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Psychological Disorders. Chapter 13. What is Abnormal?. Abnormal - literally meanss “away from the normal” so Einstein was “abnormal.” Society: Abnormal behavior must be defined within the context of the society.

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What is abnormal
What is Abnormal?

  • Abnormal - literally meanss “away from the normal” so Einstein was “abnormal.”

  • Society: Abnormal behavior must be defined within the context of the society.

  • A practial definition: Behavior is abnormal when it causes the individual or those around him discomfort, distress, or danger.

A brief history
A Brief History

  • Primitive peoples - saw aabnormal behavior as a sign that the person was possessed by demons or spirits

  • Golden age of Greece - Hippocrates and others viewed mental illness as a “natural” phenomenon like other illness

  • Middle ages - a return to belief in possession and demonology. Knowledge was kept alive in the Islamic countries.

Psychological disorders

  • Phillipe Pinel - In 1793 was made head of La Bicetre hospital in Paris and began a trend toward humane treatment

  • Dorothea Dix - In the U. S. during the 1800s fought for the rights of the mentally ill

  • A medical discovery - by 1900 it was discovered that “general paresis” (which included severe mental deterioration) was caused by syphilis (a physical disease). This gave rise to the “biological model” of mental illness

Approaches to psychological disorders
Approaches to Psychological Disorders

  • biological model: Disorders have a biochemical or physiological basis.

  • psychoanalytic model: Disorders result from unconscious internal conflicts.

  • cognitive-behavioral model: Disorders result from learning maladaptive ways of thinking and behaving.

Approaches to psychological disorders1
Approaches to Psychological Disorders

  • diathesis-stress model: A “diathesis” is a genetic or other biological predisposition or vulnerability. Under stress, a person may develop a disorder to which he/she is predisposed.

  • systems approach: Biological, psychological, and social risk factors combine to produce disorders. Also known as the “Biopsychosocial” model

Classifying psychological disorders
Classifying Psychological Disorders

  • Diagnostic & Statistic Manual of Mental Disorders (4th edition) “DSM IV” Published by the AmericanPsychiatricAssociation

  • It is the most widely used classification system of psychological disorders.

  • It is a listing of disorders, their symptoms, and statistical data (e.g., gender, age, differences)

  • It does NOT specify treatments and does NOT list causes of disorders

Prevalence and incidence
Prevalence and Incidence

  • Prevalence - refers to how common a disorder is. For example, schizophrenia is rare (1% of the population) while depression is more common at about 3-4%

  • Incidence - refers to the rate at which new cases occur. If the yearly incidence rate for depression is 1%, then there would be one new case for every hundred people in the population this year.

Mood disorders affective disorders
Mood Disorders (affective disorders)

  • Disorders in which one’s range of affect (mood) is restricted (as in depression) or expanded (as in bipolar disorder).

  • Major Depression

  • Dysthymia

  • Bipolar Disorder (formerly manic depression)

  • Cyclothymia


  • more than just a case of “the blues”

  • overwhelming feelings of sadness

  • lack of interest in activities and inability to experience pleasure

  • excessive guilt or feelings of worthlessness

  • changes in sleep, appetite, ability to concentrate

  • possible suicidal thoughts or actions

Major depression
Major Depression

  • very severe

  • symptoms must be present for two weeks

  • person may be unable to function normally and may need hospitalization


  • less severe but “chronic”or long lasting

  • symptoms must be present for two years

  • person can usually function but leads a very unhappy, painful, unfulfilling existence

Bipolar disorder
Bipolar Disorder

  • Person experiences alternating episodes of depression and mania “mood swings”

  • a manic state involves excess energy, racing thoughts, pressured speech, grandiosity, impulsive behavior, poor judgement


  • a less severe form of bipolar disorder

Causes of mood disorders
Causes of Mood Disorders

  • biological factors

    • genetics - mood disorders are more common in close relatives, esp. bipolar disorder

    • brain chemistry changes as a result of experience (e.g., stress or illness)

  • psychological (cognitive) factors

    • cognitive distortions such as (1) all or none thinking (2) inaccurate maladaptive beliefs

  • social factors/stressors

    • real or perceived loss or stress in various areas


  • myth - people who talk about it never do it

  • fact - most people will give clues about their plans

  • fact - more women attempt but more men complete, men use more lethal methods

  • fact - people thinking of suicide will often give away possessions and “put their affairs in order”

  • fact - suicide is becoming more common among teens and children

Anxiety disorders
Anxiety Disorders

Disorders in which anxiety is a characteristic feature OR the avoidance of anxiety seems to motivate abnormal behavior.

