2. Abnormal Psychology A.K.A. Psychological Disorders A “harmful dysfunction” in which behavior is judged to be maladaptive, unjustifiable, disturbing and atypical. Do Now: pick up notes and module on disorders Objective: to understand how different psychologists view the cause and “cure” of several disorders.

3. “A harmful dysfunction” in which behavior is “ MUDA” Maladaptive- inability to reach goals or to adapt to the demands of life or interferes or disrupts social group functioning Unjustifiable- without a rational basis Atypical - so different that they violate a norm, “social rules” Disturbing - troublesome to other people

4. Early Theories Abnormal behavior was evil spirits trying to get out. Trephining (trepanning) was often used. Philippe Pinel and Dorothea Dix Patients not criminal in France then in the USA.

5. Perspectives and Disorders Psychological School/PerspectiveCause of the Disorder Psychoanalytic/PsychodynamicInternal, unconscious drives HumanisticFailure to strive to one’s potential or being out of touch with one’s feelings. BehavioralReinforcement history, the environment. CognitiveIrrational, dysfunctional thoughts or ways of thinking. SocioculturalDysfunctional Society Biomedical/NeuroscienceOrganic problems, biochemical imbalances, genetic predispositions.

6. Collectivism vs Individualism Take out survey 14-23 and discuss results Cultural relativity – the need to consider the unique characteristics of the culture in which a person with a disorder was nurtured. Culture-bound syndromes - where a disorder is only found in a particular culture TKS (Taiijin-kyofu-sho) Japan – involves fear that one will do something in public that is socially embarrassing (blushing, staring) Susto – Latino Indians of the Andes – loss of soul by some frightening experience; person falls to the ground; symptoms like depression. Amok: Southeast Asia, Latin America, and Native Americans – A perceived insult/slight results in brooding and outburst.

7. Social Nonconformity Situational context – the social or environmental setting of a person’s behavior can make a difference on how behavior is labeled. Subjective discomfort – when a person experiences a great deal of emotional distress while engaging in a particular behavior. (like maladaptive and disturbing) however, some forms of disordered behavior involve showing no emotions at all. (serial killers)

8. Three Theoretical Models Biological models – explaining behavior as caused by biological changes in the chemical, structural, or genetic systems of the body.(biological- neuroscience) Psychological Models – attempts to explain disordered behavior as the result of various forms of emotion, behavioral, or thought-related malfunctioning. (psychodynamic, behaviorist, cognitive) Biopsychosocial model - behavior is seen as the result of the combined and interacting forces of bio, psycho, social, and cultural influences.

9. Diagnosing a Disorder is Difficult Is the behavior Maladaptive, Unjustifiable, Atypical, Disturbing? Culture - matters when Diagnosing and Treating disorders – how has a person been nurtured? Situational context – the social or environmental setting of a person’s behavior can make a difference on how behavior is labeled. Subjective discomfort – does the person have a normal discomfort or do they not? Now, lets see if gender may be another hindrance to accurate diagnosis.

10. Do women develop disorder more often than men? Broverman (date?)found mental health professionals viewed mature, healthy males differently from mature, healthy females. Healthy males viewed as ambitious, adventurous, self-confident, logical and independent While women were viewed as tactful, aware of other’s feeling, gentle, expressive of tender feelings, and in need of security.

11. The study found that the characteristics of a healthy adult person were more closely related to the idea of a healthy male. (Items 1,3,6, 7 and 9 equal healthy male while items 2,4,5,8, 10 healthy female.) Do the results still hold true today? What does that mean for women who are taught that by being competent people they are not normal? Are women evaluated on the same playing field as men when it comes to being mentally healthy?

12. Are the treatments the same for both sexes? Are women more likely to be diagnosed as having a disorder? Are women more likely to seek treatment?

