PSYC A232 Study Guide U1 236

PSYC A232
Introduction to Abnormal Psychology
Study Guide
Unit 1
236
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236
Contents
Unit 1 Introduction to abnormality
Introduction...................................................................................................................... 1
Unit 1 outline ................................................................................................................... 2
Module 1: An overview of abnormal psychology ............................................................. 4
Activity 1.1 ................................................................................................................ 6
Historical perspectives on abnormality..................................................................... 7
Activity 1.2 ................................................................................................................ 8
The emergence of modern perspectives.................................................................. 9
Activity 1.3 .............................................................................................................. 11
Modern mental health care .................................................................................... 11
Reading 1.1 (E-Library) .......................................................................................... 11
Activity 1.4 .............................................................................................................. 12
Self-test 1.1 ............................................................................................................ 12
Module 2: Theories and treatment of abnormality ......................................................... 12
Biological approaches ........................................................................................... 13
Psychological approaches .................................................................................... 14
Sociocultural approaches ....................................................................................... 16
Activity 1.5 .............................................................................................................. 18
Activity 1.6 .............................................................................................................. 19
Self-test 1.2 ............................................................................................................ 19
Module 3: Assessing and diagnosing abnormality ........................................................ 20
Types of assessment tools ..................................................................................... 22
Activity 1.7 .............................................................................................................. 23
Challenges in assessment ..................................................................................... 24
Diagnosis ............................................................................................................... 25
Activity 1.8 .............................................................................................................. 26
Self-test 1.3 ............................................................................................................ 26
Summary ....................................................................................................................... 27
References .................................................................................................................... 27
Feedback on activities and self-tests ............................................................................ 27
Unit 1 1
Unit 1
Introduction to abnormality
Introduction
Welcome to PSYC A232 Introduction to Abnormal Psychology! This course aims to introduce
various types of psychological disorders falling under the psychiatric nomenclature and other
behavioural models. It will cover the major theories and research concerning the origin,
diagnosis, and treatment of a selection of disorders.
Unit 1 of the course includes three modules. We will introduce the fundamental concepts of
abnormality in Module 1, and consider historical perspectives on abnormality and how
modern understandings of mental health and abnormality emerged. Module 2 explores
biological, psychological and sociocultural approaches to understanding mental disorders and
their treatment. In Module 3, we will discuss assessment and diagnosis along the continuum
of abnormality.
In short, this unit:
• defines abnormality;
• appraises the historical perspectives on abnormality and the emergence of modern
perspectives;
• evaluates modern mental health care;
• identifies the biological, psychological and sociocultural approaches along the
continuum of abnormality;
• assesses prevention programmes and common elements in effective treatments;
• describes assessment and diagnosis along the continuum of abnormality; and
• evaluates assessment tools, as well as challenges in assessment and diagnosis.
All the learning tasks are clearly outlined in this Study Guide, and it is highly recommended
you follow this guide in your study, as we will highlight and elaborate on important concepts,
and provide you with opportunities for self-assessment. However, this study guide does not
replace your textbook reading. In this unit, you will need to cover the following materials:
2 PSYC A232 Introduction to Abnormal Psychology
• Unit 1 of your custom textbook, entitled ‘Introduction to abnormality’

• Three assigned readings.
Unit 1 outline
The following provides you with an outline for working through Unit 1. The page numbers
refer to the page numbers of your custom textbook. The activities and self-tests are shown in
italics. The assigned readings are available in the University’s E-Library. Remember to refer
also to the Online Learning Environment (OLE) as you work through the unit.
Module 1: Looking at abnormality

Abnormality along the continuum [p. 3]
Defining abnormality [p. 4]
The four Ds of abnormality
The disease model of mental illness
Cultural norms
Activity 1.1
Historical perspectives on abnormality [p. 7]
Ancient theories
Medieval views
The spread of asylums
Moral treatment in the eighteenth and nineteenth centuries
Activity 1.2
The emergence of modern perspectives [p. 13]
The beginnings of modern biological perspectives
The psychoanalytic perspective
The roots of behaviourism
The cognitive revolution
Activity 1.3
Modern mental health care [p. 16]
Deinstitutionalisation
Managed care
Professions within abnormal psychology
Reading 1.1 (E-Library)
Activity 1.4
Self-test 1.1
Unit 1 3
Module 2: Theories and treatment of abnormality

Approaches along the continuum [p. 25]
Biological approaches [p. 27]
Brain dysfunction
Biochemical imbalances
Genetic abnormalities
Drug therapies
Electroconvulsive therapy and newer brain stimulation techniques
Psychosurgery
Psychological approaches [p. 38]
Behavioural approaches
Cognitive approaches
Psychodynamic approaches
Humanistic approaches
Family systems approaches
Third-wave approaches
Using new technology to deliver treatment
Sociocultural approaches [p. 50]
Cross-cultural issues in treatment
Culturally specific therapies
Activity 1.5
Prevention programs [p. 54]
Common elements in effective treatments [p. 55]
Activity 1.6
Self-test 1.2
Module 3: Assessing and diagnosing abnormality
Assessment and diagnosis along the continuum [p. 61]
Assessment tools [p. 63]
Validity
Reliability
Standardisation
Clinical interview
Symptom questionnaires
Personality inventories
Behavioural observation and self-monitoring

Intelligence tests
Neuropsychological tests
Brain-imaging techniques
Psychophysiological tests
Projective tests
Activity 1.7
Challenges in assessment [p. 71]
Resistance to providing information
Evaluating children
Evaluating individuals across cultures
Diagnosis [p. 74]
Diagnostic and Statistical Manual of Mental Disorders (DSM)
The social-psychological dangers of diagnosis
What happens after a diagnosis is made?
Activity 1.8
Self-test 1.3
Summary
Module 1: An overview of abnormal

