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Into to Abnormal Psychology


Abnormal psychology can broadly be defined as the application of the principles of psychology to the study of mental disorders, including research into the causes and treatment of psychopathologies. The controversial question of major consideration in this field centers on what constitutes abnormal behavior. The DSM-IV requires that behavior meet three general diagnostic inclusion criteria in order to be considered as clinically significant and, therefore, qualify as a mental disorder: present distress, disability, and significantly increased risk of suffering death, pain, or an important loss of freedom. In order to be classified as such, then, a mental disorder must confer great personal distress, impair physical or mental abilities, and confer biological disadvantages upon the individual that do not represent statistical norms. The exclusion criteria basically states that if behavior is an expectable and culturally sanctioned reaction to a particular event, deviant in form, such as the action of political or religious minorities, or a conflict between the individual and society, it cannot be considered as a mental disorder. This criteria, thus, is attempting to decrease cultural biases and control for any environmental event that could serve as a confounding variable.

As with any system, however, there are limitations within the definitions and characteristics outlined by the inclusion and exclusion criteria. For instance, some disorders, such as antisocial personality disorder do not cause the individual to feel personal distress. Furthermore, some things that are rare or do not represent statistical norms, such as geniuses, can be seen as good, not to mention that things such as a fear of heights can be biologically advantageous in that it actually reduces the risk of dying or suffering.

Some of the most prominent forms of psychopathology are schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, personality disorders, dissociative and somatoform disorders. Other important disorders, which have had major recent research advancements into their causes and effective treatment, include substance-abuse/dependence disorders, childhood disorders, eating disorders, and sexual and gender identity disorders.


Terms


Abnormal Psychology (psychopathology) -The manifestations of and the study of the causes and treatment of mental disorders.

Adoption Studies -A means of differentiating genetic effects from environmental effects by comparing the prevalence of mental disorders between adopted individuals and their biological parents.

Antisocial Personality Disorder -A disorder characterized by persistent and pervasive disregard for, and frequent violation of, other people's rights.

Anxiety Disorders -A group of psychological disorders that can broadly be defined as emotional reactions out of proportion to threats from the environment. Anxiety disorders are usually associated with the anticipation of future problems.

Attachment Theory -A developmental theory that proposes that the selective bonds that develop between infants and their caregivers are significant and manifest themselves throughout life.

Biopsychosocial Model -A view of etiology that states that the causes of mental disorders are the result of an interaction between biological, psychological, and social factors.

Categorical -An approach to classification that assumes that the differences among types of abnormal behavior and between normal and abnormal behavior are qualitative.

Classical Conditioning -Originally studied by Pavlov, classical conditioning is a training procedure or learning experience wherein a neutral stimulus (a conditioned stimulus) elicits as reflexive response through being paired with another stimulus (an unconditioned stimulus) that already elicits that reflexive response. Also referred to as "learning by association."

Concurrent Validity -A type of validity that is concerned with factors associated with the presence of a particular disorder.

Confounding Variable (Lurking Variable) -Any variable that correlates with the main variables under study, but is hidden or unknown and therefore may cause distortions in one's data.

Cultural Relativity Theory -A theory stating that human behavior lies on a continuum and that it is the role of culture to limit the spectrum by defining acceptable forms of behavior.

Diagnosis -The method or process by which the nature or category of an individual's disorder is determined.

Diathesis-Stress Model -A theory that stipulates that behavior is a result of both genetic and biological factors ("nature"), and life experiences ("nurture"). According to this model, mental disorders are produced by the interaction of some vulnerability characteristic, or predisposition, and a precipitating event in the environment.

Dimensional -An approach to classification that argues that since behavior exists on a continuum, the differences amongst types of abnormal behavior and between normal and abnormal behavior are quantitative in nature.

Dissociative Disorders -A group of psychological disorders that can broadly be defined as persistent and pervasive breakdowns in the integration of memory, consciousness, and identity.

DSM-IV -Diagnostic and Statistical Manual of Mental Disorders, which is currently in its fourth edition, is published by the American Psychiatry Association. It assumes a categorical, polythetic approach to classification.

Eating Disorders -A category of psychological disorders, such as anorexia and bulimia nervosa, characterized by severe disturbances in eating behavior.

Ego -One of Freud's three central personality structures, which operated on principles of reality. Much of the ego, which is caught between satisfying id impulses and obeying demands of the superego, lies in the conscious realm.

Emotion -A subjective feeling that is usually accompanied by physiological changes.

