Assignment: Mental Disorders Classification

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Assignment: Mental Disorders Classification

Assignment: Mental Disorders Classification

abnormal psychology: an overview

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learning objectives 1

·  1.1 How do we define abnormality and classify mental disorders?

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·  1.2 What are the advantages and disadvantages of classification?

·  1.3 How common are mental disorders? Which disorders are most prevalent?

·  1.4 Why do we need a research-based approach in abnormal psychology?

·  1.5 How do we gather information about mental disorders?

·  1.6 What kinds of research designs are used to conduct research in abnormal psychology?

 is concerned with understanding the nature, causes, and treatment of mental disorders. The topics and problems within the field of abnormal psychology surround us every day. You have only to pick up a newspaper, flip through a magazine, surf the web, or sit through a movie to be exposed to some of the issues that clinicians and researchers deal with on a day-to-day basis. Almost weekly some celebrity is in the news because of a drug or alcohol problem, an eating disorder, or some other psychological difficulty. Countless books provide personal accounts of struggles with schizophrenia, depression, phobias, and panic attacks. Films and TV shows portray aspects of abnormal behavior with varying degrees of accuracy. And then there are the tragic news stories of mothers who kill their children, in which problems with depression, schizophrenia, or postpartum difficulties seem to be implicated.

Abnormal psychology can also be found much closer to home. Walk around any college campus, and you will see flyers about peer support groups for people with eating disorders, depression, and a variety of other disturbances. You may even know someone who has experienced a clinical problem. It may be a cousin with a cocaine habit, a roommate with bulimia, or a grandparent who is developing Alzheimer’s disease. It may be a coworker of your mother’s who is hospitalized for depression, a neighbor who is afraid to leave the house, or someone at your gym who works out intensely despite being worrisomely thin. It may even be the disheveled street person in the aluminum foil hat who shouts, “Leave me alone!” to voices only he can hear.

The issues of abnormal psychology capture our interest, demand our attention, and trigger our concern. They also compel us to ask questions. To illustrate further, let’s consider two clinical cases.

Monique Monique is a 24-year-old law student. She is attractive, neatly dressed, and clearly very bright. If you were to meet her, you would think that she had few problems in her life; but Monique has been drinking alcohol since she was 14, and she smokes marijuana every day. Although she describes herself as “just a social drinker,” she drinks four or five glasses of wine when she goes out with friends and also drinks a couple of glasses of wine a night when she is alone in her apartment in the evening. She frequently misses early-morning classes because she feels too hung over to get out of bed. On several occasions her drinking has caused her to black out. Although she denies having any problems with alcohol, Monique admits that her friends and family have become very concerned about her and have suggested that she seek help. Monique, however, says, “I don’t think I am an alcoholic because I never drink in the mornings.” The previous week she decided to stop smoking marijuana entirely because she was concerned that she might have a drug problem. However, she found it impossible to stop and is now smoking regularly again.

John John comes from a family with no history of mental illness. He had a normal birth and seemed to develop normally when he was a child. However, when he was 21, John began to hear voices and started to believe that there was a conspiracy against him. Since that time, he has been on various different anti-psychotic medications. Although these have helped a little, he still has symptoms of psychosis. Now aged 46, John has been unable to work since he became ill. He has also been hospitalized many times. John lives in sheltered accommodation, although he maintains contact with his parents and his older brother.

Perhaps you found yourself asking questions as you read about Monique and John. For example, because Monique doesn’t drink in the mornings, you might have wondered whether she could really have a serious alcohol problem. She does. This is a question that concerns the criteria that must be met before someone receives a particular diagnosis. Or perhaps you wondered whether other people in Monique’s family likewise have drinking problems. They do. This is a question about what we call —that is, whether a disorder runs in families.

You may also have been curious about what is wrong with John and why he is hearing voices. Questions about the age of onset of his symptoms as well as predisposing factors may also have occurred to you. John has schizophrenia, a disorder that often strikes in late adolescence or early adulthood. Also, as John’s case illustrates, it is not unusual for someone who develops schizophrenia to develop perfectly normally before suddenly becoming ill. You can read more about John’s case and treatment in Valmaggia and colleagues ().

