Transcript document

Abnormal
Psychology
An Introduction
Read and respond (discussion)
A man living in the Ozark Mountains has a vision in which
God speaks to him. He begins preaching to his
relatives and neighbors, and soon he has the whole
town in a state of religious fervor. People say he has a
“calling.” His reputation as a prophet and healer
spreads, and in time he is drawing large audiences
everywhere he goes.
One day he ventures into St. Louis and attempts to hold a
prayer meeting, blocking traffic on a main street at rush
hour. He is arrested. He tells the policeman about his
conversations with God, and they hurry him off to the
nearest mental hospital.
1. How can a person be viewed as normal in one
community and abnormal in another?
2. What is a psychological disorder?
3. What is “normal?”
Important to Remember!
1 in 7 Americans will seek
help for a psychological
disorder at some time
during his or her lifetime!
• Many people develop a disorder listed in the DSM-IV at
some point in their lifetime, however many of this
incidences are temporary.
• Many people who qualify for a disorder as diagnosed in
the DSM-IV are not very different from anyone else.
Last, but NOT least…
• The disorders we are about to study are psychological
disorders, and diagnosis can stigmatize the patient- as
we’ve already discussed.
• While you may, after our study, be able to recognize
some symptoms of certain disorders remember that
those symptoms could also be nothing more than
someone having a bad day. Formal diagnosis requires
longitudinal observation by a trained professional.
• As students, you are neither trained nor encouraged to
attempt to identify any psychological disorder in yourself
or the people around you. If you have a serious concern
for someone you know, talk to your counselor- she is
trained to deal with and further probe the situation.
Anxiety Disorders
Anxiety Disorders
True or False?
1. People who experience a panic attack often think they
are having a heart attack.
2. The same drugs used to treat schizophrenia are also
used to control panic attacks.
3. Some people are so fearful of leaving their homes that
they are unable to venture outside even to mail a letter.
4. We may be genetically predisposed to acquire fears of
objects that posed a danger to ancestral humans.
5. Therapists have used virtual reality to help people
overcome phobias.
6. Obsessional thinking helps relieve anxiety.
7. Exposure to combat is the most common trauma linked
to posttraumatic stress disorder.
Introduction
• Anxiety: an emotional
state characterized by
physiological arousal,
unpleasant feelings of
tension, and a sense of
apprehension or
foreboding.
• Anxiety Disorder: a class
of psychological disorders
characterized by
excessive or maladaptive
anxiety reactions.
Classes of Anxiety Disorders:
• Panic Disorder
• Phobic Disorders
• Obsessive-Compulsive
Disorder
• Generalized Anxiety
Disorder
• Acute Stress Disorder
• Post-traumatic Stress
Disorder
Generalized Anxiety Disorder
• “Worrying about Worrying”
• Emotional distress caused by worrying
about everyday, minor things, and about
unlikely future events interferes
significantly with the
person’s daily life.
• Treatment: drug therapy** and
cognitive-behavioral therapy
Panic Disorders
• Characterized by the occurrence of
repeated, unexpected panic attacks.
– Panic attack: intense anxiety reactions
accompanied by physical symptoms such as
a pounding heart, rapid respiration, heavy
perspiration, numbness, chills, weakness or
dizziness.
• Treatment: drug therapy (usually antidepressants as they normalize
neurotransmitter activity) and cognitivebehavioral therapy
Phobic Disorders
• An intense and irrational
fear of a particular object
or situation.
– Specific phobia
– Social phobia
– Agoraphobia
• Treatment: typically
involves providing the
person opportunities to
experience the feared
object under conditions in
which he or she feels
safe and in control.
Specific Phobia Examples:
• Acerophobia: fear of itching or the
insects that cause itching
• Acrophobia: fear of heights
• Aerophobia: fear of flying
• Atelophobia: fear of imperfection
• Catagelophobia: fear of being ridiculed
• Claustrophobia: fear of closed spaces
• Entomophobia: fear of insects
• Felinophobia: fear of cats
• Heliophobia: fear of the sun
• Hemophobia: fear of blood
• Hydrophobia: fear of water
• Logizomechanophobia: fear of
computers
• Nosocomephobia: fear of hospitals
• Nyctophobia: fear of darkness
• Verminophobia: fear of germs
• Zoophobia: fear of animals
Obsessive-Compulsive
Disorder
• A type of anxiety disorder
characterized by recurrent
obsessions, compulsions,
or both.
