Models of Abnormality
Biological Model
Overview: Biological theorists explain abnormal behavior as illness arising from malfunctioning parts of the organism, typically focusing on brain-related causes such as brain chemistry, brain circuitry, and endocrine activity.
Philip Berman case context: used to illustrate how a clinician may approach abnormality from a biological perspective among others. His symptoms (depression, anger, social and employment problems) can be traced to biological processes as well as environmental and interpersonal factors.
Brain biology basics:
The brain contains roughly 86{,}000{,}000{,}000 neurons (nerve cells) and many trillions of glial cells (support cells).
Neurons communicate via electrical impulses that travel along the axon to nerve endings, where neurotransmitters are released into the synapse and bind to receptors on the next neuron.
Dendrites receive input; the axon transmits output; synapses are the gaps between neurons.
Neurotransmitters can excite or inhibit receiving neurons; abnormal activity in specific neurotransmitters has been linked to mental disorders (e.g., depression linked to low serotonin, norepinephrine, and glutamate activity).
Endocrine system: Hormones released by glands (into the bloodstream) coordinate body functions; cortisol from the adrenal glands is a key stress hormone linked to anxiety and depression when secretions are abnormal.
Brain anatomy and circuits:
Brain structures cluster into circuits that coordinate emotion, cognition, and behavior.
A brain circuit is a network of structures whose interconnections and neurotransmitters produce a particular response. Proper connectivity tends to support healthy functioning; faulty connectivity may contribute to dysfunction.
The fear circuit is a major example, involving structures such as the prefrontal cortex, anterior cingulate cortex, insula, and amygdala, with interconnecting pathways and neurotransmitters.
Dysfunction in fear circuitry has been associated with anxiety disorders and excessive fear responses (Fulena et al., 2020).
Genetics and evolution:
Humans have 23 pairs of chromosomes; about 20{,}000 genes influence physical traits and can contribute to mental disorders in combination with other factors.
Evolutionary perspectives propose that certain gene variants helped ancestors survive (e.g., fear responses), but in modern environments may predispose some individuals to anxiety or fear-related disorders.
Sources of biological abnormalities:
Prenatal events, brain injuries, infections, environmental experiences, and stress can influence biological functioning.
Twin studies and genetics indicate partial heritability; however, most disorders arise from multifactorial interactions (genes, brain development, environment).
Treatments:
Drug therapy (psychotropic medications) dominate modern treatment; effective since the 1950s. They affect brain chemistry and can reduce symptoms, often used alone or with psychotherapy.
Brain stimulation and psychosurgery exist but are less common and typically for treatment-resistant cases.
Controversies: potential overuse, limited efficacy for some individuals, and side effects; debates about cost, access, and promotional advertising.
Direct-to-consumer (DTC) drug advertising:
U.S. and New Zealand allow DTC ads; around 80\% of American adults have seen these ads, and at least 30\% ask their doctors about advertised drugs.
Advertising expenditures are immense; pharmaceutical companies spend about 6{,}600{,}000{,}000 per year on U.S. TV and online campaigns.
Critics argue ads overemphasize benefits, may drive up drug prices, and can influence prescribing in ways that may not align with best clinical evidence.
Ads may affect patient understanding and treatment decisions; calls for more balanced information and clinician-patient dialogue.
Important caveats for the biological model:
While biological factors are important, many theorists emphasize that behavior results from a combination of biological, psychological, and social factors; integrative approaches are common.
Key references and terms:
Neuron and synapse basics; neurotransmitters; hormones (e.g., cortisol); brain circuits like the fear circuit; genetic factors; evolution of fear responses.
DTC ad debates: El Fasi et al. (2019); ProCon (2018); WHO (2028).
The Psychodynamic Model
Core premise: Behavior (normal or abnormal) is largely determined by unconscious psychological forces that interact in dynamic ways. Symptoms are the result of conflicts, often rooted in early childhood experiences and relationships.
Historical grounding: Sigmund Freud (1856–1939) developed psychoanalysis; early 20th century Vienna included figures like Carl Jung who branched off with different ideas but kept the notion of dynamic, interacting forces.
