Abnormal Behavior or Psychological Disorders

1. Abnormal BehaviororPsychological Disorders Content as per College Board Abnormal Behavior 7-9 %

2. What is Normal? • In a small group of 3-5 students, determine what you would call “normal” • Not who, what is normal?

3. What is well-being? • In this same group, identify what is psychological order or well-being. • Is it just an absence of a disorder? • Is it more like that which makes a person healthy? • List 3-5 characteristics that make a person have “well-being”

4. Well being • Self acceptance • Positive relations with others • Autonomy • Environmental mastery • Purpose in life • Personal growth • Carol Ryff • Myers’ Teachers Guide

5. What is a disorder? • There is no one absolute definition of psychological disorders • A continuum exists between mental health and pathology • Some proposed definitions may include: (from sample textbooks)

6. A psychological disorder can be defined as a pattern of behaviors or psychological symptoms that cause significant personal distress and/or impairs the ability to function in one or more important areas of life. • A syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation or behavior. (adapted from American Psychiatric Association, 2013)

7. From the DSM 5 • A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. • Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. • 2013

8. From the DSM 5 • An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. • Socially deviant behavior (e.g., political, religious or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from dysfunction in the individual, as described above. • 2013

9. NOTE: • Sanity and Insanity are legal definitions • A person accused of a crime can acknowledge that they committed the crime, but argue that they are not responsible for it because of their mental illness, by pleading "not guilty by reason of insanity.”

10. Just FYI. . . • Although a defense known as "diminished capacity" bears some resemblance to the "reason of insanity" defense (in that both examine the mental competence of the defendant), there are important differences. The most fundamental of these is that, while "reason of insanity" is a full defense to a crime -- that is, pleading "reason of insanity" is the equivalent of pleading "not guilty" -- "diminished capacity" is merely pleading to a lesser crime. • One of the most famous recent uses of the insanity defense came in United States v. Hinckley, concerning the assassination attempt against then-President Ronald Reagan.

11. Also, FYI. . . The history of "not guilty by reason of insanity" • The insanity defense reflects a compromise on the part of society and the law. On the one hand, society believes that criminals should be punished for their crimes; on the other hand, society believes that people who are ill should receive treatment for their illness. The insanity defense is the compromise: basically, it reflects society's belief that the law should not punish defendants who are mentally incapable of controlling their conduct. • In the 18th century, the legal standards for the insanity defense were varied. Some courts looked to whether the defendant could distinguish between good and evil, while others asked whether the defendant "did not know what he did." By the 19th century, it was generally accepted that insanity was a question of fact, which was left to the jury to decide.

12. The M'Naghten rule -- not knowing right from wrong The first famous legal test for insanity came in 1843, in the M'Naghten case. Englishman Daniel M'Naghten shot and killed the secretary of the British Prime Minister, believing that the Prime Minister was conspiring against him. The court acquitted M'Naghten "by reason of insanity," and he was placed in a mental institution for the rest of his life. However, the case caused a public uproar, and Queen Victoria ordered the court to develop a stricter test for insanity. • The "M'Naghten rule" was a standard to be applied by the jury, after hearing medical testimony from prosecution and defense experts. The rule created a presumption of sanity, unless the defense proved "at the time of committing the act, the accused was laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing or, if he did know it, that he did not know what he was doing was wrong." • The M'Naghten rule became the standard for insanity in the United States and the United Kingdom, and is still the standard for insanity in almost half of the states.

13. In your small group, • Review and discuss the provided assignment, “What is Disordered Behavior?” • Record your thoughts upon discussion with group members. • Turn in a copy for each group member. • We will discuss this in 5-7 minutes.

14. Who suffers from disorders? • Diathesis-Stress Model-The diathesis, or predisposition, interacts with the subsequent stress response of an individual. • Stress refers to a life event or series of events that disrupt a person’s psychological equilibrium and potentially serves as a catalyst to the development of a disorder. • Sometimes referred to as the stress-vulnerability model- explanation of disorder that assumes a biological sensitivity (vulnerability) to a certain disorder will result in the development of that disorder under the right conditions of environmental or emotional stress

15. Historical Perspectives on Abnormal Behavior • The ancient world • Greece • Hippocrates- (460-377 BCE) believed that mental illness was the result of natural, as opposed to supernatural causes • Galen – (130-200 BCE) divided the causes of mental disorders into physical and psychological causes • China • Chung Ching- (200CE) stated that both organ pathologies and stressful psychological events were causes of mental disorders

16. The Middle Ages (500-1500 CE) • Europe- abnormal behavior was viewed as a demonic possession. Treatment might include prayer, laying on of hands and/or exorcism performed by the clergy. Possibly witch hunts? • Islamic Countries-known for humane hospitals for mentally ill (Baghdad 792 CE).

