Introduction to Abnormal Psychology Introduction to Abnormal Psychology

Naomi Wagner, PhDNaomi Wagner, PhD

Some slides are taken from Some slides are taken from Sue Sue

What is Abnormality? What is Abnormality?

• The prefix Ab means- away from The prefix Ab means- away from

• Norm means the typical, the averageNorm means the typical, the average

• ““Away from the average behavior”Away from the average behavior”

• It is difficult to determine what is It is difficult to determine what is normal and what is abnormal in normal and what is abnormal in human behaviorhuman behavior

• Views about abnormality have Views about abnormality have changed throughout history changed throughout history

Terms Terms

• Abnormality Abnormality

• Psychopathology Psychopathology

• Mental Illness Mental Illness

• Mental Disorders Mental Disorders

• Psychological Disorders Psychological Disorders

• Maladjustment Maladjustment

• And more And more

• These terms are used interchangeably These terms are used interchangeably

How do we Determine what is How do we Determine what is

Abnormal?Abnormal? • In some instances it is easier to put the In some instances it is easier to put the

cut-off line between normal and abnormal cut-off line between normal and abnormal • In psychosis one can easily draw the line In psychosis one can easily draw the line • Psychosis involves breaking away from Psychosis involves breaking away from

reality- having hallucinations for example reality- having hallucinations for example • In other instances it is difficult to draw he In other instances it is difficult to draw he

line- e.g. anxiety- we all have the line- e.g. anxiety- we all have the tendency to be anxious in some situations tendency to be anxious in some situations – where do you draw the line? – where do you draw the line?

(Cont-d) (Cont-d)

• In depression- where do you draw the In depression- where do you draw the line between sadness that is part of life line between sadness that is part of life and sadness that becomes clinical and sadness that becomes clinical depression? depression?

• In viewing child behavior- how can we In viewing child behavior- how can we tell that a given behavior reflects tell that a given behavior reflects developmental immaturity and will developmental immaturity and will subside, or is it the sign of a deeper subside, or is it the sign of a deeper clinical problem? clinical problem?

The Study of Abnormal PsychologyThe Study of Abnormal Psychology

– What is abnormal psychologyWhat is abnormal psychology??– An area of scientific study aimed at

describing, explaining, predicting, and modifying behaviors that are considered unusual or strange

– Uses psychodiagnosis: attempts to describe, assess, and systematically draw inferences about an individual’s psychological disorder (sue)

Some of the Difficulties Some of the Difficulties

• Can we predict abnormal behavior? Can we predict abnormal behavior?

• Can we modify it? Can we modify it?

• Sometimes behavior that appears Sometimes behavior that appears abnormal is an attempt to adjust to abnormal is an attempt to adjust to extreme life situationsextreme life situations

• Example: J.C. Duggart that was abducted Example: J.C. Duggart that was abducted at age 11 and was kept captive for 18 at age 11 and was kept captive for 18 years years

• She could have escaped- why hasn’t she? She could have escaped- why hasn’t she?

TherapyTherapy

– Modifying abnormal behaviorModifying abnormal behavior– Therapy: program of systematic

intervention aimed at improving a person’s behavioral, affective (emotional), or cognitive state

Determining Abnormality Determining Abnormality

– Psychologists use thePsychologists use the Diagnostic and Diagnostic and Statistical Manual of Mental DisordersStatistical Manual of Mental Disorders ((DSMDSM

– Most widely used classification system of mental disorders

– We are currently using the new 5th edition ( 2013)

– It lists all the currently agreed –upon mental disorders and criteria for diagnosis

DSM Definition of Abnromality DSM Definition of Abnromality

• DSM-V defines abnormal behavior asDSM-V defines abnormal behavior as: :

• ““a behavioral or psychological a behavioral or psychological syndrome or pattern that reflects an syndrome or pattern that reflects an underlying psychobiological underlying psychobiological dysfunction, is associated with dysfunction, is associated with distress or disability, and is not distress or disability, and is not merely an expectable response to merely an expectable response to common stressors or losses.” common stressors or losses.”

The Limitations of the DSM The Limitations of the DSM definition definition

•DSM definition is quite broad and raises questions

•When is a syndrome or pattern of behavior significant enough to have meaning?

•Is it possible to have a mental disorder without any signs of distress or discomfort?

•What criteria are to be used in assessing What criteria are to be used in assessing symptoms? symptoms?

