Exploring Abnormal Psychology: Diagnosis and Therapy

1. Chapter One Abnormal Behavior

2. The Concerns of Abnormal Psychology • What 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

3. The Concerns of Abnormal Psychology (cont’d.) • Modifying abnormal behavior • Therapy: program of systematic intervention aimed at improving a person’s behavioral, affective (emotional), or cognitive state

4. Determining Abnormality • Psychologists use the Diagnostic and Statistical Manual of Mental Disorders (DSM) • Most widely used classification system of mental disorders

5. Determining Abnormality (cont’d.) • DSM-V defines abnormal behavior as: • “a behavioral or psychological syndrome or pattern that reflects an underlying psychobiological dysfunction, is associated with distress or disability, and is not merely an expectable response to common stressors or losses.” (www.dsm5.org)

6. Determining Abnormality (cont’d.) • Limitations of DSM-V 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 symptoms?

7. Determining Abnormality (cont’d.) • Four major factors in judging psychopathology • Distress • Deviance (bizarreness) • Dysfunction (inefficiency in behavioral, affective, or cognitive domains) • Dangerousness

8. Clinical significance- The behavior involves measurable degrees of impairment- e.g. inability to fulfill personal, professional functions • Distress • Risk to self or others • Behavior cannot be a socially expectable response to a particular event- such as death of a friend

9. Cultural Considerations in Abnormality • Culture: • Shared values, beliefs, attitudes and behaviors transmitted from generation to generation • Powerful determinant of how behavior is defined and treated • Multicultural limitations: • How does culture affect our understanding of human behavior?

10. Cultural Considerations in Abnormality (cont’d.) • Cultural universality: • Assumption that origins, processes, and manifestations of mental disorders are the same across cultures • Cultural relativism: • Belief that lifestyles, cultural values, and worldviews affect expression and determination of abnormal behavior

11. Cultural Considerations in Abnormality (cont’d.) • Two key questions to consider: • What is universal in human behavior that is also relevant to understanding psychopathology? • What is the relationship between cultural norms, values, and attitudes, and the incidence and manifestations of behavior disorders?

12. Sociopolitical Considerations in Abnormality • Mental illness as a sociopolitical construction • Thomas Szasz: • “Problems in living” versus “mental illness” • Must be sensitive to individual value systems, societal norms and values, and potential sociopolitical ramifications

13. The Frequency and Burden of Mental Disorders • Psychiatric epidemiology: • Study of the prevalence of mental illness in a society • Prevalence: • Percentage of individuals in a targeted population who have a particular disorder during a specific period of time

14. The Frequency and Burden of Mental Disorders (cont’d.) • Incidence: • Number of new cases of a disorder that appear in an identified population within a specified time period • Lifetime prevalence: • The percentage of people in the population who have had a disorder at some point in their life

15. The Frequency and Burden of Mental Disorders (cont’d.) Figure 1-1 1-year prevalence of mental disorders in adult Americans and lifetime prevalence of mental disorders in American adolescents

16. The Frequency and Burden of Mental Disorders (cont’d.) • The cost and burden to society is great • At least 25% of adult Americans and almost 50% of American children suffer from diagnosable disorder

17. Stereotypes about People Who are Mentally Disturbed • Americans tend to be suspicious of people with mental disorders • Common myths: • People who are mentally disturbed can always be recognized by their abnormal behavior • People who are mentally disturbed have inherited their disorders

18. Stereotypes about the Mentally Disturbed (cont’d.) • More common myths: • Mental illness is incurable • People become mentally disturbed because they are weak willed • Mental illness is always a deficit • Mentally disturbed people are unstable and potentially dangerous

19. Historical Perspectives on Abnormal Behavior • Prehistoric and ancient beliefs: • Demonology treated by trephining or exorcism • Naturalistic explanations (Greco-Roman): • Naturalistic explanations supplanted supernatural • Hippocrates believed deviant behavior was caused by brain pathology, dysfunction or disease of the brain

20. Historical Perspectives on Abnormal Behavior (cont’d.) • The Middle Ages: • Reverted to supernatural explanations • Mass madness, or group hysteria • Tarantism, or St. Vitus’s dance • Witchcraft • The Renaissance: • The rise of humanism • Humanism: emphasizes human welfare and the worth and uniqueness of the individual

21. Historical Perspectives on Abnormal Behavior (cont’d.) • The Reform Movement: • Moral treatment movement: shift to more humane treatment of people who were mentally disturbed • Philippe Pinel • William Tuke • Benjamin Rush • Dorothea Dix • Clifford Beers

22. Historical Perspectives on Abnormal Behavior (cont’d.) • What role should spirituality and religion play in mental health care? • Spiritual being: a person’s animating life force that speaks to the thoughts, feelings, and behaviors related to a transcendent state or one’s capacity for creativity, growth, and love

23. Causes: Early Viewpoints • Biological (organic) view: • Belief that mental disorders have a physical or physiological basis (Griesinger) • 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

24. Causes: Early Viewpoints (cont’d.) • Biological view gained greater strength with discovery of general paresis, a progressively degenerative and irreversible physical and mental disorder

25. Causes: Early Viewpoints (cont’d.) • Psychological view: • Mental disorders are caused by psychological and emotional (not biological/organic) factors • Mesmerism and hypnotism: • Josef Breuer: • Relief by talking about traumatic experiences • Cathartic method: therapeutic use of verbal expression to release pent-up emotional conflicts • Sigmund Freud: psychoanalysis

26. Contemporary Trends • Multicultural psychology: • Culture, race, ethnicity, gender, age, and socio-economic class relevant to understand and treat abnormal behavior • Mental health professionals need to: • Increase cultural sensitivity • Acquire knowledge of diversity • Develop culturally relevant therapy approaches

27. Contemporary Trends (cont’d.) Figure 1-2 Census 2010 Racial and Ethnic Composition of the United States The rapid demographic transformation of the United States is illustrated by the fact that minorities now constitute an increasing proportion of the population. Several trends are evident. First, within several short decades, people of color will constitute a numerical majority. Second, the number of Latino/Hispanic Americans has surpassed the number of African Americans. Third, mental health providers will increasingly be coming into contact with clients who differ from them in race, ethnicity, and culture. Source: http//www.census.gov/newsroom/release/ archives/2010_census/cb11-cn125htm

28. Contemporary Trends (cont’d.) • Dimensions related to cultural diversity: • Social conditioning • Cultural values and influences • Sociopolitical influences • Cultural and ethnic bias in diagnosis

29. Contemporary Trends (cont’d.) • Positive psychology: • Study of positive human functioning, and the strengths and assets of individuals, families, and communities • Optimal human functioning: • Subjective well-being, happiness, optimism, resilience, hope, courage, ability to cope with stress, self-actualization, and self-determinism

30. Contemporary Trends (cont’d.) • Spirituality: • Animating life force or energy of the human condition that is broader than but inclusive of religion • Focus on resilience: • Positive aspects of resilience, strengths, assets in successful mental health coping

31. Contemporary Trends (cont’d.) • Changes in therapeutic landscape: • The drug revolution (1950s): • Rapidly and dramatically decreased or eliminated troublesome symptoms • Deinstitutionalization • Prescription privileges for psychologists • Managed health care: • Industrialization of health care, whereby large organizations in the private sector control the delivery of services

32. Contemporary Trends (cont’d.) • Industrialization of health care has brought about major trends: • Business interests are exerting increasing control over psychotherapy • Current business practices are depressing income of practitioners • Psychologists are being asked to justify use of their therapies • Enactment of mental health and substance abuse parity legislation

33. Contemporary Trends (cont’d.) • Appreciation 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