4/4/2013

1. ABNORMAL PSYCHOLOGY
Dr. Reem Al-Sabah
Faculty of Medicine
Psychology 220

2. TRUE OF FALSE?
 People who are mentally ill are violent.
False
 Geniuses are particularly prone to emotional disorders.
False
 Children can have serious mental disorders.
True
 Depression results from a personality weakness or
character flaw.
False
 Most mental disorders are treatable.
True

3.  What is abnormal psychology?
 The field devoted to the scientific study of
abnormal behavior to describe, predict,
explain, and change abnormal patterns of
functioning.

4. ANCIENT VIEWS AND TREATMENT
 Most of our knowledge of prehistoric societies has
been acquired indirectly, is based on inferences
from archaeological findings, and is limited.
 Most historians believe that prehistoric societies
regarded abnormal behavior as the work of evil
spirits
 May have begun as far back as the Stone Age
 The cure for abnormality was to force the demons
from the body through trephination and exorcism

5. Ancient skull with holes from trephination

6. WHAT IS ABNORMALITY?
 Deviation from cultural norms
 Every culture has certain standard, or norms, for
acceptable behavior.
 Cultural relativist perspective: we should respect
each culture’s definitions of abnormality for the
members of that culture.

7.  Opponents of this position:
Historically, societies have labeled
individuals as abnormal to justify
controlling or silencing them.
The concept of abnormality changes
over time within the same society.

8.  Deviation from statistical norms
 Abnormal: away from the norm.
 Abnormal behavior is statistically infrequent or
deviant from the norm.
E.g., very tall or very short
E.g., extremenly intelligent
 Definition of abnormality is more than statistical
frequency.

9. THE NORMAL DISTRIBUTION

10.  Maladaptive behavior
 Whether a person’s abnormal behavior is
maladaptive, that is if it has adverse effects on
the individual or on society.
 Deviant behavior harmful to the individual.
e.g., a mother with severe depression who
can’t adequately fulfill her role.
 Deviant behavior harmful to society
e.g., A teenager with violent and aggressive
outbursts.

11.  Personal distress
 Distress: feelings of anxiety, depression, or
agitation, or experiences such as insomnia,
loss of appetite, or numerous aches and pains.
 Most people diagnosed with a mental disorder
feel extremely miserable.
 Sometimes, personal distress may be the only
symptom of abnormality.

12. DEFINING NORMALITY
The following are traits that a normal person
possesses to a greater degree than an
individual who is diagnosed as abnormal:
 Appropriate perceptions of reality.
 Realistic in appraising one’s own reactions and
capabilities and in interpreting their surroundings.

13.  Ability
to exercise voluntary control
over behavior.
 Feeling confident about the ability to control
one’s behavior.
 Self-esteem and acceptance.
 Having some appreciation for one’s own worth
and feeling accepted by those around you.

14.  Ability to form affectionate relationships.
 Able to form close and satisfying relationships with
other people.
 Productivity.
 Able to channel one’s abilities into productive
activity.

15. MENTAL ILLNESS
 medical conditions that disrupt a person’s thinking,
feeling, mood, ability to relate to others, and daily
functioning.
 Just as diabetes is a disorder of the pancreas, mental
illnesses are medical conditions that often result in a
diminished capacity for coping with the ordinary
demands of life.
 Biologically
based brain disorders. They cannot be
overcome through "will power" and are not related to a
person's "character" or intelligence.

16. NEUROSIS VS. PSYCHOSIS
 Neurosis refers to mental distress that, unlike
psychosis, does not prevent rational thought or
daily functioning.
 Neurotic conditions do not interfere with daily
functions
 Most people suffer from some sort of neurosis as
a part of human nature.

17.  Psychosis is a mental state involving the loss of
contact with reality, causing the deterioration of
normal social functioning.
 Any mental state that impairs thought,
perception, and judgment.
 A person experiencing a psychotic episode
might hallucinate, become paranoid, or
experience a change in personality.

