Zainab Ahmed

AC (IR)
43rd Common
CLINICAL PSYCHOLOGY
 Abnormal vs. normal
Distinguishing abnormal from normal
• Deviation from the average: observe the
behaviors that are rare or infrequent in a given
society or culture and label these deviations
from the norm as abnormal
Criticism: some behaviors which are statistically
rare don’t lend themselves to be classified as
abnormal, insufficient definition
 Abnormal vs. normal
• Deviation from the ideal(Striving for
perfection): an approach that takes into
account not what most people do (average)
but the standard towards which most people
are striving-the ideal. Behavior is considered
abnormal if it deviates enough from some
kind of ideal or standard
Criticism: standards change overtime and
society has few standards about which people
agree
 Abnormal vs. normal
• Abnormality as a sense of subjective
discomfort: concentrates on the psychological
consequences of the behavior for the
individual. Behavior is considered abnormal if
it produces sense of distress, anxiety or guilt in
an individual or if it is harmful to others in
some way
Criticism: in some particularly severe forms of
mental distress, people report feeling euphoric
yet their behavior is bizarre for others
 Abnormal vs. normal
• Abnormality as the inability to function effectively:
those people who are unable to adjust to the
demands of the society or function effectively are
considered abnormal according to this approach eg.
Unemployed homeless woman
• Continuum of normal and abnormal behavior: the best
way is not to consider normal and abnormal behavior
as absolute states. Rather they should be viewed as
marking the two ends of a continuum (scale) of
behavior with completely normal functioning at one
end and totally abnormal at the other
 Abnormal vs. normal
• Criteria prior to interventions:
1. Dangerous to himself or herself
2. Incapable of providing for basic physical
needs
3. Unable to make reasonable decisions about
whether treatment is required
4. Require treatment or care
 Models of Abnormality
• Biological model:
When an individual displays abnormal behavior
cause is physiological. Root cause will be found
in physical examination such as hormonal
imbalance, a chemical deficiency or an injury to
the part of body
Criticism: many instances where no physiological
cause is identified
 Models of Abnormality
• Psychoanalytic model:
Abnormality stems from childhood conflicts.
Unconscious plays an important role. If conflicts
are not resolved in childhood they remain
unresolved in unconscious and eventually bring
about abnormal behavior.
Criticism: no conclusive way of linking both.
Treatment dependent on others and not the one
who is ill
 Models of Abnormality
• Behavioral model:
Abnormal behavior itself is the problem to be
treated, rather than viewing behavior as a symptom
of some underlying medical or psychological
problem. Both normal and abnormal behavior are
seen as response to a set of stimuli. Critical to
analyze how an abnormal behavior is learned by
observing the circumstances in which it is displayed
in order to explain why such a behavior is occurring
Criticism: rejects the notion of person’s thinking
 Models of Abnormality
• Cognitive model:
Thoughts and beliefs are main component of
abnormal behavior. People have complex
unobservable thoughts that influence their
behavior which cannot be ignored. A primary
goal of treatment using cognitive model is to
explicitly teach new cognitions. Opts learning as
a central approach.
 Models of Abnormality
• Humanistic model:
People are basically rational and abnormal
behavior results from an inability to fulfill
human needs and capabilities. Emphasized on
the control and responsibility that people have
for their own behavior even when such behavior
is abnormal.
Criticism: reliance on unrealistic and unverifiable
information
 Models of Abnormality
• Sociocultural model:
Behavior both normal and abnormal is shaped by
family, society and cultural influences. Daily
interactions with the environment and other people
can promote and maintain abnormal behavior. Certain
kinds of abnormal behavior are more prevalent in
some social classes than others. Schizophrenia is more
prevalent in lower socioeconomic societies.
