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					Psychological Disorders
      Chapter 13
         What is Abnormal?
• Abnormal - literally meanss “away from the
  normal” so Einstein was “abnormal.”
• Society: Abnormal behavior must be
  defined within the context of the society.
• A practial definition: Behavior is abnormal
  when it causes the individual or those
  around him discomfort, distress, or danger.
          A Brief History
• Primitive peoples - saw aabnormal
  behavior as a sign that the person was
  possessed by demons or spirits
• Golden age of Greece - Hippocrates and
  others viewed mental illness as a
  “natural” phenomenon like other illness
• Middle ages - a return to belief in
  possession and demonology. Knowledge
  was kept alive in the Islamic countries.
• Phillipe Pinel - In 1793 was made head of La
  Bicetre hospital in Paris and began a trend
  toward humane treatment
• Dorothea Dix - In the U. S. during the 1800s
  fought for the rights of the mentally ill
• A medical discovery - by 1900 it was
  discovered that “general paresis” (which
  included severe mental deterioration) was
  caused by syphilis (a physical disease). This
  gave rise to the “biological model” of mental
  illness
Approaches to Psychological Disorders

1 biological model: Disorders have a
  biochemical or physiological basis.
2 psychoanalytic model: Disorders
  result from unconscious internal
  conflicts.
3 cognitive-behavioral model: Disorders
  result from learning maladaptive ways
  of thinking and behaving.
  Approaches to Psychological
          Disorders
4 diathesis-stress model: A “diathesis”
  is a genetic or other biological
  predisposition or vulnerability. Under
  stress, a person may develop a disorder
  to which he/she is predisposed.
4 systems approach: Biological,
  psychological, and social risk factors
  combine to produce disorders. Also
  known as the “Biopsychosocial” model
  Classifying Psychological Disorders
• Diagnostic & Statistic Manual of Mental
  Disorders (4th edition) “DSM IV” Published
  by the American Psychiatric Association
• It is the most widely used classification system
  of psychological disorders.
• It is a listing of disorders, their symptoms, and
  statistical data (e.g., gender, age, differences)
• It does NOT specify treatments and does NOT
  list causes of disorders
     Prevalence and Incidence
• Prevalence - refers to how common a
  disorder is. For example, schizophrenia
  is rare (1% of the population) while
  depression is more common at about 3-
  4%
• Incidence - refers to the rate at which
  new cases occur. If the yearly incidence
  rate for depression is 1%, then there
  would be one new case for every hundred
  people in the population this year.
Basic Diagnostic Categories of DSM-IV
Basic Diagnostic Categories of DSM-IV
    Mood Disorders (affective disorders)

• Disorders in which one’s range of
  affect (mood) is restricted (as in
  depression) or expanded (as in bipolar
    disorder).
•   Major Depression
•   Dysthymia
•   Bipolar Disorder (formerly manic depression)
•   Cyclothymia
                Depression
• more than just a case of “the blues”
• overwhelming feelings of sadness
• lack of interest in activities and inability to
  experience pleasure
• excessive guilt or feelings of worthlessness
• changes in sleep, appetite, ability to
  concentrate
• possible suicidal thoughts or actions
             Major Depression
• very severe
• symptoms must be present for two weeks
• person may be unable to function normally
  and may need hospitalization

                 Dysthymia
• less severe but “chronic”or long lasting
• symptoms must be present for two years
• person can usually function but leads a very
  unhappy, painful, unfulfilling existence
              Bipolar Disorder

• Person experiences alternating episodes of
  depression and mania “mood swings”
• a manic state involves excess energy, racing
  thoughts, pressured speech, grandiosity,
  impulsive behavior, poor judgement


