Abnormal Psychology

An Introduction

Read and respond (discussion)A man living in the Ozark Mountains has a vision in which

God speaks to him. He begins preaching to his relatives and neighbors, and soon he has the whole town in a state of religious fervor. People say he has a “calling.” His reputation as a prophet and healer spreads, and in time he is drawing large audiences everywhere he goes.

One day he ventures into St. Louis and attempts to hold a prayer meeting, blocking traffic on a main street at rush hour. He is arrested. He tells the policeman about his conversations with God, and they hurry him off to the nearest mental hospital.

1. How can a person be viewed as normal in one community and abnormal in another?

2. What is a psychological disorder?3. What is “normal?”

Important to Remember!

• Many people develop a disorder listed in the DSM-IV at some point in their lifetime, however many of this incidences are temporary.

• Many people who qualify for a disorder as diagnosed in the DSM-IV are not very different from anyone else.

1 in 7 Americans will seek 1 in 7 Americans will seek help for a psychological help for a psychological disorder at some time disorder at some time

during his or her lifetime!during his or her lifetime!

Last, but NOT least…

• The disorders we are about to study are psychological disorders, and diagnosis can stigmatize the patient- as we’ve already discussed.

• While you may, after our study, be able to recognize some symptoms of certain disorders remember that those symptoms could also be nothing more than someone having a bad day. Formal diagnosis requires longitudinal observation by a trained professional.

• As students, you are neither trained nor encouraged to attempt to identify any psychological disorder in yourself or the people around you. If you have a serious concern for someone you know, talk to your counselor- she is trained to deal with and further probe the situation.

Anxiety Disorders

Anxiety DisordersTrue or False?

1. People who experience a panic attack often think they are having a heart attack.

2. The same drugs used to treat schizophrenia are also used to control panic attacks.

3. Some people are so fearful of leaving their homes that they are unable to venture outside even to mail a letter.

4. We may be genetically predisposed to acquire fears of objects that posed a danger to ancestral humans.

5. Therapists have used virtual reality to help people overcome phobias.

6. Obsessional thinking helps relieve anxiety.7. Exposure to combat is the most common trauma linked

to posttraumatic stress disorder.

Introduction

Classes of Anxiety Disorders:• Panic Disorder• Phobic Disorders• Obsessive-Compulsive

Disorder• Generalized Anxiety

Disorder• Acute Stress Disorder• Post-traumatic Stress

Disorder

• Anxiety: an emotional state characterized by physiological arousal, unpleasant feelings of tension, and a sense of apprehension or foreboding.

• Anxiety Disorder: a class of psychological disorders characterized by excessive or maladaptive anxiety reactions.

Generalized Anxiety Disorder

• “Worrying about Worrying”

• Emotional distress caused by worrying about everyday, minor things, and about unlikely future events interferes significantly with the

person’s daily life.

• Treatment: drug therapy** and

cognitive-behavioral therapy

Panic Disorders• Characterized by the occurrence of

repeated, unexpected panic attacks.– Panic attack: intense anxiety reactions

accompanied by physical symptoms such as a pounding heart, rapid respiration, heavy perspiration, numbness, chills, weakness or dizziness.

• Treatment: drug therapy (usually anti-depressants as they normalize neurotransmitter activity) and cognitive-behavioral therapy

Phobic Disorders

• An intense and irrational fear of a particular object or situation.– Specific phobia– Social phobia– Agoraphobia

• Treatment: typically involves providing the person opportunities to experience the feared object under conditions in which he or she feels safe and in control.

Specific Phobia Examples:• Acerophobia: fear of itching or the

insects that cause itching• Acrophobia: fear of heights• Aerophobia: fear of flying• Atelophobia: fear of imperfection• Catagelophobia: fear of being ridiculed• Claustrophobia: fear of closed spaces• Entomophobia: fear of insects• Felinophobia: fear of cats• Heliophobia: fear of the sun• Hemophobia: fear of blood• Hydrophobia: fear of water• Logizomechanophobia: fear of

computers• Nosocomephobia: fear of hospitals• Nyctophobia: fear of darkness• Verminophobia: fear of germs• Zoophobia: fear of animals

Obsessive-Compulsive Disorder

• A type of anxiety disorder characterized by recurrent obsessions, compulsions, or both.

