2What is Normal?Psychopathology: Scientific study of mental, emotional, and behavioral disordersSubjective Discomfort: Feelings of discomfort, unhappiness, or emotional distressStatistical Abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depressionSocial Nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior
3Figure 12.1FIGURE 12.1 The number of people displaying a personal characteristic may help define what is statistically abnormal.
4What Is Normal? (cont'd)Situational Context: Social situation, behavioral setting, or general circumstances in which behavior takes placeIs it normal to walk around strangers naked? If you are in a locker room and in the shower area, yes!Cultural Relativity: Judgments are made relative to the values of one’s culture
5Clarifying and Defining Abnormal Behavior (Mental Illness) Maladaptive Behavior: Behavior that makes it difficult to function, to adapt to the environment, and to meet everyday demandsMental Disorder: Significant impairment in psychological functioning
6Clarifying and Defining Abnormal Behavior (Mental Illness) (cont'd) Psychotic Disorder: Severe psychiatric disorder characterized by hallucinations and delusions, social withdrawal, and a move away from realityOrganic Mental Disorder: Mental or emotional problem caused by brain pathology (i.e., brain injuries or diseases)Mood Disorder: Disturbances in affect (emotions), like depression or maniaAnxiety Disorder: Feelings of fear, apprehension, anxiety, and distorted behavior
7Clarifying and Defining Abnormal Behavior (Mental Illness) (cont'd) Somatoform Disorder: Physical symptoms that mimic disease or injury (blindness, anesthesia) for which there is no identifiable physical causeDissociative Disorder: Temporary amnesia, multiple personality, 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 patternsSexual and Gender Identity Disorder: Problems with sexual identity, deviant sexual behavior, or sexual adjustment
8Clarifying and Defining Abnormal Behavior (Mental Illness) Concluded Substance Related Disorders: Abuse or dependence on a mind or mood-altering drug, like alcohol or cocainePerson cannot stop using the substance and may suffer withdrawal symptoms if they doNeurosis: Archaic; once used to refer to excessive anxiety, somatoform, dissociative disorders, and some kinds of depression
9General Risk Factors for Contracting Mental Illness Social Conditions: Poverty, homelessness, overcrowding, stressful living conditionsFamily Factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problemsPsychological Factors: Low intelligence, stress, learning disordersBiological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability
10Figure 12.11FIGURE A combination of vulnerability and stress may produce psychological problems. The top bar shows low vulnerability and low stress. The result? No problem. The same is true of the next bar down, where low vulnerability is combined with moderate stress. Even high vulnerability (third bar) may not lead to problems if stress levels remain low. However, when high vulnerability combines with moderate or high stress (bottom two bars) the person “crosses the line” and suffers from psychopathology.
11InsanityDefinition: A legal term; refers to an inability to manage one’s affairs or to be unaware of the consequences of one’s actionsThose judged insane (by a court of law) are not held legally accountable for their actionsCan be involuntarily committed to a psychiatric hospitalMany movements today are trying to abolish the insanity plea and defense; desire to make everyone accountable for their actionsHow accurate is the judgment of insanity?
12Personality Disorders: Antisocial Personality Disorder (ASPD) Definition: A person who lacks a conscience (superego?); typically emotionally shallow, impulsive, selfish, and manipulative toward othersOftentimes called psychopaths or sociopathsMany are delinquents or criminals, but many are NOT crazed murderers displayed on televisionCreate a good first impression and are often charmingCheat their way through life (e.g., Dr. Michael Swango)Blind to signs of disgust in other people
13ASPD: Causes and Treatments Possible Causes:Childhood history of emotional deprivation, neglect, and physical abuseUnderarousal of the brainVery difficult to effectively treat; will lie, charm, and manipulate their way through therapy
14Anxiety-Based Disorders Anxiety: Feelings of apprehension, dread, or uneasinessAdjustment Disorders: When ongoing stressors cause emotional disturbance and push people beyond their ability to effectively copeUsually suffer sleep disturbances, irritability, and depressionExamples: Grief reactions, lengthy physical illness, unemployment
15Anxiety-Based Disorders (cont'd) Anxiety Disorders: When stress seems greatly out of proportion to the situation at handGeneralized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety
16Panic DisordersPanic 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 insaneSymptoms include vertigo, chest pain, choking, fear of losing controlPanic Disorder (with Agoraphobia): Panic attacks and sudden anxiety still occur, but with agoraphobia
17AgoraphobiaAgoraphobia (with Panic Disorder): Intense, irrational fear that a panic attack will occur in a public place or in an unfamiliar situationIntense fear of leaving the house or entering unfamiliar situationsCan be very cripplingLiterally 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.