13. Women are diagnosed more than males for many reason but some reasons are: Women are more likely to behave in ways that others label as mental disorders and are taught to express their emotions, while men are trained to control them. And are subject to discrimination and trauma- inducing circumstances. (like rape) Psychologists - who study and are interested in statistics that could help explain the pressure and prejudices that women suffer would be the sociocultural psychologists.

14. Psychopathology The study of mental health or mental distress that supports the idea that a disorder is an illness diagnosed on the basis of its symptoms and treated (not cured) through therapy, which may include treatment in a hospital.

15. DSM IV -TR Diagnostic Statistical Manual of Mental Disorders: the big book of disorders. Classifyies disorders and describe the symptoms. Does NOT explain the causes or possible cures. Labels person with a disorder.

16. DSM AXIS Axis I- primary diagnosis (such as Panic disorder) Axis II- personality disorders or mental retardation (rules out a more severe disorder) Axis III – relevant physical disorders (i.e. high blood pressure or hypertension) Axis IV – intensity of psychosocial and environmental problems (any severe stressors, death, loss) Axis V – global assessment of level of functioning (how has person coped in the past or how functioning) The DSM does not list the etiology(causes) of the disorder nor suggests a suitable therapy.

17. Problems with Diagnostic Labeling We come to see that person differently Labels can bias our interpretations and memories of that person or ourselves. Can be self-confirming – we knew it all along (hindsight bias) Self-fulfilling prophesy – we become our diagnosis David Rosenhan(1973) famous study.

18. The Rosenhan Study (1973) Rosenhan’s associates described symptoms of hearing voices. They were ALL admitted for schizophrenia. None were exposed as imposters. When released their diagnosis was: schizophrenia in remission. Brings into question the problems with Labeling and Stigma.

19. Are disorders genuine illnesses or they a myth? Thomas Szasz- outspoken critic of psychiatric diagnosis and labels. Mental illness better viewed as “problems in living”. Society invented the concept to control or change people. “Why is it that when we talk to God we are praying, but when God talks to us, we are schizophrenic” Says some other sexist things as well.

20. Two Major Classifications in the DSM Neurotic Disorders Distressing but one can still function in society and act rationally. Psychotic Disorders Person loses contact with reality, experiences distorted perceptions. John Wayne Gacy

21. Axis I: Clinical Disorders represents acute symptoms that need treatment diagnoses are the most familiar and widely recognized. Axis I are often symptomatic of Axis II. For example, a adult patient might have depression that is the a result of a personality disorder. Axis I depression terms classified according to V-codes by the medical industry (primarily for billing and insurance purposes.)V-codes For example: 309.24 Adjustment Disorder With Anxiety Anxiety

22. Anxiety Disorders a group of conditions where the primary symptoms are anxiety or defenses against anxiety. the patient fears something awful will happen to them. They are in a state of intense apprehension, uneasiness, uncertainty, or fear.

23. Generalized Anxiety Disorder GAD An anxiety disorder in which a person is continuously tense, apprehensive and in a state of autonomic nervous system arousal. The patient is constantly tense and worried, feels inadequate, is oversensitive, can’t concentrate and suffers from insomnia.

24. Phobias A person experiences sudden episodes of intense dread. Must be an irrational fear. Phobia List http://www.youtube.com/watch?v=Xge49FuX5v4

25. Panic Disorder An anxiety disorder marked by a minutes- long episode of intense dread in which a person experiences terror and accompanying chest pain, choking and other frightening sensations.

26. Obsessive-compulsive disorder Persistent unwanted thoughts (obsessions) cause someone to feel the need (compulsion) to engage in a particular action. Obsession about dirt and germs may lead to compulsive hand washing.