18. CLASSIFYING ABNORMAL BEHAVIOR
 DSM:The Diagnostic and Statistical Manual of
Mental Disorders.
 The DSM was introduced in 1952.
 The DSM has been widely adopted by mental health
professionals
 The latest version, published in 2000, is the
DSM IV-TR, the Text Revision (TR) of the Fourth
Edition (DSM-IV).
 DSM-5 is scheduled for release in May 2013

19.  ICD: The International Statistical Classification of
Diseases and Related Health Problems.
 A classification, published by the World Health
Organization.
 Used mainly for compiling statistics on the
worldwide occurrence of disorders.
 Now in its tenth revision (the ICD-10).
 The DSM-IV is compatible with the ICD, so that
DSM diagnoses could be coded in the ICD system
as well.

20. ADVANTAGES OF THE DSM
CLASSIFICATION SYSTEM
 Diagnostic
codes are fundamental to medical
record keeping.
 Diagnosticcoding facilitates data collection
and retrieval and compilation of statistical
information.
 Facilitates communication between clinicians.

21. DISADVANTAGES OF THE DSM
CLASSIFICATION SYSTEM
 Some symptoms requirement (e.g., major depression be
present for 2 weeks before a diagnosis is reached) .
 Medical model does not pay attention to external social
influences on behavior.
 Categorical structure (a disorder is either present or not)
too rigid. Abnormal behavior occurs along a continuum
(dimensional approach ).
 Stigmatizes people by labeling them with psychiatric
diagnoses.

22. PERSPECTIVES ON MENTAL HEALTH PROBLEMS
 Biological perspective (medical or disease model):
due to brain disorders, genetic problems, brain
dysfunction.
 Psychological perspective : due to problems in the
functioning of the mind.
 Psychoanalytic perspective: defense mechanisms
are used to handle the anxiety of unconscious
conflicts (usually originating from childhood).

23.  Behavioral perspective: fears become conditioned
to specific situations; reinforcement of inappropriate
behaviors; learning theory.
 Cognitive perspective: maladaptive cognitive
processes.
 Cultural/sociological perspective: social context in
which a person lives (e.g., poverty, discrimination).
 Vulnerability-stress model
Interaction between predisposition & stressful
environmental conditions (need both to develop a
mental health problem).

24. DEFENSE MECHANISMS
 Defensemechanisms protect us from being
consciously aware of a thought or feeling
which we cannot tolerate.
 The defense only allows the unconscious
thought or feeling to be expressed indirectly
in a disguised form.

25. EXAMPLES OF DEFENSE MECHANISMS
 Denial: You completely reject the thought or feeling. "I'm
not angry with him!"
 Suppression: You are vaguely aware of the thought or
feeling, but try to hide it. "I'm going to try to be nice to
him."
 Reaction Formation: You turn the feeling into its
opposite. "I think he's really great!“
 Projection: You project your thoughts and feelings onto
someone else. "That professor hates me.” "That student
hates the prof.“

26. CATEGORIES OF MENTAL DISORDERS
1. Disorders usually first evident in infancy, childhood,
or adolescence.
2. Delirium, dementia, amnestic, and other cognitive
disorders.
3. Mental Disorders Due to a General Medical
Condition.
4. Substance-Related Disorders.
5. Schizophrenia and Other Psychotic Disorders
6. Mood Disorders.
7. Anxiety Disorders.
8. Somatoform Disorders.

