Popular in Biology: Function and Development of Organisms
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Date Created: 01/11/16
Behavioral Disorders Essentials of Psychology The Science of Behavior 5th Edition Chapter 13 Prepared by Nicholas Greco IV Adler School of Professional Psychology Images used with permission by Microsoft Corporation o 0 0 Defining Abnormal Behavior 0 Abnormal behavior Behavior that is atypical maladaptive socially unacceptable and produces emotional discomfort 0 Four criteria are used to distinguish between normal and abnormal behavior 0 Atypicality o Dysfunctional o Distressful emotional distress 0 Dangerous o o 0 Defining Abnormal Behavior 0 At ical Rarity alone is not a sufficient criterion for determining that a behavior is normal or disordered o D sfunctional The individual39s ability to function adequately in everyday social and occupational roles is impaired o Emotional distress may take the form of anxiety depression or agitation o The behaviors of behaviorally disordered people may be judged as dangerous to themselves or to others 11172015 trepanning stone age 0 0 0 Panic Disorder 0 The National Comorbidity Study 2005 estimates that approximately 6 million Americans suffer from panic attacks each year 0 Panic disorder Anxiety disorder in which an individual experiences numerous panic attacks four or more in a fourweek period that are characterized by overwhelming terror and often a feeling of unreality or depersonalization 0 0 0 Panic Disorder 0 The panic attacks associated with a panic disorder may be so overwhelming that a person may have thoughts of suicide 0 Others may have a sense of derealization the feeling that the world is not real or depersonalization a loss of sense of personal identity manifested as feeling detached from one s body 0 Physical symptoms include rapid heartbeat labored breathing dizziness chest pain sweating feelings of choking or suffocating 0 0 0 Agoraphobia o A majority of panic disorder cases may also exhibit symptoms of agoraphobia o Agoraphobia An anxiety disorder characterized by an intense fear of being in places or situations from which escape might be difficult or in which help might not be available such as stores theaters and trains o Often accompanies panic disorder Panic disorder with agoraphobia o In some cases agoraphobia is a standalone disorder 11172015 Panic disorder 4 or more panic attacks in a 4 week penod Phobias o Agoraphobia is one of several kinds of phobias o Phobia Any number of anxiety disorders that are characterized by a persistent fear and consequent avoidance of a specific object or situation 0 Examples include the following snakes spiders heights water being alone etc o Phobias are among the most common behavioral disorders 0 Approximately 14 of the general population has a phobia 11172015 specific fear of specific thinngys Social Phobias 0 Social phobia An anxiety disorder characterized by a persistent irrational fear of performing some specific behavior such as talking or eating in the presence of other people 0 Persons often avoid situations in which they may be observed behaving in an ineffective or embarrassing manner 0 Some have a poor selfimage difficulty interacting with authority figures Social Phobias 0 Two forms of social phobia 0 Discrete performance anxiety reflects fear of specific situations such as public speaking or ac ng o This social phobia is manageable by avoiding such situations yet this limits one s career growth and full potential 0 Generalized social anxiety may impose more serious limitations by causing individuals to avoid all kinds of social situations in both professional and personal activities 11172015 ObsessiveCompulsive Disorder OCD o Obsessivecompulsive disorder An anxiety disorder characterized by persistent unwanted and unshakable quot a thoughts andor irresistible 39 v 7 habitual repeated actions 0 Approximately 25 of Americans who have this disorder know that their obsessive thoughts and compulsive actions are irrational yet they cannot block these unwanted thoughts or keep from performing the act Posttraumatic Stress Disorder PTS D f o Posttraumatic stress disorder An anxiety disorder that typically follows a traumatic event or events and is characterized by the following o areliving of that event 0 avoidance of stimuli associated with the event or o numbing of general responsiveness and increased i arousal Posttraumatic Stress Disorder PTSD 0 Per the DSM lV TR PTSD develops after a person has experienced witnessed or been confronted with an event that involved actual or threatened death or serious injury 0 The person must have also experienced intense fear helplessness or horror 0 Primary symptoms 0 Re experiencing the event flashbacks