The Science of Psychopathology

What is a Psychological Disorder?

• A psychological disorder is defined as a psychological dysfunction within an individual.  

• It is associated with distress or impairment in an individual's functioning.

• The response exhibited is not typical or culturally expected.  

• Also referred to as mental disorder or mental illness, it's characterized by abnormal thoughts, feelings, or behaviors.  

• These abnormalities cause significant distress, impair daily functioning, or deviate significantly from societal norms.  

• Such disorders can impact an individual's emotional, cognitive, and social well-being.  

Study Pointers:

• Focus on the three core components: psychological dysfunction, distress/impairment, and atypical/not culturally expected response.

• Understand that "abnormal" is a complex term and the definition of a psychological disorder aims to provide a more objective framework.

Indicators of Abnormality

• Subjective Distress: If an individual suffers or experiences psychological pain, it may be considered indicative of abnormality.  

  • Study Pointer: Recognize that while distress is a common indicator, not all distress is abnormal (e.g., grief), and not all disorders cause overt distress to the individual.

• Maladaptiveness: Behavior that interferes with an individual's well-being and their ability to enjoy work and relationships is often an indicator of abnormality. However, not all disorders involve maladaptive behavior.  

  • Study Pointer: Understand "maladaptive" as behavior that prevents an individual from adjusting to or coping with life's demands.

• Statistical Deviancy: Behavior that is statistically rare can be considered abnormal. However, this is more likely if the rare behavior is also undesirable (e.g., intellectual disability) rather than highly desirable (e.g., genius).  

  • Study Pointer: Note the limitation: not all rare behaviors are pathological.

• Violation of the Standards of Society: When individuals fail to follow conventional social and moral rules of their cultural group, their behavior may be considered abnormal. This is especially true if the behavior is also statistically deviant or rare.  

  • Study Pointer: Consider the cultural context – what is a violation in one society might be acceptable in another.

• Social Discomfort: Violating implicit or unwritten social rules can cause discomfort or unease in others.  

  • Study Pointer: Think about unstated social expectations and how their violation can signal abnormality.

• Irrationality and Unpredictability: While some unconventionality is normal, behavior that is highly unorthodox may be considered abnormal.  

  • Study Pointer: Focus on behavior that seems to lack logical sense or is erratic.

• Dangerousness: Behavior that poses a danger to the individual or others can be seen as psychologically abnormal. However, dangerousness does not automatically mean someone is mentally ill, and conversely, not all individuals with a mental disorder are dangerous.  

  • Study Pointer: This is a critical indicator but avoid generalizations. Danger is a serious concern but is not synonymous with mental illness.

The DSM-5-TR (Text Revision)

• The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is the accepted standard for defining mental disorders.  

• The current version is the DSM-5-TR, published in 2022, updating the DSM-5 from 2013.  

• Within the DSM-5, a mental disorder is defined as a syndrome present in an individual involving clinically significant disturbance in behavior, emotion regulation, or cognitive functioning.  

• These disturbances are believed to reflect a dysfunction in biological, psychological, or developmental processes necessary for mental functioning.  

Study Pointers:

• Understand the DSM's role as a classification system.

• Note the key elements of the DSM definition: syndrome, clinically significant disturbance, and underlying dysfunction.

The Science of Psychopathology

• Psychopathology is the scientific study of psychological disorders.  

• It focuses on:

  • Signs and Symptoms: Observable indicators of psychological distress or dysfunction.  

    • Signs: Observable by others (e.g., crying).  

    • Symptoms: Experienced by the individual (e.g., feeling sad).  

  • Causes (Etiology): Underlying factors contributing to the onset of mental disorders.  

  • Treatment: Strategies aimed at alleviating symptoms and improving functioning.  

• Aims to differentiate between typical and atypical behaviors to define what constitutes a mental disorder.  

Study Pointers:

• Grasp the multifaceted nature of psychopathology, encompassing description (signs/symptoms), explanation (causes), and intervention (treatment).

• The distinction between "signs" and "symptoms" is crucial for understanding clinical descriptions.

Important Terms to Remember

• Presenting Problem: The specific problem or set of problems that a client "presents" with when seeking help at a clinic or hospital; it's the reason the person came to the clinic.  

