Abnormal Psychology Cherokee 2009
Refresh your Knowledge ď Ž Provide
an 1 example of behavioral therapy and 1 example client centered therapy.
What is Normal?
Brainstorm and make a list of 10 normal behaviors of teenagers and 10 behaviors that would be considered as not normal for teenagers. (10 minutes)
Break up into groups of 3 to share your lists and decide on 5 normal behaviors and 5 behaviors that are not normal. (7 minutes)
As a group you will share your list with the class
What is Normal? ď Ž
Would your list fit every teenager in the U.S. or New Jersey? Why or Why not
ď Ž
Are there situations that change your viewpoint of normal behavior? Explain
ď Ž
What is Normal?
Decide on and write down a definition for normal behavior and abnormal behavior based on our activity in class yesterday.
Reflecting ď Ž List
and explain the 4 Anxiety disorders that we saw in the video yesterday.
What is abnormal behavior? 3 criteria
Deviant - behavior deviates from what their society considers acceptable. Transvestic fetishism Maladaptive – everyday adaptive behavior is impaired (adjustments) begins to interfere with a person’s social and occupational functioning Causing personal distress – usually by individuals suffering from depression and anxiety, self report (subjective)(may or may not have deviant or maladaptive behavior)
Causes and Course Diagnosis
– identifying a disorder by its
signs and symptoms
Prognosis – you are expected to do after identifying a disorder
Prevalence Prevalence
– refers to the percentage of the population that exhibits a disorder during a specific time period. ( 1/3 of the population suffers from a mental illness) ( ages 18-54 44% of the population will suffer from a psychological disorder) Most common 1. substance abuse 2. anxiety disorders 3. mood disorders
Defining Mental Disorder
No Mild Moderate Disorder Disorder Disorder
Severe Disorder
Defining Mental Disorder
Defining Mental Disorder Homosexuality was defined as a disorder in previous DSM Manuals
Defining Mental Disorder It is current practice in China to institutionalize members of the Falun Gong religion
3-2-1
List 3 criteria for abnormal behavior. Describe 2 anxiety disorders. Identify the most common disorder (1)
Autism
First identified in 1943 by Leo Kanner There is from the start an extreme autistic aloneness that, whenever possible, disregards, ignores, shuts out anything that comes from the outside. Autistic disorder – a persuasive developmental disorder involving profound aloneness and difficulty relating to others, severe communication problems and ritualistic behavior 3 to 4 infants in 10,000 4 times more likely in males
Autism Infants – do not smile or reach out or look at their mothers when being fed May refuse to be held or cuddled Described as unusually good babies Self-absorbed and not noticing their surroundings Language problems – 50% never learn how to speak at all. When they speak: Echolalia – speech problem where they repeat back exactly what they heard Pronoun reversal – he, she, you –them I and me –others Extremely upset over change in daily routines Ritualistic hand and body movements (body rocking)
Axis I Clinical Syndromes Discussed in Text Anxiety
Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenic Disorders
Reflecting ď Ž List
and explain the 4 Anxiety disorders. ď Ž Be prepared to provide an example of each disorder to the rest of the class.
Clinical Syndromes: Anx
Generalized anxiety disorder
“free-floating anxiety” Worry is chronic, uncontrollable, and excessive Individual is jittery and strained, distractible, and apprehensive that something bad is about to happen Bodily indications – a pounding heart, fast pulse, and breathing, sweating, flushing, muscle aches, a lump in the throat, and upset stomach Occurring more days than not for 6 months
Clinical Syndromes: Anxiety Disorders
Phobic disorder
Specific focus of fear There is an intense fear and avoidance of specific objects and situations, recognized as irrational by the individual
Clinical Syndromes: Anxiety Disorders
Panic disorder and agoraphobia
Physical symptoms of anxiety/leading to agoraphobia An extreme anxiety that manifests itself in the form of panic attacks Feel that you are going to die chest pains Dizziness Fainting Smothering After a stressful event
Clinical Syndromes: Anxiety Disorders
Obsessive compulsive disorder
Obsessions Compulsions
The mind is flooded with persistent and uncontrollable thoughts (Obsessive)or the individual is compelled to repeat certain acts again and again (Compulsive), causing significant distress and interference with everyday life. Seen as irrational by the individual
Post-traumatic Stress Disorder Post-traumatic stress disorder is a condition in which a person who has experienced a traumatic event feels severe and long-lasting aftereffects dreams or flashbacks
often followed by insomnia and feelings of guilt.
