Abnormal Psych

APColley 2009

Classifying Psychological Disorders

• Psychological Disorder:– A “harmful dysfunction” in which behavior is judged

to be atypical, disturbing, maladaptive, and unjustifiable

– Neurotic Disorder: A psychological disorder that is usually distressing, but that allows one to think rationally and function socially

– Psychotic Disorder: A psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions

Psychopath v Sociopath• The traits of the psychopath and sociopath are largely similar. • Both psychopaths and sociopaths have a complete disregard for the

feelings and rights of others. – This often surfaces by age 15 and may be accompanied by cruelty to

animals. – These traits are distinct and repetitive, creating a pattern of

misbehavior that goes beyond normal adolescent mischief.• Both the psychopath and sociopath fail to feel remorse or guilt. • They appear to lack a conscience and are completely self-serving. • They routinely disregard rules, social mores and laws, unmindful of putting

themselves or others at risk.

Psychopath v Sociopath

• Sociopath: Some argue the sociopath to be less organized in his or her demeanor, nervous and easily agitated – someone likely living on the fringes of society, without solid or consistent economic support. – A sociopath is more likely to

spontaneously act out in inappropriate ways without thinking through the consequences.

• Psychopath: Some argue that the psychopath tends to be extremely organized, secretive and manipulative. – The outer personality is often

charismatic and charming, hiding the real person beneath.

– Though psychopaths do not feel for others, they can mimic behaviors that make them appear normal.

– Upon meeting, one would have more of a tendency to trust a psychopath than a sociopath.

Psychopath v Sociopath

• Sociopath– Less educated; most likely

due to inability to focus or lack of attention

– Unlikely to have a family or a steady job

– Lacks the skills and drive to mimic normal behavior

– More apt to leave ample evidence in their explosions of violence

• Psychopath– Might be better

educated– Can fly under the radar

due to their ability to maintain families and steady work

– Crimes are well planned out and organized

– Harder to catch

Classifying Psychological Disorders

• DSM-IV: The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)– Contains 17 major categories of “mental disorder”– Describes the disorders and their symptoms– Does not mention causes

• Most health insurance policies require a DSM-IV diagnosis before they will pay for therapy

Methods of Diagnosis

• Medical Model of Diagnosis and Treatment:– The concept that diseases have physical causes that can

be diagnosed, treated, and, in most cases, cured. – “Mental illnesses” can be diagnosed on the basis of

their symptoms and cured through therapy, which may include treatment in a psychiatric hospital.

• Bio-Psycho-Social Perspective:– A contemporary perspective which assumes that

biological, psychological, an socio-cultural factors combine and interact to produce psychological disorders.

Labeling

• Once we label a person, we view that person differently– Rosenhan demonstration of diagnostic labeling– Labels can create preconceptions that unfairly

stigmatize people and bias our perceptions of their past and present behavior

Anxiety Disorders

• Psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety

• Generalized Anxiety Disorder: An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal (on edge)

• May cause twitching, fidgeting, perspiration, and trembling• Concentration is very difficult• Worst characteristic is that the person cannot identify the cause of

the anxiety• “Free-floating” anxiety

Anxiety Disorders

• Panic Disorder: An anxiety disorder marked by a minutes-long episode of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations– It strikes suddenly, wreaks havoc, and disappears– 1 in 75 people suffer from this disorder

• Typically misperceived as a heart attack

– People can develop a fear of the panic disorder, thereby developing a panic disorder based on the fear of having another attack

Anxiety Disorders

• Agoraphobia: fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes

• People avoid being outside the home, being in a crowd, being on a bus, or even on an elevator

Anxiety Disorders

• Phobias: An anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object or situation – Focus the anxiety on a specific object or situation– Common psychological disorder that many people

accept and live with• Some specific phobias are incapacitating

– Especially Social phobias» An intense fear of being scrutinized by others

– These people will avoid social situations, speaking up, eating out, going to parties, etc

– Shyness taken to an extreme

Anxiety Disorders

• Obsessive-Compulsive Disorder: An anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)– Common Obsessions and Compulsions

• Obsessions:– Concern dirt, germs, toxins– Something terrible happening (Death, fire, illness)– Symmetry, order, or exactness

