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Abnormal Psychology.

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1 Abnormal Psychology

Modules 45-48

3 3 major criteria for diagnosing psychological disorders
Deviance-behavior that is not considered to be in the norm Maladaptive behavior-behavior that interferes with a person’s social or occupational functioning Personal distress-how much distress it causes the individual

4 Costs of Mental Illness
- Costs more than $150 billion each year for treatment - Schizophrenia alone costs up to $30 billion - Lithium for Bipolar Disorder has saved approximately $145 billion since 1970 - Clozapine for Schizophrenia has saved approximately $23,000/patient annually

5 Youth and Mental Illness
- U.S. adolescents appear to be at high risk for mental illness - Schizophrenia tends to manifest itself in adolescence or early adulthood - U.S. adolescents are the only group in which there continues to be an increase in the death rate, from accidents, suicide and homicide

6 Warning Signs of trouble
* - marked drop in school performance or increase in absenteeism - excessive use of alcohol and/or drugs - marked changes in sleeping and/or eating habits - many physical complaints (headaches, stomach aches) - aggressive or non-aggressive violations of the rights of others - withdrawal from friends, family and regular activities - depression demonstrated by continued, prolonged negative mood and often accompanied by poor - appetite and/or difficulty sleeping

7 - frequent outbursts of anger or rage
- low energy level, poor concentration, complaints of boredom - loss of enjoyment in what used to be favorite activities - unusual neglect of personal appearance

8 Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
- Axis I-Clinical Syndromes-includes many of the disorders that are in chapter 14 - Axis II-Personality Disorders or Mental Retardation (See personality disorders) - Axis III-General Medical Conditions-assesses any chronic physical disorders or conditions that may contribute to disorders - Axis IV-Psychosocial and Environmental Problems-negative life events, troubled relationships, trouble with the law, school, work, etc. - Axis V-Global Assessment of Functioning-After assessing axes 1-4, the psychologist makes a determination regarding a score that they would assess the person’s level of functioning. A score of a 10 means the person is in persistent danger of severely hurting themselves or others and a score of 100 means they are functioning at a superior level.

9 Generalized Anxiety Disorder (GAD)
"I always thought I was just a worrier. I'd feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about what I was going to fix for a dinner party, or what would be a great present for somebody. I just couldn't let something go." "I'd have terrible sleeping problems. There were times I'd wake up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I'd feel a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were: when I got a stomachache, I'd think it was an ulcer."

10 Anxiety Disorders Class of disorders marked by excessive or chronic anxiety or apprehension Generalized Anxiety Disorder - marked by a chronic, high level of anxiety that is not due to anything specific. Age of onset may be between 10 and 14 years of age. - Causes-No specific threat, symptoms must be present for at least 6 months - Symptoms-Restlessness or feelings of being keyed up or on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance - Treatments-Benzodiazepines (Valium and Ativan), Tricyclic Antidepressants, Psychotherapy

11 Panic Disorder "For me, a panic attack is almost a violent experience. I feel disconnected from reality. I feel like I'm losing control in a very extreme way. My heart pounds really hard, I feel like I can't get my breath, and there's an overwhelming feeling that things are crashing in on me." "It started 10 years ago, when I had just graduated from college and started a new job. I was sitting in a business seminar in a hotel and this thing came out of the blue. I felt like I was dying." "In between attacks there is this dread and anxiety that it's going to happen again. I'm afraid to go back to places where I've had an attack. Unless I get help, there soon won't be anyplace where I can go and feel safe from panic."

12 Panic Disorder characterized by sudden and unexpected attacks of anxiety. Age of onset usually between 15 and 19 - Causes-defects in the brain (specifically the brain stem, limbic system and frontal cortex) - Symptoms-heart palpitations, sweating, trembling, feeling of choking, shortness of breath, fear of dying, chest pain or discomfort, feeling dizzy. - Treatments-Tricyclic Antidepressants, SSRI’s, MAOI’s, Antianxiety druges (e.g., Xanax, Ativan), Cognitive-Behavioral treatments Panic Attack

13 Phobias "I'm scared to death of flying, and I never do it anymore. I used to start dreading a plane trip a month before I was due to leave. It was an awful feeling when that airplane door closed and I felt trapped. My heart would pound, and I would sweat bullets. When the airplane would start to ascend, it just reinforced the feeling that I couldn't get out. When I think about flying, I picture myself losing control, freaking out, and climbing the walls, but of course I never did that. I'm not afraid of crashing or hitting turbulence. It's just that feeling of being trapped. Whenever I've thought about changing jobs, I've had to think, "Would I be under pressure to fly?" These days I only go places where I can drive or take a train. My friends always point out that I couldn't get off a train traveling at high speeds either, so why don't trains bother me? I just tell them it isn't a rational fear."