                Cyclothymia
• a less severe form of bipolar disorder
    Causes of Mood Disorders
• biological factors
  – genetics - mood disorders are more common in
    close relatives, esp. bipolar disorder
  – brain chemistry changes as a result of
    experience (e.g., stress or illness)
• psychological (cognitive) factors
  – cognitive distortions such as (1) all or none
    thinking (2) inaccurate maladaptive beliefs
• social factors/stressors
  – real or perceived loss or stress in various areas
                    Suicide
• myth - people who talk about it never do it
• fact - most people will give clues about their
  plans
• fact - more women attempt but more men
  complete, men use more lethal methods
• fact - people thinking of suicide will often give
  away possessions and “put their affairs in order”
• fact - suicide is becoming more common among
  teens and children
Gender, Race, & Suicide
          Anxiety Disorders
Disorders in which anxiety is a characteristic
  feature OR the avoidance of anxiety seems
  to motivate abnormal behavior.
• phobias
• panic disorder
• generalized anxiety disorder
• obsessive-compulsive disorder
          Phobic Disorders

• phobia: (from the Greek “phobos”) which
  means fear
• The person feels intense fear when
  confronted with the phobic object or
  situation. This may lead to a “panic
  attack.”
• The phobic person avoids the phobic
  object or situation. Some may endure it
  but with great anxiety and discomfort.
              Types of Phobias
• specific phobia: fear of a particular object or
  situation, common examples
  – insects, animals, blood/injury, heights,
    enclosed spaces, thunder, water, germs
• social phobia: excessive, inappropriate fears
  connected with social situations or
  performances in front of other people
• agoraphobia: fear of multiple situations, is
  almost always a consequence of “panic
  disorder”
              Panic Disorder
• panic attack: is a sudden, unpredictable,
  and overwhelming experience of intense
  fear or terror without reasonable cause.
• Hallmark symptoms: fear of dying, losing
  control, or going crazy, depersonalization,
  and derealization (things seeming weird)
• other symptoms: chest pain, increased
  heartbeat, dizziness, choking sensations,
  intense headache, tingling in arms or legs,
  terror of being left alone
• agoraphobia: fear and avoidance of places
  (1) in which help would not be available if
  needed and (2) from which escape would be
  difficult or embarassing
• typical situations: public transportation,
  large stores/malls, interstates, bridges,
  elevators, wilderness, theatres, sports
  arenas, concerts,
• panic disorder with agoraphobia: often,
  especially in women, panic attacks lead to
  fear and avoidance of places/situations in
  which panic attacks occurred
      Generalized Anxiety Disorder
• anxiety disorder characterized by prolonged
  vague fears that are not attached to any
  particular object or circumstance
• “chronic”: long term, almost a part of the
  person’s personality
• symptoms: sleep problems, muscle aches,
  digestive problems, headaches, inability to
  relax, constant worry, difficulty in
  concentration, headaches, etc.
Obsessive-Compulsive Disorder (OCD)
• The person is plagued by “obsessions”
  and/or “compulsions”
• obsessions: unwanted intrusive thoughts,
  obsessions often involve fear of making
  mistakes which might cause harm.
  Contamination and guilt are also common
  themes
• compulsions: behaviors/rituals that reduce
  anxiety caused by obsessions, classic
  compulsions are checking, and washing
    Posttraumatic Stress Disorder
              (PTSD)
• Results from a “traumatic” event that is
  “outside the normal range of human
  experience”
• Typical experiences are military
  combat, police action, natural disaster,
  accidents, and being a crime victim.
          Symptoms of PTSD
• re-experiencing of the trauma through
  – intrusive thoughts, dreams, and “flashbacks”
• avoidance of “trauma-related” stimuli
  – the person is made anxious by, and avoids,
    reminders of the trauma
• exaggerated startle and hypervigilence
• other symptoms and associated problems:
  – tension, sleep problems, depression, social
    withdrawal, explosiveness, suspiciousness of
    others, substance abuse
   Causes of Anxiety Disorders
• heredity: anxiety disorders do tend to run in
  families (esp. OCD)
• stress: triggers anxiety in predisposed
  people, the primary cause of PTSD
• learning: fears can be acquired via
  classical/operant conditioning or modeling
• “biological preparedness hypothesis”
  (Martin Seligman) We are prepared to
  become phobic of certain things as a result
  of our evolutionary history
       Psychosomatic Disorder
      (Psychophysiological Disorder)

