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Psychology: An Introduction Benjamin Lahey 11th Edition Slides by Kimberly Foreman © 2012 McGraw-Hill Companies, Inc. All rights reserved. Chapter Fifteen: Abnormal Behavior © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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” © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document © 2012 McGraw-Hill Companies, Inc. All rights reserved. may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. Abnormal Behavior Abnormal behavior: - actions, thoughts and feelings that are distressing or harmful i.e., keeps someone from forming meaningful relationships © 2012 McGraw-Hill Companies, Inc. All rights reserved. Abnormal Behavior (cont.) Historical views of abnormal behavior: - supernatural theories - biological theories - psychological theories © 2012 McGraw-Hill Companies, Inc. All rights reserved. Table 1.1- Causes of Abnormal Behavior © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document © 2012 McGraw-Hill Companies, Inc. All rights reserved. may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. © 2012 McGraw-Hill Companies, Inc. All rights reserved. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Abnormal Behavior (cont.) The problem of stigma: - may make mental health problems worse - may prevent persons with problems from seeking help © 2012 McGraw-Hill Companies, Inc. All rights reserved. Abnormal Behavior (cont.) The concept of insanity: - not guilty by reason of insanity - competence to stand trial - involuntary commitment © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All Demographics of Lifetime Prevalence for Anxiety Disorders © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All Specific Phobias Categories Animals Natural environment Blood-injection-injury Engaging in activities in particular situations Variety of miscellaneous stimuli © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All Specific Phobias: Theories and Treatment Systematic desensitization Flooding Imaginal flooding Graduated exposure Thought stopping © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All Obsessive-Compulsive Disorder Recurrent obsessions that are inordinately time-consuming or that cause significant distress or impairment © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All Forms of Dissociative Disorders Dissociative identity disorder: Formerly called multiple personality disorder An individual develops more than one self or personality © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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.” © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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.) © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All Treatment of Dissociative Disorders Goal Integrate alters Methods Hypnotherapy Cognitive behavioral techniques Treatment of dissociative disorders often involves not only these disorders © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All Table 7.1 - Criteria for a Major Depressive Episode © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. Bipolar Disorder Manic episodes and very disruptive experiences of heightened mood, possibly alternating with major depressive episodes © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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. © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All Figure 7.2 - Range of Moods Present in People with Bipolar Disorder © 2012 McGraw-Hill Companies, Inc. All rights reserved. Copyright © 2014 McGraw-Hill Education. All 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 Copyright © 2014 McGraw-Hill © 2012 McGraw-Hill Companies, Inc. All rights reserved. Symptoms of schizophrenia POSITIVE + Positive symptoms: Exaggerations or distortions of normal thoughts, emotions, and behavior Copyright © 2014 McGraw-Hill NEGATIVE - Negative symptoms: Symptoms that involve functioning below the level of normal behavior © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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. Copyright © 2014 McGraw-Hill © 2012 McGraw-Hill Companies, Inc. All rights reserved. Diagnostic Features of Schizophrenia Copyright © 2014 McGraw-Hill © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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) Copyright © 2014 McGraw-Hill © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 Copyright © 2014 McGraw-Hill © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. Eating Disorders Diagnosis for people who experience extreme disturbances in their everyday diet along with possible distress or concern about their body weight Copyright © 2014 McGraw- © 2012 McGraw-Hill Companies, Inc. All rights reserved. Anorexia Nervosa Characterized by an inability to maintain normal weight, an intense fear of gaining weight, and distorted body perception Copyright © 2014 McGraw- © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 Copyright © 2014 McGraw- © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 Copyright © 2014 McGraw- © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 Copyright © 2014 McGraw- © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 Copyright © 2014 McGraw- © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 Copyright © 2014 McGraw- © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 Copyright © 2014 McGraw- © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 Copyright © 2014 McGraw- © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. Personality Disorders (cont.) Other personality disorders: - schizotypal: - few friendships, suspiciousness, strange ideas - paranoid: - high degree of suspiciousness and mistrust of others © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved. 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 © 2012 McGraw-Hill Companies, Inc. All rights reserved.