  • phobias

  • panic disorder

  • generalized anxiety disorder

  • obsessive-compulsive disorder

Phobic disorders
Phobic Disorders

  • phobia: (from the Greek “phobos”) which means fear

  • The person feels intense fear when confronted with the phobic object or situation. This may lead to a “panic attack.”

  • The phobic person avoids the phobic object or situation. Some may endure it but with great anxiety and discomfort.

Types of phobias
Types of Phobias

  • specific phobia: fear of a particular object or situation, common examples

    • insects, animals, blood/injury, heights, enclosed spaces, thunder, water, germs

  • social phobia: excessive, inappropriate fears connected with social situations or performances in front of other people

  • agoraphobia: fear of multiple situations, is almost always a consequence of “panic disorder”

Panic disorder
Panic Disorder

  • panic attack: is a sudden, unpredictable, and overwhelming experience of intense fear or terror without reasonable cause.

  • Hallmark symptoms: fear of dying, losing control, or going crazy, depersonalization, and derealization (things seeming weird)

  • other symptoms: chest pain, increased heartbeat, dizziness, choking sensations, intense headache, tingling in arms or legs, terror of being left alone

Psychological disorders

  • agoraphobia: fear and avoidance of places (1) in which help would not be available if needed and (2) from which escape would be difficult or embarassing

  • typical situations: public transportation, large stores/malls, interstates, bridges, elevators, wilderness, theatres, sports arenas, concerts,

  • panic disorder with agoraphobia: often, especially in women, panic attacks lead to fear and avoidance of places/situations in which panic attacks occurred

Generalized anxiety disorder
Generalized Anxiety Disorder

  • anxiety disorder characterized by prolonged vague fears that are not attached to any particular object or circumstance

  • “chronic”: long term, almost a part of the person’s personality

  • symptoms: sleep problems, muscle aches, digestive problems, headaches, inability to relax, constant worry, difficulty in concentration, headaches, etc.

Obsessive compulsive disorder ocd
Obsessive-Compulsive Disorder (OCD)

  • The person is plagued by “obsessions” and/or “compulsions”

  • obsessions: unwanted intrusive thoughts, obsessions often involve fear of making mistakes which might cause harm. Contamination and guilt are also common themes

  • compulsions: behaviors/rituals that reduce anxiety caused by obsessions, classic compulsions are checking, and washing

Posttraumatic stress disorder ptsd
Posttraumatic Stress Disorder (PTSD)

  • Results from a “traumatic” event that is “outside the normal range of human experience”

  • Typical experiences are military combat, police action, natural disaster, accidents, and being a crime victim.

Symptoms of ptsd
Symptoms of PTSD

  • re-experiencing of the trauma through

    • intrusive thoughts, dreams, and “flashbacks”

  • avoidance of “trauma-related” stimuli

    • the person is made anxious by, and avoids, reminders of the trauma

  • exaggerated startle and hypervigilence

  • other symptoms and associated problems:

    • tension, sleep problems, depression, social withdrawal, explosiveness, suspiciousness of others, substance abuse

Causes of anxiety disorders
Causes of Anxiety Disorders

  • heredity: anxiety disorders do tend to run in families (esp. OCD)

  • stress: triggers anxiety in predisposed people, the primary cause of PTSD

  • learning: fears can be acquired via classical/operant conditioning or modeling

  • “biological preparedness hypothesis” (Martin Seligman) We are prepared to become phobic of certain things as a result of our evolutionary history

Psychosomatic disorder psychophysiological disorder
Psychosomatic Disorder(Psychophysiological Disorder)

  • Disorders in which there is REAL physical illness that is largely caused by psychological factors such as stress and anxiety.