• Is it possible that a given behavior is a Is it possible that a given behavior is a reaction to stressor rather than response to reaction to stressor rather than response to common stressorcommon stressor

For Major Factors Used to Determine For Major Factors Used to Determine

abnormalityabnormality

•Most definitions of abnormality use Most definitions of abnormality use some form of statistical averagesome form of statistical average

•The 4 factors:The 4 factors:

•Distress Distress

•DevianceDeviance

•DysfunctionDysfunction

•Danger to self or others Danger to self or others

•Not all factors need to be presentNot all factors need to be present

Cont-dCont-d

• Certain behaviors are judged Certain behaviors are judged abnormal in most situations abnormal in most situations

• Examples: Hallucinations, delusions, Examples: Hallucinations, delusions, disorientationdisorientation

• Certain behaviors were considered Certain behaviors were considered abnormal in previous historical times abnormal in previous historical times

Clinical Significance Clinical Significance

• The extent to which a given behavior is The extent to which a given behavior is abnormal in terms is assessed by the 4 abnormal in terms is assessed by the 4 factorsfactors

• Clinical significance- The behavior involves Clinical significance- The behavior involves measurable degrees of impairment- e.g. measurable degrees of impairment- e.g. inability to fulfill personal, professional inability to fulfill personal, professional functionsfunctions

• DistressDistress • Risk to self or othersRisk to self or others • Behavior cannot be a socially expectable Behavior cannot be a socially expectable

response to a particular event- such as death response to a particular event- such as death of a friendof a friend

Cultural ConsiderationsCultural Considerations

– Cultural universalityCultural universality: : – Assumption that origins, processes, and

manifestations of mental disorders are the same across cultures

– Cultural relativismCultural relativism: : – Belief that lifestyles, cultural values, and

worldviews affect expression and determination of abnormal behavior

Psychiatric Epidemiology Psychiatric Epidemiology

• The study of the prevalence of mental The study of the prevalence of mental illness in a societyillness in a society

• May provide insight as to why some May provide insight as to why some mental illnesses occur in a given society mental illnesses occur in a given society

• Prevalence: the % of people that have the Prevalence: the % of people that have the disorder in a certain period disorder in a certain period

• Incidence: The number of new cases in a Incidence: The number of new cases in a specific period of time specific period of time

• Lifetime prevalence: The % of people who Lifetime prevalence: The % of people who have had the disorder at one time during have had the disorder at one time during their lives their lives

Historical Perspectives Historical Perspectives

• Prehistory: Possessions by evil spirits Prehistory: Possessions by evil spirits

• Trephining: Piercing a hole in the Trephining: Piercing a hole in the skull to release the spirit skull to release the spirit

History (cont-d) History (cont-d)

• Ancient people regarded mentally-ill people Ancient people regarded mentally-ill people as being possessed by evil spirits, and as being possessed by evil spirits, and apparently used “trephining”, piercing a apparently used “trephining”, piercing a hole in the skull of the afflicted person, in an hole in the skull of the afflicted person, in an attempt to “release” these spirits. attempt to “release” these spirits.

• Later, in ancient Greece, Hippocrates viewed Later, in ancient Greece, Hippocrates viewed abnormality as the result of imbalance abnormality as the result of imbalance among 4 fluids, or biles, in the body. Excess among 4 fluids, or biles, in the body. Excess in one of the biles caused the person to in one of the biles caused the person to display some particular behaviors.display some particular behaviors.

History (cont-d) History (cont-d)

• In the Middle Ages, the belief that In the Middle Ages, the belief that abnormal behavior is caused by abnormal behavior is caused by demonic possession was reflected in demonic possession was reflected in the “treatments” given to the mentally the “treatments” given to the mentally ill, these “treatments” were ill, these “treatments” were administered by the religious administered by the religious authorities, and included all types of authorities, and included all types of procedures to purge the afflicted person procedures to purge the afflicted person of the demons. Exotcismof the demons. Exotcism

Middle Ages: Burning “witches” at Middle Ages: Burning “witches” at the stake the stake

Asylums- 16Asylums- 16thth-17-17thth centuries centuries

St. Mary of Bethlehem in London St. Mary of Bethlehem in London

The Reform Movement 18The Reform Movement 18thth and and 1919thth centuries centuries

• A reform Movement started in A reform Movement started in Europe and the US in the 1700’s Europe and the US in the 1700’s Chiarugi, Pinel, Tuke, Rush, and Chiarugi, Pinel, Tuke, Rush, and Dorothea Dix are some of the names Dorothea Dix are some of the names associated with this movement- who associated with this movement- who advocated humane treatment of the advocated humane treatment of the mentally ill. mentally ill.

