Introduction to Psychology -Defining abnormal behaviour -Diagnosis -Mental Disorders

What is abnormal behaviour? Amy hasn’t been to work in two weeks. She has no physical problems but has trouble getting out of bed. She has little appetite and has lost 10 pounds in two weeks. She has no interest in things that she used to enjoy. Mary masturbates in public on a regular basis. She does it so all can see. Terry is a successful accountant in a good marriage. He wears silk panties to work. He dresses up in female attire when having sex with his wife. Both enjoy their lovemaking. Lloyd appears to be in an altered state of consciousness. His eyes don’t focus and he is unresponsive. He is repeating the same statement over and over.

Diagnosis Cons: -Reliability -Validity -Uniqueness of person is overlooked -Stigmatization Pros: -facilitates communication among practitioners and researchers -key to further knowledge in terms of treatment and prevention

DSM Multi-axial Diagnosis Axis I:all mental disorders (except) Axis II:personality disorders & mental retardation Axis III:physical disorders Axis IV:psychosocial and environmental problems Axis V:global assessment of functioning scale

DSM Diagnosis Axis I: Bulimia Nervosa, purging subtype Axis II: Borderline personality disorder Axis III: Diabetes Axis IV: unemployment, social isolation ongoing family difficulties Axis V: GAF: 40 (over last three months)

Anxiety Disorders When is anxiety abnormal? What is the difference between anxiety and fear?

future-oriented mood state feeling that one cannot predict or control upcoming events present-oriented emotional alarm reaction to present danger emergency “fight or flight” response Anxiety vs. Fear

Discrete period of intense fear/discomfort in which at least 4 symptoms developed abruptly and reached a peak within 10 minutes palpitations, pounding/racing heart sweating trembling/shaking shortness of breath/smothering sensations feeling of choking chest pain/discomfort nausea or abdominal distress feeling dizzy, unsteady, faint or lightheaded derealization or depersonalization fear of losing control or going crazy fear of dying paresthesias (numbness or tingling sensations) chills or hot flushes Criteria for a Panic Attack

Panic Disorder with/without Agoraphobia Specific Phobia Social Phobia Obsessive Compulsive Disorder (OCD) Generalized Anxiety Disorder (GAD) Post Traumatic Stress Disorder (PTSD) The DSM-IV Anxiety Disorders

recurrent, unexpected panic attacks AND one month of concern about additional attacks OR... worry about the implications of the attack or its consequences OR... a significant change in behaviour related to the attacks Panic Disorder

anxiety about being in places/situations from which escape might be difficult or embarrassing in the event of a panic attack situations are avoided or endured with marked distress or anxiety about having a panic attack OR require the presence of a companion Agoraphobia

Typical Agoraphobic Situations Shopping malls Cars Trains Buses Subways Wide streets Tunnels Restaurants Theatres Supermarkets Stores Crowds Planes Elevators Escalators Waiting in line Being far from home “out of safe zone”

Specific Phobia marked and persistent fear that is excessive or unreasonable, cued by a specific object or situation exposure to the phobic stimulus almost invariably provokes an immediate anxiety response (e.g., a panic attack) phobic situation/object is avoided or endured with intense anxiety and distress

Specific Phobia - Types 1. Animal 2. Natural Environment (e.g., heights, water) 3. Blood-Injection-Injury Type 4. Situational (e.g., planes, elevators, driving) 5. Other (e.g., choking, vomiting)

Social Phobia marked and persistent fear of social or performance situations situations involve exposure to unfamiliar people or to possible evaluation by others individual fears that he/she may do something humiliating or embarrassing.

recurrent and persistent obsessions and/or compulsions symptoms cause marked distress time consuming (more than 1 hour/day) interfere significantly with person’s normal routine Obsessive-Compulsive Disorder

OBSESSIONS persistent and intrusive thoughts, impulses, images inappropriate, cause marked anxiety or distress person usually attempts to ignore or suppress them...OR neutralize them with some other thought or action COMPULSIONS repetitive behaviors or mental acts performed to prevent or reduce anxiety/distress, not to provide pleasure or gratification

Mood Disorders Lifetime prevalence rates of depressive disorders: 13% men 25% women Lifetime prevalence rates of bipolar disorders: less than 1% for men and women 15% complete suicide

Mood Episodes 1.Major Depressive Episode 2.Manic Episode 3.Hypomanic Episode 4.Mixed Episode

1. Major Depressive Episode -Depressed mood -Loss of interest (anhedonia) -Significant weight loss or gain -Insomnia or hypersomnia -Psychomotor agitation or retardation -Fatigue or loss of energy -Worthlessness or guilt -Diminished ability to concentrate, indecisiveness

2. Manic Episode -Abnormally and persistently elevated, expansive, or irritable mood -Inflated self-esteem and grandiosity -Requiring very little sleep -Talkativeness -Flight of ideas -Distractibiltiy -Psychomotor agitation -Buying sprees, sexual indiscretions, foolish business investments

3. Hypomanic Episode Symptoms are milder than a Manic Episode Less intense and last at least four days 4. Mixed Episode Both a Major Depressive Episode and a Manic Episode nearly everyday for at least a one week period