Freud’s three dynamic forces:
ID: instinctual needs, drives, and impulses; operates on the pleasure principle (seeks gratification; often sexual in nature).
EGO: the rational mediator; operates on the reality principle; uses defense mechanisms to manage anxiety and to control impulses.
SUPEREGO: morality and values; internalization of parental standards; conscience.
Defense mechanisms (Freud; elaborated by Anna Freud): strategies the ego uses to manage anxiety and internal conflicts. Examples:
Repression: pushing painful thoughts out of consciousness.
Denial: refusing to acknowledge anxiety-provoking information.
Projection: attributing one’s own unacceptable impulses to others.
Rationalization: offering socially acceptable explanations for unacceptable motives.
Displacement: redirecting emotions to safer targets.
Intellectualization: focusing on abstract or logical aspects to avoid emotional impact.
Regression: retreating to an earlier developmental stage in the face of stress.
Freudian concepts: ego defenses, the role of early relationships, and unresolved conflicts influencing adult behavior.
Psychosexual development and fixation:
Stages named for body areas and linked to developmental challenges: oral (0–18 months), anal (18–36 months), phallic (3–5 years), latency (5–12 years), genital (12 years to adulthood).
Fixation at any stage may lead to personality patterns and potential dysfunction later in life (e.g., oral fixation linked to dependency or mistrust; anal to control issues).
Freud’s theory of personality development and pathology: unresolved conflicts and weak working relationships among ID, ego, and superego may produce dysfunctional behavior.
Later psychodynamic theories: developments beyond Freud include self theory (Kohut) and object relations theory (Kernberg, Siegel), emphasizing self-cohesion and relational needs rather than intrapsychic conflict alone.
Psychodynamic therapies:
Goals: uncover past traumas and inner conflicts, resolve them, and promote ongoing development.
Core techniques:
Free association: patients say whatever comes to mind; clinicians look for unconscious material.
Therapist interpretation: clinicians draw inferences about unconscious dynamics and share them when the patient is ready.
Catharsis: emotional release associated with bringing unconscious material to consciousness.
Working through: repeated consideration of problems over time to solidify insights.
Key phenomena in therapy:
Resistance: unconscious reluctance to participate fully or to free associate.
Transference: patients direct feelings about important others onto the therapist.
Dreams: Freud viewed dreams as royal road to the unconscious; two content types:
Manifest content: consciously remembered dream.
Latent content: hidden symbolic meaning; interpreted to reveal unconscious wishes.
Self theory and object relations (modern psychodynamic approaches):
Self theory emphasizes the self as the central organizing construct; innate drive toward self-cohesion.
Object relations theory emphasizes relationships with others and early caregiver experiences in shaping personality.
Philip Berman in psychodynamic terms: his problems might be seen as resulting from unresolved early relationships, family dynamics, and intrapsychic conflicts; therapies would aim to uncover these connections and address transferences and defenses.
The Cognitive-Behavioral Model
Core idea: abnormal behavior results from maladaptive behaviors and dysfunctional cognitions; current orientations often integrate both behavioral and cognitive dimensions.
Historical roots: developed from laboratory conditioning studies in the late 1800s; researchers showed how environment shapes behavior via learning processes.
Evolution of the approach:
1950s: clinicians applied conditioning principles to clinical problems (anxiety, depression, etc.).
1960s–1970s: incorporation of cognitive processes, recognizing that thoughts influence emotions and behaviors.
Today: most practitioners blend behavioral and cognitive strategies; some focus on one dimension exclusively.
The behavioral dimension (learning and conditioning):
Classical conditioning: learning by temporal association (e.g., fear responses acquired when a harmless stimulus is paired with a painful one).
Modeling (observational learning): learning by observing others; e.g., phobias can be learned by watching others’ fears.
Operant conditioning: learning via consequences (reinforcement and punishment) that increase or decrease behavior.
Applications: practitioners use conditioning principles to replace problematic behaviors with more adaptive ones; e.g., parents shaping children’s behavior by changing reinforcement patterns.
Examples in therapy: reinforcement of polite behaviors; withdrawal of attention or privileges to reduce aggression.
