Abnormal Psychology - What is Abnormal?

What is Abnormal?

Lecture Overview

  • Lecture 1: What is abnormal?
  • Lecture 2: Causes of mental disorders
  • Lecture 3: Treatments for mental disorders
  • Lecture 4: Anxiety Disorders and Mood Disorders
  • Lecture 5: Mood Disorders cont’d and Schizophrenia

Key Questions in Abnormal Psychology

  • Abnormal psychology, also known as psychopathology, addresses three key questions:
    1. What makes a thought or behavior abnormal?
    2. What is a mental disorder?
    3. How do we determine who has a mental disorder and needs treatment?

Defining Abnormality

  • Determining whether a thought or behavior is abnormal is difficult.
  • Four key characteristics to consider:
    1. Statistical infrequency
    2. Violation of social norms
    3. Distress
    4. Impairment
  • All four characteristics have limitations as diagnostic tools.
  • No universally accepted definition.
  • When taken together, the four characteristics get us close to the concept of ‘abnormal psychology’.
  • Loose definition; none of these characteristics are necessary or sufficient for a thought or behaviour to be considered abnormal.
1. Statistical Infrequency
  • Characteristics of majority = “normal.”
  • Any deviation from the norm = “abnormal.”
  • Limitation: not all statistically infrequent mental characteristics are considered ‘abnormal.’
    • E.g., superior intellectual, musical ability.
    • We wouldn’t treat ‘gifted’ people to make them ‘average.’
2. Violation of Social Norms
  • Some deviations from the norm are socially acceptable, others are not.
  • Homosexuality was classified as a mental disorder until 1973.
  • Auditory hallucinations are considered acceptable in some cultures.
  • Limitations:
    • What is considered socially acceptable changes over time.
    • What is socially acceptable differs between cultures.
3. Distress
  • Abnormal thoughts/behavior cause distress to the individual.
  • Most (widely accepted) mental disorders are associated with distress.
  • Limitations:
    • Distress is normal in some situations (e.g., bereavement, trauma).
    • Some (widely accepted) psychopathologies are not associated with distress.
      • E.g., Psychopathy, mania.
4. Impairment
  • Abnormal thoughts/behavior are associated with impairment in the individual’s ability to function.
  • Socially, occupationally, personally.
  • Asperger’s disorder (now classified on the Autism Spectrum).
  • Limitation: some people with (widely accepted) mental disorders are highly functional.

The Concept of a Mental Disorder

  • Abnormal thoughts and behaviors tend not to occur in isolation.
  • Instead, they tend to occur in distinctive clusters
    • Hallucinations and delusions tend to co-occur
    • Obsessions and compulsions tend to co-occur
    • Negative mood and flat affect and loss of energy and sleep difficulties tend to co-occur, etc.
  • A mental disorder (or mental illness) is a distinct and recognizable cluster of abnormal thoughts and behaviors.

Historical Context

  • Emile Kraepelin (1856-1926) was the first to classify types of mental disorders based on systematic empirical observations.
  • Before Kraepelin there was little agreement on what constituted a mental illness.
    • ‘Madness’ vs. each individual symptom as a separate disorder.
  • Kraepelin offered diagnostic categories defined by common patterns of symptoms.

Diagnostic Systems

  • Kraepelin’s system – and most current diagnostic systems – imply that mental disorders are separate entities.
  • That is, for any given mental disorder, you either have it OR you do not.
  • This is often the case in medicine.
  • But is it the case with mental disorders?
  • Many mental disorders seem to reflect extreme versions of normal behavior
  • For example, clinical anxiety seems to differ from normal anxiety in severity, duration, degree of impairment etc. but not in quality.
  • For the purposes of treatment we need to draw a line between ‘normal’ and ‘abnormal’ somewhere.
  • At this point a dimension becomes a category.

The Dimension and Category of Anxiety

The transition from a dimension to a category is illustrated through the example of anxiety, where a continuous spectrum of anxiety becomes categorized into normal anxiety versus anxiety disorder.

Clinical Diagnosis and the DSM

  • The major diagnostic system used by psychologists in Australia is the Diagnostic and Statistical Manual of Mental Disorders (DSM).
  • The DSM fundamentally employs a categorical approach.
  • If you fulfill the criteria then – by definition – you have the mental disorder.
  • In some sense, the DSM defines the line between normality and abnormality.
  • The major alternative classification system is the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
  • DSM more popular in USA and Australia, ICD more popular in Europe.
  • First published by the American Psychiatric Association in 1952.
  • Several revisions, reflecting changes in time & culture:
    • DSM-II (1968), DSM-III (1980), DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000)
  • Current revision is the DSM-5 (released 2013).
  • Mental disorders diagnosed on the basis of a designated list of characteristic symptoms.

Dissociative Identity Disorder (DID) in DSM-5

  • A mental disorder in the DSM-5: Dissociative Identity Disorder (DID).
  • Formerly known as Multiple-Personality Disorder.
  • Known colloquially as ‘split-personality’.
  • Characterized by the presence of two or more distinct personality states and memory variations.
  • Each ‘alter’ has access to only a subset of memories.
  • Controversial disorder.
DSM-5 Criteria for Dissociative Identity Disorder (DID)
  • A. Disruption of identity characterized by two or more distinct personality states… These signs and symptoms may be observed by others or reported by the individual.
  • B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
  • C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. (Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.)
  • E. The symptoms are not attributable to the direct physiological effects of a substance or another medical condition (e.g., epileptic seizures).
  • Statistical infrequency. Distress/impairment. Social norms.

Food for Thought

  • Homosexuality: in DSM-II but not DSM-5.
  • Koro: in DSM5 (under ‘Obsessive-Compulsive and Related Disorders’).
  • Internet Gaming Disorder: proposed as a ‘Condition for Further Study’ in DSM-5.
  • There were 182 mental disorders in DSM-II (1968).
  • There are over 300 mental disorders in DSM-5 (2013).
  • Some differences include:
    • Which mental disorders exist in reality?