| Abnormal Psychology 1
Abnormal Psychology
(Outlined)
By:
Claire Irish D. Borja
Reference: Barlow D.H, Durand and Hofmann S.G (2018). Abnormal psychology: an integrative approach, 8th ed. New
York: Nelson Education, Ltd.
| Abnormal Psychology 2
Abnormal Behavior in Historical Context
UNDERSTANDING PSYCHOPATHOLOGY
What is Psychological Disorder?
Psychological Disorder It is a psychological
dysfunction within an individual that is associated with
distress or impairment in functioning and a response
that is not typical or culturally expected
1. Psychological Dysfunction - refers to a
breakdown in cognitive, emotional, or
behavioral functioning.
2. Distress or Impairment
3. Atypical or Not Culturally Expected
4. An accepted definition - describes
behavioral, psychological, or biological
dysfunctions that are unexpected in their
cultural context and associated with present
distress and impairment in functioning, or
increased risk of suffering, death, pain, or
impairment.
The Science of Psychopathology
Psychopathology - is the scientific study of
psychological disorders.
- Within this field are specially trained
professionals, including clinical and counseling
psychologists, psychiatrists, psychiatric social
workers, and psychiatric nurses, as well as
marriage and family therapists and mental health
counselors.
1. Scientist-Practitioners - mental health
professionals take a scientific approach to their
clinical work
2. Clinical Description - represents the unique
combination of behaviors, thoughts, and feelings
that make up a specific disorder
Prognosis anticipated course of disorder
3. Causation, Treatment, and Etiology Outcomes
Etiology - study of origins, has to do with why a
disorder begins (what causes it) and includes
biological, psychological, and social dimensions.
Historical Conceptions
Supernatural Model - the driving forces behind are
these agents, which might be divinities, demons, spirits,
or other phenomena such as magnetic fields or the
moon or the stars
Ancient Greece - the mind has often been called the soul
or the psyche and considered separate from the body.
(3) Three models:
1.
2.
3.
the supernatural
the biological
the psychological
THE SUPERNATURAL TRADITION
Demons and Witches
last quarter of the 14th century, religious and lay
authorities supported these popular superstitions
and society as a whole began to believe more
strongly in the existence and power of demons and
witches.
Catholic Church had split
Roman Church fought back against the evil in the
world
magic and sorcery to solve their problems.
Treatments included exorcism
Stress and Melancholy Treatments for Possession
reflected the enlightened view that insanity
was a natural phenomenon, caused by mental
or emotional stress, and that it was curable
Mental depression and anxiety were
recognized as illnesses
Treatments for Possession
A creative therapist decided that hanging
people over a pit full of poisonous snakes
might scare evil spirits right out of their body
Mass Hysteria
characterized by large-scale outbreaks of
bizarre behavior
the phenomenon of emotion contagion, in
which the experience of an emotion seems to
spread to those around us
Modern Mass Hysteria
problem, others will probably assume that
their own reactions have the same source. In
popular language, this shared response is
sometimes referred to as mob psychology.
The Moon and the Stars
the movements of the moon and stars had
functioning.
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-
lunatic, which is derived from the Latin word
.
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| Abnormal Psychology 5
Anxiety Disorder
-
Apprehension over an anticipated problem
Comorbid to Bipolar disorder, Substance
Abuse, Personality Disorder and also Medical
Conditions
Separation Anxiety Disorder
Developmentally inappropriate and
excessive fear/anxiety in anticipating or
experiencing separation from the
individual to whom they are attached.
Applied only under 18 (DSM IV-TR)
Symptoms present for at least 4 weeks in
children/adolescents and 6 months or more
in adults
Selective Mutism
Rare childhood anxiety disorder in which a
child unable to speak in certain
situation/people
Symptoms for at least 1 month not
st
month in school
Specific Phobia
Disproportionate fear caused by specific
object/situation
At least 6 months
Object/situation is avoided/endured with
intense anxiety
Only under age 18 (DSM IV-TR)
Generalized Anxiety Disorder
Uncontrollably/persistent worrying about
minor things
At least 3 months (6 Months in DSM IVTR)
With muscle tension
Worry cognitive tendency to chew on a
problems unable to let her go of it
Agoraphobia
Anxiety about situations in which it would
be embarrassing or difficult to escape if
anxiety symptoms occurred
At least 6 months
Panic Disorder
Characterized by frequent panic attacks
that are unrelated to specific situation and
by worrying about having more panic
attacks
At least 1 month
Social Anxiety Disorder
Persistent, unrealistically intense fear of
social situations that might involve being
sanitized by exposed to unfamiliar people.
At least 6 months
SOCIOCULTURAL FACTORS
Women twice likely as men
Problems vary from culture to culture
TAIJIN KYO-FUSHO Japan (fear of
displeasing/ embarrassing others)
GENETIC FACTORS
Twin studies heritability suggest 20-40%
NEUROBIOLOGICAL FACTORS
Fear circuit involved amygdala (more activity)
Medial prefrontal cortex (less activity)
PERSONALITY FACTORS
Behavioral inhibition during infancy
Neuroticism
COGNITIVE FACTORS
Sustained negative beliefs about the future
Perceived control
Attention to threat
| Abnormal Psychology 6
Trauma and Stressor-Related Disorders
-
STRESS a
psychological responses to adjusted demands
NO TRAUMATIC EXPERIENCE
Reactive Attachment Disorder
Disturbed, developmentally inappropriate
attachment behavior to the caregivers
Persistent social and emotional disturbance
At least 9 months of age
Disinhibited Social Engagement
Overly familiar actively approached and
interacts with strangers or unfamiliar
adults
Willingness to go off
At least 9 months of age
Adjustment Disorder
Emotional and behavioral symptoms with
significant impairment in functioning after
an identifiable stressor (mostly normal
stressors)
WITH TRAUMATIC EXPERIENCE
Posttraumatic Stress Disorder
Exposure to a traumatic events/ severe
stressor (witnessed/personal0 cause an
extreme response
At least 1 intrusion and 1 avoidance
symptom
At least 3 (or 2 in children) negative
alterations in cognition and mood and
alteration in arousal and reactivity
More than 1 month
| Abnormal Psychology 7
Obsessive-Compulsive and Related Disorders
Obsessions are intrusive and recurring thoughts
images or impulses that are persistent and
uncontrollable usually irrational
Compulsions repetitive, clearly excessive behavior or
mental acts that the person feels driven to perform to
reduce the anxiety caused by obsessive thoughts to
prevent some calamity from occurring
Obsessive-compulsive Disorder
Characterized by obsessions or
compulsions that are time-consuming
(requires 1 hour per day)
Recognize as the product of their mind
Common in women than in men
*chronic
Begins in childhood
Body Dysmorphic Disorder
Preoccupied with an imagined, exaggerated
defect in their appearance
Has performed repetitive behaviors or
mental acts in response to the appearance
concerned
Slightly common in women than in men
but is very rare
Hoarding Disorder
Persistent difficulty discarding or parting
with possessions
Strong urges to save items
More often to women than in men
Excoriation (skin-picking disorder)
results in skin lesions and causes significant
Trichotillomania (hair-pulling disorder)
Characterized by compulsive, mild to severe from
anywhere on the body; can results in hair loss to
ALOPECIA (bald spots on the scalp)
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Somatic Symptom and Related Disorder
-
An excessive concern about physical
symptoms or health that had no known
physical cause
Somatic Symptom Disorder
Having a significant focus on physical
symptoms (pain, shortness or weakness of
breath) resulting to major distress and
problem in functioning
Excessive thoughts, feelings or behaviors
relating to physical symptoms
At least 1 symptoms
More than 6 months
Usually begins by age of 30
Somatic delusion
Delusion whose content pertains to bodily
functioning, bodily sensations or physical
appearance. Usually the false belief is that
the body is somehow diseased, abnormal or
changed.
Illness Anxiety Disorder
excessively that you are or may seriously ill/
having serious medical condition
At least 6 months
Begins early adulthood
Common in men than women
Conversion Disorder (Functional Neurological
Disorder)
A psychological condition that causes
symptoms that appear to be neurological
(paralysis, speech impairment, tremors)
At least 2 sensory or motor impairment
symptoms
Caused by psychological reaction to a
highly stressful event
Women have higher risk
Incompatibility of evidence between
symptoms and recognized medical
condition
Factitious Disorder
Falsification of psychological/physical
symptoms or signs for secondary gain as
emotional attention and affection
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Psychological Factor Affecting Other Medical
Conditions
When a medical condition is adversely
affected by psychological/behavioral factors
either by making it worst or stopping
recovery
Factors include psychological distress
interpersonal problems, coping styles and
maladaptive health behavior
Malingering
There is personal gain in the deception/
pretending to have psychological/physical
condition
Not considered mental illness
Dissociative Disorder
Dissociation- involves the failure of consciousness to
perform its usual role of integrating our cognitions,
emotions, motivations and other aspects of experiences
in our awareness
Dissociative Identity Disorder
Have at least 2 separate identities/ personalities
or alters-different modes of being, thinking,
feeling and acting that exist independently of
one another, emerged at different time
2 of the alters recurrently take control
Inability of at least 1 to recall important
information
Dissociative Amnesia
-
-
Unable to recall important personal
information usually about some traumatic
experience
Fugue is a severe subtype
Localize/selective amnesia for specific events
Explicit memory conscious recall of
experiences
Depersonalization/Derealization Disorder
Depersonalization
Persistent or recurrent experiences of
ocesses or
body
Loss of sense of self
Derealization
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-
Persistent or recurrent experiences of unreality
of surroundings
Sensation that the word becomes real
Dissociative Fugue (DSM IV-TR)
Memory loss revolves around an unexpected
trip
They just take off and find themselves in a new
place but unable to remember how they got
there
Mood Disorders
DEPRESSIVE DISORDERS cardinal symptoms of
depression include profound sadness and/or an
inability to experience pleasure
1. Disruptive Mood Dysregulation Disorder
- Severe recurrent temper outburst and persistent
negative mood
- Atleast 1 year
- Before age 10
2. Major Depressive Disorder
- Sad mood or loss of pleasure in usual activities
- At least 5 symptoms
- Nearly every day for at least 2 weeks (episodic)
recurring
- With suicidal thoughts
| Abnormal Psychology 11
3. Persistent depression Disorder (Dysthymia)
- Depressed mood for most of the day
- At least 2 years in adult & 1 year for children and
adolescents)
- At least 2 symptoms
4. Premenstrual Dysphoric Disorder
- Depressive or physical symptoms in the week
before menstruation
- Marked affective lability
5. Seasonal Affective Disorder
- Seasonal subtype of Mood
- Winter blues
- Depression during 2 consecutive winters then
clears during summers
BIPOLAR DISORDER people experiencing mania
and depression during their lifetime
Mania- state of intense elation/irritability
Hypomania
1. Bipolar I Disorder
At least 1 lifetime manic episode
2.
Bipolar II Disorder
At least 1 lifetime major depressive episode
and one hypomanic episode
3. Cyclothymic Disorder
Frequent mild symptoms of depression
alternating with mild symptoms of mania
=MANIA
↑serotonin = ANTIDEPRESSANT
SOCIAL FACTORS
Stressful life events
Interpersonal problems within the families
Constant reassurance-seeking of care
PSYCHOLOGICAL FACTORS
Neuroticism
Negative thoughts and beliefs (pessimistic &
self-critical thoughts)
Hopelessness