• Disorders in which there is REAL
  physical illness that is largely caused
  by psychological factors such as stress
  and anxiety.
• Examples are hypertension, headaches,
  bruxism (teeth grinding), insomnia,
  ulcers, digestive problems, etc.
        Somatoform Disorders

There is an APPARENT physical illness
 for which no organic (physical) basis
 can be found
•   somatization disorder
•   conversion disorder
•   hypochondriasis
•   body dysmorphic disorder
       Somatization Disorder
• A somatoform disorder characterized by
  recurrent vague physical complaints with
  no apparent physical cause
• Typical are bachaches, headaches,
  dizziness, stomach pains, chest pains
• It is important to distinguish this from
  “malingering” or faking in which the
  person is “acting” sick to gain something
            Conversion Disorder
• complaints of a dramatic specific disability
  with no apparent physical cause (e.g.,
  paralysis, blindness, deafness)
        Classic Conversion Phenomena
• glove anasthesia: paralysis or numbness of
  the hand that does not conform to anatomy
• la belle indifference: “beautiful indifference”
  the person’s level of concern not consistent
  with the severity of the ailment
            Hypochondriasis
• The person interprets insignificant
  symptoms as signs of serious illness
• A series of headaches might convince the
  person he/she has a brain tumor
• Again, there is no organic evidence of
  such illness.
• Patients may “doctor shop” searching for
  one who will confirm their suspicions
     Body Dysmorphic Disorder
• a recent phenomenon found in
  developed western cultures
• the person becomes preoccupied with
  his or her imagined ugliness, usually of
  a particular body part
• plastic surgery is often sought
• probably has a lot to do with society’s
  obsession with beauty and appearance
Causes of Somatoform Disorders

• Causes are less well understood than
  for depression or anxiety
• Often “secondary gain” is a major
  cause
• By being sick, the person may
  unconsciously avoid work, child care,
  or other responsibilities
       Dissociative Disorders
Disorders in which some part of the
  personality seems separated from the
  rest. These are relatively rare.
• dissociative amnesia
• dissociative fugue
• dissociative identity disorder
• depersonalization disorder
       Dissociative Amnesia

• There is a loss of memory for past
  events (days, weeks, or years) without
  organic cause.
• Dissociative amnesia may result from
  an intolerable or painful experience
  such as physical or sexual abuse.
        Dissociative Fugue
• “fugue”: literally means to take flight
• a person suddenly leaves home and
  assumes a new identity, with amnesia
  for past identity and events.
• The person may emerge from the fugue
  weeks or months later in a strange city
  not knowing how he/she got there
      Dissociative Identity Disorder
• formerly called “multiple personality
  disorder” (MPD) or “split personality”
• a person has several distinct personalities
  that emerge at different times.
• a history of physical or sexual abuse in
  childhood is common
• borderline personality and eating disorders
  often co-occur
• this is NOT the same as schizophrenia
     Depersonalization Disorder
• A dissociative disorder whose main feature
  is that the person suddenly feels strange or
  different.
• Some describe it as an “out of body”
  experience.
• Because depersonalization is also a symptom
  of panic disorder (which is much more
  common), that disorder should be ruled out
  before making this diagnosis.
Causes of Dissociative Disorders
• The most widely accepted cause is that
  the person has experiences one or more
  traumatic experiences that they cannot
  bear to think about.
• By separating the personality into
  “parts,” the traumatic memories can be
  avoided.
• General psychological instability may
  also be a factor
          Sexual Disorders
DSM-IV classifies sexual disorders
  under two major divisions:
• sexual dysfunctions: loss or
 impairment in some aspect of the
 normal human sexual response
• paraphilias: Sexual disorders in which
 unconventional objects or situations
 become the focus of sexual interest
       Sexual Dysfunctions
Some sexual dysfunctions are physical but
     most have a psychological basis

