A b n o r m a l P s y c h o l o g y A.K.A. Psychological Disorders

1. AbnormalPsychologyA.K.A. Psychological Disorders Deviant, distressful, dysfunctional patterns of thoughts, feelings or behaviors

2. Early Theories • Abnormal behavior was caused by demon possession • Led to harsh, ineffective remedial treatments • Trephining, beatings, burnings, etc.

3. History of Mental Disorders • Medical Model (Pinel)– psychological disorders are a biologically based…a “sickness”/disease that needs to be diagnosed and cured • Neglects the importance of social circumstances and psychological factors.

4. History of Mental Disorders • Biopsychosocial Model– current approach • Interaction of nature and nurture • Adds influence of culture and psych to Medical model

5. Perspectives and Disorders

6. DSM IV • Diagnostic Statistical Manual of Mental Disorders: • used to identify and diagnose disorders • Diagnoses only observable patterns of behavior • Facilitates reliability • Answer questions from 5 levels • DSM will NOT explain the causes or possible cures. • Criticism: classifies an excessively broad range of human behaviors as psychologically disordered.

8. Classifying Psychological Disorders

9. Two Major Classifications in the DSM Neurotic Disorders Psychotic Disorders A mental state that impairs thought, perception and judgment • Distressing but one can still function in society and act rationally. John Wayne Gacy

10. The Rosenhan Study • Rosenhan’s associates were feigning symptoms of hearing voices. • ALL 8 normal people were misdiagnosed with schizophrenia. • What are some of the questions raised by this study? • Labeling • Advantage - allows mental health professionals to quickly communicate complex symptoms • Disadvantages • biasing power - make false assumptions about the person • self fulfilling prophecy- process by which one’s expectations about another person eventually lead the other person to behave in ways that confirm these expectations

11. ADHD • Symptoms: • Inattention/distraction • Hyperactivity • Impulsivity • Causes: • Biological • Normal but delayed thinning of frontal cerebral cortex • Genetic • Social • Watching lots of TV as a toddler (correlational)

12. ADHD • Assessing: • Eye Tracking device • Gender: • 2-3X more in Boys • Prevalence: • 4% of all children (10% US)

13. ADHD Treatment • Treatment • Biological – assume problem is organic requires drug treatment therapy • Stimulant drugs – help calm hyperactivity and increase focus • Aderall • Ritalin • Behavioral – assume problem behaviors are the problem and apply operant and classical conditioning principles • Token economy –earn token for exhibiting desired behavior, that can later be exchanged for privileges or treats

14. Anxiety Disorders • Anxiety Disorders - a group of conditions where the primary symptoms are persistent or distressing anxiety or maladaptive defenses against anxiety. • Examples: • Generalized anxiety disorder • Panic disorder • Phobias • Obsessive compulsive disorder • Post-traumatic stress disorder

15. Generalized Anxiety Disorder • GAD - An anxiety disorder in which a person is continuously tense, apprehensive and in a state of autonomic nervous system arousal. • Fearful most of the time accompanied by heart palpitations, fatigue, dread, difficulty concentrating, sweating, or icy cold hands • Often accompanied by depression • Free Floating – person can’t identify, deal with or avoid cause

16. Panic Disorder • Panic Disorder - An anxiety disorder marked by a minutes-long episode of intense dread that something terrible will happen • Panic attack - chest pain, choking, heart palpitations, trembling, or dizziness

17. Phobias • Phobia - irrational fear causes person to avoid an activity or situation • Animals, insects, heights, blood, closed spaces • Social Phobia – fear of being scrutinized by others…avoid embarrassing social situations • Agoraphobia – fear of open spaces…having a panic attack with no way to escape…may accompany panic disorder • Phobia List

18. Obsessive-compulsive disorder • OCD - Persistent • Obsessions – repetitive thoughts • Compulsions – repetitive actions • Examples – hoarders, checkers, counters, cleaners • Causes • Evolutionary - Exaggerated behaviors of ancestors – checking territorial boundaries • Biological • insufficient serotonin • Anterior cingulated cortex • Learned – anxiety reduction reinforces behavior

19. Post-traumatic Stress Disorder • PTSD – Flashbacks, nightmares, withdrawal, anxiety, insomnia for more than 4 weeks following extremely stressful event. • Greater emotional distress the higher the risk for PTSD • Cause: • Sensitive limbic system increases vulnerability by flooding body with stress hormones • Genes • Survival resiliency - ability to survive dozens of episodes of trauma • Post-traumatic growth – increased personal growth due to trauma

