Abnormal psychology

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Abnormal psychology in clinical psychology studies the nature of psychopathology and mental disorders, their classification,diagnosis, development, cause, treatment and prevention.

It is the branch of psychology that studies unusual patterns of behavior, emotion and thought, which causes significant distress to the subject or to others and which may, or may not, be understood as diagnosable as a mental disorder. The field includes the diagnosis, treatment, and prevention of mental disorders.

There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant (statistically, morally or in some other sense), and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind body problem, as well as different approaches to the classification of mental disorders.

Clinical psychology is the applied field of psychology that seeks to assess, understand and treat psychological conditions in clinical practice. The theoretical field known as "abnormal psychology" may form a backdrop to such work, but clinical psychologists are nowadays unlikely to use the term "abnormal" in reference to their practice. Psychopathology is a similar term to abnormal psychology but has more of an implication of an underlying pathology (disease process), and as such is a term more commonly used in the medical specialty known as psychiatry.

History

People have tried to explain and control abnormal behavior for thousands of years. Historically, there have been three main approaches to abnormal behavior: the supernatural, biological, and psychological traditions. (See Biopsychiatry controversy.)

In the supernatural tradition, abnormal behaviors are attributed to agents outside human bodies. According to this model, abnormal behaviors are caused by demons, spirits, or the influences of moon, planets, and stars. During the Stone Age, trephining was performed on those who had mental illness to literally cut the evil spirits out of the victim's head. Conversely, Ancient Chinese, Ancient Egyptians, and Hebrews, believed that these were evil demons or spirits and advocated exorcism. By the time of the Greeks and Romans, mental illnesses were thought to be caused by an imbalance of the four humors, leading to draining of fluids from the brain. During the Dark Ages, many Europeans believed that the power of witches, demons, and spirits caused abnormal behaviors. People with psychological disorders were thought to be possessed by evil spirits that had to be exorcised through religious rituals. If exorcism failed, some authorities advocated steps such as confinement, beating, and other types of torture to make the body uninhabitable by witches, demons, and spirits. The belief that witches, demons, and spirits are responsible for the abnormal behavior continued into the 15th century. Swiss alchemist, astrologer, and physician Paracelsus (1493–1541), on the other hand, rejected the idea that abnormal behaviors were caused by witches, demons, and spirits and suggested that people's mind and behaviors were influenced by the movements of the moon and stars.

This tradition is still alive today. Some people, especially in the developing countries and some followers of religious sects in the developed countries, continue to believe that supernatural powers influence human behaviors. In Western academia, the supernatural tradition has been largely replaced by the biological and psychological traditions.

In the biological tradition, psychological disorders are attributed to biological causes and in the psychological tradition, disorders are attributed to faulty psychological development and to social context.

The Greek physician Hippocrates, who is considered to be the father of Western medicine, played a major role in the biological tradition. Hippocrates and his associates wrote the Hippocratic Corpus between 450 and 350 BC, in which they suggested that abnormal behaviors can be treated like any other disease. Hippocrates viewed the brain as the seat of consciousness, emotion, intelligence, and wisdom and believed that disorders involving these functions would logically be located in the brain.

These ideas of Hippocrates and his associates were later adopted by Galen, the Roman physician. Galen extended these ideas and developed a powerful and influential school of thought within the biological tradition that extended well into the 18th century.

Explaining abnormal behavior

Cultural and historical variations

Throughout time, societies have proposed several explanations of abnormal behavior within human beings. Beginning in some hunter-gatherer societies, animists have believed that people demonstrating abnormal behavior are possessed by malevolent spirits. This idea has been associated with trepanation, the practice of cutting a hole into the individual's skull in order to release the malevolent spirits.

A more formalized response to spiritual beliefs about abnormality is the practice of exorcism. Performed by religious authorities, exorcism is thought of as another way to release evil spirits who cause pathological behavior within the person. In some instances, individuals exhibiting unusual thoughts or behaviors have been exiled from society or worse. Perceived witchcraft, for example, has been punished by death. Two Catholic Inquisitors wrote the Malleus Maleficarum (Latin for "The Hammer Against Witches"), that was used by many Inquisitors and witch-hunters. It contained an early taxonomy of perceived deviant behavior and proposed guidelines for prosecuting deviant individuals.

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.

Multiple causality

The number of different theoretical perspectives in the field of psychological abnormality has made it difficult to properly explain psychopathology. The attempt to explain all mental disorders with the same theory leads to reductionism (explaining a disorder or other complex phenomena using only a single idea or perspective). Most mental disorders are composed of several factors, which is why one must take into account several theoretical perspectives when attempting to diagnose or explain a particular behavioral abnormality or mental disorder. Explaining mental disorders with a combination of theoretical perspectives is known as multiple causality.

The diathesis–stress model emphasizes the importance of applying multiple causality to psychopathology by stressing that disorders are caused by both precipitating causes and predisposing causes. A precipitating cause is an immediate trigger that instigates a person's action or behavior. A predisposing cause is an underlying factor that interacts with the immediate factors to result in a disorder. Both causes play a key role in the development of a psychological disorder.

Mind and body

Abnormal psychology revolves around two major paradigms for explaining mental disorders, the psychological paradigm and the biological paradigm. The psychological paradigm focuses more on the humanistic, cognitive and behavioral causes and effects of psychopathology. The biological paradigm includes the theories that emphasize more on physical factors, such as genetics and neurochemistry.

