Abnormal Psychology A.K.A. Psychological Disorders A “harmful dysfunction” in which behavior is judged to be atypical, disturbing, maladaptive and unjustifiable. Hmmmm…… How To Vote via Texting 1. Standard texting rates only (worst case US $0.20) TIPS 2. We have no access to your phone number Investigating abnormal behavior – our first questions: • To identify the criteria for judging whether behavior is psychologically disordered. • Describe the medical model of psychological disorders, and discuss the bio-psycho-social perspective offered by critics of this model. Activity 1.1 Write down three criteria you believe could be used to define abnormal behavior Use the prompt: “Behavior might be considered psychologically disordered if it is …” Brainstorm and reach consensus Let’s take a look - Scene 1 Denise ignored the reports to buy bottled water, canned food, plastic sheeting and duct tape after hearing that there was an increased threat of terrorism in the Us, despite the fact that she had time and money to purchase these. Scene 2 Steve is passionate in his belief that animals should not be used in research. He has devoted his life to the cause. Last week, he bombed the administrative office of a pharmaceutical company that is known to perform animal research. Four people were injured in the explosion and one died. Scene 3 Joanna’s mother died suddenly three weeks ago. She was numb for about a week, but now is overwhelmed by sadness. She has not gone back to work yet because she cannot get herself out of bed in the morning. She eats very little and feels scared that she will not be able to cope with future challenges. Psychological behaviors run a continuum from very mild to extreme. Everyone has these behaviors to one degree or another. It is not until a behavior or feeling interferes with your quality of life that they become a disorder. Psychologically disordered behavior involves that behavior which is atypical, disturbing to oneself and/or others, maladaptive and not justifiable to oneself or to others. Abnormal Behavior: Three Criteria Behavior that deviates from the norm or that is atypical. Hearing voices. Men who wear women’s clothing for sexual arousal. Behavior that is maladaptive, disrupting job or family. Alcoholism. Drug addiction. Behavior that causes personal distress or pain. Depression. Anxiety. Psychological Disorder A “harmful dysfunction” in which behavior is judged to be atypical, disturbing, maladaptive and unjustifiable. What is abnormal, disturbing maladaptive and unjustifiable depends on: •Culture •Time Period •Environmental Conditions •Individual Person What is “well-being” Defining Psychological Well-Being Carol Ryff – must define well-being in the positive – following are six core dimensions of well-being: Self – acceptance: Positive attitude toward the self but acknowledges and accepts multiple aspects of the self Positive relations with other people – capable of empathy, affection, and intimacy, and are concerned about the welfare of others Autonomy – independent, self-determining, and self-controlled Environmental mastery – sense of mastery and competence in managing the environment – able to choose or create contexts that are supportive of their personal needs or values Purpose in life – has both goals and a sense of directedness – feels that there is meaning to present and past life and holds beliefs that give life purpose Personal Growth – see themselves as growing and expanding – open to new experiences – have a sense of realizing their potential Early Theories Afflicted people were possessed by evil spirits. Early Theories Music or singing was often used to chase away spirits. •In some cases trephening was used: Cutting a hole in the head of the afflicted to let out the evil spirit. Trephening Early Theories Another theory was to make the body extremely uncomfortable. History of Mental Disorders In the 1800’s, disturbed people were no longer thought of as madmen, but as mentally ill. They were first put in hospitals. Did this mean better treatment? Early Mental Hospitals They were nothing more than barbaric prisons. •The patients were chained and locked away. •Some hospitals even charged admission for the public to see the “crazies”, just like a zoo. Philippe Pinel French doctor who was the first to take the chains off and declare that these people are sick and “a cure must be found!!!” Somatogenic At this time- it was believed that mental illness had a bodily cause- Somatogenic. But Somatogenic