“You shall know the truth and the truth shall make you mad.” —Aldous Huxley (1894-1963)
The Case of Jeffrey Dahmer — In 1988, Dahmer murdered
three people. He first met a 14-year old boy at a bus stop and asked him to pose nude photos. Soon after they arrived at Dahmer’s apartment, Dahmer had sex with the boy, drugged him, strangled him, dismembered him and smashed his bone with a sledgehammer. 2
The Case of Jeffrey Dahmer — Several months later, Dahmer
picked up a 23-year old man at a gay bar, had oral sex with him, drugged him and butchered him. — Later in the same month, Dahmer strangled a 24-year old man and painted his skull after having boiled his head to remove the skin. Dahmer told the police that he saved the skulls of only the most handsome victims so that he would not forget them. 3
The Case of Jeffrey Dahmer — In 1991, when he was
arrested, the police found in Dahmer’s apartment at least 15 dismembered bodies, a head in the refrigerator and a heart in the freezer, and a blue barrel of acid for leftovers (Matthews, 1992). — Why would a person like Dahmer commit such a deviant act? 4
Appropriate perception of reality —fairly realistic in appraising reactions and capabilities and in interpreting events Ability to exercise voluntary control over behavior—decisions are voluntary rather than the result of uncontrollable responses Self-esteem and acceptance —appreciation of own worth and feel accepted by those around them, react spontaneously Ability to form affectionate relationships — close and satisfying relationships with other people
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Productivity—enthusiastic about life and channel energy into productive activity
Violation of cultural norms—response not typically or culturally expected; deviation from ideal Deviation from statistical norm— statistical infrequency, deviation from average
A sense of personal distress or discomfort—e.g., anxiety, depression, agitation
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Maladaptive behavior— psychological dysfunction or disability with adverse effects on individuals or society
Physically damaging
Lost touch with reality and cannot control behavior or thoughts
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MALADAPTIVE BEHAVIOR
Severely interfere in one’s ability to function in daily life
Cause emotional suffering or harm
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Prehistoric times Demonic possession was thought to cause psychological disorders. Based on evidence of trephined skulls, prehistoric people tried to release the evil spirits by drilling a hole in the skull. 11
Ancient Greece & Rome: The scientific approach emerged. The Greek physician Hippocrates sought a cause within the body. This approach continued through Roman times with the writings of the physician Galen.
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Middle Ages: Return to belief in spiritual possession and attempts to exorcise the devil out of the mentally ill. The mentally ill were thrown into prisons and poorhouses. 13
Renaissance Period: First hospital to house the mentally ill was built—St. Mary’s Hospital in Bethlehem (London). Attempts to provide more humane treatment. 14
Modern Period: Era of deinstitutionalization Invention of antipsychotic medications made it possible for people with severe disorders to live outside institutions.
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y How much of abnormal behavior can be explained
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through our biological makeup? y How important are early childhood experiences and unconscious motivations in determining our mental health? y What is the role of learning in the development of abnormal behaviors? y How powerful are thoughts in causing abnormal behaviors, and can positive thinking be used to combat irrational beliefs?
Models of Psychopathology Psychosocial cause
Biological cause
Psychodynamic
Behavioral
Cognitive
Humanistic existential
Family systems
Multicultural
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Neuroanatomical Biochemical Genetics
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A predisposition to develop illness (diathesis)
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Environmental forces (stressors)
MENTAL DISORDER
• Relationship with parents • Fixations of oral, anal, phallic stages of psycho-sexual development
Childhood trauma 21
Unconscious • Childhoodbased anxieties • Repressed through defense mechanisms
• People exhibit symptoms they are unable to understand • Therapist must make the patient aware of unconscious anxieties
Psychological Disorders
Phobias • Caused by unresolved Oedipal conflict— fear of the father displaced onto some other object or situation
Obsessive-compulsive disorder • Traced to anal stage, with the urge to soil or to be aggressive transformed into compulsive cleanliness 22
The case of Anna O.
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Anna O. was a bright, attractive young woman who was perfectly healthy until she reached 21 years of age. Shortly before her problems began, her father developed a serious chronic illness that led to his death. Throughout his illness, Ann O. had cared for him; she felt it necessary to spend endless hours at his bedside. Five months after her father became ill, Ann noticed that during the day her vision blurred; and that from time to time she had difficulty moving her right arm and both legs. Soon, additional symptoms appeared.
The case of Anna O.
