EastWest Review - Abnormal Psychology

Abnormal Psychology Review Class
Dr. Arnold V. Lopez

Clinical Psychologist
Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
Understanding Abnormality:
A Look at History
and Research Methods
What is Abnormal Psychology?

the
study of the nature,

characteristics, etiology, and modes
of treatment for abnormal behaviors
What is the difference between
abnormal psychology and clinical
psychology?
MYTHS OF MENTAL ILLNESS
Creative people are a little crazy.

People with mental disorders are dangerous.
Most older people are senile.
Freud was only concerned with sex.
Criminals are born bad.
Asthma is caused by emotional problems.
Suicidal individuals rarely talk about suicide.
People with schizophrenia have multiple
personalities.
ABNORMAL BEHAVIOR:
Distress
Impairment
Risk to self or
other people
Socially and
culturally
unacceptable
behavior
The term abnormality is defined according to the following

standards:
Cultural Relativism a perspective that argues that the
norms of a society must be used to determine the normality
or abnormality of a behavior.
Unusualness Criterion (Statistical) suggests that unusual,
or rare behaviors should be labeled abnormal.
Discomfort Criterion suggests that only behaviors or
emotions that an individual finds distressing should be
labeled abnormal.
Mental Illness Criterion suggests that only behaviors
resulting from mental illness are abnormal.
Maladaptiveness (3Ds distress, dysfunction, and
deviance) behaviors that cause people to suffer distress,
that prevent them from functioning in daily life.
What Causes
Abnormality?
Causes of Abnormality
Biological
genetic inheritance
medical conditions
brain damage
exposure to environmental stimuli
Psychological
traumatic life experiences

learned associations
distorted perceptions
faulty ways of thinking
Sociocultural
disturbances in intimate relationships

problems in extended relationships
political or social unrest
discrimination toward ones social group
Causes of Abnormality
Three dimensions of the causes of abnormality:
biological
psychological
sociocultural
Social scientists use the term

BIOPSYCHOSOCIAL to characterize the
interactions among these three dimensions.
Biological Causes
Possible biological causes
Genetics
Disturbances in physical functioning
Medical conditions (e.g., thyroid problem)

Brain damage
Ingestion of substances
Environmental stimuli (e.g., toxins)
Psychological Causes
Possible psychological causes
Troubling life experiences
Interpersonal between people
(e.g., arguments)
Intrapsychic within thoughts and feelings
(e.g., irrational interpretations)
Sociocultural Causes
Sociocultural circles of influence
Immediate circle people with whom we
interact most locally.
Extended circle of relationships such as
family back home or friends from high
school.
People in our environment with whom we
interact minimally.
Biopsychosocial
Perspective
Diathesis-Stress Model:
The proposal that people are born
with a predisposition (or "diathesis)
that places them at risk for developing
a psychological disorder if exposed to
certain extremely stressful life
experiences.
Abnormal
Psychology
Throughout
History
Three prominent themes in

explaining psychological
disorders recur throughout
history:
The mystical
The scientific
The humanitarian
Prehistoric Times:
Abnormal Behavior as
Demonic Possession
Trephining
Exorcism
Ancient Greece and Rome:

Emergence of the
Scientific Model
Hippocrates (circa 460-377 B.C.)
Theory of 4 Humors
Black bile (melancholic)
Yellow bile (choleric)
Phlegm (phlegmatic)
Blood (sanguine)
Ancient Greece and Rome:

Emergence of the
Scientific Model
Hippocrates (circa 460-377 B.C.)
Aesclepiades
(1st Century B.C.)
Galen (130-200 A.D.)
The Middle Ages and

Renaissance: Re-emergence of
Spiritual Explanations
Explanations: Superstition,
astrology, alchemy
Treatments: Magical rituals,
exorcism, folk medicines
Witch hunts
Asylums
Europe and the United States

in the 1700s:
The Reform Movement
Vincenzo Chiarugi
Philippe Pinel
Jean-Baptiste Pussin
More
Reformers
William Tuke,
Moral Treatment
Benjamin Rush
Dorothea Dix,
State Hospital Movement
Benjamin Rushs Methods
Rush and his contemporaries thought that the

fright induced by their methods would counteract
their patients mental illnesses.
Source of illustration: National Library of Medicine.
1800s to 1900s:
Alternative
Models
Medical Model
Mesmerism,
Hypnotism
Psychoanalytic
Model
Psychoanalysis
Psychotherapy
Source of illustration: Corbis/Bettmann.
The Late Twentieth Century:

The Challenge of Providing
Humane and Effective
Treatment
Medications
Deinstitutionalization Movement
Managed Health Care
Research
Methods in
Abnormal
Psychology
The Scientific Method
Objectivity
Observation
Hypothesis Formation
Ruling Out Competing Explanations
With Proper Controls
The Experimental Method
independent
variable
(the possible
cause)
dependent
variable
(the outcome
measured)
The Correlational Method

correlation:
an association
(or co-relation)
between two
variables.
The Survey Method

Researcher use the survey method to gather
information from a sample considered
representative of a particular population.
Incidence:
Prevalence:
The frequency of new

cases within a given
time period.
The number of people

who ever had a
disorder or the total
number of cases at a
given time.
The Case Study Method

Single-Subject Design
Studies of Genetic Influence
Classification and
Treatment Plans
The Client:
The person
seeking
psychological
services.
Prevalence of
Psychological
Disorders:
1 in 5 people
during 2007
The Clinician:
Mental health professional.
There are many types taking
many approaches.
Clinical Psychologists (PhD or PsyD)
Psychiatrists (MD)
An important distinction between psychiatrists and
psychologists is that psychiatrists are licensed to
administer medical treatment and prescribe medications,
and psychologists are not.
The
Diagnostic
and
Statistical
Manual
The DSM-IV
of Mental Disorders
published by the
American Psychiatric Association
The DSM-IV (the fourth edition) or DSM-IV-TR

(fourth edition, text revision) contains
descriptions of all psychological disorders,
alternatively referred to as mental disorders.
The
Diagnostic
and
Statistical
Manual
The DSM-IV
of Mental Disorders
Concerns in Developing the DSM-IV:
Reliability
Validity
Base Rates
Social Context
The
Diagnostic
and
Statistical
Manual
The DSM-IV
of Mental Disorders
1952
1968
1980
1987
DSM (a.k.a. DSM-I)

DSM-II (based on ICD)
DSM-III
(more quantitative, objective)
DSM-III-R
The
Diagnostic
and
Statistical
Manual
The DSM-IV
of Mental Disorders
1952
1968
1980
1987
1994
2000
DSM (a.k.a. DSM-I)

DSM-II (based on ICD)
DSM-III
(more quantitative, objective)
DSM-III-R
DSM-IV
DSM-IV-TR
Mental Disorder
Clinically significant
behavioral or
psychological
syndrome or pattern
Distress or disability
Significant risk
Not accepted, culturally sanctioned

response to a particular event
Assumptions of the DSM-IV
Classification system based on

medical model
Descriptive rather than
explanatory
Atheoretical orientation
Categorical approach
Multiaxial system
Neurosis
Term referring to behavior that involves
distressing, unacceptable symptoms that
are enduring and lack any physical
basis.
Not a modern diagnostic term.
Psychosis
Term referring to various forms of behavior
involving a loss of contact with reality,
such as delusions (false beliefs) and
hallucinations (false perceptions).
Although not a formal diagnostic category,
psychotic is retained in the DSM-IV-TR
as a descriptive term.
The Five Axes of the DSM-IV
Axis I: Clinical Disorders

Axis II: Personality Disorders and Mental
Retardation
Axis III: General Medical Conditions
Axis IV: Psychosocial and Environmental
Problems
Axis V: Global Assessment of Functioning
(helps assess prognosis)
Planning Treatment
Establish Treatment Goals
Immediate Goals
Short-Term Goals
Long-Term Goals
Planning Treatment
Determine Treatment Site
Psychiatric Hospitals
Outpatient Treatment
Halfway Houses and
Day Treatment Programs
Guidance Counselors
Employee Assistance Program
Treatment Modality
Individual Psychotherapy
Family Therapy
Group Therapy
Milieu Therapy
Evidence-based practice
Clinical decision-making that integrates the
best available research evidence and
clinical expertise in the context of the
clients . . .
cultural background
preferences
characteristics
Treatment Implementation
The Course of Treatment

The Clinicians Role
The Clients Role
The Outcome of Treatment
Assessment
What Is Psychological
Assessment?
Assessment:
A procedure in which a clinician evaluates
a person in terms of the psychological,
physical, and social factors that influence
the individual's functioning.
Interview
The unstructured interview involves
a series of open-ended questions.
Information sought through interviews:
Reasons for being in treatment
Symptoms
The structured interview
Health status
consists of a standardized
Family background
series of questions with
Life history
predetermined wording
and order.
Mental Status Examination

To assess:
Appearance and Behavior

Orientation
Content of Thought
Thinking Style and Language
Affect and Mood
Perceptual Experiences
Sense of Self
Motivation
Cognitive Functioning
Insight and Judgment
Appearance and Behavior

Examples of Abnormal Motor Behavior:
Hyperactivity
Psychomotor Agitation
Psychomotor Retardation
Catatonia
Compulsion
Content of Thought
Content of Thought:
Ideas that fill a persons head.
Examples of Abnormalities:
Obsessions
Delusions
Overvalued Ideas
Magical Thinking
Affect and Mood

