ABNORMAL PSYCHOLOGY: BACKGROUND, DIAGNOSIS AND DISORDERS

Raise your hand if you’ve had some nausea in the last four days.

Some chills? Muscle fatigue? A sore throat?

Lethargy?

There must be something terribly wrong with you! Cholera?

Meningitis?Ebola?!

In reality, you’re FINE.

Here’s the point: Just because you exhibit the symptoms of a something, does NOT mean that you have the it!

Medical Student Syndrome

In this unit we will be examining all different types of psychological disorders.

You will have the tendency to apply the symptoms of these disorders to yourself and loved ones.

Don't.

One more thing…We should be careful about

labeling people because those labels can be permanent .

David Rosenhan

So, in summary – Don’t…

…self diagnose…diagnose people you know…label those who may be suffering from mental illness (or, even those who are not!)

Got it? Good. Now we can start!

Your present thinking…

In the space below, write what your preconceptions are about those experiencing mental disorders:

STIGMA

A History of Mental Health Treatment

In a Nutshell…▪ Psychological disorders have existed as long

as humans have.▪ However, our understanding and treatment

of them have evolved.

▪ Without understanding the mind-body connection, how were psychological disorders viewed in earlier eras?

The practice of boring holes into the skull to release “evil spirits”

that lay within, was called trepanning (Trephination).

“BUT…IT WAS EVIL SPIRITS!”

Ancient treatments

Other ancient treatments of mind-disorders included: exorcism, being caged like animals, being beaten, burned, castrated, mutilated, blood lettings,

and transfusions with animal’s blood.

Enter the Medical Model

▪ Late 1700’s: madness was not due to demonic possession, but an ailment of the mind.

▪ The Medical Model▫ A recognition that diseases

(physical and mental) have some physical cause and therefore, can be treated and cured.

▪ Understanding the medical model led to a revolution in how those with “mind-disorders” were treated.

“Dance in the madhouse.”

George W

esley Bellow

s, Dancer in a M

adhouse, 1907. © 1997 The A

rt Institute of Chicago

In addition to the Medical Model…

•Cognitive Behavioral Approach•Mental disorders are due to problems with ones thinking

(thoughts and beliefs) and/or behaviors (skills and abilities)

•Psychoanalytic Approach•A focus on unconscious conflicts cause mental disorders

Defining Mental Disorders

•Mental Disorder•Is the behavior infrequent among the general population?

•Does it deviate from social norms?

•Is it maladaptive, or negatively impact one’s life?

So, how do we diagnose today?

Why, you need the…

DSM

The DSM-5 (5th edition)

The Diagnostic and Statistical Manual of Mental Disorders

A manual used by those practicing in the field of psychology to diagnose psychological disorders.

The DSM-5

▪ The DSM-5 describes 400 psychological disorders (compared to 60 in the 1950s).

▪ The DSM S-P-E-L-L-S O-U-T specific diagnostic criteria:▫ For example, let’s say a psychiatrist (you??) is

seeking a diagnosis of a patient with a major depressive episode.

▫ So, the person must exhibit at least five or more of the listed nine characteristics and the symptoms must be evident for at least the last two weeks for that person to be diagnosed with this disorder.

Goals of DSM1. To describe (400) disorders.2. To determine how prevalent the

disorder is.

Disorders outlined by DSM-5 are reliable. Therefore, diagnoses by different professionals are similar (that’s the point).

However, some criticize DSM-5 for “putting any kind of behavior within the compass of psychiatry.”

1. Critics of the DSM argue that labels may stigmatize individuals.

Asylum baseball team (labeling)

Elizabeth Eckert, Middletow

n, NY

. From L. G

amw

ell and N

. Tomes, M

adness in America, 1995. C

ornell University Press.

LABELING PSYCHOLOGICAL DISORDERS: GOOD AND BAD

Labeling Continued…

2. However, labels are helpful for healthcare professionals when communicating with one another and establishing therapy.

Now that we have identified how to diagnose…

…let’s complete an overview!

Topics we will analyze

Anxiety DisordersObsessive-Compulsive DisordersDepressive DisordersBi-Polar DisordersPersonality DisordersSchizophrenia

What feelings and physiological reactions do you experience when you

feel anxiety?

Anxiety Disorders: In General

We all experience anxiety…

It produces a biological response in us (Sympathetic Nervous System)

But, when does it move into the category of a disorder?

Defining Mental Disorders

•Mental Disorder•Is the behavior infrequent among the general population?

•Does it deviate from social norms?

•Is it maladaptive, or negatively impact one’s life?