14 Phobic Disorder - marked by a persistent and irrational fear of things that don’t really pose a threat. Age of onset often between 7 and 9 years of age - Causes-may run in families and be present in females more often, usually a classically conditioned response - Symptoms-marked and persistent fear that is excessive or unreasonable, intentional avoidance of object or situation - Treatment-Mostly behavior therapy, but can also use Antianxiety drugs (e.g., Valium), Tricyclic Antidepressants, MAOI’s, Psychotherapy Phobias

15 Social Phobia "In any social situation, I felt fear. I would be anxious before I even left the house, and it would escalate as I got closer to a college class, a party, or whatever. I would feel sick in my stomach-it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else." "When I would walk into a room full of people, I'd turn red and it would feel like everybody's eyes were on me. I was embarrassed to stand off in a corner by myself, but I couldn't think of anything to say to anybody. It was humiliating. I felt so clumsy, I couldn't wait to get out."

16 Obsessive-Compulsive
"I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn't add up to a 'bad' number." "I knew the rituals didn't make sense, and I was deeply ashamed of them, but I couldn't seem to overcome them until I had therapy." "Getting dressed in the morning was tough, because I had a routine, and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me."

17 Obsessive-Compulsive Disorder
An unusual disorder of ritual and doubt. Obsessions are persistent and intrusive thoughts, images, ideas or impulses. Compulsions are repetitive, purposeful behaviors that are performed in response to an obsession. They understand that their actions are unreasonable, but cannot stop themselves. Age of onset is usually between 9 and 12 years of age.

18 OCD Causes-may be genetic, may be due to neurotransmitter activity, there has been some indication that some have the onset of this disorder after having strept throat (they think that possibly the antibodies that are supposed to fight the infection actually attack the basil ganglia)

19 OCD - Symptoms-Obsessions: recurrent and persistent thoughts, excessive worry about real-life problems, impulses which may be deemed inappropriate. Compulsions: repetitive behaviors or mental acts that a person feels driven to perform as a result of the obsession, behaviors done to reduce distress. Person recognizes that obsessions or compulsions are unreasonable. Marked distress, time consuming or significantly interferes with a person’s normal routine.

20 OCD - Treatments-Behavior therapy (systematic des., flooding, thought stopping), Tricyclic Antidepressants, SSRI’s (today, Luvox is commonly used, also may use Prozac or Zoloft)

21 Post-Traumatic Stress Disorder
"I was raped when I was 25 years old. For a long time, I spoke about the rape as though it was something that happened to someone else. I was very aware that it had happened to me, but there was just no feeling." "Then I started having flashbacks. They kind of came over me like a splash of water. I would be terrified. Suddenly I was reliving the rape. Every instant was startling. I wasn't aware of anything around me, I was in a bubble, just kind of floating. And it was scary. Having a flashback can wring you out." "The rape happened the week before Thanksgiving, and I can't believe the anxiety and fear I feel every year around the anniversary date. It's as though I've seen a werewolf. I can't relax, can't sleep, don't want to be with anyone. I wonder whether I'll ever be free of this terrible problem."

22 Post-Traumatic Stress Disorder (PTSD)
- display of persistent anxiety following an overwhelming traumatic event - Causes-traumatic event that is not a usual event in the normal human experience - Symptoms-traumatic event is persistently reexperienced, may have images or thoughts of the event, recurrent distressing dreams of the event, reliving the event, insomnia, exaggerated startle response. - Treatments-Psychotherapy (systematic des., flooding), Cognitive-Behavioral therapy

23 Somatoform Disorders Disorders in which the person may feel physical pain or problems but there is no physiological basis for them, they are psychological in nature. Psychosomatic: when the person feels physical pain, and there is a biological reason for them – due to stress.

