Chapter 10Abnormal Psychology

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Topics to Explore

1. Defining & Classifying Disorders

2. Three Categories of Disorders

3. Treatment of Mental Disorders

Part 1Defining & Classifying

Mental Disorders

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Abnormal Psychology: the scientific study of mental

disorders and their treatment

What is Abnormal Psychology?

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Subjective Discomfort: Feelings of anxiety, depression, or emotional distress. But people we would consider definitely abnormal may not feel subjective discomfort.

Social Nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior. But it doesn’t always. Is being a nonconformist always a disorder? 1984!

Statistical Abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depression. But having a numerically rare characteristic isn’t always a disorder (e.g., having an IQ of 180)

Ways of Defining “Abnormal”

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Statistically Abnormal

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Situational Context: Social situation, behavioral setting, or general circumstances in which an action takes place

Is it normal to walk around strangers naked? If you are in a locker room and in the shower area, yes!

Cultural Relativity: Judgments are made relative to the values of one’s culture

Two Considerations

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Maladaptive Behavior: Behavior that makes it difficult to function, to adapt to the environment, and to meet everyday demands

Significant impairment in psychological functioning: Those with mental illness lose the ability to control thoughts, behaviors, or feelings adequately

Atypical behavior: behavior that is not typical of the majority of the population

Three Criteria for Abnormality

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DSM-IV

DSM-IV: Diagnostic and Statistical Manual of Mental Disorders.

Published by the American Psychiatric Association.

Provides a classification system of mental disorders.

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Some DSM-IV Categories

• Mood Disorders

• Anxiety Disorders

• Somatoform Disorders

• Factitious Disorders

• Dissociative Disorders

• Sexual & Gender Identity Disorders

• Eating Disorders

• Sleep Disorders

• Adjustment Disorders

• Personality Disorders

• Disorders First Diagnosed in Childhood

• Organic Mental Disorders

• Substance Related Disorders

• Schizoprenia Disorders

• Paranoid Disorders

• Impulse Control Disorders

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Social Conditions: Poverty, homelessness, overcrowding, stressful living conditions

Family Factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problems

Psychological Factors: Low intelligence, stress, learning disorders

Biological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability

General Risk Factors for Mental Illness

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Incidence of Mental Disorders

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Insanity: A legal term; refers to an inability to manage one’s affairs or to be aware of the consequences of one’s actions

• Those judged insane (by a court of law) are not held legally accountable for their actions

• Can be involuntarily committed to a psychiatric hospital

• Some movements today are trying to abolish the insanity plea and defense; desire to make everyone accountable for their actions

Neurosis: Archaic; once used to refer to excessive anxiety, somatoform, dissociative disorders, and some kinds of depression

Clarifying Some Terms

Part 2Three Major Categories

of Mental Disorders

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Anxiety: Feelings of apprehension, dread, or uneasiness

Anxiety Disorder: a disorder in which excessive anxiety leads to personal distress and atypical, maladaptive, and irrational behavior

Anxiety Disorders

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Specific Phobias: Irrational, persistent fears, anxiety, and avoidance that focus on specific objects, activities, or situations

People with phobias realize that their fears are unreasonable and excessive, but they cannot control them

Specific Phobias

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Social Phobia: Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public)

Those with social phobia avoid social situations, such as eating, writing, or speaking in public.

Social phobias impair functioning at work, at school, and in personal relationships.

Estimate that 13% of all adults affected by social phobias at some time. Examples: Barbra Streisand, Woody Allen perhaps?

Social Phobia

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Agoraphobia: Intense, irrational fear that a panic attack will occur in a public place or in an unfamiliar situation

• Intense fear of leaving the house or entering unfamiliar situations

• Can be very crippling

• Literally means fear of open places or market (agora)

• Can occur with or without accompany panic disorder.

Agoraphobia

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Panic Disorder: A chronic state of anxiety with brief moments of sudden, intense, unexpected panic (panic attack)

Panic Attack: Feels like one is having a heart attack, going to die, or is going insane. Symptoms include vertigo, chest pain, choking, fear of losing control

Panic Disorder

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Generalized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety

Symptoms: sweating, racing heart, clammy hands, dizziness, upset stomach, rapid breathing, irritability, poor concentration.

More common in women than in men.

Generalized Anxiety Disorder

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Obsessive-Compulsive Disorder (OCD): Extreme preoccupation with certain thoughts and compulsive performance of certain behaviors

Obsession: Recurring images or thoughts that a person cannot prevent.

• Cause anxiety and extreme discomfort

• Enter into consciousness against the person’s will

•Most common: Being dirty, wondering if you performed an action (turned off the stove), or worrying about violence (being hit by a car)

Compulsion: Irrational acts that person feels compelled to repeat against his/her will

•Help to control anxiety created by obsessions

•Most compulsions involve either checking or cleaning something.

