Abnormal Psychology

Abnormal Psychology and Assessment – Module 1 Notes: Concept and Criteria of Abnormality

1. Introduction to Abnormal Psychology

• Definition: Abnormal psychology is a branch of psychology that studies, diagnoses, and treats unusual patterns of behaviour, emotions, and thoughts that could signify a mental disorder. It is concerned with understanding, classifying, treating, and preventing abnormal behaviour, emotions, and thoughts.

• It studies individuals who are considered "abnormal" or "atypical" compared to the members of a given society. It's important to remember that "abnormal" in this context does not necessarily imply "negative" or "bad," but rather describes behaviours and mental processes that significantly deviate from statistical or societal norms.

• The American Psychological Association (APA) defines abnormal behaviour as "any deviation from typical, usual, or healthy behavior—especially if it is maladaptive".

• Reiger (1998) suggests that abnormal behaviour is that "which is not socially confirmed, and often results from stressful life events and cognitive distortions".

• Pivotal Role of Research: Abnormal psychology research is crucial for understanding and managing mental health issues, developing treatments, and promoting mental health awareness.

2. Defining Abnormality: The Complexity

• Defining abnormality is a complex problem. While the dictionary definition is straightforward, applying it to psychology raises fundamental questions: "What is normal? Whose norm? For what age? For what culture?".

• The concept of abnormality is inherently imprecise and difficult to define. Abnormality can manifest in diverse forms and involve various features, making seemingly reasonable definitions problematic.

• Psychologists utilise several approaches and criteria to understand abnormality due to cultural, social, and individual differences, highlighting that there is no single universal definition.

3. Approaches to Defining ‘Abnormal’

There are several ways to define ‘abnormal’ in contrast to ‘normal’. These include:

• Statistical Infrequency:

  • A person’s trait, thinking, or behaviour is classified as abnormal if it is rare or statistically unusual.

  • This definition requires clarity on how rare a trait or behaviour must be to be considered abnormal. For instance, an IQ below or above the societal average might be deemed abnormal.

  • Strength: It helps to address what is meant by normal in a statistical context and assists in establishing cut-off points for diagnosis.

  • Limitations:

    • It fails to distinguish between desirable and undesirable behaviour. For example, obesity is statistically normal but undesirable, while a high IQ is statistically abnormal but desirable.

    • Many rare behaviours or characteristics have no bearing on normality or abnormality (e.g., left-handedness).

    • Some characteristics are regarded as abnormal even though they are quite frequent. For example, depression may affect a significant percentage of a population but is still considered a problem. The decision of where to set the “abnormal” classification point can be arbitrary.

• Violation of Social Norms:

  • A person’s thinking or behaviour is classified as abnormal if it violates the (unwritten) rules about what is expected or acceptable behaviour in a particular social group. Such behaviour may be incomprehensible or make others feel threatened or uncomfortable.

  • Every culture has standards for acceptable behaviour or socially acceptable norms. Norms are expected ways of behaving according to the majority. Those who do not think and behave like others break these norms and are often defined as abnormal.

  • This definition necessitates considering:

    • The degree to which a norm is violated.

    • The importance of that norm.

    • The value attached by the social group to different sorts of violations (e.g., rude, eccentric, abnormal, or criminal).

  • Influences on Social Norms:

    • Culture: Different cultures and subcultures have different social norms (e.g., personal space in Southern Europe vs. the UK). Aspects like voice pitch, touching, gaze direction, and acceptable discussion topics vary culturally.

    • Context and Situation: Behaviour considered normal at one time might be abnormal at another, depending on the context and situation (e.g., wearing a chicken suit for charity vs. everyday activities).

    • Historical Context: What is considered abnormal changes over time within the same culture (e.g., pregnancy outside of marriage was once viewed as a sign of mental illness).

    • Age and Gender: The same behaviour can be considered normal for some and abnormal for others based on age and gender (e.g., a man wearing a dress and high heels).

  • Limitations:

    • There is no universal agreement over social norms.

    • Social norms are culturally specific, varying significantly between generations and different ethnic, regional, and socio-economic groups. For example, hallucinations and screaming in the street are considered normal in some societies like the Zulu.

    • Social norms change over time. Behaviours once seen as abnormal may become acceptable and vice versa (e.g., drunk driving, homosexuality).

    • Social norms can also depend on the situation or context.

• Failure to Function Adequately:

  • A person is considered abnormal if they are unable to cope with the demands of everyday life or experience personal distress.

