Abnormal Psychology

Sarah Sifers

• Publisher: Collins Reference
• Year: 2011
• ISBN:
  9780062115126
• Topic: Manuali di studio
• Subtopic: Collocamento avanzato

The Collins College Outline for Abnormal Psychology examines the symptoms, causes, and common treatments of the most frequently noted disorders, including personality, mood, psychotic, anxiety, gender, and organic conditions. This comprehensive guide also provides essential information on the history of abnormal psychology, legal issues, social policies, and major advances in research, as well as detailed explanations of behavioral, cognitive, biogenic, and sociocultural perspectives. Completely revised and updated byDr. Sarah Sifers, this book includes a test yourself section with answers and complete explanations at the end of each chapter. Also included are bibliographies for further reading, as well as numerous graphs, charts, and examples.

The Collins College Outlines are a completely revised, in-depth series of study guides for all areas of study, including the Humanities, Social Sciences, Mathematics, Science, Language, History, and Business. Featuring the most up-to-date information, each book is written by a seasoned professor in the field and focuses on a simplified and general overview of the subject for college students and, where appropriate, Advanced Placement students. Each Collins College Outline is fully integrated with the major curriculum for its subject and is a perfect supplement for any standard textbook.

CHAPTER I

The Field of Abnormal Psychology

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Considering that approximately 44.3 million people living in the United States report meeting the diagnostic criteria for at least one psychological disorder in the past year, the issue is of top concern. Psychological disorders take many forms. They range from relatively unnoticed symptoms that largely affect only the individual with the disorder to behavior that can seriously impinge upon the rights of others. Psychological disorders also range from mild symptoms to more extreme symptoms or symptoms that seem bizarre.

In the modern world, high-tech communications reveal abnormalities around the corner as well as around the globe. Celebrities gain infamy for abuse of all kinds of substances and situations, while others are spotlighted for their suffering of such mental disorders as depression, eating disorders, and psychoses. On the societal level, whole groups of people marked by their cruelty, suicidal behavior, or common idiosyncratic behaviors have gained the attention of the world. The average person, however, still remains only vaguely aware of psychological disorders around him or her. Perhaps one knows a person with a psychological condition but, for the most part, holds opinions about abnormal behavior that are based on bits of information or erroneous reports. Common misconceptions about abnormal behavior are that it is incurable or inherited; that those with psychological disorders are dangerous; that abnormal behavior is always bizarre; that psychological disorders come from weakness of will or immoral behavior. These statements are either totally false or apply in only limited ways. Apart from misconceptions, even the question, “How does one distinguish between normal and abnormal behavior?” is a perplexing one.

Abnormal psychology is the branch of psychology that concerns itself with establishing criteria to distinguish abnormal from normal behavior, describing the various types of abnormal behavior, searching out the causes of that abnormal behavior, seeking appropriate means of treating it, and ultimately finding ways to prevent it. More formally, we can define abnormal psychology as the scientific study of behavior that is not considered normal.

The field of abnormal psychology is such a developing one that professionals have created and repeatedly modified the most frequently used classification system of psychological disorders. Originally issued in 1952 by the American Psychiatric Association, the Diagnostic and Statistical Manual (DSM) lists the symptoms and other related information about widely accepted psychological disorders. The most recently published manual, the Diagnostic and Statistical Manual, 4th Edition, Text Revision (DSM-IV-TR), was published in 2000. It provides a means of classifying all recognized psychological disorders and evaluating their severity. The manual uses five axes to enable clinicians to be precise about diagnosis and evaluation. The axes are:

Axis I: The clinician reports any recognized clinical syndromes except personality disorders and mental retardation.

Axis II: The clinician indicates any personality disorders or mental retardation.

Axis III: The clinician identifies any physical conditions that might affect psychological functioning.

Axis IV: The clinician specifies any psychosocial or environmental stressors that might influence the individual’s functioning, diagnosis, treatment, or prognosis.

Axis V: The clinician rates the highest level of the individual’s overall functioning.

Controversy over inclusion of such novel manifestations as “road rage” continue to divide those involved in the revisions of the DSM. So far, such additions have been thwarted by those who do not want this system to provide the criteria for every behavior that is not totally conformist or conventional. For now, however, the following definition of mental disorders is purported by the DSM.

