ABNORMAL PSYCHOLOGY

Chapter 1 and 2

Abnormal psychology

the branch of science of psychology that deals with the nature, description, causes, treatment of abnormal behavior patterns.

Abnormal Psychology

branch of psychology that studies unusual patterns of behavior, emotions, and thought which may or may not indicate an underlying condition.

Anxiety or depression

Abnormal behavior in which psychologists and other scholars view this condition are typified by what emotions?

Mental disorders

characterized by psychological dysfunction which causes physical and/or psychological distress or impaired functioning and is not an expected behavior according to societal or cultural standards.

Psychological Disorder

psychological dysfunction within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected

Psychological Dysfunction

refers to a breakdown on cognitive, emotional, or behavioral functioning

➢ Interferes daily functioning

Distress or Impairment

individual is extremely upset and cannot function properly

➢ Either to self or to others

Atypical or Not Culturally Expected (Deviance)

deviates from the average or the norm of the culture

➢ Not just to the society but deviation from the person’s usual behavior

Dangerousness

creates potential harm to self (suicidal gestures) and others (excessive aggression)

Duration

is this change in mental state persistent and of sufficient and significant Duration? We know that our mood, thoughts and behaviors to fluctuate constantly, moment to moment. This is normal and to be expected. However, if the change in mood and behaviors is sustained, persistent and pervasive (present across all contexts and situations), it is more concerning.

Duration cut-off

somewhat arbitrary, is decided by expert consensus backed by scientific research, and varies among different mental illnesses.

Psychopathology

scientific study of mental disorders

Clinical Psychology

applied branch of psychology that seeks to understand, assess, and treat psychological conditions in a clinical setting.

Normal Behavior

one behavior that is like other people in the society

Normal behavior characteristics

● Normality is social conformity – some behaviors are non-conforming but normal

● Normality is personal comfort

● Normality is a process

Criteria for determining Abnormal Behavior

Norm-violation

Statistical rarity

Personal Discomfort

Deviation

Maladaptiveness

Clinical Assessment

the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder

Diagnosis

process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder

MANIFESTATION OF ABNORMAL BEHAVIOR

1. Behavior is unusual.

2. Behavior is socially unacceptable or violates social norms.

3. Perception or interpretation of reality is faulty.

4. The individual is in severe personal distress.

5. Behavior is maladaptive or self-defeating.

6. Behavior is dangerous.

Behavior is unusual

Behavior that is unusual is often considered abnormal. When one claims of seeing or hearing things that do not really exist, are almost considered abnormal. Becoming overcome with the feelings of panic when standing in a crowded elevator is also uncommon and considered abnormal.

Behavior is socially unacceptable or violates social norms.

A person standing on elevated sidewalk and repeatedly shouting “kill” to passerby would be labeled abnormal. Bur shouting “kill” while watching a volleyball game is usually within normal norms.

Perception or interpretation of reality is faulty.

Normally, our sensory systems and cognitive processes permit us to form accurate mental representations of the things we see in the environment. But seeing things and fearing voices or sounds that are not present are considered hallucinations, which are often signs of mental disorder. By the same premise, holding unfounded ideas or delusions, such as ideas of persecution that the MNLF are “out to attack” our barangay again may be regarded as signs of mental disturbances.

The individual is in severe personal distress.

Various states of personal distress cause by troublesome emotions, e.g., anxiety, fear, and depression, may be considered abnormal. Appropriate feelings of distress are not usually considered abnormal unless they become prolonged and persisted long after the source of anguish or anxiety has been removed.

Behavior is maladaptive or self-defeating.

Behavior that leads to unhappiness rather than self-fulfillment can be considered abnormal. Behavior that blocks our desire and ability to function in expected roles, or to adapt to our environments may also be regarded abnormal. Persistent alcohol consumption that usually impairs one’s health and social or occupational functioning may be considered as abnormal.

