Abnormal Behavior and Psychological Disorders
Class Notes for Chapter 15

http://iws2.collin.edu/lipscomb/16_week_course/

WARNING!  For the sake of your own mental health, avoid the tendency to self-diagnose your own behavior when reviewing this chapter!  Don’t make yourself unnecessarily crazy by doing what many students of general psychology do – see themselves in every disorder they read about.


Defining Abnormal Behavior:  There are two primary definitions psychologists use to classify behavior as abnormal including:

Atypical Behavior:  behavior that deviates from the norms of society -- behavior seen as being different or weird – not necessarily harmful to self or others, just deviant – the definition most people in society use to define a behavior as being abnormal

Maladaptive Behavior:  behavior that is potentially harmful to oneself or to others -- not just physically harmful, but also emotionally harmful to the well-being of a person or others -- not necessarily deviant, but definitely potentially harmful -- the definition most clinicians are concerned about -- they are more interested in the client's mental and physical well-being than whether or not a behavior is weird

Note: Behaviors are not necessarily atypical or maladaptive.  They can be both.  For example, behaviors can be defined as atypical only (talking to the paint on the wall), both atypical and maladaptive (dancing naked while standing on an overpass railing above North Central Expressway) or maladaptive only (a college student drinking an excessive amount of alcohol at a party).

What may ultimately make an abnormal behavior into a genuine mental disorder is if the behavior:
1.      is maladaptive (harmful to self or others)
2.      causes significant social impairment
3.      causes significant occupational impairment
4.      causes great personal pain and emotional discomfort
5.      involves a psychotic loss of contact with reality
 (or to varying degrees, any combination of these five factors)

Classifying Mental Disorders Using the DSM-IV

DSM-IV:  Mental disorders are diagnosed according to the Diagnostic Statistical Manual of Mental Disorders, 4th Edition (APA, 1994), and /or the DSM-IV-TR (2000).  This book provides a list of symptoms common to each type of disorder which can be used to help classify disorders into categories.  Some of the major categories and disorders defined in each are listed below.

DSM-5:  In 2013, after years of contentious debate and revision, the American Psychiatric Association released the new DSM-5.  The DSM-5 is generally similar to the DSM-IV in terms of the disorders diagnosed in both.  Some disorders were shifted to different categories.  A primary difference between the two is that the DSM-5 operates on a somewhat different underlying philosophy of diagnosing mental disorders, moving to a more dimensional approach to diagnosing disorders.

Which version of the DSM do you need to know for the test?  Because the current edition of the textbook still discusses the diagnoses contained in the DSM-IV, test questions about mental disorders will continue to focus on DSM-IV diagnoses of mental disorders.

   

Anxiety Disorders:  disorders involving high levels of negative emotions such as fear, nervousness and dread -- the person attempts to cope with the negative emotions using an ineffective or maladaptive method -- does not involve loss of contact with reality -- anxiety disorders include:

Panic Disorder: repeated panic attacks, unclear fear of something bad happening in the absence of a threatening stimulus.  Can be diagnosed with or without Agoraphobia described below.

Phobias: intense, irrational fears that dominate a person’s life on many levels.   Examples include:

• Specific Phobia:  intense irrational fear of an object, creature or specific situation (snakes, spiders, heights, enclosed spaces, air travel are examples).
• Agoraphobia:  intense, irrational fear of being in a public situation where a tragic event may occur from which the person might not escape or may embarrassed by overreacting (will not go to the movies for fear the theater will catch fire and will be trapped or trampled to death in a panic).  Often does not leave home due to fears.  Also can be diagnosed with or without panic disorder described above.
• Social Phobia (also know on current TV commercials as “Social Anxiety Disorder”):   intense, irrational fear of being evaluated by others in social situations.  Will leave home, but either avoids public places were people are present or endures intense anxiety when forced to be in the presence of others.

Obsessive-Compulsive Disorder:  intense anxiety resulting from obsessions (uncontrollable, repeating thoughts like the inability to stop thinking about the precise order of clothes hanging in the closet) or compulsions (ritualized behaviors that are uncontrollable, repeating and unwanted like constant hand washing, lock checking, cleaning and straightening). 

Post-Traumatic Stress Disorder:  has lived through a life threatening trauma (rape, combat, plane crash, terrorist bombing, school shooting massacre) and now is dominated by repeated, unwanted thoughts, dreams and flashbacks of the event, extreme avoidance of reminders of the event, numbed emotions, jumpy, unable to sleep for fear the event will occur again.

Generalized Anxiety Disorder:  intense worry and anxiety about everything, not just one specific thing.  Intense worry about bad things happening in the future for which there is no real conclusive indication.


