Abnormal Psychology

PL1101E Sem 2, 2010-11 Dr Ryan Hong Department of Psychology

What is Abnormality?

Several criteria to understand abnormality:

Statistical or normative deviance Distressing to self and/or others Danger to self and/or others Impairment in functioning

Consideration of context cultural norms

Being in a trance state as abnormal? Homosexuality was considered a psychological disorder in the US until 1973.

Classifying Mental Disorders

The Diagnostic and Statistical Manual (DSM-IV-TR; 2000) as a classification system Comprises 5 Axes:

Axis I: Clinical Disorders (e.g., mood disorders) Axis II: Personality Disorders (e.g., Borderline PD) Axis III: General Medical Condition (e.g., brain tumor) Axis IV: Psychosocial/Env Problems (e.g. divorce) Axis V: Overall level of functioning over past year

Classifying Mental Disorders

Advantages of the DSM:

Outlining the signs and symptoms of a disorder. Easy communication among professionals. Increase reliability of diagnoses given across clinicians.

Disadvantages of the DSM:

Some of the disorders are not clearly distinct.

Avoidant Personality Disorder and Social Phobia

Too many categories of disorders - really different? People dont fit neatly into categories.

Anxiety Disorders / Moods

What are anxiety disorders?

Threat anticipation; loss of control Unrealistic, irrational fears or anxieties Disabling to daily functioning

Some examples:

Generalized Anxiety Disorder Panic Disorder (with Agoraphobia) Social and Specific Phobias Posttraumatic Stress Disorder

Generalized Anxiety Disorder

Symptom characteristics

Excessive worry Restlessness or feeling keyed up Easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbance Stomach upset

Generalized Anxiety Disorder

In constant future-oriented state of threat anticipation and apprehension
Why?

To be ever ready to deal with possible upcoming negative events

Consequences

Chronic tension, diffused restlessness, and excessive worrying

Panic Disorder/Attack

Characterized by:

unexpected and repeated episodes of intense fear

fear of losing control or going crazy fear of dying (impending doom)

accompanied by physical symptoms

chest pain, heart palpitations, sweating shortness of breath, feeling of choking dizziness, fainting Numbness or tingling sensations Chills or hot flushes

Agoraphobia
Intense fear of crowded and public places.

Escape would be physically difficult. Psychological embarrassing. Immediate help unavailable should something bad happen.

Avoidance of such places/situations. NB. About one in three people with panic disorder develops agoraphobia.

Social Phobia
Social phobia, or social anxiety, is characterized by overwhelming anxiety and excessive self-consciousness in social situations.
Why?

Fear of being exposed to scrutiny and/or potential negative evaluation from others.
Consequences

Avoid these situations or endure them with great distress. Symptoms interfere significantly with persons occupational or social functioning.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD)

Obsessions persistent thoughts, desires, impulses, or images that are intrusive.

E.g., Contamination of germs, Fear of invasion.

Compulsions behaviors that patient feels compelled to engage in in response to obsession.

E.g., Territorial checking in response to excessive worry about invasion.

Posttraumatic Stress Disorder

Symptoms:

Fear and hopelessness about the trauma. Re-living of the traumatic event (e.g., sights and sounds, flashbacks, dreams, hallucinations). Avoidance of things that are associated with trauma; accompanied by emotional numbing. Increased arousal and hypervigilance. Immediate or delayed presentation of symptoms.

Mood Disorders

Dysregulation of affect

Depression Dysthymia Bipolar Disorder

Depression

Signs and symptoms

Sad mood and crying spells Withdrawal from others Diminished interest or pleasure or motivation Sleep/eating disturbances (too much or too little) Fatigue and loss of energy Feelings of worthlessness, helplessness, or excessive guilt Self-blame, thoughts about suicide Difficulty concentrating and making decisions

Bipolar Disorder

Symptoms:

Alternates between depression and mania Manic state:

Positive euphoric moods Sense of grandeur; able to accomplish anything Works tirelessly; hyperactivity; goes on without sleep Rapid speech

Schizophrenia

Positive:

Delusions (persecution; grandeur; control) Hallucinations Disorganized and bizarre behavior Disorganized and incoherent speech

Negative:

Flat affect lack of emotions, little eye contact Poverty of speech improvished and slowed speech Avolition absence of goal-related behavior

Four Subtypes of Schizophrenia

Paranoid schizophrenia:

Delusions about people out to get them; people able to listen to their thoughts. React aggressively to people. Disorganized speech and behavior (e.g., strange dressing, obscene acts in public). Bizarre or immobile motor movements. Given if symptoms do not fit into the above subtypes.

Disorganized schizophrenia:

Catatonic schizophrenia:

Undifferentiated schizophrenia:

Borderline Personality Disorder

One of the PDs in Axis II of the DSM. Marked by instability. Their behaviors, emotions, self-images, and relationships are unpredictable.

Moods alternates between extremes. Engage in self-destructive acts like suicide and selfmutilation. About 8-10 percent do kill themselves. Other than self-destruction, people with BPD also engage in self-damaging acts (e.g., drug abuse, compulsive gambling).

Borderline Personality Disorder

Have shifting views about themselves: they do not know who they are and are confused about their values, preferences, identity, and even sexual orientation. Feeling empty; living a life without purpose and meaning. Relationships of borderline individuals tend to be intense, chaotic, emotionally-draining, and even potentially violent. One major theme is that of fear of abandonment. If BPD persons sense a hint of rejection, they get very hostile and aggressive.

