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"Abnormal" Psychology Think about it... 450 million people worldwide suffer from psychological disorders A US government survey estimates that 15% of the population are in need of psychological therapy. TRUE or FALSE? 1. Very few people are actually affected by psychological disorders. 2. People sometimes forget a very traumatic event as a way of coping with the psychological stress of the trauma. 3. People whose illnesses are “all in their heads” do not really have symptoms of disease. 4. Depression is the most common type of psychological disorder. 5. Some people never feel guilty, even when they commit serious crimes. What is "normal"? Are psychological disorders genuine illnesses or socially defined categories? What is Abnormal Behavior??? Is abnormal behavior treatable? Can we prevent abnormality? What’s Normal? What’s Abnormal? How do we decide between these two terms? Finding a “lucky” seat in an exam. Being unable to sleep, eat, study, or talk to anyone else for days after a break-up. Breaking into cold sweat at the thought of being trapped in an elevator. Swearing, throwing pillows, and pounding fists on the wall in the middle of an argument with a friend or parent. Refusing to eat solid food for days at a time in order to stay thin. Having to engage in a thorough hand-washing after coming home from a ride on a bus or train. Believing that the government has agents who are listening in on telephone conversations. Drinking a six-pack of beer a day in order to be “sociable” with friends. DEVIANCE - 39% of ppl who confess to snooping in their host’s medicine cabinets - 30% of ppl who refuse to sit on a public toilet seat - 23% confess to not flushing all the time - 10% believe they’ve seen a ghost Kanner, 1995 NOT DEVIANT - 50% of ppl use the bathroom 6x/day - 97% write own name when trying out a new pen - 50% regularly sneak food into movie theaters - 57% report having experienced déjà vu Kanner, 1995 Questions to consider… How typical is the behavior of people in general? Is the behavior maladaptive? Does the behavior cause the individual emotional discomfort? Is the behavior socially unacceptable? Abnormal is... Any behavior that differs much from the average Any behavior that leads to distress (pain), disability (impaired functioning), or an increased risk of death, pain, or loss of freedom (DSM definition) Let people decide for themselves whether they are troubled? TYPICALITY MALADAPIVITY – the behavior impairs an individual’s ability to function adequately in everyday life; behavior that is hazardous to the individual or others EMOTIONAL DISCOMFORT – feelings of helplessness, hopelessness, suicidal thoughts SOCIALLY UNACCEPTABLE BEHAVIOR – culture must be considered (culture-bound syndromes) *Unjustifiable/disturbing to other people 4 Approaches to Abnormality The following can occur alone or an interaction can contribute towards abnormality 1) Distress 2) Impairment 3) Risk to Self or Other People 4) Socially and Culturally Unacceptable Behavior Norms vs. Culture Norms: A society’s Culture: People’s stated and unstated common history, rules for proper values, institutions, conduct. habits, skills, technology and arts. Would you consider this normal? Abnormal? Along the Niger River, men of the Wodaabe tribe put on elaborate makeup and costumes to attract women. In Western society, the same behavior would break behavioral norms and probably be judged abnormal Causes of Abnormality? Biological Psychological Socio-cultural The Two Models Medical - psychological disorders are sickness/diseases - etiology/prognosis Bio-psycho-social Model - abnormal behavior has 3 major aspects: biological, psychological, sociological Biopsychosocial Perspective Refers to the interaction in which biological, psychological, and sociocultural factors play a role in the development of an individual Diathesis Stress Model - People are born with a predisposition (or “diathesis”) that places them at risk for developing a psychological disorder. - This vulnerability could be genetic or due to earlier life experience. Table 1.1 Causes of Abnormality Biological Genetic Inheritance Medical Conditions Brain Damage Exposure to environmental stimuli Psychological Traumatic life experiences Learned associations Distorted Perceptions Faulty ways of thinking Sociocultural Disturbances in intimate relationships Problems in extended relationships Political of social unrest Discrimination toward one’s social group Biological Causes Biological determinants? • Use of Medication • Brain damage; exposure to toxins Genetics • PD’s do sometimes run in families • E.g., MDD Medical Ailments Environmental Contributor Psychological Causes Disturbances often arise from an emotional, distressing or troubling life experience Interpersonal experience • Events that take place in interactions w/ other people Intrapsychic • Those that take place w/in thoughts and feelings Sociocultural Causes What does sociocultural mean? R.D. Laing (1964) • “people who refuse to abide by the norms of this society are psychologically healthier than those who blindly accept and live by such restrictive social norms” Thomas