Defining Abnormality

Defining Abnormality Shades of Gray

What are the Criteria for Abnormality? • Necessary criterion • must be present • would be found in all psychological disorders • Sufficient criterion • distinguishes normal from abnormal • would NOT be found in normal conditions

Defining Abnormality: Who’s Asking? • The “patient” • The patient’s circle (family, friends, work) • The “experts” (researchers & clinicians)

Commonly Used Criteria for Defining Abnormality (HIDES) • Help Seeking (text) • Irrationality/Dangerousness • Deviance (2 definitions) • Emotional Distress • Significant Impairment

The Core Concepts

Context • The Importance of Context in Defining and Understanding Abnormality

Continuum • The Continuum Between Normal and Abnormal Behavior

The Continuum Between Normal and Abnormal Behavior • Normal and abnormal behavior lie on a continuum • We cannot locate a precise cut-off between normal and abnormal behavior • Precise definitions of what constitutes abnormality are inherently arbitrary

Cultural and Historical Relativism • Cultural and Historical Relativism in Defining and Classifying Abnormality

Cultural Relativism in Defining Abnormality • There are no universal definitions of abnormality • Behaviors that are considered abnormal in one cultural context are not necessarily considered abnormal in another • For example, behaviors associated with “spirit possession” are not considered to be pathological in some North African and Middle Eastern cultures

Historical Relativism in Defining Abnormality • Definitions of abnormality change dramatically over time • For example, until 1973, homosexuality was included as a mental disorder in the DSM diagnostic system • Homosexuality was removed from the DSM in response to social, political, and scientific changes

Advantages and Limitations of Diagnosis • The Advantages and Limitations of the DSM-IV-TR Diagnoses

Multiple Causality • The Principle of Multiple Causality

Mind-Body • The Connection Between Mind and Body

Rates of Psychopathology • NIMH ECA & National Comorbidity Study • Approx. 20% of Americans (44 million people) in any given year • 1/3 have problems persisting > 1 year • 7% of children; 15% of elderly • Peak of onset: 25-35 years • 1:2 seek help

Mood Disorders Anxiety Disorders Somatoform Disorders Dissociative Disorders Substance Use Disorders Schizophrenia Sexual and Gender Identity Disorders Eating Disorders Sleep Disorders Impulse Control Disorders Personality Disorders Dementia/Delirum Childhood Disorders The Major Psychological Disorders

One-Year Prevalence

Lifetime Prevalence by Gender

GenderDifferences • Women: Higher rates of anxiety disorders (phobias and panic) and depression • Men: Higher rates of alcoholism and antisocial personality • No gender differences: Schizophrenia and bipolar disorder

Cultural Relativism • All disorders shaped by cultural factors • No disorders entirely due to cultural factors • Psychotic disorders less influenced by cultural factors • Symptoms more likely to vary than disorders themselves

Edward A university senior who lives in a crowded dormitory complex, Edward sneaks around in the bushes, looking for a good vantage point from which to gaze into the windows of women students. Using binoculars, he is able to find at least one room in which a woman is undressing. The thrill of watching this unsuspecting victims brings Edward to the peak of excitement as he masturbates. Edward has been engaging in this behavior for the past 3 years, dating back to an incident when he walked past a window and inadvertently saw a naked woman. This event aroused him to such a degree that he became increasingly compelled to seek out the same excitement again and again.

Lydia A 43-year-old woman who was referred to the mental health clinic by a local surgeon, Lydia has visited plastic surgeons across the country for the past 8 years to find one who will perform surgery to reduce the size of her hands, which she perceives as being “too fat.” Until she has this surgery, she will not leave her house without wearing gloves. The plastic surgeon concurs with Lydia’s family members and friends that Lydia’s perception of her hands is distorted and that plastic surgery would be inappropriate and irresponsible.

Ted Ted is a 19-year-old college student who reports that he is terrified at the prospect of speaking in class. His anxiety about this matter is so intense that he has enrolled in very large lecture classes, where he sits in the back of the room, slouching in his chair to make himself as invisible as possible. On occasion, one of his professors randomly calls on students to answer certain questions. When this occurs, Ted begins to sweat and tremble. Sometimes he rushes from the classroom and frantically runs back to the dormitory, vomits, and tries to calm himself down.

Esther A 31-year-old unmarried woman who lives with her elderly mother, Esther believes that the outside air is filled with radio waves that will insert evil thoughts into her head. This belief keeps Esther from leaving the house. The windows in her bedroom are “protected” with aluminum foil that “deflects the radio waves.” She often hears voices that comment on these radio signals. For example, one comment is the slow, deep voice of an elderly man, who angrily states, “We’re going to get these thoughts into your head. Give up your fight!”

Robert A 26-year-old man entered the psychiatrist’s office in a state of extreme agitation, almost panic. He described the terrifying nature of his “nervous attacks,” which began several years ago but had now reached catastrophic proportions. During these “attacks,” Robert feels as thought he is floating in the air, above his body, watching everything he does but feeling totally disconnected from his actions. He reports that he feels as if his body is a machine controlled by outside forces: “I look at my hands and feet and wonder what makes them move.” Robert’s thoughts are not delusions, though; he is aware that his altered perceptions are not normal. The only relief he experiences from his symptoms comes when he strikes himself with a heavy object until the pain finally penetrates his consciousness. His fear of seriously harming himself adds to his main worry that he is losing his mind.