  • Examples are hypertension, headaches, bruxism (teeth grinding), insomnia, ulcers, digestive problems, etc.

Somatoform disorders
Somatoform Disorders

There is an APPARENT physical illness for which no organic (physical) basis can be found

  • somatization disorder

  • conversion disorder

  • hypochondriasis

  • body dysmorphic disorder

Somatization disorder
Somatization Disorder

  • A somatoform disorder characterized by recurrent vague physical complaints with no apparent physical cause

  • Typical are bachaches, headaches, dizziness, stomach pains, chest pains

  • It is important to distinguish this from “malingering” or faking in which the person is “acting” sick to gain something

Conversion disorder
Conversion Disorder

  • complaints of a dramatic specific disability with no apparent physical cause (e.g., paralysis, blindness, deafness)

    Classic Conversion Phenomena

  • glove anasthesia: paralysis or numbness of the hand that does not conform to anatomy

  • la belle indifference: “beautiful indifference” the person’s level of concern not consistent with the severity of the ailment


  • The person interprets insignificant symptoms as signs of serious illness

  • A series of headaches might convince the person he/she has a brain tumor

  • Again, there is no organic evidence of such illness.

  • Patients may “doctor shop” searching for one who will confirm their suspicions

Body dysmorphic disorder
Body Dysmorphic Disorder

  • a recent phenomenon found in developed western cultures

  • the person becomes preoccupied with his or her imagined ugliness, usually of a particular body part

  • plastic surgery is often sought

  • probably has a lot to do with society’s obsession with beauty and appearance

Causes of somatoform disorders
Causes of Somatoform Disorders

  • Causes are less well understood than for depression or anxiety

  • Often “secondary gain” is a major cause

  • By being sick, the person may unconsciously avoid work, child care, or other responsibilities

Dissociative disorders
Dissociative Disorders

Disorders in which some part of the personality seems separated from the rest. These are relatively rare.

  • dissociative amnesia

  • dissociative fugue

  • dissociative identity disorder

  • depersonalization disorder

Dissociative amnesia
Dissociative Amnesia

  • There is a loss of memory for past events (days, weeks, or years) without organic cause.

  • Dissociative amnesia may result from an intolerable or painful experience such as physical or sexual abuse.

Dissociative fugue
Dissociative Fugue

  • “fugue”: literally means to take flight

  • a person suddenly leaves home and assumes a new identity, with amnesia for past identity and events.

  • The person may emerge from the fugue weeks or months later in a strange city not knowing how he/she got there

Dissociative identity disorder
Dissociative Identity Disorder

  • formerly called “multiple personality disorder” (MPD) or “split personality”

  • a person has several distinct personalities that emerge at different times.

  • a history of physical or sexual abuse in childhood is common

  • borderline personality and eating disorders often co-occur

  • this isNOT the same as schizophrenia

Depersonalization disorder
Depersonalization Disorder

  • A dissociative disorder whose main feature is that the person suddenly feels strange or different.

  • Some describe it as an “out of body” experience.

  • Because depersonalization is also a symptom of panic disorder (which is much more common), that disorder should be ruled out before making this diagnosis.

Causes of dissociative disorders
Causes of Dissociative Disorders

  • The most widely accepted cause is that the person has experiences one or more traumatic experiences that they cannot bear to think about.

  • By separating the personality into “parts,” the traumatic memories can be avoided.

  • General psychological instability may also be a factor

Sexual disorders
Sexual Disorders

DSM-IV classifies sexual disorders under two major divisions:

  • sexual dysfunctions: loss or impairment in some aspect of the normal human sexual response

  • paraphilias: Sexual disorders in which unconventional objects or situations become the focus of sexual interest

Sexual dysfunctions
Sexual Dysfunctions

Some sexual dysfunctions are physical but most have a psychological basis

  • erectile disorder: The inability of a man to achieve or maintain an erection.

  • female sexual arousal disorder: The inability of a woman to become sexually aroused.

Sexual dysfunctions1
Sexual Dysfunctions

  • sexual desire disorders: Disorders in which the person lacks sexual interest or has an active distaste for sex.

  • sexual arousal disorder: Inability to achieve or sustain arousal until the end of intercourse in a person who is capable of experiencing sexual desire.

