Abnormal Psychology
References: Barlow & Kring
Psychopathology
 Study of the nature,
symptomatology, development, and
treatment of psychological disorders
 Challenges to the study of
psychopathology:
o Maintaining objectivity
o Avoiding preconceived
notions
o Reducing stigma
Psychological Dysfunction
 Breakdown in cognitive, emotional.
Or behavioral functioning
 Internal mechanism is unable to
perform its usual function
Personal Distress
 A person’s behavior may be
classified as disordered if it causes
him or great distress.
Disability
 Impairment in some important area
of life (e.g., work or personal
relationships) – can also
characterize mental disorder.
 Impairment is set in the context of a
person’s background
The Diagnostic and Statistical Manual
(DSM)
 Widely Accepted System
o Used to classify
psychological problems and
disorders
DSM Contains Diagnostic Criteria for
Behaviors That
 Fit a pattern
 Cause dysfunction or subjective
distress
 Are present for a specified duration
 And for behaviors that are not
otherwise explainable
Basics of the DSM
 DSM-5 has better reliability than
DSM-IV
 Research to validate diagnoses
continues
 Symptoms assigned to one disorder
may occur in many other disorders
 While the DSM-5 preserves a
categorical approach to diagnosis, it
also accommodates dimensional
approaches to mental disorders.
 DSM-5 provides explicit diagnostic
criteria for each mental disorder,
supplemented by dimensional
measure when appropriate.
 Many mental disorders are on a
spectrum with related disorder that
have shared symptoms.
 Disorders categories in earlier DSMs
were overly narrow, resulting in the
widespread of Not Otherwise
Specified (NOS) diagnoses
  DSM-5 removes the NOS diagnosis.
It adds
o Other Specified Disorder
o Unspecified Disorder
Example: Suppose a client has significant
depressive symptoms but does not meet all
the criteria for a major depressive episode.
The diagnosis would be “Other specified
depressive disorder, depressive episode
with insufficient symptoms.”
Two Clusters of Disorders
 Internalizing group
Disorders with prominent
anxiety, depressive, and
somatic symptoms
 Externalizing group
Disorders with prominent
impulsive, disruptive conduct,
and substance use
symptoms
Disorders within these clusters are adjacent
in the DSM-5.
Organization of Disorders
 Disorders are organized on
developmental and lifespan
considerations.
 DSM_5 begins with diagnoses that
manifest early in life, then
adolescence and young adulthood,
then adulthood and later life.
Cultural Issues
 Culture shapes the experience and
expression of the symptoms, signs,
and behaviors that are criteria for
diagnosis.
 Section III contains a Cultural
Formulation
 The Appendix contains a Glossary of
Cultural Concepts of Distress.
o Provides a description of
some common cultural
syndromes, idioms of
distress, and causal
explanations relevant to
clinical practice.
DSM-5 is Non-Axial
 DSM-IV axes I, II, and III have been
combined.
 Continue to list relevant medical
conditions,
 The GAF in DSM_IV has been
eliminated. Instead, use the World
Health Organization Disability
Assessment Schedule (WHODAS).
 The WHODAS-2.0 is on page 747 of
the DSM-5 and is also available
online.
Section I: Basics: Use of the Manual
 Clinical Case Formulation
o Making diagnoses requires
clinical judgement not just
checking off the symptoms in
the criteria,
o The client’s cultural and
social context must be
considered.
o The DSM-5 does not include
all possible mental disorders.
 The diagnosis of a mental disorder
should have clinical utility; it should
help clinicians to determine
prognosis and treatment plans.
 The diagnosis of a mental disorder is
not equivalent to a need for
treatment.
o symptom severity
o symptom salience
o Patient’s distress
o Disability
 o Risks and benefits of
available treatments
 The etiology of most mental
disorders is unknown.
 The pathological physiological
mechanisms for most mental
disorders are unknown.
 Until such factors are identified, it
will be difficult to fully validate
specific disorders.
 In the absence of clear biological
markers for mental disorders, it has
not been possible to completely
separate normal and pathological
symptom expressions contained in
diagnostic criteria.
 Therefore, a generic diagnostic
criterion is “the disturbance
causes clinically significant
distress or impairment…”.
Elements of a Diagnosis
Diagnostic Criteria and Descriptors
 Diagnostic criteria are offered as
guidelines for making diagnoses,
and their use should be informed by
clinical judgement.
 Diagnostic Descriptors- can help
support diagnosis (e.g. providing
