The Concept Of Abnormality And Psychopathology

THE CONCEPT OF ABNORMALITY AND PSYCHOPATHOLOGY The concept of abnormality has a long and a changing history; suffice it to say, the biopsychological perspective which is adopted will affect the entire spectrum from diagnosis to treatment of the various disorders. Here are the six basic approaches • A) Statistical deviation, B). Social norm violation: , C). Maladaptive behavior:, D.) Personal distress:,E.) Deviation from an ideal , F). Medical disorder • No one definition is the "correct" or the "best" definition. ..And each definition can certainly be challenged.. • Psychological Models of Mental Illness • Basic postulate: mental illness is caused by psychological processes that occur within the individual • Psychoanalytic model: sees the past and the unconscious as the cause of a disorder; a mental model; uses psychoanalysis (insight therapy) as treatment. • Behavioral model: views environment and inappropriate types of reinforcement as causes of disorders; a mechanistic model; uses behavior modification and other behavioral therapies to change undesired behaviors into acceptable ones; no biology factored in. • Cognitive model: considers irrational thinking as the cause of abnormal behavior; *catastrophizing* daily problems; uses cognitive talk therapy in conjunction with behavioral modes for treatment. • Cognitive-Behavioral Learning Models: Basic postulate: mental illness is caused by “faulty” cognitive and/or behavioral learning; dysfunctional thoughts and behaviors •

• Classifying Psychopathology • Mental illness is classified today according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), published by the American Psychiatric Association (1994). • The DSM uses a multiaxial or multidimensional approach to diagnosing because rarely do other factors in a person's life not impact their mental health. It assesses five dimensions as described below: • Axis I: Clinical Syndromes • This is what we typically think of as the diagnosis (e.g., depression, schizophrenia, social phobia). Axis I: clinical disorders, including major mental disorders, as well as developmental and learning disorders. • Axis II: Personality Disorders and Mental Retardation • Personality disorders are clinical syndromes which have more long lasting symptoms and encompass the individual's way of interacting with the world. They include Paranoid, Antisocial, and Borderline Personality Disorders.

• Axis III: Physical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders • Physical conditions such as brain injury or HIV/AIDS that can result in symptoms of mental illness are included here. • Axis IV: Severity of Psychosocial Stressors • Events in a persons life, such as death of a loved one, starting a new job, college, unemployment, and even marriage can impact the disorders listed in Axis I and II. These events are both listed and rated for this axis. • Axis V: Highest Level of Functioning • On the final axis, the clinician rates the person's level of functioning both at the present time and the highest level within the previous year. This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected.

• Psychiatric Disorders (AXIS-1) •

AXIS(I) : 1.Delirium, Dementia, Amnestic, and Other Cognitive Disorders

• The primary symptoms of these disorders include significant negative changes in the way a person thinks and/or remembers. All of these disorders have either a medical or substance related cause • 2. Mental Disorders Due to a Medical Condition • Like those above, all disorders in this category are directly related to a medical condition. If symptoms of anxiety, depression, etc are a direct result of a medical condition, this is the classification used. • 3. Substance Related Disorders • There are two disorders listed in this category: Substance Abuse and Substance Dependence. Both involve the ingestion of a substance (alcohol, drug, chemical) which alters either cognitions, emotions, or behavior. • Abuse refers to the use of the substance to the point that it has a negative impact on the person's life. This can mean receiving a fine for drinking and driving, being arrested for public intoxication, missing work or school, getting into fights, or struggling with relationships because of the substance. • Dependence refers to what we typically think of as 'addicted.' This occurs when (a) the use of the substance is increased in order to get the same effect because the person has developed a tolerance, (b) the substance is taken more frequently and in more dangerous situations such as drinking and driving, or (c) the person continues to take the substance despite negative results and/or the desire to quit, or (d) withdrawal symptoms are present when the substance is stopped, such as delirium tremors (DTs), amnesia, anxiety, headaches, etc. • Mood Disorders: The disorders in this category include those where the primary symptom is a disturbance in mood. The disorders include Major Depression, Dysthymic Disorder, Bipolar Disorder, and Cyclothymia.