• Clinical Description: The unique combination of behaviors, thoughts, and feelings that constitute a specific disorder. It refers to problems found in clinical settings and activities related to assessment and treatment.  

• Epidemiology: The study of the distribution of diseases, disorders, or health-related behaviors in a given population.  

  • Prevalence: The proportion of a population who have a specific disorder (i.e., how many people in the population as a whole have the disorder).  

  • Incidence: Statistics on how many new cases of a disorder occur during a given period (e.g., a year).  

• Course: How a psychological disorder progresses or unfolds over time.  

  • Chronic Course: The disorder tends to last a long time, potentially a lifetime.  

  • Episodic Course: The individual is likely to recover within a few months, only to suffer a recurrence later.  

  • Time-limited Course: The disorder will improve without treatment in a relatively short period, with little or no risk of recurrence.  

• Onset: When and how the symptoms of a disorder first appear.  

  1. Acute Onset: Symptoms appear suddenly and intensely, often after a specific trigger.  

  2. Insidious Onset: Symptoms develop gradually, making the disorder harder to recognize early on.  

  3. Early-Onset: Symptoms begin in childhood or adolescence.  

  4. Late-Onset: Symptoms appear in adulthood or later in life, often due to age-related factors or stressors.  

• Prognosis: The anticipated course and outcome of a psychological disorder. It predicts how the condition will develop, the likelihood of recovery, and its impact on quality of life.  

• Developmental Psychopathology: A scientific discipline studying how psychological disorders develop across a person's life. It examines the interaction of biological and environmental factors in understanding mental health issues, particularly in children and adolescents.  

• Etiology: The study of origins; it concerns why a disorder begins (its causes) and includes biological, psychological, and social dimensions.

   

• Diagnosis: The process of identifying a disease, condition, or injury from its signs and symptoms.  

• Differential Diagnosis: A list of possible conditions that share the same symptoms described to a healthcare provider. This is not the final diagnosis but a theoretical list of potential causes.  

Study Pointers:

• Create flashcards for these terms.

• Understand the relationships between terms (e.g., prevalence and incidence are both epidemiological measures).

• For "course" and "onset," focus on the defining characteristics of each subtype.

• "Etiology" is a fundamental concept – understanding the causes of disorders is key to prevention and treatment.

• "Differential diagnosis" highlights the complexity of diagnosing mental disorders.

Historical Conceptions of Abnormal Behavior

1. The Supernatural Tradition:

• Core Belief: Mental disorders were seen as a result of supernatural phenomena like demonic possession, witchcraft, or divine punishment.  

• Demons and Witches: Abnormal behavior was interpreted as the influence of evil spirits or demons. Treatment involved religious rituals like exorcisms.  

• Witchcraft and Sorcery: During the Middle Ages, individuals with abnormal behavior were often accused of witchcraft and persecuted.  

• Astrology: The alignment of stars and planets was sometimes believed to influence mental health.  

• Decline: This perspective lost prominence during the Enlightenment with the rise of scientific reasoning.  

• Study Pointer: Recognize how a lack of scientific understanding led to supernatural explanations. Consider the societal impact of these beliefs (e.g., persecution).

2. The Biological Tradition:

• Core Belief: Abnormal behavior is caused by physical or biological dysfunctions, such as imbalances in the brain or body.

   

• Hippocrates (460–377 BCE): Proposed that mental disorders had natural causes, not supernatural ones. He believed the brain was the seat of wisdom, consciousness, intelligence, and emotion, so disorders of these functions would be located in the brain.  

  • The Four Humors: Introduced by Hippocrates, this theory suggested that imbalances in blood, black bile, yellow bile, and phlegm caused mental and physical illnesses.  

  • Hysteria: A term coined by Hippocrates (from the Greek "hysteron" for uterus), influenced by Egyptian concepts, to describe what are now known as somatic symptom disorders, often occurring in women and attributed to a "wandering womb." Cures included marriage or fumigation of the vagina.  

• Galen (129–198 CE): Expanded on Hippocrates' ideas, emphasizing biology's role in mental health and further developing the theory of the Four Humors.  

