Lesson 14: Abnormal Psychology

Attention

What is normal?  Before we can delve into “abnormal” behavior, it is first imperative to consider what our society deems appropriate and healthy behavior.  Yet, the answer is not so clear because we live in a pluralistic society in which a myriad of cultures, races, sexual orientations, social classes and religions (among others) co-exist within the framework of the United States.

What may be “normal” for a White, middle-class, Evangelical Christian, middle age male living in rural Colorado may be deviant for a Muslim Asian-American woman living in New York City.  Yet the White Christian male and the Muslim Asian woman must conform to “safe” and “healthy” behavior that does not endanger them or others in society.

Abnormal behavior, then, in the U.S. and other western countries must meet the following criteria:

1. The behavior is deviant from societal norms as a whole (socially unacceptable).
2. The behavior may lead to an increased risk to self or others in terms of daily functioning.
3. The behavior must be persistent over time.
4. The behavior causes subjective distress (such as emotional lability or heightened anxiety, inability to engage in everyday social or occupational tasks, social estrangement or isolation).
5. The individual’s judgment and insight are usually impaired and it becomes difficult, if not impossible to adequately care for themselves without treatment and intervention.
6. In many (but not all) cases, there is a biochemical imbalance.

So the White Christian male and the Muslim Asian woman can have different practices and values or sexual orientations but they must be mentally functioning in society.

Over the past century, psychiatrists, psychologists, clinical social workers and others have wrestled with classifying mental disorders.  The result is a publication entitled Diagnostic and Statistical Manual of Mental Disorders (aka DSM).  The current edition of the DSM is IV-R and a new edition is due in the next several years.

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

• Discuss the criteria for determining if behavior is "abnormal" and the sociopolitical implications of this determination
• Understand the classification system of the DSM-IV and how to use it.
• Understand what constitutes an anxiety  and mood disorder and treatments for each.
• Understand the difference between thought disorders (such as Schizophrenia or Delusional Disorder) and mood disorders (such as Major Depressive Disorder and Bipolar Disorder).
• Understand various types of therapies used to treat mental disorder.
• Explore laws and policies related to involuntary commitment

Teaching

(Really) Abnormal Behavior (Mental Disorders and Mental Illness)

Sometimes behavior can be so abnormal that it requires treatment. We use the same criteria to define abnormal behavior in the world of Abnormal Psychology as well.

• Statistics
• Social Norms
• Survival (Adaptive-does the abnormal behavior put yourself or others in danger or does it keep you from doing things that you would like to do)

For something to be considered a disorder it has to interfere with someone's life to a relatively significant degree.

Mental Illness

When we discuss mental illness we need to understand that this level of abnormal behavior nearly always meets the criteria mentioned above about what "abnormal" is...and greatly interferes with life function and happiness.

All of us, from time to time, may experience periods of OCD, depression, anxiety, etc. But when it starts to interfere with your life in dramatic ways...it is time for a diagnosis.

The Diagnostic and Statistical Handbook of Mental Health Disorders (DSM)

When we assess the status of someone's mental health (though neurological tests, clinical interviews, and psychological tests) we are trying to determine the exact nature of the problem and its potential causes. We then relate this information to research that has been conducted on abnormal behavior collected in the DSM.

This the "bible" of the Mental Health world. It describes the various disorders and highlights how to treat them (in some cases)

We don't actually know a whole lot about all the diagnoses and why they happen, but we are working on it.

Online DSM
A fairly well put-together version of the DSM

Classes of Disorders

Anxiety Disorders

Anxiety disorders are a class of disorders that involve individuals who experience a great degree of discomfort and psychological pain when exposed to particular stimuli or when they are thinking about particular things.

We trivialize the concepts of being "anxious" and "panic attacks" but these symptoms are very real and very debilitating to the individual who experiences them.

Consider the following anxiety related disorders:

• Phobias (remember, these are IRRATIONAL fears...beyond the scope of normal fear of the objects or situations)
• Obsessive-Compulsive Disorder (the anxiety occurs when someone is unable or feels restricted from following through with their ritual. This is a disorder that is commonly trivialized.)
• Psychosomatic Disorders (the belief and manifestation of real physical symptoms)
• Conversion Disorder (similar to psychosomatic disorders)
• Panic Attacks

Mood Disorders

The mood disorders are aptly named, disorders involving the emotional experiences of an individual.

