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Psychology: An Introduction
Benjamin Lahey
11th Edition
Slides by Kimberly Foreman
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Chapter Fifteen:
Abnormal Behavior
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DO YOU THINK ANY of these
behaviors are abnormal?
Finding a “lucky” seat in an exam
Unable to eat, sleep, or study for days after ending a
relationship
Breaking into a cold sweat at the thought of being trapped
in an elevator
Refusing to eat solid food for days to stay thin
Thorough hand-washing after riding a bus
Believing government agents monitor your phone calls
Drinking a six-pack of beer a day in order to be “sociable”
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Abnormal Behavior
Abnormal behavior:
- actions, thoughts and feelings that are
distressing or harmful
i.e., keeps someone from forming
meaningful relationships
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Abnormal Behavior (cont.)
Historical views of abnormal behavior:
- supernatural theories
- biological theories
- psychological theories
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Table 1.1- Causes of Abnormal
Behavior
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Abnormal Behavior (cont.)
The DSM-IV:
- Diagnostic and Statistical Manual of Mental
Disorders – Fourth Edition
- multiaxial system:
- I clinical disorders
- II personality disorders and mental retardation
- III general medical conditions
- IV psychosocial and environmental problems
- V global assessment of functioning
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Abnormal Behavior (cont.)
The problem of stigma:
- may make mental health problems worse
- may prevent persons with problems from
seeking help
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Abnormal Behavior (cont.)
The concept of insanity:
- not guilty by reason of insanity
- competence to stand trial
- involuntary commitment
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The Nature of Anxiety Disorders
The essential feature of anxiety disorders is the
experience of a chronic and intense feeling of
anxiety.
A future-oriented response which involves a sense
of dread about what might happen to you in the
future.
Fear: Innate alarm response to a dangerous or
life-threatening situation.
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Panic Disorder
Panic attacks on a recurrent basis
Has constant apprehension and worry about
the possibility of recurring attacks
Panic attack: A period of intense fear and
physical discomfort accompanied by the
feeling that one is being overwhelmed
and is about to lose control
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Demographics of Lifetime
Prevalence for Anxiety Disorders
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Case Study - generalized anxiety disorder
Kristen is a 38 year-old divorced mother of two teenagers. She has had a successful, well-paying
career for the past several years in upper-level management. Even though she has worked for the
same, thriving company for over 6 years, she’s found herself worrying constantly about losing her
job and being unable to provide for her children. This worry has been troubling her for the past 8
months. Despite her best efforts, she hasn’t been able to shake the negative thoughts.
Ever since the worry started, Kristen has found herself feeling restless, tired, and tense. She often
paces in her office when she’s there alone. She’s had several embarrassing moments in meetings
where she has lost track of what she was trying to say. When she goes to bed at night, it’s as if her
brain won’t shut off. She finds herself mentally rehearsing all the worse-case scenarios regarding
losing her job, including ending up homeless.
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Anxiety Disorders: Generalized
anxiety disorder
Persistent worrying or obsession about small or large concerns that's out of proportion to the
impact of the event
Inability to set aside or let go of a worry
Inability to relax, restlessness, and feeling keyed up or on edge
Difficulty concentrating, or the feeling that your mind "goes blank"
Worrying about excessively worrying
Distress about making decisions for fear of making the wrong decision
Carrying every option in a situation all the way out to its possible negative conclusion
Difficulty handling uncertainty or indecisiveness
Physical signs and symptoms may include:
Fatigue
Irritability
Muscle tension or muscle aches
Trembling, feeling twitchy
Being easily startled
Trouble sleeping
Sweating
Nausea, diarrhea or irritable bowel syndrome
Headaches
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Specific Phobias
Phobia: An irrational fear associated with
a particular object or situation
Specific Phobia: An irrational and
unabating fear of a particular object,
activity, or situation
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Specific Phobias
Categories
Animals
Natural environment
Blood-injection-injury
Engaging in activities in particular situations
Variety of miscellaneous stimuli
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Specific Phobias: Theories and
Treatment
Systematic desensitization
Flooding
Imaginal flooding
Graduated exposure
Thought stopping
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Anxiety Disorders (cont.)
