Abnormal psychology

UNIT – I
Introduction to Abnormal Behavior Definition, Prevalence and Incidence of mental disorders-
Research Approaches in Abnormal Psychology- Historical views -Humanitarian approach-
Contemporary views - Overview on DSM-5 classification- Clinical Assessment and Diagnosis
UNIT – II
Causal Factors and View Points Causal and Risk factors for Abnormal Behavior - Biological view
point and causal factor, Psychological view point and causal factor, Socio cultural view point and
causal factor
UNIT – III
Anxiety Related Disorders and Stress Disorders Clinical picture, Causal factors, Treatment and
Outcome of the Anxiety Disorders and their Commonalities- Specific Phobias, Social Phobias,
Generalized Anxiety Disorder, Obsessive-Compulsive and Related Disorders - Stress disorders-
Adjustment disorder, Post-traumatic Stress Disorder
UNIT – IV
Mood disorders and Suicide Mood Disorders-Clinical picture, Causal factors, Treatment and
Outcomes - Types of Mood Disorders - Unipolar Depressive Disorders, Dysthymic Disorder, Major
Depressive Disorder, Premenstrual Dysphoric Disorder, Bipolar and Related Disorders- Cyclothymic
Disorder, Bipolar Disorders (I and II) – Suicide: Clinical Picture and Causal Pattern, Prevention and
Intervention
UNIT – V
Somatic Symptom and Dissociative Disorders Clinical picture- Causal factors- Treatment and
Outcome-Somatic Symptom and Related Disorders-Somatic Symptom Disorders, Hypochondriasis,
Somatisation Disorder, Pain Disorder, Conversion Disorder (Functional Neurological Symptom
Disorder), Illness Anxiety Disorder, Dissociative Disorders- Depersonalization/Derealization
Disorder, Dissociative Amnesia and Dissociative Fugue, Dissociative Identity Disorder
Table of Contents
Introduction to Abnormal Behaviour Definition....................................................................................3
Indicators of Abnormal Behaviour....................................................................................................3
Culture, society and abnormal behaviour:......................................................................................3
DSM 5 and definition of mental disorder..........................................................................................3
Classification and diagnosis..................................................................................................................4
Culture & abnormal behaviour..............................................................................................................4
Influence of culture............................................................................................................................4
Culture specific disorders..................................................................................................................4
How common are mental health disorders?...........................................................................................5
Keywords..........................................................................................................................................5
Treatment..........................................................................................................................................5
Research approaches in abnormal Psychology......................................................................................6
Sources of information..........................................................................................................................6
Case study.........................................................................................................................................6
Self-report data.................................................................................................................................7
Observational approach....................................................................................................................7
Forming and testing hypothesis............................................................................................................8
sampling and generalisation..............................................................................................................8
Internal and external validity.............................................................................................................8
Criterion and comparison groups......................................................................................................8
Correlational research design................................................................................................................8
Measuring correlation.......................................................................................................................9
Statistical significance........................................................................................................................9
Effect size...........................................................................................................................................9
Meta analysis...................................................................................................................................10
Correlation & causality....................................................................................................................10
Retrospective vs prospective strategies..........................................................................................10
Experimental method in Abnormal Psychology...................................................................................10
Studying efficacy of therapy............................................................................................................11
Single case experimental design......................................................................................................11
Animal Research..............................................................................................................................11
Unit 1
Introduction to Abnormal Behaviour Definition
AP is concerned with understanding the nature , causes and treatment of mental disorders.

Indicators of Abnormal Behaviour

No single indicator is sufficient inn itself to determine abnormality.. some of the indicators are:

