Chapter 17 Abnormal Behavior Deviance and Disorder Table

Chapter 17 Abnormal Behavior: Deviance and Disorder Table of Contents Exit

Key Questions How is normality defined, and what are the major psychological disorders? What is a personality disorder? What are the most common sexual disorders? What problems result when a person suffers high levels of anxiety? How do psychologists explain anxiety-based disorders? Is psychiatric labeling damaging? What role does the concept of insanity play in criminal trials? Table of Contents Exit

Catch-22 (Page 557) Table of Contents Exit

Facts on Psychopathology During their lifetimes, 1 out of every 100 people will become so severely disturbed as to require hospitalization Some 3 -6% of the aged suffer from organic psychoses In any given week, 7% of the population is experiencing an anxiety-related disorder 1 out of every 8 school-aged children is seriously maladjusted 10 -20% or more of all adults will suffer a major depression in their lifetime Each year over 2 million people in North America are admitted or readmitted for psychiatric treatment in hospitals Table of Contents Exit

Andy Wilf Selfportraits The self-portraits shown here were painted by Andy Wilf between 1978 and 1981. During that time, Wilf is said to have increasingly abused drugs and alcohol. This dramatic series of images is a record of his selfdestructive descent into a private hell. The third painting shows a shrouded skull-and foretells the artists fate. Wilf died of a drug overdose early in 1982. Drug abuse is but one of the many psychopathologies, or “problems in living, ” psychologists seek to alleviate Table of Contents Exit

What is Normal? Psychopathology: Scientific study of mental, emotional, and behavioral disorders Table of Contents Exit

What is Normal? (cont. ) Subjective Feelings of anxiety, depression, or emotional distress Statistical Abnormality: Having extreme scores on some dimension, such as intelligence, anxiety, or depression Social Discomfort: Nonconformity: Disobeying societal standards for normal conduct; usually leads to destructive or self-destructive behavior Table of Contents Exit

Fig. 17. 1 The number of people displaying a personal characteristic may help define what is statistically abnormal. Social non-conformity does not automatically indicate psychopathology. Table of Contents Exit

Does social nonconformity automatically indicate psychopathology? Table of Contents Exit

What is Normal? (cont. ) Situational Context: Social situation, behavioral setting, or general circumstances in which an action takes place Is it normal to walk around strangers naked? If you are in a locker room and in the shower area, yes! Cultural Relativity: Judgments are made relative to the values of one’s culture Table of Contents Exit

The Politics of “Madness” Page 560 Table of Contents Exit

Shades of Abnormality Bob is a very intelligent, 25 year old member of a religious organization that is based on Buddhism. Bob's working for this organization caused considerable conflict between him and his parents, who are devout Catholics. Recently Bob experiences acute spells of nausea and fatigue that prevent him from working and which have forced him to return home to live with his parents. Various medical tests are being conducted, but as yet no physical causes of his problems have been found. RATE each of these people using the following scale: 1 = Basically O. K. Psychotherapy is not necessary. 2 = Mild disturbance. Psychotherapy should be considered. 3 = Significant disturbance. Psychotherapy is definitely required. 4 = Severe disturbance. Hospitalize! Table of Contents Exit

Shades of Abnormality Jim was vice president of the freshman class at a local college and played on the school's football team. Later that year he dropped out of these activities and gradually became more and more withdrawn from friends and family. Neglecting to shave and shower, he began to look dirty and unhealthy. He spent most of his time alone in his room and sometimes complained to his parents that he heard voices in the curtains and in the closet. In his sophomore year he dropped out of school entirely. With increasing anxiety and agitation, he began to worry that the "Nazis" were plotting to kill his family and kidnap him. RATE each of these people using the following scale: 1 = Basically O. K. Psychotherapy is not necessary. 2 = Mild disturbance. Psychotherapy should be considered. 3 = Significant disturbance. Psychotherapy is definitely required. 4 = Severe disturbance. Hospitalize! Table of Contents Exit

Shades of Abnormality Mary is a 30 year old musician who is very dedicated and successful in her work as a teacher in a local high school and as a part-time member of local musical groups. Since her marriage five years ago, which ended in divorce after six months, she has dated very few men. She often worries that her time is "running out" for establishing a good relationship with a man, getting married, and raising a family. Her friends tell her that she gets way too anxious around men, and that she needs to relax a little in general RATE each of these people using the following scale: 1 = Basically O. K. Psychotherapy is not necessary. 2 = Mild disturbance. Psychotherapy should be considered. 3 = Significant disturbance. Psychotherapy is definitely required. 4 = Severe disturbance. Hospitalize! Table of Contents Exit

