003 - chapter 1 - abnormal psychology an overview0001

Abnormal Psychology:

An

Overview

WHAT DO WE MEAN BY ABNORMAL BEHAVIOR?

Why Do We Need to Classify Mental Disorders?What Are the Disadvantages of Classification?The DSM -IV Definition of Mental DisorderHow Does Culture Affect What Is ConsideredAbnormal?Culture-Specific DisordersForming Hypotheses about BehaviorSampling and GeneralizationCriterion and Comparison GroupsStudying the World as It Is: ObservationalResearch DesignsRetrospective versus Prospective StrategiesManipulating Variables: The ExperimentalMethod in Abnormal PsychologyStudying the Efficacy of TherapySingle-Case Experimental DesignsAnimal Research

HOW COMMON ARE MENTAL DISORDERS?

Prevalence and IncidencePrevalence Estimates for Mental DisordersTreatmentThe Mental Health "Team"

RESEARCH APPROACHES IN ABNORMALPSYCHOLOGY

Sources of Information

UNRESOLVED ISSUES:

Are We All Becoming Mentally Ill?

hetopicsand problems central to abnormal psychology surround us every day.You have onlyto pickup a newspaper,read a magazine,watch TV,or go to a movie to be exposed to some of the issues that clinicians andresearchers deal with on a day-to-day basis.Almost weekly, it seems, some celebrityis in the news because of a drug or alcohol problem, aneating disorder,orsome otherpsychological difficulty.Bookstore shelves are lined with personal accounts of struggles with schizophrenia,depression,phobias, and panic attacks. Films suchas

A Beautifu l Mind

por-tray aspects of psychopathology with varying degrees of accuracy. And thenthere are thetragic news stories of mothers who kill their children,where problems with depression,schizophrenia, orpostpartum difficulties seem to beimplicated. Abnormal psychology also exists much closer to home. Walk around any college campus, and you willsee notices about peer support groups for people with eating disorders,depression, and avariety ofother problems.You may even know someone who has experienced a clinicalprob- lem.It may beacousin with a cocaine habit,a roommate with bulimia,or a grandparent who is developing Alzheimer's disease.It may be a co-worker of your mother's who is hospitalizedfor depression,a neighborwhois afraid to leave the house,or someone at your gym who works out intenselywhile looking worrisomely thin.It may even be the disheveled manin the aluminum foil hat who shouts, "Leave me alone!"to voices only he can hear. Theissues ofabnormal psychology capture our interest,demand our attention, and trigger our concern. Theyalsocompelus to ask questions. To illustrate further,let's consider twoclin- icalcases.

Monique is a 24-year-oldlaw schoolstudent.She is attractive, neatly dressed, and clearly very bright.If you were to meet her, you would think that shehadfew problems in her life.But Monique hasbeen drinking alcohol since she was 14, and she smokes marijuana every day. Althoughshe describes herself as "justa socialdrinker," she drinks four or five glasses of wine whenshe goesout with friends and also drinks a couple of glasses ofwine a night when she is alone in her apartment watch- ing TV in the evening. She frequently misses early morn-ing classes because she feels too hungover to get out ofbed, and on several occasions her drinking has causedher to black out.Although she denies having any problems with alcohol, Monique admits that her friends andfamily have started to get very concerned about her andhave suggested that she seek help.Monique, however,says, "Idon't think I am an alcoholicbecause I never drink in the mornings." The previous week she decidedto stop smoking marijuana entirelybecauseshe was concerned that she might have adrug problem. However, she found it impossible to stop and isnow smoking reg- ularlyagain.Donaldis 33 years old.AlthoughDonald is of relatively high intelligence, hehas neverbeen employed for more thana few days at a time, and he currentlylives in a shelteredcommunity setting. Donaldhasbrief but fre- quentperiods when he needs to be hospitalized.His hospitalizations aretriggeredby episodes of great agi- tation duringwhich Donald hears voices.These voices heapinsulting and abusive comments on him. In most socialsituations, Donald appears awkward and painfully unsure of himself,as well asrather socially inappropriate.In his mid-teens Donald began to withdraw sociallyfrom his friends and family.When he was 17, he suddenly, and without any obvious trigger, began to hear voices. Atthat time he was stubbornly insistent that the voices werecoming, with malicious intent, from within a neighbor'shouse and were being transmitted electronically to thespeakers of the family television.More recently he has begunto consider the possibility thathe somehow pro- ducesthemwithin himself.During periods of deteriora- tion,Donaldcan beheard arguing vehemently with the voices.The rest of the timehe appears tobe reasonably

