Abnormal Psychology
and Therapy
By Jake Russell, Jesus Davis, and Thomas
Shaw
Abnormal Behavior
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Behavior that is deviant, maladaptive, or
personally distressful over a long period of time
atypical from the majority of what society
considers acceptable
interferes with person’s ability to function in the
world
person engaging in behavior is troubled by it
includes Anxiety, Somatoform, Factitious,
Dissociative, Mood, Schizophrenia, Eating, and
Sleep disorders
abnormal behavior classification can lead to a
stigma
stigma is a mark of shame that causes others to
act negatively toward individual
Approaches To Abnormal Behavior
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Biological approach emphasizes medical
model, which describes psychological diseases
as having a biological origin
Disorders referred to as mental illnesses
Sociocultural approach stresses how culture
and socioeconomic background influence
disorders
Social, economic, technological, religious
factors affect frequency and intensity of
disorders
Bio psychosocial approach states that
disorders caused by sociocultural,
psychological, and biological factors working
together
Classifying Abnormal Behavior
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DSM-IV classification system classifies
based on 5 axes
axis I: all diagnostic categories except
personality disorders/mental retardation
axis II: personality disorders and mental
retardation
axis III: general medical conditions
axis IV: psychosocial/environmental
problems
axis V: current level of functioning
critiques include the manual classifies based
on medical model, and focuses solely on
problems instead of strengths as well
Therapy
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Biological Therapies- also
called biomedical therapies,
treatments that reduce or
eliminate the symptoms of
psychological disorders by
altering aspects of body
functioning.
Antianxiety Drugs- Commonly
known as tranquilizers, drugs
that reduce anxiety by making
the individual calmer and less
excitable.
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Antidepressant Drugs- drugs
that regulate mood, to help
alleviate depressed mood
through their efforts on
neurotransmitters in the brain.
Therapy (Continued)
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Antipsychotic Drugs- Powerful
drugs that diminish agitated
behavior, reduce tension,
decrease hallucinations, improve
social behavior, and produce
better sleep patterns in
individuals with a severe
psychological disorder,
especially schizophrenia.
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Electroconvulsive
Therapy(ECT)- Also called
shock therapy, a treatment,
commonly used for depression,
that sets off a seizure in the
brain. This idea of setting off a
seizure has actually been around
since Hippocrates.
https://www.youtube.com/watch?v=9L2-B-aluCE
Increase Suicide Risk in Children
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The FDA reviewed clinical trials
of antidepressant use with
children, who were randomly
assigned to receive either an
antidepressant or a placebo.
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None of the children in the
studies committed or attempted
suicide.
“Adverse event reports” were
also examined- spontaneous
statements of thoughts about
suicide reported by the
participants or their parents.
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Research did show an increase
in adverse event reports in the
participants.
Placebo participants showed 2%
of spontaneous reports of
suicidal thoughts, participants
taking antidepressants showed
4%.
This finding was the basis of the
FDA’s action to require
prescription antidepressants to
carry the severest “black box”
warning.
Drug Chart
Psychosurgery
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A biological therapy, with
irreversible effects, that involves
removal or destruction of brain
tissue to improve the individual’s
adjustment.
Antonio Egas Moniz developed a
surgical procedure, where an
instrument is inserted into the
brain and rotated, severing fibers
that connect the frontal lobe and
the thalamus.
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Moniz believed that the
procedure should be use with
extreme caution and only be
used as a last resort, due to the
fact that it can leave some
patients in a “vegetable-like
state.”
Maybe performed for OCD,
major depression, or bipolar
disorders.
Schizophrenia Symptoms
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Schizophrenia - Severe psychological disorder characterized by highly
disordered thought processes, referred to as psychotic because they are
so far removed from reality
Positive Symptoms - Distortion or excess of
normal function
○ Hallucinations - Sensory experiences in
the absence of real stimuli
○ Delusions - False, unusual, and
sometimes magical beliefs that are not
part of an individual’s culture
○ Referential thinking - Ascribing personal
meaning to completely random events
○ Catatonia - State of immobility and
unresponsiveness for long periods of
time
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Negative Symptoms - Social
withdrawal, behavioral deficits, loss or
decrease of normal functions
○ Flat affect - The display of little
or no emotion -- common
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Cognitive Symptoms
○ Difficulty keeping attention
○ Memory problems
○ Inability to interpret information
and make decisions
Causes of Schizophrenia
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Heredity
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Research supports it is at least
partially caused by genetic factors. As
genetic similarities to a person with it
goes up so does the risk of getting it.