Sexual dysfunctions2
Sexual Dysfunctions

  • orgasmic disorders: Inability to reach orgasm in a person able to experience sexual desire and maintain arousal.

  • premature ejaculation: In ability of a man to inhibit orgasm as long as desired.

  • vaginismus: Involuntary muscle spasms in the outer part of the vagina that make intercourse impossible.


Paraphillias are primarily a “male” phenomenon. Classical and operant “conditioning” likely play a role.

  • fetishism: A paraphilia in which a nonhuman object is the preferred or exclusive method of achieving sexual excitement.

Psychological disorders

  • voyeurism: Desire to watch others having sexual relations or to spy on nude people.

  • exhibitionism: Compulsion to expose one’s genitals in public to achieve sexual arousal.

  • frotteurism: Compulsion to achieve sexual arousal by touching or rubbing against a non-consenting person in public situations.

Psychological disorders

  • transvestic fetishism: Wearing the clothes of the opposite sex to achieve sexual gratification. (don’t confuse with trans-sexualism)

  • sexual sadism: Obtaining sexual gratification from humiliating or inflicting physical pain on a sex partner.

  • sexual masochism: Obtaining sexual gratification from being humiliated or receiveing physical pain from a sex partner.

Psychological disorders

  • pedophilia: “pre-pubescent” children are the focus of sexual fantasy or actual sexual activity

  • While this remains a “fantasy” it is a psychological disorder. When the person acts on the desire, it also becomes a criminal activity.

  • most pedophiles have great difficulty fighting their desires

Gender identity disorder
Gender-Identity Disorder

  • a strong belief that one is really a member of the opposite biological sex (i.e., a woman trapped in a man’s body).

  • many seek an operation to change their gender which is granted only after extensive counseling therapy (most are happy with the change)

  • These individuals are NOT transvestites nor are they homosexuals

Personality disorders
Personality Disorders

  • Disorders in which inflexible and maladaptive ways of thinking and behaving learned early in life cause distress to the person and/or conflicts with others.

  • As you might expect a person’s basic way of relating to the world is very difficult to modify

Dsm iv divides personality disorders into 3 clusters groups
DSM-IV divides Personality Disorders into 3 “Clusters” (groups)

  • Cluster A: odd - eccentric

    • schizoid, paranoid, schizotypal

  • Cluster B: erratic - dramatic

    • narcisstic, histrionic, borderline, antisocial

  • Cluster C: anxious - fearful

    • dependent, avoidant, obsessive-compulsive

Schizoid personality disorder
Schizoid Personality Disorder (groups)

  • The person is withdrawn and lacks feelings for others.

  • The person seems to have no need or desire for close relationships

  • odd behavior may also be present (a loner or hermit)

Paranoid personality disorder
Paranoid Personality Disorder (groups)

  • The person is inappropriately suspicious and mistrustful of others.

  • The person may think friends or co-workers are plotting against him and may doubt the loyalty of his spouse

  • Paranoid personality disorder is NOT the same as paranoid schizophrenia.

Schizotypal persnoality disorder
Schizotypal Persnoality Disorder (groups)

  • literally means “schizophrenic genotype,” there may be a genetic link with schizophrenia,

  • unusual belief systems are characteristic of this disorder

    • magical thinking, special powers, delusions

  • the person may also have unusual appearance and behavior

Narcissistic personality disorder
Narcissistic Personality Disorder (groups)

  • The person has an exaggerated sense of self-importance and demands constant attention and admiration

  • The person is “grandious” believing he/she is “special” and very important

  • They feel that only other “special” people can understand them

Histrionic personailty disorder
Histrionic Personailty Disorder (groups)

  • the person’s behavior and speech are exaggerated and overly dramatic

  • like the narcissist, they crave attention but more out of need than grandiousity

  • may be sexually promiscuous with stormy relationships

  • relationships with others are shallow and superficial

Borderline personality disorder
Borderline Personality Disorder (groups)

  • The most severe of the personality disorders

  • characterized by marked instability in self-image, mood, and interpersonal relationships