17. The Renaissance- brings reemergence of the scientific approach to mental illness • Teresa of Avila (1515-1582 CE) a Spanish nun established a conceptual framework that suggests the mind can be sick • Johann Weyer (1515-1588 CE) of Germany used scientific skepticism to refute the concept of demonic possession

18. Humanitarian Reforms of 18th-19th centuries • Philippe Pinel (France)-pioneered compassionate medical model for the treatment of the mentally ill • William Tuke (England)- introduced trained nurses for the mentally ill • Benjamin Rush (United States) founder of American psychiatry and established hospitals for the mentally ill • Dorothea Dix (United States) advocated for reforms to allow for humane treatment of mentally ill in institutional settings

19. Deinstitutionalization • Occurred due to scientific advances of the 20th century • Psychopharmacology • Medical advances including imaging devices (CT, MRI, PET) • Release of patients back into their usual community using out- patient care • Historical perspective from: TOPSS Unit Lesson Plan

20. Modes or Perspectives of Psychological Disorders

21. Psychological Models • Psychodynamic (Psychoanalytic)-explains disordered behavior as the result of repressing one’s threatening thoughts, memories, concerns in the unconscious mind • Sigmund Freud • Carl Jung • Alfred Adler • Erik Erikson

22. The Biopsychological Perspective • Emphasizes that mental illness should be diagnosed on the basis of its symptoms and cured through medical intervention • Relates to genetic predisposition, abnormalities in brain structure and biochemistry • Medical Doctors (M.D.)

23. The Behavioral Model • Learning perspective emphasizes inappropriate behaviors might have been reinforced and thus reoccurred • Observational learning and modeling may play a role • John B. Watson • B. F. Skinner • Albert Bandura

24. The Cognitive Model • Emphasizes the irrational, illogical and/or maladaptive thought process or thinking patterns • Aaron Beck • Albert Ellis

25. The Biopsychosocial Model • Biological, psychological (psychodynamic, behaviorist and cognitive) and sociocultural influences interact to cause the various forms of disorders • This view has become an influential way to view the connection between mind and body Ciccarelli and White, AP Edition Psychology TOPSS Unit Lesson Plan

26. Others? Evolutionary? Social Cultural?

27. The DSM-5 The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in May 2013 with revisions to the criteria for the diagnosis and classifications of mental disorders. In the interest of fairness and to allow time for publishers to integrate such changes into pertinent sections of AP Psychology textbooks, the College Board has made the following decisions regarding upcoming AP Psychology Exams: Beginning with the 2015 AP Psychology Exam, all terminology, criteria and classifications referred to among multiple-choice and free-response items will adhere to the new fifth edition of the Diagnostic and Statistical Manual (DSM-5).

28. The DSM-5 • Published by the American Psychiatric Association • Widely used diagnostic system for the United States • Provides a set of criteria to make assessments • International Classification of Diseases (ICD) • ICD published by World Health Organization

29. DSM 5 has removed the multiaxial system • Axes I, II and III are all listed on a single axis which includes all mental disorders as well as personality disorders and intellectual disabilities as well as other medical diagnosis • Reference: APA, FRQ about DSM-5 • Axis V (Global Assessment of Functioning) was used to determine medical necessity for treatment. • A single GAF score may not convey information to adequately assess functioning. • Section III of DSM provides separate assessments for severity and disability in regard to functioning

30. Consequences of labelingRefer to the Rosenhan Study • Positive: • Negative:

31. Specific Diagnostic Categories

32. Neurodevelopmental Disorders

33. Neurodevelopmental Disorders • Neurodevelopmental disorders are impairments of the growth and development of the brain or central nervous system. A narrower use of the term refers to a disorder of brain function that affects emotion, learning ability, self-control and memory and that unfolds as the individual grows. • Neurodevelopmental disorders are associated with widely varying degrees of difficulty which may have significant mental, emotional, physical, and economic consequences for individuals, and in turn their families and society in general.

