Instructor: Kevin J. Armstrong, Ph.D.

◦Director, Clinical Psychology Training Program Associate Professor & Licensed Psychologist

◦Research areas: ADHD & externalizing disorders Validity issues in diagnosis, assessment, and

treatment

PSY 3213: Abnormal Psychology

◦ 1 in ___ adults suffer from diagnosable mental disorders in a given year 2003 2012 1. Anxiety Disorders 13.3% (18%) 2. Depressive disorders 9.5% (9.5%) 3. Addictive Disorders 6% * 4. Eating Disorders 2-5% ? 5. Schizophrenia 1.1% (1.1%)

(Numbers from NIMH web page, 2003 & 2012)

Adults: __% in 2003, __% in 2012

A recent study by the World Health Organization, the World Bank, and Harvard University

Mental disorders account for ___ of the 10 leading causes of disability in established market economies worldwide. major depression manic-depressive illness schizophrenia, and obsessive-compulsive disorder.

Other research has estimated that the cost of mental illnesses in the

United States, including indirect costs such as days lost from work,

was _______billion in 1990, the last time the total bill was measured. NIMH (1999). http://www.nimh.nih.gov/publicat/numbers.cfm

Are mental illnesses costly to society?

For women: ◦More _________________ and _________________ disorders

For men: ◦More _________________ _________________

_________________ _________________

Diagnoses differ

Chapter 1: Introduction and Historical Review

I. Introduction to the Study of Mental Disorders

II. History of Psychopathology

III. The Evolution of Contemporary Thought

IV. The Mental Health Professions

Chapter Outline

Study of the nature, development, and treatment of psychological disorders

Challenges to the study of psychopathology:

◦ Maintain objectivity

◦ Avoid preconceived notions

◦ Reduce stigma

Psychopathology

Personal _________________◦ Emotional pain and suffering

Helplessness and hopelessness of depression

_________________◦ Impairment in a key area (e.g., work, relationships)

Chronic substance abuse results in job loss

Violation of Social _________________◦ Makes others uncomfortable or causes problems

Antisocial behavior of the psychopath

_________________◦ Wakefield's Harmful Dysfunction: failure of internal

mechanisms in the mind to function properly

Defining Mental Disorder

◦Can the person, given the behavior pattern in question, meet their life demands?

keep job/stay in school maintain reasonable relationships with family/friends pay bills on time, stay out of jail basically, can they handle their responsibilities

related to food, shelter, clothing, and transportation?

How I think about maladaptivenesss:

Early Demonology◦ Possession by evil beings or spirits

_________________

Early Biological Explanations◦ Hippocrates (5th century BC)

Mental disturbances have natural (not supernatural) causes (problems with the brain) Three categories of mental disorders: mania, melancholia, &

phrenitis (brain fever) Normal brain functioning depended on balance of four humors:

blood, black bile, yellow bile, & phlegm

History of Psychopathology

Dark Ages (2nd century AD)

◦ Monks cared and prayed for mentally ill

Witches (13th century AD)◦ _________________ sometimes led to bizarre delusional

sounding confessions, e.g., concourse with demons. Initially, historians concluded many of the accused were

mentally ill.

Further research found little support for this conclusion.

History of Psychopathology: Dark Ages

Lunacy Trials◦Trials held to determine sanity Began in 13th century England

◦_________________ authorities assumed responsibility for care of mentally ill

◦Lunacy attributes insanity to misalignment of moon (“luna”) and stars

History of Psychopathology: Lunacy Trials

Asylums (15th century AD)◦ Establishments for the confinement and care of mentally ill

◦ Priory of St. Mary of Bethlehem (founded in 1243) One of the first mental institutions

The wealthy _________________ to gape at the insane

Origin of the term _________________(wild uproar or confusion)

◦ Treatment non-existent or harmful at asylums Benjamin Rush recommended drawing copious amounts of

blood, to relieve brain pressure

History of Psychopathology: Asylums

Philippe _________________(1745-1826)

◦ Pioneered _________________ treatment at LaBicetre

Moral Treatment◦ Small, privately funded, humanitarian mental hospitals

Friends Asylum (1817) Patients engaged in purposeful, calming activities

(e.g., gardening) Talked with attendants

History of Psychopathology:Pinel’s Reforms and Moral Treatment

Dorothea Dix Crusader for prisoners and mentally ill

◦ Urged improvement of _________________

◦ Worked to establish 32 new, public hospitals

◦ Unfortunately, small staffs at these new public hospitals could not provide necessary individual attention

◦ Hospitals administered by physicians, who were more

interested in _________________ rather than psychological aspects of mental illness

History of Psychopathology: Dorothea Dix(1802-1887)

General paresis and _________________◦ Degenerative disorder with psychological symptoms

(delusions of grandeur) and physical symptoms (progressive paralysis)

◦ By mid-1800’s, it was known that general paresis and syphilis occurred together in some patients

◦ In 1905, biological cause of syphilis found◦ Since general paresis had biological cause, other mental illness

might also

_________________ causes of psychopathology gained credibility

The Evolution of Contemporary Thought: Biological Approaches

Galton’s (1822-1911) work lead to notion that mental illness can be inherited

◦ Nature (genetics) and _________________(environment)

◦ _________________ Promotion of enforced sterilization to eliminate

undesirable characteristics from the population

Many state laws required mentally ill to be sterilized

The Evolution of Contemporary Thought : Genetics

Insulin-coma therapy ◦Sakel (1930’s)