Reflecting
List and explain the symptoms & treatments that were illustrated in the video: “Real Life, I have OCD” Morgan (23) Jessica (18) -
Etiology of Anxiety Disorders
Biological factors
Conditioning and learning
Judgments of perceived threat
Personality
Acquired through classical conditioning or observational learning Maintained through operant conditioning
Cognitive factors
Genetic predisposition, anxiety sensitivity
Neuroticism – nervous or anxiety
Stress
A precipitator
Twin studies of anxiety disorders. The concordance rate for anxiety disorders in identical twins is higher than that for fraternal twins, who share less genetic overlap. These results suggest that there is a genetic predisposition to anxiety disorders. (Data based on Noyes et al., 1987; Slater & Shields, 1969; Torgersen, 1979, 1983)
Cognitive factors in anxiety disorders. Eysenck and his colleagues (1991) compared how subjects with anxiety problems and nonanxious subjects tended to interpret sentences that could be viewed as threatening or nonthreatening. Consistent with cognitive models of anxiety disorders, anxious subjects were more likely to interpret the sentences in a threatening light.
Diagnostic and Statistical Manual of Mental Disorders, or DSM. ď Ž
The most recent revision, the DSMIV, was published in 1994
ď Ž
This has been revised four times as the DSM-II (in 1968), the DSM-III (in 1980), and the DSM-III-Revised (1987
DSM-IV: New Ways to Categorize Mental Illness •
Within each diagnostic category of the DSM-IV, the following descriptions are included:
1. essential features of the disorder– characteristics that “define” the disorder 2. associated features –additional features that are usually present
DSM-IV: New Ways to Categorize Mental Illness 3. Information on differential diagnosis– that is, how to distinguish this disorder from other disorders with which it might be confused 4. diagnostic criteria –a list of symptoms, taken from the lists of essential and associated features, that must be present for the patient to be given this diagnostic label.
Reflecting
1. List and describe 4 Anxiety disorders
2. List 4 Causes for Anxiety disorders
3. Explain 1 of the Causes in detail
Five major dimensions, or axes, to describe a person’s mental functioning. Axis I is used to classify current symptoms into explicitly defined categories Axis II is used to describe developmental disorders and long-standing personality disorders or maladaptive traits
Five major dimensions, or axes
Axis III is used to describe physical disorders or medical conditions that are potentially relevant to understanding or managing the person.
Axis IV is a measurement of the current stress level at which the person is functioning.
Axis V is used to describe the highest level of adaptive functioning present within the past year
Axis I
DSM-IV: New Ways to Categorize Mental Illness Adaptive functioning refers to three major areas 1. Social relations 2. Occupational functioning
3.
Use of leisure time
Clinical Syndromes: Somatoform Disorders
Somatization Disorder – Anxiety converted into physical symptoms Conversion Disorder – a person sensory or muscular functions are impaired, usually suggesting neurological disease, even though the bodily organs themselves are sound. Hypochondriasis – a person misinterprets ordinary physical sensation, is preoccupied with fears of having a serious disease and is not dissuaded by medical opinion.
Glove anesthesia. In conversion disorders, the physical complaints are sometimes inconsistent with the known facts of physiology. For instance, given the patterns of nerve distribution in the arm shown in (a), it is impossible that a loss of feeling in the hand exclusively, as shown in (b), has a physical cause, indicating that the patient’s problem is psychological in origin.
Reflecting ď Ž 1.
List and Explain the 2 Somatoform disorders. ď Ž 2. Provide an example of the disorders to share with the class.
