abnormal psychology chapter 1

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Abnormal Behavior in Historical Context (Summary) H.Ahlreip 2010 :

Abnormal Behavior in Historical Context (Summary ) H.Ahlreip 2010

Understanding Psychopathology :

Understanding Psychopathology What is a psychological Disorder? A psychological disorder or abnormal behavior refers to a psychological dysfunction within an individual that is associated with personal distress or impairment in functioning and a response that is atypical or not culturally expected

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1. Psychological dysfunction Refers to a breakdown in cognitive , emotional , or behavioral functioning Abnormal behavior tends to interfere with daily functioning. Example : An individual quits his job, leaves his family and prepares to withdraw from the productive and meaningful life in order to live in an empty isolated distant apartment where he feels comfortable and satisfied. So this dysfunctional behavior indicates psychological abnormality.

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2. Personal distress or impairement is often associated with extreme expressions of otherwise “normal” emotions, behaviors, and cognitive processes it refers to the individuals’ subjective feelings of pain, anxiety, depression, agitation, disturbance in sleep, loss of appetite, numerous aches and pains. The concept of impairment refers to an inability to function optimally and independently

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3. An atypical or not culturally expected response refers to those behaviors or attitudes that do not occur in a society very frequently Violates social norms

The Diagnostic and Statistical Manual (DSM-IV-TR) :

The Diagnostic and Statistical Manual (DSM-IV-TR) Widely Accepted System Used to classify psychological problems and disorders DSM Contains Diagnostic Criteria for Behaviors that: Fit a pattern Cause dysfunction or subjective distress Are present for a specified duration And for behaviors that are not otherwise explainable (grief, medical conditions, etc.)

The Science of Psychopathology :

The Science of Psychopathology Psychopathology is the scientific study of psychological disorders The study of psychological disorders is done by Mental Health Professionals (different background, training, & approach) Many mental health professionals take a scientific approach to their clinical work and are therefore called scientist-practitioners The function of a scientist-practitioner Consumer of science (enhancing the practice) Evaluator of science (determining the effectiveness of the practice Creator of science (conducting research that leads to new procedures useful in practice)

Three major categories make up the study and discussion of psychological disorders :

Three major categories make up the study and discussion of psychological disorders

a) Clinical Description :

a) Clinical Description the presenting problem refers to the original complaint reported by the client to the therapist e.g. Elizabeth visited the mental health care centre, because of her increasing feelings of guilt and anxiety The Clinical description represents the unique combination of behaviors, thoughts and feelings that make up a specific disorder An important function of the Clinical Description is that it specifies what makes a disorder different from normal behavior or from other disorders

The clinical description of a disorder is further elaborated by the concepts of: :

The clinical description of a disorder is further elaborated by the concepts of:

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Prevalence refers to how many people in the population as a whole have the disorder Incidence means how many new cases occur during a given period of time, e.g. a year? Other statistics include the Sex Ratio (which means what percentage of males and females have the disorder?), and the typical age of onset (which often differs from one disorder to another)

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Course refers to the somewhat individual pattern that most disorders follow or take. Schizophrenia (a Psychotic disorder) follows a chronic course which tends to last a longtime , sometimes a whole lifetime. Mood disorders (say depression) follow an episodic course in which an individual is likely to recover within a few months only to suffer a reoccurrence of the disorder at a later time. A time limited course means that the disorder will improve without treatment in a short period of time.

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Acute and Insidious Onset Some disorders have an acute onset (which means that they begin suddenly) Other disorders develop generally over an extended period of time, which is sometimes called an insidious onset .

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Prognosis refers to chances of improvement of the disorder, so when we say that “prognosis” is “good”, it means that the individual will improve ( more chances of improvement), while the statement that “prognosis” is “guarded” means that the probable outcome does not looks good ( less chances of improvement )

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b) Causation, Treatment, and Etiology Outcomes The Etiology refers to the study of origins It has to do with why a disorder begins (what causes it) and it includes the biological , psychological and social dimensions Treatment /Intervention/Therapy occurs through a medication or psychosocial treatment such as Psychodynamic, cognitive, behavior or humanistic therapy. The triad approach of Etiology, the causation, and the treatment of disorder is currently used.