24 Types of Somatoform Disorders
Somatization Disorder: When the person experiences a wide variety of physical problems that are due to psychological problems. Conversion Disorder: When the person experiences a loss of physical functioning in a body part with no physical reason for this to happen. May effect, vision, hearing, use of limbs. Hypochondriasis: When the person is excessively worried about their health, worry about developing illnesses and often manufacture the symptoms of various illnesses in their head.

25 Causes and Treatments Causes of these disorders: May be due to increased sensitivity of autonomic nervous system, while others feel it is a personality or cognitive defect. People who are histrionic, that is, self-centered, suggestible, excitable, and highly emotional may be more susceptible. Treatment: Psychoanalysis or cognitive therapy may be helpful.

26 Dissociative Disorders
When a person experiences bouts of memory loss, due to loss of consciousness and have disruptions in their sense of identity. Dissociative Amnesia: A sudden loss of memory for important personal information that is too severe to be considered normal. May occur for one traumatic event or period of time. Dissociative Fugue: When a person loses their memory for their entire life along with who they are and what their identity is. May forget name, family, where they live, etc.

27 Dissociative Identity Disorder: When there is the existence of two or more personalities coexisting in the same body (used to be called Multiple Personality Disorder). The host personality is supposedly unaware of any other personalities, however, some have reported that one or more of the other personalities may be aware of what is happening. Causes: It is thought that the cause of Dissociative Identity Disorder is some type of repeated, chronic psychological trauma during childhood. Dissociative amnesia or fugue may be brought on by excessive stress. Treatment: Psychoanalysis is usually a treatment

28 Personality Disorders
- May be characterized by any of the following: affects a person’s sense of self as well as others, lacks appropriate emotional responses, impersonal functions, lacks impulse control, behavior that is inflexible, inability to function in social, occupational and other functions of life, onset traced back to early adolescence or early adulthood Disorders that are considered odd/eccentric Schizoid Personality Disorder - odd eccentric behavior, tend to be loners, may be perceived to be cold and unfeeling, trouble keeping jobs and maintaining relationships, show very little emotion

29 Paranoid Personality Disorder
- suspicious and mistrustful of others, refuse to accept criticism or blame, may be cautious, scheming, devious, or argumentative, does not like to confide in others, difficult to get along with Schizotypal Personality Disorder - suspicious, shows signs of paranoia, aloof and impersonal, shows signs of magical thinking, unusual perceptual thinking, may have speech that resembles schizophrenia (disorganized)

30 Antisocial personality disorders
failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure impulsivity or failure to plan ahead irritability and aggressiveness, as indicated by repeated physical fights or assaults reckless disregard for safety of self or others consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

31 Borderline personality disorder
frantic efforts to avoid real or imagined abandonment. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation identity disturbance: markedly and persistently unstable self-image or sense of self impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) chronic feelings of emptiness inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) transient, stress-related paranoid ideation or severe dissociative symptoms

32 Histrionic personality disorder
is uncomfortable in situations in which he or she is not the center of attention interaction with others is often characterized by inappropriate sexually seductive or provocative behavior displays rapidly shifting and shallow expression of emotions consistently uses physical appearance to draw attention to self has a style of speech that is excessively impressionistic and lacking in detail shows self-dramatization, theatricality, and exaggerated expression of emotion is suggestible, i.e., easily influenced by others or circumstances considers relationships to be more intimate than they actually are

33 Narcissistic personality disorder
has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) requires excessive admiration has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends lacks empathy: is unwilling to recognize or identify with the feelings and needs of others is often envious of others or believes that others are envious of him or her shows arrogant, haughty behaviors or attitudes

34 Avoidant personality disorder
avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection is unwilling to get involved with people unless certain of being liked shows restraint within intimate relationships because of the fear of being shamed or ridiculed is preoccupied with being criticized or rejected in social situations is inhibited in new interpersonal situations because of feelings of inadequacy views self as socially inept, personally unappealing, or inferior to others is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