could not explain disorders such as hysteria (now called conversion disorder). Many disorders are psychogenic: the origin is psychological, not physical. Current Perspectives Biological Perspective: psychological disorders are sicknesses and can be diagnosed, treated and cured. Current Perspectives Bio-Psycho-Social Perspective: assumes biological, psychological and sociocultural factors combine to interact causing psychological disorders. Used to be called Diathesis-Stress Model: diathesis meaning predisposition and stress meaning environment. Classifying Psychological Disorders DSM-IV: Diagnostic Statistical Manual of Mental Disorders: the big book of disorders. Two Major Classifications: Preview Basic Issues of Mental Disorders • Sex/culture differences in diagnosis • Diagnostic issues Perspectives to study mental disorders The idea of multiple causation Basic Issues of Mental Disorders Culturally and Gender specific Behavior is culturally dependent Hissing is a polite way to show respect for superiors in Japan Face-to-face conflict is avoided in Thailand – better to say “Why don’t you go see your house?” Thailand – polite way to say “no” is to giggle New Guinea – a man is considered “abnormal” if he has not engaged in homosexual behavior before marriage In societies where hunger is endemic, fat women are viewed as much more attractive than slender ones. India – by leaving some food on the plate, a guest indicates the generosity of the host who has so much food out it can’t be finished Thailand – public displays of affection between men and women are unacceptable – interestingly, men holding hands is considered a sign of friendship. Latin cultures – children, especially girls, are socialized to value conformity to social norms – rebelliousness and delinquency are rare Mexican adolescents will be reluctant to engage in any activity that might bring shame to their family. Behavior is gender dependent Men more likely to hiccup More boys than girls sleepwalk A man’s hands are usually warmer – women’s blood vessels are more expandable – body can accept 40% more blood during pregnancy with no blood pressure increase A woman’s forehead is more liekly to feel warm – however, at ovulation her temp increases about 1 degree and remains there for 12-14 days prior to menstuation Woman’s armpits are smellier Men perspire most heavily on upper chest Women smell, taste, and hear better – increases as estrogen increases, peaking at ovulation Men more likely to wake at night with a stomach- ache – 2 to 1 Men – more sleep apnea Men – more sneezing Who’s heart will still be beating when it’s 78 years old? Women – life expectancy is 79.5 vs 74.1 Perspectives on Mental Disorders Sociocultural Perspective larger culture important to development of mental disorders supporting evidence from culturebound syndromes Anorexia and Bulimia in North America and Western Europe Sociocultural: culture-bound syndromes Susto Found mostly in Latin America Marked by severe anxiety, restlessness, depression, loss of weight, weakness, rapid heartbeat and a fear of black magic Most likely to occur in infants and young children Claim that it is caused by contact with supernatural beings or with frightening strangers, or even by bad air from cemeteries Treatment involves rubbing certain plants and animals against the skin Sociocultural: culture-bound syndromes Latah Occurs among uneducated middle-aged or elderly women in Malaya Unusual circumstances (such as hearing someone say “snake” or even being tickled) produce a fear response that is characterized by repeating the words and actions of other people, uttering obscenities, and acting the opposite of what other people ask Sociocultural: culture-bound syndromes Koro Pattern of anxiety found in Southeast Asian men Involves the intense fear that one’s penis will withdraw into one’s abdomen, causing death Caused by an imbalance of ‘yin’ and ‘yang’ Treatment involves keeping a firm hold on his penis (often with the assistance of family members) until the fear subsides Another treatment involves clamping the penis to a wooden box Sociocultural: culture-bound syndromes Amok Found in the Philippines, Java, and certain parts of Africa occurring more often in men than in women Those suffering the affliction jump around violently, yell loudly, and attack objects and other people Symptoms preceded by social withdrawal and a loss of contact with reality The outburst is often followed by depression, then amnesia Thought that stress, shortage