psychology
What do the terms ‘abnormal’, ‘abnormality’, and ‘abnormal behaviour’ mean? This
introductory module begins by placing the label within the framework of a continuum. The
continuum model of abnormality views mental disorders not as categorically different from
‘normal’ experiences. Instead, it considers that individual behaviours, thoughts and feelings
lie somewhere along a continuum ranging from healthy and functional to unhealthy and
dysfunctional. It also takes into account elements such as history, place, tradition, culture,
purpose, and gender as important variables in determining whether a particular behaviour or
set of behaviours is normal.
Please begin your study of this unit by turning to the following topics in your custom
textbook to learn about how abnormality is defined.
Unit 1 5
Textbook topics
Abnormality along the continuum [p. 3]
Defining abnormality [p. 4]
The four Ds of abnormality
The disease model of mental illness
Cultural norms
Generally, we can say that abnormal psychology is the study of psychological dysfunctions
that an individual experiences in terms of distress or impairment in functioning; a complete
definition of abnormal behaviour allows for behaviours and experiences accepted within
one’s culture. Psychopathology refers to the scientific study of mental illness and atypical and
unexpected behaviours as well as their causes.
There are four dimensions of abnormality, often referred to as the ‘four Ds’:
• unusual for the social context (deviant);
• distressing to the individual;
• interfering with social or occupational functioning (dysfunction); and
• dangerous.
Deviance: When an individual’s behaviour deviates from norms, i.e. ‘crosses the line’ in
some way, this can be described as abnormal. For example, we dress in swimwear at the
beach, but it would be abnormal to do so in a shopping mall. An individual with deviant
behaviours might be more likely to be suffering from a mental disorder or abnormal mental
status.
Distress: This refers to non-specific unpleasant emotions or feelings that an individual
experiences that affect daily functioning. Abnormal behaviours and feelings may cause
distress to the individual or people around them. Continuing with the example above, would
you feel distress or discomfort if you went to a shopping mall and your friend showed up in a
swimsuit? This violation of a dress code norm may cause you to feel very distressed and
uncomfortable, although your friend in swimwear may not feel the same.
Dysfunction: When behaviours, thoughts and feelings interfere with one’s ability to function
in daily life, they are considered dysfunctional. The dysfunction might be psychological,
physiological and/or developmental in nature for any atypical behaviours. For example, a
depressed individual is likely to withdraw from everyday activities and to stop
communicating with family or friends, or find themselves incapable of completing assigned
job tasks because of severe inability to concentrate.
Dangerousness: Deviant behaviours or feelings can be potentially harmful, such as suicidal
thoughts or excessive aggression. These behaviours may be dangerous to the individual or to
others.
Taken together, abnormal behaviours might be explained using the four Ds. However, the
four Ds are not equivalent to, nor sufficient for, a diagnosis of a psychological disorder given
by a mental health professional. A formal diagnosis requires a psychological evaluation
fitting specific criteria.
Behaviours, thoughts, and feelings are dysfunctional, pathological or abnormal when they
interfere with the person’s ability to function in daily life, hold down a job, or form close
relationships. In other words, these are the symptoms of a mental illness. Having a mental
disorder results in lost productivity, lost personal enjoyment, and potentially even premature
death.
Cultural relativism is the idea that behaviours are relative to cultural norms of a place or
time, and that there is no universally normal or abnormal behaviour. For example, in the past,
when men were expected to become breadwinners while women were supposed to raise
children, anyone who violated these cultural norms would have been labelled abnormal.
However, today we appreciate that individuals can choose various lifestyles regardless of
their gender. Cultural norms play a large role in defining abnormality. Relativist views of
abnormality may not only arise from cultural norms but also from gender differences.
Being labelled as abnormal can lead to stigma — negative attitudes and beliefs towards
certain individuals, such as those with mental illnesses, that cause others to avoid them. The
stigma associated with the abnormal label has the effect of dehumanising people we consider
different to ourselves, and also impacts how individuals who suffer from mental health issues
perceive themselves. With a better understanding of the disorders presented throughout this
course, we can gain a deeper understanding of mental disorders and greater compassion
towards those affected by them.
Please attempt the following activity before you move on. After completing any activity or
self-test, check the feedback at the end of this Study Guide or in the interactive ePub version
on the OLE.
Activity 1.1
Consider the following scenarios and decide whether the behaviours described are normal or
abnormal. Then, try to apply the four Ds criteria for defining abnormality to each of them.
1. A man, in his shorts, goes out to his front yard every morning at about 6 a.m., climbs a
flagpole, comes back down, climbs it again, comes back down, does it one more time,
and goes back into his house to eat breakfast.
2. A man, in his shorts, goes outside every morning at about 6 a.m. and runs around the
block five times before going back inside to eat breakfast.
3. When dealing with a patient, a doctor barks like a dog and crawls on his hands and
knees.
4. Before deciding to go on a date, a woman consults her horoscope for the day to help her
make a decision.
5. A person feels that everyone is constantly watching them and making judgements about
them, and that other people’s thoughts and conversations tend to revolve around them.
6. A woman believes that the security police are watching her and have planted a
microphone inside her eyeglasses.
7. A man gets up each morning and spends an hour putting on elaborate make-up and
styling his hair before going to work.
8. A woman gets up each morning and spends an hour putting on elaborate make-up and
styling her hair before going to work.
Unit 1 7
9. A person feels extremely uncomfortable around other people, stays in their apartment
most of the time, and has chosen a job that requires minimal interactions with others.
10. Once every month, a man becomes extremely depressed and irritable to the point where
he can’t get out of bed to go to work, and he yells at his children for no apparent reason.
Historical perspectives on abnormality

Understandings of abnormality have evolved across history, from ancient and medieval views
to asylums in Europe and moral treatment in the eighteenth and nineteenth centuries. Indeed,
these historical perspectives have strong influences on modern conceptions of mental
disorders. Please now read the following topics in your custom textbook. We will highlight
some of the key developments in the discussion below.
Textbook topics
Historical perspectives on abnormality [p. 7]
Ancient theories
Medieval views
The spread of asylums
Moral treatment in the eighteenth and nineteenth centuries
Ancient theories
From the Stone Age to the Middle Ages, disease and especially mental illness was probably
seen from a religious or supernatural perspective, involving evil spirits or the devil. When
someone was observed to act in a bizarre way, it may have been assumed that they were a
witch, or that they were possessed. There was no concept of mental illness, and the
‘treatment’ was to try to drive the evil spirits from the body of the abnormally behaving
individual, according to supernatural beliefs. Trephination — drilling holes in the skull using
a tool called a trephine, which was practised in many parts of the world — is believed by
some historians to be an early treatment for abnormal behaviours.
Ancient Chinese medicine adopted yin and yang which represent the negative and positive
forces respectively. Maintaining a balance between these two forces keeps an individual
healthy, otherwise, illness and insanity might result, as recorded in the Nei Ching (Classic of
Internal Medicine). Although the writers of the time did not conceptualise the abnormal
behaviours as psychopathology, they did describe in some detail particular characteristics of
different mood disorders including bipolar disorder, depression, and such psychotic processes
as hallucinations and delusions, using the Chinese medical philosophy that emotions are
controlled by internal organs where ‘vital air’ plays a key role. For instance, when ‘vital air’
flows on the heart, we feel happy; on the lungs, we feel sad; on the kidney, we feel fear, and
so on.
In ancient Egypt, Greece and Rome, Greeks conceptualised abnormal behaviour as an
affliction from the Gods. Many philosophers such as Plato and Socrates argued that forms of
abnormal behaviours were divine and were the source of great literacy and prophetic gifts.
On the other hand, the Greek physicians rejected the idea of abnormal behaviour as
supernatural. Hippocrates proposed that abnormal behaviours were similar to other diseases
of the body in that they were caused by imbalances in the body’s humours: blood, phlegm,
yellow bile and black bile. Thus, the treatment for abnormal behaviour was to restore the
balance of the four essential humours.
The Medieval and Renaissance periods

As mentioned above, a supernatural view of abnormality was dominant in the Middle Ages in
Europe. Psychic epidemics are a feature of this era. The term refers to a phenomenon in
which a large number of people engage in unusual behaviours that appear to have a
psychological origin. For example, medieval writers described the occurrence of dance
frenzies or manias. Tarantism was another similar phenomenon in Italy in the 14th–17th
centuries. People were said to have experienced acute pain from the bite of a tarantula,
causing them to jump around wildly in the streets, beating each other and tearing at their
clothes. At the time, possession by the devil was an explanation for psychic epidemics and
tarantism. Today, psychologists try to understand psychic epidemics through social
psychological research. They might be seen as the influence of others on individuals’ self-
perceptions under different social contexts as well as physical sensations.
In Europe, starting in the twelfth century, asylums provided specific housing for people who
were considered mentally ill (displaying abnormal behaviours), often with terrible living
conditions. One famous example was the Hospital of Saint Mary of Bethlehem (nicknamed
Bedlam) established in 1547 in London. Gradually, the number of these asylums increased
and those running the hospitals embraced the concept that people with abnormal behaviour
were suffering from medical illnesses, such as problems in the brain.
The eighteenth and nineteenth centuries

A French physician, Philippe Pinel, took the revolutionary step to release patients with
abnormal behaviours from confinement within asylums. He reformed a mental hospital for
female patients in Paris as he believed that many forms of abnormality could be cured by
restoring patients’ dignity and tranquility. The moral treatment movement was initially
successful, but its rapid expansion meant that the health professionals working in the
reformed institutions were not able to give enough time and attention to each patient.
Activity 1.2
Across history, trephination (drilling holes in the skull of an individual) can be considered as
evidence that prehistoric and ancient societies believed abnormality had supernatural causes.
Alternative views consider that it could have served as therapy for mental illnesses and other
conditions, such as epilepsy. In any case, trephination would clearly have been a dangerous
procedure. Do you think that the practice of trephination was a rational one? Why or why
not?
You may read the following article to find out more about the subject:
https://thereader.mitpress.mit.edu/hole-in-the-head-trepanation/
Unit 1 9
The emergence of modern perspectives