o Avoidance of reminders of event smells sounds places 0 Hypervigilance back to the wall easily startled irritable poor concentration 11172015 Posttraumatic Stress Disorder PTSD o Explained largely if not solely on environmental grounds 0 Examples include the following military combat rape physical andor sexual assault or abuse surviving a serious vehicular accident 0 Prime examples 911 attacks on the World Trade Center and the Pentagon Generalized Anxiety Disorder GAD o Generalized anxiety disorder A chronic state of freefloating anxiety or worry that has persisted for at least 6 months 0 Occurs across a wide range of situations and is not linked to specific eliciting stimuli or events 0 Per the DSMlVTR three of the following symptoms have been present for the last 6 months restlessness feeling easily fatigued poor concentration irritability muscle tension and sleep disturbances Theoretical Perspectives on Anxiety Disorders 0 The psychoanal ic perspective Freud explained anxiety disorders as a result of internal conflicts particularly those involving sexual or aggressive impulses 0 Symptoms of anxiety disorders appear when the defense mechanisms are overused or rigidly applied or when they fall 0 Phobias may occur if the individual displaces anxiety to some object situation or social function that can be avoided 0 Little Hans phobic fear of horses Theoretical Perspectives on Anxiety Disorders 0 Panic disorders and agoraphobia may be rooted in an unresolved separation anxiety early in life fear of being separated from one s parents 0 Obsessivecompulsive disorder is seen as a result of a fixation at the anal stage of psychosexual development 0 Anal retentive or anal expulsive 11172015 o o o The Behavioral Perspective 0 Behavioral psychologists see conditioning as the source of anxiety disorders 0 Pavlovian conditioning explains phobias as the result of learned associations between previously neutral stimuli and frightening events 0 Once fear or anxiety is conditioned to certain stimuli people may then learn to reduce this conditioned fear by avoiding the fear stimulus o Avoidance learning A person avoids their fear of elevators by using stairs Avoidance behavior maintained by negative reinforcement fear reduction o o o The Behavioral Perspective 0 Certain brain structures may be involved in mediating conditioned fear the amygdala and the prefrontal cortex which do not turn off normally in some people 0 Animal research has demonstrated that the amygdala is essential for the development of conditioned fear responses 0 Damage to the amygdala prevents fear conditioning in animals o o o The Behavioral Perspective 0 The prefrontal cortex seems to be responsible for the extinction of conditioned fear 0 Animals with prefrontal cortex damage fail to extinguish conditioned fear when the unconditioned stimulus shock is no longer presented 0 People with posttraumatic stress disorder also show a failure to extinguish conditioned fear responses 11172015 o o o The Behavioral Perspective 0 Two theories stand out as plausible explanations for phobias 0 Evolution may have built a biological predisposition into humans to react fearfully to certain classes of potentially dangerous stimuli 0 Albert Bandura sociallearning theory believes that modeling or imitating the behavior of others provides a more likely explanation for the acquisition of some anxiety disorders Supported by evidence that animal phobias typically occur in children at about age five and whose parents have the same phobia o o o The Behavioral Perspective 0 PTSD is clearly linked to traumatizing experiences and possibly the failure to inhibit conditioned fear responses 0 OCD on the other hand is more complex 0 Some argue that compulsive acts occur repeatedly as they temporarily reduce anxiety and provide negative reinforcement o In the case of panic attacks with agoraphobia it has been suggested that individuals who experience sudden panic attacks develop a kind of anticipatory anxiety attached to situations in which they have previously experienced attacks o o o The Biological Perspective 0 Several researchers have suggested that some individuals with unusually responsive nervous systems may be biologically predisposed to develop certain anxiety disorders in particular panic phobic and generalized anxiety disorders 0 Rapoport believes that certain behavioral subroutines are hardwired into the human brain over the course of evolution 0 These behavioral packages are believed to have served crucial functions during the evolution of the human species 0 The repository of these behavioral packages is presumed to be within the basal ganglia 11172015 o o o The Biological Perspective 0 Basal ganglia A group of brain structures that