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Abnormal Behavior or Psychological Disorders Content as per College Board Abnormal Behavior 7-9 % What is Normal? In a small group of 3-5 students, determine what you would call “normal” Not who, what is normal? What is well-being? In this same group, identify what is psychological order or well-being. Is it just an absence of a disorder? Is it more like that which makes a person healthy? List 3-5 characteristics that make a person have “well-being” Well being Self acceptance Positive relations with others Autonomy Environmental mastery Purpose in life Personal growth Carol Ryff Myers’ Teachers Guide What is a disorder? There is no one absolute definition of psychological disorders A continuum exists between mental health and pathology Some proposed definitions may include: (from sample textbooks) A psychological disorder can be defined as a pattern of behaviors or psychological symptoms that cause significant personal distress and/or impairs the ability to function in one or more important areas of life. A syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation or behavior. (adapted from American Psychiatric Association, 2013) From the DSM 5 A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. 2013 From the DSM 5 An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from dysfunction in the individual, as described above. 2013 NOTE: Sanity and Insanity are legal definitions A person accused of a crime can acknowledge that they committed the crime, but argue that they are not responsible for it because of their mental illness, by pleading "not guilty by reason of insanity.” Just FYI. . . Although a defense known as "diminished capacity" bears some resemblance to the "reason of insanity" defense (in that both examine the mental competence of the defendant), there are important differences. The most fundamental of these is that, while "reason of insanity" is a full defense to a crime -- that is, pleading "reason of insanity" is the equivalent of pleading "not guilty" -- "diminished capacity" is merely pleading to a lesser crime. One of the most famous recent uses of the insanity defense came in United States v. Hinckley, concerning the assassination attempt against then-President Ronald Reagan. Also, FYI. . . The history of "not guilty by reason of insanity" The insanity defense reflects a compromise on the part of society and the law. On the one hand, society believes that criminals should be punished for their crimes; on the other hand, society believes that people who are ill should receive treatment for their illness. The insanity defense is the compromise: basically, it reflects society's belief that the law should not punish defendants who are mentally incapable of controlling their conduct. In the 18th century, the legal standards for the insanity defense were varied. Some courts looked to whether the defendant could distinguish between good and evil, while others asked whether the defendant "did not know what he did." By the 19th century, it was generally accepted that insanity was a question of fact, which was left to the jury to decide. The M'Naghten rule -- not knowing right from wrong The first famous legal test for insanity came in 1843, in the M'Naghten case. Englishman Daniel M'Naghten shot and killed the secretary of the British Prime Minister, believing that the Prime Minister was conspiring against him. The court acquitted M'Naghten "by reason of insanity," and he was placed in a mental institution for the rest of his life. However, the case caused a public uproar, and Queen Victoria ordered the court to develop a stricter test for insanity. The "M'Naghten rule" was a standard to be applied by the jury, after hearing medical testimony from prosecution and defense experts. The rule created a presumption of sanity, unless the defense proved "at the time of committing the act, the accused was laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing or, if he did know it, that he did not know what he was doing was wrong." The M'Naghten rule became the standard for insanity in the United States and the United Kingdom, and is still the standard for insanity in almost half of the states. In your small group, Review and discuss the provided assignment, “What is Disordered Behavior?” Record your thoughts upon discussion with group members. Turn in a copy for each group member. We will discuss this in 5-7 minutes. Who suffers from disorders? Diathesis-Stress Model-The diathesis, or predisposition, interacts with the subsequent stress response of an individual. Stress refers to a life event or series of events that disrupt a person’s psychological equilibrium and potentially serves as a catalyst to the development of a disorder. Sometimes referred to as the stress-vulnerability model- explanation of disorder that assumes a biological sensitivity (vulnerability) to a certain disorder will result in the development