What is Normal?

1. What is Normal? • A Discussion for some a challenge for others…

2. Define “Normal Behavior” • Normal refers to a lack of significant deviation from the average. • The phrase "not normal" is often applied in a negative sense (asserting that someone or some situation is improper, sick, etc.) • Abnormality varies greatly in how pleasant or unpleasant this is for other people. • The Oxford English Dictionary defines "normal" as 'conforming to a standard'. • Another possible definition is that "a normal" is someone who conforms to the predominant behavior in a society. This can be for any number of reasons such as simple imitative behavior, deliberate or inconsistent acceptance of society's standards, fear of humiliation or rejection etc.

3. Who Determines if we are Normal? • Personal Decisions • Values • Societal • Statistical

4. Ways Psychologist’s Define “Abnormal” • Behavioral: emphasizes the role of learning, particularly conditioning experiences on the development of psychological disorders • Cognitive: emphasizes cognitions (expectations, values, beliefs) in determining the responses a person will make in confronting life's situations • Medical: relates disorders to biological abnormalities

5. History of Mental Illness

6. Stigma of Mental Illness Today • CBS News- Breaking the Stigma • Silver Linings Playbook

7. How is “Abnormal” Defined? Diagnostic and Statistical Manual of Mental Disorders

8. DSM-V Codes • Covers all mental health disorders for both children and adults. It also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches • The DSM uses a multidimensional approach to diagnosing because rarely do other factors in a person's life not impact their mental health. 

9. Diagnosis of new disorders is ever changing • Diagnosis/categorization of mental illnesses can be very subjective… • Homosexuality was a mental disorder until 1973 • Cultural Norms also dictate disorders • Koro – Southeast Asia Men can develop a fear that one’s penis will withdraw into one’s abdomen, causing death • Southeast Asian cultures, men have been known to experience what is called amok, an episode of murderous rage followed by amnesia • Middle East there is zar, a condition related to spirit-possession beliefs that brings forth dissociative episodes of laughing, shouting and singing. • Winigo – Algonquin Indian hunters intense fear of being turned into a cannibal by supernatural monster

10. Why do we need the DSM? • Reliability and Consistency between psychologists • Remove individual biases based on culture, gender, race etc. 10 10

11. Changes to DSM V • New Disorders • Gambling Disorder • Binge Eating Disorder • Body Dysmorphic Disorder • Hoarding • Excoriation (skin picking disorder) • Other OCD disorders • Body Focused Repetitive Behavior Disorder • Obsessional Jealousy

13. Changes to DSM V • New Names and Changes • Mental Retardation -> Intellectual Disability • Aspergers and Autism -> Autism Spectrum Disorders • Hypchondriasis - > Illness Anxiety Disorder or Somatic Symptom Disorder • Sexual and Gender Identity Disorders -> Gender Dysphoria • Social Phobia -> Social Anxiety Disorder • Adjustment Disorders

14. Not added yet...but... “areas for further research” • Internet Addiction • Hypersexual Disorder

15. Can we over diagnose? • Many fear that there will be less of a definition of ‘normal’ than ‘abnormal’ because of the ever changing disorders • Can you diagnose anyone?!

16. What would you recommend for Martin? • Martin is a 40-year-old manager, husband, and father of three who works fourteen hours a day and brings work home on the weekends. His wife complains that he is more interested in work than he is in her and the children. Martin has trouble sleeping, is often irritated by small inconveniences, wishes he spent more time with his family, and has been diagnosed as having a stomach ulcer.

17. What constitutes a psychological disorder? • 1.The person experiences significant pain or distress,an inability to work or play, an increased risk of death, or a loss of freedom in important areas of life. • Dividing line has to do with severity, intensity and frequency of symptoms, duration of symptoms, and, especially, functional impairment • 2. The source of the problem resides within the person, due to biological factors, learned habits, or mental processes, and is not simply a normal response to specific life events such as the death of a loved one. • 3. The problem is not a deliberate reaction to conditions such as poverty, prejudice, government policy, or other conflicts with society. 13 17

18. Manifestations of Mental Disorders • Disturbances of thought and perception • Dysregulation of mood • Inappropriate anxiety • Impulse control and behavioral problems • Cognitive dysfunction

19. The Dangers of Labeling . . . • Rosenhan (1973) study • Mentally healthy confederates were admitted with schizophrenia into psychiatric hospitals • They presented with “neurotic” symptoms and paranoia on the first day. • They then behaved normally in the hospitals, but their normal behavior was interpreted as pathological based on their diagnosis • What does this say about labeling?

