Abnormal Psychology

• Abnormal psychology is a branch of psychology that studies, diagnoses, and

treats unusual patterns of behavior, emotions, and thoughts that could signify a
mental disorder.
• Abnormal psychology studies people who are “abnormal” or “atypical” compared
to the members of a given society.
• Remember, “abnormal” in this context does not necessarily imply “negative” or
“bad.” It is a term used to describe behaviors and mental processes that
significantly deviate from statistical or societal norms.
• The following characteristics are usually included:
• Abnormal behavior occurs infrequently- However, statistical infrequency alone is
not a sufficient definition. Some healthy, desirable, and beneficial behaviors also
occur infrequently. And other uncommon behaviors or characteristics have no
bearing on how a person behaves or functions. So just because something is
unusual or uncommon does not mean it should be defined as abnormal.
• Abnormal behavior creates distress- These behaviors may disturb the individual,
or they may be upsetting and disruptive to others.
• Abnormal behavior affects a person's ability to function- People who are
displaying these behaviors may struggle to function normally in their daily life,
which can affect their relationships, work, school, and home life.
• Abnormal behavior is socially disruptive- It may violate social norms and make it
difficult for people to function in social settings and maintain social relationships.
CRITERIA OF ABNORMAL BEHAVIOR
• There are four major criteria for identifying abnormal behavior in individuals,
according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-V), which is the most important text used by mental health
professionals in the United States today. These four criteria are:
• Violation of social norms
• Statistical rarity
• Personal distress
• Maladaptive behaviors
• Violation of Social Norms- Behavior that is in violation of social norms is
often considered psychologically and culturally abnormal. There are many
reasons why a person might perform such behaviors. They might be suffering
from a mental illness, but they may also be responding rationally to unusual
circumstances. They might be acting in an abnormal way as part of a performance
or because of cultural ignorance if they are a traveler.
• Violation of social norms alone is not sufficient to diagnose abnormal behavior.
Every culture has certain standards for acceptable behavior or socially acceptable
norms.
• Norms are expected ways of behaving in a society according to the majority, and
those members of a society who do not think and behave like everyone else
break these norms and are often defined as abnormal.
• .
There are a number of influences on social norms that need to be taken
into account when considering the definition of the social norm:

• Culture-Different cultures and subcultures are going to have different social

norms.
• For example, it is common in Southern Europe to stand much closer to strangers
than in the UK. Voice pitch and volume, touching, the direction of gaze, and
acceptable subjects for discussion have all been found to vary between cultures.
• Context and Situation-At any one time, a type of behavior might be considered
normal, whereas, at another time, the same behavior could be abnormal,
depending on both context and situation.
• For example, wearing a chicken suit in the street for a charity event would seem
normal, but wearing a chicken suit for everyday activities, such as shopping or
going to church, would be socially abnormal.
• Historical Context- Time must also be taken into account, as what is considered abnormal at one time
in one culture may be normal at another time, even in the same culture.
• For example, one hundred years ago, a pregnancy outside of marriage was considered a sign of mental
illness, and some women were institutionalized, whereas now this is not the case.
• Age and Gender-Different people can behave in the same way, and some will be normal and others
abnormal, depending on age and gender (and sometimes other factors).
• For example, a man wearing a dress and high heels may be considered socially abnormal as society
would not expect it, whereas this is expected of women.
• Personal Distress.
• An important thing to consider when determining whether a behavior is abnormal is whether it
causes personal distress either to the person performing the behavior or to those around them.
Personal distress alone is certainly not a sufficient marker of abnormality, as people behave in a wide
variety of ways that distress them without stepping out of the bounds of normal behavior. But if an
unusual behavior is causing or caused by personal distress, it is likely something that could and should
be treated as, if not necessarily abnormal, at least potentially pathological.

