Abnormal Psychology

Module 1: Understanding Abnormal Behavior

Module Learning Outcomes

Understanding Abnormal Behavior

1.1: Define mental disorders and explain how they are classified
1.2:
Describe the basic features of the Diagnostic and Statistical Manual of Mental Disorders and
how it is used to classify disorders
1.3: Describe and discuss various psychological assessment techniques
Mental Disorders and Classification
Understanding Mental Disorders and Classification

1.1: Define mental disorders and explain how they are classified
1.1.1:
Describe how psychological disorders are defined, as well as the inherent difficulties in doin
g so
1.1.2:
Describe etiological theories (supernatural, somatogenic, and psychogenic) used to explain
mental illness up through the Middle Ages
1.1.3: Explain the rationale for deinstitutionalization, and its impact
1.1.4: Describe the ways in which mental health services are delivered
today, including the distinction between voluntary and involuntary treatment
Class Activity: What are Psychological Disorders?

Write down your responses to the following questions and prepare for discussion.

• What comes to your mind when you think of “Psychological Disorder”?

• How do you think your generation views mental disorders or mental illness?
• How do you think this might differ from other generations?
Abnormal Psychology Overview
Psychological Disorders
• Mental disorder: a condition characterized by thoughts, feelings, and behaviors that
create dysfunction.
• Can impair a person’s relationships and disrupt their ability to live their life
productively, think clearly, communicate with others, hold a job or deal with
stressful events
• Psychopathology: the study of psychological disorders and their symptoms
• Etiology: the causes of disorders

“Four D’s” — deviance, dysfunction, distress, and danger: criteria in defining

psychological disorders

According to the APA, a psychological disorder consists of:

• Significant disturbances in thoughts, feelings, and behaviors which:
• reflect some kind of biological, psychological, or developmental dysfunction
• lead to significant distress or disability in one’s life
• do not reflect expected or culturally approved responses to certain events
Ancient Views of Mental Illness
• Etiological Theories:

• Supernatural theories: attribute mental illness to possession by evil

or demonic spirits, displeasure of gods, eclipses, planetary
gravitation, curses, and sin.

• Somatogenic theories: identify disturbances in physical functioning

resulting from either illness, genetic inheritance, or brain damage or
imbalance.

• Psychogenic theories: focus on traumatic or stressful experiences,

maladaptive learned associations and cognitions, or distorted
perceptions

• Trephination: as early as 6500 BC has identified surgical drilling of holes

in skulls to treat head injuries and epilepsy as well as to allow the evil
spirits trapped within the skull, that were presumed to be causing the
symptoms of mental disorder
Deinstitutionalization
• Asylums: the first institutions created for the specific purpose of housing
people with psychological disorders
• The focus was ostracizing them from society rather than treating their
disorders
• Late 1700s, a French physician, Philippe Pinel, argued for the more
humane treatment of the mentally ill
• In the 19th century, Dorothea Dix led reform efforts for mental health
care in the United States

• Emil Kraepelin: founder of modern scientific psychiatry,

psychopharmacology, and psychiatric genetics and believed the chief origin
of psychiatric disease to be biological and genetic malfunction
• Dementia praecox: Kraepelin’s definition for what we now call
schizophrenia; the "sub-acute development of a peculiar simple
condition of mental weakness occurring at a youthful age”
• Syndrome: common patterns of symptoms over time (rather than by simple
similarity of major symptoms)
Current Mental Health Services
Biopsychosocial model: model emphasizing the various factors influencing
disorders. While some have a genetic predisposition for a certain psychological
disorder, certain psychological stressors need to be present for them to develop
the disorder.

• Involuntary treatment: therapy that is not the individual’s choice. Other

individuals might voluntarily seek treatment.

• Voluntary treatment: the individual chooses to attend therapy to obtain

relief from symptoms

18.9% of U.S. adults experienced mental illness in 2017

• Similar for teens
• Approximately 13% of children ages 8–15 experience mental
illness in a given year
Practice Question 1

Which of the following individuals was associated with ending physical punishment of patients
within asylums?