Somatoform Disorders:  disorders involving symptoms of physical health problems or an irrational fear regarding physical health with no apparent physical cause -- in each case, medical evaluation cannot determine an actual physical cause --  therefore, a psychological cause may be presumed -- no loss of contact with reality -- somatoform disorders include:

Conversion Disorder:  the person converts an emotional trauma into a major physical symptom like blindness, deafness or paralysis as a result of an emotional trauma.  Not faking or consciously making the symptom.  In theory, an unconscious defense mechanism is at work.  Rare occurrence. 

Hypochondriasis:  intense anxiety resulting from the misinterpretation of small, common physical problems as conclusive evidence of a serious, even life-threatening illness.  Intense fear of being affected by physical illness.  Belief of serious illness continues in spite of medical evidence indicating no illness.  Commonly know as a “hypochondriac.”  More common occurrence.

Body Dysmorphic Disorder:  obsession with an imagined physical defect in the appearance of a normal-appearing person.  Person believes he/she has a facial/body feature that is grotesque, and disturbing for self and others to see.  Others do not share the persons perception.

Somatoform Pain Disorder:  intense, physical pain that cannon be explained by a genuine physical cause (like nerve damage, infection).  Believed to be psychological in nature and somewhat rare in occurrence.

Somatization Disorder:  an unexplained variety of symptoms (general physical, gastrointestinal, neurological, sexual/reproductive symptoms) that do not characteristically fit any real illness or disorder.  Believed to be psychological in nature and somewhat rare in occurrence.


Dissociative Disorders:  disorders involving a sudden change in memory or identity with no apparent physical cause – to dissociate means to separate from -- persons with dissociative disorders have likely suffered a deep psychological trauma – it is assumed that their minds have unconsciously separated from the pain of the trauma either in the form of amnesia or loss of identity -- dissociative disorders include:

Dissociative Identity Disorder (formerly Multiple Personality Disorder):  two or more distinct personality states that alternatively take control of the person’s life.  As you will read in the text, very controversial disorder.  Most who believe it is an actual, real disorder think the occurrence is rare.  Many clinicians don’t believe it actually exists, believing it to be either the misdiagnosis of another problem or an attention seeking device for the patient.

Dissociative Amnesia:  significant memory loss that cannot be explained by a physical cause or trauma.  Believed to result from extreme psychological trauma.  Also know as repressed memory syndrome.  Occurrence is believed to be generally rare.

Dissociative Fugue:  sudden, distinct loss of identity and inability to recall one’s past resulting in wandering travel away from one’s home and creation of a new identity.  Not consciously controlled.  Occurrence believed to be very rare.


Mood Disorders:  disorders involving an extreme of a normal mood state -- that is, when the normal moods of happy or sad become so extreme they become maladaptive -- mood disorders differ from simple normal changes in mood in that they involve symptoms that:

1. are much more severe than normal mood changes

2. cause significant impairment of functioning

3. often have no specific cause such as a psychosocial event like death of a relative

4. are persistent and more enduring than normal mood changes
   

The two major DSM-IV mood disorders include:

Major Depression:  Depression that is long-term, considerably debilitating, and not caused by drugs or other organic cause.

Symptoms include:

1. sad mood

2. loss of pleasure in usual activities

3. insomnia or hypersomnia

4. appetite/weight change

5. excessive guilt/worthlessness

6. problems concentrating

7.  loss of energy

8. psychomotor retardation/agitation

9.  thoughts of death or suicide, a suicide plan or suicide attempt

Person must have at least five of the symptoms above and must included either symptom #1 or #2 or both as a part of the minimum of five.  The symptoms must be severe enough to cause marked impairment in social/occupational functioning or to necessitate hospitalization to prevent harm to self/others.

Bipolar Disorder:  Formerly called “manic-depression” – diagnosis requires the person experience at least one full-blown manic episode and will also likely (but not necessarily) involve a shift from mania to a full-blown depressive episode -- person often will fluctuate between episodes of mania and depression (over the course of several days/weeks).

Symptoms of a manic episode include:

1. dramatically elevated, euphoric mood or irritable mood

2.  highly inflated self-esteem (belief one can do anything without any chance of failure)

3. decreased need for sleep (maybe only a few hours every couple of days)

4. extremely talkative, much more than usual

5. racing thoughts

6. easily distracted, unable to focus attention

7. increased goal directed behavior (like abruptly deciding to put a new roof on the house and be finished in one day while working solo)

8. involvement in pleasurable activities that have painful consequences (like spending sprees, multiple, indiscriminate sexual acts)

Again, symptoms must be severe enough to cause marked impairment in social/occupational functioning or to necessitate hospitalization to prevent harm to self/others.  Person must have a minimum of four of the symptoms noted above and must include symptom #1.


