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Unformatted text preview: SPARKCHARTST" SPARK CHARTS1 INTRODUCTION f Abnormal psychology: the study of abnormal behavior, including theories and research g about causes, assessment, and treatment 3, Psychopathology: an abnormal pattern of behavior that is unusual, distressing, t dysfunctional, and that may cause the sufferer to be dangerous to self or others A. Criteria for defining abnormal behavior include: ‘ 1. Personal distress: subjective experience of suffering 2. Statistical rarity: has unusual behaviors (e.g., binge eating) 3. Maladaptive behavior: has impaired functioning (e.g., insomnia, poor reality testing) 4. Violation of social norms: exhibits behavior that is socially undesirable 5. Danger to self or to others: usually dangerous to self via poor judgment o No single criterion is adequate; need to consider cultural norms in defining abnormality The official definition of abnormal behavior stresses: ' ‘l. Impairment: difficulty in carrying out everyday functions (e.g., work, maintaining relation- ships) in an adaptive manner 2. Distress: emotional suffering (e.g., anxiety, depression) 3. Significant risk of pain, death, or important loss of freedom (e.g., selfemutiliation) j C. No sharp dividing line between normal and abnormal MAIN THEORIES OF ABNORMAL B AVIOR BIOLOGICAL THEORY eficits or defects in the structural or functional integrity of the nervous system lead to abnormal ehavior. Types of biological abnormalities include: . Defective genes: each chromosome contains thousands of genes (carriers of DNA) that influ» ence psychological and physical development. Defective genes may adversely affect develop- ment (e.g., trisomy causes Down syndrome). - Behavior genetics: the study of individual differences in behavior that are caused by differences in genotype (a person’s genetic makeup). Typically, it takes a combination of several altered genes to cause a disorder. . Structural brain abnormalities: occurs when areas of the brain have not developed optimally or have undergone pathological changes (e.g., the ventricles, which are the fluid—filled portions of the cortex, often are larger in schizophrenics). , Neurotransmitter imbalances: the 100 billion neurons in the central nervous system (CNS) communicate by chemical messengers called neurotransmitters, which can become imbal- anced. Biological approaches to treatment focus mainly on medications that address neuro- transmitter imbalances. T. Neurotransmitters (e.g., serotonin, dopamine, norepinephrine, GABA) are released into the synaptic cleft (the small gap between the axon of one and the dendrites of the receiving or postsynaptic neuron). They regulate level of mood, anxiety, and cognitive functioning. Factors affecting imbalance include: a, Number, distribution, and functioning of receptors on the dendrites (the receiving branches of the neuron) b. Reuptake: the amount of neurotransmitter in the synaptic cleft, or vesicle, that is reab- sorbed by the releasing neuron c. Degradation: the process by which a neurotransmitter is broken down by enzymes 1 released by the receiving neuron E D. Hormones: chemicals secreted by the endocrine glands (e.g., pituitary). They play a role in ‘ the functioning of the nervous system and in the regulation of behavior (e.g., during adoles» cence, changes in the hypothalamic»pituitaryeadrenal [HPA] axis are involved in the increase in cortisol, a stress-related hormone). - Functioning of neurotransmitters and endocrine glands is based on both biological factors , and environmental stressors. E. Methods used to assess the contribution of biological factors: ‘ 1. Twin studies: concordance rates in monozygotic (100% genes in common) and dizygotic twins (50% genes in common) allow researchers to tease apart genetic causes. If the con- cordance rate (the rate at which one twin has the disorder and the other does, too) is higher in monozygotic vs. dyzgotic twins, then the argument is made for a stronger genetic component to the illness. 2. Studies of family history: a researcher identifies those people with the disorder (pro- bands), examines family trees, and compares that information with controls, to see what percentage of firstedegree relatives also have the disorder. The problem is that one cannot tease apart genetic and environmental causes. 