Desirable outcomes will not occur

Ni response to change the situation
Rumination

Repeatedly dwell on sad experiences or
thoughts

To chew on material again and again

Tendency to brood/regretfully ponder
why an episode happened
BIOLOGICAL TREATMENT
Electro cumulative therapy (ECT)
Repetitive Transcranial Magnetic Stimulation
(rTMS)
Vagus Nerve Stimulation
-
-
At least 2 years (1 year for children and
Adolescents)
*chronic
Rapid Cycling experiencing 4 or more episodes of
mania/depression in 1 year
NEUROBIOLOGICAL FACTORS
Genetic heritability among twins
Neurotransmitters
↓norepinephrine
↓dopamine
=DEPRESSION
↑norepinephrine
↑dopamine
Suicide
THREE OTHER IMPORTANT INDICES OF
SUICIDAL BEHAVIOR ARE:
1.
suicidal ideation (thinking seriously about
suicide)
| Abnormal Psychology 12
2.
suicidal plans (the formulation of a specific
method for killing oneself)
3. suicidal attempts (the person survives)
TYPES OF SUICIDE (Durkheim)
1. Altruistic Suicide for the benefit of the
community
e.g as the ancient custom of hara-kiri in Japan,
in which an individual who brought dishonor
to himself or his family was expected to impale
himself on a sword.
2. Egoistic Suicide low social integration.
e.g Older adults who kill themselves after
losing touch with their friends or family fi t
into this category.
3. Anomic suicides are the result of marked
disruptions or disappointments, such as the
sudden loss of a high-prestige job. (Anomie is
feeling lost and confused.)
4. Fatalistic Suicides result from a loss of
1997 is an example of this type because the
lives of those people were largely in the hands
of Marshall Applewhite, a supreme and
charismatic leader.
Feeding and Eating Disorders
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BULIMIA NERVOSA - Out of control eating or
binges followed by self-induced vomiting, excessive
use of laxatives, or other attempts to purge (get rid
of) the food.
ANOREXIA NERVOSA - The person eats only
minimal amounts of food or exercises vigorously to
offset food intake so body weight sometimes drops
dangerously.
BINGE EATING DISORDER - Individuals may
binge repeatedly and find it distressing, but they do
not attempt to purge the food.
OBESITY - is not considered an official disorder in
DSM, but we consider it here because it thought to
be one of the most dangerous epidemics confronting
public health authorities around the world today.
PICA eating of one or more nonnutritive food,
nonfood substances on a persistent basis
RUMINATION DISORDER repeated
regurgitation of food occurring after feeding or
eating (re-chewed, re-swallowed and re-spit out)
AVOIDANT/ RESTRICTIVE FOOD INTAKE
DISORDER avoidance of restriction of food
intake manifested by persistent failure to meet
appropriate nutritional and/or energy needs
associated w/ one or more: 9weight loss, nutritional
deficiency, dependence on enteral feeding/ oral
nutritional supplements and marked interfere w/
psychosocial functioning
Ego dystonic with stress and anxiety
Ego syntonic without stress and anxiety
BULIMIA NERVOSA
-eating a larger amount of food typically more junk food
than fruits and vegetables than most people would eat
under similar circumstances.
-ashamed of both their eating issues and their lack of
control
Purging techniquescompensate for the binge eating and potential weight
gain, almost always.
Include self-induced vomiting immediately after eating.
Subtypes:
1. Purging type
2. Non purging type
Medical Consequences
CHRONIC BULIMIA with PURGING
1. Salivary gland enlargement caused by repeated
vomiting, which gives the face chubby appearance.
2. Repeated vomiting also may erode the dental enamel
on the inner surface of the front teeth as well as tear
the esophagus.
3. Continued vomiting may upset the chemical balance
of bodily fluids, including sodium and potassium
levels.
Electrolyte imbalance- results in serious
medical complications if unattended. (e.g.
cardiac arrthymia or disrupted heartbeat,
seizures and renal/kidney failure
ANOREXIA NERVOSA
- Proud of both their diets and their extraordinary
control.
- Intense fear of obesity and relentlessly pursue thinness.
*individuals with bulimia have a history of anorexia; that
is, they once used fasting to reduce their body weight
below desirable levels.
Medical Consequences
Cessation of menstruation
Medical signs and symptoms:
1. Dry skin
2. Brittle hair and nail
3. Sensitivity to or intolerance of cold temperature.
Lanugo
1. Downy hair on the limbs and cheeks
Cardiovascular problems
Electrolyte imbalance
BINGE- EATING DISORDER
Experience marked distress because of binge
eating but do not engage in extreme
| Abnormal Psychology 14
compensatory behaviors and therefore cannot be
diagnosed with bulimia.
Found in weigh control programs
CAUSES OF EATING DISORDERS
A. Social Dimensions
For young women:
 Looking good than being healthy
 Self-worth, happiness and success are largely
determining by BODY measurements and fats.
1. Dietary restraint if cultural pressures to be thin
are is important as they seem to be in trigger eating
disorders, then such disorders would be expected to
occur where these pressures are particularly severe
(e.g ballet dancers; under extraordinary pressures to
be thin)
2. Family influences typical family of someone with
anorexia is successful, hard driving, concerned about
external appearances and eager to maintain
harmony.
B. Biological dimensions
 Genetic component
 Eating disorders runs in families
 Hypothalamus and Major neurotransmitter;
norepinephrine, dopamine and serotonin. That
passes through it to determine whether something is
malfunctioning when eating disorders occur.
 Low levels of serotonergic activity
- the system most often associated with eating
disorders.
-associated with impulsivity generally and binge
eating disorders
 Association between ovarian hormones and
dysregulated or impulsive eating in women prone to
binge episodes.







