Chapter 14: Psychological Disorders What?s Abnormal? Lots of things affect behavior. Environmental culture A behavior MUST meet certain criteria before it?s abnormal FUNDEMENTALLY- your brain is not reacting normally to stimuli Characteristics of Abnormal Behavior Deviance: Statistical Behavior must be infrequent within a population Needs to be more than just infrequent Characteristics of Abnormal Behavior Deviance: Cultural Behavior must be infrequent within a population Needs to be more than just infrequent Characteristics of Abnormal Behavior Emotional Distress Despair & unhappiness This is what leads people to seek help But still not the whole picture Characteristics of Abnormal Behavior Dysfunction Impairment in functioning: Cognitive emotional Behavioral functioning Distinguishing Normal from Abnormal Behavior Case #1 Tom is uncomfortable riding escalators. As a result, Tom avoids using any escalator. ------------------------------------------------------ List the top four questions you would want to know about the case to evaluate the behavior Distinguishing Normal from Abnormal Behavior Case #2 Rachel has been caught urinating in the comer of her bedroom. Is her behavior abnormal? ------------------------------------------------------ List the top four questions you would want to know about the case to evaluate the behavior Medical Model Psych disorders ? Disease/ illness of the brain Can be treated /cured Classified in terms of symptons Includes tendency to pursue: New drug treatment Diagnosis and classification Study of biological brain pathology itself Abnormality As a Disease Is the Medical Model the Appropriate Way? Causes of mental illness often unclear Psycho problem are just failures to adjust Unlike physical illness Social and cultural contest of symptoms is important in defining psychological problem Insanity Under the Law Different Criteria for Recognizing What?s Abnormal Competency to Stand Trial Defendant cannot be put on trial if they are unaware of why they are being tried Insanity Under the Law Different Criteria for Recognizing What?s Abnormal Legally Insanity is the Inability to: Understand certain actions are wrong at time of a crime Have control over your action Insanity Under the Law Insanity Defense: Not guilty by reason of insanity (NGRI) Temporary insanity guilty by insane (GBI) Insanity Under the Law Public Perception: Insanity defense is common Only used in less than 1% usually not successful The Problem of Labeling Diagnostic Labeling Effects Labels can become self-fulfilling prophecies Attaches stigma to a person that is difficult to overcome The Problem of Labeling The Rosenhan Study (1973) Ss arrived at hospital faking auditory hallucinations & were admitted to psychiatric ward After admission, participants behaved normally All behaviors were seen as consistent with disorder Hospital stays ranged from a week to two month Eventually released with remission label The Problem of Labeling Remember the Lessons of Social Cognition Labeling makes it difficult to recognize normal behavior Will increase the like lihood what you will act in an abnormal way Classifying Psychological Disorders What is the DSM-IV-TR Diagnostic & Statistical Manual of Mental Disorders, 4th Edition - Text Revision Published by the American Psychiatric Association DSM-IV Used for diagnosis & classification of disorders Describes nature of each disorder in terms of age cultural and gender Describes manifestations of mental disorders DSM-IV Intended to give objective measurable criteria for diagnosing psych disorders that can be measured world wide Can be measured world wide DSM-IV Does not: suggest therapies or treatments discuss possible causes subscribe to any one theoretical approach Classifying Psychological Disorders Axes of the DSM-VI-TR Five rating axes (dimensions) that help classify clinical syndromes (disorders) Axis I - Clinical Disorders Axis II ? Personality Disorders Axis III - Axis IV - Axis V - DSM-IV ? Axis I Clinical disorders- Substance related disorders Psychotic disorders Mood Disorders Anxiety Disorders Eating disorders Anxiety A mood state characterized by: marked negative affect somatic symptoms of tension apprehensive anticipation of future danger/misfortune Expressed as subjective unease, worried behaviors, and / or physiological responses. Anxiety Disorders Normal & adaptive emotion future-oriented state that prepares you to take action moderate amounts Anxiety becomes problematic when experienced in excessive amounts interferences w/ areas of life functioning Anxiety Disorders Generalized Anxiety Disorder (GAD) worrying free-floating anxiety lasts for > 6 months No single source Anxiety Disorders Panic is an abrupt experience of intense fear and emotional discomfort physical symptoms: heart palpitation, chest pain, shortness of breath, dizziness Can be situationally bound: expected in given situation Can be unexpected: completely unanticipated Anxiety Specific Phobia: Extreme & irrational fear of a specific object or situation fear interferes with ability to function recognized as unreasonable 4 Subtypes : animal, situational, natural-environment & blood-injury-injection Classifying Psychological Disorders Anxiety Disorders