Affect:
An individuals outward expression of emotion.
Inappropriate
Blunted or Flat
Exaggerated, Heightened, Overdramatic
Decreased Mobility
Excessive Mobility
Restricted Range
Affect and Mood

Mood:
An individuals personal experience of emotion.
Euthymic = Neither happy nor sad

Dysphoric = Unpleasant feelings
Euphoric = Cheerful, elated, possibly
even ecstatic
Perceptual Experiences
Hallucination:
False perceptions not corresponding to the
objective stimuli present in the environment.
Auditory
Command
Visual
Olfactory
Somatic
Gustatory
Orientation
Orientation is a persons awareness of:
Time
Place
Identity
Thinking Style & Language

Symptoms involving vocabulary use and style:
illogical thinking
incoherence
loosening of associations
neologisms
circumstantiality
blocking
tangentiality
clanging
confabulation
flight of ideas
echolalia
pressure of speech
perseveration

Motivation
Motivational impairment can make even ordinary
life tasks seem insurmountable.
Sense of Self
Disturbances of the individuals sense of who I
am include:
depersonalization
identity confusion

Cognitive Functioning:
Level of intelligence evidenced by details
such as memory and abstract ability.
Problems might include memory
impairment associated with Alzheimers.
Insight and Judgment:
Understanding and decision making.
Psychological Testing
What Makes a Good Psychological Test?
Validity
Reliability
Standardization
Intelligence Testing
Intelligence Quotient:
A method of quantifying performance
on an intelligence test.
Originally:
I.Q. =
Mental Age
Chronological Age
Intelligence Testing
First intelligence test by Binet.
Revised as the Stanford-Binet.
Wechsler scales now more widely used.
Wechsler introduced deviation IQ to
replace mental/chronological age ratio.
I.Q. =
Mental Age
Chronological Age
X 100
Personality and Diagnostic Testing

Self-Report Clinical Inventories
contain standardized questions with
fixed response categories that the
test-taker completes, selfreporting the extent to which the
responses characterize him or her.
MMPI and MMPI-2

NEO Personality Inventory
MCMI-III
Personality and Diagnostic

Testing
Projective Tests
Rorschach
TAT
Behavioral Assessment
Behavioral Assessment:
A form of measurement based on
objective recording of the
individual's behavior.
Behavioral Assessment
Behavioral Self-Reports
Behavioral Interviewing
Self-Monitoring
Target Behavior
Behavioral Checklists and

Inventories
Environmental Assessment
Environmental Assessment:
A form of measurement examining
the environment in which in the
individual lives.
Physiological Assessment
Many psychological disorders occur in
the presence of physiological
disturbances.
Disturbances may be:
localized in brain, perhaps as structural
abnormality or
physical disorders (e.g., diabetes, AIDS)
that may alter psychological functioning.
Psychophysiological
Assessment
Many clinicians and researchers assess changes
in the body associated with psychological or
emotional experiences, especially in:
cardiovascular
system
muscles
skin
brain
Neuropsychological
Assessment
Neuropsychological
assessment:
A process of
gathering information
about a client's brain
functioning on the
basis of performance
on psychological
tests.
Theoretical
Perspectives
an orientation to understanding the

causes of human behavior and the
treatment of abnormality.
The Purpose of Theoretical Perspectives in
Abnormal Psychology
Theoretical perspectives influence the ways in
which clinicians and researchers interpret and
organize their observations about behavior.
Copyright
The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
Psychodynamic Perspective
Freudian
Psychoanalytic
Theory
Sigmund Freud (1856-1939)
In Freudian theory, the ID is the instinctive,

inborn part of personality.
Personality Structure
Id
In Freudian theory, The EGO is the center of

conscious awareness.
Id
Ego
In Freudian theory, the SUPEREGO controls

the egos pursuit of the ids desires.
Id
Ego
Superego
Freud
Defense Mechanisms
Various tactics people use to keep
unacceptable thoughts, instincts, and
feelings out of conscious awareness.
Defense Mechanisms
High Adaptive Defenses:
Healthy responses to stressful
situations.
Humor
Self-assertion
Suppression
Defense Mechanisms
Tactics people use to protect themselves
from anxiety by keeping unacceptable
thoughts, instincts, and feelings out of
conscious awareness. Examples:
High defense mechanisms (e.g., humor)
Mental inhibitions (e.g., displacement)
Disavowal (e.g., denial)
Image distortions (e.g., splitting)
Psychodynamic Perspective
Psychosexual Stages
Oral
Anal
Phallic
Latency
Genital
Post-Freudians and Criticism

Carl Jung (1875-1961)
Alfred Adler (1870-1937)
Karen Horney (1885-1952)
Erik Erikson (1902-1994)
Humanistic Perspective
Person-Centered Theory
(Rogers)
(Rogers)
Self-Actualization Theory
(Maslow)
(Rogers)
Self-Actualization Theory
(Maslow)
Client-Centered Therapy
Sociocultural Perspective
Theorists within the sociocultural
perspective emphasize the ways that
individuals are influenced by people,
social institutions, and social forces.
Family Perspective
Proponents of the family perspective see
abnormality as caused by disturbances in
family interactions and relationships.
4 major
approaches:
Intergenerational approach
Structural approach
Strategic approach
Experiential approach
Social discrimination
Social influences & historical events
Treatment:
Family therapy
Group therapy
Multicultural approach
Milieu therapy
Behavioral Perspective
Classical Conditioning
Operant Conditioning (Skinner)
Social Learning & Cognition
Treatment
Counterconditioning
Systematic Desensitization
Contingency Management
Token Economy
Cognitively Based
Theory
Treatment focuses on
Automatic thoughts
Dysfunctional attitudes
Biological Perspective
Within the biological perspective,
disturbances in emotions, behavior, and
cognitive processes are viewed as being
caused by abnormalities in the functioning
of the body.
Neurotransmitter
a chemical substance released from a
transmitting neuron (nerve cell) across a
synapse to be absorbed by a receiving
neuron
Examples:
acetylcholine
GABA
serotonin
dopamine
norepinephrine
enkephalins
Genetic Influences
Deoxyribonucleic acid
(DNA):
23 sets of paired strands
spiral into double helix
contain information cells need to
manufacture protein
organized into chromosomes
Treatment:
Somatic Therapies
Psychosurgery
Electroconvulsive Therapy (ECT)
Medication
Biofeedback
Anxiety
Disorders
The Nature of Anxiety

Disorders
Fear is an innate alarm response to a
dangerous or life-threatening situation.
Anxiety is the state in which an
individual is inordinately apprehensive,
tense, and uneasy about the prospect of
something terrible happening.
People with anxiety disorders are
incapacitated by chronic and intense
feelings of anxiety.
Panic Disorder
Frequent and Recurrent Panic Attacks
Unexpected (Uncued) Attacks
Situationally Bound (Cued) Attack
Situationally Predisposed Attack
or
Constant Worry and Apprehension
About Possible Panic Attacks
Panic Disorder
Panic disorder is often
associated with agoraphobia.
Agoraphobia:
Intense anxiety about being trapped
or stranded in a situation without help
if a panic attack occurs.
Panic Disorder
Suggested explanations include:
Neurotransmitters
Anxiety Sensitivity
Conditioned Fear Reactions
Biological relatives of people

with panic disorder are 8
times more likely to develop
this condition.
Panic Disorder
Treatments
Benzodiazepines
Antidepressants
Serotonin Reuptake Inhibitors
Relaxation Training
Panic Control Therapy (PCT)
Specific Phobias
Specific Phobia:
An irrational and unabating fear of a
particular object, activity, or situation that
provokes an immediate anxiety response,
disrupts functioning, and results in
avoidance behavior.
Specific Phobias
Examples
Hematophobia
Blood
Ephidophobia
Snakes
Claustrophobia
Closed spaces
Acrophobia
Heights
Aerophobia
Flying
Death-related phobia
Funerals, corpses,
and cemeteries
Specific Phobias
Some Less Common Phobias
Ailurophobia
Cats
Chionophobia
Snow
Erythrophobia
The color red
Metallophobia
Metals
Ponophobia
Work
Triskaidekaphobia
The number 13
Specific Phobias
Treatments
Systematic Desensitization
Flooding
Imaginal Flooding
Graduated Exposure
Thought Stopping
Specific Phobias
Virtual reality software is sometimes used

to treat people with phobias such as
fear of heights or flying.
Social Phobia
A social phobia involves a fear in virtually
all social situations.
People with social phobia:

recognize their own fears as
unreasonable
show low self-esteem
underestimate their own abilities
ruminate about how they could have
acted differently in a social event.
Social Phobia
Treatments
In Vivo Exposure
Cognitive Restructuring
Social Skills Training
Sometimes Medication
Generalized Anxiety
Disorder
Generalized Anxiety Disorder:
An anxiety disorder characterized by
anxiety that is not associated with a
particular object, situation, or event,
but seems to be a constant feature of
a person's day-to-day existence.
Obsessive-Compulsive
Disorder
Obsessive-Compulsive Disorder:
An anxiety disorder characterized by
recurrent obsessions or compulsions that
are inordinately time-consuming or that
cause significant distress or impairment.
Disorder
Obsession:
A persistent and
intrusive idea, thought,
impulse, or image.
Compulsion:
A repetitive and seemingly purposeful
behavior performed in response to
uncontrollable urges or according to a
ritualistic or stereotyped set of rules.
Disorder
4 Major Dimensions
Obsessions associated with checking
compulsions.
Need for symmetry and order.
Obsessions about cleanliness
associated with washing compulsions.
Hoarding-related behaviors.
Disorder
OCD is increasingly
being understood
as a genetic disorder.
So far, treatment with clomipramine or
other serotonin reuptake inhibiting
medications, such a fluoxetine (Prozac), is
the most effective biological treatment
available for OCD.
TRAUMA
Trauma-Induced Disorders
Acute Stress Disorder:
An anxiety disorder that develops
during the month after a traumatic
event. Lasts 2-4 weeks.
Symptoms may include depersonalization,
numbing, dissociative amnesia, intense
anxiety, hypervigilance, and impairment
of everyday functioning.
Trauma-Induced Disorders
Post-Traumatic Stress Disorder:
More than a month after a traumatic
event, stress interferes with the
individuals ability to function.
Symptoms fall into two related clusters:
Intrusions and Avoidance