Classic demonstration: Bandura et al. (1963) showed that children imitate observed aggression toward a doll.
The cognitive dimension (thoughts and beliefs):
Key figures: Albert Ellis (REBT) and Aaron Beck (cognitive therapy).
Core claim: abnormal functioning arises from maladaptive cognitions (assumptions, attitudes, and beliefs) and illogical thinking.
Depressed thinking: Beck identified negative cognitive schemas and cognitive distortions (self-defeating conclusions, overgeneralization).
Cognitive distortions examples: overgeneralization, magnification, absolutistic thinking (e.g., “I am a total failure”).
Therapy goals: identify, challenge, and modify maladaptive thoughts; test beliefs against reality; apply new ways of thinking in daily life.
Beck's approach: collaborative empiricism; guided discovery; structured problem-solving and behavioral experiments.
Ellis’s approach: rational-emotive therapy; focus on altering irrational beliefs and emotional responses.
The cognitive-behavioral interplay:
Most clinicians use integrated strategies addressing both behavior and cognition.
Example: social anxiety disorder (SAD)
Maladaptive beliefs: unrealistically high social standards; perceived threat of negative evaluation; beliefs of inherent social incompetence; catastrophic expectations.
Behaviors: avoidance of social situations; safety behaviors (e.g., makeup to cover blushing) that reduce anxiety temporarily but maintain fear long-term.
Treatment combo: exposure therapy (gradual exposure to feared situations) plus cognitive restructuring (challenge maladaptive beliefs) to reduce anxiety and avoidance over time.
Techniques and therapies:
Exposure therapy: gradual, repeated exposure to feared objects/situations to reduce fear through extinction.
Cognitive restructuring: identify and challenge distorted thinking patterns; test evidence for beliefs.
Mindfulness and acceptance therapies: integrate acceptance of thoughts while maintaining actions aligned with values (e.g., acceptance and commitment therapy).
Integrated approaches include acceptance, cognitive restructuring, and exposure to create flexible coping.
Ethical note on conditioning: historical debates about the ethics of conditioning animals for experiments and the translation to human treatment; the ethics of animal training and welfare are considered in broader discussions of conditioning.
The Humanistic-Existential Model
Core idea: psychology should consider the whole person and the meaning, purpose, and values of life; dysfunction arises when individuals fail to live authentically or fail to assume responsibility for their choices.
Humanistic perspective (positive, growth-oriented):
Basic view: people are inherently good and driven toward self-actualization (fulfilling potential).
Self-actualization: a process of realizing one’s potential for goodness, growth, and creativity.
Rogers’ client-centered therapy: a nonjudgmental, supportive environment where the therapist provides unconditional positive regard, accurate empathy, and genuineness to facilitate self-discovery and self-acceptance.
Conditions of worth vs. unconditional positive regard:
Conditions of worth: love and acceptance depend on meeting certain standards; can lead to incongruence between self-image and experience.
Unconditional positive regard fosters self-acceptance and authentic self-growth.
Therapeutic aims: help clients achieve self-acceptance, congruence between self-concept and experience, and self-actualization.
Rogers’s therapy has influenced clinical practice and promoted psychotherapy as a legitimate professional field; however, empirical support is mixed, with some studies showing benefits and others not showing clear superiority over control conditions.
Key quote: “You’ve learned that people will forget what you said, people will forget what you did, but they will never forget how you made them feel.” (Maya Angelou)
Gestalt therapy (Perls):
Focus on self-recognition and self-acceptance achieved by pushing clients to experience the here-and-now and their true emotions.
Techniques include role-playing and experiential exercises; participants may cry, shout, or act out parts of themselves to own emotions.
Gestalt emphasizes subjective experience and nonverifiable self-awareness; limited controlled research but influential in practice.
Existential theories and therapy:
Existentialists stress freedom, responsibility, meaning, and authenticity; anxiety arises from confronting life’s ultimate concerns and choosing one’s path.
Therapy aims to help clients accept responsibility for their lives, acknowledge freedoms, and live with greater meaning.
Quote and emphasis on living authentically and creating meaning through choice.