18Specific PhobiasIrrational, persistent fears, anxiety, and avoidance that focus on specific objects, activities, or situationsPeople with phobias realize that their fears are unreasonable and excessive, but they cannot control them.
19Social PhobiaIntense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e.g., shyness, eating, or speaking in public)
20Obsessive-Compulsive Disorder (OCD) Extreme preoccupation with certain thoughts and compulsive performance of certain behaviorsObsession: Recurring images or thoughts that a person cannot preventCause anxiety and extreme discomfortEnter into consciousness against the person’s willMost common: Being dirty or wondering if you performed an action (turned off the stove)
21CompulsionsCompulsion: Irrational acts that person feels compelled to repeat against his/her willHelp to control anxiety created by obsessionsCheckers and cleaners
22Stress DisordersOccur when stresses outside range of normal human experience cause major emotional disturbanceSymptoms: Reliving traumatic event repeatedly, avoiding reminders of the event, and numbing of emotionsAcute Stress Disorder: Psychological disturbance lasting up to one month following stresses from a traumatic event
23Post-Traumatic Stress Disorder (PTSD) PTSD lasts more than one month after the traumatic event has occurred; may last for yearsTypically associated with combat and violent crimes (rape, assault, etc.)
24Dissociative Disorders Dissociative Amnesia: Inability to recall one’s name, address, or pastMemory loss is partial or complete for personal informationDissociative Fugue: Sudden travel away from home and confusion about personal identity
25Dissociative Identity Disorder (DID) Person has two or more distinct, separate identities or personality traits; previously known as Multiple Personality Disorder“Sybil” or “The Three Faces of Eve” are good examplesOften begins with horrific childhood experiences (e.g., abuse, molestation, etc.)Therapy often makes use of hypnosis
26Somatoform DisordersHypochondriasis: Person is preoccupied with fears of having a serious illness or diseaseInterpret normal sensations and bodily signs as proof that they have a terrible diseaseNo physical disorder can be foundSomatization Disorder: Person expresses anxieties through numerous physical complaintsMany doctors are consulted but no organic or physical causes are found
27Somatoform Disorders (cont'd) Pain Disorder: Pain that has no identifiable organic, physical causeAppears to have psychological originConversion Disorder: Severe emotional conflicts are “converted” into physical symptoms or a physical disabilityCaused by anxiety or emotional distress but not by physical causesGlove Anesthesia: Loss of sensitivity in areas of skin normally covered by a glove
28Figure 12.4FIGURE 12.4 (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.
29Theoretical 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.
30Other Theoretical Causes of Anxiety Disorders Humanistic-Existential: Unrealistic self-image conflicts with real self-imageExistential: Anxiety reflects loss of meaning in one’s lifeBehavioristic: Anxiety symptoms and behaviors are learned, like everything elseConditioned emotional responses that generalize to new situations
31More Theoretical Causes of Anxiety Disorders Avoidance Learning: When making a particular response delays or prevents the onset of a painful or unpleasant stimulusAnxiety Reduction Hypothesis: When reward of immediate relief from anxiety perpetuates self-defeating avoidance behaviorsCognitive: When distorted thinking causes people to magnify ordinary threats and failures, leading to anxiety and distress
32PsychosisPsychosis: Loss of contact with reality marked by hallucinations, delusions, disturbed thoughts and emotions, and personality disorganization
33DelusionsDelusions: False beliefs that psychotic individuals insist are true, regardless of overwhelming evidence against them
34HallucinationsHallucinations: Imaginary sensations, such as seeing, hearing, or smelling things that do not exist in the real worldMost common psychotic hallucination is hearing voicesNote that olfactory hallucinations sometimes occur with seizure disorder (epilepsy)
35Some More Psychotic Symptoms Flat Affect: Lack of emotional responsivenessDisturbed Verbal Communication: Garbled and chaotic speech; word saladPersonality Disintegration: Uncoordinated thoughts, actions, and emotions
36Other Psychotic Disorders Organic Psychosis: Psychosis caused by brain injury or diseaseDementia: Most common organic psychosis; serious mental impairment in old age caused by brain deteriorationKnown as senility at timesAlzheimer’s Disease: Most common cause of dementia; symptoms include impaired memory, confusion, and progressive loss of mental abilitiesRonald Reagan most famous Alzheimer’s victim
37Delusional DisordersMarked by presence of deeply held false beliefs (delusions)Usually involve delusions of grandeur, persecution, or jealousyParanoid Psychosis: Most common delusional disorderCenters on delusions of persecution
38Schizophrenia: The Most Severe Mental Illness Psychotic disorder characterized by hallucinations, delusions, apathy, thinking abnormalities, and “split” between thoughts and emotionsDoes NOT refer to having split or multiple personalities
39The Four Subtypes of Schizophrenia Disorganized Schizophrenia: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or grossly inappropriate emotionsCatatonic Schizophrenia: Marked by stupor where victim may hold same position for hours or days; also unresponsiveParanoid Schizophrenia: Preoccupation with delusions of grandeur or persecution; also involves hallucinations that are related to a single theme, especially grandeur or persecutionUndifferentiated Schizophrenia: Any type of schizophrenia that does not have paranoid, catatonic, or disorganized features or symptoms
40Causes of Schizophrenia Psychological Trauma: Psychological injury or shock, often caused by violence, abuse, or neglectDisturbed Family Environment: Stressful or unhealthy family relationships, communication patterns, and emotional atmosphereDeviant Communication Patterns: Cause guilt, anxiety, anger, confusion, and turmoilStress-Vulnerability Hypothesis: Combination of environmental stress and inherited susceptibility cause psychotic disorders
41Figure 12.7FIGURE 12.7 Lifetime risk of developing schizophrenia is associated with how closely a person is genetically related to a schizophrenic person. A shared environment also increases the risk.