Agoraphobic behavior

characterized by intense fear of going into public places is abnormal because it is uncommon. People to have misconceptions of reality may also be unable to perform their daily responsibilities to the employers and families. Hallucination or delusions may preoccupy or confuse people when they should be preoccupied with their responsibilities on their jobs.

Behavior is dangerous.

Behavior that is dangerous to oneself and other people may be viewed as abnormal. During wartime, soldiers who sacrifice themselves to gain freedom with little concern for their own welfare and safety may be characterized as courageous, heroic, nationalistic and patriotic. On the other hand, those who threaten or attempt to commit suicide because of problems that seem insurmountable are viewed as abnormal.

Separation Anxiety Disorder

• concerns with real or imagined separating from attachment figures

• separation may lead to extreme anxiety and panic attacks

• not entirely responsible for school absences or school avoidance

• do not attend school so they won’t be separated with their attachment figure

• fear of possible separation is the central thought

• concerned about the proximity and safety of key attachment figures

• at least 4 weeks (children) or 6 months or more (adults)

Selective Mutism

• rare childhood disorder

• characterized by a lack of speech in one or more setting in which speaking is socially expected

• restricted to a specific social situation

• a child could speak in one setting but cannot/do not in another setting

• not better explained by communication disorder

• only diagnosed when a child has established a capacity to speak in some social situations

• learn to perform avoidance and safety behaviors to avoid disasters

• at least 1 month

Specific Phobia

• irrational fear of a specific object or situation that markedly interferes with an individual’s ability to function

• acquired through direct experience, experiencing in false alarm, and observation

• it only fears one setting, unlike Agoraphobia (which requires 3 settings), then Specific Phobia-Situational can be diagnosed

• 6 months or more

⋆˚𝜗𝜚˚⋆Diagnostic Criteria ⋆˚𝜗𝜚˚⋆

A. Marked fear or anxiety about a specific object or situation (eg. flying, heights, animals, receiving an injection, seeing blood).

B. The phobic object or situation almost always provokes im-mediate fear or anxiety. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or dinging.

C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.

D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation, and to the sociocultural context.

E. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more

F. The fear, anxiety or avoidance causes dilinically significant distress or impairment in social, occupational or other important areas of functioning

G. The disturbance is not better explained by the symptoms of another mental disorder, including fear anxiety and avoid ance of situations associated with panic-like symptoms of other Incapacitating symptoms (as in agoraphobia), objects or situations related to obsessions (as in obsessive-compulsive disorder), reminders of traumatic events (as in posttraumatic stress disorder): separation from home or attachment figures (as in separation anxiety disorder; or social situations (as in social anxiety disorder)

Specify type:

1. Animal

2. Natural environment (eg, heights, storms, and water)

3. Blood-Injection-Injury

4. Situational (eg. planes, elevation, or enclosed places)

5. Other (eg. phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness, or in children, avoidance of loud sounds or costumed characters)

Specify type of Specific Phobia

1. Animal

2. Natural environment (eg, heights, storms, and water)

3. Blood-Injection-Injury

4. Situational (eg. planes, elevation, or enclosed places)

5. Other (eg. phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness, or in children, avoidance of loud sounds or costumed characters)

Social Anxiety Disorder

• fear or anxiety about possible embarrassment or scrutiny

• can have panic attacks but it is cued by social situations

• typically have adequate age-appropriate social relationships and social communication capacity

• 6 months or more

⋆˚𝜗𝜚˚⋆Diagnostic Criteria ⋆˚𝜗𝜚˚⋆

A. Marked fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others. Examples include social interactions (eg, having a conversa-tion, meeting unfamiliar people), being observed (eg, eating or drinking), or performing in front of others (e.g, giving a speech). Note in children, the anxiety must occur in peer settings and not just in interactions with adults.

B. The individual fears that he or she will act in a way, or show anxiety symptoms, that will be negatively evaluated (ie, will be humiliating, embarrassing, lead to rejection, or offend others).

