Abnormal Psychology

Module 1

INTRODUCTION TO ABNORMAL PSYCHOLOGY

ABNORMAL PSYCHOLOGY
 Is a branch of psychology that deals with psychopathology and abnormal behavior.
 It studies unusual patterns of emotion, behavior and thought which may or may not be understood as
precipitating a mental disorder.

 Abnormal psychology is a division of psychology that studies people who are "abnormal" or "atypical"
compared to the members of a given society.
 The term covers a broad range of disorders, from depression to obsession-compulsion to sexual
deviation.
 Counselors, clinical psychologists and psychotherapists often work directly in this field.

So, what is abnormal?

There are many ways in which ABNORMALITY can be defined:
1. STATISTICAL INFREQUENCY – a person’s trait, thinking or behavior is classified as abnormal if it is
rare or statistically unusual

1. Statistical Infrequency
 Limitation: However, this definition fails to distinguish between desirable and undesirable behavior.
 Many rare behaviors or characteristics (e.g. left handedness) have no bearing on normality or
abnormality. 
 Some characteristics are regarded as abnormal even though they are quite frequent.  Depression may
affect 27% of elderly people (NIMH, 2001).  This would make it common but that does not mean it isn’t
a problem

2. Violation Of Social Norms

 A person's thinking or behavior is classified as abnormal if it violates the (unwritten) rules about what is
expected or acceptable behavior in a particular social group.
 Their behavior may be incomprehensible to others or make others feel threatened or uncomfortable.
 Social behavior varies markedly when different cultures are compared.

 Limitation: Social norms change over time.  Behavior that was once seen as abnormal may, given time,
become acceptable and vice versa. 
 E.G. Drinking & driving / homosexuality
 Until 1980 homosexuality was considered a psychological disorder by the World Health Organization
(WHO) but today is considered acceptable.

3. Failure To Function Adequately

 A person is considered abnormal if they are unable to cope with the demands of everyday life. 
 They may be unable to perform the behaviors necessary for day-to-day living (e.g. self-care, hold down
a job, interact meaningfully with others, make themselves understood etc.)
 Characteristics that define failure to function adequately (Rosenhan & Seligman)
 Suffering
 Maladaptiveness (danger to self)
 Vividness & unconventionality (stands out)
 Unpredictably & loss of control
 Irrationality/incomprehensibility
 Causes observer discomfort
 Violates moral/social standards

 Limitation: abnormal behavior may actually be helpful, function and adaptive for the individual. 
 For example, for people with OCD, hand-washing may make him cheerful, happy and better able to
cope with his day.
 Many people engage in behavior that is maladaptive/harmful or threatening to self, but we don’t classify
them as abnormal
o Adrenaline sports
o Smoking, drinking alcohol

4. Deviation From Ideal Mental Health

 Under this definition, rather than defining what is abnormal, we define what is normal/ideal and
anything that deviates from this is regarded as abnormal.
 These often includes characteristics such as:
o Positive view of the self
o Capability for growth and development
o Autonomy and independence

Ideal Mental Health

o Accurate perception of reality
o Positive friendships and relationships
o Environmental mastery – able to meet the varying demands of day-to-day situations

 Limitation: It is practically impossible for any individual to achieve all of the ideal characteristics all of
the time. 
 For example, a person might not be the ‘master of his environment’ but be happy with his situation. 
 The absence of this criterion of ideal mental health hardly indicates he is suffering from a mental
disorder.

IN SUM...
 Until now, there is still no universal agreement by what is meant by abnormality or disorder but it has
been related to the following concepts:
o SUFFERING
o MALADAPTIVENESS
o DEVIANCY
o VIOLATION OF STANDARDS OF SOCIETY
o SOCIAL DISCOMFORT
o IRRATIONALITY & UNPREDICTABILITY
 o SUBJECTIVE TO SOCIAL JUDGMENTS

THE DSM’S DEFINITION OF MENTAL DISORDER

 A clinically significant behavioral or psychological syndrome or pattern
 Associated with distress or disability (impairment in one or more areas of functioning)
 Not simply a predictable or culturally sanctioned response to a particular event (e.g. grieving)
 Considered to reflect behavioral, psychological or biological dysfunction in an individual