• Treatment: behavior therapy, specifically exposure with response prevention

Adjustment Disorders

• Acute Stress Disorder (ASD): a traumatic stress reaction occurring during the month following exposure to a traumatic event. – Walking around “in a fog” for days or weeks after a hurricane.– Forgetting important features of an accident and feeling numb or

detached from your environment.

• Post-Traumatic Stress Disorder (PTSD): a prolonged maladaptive reaction to a traumatic experience. Can persist for months, years, or even decades and may not be immediately apparent.

• Treatment: cognitive-behavioral therapy (repeated exposure to cues and emotions associated with the trauma in a safe setting)

Mood Disorders

Major Depressive Disorder• Severe form of depression that

interferes with functioning, concentration, and mental and physical well-being

• Relatively short-term• At least four of the following

symptoms are present:– Problems with eating– Lack of sleep– Promblems with thinking– Problems concentrating– Problems with decition making– Lacking energy– Thinking about suicide– Feeling guilty or worthless

• Impairs people’s ability to meet the ordinary responsibility of everyday life.

• Cannot “shake it off” or “snap out of it”

• May include delusions about one’s body ‘rotting’ from illness, hallucinations, or psychosomatic manifestations

0

5

10

15

20

25

Male Female Overall

LifetimePrevalence ofMajorDepressiveDisorder

Dysthymic Disorder

• A milder form of depression which follows a chronic course of development.

• Often begins during childhood or adolescence.• Feelings of being “down in the dumps,” but not

to such a degree that they cannot function. • Persistent complaints of depression become

such a fixture in the person’s life that they seem to be intertwined with their personality.

• Despite treatment and apparent recovery, the risk of relapse is 90%.

Seasonal Affective Disorder

• Many people notice a change in their mood with the weather.

• Seasonal Affective Disorder is a type of Major Depressive Disorder in which the change of seasons from Summer to Fall and Winter brings on depression, lasting throughout the season.

• Treatment: light therapy

Bipolar Disorder• Characterized by mood swings

between states of extreme elation and depression

• Manic Phase: elation, extreme confusion, distractibility, racing thoughts.– Sometimes difficult to detect

because the person seems to be blessed with an unending state of optimism.

– “It’s an emotional state similar to Oz, full of excitement, color, noise, and speed—an overload of sensory stimulation—whereas the sane state of Kansas is plain and simple, black and white, boring and flat. Mania has such a dreamlike quality that often I confuse my manic episodes with dreams I’ve had.”

• Normalcy lasts for several months with short bursts of mania and/or depression

• Depressive Phase: overcome with feelings of failure, sinfulness, worthlessness, and despair.– Essentially the same behavior as

Major Depressive Disorder– “The patient lay in bed, immobile,

with a dull, depressed expression on his face. His eyes were sunken and downcast. Even when spoken to, he would not raise his eyes to look at the speaker. Usually he did not respond at all to questions, but sometimes, after apparently great effort, he would mumble something about the “Scourge of God.”

Cyclothymic Disorder

• Chronic, but less severe mood swings than are found in bipolar disorder.

• Begins in late adolescence, persists for years.

• Periods of normal mood last for no more than a month or so.

