Abnormal Psychology and Therapy

Abnormal Psychology and Therapy By: Laura Falb, Janki Patel, Danny Kuder and Lizzy O’Grady

Abnormal Behavior • Definition- a mental illness that affects or is manifested in a person’s brain and can affect the way an individual thinks, behaves, and interacts with others • 3 Criteria: Deviant, Maladaptive, and Personally Distressful • Deviant- atypical or statistically unusual • Maladaptive- cannot function effectively with the world • Personal Distress- involves firsthand torment • Always check context of behavior • All seem abnormal but at least 2 needed to classify anyone

Theoretical Approaches to Psychological Disorders • Biological Approach- attributes psychological disorders to organic, internal causes. • primarily focuses on the brain, genetic factors, and neurotransmitter functioning as the sources of abnormality. • medical model- describes psychological disorders as medical diseases with a biological origin • Psychological Approach- emphasizes the contributions of experiences, thoughts, emotions, and personality characteristics in explaining psychological disorders • psychologists might focus on the influence of childhood experiences or of personality traits in the development and course of psychological disorders • Sociocultural Approach- emphasizes the social contexts in which a person lives, including the individual’s gender, ethnicity, socioeconomic status, family relationships, and culture. • Biopsychosocial Approach- A theoretical framework that posits that biological, psychological and social factors all play a significant role in human disease or illness and health, rather than biology alone.

Classifying Abnormal Behavior • To understand, prevent, and treat abnormal behavior psychologists have classified those behaviors into specific psychological disorders • provides a common basis for communicating • Helps clinicians make predictions and understand the correct treatment and symptoms the individual will exhibit

DSM - IV • The Diagnostic and Statistical Manual of Mental Disorders • Classifies individuals on the basis of 5 dimensions, or axes, that take into account the individual’s history and highest level of functioning in the previous year • Axis 1 & 2 focus on the classification of psychological disorders 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

Therapy -Antianxiety Drugs -Anti-Depressant Drugs -Anti-Psychotic Drugs -Electroconvulsive Therapy -Increase Suicide Risk in Children -Drug Chart -Psychosurgery

Antianxiety Drugs -Commonly known as tranquilizers -Reduce anxiety by making individual calmer and less excitable -Benzodiazepines: antianxiety drugs that generally offer the greatest relief for anxiety symptoms\ -Relatively fast-acting, taking effect within hours -Can be addictive -Side effects include: drowsiness, loss of coordination, fatigue, and mental slowing -Have been linked to abnormalities in babies born to mothers who took them during pregnancy -When combined with alcohol, anesthetics, antihistamines, sedatives, muscle relaxants, and some prescription pain medications, they can lead to depression. -Nonbenzodiazepine- buspirone, or BuSpar- is commonly used to treat generalized anxiety disorder -Buspirone must be taken daily for two to three weeks before the patient feels benefits

Antidepressant Drugs -Antidepressant drugs regulate mood -10 percent of Americans take antidepressants -Often effective for some anxiety disorders such as generalized anxiety disorder, panic disorder, obsessive compulsive disorder, social phobia, and PTSD, as well as some eating and sleep disorders -Four main classes: tricyclics, tetracyclics, monoamine oxidase (MAO) inhibitors, and selective serotonin reuptake inhibitors (SSRIs) -Help alleviate depressed mood through their effects on neurotransmitters in the brain -All allow the person’s brain to increase or maintain its level of important neurotransmitters, especially serotonin and norepinephrine -Tricyclics: three ringed molecular structure -Believed to work by increasing the level of certain neurotransmitters, especially norepinephrine -Reduce the symptoms of depression approximately 60 to 70 percent -Usually take two to four weeks to improve mood -Side effects may include restlessness, faintness, trembling, sleepiness, and memory difficulties

Antidepressant Drugs Cont. -Tetracyclic: Four ringed structure -Also called noradrenergic and specific serotonergic antidepressants (NaSSAs) -Enhance brain levels of norepinephrine and serotonin -Tetracyclic Remeron was more effective in reducing depression than any other antidepressant drug -MAO inhibitors: block the enzyme monoamine oxidase -Breaks down norepinephrine and serotonin in the brain -Not as widely used as tricyclics because are more potentially harmful to the body -May be especially risky because of potential interactions with certain fermented foods (for example, cheese) and drugs, leading to high blood pressure and risk of stroke -SSRIs: target serotonin and work mainly by interfering only with the reabsorption of serotonin -Commonly prescribed are Prozac, Paxil, and Zoloft. -Fewer side effects than other antidepressants -Side effects include: insomnia, anxiety, headache, and diarrhea, and can impair sexual functioning and produce severe withdrawal symptoms if the individual stops taking them

