Download What Behaviors Are Abnormal?

Intro to Psychological Disorders
OCD
General Psych 2
Module 43
November 6, 2003
Class #20
Some definitions of abnormality…

Stratton & Hayes (1993)

These researchers define abnormality as:
 Behavior which deviates from the norm
 Most people don’t behave that way
 Behavior which does not conform to social
demands
 Most people don’t like that behavior
 Behavior which is maladaptive or painful to the
individual
 Its not normal to harm yourself
What Behaviors Are Abnormal?

How do we define what is abnormal?
The culture’s perspective
 The generation’s perspective
 The individual’s perspective

The Culture’s Perspective

Deviance

Here, we are looking at the degree in which an
individual’s behavior differs from cultural norms


Standards of acceptability vary from culture to culture
But to be considered disordered, the atypical
behavior must also be disturbing to other people
The Culture’s Perspective

Rationally Unjustifiable

If someone claims to be hearing mysterious voices
and claims to be talking to God (or to a lost relative,
etc.) we would likely consider there to be a problem
unless they could convince us that the voices were
real…
The Generation’s Perspective

Standards of acceptability also vary from
generation to generation

Example: Homosexuality
The Individual’s Perspective



Distress
 Does the individual feel psychological pain?
Disability
 Does the behavior interfere with the person’s ability
to function personally, socially, or occupationally?
Many psychologists believe this is the best
criterion for determining the normality of behavior
– does it foster individual and group well-being?
A Little History of Mental Illness…

The Good Old Days


Trephination
 An operation performed since Stone Age times
 A circular section of the skull is carved away, leaving a
hole in the skull allowing for “evil spirits” to be released
 Interestingly, most of these patients survived
Some were considered witches…
 Submerged into water – if they drowned it was felt they
weren’t really witches
 Thousands of women were killed in this manner during
13th-16th century
The Age of Enlightenment

Physiological Treatment

Bleeding


Fear


Excessive blood in the brain
Put in coffin-like box and submerged in water until
bubbles from the patient’s breathing had ceased to come
to the surface at which point the person was revived…
Drugs

The use of alcohol, opium, and marijuana were used to
try to cure these individuals
The Age of Enlightenment

Asylums
During this time, places where the mentally ill were
cared for began to surface
 Before this, these people were treated as criminals
and put in jails or prisons
 A medical model where psychological disorders were
considered to be sicknesses that could be cured
through therapy at a psychiatric hospital became the
prevailing viewpoint

Bedlam

Hospital of St. Mary of Bethlehem (established
officially in 1500’s)
 Bedlam – “lunatics” were treated cruelly…if
they became too excited they were chained out
of harm’s way and often beaten or doused with
water
 Visitors would pay a small fee to be allowed to
go in and ridicule the patients for entertainment
purposes
 The crowds would often become very noisy
and disorderly themselves – hence, the name
Removing the chains…

Philippe Pinel
Institutes a medical model – that these
psychological disorders were sicknesses
 That psychopathology needs to be diagnosed on the
basis of its symptoms and cured through therapy
 He removed the chains from the mentally ill and
his treatment consisted in large part along the
lines of a good diet, encouragement, and the least
restrictive setting – in general, many of the
components of psychotherapy

The Modern Era

Psychological processes
 Suggestion and hypnotism
Bio-psycho-social Perspective

Mental disorders are seen as caused by the combination
and interaction of:



Biological Factors: Includes physical illnesses and disruptions
of bodily processes that may in part be due to genetic
predispositions
Psychological Factors: Includes psychological processes such
as our wants, needs, and emotions; our learning experiences;
and our way of looking at the world
Sociocultural Factors: Includes the social and cultural context
that form the background of the abnormal behavior
Diagnostic and Statistical Manual
(DSM-IV)


The behavior pattern of all psychological
disorders were not clearly described until the
publication of the APA’s first diagnostic and
statistical manual (DSM-I) in 1952
DSM-IV defines 17 major categories of mental
disorder
Purposes of Diagnostic System


