Abnormal-Psychology-ppt1.pdf

§ How do you define “normal” and “abnormal”? § Ideas of “normal” and “abnormal” are largely shaped by social standards and can have profound social ramifications. § Take note of the following keypoints: § What is considered “normal” changes with changing societal standards. § Despite the chal...

§ How do you define “normal” and “abnormal”? § Ideas of “normal” and “abnormal” are largely shaped by social standards and can have profound social ramifications. § Take note of the following keypoints: § What is considered “normal” changes with changing societal standards. § Despite the challenges inherent in defining “normal,” it is still important to establish guidelines so as to be able to identify and help people who are suffering. This is the goal of the Diagnostic and Statistical Manual of Mental Disorders (known as the DSM- 5-TR), a publication in the field of clinical psychology. § The DSM-5 attempts to explicitly distinguish normality from abnormality based on specific symptoms. § In very crude terms, society generally sees normality as good and abnormality as bad. Being labeled as “normal” or “abnormal” can have profound ramifications for an individual, such as exclusion or stigmatization by society. § Stigma and discrimination can add to the suffering and disability of those who are diagnosed with (or perceived to have) a mental disorder. § In order to reduce stigma, a recent move has been made toward the adoption of person-centered language: referring to people as “individuals with mental illness” rather than “mentally ill individuals” (e.g., a “person with bipolar disorder,” rather §A psychological disorder is a condition characterized by abnormal thoughts, feelings, and behaviors. § However,defining what is “normal” and “abnormal” is a subject of much debate. § Definitionsof normality vary widely by person, time, place, culture, and situation. § “Normal”is, after all, a subjective perception, and also an amorphous one—it is often easier to describe what is not normal than what is normal. § In simple terms, however, society at large often perceives or labels “normal” as “good,” and “abnormal” as “bad.” § Beinglabeled as “normal” or “abnormal” can therefore have profound ramifications for an individual, such as exclusion or stigmatization by society. § Although it is difficult to define “normal,” it is still important to establish guidelines in order to be able to identify and help people who are suffering. § To this end, the fields of psychology and psychiatry have developed the Diagnostic and Statistical Manual of Mental Disorders (known as the DSM-5), recently, DSM-5-TR (Diagnostic and Statistical Manual of mental Disorders, Fifth Edition, Text Revision), a standardized hierarchy of diagnostic criteria to help discriminate among normal and abnormal (i.e. “pathological”) behaviors and symptoms. § The 5th edition, Text Revision, of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (the DSM-5-TR) lays out explicit and specific guidelines for identifying and categorizing symptoms and § It is important to analyze the societal consequences of diagnosis because so many people experience mental illness at some point in their lives. A lot of times, what is essential is invisible to the naked eye? § According to the World Health Organization (WHO), more than a third of people globally meet the criteria for at least one diagnosable mental disorder at some point in their lives. § Unfortunately, stigma and discrimination can add to their suffering and disability. This has led various social movements to work to increase societal awareness and understanding of mental illness and challenge social exclusion. § A stigma is the societal disapproval and judgment of a person or group of people because they do not fit their community’s social norms. § In the context of mental illness, social stigma is characterized as prejudiced attitudes and discriminatory behavior directed toward individuals with mental illness as a result of the label they have been given. § In the United States, people are often pressured to be “normal”— or at least perceived as such—in order to gain acceptance by society. § Society tends to be uncomfortable with “abnormality”—so if someone does not conform to what is perceived as normal, they might be given a number of negative labels, such as “sick”, “crazy”, or “psycho.” § In a related issue, self-stigmatization is when someone internalizes society’s negative perceptions of them or of people they think are like them: they begin to believe, or fear that others will believe, that the negative labels and perceptions are true. §This internalization contributes to feelings of shame and usually leads to poorer treatment outcomes. Experience of stigma or self-stigma can also lead to the following: § Refusal to receive treatment. § Social isolation. § Distorted perception of the incidence of mental illness. § Stigmas are usually deeply ingrained in society over many years and so cannot be eradicated instantly. § But with the rising awareness that mental illness affects so many people globally, more and more is being done to reduce the stigma associated with such illnesses. § The field of psychology has recently moved toward using deliberate person-centered language—referring to people as individuals with mental illness rather than mentally ill individuals. § In this way, the language emphasizes the individual’s humanity and defines them as a person first, rather than defining them by their illness. § For instance, referring to