1. Chapter 17
Abnormal Behavior: Deviance and Disorder

2. Key Questions
How is normality defined, and what are the major psychological disorders?
What is a personality disorder?
What are the most common sexual disorders?
What problems result when a person suffers high levels of anxiety?
How do psychologists explain anxiety-based disorders?
Is psychiatric labeling damaging?
What role does the concept of insanity play in criminal trials?

3. Facts on Psychopathology
During their lifetimes, 1 out of every 100 people will become so severely disturbed as to require hospitalization
Some 3-6% of the aged suffer from organic psychoses
In any given week, 7% of the population is experiencing an anxiety-related disorder
1 out of every 8 school-aged children is seriously maladjusted
10-20% or more of all adults will suffer a major depression in their lifetime
Each year over 2 million people in North America are admitted or readmitted for psychiatric treatment in hospitals

4. Andy Wilf Self-portraits
The self-portraits shown here were painted by Andy Wilf between 1978 and During that time, Wilf is said to have increasingly abused drugs and alcohol. This dramatic series of images is a record of his self- destructive descent into a private hell. The third painting shows a shrouded skull-and foretells the artists fate.
Wilf died of a drug overdose early in Drug abuse is but one of the many psychopathologies, or “problems in living,” psychologists seek to alleviate

5. What is Normal? Psychopathology:
Scientific study of mental, emotional, and behavioral disorders

6. Defining Abnormality Subjective Discomfort: Statistical Abnormality:
Feelings of unhappiness, anxiety, depression, or emotional distress (psychosis is exception)
Statistical Abnormality:
Having extreme scores on some dimension, such as anxiety or depression, see normal curve figure 17-1
Social Nonconformity:
Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior, note personal eccentricities can be charming and perfectly healthy

7. Fig The number of people displaying a personal characteristic may help define what is statistically abnormal. Social non-conformity does not automatically indicate psychopathology.

8. Does social non- conformity automatically indicate psychopathology?

9. What is Normal? (cont.) Situational Context:
Social situation, behavioral setting, or general circumstances in which an action takes place must be considered
Cultural Relativity:
Judgments are made relative to the values of one’s culture

10. Clarifying and Defining Abnormal Behavior (Mental Illness)
Maladaptive Behavior:
Behavior that makes it difficult to function, to adapt to the environment, and to meet everyday demands
Table 17-1
Levels of functioning (page 561)

11. DSM - IV The first axis incorporates clinical disorders.
The second axis covers personality disorders The remaining axes cover medical, psychosocial, environmental, and childhood factors functionally necessary to provide diagnostic criteria for health care assessments.
The DSM evolved from systems for collecting census and psychiatric hospital statistics, and from a United States Army manual. The DSM was substantially revised in The five revisions since its first publication in 1952 incrementally added to the number of mental disorders, though also removing those no longer considered to be mental disorders. The last major revision was the fourth edition ("DSM-IV"), published in 1994,

12. DSM-IV
Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa, and schizophrenia (disorders you defined for homework, with exception of pxy disorder)
Common Axis II disorders include personality disorders
Common Axis III disorders include brain injuries and other medical/physical disorders which may aggravate existing diseases or present symptoms similar to other disorders.

13. Axis IV: Severity of Psychosocial Stressors
Events in a persons life, such as death of a loved one, starting a new job, college, unemployment, and even marriage can impact the disorders listed in Axis I and II.  These events are both listed and rated for this axis.
Axis V: Highest Level of Functioning
On the final axis, the clinician rates the person's level of functioning both at the present time and the highest level within the previous year.  This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected.

14. Shades of Abnormality
Bob is a very intelligent, 25 year old member of a religious organization that is based on Buddhism. Bob's working for this organization caused considerable conflict between him and his parents, who are devout Catholics. Recently Bob experiences acute spells of nausea and fatigue that prevent him from working and which have forced him to return home to live with his parents. Various medical tests are being conducted, but as yet no physical causes of his problems have been found.
RATE each of these people using the following scale:
1 = Basically O.K. Psychotherapy is not necessary.
2 = Mild disturbance. Psychotherapy should be considered.
3 = Significant disturbance. Psychotherapy is definitely required.
4 = Severe disturbance. Hospitalize!

15. Shades of Abnormality
Jim was vice president of the freshman class at a local college and played on the school's football team. Later that year he dropped out of these activities and gradually became more and more withdrawn from friends and family. Neglecting to shave and shower, he began to look dirty and unhealthy. He spent most of his time alone in his room and sometimes complained to his parents that he heard voices in the curtains and in the closet. In his sophomore year he dropped out of school entirely. With increasing anxiety and agitation, he began to worry that the "Nazis" were plotting to kill his family and kidnap him.
RATE each of these people using the following scale:
1 = Basically O.K. Psychotherapy is not necessary.
2 = Mild disturbance. Psychotherapy should be considered.
3 = Significant disturbance. Psychotherapy is definitely required.
4 = Severe disturbance. Hospitalize!

