Abnormal

Psychology

Dr. Irene Karayianni

Abnormal Behavior

• Actions, thoughts and feelings that are distressing or harmful

• Not able to function in everyday life

• Not only strange and unusual

• 20% of USA population

– It is not a single symptom, but a syndrome (pattern of symptoms that appear

together)

– continuity hypothesis: abnormal behavior is more severe form of normal Ψ

problems

– discontinuity hypothesis: abnormal behavior is entirely different from normal Ψ

problems

• BUT – A bit subjective

Historical views

Supernatural theories

• Possessed by evil spirits

• Severe consequences

• Treatment: prayer, fasting, purgatives (help the person vomit out the

evil spirit), destroy their bodies to drive out Satan

Image source: http://mentalillness.umwblogs.org/stone-age/

Historical views

Biological theories

• Hippocrates: biological disorders of the body cause abnormal behavior

• The body contains 4 important fluids (humors)

– Blood

– Phlegm

– Black bile

– Yellow bile

• Imbalance in fluids illness and abnormal behavior

• He set the foundation for natural causes (rather than supernatural)

• Creation of Psychiatry

Image source: http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html

Historical views

Psychological theories

• Pythagoras said that abnormal behavior is caused by Psychological

factors such as stress

• He placed individuals in temples to receive rest, exercise, good

diet, someone to talk to, practical advice

Image source: http://www.cntraveler.com/hot-list/2012/spas/caudalia-vinotherapie-spa-alentejo-portugal

Contemporary views

• Abnormal behavior is due to

– Biological causes: genetic predispositions, abnormal functioning of nervous

system

– Psychological causes: stress, abnormal social learning

– Social causes: inadequate social support

Diagnostic and Statistical Manual of Mental Disorders (DSM)

• Provides common set of definitions of mental disorders

• Diagnostic criteria

• Multi axial system (give more than one diagnosis). Five axes:

I. clinical disorders: most mental disorders

II. personality disorders and mental retardation

III. general medical conditions

IV. psychosocial and environmental problems: adverse living conditions,

stressful circumstances

V. global assessment of functioning: how well the person is functioning in

life

DSM-I (1952)

DSM-II (1968)

DSM-III (1980)

DSM-III-R (1987)

DSM-IV (1994)

DSM-IV-TR (2000)

DSM-5 (2013)

How harmful are abnormal psychological problems?

• 9 in top 10 leading causes of disability are either psychological disorders

(e.g. depression) or strongly associated with them (e.g. alcohol)

• 50% of all disability experience is related to abnormal psychological

problems

Stigma

• We have negative perceptions of people with abnormal psychological

problems

• They make us uncomfortable

• We might be afraid of them

• Consequences:

– Stigma makes mental health problems worse, lose social support

– Prevent patients to seek health

• Fight stigma

– It is easier to think of mental problems through the continuity hypothesis;

emotions can get out of hand vs. mentally ill, losing your mind

– Education

Image source: http://www.imagebase.net/Concept/Test-012-copy

Insanity

• It is not psychological term

• A legal definition concerning a person’s inability to

– tell right from wrong they cannot be found guilty in trial

– understand trial proceedings they can’t stand trial, unable to help their

defense

– understand whether the person is a direct danger to self or others they

can be put in mental institution without their will

Anxiety disorders Phobias

Generalized and Panic Anxiety disorders

Post traumatic stress disorder

Obsessive Compulsive disorders

Image source: http://www.dailywt.com/10-sings-you-may-have-an-anxiety-disorder/

High level of negative emotions

Nervous, worried, tense, scared,

anxious

Phobias

• Intense, irrational fear for a specific situation /

object that that the individual will often go to

great pains to avoid.

• Specific phobia: scared of a specific thing

• Social phobia: scared of social interactions,

especially with strangers or situations they may

be evaluated negatively

• Agoraphobia: fear of open spaces; leaving your

home or other familiar places

Image source: http://www.thewellnessdirectory.co.nz/ailment/agoraphobia

Examples of specific phobias

• Acrophobia - Fear of Heights

• Claustrophobia - Fear of Enclosed Spaces

• Nyctophobia - Fear of the Dark

• Ophidiophobia - Fear of Snakes

• Herpetophobia - fear of reptiles

• Arachnophobia - Fear of Spiders

• Astraphobia - Fear of Thunder and Lightning

• Nosophobia - Fear of Having a Disease

Generalized anxiety disorders

• Generalized anxiety disorders: Vague, uneasy sense of general tension

and worry for no apparent reason that makes the individual very

uncomfortable because of its long duration

• Panic anxiety disorder: Panic attacks; pattern of anxiety in which long

periods of calm are broken by very uncomfortable attack of anxiety

that are not tied to a specific situation.

