LECTURE NOTE

ON

ABNORMAL PSYCHOLOGY

Compiled By:
Dr. Ogunlade J. O.
What is Abnormal Psychology?
Professionals in many sub-disciplines of psychological science and psychology
deal primarily with the study of abnormal psychology and the symptoms, causes, and
treatment of major mental and behavioral disorders. These disorders can range from
various forms of depression to personality disorders, anxiety disorders, psychotic
disorders, developmental disorders, and many more. And although by definition
these disorders are abnormal, researchers have found them to be surprisingly
common.
The study of abnormal psychology is so integral to the psychological sciences
that it has become a fundamental part of Counselling programmes. An in-depth
understanding of this division of psychology is necessary for those wishing to be
effective in a professional role in the psychological sciences.
How is Abnormal Psychology Defined?
There are many ways psychologists define "abnormal psychology." But, at its
root, the term refers to the study of behaviors and mental illnesses that are unusual
and atypical — out of the societal norm. In addition, abnormal psychology deals
primarily with major mental and behavioral disorders, or conditions and illnesses that
detract from an individual's mental, emotional, and behavioral health, negatively
affecting or limiting their life experience. These disorders may also be defined by or
include the way an individual's mental or behavioral conditions might negatively
affect those in their immediate social environment or society at large.
What are Some Mental and Behavioral Disorders That Abnormal Psychology
Focuses On?
Abnormal psychology focuses on many different types of disorders as the field
is broad in scope. Mood disorders such as major depression, bipolar disorder and
dysthymia are among the most commonly diagnosed, along with anxiety disorders
like generalized anxiety disorder, panic disorder, phobias and the less common
obsessive compulsive disorder. Eating disorders such as bulimia nervosa and
anorexia nervosa are also fairly common in certain populations.
Less common are the more atypical dissociative, psychotic and personality
disorders such as schizophrenia, narcissistic disorder, and borderline personality
disorder. Major developmental disorders like autism and dyslexia also fall under
abnormal psychology.

What Causes These Disorders?

There is a lot of debate over the causes of these disorders — biological versus
environmental, cognitive versus behavioral conditioning and coping, induced by
individual experience versus larger social constructs and societal norms, etc. But
most consider abnormal mental and behavioral disorders as caused by a combination
of different factors. And of course the root of disorders varies depending on the
disorder, as all are extremely different.

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What Treatments Are Used to Address These Disorders?
Clinical and medical treatments also vary according to the specific needs of
each individual and their condition and behaviors. Cognitive and behavioral therapy
is widely used to address mood disorders, anxiety disorders and personality
disorders, along with antidepressants and anti-anxiety medications where appropriate
and effective. Antipsychotic medications are often combined with various forms of
therapy to treat psychotic disorders as well as personality disorders and forms of
depression. Treatments for mental disorders may also include other forms of therapy
from various models such as psychodynamic psychotherapy and humanistic
counseling.
What Is Involved in the Study of Abnormal Psychology and Its Application in
the Professional Context?
Abnormal psychology is involved with all aspects of psychology, from
research to practice. Psychological scientists use the scientific method of
experimental research to learn about the causes and symptoms of various abnormal
disorders as well as the effectiveness of potential treatments (cognitive, behavioral or
medical). These scientists use the results of their experiments, the data and
information gathered, to form theories, build on or revise existing ones, and develops
strategies for the application of their research findings and theories.
Medical doctors and clinical professionals such as therapists and counselors
apply these findings, theories and strategies to their work in the accurate diagnosis of
disorders as well as the design of effective, evidence-based treatment plans and
therapeutic strategies. At times, psychological scientists also use data from and
evaluation of various clinical treatment programs in field and natural experiments for
their research.
And, in the classroom, educators such as the faculty of NKU's BA in
Psychological Science program base their teaching on the entirety of current
abnormal psychology research and theory as well as best practices in the diagnosis
and treatment of disorders.
Clearly, the study of abnormal psychology is an essential part of modern
psychology. Whether it be experimental research, clinical behavioral and cognitive
therapy, or medication-based treatment, most psychological work concerns abnormal
psychology.
The overall purpose of psychology and the psychological sciences could be
described as such: To better the mental and behavioral health of individuals and
groups of people, leading to greater societal health and advancing human welfare in
general. As those with major mental and behavioral disorders perhaps need the most
assistance, help, or guidance in order to live a happy, well-adjusted, "normal" life,
abnormal psychology's prominent role in the psychological sciences as a whole
makes perfect sense.
Abnormal psychology is the branch of psychology that studies unusual
patterns of behavior, emotion and thought, which may or may not be understood as

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precipitating a mental disorder. It can also be explained as a branch
of psychology that deals with psychopathology and abnormal behavior, often in a
clinical context. The term covers a broad range of disorders, from depression to
obsessive-compulsive disorder (OCD) to personality disorders.
The science of abnormal psychology studies two types of behaviors: adaptive
and maladaptive behaviors.
What is the concept of abnormality?
Abnormality can be defined as a deviation from ideal mental health. This
means that rather than defining what is abnormal, psychologists define what is
normal/ideal mental health, and anything that deviates from this is regarded
as abnormal.