Schizophrenia: the major form of psychosis (loss of reality) diagnosed -- along with bipolar disorder and major depression is one of the three major mental disorders -- affects just over 1% of the population -- happens most commonly between the ages of 15 and 45 -- onset typically in the late teens to mid 20s --        considered to be a biologically based brain disease -- may be triggered or made worse by stressful situations.

Three General Characteristics of Schizophrenia:  

1. Severe distortions of thinking, perception and mood resulting in loss of contact with reality including:  

   Delusions:  False beliefs – true belief in weird or unusual things -- often either paranoid, grandiose or bizarre in nature

   Hallucinations: False sensory experiences – they actually hear or see things that are not there -- most commonly auditory, but also visual or even tactile           

   Loose Associations: illogical thinking seen in jumbled, confusing speech that jumps from one topic to another during the course of one sentence and is offen referred to as "word salad"
   

2. Social withdrawal -- all schizophrenics are to some degree cognitively withdrawn from others and many become physically withdrawn from others also

3. Deterioration from a previous level of functioning -- schizophrenia happens to persons who have developed at least into the early stages of adulthood -- that is, it does not happen to children -- it is not a developmental disorder.
   

Types of Schizophrenia (3 of 5 common types):  

Disorganized Type:  fits the common stereotype of a "crazy person" -- disorganized, purposeless, or bizarre behavior -- incoherence -- silly or inappropriate mood – delusions (non-paranoid) -- hallucinations (non-paranoid)

Paranoid Type:  system of paranoid delusions – often a complex web of false beliefs involving being spied on or conspired against by others -- auditory or visual hallucinations often paranoid in nature -- otherwise "normal" in other behaviors, for example does not show extremely disorganized behavior, incoherence, jumbled speech, or catatonia -- most common type accounting for about 50% of all cases of schizophrenia 

Catatonic Type:  extreme social withdrawal -- does not react to others or things in environment -- in a stupor or zombie-like state -- often shows rigid, bizarre body postures -- most rare type -- most severe type – often does not respond to medication.

Common Myths About Schizophrenia:  

1. “All schizophrenics are violent and dangerous” -- not true -- some may be but most are so withdrawn they aren't violent.

2. “Schizophrenics are fine until, one day, they just snap” -- not true -- symptoms develop gradually over many months if not years.

3. “Schizophrenia and DID or 'multiple personality’ are the same thing” -- not true -- diagnosed in two separate categories -- schizophrenia is a form of psychosis, DID is not

Personality Disorders:  disorders involving long-term patterns of maladaptive behavior seen in interactions with others.

Personality disorders differ from other disorders in that they:

1. do not have as a root cause anxiety, depression, mania, or psychosis

2. are persistent – symptoms don't come & go like some other disorders

3. are generally not treated with medication

4.  are considered by many to be learned faulty patterns of dealing with  life situations

5. are often difficult to treat with psychotherapy -- person thinks the problem is with everyone but them
   

Note: When reading the examples below, keep in mind that from time to time, just about anybody could have the symptoms of these personality disorders as they involve some fairly common human behaviors.  However, also keep in mind that a person will only be diagnosed with a personality disorder if the symptoms are clearly extreme and in excess of what most people experience.  That is, when the symptoms become a way of life and significantly interfere with a person’s daily, social and occupational life.  So even though it may be fun, avoid the temptation to diagnose all of your friends and relatives!

Some Personality Disorder examples include:

Histrionic Personality Disorder:  neurotic attention seeking behavior, highly dramatic, upset if not center of attention in a group, often acts and dresses in shocking ways meant to draw attention.

Narcissistic Personality Disorder:  falsely inflated sense of self, thinks self superior to others and therefore should receive special treatment in life, self-absorbed, unable to understand the feelings and rights of others.

Anti-social Personality Disorder:  consistently violates the rights of others with no guilt or remorse for doing so, will lie, cheat, steal and not feel sorry, often physically violent, no regard for lawful behavior, often engaged in high risk behaviors (speeding, gun shooting), impulsive and un able to maintain consistent work, evidence of unusually cruel abusive behavior in childhood and adolescent years.  Keep in mind that when psychologists say “anti-social,”  they are not referring to someone who is a loner or hermit (like Schizoid Personality Disorder described below) but rather someone who behaves in ways that are against society.

Borderline Personality Disorder:  highly unstable in personal relationships, in relationships, vacillates from over-idealization (“I LOVE you!”) to brutal hostility (“I HATE you!”) and then to fear of abandonment (“DON”T leave me!”), can be violent but generally less than anti-social types, has some sense of conscience, chronic feelings that life has no meaning or purpose, may engage in attention seeking self mutilation or manipulative suicide attempts.

Schizoid Personality Disorder: extreme loner, wants no friends or relations including sexual relations, seeks solitary life-style, avoids eye contact with others, has no outward of emotion, cold, flat and non-reactive, just wants to be left alone.