27. Post-traumatic Stress Disorder a.k.a. PTSD Flashbacks or nightmares following a person’s involvement in or observation of an extremely stressful event. Memories of the even cause anxiety. Guilt

28. Perspectives and Disorders Psychological School/PerspectiveCause of the Disorder Psychoanalytic/PsychodynamicInternal, unconscious drives HumanisticFailure to strive to one’s potential or being out of touch with one’s feelings. BehavioralReinforcement history, the environment. CognitiveIrrational, dysfunctional thoughts or ways of thinking. SocioculturalDysfunctional Society Biomedical/NeuroscienceOrganic problems, biochemical imbalances, genetic predispositions.

29. Biological Key Terms Heredity – Predisposition: the likelihood for developing a disorder. (OCD) Brain function – higher degree of activity in the frontal lobes (OCD) - high ordered thinking and amygdala (phobias) – emotional part. Evolution - fear associated with situations that posed danger to earliest humans. (anxiety in general)

30. Behaviorist/Learning Key Terms Conditioning – learned to associate fear with certain places or things (Watson and Little Albert) Observational learning – fear learned from observing others (Bandura’s Bobo doll) Reinforcement – learned to associate emotions with actions. Get some kind of Pay- off (OCD). Cognitive Key Terms Maladaptive thinking – Catastrophizing - believing something is far worse than it is

31. Mood Disorders Experience extreme or inappropriate emotion. We will discuss two types. Depression and Bipolar Biological Explanations - Neurotransmitters – serotonin, norepinephrine, and dopamine

32. Major Depression A.K.A. unipolar depression Unhappy for at least two weeks with no apparent cause. Depression is the common cold of psychological disorders. Dysthymia – a moderate depression that lasts for 2 years or more and is typically a reaction to some external stressor. Cyclothymia – mood swings from moderate depression to hypomania and last 2 yrs.

33. Seasonal Affective Disorder Experience depression during the winter months. Based not on temperature, but on amount of sunlight. Treated with light therapy.

34. Bipolar Disorder Formally manic depression. Involves periods of depression and manic episodes. Manic episodes involve feelings of high energy (but they tend to differ a lot…some get confident and some get irritable). Engage in risky behavior during the manic episode. May be related to ADHD – hyperactivity-excessive movement and low concentration.

35. Schizophrenic Disorders About 1 in every 100 people are diagnosed with schizophrenia, with more young men diagnosed rather than women. Symptoms of Schizophrenia 1.Disorganized thinking. 2.Disturbed Perceptions 3.Inappropriate Emotions and Actions

36. Disorganized Thinking The thinking of a person with Schizophrenia is fragmented and bizarre and distorted with false beliefs. Disorganized thinking comes from a breakdown in selective attention.- they cannot filter out information.

37. Delusions (false beliefs) Delusions of Persecution Delusions of Grandeur

38. Disturbed Perceptions hallucinations- sensory experiences without sensory stimulation.

39. Inappropriate Emotions and Actions Laugh at inappropriate times. Flat Effect Senseless, compulsive acts. Catatonia- motionless Waxy Flexibility

40. Positive v. Negative Symptoms Positive Symptoms Presence of inappropriate symptoms Negative Symptoms Absence of appropriate ones.

41. Types of Schizophrenia

42. Disorganized Schizophrenia disorganized speech or behavior, or flat or inappropriate emotion. "Imagine the worst Systematic, sympathetic Quite pathetic, apologetic, paramedic Your heart is prosthetic"

43. Paranoid Schizophrenia preoccupation with delusions or hallucinations. Somebody is out to get me!!!!

44. Catatonic Schizophrenia Flat effect Waxy Flexibility parrot like repeating of another’s speech and movements

45. Undifferentiated Schizophrenia Many and varied Symptoms Some causes may be too much dopamine or shrinkage of the thalamus

46. Somatoform Disorders Occur when a person manifests a psychological problem through a physiological symptom. Two types……

47. Hypochondriasis Has frequent physical complaints for which medical doctors are unable to locate the cause. They usually believe that the minor issues (headache, upset stomach) are indicative are more severe illnesses.

48. Conversion Disorder Report the existence of severe physical problems with no biological reason. Like blindness or paralysis.