A. Phillippe Pinel
B. Dorothea Dix
C. Emil Kraepelin
D. Sigmund Freud
DSM Classification
Understanding DSM Classification
1.2: Describe the basic features of the Diagnostic and Statistical Manual of Mental D
isorders and how it is used to classify disorders
1.2.1:
Describe the basic features of the Diagnostic and Statistical Manual of Mental Disorders, Fif
th Edition (DSM-5) and how it is used to classify disorders
1.2.2: Outline the major disorder categories of the DSM-5
1.2.3:
Explain how the International Classification of Diseases is used to classify mental disorders
1.2.4: Explain steps of the diagnostic process, including the case formulation
1.2.5: Discuss arguments and objections surrounding the DSM classification system
1.2.6: Describe problems associated with classification and labeling
1.2.7: Describe the types of stigma associated with mental disorder
DSM-V Simplified
 DSM-V Basic Features
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5): published by the American Psychiatric
Association
• The DSM-5 includes many categories of disorders
(e.g., anxiety disorders, depressive disorders, and
dissociative disorders).
• Each disorder is described in detail, including an
overview of the disorder (diagnostic features),
specific symptoms required for diagnosis
(diagnostic criteria), prevalence information (what
percent of the population is thought to be afflicted
with the disorder), and risk factors associated with
the disorder
Comorbidity: the co-occurrence of two disorders
Major Disorder Categories of DSM-V
The DSM-5 begins with neurodevelopmental
disorders and is divided into 22 chapters that include
sets of related disorders.

• Internalizing problems: depression, anxiety,

social anxiety, somatic complaints, post-
traumatic symptoms, and obsession-compulsion

• Externalizing problems: disruptive, impulse-

control, conduct disorders and substance use
International Classification of Diseases
• ICD-11: the 11th revision of the International Classification of
Diseases and will eventually replace the ICD-10 as the global
standard for coding health information and causes of death.
• Will officially come into effect on January 1, 2022
• In conjunction with changes in DSM-5, the ICD-11 will
help harmonize the two classification systems

• A study that compared the use of the two classification systems

found that worldwide, the ICD is more frequently used for
clinical diagnosis, whereas the DSM is more valued for research
• Most research findings concerning the etiology and treatment
of psychological disorders are based on criteria set forth in the
DSM
• DSM is the classification system of choice among U.S. mental
health professionals, and the modules in this course are based
on the DSM paradigm.
Steps of the Diagnostic Process
Diagnosis: commonly refers to the identification of the nature and cause of an
illness

• Clinician: a professional who works directly with patients or clients and

may diagnose, treat, and otherwise care for them
• Mental status examination: where evaluations are made of appearance and
behavior, self-reported symptoms, mental health history, and current life
circumstances
• Principal diagnosis: determining the single diagnosis that is most relevant
to the person's chief complaint or need for treatment
• this will be the main focus of clinical attention or treatment
• Comorbidity: the presence of more than one diagnosis occurring in an
individual at the same time
• Clinical formulation: a theoretically-based explanation of the information
obtained from a clinical assessment
• Cultural formulation: the systematic review of a person's cultural
background and the role of culture in the manifestation of symptoms and
dysfunction
• Treatment plan: type of contract that specifies the goals of treatment,
treatment procedures, and a regular schedule for the time, place, and
duration of their treatment sessions
Arguments for/against DSM-5
Positive:
• Wide acceptance and use of the DSM system
• Revisions of the DSM from the 3rd Edition forward have been mainly concerned
with diagnostic reliability—the degree to which different diagnosticians agree on
a diagnosis
• Useful to insurance companies who adopt its use to establish coverage for certain
clinical disorders
• Helpful in allowing researchers and clinicians to have a common language with
which to discuss clients
• DSM-IV organized diagnoses using five separate axes (clinical disorders,
personality disorders, general medical disorders, and then sections on
psychosocial and environmental factors, and the global assessment of functioning)
• The inclusion of dimensions in diagnoses; for example, how severely ill is a
patient with schizophrenia or depression