[A mental disorder] is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above (American Psychiatric Association 2000, pp. xxi).

The DSM does not refer to the causes of mental disorders in order to avoid implying adherence to any specific theoretical orientation. It also refers to mental disorders as the product of dysfunctions that reside in individuals, not groups. Hence, according to this definition, there are no disordered groups. Although the DSM’s definition of mental disorders is generally accepted, it has been challenged for its redundancy. Using this definition requires that problematic behavior be a symptom of dysfunction in the individual if it is to qualify as an instance of mental disorder. So, the problem behavior could not itself be the dysfunction.

In the 1990s, Jerome Wakefield offered the idea of mental disorder as “harmful dysfunction.” Harm, in this definition, is explained in terms of social values (for example, suffering, the inability to work, and so on), with dysfunction referring to an underlying mechanism that does not perform according to its evolutionary design. Wakefield’s definition follows:

A mental disorder is a mental condition that (a) causes significant distress or disability, (b) is not merely an expectable response to a particular event, and (c) is a manifestation of a mental dysfunction. (1992a, p. 235).

Although this definition is viewed as an improvement by some, there are still problems with it. Specifically, no defective operating mechanisms have been identified for most disorders. It would be quite an incredible undertaking to be able to identify a distinct underlying dysfunction that is biological in nature for the many DSM diagnoses currently in existence.

Thus, this chapter further examines the basic aspects of abnormal psychology—answering, in a basic way, questions that novices to its study often have in mind. How does one distinguish between normal and abnormal behavior? How prevalent is mental illness? What causes mental illness? Why does professional help become necessary? Where can such help be found? Who is professionally qualified to offer help?

WHAT IS NORMAL? WHAT IS ABNORMAL?

“Normal” and “abnormal,” as applied to human behavior, are relative terms. Many people use these classifications subjectively and carelessly, often in a judgmental manner, to suggest good or bad behavior. As defined in the dictionary, their accurate use would seem easy enough: normal means conforming to a typical pattern; abnormal means deviating from a norm. The trouble lies in the word norm. Whose norm? For what age person? At what period of history? In which of the world’s many cultures?

Goodness As a Criterion of Normal

Equating normal with good behavior and abnormal with bad behavior has its problems. Some questions that must be asked are these: Good or bad by whose values or standards? Under what circumstances? Is assertive behavior bad because it is disconcerting, and compliant behavior good because it is easy to accept? Is aggressive behavior always bad? Is behavior that violates parental rules bad, and behavior that conforms to parental expectations good? Is behavior that conforms to minority cultural standards but not to mainstream cultural standards bad? Psychologists who work in the field of abnormal behavior (usually referred to as clinical psychologists) have come to grips with those problems and offer more objective criteria.

Two Basic but Different Concepts of Normal and Abnormal

Social science offers two ways of distinguishing between the normal and abnormal. One way, emphasized by sociologists and anthropologists, considers the question meaningful only as it applies to a particular culture at a particular time: Abnormal is that which deviates from society’s norms. The other, stressed more by psychologists, sets as the basic criterion the individual’s well-being and the maladap-tiveness of his or her behavior. The first we will call the criterion of deviance; the second, the criterion of maladaptive behavior.

Abnormal Defined As Deviation from Social Norms

The criterion of deviation from society’s norms—that is, cultural relativism—provides an easy way of identifying abnormal behavior. According to this definition, if behavior differs significantly from the way in which others in the same society typically behave, it is abnormal. Cultural relativism bypasses the question of whether there are sick societies whose values are pathological, such as disregarding basic human rights. When such a sick society changes radically, for example as Germany did after World War II, does that make all the previously conforming individuals abnormal and all the resistive, nonconforming individuals now normal?

Another problem faced by the cultural relativists is the question of whether there are any types of abnormal behavior whose observable symptoms cut across all cultures. Emil Kraeplin’s Textbook of Psychiatry, published in 1923, provided a basis for classifying mental illness that is still used today. Through his case studies, he felt that depression, sociopathy (fixed patterns of antisocial behavior), and schizophrenia were universal disorders, appearing in all cultures and societies. Kraeplin’s astute observations were reinforced by a Swiss psychiatrist named Eugen Blueler (1857-1939), whose detailed descriptions of patients were clearly indicative of those suffering from the symptoms or clusters of symptoms (syndromes) of what we today call schizophrenia and bipolar disorder. Alois Alzheimer (1864-1915) presented an unusual clinical picture of his patients that came to be known as Alzheimer’s disease. The founder of psychoanalysis, Sigmund Freud (1856-1939), described many interesting cases of what we would now recognize as specific phobia and obsessive-compulsive disorder.

