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Unit 12 Abnormal Psychology “To study the abnormal is the best way to understand the normal” - William James Defining disorders Hard to do from culture to culture Hearing voices may make you disturbed in one culture, may make you a religious figure in others Mass killing during war time = hero ? Homosexuality from 1952 – December 9 1973 was viewed as a mental illness Patterns of thoughts, feelings or behaviors that are deviant (different), distressful and dysfunctional Harmful dysfunction* Understanding disorders Different perspectives may help explain some disorders 1. Medical model Philippe Pinel Not any type of possession, but a mental sickness Moral care and treatment No more being chained to a wall in filthy conditions Part of the mental health movement Psychopathology needs to be diagnosed on the basis of symptoms and cured through therapy and treatment Understanding disorders 2. Biopsychosocial Approach All behaviors, normal or not, come from interaction of genes and experiences Not just a matter of being sick, but in the wrong environment Different cultures have different prevalence of disorders Environments may attribute or cause the disorders Eating disorders, far more prevalent in the West Biopsychosocial Psychological Influences Biological influences •Stress •Evolution •Trauma •Individual genes •Learned helplessness •Brain structure and chemistry •Mood related perceptions and memories PSYCHOLOGICAL DISORDER Social Cultural influences •Roles •Expectations •Definitions of normality and disorder Classifying disorders Classifications not only used to describe symptoms but to predict future courses Diagnostic and Statistical Manual of Mental Health Disorders DSM-V Defines a diagnostic process and 16 syndromes No explanation of causes International Classification of Diseases (ICD) Covers both medical and psych disorders 16 syndromes of DSM IV under Axis 1 p.566 (Clinical Diagnoses) Disorders diagnosed during infancy, childhood and adolescence Delirium, dementia, amnesia and other cognitive disorders Mental disorders due to a general medical condition (organic disorders) Substance related disorders Schizophrenia and other psychotic disorders Mood disorders Anxiety disorders Somatoform disorders Factitious disorders (intentionally faked) Dissociative disorders Eating disorders Sexual disorders and gender identity disorders Sleep disorders Impulse control disorders not classified elsewhere Adjustment disorders Other conditions that may be a focus of clinical attention DSM-IV Gives guidelines for classifications, not explanations for disorders 5 Axes that ask questions Axis 1 Is a Clinical Syndrome present? Axis 2 Is a personality disorder/ mental retardation present? Axis 3 Is a general medical condition present (diabetes)? Axis 4 Are there psychosocial or environmental problems present (schooling or housing)? Axis 5 What is the Global Assessment? Labeling Disorders Problems with labels Once a label is applied, hard to see past it Automatically view that person differently Self fulfilling prophecy “Gifted” Beneficial for diagnosis and communicating for effective treatments Anxiety Disorders Public speaking, heights, performance Distressing, persistent anxiety or maladaptive behaviors that reduce anxiety 5 basic disorders Anxiety Disorders 1. Generalized Anxiety Disorder Continually tense, apprehensive, and in a state of autonomic nervous system arousal Mostly women (about 2/3) A person cannot seem to identify their cause of stress Often associated with depression/depressed mood Jittery, sleep deprived High blood pressure Passes with age – very rare by age 50 Emotions mellow over time Anxiety Disorders 2. Panic Disorder An Anxiety Tornado Comes on suddenly and will disappear Panic Attacks – minutes long intense fear that something terrible is going to happen Can be misperceived as a heart attack Anxiety Disorders 3. Phobias Irrational fears that causes a person to avoid some object, activity, or situation Specific phobias – fear of certain animals, insects, blood, things Social phobias – extreme shyness and avoidance of others. Fear of being judged by others Afraid of the fear, so avoidance of all things Anxiety Disorders 4. Obsessive Compulsive Disorder OCD When behaviors cross the line and persistently interfere with everyday living and cause distress Can be extremely debilitating More common with teens and young adults Common compulsions – excessive hand washing, bathing, grooming, rituals, checking locks, windows Common obsessions – germs, something terrible happening, symmetry, order, neatness Anxiety Disorders 5. Post-traumatic Stress Disorder (PTSD) Haunting memories, nightmares, social withdrawal, jumpy anxiety and or insomnia The higher the emotional distress during trauma, the more likely to develop PTSD Post traumatic growth Positive psychological changes as a result of struggling with extremely challenging circumstances and life crises Understanding Anxiety Learning Perspective Fear Conditioning Exposure to something that causes harm can lead to anxiety Stimulus generalization –attacked by a dog, afraid of all dogs Reinforcement – maintains our phobias after they arise Returning to the scene of the crime Washing hands or going inside to relieve anxiety Observational Learning Watching others fears may cause us to develop our own Understanding Anxiety Biological Perspective Natural Selection Genes We seem to be afraid of the same things that would have caused harm to our ancestors Those without these fears would have been more likely to not survive Fearfulness can run in families (monkeys) Identical twins often develop similar phobias Anxiety Gene? Impacting serotonin or glutamate The Brain Over arousal of brain areas involved in impulse control (anterior cingulate cortex) Mental hiccups of repeating thoughts Somatoform Disorders Disorder that takes a somatic (bodily) form without any apparent physical cause Vomiting, dizziness, blurred