Obsessive-Compulsive Disorder: persistent, uncontrollable thoughts (obsessions) compelling need to perform repetitive acts (compulsions) Intrusive thoughts / urges: contamination, aggressive impulse, somatic concerns Actions suppress thoughts & provide relief: hand washing, checking counting, praying Axis I- Somatoform Disorders Centered around the body & experiences of physical symptoms Excessive preoccupation w/ bodily functioning physiologically, person is not ill Axis I - Somatoform Disorders Hypochondriasis: Long-lasting preoccupation with idea that one has a serious disease, or illness based on misinterpretation of normal & ambiguous bodily reactions as life-threatening reassurance by professionals rarely has an impact over-focused attention on normal bodily sensations Axis I - Somatoform Disorders Somatization Disorder: Preoccupation w/ physical symptoms that have no physical cause focused on finding relief from specific symptoms do not focus on dying from a disease Axis I - Somatoform Disorders Impulsive & unable to inhibit behaviors that yield immediate rewards attention from doctors Axis I - Somatoform Disorders Conversion Disorder: Appearance of real physical or neurological problem that has no physical cause conditions are not intentionally faked symptoms can being & worsen with stressful events Axis I - Somatoform Disorders Usually involves either sensory malfunction or problem of voluntary motor activity Paralysis, numb extremities, inability to see or hear nothing is physiologically wrong!!! Axis I - Dissociative Disorders Characterized by separation of conscious awareness from thoughts & memory Detachment from Actions: not knowing what is being done or what was done Feeling of Detachment: from body, mind & outside world Axis I - Dissociative Disorders Dissociative Amnesia: Inability to remember important personal information or experiences Psychological in origin (not brain injury) General: unable to recall identity or family history Localized: forgetting specific trauma or stressful events Axis I - Dissociative Disorders Dissociative Fugue: Loss of personal identity flight from home or area of residence lasts several days, months or years Axis I - Dissociative Disorders Dissociative Fugue: recovery is typically sudden & complete no recollection of activities or identity assumed during episode Axis I - Dissociative Disorders Dissociative Identity Disorder: Individual alternates b/w what appear to be two or more distinct identities or personalities A.k.a multiple personality disorder Very Rare Axis I - Dissociative Disorders Recognized by DSM-IV, not all clinicians believe symptoms can be faked; others (optical changes) can?t causes unclear; related to sexual/physical abuse in childhood Axis I - Mood Disorders Prolonged, disabling disruptions in emotional state day-to-day thoughts, perceptions & behavior deep depression or combination of depression & euphoria Axis I - Mood Disorders Major Depressive Episode: 5 symptoms for 2 weeks depressed mood for most of the day Loss of interest in normal daily activities Significant weight change Change in activity level (daily fatigue/loss of energy) Negative self-concept (worthlessness; excessive guilt) Trouble concentrating or making decisions Suicidal thoughts Are more accurate Axis I - Mood Disorders Major Depressive Disorder: Occurrence of at least one major depressive episode over 6 month period perspective on life Can occur more than once in a lifetime Can be milder and less disruptive yet very persistent Axis I - Mood Disorders Bipolar Disorder: Mood disturbance shifts in two directions, from depression to manic state Manic State: hyperactive Talkative Decreased need for sleep Grandiose for at least a week Self-destructive behavior *such as spending sprees, risk-taking Axis I - Mood Disorders Suicide: mood disorder high risk group 3rd leading cause of death among adolescents Risk highest for white males Men are also more likely to be successful Axis I - Mood Disorders Risk factors for Suicide Include: prior suicide attempts Psychiatric disorders Expressing thoughts of suicide Impulsive behavior Recent stressful events Exposure to suicidality of others Axis I - Mood Disorders Being helpful to those threatening suicide: Be Direct: Talk openly & matter-of-factly about suicide Be Willing To Listen: Allow expressions of feelings Be Non-Judgmental: Don?t debate right or wrong of act Don?t lecture on the value of life. Get Involved: Show interest and support Don?t Be Sworn to Secrecy: Seek support. Axis I - Schizophrenia Characterized by fundamental disturbances in thought processes, emotion, and/or behavior Present for at least one month w/ 6 mos. Of clear signs Delusions Hallucinations Disorganized speech Disorganized behavior Axis I - Schizophrenia Positive Symptoms: observable expressions of behavior Caused by distortion of normal experiences ? delusions, hallucinations Axis I - schizophrenia Negative symptoms absence of behavior caused by Axis I - schizophrenia Disorganized symptoms: incoherent, jumbled behavior due to breakdown in organized experience schizophrenia Reduced activity in areas of the prefrontal cortex Abnormally small temporal or limbic regions Enlargement of cerebrospinal fluid