  • This may involve an inability to perform behaviours necessary for day-to-day living, such as self-care, holding down a job, interacting meaningfully with others, and making themselves understood.

  • Rosenhan & Seligman (1989) suggested characteristics defining failure to function adequately:

    • Suffering

    • Maladaptiveness (danger to self)

    • Vividness & unconventionality (stands out)

  • Limitations:

    • Apparently abnormal behaviour may actually be helpful, functional, and adaptive for the individual (e.g., compulsive hand-washing providing cheerfulness).

    • Many people engage in behaviour that is maladaptive/harmful or threatening to self but are not classified as abnormal (e.g., adrenaline sports, smoking, drinking alcohol, skipping classes).

• Deviation from Ideal Mental Health:

  • Abnormality is defined as a deviation from ideal mental health.

  • This approach focuses on defining what normal/ideal mental health is, and anything deviating from this is considered abnormal.

  • Jahoda (1958) defined six criteria for measuring mental health:

    • positive attitude toward the self, growth and self-actualization, integration, autonomy, accurate perception of reality, and environmental mastery

  • Limitations:

    • It is practically impossible for any individual to achieve all ideal characteristics all the time. For example, someone might not be the ‘master of their environment’ but still be happy.

    • The absence of one criterion does not necessarily indicate a mental disorder.

• Ethnocentric Bias:

  • Ethnocentrism in psychology refers to the tendency to view one’s own culture or ethnic group as the standard or norm, and to judge other cultures based on those norms.

  • Most definitions of psychological abnormality have been devised by white, middle-class men, potentially leading to a disproportionate number of people from certain groups being diagnosed as “abnormal”.

  • For example, in the UK, depression is more commonly identified in women, and black people are more likely to be diagnosed with schizophrenia than their white counterparts. Working-class people are also more likely to be diagnosed with a mental illness.

4. Characteristics of Mental Health – Maslow & Mittelman

• Maslow and Mittelman proposed 10 indicators of psychological well-being:

  1. Adequate Security

  2. Adequate Emotional Support

  3. Adequate Self-Evaluation

  4. Adequate Self-Knowledge

  5. Adequate Desire Gratification

  6. Contact with Reality

  7. Realistic Life Goals

  8. Consistency & Integration of Personality

  9. Learning from Experience

  10. Satisfying the Group (social adaptability)

• These elements reflect healthy psychological functioning and resilience.

5. Common Criteria of Abnormality (Comer, 1995)

• Personal Distress: Emotional suffering as reported by the individual.

• Disability (Dysfunction): Impairment in social, occupational, or other important areas of life.

• Unexpectedness: Behaviour occurs in unexpected or inappropriate contexts.

• The 4 D’s:

  • Distress: Subjective discomfort.

  • Dysfunction: Interference with daily functioning.

  • Deviance: Violation of cultural/societal norms.

  • Danger: Poses risk to self or others.

• Moral Standards Violation: Behaviour that violates moral or ethical standards.

6. Classification of Abnormality: The DSM

• Why Classify?

  • To ensure accurate diagnosis.

  • Enable effective treatment.

  • Promote research and communication among professionals.

  • Guide policy and insurance practices.

• Introduction to the DSM (Diagnostic and Statistical Manual of Mental Disorders):

  • Developed by the American Psychiatric Association (APA).

  • Current edition: DSM-5 (2013).

  • Historical Origin: Rooted in the Association of Medical Superintendents of American Institutions for the Insane.

7. Evolution of DSM

8. DSM-III & DSM-IV: The Multiaxial System

9. DSM-5 Structure

• Section I: Basics and Use of Manual:

  • Introduces the diagnostic framework.

  • Encourages clinical judgment in making diagnoses.

  • Provides a cautionary note against using diagnoses for legal discrimination.

  • Emphasises that diagnosis is a blend of assessment, clinical opinion, and cultural sensitivity.

• Section II: Diagnostic Criteria and Codes:

  • Based on ICD-10-CM for coding.

  • Organized in a developmental lifespan manner.

  • Emphasis on clinical utility.

  • Major Terminological Changes:

    • Mental Retardation → Intellectual Disability (ID)

    • Dysthymia → Persistent Depressive Disorder

    • Hypochondriasis → Illness Anxiety Disorder

    • Conversion Disorder → Functional Neurological Symptom Disorder

    • Munchausen’s Syndrome → Factitious Disorder

  • Key Additions:

    • PTSD and OCD now in separate categories (Trauma and Stressor-Related Disorders, and Obsessive-Compulsive and Related Disorders, respectively).