Hyperarousal and Numbing
Somatoform
Disorders,
Somatoform Disorders,
Psychological Factors
FactorsAffecting
Affecting
Psychological
Medical Conditions,
Conditions, and
and
Medical
Dissociative Disorders
Disorders
Dissociative
Somatoform
Disorders
SOMATOFORM DISORDERS
soma = body in Greek
A wide variety of conditions in which
psychological conflicts are translated into
physical problems or complaints.
Impair functioning, cause distress.
No physiological basis.
Wont be indicated on physical or
neurological tests.
CONVERSION DISORDER
Conversion disorder (hysteria) sufferer Bertha

Pappenheim, called Anna O. in Freuds writings.
CONVERSION DISORDER
A somatoform disorder
involving the translation of
unacceptable drives or troubling
conflicts into physical symptoms.
CONVERSION DISORDER
Four categories of symptoms:
Motor symptoms or deficits.

Sensory symptoms or deficits.
Seizures or convulsions.
Mixed presentations.
SOMATIZATION DISORDER
Somatization Disorder:
A somatoform disorder involving
the expression of psychological issues
through bodily problems that have no
basis in physiological function.
SOMATIZATION DISORDER
May be exaggerating a real

physical condition
Not deliberately faking
Mostly women sufferers
Most do not voluntarily seek
psychotherapy
PAIN DISORDER
In pain disorder, pain itself is the
predominant complaint not related
to a physical cause, whereas
conversion disorder patients rarely
complain of strong pain as part of
their primary affliction.
BODY DYSMORPHIC
DISORDER
BODY DYSMORPHIC
DISORDER
Body Dysmorphic Disorder:
Somatoform disorder in which
people are preoccupied, almost to the
point of being delusional, with the idea
that part of their body is ugly or
defective.
BODY DYSMORPHIC
DISORDER
Gender based concerns.

Men - Body build, genitals, hair.
Women - Weight, breast size or shape,
facial features, scars, aging.
The defects are imagined or grossly

exaggerated.
Obsessed with looking at it, thinking
about it, concealing it.
HYPOCHONDRIASIS
Hypochondriasis:
Somatoform
disorder that is
characterized by the
misinterpretation of
normal bodily
functions as signs of
serious illness.
HYPOCHONDRIASIS
Preoccupation with perceived abnormal
functioning
Distress that medical tests do not
confirm their fears
Many also suffer anxiety or depression
Unlike somatization or conversion
disorder, there is no abnormal bodily
function or medical symptoms
RELATED CONDITIONS
These conditions and behaviors also
involve a focus on the body, but are
not somatoform disorders because the
individuals know they are not really ill.
MALINGERING
FACTITIOUS DISORDER
MUNCHAUSENS SYNDROME
FACTITIOUS (or MUNCHAUSENS)
BY PROXY
THEORIES OF SOMATOFORM
DISORDERS
MOTIVATIONS FOR ILLNESS
Primary gain
Secondary gain
INTEGRATIVE EXPLANATION
TREATMENT OF
SOMATOFORM DISORDERS
Explore need to play the sick

role
Evaluate stress
Provide behavioral techniques
to control symptoms
Psychological
Factors
Affecting
Medical Conditions
THEORIES OF MIND-BODY
INTERACTION
STRESS
COPING STRATEGIES FOR STRESS
Problem-focused
Emotion-focused
PSYCHONEUROIMMUNOLOGY
EMOTIONAL EXPRESSION
PERSONALITY FACTORS
TREATMENT FOR
PSYCHOLOGICAL FACTORS
AFFECTING HEALTH
BEHAVIORAL MEDICINE
Take responsibility for health
Initiate and maintain healthy behaviors
Stop unhealthy behaviors
STRESS INOCULATION TRAINING
Cognitive focus and method

Guided self-dialogue
Coping self-statements
More adaptive lifestyle
Sleep Disorders
Dyssomnias:
Disturbances in the amount, quality, or timing of
sleep.
Primary Insomnia
Primary Hypersomnia
Circadian Rhythm Sleep Disorder
Breathing-Related Sleep Disorder
Sleep Disorders
Parasomnias:
Conditions involving abnormal behavior or bodily
events during sleep or sleep-wake transitions.
Nightmare Disorder
Sleep Terror Disorder
Sleepwalking Disorder
Narcolepsy
Dissociative
Disorders
DISSOCIATIVE IDENTITY
DISORDER
Dissociative identity disorder:
A dissociative disorder, formerly called
multiple personality disorder, in which
an individual develops more than one
self or personality.
DISORDER
Alters
Usually fewer than 10 identities
Host
Memory Gaps
The disorder is highly controversial.

THEORIES OF DISSOCIATIVE
IDENTITY DISORDER
Highly Traumatic
Childhood
Explanation
vs.
Sociocognitive
Model
TREATMENT OF
DISORDER
GOAL
Integrate alters
METHODS
Hypnotherapy
Cognitive Behavioral
Techniques
DISSOCIATIVE AMNESIA
Inability to remember details and

experiences associated with
traumatic or stressful event
Four forms:
Localized
Selective
Generalized
Continuous
DISSOCIATIVE FUGUE
formerly called psychogenic fugue
Dissociative fugue:
A dissociative disorder in which a
person, confused about personal
identity, suddenly and unexpectedly
travels to another place and is unable
to recall past history or identity.
DEPERSONALIZATION
DISORDER
Depersonalization:
An altered experience of the self, ranging from
feeling that one's body is not connected to one's
mind to the feeling that one is not real.
Sexual
Sexual
Disorders
Disorders
What is Abnormal
Sexual Behavior?
Sexual behavior is considered a
psychological disorder if it causes:
harm
to other people,
persistent or recurrent distress, or
impairment in important areas of
functioning.
Paraphilias
Paraphilias
para = abnormal; philia =
attraction
Paraphilias
Disorders in which an individual has

recurrent, intense sexually arousing
fantasies, sexual urges, or behaviors
involving
nonhuman objects,
children or other nonconsenting persons, or
the suffering or humiliation of self or partner.
Inability to experience sexual gratification

in the absence of the desired stimulus.
Lasting at least six months.
Pedophilia
Pedophilia:
A paraphilia in
which an adult's
sexual urges are
directed toward
children.
PEDOPHILIA
Types of molester
Situational molesters
Preference molesters
Child rapists
PEDOPHILIA
2/3 of all sexual assault victims are children &
adolescents
Among children age 12-17, 14-year-olds are
the most common victims
For children under 12, 4-year-olds are the
most commonly abused
Nearly 2/3 of victims are female
Vast majority of perpetrators are male
About 1/3 of offenders are relatives of the
victimized children
Types of sexual aggressor in

general
Physiological
Cognitive
Affective
Developmentally-related
THEORIES
EARLY LIFE EXPERIENCE