Why is abnormal psychology important?

In any of these mental health professional positions with an advanced degree
and studies in abnormal psychology, you can be involved in better understanding
the underlying causes of behavior, determining how the behavior should be
addressed, and developing a treatment plan to help patients reach for a higher quality
of life.

What is the concept of abnormality?

Abnormality can be defined as a deviation from ideal mental health. This
means that rather than defining what is abnormal, psychologists define what is
normal/ideal mental health, and anything that deviates from this is regarded
as abnormal.

What are the five perspectives of Abnormal Psychology?

The five major perspectives in psychology are biological, psychodynamic,
behavioral, cognitive and humanistic.

Indices of definitions of abnormality?

Statistical Infrequency, Deviation from Social Norms, Failure to Function
Adequately, Deviation from Ideal Mental Health.

Models of abnormality?
Trying to clarify or comprehend events is known as a model. There are six
models of abnormality. The six different models are the biological model,
the psychodynamic model, the behavioral model, the cognitive model, the
humanistic-existential cultural model, and the social cultural model.

What is normal behavior in psychology?

Normality is a behavior that can be normal for an individual (intrapersonal
normality) when it is consistent with the most common behavior for that
person. Normal is also used to describe individual behavior that conforms to the most
common behavior in society (known as conformity).

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Who is the father of Abnormal Psychology?
The Greek physician Hippocrates, who is considered to be the father of
Western medicine, played a major role in the biological tradition. Hippocrates and
his associates wrote the Hippocratic Corpus between 450 and 350 BC, in which they
suggested that abnormal behaviors can be treated like any other disease.

What is normal and abnormal behavior in psychology?

"Any behavior that pertains to accepted societal patterns is called normal
behaviour whereas that is against social norms is called abnormal behaviour."
Examples of Abnormal Psychology
 Anxiety Disorders.
 Dissociative Disorders.
 Mood Disorders.
 Schizophrenia.
 Personality Disorders.

Causes abnormal Behaviour?

Lack of development in the Superego, or an incoherently developed Superego
within an individual, will result in thoughts and actions that are irrational
and abnormal, contrary to the norms and beliefs of society. Irrational beliefs that are
driven by unconscious fears, can result in abnormal behavior.

What is a psychological model?

1. A theory, usually including a mechanism for predicting psychological
outcomes, intended to explain specific psychological processes.
What are the 3 pillars of positive psychology?
The Three Pillars: Positive Psychology has three central concerns: positive
experiences, positive individual traits, and positive institutions

What are the elements of positive psychology?

Here are the five core elements explored in Flourish:
 Positive emotions. Feeling good and having a sense of happiness is key. ...
 Engagement. Also measurable, engagement is becoming immersed or wrapped
up in a task at hand. ...
 Interest. Interest plays a role. ...
 Meaning. ...
 Purpose.

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What are 5 qualities of a mentally healthy person?
Characteristics of Mental Health
 They feel good about themselves.
 They do not become overwhelmed by emotions, such as fear, anger, love,
jealousy, guilt, or anxiety.
 They have lasting and satisfying personal relationships.
 They feel comfortable with other people.
 They can laugh at themselves and with others.

What are the 4 Ds in psychology?

The “Four D's” consisting of deviance, dysfunction, distress, and danger can
be a valuable tool to all practitioners when assessing reported traits, symptoms, or
conditions in order to illuminate the point of at which these factors might represent a
DSM IV-TR disorder.

What is Behaviour in psychology?

In psychology, behavior consists of an organism's external reactions to its
environment. Other aspects of psychology, such as emotions, thoughts, and other
internal mental processes, don't usually fall under the category of behavior.

How do psychologists diagnose?

A physical examination, lab tests, and psychological questionnaires may be
included, often to rule out other illnesses. As all of this information is obtained and
integrated, the professional will begin to determine if the person's symptoms match
up with one or more official diagnoses.

Where do abnormal psychologists work?

Abnormal Psychologists typically work in clinical settings, mental health
facilities or hospitals.