Criticism: “Nothing is wrong with the individual
violating laws rather something is wrong with the
society”
 Classifying Abnormal Behavior
Classification systems are necessary in order to
be able to understand and ultimately describe
abnormal behavior
Diagnostic and Statistical Manual of Mental
Disorders(DSM): A manual that presents
comprehensive definitions of more than 20
separate diagnostic categories for identifying
problems and behaviors
 Classifying Abnormal Behavior (DSM)
• Evaluates behavior according to 5 dimensions or
axes
• First three axes asses the person’s present
condition according to the particular maladaptive
behavior being exhibited
• Fourth and fifth axes take into account a broader
consideration of people focusing on the severity of
stressors present and the general level of
functioning over the past year in social
relationships, work and leisure time
 Classifying Abnormal Behavior (DSM)
Advantages:
• Provides a descriptive system
• Allows communication between mental health
professionals of diverse backgrounds and approaches
and does not immediately suggest that there is only
one appropriate treatment
• Precise classification enables researchers to go forward
and explore the causes
• Revised periodically reflecting the fact that changes in
society affect what behaviors are viewed as abnormal
 Classifying Abnormal Behavior (DSM)
Disadvantages:
• Criticized as viewing abnormal behavior primarily in terms
of symptoms of some underlying physiological disorder
• Restricts people into inflexible categories. It would be more
reasonable to use systems that classify people along some
sort of continuum or scale
• Labeling an individual as a deviant provides a lifetime
stigma that is dehumanizing
• Tendency for a diagnosis itself to be mistaken for an
explanation of a problem
• Rigid labels with more concentration on initial diagnosis
MAJOR DISORDERS
 Differentiation
Neurotic Disorder Psychotic Disorder Psychosomatic Disorder
Patients are well aware of Patients are not well aware Psychosomatic is a term
their own behavior and of their own disorder and which combines body and
disorder. Consciousness of the consciousness of the mind. It refers to the mind
the patient is well patient is not well having influence or
maintained maintained possibly creating a bodily
illness
Causes can be physical Genetic, environmental or Cause of somatoform
factors stressing out the psychological factors could disorder is not understood.
mind which may produce be the cause. They are also They manifest themselves
psychoneurotic symptoms known to run in families as medical symptoms with
no medical cause
Examples: anxiety Example: schizophrenia Example: conversion
disorders and mood disorders and
disorders hypochondriasis
 Anxiety Disorder
The occurrence of anxiety without obvious
external cause intruding on daily functioning.
Anxiety: a feeling of apprehension and tension
• No external reason or cause
• Four types
 Anxiety Disorder
Generalized Anxiety Disorder:
• The experience of long term anxiety without
explanation. Such people are afraid of
something but are unable to articulate what it is.
• Cannot concentrate and set aside their fears
• Because of heightened muscle tension,
individuals with generalized anxiety disorder
may begin to experience headaches, dizziness,
heart palpitation or insomnia
 Anxiety Disorder
Panic Disorder:
• Sudden anxiety characterized by heart palpitations,
shortness of breath, sweating, faintness and great
fear
• Panic attacks last from a few seconds to as much as
several hours
• Sense of unavoidable doom
• Symptoms vary from person to person, may include
heart palpitation, sweating, shortness of breath etc.
• After such an attack people tend to feel exhausted
 Anxiety Disorder
Phobic Disorder:
• A disorder characterized by unrealistic fears (phobias)
that may keep people from carrying out routine work
• Phobias: intense, irrational fears of objects or
situations
• Although the objective danger posed by an anxiety
producing stimulus is typically small or non existent, to
the individual suffering from phobia it represents great
danger
• Specific identifiable stimulus that triggers anxiety
 Anxiety Disorder
Obsessive Compulsive Disorder:
• A disorder characterized by obsessions and compulsions
• Obsessions: a though or an idea that keeps recurring or they
feel they must carry out some actions termed “compulsions”
against their will.