able to ignorethem, although his

voices

are

never

entirelyabsent for sustained periods. Priorto his breakdown, Donald

lived

a relatively normal middle-class life.Hewas reasonably popularamong peersand showed considerable athletic prowess. He earned passing grades in school, although his parents and teachers often complained thathe seemed inatten-

tive

and preoccupied. There was no

evidence

of his everhaving abused drugs.Perhaps you foundyourself asking questionsas you read about Monique and Donald.Forexample,because Monique doesn't drink in the mornings,you might have wondered whether she could really have a serious alcoholproblem.She does. Thisisa question that concerns the cri- teriathatsomeonehastomeet beforegetting a particular diagnosis.Or perhaps youwonderedwhether other people in Monique'sf amily also have drinking problems.Theydo. This is a questionabout whatwecall family aggregation, or whether a disorder runsin families. No doubt you were alsocuriousaboutwhat is wrongwith Donaldand whyhe ishearing voices. Donaldsuffersfrom schizophrenia.Also, as Donald'scaseillustrates, it isnot unusual f orsomeone who develops schizophrenia to beapparentlyperfectly normal before suddenlybecoming ill. These cases give someindication of how profoundly lives can bederailed becauseof mental disorders.Although thenames of thepeoplehavebeenchanged to protect their identities, thesecasesdescribe real peoplewith real problems. It ishard toread about difficultiessuch as these without feel-

Just und er

50

per cent of peoplewill suffer from

a

mental disorder at some point in their lives , with an xietydisord ersbeinges peciall y common.

ing compassion for the people who are struggling.But inaddition to compassion,clinicians andresearcherswho want to help people like Monique and Donald must haveother skills.If weare to understand mental disorders,we must learn to ask the kindsof questions that will enable us to help the patients and the f amilies who suffer from mental disor-ders.These questions areat the veryheartof a research-based approach that look stousescientific inquiryand careful observation to understand abnormal psychology. Asking questionsisan important aspect of beinga psychologist.Psychology isa fascinating field, and (although we are undoubtedly biased)abnormal psychology isoneof themost interesting areasof psychology.Psy- chologistsare trained toask questionsand toconduct research.Though notall peoplewho aretrained in abnormal psychology (sometimes called"psychopathology") conduct research, theystill relyheavily on their scientific skills andabilityboth to ask questions and to putinforma- tion togetherin coherentand logicalways. For example, when aclinician firstsees anew clientor patient,he or she asksalot of questionsto tryand understand theissuesor problems related to that person.Theclinician will also rely on current research tochoosethemost ef fectivetreatment. The"best treatments"of 20,10,or even5 years ago are not invariablythebest treatments of today.Knowledgepro- gresses,andadvances aremade.And research isthe engine that drives all of these developments. In this chapter,wewill outlinethe field of abnormal psychology and the varied training and activities of the people who work in it.First wedescribethe waysin whichabnormal behavior isdefined andclassif ied so that researchers and mental health professionals can communicatewith each otherabout the people theysee.Some of the issueshereare probablymore complexand controversial thanyou might expect.Wealso outline basic informationabout the extentof behavioral abnormalitiesin the populationat large. You will notice that a large sectionof thischapter is devoted to research.We makeeveryeffort to conveyhow abnormal behavior is studied.Research isat theheart of progressand knowledge inabnormal psychology.The moreyou knowand understandabout howresearch is conducted, the more educatedand aware you will beabout what research findingsmeanand what they donot mean. For example,read Developmentsin Research 1.1 bef ore you buy amagnet tohelpyouwitha repetitive-stress injury caused bytypingtoo manyterm papers!

WHAT

Do

WE MEAN ByABNORMAL BEHAVIOR?