lie under the cerebral cortex and function as way stations between the input of sensory messages and resulting cortically initiated motor or cognitive outputs o Rapoport theorizes that in OCD patients disturbances in these way stations have shortcircuited the loop that normally connects sensory input with behavioral output thereby releasing stored hardwired behavioral packages 0 Dopamine dysfunction in the basal ganglia may underlie OCD o o o The Biological Perspective 0 Drugs that increase GABA activity are typically used to treat anxiety disorders 0 Drugs that inhibit the synthesis of GABA or block GABA receptors and its ability to inhibit target neurons produce anxiety in both animals and humans 0 Given the above anxiety disorders may result from GABA dysfunction in the frontal cortices and the amygdala o o o Mood Disorders 0 Mood disorder 0 Class of disorders including major depression and bipolar disorder that are characterized by persistent depression which in bipolar disorder is accompanied by intermittent episodes of mania 0 Depression may be a secondary condition to other symptoms 0 In contrast depression is the primary problem in mood disorders o o 0 Major Depressive Disorder 0 Major depressive disorder MDD A severe mood disorder characterized by deep and persistent depression 0 DSMlVTR criteria state that the individual has 5 of 9 symptoms for at least a 2 week period see next slide 0 Not everyone who has depression becomes suicidal o The symptoms impact social and occupational functioning Major Depressive Disorder DSMIVTR Criteria 0 Five or more of the following symptoms 0 have been present during a 2week period and represent a change from 0 previous functioning at least one of the symptoms is either 1 depressed mood O or 2 loss of interest or pleasure o 1 Depressed mood most of the day nearly every day 0 2 Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day 0 3 Significant weight loss when not dieting or weight gain 5 change Decrease or increase in appetite o 4 Insomnia or hypersomnia nearly every day 5 Psychomotor agitation or retardation 6 Fatigue or loss of energy nearly every day 7 Feelings of worthlessness or excessive or inappropriate guilt nearly every day 8 Diminished ability to think or concentrate or indecisiveness nearly every day 9 Recurrent thoughts of death not just fear of dying recurrent suicidal ideation with a specific plan or a suicide attempt or a specific plan for committing suicide 11172015 Recurrent over the course of ones life They last about 2 5 months Women are twice more likely to get depressed Men less inclined to look for help 1O 11172015 o o 0 Major Depressive Disorder 0 The depression associated with bipolar disorder typically causes a person to become lethargic and sleep more 0 Major depressive disorder is characterized by insomnia and agitation 0 One in five Americans may experience a severe depressive episode at any point in time but only 1 percent of the population has been diagnosed with bipolar disorder 0 Ratio of women to men with depression is 21 o It is estimated that about 20 million people in American suffer from a depression severe enough to interfere with their life each year Depression may lead to substance abuse and eating disorders The economic impact of depression exceeds 44 billion a yeah Used to be manic disorder More likely to occur from late teens to early 30s o o o Bipolar Disorder o Bipolar affective disorder BAD o Mood disorder characterized by intermittent episodes of both depression and mania highly energized behavior 0 Formerly called manic depressive disorder 0 Bipolar presents in the early twenties depression may present at anytime but may often present in a person s thirties Bipolar Disorder DSMlVTR Criteria 0 Mania period of at least one week 0 m DeriOd 0f at of abnormally and persistently least 4 days Of a Pers39stemly elevated expansive or irritable mood e39eVated expans39Ve or severe enough to cause significant quotr39table mOOd Clearly different from the Impairment in some occupational or nondepressed mood state interpersonal functioning or warrant Presence of 3 or 4 outof 7 hospitalization Presence of 3 or 4 Specific Symptoms listed in out of 7 speCific symptoms listed in the DSMVTR but not the DSM lV TR Psychotic features severe enough to cause can be present marked impairment in 0 Known as Bipolar Affective S C39a39 occupat39on39c of Disorder I or Bipolar I interpersonal functioning necessitate hospitalization and there are no psychotic features 0 Known as Bipolar Affective Disorder II or Bipolar ll 11 Bipolar Disorder DSMlVTR Criteria 0 1 Inflated selfesteem or grandiosity o 2 Decreased need for sleep 0 3 More talkative than usual or pressure to keep talking o 4 Flights of ideas or racing