For example-Failure to function adequately is a definition of abnormality where a person is considered

abnormal if they are unable to cope with the demands of everyday life, or experience personal distress.
• They may be unable to perform the behaviors necessary for day-to-day living, e.g., self-care, holding
down a job, interacting meaningfully with others, making themselves understood, etc.
• Maladaptive Behaviors- Maladaptive behaviors are defined as actions that
inhibit appropriate personal growth. They are created to deal with challenging life
circumstances and are usually a kind of survival mechanism. However, when
carried outside of a particular context, maladaptive behaviors can become
abnormal and can be harmful to an individual. Understanding the causes of
behaviors and seeing if they are maladaptive in nature can help determine
whether a behavior is abnormal.
Models of Abnormal Behaviour
• 1. Biological Model of Abnormal Behavior-Various biological factors
like genetic defects, dysfunction in the endocrine system, brain
dysfunction, may together or individually become the cause of
abnormal behavior. Research has found hat disorders like
schizophrenia and manic-depressive psychoses are genetically
transmitted. In the same way many other factors like extreme physical
deprivation may also lead to psychological abnormality.
• For example, differences in brain structure (abnormalities in the
frontal and pre-frontal cortex, enlarged ventricles) have been
identified in people with schizophrenia.
• Psychodynamic Perspective/ Psychoanalytical Model- The main assumptions include
Freud’s belief that abnormality came from psychological causes rather than physical
causes, that unresolved conflicts between the id, ego, and superego can all contribute to
abnormality,
• for example-Weak ego: Well-adjusted people have a strong ego that can cope with the
demands of both the id and the superego by allowing each to express itself at
appropriate times. If the ego is weakened, then either the id or the superego, whichever
is stronger, may dominate the personality.
• Unchecked id impulses: If id impulses are unchecked, they may be expressed in self-
destructive and immoral behavior. This may lead to disorders such as conduct disorders
in childhood and psychopathic [dangerously abnormal] behavior in adulthood.
• Too powerful superego: A superego that is too powerful, and therefore too harsh and
inflexible in its moral values, will restrict the id to such an extent that the person will be
deprived of even socially acceptable pleasures. According to Freud, this would create
neurosis, which could be expressed in the symptoms of anxiety disorders, such as
phobias and obsessions.-
• Behavioral Model of Abnormality
• Behaviorists believe that our actions are determined largely by the experiences we have in life
rather than by the underlying pathology of unconscious forces.
• Abnormality is therefore seen as the development of behavior patterns that are considered
maladaptive (i.e., harmful) for the individual. Behaviorism states that all behavior (including
abnormal) is learned from the environment (nurture) and that all behavior that has been learned
can also be ‘unlearnt’ (which is how abnormal behavior is treated). Classical conditioning has
been said to account for the development of phobias. The feared object (e.g., spider or rat) is
associated with fear or anxiety sometime in the past.
• The conditioned stimulus subsequently evokes a powerful fear response characterized by
avoidance of the feared object and the emotion of fear whenever the object is encountered.
• Learning environments can reinforce (re: operant conditioning) problematic behaviors. E.g., an
individual may be rewarded for having panic attacks by receiving attention from family and
friends – this would lead to the behavior being reinforced and increasing in later life.
• Cognitive Approach/Model-The cognitive approach to abnormal psychology focuses on
how internal thoughts, perceptions, and reasoning contribute to psychological disorders.
Cognitive treatments typically focus on helping the individual change their thoughts or
reactions.
• Sociocultural Model- The socio-culture perspective assume that people’s behavior- both
normal and abnormal is shaped by the kind of family group, society , and culture in
which they live.
• Humanistic Perspective- Humanistic perspective emphasize the responsibility people
have for their own behavior, even when their behavior is considered abnormal. The
humanistic perspective concentrates on what is uniquely human- that is a view of people
as basically rationale, oriented toward a social world and motivated to seek self-
actualization. As long as they are not hurting others and do not feel personal distress,
people should be free to choose the behaviors in which they engage.
What Is the DSM or DSM-5

