PSYC 475 1

Jan. 10, 2006

What is Abnormality? Normal vs. abnormal psychology

o Psychology
o Thinking
o Feeling
o Behavior
o What is “abnormal”?
o Statistical deviation
o Defined relative to some standard of behavior
 Abnormal differs across settings and cultures
 Abnormal changes over time
o What is “Mental Illness”?
o Not all abnormal behavior is mental illness
o Implies a disease
o “Mental”
 Assumption is that problem is located within the person
 Can have problems within society too
 Mental vs. physical
Models of mental illness
o Medical model
o Treats is as an illness
o Biological causes
 Structural abnormalities in the brain
 NT/ hormones
 Genetics
o Psychological models
o Psychoanalytic model
o Behavioral (learned)
o Cognitive (stems from irrational or dysfunctional thoughts)
o Humanistic/ existential (get rid of blocks)
o Sociocultural models
 Interpersonal model
 Caused by interpersonal problems
 Family systems
 Social structural theories
o Biopsychosocial model
 Focus on all levels
o Diathesis—stress model (vulnerability—stress model)
 Various risk factors
 Stress caused by traumatic experience.

Jan 12, 2006

Diagnosis
 PSYC 475 2

o Diagnostic and Statistical Manual (DSM)—first published in 1952

o Theoretically based
o Reliability problems
o DSM—III, III-R, IV, IV-TR—R=revision
o Describe specific symptoms
o Increased reliability (every time you measure you get the same thing) validity
measurement is reflection of actual reality) Are we measuring what’s already
there?
o If it’s not reliable then it’s not really valid
o Assumes Mental Disorders are the same across
o Relatively low cultural sensitivity
o Attempts to address this by including text describing symptoms in various
cultures
o ICD-10 (international classification of diseases) physical and mental
DSM Multiaxial System
o Axis I—Conditions that cause significant distress or impairment—most of the
mental disorders
o Axis II—lifelong pervasive mental disorders
o Mental retardation and personality disorders
o Axis III—Medical conditions
o Axis IV—Psychosocial or environmental stressors
o Axis V—Global Assessment of Functioning
Sample Diagnosis
o Axis I—309.00 Adjustment disorder w/ depressed mood
V61.12—Partner Relational Problem
o Axis II—199.90—diagnosis deferred on Axis II
o Axis III—chronic asthma
o Axis IV—change of job, move
o Axis V—current GAF: 66
 Highest GAF Past Year: 80

Jan 13, 2006

Assessment & Treatment

o Assessment
o Interview for symptoms and history
o What symptoms, how long, how severe, etc.
o Family history
o Current stressors
o Personal and family history of mental illness
o Educational, social, occupational, and legal history
o Medical history—referral if necessary
o Sociocultural factors
o Social resources
 PSYC 475 3

o Assessment
o Psychological testing
o Intellifence3 testing
o Achievement testing
o Neuropsychological testing
 Narrow in on psychological disorders
 Or, if receive traumatic brain injury
o Personality Testing
 Objective
 Projective—ink blots
o Symptom based questionnaires
o Adaptive functions
o Behavioral observations and self-monitoring
o Treatment
o Biological treatment
 Drugs
 ECT
 Psychosurgery
o Psychotherapy
 Psychodynamic therapies
 Cognitive therapies
 Family therapy

Jan. 17, 2006

Phobias
o Specific Phobias
o Persistent and unmarked fear of specific situations and objects
o Must be excessive or unreasonable
o Phobia interferes w/ everyday life
o Types
 Animal type
 Natural environment type
 Blood-injection-injury type
 Situational type
o Social Phobias
o Fear of social or performance situations
o Avoidance
o Interferes w/ the person’s normal functioning
How do Phobias develop?
 Classical conditioning
o Unconditioned stimulus lends to an unconditioned response
o An innocuous stimulus is paired with the unconditioned response
o The response becomes conditioned
o Little Albert Example
 Modeling
 PSYC 475 4