C. The social situations almost always provoke fear or anxiety. Note: in children, the fear or anxiety may be expressed by cry-ing, tantrums, freezing, clinging, shrinking, or failing to speak in social situations

D. The social situations are avoided or endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual threat posed by the social situation, and to the sociocultural context.

F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.

G. The feat, anxiety or avoidance causes clinically significant dis-tress or impairment in social, occupational or other important areas of functioning.

H. The fear, anxiety or avoidance is not attributable to the effects of a substance (eg, a drug of abuse, a medication) or another medical condition

I. The fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder (eg, anxiety about having a panic: attack) or separation anxiety disorder (eg, fear of being away from home or a close relative).

J. If another medical condition (eg, stuttering, Parkinson's dis-case, obesity, disfigurements from burns or injury) is present, the fear, anxiety or avoidance is clearly unrelated or is excessive.

Panic Disorder

• cannot be diagnosed unless full symptom panic attacks were experienced

• norepinephrine activities are irregular

• abrupt surge of intense fear or discomfort out of nowhere, with no triggers

• followed by persistent concerns about more attacks or the consequences of it or maladaptive change in behavior related to the attacks

⋆˚𝜗𝜚˚⋆ Diagnostic Criteria ⋆˚𝜗𝜚˚⋆

A. Recurrent unexpected panic attacks are present.

B. At least one of the attacks has been followed by 1 month or more of one or both of the following: (a) Persistent concern or worry about additional panic attacks or their consequences (eg. losing control, having a heart attack, "going crazy"), or (b) A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks such as avoidance of exercise or unfamiliar situations).

C. The disturbance is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).

D. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder)

Agoraphobia

• developed after a person has unexpected panic attacks

• fear in two or more situations (public transportation, open spaces, enclosed spaces, standing in line, being outside of the home alone) due to thoughts that escape might be difficult or no one will help them in case panic-like symptoms would manifest

• 6 months or more

˚𝜗𝜚˚⋆ Diagnostic Criteria for Agoraphobia ⋆˚𝜗𝜚˚⋆

A. Marked fear or anxiety about two or more of the following five situations: Public transportation, open spaces, enclosed places. standing in line or being in a crowd, being outside the home alone.

B. The individual fears or avoids these situations due to thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (eg, fear of falling in the elderly, fear of incontinence).

C. The agoraphobic situations almost always provoke fear or anxiety. '

D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations, and to the sociocultural context

F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.

G. The fear, anxiety or avoidance causes clinically significant dis-tress or impairment in social, occupational or other important areas of functioning.

H. If another medical condition (eg. inflammatory bowel disease, Parkinson's disease) is present, the fear, anxiety or avoidance is clearly excessive.

I. The fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder, e.g. the symptoms are not confined to specific phobia, situational type, do not involve only social situations (as in social anxiety disorder) and Trauma-and-Stressor Related Disorders are not related exclusively to obsessions (as in obsessive-compulsive disorder), perceived deficits or flaws in physical appearance (as in body dysmorphic disorder), reminders of traumatic events (as in posttraumatic stress disorder) or fear of separation (as in separation anxiety disorder).

Generalized Anxiety Disorder

• difficulty to control worry

• excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities

• "the world is a dangerous place"

• intense cognitive processing in the frontal lobes, particularly in the left hemisphere

• intense worrying may act as avoidance

• worry whether or not they are judged/evaluated

• fear circuit is excessively active

⋆˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. Excessive anxiety and worry (apprehensive expectation), occur-ring more days than not for at least 6 months about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with at least three (or more) of the following six symptoms (with at least some symp-toms present for more days than not for the past 6 months) [Note: Only one item is required in children]: 1. Restlessness or feeling keyed up or on edge 2. Being easily fatigued 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle tensión 6. Sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep)

D. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social occupational, or other important areas of functioning.