Shades of Abnormality Larry, a homosexual who has lived for three years with a man he met in graduate school, works as a psychologist in a large hospital. Although competent in his work, he often feels strained by the pressures of his demanding position. An added source of tension on the job is his not being able to confide in all his co -workers about his private life. Most of his leisure activities are with good friends who belong to the gay subculture RATE each of these people using the following scale: 1 = Basically O. K. Psychotherapy is not necessary. 2 = Mild disturbance. Psychotherapy should be considered. 3 = Significant disturbance. Psychotherapy is definitely required. 4 = Severe disturbance. Hospitalize! Table of Contents Exit

Clarifying and Defining Abnormal Behavior (Mental Illness) Maladaptive Behavior: Behavior that makes it difficult to function, to adapt to the environment, and to meet everyday demands Table 17 -1 Levels of functioning (page 561) Table of Contents Exit

Clarifying and Defining Abnormal Behavior (Mental Illness) Mental Disorder: Significant impairment in psychological functioning Those with mental illness lose the ability to adequately control thoughts, behaviors, or feelings Table of Contents Exit

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Psychological problems can be grouped into broad categories. DSM-IV is not the only system for classifying mental disorders. Nevertheless, most activities in mental health settings-from diagnosis to therapy to billing of insurance companies- are influenced by the DSM-IV is both a scientific document and a social one. Major disorders are well-documented problems. Some problems, however, have little to do with “mental illness. ” Instead, they are primarily socially disapproved behaviors. Table of Contents Exit

Diagnostic and Statistical Manual of Mental Disorders (DSMIV) Major DSM-IV Categories Page 563 -564 Table of Contents Exit

Clarifying and Defining Abnormal Behavior (Mental Illness) Psychotic Disorder: Severe psychiatric disorder characterized by hallucinations and delusions, social withdrawal, and a move away from reality Organic Mental Disorder: (cont. ) Mental or emotional problem caused by brain pathology (i. e. , brain injuries or diseases) Substance Related Disorders: Abuse or dependence on a mind- or mood-altering drug, like alcohol or cocaine l Person cannot stop using the substance and may suffer withdrawal symptoms if they do Table of Contents Exit

Fig. 17. 2 This MRI scan of a human brain (viewed from the top) reveals a tumor (dark spot). Mental disorders sometimes have organic causes of this sort. However, in many instances no organic damage can be found. Table of Contents © Scott Camazine/Photo Researchers Exit

Clarifying and Defining Abnormal Behavior (Mental Illness) (cont. ) Mood Disorder: Disturbances in mood or emotions, like depression or mania Anxiety Disorder: Feelings of fear, apprehension, anxiety, and behavior distortions Table of Contents Exit

© Bettmann/CORBIS The Mad Hatter, from Lewis Carroll’s Alice’s Adventures in Wonderland. History provides numerous examples of psychosis caused by toxic chemicals. Carroll’s Mad Hatter character is modeled after an occupational disease of the eighteenth and nineteenth centuries. In that era, hatmakers were heavily exposed to mercury used in the preparation of felt. Consequently, many suffered brain damage and became psychotic, or “mad” (Kety, 1979). Table of Contents Exit

Alice in Wonderland Video (Johnny Depp) Video (Disney) Table of Contents Exit

Clarifying and Defining Abnormal Behavior (Mental Illness) (cont. ) Somatoform Disorder: Dissociative Disorder: Physical symptoms that mimic disease or injury (blindness, anesthesia) for which there is no identifiable physical cause Temporary amnesia, multiple identity, or depersonalization (like being in a dream world, feeling like a robot, feeling like you are outside of your body) Personality Disorder: Deeply ingrained, unhealthy, maladaptive personality patterns Table of Contents Exit

Clarifying and Defining Abnormal Behavior Illness) (cont. ) Sexual and Gender Identity Disorder: (Mental Problems with sexual identity, deviant sexual behavior, or sexual adjustment Neurosis: Archaic; once used to refer to anxiety, somatoform, and dissociative disorders, also used to refer to some kinds of depression Table of Contents Exit

Personality Disorders: Blueprints for Maladjusted Paranoid person Overly suspicious, mistrusting Narcissistic person Pre-occupied with their own self-importance. Absorbed in fantasies of power, wealth, brilliance, beauty, and love Borderline Very unstable relationships, erratic emotions, self-damaging behavior, impulsive Histrionic Overly dramatic, attention seekers, easily angered, seductive, vain, shallow and manipulative TABLE 17 -5 (Page 568) Table of Contents Exit

Personality Disorders Borderline Narcissistic Girl Interrupted There Will be Blood Histrionic Gone With The Wind Table of Contents Exit

Let’s Have A Party Imagine a party where all the people had a personality disorder Table of Contents Exit