Researchers are seeking the location
of genes involved in susceptibility to
schizophrenia.
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Structural Brain Abnormalities
○ Enlarged ventricles in the brain.
Indicates deterioration in other brain
tissue. Small prefrontal cortex and
lower activity in the area. Microscopic
studies of brain tissue after death
shows small changes in the
distribution or characteristics of brain
cells. Problems appear prenatal.
Neurotransmitter Regulation Problems
○ Linked excess dopamine production to schizophrenia. First noticed with study involving the
drug L-dopa and Parkinson’s disease. The person is bombarded with thoughts and they
might think those thoughts are someone else’s voice talking inside their head. But when
levels are balanced they might still hang on to their prior beliefs. Kapur says delusions
serve as explanatory schemes that have helped the person make sense of the random and
chaotic experiences caused by all of the dopamine.
Factors of Schizophrenia
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Psychological Factors
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Diathesis- Stress Model - View of
schizophrenia emphasizing that a
combination of biogenetic disposition
and stress causes the disorder
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Used to explain schizophrenia as
rooted in an individual’s difficult
childhood experiences with parents
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Sociocultural Factors
○ They appear to affect the course of
the disorder. Influence how
schizophrenia progresses.
○ Individuals with schizophrenia in
developing, non industrialized nations
tend to have better outcomes than
those in developed, industrialized
nations
Schizophrenia Case Study and
Video
Jack is a 27 year old man diagnosed with schizophrenia. He has been referred to Top Quality Rehabilitation (TQP)
to provide supported employment services. Jack graduated from high school and got a job working in a video
store. After working for about 6 months Jack began to hear voices that told him he was no good. He also began to
believe that his boss was planting small video cameras in the returned tapes to catch him making mistakes. Jack
became increasingly agitated at work, particularly during busy times, and began "talking strangely" to customers.
For example one customer asked for a tape to be reserved and Jack indicated that that tape may not be available
because it had "surveillance photos of him that were being reviewed by the CIA". After about a year Jack quit his
job one night, yelling at his boss that he couldn't take the constant abuse of being watched by all the TV screens in
the store and even in his own home. Jack lived with his parents at that time. He became increasingly confused
and agitated. His parent took him to the hospital where he was admitted. He was given Thorazine by his
psychiatrist, this is a very powerful psychotropic medication. However, he had painful twisting and contractions of
his muscles. He was switched to Haldol and had fewer side effects. From time to time Jack stopped taking his
Haldol, and the voices and concerns over being watched became stronger. During the past 7 years Jack was
hospitalized 5 times. He applied for and now receives SSI, and with the assistance of a case manager has moved
into his own apartment. He is now a member of a psychosocial "clubhouse" for people with mental illness. He
attends the clubhouse 3 times a week. He answers the phone, and helps write the clubhouse newsletter. He has a
few friends at the clubhouse, but he has never had a girlfriend. Jack told his case manager he would like to get a
job so he can earn more money and maybe buy a car. Jack is very worried about looking for a job. He doesn't
know how to explain his disorder to a potential employer, and he is afraid of becoming overwhelmed. He likes
movies and would like to work with them in some manner.
http://www.youtube.com/watch?v=bWaFqw8XnpA
Mood Disorders
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Are psychological disorders in which there is a primary disturbance of mood:
prolonged emotion that colors the individual's entire emotional state. Can
include cognitive, behavioral, and somatic symptoms, as well as
interpersonal difficulties. Two main types are depressive and bipolar
disorder. Often leads to suicide.
Depressive Disorders are mood disorders in which the individual suffers
from depression: an unrelenting lack of pleasure in life. They are common.
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Major depressive disorder (MDD) involves a significant depressive
episode and depressed characteristics, such as lethargy and
hopelessness, for at least two weeks.