C. Psychological Dimensions
Young women with eating disorder diminished a
sense of personal control and confidence in their
own abilities and talents.
More perfectionist attitude which may reflect
attempts to exert control over important events in
their lives.
Preoccupied with how they appear to others
Perceived themselves as frauds, considering false any
impressions they make of being adequate, selfsufficient or worthwhile.
Feel like impostors in their social group and
experienced heightened levels of social anxiety.
Women with bulimia judged that their bodies were
larger after they ate a candy bar and soft drinks
Difficulty tolerating any negative emotion (mood
intolerance)
TREATMENT OF EATING DISORDER
A. Drug treatments
 Not been found effective in the treatment of
anorexia nervosa
 May be useful for people with bulimia,
particularly during the bingeing and purging
cycle. (same antidepressant medications for
anxiety and mood disorders)
 Prozac
B. Psychological treatments
BN:
Short term cognitive behavioral therapy (CBT) to
address behavior and attitudes on eating and body
shape
Interpersonal psychotherapy (IPT) to improve
interpersonal functioning
Tends to be chronic if left untreated
AN:
Outpatient treatment to restore weight and correct
dysfunctional attitudes on eating and body shape.
Family therapy
Tends to be chronic if left untreated more resistant
to treatment than bulimia
BE:
Short term CBT to address behavior and attitudes
on eating and body shape.
IPT to improve interpersonal functioning
Self-help approaches
Prevent Eating Disorders: Healthy Weight
OBESITY
- not formally considered as eating disorder in DSM
- increases risk of cardiovascular disease, diabetes,
hypertension, stroke and other physical problems.
Night eating syndrome
Consume a third or more of their daily intake after
their evening meal and get out of bed at least once
during the night to have a high calories snack.
In the morning, they are not hungry and do not
usually eat breakfast.
CAUSE
Psychological Influences
Affects impulse control, attitudes and
motivation towards eating and responsiveness
to the consequences of eating
Social Influences
Advancing technology promotes sedentary
lifestyle and consumption of high fat foods.
Biological Influences
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3.
cells tendency toward fat storage and activity
levels.
TREATMENT
1. Self- directed weight loss programs
2. Commercial self-help programs, such as
weight watchers
4.
Professionally directed behavior modification
programs which are the most effective
treatment.
Surgery as a last resort.
Sleep-Wake Disorders: Major Dyssomnias
DYSSOMNIAS problems in the amount, thing or
quality of sleep; involve in difficulties in getting enough
sleep, problems with sleeping when you want to and
complaints about the quality of sleep.
Insomnia Disorder difficulty falling asleep at
bedtime, problems staying asleep throughout the
night, or sleep that does not result in the person
feeling rested even after amounts of sleep
Hypersomnolence Disorders excessive sleepiness
that is displayed as either sleeping longer than is
typical or frequent falling asleep during the day.
Narcolepsy episodes of irresistible attacks of
refreshing sleep occurring daily, accompanied by
episodes of brief muscle tone (cataplexy)
BREATHING RELATED SLEEPING DISORDERS
a variety of breathing disorders occur during sleep
and that lead to excessive sleepiness or insomnia
Obstructive Sleep Apnea Hypopnea Syndrome
occurs when Airflow stops despite continued activity
by the respiratory system.
Central Sleep Apnea complete cessation of
respiratory activity for brief periods and is often
associated with certain central nervous system
disorders (cerebral vascular diseases, head trauma
and degenerative disorders)
Sleep related Hypoventilation a decrease in airflow
without a complete pause in breathing
CIRCADIAN RHYTHM SLEEP DISORDER
disturbed sleep (either insomnia or excessive
current pattern of day and night.
Jet Lag Type caused by rapidly crossing multiple
time zones
Shift Work Type associated with work problems
Delayed sleep phase type sleep is delayed or there
is a later than normal bedtime
Irregular sleep wake type people who experience
highly varied sleep cycles
Non- 24 hour sleep- wake type sleeping on a 25-26
hour cycle with later and later bedtime ultimately
going throughout the day.
PARASOMNIAS - abnormal behavior or
physiological events that occur during sleep.
Disorder of Arousal motor movements and
behaviors that occur during NREM sleep including
incomplete awakening (confusional arousals) sleep
waking, or sleep terrors (abrupt awakening from
sleep that begins with a panicky scream)
Nightmare Disorder frequently being awakened by
extended and extremely frightening dreams that
causes significant distress and impaired functioning.
Rapid Eye Movement Sleep Behavior Disorder
episodes of arousal during REM sleep that result in
behaviors that can cause harm to the individual and
others.
Restless Legs Syndrome irresistible urges to move
the legs as a result of unpleasant sensations
in the limbs) (otherwise referred to as Willis-EkbomDisease)
Polysomnigraphic evaluation patient spend one or
more nights sleeping in a sleep laboratory and being
monitored on a number of measures including:

respiration and oxygen desaturation (a measure
of airflow)

leg movements
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
brain wave activity (by EEG)

eye movements (by electrooculagram)

muscle movements (by electromyogram)

heart activity (by electrocardiogram)
Actigraph records the number of arm movements and
the data can be downloaded into a computer to
determine the length and quality of sleep.
Sleep efficiency the percentage of time actually spent
asleep.
100%: you fall asleep as soon as your head hits the
pillow and do not wake up during the night.
50%: half of your time in bed is spent trying to
sleep- you are half the time awake.
INSOMIA DISORDER:
most common sleep wake disorder
micro sleeps
Fatal Insomnia: total lack of sleep eventually leads
to death
night
(difficulty iniating sleep), if they wake up
Sleep Stress- includes a number of events that can
negatively affect sleep
Rebound Insomnia- sleep problems reappear
sometimes worst- may occur when the medication
is withdrawn.
HYPERSOMNOLENCE DISORDER
people who sleep all night find themselves
falling asleep several times the next day.
excessive sleepiness
NARCOLEPSY
experience cataplexy, a sudden loss of muscle
tone.
Cataplexy
- person is awake and can range from slight
weakness in the facial muscles to complete
physical collage
- preceded by strong emotion such as anger or
happiness.
-
Two characteristics:
1. Sleep Paralysis brief period after awakening
sleep reasonable number of hours but still not
rested the next day (NONRESTORATIVE SLEEP)
2.
Primary Insomnia- sleep problems were not related to
other medical or psychiatric problems.
CAUSE

Problems with the biological clock and its control
of temperature.

Delayed temperature rhythm:
1.
2. Drowsy until later at night

People with Insomnia seems to have higher body
temperature than good sleepers

Drug use

Environmental influences: light, noise and
temperature
Sleep apnea - a disorder that involves obstructed
nighttime breathing

Periodic limb movement disorder- excessive leg
movements
Family history of insomnia, narcolepsy or
obstructed breathing. (Predispotioning
Conditions)
Light sleeper- easily aroused at night
frightening to those who go through.
Hyponagogic hallucinations vivid and often
terrifying experiences that begin at the start of
sleep and are said to be unbelievably realistic
because they include not only visual aspects
but also sensation of body movements.
Isolated sleep paralysis sleep paralysis commonly
occurs with anxiety disorders.
BREATH-RELATED SLEEP DISORDERS
People whose breathing is interrupted during their
sleep often experience numerous brief arousals
throughout the nights and do not feel rested even
after 8 or 9 hours.
Hypoventilation breathing is constricted a great
deal and may be labored
Signs:
o loud snoring
o heavy sweating during the night
o morning headaches
o sleep attacks
-
Three types of Apnea
1. OBSTRUCTURE SLEEP APNEA HYPOPNEA
SYNDROME
 airflows stop continued activity by the
respiratory system
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



snoring at night
obesity
used of MDMA (ecstasy)
young and healthy adults (mostly male)
CIRCADIAN RHYTHM SLEEP DISORDERS
-
–
–
Disturbed sleep (either insomnia or excessive
inability to synchronize its sleep patterns with the
current patterns of day and night.
Suprachiasmatic nucleus
Our biological clock (hypothalamus)
connected to it is a pathway that comes from our
eyes
Types of Circadian Rhythm
1. Jet lag type caused by rapidly crossing
multiple time-zones
2. Shift work type sleep associated with work
schedules
3. Delayed sleep phase type sleep is delayed or
there is a later than normal bedtime
4. Advanced sleep phase type early to bed
early to rise
5. Irregular sleep wake type people who
experience highly varied sleep cycles
6. Non- 24 hour sleep- wake type sleeping on a
25-26 hour cycle with later and later bedtime
ultimately going throughout the day.
TREATMENT OF SLEEP DISORDER
1. Medical Treatment
Insomnia:
 Benzodiazepine - can cause excessive sleep
 Medications:
o triazolam (halcion)
o zaleplon (sonata)
o zolpidem (ambien)
 Long acting drug: flurazepam (dalmane)
 Short acting drug:
Cause only brief drowsiness
Drawbacks:
Benzodiazepines can cause excessive sleepiness
People can easily become dependent on them
and rather easily misuse them
Meant for short-term treatment and are not
recommended for use longer than 4 weeks.
Longer use may cause dependence and
rebound insomnia.
Increase the likelihood of sleepwalking related
problems
Not intended for long term chronic problems.
Hypersomnolence or Narcolepsy
Methylphenidate
Modafinil
Cataplexy
Antidepressant medication, suppress REM
(dream) sleep
Breathing- related sleeping disorder
Recommending weight loss
Obstructive Sleep apnea
Mechanical device called CPAP or Continuous
Positive Air Pressure Machine
2. Environmental Treatments
General principles in treating Circadian rhythm
disorder
Phase Delays (moving bedtime later)
Phase advances (moving bedtime earlier)
Light Therapy (using bright light to trick the brain
into readjusting the biological clock)
3. Psychological Treatment
4. Relaxation treatment: reduce physical tension
that seems to prevent some people from falling
asleep at night.
5. Cognitive Treatment: Focus on worries about
sleep.
a) Guided Imagery Relaxation
Uses medication or imagery to help with
relaxation at bedtime or after a night
waking
b) Graduated Extinction
6. Instruct the parents of the child who has
tantrums to check the progressively longer period
until the child falls asleep on his or her own.
Paradoxial Intention
7. Instructing individuals in the opposite behavior
from the desired outcome.
Progressive Relaxation
8. Relaxing muscles of the body in an effort to
introduce drowsiness
Sleep Hygiene changes in lifestyle can be relatively
simple to follow and can help avoid problems such as
insomnia for some people.
-
PARASOMNIAS
Not problems with sleep itself but abnormal events
that occur during sleep or during that twilight
time between sleeping and waking.
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Nightmare
- occur during REM or dream sleep
- disturbing dreams that awaken the sleeper
Disorder of Arousal
- Includes a number of motor movements and
behavior during NREM sleep such as
sleepwalking, sleep terrors and incomplete
awakening.
Sleep terrors
- The child is extremely upset often sweating and
frequently has a rapid heartbeat.
Sleep walking (Somnambulism)
- Occurs during NREM sleep
- People walk in their sleep, they probably not
acting out a dream.
- Occurs during the first few hours while a person
is in deep stages of sleep.
1.
2.
3.
RELATED DISORDER:
Nocturnal Eating Syndrome - Individuals rise from their
beds and eats while they are still sleeping.
Night Eating Syndrome
Sexsomnia - Acting out a sexual behavior such as
masturbation and sexual intercourse with no memory of
the event.
Sexual Dysfunction
difficulty to function adequately while having sex
Two disorder (sex specific)
2.
Heterosexual Behavior: Sex with opposite sex
Homosexual Behavior: Sex with same sex
3.
Gender Difference
Men and women tend toward a monogamous
(one Partner) pattern of relationship, gender
differences in sexual behavior do exist and
some of them are quite dramatic.
Reflected in the incidence of casual sex,
attitudes toward casual premarital sex and
pornography use, with men expressing more
permissive attitudes and behaviors than
women.
Four themes of gender differences in human
sexuality:
1. Men show more sexual desire and arousal
than women.
4.
Women emphasize committed
relationships as a context for sex more
than me
-concept, unlike
independence and aggression
in that they are more easily shaped by
cultural, social and situational factors.
1. Premature (early) ejaculation- males
2. Genito-pelvic pain/penetration disorderfemales
SD can be:
 Lifelong present during entire sexual history