General Risk Factors for Contracting Mental Illness Social Conditions: Poverty, homelessness, overcrowding, stressful living conditions Family Factors: Parents who are immature, mentally ill, abusive, or criminal; poor child discipline; severe marital or relationship problems Psychological Factors: Low intelligence, stress, learning disorders Biological Factors: Genetic defects or inherited vulnerabilities; poor prenatal care, head injuries, exposure to toxins, chronic physical illness, or disability Table of Contents Exit

Focus on a Controversy Are the Mentally Ill Prone to Violence? Jeffrey Dahmer Page 565 Table of Contents Exit

Personality Disorders: Antisocial Personality Disorder (APD) Antisocial Personality Disorder: A person who lacks a conscience (superego? ); typically emotionally shallow, impulsive, selfish, and manipulative toward others l Oftentimes called psychopaths or sociopaths Many are delinquents or criminals, but many are NOT crazed murderers displayed on television Create a good first impression and are often charming Cheat their way through life (e. g. , Dr. Michael Swango, Scott Peterson) Table of Contents Exit

APD: Causes and Treatments Possible Causes: l l Childhood history of emotional deprivation, neglect, and physical abuse Underarousal of the brain Very difficult to effectively treat; will likely lie, charm, and manipulate their way through therapy Table of Contents Exit

Antisocial Personality Disorder CINEMA EDUCATION Michael Swango Clockwork Orange The Joker Ted Bundy Table of Contents Exit

© Robert Hare Fig. 17. 3 Using PET scans, Canadian psychologist Robert Hare found that the normally functioning brain (left) lights up with activity when a person sees emotion-laden words such as “maggot” or “cancer. ” But the brain of a psychopath (right) remains inactive, especially in areas associated with feelings and self-control. When Dr. Hare showed the bottom image to several neurologists, one asked, “Is this person from Mars? ” (Images courtesy of Robert Hare. ) Table of Contents Exit

Anxiety-Based Disorders Anxiety: Feelings of apprehension, dread, or uneasiness Adjustment Disorders: When ordinary stress causes emotional disturbance and pushes people beyond their ability to effectively cope l Usually suffer sleep disturbances, irritability, and depression l Examples: Grief reactions, lengthy physical illness, unemployment Table of Contents Exit

Anxiety-Based Disorders (cont. ) Generalized Anxiety Disorder (GAD): Duration of at least six months of chronic, unrealistic, or excessive anxiety Free-Floating Anxiety: Anxiety that is very general and persuasive Table of Contents Exit

Anxiety Neurosis Worksheet (Page 125) Anxiety Neurosis Table of Contents Exit

Panic Disorders Panic l l A chronic state of anxiety with brief moments of sudden, intense, unexpected panic (panic attack) Panic Attack: Feels like one is having a heart attack, going to die, or is going insane Symptoms include vertigo, chest pain, choking, fear of losing control Panic Disorder (without Agoraphobia): Disorder (with Agoraphobia): Panic attacks and sudden anxiety still occur, but with agoraphobia Table of Contents Exit

Agoraphobia (with Panic Disorder): Intense, irrational fear that a panic attack will occur in a public place or in an unfamiliar situation l l l Intense fear of leaving the house or entering unfamiliar situations Can be very crippling Literally means fear of open places or market (agora) Agoraphobia (without Panic Disorder): Fear that something extremely embarrassing will happen away from home or in an unfamiliar situation Table of Contents Exit

Specific Phobias Irrational, persistent fears, anxiety, and avoidance that focus on specific objects, activities, or situations People with phobias realize that their fears are unreasonable and excessive, but they cannot control them Examples: (Table 17 -7 page 573) Animal type: Fear of a specific type Natural environment: Fear of heights, storms, ocean… Blood, injection, injury: Fear of blood, injections, treatments Situational: Fear of situations, airplanes, elevators, enclosed spaces Other: Fear of other situations that lead to choking, vomiting, sick Table of Contents Exit

Social Phobia Intense, irrational fear of being observed, evaluated, humiliated, or embarrassed by others (e. g. , shyness, eating, or speaking in public) Celebrities with Anxiety Disorders Table of Contents Exit

Phobia Worksheet (Page 126) Phobias Table of Contents Exit

Obsessive-Compulsive Disorder (OCD) Extreme preoccupation with certain thoughts and compulsive performance of certain behaviors Obsession: Recurring images or thoughts that a person cannot prevent Cause anxiety and extreme discomfort Enter into consciousness against the person’s will Most common: Being dirty, wondering if you performed an action (turned off the stove), or violence (hit by a car) Compulsion: Irrational acts that person feels compelled to repeat against his/her will Help to control anxiety created by obsessions Checkers and cleaners Table of Contents Exit

Obsessive-Compulsive Disorder (OCD) Cinema Education The Odd Couple Matchstick Men As Good As It Gets Table of Contents Exit