– Increase in breathing

– Rapid heartbeats, like having a heart attack

– 5% of population

Image source: http://www.nativeremedies.com/ailment/symptoms-of-panic-attacks.html

Post-traumatic stress disorder

• Severe anxiety and distress that persists long after traumatic event

• Many recover, but for others it is chronic

• Can lead to serious problems (alcohol, suicide)

• It involves:

– memories of event that intrude into consciousness and dreams

– intense emotional and autonomic reactions to reminding stimuli

– avoidance of stimuli associated with event

– feeling numbed to the ordinary emotions and pleasures of life

– difficulty sleeping, hyperarousal, irritability and difficulty concentrating

Stressors that cause Post-traumatic stress disorder

• war, combat-related stress

• physical assault

• rape and sexual molestation

• automobile accident

• witnessing violence and disasters

• terrorism

Who develops Post-traumatic stress disorder

• Not everyone who experiences a traumatic event <10%

• MORE likely…

– Those who experienced a more severe stressful event

– Lower intelligence

– More mental health problems prior to event

– Exposed to previous trauma

– Genetic predisposition

– People with less social support after event

– Females that were raped

Obsessive-Compulsive Disorders

• Obsession = anxiety provoking thoughts that don’t go away

• Compulsion: irresistible urge to engage in specific irrational behaviors,

such as washing your hands, repeatedly touching a spot in your

shoulder, checking the locks on doors, etc.

• 2% of population

http://www.youtube.com/watch?v=dSZNnz9SM4g

Image source: http://www.patient.co.uk/blogs/sarah-says/obsessive-compulsive-disorder

Somatoform disorders Somatization disorders

Hypochondriasis

Conversion disorders

Somatoform pain disorders

Image source: http://www.minddisorders.com/Py-Z/Somatization-and-somatoform-disorders.html

Experiencing symptoms of physical

health problems that have

psychological causes

Somatization disorders

• Chronic and recurrent aches, pains, tiredness and other symptoms of

body illness in the absence of a known medical cause.

• Usually experience other psychological difficulties (anxiety, depression)

• Dangerous because they go to extremes to alleviate symptoms (too

many medicines, alcohol, etc)

Image source: http://mighty-pen.hubpages.com/hub/Somatoform-Disorders

Hypochondriasis

• Milder form of somatization disorder

• Preoccupation with health

• Overreact to minor coughs and pains

• Going to unreasonable lengths to avoid germs and cancer-causing agents

Conversion disorders

• Rare

• Anxiety is “converted” into serious body symptoms

• Individuals experience serious body symptoms such as functional

blindness, deafness, inability to speak and paralysis without apparent

physical cause

• Individuals are ineffective and depend on others

• They show a beautiful indifference (they don’t seem to care so much,

little emotional response for their condition)

Somatoform pain disorders

• Primary symptom is pain with no physical cause

• The pain does not follow nerve pathways

• Occurs at time of high stress

Dissociative disorders Depersonalization

Dissociative amnesia

Dissociative fugue states

Dissociative identity disorder (multiple personality)

Image source: http://www.flickr.com/photos/theojunior/12146506273/

Sudden changes in cognition

Change in memory, perception, identity

Depersonalization

• Perceptual experience of one’s body or surroundings becoming distorted

or unreal

• E.g. enlarged hands, leaving one’s body and looking at it from the

ceiling

Image source: https://www.healthtap.com/user_questions/481914-what-is-the-definition-or-description-of-depersonalization

Dissociative amnesia

• Memory loss that is psychologically caused

• Loss of memory for all or part of the event

• Occurs after a period of intense stress

• Memories are recovered in time

Image source: http://psych.answers.com/abnormal/avoidant-personality-disorder-the-dos-and-donts-of-managing-your-symptoms

Dissociative fugue states

• Reversible amnesia for personal identity, including the memories,

personality, and other identifying characteristics of individuality

• usually involves unplanned travel or wandering

• Is sometimes accompanied by the establishment of a new identity.

• After recovery, previous memories usually return intact, but there is

typically amnesia for the fugue episode.

Image source: http://www.comediva.com/how-to-throw-ultimate-breaking-bad-marathon-party/

Dissociative identity disorder (multiple personality)

• Shift abruptly and repeatedly from one personality to another

• Two or more personalities, different from one another

• The original personality is often conventional, unhappy, moralistic

• At least one alternative personality is sensual and rebellious

• The original personality is not aware of the alternatives

• The alternatives are aware of the original personality

• Effort to cope with painful memories from abuse during childhood?