Spiritual views and interventions:
Historically religion was viewed skeptically in mental health; now recognized as diversity and often correlated with better mental health for devout individuals who view God as warm and supportive.
Spirituality can be integrated into treatment; many clinicians encourage clients to draw on spiritual resources during stress.
Dalai Lama meeting with researchers demonstrated interest in science, spirituality, and mental health intersections.
Community resources, religious organizations, and spiritually oriented therapies may be integrated into care.
Existential-psychotherapeutic implications:
Emphasize meaning, freedom, responsibility, and personal choice as central to psychological health.
See Philip Berman’s case as an example of existential concerns: feeling overwhelmed by social structures and the responsibilities of life; yet existential therapy emphasizes choosing meaning despite external pressures.
The Sociocultural Model
Core idea: abnormal behavior is best understood in the context of social and cultural forces; individual problems emerge from social environments, cultural norms, and family dynamics.
Two major perspectives:
Family-social perspective: emphasizes family structure, social networks, and roles; how relationships and environment shape behavior.
Multicultural perspective: emphasizes cultural, ethnic, and social conditioning and their effects on mental health and treatment.
Key social factors and constructs:
Social labels and roles: labeling can influence self-concept and behavior; being labeled as “mentally ill” can shape self-perception and treatment by others (Rosenthal et al., 1973).
Social networks and supports: inadequate social connections and support can increase risk of depression and prolong distress; social support buffers stress.
Family structure and communication: family systems theory views the family as a system; problems arise from patterns of interaction and boundaries (enmeshment vs disengagement), and parental roles.
Rosenthal’s classic “Being Sane in insane places” study (1973): normal individuals admitted to psychiatric hospitals were misdiagnosed due to labeling; highlights the power of social labels and institutional bias.
Online social behavior and relationships:
Online social interactions can reflect offline patterns; online relationships may parallel offline social functioning.
Studies on social media indicate a link between online self-disclosure, friendship networks, and offline social behavior.
Family systems theory details:
The family is a system with implicit rules and patterns; changing one member’s behavior often requires adjusting the entire system.
Variants include enmeshed (overly close) vs disengaged (rigid boundaries) families; these patterns can contribute to abnormal functioning in a member.
Philip Berman might be seen as influenced by family dynamics (e.g., conflict between parents, perceived parental overcontrol, and sibling relationships).
Family therapy, group therapy, and couple therapy:
Family therapy: treats the family as a unit; aims to change interaction patterns and improve family functioning; various models can be used.
Group therapy: therapist works with a group of clients with similar problems; provides support, feedback, and modeling; may be as effective as individual therapy for some disorders.
Self-help and mutual-help groups: peer-led, often without professionals; e.g., groups for bereavement, substance abuse, etc.; millions of groups exist worldwide.
Couple therapy: focuses on the dyadic relationship, problem-solving, communication, and how the couple’s dynamic affects individual functioning; effectiveness often comparable to other forms of therapy; no single approach dominates.
Sociocultural interventions and modern technologies:
Community treatment: care in familiar settings; emphasis on prevention (primary, secondary, and tertiary); outreach to at-risk individuals; often effective for severe mental illness.
Technology-assisted care: text-based interventions and mobile apps for mental health; wearables for monitoring physiological/behavioral states; just-in-time adaptive interventions (JITAIs) for real-time support; debate about human elements vs algorithmic interventions.
Group formats (group therapy, family therapy, couple therapy) and community programs can be integrated with other models.
Integrating the models: the developmental psychopathology perspective
No single model is superior; each provides a piece of the puzzle.
Developmental psychopathology uses a developmental framework to integrate factors across models and emphasizes timing and context of influential variables.
Key principles:
Equifinality: different developmental pathways can lead to the same disorder.
Multifinality: similar early experiences can lead to different outcomes.
Example: conduct disorder can arise from different paths (unfavorable genes, difficult temperament, and poor parenting vs positive genes, good temperament, and supportive parenting) but converge on similar teenage behavior.
Developmental psychopathology draws from biology, psychodynamics, cognitive-behavioral, humanistic-existential, and sociocultural models to explain adaptive and maladaptive outcomes.