35 Dependent personality disorder
has difficulty making everyday decisions without an excessive amount of advice and reassurance from others needs others to assume responsibility for most major areas of his or her life has difficulty expressing disagreement with others because of fear of loss of support or approval. has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy) goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself

36 Obsessive-compulsive personality disorder
is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification) is unable to discard worn-out or worthless objects even when they have no sentimental value is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes shows rigidity and stubbornness

37 Mood Disorders 1) Major Depression: A “whole body” illness involving body, mood and thoughts. Affects the way the person eats, sleeps and how they feel about themselves. Symptoms can last for weeks, months or years. Usually lasts around 9 months, but if it goes longer, it will usually dissipate within 2 years.

38 DEPRESSION CONTINUED Causes: 1) Some types run in families, 2) low levels of serotonin, 3) low self-esteem, 4) those who are pessimistic, 5) those overwhelmed by stress, 6) serious loss, 7) chronic illness, 8) difficult relationships, 9) financial problems Symptoms: 1) persistent sad, anxious, “empty” mood, 2) feelings of hopelessness, 3) feelings of guilt, worthlessness, helplessness, 4) loss of interest in pleasures or hobbies, 5) insomnia or oversleeping, 6) weight loss or weight gain, 7) decreased energy/fatigue, 8) thoughts of suicide or death

39 Depression continued Treatments: 1) Antidepressants (Tricyclics, MAOI’s, SSRI’s), 2) Psychotherapy (“talking” therapies, gaining insight), 3) ECT (for severe depression), Lithium (for recurrent major depression), 4) behavior therapy (gaining self-reinforcements for positive behavior)

40 Teen Depression Approximately 1 in 33 children and 1 in 8 adolescents are affected by depression at any given time Suicide is the 3rd leading cause of death for year olds and the 6th leading cause for 5-14 year olds 70% of those diagnosed do not get any treatment

41 High risk: loss, attention disorders, conduct or anxiety disorders
High risk: Teenage girls, minorities Treatment is most effective when there is early intervention, yet most people do not know the symptoms of depression

42 Often, a teen with depression may be seen as a “normal” teen angst as they may appear angry, belligerent, irritable and hostile When this extends beyond 6 months, however, this is considered to be a problem

43 Bipolar Disorder Bipolar Disorder: A disorder that is characterized by episodes of depression and mania. Causes: 1) runs in families, 2) many different genes may be working together Symptoms: Depression: See major depression Mania: 1) inappropriate elation, 2) inappropriate irritability, 3) severe insomnia, 4) increased talking, 5) disconnected and racing thoughts, 6) inappropriate social behavior, 7) feelings of grandiosity, 8) racing thoughts, 9) abuse of drugs and alcohol

44 Bipolar is a continuous range.
At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic.

45 Descriptions by Bipolars
Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless…. [I am] haunt[ed]… with the total, the desperate hopelessness of it all…. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?

46 Hypomania: At first when I'm high, it's tremendous… ideas are fast… like shooting stars you follow until brighter ones appear…. All shyness disappears, the right words and gestures are suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but, somewhere this changes.

47 Mania: The fast ideas become too fast and there are far too many… overwhelming confusion replaces clarity… you stop keeping up with it—memory goes. Infectious humor ceases to amuse. Your friends become frightened…. everything is now against the grain… you are irritable, angry, frightened, uncontrollable, and trapped.

48 Treatments: 1) Lithium 2) Antipsychotic drugs 3) Psychosocial treatment 4) Psychoeducation 5) Family Therapy 6) Psychotherapy (individual and group therapy)

49 Seasonal Affective Disorder: Disorder in which there is some form of depression associated with the time of year (usually found in fall and winter. Causes: Thought that the pineal gland monitors the amount and quality of light that our eyes receive. The Pineal body secretes chemicals, which controls sleep and may switch the body into a “hibernating” mode for the winter months. Symptoms: 1) depression occurs during certain seasons in the year, 2) weight gain, 3) excessive sleeping, 4) loss of interest in pleasures or hobbies Treatments: Light therapy (phototherapy)