• erectile disorder: The inability of a
  man to achieve or maintain an erection.
• female sexual arousal disorder: The
  inability of a woman to become
  sexually aroused.
        Sexual Dysfunctions
• sexual desire disorders: Disorders in
  which the person lacks sexual interest
  or has an active distaste for sex.
• sexual arousal disorder: Inability to
  achieve or sustain arousal until the end
  of intercourse in a person who is
  capable of experiencing sexual desire.
        Sexual Dysfunctions
• orgasmic disorders: Inability to reach
  orgasm in a person able to experience
  sexual desire and maintain arousal.
• premature ejaculation: In ability of a
  man to inhibit orgasm as long as desired.
• vaginismus: Involuntary muscle spasms
  in the outer part of the vagina that make
  intercourse impossible.
             Paraphilias
Paraphillias are primarily a “male”
  phenomenon. Classical and operant
  “conditioning” likely play a role.
• fetishism: A paraphilia in which a
  nonhuman object is the preferred or
  exclusive method of achieving sexual
  excitement.
• voyeurism: Desire to watch others
  having sexual relations or to spy on
  nude people.
• exhibitionism: Compulsion to expose
  one’s genitals in public to achieve
  sexual arousal.
• frotteurism: Compulsion to achieve
  sexual arousal by touching or rubbing
  against a non-consenting person in
  public situations.
• transvestic fetishism: Wearing the
  clothes of the opposite sex to achieve
  sexual gratification. (don’t confuse with
  trans-sexualism)
• sexual sadism: Obtaining sexual
  gratification from humiliating or
  inflicting physical pain on a sex partner.
• sexual masochism: Obtaining sexual
  gratification from being humiliated or
  receiveing physical pain from a sex
  partner.
• pedophilia: “pre-pubescent” children are
  the focus of sexual fantasy or actual sexual
  activity
• While this remains a “fantasy” it is a
  psychological disorder. When the person
  acts on the desire, it also becomes a
  criminal activity.
• most pedophiles have great difficulty
  fighting their desires
     Gender-Identity Disorder
• a strong belief that one is really a
  member of the opposite biological sex
  (i.e., a woman trapped in a man’s body).
• many seek an operation to change their
  gender which is granted only after
  extensive counseling therapy (most are
  happy with the change)
• These individuals are NOT transvestites
  nor are they homosexuals
       Personality Disorders
• Disorders in which inflexible and
  maladaptive ways of thinking and
  behaving learned early in life cause
  distress to the person and/or conflicts
  with others.
• As you might expect a person’s basic
  way of relating to the world is very
  difficult to modify
     DSM-IV divides Personality
  Disorders into 3 “Clusters” (groups)
• Cluster A: odd - eccentric
  – schizoid, paranoid, schizotypal
• Cluster B: erratic - dramatic
  – narcisstic, histrionic, borderline, antisocial
• Cluster C: anxious - fearful
  – dependent, avoidant, obsessive-compulsive
Cluster A Disorders
  Schizoid Personality Disorder
• The person is withdrawn and lacks
  feelings for others.
• The person seems to have no need
  or desire for close relationships
• odd behavior may also be present
  (a loner or hermit)
 Paranoid Personality Disorder

• The person is inappropriately
  suspicious and mistrustful of others.
• The person may think friends or co-
  workers are plotting against him and
  may doubt the loyalty of his spouse
• Paranoid personality disorder is NOT
  the same as paranoid schizophrenia.
Schizotypal Persnoality Disorder
• literally means “schizophrenic
  genotype,” there may be a genetic link
  with schizophrenia,
• unusual belief systems are
  characteristic of this disorder
  – magical thinking, special powers, delusions
• the person may also have unusual
  appearance and behavior
Cluster B Disorders
Narcissistic Personality Disorder
• The person has an exaggerated sense of
  self-importance and demands constant
  attention and admiration
• The person is “grandious” believing
  he/she is “special” and very important
• They feel that only other “special” people
  can understand them
  Histrionic Personailty Disorder
• the person’s behavior and speech are
  exaggerated and overly dramatic
• like the narcissist, they crave attention
  but more out of need than grandiousity
• may be sexually promiscuous with
  stormy relationships
• relationships with others are shallow
  and superficial
   Borderline Personality Disorder
• The most severe of the personality disorders
• characterized by marked instability in self-
  image, mood, and interpersonal relationships
• a classic symptom is “cutting” oneself and
  other self-mutilating behaviors
• other symptoms are depression, anxiety/panic
  depersonalization, and drug use
• often co-occurs with MPD and like MPD a
  history of childhood abuse is common
 Antisocial Personality Disorder
• involves a pattern of violent, criminal, or
  unethical and exploitative behavior and
  an inability to feel affection for others
• the vast majority are males
• sly, cunning, charming, irresponsible,
  shallow and unemotional, feel no
  remorse
• substance abuse is common. These
  behaviors are very difficult to change
Cluster C Disorders
 Dependent Personality Disorder