Posttraumatic stress disorder (PTSD):
- characteristics:
- recollections of an event that intrude into
consciousness and dreams
- intense emotional and autonomic reactions to
reminding stimuli
- feeling numbed to the ordinary emotions and
pleasures of life
- difficulty sleeping, hyperarousal, irritability, and
difficulty concentrating
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The following are examples of people with PTSD:
• A firefighter quits his job two years short of retirement because of persistent
fiery nightmares and chest pains.
• A young girl has become hyperactive since her tonsillectomy nine months
before.
• A previously studious teenaged boy is no longer able to concentrate on his
school work and is failing his classes since the death of his grandmother last
year. He no longer enjoys going to school, and is becoming increasingly
house-bound.
• A Middle Eastern refugee is arrested after a fight in a bar. He says all he
remembers is a smell that reminded him of the prison where he was tortured,
then he woke up in a police cell.
• A war veteran still awakes screaming from nightmares of combat, thirty years
after he was discharged from service.
• A woman who was molested when she was six years old begins to be
disturbingly over-protective of her own six year old daughter.
• A man seeks psychotherapy because he is suffering from persistent anxiety
and panic attacks.
• A boy is observed aggressively trying to stick pencils and crayons under the
tails of his stuffed animals.
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Obsessive-Compulsive and
Related Disorders
Obsession: Persistent and intrusive idea,
thought, impulse, or image.
Compulsion: Repetitive and seemingly
purposeful behavior performed in
response to:
Uncontrollable urges or according to a
ritualistic or stereotyped set of rules
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Obsessive-Compulsive Disorder
Recurrent obsessions that are inordinately
time-consuming or that cause significant
distress or impairment
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Obsessive-Compulsive Disorder
4 major dimensions
Obsessions associated with checking
compulsions
Need for symmetry and order
Obsessions about cleanliness associated
with washing compulsions
Hoarding-related behaviors
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Forms of Dissociative Disorders
Dissociative identity disorder:
Formerly called multiple personality disorder
An individual develops more than one self or
personality
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From October 14–26, 1977, three women around Ohio State
University were kidnapped, taken to a secluded area, robbed, and
raped. One woman claimed the man who raped her had a German
accent, while another one claimed that (despite kidnapping and raping
her) he was actually kind of a nice guy. However, one man committed
the rapes: 22-year-old Billy Milligan.
After his arrest, Milligan saw a psychiatrist, and he was diagnosed with
DID. Altogether, he had 24 different personalities. So when the
kidnapping and rapes happened, Milligan’s defense attorney said it
wasn’t Billy Milligan who was committing the crimes. Two different
personalities were in control of his body—Ragen, who was a
Yugoslavian man, and Adalana, who was a lesbian. The jury agreed,
and he was the first American found not guilty due to DID. He was
confined to a mental hospital until 1988 and released after experts
thought that all the personalities had melded together.
In 1981, Daniel Keyes, the award-winning author of Flowers for
Algernon, released a book about Milligan’s story called The Minds of
Billy Milligan. An upcoming film based on his story, The Crowded
Room, will reportedly star Leonardo DiCaprio.
Milligan died December 12, 2014 at the age of 59 from cancer.
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People with DID have distinct personalities. Instead of distinct
personalities, people with DID have different states. Brand describes it
as “having different ways of being themselves, which we all do to
some extent, but people with DID cannot always recall what they do or
say while in their different states.” And they may act quite differently in
different states.
Also, “There are many disorders that involve changes in state.” For
instance, people with borderline personality disorder may go “from
relatively calm to extremely angry with little provocation.” People with
panic disorder may go “from an even emotional state to extremely
panicked.” “However, patients with those disorders recall what they do
and say in these different states, in contrast to the occasional amnesia
that DID patients experience.”