What is the best definition of psychology?

Psychology is the study of the mind and behavior, according to the
American Psychological Association. It is the study of the mind, how it works, and
how it affects behavior. Feb 1, 2018

Common treatments for psychological disorders

1. Anti-anxiety medications.
2. Antidepressant medications to improve moods.
3. Antipsychotic medications to treat disordered thought patterns and altered
perceptions.
4. Cognitive behavioral therapy to work on thought patterns and behavior.

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Who are the major theorists in psychology?
10 of the Most Influential Psychologists
 B. F. Skinner. ...
 Jean Piaget. Jean Piaget's theory of cognitive development had a profound
influence on psychology, especially the understanding of children's intellectual
growth. ...
 Sigmund Freud. ...
 Albert Bandura. ...
 Leon Festinger. ...
 William James. ...
 Ivan Pavlov. ...
 Carl Rogers.

How has psychology changed the study of human behavior?

Psychology has changed the study of human and animal behavior by gaining a
better understanding of how both human and animal minds work and comparing
them to learn and gain information.

How is personality measured in psychology?

Psychologists seek to measure personality through a number of methods, the
most common of which are objective tests and projective measures. ... Some of the
more widely used personality self-report measures are the Myers-Briggs Type
Indicator, Neo Pi-R, MMPI/MMPI-2, 16 PF, and Eysenck Personality Questionnaire.

Why is it important to classify abnormal behavior?

For one thing, classification is the core of science. Without labeling and
organizing patterns of abnormal behavior, researchers could not communicate their
findings to one another, and progress toward understanding these disorders would
come to a halt.

What are signs of behavioral problems?

Behavioral symptoms are persistent or repetitive behaviors that are unusual,
disruptive, inappropriate, or cause problems.
Aggression, criminal behavior, defiance, drug use, hostility, inappropriate
sexual behavior, inattention, secrecy, and self-harm are examples of behavioral
symptoms.

What is mental health model?

The model proposes that biological and social factors, together with a person's
individual experiences, lead to mental disorder through their conjoint effects on
those psychological processes. Implications for research, interventions, and policy
are discussed.

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Most mental health practitioners practice one of six types of psychotherapy:
 Behavioral therapy.
 Cognitive therapy.
 Interpersonal therapy.
 Psychoanalysis.
 Psychodynamic psychotherapy.
 Supportive psychotherapy.

What are the 4 dimensions of psychosocial health?

Psychological health includes mental, emotional, social, and spiritual
dimensions of health.

Why are theories important in psychology?

Theories provide a framework for understanding human behavior, thought, and
development. By having a broad base of understanding about the how's and why's of
human behavior, we can better understand ourselves and others. Each theory
provides a context for understanding a certain aspect of human behavior.

What is human factors psychology?

Human factors is an interdisciplinary area of psychology that focuses on a
range of different topics, including ergonomics, workplace safety, human error,
product design, human capability, and human-computer interaction.

What is the role of psychology in health?

Psychologists provide vital mental and behavioral health services in primary
care; they identify and modify behaviors to promote the health and wellness of
individuals across the lifespan.

What are psychological factors in psychology?

When we talk about psychological factors that influence consumer decisions,
we are referring to the workings of the mind or psyche: motivation, learning and
socialization, attitudes and beliefs.

Why is Positive Psychology important?

Positive psychology is important because discovering what leads people to live
more meaningful lives can translate to better strategies for managing mental illness,
correcting negative behaviors, and increasing our happiness and productivity. May
10, 2020