• Treatment: behavior
therapy, specifically
exposure with response
prevention
Adjustment Disorders
• Acute Stress Disorder (ASD): a traumatic stress reaction
occurring during the month following exposure to a
traumatic event.
– Walking around “in a fog” for days or weeks after a hurricane.
– Forgetting important features of an accident and feeling numb or
detached from your environment.
• Post-Traumatic Stress Disorder (PTSD): a prolonged
maladaptive reaction to a traumatic experience. Can
persist for months, years, or even decades and may not
be immediately apparent.
• Treatment: cognitive-behavioral therapy (repeated
exposure to cues and emotions associated with the
trauma in a safe setting)
Mood Disorders
Major Depressive Disorder
• Severe form of depression that
interferes with functioning,
concentration, and mental and
physical well-being
• Relatively short-term
• At least four of the following
symptoms are present:
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Problems with eating
Lack of sleep
Promblems with thinking
Problems concentrating
Problems with decition making
Lacking energy
Thinking about suicide
Feeling guilty or worthless
25
20
Lifetime
Prevalence of
Major
Depressive
Disorder
15
10
5
0
Male
Female
Overall
• Impairs people’s ability to meet
the ordinary responsibility of
everyday life.
• Cannot “shake it off” or “snap
out of it”
• May include delusions about
one’s body ‘rotting’ from
illness, hallucinations, or
psychosomatic manifestations
Dysthymic Disorder
• A milder form of depression which follows a
chronic course of development.
• Often begins during childhood or adolescence.
• Feelings of being “down in the dumps,” but not
to such a degree that they cannot function.
• Persistent complaints of depression become
such a fixture in the person’s life that they seem
to be intertwined with their personality.
• Despite treatment and apparent recovery, the
risk of relapse is 90%.
Seasonal Affective Disorder
• Many people notice a change in their mood
with the weather.
• Seasonal Affective Disorder is a type of Major
Depressive Disorder in which the change of
seasons from Summer to Fall and Winter
brings on depression, lasting throughout the
season.
• Treatment: light therapy
Bipolar Disorder
• Characterized by mood swings
between states of extreme
elation and depression
• Manic Phase: elation, extreme
confusion, distractibility, racing
thoughts.
– Sometimes difficult to detect
because the person seems to be
blessed with an unending state
of optimism.
– “It’s an emotional state similar to
Oz, full of excitement, color,
noise, and speed—an overload
of sensory stimulation—whereas
the sane state of Kansas is plain
and simple, black and white,
boring and flat. Mania has such
a dreamlike quality that often I
confuse my manic episodes with
dreams I’ve had.”
• Normalcy lasts for several months
with short bursts of mania and/or
depression
• Depressive Phase: overcome with
feelings of failure, sinfulness,
worthlessness, and despair.
– Essentially the same behavior as
Major Depressive Disorder
– “The patient lay in bed, immobile,
with a dull, depressed expression
on his face. His eyes were sunken
and downcast. Even when spoken
to, he would not raise his eyes to
look at the speaker. Usually he did
not respond at all to questions, but
sometimes, after apparently great
effort, he would mumble something
about the
“Scourge of God.”
Cyclothymic Disorder
• Chronic, but less severe mood swings
than are found in bipolar disorder.
• Begins in late adolescence, persists for
years.
• Periods of normal mood last for no more
than a month or so.
