UNIT 2 - TOPIC 2

Normality

The state of being normal. It includes different concepts such as sociocultural, function, historical, situational, medical and statistical. It is defined in terms of typical and atypical behaviours, and how some behaviours are adaptive or maladaptive.

Normal behaviour

A behaviour that is accepted within society. It is typical for the specific situation or context.

Maladaptive behaviour

Actions or responses that are counterproductive or harmful to an individual’s wellbeing, functioning or goals.

Adaptive behaviour

Actions or responses that enable an individual to effectively navigate and cope with the demands of their environment, interact with others and achieve personal goals.

Atypical/abnormal behaviours

viewed as “out of the ordinary”. It goes against societal and cultural expectations, may reflect some kind of impairment, or consist of unwelcome behaviours.

Situational approach

based on the social situation, behavioural setting or general circumstances in which the behaviour occurs.

Sociocultural approach

based on what is normal or acceptable in a particular society or culture.

Historical approach

based on what was considered normal or acceptable at a particular time in history.

Statistical approach

based on the idea that any behaviour or characteristic in a large group of individuals is distributed in a particular way.

Medical approach

based on the view that abnormal behaviour has a biological cause and can usually be diagnosed and treated.

Functional approach

based on whether the individual can function independently and effectively in society.

Example of situational approach

Yelling and screaming at a football match is normal, but the same behaviour in a classroom would be considered abnormal.

Example of sociocultural approach

Spiritual possession is common and considered normal in Sudan. However, in Western society, the same behaviour might be interpreted as a psychological disorder.

Example of historical approach

In ancient times, it was considered normal to believe that mental illness was caused by evil spirits or supernatural forces.

Example of functional approach

If a person is so shy that they avoid going to parties and social events, this behaviour could be considered abnormal because it interferes with their ability to lead a normal life.

Example of medical approach

Mental illness is diagnosed based on symptoms, and treatment may involve medication, therapy or hospitalisation.

Example of statistical approach

Intelligence is normally distributed in the population, with most people falling in the average range and fewer people at the high and low extremes.

Criticism of situational approach

Judgements about normality “can vary depending on context and may not reflect a person’s actual mental health.” It’s also subjective — one person might accept the behaviour, another may not.

Criticism of sociocultural approach

This approach “may overlook the individual differences within cultures” and struggles with behaviours that “may be accepted in some groups but rejected in others.” Cultural values also change over time.

Criticism of statistical approach

This approach “does not take into account whether the behaviour is desirable or harmful.” A rare trait (e.g., giftedness) may be statistically abnormal but not psychologically problematic.

Criticism of historical approach

This approach is limited because “what was once considered normal may now be seen as outdated or even unacceptable.” It fails to reflect current scientific understanding.

Criticism of medical approach

“This approach can sometimes ignore the influence of psychological, environmental or social factors on behaviour.” It may also “over-rely on medication and diagnosis.

Criticism of functional approach

It “can be subjective and influenced by personal judgment,” meaning what’s functional to one person may not be for another. It also ignores whether someone feels happy even if not functioning by society’s standards.

Coping mechanisms

There are two types: functional (adaptive) and dysfunctional (maladaptive)

Adaptive behaviour

refers to age-appropriate ‘everyday living skills’ that people learn through experience. These are essential for functioning independently in daily life. In childhood, examples include talk, walk, play with others, rules in school. In adulthood, they include maintaining a job, living independently, managing a household.

What factors impact adaptive behaviour?

personality predisposition, resilience, secure and happy environment/attachment, parental interest in education, and financial security.

How is adaptive behaviour measured?

through standardised tests (how well someone performs everyday tasks

How can disabled people improve their adaptive skills?

They have difficulty following social rules, but their adaptive skills can improve by focusing on a specific skill e.g. cooking, budgeting.

Maladaptive behaviour

coping mechanisms that are dysfunctional—they may temporarily reduce anxiety but can cause harm or prevent personal growth. They are different from adaptive coping because mal means dysfunctional. It can be habit forming making them difficult to change with constant effort.

What factors cause maladaptive behaviour?

They often originate from early childhood experiences, family situations and environmental stressors. They can show up in social interactions, work, school, [and] emotional regulation, and they “often lead to stress, anxiety, or difficulty in relationships.

