*definition of terms

1. Psychopathology – branch of psychology that deals with the systematic investigation of behavioral
disorders.

2. Clinical Psychology – branch of psychology that deals with the psychological knowledge and practice
used in helping a person with some behavioral disorders to find better coping and adjustment.

3. Abnormal Psychology – branch of psychology that includes both Psychopathology and clinical
psychology.

4. Psychiatry – branch of medicine dealing with the prevention, diagnosis and therapy of mental
illnesses.

Defining Abnormal Behavior

1. As judged by the Society - Behavior is abnormal when it violates the norms of a society.
2. As judged by an inability to meet demands of life – abnormal behavior is maladaptive behavior.
- It assumes that normal behavior consists in coping with the demands of life-
holding a job, dealing with friends and family, accepting the realities of
everyday life.

The 4Ds which Defines Abnormality

2. Deviance – unacceptable and uncommon thoughts, behaviors, and emotions within his
society
3. Distress – negative feelings of an individual
4. Dysfunction – abnormal behavior hindering an individual from performing daily
functions
5. Danger – harmful behavior towards individuals in a society

*Symptoms

1. Long periods of discomfort

2. Impaired functioning
3. Bizarre behavior
4. Disruptive behavior
Models of Abnormality

1. Behavioral – an individual’s actions are dictated by his experiences in life rather than
pathological. Behavior can be learned from the environment and it can be unlearned.
- This unlearning is how abnormal behavior is treated.
2. Cognitive – behavior of a person stems from his thoughts
3. Medical/Biological – abnormal behaviors have organic and physical cause
- Focuses on genetics, neurotransmitters, neurophysiology, neuroanatomy,
biochemistry, etc
4. Psychodynamic (4)
A. Weak ego- either id or superego may dominate if ego is weak
B. Unchecked Id impulses – may lead to destructive and immoral behavior
C. Too powerful Superego – will lead to neurosis
Classifying Abnormal Behavior
At present, there are two different classification systems of behavioral disorders that are in use:
*THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDER (DSM) – proposed by the
American Psychiatric Association (DSM-IV-1994), and the International Classification of Diseases
(ICD) as adopted by the World Health Organization
*DSM-IV – uses a multidimensional assessment to code clinical information about mental
disorders. - - The five dimensions, called AXES, was arbitrary and had to do with making the
diagnostic system useful without being too intricate and cumbersome.

The first three diagnostic axes

AXIS 1 – the most common reasons individuals come to clinical attention.
*16 categories:
1. Disorders usually first diagnosed in infancy,
childhood and adolescence with the exception of
intellectual disability disorder.
2. Delirium, dementia, amnesic and other cognitive
disorders
3. Mental disorders due to a general medical
condition not elsewhere classified
4. Substance-related disorders
5. Schizophrenia and other psychotic disorders
6. Mood disorders
7. Anxiety disorders
8. Somatoform disorders
9. Factitious disorders
10. Dissociative disorders
11. Sexual and gender identity disorders
12. Eating disorders
13. Sleep disorders
14. Impulse control disorders not elsewhere classified
15. Adjustment disorders
16. Other conditions that may be a focus of clinical
Attention

AXIS 2 – it includes the personality disorders and intellectual disability disorder.

*11 categories:
1. Paranoid
2. Schizoid
3. Schizotypal
4. Antisocial
5. Borderline
6. Histrionic
7. Narcissistic
 8. Avoidant
9. Dependent
10. Obsessive-compulsive
11. Personality disorder not classified elsewhere

AXIS 3 – it covers the medical conditions relevant to the understanding and management of the
case (Persons with severe mental disorders have a higher incidence of medical illnesses than the
general population).
*Non-Diagnostic Axes:
AXIS IV – it records external psychosocial and environmental problems that might impact on the
disorders listen on Axes I, II, III.
*The following categories of psychosocial and environmental problems when coding Axis Iv are
(DSM IV) :

1. Problems with primary support group (death in the family, birth of a sibling, separation, divorce,
remarriage, abuse, neglect, sickness in the family, etc.)
related to the social environment (breakup of friendships, relocation, retirement, problems due to
cultural differences, etc.
2. Problems
3. Educational problems
4. Occupational problems
5. Housing problems
6. Economic problems

AXIS V – A GAF scale (Global Assessment of Functioning).

- The clinician uses the axis to record an assessment of the individual’s overall level of
psychological, social, and occupational functioning at the time of the evaluation.

