(Am. Indian Tribes) Symptoms- bad dreams, weakness, preoccupation with death and the dead • 4. Hwa-byung(Location Korea) Symptoms- suppression of anger, no yelling, look like you’re going to explode • 5. Koro(Location South and East Asia) Symptoms- sudden, intense anxiety during which the penis or nipples recede into the body. Can possible cause death

9. Major Psychological Disorders • 1. Organic Mental Disorders – Problems caused by known and verifiable brain pathology (pathology=disease) • A. Delirium- disturbance of consciousness and changes in cognition • Ex. Memory deficit, disorientation, language and perceptual disturbances • B. Dementia- memory impairment and cognitive disturbances • Ex. Aphasia, Apraxia, Agnosia, disturbances in planning or abstracting, Alzheimers

10. Major Psychological Disturbances • C. Amnestic Disorder- Memory impairment • Ex. Retrograde, Anterograde • D. Toxic Effects of Poisons • Ex. Severe emotional disturbances, memory loss, can lead to death

11. Major Psychological Disturbances • 2. Substance Use Disorders- Psychological dependence on a mood or behavior altering drug • A. Abuse- Maladaptive pattern or recurrent use extending over a period of 12 months and continuing despite social, occupational, psychological, physical, or safety problems. • B. Dependence- Maladaptive pattern of use extending over a 12 month period and characterized by unsuccessful efforts to control use despite knowledge of harmful effects; taking more of substance than intended; tolerance; or withdrawal • EX: Alcohol, opiates, barbiturates, benzodiazepines, amphetamines, caffeine, nicotine, cocaine, marijuana, LSD, PCP, Inhalants, heroin, ecstasy

12. Major Psychological Disturbances • 3. Disorders Evident in Infancy, Childhood, & Adolescence • A. Mental Retardation • 1. Significant sub-average general intellectual function • Ex. IQ score • 2. Concurrent deficiencies in adaptive behavior • Degree of independence lower than would be expected by age or cultural group • 3. Onset before 18 years of age • 4. Levels and IQ range • Mild, Moderate, Severe, Profound

13. Disorders Evident in Infancy, Childhood & Adolescence • B. Communication Disorders-Impairments in communication • 1. Limited speech • 2. Poor vocabulary • 3. Unusual word order • 4. Stuttering • Reading Disorder-significant impairment of reading accuracy, speed, or comprehension • 1. Dyslexia • difficulty identifying single words • problems understanding the sounds in words, sound order, or rhymes • problems with spelling • transposing letters in words • omitting or substituting words • poor reading comprehension • slow reading speed (oral or silent)

14. Disorders Evident in Infancy, Childhood and Adolescence • C. Separation Anxiety-Constantly seek their parents’ company and may worry too much about losing them. • Must display at least three of the following symptoms: • Excessive anxiety about separation from the attachment figure • Unrealistic fear that the attachment figure will be harmed • Reluctance to attend school • Persistent refusal to go to sleep unless the attachment figure is nearby • Persistent avoidance of being alone • Nightmares involving themes of separation • Repeated physical complaints when separated • Excessive distress when separation is anticipated

15. Disorders Evident in Infancy, Childhood and Adolescence • D. ADD (Attention Deficit Disorder)- Distractible, inattentive, not completing tasks • ADHD (Attention Deficit Hyperactivity Disorder)- impulsive, heightened motor activity, interrupts • Symptoms are present before age seven and present in two or more settings (not just in school)

16. Disorders Evident in Infancy, Childhood, and Adolescence • E. Oppositional Defiant Disorder • Pattern of negativistic, hostile behavior, often loses temper, argues with adults, defies or refuses adult requests, does not take responsibility for actions, angry, resentful, often blames others, spiteful, and vindictive • Symptoms present before age eight

17. Disorders Evident in Infancy, Childhood, and Adolescence • F. Autism-qualitative impairment in social interaction, communication, restricted activities • Symptoms: • 1. 6 mos to 3 yrs of age onset • 2. Social isolation- Ignore parents • 3. Stereotyped behavior- rocking, bites hands, stares at same object • 4. Resistance to any change in routine • 5. Abnormal responses to sensory stimuli • 6. Remarkably insensitive to cuts, burns • 7. Inappropriate emotional expressions • 8. Poor development of speech