Epidemiology -The scientific study of the frequency and distribution of disorders within a population.

Etiology -The causes or origins of a disorder.

Etiological Validity -A type of validity that is concerned with factors that contribute to the onset of a disorder.

Exclusion Criteria -Symptoms or characteristics that are used to rule out the presence of a disorder.

False Negative -A test result that is read as negative when it is really positive.

False Positive -A test result that is read as positive when it is really negative.

Id - One of Freud's three personality constructs, which operates according to the pleasure principle. The id, which is innate, is constantly in an antagonistic relationship with the ego, as it attempts to fulfill basic biological and psychological drives and motivations.

Incidence (Point Prevalence) -An epidemiological term that refers to the number of new cases of a disorder that appear in a population during a specific period of time.

Inclusion Criteria -Symptoms or characteristics that must be present in order for an individual to meet the diagnostic criteria for a particular mental disorder.

Modeling -The process of teaching a person what to do or how to do it by having that person watch another individual (the model) engage in that behavior. Also known as the process of learning through imitation.

Monothetic Class -A category or class defined in terms of characteristics that are both necessary and sufficient in order to identify members of that class.

Mood Disorders (Affective Disorders) -A group of psychological disorders, including depressive and bipolar disorders, characterized by severe and prolonged disruptions in mood such as periods of mania and clinical depression.

Motivation -The collective group of factors, both internal and external, that causes an individual to behave in a particular way at a particular time.

Nature-Nurture Debate -A controversy concerning whether differences in behavior are a result of genetic and biological factors ("nature") or life experiences ("nurture").

Operant Conditioning (Instrumental Conditioning) -Originally studied by B. F. Skinner, operant conditioning is a training or learning process wherein the likelihood of repeating a particular behavior is influenced by its consequences. More specifically, this theory postulates that the behavior will increase if it is rewarded and decrease if it is punished.

Personality Disorders -Inflexible and maladaptive patterns of personality that usually stabilize over time and result in functional impairment and distress to the individual.

Polythetic Class -A category or class that is defined in terms of a broad set of criteria that are neither necessary nor sufficient. Each member of the category must possess a certain minimal number of defining characteristics, but none of the features has to be found in each member of the category.

Predictive Validity -A type of validity that is concerned with the future and the stability or other outcomes of the disorder over time.

Prevalence -An epidemiological term that refers to the active number of cases, both old and new, that are present within a given population during a particular period.

Psychoanalytic Approach -Based on the writings of Sigmund Freud, the psychoanalytic approach is a paradigm for conceptualizing abnormal behavior proposing that mental disorders arise from conflicts between unconscious and conscious mental processes. This is also a therapy technique wherein such techniques as dream interpretation, free association, and analysis of transference are used to gain insight into the unconscious and to make the unconscious conscious.

Reliability -The consistency of measurements, including diagnostic decisions. Agreement amongst clinicians is one index of the reliability of a measure.

Schizophrenia -A group of psychological disorders characterized by disrupted perceptual and thought processes and associated with a deterioration in role functioning.

Sensitivity -The extent to which a definition includes all valid cases. Poor sensitivity leads to an increase in false negatives.

Sign -Any observable feature of behavior.

Somatoform Disorders -A group of psychological disorders that are characterized by unusual physical symptoms that occur in the absence of any known physical pathology.

Specificity -The extent to which a definition excludes all valid cases. Poor specificity leads to an increase in false positives.

Statistical Norms -Statistics that indicate and describe behavior in the general population.

Superego -One of Freud's three central personality structures, roughly associated with the "conscience." The superego represents internalized societal rules and values and attempts to control id impulses.

Symptom -Any self-reported feature of behavior.

Syndrome -A pattern or group of symptoms and signs appearing together in a persistent fashion that may constitute evidence of a mental disorder.

Temperament -Characteristic ways of behaving in relation to the environment that are usually seen as inborn traits.

Threshold Model of Behavior -This model basically states that an individual may exhibit characteristics of a disorder without experiencing any adverse effects until a certain point, or threshold. As they cross that threshold, the quantitative element, however, there is an increase in the number of problems experienced, and therefore, qualitatively, the individual can be evaluated as having a disorder.

Twin Studies -A method of determining the heritability of a mental disorder by comparing the concordance, or agreement, rates between monozygotic and dizygotic twin pairs.

Validity -The degree to which a measurement system actually measures the characteristic that it is supposed to measure.