• Compulsions:– Excessive hand washing, bathing, tooth brushing, or grooming– Repeating rituals (in/out of a door, up/down from a chair)– Checking doors, locks, appliances, car brake, homework

Treatments

• Treatments– Behavior Therapy– Medication– Relaxation techniques– Hypnotherapy– Acupuncture

Explaining Anxiety

• Learning Perspective• Fear Conditioning

– When bad events happen unpredictably and uncontrollably, anxiety often develops

– Link between general anxiety and the classical conditioning of fear• Victims of post-traumatic stress disorder feel a swell of anxiety with

any reminder of their trauma• Possible explanation for why anxious people are hyper-attentive to

possible threats and how panic-prone people come to associate anxiety with certain cues

– 58% of people with a social phobia experienced their disorder after a traumatic event

Explaining Anxiety

• Stimulus Generalization– Conditioned fears may remain long after we have forgotten the

experiences that produced them– Some fears arise from stimulus generalization

• Person who fears heights may be afraid of airplanes without ever having flown

• Reinforcement– Helps to maintain phobias and compulsions– Avoiding the feared situation reduces anxiety, thus reinforcing the

phobic behavior– Compulsive behaviors reduce anxiety as well

• Observational Learning– Learn fear through observing others’ fears

Mood Disorders

• Mood disorders come in two principal forms:– Major Depressive Disorder• Person experiences prolonged hopelessness and

lethargy until usually rebounding to normality

– Bipolar Disorder (formally known as manic depressive disorder)• Person alternates between depression and mania (an

overexcited, hyperactive state)

Mood Disorders

• Major Depressive Disorder:– A mood disorder in which a person, for no

apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities• Depression is the #1 reason why people seek mental

health services

– Leading cause of disability worldwide– Depression is often a response to past and current

loss

Depression

• A sort of psychic hibernation– It slows us down– We temporarily grind to a halt and ruminate

• Reassess one’s life when we are feeling threatened

• Line between normal “downs” and major depression is blurry• Difference between a blue mood and a mood disorder is like

the difference between gasping for breath for a few minutes and constantly being short of breath

• With or without therapy, episodes of major depression usually end and people temporarily or permanently return to their previous behavior patterns

Mood Disorders

• Dysthymic Disorder– A down-in-the-dumps mood that fills most of the

day, almost every day, for two years or more• People experience chronic low energy and self-esteem• Difficulty concentrating or making decisions• Sleep and eat too much or too little

Mood Disorders

• Bipolar Disorder: – A mood disorder in which the person alternates between the

hopelessness and lethargy of depression and the overexcited state of mania

• Manic Episode:• A mood disorder marked by a hyperactive, wildly optimistic state• Overtalkative, overactive, elated• Has little need for sleep• Shows fewer sexual inhibitions

– Experience grandiose optimism– Can lead to reckless behaviors– But, can also fuel creativity and energy

» Walt Whitman, Ernest Hemingway, Margot Kidder all had bipolar disorder

Explaining Mood Disorders• Five facts that any theory of depression must explain

– Many behavioral and cognitive changes accompany depression• Sensitive to negative happenings, expect negative outcomes, etc• Nearly half the time depressed people exhibit symptoms of another disorder

– Depression is widespread• Causes must be common then

– Women are twice as vulnerable to major depression, even more so if they have been depressed before• Women are most vulnerable to passive disorders• When women get sad, they get sadder than men do

– Most major depressive episodes self-terminate• Most people return to normal without professional help

– Stressful events related to work, marriage, and close relationships often precede depression

Explaining Mood Disorders

• The Biological Perspective• Depression is a whole body disorder• Involves genetic predispositions, biochemical

imbalances, melancholy mood, and negative thoughts– Genetic Influences

• Mood disorders run in families• Risk increases if you have a parent or sibling who suffers from

depression (bipolar disorder)• 15 groups worldwide are searching the genes that make one

vulnerable to bipolar disorder– Linkage analysis

The Depressed Brain

• The Depressed Brain– Genes act by directing biochemical events that

influence behavior– Biochemical key is neurotransmitters

• Norepinephrine increases arousal and boosts mood– Overabundant during mania, but scarce during depression