3. Adoption studies: comparisons of rates of the disorder in the adoptive relatives vs. biologi- cal relatives of the adoptees. This helps tease apart genetic and environmental causes. PSYCHOLOGICAL THEORIES 3A. Psychodynamic: refers to the conflict of forces in the mind. Sigmund Freud, the father of ‘ psychoanalysis, was the founder of modern psychodynamic therapy. T. Key assumptions include: a. Psychic determinism: mental life is lawful (i.e., the apparently random sequences of thoughts are not really random but are guided and connected by underlying motives). b. Unconscious motivation: most of mental life, particularly wishes, operates outside of awareness 2. The mind is organized on the basis of conflicts between: a, Id: the unconscious wishes b. Ego: coping and defense mechanisms c. Superego: the conscience 3. Instinctual drives: Freud posited that sex (broadly defined as physical urges) and aggres- sion are the two main instinctual drives 4. Defenses: if a person has wishes, desires, and fantasies (based on these drives) that he/ she regards as unacceptable and that arouse anxiety, he/she deals with them by means of defense mechanisms - Defense mechanism: any mental process or behavior can be used to ward off negative feelings (see chart, above right) Defense Mechanism Description Repression Keeping unacceptable wishes from consciousness Projection Attributing unacceptable wishes to someone else (e.g., "I don’t hate youiyou hate me") Reaction formation Transforming unacceptable wishes into their opposite (e.g., being saccharine-sweet rather than hostile) Displacement Redirecting a feeling from one person to another Regression Reverting to behavior from an earlier stage in development to avoid anxiety Rationalization Presenting a socially acceptable reason for behavior as a way of avoiding the real reason Denial Disavowing an action, thought, or feeling; refusing to admit to an aspect of reality lntellodualization Avoiding unpleasant feelings by adopting a highly ideational approach isolation of affect Keeping ideas and their feelings they excite separate in one's mind Sublimation Redirecting unacceptable impulses to socially desirable behavior 5. Symptoms arise when threatening wishes are too strong and/or defenses are too weak. , 6. Freud described four psychosexual stages of development: oral, anal, phallic, and genital. ,- Excessive gratification or deprivation at a given stage can result in: ' a, Fixation: stagnation at that stage _ b. Regression: a return to aspects of a given stage at times of stress (e.g., reverting to 3 thumbesucking following the birth of a sibling) ‘ B. Behavioral: focus on observable behavior rather than on the person's inner mental lifef Abnormal behavior is based on learning and environmental experiences. I 1. Classical conditioning (Pavlov): the pairing of contiguous events makes organisms learn 1 associations between things, creating involuntary responses to stimuli ‘ Elements of classical conditioning: , o UCS (unconditioned stimulus, food) :> UCR (unconditioned response, salivation to food) 2 b, UCS (food) + CS (conditioned stimulus, bell):> UCR (salivation to food) c. CS (bell) => CR (conditioned response, salivation to bell) , - Extinction of the conditioned response happens when, over the course of many trials, the sound of the bell is not followed by food , 2. Operant conditioning: the shaping of behaviors via reintorcers (i.e., rewards and ‘ punishments). a, Positive reinforcers: rewards that increase the probability of behavior b. Negative reinforcers: the removal of aversive stimuli that increase the probability of behavior (e.g., a social phobic feels relieved of anxiety when she avoids parties, so she continues to avoid) Punishment: negative consequences that decrease the probability of behavior d. Thorndike’s law of effect: behaviors followed by punishment are weakened; behaviors I followed by rewards are strengthened. ‘ e. Extinction is more difficult with a partial, in comparison with a continuous, reintorce- 3 ment schedule. I 3. Modeling: learning based on observing others. Even in the absence of obvious reinforcers, 3 we learn and behave by watching and imitating others. We are influenced by the rewards l and punishments others receive for their actions. ‘ C. Cognitive: one’s misconceptions of the world and misinterpretations of experience lead to beliefs and thoughts that cause negative feelings and behaviors, making one more vulnerable to abnormalities 1 1. Dysfunctional ideas and causal attributions are distorted, self—defeating, . and irratio- t nal. These incorrect thoughts are based on faulty schemas (organizations of beliefs and assumptions). ‘ 2. Beck and Ellis are major proponents of the cognitive view. Ellis focuses on common irratioe ‘ nal beliefs that must be overcome (e.g., “Everyone must love me"). Beck emphasizes the ‘ cognitive triad in depressed patients (having a negative view of themselves, the world, and 1 their future). D. Humanistic/existential views: focus on man's mortality, responsibility for decision—making, ‘ and his search for meaning in life. Proponents believe that disorders arise when people feel I compelled to conform to parental/societal demands instead of acting with authenticity in the ‘ pursuit of their own true values and goals. Authencity is more apt to promote self-actualiza- ‘ tion (the fulfillment of one’s potential). E. Sociocultural perspectives T. Focuses on the impact of social forces, family and cultural influences, and failures of society on individual mental health 2. Failure of support system: family, friends, community in times of stress (e.g., poverty, gender or racial discrimination, lack of opportunity) BIO-PSYCHO-SOGIAL INTEGRATION Abnormality is a function of the interaction of these three sets of factors and the vulnerability ' they create in the individual. THE DIATHESIS—STRESS MODEL Individual differences in vulnerability (diathesis), due to biological and psychological factors, ' interact with stressors in the environment. Proponents believe that particular combinations of diathesis and stress cause abnormal behavior. - High stress and low diathesis or low stress and high diathesis both can lead to psychological 3' disturbance. l" SPARKCHARTSm ABNORMAL psvcuomav CLASSIFICATION OF MENTAL DISORDERS CLASSIFICATION I A. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th ed.. Text Revision (DSM»IV—TR), published by the American Psychiatric Association (2000). I. This is the current classification system of mental disorders used for insurance, research, and record-keeping. Researchers use the DSM-IV»TR to classify: 0 Dimensions: quantitative (e.g., a matter of degree of the disorder) b. Categories: qualitative (e.g., presence vs. absence of a disorder) 2. Contains information on inclusion criteria, exclusion criteria, duration of disorder, and asso ciated features . Includes a classification system that classifies via five axes . Each axis includes categories that describe syndromes—sets of symptoms. Each general category consists of a number of subcategories #93 Axis I All categories of clinical syndromes (a configuration of symptoms), except personality disorders and mental retardation Axis II ‘ Personality disorders (long-standing patterns of maladaptive behavior) and mental retardation (deficient cognitive functioning) Axis III General medical conditions Axis W Psychosocial slressors (recent stressors, social resources, sociocultural background) and environmental problems 7 Axis v Global level of current functioning (overall clinical rating of degree of impairment) . _ I‘ clinical Assessment: sampling of behavior in different domains to arrive at a diagnosis, case I formulation, and treatment plan. A. Methods of assessment 1. Interview a. Structured: preeset format of questions b. Unstructured: open‘ended set of questions. Format depends on purpose of interviewer (i.e., research vs. treatment) and on the theoretical orientation of the interviewer. 2. Psychological tests and questionnaires a Performance-based measures i. Intelligence tests (e.g., Wechsler Adult Intelligence ScaleeRevised, or WAIs-R): used to derive Intelligence Quotient (IQ) based on verbal (e.g., abstract thinking, vocabue Iary) and nonverbal (e.g., visual-spatial ability, information processing speed) function, ing. IQ of 90-110 Is considered average. ii Neuropsychological tests (e.g., HalsteadeReitan Test): used to assess cognitive/ perceptual, emotional, and behavioral deficits and disturbances caused by brain dysfunctions (e.g., the Bender Visual-Motor Gestalt Test requires the reconstruction of and memory for designs, and can aid in the diagnosis of organic brain impairment). TYPES OF DISORDERS ANXIETY DISORDERS b. Psychosocial/affective measures 1 I. Praiective tests (e.g., Rorschach; Thematic Apperception Test, or TAT): tests are based I on the theory that the person’s interpretation of ambiguous stimuli is a good way to I uncover feelings and conflicts. particularly unconscious ones. I Ii. Self-report inventories: structured questionnaires and rating scales - BDI (Beck Depression Inventory): 21-item questionnaire; responses indicate severity of depressive symptoms ‘ - MMPI (Minnesota Multiphasic Personality Inventory): most popular personality I inventory; tests for symptoms of personality disorders c Behavioral assessments i Observation by others: observations of nonverbal or verbal behaviors ; II Self-observation: patient tracks aspects of own behavior (e.g., eating, smoking), a pro- I cess called self-monitoring I d Physical assessments i Physiological (EEG, EKG, EMG) - EEG: electrodes on the scalp record the electrical activity of brain areas ii, Neuroirnaging - Structural imaging (e.g., CT scan, MRI) - Functional imaging (e.g., fMRI, PET, SPECT): provide a picture of the structure and functioning of the brain a MultI-method assessment: integration of several or all other types of assessments Pros and cons of formal diagnosis using DSM-IVPR: A. Pros: 1. Facilitates research, recordekeeping, and statistical information : 2. Helps one search for etiology, implications for treatment and case management decisions, 3 and prognosis I 3. Provides a common language for clinitbians B. Cons: 'I. Stigmatizing 2. Categories not homogeneous 3. Condensed format leads to a loss of information RESEARCH METHODS A. Case study: a detailed history of an individual's life and psychological problems I B. Correlational study: examines strength of the relationship between events or characteristics C. Epidemiological studies: study of the frequency and distribution of disorders within a I population in relation to