differential diagnoses; describing the
criteria more fully under “Diagnostic
Features”).
Subtypes and Specifiers
 Subtypes- define mutually exclusive
and jointly exhaustive
phenomenological subgroupings
within a diagnosis and are indicated
by the instructions “Specify whether”
 Specifiers- are not intended to be
mutually exclusive or jointly
exhaustive, and as a consequence,
more than one specifier may be
given. It tells us about the course,
severity and descriptive features
Specifiers are indicated by the
instruction “Specify” or “Specify if”.
Principal and Reason for Visit
 When more than one diagnosis for
an individual is given in an inpatient
setting, the principal diagnosis is
the condition established after study
to be chiefly responsible for
occasioning the admission of the
individual.
 When more than one diagnosis is
given for an individual in an
outpatient setting, the reason for visit
is the condition that is chiefly
responsible for the ambulatory care
medical services received during the
visit.
Provisional Diagnosis
 The specifier “provisional” can be
used when there is a strong
presumption that the full criteria
will ultimately be met for a
disorder but not enough
information is available to make
a firm diagnosis.
Clinical Description, Etiology, Treatment,
and Outcome in Psychopathology
Clinical Description
 Presents- what is the presenting
problem of the client?
 Prevalence- how many people
in the population as a whole
have the disorder?
 Incidence- how many new
cases occur during a given
period, such as a year?
 Onset- how’s the beginning of
the disorder
o Acute onset- they
beging suddenly
o Insidious onset- develop
gradually
 Course- disorders follow a
somewhat individual pattern
o Chronic course- they
tend to last a long time
o Episodic course- likely
to recover and to suffer a
recurrence
 o Time-limited course- will
improve without
treatment in a relatively
short period
Steps in Making a Diagnosis
 Administer cross-cutting
assessments
 Administer WHODAS 2.0
 Conduct clinical interview
 Determine whether a diagnostic
threshold is met
 Consider subtypes and/or specifiers
 Consider contextual information,
disorder text, distress, clinician
judgement
 Apply codes and develop a
treatment plant
DSM-5: The Current Edition –
Controversy Surrounding DSM-5
 Many “work group” members quit
midway
 Leaders of mental health
organizations boycotted DSM-5
 Most vocal critic was Allen Frances
 Allen Frances’ criticism
o Changes unsafe and
scientifically unsound
o Medical illnesses diagnosed
as somatic symptom disorder
o DSM-5 will mislabel normal
people, promote diagnostic
inflation, encourage
inappropriate medication use
 Specific criticism by others
o Field trial problems
o Price
Criticisms of the DSM
 Recent editions of DSM widely used
by all mental health professions
 Strengths:
o Emphasis on empirical
research
o Use of explicit diagnostic
criteria
o Inter-clinician reliability
o Atheoretical language
o Facilitated communication
between researchers and
clinicians
 Breadth of coverage
 Controversial cutoffs
 Cultural issues
 Gender bias
 Non-empirical influences
 Limitations on objectivity
Approaches to the Scientific Study of
Psychological Disorders
 Mental Health Professionals
o The Ph.D.’s: Clinical and
counselling pscyhologists
o The Psy.D.’s: Clinical and
counselling “Doctors of
Psychology”
o The RPsy’s Registered
Psychologists
o M.D.’s: Psychiatrists
o M.S.W.’s: Psychiatric and
non-psychiatric sowial
workers
o MN/MSN’s: Psychiatric
nurses
o The lay pubic and
community groups
 United by the Scientist-
Practictioner Framework
History of Psychopathology
o Before the Age of Scientific Inquiry
o The Evolution of Contemporary
Thought
o Early Foundations on
Biological Approaches,
Genetic and Biological
treatments
o Psychological Approaches
Demonology
o The doctrine that an evil being or
spirit can dwell within a person and
control his or her mind and body
thereby can be treated by Exorcism
the ritualistic casting out of evil
spirits.
o Trephination- cutting holes to the
skull in the belief that evil spirits may
come out
o Hydrotherapy- patients were
shocked back to their senses by
being submerged in iced-cold water.
Early Biological Explanations
o Hippocrates (5th Cetury BC)
o Mental disturbances have
natural (not supernatural)
causes
 Four humors:
 Blood- sanguine
 Black bile-
melancholia
 yellow bile-choleric
 phlegm- phlegmatic
o Three categories: mania,
melancholia, and phrenitis
Dark Ages
o Church gained in influence, and the
papacy was declared independent of
the state. Christian monasteries,