• Compulsions: an urge to repeatedly carry out an act that even
the sufferer realizes is unreasonable
• For people with serious obsessions, thoughts persist for days or
months or may consist of bizarre and troubling images
• There is no reduction of anxiety from carrying out a compulsive
ritual. They tend to lead their lives with unrelenting tension
 Causes of Anxiety Disorder
Biological Approaches:
• Genetic factors play an important role in anxiety disorder
• Chemical deficiencies in the brain may produce some kind of
anxiety disorder eg. Low level of certain neurotransmitters lead
to OCD
Environmental Approaches:
• Behavioral psychologists consider anxiety to be a learned
response to stress
Cognitive Approaches:
• Suggest that anxiety disorders are an out growth of
inappropriate and inaccurate cognitions about circumstances in
a person’s world
 Mood Disorders
• Affective disturbance (disturbances in emotions and feelings),
severe enough to interfere with normal living
Major Depression:
• Severe form of depression that interferes with concentration,
decision making and sociability
• One of the most common form of disorders
• Women are twice as likely as men to suffer from depression
• Experiencing life’s disappointments are fine but people who suffer
from major depression experience similar sort of feelings but the
severity is considerably high
• May feel useless, worthless, lonely, uncontrollable crying etc.
• The depth of such behavior and length of time it lasts are
hallmarks of major depression
 Mania and Bipolar
Mania: an extended state of intense euphoria
and elation. People experiencing mania feel
intense happiness, power invulnerability and
energy.
May become involved in wild schemes. Mania is
often found paired with bouts of depression.
This alteration of mania is bipolar disorder
 Mania and Bipolar
Bipolar: a disorder in which a person alternates
between euphoric feelings of mania and bouts
of depression. Also known as manic depression
disorder
The swings between highs and lows may
alternate over a period of years.
Periods of depression tend to be longer than
periods of mania
 Causes of Mood disorders
• Psychoanalytic Approach: depression as the result
of anger at one’s self. People feel responsible for the
bad things that happened to them and direct their
anger inwards
• Biological Approach: heredity plays a role in bipolar
disorder. Chemical imbalances.
• Cognitive Approach: depression is largely a response
to learned helplessness. A state in which people
believe they cannot escape from or cope with stress
and they give up fighting. Negative cognitions.
 Somatoform Disorders
• Psychological difficulties that take on physical
form of one sort or another
• No underlying physical problem but patient
reports physical symptoms
• Hypochondriasis: constant fear of illness and
misinterpretation of normal aches and pain.
Symptoms are not fake
 Somatoform Disorders
Conversion disorder: psychological disturbances
characterized by actual physical disturbances such as
inability to speak or move one’s arm (no biological basis)
• Rapid onset eg wake up blind or deaf
• Lack of concern over symptoms
• Occurs when individual is under some kind of
emotional stress
• The emotional problem is turned into a physical
ailment that acts to relive the source of the original
emotional problem
 Dissociative Disorders
• Psychological dysfunction characterized by the
splitting apart of critical personality facets that
are normally integrated allowing stress
avoidance by escape
• By dissociating themselves from key parts of
their personality, individuals with this disorder
can eliminate anxiety
 Dissociative Identity Disorder
• A disorder in which a person displays
characteristics of two or more distinct
personalities
• Each personality has a unique set of likes and
dislikes and its own reactions to situations
• Behavior appears inconsistent
 Dissociative Amnesia
• A failure to remember past experience
• Forgotten things are still present in the
memory but cannot be retrieved
• In severe form, individual cannot remember
their names
• Unable to recall skills and abilities
 Dissociative Fugue
• An amnesiac condition in which people take sudden
impulsive trips sometimes assuming a new identity
• After a period of time, days, months or even years
they suddenly realize they are in a completely
strange place and forget the time they have spent
wandering
• The last memories are those just before they
entered fugue state
• These disorders allow people to escape from some
anxiety producing disorder
 Psychosis (Schizophrenia)
A severe mental disorder in which thought and
emotions are so impaired that contact is lost
with external reality
Schizophrenia: A class of disorders characterized
by a severe distortion of reality resulting in anti