Clinical Syndromes: Dissociative Disorders Dissociative Disorders – anxiety expressed as loss of memory and/or identity
Dissociative amnesia – sudden inability to recall personal information that is too extensive to be explained by ordinary forgetfulness Dissociative fugue – sudden unexpected travel away from home or work, with inability to recall one’s past and having a new identity (partial or complete)
Dissociative Disorders
Dissociative identity disorder – an individual has two or more fairly distinct and separate personalities ( called alters), each with its own memories, relationships, and behavior patterns and only one of which is dominate at any given time.
Etiology
severe emotional trauma during childhood
Controversy
Media creation?
Clinical Syndromes: Mood Disorders Disorder ď Ž
Mood Disorders – pronounced and long lasting disturbances in emotional feelings, strong enough to intrude on everyday life.
Major depressive disorder Major
depressive disorder
Depressed mood all day everyday Diminished interest and pleasure in nearly all activities Significant weightloss or gain, significant decrease or increase in appetite Insomnia or hypersomnia
psychomotor retardation or agitation nearly everyday (shift in activity level)
Major depressive disorder
fatigue or loss of energy nearly everyday Feelings of worthlessness or inappropriate guilt
Diminished ability to think &/or concentrate Recurrent thoughts of death or suicide (with or without a plan) 5 of the following for over two weeks 17% more likely in women Avg. untreated episode 6-8 months
Mood Disorders
Bipolar disorder (manic-depressive disorder) – altering episodes of depression and mania (cyclical) Mania: characteristics 1. intense feeling of euphoria 2. intense feelings of power & invulnerability 3. excessive energy (frequently can’t sleep or sit still) 4. Sexual preoccupation or inappropriate sexual acting out 5. involvement in wild schemes (spending huge amount of money, huge gambling) 6. Delusions – beliefs contrary to reality, firmly held in spite of contradictory evidence
Bipolar Disorder (cont’d)
Symptoms must be severe enough to cause serious impairment in social or occupational functioning or require hospitalization. 3 out of the 6 symptoms are needed to have a diagnosis Men and women have equal occurrence, over 50% have 4 or more episodes
Reflecting What
are a few of the symptoms displayed by someone who has Bipolar disorder?
What
are some of the causes for Bipolar?
Bipolar disorder Etiology Genetic vulnerability Neurochemical factors Cognitive factors Interpersonal roots Precipitating stress ď Ž
Reflecting ď Ž 1.
Compare and Contrast Major Depression disorder and Bipolar disorder.
Seasonal Affective Disorder •
There are people who develop a deep depression in the midst of winter.
People
suffering from SAD tend to sleep and eat excessively during their depressed periods Researchers have proposed that the hormone melatonin may play a role
Seasonal Affective Disorder The less light available (in winter), the more melatonin is secreted by the brain’s pineal gland • Many SAD sufferers can be treated by sitting under bright fluorescent lights during the evening or early morning hours.
Clinical Syndromes: Schizophre
General symptoms
Delusions and irrational thought Deterioration of adaptive behavior Hallucinations Disturbed emotions Episodic – from time to time Chronic – continuous Single Episode – acute or in remission
Reflecting ď Ž
Explain what Seasonal-Affective Disorder is and what causes it.
ď Ž
What are the 2 possible treatments for Seasonal-Affective Disorder.
Subtyping of Schizophrenia
Subtypes
Paranoid type Catatonic type Disorganized type Undifferentiated type
New model for classification
Positive vs. negative symptoms
Paranoid type
Involves prominent delusions, usually of persecution as well as hallucinations Delusions – false beliefs that a person maintains in contrary to evidence Hallucinations – perceptions that have no direct external cause Grandiose delusions – an exaggerated sense of one’ s importance, power, knowledge or identity. Delusional jealousy – unfounded conviction that one’s mate is unfaithful Ideas of reference – reading personal significance into unrelated remarks and activities of others.