In the previous section we have seen that psychopathology has been shaped by different
perspectives across time. Since the twentieth century, modern perspectives dominate
abnormal psychology and psychiatry.
Please read the following sections on the emergence of modern perspectives and then move
on to the modern approach of mental health care.
The emergence of modern perspectives [p. 13]

The beginnings of modern biological perspectives
The psychoanalytic perspective
The roots of behaviourism
The cognitive revolution
Modern mental health care [p. 16]
Deinstitutionalisation
Managed care
Professions within abnormal psychology
In the twentieth century, different perspectives have shaped modern understandings of

abnormality. The following table provides a summary.
Table 1.1 Overview of key modern psychological perspectives
Perspectives Description
Modern Rapid development of knowledge in the fields of anatomy, physiology,
biological neurology, and basic sciences in the late 19th century led to an
perspectives emphasis on understanding abnormality using biological causes.
Biological theories emphasise the role of genetics, structural and
functional abnormalities in the brain, and biochemical imbalances.
These perspectives have enabled classification systems for various
psychological disorders and their symptoms, as well as therapeutic
medications to be developed.
Psychoanalytic Psychoanalysis is the study of the unconscious, most associated with
perspective the work of Sigmund Freud. Freud proposed that abnormal behaviours
and emotions arise from conflicts at an unconscious level. Freud’s
psychoanalytic perspective led to an approach in psychological therapy
that seeks to explore how behaviours and experiences (especially
childhood experiences) may be influenced by internal processes outside
of an individual’s awareness. The perspective remains popular to this
day.
Behavioural Ivan Pavlov conceptualised behaviour in terms of the association of
perspectives stimuli and responses. His most famous discovery is the mechanism of
classical conditioning, through his experiments on dogs pairing food
and sounds to induce salivation. Two subsequent behaviourists, Edward
Thorndike and B F Skinner, viewed conditioning as the degree to which
the consequences of a particular behaviour shape the likelihood of
recurrence, known as operant conditioning. In all, the behavioural
perspective refers to a psychological approach focused only on actions
and behaviours, rather than internal processes or aspects of
consciousness.
Cognitive Observational learning (also known as modelling) illustrates how
perspectives humans imitate the behaviours of others even without reinforcement as
shown in the work of Albert Bandura. The cognitive behavioural
perspective suggests that dysfunctional thinking is common to all
psychological disturbances, and by learning in therapy how to
understand one’s thinking, it is possible to change the way one thinks as
well as one’s emotional state and behaviours. Cognitive behavioural
therapy (CBT) developed by Albert Ellis and Aaron Beck is directed at
changing the individual’s faulty logic and maladaptive behaviours.
Unit 1 11
Activity 1.3
Please answer the following questions.
1. Every time somebody flushes a toilet in the house, the shower becomes very cold and
causes the person to jump back. Over time, the person begins to jump back
automatically after hearing the flush, before the water temperature changes. Please
explain the mechanism of classical conditioning in this example.
2. Suggest one limitation of behaviourism.
3. What is the common feature of all psychological disturbances from a cognitive
behavioural perspective, and how does this relate to therapy?
Modern mental health care

The discovery of drugs to treat psychological disorders was one of the major breakthroughs
of the twentieth century. Other than drugs, deinstitutionalisation marked another milestone of
progress in mental health care delivery. Deinstitutionalisation is the process by which the
mentally ill can recover more fully or live more satisfying lives if they are integrated into the
community, with the support of community-based treatment facilities.
The deinstitutionalisation movement which occurred alongside the patients’ rights movement
had a massive effect on the lives of people with serious psychological problems. Taking a
multi-disciplinary approach, community-based treatment facilities were created with services
provided by social workers, therapists, and physicians, moving away from long-term
inpatient hospitals. Hospitalisation is still necessary in times of need. The goal of this
approach is to provide the least restrictive methods of care to those with mental illnesses. Yet,
this approach brings along both positive and negative results. While deinstitutionalisation has
allowed many people with mental illnesses to live independently, some end up homeless or
incarcerated. Depending on the location and context, this may be because community clinics
and other support systems are not available or are inadequately funded, or perhaps because
mental illness is seen as a personal failing rather than a social problem. Thus, the outcome of
the deinstitutionalisation movement is mixed.
We have just learnt that shifting care for individuals from a hospital setting to community-
based mental health care setting is called deinstitutionalisation. Please now read the following
review article which will give you a deeper understanding of deinstitutionalisation by
describing its effects on schizophrenia patients.

Kunitoh, N. (2013). From hospital to the community: The influence of
deinstitutionalization on discharged long‐stay psychiatric patients. Psychiatry and
Clinical Neurosciences, 67(6), 384–396.
This article is available in the University’s E-Library → E-Reserve.
The author of this paper reviewed 14 articles that examined the effects of
deinstitutionalisation on schizophrenia patients. Its aim is to explore the influences of
deinstitutionalisation from two perspectives: (1) the differences in discharged long-stay
patients before and after discharge, and (2) the differences between discharged patients and
patients in hospital. The study found that this rehabilitation approach can improve outcomes
such as psychiatric symptoms, social functioning, quality of life and stability. It is suggested
that re-involving patients in the community is of benefit to these patients.
Activity 1.4
What are the advantages and disadvantages of the deinstitutionalisation of people with
serious mental illnesses, for example schizophrenia? Note down at least three arguments for
each side.
Self-test 1.1
This module has presented different explanations of abnormality from history to the modern
day. Briefly define and summarise the characteristics and approaches to treatment for each of
the following broad groups of theories:
• Biological theories of abnormality
• Supernatural theories of abnormality
• Psychological theories of abnormality
Module 2: Theories and treatment of

abnormality
You have explored concepts of abnormality from past to present in Module 1. Module 2
investigates three general approaches to understanding psychological disorders: biological,
psychological, and sociocultural. In this module, we are going to identify each approach
along the continuum of abnormality in an attempt to see how these three seemingly
incompatible approaches might be integrated into a biopsychosocial approach to mental
disorders.
Please now read the following topics in your custom textbook, and then come back to this
study guide.
Textbook topics
Approaches along the continuum [p. 25]
Biological approaches [p. 27]
Brain dysfunction
Drug therapies
Electroconvulsive therapy and newer brain stimulation techniques
Psychosurgery
Unit 1 13
Psychological approaches [p. 38]