 Stimulus generalization
 Some stimuli seem to be predisposed to elicit fear i.e. snakes and heights
Treatment
 Flooding
o Massive exposure to the feared stimulus
o No reinforcement
o Response prevention
o Should lead to extinction
o Outcome vary
o Ethical concerns
 Systematic Desensitization
o Fear hierarchy
o Gradual exposure w/ relaxation training
o Reciprocal inhibition
o Rating levels of distress
o Can be either in vivo or covert
o About 75% of people improve
 Modeling
o Participant modeling
 Patient watches the therapist experience the fear stimulus
 Patient experiences the feared stimulus

Jan. 19, 2006

Effectiveness of treatments for specific phobias
 Flooding, systematic desensitization, and modeling all appear to be about equally
effective
 Choice of treatment dependent on speed and intensity of treatment desired
 In vivo (live) is more effective than covert
 Drugs don’t work well
o Don’t treat the problem, simply numb the patient to their fear

Treatments for social phobia

 Drug treatments
o Don’t work for social phobias
 Ex. If you are drunk you will not be able to do the presentation
 Exposure treatments—groups particularly effective
o Through interaction in groups can overcome phobia
 Cognitive treatments
 Social skills training
 No one approach is better than the others
o Social phobias are more difficult to treat than social phobias
Generalized Anxiety Disorder
 Excessive worry and anxiety
 Worry about a wide variety of things
 PSYC 475 5

o Not targeted to a specific thing (will find something to worry about if

there is nothing directly present)
 Symptoms:
o Physiological: restlessness, fatigue, muscle tension, sleep disturbances
o Irritability
o Concentration problems
 4% of the population
o Most are not diagnosed
 People will often self-medicate
o Alcohol
o Pain-killers (excessively)
o Smoke

Treatments for Generalized Anxiety Disorder

 Cognitive treatments
o Rational Emotive Therapy
 Uncover and debunk irrational assumptions
o Self-instructional training
 Talk yourself though things
 Medications
 Relaxation training
 Biofeedback

Panic Disorder & Agoraphobia

 Agoraphobia—fear of open spaces
 Panic disorder—(symptoms) panic attacks

Panic attacks vs. Panic Disorder

 About 40% of young adults have had one or more panic attacks
 Most often diagnosed in E.R. patients thought that they were having a heart attack
 Symptoms:
o Heart palpitations
o Sweating
o Tingling sensation in hands and feet
o Trembling
o Choking sensations/shortness of breath
o Chest pains
o Dizziness
o Faintness
o Hot and cold flashes

Panic Disorder
 About 2% of people have panic disorder in a given year
 More common in women
 Genetic connection
 PSYC 475 6

o About ¼ of first degree relatives will have had it

 What does it look like?
o One or more panic attacks
o Persistent dread of future attacks interferes with functioning
o Avoidance
o Can lead to agoraphobia
 Connection with agoraphobia
o Controversial connection
 Studies use people who come to clinics for help
 Probably already suffering from agoraphobia
 Not generalizable to the entire population
o Mechanism—avoidance
o Diagnosis with or without agoraphobia

Explanations for Panic Disorder

 Looks like the best explanation for panic disorder probably combines biological,
cognitive, and behavioral factors
 Biological factors (triggers)
o READ BOOK
o One theory is that people have a sensitivity to CO2, when they start losing
their breath react more violently
o Basic idea is that it starts with a physiological event and is then dependent
on the individuals reaction

Jan. 20, 2006

Cognitive processes
o Misattribution for bodily symptoms
o Anticipation of future attacks
o Fear of losing control
o Avoidance behavior leads to agoraphobia
 Behavior process
o If avoidance is successful, it becomes self-reinforcing
Treatments
 Drug treatments
o Types of drugs
 SSRI’s
o When it is useful?
 When the person can no get out of their house
o Disadvantage
 Relapse is common
 Cognitive behavior therapy
o Helps person correct misattributions
o 85-90% effective
 PSYC 475 7

o 90% still panic free after 2 yrs.