• The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook
widely used by clinicians and psychiatrists in the United States to
diagnose psychiatric illnesses. Published by the American Psychiatric Association
(APA), the DSM covers all categories of mental health disorders for both adults
and children. The DSM-5 refers to the fifth edition of this handbook, though the
DSM-5-TR (text revision) is the latest version used.
• It contains descriptions, symptoms, and other criteria necessary for diagnosing
mental health disorders. It also contains statistics concerning who is most
affected by different types of illnesses, the typical age of onset, the development
and course of the disorders, risks and prognostic factors, and other related
diagnostic issues.
DSM History

• The Diagnostic and Statistical Manual was first published in 1952. Since then, there have been several updates
issued. In the DSM-I, there were 102 categories of diagnoses, increasing to 182 in the DSM-II, 265 in the DSM-III,
and 297 in the DSM-IV.
• In 2013, then-NIMH director Thomas Insel and APA president-elect Jeffrey Lieberman issued a joint statement
saying that the DSM-5 represents "the best information currently available for clinical diagnosis of mental
disorders.“The Multiaxial System
• The DSM-III introduced a multiaxial or multidimensional approach for diagnosing mental
disorders.
• The multiaxial approach was intended to help clinicians and psychiatrists make comprehensive
evaluations of a client's level of functioning because mental illnesses often impact many different
life areas.
• It described disorders using five DSM "axes" or dimensions to ensure that all factors—
psychological, biological, and environmental—were considered when making a mental health
diagnosis.

•
• Axis I – Clinical Syndromes
• Axis I consisted of mental health and substance use disorders that cause
significant impairment. Disorders were grouped into different categories such
as mood disorders, anxiety disorders, and eating disorders.
• Axis II – Personality Disorders and Mental Retardation
• Axis II was reserved for what we now call intellectual development disorders
(intellectual disability) and personality disorders, such as antisocial personality
disorder and histrionic personality disorder. Personality disorders cause
significant problems in how a person relates to the world.
• Axis III – General Medical Conditions
• Axis III was used for medical conditions that influence or worsen Axis I and
Axis II disorders. Some examples include HIV/AIDS and brain injuries.
• Axis IV – Psychosocial and Environmental Problems
• Any social or environmental problems that may impact Axis I or Axis II
disorders were accounted for in this axis. These include such things
as unemployment, relocation, divorce, or the death of a loved one.
• Axis V – Global Assessment of Functioning
• Axis V is where the clinician gives their impression of the client's overall
level of functioning. Based on this assessment, clinicians could better
understand how the other four axes interacted and the effect on the
individual's life.
Changes in the DSM-5