• MAJOR DEPRESSION: (also known as depression or clinical depression) is characterized by depressed mood, diminished interest in activities previously enjoyed, weight disturbance, sleep disturbance, loss of energy, difficulty concentrating, and often includes feelings of hopelessness and thoughts of suicide. • Dysthymia:is often considered a lesser, but more persistent form of depression. Many of the symptoms are similar except to a lesser degree. Also, dysthymia, as opposed to Major Depression is more steady rather than periods of normal feelings and extreme lows. • Bipolar Disorder (previously known as Manic-Depression) is characterized by periods of extreme highs (called mania) and extreme lows as in Major Depression. Bipolar Disorder is subtype either I (extreme or hypermanic episodes) or II (moderate or hypomanic episodes). • Like Dysthymia and Major Depression, Cyclothymia is considered a lesser form of Bipolar Disorder.

• Schizophrenia and Other Psychotic Disorders • The major symptom of these disorders is psychosis, or delusions and hallucinations. The major disorders include schizophrenia and schizoaffective disorder. • Schizophrenia is probably the most recognized term in the study of psychopathology, and it is probably the most misunderstood. • First of all, it does not mean that the person has multiple personalities. The prefix 'schiz' does mean split, but it refers to a splitting from reality. • The predominant features of schizophrenia include hallucinations and delusions and disorganized speech and behavior, inappropriate affect, Schizoaffective Disorder is characterized by a combination of the psychotic symptoms such as in Schizophrenia and the mood symptoms common in Major Depression and/or Bipolar Disorder. The symptoms are typically not as severe although when combined together in this disorder, they can be quite debilitating as well. • Diagnostic Criteria • Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): • Delusions, hallucinations, disorganized speech (e.g., frequent derailment or incoherence), grossly disorganized or catatonic behaviour, negative symptoms (i.e., affective flattening,), •

Types of Schizophrenic Symptoms:

• Positive symptoms: active symptoms like hallucinations, delusions, incoherent speech, disorganized thinking. responds better to medications • Negative symptoms: Lacks appropriate emotional experience, inappropriate, blunted/flat affect, Avolition: lacks volition and motivation to do things, Alogia: poverty of speech.

• Delusional Disorder

• here is not a single type of Delusional Disorder. There are a number of subtypes, but they share a major common feature. This is that the person has a non-bizarre delusion a delusion that could occur in real life, that is. For example, a person that feels they are being followed or poisoned is non-bizarre, while a person who feels their parents are from mars is bizarre. • The subtypes are • erotomanic, in which the person believes that a person of usually higher status is in love with them; • grandiose, which is delusions of inflated worth, power, knowledge, identity, or special relationships; • jealous is that where they believe the sexual partner is unfaithful; • persecutory by which they believe they or someone they are close to is being maltreated; • somatic, in which they believe they have a physical problem, defect, or illness; or, the mixed type, in which more than one of the previous types is present.

• 6. Anxiety Disorders • Anxiety Disorders categorize a large number of disorders where the primary feature is abnormal or inappropriate anxiety. The disorders in this category include Panic Disorder, Agoraphobia, Specific Phobias, Social Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, and Generalized Anxiety Disorder. • Panic Disorder is characterized by a series of panic attacks. A panic attack is an inappropriate intense feeling of fear or discomfort including many of the following symptoms: heart palpitations, trembling, shortness of breath, chest pain, dizziness. These symptoms are so severe that the person may actually believe he or she is having a heart attack. In fact, many, if not most of the diagnoses of Panic Disorder are made by a physician in a hospital emergency room. • Agoraphobia: It refers to a series of symptoms where the person fears, and often avoids, situations where escape or help might not be available, such as shopping centers, grocery stores, or other public place. • Agoraphobia is often a part of panic disorder if the panic attacks are severe enough to result in an avoidance of these types of places. • Specific or Simple Phobia and Social Phobia represents an intense fear and often an avoidance of a specific situation, person, place, or thing. To be diagnosed with a phobia, the person must have suffered significant negative consequences because of this fear and it must be disruptive to their everyday life. • Generalized Anxiety Disorder: •

is diagnosed when a person has extreme anxiety in nearly every part of their life. It is not associated with just open places (as in agoraphobia), specific situations (as in specific phobia), or a traumatic event (as in PTSD). The anxiety must be significant enough to disrupt the person's everyday life for a diagnosis to be made.

