Chapter 15: Abnormality Psychology: Disorders and Treatment
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Establishes uniform definitions and standards for diagnosis
Defining Abnormal Behavior
1. Distress – emotional distress and suffering
2. Impairment in function – not able to attend to the daily activities, as they once were able
to such as work, relationships, school
3. Cultural implications – behavior is view as being atypical for that society
Biopsychosocial Model
• Biological – genetic factors, brain injury, imbalances of neurotransmitters and hormones
• Psychological – individual experiences that contribute to one’s ability to cope
• Social and Cultural – influence of others’ behaviors and expectations
Psychological Disorders
50% people have a diagnosable disorder at some point in their lives.
Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) – the person has constant and exaggerated worry
There is little basis for the worries.
Excessive worry occurs most of the days during the week for which they find difficult to
control. They often feel restless, have difficulty concentrating, are irritable, muscle tension,
fatigue, heart palpitations and have sleep disturbances.
Adults worry about:
job, family, chores, appointments
Children worry about :
academic, social, athletic performance
The anxiety causes significant distress or impairment in functioning.
Treatments:
Pharmacological
Benzodiazepines
Antidepressants
Treatments:
Psychological
Cognitive-behavioral treatments
• Exposure to anxiety-provoking situations
• Confronting anxiety-provoking thoughts
• Coping strategies
Panic Disorder
Panic disorder – characterized by frequent periods of anxiety and occasional panic attacks
Panic attacks involve rapid breathing, increased heart rate, chest pains, sweating,
trembling and faintness. Hyperventilation, or rapid deep breathing, is a key symptom.
Common co-existing disorder with Panic Disorder
Agoraphobia – an intense fear of open or public places
(Fear or avoidance of situations/events)
Treatments:
Medications
Multiple systems
Serotonergic – SSRIs (e.g., Prozac and Paxil)
Noradrenergic
Benzodiazepine GABA
High relapse rates
Psychological
Exposure – based
Cognitive therapy
Relaxation/breathing
Phobias
Phobia – persistent and irrational fear of a specific object or situation that presents no realistic
danger – and interferes with daily functioning
Some common phobias include:
Open spaces
Public speaking
Heights
Storms (lightening, thunder)
Blood
Certain animals – (snakes, bugs, spiders, dogs)
Treatments:
Cognitive-behavior therapies
Exposure
Relaxation
Behavioral Treatments
Systematic Desensitization – technique that associates a pleasant, relaxed state with
gradually increasing anxiety provoking stimuli
Systematic Desensitization is a three step process:
1. First – building an anxiety hierarchy
2. Second – involves relaxation training
3. Third – working through the hierarchy, learning to relax while imaging each
stimulus
Exposure Therapy (Flooding) – a method for extinguishing anxiety by exposing the
person to the feared stimulus situation
Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals
(compulsions) that cause distress
Obsessions – repetitive thoughts
Compulsions – repetitive actions
Most common compulsive behaviors are:
Checking
Cleaning
Treatments:
Medications
SSRIs
60% benefit
High relapse when discontinued
Treatments:
Cognitive-behavioral therapy
Exposure
Confronting anxiety-provoking thoughts
Highly effective (86% benefit)
Major Depression
Major depression
Usually persists for months
The person experiences little interest in anything, little pleasure, and little motivation to
be productive.
Changes in appetite
Feelings of worthlessness, guilt and helplessness
Sleep abnormalities (rapid onset of REM)
Possible suicide attempt
Genetic predisposition:
Close biological relatives diagnosed with depression increases the probability of
developing it. Having biological relatives diagnosed with depression before age 30
increases risk substantially.
No single gene causes depression
Genes influence temperament and response to life events
Gender differences:
Before adolescence, depression is equally common in boys and girls.
From adolescence on, women are twice as likely to experience it.
Hormones
Women experience rapid hormonal changes (menstrual cycles, pregnancy,
childbirth and menopause).
Coping
Men tend to distract themselves
Women tend to dwell on their feelings
(Ruminating is not useful and leads to feeling worse)
Events that precipitate depression:
Negative life events
Interpersonal crises, intense feelings of frustration, anger or self-hatred, the absence
of meaningful life goals
Stress leads to neurochemical changes and disruptions in sleep that can cause depression
Cognitive aspects of depression:
The person’s interpretation of the event can influence degree of depression.
Our explanatory style is how we account for successes and failures.
Explanatory Style
1. Stable vs. Temporary – whether a person believes a repeated event will be the
same or subject to change
2. Global vs. Specific – whether or not a person’s explanation generalizes the event
to others beyond the specific event in hand
3. Internal vs. External – whether or not a person believes that they have control or
influence over events
Behavioral aspects of depression:
Lack of interpersonal skills – interferes with interpersonal relationships
Lack of social support increases vulnerability
Treatment:
Cognitive therapy helps people develop more positive beliefs.
Antidepressant medications including:
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Selective Serotonin Reuptake Inhibitors (SSRI’s) – prevent the reabsorption of
serotonin
Tricyclics – prevent the reabsorption of dopamine, norepinephrine, and serotonin
Monoamine Oxidase Inhibitors (MAOIs) – prevent the enzyme, monoamine
oxidase, from breaking down neurotransmitters.
It usually takes 2-3 weeks for most drugs to take effect.
