ABNORMAL BEHAVIOR (7-9% OF AP EXAM) To study the abnormal is the best way of understanding the normal. - William James (1842-1910) PSYCHOLOGICAL DISORDERS Paradox: Antonyms such as mental health and mental illness suggest a sharp distinction

between those who are normal and those who are not, but its often difficult to draw a line that clearly separates normality from abnormality. HISTORICAL AND CONTEMPORARY APPROACHES TO PSYCHOLOGICAL DISORDERS

HISTORICAL APPROACHES Prospectives on psychological disorders have changed through the centuries. Historically mental illnesses have been regarded as having supernatural or religious origins: Demonic possession or punishment for sin. Trephination: drilling a hole in the skull in order to release demons thought to possess someone Also used exorcism, beatings, castration, mutilation even execution as early treatments.

THE EXTRACTION OF THE STONE OF MADNESS (C. 1500) REFORMERS MAKE AN IMPACT In the 18 t h century, the systematic treatment of psychological disorders began to transform. Conditions had improved but the mentally ill were often

chained up in filthy institutions. Philippe Pinel: French physician who sought to eliminate the institutionalized brutality of mental institutions. Later, Dorothea Dix would bring the reform movement for the mentally insane to the

THE MEDICAL MODEL During the 1800s, scientist discovered the physical effects of the syphilis germ. If the dementia that accompanied syphilis had a physical cause, might it be that ALL mental disorders could be traced to diseases of the body? Medical Model: belief that abnormal behavior should be thought of as a disease; with physical causes and a subsequent cure Key Terms: Diagnosis: distinguishing one illness from another

Etiology: apparent cause and developmental history of an illness Prognosis: forecast about the probable course of an illness THE BIO-PSYCHO-SOCIAL APPROACH Bio-psycho-social approach: studies of how biological, psychological and social-cultural factors interact to produce specific psychological disorders

DIATHESIS-STRESS MODEL The diathesis-stress model is psychologys attempt to explain abnormal behavior as both: 1. a predispositional vulnerability (diathesis) 2. and a reaction to the stress from life experiences The D-S Model attempts to determine which individuals are at the highest risk of developing psychological disorders. Why does Person A develop schizophrenia while Person B does not even when all other

life factors are similar? CRITERIA OF ABNORMAL BEHAVIOR In making diagnoses of mental disorders, clinicians rely on a variety of criteria. The foremost of these criteria include: 1. Deviance: the behavior deviates from what their society considers acceptable. 2. Dysfunctional: when ones everyday adaptive behavior becomes impaired. 3. Distress: subjective feelings of pain and suffering

People are judged to have a psychological disorder only when their behavior becomes extremely deviant, dysfunctional or distressing. Thus, normality and abnormality exist on a continuum, not an either- or proposition. THE CLASSIFICATION OF DISORDERS In order to facilitate empirical research and enhance communication among clinicians, psychologists devised a

system for classifying psychological disorders. This system is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is currently in its 5th edition released in May 2013. Over the years many disorders have been added (anorexia), while others have been dropped (homosexuality). Recall that what constitutes abnormal

varies not only from culture to culture, but over time as well. DANGERS OF PSYCHOLOGICAL LABELING In the 1960s, many psychologists began to question to validity of classifying psychological disorders. These anti-psychiatrists believed that the current system of psychiatric diagnosis was too vague, selfopinionated and subjective; not

scientific. Labels create preconceptions that guide our perceptions and our interpretations. To highlight the dangers of these diagnoses, psychologist David Rosenhan conducted his famous On Being Sane In Insane Places study in the early 1970s. THE ROSENHAN STUDY

Rosenhan and 7 other pseudo -patients sought admission to various mental hospitals by faking hallucinations. They claimed the voices spoke the following words: empty, hollow and thud; sometimes called The Thud Experiment Once inside, the pseudo -patients were told to behave normally. All were admitted to the psychiatric hospitals; most diagnosed as schizophrenic. Their stays in these hospitals ranged from 7 to 52 days; average was 19 days.

Clinicians even perceived abnormal behavior in very normal acts, such as note-taking done by one pseudo -patient. Patients were dismissed with a diagnosis of schizophrenia in remission only after admitting to their doctors that they were mentally ill. IMPACTS OF THE ROSENHAN STUDY Many psychologists were shocked at the results of Rosenhans study when he published the results in 1973. Study highlighted the dangers of labeling; what

constitutes sane and what constitutes insane? Showed the extent to which mental patients were dehumanized and stigmatized by hospital doctors and staff. Compared the differences in quality of care between state-run and privately operated facilities. Led to the deinstitutionalization movement of the 1970s which released many from the confines of

SPECIFIC TYPES OF PSYCHOLOGICAL DISORDERS ANXIETY DISORDERS Anxiety disorders: class of disorders marked by feelings of excessive apprehension and anxiety. Generalized anxiety disorder : marked by a chronic, high level of anxiety that is not tied to any specific threat Worry about yesterdays mistakes and tomorrows problems.

