"Abnormal" Psychology

1. "Abnormal" Psychology

2. Think about it... • 400 million people worldwide suffer from psychological disorders • Worldwide, mental disorders account for 15.4% of the years of life lost due to death or disability, slightly below cardiovascular conditions and slightly above cancer (1996) • A US government survey estimates that 15% of the population are in need of psychological therapy.

3. TRUE or FALSE? 1. Very few people are actually affected by psychological disorders. 2. People sometimes forget a very traumatic event as a way of coping with the psychological stress of the trauma. 3. People whose illnesses are “all in their heads” do not really have symptoms of disease. 4. Depression is the most common type of psychological disorder. 5. Some people never feel guilty, even when they commit serious crimes.

4. What is "normal"? Are psychological disorders genuine illnesses or socially defined categories? What is Abnormal Behavior??? Is abnormal behavior treatable? Can we prevent abnormality? What’s Normal? What’s Abnormal? How do we decide between these two terms?

5. Finding a “lucky” seat in an exam. • Being unable to sleep, eat, study, or talk to anyone else for days after a break-up. • Breaking into cold sweat at the thought of being trapped in an elevator. • Swearing, throwing pillows, and pounding fists on the wall in the middle of an argument with a friend or parent. • Refusing to eat solid food for days at a time in order to stay thin. • Having to engage in a thorough hand-washing after coming home from a ride on a bus or train. • Believing that the government has agents who are listening in on telephone conversations. • Drinking a six-pack of beer a day in order to be “sociable” with friends.

6. Norms: A society’s stated and unstated rules for proper conduct. Culture: People’s common history, values, institutions, habits, skills, technology and arts. Norms vs. Culture

7. - 39% of ppl who confess to snooping in their host’s medicine cabinets - 30% of ppl who refuse to sit on a public toilet seat - 23% confess to not flushing all the time - 10% believe they’ve seen a ghost Kanner, 1995 - 50% of ppl use the bathroom 6x/day - 97% write own name when trying out a new pen - 50% regularly sneak food into movie theaters - 57% report having experienced déjà vu Kanner, 1995 DEVIANCE NOT DEVIANT

8. Questions to consider… • How typical is the behavior of people in general? • Is the behavior maladaptive? • Does the behavior cause the individual emotional discomfort? • Is the behavior socially unacceptable?

9. Abnormal is... • Any behavior that differs much from the average • Any behavior that leads to distress (pain), disability (impaired functioning), or an increased risk of death, pain, or loss of freedom (DSM definition) • Let people decide for themselves whether they are troubled?

10. TYPICALITY • MALADAPIVITY – the behavior impairs an individual’s ability to function adequately in everyday life; behavior that is hazardous to the individual or others • EMOTIONAL DISCOMFORT – feelings of helplessness, hopelessness, suicidal thoughts • SOCIALLY UNACCEPTABLE BEHAVIOR – culture must be considered (culture-bound syndromes)

11. 4 Approaches to Abnormality • The following can occur alone or an interaction can contribute towards abnormality 1) Distress 2) Impairment 3) Risk to Self or Other People 4) Socially and Culturally Unacceptable Behavior

12. Along the Niger River, men of the Wodaabe tribe put on elaborate makeup and costumes to attract women. In Western society, the same behavior would break behavioral norms and probably be judged abnormal Would you consider this normal? Abnormal?

13. Causes of Abnormality? • Biological • Psychological • Socio-cultural

14. Biological Causes • Biological determinants? • Use of Medication • Brain damage; exposure to toxins • Genetics • PD’s do sometimes run in families • E.g., MDD • Medical Ailments • Environmental Contributor

15. Psychological Causes • Disturbances often arise from an emotional, distressing or troubling life experience • Interpersonal experience • Events that take place in interactions w/ other people • Intrapsychic • Those that take place w/in thoughts and feelings

16. Sociocultural Causes • What does sociocultural mean? • R.D. Laing (1964) • “people who refuse to abide by the norms of this society are psychologically healthier than those who blindly accept and live by such restrictive social norms” • Thomas Szasz (1961) • “Problems with living” vs. “sick” • Trouble stems from a “mismatch b/w personal needs and society’s ability to meet those needs”

17. The Two Models • Medical - psychological disorders are sickness/diseases • Bio-psycho-social Model - abnormal behavior has 3 major aspects: biological, psychological, sociological

18. Biopsychosocial Perspective • Refers to the interaction in which biological, psychological, and sociocultural factors play a role in the development of an individual • Diathesis Stress Model - People are born with a predisposition (or “diathesis”) that places them at risk for developing a psychological disorder. - This vulnerability could be genetic or due to earlier life experience.

