Transcript Diagnostic and Statistical Manual of Mental Disorders

Introduction to Abnormal Psychology
Naomi Wagner, PhD
Some slides are taken from Sue
What is Abnormality?
• The prefix Ab means- away from
• Norm means the typical, the average
• “Away from the average behavior”
• It is difficult to determine what is normal
and what is abnormal in human behavior
• Views about abnormality have changed
throughout history
Terms
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Abnormality
Psychopathology
Mental Illness
Mental Disorders
Psychological Disorders
Maladjustment
And more
These terms are used interchangeably
How do we Determine what is
Abnormal?
• In some instances it is easier to put the cut-off
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line between normal and abnormal
In psychosis one can easily draw the line
Psychosis involves breaking away from realityhaving hallucinations for example
In other instances it is difficult to draw he linee.g. anxiety- we all have the tendency to be
anxious in some situations – where do you draw
the line?
(Cont-d)
• In depression- where do you draw the line
between sadness that is part of life and
sadness that becomes clinical depression?
• In viewing child behavior- how can we tell
that a given behavior reflects
developmental immaturity and will
subside, or is it the sign of a deeper
clinical problem?
The Study 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
(sue)
Some of the Difficulties
• Can we predict abnormal behavior?
• Can we modify it?
• Sometimes behavior that appears abnormal is
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an attempt to adjust to extreme life situations
Example: J.C. Duggart that was abducted at age
11 and was kept captive for 18 years
She could have escaped- why hasn’t she?
Therapy
– Modifying abnormal behavior
– Therapy: program of systematic intervention
aimed at improving a person’s behavioral,
affective (emotional), or cognitive state
Determining Abnormality
– Psychologists use the Diagnostic and
Statistical Manual of Mental Disorders( DSM
– 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-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.”
The Limitations of the DSM 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?
• Is it possible that a given behavior is a reaction to
stressor rather than response to common stressor
For Major Factors Used to Determine abnormality
• Most definitions of abnormality use some
form of statistical average
• The 4 factors:
• Distress
• Deviance
• Dysfunction
• Danger to self or others
• Not all factors need to be present
Cont-d
• Certain behaviors are judged abnormal in
most situations
• Examples: Hallucinations, delusions,
disorientation
• Certain behaviors were considered
abnormal in previous historical times
Clinical Significance
• The extent to which a given behavior is
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abnormal in terms is assessed by the 4 factors
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
Cultural Considerations
– 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
Psychiatric Epidemiology
• The study of the prevalence of mental illness in
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a society
May provide insight as to why some mental
illnesses occur in a given society
Prevalence: the % of people that have the
disorder in a certain period
Incidence: The number of new cases in a
specific period of time
Lifetime prevalence: The % of people who have
had the disorder at one time during their lives
Historical Perspectives
• Prehistory: Possessions by evil spirits
• Trephining: Piercing a hole in the skull to
release the spirit
History (cont-d)
• Ancient people regarded mentally-ill people as
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being possessed by evil spirits, and apparently
used “trephining”, piercing a hole in the skull of
the afflicted person, in an attempt to “release”
these spirits.
Later, in ancient Greece, Hippocrates viewed
abnormality as the result of imbalance among 4
fluids, or biles, in the body. Excess in one of the
biles caused the person to display some
particular behaviors.
History (cont-d)
• In the Middle Ages, the belief that
abnormal behavior is caused by demonic
possession was reflected in the
“treatments” given to the mentally ill,
these “treatments” were administered by
the religious authorities, and included all
types of procedures to purge the afflicted
person of the demons. Exotcism
Middle Ages: Burning “witches” at the
stake
Asylums- 16th-17th centuries
St. Mary of Bethlehem in London
The Reform Movement 18th and 19th
centuries
• A reform Movement started in Europe and
the US in the 1700’s Chiarugi, Pinel,
Tuke, Rush, and Dorothea Dix are some of
the names associated with this movementwho advocated humane treatment of the
mentally ill.
The mental patients were treated like
animals in the zoo
The Biological Viewpoint
Late 19th century
• Main models at the beginning of modern times
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(end of 19th century): The Somatic model,
started with the work of Greisinger and
Kraepelin, who saw mental disorders as
disorders of the brain. Somatic (body)
treatments such as psychosurgery and electroconvulsive therapy were used and abused as
treatment methods for those institutionalized.
Kraepelin identified clusters of symptoms called
syndromes –representing a unique disorder
The Psychological Viewpoint
• The psychological model, viewing mental
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disorders as a product of the mind started with
the interest in hypnosis, the early work of
Mesmer, culminating with the work of Freud.
The main contention of this model was that
mental disorders are caused by unconscious
factors. Psychoanalysis had emerged as an
attempt to understand a condition that got the
name Hysteria
– 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-d
• Sigmund Freud (1856-1939) was a neurologist in
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Vienna practicing with hypnosis to treat patients who
suffered from hysteria: a disorder in which the patient
displays a variety of physical symptoms without having
any organic basis for them. He found that under
hypnosis his patients uncovered early childhood
memories, typically dealing with unpleasant events of
sexual nature. He later used the technique of free
associations instead of hypnosis. When his patients
talked about their early memories their symptoms have
subsided.
There was no way to confirm the validity of these early
memories.
The Deinstitutionalization
Movement
• With the advent of the anti-psychotic
(psychotropic) drugs in the late1950’s, a belief
that these drugs will cure mental illness brought
about the movement toward empting the big
mental hospitals, and sending the mental
patients into the community, where, as it was
hoped, they could function in semi-independent
environments. The hope did not materialized,
and many mental patients found themselves on
the streets.
New Trends
– 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
Resilience
Current genetic findings
– Focus 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
– 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