Unit XII Abnormal Behavior Modules 65-69

1. Unit XII Abnormal Behavior Modules 65-69 Mr. McElhaney 2019

2. Unit XII Abnormal Behavior Modules 65-69 • Module 65 Introduction to Psychological Disorders • Module 66 Anxiety Disorders, Obsessive-Compulsive Disorder, and Post-traumatic Stress Disorder • Module 67 Mood disorders • Module 68 Schizophrenia • Module 69 Other Disorders

3. What is abnormal?Defining a disorder: • Defining Psych Disorders: • A disorder- is a syndrome marked by clinically significant disturbances in an individual’s cognition, emotion regulation, or behavior. • Maladaptive- • Disturbed or dysfunctional • Interferes with normal day to day life. Mental Health consists of the ability to adapt to the inevitable stresses and misfortunes of life. It means the ability to cope with anxiety, depression in a healthy way. We adapt and can have growth

4. Criteria of Ab-normal • Other detail • Deviance from Statistical Norm • Deviance from Social Norma • Personal distress • Maladaptiveness • Unusual • Infrequency • Statistical infrequency- behavior that is unusual (but that alone is not enough to determine abnormality) • Norm Violation • People who behave in bizarre, unusual, disturbing enough to violate norms • Society decides what is normal • Personal Suffering • Is the problem severe enough to require treatment? • But not by itself, sometimes people with disorders are not suffering.

5. Psychopathology: the scientific study of mental disorders. (simple definition) • Psychopathology is generally defined • “as patterns of thought, emotion, and behavior that result in personal distress or significant impairment in a person’s social or occupational functioning.”

6. Culture and Mental Disorders • Controversy- disorders are sometimes dependent on culture. • Mental disorders determination or diagnosis are subjective example homosexuality was a disorder till 1973. Today we think of HDHD in similar terms…

7. Culture and Mental Illness • Cultural issues relate, for example Anorexia/bulimia are found in Western cultures. • Running Amok- in Malesia • Susto- Latin America, severe anxiety, restlessness, fear of black magic. • Taijin- Kyofusho- social anxiety, fear of eye contact • Hikikomori (Japan) extreme withdrawal

8. The Medical Model:Philippe Pinel died 1820’s • Reformer in France • Started reforms in hospitals • Argued “abnormal behavior is disease of the mind.” • Moral Treatment • Boost morale • Treatment is more humane • Gentle • Activity vs. Isolation • Clean air/sunshine Charcot Dorothea Dix Michel Foucalt Madness and Civilization

9. Bias and Labeling Psychological Disorders • Labels- problem when a label is given it creates expectancy and preconceptions • Preconceptions guide our perceptions and attitudes. We judge and change our behavior when we get information, also creates prejudice • Rosenhan study: 1973 • Patients misdiagnosed with mental disorder were held 19 days • Stereotypes were reinforced.

10. Medical Model (sees abnormal behavior as a medical problem) is known as the Neurobiological Model- • OBS • Neurobiological Modelis really explains psychological disorders in terms of disturbances in anatomy and chemistry of the brain and other bio processes – genetic • Example of Dementia- loss of mental functions including memory, personality, cognitive abilities, • Caused by- aging, long term alcohol abuse, disease such as encephalitis, brain tumors, head injuries, drug intoxication… • Alzheimer’s Disease- is a severe form of dementia, • Schizophrenia, Bi-polar disorders, autism, are bio related

11. BiopsychosocialApproach Psychopathology is a combination of these factors:

12. Psychological Factors • Explanation of disorders as caused by psychological factors: • wants, needs, emotions, our learning experiences, attachment history, the minds struggle to resolve inner conflicts • Freud argued mental disorders arise because of “unresolved, mostly unconscious conflicts that began in childhood.” Pg. 594 • Social Cognitive Schoolsays, “see most psychological disorders as resulting from the interaction of past learning and current situations.” They also see learned expectations, thinking (negative thinking, and maladaptive thoughts) • Humanistic Approachsays, “suggests that behavior disorders appear when a person’s natural tendency toward growth is blocked, by failure to be aware of and express true feelings… creates distorted perception of reality.”