• Developmental focus: DSM-5 places disorders according to the age at which they are most likely
to appear, starting in childhood and ending with disorders that usually occur in old age.
Descriptions of disorders also include the different ways they might present according to age.
• New diagnostic criteria: Criteria for some disorders will change, including the addition of new
disorders and removal of subtypes of schizophrenia.
• Dimensional measures: DSM-5 includes measures of a disorder’s severity to help clinicians think
about what dimensions of disorders are similar. These measures aim to benefit patients with
multiple diagnoses by providing more nuanced insight into their continuum of symptoms.
• Culture and gender emphasis: A multitude of cultural and social factors can impact diagnosis.
DSM-5 has a new section describing cultural syndromes, their potential causes and how people
express them.
• Further research: The DSM now contains a section that describes conditions that need further
research. Future editions of the DSM may or may not add these conditions based on the results of
ongoing research.
• The fifth edition of the DSM contains a number of significant changes from the
earlier DSM-IV and DSM-IV-TR. The most immediately obvious change is the shift
from using Roman numerals to Arabic numbers in the name (i.e., it is now written
as DSM-5, not DSM-V).
• DSM-5 eliminated the multiaxial system. Instead, the DSM-5 lists categories of
disorders along with a number of different related disorders. Example categories
in the DSM-5 include anxiety disorders, bipolar and related disorders, depressive
disorders, feeding and eating disorders, obsessive-compulsive and related
disorders, and personality disorders.
• A few other changes that came with the DSM-5 included:
• Asperger syndrome was eliminated as a diagnosis and, instead, incorporated under the category
of autism spectrum disorder.
• Disruptive mood dysregulation disorder was added, in part to decrease the over-diagnosis of
childhood bipolar disorders.
• Several diagnoses were officially added to the manual, including binge eating disorder, hoarding
disorder, and premenstrual dysphoric disorder (PMDD).
• The DSM, fifth edition, text revision (DSM-5-TR) contains revised criteria for more than 70
disorders.
• The DSM-5-TR also includes the addition of a new diagnosis called prolonged grief disorder. There
are new codes added to the DSM-5-TR that will allow clinicians to document suicidal behavior and
nonsuicidal self-injury in patients that don't have another psychiatric diagnosis.
• The parenthetical "(social phobia)" next to social anxiety disorder was removed. The term
"intellectual disability" was revised to intellectual development disorder. The DSM-5-TR also
made significant revisions to terms surrounding gender dysphoria.
• Used in DSM-5
• Desired gender
• Cross-sex medical procedure
• Natal male
• Natal female
• Used in DSM-5-TR
• Experienced gender
• Gender affirming medical procedure
• Individual assigned male at birth
• Individual assigned female at birth
Mental Disorder Diagnoses
Mental disorder diagnoses are classified under headings, which are organized into chapters of the
DSM-5.

• Mental Disorder Diagnoses

• Mental disorder diagnoses are classified under headings, which are organized into chapters of the DSM-5.
• These include:
• Neurodevelopmental Disorders
• Schizophrenia Spectrum and Other Psychotic Disorders
• Bipolar and Related Disorders
• Depressive Disorders
• Anxiety Disorders
• Elimination Disorders
• Other Mental Disorders and Additional Codes
• Obsessive-Compulsive and Related Disorders
• Trauma- and Stressor-Related Disorders
• Dissociative Disorders
• Somatic Symptoms and Related Disorders
• Feeding and Eating Disorders
• Sleep-Wake Disorders
• Sexual Dysfunctions
• Gender Dysphoria
• For example, seven conditions fall under the heading "Neurodevelopmental Disorders":
• Intellectual disabilities
• Communication disorders
• Autism spectrum disorders
• Attention deficit hyperactivity disorder
• Specific learning disorder
• Motor disorders
• Other neurodevelopmental disorders
New and Updated Diagnoses