50 SD

51 Psychological Disorders and Therapies

52 Why does someone develop an eating disorder?
Dieting Sports Control issues Emotional instability

53 Very often, the female (or male) will also engage in the use of laxative, diuretics and /or diet pills May also engage in overexercising May be an addictive behavior

54 Anorexia nervosa: the relentless pursuit of thinness
Person refuses to maintain normal body weight for age and height. Weighs 85% or less than what is expected for age and height. In women, menstrual periods stop. In men levels of sex hormones fall. Young girls do not begin to menstruate at the appropriate age

55 Person denies the dangers of low weight.
Is terrified of becoming fat.  Is terrified of gaining weight even though s/he is markedly underweight. Reports feeling fat even when very thin. often includes depression, irritability, withdrawal, and peculiar behaviors such as compulsive rituals, strange eating habits, and division of foods into "good/safe" and "bad/dangerous" categories. May be overly engaged with or dependent on parents or family. Dieting may represent avoidance of, or ineffective attempts to cope with, the demands of a new life stage such as adolescence.

56 Research suggests that about one percent (1%) of female adolescents have anorexia.
That means that about one out of every one hundred young women between ten and twenty are starving themselves, sometimes to death.

57 Bulimia nervosa: the diet-binge-purge disorder
Person binge eats. Feels out of control while eating. Vomits, misuses laxatives, exercises, or fasts to get rid of the calories. Diets when not bingeing. Becomes hungry and binges again. Believes self-worth requires being thin. (It does not.)

58 May shoplift, be promiscuous, and abuse alcohol, drugs, and credit cards.
Weight may be normal or near normal unless anorexia is also present. Like anorexia, bulimia can kill. Bulimics are often depressed, lonely, ashamed, and empty inside. Friends may describe them as competent and fun to be with, but underneath, where they hide their guilty secrets, they are hurting.

59 Research suggests that about four percent (4%), or four out of one hundred, college-aged women have bulimia. About 50% of people who have been anorexic develop bulimia or bulimic patterns. Because people with bulimia are secretive, it is difficult to know how many older people are affected.

60 What are the health risks?
Nausea, irritability, fatigue, dizzy Body lacks essential nutrients Irregular or cessation (amenorrhea) of menstrual cycles Bones may become brittle and susceptible to breakage – osteoporosis due to low estrogen levels

61 Bones tend to age prematurely
Skin may become dry and cold Fine hair develops on arms, face, back and legs (lanugo) Depressed functioning of the brain

62 Risk increased of heart failure
Restlessness Kidney problems

63 Changes in body metabolism associated with weight loss leads to a lowering of:
Heart rate Blood pressure Breathing rate Body temperature (which may result in feeling cold)

64 Self-induced vomiting and laxative abuse are associated with physical complications such as:
Swollen salivary glands (evident by swelling on the sides of the face) Erosion of tooth enamel, increase in dental cavities Fatigue Body fluid loss Bloating, swelling of the feet and ankles

65 Soreness or tears in the lining of the mouth or throat
Constipation, stomach cramps Numbness and tingling in the limbs Dizziness, weakness, fainting

66 Binge eating disorder The person binge eats frequently and repeatedly.
Feels out of control and unable to stop eating during binges. May eat rapidly and secretly, or may snack and nibble all day long. Feels guilty and ashamed of binge eating. Has a history of diet failures

67 Tends to be depressed and obese.
People who have binge eating disorder do not regularly vomit, overexercise, or abuse laxatives like bulimics do. They may be genetically predisposed to weigh more than the cultural ideal (which at present is exceedingly unrealistic), so they diet, make themselves hungry, and then binge in response to that hunger. Or they may eat for emotional reasons: to comfort themselves, avoid threatening situations, and numb emotional pain. Regardless of the reason, diet programs are not the answer. In fact, diets almost always make matters worse.

68 Anorexia athletica (compulsive exercising)
Not a formal diagnosis. The behaviors are usually a part of anorexia nervosa, bulimia, or obsessive-compulsive disorder. The person repeatedly exercises beyond the requirements for good health. May be a fanatic about weight and diet. Steals time to exercise from work, school, and relationships. Focuses on challenge. Forgets that physical activity can be fun. Defines self-worth in terms of performance

69 Is rarely or never satisfied with athletic achievements.
Justifies excessive behavior by defining self as a "special" elite athlete. Compulsive exercising is not an official diagnosis as are anorexia, bulimia, and binge eating disorder. The real issues are not weight and performance excellence but rather control and self-respect.

