Chapter Sixteen📖

Abnormal psychology in everyday life 

• Mental disorders are common 

• 1 out of every 5 Canadians suffer from a mental disorder 

• 1 in 5 are hospitalized because of a psychiatric disorder 

• Possibly under reported up to 46.4% 

• Abnormal states occur in all of us language of abnormal psychology permeates everyday conversation 

  • Psychosis/Psychotic 

  • Insanity 

  • Nervous breakdown 

  • Delusional 

  • Panic attack 

  • Schizophrenic 

 What is common or Abnormal?

• A student drinking until she passes out 

• A man kissing another man on the lips → common 

• A parent slapping a child 

• Believing that and acting like Jesus Christ 

• A woman refusing to eat for several days 

• A man barking like a dog 

• Feeling really sad 

• An elderly woman kicking others and screaming in a hospital 

Abnormal 

• Depending on different cultures something abnormal in western culture could be normal in other cultures 

  • Ex. cannibalism is practiced in many cultures all around the world, but in western culture this is viewed as extraordinary pathological  

• Discontinuity hypothesis → only strong terms can accurately portray true nature of abnormal behaviour 

  • Shift or break in that person's thinking, behaviour, the way they feel 

• Continuity hypothesis → insanity and mental illness terms should not be used 

  • Mental health moods, emotions of way of thinking, there has been one day in your life where you have felt the best (mentally, emotionally, physically) and a time in your life you have felt your worst 

    • It could be now, before or later 

  • Mental disorder best viewed as continuum that varies between mental health to mental illness 

• No single “abnormal” criteria 

• Optimal mental health 

  • Individual, group, and environmental factors work together effectively, ensuring: 

    • Subjective well being 

    • Optimal development and use of mental abilities 

    • Achievement of appropriate goals 

    • Conditions of fundamental equality 

• Minimal mental health 

  • Individual, group, and environmental factors conflict, producing: 

    • Subjective distress 

    • Impairment or underdevelopment of mental ability 

    • Failure to achieve appropriate goals 

    • Destructive behaviour 

    • Entrenchment of inequities 

Objective and Abnormality 

• Important for mental health judgment to be objective 

  • Consideration of content and context 

• Reliability and validity is key 

  • Reliability → that clinicians using the system should show high levels of agreement in their diagnostic decisions because professionals with different types and amounts of training including psychologists, psychiatrists, social worker and general physicians make diagonsit decisions, the system should be couched in terms of observable behaviours which can be reliably detected and should minimize subjective judgments 

  • Validity → that the diagnostic categories should accurately capture the essential features of the various disorders. Thus, if research and clinical observations show that a given disorder should also have those four features 

    • These categories allow us to differentiate one psychological disorder from another 

• People improperly labelled as “abnormal” due to norms and values 

  • Ex. individual, cultural, group 

• Labels used to interpret later behaviour 

  • David Rosehan and being “sane in insane places” 

  • Given diagnoses → bipolar, schizophrenia (even upon discharge) 

• What is abnormal 

Distress → to self or others 

• On the one hand, people who are excessively anxious, depressed, dissatisfied, or otherwise seriously upset with themselves or about life circumstances may be viewed as disturbed mainly if they seem to have little control over these reactions

• Person distress is neither necessary nor sufficient to define abnormality 

• Some seriously disturbed mental patients are so out of touch with reality they seem to experience little distress and yet their bizarre thought processes and behaviours are considered very abnormal

Dysfunctional for person or society 

• Behaviours which interfere with a person’s ability to work or to experience satisfying relationships with other people are likely to be seen as abnormal and self defeating, mainly if the person seems unable to control such behaviours 

  • Some behaviours are seen as abnormal since they interfere with the well being of society 

Deviance violates social norms 

• Norms are behavioural rules which specify how people are expected to think, feel and behave 

Psychological disorders 

• Psychopathological functioning 

  • Involves disruptions in emotional, behavioural, or thought processes that lead to personal distress or that block one’s ability to achieve important goals 

• Abnormal psychology 

  • Area of psychological investigation most directly concerned with understanding the nature of individual pathologies of mind, mood, and behaviour 

Etiology of disorders 

• Vulnerability stress/diathesis stress models 

  • Diathesis (vulnerability) + STRESS = disorder 

    • The vulnerability or predisposition can have a biological basis, such as our genotype, over or under activity of a neurotransmitter system in the brain, a hair trigger autonomic nervous system, or a hormonal factor 