of sleep, alcohol consumption, and extreme heat are the primary causes Sociocultural: culture-bound syndromes Winigo Intense fear of being turned into a cannibal by a supernatural monster Once common among Algonqauin Indian hunters Characterized by depression, lack of appetite, nausea, and sleeplessness Could be brought on by coming back from a hunting expedition empty-handed Some afflicted hunters did kill and eat ,members of their own households Perspectives School or Perspective Cause of Disorder Psychoanalytic/Psychody namic Internal, unconscious conflicts Behavioral Reinforcement history/ the environment Biomedical Organic problems, biochemical imbalances, genetic predispositions Cognitive Irrational, dysfunctional thoughts or ways of thinking Humanistic Failure to strive towards one's potential or being out of touch with one's feelings Sociocultural Dysfunctional society Case Study - Anne Read your case study Discuss with a partner Share with class Mental Disorders, Basic Concepts “Mental Disorder” controversy Symptom vs. Syndrome symptom: individual characteristic of thought, feelings, behaviors syndrome: constellation of symptoms an individual shows Syndrome clinically significant detriment internal source of distress involuntary manifestation Issues with Diagnosis reliability: individual diagnosticians reach the same conclusions using the same system DSM-IV: observable characteristics to maximize reliability validity: the extent to which the system’s categories are clinically meaningful Labeling people The Legal Notion of Insanity: Insanity is a legal term with three meanings: (1) Insanity as a criminal defense. Cannot control behavior or understand its meaning. Alternative: Guilty but Mentally Ill. (2) Insanity as incompetence to stand trial. Not able to participate in own defense. (3) Insanity as a condition of involuntary commitment. A danger to oneself or others. Perspectives on Mental Disorders Biopsychological Perspective mental disorders as physical diseases – focus on symptoms The perspective has gained credibility from recent discoveries that genetically influenced abnormalities in brain structure and biochemistry contribute to a wide range of disorders, including schizophrenia, depression, and anxiety disorders. chemical imbalances – impacted by medicene birth difficulties heritability Perspectives on Mental Disorders Psychodynamic Perspective Sigmund Freud Unconscious conflicts and drives over aggressive or sexual impulses Early childhood trauma therapy helps person become aware of underlying conflicts Currently practiced to a lesser extent Perspectives on Mental Disorders Cognitive Perspective conscious thoughts learned maladaptive thought patterns cause mental disorder Behavioral Perspective learned maladaptive patterns of behavior cause mental disorder Multiple Causation Predisposing causes High Amount of stress in place before onset make person susceptible inherited characteristics learned beliefs sociocultural beliefs Disorder manifested Disorder not manifested Low Low High Predisposition for the disorder Multiple Causation Precipitating causes High Amount of stress immediate events that bring on the disorder (stress) loss (e.g., loved one, job) perceived threat when predisposition high, precipitating event may be small Disorder manifested Disorder not manifested Low Low High Predisposition for the disorder Multiple Causation Maintaining causes consequences of the disorder keep disorder going once it begins sometimes positive consequences (e.g., extra attention) often negative consequences (e.g., lack of friends) Sex Differences in Prevalence Large sex differences in prevalence Differences in Reporting men report less psychological distress than women don’t admit distress? Physiological vs. psychological distress tradeoff? Men use more alcohol and drugs men seem to express anger more than distress Issues with Diagnosis reliability: individual diagnosticians reach the same conclusions using the same system DSM-IV: observable characteristics to maximize reliability validity: the extent to which the system’s categories are clinically meaningful Labeling people DSM IV A. Published by the American Psychiatric Association, the DSM-IV, as it is known, is a widely used diagnostic classification system. It provides a set of criteria which allows diagnosticians to make assessments. B. The diagnostic system is based on five axes which are used by clinicians to provide a complete diagnosis. 