Mood Disorders

Causes• Chemical Imbalance• Emotional Disturbance• Social Support• Continually making

illogical conclusions– Ex: blaming themselves for

normal, everyday failures

Treatment• Antidepressants• Psychotherapy• Electroconvulsive

Therapy• Mood Stabilizers

Personality Disorders

Odd or Eccentric• Paranoid: undue suspiciousness of

other’ motives, but not to the point of delusion

– Overly sensitive to criticism (real or imagined)

– Question the sincerity and trustworthiness of friends

– Hypervigilant, as though they are under constant threat of betrayal or harm

– Tend to be: argumentative, cold, aloof, scheming, devious, and humorless

– Not delusional (as in paranoid schizophrenia)

– Unlikely to seek treatment

• Schizoid: persistent lack of interest in social relationships, flattened affect, and social withdrawal

– Outer Appearance:• Loner or ‘eccentric’• Emotions normally appear shallow or dampened• Indifferent to praise or criticism

– Inner Lives generally compensate (not balance) for lack of outer emotion

• Schizotypal: eccentricities of thought and behavior, but without clearly psychotic features

– Have difficulty forming close relationships (lack of interest)

– Behavior, mannerisms, and thought patterns seem peculiar, but not disturbed

– May experience unusual perceptions or illusions (“feeling the presence” of a deceased family member)

– Common among those who believe they have a ‘sixth sense’ or can tell the future

– Vague or generally abstract speech, unkempt appearance, little emotion registered in facial expressions

Anxious or Fearful• Avoidant: avoidance of social

relationships due to fear of rejection– Absolutely terrified of rejection– Few relationships outside of

family– Have interest in, and feelings

toward other people (unlike schizoid personalities)

– Severe form of social phobia

• Dependent: difficulty making independent decision and display overly dependent behavior– Seek advice in making even the

smallest decision– Overly submissive and clinging in

their relationships, extremely fearful of separation

– Avoid positions of responsibility– Often linked to other psychological

disorders:• Major depression• Bipolar• Social phobia

**culture is important as many of the ‘symptoms’ of dependent disorder are perfectly normal in some cultures

Dramatic, Emotional, or Erratic

• Borderline: abrupt shifts in mood, lack of a coherent sense of self, and unpredictable, impulsive behavior– Alternate between extremes of

adulation and loathing– Intense fear of abandonment

makes them clinging and demanding in their relationships

– View people as all good or all bad, shifting abruptly between extremes

• May show fleeting psychotic behaviors when stressed, but are not as dysfunctional as those with psychotic disorders.

• Have difficulty regulating their emotions– May harbor intense

psychological pain, and exhibit features such as chronic anger, loneliness, or boredom

• Self-mutilation:– Fairly common among borderline

women– Men tend to show outward signs

of aggression.– Often motivated by need to

escape from troubling emotions or “numbness”

Dramatic, Emotional, or Erratic

• Histrionic: – excessive need for

attention, praise, reassurance, and approval

• Narcissistic:– adoption of an inflated

self-image and demands for attention and admiration

Dramatic, Emotional, or Erratic

• Antisocial: antisocial and irresponsible behavior and a lack of remorse for misdeeds– Often violate the rights of

others, disregard social norms, and break the law

– Pattern of behavior begins in childhood or adolescence

• Two dimensions: – Personality: selfishness, lack

of empathy, callous and remorseless use of others, disregard for others’ feelings or welfare

– Behavioral: unstable and antisocial lifestyle, poor employment history, unstable relationships

• Not all criminals show signs of psychopathy, and not all people with psychopathic personalities become criminals.

Film Clip: The Dark Knight

Schizophrenia

SchizophreniaTrue or False?

Schizophrenia exists in the same form in every culture that has been studied.

Visual hallucinations (“seeing things”) are the most common type of hallucinations in people with schizophrenia.

It is normal for people to hallucinate nightly. If you have two parents with schizophrenia, it’s nearly certain that

you will develop schizophrenia yourself. Although schizophrenia is widely believed to be a brain disease,

evidence of abnormalities in the brains of schizophrenic patients remains lacking.

We now have drugs that not only treat schizophrenia but can also cure it in many cases.

Some people have delusions that they are loved by a famous person.

Schizophrenia- what it isn’t

• It is NOT dissociative identity disorder.

