Abnormal Psychology

Module 1

Abnormal Psychology: An Overview, The concepts of normality and abnormality,

Different Criteria , Historical views of abnormal behavior,Current status,
classification System ICD, and DSM ,The evolution of DSM DSM 5, definition of
mental disorders DSM 5,Major changes in classification,Mertis and demerits of
classification Prevalence of mental disorders

Abnormal Psychology: An Overview

Abnormal psychology is the branch of psychology that studies unusual patterns of

behavior, emotion, and thought, which may or may not be understood as
precipitating a mental disorder. It aims to understand the nature of these behaviors,
the causes behind them, and the most effective treatments.

Scope and Significance

The scope of abnormal psychology includes a wide range of disorders such as

anxiety disorders, mood disorders, personality disorders, psychotic disorders, and
developmental disorders. The significance lies in its ability to provide insights into
the human mind and behavior, contributing to the development of effective
treatments and interventions.

The concepts of normality and abnormality

Defining mental disorders is challenging due to the complexity and variability of
human behavior because no single behavior makes someone "abnormal." Instead,
several indicators help determine if someone might have a mental disorder.
.

Different Criteria

In psychology, various criteria are used to define and assess abnormality. These
criteria help professionals determine whether a behavior or mental state qualifies as
a mental disorder. Here are some of the key criteria:

1. Statistical Rarity: This criterion considers behaviors or mental states that are
statistically uncommon or rare within a population. For example, intellectual
disabilities are considered abnormal because they deviate significantly from the
average cognitive functioning. However, this criterion alone is insufficient, as
some rare behaviors (like genius) are not considered abnormal.

2. Violation of Social Norms: Abnormality can also be defined by behaviors that

violate societal rules or norms. Abnormality can also be defined by behaviors that
violate societal rules or norms, such as public nudity, which is generally
considered inappropriate and abnormal in many societies where modesty and
privacy are strongly valued.

3. Maladaptiveness: This criterion focuses on how behavior affects an individual's

ability to function in daily life. Maladaptive behaviors, such as those seen in eating
disorders or severe substance abuse, can lead to significant impairment in social,
occupational, or other important areas of functioning.
4. Personal Distress: The experience of psychological pain or suffering is often a
key indicator of abnormality. Individuals with anxiety disorders or depression
typically report significant distress, which can be a strong indicator of a mental
disorder. However, not all individuals with mental disorders experience distress
(e.g., those in a manic state may feel elated).

5. Social Discomfort: This criterion considers the discomfort or unease that others
may feel in response to an individual's behavior. For example, if someone shares
personal or distressing information inappropriately, it may be perceived as
abnormal due to the discomfort it causes in social situations.

6. Cultural Context: The definition of abnormality is also influenced by cultural

context. What is considered abnormal in one culture may be accepted in another.
Each culture has its own set of expectations, and when individuals fail to adhere to
these, their behavior may be labeled as abnormal. For instance, certain behaviors
may be considered normal in one culture but deviant in another, such as tipping,
which is a normal and expected practice in the United States but is often seen as
unnecessary and potentially rude in Japan

7. Functional Impairment: This criterion assesses whether an individual's

behavior interferes with their ability to perform daily activities or fulfill societal
roles. If a behavior significantly disrupts a person's life, it may be classified as
abnormal.

In summary, the criteria for defining abnormality are multifaceted and often
interrelated. No single criterion is sufficient on its own; rather, a combination of
these factors is typically considered when assessing whether a behavior or mental
state is abnormal. Understanding these criteria is essential for mental health
professionals in diagnosing and treating mental disorders

Historical views of abnormal behavior

The historical views of abnormal behavior have evolved significantly over time,
reflecting changes in societal beliefs, scientific understanding, and cultural
contexts. Here are some key historical perspectives on abnormal behavior:

1. Supernatural Explanations: In ancient times, abnormal behavior was often

attributed to supernatural forces, such as demons, gods, or evil spirits. Many
cultures believed that individuals exhibiting unusual behaviors were possessed or
cursed. Treatments during this period included exorcisms, rituals, and other
spiritual interventions.
2. Ancient Medical Theories: The ancient Egyptians, Greeks, and Romans began
to shift towards natural explanations for abnormal behavior. For instance, the
Greeks, particularly Hippocrates, proposed that mental disorders could be linked to
imbalances in bodily fluids or "humors." This marked a significant move away
from supernatural explanations towards a more biological understanding of mental
health.