of that disorder under the right conditions of environmental or emotional stress Historical Perspectives on Abnormal Behavior The ancient world Greece Hippocrates- (460-377 BCE) believed that mental illness was the result of natural, as opposed to supernatural causes Galen – (130-200 BCE) divided the causes of mental disorders into physical and psychological causes China Chung Ching- (200CE) stated that both organ pathologies and stressful psychological events were causes of mental disorders The Middle Ages (5001500 CE) Europe- abnormal behavior was viewed as a demonic possession. Treatment might include prayer, laying on of hands and/or exorcism performed by the clergy. Possibly witch hunts? Islamic Countries-known for humane hospitals for mentally ill (Baghdad 792 CE). The Renaissance- brings reemergence of the scientific approach to mental illness Teresa of Avila (1515-1582 CE) a Spanish nun established a conceptual framework that suggests the mind can be sick Johann Weyer (1515-1588 CE) of Germany used scientific skepticism to refute the concept of demonic possession Humanitarian Reforms th of 18th-19 centuries Philippe Pinel (France)-pioneered compassionate medical model for the treatment of the mentally ill William Tuke (England)- introduced trained nurses for the mentally ill Benjamin Rush (United States) founder of American psychiatry and established hospitals for the mentally ill Dorothea Dix (United States) advocated for reforms to allow for humane treatment of mentally ill in institutional settings Deinstitutionalization Occurred due to scientific advances of the 20th century Psychopharmacology Medical advances including imaging devices (CT, MRI, PET) Release of patients back into their usual community using out- patient care Historical perspective from: TOPSS Unit Lesson Plan Modes or Perspectives of Psychological Disorders Psychological Models Psychodynamic (Psychoanalytic)explains disordered behavior as the result of repressing one’s threatening thoughts, memories, concerns in the unconscious mind Sigmund Freud Carl Jung Alfred Adler Erik Erikson The Biopsychological Perspective Emphasizes that mental illness should be diagnosed on the basis of its symptoms and cured through medical intervention Relates to genetic predisposition, abnormalities in brain structure and biochemistry Medical Doctors (M.D.) The Behavioral Model Learning perspective emphasizes inappropriate behaviors might have been reinforced and thus reoccurred Observational learning and modeling may play a role John B. Watson B. F. Skinner Albert Bandura The Cognitive Model Emphasizes the irrational, illogical and/or maladaptive thought process or thinking patterns Aaron Beck Albert Ellis The Biopsychosocial Model Biological, psychological (psychodynamic, behaviorist and cognitive) and sociocultural influences interact to cause the various forms of disorders This view has become an influential way to view the connection between mind and body Ciccarelli and White, AP Edition Psychology TOPSS Unit Lesson Plan Others? Evolutionary? Social Cultural? The DSM-5 The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in May 2013 with revisions to the criteria for the diagnosis and classifications of mental disorders. In the interest of fairness and to allow time for publishers to integrate such changes into pertinent sections of AP Psychology textbooks, the College Board has made the following decisions regarding upcoming AP Psychology Exams: Beginning with the 2015 AP Psychology Exam, all terminology, criteria and classifications referred to among multiple-choice and free-response items will adhere to the new fifth edition of the Diagnostic and Statistical Manual (DSM-5). The DSM-5 Published by the American Psychiatric Association Widely used diagnostic system for the United States Provides a set of criteria to make assessments International Classification of Diseases (ICD) ICD published by World Health Organization DSM 5 has removed the multiaxial system Axes I, II and III are all listed on a single axis which includes all mental disorders as well as personality disorders and intellectual disabilities as well as other medical diagnosis Reference: APA, FRQ about DSM-5 Axis V (Global Assessment of Functioning) was used to determine medical necessity for treatment. A single GAF score may not convey information to adequately assess functioning. Section III of DSM provides separate assessments for severity and disability in regard to functioning Consequences of labeling Refer to the Rosenhan Study Positive: Negative: Specific Diagnostic Categories Neurodevelopmental Disorders Neurodevelopmental Disorders Neurodevelopmental disorders are impairments of the growth and development of the brain or central nervous system. A narrower use of the term refers to a disorder of brain function that affects emotion, learning ability, self-control and memory and that unfolds as the individual grows. Neurodevelopmental