ABNORMAL PSYCHOLOGY

What is normal?
 ABNORMALITY…
… a deviation from the average
… a deviation from the ideal
… a sense of personal discomfort
… an inability to function effectively
… a legal concept (Insanity NOT
psychological term)
ABNORMAL BEHAVIOR
• ….causes people to experience
distress & prevents them from
functioning in their daily lives.
 5 PERSPECTIVES
• Biological (neurological; medical)
• Psychoanalytic (psychoanalytical)
• Behavioral (behaviorism)
• Humanistic
• Cognitive
 DIAGNOSIS
• A professional determination
of whether or not a person
meets the criteria for the
behaviors related to a disorder.
DSM-V

Diagnostic and Statistical

Manual for Mental Disorders
(5th edition)
 DSM-V CLASSIFICATIONS
• Mood Disorders • Delirium,
• Anxiety Dementia, Amnesia
• Somatoform • Substance related
• Dissociative disorders
• Schizophrenia • Eating Disorders
• Personality
• Disorders from
birth or infancy
 DSM-IV
• Benefits
– Diagnostic consistency
– Enhances communication with other clinicians
– Assists in education & training
• Drawbacks
– Reification (over identification with diagnosis)
– Diagnostic Heterogeneity (overlap; misdiagnose)
– Lack of scientific basis (some markers of disorders
are not clear or too general)
 MOOD DISORDERS
• Major Depression
• Bipolar Disorder
–Causes, symptoms & treatment
 Major Depression
• ‘Clinical Depression’ or ‘Major Depressive Disorder’ (MDD)
• 2x more likely in women
• Causes (unknown)
– Chemical imbalances due to genes or stressful life events (loss;
marital problems, etc…)
• Treatment
– Anti-depressant medication (SSRI)
• Zoloft commercial
– Talking cure (psychoanalysis)
• Prognosis
– 80% can recover; 2/3 never seek treatment
 Major Depression
• Symptoms (at least 5) – Loss of interest or
– Weight changes pleasure in activities that
were once enjoyed
– Concentration problems
– Thoughts of death or
– Fatigue
suicide
– Feelings of hopelessness – Trouble sleeping or
& helplessness excessive sleeping
– Becoming withdrawn or
isolated
 Bipolar
• ‘Manic-Depression’ • Treatment
• Causes (not known) – Controlling episodes
– Genetics/ higher chance – Medication
• Symptoms • Lithium; antipsychotics;
anti depressants
– Manic episodes (extreme
– Weight gain, sleepiness,
happiness & energy) memory loss
– Depressive episodes – Group/ family counseling
– Reckless behavior and – Substance abuse
lack of self control counseling
 ANXIETY
• A feeling of constant worry,
nervousness or unease.
• Normal VS Abnormal?
 ANXIETY
• Generalized Anxiety Disorder (GAD)
• Post-Traumatic Stress Disorder (PTSD)
• Obsessive-Compulsive Disorder (OCD)
• Panic Disorder
• Specific Phobias
 G.A.D.
• Causes (stress; genes)
• Symptoms (occurring more days than not for 6 months)
– Constant presence of worry; Difficult to control
– Restlessness (‘keyed up’ or on edge)
– Fatigue and irritability
– Concentration problems; mind ‘goes blank’
– Muscle tension
– Problems falling or staying asleep
– Startled very easily
 G.A.D.
• Physical symptoms
– muscle tension (shakiness; headaches)
– stomach problems (nausea; intestinal)
• Treatment
– Medication
• Antidepressants; Benzodiazepines
– Cognitive-behavioral therapy
– Psychotherapy
 P.T.S.D.
• Causes A-motivational
– after seeing or – Arousal
experiencing a traumatic • Difficulty in
event involving the threat concentration;
of injury or death. Startling easily with
• Symptoms (30+ days) exaggerated response;
– Reliving the event sleep disturbances;
• Flashbacks; memories; feeling overly aware all
nightmares; the time
associations

– Avoidance
 P.T.S.D.
• Treatment
– Desensitization treatment
– Group/ Family Therapy
– Medications (antidepressant, anti-
anxiety and sleep aids)
 O.C.D.
• Obsessions- persistent unwanted thoughts
that keep reoccurring.