Mood Disorders
Causes
• Chemical Imbalance
• Emotional Disturbance
• Social Support
• Continually making
illogical conclusions
– Ex: blaming themselves for
normal, everyday failures
Treatment
• Antidepressants
• Psychotherapy
• Electroconvulsive
Therapy
• Mood Stabilizers
Personality Disorders
Odd or Eccentric
•
Paranoid: undue suspiciousness of
other’ motives, but not to the point of
delusion
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Overly sensitive to criticism (real or
imagined)
Question the sincerity and
trustworthiness of friends
Hypervigilant, as though they are
under constant threat of betrayal or
harm
Tend to be: argumentative, cold, aloof,
scheming, devious, and humorless
Not delusional (as in paranoid
schizophrenia)
Unlikely to seek treatment
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Schizoid: persistent lack of interest in social
relationships, flattened affect, and social
withdrawal
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Outer Appearance:
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Loner or ‘eccentric’
Emotions normally appear shallow or dampened
Indifferent to praise or criticism
Inner Lives generally compensate (not
balance) for lack of outer emotion
Schizotypal: eccentricities of thought and
behavior, but without clearly psychotic
features
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Have difficulty forming close relationships (lack
of interest)
Behavior, mannerisms, and thought patterns
seem peculiar, but not disturbed
May experience unusual perceptions or
illusions (“feeling the presence” of a deceased
family member)
Common among those who believe they have
a ‘sixth sense’ or can tell the future
Vague or generally abstract speech, unkempt
appearance, little emotion registered in facial
expressions
Anxious or Fearful
• Avoidant: avoidance of social
relationships due to fear of
rejection
– Absolutely terrified of rejection
– Few relationships outside of
family
– Have interest in, and feelings
toward other people (unlike
schizoid personalities)
– Severe form of social phobia
• Dependent: difficulty making
independent decision and display
overly dependent behavior
– Seek advice in making even the
smallest decision
– Overly submissive and clinging in
their relationships, extremely
fearful of separation
– Avoid positions of responsibility
– Often linked to other psychological
disorders:
• Major depression
• Bipolar
• Social phobia
**culture is important as many of the
‘symptoms’ of dependent disorder
are perfectly normal in some
cultures
Dramatic, Emotional, or Erratic
• Borderline: abrupt shifts in
mood, lack of a coherent
sense of self, and
unpredictable, impulsive
behavior
– Alternate between extremes of
adulation and loathing
– Intense fear of abandonment
makes them clinging and
demanding in their
relationships
– View people as all good or all
bad, shifting abruptly between
extremes
• May show fleeting psychotic
behaviors when stressed, but are
not as dysfunctional as those
with psychotic disorders.
• Have difficulty regulating their
emotions
– May harbor intense
psychological pain, and exhibit
features such as chronic anger,
loneliness, or boredom
• Self-mutilation:
– Fairly common among borderline
women
– Men tend to show outward signs
of aggression.
– Often motivated by need to
escape from troubling emotions
or “numbness”
Dramatic, Emotional, or Erratic
• Histrionic:
– excessive need for
attention, praise,
reassurance, and
approval
• Narcissistic:
– adoption of an inflated
self-image and
demands for attention
and admiration
Dramatic, Emotional, or Erratic
• Antisocial: antisocial and
irresponsible behavior and a
lack of remorse for misdeeds
– Often violate the rights of
others, disregard social
norms, and break the law
– Pattern of behavior begins in
childhood or adolescence
• Two dimensions:
– Personality: selfishness, lack
of empathy, callous and
remorseless use of others,
disregard for others’ feelings
or welfare
– Behavioral: unstable and
antisocial lifestyle, poor
employment history, unstable
relationships
• Not all criminals show signs of
psychopathy, and not all
people with psychopathic
personalities become
criminals.
Film Clip: The Dark Knight
Schizophrenia
Schizophrenia
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True or False?
Schizophrenia exists in the same form in every culture that has been
studied.
Visual hallucinations (“seeing things”) are the most common type of
hallucinations in people with schizophrenia.
It is normal for people to hallucinate nightly.
If you have two parents with schizophrenia, it’s nearly certain that
you will develop schizophrenia yourself.
Although schizophrenia is widely believed to be a brain disease,
evidence of abnormalities in the brains of schizophrenic patients
remains lacking.
We now have drugs that not only treat schizophrenia but can also
cure it in many cases.
Some people have delusions that they are loved by a famous
person.
Schizophrenia- what it isn’t
• It is NOT dissociative identity disorder.
• People afflicted with schizophrenia or any
of the psychotic disorders to not have
several people or personalities in one
body.
So, what is it?