social behavior, silly or obscene behavior,
hallucinations and disturbances in movement
 Psychosis (Schizophrenia)
• Thinking, perception and emotion may
deteriorate
• There may be a withdrawal from social
interaction
• Bizarre behavior
• Significant differences in patterns of
symptoms after diagnosis
 Psychosis (Schizophrenia)
Types
i. Disorganized: characterized with
inappropriate laughter and giggling and
incoherent speech
ii. Paranoid: patients suffer with hallucinations,
delusions and loss of judgment
iii. Catatonic: patients may face major
disturbances in movement or loss of all
motion
 Psychosis (Schizophrenia)
Symptoms
i. Positive symptoms: they include hallucinations,
delusions and emotional extremes
ii. Negative symptoms: show the absence or loss of
normal functioning eg social withdrawal
In type l schizophrenia positive symptoms are more
evident while in type ll , negative symptoms are
dominant
 Psychosis (Schizophrenia)
Symptoms
Symptoms may also follow different course. In process
schizophrenia, the symptoms develop slowly and subtly. In
reactive schizophrenia the symptoms are sudden and
conspicuous. Process schizophrenia is more difficult to treat
Following are few symptoms which differentiate
schizophrenia from other disorders
a. Decline of previous level of functioning
b. Disturbance in thought and speech
c. Hallucinations and delusions
d. Withdrawal from reality
 Psychosis (Schizophrenia)
Causes
Biological:
• Genetic factors produce a susceptibility for the
disorder
• Research indicates that structural abnormalities exist
in brains of individuals suffering from the disorder
• Low brain activity in frontal lobes of patients which
controls emotional regulation
• And when they experience hallucinations, parts
responsible for hearing and language processing
become active
 Psychosis (Schizophrenia)
Causes
Biological theories/hypothesis:
• Neurodevelopmental theory of schizophrenia: suggests that it is
the behavioral outcome of an aberration in neurodevelopmental
processes that begin long before the onset of clinical symptoms
• Dopamine hypothesis: proposes that disorder occurs when there
is excess activity in the areas of the brain that use dopamine.
Drugs that block dopamine actions in brain pathways can be
effective to reduce the symptoms. Criticism: although dopamine
inhibiting medications modify dopamine levels within minutes,
the associated improvement in patients is not visible for days,
suggesting that dopamine may be indirectly responsible for
illness
 Psychosis (Schizophrenia)
Causes
Environmental:
• Psychoanalytic approach: form of regression
to earlier experiences and stages in life. Freud
was of the view that patients lack egos that
are strong enough to cope with their
unacceptable impulses and desires. They
regress to time when ego and id are not
separated. Little evidence.
 Psychosis (Schizophrenia)
Causes
Environmental:
• Emotional and communication approach: characterized
by family members’ criticism, hostility and intrusiveness
• Cognitive approach: some researchers think that cause
is over attention to stimuli in environment. There is no
screening out of stimuli and patients may be receptive
to everything in environment. Some suggest that under
attention to a stimuli may be the cause. Patients fail to
pay importance to important stimuli and focus on less
important information
 Psychosis (Schizophrenia)
Causes
Multiple causes:
• The most famous approach which suggests
that there are number of biological and
environmental factors responsible for
schizophrenia. Individuals may have inborn
sensitivity to the disease which makes them
vulnerable to stressful factors of environment
like rejection
 Psychosis (Schizophrenia)
Treatment:
• Medications: Anti psychotics are most commonly
prescribed to the patients of schizophrenia. They
control the symptoms by affecting
neurotransmitters like dopamine and serotonin.
• Psychosocial treatment: includes individual and
family therapy, social skills training and vocational
rehabilitation. Psychosocial treatments are
necessary along with medications to minimize
the symptoms
 Personality disorders
• A mental disorder characterized by a set of
inflexible, maladaptive personality traits that
keep a person from functioning properly in
society
• Anti social-sociopathic personality disorder:
patients display no regard for moral or ethical
rules or for the rights of others. They appear
intelligent and are usually likeable at first.
Impulsive behavior, manipulation of others.
 Personality disorders
• Narcissistic personality: a disorder
characterized by an exaggerated sense of self
and an inability to experience empathy for
others. They expect special treatment from
others while at the same time they disregard
others feelings
• Psychoactive substance disorder: behavior
involving the drug abuse