Third-wave approaches
Using new technology to deliver treatment
Sociocultural approaches [p. 50]
Cross-cultural issues in treatment
Culturally specific therapies
Biological approaches
Biological approaches provide three explanations of the causes of mental disorders, namely
brain dysfunction, biochemical imbalances, and genetic abnormalities.
Brain dysfunction
People whose brains do not function properly experience problems in psychological
functioning. Different brain regions are responsible for different functions. The three major
divisions are the hindbrain which is crucial for basic life function, the midbrain which relays
sensory information and controls movement, and the forebrain which handles receiving and
processing sensory information, producing and comprehending language, controlling
emotions, and memory processing amongst others. Both injury and diseases can cause brain
dysfunction.
Different biochemicals serve to communicate brain signals, and mental disorders may result
when these are dysregulated. These biochemicals include neurotransmitters (biochemicals
that act as messengers carrying impulses between neurons throughout the brain and nervous
system) and hormones (chemicals produced by endocrine glands and released directly into
the blood, transmitting messages through the body). The master gland of the endocrine
system is called the pituitary gland, which is located just below the hypothalamus in the
brain. It produces the largest number of hormones and controls the secretions of the other
endocrine glands.
The study of the genetics of personality and abnormality is called behavioural genetics and
its focus is to investigate the extent to which behaviours / behavioural tendencies are
inherited, and identify the processes by which genes affect behaviours. The interaction
between genes and environment is a key consideration — our genetic factors may influence
our choice of environment, and at the same time, this interaction reinforces our genetically
influenced characteristics and interests. Moreover, genetic predispositions may manifest
differently depending on the environment, as not all individuals are affected the same way
with the same extent of exposure. The environment may act as a catalyst for genes to be
expressed, an area of research known as epigenetics.
Drug therapies
Medications aim to relieve psychological symptoms by tackling the functioning of
neurotransmitter systems. They are further classified based on what they are designed to
accomplish. These categories include mood stabilisers, antianxiety drugs, antidepressant
drugs, and antipsychotic drugs. Table 1 on page 35 of your textbook provides a summary and
examples of different drug therapies for psychological disorders.
Psychological approaches
Psychological approaches view disorders as the result of thinking processes, personality
styles, emotions, and conditioning. Your textbook covers six major psychological
approaches: behavioural, cognitive, psychodynamic, humanistic, family systems and third-
wave approaches. We will review the first five below. Third-wave approaches are a more
recent development building on behavioural and cognitive approaches with the additional
element of mindfulness to understand and manage emotions.
Under behaviourism, the major theories are classical conditioning, operant conditioning and
observational learning. These theories can help to explain and treat psychological disorders.
We review classical and operant conditioning below.
Classical conditioning
This is a form of learning whereby a reflex (i.e. involuntary) response is attached to a
stimulus other than the original, natural stimulus that would normally produce the reflex.
Classical conditioning can be used to explain people’s irrational responses towards a neutral
stimulus. Its elements are as follows:
• Unconditioned stimulus (US): a naturally occurring stimulus that leads to an involuntary
response.
• Unconditioned response (UR): an involuntary response to a naturally occurring or
unconditioned stimulus.
• Conditioned stimulus (CS): a stimulus that becomes able to produce a learnt reflex
response by being paired with the original unconditioned stimulus. Conditioned means
‘learnt’.
• Neutral stimulus (NS) can become a conditioned stimulus when paired with an
unconditioned stimulus.
• Conditioned response (CR): the learnt reflex response to a conditioned stimulus.
Operant conditioning
This is the learning and shaping of voluntary behaviour through the effects of pleasant and
unpleasant consequences. Thorndike and Skinner contributed significantly to the
development of the principles of operant conditioning. Thorndike proposed the law of effect
that states that if a behaviour is followed by a reward, the behaviour is strengthened, while if
a behaviour is followed by a punishment, it will be weakened. Skinner built on Thorndike’s
Unit 1 15
work by studying only observable, measurable behaviour. He proposed that learning depends
on the consequences of the behaviour. Operant conditioning mechanisms can help us
understand certain abnormal behaviours in people. Its elements are as follows:
• Reinforcement: any event or stimulus that, when following a response, increases the
probability that the response will occur again.
• Positive reinforcement: the reinforcement of a response by the addition or experience of
a pleasurable stimulus.
• Negative reinforcement: the reinforcement of a response by the removal, escape from, or
avoidance of an unpleasant stimulus.
• Punishment: any event or object that, when following a response, lowers the likelihood
of that response happening again.
• Punishment by application: the punishment of a response by the addition or
experiencing of an unpleasant stimulus.
• Punishment by removal: the punishment of a response by the removal of a pleasurable
stimulus.
The following matrix illustrates the four ways to modify behaviours using operant
conditioning.
Reinforcement Punishment
Positive (Adding) Something valued or Something unpleasant

desirable
Positive reinforcement Punishment by application

Example: getting a gold star Example: getting a spanking
for good behaviour at for disobeying
school
Negative (Removing/ Something unpleasant Something valued or

Avoiding) desirable
Negative reinforcement Punishment by removal

Example: fastening a seat Example: losing a privilege
belt to stop the alarm from such as going out with
sounding friends
Figure 1.1 Modification of behaviour via operant conditioning
By identifying reinforcements and punishments that contribute to an individual’s maladaptive

behaviours, behavioural therapies can help to change specific behaviours. An example of a
behavioural therapy is systematic desensitisation therapy which helps to treat phobias.
Cognitive theories propose that punishment and rewards alone are not sufficient to motivate
human behaviour, and that we should also take cognitions (thoughts or beliefs) into account
to explain how our behaviour and emotions are shaped. The cognitive model suggests that
people’s emotions and behaviours are influenced by their perceptions of events. The
implication here is that the way people perceive and interpret situations determines what and
how people feel, rather than the nature of the event itself. These theories led to the
development of cognitive therapies to help clients to identify their negative or irrational
thoughts and help them to challenge these forms of thinking. Cognitive techniques can also
be combined with behavioural techniques, as in the case of cognitive-behavioural therapy
(CBT) which helps clients to focus on problems and difficulties in the ‘here and now’. CBT
therapists guide clients to gather evidence to undermine unhelpful beliefs and use behavioural
assignments as coping strategies.
Psychodynamic theories of abnormality suggest that all behaviours, thoughts and emotions
are influenced by unconscious processes. Freud developed psychoanalysis and his followers,
although many did not fully agree with his theories, placed an emphasis on uncovering and
resolving the unconscious conflicts that are thought to drive psychological symptoms. The
goals of psychodynamic therapies are to help clients with maladaptive coping strategies by
going to the source of their unconscious conflicts. In this way, clients can gain insights which
can free them from the grip of the past and give them a sense of agency to make changes in
the present. Examples of psychodynamic techniques are free association and dream analysis.
Humanistic theories are based on the assumptions that humans have an innate capacity for
goodness and for living a full life (i.e. to live to the fullest potential). Humanistic theorists
recognise that we are not often aware of the forces shaping our behaviour and that the
environment can play a major role in our happiness and unhappiness. One of the key figures
in humanism is Carl Rogers. He believed that individuals naturally move towards personal
growth, self-acceptance and self-actualisation (the fulfilment of their potential for love,
creativity and meaning). People often experience conflict when there are differences between
the ideal self and actual self, which leads to emotional distress and unhealthy behaviours. As
such, the goal of humanistic therapy is to help clients to discover their greatest potential
through self-exploration.

Theories of family systems view the family as a complex interpersonal system which
possesses its own hierarchy and rules that govern family members’ behaviours. The family
system can function well and promote the well-being of its members, supporting their growth
and accepting their changes. Family systems therapy is based on the belief that an
individual’s problems are always rooted in the larger interpersonal system. It is suggested that
one can only be treated when the entire family system is treated. Behavioural family systems
therapy targets family communication and problem solving and identifies systemic barriers.
Sociocultural approaches
Sociocultural approaches to mental disorders view them as the result of environmental
conditions and cultural norms. These approaches ask us to look beyond the individual or
family level to the larger society in order to understand the needs of the individual. Each of
us is born into a cultural matrix of beliefs, values, rules, and social practices. This matrix
creates differences in how society views socio-demographic groups and how the members of
those groups see themselves and others. Stigmatisation and marginalisation of certain groups
Unit 1 17
might be created as a result of social norms and policies. Thus therapists adopting
sociocultural approaches seek to adapt the therapy to the culture of the client.
The following table provides a summary of the key concepts in each domain of the three
major approaches we have covered in Module 2.
Table 1.2 Summary of key ideas from the biological, psychological and sociocultural approaches
Domain Evidence/Method
Biological Brain dysfunction The case of Phineas Gage; brain
approaches structures; cerebral cortex;
limbic system
Biochemical imbalances Neurotransmitters and the
synapse; endocrine system
Genetic abnormalities Chromosomes and DNA;
interaction between genes and
environment; epigenetics
Drug therapies Antipsychotic drugs;
antidepressant drugs; lithium;
antianxiety drugs
Psychological Behavioural approaches Classical conditioning; operant
approaches conditioning; modelling and
observational learning;
behavioural therapies
Cognitive approaches Cognitive therapies
Psychodynamic approaches Psychodynamic theories and
therapies
Humanistic approaches Humanistic theories and
therapies
Family systems approaches Family systems therapy
Third-wave approaches Dialectical behaviour therapy;
acceptance and commitment
therapy
Sociocultural The individual in the context of Culturally-specific therapies
approaches the wider society and culture
Contemporary theorists use the term biopsychosocial to recognise the fact that psychological
symptoms integrate biological, psychological and sociocultural factors. This view suggests
that individuals with mental illnesses or other medical disorders should be understood from
more than one single perspective — not just as chemical imbalances in the brain, or
unconscious conflicts, for instance, but a combination of these and perhaps others. A
biopsychosocial view recognises that the three factors contribute to the way psychological
symptoms develop. Figure 13 on page 57 of your textbook provides an illustration of this
idea.
Moreover, these various factors can be conceptualised as risk factors. However, do not get
confused here — a risk factor itself may not be strong enough to lead to one to develop
severe psychological symptoms. Another term for risk factor is diathesis. According to the
diathesis-stress model, the creation of a psychological disorder requires both an existing
diathesis to a disorder and a trigger or stress. Triggering factors such as changes in hormone
levels or the experience of traumatic events might cause the onset of mental problems.
Activity 1.5
You have explored the three broad categories of approaches to understanding psychological
disorders (biological, psychological and sociocultural) along the continuum of abnormality.
In the following table, please identify which broad approach is associated with each
subdomain or therapy, and outline the criticisms or concerns associated either with the
therapy or the approach more broadly.
Subdomain/Therapy Approach Critiques and concerns