Types of Anxiety Disorders

▪General Anxiety Disorder▪ Panic Disorder▪ Phobias

Generalized Anxiety Disorder (GAD):

DSM Criteria (Summarized) 1. Excessive anxiety & worry occurring more days than not for at least 6 months. 2. Unable to control worry. 3. Display of at least 3 of the following 6 symptoms:

Restlessness, fatigue, irritability, difficulty concentrating, muscle tension, sleep disturbances

Anxiety Disorder: Panic Disorder (not a diagnosis!)

Characterized by recurrent and unexpected panic attacks.Panic attack: A specific period of intense fear or discomfort, in which 4 or more

of the following abruptly and reach a peak within 10 minutes:▫ Palpitations▫ Sweating▫ Trembling/aching▫ Sensations of shortness of breath or smothering▫ Feeling of choking▫ Chest pain/discomfort▫ Nausea/abdominal distress▫ Feeling dizzy/unsteady/lightheaded/faint▫ Derealization/depersonalization▫ Fear of losing control/going crazy▫ Fear of dying▫ Paresthesias (numbness or tingling sensation)▫ Chills/hot flushes

Fear Or Phobia?

What’s the difference?

Anxiety Disorder: Phobias

An anxiety disorder that is marked by a persistent and irrational fear.

DSM Criteria (summarized)1. Fear that is excessive and unreasonable, and

is cued by anticipation or presence of fear stimuli.

2. Exposure to stimulus provokes immediate anxiety response.

3. Person recognizes fear is excessive and unreasonable.

Phobias

DSM Criteria (summarized)

4. Phobic situation is avoided or endured with intense anxiety.

5. Avoidance of phobia interferes with normal daily routine.

6. Under 18: present for at least 6 months7. Phobia is not accounted for by any other

anxiety disorder.

Phobia or Fear?

Types of Phobias…▪ Acrophobia: Heights Aquaphobia: Water▪ Gephyrophobia: Bridges Ophidiophobia: Snakes▪ Aerophobia: Flying Arachnophobia: Spiders▪ Herpetophobia: Reptiles Ornithophobia: Birds▪ Agoraphobia: Open spaces Astraphobia: Lightning▪ Mikrophobia: Germs Phonophobia: Speaking aloud▪ Ailurophobia: Cats Brontophobia: Thunder▪ Murophobia: Mice Pyrophobia: Fire▪ Amaxophobia: Vehicles, driving Claustrophobia: Closed

spaces▪ Numerophobia: Numbers Thanatophobia: Death▪ Anthophobia: Flowers Cynophobia: Dogs

Famous People With Anxiety Disorders

Obsessive-Compulsive Disorders

Obsessive-Compulsive Disorder (OCD)

Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress.

Typical Obsessions (thoughts)

▪ Doubts (e.g. Did I turn off the stove? Did I lock the door? Did I hurt someone?)

▪ Fear of dirt/germs ▪ Fears that someone else has been hurt or killed▪ Fears that one has done something criminal▪ Constant thought about a certain number ▪ Worry that one has become dirty or contaminated▪ Blasphemous or obscene thoughts

▪ Again, NOT just excessive worries about real-life problems

Typical Compulsions (Behaviors)

▪ Checking▪ Cleaning/washing▪ Doing things a certain number of times in a

row▪ Doing and then undoing things▪ Doing things in a certain order, with

symmetry

Depressive Disorders

Class Activity

For each of the following words, write a sentence that describes an experience you had that is associated with that respective word…

▫ Train▫ Ice▫ House▫ Meeting▫ Machine▫ Road▫ Rain

Class Activity

▪ For each experience you wrote down, rate whether the experience was pleasant or unpleasant.

▪ After you have rated all experiences, tally the total number of pleasant and unpleasant experiences.

Class Activity

▪ How have you felt today?▫ Happy? Sad? Somewhat depressed?

▫ The number of pleasant vs. unpleasant experiences you recalled should be related to your

mood today.

▫ When we are in a sadder mood, we remember more unpleasant than pleasant events. (WHAT IS THIS CALLED?) ☺

Depression

Sad mood one day (or even over a few days – or many!) does NOT mean

depression.

Types of Depressive Disorders

Depressive Disorders

Major• Unipolar/Clinical depression/MDD• Post-Partum depression• Seasonal Affective Disorder (SAD)

Milder (-thymia disorders)• Dysthymia (mild, long lasting depression)• Cyclothymia (less severe bi-polar disorder)

Major-Depressive Disorder

Also known as Uni-Polar Depressive Disorder or Clinical Depression.