• People afflicted with schizophrenia or any of the psychotic disorders to not have several people or personalities in one body.

So, what is it?

• A cognitive disorder (as opposed to the emotional disorders we have studied so far). It involves motor function, perception, and some emotion, but it is primarily a cognitive issue.

• The term ‘schizophrenia’ actually refers to a group of disorders characterized by confused and disconnected thoughts, emotions, and perceptions.

Major Features of Schizophrenia

Two or more of the following must be present for a significant portion of time over the course of one month:

• Delusions: false beliefs maintained in the face of contrary evidence• Hallucinations: perceptions in the absence of corresponding

sensation; “hearing voices,” “seeing things”• Incoherence: marked decline in thought processes; indicated by use

of a “word salad” in which the speaker gradually speeds up his or her speech to the point where it all becomes a jumble of words seemingly thrown together

• Disturbances of affect: emotions that are inappropriate for the circumstances

• Deteriorations in normal movement: slowed movement, catatonic behavior, or highly agitated behavior

• Decline in previous levels of functioning• Diverted attention: possibly brought on by cognitive flooding

Causes of Schizophrenia

• Biochemical Factors: excessive levels of dopamine have been linked to schizophrenia.

• Viral Infections: theory, those exposed to influenza during the 1st trimester of their prenatal development have seven times the chance of developing schizophrenia.

• Brain Abnormalities: Many (though notable not all) schizophrenic patients have up to 5% more brain tissue loss than those without schizophrenia.

• Disorganized Schizophrenia: characterized by – disorganized behavior: including incoherent speech, silly irrelevant laughter,

and inappropriate affect– bizarre delusions often involving sexual or religious themes– vivid hallucinations

A 40-year old man who looks more like 30 is brought to the hospital by his mother, who reports that she is afraid of him. It is his twelfth hospitalization. He is dressed in a tattered overcoat, baseball cap, and bedroom slippers, and sports several medals around his neck. His affect ranges from anger (hurling obscenities at his mother) to giggling. He speaks with a childlike quality and walks with exaggerated hip movements and seems to measure each step carefully. Since stopping his medication about a month ago, his mother reports, he had been hearing voices and looking and acting more bizarrely. He tells the interviewer he has been “eating wires” and lighting fires. His speech is generally incoherent and frequently falls into rhyme and clanging associations. His history reveals a series of hospitalizations since the age of 16. Between hospitalizations, he lives with his mother, who is now elderly, and often disappears for months at a time, but is eventually picked up by police for wandering the streets.

Sub-types of Schizophrenia

• Catatonic Schizophrenia: characterized by gross disturbances in motor activity, such as catatonic stupor.

– Patient may, however, still be aware of what is happening around them, despite being unable to respond

• Movements typically slow down until they reach a stupor, but may abruptly switch into an agitated phase.

• May maintain unusual or apparently strenuous positions for hours, despite limbs becoming stiff or swollen.

– Waxy flexibility may also be a feature.

*Note: catanonia is not unique to schizophrenia. It is more typically found in those with mood disorders

Sub-types of Schizophrenia

Treating Schizophrenia

• Anti-psychotics: drug therapy is often used to help patient cope with having schizophrenia and to lessen symptoms or episodes

• Personal Therapy: working one on one with a psychoanalyst to help patients cope with stress and build social skills (helps reduce relapse rates and improve social functioning)

Somatoform

and Dissociative Disorders

Why Can’t the Prince Walk?

There is an ancient Persian legend about a physician named Rhazes who was called into the palace for the purpose of diagnosing and treating a young prince. Apparently, the prince could not walk. After the usual examination, Rhazes determined that there was nothing wrong with the prince’s legs, at least not physically. With little more than a hunch, Rhazes set out to treat what may be the first recorded case of conversion. In doing so, he took a risk: Rhazes unexpectedly walked into the Prince’s bathroom brandishing a dagger and threatened to kill him. Upon seeing him, “the startled prince abruptly fled, leaving his clothes, his dignity, and undoubtedly part of his self-esteem behind.”