20. Causes of Anxiety Disorders • Learned Perspective • Conditioned • Classically conditioned by associating stimuli (i.e. a traumatic event) with anxiety • Example: Rats who received unpredictable shocks in a lab become fearful when they return to the lab • Stimulus generalization – fear stimuli that are associated with the original CS • Example: Fear all dogs after bitten by Maui • Reinforcement (operant) – helps maintain phobias and compulsions after they arise • Avoiding or escaping the feared situation reinforces the behavior • Example: After feeling anxious you go inside your house which calms you down • Observational Learning • Observing others’ fears • Example: Monkeys transmit fear of snakes to offspring

21. Causes of Anxiety Disorders • Biological Perspective • Natural Selection/evolutionary perspective • Biological predisposition to fear: spiders, snakes, close spaces, heights, storms and darkness • Compulsive acts exaggerate fears that contribute to survival: • Examples: • Washing up = ritual hand washing • Checking boundaries = checking and rechecking locks • Genes • High strung temperament • Anxiety disorders: high correlation in identical twins • 17 genes expressed with Anxiety • Neurotransmitters • Anxiety gene affects brain levels of serotonin • Too much glutamate : brain’s alarm centers overactive • Brain • Anterior Cingulate Cortex monitors actions and checks for errors – elevated activity in OCD • Amygdala – fear circuits created in traumatic experiences • Neurotransmitters • Serotonin low • Glutamate High

22. Causes of Anxiety Disorders • Psychoanalytic Perspective • Produced by repressed memories, hidden wishes, unconscious conflicts • Example: Afraid to go out on dates because sexually abused by father

23. Think Pair Share • A variety of specific psychological disorders are categorized as anxiety disorders in the DSM-IV-TR. List at least three specific anxiety disorders, and identify elements they have in common and those that are unique to each disorder.

24. Somatoform Disorders • Somatoform Disorders - psychological problem that presents itself through physical symptoms • Examples • Conversion Disorder • Hypochondrias • Cause: socio-cultural • Cultural expectations about what symptoms/diseases are socially acceptable • More common in Freud’s day • China – depression not acceptable = more somatoform disorders

25. Conversion Disorder • Conversion Disorder – anxiety is converted to a physical symptom with no physiological basis. • Examples: blindness or paralysis. • 12 teenage girls in LeRoy, NY report uncontrollable body movements, tics and verbal outbursts

26. Hypochondriasis • Hypochondriasis – normal sensations are interpreted as a symptoms of a dreaded disease • Patients go from physician to physician seeking medical attention, but fail to find a biological root. • Example: Headache= brain tumor

27. Dissociative Disorders • Dissociative Disorders – involve • disruption to conscious awareness • sudden loss of memory • change in identity, • Two types • Dissociative Fugue, Dissociative Identity Disorder • Symptoms in common • Memory loss of time periods, events, people • Distorted perception of people and things • watch self with sense of attachment • Blurred sense of identity

28. Dissociative Fugue • Conscious awareness is separated from painful memories or feelings • Patients find themselves in an unfamiliar environment with no knowledge of past life - create physical distance from real identity • Triggered by stress

29. Dissociative Identity Disorder • Dissociative Identity Disorder (DID) - 2 or more distinct personalities control a person’s behavior • Used to be known as Multiple Personality Disorder. • Patients commonly have a history of childhood abuse or trauma.

30. DID Controversy AGAINST • Could be extreme version of our capacity to vary the “selves” we present in different situation • Constructive memory – leading questions may lead to constructing false memories of childhood trauma • Role-playing (Spanos) of fantasy-prone patients in response to leading questions • Increase in DID in last 20 years (Outside US disorder is much less prevalent) FOR • Distinct brain and body states associated with differing personalities • Heightened brain activity in areas associated with control and inhibition of traumatic memories

31. DID Causes • Psychoanalytic – defense against anxiety caused by unacceptable impulses • Learning – behaviors reinforced by anxiety reduction

32. Mood Disorders • Characterized by emotional extremes • 2 typical forms • Major Depressive Disorder • Bi-polar • The Common Cold of Psych Disorders • Inhibits aggression and risk taking, slows us down • More prevalent in women