Negative:
• Limitations reflected in the terminology related to diagnosis itself
• Since the DSM III, the goal was to improve the uniformity and validity of
psychiatric diagnosis in the wake of a number of critiques
• Critics believe the DSM needs to become more sensitive to the importance of
cultural and ethnic factors in diagnostic assessment
Classification and Labeling Problems
Labeling: occurs when information about a person's diagnostic
classification is communicated in a negative manner that leads
to stigma for the individual with a mental disorder
• The labeling theory was first applied to the term "mentally
ill" in 1966 when Thomas J. Scheff published Being
Mentally Ill.
Labeling theory: posits that self-identity and the behavior of
individuals may be determined or influenced by the terms used
to describe or classify them
• Labeling theory is associated with the concepts of self-
fulfilling prophecy and stereotyping
Mental Illness Stigma
Some negative stereotypes about individuals with mental health
problems are that they are considered dangerous, unpredictable,
and difficult to talk to.

• Stereotype: an expectation that people might have about

every person of a particular group.
• Public stigma: a set of negative attitudes and beliefs that
motivate individuals to fear, reject, avoid, and discriminate
against people with mental illness
• Self-stigma: is thought to be particularly damaging, and is
said to occur when individuals internalize stigmatizing
social attitudes, and come to believe the negative societal
conceptions and stereotypes associated with their condition
• Stigma expectations: “the extent to which individuals
believe that ‘most people’ will devalue and discriminate
against a mental patient” do not differ between individuals
with and without mental health problems or history of
treatment
Practice Question 2

How many chapters are part of the current Diagnostic Statistical Manual of Mental Disorders or
DSM-V?

A. 15
B. 20
C. 22
D. 23
Evaluation and Assessment of Mental Disorders
Evaluation and Assessment
1.3: Describe and discuss various psychological assessment techniques
1.3.1: Describe the types and purposes of psychological assessment
1.3.2: Describe clinical interviews and the mental status examination
1.3.3: Explain why intelligence testing is used and the various types of intelligence testing
1.3.4: Describe personality testing, including self-report inventories and projective personalit
y tests
1.3.5: Describe how cognitive and behavioral assessments are used to inform psychotherapy
Types and Purposes of Psychological Assessment
Psychological tests: written, visual, or verbal evaluations administered to assess
the cognitive and emotional functioning of clients or patients
Standardized tests: are administered and scored in a consistent manner and the
questions, conditions for administering, scoring procedures, and interpretations
are consistent and are administered and scored in a predetermined, standard
manner
Psychological assessments are most often used in the psychiatric, medical,
legal, educational, or psychological clinic settings
● Intelligence & achievement tests: Designed to measure certain specific
kinds of cognitive functioning (often referred to as IQ) in comparison to a
norming group
● Personality tests: aim to describe patterns of behavior, thoughts, and
feelings
● Neuropsychological tests: consist of specifically designed tasks used to
measure psychological functions known to be linked to a particular brain
structure or pathway
● Diagnostic Measurement Tools: Clinical psychologists are able to
diagnose psychological disorders and related disorders found in the DSM-
5 and ICD-10
● Clinical observation: Clinical psychologists are also trained to gather
data by observing behavior
Clinical Interviews and Mental Status Exam
Clinical interview: a face-to-face encounter between a mental health
professional and a patient in which the former observes the latter and gathers
data about the person’s behavior, attitudes, current situation, personality, and
life history.
• Types of Interviews:
• Unstructured: questions are open-ended and not prearranged.
• More informal and free flowing than a structured interview,
much like an everyday conversation.
• Structured: a specific set of questions according to an interview
schedule are asked.
• Can provide a diagnosis or classify the client’s symptoms
into a DSM-5 disorder
• Semi-structured: a list of questions are pre-set but clinicians are
able to follow up on specific issues that catch their attention
Mental status examination: a medical process where a clinician working in the
field of mental health systematically examines a patient’s mind and the way
they look, think, feel and behave.
• a structured way of observing and describing a patient’s
psychological functioning at a given point in time, under the
domains of appearance, attitude, behavior, mood, and affect,
speech, thought process, thought content, perception, cognition,
insight, and judgment.
Class Discussion: Visiting a Therapist

