Understanding Abnormal Psychology & Mental Disorders
Psychopathology Notes
Criteria for Abnormal Behavior
Distress
How do we know it when we see it?
- Discomfort
- Behavior
- Speech pattern
Abnormal behavior refers to patterns of thought, feeling, or behavior that are atypical, distressing, dysfunctional, and sometimes dangerous.
Impairment
- In major life functions: struggle at work or at school, in relationships
- AKA “psychological disability”
Cultural “Inappropriateness”
- Or behaviors that are “culturally unexpected”?
Diagnosing Syndromes, Not Symptoms
- The difference is that syndromes are clusters of symptoms
Definition of Mental Disorder
- An underlying dysfunction…
- Produces a syndrome…
- Characterized by clinically significant (distress or impairment)
Notes Exclusion
- Especially “expected or culturally approved responses to common stressors”
Mental Health
- Negative definition – Freedom from psychological disability
- Positive Definition –
– Effective function
– Gratifying relations
– Can work effectively and productively
– Ability to make “realistic appraisals”
– Being able to understand and fully grasp the word NO or BOUNDARIES
DSM-V: Four Main Criteria for Identifying Abnormal Behavior
- Violation of social norms
- Statistical rarity: Behaviors that are uncommon or rare
- Personal distress: subjective discomfort
- Maladaptive behaviors: behaviors that are detrimental to a person’s life, such as a way of responding to stress
Criteria of Abnormality
In general, psychologists look at four different criteria for defining abnormal behavior. Each has its strengths, and each has its problems.
The first criterion is violation of social norms. Behavior that goes against what is considered normal by society is abnormal. As we just saw, culture plays a role in social norms, as does age. A man who takes off all his clothes and jumps in a fountain is likely to be seen as acting strangely, whereas a three-year-old who does it might just be seen as cute.
Another criterion for identifying abnormal behavior is statistical rarity. A person who has an extremely low IQ, for example, might be classified with some type of intellectual disability. Because there is only a small percentage of the population with intellectual disabilities, it is rare and therefore abnormal. Of course, the problem with statistical rarity is that people who are exceptionally intelligent are just as rare as those with intellectual disabilities. So according to this criterion, Albert Einstein would be abnormal.
A third criterion of abnormal behavior is personal distress. When we engage in abnormal behavior, the cause (and sometimes, result) of our behavior can be distress. A good example of this is obsessive-compulsive disorder, where anxiety about something can lead to compulsive behaviors meant to relieve that distress. The problem with personal distress, though, is that some people with mental illness do not feel distress, such as people with antisocial personality disorder who have an underdeveloped conscience.
The final criterion for defining abnormal behavior is maladaptive behavior. Is the behavior likely to hurt the person or someone else? Whether it is physical harm or social harm, such as losing a job or the respect of your peers, maladaptive behavior leads to some type of harm.
Categories or a Continuum
Prevalence of Mental Disorders
Research Concepts
- Case Studies – Correlation
- Epidemiological Research – Experimental Research
- Sampling/Generalization – Placebo Effect
- Reliability – Double-blind design
- Validity
Historical Perspectives/Paradigms
Supernatural Perspectives
Naturalistic Perspectives
- Look at more biological things
Humanitarian Perspectives
Class: September 5th
- Number of disorders continues to grow
- Criteria have become more specific, detailed
- Shifted from psychodynamic perspective to “atheoretical perspective” and a “medical model”
Classification Challenges
Reliability
– Does it allow clinicians to diagnose consistently?
– Does it allow clinicians to agree on a diagnosis?
– Interrater/interobserver reliability
Validity
- Are DSM diagnoses actually distinctive/discrete conditions?
- Construct validity…desire
- Do DSM diagnoses help us to expect the course/outcome for clients?
- Predictive validity
The Diagnostic Process
Clinical Interview
- To get a better understanding of the patient, you need to find out what’s relevant and what is not.
The Mental Status Examination
- Appearance and Behavior
- Overt behavior
- Attire
- Appearance, posture, expression
- You are able to read people more easily if you pay attention to what someone wears.
- Although you have to separate assumption and the actual situation
- Clinical judgment
- Thought Process
- Rate of speech
- Continuity of speech
- Content of speech
- Mood and Affect
- Predominate feeling state of the individual
- Feeling state accompanying what the individual says
- Intellectual Functioning
- Types of vocabulary
- Use of abstraction and metaphors
- Sensorium
- Awareness of surroundings in terms of person (self and clinician), time, and place. “Oriented times three”
Psychological Tests
- IQ tests
- Projective tests
- Personality inventories – purpose is to categorize or level them
- Other self-report inventories
Neuropsychological Assessment
– Neuropsychological testing doesn’t determine your diagnosis.
