Download Abnormal Psychology

Chapter 10
Abnormal Psychology
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Topics to Explore
1. Defining & Classifying Disorders
2. Three Categories of Disorders
3. Treatment of Mental Disorders
Part 1
Defining & Classifying
Mental Disorders
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What is Abnormal Psychology?
Abnormal Psychology: the scientific study of mental
disorders and their treatment
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Ways of Defining “Abnormal”
Subjective Discomfort: Feelings of anxiety, depression,
or emotional distress. But people we would consider
definitely abnormal may not feel subjective discomfort.
Social Nonconformity: Disobeying societal standards for
normal conduct; usually leads to destructive or selfdestructive behavior. But it doesn’t always. Is being a
nonconformist always a disorder? 1984!
Statistical Abnormality: Having extreme scores on some
dimension, such as intelligence, anxiety, or depression.
But having a numerically rare characteristic isn’t always a
disorder (e.g., having an IQ of 180)
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Statistically Abnormal
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Two Considerations
Situational Context: Social situation, behavioral setting, or
general circumstances in which an action takes place
Is it normal to walk around strangers naked? If you are in a
locker room and in the shower area, yes!
Cultural Relativity: Judgments are made relative to the
values of one’s culture
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Three Criteria for Abnormality
Maladaptive Behavior: Behavior that makes it difficult to
function, to adapt to the environment, and to meet everyday
demands
Significant impairment in psychological functioning:
Those with mental illness lose the ability to control thoughts,
behaviors, or feelings adequately
Atypical behavior: behavior that is not typical of the
majority of the population
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DSM-IV
DSM-IV: Diagnostic and Statistical Manual of Mental
Disorders.
Published by the American Psychiatric Association.
Provides a classification system of mental disorders.
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Some DSM-IV Categories
• Mood Disorders
• Adjustment Disorders
• Anxiety Disorders
• Personality Disorders
• Somatoform Disorders
• Disorders First Diagnosed in
Childhood
• Factitious Disorders
• Dissociative Disorders
• Sexual & Gender Identity
Disorders
• Organic Mental Disorders
• Substance Related Disorders
• Schizoprenia Disorders
• Eating Disorders
• Paranoid Disorders
• Sleep Disorders
• Impulse Control Disorders
General Risk Factors
for Mental Illness
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Social Conditions: Poverty, homelessness, overcrowding,
stressful living conditions
Family Factors: Parents who are immature, mentally ill,
abusive, or criminal; poor child discipline; severe marital or
relationship problems
Psychological Factors: Low intelligence, stress, learning
disorders
Biological Factors: Genetic defects or inherited vulnerabilities;
poor prenatal care, head injuries, exposure to toxins, chronic
physical illness, or disability
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Incidence of Mental Disorders
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Clarifying Some Terms
Insanity: A legal term; refers to an inability to manage one’s affairs
or to be aware of the consequences of one’s actions
• Those judged insane (by a court of law) are not held legally
accountable for their actions
• Can be involuntarily committed to a psychiatric hospital
• Some movements today are trying to abolish the insanity plea and
defense; desire to make everyone accountable for their actions
Neurosis: Archaic; once used to refer to excessive anxiety,
somatoform, dissociative disorders, and some kinds of depression
Part 2
Three Major Categories
of Mental Disorders
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Anxiety Disorders
Anxiety: Feelings of apprehension, dread, or uneasiness
Anxiety Disorder: a disorder in which excessive anxiety
leads to personal distress and atypical, maladaptive, and
irrational behavior
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Specific Phobias
Specific Phobias: Irrational, persistent fears, anxiety, and
avoidance that focus on specific objects, activities, or
situations
People with phobias realize that their fears are unreasonable
and excessive, but they cannot control them
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Social Phobia
Social Phobia: Intense, irrational fear of being observed,
evaluated, humiliated, or embarrassed by others (e.g., shyness,
eating, or speaking in public)
Those with social phobia avoid social situations, such as eating,
writing, or speaking in public.
Social phobias impair functioning at work, at school, and in
personal relationships.
Estimate that 13% of all adults affected by social phobias at
some time. Examples: Barbra Streisand, Woody Allen perhaps?
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Agoraphobia
Agoraphobia: Intense, irrational fear that a panic attack will
occur in a public place or in an unfamiliar situation
• Intense fear of leaving the house or entering unfamiliar
situations
• Can be very crippling
• Literally means fear of open places or market (agora)
• Can occur with or without accompany panic disorder.
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Panic Disorder
Panic Disorder: A chronic state of anxiety with brief moments
of sudden, intense, unexpected panic (panic attack)
Panic Attack: Feels like one is having a heart attack, going to
die, or is going insane. Symptoms include vertigo, chest pain,
choking, fear of losing control
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Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD): Duration of at least six
months of chronic, unrealistic, or excessive anxiety
Symptoms: sweating, racing heart, clammy hands, dizziness,
upset stomach, rapid breathing, irritability, poor concentration.
More common in women than in men.