Acquired interrupts normal sexual pattern
Generalized present in every encounter
Situational present only with a certain
partners or at certain times
| Abnormal Psychology 19
Four Phases of sexual response cycle
1. Desire Phase refers to sexual interest/desire
associated with arousing fantasies or thoughts
2. Excitement Phase experience of pleasure and
increase blood flow to the genitalia
3. Orgasm phase sexual pleasure peaks in ways
occurring a general muscle tension
4. Resolution phase relaxation and sense of wellbeing followed an orgasm
Types of Sexual Dysfunction
Male Hypoactive Sexual Desire Disorder
A. Persistently or recurrently deficient (or absent)
sexual/erotic thoughts or fantasies and desire for
sexual activity. The judgment of deficiency is made
by the clinician, taking into account factors that affect
sexual functioning, such as age and general and
.
Female Sexual Interest/Arousal Disorder
A. Lack of, or significantly reduced, sexual
interest/arousal, as manifested by at least three of the
following:
1. Absent/reduced interest in sexual activity.
2. Absent/reduced sexual/erotic thoughts or
fantasies.
3. No/reduced initiation of sexual activity, and
4.
5.
6.
initiate.
Absent/reduced sexual excitement/pleasure
during sexual activity in almost all or all
(approximately 75%-100%) sexual encounters
(in identified situational contexts or, if
generalized, in all contexts).
Absent/reduced sexual interest/arousal in
response to any internal or external sexual/
erotic cues (e.g., written, verbal, visual).
Absent/reduced genital or nongenital sensations
during sexual activity in almost all or all
(approximately 75%-100%) sexual encounters
(in identified situational contexts or, if
generalized, in all contexts).
Erectile Disorder
A. At least one of the three following symptoms must
be experienced on almost all or all (approximately
75%-100%) occasions of sexual activity (in identified
situational contexts or, if generalized, in all contexts):
1. Marked difficulty in obtaining an erection
during sexual activity.
2. Marked difficulty in maintaining an
erection until the completion of sexual
activity.
3. Marked decrease in erectile rigidity.

Female sexual interest/arousal disorder
recurring inability to maintain adequate
lubrication
Female Orgasmic Disorder
A. Presence of either of the following symptoms and
experienced on almost all or all (approximately
75%-100%) occasions of sexual activity (in identified
situational contexts or, if generalized, in all contexts):
1. Marked delay in, marked infrequency of, or
absence of orgasm.
2. Markedly reduced intensity of orgasmic
sensations.
Premature (Early) Ejaculation
A. A persistent or recurrent pattern of ejaculation
occurring during partnered sexual activity within
approximately 1 minute following vaginal
penetration and before the individual wishes it.
(approximately 75%-100%) occasions of sexual
activity (in identified situational contexts or, if
generalized, in all contexts).
Delayed Ejaculation
A. Either of the following symptoms must be
experienced on almost all or all occasions
(Approximately 75%-100%) of partnered sexual
activity (in identified situational contexts or, if
generalized, in all contexts), and without the
individual desiring delay:
1. Marked delay in ejaculation.
2. Marked infrequency or absence of
ejaculation.


