Abnormal Psychology
Mental Disorder:
*Significant impairment in psychological functioning
*Lose the ability to adequately control thoughts, behaviors, or
feelings interrupts daily functioning
DSM-IV – Diagnostic and Statistical Manual
*A medical book and model used to classify of psychological disorder
*A guidebook for mental health professionals
FYI: There are copies of the DSM in our Public Library. You can
not check it out and take it home, but you can peruse it while
spending time in there.
*Contains roughly 400 disorders
*This year is a transition year in the world of Psych= The new,
updated DSM-V is currently being adopted by medical
professionals
DSM – I = 1952
DSM III = 1987 DSM V = 2013
DSM –II = 1968
DSM IV = 1994
The DSM is a living document that has changed several times over the decades to
reflect new research and ongoing psychiatric practice. The criteria were changed to
improve the accuracy of the diagnoses and to allow clinicians the ability to describe
specific symptoms seen in individuals.
The American Psychiatric Association assembled this committee of experts to
consider revisions to the current definitions of disorders that reflect advances in
research since the DSM-IV criteria were created. The committee solicited and
integrated input from the community, including families and people on the
spectrum, scientists and clinicians, and advocacy organization. The goal was to
overcome inconsistencies and improve reliability in how disorders are diagnosed.
*Axis I (Clinical Syndromes) –
*disorders usually first diagnoses in infancy, childhood, or
adolescence
*contains all the major disorders including:
anxiety, psychotic (schizophrenia), mood, dissociative
(“multiple personalities”), somatoform, sexual, sleep, impulse
control, factitious, substance related (the most common
diagnosis), and organic mental disorders
1)Organic psychosis:
• Psychosis caused by brain injury (gunshot wound)
or disease effecting the brain
• Dementia:
• Most common organic psychosis; serious mental
impairment in old age caused by brain deterioration
• Alzheimer’s Disease:
• Symptoms include impaired memory, confusion, and
progressive loss of mental abilities
2)Functional psychosis
• Based on unknown causes or psychological factors
*Axis II - includes Pxy disorders, Developmental Problems &
Mental Retardation
Narcissistic Pxy, ADHD, Tic disorder, Anorexia are
examples
*Insurance providers requires medical professionals to
classify, diagnose and code a patients mental illness before
payments made = main purpose of DSM
Axis III: Physical Conditions which play a role in the
development, continuance, or exacerbation of Axis I and II
Disorders
 Physical conditions such as brain injury or HIV/AIDS that
can result in symptoms of mental illness are included here.
Axis IV: Severity of Psychosocial Stressors
 Events in a persons life, such as death of a loved one,
diagnosis with illness, starting a new job, college,
unemployment, and even marriage can impact the
disorders listed in Axis I and II. These events are both
listed and rated for this axis.
Axis V- GAF scale
The Global Assessment of Functioning Scale
pg 561 AP textbook
The GAF is a 100-point tool rating overall
psychological, social and occupational functioning
of people over 18 years of age and older.
Superior functioning in a wide rage of activities, life's problems
91never seem to get out of hand, is sought out by others because of
100
his or her many qualities. No symptoms.
Absent or minimal symptoms, good functioning in all areas,
interested and involved in a wide range or activities, socially
90-81
effective, generally satisfied with life, no more than everyday
problems or concerns.
If symptoms are present they are transient and expectable
80-71 reactions to psychosocial stresses; no more than slight
impairment in social, occupational, or school functioning
Some mild symptoms OR some difficulty in social, occupational,
70-61 or school functioning, but generally functioning pretty well, has
some meaningful interpersonal relationships.
Moderate symptoms OR any moderate difficulty in social,
60-51
occupational, or school functioning.
Serious symptoms OR any serious impairment in social,
50-41
occupational, or school functioning.
Some impairment in reality testing or communication OR major
40-31 impairment in several areas, such as work or school, family
relations, judgment, thinking, or mood.
Behavior is considered influenced by delusions or hallucinations
30-21 OR serious impairment in communications or judgment OR
inability to function in all areas.
Some danger or hurting self or others OR occasionally fails to
20-11 maintain minimal personal hygiene OR gross impairment in
communication.
Persistent danger of severely hurting self or others OR persistent
10-1 inability to maintain minimum personal hygiene OR serious
suicidal act with clear expectation of death.
Let’s take a look at the classifications and codes!
