Abnormal Behavior and Mental Disorders

Abnormal: literally “away from the norm”. a “deviation”

  • “ab” = away
  • “norms” = social norms
  • outliers or critical area of rejection
    • the further away from the norm or mean
    • no longer belongs in the normal distribution

Criteria for Defining or Assessing Abnormal or Maladaptive Behavior

  1. Dysfunction
    • ability to function in daily life is disrupted
    • the person might be impaired
  2. Distress
    • emotional or physical pain; upset of suffering
  3. Deviance
    • highly unusual behavior, based on social or cultural norms
  4. Dangerous
    • potential harm to self and others
  • assess degree of criterion
  • how many from criteria is interacting and degree of each criterion
  • normal → abnormal = spectrum

Mental Disorder

  • is a ^^syndrome^^ (cluster of related symptoms) characterized by ^^clinically significant^^ (enough length of time; different in old ways and dysfunction or distress) disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning
  • usually associated with significant distress or disability (and/or) in social, occupational, or other important activities
  • an expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder
    • if accepted in the culture, not a mental disorder
  • socially deviant behavior (e.g., political, religious, or sexual) conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above

Syndrome

  • Signs: objective observation (clinician or professional judgment)
  • Symptoms: subjective experience (patient’s complaints)
  • signs and symptoms overlap (in general)
  • Syndrome: a constellation → recognizable situation

Neurosis and Psychosis

  • Neurosis
    • high level of unrealistic anxiety
    • symptoms are distressing and have no physical basis
    • symptoms recognized as unacceptable by the person who has them, and are enduring
    • distressing
    • enduring (chronic)
    • no physical or medical basis
    • recognition of symptoms are unacceptable
    • has self-awareness, no control
  • Psychosis
    • loss of contact with reality (majority of the time)
    • bizarre thoughts and perception
    • grossly disturbed or out of control behavior
    • no self-awareness, blissfully ignorant

Acute vs Chronic

  • Acute: relatively short duration but with high intensity of symptoms
  • Chronic: long duration but with low intensity of symptoms

Prominent Themes in Explaining Psychological Disorders Recur Throughout History

  1. mystical explanations of psychological disorders or the supernatural view
    • regard abnormal behavior as the product of possession by evil or demonic spirits
  2. scientific approach
    • looks for natural causes such as biological imbalances, learning processes, or emotional stressors
  3. humanitarian approach
    • views psychological disorders as the result of cruelty, nonacceptance, or poor living conditions
    • sees a human being as someone who has both strengths and weaknesses

Classification and Diagnosis

  • Classification System (nonenclature or nosology)
    • a set of definitions of syndromes and rules for determining when a person’s symptoms are part of each syndrome
    • Classification Systems used
    • Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
    • International Statistical Classification of Diseases and Related Health Problems

DSM-5

  • specific, concrete criteria for each disorder
    • criteria are very specific and concrete
  • descriptive, not explanatory
    • does not provide explanation for the causes; only provides description
  • atheoretical
    • no theory; absence of theoretical approach
    • (+) any professional can use this
    • (-) cannot depend on any theory or causal factors
    • clinical basis, statistics
  • Categorical Model vs Dimensional Model of Classification
    • except for autistic spectrum disorder, and the alternative dimensional model for personality disorders
  • Non-Axial Approach
    • DSM-5: no more axis (mental disorder, medical)
    • DSM-4: multi-axial
    • Axis 1: mental disorders
    • Axis 2: mental disorders; personality disorder; mental retardation
    • Axis 3: general medical condition (physical illnesses that do not have a natural termination)
    • Axis 4: psychosocial stressors
    • Axis 5: global assessment of function (GAF)- capacity of the person to function in the daily life
Issues about DSM-5
  • reifying diagnoses
    • diagnosis is merely a label place on the classification system
    • making it seem like it is fixed and permanent thing
  • category vs continuum
    • clusters are not based on a continuum model; still based on categorical model
    • Comorbidity: more than 1 diagnosis of disorder in a person
    • Morbidity: there is an onset disorder
    • Interventions: biological (medication); psychological
  • validity and reliability
    • DSM has a high reliability but moderate or not so high validity
  • differentiating mental disorders
    • some disorders might overlap
  • cultural issues
    • DSM is mostly on the Western context
Issues about Classification and Diagnosis
  • the problem of labelling
    • Self-Fulfilling Prophecy
    • see the behavior as part of the mental illness
    • diagnostic labelling can affect people’s perception of the mentally ill person, and can act as a self-fulfilling prophecy to the patient
    • David Rosenhan (1973) conducted a study and concluded
    • psychiatrists and other mental health professionals cannot reliably distinguish sane from insane individuals
    • psychiatric labels became self-fulfilling prophecies -- common place behaviors were interpreted as signs of mental illness
    • misattribution of abnormality due to bias of hospital staff to call a healthy person sick
      • misinterpret behavior as abnormal even if you are no longer such