Antipsychotic Drugs -Antipsychotic drugs: powerful drugs that diminish agitated behavior, reduce tension, decrease hallucinations, improve social behavior, and produce better sleep patterns in individuals who have a severe psychological disorder, especially schizophrenia -Neuroleptics are most extensively used -Reduce variety of schizophrenic symptoms -Do not cure schizophrenia, only treat the symptoms. If individual stops taking the drug, the symptoms return -In the absence of symptoms, many struggle to justify to themselves that they should continue to take the very medications that have reduced their symptoms -Tardive dyskinesia- neurological disorder characterized by involuntary random movements of the facial muscles, tongue, and mouth, as well as twitching of the neck, arms, and legs. -Up to 20% of individuals with schizophrenia who take neuroleptics develop -Atypical antipsychotic medications carry much lower risk of these side effects -Clozaril and Risperdal

Electroconvulsive Therapy (ECT) -Also called electric shock therapy, a treatment commonly used for depression that sets off a seizure in the brain -Hippocrates (ancient Greek father of medicine) first noticed that malaria-induced convulsions would sometimes cure individuals who were thought to be insane -Primarily used to treat severe depression -About 100,000 individuals a year undergo ECT -Passing a small electric current of a second or less through two electrodes placed on the individual's head. The current excites neural tissue, stimulating a seizure that lasts for approximately a minute -Patient receives anesthesia and muscle relaxants before current is applied -Given mainly to individuals who have not responded to drug therapy or psychotherapy -Possible side effects: memory loss, and other cognitive impairments and are generally more severe than drug side effects -Deep brain stimulation- A procedure for treatment- resistant depression that involves the implantation of electrodes in the brain that emit signals to alter the brain’s electrical circuitry

Increase Suicide Risk in Children -In 2004 FDA held hearings to address concerns of parents and health professionals about the potential risk of suicide as an unexpected, tragic side effect of antidepressant treatment -23 clinical trials involving 4,300 children randomly assigned to receive either an antidepressant or placebo -None of the children committed or attempted suicide -October 2004, FDA required prescription antidepressants to carry the severest “black box” warning, describing the potential of antidepressants to be associated with suicidal thoughts and behaviors in children and adolescents. -Prescriptions for antidepressants for children declined dramatically -Since black box warning, number of studies have found no link between antidepressants in either adults or children

Psychosurgery -A biological intervention that involves the removal or destruction of brain tissue to improve the individual’s adjustment -Effects cannot be reversed -1930s, Antonio Egas Moniz developed surgical procedure to treat psychological disorders- instrument inserted into the brain and rotated, severing fibers that connect the frontal lobe (important in higher thought processes) and thalamus (plays key role in emotion) -Some patients may have benefited but many left in vegetable-like state -Said should be used as last resort -Walter Freeman and prefrontal lobotomies- developed own technique which he performed using a device similar to an ice pick -“Lobotomobile” -Performed over 3,000 lobotomies -Began being used as punishment, then regulations set -Today, psychosurgery performed for OCD, major depression, or bipolar disorders rather than just schizophrenia and is used only as a last resort.

Anxiety Disorders • An anxiety disorder is a serious mental illness. For people with anxiety disorders, worry and fear are constant and overwhelming, and can be crippling. • Defined as “psychological disorders involving fears that are uncomfortable, disproportionate to the actual danger the person might be in, and disruptive of ordinary life.” • Classified into five types: Generalized anxiety disorder, panic disorder, phobic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder

Generalized anxiety disorder (GAD) • Marked by persistent anxiety for at least six months in which the individual is unable to specify the reasons for the anxiety • Worry about their work, relationships, or health can actually take a physical toll (fatigue, muscle tension, stomach problems, and difficulty sleeping) • Can be influenced or worsened by sociocultural factors such as having impossible self-standards, authoritarian type parents, negative thoughts when stressed, and a history of trauma or stressors (such as abuse)

