Chapter 13: Abnormal Psychology

Psychological Disorders

• Afflict more than 1 in 10 Americans

– more common than cancer

– the leading reason for hospital admissions

• filling 21% of hospital beds nationwide

• Costly

– direct costs (medical bills)

– indirect (lost work or decreased productivity)

– mental illness costs $70 billion per year

• Important to recognize and treat mental illness

Defining Abnormal Behavior

• Abnormality

– Social Norm violation

– Statistical abnormality

– Personal discomfort (distress)

– Maladaptive (Dysfunctional) behavior

– Deviation from an ideal

Models to Understand Mental Illness

• Medical Model

– Abnormal behavior seen as a symptom of an underlying disease

– Interventions:

• Remove/repair the defect surgically

• Medicate

Models to Understand Mental Illness

– Equates health with lack of illness

– Medication is not the appropriate intervention as long as surgery is possible

– Garage Model of Psychotherapy

Models to Understand Mental Illness

– diathesis-stress model

– biopsychosocial model

DSM-IV

• Diagnostic and Statistical Manual, Fourth Edition

• Taxonomy of behavioral, mental, and psychiatric disorders

– Atheoretical

– Nomothetical

Multi-Axial System

• Axis I

– Clinical syndromes and V-Codes

• Axis II

– Developmental and Personality Disorders

• Axis III

– Physical disorders

• Axis IV

– Severity of Psychosocial Stressors

• Axis V

– Global Assessment of Functioning

Criticisms of Labeling

• Self-fulfilling prophesy

• Create preconceptions leading to bias

• stigmatizing

Insanity Defense

• Insanity

– Legal term

– Determination whether individual has the ability to tell the difference between right and wrong

– Kentucky Statute:

• “insanity” means that, as a result of a mental condition, [a person lacks] substantial capacity to either appreciate the criminality of one’s conduct or to conform one’s conduct to the requirements of the law

Insanity Defense

• Furthermore, a person is “not responsible for criminal conduct” if he or she is determined to have been insane at the time that conduct occurred

• Insanity defense is seldom used

– And seldom successful

Anxiety Disorders

• Phobic disorder

– Individual has irrational, overwhelming, persistent fear of a particular object or situation

• Social phobia

– Intense fear of being humiliated or embarrassed in social situations

Anxiety Disorders

• Generalized anxiety disorder

– Consists of persistent anxiety for at least a month

– Individual is unable to specify the reasons for the anxiety

• Panic disorder

– Marked by recurrent sudden onset of intense apprehension or terror

Anxiety Disorders

• Agoraphobia

– characterized by an intense fear of

• entering crowded, public places

• traveling away from home, especially by public transportation

• feeling confined or trapped

• being separated from a place or person associated with safety

Anxiety Disorders

• Obsessive-compulsive disorder

– Individual has anxiety-provoking thoughts that will not go away (obsession) and/or urges to perform repetitive, ritualistic behaviors to prevent or produce some future situation (compulsion)

Anxiety Disorders

• Post-traumatic stress disorder

– Develops through exposure to a traumatic event, severely oppressive situation, severe abuse, natural disaster, or accidental disaster

– Anxiety symptoms may immediately follow the trauma or be delayed

Somatoform Disorders

• Somatoform disorders

– Mental disorders in which psychological symptoms take a physical, or somatic, form even though no physical causes can be found

Somatoform Disorders

• Hypochondriasis

– Individual has a pervasive fear of illness and disease

• Conversion disorder

– individual experiences specific physical symptoms event though no physiological problems can be found

Glove Anesthesia

Dissociative Disorders

• Dissociative disorders

– Involve a sudden loss of memory or change in identity

• Dissociative amnesia

– Memory loss caused by extensive psychological stress

Dissociative Disorders

• Dissociative fugue

– Individual not only develops amnesia, but also unexpectedly travels away from home and assumes a new identity

• Dissociative identity disorder

– Formerly called multiple personality disorder

– Individuals have two or more distinct personalities or selves

Mood Disorders

• Mood disorders

– Psychological disorders characterized by wide emotional swings, ranging from deep depression to extreme euphoria and agitation

Mood Disorders

• Major depressive disorder

– Individual experiences a major depressive episode and depressed characteristics for at least two weeks or longer

– Vegetative symptoms of depression

• Dysthymic disorder

– Generally more chronic and has fewer symptoms than major depressive disorder

Mood Disorders

• Bipolar disorder

– A mood disorder characterized by extreme mood swings that include one or more episodes of mania (an overexcited, unrealistically optimistic state)

– Person may experience depression and mania

Causes of Mood Disorders

• Biological causes

– Heredity and brain processes

• Psychological causes

– Learned helplessness

• occurs when individuals are exposed to aversive stimulation, such as prolonged stress or pain, over which they have no control