DSM 5 Definition
 A mental disorder is a syndrome characterized by clnically significant disturbance in an individual's
cognition, emotion regulation, or behavior that reflects a dysfunction in psychological, biological, or
developmental processes underlying mental functioning.
 Usually associated with significant distress and disability in social, occupational, other important
activities.
 Not an expectable, culturally approved response to an event, nor socially deviant behavior (political,
religious, sexual) and conflicts between an individual and society unless it results from a dysfunction of
the individual

HISTORY OF ABNORMAL PSYCHOLOGY

Supernatural Traditions
 Animists believed that people suffering from abnormal behavior are possessed by malevolent spirits
 A more formalized response to spiritual beliefs about abnormality is the practice of exorcism

HIPPOCRATES’ (460-377 BC) EARLY MEDICAL CONCEPTS

 Mental disorders, like other diseases, had natural causes & appropriate treatments
 Mental disorders were due to brain pathology.
 He classified mental disorders in 3 major categories:
o Mania
o Melancholia
o Phrenitis (brain fever)
 He relied heavily on clinical observation

FOUR HUMORS (Fluids of the Body)

Hippocrates & Galen
 Blood (sanguis)
 Phlegm
 Yellow Bile (Choler)
 Black Bile (Melancholer)

 The fluids combine in different proportions in each individual and a person’s temperament was
determined by which of the humors was dominant
GALEN’S CONTRIBUTIONS (130-200 AD)
 Elaborated on the Hippocratic tradition & made several new contributions concerning the anatomy of
the nervous system
 He divided causes of psychological disorder into physical & mental categories (head injury, alcohol,
adolescence, menstrual changes, economic reversals & disappointments in love)

PARACELSUS (1490-1541)
 A Swiss physician rejected views on demonology and possession but his view on abnormal behavior
was influenced by his belief in astral influences.
 Lunaticism – the moon and tides exerted supernatural influence on the brain & behavior

ASYLUMS
 The first asylum recorded was established in Spain in 1409 – The Valencia Mental Hospital founded by
Fr. Juan Pilberto Jofre.
 Little is known about the treatment of patients in this asylum

 The act of placing mentally ill individuals in a separate facility known as an asylum dates to 1547, when
King Henry VIII of England established the St. Mary of Bethelem asylum.
 Asylums remained popular throughout the Middle Ages and the Renaissance era.
 These early asylums were often in miserable conditions.

JOHANN WEYER (1515-1588)

 A German physician who first specialized in mental disorders & his wide experience and progressive
views justify his reputation as the father of modern psychopathology.
 He made a study of imprisonment, torture & burning of people accused of witchcraft as he was deeply
disturbed by these methods.

ST. VINCENT DE PAUL (1576-1660)

 “Mental disease is no different than body disease and Christianity demands of the humane and powerful
to protect, and the skillful to relieve the one as well as the other” (Castiglione, 1924)

REFORMS IN TRADITIONAL PRACTICES

 In the late 18th century the idea of humanitarian treatment for the patients gained much favor due to the
work of Philippe Pinel in France.
 He pushed for the idea that the patients should be treated with kindness and not the cruelty inflicted on
them as if they were animals or criminals.
 His experimental ideas such as removing the chains from the patients were met with reluctance. The
experiments in kindness proved to be a great success, which helped to bring about a reform in the way
mental institutions would be run

 William Tuke (1732-1822), from England established the York Retreat, a pleasant country house where
mental patients lived, worked and rested in a kindly, religious amtosphere.
 The Quaker retreat at York has continued to provide humane mental health for over 200 years
  The success of Pinel’s and Tukes humanitarian experiments revolutionized the treatment of mental
patients throughout the western parts.
 Benjamin Rush (1745-1813), an American physician encouraged more humane treatment of the
mentally ill & first to organize a course in psychiatry
 Associated with the Pennsylvania Hospital (1783), and invented the tranquilizing chair
 “Moral Management” in asylums emphasized the patient’s moral and spiritual development and the
rehabilitation of their character rather than their physical & mental disorders , because very little
effective treatment was available at that time.
 Moral Management achieved a high degree of effectiveness & was done without the help of
antipsychotic drugs
 Despite its effectiveness, the concept was abandoned by the latter part of the 19th century

DOROTHEA DIX (1802-1887) AND THE MENTAL HYGIENE MOVEMENT

 She became an important driving force in humane treatment of psychiatric patients
 1841-1881 she campaigned for improving conditions in American mental hospitals, opening of 2 large
institutions in Canada & completely reformed asylum system in Scotland
 Mental Hygiene Movement – focused almost exclusively on the physical well being of hospitalized
patients.