1. Subjective distress - If people suffer or experience psychological pain we are inclined to

consider this as indicative of abnormality, eg dep or anxiety
On the other hand, manic people would deny taking medicine because they dontw ant to lose
their manic highs
Situational distress cannot be abnormal as well
2. Maladaptiveness - Maladaptive behavior is often an indicator of abnormality. Interferes with
wellbeing and our ability to enjoy our work and rel
3. Statistical deviancy – when something is statistically rare and represents a deviation from the
considered normal, it is called abnormal. But not all statistical deviance can be called
abnormal e.g. perfect pitch or high IQ.
4. Violation of standard of society- when people fail to follow the conventional and moral rules
of their cultural group.
Is mostly considered abnormal when an indv violates the standard or society and is
statistically rare
5. Social discomfort – when someone violates an implicit social rule, it may casue discomfort
for thos around them
6. Irrationality and unpredictability – irrationality and unpredictability to a certain extent is
normal or even adventurous, but the ability to control such behaviour is what separates it from
actual craziness or the craziness of a drama person.
7. Dangerousness – a person who is dangerous to oneself or others. Just because we may be a
danger to ourselves or to others does not mean we are mentally ill. Conversely, we cannot
assume that someone diagnosed with a mental disorder must be dangerous.

Culture, society and abnormal behaviour:

 Decision about abnormal behaviour always involve social judgement based on the values of
the society and culture.
 Society is constant changing, hence the definition of abnormal beh in accordance to social
view also changes.
o Homosexuality was once a mental disorder, is not anymore.

DSM 5 and definition of mental disorder

DSM 5 – 2013, Diagnostical Statistical Manual of mental disorders | APA | US
ICD 10 – International Classification of diseases | WHO | Europe
“Mental disorders are defined as a syndrome that is present in an individual and that
involves clinically significant disturbance in behaviour, emotional regulation or cognitive
functioning. Tehse disturbances reflect dysfunction in biological, psychological or
development processes that are necessary for mental functioning” DSM
 Mental disorders are associated with significant distress or disability in key areas of
functioning.

Classification and diagnosis

Advantages:
1. Nomenclature – gives clinicians shorthand and common language
2. Structure organisation – shapes the way information is organised
3. Classification facilitates research
Disadvantages:
1. Loss of information – simplification inevitably leads to loss if info
2. Stigma leads to stereotyping - Because we may have heard about certain behaviours that can
accompany mental disorders, we may automatically and incorrectly infer that these
behaviours will also be present in any person we meet who has a psychiatric diagnosis.
3. Labelling - person’s self-concept may be directly affected by being given a diagnosis of
schizophrenia, depression, or some other form of mental illness.

Culture & abnormal behaviour

Influence of culture
Within a given culture, many shared beliefs and behaviours exist that are widely accepted and that may constitute one
or more customary practices.
e.g Americans no. 13 (13 ppl in the last supper), Japanese people no. four (because it sounds a like the Japanese word
for death)

Culture specific disorders

1. Ataque de Nervoius
Attack of nerves
which is often triggered by a stressful event such as divorce or bereavement, include crying,
trembling, and uncontrollable screaming. There is also a sense of being out of control.
Sometimes the person may become physically or verbally aggressive. Alternately, the person
may faint or experience a seizure-like fit. Once the ataque is over, the person may promptly
resume his or her norm
2. Taijin kyofusho
Anxiety disorder prevalent in Japan.
Symptom – fear that one’s body fn, body parts may a offend others | people with this disorder
are afraid of blushing or upsetting people by their gaze, facial exp or body odour
3. Amok*
Male sp. group in Malaysia, characterised by depression and apathy, attacking others
4. Amurakh*
 Specific to Siberian women | echolalia |echopraxia (mimicking others behaviour)
5. Jumping men from Maine syndrome
Specific to men in malay and cuba
6. Windigo Psychosis
Specific north America
Delusions of flesh-eating monsters, they see spirits

How common are mental health disorders?

This information is needed to
1. Establish and plan mental health services
2. Estimates the frequency of mental health disorders in different groups of people may provide
valuable information as to the causes of this dimension.