Mood disorders Major depression

Bipolar disorder

Schizophrenia

Image source: http://anxietyreliefzone.com/generalized-anxiety-disorder/anxiety-disorders-in-teens-when-should-they-get-help/

Involving depression and/or abnormal joy

Major depression

• Episodic disorder – symptoms come and go

• 1/3 experience it only once

• Half usually recover after 12 weeks

– Deep unhappiness, loss of interest in life

– Believe that the future is miserable

– Negative opinion of self and others

– No reason to live

– Increased / decreased sleep

– Increased / decreased appetite

– Loss of interest in sex

– Loss of energy

– Difficulty concentrating

– Loss of productivity

• Causes: high stress, loss of loved one, firing, personal humiliation,

genetic reasons, negative opinion of self

Bipolar disorder (manic-depressive psychosis)

• Experiencing periods of mania that alternate irregularly with periods of

depression

• Some shift frequently, some infrequently. Avg: 3-4 / year

• 1% of population

• Manic episode:

– intense pleasure, “high”, euphoria, high self esteem, unrealistic optimism,

little sleep is needed; also shopping sprees, quitting job, getting divorce,

sexual promiscuity

– If someone tries to control them, they get angry

• Causes: genetic predisposition

Schizophrenia

• Involves

– disturbance in the way of thinking (delusions – strange false beliefs,

hallucinations – bizarre false perceptual experiences) out of touch with

reality

– Disorganized, illogical emotions, thinking, behavior difficult to have

conversations with them

– reduced enjoyment and interests less pleasure

• 1% of population

• Males are 30% more likely than women

• Some people recover completely, more than half experience repeated

episodes

http://www.youtube.com/watch?v=rWsYIoLZHYI

Movie: a beautiful mind

Schizophrenia causes

• genetic factors

• environmental factors

– pregnancy complications that cause abnormal brain development

– childhood head injuries

– viral infections of the brain

– living in stressful urban environments

– living in families with high levels of disharmony

Schizophrenia types

• It is a broad class of psychotic disorders, broken down into 3 subtypes

– Paranoid schizophrenia: false beliefs or delusions that seriously distort

reality. Exceptional importance of self (e.g. being Jesus Christ) and hence

others are out to get them. Hallucinations (see, hear or feel things that are

not there).

– Disorganized schizophrenia: delusions and hallucinations have little

recognizable meaning because the speech and thoughts are so disorganized.

Withdrawal from human contact, silliness of emotion, childlike.

– Catatonic schizophrenia: abnormalities in social interaction, posture and

body movement. Long periods of catatonic blankness, like statues, no

talking, not seem to be listening. Frequently, periods of agitation and anger.

Image source: http://thebestpictureproject.wordpress.com/2011/04/30/awakenings/

Attention-Deficit/Hyperactivity Disorder (ADHD)

Begins in childhood, but does not always end there

Inattention symptoms:

• Can’t sustain attention

• No attention to details

• Careless mistakes

• Distracted easily

• Not complete tasks

• Disorganized

• Loses pencils, pen, assignments

• Not listen when being spoken to

• Avoids tasks that require sustained

attention

• Forgetful

Hyperactivity – impulsivity symptoms

• Twists and turns when seated

• Runs or climbs excessively

• Restlessness

• Difficulty in sitting quietly and

playing

• Talks excessively

• Answers before the questions is

completed

• Has difficulty waiting his/her turn

• Interrupts others

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Associated with difficulties at school

• Difficulties in relationships

• Accidental injuries

• Diagnosis when the individual exhibits 6+ of either group of symptoms

that cause problem in at least 2 areas of life

• Difficult to diagnose:

– Symptoms are variation of normal behavior

– Other mental problems are characterized by restlessness and attention

problems

Personality disorders Schizoid

Antisocial

Schizotypal

Paranoid

Histrionic

etc

Psychological disorders that result from personalities that developed improperly during childhood

Schizoid personality disorder

• Were very shy as children

• Emotional coldness, apathy

• Distant

• Lack of interest in social relationships

• Little or no desire to have friends

• Withdrawal in solitude, loners

• Later in life: lose interest in personal appearance, hygiene and polite

social conventions

• Often they do not work / homeless

Antisocial personality disorder

• Smooth social skills, sweet talking

• Lack of guilt about violating social rules and laws

• Unemotional

• Taking advantage of others

• Difficulty in maintaining relationship with others

• They enter easily intimate relationships but break up quickly

• Impulsive

• Abnormal need for stimulation, novelty (they may become addicts)

