1) Abnormal behavior: myths, realities, and controversies
a. The medical model applied to abnormal behaviour
i. The medical model proposes that it is useful to think of abnormal
behavior as a disease. Refers to abnormal behavior, including
1. Mental illness
2. Psychological disorder
3. Psychopathology (pathology refers to manifestations of
ii. The medical model (only analogy) gradually became the dominant way
of thinking about abnormal behavior during the 18th and 19th
centuries, and its influence remains strong today.
iii. Prior to the 18th century, most conceptions of abnormal behavior
were based on superstition.
iv. Critics of medical model:
1. Thomas Szasz asserts that ―strictly speaking, disease or illness
can affect only the body; hence there can be no mental illness.
Minds can be ‗sick‘ only in the sense that jokes are ‗sick‘ or
economies are ‗sick‘‖
2. Abnormal behavior usually involves a deviation from social
norms rather than an illness.
3. According to Szasz, the medical model‘s disease analogy
converts moral and social questions about what is acceptable
behavior into medical questions.
v. Diagnosis involves distinguishing one illness from another.
vi. Etiology refers to the apparent causation and developmental history of
vii. A prognosis is a forecast about the probable course of an illness
b. Criteria of abnormal behavior
i. Deviance. All cultures have such norms. When people violate these
standards and expectations, they may be labeled mentally ill. For
example, transvestic fetishism is a sexual disorder in which a man
achieves sexual arousal by dressing in women‘s clothing.
ii. Maladaptive behavior. Alcohol and drug use is not unusual or deviant.
However, when the use of cocaine, for instance, begins to interfere
with a person‘s social or occupational functioning, a substance use
iii. Personal distress. Depressed people, for instance, may or may not
exhibit deviant or maladaptive behavior. Such people are usually
labeled as having a disorder when they describe their subjective pain
and suffering to friends, relatives, and mental health professionals.
iv. Diagnoses of psychological disorders involve value judgments about
what represents normal or abnormal behavior. Judgments about mental
illness reflect prevailing cultural values, social trends, and political
forces, as well as scientific knowledge
v. People are judged to have psychological disorder only when their
behavior becomes extremely deviant, maladaptive, or distressing. Thus,
normality and abnormality exist on a continuum. It‘s a matter of
degree, not an either-or proposition c. Stereotypes of psychological disorders (3 stereotypes are
i. Psychological disorders are incurable. The vast majority of people who
are diagnosed as mentally ill eventually improve and lead normal,
productive lives. Even the most severe psychological disorders can be
ii. People with psychological disorders are often violent and dangerous.
This stereotype exists because incidents of violence involving the
mentally ill tend to command media attention
iii. People with psychological disorders behave in bizarre ways and are
very different from normal people. This is true only in a small minority
of cases, usually involving relatively severe disorders.
d. Psychodiagnosis: The Classification of Disorders
i. Guidelines for psychodiagnosis were extremely vague and informal
prior to 1952 when the American Psychiatric Association unveiled its
Diagnostic and Statistical Manual of Mental Disorders
ii. The third edition (DSM-III), published in 1980, represented a major
advance, as the diagnostic criteria were made much more explicit,
concrete, and detailed to facilitate more consistent diagnoses across
iii. The publication of DSM-III in 1980 introduced a new multiaxial
system of classification, which asks for judgments about individuals on
five separate dimensions, or ―axes.‖
iv. DSM-IV is the official psychodiagnostic classification sys- tem in the
United States. This system asks for information about patients on five
axes, or dimensions.
v. The diagnoses of disorders are made on Axes I and II. Clinicians
record most types of disorders on Axis I: Clinical syndromes. They use
Axis II to list long-running personality disorders or mental retardation.
A patient‘s physical disorders are listed on Axis III (General Medical
Conditions). On Axis IV (Psychosocial and Environmental Problems),
the clinician makes notations regarding the types of stress experienced
by the individual in the past year. On Axis V (Global Assessment of
Functioning), estimates are made of the individual‘s current level of
adaptive functioning (in social and occupational behavior, viewed as a
whole) and of the individual‘s highest level of functioning in the past
e. The Prevalence of Psychological Disorders
i. Epidemiology—the study of the distribution of mental or physical
disorders in a population.
ii. Prevalence refers to the percentage of a population that exhibits a
disorder during a specified time period.
iii. Prior to the advent of DSM-III, studies suggested that about one-fifth
of the population exhibited clear signs of mental illness at some point
in their lives
iv. Studies published in the 1980s and early 1990s, using the explicit
criteria for substance use disorders in DSM-III, found psychological
disorders in roughly one-third of the population
v. All these figures are estimates that depend to some extent on the
sampling methods and assessment techniques used vi. Critics of the recent high estimates argue that they include many
people whose problems have little clinical significance;
vii. Those who defend the recent research argue that it makes sense to
count people with mild disorders because such disorders often progress
into more severe disorders and this progression might be prevented by
early diagnosis and intervention
viii. The most common types of psychological disorders are (1) substance
(alcohol and drugs) use disorders, (2) anxiety disorders, and (3) mood
ix. The data that yielded the 44% estimate of total lifetime prevalence
2) Anxiety disorders: five principle Anxiety disorders are a class of disorders
marked by feelings of excessive apprehension and anxiety.
a. Generalized anxiety disorder
i. The generalized anxiety disorder is marked by a chronic, high level of
anxiety that is not tied to any specific threat.
