DESCRIBING AND CLASSIFYING ABNORMAL BEHAVIOR.

CHAPTER 2: DESCRIBING AND

CLASSIFYING ABNORMAL
BEHAVIOR.
Introduction

• Abnormal behaviours are diverse and pervasive; need a sub-

discipline in psychology.
• Psychopathology:
 Derived from the words ‘psyche’ (mind or soul) and ‘pathology’
(disease or illness) = mind illness.
• Psychological disorder:
• Psychological dysfunction within an individual
• associated with distress or impairment in functioning
• and a response to this that deviates from that individual’s culture.

2
Statistical deviance
 Determine what is normal (far from normal = ‘abnormal’).
 Norm is influenced by cultural/social perspectives.
 What is considered normal is not necessarily healthy.
 
Maladaptiveness
 Behaviours that prevent individual adapting for the good of individual/group
are considered abnormal (e.g. depression).
 Relative to culture.
 
Personal distress
 Psychopathology often accompanied by distress and suffering.
 Diagnosis of abnormality set in person’s context (e.g. ‘normal’ distress from
bereavement).
3
A brief history of psychopathology

The pre-scientific era

 Initial belief that abnormal behaviour was caused by supernatural forces.
 Hippocrates – first biological view.
 Galen: 4 humours of the brain.
 Galenic-Hippocratic tradition
 Middle Ages: Move away from biological views - mental illness
considered punishment for sin (thus people had to be exorcised).
 Institutionalisation on the increase – inhumane treatment in ‘asylums’.
 Around 1800: Reforms in treatment of mentally ill (Pinel; Tuke).

4
The scientific era
 Shift back to a biological approach.
 Development of variety of psychological theories.
 Sigmund Freud - disorder the result of:
 conflict of different personality structures;
 over-reliance on certain defence mechanisms.
 Behavioural theory (John Watson; Pavlov; Skinner) – Disorder the result of
learned behaviour.
 The 1950s:
 Medications becoming increasingly available.
Included neuroleptics (antipsychotics, e.g. reserpine) and major tranquillizers

5
Psychopathology in South Africa
 South Africa was the scene of ongoing conflict
between various world powers.
 Led to subjugation of white Afrikaner and black
South Africans.
 Racial segregation was formalised by H.F
Verwoerd (‘father of apartheid’).
 Use of culturally biased psychological tests to
endorse racial oppression.
 SA still dealing with colonial and apartheid legacy.

6
Two classifications of mental illness:
 
1. Classification of Disease (ICD)
 Published by WHO.
 Includes a section on mental, behavioural, and neurodevelopmental
disorders.
 Aimed at primary care practitioners and is mandated for use world
wide.

2. Diagnostic Manual of Mental Disorders (DSM)

 Published by APA.
 Solely focused on mental health disorders.
Aim of the manuals:
 Develop repliable and clinically useful categories and criteria. 7
DSM-5 includes:
 Recognisable conditions for diagnosis, care or research.
 Useful guide to current treatments.
 Prognosis: Information for likely outcome of psychiatric disorders.
 Aetiology: Causes or patho-physiological processes.
 
Problems associated with these systems
 Diagnostic categories are based on particular psychiatric theories
and data – not truly theoretical.
 Categories are broad and are specified by numerous possible
combinations of symptoms.
 Many categories overlap.
 Were originally intended as a guide to experienced clinicians

8
 .
The Diagnostic Statistical Manual of Mental Disorders (5th
ed.)
Background and history
 1952: 1st DSM.
 Number of disorders grew to 400 by DSM-IV.
 Anti-Psychiatry Movement critically viewed DSM diagnoses
as labels constructed by society in order to silence
deviance.
 DSM-III and DSM-IV criticised for their approach to
diagnoses:
 Minimum number of symptoms from a list determines the
presence or absence of the disorder.
9
DSM-IV-TR: Multi-axial diagnostic system
 DSM-IV-TR based on biomedical model:
 Signs and symptoms are grouped together to identify the pathological cause or
syndrome.
Five axes:
 AXIS I: Clinical Disorders (e.g. Schizophrenia; depression)
 AXIS II: Personality Disorders; Mental Retardation
 Pervasive maladaptive personality problems (e.g. Borderline Personality
Disorder)
 AXIS III: General Medical Conditions (e.g. Temporal Lobe Epilepsy)
 AXIS IV: Social Functioning and Impact of Symptoms (e.g. psychosocial
stressors; unemployment)
 AXIS V: Global Assessment of Functioning (level of adaptive functioning/ degree
of coping; e.g. suicide ideation)
10
Criticisms of the DSM-IV system
 Only describes disorders (lack of focus on aetiology).
 Has evolved into a biomedical system.
 Adopts an individualistic approach.
 Often criticised for creating diagnostic categories that have a
Western cultural perspective.
 Concerns raised about the validity of the DSM-IV system.
 Reliability of the DSM-IV system also questioned.
 Caution: A diagnosis does not describe the person, but only a set
of behaviours associated with the person’s problem.

11
The International Classification of Diseases (ICD)
Background and history
1893: Jacques Bertillon introduced Bertillon Classification of Causes of Death at International Statistical
Institute (Chicago).
1960s: WHO became actively engaged in improvement in diagnosis and classification of mental
disorders.
Extensive consultation process: Numerous proposals to improve classification of mental disorders
led to eighth revision of International Classification of Diseases (ICD-8).
 
The ICD only has 3 axes:
AXIS I: Clinical Diagnoses (mental disorders, physical disorders and personality disorders)
AXIS II: Description of any activity, limitation or participation restrictions in specific areas of functioning
(including personal care; occupation; family and household; and functioning in the broader social
context)
AXIS III: Used to describe contextual factors (environmental and lifestyle factors) relevant to
pathogenesis and course of the patient’s illness
ICD includes personality disorders on the same axis as other mental disorders, unlike DSM.
The ICD-10 also attempts to be more culture-sensitive than the DSM-IV-TR.

12
Classification systems: Comparison and critique
 The most reliable of diagnostic criteria are not necessarily valid (they do not measure
what they are supposed to measure).
 Criticism of ICD and DSM  different schemes of classification proposed to replace current
descriptive model of mental disorders:
 Dimensional model (mental disorders lie on a continuum)
 Holistic model (equal emphasis on social, spiritual, and pharmacological treatments)
 Essential/Perspectival model (Johns Hopkins).
 
Conclusion
 Assessment and diagnosis involves complex and time-consuming procedures.
 Requires investigative and deductive reasoning, technical skills, and sensitivity to person’s
cultural background.

13