PANIC! (at the disco) disorders • Anxiety disorder in which the individual experiences recurrent, sudden onsets of intense apprehension or terror, often without warning and with no specific cause • Panic attacks can cause severe palpitations, extreme shortness of breath, chest pains, trembling, sweating, dizziness, and a feeling of helplessness • Many people with the disorder feel like they might die, go crazy, or do something they cannot control

Panic disorders (cont.) • Biological factors: Genetics; may have an autonomic nervous system that is predisposed to be overly active; may stem from problems involving the neurotransmitters norepinephrine and GABA • Sociocultural factors: American women are 2x more likely to have panic attacks due to biological differences in hormones and neurotransmitters. Women also cope with anxiety-provoking situations differently than men https://www.youtube.com/watch?v=32K-rEIbBgE

PHOBIC DISORDERS • Characterized by an irrational, overwhelming, persistent fear or a particular object or situation • A situation is so dreaded the individual will go to any length to avoid it (i.e. - a snake phobia keeping someone in their apartment for the extremely small chance they would encounter a snake) • Social phobia - Intense fear of being humiliated or embarrassed in social situations

case study: social phobia http://anxietynetwork.com/content/social-anxiety-case-study • Jim - mid 30’s - husband with 3 kids, worked as a manager in a national corporation; had difficulty calling on the phone - his voice would break, etc. • His wife often talked for him in public places • Treatment included therapy involving purposely making mistakes to show him it was alright and not to feel embarrassment

phobic disorders (cont.) • Many phobias begin in childhood and have a link to genetics, though some consider them learned • Classical conditioning shows that association with an earlier experience (i.e. fear of heights - height is associated with pain because you fell from a high tree as a child) • Observing also can cause phobic disorders (i.e. little girl sees her mother terrified of a roller coaster)

Obsessive compulsive disorder (ocd) • Defined as having anxiety-provoking thoughts that will not go away and/or urges to perform repetitive, ritualistic behaviors to prevent some future situation • Obsessions - recurrent thoughts, compulsions - recurrent behaviors • Common compulsions include excessive checking, cleaning, and counting (i.e. a person might believe they have to touch the door handle with their left hand or something bad will happen to them)

obSessive compulsive disorder (cont.) • Biological factors: basal ganglia/thalamus is overly active generating compulsive actions and obsessive thoughts • Low levels of neurotransmitters serotonin and dopamine • Occurs in stressful periods of life (i.e. having a child or getting married); inability to turn off negative, intrusive thoughts by ignoring them or dismissing them https://www.youtube.com/watch?v=ZkX-Vu_A-3s

POST-TRAUMATIC STRESS disorder (ptsd) • Disorder that develops through exposure to a traumatic event that has overwhelmed the person’s ability to cope • Symptoms: Flashbacks (images, smells, sounds), avoidance of emotional experiences, feeling “numb,” excessive arousal, lack of sleep, inability to concentrate, bad memory, anxiousness/nervousness, and aggression • Symptoms can last up to years • Usually caused by experiences like war-related traumas, sexual abuse and assault, natural disasters, and other disasters like a plane crash or terrorist attack • Factors like genetics and history of previous traumatic events can increase a person’s vulnerability to the disorder

case study: PTSD • 90 year old woman who was self-sufficient was raped and robbed • Brought to hospital; distressed and confused • After 2 months she was brought to a nursing home; has frequent hallucinations that strange men are in her bed • Eventually agreed to take neuroleptic drugs to ease her hallucinations and eventually was stabilized http://www.hopkinsmedicine.org/gec/studies/ptsd.html

treatments • Anxiety disorders are treated with medication, specific types of psychotherapy, or both • Medication such as antidepressants, beta blockers, and other anti-anxiety drugs; must be administered at least two weeks to have an effect • Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations.