Designed to determine nature of client’s
problems
Once characteristics are understood, problem’s
probable course can be predicted and most
appropriate method of treatment can be
administered
Problems With Diagnostic System





Some critics believe that now there are too many
behaviors are considered to be within “the compass of
psychiatry” – only about 60 in DSM-I and now about
400
People’s problems often do not fit neatly in one
category
The same symptoms appear as part of more than one
disorder
Possibility of personal bias due to the somewhat
subjective nature of diagnostic judgments – some feel
these are “value judgments masquerading as a science”
Labeling people may be dehumanizing
Rosenhan (1973):
Does madness lie in the eye of the observer?


This study addressed the following question?
Do the characteristics of abnormality reside in
the patients or in the environments in which
they are observed?
An astonishing study:
On being sane in insane places

The brave volunteers…
 EIGHT
sane people!
 A pediatrician
 A painter
 Two housewives
 One graduate student
 Three psychologists (including David
Rosenhan)
What did they do?

The procedure
Participants telephoned 12 psychiatric hospitals for
an urgent appointment (in five USA states)
 When arriving at admissions they gave false name
and address
 But did give other ‘life’ details correctly

What else did they do?
They complained of hearing unclear voices
… saying “empty, hollow, thud”
 Said the voice was unfamiliar, but was the
same sex as themselves

What happened?




All were admitted to hospital
All but one were diagnosed as suffering from
schizophrenia
Once admitted the ‘pseudo-patients’ stopped
simulating ANY symptoms
They had agreed to stay until they
convinced the staff they were sane!!
What happened on the wards?

Took part in all ward activities:
 The pseudo-patients were never detected
 All pseudo-patients wished to be discharged
immediately
 BUT – as they had agreed to before the
experiment – they waited patiently until they
were diagnosed as ‘fit to be discharged’
How did the ward staff see them?

Normal behavior was misinterpreted…
Writing notes was described as…
 “The patient engaged in writing behaviour”
 Arriving early for lunch described as…
 “Oral acquisitive syndrome”
 Behavior distorted to ‘fit in’ with theory

The pseudo-patient’s observations…

If they approached nurses or attendants with
simple requests:
88% ignored them completely – walked away with
head averted
 Only 10% even made eye contact
 Just 2% stopped for a chat
 1283 attempts

The pseudo-patient’s observations…

If they approached the psychiatrists with simple
requests:
71% ignored them – walked away with head averted
 Only 23% made eye contact
 Just 2% stopped for a chat
 185 attempts

How long did they stay in hospital?

The shortest stay was 7 days

The longest stay was 52 days

The average stay was 19 days
They were treated in the same
way as the real patients...

Given total of 2100 medication tablets
They flushed them down the toilets
 Noted that other patients did the same and that this
was ignored as long as patients behaved themselves !!

DID ANYONE SUSPECT?

What do you think – did anyone suspect it was a
hoax?
On release…

The pseudo-patients were diagnosed as
 Schizophrenia
“IN REMISSION”
Rosenhan (1973b):
The follow up study
A teaching & research hospital was told
of the first study and warned that …
 Over the next three months ONE
OR MORE pseudo-patient would
attempt to be admitted in their
hospital as well…

What happened?

Staff members rated ‘new patients’ on scale 1 10 as ‘how likely to be a fraud’…

193 patients ‘assessed’
 41 rated as a pseudo-patient (by staff)
 23 rated as pseudo-patient (by psychiatrist)
 19 rated as pseudo-patient (by both)
How many of these SUSPECTS
were pseudo-patients?
 NONE

No pseudo-patients were sent
 Staff were rating their regular intake
Rosenhan’s conclusion…..