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She began to experience some difficulty speaking, and her behaviors became very erratic. Shortly thereafter, she consulted Joseph Breuer. In a series of treatment sessions, Breuer dealt with one symptom at a time through hypnosis and subsequent “talking through,” tracing each symptom to its hypothetical causation of circumstances surrounding the death of Anna’s father. One at a time, her “hysterical” ailments disappeared, but only after treatment was administered. Anna O.’s real name was Bertha Pappenheim.
Behavioral models • Behaviorism stressed the importance of directly observable behaviors and the conditions or stimuli that evoked, reinforced and extinguished them
Obsessive-compulsive disorder • Traced to anal stage, with the urge to soil or to be aggressive transformed into compulsive cleanliness 25
Major Assumptions of Cognitive Model
Three types of Man is a thinking People actually cognition cause being—his create their own abnormal cognitions (i.e., problems (and behavior: (1) thoughts and symptoms) by the causal attributions, beliefs) influence way they (2) control beliefs; behavior and interpret events (3) dysfunctional emotions and situations assumptions 26
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• The individual’s belief systems produce irrational thought patterns
Cognitions
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Unpleasant emotional responses • They result from one’s thoughts about an event rather than from the event itself • Lead to anger, unhappiness, depression, fear, anxiety
• Irrational and maladaptive thoughts • Distortions of reality
Psycholog ical problems
The individual’s assessment of his own value and worth 29
Abnormal behavior
Incongruence
Conditions of worth 30
Standards by which people determine their worth
When the person’s selfconcept is defined as having worth only when other’s approve but is inconsistent with self-actualizing potential
When a person’s inherent potential is inconsistent with his selfconcept
Individual as member of the family
All family members have interdependent roles, statuses, values and norms
People behave in ways that reflect family influences
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The behavior of one member affects the entire family systems
Personality • Influenced by attributes of the family especially how parents behave towards development children
Abnormal behavior
Therapy methods 32
• A reflection or “symptom” of unhealthy family dynamics, or poor communication among family members
• Must focus on the family system, not solely on the individual, and must strive to involve the entire family in therapy
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“Madness need not be all breakdown. It may also be break-through.” —R.D. Laing (1927-1982).
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SOMATIC
BEHAVIORAL
EMOTIONAL
COGNITIVE
Dizziness
Escape
Sense of dread
Anticipation of harm
Sweating palms
Avoidance
Terror
Exaggerating of danger
Heart palpitations
Aggression
Restlessness
Hypervigilance
Ringing of the ears
Freezing
Irritability
Fear of losing control
Dry mouth and throat
Decrease appetitive responding
Fear of dying
Muscle tension
Increased aversive responding
Sense of unreality
Constant “edgy” feeling Uncontrollable 2010shaking @ abmartinez 36
Phobias Panic disorders Generalized anxiety disorder Obsessive-compulsive disorder Posttraumatic stress disorder Acute stress disorder 37
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Mood disorders
• Disturbances in emotions that cause subjective discomfort and hinder the person’s ability to function
Depression
• Characterized by intense sadness, feelings of futility and worthlessness and withdrawal from others
Mania
• Characterized by elevated mood, expansiveness, or irritability, often resulting in hyperactivity, incoherent speech (flight of ideas)
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Domain
Depression
Mania
Affective
Sadness, unhappiness, apathy, anxiety, brooding, dejection
Elation, grandiosity, irritability
Cognitive
Pessimism, guilt, inability to concentrate, negative thinking, loss of interest and motivation, suicidal thoughts
Flighty and pressured thoughts, lack of focus and attention, poor judgment
Behavioral
Low energy and productivity, neglect of Overactive, incoherent personal appearance, crying, psychomotor speech, talkative, uninhibited, retardation, agitation impulsive
Physiological
Poor or increased appetite, constipation, High levels of arousal, sleep disturbance, disruption of menstrual decreased need for sleep cycle in women, loss of sex drive
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þPsychological disorders take a physical
form þPhysical symptoms have no known physiological explanation or organic basis þPhysical symptoms are not under voluntary or conscious control and linked to psychological factors—anxiety 41
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Two forms
Additional categories 42
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• Conversion disorder • Somatization disorder • Pain disorder • Body dysmorphic disorder • Hypochondrias
Pain disorder
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• The person experiences pain that causes significant distress and impairment • Psychological factors have a role in the onset, maintenance and severity of the pain • The pain may have temporal relations to conflict or stress, or may allow the person to avoid unpleasant activity and to secure attention abmartinez @ 2010
Pain disorder • Reports of severe pain may (1) have no physiological or neurological basis, (2) be greatly in excess of that expected with an existing physical condition, or (3) linger long after a physical injury has healed 44