Sexual Pain Disorder
Genito-Pelvic pain/Penetration Disorder marked pain, anxiety, and tension associated
with intercourse for which there is no medical
cause
Vaginismus muscle spasm in the front of the
vagina that prevent the intercourse
pelvic muscles in the outer third of the
vagina undergo involuntary spasms when
intercourse is attempted
| Abnormal Psychology 20
.
Assessing Sexual Behavior
1. Interview- supported by numerous questionnaire
because patients may provide more information
on paper than in verbal interview
2. Thorough medical evaluation- to rule out variety
of medical conditions that can contribute to sexual
problems
3. Psychophysiological assessment- to directly
measure the physiological aspects of sexual
arousal.
Vaginal photoplethysmograph- smaller than a
tampon, inserted by the woman into her vagina.
Causes:
Biological predisposition and psychological factors
a. Neurological and other NS problems
b. Vascular Disease
c. Chronic illness
d. Prescription medication
e. Drug abuse, and alcohol
f. Distraction
g. Underestimates arousal
h. Negative thought processes
i.
Erotophobia sexuality can be negative and
somewhat threatening and the responses they
develop reflect this belief
j.
Negative experiences, such as rape
k. Deterioration of relationship
Treatment:
1. Education- ignorance of the most basic aspects of
the sexual response cycle and intercourse often
leads to long lasting dysfunction
2. Psychosocial treatments: SEX THERAPY
providing a brief, and reasonably successful
therapeutic program for sexual dysfunction.
Conducted over a 2-weeks period
Primary goal is to eliminate psychologically based
performance
3. Sensate and nondemand pleasuring-couples are
instructed to refrain from intercourse or genital
caressing and simply explore and enjoy each
4.
massaging or similar kinds of behavior.
Squeeze technique- penis is stimulating usually by
the partner, to nearly full erection. Partners firmly
squeeze the penis near the top where the head of
penis joins the shaft, which quickly reduces
arousal. Steps are repeated until eventually penis is
briefly inserted in the vagina without thrusting.
5.
6.
Explicit training in masturbatory procedureLifelong female orgasmic disorder
To treat vaginismus and pain related to
penetration in genital pelvic pain/ penetration
disorder, the woman and eventually the partner
gradually insert increasingly larger dilators at the
carried out in the context of genital and nongenital
pleasuring so as to retain arousal.
7. MEDICAL:
b. Viagra, Levitra and Cialis
c. Four most popular procedures:
A. Oral medication,
B. Injection of vasoactive substances directly into
the penis,
C. surgery and
D. Vacuum device therapy
8. Testosterone- treat erect dysfunction
9. Papaverine or prostaglandin- vasodilating drugs
that inject directly into the penis when they want
to have sexual intercourse.
10. Medical Urethral System for Erection (MUSE) a
soft capsule that contains papaverine inserted
directly into the urethra, somewhat painful, is less
effective than injections and remain awkward and
artificial enough to preclude wide acceptance
11. Penile Protheses- implants, good enough to
approximate normal sexual functioning.
12. Vacuum Device Therapy- creating a vacuum in a
cylinder and placed over the penis it draws blood
into the penos, which is then trapped by a specially
designed ring placed around the base of the penis.
| Abnormal Psychology 21
Paraphilic Disorder
| Abnormal Psychology 22
sexual arousal occurs almost exclusively in the context
of inappropriate objects or individuals
-
-
-
-
Types of Paraphilic Disorder
1) Fetishistic Disorder
sexual attraction to nonliving objects (1) an
inanimate object or (2) a source of specific tactile
stimulation such as rubber, particularly clothing
made out of rubber.
Over a period of at least 6 months, recurrent
and intense sexual arousal from either the use of
nonliving objects or a highly specific focus on
nongenital body part(s), as manifested by
fantasies, urges, or behaviors.
2) Voyeuristic Disorder
sexual arousal achieved by viewing unsuspecting
person undressing or naked
at least 6 months, recurrent and intense sexual
arousal from observing an unsuspecting person
who is naked, in the process of disrobing, or
engaging in sexual activity, as manifested by
fantasies, urges, or behaviors.
The individual has acted on these sexual urges
with a nonconsenting person, or the sexual urges
or fantasies cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
3) Exhibitionistic Disorder
-
-
to unsuspecting strangers
Over a period of at least 6 months, recurrent
and intense sexual arousal from the exposure of
manifested by fantasies, urges, or behaviors.
4) Transvestic Disorder
sexual arousal from Cross dressing
A. Over a period of at least 6 months, recurrent
and intense sexual arousal from crossdressing, as
manifested by fantasies, urges, or behaviors.
Autogynephilia arousal by thought/ images of self
as a FEMALE
5) Frotteuristic Disorder
grope in public places
at least 6 months, recurrent and intense sexual
arousal from touching or rubbing against a
nonconsenting person, as manifested by
fantasies, urges, or behaviors.
-
-
-
-
6) Sexual Sadism Disorder
sexual arousal associated with inflicting pain or
humiliation
at least 6 months, recurrent and intense sexual
arousal from the physical or psychological
suffering of another person, as manifested by
fantasies, urges, or behaviors.
7) Sexual Masochism Disorder
sexual arousal associated with experiencing pain
or humiliation
at least 6 months, recurrent and intense sexual
arousal from the act of being humiliated, beaten,
bound, or otherwise made to suffer, as
manifested by fantasies, urges, or behaviors.
8) Pedophilic Disorder
strong sexual attraction to children
at least 6 months, recurrent, intense sexually
arousing fantasies, sexual urges, or behaviors
involving sexual activity with a prepubescent
child or children (generally age 13 years or
younger).
The individual has acted on these sexual urges,
or the sexual urges or fantasies cause marked
distress or interpersonal difficulty.
The individual is at least age 16 years and at
least 5 years older than the child or children
in Criterion A.
9) Incest sexual attraction to family
members
Causes:
a. Preexisting deficiencies
b. Treatment received from adults during
childhood
c. Early sexual fantasies reinforced by
masturbation
d. Extremely strong sex drive combined with
uncontrollable thought processes
Treatment:
1. Covert sensitization repeated mental
reviewing of aversive consequences to
establish negative associations with behaviors
2. Relapse intervention therapeutic
preparation for coping with future situation
3. Orgasmic reconditioning pairing
appropriate stimuli with masturbation to
create positive arousal patterns
| Abnormal Psychology 23
4.
Medical drug that reduce testosterone to
suppress sexual desire; fantasies and arousal
return when drugs are stopped
Gender Dysphoria
–
incongruences and psychological distress and
dissatisfaction with the gender one has assigned at
birth (boy or girl)
Gender Dysphoria in Children (2 or 4 of age)
experienced/expressed gender and assigned
gender, of
, as
manifested by at least six of the following: (A
Strong.)
1. To be of the other gender or an insistence that
one is the other gender
2. In boys (assigned gender), a strong preference for
cross-dressing or simulating female attire: or in
girls (assigned gender), a strong preference for
wearing only typical masculine clothing and a
strong resistance to the wearing of typical
feminine clothing.
3. preference for cross-gender roles in make-believe
play or fantasy play.
4. preference for the toys, games, or activities
stereotypically used or engaged in by the other
gender.
5. preference for playmates of the other gender.
6. In boys (assigned gender), a strong rejection of
typically masculine toys, games, and activities
and a strong avoidance of rough-and-tumble
play; or in girls (assigned gender), a strong
rejection of typically feminine toys, games, and
activities.
7.
8. desire for the primary and/or secondary sex
gender.
Gender Dysphoria in Adolescents and Adults
experienced/expressed gender and assigned gender,
of at
as manifested by at
least two of the following:
1.
experienced/expressed gender and primary
and/or secondary sex characteristics (or in young
adolescents, the anticipated secondary sex
characteristics).
2.
secondary sex characteristics because of a
3.
4.
5.
6.
experienced/expressed gender (or in young
adolescents, a desire to prevent the development
of the anticipated secondary sex characteristics).
A strong desire for the primary and/or secondary
sex characteristics of the other gender.
A strong desire to be of the other gender (or
some alte
assigned gender).
A strong desire to be treated as the other gender
assigned gender).
A strong conviction that one has the typical
feelings and reactions of the other gender (or
assigned gender).
Transman / transwoman- if the natal sex is female/male
but the experienced gender is strongly male/female.
Posttrasition-if the individual made the transition to
full time living in their experienced gender and they are
preparing for, or have undergo sexual reassignment.
Intersexuality or hermaphroditism born with
ambiguous genitalia associated with documented
hormonal or other physical abnormalities.
Autogynephilia distinct subset of transwoman with
different pattern of development.
Causes:

Hormonal variation
| Abnormal Psychology 24

Gender nonconformity boys who behave in
feminine ways and girls who behave on
masculine ways
Treatment:

Sex reassignment surgery alter anatomy
physically to be consistent with gender
identity