18. Disorders Evident in Infancy, Childhood and Adolescence • G. Tic Disorders (Tourette’s Syndrome) • Symptoms: • 1. Begins between ages two and thirteen • 2. involuntary twitching • 3. facial grimacing • 4. head jerking • 5. unusual sounds-hooting, barking, whirling • 6. coprolalia-uncontrollable swearing

19. Major Psychological Disorders • 4. Sleep Disorders • Difficulty in initiating and maintaining sleep • EX: • 1. Insomnia • 2. Apnea • 3. Narcolepsy • 4. Somnambulism • 5. Sleep disruptions

20. Major Psychological Disorders • 5. Impulse Control Disorders- failure to resist an impulse or urge to act that is harmful to oneself or to others • A. Kleptomania- urge to steal • B. Pathological Gambling- urge to gamble • C. Pyromania- urge to set fires • D. Intermittent Explosive- express strong, angry feelings • E. Trichotillomania- urge to pull one’s hair • F. Sexual Impulsivity- (Nymphomaniac) urge to have indiscriminate sex

21. Trichotillomania

22. Major Psychological Disorders • 6. Eating Disorders- Characterized by physically and/or psychologically harmful eating patterns • A. Anorexia Nervosa-Refusal to maintain a body weight above the minimum normal weight for one’s age and height, intense fear of becoming obese, body image distortion, absence of at least three menstrual cycles otherwise expected to occur. • B. Bulimia Nervosa- Recurrent episodes of binge eating, loses control of eating behavior when binging, uses vomiting, exercise, laxatives, or dieting to control weight, two or more eating binges a week, occurring for three or more months, over concern with body weight and shape.

23. More common among young women than young men. More common among young women working in fields that especially emphasize weight and appearance More common among middle- and upper-class whites who equate thinness with beauty More prevalent in industrialized societies Higher among Arab and Asian women who are living or studying in Western countries 1 out of every 100 women age 10-20 has an eating disorder Each day Americans spend an average of $109 million on dieting and diet related products. Eating Disorders

25. Major Psychological Disturbances • 7. Anxiety Disorders-Characterized by persistent anxiety • A. Generalized Anxiety Disorder – Excessive anxiety and apprehension over a number of life circumstances for a period of at least six months. • i. Worry is difficult to control • ii. Symptoms include • Vigilance, muscle tension, restlessness, edginess, difficulty concentrating • B. Panic Attacks- recurrent and unexpected feelings of anxiety (feel like you’re having a heart attack) • i. Sweating, racing heart, dizziness, nausea, intense fear, difficulty in breathing • ii. Concern about expected future panic attacks or about losing control • iii. Can occur with or without agoraphobia

26. Anxiety Disorders • C. Phobic Disorder – Persistent, unrealistic fears of specific objects or situations • i. Most common- agoraphobia (fear of public spaces) • Three broad categories • Social- social or professional encounters • Panic- overwhelming fear for no reason • Specific- snakes, heights, etc

27. Acrophobia Ailurophobia Arachnophobia Hydrophobia Claustrophobia Coulrophobia Dishabliliophobia Dentophobia Gephydrophobia Gynephobia Hemophobia Necrophobia Ophidiophobia Philemaphobia Thaasophobia Xenophobia Arachibutyrophobia Triskaidekaphobia Hippopotomonstrosesquipedaliophobia Phobias

28. Anxiety Disorders • D. Post-Traumatic Stress Disorder (PTSD) • Re-experiencing a traumatic event through recurrent and intrusive memories and dreams • Ex: War, imprisonment, severe abuse, natural disaster (hurricane, tsunami, earthquake), accidental disaster (plane crash, bombing, etc) • Symptoms: flashbacks, dreams, recurrent recollections, persistent avoidance of stimuli associated with the trauma, numbing of general responsiveness, sleep difficulty, angry outbursts, startled easily, difficulty in concentration

29. Anxiety Disorders • E. OCD-Obsessive-Compulsive Disorder • Having continued thoughts about performing a certain act over and over • 1. Obsessive-endless preoccupation with an urge or thought • Images or impulses that are experienced are either inappropriate, intrusive and anxiety provoking • Sufferer realizes that these thoughts are the product of their mind • Attempts to ignore or suppress them by thinking another thought or performing some action • 2. Compulsions-involve repetitive and rule following behaviors (handwashing, cleaning) or mental acts (counting, praying) • Sufferer feels driven to perform to reduce stress or to avoid imagined catastrophe • Acts are excessive and not realistically linked with what the sufferer is trying to avoid

