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ABNORMAL BEHAVIOR Historical aspects of mental disorders The medical model What is abnormal behavior? 3 criteria Deviant Maladaptive Causing personal distress A continuum of normal/abnormal PREVALENCE, CAUSES, AND COURSE Epidemiology Prevalence Lifetime prevalence Diagnosis Etiology Prognosis PSYCHODIAGNOSIS: THE CLASSIFICATION OF DISORDERS American Psychiatric Association – published first taxonomy in 1952 Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV) Multiaxial system 5 axes or dimensions – F 14.3 Axis I – Clinical Syndromes Axis II – Personality Disorders or Developmental Disorders Axis III – General Medical Conditions Axis IV – Psychosocial and Environmental Problems Axis V – Global Assessment of Functioning DSM Figure 14.4 – Example multiaxial evaluation TWO MAJOR CLASSIFICATIONS IN THE DSM NEUROTIC DISORDERS PSYCHOTIC DISORDERS Distressing but one can still function in society and act rationally. Person loses contact with reality, experiences distorted perceptions. AXIS I CLINICAL SYNDROMES AND AXIS II PERSONALITY DISORDERS Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenic Disorders Eating Disorders Axis II – Personality Disorders CLINICAL SYNDROMES: ANXIETY DISORDERS Generalized anxiety disorder “free-floating anxiety” Phobic disorder Specific focus of fear Panic disorder and agoraphobia Physical symptoms of anxiety/leading to agoraphobia Obsessive compulsive disorder Obsessions Compulsions PTSD ETIOLOGY OF ANXIETY DISORDERS Biological factors Genetic predisposition, anxiety sensitivity GABA circuits in the brain Conditioning and learning Acquired through classical conditioning or observational learning Maintained through operant conditioning Cognitive factors Judgments of perceived threat Personality Neuroticism Stress A precipitator CLINICAL SYNDROMES: SOMATOFORM DISORDERS Somatization Disorder 1. Conversion Disorder 2. Hypochondriasis Etiology Reactive autonomic nervous system Personality factors Cognitive factors The sick role QUICK WRITE Ellie, a new student at Skinner High School, is determined to make friends. When she attends the first psychology club meeting she finds herself in the room with twenty strangers who seem to know each other well. She plans to attend a few more meetings before deciding whether she will join. A. Demonstrate how each of the following could HELP play a role in Ellie’s quest for friendship. You may use a different example for each concept. Definitions will not score. • Operant conditioning • Locus of control B. Demonstrate how each of the following could HINDER Ellie’s quest for friendship. You may use a different example for each concept. Definitions will not score. HINDER • Agorapohia • Circadian rhythm • Narcissitic Personality Disorder CLINICAL SYNDROMES: DISSOCIATIVE DISORDERS Dissociative amnesia Dissociative fugue Dissociative identity disorder Etiology severe emotional trauma during childhood Controversy Media creation? Sybil Repressed memories CLINICAL SYNDROMES: MOOD DISORDERS Major depressive disorder Dysthymic disorder Bipolar disorder (manic-depressive disorder) Cyclothymic disorder Seasonal Affective Disorder Etiology Age of onset Genetic vulnerability Neurochemical factors Cognitive factors Interpersonal roots Precipitating stress CLINICAL SYNDROMES: SCHIZOPHRENIA General symptoms Delusions and irrational thought Deterioration of adaptive behavior - avolition Hallucinations – any modality but usually auditory Disturbed emotions – 66% Prognostic factor Gradual onset Sudden onset SUBTYPING OF SCHIZOPHRENIA 4 subtypes Paranoid type Catatonic type Disorganized type Undifferentiated type New model for classification Positive vs. negative symptoms ETIOLOGY OF SCHIZOPHRENIA Genetic vulnerability Neurochemical factors – Dopamine hypothesis Structural abnormalities of the brain – prefrontal lobe and ventricles The neurodevelopmental hypothesis Expressed emotion Precipitating stress – stress-vulnerability model Figure 14.19 The dopamine hypothesis as an explanation for schizophrenia NEUROLOGICAL CHANGES IN SCHIZOPHRENIA Figure 14.21 – Neurodevelopment hypothesis of schizophrenia Figure 14.22 – Expressed emotion and relapse rates in schizophrenia Slide 33 – The stress-vulnerability model of schizophrenia PERSONALITY DISORDERS Anxious-fearful cluster Avoidant, dependent, obsessivecompulsive Dramatic-impulsive cluster Histrionic, narcissistic, borderline, antisocial Odd-eccentric cluster Schizoid, schizotypal, paranoid Etiology Genetic predispositions, inadequate socialization in dysfunctional families Prognosis PSYCHOLOGICAL DISORDERS AND THE LAW Insanity M’naghten rule The insanity defense Involuntary commitment – varies by states danger to self danger to others in need of treatment Culture and pathology EATING DISORDERS Issues of weight Anorexia nervosa Criteria and subtypes: restrictive and binge/purge Bulimia nervosa Binge eating History and prevalence Age onset Etiology Genetics Personality – perfectionism Cultural issues - “perfect” body type and digital photograph Family role Cognitive factors Figure 14.25 - Age of anorexia nervous in the United States – Lucas et al. (1991)