Keywords
 Epidemiology: study of the distribution of diseases, disorders, or health related behaviours in
a given population.
 Prevalence: refers to the number of active cases in a population during any given period of
time.
 Point prevalence: estimated proportion of actual, active cases of a disorder in a given
population at a given point in time.
 Period prevalence: estimated proportion of actual, active cases of a disorder in a given
population at a given period
 Lifetime prevalence: estimated proportion of actual, active cases of a disorder in a given
population at least one time in life
 Incidence: rate of new cases
 Comorbidity: having two or more disorders existing in a person for a peiod of time
 DACY: Disability adjusted life years (number of healthy years they have lost)

Treatment
There is no treatment for every mental health disorder but, there is therapeutic procedures for
many of them. These include psychotherapy and medications as well

Half of individuals with depression delay seeking treatment for more than 6 to 8 years. For anxiety
disorders, the delay ranges from 9 to 23 years. When people with mental disorders do seek help,
they are often treated by their family physician rather than by a mental health specialist

Outpatient treatment: requires that a patient visit a mental health facility practitioner; however, the
patient does not have to be admitted to the hospital or stay there overnight.

Hospitalization and inpatient care:

are the preferred options for people who need more intensive treatment than can be
provided on an outpatient basis.

Budget cuts have also forced many large state or county facilities to close. The limitations
that insurance companies place on hospital admissions also contribute.

In inpatient care, treatment is given by a multi disciplinary band of people ranging from
psychiatric nurse, clinical psychologist, counselling psychologist, social worker and
psychiatrist. Patients treated in outpatient settings may also work with a team of
 professionals. However, the number of mental health specialists involved is typically much
smaller

Deinstitutionalisation movement away from long-stay inpatient hospitalization

Research approaches in abnormal Psychology

Through research we can learn about the symptoms of a disorder, its prevalence, whether it tends to
be either acute (short in duration) or chronic (long in duration), and the problems and deficits that
often accompany it. (why is research in abnormal psych important?)
Research allows us to further understand the etiology (or causes) of disorders. Finally, we need
research to provide the best care for the patients who are seeking assistance with their difficulties.
Limitations of research: we often attend only to data that confirm our view of how things are

Where can research take place ?

Abnormal psychology research can take place in clinics, hospitals, schools, prisons, and even highly
unstructured contexts such as naturalistic observations of the homeless on the street.
It is not the setting that determines whether a given research project may be undertaken
“Methodology is not merely a compilation of practices and procedures. Rather it is an approach
toward problem solving, thinking, and acquiring knowledge.”
As new techniques become available (brain-imaging techniques and new statistical procedures, to
name a few)

Sources of information
Case study
Case study in psychology refers to the use of a descriptive research approach to obtain an in-depth
analysis of a person, group, or phenomenon.

Goodies:

They can also provide some limited support for a particular theory or provide some negative
evidence that can challenge a prevailing idea or assumption.

case studies can be a valuable source of new ideas and serve as a stimulus for research, and
they may provide insight into unusual clinical conditions that are too rare to be studied in a
more systematic way.

Limitations:

the information presented in them is subject to bias because the writer of the case study
selects what information to include and what information to omit.

material in a case study is often relevant only to the individual being described.

conclusions of a case study have low generalizability—that is, they cannot be used to draw
conclusions about other cases even when those cases involve people with a seemingly
similar abnormality.

when the observations are made in a relatively uncontrolled context and are anecdotal and
impressionistic in nature, the conclusions we can draw are very narrow and may be mistaken
Self-report data
Methods of collecting self report data:

having our research participants complete questionnaires of various types

interviews. The researcher asks a series of questions and then records what the person says

limitations:

Self-report data can sometimes be misleading

people may not be very good reporters of their own subjective states or experiences.
Because people will occasionally lie, misinterpret the question, or desire to present
themselves in a particularly favorable (or unfavorable) light, self-report data cannot always
be regarded as highly accurate and truthful

Observational approach
When we collect information in a way that does not involve asking people directly (self-report), we
are using some form of observational approach

Forming and testing hypothesis

hypothesis is an effort to explain, predict, or explore something. Hypotheses are vital because they
frequently determine the therapeutic approaches used to treat a particular clinical problem
sampling and generalisation
Research in abnormal psychology is concerned with gaining enhanced understanding and, where
possible, control of abnormal behavior (i.e., the ability to alter it in predictable ways).
Whom should we include in our research study? In general, we want to study groups of individuals who have similar
abnormalities of behavior. a first step would be to determine criteria such as those provided in the current DSM for
identifying people affected with this clinical disorder. Ideally we would study everyone in the world with this
disorders, but since that is not possible we would try to get a representative sample of people who are drawn from this
underlying population. Sampling : select people who are representative of a much larger group
This sample group is them subjected to all the tests that is to be conducted in a large population, and are randomly
selected to reduce bias and give proper representation of the larger population. But this is not possible due to various
constraints, such as many don’t want to participate in studies like this.
Later the results from this sample population is generalised for the larger population.