20. Somatic Symptom disorders • Feeding and eating disorders • Sleep-wake disorders • Sexual dysfunction disorders • Gender Dysphoria • Disruptive, impulse control and conduct disorders • Substance- related and addictive disorders • Neurocognitive disorders • Personality disorders Types of Disorders • Neurodevelopmental disorders • Schizophrenia spectrum and psychotic disorders • Bipolar disorders • Depressive Disorders • Anxiety Disorders • Obsessive Compulsive disorders • Trauma and stressor related disorders • Dissociative disorders 17 20

21. Neurodevelopmentaldisorders • Intellectual disability • Autism Spectrum disorders • Motor disorders • Learning disorders

22. Schizophrenia • Group of disorders • Positive, negative, and psychomotor symptoms 22

23. Bipolar and Related Disorders • Bipolar Disorder • Cyclothymic Disorder

24. Depressive Disorders • Major Depressive Disorder • Persistent Depressive Disorder 23 24

25. Anxiety Disorders • Panic Disorder • Generalized Anxiety Disorder • Agoraphobia • Social Anxiety Disorder • Specific Phobia Disorder • Separation Anxiety Disorder 19 25

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28. Obsessive Compulsive Disorders • Obsessive Compulsive Disorder • Trichotillomania and Excoriation • Body Dysmorphic Disorder • Hoarding

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30. Trauma and Stress Related Disorders • Adjustment Disorders • Post Traumatic Stress Disorder

31. Dissociative Disorder • Dissociative Identity Disorder • Dissociative Amnesia 25 31

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33. Somatoform Disorders • Somatic Symptom Disorder • Illness Anxiety Disorder • Conversion Disorder 24 33

34. Feeding and Eating Disorders • Anorexia Nervosa • Bulimia Nervosa • Binge eating disorder

35. Disruptive, Impulse-Control and Conduct Disorder • Oppositional defiant disorder • Conduct disorder • Intermittent explosive disorder

36. Substance-related and addictive disorder • Gambling disorder • Substance abuse and dependence

37. Neurocognitive Disorders • Delirium • Dementia

38. Personality Disorders • Antisocial • Borderline • Narcissistic 28 38

39. Celebrities • http://health.howstuffworks.com/mental-health/mental-disorders/15-celebrities-with-mental-health-disorders2.htm 30 39

40. Types of Therapy

41. What makes a good therapist? • Therapists- teach people that they are the ones that can solve their own problems • Eclectic approach-choose from different types of therapy and choose the best one for the case • 1.        person’s behavior is based on choice- not fixed • 2.        people must understand their problem-where the problem comes from • 3.help patients find alternatives to unsatisfactory behaviors

42. What makes a good therapist? • 1.good listener • 2.empathy-warmth and understanding • 3.psychologically healthy • 4.experience in dealing with people • 5.trustworthy

43. Psychoanalytic Therapy • Freudian Therapy • Psychoanalysis- based on teaching of Sigmund Freud-said psychological disturbances are due to hidden conflict and anxiety in the unconscious personality • Psychoanalysts-make people aware of their feelings- INSIGHT • Free association- relax and talk about anything that comes to mind • Resistance- behavior that impedes the course of therapy • Transference-when patient begins to feel to the psychologist as they had to another person • Becomes aware of real feelings and motivations

44. Behavior Therapy • Therapy Session • Reaction to “ All talk and no action” • To find what is immediately wrong and fix it • Patient has learned behavior- therapist helps to unlearn • Systematic desensitization

45. Group Therapy • Group • Used with the help of others • People are struggling with similar problems can share those experiences and feel “less alone” • Used with Eating disorders, grief, substance abuse

46. Client Centered Therapy • Frances 4:00 • Equal relationships between therapist and client • Therapist listen, encourage, avoid giving opinions to the clients • Unconditional positive regard-continually encourage • Set realistic goals and reach them

47. Rational Emotive Therapy • Session • People behave rationally and deliberately based on assumption on life • Emotional problems occur when people think irrationally • Get patient to think realistically • Therapist-model correct behavior, humor for irrational thoughts, persuasion • Break old habits, self-discipline

48. Example: My boyfriend/girlfriend broke up with me so that means I am ugly and unlovable and will be alone forever Example: I didn’t get into my first choice college because I am dumb and Will never get into a good college

49. Gestalt Therapy • Feeling • Emphasizes personal responsibility, • Focuses upon the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person's life, and the self-regulating adjustments people make as a result of their overall situation.

50. Cognitive Behavioral Therapy • Goal: to help a person learn to recognize negative patterns of thought, evaluate their validity, and replace them with healthier ways of thinking. • Focuses on the immediate present: what and how a person thinks more than why a person thinks that way. • CBT is goal oriented. Patients working with their therapists are asked to define goals for each session as well as longer-term goals • Therapists also teach important coping skills, such as problem solving and scheduling pleasurable experiences. This includes homework outside of session