– Brain imaging, e.g., MRI
Class: September 12th
Panic Attack Symptoms
- Palpitations, heart pounding, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensation of shortness of breath or smothering
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Chills or heat sensations
- Paresthesias (numbness or tingling sensations)
- Derealization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or going crazy
- Fear of dying
Panic Disorder
A. Recurrent unexpected panic attacks
- The single most important thing to remember about panic attacks is that they must be unintentional.
Agoraphobia
- They don’t leave their house, societal embarrassment
- The heart of this phobia is losing control or being unable to control what others will think due to their actions.
- Nausea and vomiting due to the thought of losing control of their bladder
- Side note: Never actually happened
Specific Phobias
- Marked fear of objects – seeing or touching this object creates an intense fear or anxiety
Biological Contributing Factors
- Genetics/hereditary patterns
- Looking at the brain structures and functions
Psychological Contributing Factors
Behavioral Factors
- Learned associations of cues (interoceptive and exteroceptive) and fear
Two-Factor Theory
- Forms through classical conditioning
- Maintained through operant conditioning
- Vicarious conditioning (via observational learning)
Cognitive Factors
- Misinterpretation of bodily sensations
- Interpreting events catastrophically
- Belief of limited control
Psychodynamic Factors
- Intrapsychic conflicts
- Overwhelmed ego
Sociocultural Contributing Factors
- Stressful life events
- Interpersonal difficulties
Cultural Factors
- Variable symptom expression
- Culturally-bound syndromes
GAD (Generalized Anxiety Disorder)
People with Generalized Anxiety Disorder (GAD) worry about a wide range of things, including:
- Everyday situations: Job security, performance, finance, health, family, chores, and being late
- Future events: What might happen, rather than what is happening
- Catastrophic events: Earthquakes, nuclear war, and disasters
- Minor issues: Household chores and other minor concerns
Anxiety Treatments
(How can we go back? How can we change what happened?)
Biological (Medication)
Benzodiazepines
– Used to treat anxiety
– How benzos work: Used to stimulate GABA
– GABA is involved in calming the person with anxiety
– Examples of Benzodiazepines: Xanax, Ativan, Klonopin, Valium
SSRIs (Selective Serotonin Reuptake Inhibitors)
– Medications: Prozac, Paxil, Zoloft
– SSRIs stimulate serotonin
– Increase serotonin levels in the brain by blocking the reabsorption of serotonin after it carries a message between nerve cells
Psychological Therapies
Exposure Treatment/Therapy
– Systematic desensitization, flooding
– Example: Red cape and anger implies the bull will get angry when seeing the color, then pulling it away and doing that a few more times to get them used to it.
– Changing the associations they have with these things from anger and fear to comfort and calm
Cognitive Restructuring
– Identifies, challenges, and modifies distorted thoughts.
Social Skills Training
Acceptance/Commitment Therapy
More Anxiety Disorders
Usually diagnosed in children
- Selective mutism
- Separation anxiety disorder
Exclusionary Diagnoses
- Substance/Medication-Induced Anxiety Disorder
- Anxiety Disorder Due to Medical Conditions
Obsessive-Compulsive Disorder
- Presence of obsessions and/or compulsions
Obsessions are cognitive; you can’t see them in person.
Behavioral compulsions: Washing hands, turning off lights repetitively
Mental compulsions: Replaying conversations over and over in your head
- Time-consuming or significant distress or impairment
- Not due to substance or medical conditions
- Not better explained by other disorders
More Obsessive-Compulsive Disorders
- Body Dysmorphic Disorder
– Preoccupation with perceived physical defects plus related repetitive acts - Hoarding Disorder
– Difficulty discarding possessions, regardless of value
– Inability to distinguish what’s important and what’s not important - Trichotillomania
– Repetitive, compulsive hair-pulling - Excoriation Disorder
– Repetitive, compulsive skin-picking
Contributing Factors
Biological
- Genetics/heritability
- High left frontal cortex activity
Psychological
- Behavioral: Two-factor theory
– A concept that states the factors that affect an individual’s satisfaction and motivation level. Motivators have a more important impact on job performance than hygiene factors. - Psychodynamic: Overuse of defense mechanisms, fixation/regression to “anal-retentive” tendencies (following rules to a T)
Sociocultural
- Exposure to trauma, abuse
Treatments
Biological
- SSRIs
- Cingulotomy – a neurosurgical procedure that alters tissue in the brain’s anterior cingulate region to treat chronic pain, obsessive-compulsive disorder (OCD), and other debilitating diseases.
Psychological
- Behavioral: Exposure and response prevention (ERP) – similar to flooding but not the same
- Cognitive: Cognitive restructuring
Mood Disorders
- Split into depressive disorders and bipolar disorders
Mood Episodes
*Difference between episodes and disorders: The length of time they occur
Cannot have an episode without a change in function