Labeling Theory

Labeling theory proposes that abnormal disorders are in fact created by social expectations. This means that society sets up certain norms and rules that individual must follow, and failure to adhere to these rules defines abnormal behavior. Thus labeling theory is concerned with the social context and the social factors concerned with the diagnosis of an abnormal behavior. Thomas Scheff (1984), a supporter of the theory of mental disorders as maladaptive social roles, goes even further than categorizing abnormal behavior as violations of societal rules. He proposes that the condition of those suffering from mental disorders usually worsens after they have been given the label of "crazy." A type of self-fulfilling prophecy inevitably occurs wherein the individual conforms his or her behavior to the label given to him or her. This introduces such important ideas such as that a diagnostic label actually confers a type of reward to individuals for certain atypical behaviors and that stigma (negative attitudes others have of the subjects) contributes to the maintenance of the mental disorder. Yet, studies like the Epidemiological Catchment Area Study indicate that many mental disorders are long- lasting and full of suffering, regardless of other people's reaction, if they go untreated.


Classification Issues

There are two major approaches to classification: categorical and dimensional. The categorical approach is based on the assumption that differences between normal and abnormal behavior or between different types of abnormal behavior are qualitative. The dimensional approach, on the other hand, is based on the assumption that these differences are quantitative, since behavior can be seen as distributed on a continuum from normal to abnormal. The threshold model of behavior is a compromise between these two approaches. This model basically states that an individual may exhibit characteristics of a disorder without experiencing any adverse effects until a certain point, or threshold. As they cross that threshold, the quantitative element, however, there is an increase in the number of problems experienced; therefore, qualitatively, the individual can be evaluated as having a disorder.

In diagnosing mental disorders, physicians seek to diagnose syndromes. Syndromes are a group or pattern of symptoms that occur together in a persistent fashion, potentially constituting evidence of a mental disorder. A symptom is any characteristic of a person's actions, thoughts, or feeling that could serve as a potential indicator of the presence of a mental disorder. Symptoms are self-reported and generally not observable while signs, such as affect, are observable features of the person's mental state. By using both signs and symptoms, a diagnosis can be met. The ability to define syndromes and to observe how they appear in the general population, or epidemiology, is very important in understanding the etiology of mental disorders and in finding the most effective form of treatment. This is the reason that descriptive statistics such as age of onset, prevalence, and gender differences are important. If, for example, we are able to understand such things as why major depression is more prevalent among women--whether it is because women are more likely to report such distress or because greater societal acceptance of women being depressed has led to biases in the diagnostic criteria--the entire system as a whole becomes more systematic, valid, and reliable.

Diagnostic approaches should always attempt to be high in validity and reliability. Another goal of classification systems is to be high in both specificity and sensitivity. Specificity refers to the extent to which any definition excludes invalid cases. If a definition has poor specificity, it is high in false positives. This means that it labels individuals as having a disorder when there is really no disorder present. Sensitivity refers to the extent to which any definition includes all valid cases. If a definition has poor sensitivity, it is high in false negatives (individuals who have a disorder present are falsely being diagnosed as not having one).

Two diagnostic approaches, which highlight the cost and benefits of poor specificity and sensitivity are the monothetic and polythetic classes. The monothetic category is defined as features that are both necessary and sufficient in order to identify members of that class. This category leads to more homogeneity across members, which results in greater specificity but poor sensitivity. The benefits of this diagnostic approach are that it leads to improved research and treatment findings and decreases marginalization of individuals having a mental disorder. Yet the costs, as with any system that is poor in sensitivity, are that the validity of the research findings decreases and the number of people who need treatment also decreases, since the potential for false negatives increases. The polythetic category presents a broad set of characteristics that are neither necessary nor sufficient. Instead, each member of the category must possess a certain minimal number of defining characteristics, but none of the features have to be found in each member of the group. The heterogeneous quality of this category increases sensitivity but leads to a decrease in specificity. Benefits of this approach are that the amount of individuals who need help receive treatment, yet at the same time, this may lead to punishing and labeling of individuals who are normal as "sick," which may, in turn, have an iatrogenic effect of perpetuating the disorder and maintaining functional impairment. It is also dangerous, as any medical field, to medicate and treat individuals for diseases and disorders that they do not truly have, thus leading to a decrease in reliability of treatment methods.