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How can positive psychology help you become happier?
When you smile and laugh, you give yourself an endorphin boost. Endorphins
(also known as happy hormones) have many benefits, from reducing stress levels to
making you feel happier and acting as a natural painkiller. You can even make
yourself smile for no specific reason, and still get the same benefits. Jul
Abnormal psychology is the study of human behavior that differs from the norm in
significant ways. The field studies the causes and manifestations of habits, behaviors,
thoughts or basic drives that are different from others, and typically, result in significant
impairment in life functioning. Clinical psychologists today seek to reduce the value
judgments of the past regarding many facets of psychological conditions deemed
abnormal. Abnormal technically just means “different from the norm.” Clinical
psychologists focus on whether or not a person’s thoughts and behavior cause distress and
social problems. Some abnormal psychological conditions can cause irrational or harmful
behavior, either to the self or to others. There are four main criteria used to define
abnormality in psychology.
Deviation from the Norm
Statistical criteria can be applied to emotions, thoughts and behaviors. When the
intensity of these feelings or behaviors is either significantly higher or lower than the
majority of people, the behaviors can be categorized as abnormal. Frequency of behavior
and cognition is also important for whether or not a psychological condition meets this
criterion. As one example, a person who has an episode of fear and distress upon seeing a
spider once, but who is able to overcome this fear easily would be unlikely to be
diagnosed with a phobia. Another person who is extremely fearful of spiders and
frequently distressed when thinking about them would meet the criteria of frequency and
significantly greater than normal fear, thus having a potential phobia.
Maladaptive Functioning
The functional effect of a person’s feelings, behaviors and cognition is another
important criterion for defining whether or not a psychological condition is abnormal. If
the condition significantly affects a person’s ability to care for themselves, have positive
relationships, and function well in work or school, it can be classified as abnormal.
Distress and Discomfort
When a psychological condition causes significant personal distress, a third criteria
for diagnosis and treatment can be made. Any neurosis, psychosis or cognitive difference
such as developmental delay can cause a person to feel very distressed and unhappy.
Social discomfort is also a hallmark, such as unhappiness at work, school or at home.
Desirability
The desirability of a behavior or cognitive difference is the fourth factor used in
determining whether or not a psychological condition is abnormal. A genius IQ falls
outside the statistical norm, but most people would not say that geniuses are abnormal in a
negative way. Individuals with developmental delays are considered to fall under the
banner of abnormal psychology, because low cognitive abilities aren’t desirable and cause
more distress and discomfort than a genius-level IQ.

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 Some psychologists include varied abnormal categories that recognize that not all
abnormal psychological conditions are bad, such as subnormal, supernormal, and
paranormal. The Diagnostic and Statistical Manual is currently in its fifth edition,
representing a mutually-agreed upon reference and diagnosis book for North American
clinical psychologists and other mental health practitioners. In other areas of the world,
the ICD-10, used by the World Health Organizations, offers a numerical category and
range of disorders that fit under the banner of abnormal psychology.
What are the Core Concepts of Abnormal Psychology?
Abnormal psychology consists of three core concepts: cultural and historical
relativism, the principle of multiple causality and the connection between mind and
body.

Cultural and Historical Relativism

Throughout time, societies have proposed several explanations of abnormal

behavior within human beings. Beginning in some hunter-gatherer societies, animists
have believed that people demonstrating abnormal behaviors are possessed by
malevolent spirits. This idea has been associated with trephination, the practice of
cutting a hole into the individual’s skull in order to release the malevolent spirits.

A more formalized response to spiritual beliefs about abnormality is the

practice of exorcism. Performed by religious authorities, exorcism is thought of as
another way to release evil spirits who cause pathological behavior within the person.

In some instances, individuals exhibiting unusual thoughts or behaviors have

been exiled from society or worse. Perceived witchcraft, for example, has been
punished by death. Two Catholic Inquisitors wrote a manual, the Malleus Malefic
arum that became co-opted by many Inquisitors and witch-hunters. It contained an
early taxonomy of deviant behavior and proposed guidelines for prosecuting deviant
individuals.

The act of placing mentally ill individuals in a separate facility known as an

asylum dates to 1547, when King Henry VIII of England established the St. Mary of
Bethlehem asylum. Asylums remained popular throughout the Middle Ages and the
Renaissance era.

Multiple Causality

The number of different theoretical perspectives in the field of psychological

abnormality has made it difficult to properly explain psychopathology.

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 The attempt to explain all mental disorders with the same theory leads to
reductionism (explaining a disorder or other complex phenomena using only a single
idea or perspective).

Most mental disorders are composed of several factors, which is why one must
take into account several theoretical perspectives when attempting to diagnose or
explain a particular behavioral abnormality or mental disorder. Explaining mental
disorders with a combination of theoretical perspectives is known as multiple
causality.

The diathesis-stress model emphasizes the importance of applying multiple

causality to psychopathology by stressing that disorders are caused by both
precipitating causes and predisposing causes. A precipitating cause is an immediate
trigger that instigates a person’s action or behavior. A predisposing cause is an
underlying factor that interacts with the immediate factors to result in a disorder.
Both causes play a key role in the development of a psychological disorder.

Mind and Body

A paradigm is a general viewpoint on the world and is much broader than a

theory. Today’s field of psychology revolves around two major paradigms for
explaining mental disorders, the psychological paradigm and the biological
paradigm.

The psychological paradigm focuses more on the humanistic, cognitive and

behavioral perspectives. The biological paradigm includes t

Bottom of FormThe DSM APPROACH to Abnormal Psychology.