The Emotional Disorders

1. Anxiety Disorders
- anxiety is a part and parcel of human existence
- All people feel it in moderate degrees, and an adaptive response
- keeps us out of trouble and danger
- Most people feel anxiety sometimes, but some people feel it most of the time
- Not an adaptive response rather a source of distress
-it can be experienced in variety of ways:
A. Generalized Anxiety Disorder (GAD) – anxiety is unfocused, unconnected to any special
stimulus
- it features a chronic state of diffuse anxiety, leaving the person in a state of constant
tension (Free-floating anxiety).
- people with GAD are continually waiting for something dreadful to happen, either to
themselves or those they care.
B. Phobic disorder – fear is aroused by one particular object or situation

*Two factors:
 * A phobia or intense fear of some object or stimulus – poses no major threat.
- A fear of looking at itself in the mirror
- The malignant disease if “what ifs”

*Avoidance of Phobia Stimulus – phobic people must design their lives in function of this
Avoidance

- the phobic reaction

C. Obsessive-compulsive disorder – anxiety occurs if the person does not engage in some thought or
behavior that serves no purpose and in fact unpleasant and embarrassing.

*obsession – persistent, recurrent thought or image that is ego-alien (the individual considers it
unwanted senseless, unpleasant).

- accompanied by severe doubting, brooding and little constructive behavior

*compulsion – an action that a person feels compelled to repeat again and again or an unwanted action.

Three Types of Anxiety (Freud)

1. Reality Anxiety - fear of physical dangers in

the external world
2. Neurotic Anxiety - fear that the mind will get
out of control and lead a person to punishment
by doing something terrible
- 3. Moral Anxiety - fear of the conscience

THE POSTTRAUMATIC STRESS DISORDER (PTSD)

- Acute psychological reactions to intensely traumatic events accompanied with extreme
terror, helplessness, and fear or events much more disturbing than most ordinary human
troubles
- Characterized by anxiety, and are therefore classified under anxiety – disorders
- Not all individuals exposed to a traumatic event develop PTSD
*FIRST CRITERIA – exposure to an extreme traumatic stressor involving direct personal
experience.
*SECOND CRITERIA – individual’s response to an event must involve intense fear,
helplessness, or horror

*SYMPTOMS OF PTSD
- persistent avoidance of anything that is associated with trauma or crime
- it maked difficult for the recovery of the client because of the difficulty discussing the event
due to the avoidance because it is too painful to talk about.
*Ex: (copy)

*ADDITONAL SYMPTOMS
 - depression, anxiety, agoraphobia, self-medication, substance abuse, trouble concentrating,
anger outbursts, disturbed
sleep pattern-insomnia or excessive sleeping, nightmares, avoidance, hyper-vigilance, hyper-
startle response, disturbed eating pattern cannot eat, or eating too much leading to weight
loss or weight gain, panic attacks, looking out for
danger, checking and locking doors and windows frequently.
-Survivors may not want to leave the house (agoraphobia).
-High rate of absenteeism.

*RECOVERY PROCESS
- Nontreatment of PTSD will lead to further deterioration of the client
- crisis intervention
*Individual Therapy – therapist/counselor helps the victim restructure the fragments of their
lives
-understand and accept some irreversible changes brought by the trauma
-reopen channnels of feeling that may have been repressed, -
learn to manage the impact of distressing, invasive thoughts or flashbacks
*Medications – anti-depressants, benzodiazepines, sleep aids, and beta blockers
- However, these medications may lead to additional symptoms due its side effects
*Eye Movement Desensitization Repossessing (EMDR) – does not involve use of drugs or
hypnosis
- simple non-evasive patient-therapist collaboration

THE SOMATOFORM DISORDERS

- Psychological conflicts take on a somatic, or physical form.
A. Hypochondriasis – a growing fear of disease (a fear maintained by a constant
misinterpretation of physical signs and sensations as abnormal
- Has no real physical disability, but has a conviction that a disability is about to appear
B. Conversion disorder – there is actual disability, (loss or impairment of some motor or
sensory function is real)
*Symptoms: Blindness, deafness, paralysis, anesthasia. (Not supported by medical
evidence, but neither are faked. They are involuntary/unconscious responses and
contradict the medical facts).

THE DISSOCIATIVE DISORDERS

- Involves a dissociation, splitting apart, of the components of the personality that are
normally integrated. As a result, some psychological function-identity, memory, control over
motor behavior is screened out of consciousness.
*Three Dissociative syndromes
A. Psychogenic Amnesia – the partial or total forgetting of past experiences, appears in
organic brain diseases. It may also occur without any organic cause, as a response to
psychological stress.
*Three Paterns of psychogenic amnesia
 - Localized amnesia = all events occuring during a circumscribed period of time are blocked
out.
- Selective amnesia (less common) = the person forgets only certain events that occurred
during that period of time.
- Generalized amnesia (actually rare) = the person forgets his entire past life.
B. Pyschogenic Fugue – the individual takes a sudden, unexpected trip, forgetting his identity
and assuming a new identity.
- a sort of traveling amnesia, but more elaborate than amnesia
- common in wartime and after natural disasters
- tends to occur after a severe psychological trauma and functions as an escape (fugue-flight)
from an unbearable psychological stress.
C. Multiple Personality Disorder – the individual alternates between two or more distinct
personalities (each well integrated and developed, with its own tastes, habit memories and
behaviors).
*Different patterns of Mutiple Personality Disorder:
- Alternating Personality = two identities alternate with each other, each having amnesia for
thoughts and actions of the other.
- One Dominant (primary) personality and one or more subordinate ones = the dominant
personality is ostensibly controlling the person’s behavior, personality, fully aware of
thoughts and actions of the dominant personality, continues to operate subconsciously and
makes its presence felt now and then overtly.
= the subordinate personality is conscious with the dominant personality