Obsessive-Compulsive Disorder

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Mood Disorders: Major disturbances in emotion, such as depression or mania

Depressive Disorders: Sadness or despondency that are prolonged, exaggerated, or unreasonable

Bipolar Disorders: Involve both depression and mania or hypomania

Mood Disorders

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Maternity Blues: Mild depression that lasts for one to two days after childbirth

•Marked by crying, fitful sleep, tension, anger, and irritability

•Brief and not too severe

Postpartum Depression: Moderately severe depression that begins within three months following childbirth

•Marked by mood swings, despondency, feelings of inadequacy, and an inability to cope with the new baby

•May last from two months to one year

•Part of the problem may be hormonal

Childbirth-related Mood Disorders

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Psychosis: Loss of contact with shared views of reality

Delusions: False beliefs that psychotic individuals insist are true, regardless of overwhelming evidence against them

Hallucinations: Imaginary sensations, such as seeing, hearing, or smelling things that do not exist in the real world

•Most common psychotic hallucination is hearing voices

•Note that olfactory hallucinations sometimes occur with seizure disorder (epilepsy)

Psychotic Disorders

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Flat Affect: Lack of emotional responsiveness; face is frozen in blank expression

Disturbed Verbal Communication: Garbled and chaotic speech; word salad

Personality Disintegration: Uncoordinated thoughts, actions, and emotions

Other Psychotic Symptoms

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The Mad Hatter

In Lewis Carroll’s time, hatmakers were heavily exposed to mercury used in making felt. Many suffered brain damage and became psychotic; thus, the Mad Hatter.

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Schizophrenia: Psychotic disorder characterized by hallucinations, delusions, apathy, thinking abnormalities, and “split” between thoughts and emotions

Does NOT refer to having split or multiple personalities

Schizophrenia: The Most Severe Disorder

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Disorganized Type: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or inappropriate emotions

Catatonic Type: Marked by stupor, unresponsiveness, posturing, and mutism

Paranoid Type: Preoccupation with delusions; also involves hallucinations that are related to a single theme, especially grandeur or persecution

Undifferentiated Type: Any type of schizophrenia that does not have paranoid, catatonic, or disorganized features or symptoms

Four Types of Schizophrenia

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Psychological Trauma: Psychological injury or shock, often caused by violence, abuse, or neglect

Disturbed Family Environment: Stressful or unhealthy family relationships, communication patterns, and emotional atmosphere

Deviant Communication Patterns: Cause guilt, anxiety, anger, confusion, and turmoil

Stress-Vulnerability Hypothesis: Combination of environmental stress and inherited susceptibility cause schizophrenic disorders

Causes of Schizophrenia

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Biochemical Abnormality: Disturbance in brain’s chemical systems or in the brain’s neurotransmitters

Dopamine: Neurotransmitter involved with emotions and muscle movement. Works in limbic system

Dopamine overactivity in brain may be related to schizophrenia

Biochemical Causes

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Genetic Predisposition

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PET Scans of Normal & Schizophrenic Brains

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Schizophrenic Patients 10 Years Later

Part 3Treatment of Mental Disorders

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Types of Therapists

• Clinical psychologist: has doctoral degree in clinical psychology; provides therapy for people with mental disorders

• Counseling psychologist: has doctoral degree in psychological or educational counseling; counsels people with milder problems

• Psychiatrist: has medical degree with residency in mental health, provides therapy for people with mental disorders and is only type of therapist who can prescribe drugs or other biomedical treatment

• Psychoanalyst: Any of the above types of credential, but with training in psychoanalysis from a psychoanalytic institute

• Clinical social worker: has master’s or doctoral degree in social work with specialized training in counseling; provides help with social problems, such as family problems.

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Biomedical Therapies

Biomedical therapies: medical treatment for mental disorders; includes drug therapy and medical procedures treating the brain

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Pharmacotherapy: Use of drugs to alleviate emotional disturbance; three classes:

Antianxiety (Minor Tranquilizers): Produce relaxation or reduce anxiety (Valium, Lithium, Zanax)

Antidepressants: Elevate mood and combat depression (Elavil, Paxil, Prozac, Zoloft)

Antipsychotics (Major Tranquilizers): Tranquilize and also reduce hallucinations and delusions in larger dosages (Thorazine, Clozaril)

Pharmacotherapy

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Problems with Drug Therapy

• There can be serious side-effects (tranquilizers can cause neurological disorders; Clozaril associated with a fatal blood disorder)

• Drugs do not cure the disorder; they only ameliorate the symptoms.

