Comprehensive Study Notes: Abnormal Psychology (Comer, 9th Edition)

Characteristics and Development of the DSM-5

  • General Overview: In 2013, the American Psychiatric Association (APA) published the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), which is the most widely used classification system in North America. It is a 947-page manual listing 541 diagnoses.
  • Production Data and Economics:
    • The production of DSM-5 was a 12-year undertaking marked by delays and controversy.
    • Production cost to the APA: $25,000,000.
    • Initial presales: 150,000 copies.
  • Pricing Evolution of the DSM:
    • 1952 (DSM-I): $3.00, 128 diagnoses.
    • 1968 (DSM-II): $3.50, 193 diagnoses.
    • 1980 (DSM-III): $32.00, 228 diagnoses.
    • 1987 (DSM-III-R): $40.00, 253 diagnoses.
    • 1994 (DSM-IV): $49.00, 383 diagnoses.
    • 2000 (DSM-IV-TR): $75.00, 383 diagnoses.
    • 2013 (DSM-5): $199.00, 541 diagnoses.
  • Work Group Composition:
    • The task force (oversight committee) consisted of 30 persons.
    • There were 13 work groups (pathology groups) with 160 persons total (approximately 12 per group).
    • Professional breakdown: 2/3 were psychiatrists and 1/3 were psychologists.
    • 300 outside advisors were included.
  • Major Changes and Controversy:
    • Somatic Symptom Disorder: Diagnosed in people overly anxious about medical problems; clinicians no longer need to distinguish hysterical from medical symptoms. Even cancer patients can receive this psychiatric diagnosis.
    • Bereavement Exclusion: Major depressive disorder can now be given to recently bereaved people, allowing quicker spot/treatment of depression among grieving people.
    • Asperger’s Disorder Eliminated: Individuals with severe social impairments are now reassigned alternative diagnoses; there is a concern that some may lose special educational services without the specific label.
    • Substance Use Disorder: Combines traditional categories of "substance abuse" and "substance dependence" (addiction) because patterns were often indistinguishable.
    • New Categories: Hoarding disorder, Excoriation (skin-picking) disorder, Persistent depressive disorder, Premenstrual dysphoric disorder, Disruptive mood dysregulation disorder, Binge eating disorder, and Mild neurocognitive disorder.
    • Gambling Disorder: Now officially considered an addiction because it shares similar brain dysfunctioning with substance addictions.
  • Diagnostic Competitors:
    • ICD (International Classification of Disorders): Produced by the WHO (World Health Organization). Focuses on both psychological and medical disorders with brief criteria. Used worldwide.
    • RDoC (Research Domain Criteria): Produced by the NIMH (National Institute of Mental Health). Focuses on neurosciences/scanning and research in the United States.

Defining Psychological Abnormality: The Four Ds

  • Overview: Most contemporary definitions of abnormality share common features known as the "Four Ds."
  • The Four Ds:
    1. Deviance: Behaviors, thoughts, and emotions that differ markedly from a society's ideas about proper functioning. Judgments vary by culture (e.g., Wodaabe men in Niger wearing elaborate makeup to attract women is normal there but would be deviant in the West).
    2. Distress: To be labeled abnormal, ideas or emotions usually have to cause unpleasantness for the person. Exceptions exist, such as the "Ice Breakers" in Michigan who enjoy swimming in freezing water.
    3. Dysfunction: Interferes with daily activities (social, work, or self-care). Dysfunction alone doesn't prove abnormality; for instance, political fasters (Gandhi or Cesar Chavez) choose deprivation for heroic/social purposes.
    4. Danger: Behavior that is consistently careless, hostile, or confused. Research suggests that danger is the exception rather than the rule for most struggling with mental disorders.
  • The Elusive Nature of Abnormality:
    • Thomas Szasz: Placed such emphasis on society's role that he called mental illness a "myth." He argued societies use the label to control people who threaten social order.
    • Eccentricity: David Weeks studied 1,000 eccentrics and estimated there is 1 in 5,000 classic, full-time eccentrics. Characteristics include nonconformity, creativity, and unusual eating habits. Eccentricity is chosen freely and provides pleasure, unlike mental illness which is usually thrust upon a person.