Behavioural
approaches
Drug therapies
Psychodynamic
approaches
Humanistic
approaches
Culturally-specific
therapies
Family systems
approaches
Please now read the following sections in your custom textbook.
Textbook topics
Prevention programs [p. 54]
Common elements in effective treatments [p. 55]
Prevention programmes are designed to reduce the likelihood of people developing

psychopathology in the first place, rather than waiting to treat it once it develops. There are
three levels of prevention strategies:
• The primary prevention goal is to stop psychological disorders from developing by
conducting awareness campaigns or education programmes.
• The secondary prevention goal is to arrange early detection and intervention for those at
higher risk of experiencing mental health problems, such as through screening to detect
certain types of psychological disorders.
• The tertiary prevention goal is to prevent relapse and reduce symptoms of psychological
disorders and improve quality of life.
Unit 1 19
Figure 12 on page 55 of your textbook illustrates this model. This preventive care model
focuses on the social determinants of mental health, i.e. societal problems that affect large
segments of the population and interfere with optimal mental health both directly and
indirectly.
We have touched on a variety of therapeutic approaches in this module. There is no universal
type of therapy — some forms might be more effective for a particular group but not the right
fit for others. Nevertheless, successful therapies have some common elements. The following
list suggests some of the components of effective therapies:
• Positive therapeutic relationship between the client and the therapist
• Psychotherapy sessions that involve authenticity, empathy and positive regard
• Building a client-therapist alliance
• The therapy gives clients an explanation or interpretation of why they are suffering
• Clients are encouraged to confront painful emotions
• The therapy is characterised by warmth, cooperation and transparency.
Activity 1.6
What are the qualities that a psychotherapist should have in order to offer effective
treatments? Please suggest at least three.
Self-test 1.2
The stages of primary, secondary and tertiary prevention indicate the scope of interventions
available to health experts who implement prevention programmes. What is the overarching
aim of a prevention programme and what are the key goals at each level?
Module 3: Assessing and diagnosing

abnormality
Mental health professionals have various tests or tools at their disposal to assess clients’
mental health. The accuracy, standardisation and reliability of tools that clinicians use are
important for good quality assessment and diagnosis. Module 3 will explore these issues.
Please now turn to the following topics in your custom textbook.
Textbook topics
Assessment and diagnosis along the continuum [p. 61]
Assessment tools [p. 63]
Validity
Reliability
Standardisation
Clinical interview
Symptom questionnaires
Personality inventories
Behavioural observation and self-monitoring
Intelligence tests
Neuropsychological tests
Brain-imaging techniques
Psychophysiological tests
Projective tests 　
How are psychological disorders evaluated? Assessment is the process of evaluating

psychological, social and emotional functioning through a variety of methods. Psychological
assessments include interviews, observation, and psychological and neurological tests in an
attempt to determine clients’ possible presenting problems and their severity. During the
assessment process, various pieces of information would be gathered such as symptoms,
physical condition, cognitive functioning, recent life events, drug and alcohol use, personal
and family history of psychological disorders as well as sociocultural background.
Next is the diagnostic process that helps to determine if the pattern of the presenting
symptoms is consistent with the diagnostic criteria for any particular psychological disorder.
Health care professionals use classification systems to assign a diagnosis. A classification
system is constituted of a set of syndromes and the rules for determining whether an
individual’s symptoms are part of one of these syndromes. This helps clients to understand
their problems and plan treatments.
Validity
To understand if a test used in psychological assessment is accurate, we need to consider its
psychometric properties including validity and reliability. Validity is defined as the accuracy
Unit 1 21
of a test in assessing what it aims to measure. For example, if you want to measure your
weight, you would need to use a set of bathroom scales and not a ruler, and measure yourself
in kilograms (kg), not centimetres. Using scales and kg would result in a valid measurement
of weight. More specifically, this is an illustration of construct validity. There are different
aspects of validity, as outlined in the table below (please also refer to page 63 in the
textbook).
Table 1.3 Types of validity
Type of validity Description

Construct validity The extent to which the test measures the phenomenon that it is
supposed to measure (i.e. the construct), and not something else
Face validity The first impression or judgement of whether the test items
appear to represent the construct (the phenomenon that it is
supposed to measure) and whether the test or instrument looks
valid
Content validity Whether the measure assesses all the aspects of the phenomenon
that it is supposed to measure
Predictive validity The degree to which the measure can accurately predict a future
outcome or behaviour that it is supposed to measure
Concurrent validity The degree to which the results of the measure correlate with
other independent measures of the same construct
Reliability
The reliability of a test indicates its consistency in measuring what it is supposed to measure.
For example, if you measure your weight using electronic bathroom scales, and measure it
again five minutes later, you would expect to get a similar reading. But if your electronic
scale sensor is faulty and gives you 57 kg on one reading, and 83 kg on the next, your
measuring tool (the bathroom scale) lacks reliability. More specifically, this is an illustration
of test-retest reliability. Like validity, there are also different types of reliability, as outlined
in the table below.
Table 1.4 Types of reliability
Type of reliability Description

Test-retest reliability Whether the test produces similar results when given at two
points in time
Alternate form reliability Whether versions of the same test produce similar results
Internal reliability Whether different parts of the same test produce similar
results
Interrater or interjudge Whether two or more people who administer and score a test
reliability come to similar conclusions
You have seen that reliability and validity of data are crucial issues in assessment, diagnosis,
and treatment in mental health. Standardisation of administration and interpretation of tests is
the way to improve both validity and reliability. However, these are not the only aspects that
psychological researchers need to be aware of in order to increase the quality of empirical
evidence. Please now read the following article.