A psychological disorder is a condition characterized by abnormal thoughts,

feelings, and behaviors. However, defining what is “normal” and “abnormal” is a
subject of much debate. Definitions of normality vary widely by person, time, place,
culture, and situation. “Normal” is, after all, a subjective perception, and also an
amorphous one—it is often easier to describe what is not normal than what is normal.

In simple terms, however, society at large often perceives or labels “normal”

as “good,” and “abnormal” as “bad.” Being labeled as “normal” or “abnormal” can
therefore have profound ramifications for an individual, such as exclusion or
stigmatization by society.

Although it is difficult to define “normal,” it is still important to establish

guidelines in order to be able to identify and help people who are suffering. To this
end, the fields of psychology and psychiatry have developed the Diagnostic and

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Statistical Manual of Mental Disorders (known as the DSM-5), a standardized
hierarchy of diagnostic criteria to help discriminate among normal and abnormal (i.e.
“pathological”) behaviors and symptoms. The 5th edition of the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental
Disorders (the DSM-5) lays out explicit and specific guidelines for identifying and
categorizing symptoms and diagnoses.

Clinical Definitions of Abnormal: The DSM

The DSM is a central element of the debate around defining normality, and it
continues to change and evolve. Currently, in the DSM-5 (the fifth edition),
abnormal behavior is generally defined as behavior that violates a norm in society, is
maladaptive, is rare given the context of the culture and environment, and is causing
the person distress in their daily life. Specifically, the goal of the DSM-5 is to
identify abnormal behavior that is indicative of some kind of psychological disorder.
The DSM identifies the specific criteria used when diagnosing patients; it represents
the industry standard for psychologists and psychiatrists, who often work together to
diagnose and treat psychological disorders.

As the DSM has evolved over time, there have been a number of conflicts
surrounding the categorization of abnormal versus normal mental functioning. Much
of this difficulty comes from distinguishing between an expected stress reaction (a
reaction to stressful life events that could be considered “normal”) and individual
dysfunction (symptoms or stress reactions that are beyond what a “normal” or
expected reaction might be). As a result, the DSM explicitly distinguishes mental
disorders and non-disordered conditions. A non-disordered condition results from, or
is perpetuated by, social stressors. To this end, the DSM requires that to meet the
diagnostic criteria for a mental disorder, an individual’s symptoms “must not be
merely an expectable and culturally sanctioned response to a particular event; for
example, the death of a loved one. Whatever [the pattern of symptoms’] original
cause, it must currently be considered a manifestation of a behavioral, psychological,
or biological dysfunction in the individual.”

That said, if an individual’s response to a particular situation is causing

significant impairment in more than one area of the individual’s life (such as work,
home, school environment, or relationships), it may be considered abnormal or an
indicator of a psychological disorder regardless of its etiology.

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Stigma

It is important to analyze the societal consequences of diagnosis because so

many people experience mental illness at some point in their lives. According to the
World Health Organization (WHO), more than a third of people globally meet the
criteria for at least one diagnosable mental disorder at some point in their lives.
Unfortunately, stigma and discrimination can add to their suffering and disability.
This has led various social movements to work to increase societal awareness and
understanding of mental illness and challenge social exclusion.

A stigma is the societal disapproval and judgment of a person or group of

people because they do not fit their community’s social norms. In the context of
mental illness, social stigma is characterized as prejudiced attitudes and
discriminatory behavior directed toward individuals with mental illness as a result of
the label they have been given. In the United States, people are often pressured to be
“normal”—or at least perceived as such—in order to gain acceptance by society.
Society tends to be uncomfortable with “abnormality”—so if someone does not
conform to what is perceived as normal, they might be given a number of negative
labels, such as “sick”, “crazy”, or “psycho.” These labels lead to discrimination,
marginalization, and isolation of—even violence against—the individual.

Self-Stigma

In a related issue, self-stigmatization is when someone internalizes society’s

negative perceptions of them or of people they think are like them: they begin to
believe, or fear that others will believe, that the negative labels and perceptions are
true.

Effects of Stigma and Self-Stigma

This internalization contributes to feelings of shame and usually leads to

poorer treatment outcomes. Experience of stigma or self-stigma can also lead to the
following:

Refusal to receive treatment. An individual’s fear of stigmatization and alienation

may lead them to refuse treatment altogether. Anxiety about others’ perceptions and
the social consequences that come along with a label of mental illness often deter
people from seeking help in any therapeutic, familial, social, or pharmacological
context.

Social isolation. An individual with mental illness may avoid social settings
altogether; for example, an individual struggling with depression may choose not to
see or speak with friends and family for fear of “bringing them down” or “being a

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burden.” This is especially dangerous in light of the knowledge that social
connectedness is one of the key factors in recovery from mental illness.