• Personality disorder in which the
  person is unable to make choices and
  decisions independently and cannot
  tolerate being alone.
• Appear to have an underlying fear of
  being abandoned or rejected.
  Avoidant Personality Disorder
• Personality disorder in which the
  person’s fears of rejection by others leads
  to social isolation.
• Avoidant personality disorder differs
  from schizoid personality disorder in that
  avoidant individuals want to have close
  relationships with other people.
• Some believe this disorder is really the
  same thing as social phobia
Obsessive-Compulsive Personality Disorder

 • rigid, inflexible, overly moralistic,
   unable to “have fun” and relax
 • perfectionistic and cannot delegate
   responsibility to others
 • may get so caught up in details that the
   main task is never completed
 • may be an asset in some types of work
      Schizophrenic Disorders
• Severe disorders in which there are
  disturbances of thoughts,
  communication, and emotions.
• positive symptoms: presence of some
  behavior not seen in normal persons
  (e.g., hallucinations, delusions)
• negative symptons: absence of behaviors
  seen in normal persons (e.g., lack of
  normal range of mood, normal hygiene)
        Hallmark Symptoms
• delusions: false beliefs about reality that
  have no basis in fact. Common delusions
  involve thought broadcasting, thought
  insertion, religious or supernatural topics
  (vary with historical era and society)
• hallucinations: Sensory experiences in the
  absence of external stimulation, most often
  auditory. Voices may be heard talking
  about the person or to the person, telling
  him/her to do things
        additional symptoms
• loosening of associations or tangential
  thinking
• clanging (rhyming words with no
  meaning)
• flat or blunted affect (no change in mood)
• social withdrawal/isolation
• lack of normal hygiene
• unpredictability
Types of Schizophrenic Disorders
• disorganized schizophrenia: bizarre and
  childlike behaviors, giggling, odd faces,
  gesturing
• paraniod schizophrenia: disorder is less
  obvious, suspiciousness and complex
  delusisonal systems are common
• catatonic schizophrenia: motor activity
  disturbance is prominent.
• undifferentiated schizophrenia: those who
  don’t really fit into one of the above
     Causes of Schizophrenia
• twin studies suggest vulnerability is quite
  heritable
• schizophrenics have high amounts of the
  neurotranasmitter dopamine
• enlarged “ventricles” are seen in brains
• abnormal patterns of brain activiy have
  been observed
• disturbed family relations are common
       Childhood Disorders

• Attention-deficit/hyperactivity
  disorder (ADHD)
• Autistic disorder
 Attention-Deficit/Hyperactivity
            Disorder
• A childhood disorder characterized by
  inattention, impulsiveness, and
  hyperactivity.
• Much more common in boys than girls.
• Diagnosis has been increasingly common
  in recent years
• Commonly treated with psychostimulants
  (e.g., ritalin)
          Autistic Disorder
• literally: “turned inward”
• occurrence: autism is a very rare
  disorder
• typical symptoms: lack of social
  interaction, strange motor behaviors,
  self destructive behaviors, fascination
  with movement, attachment to odd
  objects, intolerance of change
• echolalia: repeating words said to
  them.
• “savant”: an autistic with special
  abilities in some area (e.g., numbers,
  art) most autistics are NOT “savants”
• causes: not known but genetics/biology
  are strongly implicated
• there is some connection with mental
  retardation and fragile x syndrome

				
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