“You shall know the truth and the truth

shall make you mad.”

—Aldous Huxley (1894-1963)
 The Case of Jeffrey Dahmer
— In 1988, Dahmer murdered
three people. He first met a
14-year old boy at a bus stop
and asked him to pose nude
photos. Soon after they arrived
at Dahmer’s apartment,
Dahmer had sex with the boy,
drugged him, strangled him,
dismembered him and smashed
his bone with a sledgehammer.

2
 The Case of Jeffrey Dahmer
— Several months later, Dahmer
picked up a 23-year old man at a
gay bar, had oral sex with him,
drugged him and butchered him.
— Later in the same month, Dahmer
strangled a 24-year old man and
painted his skull after having boiled
his head to remove the skin.
Dahmer told the police that he
saved the skulls of only the most
handsome victims so that he would
not forget them.
3
 The Case of Jeffrey Dahmer
— In 1991, when he was
arrested, the police found in
Dahmer’s apartment at least
15 dismembered bodies, a
head in the refrigerator and
a heart in the freezer, and a
blue barrel of acid for
leftovers (Matthews, 1992).
— Why would a person like
Dahmer commit such a
deviant act?
4
 Appropriate perception of reality —fairly
realistic in appraising reactions and capabilities and in
interpreting events

Ability to exercise voluntary control over

behavior—decisions are voluntary rather than the
result of uncontrollable responses

Self-esteem and acceptance —appreciation of

own worth and feel accepted by those around them,
react spontaneously

Ability to form affectionate relationships —

close and satisfying relationships with other people

Productivity—enthusiastic about life and

channel energy into productive activity
6
 Violation of cultural
norms—response not
typically or culturally
expected; deviation from
ideal
Deviation from
statistical norm—
statistical infrequency,
deviation from average

A sense of personal distress

or discomfort—e.g., anxiety,
depression, agitation

Maladaptive behavior—
psychological dysfunction or
disability with adverse effects on
7 individuals or society
 Physically
damaging

Lost touch
with reality Cause
and cannot MALADAPTIVE emotional
control BEHAVIOR suffering or
behavior or harm
thoughts

Severely interfere in
one’s ability to
function in daily life
8
9
10
 Prehistoric times
Demonic possession was thought to cause
psychological disorders. Based on
evidence of trephined skulls, prehistoric
people tried to release the evil spirits by
drilling a hole in the skull.
11
 Ancient Greece & Rome:
The scientific approach emerged. The
Greek physician Hippocrates sought a
cause within the body. This approach
continued through Roman times with
the writings of the physician Galen.

12
 Middle Ages:
Return to belief in spiritual
possession and attempts to exorcise
the devil out of the mentally ill. The
mentally ill were thrown into
prisons and poorhouses.
13
 Renaissance Period:
First hospital to house the
mentally ill was built—St.
Mary’s Hospital in Bethlehem
(London). Attempts to provide
more humane treatment.
14
 Modern Period:
Era of deinstitutionalization
Invention of antipsychotic
medications made it possible for
people with severe disorders to live
outside institutions.

15
16
 y How much of abnormal behavior can be explained
through our biological makeup?
y How important are early childhood experiences and
unconscious motivations in determining our mental
health?
y What is the role of learning in the development of
abnormal behaviors?
y How powerful are thoughts in causing abnormal
behaviors, and can positive thinking be used to
1717 combat irrational beliefs?
Models of Psychopathology
Psychosocial cause Biological
cause
Psychodynamic Behavioral Cognitive
Neuroanatomical
Biochemical
Genetics
Humanistic
Family systems Multicultural
existential
18
19
 A Environ-
predisposition mental MENTAL
to develop
illness forces DISORDER
(diathesis) (stressors)

20
• Relationship • People exhibit
with parents symptoms they are
Unconscious
• Fixations of unable to understand
oral, anal, • Therapist must make
phallic stages of • Childhood- the patient aware of
psycho-sexual based anxieties unconscious anxieties
development • Repressed
through defense
mechanisms
Childhood
trauma Psychological
Disorders
21
 Phobias
• Caused by unresolved Oedipal conflict—
fear of the father displaced onto some
other object or situation