DSM Criteria (summarized)A. At least 2 weeks of severely depressed mood.B. Behaviors not accounted for by trigger stimuli. C. Behaviors are maladaptive. D. Cannot be related to substance or other medical

condition.

Unipolar vs. Bipolar Disorder

Bipolar

Unipolar

Elevated Mood

Elevated Mood

Depressed Mood

Depressed Mood

Major Depressive Disorder Example: Postpartum Depression

Form of depression that sets in for some women (about 15% as reported by the CDC) after childbirth.

Mild form: Short term depression symptomsSevere form: Psychosis

Brook Shields

Andrea Yates

Dysthymic Disorder

Dysthymic disorder lies between a blue mood and major depressive disorder. It is a disorder characterized by daily, milder depression lasting two years or more.

Major DepressiveDisorder

Blue Mood

DysthymicDisorder

Major Depression vs. Dysthymia

RecurrentMajor

DepressiveEpisodes

Dysthymia

Bi-Polar Disorders

Bipolar DisorderFormerly called manic-depressive disorder.

An alternation between depression and mania signals bipolar disorder.

Multiple ideas

Hyperactive

Desire for action

Euphoria

Elation

Manic Symptoms (mania)

Slowness of thought

Tired

Inability to make decisions

Withdrawn

Gloomy

Depressive Symptoms

Bipolar I vs. II

Different from Major Depressive Disorder by the lifetime history of at least one Manic or Mixed Episode

Bipolar I•A Manic/Mixed (mania

and signs of depression) ± Depression

Bipolar II•Hypomania (a

prolonged, elevated euphoria) followed by even periods of depression (no mania ever)

Topics we will analyze

Anxiety DisordersObsessive-Compulsive DisordersDepressive DisordersBi-Polar DisordersPersonality DisordersSchizophrenia

Personality Disorders

What is Personality?

The enduring traits you have that make you, you!

You are flexible in different situations!

Your personality is quite adaptive!

Personality Disorders Defined

Classified in DSM as ▪ Maladaptive personality styles ▪ Develop early in life and are very resistant to

change▪ “an enduring pattern of inner experience and

behavior that deviates markedly from the expectations of the culture of the individual who exhibits it.” (APA)

▪ They are inflexible and pervasive across many situations▫ the behaviors are acceptable to the

person diagnosed with the disorder.

ClustersCluster A:

Odd-Eccentric Cluster

(Eccentricity)

Cluster B:Dramatic-Impulsive

Cluster

(Impulsivity)

Cluster C:Anxious-Fearful Cluster

(Anxiety)

• Paranoid• Schizoid• Schizotypal

• Antisocial • Borderline• Histrionic• Narcissistic

• Avoidant• Dependent

• Obsessive-Compulsive

What are the “Red Flags”?

Personality patterns that are: ▫ Maladaptive

▫ Inflexible

▫ Pervasive

▫ Enduring

▫ Deviant

▫ Causes significant distress or impairment

Cluster A (Eccentricity)

Paranoid Personality Disorder ▫Pervasive distrust and

suspiciousness of others; Belief that the motives of others are malevolent.

• Remain aloof, distrustful and shield themselves from the anxieties of interpersonal intimacy

• Odd, eccentric ways of thinking or behaving

ClustersCluster A:

Odd-Eccentric Cluster

(Eccentricity)

Cluster B:Dramatic-Impulsive

Cluster

(Impulsivity)

Cluster C:Anxious-Fearful Cluster

(Anxiety)

• Paranoid• Schizoid• Schizotypal

• Antisocial • Borderline• Histrionic• Narcissistic

• Avoidant• Dependent

• Obsessive-Compulsive

Cluster B(Impulsivity) Antisocial Personality Disorder (Video example)▫ Pervasive pattern of disregard for and

violation of the rights of others; No sense of right and wrong; Manipulative◾Psychopath: Adapts to or is high

functioning in society. ◾Sociopath: Erratic behavior stands

out in society.

Dramatic, emotional, or erratic behavior

Mansion and Antisocial PD

Psychopath or sociopath?

•Psychopath•Psychopaths can be superficially charming•Psychopaths make a good first impression on others•Psychopaths appear to be remarkably normal•Psychopaths are actually self-centered, dishonest and undependable•Psychopaths engage in irresponsible behavior for no apparent reason other than the sheer fun of it•Psychopaths have an extreme lack of guilt, empathy and love•Psychopaths have casual and callous interpersonal and romantic relationships•Psychopaths “routinely offer excuses for their reckless and often outrageous actions, placing

blame on others instead.” They rarely learn from their mistakes or benefit from negative feedback, and they have difficulty inhibiting their impulses.