16. Shades of Abnormality
Mary is a 30 year old musician who is very dedicated and successful in her work as a teacher in a local high school and as a part-time member of local musical groups. Since her marriage five years ago, which ended in divorce after six months, she has dated very few men. She often worries that her time is "running out" for establishing a good relationship with a man, getting married, and raising a family. Her friends tell her that she gets way too anxious around men, and that she needs to relax a little in general
RATE each of these people using the following scale:
1 = Basically O.K. Psychotherapy is not necessary.
2 = Mild disturbance. Psychotherapy should be considered.
3 = Significant disturbance. Psychotherapy is definitely required.
4 = Severe disturbance. Hospitalize!

17. Shades of Abnormality
Larry, a homosexual who has lived for three years with a man he met in graduate school, works as a psychologist in a large hospital. Although competent in his work, he often feels strained by the pressures of his demanding position. An added source of tension on the job is his not being able to confide in all his co-workers about his private life. Most of his leisure activities are with good friends who belong to the gay subculture
RATE each of these people using the following scale:
1 = Basically O.K. Psychotherapy is not necessary.
2 = Mild disturbance. Psychotherapy should be considered.
3 = Significant disturbance. Psychotherapy is definitely required.
4 = Severe disturbance. Hospitalize!

18. Clarifying and Defining Abnormal Behavior (Mental Illness)
Mental Disorder:
Significant impairment in psychological functioning
Those with mental illness lose the ability to adequately control thoughts, behaviors, or feelings

19. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
Psychological problems can be grouped into broad categories.
DSM-IV is not the only system for classifying mental disorders. Nevertheless, most activities in mental health settings-from diagnosis to therapy to billing of insurance companies- are influenced by the DSM. DSM-IV is both a scientific document and a social one. Major disorders are well-documented problems. Some problems, however, have little to do with “mental illness.” Instead, they are primarily socially disapproved behaviors.

20. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
Major DSM-IV Categories
Page

21. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)
Psychotic Disorder:
Severe psychiatric disorder characterized by hallucinations and delusions, social withdrawal, and a move away from reality
Organic Mental Disorder:
Mental or emotional problem caused by brain pathology (i.e., brain injuries or diseases)
Substance Related Disorders:
Abuse or dependence on a mind- or mood-altering drug, like alcohol or cocaine
Person cannot stop using the substance and may suffer withdrawal symptoms if they do

22. © Scott Camazine/Photo Researchers
Fig This MRI scan of a human brain (viewed from the top) reveals a tumor (dark spot). Mental disorders sometimes have organic causes of this sort. However, in many instances no organic damage can be found.

23. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)
Mood Disorder:
Disturbances in mood or emotions, like depression or mania
Anxiety Disorder:
Feelings of fear, apprehension, anxiety, and behavior distortions

24. © Bettmann/CORBIS
The Mad Hatter, from Lewis Carroll’s Alice’s Adventures in Wonderland. History provides numerous examples of psychosis caused by toxic chemicals. Carroll’s Mad Hatter character is modeled after an occupational disease of the eighteenth and nineteenth centuries. In that era, hatmakers were heavily exposed to mercury used in the preparation of felt. Consequently, many suffered brain damage and became psychotic, or “mad” (Kety, 1979).

25. Alice in Wonderland
Video (Johnny Depp)
Video (Disney)

26. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)
Somatoform Disorder:
Physical symptoms that mimic disease or injury (blindness, anesthesia) for which there is no identifiable physical cause
Dissociative Disorder:
Temporary amnesia, multiple identity, or depersonalization (like being in a dream world, feeling like a robot, feeling like you are outside of your body)
Personality Disorder:
Deeply ingrained, unhealthy, maladaptive personality patterns

27. Clarifying and Defining Abnormal Behavior (Mental Illness) (cont.)
Sexual and Gender Identity Disorder:
Problems with sexual identity, deviant sexual behavior, or sexual adjustment
Neurosis:
Archaic; once used to refer to anxiety, somatoform, and dissociative disorders, also used to refer to some kinds of depression

28. Personality Disorders: Blueprints for Maladjusted
Paranoid person-
Overly suspicious, mistrusting
Narcissistic person-
Pre-occupied with their own self-importance. Absorbed in fantasies of power, wealth, brilliance, beauty, and love
Borderline-
Very unstable relationships, erratic emotions, self-damaging behavior, impulsive
Histrionic
Overly dramatic, attention seekers, easily angered, seductive, vain, shallow and manipulative
TABLE 17-5 (Page 568)