Personality Disorders Chronic, maladaptive cognitive-behavioral patterns that are thoroughly integrated into an individual’s personality • 15% had a personality disorder • two personality disorders that have been the greatest of study

Antisocial Personality Disorder A psychological disorder characterized by guiltlessness, law-breaking, exploitation of others, irresponsibility, and deceit Symptoms: • Failure to conform to social norms or obey the law • Deceitfulness, lying, using aliases, or conning others for personal profit or pleasure • impulsivity or failure to plan ahead • irritability and aggressiveness, getting into fights • Reckless disregard for the safety of self or others • irresponsible, inconsistent work behavior Treatment- • Many rarely seek therapy • Others end up in prison, where treatment is rarely an option http://www.youtube.com/watch?v=NfHo-HJObU8

Antisocial Personality Disorder COnt’d • Genetically heritable • Low levels of activation in the prefrontal cortex>> poor decision making and problems in learning • Autonomic nervous system-less stressed, ability to keep cool while engaging in deception

Case Study Antisocial personality disorder- • John Wayne Gacy a serial killer who murdered 33 boys and young men • Sentenced to death • Evidence showed that the defendant led a double life • Engaging in charitable and political activities at the same time he was committing a series of sadistic torture murders

Borderline Personality Disorder Pervasive pattern of instability in interpersonal relationships, self-image, and emotions, and of marked impulsivity beginning by early adulthood and present in a variety of contexts Symptoms- • frantic efforts to avoid being abandoned • unstable and intense interpersonal relationships • unstable sense of self-image • impulsivity • recurrent suicidal behavior • unstable and extreme emotional responses • chronic feelings of emptiness • inappropriateness, intense anger Treatment- • Reduction in social stress(leaving abusive partner, sense of trust in therapist) • Psychotherapy

Case Study-BPD • Ms. S was an attractive, very bright young woman who entered into an intensive Psychotherapy to deal with issues related to her chronic insecurity and unhappiness and her tendency to get involved with unsuitable and disappointing men. • She tended to heavily idealize new men she met, as long as they met certain threshold criteria • this man was the answer to all her problems, nothing else mattered in her life • He was extremely talented and very good looking; he was quite well known in his field. Until he met her he had only dated women younger than 21. • She would fantasize about marriage and their future together for several sessions and then, without any apparent warning, he would disappear from her sessions. • She would mention that she had stopped seeing him because he was a loser • When he failed her, by dating an 18 year old while they were supposedly in love, the disappointment meant that if he remained perfect, she would have to accept that she was deeply flawed • Her rage would not tolerate such an outcome, which would have led to a serious depression, so she devalued him; he became worthless and she maintained her protective sense of herself as without flaws.

Psychological Disorder and Health & Wellness http://www.youtube.com/watch?v=LmXpafMCtWg *From 1:50 to 4:10 • Huge misconception: Psychological disorders are just about otherpeople • 26% aged 18+ have one • Fear of public is almost as bad as actual disorder • stigmas, prejudice, non understanding, disrespect • Once person is labeled, everything in misperceived • once a person is annoying to you, literally everything they do is unbearable • barriers are instantly made and barely ever broken • Barriers even affect families and close friends of mentally ill

Psychological Disorder and Health & Wellness case study • Cho Seung-Hui, 23 year old Virginia Tech college student • diagnosed and struggled with mental illnesses • shot/killed 32 students and staff then himself • No more likely to commit this than any other person • Compare to man with a cold • nobody wants to be near him, he could hurt you, get you sick • he lashes out at world, commits similar crime • everybody now associates any person with a cold with his actions • totally goes against any possible logic and reason

Psychological Disorder and Health & Wellness treatments Overcoming the stigma: • View people with mental illnesses how they should be viewed • Find positive examples of people with mental illnesses • End the stigma in any way you want

Duties of Each Group Member • Abnormal disorder: Defining- Danny Theoretical approaches- Lizzy Classifying abnormal behavior- Janki DSM-IV- Laura • Therapy- Lizzy • Personality- Janki • Psychological Disorder and Health & Wellness- Danny • Anxiety disorder-Laura • Printing/Making handouts-Laura

References http://www.clarkprosecutor.org/html/death/US/gacy237.htm http://www.psychologytoday.com/blog/shrinkwrapped/201103/the-borderline-personality-clinical-example http://www.youtube.com/watch?v=NfHo-HJObU8 http://www.youtube.com/watch?v=es9RS-wnq94 http://www.nimh.nih.gov/health/publications/anxiety-disorders/index.shtml http://gsappweb.rutgers.edu/centers/stigma/people.php http://www.youtube.com/watch?v=LmXpafMCtWg http://medical-dictionary.thefreedictionary.com/Biopsychosocial+approach

Abnormal Psychology and Therapy