34. Neurodevelopmental Disorders • Intellectual disabilities • Intellectual Disabilities: • Diagnostic criteria for intellectual disability emphasize the need for an assessment of both cognitive capacity (IQ) and adaptive functioning • The term “mental retardation” was used in the DSM IV, however, intellectual disability has become more commonly used in the past two decades • Global Developmental Development Delay: • Language Disorder: • Speech Sound Disorder: • Social Communication Disorder (combines expressive and mixed receptive – expressive language disorders):

35. Neurodevelopment Disorders • Autism Spectrum Disorder: • This is new to the DSM 5 and reflect scientific consensus four previously separate disorders are actually a single condition • ASD is characterized by 1) deficits in social communication and social interaction and 2) restricted repetitive behaviors, interest and activities

36. Neurodevelopmental Disorders • Attention-Deficit/Hyperactivity Disorder (ADHD): • This was added to the neurodevelopmental disorders chapter to reflect brain development correlates with ADHD and the DSM 5 elimination of diagnosis of those first made in infancy, childhood or adolescence • DSM 5 uses the same 18 symptoms used in DSM-4 and continues to be divided into two symptoms domains (inattention and hyperactivity/impulsivity)

37. Neurodevelopmental Disorders • Specific Learning Disorders: • This combines the diagnosis of reading, mathematics disorders and disorder of written expression Motor Disorders: Developmental Coordination Disorder Stereotypic Movement Disorder Tic Disorders Tourette’s Disorder Persistent (Chronic) Motor or Vocal Tic Disorder Provisional Tic Disorder

38. Neurocognitive Disorders

39. Neurocognitive Disorders • The criteria for these disorders are based on defined cognitive domains • The domains as defined by the DSM 5 along with guidelines for clinical thresholds, form the basis on which neurocognitive disorders are diagnosed • Cognitive domains: • Complex attention • Executive function

40. Cognitive Domains • Complex attention (sustained, divided, selective attention, processing speed) • Executive Function (planning, decision making, working memory, responding to feedback, error correcting) • Learning and memory( immediate, short term, long term memory) • Language (expressive and receptive) • Perceptual –motor (visual perceptive, perceptual motor) • Social Cognitive (recognition of emotion, theory of mind)

41. Examples (but not limited to) • Delirium • Alzheimer’s disease • Traumatic brain injury • Substance/medication use • HIV infection • Parkinson’s disease • Huntington’s disease

42. Schizophrenia Spectrum and Other Psychotic Disorders

43. Schizophrenic Disorders • A psychological disorder characterized by delusions, hallucination, disorganized speech and/or diminished or inappropriate emotional expression • Literally translated, schizophrenia means “split mind,” as in split from reality • Myers’ Psychology for AP

44. Schizophrenia Spectrum and Other Psychotic Disorders • In the DSM 5, two Criterion A symptoms are required for any diagnosis of schizophrenia • Delusions • Hallucinations • Disorganized speech • (At least one of these positive symptoms is necessary for a reliable diagnosis) • Grossly disorganized or catatonic behavior • Negative symptoms (diminished emotional behavior) • Simulated Schizophrenia: https://www.youtube.com/watch?v=dkB2CGL769o

45. Schizophrenia subtypes • Subtypes of schizophrenia have been eliminated (paranoid, disorganized, catatonic, undifferentiated and residual) https://www.youtube.com/watch?v=48YJMOcykvc • DSM 5 includes in this category: • Schizotypal (Personality) Disorder • Delusional Disorder • Brief Psychotic Disorder • Schizophrenia • Schizoaffective Disorder • Catatonia

46. Bipolar and Related Disorders

47. Bipolar Disorder • A mood disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania • Long ago referred to as manic - depression

48. Bipolar and Related Disorder • Bipolar I Disorder – for a diagnosis, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or depressive episode • During the period of mood disturbance and increased activity, three (or more) of the following are present (representing a change from usual behavior) • Inflated self-esteem or grandiosity • Decreased need for sleep • More talkative • Flight of ideas • Distractibility • Increased in goal directed activity or psychomotor agitation • Excessive involvement in activities that might have painful consequences

49. Bipolar Disorders • The major depressive episode includes five or more of the following symptoms • Depressed mood for most of the day • Marked diminished interest or pleasure in all (or almost all) activities • Significant weight loss or weight gain • Insomnia or hypersomnia • Psychomotor agitation or retardation • Fatigue or loss of energy • Feeling of worthlessness or excessive or inappropriate guilt • Diminished ability to think or concentrate • Recurrent thoughts of death or suicide ideation

50. Bipolar Disorders • Bipolar II- a categorization for individuals with a past history of a major depressive disorder who meet all of the criteria for hypomania except duration • Cyclothymic disorder-disorder that has too few symptoms of hypomania to meet the full criteria