MENTAL HOSPITAL CARE IN THE 21st CENTURY

 Mary Jane Ward (1946) – marked the beginning of an important change in institutionalization.
 Published a book “The Snake Pit” – called attention to the plight of mental patients & created concern
over the need to provide more humane mental health care in the community instead of over crowded
hospitals
 National Institute of Mental Health was organized in the same year
 Community Health Service Act of 1963
 Deinstitutionalization – refers to the significant reduction of mental hospitals in an attempt to
reintegrate mental patients back into the community
 From half a million to 100,000
 In England, only 14 out of 130 mental hospitals remained operational
 Many professionals were concerned that mental hospitals were becoming permanent refuges, escaping
the demands of everyday life & settling into a “chronic sick role” depending on others to care for them
 MULTIAXIAL ASSESSMENT

CLASSIFICATION SYSTEMS
 Diagnostic and Statistical Manual of Mental Disorders (DSM) developed by the American Psychiatric
Association
 International Classification of Diseases (ICD) developed by the World Health Organization

Purposes Of Classifying Mental Disorders

 To distinguish one psychiatric diagnosis from another so that clinicians can offer the most effective
treatment
 To provide a common language among health care professionals
 To explore the still unknown causes of many mental disorders

MULTIAXIAL EVALUATION
 DSM-IV-TR is a multi-axial system that evaluates patients along several variables and contains 5 axes.
 Axis I and II make up the entire classification of mental disorder: 17 major classifications and more than
300 specific disorders

o AXIS I – consists of Clinical Disorders and other conditions that may be a focus of clinical attention
o AXIS II – consists of personality disorders and mental retardation. The habitual use of a particular
defense mechanism can be indicated on Axis II.

 AXIS I Diagnoses
 Disorders first diagnosed in infancy, childhood or adolescence (excluding M.R)
 Delirium, dementia, amnestic and other cognitive disorders
 Mental Disorder due to a general medical condition
 Substance-related disorders
 Schizophrenia & other psychotic disorders
 Mood Disorders
 Anxiety Disorders
 Somatoform Disorders

 Dissociative Disorders
 Sexual & Gender Identity Disorders
 Eating Disorders
 Sleep Disorders
 Impulse-control disorders
 Adjustment disorders
 Other conditions that may be a focus of clinical attention

 AXIS II Diagnoses
 Paranoid Personality Disorder
 Schizoid Personality Disorder
  Schizotypal Personality Disorder
 Antisocial Personality Disorder
 Borderline Personality Disorder
 Histrionic Personality Disorder
 Narcissistic Personality Disorder

 Avoidant Personality Disorder

 Dependent Personality Disorder
 Obsessive Compulsive Personality Disorder
 Personality Disorder (Not otherwise specified)
 Mental Retardation

 AXIS III – lists any physical disorder or general medical condition that is present in addition to the
mental disorder
 It may be a cause (kidney failure causing delirium)
 Or a result (alcohol gastritis secondary to alcohol dependence)
 Or unrelated to the mental disorder
 If it is causative, it is listed in both Axis I & III

 AXIS IV – is used to code the psychosocial and environmental problems that contribute significantly to
the development / exacerbation of the current disorder

 AXIS V – is a global assessment of functioning 100-pt. scale in which clinicians judge patients’ overall
level of functioning during a particular time
 Functioning refers to a composite of 3 major areas: social, occupational & psychological

AXIS IV EXAMPLES
 Problems with primary support group
 Problems related to the social environment
 Educational problems
 Occupational problems
 Housing problems
 Economic problems
 Problems with access to health care services
 Problems related to interaction with the legal system
 Other psychosocial & environmental problems

AXIS V - GAF Scale

 91-100 – superior functioning, no symptoms
 81 – 90 – absent /minimal symptoms, good functioning in all areas, socially effective, generally satisfied
with life
 71-80 – symptoms present are transient & expectable reactions to psychosocial stressors
 61-70 – some mild symptoms OR some difficulty in social, occupational / school functioning,
meaningful interpersonal relationships

