Abnormal Psychology and Therapy

Abnormal Psychology and Therapy By: Spencer Bumpus, Jamie Schick, Kristina Depaola, Sarah Clay

Abnormal Behavior • Abnormal behavior is behavior that is deviant, maladaptive, or personally distressful over a long period of time • An example of deviant behavior is a woman who washes her hands 5 times in one hour and takes 7 showers a day because her behavior is abnormal • An example of maladaptive behavior is a man who thinks he can harm people by breathing, he may try to hold his breath for long periods of time • An example of a behavior causing personal distress is a woman who makes herself vomit after each meal

Abnormal Behavior • Biological Approach • This approach focuses on the brain, genetics, and the neurotransmitter functioning as a source of abnormality • The biological approach is evident to the medical model that says that psychological disorders have a background of biological factors

Abnormal Behavior • Sociocultural Approach • The social contexts that a person lives in are highly emphasized with this approach • gender, ethnicity, social status, family relationships, and culture • This perspective stresses the ways that cultures influence the understanding and treatments of psychological disorders

Abnormal Behavior • Bio Psychosocial Approach • Biological factors such as genes, psychological factors such as childhood experiences, and sociocultural factors such as gender, can act alone but they can also operate together • Biological, psychological, and sociocultural all play a factor in normal and abnormal behavior

Abnormal Behavior • Classifying Abnormal Behavior • Psychologists have a system to classify symptoms into specific disorders • Having a classification system helps doctors be on the same page about identifying disorders

Abnormal Behavior • DSM-IV • The Diagnostic and Statistical Manual of Mental Disorders • It includes 374 disorders • It is split up into five parts • Axis I: All diagnostic categories except personality disorders and mental retardation • Axis II: Personality disorders and mental retardation • Axis III: General medical conditions • Axis IV: Psychosocial and environmental problems • Axis V: Current level of functioning

Abnormal Behavior • Critiques of DSM-IV • the manual classifies individuals based on their symptoms, using medical terminology in the psychiatric tradition of thinking about mental disorders in terms of disease • It focuses strictly on pathology and problems, critics say that they should also focus on positive things • Another criticism is the labels it gives people

Anxiety Disorders • GAD • Panic Disorder • Phobic Disorder • OCD • PTSD

Generalized Anxiety Disorder (GAD) • experience anxiety for at least 6 months but are unable to specify the reasons for the anxiety. • people are nervous most of the time • worry about work, relationships, or health • suffer from fatigue, muscle tension, stomach problems, and difficulty sleeping.

Causes of GAD • genetic predisposition • deficiency in GABA • sympathetic nervous system activity • respiratory system abnormalities

GAD Video http://www.youtube.com/watch?v=KbY4HG4Uod4

Panic Disorder • person experiences recurrent, sudden onsets of intense apprehension or terror, often without warning and with no specific cause. • produce severe palpitations, extreme shortness of breath, chest pains, trembling, sweating, dizziness, and feeling helplessness.

Causes of Panic Disorder • may have a genetic predisposition • may have an autonomic nervous system that is predisposed to be overly active. • may stem from problems involving one or both of norepinephrine and GABA • women are twice as likely to have panic disorder as opposed to men.

Panic Disorder Case Study I remember my first panic attack like it was yesterday. I guess I’d always been an anxious type, but this was like nothing I’d ever experienced. I was at a football game about six years ago, big crowd, St Kilda getting hammered by the Pies. I think I was a bit edgy – I’ve never liked being hemmed in, stuck somewhere I couldn’t get out of easily. Then suddenly this thing just took me over. I got these pains in my chest and I couldn’t breathe. I was sure I was having a heart attack and was going to die. I was thinking about my daughter – she was two at the time – and thinking it can’t end like this, I’ve got to see her again. I was sweating, heart racing, trembling….I had to get out of there. I managed to push my way through the crowd and I saw a St John’s ambo. What a relief. He helped me to the ambulance and they took me straight to hospital, wired me up to all sorts of machines and then…..they told me there was nothing wrong, that it was all in my head. All in my head? Those pains were real, I can tell you. All they said was that I’d had a panic attack, and I was so happy to be alive, I didn’t ask them more about it. I just wanted to get home. But since then, my life has changed. I only went back to sea once (my skills are needed more on shore than at sea, thank God) but that was terrifying. I spent the whole time worrying about whether I’d have an attack while we were far from land and I avoided being below decks whenever I could. Since the first time, I’ve had about a dozen attacks and each one was terrifying. I’ve stopped going anywhere that I can’t get out of easily in case I have another one. No shopping centres. No cinemas. No football games. No public transport. No crowded places. I left the navy because I couldn’t face going to sea again.