13. Sociocultural Causes of Psychological Disorders: • WE must look outside the individual for causes; at social cultural factors- gender, age, marital status, physical, economic , marital situations… • Diathesis Stress= a “predisposition for a psychological disorder.” Symptoms reveal themselves when stress is present. Stress triggers the disorder

14. Causes of Mental Illness • Nature-Genetic and Physiological causes • Nurture- Experience/conditioning/social factors

15. Psychological Disorders are costly • Quality of life/Quality of Relationships is impacted • Economic factors are generally negatively impacted • Any given year in US 30% of adults = 60 million people, display some form of mental disorder • I/2 of all Americans can expect to experience a disorder by age 75 • Any given year 20% of children display significant mental disorders • ¾ of adult disorders appear before age 25

16. Rates of Psychological Disorders P 657

17. Risk Factors to mental disorders

18. Onset of Mental Disorders • Usually in early adulthood for most disorders manifest mostly by age 24 • Antisocial Personality Disorder and phobias emerge ages 8-10 • Alcohol use Disorder – emerges around age 20 • OCD, Bipolar, Schizophrenia, and Major Depression- all emerge around age 25.

20. DSM Info • “it is important to emphasize that the current diagnostic criteria are the best available description of how mental disorders are expressed and can be recognized by trained clinicians.” DSMV- Preface • “The criteria are concise and explicit and intended to facilitate an objective assessment of symptom presentations in a variety of clinical settings” DSMV- Preface • harmonized with the World Health Organization's International Classification of Diseases (ICD) • change in chapter organization better reflects a lifespan approach • Childhood adult • Physiological indicators/neurocircuitry • to identify the most prominent symptoms that should be assessed when diagnosing a disorder.

21. DSM V is the Diagnostic and Statistical Manuel of Mental Disorders is used to diagnose disorders • (International Classification of Impairments- is another diagnostic manual) • Manual describes and defines the abnormal patterns of thinking, emotion and behavior • Provides specific criteria for each disorder • The DSM-V says, “that in order to be given a particular diagnosis, a person must display a certain number of symptoms at a certain level of severity for a certain period of time.” • Diagnosis can be impacted by bias

22. Classifying Psychological Disorders • DSM-5 Organizes and describes Symptoms • Diagnostic Criteria for mental disorders • Defines criteria= frequency, causes, duration, multiple symptoms, treatment options • Example Insomnia Disorders • Revisions are made regularly (link)

23. Lots of information here link

24. DSM Organization

25. Module 66 Anxiety, Obsessive-Compulsive Disorder, and Post-traumatic Stress Disorder • Anxiety • Generalized Anxiety • Panic Disorder • Phobias • Social Anxiety Disorder • Agoraphobia • Obsessive Compulsive Disorder • Post-Traumatic Stress Disorder When anxiety is so intense and long lasting that it impairs a person’s daily functioning it is called an Anxiety Disorder.

26. Anxiety • Uneasiness • Tense- intense dread/fear • Distressing • Persistent Anxiety • Dysfunctional anxiety reducing behavior (maladaptive coping behaviors of drugs and alcohol) • Generalized Anxiety • • Unexplained • • Continual • • Tense and uneasy • • Unfocused • • Out of control • • Agitated feelings • • Pathological worry • • Persistence 6 months or more • • 2/3 are women • • Jittery/agitated • • Sleep deprived • • Cause many not be easily identified • • Also with depressed mood • • High blood pressure • • Childhood causes- maltreatment, • • By age 50 relatively rare

27. Panic Disorder • Sudden episodes • Creates intense dread • Panic attack • Physical manifestations • Heart beat • Shortness of breath • Choking sensation • Trembling • Dizziness • Phobias • Intense • Irrationally afraid of specific object or situation • (Anxiety disorder) • Irrational fear • Causes person to avoid 1. Object 2. Activity 3. Situation • Social Anxiety Disorder • Shyness to an extreme • Fear of being scrutinized by others • Worries about anxiety • Agoraphobia • Fear or avoidance of public crowds/public situations

28. Obsessive Compulsive Disorder • Repetitive thoughts or actions • Being obsessed with thoughts that will not go away • Maladaptive • 2/3 % • Often @ late teens • Young people and adults

29. OCD • Affects 1% of population in any given year, persistent, upsetting, unwanted thoughts (common thoughts center on possibility of infection, contamination, doing harm to themselves or others) • Obsessive thoughts motivate compulsive behaviors use ritualistic or repetitive behaviors, • cleaning, checking locks, repeating words, arranging things “just so” that severely impair daily activities, “more than 1 hour a day” • Thoughts and actions are irrational

30. Post-Traumatic Stress Disorder • 250,000 US Vets have been diagnosed with PTSD or Traumatic Brain Injury • Characterized by • Emotional traumatic experiences • Social Withdrawal • Nightmares • Jumpy anxiety • Insomnia • 1 in 6 people in combat report either PTSD/Depression/severe anxiety • Brain Areas • Amygdala- emotion • Temporal lobe = memory • Genetic predisposition • Resiliency-lots of people don’t experience PTSD even with lots of trauma