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It’s obvious when someone has DID. Sensationalism
sells. So it’s not surprising that depictions of DID in
movies and TV are exaggerated. The more bizarre the
portrayal, the more it fascinates and tempts viewers to
tune in. Also, overstated portrayals make it obvious that
a person has DID. But “DID is much more subtle than
any Hollywood portrayal,” Brand said. In fact, people with
DID spend an average of seven years in the mental
health system before being diagnosed.
They also have comorbid disorders, making it harder to
identify DID. They often struggle with severe treatmentresistant depression, post-traumatic stress disorder
(PTSD), eating disorders and substance abuse. Because
standard treatment for these disorders doesn’t treat the
DID, these individuals don’t get much better, Brand said.
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DID is rare. Studies show that in the general
population about 1 to 3 percent meet full criteria for
DID. This makes the disorder as common as bipolar
disorder and schizophrenia. The rates in clinical
populations are even higher, Brand said.
Unfortunately, even though DID is fairly common,
research about it is grossly underfunded. Researchers
often use their own money to fund studies or
volunteer their time. (The National Institute of Mental
Health has yet to fund a single treatment study on
DID.)
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Dissociative Amnesia
An inability to remember important
personal details and experiences that is
associated with traumatic or very
stressful events.
This amnesia can be diagnosed with a
specifier of dissociative fugue:
During which they travel or wander without
knowing their identity.
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A 29-year-old female experienced the onset of dissociative
amnesia during an academic trip to China.[2] She was found
in a hotel bathroom unconscious, with no signs of structural
or neurologic abnormalities or alcohol or chemical
consumption. The woman was sent home but could not
remember her name, address, family, or any facts about her
home life. The amnesia persisted for nearly 10 months, until
the feeling of blood on the woman's fingers triggered the
recollection of events from the night of onset of dissociative
amnesia, and, subsequently, other facts and events. The
woman finally remembered having witnessed a murder that
night in China. She recalled being unable to help the victim
out of fear for her own safety. She came to remember other
aspects of her life; however, some memories remain elusive.
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depersonalization/
Derealization disorder
A dissociative disorder in which the
individual experiences recurrent and
persistent episodes of
depersonalization, derealization, or both:
Depersonalization is the condition in which
people feel they are detached from their
own body.
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27, single, with a university degree, sought psychiatric treatment with
complaints that she "did not feel her body". She reported that she felt
strange and empty, that her body seemed to be somewhere else and hollow,
with nothing but the skin, and it seemed to be someone else's body. She
had come to the point of wearing numerous bracelets to mark the
boundaries of her own limbs. She also suffered from affective detachment,
frequently stating "I feel like I was dead" or "I feel nothing", but complained
of intense anxiety in social situations. Reality testing was intact. Slightly
depressed mood and mitigated panic-like symptoms were also identified;
however, she did not fulfill the criteria for any other DSM axis I disorder, as
confirmed by the MINI-plus. There were no comorbid conditions or history of
drug abuse. She had a normal neurological examination, and an EEG
showed no abnormalities.
As the patient did not respond to risperidone 2 mg/day, it was replaced with
a selective serotonin reuptake inhibitor (SSRI), which led to anxiety
improvement, but the specific symptoms of DPD grew worse. A subsequent
change to venlafaxine 225 mg/day led to a significant mood improvement
and a reduction in panic-like episodes; however, depersonalization and
derealization remained unchanged.
ed for the young man to speak with a therapist. The young man described
feeling as though he were observing the interactions of others as if it were a
film. The young man's anxiety was determined to contribute to severe sleep
deprivation, which triggered episodes of depersonalization.