Integrating and Summarizing the Models
Purpose of models: frameworks to understand, explain, and guide treatment of abnormal behavior; each model offers unique insights and limitations.
When evaluating a case (e.g., Philip Berman):
Biological explanations focus on brain chemistry, circuits (fear circuit), and genetics.
Psychodynamic explanations highlight early experiences, internal conflicts, and defense mechanisms.
Cognitive-behavioral explanations focus on learned behaviors and maladaptive thoughts; treatment aims at behavior change and cognitive restructuring.
Humanistic-existential explanations emphasize meaning, responsibility, authenticity, and self-actualization.
Sociocultural explanations stress family, community, culture, and social roles and networks.
The developmental psychopathology perspective emphasizes when and how factors interact across the lifespan, recognizing equifinality and multifinality.
Treatment implications:
Most contemporary clinicians integrate models, tailoring approaches to individual needs and context.
Prevention and community-based approaches are emphasized in sociocultural models.
Technology-enhanced care and group/family formats expand access and support networks.
Case Illustration: Philip Berman (Integrated lens)
Background: 25-year-old, single, unemployed former copy editor; hospitalized after a suicide attempt with wrist laceration; subsequent conflicted behavior and resistance to hospitalization; paranoid and jealous thoughts following interactions with former girlfriend.
Presenting concerns: depression, anger, social withdrawal, histories of suboptimal relationships, and family conflict; critical self-view (calling himself a 25-year-old virgin); inconsistent work history; multiple hospitalizations.
Family context: two children in a middle-class family; father is 55 and in a managerial insurance role; mother described as powerful, overbearing, and cruel; Philip perceives his father as weak; he harbors intense hostility toward his mother.
Early experiences: mother’s depression noted; Arnold (younger brother) birth around age 10 linked to changes in Philip’s behavior; was disciplined inconsistently; mother’s depression and lack of belief in psychiatry noted.
Current functioning: thin, bearded, pale; limited eye contact; preoccupied with anger toward parents; unstable employment history; limited intimate relationships with women; difficulty maintaining commitments; feels victimized by heredity and environment; socially isolated and resentful.
Psychodynamic interpretation: conflicts rooted in early family dynamics, parental relationships, and unresolved traumas; defenses (anger, withdrawal) and transference may influence current interactions with clinicians and others.
Cognitive-behavioral interpretation: maladaptive beliefs about self and others; possible cognitive distortions (e.g., overemphasis on past victimization, universal pessimism about social success); patterns of avoidance and extreme self-criticism.
Biological interpretation: potential involvement of brain circuits and chemical processes (e.g., serotonin, norepinephrine, glutamate) and endocrine factors (e.g., cortisol) that could contribute to mood and impulse control symptoms.
Sociocultural interpretation: family power dynamics, parental roles, and broader social expectations may shape his behavior and stress responses; cultural and environmental stressors may contribute to his worldview.
Treatment implications (illustrative):
Biological: pharmacotherapy to regulate mood and arousal; consideration of side effects and monitoring.
Psychodynamic: exploration of early relationships, family dynamics, and defenses; interpretation of transference and resistance in therapy.
Cognitive-behavioral: identification and modification of negative automatic thoughts; behavioral activation to improve functioning; exposure to social situations; skills training for relationships.
Humanistic-existential: emphasis on meaning, responsibility, and authentic living; support in developing self-acceptance and personal values.
Sociocultural: engage family (family therapy) or social supports; consider community resources and social networks to reduce isolation.
Note: Real-world case references include Spitzer et al. (1983), pages 59–61; and broader literature on models and therapies cited throughout the chapter.
Key Takeaways
Abnormal behavior is typically viewed through multiple lenses; no single model fully explains all cases.
The developmental psychopathology perspective emphasizes timing, context, and integration of factors across models (equifinality and multifinality).
Treatments are most effective when aligned with the underlying model and tailored to individual needs, often integrating elements from multiple approaches.
Ethical, social, and technological considerations (e.g., DTC drug advertising, online therapies, wearables) shape contemporary practice and access to care.