Obsessive Compulsive Disorder
 Obsessions
o Constant overwhelming wishes, impulses, images, ideas, or doubts
o Feel intrusive and foreign
o Attempts to ignore thoughts causes anxiety
o Common themes:
 Dirt or contamination
 Violence or aggression
 Orderliness
 Religion
 Sexuality
 Compulsions
o Behaviors that feel uncontrollable
o Belief that something terrible will happen if they don’t do the behavior
o Generally recognize it’s excessive
o Often develop rituals
o Typical compulsions
 Cleaning (or not)
 Checking
 Seeking symmetry, order, and balance
 Counting
 Touching
 Verbal rituals

Jan. 23, 2006

Post-traumatic Stress Disorder

 Caused by exposure to an event that was traumatic
 Characterized by:
o Persistent re-experiencing of the event (i.e. flashbacks, nightmares, or
intrusive thoughts)
o Hyper-vigilance— hyper aware of circumstances and surroundings
o startle response
 To be diagnosed with P.T.S.D. need to suffer from it for one months
 Often results in self-medication with alcohol or drugs
 Often results from rape, war, assault—pretty much anything that is sufficiently
traumatic for that person

January 24, 2006

Somatoform Disorder
 Physical symptoms that can’t be explained by any medical or organic cause
 Must be evidence that psychological factors are involved
 Risk-exposure to unnecessary medical procedures and treatments
 PSYC 475 8

“Hysterical” Somatoform Disorders

 Conversion Disorder
o Loss of function in one part of body (i.e. false pregnancy)
o Fairly rare
o Often under severe stress (found in veterans of WWII)
o La belle indifference
 People don’t care about their symptoms
o Gender differences
 Women are more likely to be diagnosed with this than men
 Might be the result of gender bias
o SES differences
 More common with people with lower education and
fundamentalist background
o Cultural factors
 More common in the U.S. than anywhere else
 Conversion disorder
o Cause:
 Primary and secondary gain
 Stress (primary)
 Get rid of the anxiety
 Sympathy (secondary)
o Treatment
 Psychoanalytic vs. Behavioral/cognitive
 Psychoanalytic—remove primary gain
 Behavioral—remove secondary gain
o The longer the symptoms are present the poorer the outcome
 Somatization Disorder
o Multiple physical complaints (at least 8, across four categories)
o Undifferentiated somatoform disorder
 Same as somatization disorder but without all eight symptoms
o Course
o Dr. shopping
o Potential for iatrogenic problems
 Problems that are induced by doctors
o More common in women
o Tends to run in families
 Treatment
o Similar to conversion disorder
 Response prevention
 Prevent them from going to so many doctors
 Team approach
 Carefully observe patient behavior
 PSYC 475 9

 Pain disorder
o Pain related to psychological factors
o Is this a useful diagnosis?
“Preoccupation” Somatoform Disorders
 Hypochondriasis
o Obsession with being sick
o Disappointment when it’s not confirmed
o Spend lots of time on books and doctor visits and “cures”
 Becomes like a “hobby”
 Theories about cause
o Repressed conflicts
o Reinforcement
o Phobia
o Attribution bias
 Body Dysmorphic Disorder
o Preoccupation with imagined deficits in their body

January 26, 2006

What is dissociation?
 “A disruption in the usually integrated functions of memory, consciousness,
identity, or perception of the environment”
o Can be present in the separation of memory, consciousness, identity
o Elements
 Amnesia
 Depersonalization
 Disattachment from oneself
 Derealization
 Disattachment from the world, perceive it as not being real
 Identity confusion
 Identity alteration
 When someone suddenly develops a sudden skill that they
did not realize that they had
 Pathological examples
 Non-pathological examples

Dissociative amnesia
 Retrograde amnesia for personal information, not general info.
 Usually amnesia for near and distant past
 Often reverses abruptly
 Often associated with war or trauma
 Lots of debate about this category—possible malingering
 Dissociative Fugue
o Where in your state of amnesia you begin to travel
 PSYC 475 10

 Types of dissociative amnesia

o Localized
o Selective
o Generalized
 Amnesia for all events in the past
o Continuous
 Retrograde and future events are continued to be forgotten

Dissociative Identity Disorder a.k.a. Multiple Personality Disorder

 Sometimes the personalities are aware of each other
 Sometimes alternate personalities will switch without control of the host
 Diagnostic problems?
o Greatly increasing incidence 1% of the population
o Debate about whether this is a true disorder
 Demographics
o Mostly adult women
o Higher prevalence in Latinos than in general population
o High coincidence with child abuse
 Explanations
o Repression of some extremely traumatic event that splits off

Explanations for DID (Comer, 2001)