disorders are associated with widely varying degrees of difficulty which may have significant mental, emotional, physical, and economic consequences for individuals, and in turn their families and society in general. Neurodevelopmental Disorders Intellectual disabilities Intellectual Disabilities: Diagnostic criteria for intellectual disability emphasize the need for an assessment of both cognitive capacity (IQ) and adaptive functioning The term “mental retardation” was used in the DSM IV, however, intellectual disability has become more commonly used in the past two decades Global Developmental Development Delay: Language Disorder: Speech Sound Disorder: Social Communication Disorder (combines expressive and mixed receptive – expressive language disorders): Neurodevelopment Disorders Autism Spectrum Disorder: This is new to the DSM 5 and reflect scientific consensus four previously separate disorders are actually a single condition ASD is characterized by 1) deficits in social communication and social interaction and 2) restricted repetitive behaviors, interest and activities Neurodevelopmental Disorders Attention-Deficit/Hyperactivity Disorder (ADHD): This was added to the neurodevelopmental disorders chapter to reflect brain development correlates with ADHD and the DSM 5 elimination of diagnosis of those first made in infancy, childhood or adolescence DSM 5 uses the same 18 symptoms used in DSM-4 and continues to be divided into two symptoms domains (inattention and hyperactivity/impulsivity) Neurodevelopmental Disorders Specific Learning Disorders: This combines the diagnosis of reading, mathematics disorders and disorder of written expression Motor Disorders: Developmental Coordination Disorder Stereotypic Movement Disorder Tic Disorders Tourette’s Disorder Persistent (Chronic) Motor or Vocal Tic Disorder Provisional Tic Disorder Neurocognitive Disorders Neurocognitive Disorders The criteria for these disorders are based on defined cognitive domains The domains as defined by the DSM 5 along with guidelines for clinical thresholds, form the basis on which neurocognitive disorders are diagnosed Cognitive domains: Complex attention Executive function Cognitive Domains Complex attention (sustained, divided, selective attention, processing speed) Executive Function (planning, decision making, working memory, responding to feedback, error correcting) Learning and memory( immediate, short term, long term memory) Language (expressive and receptive) Perceptual –motor (visual perceptive, perceptual motor) Social Cognitive (recognition of emotion, theory of mind) Examples (but not limited to) Delirium Alzheimer’s disease Traumatic brain injury Substance/medication use HIV infection Parkinson’s disease Huntington’s disease Schizophrenia Spectrum and Other Psychotic Disorders Schizophrenic Disorders A psychological disorder characterized by delusions, hallucination, disorganized speech and/or diminished or inappropriate emotional expression Literally translated, schizophrenia means “split mind,” as in split from reality Myers’ Psychology for AP Schizophrenia Spectrum and Other Psychotic Disorders In the DSM 5, two Criterion A symptoms are required for any diagnosis of schizophrenia Delusions Hallucinations Disorganized speech (At least one of these positive symptoms is necessary for a reliable diagnosis) Grossly disorganized or catatonic behavior Negative symptoms (diminished emotional behavior) Simulated Schizophrenia: https://www.youtube.com/watch?v=dkB2CGL769o Schizophrenia subtypes Subtypes of schizophrenia have been eliminated (paranoid, disorganized, catatonic, undifferentiated and residual) https://www.youtube.com/watch?v=48YJMOcykvc DSM 5 includes in this category: Schizotypal (Personality) Disorder Delusional Disorder Brief Psychotic Disorder Schizophrenia Schizoaffective Disorder Bipolar and Related Disorders Bipolar Disorder A mood disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania Long ago referred to as manic - depression Bipolar and Related Disorder Bipolar I Disorder – for a diagnosis, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or depressive episode During the period of mood disturbance and increased activity, three (or more) of the following are present (representing a change from usual behavior) Inflated self-esteem or grandiosity Decreased need for sleep More talkative Flight of ideas Distractibility Increased in goal directed activity or psychomotor agitation Excessive involvement in activities that might have painful consequences Bipolar Disorders The major depressive episode includes five or more of the following symptoms Depressed mood for most of the day Marked diminished interest or pleasure in all (or almost all) activities Significant weight loss or weight gain Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feeling of worthlessness or excessive or inappropriate guilt Diminished ability to think or concentrate Recurrent thoughts of death