Abnormal Psychology

Abnormal Psychology

3 major criteria for diagnosing psychological disorders • - 1. Deviance-behavior that is not considered to be in the norm • - 2. Maladaptive behavior-behavior that interferes with a person’s social or occupational functioning • - 3. Personal distress-how much distress it causes the individual

Costs of Mental Illness - Costs more than $150 billion each year for treatment - Schizophrenia alone costs up to $30 billion - Lithium for Bipolar Disorder has saved approximately $145 billion since 1970 - Clozapine for Schizophrenia has saved approximately $23,000/patient annually

Youth and Mental Illness • - U.S. adolescents appear to be at high risk for mental illness • - Schizophrenia tends to manifest itself in adolescence or early adulthood • - U.S. adolescents are the only group in which there continues to be an increase in the death rate, from accidents, suicide and homicide

Warning Signs of trouble * - marked drop in school performance or increase in absenteeism • - excessive use of alcohol and/or drugs • - marked changes in sleeping and/or eating habits • - many physical complaints (headaches, stomach aches) • - aggressive or non-aggressive violations of the rights of others • - withdrawal from friends, family and regular activities • - depression demonstrated by continued, prolonged negative mood and often accompanied by poor • - appetite and/or difficulty sleeping

- frequent outbursts of anger or rage • - low energy level, poor concentration, complaints of boredom • - loss of enjoyment in what used to be favorite activities • - unusual neglect of personal appearance • - frequent outbursts of anger or rage • - low energy level, poor concentration, complaints of boredom • - loss of enjoyment in what used to be favorite activities • - unusual neglect of personal appearance

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) • - Axis I-Clinical Syndromes-includes many of the disorders that are in chapter 14 • - Axis II-Personality Disorders or Mental Retardation (See personality disorders) • - Axis III-General Medical Conditions-assesses any chronic physical disorders or conditions that may contribute to disorders • - Axis IV-Psychosocial and Environmental Problems-negative life events, troubled relationships, trouble with the law, school, work, etc. • - Axis V-Global Assessment of Functioning-After assessing axes 1-4, the psychologist makes a determination regarding a score that they would assess the person’s level of functioning. A score of a 10 means the person is in persistent danger of severely hurting themselves or others and a score of 100 means they are functioning at a superior level.

Generalized Anxiety Disorder (GAD) • "I always thought I was just a worrier. I'd feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about what I was going to fix for a dinner party, or what would be a great present for somebody. I just couldn't let something go." • "I'd have terrible sleeping problems. There were times I'd wake up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I'd feel a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were: when I got a stomachache, I'd think it was an ulcer."

Anxiety Disorders Class of disorders marked by excessive or chronic anxiety or apprehension • Generalized Anxiety Disorder • - marked by a chronic, high level of anxiety that is not due to anything specific. Age of onset may be between 10 and 14 years of age. • - Causes-No specific threat, symptoms must be present for at least 6 months • - Symptoms-Restlessness or feelings of being keyed up or on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance • - Treatments-Benzodiazepines (Valium and Ativan), Tricyclic Antidepressants, Psychotherapy

Panic Disorder • "For me, a panic attack is almost a violent experience. I feel disconnected from reality. I feel like I'm losing control in a very extreme way. My heart pounds really hard, I feel like I can't get my breath, and there's an overwhelming feeling that things are crashing in on me." • "It started 10 years ago, when I had just graduated from college and started a new job. I was sitting in a business seminar in a hotel and this thing came out of the blue. I felt like I was dying." • "In between attacks there is this dread and anxiety that it's going to happen again. I'm afraid to go back to places where I've had an attack. Unless I get help, there soon won't be anyplace where I can go and feel safe from panic."