Phobic Disorders • characterized by an irrational, overwhelming, persistent fear of a particular object or situation. • CAN pinpoint the cause of their feelings • fear becomes a phobia when the person goes to almost any length to avoid it • social phobia: fear of being humiliated or embarrassed in a social situation

Causes of Phobic Disorders • could be a neural circuit for social phobia that involves the thalamus, amygdala, and cerebral cortex. • serotonin may also be involved • some theorists consider phobias to be learned fears

Phobic Disorder Case Study Sarah Bromley, 35, is a make up artist from Sheffield. She developed her phobia while living in the Middle East as a child. Aged seven, a cockroach became entangled in her hair, Sarah screamed for help, but her parents had great difficulty removing it, and as a result of this traumatic experience she began to develop an extreme phobic reaction to them. For the next 28 years Sarah's phobia increasingly impacted on her life. She refused to go on a trekking holiday with her husband, music producer Roo, for fear of coming face-to-face with cockroaches and has also had to turn down work abroad because of her phobia. After years, Sarah bravely volunteered to enter The Panic Room. Over the course of three days she underwent a course of treatment with Dr Felix Economakis. Using a combination of clinical hypnosis, systematic desensitisation and graded exposure, she gradually became more comfortable in the presence of cockroaches, but how would she cope with a giant Madagascan cockroach awaiting her in the final Panic Room? A few weeks after her treatment Sarah has for the first time been able to visit her parents in Spain without fear of breaking into cold sweat and panic should she see a cockroach, and is overjoyed at the change she's experienced - "It's a huge relief, that black cloud's completely gone."

Obsessive-Compulsive Disorder (OCD) • anxiety provoking thoughts that will not go away and/or urges to perform repetitive, ritualistic behaviors to prevent or produce some future situation. • obsession (recurrent thought) -> compulsion (recurrent behavior) • checking, cleansing, and counting are common compulsions.

Causes for OCD • brain imaging studies show neurological links for OCD • basal ganglia are so active in OCD that numerous impulses reach the thalamus which causes obsessive thoughts or compulsive behaviors.

OCD Video http://www.youtube.com/watch?v=Rn1OYlYzgm8

Post-Traumatic Stress Disorder (PTSD) • develops through exposure to a traumatic event that has overwhelmed the persons abilities to cope. • flashbacks, avoidance, reduced abilities to feel emotions, excessive arousal, difficulties with memory and concentration, feelings of apprehension, and impulsive outbursts of behavior.

Causes of PTSD • can immediately follow a traumatic event or come months after. • most individuals exposed to a traumatic event will experience some type of PTSD but the level of the disorder varies.

PTSD Case Study Joe saw a good deal of active combat during his time in the military. Some incidents in particular had never left his mind – like the horrifying sight of Gary, a close comrade and friend, being blown-up by a land-mine. Even when he returned to civilian life, these images haunted him. Scenes from battle would run repeatedly through his mind and disrupt his focus on work. Filing up at the gas station, for example, the smell of diesel immediately rekindled certain horrific memories. At other times, he had difficulty remembering the past — as if some events were too painful to allow back in his mind. He found himself avoiding socializing with old military buddies, as this would inevitably trigger a new round of memories. His girlfriend complained that he was always pent-up and irritable – as if he were on guard, and Joe noticed that at night he had difficulty relaxing and falling asleep. When he heard loud noises, such as a truck back-firing he literally jumped, as if he were readying himself for combat. He began to drink heavily.

Personality Disorders Personality disorders are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition and inner experience exhibited across many contexts and deviating markedly from those accepted by the individual's culture.

