psychological disorders what is abnormality? psychological disorders

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1 Psychological Disorders Psychological Disorders Behavior patterns or mental processes that cause serious personal suffering or interfere with a person’s ability to cope with daily life What Is Abnormality? No biological test for mental disorders; it’s a judgment call Heavily influenced by Social norms Person’s characteristics Context What Is Abnormality? Current consensus: 1. Deviance 2. Dysfunction 3. Distress What Is Abnormality? Deviance Statistically uncommon Wearing beekeeper’s outfit …to a restaurant. Talking to a baseball …and hearing it talk back. What Is Abnormality? Never recycling cans …for 8 years. …and having 70,000 of them in your apartment. What Is Abnormality? Dysfunctional Interferes with day-to-day life Avoiding people b/c they make you anxious …so you haven’t left the house in 2 years. Defining Abnormal Behavior Distress (to self or others) Negative emotions Crying because you’re sad …every day for months. Mental Disorder Rates, 18+ 0% 10% 20% 30% 40% 50% Lifetime 1 Year 1 Year - Serious 46% 26% 6%

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Page 1: Psychological Disorders What Is Abnormality? Psychological Disorders

1

Psychological Disorders

Psychological Disorders

Behavior patterns or mental

processes that cause serious

personal suffering or interfere with a

person’s ability to cope with daily life

What Is Abnormality?

No biological test for mental

disorders; it’s a judgment call

Heavily influenced by

– Social norms

– Person’s characteristics

– Context

What Is Abnormality?

Current consensus:

1. Deviance

2. Dysfunction

3. Distress

What Is Abnormality?

Deviance

– Statistically uncommon

Wearing beekeeper’s

outfit

…to a restaurant.

Talking to a baseball

…and hearing it talk back.

What Is Abnormality?

Never recycling cans

…for 8 years.

…and having 70,000

of them in your

apartment.

What Is Abnormality?

Dysfunctional

– Interferes with day-to-day life

Avoiding people b/c

they make you anxious

…so you haven’t left

the house in 2 years.

Defining Abnormal Behavior

Distress (to self or others)

– Negative emotions

Crying because

you’re sad

► …every day

for months.

Mental Disorder Rates, 18+

0%

10%

20%

30%

40%

50%

Lifetime 1 Year 1 Year - Serious

46%

26%

6%

Page 2: Psychological Disorders What Is Abnormality? Psychological Disorders

2

Facts About Mental Illness

Most can be treated

Most suffer privately

Few are violent

Diagnosing Mental Disorders

Diagnostic and Statistical Manual of Mental Disorders (DSM)

Current version: DSM-IV-TR

Lists of symptoms, with required symptoms, and required number

17 categories

Categories of Disorders

Anxiety Disorders

Mood Disorders

Schizophrenia

Adjustment Disorders

Delirium, Dementia, and Amnestic and Other Cognitive Disorders

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Dissociative Disorders

Eating Disorders

Factitious Disorders

Impulse-Control Disorders

Mental Disorders Due to a Medical Condition

Personality Disorders

Psychotic Disorders

Sexual and Gender Identity Disorders

Sleep Disorders

Somatoform Disorders

Substance-Related Disorders

Anxiety Disorders

What is anxiety?

How does it affect your behavior?

Can anxiety ever be healthy or helpful?

Anxiety Disorders

What Is Anxiety?

– Fear of future danger or

misfortune, accompanied by

emotional and/or physical tension

May be related to specific object or

situation

About 75% before age 22

"I always thought I was just a

worrier. I'd feel keyed up and unable

to relax. At times it would come and

go, and at times it would be constant.

It could go on for days. I'd worry about

what I was going to fix for a dinner

party, or what would be a great present

for somebody. I just couldn't let

something go."

"I'd have terrible sleeping problems.

There were times I'd wake up wired in

the middle of the night. I had trouble

concentrating, even reading the

newspaper or a novel. Sometimes I'd

feel a little lightheaded. My heart

would race or pound. And that would

make me worry more. I was always

imagining things were worse than they

really were: when I got a stomachache,

I'd think it was an ulcer."