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Hypochondr iasis • Individuals are preoccupied with fears of having a serious disease, which persist despite medical reassurance to the contrary. • Patients tend to overreact to ordinary physical sensations or minor abnormalities (e.g., irregular heartbeat, sweating, sore spot, occasional coughing) • Includes fear of having a disease, fear of death or illness, tendency towards self-observation, oversensitivity to bodily sensations 45
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Conversion Disorder • Loss or disturbance of physical functioning resembling a physical disorder • Psychological factors involved in either: • (a) Initiating or exacerbating the symptoms • (b) Allowing individual to avoid aversive activity • (c) Receiving reinforcements for sick behavior 46
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Somatization Disorder
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• History of vague multiple physical complaints before the age of 30 • 4 pain symptoms involving at least 4 different sites or functions • 2 gastrointestinal symptoms • One sexual symptom • One pseudoneurologic symptom abmartinez @ 2010
Dissociative disorders • Disturbances or changes in memory, consciousness or identity due to psychological factors 49
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Dissociative amnesia
Dissociative identity
Dissociative disorders
Depersonalization 50
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Dissociative fugue
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Dissociative amnesia
• The sudden inability to recall information of a personal nature—not due to forgetfulness or other organic conditions—usually of traumatic or stressful nature
Dissociative identity (Multiple personality)
• Existence of two or more distinct personalities, each with its own memories, attitudes and perceptions • Personalities alternate (identity fragmentation) • Inability to recall important personal information
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Dissociative fugue
• Inability to recall personal identity and past with: (1) sudden departure to new area or unexpected trip; (2) confusion about personal identity or assumption of new identity
Depersonalization
• Changes in perception, and being detached from one’s own thoughts and body • Feelings of unreality concerning the self and the environment; may have a sense of being in a dreamlike state; reality testing remains intact
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Dissociative disorders
Prevalence
Age of Onset
Course
Dissociative amnesia
Recent increase Any age group involving forgotten early childhood trauma
Acute forms may remit spontaneously; others are chronic
Dissociative fugue
May increase during Usually adulthood natural disasters or war time
Related to stress or trauma; recovery is generally rapid
Depersonalization
50% of adults may experience brief episodes of stressrelated depersonalization
Adolescence or adulthood
May be short lived or chronic
Dissociative identity
Sharp rise in recently reported cases; up to nine times more frequent in women
Childhood to adolescence
Fluctuates; tends to be chronic and recurrent
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Schizophrenia • A group of disorder consisting of unreal or disorganized thoughts and perceptions, personality disintegration, affective disturbance, social withdrawal as well as verbal, cognitive and behavioral deficits
Hallucinations— unreal perceptual experience (auditory and visual)
Delusions—fixed beliefs with no basis in reality
Psychotic symptoms— loss of realitytesting
A long-standing and pervasive pattern of behavior, thought and feeling that is highly maladaptive for the individual and for people around him/her Must be present continuously from adolescence or early adulthood into adulthood 57
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Chronic and pervasive mistrust and suspicion of other people that is unwarranted and maladaptive Hypervigilant for confirming evidence of their suspicions and sensitive to criticisms
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Misinterpret or over-interpret situations in line with their suspicions abmartinez @ 2010
Pervasive tendency to interpret actions of others as deliberately demeaning, malevolent, threatening, exploiting, or deceiving
Resistant to rational arguments against their suspicions
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Some become withdrawn in an attempt to protect themselves; others are aggressive and abmartinez @ 2010 arrogant
• neither desires nor enjoys close relationships (including being part of a family) • almost always chooses solitary activities • has little interest in sexual encounters • takes pleasure in few, if any activities • appears indifferent to praise or criticism of others • shows emotional coldness and detachment 60
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Diagnostic Criteria
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• Disturbed thinking and communicating • Frank thought disorder is absent but speech may be distinctive or peculiar, may have meaning only to them, and often needs interpretation • May not know their own feelings and yet are exquisitely sensitive to, and aware of, the feelings of others • May be superstitious or claim powers of clairvoyance • Vivid imaginary relationships and child-like fears and fantasies • Poor interpersonal relationships and may act inappropriately • isolated and have few, if any, friends • Under stress, may decompensate and have psychotic symptoms abmartinez @ 2010
Impairment in the ability to form positive relationships with others
Tendency to engage in behaviors that violate basic social norms and values 62
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Cold, callous, gains pleasure by competing with and humiliating anyone
Can be cruel and malicious; insists on being seen as faultless and are dogmatic in their opinions 63
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Low tolerance of frustration and acts impulsively, often takes chances and seek thrills with no concern for danger