or suicide ideation Bipolar Disorders Bipolar II- a categorization for individuals with a past history of a major depressive disorder who meet all of the criteria for hypomania except duration Cyclothymic disorder-disorder that has too few symptoms of hypomania to meet the full criteria Depressive Disorders Depressive Disorders A mood disorder in which a person experiences, in the absence of drugs or another medical condition, two or more weeks of five or more symptoms, at least one of which must be either 1) depressed mood or 2) loss of interest or pleasure. Myers’ Psychology for AP Diagnosis Of Depression The DSM 5 classifies major depressive disorder as the presence of at least five of the following symptoms over a two-week period. Symptoms must cause near daily distress or impairment and not be attributed to substance use or another medical or mental illness Myers’ Psychology for AP Signs Depressed mood most of the day Markedly diminished interest or pleasure in activities most of the day Significant weight loss or gain when not dieting, or significant decrease or increase in appetite Insomnia or sleeping too much Physical agitation or lethargy Fatigue or loss of energy Feeling worthless or excessive or inappropriate guilt Problems in thinking, concentrating or making decisions Recurrent thoughts of death and suicide Included in the category of Depressive Disorders Disruptive Mood Dysregulation Disorder Major Depressive Disorder, Single and Recurrent Episodes Persistent Depressive Disorder (Dysthymia) Anxiety Disorders Anxiety Disorders Psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety Myers’ Psychology for AP Specific Anxiety Disorders Panic Disorder- Recurrent and unexpected panic attacks are severe and involve feelings of terror and physiological involvement. Generalized Anxiety Disorder- characterized by persistent high levels of anxiety and excessive worry with symptoms present for at least 6 months; more persistent than panic disorder Specific Anxiety Disorders Phobia – a persistent, unrealistic, irrational fear of specific objects or situations. Exposure to a feared stimulus produces intense panic or fear, anxiety dissipates when the phobic situation is not confronted No longer is there a requirement that individual over the age is 18 recognize that their anxiety is excessive or unreasonable Duration of symptoms to 6 month is extended to all ages Examples: Specific phobias Agoraphobia Social Anxiety Disorder (Social Phobia) Other Examples Separation Anxiety Disorder- previously classified as a developmental disorder, in DSM 5, classified as an anxiety disorder. The DSM 5 indicates a possibility of adult onset, with an added duration criterion as “typically lasting for 6 months or more.” Selective Mutism- previously classified as a developmental disorder, now it is classified as an anxiety disorder given that a large majority of children with selective mutism are anxious. Highlights of Changes from DSM IV TR to DSM 5 Changed from DSM IV to DSM 5 Classified separately in the DSM 5 Obsessive Compulsive Disorder Posttraumatic Stress Disorder ObsessiveCompulsive and Related Disorders Obsessive-Compulsive Disorder A disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions) Reported obsessions: concerns are dirt, germs, toxins, something terrible happening (fire, death, illness), symmetry, order or exactness Reported compulsions: excessive hand washing, bathing, tooth brushing, grooming, repeated rituals, checking doors, locks, appliances, car brakes, homework) These thoughts cross the line between normality and abnormality when they persistently interfere with our daily living and cause distress Myers’ Psychology for AP Obsessive-Compulsive and Related Disorders Obsessive-Compulsive Disorders Body Dysmorphic Disorder Hoarding Disorder Trichotillomania (Hair-pulling disorder) Excoriation (Skin Picking) Disorder https://app.discoveryeducation.com/learn/videos/18 71337F-EF55-4D19-A74B1C8863FCB873?hasLocalHost=false Trauma and Stressor Related Disorders Trauma and stressor-related disorders include disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion. These include: Reactive Attachment Disorder Disinhibited Social Engagement Disorder Posttraumatic Stress Disorder (PTSD) Acute Stress Disorder Adjustment Disorders. PTSD A disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling and/or insomnia that linger for four weeks or more after a traumatic experience Symptoms have been reported by survivors of accidents, disasters, violent sexual assault, terrorist attacks, natural disasters, war and the like. https://app.discoveryeducation.com/learn/videos/97 5FADD8-5074-4F72-8EFBA12C7E1CEAE8?hasLocalHost=false Somatic Symptom and Related Disorders Somatic Symptom and Related Disorders Disorders Somatic symptom disorder and other disorders with prominent somatic symptoms constitute a new category in DSM-5. A psychological disorder in which the symptoms take on a