Today’s Goals and HW Goals: 1. To define psychologically abnormal behavior. 2. Describe historical and cross-cultural views of abnormality. 3. Describe the classification of psychological disorders.

Mental Illness - A Brief History of Psychiatric Centers cY cY

Psychological Disorders and Treatment When should behavior be considered to be disordered? Criteria for “disordered” behavior: – Deviant (different) – Distressful (causes distress) – Dysfunctional (impairs your life and your ability to function) Another set of criteria for “disordered” behavior: – Atypical – Maladaptive (poorly adapted to situation, to life, etc.) – Disturbing (either to self or others) – Unjustifiable

“Anne” Anne is a sixteen-year-old girl living in a medium-sized city in the Midwest. Her family includes a mother, father, fourteen-year-old brother, and a great-aunt, who has lived with the family since Anne was four. Anne is a junior at City High School and is taking a college-preparatory program. Her appearance is strikingly different from the other girls in her class. She wears tops which she has made out of various scraps of material. The tops are accompanied by the same pair of overalls everyday, two mismatched shoes, and a hat with a blue feather. She is a talented artist, producing sketches of her fellow classmates that are remarkably accurate. She draws constantly, even when told that to do so will lower her grade in classes where she is expected to take lecture notes.

“Anne” She has no friends at school, but seems undisturbed by the fact that she eats lunch by herself and walks alone around the campus. Her grades are erratic; if she likes a class she often receives an A or B, but will do no work at all in those she dislikes. Anne can occasionally be heard talking to herself; she is interested in poetry, and says she is "composing" if asked about her poetry. She refuses to watch television, calling it a "wasteland." This belief is carried into the classroom, where she refuses to watch any type of video within the lesson, saying they are poor excuses for teaching. Her parents say they don’t understand her; she isn’t like anyone in their family. She and her brother have very little in common. He is embarrassed by Anne’s behavior, and doesn’t understand her either. Anne seems blithely unaware of her apparent isolation, except for occasional outbursts about the meaninglessness of most people’s activities.

5 minute small group discussion: Given the criteria for disordered behavior, should Anne be considered to be disordered? Why or why not?

Overview of mental disorders from DSM-IV

The Five Axes of DSM-IV To diagnose and describe a patient using DSM-IV, a clinician rates the patient on five dimensions or axes. Axis 1: principle disorder - problem that requires immediate attention from a clinician (often what brings the person in). Axis 2: personality disorders/developmental disorder - may not require immediate care -may be predisposing the person to the Axis I problem -can complicate treatment Axis 3: general medical conditions/neurological problems that may be relevant to the individual's current or past psychiatric problems - sometimes psychological problems are the byproduct of an illness such as diabetes or heart disease. Axis 4: "psychosocial and environmental problems" - things such as recent life stressors, poverty, dysfunctional families, and other factors in the patient's environment - might impact the person's ability to function. Axis 5: "Global Assessment of Functioning Scale." - overall rating of a person's ability to cope with normal life over the past year. - see next slide for scoring Advantages of DSM-IV - encourages comprehensive evaluation - standardized format - allows psychiatrists, psychologists, and other mental health care workers to communicate in a common language that all can understand.

Global Assessment of Functioning (GAF) Scale (DSM– IV, Axis V) CodeDescription of Functioning Person has no problems OR has superior functioning in several areas OR is admired and sought after by others due to positive qualities Person has few or no symptoms. Good functioning in several areas. No more than "everyday" problems or concerns Person has symptoms/problems, but they are temporary, expectable reactions to stressors. There is no more than slight impairment in any area of psychological functioning Mild symptoms in one area OR difficulty in one of the following: social, occupational, or school functioning. BUT, the person is generally functioning pretty well and has some meaningful interpersonal relationships Moderate symptoms OR moderate difficulty in one of the following: social, occupational, or school functioning Serious symptoms OR serious impairment in one of the following: social, occupational, or school functioning Some impairment in reality testing OR impairment in speech and communication OR serious impairment in several of the following: occupational or school functioning, interpersonal relationships, judgment, thinking, or mood Presence of hallucinations or delusions which influence behavior OR serious impairment in ability to communicate with others OR serious impairment in judgment OR inability to function in almost all areas There is some danger of harm to self or others OR occasional failure to maintain personal hygiene OR the person is virtually unable to communicate with others due to being incoherent or mute Persistent danger of harming self or others OR persistent inability to maintain personal hygiene OR person has made a serious attempt at suicide.

Psychotic disorders A group of disorders with psychotic symptoms, ie the person loses touch with reality as in hallucinations or delusions Schizophrenia is the most common, where the person has disturbances in thought and perception, and bizarre behaviour

Anxiety Disorders Several disorders where the main symptom is anxiety, this could be particular irrational fears such as in phobias, or general anxiety. Also cover panic attacks, where the person suddenly is overwhelmed by intense anxiety

Mood disorders Disturbances of normal mood ranging from extreme depression to abnormal elation (‘mania’) The condition can be unipolar (depression) or bi-polar (alternating between periods of depression and mania)

Somatoform disorders Somatoform disorders are problems that seem to be medical but are actually psychological. This could be pain or paralysis For example, a mother who loses the use of her right arm when her son joins the army (conversion disorder) Also included in this category is hypochondriasis – the erroneous belief that one has a fatal disease!

Impulse control disorders This is when the individual is unable to resist an impulse or temptation, e.g., kleptomania involving compulsive stealing for no personal gain, or Trichotillomania, the habitual pulling out of one’s hair for pleasure or tension relief

Personality disorders The person has some permanent personality characteristics which often deviate from social norms and can cause distress to others, for example, a psychopath may display superficial charm and pathological lying Psychopaths feel no guilt for wrong actions. They may commit sexual assaults or violent crimes for which they feel no remorse. Another personality disorder is OCPD.

Dissociative disorders Dissociative disorders cause losses or changes in memory and identity. Included in this category are dissociative identity disorder, fugue, and amnesia The cause could be a traumatic experience

Factitious disorders This is when a person produces physical or psychological symptoms in order to assume a ‘sick role’ or gain financial benefits or reduced responsibility, because they are ‘ill’. Munchausen’s and Munchausen’s by proxy

Eating disorders The most common are Anorexia nervosa and Bulimia nervosa. The person has severe disturbances in eating behaviour False beliefs about body shape and image The reason could be biological, social, or psychological.

Coming Soon: DSM-V Article: What Counts As Crazy (Time, March 19, 2012) How does one use the DSM? What changes in DSM-V? What additions? What controversies?