Tackett, J. L., & Miller, J. D. (2019). Introduction to the special section on increasing
replicability, transparency, and openness in clinical psychology. Journal of Abnormal
Psychology, 128(6), 487–492.
This article points out various issues relating to methodological rigour in the context or the
replication crisis affecting the field of social science research more broadly. The authors
stress the importance of replicability, openness and transparency so as to improve scientific
endeavours in the field of clinical psychology.
Types of assessment tools

Your textbook describes nine types of assessment tools. The following table provides a
summary of the key points.
Table 1.5 Summary of assessment tools
Assessment tool Format Example

Clinical interview Structured, Mental status exam
Conversation between a mental health unstructured and (a clinical interview
professional and a client where semi-structured organised into standard
information is gathered about the interviews categories used all over
client’s behaviour, attitudes, emotions, the world)
life history, and personality
Symptom questionnaires Self-report Beck Depression
These questionnaires can be questionnaire Inventory, BDI-II
generalised to cover a wide variety of (a 21-item self-report
symptoms that represent several symptom instrument;
disorders, or may focus on the each question item
symptoms of a specific disorder describes four levels of a
given symptom of
depression ranging from
‘I do not feel unhappy’
to ‘I am so unhappy that
I can’t stand it’ measured
on a scale of 0 to 3)
Personality inventories Self-report Minnesota Multiphasic
Questionnaires designed to assess questionnaire Personality Inventory
people’s typical ways of thinking, (MMPI)
feeling, and behaving to obtain
information on people’s well-being,
self-concept, attitudes and beliefs,
ways of coping, perceptions of their
environment, social resources, and
vulnerabilities
Unit 1 23
Behavioural observation and self- Direct behaviour Patient Reported

monitoring observation / self- Outcome Measures
To assess deficits in clients’ skills in monitoring (PROMs)
handling situations
Intelligence tests Scales that measure Wechsler Adult
Tests consisting of a series of tasks verbal Intelligence Scale
that involve both verbal and nonverbal comprehension (WAIS-IV)
skills, to determine an individual’s (VC), perceptual
level of cognitive functioning reasoning (PR),
working memory
(WM), and
processing speed
(PS)
Neuropsychological tests Paper-and-pencil Bender-Gestalt Test
Used to detect specific cognitive tests
deficits such as memory problems
Brain-imaging techniques Brain imaging Computerised
Used to identify specific deficits and tomography (CT),
possible brain abnormalities Positron-emission
tomography (PET),
Magnetic resonance
imaging (MRI)
Psychophysiological tests Measuring electrical Electroencephalogram
Used to detect changes in the brain activities along the (EEG)
and nervous system that reflect scalp produced by
emotional and psychological changes the firing of specific
neurons in the brain
Projective tests Image cards Rorschach Inkblot Test,
Tests based on the assumption that Thematic Apperception
when people are presented with an Test (TAT)
ambiguous stimulus, they will
interpret the stimulus in line with their
current concerns and feelings,
relationships with others, and conflicts
or desires
Activity 1.7
1. Briefly define the mental status exam.
2. Imagine a hypothetical client visiting a clinician. The client is distressed by feelings of
anxiety or depression. Highlight some of the things the clinician might note with respect
to the first three categories of the mental status exam, as they are described in the
textbook. Do not worry about exactly how accurately your descriptions reflect specific
DSM-5 disorders — just imagine a client who is either anxious or depressed, and create
plausible notes that accurately reflect the first three categories on the exam.
Challenges in assessment
We now move on from assessment tools to explore the challenges in assessment and
diagnosis. Please read the following topics in your custom textbook.
Textbook topics
Challenges in assessment [p. 71]
Resistance to providing information
Evaluating children
Evaluating individuals across cultures
Diagnosis [p. 74]
Diagnostic and Statistical Manual of Mental Disorders (DSM)
The social-psychological dangers of diagnosis
What happens after a diagnosis is made?
Common problems in assessment and diagnosis arise from the individual’s inability or
unwillingness to provide information, as well as cultural misunderstandings. In brief:
• Resistance to providing information: While it is essential to obtain valid information
from a client, there might be cases in which the client does not want to be treated or
assessed, or there might be bias or lack of truthfulness in the clients’ presentation of the
information.
• Evaluating children: Children may not have the ability to express themselves in words
due to feeling afraid, overwhelmed or helpless and they may not be able to differentiate
among different types of emotions. There are therefore some challenges surrounding
children’s self-reporting of emotions and/or behaviour, and clinicians may need to rely
on their parents to provide relevant information of children’s functioning.
• Evaluating individuals across cultures: One of the challenges in assessment arises when
there are significant cultural differences between clients and therapists. In cases of
cultural mismatch, there might be a higher likelihood of miscommunication or subpar
treatment. Therefore, it is advisable to have culturally competent professionals to avoid
the risk of bias and minimise disparities in diagnostic and treatment outcomes.
To deepen your exploration of the latter, please read the following article. It examines the
interrelationship of culture and psychopathology based on context, observer, institution and
community differences with respect to the types of psychological disorders.

Draguns, J. G., & Tanaka-Matsumi, J. (2003). Assessment of psychopathology across
and within cultures: Issues and findings. Behaviour Research and Therapy, 41,
755–776.
This article addresses the links between cultural characteristics and psychopathology in
different disorders (depression, somatisation, schizophrenia, anxiety, and dissociation). For
Unit 1 25
example, variations between individualistic and collective cultures as well as power distance
may cause differences in the development of assessment tools as well as standardised
procedures. Thus, culture plays an important role in assessment and diagnosis.
Diagnosis
Diagnosis is a label that clinicians or therapists attach to a set of symptoms (a set of
symptoms is called a syndrome) that occur together. For example, in a diagnosis of
depression, the criteria include sad mood, loss of interest in one’s usual activities,
sleeplessness, difficulty in concentrating, and suicidal thoughts. However, not all clients who
are depressed experience all of these symptoms. In addition, there are different lists of
symptoms that tend to co-occur in individuals. Therefore, symptoms of one syndrome may be
shared with those of another. For instance, major depressive disorder and posttraumatic stress
disorder share the following symptoms: substance use, recurrent suicidal ideations, negative
thoughts or feelings, and significant distress or social impairments. As another example,
Figure 4 on page 74 of your textbook illustrates the overlapping symptoms of depression and
anxiety.
Classification systems guide clinicians for diagnosis and avoid confusion. For more than 60
years, the official manual for diagnosing psychological disorders in the United States is the
Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric
Association (APA). In Hong Kong, most of the allied health care professionals also use the
DSM, but in the psychiatric field some may additionally refer to another classification manual
called the International Classification of Diseases (ICD) created by the World Health
Organization.
The fifth edition of the DSM (DSM-5) was published in 2013. A revision of this edition, the
DSM-5-TR, was published in 2022. This latest revision reclassified certain disorders and
updated the diagnostic criteria based on emerging research and clinical knowledge. The
developments and updates to the DSM facilitate improved communications among clinicians
of different specialties.
The DSM is the subject of a number of ongoing debates:
• Reifying diagnoses: Once a diagnosis is defined in any classification system, people tend
to reify it, i.e. seeing it as real and true rather than as the product of a set of judgements
about how symptoms tend to occur together.
• Category or continuum: The DSM-IV-TR and its predecessors were categorical
diagnostic systems, i.e. their diagnostic criteria defined where normality ends and
psychopathology begins. The DSM-5 largely retains the categorical system but
introduces a continuum or dimensional perspective for certain disorders, such as autism
spectrum disorders and personality disorders. These changes reflect the growing
consensus that all behaviours can be placed along a continuum with disorders
representing the extremes. You may, however, consider whether a continuum model is
practical for the real world and whether it creates issues in diagnosis.
• Differentiating mental disorders: A complaint with older editions of the DSM was the
difficulty in differentiating mental disorders from one another. People who were
diagnosed with one disorder may also have met the criteria for at least one other
disorder, due to the overlapping characteristics of disorders. This simultaneous presence
of disorders or conditions is known as comorbidity. As the DSM has evolved, many of
the diagnoses for personality disorders (which we will explore in Unit 4) were revised to
reduce this overlap, but questions such as which diagnosis should be considered the
primary diagnosis, and which diagnosis should be treated first, remain.
• Cultural issues: The DSM-5 and its predecessors support clinicians with guidelines on
cultural issues, such as the kinds of symptoms acceptable in the individual’s culture.
Some critics do not believe these guidelines have gone far enough in recognising
cultural variations in the behaviours, thoughts, and feelings that can be considered
healthy or unhealthy.
After a diagnosis is made, a comprehensive treatment plan can be designed to meet the
clients’ needs by providing timely and appropriate treatment in an interdisciplinary team
approach (psychiatrist, psychologist, counsellor, social worker and so on). Organising the
treatment goals, tracking the progress with the clients and keeping a clear record of patient
care are essential tasks of a good treatment plan.
Activity 1.8
The DSM-5 remains primarily a categorical model (although indicators of severity are used).
The categorical approach suggests that a disorder is either present (because it meets the
criteria) or absent (because it doesn’t meet the criteria). These categories differ from each
other in kind, not in degree. Categorical approaches work well for a number of medical
diagnoses (e.g. you are either pregnant or you are not). What is the key criticism of this
approach?
Self-test 1.3
1. Several of Kay’s friends have completed a short quiz entitled ‘How friendly are you …
really?’ on a popular social media platform. Although Kay knows the quiz is intended
for entertainment value only, she is curious as to how sound it really is. Suggest two
ways that Kay might establish the quiz’s reliability and two ways that she might
establish its validity. Make explicit reference to the types of reliability and types of
validity described in the textbook.
2. ‘Brain-imaging techniques, such as EEG, fMRI, etc., are expected not only to deepen
psychopathologists’ understanding of particular disorders, but also spur a
reconsideration of the relationships among disorders and a reconceptualisation of the
schemes by which they are organised in such systems as the DSM-5.’
Support this statement by drawing on the textbook’s discussion of using neuroscience
techniques to identify mental illness.
Unit 1 27
Summary
Unusual or deviant behaviours that cause a person to suffer distress, prevent them from
functioning in daily life or which pose a threat to the person or others are considered
abnormal. We saw in Module 1 how the ‘four Ds’ criteria of abnormality — dysfunction,
distress, deviance, and dangerousness — allow us to see abnormal behaviours along a
continuum from adaptive to maladaptive. The deinstitutionalisation movement in the 20th
century introduced the idea of moving mentally ill patients out of mental health facilities and
into community-based mental health centres; meanwhile prevention community-level
programmes allow health professionals to focus on preventing disorders before the disorders
develop. Thus, an understanding of psychological disorders should integrate biological,
psychological, and social perspectives.
Module 2 emphasised how these three perspectives evolved and how they interact with and
influence one another to produce and maintain mental health problems. The integrated model
can help us to see how traumatic experiences and interpersonal relationships can cause
changes in a person’s emotions, thoughts, and behaviours.
Building on the concept of biopsychosocial integration of the three perspectives, in Module 3
we discussed assessment and diagnosis. Clinicians and therapists can administer a battery of
standardised, valid and reliable assessment tools and gather the necessary information to form
a coherent understanding of the clients’ background and biological, psychological and social
functioning in an attempt to make a timely and culturally appropriate diagnosis and treatment
plan.
This unit has served as an introduction to the key ideas for understanding the concept of
abnormality from historical perspectives to modern day ones, as well as how biological,
psychological and sociocultural approaches can be integrated to understand, assess and
diagnose abnormal psychological conditions. The next unit will focus on anxiety and mood
disorders as well as suicide.
References
Gralnick, A. (1985). The case against deinstitutionalization. American Journal of Social
Psychiatry, 5(3), 7–11.
Okin, R. L. (1985). Expand the community care system: Deinstitutionalization can work.
Hospital & Community Psychiatry, 36(7), 742–745.
Feedback on activities and self-tests