DSM-IV Diagnostic and Statistical Manual
1. Anxiety Disorders (Axis I)
a. Anxiety - Impending feeling of doom or disaster
characterized by mood symptoms: tension, agitation and
apprehension/bodily symptoms: sweating, muscle
tension, increased heart rate & blood pressure/
cognitive symptoms: worry, distractibility
1) Panic Disorder – attacks of intense anxiety, chest pains,
tightness muscles, choking, sweating / sometimes have
no apparent trigger (intense symptoms, short duration)
2) Generalized Anxiety Disorder – chronic anxiety not
associated with any specific situation or object,
hypervigilant, tense, irritable, difficulty focusing &
trouble sleeping (symptoms must occur for at least 6
months)
3) Phobias – intense irrational fear to a stimuli, disrupting
the person’s daily life
a. Agoraphobia – fear of being out in public places
b. Acrophobia – fear of heights
c. Claustrophobia – fear of enclosed spaces
d. Zoophobia – fear of animals (snakes, dogs, cats,
rats…)
4) Obsessive-Compulsive Disorder (OCD) – thoughts and
BX = compound disorder (obsession + compulsions)
Persistent, intrusive, unwanted thoughts that an
individual can NOT ignore (obsessions)
Irrational behavior (compulsions) performed
repeatedly to “counter” the obsessions
5) Post-Traumatic Stress Disorder (PTSD) – results from
trauma, consists of nightmares, flashbacks where
individual relives the traumatic experiences
________________________________________________________________________
Today’s Goal = Complete Gr. Org!
2. Somatoform Disorders (Axis I)
characterized by physical symptoms such as pain, paralysis,
blindness, or deafness without any physical cause
1. Somatization disorder-
2. Conversion disorder3. Hypochondriasis3. Dissociative Disorders (Axis I)
sudden loss of memory or change in identity
1. Dissociative Amnesia 2. Dissociative Fugue 3. Dissociative Identity Disorder (DID) –
4. Mood Disorders (Axis I)
Unipolar = depression only
Bipolar = mania and depression
Disrupts a person’s normal function in daily life
Mania Symptoms:
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Excessive happiness, hopefulness, and excitement
Restlessness, increased energy, and less need for sleep
Rapid talk, talkativeness
Distractibility
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Shopping Sprees
Racing thoughts
High sex drive
Tendency to make grand and unattainable plans
Tendency to show poor judgment, such as impulsively
deciding to quit a job
Inflated self-esteem or grandiosity -- unrealistic beliefs in one's
ability, intelligence, and powers; may be delusional
Increased reckless behaviors (such as lavish spending sprees,
impulsive sexual indiscretions, abuse of alcohol or drugs, or illadvised business decisions)
1. Major Depressive Disorder 2. Seasonal Affective Disorder –
3. Bipolar Disorder –
4. Dysthymic Disorder- (not in handout)
Moderate depression that lasts for at least two years
5. Cyclothymic Disorder- (not in handout)
Moderate manic and depressive behavior that lasts for at
least two years
5. Psychotic Disorders (Schizophrenia) (Axis 1)
Psychosis- characterized by lack of touch with reality
Show signs of abnormal thinking, emotion, movement,
socialization and perception,
like “flight of thought”- garbled, non-cohesive sentences
Positive symptoms (not good but additions):
Delusions – erroneous beliefs that are maintained even when
compelling evidence to the contrary is presented
Hallucinations – are false sensory perceptions (seeing, hearing
things that aren’t present)
Negative Symptoms (taking away):
Flat effect - Lack of emotion
Social withdrawal, apathy, inattention, lack of communication
1. Disorganized Schizophrenia –
2. Paranoid Schizophrenia –
3. Catatonic Schizophrenia –
4. Undifferentiated (simple) Schizophrenia –
6. Personality Disorders (Axis II):
Longstanding, maladaptive thought patterns and behavior
that is troublesome to others (can be harmful or illegal)
Impaired social functioning
1. Paranoid –
2. Schizoid3. Schizotypal 4. Histrionic –
5. Narcissistic –
6. Borderline –
7. Antisocial – (PC term for sociopath or psychopath)
8. Avoidant –
9. Dependent –
10. Obsessive-Compulsive PXY Disorder –
7. Developmental Disorders (Axis II) –
Related to infancy, childhood, adolescence
1. Attention-Deficit Hyperactivity Disorder 2. Autism –
3. Anorexia Nervosa –
4. Bulimia Nervosa -
Common Explanation & Treatments for Disorders:
Commonly used approaches:
Psychotherapy:
– Any psychological treatment for behavioral or emotional problems
*Typically involves two people talking about one’s personal problems
Psychopharmacotherapy:
– Use of drugs to alleviate the symptoms of emotional, mental disturbance
– Criticism only 50% of victims with disabling mental illness are helped by drugs
1. Anxiety Disorder
Biological Explanation for Anxiety Disorders –
Too little of a neurotransmitter (GABA or serotonin) most commonly believed explanation =
Generalized anxiety disorders treated with anti-anxiety drugs (minor traquilizers) Zanax, Valium minimize
OCD and Panic disorder are treated with antidepressants (Prozac, Paxil, Zoloft)
Behavior Explanation for Anxiety Disorders – anxiety responses are acquired through classical conditioning
and maintained through operant conditioning