Unable to anticipate the implications of their behaviors; easily bored and restless 64
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üunlawful behavior despite potential for arrest üdeceitfulness (repeated lying, use of aliases, conning others
for personal profit or pleasure) ürepeated physical fights or assaults üreckless disregard for safety of self or others üirresponsible ülack of remorse ücriteria for diagnosis includes: evidence of this behavior before 15 years of age 65
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Benchmarks: out-of-control emotions that cannot be soothed, hypersensitivity to abandonment, tendency to cling too tightly to other people, history of hurting oneself
Characterized by rapidly shifting and unstable mood, self-concept and interpersonal relationships, as well as impulsive behavior and transient dissociative states. 66
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Problems shifting emotions and unstable relationships
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Syndrome marked by rapidly shifting moods, unstable relationships, intense need for attention and approval
Such is sought by means of overly dramatic behavior, seductiveness and dependence 70
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üalways wants to be center of attention üinappropriate sexually seductive or provocative
behavior ürapidly shifting and shallow expression of emotions üuses physical appearance to draw attention to self üspeech is dramatic and exaggerated with emotion üis easily influenced by others or circumstances üconsiders relationships to be more intimate than they actually are 71
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Acting in dramatic and grandiose manners, seeking admiration from others, shallow in emotional expression and relationships
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Preoccupied with thoughts of own self-importance and with fantasies of power and success, viewing themselves as above most others Make unreasonable demands in interpersonal relationships to follow their wishes, ignore others’ needs and wants, exploit others to gain power, are arrogant and demeaning Very rare, with lifetime prevalence of less than 1%, more frequently diagnosed in men 74
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üsense of self-importance (e.g. exaggerates achievements and talents,
expects to be recognized as superior) üpreoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love übelieves he/she is “special” and requires excessive admiration ühas sense of entitlement ütakes advantage of others to achieve own ends ülacks empathy üoften envious of others or believes that others are envious of him üarrogant, haughty behavior or attitude 75
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Pervasive anxiety, sense of inadequacy, fear of being criticized that leads to avoidance of most social interactions When interacting with others, avoidant people are restrained and nervous, and hypersensitive to signs of being evaluated 76
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üavoids occupational and social activities that involve
interpersonal (fears of criticism, disapproval, or rejection) üunwilling to get involved with people unless certain of being liked üshows restraint within intimate relationships because of fear of being ridiculed üinhibited in new interpersonal situations üviews self as socially inept, personally unappealing, or inferior üreluctant to take personal risks or engage in new activities 77
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Anxious about interpersonal relations but anxiety stems from a deep need to be cared for by others rather than a concern that they will be criticized
Fear of rejection that lead to total dependence on and submission to others 78
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They deny their own thoughts and feelings that might displease others, submit to even the most unreasonable demands, frantically cling to others
Cannot make decisions for themselves, do not initiate new activities except in an effort to please others 79
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üdifficulty making decisions without advice and
reassurance üneeds others to assume responsibility for most major areas of life üdifficulty expressing disagreement with others (fear of loss of support or approval) üdifficulty initiating projects or doing things on own ügoes to excessive lengths to obtain nurturance and support (volunteers to do things that are unpleasant) üfeels uncomfortable or helpless when alone 80
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Pervasive rigidity in one interpersonal relationships
Includes qualities such as emotional constriction, extreme perfectionism and anxiety resulting from even slight disruptions in one
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Rigid, perfectionist, dogmatic, emotionally blocked—preoccupation with orderliness and abmartinez @ 2010 perfection
’ s ac
OC personality disorder are more generalized way of interacting
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OCD involves only specific and constrained obsessive thoughts and compulsive behaviors
Seem grim and austere, tensely in control of their emotions, lacking spontaneity (Millon, 1981) Workaholics and see little need for leisure activities or friendships Lifetime prevalence is 1.7% and 6.4%; more common in men than women 83
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Seen as stubborn, stingy, possessive, moralistic Ingratiating and deferential to “superiors” but dismissive, demeaning or authoritarian toward “inferiors” Extremely concerned with efficiency, but perfectionism and obsessions on following rules often interfere with completion of tasks 84
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Fin.
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—Fin
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