27. 9. Factitious Disorders
10. Dissociative Disorders
11. Sexual and Gender Identity Disorders
12. Eating Disorders
13. Sleep disorders
14. Impulse-Control Disorders Not Elsewhere Classified
15. Adjustment Disorders
16. Personality Disorders
17. Other Conditions That May Be a Focus of Clinical
Attention

28. PERVASIVE DEVELOPMENTAL DISORDERS
 Pervasive developmental disorders
 Set of disorders characterised by severe & lasting
impairment in several areas of development.
 Diagnosis of autism
 Involves three types of deficits:
 Social interaction – lack of connection with others
 Communication – difficulties in communication & speech
 Activities & interests – preoccupation/routines/rituals
 Autistic boys outnumber autistic girls three to one

29. PERVASIVE DEVELOPMENTAL DISORDERS
 Asperger’s
syndrome & other pervasive
developmental disorders (PDDs)
 Rett’s disorder & childhood disintegrative disorder
 Children appear to develop normally for while & then show
apparent permanent loss of basic skills in social interaction,
language, and/or movement
 Asperger’s syndrome
 Characterized by deficits in social interactions & in activities
and interests that similar to autism but different from autism in
that no significant delays or deviance in language
 PDDs viewed as falling along continuum with autism most
severe & others lower on continuum

30. PERVASIVE DEVELOPMENTAL DISORDERS
 Understanding pervasive developmental
disorders
 Biological factors – several have been implicated in
development of PDDs
 Family & twin studies suggest genetics play a role
 Neurological factors also likely – disruption in normal
development & organization of the brain
 Studies suggest that PDD sufferers lack theory of
mind which may make it impossible for these
children to understand & operate in the social world

31. 5. ANXIETY DISORDERS
 Includes disorders in which anxiety is the
main symptom (generalized anxiety or panic
disorders).
 Or anxiety is experienced unless the
individual avoids feared situations (phobic
disorders) or tries to resist performing certain
rituals.

32. ANXIETY DISORDERS (CONT.)
 Anxiety is only considered unhealthy when occurs in
situations that most people can handle with little
difficulty.
 Four types of symptoms:
 Physiological, cognitive, behavioral & emotional
symptoms.
 Generalised anxiety disorder
 Person experiences constant sense of tension &
dread, and continuously worries about potential
problems and has difficulty concentrating or
making decisions.

33. ANXIETY DISORDERS (CONT.)
 Panic disorders
 Panic attack – episode of acute & overwhelming
apprehension or terror (approx. 28% have them
occasionally).
 Panic disorder is rare (approx. 2%). When panic
attacks become frequent and person worries
about having attacks.
 Agoraphobia: anxiety about being in places
where escape might be difficult or embarrassing
or in which help may not be available should a
panic attack develop
 About 20% people with panic disorder develop
agoraphobia.

34. UNDERSTANDING PANIC DISORDER &
AGORAPHOBIA
 Panic disorders likely to have biological
component
May have over-reactive fight-or-flight
response
 Cognitive factors play strong role in panic
attacks & agoraphobic behavior may be
conditioned through learning experiences
 Interoceptive conditioning
 Misinterpret bodily sensations
 Catastophic thinking

35. ANXIETY DISORDERS

36. ANXIETY DISORDERS (CONT.)
 Phobias
 Intense fear of stimulus/situation most do not
find particularly dangerous & it interferes with
person’s life
 Specific phobia
 fear of specific object/animal/situation
 Common about 8%
 Social phobia
 extreme insecurity in social situations (fear of public
speaking, fear of eating in public)
 2.4%

37. UNDERSTANDING PHOBIAS
 Freud argued – phobias result of people
displacing anxiety over unconscious motives
onto symbolic objects
 Behaviorists – phobias develop from
classical & operant conditioning.
 Many phobias emerge after a traumatic
experience (classical conditioning).
 Phobias are maintained through operant
conditioning.

38. ANXIETY DISORDERS (CONT.)
 Obsessive-Compulsive Disorder: repetitive acts
or thoughts.
 central feature is subjective loss of control (sufferers
don’t trust senses/judgements)
 Obsessions: persistent intrusions of unwelcome
thoughts, images, or impulses that elicit anxiety
 Compulsions: irresistible urges to carry out
certain acts or rituals that reduce anxiety

39. UNDERSTANDING OBSESSIVE-
COMPULSIVE DISORDER
 Cognitive & behavioral theorists – those with obsessive-
compulsive disorder have more trouble “turning off”
intrusive thoughts due to more rigid thinking.
 OCD begins at a young age.
 Prevalence 1-3%.
 May also have biological causes – possible deficiencies
in serotonin in areas of the brain that regulates primitive
impulses.