29. Personality Disorders
Borderline
Girl Interrupted
Narcissistic
There Will be Blood
Histrionic
Gone With The Wind

30. Let’s Have A Party
Imagine a party where all the people had a personality disorder

31. General Risk Factors for Contracting Mental Illness
Social Conditions: Poverty, homelessness, overcrowding, stressful living conditions
Family Factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problems
Psychological Factors: Low intelligence, stress, learning disorders
Biological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability

32. Focus on a Controversy Are the Mentally Ill Prone to Violence?
Jeffrey Dahmer
Page 565

33. Personality Disorders: Antisocial Personality Disorder (APD)
A person who lacks a conscience (superego?); typically emotionally shallow, impulsive, selfish, and manipulative toward others
Oftentimes called psychopaths or sociopaths
Many are delinquents or criminals, but many are NOT crazed murderers displayed on television
Create a good first impression and are often charming
Cheat their way through life (e.g., Dr. Michael Swango, Scott Peterson)

34. APD: Causes and Treatments
Possible Causes:
Childhood history of emotional deprivation, neglect, and physical abuse
Underarousal of the brain
Very difficult to effectively treat; will likely lie, charm, and manipulate their way through therapy

35. Antisocial Personality Disorder
CINEMA EDUCATION
Michael Swango
Clockwork Orange
The Joker
Ted Bundy

36. © Robert Hare
Fig Using PET scans, Canadian psychologist Robert Hare found that the normally functioning brain (left) lights up with activity when a person sees emotion-laden words such as “maggot” or “cancer.” But the brain of a psychopath (right) remains inactive, especially in areas associated with feelings and self-control. When Dr. Hare showed the bottom image to several neurologists, one asked, “Is this person from Mars?” (Images courtesy of Robert Hare.)

37. Anxiety-Based Disorders
Feelings of apprehension, dread, or uneasiness
Adjustment Disorders:
When ordinary stress causes emotional disturbance and pushes people beyond their ability to effectively cope
Usually suffer sleep disturbances, irritability, and depression
Examples: Grief reactions, lengthy physical illness, unemployment

38. Anxiety-Based Disorders (cont.)
Generalized Anxiety Disorder (GAD):
Duration of at least six months of chronic, unrealistic, or excessive anxiety
Free-Floating Anxiety:
Anxiety that is very general and persuasive

39. Anxiety Neurosis
Worksheet (Page 125)
Anxiety Neurosis

40. Panic Disorders Panic Disorder (without Agoraphobia):
A chronic state of anxiety with brief moments of sudden, intense, unexpected panic (panic attack)
Panic Attack: Feels like one is having a heart attack, going to die, or is going insane
Symptoms include vertigo, chest pain, choking, fear of losing control
Panic Disorder (with Agoraphobia):
Panic attacks and sudden anxiety still occur, but with agoraphobia

41. Agoraphobia Agoraphobia (with Panic Disorder):
Intense, irrational fear that a panic attack will occur in a public place or in an unfamiliar situation
Intense fear of leaving the house or entering unfamiliar situations
Can be very crippling
Literally means fear of open places or market (agora)
Agoraphobia (without Panic Disorder):
Fear that something extremely embarrassing will happen away from home or in an unfamiliar situation

42. Specific Phobias
Irrational, persistent fears, anxiety, and avoidance that focus on specific objects, activities, or situations
People with phobias realize that their fears are unreasonable and excessive, but they cannot control them
Examples: (Table 17-7 page 573)
Animal type: Fear of a specific type
Natural environment: Fear of heights, storms, ocean…
Blood, injection, injury: Fear of blood, injections, treatments
Situational: Fear of situations, airplanes, elevators, enclosed spaces
Other: Fear of other situations that lead to choking, vomiting, sick

43. Social Phobia
Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public)
Celebrities with Anxiety Disorders

44. Phobia
Worksheet (Page 126)
Phobias

45. Obsessive-Compulsive Disorder (OCD)
Extreme preoccupation with certain thoughts and compulsive performance of certain behaviors
Obsession:
Recurring images or thoughts that a person cannot prevent
Cause anxiety and extreme discomfort
Enter into consciousness against the person’s will
Most common: Being dirty, wondering if you performed an action (turned off the stove), or violence (hit by a car)
Compulsion:
Irrational acts that person feels compelled to repeat against his/her will
Help to control anxiety created by obsessions
Checkers and cleaners