Major Depressive Disorder One or more Major Depressive Episodes No history of Manic, Hypomanic or Mixed Episodes Dysthymic Disorder Less severe but more chronic than Major Depressive Disorder Symptoms are milder but remain unchanged over long periods of time

Bipolar I Disorder One or more Manic or Mixed Episodes Often individuals have also had one or more Major Depressive Episodes Bipolar II Disorder Presence (or history) of one or more Major Depressive Episodes Presence (or history) of at least one Hypomanic Episode There has never been a Manic Episode or a Mixed Episode

Cyclothymic Disorder Less severe but more chronic than Bipolar Disorder Symptoms of hypomania and depression are milder but remain unchanged over long periods of time

DSM-IV Specifiers 1.Chronic 2.Psychotic 3.Melancholic 4.Atypical 5.Catatonic 6.Postpartum Onset 7.Seasonal Pattern 8.Rapid Cycling Pattern

Somatoform & Dissociative Disorders Somatoform Disorders: –Hypochondriasis –Somatization Disorder –Conversion Disorder –Factitious Disorder –Body Dysmorphic Disorder Dissociative Identity Disorder

Hypochondriasis DSM-IV Criteria A.Preoccupation with the belief that one has a serious disease B.The preoccupation persists despite medical evaluation and reassurance C.Not delusional D.Distress or impairment E.Lasts at least 6 months

Somatization Disorder A.History of many physical complaints beginning before age 30 that result in treatment being sought or significant impairment B.Each of the following criteria must have been met: 1. Four pain symptoms 2. Two gastrointestinal symptoms 3. One sexual or reproductive symptom 4. One neurological symptom

Somatization Disorder C.Symptoms cannot be fully explained by a known medical condition D.The symptoms are not intentionally produced or feigned Causes: unclear, anxiety, secondary gain Treatment: gatekeeper physician, work, treatment for anxiety and depression

Conversion Disorder A.One or more symptoms or deficits affecting voluntary motor or sensory function that suggests a neurological or general medical condition B.Preceded by a conflict or stressor C.Not intentionally produced D.Cannot be fully explained by a medical condition E.Significant distress or impairment or warrants medical evaluation

Body Dysmorphic Disorder A.Preoccupation with an imagined defect in appearance, or if a slight physical anomaly is present, the person’s concern is excessive B.Significant distress or impairment

Dissociative Identity Disorder A.The presence of two or more distinct identities or personality states B.At least two of these identities recurrently take control of the person’s behaviour C.Inability to recall important personal information that is too excessive to be explained by forgetfulness

Dissociative Identity Disorder Host Identity Alternate Identities Switch Causes: abuse, neglect, iatrogenic, feigned Treatment: skillful therapist, build a therapeutic alliance, ground rules, reintegration: process trauma & dissociative defenses, post integration therapy

Eating Disorders Females 10 x more likely to develop an eating disorder Around 5% of young women will develop an eating disorder Course and outcome of eating disorders is highly variable Eating disorders are associated with serious complications, and have the highest mortality rate

DSM-IV Diagnostic criteria for Anorexia Nervosa A.Low body weight B.Fear of gaining weight or becoming fat C.Weight-related self-evaluation, or denial of the seriousness of the low body weight D.Amenorrhea RESTRICTING TYPE BINGE EATING/PURGING TYPE

DSM-IV: Diagnostic criteria for Bulimia Nervosa A.Binge eating B.Inappropriate compensatory behavior C.Both occur, at least 2/ week for 3 months D.Weight-related self-evaluation PURGING TYPE NON PURGING TYPE

Physical Complications Menstrual Dysfunction Hypothermia Hypotension Tiredness, Lethargy Headaches Hair Loss Dental Problems Electrolyte Abnormalities Parathesias Acute Gastric Dilation Delayed Gastric Emptying Constipation Swollen salivary gland Kidney Dysfunction

Psychological Complications Depression Anxiety Mood swings Food Preoccupation Social Isolation Sleep Disturbances Self-Esteem Deficits Impulsive Behaviors

Schizophrenia Delusions and Irrational thought Deterioration of Adaptive Behaviors Hallucinations Disturbed Emotion Paranoid, Catatonic, Disorganized, Undifferentiated Positive vs. Negative symptoms Chronic, resistant to treatment

DSM-IV Personality Disorders General Criteria A.A pattern of inner experience & behaviour that deviates markedly from expectations of the individual’s culture in 2 or more of the following areas… -cognition -affect -interpersonal functioning -impulse control

DSM-IV Personality Disorders General Criteria B.The pattern is inflexible and pervasive across a broad range of personal and social situations. C.Clinically significant distress or impairment (occupational, social). D.The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood.

Personality Disorders Relationship between the 5-factor model of personality and DSM-IV PDs NEOAC Paranoidlowlowlow Schizoidlow Schizotypalhilowhi Borderlinehihilowlow Narcissistichihilowhi Histrionichihihilow Antisociallowlowlow Dependenthihihi Avoidanthilow OChilowlowhi