Activity 1.1
You can think about each scenario and determine if the behaviour seems normal or abnormal
to you and why by listing the reasons. If it seems abnormal, can you think of a situation in
which the same behaviour could be considered normal? It will become clear that different
individuals view the same behaviour in different ways. This makes a good introduction to the
problem of defining abnormality using the four Ds. If the same behaviour is viewed as
normal by some and as abnormal by others, whose view do we accept? You can apply the
four Ds criteria for defining abnormality as discussed in the textbook with the help of the
following questions:
• Would you describe the behaviour as unusual?
• Is the person showing the behaviour uncomfortable or making others feel distressed?
• Is the behaviour maladaptive to the person’s daily functioning?
• Does the person meet criteria for a mental illness using the DSM?
• Does this behaviour violate cultural and/or gender norms?
You may notice that many of the behaviours only meet one of the criteria (e.g. flagpole
climbing may be unusual but not maladaptive) and are therefore difficult to classify as
abnormal, even if they strike us as ‘odd’ or ‘weird’ at first. Other behaviours may be normal
only in certain contexts (e.g. scenario 5 may be considered a normal phase of adolescence).
Activity 1.2
You may take either standpoint in your response.
Considering trephination as rational:
Ancient Greek doctors believed that stagnant or non-circulating blood was bad for health as
this kind of blood could decay and turn into pus. Thus, one rational reason would have been
to allow the blood to flow out before it spoiled inside the body. In this way, trephination was
a type of brain surgery. Besides, trephination was later used as a medical therapy for specific
forms of epilepsy as well as mental disease.
Considering trephination as irrational:
In the Stone Age and Middle Ages, historians suggest that trephination was used to allow
spirits to depart from an affected individual. However, we may question this assumption since
it is clear from archaeological evidence that many who underwent trephination survived the
procedure, and thus may still have continued to display abnormal behaviour. Nevertheless,
the use of trephination was arguably practised in the context of superstition, magic or
exorcism.
Activity 1.3
1. This question serves as a revision of your previous learning in psychology. You may
describe the classical conditioning mechanism as follows:
Step 1: The neutral stimulus (NS) does not elicit a particular response. Here, NS =
flushing a toilet.
Step 2: The NS is repeatedly paired with the unconditioned stimulus (UCS), which
elicits an unconditioned response (UCR). Here, UCS = cold temperature of the shower;
UCR = jumping back.
Step 3: Eventually, the NS becomes a conditioned stimulus (CS), eliciting a conditioned
response (CR). The organism reacts the same way to the previous NS as it did to the
UCS. Here, CS = toilet flushing; CR = jumping back.
We will revisit and recap classical conditioning in Module 2 of this unit.
Unit 1 29
2. Behaviourism assumes that all humans are like animals, and ignores the internal
cognitive processes that underlie our behaviour. It focuses solely on changes in
observable and measurable behaviour.
3. The cognitive behavioural perspective rests on the assumption that dysfunctional
thoughts underlie mood and/or other psychological disorders. Therefore dysfunctional
thinking is at the heart of cognitive therapy, which aims to alter negatively biased
thoughts or cognitive distortions.
Activity 1.4
The case against deinstitutionalisation might include the following key points (adapted from
Gralnick, 1985):
• The rate of mental illness has not declined in spite of the deinstitutionalisation
movement.
• The acutely ill are neglected in the context of community-based care models and often
do not receive the treatment they need until or unless they become dangerous to
themselves or others.
• Patients who never become dangerous may never become hospitalised and therefore
may never receive treatment.
• Many patients who manage to receive treatment without or before presenting a threat to
themselves or others are only seen in an advanced stage in the course of their disorder
and when they have less chance to recover.
• A small percentage of patients discharged from hospitals continue in community
aftercare.
• Many patients discharged from hospitals discontinue taking medications.
• Increasing numbers of persons with mental illness who have no families live in nursing
homes, jails, on the streets, and in public shelters.
The case for deinstitutionalisation might include the following arguments (adapted from
Okin, 1985):
• Treatment usually works best in an environment that minimises coercion and encourages
contact with family members and the rest of society.
• Most patients will eventually live in the community, and therefore, they should learn the
needed skills in the place where they will be used.
• Given adequate services, many severely ill people prefer to live in the community rather
than in hospitals.
• Family therapy in conjunction with medication can be effective in reducing the need for
rehospitalisation and reduces the burden on families.
• The visibility of people with mental illness in the community compels increased public
awareness and allocation of resources to their needs.
Activity 1.5
Subdomain/Therapy Approach Critiques and concerns
Behavioural Psychological • Behavioural theories have been criticised for

approaches not recognising an individual’s free will
towards their choice of behaviours.
Drug therapies Biological • Drug therapies can have serious side-effects.