  • a classic symptom is “cutting” oneself and other self-mutilating behaviors

  • other symptoms are depression, anxiety/panic depersonalization, and drug use

  • often co-occurs with MPD and like MPD a history of childhood abuse is common

Antisocial personality disorder
Antisocial Personality Disorder (groups)

  • involves a pattern of violent, criminal, or unethical and exploitative behavior and an inability to feel affection for others

  • the vast majority are males

  • sly, cunning, charming, irresponsible, shallow and unemotional, feel no remorse

  • substance abuse is common. These behaviors are very difficult to change

Dependent personality disorder
Dependent Personality Disorder (groups)

  • Personality disorder in which the person is unable to make choices and decisions independently and cannot tolerate being alone.

  • Appear to have an underlying fear of being abandoned or rejected.

Avoidant personality disorder
Avoidant Personality Disorder (groups)

  • Personality disorder in which the person’s fears of rejection by others leads to social isolation.

  • Avoidant personality disorder differs from schizoid personality disorder in that avoidant individuals want to have close relationships with other people.

  • Some believe this disorder is really the same thing as social phobia

Obsessive compulsive personality disorder
Obsessive-Compulsive Personality Disorder (groups)

  • rigid, inflexible, overly moralistic, unable to “have fun” and relax

  • perfectionistic and cannot delegate responsibility to others

  • may get so caught up in details that the main task is never completed

  • may be an asset in some types of work

Schizophrenic disorders
Schizophrenic Disorders (groups)

  • Severe disorders in which there are disturbances of thoughts, communication, and emotions.

  • positive symptoms: presence of some behavior not seen in normal persons (e.g., hallucinations, delusions)

  • negative symptons: absence of behaviors seen in normal persons (e.g., lack of normal range of mood, normal hygiene)

Hallmark symptoms
Hallmark Symptoms (groups)

  • delusions: false beliefs about reality that have no basis in fact. Common delusions involve thought broadcasting, thought insertion, religious or supernatural topics (vary with historical era and society)

  • hallucinations: Sensory experiences in the absence of external stimulation, most often auditory. Voices may be heard talking about the person or to the person, telling him/her to do things

Additional symptoms
additional symptoms (groups)

  • loosening of associations or tangential thinking

  • clanging (rhyming words with no meaning)

  • flat or blunted affect (no change in mood)

  • social withdrawal/isolation

  • lack of normal hygiene

  • unpredictability

Types of schizophrenic disorders
Types of Schizophrenic Disorders (groups)

  • disorganized schizophrenia: bizarre and childlike behaviors, giggling, odd faces, gesturing

  • paraniod schizophrenia: disorder is less obvious, suspiciousness and complex delusisonal systems are common

  • catatonic schizophrenia: motor activity disturbance is prominent.

  • undifferentiated schizophrenia: those who don’t really fit into one of the above

Causes of schizophrenia
Causes of Schizophrenia (groups)

  • twin studies suggest vulnerability is quite heritable

  • schizophrenics have high amounts of the neurotranasmitter dopamine

  • enlarged “ventricles” are seen in brains

  • abnormal patterns of brain activiy have been observed

  • disturbed family relations are common

Childhood disorders
Childhood Disorders (groups)

  • Attention-deficit/hyperactivity disorder (ADHD)

  • Autistic disorder

Attention deficit hyperactivity disorder
Attention-Deficit/Hyperactivity Disorder (groups)

  • A childhood disorder characterized by inattention, impulsiveness, and hyperactivity.

  • Much more common in boys than girls.

  • Diagnosis has been increasingly common in recent years

  • Commonly treated with psychostimulants (e.g., ritalin)

Autistic disorder
Autistic Disorder (groups)

  • literally: “turned inward”

  • occurrence: autism is a very rare disorder

  • typical symptoms: lack of social interaction, strange motor behaviors, self destructive behaviors, fascination with movement, attachment to odd objects, intolerance of change

Psychological disorders

  • echolalia: (groups) repeating words said to them.

  • “savant”: an autistic with special abilities in some area (e.g., numbers, art)most autistics are NOT “savants”

  • causes: not known but genetics/biology are strongly implicated

  • there is some connection with mental retardation and fragile x syndrome