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Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD): Extreme preoccupation
with certain thoughts and compulsive performance of certain
behaviors
Obsession: Recurring images or thoughts that a person cannot
prevent.
• Cause anxiety and extreme discomfort
• Enter into consciousness against the person’s will
•Most common: Being dirty, wondering if you performed an action
(turned off the stove), or worrying about violence (being hit by a car)
Compulsion: Irrational acts that person feels compelled to repeat
against his/her will
•Help to control anxiety created by obsessions
•Most compulsions involve either checking or cleaning something.
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Mood Disorders
Mood Disorders: Major disturbances in emotion, such as
depression or mania
Depressive Disorders: Sadness or despondency that are
prolonged, exaggerated, or unreasonable
Bipolar Disorders: Involve both depression and mania or
hypomania
Childbirth-related
Mood Disorders
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Maternity Blues: Mild depression that lasts for one to two days
after childbirth
•Marked by crying, fitful sleep, tension, anger, and irritability
•Brief and not too severe
Postpartum Depression: Moderately severe depression that
begins within three months following childbirth
•Marked by mood swings, despondency, feelings of
inadequacy, and an inability to cope with the new baby
•May last from two months to one year
•Part of the problem may be hormonal
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Psychotic Disorders
Psychosis: Loss of contact with shared views of reality
Delusions: False beliefs that psychotic individuals insist are
true, regardless of overwhelming evidence against them
Hallucinations: Imaginary sensations, such as seeing,
hearing, or smelling things that do not exist in the real world
•Most common psychotic hallucination is hearing voices
•Note that olfactory hallucinations sometimes occur with
seizure disorder (epilepsy)
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Other Psychotic Symptoms
Flat Affect: Lack of emotional responsiveness; face is frozen in
blank expression
Disturbed Verbal Communication: Garbled and chaotic
speech; word salad
Personality Disintegration: Uncoordinated thoughts, actions,
and emotions
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The Mad Hatter
In Lewis Carroll’s time, hatmakers were heavily exposed to mercury
used in making felt. Many suffered brain damage and became
psychotic; thus, the Mad Hatter.
Schizophrenia:
The Most Severe Disorder
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Schizophrenia: Psychotic disorder characterized by
hallucinations, delusions, apathy, thinking abnormalities, and
“split” between thoughts and emotions
Does NOT refer to having split or multiple personalities
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Four Types of Schizophrenia
Disorganized Type: Incoherence, grossly disorganized
behavior, bizarre thinking, and flat or inappropriate emotions
Catatonic Type: Marked by stupor, unresponsiveness,
posturing, and mutism
Paranoid Type: Preoccupation with delusions; also involves
hallucinations that are related to a single theme, especially
grandeur or persecution
Undifferentiated Type: Any type of schizophrenia that does
not have paranoid, catatonic, or disorganized features or
symptoms
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Causes of Schizophrenia
Psychological Trauma: Psychological injury or shock, often
caused by violence, abuse, or neglect
Disturbed Family Environment: Stressful or unhealthy
family relationships, communication patterns, and emotional
atmosphere
Deviant Communication Patterns: Cause guilt, anxiety,
anger, confusion, and turmoil
Stress-Vulnerability Hypothesis: Combination of
environmental stress and inherited susceptibility cause
schizophrenic disorders
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Biochemical Causes
Biochemical Abnormality: Disturbance in brain’s chemical
systems or in the brain’s neurotransmitters
Dopamine: Neurotransmitter involved with emotions and
muscle movement. Works in limbic system
Dopamine overactivity in brain may be related to
schizophrenia
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Genetic Predisposition
PET Scans of
Normal & Schizophrenic Brains
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Schizophrenic Patients
10 Years Later
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Part 3
Treatment of Mental Disorders
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Types of Therapists
•
Clinical psychologist: has doctoral degree in clinical psychology;
provides therapy for people with mental disorders
•
Counseling psychologist: has doctoral degree in psychological or
educational counseling; counsels people with milder problems
•
Psychiatrist: has medical degree with residency in mental health,
provides therapy for people with mental disorders and is only type of
therapist who can prescribe drugs or other biomedical treatment
•
Psychoanalyst: Any of the above types of credential, but with
training in psychoanalysis from a psychoanalytic institute
•
Clinical social worker: has master’s or doctoral degree in social
work with specialized training in counseling; provides help with social
problems, such as family problems.
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Biomedical Therapies
Biomedical therapies: medical treatment for mental disorders;
includes drug therapy and medical procedures treating the brain
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Pharmacotherapy
Pharmacotherapy: Use of drugs to alleviate emotional
disturbance; three classes:
Antianxiety (Minor Tranquilizers): Produce relaxation or reduce
anxiety (Valium, Lithium, Zanax)
Antidepressants: Elevate mood and combat depression (Elavil,
Paxil, Prozac, Zoloft)
Antipsychotics (Major Tranquilizers): Tranquilize and also
reduce hallucinations and delusions in larger dosages
(Thorazine, Clozaril)
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Problems with Drug Therapy
• There can be serious side-effects (tranquilizers can cause
neurological disorders; Clozaril associated with a fatal blood
disorder)
• Drugs do not cure the disorder; they only ameliorate the
symptoms.