3. Middle Ages: During the Middle Ages, the belief in supernatural causes
resurfaced, and individuals with mental disorders were often viewed as possessed.
This period saw the rise of witch hunts and the persecution of those deemed "mad."
Treatments were often brutal, including confinement, torture, and execution.

4. Renaissance and Enlightenment: The Renaissance brought about a renewed

interest in science and reason. Thinkers like Descartes and Locke began to explore
the mind and behavior more critically. The establishment of asylums in the 17th
and 18th centuries aimed to provide care for the mentally ill, although conditions
were often poor and inhumane.

5. Moral Treatment Movement: In the 19th century, the Moral Treatment

Movement emerged, advocating for the humane treatment of individuals with
mental disorders. Figures like Philippe Pinel in France and Dorothea Dix in the
United States pushed for better living conditions and the use of kindness and
compassion in treatment.

6. Psychoanalysis: In the late 19th and early 20th centuries, Sigmund Freud
introduced psychoanalysis, emphasizing the role of unconscious processes and
childhood experiences in shaping behavior. This perspective shifted the focus from
purely biological explanations to psychological factors influencing mental health.

7. Behaviorism and Biological Perspectives: The mid-20th century saw the rise
of behaviorism, which focused on observable behaviors and the role of the
environment in shaping them. Concurrently, advances in neuroscience and genetics
began to highlight the biological underpinnings of mental disorders, leading to a
more integrated understanding of mental health that considers both psychological
and biological factors.

8. Contemporary Views: Today, the understanding of abnormal behavior is more

holistic, incorporating biological, psychological, and social factors. The
biopsychosocial model recognizes that mental disorders result from a complex
interplay of genetic, environmental, and psychological influences. The DSM-5
(Diagnostic and Statistical Manual of Mental Disorders) is a key reference for
diagnosing mental disorders based on current scientific understanding.

In summary, the historical views of abnormal behavior reflect a journey from

supernatural explanations to a more nuanced understanding incorporating
biological, psychological, and social factors. This evolution highlights the
importance of context in shaping our understanding of mental health and illness.

Current status, classification System ICD, and DSM

The current status of the classification of mental disorders is primarily represented

by two major systems: the International Classification of Diseases (ICD) and the
Diagnostic and Statistical Manual of Mental Disorders (DSM). Both systems are
essential for clinicians, researchers, and policymakers in diagnosing and treating
mental health conditions. Here’s an overview of each:

1. International Classification of Diseases (ICD)

Overview: The ICD is published by the World Health Organization (WHO) and is
used globally to classify diseases and health conditions, including mental
disorders. The latest version, ICD-11, was released in 2019 and became effective
in January 2022.
Structure: The ICD provides a comprehensive coding system for various health
conditions, including physical and mental disorders. It includes detailed
descriptions, diagnostic criteria, and guidelines for each condition.
Global Use: The ICD is used by healthcare providers and researchers worldwide,
making it a critical tool for international health statistics and epidemiological
studies. It facilitates the comparison of health data across different countries and
regions.
Focus on Holistic Health: The ICD emphasizes a holistic approach to health,
integrating physical and mental health conditions. It recognizes the importance of
social determinants of health and the impact of cultural factors on health outcomes.