    • This could be due to personality factor, such as low self esteem or extreme pessimism, or to previous environmental factors including poverty or a severe trauma or loss earlier in life 

    • Parenting styles and cultural factors can create vulnerability to certain kinds of disorders 

  • Stress (environmental stimulus) triggers psychopathology 

  • Stressors: loss of job, divorce, death in family, being stuck in traffic 

  • Neither a diathesis or a stress alone is sufficient to cause disorder 

Historical views 

• Psychological theories 

  • Psychological factors like stress caused problems 

  • Freud revived the theory; able to compete with supernatural and biological approaches 

    • Model of unconscious conflicts 

      • Id, ego, superego 

• Supernatural theories 

  • Early views linked psychological disorders with evil (demonological view) 

• Resulted in more harmful treatments with exorcism, drinking foul concoctions, witches put to death (mostly women), trephining  

• Biological theories 

  • Ancient Greece: four humors of body excess black bile leads to depression, excess yellow bile leads to irritability (bloodletting) 

Historical Classifications 

• View that disorders reflected disease or sickness 

  • Philippe Pinel and classification of disorders by patterns of symptoms → thoughts, behaviour, mood 

• Classification systems given medical basis 

  • Emil Kraepelin 

  • Made effective drug therapies possible 

  • Paresis, melancholia, dementia, epilepsy (1880) 

Etiology of Disorders 

• Etiology 

  • The factors that cause or contribute to the development of psychological and medical problems 

• Biological approaches assume structural abnormalities, biochemical processes, and genetic influences 

• Psychological approaches focus on personal experiences, traumas, conflicts, and environmental factors as roots of disorder 

  • Psychodynamic, behavioural, cognitive, and sociocultural perspectives 

Classifying Disorders 

• Psychological diagnosis 

  • A label given to an abnormality by classifying and categorizing the observed behaviour pattern into an approved diagnostic system 

Diagnostic system should involve 

• Common shorthand language 

• Understanding of casualty 

• Treatment plan 

DSM - IV - TR (2000) 

• Diagnostic and statistical Manual of Mental Disorders 

• classifies , defines, describes over 200 disorders 

• First DSM was published in 1952, DSM - V published in 2013 

• Divided into axes 

Comorbidity → the co - occurrence of diseases, most common with anxiety, mood disorders, alcohol/drug abuse/ dependence 

• Prevalence rates listed in report on mental illness in Canada 

• International classification of Diseases (ICD - 10)  

DSM 5 

Add dimensional assessments not just presence of symptom, but also severity rating 

Removal of multi - axial system 

Chapters organized based on similarities in disorders underlying vulnerabilities (but not a one size fits all ex. Pg. 634) 

Chapters reorganized and new diagnoses (Hoarding D/O, Skin Picking D/O) 

Anxiety disorder 

• Anxiety disorders → class of disorders which involves anxiety that interferes with ability to function effectively 

• Disorders differ in extent that anxiety is experienced, severity of anxiety, and situations that trigger disorders 

• 5 major categories of anxiety disorders 

• Share emotional (fear), physiological (heart racing), cognitive (I too afraid to come to class), and behavioural symptoms (avoidance) 

  • Emotional symptoms 

    • Feeling of tension 

    • Apprehension 

  • Cognitive symptoms 

    • Worry 

    • Thoughts about inability to cope 

  • Physiological symptoms 

    • Increased heart rate 

    • Muscle tension 

    • Other autonomic arousal symptoms 

  • Behavioural symptoms 

    • Avoidance of feared situations 

    • Decreased task performance 

    • Increased startle response 

• Types of Anxiety disorders 

  • Generalized Anxiety disorder 

    • Feeling of anxiety and worry most of the time without specific threats or danger 

    • Must also display physical and cognitive symptoms of impairment 

    • Restless, muscle tension, easily fatigue, concentration issues 

    • Majority of the day for 6 months 

  • Panic disorder 

    • Experience of unexpected and severe panic attacks that are brief in duration 

    • Include intense psychological and physical symptoms 

    • Palpitations, trembling, sweating, chest pain, choking 

    • Many individuals with panic attacks develop agoraphobia which is a phobia of public places, because of their fear that they will have an attack in public 

