ABNORMAL PSYCHOLOGY. Unit 12

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1 ABNORMAL PSYCHOLOGY Unit 12

2 DID YOU KNOW? 12 million Americans suf fer from depression each year 1:5 Americans will suffer at least one episode of major depression during lifetime Mood disorders like depression are the 3 rd most common cause of hospitalization in the US for both youth and adults 20% of year olds experience severe mental disorders in a given year 54% of children with emotional and behavioral disturbances drop out of school (US Dept. of Education, 2005.) US Department of Justice suggests that 16% of inmates have serious mental illnesses Mental disorders are the leading cause of workplace disability in the US for ages % of people who live with mental illness are unemployed

potentially to transition back into community.

3 STATS CONT.. 1. Roughly 2 million people in the US: Inpatients psychiatric units Under lock & key, most serious disturbances 2. Over 2.4 million people in the US are residents in group homes Shared living spaces that provide assistance potentially to transition back into community. Typically are able to come & go, but with supervision & support. 3. Roughly 15% of Americans utilize services for treatment of a psychological disorder People who either use medication to treat a disorder (such as Xanax for anxiety) or are under the treatment of a psychotherapist. 4. Over 400 million people worldwide are in need of some form of psychological assistance

5 Distress: Does the individual show unusual or prolonged levels of unease or anxiety. Maladaptiveness: Does the individual act in ways that makes others fearful or that interferes with their well-being. Copyright Allyn & Bacon 2007

Irrationality: Does the individual talk/act in ways that are

Unpredictability: Does the individual behave erratically at different

undesirable behavior: Does the individual behave in ways that violate

6 Irrationality: Does the individual talk/act in ways that are irrational or incomprehensible to others. Unpredictability: Does the individual behave erratically at different times, as if experiencing a loss of control Unconventional and undesirable behavior: Does the individual behave in ways that violate social norms. Ex: Strolling naked in the mall as opposed to dying you hair green. Copyright Allyn & Bacon 2007

A disorder may also be a deviation from a typical developmental pathway.

7 DEVIANT? To deviate, in general, means to vary from what typically would happen. In psychology, a behavior or mental state is considered deviant by a culture when it is different from what would be expected in that culture. A disorder may also be a deviation from a typical developmental pathway. Examples: Bulimia Nervosa: binging/purging, in the United States Running amok: violent outbursts, in Malaysia Hikikomori: social withdrawal, in Japan Defining Deviance: The Role of Context and Culture Context: whether a behavior varies from expectation depends on the situation in which the behavior occurs Yelling for hours is not deviant when it happens at a football game. Culture: these painted faces might seem deviant when viewed from a different culture

8 UNDERSTANDING THE NATURE OF PSYCHOLOGICAL DISORDERS One reason to diagnose a disorder is to make decisions about treating the problem. To treat a disorder, it helps to understand the nature/cause of the psychological symptoms. Based on older understanding of psychological disorders, treatments have included: exorcising evil spirits, beatings, caging/restraint, and

PINEL S NEW APPROACH Philippe Pinel (1745-1826) and others sought to reform brutal treatment by promoting a new understanding of the nature of mental disorders.

10 PINEL S NEW APPROACH Philippe Pinel ( ) and others sought to reform brutal treatment by promoting a new understanding of the nature of mental disorders. Pinel proposed that mental disorders were not caused by demonic possession, but by environmental factors such as stress and inhumane conditions. Pinel s moral treatment involved improving the environment and replacing the asylum beatings with patient dances. From the humane view to the scientific view of the mentally ill: Pinel s humane environmental interventions improved lives but often did not effectively treat mental illness But then

13 PERSPECTIVES AND DISORDERS Psychological School/Perspective Psychoanalytic/Psychodynamic Humanistic Cause of the Disorder Internal, unconscious drives Failure to strive to one s potential or being out of touch with one s feelings. Behavioral Cognitive Sociocultural Biomedical/Neuroscience Reinforcement history, the environment. Irrational, dysfunctional thoughts or ways of thinking. Dysfunctional Society Organic problems, biochemical imbalances, genetic predispositions.

14 HOW ARE PSYCHOLOGICAL DISORDERS CLASSIFIED? The most widely used system, found in the DSM-V, classifies disorders by their mental and behavioral symptoms Copyright Allyn & Bacon 2007

DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)

primary reference for diagnostic judgments Standard for

every psychiatric disorder Psychiatrists & physicians,

rehabilitation therapists, & counselors, as well as by

of diagnostic criteria Necessary tool for collecting &

15 DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS (DSM) Published: American Psychiatric Association (APA) as primary reference for diagnostic judgments Standard for classification of mental disorders Diagnostic criteria for every psychiatric disorder Psychiatrists & physicians, psychologists, social workers, nurses, occupational & rehabilitation therapists, & counselors, as well as by clinicians & researchers use the DSM Detailed descriptions of diagnostic criteria Necessary tool for collecting & communicating accurate public health statistics about diagnosis of psychiatric disorders

Obsessive-Compulsive Disorder (OCD) 2. Dissociative Disorders Psychogenic Fugue (waldo?