Paranoid Personality Disorder:  thinks others are trying to purposefully make life difficult, often interprets casual non-threatening remarks from others as insults, often questions without sufficient cause the loyalty and fidelity of friends and spouses, but does not have true psychotic intensity paranoid delusions like a paranoid schizophrenic would. 

Obsessive-compulsive Personality Disorder:  extreme perfectionist, must do things his/her way, total control freak, doesn’t let others do their part on a task even when capable, may hoard objects or money in order to gain a sense of control over such items.

Dependent Personality Disorder:  dependent on others for happiness and decision-making, often will volunteer to do unpleasant tasks just so others will still like him/her, goes along with others even when they’re wrong for fear of rejection,  fears abandonment, uncomfortable being alone, easily hurt by criticism.


Adjustment Disorder:  may occur when a person has had a normal stressful life event (death of relative, loss of job, divorce) and where person has trouble dealing with the life altering event  – problems adjusting to the change brought by event -- causes minor to moderate impairment in social / occupational functioning – not  long-term -- not driven by anxiety, depression, psychosis – good prognosis for recovery -- many therapists give this diagnosis to patients so they can have some disorder worthy of insurance company reimbursement for treatment.


Variant Sexual Behavior:  Variant sexual behavior is behavior that in some way is not common or deviates from the norms of society.  These behaviors may or may not be classified in the DSM-IV as a legitimate mental disorder.  For example, pedophilia (preference for sex with children in fantasy and/or act) is maladaptive, atypical, a crime, and a legitimate DSM-IV disorder.  On the other hand, homosexuality (same sex orientation) is considered to be atypical as it is not the statistical norm, but is not classified in the DSM-IV as a disorder.  Variant sexual behavior may be divided into either:

Atypical/Maladaptive Sexual Behavior -- deviates from norms of society and is harmful to that person or to others (pedophilia, sexual sadism/masochism, rape).

Atypical Sexual Behavior -- deviates from norms of society but is not inherently harmful to person or to others – is simply different from the norm (homosexuality, fetishism).


Sexual Disorders:  sexual disorders currently included in the DSM-IV as actual disorders are divided into two groups:

Sexual Dysfunctions:  problems in ability to perform sexually, desire for sex, sexual arousal, inability to achieve orgasm, or pain during sex.  Some examples include:

Hypoactive Sexual Desire Disorder:  extremely low or no interest in sex at all.

Sexual Aversion Disorder:  extreme aversion to sex, totally repulsed by mere thoughts of sex.

Female Sexual Arousal Disorder:  failure to attain the lubrication-swelling response of sexual excitement.

Male Erectile Disorder:  inability to attain or maintain an erection until completion of sexual activity.

Inhibited Male/Female Orgasm:  desire for sex, ability to become aroused, but no ability to reach sexual climax.

Premature Ejaculation:  this is a quote from the DSM: “Persistent or recurrent ejaculation with minimal sexual stimulation or before, upon, or shortly after penetration and before the person wishes it.”  Not a funny disorder, but a funny way of describing it!

Dyspareunia:   ongoing genital pain in a male or female either before, during or after sexual activity (taking all factors into account).


Sexual Paraphilias:  when an individual requires some unusual object, situation, or ritual to achieve sexual arousal and pleasure.  Some examples include:

Sexual Sadism:  sexual arousal and gratification dependent on beating, humiliating and inflicting pain on another person during sex.

Sexual Masochism:  sexual arousal and gratification dependent on being beaten, humiliated and receiving pain from another person during sex.

Pedophilia:  sexual arousal and gratification dependent on fantasies of or actually having sex with children.

Fetishism:  sexual arousal and gratification dependent on the presence of an inanimate object for example undergarments or leather but could be just about anything.

Exhibitionism:  sexual arousal and gratification dependent on exposing one’s genitals to an unsuspecting stranger.

Voyeurism:  sexual arousal and gratification dependent on observing unsuspecting persons either disrobing, naked or in sexual activity (“peeping tom”).

Frotteurism:  sexual arousal and gratification dependent on rubbing one’s genitals against the legs or buttocks of an unsuspecting, nonconsenting stranger in a crowded situation.

Transvestic Fetishism:  sexual arousal and gratification dependent on dressing up in the clothing of the opposite sex.  Person does not necessarily want to become the other sex as in gender identity disorder or “transsexualism,” nor dresses up for entertainment purposes as a “drag queen,” but only cross-dresses for sexual arousal.

There are many other paraphilias described in the DSM-IV like telephone scatologia (lewd phone talk), necrophilia (corpses), zoophilia (animals), copraphilia (feces), and urophilia (urine), but we won’t go into those!