• A cognitive disorder (as opposed to the
emotional disorders we have studied so
far). It involves motor function, perception,
and some emotion, but it is primarily a
cognitive issue.
• The term ‘schizophrenia’ actually refers to
a group of disorders characterized by
confused and disconnected thoughts,
emotions, and perceptions.
Major Features of
Schizophrenia
Two or more of the following must be present for a significant portion of
time over the course of one month:
• Delusions: false beliefs maintained in the face of contrary evidence
• Hallucinations: perceptions in the absence of corresponding
sensation; “hearing voices,” “seeing things”
• Incoherence: marked decline in thought processes; indicated by use
of a “word salad” in which the speaker gradually speeds up his or
her speech to the point where it all becomes a jumble of words
seemingly thrown together
• Disturbances of affect: emotions that are inappropriate for the
circumstances
• Deteriorations in normal movement: slowed movement, catatonic
behavior, or highly agitated behavior
• Decline in previous levels of functioning
• Diverted attention: possibly brought on by cognitive flooding
Causes of Schizophrenia
• Biochemical Factors:
excessive levels of dopamine
have been linked to
schizophrenia.
• Viral Infections: theory, those
exposed to influenza during
the 1st trimester of their
prenatal development have
seven times the chance of
developing schizophrenia.
• Brain Abnormalities: Many
(though notable not all)
schizophrenic patients have up
to 5% more brain tissue loss
than those without
schizophrenia.
Sub-types of Schizophrenia
•
Disorganized Schizophrenia: characterized by
– disorganized behavior: including incoherent speech, silly irrelevant laughter,
and inappropriate affect
– bizarre delusions often involving sexual or religious themes
– vivid hallucinations
A 40-year old man who looks more like 30 is brought to the hospital by his
mother, who reports that she is afraid of him. It is his twelfth
hospitalization. He is dressed in a tattered overcoat, baseball cap, and
bedroom slippers, and sports several medals around his neck. His affect
ranges from anger (hurling obscenities at his mother) to giggling. He
speaks with a childlike quality and walks with exaggerated hip movements
and seems to measure each step carefully. Since stopping his medication
about a month ago, his mother reports, he had been hearing voices and
looking and acting more bizarrely. He tells the interviewer he has been
“eating wires” and lighting fires. His speech is generally incoherent and
frequently falls into rhyme and clanging associations. His history reveals a
series of hospitalizations since the age of 16. Between hospitalizations, he
lives with his mother, who is now elderly, and often disappears for months
at a time, but is eventually picked up by police for wandering the streets.
Sub-types of Schizophrenia
•
Catatonic Schizophrenia:
characterized by gross
disturbances in motor activity,
such as catatonic stupor.
– Patient may, however, still be
aware of what is happening
around them, despite being
unable to respond
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Movements typically slow down
until they reach a stupor, but may
abruptly switch into an agitated
phase.
May maintain unusual or
apparently strenuous positions for
hours, despite limbs becoming stiff
or swollen.
– Waxy flexibility may also be a
feature.
*Note: catanonia is not unique to
schizophrenia. It is more typically
found in those with mood
disorders
Treating Schizophrenia
• Anti-psychotics:
drug therapy is often
used to help patient
cope with having
schizophrenia and to
lessen symptoms or
episodes
• Personal Therapy:
working one on one
with a psychoanalyst
to help patients cope
with stress and build
social skills (helps
reduce relapse rates
and improve social
functioning)
Somatoform
and Dissociative
Disorders
Why Can’t the Prince Walk?
There is an ancient Persian legend about a physician
named Rhazes who was called into the palace for the
purpose of diagnosing and treating a young prince.
Apparently, the prince could not walk. After the usual
examination, Rhazes determined that there was nothing
wrong with the prince’s legs, at least not physically. With
little more than a hunch, Rhazes set out to treat what
may be the first recorded case of conversion. In doing
so, he took a risk: Rhazes unexpectedly walked into the
Prince’s bathroom brandishing a dagger and threatened
to kill him. Upon seeing him, “the startled prince abruptly
fled, leaving his clothes, his dignity, and undoubtedly part
of his self-esteem behind.”