Sexually and emotionally abused as
children
Victim-to-abuser cycle
PERSONALITY TRAITS
Antisocial personality traits
Anger stemming from feelings of
inadequacy, introversion, cognitive rigidity
TREATMENT
BIOLOGICAL APPROACH
IN TREATMENT
Lowering testosterone.
Castration (rare).
Hypothalamotomy.
These may help curb sex drive, but

inappropriateness of the choice of partner must
also be addressed.
TREATMENT
BEHAVIORAL TREATMENT
Aversive therapy
Ridicule
COGNITIVE
Relapse prevention
GROUP THERAPY
Confront denial and rationalizations
Supportive context to discuss desires and
conflicts
Exhibitionism
Exhibitionism:
A paraphilia in which a person has intense sexual
urges and arousing fantasies involving the
exposure of genitals to a stranger.
Fetishism:
A paraphilia in which the individual is
preoccupied with an object and depends
on this object rather than sexual intimacy
with a partner for achieving sexual
gratification.
Behavior is not fetishistic when involving

an object specifically designed for sexual
excitation (e.g., vibrator).
Partialism:
A paraphilia in which the person is
interested solely in sexual gratification
from a specific body part, such as feet.
Some experts regard this as a kind of fetishism.
Frotteurism:
from French frotter (to rub)
A paraphilia in which the individual has intense

sexual urges and sexually arousing fantasies of
rubbing against or fondling an unsuspecting
stranger.
Sexual Masochism
Attraction to achieving
sexual gratification by
having painful
stimulation applied to
one's own body, either
alone or with a partner.
Sexual Sadism
Deriving sexual gratification
from activities that harm,
or from urges to harm,
another person.
The term sadomasochist refers to
someone who derives pleasure from
both inflicting and receiving pain.
Some Sadomasochistic
Activities
spanking
cutting
master-slave
shocking
bondage
asphyxiation
humiliation
restraint
pain infliction
whipping
verbal abuse
toilet-related activities
Transvestic fetishism:
A paraphilia in which a man has an
uncontrollable craving to dress in
Transvestic
Fetishism
women's clothing in order to derive
sexual gratification.
Homosexual men who make themselves up as
women are not transvestic fetishists because
they are not dressing this way to gain sexual
satisfaction.
Voyeurism:
from French voir (to see)
A paraphilia in which the individual has a

compulsion to derive sexual gratification from
observing the nudity or sexual activity of
others.
OTHER PARAPHILIAS
Telephone scatologia
Making obscene calls
Necrophilia
Zoophilia
Coprophilia
Klismaphilia
Urophilia
Autagonistophilia
Somnophilia
Stigmatophilia
Autonepiophilia
Corpses
Animals
Feces
Enemas
Urine
Sex in front of others
Sleeping people
Skin piercing or tattoo
Wearing diapers
Gender
Identity
Disorder
Gender identity:
The individual's self-perception as a
male or female
Gender identity disorder:
A condition in which there is a
discrepancy between an individual's
gender identity and assigned
(biological) sex.
GENDER IDENTITY
DISORDER
Strong and persistent (but not

delusional) belief that a person is the
wrong sex
Refusal to engage in culturally genderappropriate behaviors
Recurrent fantasies and cross-dressing
No sexual gratification from crossdressing
THEORIES OF GENDER
IDENTITY DISORDER
BIOLOGICAL
Abnormal fetal hormone levels
Vulnerability to high sensory arousal
Sensitive to parents emotional expressions
PSYCHOLOGICAL
Parental preferences for child of other sex

Parental unintentional reinforcement of
cross-gender behaviors
SOCIAL - Cultural idealization of
stereotypical male and female types
TREATMENT
PSYCHOTHERAPY
Very young child
Help develop self-esteem
Older child
Deal with cross-gender behavior and fantasy,
low self-esteem, peer rejection
Adults
Focus on the biopsychosocial causes, provide
support and coping strategies
Sexual
Dysfunctions
SEXUAL DYSFUNCTIONS
Abnormality in individual sexual
responsiveness
Individually defined
Usually related to other problems
Lifelong or acquired
Generalized or situational
Hypoactive Sexual Desire

Disorder
A sexual dysfunction in which the
individual has an abnormally low level of
interest in sexual activity.
Possible Causes:
Psychological difficulties
Poor body image or self-esteem
Interpersonal hostility
Relationship power struggles
Sexual Aversion Disorder

A sexual dysfunction characterized by an
active dislike and avoidance of genital
contact with a sexual partner.
4 Primary Causes:
1. Severely negatively parental sex attitudes
2. History of sexual trauma
3. Sexual pressuring by partner
4. Gender identity confusion
Sexual Arousal Disorders
Female Sexual
Arousal Disorder
Male Erectile
Disorder
Orgasmic Disorder
Female Orgasmic
Disorder
Male Orgasmic
Disorder
Premature Ejaculation
The man reaches orgasm long
before he wishes to, perhaps even
prior to penetration.
More commonly reported in young men,
perhaps associated with lack of maturation &
experience.
Sexual Pain Disorders

Dyspareunia
Involves recurrent or persistent
genital pain before, during, or
after intercourse.
Vaginismus
Involves recurrent or persistent
involuntary spasms of the
outer vaginal muscles.
THEORIES
Sexual dysfunctions may arise from
physical and/or psychological problems.
Neurological, cardiovascular disorders

Liver or kidney disease
Hormonal abnormalities
Problems with reproductive system
Substance-induced
TREATMENT
Treatment - Variety of physical, educative,
attitudinal, intrapsychic, and interpersonal
treatments
Treatment varies depending on the
cause, the specific problem, and
influencing factors.
TREATMENT
Masters & Johnson
recommend sensate
focus:
The partners take turns
stimulating each other in
nonsexual but affectionate
ways at first, then
gradually progress over a
period of time toward
genital stimulation.
Mood
Mood
Disorders
Disorders
Euphoric mood:
A feeling state that is more cheerful and
elated than average, possibly even
ecstatic.
Dysphoric mood:
Unpleasant feelings, such as sadness or
irritability.
Episode
A time-limited period during which specific
symptoms of a disorder are present.
The clinician will:
1. Rate severity: mild, moderate, or severe.
2. Note whether its the first episode or a
recurrence.
3. Specify nature of a prominent set of
symptoms (e.g., catatonic, postpartum).
Depressive
Disorders
MAJOR DEPRESSIVE
DISORDER
Depressed mood
Lethargic or agitated
Disturbed eating and/or sleeping
Duration: at least 2 weeks
Most cases run their course some time
after 6 months
Types of Depression
In episodes with melancholic features,
people lose interest or pleasure in most
daily activities.
Types of Depression
People with a seasonal pattern develop a
depressive episode at about the same
time each year, usually 2 months in fall
or winter.
Prevalence and Course

Out of every 100 people, about 13 men
and 21 women develop this disorder
at some point in life.
About 40% will never have a
second episode.
So 60% will have a second
major depressive episode.
Dysthymic Disorder
Have symptoms of major depression,
but not as deeply or as intensely.
Chronic: Have symptoms for at least 2
years, during which they are symptomfree for no more than 2 months.
Major Depressive
Disorder
5 or more
symptoms
including
sadness or loss
of interest or
pleasure
At least 2
weeks in
duration
Dysthymic
Disorder
3 or more
symptoms
including
depressed mood
At least 2 years in
duration
Disorders
Involving
Alterations in
Mood
BIPOLAR DISORDER
A mood disorder
involving manic
episodes and very
disruptive
experiences of
heightened mood,
possibly alternating
with major
depressive episodes.
BIPOLAR DISORDER
Suffer mania and sometimes
depression
Manic episode
Racing thoughts
Hyperactivitiy
Easily distracted
Grandiose sense of self
May hear voices
Highly energetic
BIPOLAR DISORDER
TYPES
Bipolar I disorder: One or more manic
episodes, and maybe depressive episodes
Bipolar II disorder: One or more major
depressive episodes and at least one
hypomanic (mildly manic) episode
Cyclothymic Disorder
Dramatic and recurrent mood shifts
Not as intense as bipolar
Chronic condition:
Lasts at least 2 years
May feel productive and creative but
others regard them as moody, irritable
Bipolar
Type I
Bipolar
Type II
Cyclothymic
Disorder
Manic episodes
and possibly
depressive
episodes
Hypomania
with major
depressive
episodes
Hypomania
with mild
depressive
episodes
Duration
varies
Duration
varies
At least
2 years
in
duration
Theories and
Treatment of
Mood Disorders
BIOLOGICAL
PERSPECTIVES
GENETICS
First-degree relatives of those with major
depression are twice as likely to develop
depressive disorders as are people in the
general population.
Heritability estimated at 31-42%.
BIOCHEMICAL FACTORS
Catecholamine hypothesis
Indolamine hypothesis
Monoamine depletion model
Stress hormone
PSYCHOLOGICAL
PERSPECTIVES
PSYCHODYNAMIC
Rejection or loss of parental love
Defensive mechanisms
BEHAVIORAL & COGNITIVE

Low response-contingent positive
reinforcement
Lack of social skills
Stressful life events
Suicide
SUICIDE
WHO COMMITS SUICIDE?
About 30,000 Americans a year
Women attempt suicide more often, but
male success rate is 4 times as high
More white suicides
More unmarried suicides
Suicide associated with certain DSM
disorders
WHY SUICIDE?
BIOLOGICAL
Family history
Abnormal neurochemical levels
Stress and immune system functioning
PSYCHOLOGICAL
Expression of hopelessness
Belief that stressor is insurmountable
Plea for interpersonal communication
SOCIOCULTURAL
Anomie
Suicide Risk Factors

Demographic or Social Factors
Young or elderly male

Native American or Caucasian
Single (especially if widowed)
Economic/occupational stress
Incarceration
Gambling history
Easy access to firearm

Clinical Factors
Major psychiatric illness

Personality disorder
Impulsive or violent traits
Current medical illness
Family history of suicide
Previous self-injurious acts or attempts
Anger, agitation, excessive preoccupation
Abuse of alcohol, drugs, heavy smoking
Easy access to toxins (including medicines)
Suicide plans, preparation, or note
Low ambivalence about dying vs. living

Factors Specific to Youth
Less racial difference

Recent marriage, unwanted pregnancy
Lack of family support
Abuse history
School problems
Social ostracism, humiliation
Conduct disorder
Homosexual orientation

Precipitating Factors
Recent stressors,
especially losses of
security in these
domains
Emotional
Social
Physical
Financial
ASSESSMENT OF
SUICIDALITY
ASSESS RISK FACTORS
Suicidal intent
Suicidal lethality
Talking about suicide
Giving away possessions
TREATING SUICIDALITY
PROVIDE SOCIAL
SUPPORT
THERAPY
Cognitive/behavioral
techniques
Suicide prevention
centers
Suicide hotlines
Chapter 1
Chapter 1
Schizophrenia
A disorder with a range of
psychotic symptoms involving
disturbances in content of
thought, form of thought,
perception, affect, sense of self,
motivation, behavior, and
interpersonal functioning.
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McGraw-Hill Companies,
Bleuler coined the term schizophrenia.