• Reliance on drugs increase belief in the “quick fix”; belief that any disorder can be cured with a pill.

• Generally, psychotherapy is needed in addition to medication.

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Electroconvulsive Therapy (ECT): Electric shock is passed through the brain inducing a convulsion.

• Based on belief that seizure alleviates depression by altering brain chemistry

• Used in treatment of depression

• Produces only temporary improvement

• Causes permanent memory loss in many patients

• Should only be used as a last resort

Shock Therapy

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Psychosurgery: Any surgical alteration of the brain

Prefrontal Lobotomy: Frontal lobes in brain are surgically cut from other brain areas

• Supposed to calm people who did not respond to other forms of treatment

• Was not very successful

Deep Lesioning: Small target areas in the brain are destroyed by using an electrode

Psychosurgery

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Psychotherapy: Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment;

Some types of psychotherapy:

Psychoanalysis: therapy based on Freud’s theory

Client-centered therapy: based on Humanism

Behavioral and Cognitive therapies

What is Psychotherapy?

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Main Goal of Psychoanalysis: To resolve internal conflicts that lead to emotional suffering

Free Association: Saying whatever comes to mind, regardless of how embarrassing it is. By doing so without censorship and censure, unconscious material can emerge

Dream Analysis: Dreams express forbidden desires and unconscious feelings

• Latent Content: Hidden, symbolic meaning of dreams

• Manifest Content: Obvious, visible meaning of dreams

• Dream Symbols: Images in dreams that have personal or emotional meanings

Psychoanalytic Techniques

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Analysis of Resistance: analysis of blockage in flow of ideas; topics the client resists thinking about or discussing. Resistances reveal particularly important unconscious conflicts

Analysis of Transference: analysis of tendency to transfer feelings to a therapist that match those the patient has for important people in his or her past. The patient might act like the therapist is a rejecting father, loving mother, etc.

Psychoanalytic Techniques, continued

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Client-Centered Therapy (Rogers): Nondirective and based on insights from conscious thoughts and feelings

Effective therapist must have four basic conditions

• Unconditional Positive Regard: Unshakable acceptance of another person, regardless of what they tell the therapist or how they feel

• Empathy: Ability to feel what another person is feeling; capacity to take another person’s point of view

• Authenticity: Ability of a therapist to be genuine and honest about his or her feelings

• Reflection: Rephrasing or repeating thoughts and feelings of the clients; helps clients become aware of what they are saying

Client-Centered (Humanistic) Therapies

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Existential Therapy: An insight therapy that focuses on

problems of existence, such as meaning, choice, and

responsibility; emphasizes making difficult choices in life

Therapy focuses on death, freedom, isolation, and

meaninglessness

Free Will: Human ability to make choices. You can choose to

be the person you want to be

Confrontation: Clients are challenged to examine their values

and choices

Humanistic Therapies

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Behavior Therapy: Use of learning principles to make constructive changes in behavior

Behavior Modification: Using any classical or operant conditioning principles to directly change human behavior

• Deep insight is often not necessary

• Focus on the present; cannot change the past, and no reason to alter that which has yet to occur

• Can also use classical conditioning techniques

Behavioral Therapies

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Aversion Therapy: Associate a strong aversion to an undesirable habit like smoking, overeating, drinking alcohol, or gambling

Flooding: client is exposed to feared object or situation.

Behavioral Therapies

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Systematic Desensitization: Guided reduction in fear, anxiety, or aversion; attained by approaching a feared stimulus gradually while maintaining relaxation

• Best used to treat phobias: intense, unrealistic fears

• Hierarchy: Rank-ordered series of steps, amounts, or degrees

• Reciprocal Inhibition: One emotional state is used to block another (e.g., impossible to be anxious and relaxed at the same time)

Behavioral Therapies

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Cognitive Therapy: Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions

Selective Perception: The tendency to screen out information with which we aren’t comfortable or what we do not consider relevant.

Overgeneralization: Allowing upsetting events to affect unrelated situations. :

Example: John makes a mistake while speaking in a meeting at work. He thinks to himself, "This always happens to me, I will never be any good in meetings." This defeating thought was an overgeneralization.

All-or-Nothing Thinking: Seeing objects and events as absolutely right or wrong, good or bad, and so on

Cognitive therapy is VERY effective in treating depression, shyness, and stress

Cognitive Therapy

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Rational Emotive Behavior Therapy (Albert Ellis): Attempts to change irrational beliefs that cause emotional problems

Common Sense: Activating Event Consequence (feelings, behavior)

Rational Emotive View:Activating Event Beliefs Consequence (feelings,

behavior)

Rational Emotive Therapy

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Rational Emotive Therapy