demographic factors ‘ 1. Incidence: number of new cases ofa disorder that appear in a population in a specific time period. ‘ 2. Prevalence: number of active cases in a population at a specific time a, Lifetime prevalence: proportion of people in population affected at some point In their lives ‘ b. Point prevalence: number of people who have the disorder at one given point in time D. Experiment: controlled manipulation of a variable and the observation of its effect Anxiety: 0 slate of unpleosoni apprehension and tension in which a person fears some type of future negative experience TYPES OF ANXIETY DISORDERS I A. Phobias: Characterized by disruptive and intense, Irrational fears of specific objects or situa» tions. These fears are disproportionate to the actual danger of the object or event. 1. Specific phobias: excessive, irrational fear caused by a particular object or event (e.g., anie mals, blood, injections, heights) 0 Agoraphobia: fear of open, public spaces or being unable to escape a public situation if one is incapacitated, especially by a panic attack b claustrophobic: fear of closed spaces c. Acrophobia: fear of heights 2. Social phobia: constant, irrational fear of specific or general situations that involve other people; fear of social performance and being judged by others. Sufferer avoids social situations that could be embarrassing, result in a negative evaluation, or show that he/she is anxious. B. Panic disorder: characterized by intermittent anxiety and by a sudden onslaught of symptoms called panic attacks. People with panic disorder can fear losing control, going crazy, or dying, and experience depersonalization and derealization. Can occur with or without agoraphobia. 1. Panic attacks: episodes of intense fear and four or more symptoms (e.g., heart palpitations, nausea, chest pain, dizziness, sweating, trembling, choking sensations, difficulty breathing, terror, intense apprehension). Attacks tend to be brief but are recurrent and unexpected. 2. Depersonalization: state of feeling estranged from one’s body 3. Derealization: state of feeling as if the world or surroundings are not real C. Obsessive-compulsive disorder (OCD): sufferer is compelled to repeat acts (compulsions) and/or is flooded with uncontrollable and persistent thoughts (obsessions), which cause dis, tress and interfere with daily functioning 'l. Obsessions: uncontrollable, intrusive. and repetitive thoughts, images, and impulses that cause anxiety 2. Compulsions: repetitive behavior or mental act that is performed to counteract the dis- tress of the obsessive thoughts (e.g., hand-washing, counting) D. Generalized anxiety disorder (GAD) l. sufferer experiences chronic, uncontrollable, and pervasive Iow»level anxiety and worry 2. Symptoms include: difficulty concentrating and sleeping, irritability, muscle tension, pounding heart, sweating, restlessness, and upset stomach E. Post-traumatic stress disorder: intense fear in reaction to a traumatic event I. Sufferers experience all of the following categories of symptoms: a, Rte-experiencing the event through intrusive memories, nightmares, or flashbacks b. Avoidance of reminders of the event or other, unrelated people and activities c Persistently increased arousal (e.g., anger, trouble sleeping, hypervigilance) CAUSES OF ANXIETY DISORDERS A. Biological: 1. Neurotransmitter dysregulation (e.g., deficiency of GABA in generalized anxiety disorder) 2. Increased physiological sensitivity (some people are more reactive and easily aroused) 3. Genetic factors B. Behavioral: 1. Learned alarms (e.g., mild physical cues become linked with panic attacks) 1 2. Classical conditioning creates fear of non-dangerous events/objects; operant conditioning I maintains avoidance of feared stimuli ‘ 3. Modeling (observational learning) C. Cognitive: 1 1. Misinterpretations (e.g., overestimate probability of negative event, underestimate own I ability to cope) 3 2. Sense of unpredictability and lack of safety/control, magical thinking (e.g., thinking that I worrying or performing compulsion may superstitioust prevent feared event) ‘ TREATMENT FOR ANXIETY DISORDERS A. Drug therapy: benzodiazepines, beta blockers, antidepressants I B. Cognitive therapy: helps patients Identify and change negative, irrational thoughts associA I ated with their anxieties I C. Behavior therapy: focuses on extinguishing fear by exposing patient to the feared object or I situation, gradually (e.g., systematic desensitization) or intensely (e.g., flooding) I 0 Modeling: therapist models behavior that the patient fears and then encourages the I patient to do so D. Psychodynamic therapy: addresses underlying, often unconscious conflicts associated with various anxieties I ABNORMAL PSYCHOLOGY w DISSOCIATIVE DISORDERS Aspects of one's identity, consciousness, or memory become split off from one B. Dissociative fugue: person loses all memory ofhis/her identity, moves to a new place, and anothe...
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