Panic Disorder characterized by sudden and unexpected attacks of anxiety. Age of onset usually between 15 and 19 • - Causes-defects in the brain (specifically the brain stem, limbic system and frontal cortex) • - Symptoms-heart palpitations, sweating, trembling, feeling of choking, shortness of breath, fear of dying, chest pain or discomfort, feeling dizzy. • - Treatments-Tricyclic Antidepressants, SSRI’s, MAOI’s, Antianxiety drugs (e.g., Xanax, Ativan), Cognitive-Behavioral treatments

Phobias • "I'm scared to death of flying, and I never do it anymore. I used to start dreading a plane trip a month before I was due to leave. It was an awful feeling when that airplane door closed and I felt trapped. My heart would pound, and I would sweat bullets. When the airplane would start to ascend, it just reinforced the feeling that I couldn't get out. When I think about flying, I picture myself losing control, freaking out, and climbing the walls, but of course I never did that. I'm not afraid of crashing or hitting turbulence. It's just that feeling of being trapped. Whenever I've thought about changing jobs, I've had to think, "Would I be under pressure to fly?" These days I only go places where I can drive or take a train. My friends always point out that I couldn't get off a train traveling at high speeds either, so why don't trains bother me? I just tell them it isn't a rational fear."

Phobic Disorder - marked by a persistent and irrational fear of things that don’t really pose a threat. Age of onset often between 7 and 9 years of age • - Causes-may run in families and be present in females more often, usually a classically conditioned response • - Symptoms-marked and persistent fear that is excessive or unreasonable, intentional avoidance of object or situation • - Treatment-Mostly behavior therapy, but can also use Antianxiety drugs (e.g., Valium), Tricyclic Antidepressants, MAOI’s, Psychotherapy

Social Phobia • "In any social situation, I felt fear. I would be anxious before I even left the house, and it would escalate as I got closer to a college class, a party, or whatever. I would feel sick in my stomach-it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else." • "When I would walk into a room full of people, I'd turn red and it would feel like everybody's eyes were on me. I was embarrassed to stand off in a corner by myself, but I couldn't think of anything to say to anybody. It was humiliating. I felt so clumsy, I couldn't wait to get out."

Obsessive-Compulsive • "I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn't add up to a 'bad' number." • "I knew the rituals didn't make sense, and I was deeply ashamed of them, but I couldn't seem to overcome them until I had therapy." • "Getting dressed in the morning was tough, because I had a routine, and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me."

Obsessive-Compulsive Disorder An unusual disorder of ritual and doubt. Obsessions are persistent and intrusive thoughts, images, ideas or impulses. Compulsions are repetitive, purposeful behaviors that are performed in response to an obsession. They understand that their actions are unreasonable, but cannot stop themselves. Age of onset is usually between 9 and 12 years of age.

OCD • Causes-may be genetic, may be due to neurotransmitter activity, there has been some indication that some have the onset of this disorder after having strep throat (they think that possibly the antibodies that are supposed to fight the infection actually attack the basil ganglia)

OCD • - Symptoms-Obsessions: recurrent and persistent thoughts, excessive worry about real-life problems, impulses which may be deemed inappropriate. Compulsions: repetitive behaviors or mental acts that a person feels driven to perform as a result of the obsession, behaviors done to reduce distress. Person recognizes that obsessions or compulsions are unreasonable. Marked distress, time consuming or significantly interferes with a person’s normal routine.

OCD • - Treatments-Behavior therapy (systematic des., flooding, thought stopping), Tricyclic Antidepressants, SSRI’s (today, Luvox is commonly used, also may use Prozac or Zoloft)

Post-Traumatic Stress Disorder • "I was raped when I was 25 years old. For a long time, I spoke about the rape as though it was something that happened to someone else. I was very aware that it had happened to me, but there was just no feeling." • "Then I started having flashbacks. They kind of came over me like a splash of water. I would be terrified. Suddenly I was reliving the rape. Every instant was startling. I wasn't aware of anything around me, I was in a bubble, just kind of floating. And it was scary. Having a flashback can wring you out." • "The rape happened the week before Thanksgiving, and I can't believe the anxiety and fear I feel every year around the anniversary date. It's as though I've seen a werewolf. I can't relax, can't sleep, don't want to be with anyone. I wonder whether I'll ever be free of this terrible problem."

Post-Traumatic Stress Disorder (PTSD) - display of persistent anxiety following an overwhelming traumatic event • - Causes-traumatic event that is not a usual event in the normal human experience • - Symptoms-traumatic event is persistently reexperienced, may have images or thoughts of the event, recurrent distressing dreams of the event, reliving the event, insomnia, exaggerated startle response. • - Treatments-Psychotherapy (systematic des., flooding), Cognitive-Behavioral therapy

Somatoform Disorders • Disorders in which the person may feel physical pain or problems but there is no physiological basis for them, they are psychological in nature.