• Compulsions- irresistible urges to repeatedly

carry out acts that seems strange and
unreasonable.
– Relieves anxiety from obsessions
 O.C.D.
• Washers
• Checkers
• Doubters & sinners
• Counters & arrangers
• Hoarders (now listed as ‘Hoarding Disorder’)
 O.C.D.
• Treatment
–Exposure/response therapy
–Cognitive-behavioral
–Family/ Group therapy
 Hoarding Disorder
• New to DSM-V
• Listed as OCD Related Disorder
• Symptoms:
– Difficulty discarding items
– Strong perceived need
– Accumulate large number of possessions
• Usually no real-world value
– Affects functioning socially, job etc…
 Hoarding Disorder
• Causes
– Genes
– Brain injuries
– Trauma or loss
– Other psychiatric disorders
• Treatment
– CBT
• Learn to let go of unnecessary possessions
• Improve organization, decision-making and relaxation
– Medication
• Antidepressants
Hoarding: Assessment Questions
1. Do you have trouble discarding (or recycling, selling, giving
away) things that most other people would get rid of?
2. Because of the clutter or number of possessions, how difficult
is it to use the rooms and surfaces in your home?
3. To what extent do you buy items or acquire free things that
you do not need or have enough space for?
4. To what extent do your hoarding, saving, acquisition, and
clutter affect your daily functioning?
5. How much do these symptoms interfere with school, work, or
your social or family life?
6. How much distress do these symptoms cause you?
 Panic Disorder
• repeated "panic attacks" of intense
fear that something bad will occur.
• Causes (unknown; genetics)
– 2x more in women
 Panic Disorder
• Chest pain or discomfort • Palpitations, fast heart
• Dizziness or faintness rate, or pounding heart
• Fear of dying, losing • Sensation of shortness of
control or impending breath or smothering
doom • Sweating, chills, or hot
• Feeling of choking flashes
• Nausea or upset stomach • Trembling or shaking
• Numbness or tingling in
the hands, feet, or face
 Panic Disorder
• Begin suddenly/ peak at 10-20mins
• Treatment
– Therapy and Medication
• Benzodiazepines or anti-depressants
 Specific Phobias
• Intense, irrational fear of a
specific object or situation
• Sense of extreme danger
• Panic Attacks; ‘Trigger’ known
• Possible Cause: Conditioning
 Specific Phobias
• Acrophobia- heights • Ochlophobia- crowds
• Agrophobia- entering public • Ophidiophobia- snakes
places (PD) • Phonophobia- speaking out
• Ailurophobia- cats loud
• Ablutofobia- bathing • Xenophobia- strangers
• Cynophobia- dogs • Coulrophobia- clowns
• Arachnaphobia- spiders • Gamophobia- commitment
• Claustrophobia- closed or marriage
spaces
• Mikrophobia- germs
• Nyctophobia- dark
 Phobias – Treatment Options
• Exposure Therapy – focuses on changing patients
response to the feared object or situation
• Gradual, repeated exposure to the source of phobia
• For example, if you're afraid of elevators, your
therapy may progress from simply thinking about
getting into an elevator, to looking at pictures of
elevators, to going near an elevator, to stepping into
an elevator. Next, you may take a one-floor ride, then
ride several floors, and then ride in a crowded
elevator.
 Phobias – Treatment Options
• Cognitive Behavioral Therapy - exposure combined
with other techniques to learn ways to view and
cope with the feared object or situation differently.
• Learn alternative beliefs about fears and bodily
sensations and the impact they've had on the
person’s life.
• Emphasizes learning to develop a sense of mastery
and confidence with thoughts and feelings rather
than feeling overwhelmed by them.
 Perspectives view on
Anxiety
• Neurological (Biological)
• Behaviorism
• Cognitive
 SOMATOFORM
• Psychological
disturbances that take
on a physical (somatic)
form, without medical
cause.
Hypochondriasis
• Constant fear of illness and a preoccupation
with their health.
• Cause is usually some form of stress (aging in
or loss of loved one)
• Treatment: Learn skills for coping with….
– CBT
– Exposure Therapy
 Conversion
• Involves an actual physical disturbance
– Loss of movement in a limb
– Inability to use sensory organ
• Treatment:
– CBT
– Physical therapy
– Transcranial magnetic stimulation
 DISSOCIATIVE
• Psychological dysfunction where
parts of the personality become
separated (dissociate)
• Normally work together but
separate can hide memories or
perceptions (reduces anxiety)
 Dissociative Identity
Disorder (DID)
• Multiple Personality- person displays
two or more distinct personalities
that often “take control”
• Cause- severe trauma or abuse
 D.I.D.
• Listed in the DSM but still
controversial
