PSCHOMETRICIAN BOARD EXAMINATION
ABNORMAL PSYCHOLOGY (PART 1)
DEFINITION OF NORMALITY AND ABNORMALITY
What is abnormal psychology?
The field devoted to the scientific study of abnormal behavior to describe, predict, explain, and change abnormal
patterns of functioning
Also referred to as clinical psychology
Mental illness
Psychopathology
Core Concepts in Abnormal Psychology
“describes behavioral, emotional, or cognitive dysfunctions that are unexpected in their cultural context and
associated with personal distress or substantial impairment in functioning”
(DSM-IV)
Psychopathology Defined
A psychological dysfunction associated with distress or impairment in functioning that is not a typical or culturally
expected response
Mental Illness is a less preferred term
Psychopathology is the scientific study of psychologicaldisorders
Features of Abnormality
“The Four Ds”
Deviance – Different, extreme, unusual
Distress – Unpleasant & upsetting
Dysfunction – Causes interference with life
Danger – Poses risk of harm
Deviance
From what?
From behaviors, thoughts, and emotions considered normal in a specific place and time and by specific
people
From social norms
Stated and unstated rules for proper conduct in a given society or culture
Examples?
Deviance
Judgments of deviance also depend on specific circumstances (i.e., social context)
Distress
According to many clinical guidelines, behavior must be personally distressing before it can be labeled
abnormal
Not always the case
Examples?
Dysfunction
Abnormal behavior tends to be dysfunctional – it interferes with daily functioning
Culture has an influence on determinations of dysfunction, as well
Dysfunction alone does not necessarily indicate psychological abnormality
Danger
Abnormal behavior may become dangerous to oneself or others
Behavior may be careless, hostile, or confused
Although cited as a feature of psychological abnormality, being dangerous is the exception rather than the
rule.
Definition of Abnormality
Statistical Deviation
The defining characteristic is uncommon
behavior - a significant deviation from the average/majority. Many
human characteristics are normally distributed.
Definition of Abnormality
Social Norm Violation
Breaking social “rules.” Most of our behavior is shaped by norms – cultural expectations about the right and
wrong way to do things.
Maladaptive Behavior
1.Maladaptive to one’s self – inability to reach goals. Difficulty in adapting to the demands of life.
2. Maladaptive to society – interferes, disrupts, social group functionings.
Personal Distress
Stress should be normal but distress is unbearable to a person that leads to burn out or worst to disorders.
Deviation From An Ideal
Humanistic and existentialist in nature. Abnormal behavior depends on the culture.
Medical Disorder
Abnormality exist because there is physical diseases.
Problems With The Definition Of Abnormality
Statistical Deviation
Is the average normal?
Social Norm Violation
a.Social Reformers – are they all abnormal?
b. Cultural Relativism – Each of culture is different from one another. By which culture’s standard do we
judge a behavior to be abnormal?
Deviation From An Ideal
On whose ideal? The ideal for an individual? The species? The culture? The god?
Medical Disorder
a.Hope that biological causes would be found for all psychological diseases.
b. Implies “health” = absence of disease.
Classification Of Mental Disorders
Introduction
In any given year in the US, 30% of adults and 19% of children display serious psychological disturbances
and are in need of treatment
In addition, most people have difficulty coping at various times in their lives.
Is this the fault of modern society?
Not entirely; historical records demonstrate that every society has witnessed psychological abnormality and
had its own form of treatment…
History
In ancient pre – history when people first noticed differences in others and wanted to understand those
differences.
Europe in the Middle Ages: Demonology
A.D. 500 – 1350
With the rise of clergy came the downplay of science
Abnormality was again seen as a conflict between good & evil
The incidence of abnormality increased dramatically as outbreaks of mass madness occurred
Earlier (largely discarded) treatments such as exorcism re-emerged .
The Renaissance
and the Rise of Asylums
A.D. 1400 – 1700
Jean Fernel (1497 – 1588): First used the word “physiology” in the modern sense, and coined
“pathology.
A.D. 1400 – 1700
German physician Johann Weyer (1515 - 1588) believed that the mind was as susceptible to
sickness as the body
Weyer is considered the founder of modern study of psychopathology
Patient care improved as demonological views declined.
The Nineteenth Century :
Reform and Moral Treatment
Philippe Pinel (1745 – 1826) a French psychiatrist and a pupil of Sauvages (who developed system
based on his detailed observation). He developed the 1st workable psychiatric nosography. 5
forms of insanity: melancholia with delirium, melancholia without delirium, dementia, idiotism.
Avoided physiological fictions and metaphysical hypotheses. Purely descriptive.
Emil Kraepelin (late 19th century) a student of Wilhem Wundt, and the “father of systemetic
psychiatry.” His book contains his medical classification scheme (the 1st truly comprehensive).
Defined 2 major groups of mental disorders: the manic depressive psychoses and dementia
praecox. It defined the discipline of Neurology and Psychiatry.