2. Diagnostic and Statistical Manual of Mental Disorders (DSM)

Overview: The DSM is published by the American Psychiatric Association (APA)
and is primarily used in the United States. The most recent edition, DSM-5, was
released in 2013, with updates and revisions ongoing.
Structure: The DSM provides specific diagnostic criteria for each mental disorder,
including symptom descriptions, prevalence rates, and associated features. It
categorizes disorders into various groups, such as mood disorders, anxiety
disorders, and psychotic disorders.
Clinical Utility: The DSM is widely used by mental health professionals for
diagnosing and treating mental disorders. It provides a common language for
clinicians, ensuring diagnosis consistency and accuracy.
Research and Policy: The DSM also plays a crucial role in research, as it provides
standardized criteria for studies on mental health. It influences funding, treatment
guidelines, and public policy related to mental health care.
Comparison of ICD and DSM
Scope: The ICD covers all health conditions, while the DSM focuses specifically
on mental disorders. The ICD is used globally, whereas the DSM is primarily used
in the United States.
Approach: The ICD takes a broader public health perspective, while the DSM is
more clinically oriented, providing detailed diagnostic criteria for mental health
professionals.
Updates and Revisions: Both systems undergo periodic revisions to incorporate
new research findings and changes in the understanding of mental health. The
DSM-5 revision process involved extensive debate and input from experts,
reflecting the dynamic nature of mental health classification.
Current Trends in Classification
Biopsychosocial Model: Both the ICD and DSM increasingly recognize the
importance of a biopsychosocial approach, considering biological, psychological,
and social factors in understanding mental disorders.
Cultural Sensitivity: There is a growing emphasis on cultural considerations in
the classification and diagnosis of mental disorders, acknowledging that cultural
context can influence the presentation and interpretation of symptoms
Integration of Research: Ongoing research in genetics, neuroscience, and
psychology continues to inform updates to both classification systems, leading to a
more nuanced understanding of mental health conditions.

In summary, the ICD and DSM are essential tools in the classification and
diagnosis of mental disorders, each with its unique focus and application. Their
ongoing evolution reflects advancements in our understanding of mental health and
the need for culturally sensitive and scientifically informed approaches to
diagnosis and treatment.

The evolution of DSM 5

The evolution of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
reflects significant changes in the understanding of mental health and the
classification of mental disorders over time. Here’s an overview of the history
leading up to DSM-5, including key developments and changes:
1. Historical Background
• DSM-I (1952): The first edition of the DSM was published by the American
Psychiatric Association (APA) in 1952. It was based on the psychiatric
nomenclature of the time and included 106 disorders. The DSM-I was
heavily influenced by psychoanalytic theory and focused on descriptive
categories rather than specific diagnostic criteria.

• DSM-II (1968): The second edition expanded the number of disorders to

182 and continued to reflect psychoanalytic concepts. However, it faced
criticism for lacking empirical support and reliance on subjective judgments.
2. Shift Towards Empirical Research
• DSM-III (1980): A major turning point occurred with the publication of
DSM-III, which introduced a more systematic and empirical approach to
classification. It included specific diagnostic criteria for each disorder,
allowing for greater diagnosis reliability and consistency. This edition also
expanded the number of disorders to 265 and emphasized a multi-axial
system, which considered various aspects of a person's functioning.

• DSM-III-R (1987): A revision of DSM-III, this edition made minor

adjustments to diagnostic criteria and added new disorders. It continued to
build on the empirical foundation established in DSM-III.
3. Further Refinements and Controversies
• DSM-IV (1994): The fourth edition incorporated extensive research and
input from experts in the field. It included 297 disorders and refined
diagnostic criteria further. The DSM-IV also introduced a more
 comprehensive multi-axial system, which assessed clinical disorders,
personality disorders, medical conditions, and psychosocial stressors.