Catatonic type ď Ž
Primary symptoms alternate between stuporous immobility (waxy flexibility) and excited agitation (wild child like behavior)
Disorganized type Subject to hallucinations and delusions (sexual, hypochondriacally, religious, or persecution and bizarre ideas often involving deterioration of the body) ď Ž Constantly changing moods and has poor hygiene ď Ž
Positive and Negative Symptoms
Positive – an excess distortion of normal functioning -delusions and hallucinations
Negative – restriction related to normal behavior Affective flattening - emotions Alogia – restriction in fluency thought/speech Avollition – restriction in goal related behavior
Undifferentiated type
Marked by idiosyncratic mixture of schizophrenic symptoms Fairly common Clearly have schizophrenia, but do not fit into any of the previous 3 categories.
Etiology of Schizophrenia
Genetic vulnerability Neurochemical factors Structural abnormalities of the brain The neurodevelopmental hypothesis Expressed emotion Precipitating stress
Reflecting
List the 4 types of schizophrenia.
What are 2 common themes in all 4 disorders?
What neurotransmitter is involved with schizophrenia?
Personality Disorders
Anxious-fearful cluster
Dramatic-impulsive cluster
Histrionic, narcissistic, borderline, antisocial
Odd-eccentric cluster
Avoidant, dependent, obsessive-compulsive
Schizoid, schizotypal, paranoid
Etiology
Genetic predispositions, inadequate socialization in dysfunctional families
Personality Disorders ď Ž
ď Ž
A diverse group of long lasting, inflexible, and maladaptive patterns of inner experience and behavior that cut across many situations and impair social and occupational functioning Personality disorders usually fail to recognize that their deviant behavior is anything but normal.
Dramatic-impulsive cluster
Borderline Personality – This impulsive and unpredictable person has an uncertain selfimage, intense and unstable social relationships, and extreme mood swings Antisocial Personality – repeated conflicts with society in the form of irresponsibility, manipulation, and conscienceless violations of others rights (sociopath/psychopath) - impulsive behavior is difficult to reform and they have a superficial emotion.
Dramatic-impulsive cluster
Histrionic Personality – overly dramatic, attention seeking, given to emotional excess, and immature Narcissistic Personality – a preoccupation with the self, including one’s own body - Often have an exaggerated sense of their own importance, a need to be admired by others, and insensitivity to others.
Anxious-fearful cluster
Avoidant Personality – poor self-esteem and are extremely sensitive to rejection and remain aloof, even though they very much desire affiliation and affection Dependent Personality – lack in selfconfidence, allow others to run their lives and make no demands on them to endanger these protective relationships
Anxious-fearful cluster
Obsessive-Compulsive Personality – have inordinate difficulty making decisions, are overly concerned with details and efficiency and relate poorly with others because they demand things done their way. They are perfectionist, unduly professional, conventional, serious, and formal.
Odd-eccentric cluster ď Ž
Paranoid Personality - This person, expecting to be mistreated by others, becomes suspicious, secretive, jealous, and argumentative. He/she will not accept blame.
Odd-eccentric cluster
Schizoid Personality – this person , emotionally aloof and indifferent to praise, criticism, and feelings of others, is usually a loner with few, if any close friends. Schizotypal Personality – this eccentric individual has oddities of thought and perception, speaks digressively and with over elaborations, and is usually socially isolated. - under stress he/she may seem psychotic
Diagnosis ADD Six or more symptoms of inattention must be present for at least 6 months –frequent mistakes or failure to pay close attention to details –difficulty sustaining attention –often does not listen when spoken to directly –fails to finish work and does not follow instructions –lacks organizational skills –avoids sustained mental effort –misplaces items –easily distracted –forgetful
Diagnosis (cont.’d) Six symptoms of hyperactivity-impulsivity must be present for at least 6 months
frequently fidgets or squirms frequently leaves his expected seating area frequently acts inappropriately has difficulty being quiet while in leisure activities frequently “on the go” talks excessively shouts answers out-of-turn impatient interrupts or intrudes on others
Associative Features in ADHD
Some symptoms must have been present before age 7 Symptoms must occur in at least 2 of the following settings home school work Clear evidence of interference with social, academic, or occupational functioning must be observed
20-25% have learning disabilities (Davidson & Neale, 1998)
Disturbances cannot occur during any other mental disorder; ADHD must be diagnosed separately *Diagnosis slides from DSM-IV (1994, APA), unless cited different
Psychological Disorders and the Law
Insanity
M’naghten rule – insanity exists when a mental disorder makes a person unable to distinguish right from wrong.