PSYCHOLOGICAL STRESS AND PHYSICAL DISORDERS

1.) Gastric and Duodenal Ulcers – impressive body of evidence indicating emotion
states are accompanied by important changes in gastrointestinal functions.
- Number of emotional states ( anger and pleasurable excitement) common in active
involvement with the environment are capable of leading to increased gastric motility and
secretion (Depressed withdrawal results in diminished secretion and motility if the stomach).
2.) Essential Hypertension – high blood pressure know as hypertension, is by far the
most common and most dangerous of all the physical disorders associated with
psychological stress.
- It is linked to an identifiable organic cause in small percentage of cases (10-15%),usually
kidney Dysfunction.
- In remaining cases (essential hypertension), there is no known organic cause, many different
factors have been suggested:
A. Highly stressful environment = requiring a person to maintain a constant high level of
alertness against the threat of danger.
B. Difficulty on how to handle feelings of anger = normal subject elevates blood pressure
when angered, remains elevated if the anger is suppressed but returns to normal if the
anger finds an appropriate expression.
C. Handling anger to the simple matter of daily coping with stress as observed from recent
research.
D. Individual response specificity (genes or experiences)
 = The observation that “Hypertension runs in families” supports to this.

3.) Headaches – may accompany any number of other physical disorders.

- Chronic headaches is often thought to be related to psychological stress. It has two
types :
*Tension headaches – range from mild to severe, described as an acting or tightness
around the neck or head.
- In most cases, it is felt on both sides of the head (front or back).
- In response to stress, the muscles of the head and neck contract that causes the
neighboring blood vessels to constrict which produces head pain.
*Migraine = headaches are more intense and are usually localized on one side of the
head.
= preceded by an aura (subjective sensation alerting the person that the headache is
about to begin)
= accompanied by somatic disturbances (dizziness, fainting, nausea and vomiting)
= migraine attacks (bearable comfort to complete immobilization) and last
anywhere( several hours to several days) .
= also a cardiovascular disorder and appears due to the following sequence of events:
1. Blood vessels in the brain constrict as a result of stress.
2. Once the stress is relieved, the arteries leading to the brain dilate, more blood and delivered to
the area that cannot be comfortably accommodate.
3. Results in a sharp, painful, throbbing sensation in the head (migraine).
4. The period of relief after the stress that actually ushers in the headache. Helps explain why
migraine attacks often at night or early in the morning, when the person has rested after a
stressful day.
Migraine appears to be a common disorder, 2/3 of those developing migraine have a family
history of said disorder. The incidence of migraine is twice as high in women as in men and
susceptible individuals may have migraine attacks triggered by foods like chocolate, coconut,
citrus fruits.

4.) Respiratory Disorders

*Respiration – single bodily activity that comes under both the voluntary and involuntary control
of the nervous sytem.
- if oxygen is not inspired and carbin dioxide not expired, death results, making respiratory
difficulties beautifully subject to psychological implications.
4.1 The hyperventilation syndrome – consists if an over breathing, oversaturation of oxygen as a
result of excessive activity of the sympathetic nervous system, when there is no need for it.
- it comes in episodic attacks
- increase in the depth and rapidity of the respiration
4.2 Bronchial Asthma – disorder of the respiratory system
-the body’s air passageways narrow that causes coughing, wheezing, and general difficulty in
breathing.
-Asthma attacks (few minutes or several hours
- Series of severe attacks can cause progressive deterioration of the bronchial system, so that
mucus accumulates and the muscles lose their elasticity. In weakened condition, the bronchial
system loses its ability to fight back and any attack may indeed prove fatal. However few
asthmatics die of the disorder.

5.) Insomnia – chronic inability to sleep

 Three broad patterns of disturbed sleep:
*Some people take an extremely long time to fall asleep
*Others fall asleep easily but awaken repeatedly during the night
*Others fall asleep easily but wake up much too early in the morning and unable to
sleep again

 FACTORS:
-drugs, alcohol, caffeine, stress and anxiety, inactivity, psychological disturbance,
poor sleeping habits and environment.
- Evidently, poor sleeper are more likely to be psychologically disturbed than good
sleeper
- It is also observed that poor sleepers show abnormally high level of physiological
arousal during their sleep. Heart beat faster, temperatures higher, peripheral blood
vessels constrict more often, and move more frequent during their sleep hours than
those good sleepers.