46. Obsessive-Compulsive Disorder (OCD)
Cinema Education
The Odd Couple
Matchstick Men
As Good As It Gets

47. OCD & Profile of a Neurotic
Worksheet( )
Obsession/Compulsion and Hysteria
The Case of A.H./Profile of a Neurotic

48. Stress Disorders
Occur when stresses outside range of normal human experience cause major emotional disturbance
Symptoms: Reliving traumatic event repeatedly, avoiding stimuli associated with the event, and numbing of emotions
Acute Stress Disorder:
Psychological disturbance lasting up to one month following stresses from a traumatic event
Post Traumatic Stress Disorder (PTSD):
Lasts more than one month after the traumatic event has occurred; may last for years
Typically associated with combat and violent crimes (rape, assault, etc.)
Terrorist attacks on September 11th, 2001, likely led to an increase of PTSD

49. Dissociative Disorders
Dissociative Amnesia:
Inability to recall one’s name, address, or past
Dissociative Fugue:
Sudden travel away from home and confusion about personal identity

50. Dissociative Identity Disorder (DID)
Person has two or more distinct, separate identities or personality states; previously known as Multiple Personality Disorder
“Sybil” or “The Three Faces of Eve” are good examples
Often begins with horrific childhood experiences (e.g., abuse, molestation, etc.)
Therapy often makes use of hypnosis
Goal: Integrate and fuse identities into single, stable personality

51. Dissociate Identity Disorder (DID)
Sybil
3 Faces of Eve
Fight Club

52. Somatoform Disorders Hypochondriasis: Somatization Disorder:
Person is preoccupied with having a serious illness or disease
Interpret normal sensations and bodily signs as proof that they have a terrible disease
No physical disorder can be found
Somatization Disorder:
Person expresses anxieties through numerous physical complaints
Many doctors are consulted but no organic or physical causes are found

53. Somatoform Disorders (cont.)
Pain Disorder:
Pain that has no identifiable organic, physical cause
Appears to have psychological origin
Conversion Disorder:
Severe emotional conflicts are “converted” into physical symptoms or a physical disability
Caused by anxiety or emotional distress but not by physical causes

54. Fig (left) “Glove” anesthesia is a conversion reaction involving loss of feeling in areas of the hand that would be covered by a glove (a). If the anesthesia were physically caused, it would follow the pattern shown in (b). (right) To test for organic paralysis of the arm, an examiner can suddenly extend the arm, stretching the muscles. A conversion reaction is indicated if the arm pulls back involuntarily. (Adapted from Weintraub, 1983.)

55. Theoretical Causes of Anxiety Disorders: Psychodynamic
Psychodynamic (Freud):
Anxiety caused by conflicts among id, ego, and superego
Forbidden id impulses for sex or aggression are trying to break into consciousness and thus influence behavior; person fears doing something crazy or forbidden
Superego creates guilt in response to these impulses
Ego gets overwhelmed and uses defense mechanisms to cope

56. Other Theoretical Causes of Anxiety Disorders
Humanistic:
Unrealistic self-image conflicts with real self-image
Existential:
Anxiety reflects loss of meaning in one’s life
Behavioristic:
Anxiety symptoms and behaviors are learned, like everything else
Conditioned emotional responses that generalize to new situations

57. More Theoretical Causes of Anxiety Disorders
Avoidance Learning:
When making a particular response delays or prevents the onset of a painful or unpleasant stimulus
Anxiety Reduction Hypothesis:
When reward of immediate relief from anxiety perpetuates self-defeating avoidance behaviors

58. Cognitive Approach Cognitive:
When distorted thinking causes people to magnify ordinary threats and failures, leading to anxiety and distress

59. Insanity Insanity: Expert Witness:
A legal term; refers to an inability to manage one’s affairs or to be aware of the consequences of one’s actions
Those judged insane (by a court of law) are not held legally accountable for their actions
Can be involuntarily committed to a psychiatric hospital
Some movements today are trying to abolish the insanity plea and defense; desire to make everyone accountable for their actions
How accurate is the judgment of insanity?
Expert Witness:
Person recognized by a court of law as being qualified to give expert testimony on a specific topic
May be psychologist, psychiatrist, and so on

60. Insanity
Insanity Defense: Person was incapable of knowing right from wrong while committing a crime
M’Naghten Rule: Standard for judging legal insanity in English common law
Must understand wrongfulness of actions to be held responsible for them
If suffering from mental disease preventing person from knowing right from wrong, can be deemed insane
Taking of a life due to insanity is not murder
Irresistible Impulse: Uncontrollable urge to act
Diminished Capacity: Temporary loss of ability to control actions or to know right from wrong

61. Psychology and the Law
The “Twinkie Defense”

62. Panic Disorder Part A read (Page 203-206)
Part B complete using Part A (Page )