• DSM-IV-TR (2000): This text revision updated the DSM-IV with new
information and research findings but did not change the diagnostic criteria
or the structure of the manual.
4. Introduction of DSM-5
DSM-5 (2013): The fifth edition marked a significant shift in the classification of
mental disorders. Key changes included:
• Elimination of the Multi-Axial System: DSM-5 replaced the multi-axial
system with a single-axis system that integrates all mental and medical
disorders into one list, reflecting a more holistic approach to diagnosis.
• Revised Diagnostic Criteria: Many disorders received updated criteria
based on the latest research, and some disorders were reclassified or
renamed. For example, the category of "autism spectrum disorders" was
introduced, combining previous diagnoses of autism, Asperger's disorder,
and pervasive developmental disorder.
• Cultural Considerations: DSM-5 emphasized the importance of cultural
context in understanding and diagnosing mental disorders, recognizing that
cultural factors can influence symptom presentation and interpretation.
• Inclusion of New Disorders: Several new disorders were added, such as
"hoarding disorder" and "premenstrual dysphoric disorder." Additionally,
conditions like "Internet gaming disorder" were included in a section for
further study, reflecting ongoing debates about the classification of emerging
issues in mental health.
 • Focus on Dimensional Assessments: DSM-5 introduced dimensional
assessments for certain disorders, allowing clinicians to evaluate the severity
of symptoms rather than relying solely on categorical diagnoses.
5. Ongoing Developments and Future Directions
• Work in Progress: DSM-5 is viewed as a living document, with ongoing
research and updates expected. The APA has indicated that future revisions
will continue incorporating new scientific findings and address criticisms of
the current system.
• Controversies and Critiques: The DSM-5 has faced criticism regarding the
potential for overdiagnosis, the medicalization of normal behavior, and the
influence of pharmaceutical companies on the classification of disorders.
These concerns highlight the need for ongoing dialogue and critical
evaluation of the classification system.
In summary, the evolution of the DSM reflects a shift from psychoanalytic and
subjective approaches to a more empirical and research-based framework for
understanding and diagnosing mental disorders. DSM-5 represents the culmination
of this evolution, incorporating contemporary research, cultural considerations, and
a more integrated approach to mental health.

Definition of mental disorders DSM 5

In DSM-5, a mental disorder is defined as a syndrome that is present in an

individual and involves clinically significant disturbances in behavior, emotion
regulation, or cognitive functioning. These disturbances are thought to reflect
dysfunction in biological, psychological, or developmental processes that are
necessary for mental functioning. Additionally, mental disorders are usually
associated with significant distress or disability in key areas of functioning, such as
social, occupational, or other important activities.
The definition also specifies that predictable or culturally approved responses to
common stressors or losses (such as the death of a loved one) are excluded from
being classified as mental disorders. Furthermore, it is important that the
dysfunctional pattern of behavior does not stem from social deviance or conflicts
that the person has with society as a whole.

Major changes in classification

The DSM-5 introduced several major changes in the classification of mental

disorders compared to its predecessor, DSM-IV. Here are some of the key changes:
1. Elimination of the Multi-Axial System
• Previous Structure: DSM-IV used a multi-axial system that assessed five
different axes, including clinical disorders, personality disorders, medical
conditions, psychosocial stressors, and global functioning.
• DSM-5 Change: The multi-axial system was replaced with a single-axis
system that integrates all mental and medical disorders into one list. This
change reflects a more holistic approach to diagnosis and treatment

2. Revised Diagnostic Criteria

• Specificity and Clarity: Many disorders received updated diagnostic
criteria based on the latest research, enhancing the specificity and clarity of
the definitions. This aimed to improve diagnostic reliability and validity.
• Reclassification of Disorders: Some disorders were reclassified or
renamed. For example, the category of "autism spectrum disorders" was
introduced, combining previous diagnoses of autism, Asperger's disorder,
and pervasive developmental disorder into one spectrum.
3. Inclusion of New Disorders
 • New Additions: DSM-5 added several new disorders, such as "hoarding
disorder" and "premenstrual dysphoric disorder." It also included "Internet
gaming disorder" in a section for further study, reflecting ongoing debates
about emerging issues in mental health.
4. Dimensional Assessments
• Severity Ratings: DSM-5 introduced dimensional assessments for certain
disorders, allowing clinicians to evaluate the severity of symptoms rather
than relying solely on categorical diagnoses. This approach acknowledges
that mental health conditions can exist on a spectrum.
5. Cultural Considerations
• Cultural Context: DSM-5 emphasized the importance of cultural context in
understanding and diagnosing mental disorders. It recognized that cultural
factors can influence symptom presentation and interpretation, crucial for
accurate diagnosis and treatment.