Types of Somatoform Disorders • Somatization Disorder: When the person experiences a wide variety of physical problems that are due to psychological problems. • Conversion Disorder: When the person experiences a loss of physical functioning in a body part with no physical reason for this to happen. May effect, vision, hearing, use of limbs. • Hypochondriasis: When the person is excessively worried about their health, worry about developing illnesses and often manufacture the symptoms of various illnesses in their head.

Causes and Treatments • Causes of these disorders: May be due to increased sensitivity of autonomic nervous system, while others feel it is a personality or cognitive defect. People who are histrionic, that is, self-centered, suggestible, excitable, and highly emotional may be more susceptible. • Treatment: Psychoanalysis or cognitive therapy may be helpful.

Malingering – those who fake a disease or disorder Are fully aware of why they are engaging in these behaviors Factitious Disorder Symptoms under voluntary control, but don’t know why (Munchausen Syndrome) When done to others it is referred to as by proxy (Munchausen Syndrome by proxy) Differences from other problems

Dissociative Disorders When a person experiences bouts of memory loss, due to loss of consciousness and have disruptions in their sense of identity. • Dissociative Amnesia: A sudden loss of memory for important personal information that is too severe to be considered normal. May occur for one traumatic event or period of time. • Dissociative Fugue: When a person loses their memory for their entire life along with who they are and what their identity is. May forget name, family, where they live, etc.

Dissociative Identity Disorder: When there is the existence of two or more personalities coexisting in the same body (used to be called Multiple Personality Disorder). The host personality is supposedly unaware of any other personalities, however, some have reported that one or more of the other personalities may be aware of what is happening. • Causes: It is thought that the cause of Dissociative Identity Disorder is some type of repeated, chronic psychological trauma during childhood. Dissociative amnesia or fugue may be brought on by excessive stress. • Treatment: Psychoanalysis is usually a treatment Chris Sizemore

Personality Disorders • - May be characterized by any of the following: affects a person’s sense of self as well as others, lacks appropriate emotional responses, impersonal functions, lacks impulse control, behavior that is inflexible, inability to function in social, occupational and other functions of life, onset traced back to early adolescence or early adulthood • Disorders that are considered odd/eccentric • Schizoid Personality Disorder • - odd eccentric behavior, tend to be loners, may be perceived to be cold and unfeeling, trouble keeping jobs and maintaining relationships, show very little emotion

Paranoid Personality Disorder • - suspicious and mistrustful of others, refuse to accept criticism or blame, may be cautious, scheming, devious, or argumentative, does not like to confide in others, difficult to get along with • Schizotypal Personality Disorder • - suspicious, shows signs of paranoia, aloof and impersonal, shows signs of magical thinking, unusual perceptual thinking, may have speech that resembles schizophrenia (disorganized)

Antisocial personality disorders • failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest • deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure • impulsivity or failure to plan ahead • irritability and aggressiveness, as indicated by repeated physical fights or assaults • reckless disregard for safety of self or others • consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations • lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Borderline personality disorder • frantic efforts to avoid real or imagined abandonment. • a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation • identity disturbance: markedly and persistently unstable self-image or sense of self • impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating) • recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior • affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) • chronic feelings of emptiness • inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) • transient, stress-related paranoid ideation or severe dissociative symptoms

Histrionic personality disorder • is uncomfortable in situations in which he or she is not the center of attention • interaction with others is often characterized by inappropriate sexually seductive or provocative behavior • displays rapidly shifting and shallow expression of emotions • consistently uses physical appearance to draw attention to self • has a style of speech that is excessively impressionistic and lacking in detail • shows self-dramatization, theatricality, and exaggerated expression of emotion • is suggestible, i.e., easily influenced by others or circumstances • considers relationships to be more intimate than they actually are

Narcissistic personality disorder • has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) • is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love • believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) • requires excessive admiration • has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations • is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends • lacks empathy: is unwilling to recognize or identify with the feelings and needs of others • is often envious of others or believes that others are envious of him or her • shows arrogant, haughty behaviors or attitudes