someone as “the anorexic girl” has a different impact than “the girl with anorexia.” § In the first example, the individual is entirely defined by the disorder; in the second, anorexia is a characteristic, but not a defining one. § The same goes for “the student with ADHD,” “the child with autism,” and “the mother with depression”—each of these is far less stigmatizing than “the ADHD student,” “the autistic child,” and “the depressed mother.” § i. The scientific study of abnormal behavior, with the intent to be able to reliably predict, explain, diagnose, identify the causes of, and treat maladaptive behavior. § ii. Abnormal behavior can become pathological in nature and so leads to the scientific study of psychological disorders, or psychopathology. § iii. Mental disorders are characterized by psychological dysfunction which causes physical and/or psychological distress or impaired functioning and is not an expected behavior according to societal or cultural standards. § Dysfunction: includes clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. § Distress: When the person experiences a disabling condition in social, occupational, or other important activities. Distress can take the form of psychological or physical pain, or both concurrently. § Deviance: Closer examination of the word abnormal shows that it indicates a move away from what is normal. Our culture, or the totality of socially transmitted behaviors, customs, values, technology, attitudes, beliefs, art, and other products that are particular to a group, determines what is normal and so a person is said to be deviant when he or she fails to follow the stated and unstated rules of society, called social norms. § 1. Classification is the way in which we organize or categorize things. § 2. Nomenclature, or naming system, to structure the understanding of mental disorders in a meaningful way. § 3. Epidemiology is the scientific study of the frequency and causes of diseases and other health-related states in specific populations such as a school, neighborhood, a city, country, and the world. § 4. Presenting problem refers to the specific problem the patient presents. Ex: rapid heart rate, panic attack, § 5. Clinical description are the information about the thoughts, feelings, and behaviors that constitute a mental disorder. It also seeks to gain information about the occurrence of the disorder, its cause, course, and treatment possibilities. § 6. Prevalence is the percentage of people in a population that has a mental disorder or can be viewed as the number of cases per some number of people. For instance, if 20 people out of 100 have bipolar disorder, then the prevalence rate is 20%. Prevalence can be measured in several ways: § a.Point prevalence indicates the proportion of a population that has the characteristic at a specific point in time. In other words, it is the number of active cases. § b.Period prevalence indicates the proportion of a population that has the characteristic at any point during a given period of time, typically the past year. § c. Lifetime prevalence indicates the proportion of a population that has had the characteristic at any time during their lives. § 7. Incidence indicates the number of new cases in a population over a specific period of time. § 8. Comorbidity describes when two or more mental disorders are occurring at the same time and in the same person. Ex: depression and anxiety, chronic pain and major depressive disorder, substance abuse and mental illness, etc. § 9. Etiology is the cause of the disorder. There may be social, biological, or psychological explanations for the disorders beginning which need to be understood to identify the appropriate treatment. Likewise, the effectiveness of a treatment may give some hint at the cause of the mental disorder. § 10. Course of the disorder is its particular pattern. A disorder may be acute, meaning that it lasts a short period of time, or chronic, meaning it lasts a long period of time. It can also be classified as time-limited, meaning that recovery will occur in a short period of time regardless of whether any treatment occurs. § i. Prehistoric and Ancient Beliefs: Prehistoric cultures often held a supernatural view of abnormal behavior and saw it as the work of evil spirits, demons, gods, or witches who took control of the person. § This form of demonic possession often occurred when the person engaged in behavior contrary to the religious teachings of the time. § Treatment by cave dwellers included a technique called trephination, in which a stone instrument known as a trephine was used to remove part of the skull, creating an opening. Through it, the evil spirits could escape thereby ending the person’s mental affliction and returning them to normal behavior. § EarlyGreek, Hebrew, Egyptian, and Chinese cultures used a treatment method called exorcism in which evil spirits were cast out through prayer, magic, flogging, starvation, having the § ii. Greco-Roman Thought: Rejecting the idea of demonic possession, Greek physician, Hippocrates (460-377 B.C.), said that mental disorders were akin to physical disorders and had natural causes. § Specifically, they arose from brain pathology, or head trauma/brain dysfunction or disease, and were also affected by heredity. § Hippocrates classified mental disorders into three main categories – melancholia, mania, and phrenitis (brain fever) and gave detailed clinical descriptions of each. § He also described four main fluids or humors that directed normal brain functioning and