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Dysthymic disorder (DD) is mood disorder that is generally more
chronic and has fewer symptoms than MDD; the individual is in a
depressed mood for most days at least two years as an adult or at
least one year as as a child or an adolescent.
Factors of Depressive Disorders
Biological Factors
Psychological Factors
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Genetics influences , such as specific brain
structures and neurotransmitters, play a role
in depression. Depressed individuals show
lower levels of brain activity in a section of
the prefrontal cortex that is involved in
initiating behavior.
Depression likely involves problems in the
body’s regulation of a number of
neurotransmitter. Individuals with major
depressive disorder appear to have difficulty
regulating the neurotransmitter serotonin or
too few receptors for serotonin and
norepinephrine.
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When people cannot control their stress, they
eventually feel helpless and stop trying to
change their situations, this learned
helplessness turns into hopelessness.
Depression is thought to be related to a
pessimistic attributional style: blaming oneself
for negative events and expecting the
negative events to recur in the future.
Sociocultural Factors
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Individuals with a low socioeconomic status
(SES), especially people living in poverty, are
more likely to develop depression than their
higher-SES counterpart.
Depression Among Men & Women
Across Cultures
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Beirut, Lebanon has
the highest
depression and
Korea has the lowest.
Florence, Italy has
the biggest difference
in depression by 12.5
males.
Depressed Children
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The Prevalence of major
depressive disorder among
children ranges from 1.5-2.5% in
school-age children and 15-20%
in adolescents.
Higher risk of substance abuse,
academic problems, increased
physical illness, and others.
Provide the child with love,
encouragement, and a role
model or a strong extended
family that supports the child’s
attempt to cope with difficulties.
Bipolar Disorder
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Is a mood disorder that is
characterized by extreme mood
swings that include one or more
episodes of mania, an overexcited,
unrealistically optimistic state.
Bipolar I Disorder- individuals who
have manic episodes during which
they may experience hallucinations.
Bipolar II Disorder- the individual may
not experience full-blown mania but
rather a less extreme level of
https://www.youtube.com/watch?v=fyJn_3LkE8w
euphoria.
Suicide
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Not a diagnosable disorder but a
tragic consequence of
psychological disorders, most
commonly depression and
anxiety.
Biological Factors- Tends to
run in the family, have low
serotonin levels, and poor
physical health.
Psychological Factors- Mental
disorders and traumas such as
sexual abuse.
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Sociocultural Factors- Chronic
economic hardship can be a
factor in suicide, and cultural and
ethnic contexts also are related
to suicide attempts.
Mood Disorders (Continued)
Symptoms:
feelings of sadness
hopelessness
helplessness
suicidal thoughts
fatigue
mania
changes in appetite
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Treatments:
support groups
individual therapy
antidepressants
cognitive behavioral
therapy
psychodynamic therapy
family therapy
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Mood Disorder Case Study
Jessica is a 28 year-old married female. She has a very demanding, high stress job as a second year medical resident in a
large hospital. Jessica has always been a high achiever. She graduated with top honors in both college and medical school.
She has very high standards for herself and can be very self-critical when she fails to meet them. Lately, she has struggled
with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past. For
the past few weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her
coworkers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly
disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all
day, watching TV or sleeping. At home, Jessica’s husband has noticed changes as well. She’s shown little interest in sex
and has had difficulties falling asleep at night. Her insomnia has been keeping him awake as she tosses and turns for an
hour or two after they go to bed. He’s overheard her having frequent tearful phone conversations with her closest friend,
which have him worried. When he tries to get her to open up about what’s bothering her, she pushes him away with an
abrupt “everything’s fine”. Although she hasn’t ever considered suicide, Jessica has found herself increasingly dissatisfied
with her life. She’s been having frequent thoughts of wishing she was dead. She gets frustrated with herself because she
feels like she has every reason to be happy, yet can’t seem to shake the sense of doom and gloom that has been clouding
each day as of late. This demonstrates major depressive disorder where it’s only a 2 week long episode with a feeling of
hopelessness.