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Fergie has spoken about her past struggles with substance abuse, specifically crystal meth.

These cases, which describe real people, give some indication of just how profoundly lives can be derailed because of mental disorders. It is hard to read about difficulties such as these without feeling compassion for the people who are struggling. Still, in addition to compassion, clinicians and researchers who want to help people like Monique and John must have other attributes and skills. If we are to understand mental disorders, we must learn to ask the kinds of questions that will enable us to help the patients and families who have mental disorders. These questions are at the very heart of a research-based approach that looks to use scientific inquiry and careful observation to understand abnormal psychology.

Asking questions is an important aspect of being a psychologist. Psychology is a fascinating field, and abnormal psychology is one of the most interesting areas of psychology (although we are undoubtedly biased). Psychologists are trained to ask questions and to conduct research. Though not all people who are trained in abnormal psychology (this field is sometimes called psychopathology) conduct research, they still rely heavily on their scientific skills and ability both to ask questions and to put information together in coherent and logical ways. For example, when a clinician first sees a new client or patient, he or she asks many questions to try and understand the issues or problems related to that person. The clinician will also rely on current research to choose the most effective treatment. The best treatments of 20, 10, or even 5 years ago are not invariably the best treatments of today. Knowledge accumulates and advances are made. And research is the engine that drives all of these developments.

In this chapter, we will outline the field of abnormal psychology and the varied training and activities of the people who work within its demands. First we describe the ways in which abnormal behavior is defined and classified so that researchers and mental health professionals can communicate with each other about the people they see. Some of the issues here are probably more complex and controversial than you might expect. We also outline basic information about the extent of behavioral abnormalities in the population at large.

You will notice that a large section of this chapter is devoted to research. We make every effort to convey how abnormal behavior is studied. Research is at the heart of progress and knowledge in abnormal psychology. The more you know and understand about how research is conducted, the more educated and aware you will be about what research findings do and do not mean.

What Do We Mean By Abnormality?

It may come as a surprise to you that there is still no universal agreement about what is meant by abnormality or disorder. This is not to say we do not have definitions; we do. However, a truly satisfactory definition will probably always remain elusive (Lilienfeld & Landfield, ; Stein et al., ) even though there is a great deal of general agreement about which conditions are disorders and which are not (Spitzer, ).

Why does the definition of a mental disorder present so many challenges? A major problem is that there is no one behavior that makes someone abnormal. However, there are some clear elements or indicators of abnormality (Lilienfeld & Marino, ; Stein et al., ). No single indicator is sufficient in and of itself to define or determine abnormality. Nonetheless, the more that someone has difficulties in the following areas, the more likely he or she is to have some form of mental disorder.

·  1.  Suffering:  If people suffer or experience psychological pain we are inclined to consider this as indicative of abnormality. Depressed people clearly suffer, as do people with anxiety disorders. But what of the patient who is manic and whose mood is one of elation? He or she may not be suffering. In fact, many such patients dislike taking medications because they do not want to lose their manic “highs.” You may have a test tomorrow and be suffering with worry. But we would hardly label your suffering abnormal. Although suffering is an element of abnormality in many cases, it is neither a sufficient condition (all that is needed) nor even a necessary condition (a feature that all cases of abnormality must show) for us to consider something as abnormal.

·  2.  Maladaptiveness:  Maladaptive behavior is often an indicator of abnormality. The person with anorexia may restrict her intake of food to the point where she becomes so emaciated that she needs to be hospitalized. The person with depression may withdraw from friends and family and may be unable to work for weeks or months. Maladaptive behavior interferes with our well-being and with our ability to enjoy our work and our relationships. However, not all disorders involve mal-adaptive behavior. Consider the con artist and the contract killer, both of whom have antisocial personality disorder. The first may be able glibly to talk people out of their life savings, the second to take someone’s life in return for payment. Is this behavior maladaptive? Not for them, because it is the way in which they make their respective livings. We consider them abnormal, however, because their behavior is maladaptive for and toward society.

·  3.  Statistical Deviancy:  The word abnormal literally means “away from the normal.” But simply considering statistically rare behavior to be abnormal does not provide us with a solution to our problem of defining abnormality. Genius is statistically rare, as is perfect pitch. However, we do not consider people with such uncommon talents to be abnormal in any way. Also, just because something is statistically common doesn’t make it normal. The common cold is certainly very common, but it is regarded as an illness nonetheless.