31. Understanding Anxiety Disordersorigins • Learning/Conditioning • Conditioned fear through Classical and Operant conditioning • People become hyper-attentive to threats • They associate anxiety with certain cues/stimuli • Stimulus generalization • Reinforcement • Avoidance • Observational learning • We learn fear through observing others in fear • Monkeys and fear of snakes experiment • Cognition • • Irrational beliefs • • Hyper vigilance • • Intrusive thoughts • Biological Factors – biological dispositions, genetic- it runs in families shown in twin studies, too much serotonin • Social Factors- learning experiences

32. Biological Perspective • Evolutionary/Genetic • Anxiety genes • Coping genes • Neurotransmitters • Serotonin (related to genes) • Glutamate - too much = anxiety • The Brain and Anxiety • “As an over arousal of brain areas involved in impulse control and habitual behaviors.” • OCD • Anterior cingulate cortex • Region monitors our actions and checks for errors • Is hyperactive • Frontal lobe

33. Module 67 Mood disorders p 671 • Extreme Moods- (AKA Affective Disorder) • for long periods, then shift to another extreme mood, moods and shifts are not consistent with events around them • Depression is the number one reason people seek mental health services • Stats say, depression is affects 17% of US adults. • Depressive Episode plagues 5.8% of men and 9.5% if women • Major Depressive Disorder • Bipolar Disorder • Persistent Depressive Disorder (AKA Dysthymia)

34. Depression as an evolutionary interpretation- • Depression as an evolutionary interpretation- • “it protects the psyche. It slows us down, defuses aggression, helps us let go of unattainable goals, and restrains risk taking…” • “Redirects energy in more promising ways”

35. Major Depressive Disorder • Prolonged hopelessness • Lethargy • Depressive symptoms: • Feeling deeply discouraged about the future • Dissatisfied with life, conversation is unbearable • Feeling socially isolated • Lack energy to get things done • May not have energy to get out of bed • May be unable to concentrate, eat, sleep, • Thoughts of suicide • Social Stresses • Often caused by a response to past and current loss, death, marital disruption, lost job… • Ruminative thinking • People feel sad and overwhelmed, typically losing interest in activities and relationships and taking pleasure in nothing= Anhedonia • Eating habits are affected so weight loss or gain is an issue… • Problems in working, • Problems concentrating • Making decisions… Extreme cases may exhibit false beliefs. Can establish suddenly or gradually. • Characterized by depressive periods, episodes can last for weeks or months, average 4-9 months • Common aspects: Exaggerated feelings-of inadequacy, worthlessness, • hopelessness or guilt • Women are 2-3 times more likely to be victims, 10-25% of women may experience • Late adolescence and old age correlation • Very common to appear (Comorbid) with PTSD, OCD, and Anxiety Disorders • Depressed people think about negative events that also increases and prolongs depression

36. Bipolar Disorder (less common than depression) • Formerly called Manic Depressive • A person alternates between depressionandmania (an overexcited, hyperactive state, euphoric, hyperactive, wildly optimistic) • Alternating between depression and mania • a week to week (not day to day) • Issue of lots of diagnosis for adolescent boys. Which will be remedied by new classification • During Manic Phase: • Over talkative • Overactive • Elated • Have little need for sleep • Show less sexual inhibitions • Reckless/poor judgment • (some connection of mania to creativity) • Famous Bi-polar: • Fredric Handel, Schuman, • Composers, artists, poets, novelists, and entertainers seem especially prone • Mania is followed by depressive episode

38. Persistent Depressive Disorder (AKA dysthymia) • Characteristics: • Mildly depressed mood more often than not, for a least 2 years. • Also at least two of the following symptoms: • 1. Problems regulating appetite • 2. Problems regulating sleep • 3. Low energy • 4. Low self-esteem • 5. Difficulty concentrating and making decisions • 6. Feelings of hopelessness

39. Understanding Mood Disorders: • Behavioral and Cognitive changes come with Depression: • Negative thinking • Behavioral aspects could include anxiety and substance abuse (self-medicating) • Depression is widespread • Women risk of major depression is nearly double to men 13% men/22% Women • Most major depressive episodes self-terminate • Therapy helps, but most people eventually recover on their own. • Stressful events related to work, marriage, and close relationships often precede depression. • Stressful incidents correlate with depression • Death/marital crisis, physical assault- related to depression • More younger people are experiencing depression • Perhaps more reporting of depressive feelings.