• Ancient China: A similar concept to humors existed, focusing on the movement of "wind" (air) throughout the body. Mental disorders were attributed to blockages of wind or an imbalance of cold, dark wind (yin) versus warm, life-sustaining wind (yang). Treatment included acupuncture.  

• General Paresis: In 1825, this condition was identified as a disease (neurosyphilis), where syphilis bacteria attack the brain and nervous system, providing a strong link between physical illness and mental disorder.  

• John P. Grey: Advocated that insanity had physical roots and promoted humane treatment in asylums.  

• Emil Kraepelin: Made significant contributions to diagnosis and classification, being among the first to distinguish various psychological disorders based on onset, course, symptoms, and potential causes.  

• Study Pointer: Understand the shift from supernatural to natural/biological explanations. Note key figures and their contributions (Hippocrates' humors, Kraepelin's classification). "Hysteria" and the "wandering womb" concept are important historical examples of how gender and culture influenced theories of mental illness.

3. The Psychological Tradition:

• Core Belief: Abnormal behavior arises from psychological and social factors, such as emotions, thought patterns, and environmental influences.  

• Moral Therapy (18th and 19th centuries): Advocated for humane and supportive treatment, focusing on moral and social rehabilitation.  

  • Philippe Pinel: A key figure in moral therapy in Europe.

  • William Tuke: Introduced moral therapy in the USA (the presentation incorrectly states he is often considered the founder of U.S. psychiatry; Benjamin Rush is more commonly cited for that, though Tuke was influential in reform).  

  • Asylums, which appeared in the 16th century and were often like prisons, became more habitable and therapeutic due to moral therapy.  

• Dorothea Dix: Campaigned for improved care for people with mental illness and was a prominent figure in the Mental Hygiene Movement, leading to more humane treatment in U.S. institutions.  

• Psychoanalytic Theory (Sigmund Freud): Proposed that unconscious conflicts, childhood experiences, and defense mechanisms shape behavior. Treatment involved psychoanalysis to uncover unconscious thoughts.  

• Behaviorism: Suggested that abnormal behavior is learned through conditioning and can be unlearned. Key figures included John Watson, Ivan Pavlov, and B.F. Skinner.  

  • Example: Exposure therapy for phobias is based on behaviorist principles.  

• Humanistic Psychology: Focused on self-actualization and personal growth. Key figures included Carl Rogers and Abraham Maslow.  

• Study Pointer: Contrast this tradition with the biological and supernatural views. Understand the core tenets of moral therapy, psychoanalysis, behaviorism, and humanistic psychology. Recognize the impact of reformers like Dix.

The 4 D’s of Abnormal Behavior (in Diagnosing according to the DSM)

• Deviance: Behavior that significantly deviates from cultural, social, or societal norms or behavioral functioning.  

  • Key Considerations: Context and culture are crucial, as what is deviant in one culture might be acceptable in another.  

  • Example: Hearing voices might be abnormal in most Western societies but seen as spiritual communication in some indigenous cultures.  

• Dysfunction: Behavior that interferes with a person's ability to function in daily life, including work, relationships, and self-care.  

  • Key Considerations: Dysfunctional behavior prevents individuals from meeting basic needs or fulfilling societal roles and often impairs productivity or relationships.  

  • Example: A person with severe anxiety who cannot leave home for work or social activities.  

• Distress: Behavior or symptoms that cause significant emotional pain or suffering to the individual or those around them.  

  • Key Considerations: The subjective experience of distress is important. Not all distressing emotions (like grief) are pathological unless prolonged or impairing functioning.  

  • Example: A person experiencing chronic sadness, hopelessness, and crying spells.  

• Danger: Behavior that poses a risk of harm to the individual (e.g., suicidal tendencies, self-harm) or others (e.g., violent behavior).  

  • Key Considerations: The level of danger must be assessed for safety and appropriate intervention.  

  • Example: A person exhibiting aggressive behavior and threats toward others.  

Study Pointers:

• Understand each of the 4 D's and how they contribute to the assessment of abnormal behavior.

• Be able to apply these concepts to examples, like those provided in the presentation.  

• Remember that these are guidelines, and not all four D's need to be present, nor is any single D sufficient on its own, for a diagnosis. The overall clinical picture is most important.