vision/blindness, difficulty swallowing, prolonged pain Conversion Disorder – a psychological cause of a physical ailment Limbs going numb without any cause People don’t seem to mind – indifferent Hypochondriasis – interpreting normal discomfort as symptoms of a terrible disease Dissociative Disorders Disorders of consciousness Sudden loss of memory Change in identity Could be caused by overwhelming stress Dissociative fugue – losing memory of yourself Dissociate – become separated from painful memories, thoughts, and feelings Dissociative Identity Disorder 2 or more distinct identities are present alternately controlling the person’s behavior Each personality has its own voice and mannerisms Jekyll and Hyde The Hillside Strangler Used to be called Multiple Personality Disorder Understanding DID Is it a real disorder or just a an extension of our capacity to shift our personality? Outside the US, not very common diagnosis Extreme versions of our self? Often referred to as being possessed Creates distinct changes in brain activity, can it be a different personality? Mood Disorders 2 major types 1. Major Depressive Disorder At least 5 signs of depression last two or more weeks without drugs or medication Lethargy Worthlessness Loss of interest in family, friends, or activities Mood Disorders Bipolar Disorder More than just recovering from bouts of depression Extreme mood swings from euphoric, hyperactive to deep depression Mania can fuel creativity Walt Whitman, Virginia Woolf, Mark Twain, Ernest Hemingway Understanding Mood Disorders Many behavioral and cognitive changes occur with depression Women are 2x as likely to have depression Lethargic and unmotivated More sensitive to negative happenings Expect more negative outcomes These disappear when the mood lifts Begins in adolescence Most depressive moods self terminate Understanding Biological Perspective Mood disorders run in families Twin studies 1 identical twin with a disorder, odds are 1 in 2 that at some time the other will as well Mood disorders are often related to close biological relatives Neurotransmitters Much smaller odds in fraternal Adoption Bipolar – 7/10 Norepinephrine – mood booster absent (too much during manic state) Serotonin – also scarce Brain is slower or inactive in areas during depressed states Exercise can help boost neurotransmitters and activate brain areas Understanding Social Cognitive Perspective Depression is a whole body disorder Self defeating beliefs and negative explanatory style Learned helplessness Thoughts and moods interact More common in women than men Stable, global and internal Its going to last forever, everything I do is wrong, its all my fault Vicious Cycle of Depression Negative/Stressful experience Cognitive and behavioral changes Negative explanatory style Depressed mood Personality Disorders Inflexible and enduring patterns of behavior that impair social functioning Avoidant personality disorder Anxiety and sensitivity to rejection Schizoid personality disorder Emotionless disengagement Rich fantasy life, no desire for connection with others Histrionic personality disorders Impulsive behaviors, attention getting Narcissistic personality disorders Self focused, self inflating Antisocial Personality Disorder Most researched Usually male, noticeable before the age of 15 Formally called psychopaths or sociopaths Often become criminals If Antisocial disorder is combined with high intelligence, it can be very dangerous Remorseless criminals, no feeling for victims Henry Lee Lucas BTK Understanding Antisocial Twin studies have shown a possible genetic link It has been detected in children as young as 3 Reduced activity in frontal lobes Where inhibition is located Passed down through genes? Australia? Research does indicate genes AND environment can correlate with criminal behavior Schizophrenia Almost 1 in 100 people will develop schizophrenia Schizophrenia “split mind” Split from reality Thinking is fragmented, bizarre and distorted by false beliefs (delusions) Paranoid – delusions of persecutions Breakdown in selective attention – no filter Schizophrenia Perceptions Hallucinations Seeing, feeling, smelling, tasting things Most often auditory Inappropriate emotions and actions Crying when others are laughing Flat affect – having no emotion Schizophrenia Onset Usually comes on in early adulthood No more in men than women Cluster of disorders Positive symptoms – hallucinations, emotions Negative – toneless voices, mute, rigid, waxy flexibility Schizophrenia Subtypes Paranoid – Disorganized Immobility/waxy flexibility Undifferentiated Emotional behavior and speech Catatonic Persecution or grandiosity Many varied symptoms Residual Withdrawal after hallucinations have disappeared Schizophrenia Brain abnormalities Dopamine over activity 6x the normal level Intensifies brain signals Dopamine blockers impact positive symptoms Abnormal brain anatomy Neural signals out of sync Activity in the amgydala and thalamus Enlarged, fluid filled areas in the cerebral tissue Shrinkage in other areas Schizophrenia Maternal Virus during pregnancy If mom gets the flu at midpoint of pregnancy Areas where disease spreads more rapidly Viral infections while pregnant do show a correlation with increased rates of schizophrenia Schizophrenia Genetic Factors Adopted children rarely develop the disorder if the adopted parents have it Much more likely to develop if it runs in the family Odds 1 in 100 develop schizophrenia 1 in 10 if a family member has it (including fraternal twins) 1 in 2 if an identical twin does Rates of Disorders NIMH estimates 26% of adult Americans suffer from a diagnosable disorder at some point during the year Generalized Anxiety – Social Phobias – Phobia of a specific object – Mood disorder OCD – Schizophrenia – PTSD – ADHD – 3.1% 6.8 8.7 9.5 1.0 1.1 3.5 4.1 Prevalence 2x as likely to develop if living under the poverty line Does one cause the other? 75% of disorders appear after 24 Antisocial most recognizable at youngest age