personality – blood which arose in the heart, black bile arising in the spleen, yellow bile or choler from the liver, and phlegm from the brain. § Mental disorders occurred when the humors were in a state of imbalance such as an excess of yellow bile causing frenzy and too much black bile causing melancholia or depression. Hippocrates believed mental illnesses could be treated as any other disorder and § Also important was Greek philosopher, Plato (429-347 B.C.), who said that the mentally ill were not responsible for their own actions and so should not be punished. § It was the responsibility of the community and their families to care for them. § Greek physician, Galen (A.D. 129-199) said mental disorders had either physical or mental causes and included fear, shock, alcoholism, head injuries, adolescence, and changes in menstruation. § In Rome, physician Asclepiades (124-40 BC) and philosopher Cicero (106-43 BC) rejected Hippocrates’ idea of the four humors and instead stated that melancholy arises from grief, fear, and rage; not excess black bile. § Roman physicians treated mental disorders with massage or warm baths, the hope being that their patients would be as comfortable as they could be. They practice the concept of “contrariis contrarius”, meaning opposite by opposite, and introduced contrasting stimuli to bring about balance in the physical and mental domains. An example § iii.The Middle Ages – 500 AD to 1500 AD: The progress made during the time of the Greeks and Romans was quickly reversed during the Middle Ages with the increase in power of the Church and the fall of the Roman Empire. § Mental illness was yet again explained as possession by the Devil and methods such as exorcism, flogging, prayer, the touching of relics, chanting, visiting holy sites, and holy water were used to rid the person of his influence. § In extreme cases, the afflicted were exposed to confinement, beatings, and even execution. Scientific and medical explanations, such as those proposed by Hippocrates, were discarded. § iv. The Renaissance – 14th to 16th Centuries: The most noteworthy development in the realm of philosophy during the Renaissance was the rise of humanism, or the worldview that emphasizes human welfare and the uniqueness of the individual. This helped continue the decline of supernatural views of mental illness. § In the mid to late 1500s, Johann Weyer (1515-1588), a German physician, published his book, On the Deceits of the Demons, that rebutted the Church’s witch-hunting handbook, the Malleus Maleficarum (Hammer of Witches), and argued that many accused of being witches and subsequently imprisoned, tortured, and/or burned at the stake, were mentally disturbed and not possessed by demons or the Devil himself. He believed that like the body, the mind was susceptible to illness. § Not surprisingly, the book was met with vehement protest and even banned from the church. It should be noted that these types of acts occurred not only in Europe, but also in the United States. The most famous example was the Salem Witch Trials of 1692 in which more than 200 people were accused of practicing witchcraft and 20 were § Thenumber of asylums, or places of refuge for the mentally ill where they could receive care, began to rise during the 16th century as the government realized there were far too many people afflicted with mental illness to be left in private homes. § Hospitals and monasteries were converted into asylums. Though the intent was benign in the beginning, as they began to overflow patients came to be treated more like animals than people. § In1547, the Bethlem Hospital opened in London with the sole purpose of confining those with mental disorders. Patients were chained up, placed on public display, and often heard crying out in pain. The asylum became a tourist attraction, with sightseers paying a penny to view the more violent patients, and soon was called “Bedlam” by local people; a term that today means “a state of uproar and confusion” (https://www.merriam-webster.com/dictionary/bedlam). § v. Reform Movement – 18th to 19th centuries: The rise of the moral treatment movement occurred in Europe in the late 18th century and then in the United States in the early 19th century. § vi.20th – 21st Centuries: The decline of the moral treatment approach in the late 19th century led to the rise of two competing perspectives – the biological perspective and the psychological perspective. § a. Biological or Somatogenic Perspective § German psychiatrist, Emil Kraepelin (1856-1926), discovered that symptoms occurred regularly in clusters which he called syndromes. These syndromes represented a unique mental disorder with its own cause, course, and prognosis. In 1883 he published his textbook, Compendium der Psychiatrie (Textboook of Psychiatry), and described a system for classifying mental disorders that became the basis of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). § The work of American psychiatrist John P. Grey, appointed as superintendent of the Utica State Hospital in New York, Grey asserted that insanity always had a physical cause. As such, the mentally ill should be seen as physically ill and treated with rest, proper room temperature and ventilation, and a proper diet. § The1930s also saw the use of electric shock as a treatment method, which was stumbled upon accidentally by Benjamin Franklin while experimenting with electricity in the early 18th century. He noticed that after suffering a severe shock his memories had changed and in published