 Trauma with hypnotizability
 Repression
 Operant conditioning
 State-dependent learning
 Self-hypnosis

Treatments for Dissociative Identity Disorder

 Psychodynamic therapy
 Recognizing the disorder
 Educating the client
 Recovering memories
 Becoming aware of “alter” personalities
 Integrating the sub-personalities

January 30, 2006

Mood Disorders
 Diagnosing Mood Disorders
o “Episodes” vs. “Disorders”
 Episode—period of time when you have a set of more severe
symptoms
 PSYC 475 11

 Disorder—when you actually suffer from a disorder

 Major Depressive Episode
o Do you have to have depressed mood to be
“depressed?” NO
Either depressed mood or anhedonia
o Other symptoms
 Weight gain/loss
 Sleep problems
 Fatigue
 Feelings of worthlessness
 Thoughts about death
 Difficulty concentrating
o Need to suffer from most of these symptoms for
two consecutive weeks to have a “Depressive
Episode”
o No delusions or hallucinations without mood
symptoms
 Unipolar depression
o Major Depressive Disorder
 Major depressive Episode (Need to have one or more major
depressive Episode to have a Depressive disorder)
 Not from a medical cause
 5-10% of people have this within a given yea
 Dysthymia
o 2 years—chronic
o Not all the symptoms of Major Depression
o Never or rarely have elevated mood
o 2.5-5.4% of people have this any given year
 “Double Depression”
o Suffer from dysthymia and depressive episodes
o Explanations for Unipolar depression
 Genetic Factors
 20% of close relatives are also depressed
 Twin Studies
 Neurotransmitters
 Serotonin and norepinephrine
 Psychodynamic views
 Childhood loss—anaclitic depression (orphan studies)
 Anger turned inward
 Explanations for Unipolar Depression
o Behavioral view
 Depressed people lack social reinforcements (particularly social)
 Downward spiral
o Cognitive approach
 PSYC 475 12


Depression is based in maladaptive attitudes—people that are
depressed have negative attitudes about themselves
 Cognitive triad—people who are depressed view the following
categories in a consistently negative way
 Experiences
 Self
 Future
 Errors in thinking
 Depressed people tend to minimize their positive
experience
 Focus on changing cognitive patterns
o Cognitive—Behavioral View
 Learned helplessness

January 31, 2006

Grief vs. Depression

 When does normal grieving become depression?
 What is “abnormal” in grieving?
 Is it normal to be “depressed” when grieving

Biological Treatments
 Drugs
o MAOIs
 Neg: must be very compliant with diet because there are all sorts of
things that you cannot eat (cheese, beer, milk)
o Tricyclics
 Neg: fatally toxic in high doses
o SSRIs
 Electroconvulsive Therapy

Behavioral Approaches
 Pleasant Activity Scheduling
 Reinforcing nondepressed behavior
 Social skills training
 Effectiveness of behavioral approaches

Cognitive Therapy—Beck
 Increase Activities
 Examine and Invalidate Automatic Thoughts
o Record
o Discuss these
o Dispute
 Identify Distorted Thinking and Negative Biases
 PSYC 475 13

Symptoms of Bipolar Disorders

 Emotional
o Elation
o Laughing
o Over-confident
o Irritable
 Cognitive
o Inflated self-image/grandiosity
o Positive expectations
o Arbitrary decision making
o Flight of ideas

February 3, 2006
Eating Disorders
Historical Perspective
 Anorexia in 13th century
o “Holy Anorexics”—religious women who were canonized for their
fasting practices (among other things)
o When definition of holiness altered, so did incidence of holy anorexia;
hints that some of these women were bulimic, but no confirmed cases
 Bulimia in 700 BC
o Roman vomitoriums—“Eat, drink, and be merry”

Complex Picture of Eating Disorders

 Disorders are interrelated with:
o Brain chemistry (including genetics)
o Physiological and social factors
o Nutritional factors
 Multidimensional Treatments required
o Nutrition
o Biochemical/ Psychosocial
o Pay attention to underlying etiology, not just symptom management, else
other symptoms emerge
Not just a woman’s problem
 More common and more visible in women. Why?
 Women historically judged according to different criteria than men
 Women’s bodies within the purview of society
o Current mismatch between biology and culture
o Maturation right when girls are most self-critical
Eating and Disordered Eating
 80% of 8th grade girls say starving and/or purging are reasonable methods for
weight control
 PSYC 475 14