Historical Perspectives on Abnormality

  • Ancient Views: Abnormality was seen as the work of evil spirits.
    • Trephination: An operation using a stone instrument (trephine) to cut a circular section of the skull, supposedly to release demons.
    • Exorcism: Coaxing evil spirits to leave through prayer, magic, or physical torture (whipping/starving).
  • Greek and Roman Views (500 B.C.500\text{ B.C.} to 500 A.D.500\text{ A.D.}):
    • Hippocrates: The "father of modern medicine" taught natural causes for illness. He believed in the four humors: yellow bile (causes mania), black bile (causes melancholia), blood, and phlegm. Treatment involved quiet life, vegetable diets, and bleeding.
  • The Middle Ages ($500$ to 1350 A.D.1350\text{ A.D.}):
    • Demonology returned. The church controlled education and rejected science.
    • Mass Madness: Outbreaks like tarantism (Saint Vitus' dance), where people danced in convulsions believing they were bitten by a tarantula, and lycanthropy, where people believed they were wolves.
  • The Renaissance ($1400$ to $1700$):
    • Johann Weyer: Founder of the modern study of psychopathology; believed the mind could be sick like the body.
    • Gheel, Belgium: A colony where residents welcomed people with mental disorders into their homes for psychic healing.
    • Asylums: Initially intended for good care, they became "virtual prisons." Example: Bethlehem Hospital (pronounced "Bedlam") in London, where tourists paid to watch inmates.
  • The Nineteenth Century Reform:
    • Philippe Pinel: Unchained patients at La Bicêtre and La Salpetrière, advocating for sympathy and kindness.
    • William Tuke: Founded the York Retreat in England.
    • Benjamin Rush: Father of American Psychiatry, required hospital attendants to talk to and walk with patients.
    • Dorothea Dix: Campaigned for government-funded state hospitals to provide moral treatment.
  • Early Twentieth Century Perspectives:
    • Somatogenic Perspective: Abnormal functioning has physical causes. Emil Kraepelin linked physical factors like fatigue to dysfunction. General Paresis was linked to syphilis in 1905.
    • Psychogenic Perspective: Causes are psychological. Friedrich Mesmer treated hysterical disorders with mesmerism (early hypnotism). Sigmund Freud developed psychoanalysis.

Research Methods and Clinical Science

  • Nomothetic Understanding: A general understanding of the nature/causes of abnormality (contrast with idiographic: individual understanding).
  • Variables and Hypotheses: A variable is any characteristic that can vary. A hypothesis is a tentative explanation/prediction.
  • The Case Study: Detailed description of a person's life and symptoms.
    • Merits: Source of new ideas, study of rare problems (e.g., The Three Faces of Eve).
    • Limitations: Low internal and external validity; biased observers.
  • The Correlational Method:
    • Correlation Coefficient ($r$): Ranges from $+1.00$ (perfect positive) to $-1.00$ (perfect negative). $r = .00$ means no correlation.
    • Statistical Significance: Findings are significant if the probability of occurring by chance is less than $5\%$ (symbolized as p<.05p < .05).
    • Epidemiological Studies: Reveal incidence (new cases/period) and prevalence (total cases/period).
    • Longitudinal Studies: Observe the same individuals on many occasions over a long period.
  • The Experimental Method:
    • Independent Variable (IV): The manipulated variable.
    • Dependent Variable (DV): The variable being observed for changes.
    • Control Features: Use of a control group, random assignment, and blind designs (to avoid the "Rosenthal effect" or experimenter bias).
    • Alternative Designs:
      • Quasi-experiment: Uses existing groups in the world (e.g., abused children).
      • Natural experiment: Nature manipulates the IV (e.g., tsunamis, earthquakes).
      • Analogue experiment: Inducing abnormal behavior in lab participants (human or animal). Example: Seligman's "learned helplessness" model.
      • Single-subject experiment: ABAB design where a subject serves as their own control.
  • Ethics: Institutional Review Boards (IRBs) protect human rights, ensuring voluntary enlistment and informed consent.