removal of breasts or penis
genital reconstruction
Psychosocial intervention to change gender
identity
Gynecomastia (the growth of breast)
Elimination Disorder
Enuresis
–
when children repeatedly urinate in
inappropriate places
Involuntary in nature/ perceived by the
child as unavoidable
At least 2 times per week for 3 consecutive
months
Subtypes:
Nocturnal only (night)
Diurnal only (day)
Nocturnal and Diurnal (both)
Encopresis
–
repeatedly defecate in inappropriate places
At least once a month for 3 months
Subtypes:
With constipation and overflow
incontinence
Without constipation and overflow
incontinence
ADVERSE EFFECTS OF MEDICATION
Tardive Dyskinesia
Result in involuntary, repetitive body
movement; NEUROLOGICAL
Often in the lips, jaw, tongue can also affect
the arms, legs, fingers and toes
Purely medication is the main cause
Tardive Dystonia
A movement disorder characterized by
involuntary muscle contractions; MUSCULAR
Mostly inherited or acquired is the main cause
Tardive Akithisia
Subjective sense of inner restlessness leading
to inability to sit still and a compulsion to
move
Antidepressant Discontinuation Syndrome
Is a set of symptoms that may occur abruptly
stopping or great reduction of an
-
antidepressant medication that has been taken
continuous for at least 1 month.
Symptoms usually begin within 2-4 days
No symptom present prior to reduction of
antidepressant (SSRI or SNRI)
Flashes of light, electric shock sense, nausea,
hyper responses to noise/tight, anxiety,
feelings of dread, ringing in the ears, inability
to sleep
| Abnormal Psychology 25
Disruptive, Impulse Control and Conduct
Disorder
Problems in the self-control and behaviors
Oppositional Defiant Disorder frequent and
persistent pattern of:
Angry/Irritable mood (often loses temper,
often touchy or easily annoyed, often angry
& resentful)
Argumentative/ defiant behavior (often
argues w/ authority)
Vindictiveness (has been spiteful/
vindictive at least twice within the past 6
months)
At least 4 symptoms in any of the categories
At least 6 months (age 5 below most days, age 5
above at least 1 per week)
Intermittent Explosive Disorder
Recurrent behavioral outbursts/ impulsive
aggressive outburst typically last for less
than 30 mins. Occurred in response to
minor provocation by a close intimate or
associate
At least 6 years of age
Verbal aggression/ physical aggression
twice weekly for 3 months or behavioral
outbursts (destruction of property/ physical
assault in 12 months
Conduct Disorder
Repetitive and persistent pattern of
violating the basic rights of others, societal
norms or rules
For age 18 years below
At least 3 symptoms form 15 criteria
-
Occurring in the past for 12 months
At least 1 criterion for 6 months
Categories:
Aggressive to people/ animals
Destruction of property
Deceitfulness/ theft
Serious violation of rules
Antisocial Personality Disorder
Pyromania
–
multiple episodes of deliberate and
purposive fire setting
–
often in male
Kleptomania
–
recurrent failure to resist impulses to steal
items even though the items are not needed
for personal use or for their monetary
value.
–
Often in female
| Abnormal Psychology 26
Substance-Related and Addictive Disorder
SUBSTANCE-RELATED
Substance Use Disorder cluster of cognitive,
behavioral, and physiological symptoms indicating
that the person continues to pathologically use the
substance despite substance-related symptoms
Substance-Induced Disorder the development of a
reversible substance specific syndrome due to the
recent ingestion of a substance
Clinically significant changes involve
disturbances of perception, wakefulness,
attention, thinking, judgment, psychomotor
behavior and interpersonal behavior
Different substances;
1. Alcohol
2. Caffeine
3. Cannabis
4. Hallucinugen
5. Inhalant
6. Opiod
7. Sedative/ hypnotic/ anxiolytic
8. Stimulant
9. Tobacco
NON-SUBSTANCE RELATED
Gambling Disorder -4 or more symptoms occurring
anytime at 12 months
Persistent & recurrent problematic
gambling behavior leading to/ clinically
significant impairment
Distress
| Abnormal Psychology 27
-
-
Involves risking of something value in the
hopes of obtaining something of great
value
Often in male
Substance Abuse harmful or hazardous use of
psychoactive substances that are no legal usage
Substance Dependence persist to use despite problems
related to compulsive and repetitive use that may result in
tolerance and withdrawal symptoms
Substance Intoxication developing irreversible substance-specific syndrome due to recent ingestion of substance
Addiction having more symptoms, tolerance, withdrawal by using more than intended by trying unsuccessfully to
stop by having physical and psychological problems made worse
Tolerance indicated by larger doses of the substance being needed to produce the desired effect and becoming less
effect if using amount
Withdrawal the negative physical and psychological effects that develops when a person stop taking/ reduces the
amount
BIOLOGICAL FACTORS
DOPAMINE pro
(euphoria
Personality Disorders
| Abnormal Psychology 28
-
An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the
individual's culture 9pervasive and flexible) has onset in adolescence/ early adulthood, stable over time and
leads to distress or impairment
Cluster A Odd or Eccentric Disorders
1. Paranoid personality disorder
A pervasive distrust and suspiciousness of others
such that their motives are interpreted as
malevolent.
Are excessively mistrustful and suspicious of
others, without any justification.
Begins early adulthood (4 or more criteria)
TREATMENT
•
suspicion
•
Cognitive work to change thoughts
•
Low success rate
2. Schizoid personality disorder
A pervasive pattern of detachment from social
relationships and a restricted range of expression
of emotions in interpersonal settings.
Begins early adulthood (4 or more criteria)
*MALE
TREATMENT
relationships
ills training with role playing
3.
-
Schizotypal personality disorder
A pervasive pattern of social and interpersonal
deficits marked by acute discomfort with reduced
capacity for close relationships, as well as by
cognitive or perceptual distortions and
eccentricities of behavior.
People with schizotypal personality disorder are
typically socially isolated, like those with schizoid
personality disorder.
They also behave in ways that would seem
unusual to many of us, and they tend to be
suspicious and to have odd beliefs.
Begins early adulthood (5 or more criteria)
*MALE
TREATMENT
Treatment
•
Teaching social skills to reduce isolation
and suspicion
•
Medication (haloperidol) to reduce ideas of
reference, odd communication, and
isolation
•
Low success rate
Cluster B Dramatic, Emotional, or Erratic
Disorders
1. Antisocial personality disorder
A pervasive pattern of disregard for and violation
of the rights of others.
They perform actions most of us would find
unacceptable, such as stealing from friends and
family.
Begins age 15 evidence of Conduct Disorder
(3 or more criteria)
Callous and unemotional traits
*MALES
TREATMENT
•
Seldom successful (incarceration instead)
•
Parent training if problems are caught early
•
Prevention through preschool programs
2. Borderline personality disorder
A pervasive pattern of instability of interpersonal
relationships, self-image, affects, and control
over impulses.
Their moods and relationships are unstable, and
usually they have a poor self-image.
These people often feel empty and are at great
risk of dying by their own hands.
Begins early childhood (5 or more criteria)
*75% in FEMALES
TREATMENT
•
Dialectical behavior therapy (DBT)
Medication:
tricyclic antidepressants
minor tranquilizers
lithium
3. Histrionic personality disorder
A pervasive pattern of excessive emotion and
attention seeking.
Begins early childhood (5 or more criteria)
*more frequently in FEMALES
TREATMENT
•
Little evidence of success
•
Rewards and fines
•
Focus on interpersonal relations
-
| Abnormal Psychology 29
4. Narcissistic personality disorder
A pervasive pattern of grandiosity (in fantasy or
behavior), need for admiration, and lack of
empathy.
people who think highly of themselves perhaps
exaggerating their real abilities.
They consider themselves somehow different
from others and deserving of special treatment.
In Greek mythology, Narcissus was a youth who
spurned the love of Echo, so enamored was he of
his own beauty. He spent his days admiring his
own image reflected in a pool of water.
Begins early adulthood (5 or more symptoms)
TREATMENT
•
Cognitive therapy focus on the day-to-day
pleasurable experiences that are attainable
•
Teaching coaching strategies to use and
accept.
-
Cluster C Anxious or Fearful Disorders
1. Avoidant personality disorder
A pervasive pattern of social inhibition, feelings
of inadequacy, and hypersensitivity to negative
evaluation.
Their extremely low self-esteem, coupled with a
fear of rejection, causes them to be limited in
their friendships and dependent on those they
feel comfortable with.
Begins early adulthood (4 or more symptoms)
TREATMENT
•
Behavioral intervention techniques
sometimes successful
–
systematic desensitization
–
behavioral rehearsal
•
Improvements usually modest
2. Dependent personality disorder
A pervasive and excessive need to be taken care
of, which leads to submissive and clinging
behavior and fears of separation.
People with dependent personality disorder,
however, rely on others to make ordinary
decisions as well as important ones, which results
in an unreasonable fear of abandonment
Begins early adulthood 95 or more symptoms)
*FEMALES
TREATMENT
•
Very little research
•
Appear as ideal clients
•
Submissiveness negates independence
-
-
3. Obsessive-compulsive personality
A pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and
interpersonal control, disorder at the expense of
flexibility, openness, and efficiency.
People who have obsessive-compulsive
personality disorder are characterized by a
Begins early adulthood (4 or more symptoms)
*twice often in MALE
*control freaks
TREATMENT
•
Little information
•
Therapy
attack fears behind need
relaxation or distraction techniques redirect
compulsion to order
Acute Stress Disorder
Same w/ PTSD but in shorter duration
Lasting in 3 days up to 1 month after the
exposure
At least 8 months
5 Personality Traits
I.
Negative Affectivity
Anxiousness
Emotional lability
Hostility
Perseveration
Restricted (lack of) affectivity
Separation insecurity
Submissiveness
II. Detachment
Anhedonia
Depressivity
Intimacy avoidance
Suspiciousness
Withdrawal
III. Antagonism
Attention seeking
Callousness
Deceitfulness
Grandiosity
Manipulativeness
IV. Disinhibition
distractibility
Impulsivity
Irresponsibility
Rigid perfection
Risk-taking
V. Psychoticism
Eccentricity
| Abnormal Psychology 30
-
Perceptual dysregulation
Unusual beliefs and experience
Schizophrenia Spectrum and Other
Psychotic Disorders
-
Abnormalities in 1 or more of the following domain
POSITIVE SYMPTOMS comprise excesses and
distortions
1. Delusions fixed belief that are not amenable to
change in spite of conflicting evidence
2. Hallucinations perception like experiences
that occur without an external stimulus
3. Disorganized thinking/ speech problems in
organizing ideas and in speaking so that the
listener can understand.
GROSSLY DISORGANIZED. ABNORMAL MOTOR
BEHAVIOR
Catatonia severe motor abnormalities marked by
decrease reactivity to the environment
o negativism (resistance to instructions) to
maintain a rigid/ bizarre posture
o mutism/ stupor (complete lack of verbal and
motor responses
o catatonic excitement (purposeless and excessive
motor activity without obvious cause)
NEGATIVE SYMPTOMS behavioral deficits
- Avolition lack of motivation and seeming
absence of interest/ inability to persist in routine
activities
- Asociality severe impairment in social
relationships
- Anhedonia loss of interest/ decrease in
experiencing of pleasure either consummatory or
anticipatory
- Blunted Affect lack of outward expression of
emotion, face motionless, eyes lifeless
- Alogia significant reduction in the amount of
speech
Delusional Disorder presence of 1 month or for
longer
(Specifiers: Erotomatic, Grandiose, Jealous,
Persecutory, Somatic and Mixed)
Brief Psychotic Disorder disturbance that involves
sudden onset from non-psychotic state to clearly
psychotic state within 2 weeks
at least 1 positive symptoms or more negative
symptoms
duration of episode is at least 1 day but less than 1
month
Schizophreniform Disorder same with
schizophrenia but differ in duration
total duration is at least 1 month but less than 6
months
duration of episodes is more than 1 day but remits
by 1 month
2 conditions to diagnose 1) when episode of illness
2)
when symptomatic for less than 6 months duration
required for schizophrenia but not yet recovered.
Schizophrenia involve range of cognitive,
behavioral and emotional dysfunctions but no single
symptoms is pathogenic of the disorder
2 or more symptoms with at least 1 positive
symptoms
at least 6 months (slightly high in MALES)
| Abnormal Psychology 31
Schizoaffective Disorder delusions/ hallucinations
at least 2 weeks without Major episodes
uninterrupted period of illness which the individual
continues to display active/ residual symptoms of
psychotic illness.
inclusion of major mood episode (Major
Depression with Manic) concurrent with
schizophrenia (Criteria A) Criteria has not been met
Prodromal Phase
- Early symptoms gradually
appear to the person
- Lasts for weeks/ months
Active Phase
- Acute phase, wherein
patient is psychotic
Residual Phase
- active phase symptoms
subsides then returning of
symptoms similar to prodomal
phase
12 Psychomotor Features
1. Stupor
2. Catalepsy
3. Waxy flexibility
4. Mutism
5. Negativism
6. Posturing
7. Mannerism
8. Streatype
9. Agitation
10. Grimacing
11. Echolalia
12. Echopraxia
Biological factors
↑dopamine (psychosis) hallucination/delusions
↓dopamine antipsychotic (Neuroleptics)
*dopamine theory positive symptoms result decrease
volume of prefrontal cortex
- age 15-25 YEARS: schizophrenia for men are high
- age 40 YEARS: schizophrenia for women are high
Sociocultural Factors
Downward drift hypothesis fail to rise out of
a low socioeconomic because of illness
PHASES OF SCHIZOPHRENIA
SUBTEST OF SCHIZOPHRENIA
1.
2.
3.
4.
Paranoid Extreme suspicion/ persecution
Schizoaffective schizophrenia + major
mood disorder
Catatonic psychomotor activities
disturbances
Disorganized disordered thought, feelings,
emotions
| Abnormal Psychology 32
Neurodevelopmental Disorder
-
Characterize by developmental deficits that
produce impairment of personal, social, academic
or occupational functioning
INTELLECTUAL DISABILITIES
Intellectual Disability (Intellectual Developmental
Disorder) characterized by deficits in general
mental abilities (reasoning, problem-solving,
planning, abstract, thinking, judgment, academic
learning and learning from experience) *Males
Global Developmental Delay reserved for under
age 5 that cannot be reliably assesses/unable to
undergo. an individual fail to meet expected
developmental milestones in several areas of
intellectual functioning
Types and Levels of Intellectual Disabilities
1. Mild IQ (50-70) capable of functioning but slight
delay on learning to communicate
2. Moderate IQ (35-49) capable for simple and
basic activities but noticeable delays in learning
3. Severe IQ (20-34) capable of being taught in daily
routine activities but requires supervision/ directions
with noticeable motor movement
4. Profound IQ (20 below) slower and delayed in all
aspects, incapable of performing activities
COMMUNICATION DISORDERS
Language Disorder- difficulties in the acquisition
and use of language due to deficit in the
comprehension or production of vocabulary,
sentence structure and discourse (spoken, written or
sign language)
- Expressive Ability production of vocal, gestural
and/or verbal signs
- Receptive Ability process of receiving and
comprehending language messages
Speech Sound Disorder difficult in speech sound
production that interferes w/ speech intelligibility or
prevents verbal communication of messages
Childhood-Onset Fluency Disorder (Stuttering)
disturbance in the normal fluency and time pattern of
speech that is inappropriate in individuals age. 1 or
more criteria
Social (pragmatic) Communication Disorder
primarily difficulty w/ pragmatic or social use of
language and communication manifested by
deficits in understanding and following social rules
(verbal or nonverbal)
Autism Spectrum Disorder characterized by
persistent deficits in social communication and
interaction across multiple context that requires
presence of restricted, repetitive patterns of behavior,
interest or activities.
| Abnormal Psychology 33
Attention- Deficit Hyperactivity Disorder
persistent pattern of inattention/ hyperactivity,
impulsivity that interferes w/ functioning or
development 6 or more symptoms for at least 6
months Age 17 above = 5 or more symptoms
Inattention wandering off tasks, lacking
persistence/ focus, disorganized
Hyperactivity excessive motor activity when
it is inappropriate (fidgeting, tapping,
talkativeness)
Specific Learning Disorder abnormalities at a
cognitive level associated w/ behavioral signs of
disorder characterized by persistent and impairing
difficulties w/ learning foundation/ key stones
academic skills (reading, writing or math) at least 1
month or more symptoms for 6 months
Dyslexia difficulty in reading
Dyscalculia difficulty in math
Developmental Coordination Disorder
characterized by deficits in the acquisition and
execution of coordinated motor skills manifested
by clumsiness and slowness/ inaccuracy of
performance that interfere daily activities
Stereotypic Movement Disorder repetitive
seemingly driven and apparently purposeless motor
behaviors (hand flapping, body rocking, head
banging, self-biting, hitting) interfering social,
academic and other activities
TIC DISORDERS
- Rapid/ sudden/ recurrent nonrhythmic motor
movement or vocalization
multiple motor and vocal tics
that may wax and wane in frequency present both at
the same time more than 1 yr. since first tic onset
onset before 18 of age
Provisional Tic Disorder never met the criteria for
MOTOR DISORDERS
disorder
Persistent (chronic) Motor or Vocal Tic Disorder
single or multiple motor and vocal tics that may and
wane but not both motor and vocal occurs. more
than 1 year since first tic onset onset before 18 of
age
Specifiers: w/ Motor Tics only & w/ Vocal
Tics only
*TIC DISORDERS ARE COMMONLY IN MALES
| Abnormal Psychology 34
Neurocognitive Disorder
-
Cognitive function deficits that are acquired
rather than developmental
Delirium
out of track
- Clouded state of consciousness/ state of mental
confusion
- Disturbance of attention and awareness
accompanied by changed in baseline cognition that
cannot be better explained by preexisting or
evolving NCD