Obsessive-compulsive
disorder
• Traced to anal stage, with the urge to soil
or to be aggressive transformed into
compulsive cleanliness
22
 The case of Anna O.
Anna O. was a bright, attractive young
woman who was perfectly healthy until she
reached 21 years of age. Shortly before her
problems began, her father developed a serious
chronic illness that led to his death. Throughout
his illness, Ann O. had cared for him; she felt it
necessary to spend endless hours at his bedside.
Five months after her father became ill, Ann
noticed that during the day her vision blurred;
and that from time to time she had difficulty
moving her right arm and both legs. Soon,
23
additional symptoms appeared.
 The case of Anna O.
She began to experience some difficulty
speaking, and her behaviors became very erratic.
Shortly thereafter, she consulted Joseph Breuer.
In a series of treatment sessions, Breuer dealt
with one symptom at a time through hypnosis and
subsequent “talking through,” tracing each
symptom to its hypothetical causation of
circumstances surrounding the death of Anna’s
father. One at a time, her “hysterical” ailments
disappeared, but only after treatment was
administered. Anna O.’s real name was Bertha
24 Pappenheim.
 Behavioral models
• Behaviorism stressed the importance of
directly observable behaviors and the
conditions or stimuli that evoked,
reinforced and extinguished them

Obsessive-compulsive
disorder
• Traced to anal stage, with the urge to soil
or to be aggressive transformed into
compulsive cleanliness
25
 Major Assumptions of
Cognitive Model
Three types of
Man is a thinking People actually
cognition cause
being—his create their own
abnormal
cognitions (i.e., problems (and
behavior: (1)
thoughts and symptoms) by the
causal attributions,
beliefs) influence way they
(2) control beliefs;
behavior and interpret events
(3) dysfunctional
emotions and situations
26
assumptions
27
 Unpleasant
emotional
responses
• The individual’s
belief systems • They result from • Irrational and
produce irrational one’s thoughts about maladaptive
thought patterns an event rather than thoughts
from the event itself
• Lead to anger, • Distortions of
unhappiness, reality
depression, fear,
Cognitions anxiety Psycholog ical
problems

28
 The individual’s assessment of his own
value and worth
29
 When the When a
person’s self- person’s
Incongruence
Conditions of

concept is inherent
Standards by

Abnormal
behavior
defined as having potential
which
worth

worth only when

people other’s approve is incon-
determine but is sistent
their worth inconsistent with with his
self-actualizing self-
potential concept

30
 Individual as
member of the
family

People behave in All family members

have interdependent
ways that reflect roles, statuses, values
family influences and norms

The behavior of one

member affects the
entire family
31 systems
 Personality • Influenced by attributes of the family
especially how parents behave towards
development children

• A reflection or “symptom” of
Abnormal unhealthy family dynamics, or
behavior poor communication among
family members

• Must focus on the family

Therapy system, not solely on the
individual, and must strive to
methods involve the entire family in
32 therapy
33
“Madness need not be all breakdown. It
may also be break-through.”
—R.D. Laing (1927-1982).
35
 SOMATIC BEHAVIORAL EMOTIONAL COGNITIVE

Dizziness Escape Sense of dread Anticipation of harm

Sweating palms Avoidance Terror Exaggerating of danger

Heart palpitations Aggression Restlessness Hypervigilance

Ringing of the ears Freezing Irritability Fear of losing control

Dry mouth and throat Decrease appetitive Fear of dying

responding
Muscle tension Increased aversive Sense of unreality
responding
Constant “edgy” feeling

Uncontrollable
36 2010shaking
@ abmartinez
 Phobias

Panic disorders

Generalized anxiety disorder

Obsessive-compulsive disorder

Posttraumatic stress disorder

Acute stress disorder

37 2010 @ abmartinez
 Mood • Disturbances in emotions that cause subjective
discomfort and hinder the person’s ability to
disorders function