Antisocial Personality Disorder A psychological disorder characterized by guiltiness, law breaking, exploitation of others, irresponsibility, and deceit. These individuals don't play by the rules and they often live a life full of crime and violence. This disorder is far more common in men than in women and is related to criminal behavior, vandalism, substance abuse, and alcoholism. • Hostility, significant irritability, agitation, impulsiveness, aggression or violence • Lack of empathy for others and lack of remorse about harming others • Unnecessary risk-taking or dangerous behaviors • Poor or abusive relationships • Irresponsible work behavior • Failure to learn from the negative consequences of behavior • Disregard for right and wrong • Persistent lying or deceit to exploit others • Using charm or wit to manipulate others for personal gain or for sheer personal pleasure • Intense egocentrism, sense of superiority and exhibitionism • Recurring difficulties with the law • Repeatedly violating the rights of others by the use of intimidation, dishonesty and misrepresentation • Child abuse or neglect

Antisocial Personality Disorder Those with antisocial personality disorder rarely seek out treatment on their own. Individuals generally receive treatment only after some type of altercation with the legal system. Results usually occur after long term treatment.

Case Study Ted Bundy was born in Vermont on November 24, 1946. He grew up with his mother, never knowing who his father was. Bundy spent the first three years of his life in Philadelphia. At age 4 Bundy and his mother moved to Washington. It was at this time that his mother met Johnnie Bundy. Ted was very jealous of his mother’s relationship with Johnnie. In 1953 Ted’s mother and Johnnie were married. They later had four children. At the age of 7, Ted’s second grade teacher broke a ruler over his hand for punching one of his classmates in the face. This is when he first noticed his feelings of “disturbing uneasiness” as he called it. Although Ted seemed to have some behavioral problems in school, his grades were above average. He attributes his success to his mother’s diligent efforts to help him with his homework. His mother did not however discuss any personal matters with Ted. She did not socialize or gossip with others and never discussed her childhood. Ted also kept to himself and from early on chose to be alone. Ted found it difficult to socialize and did not participate in organized activities. Ted tried out for the baseball and basketball teams, but didn’t make it. This was very traumatic for him. Because of this Ted decided to try skiing. He used to make fake ski tickets so he could ski for free. He was never caught. When Ted was asked about his childhood, he described it as lonely and empty. He felt that he was overlooked by his parents. He did make some friends in junior high , but still lacked in his social skills. In high school he had only one date because he felt “inept with girls”. In January of 1974 in Seattle, Ted Bundy’s first murder was documented. His had smashed a rod over Sharon Clarke’s head while she was sleeping. Sharon was a stranger to Bundy and no reason for the attack was ever given. A few weeks later, a college student living a couple of blocks from Sharon disappeared. From March until June four more female college students disappeared.

Bundy used his good looks and charm to persuade young women to help him. In July of 1974 Bundy approached several young women with his arm in a sling and asked them to help him put a sailboat on top of his car. One young women agreed to help him and was never seen again. The same day another women disappeared from the washroom at the same lake. The remains of these two women and several others were found in a forest near the lake. All of his victims tended to be college-age, white, attractive women. Bundy continued this killing spree until October of 1974. In November Bundy tried to catch another victim, but she escaped, however he did kill another woman that same day. Then in January of 1975 Bundy began killing again, this time in Colorado. Several woman were reported missing from different places. Finally on August 16, 1975 Bundy was arrested for driving suspiciously slowly down the street and refusing to stop when ordered by a police officer. The officer found a hair that matched one of the victim’s in Bundy’s car, and a witness said they saw Bundy the night another victim disappeared. Bundy was tried for murder in Aspen, Colorado. Bundy insisted on defending himself and was provided law books as he requested. He was also allowed to wander the Aspen law library where he jumped out the window and escaped. Eight days later he was recaptured and this time kept under heavy watch. Because of Bundy’s legal skills, he was able to delay the case by filing many motions. During this time period he lost weight and carved a hole in his prison cell, which he was able to squeeze through and escape a second time. He traveled to many places and ended up in Tallahassee, Florida near the FSU sorority houses. On January 15,1978 five young women from a sorority house were severely beaten. Two of them died and at least two of them were raped. One month later a 12 year old was found raped and strangled to death. On February 15, 1978 Bundy was again arrested for failing to stop when ordered by a police officer. It didn’t take long for them to discover Bundy was wanted for murder in Colorado. Bundy admitted to 23 murders and was sentenced to death. He died in the electric chair on January 24, 1989, in Florida. Bundy was classified as high Factor 1 psychopath. This means he is very intelligent and had few indications of psychopathy early in life. The components of a factor 1 psychopath include a grandiose sense of self, pathological lying, conning-manipulative behaviors, lack of remorse, lack of empathy, and failure to accept responsibility. Psychopathy is the label name for antisocial personality disorder. Individuals with antisocial personality disorder are often charming, spontaneous, and likable at first, but are actually deceitful and manipulative. Many people suffering from ASPD live only in the present and have no consideration for the past or future (Carson, Butcher, & Mineka, p.312). People with ASPD behave as if social regulations do not apply to them. They do as they please and feel no remorse for their wrong-doing. They persistently disregard and violate the rights of others.