Recent concepts of abnormality

• Statistical abnormality -when a certain behavior/characteristic is relevant to a low percentage of the population. However, this does not necessarily mean that such individuals are suffering from mental illness (for example, statistical abnormalities such as extreme wealth/attractiveness)
• Psychometric abnormality -when a certain behavior/characteristic differs from the population's normal dispersion e.g. having an IQ of 35 could be classified as abnormal, as the population average is 100. However, this does not specify a particular mental illness.
• Deviant behavior - this is not always a sign of mental illness, as mental illness can occur without deviant behavior, and such behavior may occur in the absence of mental illness.
• Combinations - including distress, dysfunction, distorted psychological processes, inappropriate responses in given situations and causing/risking harm to oneself.

Approaches

• Somatogenic - abnormality is seen as a result of biological disorders in the brain. However, this approach has led to the development of radical biological treatments, e.g. lobotomy.
• Psychogenic - abnormality is caused by psychological problems. Psychoanalytic (Freud), cathartic, hypnotic and humanistic psychology (Carl Rogers, Abraham Maslow) treatments were all derived from this paradigm. This approach has, as well, led to some esoteric treatments: Franz Mesmer used to place his patients in a darkened room with music playing, then enter it wearing a flamboyant outfit and poke the "infected" body areas with a stick.

Classification

DSM-IV TR

The standard abnormal psychology and psychiatry reference book in North America is the Diagnostic and Statistical Manual of the American Psychiatric Association. The current version of the book is known as DSM IV-TR. It lists a set of disorders and provides detailed descriptions on what constitutes a disorder such as Major Depressive Disorder or anxiety disorder. It also gives general descriptions of how frequent the disorder occurs in the general population, whether it is more common in males or females and other such facts. The diagnostic process uses five dimensions called "axes" to ascertain symptoms and overall functioning of the individual. These axes are as follows

• 'Axis I - Symptom Disorders
• 'Axis II - Personality Disorders
• 'Axis III - General medical conditions
• 'Axis IV - Psychosocial/environmental problems
• 'Axis V - Global assessment of functioning (often referred to as GAF)

ICD-10

The major international nosologic system for the classification of mental disorders can be found in the most recent version of the International Classification of Diseases, 10th revision (ICD-10). The ICD-10 has been used by World Health Organization (WHO) Member States since 1994. Chapter five covers some 300 mental and behavioral disorders. The ICD-10's chapter five has been influenced by APA's DSM-IV and there is a great deal of concordance between the two. WHO maintains free access to the ICD-10 Online. Below are the main categories of disorders:

• F00–F09 Organic, including symptomatic, mental disorders
• F10–F19 Mental and behavioral disorders due to psychoactive substance use
• F20–F29 Schizophrenia, schizotypal and delusional disorders
• F30–F39 Mood [affective] disorders
• F40–F48 Neurotic, stress-related and somatoform disorders
• F50–F59 Behavioral syndromes associated with physiological disturbances and physical factors
• F60–F69 Disorders of adult personality and behavior
• F70–F79 Mental retardation
• F80–F89 Disorders of psychological development
• F90–F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
• F99 Unspecified mental disorders

Etiology

Genetics

• Investigated through family studies, mainly of monozygotic (identical) and dizygotic (fraternal) twins, often in the context of adoption.
• These studies allow calculation of a heritability coefficient.

Biological causal factors

• Neurotransmitter [imbalances of neurotransmitters like (1) Norepinephrine (2) Dopamine (3) Serotonin and (4) GABA (Gamma aminobutryic acid)] and hormonal imbalances in the brain
• Genetic vulnerabilities
• Constitutional liabilities [physical handicaps and temperament]
• Brain dysfunction and neural plasticity
• Physical deprivation or disruption [deprivation of basic physiological needs]

Socio-cultural factors

• Effects of urban/rural dwelling, gender and minority status on state of mind
• British Psychiatric Morbidity Survey conducted by Jenkins (1998)

Systemic factors

• Family systems
• Negatively Expressed Emotion playing a part in schizophrenic relapse and anorexia nervosa.

Biopsychosocial factors

• Holistic causal model
• Illness dependent on stress "triggers".

Therapies

• Psychoanalysis (Freud)
• Behavioral therapy (Wolpe) based on behaviorism, and involving classical and operant conditioning.
• Humanistic therapy aiming to achieve self-actualization (Carl Rogers, 1961)
• Cognitive Behavioural Therapy aims to influence thought and cognition (Beck, 1977).

See also

• Abuse
• Cognitive Behavioral Therapy
• DSM-IV Codes
• International Classification of Diseases
• Insanity defense
• Mental Health Act 1983
• Mental Health Act 2007
• Mental Health Alliance
• M'Naghten Rules
• Models of abnormality
• Outline of psychology
• Parapsychology
• Postmodern therapy
• Structured Clinical Interview for DSM-IV (SCID)
• Seasonal Affective Disorder
• Zero stroke

Key texts

Books

• Bennett, Paul (2003). Abnormal and Clinical Psychology.
• Hansell, James; Lisa Damour (2005). Abnormal Psychology, Von Hoffman Press.
• Barlow, David H.; Vincent Mark Durand (2004). Abnormal Psychology: An Integrative Approach, Thomson Wadsworth.

External links

• Abnormal Psychology Students Practice Resources
• Science Direct
• Psychology Terms
• A Course in Abnormal Psychology