Accompanied by physical symptoms: Trembling Muscle tension Dizziness Faintness Sweating Heart palpitations ANXIETY DISORDERS Panic disorders: recurrent attacks of overwhelming

anxiety that usually occur suddenly and unexpectedly. Panic attacks have similar symptoms of generalized anxiety disorder, but their effects are more intense and their occurrence is unpredictable. ANXIETY DISORDERS Phobic disorders: persistent and irrational fear of an object of situation that presents no realistic danger.

Common phobias include fears of specific animals, heights, blood, flying, enclosed spaces, etc. Agoraphobia: fear of open places; seen more today as a complication of panic disorder than an independent phobia Individual concerns about exhibiting panic in public may escalate to the point where one is

afraid to leave home. OBSESSIVE-COMPULSIVE AND RELATED DISORDERS Obsessive-Compulsive Disorder (OCD): marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) Obsessions often center on

inflicting harm on others, personal failures, suicide or sexual acts. Compulsions usually involve stereotyped rituals that temporarily relieve anxiety. Constant hand washing, repetitive cleaning, endless rechecking of locks, faucets, etc. OBSESSIVE-COMPULSIVE AND RELATED DISORDERS

Hoarding disorder: persistent difficulty discarding or parting with possessions due to a perceived need to save the items. TRAUMA AND STRESSOR-RELATED DISORDERS Posttraumatic Stress Disorder (PTSD): involves enduring psychological disturbance attributed to the experience of a major traumatic event.

Symptoms include haunting memories, recurrent nightmares, social withdrawal, anxiety and insomnia Often seen following: Combat experience Rape or assault Automobile accidents Natural disasters Witnessing violent death

SOMATIC SYMPTOM AND RELATED DISORDERS Somatic symptom disorder : psychological disorder characterized by physical symptoms with no apparent physical cause Patients often become worried about their health because doctors are unable to find a cause for their problems. Specific types of somatic symptom disorders include: Conversion disorder: involves the actual loss of bodily function such as blindness, paralysis and numbness due to excessive anxiety.

Illness anxiety disorder (IAD) : involves persistent and excessive worry about developing or having a serious illness Body dysmorphic disorder : excessive concern about body image and preoccupation with a perceived defect of physical features MOOD DISORDERS Mood disorders: marked by emotional disturbances of varied kinds that may spill over to disrupt physical, perceptual, social and thought processes.

Two basic types of mood disorders: unipolar and bipolar. DEPRESSIVE DISORDERS Major Depressive Disorder: unipolar condition in which people show persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure Most common of the psychological disorders. About twice as common in women; postpartum and postmenopausal depression

Seasonal Affective Disorder : tendency to become depressed during specific times of the year (mostly fall and winter) BIPOLAR DISORDER Bipolar Disorder: (formerly manic-depressive disorder) characterized by the experience of one or more manic episodes and well as periods of depression Mania: hyperactive, wildly optimistic state People afflicted with bipolar disorder

experience periods of extreme highs (mania) and extreme lows (depression) usually lasting weeks at a time. Roughly affects about 1% of the population; unlike MDD equally affects men and women. SUICIDE AND MOOD DISORDERS One tragic side effect of mood disorders is suicide. 11 t h leading cause of death in the United States. Estimate that suicide attempts and suicide

completions are at about a 10:1 ratio. Women attempt suicide more often than men; men complete suicide four times more often than women. Completed suicides are highest amongst adults over the age of 75. ETIOLOGY OF MOOD DISORDERS As with most psychological disorders, twin studies have suggested that heredity can create a predisposition to mood disorders.

Correlations have been found between mood disorders and two key neurotransmitters: Serotonin: low levels underlie many instances of depression Norepinephrine: overabundant during mania but scarce during depression Depressed patients also tend to show an elevated level of cortisol, a hormone released during times of stress.

DISSOCIATIVE DISORDERS Dissociative Disorders: class of disorders in which people lose contact with portions of consciousness or memory, resulting in the disruption of their sense of identity. Two main types of dissociative disorders: 1. Dissociative amnesia: sudden loss of memory for important personal information that is too extensive to be due to normal forgetting; normally occurs after a single, traumatic event Dissociative fugue: involves the loss of memory for ones

entire life along with their sense of personal identity; typically rebuild their lives in another location with a different identity 2. Dissociative Identity Disorder : coexistence in one person of two or more largely complete and usually different personalities; formerly called multiple DISSOCIATIVE IDENTITY: A CLOSER LOOK Each personality

has his or her own name, memories, traits and physical mannerisms. The various personalities tend to be unaware of each other. Transitions between identities often occur suddenly.