Bleuler
The four fundamental features are still
referred to as Bleulers Four As:
Association (thought disorder)
Affect (emotional disturbance)
Ambivalence (inability to make or follow
through on decisions)
Autism (idiosyncratic style of egocentric
thought and behavior)
Phases of Schizophrenia
Active
Prodroma
l
Residual
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Schizophrenic Symptoms
Disturbances can be seen in . . .
Perception
Hallucinations
Thoughts
Lack cohesiveness and logic
Language
Incomprehensibility
Actions
Odd and disturbing
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Schizophrenic Symptoms
delusions
hallucinations
disturbed speech
disturbed behavior
affective flattening
alogia
avolition
anhedonia
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Types of Schizophrenia
Characterized by at least two bodily

movement abnormalities:
Motor immobility or stupor
Purposeless motor activity
Mutism or extreme negation
Peculiarities of movement or odd
mannerisms and grimacing
Echolalia or echopraxia
Characterized by a combination of
symptoms, including disorganized
speech and behavior and flat or
inappropriate affect.
Even delusions and hallucinations
lack a coherent theme.
Characterized by preoccupation with

one or more bizarre delusions, or
with auditory hallucinations that are
related to a particular theme of
being persecuted or harassed.
Without disorganized speech or
disturbed behavior.
Characterized by a complex of schizophrenic

symptoms that does not meet the criteria for
other types of schizophrenia.
Applies to people previously

diagnosed as
schizophrenic if they no
longer show prominent
psychotic symptoms but
still show lingering signs of
the disorder.
Factors Associated With

More Favorable Prognosis
Good premorbid functioning

Acute onset
Later age at onset
Good insight
Being female
Consistent in medication usage
Brief active-phase symptoms
Good functioning between episodes
Absence of structural brain abnormalities
Normal neurological functioning
No family history of schizophrenia
Other
Psychotic
Disorders
Brief Psychotic Disorder

with marked stressor(s),
without marked stressor(s), or
with postpartum onset
A disorder characterized by the
sudden onset of psychotic
symptoms that are limited to a
period of less than a month.
Schizophreniform Disorder
A disorder with essentially the same

symptoms as schizophrenia, but that lasts
less than 6 months (and more than 1).
Schizoaffective Disorder
Schizophrenia with co-occurring

mood disorder.
Delusional Disorders
People with delusional disorders have a
single striking psychotic symptom: an
organized system of nonbizarre false
beliefs.
Delusional Disorders
People with delusional disorders have a
single striking psychotic symptom: an
organized system of nonbizarre false
beliefs.
Erotomanic
Somatic
Persecutory
Grandiose
Jealous
Shared Psychotic Disorder

In shared psychotic disorder, the person
develops a delusional system as a result
of a close relationship with a psychotic
person who is delusional.
Intervention calls for:
Separating them.
Focusing on personal issues related to this
persons vulnerability to being dominated.
Bolstering the clients self-esteem.
Biological Theories
Brain Structure and Function
Cortical atrophy
Reduced brain activation
Dopamine hypothesis
Possible serotonin deficit
Lines of Evidence for Dopamine

Hypothesis
Antipsychotic medications
Effects of drugs like amphetamines
Psychological Perspective
No credible theory proposes that
schizophrenia develops exclusively as
the result of psychological phenomena.
However, behavioral psychologists have
found factors influencing whether the
likelihood the schizophrenic individual will
act in a normal way or not.
Failure to learn important social cues.

Lack of attention from others.
Retreat into fantasy world.
Behaviors become odd and eccentric.
Being labeled as odd or schizophrenic.
Hospitalization exacerbates maladaptive behaviors.
Focus on the Family System

Faulty modes of behavior and
communication
High degree of expressed emotion
Cognitive distortions
Social Class and Income

Onset may be associated with
environmental stressors of poverty.
Contracting the disease leads to social and
economic downward drift.
Biological Treatment
Neuroleptics
Vary in potency
All block dopamine receptors
Side effects:
Tardive dyskinesia
Compromise of immune system
Psychosocial Treatment
Psychological
Token economy
Social skills training
Cognitive behavioral techniques
Sociocultural
Milieu therapy
Family therapy
Biopsychosocial Approach
Personality
Personality
Disorders
Disorders
Personality trait
An enduring pattern
of perceiving,
relating to, and
thinking about the
environment and
others.
Personality disorders
Ingrained patterns of
relating to other
people, situations,
and events with a
rigid and
maladaptive pattern
of inner experience
and behavior, dating
back to adolescence
or early adulthood.
ANTISOCIAL PERSONALITY
DISORDER
DSM-IV Personality Disorder

Clusters
The DSM-IV includes a set of
separate diagnoses grouped into
three clusters based on shared
characteristics:
CLUSTER A The Eccentric Ones

CLUSTER B The Dramatic Ones
CLUSTER C The Anxious Ones
Because Cluster B disorders have been the most

extensively researched, well start with them.
The Dramatic Ones

Antisocial Personality Disorder
Borderline Personality Disorder

Histrionic Personality Disorder
Narcissistic Personality Disorder
DISORDER
A personality disorder characterized by a

lack of regard for society's moral or
legal standards.
DISORDER
ANTISOCIAL
History
Philippe Pinel (1801)
- Defect of moral character
Hervey Cleckley (1941)
- Psychopathy
Robert Hare (1997)
- Psychopathy Check List
DSM
Goes beyond psychopathy traits
ANTISOCIAL
Associated Behaviors
Deceitfulness
Impulsivity
Unlawfulness
Recklessness
Aggressiveness
Manipulativeness
Lack of remorse
Important Distinctions
Adult Antisocial Behavior

Illegal or immoral behavior
such as stealing, lying, or
cheating
Criminal
A legal term, not a
psychological concept.
Perspectives on
Antisocial Personality
BIOLOGICAL
Various brain
abnormalities
Diminished
autonomic response
to social stressors
Possible genetic
causes
Perspectives on
PSYCHOLOGICAL
Neurological deficits related to

psychopathic symptoms
Response modulation hypothesis
Unable to process information not
relevant to their primary goals
Low self-esteem
Perspectives on
SOCIOCULTURAL
Family variables
Childhood abuse
Childhood neglect
TREATMENT OF ANTISOCIAL
PERSONALITY DISORDER
Address low selfesteem

Confrontational
techniques
Group therapy
BORDERLINE PERSONALITY DISORDER
A personality disorder characterized

by pervasive instability with a
pattern of poor impulse control.
Instability is evident in mood, interpersonal
relationships, and self-image.
Often sufferers are confused about their
own identity or concept of who they are.
BORDERLINE
Observed characteristics:
Intense interpersonal relationships

Splitting
Feelings of emptiness
Anger, rage
Identity confusion
Shifting goals, plans, partners
Poor boundaries with others
Risk taking, self injurious behaviors
Parasuicidal
PERSPECTIVES ON BORDERLINE
PERSONALITY
BIOPSYCHOSOCIAL
Vulnerable temperament
Traumatic early childhood experiences
Triggering events in adulthood
BIOLOGICAL
Hippocampus smaller
Amygdala smaller
PERSONALITY
PSYCHOLOGICAL
Physical or sexual abuse
Childhood caregiver interaction
Emotionally unavailable
Inconsistent treatment
Failed to validate their thoughts and
feelings
Failed to protect from abuse
Anxious attachment style with mother
PERSONALITY
PSYCHODYNAMIC
Poor ego development
Caregiver overinvolved
yet inconsistent
Distorted perception of
others
PERSONALITY
COGNITIVE-BEHAVIORAL
Splitting
Low sense of selfefficacy
Lack of confidence
Low motivation
Inability to seek
long-term goals
Modern pressures
on family
Diminished social
cohesion and mental
cohesion
Unstable family
patterns
TREATMENT OF BORDERLINE
PERSONALITY
CHALLENGING AND COMPLEX

Unlikely to remain in treatment long
Unstable relationships with therapist
TECHNIQUES
Confrontive or
Supportive
Dialectical Behavioral Therapy
May need medication
HISTRIONIC
PERSONALITY
DISORDER
A personality disorder
characterized by
exaggerated
emotional reactions,
approaching
theatricality, in
everyday behavior.
Melodramatic.
The term
histrionic is
derived from
a Latin word
meaning
actor.
HISTRIONIC
Dramatic, attention-getting behavior
Fleeting, shifting emotional states
More commonly diagnosed in women
Flirtatious and seductive
Need for immediate gratification
Easily influenced by others
Lack analytical ability
Superficial relationships
VIEWS AND TREATMENT OF

HISTRIONIC PERSONALITY
Feelings of inadequacy and need for others
Global nature of thinking underlies diffuse,
exaggerated and changing emotional states
TREATMENT GOALS
Learn how to think more objectively and
precisely
Learn self-monitoring strategies
Learn impulse control
Acquire assertiveness skills
NARCISSISTIC
PERSONALITY
DISORDER
Personality disorder characterized by an

unrealistic, inflated sense of selfimportance and lack of sensitivity to other
peoples needs:
egotistical
arrogant
exploitative of others
Named for Greek legend of Narcissus.
NARCISSISTIC SUBTYPES
Noting the many types of behaviors
involved, Millon and colleagues proposed
subtypes:
elitist
amorous
unprincipled
compensatory
THEORIES OF NARCISSISTIC
PERSONALITY
Freudian
Stuck in early
psychosexual stages
CognitiveBehavioral
Lack insight into or
concern for feelings
of others
Grandiose sense of
self clashes with real
world failures
TREATMENT OF NARCISSISTIC
PERSONALITY
PSYCHODYNAMIC and COGNITIVEBEHAVIORAL therapies overlap in their
goals for the client:
Reduce grandiose thinking.