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Treatment of
Dissociative Disorders
Goal
Integrate alters
Methods
Hypnotherapy
Cognitive behavioral techniques
Treatment of dissociative disorders often
involves not only these disorders
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Mood Disorders
Major depression:
- characteristics:
- increased or decreased sleep
- increased or decreased appetite
- loss of interest in sex
- loss of energy or excessive energy
- difficulty concentrating and making decisions
- suicidal thoughts
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SIGECAPS for Major Depression
S leep changes: increase during day or decreased sleep
at night
I nterest (loss): of interest in activities that used to
interest them
G uilt (worthless): depressed elderly tend to devalue
themselves
E nergy (lack): common presenting symptom (fatigue)
C ognition/C oncentration: reduced cognition &/or
difficulty concentrating
A ppetite (wt. loss); usually declined, occasionally
increased
P sychomotor: agitation (anxiety) or retardations
(lethargic)
S uicide/death preocp.
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Table 7.1 - Criteria for a Major
Depressive Episode
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Human Diversity: Ethnic and Gender
Differences in Depression and Suicide
- likelihood of
depression is
approximately
twice as high in
women as in
men
- men are 4 to 5 times
more likely to
commit suicide than
women
- ethnic differences in
suicide rates
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Bipolar Disorder
Manic episodes and very disruptive
experiences of heightened mood,
possibly alternating with major
depressive episodes
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BIPOLAR DISORDER
Manic episode: A period of euphoric mood
with symptoms involving:
Abnormally heightened levels of thinking,
behavior, and emotionality
https://www.youtube.com/watch?v=Y4GYwy
mtbUU
Children and teens having a manic episode may:
Feel very happy or act silly in a way that's unusual
Have a very short temper
Talk really fast about a lot of different things
Have trouble sleeping but not feel tired
Have trouble staying focused
Talk and think about sex more often
Do risky things.
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Criteria for a Manic Episode
Inflated self-esteem or grandiosity
Decreased need for sleep
Pressure to keep talking
Flight of ideas
Distractibility
Increase in goal-directed activity
Excessive involvement in activities that
have a high potential for painful
consequences
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Bipolar Disorder
Types
Bipolar I disorder - One or more manic
episodes, and possibility of major
depressive episodes
Bipolar II disorder - One or more major
depressive episodes and at least one
hypomanic episode
https://www.youtube.com/watch?v=8Ki9dgG3
P5M
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Figure 7.2 - Range of Moods Present in
People with Bipolar Disorder
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Schizophrenia
The broad category of schizophrenia includes a set of disorders in which
individuals experience distorted perception of reality and impairment in
thinking, behavior, affect, and motivation.
A disorder with a range of symptoms involving disturbances In:
Content of thought
Form of thought
Perception
Affect
Sense of self
Motivation
Behavior
Interpersonal functioning
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Symptoms of schizophrenia
POSITIVE +
Positive symptoms:
Exaggerations or distortions of
normal thoughts, emotions, and
behavior
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NEGATIVE -
Negative symptoms:
Symptoms that involve functioning
below the level of normal behavior
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Symptoms of schizophrenia
POSITIVE +
NEGATIVE -




 Restricted affect
 Avolition
 A-sociality
Delusions
Hallucinations
Disorganized speech
Disturbed behavior
Researchers proposed that positive symptoms reflected activated
dopamine levels in the nervous system and negative symptoms
reflected abnormalities in brain structure.
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Diagnostic Features of Schizophrenia
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Characteristics of Schizophrenia
Bleuler coined the term schizophrenia
The four fundamental features are still
referred to as Bleuler’s Four A’s:
Association (thought disorder)
Affect (emotional disturbance)
Ambivalence (inability to make or follow through
on decisions)
Autism (withdrawal from reality)
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Features of schizophrenia
Inappropriate affect is the extent to
which a person’s emotional
expressiveness fails to correspond to
the content of what is being discussed.
Paranoia is the irrational belief or
perception that others wish to cause you
harm, may be associated with delusions
or auditory hallucinations related to a
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Schizophrenia (cont.)