49. Dissociative Disorders These disorders involve a disruption in the conscious process. Three types….

50. Dissociative Identity Disorder Used to be known as Multiple Personality Disorder. A person has several rather than one integrated personality. People with DID commonly have a history of childhood abuse or trauma.

51. Psychogenic Amnesia A person cannot remember things with no physiological basis for the disruption in memory. Retrograde Amnesia NOT organic amnesia. Organic amnesia can be retrograde or antrograde.

52. Dissociative Fugue People with psychogenic amnesia that find themselves in an unfamiliar environment.

53. Personality Disorders Are disorders that fall under Axis II Well-established, maladaptive ways of behaving that negatively affect people’s ability to function. Dominates their personality.

54. DSM Axis II - Personality Disorders and Intellectual disabilities Disorders that are usually life-long problems that first arise in childhood and are accompanied by considerable social stigma because they are suffered by people who often fail to adapt well to society

55. Axis II disorders can seem untreatable and be difficult to pinpoint. often disputed whether Axis II disorders are caused primarily by genetic influences or environmental causes. 'personality disorder' should be replaced by the diagnosis 'adaptation disorders' Autism used to be on Axis II but was moved to Axis I. Because some cases of autism are transient - they respond well to treatment and/or diminish over time. Axis II disorders are regarded as more permanent and less responsive to treatment.

56. Here is a list of some more commonly diagnosed Axis II disorders Antisocial Personality Avoidant Personality Borderline Personality Dependent Personality Histrionic Personality Mental Retardation Narcissistic Personality Obsessive-Compulsive Personality Obsessive-Compulsive Personality Paranoid Personality Personality Disorder Not Otherwise Specified Personality Disorder Not Otherwise Specified Schizoid Personality Schizotypal Personality Schizotypal Personality

57. Antisocial Personality Disorder Lack of empathy. Little regard for other’s feelings. View the world as hostile and look out for themselves.

58. Dependent Personality Disorder Rely too much on the attention and help of others.

59. Histrionic Personality Disorder Needs to be the center of attention. Whether acting silly or dressing provocatively.

60. Narcissistic Personality Disorder Having an unwarranted sense of self-importance. Thinking that you are the center of the universe.

61. Obsessive –Compulsive Personality Disorder Overly concerned with certain thoughts and performing certain behaviors. Personality disorder with OCD more extreme than OCD anxiety, but that’s not their major problem.

62. Other Disorders on Axis II Development Gender Identity Speech disorder Impulse control disorders ADD and ADHD Personality Disorder Not Otherwise Specified Personality Disorder Not Otherwise Specified

63. Two Main Types of Therapy Psychotherapies – talk therapy, includes group, insight, action or a combination Biomedical – drugs or some medical procedure such as electrical shock treatment (ECT). Most therapy today focus on individual therapy and include some kind of action

64. Before Individual Therapy It used to be that if someone exhibited abnormal behavior, they were institutionalized. Because of new drugs and better therapy, the U.S. went to a policy of deinstitutionalization. Also, had more to do with money and badly run institutions.

65. Deinstitutionalization 1950’s - released mental ill persons from hospitals. Result-Homeless who lot of them suffer from disorders Preventative efforts: primary prevention- to reduce homelessness. Secondary prevention- provide counseling. Tertiary prevention- work with those who suffer. How is that working?

66. Different Therapies for different perspectives Psychoanalytic Therapy Humanistic Therapy Behavioral Therapies Cognitive Therapy Somatic Therapies- Psychopharmacology- drugs and ECT and Psychosurgery

67. Different training Different focus Psychiatrists – M.D. Can give drugs; most biopsychological perspective; some may also be psychologists. Psychoanalysts – Freud, Psychiatric Social Worker - usually have masters degree and are licensed; more focused on environmental issues that effect a person.(stress, bullying, poverty, abuse) Psychologists – usually have a Ph.D.; if not then called therapists or counselors.