Childhood Disorders

Common Childhood Disorders:

Mental Retardation Autism Disorder Oppositional Defiant and Conduct Disorder Depression and Anxiety Attention Deficit Hyperactivity Disorder

ADHD

Most frequently diagnosed Symptoms:

Inattention and inability to focus and concentrate Hyperactivity and impulsivity

More prevalent in boys than in girls (4:1) Poor psychological adaptation:

Poor social relationships with peers Do poorly in school

Autism

One of the most disabling disorders Symptoms:

Social deficits: no need for affection or interaction; inability to understand the minds of others or read social cues. Absence of speech or use of echolalia. Self-stimulation: repetitive movements like rocking and head banging. Impairment in intellect ability. Obsessed with maintaining sameness: strong attachment to objects (e.g., light switches, toy car).

Causes of Disorders

Multiple influences

Biological Genes Brain circuitry; imbalances in neurotransmitters Psychological Cognitions, beliefs, and personality Environment Role of learning Stress at home, in workplace, in relationships Trauma

Diathesis-Stress Model

The onset of a disorder is most likely a complex interaction between a persons preexisting vulnerabilities and environmental stressors. Vulnerabilities may include genes, brain anomalies, personality, and cognitive processes. Stressors may include abuse, neglect, loss, negative life events, etc. For people who are not vulnerable, they do not develop symptoms in either low or high stress environments. However, for people who are vulnerable, they may not have symptoms when there are low stress, but they may develop symptoms in the presence of stressors.

Example
4 3

Residual Change in Anxiety Symptoms

2 1 0 -1 -2 -3 Negative Life Events Low High Low Intolerance High Intolerance

Biological Factors

Genes matter

Heritability of Common Disorders:

Schizophrenia: .80 Major Depression: .37 Panic Disorder: .30 - .40 Generalized Anxiety Disorder: .30 Phobias: .20 - .40 Schizophrenia: concordance rate for MZ twins about 45%; for 1st degree relatives about 10%.

Biological Factors

Brain abnormalities

Schizophrenia:

Loss of grey matter Enlarged brain ventricles

OCD:

Subcortical structures like basal ganglia; linked at amygdala to the limbic system (control emotions). Involve in primitive beh like aggression, danger and hygiene concerns. Evoluntionary preparedness.

Biological Factors

Neurotransmitter Abnormalities

Depression:

Depletion in serotonin Dopamine dysfunction (experience of pleasure and reward)

Generalized Anxiety Disorder:

Deficiency in gamma aminobutyric acid (GABA) GABA plays a role in inhibiting anxiety Serotonin

Psychological Factors

Generalized Anxiety Disorder

Cognitions and beliefs

By worrying, can prevent bad events from happening. Believes that worrying facilitates problem solving; but actually seldom problem-solve. Even if they did, think that solutions are not effective. Intolerance of uncertainty interpret ambiguity as stressful and frustrating.

Psychological Factors

Panic Disorder
Persons vulnerable to PD are hypersensitive to their bodily sensations. (My heart is beating very fast.)

Misinterpret sensations as negative and threatening. (This is not good!) Snowballing catastrophic thinking, exaggerate sensations and consequence of sensations. (Oh no! I am having a heart attack now and I will die!) Induce even more intense bodily sensations feedback loop

Psychological Factors

Depression

Maladaptive Cognitions

Filtering out the positives

(e.g., The wedding was a disaster because my hand bouquet did not arrive.) (e.g., Failing one test means that I cannot graduate.) (e.g., The girl whom I am interested in rejected me, I am such a loser that I can never be in a relationship ever!)

Catastrophizing

Over-generalization

Psychological Factors

Depression

Faulty contingencies of self-worth (e.g., If only I can do this, then I will be a worthy person.) Pessimistic inferences on the cause of negative event Stable? (e.g., Is the cause temporary or more permanent?) Global? (e.g., Is the cause something that is going to affect only one aspect or every aspects of my life?) Pessimistic inferences on the negative event Reflects badly on oneself? Leads to other undesirable consequences?

Psychological Factors

Depression

Rumination

Focus on the sad feelings and symptoms of fatigue in order to identify the causes of these negative feelings. However, entrapped in the dwelling of negative symptoms without actually trying to solve problems. Women more prone to men in ruminating.

Perfectionism

Overly-hard on oneself to excel and meet standards (imposed by self or others); no room for mistakes.

Role of Learning

Phobias

Classical conditioning

Previously neutral stimulus paired with painful events (e.g., fear of enclosed area because Jane accidentally locked herself in closet as a child)

Observational learning

Simply watching others reacting in fear to an object can induce phobic reactions even without prior contact with object.

Role of Learning

Obsessive-Compulsive Disorder

Classical conditioning:

Shaking someones hand becomes associated with the idea of contamination by germs. Produces anxiety reactions. Washing hands reduces anxiety, so hand washing response becomes reinforced. Washing increases in future when situations evoke anxiety about contamination. Hard to extinguish such behavior when learned.

Operant conditioning:

Environmental Factors

Posttraumatic Stress Disorder

Trauma Exposure:

Nature and severity of trauma. Perception of real threat of death or injury.

Social Support:

Availability of social support modulate the course of PTSD. (Important for depression as well).

Labeling

The medical student syndrome. Labeling ourselves and others can be detrimental. Leave this to the professionals. You are not trained. Rosenhan (1973)s study on the effects of labeling:

Normal people acted as subjects and got themselves admitted into psychiatric hospitals by claiming that they heard voices in their heads. After being admitted, they acted normally. Hospital staff interpreted all behaviors through diagnostic lens. Subjects were abnormal because of their label.