• People may rely on medications rather than
directly dealing with the issues in their lives
that contribute to their psychological
problems.
• Biological theories (in general) might tend to
overlook the role of environmental and
psychological processes in biological
functioning.
Cognitive approaches Psychological • It is difficult to prove that maladaptive

cognitions precede and cause disorders.
Psychodynamic Psychological • Lack of scientific data and the inability to test

approaches the fundamental assumptions with valid and
reliable research methods.
• Freud developed his psychodynamic theories
based on a limited sample of upper-class
people.
Humanistic Psychological • Humanistic theories have been criticised for

approaches being vague and not subject to scientific
testing.
Culturally-specific Sociocultural • Sociocultural theories (in general) have been

therapies criticised for being vague about exactly how
social and cultural forces lead to
psychological disturbances in individuals.
Family systems Psychological • Family systems theories have not been

approaches thoroughly tested in research.
Activity 1.6
There is no single answer to this question. The following are some ideas you might suggest:
• Active listening
• Non-judgemental behaviour
• The therapist’s ability to foster the client’s trust towards them
Unit 1 31
• The ability to build an alliance with the client

• The ability to develop a consistent and reasonable treatment plan
• Sensitivity towards clients’ cultural background
• Able to provide an explanation of the clients’ symptoms and problems
• Acting in accordance with the best and latest research evidence
• Involved in continued training and education
• Excellent communication skills
Activity 1.7
1. The mental status exam is a clinical interview organised into five standard categories. It
is used all over the world.
2. The below notes are an example for a hypothetical client who is suffering from anxiety.
Your responses may differ.
• The first category of the mental status exam entails an assessment of appearance and
overall behaviour.
Clinician notes: The client appears neatly dressed and meticulously groomed.
Posture is good. Motor behaviour seems mostly normal, but the client does seem to
fidget and move around in her seat quite a bit.
• The second category is mood and affect.
Clinician notes: The client’s affect is mostly positive. The client appears somewhat
tense, however. The client describes feeling tense and worried quite often over the
past few weeks. She describes being unable to simply relax and enjoy the moment,
even during situations usually considered happy or joyous.
• The next category is speech.
Clinician notes: Speech is normal — perhaps a little rapid.
Activity 1.8
There are at least two criticisms you could highlight in your response:
• The categorical approach tends to ‘medicalise normality’ by classifying ranges of
normal experiences as disordered.
• Many psychological experiences are not ‘either/or’, and the categorical model doesn’t
really recognise that meeting criteria is not the same as being dysfunctional or
functional.
Self-test 1.1
• Biological theories view abnormal behaviour as similar to physical diseases, caused by
the breakdown of systems in the body. The appropriate cure is the restoration of bodily
health.
• Supernatural theories view abnormal behaviour as a result of divine intervention, curses,
demonic possession, or personal sin. To rid the person of the perceived affliction,
religious rituals, exorcisms, confessions, and atonement have been prescribed.
• Psychological theories view abnormal behaviour as a result of psychological processes,

such as beliefs, coping styles, and life events such as trauma, bereavement, or chronic
stress. There are a variety of methods to treat abnormal behaviour with these theories
such as relaxation, talking therapy, or changes of environment to improve psychological
health.
Self-test 1.2
Preventing people from developing psychological disorders in the first place is better than
waiting to treat it once it develops. Thus, prevention programmes are designed to reduce the
likelihood of psychological disorders developing.
At each level of prevention, the goals are as follows:
• Primary prevention: to prevent the development of disorders in the first place.
• Secondary prevention: to undertake early detection and identification through screening,
as well as providing interventions to prevent the illness from advancing.
• Tertiary prevention: to prevent relapse and reduce symptoms of psychological disorders.
The focus of tertiary prevention is on people who already have a disorder. The
intervention is implemented after symptoms are established so as to improve their
quality of life.
Self-test 1.3
1. Reliability refers to the consistency with which an instrument assesses a construct. Kay
might assess the quiz’s test-retest reliability by having a sample of participants take the
quiz twice, with a week or two intervening between each completion. If the quiz has
good test-retest reliability, an individual should receive very similar scores on the two
attempts. Kay might also examine the quiz’s internal reliability — the questions should
generally seem to relate to each other.
With respect to validity, Kay could establish the concurrent validity of the quiz by
finding a positive correlation between friendliness scores on the quiz and other plausible
measures of friendliness — people with higher scores on the quiz should have more
Facebook friends, for instance. Kay can check the quiz’s content validity by ensuring
that the questions cover the different aspects of friendship — a quiz that focuses only
on, say, whether the respondent helps other people may have limited content validity.
2. People diagnosed with the same disorder often experience quite different symptoms. For
example, some people with schizophrenia experience auditory hallucinations, whereas
others experience visual ones. These differences may correspond to quite different brain
mechanisms, suggesting that traditional diagnoses such as schizophrenia may actually
subsume different disorders. Somewhat conversely, neuroscience research may also
suggest similarities between disorders traditionally thought quite different. For example,
genetic research suggests commonalities between bipolar disorder — long aligned in the
DSM with depression as a mood disorder — and schizophrenia, historically considered a
psychotic disorder. Such traditional, broad categories as neurosis, psychosis, and so on
may need to be reconsidered, perhaps provoking a realignment of various disorders.

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PSYC A232

Introduction to Abnormal Psychology

Internal Course Reviewer

Copyright © Hong Kong Metropolitan University 2023

Unit 1 Introduction to abnormality

• Unit 1 of your custom textbook, entitled ‘Introduction to abnormality’

Module 1: Looking at abnormality

Module 2: Theories and treatment of abnormality

Behavioural observation and self-monitoring

Module 1: An overview of abnormal

Historical perspectives on abnormality

The Medieval and Renaissance periods

The eighteenth and nineteenth centuries

The emergence of modern perspectives

The emergence of modern perspectives [p. 13]

In the twentieth century, different perspectives have shaped modern understandings of

Table 1.1 Overview of key modern psychological perspectives

Modern mental health care

Reading 1.1 (E-Library)

Module 2: Theories and treatment of

Psychological approaches [p. 38]

Positive (Adding) Something valued or Something unpleasant

Positive reinforcement Punishment by application

Negative (Removing/ Something unpleasant Something valued or

Negative reinforcement Punishment by removal

Figure 1.1 Modification of behaviour via operant conditioning

By identifying reinforcements and punishments that contribute to an individual’s maladaptive

Family systems approaches

Subdomain/Therapy Approach Critiques and concerns

Please now read the following sections in your custom textbook.

Prevention programmes are designed to reduce the likelihood of people developing

Module 3: Assessing and diagnosing

How are psychological disorders evaluated? Assessment is the process of evaluating

Type of validity Description

Type of reliability Description

Reading 1.2 (E-Library)

Types of assessment tools

Assessment tool Format Example

Behavioural observation and self- Direct behaviour Patient Reported

Reading 1.3 (E-Library)

Psychiatry, 5(3), 7–11.

Hospital & Community Psychiatry, 36(7), 742–745.

Feedback on activities and self-tests

Subdomain/Therapy Approach Critiques and concerns

Behavioural Psychological • Behavioural theories have been criticised for

Drug therapies Biological • Drug therapies can have serious side-effects.

Cognitive approaches Psychological • It is difficult to prove that maladaptive

Psychodynamic Psychological • Lack of scientific data and the inability to test

Humanistic Psychological • Humanistic theories have been criticised for

Culturally-specific Sociocultural • Sociocultural theories (in general) have been

Family systems Psychological • Family systems theories have not been

• The ability to build an alliance with the client

• Psychological theories view abnormal behaviour as a result of psychological processes,

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