• Major Depression (primarily a motivation issue----the sense of hopelessness is such that they are not motivated to do much of anything)
• Bipolar Disorder (periodic and cyclic experiences of highs and lows----really and extreme of what we may feel every day as we go through ups and downs in our lives)
• Dysthymic Disorder (a low grade depression----the blues----thought to be experienced by quite a number of people leading to questions as to the statistical test of "normal")

The primary treatment for many of the mood disorders is medication. These have been shown to be very effective.

To the degree that the mood disorder is related to psychosocial and intrapsychic factors (coping, cognitive factors) therapy may help as well.

Personality Disorders

Axis II of the DSM outlines the Personality Disorders. These are some of the least understood disorders and most difficult to treat.

• Paranoid Personality Disorder
  • pattern of distrust and suspiciousness
• Schizotypal Personality Disorder
  • acute discomfort in close relationships, distortions in thinking, and eccentric behavior
• Histrionic Personality Disorder
  • excessive emotionality and attention seeking behaviors
• Obsessive-Compulsive Personality Disorder
  • intense interest in being orderly, achieving perfection, and having control
• Dependent Personality Disorder
  • pattern of being submissive and clingy because of an excess need to be taken care of
• Antisocial Personality Disorder
  • pattern of disregard or violating the rights of others without feeling remorse or guilt
• Borderline Personality Disorder
  • chaotic dissociative disorder characterized by intense, often dysfunctional, relationships, splitting, and sabotage of plans for success. Associated with long term trauma
• Multiple Personality Disorder
  • the most complex of the dissociative disorders it is characterized by the manifestation of various personalities and personality fragments within a single individual. Associated with long term trauma.

Schizophrenia

Schizophrenia describes a set of various diagnoses that are typified by the following symptoms:

• delusions
• hallucinations
• disorganized speech
• disorganized behavior
• decreased emotional expression

Overcoming Mild Depression

A lot of us have felt the blues and have felt down. Sometimes it is associated with real loss or disappointment. But even then we feel that we should be able to shake it...but it persists.

We might have a case of dysthymia. Because dysthymia can develop into Major Depression we need to be able to deal with it when it comes up.

Some of the reasons we may become dysthymic include:

• negative thoughts about the self
• overgeneralization (absolutes like "never" and "always" which disempower us)
• Selective attention (only focusing on the negatives)
• Specific Psychosocial Situations
  • Academic pressure
  • Financial stress
  • Role stress (ex: your role as a parent conflicting with your role as a student)
  • Family pressures

Here are some strategies that really do help...they might seem a bit hokey but they have a good history of working!

• Socializing (practicing social skills, hanging out with friends, family, etc.)
• Exercise (promotes healthy biology)
• Identifying negative thoughts and creating a plan to replace them with more positive thoughts
• Positive thinking
• Time Management
• Personal behavior plans

Sometimes it may be important to seek help with the "blues" if they seem to be out of your control. Asking for help does not mean that you have a mental illness, it means that you need help coming up with strategies to deal with the feelings that you are having.

Assessment

Lesson 14 Discussion A

Consider the concept of "abnormal" as it is described in the Lesson. Throughout history there has been controversy related to those who have the power to determine what is considered "abnormal" and what is not...it has not always been decided for the right reasons. This is why the three criteria (and in particular, the third one) are so important to consider when we are deeming something to be "abnormal".

Let's discuss the fringe of "normal"...cite examples of behavior that some individuals engage in that SOME might deem as "abnormal" but those individuals feel is "normal" for them. Keep in mind that "abnormal" can be a "violation" of any of the three criteria...it can be behavior that is rare, it can be behavior that is unacceptable to certain groups, and/or it can be behavior that is harmful to the individual or others.

Lesson 14 Discussion B

Consider where we are in the semester...appraoching the end. You might be exhausted, tired of learning, and even wondering why you are doing this. Your motivation might be low just when you need to kick into high gear to get through finals and project assignments. Review the content on "Overcoming Mild Depression" and share your strategies for keeping yourself "up" when you are "down".