• Information from: http://www.examiner.com/article/nancy-lanza-adam-lanza-s-dna-psychopath-or-sociopath

•Sociopath •Sociopaths have a pervasive pattern of disregard for and violation of the rights of others•Sociopaths have difficulties to conform to social norms with respect to lawful behaviors•Sociopaths are excellent in deception, repeated lying•Sociopaths like to use aliases and con others for personal profit or pleasure•Sociopaths are impulsive and fail to plan ahead•Sociopaths often display irritability, aggressiveness, or get into repeated physical fights or

assaults•Sociopaths show reckless disregard for safety of self or others•Sociopaths display consistent irresponsibility, repeated failure to sustain consistent work

behavior or honor financial obligations;•Sociopaths show a lack of remorse, being indifferent to or rationalizing having hurt,

mistreated, or stolen from another

Cluster B(Impulsivity)

Antisocial Personality Disorder (Video example)▫ Pervasive pattern of disregard for and violation of the rights of others; No sense of right and wrong;

Manipulative◾ Psychopath: Adapts to or is high functioning in society. ◾ Sociopath: Erratic behavior stands out in society.

Histrionic Personality Disorder (Video example)▫ Pervasive pattern of excessive

emotionality and attention seeking; begins in early adulthood and presents in a variety of contexts; pervasive shallow emotions and values

Dramatic, emotional, or erratic behavior

Cluster B(Impulsivity)

Antisocial Personality Disorder (Video example)Histrionic Personality Disorder (Video example)Narcissistic Personality DisorderConceited, boastful or pretentious behavior.

Belittle perceived enemies or those who are inferior.

Over-exaggerate achievements/talents.

Fantasize about power and insecure when faced with criticism (will lash out – sues, attacks, verbally torments).

Dramatic, emotional, or erratic behavior

Cluster C(Anxiety)

Dependent Personality Disorder▫ Pervasive and excessive need to be

taken care of that leads to submissive and clinging behavior and fears of separation

Obsessive-Compulsive Personality Disorder (NOT OCD!)

▫ Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency

Focus on efforts to control anxiety about social rejection. Anxious or fearful behavior are hallmarks of this cluster.

Schizophrenia

Schizophrenia

The artwork of Louis Wain (1860-1939)

Schizophrenia Facts

A type of psychosis (the individual loses touch with reality)

About 1 in 100 people worldwide have the disorder.

Can develop at any age, but usually emerges during the late teens and early twenties.

Very often, onset of symptoms correlate with onset of excessive and extreme stress.

Can be very debilitating without treatment.

Let’s gain some insight into the disease:

1. Schizophrenia Overview Video (Beginning to 3:32)

SchizophreniaDSM Criteria (summarized)Two or more of the following, each present for a significant portion of the time during a 1-month period**

1. Delusions – irrational/false beliefs (“I am God! I am Zeus!”)2. Hallucinations – false perceptions of things not there3. Disorganized speech – (more on next page)4. Grossly disorganized or catatonic behavior – stillness/rigidity

**Exception to the 2+ symptom requirement: only 1 psychotic symptom required if:1. Delusion is bizarre

OR2. Hallucination consists of either:

a. voice keeps up a running commentary on the person’s thoughts or behavior

ORb. two or more voices conversing with each other

Positive Symptom: Disorganized Speech

Q A A

A

A

Q

Q

Q

Normal: goal directed and linear Tangential

Loosening of Associations

Incoherence

AQ

Circumlocution

(Old classification insight – NOT IN PACKET!) Types of Schizophrenia

▪ Paranoid Schizophrenia - Common Form – highest functioning.▫ Auditory Hallucinations/delusions; thoughts of being

persecuted by others

▪ Disorganized Schizophrenia - Common Form ▫ Unusual behavior in which the individual acts any

number of ways from silly and childlike to angry and aggressive (disorganized speech and behavior present).

▫ Extreme emotional swings. Neglect of personal appearance.

▪ Catatonic Schizophrenia - Rare Form▫ Patient may experience rigid immobility for hours

2. Case study: Gerald

With your partner – which symptoms of schizophrenia are

present?

Quick Debrief…

Look back to what we wrote in Google regarding our understanding of psychological disorders.

On the index card, describe how your thinking has changed in one – two sentences.

What about treatments?

Biological?Cognitive?Behavioral? Psychodynamic?Humanistic? Socio-cultural?