42Biochemical Causes of Schizophrenia Biochemical Abnormality: Disturbance in brain’s chemical systems or in the brain’s neurotransmittersDopamine: Neurotransmitter involved with emotions and muscle movementWorks in limbic systemDopamine overactivity in brain may be related to schizophreniaGlutamate may also be related to schizophrenia
43Figure 12.8FIGURE 12.8 Dopamine normally crosses the synapse between two neurons, activating the second cell. Antipsychotic drugs bind to the same receptor sites as dopamine does, blocking its action. In people suffering from schizophrenia, a reduction in dopamine activity can quiet a person’s agitation and psychotic symptoms.
44Schizophrenic BrainComputed Tomography (CT) Scan: Computer enhanced X-ray of brain or bodyCT scans show schizophrenic brains as having wider surface fissuresMagnetic Resonance Imaging (MRI) Scan: Computer enhanced three-dimensional image of brain or body; based on magnetic fieldMRIs show schizophrenic brains as having enlarged ventricles
45Schizophrenic Brain (cont'd) Positron Emission Tomography (PET) Scan: Computer-generated color image of brain activity; radioactive sugar solution is injected into the brain.Activity is abnormally low in frontal lobes of schizophrenics
46Mood DisordersMajor disturbances in emotion, such as depression or maniaDepressive Disorders: Sadness or despondency are prolonged, exaggerated, or unreasonableBipolar Disorders: Involve both depression, and mania or hypomaniaDysthymic Disorder: Moderate depression that lasts for at least two yearsCyclothymic Disorder: Moderate manic and depressive behavior that lasts for at least two years
47Major Mood DisordersLasting extremes of mood or emotion and sometimes with psychotic features (hallucinations, delusions)Major Depressive Disorder: A mood disorder where the person has suffered one or more intense episodes of depression; one of the more serious mood disorders.Bipolar I Disorder: Extreme mania and deep depression; one type of manic-depressive illness.Mania: Excited, hyperactive, energetic, grandiose behaviorBipolar II Disorder: Person is mainly sad but has one or more hypomanic episodes (mild mania)
48Major Mood Disorders (cont'd) Endogenous Depression: Depression that seems to be produced from inside the body (due to chemical imbalances) and NOT from life eventsSeasonal Affective Disorder (SAD): Depression that only occurs during fall and winter.May be related to reduced exposure to sunlightPhototherapy: Extended exposure to bright light to treat SAD
49Figure 12.12FIGURE Seasonal affective disorder appears to be related to reduced exposure to daylight during the winter. SAD affects 1 to 2 percent of Florida’s population, about 6 percent of the people living in Maryland and New York City, and nearly 10 percent of the residents of New Hampshire and Alaska
50Suicide: Major Risk Factors Drug or alcohol abusePrior suicide attemptDepression or other mood disorderAvailability of a firearmSevere anxiety or panic attacksFamily history of suicidal behaviorShame, humiliation, failure or rejection
51Figure 12.14FIGURE Adolescent suicide rates vary for different racial and ethnic groups. Higher rates occur among whites than among non-whites. White male adolescents run the highest risk of suicide. Considering gender alone, it is apparent that more male than female adolescents commit suicide. This is the same as the pattern observed for adults.
52Figure 12.15FIGURE Suicidal behavior usually progresses from suicidal thoughts, to threats, to attempts. A person is unlikely to make an attempt without first making threats. Thus, suicide threats should be taken seriously
53Common Characteristics of Suicidal Thoughts and Feelings (Shneidman) EscapeUnbearable Psychological Pain: Emotional pain that the person wishes to escapeFrustrated Psychological Needs: Such as searching for love, achievement, or securityConstriction of Options: Feeling helpless and hopeless and deciding that death is the only option left