• Characterized by intense sadness, feelings of

Depression futility and worthlessness and withdrawal from
others

• Characterized by elevated mood, expansiveness,

Mania or irritability, often resulting in hyperactivity,
incoherent speech (flight of ideas)
38 2010 @ abmartinez
 Domain Depression Mania
Affective Sadness, unhappiness, apathy, anxiety, Elation, grandiosity,
brooding, dejection irritability

Cognitive Pessimism, guilt, inability to concentrate, Flighty and pressured

negative thinking, loss of interest and thoughts, lack of focus and
motivation, suicidal thoughts attention, poor judgment

Behavioral Low energy and productivity, neglect of Overactive, incoherent

personal appearance, crying, psychomotor speech, talkative, uninhibited,
retardation, agitation impulsive

Physiological Poor or increased appetite, constipation, High levels of arousal,

sleep disturbance, disruption of menstrual decreased need for sleep
cycle in women, loss of sex drive
39 2010 @ abmartinez
40 2010 @ abmartinez
 þPsychological disorders take a physical
form
þPhysical symptoms have no known
physiological explanation or organic basis
þPhysical symptoms are not under
voluntary or conscious control and linked
to psychological factors—anxiety

41 abmartinez @ 2010
 • Conversion
Two disorder
forms • Somatization
disorder

• Pain disorder
Additional • Body dysmorphic
categories disorder
42 abmartinez @ 2010
• Hypochondrias
 Pain disorder
• The person experiences pain that causes
significant distress and impairment
• Psychological factors have a role in the onset,
maintenance and severity of the pain
• The pain may have temporal relations to
conflict or stress, or may allow the person to
avoid unpleasant activity and to secure
attention
43 abmartinez @ 2010
 Pain disorder
• Reports of severe pain may (1) have
no physiological or neurological
basis, (2) be greatly in excess of that
expected with an existing physical
condition, or (3) linger long after a
physical injury has healed
44 abmartinez @ 2010
 Hypochondr iasis
• Individuals are preoccupied with fears of
having a serious disease, which persist
despite medical reassurance to the contrary.
• Patients tend to overreact to ordinary
physical sensations or minor abnormalities
(e.g., irregular heartbeat, sweating, sore
spot, occasional coughing)
• Includes fear of having a disease, fear of death
or illness, tendency towards self-observation,
oversensitivity to bodily sensations
45 abmartinez @ 2010
 Conversion Disorder
• Loss or disturbance of physical functioning
resembling a physical disorder
• Psychological factors involved in either:
• (a) Initiating or exacerbating the symptoms
• (b) Allowing individual to avoid aversive
activity
• (c) Receiving reinforcements for sick behavior
46 abmartinez @ 2010
 Somatization Disorder
• History of vague multiple physical
complaints before the age of 30
• 4 pain symptoms involving at least 4
different sites or functions
• 2 gastrointestinal symptoms
• One sexual symptom
• One pseudoneurologic symptom
47 abmartinez @ 2010
 Dissociative disorders
• Disturbances or changes in
memory, consciousness or
identity due to psychological
factors
49 abmartinez @ 2010
 Dissociative amnesia

Dissociative Dissociative Dissociative

identity disorders fugue

Depersonalization
50 abmartinez @ 2010
 • The sudden inability to recall information of a
Dissociative personal nature—not due to forgetfulness or
amnesia other organic conditions—usually of traumatic
or stressful nature

Dissociative • Existence of two or more distinct

personalities, each with its own memories,
identity attitudes and perceptions
(Multiple • Personalities alternate (identity fragmentation)
• Inability to recall important personal
personality) information
51 abmartinez @ 2010
 • Inability to recall personal identity and past
Dissociative with: (1) sudden departure to new area or
unexpected trip; (2) confusion about
fugue personal identity or assumption of new
identity

• Changes in perception, and being detached

from one’s own thoughts and body
Depersona- • Feelings of unreality concerning the self
lization and the environment; may have a sense of
being in a dreamlike state; reality testing
remains intact
52 abmartinez @ 2010
 Dissociative Prevalence Age of Onset Course
disorders
Dissociative amnesia Recent increase Any age group Acute forms may remit
involving forgotten spontaneously; others
early childhood trauma are chronic