somatic (bodily) form without apparent physical cause Myers’ Psychology for AP All of the disorders in this area share a common feature: the prominence of somatic symptoms associated with significant distress and impairment. DSM 5 Library Examples Somatic Symptom Disorder (A psychological disorder in which the symptoms take on a somatic (bodily) form without apparent physical cause) Illness Anxiety Disorder (Hypochondriasis has been eliminated as a disorder) Conversion Disorder (a disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found) Factitious Disorder (Previously Munchausen Syndrome) Myers’ Psychology for AP Dissociative Disorders Dissociative Disorders Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts and feelings Dissociative Disorders Dissociative amnesia- involves partial or total loss of important personal information (memory) that may occur after a stressful or psychologically traumatic event. There is no organic cause. Dissociative fugue has been eliminated from DSM 5 Dissociative Disorders Depersonalization/Derealization Disorder- most common dissociative disorder that is characterized by feeling of unreality concerning the self and the environment. Characterized by intensity of symptoms and anxiety provoked by symptoms Dissociative Identity Disorder (DID)- formerly called Multiple Personality Disorder. 2 or more distinct personalities that alternately control the person’s behaveor with memory impairment. https://www.youtube.com/watch?v=YXuG2zI39yA Feeding and Eating Disorders Feeding and Eating Disorders Feeding and eating disorders are characterized by a persistent disturbance of eating or eatingrelated behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning. Feeding and Eating Disorders Pica -persistent eating of nonnutritive, nonfood substances over a period of one month, no age restriction Rumination Disorder - repeated regurgitation of food over a period of at least 1 month. Food may be rechewed, re-swallowed or spit out Avoidant/Restrictive Food Intake Disorder – a disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs DSM 5 Feeding and Eating Disorders Anorexia Nervosa – an eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly (15% or more) underweight Bulimia Nervosa – an eating disorder in which a person alternates binge eating (usually high calorie foods) with purging (by vomiting or laxative use), excessive exercising or fasting Binge Eating Disorder – significant binge-eating episodes, following distress, disgust or guilt but without compensatory purging or fasting that marks bulimia nervosa Myers’ Psychology for AP Personality Disorders Personality Disorders Characterized by long standing, chronic, inflexible, maladaptive patterns of perception, thought and behavior that seriously impair an individual’s ability for function personally or socially Usually recognized by the time a person reaches adolescence As a group, these disorders are among the least reliably judged Clusters Cluster A: Paranoid, Schizoid and Schizotypal (Odd or Eccentric Behaviors) Cluster B: Antisocial, Borderline, Histrionic and Narcissistic (Dramatic or Erratic Behaviors) Cluster C: Obsessive-Compulsive, Avoidant and Dependent (Anxious or Fearful Behaviors) Personality Disorders Narcissistic personality disorder- marked by a grandiose sense of self-importance and preoccupation with fantasies of success or power. Individual is in constant need of attention or admiration and has inappropriate reactions to criticism Personality Disorders Antisocial personality disorder – marked by long standing pattern of irresponsible behavior that hurts others without causing feelings of guilt or remorse Individual does not experience shame or intense emotion of any kind. Violation of social norms, may include criminal acts Some studies detect early signs of antisocial behavior in children as young as 3-6 years old The Big Picture: Perspectives in Studying Personality, Abnormal Behaviors and Treatment Draw a graphic of your choosing (flower, fish, balloons, whatever) Somewhere on your graphic, identify, define and list names associated with the 6 current perspectives in psychology (listed below) behavioral, biological, cognitive, evolutionary, humanistic, psychodynamic/psychoanalytic Predict how each perspective would explain development of personality. Analyze (Predict) how each perspective would explain the development of a disordered behavior. Evaluate a list of major treatment orientations for each perspective used in therapy. Note To Teacher: This may be a preview or review of content. Suggested Activities Student Project: Encounters with the Mentally Ill Multimedia Project for the Introduction of Psychological Disorders Movies and Mental Illness Your Suggestions? From the Office of Teaching Resources in Psychology (OTRP) APA Div. 2 Society for the Teaching of Psychology Films Illustrating Psychopathology OTRP Danny Wedding Using Film to Teach Psychology Elizabeth M. Nelson