THE CONCEPT OF ABNORMALITY AND PSYCHOPATHOLOGY
The concept of abnormality has a long and a changing history; suffice it to say, the biopsychological perspective which is adopted will affect the entire spectrum fromdiagnosis to treatment of the various disorders. Here are the six basic approaches
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A) Statistical deviation
, B). Social norm violation: , C). Maladaptive behavior:
, D.) Personal distress:,E.) Deviation from an ideal , F). Medical disorder
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No one definition is the "correct" or the "best" definition. ..And each definition cancertainly be challenged..
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Psychological Models of Mental Illness
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Basic postulate : mental illness is caused by psychological processes that occur within the individual
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Psychoanalytic model : sees the past and the unconscious as the cause of a disorder;a mental model; uses psychoanalysis (insight therapy) as treatment.
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Behavioral model :
views environment and inappropriate types of reinforcement ascauses of disorders; a mechanistic model; uses behavior modification and other behavioral therapies to change undesired behaviors into acceptable ones; no biologyfactored in.
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Cognitive model :
considers irrational thinking as the cause of abnormal behavior;*catastrophizing* daily problems; uses cognitive talk therapy in conjunction with behavioral modes for treatment.
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Cognitive-Behavioral Learning Models :
Basic postulate
: mental illness is caused by “faulty” cognitive and/or behavioral learning; dysfunctional thoughts and behaviors
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Classifying Psychopathology
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Mental illness is classified today according to the Diagnostic and Statistical Manualof Mental Disorders, Fourth Edition (DSM IV), published by the American PsychiatricAssociation (1994).
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The DSM uses a multiaxial or multidimensional approach to diagnosing becauserarely do other factors in a person's life not impact their mental health. It assesses fivedimensions as described below:
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Axis I: Clinical Syndromes
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This is what we typically think of as the diagnosis (e.g., depression, schizophrenia,social phobia)
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Axis I:
clinical disorders, including major mental disorders, as wellas developmental and learning disorders.
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Axis II: Personality Disorders and Mental Retardation
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Personality disorders are clinical syndromes which have more long lastingsymptoms and encompass the individual's way of interacting with the world. Theyinclude Paranoid, Antisocial, and Borderline Personality Disorders.
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Axis III: Physical Conditions
which play a role in the development, continuance,or exacerbation of Axis I and II Disorders
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Physical conditions such as brain injury or HIV/AIDS that can result in symptomsof mental illness are included here.
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Axis IV: Severity of Psychosocial Stressors
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Events in a persons life, such as death of a loved one, starting a new job, college,unemployment, and even marriage can impact the disorders listed in Axis I and II.These events are both listed and rated for this axis.
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Axis V: Highest Level of Functioning
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On the final axis, the clinician rates the person's level of functioning both at the present time and the highest level within the previous year. This helps the clinicianunderstand how the above four axes are affecting the person and what type of changescould be expected.
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Psychiatric Disorders (AXIS-1)
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AXIS(I) : 1.Delirium, Dementia, Amnestic, and Other Cognitive Disorders
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The primary symptoms of these disorders include significant negative changes inthe way a person thinks and/or remembers. All of these disorders have either a medicalor substance related cause
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2. Mental Disorders Due to a Medical Condition
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Like those above, all disorders in this category are directly related to a medicalcondition. If symptoms of anxiety, depression, etc are a direct result of a medicalcondition, this is the classification used.
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3. Substance Related Disorders
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There are two disorders listed in this category: Substance Abuse and SubstanceDependence. Both involve the ingestion of a substance (alcohol, drug, chemical)which alters either cognitions, emotions, or behavior.
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Abuse
refers to the use of the substance to the point that it has a negative impact onthe person's life. This can mean receiving a fine for drinking and driving, beingarrested for public intoxication, missing work or school, getting into fights, or struggling with relationships because of the substance.
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Dependence
refers to what we typically think of as 'addicted.' This occurs when(a) the use of the substance is increased in order to get the same effect because the person has developed a tolerance, (b) the substance is taken more frequently and inmore dangerous situations such as drinking and driving, or (c) the person continues totake the substance despite negative results and/or the desire to quit, or (d) withdrawalsymptoms are present when the substance is stopped, such as delirium tremors (DTs),amnesia, anxiety, headaches, etc.
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Mood Disorders:
The disorders in this category include those where the primarysymptom is a disturbance in mood. The disorders include Major Depression,Dysthymic Disorder, Bipolar Disorder, and Cyclothymia.
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MAJOR DEPRESSION
: (also known as depression or clinical depression) ischaracterized by depressed mood, diminished interest in activities previously enjoyed,weight disturbance, sleep disturbance, loss of energy, difficulty concentrating, andoften includes feelings of hopelessness and thoughts of suicide.
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Dysthymia:is often considered a lesser, but more persistent form of depression.Many of the symptoms are similar except to a lesser degree. Also, dysthymia, asopposed to Major Depression is more steady rather than periods of normal feelings andextreme lows.
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(previously known as Manic-Depression) is characterized by periods of extreme highs (called mania) and extreme lows as in Major Depression.Bipolar Disorder is subtype either I (extreme or hypermanic episodes) or II (moderateor hypomanic episodes).
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Like Dysthymia and Major Depression, Cyclothymia is considered a lesser form of Bipolar Disorder.
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Schizophrenia and Other Psychotic Disorders
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The major symptom of these disorders is psychosis, or delusions andhallucinations. The major disorders include schizophrenia and schizoaffectivedisorder.
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is probably the most recognized term in the study of psychopathology, and it is probably the most misunderstood.
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First of all, it does not mean that the person has multiple personalities. The prefix'schiz' does mean split, but it refers to a splitting from reality.
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The predominant features of schizophrenia includehallucinationsanddelusions
and disorganized speech and behavior, inappropriate affect,Schizoaffective Disorder ischaracterized by a combination of the psychotic symptoms such as in Schizophreniaand the mood symptoms common in Major Depression and/or Bipolar Disorder. Thesymptoms are typically not as severe although when combined together in thisdisorder, they can be quite debilitating as well.
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Diagnostic Criteria
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Characteristic symptoms:
Two (or more) of the following, each present for asignificant portion of time during a 1-month period (or less if successfully treated):
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Delusions, hallucinations, disorganized speech (e.g., frequent derailment or incoherence), grossly disorganized or catatonic behaviour, negative symptoms (i.e.,affective flattening,),
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Types of Schizophrenic Symptoms:
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Positive symptoms:
active symptoms like hallucinations, delusions, incoherentspeech, disorganized thinking. responds better to medications
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Negative symptoms:
Lacks appropriate emotional experience, inappropriate, blunted/flat affect, Avolition: lacks volition and motivation to do things, Alogia: poverty of speech.
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