• Obsessive-Compulsive Disorder is characterized by obsessions (thoughts which seem uncontrollable) and compulsions (behaviors which act to reduce the obsession). Most

people think of compulsive hand washers or people with an intense fear of dirt or of being infected. These obsessions and compulsions are disruptive to the person's everyday life, with sometimes hours being spent each day repeating things which were completed successfully already such as checking, counting, cleaning, or bathing. • Posttraumatic Stress Disorder (PTSD) occurs only after a person is exposed to a traumatic event where their life or someone else's life is threatened. • The most common examples are war, natural disasters, major accidents, and severe child abuse. Once exposed to an incident such as this, the disorder develops into an intense fear of related situations, avoidance of these situations, reoccurring nightmares, flashbacks, and heightened anxiety to the point that it significantly disrupts their everyday life. • ( the most important here , reoccurring nightmares and flashbacks- ‫أن المريسض يسسترجع‬ ‫ الموقف نفس الصور و نفس المشاعر‬- . • 7. Somatoform Disorders • Disorders in this category include those where the symptoms suggest a medical condition but where no medical condition can be found by a physician. Major disorders in this category include Somatization Disorder, Pain Disorder, Hypochondriasis. • Somatization Disorder ( vagusomatic disorder ) refers to generalized or vague symptoms such as stomach aches, sexual pain, gastrointestinal problems, and neurological symptoms which have no found medical cause. • Pain Disorder refers to significant pain over an extended period of time without medical support. • Hypochondriasis is a disorder characterized by significant and persistent fear that one has a serious or life-threatening illness despite medical reassurance that this is not true. • 8. Factitious Disorder • Factitious Disorder is characterized by the intentionally produced or feigned symptoms in order to assume the 'sick role.' These people will often ingest medication and/or toxins to produce symptoms and there is often a great secondary gain in being placed in the sick role and being either supported, taken care of, or otherwise shown pity and given special rights. • (‫)إدعاء بالمرض بسبب اضطراب في الشخصية بغرض الدخول والنوم بالمستشفى‬ • 9. Dissociative Disorders ( ‫)كان أحد أنواع الهستيريا و لكن الن مصطلح هستيريا ل يستخدم‬ • dissociative disorders or conversion disorders ( ‫)أنواع الهستيريا‬ • The main symptom cluster for dissociative disorders include a disruption in consciousness, memory, identity, or perception. In other words, one of these areas is not working correctly causing significant distress within the individual. The major diagnoses in this category include: Dissociative Amnesia, Dissociative Fugue, Depersonalization Disorder, and Dissociative Identity Disorder.

• Dissociative Amnesia is characterized by memory gaps related to traumatic or stressful events(not traumatic) which are too extreme to be accounted for by normal forgetting. A traumatic event is typically a precursor to this disorder and memory is often restored. • Dissociative Fugue represents an illness where an individual, after an extremely traumatic event, abruptly moves to a new location and assumes a new identity. This disorder is very rare and typically runs its course within a month.( ‫ترجع له الذاكرة بعد شهر‬ ‫) بس ممكن أقل‬ • Depersonalization Disorder, occurring after an extreme stressor, includes feelings of unreality, that your body does not belong to you, or that you are constantly in a dreamlike state. • Dissociative Identity Disorder (DID) is most widely known as Multiple Personality Disorder or MPD. DID is the presence of two or more distinct personalities within an individual. These personalities must each take control of the individual at varying times and there is typically a gap in memory between personalities or "alters." This disorder is quite rare and a significant trauma such as extended sexual abuse is usually the precursor. •

‫ و في كل شخصية ل يذكر شيئا عن الخرى ال بعد العلج فقد يذكر شيئا‬, ‫ شخصيات‬6 ‫ أو‬5 ‫ممكن تصل الى‬

•

‫نسبة كبيرة من المرضى كانوا مستغلين جنسيا في طفولتهم‬

• 10. Sexual Dysfunctions, Paraphilias, and Gender Identity Disorders • These disorders are all related to sexuality, either in terms of functioning (Sexual Dysfunctions), distressing and often irresistible sexual urges (Paraphilias), and gender confusion or identity (Gender Identity Disorder. •

It should be noted that for these, as well as many other categories, a medical reason should always be ruled out before making a psychological diagnosis.