• Serotonin is also scarce during depression– Drugs that relieve depression increase norepinephrine or serotonin

by blocking either their reuptake or chemical breakdown

• Left frontal lobe is likely to be inactive in depressed states– MRI’s have shown frontal lobes to be 7% smaller in severely

depressed patients

Mood Disorders

• Vicious Cycle of Depression• Negative, stressful events are interpreted

through…• A pessimistic explanatory style, which creates…• A hopeless, depressed state that…• Hampers the way the person thinks and acts,

which, in turn, fuels…• More negative experiences (back at step 1)

Dissociative Disorders

• Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings– Most intriguing and rare disorders• In which a person appears to experience a sudden loss

of memory or change in identity

Dissociative Disorders

• Dissociative Identity Disorder– A rare dissociative disorder in which a person

exhibits two or more distinct and alternating personalities.• Also known as multiple personality disorder

– A person with this disorder may be prim and proper one moment, and loud and flirtatious the next• Each personality has its own voice and mannerisms• Original personality typically denies awareness of the

other(s) existence

Dissociative Disorders

• Criticism of the disorder’s existence is quite loud– The average number of cases per decade was 2 between

the 1930’s and 1960’s– Rocketed to 20,000 in the 1980’s

• “The Three Faces of Eve” and “Sybil” were movies that depicted multiple personalities and came out in the 1980s

– The diagnosis is rare in Britain and virtually nonexistent in India and Japan

• Often seen as a way of dealing with anxiety– Defenses against anxiety caused by unacceptable

impulses

Schizophrenia

• A group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions– Literally means “split mind”

• Split from reality

Schizophrenia• Disorganized Thinking

– The thinking of a person with schizophrenia is fragmented, bizarre, and distorted by false beliefs • Delusions: False beliefs, often of persecution or grandeur• Often accompany psychotic disorders

– Schizophrenics cannot give undivided attention to anything– Easily distracted

• Disturbed Perceptions– A person with schizophrenia may perceive things that are not there

• Hallucinations– Sensory experiences without sensory stimulation– Usually auditory (hearing voices)

» May make insulting comments or give orders

• When the unreal seems real, the resulting perceptions are at best bizarre, at worst terrifying

Schizophrenia

• Inappropriate Emotions and Actions– Emotions of schizophrenia are often utterly

inappropriate• Laughing while recalling death, crying when others laugh,

becoming angry for no apparent reason, etc

– Other victims may lapse into flat affect• Zombie-like state of apathy

– Motor behavior may also be inappropriate• Rocking, rubbing, senseless compulsive acts• Catatonia

– May remain motionless for hours on end and then become agitated

Subtypes of Schizophrenia

• Schizophrenia is actually a cluster of disorders– Patients with positive symptoms may experience hallucinations,

are often disorganized, may exhibit inappropriate laughter, tears, or rage

– Patients with negative symptoms have toneless voices, expressionless faces, rigid and mute bodies

• Chronic Schizophrenia– Slow-developing process– Recovery is doubtful

• Acute Schizophrenia– Developed rapidly out of the blue, recovery is much more likely

Subtypes of Schizophrenia• Paranoid Schizophrenia

– Preoccupation with delusions or hallucinations– Often with themes of persecution or grandiosity

• Disorganized Schizophrenia– Disorganized speech or behavior, OR– Flat or inappropriate emotion

• Catatonic Schizophrenia– Immobility, extreme negativism, and/or parrot-like repeating of another’s

speech or movements• Undifferentiated Schizophrenia

– Many and widely varied symptoms• Residual Schizophrenia

– Withdrawal, after hallucinations and delusions have disappeared

Understanding Schizophrenia

• Brain Abnormalities– Dopamine Overactivity• One key to schizophrenia involves the neurotransmitter

dopamine• Sixfold excess of dopamine receptors have been found

in the brains of deceased schizophrenic patients– Speculate that such a high level may intensify brain signals,

creating positive symptoms

• Drugs that block the receptors, often limit the symptoms– Have little effect on persist negative symptoms

