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Abnormal Behavior * A psychological disorder, causing distress, disability, or dysfunction. Defined symptomatically by the DSM. Biopsychosocial Model * Key concept is Interaction. biological factors • come from the body • e.g., genes; neurotransmitters social factors • come from society and culture • e.g., socioeconomic status, homelessness, abuse psychological factors • come from the individual • e.g., patterns of negative thinking; stress responses Statistics on Disorders • • • • • • • • • 1 in 4 affected each year Each year prevalence: 18.1% anxiety disorders; 1% schizophrenia; 4.4% alcohol use disorder More lower SES Mentally ill stigmatized Many disorders comorbid. Comorbid = more than one disorder at a time Most severe disorders in a small group of people 6% of population have 3 or more disorders DSM * • • • • Diagnostic and Statistical Manual American Psychiatric Association Currently DSM-5 Common language and standard criteria for classifying mental disorders • • • • Controversies include: Cultural bias (e.g. sexual disorders) Medical rather than behavioral model Diagnosing, e.g. ADHD, autism. Diagnosing Disorder: The DSM • The DSM organizes disorders by category. Within a diagnostic category, clinicians may also identify specifiers and rate severity. Categories of Disorders include: • • • • • • • • • • • • • • • Obsessive Compulsive and Related Disorders Neurodevelopmental Disorders Dissociative disorders Substance Related and Addictive Disorders Depressive Disorders Bipolar and related disorders Schizophrenia spectrum and other psychotic disorders Anxiety Disorders Somatic Symptom and Related Disorders Trauma and Stressor-Related Disorders Feeding and Eating Disorders Sexual Dysfunction Personality Disorders Autism Spectrum Disorders Neurocognitive Disorders Anxiety Disorders • Anxiety – irrational fear, dread, or agitation; physiological arousal • 1. Phobias: unreasonable fear; avoidance • a. Specific phobia – clearly defined object or situation, e.g. dogs • b. Social phobia – extreme shyness or discomfort in social situations • 2. Panic Disorder * • Sudden attacks of terror leading to behavioral changes & physical symptoms Phobias • An anxiety disorder characterized by intense fear of specific situations or objects. • The individual knows the fear is irrational. • Common phobias include animals, heights, closed places, needles • Social phobias – An irrational fear and avoidance of any social or performance situation in which one might embarrass or humiliate oneself in front of others Shaking, blushing, sweating, or appearing clumsy, foolish, or incompetent – Most common type of anxiety disorder – Ricky Williams Phobias • Specific phobias- A marked fear of a specific object or situation. – Phobic items include (ordered by frequency of occurrence): Situational phobias (elevators, airplanes, enclosed places, tunnels) Fear of natural environment (storms or water) Animal phobias (dogs, snakes, insects, or mice) Blood injection-injury phobia (fear of seeing blood or receiving an injection Panic Disorder • An anxiety disorder marked by unpredictable minutes-long episodes of intense fear and other frightening sensations (heart pounding, shortness of breath, choking sensations, dizziness) • Visit doctors and emergency rooms quite frequently • Person is often left with fear of having another panic attack • Can lead to agoraphobia-intense fear of being in a situation from which no escape is possible if the person experienced a panic attack. • Post Traumatic Stress Disorder * • Obsessive Compulsive Disorder * • a. Obsessions * • • • Repetitive, distressing or frightening thoughts b. Compulsions * Repetitive behaviors (an attempt to calm the thoughts) • OCD love poem • Examples of obsessions: – Concern for order and constancy – Cleanliness (body or living space) – Forbidden sexual thoughts • Examples of compulsions: – Hand washing – Checking – Collecting – Repeating behaviors (in and out of a door) – Arranging things – Cleaning Etiology of Anxiety Disorders • Biological factors – Genetic predisposition – GABA circuits in the brain • Conditioning and learning – Acquired through classical conditioning – Maintained through operant conditioning • Cognitive factors – Judgments of perceived threat • Stress—a precipitator Figure 13.4 Conditioning