Schizophrenia

• Schizophrenia

– A severe psychological disorder characterized by

• Thought disorders

– Delusion: irrational beliefs held despite evidence to the contrary

– Clang associations

– Perseveration

– Word Salad

– Tangential Thinking

Schizophrenia

• Disorders of perception

– Hallucinations: strong mental images with no basis in reality

• inappropriate emotion

• abnormal motor behavior

• social withdrawal

• odd communication

– Positive vs. Negative symptoms

Types of Schizophrenia

• Disorganized schizophrenia

– Individual has delusions and hallucinations that have little or no recognizable meaning

• Catatonic schizophrenia

– Characterized by bizarre motor behavior, which sometimes takes the form of a completely immobile stupor

Types of Schizophrenia

• Paranoid schizophrenia

– Characterized by delusions of reference, grandeur, and persecution

• Undifferentiated schizophrenia

– Characterized by disorganized behavior, hallucinations, delusions, and incoherence

Causes of Schizophrenia

• Biological factors

– Heredity and neurobiological factors

• Psychosocial factors

– Diasthesis-stress view

• A combination of biogenetic disposition and stress causes schizophrenia

Social Disorders

• Types of social disorders:

– Personality Disorders

– Sexual Disorders

• Sexual Dysfunction

• Paraphilias

– Substance Use Disorders

Personality Disorders

• Personality disorders

– Chronic, maladaptive cognitive-behavioral patterns that are thoroughly integrated into the individual’s personality

Odd/Eccentric Cluster

• Paranoid

• Schizoid

• Schizotypal

Dramatic/Emotionally Problematic Cluster

• Histrionic

• Narcissistic

• Antisocial

• Borderline

Chronic Fearfulness/Avoidant Cluster

• Avoidant

• Dependent

• Obsessive-compulsive

• Passive-aggressive

Paraphilias

• Exhibitionism

• Fetishism

• Frotteurism

• Pedophilia

• Sexual Masichism

• Sexual Sadism

• Transvestic Fetishism

• Voyeurism

Substance Use Disorders

• Substance Dependence

– Tolerance

– Withdrawal

– Substance taken in larger amounts than intended

– Persistent desire or attempt to cut down

Substance Use Disorders

– Great deal of time is spent in activities related to drug

– Important social, occupational, or educational activities are given up

– Substance is continued despite knowledge of a problem that has been caused or made worse by use

• 3 of 7 needed in last 12 months

Substance Use Disorders

• Substance Abuse

– Recurrent use resulting in failure to fulfill major role obligations at work, school or home

– Recurrent use in situations where it is physically hazardous

– Recurrent substance-use related legal problems

– Continued use despite persistent or recurring social or interpersonal problems caused or exacerbated by substance use

References

• American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (Fourth Ed.). Washington, D. C.: Author.

• Chambless, D. L., Bryan, A. D., Aiken, L. S., Steketee, G., & Hooley, J. M. (1999). The structure of expressed emotion: A three-construct representation. Psychological Assessment, 11, 67-76.

• Cohen, J. (2001). World Health Assembly adopts revised classification system. APA Monitor on Psychology, 32(7), 20.

• Fong, M. L, & Silien, K. A. (1999). Assessment and diagnosis of DSM-IV anxiety disorders. Journal of Counseling and Development, 77 (2), 209-217.

• Hayes, L. L. (1999, November). Programs aid the mentally ill: From Greed Door to Fountain House, 'clubhouse' rehabilitation helps scores of mentally ill individuals. Counseling Today, 42(5), 1, 22-23.

• Heilbrun (1993). In G.G. Costello (Ed.), Symptoms of schizophrenia.

• Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. R., Hughes, M., Eshleman, S., Wittchen, H. U., & Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8-19.

• McGuire, P. A. (2000). New hope for people with schizophrenia. Monitor on Psychology, 31(2), 24-28.

References

• Nairne, J. S. (1995). Psychology: The adaptive mind. Albany, NY: Brooks/Cole Publishing Company.

• Nairne, J. S. (1999). Psychology: The adaptive mind (2nd Ed.). Albany, NY: Brooks/Cole Publishing Company.

• Newman, R. (2000). A psychological model for prescribing. Monitor on Psychology, 31(3), 45.

• Santrock, J. W. (2002). Psychology (6^th Edition). Boston, MA: McGraw-Hill.

• Seligman, L., & Hardenburg, S. A. (2000). Assessment and treatment of paraphilias. Journal of Counseling and Development, 78(1), 107-113.

• Tanouye, E. (2001, June 13). Mental illness: A rising workplace cost. Wall Street Journal.

• Waters, M. [1999]. Men and women handle negative situations differently, study says. APA Monitor, 30(9), 8.