Theoretical Models of Abnormality

  • Biological Model:
    • Focuses on brain anatomy (e.g., Huntington's disease linked to basal ganglia) and brain chemistry.
    • Synapse: Space between neurons where neurotransmitters (like serotonin and norepinephrine) travel.
    • Treatments: Psychotropic drugs (Antianxiety, Antidepressant, Antibipolar, Antipsychotic), ECT (electroconvulsive therapy), and Psychosurgery (modern neurosurgery).
  • Psychodynamic Model:
    • Personality shaped by three forces: Id (pleasure principle), Ego (reality principle, uses defense mechanisms), and Superego (morality principle).
    • Defense Mechanisms: Repression, Denial, Projection, Rationalization, Displacement, Intellectualization, Regression.
    • Therapy: Free association, interpretation of resistance and transference, dream analysis (manifest vs. latent content), and catharsis.
  • Behavioral Model:
    • Focuses on principles of learning.
    • Conditioning: Operant (rewards), Modeling (observation), and Classical (temporal association, e.g., Pavlov's dogs).
    • Treatments: Systematic desensitization (using relaxation and a fear hierarchy).
  • Cognitive Model:
    • Focuses on maladaptive assumptions and illogical thinking (e.g., overgeneralization).
    • Treatments: Aaron Beck's cognitive therapy. New Wave therapies include Acceptance and Commitment Therapy (ACT) using mindfulness-based techniques.
  • Humanistic-Existential Model:
    • Humanists: Driven to self-actualize. Carl Rogers' client-centered therapy provides unconditional positive regard, empathy, and genuineness.
    • Gestalt Therapists: Use skillful frustration and role playing (Fritz Perls).
    • Existentialists: Focus on authentic living and accepting responsibility for choices.
  • Sociocultural Model:
    • Family-Social: Focuses on social labels, networks, and family systems (enmeshed vs. disengaged). Treatments include group, family, and couple therapy.
    • Multicultural: Examines how culture, race, and gender affect behavior. Poverty is a major factor (psychosis is higher $(1.9\%)$ in individuals earning under \text{\20,000}$ vs. $0.3\%$ in those over \text{\70,000}$).

Clinical Assessment and Diagnosis

  • Assessment Characteristics:
    • Standardization: Setting common steps for administration and interpretation.
    • Reliability: Test-retest and interrater (interjudge) consistency.
    • Validity: Face validity, predictive validity, and concurrent validity.
  • Clinical Tests:
    • Projective Tests: Rorschach Psychodynamic Inkblot Test; Thematic Apperception Test (TAT); Sentence-Completion; Drawings (Draw-a-Person).
    • Personality Inventories: MMPI-2 (Minnesota Multiphasic Personality Inventory) uses 567 items across 10 scales (Hypochondriasis, Depression, Hysteria, etc.).
    • Psychophysiological Tests: Polygraph (lie detector) measures heart rate/breathing; often inaccurate (8 out of 100 truths called lies).
    • Neurological Tests: EEG, CAT scans, PET scans, MRI, and fMRI (functional magnetic resonance imaging).
    • Intelligence Tests: Measured as an Intelligence Quotient (IQ). Highly reliable/valid but can have cultural bias.
  • DSM-5 Diagnosis Procedure:
    • Requires Categorical Information (name of the disorder).
    • Requires Dimensional Information (rating of severity, e.g., using the Cross-Cutting Symptom Measure).

Questions & Discussion

  • Q: Why do actors portraying characters with disorders receive more awards?
    • A: Discussion centers on the intensity of the performances and public fascination with abnormal patterns of functioning.
  • Q: What is a "nervous breakdown"?
    • A: It is a layperson's term for a sudden psychological disturbance, not an official clinical diagnosis.
  • Q: Can machines develop schizophrenia?
    • A: Referenced in "MindTech"; explores computational models of disordered thinking.
  • Q: How reliable is the polygraph in court?
    • A: Very few courts admit these results due to validity concerns; research shows they are frequently inaccurate.