Electroconvulsive Therapy (___________)◦Cerletti and Bini (1938)◦Induce epileptic seizures with electric shock

Prefrontal lobotomy◦Moniz (1935)◦Often used to control violent behaviors; led to

listlessness, apathy, and loss of cognitive abilities

Early Biological Treatments

Mesmer (1734-1815)◦ Treated patients with hysteria using “animal magnetism”◦ Early practitioner of hypnosis (started with iron rods in

bathtubs, found he didn’t need them…)

Charcot (1825-1893)◦ His support _________________ hypnosis as treatment for hysteria

Breuer (1842-1925)◦ Used hypnosis to facilitate catharsis in Anna O. ◦ Cathartic Method

Release of emotional tension triggered by reliving and talking about event

The Evolution of Contemporary Thought:Psychological Approaches

Breuer and Freud (1856-1939) jointly publish, “Studies in Hysteria” in 1895, which serves as the basis for Freud’s theory.

Freudian or Psychoanalytic theory

◦ Human behavior determined by _________________ forces.

◦ Psychopathology results from _________________ among these unconscious forces.

Freud

Id Unconscious _________________ principle

Immediate gratification Libido

Energy of ID

Ego Primarily conscious _________________ principle

Attempt to satisfy ID’s demands within reality’s constraints Superego

The ____________________ Develops as we incorporate parental and society values

Freud’s Structures of the Mind

Id, Ego, & Superego continually in conflict

◦ Conflict generates _________________

◦ Ego generates _________________ to protect itself from anxiety Defense mechanisms (see next slide)

Psychological maneuvers used to manage stress & anxiety

Defense Mechanisms

Goals of Psychoanalytic Therapy or Psychoanalysis◦ Understand early-childhood experiences, particularly key

(parental) relationships◦ Understand patterns in current relationships

Psychoanalytic Techniques◦ Free Association◦ Analysis of Transference◦ Interpretation

Psychoanalytic Therapy

Jung (1875-1961)◦Analytical psychology

◦Collective unconscious Archetypes

◦Catalogued personality characteristics

_________________ vs. _________________

Adler (1870-1937)◦ Individual psychology

Fulfillment derived from working for the _________________ good

Neo-Freudians

Childhood experiences help shape adult personality

There are _________________ influences on behavior

The causes and purposes of human behavior are

not always _________________

Continuing Influences of Freud and His Followers

John Watson (1878-1958)

Behaviorism◦ Focus on _________________ behavior◦ Emphasis on _________________ rather than thinking or

innate tendencies

Three types of learning:◦ Classical Conditioning◦ Operant Conditioning◦ Modeling

The Evolution of Contemporary Thought: Rise of Behaviorism

Discovered by Pavlov (1849-1936)◦ Unconditioned Stimulus (UCS)

Meat powder (automatically elicits salivation)◦ Unconditioned Response (UR)

Salivation (automatic response to meat powder)◦ Neutral Stimulus (NS)

Initial ringing of bell (does not automatically elicit salivation)◦ Conditioned Stimulus (CS)

After pairing the NS and the UCS, the NS becomes a CS (bell now automatically elicits salivation)

◦ Conditioned Response (CR) Salivation (automatic response to bell)

◦ Extinction CS (bell) not followed by UCS (meat powder) causes gradual

disappearance of CR (salivation)

Classical Conditioning

© 2012 John Wiley & Sons, Inc. All rights reserved.

Figure 1.3: The process of classical conditioning

E. Thorndike (1874-1949)◦ Learning through consequences

◦ Law of _________________ Behavior that is followed by satisfying consequences will be repeated;

behavior that is followed by unpleasant consequences will be discouraged

B.F. Skinner (1904-1990)

◦ Principle of _________________

Positive reinforcement Behaviors followed by pleasant stimuli are strengthened

Negative reinforcement Behaviors that terminate a negative stimulus are strengthened

Operant Conditioning

Learning by watching and imitating others’ behaviors

◦ Can occur _________________ reinforcement

Bandura & Menlove (1968)◦ Modeling reduced children’s fear of dogs

Modeling

Behavior Therapy or Behavior Modification

◦ Systematic _________________ Used to treat phobias and anxiety Combines deep muscle relaxation and gradual exposure

to the feared condition or object Starts with minimal anxiety producing condition and

gradually progresses to most feared

◦ _________________ Reinforcement Rewarding a behavior only occasionally more effective

than continuous schedules of reinforcement

Behavior Therapy

Limitations of Behavior Therapy◦ How we think or appraise a situation influences our feelings and

behaviors

Cognitive Therapy◦ Emphasize how people think about themselves and their

experiences can be a major _________________ of psychopathology

◦ Focus on understanding maladaptive thoughts

◦ Change _________________ to change feelings and behaviors

Ellis (1913-2007)◦ REBT (Rational-Emotive Behavior Therapy)

Importance of Cognitions

Psychologists◦ Clinical or Counseling; Ph. D. or Psy. D.◦ Some states allow specially trained psychologists to prescribe psychotropic

medications

Psychiatrists◦ M.D.’s can prescribe psychotropic medications

Psychiatric Nurses & Psychiatric Nurse Practitioners◦ Nurse Practitioners can prescribe psychotropic medications

Social Workers◦ M.S.W.◦ Not trained in psychological assessment

Master’s Level Therapists & Counselors◦ MFT’s (Marriage and Family Therapists)

Mental Health Professions