Understanding Schizophrenia

• Brain Anatomy– Many people with chronic schizophrenia have

abnormal brain activity• Some have abnormally low brain activity in the frontal

lobes• Many studies have found enlarged, fluid-filled areas and

a shrinkage of cerebral tissue in schizophrenic patients• Studies have also shown the thalamus to be smaller-

than-normal in schizophrenics– May explain why patients have a difficulty filtering sensory

input and focusing attention

Understanding Schizophrenia

• Schizophrenia involves not a single brain abnormality, but problems in several regions and their interconnections– One possible cause is low birth weight and oxygen deprivation– Another possible cause is mid-pregnancy viral infection that

impairs fetal brain development– People are at an increased risk of schizophrenia if…

• during the middle of their development, their country experiences a flu epidemic

• Born in densely populated areas where viral diseases spread more easily• Born during the winter and spring months, after the fall-winter flu season• A child’s mother is sick with the flu during pregnancy• During pregnancy, your mother is fighting some sort of virus

Understanding Schizophrenia

• Genetic Factors– Odds are 1 in 10 that one will be diagnosed with

schizophrenia if a sibling or parent is afflicted (1 in 100 otherwise)• 1 in 2 if that person is an identical twin

– Researchers have yet to find the specific genes that might predispose someone to having schizophrenia-inducing brain abnormalities

Personality Disorders

• Psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning– Avoidant personality disorders

• Cluster of disorders that express anxiety– Ex. Fearful sensitivity to rejection that predisposes a withdrawn behavior

– Schizoid personality disorders• Expresses eccentric behaviors

– Histrionic personality disorders• Exhibits dramatic or impulsive behaviors

– Displays shallow, attention-getting emotions and go to great lengths to gain others’ praise and reassurance

Personality Disorders

• Narcissistic personality disorders– Exaggerate your own importance• Aided by success fantasies• Find criticism harder to accept, often reacting with rage

or shame

• Borderline personality disorder– Have an unstable identity, unstable relationships,

and unstable emotions

Personality Disorders

• Antisocial personality disorder– Disorder in which the person (usually a man) exhibits a

lack of conscience for wrongdoing, even toward friends and family

– May be aggressive and ruthless or a clever con artist– The most troubling of impulsive personality disorders

• Formerly called a sociopath or psychopath• Around 15 or so years old, begin to lie, steal fight, have

unrestrained sexual urges– Combine with a keen intelligence and the results can be horrifying

• Feel little and fear little

Personality Disorders

• Antisocial personality disorder is composed of both biological and psychological factors– Biological relatives of certain individuals are at increased

risk for antisocial behavior• Genetic vulnerability appears as a fearless approach to life• Show little autonomic nervous system arousal to aversive events

– React with lower levels of stress hormones than do others of their age (as children)

• If channeled in a more productive direction, this may lead to courageous heroism, adventurism, or star-level athleticism– However, lacking a feeling of social responsibility may produce a con

artist or killer

Treatments

• Antipsychotic Drugs– The revolution in drug therapy began with the accidental

discovery of drugs that calmed psychotic patients• Chlorpromazine (Thorazine) dampens responsiveness to

irrelevant stimuli– Can produce sluggishness, tremors, and twitches

» Twitches are similar to those of Parkinson’s disease patients

• Provide the most help to schizophrenia patients experiencing positive symptoms– Not as much of a help to patients with negative symptoms– Clozapine (Clozaril) has been sometimes shown to enable

“awakenings” in some patients

Treatments

• Anti-anxiety Drugs– Xanax and Valium depress the central nervous system

activity • Like alcohol

– Used in combination with other therapy, these drugs can help a person learn to cop with frightening situations and fear-triggering stimuli

– Criticism is that these drugs reduce symptoms without resolving underlying problems• People can develop a psychological dependence on the

drugs

Treatments

• Antidepressant Drugs– Sometimes lift people from a state of depression– Most work by increasing the availability of the

neurotransmitters norepinephrine or serotonin• Elevates arousal and mood

– Fluoxetine (Prozac) partially blocks the re-absorption and removal of serotonin from synapses• Prozac, Paxil, and Zoloft all do this• Known as selective-serotonin-reuptake-inhibitor drugs

(SSRI’s) – One side effect is decreased sexual appetite

Treatments

• Other antidepressants block the re-absorption of both norepinephrine and serotonin or by blocking the enzyme that breaks down serotonin– Have more potential side effects• Dry mouth, weight gain, hypertension, dizzy spells

• The full effects of these drugs often takes about four weeks