Examples of maladaptive behaviour

Avoidance, escaping stressful situations rather than facing them, Procrastination, negative self-talk, inflexibility, Social withdrawal due to anxiety (which can temporarily reduce stress but in the long-run leads to more stress), Perfectionism (excessive criticism)

How can maladaptive behaviour be improved?

cognitive behavioural techniques (help individuals recognise harmful patterns) and natural exposure can be used. The goal is to replace maladaptive [behaviours] to adaptive so individuals can help reduce their anxiety.

Examples of adaptive coping

problem solving skills, mindfulness, and seeking support from others.

Examples of early childhood experience that can influence the development of maladaptive behaviours

- Avoidant or ambivalent attachment as an infant

- Unhelpful parenting

- Parents who prioritise their own needs over those of their children

- Parents who model maladaptive behaviours

- Parents who show little interest in their children’s educational needs

- Parents who encourage risk-taking behaviours

- Marital conflict

- Violence/abuse/neglect

- Genetics

- Personality predisposition

- Trauma/grief/loss

Psychological disorders

Any condition characterised by cognitive and emotional disturbances, abnormal behaviours, impaired functioning, or any combination of these - American Psychiatric Association (APA)

How are psychological disorders managed?

often involves a combination of psychotherapy, medication and other therapeutic interventions aimed at alleviating symptoms and improving overall wellbeing

How are psychological disorders diagnosed?

diagnosis uses WHO’s ICD-11 and APA’s DSM-5. They are the most respected medical manuals / classification systems in the world for classifying diseases and disorders in a standardised way. Clinicians use diagnostic manuals to correctly diagnose patients and determine the correct treatment for illnesses.

ICD-11

Internal Classification of Diseases (11th edition) by WHO (World Health Organisation). It is used to classify ALL health conditions (including psychological) INTERNATIONALLY and there are multiple versions and languages. However, its diagnostic criteria does NOT include social consequences. It is available at a discounted price for low-income countries.

DSM-5

Diagnostic and Statistical Manual of Mental Disorders (5th edition) by APA (American Psychiatric Association). It is used to classify ONLY psychological disorders MAINLY in Australia and America with partial acceptance around the world. There is only a single document in English. Its diagnostic crieria DOES include social consequences. It is mostly used by high-income countries.

What are some factors that cause psychological disorders?

genetic predisposition, biological factors, environmental stressors, and psychological or social factors

Other names for psychological disorders

psychiatric illness, psychiatric disorder, mental disorder and mental illness

How are psychological disorders managed?

It often involves a combination of psychotherapy, medication and other therapeutic interventions aimed at alleviating symptoms and improving overall wellbeing.

What factors can hinder treatment and long-term management of psychological disorders?

social isolation, lack of family or friendships, unemployment, poverty and homelessness

Steps for diagnosing a psychological disease/disorder

clinical interview, assessment of personality, cognitive assessment, neuropsychological assessment → identification of clinical symptoms → use of DSM or ICD to diagnose the disorder → design the interventions, implement treatment → REVIEW

Origin of DSM-5

Its major event was World War II. It was believed before the war that mental illnesses were biological and cannot be developed from a life event. For example, PTSD was called shell shock because scientists did not believe it was a mental disorder.

Stigma

where others view someone in a negative way because they have a mental illness, which can lead to disadvantage.

Self-fulfilling prophecy

the stigma of being labelled mentally ill can, in some cases, cause an individual to develop a mental illness. For example, for people with depression, others may think that they can’t succeed academically, and this makes the people with depression think this and then actually follow it.

Strategies for psychological disorders

getting help at school, getting treatment, asking family and friends for support etc.

Advantages of ICD-11 and DSM-5

- Enables psychologists to offer valid explanations for maladaptive behaviour and make reliable predictions for prognosis.

- Allows diagnosis to be standardised, helping to ensure patients with similar symptoms receive appropriate treatment for those symptoms. This improves quality of care.

- Guides mental health research by ensuring that different groups of researchers studying particular sets of symptoms study, and apply results to, the same disorder.

Disadvantages of ICD-11 and DSM-5

- Oversimplification of human behaviour can lead to misdiagnosis and incorrect treatment. Also, patients can meet the criteria for more than one treatment.

- DSM-5 manuals generally does not consider the social, cultural and environmental factors that influence mental health.

- Changes in the diagnostic criteria can lead to stigmatisation.

How do psychiatrists and psychologists use DSM-5?

Acts as the primary tool for diagnosing mental disorders and guides treatment planning based on specific criteria. It also facilitates communication among mental health professionals.

How do clinical social workers and counsellors use DSM-5?

Provides a framework for understanding and addressing mental health issues and assists in developing treatment plans. It also “enhances communication with clients.