thoughts 0 5 Distractibility o 6 Increase in goaldirected activity work school sexually socially o 7 Excessive involvement in pleasurable activities that have a high potential for painful consequences spending sprees sexual indiscretions foolish business investments 11172015 Bipolar Disorder DSMlVTR Criteria 0 Mixed EpisodeMixed Mania The criteria are simultaneously met for both a Manic Episode and for a Major Depressive Episode except for duration nearly every day during at least a 1week period 0 Criteria are met both for Manic Episode and for a Major Depressive Episode 0 The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others 0 The disturbance is not due to the direct physiological effects of a substance eg a drug of abuse a medication or a general medical condition o o o Bipolar Disorder 0 About one in one hundred people suffer from bipolar disorder which is similar to the rate of schizophrenia but far lower than the incidence of major depression 0 Men and women are equally likely to develop bipolar disorder 0 There is a higher likelihood of attempted and completed suicides among those with bipolar disorder than any other behavioral disorder 12 o o o Bipolar Disorder 0 Delusions An exaggerated and rigidly held belief that has little or no basis in fact 0 Hallucinations False perception that lacks a sensory basis that can be produced by hallucinogenic drugs fatigue or sensory deprivation Auditory hallucinations can be associated with severe psychotic disorders 0 Auditory are the most common 0 Visual tactile gustatory and olfactory may occun Seasonal Affective Disorder 0 Seasonal affective disorder SAD 0 Diagnostic category in which jg depression or bipolar depression recurrently follows a seasonal pattern Recurrent winter depression Present with carbohydrate cravings overeating weight gain and oversleeping May be caused by reduced light exposure phototherapy possibly helpful Recurrent summer depression Present with loss of appetite weight loss and insomnia Theoretical Perspectives on Mood Disorders 0 The psychoanal ic perspective Mood disorders are rooted in an oral fixation as individuals develop ambivalent feelings toward their mother they transfer these feelings to others and ultimately are unable to relate to people they love 0 Excessive love toward themselves results in mania o Exaggerated self hatred results in depression 0 Freud theorized the fixation causes a person to depend too heavily on others for gratification of basic needs and for maintaining selfesteem o Mood disorders were rooted in relationships of overdependence and ambivalent feelings of love and hate 11172015 Delusions mistaken thoughts Hallucinationsfalse perception of Sensory experiences Depression that occurs oneseasonaLpa em 13 Theoretical Perspectives on Mood Disorders 0 The behavioral perspective The death separation or loss of a loved one means the loss of a primary source of positive reinforcement which may result in depression due to falling into a rut of loneliness o Other sources of loss include loss of a job significant move or prolonged illness 0 Learned helplessness A diminished ability to learn an avoidance response following exposure to unavoidable aversive stimulation May contribute to some forms of depression and non responsiveness in humans and other animals 11172015 positive psychology Theoretical Perspectives on Mood Disorders 0 The biological perspective o Genetics 0 The average concordance rate for identical twins 65 o is almost five times that for fraternal twins 14 o o The concordance rates for identical twins are much higher for bipolar than unipolar depression 72 versus 40 o Concordance rates among identical twins are higher in severe than in milder forms of mood disorders Theoretical Perspectives on Mood Disorders 0 The biological perspective 0 Brain biochemistry o In the 19505 two classes of drugs were discovered Monoamine oxidase inhibitors MAOls and the tricyclics TCAs Increases the brain levels of serotonin and norepinephrine o Monoamine theory The first formal biochemical theory of mood disorders proposes that depression is related to reduction in activity of the monoamine neurotransmitters norepinephrine andor serotonin in specific regions in the brain 14 0 0 0 Schizophrenia o Schizophrenia 0 Class of severe andbi blifg imental disorders characterized by extreme disruptions Ofi iperceptions tmhts emotions land behavior Types identified by DSMlVTR include disorganized catatonic paranoid undifferentiated and residual schizophrenia 0 0 0 Schizophrenia o Emerges typically in early adulthood and is a chronic lifelong illness with some periods Ofi reimi ioTi o39fAffects about 1 percent of people worldWidEat any given point 0 Estimated that three out of every 100 