      • In extreme cases, they may fear leaving the familiar setting of the home and agoraphobics have been known to be housebound for years at a time because of their “fear of fear” 

  • Phobias 

    • Suffering from a persistent and irrational fear of a specific object, activity, or situation that is excessive and unreasonable given the reality of the threat 

    • Social phobias → public situations involving begging observed by others 

    • Specific phobias → related to types of objects or situations 

      • Animal, natural environment, blood injection injury, situational, not otherwise specified 

    • Common phobias in Western society 

      • Agoraphobia → fear of open and public places 

        • Social anxiety disorder → social phobia 

        • Excessive fear of situations in which person might be evaluated or possible embarrassed 

        • Specific phobias → fear of  dogs, snakes, spiders, airplanes, elevators, enclosed spaces, water, injections, illness, or death 

  • Obsessive compulsive disorder (OCD) 

    • Obsessions → thoughts, images, impulses that recur despite efforts to suppress them and cause distress 

    • Compulsions → repetitive and purposeful acts performed accordion to certain rules or in a ritualized manner in response to an obsession 

      • Used to reduce discomfort 

      • If an individual doesn’t perform the compulsive act, they may experience tremendous anxiety, perhaps even a panic attack 

  • Post Traumatic Stress Disorder (PTSD) 

    • Disorder characterized by persistent re-experience of traumatic events through distressing recollections, dreams, hallucinations, or flashbacks 

    • Often comorbid with other disorders 

      • Ex. depression, substance abuse  

• Causes of anxiety disorder 

  • Biological → evolutionary preparedness, neurotransmitter GABA, neuroimaging 

    • Some researchers believe that abnormally low levels of inhibitory GABA activity in these arousal areas may cause some people to have highly reactive nervous system which quickly produce anxiety responses in response to stressors 

  • Psychodynamic → anxiety stems from underlying psychic conflicts or are substitutions for forbidden impulses 

  • Behavioural → anxiety linked to reinforcement or conditioning, disorder may be maintained by reinforcement contingencies 

  • Cognitive → focus on perceptual processes, attitudes, interpretations that distort estimates of danger or fear 

Mood Disorders 

• Major depressive disorder 

• Severity of symptoms differ 

• Share emotional, motivational, cognitive, and somatic symptoms 

Major depressive episode

• For a 2 week period, person displays an increase in depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day 

• For the same 2 weeks, person also experiences at least 3 or 4 of the following symptoms: considerable weight change or appetite change - daily insomnia or hypersomnia - daily agitation or decrease in motor activity - daily fatigue or lethargy - Daily feelings of worthlessness or excessive guilt - Daily reduction in concentration or decisiveness - repeated focus on death or suicide, a suicide plan, or a suicide attempt

• Significant distress or impairment 

Depression symptoms 

• Emotional symptoms 

  • Sadness 

  • Hopelessness 

  • Anxiety 

  • Misery 

  • Inability to enjoy 

• Cognitive symptoms → difficulty concentrating and making decisions 

  • Negative cognitions about self, world, and future  

• Motivational symptoms → inability to get started or perform behaviours which might produce pleasure or accomplishment 

  • Loss of interest 

  • Lack of drive 

  • Difficulty starting anything

• Somatic symptoms → weight loss and sleep disturbance lead to fatigue and weakness

  • Loss of appetite 

  • Lack of energy 

  • Sleep difficulties 

  • Weight loss/gain

  • Sexual desire and responsiveness 

Major depressive disorder 

• Presence of a major depressive episode 

• No pattern of mania, or hypomania 

Persistent depressive disorder 

• Person experiences the symptoms of major or mild depression for at least 2 years 

• During the 2 year period, symptoms not absent for more than 2 months at a time 

• No history of mania or hypomania 

• Significant distress or impairment 

Bipolar disorder 

• Characterized by periods of severe depression alternating with manic episodes 

• Manic episode - involves feelings and actions that unusually elated, expansive, and often excessive 

  • Ex. decreased need for sleep 

• Also associated with unwarranted optimism and risk taking 

• Goals are blocked or thwarted 

• Depression sets in when dealing with damage of frenzy 

• Duration vary from person to person some people experience manic and depressive episodes 

• Some individuals cycle back and forth (some rapidly) 

Causes of Mood Disorders 

• Biological → neurotransmitters of serotonin and norepinephrine linked to depression (reduced levels) and mania (increased levels) 