Somatoform Disorders Somatization Disorder (hypochondriac) Conversion Disorder (stress paralysis)) Illness Anxiety

16 6 CATEGORIES OF PSYCH DISORDERS 1. Anxiety Disorders General Anxiety Disorder (GAD) Phobic Disorder Post Traumatic Stress Disorder (PTSD) Panic Disorder Obsessive-Compulsive Disorder (OCD) 2. Dissociative Disorders Psychogenic Fugue (waldo?) Psychogenic Amnesia (amnesia of self) Dissociative Identity Disorder (DID) 3. Somatoform Disorders Somatization Disorder (hypochondriac) Conversion Disorder (stress paralysis)) Illness Anxiety Disorders (fear of conditions) 4. Mood Disorders Major clinical Depression Manic Depression Bipolar Disorder 5. Schizophrenia Paranoid Schizophrenia Disorganized Schizophrenia Catatonic Schizophrenia 6. Personality Disorders Borderline Personality Disorder (BPD) Antisocial Personality Disorder (APD)

18 Rosenhan HAN

Table 65.2 Risk and Protective Factors for Mental Disorders David G.

Anxiety is the most common mental disorder in the US Considering healthcare expenses, lost wages, and lost productivity, anxiety

21 ANXIETY DISORDERS Mental problems characterized mainly by anxiety. anxiety. Anxiety is the most common mental disorder in the US Considering healthcare expenses, lost wages, and lost productivity, anxiety disorders cost an estimated $42 billion Anxiety is a normal reaction to stress. It helps one deal with a tense situation work, study harder for an exam, or keep focused on an important speech. In general, it helps one cope. But when anxiety becomes Copyright an Allyn excessive, & Bacon 2007 irrational dread of

22 COMMON SYMPTOMS OF IRRATIONAL ANXIET Y Feelings of panic, fear, and uneasiness Uncontrollable, obsessive thoughts Repeated thoughts or flashbacks of traumatic experiences Nightmares Ritualistic behaviors, such as repeated hand washing Problems sleeping Cold or sweaty hands and/or feet Shortness of breath Palpitations An inability to be still and calm Dry mouth Numbness or tingling in the hands or feet Nausea Muscle tension

24 Anxiety Disorders 3 Core Features 1. Abnormal/Extreme levels of anxiety 2. Inappropriate anxiety occurs without stimulus 3. Intense anxiety may lead to panic like symptoms List of Disorders Generalized Anxiety Disorder (GAD) Panic Disorder Phobic Disorder Post-Traumatic Stress Disorder (PTSD) Obsessive-Compulsive Disorder (OCD) DSM-V CRITERIA

25 Generalized Anxiety Disorder (GAD) Anxiety that makes someone continually tense, apprehensive, and in a state of autonomic nervous system arousal DSM-V CRITERIA

26 Panic Disorder Experience of terror and physical symptoms (chest pains, choking) in unpredictable situations DSM-V CRITERIA

27 PANIC ATTACK Copyright Allyn & Bacon 2007

SOCIAL ANXIET Y THOUGHTS HANDOUT "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.

29 SOCIAL ANXIET Y THOUGHTS HANDOUT "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 at 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.

30 THE AVOIDANCE OF SITUATIONS IN WHICH ONE WILL FEAR HAVING A PANIC ATTACK, ESPECIALLY A SITUATION IN WHICH IT IS DIFFICULT TO GET HELP, AND FROM WHICH IT DIFFICULT TO ESCAPE.

POST-TRAUMATIC STRESS DISORDER Delayed stress reaction in which an individual involuntarily re-experiences emotional, cognitive, and behavioral aspects of past trauma 1. Haunting memories 2.

31 POST-TRAUMATIC STRESS DISORDER Delayed stress reaction in which an individual involuntarily re-experiences emotional, cognitive, and behavioral aspects of past trauma 1. Haunting memories 2. Nightmares 3. Social withdrawal 4. Jumpy anxiety 5. Sleep problems Posttraumatic Growth: positive psychological changes as a result of struggling with extremely challenging Prevalence: 4% (women 2x as likely as men) PTSD & the Military Report: 950 suicide attempts per month among veterans receiving care Approximately 18 suicides by US veterans per day Copyright Allyn & Bacon 2007

Obsessions Persistent thoughts, ideas, images, or impulses that invade consciousness 2.