“It is clear that we are unable to distinguish
the sane from the insane in psychiatric
hospitals”…
In the first study
 They were unable to detect ‘sanity’
 In the follow up study
 They were unable to detect ‘insanity’

Rosenhan’s study highlighted…


The depersonalisation and powerlessness of
patients in psychiatric hospitals
That behavior is interpreted according to
expectations of staff and that these expectations
are created by the labels SANITY & INSANITY
A comment…



Although, the pseudo-patients described
their stay in the hospitals as a negative
experience
This is not to say that REAL patients have
similar experiences
Real patients do not know the diagnosis is
false & are NOT pretending
Some questions…


Was this study ethical?
Why might the reports of the pseudopatients have been unreliable?
The power of labels to stigmatize…

Page (1977)
Is the room still available for rent?
 Yes – over 95% of the time
 I’m just about to be released from the mental
hospital and was wondering is the room still
available for rent?
 Yes – only about 25% of the time
 I’m calling for my brother who is about to be
released from jail and was wondering is the
room still available for rent?
 Yes – only about 25% of the time

Obsessive-Compulsive Disorder (OCD)

To be diagnosed with OCD, a person must
have recurrent obsessions and compulsions
that are disabling

Significantly interfere with a person’s routine,
making it difficult to work, or to have a normal
social life or relationships
Prevalence and Onset

Prevalence



Life-time prevalence
 Afflicts 2%-3% of population some time in their lives
Group differences
 No sex differences
 Knows no geographic, ethnic, or economic
boundaries
Onset
About two-thirds develop the disorder before they are
25 years old and only 15% after the age of 35
 Onset after 40 is very rare

Obsessions

Constant, intrusive, unwanted thoughts causing
distressing emotions such as anxiety or disgust

Examples:
 Thoughts of violence (person feels he/she will
hurt someone)
 Thoughts of contamination (germs)
 Thoughts of uncertainty (did I lock the door?)
Compulsions


Compulsions are urges to do something to
lessen discomfort
Rituals are the behaviors in which these people
engage in to accomplish this
Common OCD Compulsions

Cleaning


Repeating


Feel harm will occur if they don't
Completing


Fear of germs, etc.
Exact order until perfection
Being meticulous

Exact place for things (ex: appearance of room, etc.)
OCD Compulsions





Avoiding
 Exaggerated avoidance of anxiety producing stimuli
Counting
 Compelled to count things (like how many steps it takes
to get somewhere)
Hoarding
 Constant collection of useless items
Slowness
 Tasks done extremely slowly
Excessive and Ritualized praying
 May pray literally all day long in a ritualized manner
Physiological Explanations




Scarcity of serotonin
In certain brain structures there are high levels
of brain activity (orbital frontal, etc.)
Brain damage
Genetics
Common Treatments for OCD



No treatment
Cognitive-Behavioral Therapy
Antidepressant Medications
If you can wait 40 years…

Skoog and Skoog (1999)
No treatment
 83% showed some improvement while 20% showed
complete recovery

Cognitive-Behavioral Therapy

This type of therapy is based on learning
(reconditioning specific behaviors) and changing
the beliefs (thinking processes) of the individual
suffering from OCD…
 Systematic
 Expose
desensitization
them to what is making them anxious
at increasing intervals…the idea here is that
by facing the thing that they fear a little at a
time they will eventually conquer the fear
 May have to start some off by having them
imagine the situation
Cognitive-Behavioral Therapy

Response prevention


Preventing the person from doing the compulsion or
mental act
Relaxation techniques

Cognitive techniques such as self-talk are often
combined with the above techniques
Cognitive-Behavioral Therapy

Effectiveness:
 60-80% of those using the cognitivebehavioral treatments improve (show at least
a partial reduction in symptoms)
Antidepressant Medications

Drugs that influence (increase) serotonin levels have been used
effectively
 Prozac, Zoloft, Paxil, Anafranil, etc.
 Drawbacks:
 High doses of these drugs may be required in the
treatment of OCD
 It can take several weeks to feel their beneficial effects
 Additionally, there are potential side effects to
consider
Prognosis


The disease is chronic for most people even
with drug treatment
Most take medication indefinitely, and about
85% of people relapse within one or two
months after discontinuing usage