through their missionary and
educational work, replaced
physicians as healers and as
authorities on mental disorders
o Monks cared and prayed for
mentally ill; concocted potions
o The Persecution of the Witches
(Beginning 13th Century)
o Witchcraft, was viewed as
instigated by satan, was
seen as a heresy and a
denial of God.
o Those accused of witchcraft
should be tortured
o Historians concluded many of
the accused were mentally
ill.
o Mass Hysteria
o Characterized by large-scale
outbreaks of bizarre
behavior.
o In Europe, whole groups of
people were simultaneously
compelled to run out in the
streets, dance, shout, rave,
and jump around in patterns
as if they were at a particular
wild party late at night (still
called a rave), but without the
music.
o The behavior was known by
several names including
Saint Vitus’s Dance and
tarantism.
Renaissance and the Rise of Asylums
o Characterized as a time of extreme
cultural and scientific growth, and a
decline of religious influence.
o Rise of Asylums and specializations
in mental health care.
o Johann Weyer- the first physician
to specialize in illnesses of the mind.
o Gheel Belgium- First religious
mental health facility
o Bethlehem Hospital, Spain- First
medical mental Asylum
o Asylum
o Establishments for the
confinement and are of
mentally ill
o Priory of St. Mary of
Bethlehem (1243)
 One of the first mental
institutions
  Origin of the term
bedlan
 Eventually became
one of London’s great
tourist attractions
o St. Mary of Bethlehem
 Treatment non-
existent or harmful at Dorothea Dix (1802-1887)
asylum
 Early medical
treatment could be
harmful
 Benjamin Rush
recommended
drawing copious
amounts of blood and
believed that they
could be cured by
being frightened.
Early Foundations: Biological
The Nineteenth Century: Reform and Approaches
Moral Treatment
o Philippe Pinel and Jean-Baptiste
Pussin (18th-19th Century)
o Pioneered humanitarian
treatment at LaBicetre
o Pinel is said to have begun to
treat the patients as sick
human beings rather than as
beasts
o He unchained the patients
and allowed them to move
freely about the hospital
grounds
o Moral Treatment
o Small privately funded,
humanitarian mental
hospitals
 Friends Asylum
(1817) and Hartfort
Retreat (1824) Early Foundations: Genetics
 Patients engaged in
purposeful, calming
activities (e.g.
gardening)
 Talked with
attendants
o William Tuke (1732-1819) was
bringing similar reforms to northern
England.
o In 1796 he founded the York
Retreat, a rural estate where about
30 mental patients lived as guests
and in quiet country houses and
were treated with a combination of
rest, talk, prayer, and manual work
o Crusader for prisoners and mentally
ill
o Urged improvement of institutions
o Worked to establish 32 new, public
hospitals
o Unfortunately, the small staffs of
these new hospitals were unable to
provide the individual attention
o Known as mental hygiene
movement.
o Mid-1800s not enough information is
known about the biological basis of
mental illness
o Louis Pasteur (1860s) established
the germ theory of disease, which
set forth the view that disease is
caused by infection of the body by
minute organisms
General paresis
o Degenerative disorder with
psychological symptoms and
individuals with GP also have
syphilis
o 1905 discovery of microorganism
that causes syphilis
o Since general paresis had
biological cause, other mental
illness might also.
o Galton’s work (late 1800s) lead to
notion that mental illness can be
inherited
Behavioral genetics
o Extent to which behavioral
differences are due to genetics
Eugenics
 o Promotion of enforces sterilization to
eliminate undesirable characteristics
from the population
o Many state law (late 1800s and early
1900s) prohibited marriage and
required mentally ill to be sterilized
o Such laws were upheld by the U.S.
Supreme Court in 1972
o By 1945, more than 45,000 people
with mental illness in the USA had
been forcibly sterilized
Early Foundations: Emil Kraepelin (1856-
1926)
o Pioneered classification of mental
illness based on biological causes
o Published 1st psychiatry text (1883)
o Mental illness as syndrome
o Cluster of symptoms that co-
occur
o Proposed two major syndromes
o Dementia praecox
o Manic-depressive psychosis
Early Foundations: Psychological
Approaches
o Mesmer (1734-1815)
o Treated patients with
hysteria using “animal
magnetism”
o Early practitioner of hypnosis
called mesmerism
o Jean Martin Charcot (1825-1893)
o Hysteric symptoms could be
removed through hypnosis
o It’s a problem with the
nervous system and had a
biological cause, he was also
persuaded by psychological
explanations.