 We all like to eat

o Meets nutritional requirements
o Fulfills social and emotional needs
 Yet eating may compete with our ability to meet societal ideas re: body sice/shape
Definition and criteria
 Anorexia Nervosa
o From Greek, meaning “without appetite, mental cause”
 Mind over matter; control
 Gain more from control than eating
 Spend ¾ of day thinking of food
 Losenot gain backbuffer re: gain
 Afraid that if control is lost it will be impossible to regain it
DSM IV Criteria
 Anorexia Nervosa
o Body weight less than 85% of normal
o Intense fear of overweight
o Denial of seriousness or undue influence of weigh/ shape on self image
o Amenorrhea (no menstruation for 3 consecutive months)
 Restricting Type
 Binge Eating/ Purging Type
Definition and Criteria
 Bulimia Nervosa
o From Latin, “hunger of an ox”
 Sometimes termed “failed anorexics”
 Use food as mood regulator—both the eating and the purging calm, soothe, meet
some need
 Easier to hide than anorexia
 Binge on up to 50,000 calories per day
DSM IV Criteria
 Bulimia Nervosa
o Recurrent episodes of binge eating
 Eating, in set time, more than normal
 Feeling of being out of control
o Recurrent inappropriate compensatory behavior
 Vomiting, laxatives, diuretics, enemas, fasting, exercise
o Both occur 2x week for 3 months
o Self-evaluation unduly influenced by body
o Not occurring exclusively w/in Anorexia Nervosa
 Purging Type (vomiting, laxatives, diuretics, enemas)
 Non-purging type (fasting or exercise)
EDNOS
 Eating Disorders Not Otherwise Specified
 Includes AN and BN with component missing…
o Binge Eating Disorder (BED)
 PSYC 475 15

 Food Addicts
o Proposed DSM IV category
o 1/5 of those seeking treatment for obesity
o 2 types?—deprivation sensitive and addictive/dissociative
 Important implications for treatment, if this is true
DSM IV Research Criteria
 Recurrent episodes of binge eating (defined same as for BN)
 Binge associated with 3+ of following
o Eating rapidly; eating to discomfort; eating lots when not hungry; eating
alone b/c of embarrassment re: amount, feeling disgusted, depressed, or
guilty after binge
 Marked distress re: binge eating
 Binge 2 days/week for 6 months (days vs. times)
 No9 inappropriate compensatory behaviors; not part of course of AN or BN
Incidence, Prevalence, Co-morbidity
 Co-morbidity
 Anorexia Nervosa
o Major depression (68%)
o Anxiety (65%)
o OCD (26%)
o Social phobia (34%)
 Bulimia Nervosa
o Major Depression (36-70%)
o Substance abuse (18-32%)
Eating Disorder Men
 Men have always been seen within BED (albeit with different names)
 In AN and BN, men have been “overlooked, understudied, and underreported”
 Increase in male incidence due to:
o Increased knowledge, reporting
o Increased societal pressure on male form
Continued…
 Men make up about 10% of eating disorder population
 Emphasis is different for boys
o In HS, 63% of girls try to lose, 9% try to gain
o In HS, 16% of boys try to lose, 28% try to gain
o In college, 48% of women see self as overweight; only 26% of men do
 Risk factors for men
o Prior obesity
o Avoiding weight-related illness
o Athletics
February 6, 2006

Bi-Polar Disorder
 Manic episode
 PSYC 475 16

o Extreme high
o Pressured speech
o Less need for sleep
o Engage in risky activities
 Hypomanic episodes
o Does not cause functional impairment
 Mixed Episodes
o Have symptoms from both
o Looks like agitation
Diagnostic classification
 Bipolar 1 disorder
o One or more manic or mixed episodes (most severe)
o Individual may or may not have depressive symptoms or hypomanic
 Bipolar 2 disorder
o A variant of major depressive disorder that includes hypomanic episodes
o Includes major depressive episodes as well as hypomanic
 Psychophonic disorder
o Cannot have any severe episodes on either extreme (manic or hypomanic)