Internal and external validity

The extent to which we can generalize our findings beyond the study itself is called external validity.

degree to which research findings from a specific study can be generalized to other samples,
contexts, or times, internal validity. In other words, internal validity is the extent to which a study is
methodologically sound, free of confounds, or other sources of error, and able to be used to draw valid conclusions.

Criterion and comparison groups

Comparison group (control group) : group of people who do not exhibit the disorder being studied
but who are comparable in all other major respects to the criterion group. Typically this group is
psychologically healthy or normal according to certain specified criteria.

Criterion group (group of interest) | comparison group (the group with which relationship is
established)

PLACIBO – Positive belief that treatment will work

NACIBO – negative belief that treatment will not work. The experimenter often says t hat they have
been receiving placebo instead of the actual treatment,
which discourages the patient.

Correlational research design

A correlational research design involves studying the
world as it is. Unlike a true experimental research design
(described later), correlational research does not involve
any manipulation of variables. Rather, the researcher
selects certain groups of interest then compare the groups on
a variety of different measures.
Using these types of research designs, we are able to
identify factors that appear to be associated with
depression, alcoholism, binge eating, or alternate
psychological states of distress.

Measuring correlation
Measures vary together in a direct, corresponding manner (known as a positive correlation)

Or conversely, an inverse correlation, or negative correlation, between the variables of interest.

The strength of a correlation is measured by a correlation coefficient, which is denoted by the

symbol r. A correlation runs from 0 to 1, with a number closer to 1 representing a stronger
association between the two variables. The + sign or – sign indicates the direction of the association
between the variables.

Statistical significance
Next to the correlation you will almost certainly see a notation that reads p < .05. This is the level of
statistical significance, indicating that the probability that the correlation would occur purely by chance is less
than 5 out 100. Researchers adopt this conventional level of significance and consider correlations that have a p < .05
to be statistically significant and worthy of attention.
Statistical significance is influenced not only by the magnitude or size of the correlation between the two variables but
also by the sample size.
Correlations based on very large samples (e.g., 1,000 people) can be very small and yet still reach statistical
significance. Conversely, correlations drawn from small samples need to be very large to reach statistical
significance

Effect size
The effect size reflects the size of the association between two variables independent of the sample
size. An effect size of zero means there is no association between the variables. Because it is
independent of sample size, the effect size can be used as a common metric and is very valuable
when we want to compare the strength of findings across different studies.

Meta analysis
When researchers want to summarize research findings in a specific area, they often do a literature
search and write a review. In drawing their conclusions, they will rely on significance levels.

A meta-analysis is a statistical approach that calculates and then combines the effect sizes from all
of the studies.

Correlation & causality

Correlation does not mean causation
Much more likely is that some unknown third variable might be causing both events to happen; third
variable problem.

Retrospective vs prospective strategies

Retrospective strategies : This involves looking back in time. In other words, we would try to collect
information about how the patients behaved early in their lives with the goal of identifying factors
that might have been associated with what went wrong later.

Limitations:

 A challenge with this technique is the potential for memories to be both faulty and selective.
 person who currently has a mental disorder may not be the most accurate or objective
source of information
 such a strategy invites investigators to discover what they already presume they will
discover concerning background factors theoretically linked to a disorder
 It invites biased procedure, unconscious or otherwise.

Prospective research : Here the idea is to identify individuals who have a higher-than average
likelihood of becoming psychologically disordered and to focus research attention on them before
any disorder manifests.