o Josef Breuer (1842-1925)
o Used hypnosis to facilitate
catharsis, the case of Anna
O.
o Catharsis
-Release of emotional
tension triggered by relieving
and talking about event
o In 1895, Breuer and a
younger colleague, Sigmund
Freud (1856-1939), jointly
published Studies in
Hysteria, partly based on the
case of Anna O.
Early Foundations: Freud and
Psychoanalysis (1856-1939)
o Psychoanalytic Theory
- Human behavior
determined by unconscious
forces.
- Psychopathology results
from conflicts among these
unconscious forces
“I received the proudest impression, of the
possibility that there could be powerful mental
processes which nevertheless remained hidden
from the consciousness of men” – Freud wrote
of his experience with Charcot.
Overview of Freud’s Psychoanalytic
theory
o The structure of the Mind
o The Structure of Personality
o Theory of Psychosexual
Stages Development
o Defense Mechanisms
o Techniques of
Psychoanalysis
Neo-Freudians
Jung (1875-1961)
o Broke with Freud in 1914
o Analytical Psychology
o Hypothesized that in addition
to the personal unconscious
postulated by Freud, there is
a collective unconscious
o Also catalogued various
personality characteristics
Adler (1870-1973)
o Individual Psychology
o Regarded people as
inextricably tied to their
 society because he believed
that fulfillment was found in
doing things for the social
good.
o Focused on feelings of inferiority and
the striving for superiority
o Created the term inferiority complex
Other Psychoanalytic Theories
Karen Horney (1885-1952) and Erich
Fromm (1900-1980)
o Others took psychoanalytical
theorizing in different directions,
emphasizing development over the
life span and the influence of culture
and society on personality.
Erik Erikson (1902-1994)
o theory of development across the life
span (Psychosocial Development)
Watson and the Rise of Behaviorism
John Watson (1878-1958)
Behaviorism
o Revolutionized psychology in 1913
o Strongly influenced by the work of
Pavlov
o Emphasis on learning rather than
innate tendencies
o Focus on observable behavior
o He and a student, Rosalie Rayner
experiment on “Little Albert” (1920)
Mary Cover Jones (1896-1987)
o was one of the first psychologists to
use behavioral techniques to free a
patient from phobia
o individuals were gradually
introduced to the objects or
situations they feared so that their
fear could extinguish (Case of Little
Peter)
The Beginnings of Behavior Theraphy
Joseph Wolpe (1915-1997)
o His best-known technique was
termed systematic desensitization.
o In principle, it was similar to
the treatment of Little Peter
o Wolpe added another
element by having his
patients do something that
was incompatible with fear
while they were in the
presence of the dreaded
object or situation.
B.F Skinner and Operant Conditioning
E. Thorndike (1874-1949)
-Learning through consequences
- Law of Effect
B.F Skinner (1904-1990)
- Principle of Reinforcement
o Positive reinforcement
-Behaviors followed by
pleasant stimuli are
strengthened.
o Negative Reinforcement
-Behaviors that terminate a
negative stimulus are
strengthened.
Modelling
-Learning by imitating other’s behavior
o Can occur without
reinforcement
-Bandura & Menlove (1968)
 o Modelling reduced children’s
fear of dogs
-After witnessing a fearless
model engage in various activities
with a dog, initially fearful children
showed an increase in their
willingness to approach and touch a
dog.
-In the 1990s, two developments came
together as never before to shed light on the
nature of psychopathology:
1. The increasing sophistication of
scientific tools and methodology
2. Realization that no one influence-
biological, behavioral, cognitive,
emotional, or social- ever occurs in
isolation.

Humanistic Theory

Abraham Maslow (1908-1970)

- Most systematic in describing the
structure of personality
- Postulated a hierarchy of needs

Carl Rogers (1902-1987)

- Originated client-centered therapy,
later known as person-centered
therapy
- the therapist takes a passive role,
making as few interpretations as
possible

The Importance of Cognition

Aaron Beck (1921-present)

- developed a cognitive therapy for
depression based on the idea that
depressed mood is caused by
distortions in the way people
perceive life experiences.

Albert Ellis (1913-2007)

- principal thesis was that sustained
emotional reactions are caused by
internal sentences that people
repeat to themselves, these self-
statements reflect sometimes
unspoken assumptions- irrational
beliefs.
- Developed rational-emotive
behavior therapy (REBT) in 1993.

The Present: The Scientific Method and

an Integrative Approach