Involuntary commitment – people are hospitalized in psychiatric facilities against their will.
danger to self danger to others in need of treatment
Culture and Pathology Cultural variations - depression, bipolar, schizophrenia - not seen as disorders – narcissistic, GAD, hypochondria Culture bound disorders
Koro – China/Southern asia –obsessive fear that one’s penis will withdraw into one’s abdomen Windigo – Algonquin Indian culture – intense craving for human flesh and fear of becoming a cannibal Anorexia nervosa – largely seen in affluent Western cultures
Types of Treatment
Psychotherapy
Insight therapies
Behavior therapies
“talk therapy” Changing overt behavior
Biomedical therapies
Biological functioning interventions
Who Seeks Treatment?
15% of U.S population in a given year Most common presenting problems
Anxiety and Depression
Women more than men Medical insurance Education level
Who Provides treatment?
Clinical psychologists – full fledged disorders Counseling psychologists – everyday adjustment problems Psychiatrists- provide medication Clinical social workers – work with patients and families to integrate back into the community (can have a private practice) Psychiatric nurses – hospital inpatient treatment (can have private practice) Counselors – schools, college, youth centers, family planning centers
Refresh your Knowledge ď ŽExplain
the difference between a Clinical Psychologist and a Psychiatrist
Insight Therapies: Psychoanalysis
Sigmund Freud and followers Goal: discover unresolved unconscious conflicts Free association – clients freely express their thoughts and feelings exactly as they occur, with little censorship as possible. Dream analysis – therapists interpret the symbolic meaning of the client’s dreams.
Psychoanalytic Therapy
Freud saw many things as having sexual overtones
Insight Therapies: Psychoanalysis Resistance
– refers to largely unconscious defense maneuvers intended to hinder the progress of therapy Transference – occurs when the clients unconsciously start relating to their therapists in ways that mimic critical relationships in their lives.
Insight Therapies: Psychoanalysis ď Ž Working
Through – once aware of conflicts, patient goes over them again and again as they are worked out.
Insight Therapies: Client Centered Therapy
Carl Rogers
Goal: restructure self-concept to better correspond to reality Therapeutic Climate Genuineness communicating honestly and spontaneously, not phony or defensive Unconditional positive regard – complete, nonjudgmental acceptance of the client as a person. Empathy – therapist must understand the clients world from the clients point of view
Client Centered Therapy
Thought stopping – learning to stop unhealthy thoughts Reprogramming – replacing negative thoughts with positive ones Development of new strategies for approaching one’s experiences and problems
Cognitive Therapy Constant Repetition of Negative thoughts leads to abnormality Aaron Beck
Cognitive Therapy Nobody likes me Even people who like me occasionally get mad at me I’m a moron
I’m smart, even if I do make mistakes now and then
I’m worthless
I’m a good person
My jokes are bad It’s not my fault that the class has no sense of humor.
Behavior Therapies
B.F. Skinner, Bandura, Dollard and Miller
Goal: unlearning maladaptive behavior and learning adaptive ones Systematic Desensitization – Joseph Wolpe
Aversion therapy
Classical conditioning Anxiety hierarchy Alcoholism, sexual deviance, smoking, etc.
Social skills training
Modeling - observing others Behavioral rehearsal – role playing social techniques
Aversion therapy. Aversion therapy uses classical conditioning to create an aversion to a stimulus that has elicited problematic behavior. For example, in the treatment of drinking problems, alcohol may be paired with a nausea-inducing drug to create an aversion to drinking.
Behavioral Therapy Flooding
Biomedical Therapies
Psychopharmacotherapy
Antianxiety - Valium, Xanax, Buspar - SSRI Antipsychotic - Thorazine, Mellaril, Haldol
Antidepressant:
Tricyclics – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft
Mood stabilizers
Tardive dyskinesia Clozapine
Lithium Valproic acid
Electroconvulsive therapy (ECT)