Demographic characteristics
o 1% of population suffer from Bipolar 1 Disorder at some point in their life
o Crosses gender, social, cultural, gender lines
o .1% of lifetime prevalence
o More prevalent among women
o Rapid Cycling Bipolar Disorder
o Can cycle between manic and hypomanic with a day
o Seasonal Bipolar Disorder
o Postpartum onset Bipolar Disorder
o Bipolar disorder tends to burn out later in life
Cause
o Strong evidence of biological cause
o Treatments
o Drugs
 Lithium
 Problems: cause diarrhea, effective dose differs depending
people
 Can be overdone—can become toxic
 Anti-Convulsionants
 Low adherence to drug treatment
o Psychotherapy
 Helpful in managing treatment
 Not a cure because of biological basis of bipolar disorder
 Usually includes
 Education about the disorder
 PSYC 475 17

 Family therapy
 Problem solving and social skills
Suicide
o Factors that impact the risk for suicide
o Previous attempts
o Family history of suicide
o Contagious—the taboo is already broken, opening the door for others
 Copycat suicides
o Current mental status (i.e. is the person thinking clearly, depressing,
impulsive, etc.)
o Psychiatric history
Demographic Variables
o Women are 3x more likely to Attempt suicide than men
o Men are more likely to complete suicide
o Whites are more likely to attempt suicide that any other race
o Exception Native American (4-10x the national average)
 Alcohol abuse

Factors that impact risk for suicide

 Previous attempts or family history of suicide
 Contagion
 Current mental status
 Psychiatric history and/or medical background
 Demographic variables
o People over 45 have highest rate of suicide
o Immigrants are more likely to kill themselves than native born
o Married people are less likely than single or divorced

Assessing for Suicidality

 Ideation: “Have you ever thought about it?”
 Intent: “Would you ever actually do it?”
 Plan: “How would you do it?”
o Look at how thoroughly they have planned it
 Means: “Do they have the means to do it?”

February 10, 2006

Substance Abuse

 Substance Abuse
o Impairment or distress associated with substance use
 Legal, social, occupational, or family problems
 Hazardous use
o Can be used for all substances but caffeine
 PSYC 475 18

 Substance Dependence
o Person keeps using the substance “despite significant substance-related
problems”
 Tolerance
 Withdrawal
 Loss of control over use (using more, can’t but down, etc.)
 Use despite physical or psychological consequences
 Giving up occupational or social activities
 Spending lots of time and money to obtain the substance
o Can be used for all substances but caffeine
 Substance-Induced Disorders
o Intoxication
o Withdrawal
o Substance-Induced Mental Disorders
Fetal Alcohol Syndrome
 It’s not clear how much alcohol is “too much”
 Characteristics of FAS:
o Distinctive facial features
o Neurological damage
o Growth retardation

Facial Characteristics in Fetal Alcohol Syndrome

 Thin upper lip
 No valley in upper lip
 Epicanthal folds
 Minor ear anomalies
 Low nasal bridge
 Flat forehead
Disabilities associated with FAS
 Primary Disabilities—those the child is born with
o Low IQ
o Learning problems
o Social problems
o Impulsivity
 Secondary disabilities—arise from the primary disabilities
o Mental health problems
o Disrupted school experiences
o Legal problems
o Poor work history

Post Mid-Term Notes

Paraphilias
 In order for it to be defined as paraphilia there must be some sort of distress by
one of the partners (not applicable to consenting adults)
 PSYC 475 19

 Fetishism
o The need to have a particular object in order to become sexually aroused
 Totally dependent
o Transvestic fetishism
o Sexual sadism—person that gets aroused by causing pain to their partner
o Sexual masochism—person becomes sexually aroused by receiving pain
from partner
o Voyeurism—violating someone’s rights by looking at them without their
consent
o Exhibitionism—arousal by doing sexual things in from of other people
o Frotteurism—sexual arousal by rubbing up against someone without their
consent
o Pedophilia
 Unlike the other fetishes, has been well studied
 80% of pedophiles were sexually abused as children
 Emotional Congruence theory—need for the adult to relate to
children
 Need to feel more powerful
 Identify with the person that abused them
 Sexual arousal theories
 Blockage theories
 Dinsinhibition theories
 Individuals lack restraint, act on impulse
Causes and treatment for paraphilias
 Causes
o Conditioning
o Trauma
 Treatment
o Aversion therapy
 Trying to associate whatever the object of pleasure is with
something displeasurable (i.e. vomiting, pain, etc.)
o Desensitization
o Social skills training
 Pedophiles feel that they do not have the skills to interact with
people in any other way
o Orgasmic reconditioning
o Satiation
 Making the individual overdose on whatever was their problem
o Relapse prevention
o Chemical castration
 Chemical way to change hormones in the individuals so that they
do not become aroused.