40. MOOD DISORDERS
 Disturbances of normal mood; the person may be
extremely depressed, abnormally elated, or may
alternate between periods of elation and
depression.
 Depressive disorders: one or more periods of
depression.
 Common, about 13%.
 Depression becomes a disorder when the symptoms
become so severe they interfere with normal
functioning & continue for weeks at a time
 Women twice as likely to suffer depression as men

41. MOOD DISORDERS (CONT.)
 Depression is a disorder of the whole person, affecting bodily
functions, behaviors, thoughts, and emotions).
 Emotional symptoms:
 Unrelenting pain and despair
 Anhedonia: loss of ability to experience joy even in
response to the most joyous occasions
 Cognitive Symptoms:
 Negative thoughts (hopelessness, worthlessness, guilt)
 Physical Symptoms:
 changes in appetite and sleep, very fatigued, drained

42. MOOD DISORDERS

43. MOOD DISORDERS (CONT.)
 Bipolar disorders: person alternates between
periods of depression & mania
 individual alternates between depression &
extreme elation
 Manic symptoms often change from joyful
exuberance to hostile agitation & equally found
in men & women
 Uncommon, <2%
 Occur equally in men and women

44. UNDERSTANDING MOOD DISORDERS
 The biological perspective
 Tendency to develop mood disorders, especially
bipolar disorders, appears to be inherited
 1st degree relatives 5-10 times as likely
 Twins 45-75 times as likely
 Recurrent depression
 1st relatives 2-4 times as likely
 Structural & functional brain abnormalities could
be precursors & causes of mood disorders or
result of biochemical processes in mood
disorders which are toxic for brain

45. UNDERSTANDING MOOD DISORDERS
 The cognitive perspective
 Depressed people interpret life in pessimistic, hopeless
ways
 Beck developed the cognitive triad: negative thoughts
about the self, present experiences and the future
 Depression also affected by maladaptive attributional
styles
 Interpersonal perspectives
 Depressed people often too dependent on opinions &
support of others, e.g. through excessive reassurance
seeking
 Psychosocial factors in bipolar disorders
 Stressful life events can trigger new bipolar episodes

46. SCHIZOPHRENIA

47. SCHIZOPHRENIA
 Schizophrenia is a chronic, severe, and disabling
brain disease.
 Schizophrenia occurs in all cultures.
 Approximately 1 % of the population develops
schizophrenia during their lifetime.
 men (late teens or early twenties)
 women (twenties to early thirties)

48.  The first signs of schizophrenia often appear as
confusing, or even shocking, changes in
behavior.
 Coping with the symptoms of schizophrenia can
be especially difficult for family members who
remember how involved or vivacious a person
was before they became ill.
 One of the most stigmatized disorders.

49. CHARACTERISTICS OF SCHIZOPHRENIA

50. DISTURBANCES OF THOUGHT AND
ATTENTION
 Process of thinking
difficulty focusing attention and filtering out
irrelevant stimuli
(‘world salad’, loosening of associations)
 Content of thought
Lack of insight into their condition
delusions

51.  Thoughts may come and go rapidly; the person
may not be able to concentrate on one thought for
very long and may be easily distracted .
 Delusions: are false beliefs that usually involve a
misinterpretation of perceptions or experiences.
Most common: delusion of persecution
Least common: delusion of grandeur

52. Types of Delusions:
 Persecutory delusions
 Most common
 Person believes he is being tormented,
followed, tricked, spied on, or subjected to
ridicule.
 Referential delusions
 Person believes that certain gestures,
comments, passages from books, newspapers,
song lyrics..etc are specifically directed at him
or her.