Historical Conceptions of Abnormal Behavior :

Historical Conceptions of Abnormal Behavior Historically, there have been three prominent approaches to abnormal behaviour: Supernatural Tradition Biological Tradition Psychological Tradition

1. Supernatural Tradition :

1. Supernatural Tradition In the supernatural tradition , abnormal behavior is attributed to agents outside our bodies or social environment, such as demons, spirits, or the influence of the moon and the stars This model includes: Demons, Witches and Possession Stress and Melancholy Mass Hysteria Moon and Stars

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a) Demons, Witches and Possession during end of 14 th century, and the start of 15 th century there was a split in the Roman Catholic Church and superstition became prominent abnormal behaviour was seen as the work of the devil and witches (sorcery) possessed individuals were blamed for the misfortune in the community so drastic actions were taken against them however the notion that possession could be involuntary was also present (i.e. possessed individuals are blameless)

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Treatment included Exorcism, trephining Shaving pattern of cross on the individual’s head Individuals were secured to a wall near the church to benefit from mass Confinement, beatings, torture And ‘creative therapies’ , whereby individuals were hung over snake-pits, or dunked in ice-cold water to scare the devil out of them

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b) Stress and Melancholy during end of 14 th century, and the start of 15 th century the enlightened view was that insanity was a natural phenomena, caused by mental or emotional stress, and that it was curable mental depression and anxiety were recognized as illnesses though symptoms such as despair and lethargy were viewed as a sin of sloth by the church

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Treatment included Rest, sleep, and a healthy happy environment The insane and the physically ill were taken care of within the community

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c) Mass Hysteria during the middle ages large-scale outbreaks of bizarre behaviour lent support to the notion of possession in Europe groups of people were simultaneously compelled to run out into the street, shout, and dance without music this behaviour was known as ‘ Saint Vitus’s Dance’ and ‘ tarantism ’ mass hysteria demonstrates the phenomena of emotion contagion , in which the experience of an emotion seems to spread to those around us people are also suggestible when they are in a state of high emotion this is referred to as mob psychology (one person identifies a cause, others may then assume that their own reaction has the same cause)

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d) Moon and Stars The Latin word for moon is Luna , this inspired people to use the word lunatic for abnormal people According to this notion the movements of the full moon and the stars have an effect on behaviour of people. This view is reflected by followers of astrology who think that their behaviour as well as major events in their lives can be predicted by the position of the planets.

2. The Biological Tradition :

2. The Biological Tradition In the biological tradition, disorders are attributed to disease or biochemical imbalances The Greek physician Hippocrates , who is considered to be the father of Western medicine, played a major role in the biological tradition. He suggested that psychological disorders can be treated like any other disease. Hippocrates and his associates believed that psychological disorders may also be caused by brain pathology or head trauma, and that they could be influenced by heredity Hippocrates viewed the brain as the seat of consciousness , emotion , intelligence , and wisdom and believed that disorders involving these functions would logically be located in the brain He also recognized the importance psychological and interpersonal contributions to psychopathology

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Galan adopted the ideas of Hippocrates and developed them further The Hippocratic-Galantic approach includes the humoral theory of disorders This theory reflected the belief that normal functioning of the brain required a balance of four bodily fluids or humors (blood, black bile, yellow bile, and phlegm) The biological tradition contributed to our understanding of chemical imbalances

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Treatment included: Bloodletting and Induced vomiting Other contributions Hippocrates coined the term ‘ hysteria ’ And he wrongly believed that it was restricted to women, and described the cause as being an empty uterus that wanders to various parts of the body in search of conception Treatment included marriage, or sometimes, the fumigation of the vagina

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The 19th Century During the 19th century, syphilis was discovered to be a cause of general paresis (a disorder characterized by both behavioral and cognitive symptoms). Eventually scientists ( Pasteur ) discovered that syphilis could be cured by penicillin, which in turn led many mental health professionals to believe that similar cures could be discovered for all psychological disorders.

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John P. Grey , and American Psychiatrist, believed that insanity was always due to physical causes and that mentally ill patients should be treated like the physically ill. Reformers stated that the treatment of those with mental illness should parallel the treatment of those with physical illness. As a result, mental hospital conditions improved significantly and many advocated the practice of " deinstitutionalization ."

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New Developments of Biological Treatments Insulin shock therapy - In 1927 Manfred Sakel began using higher and higher dosages of Insulin, the patients had convulsions and went into a state of coma but surprisingly these patients recovered so physicians started to use it frequently. The method was however abandoned because it was dangerous, as it caused coma and even death.

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Joseph Meduna , in 1920 observed that Schizophrenia was rarely found in epileptics (which later did not prove to be true) and his followers concluded that induced brain seizures might cure Schizophrenia. Electroconvulsive Therapy (ECT) was also used to treat depression However it can lead to memory impairments (remains controversial)

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During the 1950s, the first effective drugs for severe psychotic disorders were developed in a systematic way Drugs developed included neuroleptics (major tranquilizers), and benzodiazepines (minor tranquilizers, e.g. valium and librium) These two were among the most prescribed by the 1970s

3. The Psychological Tradition :

3. The Psychological Tradition Key words : Moral therapy , asylum reform , and the decline of moral therapy The psychosocial tradition predominate as of the 18th century with the dawn of moral therapy moral therapy as a system originated with Philippe Pinel It refers to the practice of treating institutionalized patients as normally as possible, in a setting that encouraged and reinforced social interaction. Because of the rise of the moral therapy movement, institutions became habitable and even therapeutic.