Culture-bound Syndromes (DSM-4)

  • only manifesting in specific cultures
  • Amok
    • symptoms: brooding followed by an outburst of violent, aggressive, or homicidal behavior
    • found in the Philippines and other Malay countries
  • was used in the DSM-IV-TR but no longer used in DSM-5

Culture Concepts of Distress

  • ways that cultural groups experience, understand, and communicate suffering, behavioral problems, or troubling thoughts and emotions
  • Cultural Syndromes: clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups and are recognized locally as coherent patterns of experiences
    • happens in a specific cultural group
  • Cultural Idioms of Distress: ways of expressing distress that may not involve specific symptoms but that provide collective, shared ways of experiencing and talking about personal or social concerns
    • what language used
  • Cultural Explanations: labels, attributions, or features of an explanatory model that indicate cultural recognized meaning or etiology
    • the way they try to understand

Research Methods

  • observation includes overt action, measurable internal states and behavior, verbal reports about inner processor events
  • Hypothesis: about abnormal behavior is a plausible idea to explain a behavior based on a viewpoint or model; it determines the therapeutic approach to be used

Basic Research Approaches in Abnormal Psychology

  1. Correlational Study: involves the investigation of association of 2 or more variables; determines the direction and magnitude of relationship
  2. Experimental Study: the use of control to establish causation between variables
    • commonly used in research on the efficacy of therapy
    • alternatives
      • the use of analogue studies on animal or human participants (e.g., Martin Seligman’s “learned helplessness”)
      • single-case experimental designs are intensive investigations of single individuals or small groups before or after an intervention (e.g., ABAB design or reversal; multiple baseline design)
  3. Clinical Case Study: in-depth examination of an individual that draws from a number of data sources (e.g., The Case of Anna O. by Breuer -- a case of hysteria)

Epidemiology

  • frequency and distribution of a disorder in a population
  • not limited to mental disorders; based on medical diseases
  • Prevalence: proportion of the population that has the disorder at a given period in time; lifetime prevalence, a short period prevalence
    • How many people in the population who have the particular disorder at a specific period of time?
  • Incidence: number of new cases of the disorder that develop during a specific period of time
  • Risk Factors: conditions associated with a higher risk of having the disorder

Ethics in Research

  • ethical principles in research serve to promote the dignity of participants, protect human welfare or risk, and preserve scientific integrity
  • an institutional review board ensures that the benefits of the study far outweigh the risks to the participants and those risks have been minimized, through the following rights
    • Understanding the Study: factors that might influence willingness to participate
    • Confidentiality: not many people will know the identity of the participants
    • Right to Refuse or Withdraw Participation: not coerced; agreeing to participate, they can decide to withdraw at any time before, during, and after the participation
    • Informed Consent
    • To Be Free from Deception (unless justified): some studies require deception to be able to conduct the study
    • Debriefing

Clinical Assessment and Interventions

  • Clinical Assessment: a process of collecting information about an individual for understanding and arriving at an informed decision

