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Lecture 18:Abnormality Dr. Reem AlSabah

  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.
  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
  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
  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
  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.
  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.
  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.
  72. 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)
  73.  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.
  74. 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.
  75.  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.
  76. 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.