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decline of moral therapy During mid 19 th century, moral therapy declined to factors such as overcrowded hospitals, limited staff, and lack of individual treatment The Mental Hygiene movement is associated with Dorthea Dix She urged that special facilities be provided to house mental patients, as well as the homeless Through her efforts humane treatment became more widely available in American institutions Another factor that led to a decline in moral therapy was the decision in the middle of the 19 th century, that mental illness was caused by pathology, and it was therefore incurable

Psychoanalytic Theory:

Psychoanalytic Theory Anton Mesmer is considered to be the father of hypnosis (mesmerize) He suggested that psychological problems come about due to an undetectable fluid called ‘animal magnetism’ which could become blocked others associated with the early beginnings of psychoanalytic theory include Charcot , Breuer and Freud

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According to Freud, the mind is composed of the id , ego , and superego The id operates on the pleasure principle , or the maximization of pleasure and minimization of competing tension. And was thought to be the source of sexual and aggressive thoughts and behaviors.

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The ego was thought to develop a few months after birth to realistically address one's environment; it operates on the reality principle via the secondary process, with an emphasis on logical and reasonable thought The superego (conscience) develops last and represents the moral standards instilled by parents or other important influences. The Ego mediates and resolves conflict between Id and Superego.

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Defense Mechanisms according to Freud, unconscious conflicts between the id, ego, and superego sometimes leads to anxiety to ward off anxiety, the ego may employ defense mechanisms, or unconscious protective processes to keep conflicts in check. Pychosexual Stages of Development Freud also theorized that people progress through psychosexual stages of development

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Ego Psychology Anna Freud (Freud’s daughter), emphasized the influence of the ego in defining behavior She was the first proponent of the modern field of ego psychology Ego psychology is derived from psychoanalytic theory It emphasizes the role of the ego in development, and attributes psychological disorders to the failure of the ego to manage impulses and internal conflicts Also known as self-psychology

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Object Relation Melanie Klein and Otto Kernberg developed Object Relations , which refers to the study of how children incorporate the images, memories, and sometimes the values of significant others object in this case refers to these important people the process of incorporation is called introjection Introjected objects can become an integrated part of the ego, or may assume conflicting roles in determining the identity, or self

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Psychoanalytic Therapy Many techniques of psychoanalytic therapy, or psychoanalysis, are designed to reveal the nature of unconscious mental processes and conflicts through catharsis and insight Freud developed techniques of free association whereby the patient is instructed to say whatever comes to mind without censoring Other techniques include dream analysis , whereby the content of dreams is examined as being symbolic of id impulses and intrapsychic conflicts

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The relationship between therapist and client in psychoanalysis is very important, for it is here where transference (i.e., when the patient begins to relate to the therapist as they did with important people in their lives) and countertransference (i.e., where the therapist projects their own personal issues and feelings, usually positive, onto the patient) play out

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Humanistic theory Primary humanistic theorists include Carl Rogers , Abraham Maslow , and Fritz Perls. A major theme running through this work is the view that people are basically good . A central concept of this approach is self-actualization , or the assumption that all people strive to reach their highest potential. With freedom and support, one's drive toward self-actualization can be highly successful. If this drive is thwarted, however, psychological problems may develop. Unlike psychoanalysis, the therapist takes a passive role, makes very few interpretations, and attempts to convey to the client a sense of unconditional positive regard.

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The Behavioral Model Ivan Pavlov discovered a simple form of learning, known as classical conditioning , where a neutral stimulus is paired with a response until it elicits that (conditioned) response (e.g., phobias, nausea associated with chemotherapy, food aversions). John Watson stated that the field of psychology should be based on scientific analyses of observable and measurable behavior. Watson is credited with creating the School of Behaviorism

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B. F. Skinner was strongly influenced by Watson’s conviction that a science of psychology must take as its subject matter behavior, but unlike Watson believed that the task of psychology was to account for all behavior, even behavior that can not be observed directly (e.g., thoughts, feelings). Skinner developed the field of behavior analysis and concepts related to operant conditioning (i.e., learning which occurs when responses are modified as a function of the consequence of the response).

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The behavioral model has contributed greatly to our understanding of abnormal behavior; however, this model has several limitations, failing to take into account biological and information processing factors, which requires us to seek better models. The present : The scientific method and an integrative approach The view that psychopathology is determined by different processes does possess a historical basis, and recent evidence suggests a strong reciprocal influence among biological, psychological, and social factors. No account alone is complete.

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