A study that follows people over time and that tries to identify factors that predate the onset of a
disorder employs a longitudinal design

Experimental method in Abnormal Psychology

Direction of effect problem: does A cause B, or B cause A
scientists control all factors except one—the factor that could have an effect on a variable or outcome of interest. They
then actively manipulate (or influence) that one factor.
The factor that is manipulated is referred to as the independent variable. If the outcome of interest, called
the dependent variable, is observed to change as the manipulated factor is changed, then that independent
variable can be regarded as a cause of the outcome

Studying efficacy of therapy

In treatment research it is important that the two groups (treated and untreated) be as equivalent as possible except for
the presence or absence of the proposed active treatment.
This is done by random assignment : means that every research participant has an equal chance of being placed in
the treatment or the no-treatment condition.
Once a treatment has been established as effective, it can then be provided for members of the original control
(untreated) group, leading to improved functioning for all those involved.

Standard treatment comparison study : two or more treatment are compared in differing yet comparable groups.

Single case experimental design

central feature of such designs is that the same individual is studied over time. Behavior or performance at one point
in time can then be compared to behavior or performance at a later time, after a specific intervention or treatment has
been introduced.
ABAB design
 First A phase serves as a baseline condition. Here we simply collect data on or from the participant.
 Then, in the first B phase, we introduce our treatment. Perhaps the person’s behavior changes in some way.
Even if there is a change, however, we are not justified in concluding that it was due to the introduction of
our treatment. Other factors might have coincided with its introduction, so any association between the
treatment and the behavior change might be spurious.
 To establish whether it really was the treatment that was important, we therefore withdraw the treatment and
see what happens. This is the reasoning behind the second A phase (i.e., at the ABA point).
 Finally, to demonstrate that the behavior observed during the B phase is attainable once again, we reinstate
our treatment and see if the behavioral changes we saw in the first B phase become apparent again.

Animal Research
An additional way in which we can use the experimental method is by conducting research with animals. Although
ethical considerations are still critical in animal research, we are able to perform studies using animal subjects that
would not be possible to implement with humans.
These type of studies are called analogue studies, where the true item of interest is not studied, but rather the mere
approximation to it.

Historical approach
Most of the treatment was given by the church
Edwin smith papyrus – surgery
Ashurbanipal cuneiform – first book to describe psychological disorder, mainly personality disorder
And treatment were usally related to exorcisim
Demonology, gods & magic
All mental disorders and some medical disorders were related to spirits and ghosts. Good spirits, bad
spirits.
Hippocrates early mediwomen hyster,cal concepts
Mania, melancholia (depression), Phrenitis (brain fever)
Made huge contribution for scientifc advancements
The earlist concept of delirium as a psychological condition - celsus

Early philosophical conceptions of consciousness

PLATO – studied criminal behaviour and stated that they need treatment for a medical hospital.
Psychological disorders arfe a mechanism of body disorders a whole. His book; the republic talks
about indv diff and sociocultural influence. Followed Hippocratic theory of humourism
Later Greek and roman thought
All the theories of Hippocrates was taken to Egypt. Egypt had more holistic therapy like rowing in
nile etc,
Ascelepiades of prusa – developed a theory of disease where he discussed the flow of ataom through
pores. Sp baths, sp diets, massages, sleep etc
Galen – developed on the humoural theory. Galen divided into two categories, physical and mental.
Cause- brain trauma, rel issues, subs abuse
Contraris contrarias- treatments would involve, opposing activities like having chilled wine inn hot
war. Treatment of opp of opp
Early views of mental dis in china

Dorothea Dix – Est 32 mental hospital, force of nurse in the American civil war. Vouched for better
mental treatment. 2 large mental institution in Canada. Mental hygiene movement grew in America.
Clifford beers continued this in America, he himself was a mental patient, kenw the horibbleness of
their mental innst.
1946 – The snake pit- Mary Jane Wart: how horrible the condition was in mental inst.
NIMH was established
Hill Burton Act along with community health service act came to effect. NIMH came with proper
clinical psych courses. Grace hospital – one of the community service hospital which was et up.
1961 Erwing Coffman - how horrible the condition was in mental inst.
Lithium – manic dep dis
Phenothyazin – schizo
William; Haloperidole (Hal dol)- psychotic disorders
CONTEMPRORY VIEWS
1 biological discoveries
2. development of classification system – creplin ; forerunner for DSM
3. Psychological causation Meser + Freud+ Nancy School
4. Psych Labs