Questions must be repeated due to
attention wanders

Easily distracted by irrelevant stimuli

Manifested by reduced orientation to
environment and self
Cause by medical conditions
Common in children and older adults
Major Neurocognitive Disorder significant
cognitive decline from a previous level of
performance in 1 or more cognitive domain
- Tasks may only be completed with assistance or
may be abandoned altogether
- Low score for at least 2 different cognitive test
-
Mild Neurocognitive Disorder modest cognitive
decline from a previous level of performance in one
or more cognitive domains
- May view as normal for the elderly
- Require a low score on only 1 cognitive test
- Not all people develop to dementia, only 1% per
year
* common in children and older adults
COGNITIVE DOMAIN
I.
Complex Attention
Sustained attention
Divided attention
Selective attention
Processing speed
II.
Executive Function
Planning
Decision making
Working memory
Responding to feedback/ error correction
Overriding habits/ inhibition
Mental flexibility
III.
Learning and Memory
| Abnormal Psychology 35
-
Immediate memory
Recent memory (free call, recall, recognition)
Very long term (semantic, autobiographical,
implicit)
IV.
Language
Expressive language (naming, word finding,
fluency, grammar
Receptive language (comprehension)
V.
Perceptual Motor
Abilities subsumed under visual perception,
visuo-construct
VI.
Social Cognition
Recognition of emotions
Theory of mind
Physical Disorders and Health Psychology
PSYCHOLOGICAL AND SOCIAL FACTORS THAT
INFLUENCE HEALTH
Psychological, Behavioral, and Social Factors - Are
major contributors to medical illness and disease
Examples: Genital herpes, AIDS, cancer,
cardiovascular diseases
1.
2.
3.
(PHYSICAL DISORDERS) known physical causes
and mostly observable physical pathology.
(PHSYCHOSOMATIC MEDICINE) study of how
a psychological and social factor affects physical
disorders used to be distinct and somewhat separate
from the remainder of psychopathology.
(PSYCHOPHYSIOLOGICAL DISORDER) used to
communicate a similar idea.
Psychosocial factors directly affect physical health
Psychological and Social Factors that Influence Health
(continued)
DSM-IV-TR and Physical Disorders
Coded on Axis III
Recognize that psychological factors affect medical
conditions
-
Psychological Approaches to Health and Disease
-
Behavioral medicine Study of factors affecting
medical illness
Health psychology Promotion of health
HOW DO PSYCHOLOGICAL AND SOCIAL
FACTORS INFLUENCE MEDICAL ILLNESS?
| Abnormal Psychology 36
Two Primary Paths
1. Psychological factors can influence basic biological
processes that lead to illness and disease.
2. Long-standing behavior patterns may put people
at risk to develop certain physical disorders.
– AIDS is an Example of Both Forms of
Influence
– Leading Causes of Death in the U.S.
o 50% are linked to lifestyle and
behavior patterns
OVERVIEW OF STRESS AND THE STRESS
RESPONSE
Nature of Stress
o Stress Physiological response of an
individual
o Stressor Event that evokes stress response
o Stress responses vary from person to person
o Stress Physiology
The Stress Response and the General Adaptation
Syndrome (Sustained Stress)
1.
Phase 1 Alarm response to immediate danger
or threat (sympathetic arousal)
Phase 2 Resistance (mobilized coping and
action mechanisms to stress)
Phase 3 Exhaustion (chronic stress, permanent
damage)
2.
3.
PHYSIOLOGY OF STRESS
The Biology of Stress
– Activates the sympathetic branch of the ANS
– Neuromodulators and neuropeptides act like
neurotransmitters
– Activates the HPA axis, producing cortisol
– The relation between the hippocampus and
HPA activation
The Function of the Hippocampus in HPA-Stress
Response Cycle
–
–
–
–
–
Part of the limbic system
Highly responsive to cortisol
Hippocampus helps to turn off the HPA cycle
Chronic stress may damage cells in the
hippocampus
Damage to hippocampal cells interferes with
stopping the HPA loop
PSYCHOLOGICAL AND SOCIAL FACTORS: THEIR
RELATION TO STRESS PHYSIOLOGY
Primate Research: High and Low Social Status
–
High cortisol is associated with low social
status
Low social status Fewer lymphocytes and
immune suppression
Dominant males benefit from predictability
and controllability
–
–
Vulnerabilities in Mental Illness Contribute to
Physical Illness
–
–
Stress
Perceived uncontrollability, low social
support, negative affect
Interpretation of Physiological Response and Situation
–
–
Seems critical in the stress response
The role of self-efficacy
STRESS AND THE IMMUNE SYSTEM
Immune system- protects the body from foreign
materials that may enter it, including cold viruses.