• Still rare and not widely diagnosed
–Hollywood portrayals
• Video- CBS Multiple Personality
Disorder
 INFANCY, CHILDHOOD,
ADOLESCENCE
• Mental retardation
• ADHD
• Developmental Disorders
–Autism
–Down’s Syndrome
 Mental Retardation
• Disability that has to do with how well or
how fast a person can think & learn
• Appears before adulthood
• Highly impaired cognitive functioning and
deficits in two or more adaptive behaviors
• Caused by brain damage or birth defects
• Permanent
IQ score under 70; Bell curve (HW: quickiqtest.net)
Class AVG: 122
 Mental Retardation
• The primary goal of treatment is to
develop the person's potential to the
fullest
• Encourage them to live
independently if possible
• Develop sense of self & nurture
strengths
 Mental Retardation
Prognosis
• The outcome depends on a person’s
opportunities, personal motivation &
quality of treatment
– Some have productive lives & function well on their
own
– Some need constant care and support
 What are these stats for?
• 3-5 % of School Age Children (1:25)
• 2 % of Adolescents (1:50)
• 0.8 % of 20 year-olds (1:125)
• 0.2 % of 30 year olds (1:500)
• 0.05 % of 40 year olds (1:2000)
 ADHD
• Attention Deficit Hyperactivity Disorder
• Triad:
– (a) Inattentiveness, (b) Hyperactivity,(c) Impulsiveness
• Patient must have 6 of either a or b
• Maladaptive & Pervasive
– Impairment in at least 2 settings (ex. Home or school)
• Academic & Behavioral Problems
– Onset Prior to Age 7
• boys 3 to 1
 ADHD
You must know a person’s HISTORY to diagnose.
• Behavioral: classroom & home
• Medical: year by year school performance,
developmental
• Psychiatric: other disorders
• Family: ADHD, psychiatric disorders
• Social: Family Dysfunction, Parenting Skills
(NOT the cause!)
 ADHD
• Treatment usually involves medication
– Ritalin or Adderall.
• Sleep problems; loss of appetite; tics
– Sometimes combined with anti-depressants or
other psychotropic drugs
• Behavioral Modification Therapy
• Meditation
 ADHD over diagnosed?
• Video
• Transcendental
Meditation VS Meds
Developmental Disorders
• Autism
• Downs Syndrome
 AUTISM
• Complex neurological disorder
• 1st 3 years of life
• Affects brain's development of social &
communication skills
• No known cause
– past= unfit mothering; vaccines
• Regression
• 3-4 times more in boys
 Symptoms
• 1. Social interaction (at least 2)
– Obvious difficulties in use of nonverbal
behaviors
• eye contact, facial expressions, posture etc …
– No peer relationships
• play alone; don’t interact
– Don’t share enjoyment, interest or
achievements
– Lack of social or emotional reciprocity
 Symptoms cont…
• 2. Communication (at least 1)
– Delay or lack of development of spoken language
• echolalia
– Inability to initiate or sustain conversation
– Lack of “make-believe” play
 Symptoms cont…
• 3. Repetitive patterns of behavior (at
least 2)
– Preoccupation or focusing on one object or
parts of objects
• gives stability
– Inflexible to change
• Routines, schedules
– Repetitive mannerisms
• hand or finger flapping or twisting, tip toes
 Treatment
• No cure; life long
• Iintervention & education
• learn to function & use the positive
aspects of their condition to their benefit
• Treat it early and modify to the child's
unique strengths, weaknesses & needs.
• Music therapy
• Family couseling
ASPERGER'S SYNDROME
• Higher functioning autism
• Social difficulties; restricted & repetitive
patterns of behavior & interests (same as
autism)
• Relatively no verbal or cognitive issues (above
average IQ)
• Physical clumsiness & atypical use of language
(not for diagnosis)
 SAVANT SYNDROME
• ‘Idiot Savant’ (knowledgeable idiot) or ‘Autistic
Savant’
• Memorization; musical; artistic; calendar;
calculations; languages
• Men 6 to 1
 DOWN’S SYNDROME
• Dr. J. Langdon Down (Down’s Syndrome)
• genetic disorder; results from extra copy
of Chromosome 21
• 1 in every 732 live birth
• 80% of 'trisomy 21' pregnancies end in
miscarriages
• Screening during pregnancy
• Mild to moderate mental impairment
 Physical Symptoms
• small hands and feet, a flat face, irregular ear
shape, poor muscle tone, and short necks
• Problems with vision, heart, speech
 Treatment
• Ongoing throughout patient’s life
• Support systems (medical/
family)
• Meds and behavioral therapy
• Encouragement to lead normal
life
 DEMENTIA
• A progressive decline in memory & at least
one other cognitive area in an alert person
– Rare in people under 50 yrs old
– Not specific; collective term
• Caused by: Alzheimer's, stroke, Down’s Syndrome,
AIDS, alcoholism, Parkinson’s disease
– Personality changes; delusions; hallucinations;
loss of emotional control
 