By the end of the nineteenth century, there was a reversal of the moral treatment movement
because of several factors:
Money and staff shortages
Declining recovery rates
Lack of more effective treatment for severely mentally ill
Long-term hospitalization became the rule once again.
The Early Twentieth Century :
Dual Perspectives
As the moral movement was declining in the late 1800s, two opposing perspectives emerged:
The Somatogenic Perspective
Abnormal functioning has physical causes
The Psychogenic Perspective
Abnormal functioning has psychological causes
The Early Twentieth Century :
The Somatogenic Perspective
Two factors responsible for rebirth of this perspective:
Emil Kraepelin’s textbook argued that physical factors (like fatigue) are responsible for mental
dysfunction
Several biological discoveries were made, such as the link between untreated syphilis & general
paresis
This approach, while creating optimism, lead to few positive results until the 1950s, when a
number of effective medications were discovered.
The Early Twentieth Century :
The Psychogenic Perspective
Rise in popularity of this perspective was based on work with hypnotism:
Friedrich Mesmer and hysterical disorders
Sigmund Freud: father of psychoanalysis
Unconscious processes at the root of abnormality
The psychoanalytic approach had little effect on the treatment of severely disturbed patients in
mental hospitals.
The Renaissance and the Rise of Asylums
Shrines devoted to loving care of the mentally ill were established and one, at Gheel, became a
community mental health program of sorts
This time also saw a rise of asylums – institutions whose primary purpose was care of the mentally
ill .The intention was good care, but because of overcrowding they became virtual prisons.
.How Are People with Severe Disturbances Treated?
1950s – Psychotropic medications discovered
Drugs that affect the brain and alleviate symptoms of mental illness.
These discoveries led to deinstitutionalization and a rise in outpatient care
This change in care was not without problems.
Historical Conceptions of Abnormal Behavior
Psychoanalytic Theory
Freud
Structure of the mind
Defense mechanisms
Stages of development
Humanistic Theory
Jung, Alder, Rogers
Self actualization
Historical Conceptions of Abnormal Behavior
Behaviorism
Pavlov’s classical conditioning
Watson’s Albert experiment
Skinner’s operant conditioning
Thomas Szasz
Anti-psychiatry movements
Myth of Mental Illness
“if you talk to God, you are praying; if God talks to you, you have schizophrenia
Objective of Classifying Psychiatric Disorders
To distinguish one psychiatric diagnosis from another
To enable clinicians to offer the most effective treatment
To provide a common language among health care professionals.
Objective of Classifying Psychiatric Disorders
To explore the causes of the many mental disorders that are unknown.
Fundamental Approaches in Psychiatric Classification
Etiological – Disorders classified according to underlying cause
E.g., Paracelsus (famous physician)
Vesania – caused by poison
Insanity – heredity
Lunacy – influenced by phases of the moon
Descriptive – Disorders classified according to presenting symptoms.
Important Classifications of Psychiatric Disorders
Diagnostic and Statistical Manual of Mental Disorders (DSM)
International Statistical Classification of Diseases and Related Health Problems (ICD)
ICD
Currently on its 10th edition (1992)
Published by World Health Organization
Comprehensive classification system of medical conditions and mental disorders
Official medical and psychiatric nosology used throughout most of the world.
DSM
Published by the American Psychiatric Association
Official classification system in the USA
Evolution of DSM
1840 census – recorded frequency of “idiocy / insanity”
1880 census – recorded 7 categories of mental illness
Mania Dementia
Melancholia Dipsomania
Monomania Epilepsy
Paresis
1917 – uniform gathering of statistics across mental hospitals adopted by Bureau of Census
1952 – APA published DSM I, the next step in the evolution od psychiatric taxonomy.
Nevertheless, it was still largely unreliable and some complained that it was too theory laden,
especially with psychodynamic view (APA, 1987).
1968 – Published DSM II so it would be compatible with ICD 8. There were problems in DSM II
were unreliability, largely psychodynamic in orientation, inconsistent with new research advances
and new diagnostic methodologies
1980 – DSM III was published. It was a “bold departure” from previous DSM’s. DSM III has a
number of important characteristics (APA, 1980):
Descriptive approach
Specific criteria for making diagnoses
Systematic description
Multiaxial system
1987 – DSM III – R was published. Its features were:
expanded coverageincreased reliability (a major complaint with the 3rd edition was the
unreliability of the personality disorders)updated with the latest research findings
1994 – DSM IV was published. There were comprehensive and systematic review of published
literature, data re – analyses, and field trials.
2000 – DSM IV – TR was published. Diagnostic criteria and specific criteria for diagnosis were
unchanged.The text sections giving extra information on each diagnosis were updated
2013 – DSM 5 was published. It contains extensively revised diagnoses and, in some cases,
broadens diagnostic definitions while narrowing definitions in other cases. It has discarded the
multiaxial system of diagnosis (formerly Axis I, Axis II, Axis III), listing all disorders in Section II. It
has replaced Axis IV with significant psychosocial and contextual features and dropped Axis V
(GAF).