Anxiety Disorders
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Involve fears that are
uncontrollable and disproportionate
to the actual level of danger, and
disruptive of day-to-day life
characterized into five typesgeneralized anxiety disorder, panic
disorder, phobic disorder,
obsessive-compulsive disorder,
and post-traumatic stress disorder
Are Psychological Disorders a Myth?
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NAMI, American Psychiatric Association, and NHMA all agree that mental illnesses are very real
medical conditions
Some claim that mental illnesses are better labeled “problems of living”
Number of ADHD diagnoses caused some to wonder if normal behavior is being labeled as
psychology
NIMH sponsored a conference to review the scientific evidence
conference concluded that ADHD was a real disorder
controversy serves as a reminder of the role of research in clarifying and defining diagnostic
categories
GAD (Generalized Anxiety Disorder)
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marked by persistent anxiety for at least
6 months
unable to specify reason for anxiety
nervous all the time
worry about work, relationships, health
GAD (cont.)
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excessive worrying can cause
fatigue, muscle tension,
stomachaches, and difficulty
sleeping
factors include genetic
predisposition, sympathetic
nervous system activity,
harsh/impossible self
standards,overly strict parents,
and history of uncontrollable
traumas/stressors (abusive
parent)
Anxiety Disorder Case Study
Nancy L., a 45-year-old married lawyer, presented with exacerbation of her chronic generalized anxiety and recurrent depressive symptoms in January 2005.
Nancy had a history of anxiety dating back "as far as I can remember." She was an anxious young girl with separation anxiety and shyness that manifested in elementary school. As she grew up, she experienced ongoing anxieties
about the health of her parents (worrying that her parents would die, even though they were in good health) and her school performance (though she was a good student). She remembers marked fears, including fears of the
dark and thunder, most of which she "outgrew" except for a persistent fear of insects, particularly spiders.
Her anxiety became more prominent and persistent after she left home at age 18 and entered college. She sought care at the university health service and received a prescription for diazepam that she used over the next 4 years on
an as-needed basis during periods of increased anxiety such as examinations; she also met episodically with a therapist at the counseling center. In the spring of her freshman year, she experienced her first major depressive
episode following a break-up with a boyfriend. She was prescribed imipramine, which she took for a couple of months but then discontinued because of intolerable side effects (dry mouth and lightheadedness). The depression
gradually resolved over the next 6 months.
Nancy continued to be plagued by persistent feelings of anxiety and worry associated with insomnia, irritability, tension, and fatigue. Over the years, her friends and family chided her for "worrying too much," and she reported difficulty
controlling her anxiety over her financial situation, job security, and her children's safety, despite evidence that none of these were problematic. Her husband reported that he found her persistent anxiety and ongoing need for
reassurance "exhausting" and that he noticed himself withdrawing from her, which led to significant tension between them. The high quality of her work at the law firm was recognized and she was well-compensated financially,
yet she continued to worry about her performance and was, in fact, passed over for promotion to team leader because, as one of her annual reviews stated, her "constant anxiety makes everyone else too nervous." In addition,
over the last 25 years, she has had 5 or 6 episodes of major depression lasting from 3 to 4 months to over a year. These episodes have sometimes, but not always, been triggered by situational stressors; one occurred during a
postpartum period.
After college, she was treated intermittently with benzodiazepines at low doses (eg, diazepam 5-10 mg), which she took on an as-needed rather than daily basis when the anxiety worsened because of her concerns about addiction.
As noted, she was briefly on imipramine during college but discontinued it because of side effects. About 10 years before the January 2005 examination, she was started on fluoxetine 20 mg/day by her primary care doctor. She
discontinued it after a few days because it made her feel jittery and more anxious. She had been in supportive therapy on and off since college to help her deal with situational stressors.
Other relevant aspects of her medical and psychiatric history include the fact that her overall health had been generally good, although she had presented numerous times to her primary care physician with a variety of somatic
complaints, including headaches, gastrointestinal disturbance, and muscular aches and pains with no clear etiology. She had repeated thyroid testing with normal results. Her mother had had a history of menopause in her early
40s and the patient noted that her menstrual cycles had become more irregular over the last couple of years, and her anxiety and irritability become notably worse premenstrually.