Develop more realistic view of self.
Develop more realistic view of others.
Enhance ability to relate to others
Avoid demands for special attention
The Eccentric Ones

Paranoid Personality
Schizoid Personality
Schizotypal Personality
PARANOID PERSONALITY
DISORDER
SUSPICIOUSNESS
GUARDEDNESS
PROJECTION OF NEGATIVITY AND
DAMAGING MOTIVES ONTO OTHERS
ATTRIBUTION OF THEIR PROBLEMS
TO OTHERS
LOW SELF-EFFICACY
TREATMENT OF PARANOID
PERSONALITY
COGNITIVE BEHAVIORAL
COUNTER ERRONEOUS THINKING

ESTABLISH TRUSTING RELATIONSHIP
INCREASE FEELINGS OF SELF-EFFICACY
REDUCE VIGILANT AND DEFENSIVE STANCE
INSIGHT INTO OTHERS PERSPECTIVES
APPROACH CONFLICT ASSERTIVELY
IMPROVE INTERPERSONAL SKILLS
SCHIZOID
PERSONALITY
DISORDER
Main characteristic: Indifference to social
relationships, as well as a very limited
range of emotional experience and
expression.
SCHIZOID
INDIFFERENCE TO SOCIAL AND SEXUAL

RELATIONSHIPS
SECLUSIVE; PREFER TO BE ALONE
NO DESIRE TO LOVE OR BE LOVED
COLD, RESERVED, WITHDRAWN
INSENSITIVE TO FEELINGS OF OTHERS
TREATMENT:
Unlikely to seek or respond to therapy.
SCHIZOTYPAL
PERSONALITY
DISORDER
Main characteristic:
Peculiarities and
eccentricities of
thought,
behavior,
appearance, and
interpersonal
style.
SCHIZOTYPAL
PERSONALITY
DISORDER
CONSTRICTED, INAPPROPRIATE
AFFECT
IDEAS OF REFERENCE, MAGICAL
THINKING
SOCIAL ISOLATION
PECULIAR COMMUNICATION
TREATMENT: Parallels interventions

commonly used in treating schizophrenia.
The Anxious Ones

Avoidant Personality
Dependent Personality
AVOIDANT PERSONALITY DISORDER
Most prominent feature:

The individual desires, but is fearful of,
any involvement with other people and is
terrified at the prospect of being publicly
embarrassed.
AVOIDANT - THEORIES
Hypersensitive due to parental criticism

Feel unworthy of others regard
Expect not to be liked
Avoid getting close to avoid expected
rejection
Distorted perceptions of experiences with
others
TREATMENT OF AVOIDANT
PERSONALITY
BREAK NEGATIVE CYCLE OF
AVOIDANCE
CONFRONT AND CORRECT
DYSFUNCTIONAL ATTITUDES AND
THOUGHTS
GRADUATED EXPOSURE TO SOCIAL
SITUATIONS
LEARN SKILLS TO IMPROVE CHANCE
OF INTIMACY
DEPENDENT PERSONALITY
DISORDER
Main characteristic: This individual is

extremely passive and tends to cling to
other people to the point of being unable
to make any decisions or to take
independent action.
Others may characterize them as clingy.
DEPENDENT
Fear of abandonment
Despondent without others
Unable to initiate activities
Insecure about making decisions without
others
Go to extreme to get approval from
others
Devastated when relationships end
DEPENDENT - THEORIES
Theories
PSYCHODYNAMIC
Fixated at oral psychosexual stage because of
parental overindulgence or neglect
OBJECT RELATIONS
Insecure attachment to parents led to fear of
abandonment
Low self-esteem leads them to rely on others
Thinking they are inadequate and helpless,
they find someone to take care of them
TREATMENT OF DEPENDENT
PERSONALITY
Therapist and client develop structured
ways to increase client independence
in daily activities
Identify skill deficits and improve
functioning
Therapist must avoid becoming an
authority figure or making client
dependent on therapist
Main characteristic: Perfectionistic

So overwhelmed with their concern for
neatness and minor details that they
have trouble making decisions or getting
things accomplished.
OBSESSIVE-COMPULSIVE
RIGID BEHAVIORAL PATTERNS
FANATICAL CONCERN WITH
SCHEDULES
STINGY WITH TIME AND MONEY
TENDENCY TO HOARD WORTHLESS
OBJECTS
LOW LEVEL OF EMOTIONALITY
THEORIES OF
OBSESSIVE-COMPULSIVE
FREUDIAN
Fixation at anal psychosexual stage
OBJECT RELATIONS
Insecure parent-child attachments
Distorted world view
Unrealistic standard of perfection
TREATMENT: Difficult to treat. Therapy may

reinforce ruminative tendencies.
And in conclusion . . . ?
Personality disorders are
Chronic and persistent
Hard to explain
Difficult to treat
Subject to much further study
Development-Related
Development-Related
Disorders
Disorders
DEVELOPMENT-RELATED
DISORDERS first appear at
birth or during youth.
MENTAL RETARDATION is
characterized by significantly below
average intellectual functioning,
indicated by an IQ of 70 or below.
LEVELS OF MENTAL
RETARDATION
MILD
IQ = 50/55 to 70
MODERATE
IQ = 35/40 to 50/55
SEVERE
IQ = 20/25 to 35/40
PROFOUND
IQ below 20/25
Mental retardation may result from

an inherited condition or from an
event or illness at any point from
conception through adolescence.
Inherited Causes
PKU
Tay-Sachs Disease
Fragile X Syndrome
Down Syndrome
Mental retardation may result from

an inherited condition or from an
event or illness at any point from
conception through adolescence.
Environmental Causes
Prenatal disease
Difficult delivery
Premature birth
Prenatal substance abuse
Failure to thrive
PERVASIVE DEVELOPMENTAL
DISORDERS are characterized by severe
impairment in several areas (e.g., social,
communication) or by extremely odd
behavior, interests, and activities.
Retts disorder
Childhood disintegrative disorder
Aspergers disorder
The most common of these disorders

is AUTISTIC DISORDER.
Apparent before age 3, usually in infancy.
Clinicians assign the diagnosis based on
symptoms that fall in three groups:
1. Impaired social interaction.
2. Impaired communication.
3. Oddities of behavior, interests, and/or
activities.
AUTISTIC SAVANT SYNDROME

In an unusual variant of autism, the
individual possesses an extraordinary
skill, such as:
Ability to perform extremely complicated
numerical operations.
Exceptional musical talents.
Ability to solve extremely challenging
puzzles.
THEORIES OF AUTISM
Evidence supports the theory of
BIOLOGICAL causation:
Patterns of family inheritance.

Concordance among identical twins.
Chromosomal abnormalities.
Structural brain abnormalities.
Functional brain abnormalities.
Although prognosis for autistic disorder

can appear bleak, MEDICATION and
BEHAVIORAL treatments can change
the behavior of these children.
BEHAVIORAL:
Train child to communicate needs

more effectively.
Improve parental response.
Teach caregivers not to reward
negative behaviors.
Although prognosis for autistic disorder

can appear bleak, MEDICATION and
BEHAVIORAL treatments can change
the behavior of these children.
BEHAVIORAL:
Help develop new learning and

problem-solving skills.
Teach self-control through
self-monitoring.
Aversive conditioning.
Learning,
Communication, and
Motor Skills Disorders
Learning
Disorder
Delay or deficit in academic skill
evidenced by difference in ability
and achievement on standardized
tests, substantially below what
would be expected for others of
comparable age, education, and
level of intelligence.
Reading Disorder
(Dyslexia)
Mathematics Disorder
(Dyscalculia)
Disorder of Written Expression

(Dysgraphia)
Attention Deficit and

Disruptive Behavior
Disorders
ATTENTION DEFICIT HYPERACTIVITY

DISORDER
A behavior disorder of child involving
problems with inattentiveness and
hyperactivity-impulsivity.
Inattentiveness
carelessness
forgetfulness in daily activities
commonly lose belongings
easily distracted
cannot follow through on instructions
difficulty organizing tasks

DISORDER
The hyperactive-impulsive component is
further divided into subtypes of
hyperactivity and impulsivity.
Hyperactivity
fidgeting
restlessness
running about inappropriately
difficulty in playing quietly
talking excessively