Organizing Principle of DSM
The fundamental element is the “syndrome”
Group or pattern of symptoms
Appear together
Appear temporally
Appear in many individuals
Symptoms may reflect common
Etiological process
Course and Treatment response
Basic Features of DSM
Descriptive approach
Describes manifestations
No theory about causes
Diagnostic criteria
List of features tha tmust be present for the diagnosis to be made
Increases reliability of diagnostic process among clinicians.
Systematic description of associated features
age culture
gender prevalence
ncidence risk, course
complications predisposing factors
familial patter differential diagnosis
Describes relevant laboratory findings and physical examination signs and symptoms.
Does not describe management or treatment
Provides explicit rules when information is insufficient
Diagnosis to be deferred
Provisional diagnosis
Provides rules when patient’s clinical presentation and history do not meet full criteria od a
prototypical category
Atypical
Residual
Not otherwise specified
Limitations of the Categorical Approach of DSM
Does not assume that:
each category is a complete discrete entity with absolute boundaries
all individuals are alike in all important ways
To be used in clinical, educational and research settings
Multiaxial Evaluation:
Axis I
Clinical disorders
Conditions that may be a focus of clinical attention
Axis II Personality disorders
Mental retardation
Defense mechanism
Axis III Physical disorders
General medical condition
Present in addition to mental disorder
Axis IV Psychosocial problems
Environmental problems
Significantly contributes to development or exacerbation of disorder
Axis V Overall levels of functioning during a particular time (GAF)Social, occupational and
psychological functioning
Therapeutic Intervention and Related Issues Psychodynamic
CORE IDEA
Intrapsychic forces (unconscious)
Past (childhood) affects a person’s present
Developmental stages
HEALTHY PERSONALITY
Awareness of the unconscious
ADVANTAGES
Gives an “elite” feeling
Contributions to other fields
DISADVANTAGES :
Concepts are not measurable
Everything has an unconscious interpretation
Can tell you what went wrong but not what can be done
Behavioral – Cognitive
CORE IDEA
External forces
How we think affects the way we behave and feel
How we perceive and react
Learning and conditioning
HEALTHY PERSONALITY
Proper learning and modeling
Less irrational beleifs
ADVANTAGES
Concepts are measurable and observable
Quick way of changing a person
Contributions to society
DISADVANTAGES
Demotes human to the level of animals and machines; takes away feelings, fantasies,
goals, motives and meaning making Behavior can be unlearned quickly . Disregards role of
genetics and subjective experiences
Humanistic
CORE IDEA
Free will and to achieve our full potential
Future aspirations mold the personality
Meaning in life / reason to live
HEALTHY PERSONALITY
Present self = ideal self
Unconditional positive regard
ADVANTAGES
Strong intrinsic appeal / positive psychology
Gives importance to subjective experiences
DISADVANTAGES
Disregards role of unconscious, reinforcements, environment and biological factors“Too ideal”
and sometimes unrealistic
…DISADVANTAGES
Lacks explanation on development and immeasurable concepts.
Transpersonal
CORE IDEA
Beyond our being “human”
Spirituality, enlightenment
HEALTHY PERSONALITY
Embracing human potential
ADVANTAGES
Close to the culture of the people
Promotes spirituality (soul)
Experience of “transcendence”
DISADVANTAGES
Concepts are vague and hard to measure
Disregards the role of past experiences
Biopsychosocial
CORE IDEA
Personality is a product of the environment, physiology, culture, etc.
HEALTHY PERSONALITY
Recognition of the roles that all these factors play in an individual
ADVANTAGES
“Open to all possible reasons” : multidisciplinary approach
Recognizes that humans are very complex beings
Appreciates the role of culture, religion, government, economy, genetic influence and evolution
DISADVANTAGE
Shotgun approach : Lacks focus (tendency to have too many possible explanations)
Family Systems
CORE IDEA
Personality is a product of family interaction
HEALTHY PERSONALITY
Family that is not too enmeshed nor diffused, good interaction and communication.
ADVANTAGES
Gives insight to the family (Maybe the whole family is at fault)
Fits well to the Filipino culture
Gives importance to the interaction and communication
DISADVANTAGE
Disregards role of significant others outside of the family, biological factors and experiences
POSITIVE PSYCHOLOGY
CORE IDEA
Virtues, strengths, values and other positive traits promote mental health
HEALTHY PERSONALITY
Proper use of strength to overcome weaknesses
ADVANTAGES
Provides empirical basis for the humanistic approach
…ADVANTAGES
Appealing to almost all sector of society
DISADVANTAGES
Relatively young paradigm
Less emphasis on the disease model
Hard to dismiss the negative side of reality
INTERPERSONAL
CORE IDEA
Personality is shaped by our relationship with our significant others Attachment theories
HEALTHY PERSONALITY
Good relationships with significant others
Healthy attachment
ADVANTAGE
Effective in dealing with depression and anxiety
DISADVANTAGES
Too much emphasis on relationships with other people and not on agency
Overlaps with cognitive - behavioral and family systems
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