• Sexual Dysfunctions include Hypoactive Sexual Desire Disorder (deficiency or absence of sexual fantasies and desire for sexual activity), • Sexual Aversion Disorder ‫( كراهيية‬persistent or recurring aversion to or avoidance of sexual activity), • Sexual Arousal and Male Erectile Disorder (Inability to attain or maintain until completion of sexual activity adequate lubrication (in women) or erection (in men) in response to sexual excitement) • Orgasmic Disorder [male] [female] (delay or absence of orgasm following normal excitement and sexual activity), and Premature Ejaculation (ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it). • The final category, Gender Identity Disorder, is characterized by a strong and persistent identification with the opposite sex and the belief that one is actually the opposite sex due to an extreme discomfort in one's present sexual identity. •

‫فسي مرحلة قبسل المدرسسة تتكون هذه الحالة عنسد الطفال بسسبب بعسض العوامسل التسي تسسبب عدم الرضسا بالجنسس ان‬ ‫كان ذكرا أو أنثى‬

• 11. Eating Disorders • Eating disorders are characterized by disturbances in eating behavior. There are two types: Anorexia Nervosa and Bulimia Nervosa. • Anorexia is characterized by failure to maintain body weight of at least 85% of what is expected, with a continious fear of losing control over your weight or of becoming 'fat.' There is typically a distorted body image, where the individual sees themselves as overweight despite overwhelming evidence to the contrary. •

‫ممكن يصل الخوف بالشخص الى أنه ينزل جزء كبير من وزنه خلل فترة قصيرة مما يشكل خطرا على حياته‬

• The key characteristics of Bulimia include bingeing (the intake of large quantities of food) and purging (elimination of the food through artificial means such as forced vomiting, excessive use of laxatives, periods of fasting, or excessive exercise). •

‫ فيكون شره‬, ‫الشخص يكون عامل رجيم و بعدما يقطع الرجيم يصير له ردة فعل عكسية في الكل‬

• 12. Sleep Disorders • All sleep disorders involve abnormalities in sleep in one of two categories, dysomnias and parasomnias. • Dysomnias are related to the amount, quality and/or timing of sleep. Examples of sleep disorders include insomnia (inability or reduced ability to sleep ‫)خاصسسة فسسي حالة الغلق‬, hypersomnia (excessive sleepiness and prolonged sleep without physical justification), and narcolepsy (irresistible attacks of sleep) ‫المريض ينام في أي وقت و أي مكان بشكل مفاجئ‬. • Parasomnias refer to sleep disturbances related to behavioral or physiological events related to sleep. Disorders in this subcategory include nightmare disorder (occurrence of extremely frightening dreams which result in awakening and resulting distress), sleep terror disorder (similar to nightmare disorder but the fear is more intense and the person is often unresponsive during the episode ‫)نفس النايتميرز لكن صعب جدا أنك تجلسه‬, and sleepwalking disorder (walking or performing tasks during sleep without recollection once awakened). • 13. Impulse Control Disorders • Disorders in this category include the failure or extreme difficulty in controlling impulses despite the negative consequences.( •

‫معناها أن المرض يدرك و يعرف نتائج تصرفاته لكنه ما يقدر يسيطر على نفسه‬

• Specific disorders include Intermittent Explosive Disorder (failure to resist aggressive impulses resulting in serious assaults or destruction of property), Kleptomania (stealing objects which are not needed ‫) أشهر اثنين نابليون و الملك فاروق‬, Pyromania (fire starting for pleasure or relief of tension ‫) يقصسد بهسا النار و ليسس اللعاب الناريسة‬, Pathological Gambling ‫(القمار‬maladaptive gambling behavior ), and trichotillomania (pulling out of one's own hair).

• 14. Adjustment Disorders????

• This category consists of an inappropriate or inadequate adjustment to a life stressor. Adjustment disorders can include depressive symptoms, anxiety symptoms, and/or conduct or behavioral symptoms.