Szasz (1961) • “Problems with living” vs. “sick” • Trouble stems from a “mismatch b/w personal needs and society’s ability to meet those needs” The Human Experience of Psychological Disorders Myths of Mental Illness Creative people are a little “crazy” Ppl w/ mental disorders are dangerous Most older ppl are senile Criminals are born “bad” Asthma is caused by emotional problems Suicidal individuals rarely talk about suicide People wilth Schizophrenia have multiple personalities The Human Experience of Psychological Disorders Stigma, social reactions - People treat individuals suffering from a psychological disorder differently Why is stigma around PD’s and treatment a problem?? Social Cognitive Processes Cues 1) Psychiatric symptoms 2) Social Skill Deficits 3) Physical appearance 4) Labels Stereotypes Prejudice Discrimination Why do some psychologists criticize diagnostic labels? Classification DSM- IV- TR DSM V Diagnostic and Statistical Manual of Mental Disorders (DSM) First developed in 1952 by American Psychiatric Association Many revisions, movement away from the conceptualization of psychological disorders as emotional reactions History of DSM • DSM-IV (the 4th ed.) 1994 • DSM-IV-TR (4th ed., text revision) 2000 - Includes editorial revisions • Diagnostic and Statistical Manual of Mental Disorders - Provides both clinicians and researchers with a common language for delineating disorders - This helps professionals with differing backgrounds understand one another - This helps create confidence in labeling a ct or pt • Published by the American Psychiatric Assoc. DSM Concerns in developing the DSM-IV Reliability Validity Base Rates Social Context Mental Disorder What does this term mean to you? “Clinically Significant” • Consistently present over time • Dramatically affects daily life Syndrome • Collection of symptoms (observable actions) that form a definable pattern. • Based on client report of thoughts and feelings Assumptions of the DSM Medical Model • Disorders are viewed as diseases • MD’s usually use term “patient” and “mental disorder.” The latter = neg conotation Atheoretical Orientation • Descriptive, rather than explanatory • Describes Sx, not causes Categorical Approach Multiaxial System (described next!!!) NOTE: Neurosis: Term referring to behavior that involves distressing, unacceptable symptoms that are enduring and lack any physical basis. Not a modern diagnostic term Psychosis: Term referring to various forms of behavior involving a loss of contact with reality, such as delusions (false beliefs) and hallucinations (false perceptions) The 5 Axes of the DSM - V Axis I: Clinical Disorders Axis II: Personality Disorders and Mental Retardation Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Problems Axis V: Global Assessment of Functioning Axis I To be listed on Axis I Must be primary focus of clinical attention Typically, an overlay of an otherwise healthy personality E.g., substance related disorders; anxiety disorders, schizophrenia, depression Axis II Personality traits that are inflexible and maladaptive Usually a long standing condition E.g., Narcissism, OCPD, Borderline Can an individual have a diagnosis on Axis I and Axis II? Example?? Axis III Physical conditions can be the basis of psychological problems and should be documented. E.g., Lyme’s/Bells & Dep Ct. Also important b/c of medication interaction and causality Axis IV Negative life events E.g., problem with primary support group Details: parent died OR falling out with family All areas of this Axis are stressors which can contribute towards a dx on Axis I or II Axis V An overall judgment of functioning Consider psychological status, social functioning (including personal and work relationships) What’s normal? 65 and Up is generally high functioning Review 1. Define each of the following terms: phobia, dissociation, depersonalization, and mania. 2. What are obsessions and compulsions, and how are they related? 3. What fears are associated with each of the following phobias: agoraphobia, claustrophobia, and zoophobia? 4. What must occur before a psychologist will make a diagnosis of major depression? Adapted from Kessler et al., 2005 Who Seeks Therapy? This chart is based on U.S. Surveys Percentages represent individuals who have been in therapy at some point in their life -(Adapted from Fetto, 2002) Anxiety Disorders Generalized Anxiety Disorder Panic disorder Phobias OCD http://www.youtube.com/watch?v=45PVIo2968E http://www.youtube.com/watch?v=Rn1OYlYzgm8 PTSD Mood Disorders Major Depressive Disorder Dysthymic disorder Bipolar Disorder Other categories Substance-related Developmental-related Disorders - mental retardation, pervasive disorders, ADHD Age-related and Cognitive Disorders - Dementia, Alzheimer's Personality Disorders - Histronic, Narcissistic, Paranoid, Schizoid, Schizotypal, Avoidant, Antisocial, Borderline Schizophrenia Somatoform Disorders - Conversion, Body Dysmorphic, Hypchondrias Dissociative Disorders - Dissociative Amnesia, Diss. Fugue, Depersonalization Eating Disorders/Impulse Control Disorders - Anorexia, Bulimia, Kleptomania Sexual Disorders - Pedophilia, Exhibitionism, Fetishism, Sadism/Masochism