• If you were to visit a therapist or mental health counselor, what things might take place
during your first few appointments?
• How does a therapist make a diagnosis?
• What are the benefits of getting a diagnosis?
Intelligence Testing
Intelligent testing is important for children who seem to be experiencing
learning difficulties or severe behavioral problems.
• can be used to ascertain whether the child’s difficulties can
be partly attributed to an IQ score that is significantly
different from the mean for her age group
• IQ or Intelligence Quotient: the score derived by dividing a
child’s mental age by their chronological age to create an overall
quotient (Stanford-Binet is well known and was standardized)
• Wechsler Adult Intelligence Scale (WAIS): made up of a pool of
specific abilities and assesses people's ability to remember,
compute, understand language, reason well, and process
information quickly
• Wechsler Intelligence Scale for Children (WISC): an
individually administered intelligence test for children between the
ages of 6 and 16
• Kaufman Assessment Battery for Children (KABC): a clinical
instrument for assessing cognitive development and incorporates
several recent developments in both psychological theory and
statistical methodology
Personality Testing
• Self-report inventories: a kind of objective test used to assess personality
• standardized questions with fixed response categories that the test-taker
completes independently
• Minnesota Multiphasic Personality Inventory (MMPI): The original MMPI was
based on a small, limited sample, composed mostly of Minnesota farmers and
psychiatric patients.
• Now the responses are scored to produce a clinical profile composed of 10
scales: hypochondriasis, depression, hysteria, psychopathic deviance,
masculinity versus femininity, paranoia, psychasthenia , schizophrenia,
hypomania, and social introversion
• Projective testing: sometimes called performance-based testing
• Rorschach Inkblot Test: a series of symmetrical inkblot cards that are presented to a
client by a psychologist
• what the test-taker sees reveals unconscious feelings and struggles
• Thematic Apperception Test (TAT): a person taking the TAT is shown 8–12
ambiguous pictures and is asked to tell a story about each picture
• the stories give insight into their social world, revealing hopes, fears, interests,
and goals
• Rotter Incomplete Sentence Blank (RISB): there are three forms of this test for use
with different age groups: the school form, the college form, and the adult form
• people are asked to complete as quickly as possible, and it is presumed that
responses will reveal desires, fears, and struggles
 Cognitive and Behavioral Assessments
Cognitive assessments: are useful to test for cognitive or neurological
impairments, deficiencies in knowledge, thought process, or judgment
• MMSE: usually takes less than ten minutes to administer but is now
used less frequently due to copyright laws and additional costs
• MoCA: a popular screening tool that evaluates visuospatial skills,
attention, language, abstract reasoning, delayed recall, executive
function, and orientation
• Mini-Cog: one of the faster cognitive assessment screens used. Tests
memory, while the clock drawing test evaluates cognitive function,
language, executive function, and visuospatial skills
Behavioral assessment: involves the identification and measurement of
particular behaviors and the variables affecting their occurrence
• Child Behavior Checklist (CBCL): a widely used caregiver report
form identifying problem behavior in children and examines:
Aggressive Behavior, Anxious/Depressed, Attention Problems, Rule-
Breaking Behavior, Somatic Complaints, Social Problems, Thought
Problems, Withdrawn/Depressed
Practice Question 3

Which of the following Personality tests focuses on examining instantaneous unconscious

factors by asking for word association with an abstract image?

A. MMPI
B. TAT
C. Rorschach’s
D. RISB