Distorted perception of the incidence of mental illness. Although approximately one

in three people will experience mental illness at some point in their life, there are still
many people who do not acknowledge mental illness as a public health concern. By
causing people to not seek out treatment, society’s stigma of mental illness leads to
fewer diagnoses and fewer people getting help. This means that mental illness seems
far less common than it actually is.

Combating Stigma

Stigmas are usually deeply ingrained in society over many years and so cannot
be eradicated instantly. But with the rising awareness that mental illness affects so
many people in the United States and globally, more and more is being done to
reduce the stigma associated with such illnesses.

Person-Centered Language

For example, the field of psychology has recently moved toward using
deliberate person-centered language—referring to people as individuals with mental
illness rather than mentally ill individuals. In this way, the language emphasizes the
individual’s humanity and defines them as a person first, rather than defining them
by their illness.

For instance, referring to someone as “the anorexic girl” has a different impact
than “the girl with anorexia.” In the first example, the individual is entirely defined
by the disorder; in the second, anorexia is a characteristic, but not a defining one. The
same goes for “the student with ADHD,” “the child with autism,” and “the mother
with depression”—each of these is far less stigmatizing than “the ADHD student,”
“the autistic child,” and “the depressed mother.”

The DSM guides the diagnoses of psychological disorders; it has been revised
many times and is both praised and criticized.

LEARNING OBJECTIVES

Evaluate the pros and cons of the DSM system of classifying mental disorders

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KEY TAKEAWAYS

Key Points

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the

standard classification manual used by mental health professionals in the United
States.

The DSM contains a hierarchy of diagnostic criteria for every mental-health

disorder recognized by the American Psychiatric Association.

The DSM has been revised multiple times since the initial writing of the DSM-
I (including the DSM-II, DSM-III, DSM-III-Revised, DSM-IV, DSM-IV-TR, and
DSM-5).

Some of the strengths of the DSM are that it helps develop evidence-based
treatments and it affords consistency among clinicians, insurance companies, and
other healthcare providers.

The DSM has been criticized for its lack of reliability and validity in its
diagnoses; basing its diagnoses on superficial symptoms rather than underlying
causes; its distinct cultural bias; and a conflict of interest related to its relationship
with pharmaceutical companies.

Key Terms

Comorbidity: The presence of one or more disorders (or diseases) in addition to a

primary disease or disorder.

Neurosis: A mental disorder, less severe than psychosis, marked by anxiety or fear.

Psychodynamic: Of an approach to psychology that emphasizes the systematic study

of psychological forces that underlie human behavior, feelings, and emotions, as well
as how these might relate to early experience.

Psychosis: A severe mental disorder, sometimes with physical damage to the brain,
marked by a distorted view of reality.

What Is the DSM?

Although a number of classification systems have been developed over time

for the diagnosis of mental disorders, the one that is used by most mental health
professionals in the United States is the Diagnostic and Statistical Manual of Mental
Disorders (DSM), published most recently in its 5th edition (known as the “DSM-5”)
by the American Psychiatric Association in 2013.

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 The DSM is the standard classification manual of mental disorders and
contains a hierarchy of diagnostic criteria for every mental-health disorder
recognized by the American Psychiatric Association. The DSM is used by
psychiatrists and psychologists, doctors and nurses, and therapists and counselors. It
is used for individual clinical diagnoses, but its codes and criteria are also used in the
collection of data about the incidence of different disorders.

The DSM is often considered a “necessary evil”—it has many flaws, but it is
also the only widely accepted method of diagnosing mental disorders.

History of the DSM

The initial impetus for developing a classification of mental disorders in the

United States was the need to collect statistical information. Research and changing
cultural norms have contributed to the DSM’s evolution over time.

DSM-I (1952)

The first version of the DSM was created in response to the large-scale
involvement of psychiatrists in the treatment, processing, and assessment of World
War II soldiers. The DSM-I was 130 pages long and listed 106 mental disorders,
many of which have since been abandoned.

DSM-II (1968)

The DSM-I and the DSM-II are clear reflections of the strongly
psychodynamic slant the field of psychology had at the time of their publication.
Symptoms were not specified in detail for specific disorders, and many were seen as
reflections of broad underlying conflicts or maladaptive reactions to life problems,
rooted in a distinction between neurosis and psychosis. Sociological and biological
knowledge was incorporated in a model that did not emphasize a clear boundary
between normality and abnormality.