• Lose their temper quickly

• Lie easily and skillfully

• As children: bullies who fight, lie, cheat, steal, blame others, not learn

from mistakes

https://www.youtube.com/watch?v=wTuzVm8xtjM

Schizotypal personality disorder

• Few friends

• Suspicious

• Misinterpret situations as being strange

• Strange ideas (e.g. their mind can be read by others, or messages can

be received in strange ways)

• paranormal and superstitious beliefs

Paranoid personality disorder

• Very suspicious of others

• No trust to others

• Extreme irritability and sensitivity

• Coldness

• Lack of tender feelings

Image source: http://anxietyreliefzone.com/generalized-anxiety-disorder/anxiety-disorders-in-teens-when-should-they-get-help/

Histrionic personality disorder

• Self-centered

• Wants to be the center of attention

• Manipulating others through exaggerated expression on emotions

• Superficially charming and seductive

• Lacks genuine concern for others

• Frequent angry outbursts

Image source: http://learnhowtorock.alloyentertainment.com/perfs-back-to-school-style/#1 http://www.alexiscolby.com/2011/11/in-every-way-lady.html h

Narcissistic personality disorder

• Too self absorbed

• Egocentric

• Vanity

• Unrealistic sense of self importance

• Feels entitled to special consideration

• Fantasies of future success

• Requires constant attention and compliment

• Reacts negatively / indifferent to criticism

• Exploits others

• Lack of genuine concern for others

Image source: http://setfreefromtheic.wordpress.com/2011/08/20/why-narcissists-make-bad-church-leaders/

Borderline personality disorder

• Emotionally unstable

• Impulsive

• Unpredictable

• Unstable personal relationships

• Angry

• Almost constantly needs to be with others

• Lack of clear identity

• Feelings of emptiness

Avoidant personality disorder

• Extreme shyness

• Social withdrawal

• Although they desire friends

• Extremely sensitive to rejection

• Very low self-esteem

Image source: http://lostemerald.wordpress.com/2011/02/09/i-am-shocked-histrionic-and-avoidant-personality-disorders/

Dependent personality disorder

• Passive dependence on others for support and decisions

• Low self esteem

• Puts needs of others before self

Image source: http://blog.turbotax.intuit.com/2011/03/29/who-can-i-claim-as-a-dependent-for-this-tax-year/

Obsessive compulsive personality disorder

• Perfectionist

• Dominating

• Poor ability to express affection

• Excessive devotion to work

• Indecisive when faced with major decisions

Sexual and Gender

identity disorders

Sexual practice that differs considerably from the norm

Image source: http://hqworld.net/gallery/details.php?image_id=13553&sessionid=07448aa8acc039bb553b33356fbe23a7

Transvestism

• Almost always males

• Dressing in clothes of the other sex

– They find this sexually stimulating

– They free themselves from limiting sexual stereotypes

• With relatively well-adjusted sex lives

Gender identity disorder

• Aka transsexualism

• The individual feels trapped in the body of the wrong sex

• May dress in the clothes of the other sex

• May undergo hormone injections and plastic surgery

• Possible sex-change operation

Fetishism

• Obtaining sexual arousal primarily or exclusively from specific objects

or types of material (e.g. leather, lace)

• Is considered abnormal if it interferes with sexual adjustment of the

person or the partner

Image source: http://www.papermag.com/2011/05/a_hush-hush_louboutin_sale_lit.php

Sexual sadism and masochism

• S&M

• Sexual Sadism: receiving sexual pleasure from causing pain on others

• Sexual Masochism: receiving pain is sexually exciting

• Sometimes verbal abuse or degradation, instead of physical pain

• Many individuals who practice S&M, do so with a consenting partner,

and do not cause pain that is medically dangerous

• In some cases, it involves intense pain or death

Image source: http://lordsofthedrinks.com/2014/01/09/men-in-saudi-arabia-get-whip-lashes-and-jail-time-for-party-with-alcohol-and-girls/

Voyeurism

• Obtaining sexual pleasure by watching others undressing or engaging in

sexual activities

• Usually when the other is not aware of their presence

• Element of danger involved

• Usually heterosexual males who find it difficult to establish a normal

sexual relationship

• Few commit rape

Image source: http://yatin.chawathe.com/photos/2002-07-Turkey/istanbul/html/peeping-tom.html

Exhibitionism

• Obtain sexual pleasure from exposing their genitals to others

• They want to shock their victims

• Rarely dangerous in other ways

• Almost all are heterosexual males

• Typically married

• Shy and with inhibited sex lives

Forced sexual behavior

• Rape: forcing sexual activity on an unwilling person

– Usually males

– Aggressive impulses, need to feel powerful and dominating rather than

sexual desire

– 18 mil women have been raped in the USA

– Usually by someone they already know