Only people 18 years or older are diagnosed with ASPD. According to the DSM, this diagnosis is made only when these three criteria are met. (1)There have been at least three behavioral problems occurring after age 15. (2) There were at least three instances of deviant behavior before age 15. (3) The antisocial behavior is not a symptom of another mental disorder such as schizophrenia or a manic episode. Bundy is a classic example of an antisocial behavior. He was charming and likable while at the same time extremely manipulative. He showed no feelings of remorse for any of his victims. He was also very intelligent and used this to his advantage. The problem with ASPD, especially factor 1 psychopathy, is that it is very difficult to treat. Treatment has shown to be effective in the average criminal, however not with psychopaths, such as Bundy. There is actually a chance that psychopaths who are high factor 1 may get worse with treatment because instead of learning about themselves, they learn more about others and use that information. As with treating any personality disorder, getting the person into therapy and keeping them involved is very difficult. Most individuals, including Bundy, have no interest in changing their behavior. It is also difficult because high factor 1s are so deceitful and manipulative it is hard to believe anything they say. Cognitive-behavioral therapy is a technique often used for the treatment of ASPD. According to our book, cognitive-behavioral interventions include: increasing self-control, self-critical thinking, and social perspective-taking; victim awareness; anger management; changing antisocial attitudes; curing any drug addictions; and reducing contacts with antisocial peers and improving interactions with nonantisocial peers. It is very unlikely that cognitive therapy will be effective, especially with someone like Ted Bundy. The most effective tool possible is prevention. It is very important to prevent children misbehaving and intervene any behavioral problems at an early age.

Borderline Personality Disorder A psychological disorder characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and images, and of marked impulsivity beginning by early adulthood and present in a variety of contexts. • Impulsive and risky behavior, such as risky driving, unsafe sex, gambling sprees or illegal drug use • Awareness of destructive behavior, including self-injury, but sometimes feeling unable to change it • Wide mood swings • Short but intense episodes of anxiety or depression • Inappropriate anger and antagonistic behavior, sometimes escalating into physical fights • Difficulty controlling emotions or impulses • Suicidal behavior • Feeling misunderstood, neglected, alone, empty or hopeless • Fear of being alone • Feelings of self-hate and self-loathing

Borderline Personality Disorder Therapy is often effective in many patients. The goal of the therapist is to help the client learn to be more aware of other peoples perspectives. Psychiatric drugs such as antidepressants are often effective, both alone and in combination with psychology. Antipsychotic medications are sometimes used in cases involving distorted thinking patterns.

Video http://bpdvideo.com/videos/1-understanding-borderline-personality-disorder/ http://bpdvideo.com/videos/2-causes-of-borderline-personality-disorder/

Psychological Disorder & Health & Wellness • A psychological disorder, also known as a mental disorder, is a pattern of behavioral or psychological symptoms that impact multiple life areas and/or create distress for the person experiencing these symptoms. • Over 26 percent of Americans aged 18 and older suffer from a diagnosable psychological disorder in any given year. • Often comes along with judgement and a negative stigma

Consequences of Stigma • Stigma: a mark of disgrace associated with a particular circumstance, quality, or person • For many individuals who are diagnosed with one or more such disorders, a significant obstacle in the pursuit of normal life is the fear of stigma, stereotypes, prejudice, and discrimination • Fear of Stigma can prevent individuals from seeking treatment and from talking about their problems to friends and family

Consequences of Stigma • Having a disorder and experiencing the stigma associated with it can negatively affect the physical health of a person and also worsen the condition of their mental state • The stigma attached to psychological disorders can provoke prejudice and discrimination toward individuals who are struggling with these problems.