On the other hand, intellectual disability (which is statistically rare and represents a deviation from normal) is considered to reflect abnormality. This tells us that in defining abnormality we make value judgments. If something is statistically rare and undesirable (as is severely diminished intellectual functioning), we are more likely to consider it abnormal than something that is statistically rare and highly desirable (such as genius) or something that is undesirable but statistically common (such as rudeness).

·  4.  Violation of the Standards of Society:  All cultures have rules. Some of these are formalized as laws. Others form the norms and moral standards that we are taught to follow. Although many social rules are arbitrary to some extent, when people fail to follow the conventional social and moral rules of their cultural group we may consider their behavior abnormal. For example, driving a car or watching television would be considered highly abnormal for the Amish of Pennsylvania. However, both of these activities reflect normal everyday behavior for most other Pennsylvania residents.

Of course, much depends on the magnitude of the violation and on how commonly the rule is violated by others. As illustrated in the example above, a behavior is most likely to be viewed as abnormal when it violates the standards of society and is statistically deviant or rare. In contrast, most of us have parked illegally at some point. This failure to follow the rules is so statistically common that we tend not to think of it as abnormal. Yet when a mother drowns her children there is instant recognition that this is abnormal behavior.

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As with most accomplished athletes, Venus and Serena Williams’ physical ability is abnormal in a literal and statistical sense. Their behavior, however, would not be labeled as being abnormal by psychologists. Why not?

·  5.  Social Discomfort:  When someone violates a social rule, those around him or her may experience a sense of discomfort or unease. Imagine that you are sitting in an almost empty movie theater. There are rows and rows of unoccupied seats. Then someone comes in and sits down right next to you. How do you feel? In a similar vein, how do you feel when someone you met only 4 minutes ago begins to chat about her suicide attempt? Unless you are a therapist working in a crisis intervention center, you would probably consider this an example of abnormal behavior.

·  6.  Irrationality and Unpredictability:  As we have already noted, we expect people to behave in certain ways. Although a little unconventionality may add some spice to life, there is a point at which we are likely to consider a given unorthodox behavior abnormal. If a person sitting next to you suddenly began to scream and yell obscenities at nothing, you would probably regard that behavior as abnormal. It would be unpredictable, and it would make no sense to you. The disordered speech and the disorganized behavior of patients with schizophrenia are often irrational. Such behaviors are also a hallmark of the manic phases of bipolar disorder. Perhaps the most important factor, however, is our evaluation of whether the person can control his or her behavior. Few of us would consider a roommate who began to recite speeches from King Lear to be abnormal if we knew that he was playing Lear in the next campus Shakespeare production—or even if he was a dramatic person given to extravagant outbursts. On the other hand, if we discovered our roommate lying on the floor, flailing wildly, and reciting Shakespeare, we might consider calling for assistance if this was entirely out of character and we knew of no reason why he should be behaving in such a manner.

·  7.  Dangerousness:  It seems quite reasonable to think that someone who is a danger to him- or herself or to another person must be psychologically abnormal. Indeed, therapists are required to hospitalize suicidal clients or contact the police (as well as the person who is the target of the threat) if they have a client who makes an explicit threat to harm another person. But, as with all of the other elements of abnormality, if we rely only on dangerousness as our sole feature of abnormality, we will run into problems. Is a soldier in combat mentally ill? What about someone who is an extremely bad driver? Both of these people may be a danger to others. Yet we would not consider them to be mentally ill. Why not? And why is someone who engages in extreme sports or who has a dangerous hobby (such as free diving, race car driving, or keeping poisonous snakes as pets) not immediately regarded as mentally ill? Just because we may be a danger to ourselves or to others does not mean we are mentally ill. Conversely, we cannot assume that someone diagnosed with a mental disorder must be dangerous. Although mentally ill people do commit serious crimes, serious crimes are also committed every day by people who have no signs of mental disorder. Indeed, research suggests that in people with mental illness, dangerousness is more the exception than it is the rule (Corrigan & Watson, ).

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