E. The disturbance is not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition (e.g. hyperthyroidism).

F. The disturbance is not better explained by another mental disorder (eg, anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder)

Reactive Attachment Disorder

• withdrawn toward adult caregivers

• evident before age 5 years

• history of severe social neg

Disinhibited Social Engagement Disorder

• actively approaches and interacts with unfamiliar adults

• can be distinguished from ADHD by not showing difficulties in attention or hyperactivity

Posttraumatic Stress Disorder (PTSD)

• Is identified by the development of physiological, psychological, and emotional symptoms following exposure to a traumatic event. Individuals must have been exposed to a situation where actual or threatened death occurred.

Examples of these situations include but are not limited to:

a. witnessing a traumatic event as it occurred to someone else;

b. learning about a traumatic event that occurred to a family member or close friend;

c. being exposed to repeated events where one experiences an aversive event (e.g. victims of child abuse/neglect, ER physicians in trauma center, etc.).

- It should be understood that while the presentation of these symptoms varies among individuals, to meet criteria for a diagnosis of PTSD

first category

➢ The category involves recurrent experiences of the traumatic event. This can occur via:

✓ Flashbacks

✓ Distinct memories (which may be voluntary or involuntary)

✓ Distressing dreams.

Regardless of the method, the recurrent experiences can last a short time several seconds- or extend for several days. They are often initiated by physical sensations similar to those experienced during the traumatic events, or even environmental triggers such as a specific location. Because of these triggers, individuals with PTSD are known to avoid stimuli (1.E. Activities, objects, people, etc.) Associated with the traumatic event.

second category

➢ The category involves avoidance of stimuli that is related to the traumatic event.

Individuals with PTSD may be observed trying to avoid the distressing thoughts and/or feelings related to the memories of the traumatic event. One way individuals will avoid these memories is by avoiding physical stimuli such as locations, individuals, activities, or even specific situations that trigger the memory of the traumatic event.

third category

➢ The category experienced by individuals with PTSD is negative alterations in cognitions or mood. This is often reported as difficulty remembering an important aspect of the traumatic event.

It should be noted that this amnesia is not due to a head injury, loss of consciousness, or substances, but rather, due to the traumatic nature of the event.

The impaired memory may also leading individuals to have false beliefs about the causes of the traumatic event, often blaming themselves or others. An overall persistent negative state, including a generalized negative belief about oneself or others is also reported by those with PTSD. Similar to those with depression, individuals with PTSD may report a reduced interest in participation of previously enjoyable activities, as well as the desire to socially engage with others.

fourth category

➢ The category is alterations in arousal and reactivity. Because of the negative mood and increased irritability, individuals with PTSD may be quick tempered and act out in aggressive manners, both verbally and physically.

While these aggressive responses may be provoked, they are also sometimes unprovoked. It is believed these behaviors occur due to the heightened sensitivity to potential threats, especially if the threat is similar in nature to their traumatic event.

More specifically, individuals with PTSD have a:

✓ heightened startle response

✓ easily jump/respond to unexpected noises (ex: telephone ringing or a car backfiring)

Given this heightened arousal state, it should not be surprising that individuals with PTSD also experience significant sleep disturbances:

✓ difficulty falling asleep

✓ staying asleep due to nightmares

These symptoms likely cause significant distress in:

✓ Social

✓ Occupational

✓ Other areas of functioning (i.e. romantic, personal).

PTSD cannot be diagnosed unless symptoms have been present for at least one month. If they have not been present for a month, the individual may meet criteria for Acute Stress Disorder.

