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) 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) 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) 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 Biological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disabilityPsychological Factors: Low intelligence, stress, learning disorders ________________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 problemsOther sources of psychological stress
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.
11Personality 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
12ASPD: 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
13Anxiety-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 can be some triggers for anxiety
14Anxiety-Based Disorders (cont'd) Anxiety Disorders: When stress seems greatly out of proportion to the situation at hand …usually accompanied by some form of avoidance3 Main TypesGeneralized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxietyPanic Disorder (w/ or w/o agoraphobia)Phobia
15Generalized Anxiety Disorder Extreme anxiousness and worry for at least 6 monthsAnxiousness/anxiety do not fade when life circumstances get betterMultiple topics of worry
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)
20Review: 3 Anxiety Disorders 1. Phobia—objects, situation, socialCauses: not only experience…also inherit tendencies (prepared fears)2. Generalized Anxiety—constant anxiety and worry3. Panic Disorder—discrete panicky episodes
21Obsessive-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)
22CompulsionsCompulsion: Irrational acts that person feels compelled to repeat against his/her willHelp to control anxiety created by obsessionsCheckers and cleaners
24AnxietyFeelings of tension, uneasiness, apprehension, worry, and vulnerabilityWe are motivated to avoid experiencing anxiety
25Figure 10.6FIGURE 10.6 The approximate relationship between the id, ego, and superego, and the levels of awareness.
26Theoretical 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.
27Other Theoretical Causes of Anxiety Disorders Humanistic-Existential: Unrealistic self-image conflicts with true self
28Other Theoretical Causes of Anxiety Disorders Behavioristic: Anxiety symptoms and behaviors are learned, like everything elseConditioned emotional responses generalize to new situationsAnxiety 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
29Freudian Defense Mechanisms Defense Mechanisms: Habitual and unconscious (in most cases) psychological processes designed to reduce anxiety
30More on Defense Mechanisms Work by avoiding, denying, or distorting sources of threat or anxietyIf used short term, can help us get through everyday situationsIf used long term, we may end up not living in realityProtect idealized self-image so we can live with ourselves
31Freudian Defense Mechanisms: Some Examples Denial: Most primitive; denying reality; usually occurs with death and illnessRepression: When painful memories, anxieties, and so on are held out of our awarenessReaction Formation: Impulses are repressed and the opposite behavior is exaggerated
32More Defense Mechanisms Projection: When one’s own feelings, shortcomings, or unacceptable traits and impulses are seen in others; exaggerating negative traits in others lowers anxietyRationalization: Justifying personal actions by giving “rational” but false reasons for them
34Name that defense mechanism! Your ex-spouse, who cheated on you, writes a best-selling nonfiction book arguing that human beings are not naturally monogamous and have an instinctive need for variety.rationalization
35Name that defense mechanism! You are in love with your best friend’s new flame. The friendship is an old one and very valuable to you. You tell everybody that your friend’s new love interest is a terrible human being and you don’t understand the attraction at all.
36Mood 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 hypomaniaSeasonal 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
37Major 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)
38Suicide: 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
39Figure 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.
40Figure 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
41Common 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
42Stress 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
43Post-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.)
44Dissociative 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
45Dissociative 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
46Somatoform 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
47Somatoform 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
48Figure 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.
49Other 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
50More 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
51PsychosisPsychosis: Loss of contact with reality marked by hallucinations, delusions, disturbed thoughts and emotions, and personality disorganization
52Other 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
53Delusional 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
54Schizophrenia: 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
55DelusionsDelusions: False beliefs that psychotic individuals insist are true, regardless of overwhelming evidence against themCommon forms:ErotomanicGrandioseJealousPersecutionSomaticErotomanic: Delusions of love from another person, especially someone famous or of higher statusGrandiose type: In this case, people suffer from the delusion that they have some great, unrecognized talent, knowledge, or insight. They may also believe that they have a special relationship with an important person or with God or that they are a famous person. (If the famous person is alive, the deluded person regards her or him as an imposter.)Jealous type: An example of this type of delusion would be having an all-consuming, but unfounded, belief that your spouse or lover is unfaithful.Persecutory type: Delusions of persecution involve belief that you are being conspired against, cheated, spied on, followed, poisoned, maligned, or harassed.Somatic type: People suffering from somatic delusions typically believe that their bodies are diseased or rotting, or infested with insects or parasites, or that parts of their bodies are defective.People with delusional disorders usually do not suffer from hallucinations, emotional excesses, or personality disintegration.
56HallucinationsHallucinations: 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)
57Some More Psychotic Symptoms Flat Affect: Lack of emotional responsivenessInappropriate emotions:Disturbed Verbal Communication: Garbled and chaotic speech; word saladPersonality Disintegration: Uncoordinated thoughts, actions, and emotions…a “split” between thought and emotionWithdrawal and apathyBreakdown of personal habitsProblems with selective attentionImpaired “sensory filter” –it is hard for people with schizophrenia to focus on one item of info. at a time….overwhelmed by a jumble of thoughts, sensations, images, and feelings
58The 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 symptomsDisorganized—comes close to matching the stereotypes in the movies—Personality disintegration is almost complete—Emotions, speech, and behavior are all highly disorganized. The result is silliness, laughter, bizare or obscene behaviorCatatonic—seem to be in a total panic and trying desperately to control their inner turmoil…similar to freezing at times of great emergency or panic…Mutism (no speaking) and unresponsive to environmentParanoid—most common—centers on delusions of grandeur and persecution…also hallucinate…may erupt in violence in attempt to protect themselves
59Causes of Schizophrenia Psychological Trauma: Psychological injury or shock, often caused by an environment of violence, abuse, or neglectDisturbed Family Environment: Stressful or unhealthy family relationships, communication patterns, and emotional atmosphereDeviant Communication Patterns: Cause guilt, anxiety, anger, confusion, and turmoilHeredity—if one identical twin becomes schizophrenic then the other twin has about 50% chanceStress-Vulnerability Hypothesis: Combination of environmental stress and inherited susceptibility cause psychotic disorders
60Figure 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.
61Biochemical 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 schizophreniaDopamine appears to trigger a flood of unrelated thoughts, feelings, and perceptions, which may account for the voices, hallucinations, and delusions of schizophreniaGlutamate is implicated as well—glutamate influences brain activity in areas that control emotions and sensory informationAlso—stress alters glutamate levels which in turn alter dopamine systems
62Figure 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.
63Schizophrenic 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
64Schizophrenic 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
65Major 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
66Figure 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