53.  Delusion of control: a false belief that another
person, group of people, or external force
controls one's thoughts, feelings, impulses, or
behavior.
 Thought broadcasting, Thought insertion
 Nihilisticdelusion: A delusion whose theme
centers on the nonexistence of self or parts of
self, others, or the world. A person with this type
of delusion may have the false belief that the
world is ending.

54.  Delusion of guilt or sin
 A false feeling of remorse or guilt of delusional
intensity.
 A person may believe that he or she has committed
some horrible crime and should be punished
severely, or that he or she is responsible for some
disaster (such as fire, flood, or earthquake) with
which there can be no possible connection.
 Religious delusion:
 Any delusion with a religious or spiritual content.
 Beliefs that would be considered normal for an
individual's religious or cultural background are not
delusions.

55.  Erotomania:
 A belief that another person (of higher status) is in
love with him or her.
 Individuals may attempt to contact the other person
(through phone calls, letters, gifts, and sometimes
stalking).
 Grandiose delusion:
 Exaggerating one’s sense of self-importance and
being convinced that one has special powers,
talents, or abilities.
 Person may actually believe he or she is a famous
person (for example, a rock star or religious /political
figure).

56.  Somatic delusion:
 A 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.
 (e.g. a person who believes that his or her
body is infested with parasites. Or a belief that
one emits a foul odor ).

57. DISTURBANCES OF PERCEPTION
 Hallucinations
 sensory experiences in the absence of
relevant or adequate external stimulation.
 Hallucinations can occur in any sensory
form: auditory (sound), visual (sight),
tactile (touch), gustatory (taste), and
olfactory (smell).
 Most common: auditory hallucination

58.  Auditory hallucinations
 A false perception of sound/noise.
 most common type of hallucination
 "running commentary" on the person's behavior as
it occurs or “command hallucinations” or telling the
person to do something.
 Visual hallucination
 A false perception of sight.
 The content of the hallucination may be anything
(such as shapes, colors, and flashes of light) but are
typically people or human-like figures.

59.  Tactile hallucination:
 A false perception or sensation of touch or
something happening in or on the body.
 A common tactile hallucination is feeling like
something is crawling under or on the skin.
 Actual physical sensations stemming from
medical disorders (perhaps not yet diagnosed)
and hypochondriasis with normal physical
sensations are not thought of as somatic
hallucinations.

60.  Gustatory hallucination
 A false perception of taste. Usually, the
experience is unpleasant (e.g. a persistent
taste of metal).
 Olfactory hallucination
 A false perception of odor or smell. Typically,
the experience is very unpleasant (e.g. the
person may smell decaying fish, dead bodies,
or burning rubber).

61. DISTURBANCES OF EMOTIONAL
EXPRESSION
 Exhibit unusual emotional reactions.
 Express emotions that are inappropriate to
the situation or to the thought being
expressed.

62. MOTOR SYMPTOMS AND
WITHDRAWAL OF REALITY
 Sometimes exhibit bizarre motor activity.
 Examples:
 Strange facial expressions
 Very agitated and move about in continual
activity
 Totally unresponsive or immobile for extended
periods of time (catatonic immobility).

63. DECREASED ABILITY TO FUNCTION
 Impaired ability to carry out the daily routines of living.
 School, job, personal hygiene, grooming.
 Person avoids company of others.
 Schizophrenia symptoms: due to disorder, reaction to life in
a mental hospital, or to the effects of medication.

64. POSITIVE AND NEGATIVE SYMPTOMS OF
SCHIZOPHRENIA
 The positive symptoms appear to reflect an
excess or distortion of normal functions. They
include:
 Distortion of inferential thinking (delusions).
 Distortion of perception (hallucinations).
 Distortions in language and thought processes
(Disorganized speech).
 Distortions in self-monitoring of behavior (grossly
disorganized or catatonic behavior).

65.  whereas the negative symptoms appear to
reflect a loss of normal functions. They include
restrictions in:
 The range and intensity of emotional
expression (affective flattening).
 The fluency and productivity of thought and
speech (alogia).
 The inability to initiate of goal-directed
behavior (avolition).