DISORDER
The hyperactive-impulsive component is
further divided into subtypes of
hyperactivity and impulsivity.
Impulsivity
blurting out answers
inability to wait their turn
interrupting or intruding on others
ADHD THEORIES
Abnormal brain development and
cognitive functioning arising from
genetic causes, birth complications,
acquired brain damage, exposure to
toxic substances, infectious diseases.
Biological abnormalities affect ability to
inhibit and control behavior as well as
memory, self-directed speech, and
regulation of mood.
Social Influence: Dysfunctional family
environment and school failure.
ADHD TREATMENT
MEDICATION
Stimulants (e.g., Ritalin)
Antidepressants
COGNITIVE-BEHAVIORAL THERAPY
Teach self-control, self-motivation, and selfmonitoring using reinforcement
Coordinate efforts with family and teachers
Behavioral interventions must begin early
CONDUCT DISORDER
The childhood precursor of antisocial
personality disorder in adulthood.
Involves repeated violations of the rights of

others and society's norms and laws.
CONDUCT DISORDER
Delinquent behaviors include:
lying
stealing
truancy
running away from home,
physical cruelty to people & animals
setting fires
using drugs and alcohol
OPPOSITIONAL DEFIANT
DISORDER
A disruptive behavior disorder
characterized by undue hostility,
stubbornness, strong temper,
belligerence, spitefulness, and
self-righteousness.
A combination of approaches
appears to be the most useful
strategy in working with youths
with disruptive behavior
disorders:
Behavioral
Cognitive
Social
learning
Separation Anxiety
Disorder
Children may have intense and inappropriate
anxiety concerning separation from home or
caregivers:
upset and often physically ill when facing a normal

separation such as parent leaving home for work
may refuse to sleep overnight at friends house
panicky, miserable, homesick, withdrawn, sad when
without the attachment figure
demanding, intrusive, feel need for constant attention
Other Disorders
Originating in
Childhood
CHILDHOOD EATING DISORDERS

Pica
Feeding
Disorder of
Infancy or Early
Childhood
Rumination Disorder
TIC DISORDERS
MOTOR TICS
examples:
eye blinking
facial twitches
shoulder shrugging
TIC DISORDERS
VERBAL TICS
examples:
grunting
coprolalia
tongue clicking
TIC DISORDERS
TOURETTES DISORDER
A combination of chronic movement and
vocal tics more commonly reported in
males.
Usually a lifelong condition
Onset usually in childhood or
adolescence
ELIMINATION DISORDERS
ENCOPRESIS
ENURESIS
repeated
incontinence of
bowel
movements
at least age 4
repeated
incontinence of
bladder
at least twice
weekly for 3
months
age 5 or older
REACTIVE ATTACHMENT
DISORDER OF INFANCY
OR CHILDHOOD
severe disturbance in ability to relate
to others
do not initiate social interactions
do not respond when appropriate
may be extremely inhibited & avoidant
show inappropriate familiarity with
strangers
People with STEREOTYPIC

MOVEMENT DISORDER engage in
repetitive, seemingly driven
behaviors such as:
waving
body rocking
head-banging
self-biting
picking at their bodies
SELECTIVE MUTISM
The individual consciously
refuses to talk, usually when
there is an expectation for
interaction.
for at least one month
interferes with normal functioning
Aging-Related
Aging-Related
and Cognitive
and
Cognitive
Disorders
Disorders
NATURE OF COGNITIVE
DISORDERS
Impairment of thought, memory, attention
(cognitive impairment) arising from brain
trauma, disease, or exposure to toxic
substances.
DSM-IV diagnoses include:
Delirium
Dementia
Amnesia
Delirium
A temporary state in which individuals

experience a clouding of consciousness, they
are unaware of what is happening around
them and are unable to focus or pay attention.
In a state of delirium, people

experience cognitive changes in which
their memory is foggy and they are
disoriented.
Delirium
delirium
Caused by a change in brain
metabolism due to factors such as:
substance intoxication
substance withdrawal
head injury
high fever
vitamin deficiency
Amnestic Disorder
Cognitive disorders involving inability to
(a)recall previously learned information or
(b)register new memories.
This inability can be very disturbing,
because the individual loses a sense of
personal identity.
Categories of
Amnestic Disorder
Amnestic
disorders due
to medical
conditions.
chronic
transient
Substanceinduced
persisting
amnestic
disorders.
Substances That Induce

Amnestic Disorder
Medications
The most common
cause:
Illicit drugs
Industrial solvents Chronic alcohol
use
Mercury
Lead
Insecticides
Dementia
Generalized progressive deficits in
memory, learning, communication,
judgment, and motor coordination.
The first sign of dementia is memory

loss.
Dementia: Other Prominent

Symptoms
Aphasia
Wernickes
Brocas
Apraxia
Agnosia
Dementia: Other Prominent

Symptoms
Disturbance in Executive Functioning
Executive functioning: Cognitive
abilities such as abstract thinking,
planning, organizing, and carrying out of
behaviors.
Relatively simple everyday tasks may be
forgotten or confused.
ALZHEIMERS DEMENTIA
Stages
Forgetfulness
Early confusional
Late confusional
Early dementia
Middle dementia
Late dementia
ALZHEIMERS DEMENTIA
BIOLOGICAL FEATURES
Neurofibrillary tangles
Amyloid plaques
Deficits in neurotransmitter acetylcholine
40 to 50 percent twin concordance rate
ENVIRONMENTAL factors must play a role;

otherwise, concordance would be higher, but
specific factors are not yet confirmed.
Parkinsons Disease
Involves neuronal degeneration of
subcortical structures controlling
movements.
Dementia occurs in up to 60% of
Parkinsons patients.
Parkinsons Disease
Symptoms
Hands, ankles, or head may shake involuntarily.

Bradykinesia: General slowing of motor activity.
Akinesia: Muscular rigidity, difficulty initiating
movement.
Loss of fine motor coordination.
Slowed, shuffling gait.
Difficulty starting or stopping movement like
walking.
Expressionless appearance.
Loss of normal rhythmic speech quality.
Pseudodementia
Pseudodementia:
False dementia, symptoms
caused by depression that
mimic those apparent in early
stages of Alzheimer's.
ALZHEIMERS TREATMENT
MEDICATION
Slow breakdown of acetylcholine.
Antioxidants target free radicals that
may damage neurons.
BEHAVIORAL MANAGEMENT
Target both patient and caregiver
to:
Increase patient independence.
Eliminate wandering and
aggression.
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Chapter 1
SubstanceInduced
SubstanceDisorders
Induced
Disorders
More than half (51%) of all

Americans have used
nonprescription or illegal drugs
for nonmedical purposes.
Over one quarter have abused or been

dependent on drugs during their lifetime.
Key Terms
SUBSTANCE INTOXICATION Temporary
behavioral or psychological changes due to
substance accumulation.
TOLERANCE After repeated use of a
substance, state in which the individual would
have to increase amount used to achieve the
same effects.
SUBSTANCE WITHDRAWAL Set of
physical and psychological disturbances
experienced when substance is discontinued.
Substance Use Disorders

SUBSTANCE
ABUSE Maladaptive substance use that

leads to significant impairment or
distress.
SUBSTANCE
DEPENDENCE -
Addiction.
Alcohol
Effects
Alcohol Use
AlcoholofEffects
Immediate Effects
Sedating
Central Nervous System
Depressant
Potentially Fatal in Excess
Alcohol Effects
Immediate Effects
Sedating
Central Nervous System
Depressant
Potentially Fatal in Excess
POTENTIATION compounds
these effects.
Effects
Alcohol Use
AlcoholofEffects
Long-Term Effects
Tolerance
Heavy drinkers tend to

increase intake, thereby
increasing likelihood of
bodily damage.
Effects
Alcohol Use
AlcoholofEffects
Long-Term Effects
Tolerance
Dementia
Wernickes or Korsakoffs
Liver damage
Zinc deficiency
The list goes on and on . . . .
THEORIES OF ALCOHOL
TheoriesDEPENDENCE
of Alcohol Dependence
BIOLOGICAL
Runs in families
Genetic markers and genetic mapping
PSYCHOLOGICAL
Expectancy model
Abstinence violation effect
SOCIOCULTURAL
Family, community, & cultural stressors
Children of alcoholics at greater risk
TREATMENT FOR
Alcohol
Treatment
ALCOHOL
DEPENDENCE
BIOLOGICAL
Medications to control withdrawal symptoms.
Medications as aversive agents.
PSYCHOLOGICAL
Cue exposure method.
Relapse prevention therapy.
ALCOHOLICS ANONYMOUS
12-step program treating alcoholism as
disease.
Spiritually based, providing social support.
Substances
Other Than
Alcohol
Stimulants
Stimulant
Amphetamines &
Methamphetatmines
Cocaine
Caffeine
Cannabis
Cannabis
Marijuana
THC
Hashish
Hallucinogens
Hallucinogens
LSD
Psilocybin
PCP
Opioids
Opioids
Natural Opioids:
Opium
Morphine
Heroin
Synthetic Opioids
Methadone
Codeine
S
e
d
a
v
e
s
H
y
p
n
o
c
s
a
n
d
A
n
x
c
s
Sedatives, Hypnotics, &