• The DSM-5 classifications include updates and additions for many mental
disorders. Clinicians and researchers have eliminated some classifications and
combined others. The following 17 mental disorders are new or updated in DSM-
5.
• Social communication disorder: This addition allows clinicians to diagnose speech and
language issues that aren’t symptoms of reduced cognitive ability or autism.
• Disruptive mood dysregulation disorder: This diagnosis applies to children under 18 who
display extreme rages and frequent outbursts, eliminating the classification of childhood
bipolar disorder.
• Premenstrual dysphoric disorder: This extremely controversial addition affects up to 5%
of premenopausal women.
• Hoarding disorder: This condition, depicted in multiple TV shows, is now an official diagnosis
listed under obsessive-compulsive disorders.
• Caffeine withdrawal: Another divisive addition, caffeine withdrawal has moved from the
appendix of DSM-IV to “Caffeine-Related Disorders” in DSM-5.
• Cannabis withdrawal: The proliferation of legal cannabis led to a pronounced increase in people
experiencing cannabis withdrawal, which now falls under “Substance-Related and Addictive
Disorders.”
• Excoriation disorder: This diagnosis addresses chronic scratching and picking at the skin, and is
under “Obsessive-Compulsive and Related Disorders.”
• Binge eating disorder: Binge eating even once a week now qualifies a patient for this diagnosis,
rather than biweekly.
• Rapid eye movement sleep behavior disorder: This disorder causes people to act out dreams in
potentially dangerous ways, and is now separate from the parasomnia category it occupied in the
previous DSM.
• Restless leg syndrome: Previously classified as a form of dyssomnia, restless leg
syndrome now has full DSM status as a separate diagnosis.
• Major neurocognitive disorder with Lewy body disease: This classification differentiates
major and mild neurocognitive disorders, allowing for more specific treatment.
• Disinhibited social engagement disorder: This classification previously fell under reactive
attachment disorder, but is now under a separate category because children with it do
not necessarily lack attachment.
• Additional eating disorders: In addition to recognizing binge eating disorder, the newest
edition of the DSM adds rumination, pica and avoidant/restrictive food intake disorder.
• Gender dysphoria: Individualswhose gender at birth is contrary to the one they identify
with will now receive a diagnosis of gender dysphoria instead of gender identity disorder.
The shift in language intends to represent these individuals’ experiences more accurately
and reduce stigma. Gender dysphoria will also now have a dedicated chapter separate
from sexual dysfunctions and paraphilic disorders.
• Gambling disorder: The chapter on addictive disorders now includes gambling disorder as a
diagnosable condition. The DSM-IV included a section on pathological gambling but did not
classify it as an official addictive disorder.
• Somatic symptom disorder: DSM-5 replaces the old somatoform disorders — such
as somatization disorder, hypochondriasis, pain disorder and undifferentiated somatoform
disorder — with somatic symptom disorder. It makes substantial changes to the disorder criteria
to clarify the distinctions between similar conditions and minimize overlap.
 ICD-11
• The International Classification of Diseases (ICD-11) is the 11th edition of a global
categorization system for physical and mental illnesses published by the World
Health Organization (WHO). The ICD-11 is a revised version of the ICD-10 and the
first update to be developed and published in two decades.
• The 11th version of the ICD was released on June 18, 2018, as a preliminary
version. It was officially presented at the World Health Assembly in May 2019 and
began to be used as the official reporting system by member states beginning
January 1, 2022.
• This version is the result of work completed over the course of a decade involving
300 specialists divided into 30 workgroups across 55 countries who provided
input. Healthcare workers joined collaborative meetings to incorporate practical
applications in the ICD-11 revision in addition to theoretical concepts, particularly
in the area of mental health.
• The ICD-11 catalogs known human diseases, medical conditions, and mental
health disorders and is used for insurance coding purposes, for statistical tracking
of illnesses, and as a global health categorization tool that can be used across
countries and in different languages.
• Improvements in the ICD-11
• Improvements included in the ICD-11 are intended to address gaps in the ICD-
10 and incorporate medical updates, discoveries, and changes in thinking. Key
revisions were made to the new ICD in terms of the approach to categorization
and coding structure, international usage, digital-readiness, and user-friendliness.
• Coding Structure
• In terms of general improvements, the ICD-11 has a more
sophisticated structure than the ICD-10. With around 55,000 codes
that can be used to classify diseases, disorders, injuries, and causes of
death, the ICD-11 offers a fine level of detail in coding these illnesses.