She smoked a pack of cigarettes a day and reported that having a cigarette would sometimes temporarily decrease her tension and anxiety. She attempted to quit smoking several times and noted that the increased anxiety and
tension she experienced during these attempts contributed to her lack of success in these efforts. She typically had 1 or 2 glasses of wine at social occasions or on the weekends; she has no history of abuse or dependence on
alcohol but did say that a glass of wine made her feel temporarily less anxious. She carefully monitored her intake because of worry that she would become an alcoholic. She smoked marijuana a few times in college but it made
her feel dysphoric and more anxious, and she had not used it or other illicit drugs since that time.
Social and Family History
After finishing college, Nancy went to law school, where she met her husband. She reported being attracted to his sense of calm and stability. He reported that part of what drew him to her was the sense of how much she seemed to
need and depend on him. They were married shortly after graduation and had 2 children over the next 5 years. After the birth of her second child, she developed a postpartum depression that lasted almost a year and for which
she didn't seek treatment. She said that her youngest child "is just like I was -- she's afraid of her own shadow."
She grew up in a middle-class home, the second of 3 children. She reported that childhood was "generally happy," although she was troubled by anxiety starting early in life. There was no history of physical or sexual abuse. Both
parents were still alive in January 2005, although they had significant medical conditions and she was worried about their health. She noted that her mother and father were both "nervous" people, and though never formally
diagnosed and treated, her maternal grandmother had a history of depression
Panic Disorder
● person experiences sudden, recurrent
onsets of intense apprehension or
terror
● often without warning/specific cause
● symptoms:
● severe palpitations, shortness of
breath, chest pains, trembling,
sweating, dizziness, feeling of
helplessness
Panic Disorder (cont.)
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Biological:
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Sociocultural:
genetic predisposition, overly
active autonomous nervous
system, problems with
norepinephrine/GABA
American Women twice as likely
as men to experience panic
attacks, biological differences in
hormones/neurotransmitters
Phobic Disorder
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irrational, overwhelming, persistent fear of a particular object or situation
GAD sufferers cannot pinpoint source of anxiety, those with phobias can
fear changes to phobia when individual goes to extreme lengths to avoid it
typically begin in childhood
Phobic Disorder (cont.)
● Biological:
● neural circuit for phobias that
includes thalamus, amygdala,
and cerebral cortex
● number of neurotransmitter,
especially serotonin
● Psychological:
● phobias could be learned
fears
Obsessive Compulsive Disorder (OCD)
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anxiety-provoking thoughts that will not go away
urges to perform repetitive, ritualistic behaviors
rituals prevent future situations
Obsessions are recurrent thoughts
Compulsions are recurrent behaviors
repeat routines up to 100s of times a day
most do not enjoy ritualistic behavior
OCD (cont.)
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Biological:
Genetic component, neurological links, frontal cortex
and basal ganglia are so active that impulses reach the
thalamus, amygdala may be smaller, low levels of
serotonin/dopamine
Psychological:
occurs during period of life stress
individuals do not have the ability to turn off negative
thoughts
Post Traumatic Stress Disorder (PTSD)
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develops through exposure to
traumatic event that overwhelms
abilities to cope
● can follow immediately after or
years after
● traumas include war/combat,
natural disasters, sexual
abuse/assault, unnatural disasters
such as car crashes/terrorist attacks
PTSD (cont.)
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flashbacks
avoidance of emotional experiences
reduced ability to feel emotions, inability to experience happiness/desire
excessive arousal, exaggerated startle response/inability to sleep
difficulties with memory/concentration
feelings of apprehension
impulsive outbursts of behavior
PTSD (cont.)
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primary cause is traumatic event
itself
other factors can influence
vulnerability
history of previous traumatic events
conditions such as
abuse/psychological disorders
http://www.youtube.com/w
atch?v=-Fc6_aTnRXQ
Reference Slide
Thomas Shaw: Presented the topics of abnormal behavior
and anxiety disorders( #’s 1&2) and created guided
notes.
Jesus Davis: Presented the topics of therapy and mood
disorders( #’s 3&8) and mood disorder case study.
Jake Russell: Presented the topic of Schizophrenia(# 5)
and Schizophrenia case study.