  • Twin studies on mood d/0 → 67% identical, 20% fraternal 

• Psychodynamic →  unconscious conflicts and hostile feeling originating in early childhood are transferred to adult symptoms - turned inward 

• Behavioural → focuses on positive reinforcements (lacking) and punishments (in excess) 

• Cognitive → cognitive triad (Beck) - negative view of self, negative view of ongoing experiences - the world, and negative view of the future and learned helplessness - people believe bad things are going to happen and can’t do anything about it 

• Seligman’s attribution theory → internal stable global vs external, unstable, specific 

Mood disorders and gender 

• Comorbidity → when an individual has more than one mental health disorder 

• Depression rate for women is 2x more than men 

  • Greater likelihood of negative experiences - sexual abuse, poverty, single parent, taking care of parents 

  • Internal global explanatory style 

  • Rumination on causes and implications - learned helplessness 

    • People believe bad things are going to happen and can’t do anything about it 

• Depression linked to suicide attempts 

  • Women make 3x more attempts than men 

  • Men are more likely to commit suicide 

  • Suicide most common in Canadian youth aged 15-24 especially in northern provinces and territories → Dr. David Danto’s Research 

  • Final stage of inner turmoil 

Somatoform Disorders 

• Somatic disorders → physical illnesses or complaints that can’t be fully explained by actual medical conditions 

• Anxiety Illness Disorder/Hypochondriasis – preoccupation & belief they are physically ill or will get physically ill despite medical reassurances – often go from doctor to doctor

Somatic Symptom Disorder/Somatization disorder/Pain Disorder – long history of physical complaints that are not medically explained They cross many medical categories – must have 4 pain symptoms (eg. headaches/stomach aches), 2 gastrointestinal (eg. Nausea), 1 sexual symptom, and 1 neurological (eg. Double vision) 

Conversion disorder/functional neurological symptom disorder – loss of motor or sensory functioning not explained by nervous system or physical

Dissociative Disorders 

• Disturbance in the integration of identity, memory, or consciousness – often a survival mechanism from traumatic past

• Dissociative amnesia – forgetting of important personal experiences caused by psychological experiences in the absence of any organic dysfunction

• Dissociative Fugue - period of “wandering” that involves a loss of memory and a change of identity

• Dissociative identity disorder (DID) – disorder in which two or more distinct personalities exist within the same individual (unique behavioural patterns)

  • Formerly called multiple personality disorder 

  • According to Frank Putnam’s trauma dissociation theory, could cause the development of DID which is the development of new personalities occur in response to severe stress 

    • For many patients. This begins in early childhood, frequently in response to physical or sexual buse 

• Formerly called multiple personality disorder or split personality

• Three Faces of Eve, Sybil

Schizophrenic disorder → not episodic 

• Severe form of psychopathology in which personality seems to disintegrate, thought and perception are distorted, and emotions are blunted

• Symptoms can involve illogical thinking, hallucinations, delusions, language problems, flat emotions, psychomotor disturbances

• Existence of both positive (hallucinations, delusions, disorganization – type 1) and negative symptoms (flat affect – type 2)

• Relatively rare – 1% of the population

• Some experience a few episodes, while others it is life long

  • uncommon disorder affecting more men than women

  • Can appear gradually or with sudden break – men experience the break on average younger than women

  • Characterized by 3 types of serious problems

    • Delusions and hallucinations

    • Disorganized thinking, emotions, behavior

    • Reduced enjoyment and interests 

• Delusions 

  • False beliefs that distort reality 

• Hallucinations 

  • False perceptual experiences which distort reality 

  • Tell you do things which you don’t feel comfortable doing 

  • Tell you bad things about yourself 

  • Its like having your earbuds in on full volume x 100 

• Cause of Schizophrenia 

  • Biological factors  

    • ⇧ genetic relatedness = ⇧ risk – both parents (46%) or identical twins (48%) 

    • Biological markers – brain abnormalities in ventricles, (flow of cerebrospinal fluid) which impacts support/stability, chemical balances, loss of cortical tissue and activity in frontal & temporal lobe 

Environmental conditions

• Diathesis-stress hypothesis – genetic factors place individuals at risk but environmental factors trigger the manifestation of the disorder – lack of support (empathy), housing/safety

• Deviations in parental interactions may play a role (expressed emotion) – emotionally overinvested, critical, hostile