Somatoform Disorders

• Characterized by complaints of physical problems or symptoms that cannot be explained by physical causes.

• Illnesses are not purposefully “faked,” they seem to serve a psychological need; hence, they are classified as psychological disorders.

Types of Somatoform DisordersType of Disorder Description Associated Features

Conversion Disorder Change or loss of a physical function without medical cause

Emerges in context of conflicts or stress

Hypochondriasis Preoccupation with the belief that one is seriously ill

-Fear persists despite medical reassurance

-Tendency to interpret minor aches and pains as serious illness

Somatization Disorder Recurrent, multiple complaints about physical symptoms that have no clear organic basis

Body Dysmorphic Disorder Preoccupation with an imagined or exaggerated physical defect

-Person may believe that others think less of them because of the perceived defect

-May engage in compulsive behaviors that aim to correct the perceived defect

Pain Disorder Persistent physical pain believed to be associated with psychological factors

Pain severe and persistent enough to interfere with daily functioning; medical conditions and psychological factors may play important roles in accounting for the pain

Somatoform Disorders:Treatment

• Psychoanalysis: seeks to uncover and bring unconscious conflicts that originated in childhood into conscious awareness.

• Behavioral therapy: removes sources of secondary reinforcement (sympathy, etc.).

• Cognitive-behavioral therapy: restructures distorted beliefs to help people replace exaggerated illness-related beliefs with rational alternatives; also employs exposure with response prevention.

Munchausen Syndrome

• A form of feigned illness in which the person either fakes being ill or makes himself ill. Differs from somatoform disorders because the symptoms are intentionally induced.

• Munchausen by proxy: a pernicious form of child maltreatment in which people intentionally falsify or induce physical or emotional illness or injury in a child or dependent person.

• Named for an 18th century German Baron who was famous for entertaining his friends with tales of outrageous adventures.

Dissociative Disorders

• Dissociative disorder: a disorder in which a person experiences alterations in memory, identity, or consciousness

• Dissociative Identity Disorder: a person exhibits two or more personality states, each with its own patterns of thinking and behaving

• Dissociative amnesia: the inability to recall important personal events or information; is usually associated with stressful events

Dissociative AmnesiaName Characteristics Example

Localized Amnesia

Events occurring during a specific time period are lost to memory

Person cannot recall events for a number of hours or days after a stressful or traumatic incident

Selective Amnesia

Only the disturbing particulars that take place during a certain period of time are forgotten

A soldier recalls most of a battle, but not the death of his friend. A person recalls the period of life during which he had an affair, but not the affair itself.

Generalized Amnesia*

*very rare

Entire life is forgotten; cannot recall personal information, but usually retain habits, tastes and skills

Person cannot recall any events or names from his life. Cannot remember elementary reading teacher’s name, but can still read.

Continuous Amnesia

The person forgets everything that occurred from a particular point in time up to and including the present

Person cannot recall anything from the last four weeks, including the conversation they just finished.

Systematized Amnesia

Memory loss is specific to a particular category of information

Person cannot recall anything having to do with his older brother.

Dissociative Identity Disorder

• At least two distinct personalities exist within the person, each having a relatively enduring and distinct pattern of perceiving, thinking and feeling.

• Two or more of these personalities repeatedly take complete control of the individual.

• There is a failure to recall important personal information too substantial to be accounted for by ordinary forgetfulness.

• The disorder cannot be accounted for by the effects of a psychoactive substance or a general medical condition.

The Three Faces of Eve

• Real Name: Chris Sizemore

• Eve White: timid housewife• Eve Black: libidinous and

antisocial personality• Jane: integrated

personality who can accept her aggressive urges, but still engage in socially appropriate behavior.

• Therapy led to the integration of the three personalities.

• Later, however, Sizemore’s personality later fractured into 22 individual personalities, and she reentered therapy.