Depression lowers immune system
functioning (older adults)
Optimism & positive affect Stronger
immune system
How Immune System work?
1. Eliminates foreign materials called
ANTIGENS (bacteria, viruses or parasites)
2. Divisions of the Immune System
a. Humoral branch
i. Blood and other bodily fluids
b. Cellular branch
i. Protects against viral and parasitic
infections
Function of the Immune System
 Identify and eliminate antigens from the
body
 Leukocytes (White Blood Cells) are the
primary agents
LEUKOCYTES: Subtypes and Functions
a.
i.
Macrophages
First line of defense, destroy antigens, signal
lymphocytes
| Abnormal Psychology 37
LYMPHOCYTES
a. B cells (humoral branch) releasing molecules
that seek antigens in blood and other bodily
fluids with purpose of neutralizing them
b. B cells produce highly specific molecule called
IMMUGNOGLOBIN act as antibodies,
combine with the antigens to neutralize.
c. Memory B cells are created so that the next
time that the antigen is encountered, the
immune system response will be even faster.
d. Functional role of B and T cells and associated
memory cells
e. T cells (cellular branch
antibodies.
f. Killer T cells directly destroy viruses and
cancer cells.
g. Memory T cells are created to speed future
responses to the same antigen.
h. T4 cells (Helper T cells) enhance the immune
system response by signaling B cells to
produce antibodies and telling other T cells to
destroy the antigen.
i.
Autoimmune disease such as Rheumatoid
arthritis, over reactive and may attack the
ens.
j.
Psychoneuroimmunology or PNI object of
study is psychological influences on the
neurological responding implicated in our
immune response.
The Development and Course of AIDS
 Influenced by psychological, behavioral, and
social factors
CANCER: PSYCHOLOGICAL AND SOCIAL
INFLUENCES
Oncology- Study of cancer
Psychoncology - Study of psychological factors and their
relation to cancer
Psychological and Behavioral Contributions to Cancer
 Perceived lack of control
 Inadequate or inappropriate coping responses
(e.g., denial)
 Overwhelming stressful life events
 Life-style risk behaviors
 Psychological factors also are involved in
chemotherapy
Cancer is influenced by Psychological, Behavioral,
and Social Factors
CARDIOVASCULAR PROBLEMS:
HYPERTENSION
Cardiovascular System
 Heart, blood vessels and complex control
mechanisms for regulating function
Hypertension High Blood Pressure

Psychosocial Effects on Physical Disorders
ACQUIRED IMMUNODEFICIENCY VIRUS
(AIDS)

Nature of AIDS
o
o

o
o
Course from HIV to full blown AIDS is variable
Median time from initial infection to full-blown
AIDS?
7.3 to 10 years or more
Stress of getting an AIDS diagnosis can be
devastating
AIDS-related complex (ARC) after several
months to several years with no symptoms,
patients may develop minor health problems
such as weight loss, fever and night sweats.
Role of Stress Reduction Programs
 Higher stress and low social support speed
disease progression
 Reduce stress, improve immune system
functioning




Major risk factor for stroke, heart disease, and
kidney disease
Blood pressure increases when the blood vessels
leading to organs and peripheral areas constrict
(become narrower) forcing increasing amounts
of blood to muscles in central parts of the body.
Causes wear and tear of the blood vessels
Essential hypertension is the most common
form
Sytolic Blood Pressure- pressure when the heart
is pumping blood.
Diastolic Blood Pressure- pressure between
beats when the heart is at rest.

Contributing Factors and Associated Features
 Affects 20% of all adults (between ages of 25 and
74)
 African Americans are most at risk
 Affected by salt, fluid volume, sympathetic
arousal, and stress
 Psychological contributors include anger and
hostility
| Abnormal Psychology 38
Pain: Some Clinical Distinctions
Influenced by Psychological, Behavioral, and Social
Factors
Subjective vs. overt behavioral
manifestations of pain
CARDIOVASCULAR DISEASES: CORONARY
HEART DISEASE (CHD)
Coronary Heart Disease (CHD)- Blockage of the
arteries supplying blood to the heart muscle (
MYOCARDIUM)
Angina pectoris: Chest pain from partial obstruction of
the arteries
Atherosclerosis: Accumulation of artery plaque (i.e., fatty
substances)
Ischemia: Deficiency of blood supply because of too
much plaque
Myocardial infarction: Heart attack involving death of
heart tissue
Psychological and Social Factors in Chronic Pain

Perceived control over pain and its
consequences

Negative emotion, poor coping skills

Low social support, compensation

Social reinforcement for pain behaviors
MECHANISMS OF PAIN EXPERIENCE AND PAIN
CONTROL
Gate Control Theory: nerve impulses from painful
stimuli make their way to the spinal column and
from the brain.
Dorsal Horns of the Spinal Column: acts as a gate
and may open and transmit sensations of pain if the
stimulation is sufficiently intense.
Psychological and Behavioral Risk Factors for CHD
 Stress, anxiety, anger,
 Poor coping skills
 Low social support
 Lifestyle factors (e.g., smoking, diet, exercise)
Classic Type A Behavior Pattern
 Anger and negative affect
 Impatience, accelerated speech and motor
activity
Classic Type B Behavior Pattern
 Relaxed, less concerned about deadlines and
seldom feels the pressure or excitement of
challenges or overriding ambition.
CHD Is Influenced by Psychological, Behavioral,
and Social Factors
CHRONIC PAIN
Two Kinds of Clinical Pain


Acute pain- follows an injury and disappears
once the injury heals or effectively treated, often
within a month.
chronic pain- may begin with an acute episode
but does not decrease over time, even when the
injury has healed or effective treatments have
been administered

to it
-
Small Fibers: A-Delta and C fibers
Large Fibers: A-Beta fibers
THE ROLE OF ENDOGENOUS (Natural) OPIODS
-
the neurochemical means by which the brain
inhibits pain is an important discovery
drugs such as heroin and morphine are
manufactured from opioid substances.
Exist within the body
Endorphins (shut down pain even in the presence
of marked tissue damage or injury.) and
encephalin.
CHRONIC FATIGUE SYNDROME:
PSYCHOLOGICAL, BEHAVIORAL, AND SOCIAL
INFLUENCES
Nature of Chronic Fatigue (CF)




Lack of nerve strength, marked fatigue, pain, lowgrade fever
Most common in females
Incidence increasing in Western countries
Unrelated to viral infection, immune problems,
depression
| Abnormal Psychology 39
Speculation About Causes
 High-achievement oriented lifestyle
 Fast paced lifestyle combines with stress and
illness
 Psychological misinterpretation of consequences
of illness
Treatment
 Medications are ineffective
 Cognitive-behavioral interventions appear
promising
PSYCHOSOCIAL TREATMENT OF PHYSICAL
DISORDERS
SUMMARY OF PHYSICAL DISORDERS AND
HEALTH PSYCHOLOGY
Psychological Factors Play a Major Role in Physical
Disorders
o
Behavioral medicine and health
psychology
Psychological and Social Factors: Their Role in
Illness and Disease
o
o
Stress, immune function, and disease
Such influences interact with other
psychosocial factors
Biofeedback: An Overview

Patient learns to control bodily responses

Used with chronic headache and
hypertension
Risk for Physical Illness
o Related to long-standing patterns of
behavior & life-style factors
Relaxation and Meditation

Progressive muscle relaxation

Transcendental meditation (TM)
Psychosocial Treatments
o Aim to prevent and/or treat physical
disorders
o Comprehensive individual or community
programs are best
Comprehensive Stress Reduction and Pain
Management Programs


Own stress- management program
More effective and durable than
individual interventions alone
Modifying Behaviors to Promote Health
Life-Style Practices Core of Many Health Problems

Behavioral risk factors are also influenced
by psychosocial factors

Prevention and intervention programs
target behavioral risks
Types of Life-Style Behaviors

Injury and injury prevention: Repeated
warnings are not enough



AIDS: Highly preventable by changing
behaviors
Smoking in China: Children intervene
in smoking. They wrote letters to their
father asking them to quit smoking and
they submitted monthly reports on their
fathers smoking habits to the school.
Stanford three community study: Diet,
exercise, promotion of health and
wellness