第十八章
變態心理學
第十八章 變態心理學
國立中正大學心理系所
作者：心理學研究所 陳冠銘
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一、Definition of Abnormal Behavior
-可能會翻譯成「變態行為」或「偏差行為」。
-必須符合下列四項標準：
1.statistically unusual: it deviates from statistical normal, average behavior
2.nonadaptive: it hampers the individuals's ability to function more effectively withing a given context
3.labeled by the majority in a given social context
4.some degree of perceptual or cognitive distortion
-No exceptions in the above criterion?
1.winning a Nobel Prize?
2.throwing food wrappers ot of a car window on a highway?
3.Yoruba, shamans, Nazi
4.Taylor and Jonathon(1988), distortion for mental health?
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二、Etiology of Abnormal Behavior
demonology, daemon, demon, see p.602, Girls of Salem, LSD
Hippocrates suggested that people with mental illness suffered from some kind of pathology of the brain.
four humors: yellow bile, black bile, phlegm (/flem/, 黏液) ,and blood.
Psychodynamic Approach: Sigmund Freud
-abnormal behavior is largely a result of intrapsychic conflict.
-conflict of id, ego, superego
The Humanistic Approach
-abnormal behavior arise when people are overly sensitive to other people's judgemnet, or when they are unable to accept their own nature.
The Behavioral Approach
-abnormal behaivor is the result fo either classical or instrumental condition gone awry.
-e.g. little Albert, OCD
The Cognitive Approach
-abnormal is the result of distorted thinking.
The Psychophysiological Approach
-abnormal behavior is due to underlying physiological abnormalities in the nervous system, particularly the brain.
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三、Diagnosing Abnormal Behavior
兩大分類系統ICD-10與DSM-IV，都具有兩項特徵：
descriptive and atheoretical(i.e. a-theoretical), which means that it is not based on any particular theoretical approach.
based wholly on observable symptoms, making it usable by psychologists and psychiatrists of a wide variety of theoretical orientations.
1.International Classification of Disease (ICD-10, 1992)
2.Diagnostic and Statistical Manual IV (DSM-IV, American Psychiatric Association, 1994; table 18-1, pp.604-5)
(1)clinical syndromes: schizophrenia, anxiety disorders, somatoform disorders, sexual disorders......
(2)personality disorders:antisocial, avoidant, dependent, OCD.....
(3)general medical conditions /physical disorders: asthama, diabetes, heart problem....
(4)psychosocial and environmental problems: e.g. economic problem, educational problem.
(5)global assessment of functioning scale
The goal of diagnosis is to provide as comprehensive a portrait of abnormal functioning as possible.
**Problems of DSM-IV or ICD-10:
1.atheoretical
2.subjectivity in diagnosis
3."mapping" behaivor ontothe descriptive categories
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四、Psychological Disorders
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1.Anxiety disorders
-characterized primarily by feelings of anxiety -- tension, nervousness, distresss, or uncomfortable arousal -- of varying levels of intensity, excessive worry and a concentration of thoughts on worrisome phenomena, many purposeless movements, and somatic symptoms associated with high arousal of the autonomic nervous system.
-Five Subtypes:
(1) Phobias:
-def.: exaggerated, persistent, irrational, and disruptive fears of a particular object, a particular event, or a particular setting, or fears of a general kind of object, event, or setting.
a. simple phobias: irrational fears of objects. e.g.spiders, snkaes, high places.
b. social phobias : extreme fear of being criticized by others. e.g. meeting new people
c. agoraphobia: fear of open space or of being in public places from which it might be difficult to escape in the event of panic attack.
(2)Panic disorder:
brief, abrupt, and unprovoked but recurrent episodes during which a person experiences intense and uncontrollable anxiety.
(3)Generalized anxiety disorder (GAD, 泛慮症):
general, persistent, constant, and often debilitating high levels of anxiety.