Acute Stress Disorder

• exposure to trauma (direct experience, witness, learning that event occurred to close family, repeated exposure)

• 3 days to 1 month after trauma exposure

• if the symptoms persist for more than 1 month and meet the criteria for PTSD, then PTSD will be diagnosed

Adjustment Disorder

• development of emotional or behavior symptoms in response to identifiable stressors occurring within 3 months of the onset of the stressors

• If symptoms persist beyond 6 months after the stressor or its consequences have ceased, the diagnosis will no longer apply

• May sometimes be diagnosed instead of bereavement if bereavement is judged to be out of proportion to what would be expected or significantly impairs self-care and interpersonal relations

Prolonged Grief Disorder

• death, at least 12 months, of a person close to the bereaved individual (6 months for children)

• focused on loss and separation from a loved one rather than reflecting generalized low mood distress from a deceased person

Obsessive-Compulsive Disorder

• Obsessions: intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist or eliminate

• Compulsions: thoughts or actions used to suppress the obsessions and provide relief

• Tic disorders commonly co-occur in patients with OCD; obsessions usually do not involve real-life concerns and can include one, irrational or magical content

• In BDD and Tricho, the compulsive behavior is limited to hair pulling or distortions in the absence of obsessions

• Obsessions and compulsions are not limited to concerns about weight and food

• Compulsions are usually preceded by obsessions; tics are often preceded by premonitory sensory urges

˚𝜗𝜚˚⋆Diagnostic Criteria⋆˚𝜗𝜚˚⋆

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by 1 and 2:

1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that in most individuals cause marked anxiety or distress

2. The individual attempts to ignore or suppress such thoughts, Impulses, or Images, or to neutralize them with some other thought or action

Compulsions are defined by 1 and 2:

1. Repetitive behaviors (eg, handwashing, ordering, checking) or mental acts (eg., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rigidly

2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected realistically with what they are designed to neutralize or prevent or are clearly excessive

B. The obsessions or compulsions are time-consuming (eg, take more than 1 hour per day), or cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

C. The disturbance is not due to the direct physiological effects of a substance (eg, a drag of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder (eg, excessive worries, as in generalized anxiety disorder, or preoccupation with appearance as in body dysmorphic disorder)

Specify if:

With good or fair insight: the individual recognizes that obsessive- compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.

With absent insight/delusional: the person is completely convinced that obsessive-compulsive disorder beliefs are true.

TIC-related: The individual has a current or past history of a tic disorder.

Body Dysmorphic Disorder

• preoccupation with some imagined defect

• imagined ugliness

• excessive appearance-related preoccupations and repetitive behaviors that are time-consuming

• can be co-morbid with eating disorders

˚𝜗𝜚˚⋆Diagnostic Criteria ⋆˚𝜗𝜚˚⋆

A. Preoccupation with one or more defects or flaws in physical appearance that are not observable or appear slight to others.

B. At some point during the course of the disorder, the individual has performed repetitive behaviors (eg, mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (eg, comparing his or her appearance with that of others) in response to the appearance concerns.

C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Specify if:

With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true.

With absent insight/delusional beliefs: the individual is completely convinced that the body dysmorphic disorder beliefs are true.

With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular.

This specifier is used even if the individual is preoccupied with other body areas, which is often the case

Hoarding

• Difficulty discarding or parting with possessions

• Prader-Willi Syndrome: characterized by severe hypotonia, poor appetite, and feeding difficulties in early infancy, followed in early childhood by excessive eating and gradual development of morbid obesity

• Not a direct consequence of a neurodevelopmental disorder, nor delusion, nor psychomotor retardation, fatigue, or loss of energy

Prader-Willi Syndrome

characterized by severe hypotonia, poor appetite, and feeding difficulties in early infancy, followed in early childhood by excessive eating and gradual development of morbid obesity.

Trichotillomania

• should not be diagnosed when hair removal is performed solely for cosmetic reasons

• diagnosis will be OCD, if there is obsession of symmetry

• someone with ASD could have hair-pulling behaviors when frustrated or angry, so if it's impairing then it can be diagnosed as stereotypic movement disorder

• note the delusion or hallucination, if then, psychotic disorder

Excoriation

• note delusion or tactile hallucination

• In absence of deception, excoriation disorder can be diagnosed if there are repeated attempts to decrease or stop skin picking