1. Generalized Anxiety Disorder

3% of population; median age 31

Ongoing anxiety on most days for at least 6 months

Anxiety difficult to control

No specific trigger

"For me, a panic attack is almost a violent

experience. I feel disconnected from

reality. I feel like I'm losing control in a

very extreme way. My heart pounds really

hard, I feel like I can't get my breath, and

there's an overwhelming feeling that things

are crashing in on me."

"It started 10 years ago, when I had just

graduated from college and started a new

job. I was sitting in a business seminar in a

hotel and this thing came out of the blue. I

felt like I was dying."

Page 3: Psychological Disorders What Is Abnormality? Psychological Disorders

3

"In between attacks there is this

dread and anxiety that it's going to

happen again. I'm afraid to go back

to places where I've had an attack.

Unless I get help, there soon won't be

anyplace where I can go and feel safe

from panic."

2. Panic Disorder

3% of population; median age 24

Panic attacks

– No obvious trigger for attacks

– Sweating, dizziness, numbness or

tingling

"I was in a car accident when I was 25

years old in which my girlfriend died. For a

long time, I spoke about it as though it was

something that happened to someone

else. I was very aware that it had happened

to me, but there was just no feeling."

"Then I started having flashbacks. They

kind of came over me like a splash of water.

I would be terrified. Suddenly I was reliving

the accident. Every instant was startling.

“I wasn't aware of anything around me, I was

in a bubble, just kind of floating. And it was

scary. Having a flashback can wring you out.

“It happened the week before the Fourth

of July, and I can't believe the anxiety and

fear I feel every year around the anniversary

date. It's as though I've seen a monster. I

can't relax, can't sleep, don't want to be

with anyone. I wonder whether I'll ever be

free of this terrible problem."

3. Post-Traumatic Stress

Disorder

3.5% of population; median age 23

20% of Vietnam vets

Extreme anxiety after event that

almost anyone would find stressful

Car/plane crash Mugging

Extreme abuse War

Flashbacks

Avoid things that remind of event

4. Phobias

From phobos, Greek for “fear”

Three kinds

1. Specific phobia

2. Agoraphobia

3. Social phobia

Excessive, irrational fear & avoidance

of specific object or situation

"I'm scared to death of flying, and I

never do it anymore. I used to start

dreading a plane trip a month before I

was due to leave. It was an awful

feeling when that airplane door closed

and I felt trapped. My heart would

pound, and I would sweat bullets. When

the airplane would start to ascend, it

just reinforced the feeling that I couldn't

get out.”

“When I think about flying, I picture myself

losing control, freaking out, and climbing

the walls, but of course I never did that. I'm

not afraid of crashing or hitting turbulence.

It's just that feeling of being trapped.

Whenever I've thought about changing jobs,

I've had to think, "Would I be under pressure

to fly?" These days I only go places where I

can drive or take a train. My friends always

point out that I couldn't get off a train

traveling at high speeds either, so why don't

trains bother me? I just tell them it isn't a

rational fear."

4. Phobic Disorders

A. Specific Phobia

9% of population; median age 7

Usually begins in childhood

Fear of specific object/situation

Avoidance of what is feared

Page 4: Psychological Disorders What Is Abnormality? Psychological Disorders

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4. Phobic Disorders

A. Specific Phobia

Most common phobia:

Other common phobias

hemophobia

acrophobia

claustrophobia

animals & insects

heights

closed-in places

blood

zoophobia

Some Unusual Phobias

Alektorophobia chickens

Geniophobia chins

Some Unusual Phobias

long words

Peladophobia bald people

Hippopotomonstrosesquippedaliophobia

Hexakosioihexekontahexaphobia the number 666

Some Unusual Phobias

Automatonophobia ventriloquist's dummies

Triskaidekaphobia

Arachibutyrophobia peanut butter sticking to

the roof of the mouth

4. Phobic Disorders

B. Agoraphobia

1% of population; median age 20

Fear of being not being able to escape if anxiety gets too high

Avoid

– Being alone outside home

– Traveling by car, airplane

– Crowded places

"In any social situation, I felt fear. I

would be anxious before I even left the

house, and it would escalate as I got

closer to a college class, a party, or

whatever. I would feel sick in my

stomach - it almost felt like I had the

flu. My heart would pound, my palms

would get sweaty, and I would get this

feeling of being removed from myself

and from everybody else.