Cognitive Explanation for Anxiety DisordersMisinterpretation of harmless situations as threatening
2. Somatoform Disorder
Psychoanalysts Explanation for Somatoform Disorders:
Bottled up emotional energy is transformed into physical symptoms
Behavior Explanation for Somatoform Disorders:
Operant responses are learned and maintained because they result in rewards, like attention
Cognitive Explanation for Somatoform Disorders:
Rewards enable individuals with the disorder to avoid unpleasant or threatening situations, provide a
justification for failure, attract concern or attention
3. Dissociative Disorder
Psychoanalysts Explanation for Dissociative Disorders
Psychoanalysts say this disorder results from the repression of anxiety or trauma caused by disturbances in
home life (beatings, rejection from parents, or sexual abuse
4. Mood Disorder
Biological Explanation & Treatment of Mood Disorders:
*Evidence from family and twin studies suggests there is a genetic component to these disorders
*Too much neurotransmitter (norepinephrine) during mania
*Too little neurotransmitter (serotonin) during depression/
Treated with antidepressants: Prozac, Zoloft, and Paxil increase availability of serotonin
*Brain scans (PET and/or MRI) reveal lower brain activity in depressed individuals, especially in the left
frontal lobe
*MRI and CAT shows shrinkage of frontal lobes in long-term severely depressed individuals
Psychoanalysts Explanation for Mood Disorders:
Due to early loss of or rejection by a parent
Behaviorists Explanation for Mood Disorders:
Depressed people elicit negative reactions from others, resulting in continued depressed behaviors
Cognitive Explanation for Mood Disorders:
*Learned Helplessness: Negative explanatory style of person puts person at risk for depression, when a bad
event happens this same person will be pessimistic and think the bad event will last forever, affecting their
behavior and mood
*Depressed people have an overall negative viewpoint of everything (themselves, their circumstances, and
their future)
*depressed people continually go over the event and think about the event again and again. Leads to more
depressed behavior
5. Psychotic Disorder (Schizophrenia)
Biological Explanation & Treatment of Psychotic Disorders:
*Excessively high levels of neurotransmitter (dopamine) or dopamine receptors are overactive=
hallucinations and delusions
*Low levels or lack of neurotransmitter (glutamate) = flat effect, lack of emotion, social withdraw
*Brain scans show abnormalities in numerous brain regions of sufferers of schizophrenia, resulting from
teratogens, viruses, or genetic predisposition (differences obvious in PET scan, MRI and CT see AP text pg.
592)
*Diathesis-stress model (or stress vulnerability model)– people predisposed to schizophrenia are more
vulnerable to stressors than others (predisposition + stress = schizophrenia)
*Current research in the field is working on finding a genetic biomarker for early detection, as of now there is
no test for early indication of genetic predisposition to schizophrensia
* Also current research has identified that 1st trimester infections, like influenza, increase the likelihood of
schizophrenia developing
*Twin studies and family studies have identified a genetic component to disorder
*Unfortunately, after 10 years of treatment:
15% of schizophrenic patients show no improvement
10% die, often from suicide
25% report moderate improvement
25% improved but need extensive support
25% completely recover
PET SCAN (Colorful, radioactive sugar solution injected into vein, sugar reaches the brain and machine
measures the activity of each area (more blue less activity)
MRI (magnetic imaging) more sophisticated, and 3d image of the body
CT scan (computed tomography) , X-ray picture
Schizophrenic brains have enlarged ventricles (fluid-filled spaces in the brain) in areas of the brain that are regulating
motivation, emotion, perception and attention
Also schizophrenic brains havedeeper, more pronounced fissures, think “walnut effect”
Treatment for Psychotic Disorders: Antipsychotics
• Neuroleptics: major tranquilizers - powerful meds that lesson agitated bx, reduce tension, improve
social bx and improve sleep pattern
• Tend to reduce hallucinations and delusional thinking (Thorazine, Haldol, Clozaril (2 of every 100
prescribed Clozaril suffer from potentially fatal blood disease)
• Side effects anyone? Tardive Dyskinesia
• 15% of patients taking major tranquilizers develop these
Psychoanalysts Explanation of Psychotic Disorders:
Fixation in the oral stage and a weak ego
Behaviorists Explanation of Psychotic Disorders:
Schizophrenics received reinforcements of bizarre behavior
Humanists Explanation of Psychotic Disorders:
Lack of congruence between public self and real self
6. Pxy Disorders
Biological Explanation & Treatment of Pxy Disorders:
Psychoanalysts Explanation of Pxy Disorders:
Behaviorists Explanation of Pxy Disorders:
Humanists Explanation of Pxy Disorders:
7. Developmental Disorders
Biological Explanation & Treatment of Developmental Disorders:
Teratogens,
Psychoanalysts Explanation of Developmental y Disorders:
Behaviorists Explanation of Developmental Disorders:
Humanists Explanation of Developmental Disorders: