What makes a behavior disorded?

4 D's

• Deviance
• different from the norm
• Distress
• causes discomfort/anguish to self or others
• Dysfunction
• interferes with day-to-day life
• Danger
• to self or others

major clinical syndrome 

EX: depression, anxiety, eating disorders, schizophrenia

personality and developmental disorders (mental retardation)

EX: mental retardation, personality disorders, phobias, OCD

medical conditions

EX: brain injury, relevant medical conditions

psychological factors

EX: homelessness, unemployment

global assesment of functioning

EX: level of dysfunction in society on 1-10

• Symptoms
• recurrent, unexpected panic attacks
• worry, concern about having panic attacks
• significant change in behavior
• Prevalence
• lifetime: 1-2%
• onset: between adolescence and mid thirties
• 8x more likely if 1st degree relative has panic disorder

• anxiety about being in situations in which they can't escape/get help if needed

• heart palpitations
• sweating
• trembling/shaking
• nausea/dizziness

• Symptoms
• fear of social or performance situations due to fear of scrutiny/humiliation
• individual recognizes fear is excessive
• social or performance situation avoided or endured with extreme anxiety/discomfort
• Prevalence
• lifetime: 3-13%
• women > men
• onset: mid-teens or childhood
• may be caused by humiliating experience

• Symptoms
• intense, persistent fear that is excessive/unreasonable cued by the presence of a specific object or situation
• individual recognizes fear is excessive/unreasonable
• avoidance of feared stimulus
• Prevalence
• lifetime: 7.2%-11.3%
• onset: usually childhood

anxiety caused by trauma

• Symptoms
• re-experiencing the trauma
• nightmares, unwanted thoughts, flashbacks, distress when exposed to "triggers"
• avoidance
• emotional, situational, behavioral, social
• increased arousal
• hypervigilance, restlessness, irritability, exaggerated startled response
• Prevalence
• 8% of population in US
• high amount of war veterans, rape victims, survivors of genocide
• can occur at any age
• severity and duration related to factors related to the traumatic event

Obsessive-Compulsive Disorder

(OCD)

• Symptoms
• recurrent obsessions which they cannot control
• engaging in compulsive behaviors to alleviate distress due to obsessions
• compulsion is often ritualized
• Common Obsessions
• cleaning, safety, orderliness
• Prevalence:
• men=women
• in childhood---> boys > girls
• onset in adolescence/early childhood
• gradual onset

• genetic predisposition
• GABA deficiency
• anterior cingulate cortex overactive
• especially in OCD

• abuse/trauma
• chronic abuse/stress
• conditioning/modelling

• neuroticism
• cognitive style

• Symptoms
• depressed mood (feeling sad/empty)
• anhedonia (loss of interest/pleasure)
• must have one of the above 2 to be diagnosed
• changes in apetite
• changes in sleep
• changes in motor activity
• fatigue
• feelings of worthlessness and guilt
• difficulty concentrating
• suicidal ideation
• must have atleast 5 of the above to be diagnosed
• Prevalence
• lifetime prevalence of 8-19%
• most common psych disorder
• women>men
• onset: early 20s but can happen at any age
• course: episodic
• a month of feeling fine, a month of feeling depressed

• not a distinct disorder
• subtype of major depressive disorder
• symptoms of depression begin in late fall/early winter
• specific symptoms
• hypersomnia
• over eating
• weight gain
• increased craving of carbs

• milder form of depression
• rarely suicidal
• 6% lifetime prevalence
• women>men
• usually begins in childhood
• course is chronic
• may lead to major depressive disorder

• course
• episodic vs. chronic
• severity
• MDD > dysthymia

• genetic disposition
• 2 short forms of the serotonin gene
• serotonin deficiency
• stress shown to kill neurons in animals
• interaction between gene for serotonin & number of stressors

• multiple stressors
• loss

• cognitive behavioral theory
• learned helplessness
• social norms

• acquired belief that one is helpless and unable to affect the outcomes of one's life
• Martin Seligman's dog study
• loss of control over circumstances lead to depression like symptoms
• shock dogs with barrier and then remove barrier dogs still dont move

• cycles of depressive and manic episodes
• sypmtoms of mania (DIGFAST)
• prevalence
• lifetime: .4-1.6%
• no major sex difference
• onset: early 20s (any age possible)
• course: episodic

• sypmtoms of mania (DIGFAST)
• distractibility
• indiscretion: more risky behaviors that the wouldnt usually participate in
• grandiosity: "messenger of god"
• flight of ideas: jump from one idea to the next
• activity increased: "clean entire house x3" "cook same meal 5 times"
• sleep: decreased need
• talkativeness:  talking so much/fast that person cannot get a word in

• milder form of bipolar
• lifetime prevalence: .4-1 %
• no sex differences
• onset often in adolescence
• chronic course

• cyclothymia is a milder form of bipolar
• course
• episodic vs. chronic
• onset
• early 20s vs. adolescence

• paranoid
• catatonic
• disorganized

• hallucinations/delusions
• relative preservations of cognitive ability

• immobility or excessive motor activity
• negativism/mutism
• echolalia/echophoria: mimicking speech or actions

• disorganized speech, behavior
• flat/inappropriate affect
• EX: laughter in an inappropriate situation

• mix from several categories

• may still have small symptoms after treatment

• lifetime: .5-15%
• no gender or cultural differences
• onset:
• men early 20s
• women late 20s
• prodromal phase
• 80-85% heritability

• excessive dopamine
• glutamate dysregulation
• enlarged ventricles/decreased corticol volume
• abnormal brain activity

• frontal lobe: emotion regulation, thinking actions
• auditory/occipital: hallucinations
• basal ganglia: disturbed motor movements
• hippocampus: memory problems
• paranoid- remember too much
• disorganized/catatonic- loss of memory

• Axis II diagnosis
• begins in childhood, relatively stable/permanent, pervasive
• 3 main families
• odd-eccentric
• dramatic-emotional
• anxious-fearful

• asocial
• odd/bizarre thoughts/beliefs
• sometimes seen as a mild form of shizophrenia
• may experience transient psychotic episodes (lasting minutes to hours)
• males > females
• theory of development similar to that of schizophrenia

• arrogance/extremely positive self view
• self centered/egocentric
• lack of empathy
• more sensitive to "injury" frin criticism/defeat, and may react with rage or vengeful behaviors
• slightly more with men than women

• emotional lability
• fear of abandonment
• idealizing vs. despising others
• high rate of suicide/self-harm/substance abuse
• history of undermining goal attainment
• women>men
• high treatment seeking

• impulsive, deceptive, violent, callous
• often engage in criminal behavior/disregard for social norms
• lack of guilt/remorse/empathy
• psychopathy
• high rate of young deaths/suicides
• prevalence: 41%

• extreme fear of criticism
• low self-esteem
• avoidance of social interactions
• more severe/general social phobia
• often completely socially isolated

• rigid habits
• need to have control (may become angry if lose control)
• extreme perfectionism
• may express emotion in a highly controlled/stylized manner
• men>women

Attention Defecit Hyperactivity Disorder

(ADHD)

• Inattention
• Hyperactivity
• Impulsivity
• Prevalence
• 3-7% of school aged children
• boys > girls
• Course
• first diagnosed in elementary school
• symptoms go away once child reaches adolescence/adulthood

• genetic disposition
• low levels of brain activation- norepinepherine deficiency
• slower development in frontal lobes

• prenatal exposure to drugs
• unstructured parenting style (exacerbates symptoms)
• sugar intake is NOT associated with the development of ADHD

• impulsivity
• O.D.D. or conduct disorder

Autistic Disorder

(autism)

• Symptoms
• impaired social interaction
• impaired communication
• repetitive, stereotyped behavior
• Prevalence
• 6-7% (increased since past years)
• men > women
• course
• chronic
• symptoms began prior to age 3

• on the autism spectrum
• impaired social interaction
• repetitive/stereotyped behavior or interests
• NO significant delay in language or cognitive development

• developmental disorder
• abnormal brain growth
• smaller at birth, then grows rapidly
• mirror neurons

• "hot spots" (areas of high incidence)
• NOT caused by vaccines

• theory of mind
• hypersensitivity to sensory stimulation

• cause of mental illness is unconcious conflict
• goal is to help clients
• therapists role is to interpret and analyze information

• free association
• dream interpretation
• resistance: as they get closer to uncovering conflict & patient resists
• transference:  most important part of psychodynamic therapy (positive or negative)
• interpretation

• cause of mental illness is that self-growth is being blocked
• goal is to help clients achieve self actualization
• therapists' role is to provide an environment condusive from self actualization and self growth

• person-centered approach (Carl Rogers)
• unconditional positive regard
• empathy
• genuineness

• cause of mental illness is maladaptive thought process
• goal is to discover and change maladaptive conditions
• therapists role is to challenge clients thoughts
• identify and dispute irrational thoughts

• Activating Event
• Belief System
• Consequences
• Disputing

making worst possible assumption

(cognitive therapy "patterns of problematic thinking")

black and white, no in between

(cognitive therapy "patterns of problematic thinking")

making assumptions about what other people think

(cognitive therapy "patterns of problematic thinking")

making something significant seem like nothing

(cognitive therapy "patterns of problematic thinking")

one bad exam means going to fail all exams

(cognitive therapy "patterns of problematic thinking")

• behaviors can cause mental illness (may not only be a symptom)
• goal is to learn more adaptive behaviors
• therapists role is to help identify problem behaviors and use operant conditioning as well as modeling to teach new behaviors

• used to treat anxiety disorders (most commonly phobia, but also OCD and PTSD)
• expose client to feared stimulus until fear response is extinguished
• controversial
• classical conditioning principles

• type of exposure therapy
• hierarchy of overse stimuli
• slowly expose client to feared stimulus while practicing relaxation techniques
• classical conditioning principles

• use reinforcement/punishment to increase/decrease behaviors
• applying principles of operant conditioning
• often used in childhood disorders, autism spectrum disorders, and health psychology
• EX: token economy- desirable behaviors are reinforced with a token such as a small chip or fake coin to be exchanged for privelages

• used to treat depression
• help the client engage in activities that are rewarding
• hierarchy of rewarding activities
• teach problem solving, social skills
• operant conditioning and modeling principles

• integration of cognitive and behavioral therapies
• most commonly used therapy
• also looks at the interaction between thoughts and behaviors

• incorporate concept of mindfullness to humanistic and CBT
• elements of eastern philosophy
• types
• acceptance and commitment therapy
• dialectical behavior therapy

• mental illness is caused by psychological inflexibility
• Fusion with thoughts, Evaluation of experience, Avoidance, and Reason-giving
• focus is on becoming more psychologically flexible
• accept your experience and be mindfully present, choose a valued direction and take action

• developed to treat a boderline personality disorder
• also used with eating disorders and substance use disorders
• goal is to reduce self-destructive behaviors
• focus on mindfullness, distress tolerance, emotion regulation, and effective interpersonal skills
• individual and group therapy

• goal is to experience acceptance, support, and a sense of belonging
• learn new approaches to problems by observing others
• gain insight into how you are perceived by others

• client variables
• therapist variables
• techniques

• personal problems originate within an individual
• problems take the form of dysfunctional thinking, conflict and stress responses
• people are capable of expressing feelings
• people should take personal responsibility for impovement
• rates of mental illness and utilization of services differ among ethnic groups

• cultural norm against turning to proffesionals outside one's culture
• experience with discrimination
• language barriers
• access
• cant afford it
• not in an area where available
• therapists knowledge of cultural issues

• psychological disorders occur more frequently among women
• impact of specific stressors
• lack of opportunity
• strains of multiple roles
• history of violence and abuse

• decrease action of dopamine
• reduce positive symptoms of schizophrenia (hallucinations, delusions)
• little effect on negative symptoms
• can prodice tardive dyskinesia

• newer antipsychotic medications reduce this risk
• irreversible

• reduce anxiety without affecting alertness or concentration
• slow down excitatory synaptic activity in the nervous system
• multiple side effects: drowsiness, easily overdose
• EX: nezodiazepines, barbituates

• possibility for toxicicity
• antidepressant drug

• milder side effects
• reduce depressive symptoms more rapidly
• antidepressant and anxiety drug

• norepinepherin & dopamine
• more effective for extreme fatigue
• no effect on seratonin
• can cause seizures/anxiety
• antidepressant drug

• mood stabilizer
• used to treat bipolar disorder
• mechanism of action unknown, but thought to affect serotonin and norepinepherin
• adverse side affects

• used to treat ADHD
• derived from amphetamines
• work by increasing norepinepherin in the frontal lobes
• side effects include anxiety, restlesness, irritability, weight loss, and insomnia

• patient is given a sedative and a muscle relaxant
• brief shock (less than one second) is applied to one hemisphere of the brain, causing seizure
• short term effects: headache, sore muscles, confusion
• long term effects: memory loss
• short term fix, feels better but eventually depressed again
• effect can be immediate
• no one knows why it works
• used primarily in patients with major depression who cannot take or do not respond to medication
• used only in extreme cases
• used particularly with incidents of high suicide thoughts

• used to treat parkinson's disease and severe depression
• electrodes implemented deep in the brain to regulate neural activity which can be activated by external "pacemaker"

• bursts of high-intensity magnetic field
• optimal levels not yet clear

• removal or destruction of brain tissue in an attempt to change a disordered behavior
• used rarely, as a last resort
• more common in early 20th century
• most common use - treating uncontrollable epilepsy
• temporal lobe and corpus collosum
• removal of dead tissue impacting regular brain functioning due to stroke, epilepsy, traumatic brain injury