Causes:
- genetic factors
- environmental factors:
- pregnancy complications that cause abnormal
brain development
- childhood head injuries and viral infections of
the brain
- living in families with high levels of discord
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Attention-Deficit/Hyperactivity
Disorder
Characteristics of inattention:
- cannot sustain attention
- fails to attend to details or makes careless mistakes
- highly distractible
- loses pencils, paper, and assignments at school or
work
- does not seem to listen when being spoken to
- dislikes or avoids tasks that require sustained
attention
- often forgetful
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Attention-Deficit/Hyperactivity
Disorder (cont.)
Characteristics of hyperactivity-impulsivity:
- fidgets and squirms when seated
- leaves seat when should remain seated
- runs or climbs excessively
- has difficulty quietly engaging in play or leisure activities
- often “on the go” or acts like he or she is “driven by a
motor”
- talks excessively
- blurts out answers before completion of question
- difficulty awaiting his or her turn
- interrupts or intrudes on others
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Eating Disorders
Diagnosis for people who experience
extreme disturbances in their everyday
diet along with possible distress or
concern about their body weight
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Anorexia Nervosa
Characterized by an inability to maintain
normal weight, an intense fear of gaining
weight, and distorted body perception
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Effects of Anorexia Nervosa
Bones, muscles, hair, and nails become
weak and brittle
Develop low blood pressure, slowed
breathing and pulse
Lethargic, sluggish, and fatigued
Gastrointestinal system functions
abnormally
Heart and brain damage
Multiple organ failure
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Bulimia Nervosa
Alternation between the extremes of
eating large amounts of food in a short
time
Compensating for the added calories either
by:
Vomiting
Other extreme actions to avoid gaining weight
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Bulimia Nervosa
Binge eating
Ingestion of large amounts of food during a
short period of time
Lack of control over what or how much is
eaten
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Bulimia Nervosa
Purging: Eliminating food through
unnatural methods
Vomiting
Administering enemas
Taking laxatives or diuretics
Nonpurging type - Trying to compensate
by fasting or excessive exercise
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Effects of Bulimia Nervosa
Ipecac syrup has toxic effects
Dental decay
Laxatives, diuretics, and diet pills also
have toxic effects over time
Gastrointestinal damage may be
permanent
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Binge-Eating Disorder
The ingestion of large amounts of food
during a short period of time, even after
reaching a point of feeling full, and a
lack of control over what or how much is
Binges occur at least twice a week for 6
months.
Significant weight gain can occur since
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Theories and Treatment
Of Eating Disorders
Biological - Serotonin and dopamine
receptor genes
SSRIs
Psychological
Cognitive-behavioral therapy
Exposure therapy
Holistically viewing their bodies in front of a
mirror
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Personality Disorders
Personalities that have developed
improperly:
- Axis II disorders:
- characteristics:
- begin early in life
- disturbing to the person or to others
- very difficult to treat
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Personality Disorders (cont.)
Schizoid personality disorder:
- little or no desire to have friends,
not interested in even casual social
contact
- display little emotion and appear cold and
aloof
- often do not work
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Personality Disorders (cont.)
Antisocial personality disorder:
- frequently violate social rules and laws,
take advantage of others and feel
little guilt about it
- smooth social skills
- low tolerance for frustration
- blame others for misdeeds
- unemotional and guiltless
- need excitement
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Personality Disorders (cont.)
Other personality disorders:
- schizotypal:
- few friendships, suspiciousness, strange
ideas
- paranoid:
- high degree of suspiciousness and
mistrust of others
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Personality Disorders (cont.)
Other personality disorders (cont.):
- histrionic:
- self-centered, seeking to be center of attention,
manipulative through emotion, superficially
charming, frequent angry outbursts
- narcissistic:
- unrealistic sense of self-importance,
preoccupied with fantasies of future
success, exploits others, feels entitled to
special consideration
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Personality Disorders (cont.)
Other personality disorders (cont.):
- borderline:
- impulsive and unpredictable, unstable personal
relationships, angry, almost constantly
needs to be with others, lack of clear
identity, feelings of emptiness
- avoidant:
- extreme shyness, extreme sensitivity to
rejection, low self-esteem
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