Brain Review
 TYPES OF DEMENTIA
A. Cortical- cortex of brain affected; memory,
language & social behavior
B. Sub cortical- below cortex; changes in
emotions & movement; also some memory

1. Primary- doesn’t result from another

disease (Alzheimer's)
2. Secondary- physical disease or injury
 Alzheimer's
• Form of dementia that causes a gradual
decline in thinking abilities, usually
during a span of 7 to 10 years
• Nearly all brain functions are eventually
affected due to nerve cell death.
• #1 cause of Dementia
 Alzheimer's
• Average expectancy after diagnosis
3-10 years
• No cure
• Maintain functioning with meds that
slow the progression
• Prevention: Exercise your brain!!
 DELIRIUM
• Delirium is characterized by confusion
and rapidly altering mental states.
– TREATABLE
• People with dementia are at increased
risk of delirium; may have both.   
• Causes: Dementia, Infection, Rx Drugs,
HIV….
 Delirium & Dementia?
• Onset-
– delirium occurs quickly
– dementia is progressive
• Attention-
– The inability to stay focused or maintain attention is
significantly impaired with delirium.
– A person in the early stages of dementia remains
generally alert.
• Fluctuation-
– delirium daily ups and downs
– dementia stays consistent (except: moonlighting)
 AMNESIA
• Memory loss
• Retrograde
– able to gain new memories but can’t
remember anything before onset
• Anterograde
– memories don’t transfer from short
term to long term memory
 SUBSTANCE RELATED
DISORDERS
• Abuse
• Dependence
• Induced disorders
• Withdrawal
 Drug Abuse
• DSM-"maladaptive pattern of
substance use manifested by
recurrent and significant
adverse consequences related
to the repeated use of
substances."
 Drug Abuse
• failure to meet obligations at home or
work
• recurrent use in dangerous situations
• multiple drug-related legal problems
• continued drug use despite ongoing
social or interpersonal problems brought
on by the drug use
 Drug Dependence
• Symptoms ranging from cognitive
to behavioral to physiological
• Pattern of use resulting in
tolerance, withdrawal and
compulsive behavior.
 Treatment
• 12-step support groups
• inpatient rehabilitation
• medical detoxification
• group therapy
• outpatient drug treatment
• Music therapy
 Opiate Withdrawal
Early symptoms : Late symptoms:
• Agitation • Abdominal cramping
• Anxiety • Diarrhea nausea and
• Muscle aches vomiting
• Insomnia • Dilated pupils
• Runny nose • Goose bumps
• Sweating
• Yawning
 Cannabis Withdrawal
 3 or more of the •    Depressed mood
following: •    Physical symptoms
• Irritability, anger or causing significant
aggression discomfort: stomach
• Nervousness or pain, shakiness,
anxiety sweating, fever, chills,
• Insomnia  headache
• Decreased appetite or
weight loss