6. Changes in Terminology
• Updated Language: Some terms and classifications were updated to reflect
current understanding and reduce stigma. For example, the term "mental
retardation" was replaced with "intellectual disability".
7. Removal of Certain Disorders
• Disorders Excluded: Some previously recognized disorders were removed
or combined with others. For instance, the diagnosis of "gender identity
disorder" was replaced with "gender dysphoria," focusing on the distress
associated with gender incongruence rather than labeling the identity itself
as a disorder
8. Focus on Research and Evidence-Based Practices
 • Research Integration: DSM-5 aimed to incorporate new scientific
developments and research findings into the classification of mental
disorders, ensuring that the manual reflects the most current understanding
of mental health.
These changes in classification within DSM-5 represent a significant evolution in
the understanding and diagnosis of mental disorders, aiming to improve the
accuracy and relevance of mental health diagnoses in contemporary practice.

Merits and demerits of classification Prevalence of mental disorders

Merits of Classification of Mental Disorders

1. Standardization: Classification provides a standardized language and
criteria for diagnosing mental disorders, which helps ensure consistency and
reliability among clinicians. This facilitates communication and
understanding across different healthcare providers.
2. Facilitates Research: A clear classification system allows researchers to
study specific disorders more effectively, compare treatment outcomes, and
develop evidence-based practices. It enables the accumulation of knowledge
about mental health conditions.
3. Guides Treatment: Accurate classification helps clinicians select
appropriate treatment options based on specific diagnoses, improving the
chances of effective intervention and management of mental health issues.
4. Identification of Prevalence: Classification aids in identifying and
estimating the prevalence of mental disorders within populations, which is
crucial for public health planning and resource allocation.
5. Awareness and Education: A structured classification system can
enhance public awareness and understanding of mental health issues,
reducing stigma and promoting mental health literacy.
Demerits of Classification of Mental Disorders
1. Loss of Individuality: Classification can lead to oversimplification,
where individuals' unique experiences and complexities are lost in the
diagnostic label. This can result in a lack of personalized care.
2. Stigmatization: Labeling individuals with a mental disorder can lead to
stigma and discrimination, affecting their social interactions and self-esteem.
People may be judged based on their diagnosis rather than their individual
characteristics.
3. Cultural Bias: Classification systems may not adequately account for
cultural differences in expressing and understanding mental health issues.
This can lead to misdiagnosis or misunderstanding of symptoms in diverse
populations.
4. Overdiagnosis and Medicalization: There is a risk of overdiagnosing
normal variations in behavior or emotional responses as mental disorders,
leading to unnecessary treatment and medicalization of everyday life.
5. Dynamic Nature of Mental Health: Mental health conditions can change
over time, and rigid classification may not capture the fluidity of symptoms
and experiences, making it challenging to adapt diagnoses as individuals
evolve.
Prevalence of Mental Disorders
The prevalence of mental disorders is a critical aspect of understanding mental
health in populations. According to the DSM-IV data referenced in the text, the
lifetime prevalence of having any DSM-IV disorder is approximately 46.4%,
indicating that nearly half of Americans have experienced a mental illness at some
point in their lives.
 • Common Disorders: The most prevalent categories of psychological
disorders include anxiety disorders, major depressive disorder, alcohol
abuse, and specific phobias. Social phobias are also notably common.
• Severity of Disorders: While lifetime prevalence rates are high, it is
important to note that many individuals diagnosed with a mental disorder
may experience mild symptoms. For instance, in the NCS-R study, nearly
half of those with specific phobias had mild severity ratings, and only a
small percentage were considered severely impaired.
Understanding the prevalence of mental disorders helps inform public health
initiatives, resource allocation, and the development of effective treatment
strategies to address the mental health needs of the population.