Dissociative fugue May increase during Usually adulthood Related to stress or

natural disasters or war trauma; recovery is
time generally rapid

Depersonalization 50% of adults may Adolescence or May be short lived or

experience brief adulthood chronic
episodes of stress-
related
depersonalization
Dissociative identity Sharp rise in recently Childhood to Fluctuates; tends to be
reported cases; up to adolescence chronic and recurrent
nine times more
frequent in women
53 abmartinez @ 2010
Schizophrenia
• A group of disorder consisting of
unreal or disorganized thoughts
and perceptions, personality
disintegration, affective
disturbance, social withdrawal as
well as verbal, cognitive and
behavioral deficits
Delusions—fixed Hallucinations—
beliefs with no basis unreal perceptual
in reality experience
(auditory and visual)

Psychotic
symptoms—
loss of reality-
testing
 A long-standing and pervasive
pattern of behavior, thought and feeling
that is highly maladaptive for the
individual and for people around him/her

Must be present continuously from

adolescence or early adulthood into
adulthood

57 abmartinez @ 2010
 Chronic and pervasive mistrust and
suspicion of other people that is
unwarranted and maladaptive

Hypervigilant for confirming evidence

of their suspicions and sensitive to
criticisms

Misinterpret or over-interpret
58
situations in line with their suspicions
abmartinez @ 2010
 Pervasive tendency to interpret actions of
others as deliberately demeaning, malevolent,
threatening, exploiting, or deceiving

Resistant to rational arguments against their

suspicions

Some become withdrawn in an attempt to

protect themselves; others are aggressive and
59 abmartinez @ 2010 arrogant
• neither desires nor enjoys close relationships
(including being part of a family)
• almost always chooses solitary activities
• has little interest in sexual encounters
• takes pleasure in few, if any activities
• appears indifferent to praise or criticism of others
• shows emotional coldness and detachment
60 abmartinez @ 2010
 Diagnostic Criteria
• Disturbed thinking and communicating
• Frank thought disorder is absent but speech may be distinctive
or peculiar, may have meaning only to them, and often needs
interpretation
• May not know their own feelings and yet are exquisitely
sensitive to, and aware of, the feelings of others
• May be superstitious or claim powers of clairvoyance
• Vivid imaginary relationships and child-like fears and fantasies
• Poor interpersonal relationships and may act inappropriately
• isolated and have few, if any, friends
• Under stress, may decompensate and have psychotic symptoms
abmartinez @ 2010
61
 Impairment in the ability to form
positive relationships with others

Tendency to engage in behaviors that

violate basic social norms and values

62 abmartinez @ 2010
 Cold, callous, gains pleasure by
competing with and humiliating anyone

Can be cruel and malicious; insists on

being seen as faultless and are dogmatic
in their opinions

63 abmartinez @ 2010
 Low tolerance of frustration and acts
impulsively, often takes chances and
seek thrills with no concern for danger

Unable to anticipate the implications of

their behaviors; easily bored and
restless

64 abmartinez @ 2010
 üunlawful behavior despite potential for arrest
üdeceitfulness (repeated lying, use of aliases, conning others
for personal profit or pleasure)
ürepeated physical fights or assaults
üreckless disregard for safety of self or others
üirresponsible
ülack of remorse
ücriteria for diagnosis includes: evidence of this behavior
before 15 years of age

65 abmartinez @ 2010
 Benchmarks: out-of-control emotions that
cannot be soothed, hypersensitivity to
abandonment, tendency to cling too tightly to
other people, history of hurting oneself

Characterized by rapidly shifting and unstable

mood, self-concept and interpersonal
relationships, as well as impulsive behavior and
transient dissociative states.