32 Obssessive Compulsive Disorder (OCD) Characterized by pattern of persistent, unwanted thoughts and behaviors OCD is made up of two components: 1. Obsessions Persistent thoughts, ideas, images, or impulses that invade consciousness 2. Compulsions Repetitive and rigid behaviors or thoughts that people must perform to prevent or reduce anxiety DSM-V CRITERIA

yourself or others Intrusive sexually explicit or violent thoughts and images Fear of losing or not having

33 WHAT ARE THE FEATURES OF OBSESSIONS AND COMPULSIONS? Common Obsessions Fear of being contaminated by germs or dirt or contaminating others Fear of causing harm to yourself or others Intrusive sexually explicit or violent thoughts and images Fear of losing or not having things you might need Order and symmetry: the idea that everything must line up just right. Superstitions; excessive attention to something considered lucky or unlucky

appliances, and switches. Repeatedly checking in on loved ones to make sure they re safe.

34 WHAT ARE THE FEATURES OF OBSESSIONS AND COMPULSIONS? Excessive cleaning, scrubbing, or washing of objects or body parts Excessive double-checking of things, such as locks, appliances, and switches. Repeatedly checking in on loved ones to make sure they re safe. Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety. Ordering, evening out, or arranging things just so. Accumulating junk Comer, Abnormal Psychology, 7e Common Compulsions

35 UNDERSTANDING ANXIETY DISORDERS: EXPLANATIONS FROM DIFFERENT PERSPECTIVES Psychodynamic / Freudian: repressed impulses Classical conditioning: overgeneralizing a conditioned response Operant conditioning: rewarding avoidance Observational learning: worrying like mom Cognitive appraisals: uncertainty is danger Evolutionary: surviving by avoiding danger

36 Classical Conditioning and Anxiety In the experiment by John B. Watson and Rosalie Rayner in 1920, Little Albert learned to feel fear around a rabbit because he had been conditioned to associate the bunny with a loud scary noise. Sometimes, such a conditioned response becomes overgeneralized. We may begin to fear all animals, everything fluffy, and any location where we had seen those, or even fear that those items could appear soon along with the noise. The result is a phobia or generalized anxiety. Operant Conditioning and Anxiety We may feel anxious in a situation and make a decision to leave. This makes us feel better and our anxious avoidance was just reinforced. If we know we have locked a door but feel anxious and compelled to re-check, rechecking will help us temporarily feel better. The result is an increase in anxious thoughts and behaviors.

37 OBSERVATIONAL LEARNING AND ANXIET Y Experiments with humans and monkeys show that anxiety can be acquired through observational learning. If you see someone else avoiding or fearing some object or creature, you might pick up that fear and adopt it even after the original scared person is not around. In this way, fears get passed down in families.

Cognition includes mental habits such as hypervigilance (persistently watching out for

38 COGNITION AND ANXIET Y Cognition includes worried thoughts, as well as interpretations, appraisals, beliefs, predictions, and ruminations. Cognition includes mental habits such as hypervigilance (persistently watching out for danger). This accompanies anxiety in PTSD. In anxiety disorders, such cognitions appear repeatedly and make anxiety worse.

39 EXAMPLES OF COGNITIONS THAT CAN WORSEN ANXIET Y: Cognitive errors, such as believing that we can predict that bad events will happen Irrational beliefs, such as bad things don t happen to good people, so if I was hurt, I must be bad Mistaken appraisals, such as seeing aches as diseases, noises as dangers, and strangers as threats Misinterpretations of facial expressions and actions of others, such as thinking they re talking about me

40 BIOLOGY AND ANXIET Y: AN EVOLUTIONARY PERSPECTIVE 1. Human phobic objects: Snakes Heights Closed spaces Darkness 2. Similar but non-phobic objects: Low places Open spaces Bright light 3. Dangerous yet non-phobic subjects: We are likely to become cautious about, but not phobic about: Guns Electric wiring Cars Evolutionary psychologists believe that ancestors prone to fear the items on list #1 were less likely to die before reproducing. There has not been time for the innate fear of list #3 (the gun list) to spread in the population.

41 BIOLOGY AND ANXIET Y: GENES Studies show that identical twins, even raised separately, develop similar phobias (more similar than two unrelated people). Some people seem to have an inborn highstrung temperament, while others are more easygoing. Temperament may be encoded in our genes. Genes and Neurotransmitters Genes regulate levels of neurotransmitters. People with anxiety have problems with a gene associated with levels of serotonin, a neurotransmitter involved in regulating sleep and mood. People with anxiety also have a gene that triggers high levels of glutamate, an excitatory neurotransmitter involved in the brain s alarm centers.

Anxiety disorders include overarousal of brain areas involved in impulse control and habitual

42 BIOLOGY AND ANXIET Y: THE BRAIN Traumatic experiences can burn fear circuits into the amygdala; these circuits are later triggered and activated. Anxiety disorders include overarousal of brain areas involved in impulse control and habitual behaviors. The OCD brain shows extra activity in the ACC, which monitors our actions and checks for errors. ACC = anterior cingulate gyrus

Post-Traumatic Stress Disorder [PTSD]

Post-Traumatic Stress Disorder [PTSD] About 10 to 35 percent of people who experience trauma not only have burned-in memories, but also four weeks to a lifetime of: repeated intrusive recall of those memories.