1. Axis l includes 16 major categories of adult psychological disorders, such as mood disorders and schizophrenic disorders. 2. Axis 2 includes the personality disorders and developmental disorders. 3. Axis 3 includes medical conditions that might affect or interact with the client’s psychological disorder, such as hypothyroidism or headaches. 4. Axis 4 is a rating of recent social and environmental sources of stress, such as a death in the family or chronic unemployment. 5. Axis 5 is a Global Assessment of Functioning (GAF) made on a scale that ranges from 1 to 100, where 100 represents unimpaired function and 1 represents severe dysfunction 6. An example of how a therapist might make a complete DSM multiaxial diagnosis is: a) Axis 1: alcohol dependence b) Axis 2: dependent personality disorder c) Axis 3: diabetes d) Axis 4: death of spouse; unemployment e) GAF = 60 (moderate symptoms, e.g., occasional panic attacks or moderate difficulty in social, occupational, or school functioning) Criticism of DSM IV 1. The system relies heavily on the medical perspective. 2. Reliability in diagnosis remains a problem; psychological disorders have "fuzzy borders." Different disorders share certain characteristics, for example, and a person might exhibit some, but not all, characteristics of a particular disorder. Bias in Diagnosis Diagnosed as histrionic personality Diagnosed as antisocial personality diagnose men with “male” disorders and women with “female” disorders Ford & Widiger (1989) antisocial = “male” disorder histrionic = “female” disorder Differences in Experiences Men & women have different social experiences Women abuse from spouses abuse in childhood traditional roles As employment for genders becomes more similar, gender gap in some disorders decreases End Dissociative and Personality Disorders Dissociative amnesia (psychogenic) Lose memory for distant and recent Lose personal identity – general knowledge remains intact No anterograde amnesia Often reverses itself abruptly Dissociation Incapacity to integrate one’s thoughts, feelings or experiences into one’s present consciousness The Curious Experiences Survey – measures self reported Dissociative experiences. Total your score Range from 17 – 85 – higher means more experience with dissociation Three factors in dissociation: Depersonalization Self-absorption Amnesia Dissociative Disorder Interview Schedule Have you ever walked in your sleep? Did you have imaginary playmates as a child? Were you physically abused as a child or adolescent? Were you sexually abused as a child or adolescent? Have you ever noticed that things are missing from your personal possessions or where you live? Have you ever noticed that things appear where you live, but you don’t know where they cam from or how they got there? Do people ever talk to you as if they know you but you don’t know them, or only know them faintly? Do you ever speak about yourself as “we” or “us”? Do you ever feel that there is another person or persons inside you? If there is another person inside you, does he or she ever come out and take control of your body? Personality Disorders Important: Strictly for research, not clinical diagnosis. Score one for every true Used in a study of risk taking: 8.33 for residents in long-term drug rehap 6.06 for skilled rock climbers 5.15 for Police officers/fire fighters commended for bravery Major Depressive Disorder Reverse responses to 2, 5, 6, 11, 12, 14, 16, 17, 18, and 20. (1=4, 2=3, 3=2, 4=1) Add all numbers Range from 20 – 80 50-59 – suggest mild to moderate depression 60 – 69 indicate moderate to severe depression >70 – severe depression College Especially prone to depression – experience all the stress transitions simultaneously Lose family Lose friends Lose familiar surroundings Equally able students Suicide Unendurable psychological pain Frustrated psychological needs The search for a solution An attempt to end consciousness Helplessness and Hopelessness Constriction of options Ambivalence Communication of intent Departure Lifelong coping patterns • It is estimated that depression increases the risk of a first suicide attempt by at least 14-fold. • Over half of all kids who suffer from depression will eventually attempt suicide at least once, and more that seven percent will die as a result. • Four times as many men commit suicide than women, but young women attempt suicide three times more frequently than young men. • Fifty-three percent of young people who commit suicide abuse substances. • Firearms are used in