DISSOCIATIVE IDENTITY: DOES IT EXIST? D.I.D. Does Not Exist DID Does Exist People with DID are engaging in intentional role playing to use mental illness as an excuse for personal failings.

DID is a creation of modern North American culture. Since the publication of Sybil in 1973, the number of average personalities has increased from 2 or 3 to about 15. Therapists subtly encourage creation of different personalities in their patients.

Believe that DID has been historically underdiagnosed. No incentive exists for patients or therapists to manufacture cases of DID. DID is actually rooted in severe emotional trauma that occurred during childhood.

SCHIZOPHRENIA Schizophrenia: class of disorders marked by delusions, hallucinations, disorganized speech and deterioration of adaptive behavior At the core of schizophrenia lie disturbed thoughts. It is a severe, debilitating disorder that tends to have an early onset (adolescence or early adulthood) and often requires lengthy hospital care.

The financial impact of schizophrenia is estimated to exceed the costs of ALL types of cancer combined. SCHIZOPHRENIA: GENERAL SYMPTOMS Delusions: false beliefs that are maintained even though they clearly are out of touch with reality

Believe private thoughts are being broadcast to others. Thoughts are being injected into their minds against their will. Their thoughts are being controlled by some external force. Thinking becomes chaotic rather than logical or linear. Hallucinations: sensory perceptions that occur in the absence of real, external stimuli or gross distortions of perceptual input Auditory: hearing things that dont exist (most common)

Visual, Tactile, Olfactory and Gustatory hallucinations Catatonia: characterized by the presence of behavior and movement traits Can include immobility, non-responsiveness (stupor), posturing, staring and grimacing. MODERN ORGANIZATION OF SCHIZOPHRENIA Positive Symptoms

Negative Symptoms Involve behavioral excesses or peculiarities. Hallucinations Delusions of grandeur Delusions of persecution (paranoia) Delusions of reference Bizarre behavior

(including catatonia) Involve behavioral deficits . Flattened emotions; flat affect Social withdrawal Apathy Inability to maintain motivation; avolition Alogia, or poverty of

speech ETIOLOGY OF SCHIZOPHRENIA Children of parents who BOTH have schizophrenia roughly have a 50-50 chance of developing the disease as well. The neurotransmitter dopamine in excess could be the neurochemical basis for schizophrenia. Patients with schizophrenia tend to have a smaller thalamus than those without the disease. Reductions of both gray and white matter; impair the

brains neural communication. Disruptions in normal maturational processes during gestation: Viral infection of the mother (particularly influenza) Malnutrition (i.e. Dutch Winter famine victims) Severe maternal stress PERSONALITY DISORDERS Personality disorders: marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning.

DSM 5 lists ten different types of personality disorders. Grouped into three related clusters: 1. anxious-fearful: avoidant, dependent and obsessive-compulsive 2. odd-eccentric: schizoid, schizotypal, paranoid 3. dramatic-impulsive: histrionic, narcissistic, borderline, antisocial ANTISOCIAL PERSONALITY DISORDER

Antisocial personality disorder: marked by impulsive, callous, aggressive and irresponsible behavior that fails to accept social norms; formerly called sociopaths or psychopaths Individuals with APD chronically violate the rights of others yet feel little guilt about their transgressions. Rarely experience affection for others Irresponsible and impulsive. Sexually predatory and promiscuous; pursue

immediate gratification. NEURODEVELOPMENTAL DISORDERS Neurodevelopmental disorders include disorders whose onset typically occurs during infancy, childhood or adolescence. These disorders occur as a result of impairments in the growth and/or development of the brain or the central nervous system. 1. Attention-deficit disorder/hyperactivity disorder (ADHD):

symptoms include difficulty paying attention, staying focused and controlling behavior 2. Autism spectrum disorder : diagnosis based on three primary symptoms: Lack of responsiveness to other people Impairment in verbal and non-verbal communication Limited interests and activities 3. Tourettes syndrome : characterized by multiple physical and at least one phonic tic

ORGANIC DISTURBANCE/NEUROCOGNITIVE DISORDERS Changes in the brain can affect all aspects of behavior and mental processes. The DSM-5 labels disorders characterized by a decline from previous levels of cognitive function as neurocognitive disorders. 1. Alzheimers disease: disease in which the brains neurons progressively die leading to loss of memory, reasoning and bodily function

Thought to be caused by lack of acetylcholine and vascular conditions such as high blood pressure. 2. Delirium: characterized by impaired attention and lack of awareness of the environment Delirium differs from dementia in that delirium is typically acute, suddenly occurring out of no where.

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