70 Body dysmorphic disorder
BDD is thought to be a subtype of obsessive-compulsive disorder. It is not a variant of anorexia nervosa or bulimia nervosa. The person with an eating disorder says, "I am so fat." The person with BDD says, "I am so ugly." BDD often includes social phobias. Sufferers are shy and withdrawn in new situations and with unfamiliar people. BDD affects about two percent of the people in the United States. It strikes males and females equally. Seventy percent of cases appear before age eighteen. Sufferers are excessively concerned about appearance, in particular perceived flaws of face, hair, and skin. They are convinced these flaws exist in spite of reassurances from friends and family members who usually can see nothing to justify such intense worry and anxiety.

71 BDD sufferers are at elevated risk for despair and suicide
BDD sufferers are at elevated risk for despair and suicide. In some cases they undergo multiple, unnecessary plastic surgeries. BDD is treatable and begins with an evaluation by a physician and mental health care provider. Treatments that have been found to be effective include medication (especially meds that adjust serotonin levels in the brain) and cognitions

72 Orthorexia nervosa Not an official eating disorder diagnosis. A pathological fixation on eating "proper" or "pure" or "superior" food. People with orthorexia nervosa feel superior to others who eat "improper" food, which might include non-organic or junk foods Orthorexics obsess over what to eat, how much to eat, how to prepare food "properly," and where to obtain "pure" and "proper" foods. Eating the "right" food becomes an important ,or even the primary, focus of life. One's worth or goodness is seen in terms of what one does or does not eat. Personal values, relationships, career goals, and friendships become less important than the quality and timing of what is consumed. Perhaps related to, or a type of, obsessive-compulsive disorder

73 Attention Deficit Hyperactivity Disorder
(ADHD)-disorder in which the individual may experience periods of inattentiveness, hyperactivity, impulsivity, and difficulty concentrating. Age of onset may be earlier than 6 or 7, but not clearly diagnosed until this time. - Causes-implications regarding various areas of the brain

74 Symptoms-Inattentive type:
inattention that has persisted for at least 6 months which becomes maladaptive, may lack attention to detail, make careless mistakes, difficulty maintaining attention for in tasks or play, difficulty following directions, often loses things, often forgetful in their daily activities.

75 Hyperactivity-impulsive type-fidgeting with hands or feet, squirms in seat, leaves seat in classroom, runs about or climbs excessively when inappropriate, has difficulty playing or engaging in leisure activities, often talks excessively. Combined type: symptoms of the above two.

76 Symptoms were present before the age of 7 and some impairment must be present in two or more settings. -Treatments-behavioral therapy, pharmacological (usually Ritalin) See a nutritionist

77 Schizophrenic Disorders
Class of disorders that may be characterized by delusions, hallucinations, disorganized speech and maladaptive behavior. People are often on medications for life. 4 types: 1. Paranoid type: marked by delusions of persecution and delusions of grandeur. 2. Catatonic type: marked by either long periods of motionlessness and unaware of environment or periods of hyperactive movement and incoherent speech.

78 3. Disorganized type: marked by emotional indifference, incoherent speech, random babbling and silliness 4. Undifferentiated type: demonstrates behaviors from the other three categories. Causes: May be the only disorder that people agree has a genetic component. May be related to neurotransmitter activity, especially an excess of dopamine. May have structural abnormalities of the brain. Treatments: Medications are usually effective.

79 Abnormal Psych-Therapies
Psychotherapy Likely to seek therapy are: insured, divorced/separated, single, over 16 years of age, females Psychologists may earn a Ph.D., Psy.D., or Ed.D. They have 5 to 7 years of training beyond bachelor’s degree. Also there is a requirement of 1 to 2 years in a clinical setting. Psychiatrists earn an M.D. degree. Graduate training requires 4 years of coursework in medical school. There is also a requirement of a 4 year apprenticeship in a residency at a hospital.