a little more than half of all youth suicides. Close-up Extension: Self Mutilation Reverse 2, 3, 5, 7, 9, 11, 13, 17, 22 Add all numbers Range from 24 – 120 Higher – more positive emotional investment in one’s body Higher scale report higher self-esteem as well as having experienced greater maternal care – more likely to indicate a capacity to enjoy sensual and bodily pleasures Body Image Feelings and Attitudes # 5, 10, 13, 16, 17, and 21 Comfort in Physical Contact with Oters #2, 6, 9, 11, 20, and 23 Concern for Body Care #1, 4, 8, 12, 14, and 19 Investment in body Protection #3, 7, 15, 18, 22, and 24 Self Mutilation 2 million self-mutilators – vast majority women Typically begin as teenagers Princess Diana brought attention to the disorder Some suicidal, most do it to cope with stresses Many sexually abused as children learning to shield themselves by dissociating Almost all – grew up with poor communication between parent and child Schizophrenia Schizophrenia literal translation “split mind” a group of severe disorders characterized by: disorganized and delusional thinking disturbed perceptions inappropriate emotions and actions Schizophrenia Delusions false beliefs, often of persecution or grandeur, that may accompany psychotic disorders Hallucinations sensory experiences without sensory stimulation Psychosis refers to a general lack of contact with reality Schizophrenia form of psychosis involving disorders of perception language thought emotion behavior Schizophrenia Symptoms Perceptual Symptoms Sensory filtering & perception impaired Hallucinations - perceptions without sensations Language and Thought Disturbance Word salad: jumbled speech Delusions - mistaken beliefs maintained despite contrary evidence Paranoid Persecution Schizophrenia Symptoms Emotional Disturbance Behavioral Disturbance Unusual actions that have meaning to the person Catalepsy immobile stance (like a statue) Waxy Flexibility Refusal to communicate with others Classification of Schizophrenia 1. Positive symptoms involve distorted or excessive mental activity Delusions, hallucinations,altered emotions, erratic behaviors Positive symptoms occur during acute episodes 2. Negative symptoms involve behavioral and mental deficits Flattened emotions, social withdrawal Negative symptoms are chronic 3. Disorganization of behavior Biological Views of Schizophrenia Genetics: 43 to 83% concordance (identical twins) Neurotransmitters: Dopamine activity excessive in the schizophrenic brain Brain damage: enlarged ventricles are evident in schizophrenia A common finding in the brains of people with schizophrenia is larger than normal lateral ventricles. Heritability of Schizophrenia Biological Views of Schizophrenia Genetics: 43 to 83% concordance (identical twins) Neurotransmitters: Dopamine activity excessive in the schizophrenic brain Brain damage: enlarged ventricles are evident in schizophrenia Decreased frontal and temporal lobe activity Other potential causes… A common finding in the brains of people with schizophrenia is larger than normal lateral ventricles. Psychosocial Theories of Schizophrenia Stress – Diathesis-stress model Genetic predisposition + overwhelming stress Family communication Schizophrenia Schizophrenia Understanding Schizophrenia Triggering experiences, genes predispose but some react to traumatic triggers by developing schizophrenia. Biochemical: 6 times the normal amount of dopamine receptors that increase brain activity to manic levels. Thus dopamine blockers reduce symptoms. Dopamine-blocking drugs have little impact on persistent negative symptoms It is also thought to perhaps be triggered or caused by the introduction of a prenatal virus that affects brain development, possibly in the thalamus. People conceived in Winter months are more apt to develop schizophrenia in Northern hemisphere, while the reverse is true in the Southern. Abnormal brain activity – low in frontal lobes Studies have found enlarged, fluid-filled areas Genetic Factors Definite genetic link: the closer you are genetically to someone with Schizophrenia, the more likely you are to get it. 1 in 100 people get it. 1 in 10 of siblings 1 in 2 identical twins, even if raised apart Psychological Factors Genetically predisposed physiological abnormalities do not, by themselves, cause schizophrenia, neither do prenatal and psychological factors alone MAYBE, in conjunction, there are psychologial triggers As the bio-psycho-social perspective emphasizes, the traffic runs both ways.