• A key feature of the revised system is that it provides a simple coding
structure that makes it easier to record various conditions with
specificity.
• International Applicability
• The ICD-11 offers guidance for its use with different cultures as well as translations into
43 different languages. In this way, the revised system provides a common coding
language that can be used by healthcare professionals and researchers worldwide, which
will aid in international comparisons and usage.
• Digital-Ready and User-Friendly
• The new ICD-11 was designed to be electronic and user-friendly for use by a global
audience. It runs on a central platform and can connect to any software. In addition, it
can be a machine-readable format, expanding its potential uses in the digital age.
• Dimensional Approach
• Another enhancement of the ICD-11 is that it's based on a dimensional approach that
makes it better at capturing change over time, is consistent with research evidence, and
will improve recovery from illness.
• ICD vs. DSM
• The ICD and the Diagnostic and Statistical Manual of Mental Disorders (DSM)
share many similarities. Both are authoritative guidebooks for medical
professionals to use for the diagnosis and treatment of diseases and disorders.
They share a great overlap of material on mental disorders, with the DSM solely
focused on mental health concerns, while the ICD covers all parts of the body and
mind.
• Compared to the DSM, the ICD is broader both in its scope and its authorship.
• Mental health professionals in the United States are more likely to rely on and be
familiar with the DSM mental health classifications (rather than classifications of
the ICD) because the DSM guidebook is specifically tailored to cover mental
health disorders as they are experienced and treated in this country.
• While the DSM is published by the American Psychiatric Association (APA) and
has a rather narrow scope and authoritativeness as it's focused on North
America, the ICD draws its authorship globally and is open to the public for
submissions. The ICD also covers medical diseases in addition to mental
disorders.
• Another difference is that the ICD provides codes for each diagnosis
for insurance billing purposes. The DSM doesn't have its own codes, but rather,
publishes the corresponding ICD codes for each mental health diagnosis. For
instance, the DSM-5 uses both ICD-9 and ICD-10 codes. The DSM-5-TR (DSM-5
text revision) uses codes from the ICD-10-CM, which is the ICD-10 Clinical
Modification.
• Changes in the ICD-11
• The ICD-11 includes several changes to the mental health disorders that are
listed, including some that may be considered controversial and others that
may be long overdue in the eyes of clinicians. The following sections detail
the diagnoses that were either added or deleted in the new ICD-11. ICD-11
Added Diagnoses
• The following diagnoses are now included in the ICD-11.
• Complex PTSD
• The definition of complex post-traumatic stress disorder in the ICD-11
involves the three symptoms of PTSD (re-experiencing, avoiding reminders,
and a heightened sense of threat/arousal) along with broader problems
in emotion regulation, shame, guilt, and interpersonal conflict, such that it
affects the person's entire life.
• Compulsive Sexual Behavior Disorder
• Compulsive sexual behavior disorder is defined in the ICD-11 as "characterized by a
persistent pattern of failure to control intense, repetitive sexual impulses or urges
resulting in repetitive sexual behavior." It is classified as an impulse control disorder
rather than an addictive disorder.
• Gaming Disorder
• Gaming disorder is newly defined in the ICD-11 as “a pattern of persistent or recurrent
gaming behavior ('digital gaming’ or ‘video-gaming’).
• Prolonged Grief Disorder
• Prolonged grief disorder is defined in the ICD-11 as grief that extends beyond what most
people would consider a reasonable or expected amount of time.4 Prolonged grief
disorder is listed as a proposed disorder in the DSM-5 and is officially listed as a new
diagnosis in the DSM-5-TR.
ICD-11 Deleted Diagnoses

• The following disorders were removed from the ICD with the publication of the ICD-11.
• Acute Stress Disorder
• Acute stress disorder is no longer included as a mental disorder and instead is now
classified as a reaction to trauma (factor influencing health). This is in contrast to the
DSM-5.
• Gender Incongruence
• Gender incongruence (gender dysphoria in the DSM) is no longer listed as a mental
disorder but rather a sexual health condition to avoid stigma about it being a
psychological rather than medical condition.
• Personality Disorders
• The section on personality disorders has been completely overhauled. There is now one
diagnosis of "personality disorder" as it was found that there was much overlap in clinical
practice.
• What's Included in the ICD-11
• The ICD-11 includes an implementation package with the following
components that can be used to help ease the transition and better use the
categorization system:6
• Coding tool
• Manual
• Training material
• Transition tables from ICD-10 to ICD-11
• Translation tool
• Web services