Carol With the pressures of managing a full-time advertising job and raising 3-year-old twins, Carol says that she has “no time or energy” for sexual relations with her husband, Bob. In fact, they have not been sexually intimate since the birth of their children. Initially, Bob tried to be understanding and to respect the fact that Carol was recovering from a very difficult pregnancy and delivery. As the months--and years--went by, however, he became increasingly impatient and critical. The more he pressured Carol for sexual closeness, the more angry and depressed she became. Carol feels that she loves Bob, but she has no interest in sexuality. She does not think about sex and can’t imagine ever being sexual again. She is saddened by the effect that this change has had on her marriage, but feels little motivation to try to change.

Chris A 14-year-old African American, Chris presented to the hospital emergency room with complaints of joint pain. His mother has sickle cell disease and is frequently disabled from her condition, leaving Chris to take care of his three younger siblings. Chris does not have SSD, but is experiencing the same pains his mother experiences. Upon examination, Chris complains that he cannot stand up and subsequently falls to the floor. Repeated medical tests fail to find any physical evidence of disease. However, Chris continues to be paralyzed from the waist down, resisting all efforts of physical therapy to help him walk again. Curiously, he seems unfazed by these recent physical impairments.

Isabel Isabel is a 33-year-old realtor who, for the past week, has shown signs of uncharacteristically outlandish behavior. First, Isabel developed an unrealistic plan to create her own real estate “empire.” She went without sleep or food for 3 days, spending most of her time at her computer developing far-fetched financial plans. Within 3 days, she put deposits on 7 houses, valued at more than $3 million, although she had no financial resources to finance even one of them. She made several visits to local banks where she was known and respected, and “made a scene” with each loan officer who expressed skepticism about her plans. In one instance, she angrily pushed over the banker’s desk, yanked his phone from the wall, and screamed at the top of her lungs that the bank was keeping her from earning a multimillion dollar profit. She was subsequently hospitalized against her will.

Bert A 16-year-old high school dropout who takes pride in his ability to burglarize homes and to shoplift without getting caught, Bert brags about his skills and flashes money in his friends’ faces. Recently, he has become more sophisticated in his approach--going door-to-door to homes in which elderly people live and offering to do “odd jobs” around the house. Once allowed to enter, he steals jewelry and money from the unsuspecting people. Last Saturday, an elderly man caught him and Bert threatened to kill him if he called the police. Bert also invites his friends to “rock” with him--throwing rocks at animals, store windows, and cars. He also likes to taunt people by laughing at them and calling them hurtful names. Bert lives with his mother who spends most of her days and evenings at a local bar, not particularly interested in what Bert is doing.

Gina A 32-year-old single mother of two children, Gina sought professional help for her long-standing feelings of anxiety. Despite the fact that he life is relatively stable in terms of financial and interpersonal matters, she worries most of the time that she will develop financial problems, that her children will become ill, and that the political situation in the country will make life for her and her children more difficult. Although she tries to dismiss these concerns as excessive, she finds it virtually impossible to control her worrying. She finds it difficult to sleep at night, and feels tense, restless, and keyed-up all the time.

Karl Karl was in the World Trade Center on September 11, 2001, working as a financial consultant. After the planes hit the building, he found himself standing in a smoky, hot office surrounded by debris. Dazed and confused, he worked himself out of the rubble and climbed down 30 flights of steps to the outside. Along the way, he passed people crying for help and others who were clearly beyond help. Ten minutes after he walked away from the buildings, they collapsed. Four months later, Karl still cannot bring himself to go back to work. He has recurrent nightmares and flashbacks about September 11, and feels tense all the time. He has difficulty thinking and has begun drinking to calm himself down. Offered a lucrative job in a downtown office one day, Karl got dressed, and went to work. Once he got near the 50-story building, he began to sweat, tremble, and feel faint. He went home, called in sick, and opened a beer.

Barbie A 20-year-old college sophomore, Barbie loves to be the center of attention. She enters the room with a flair, interrupting others’ conversations to describe her latest purchase, accomplishment, or sexual adventure. Wearing provocative clothing, Barbie flirts with every man she meets--her professors and her friends’ boyfriends included! Once when a friend criticized her for doing so, Barbie suddenly said that she felt ill and needed to lie down. Subsequently, she refused to talk to her friend, calling her a “nasty little twit.”

Max A delivery person for a large equipment corporation, Max is a loner. He does not spend time in casual conversation and avoids going out to lunch with others. It is not that Max is shy--he simply prefers to be alone. He coworkers describe him as “odd” and a “cold fish.” The few times they have approached him, Max has rebuffed them with a sneer and walked away. Max is indifferent to both praise and criticism, preferring to work his day quietly and without emotion, returning home at the end of the day where he sits alone in his house watching the Discovery Channel and surfing the Internet (but not chatting!).

Defining Abnormality