DSM-III (1980)

Around this time, a controversy emerged regarding the deletion of the concept
of neurosis. Faced with enormous political opposition, the DSM-III was in serious
danger of not being approved by the American Psychological Association’s (APA’s)
board of trustees unless “neurosis” was included in some capacity; a political
compromise reinserted the term in parentheses after the word “disorder,” in some
cases. The DSM-III included more than twice as many diagnoses (265) as the
original DSM-1 and was nearly seven times its size (886 total pages).

DSM-IV (1994)

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 In this version, a clinical significance criterion was added to almost half of all
the categories. This criterion required that symptoms cause “clinically significant
distress or impairment in social, occupational, or other important areas of
functioning.”

A “text revision” of the DSM-IV, known as the DSM-IV-TR, was published in

2000. The DSM-IV-TR was organized into a five-part axial system.

Axis I: Clinical disorders, such as depression and anxiety.

Axis II: Personality disorders and/or developmental disorders (such as intellectual

disabilities, formerly called mental retardation).

Axis III: Physical issues that may impact mental health, such as diabetes.

Axis IV: Psychosocial stressors, such as occupational problems.

Axis V: A global assessment of functioning score (GAF), which provides a score of

the person’s overall functioning from 1 to 100.

DSM-5 (2013)

Perhaps the most controversial version yet, the DSM-5 contains extensively
revised diagnoses; it broadens diagnostic definitions in some cases while narrowing
definitions in other cases. Notable changes include the change from autism and
Asperger syndrome to a combined autism spectrum disorder; dropping the subtype
classifications for variant forms of schizophrenia; dropping the “bereavement
exclusion” for depressive disorders; a revised treatment and naming of gender -
identity disorder to gender dysphoria; and changes to the criterion for post-traumatic
stress disorder (PTSD). The DSM-5 has discarded the multiaxial system of diagnosis
of the DSM-IV, listing all disorders on a single axis. It has replaced Axis IV with
significant psychosocial and contextual features and dropped Axis V (the GAF)
entirely. Although DSM-5 is longer than DSM-IV, the volume includes only 237
disorders, a decrease from the 297 disorders that were listed in DSM-IV.

Strengths of the DSM

Evidence-Based Treatment

One of the strengths of the DSM is its use in researching and developing
evidence-based treatments. Researchers use the DSM diagnoses to conduct studies
and trials on patients, and this research determines which treatment approaches

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provide the most effective results. As studies get published, mental-health service
providers learn how to incorporate the most evidence-based treatments into their
practice.

Consistency and Insurance Coverage

The DSM also provides a common language for physicians, social workers,
nurses, psychologists, marriage and family therapists, and psychiatrists to
communicate about mental illness. In addition to providing a common language
among practitioners, hospitals, clinics, and insurance companies in the US also
generally require a DSM diagnosis for all patients treated. Providers must often use
the DSM in order to get coverage for their clients from insurance companies, which
require certain DSM diagnoses for treatment.

Weaknesses of the DSM

Reliability and Validity Concerns

The revisions of the DSM from the 3rd edition forward have been mainly
concerned with diagnostic reliability—the degree to which different diagnosticians
agree on a diagnosis. Many diagnoses are so similar that there is a high rate of
comorbidity between disorders.

Diagnoses Based on Superficial Symptoms

The DSM is primarily concerned with the signs and symptoms of mental
disorders, rather than their underlying causes. It claims to collect them together based
on statistical or clinical patterns. Furthermore, diagnostic labels can be stigmatizing
for patients by creating stereotypes about certain diagnoses.

Cultural Bias

Current diagnostic guidelines have been criticized as having a fundamentally

Euro-American outlook. Common criticisms include both disappointments over the
large number of documented non-Western mental disorders still left out and
frustration that even those included are often misinterpreted or misrepresented.

Medicalization and Financial Conflicts of Interest

It has been alleged that the way the categories of the DSM are structured and
the substantial expansion of the number of categories are representative of an
increasing medicalization of human nature. This has been attributed by many to the
expanding power and influence of pharmaceutical companies over the last several
decades. Of the authors who selected and defined the DSM-IV psychiatric disorders,

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roughly half have had financial relationships with the pharmaceutical industry at one
time, raising the prospect of a direct conflict of interest.

Stigma

Because the DSM is a system of labeling, it is often criticized for contributing

to the creation of social stigma against those with mental illnesses. In the context of
mental illness, social stigma is characterized as prejudiced attitudes and
discriminating behavior directed toward individuals with mental illness as a result of
the label they have been given. Stigma and discrimination can add to the suffering
and disability of those who are diagnosed with a mental disorder.