Sexual Response Cycle

 PSYC 475 20

February 23, 2006

Schizophrenia
 Demographics
o Lifetime Prevalence
 Approximately 1 of every 100
o Onset
 Usually during late adolescence
o Sex Ratios
 Equally common in males and females
 Onset earlier in males
 Peaks in early 20’s for males & late 20’s/early 30’s for females
o Comorbidity
 Substance abuse in 50% of schizophrenia patient
o Impact
 Costs U.S. in excess of $100 billion annually in direct care,
aftercare, & lost earnings
 Increased risk of suicide

February 24, 2006

Subtypes of Schizophrenia
 Disorganized type—confused, almost incoherent, emotions don’t range,
sometimes are silly, poor hygiene
 Catatonic type—rare, movement disturbance
 Paranoid type—delusions and hallucinations
 Undifferentiated type
 Residual type—had one of the other types, but are now getting better
Diagnosing
 Two or more of:
o Delusions
o Hallucinations
o Disorganized speech
o Disorganized or catatonic behavior
o Negative symptoms (doesn’t have something they should have)
 Social/occupational functioning is impaired
 Duration at least 6 months
 No other medical condition to explain symptoms

February 27, 2006

Anhedonia—partial or total lack of interest in some or all activities
Remember this for final!!!

February 28, 2006

Personality Disorders
 PSYC 475 21

What is a personality disorder?

Pervasive style
Marked deviation from cultural norms
Inflexibility in thinking and behavior
Long standing problems
Often not perceived as problematic by the individual
Often very difficult for other people to live with
Very difficult to treat
The Categorization Problem
Symptoms overlap across diagnoses
Many people can be diagnosed with more than one disorder
Same of these are just exaggerations of “normal” traits
The Clusters
 “Odd” and eccentric
o Paranoid
o Schizoid
 Dramatic, emotional, or erratic
o Antisocial
o Borderline
o Histrionic
o Narcissistic
 Fearful or anxious
o Avoidant
o Dependent
o Obsessive-compulsive
Cluster A: Odd and eccentric
 Relationship to schizophrenia
o Extreme suspiciousness, social withdrawal, bizarre sets of beliefs
 Paranoid personality disorder
o View world with distrust and suspiciousness
o Strong trust in own ideas
o Some can qualify as schizophrenic
o Guarded with others
o Critical and fault-finding, but hyper-sensitive to criticism
o Little research on causes
o Difficult to treat
 Schizoid Personality Disorder
o Inability to form social relationships
o Lack of interest in social relations
o Poor social skills
o Insensitivity to other people’s feelings
o Indifference to raise or criticism
o Withdrawn and seclusive
 PSYC 475 22

o May have genetic links

o Treatment-teaching social skills and establishing social connections
 Schizotypical Personality Disorder
o Oddities in thinking, perceiving, communication, and behaving. NOT
PARANOID
o Superstitious
o Social withdrawal and anxiety
o Constricted or inappropriate emotions
o Genetic cases—may be closely related to schizophrenia
o Treatment
 Antipsychotic drugs
 Side effects: cause Tarditive dyskinesa—unusual
involuntary movements
 Cognitive-behavioral therapy—express emotions more
inappropriately

March 2, 2006

Personality Disorders
Cluster B: Dramatic emotional, or erratic
 Antisocial Personality Disorder
o Causal factors
 Biological
 Genetics
 Birth Complications
 Low arousal in response to emotional situations
 Decrease in frontal lobe functioning
 Environmental—Childhood
 Witnessing violence
 Parental divorce, separation, desertion
 Corporal punishment or abuse
 Defects in learning from consequences