The mental patients were treated The mental patients were treated

like animals in the zoolike animals in the zoo

The Biological Viewpoint The Biological Viewpoint Late 19Late 19thth century century

• Main models at the beginning of modern times Main models at the beginning of modern times (end of 19th century): (end of 19th century): The Somatic modelThe Somatic model, , started with the work of Greisinger and started with the work of Greisinger and Kraepelin, who saw mental disorders as Kraepelin, who saw mental disorders as disorders of the brain. Somatic (body) disorders of the brain. Somatic (body) treatments such as psychosurgery and electro-treatments such as psychosurgery and electro-convulsive therapy were used and abused as convulsive therapy were used and abused as treatment methods for those institutionalized.treatment methods for those institutionalized.

• Kraepelin identified clusters of symptoms Kraepelin identified clusters of symptoms called syndromes –representing a unique called syndromes –representing a unique disorder disorder

The Psychological Viewpoint The Psychological Viewpoint

• The psychological modelThe psychological model, viewing mental , viewing mental disorders as a product of the mind started disorders as a product of the mind started with the interest in hypnosis, the early work with the interest in hypnosis, the early work of Mesmer, culminating with the work of of Mesmer, culminating with the work of Freud. Freud.

• The main contention of this model was that The main contention of this model was that mental disorders are caused by unconscious mental disorders are caused by unconscious factors. Psychoanalysis had emerged as an factors. Psychoanalysis had emerged as an attempt to understand a condition that got attempt to understand a condition that got the name the name HysteriaHysteria

– Kraepelin•Symptoms occur in clusters (syndromes) to

represent mental disorders, each with unique cause, course, and outcome

•Classified mental illness based on organic causes

•Original basis for Diagnostic Statistical Manual of American Psychiatric Association

•Biological view gained greater strength with discovery of general paresis, a progressively degenerative and irreversible physical and mental disorder

Cont-dCont-d

• Sigmund Freud (1856-1939)Sigmund Freud (1856-1939) was a neurologist was a neurologist in Vienna practicing with hypnosis to treat in Vienna practicing with hypnosis to treat patients who suffered from patients who suffered from hysteria: hysteria: aa disorder in disorder in which the patient displays a variety of physical which the patient displays a variety of physical symptoms without having any organic basis for symptoms without having any organic basis for them. He foundthem. He found that under hypnosis his patients that under hypnosis his patients uncovered early childhood memories, typically uncovered early childhood memories, typically dealing with unpleasant events of sexualdealing with unpleasant events of sexual nature. nature. He later used the technique of He later used the technique of free associations free associations instead of hypnosis. When his patients talked instead of hypnosis. When his patients talked about their early memoriesabout their early memories their symptoms have their symptoms have subsided. subsided.

• There was no way to confirm the validity of these There was no way to confirm the validity of these early memories. early memories.

The Deinstitutionalization The Deinstitutionalization MovementMovement

• With the advent of the anti-psychotic With the advent of the anti-psychotic (psychotropic) drugs in the late1950’s, a (psychotropic) drugs in the late1950’s, a belief that these drugs will cure mental belief that these drugs will cure mental

illness brought about the movement toward illness brought about the movement toward empting the big mental hospitals, and empting the big mental hospitals, and sending the mental patients into the sending the mental patients into the

community, where, as it was hoped, they community, where, as it was hoped, they could function in semi-independent could function in semi-independent

environments. The hope did not environments. The hope did not materialized, and many mental patients materialized, and many mental patients

found themselves on the streets. found themselves on the streets.

New TrendsNew Trends

– Positive psychologyPositive psychology::– Study of positive human functioning,

and the strengths and assets of individuals, families, and communities

– Optimal human functioningOptimal human functioning::– Subjective well-being, happiness,

optimism, resilience, hope, courage, ability to cope with stress, self-actualization, and self-determinism

Resilience Resilience Current genetic findings Current genetic findings

– Focus on resilienceFocus on resilience::– Positive aspects of resilience, strengths,

assets in successful mental health coping

– The longer allele of the serotonin-transporter gene has been found related to resilience

Current Findings Current Findings

– Appreciation for researchAppreciation for research• Breakthroughs in neuroscience

– Role of neurotransmitters in mental disorders– Renewed interest in brain-behavior relationship

with success of psychopharmacology – Increasing exploration of biological bases of

abnormal behavior– Integration of drug therapy with psychotherapy– Move toward empirically-based treatments