People with psychological disorders are not:
Lazy and should just pull themselves together
-Weak in character
-Dangerous to self and others
-Hopeless and impossible to help
Facts about Psychological Disorders
Most psychological disorders are not flamboyant
You can't necessarily tell someone has a disorder
Many people suffer in private with their problems, although friends and families may realise something is wrong
Psychological treatment can make a real difference to these people
To know what is "abnormal", we have to agree on what is "normal"
We need to be able to reliably tell who has a disorder and needs treatment
Defining Abnormal; Deviation from the norm:
Characteristics of majority, "normal"
.Any deviation from the norm, "abnormal"
.But lots of characteristics are rare, not "average"
.Very talented people, highly intelligent
.Wouldn't treat these to make them "average"
Defining Abnormal; Culturally unacceptable:
Some deviations are acceptable, others are not
.Definitions of "abnormal" are influenced by culture
.Until 1973, homosexuality was classed as a psychological disorder
.Wouldn't treat people simply because they are socially unacceptable
Causes distress or impairment:
Perhaps distress/dysfunction determines disorder?
-But distress is often a part of everyday life
-Bereavement or trauma
-Being distressed is normal
-In some disorders, the "sufferer" is not distressed
Problems in classifying behavior as "abnormal", The myth of mental illness (Szasz, 1960):
-mental illness "is a myth, whose function it is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations"
Problems in classifying behavior as "abnormal", Labelling sane as insane (Rosenhan, 1973):
8 well-adjusted people acted as patients
-Presented for admission at psychiatric hospitals
-Reported they were hearing noises/voices, otherwise told truth about themselves
-All but 1 diagnosed as schizophrenic, hospitalised, prescribed medication
-Psychiatric staff interpreted their behaviour as insane
Problems in classifying behavior as "abnormal"; Stigma of "mentally ill" label (Lamy, 1966):
College students asked to decide whether they would prefer to employ:
a)an ex-convict with an offence, or
b)a psychiatric patient who was hospitalised for 30 different jobs
-Ex-convict chosen over psychiatric patient as more reliable
-Ex-convict considered preferable to mind a child
3 Aims of Psychopathology
To describe abnormal behaviour
-To explain what causes abnormal behaviour
-To treat abnormal behaviour
First task is to describe the nature of psychological disorders
Hard to explain cause or effectively treat without a clear description of disorder
Need to agree on the signs and symptoms that characterise (diagnose) specific disorders
Kraepelin (1856-1926) first to classify types of mental disorders based on systematic empirical observations
Before then, little agreement on what constitutes mental illness:
-„Mad. vs. each symptom = separate disorder
Kraeplin offered diagnostic categories defined by
common patterns of symptoms
Kraepelin.s system and current diagnostic systems
imply that mental disorders are separate entities:
You have a disorder OR you do not
This is often the case in medicine
But is it the case in psychopathology?
This is where a dimension becomes a category
Most psychological disorders are extreme versions of normal behaviour:
We all feel anxious and depressed some times
Clinical anxiety differs from normal anxiety in severity, duration, impairment NOT quality
But it is important to draw the line somewhere
Diagnostic and Statistical Manual of Mental Disorders (DSM)
One major system used by psychologists:
Draws the line between normal and abnormal feelings and behaviours
Focuses on signs and symptoms of mental disorders
Diagnosis and the DSM
First published by American Psychiatric Association in 1952
5 revisions reflecting time & culture:
DSM-II (1968), DSM-III (1980), DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000)
Categorical disorders diagnosed by set lists of signs and symptoms
Uses a multiaxial approach
Wider clinical assessment of overall functioning on Axes III-V:
Medical, social, family, economic problems
Diagnostic information on Axes I-II:
Presently known psychiatric disorders
DSM designed to
provide complete picture of client
most major disorders
stable, enduring problems (e.g., personality disorders, mental retardation)
medical conditions relevant to each disorder
psychosocial and environmental factors including specific sources (e.g., stress)
global assessment of current functioning
Diagnostic Criteria: Bulimia Nervosa (a) (1)
eating, in a discreet period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
Diagnostic Criteria: Bulimia Nervosa (a)(2)
a sense of lack of control over eating during the episode (e.g., a feeling that one can not stop eating or control what or how much one is eating).
Diagnostic Criteria: Bulimia Nervosa (B)
Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
Diagnostic Criteria: Bulimia Nervosa (a)
Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:
Diagnostic Criteria: Bulimia Nervosa (C)
The binge eating and inappropriate compensatory behaviours occur, on average, at least twice a week for 3 months.
Diagnostic Criteria: Bulimia Nervosa (D)
Self-evaluation is unduly influenced by body shape and weight.
Diagnostic Criteria: Bulimia Nervosa (E)
The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Bulimia Nervosa Purging Type:
during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Bulimia Nervosa Non-purging Type:
during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviours, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Examples of DSM-V revisions
Clinical characteristics of individuals reporting a frequency of once/week were similar to those meeting the current criterion.
Therefore, the required minimum frequency will be reduced to once/week.
Examples of DSM-V revisions subtype
A literature review indicated that the non-purging subtype had received relatively little attention, and that these individuals more closely resemble individuals with Binge Eating Disorder. In addition, how to define non-purging inappropriate behaviors (e.g., fasting or excessive exercise) is unclear.
Deletion of this subtype is recommended.
Structured diagnostic interviews
Reports by significant others
is hard to define; does not have one necessary or sufficient characteristic
is the empirical study of description, causes and treatment of abnormal psychology
Psychologists describe disorders in terms of
signs & symptoms
is the clinical psychologist.s main diagnostic system
Value of assessment:
reliability, validity, standardisation
Do we all agree?
Just because we all agree, does not mean that we are right!
What is normal?