There are three types of validity: etiological, concurrent, and predictive. Etiological validity looks at the extent to which we can identify distinct factors or characteristics that contribute to the onset of a disorder. Concurrent validity is concerned with factors currently associated with the presence of a disorder. And predictive validity assesses the outcome of individuals affected with a disorder. By looking at these three components of validity, advancements in research concerning the causes, classification, and treatment of disorders can be made. The criteria for "vulnerability markers" for developing a disorder, for instance, states that the marker must distinguish between people who have the disorder and those who do not, and should identify more people among the relatives of the individual with the disorder than relatives of people in the general population, both of these being characteristics of concurrent validity. Furthermore, the marker should also be transmitted genetically, etiologically valid, and a stable characteristic over time, and should predict the future development of the disorder, qualities that are inherent in the definition of predictive validity.


Etiological Issues


One of the major controversies in considering the causes of mental disorders is that of the nature-nurture debate. Proponents of the "nature" school of thought believe that the ultimate cause of psychopathology is biological and tend to emphasize the role of genes, infectious diseases, physical diseases, and malfunctions of the brain and nervous system in the onset of mental disorders. Individuals who place more emphasis on nurture, however, stress that the ultimate cause of psychopathology is experience. These scientists are more interested in how role learning, methods used to adapt to one's environment, societal demands, and parent-child relationships play in the onset and expression of psychological disorders.

One system that has developed that incorporates theories of both camps is that of the diathesis-stress model of abnormal behavior. This view assumes that the development of any disorder is the result of the interaction between some precipitating event and the predisposition of the individual. Psychopathology, then, can be multiply determined in that there is a predisposition, or vulnerability factor, for developing a disorder--the nature element--but it must be combined with some triggering event in the environment, such as stress or a challenging experience--the nurture factor--before abnormal behavior is expressed. One useful and common analogy used, therefore, is that genes load the gun, but it is the environment that pulls the trigger. The biopsychosocial systems approach, then, embodies the concept of a diathesis- stress model in that it proposes that the etiology of mental disorders is best understood as an interaction between biological, psychological, and social factors. Biological factors focus on the role that genes and neurophysiology play in the development of mental disorders. This category uses such techniques as adoption studies, twin studies, and the efficacy of drug treatments to understand the biological bases of psychopathology.

One major component of the psychological category is behavioral theories. The premise of these theories is that just as all normal behaviors are learned, so are abnormal behaviors. Proponents of this theory consider such issues as classical conditioning, operant conditioning, and modeling. Attachment theory is also an important factor of the psychological perspective. It is based on the assumptions that we all have a central need to establish a healthy relationship with our caregiver and that mental disorders arise when that core relationship has been violated, through such means as neglect and abuse. Motivation, temperament, and emotion also play a very important role within the psychological construct. Abraham Maslow, a humanist psychologist, for example, proposed that there is a hierarchy of basic human needs ranging from survival needs, such as the need for food, to self-actualization needs, such as the need to fulfill one's potential.

Mental disorders, then, arise from unmet or frustrated needs. One final category within the psychological approach to the etiology of mental disorders is the psychoanalytic approach, which emphasizes the importance of stages of development. Stages of psychological development are important especially because the stress associated with developmental transitions can serve as precipitators, or triggers, of mental disorders if there already exists a predisposing diathesis. The two main theories are that of Erik Erikson's theory of psychosocial development, emphasizing social conflicts and tasks, which continues throughout the life span, and Sigmund Freud's theory of psychosexual development, which emphasizes struggles regarding sexuality, where more emphasis is placed on internal conflicts of the child. Freud, especially, placed great emphasis on the struggles and conflicts between the unconscious and conscious mind. According to Freud, conflicts between the id, the pleasure-seeking drive, and the ego, the reality principle, lead to neurotic anxiety, while conflicts between the ego and the superego, which represents our internalization of societal rules and values, are manifested as moral anxiety.

The social category of the biopsychosocial model argues that there is something in society that fosters the mental disorder, such as assumed social roles. Although all mental disorders are shaped to some extent by culture, no mental disorder can be entirely attributed to cultural or social factors. (Psychotic disorders, such as schizophrenia, are less influenced by culture than non-psychotic disorders.) This field of research is especially interested in such characteristics as interpersonal relationships, and gender and race differences within disorders. More importantly, cross-cultural studies are very important in their assessment and demonstration of culture-bound syndromes. One theory of the social category that is very intriguing is the theory of cultural relativity. This theory argues that there is a full spectrum of behavior for human kind, but the role of culture precisely is to make parts of the spectrum allowable and other parts punishable. While this method maintains cohesiveness, identity, and unity amongst groups, it also artificially limits normal behavior within the human race.


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