as an explanation for phobias Figure 13.3 Twin studies of anxiety disorders Dissociative Disorders Disorders in which, under unbearable stress, consciousness becomes dissociated from a person’s identity, her/his memories of important personal events, or both • Types of Dissociative Disorders: – Dissociative Amnesia: retrograde forgetting of autobiographical info – Dissociative Fugue: forgets…and leaves old life – Depersonalization Disorder: everything’s surreal – Dissociative Identity Disorder Copyright © 2011 Pearson Education, Inc. All rights reserved. Dissociative Disorders • Disorders which, under unbearable stress, consciousness becomes dissociated from a person’s identity or her/his memories of important personal events, or both • Dissociative Amnesia – A complete or partial loss of the ability to recall personal information or identify past experiences – Cannot be attributed to forgetfulness or substance abuse. – Often caused by traumatic experience or – A situation creating unbearable anxiety causing the person to escape by “forgetting” • Victims of 9-11 tragedy were discovered in mental hospital months later with dissociative amnesia • Brought to hospitals with no identification and couldn’t recall it – Sufferers forget name, age, address, and may not recognize parents, family or friends – Do not forget how to carry out routine tasks – basic personality remains intact WWB Copyright © Allyn & Bacon 2006 Dissociative Identity Disorder * • 2 or more distinct personalities in the same person • Memory disruption regarding the “alter” • Rare • Some psychologists don’t believe the disorder really exists • NOT the same as Schizophrenia Schizophrenia A severe psychological disorder characterized by loss of contact with reality, hallucinations, delusions, inappropriate or flat affect, some disturbance in thinking, social withdrawal, and/or other bizarre behavior • Positive Symptoms (added) – Hallucinations – Delusions – Derailment – Inappropriate affect WWB • Negative Symptoms (loss of deficiency) – Social Withdrawal – Apathy – Loss of motivation – Lack of goal-directed behavior – Very limited speech – Slow movements – Poor hygiene – Poor problem-solving – Distorted sense of time Copyright © Allyn & Bacon 2006 Schizophrenia * Video – Gerald • Psychosis: loss of contact with reality • Positive symptoms – hallucinations, delusions, inappropriate affect, disorganized speech and behavior • Negative symptoms – social withdrawal, deterioration of adaptive behavior, flat affect, poor problem solving abilities • Cognitive symptoms – problems with focus, memory, problem-solving; control Symptoms of Schizophrenia • Delusions and irrational thought – Delusions are false beliefs that are maintained even though they are clearly out of touch with reality. • Distorted perceptions (Hallucinations) – Sensory perceptions that occur in the absence of real stimulus. Usually auditory. • Disturbed emotions – Some show a flattening of emotion. – Some show inappropriate emotional responses. Brain Abnormalities in Schizophrenia • Several abnormalities in brain structure and function have been found – Low levels of neural activity in the frontal lobes – Defects in neural circuitry of the cerebral cortex and limbic system – Reduced volume in hippocampus, amygdala, thalamus, and frontal lobes – Abnormal lateralization of brain functions slow communications between left and right hemispheres – Abnormal dopamine activity is common • May result from cocaine abuse – Medication effective in reducing symptoms of schizophrenia block dopamine action – One third who take these medications do not show improvement WWB Copyright © Allyn & Bacon 2006 Etiology of Schizophrenia • • • • • • Genetic vulnerability Neurochemical factors Structural abnormalities of the brain The neurodevelopmental hypothesis Expressed emotion Precipitating stress Possible Causes of Schizophrenia * • • • • • • • • Genes – runs in families Brain– loss of neurons; enlarged ventricles Neurotransmitters – e.g. excess dopamine Poverty, malnutrition, disease Prenatal damage – e.g. viruses Stress Substance Abuse may trigger Interactions between items above Causes of Schizophrenia • Genetic vulnerability – Evidence suggests heredity plays a role – Identical twins concordance rates-48% – Offspring of two schizophrenic parents has about a 46% probability of developing