March 3, 2006
Borderline Personality Disorder
 Instability in mood, relationships, self-image
 Erratic behaviors
 Often diagnosis is used pejoratively (used as name calling)
 Can be a “wastebasket” category
 Possible causes
o High rate of early abuse and trauma
o Brain abnormalities
 Treatment
o Dialectical behavior therapy ~ teaches how to deal with stress and self-
regulation
 PSYC 475 23

o Is psychotherapy worth the cost? It’s not very effective

 Narcissistic Personality Disorder
o Inflated sense of self-importance
o Need for constant admiration
o Page at criticism
o Entitlement and exploitation
o Unstable relationships
o Dislike being dependent on others
 Histrionic Personality Disorder (female form of antisocial personality disorder)
o Read in Book
Cluster C: Fearful & Anxious
 Avoidant Personality Disorder *Difference from social
o Fear of seeming foolish phobia because this is pervasive
o Hypersensitivity to criticism across lifetime*
o Reluctance to take social risks
o Social inhibition
o Desire for social contact
o Parallels with social phobia
o Treatment is behavioral—exposure and social skills training
 Dependent (read in book)
 Obsessive—Compulsive Personality Disorder
o Preoccupation with orderliness & perfectionism
o Fixated in details
o Devoted to work—leisure time and family suffers
o Over-conscientious and inflexible
o Reluctance to delegate
o Miserly
o OCD vs. OCPDbeing like a perfectionist
 True obsessions and true compulsions that becomes disabling
o Theories about causes—parental punishment in response to mistakes
o Treatment—cognitive approaches (is that a reasonable thing to believe or
not)

March 6, 2006
Conduct Disorder and Oppositional Defiant Disorder
 Conduct Disorder: consistent violations of social norms and other people’s rights
 Oppositional Defiant Disorder: Defiance, irritability, arguing
 Sex ratio: 3 boys: 1 girl
 Causal factors
o High concurrence with ADHD
o Exposure to violence
 Modeling after violence in family, neighborhood
o Biological factors
 PSYC 475 24

 Genetics—kids with conduct disorder likely to have parents with

Antipersonality Disorder
 Prenatal factors
 Anything damaging prenatal—alcohol
 Low arousal
 Deficits in learning from consequences
 Causal factors
o Low socioeconomic scale—poverty vs. “downward social drift?”
o Quality of parenting & supervision
 Treatment
o Cognitive Problem Skills Training
o Parent Management Training
o Mutisystemic Therapy
o Ethnic differences in treatment received
 European-American kids—treatment by mental health providers
and psych hospitals
 African American kids—treated in schools and sent to jail
Attention Deficit Hyperactivity Disorder—Key characteristics
 Inattention—immediate response without thinking about consequences
 Impulsivity—inability to control responses (i.e. call out responses, interrupt
people)
 Hyperactivity—high energy level
 Subtypes:
o Hyperactive-Impulsive Type—disruptive
o Inattentive Type—daydream, difficulty staying on task
 More likely to be diagnosed in girls
 Not disruptive
o Combined Type
 Onset before age 7
 Present in two or more settings

March 9, 2006

ADHD Treatment
 Stimulant medication
o Ethical questions about the use of chemical restraints
o Dosage issues—improving behavior vs. attention/school performance
o Side effects
 Behavior Therapy
o Less effective than medication alone
o Lower relapse rate than medication
o Combined with medication is most effective
 Controlling the environment
 Special education issues
 PSYC 475 25

Tourette Syndrome
 “Tics”—involuntary movements or vocalizations
 Multiple motor tics and vocal tics
 Can be suppressed for a short time
 More often in men than women (2:1)
 Genetic
 High comorbidity with OCD
 Has reputation with being the swearing disease
Developmental Disorders
 Coded on axis two
 Lifelong
 Mental Retardation
o IQ of about 70 or below (two standard deviations below the mean: 2% of
population)
 True score = obtained score + error
o Deficits in adaptive functioning
 Ability to be independent and take social responsibility for your
age
o Mild MR (IQ about 50-55 to 70)
o Moderate MR (IQ about 35-40 to 50-55)
o Severe MR (IQ about 20-25 to 35-40)
o Profound MR (IQ below about 20-25)
o Onset before age 18