66. CAUTIONARY NOTE
 At
times, normal individuals may feel, think, or act in
ways that resemble schizophrenia.
 Normal people may sometimes be unable to think
straight, may become extremely anxious, be unable
to pull their thoughts together, and forget what they
had intended to say. This is not schizophrenia.
 Hypnagogic (while falling asleep) and hypnopompic
(waking up) hallucinations are considered normal
human experiences

67.  Peoplewith schizophrenia do not always act
abnormally. They can appear completely normal
and be perfectly responsible, even while they
experience hallucinations or delusions.
 An individual’s behavior may change over time,
becoming bizarre if medication is stopped and
returning closer to normal when receiving
appropriate treatment.

68. WHAT CAUSES SCHIZOPHRENIA?

69.  Thereis no known single cause of
schizophrenia.
 Many diseases, such as heart disease, result
from an interplay of genetic, behavioral, and
other factors; and this may be the case for
schizophrenia as well.
 Scientists
do not yet understand all of the factors
necessary to produce schizophrenia.

70. The Path to Schizophrenia - The diagram shows how biological, genetic
and prenatal factors are believed to create a vulnerability to schizophrenia. Additional
environmental exposures (for example, frequent or ongoing social stress and/or isolation
during childhood, drug abuse, etc.) then further increase the risk or trigger the onset of
psychosis and schizophrenia. Early signs of schizophrenia risk include neurocognitive
impairments, social anxiety (shyness) and isolation and "odd ideas". (note: "abuse of DA
drugs" referes to dopamine affecting (DA) drugs).
Dr. Ira Glick (2005)"New Schizophrenia Treatments“

71. THE BIOLOGICAL PERSPECTIVE
 Schizophrenia runs in families (hereditary
predisposition for schizophrenia).
 First-degree biological relatives have about a 10%
chance, whereas the risk of schizophrenia in the
general population is about 1%.
A monozygotic twin of a person with schizophrenia
has the highest risk (40 to 50%) of developing the
illness, while dizygotic twins have approx. 15%
risk.

73. HOW DO GENETIC ABNORMALITIES OF
SCHIZOPHRENIA AFFECT THE BRAIN?
1. Brain structure
 Prefrontal cortex is smaller and shows less activity
 Enlarged ventricles (cavities inside the brain
containing cerebrospinal fluid).
2. Biochemistry
 Imbalance in levels of dopamine in different areas of the
brain.
 Excess dopamine in the mesolimbic system (emotion ,
cognition)
 Low dopamine activity in the prefrontal area of the
brain (attention, motivation, organization of behavior)

75.  Multiple
genes are involved in creating a
predisposition to develop the disorder (the
transmission of this genetic predisposition is not
yet understood).
 Prenatal difficulties (e.g., intrauterine starvation,
viral infections, perinatal complications, and
various nonspecific stressors, seem to influence
the development of schizophrenia.

76. THE PSYCHOSOCIAL PERSPECTIVE
 Determine severity of the disorder and may
trigger new episodes of psychosis.
 Family-related stress: High in expressed
emotion.
(hostility, intrusiveness, over-involved in one
another, overprotective, critical, hostile, resentful)
 buthow exactly they interact, or to what degree
is not completely understood.

77.  Life
stressors may trigger schizophrenia in people
whose genetics leave them susceptible to the illness.
 Ending relationships, leaving home, and other life
stressors have been linked to schizophrenia onset in
some cases.
 Certain personality traits may predispose individuals to
the disease.
 Low levels of social competence and a diminished
ability to experience pleasure have been linked to
schizophrenia, as have pre-existing problems with
cognitive and perceptual distortion.

78. CONCLUSION
 Clinically,
schizophrenia is heterogeneous
and this may point to heterogeneous
etiology.
 Itseems that genetics, neurodevelopmental
problems, neurochemistry and abnormal
connectivity, as well as psychosocial
stressors probably all contribute to
developing the typical clinical pictures of
schizophrenia.