Aspects of Assessment

  • Presenting Problem or Reason or Referral: should have a problem before approaching professional help; self-referred is possible (there is a reason for referral)
    • does not always lead to a diagnosis
    • dimensions of behavior to be assessed
    • characteristic patterns of behavior (description, frequency, duration)
    • excesses or deficits
    • appropriateness or inappropriateness
    • strengths or weaknesses
    • Background of the Problem (context)
    • what happened before and at the time of onset of problem or symptoms
  • Areas of Functioning
    • intellectual functioning or cognition
    • personality or social and emotional functioning
    • coping resources
  • Social Context
    • family, friendship, occupation, community, and culture
  • Diagnostic or Dynamic Formulation: formulation leads to diagnosis
    • Assessment of Physical Organism
    • General Physical Examination: physical aspect
    • Neurological Exam: concerning the brain (e.g., MRI, CT scan); required depending on the presenting problem
    • Neuropsychological Exam: looking at the interface between the brain and the mind and behavior; no gadgets to be used; complex tests; psychological exam to examine what is wrong with the brain; done by psychologists with neuropsychology as a specialty
    • Psychosocial Assessment
    • Interview (Structured or Unstructured)
      • Structured: format of the questions and the entire interview is standardized, and the clinician uses concrete criteria to score the person’s answers
    • Clinical Observation of Behavior
      • clinician, self-monitoring, self-report, rating scales
    • Psychological Tests
      • intelligence tests (e.g., WAIS)
      • personality tests
      • projective (e.g., draw a person, sentence completion test, TAT, Rorschach)
      • objective (e.g., MMPI)
    • Hypothesis: what is the plausible problem?
    • Diagnosis
    • Treatment or Plan or Intervention

assessment → hypothesis → diagnosis → treatment

Interventions

Biologically-Based Therapies

  1. Psychopharmacotherapy or Psychopharmacology
    • the science of determining which drugs work to alleviate which disorders
    • medicine target the chemicals; reduce, increase, and regulate production
      • Antianxiety Drugs or Anxiolytics (“Minor Tranquilizers”)
      • prescribed to people with anxiety-based problems; neurosis
      • Ativan: makes you calm and relaxed
      • Valium
      • Antidepressant Drugs
      • Lithium
      • Antipsychotic Drugs (“Major Tranquilizers”)
      • very potent especially with a high dosage, the person stops being active; psychosis
  2. Electroconvulsive Therapy (ECT)
    • used to be called “shock therapy”
    • induced seizure; electricity passes through one lobe of the brain
    • parts of the brain that may not be working well will be “zapped” to become alive
    • very painful; has side effects
    • voltage is low; goes in dosage (by session)
  3. Neurosurgery or Psychosurgery
    • severance a part of the brain
    • opening the skull and removing a part of the brain

Psychological Therapies

  1. Psychodynamic Theory
    • Goal: to help clients recognize their maladaptive coping strategies and the sources of their unconscious conflicts
    • resulting insights are thought to free clients from the grip of the past and give them a sense of agency in making changes in the present
    • Free Association: a client is taught to talk about whatever comes to mind, trying not censor any thoughts
    • Resistance to Certain Material: important clue to the client’s central unconscious conflicts, because the mot threatening conflicts are those the ego tries hardest to repress
    • Transference: occurs when the client reacts to the therapist as if the therapist were an important person in the client’s early development
    • Working Through: going over and over memories and issues can help clients understand and weave them into their self-definition is acceptable ways
    • Catharsis: the expression of emotions connected to memories and conflicts
      • also central to the healing processes in therapy
      • unleashes the energy bound in unconscious memories and conflicts, allowing this material to incorporated into a more adaptive self-view
    • Psychoanalysis: 3-4 sessions a week over a period of many years
      • Focus: primarily on the interpretation of transferences and resistances, as well as an experience in the client’s past
    • Psychodynamic Therapy: may go on for years but it can be as short as 12 weeks
      • Focus: transferences, resistances, and the client’s relationships with early caregivers
      • may focus more on current situations in the client’s life
    • Interpersonal Therapy (IPT): designed to be short-term therapy, often lasting only about 12 weeks
      • Focus: client’s pattern of relationships with important people in his or her life
      • much more structuring and directive in the therapy, offering interpretations much earlier and focusing on how to change current relationships
    • Assessing Psychodynamic Approaches: Weaknesses
      • ^^difficult or impossible to test^^ their fundamental assumptions scientifically
      • processes are ^^abstract and difficult to measure^^
      • ^^long-term^^, intensive nature makes it ^^unaffordable^^ for many people
  2. Behavior Therapy
  3. Cognitive-Behavioral Therapy
  4. Humanistic-Experimental Therapy
  5. Interpersonal Therapy
  6. Family Therapy