30. OCD • Obsession- A woman cannot rid herself of the thought that she might accidentally leave her gas stove turned on, causing her house to explode • Compulsion- Every day she feels the irresistible urge to check the stove exactly 10 times before leaving for work ________________________________________ Obsession- A young boy worries incessantly that something terrible might happen to his mother while sleeping at night Compulsion- On his way up to bed each night, he climbs the stairs according to a fixed sequence to three steps up, followed by two steps down in order to ward off danger

31. OCD • 4 million Americans have OCD (makes it more common than panic disorder and even schizophrenia) • Affects children, teenagers, and adults • Occurs across all social and economic levels • 80% of all cases, it involves washing rituals linked to contamination fears

32. Mood (Affective) DisordersOn the Dark Side of the Mood • A. Unipolar Depression “common cold” of mental illness • 1. depressed mood or loss of pleasure • 2. intense feelings of sadness or guilt (emotional) • 3. passivity and great difficulty in initiating action or making decisions (motivational) • 4. Frequent negative thoughts, faulty attribution of blame, low self-esteem (cognitive) • 5. Loss of energy, restlessness (physical) • 6. May last six or more months • 12% of adult population will be affected by this • Can turn into a major depressive episode • Thoughts of suicide, death

33. Mood (Affective) Disorders • B. Bipolar Depression-involves symptoms of depression, followed by mania • 1. Manic symptoms-abnormally euphoric, elevated, or irritable mood • 2. Increase in pleasurable activities that have a high risk of painful consequences • 3. Inflated self-esteem, racing ideas, and thoughts • 4. Decreased need for sleep • 5. Lasting at least one week

34. Account of a Manic-Depressive Episode • “There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you’re high it’s tremendous. The ideas and feelings are fast and frequent…Shyness goes, the right word and gestures are suddenly there…There are interests found in uninteresting people. Feelings of ease, intensity, power, …But somewhere, this changes. The fast ideas are far too fast and there are far too many; overwhelming confusion replaces clarity. Memory goes. ----you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.”

35. Major Psychological Disorders • 9. Somatoform Disorders-mental disorders in which psychological symptoms take a physical(somatic) form, even though no physical causes can be found. • A. Hypochondriasis-Individual has a pervasive fear of illness and disease • Ex. Calls the doctor for every little symptom, goes in for a physical exam, when nothing is detected, will call another doctor. Tend to be pill enthusiasts • B. Conversion Disorder-Individual experiences genuine physical symptoms, even though no physiological problems can be found. • Ex. May be unable to speak, become deaf or blind, faint

36. Somatoform Disorders • C. Factitious Disorders-People voluntarily induce an actual physical condition or simulate physical or mental conditions • Ex. Drink Ipecac (emetic), purposefully slip and fall, (Not Self-Mutilation) • Munchausen’s syndrome-Extreme form of factitious disorder • When a person deliberately feigns or induces an illness in another person • Parents make their children ill in order to require hospitalization

37. Somatoform Disorders • D. Body Dysmorphic Disorder-involves a preoccupation with some imagined defect in appearance, in a normal-appearing person. • Examples of Imagined Defects • 1. excessive hair or lack of hair • 2. size or shape of the nose, face or eyes • 3. skin, acne, and blemishes • Symptoms • 1. frequent mirror checking • 2. constant concern that others may be looking at their “defect” • 3. frequent requests for additional operations • 4. avoid social activities, work and school

40. Major Psychological Disturbances • 10. Dissociative Identity Disorder (AKA Multiple Personality Disorder)-mental disorders that involve a sudden loss of memory or change in identity • A. Psychogenic Amnesia-Memory loss caused by extensive psychological stress • Ex. Lose memory for both the distant and recent past, lose their personal identity (name, address, job) but general knowledge remains intact, remembers events after the amnesia starts

41. Dissociative Identity Disorders • B. Fugue –Individual develops amnesia, but also unexpectedly travels away from home and establishes a new identity. • Ex. Person shows up in new city, can’t remember anything, lives with new identity. What makes this real? Consistency! • C. Dissociative Identity Disorder-Multiple Personality Disorder- Individual has two or more distinct/separate personalities • Extremely rare

