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What is Abnormal? It is not whether one is normal or not, but one of degrees. We all have some abnormalities. Some are more adaptive than others. Some can endure more stress. It is whether we can function in our society. One may be depressed, but one still gets up in the morning to go to work. One can hold down a job. One can still stay in school.
Adaptation: This is the balance between what people want to do and what society lets them do. Our genetic make up and the environment are two key factors to how well we adapt or survive.
Adjustment: Adjustment refers to our mastery over our environment and peace with ourselves. Maladaptive behavior results when there is either: 1. An inability to cope 2. Too much stress in one's environment 3. or a vulnerability. Stress is one's reaction to different situations. Coping refers to our ability to control ourselves in difficult situations. Vulnerability refers to how likely we will respond the wrong way to a certain situation. Genetics will play a key role here. Groups that are at higher risk are children, teens, elderly, disabled, and minorities.
DSM=Diagnostic and Statistical Manual of Mental Disorders. This is a multiaxial classification system of mental problems. There are five main axes, or categories.
- Axis I - primary problem
- Axis II - developmental and personality problems
- Axis III - physical problems
- Axis IV - psychosocial stressors
- Axis V - global assessment of functioning, current and highest level in past year.
Two major types of stress are:
- stress-arousing situations, natural disasters, accidents, combat
- developmental transitions, childhood, puberty, college, work, marriage, rearing children, moving, retirement.
There are three different levels of reactions to stress:
- physically, blood pressure goes up
- mentally, excessive worry
- behaviorally, poor performance at work or school.
Result of a traumatic disaster survivors experience:
- Preoccupation with fears of sudden death.
- Horrible dreams like feeling trapped.
- Guilt for having lived while other died.
- Reduced ability of feelings, numbness.
- Social relationships are impaired.
- Search for meaning in the disaster.
There are three main categories of stress related disorders: adjustment, post-traumatic, and dissociative.
More than three months of inability to adjust to common stresses in their life like marriage, divorce, moving, job, or menopause. When the stress is removed, or adapted to, things return to normal.
Post-Traumatic Stress Disorder
Inability to adjust to traumatic events, like combat.
- Re-experiencing the traumatic event. Much energy is spent of fending off painful thoughts.
- Painful memories and nightmares.
- Hyperalertness, an exaggerated startled response.
- Depression, restlessness, irritability.
- Guilt feelings.
- Poor concentration, impulsive behavior.
Similar stressors, and situations can elicit the opposite reactions in people. In this disorder instead of being preoccupied with the stress, they try to escape the stress my some type of memory loss.
A. Psychogenic Amnesia.
Memory loss not organically caused (like a head injury) usually a result of a traumatic event. This condition is rare and recovery is rapid.
B. Psychogenic Fugue.
Sudden loss of their identity. They suddenly drop out of life, move far away, and start a new life. This is usually the result of a traumatic event.
C. Multiple personality Disorder.
This is the most extreme form where a person assumes alternate personalities. Most think this is a result of traumatic experiences in early childhood like physical and sexual abuse. Some go into hypnotic trances.
II. Anxiety Disorders
Anxiety is a vague, very unpleasant feeling of fear and apprehension. An anxious person worries a lot usually about unknown dangers. They are not aware of why they are anxious. They show some of the following symptoms: fast heart rate, shortness of breath, fainting, dizziness, sweating, sleeplessness, diarrhea, frequent urination, loss of appetite, and tremors.
A. General Anxiety Disorder
Anxiety for more than a month. 1. Tension, unable to relax 2. Nervous system is working over time. See above symptoms. 3. Apprehension of the future 4. Excessive vigilance, looking for possible danger.
B. Panic Disorder
This is similar to general anxiety except there is a sudden onset with magnified symptoms of severe palpitations, shortness of breath, chest pain, sweating, dizziness, a feeling of helplessness, and fear of dieing or going crazy. Breathing into a paper bag can help the panic attack.
The word comes from the Greek god of fear. The most common phobia is agoraphobia, the fear of unfamiliar situations. There are five types of phobia: 1. Separation fears (crowds, traveling alone, home alone) 2. Animal fears (rats, mice, insects, snakes) 3. Mutilation fears (operations, blood, open wounds) 4. Social fears (strangers, being watched) 5. Natural fears (heights, cliffs, water).
D. Obsessive Compulsive Disorder
Traumatized by repetitive thoughts and acts. Obsessive people are unable to get an idea out of their head (like sexual, aggressive, or religious thoughts). Compulsive people feel compelled to keep repeating a certain act (like repetitive hand washing, brushing teeth, counting, checking the doors locked). Generally phobic people fear what may happen to them, obsessive compulsive people fear what they might do to others. The four main types are: 1. Checking frequently the gas, water, doors. 2. Cleanness, like avoiding public telephones because of germs. 3. Slowness in completing things. 4. Doubt even when everything is done carefully. Most of us have these thoughts, but they do not consume us and disrupt our lives. symptoms increase with stress.
III. Personality Disorders
There are three groups of personality disorders
Odd or eccentric behavior
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
Dramatic, emotional, or erratic behaviors
- Histrionic personality disorder
- Narcissistic personality disorder
- Borderline personality disorder
- Antisocial personality disorder
Fearful or anxious behaviors
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive Compulsive personality disorder
IV. Mood Disorders
The two factors in depression are:
- a sad mood, feeling blue, hopeless, irritable and worried.
- a loss of interest or pleasure in things.
Often a stressful event can cause depression. Women are twice as likely to be depressed. We all feel blue when bereaved, disappointed, or after holidays. Clinical depression lasts for at least three months. Depression is the result of the lack of certain chemical neurotransmitters in certain places in the brain. Sleep is usually disrupted. One has trouble going to sleep and then staying asleep. One usually feels most depressed in the morning. Doctors prescribe anti-depressant drugs to help people over come depression.
B. Bipolar Disorder
Bipolar disorder is also called manic-depressive disorder. There are two phases: depression and mania. Mania involves flight of ideas, extreme elevated mood, impulsive behavior, talkative, delusions of grandeur, hyperactive, not tired, and needs less sleep. A person will have mood swings from mania to depression. Usually lithium is used to stabilize a person with bipolar disorder.
Always take threats of suicide seriously, even indirect statements like, "I wish I was never born," or "you'll be sorry when I'm gone."
V. Schizophrenic Disorders
Symptoms of schizophrenia are: problems of perception (delusional, hallucinations), lack of concentration, inability to express thoughts, flat emotional responses, unusual motor behavior, and lack of initiative.
Delusion is a wrong interpretation of reality which logic can not change. There are paranoid delusions of jealousy, persecution, someone is after them, someone is trying to kill them, or poison them.
Hallucinations are internal impulses projected onto images in the real world. Most common is hearing voices. Some see things that are not there.
Some researchers think that it is the result of problems with the chemical neurotransmitter dopamine. Doctors prescribe anti-psychotic mediation.
Much abnormal behavior is do the result of dealing with stress. Psychological factors can affect your health. Stress can cause headaches, allergies, asthma, diarrhea, ulcers.
Somatoform disorder is marked by bodily complaints that have no physical explanation.
Physical problems can also cause mental disorders.
Genetics also play an important role in mental and physical health.
For more information on health, Dr. Koop has an excellent web site at drkoop.com.
For more information on abnormal psychology see http://www.wadsworth.com/.