Bipolar Disorder
Moods alternate between mania and depression
Bipolar: Manic Symptoms
Emotional symptoms
elated mood
euphoric
Cognitive symptoms
racing thoughts
soaring self-esteem
unrealistically optimistic
delusions of grandeur
Behavioral symptoms
boundless energy in spite of a reduced need for sleep
rapid speech
extravagant
impulsive behaviors
People with bipolar cycling between periods of depression and mania.
(Age of onset is usually in early 20’s)
About 1% of the adult population of the U.S. is diagnosed.
Numerous studies have found that people with bipolar typically have at least one close relative
with the disorder.
Bipolar Relative
Concordant Rates
Children with one parent with bipolar
15% – 30%
Children with two parents with bipolar
50% – 75%
Fraternal twin has bipolar
15% – 25%
Identical twin has bipolar disorder
40% – 70%
Drug therapies:
Lithium – chemical that controls mood swings
How it works is not well understood
Toxic at high doses, careful monitoring is necessary
Symptoms often return after medication is stopped
Suicide: People suffering from depression and bipolar disorders consider or attempt suicide.
Previous attempts, substance abuse, a history of losses, a recent loss, or a family history of
suicide all increase risk.
Schizophrenia
What is schizophrenia?
Deterioration of daily activities and two of the following symptoms:
Hallucinations
Delusions
Incoherent speech
Grossly disorganized behavior
Loss of, or inappropriate, emotional responses
Positive symptoms – the presence of inappropriate behaviors (hallucinations, disorganized or
delusional thinking)
Negative symptoms – the absence of appropriate behaviors (lack of emotional responses)
Delusions could include:
Delusions of persecution
“Someone is following me”
Delusions of grandeur
“I am a king”
Hallucinations: A schizophrenic person may perceive things that are not there (hallucinations) –
usually they are more auditory and less visual, somatosensory, or olfactory.
Inappropriate Emotions & Actions: A schizophrenic person may laugh at the news of someone
dying (inappropriate affect) or show no emotion at all (flat affect).
Prevalence:
Most frequently diagnosed in young adults
Men are diagnosed earlier than women
The onset seems sudden
There are some markers during childhood
Causes:
Genetic influences
Studies of twins and adopted children suggest a genetic basis. The likelihood of
an individual suffering from schizophrenia is 50% if their identical twin has the
disease.
Brain abnormalities – brain scans indicate:
The hippocampus and cortical regions somewhat smaller than normal
Larger than normal cerebral ventricles
Smaller neurons and fewer synapses in the prefrontal cortex
Schizophrenia patients may exhibit enlargement of fluid-filled ventricles.
Dopamine Overactivity – researchers found that schizophrenic patients express higher
levels of dopamine activity in the brain
Drug Therapy – with the advent of drugs, hospitalization in mental institutions has rapidly
declined over the years
Antipsychotic or neuroleptic drugs help to relieve the symptoms of schizophrenia.
They work by blocking the production of dopamine at the synapses.
Side effects of Tardive Dyskinesia
Atypical (Second Generation) Antipsychotic drugs
Alter activity at both dopamine and serotonin synapse
Relieve negative symptoms which earlier drugs failed to do
Don’t have the side effects of Tardive Dyskinesia
But have their own side effects
Most improvement occurs in the first month and after that, the drugs merely maintains behavior.
When people stop taking the drugs, the symptoms return.
Psychotherapy
Psychotherapy – treatment of psychological disorders
Psychoanalysis: The first formal psychotherapy to emerge was psychoanalysis, developed by
Sigmund Freud.
Goal of psychoanalysis is to bring repressed feelings into conscious awareness where the patient
can deal with them.
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Free Association – the patient thinks about a symptom or problem and says everything that
comes to mind about it
Dream analysis – therapist analyzes the symbolic meaning of dreams
Resistance – unconscious defensive maneuvers intended to hinder the progress of therapy
Transference – the client’s experience of feelings previously associated with a parent or
other important figure that are “transferred” to the therapist.
Behavior therapy: applies learning principles to eliminate unwanted behaviors
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Classical Conditioning
Operant Conditioning
Systematic Desensitization – technique that associates a pleasant, relaxed state with
gradually increasing anxiety provoking stimuli
Exposure Therapy – exposing the person to the feared stimulus or situation
Behavior Modification – desired behaviors are rewarded and undesired behaviors are either
unrewarded or punished
Cognitive therapy: seeks to improve people’s functioning by changing how they think about
situations
Cognitive-behavioral therapy: aims to alter the way people act (behavior therapy) and alter the
way they think (cognitive therapy)
Humanistic therapy: aims to help people grow in self-awareness and self-acceptance
Client-Centered Therapy
• Genuineness
• Unconditional Acceptance
• Empathy
Family therapy: treats the family as a system
Therapy guides family members toward positive relationships and improved communication.
Group therapy – therapy administered to several people at once
Benefits of Group Therapy:
• can help more people at once
• costs less
• members benefit from knowing others have similar problems
• helps to build social skills
Self-help groups – similar but there is no therapist involved
Eclectic therapists – do not use any single method of treatment exclusively, but a combination of
approaches
How effective is psychotherapy?
A study by Consumer Reports of mental health treatment and psychotherapy concluded that
most mental health treatment is helpful in improving the psychological and emotional well
being of clients. Research shows that treated patients were 80% better than untreated ones.
Research has shown that there is no one method of therapy that stands out as being better than
others.
There are distinct advantages to seeking professional mental health care.
A trained clinician:
• keeps confidentiality
• uses methods with some demonstrated level of effectiveness
• makes referrals to other professionals if necessary (for example, if a medical problem
exists)

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