Somatoform Disorders
• Characterized by complaints of physical
problems or symptoms that cannot be
explained by physical causes.
• Illnesses are not purposefully “faked,” they
seem to serve a psychological need;
hence, they are classified as psychological
disorders.
Types of Somatoform Disorders
Type of Disorder
Description
Associated Features
Conversion Disorder
Change or loss of a physical
function without medical cause
Emerges in context of conflicts
or stress
Hypochondriasis
Preoccupation with the belief
that one is seriously ill
-Fear persists despite medical
reassurance
-Tendency to interpret minor
aches and pains as serious
illness
Somatization Disorder
Recurrent, multiple complaints
about physical symptoms that
have no clear organic basis
Body Dysmorphic Disorder
Preoccupation with an imagined
or exaggerated physical defect
-Person may believe that others
think less of them because of
the perceived defect
-May engage in compulsive
behaviors that aim to correct the
perceived defect
Pain Disorder
Persistent physical pain
believed to be associated with
psychological factors
Pain severe and persistent
enough to interfere with daily
functioning; medical conditions
and psychological factors may
play important roles in
accounting for the pain
Somatoform Disorders:
Treatment
• Psychoanalysis: seeks to
uncover and bring
unconscious conflicts that
originated in childhood
into conscious
awareness.
• Behavioral therapy:
removes sources of
secondary reinforcement
(sympathy, etc.).
• Cognitive-behavioral
therapy: restructures
distorted beliefs to help
people replace
exaggerated illnessrelated beliefs with
rational alternatives; also
employs exposure with
response prevention.
Munchausen Syndrome
• A form of feigned illness in
which the person either fakes
being ill or makes himself ill.
Differs from somatoform
disorders because the
symptoms are intentionally
induced.
• Munchausen by proxy: a
pernicious form of child
maltreatment in which people
intentionally falsify or induce
physical or emotional illness or
injury in a child or dependent
person.
• Named for an 18th century
German Baron who was
famous for entertaining his
friends with tales of outrageous
adventures.
Dissociative Disorders
• Dissociative disorder: a
disorder in which a
person experiences
alterations in memory,
identity, or consciousness
• Dissociative Identity
Disorder: a person
exhibits two or more
personality states, each
with its own patterns of
thinking and behaving
• Dissociative amnesia: the
inability to recall
important personal events
or information; is usually
associated with stressful
events
Dissociative Amnesia
Name
Characteristics
Example
Localized
Amnesia
Events occurring during a specific
time period are lost to memory
Person cannot recall events for a number of hours or
days after a stressful or traumatic incident
Selective
Amnesia
Only the disturbing particulars that
take place during a certain period of
time are forgotten
A soldier recalls most of a battle, but not the death of
his friend. A person recalls the period of life during
which he had an affair, but not the affair itself.
Generalized
Amnesia*
*very rare
Entire life is forgotten; cannot recall
personal information, but usually
retain habits, tastes and skills
Person cannot recall any events or names from his
life. Cannot remember elementary reading teacher’s
name, but can still read.
Continuous
Amnesia
The person forgets everything that
occurred from a particular point in
time up to and including the present
Person cannot recall anything from the last four
weeks, including the conversation they just finished.
Systematized
Amnesia
Memory loss is specific to a
particular category of information
Person cannot recall anything having to do with his
older brother.
Dissociative Identity Disorder
• At least two distinct personalities exist within the
person, each having a relatively enduring and
distinct pattern of perceiving, thinking and
feeling.
• Two or more of these personalities repeatedly
take complete control of the individual.
• There is a failure to recall important personal
information too substantial to be accounted for
by ordinary forgetfulness.
• The disorder cannot be accounted for by the
effects of a psychoactive substance or a general
medical condition.
The Three Faces of Eve
• Real Name: Chris
Sizemore
• Eve White: timid housewife
• Eve Black: libidinous and
antisocial personality
• Jane: integrated
personality who can
accept her aggressive
urges, but still engage in
socially appropriate
behavior.
• Therapy led to the integration
of the three personalities.
• Later, however, Sizemore’s
personality later fractured into
22 individual personalities, and
she reentered therapy.