"When I would walk into a room full

of people, I'd turn red and it would feel

like everybody's eyes were on me. I

was embarrassed to stand off in a

corner by myself, but I couldn't think of

anything to say to anybody. It was

humiliating. I felt so clumsy, I couldn't

wait to get out."

4. Phobic Disorders

C. Social Phobia

7% of population; median age 13

fear and anxiety of being judged and

evaluated by other people

Situations to avoid

– Eating in public

– Public speaking

– Center of attention

– Talking to people

"I couldn't do anything without rituals. They

invaded every aspect of my life. Counting really

bogged me down. I would wash my hair three

times as opposed to once because three was

a good luck number and one wasn't. It took me

longer to read because I'd count the lines in a

paragraph. When I set my alarm at night, I had

to set it to a number that wouldn't add up to a

'bad' number."

"I knew the rituals didn't make sense, and

I was deeply ashamed of them, but I couldn't

seem to overcome them until I had therapy."

Page 5: Psychological Disorders What Is Abnormality? Psychological Disorders

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"Getting dressed in the morning was

tough, because I had a routine, and if I didn't

follow the routine, I'd get anxious and

would have to get dressed again. I always

worried that if I didn't do something, my

parents were going to die. I'd have these

terrible thoughts of harming my parents.

That was completely irrational, but the

thoughts triggered more anxiety and more

senseless behavior. Because of the time I

spent on rituals, I was unable to do a lot of

things that were important to me."

5. Obsessive-Compulsive

Disorder

1% of population; median age 19

Either obsessions, compulsions, or both

Obsession

– Unwanted thought that person can’t stop thinking about

Compulsion

– Ritualistic behavior that person feels they must do; reduces anxiety

Obsessive-Compulsive Disorder

Common obsessions:

– Dirt, germs

– Something terrible happening

– Order, exactness

– Religious obsessions

Common Obsessions Table Obsessive-Compulsive Disorder

Common rituals:

– Cleaning

– Repeating

– Checking

Common Compulsions Table

“Self-Portrait” “The Old

Guitarist”

“The Tragedy”

Picasso’s “Blue Period” Mood Disorders

Mood

– Long-lasting emotion that affects

how one perceives the world

Median age = 30

Page 6: Psychological Disorders What Is Abnormality? Psychological Disorders

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Range of Emotions

Extreme

sadness “Neutral”

emotions

Mild

sadness Mild

happiness

Extreme

elation

Brain

chemistry Cognition

Mood

Breakup with romantic partner

Stable

“I’ll never get over this.”

Global

“Without her, I’m nothing.”

Internal

“It was all my fault.”

Depression

Temporary

“It’s hard, but I’ll get over it.”

Specific

“I miss her, but I have family

and friends.”

External

“It wasn’t meant to be.”

Successful coping

1. Major Depressive Disorder

“Common cold” of serious mental illness

Leading cause of disability in U.S. for

ages 15-44

Lifetime rates:

– Around 25% for women

– Around 13% for men

Major Depressive Disorder

Groups most likely to meet criteria:

45-64 years

Women

< HS education

Unable to work or unemployed

Divorced

No health insurance

1. Major Depressive Disorder

1.Depressed mood

2.Loss of pleasure

3.Weight loss

4.Sleep changes

5.Restlessness or being slowed down

6.Loss of energy

7.Worthlessness or guilt

8.Poor concentration

9.Thoughts of death

5 or more symptoms in 2 week period

2. Dysthymic Disorder

1. Depressed mood most days for

2+ years

2. Changes in eating

3. Changes in sleeping

4. Fatigue

5. Low self-esteem

6. Poor concentration

7. Hopelessness

2 or more

Seasonal Affective Disorder

(SAD)

Symptoms of major depression during

fall and winter

– Related to light

– Higher latitudes show higher rates

SAD Rates in the U.S.