42. DID-Dissociative Identity Disorder • 1. Most famous case-Chris Sizemore • a. Three distinct personalities • “Eve White”, “Eve Black” and “Jane” • 2. Sybil-16 complete and totally different personalities • 3. Often, personalities are aware of some or all of the others to a varying degree • 4. In nearly all cases, the disorder has been preceded by abuse (sexual, physical, and emotional) • 5. Occurs more frequently in woman than man

43. 1. Victoria Antoinette Scharleau 2. Peggy Lou Baldwin 3. Peggy Ann Baldwin 4. Mary Lucinda Saunders Dorsett 5. Marcia Lynn Dorsett 6. Vanessa Gail Dorsett 7. Mike Dorsett 8. Sid Dorsett 9. Nancy Lou Ann Baldwin 10. Sybil Ann Dorsett 11. Ruthie Dorsett 12. Clara Dorsett 13. Helen Dorsett 14. Marjorie Dorsett 15. The Blonde 16. The New Sybil Sybil’s Personalities

44. DID-Dissociative Identity Disorder • 6. When it goes to court! • Kenneth Bianchi • AKA “The Hillside Strangler” 1979 charges with murdering two college women and implicated in several other rape-murder cases • Created Steve and Billy • Mark Peterson • Was prosecuted for sexually assaulting a 26 yr old woman who had 21 distinct personalities • The Wisconsin jury had three issues to consider • 1. whether Sarah was mentally ill at the time of the sexual act • 2. whether she was able to appraise Peterson’s conduct • 3. whether Peterson knew of Sarah’s condition

45. Major Psychological Disorders • 11. Personality Disorders-Inflexible and maladaptive personality traits that cause significant functional impairment or subjective distress for the individual. • Three Categories • 1. Odd, Eccentric • 2. Anxious, Fearful • 3. Dramatic, Emotional, Erratic

46. Personality Disorders • A. Odd and Eccentric • 1. Paranoid-Unwarranted suspiciousness, hypersensitivity, reluctance to confide in others • Ex. Overly suspicious, mistrusting, guarded • More prevalent in males • 2. Schizoid-Socially isolated, emotionally cold, indifferent to others • Ex. Tend to be loners; do not experience strong emotions such as sadness, anger or happiness • More prevalent in males • 3. Schizotypal-Peculiar thoughts and behavior, poor interpersonal relationships • Ex. May report bizarre fantasies and unusual perceptual experiences. Their speech may be slightly difficult to follow • More prevalent in males (Travis Bickle-Taxi Driver)

47. Personality Disorders • B. Anxious or Fearful • 1. Avoidant-Fear of rejection and humiliation, reluctance to enter into social relationships, hypersensitivity to criticism or negative evaluation • Ex. They want to be liked by others, have few if any friends, extremely shy (not a social phobia) • No gender difference • 2. Dependent-Reliance on others and inability to assume responsibilities, submissive, clinging • Ex. Unable to make everyday decisions on their own, feel anxious and helpless when they are alone • No gender difference • 3. Obsessive-Compulsive-Perfectionism, interpersonally controlling, devotion to details • Ex. Workaholics, so preoccupied with details and rules that they lose sight of the main point. Judgmental • More prevalent in males

48. Personality Disorders • C. Dramatic, Emotional, or Erratic • 1. Histrionic-Self-dramatization, exaggerated emotional expressions, and attention-seeking behaviors • Ex. Thrive on being the center of attention; self centered , vain, and demanding; inappropriately sexually seductive or provocative • More prevalent in women • 2. Narcissistic- Exaggerated sense of self-importance, lack of empathy • Ex. Preoccupied with their own achievements and abilities; consider themselves to be very special • More prevalent in men • 3. Borderline- Intense fluctuations in mood, self-image, and interpersonal relations • Ex. Form intense, unstable relationships; seen by others as being manipulative; temper tantrums • More prevalent in women

49. Personality Disorders • 4. Antisocial (Psychopath or Sociopath) • Characteristics • 1. superficial charm and good intelligence • 2. shallow emotions-lack of empathy, guilt or remorse • 3. behaviors indicative of little life plan • 4. failure to learn from experiences • 5. absence of anxiety • 6. unreliability, insincerity, and untruthfulness • 7. not diagnosed in children or adolescents • Must be 18 or older

50. Antisocial Personality Disorder • Dangerous? • Depends on each person. Do you consider a con-artist to be dangerous? Is a televangelist dangerous? • Not all Sociopaths are Serial Killers! • They do tend to break laws and have a reckless disregard for safety of self and others • Treatment • Rarely treated with success • Manipulate therapy