Avoidant personality disorder • avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection • is unwilling to get involved with people unless certain of being liked • shows restraint within intimate relationships because of the fear of being shamed or ridiculed • is preoccupied with being criticized or rejected in social situations • is inhibited in new interpersonal situations because of feelings of inadequacy • views self as socially inept, personally unappealing, or inferior to others • is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Dependent personality disorder • has difficulty making everyday decisions without an excessive amount of advice and reassurance from others • needs others to assume responsibility for most major areas of his or her life • has difficulty expressing disagreement with others because of fear of loss of support or approval. • has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy) • goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant • feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself

Obsessive-compulsive personality disorder • is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost • shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met) • is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity) • is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification) • is unable to discard worn-out or worthless objects even when they have no sentimental value • is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things • adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes • shows rigidity and stubbornness

Mood Disorders • 1) Major Depression: A “whole body” illness involving body, mood and thoughts. Affects the way the person eats, sleeps and how they feel about themselves. Symptoms can last for weeks, months or years. Usually lasts around 9 months, but if it goes longer, it will usually dissipate within 2 years.

DEPRESSION CONTINUED • Causes: 1) Some types run in families, 2) low levels of serotonin, 3) low self-esteem, 4) those who are pessimistic, 5) those overwhelmed by stress, 6) serious loss, 7) chronic illness, 8) difficult relationships, 9) financial problems • Symptoms: 1) persistent sad, anxious, “empty” mood, 2) feelings of hopelessness, 3) feelings of guilt, worthlessness, helplessness, 4) loss of interest in pleasures or hobbies, 5) insomnia or oversleeping, 6) weight loss or weight gain, 7) decreased energy/fatigue, 8) thoughts of suicide or death

Depression continued • Treatments: 1) Antidepressants (Tricyclics, MAOI’s, SSRI’s), 2) Psychotherapy (“talking” therapies, gaining insight), 3) ECT (for severe depression), Lithium (for recurrent major depression), 4) behavior therapy (gaining self-reinforcements for positive behavior)

Teen Depression • Approximately 1 in 33 children and 1 in 8 adolescents are affected by depression at any given time • Suicide is the 3rd leading cause of death for 15-24 year olds and the 6th leading cause for 5-14 year olds • 70% of those diagnosed do not get any treatment

High risk: loss, attention disorders, conduct or anxiety disorders • High risk: Teenage girls, minorities • Treatment is most effective when there is early intervention, yet most people do not know the symptoms of depression

Often, a teen with depression may be seen as a “normal” teen angst as they may appear angry, belligerent, irritable and hostile • When this extends beyond 6 months, however, this is considered to be a problem

Bipolar Disorder • Bipolar Disorder: A disorder that is characterized by episodes of depression and mania. • Causes: 1) runs in families, 2) many different genes may be working together • Symptoms: • Depression: See major depression • Mania: 1) inappropriate elation, 2) inappropriate irritability, 3) severe insomnia, 4) increased talking, 5) disconnected and racing thoughts, 6) inappropriate social behavior, 7) feelings of grandiosity, 8) racing thoughts, 9) abuse of drugs and alcohol

Bipolar is a continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic.

Descriptions by Bipolars • Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless…. [I am] haunt[ed]… with the total, the desperate hopelessness of it all…. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?

Hypomania: At first when I'm high, it's tremendous… ideas are fast… like shooting stars you follow until brighter ones appear…. All shyness disappears, the right words and gestures are suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but, somewhere this changes.

Mania: The fast ideas become too fast and there are far too many… overwhelming confusion replaces clarity… you stop keeping up with it—memory goes. Infectious humor ceases to amuse. Your friends become frightened…. everything is now against the grain… you are irritable, angry, frightened, uncontrollable, and trapped.

Treatments: • 1) Lithium • 2) Antipsychotic drugs • 3) Psychosocial treatment • 4) Psychoeducation • 5) Family Therapy • 6) Psychotherapy (individual and group therapy)

Seasonal Affective Disorder: Disorder in which there is some form of depression associated with the time of year (usually found in fall and winter. • Causes: Thought that the pineal gland monitors the amount and quality of light that our eyes receive. The Pineal body secretes chemicals, which controls sleep and may switch the body into a “hibernating” mode for the winter months. • Symptoms: 1) depression occurs during certain seasons in the year, 2) weight gain, 3) excessive sleeping, 4) loss of interest in pleasures or hobbies • Treatments: Light therapy (phototherapy)

Abnormal Psychology