Disorders First Diagnosed in Infancy, Childhood, & Adolescence 5b Developmental, or childhood disorders are classified under axis (I) in the DSM-IV, and include autism and pervasive developmental disorders, ADHD, Conduct Disorders, Oppositional Defiant Disprders, and various types of learning and communication disorders, which are referred to as disorders which are typically first evident in childhood.. However, another way of classifying many of the childhood emotional and behavioural disorders is to categorize them into two broad groups: Externalization Disorders and Internalization Disorders. •

Externalizing Disorders

•

ADHD: disorder characterized by inattention, and/or impulsivity, hyperactivity

•

Three types of ADHD: Inattentive, Hyperactive/Impulsive, and Mixed

•

Oppositional-Defiant Disorder

•

Conduct Disorder

•

Internalizing Disorders

•

•

Separation Anxiety Disorder

•

Depressive Disorders

Developmental disorders include autism and mental retardation, disorders which are typically first evident in childhood, and language and learning disorders.

• EXAMPLES OF EXT/INT BEHAVIOURS • EXTERNALIZING • VIOLATES THE RIGHTS OF OTHERS • VIOLATES THE SOCIAL NORMS • HAS TANTRUM • IS HOSTILE • IS DEFIANT,, ARGUES • PHYSICALLY AGGRESSIVE • IGNORE TEACHERS DEMANDS • STEAL,, DAMAGE PROPERTY,, LIES • SHOWS OBSESSIVE-COMPULSIVE • CAUSES OR THREATEN HARM PEOPLE OR ANIMALS • USES OBSCENE WORDS OR GESTURE

• IS HYPERACTIVE • INTERNALIZING • IS TEASED BY OTHER • IS NEGLECTED BY OTHERS • IS ANOREXIC OR BULIMIC • IS SOCIALLY WITHDRAWN • HAS UNFOUNDED FEARS • TENDS TO BE DEPRESSED • TENDS TO HAVE LOW SELF-ESTEEM • HAS EXCESSIVE WORRIES • PANIC • HYPOCHONDRIA (HYPOCHONDRIAC) • EASILY UPSET AND DIFFICULT TO CALM

• Personality Disorders • Personality Disorders are characterized by an enduring pattern of thinking, feeling, and behaving which is significantly different from the person's culture and results in negative consequences. This pattern must be longstanding and inflexible for a diagnosis to be made. There are ten types of personality disorders, all of which result in significant distress and/or negative consequences within the individual: • Cluster A: characterized by odd and/or eccentric behavior • Paranoid (includes a pattern of distrust and suspiciousness, •

‫المريض يكون شكاك خواف ما يثق بأحد و يؤمن بنظرية المؤامرة‬

•

Schizoid (pattern of detachment from social norms and a restriction of emotions): inability or desire to form social relationships and no warm or tender feelings for others

•

‫ ما عنده القدرة أو الرغبة في تكوين صداقات‬, ‫محدود جدا في عواطفه‬

•

Schizotypal (pattern of discomfort in close relationships and eccentric thoughts and behaviors),

• (Cluster B: Dramatic, Emotional, and Unstable • Antisocial: rule-violation with little remorse or desire to change (pattern of disregard for the rights of others, including violation of these rights and the failure to feel empathy), • • Borderline: unstable affect, sense of self, and interpersonal relationships; chronic loneliness and emptiness (pattern of instability in personal relationships, including

frequent bouts of clinginess and affection and anger and resentment, often cycling between these two extremes rapidly), •

‫أكثر مرض يكرهه الطباء النفسيين لنه صعب العلج‬

•

‫ خلص صار عنده أصحاب جدد‬, ‫كل يوم له صاحب و اذا مر على صاحبه القديم ما يسلم‬

• Narcissistic: grandiose sense of self importance (pattern of grandiosity, exaggerated self-worth, and need for admiration), •

‫اضطراب الشخصية النرجسية يكون الشخص ل يرى ال نفسه‬

• Histrionic: excessive emotionality and attention seeking (pattern of excessive emotional behavior and attention •

‫المبالغة في العواطف و جلب النتباه بطريقة أخلقية‬

• Cluster C: Anxious or Fearful • Obsessive-Compulsive: persistent organization, order, and rule (pattern of obsessive cleanliness, and perfection) •

‫شخص مرتب منظم ما يحب أحد يستخدم أغراضه‬

• Avoidant: persistent fear and avoidance of others (pattern of feelings of social inadequacies, low self-esteem, and hypersensitivity to criticism), • Dependant: over-reliance and dependence on others for making decisions •

‫شخص يعتمد على الخرين في اتخاذ القرارات‬