 51-60 moderate symptoms OR moderate difficulty in social, occupational / school functioning (few
friends, conflicts with peers)
  41-50 - serious symptoms (suicidal ideations, frequent shoplifting) or serious impairment in social,
occupational / school functioning (no friends, cant keep a job)
 31-40 – some impairment in reality testing and communication or major impairment in several areas
(work/school, family relations, judgment, thinking, mood )
 21-30 – behavior is influenced by delusions/hallucinations, serious impairment in communication &
judgment, inability to function in almost all areas
 11-20 – some danger of hurting self or others OR occasionally fails to maintain minimal personal
hygiene, gross impairment in speech
 1-10 – persistent danger of severely hurting self or others OR persistent inability to maintain minimal
personal hygiene
 0 – inadequate information

BIO PSYCHOSOCIAL MODEL OF MENTAL ILLNESS

George Engel & John Romano

 best known for their formulation of the biopsychosocial model, a general theory of illness and
healing.

Biopsychosocial model of mental illness is the complex interplay of three major dimensions in the dev
elopment of psychiatric disorders.
o Biological- provides causal factors from genetics to neuroscience
o Psychological- includes causal factors from behavioral and cognitive processes
o Social/Emotional- any environmental interaction or emotional influences contribute in a variety of ways
to psychopathology
This provides a holistic approach to psychiatric illnesses where a person does not suffer as isolated organs but
rather as a whole.

BIOLOGICAL
Genetic Paradigm:
Nueroscience Paradigm:
Neurotransmitter, Brain Structure and Hypothalamic–Pituitary– Adrenocortical(HPA) Axis

Genetic Paradigm
NATURE-
 Individual's innate attributes.
 Our genetics determine our behavior, physical appearance and personality characteristics.
NURTURE

 explains that an individual inherits certain vulnerabilities that are susceptible to a disorder when
the right kind of stressor comes along.

 The environment, upbringing and life experiences determine our behavior.

 We are “nurtured” to behave in certain ways.

 Ex. Diathesis-Stress Model

Nueroscience Paradigm

mental disorders are linked to aberrant processes in the brain

 Neurotransmitter, a biochemical messenger that sends signals from one neuron to another.
Several neurotransmitters are involved in the development of psychopathology like dopamine,
serotonin, norepinephrine and GABA (gamma-aminobutyric acid).
o Ex. low serotonin may be associated with aggression, suicide, over eating, etc.

 Brain structure and function is related to mental disorder.

The development of the brain starts at the first trimester of pregnancy until early adulthood. However,
failure to undergo processes lead to the development of disorders.

o Ex.brain size of children with autism expands at a much greater rate than it should
in typical development.

 The HPA axis is responsible for the body’s response to stress and thus is relevant for several stress-
related disorders.

o Ex. Cortisol levels of a person with depression are elevated. A finding that makes
sense considering the relationship between depression and severe life stress.

PSYCHOLOGICAL

includes causal factors from behavioral and cognitive processes.

✓ Behavioral Conditioning contributes to the development of psychopathology

In behavior therapy, it is believed that problem behavior is likely to continue if it’s reinforced by
consequences.

Once reinforcement has been identified, treatment is then tailored to alter the consequences

 For example if it was established that getting attention reinforced problem behavior, ignoring
the behavior is said to be the treatment and could be followed by a time-out. In time-out, a
person is sent out to a location where positive reinforcers are not present
 Increasing the freq uency of desirable behav ior makes positiv e reinforcers contingent on
behav ior
 For example, exposing a socially withdrawn child to socialize through playing. Similarly,
positive reinforcement helps children with autism develop language and children with mental
retardation develop life skills

O ther techniq ues include Behavioral Activation (BA) therapy of depression

(J acobson, M artell, & Dimidjian, 2011) a person is involved in activities that anticipates positive
reinforcement. M oreov er, systematic desensitiz ation is also helpful in problem behav ior especially to people
w ith anx iety. In systematic desensitiz ation, a person w ill be ex posed from a minimal arousal of anx iety to
the most frightening to ex tinguish if a person can face the object or situation for so long w ithout harm.