19. Table 1.1 Causes of Abnormality

20. The Human Experience of Psychological Disorders

21. Myths of Mental Illness • Creative people are a little “crazy” • Ppl w/ mental disorders are dangerous • Most older ppl are senile • Criminals are born “bad” • Asthma is caused by emotional problems • Suicidal individuals rarely talk about suicide • People wilth Schizophrenia have multiple personalities

22. The Human Experience of Psychological Disorders • Stigma, social reactions - People treat individuals suffering from a psychological disorder differently • Why is stigma around PD’s and treatment a problem??

23. Social Cognitive Processes • Cues 1) Psychiatric symptoms 2) Social Skill Deficits 3) Physical appearance 4) Labels • Stereotypes • Prejudice • Discrimination

24. Why do some psychologists criticize diagnostic labels?

25. Classification • DSM- IV- TR

26. Diagnostic and Statistical Manual of Mental Disorders (DSM) • First developed in 1952 by American Psychiatric Association • Many revisions, movement away from the conceptualization of psychological disorders as emotional reactions

27. History of DSM • DSM-IV (the 4th ed.) 1994 • DSM-IV-TR (4th ed., text revision) 2000 - Includes editorial revisions • Diagnostic and Statistical Manual of Mental Disorders - Provides both clinicians and researchers with a common language for delineating disorders - This helps professionals with differing backgrounds understand one another - This helps create confidence in labeling a ct or pt • Published by the American Psychiatric Assoc.

28. DSM • Concerns in developing the DSM-IV • Reliability • Validity • Base Rates • Social Context

29. Mental Disorder • What does this term mean to you? • “Clinically Significant” • Consistently present over time • Dramatically affects daily life • Syndrome • Collection of symptoms (observable actions) that form a definable pattern. • Based on client report of thoughts and feelings

30. Assumptions of the DSM • Medical Model • Disorders are viewed as diseases • MD’s usually use term “patient” and “mental disorder.” The latter = neg conotation • Atheoretical Orientation • Descriptive, rather than explanatory • Describes Sx, not causes • Categorical Approach • Multiaxial System (described next!!!)

31. Neurosis: Term referring to behavior that involves distressing, unacceptable symptoms that are enduring and lack any physical basis. Not a modern diagnostic term Psychosis: Term referring to various forms of behavior involving a loss of contact with reality, such as delusions (false beliefs) and hallucinations (false perceptions) NOTE:

32. The 5 Axes of the DSM-IV-TR • Axis I: Clinical Disorders • Axis II: Personality Disorders and Mental Retardation • Axis III: General Medical Conditions • Axis IV: Psychosocial and Environmental Problems • Axis V: Global Assessment of Functioning

33. Axis I • To be listed on Axis I • Must be primary focus of clinical attention • Typically, an overlay of an otherwise healthy personality • E.g., substance related disorders; anxiety disorders, schizophrenia, depression

34. Axis II • Personality traits that are inflexible and maladaptive • Usually a long standing condition • E.g., Narcissism, OCPD, Borderline • Can an individual have a diagnosis on Axis I and Axis II? • Example??

35. Axis III • Physical conditions can be the basis of psychological problems and should be documented. • E.g., Lyme’s/Bells & Dep Ct. • Also important b/c of medication interaction and causality

36. Axis IV • Negative life events • E.g., problem with primary support group • Details: parent died OR falling out with family • All areas of this Axis are stressors which can contribute towards a dx on Axis I or II

37. Axis V • An overall judgment of functioning • Consider psychological status, social functioning (including personal and work relationships) • What’s normal? • 65 and Up is generally high functioning

38. Review • 1. Define each of the following terms: phobia, dissociation, depersonalization, and mania. • 2. What are obsessions and compulsions, and how are they related? • 3. What fears are associated with each of the following phobias: agoraphobia, claustrophobia, and zoophobia? • 4. What must occur before a psychologist will make a diagnosis of major depression?

39. Adapted from Kessler et al., 2005

40. Who Seeks Therapy? This chart is based on U.S. Surveys Percentages represent individuals who have been in therapy at some point in their life -(Adapted from Fetto, 2002)

41. Anxiety Disorders • Generalized Anxiety Disorder • Panic disorder • Phobias • OCD • http://www.youtube.com/watch?v=45PVIo2968E • http://www.youtube.com/watch?v=Rn1OYlYzgm8 • PTSD

42. Mood Disorders • Major Depressive Disorder • Dysthymic disorder • Bipolar Disorder

43. Other categories • Substance-related • Developmental-related Disorders - mental retardation, pervasive disorders, ADHD • Age-related and Cognitive Disorders - Dementia, Alzheimer's • Personality Disorders - Histronic, Narcissistic, Paranoid, Schizoid, Schizotypal, Avoidant, Antisocial, Borderline • Schizophrenia • Somatoform Disorders - Conversion, Body Dysmorphic, Hypchondrias • Dissociative Disorders - Dissociative Amnesia, Diss. Fugue, Depersonalization • Eating Disorders/Impulse Control Disorders - Anorexia, Bulimia, Kleptomania • Sexual Disorders - Pedophilia, Exhibitionism, Fetishism, Sadism/Masochism