the condition. WWB Copyright © Allyn & Bacon 2006 Causes of Schizophrenia • Effects of Prenatal environment – Malnutrition – Prenatal viral infections and birth complications • Effects of the family environment – Results of research shows that a degree of disorganized communication at home that does not harm most children may have damaging effects on those genetically predisposed to schizophrenia Depressive Disorders * • Major depressive disorder * • Low mood (despair) - withdrawal, loss of interest & pleasure; eating & sleeping disturbance Video • • • • • More than 2 weeks Impaired functioning Twice as many women May have psychotic features Suicidal thoughts or attempts Risk Factors for Suicide * • • • • • • • • Diagnosable psychiatric disorder Male, esp. older and physically ill Method (guns succeed more than pills) Prior attempts, family history, exposure History of being abused Incarceration High risk behavior Adolescence 2% attempt Suicide and Race, Gender, and Age • Mood disorders, schizophrenia, and substance abuse are major risk factors for suicide in all age groups • Suicide risk increases when exposed to troubling life stressor • Suicidal behavior runs in families • 30,000-31,000 suicides are reported annually in the U.S. • Suicide rates far lower for white and African American women than men • Older Americans are at far greater risk than young people • 90% of individual who commit suicide leave clues – Verbally – “you won’t be seeing me again” – Behavioral – giving away most valued possessions – Taking unnecessary risks – Showing personality changes – Losing interest in favorite activities • Warning signs should be taken seriously • Encourage them to get professional help or call 24-hour hotline WWB Copyright © Allyn & Bacon 2006 • Bipolar and related disorders * Video • Mood & energy swings from low (depression) to high (mania); near normal in between • Mania * • Exceptional energy, enthusiasm, agitation, irritability, reckless behavior. Causes of Mood Disorders Neurological Correlates – Heredity and abnormal brain structure and chemistry Abnormal levels of serotonin linked to depression and suicide Neurotransmitter abnormalities may reflect genetic variations Heritability of depressive disorder is 70%, environment 30% – Twins of those diagnosed with bipolar disorder: 50% of identical twins also diagnosed 7% of fraternal twins also diagnosed Personality Disorders * • Inflexible patterns of thinking, feeling or relating to others • These patterns cause problems in personal, social & work situations. • Inability to understand needs of others • Three “clusters” • A) Odd, eccentric • B) Dramatic/erratic, BPD Video • C) Anxious/inhibited Personality Disorders Characteristics of personality disorders Extremely difficult to get along with Unstable work and social histories Know their behavior causes problems, yet seem unable to change Blame other people or situations for their problems Treatment options are few – Most seek treatment by legal authorities or family members – Seldom engage in self-reflection essential for success Psychological and behavioral factors that lead to a personality disorder diagnosis may be resolved to some degree or become less severe over time Personality Disorders • Three clusters – Dramatic, Emotional: Histrionic Narcissistic Antisocial Borderline – Anxious, Fearful: Avoidant Dependent Obsessive-Compulsive Odd, Eccentric: Paranoid Schizoid Schizotypal Antisocial Personality Disorder * • Pervasive pattern of violating the rights of others • 3x more males • Alcohol, drug abuse • Egocentric, impulsive • Lie, cheat, steal, criminal behavior • Biological and environmental factors Personality Disorder • Antisocial Personality Disorder – Most troubling and heavily researched personality disorder – Disregards rights, feelings; manipulates, etc. without remorse – Aggressive, irresponsible, reckless, willing to break the law – Breaks the law, lies, cheats, exploits, and fails to hold jobs – Typically a male, whose lack of conscience becomes plain before age 15 Somatic Symptom Disorders * • Substantial physical symptoms • May have no documented illness or may have a real illness with “overreaction”. • Stress-related • More females • Distressing and disruptive • Contrast with illness anxiety disorder – exaggerated “normal” physical sensations and no real physical illness.