10.2%

5.8%

3.6%

1.4%

8%

Page 7: Psychological Disorders What Is Abnormality? Psychological Disorders

7

Light treatment for SAD 3. Bipolar Disorder

3%

Severe mood swings

– mania and depression

“Manic-depression”

3. Bipolar Disorder Manic Episode

A. At least 1 week of abnormally elevated,

expansive, irritable mood

B. 3 or more of following

1. Inflated self-esteem

2.Decreased need for

sleep

3.More talkative

4.Racing thoughts

5.Distractibility

6.Psychomotor

agitation

7.Excessive risky

pleasurable

activities

Manic vs. Depressed

Brain Activity

Depressed state Manic state Depressed state

A Typical Bipolar Cycle

Mo

od

Mania

Depression

1 2 3 4 Years

1 cycle over

several years

Bipolar Disorder - Rapid Cycling

Mo

od

Mania

Depression

4 or more

cycles

per year

1 Year

Suicide Facts

About 15% with depression commit suicide

32,439 in 2004

Fewest = winter, most = spring

Women 3x more likely to attempt

Men 4x more likely to die from suicide

3rd leading cause of death for 15-24s

– 86% male

Highest rate = 80+

Suicide Risk Factors

depression, other mental disorders, or a substance-abuse disorder

prior suicide attempt

family history of mental disorder or substance abuse

family history of suicide

family violence

firearms in the home

incarceration

exposure to the suicidal behavior of others

Gender Differences in

Suicide Method 56%

24%

13%

30%

21%

40%

0%

10%

20%

30%

40%

50%

60%

Firearms Suffocation Poisoning

Men

Women

Page 8: Psychological Disorders What Is Abnormality? Psychological Disorders

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Rates of Suicide By Sex and Age, All Races 2004

0

5

10

15

20

25

30

35

40

45

50

10-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age

Ra

tes

Males

Females

Jennifer Lawrence admits she’s

“schizophrenic” when it comes to fashion.

Showbiz Spy, 3/1/12

"The Jets are schizophrenic, and that should

be no surprise to the legions of genuinely long-

suffering fans that follow them."

Yahoo! Sports, 3/21/12

"Schizophrenic weather aside, we're finally

starting to see signs of spring, which has most of

us daring to daydream of summer fun.”

Boise Weekly, 3/14/12

Schizophrenia

1% of world population

#1 reason for being in mental hospital

Same rates by gender, different age of onset

– Men – 18-25

– Women – 26-45

Strong genetic link

– If parents have it, risk = 10%

– When 1 identical twin has it, risk around 50%

Schizophrenia and

“The Rule of Thirds”

Full

Recovery

Some

Improvement

No Improvement

Schizophrenia: Symptoms

Two or more of the following, during a

1-month period:

1. delusions

2. hallucinations

3. disorganized speech

4. disorganized or catatonic behavior

5. “negative” symptoms

Page 9: Psychological Disorders What Is Abnormality? Psychological Disorders

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Schizophrenia: Symptoms

Two or more of the following, during a

1-month period:

1. delusions

2. hallucinations

3. disorganized speech

4. disorganized or catatonic behavior

5. “negative” symptoms

1. Delusions

False beliefs

A. Delusions of Persecution

B. Delusions of Reference

C. Delusions of Grandeur

Bizarre vs non-bizarre

2. Hallucinations

False perceptions

Any of the senses

Most common = hearing voices

3. Disorganized Speech

Seen as sign of disorganized thinking

A. Loose associations

Thoughts are unrelated

A. Loose Associations

Normal 1: Both are salmon colored. This one, however, is more pink.