people may experience thi immhroughout tf i i i o Presents equally across both sexes 0 0 0 Schizophrenia o Emil Kraeplin originally named it dementia praecox oijiPraecox meaning early onset and characterized by at progressi initellectual i ion or dementia 0 Eugene Bleuler later changed the term to schizophrenia to describe the primary symptom at dissociation of thoughts from appropriate emotions caused by a spli ing offof parts ofthe mind This does not mean split personality 11172015 people don t always stay in one category of I I H one of the longest studied mental dissorder 15 Primary Symptoms of Schizophrenia o Delusions and disturbances of thought 0 Disturbances 01 content Actual ideas expressed thought content c Disturbances of form The manner in which ideas are organized thought process 11172015 Primary Symptoms of Schizophrenia o Hallucinations and disturbance of perception 0 Disturbed perception may include changes in how the body feels or a feeling of depersonalization that makes a person feel detached from their body Some schizophrenics are unable to filter out irrelevant information o Hallucinations are quite common most common is auditory 0 Voices may be derogatory You are worthless Primary Symptoms of Schizophrenia o Disturbance in emotional expression 0 May take the form of blunted or flat affect characterized by a dramatic lack of emotional expression Monotone speech little or no facial expression 16 Primary Symptoms of o o I Schizophrenia o Disturbances in speech 0 l7lutism An individual may not utter a soundlfor hours or days at a time o EEf laliai The person repeats virtually every i39statement they hear uttered 3 o Disorganized or catatonic behavior ofCWl lW l is characterized by aim rigidness of posture that can be mai inied foirlm 11172015 The Development of O O O I I Schizophrenia j o Prodromal staggl o Deterioration of function without being actively psychotic o Appear in late adolescence or early adulthood 0 May last for months or even years to Active stage 0 Appearance of major symptoms disorganized thinking delusions hallucinationsl 0 May last for months to a lifetime g i lw 9g 0 Continued impairment but no severe psychotic symptoms 0 Presenting low motivation blunted affect and unusual perceptual experiences prodromal II lltlaI OHSGt active stage is really bad Things begin to get better again reduced activity o 0 0 Subtypes of Schizophrenia o The DSMlVTR distinguishes five subtypes to Disorganized characterized by markedl ldisorganization and regression in thinking and behavioral patterns accompanied by sudden mood swings and often hallucinationsl Word salad lllogical ramblings of speech Neologisms This desk is a cramstile He s an easterhorned head Clang How are you Well hell it s well to tell So hot you know it runs on a cot o Catatonic characterized by extreme psychomoton ldisturbances which may range from stuporousl limmobility to wild excitement and agitations word salad illogical ramblings Neologisms making up things on the spot Clang nonsensical stuff 17 o 0 0 Subtypes of Schizophrenia o The DSMlVTR distinguishes five subtypes o Paranoid characterized by the presence of ll organized delusional thoughts igihest level of awareness and least impairment in the ability to carry out daily functions 0 Undifferentiated characterized by symptoms which fit no subtype vague catchall category 0 Residual Describing the recovery phase during which major symptoms are absent or markedly diminished in strength and number person may continue to display blunted or inappropriate emotions 11172015 Positive and Negative Symptoms of Schizophrenia Jo Positive symptoms Represent an excess or distortion of normal behavior of schizophrenia and may include hallucinations delusions and excessive verbal behavior 0 Negative symptoms Represent diminished or absent behavior of schizophrenia and may include flattened emotions diminished social behavior apathy anhedonia and catatonic motor behavior Theoretical Perspectives on Schizophrenia o The psychoanal ic perspective Freud believed that schizophrenia occurs when a person s ego either becomes overwhelmed with id demands or is besieged by unbearable guilt o The person undergoes a massive regression back to the oral stage 0 Regressive symptoms demonstrate a return to the infantile o Restitution symptoms appear in the form of hallucinations delusions and bizarre speech patterns 0 Very few clinicians today place any credibility in Freud s explanation of schizophrenia 18 Theoretical Perspectives on Schizophrenia o The behavioral perspective Learning theorists propose that schizophrenics either have not been reinforced adequately for responding to normal social stimuli or perhaps have even been punished for such responses Behavioral