Preventing Psychological Disorders

Focusing on the prevention of mental illness, rather than only on treating

existing mental illness, has numerous health and economic benefits.

LEARNING OBJECTIVES

Give examples of primary, secondary, and tertiary approaches to preventing

psychological disorders

KEY TAKEAWAYS

Key Points

Prevention of mental illness has a number of benefits, ranging from

improvements in individuals’ well-being to positive economic and social changes.

Risk factors for mental illness include both genetic and environmental influences.

Prevention efforts involve assessing risk factors for mental illness. There are
three levels of prevention: primary, secondary, and tertiary.

Primary prevention targets individuals who are at high risk for developing a
disorder based on biological, social, or psychological risk factors (e.g., teaching
emotion-regulation skills to teens).

Secondary prevention seeks to diagnose and treat a disorder in its early stages
(e.g., rape crisis counseling).

Tertiary prevention targets individuals who already have a disorder by seeking

to reduce or eliminate the negative impact of the disorder (e.g., Alcoholics
Anonymous, or AA).

Key Terms

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Predisposition: The state of being susceptible to something, especially to a disease
or other health problem.

Stressor: An environmental condition or influence that causes distress for an

organism.

Intervention: The action of interfering in a course of events.

Primary prevention: Efforts to avoid occurrence of disease either through

eliminating disease agents or through increasing resistance to disease. Examples in
the context of physical health include immunization against disease, maintaining a
healthy diet and exercise regimen, and avoiding smoking.

Prevention of mental illness has a number of benefits, ranging from

improvements in individuals’ well-being to positive economic and social changes.
The 2004 report of the World Health Organization (WHO) Prevention of Mental
Disorders stated that “prevention of these disorders is obviously one of the most
effective ways to reduce the [disease] burden.” Similarly, the 2011 European
Psychiatric Association (EPA) guidance on prevention of mental disorders states that
“There is considerable evidence that various psychiatric conditions can be prevented
through the implementation of effective evidence-based interventions.”

Risk Assessment

Risk factors for mental illness include both genetic and environmental
influences. Environmental influences include early childhood relationships and
experiences (such as abuse or neglect), poverty, the effects of race and racism, and
major life stressors (such as a breakup, the loss of a job, or the death of a loved one).
Other risk factors may include family history of mental illness (such as depression or
anxiety ), temperament, and attitudes (e.g., pessimism).

Some mental disorders have a genetic link. Usually this link is a predisposition
to developing the disorder, which means that while an individual may be more likely
than other individuals to develop it, there is no guarantee that they will. Primary
prevention (discussed below) can help reduce the likelihood that a genetically
predisposed individual will develop a given disorder.

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Risk factors and genetics: A person’s risk of developing schizophrenia increases if
a relative has schizophrenia—the closer the genetic relationship, the higher the risk.

Three Levels of Prevention

Prevention falls into three levels: primary, secondary, and tertiary. Primary
prevention targets individuals who are at a high risk for developing a disorder;
secondary prevention targets those who are in the early stages of a disorder; and
tertiary prevention targets individuals who already have a disorder by seeking to
reduce or eliminate its negative impact.

Primary Prevention

Primary prevention includes methods to avoid the occurrence of a disorder or

disease altogether. Most population-based health promotion efforts are of this type.
This method targets individuals and groups who have a high risk of developing a
mental illness based on biological, social, or psychological risk factors. Primary
prevention programs might include teaching parents effective parenting skills,
distributing condoms to students who are at high risk for STIs or teen pregnancy, or
providing social support to children of divorce. Research has found such programs to
be highly effective, and financially speaking the cost of implementing such primary
prevention programs is often much lower than the ultimate cost of caring for
individuals after they have been diagnosed with the disorder or disease.

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Secondary Prevention

Secondary prevention includes methods to diagnose and treat a disorder or

disease in its early stages before it causes significant distress. This approach also
aims to lower the rate of established cases. An example of a secondary prevention
program is rape crisis counseling. After being raped, an individual may develop or be
in the early stages of developing a number of disorders such as depression, anxiety,
or post-traumatic stress disorder (PTSD). Early intervention through counseling can
help minimize the progression of one or more of these mental health issues.

Tertiary Prevention

Tertiary prevention includes methods to reduce the negative impact of existing

disorders or diseases by reducing complications and restoring lost function. These
methods include interventions that prevent relapse, promote rehabilitation, and
reduce the nature of the disorder. Examples of tertiary prevention programs include
Alcoholics Anonymous (AA), diabetes control programs, and home visits to those
who are chronically ill.4

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