66 abmartinez @ 2010
67 abmartinez @ 2010
68 abmartinez @ 2010
 Problems
shifting
emotions and
unstable
relationships

69 abmartinez @ 2010
 Syndrome marked by rapidly shifting moods,
unstable relationships, intense need for
attention and approval

Such is sought by means of overly dramatic

behavior, seductiveness and dependence

70 abmartinez @ 2010
 üalways wants to be center of attention
üinappropriate sexually seductive or provocative
behavior
ürapidly shifting and shallow expression of emotions
üuses physical appearance to draw attention to self
üspeech is dramatic and exaggerated with emotion
üis easily influenced by others or circumstances
üconsiders relationships to be more intimate than they
actually are

71 abmartinez @ 2010
 Acting in dramatic
and grandiose
manners, seeking
admiration from
others, shallow in
emotional
expression and
relationships

72 abmartinez @ 2010
73 abmartinez @ 2010
 Preoccupied with thoughts of own self-importance and
with fantasies of power and success, viewing themselves as
above most others

Make unreasonable demands in interpersonal relationships

to follow their wishes, ignore others’ needs and wants,
exploit others to gain power, are arrogant and demeaning

Very rare, with lifetime prevalence of less than 1%, more

frequently diagnosed in men
74 abmartinez @ 2010
 üsense of self-importance (e.g. exaggerates achievements and talents,
expects to be recognized as superior)
üpreoccupied with fantasies of unlimited success, power, brilliance,
beauty, or ideal love
übelieves he/she is “special” and requires excessive admiration
ühas sense of entitlement
ütakes advantage of others to achieve own ends
ülacks empathy
üoften envious of others or believes that others are envious of him
üarrogant, haughty behavior or attitude

75 abmartinez @ 2010
 Pervasive anxiety, sense of
inadequacy, fear of being
criticized that leads to avoidance
of most social interactions

When interacting with others,

avoidant people are restrained
and nervous, and hypersensitive
to signs of being evaluated
76 abmartinez @ 2010
 üavoids occupational and social activities that involve
interpersonal (fears of criticism, disapproval, or rejection)
üunwilling to get involved with people unless certain of being
liked
üshows restraint within intimate relationships because of fear of
being ridiculed
üinhibited in new interpersonal situations
üviews self as socially inept, personally unappealing, or inferior
üreluctant to take personal risks or engage in new activities

77 abmartinez @ 2010
 Anxious about interpersonal relations
but anxiety stems from a deep need to
be cared for by others rather than a
concern that they will be criticized

Fear of rejection that lead to total

dependence on and submission to
others

78 abmartinez @ 2010
 They deny their own thoughts and feelings that
might displease others, submit to even the most
unreasonable demands, frantically cling to others

Cannot make decisions for themselves,

do not initiate new activities except in
an effort to please others

79 abmartinez @ 2010
 üdifficulty making decisions without advice and
reassurance
üneeds others to assume responsibility for most major
areas of life
üdifficulty expressing disagreement with others (fear of
loss of support or approval)
üdifficulty initiating projects or doing things on own
ügoes to excessive lengths to obtain nurturance and
support (volunteers to do things that are unpleasant)
üfeels uncomfortable or helpless when alone

80 abmartinez @ 2010
 Pervasive rigidity in one ’ s ac
interpersonal relationships

Includes qualities such as emotional constriction,

extreme perfectionism and anxiety resulting from
even slight disruptions in one

Rigid, perfectionist, dogmatic, emotionally

blocked—preoccupation with orderliness and
81 abmartinez @ 2010 perfection
 OC personality
disorder are more
generalized way of OCD involves only
interacting
specific and constrained
obsessive thoughts and
compulsive behaviors

82 abmartinez @ 2010
 Seem grim and austere, tensely in control of
their emotions, lacking spontaneity (Millon,
1981)

Workaholics and see little need for leisure

activities or friendships

Lifetime prevalence is 1.7% and 6.4%; more

common in men than women
83 abmartinez @ 2010
 Seen as stubborn, stingy, possessive, moralistic

Ingratiating and deferential to “superiors” but

dismissive, demeaning or authoritarian toward
“inferiors”

Extremely concerned with efficiency, but perfectionism

and obsessions on following rules often interfere with
completion of tasks
84 abmartinez @ 2010
 Fin.

85 abmartinez @ 2010
 —Fin

86