80 Insight Therapies 1) Psychoanalysis-deals with unconscious conflicts, motives, and defenses through techniques such as free association and transference. (Freud) a) free association: where the client spontaneously express their thought and feelings exactly as they occur, with very little censorship. b) dream analysis: when therapist interprets symbolic meanings of client’s dreams

81 c) talking therapies: in which the client talks, trying to reach catharsis (release of emotions)
Possible negative problems during therapy a) resistance: a mostly unconscious defense mechanism that may hinder the progress of therapy b) transference: when the client transfers feelings for their critical relationships onto the therapist c) countertransference: when the therapist transfers feelings they have for others onto the client

82 2) Client-centered therapy-therapy in which the client plays a major role in determining the pace and direction of therapy. The client is thought to be “their own best therapist”. Therapist serves as a facilitator, they provide clarification. Carl Rogers, founder of this method of therapy, states:

83 “It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried. It began to occur to me that unless I had a need to demonstrate my own cleverness and learning, I would do better to rely upon the client for the direction of movement in the process”

84 Rogers believed that the therapist should be:
genuine empathetic (feeling for the client) have unconditional positive regard (be nonjudgmental towards the client regardless of what they tell the therapist)

85 3) Cognitive therapy: helps the client to recognize and overcome negative thoughts about themselves. (Aaron Beck and Albert Ellis). Client is trained to detect their automatic thought processes. Often utilized with behavioral therapy today. 4) Group therapy: when several clients are treated at the same time. Participants often act as the “therapist” while the therapist serves as a facilitator. Advantages: 1) saves time and money 2) clients realize that their misery is not unique 3) participants can work on social skills

86 Behavior Therapies-based on the principles of classical, operant and observational learning.
1. Aversion therapy-an aversive stimulus is paired with a stimulus that brings on an undesirable response. 2. Systematic desensitization-clients slowly faces phobic stimulus in a step-by-step process in which they relieve themselves of anxiety at each step 3. Flooding-clients are quickly exposed to phobic stimulus not allowing for time to relieve anxiety

87 3. Token economies – giving tokens for correct behavior that can be later exchanged for desired goods. 4. Social skills training-designed to improve interpersonal skills that emphasizes modeling, behavioral rehearsal and shaping (reinforcing each step towards desired goal behavior) 5. Biofeedback-a bodily function (such as heart or blood pressure) is monitored, and information about the bodily function is given back to the client. Helps control physiological processes.

88 Biomedical Therapies 1. Psychopharmacotherapy-treatment of mental disorders with medication a) Antianxiety drugs: relieve tension, apprehension and nervousness. Effects are seen rather immediately and can last for several hours. Most popular are Xanax and Valium.

89 b) Antipsychotic drugs:
primarily used to treat Schizophrenia, but may be given to those with severe mood disorders who become delusional. appear to decrease the levels of dopamine in a person’s system. Most popular are Thorazine, Mellaril and Haldol. Antipsychotics may have a negative side effect called tardive dyskinesia, which has symptoms similar to Parkinson’s disease (involuntary writing and ticklike movements of the mouth, tongue, face, hands and feet).

90 c) Antidepressant drugs: drugs that gradually elevate mood and help bring people out of a depression. Takes several weeks to see improvement. There are three types: 1. Tricyclics: the first group of antidepressant drugs. Have a tendency to have more side effects than SSRI’s. (Elavil) 2. MAOI’s (monoamine oxidase inhibitors)-Second group of antidepressant meds. One has to be very careful about certain foods and meds taken with these drugs as they could have potentially fatal results. (Nardil) 3. SSRI’s (selective serotonin reuptake inhibitors)-Newest class of antidepressant drugs. Include meds such as Prozac, Paxil, and Zoloft.

91 d) Lithium-chemical used to control mood swings in patients with bipolar disorder. Lithium levels in the blood must be monitored carefully because high levels could be toxic or even fatal.

92 2. Electroconvulsive Therapy (ECT)-treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. Primarily used on those with severe depression. May lead to gaps in memory or short-term memory loss. Seems to “rewire” the brains circuitry. 3. Lobotomy-Procedure in which cells in the forebrain are lesioned. Has been used to treat severe schizophrenics.

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