Abnormal PsychologyA.K.A. Psychological Disorders

Deviant, distressful, dysfunctional patterns of thoughts, feelings or

behaviors

Early Theories

• Abnormal behavior was caused by demon possession

• Led to harsh, ineffective remedial treatments– Trephining, beatings, burnings,

etc.

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.

History of Mental Disorders

• Biopsychosocial Model– current approach– Interaction of nature and nurture– Adds influence of culture and psych to

Medical model

Perspectives and DisordersPsychological

School/PerspectiveCause of the Disorder

Psychoanalytic/Psychodynamic Internal, unconscious drives

Humanistic Failure to strive to one’s potential or being out of touch with one’s feelings.

Behavioral Learning : classical or operant (rewards and punishments) conditioning, modeling

Cognitive Irrational, dysfunctional thoughts or ways of thinking.

Sociocultural Dysfunctional Society, family

Biomedical/Neuroscience Organic problems, biochemical imbalances, genetic predispositions.

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.

Classifying Psychological Disorders

Two Major Classifications in the DSM

Neurotic Disorders• Distressing but one

can still function in society and act rationally.

Psychotic Disorders• A mental state that

impairs thought, perception and judgment

John Wayne Gacy

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

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)

ADHD

• Assessing:– Eye Tracking device

• Gender:– 2-3X more in Boys

• Prevalence:– 4% of all children (10% US)

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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.

DID ControversyAGAINST

1. Could be extreme version of our capacity to vary the “selves” we present in different situation

2. Constructive memory – leading questions may lead to constructing false memories of childhood trauma

3. Role-playing (Spanos) of fantasy-prone patients in response to leading questions

4. Increase in DID in last 20 years (Outside US disorder is much less prevalent)

FOR1. Distinct brain and body

states associated with differing personalities

2. Heightened brain activity in areas associated with control and inhibition of traumatic memories

DID Causes

• Psychoanalytic – defense against anxiety caused by unacceptable impulses

• Learning – behaviors reinforced by anxiety reduction

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

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)

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

Suicide

• Risk highest when rebounding from depression

• Higher risk if abuse alcohol

• Social suggestion may trigger suicide

• Talk about suicide – attempt suicide – few succeed

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

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.

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.

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

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

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

Histrionic Personality Disorder

• Histrionic Personality Disorder – attention seeking behaviors

Narcissistic Personality Disorder

• Narcissistic Personality Disorder – self involvement/obsession with self

• Thinking that you are the center of the universe.

Schizoid Personality Disorder

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

Avoidant Personality Disorder

• Anxiety personality disorder

• Lifelong pattern of feeling very shy, inadequate, and fear social rejection.

Schizophrenic Disorders• Schizophrenia – meaning split mind and

characterized by1. Disorganized thinking.2. Disturbed Perceptions3. 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

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.

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”

Disturbed Perceptions

• hallucinations- sensory experiences without sensory stimulation.

• Example:– Hear voices saying

“You are bad and should burn yourself with a cigarette”

Inappropriate Emotions and Actions

• Laugh at inappropriate times.

• Flat Effect – no emotion

• Senseless, compulsive acts.

• Catatonia- remain motionless for hours

Positive v. Negative Symptoms

Positive Symptoms•Presence of inappropriate symptoms•Hallucinations, disorganized thoughts, delusion, inappropriate emotions

Negative Symptoms•Absence of appropriate ones.•Toneless voices, expressionless faces, mute, rigid bodies

Subtypes of Schizophrenia• Disorganized - disorganized

speech or behavior, or flat or inappropriate emotion.

• Paranoid – preoccupation with delusions or hallucinations, often with themes of persecution or grandiosity

• Catatonic – immobility, extreme negativism, parrot-like repeating of speech and movement

• Undifferentiated – many and varied symptoms

• Residual – Withdrawal after hallucinations and delusions have disappeared.

Causes of Schizophrenia• Brain Abnormalities

– Dopamine Hypothesis – excess dopamine receptors • May intensify brain signals creating positive symptoms

– Abnormal Brain Activity and Anatomy• Low brain activity in frontal lobes critical for planning and

reasoning• Out of synch neurons • Smaller thalamus (difficulty filtering info) and increased

activity (hallucinations)• Increased activity in amygdala (paranoia)• Enlarged fluid filled areas and shrinkage of cerebral tissue

Causes of Schizophrenia

–Maternal Virus during Pregnancy• Affects fetal brain development

– Flu epidemics increase risk– Born during winter and spring months after fall/winter

flu season have greater risk– Abnormal levels of anti-bodies

• Genetic Factors– 1 in 10 chance if sibling or parent has – 6 in 10 in identical twins

• Some genes influence the effects of dopamine• Some genes affect the production of myelin