How do clinical nurses and nurse practitioners use DSM-5?

Aids in the assessment and understanding of mental health symptoms and supports collaboration with other healthcare professionals.

How do researchers in psychology and psychiatry use DSM-5?

Standardises the classification of mental disorders, enabling consistent methodology, and facilitates the comparison of research findings across studies.

How do physicians and general practitioners use ICD-11?

Acts as the primary tool for coding and billing in healthcare settings, and guides treatment and management decisions.

How do health information management professionals use ICD-11?

Used for accurate documentation, coding, and classification of diseases, and supports billing, and reimbursement processes.

How do epidemiologists use ICD-11?

Aid in the analysis of health trends and the identification of emerging health issues, and support health surveillance and monitoring efforts.

How do public health professionals use ICD-11?

Facilitate the planning and implementation of public health interventions, and enhance the understanding of the burden of disease (financial and psychosocial costs) in different populations.

Major classes of psychological disorders categorised by the DSM-5-TR

- schizophrenia spectrum and other psychotic disorders

- bipolar and depressive disorders

- anxiety disorders

- personality disorders.

Significant symptoms of the schizophrenia spectrum and other psychotic disorders

Characterised by the presence of psychotic symptoms including hallucinations, delusions, disorganised speech, bizarre behaviour, or loss of contact with reality.

Significant symptoms of bipolar and depressive disorders

Mood disorders that are characterised by periods of extreme and/or prolonged depression or mania or both

Significant symptoms of anxiety disorders

Characterised by avoidance and anxiety behaviours

Significant symptoms of personality disorders

Characterised by long-standing, inflexible, maladaptive patterns of behaviour beginning early in life and causing personal distress or problems in social and occupational functioning

Examples of schizophrenia spectrum and other psychotic disorders

schizophrenia

Example of bipolar and depressive disorder

major depression disorder and bipolar I and II

Example of anxiety disorder

a specific phobia

Example of personality disorder

antisocial personality disorder

Schizophrenia

characterised by a withdrawal from reality, possible delusions and hallucinations, illogical thinking and disturbances in emotions, behaviours or thinking.

Symptoms of scizophrenia

- Positive symptoms (e.g. hallucinations, delusions)

- Negative symptoms (e.g. lack of motivation, reduced emotional expression)

- Cognitive symptoms (e.g. poor concentration and problem-solving). For diagnosis, symptoms must last for at least six months and interfere with daily functioning, such as interpersonal relationships and self-care.

Major depression disorder

persistent sadness, worthlessness, loss of interest in activities, and changes in appetite, sleep, and energy. To be diagnosed, five or more symptoms must be present most days for at least two weeks.

Bipolar I and II

- Bipolar I refers to full manic episodes, possibly with psychotic features

- Bipolar II refers to hypomania (milder mania) and depressive episodes. People may show elevated mood, reduced need for sleep, racing thoughts, and risky behaviours.

Specific phobia

intense, irrational fear of specific objects or situations (e.g. spiders, flying), lasting six months or more, causing avoidance and distress.

Generalised anxiety disorder

constant and excessive worrying about various topics for six months or more, often with physical symptoms (e.g. fatigue, sleep problems, muscle tension) and cognitive symptoms (e.g. trouble concentrating).

Antisocial personality disorder

marked by disregard for the rights of others, manipulation, lack of remorse, impulsivity, and criminal behaviour. Often begins in childhood as conduct disorder, and is more common in men.

Borderline personality disorder

involves unstable relationships, intense emotions, impulsive behaviour, fear of abandonment, and distorted self-image.

Validity of diagnosis

The accuracy of classification systems for diagnosis that leads to appropriate and effective treatment. It asks: “does the person diagnosed have real symptoms with a real underlying cause (the illness is not socially structured)?”

Reliability of diagnosis

The consistency of diagnosis using a classification system such as the DSM-5-TR or ICD-11. A diagnosis is considered reliable when different clinicians using the same system reach the same diagnosis for a particular individual. It asks: “Will different diagnosticians using the same classification system arrive at the same diagnosis?”

Factors that challenge reliability

- symptom clusters assume they are connected

- comorbidity

- lack of physiological testing

- symptoms are subjective and may be exaggerated, hidden or misunderstood.

Factors that challenge validity

- self-reported symptoms or observer reports may be inaccurate (this is proven by Rosenhan’s 1973 study)

- cultural differences

- treatment outcomes do not always confirm whether the original diagnosis was correct