Normal 2: My God, this is hard. They are both about the same, except this one must be redder.

Normal 3: They are both either the color of canned salmon or clay. This one here is the pinker one.

A. Loose Associations

Schiz 1: A fish swims. You call it a salmon. You

cook it. You put it in a can. You open the can.

You look at it in this color. Salmon fish.

Schiz 2: This is a stupid color of a ------ bowl of

salmon. Mix it with mayonnaise. Then it gets

tasty. Leave it alone and puke all over the ------

place. Puke fish.

Schiz 3: Make-up. Pancake make-up. You put

your face on it and the think guys run after you.

Wait a second! I don’t put it on my face and guys

don’t run after me. Girls put it one them.

Page 10: Psychological Disorders What Is Abnormality? Psychological Disorders

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3. Disorganized Speech

B. Poverty of content

Many words, little meaning

B. Poverty of Content

I am writing on paper. The pen which I am using is from a factory called “Perry & Co.” The factory is in England. I assume this. Behind the name of Perry & Co. the city of London is inscribed. But not the city. The city of London is in England. I know this from my school days. Then, I always liked geography. My last teacher in that subject was Professor August A. he was a man with black eyes. There are also blue eyes and gray eyes and other sorts, too. I have heard it said that snakes have black eyes.

3. Disorganized Speech

C. Clanging

Words that rhyme or sound

similar

C. Clanging

Dr: How are things going today, Ernest?

Patient: OK for a flump.

Dr: What is a flump?

Pt: A flump is a gump.

Dr: What do you mean by that?

Pt: Well, when you go to the next planet from the planet beyond the planet that landed on the danded and planded on the standed.

Dr: Wait a minute. I didn’t follow any of that.

Pt: Well, when we was first bit on the slit on the rit and the man on the ran or the pan on the ban on the can on the man on the fan on the pan.

Dr: What’s all that hitting your head for. And waving your arms?

Pt: That’s to keep the boogers from eating the woogers.

3. Disorganized Speech

D. Word salad

Words jumbled together

D. Word Salad

It’s all over for me now and there ain’t no

music, there ain’t no nothing besides my

mother and father who stand alone on the

Island of Capri where there is no ice, there is

no nothing but changers, changers,

changers. That comes in like first and last

names, so that thing does. Well, it’s my

suitcase sir. I’ve got to travel to keep my

energy alive.

4. Disorganized or Catatonic

Behavior

Disorganized

A. Problems in goal-directed behavior

B. Inappropriate sexual behavior

C. Unpredictable agitation

D. Inappropriate emotions

4. Disorganized or Catatonic

Behavior

Catatonic Behavior

A. Catatonic posturing

B. Rigidity

C. Waxy flexibility

D. Stupor

5. Negative Symptoms

Absence of certain normal behaviors

1. Emotions

2. Speech

3. Goal-directed behavior

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Schizophrenia Subtypes

1. Paranoid Schizophrenia

− Delusions, auditory hallucinations

2. Disorganized Schizophrenia

− Disorganized speech/behavior, emotions absent or inappropriate

3. Catatonic Schizophrenia

− Catatonic symptoms

4. Undifferentiated Schizophrenia

− Don’t fit another subtype

Understanding Schizophrenia

1. Brain Abnormalities

– Excessive dopamine levels

– Abnormal brain activity

– Tissue loss

Understanding Schizophrenia

2. Prenatal Environment

– Maternal viral infections

– Born during winter & spring

Reversed below equator

Possible Risk Factors

Prenatal malnutrition

Fathers’ age at birth, esp. 50+

Family history of epilepsy

Twice as common in unmarried or

divorced people

"I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn't add up to a 'bad' number."

"I knew the rituals didn't make sense, and I was deeply ashamed of them, but I couldn't seem to overcome them until I had therapy."

"Getting dressed in the morning was tough, because I had a routine, and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me."