(4)Stress disorder(壓力失常):
def: an extreme reaction to a highly stressful event or situation.
posttraumatic stress disorder (PTSD, 巨變後壓力失常)：the psychological reenactment of a past traumatic event, such as recurring nightmares or repeated wakeful resurfacing of painful memories of the event while consciously engaged in other activites. 如火災、地震後。
acute stress disorder：a brief mental illness that arises in response to a traumatic even, lasting fewer than 4 months.
(5) Obsessive-compulsive disorder (OCD,強迫症)：
-def.: obsession, unwanted, persistent thoughts, images, or impulses that cannot be suppressed; compulsion, irresistible impulses to perform a relatively meaningless act repeatedly and in a stereotypical fashion. 思考上，慾望上或行為上無法控制的反覆出現。不自主的重複行為
-Symptoms:
a.Mood symptoms: feelings of tension, apprehension, and sometimes panic.
b.Cognitive symptoms: a person's spending a lot of time trying to figure out why various mood symptoms are occurring.
c.Somatic symptoms: sweating, hyperventilation, high pulse or blood pressure, and muscle tension.
d.Motor symptoms: restlessness, fidgeting, and various kinds of bodily movements that seem to have no particular purpose.
-Three critical factors of diagnosis:
a.level of anxiety:
b.justification of the anxiety:
c.consequences of the anxiety:
-Cognitive anxiety vs. Somatic anxiety
-Explanations of Anxiety Disorders
a.Psychodynamic Explanations
-Freud distinguished three types of anxiety:
(1)objective anxiety: from threats in the external world
(2)moral anxiety: derived from fear of punishmend by the superego
(3)neurotic anxiety: derived from a persons fear that the superego will not be able to control the id, and that the person may not be able to avoid engaging in unacceptable behavior.
-psychosis vs. (experimental) neurosis
-how to explain phobia in terms of psychodynamics?
b.Learning Theory Explanations
-classical conditioning: e.g. vacarious conditioning
-operant conditioning:
c.Cognitive Explanations
-automatic thoughts
d.Humanistic Explanations
-the discrepancies between perceived self and idealized self
e.Psychophysiological Explanations
-inhibitory neuron: e.g. insufficient level of GABA activity
-tranquilizer: diazepam(valium), benzodiazepam(BZD)
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2.Mood disorders
-def.: extreme disturbance in a person's emotional state, e.g. major depression and bipolar disorder
1. Major Depression (also called unipolar depression):
-persons with major depression feel down, discouraged, and hopeless.
-origins of depression (Table 18-2, p. 614):
e.g.Seasonal affective disorder(SAD):
(1)typically occurs during the winter months or the months surrounding them.
(2)appears to be linked to irregularties in the body's production of melatonin, which is secreted by the pineal gland and is implicated in the sleeping-waking cycle.
2.Bipolar disorder (also called Manic-depressive disorder)
-def.: refers to alternating depression and mania
-mania is a mood of unrestrained euphoria involving high excitement, expansiveness, and often hyperactivity.
-symptoms of bipolar disorder patient: text and figure 18-2, p.615
-e.g. 太陽花的汪子敏
-Explanations of Mood Disorders
a.Psychodynamic Explanations
-feel angry to the lost person or object
b.Learning Theory Explanations
-depressed people receive fewer rewards and more punishments than do people who are not depressed.
c.Cognitive Explanations
-learned helplessness may contribute to the higher rate of depression in women than in men.
-inappropriate attributions and inferences directly contribute to depression. (Aaron Beck, 1967)
-Beck suggests taht depressed people are particularly susceptible to logical errors in thingking:
(1)arbitrary inferences:
(2)selective abstraction:
(3)overgeneralization:
(4)magnification and minimization:
(5)personalization:
d.Humanistic Explanations: Viktor Frankl(1959)
-depression results from a lack of purpose in living.