    • New subtypes/disorders like Body Dysmorphia, Trichotillomania, Hoarding Disorder, Binge Eating Disorder added.

    • Bereavement exclusion removed from depression diagnosis.

• Section III: Emerging Models and Tools:

  • Dimensional Assessments for severity.

  • WHODAS 2.0 for global disability assessment.

  • Cultural Formulation Interview (CFI).

  • Lists disorders for further study.

• Appendix:

10. Summary: Key Concepts to Remember

This provides a comprehensive overview of the concepts and criteria of abnormality as outlined in the initial sources. Let me know when you are ready to proceed with the notes for the next module.

Sure! Here's the final, integrated, and detailed version of your Module 1 notes for Abnormal Psychology and Assessment, combining all the content provided so far into a clean, comprehensive, and easy-to-study format.

📘 Abnormal Psychology and Assessment – Module 1

✅ Title: Concept and Criteria of Abnormality & Classification of Abnormality (DSM-5)

🔹 1. Introduction to Abnormal Psychology

🔸 Definition

Abnormal Psychology is the branch of psychology concerned with the study, understanding, classification, treatment, and prevention of abnormal behavior, emotions, and thoughts.

🧠 APA Definition:
“Any deviation from typical, usual, or healthy behavior—especially if it is maladaptive.”

🧠 Reiger (1998):
Abnormal behavior is that which is not socially confirmed, and often results from stressful life events and cognitive distortions.

🔹 2. Criteria of Abnormality

There is no single universal definition of abnormality due to cultural, social, and individual differences. Psychologists use several approaches and criteria to understand it.

🔸 Common Criteria (Comer, 1995):

1. Personal Distress – Emotional suffering as reported by the individual.

2. Disability (Dysfunction) – Impairment in social, occupational, or other areas of life.

3. Unexpectedness – Behavior occurs in unexpected or inappropriate contexts.

4. The 4 D’s:

   • Distress – Subjective discomfort.

   • Dysfunction – Interference with daily functioning.

   • Deviance – Violation of cultural/societal norms.

   • Danger – Poses risk to self or others.

🔹 3. Approaches to Defining Abnormality

🔹 4. Characteristics of Mental Health – Maslow & Mittelman

Maslow and Mittelman proposed 10 indicators of psychological well-being:

1. ✅ Adequate Security

2. ✅ Adequate Emotional Support

3. ✅ Adequate Self-Evaluation

4. ✅ Adequate Self-Knowledge

5. ✅ Adequate Desire Gratification

6. ✅ Contact with Reality

7. ✅ Realistic Life Goals

8. ✅ Consistency & Integration of Personality

9. ✅ Learning from Experience

10. ✅ Satisfying the Group (social adaptability)

These elements reflect healthy psychological functioning and resilience.

🔹 5. Classification of Abnormality

🔸 Why Classify?

• To ensure accurate diagnosis

• Enable effective treatment

• Promote research and communication

• Guide policy and insurance practices

🔹 6. Introduction to the DSM

🔸 What is DSM?

• DSM = Diagnostic and Statistical Manual of Mental Disorders

• Developed by: American Psychiatric Association (APA)

• Current edition: DSM-5 (2013)

🏛 Historical origin:
Rooted in the Association of Medical Superintendents of American Institutions for the Insane.

🔹 7. Evolution of DSM

🔹 8. DSM-III & DSM-IV: The Multiaxial System

🔹 9. DSM-5 Structure

📘 Section I: Basics and Use of Manual

• Introduces diagnostic framework

• Encourages clinical judgment

• Provides cautionary note: Diagnoses should not be used for legal discrimination

• Diagnosis is a blend of assessment + clinical opinion + cultural sensitivity

📘 Section II: Diagnostic Criteria and Codes

• Based on ICD-10-CM for coding

• Organized in a developmental lifespan manner

• Emphasis on clinical utility

🟡 Major Terminological Changes

🟡 Key Additions

• PTSD and OCD now in separate categories

• Subtypes like:

  • Body Dysmorphia

  • Trichotillomania

  • Hoarding Disorder

• Binge Eating Disorder added

Bereavement exclusion removed → allows diagnosis of depression shortly after a loss

📘 Section III: Emerging Models and Tools

• Dimensional Assessments for severity

• WHODAS 2.0 for global disability assessment

• Cultural Formulation Interview (CFI)

• Lists disorders for further study

🔹 10. Summary: Key Concepts to Remember