Anxiolytics
SEDATIVES have calming effects
on the central nervous system.
HYPNOTICS have sleep-inducing
qualities.
ANXIOLYTICS are antianxiety
medications.
TREATMENT
Treatment
BIOLOGICAL
Substances to block or reduce craving.
BEHAVIORAL
Contingency management.
COGNITIVE
Help modify thoughts, expectancies,
behaviors concerning drugs.
Eating
Eating
Disorders
&
Disorders &
ImpulseImpulseControl
Control
Disorders
Disorders
Eating
Disorders
Anorexia and Bulimia

Anorexia nervosa:
Eating disorder
characterized by
an inability to
maintain normal
weight, an intense
fear of gaining
weight, and
distorted body
perception.
Bulimia nervosa:
Eating disorder
involving alternation
between eating
large amounts of
food in a short time,
then compensating
by vomiting or other
extreme actions to
avoid weight gain.
Anorexia and Bulimia

Anorexia nervosa:
Eating disorder
characterized by
an inability to
maintain normal
weight, an intense
fear of gaining
weight, and
distorted body
perception.
Anorexia Nervosa
1. Refuse/unable to maintain 85% of
expected weight for frame, height.
2. Intense fear of gaining weight,
though underweight.
3. Distorted perception of weight
or body shape.
4. Amenhorrhea.
Bulimia Nervosa
People with bulimia
nervosa alternate
between eating large
amounts of food in a
short time, then
compensating for the
added calories by
vomiting or other
extreme actions.
Bulimia Nervosa
BINGES:
Episodes of eating large amounts of food,
characterized by:
1. in a 2-hour period, eating an amount
much greater than others would eat;
2. feeling a lack of control over what or how
much is being eaten.
Bulimia Nervosa
COMPENSATING BEHAVIORS
PURGING TYPE try to force out of their
bodies what theyve just eaten by
vomiting
administering enemas
taking laxatives or diuretics
NONPURGING TYPE try to compensate

by fasting or overexercising.
THEORIES OF EATING
DISORDERS
BIOLOGICAL
- Altered dopamine and

serotonin neurotransmitter systems.
PSYCHOLOGICAL - Turn to food to
escape inner turmoil and pain; from
cognitive standpoint, over time get
trapped in eating patterns.
SOCIOCULTURAL - Dysfunctional
family functioning and societal
obsession with food.
TREATMENT OF EATING
DISORDERS
COMBINATION OF APPROACHES
MEDICATION
PSYCHOTHERAPY
Cognitive/Behavioral
Interpersonal Therapy
Family Therapy
TREATMENT OF EATING
DISORDERS
Therapists have found multifamily
therapy to be particularly effective.
Several families participate in group
sessions together.
ImpulseControl
Disorders
IMPULSE-CONTROL DISORDERS
These disorders involve disturbances in
the ability to regulate specific impulses
not attributable to other DSM-IV-TR
diagnoses.
Kleptomania
An impulse-control disorder that

involves the persistent urge to steal.
The act of stealing excites sufferers. The
object stolen is not particularly desired.
Stealing releases tension, although the
urge feels unpleasant, senseless.
Kleptomania
The lack of interest in

the stolen item is
the main feature
that differentiates a
kleptomaniac from a
typical shoplifter or
burglar.
Pathological
Gambling
An impulse-control disorder involving

the persistent urge to gamble.
Pathological
Gambling
Pyro
mania
Urge to prepare,
set, and watch
fires for fun
(unlike arsonists
motivated by
greed or
revenge).
An impulse-control disorder involving the
persistent and compelling urge to start fires.
Sex
ual
Imp
ulsiv
ity
Although this is not an official DSM-IVTR diagnosis, symptoms of sexually

impulsive people are similar to those
of impulse-control disorders.
Clinicians have seen growing numbers
of clients looking for help to contain
uncontrollable sexuality.
SEXUAL IMPULSIVITY
Driven to engage in frequent,

indiscriminate sex.
Often feel bad after they engage in sex.
May extend into violent deviance, like
rape, rape/murders, serial killing.
Usually also have substance abuse
disorder and depression; some may
have dissociative symptoms.
Trichotill
omania
The compulsion to pull out ones hair.
Trichotill
omania
The compulsion to pull out ones hair.
Co-occurring disorders - depression, anxiety

disorder, substance abuse, eating disorder
Biological base - Related to OCD
(abnormalities in basal ganglia, motor
control area)
Behavioral base - Rooted in environmental
cues, done to relieve tension
Sociocultural The result of feeling
abandoned, neglected, emotionally
overburdened
INTERMITTENT
EXPLOSIVE
DISORDER
An impulse-control disorder involving an

inability to hold back urges to express
strong angry feelings and associated
violent behaviors.
Over 90% have co-occurring mood
disorder.
Other co-occurring disorders include
substance problems and anxiety.
Internet Addiction
An impulse control condition in
which an individual feels
irresistible need for Internetbased activities.
Although not included in the
DSM-IV-TR, Internet addiction
shares characteristics of
impulse-control disorders.
Cyber-disorders
An informal diagnostic term for clients
whose primary clinical problem involves
the Internet.
Cyber-disorders
An informal diagnostic term for clients
whose primary clinical problem involves
the Internet.
Subtypes:
cyber-sexual addiction
cyber-relation addiction
net compulsions
(e.g., online gambling, shopping, trading)
information overload
compulsive online game playing
Ethical and
and
Ethical
Legal
Legal
Issues
Issues
Ethical Issues
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ROLES and RESPONSIBILITIES

OF CLINICIANS
Therapist Competence
Informed Consent
Confidentiality
Privileged Communication
EXCEPTIONS TO PRIVILEGED
COMMUNICATION
Mandated Reporting
Duty to Warn
RELATIONSHIPS WITH
CLIENTS
The therapist must
keep therapeutic
boundaries. Most
ethical codes forbid
romantic and sexual
involvement.
SPECIAL ROLES FOR

CLINICIANS
EXPERT WITNESS
EVALUATION IN CHILD PROTECTION
CASES
GUARDIAN AD LITEM
EVALUATIONS OF PEOPLE WITH
COGNITIVE DISORDERS
ALL HAVE INHERENT ETHICAL DILEMMAS: SOMEONE
OTHER THAN THE ONE THEY ARE EVALUATING IS
PAYING FOR THEIR SERVICES.
COMMITMENT OF CLIENTS
COMMITMENT:
An emergency procedure for the
involuntary hospitalization of a
person who is deemed likely to
create harm for self or other
people as a result of mental
illness.
COMMITMENT ISSUES
BALANCE CLIENTS RIGHTS WITH

CLIENTS BEST INTERESTS
RIGHT TO LEAST RESTRICTIVE

TREATMENT
RIGHT TO REFUSE MEDICATION
Forensic
Issues
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INSANITY DEFENSE
The argument, presented by a lawyer
acting on behalf of the client, that,
because of the existence of a mental
disorder, the client should not be held
legally responsible for criminal actions.
Contrary to popular belief, this is a

legal term, not a psychological term.
INSANITY DEFENSE
In question is the individuals state of
mind at the time of the criminal action.
Unable to appreciate wrongfulness of their
conduct and to control their actions due to
a severe mental disturbance.
Generally require DSM-IV-TR diagnosis of
psychotic disorder, severe mood disorder,
dissociative disorder.
Personality disorder will not be sufficient.
COMPETENCY TO STAND
TRIAL
Whether a defendant is aware of and able
to participate in criminal proceedings
against him or her.
Mental health professionals play an

increasingly important role in the legal
system and find they must familiarize
themselves with a whole array of
forensic issues.
The intersection between psychology
and law will continue to grow as
society looks for interventions that are
humane, ethical, and effective.

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EastWest Review - Abnormal Psychology

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Abnormal Psychology Review Class

Dr. Arnold V. Lopez

What is Abnormal Psychology?

study of the nature,

MYTHS OF MENTAL ILLNESS

Creative people are a little crazy.

The term abnormality is defined according to the following

traumatic life experiences

disturbances in intimate relationships

Social scientists use the term

Medical conditions (e.g., thyroid problem)

Three prominent themes in

Ancient Greece and Rome:

Ancient Greece and Rome:

Galen (130-200 A.D.)

The Middle Ages and

Europe and the United States

Benjamin Rushs Methods

Rush and his contemporaries thought that the

The Late Twentieth Century:

The Scientific Method

The Experimental Method

The Correlational Method

The Survey Method

The frequency of new

The number of people

The Case Study Method

The DSM-IV (the fourth edition) or DSM-IV-TR

DSM (a.k.a. DSM-I)

DSM (a.k.a. DSM-I)

Not accepted, culturally sanctioned

Assumptions of the DSM-IV

Classification system based on

The Five Axes of the DSM-IV

Axis I: Clinical Disorders

The Course of Treatment

The Outcome of Treatment

Mental Status Examination

Appearance and Behavior

Mental Status Examination

Appearance and Behavior

Mental Status Examination

Mental Status Examination

Affect and Mood

Mental Status Examination

Affect and Mood

Euthymic = Neither happy nor sad

Mental Status Examination

Mental Status Examination

Mental Status Examination

Thinking Style & Language

Mental Status Examination

Mental Status Examination

Personality and Diagnostic Testing

MMPI and MMPI-2

Personality and Diagnostic

Behavioral Checklists and

an orientation to understanding the

In Freudian theory, the ID is the instinctive,

In Freudian theory, The EGO is the center of

In Freudian theory, the SUPEREGO controls

Post-Freudians and Criticism

The Nature of Anxiety