There is no question that cultural factors color the symptoms of any mental illness, nor is there question that some mental illnesses appear more frequently in some cultures than in others. However, most psychologists question the usefulness of social acceptability as a meaningful criterion for sorting out abnormal behavior from normal behavior.

Maladaptiveness As a Criterion of Abnormal Behavior

To reject cultural relativism requires that the individual or the society make a value judgment—one not necessarily scientifically justifiable—that some values are intrinsically good in themselves. In the United States, society has made such an initial judgment, that the well-being of the individual is important and that assuring the well-being of the individual assures the well-being of society. The Western world has followed suit, although such an individualistic orientation is not consistent across all cultures. With that value in place, instead of acceptability by the society, behavior that promotes an individual’s growth and well-being is considered normal behavior, while behavior that maladaptively prevents that growth or significantly limits it is considered abnormal.

Such a criterion does not do away with all subjectivity in evaluating the normality of anyone’s behavior, but it does put that decision in the hands of those who will use science to evaluate whether any given behavior is adaptive and normal or maladaptive and abnormal. “Well-being” here is given a broad definition: not merely survival, but growth and fulfillment, which are paths to self-actualization. The well-being perspective allows room for the conforming behavior necessary for group cohesiveness and for deviant behavior, which may stimulate the society to re-examine itself and its goals, so long as it is not irreparably self-damaging. It includes a concern for the well-being of families and a mission to work to eliminate those social problems that can erode a society’s well-being, such as racism, discrimination, and poverty.

SPECIFIC CRITERIA FOR JUDGING MALADAPTIVENESS

Using maladaptive behavior as a criterion of abnormality has its own problems. It is the rare person whose behavior is never maladaptive—who never becomes angry in a self-damaging way, who never takes one alcoholic drink more than is sensible, never feels depressed or anxious. In evaluating the maladaptiveness of behavior, psychologists consider the frequency of the behavior and the extent to which it impairs necessary functioning, especially in interpersonal relations and in occupational pursuits. They also take account of severely stressful life situations that the individual may face or catastrophic events through which he or she may have lived. Those factors may cause a transitory spell of maladaptive behavior.

There are certain kinds of conditions or behaviors that suggest the presence of psychological disorders that may benefit from psychological treatment. All those disorders, in one way or another, are maladaptive in that they threaten the well-being of the individual. A description of them follows.

Long Periods of Subjective Discomfort

Everyone goes through periods of psychological discomfort such as worry about the severity of a loved one’s illness, fearful anticipation of a challenging assignment, or aggrieved feelings after an unfair criticism. But those feelings are transitory, and they are related to real or threatened events. When such feelings as anxiety and depression or frenetic behavior persist and appear to be unrelated to events sur rounding the person, they would be considered abnormal. Thoughts, feelings, or behaviors that are distressing to an individual and do not pass in a reasonable period of time suggest the possible presence of a psychological disorder.

Impaired Functioning

A distinction must be drawn between periods of transitory inefficiency and prolonged inefficiency; between inefficiency whose cause can be identified and lasting inefficiency which seems to be inexplicable. Important examples that would be considered signs of an abnormal psychological condition are as follows: frequent loss of jobs or frequent job changes without apparent justification; prolonged performance notably below the individual’s potential, the most common examples of which are the very bright student who gets only low or failing grades, or the brilliantly talented person who fails in one effort after another.

Bizarre Behavior

The term “bizarre” does not refer to unconventional behavior that is carried out for some specific reason that can be understood by others—for example, behavior carried out to gain attention or to achieve notoriety. Just a mere decade and a half ago, body piercings were considered highly deviant. Today, such embellishments are considered a fashion statement and are more typically known as body art. Rather, bizarre behavior indicative of abnormality has no rational basis, is unconnected to reality, and seems to suggest that the individual is disoriented. Such behavior indicates a serious psychological disorder. These psychoses (to be described in Schizophrenia and Other Psychotic Disorders) frequently bring on hallucinations (bas...