40. Biological Perspective • Genetic Influences: • Mood disorders runs in families, risks increase with a family member who manifests behavior • Twin studies really show this • The Depressed Brain: • Neurotransmitters • Norepinephrine- increases arousal/boosts mood/ scarce during depression (smoking increases) • Serotonin- creates euphoria, diminished serotonin associated with depression (SSRI selective Serotonin Reuptake Inhibitor) • Diminished brain activity in depressive mood left frontal • Brain size depressed people smaller frontal lobes • Hippocampus with stress related damage

42. Social Cognitive PerspectiveDepression • The role of thinking and acting in depression • Low self esteem • Negative thought patterns/their future • Catastrophizing • Minimizing the positive

43. Suicide and Depression: • Suicide is closely associated with depression and mood disorders • Thinking about suicide is a symptom of depressive disorders, as well as hopelessness… • 10 in 100,000 rate, 11th leading cause of death • Suicide is common among people over 65 years • ” • Second leading cause of death among college students 10,000 attempt per year, 1000 succeed. • Women attempt suicide 3 times more than men • Men are 4 times more likely to actually kill themselves • “The male suicide rate of 65 per 100,000 is ten times higher than the rate for women

44. Predicting Suicide: • European males, older than 45, single or divorced and living alone • People diagnosed with mood disorder, anxiety disorder, or schizophrenia • Elderly males who suffer depression over health problems • People who make a plan to give away their possessions • Not previous attempts- those are help seeking gestures • Most people who attempt suicide made no prior attempts. (10 percent do attempt again) • “those who say they are thinking of suicide are much more likely than other people to attempt suicide… 80% of suicides are preceded by some kind of warning.” Pg. 617

45. Arron Beck 1967 cognitive theory of depression: • Said, depressed people develop mental (cognitive) habits • Blaming themselves when things go wrong • Focusing on and exaggerating the negative side of events • Jumping to overly generalized pessimistic conclusions • These are errors that lead to depressive thoughts.

46. Social Cognitive Factors for Depression • Negative patterns of thinking can be acquired during childhood • Children need close, protective, predictable, and responsive early relationships to form healthy views of themselves. • People who RUMINATE, or continuously dwell on negative events, on why they occur, and even feelings of depression are likely to feel more and more depressed. • Women seem to ruminate a lot and this might explain greater incidence of depression. • Men seem to use a “distracting style”… they engage in activity that distracts them from their concerns and helps bring them out of their depressed mood.” Pg. 621 • Certain cognitive styles constitute a (diathesis) predisposition to depression. Then stress makes depression more likely.

47. Schizophrenia • Schizophrenia is a pattern of extremely disturbed thinking, emotion, perception, and behavior that seriously impairs their ability to function efficiently. • 1-2% of population, equally in men and women • Develops in adolescent and early adulthood 75% of time, it is usually gradual, but can be sudden onset. • 40% of people with schizophrenia respond well to treatment (medication) • Estimated 10-13% of homeless suffer from Schizophrenia

48. Symptoms of Schizophrenia: • Disorders of Thought- • Content of Schizophrenic thinking is disturbed • disturbed content, delusions, • Delusions or false beliefs, • Disorder of Perception • Hallucinations, or false perceptions, poorly focused attention • Problems with cognition (The term means split mind, but is really about thinking, “splitting normally integrated thinking) • Thought and language are disorganized • Neologism “new words” that have only meaning to them, are common disorganization, loose associations, neologisms, “word salad” • Loose associations- the tendency for one thought to be connected to others, but they just don’t fit. • “Upon the advisability of held keeping, environment of the seabeach, gathering, to the forest stream, reinstatement to be placed, poling the paddleboat, of the swamp morass, to the forest compensation, of the dance…” • Disorders of Emotion • Flat affect; inappropriate tears, laughter, or anger

49. Causes of Schizophrenia: Bio-Psycho-Social model: • Chemistry: • Poor functioning of Dopamine, (excess dopamine- drugs to reduce reception of dopamine work to control some Schizophrenia) • Biological Explanation: • Schizophrenia runs in families • Genetic/Heredity • 16% of the children of schizophrenic mothers develop Schizophrenia • Children of Schizophrenics are 10x more likely to develop Schizophrenia. • Predisposition;/Diathesis • Probably several genes • 40% of twins both have it • Brain Structure Aspects of Schizophrenia • Structure • Tissue is thinner in thalamus region, prefrontal cortex, subcortical areas • Shrinkage of tissue leads to enlarged ventricles (brain fluid transfer mechanism)