ventricles Axis I - Schizophrenia Delusions as positive symptoms: Delusion of Grandeur: one has been chosen by destiny or that one is rich, titled, powerful, etc. Delusion of Persecution: one is being plotted against Axis I - Schizophrenia Hallucinations as positive symptoms: Auditory: hearing one?s internal thoughts as if they are coming from outside Visual: seeing things that are not/could not be there Axis I - Schizophrenia Affective flattening as a negative symptom: individual becomes unable to respond emotionally may also be accompanied by reduction or absence of speech and inability to experience pleasure Axis I - Schizophrenia Disorganized speech & catatonic symptoms: Person speaks tangentially in word salad and neologisms Person adopts and remains immobile in particular position for hours Axis II - Personality Disorders Enduring pattern of: - inner experience & behavior - deviates from culture manifested in cognition, affect, interpersonal Functioning & impulse control Pattern is inflexible & is pervasive across a broad range of personal & social situations Axis II - Personality Disorders Antisocial Personality Disorder: the rights of others are violated & social norms are disregarded criminals who repeatedly perpetrate illegal acts Violations committed: - lack of empathy, - amusement / the thrill Axis II - Personality Disorders Paranoid Personality Disorder: Characterized by pattern of excess & unjustified distrust or suspicion - belief that other?s motives are malevolent - assumes others are out to harm/trick them - doubt reliability & faithfulness of friends & associates Axis II - Personality Disorders Borderline personality- Inability to regulate emotions aggression Self-harm Substance abuse Unstable patterns of relationships with others Understanding Psychological Disorders Bio-Psycho-Social Perspective Several factors biological (brain physiology) cognitive (psychological) social (environmental) Understanding Psychological Disorders Biological Factors: Genetics & the Brain Neurotransmitter Imbalance: Biochemical interactions in the brain can be implicated in various disorders Dopamine excess ? schizophrenia Serotonin levels ? mood disorders Understanding Psychological Disorders Biological Factors: Genetics & the Brain Structural Problems: deviations in structures of brain may cause deviation of function Genetic abnormality: we inherit tendency & predisposition to behave in a certain way Understanding Psychological Disorders Biological Factors: Genetics & the Brain Genetic Abnormality: If you have a schizophrenic brother, sister, or parent ? 1 in 10 that you will be schizophrenic If you have schizophrenic twin, odds increase to 1 in 2 If you have a depressed or bi-polar twin then odds of mood disorder are 50% greater than normal Biological factors: genetics & the brain Don?t over-exaggerate bio cause *avoid 1. bio reductionism 2. premature conclusions 3. avoid simplistic approach Emphasis on biological ?causes? results in less focus on economic & societal contribution Understanding Psychological Disorders Biological Factors: Genetics & the Brain It is important do strike a balance and avoid the pitfalls of over-exaggerating biological causes Emphasis on biological ?causes? results in less focus on economic & societal contribution Understanding Psychological Disorders Cognitive Factors: Thoughts Maladaptive Attributions: Beliefs and thoughts that have no basis in reality anxiety about vague threats that don?t exist Perceptions of worthlessness despite success Understanding Psychological Disorders Cognitive Factors: Maladaptive Thoughts Depressed individuals may be prone to distorted attributions to events in their lives Internal Attribution: blaming failure on inner flaws Global Attribution: seeing failure as widespread Stable Attribution: seeing failure are long-lasting Understanding Psychological Disorders Cognitive Factors: Maladaptive Thoughts Learned Helplessness: Theory of depression that says prolonged exposure to failure may lead you to give up Understanding Psychological Disorders Environmental Factors: Learning Abnormality Role of Culture: Culture helps determine how abnormal behavior is expressed & perceived Swat Pukhtun (Pakistan): all men carry arms, are vigilant to defend their honor & trust no-one (including their wives, whom they lock up at home) China & Mylasia: Koro is a culture bound syndrome where anxiety surrounds sensation of penis or breasts retracting into the body Understanding Psychological Disorders Environmental Factors: Learning Abnormality Role of Culture India: amok is a trance syndrome characterized by outbursts of violent, homicidal behavior, once self induced by warriors prior to battle so as to fight with indiscriminant abandon & fearless rage Native American: shamanic ritual involves the healer going into a frenzy to channel spirits of animals & natural forces Understanding Psychological Disorders Environmental Factors: Learning Conditioning Disorders: Acquisition of abnormal behaviors through basic learning principles phobias learned by classical conditioning or observational learning Even though you may not remember the traumatic/fear-provoking event itself
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