Psychopathology

Behavioral definitions of psychopathology (aka "mental disorder"): psychopathology refers to behaviors

Eg. Unusual behaviors, socially deviant behaviors, maladaptive behaviors

This Class Definition of psychopathology

1.      Many consensus pathologies do not involve by characteristic behaviors (behaviorist didn’t cover the whole definitions)

2.      Specific type of behaviors doesn’t apply to all with a similar issue (depression & anxiety people don’t behave such behavior) -hard to measure

Disability/dysfunction definition of psychopathology:

Behavioral definition: Harmful disfunction (behavioral disability – disjunction) not to kind of behavior.

Ossorio’s Disability definition: psychopathology refers to behavioral disability (dysfunction, functional impairment), not to a kind of behavior

A.    The preferred version” A person is pathological state when there’s a significant restriction in his or her ability to engage in deliberate action and, equivalently, to participate in the social practices of the community” (Ossorio, 2006)

B.     Elements of Ossorio’s Definition:

·        Significant restriction inability

·        To engage in deliberate action (e.g., People doesn’t know what he or she is doing)

　　　　　　　　　　　　                 (e.g., People can’t control of behaviors) 　　　　　　　　　　　　

·        Participate

·        The social practice of community

·        Mental health cf.- Fread: the ability to love and work

Base on Ossori’s definition:

Jill choose to starve in order to reach a certain goal (release her husband’ Infor from the government); therefore, she was not mentally impaired. (huger strike) However, base on the behavioral she did.

Normality and Positive Mental Health:  

Normality: “normal” = not abnormal, not pathological; it’s simply absence of pathology.

Does that mean the success of therapy only bring you back to normal? 

Beyond normality: “positive mental health.” a person is

(1) not in a pathological state, but, beyond this, is

(2) very capable of participating in life in a meaningful and fulfilling way—very able to “love and   

      work”

Phobia

Definition: a persistent and unreasonable fear of a particular object, activity, or situation(comer,2018).

      -------Must be debilitating, disabling

Typical kinds of phobia:

1.      Agoraphobia(廣場恐懼症): fear of being away from safe home base and having something terrible happen (especially a panic attack) most common phobia

2.      Claustrophobia   幽閉恐懼症

3.      Specific phobias 特殊恐懼症

--Animal phobias (e.g., cats, snakes, birds, spiders)

--Inanimate objects or situations (e.g., the dark, heights, flying, enclosed spaces)

--Social anxiety disorder/social phobia社交恐懼: fear of doing something in public that would bring about intense embarrassment or humiliation.

-- Case: Hilda’s snow phobia (forgotten experience 11 years ago)

7. What is the behavioral explanation of phobias? What causes them to develop in the first place

            and what causes them to persist for a long time?

Behavioral Theory Explanation of Phobias:

1.       Classical conditioning: some neutral stimulus (e.g., snow) gets paired with another stimulus that naturally elicits an intense fear response (e.g., getting buried in an avalanche), and thereby acquires the ability to elicit that fear response.

2.      Modeling explanation of phobia. (Behavioral theory)

A person acquires phobia by observing another person who is afraid.

(e.g., Stephine’s child washing her hands)                                                                                                                            

3.      Phobia endure because extinction (re-exposure without negative consequences) doesn’t occur –person doesn’t learn that X (e.g., snow) is safe, continues to avoid X.

Loophole: However, it doesn’t cover all cases (e.g., they are afraid where never had any experience)

                                                                           (e.g. Delay fear condition)

What are the two psychoanalytic explanations of phobias? 

Freud’s psychoanalysis:

1.      Phobic person really afraid of something else. Apparent feared object is really a “displacement object” (afraid of X is because they are afraid of Y—attach the fear to X)　　

2.       Freud’s theory of all neurotic symptoms: stressful life event(s) drain energy from ego and superego or give additional energy to repressed contents, resulting in symptoms

10. What explanation was offered in class for the delayed onset of many phobias?

People repress contents and anxiety, and then an event occurs that is similar to the repressed events, and this evokes the phobia symptoms. Phobia can be repressed until the ego runs out of energy and the id surfaces. Big changes stress a person out, and stress comes in the form of a phobia.

Post-traumatic Stress Disorder (PTSD)

Symptoms: Anxiety/fear that something traumatic will happen again, triggered by event.

·        Anxiety (hypervigilance 過度警惕) a) Expecting repeat event; the unsafe, unpredictable world

·        Reliving                                                b) Relive problem in order to solve it

·        Emotional numbness (麻木)            c) Preemptive motive: so focused on event that nothing else                

                                                              matters

·        Survivor guilt                                    d) Didn't deserve to live- the world should be just

III. After a traumatic event, who is at greatest risk?

A.    Those with the greatest severity, proximity to, and duration of trauma

B.     Those with less social support or can’t access (such as sexual assault)

C.     Those who suffer “shattered assumptions” (implicit assumption)

E.g. People believe the world is meaningful and things happen for a reason, but if they seem.  

       unreasonable they will suffer a greater risk of PTSD 

·        People believe that bad thing shouldn’t happen to good people                    

·        Try to make meaning to the unreasonable event will help them feel better

·        Janoff-Bulman's (1992) shattered assumptions theory proposes that people possess three kinds of fundamental assumptions, specifically that the world is benevolent, the world is meaningful, and the self is worthy.

D.    Biological factors

·        Genetics: stronger than average physiological responders

IV. Why delayed onset in some cases?

1.      Psychoanalytic explanation: recall from phobia lecture:

People represses something => later, life stressor occurs=> People can’t maintain repression

=> repressed contents emerge as symptoms.

Counter example: people who doesn’t have the memory of the event (John)

2.      What about John? NO repression and No memory at all for his car accident where his wife passed away, and his daughter got hurt. Later, when he back to work, he starts to get PTSD, which didn’t appear in the first six months.

IV. Therapies for PTSD

A.    Drug therapy

1.      SSRI’S(e.g., Zoloft, Paxil) most helpful (Selective serotonin reuptake inhibitors)

2.      Drugs achieve partial symptom Relief

·        Drug won’t take away someone’s believe which is the main reason leading to PTSD

·        Can help with the reliving and savior guilt

3.      Usually suppress, but do not cure --- problem often returns when drugs discontinued

B.     Psychotherapy

1.      Exposure therapies (confront the worse fear--imaging the event or use VR to re-experience)

a.      Disclosure (telling the story/ re-exposing to the event)—relief by the attentive listener 

b.      Desensitization: de-muscular realization, create a hierarchy of fear and realization

c.      EMDR (eye movement desensitization and reprocessing).

--the case of “Anne.” (car accident—can’t drive)

·        First, imagine yourself back to the event

·        Picture the emotion at that particular moment and the thought

·        Keep your eye on my hand then wave your hand (couple time)

·        Imagine the event and repeat the procedure.

Panic Attack

I.                 Panic disorder: P has recurrent, sudden, intense panic attacks of short duration.

A.    Seem to come out of nowhere; no identifiable feared object.

B.     Often accompanied by agoraphobia (P afraid leave safe home base and have attack)

C.     Some point in their life experience 5 % of American experience the panic attack

                    e.g., Sadata’s story of panic attack leads to agoraphobia (can’t leave home)

                   Stress event: Intensive interpersonal relationship with bf/ leg break / Grandfather died.

                            Intensive closure therapy (step by step)

II.               The Diathesis-stress model of panic disorder: a biological vulnerability (diathesis) and psychological factors (stress)combine to cause disorder

A.    Diathesis (biological vulnerability):

1.      Genetics: 31% concordance rate: similar genetic composition will lead to a higher rate

2.      What is inherited? Dysregulation of neurotransmitter norepinephrine: makes P more physiologically responsive.

3.      Stress: panic reaction due to cognitive factor, a misinterpretation of anxiety-related

             bodily events.  (stronger physical response to stress)

III.            Therapy for Panic Disorder

A.    Drug therapy

1.      Antidepressants (e.g., SSRIs) and antianxiety drugs(e.g., Xanax) helpful

2.      Reduce panic attacks, but high relapse rate when P goes off drugs

             Why high relapse rate: only stop the physical part that triggers the panic but did not fix the roots

B.     Cognitive behavior therapy (CBT)

1.      Exposure therapy

2.      Reattribution therapy (reconsider the anxiety)

3.      Relapse rate only 10%

4.      Remove the root of misattribution (the cause)

      IV. A final thought about Sadata’s case

            1.    after affect therapy

Cognitive perspective on the development of Panic Disorder:

People who misinterpret the physiological events that are occurring within their bodies. (Cognitive aims to correct misinterpretations)

Generalized Anxiety Disorder (GAD)

+++廣泛性焦慮症+++

I.                 Clinical picture: person in high anxiety state much or all of time: can’t identify source of fear; worries excessively (Worriers tend to have higher IQ)

II.               Theories

A.    Biological

1.      Primary theory: deficiency of neurotransmitter GABA at critical brain sites.

2.      Secondary theory: serotonin deficiency

B.     Cognitive theory

1.      P has “maladaptive assumption” E.g., Dangerous world view

The world is a dangerous place where bad things could happen at any time

Chronically worries about: Social, financial, or objects could hurt you.  

2.      I would be unable to deal with these bad things effectively

(not tide to a specific object or places)

(something bad happened to trigger the taught)

III.             Treatment

A.    Drug treatment

1.      Anti-anxiety and antidepressant drugs helpful in reducing anxiety levels.

·        Might have side effect

2.      High rates of relapse

B.     Cognitive Therapy

1.      Therapist works with P to alter maladaptive assumptions

·        Target the maladaptive idea=> and alternat the way of maladaptive thinking

·        How the danger is your world

·        Remind themselves about their ability to handle things

·        Solution Therapy

Obsessive-Compulsive Disorder (“OCD”)

Case:

Brian: claiming up to stair- the position must be right, neatness

Ruth: Imagine something bad might happen if not perform certain behaviors/ hand wash (70 time/day)

Definition: OCD is a mental disorder in which a person feels the need to perform certain routines repeatedly (called "compulsions"), or has certain thoughts repeatedly (called "obsessions"). The person is unable to control either the thoughts or activities for more than a short period of time.

I.                 Symptoms: recurrent obsessions and compulsions

A.    Obsessions: distressing, anxiety-provoking thoughts, images, and temptations that intrude into a person’s consciousness and which person can’t get rid of. Thought about different kinds of dangers or impulsive to perform something bad such as killing.  

B.     Compulsions: actions, overt or mental, which person feels compelled to engage in over and over

·        Public observable behaviors or mental virtual/hand wash

·        Acting on the content of the obsession

However, the person is “not” mentally disable and can pass mental pathology tests like normal P do. 

II.               The case of “Ben FN:

·        Overprotective - an only child (smart)

·        Freshmen in college- first time away from home (N Colorado)

·        Lived in ranch

·        Want to become a Ranch consultant

·        During consoling session “to keep them from being wipe out” (protect)

                                          “keep my parent out of this”

·        Want to have control over the situation

The compulsive action: turn off all the electrical switch

Anxiety-provoking thoughts: Electrical fire

Why: this might cause hug property loss and fail to have insurance cover. Therefore, his  

          Parents have to pay for the bill, and they will be bankrupt. His parent will be disgraceful.

          in public because of him. (Don’t want his parent to worry what he does) 

III.             Theories of causation

                                i.          Psychoanalytic theory

                                              1.          General theory of neurotic symptoms again: repressed contents emerge as symptoms (recall case of Hilda/ don’t like snow)

                                              2.          Displacement theory: person defends against more threatening idea by substituting less threatening one.

                              ii.          Cognitive-behavioral theory of OCD

                                              1.          Most people have distressing thought and images once in a while

                                              2.          Most shrug them off; others can’t

                                              3.          Latter tend to be persons who…

                                                             a.          Are depressed

                                                             b.          Are under a lot of stress

                                                             c.          Have especially abhorrent ideas

                                                             d.          Reach harshly to self

                                              4.          Person reduces anxiety from the obsessions by

                                                             a.          Engaging in compulsive acts

                                              5.          Preferred therapy: (a) exposure with response prevention + (b) cognitive structuring

             Explanation:

When people have the thought and can't shake it, it can become an obsession. The people who can't shrug them off are people who tend to be depressed, under a lot of stress, have especially abhorrent ideas, react harshly to self. The person reduces anxiety from obsessions by engaging in compulsive acts. Action is reinforced by anxiety reduction.

                             iii.          The biological theory of OCD:

                                              1.          Genetics: concordance rate = 53%

                                              2.          A dysfunction in areas of brain regulating primitive impulses -- overactive in OCD sufferers

                                                             a.          MRIs show high activity levels in these areas in OCD patients (Recall Stephanie's MRIs)

                                                             b.          Are brain events cause? Consequences? Related as part to the whole?

                                              3.          Drug therapy:

                                                             a.          Antidepressant drugs that elevate serotonin (SSRIs) are helpful 50-60% of the time on reducing, but not eliminating, OCD symptoms

                                                             b.          But relapse rate high after P goes off drugs

IV.            Therapies for OCD

                                              1.          Meta-analysis: effective 83% of the time

                                                             a.          E.g., Stephanie, Ben F, Barlow's patients

                                                             b.          Successful psychotherapy changes brain chemistry

                                            

Disorders Focusing on Somatic Symptoms - Conversion Disorder (Read the Book)

Case: Bell & Harry feel unexpected pain but not a thing wrong with the neurology

I.                Characteristic of conversion disorder

A.    Lost or altered physical function

B.     No physical basis

C.     Person not faking; can’t control

D.    P seems oddly indifferent to the problem

II.               Explanations:

A.    Hypnosis & Autohypnosis (highly suggestible people)

　　　　　　　Relaxation Test: but the patient said you paralysis me (not sure)                           

                            Auto Hypnosis: Not base on physiological cause

B.     Psychoanalysis:

1.      Primary Gain: Solves a Problem in P’s life w/o P having to recognize it

·        Don’t want to face it: Feel guilty but don’t want to recognize it therefore they repressed the problem (unconsciousness punish himself of what he done to his friend)

·        Feel she don’t want to stay home to take care of her father anymore: unconsciousness symptom against from staying at home

2.      Secondary gain: P may derive advantages from problem; E.G., get out of work

(primary behavioral explanation)

C.    Cognitive-Communication Theory

1.      P is communicating with illness (Can’t say it but use what I do to communicate)

·        Verbally articulate (can't explain what’s wrong)

　　　　　　Harry unconsciousness use this to gain attention from his wife base on childhood experience.

                           (gain attention to his parent’s attention when he was sick) 

D.    Why indifference to the Problem?

1.      Are there aware at some level it’s not real?

2.      It’s your solution, not your problem

Dissociative Identity Disorder (AKA” multiple personality disorder”)

I.                 Definition: Dissociative disorder in which a person develops two or more distinct personalities

Case: Wamedia

·        Split form of personalities in the sense of survival

·        Create he/she they to face the situation they can’t deal or protect themselves  

II.               Bliss’ Theory of D.I.D

A.    P experiences early trauma

B.     Copes by creating an alternative personality to deal with it

1.      First “alter” very unacceptable, thus very hard to integrate

·        Virtually always has trauma and all experience 97% early traumatic event

·        11 out of 12 case murder who have D.I.D and ware abused and removed from their home when they were young. 

2.      When called personality can’t P “Dissociates”

I E.,” Split off” (Switches) into second personality that can deal with it

C.     P are good at autohypnosis (self-hypnosis)

1.      Able to induce Amnesia (the first personality don’t know what second has done)

2.      Single way amnesia or mutual way amnesia

D.    P makes life pattern, in the face of difficult situations of creating a new personality to deal with it

In general, women have average of 15 personalities and men have 8

                                                         

III.             Dramatic Difference Exist Between Personalities

e.g: different “allergic”, gender, identity, sexual orientation, blood pressure, cycle  

IV.            Therapy for D.I.D

Help the patient to A. Recognize their disorder

                            B. Recognize lost memories

                            C. integrate the sub-personalities

V.              Issue: is it real? Racheal Beyoncé (fake)

Different in Brain wave patterns, evoke potential (react to a flashlight)

Ask college students to play role shows not different on brain waves.