OCD & Profile of a Neurotic Worksheet(129 -131) Obsession/Compulsion and Hysteria The Case of A. H. /Profile of a Neurotic Table of Contents Exit

Stress Disorders Occur when stresses outside range of normal human experience cause major emotional disturbance l Acute Stress Disorder: Symptoms: Reliving traumatic event repeatedly, avoiding stimuli associated with the event, and numbing of emotions Psychological disturbance lasting up to one month following stresses from a traumatic event Post Traumatic Stress Disorder (PTSD): Lasts more than one month after the traumatic event has occurred; may last for years l l Typically associated with combat and violent crimes (rape, assault, etc. ) Terrorist attacks on September 11 th, 2001, likely led to an increase of PTSD Table of Contents Exit

Dissociative Disorders Dissociative Amnesia: Inability to recall one’s name, address, or past Dissociative Fugue: Sudden travel away from home and confusion about personal identity Table of Contents Exit

Dissociative Identity Disorder (DID) Dissociative Identity Disorder (DID): Person has two or more distinct, separate identities or personality states; previously known as Multiple Personality Disorder “Sybil” or “The Three Faces of Eve” are good examples Often begins with horrific childhood experiences (e. g. , abuse, molestation, etc. ) Therapy often makes use of hypnosis Goal: Integrate and fuse identities into single, stable personality Table of Contents Exit

Dissociate Identity Disorder (DID) Sybil 3 Faces of Eve Fight Club Table of Contents Exit

Somatoform Disorders Hypochondriasis: Person is preoccupied with having a serious illness or disease l l Interpret normal sensations and bodily signs as proof that they have a terrible disease No physical disorder can be found Somatization Disorder: Person expresses anxieties through numerous physical complaints l Many doctors are consulted but no organic or physical causes are found Table of Contents Exit

Somatoform Disorders (cont. ) Pain Disorder: Pain that has no identifiable organic, physical cause Appears to have psychological origin Conversion Disorder: Severe emotional conflicts are “converted” into physical symptoms or a physical disability Caused by anxiety or emotional distress but not by physical causes Table of Contents Exit

Fig. 16. 4 (left) “Glove” anesthesia is a conversion reaction involving loss of feeling in areas of the hand that would be covered by a glove (a). If the anesthesia were physically caused, it would follow the pattern shown in (b). (right) To test for organic paralysis of the arm, an examiner can suddenly extend the arm, stretching the muscles. A conversion reaction is indicated if the arm pulls back involuntarily. (Adapted from Weintraub, 1983. ) Table of Contents Exit

Theoretical Causes of Anxiety Disorders: Psychodynamic (Freud): Anxiety caused by conflicts among id, ego, and superego l Forbidden id impulses for sex or aggression are trying to break into consciousness and thus influence behavior; person fears doing something crazy or forbidden l Superego creates guilt in response to these impulses l Ego gets overwhelmed and uses defense mechanisms to cope Table of Contents Exit

Other Theoretical Causes of Anxiety Disorders Humanistic: Existential: Unrealistic self-image conflicts with real self-image Anxiety reflects loss of meaning in one’s life Behavioristic: Anxiety symptoms and behaviors are learned, like everything else Conditioned emotional responses that generalize to new situations Table of Contents Exit

More Theoretical Causes of Anxiety Disorders Avoidance Learning: When making a particular response delays or prevents the onset of a painful or unpleasant stimulus Anxiety Reduction Hypothesis: When reward of immediate relief from anxiety perpetuates self-defeating avoidance behaviors Table of Contents Exit

Cognitive Approach Cognitive: When distorted thinking causes people to magnify ordinary threats and failures, leading to anxiety and distress Table of Contents Exit

Insanity Insanity: A legal term; refers to an inability to manage one’s affairs or to be aware of the consequences of one’s actions Those judged insane (by a court of law) are not held legally accountable for their actions Can be involuntarily committed to a psychiatric hospital Some movements today are trying to abolish the insanity plea and defense; desire to make everyone accountable for their actions How accurate is the judgment of insanity? Expert Witness: Person recognized by a court of law as being qualified to give expert testimony on a specific topic May be psychologist, psychiatrist, and so on Table of Contents Exit

Insanity Defense: Person was incapable of knowing right from wrong while committing a crime M’Naghten Rule: Standard for judging legal insanity in English common law Must understand wrongfulness of actions to be held responsible for them If suffering from mental disease preventing person from knowing right from wrong, can be deemed insane Taking of a life due to insanity is not murder Irresistible Impulse: Uncontrollable urge to act Diminished Capacity: Temporary loss of ability to control actions or to know right from wrong. Table of Contents Exit

Psychology and the Law The “Twinkie Defense” Table of Contents Exit

Panic Disorder Part A read (Page 203 -206) Part B complete using Part A (Page 207 -208) Table of Contents Exit