theory may have some difficulty explaining why some people become schizophrenic Behavioral theory may account for the persistence of some abnormal behaviors and it has been a useful approach in the treatment of schizophrenic behavior 11172015 Theoretical Perspectives on Schizophrenia o The biological perspective Genetics 0 Family studies have shown a substantially higher incidence of schizophrenia among relatives of schizophrenics than among the general population 0 Adoption studies have confirmed this however genetics cannot account for the disorder 100 Theoretical Perspectives on Schizophrenia o The biological perspective Brain biochemistry o The dopamine hypothesis suggests that schizophrenia is caused either by abnormally high levels of dopamine or by abovenormal activity to dopamine due to an increased number of dopaminergic receptors 0 Supported by research and by medications such as the phenothiazines which reduce dopamine activity by blocking the postsynaptic dopamine receptors 19 Theoretical Perspectives on Schizophrenia o The biological perspective Brain structural abnormalities 0 Structural abnormalities include unusually large ventricles reduced volume of temporal lobe gray matter reduced volume of the hippocampus and an unusually small corpus callosum 11172015 0 free associa talks about an comes to mind criticism 20 0 0 0 Psychoanalysis oResistance n r patientclientbecomes g I reluctanttotalkabout w quot Wptc o Transference I quot patientclientprojects 39 feelings tot importanti others onto therapist What do we mink aw mud ft on Ella and o o o Psychoanalysis Today 0 Psychodynamic therapy newert m for psychoanalysis more focus on 39 transference shorter treatment o Nondirective therapist is a 39 neutral nonjudgmental listener o Directive earlier quot1quot interpretations of client statements and dire 39 of certain behavi O O O CognitiveBehavioral Therapies 0 Cognitivebehavioral therapy CBT learning to think more rationally and logically Three goals 1 Relieve symptoms and solve problems 2 Develop strategies for solving future 1 problems I 3 Help change irrational distorted j I thinking Qquot 11172015 21 o o o RationalEmotive Therapy 0 Rationalemotive behavior therapy REBT cognitivebehavioral therapy irrational beliefs challenged and Nag 39ju red 7 Vt at J kquot 11172015 O O 0 Learning One s Way to Better Behavior 0 Behavior therapies action therapies focused on behavior not causes 0 classical and operant conditioning 0 Behavior modification or applied behavior analysis change behaviors via learning techniques V 22 Figure 145 0 O O Desensitization is S H ilii39t39E39ndEd to weaken Bridge and replace this association CR I us I Fear Lighitn Ing strikes um Thurman 11172015 o o 0 Systematic Desensitization o ystematic desensitization for treating phobias 3 STEPS 1 Relaxation training 2 Fear hierarchy 3 Progressive Aversion and Flooding Therapies 0 Aversion therapy undesirable behavior paired with aversive stimulus o Flooding for treating phobias stress disorders 0 intense inescapable exposure to feared situation or object 23 Operant Conditioning Therapies 0 Modeling learning via observation and imitation o participant modeling model takes client through stepbystep process for desired behavior 11172015 Operant Conditioning 39 39 39 Therapies 0 Positive and negative reinforcement o token economy reinforcers earned and exchanged for desired things 0 contingency contract formal agreement on behavior change reinforcements penalties Operant Conditioning Therapies 0 Extinction remove reinforcer reduce undesirable behavior 0 time out removal from situation that reinforces undesirable behavior 24 11172015 Psychosurgery o Psychosurgery surgery on brain tissue to relieve severe psychological disorders 0 Prefrontal lobotomy connections between pre frontal lobe and rest of brain severed o Bilateral cingulotomy deep lesioning of cingulate gyrus via electrode wire severe depression and bipolar disorders Electroconvulsive Therapy 0 Electroconvulsive therapy ECT electric current passed through electrodes to one or both sides of head 0 quick short term treatment for severe depression bilateral and unilateral ECT 25 o o o Biomedical Therapies 0 Biomedical therapies affect biological functioning of body and brain 0 Psychopharmacology use of drugs to relieve symptoms of disorders 0 antipsychotic drugs treat psychotic symptoms such as delusions and hallucinations 11172015 o o o Psychopharmacology o antianxiety drugs calm anxiety reactions 0 antimanic drugs treat mania and bipolar disorder 0 antidepressant drugs treat depression and anxiety 0 Monamine oxidase inhibitors MAOs Tricyclics Selective serotonin reuptake inhibitors SSHs 26
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