 Classical conditioning helps create expectations and prepares the self from future events/ threats.
Similarly, it is also helpful in treating certain disorders like phobias through counterconditioning.

Cognitive Science

T he role of the unconscious.

 The concept of implicit memory clearly acts on the basis of things that have happened in the past but
can’t remember the events. The story of Anna O and her hysteria works with implicit memory and the
existence of the unconscious. It was only after therapy that Anna O remembered events surrounding
her father’s death and the connection of these events to her paralysis. Thus, Anna O.’s behavior
(occasional paralysis) was evidently connected to implicit memories of her father’s death.

 people believe e that situations are uncontrollable so they do not try to change the situation. For
example ,people become depressed if they “decide” or “think” they can do little about the stress in
their lives, even if it seems to others that there is something they could do. People make an attribution
that they have no control, and they become depressed Abramson, Seligman & Teasdale, M iller &
Norman,

 According to the concept of prepared learning, an individual become highly prepared for learning
about certain types of objects or situations over

 the course of evolution because this knowledge contributes to the survival of the species. For example,
we are more likely to fear snakes or spiders than flowers or rocks without any contact even if we know
rationally that snakes and spiders are harmless (Fredrikson, Annas, &Wik, 1997; Pury & Mineka,
1997).
SOCIAL /EMOTIONAL

 Emotions
 Gender
 Poverty
 Culture and Ethnicity

gender roles.

Studies also show the role of gender to several disorders. These studies suggest that men and women have
different effects on disorders.

o Depression is nearly twice as common for women than men.

emotions

emotions influence how we respond to problems and challenges in our environment. Hence, disturbance in
emotions also contributes to psychopathology

o People with panic disorder may express intense fear and anxiety with no presence
of actual threat.

poverty.

Poverty also influences the development of psychological disorders.

o Living in a lower economic status relates to depression, antisocial personality

disorder and anxiety disorder.

culture and ethnicity

Other studies show that culture and ethnicity influence psychopathology.

o Hikikomori is a japanese condition where people withdraw from the social world
for many years and refuse to interact with other people.

BIOPSYCHOSOCIAL MODEL

Biological – Genetics – Neuroscience

Psychological- Behavioral – Cognitice

Social- Emotions- Gender – Poverty- Culture and Ethnicity

CRITIQUE:
According to Peter Stilwell and Katherine Harman, a postdoctoral researcher and physiotherapist and pain researcher
respectively, the biopsychosocial model is unclearly defined. They indicated that researchers, clinicians, and educators
had a hard time when educating and relating the model in a general manner. Once using the biopsychosocial model, there
is a predisposition to split patients’ pain into two (biological or psychosocial) or three (biological, psychological, or
social) areas. In educational and clinical settings, when these areas are divided, the attention leans to be on the biological
thus, not clearly indicating the other areas to support the BST model. Also, Wideman et al. (2019) contend that the
biopsychosocial model does not evidently explain how various types of reviews relate to the personal understanding of
pain. This absence of addition and inclusion of phenomenological aspects can be drawn back to the point that there is no
solid theoretical foundation for the biopsychosocial model and because of it, teaching, research, and the clinical
application does not have a sure path.

“McLaren stated in his critical evaluation of the Biopsychosocial Model by Engel, that it does not fit to the standards for
being a model. When looking at the difference between models and theories, McLaren indicated that though theories
may perhaps be abstract, an overall further strict set of criteria such as the methodological robustness, are related to
models. Models are genuine and their material outcomes can be evaluated. Also, McLaren reasoned that models connect
to related theories in certain ways. He stated, “they model theories or theoretical constructs, meaning they embody,
actualize or realize and idea, notion or concept.” McLaren believes that the lack of actual evidence for the BST Model,
leads to a conclusion that this may not be a model, but perhaps mere speculation.

Connective Chiropractic Clinic believes that some of the main critiques about Biopsychosocial Model has been with
respect to mental healthcare. It implies that mental health issues cannot happen alone but will likewise get a physical
and/or social factor to them as well. There is constantly increased proof to indicate chemical, physical or social elements
following mental health problems. It is believed by some that the belief can add the stigma, polarization or stereotyping
of such problems. Several have also reasoned that the separation of biology and brain is also confusing.