33. Causes of Mood Disorders • Biological • Genes • Increased risk if have parent or sibling with disorder • Identical twins • Major Depression = 1 in 2 chance • Bipolar = 7 in 10 chance (2 in 10 for Fraternal) • Linkage analysis – isolating genes across generations • Not one single gene found • Heritablity – 35 to 40% in major depression • Brain • Less activity in brain during depressed states, more activity during mania • Left frontal lobe (positive emotions ) is inactive during depression • Hippocampus – vulnerable to stress related damage • Biochemical • Norepinephrine – scarce: depression;abundant: mania • Serotonin – scarce; abundant: mania • Drugs used to block reuptake of norepinephrine and serotonin relieve symptoms • SSRI – Selective Serotonin Reuptake Inhibiter (Zoloft/Prozac)

34. Causes of Mood Disorders • Social Cognitive • Cognition • increased expectations of negative outcomes • Self defeating beliefs • Learned helplessness • Negative explanatory style - tend to explain events in stable (forever), global (affects everything) and internal (my fault) terms • Women : greater emotional memory to recall negative events, more likely to sense a lack of personal control, and over think in response to stressful situations • Social • Stressful life experiences • Individualistic countries • Psychoanalytical • Internalization of anger

35. Suicide • Risk highest when rebounding from depression • Higher risk if abuse alcohol • Social suggestion may trigger suicide • Talk about suicide – attempt suicide – few succeed

36. Major Depression • Major Depressive Disorder – at least 5 signs of depression and lasts 2 or more weeks • Signs of depression: • lethargy • feelings of worthlessness • loss of interest in family/friends • Loss of interest in activities • Withdrawn • Self-defeating beliefs • With or without therapy, episodes usually end

37. Bipolar Disorder • Bipolar Disorder – alternating between depression and mania. • Mania – euphoric, hyperactive/high energy, over-talkative, overactive, require less sleep, take more risks, and are wildly optimistic state • Formally manic depression.

38. Seasonal Affective Disorder • Seasonal Affective Disorder - Experience depression during the winter months. • Based not on temperature, but on amount of sunlight. • Treated with light therapy.

39. Personality Disorders • Personality Disorders - Well-established, maladaptive ways of behaving that negatively affect people’s ability to function. • 3 clusters • Anxious/fearful • Avoidant personality disorder • Eccentric/Odd • Schizoid personality disorder • Impulsive/erratic/Emotional • Histrionic personality disorder • Narcissistic personality disorder • Antisocial personality disorder

40. Antisocial Personality Disorder • Antisocial Personality Disorder – Lack of conscience = antisocial behavior (lying, cheating, stealing, sexual promiscuity • Feel and fear little • May be aggressive and ruthless or a clever con artist • Usually Male • Called Conduct disorder in children

41. Causes of Antisocial Personality Disorder • Biological • Little or no physical reaction • No autonomic nervous system arousal (low levels of adrenaline)to adverse events • May lead to fearless behaviors • Low levels of stress hormones • Reduced frontal lobe activity and tissue • Genes • Prone to alcohol and drug addiction • Social – poverty and family instability, child abuse

42. Histrionic Personality Disorder • Histrionic Personality Disorder – attention seeking behaviors

43. Narcissistic Personality Disorder • Narcissistic Personality Disorder – self involvement/obsession with self • Thinking that you are the center of the universe.

44. Schizoid Personality Disorder • Schizoid Personality Disorder – lack of interest in social events and relationships

45. Avoidant Personality Disorder • Anxiety personality disorder • Lifelong pattern of feeling very shy, inadequate, and fear social rejection.

46. Schizophrenic Disorders • Schizophrenia – meaning split mind and characterized by • Disorganized thinking. • Disturbed Perceptions • Inappropriate Emotions and Actions • 2 General Types • Reactive (acute) schizophrenia – develops rapidly, but more likely recovery • Chronic(process) schizophrenia– slow to develop and less likely to recover • Prevalence 1/100 • Gender – Men slightly more than women

47. Disorganized Thinking • Thinking that is fragmented, bizarre and distorted with false beliefs (delusions). • Speech is fragmented and full of unrelated words = word salad • May be caused by breakdown in selective attention –inability to filter out information.

48. Delusions (false beliefs) • Delusions of Persecution • Example: “The police are trying to get me and take me to prison” • Delusions of Grandeur • Example: “I am Jesus and can walk on water”

49. Disturbed Perceptions • hallucinations- sensory experiences without sensory stimulation. • Example: • Hear voices saying “You are bad and should burn yourself with a cigarette”

50. Inappropriate Emotions and Actions • Laugh at inappropriate times. • Flat Effect – no emotion • Senseless, compulsive acts. • Catatonia- remain motionless for hours