Prejudice and Discrimination • Labels of Psychological disorders can lead to negative stereotypes; stereotypes: a generalization about a group’s characteristics that does not carry any variations from one individual to another • Often vivid cases of a violence etc. from people with a mental disorder paint the stereotype for the rest of people with disorders. • An Oxford University researcher found that only about 18% of homicides are committed by people with a psychological disorder while many people believe the number would be much higher • One of the most feared aspects of a mental disorder is discrimination; discrimination is acting prejudicially toward a person who is a member of a stigmatized group.

Overcoming Stigma • The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities in employment, transportation, public accommodation, and telecommunications • Fair Housing Act – This law makes it illegal to deny housing to a renter or buyer because of a disability. • The Individuals with Disabilities Education Act – This law requires that a free public education be made available to children and youth with disabilities. It also requires that the education be designed to meet their unique educational needs. • The Rehabilitation Act – The purpose of this law is to help people with disabilities become employed and independent.

Overcoming Stigma • Vital to recognize the strengths in people with mental disorders- both in confronting the disorder and in carrying on despite their problems- and their achievements • Many people who have accomplished great things in life have been diagnosed with some sort of psychological disorder: • Abraham Lincoln- Bipolar Disorder and Anxiety • Jim Carrey- Manic Depression • Demi Lovato- Bipolar Disorder • Halle Berry

Therapy • Biological therapies are treatments that reduce or eliminate the symptoms of psychological disorders by altering aspects of body functioning. • Drug therapy is the most common form of biomedical therapies • Psychotherapeutic drugs are mainly used in three diagnostic categories: anxiety disorders, mood disorders, and schizophrenia • antianxiety drugs, antidepressant drugs, antipsychotic drugs

Anti-anxiety Drug Therapy • Antianxiety drugs are commonly known as tranquilizers • Reduce anxiety by making the individual calmer and less excitable and also reduce brain activity • Benzodiazepines are potentially addictive but offer the most relief for the symptoms of anxiety disorders • Xanax, Valium, and Librium are the most commonly prescribed; fast acting medications taking effect within hours • Come with side effects including drowsiness, loss of coordination, fatigue, and mental slowing

Anti-anxiety Drug Therapy • Non-benzodiazepines are often used to treat generalized anxiety disorder • must be taken daily for two to three weeks before the patient notices a difference • Benzodiazepines and non-benzodiazepines are not generally prescribed for long periods of time due to the risk of addiction and increasing tolerance.

Antidepressant Drug Therapy • Antidepressant drugs regulate mood • Four main classes of antidepressant drug: tricyclics, tetracyclics, monoamine oxidase (MAO) inhibitors, and selective serotonin reuptake inhibitors • help alleviate the depressed mood though their effects on the neurotransmitters in the brain. • All antidepressant drugs allow the person’s brain to increase or maintain its levels of neurotransmitters, especially serotonin and norepinephrine

Antidepressant Drug Therapy • Tricyclics are believed to work by increasing the level of certain neurotransmitters, especially norepinephrine and serotonin • reduce the symptoms in about 60 to 70 percent of cases • Take 2-4 weeks to improve mood • Tetracyclic antidepressants also called noradrenergic and specific serotonergic antidepressants, enhance brain levels of neurotransmitters and are often related to tricyclics • Are now more often used due to the short list of side effects.

Antidepressant Drug Therapy • MAO inhibitors are thought to work because they block the enzyme monoamine oxidase; this breaks down norepinephrine and serotonin in the brain. • Scientists believe that by blocking MAO inhibitors the neurotransmitters are able to stick in the brain’s synapses and help regulate mood • May be dangerous due to the risk of stroke and high blood pressure if mixed with certain foods or different drugs • SRRIs target serotonin and work mainly by interfering only with the reabsorption of serotonin in the brain • Prozac, Paxil, and Zolof are the main SRRIs prescribed due to the low risk of side effects compared to other antidepressants. • Do have some side effects such as insomnia, anxiety, and headaches

Antidepressant Drug Therapy • The number of Americans who had been prescribed antidepressants doubled between 1996 and 2005, with 10% of Americans taking antidepressants at some point of their life • Also effective in some cases of anxiety disorders • Lithium: a widely used treatment for bipolar disorder; thought to stabilize moods by influencing norepinephrine and serotonin, but the exact mechanism is unknown

Abnormal Psychology and Therapy