work, suggested physicians study electric shock as a treatment for melancholia. § b. Psychological or Psychogenic Perspective: The psychological perspective states that emotional or psychological factors are the cause of mental disorders and represented a challenge to the biological perspective. § Bythe end of the 19th century, it had become evident that mental disorders were caused by a combination of biological and psychological factors and the investigation of how they develop began. § Sigmund Freud’s development of psychoanalysis followed on the heels of the work of Bruner, and others who came before him. § 1. Biological Model: § a. Genetics: § a.1. Genetic Issues and Explanations - DNA, or deoxyribonucleic acid, is our heredity material and is found in the nucleus of each cell packaged in threadlike structures known as chromosomes. Most of us have 23 pairs of chromosomes or 46 total. Twenty-two of these pairs are the same in both sexes, but the 23rd pair is called the sex chromosome and differs between males and females. Males have X and Y chromosomes while females have two Xs. Recent research has discovered that autism, ADHD, bipolar disorder, major depression, and schizophrenia all share genetic roots. They were more likely to have suspect genetic variation at the same four chromosomal sites. These included risk versions of two genes that regulate the flow of § Likewise, twin and family studies have shown that people with first-degree relatives with OCD are at higher risk of developing the disorder themselves. The same is true of most mental disorders. Indeed, it is presently believed that genetic factors contribute to all mental disorders but typically account for less than half of the explanation. Moreover, most mental disorders are linked to abnormalities in many genes, rather than just one; that is, most are polygenetic. § Moreover, there are important gene-environment interactions that are unique for every person (even twins) which help to explain why some people with a genetic predisposition toward a certain disorder develop that disorder and others do not (e.g., why one identical twin may develop schizophrenia but the other does not). § The diathesis-stress model posits that people can inherit tendencies or vulnerabilities to express certain traits, behaviors, or disorders, which may then be activated under certain § a.2. Hormonal Imbalances: The body has two coordinating and integrating systems in the body. The nervous system is one and the endocrine system is the second. § The main difference between these two systems is in terms of the speed with which they act. The nervous system moves quickly with nerve impulses moving in a few hundredths of a second. The endocrine system moves slowly with hormones, released by endocrine glands, taking seconds, or even minutes, to reach their target. § Hormones are important to psychologists because they organize the nervous system and body tissues at certain stages of development and activate behaviors such as alertness or sleepiness, sexual behavior, concentration, aggressiveness, reaction to stress, a desire for companionship. § The pituitary gland is the “master gland” which regulates other endocrine glands. It influences blood pressure, thirst, contractions of the uterus during childbirth, milk production, sexual behavior and interest, body growth, the amount of water in the body’s cells, and other functions as well. § The pineal gland produces melatonin which helps regulate the sleep-wake cycle and other circadian rhythms. Overproduction of the hormone melatonin can lead to Seasonal Affective Disorder. § The thyroid gland produces thyroxin which facilitates energy, metabolism, and growth. Hypothyroidism is a condition in which the thyroid glands become underactive and this condition can produce symptoms of depression. In contrast, hyperthyroidism is a condition in which the thyroid glands becomes overactive and this condition can produce symptoms § Therefore, it is important for individuals experiencing these symptoms to have their thyroid checked, because conventional treatments for depression and mania will not correct the problem with the thyroid, and will therefore not resolve the symptoms. § Rather, individuals with these conditions need to be treated with thyroid medications. Also of key importance to mental health professionals are the adrenal glands which are located on top of the kidneys, and release cortisol which helps the body deal with stress. § However, chronically, elevated levels of cortisol can lead to increased weight gain, interfere with learning and memory, decrease the immune response, reduce bone density, increase cholesterol, and increase the risk of depression. § The Hypothalamic-Pituitary-Adrenal (HPA) Axis is the connection between the hypothalamus, pituitary glands, and adrenal glands. § Specifically, the hypothalamus releases corticotropin-releasing factor (CRF) which stimulates the anterior pituitary to release adrenocorticotrophic hormone (ACTH), which in turn stimulates the adrenal cortex to release cortisol. § Malfunctioning of this system is implicated in a wide range of mental disorders including, depression, anxiety, and post- traumatic stress disorder. § Exposure to chronic, unpredictable stress during early development can sensitive this system, making it over-responsive to stress (meaning it activates too readily and does not shut down appropriately). § Sensitization of the HPA axis leads to an overproduction of cortisol which once again can damage the body and brain when it