• Reliance on drugs increase belief in the “quick fix”; belief that
any disorder can be cured with a pill.
• Generally, psychotherapy is needed in addition to medication.
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Shock Therapy
Electroconvulsive Therapy (ECT): Electric shock is passed
through the brain inducing a convulsion.
• Based on belief that seizure alleviates depression by altering
brain chemistry
• Used in treatment of depression
• Produces only temporary improvement
• Causes permanent memory loss in many patients
• Should only be used as a last resort
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Psychosurgery
Psychosurgery: Any surgical alteration of the brain
Prefrontal Lobotomy: Frontal lobes in brain are surgically cut
from other brain areas
• Supposed to calm people who did not respond to other forms
of treatment
• Was not very successful
Deep Lesioning: Small target areas in the brain are destroyed
by using an electrode
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What is Psychotherapy?
Psychotherapy: Any psychological technique used to facilitate
positive changes in personality, behavior, or adjustment;
Some types of psychotherapy:
Psychoanalysis: therapy based on Freud’s theory
Client-centered therapy: based on Humanism
Behavioral and Cognitive therapies
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Psychoanalytic Techniques
Main Goal of Psychoanalysis: To resolve internal conflicts that
lead to emotional suffering
Free Association: Saying whatever comes to mind, regardless
of how embarrassing it is. By doing so without censorship and
censure, unconscious material can emerge
Dream Analysis: Dreams express forbidden desires and
unconscious feelings
• Latent Content: Hidden, symbolic meaning of dreams
• Manifest Content: Obvious, visible meaning of dreams
• Dream Symbols: Images in dreams that have personal or
emotional meanings
Psychoanalytic Techniques,
continued
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Analysis of Resistance: analysis of blockage in flow of ideas;
topics the client resists thinking about or discussing.
Resistances reveal particularly important unconscious conflicts
Analysis of Transference: analysis of tendency to transfer
feelings to a therapist that match those the patient has for
important people in his or her past. The patient might act like
the therapist is a rejecting father, loving mother, etc.
Client-Centered (Humanistic)
Therapies
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Client-Centered Therapy (Rogers): Nondirective and based on
insights from conscious thoughts and feelings
Effective therapist must have four basic conditions
• Unconditional Positive Regard: Unshakable acceptance of
another person, regardless of what they tell the therapist or how
they feel
• Empathy: Ability to feel what another person is feeling; capacity to
take another person’s point of view
• Authenticity: Ability of a therapist to be genuine and honest about
his or her feelings
• Reflection: Rephrasing or repeating thoughts and feelings of the
clients; helps clients become aware of what they are saying
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Humanistic Therapies
Existential Therapy: An insight therapy that focuses on
problems of existence, such as meaning, choice, and
responsibility; emphasizes making difficult choices in life
Therapy focuses on death, freedom, isolation, and
meaninglessness
Free Will: Human ability to make choices. You can choose to
be the person you want to be
Confrontation: Clients are challenged to examine their values
and choices
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Behavioral Therapies
Behavior Therapy: Use of learning principles to make
constructive changes in behavior
Behavior Modification: Using any classical or operant
conditioning principles to directly change human behavior
• Deep insight is often not necessary
• Focus on the present; cannot change the past, and no reason
to alter that which has yet to occur
• Can also use classical conditioning techniques
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Behavioral Therapies
Aversion Therapy: Associate a strong aversion to an
undesirable habit like smoking, overeating, drinking alcohol, or
gambling
Flooding: client is exposed to feared object or situation.
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Behavioral Therapies
Systematic Desensitization: Guided reduction in fear, anxiety,
or aversion; attained by approaching a feared stimulus gradually
while maintaining relaxation
• Best used to treat phobias: intense, unrealistic fears
• Hierarchy: Rank-ordered series of steps, amounts, or degrees
• Reciprocal Inhibition: One emotional state is used to block
another (e.g., impossible to be anxious and relaxed at the same
time)
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Cognitive Therapy
Cognitive Therapy: Therapy that helps clients change
thinking patterns that lead to problematic behaviors or
emotions
Selective Perception: The tendency to screen out information with
which we aren’t comfortable or what we do not consider relevant.
Overgeneralization: Allowing upsetting events to affect unrelated
situations. :
Example: John makes a mistake while speaking in a meeting at work. He
thinks to himself, "This always happens to me, I will never be any good in
meetings." This defeating thought was an overgeneralization.
All-or-Nothing Thinking: Seeing objects and events as absolutely
right or wrong, good or bad, and so on
Cognitive therapy is VERY effective in treating depression, shyness, and
stress
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Rational Emotive Therapy
Rational Emotive Behavior Therapy (Albert Ellis): Attempts to
change irrational beliefs that cause emotional problems
Common Sense:
Activating Event  Consequence (feelings, behavior)
Rational Emotive View:
Activating Event  Beliefs  Consequence (feelings, behavior)
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Rational Emotive Therapy