68. Psychoanalytic Therapy Psychoanalysis (manifest and latent content through…. hypnosis free association, dream, interpretation). Insight therapy Unconscious conflicts Defense mechanisms Transference/ Resistance Psychotherapy- new; (psychodynamic) – less Id and more on ego and sense of self.

69. Humanistic Therapy Client-Centered Therapy by Carl Rogers (Rogerian person-centered) These are non-directive therapies and use active listening.(person centered) Self-actualization, free-will and unconditional positive regard, empathy, reflection, authenticity. The closer the ideal self and the real self are the better one feels. Gestalt Therapy by Fritz Pearls encourage clients to get in touch with whole self. Focus is not on unconscious but on conscious emotional experiences and sense of self.

70. Behavioral Therapies Action based rather than insight-based. They aim to change behaviors through learning principles: Classical Conditioning: 1.Aversive Conditioning 2.Systematic desensitization 3.Flooding Operant Conditioning Token Economy - reinforcement Behavior modification – now called Applied behavior Analysis(ABA) Contingency contracting

71. Cognitive Therapy Change the way we Think about the world (change our schemas) Aaron Beck – focus on changing maladaptive thinking cognitive-behavioral therapy(CBT) - Albert Ellis - Rational Emotive Therapy (REBT) – more challenging less accepting of irrational beliefs and thoughts. Make you do homework and report back.

72. Group Therapy Not for the shy Self-help Group therapy like AA and ALNON, MADD, etc. “Keep coming back it works!” Family counseling (therapy) May or may not used a trained therapist.

73. How effective is psychotherapy? Hard to measure. Different problems take different therapy. People are different – some want help, some do not. Placebo effect Most crucial – therapeutic alliance between client and therapist. Gender and culture matter. Most effective are individual outlook on life and each individual way of perceiving of themselves in society.

74. Somatic Therapies – Biomedical- 3 types: drugs, surgery, shock(ECT) Psychopharmacology Antipsychotics (thorazine, haldol) Anti-anxiety (valium, barbiturates, Xanax) Mood Disorders (serotonin reuptake inhibitors) Bipolar (lithium)

75. Somatic Therapy Electroconvulsive Therapy (ECT)- for depression. Psychosurgery Prefontal lobotomy

76. Stress is a major cause of disorders and when a stressful situation occurs we have a physical response (how does it make your body feel) a cognitive one (what are you thinking) a behavioral one (what are you going to do)

77. There is also a Psychological Response A response that affects how you feel about yourself. Could be a lasting negative emotional state, such as frustration, fear, anxiety, sense of pressure. This is when one might exhibit symptoms of disorders

78. How does Stress make us unhealthy? Physically sick: Chronic stress produces too much Cortisol and suppresses the immune system, disrupts sleep, results in illness. And too much Epinephrine increases risk factors for cardiovascular disease. Cognitively: leads to negative mood states, i.e. depression and anxiety,which in turn can affect how a person appraises new events; the person appraises the new events more negatively. Memory loss, distractibility, obsessiveness, lack of concentration.

79. Stress affects us Psychologically Emotional symptoms of stress: crying, nervousness, irritability, anger, sadness, anxiety, fear, feelings of dissatisfaction, feeling over-whelmed, powerless, apathetic, or empty. Behavioral reactions to stress can include problems in relationships, alcohol and substance abuse, compulsive eating, teeth grinding, or uncommunicativeness.

80. Vulnerability-stress-model (aka Diasthesis-stress-hypothesis ) Predisposition: If someone who has a genetic predisposition to depression To pronounce Diasthesis use link: http://dictionary.referenc e.com/browse/diathesis?s =t Environmental influences: suffers a traumatic loss May be prime to develop a depressive disorder.

81. Bio-Psycho-Social Model Causes of Disorder (aka. Diathesis-Stress view)