e.Psychophysiological Explanations
-NE theory: excessive NE in manic state, inenough NE in depressive state
-Serotonin theory: 5-HT level is too low
-drugs: lithium; SSRI drug, e.g. Prozac,
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3.Suicide
-suicide attempters vs. completers (Table 18-3, p.618)
特徵 嘗試者 完成者
性別 女佔大多數 男佔大多數
年齡 年輕 年紀越大越可能
方法 較不致命的（藥物，割傷） 較激烈（槍，跳樓）
環境上可做的 可阻止 不容易被發現
診斷 邊緣上的 情感症，酗酒，精神分裂
情緒 生氣的憂鬱 絕望的憂鬱
動機 渴求幫助 死
-7 Myths of suicide
(1)說要自殺的人不會真的去自殺。錯！十個中有八個人會給一些訊號。
(2)要自殺的人不肯定要死。
(3)富人較多自殺。錯！所有社會階層的人都有可能。
倒是專業人員如心理學家，精神科醫師，律師，醫生的自殺比例較其他行業高。
(4)要自殺的人會有憂鬱的症狀。不一定。
(5)自殺的人都不正常，與現實脫節。錯！
(6)改變自殺者憂鬱的心情可挽回一條命。不一定。
因太憂鬱的人沒力氣做什麼事。當心情好時，才有力氣作一些與自殺有關的動作。
(7)自殺受大氣，月換星移的影響。錯！
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4.Schizophrenia
-def.: p.620
-positive symptoms:
-negative symptoms:
-types of schizophrenia and their symptoms:
(1)disorganized schizophrenia:
(2)catatonic schizophrenia:
(3)paranoid schizophrenia:
(4)undifferentiated schizophrenia:
(5)residual schizophrenia
-Social-drift hypothesis (Myerson, 1940): SES and schizophrenia
a.Psychodynamic Explanations
-primary naricissism
-schizophrenogenic mother
-double-bind theory (Bateson, Jackson, Haley, & Weakland, 1956)
b.Learning Theory Explanations
-labeling theory
c.Cognitive Explanations
-different sensory experiences, cognitive flooding, stimulus overload
d.Humanistic Explanations
-mental illness is simply a myth. (Thomas Szaza, 1961)
-schizophrenia is not an illness but merely a label that society applies to behavior it find problematic. (R.D. Laing, 1964)
e.Psychophysiological Explanations
-Dopamine theory: excess dopamine
-enlarged ventricle in the brain
-virus
-genetic disorder
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5.Dissociative disorders
-formerly termed multiple personality disorder (MPD)
-three types of dissociative disorders
(1)dissociative amnesia:（失憶症）
(2)dissociative fugue:（遁逃症）重新一新生活，也是失憶。
(3)dissociative identity disorder:（認同解離，多重人格）每個人格獨立，各有其記憶，態度和行為
-24個比利, the three faces of Eve
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6.Disorders in infancy, childhood（嬰兒，兒童期的問題）
a.attention-deficit hyperactivity disorder(ADHD): 注意力不集中，過動, cf. ADD
b.conduct disorder（行為異常）：打架、破壞、對動物殘忍
c.pervasive developmental disorder(PDD, also known as autism):
-symptoms:(1)no response to others, (2)impairment in communication, (3)restricted range of interest
-for more information, please contact 姜忠信老師
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7.Personality disorder（人格異常）
-def.: p.628
-Ten types of personality disorders:
(1) paranoid personality disorder
(2) schizoid personality disorder
(3) schizotypal personality disorder
(4) borderline personality disorder
(5) narcissistic personaltiy disorder
(6) histrionic personality disorder
(7) avoidant personality disorder
(8) dependent personality disorder
(9) obsessive-compulsive personality disorder
(10) antisocial personality disorder: ***
-diminished volume in prefrontal cortex of antisocial patients
-Damasio, H., Grabowski, T., Frank, R., Galaburda, A.M., Damasio, A.R. (1994). The return of Phineas Gage: clues about the brain from the skull of a famous patient. Science, 264, 1102-5.
-Raine, A., Lencz, T., Bihrle, S., LaCasse, L., & Colletti, P.(2000). Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder. Archives of General Psychiatry, 57, 119-27.
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最後更新日期：02-06-01 04:09.（香港時間）