ii. People with this disorder worry constantly about yesterday‘s mistakes
and tomorrow‘s problems.
iii. Their anxiety is commonly accompanied by physical symptoms, such
as trembling, muscle tension, diarrhea, dizziness, faintness, sweating,
and heart palpitations.
iv. Generalized anxiety disorder tends to have a gradual onset and is seen
more frequently in females than males.
v. The lifetime prevalence of generalized anxiety disorder appears to be
b. Phobic disorder
i. A phobic disorder is marked by a persistent and irrational fear of an
object or situation that presents no realistic danger.
ii. People are said to have a phobic disorder only when their fears
seriously interfere with their everyday behavior.
iii. Phobic reactions tend to be accompanied by physical symptoms of
anxiety, such as trembling and palpitations
iv. People can develop phobic responses to virtually anything.
v. Particularly common are acrophobia (fear of heights), claustrophobia
(fear of small, enclosed places), brontophobia (fear of storms),
hydrophobia (fear of water), and various animal and insect phobias
vi. Even imagining a phobic object or situation can trigger great anxiety
c. Panic disorder and agoraphobia
i. A panic disorder is characterized by recurrent attacks of overwhelming
anxiety that usually occur suddenly and unexpectedly.
ii. These paralyzing panic attacks are accompanied by physical symptoms
iii. Agoraphobia is a fear of going out to public places (its literal meaning
is ―fear of the marketplace or open places‖).
iv. About two-thirds of people who suffer from panic disorder are female
v. The onset of panic disorder typically occurs during late adolescence or
d. Obsessive-compulsive disorder
i. An obsessive-compulsive disorder (OCD) is marked by persistent,
uncontrollable intrusions of unwanted thoughts (obsessions) and urges
to engage in senseless rituals (compulsions). ii. People troubled by obsessions may feel that they have lost control of
their mind. Compulsions usually involve stereotyped rituals that
temporarily relieve anxiety.
iii. Full-fledged obsessive-compulsive disorders occur in roughly 2.5% of
iv. The typical age of onset for OCD is late adolescence, with most cases
(75%) emerging before the age of 30
e. Posttraumatic stress disorder
i. Posttraumatic stress disorder (PTSD) involves enduring psychological
disturbance attributed to the experience of a major traumatic event.
ii. PTSD is often seen after a rape or assault, a severe automobile accident,
a harrowing war experience, a natural disaster, or the witnessing of
iii. In some instances, PTSD does not surface until many months or years
after a person‘s exposure to severe stress
iv. Common symptoms include re-experiencing the traumatic event in the
form of nightmares and flashbacks, emotional numbing, alienation,
problems in social relations, an increased sense of vulnerability, and
elevated arousal, anxiety, anger, and guilt.
v. Increased vulnerability is associated with greater personal injuries and
losses, greater intensity of exposure to the traumatic event, and more
exposure to the grotesque aftermath of the event. One key predictor of
vulnerability that emerged in a recent review of the relevant research is
the intensity of one‘s reaction at the time of the traumatic event.
f. Etiology of anxiety disorders
i. Biological factors
1. A concordance rate indicates the percentage of twin pairs or
other pairs of relatives who exhibit the same disorder.
2. Anxiety sensitivity may make people vulnerable to anxiety
3. The results of both twin studies and family studies suggest that
there is a moderate genetic predisposition to anxiety disorder.
4. If relatives who share more genetic similarity show higher
concordance rates than relatives who share less genetic overlap,
this finding supports the genetic hypothesis
5. Anxiety sensitivity may fuel an inflationary spiral in which
anxiety breeds more anxiety, which eventually spins out of
control in the form of an anxiety disorder.
6. Recent evidence suggests that a link may exist between anxiety
disorders and neurochemical activity in the brain.
7. Therapeutic drugs (such as Valium) that reduce excessive
anxiety appear to alter neurotransmitter activity at GABA
8. Abnormalities in neural circuits using serotonin have recently
been implicated in panic and obsessive-compulsive disorders
ii. Conditioning and learning
1. Many anxiety responses may be acquired through classical
conditioning and maintained through operant conditioning.
2. An originally neutral stimulus may be paired with a frightening
event so that it becomes a conditioned stimulus eliciting anxiety.
3. Once a fear is acquired through classical conditioning, the
person may start avoiding the anxiety- producing stimulus. The
avoidance response is negatively reinforced because it is
followed by a reduction in anxiety. This process involves
operant conditioning. Thus, separate conditioning processes
may create and then sustain specific anxiety responses
4. The tendency to develop phobias of certain types of objects and
situations may be explained by Martin Seligman‘s concept of
preparedness. Like many theorists, Seligman believes that
classical conditioning creates most phobic responses. However,
he suggests that people are biologically prepared by their
evolutionary history to acquire some fears much more easily
than others. Evidence is inconsistent.
5. Critics: many people with phobias cannot recall or identify a
traumatic conditioning experience that led to their phobia.
Conversely, many people endure extremely traumatic
experiences that should create a phobia but do not.
6. Observational learning occurs when a new response is acquired
through watching the behavior of another
iii. Cognitive factors
1. According to these theorists, some people are more likely to
suffer from problems with anxiety because they tend to
a. (a) Misinterpret harmless situations as threatening
b. (b) Focus excessive attention on perceived threats
c. (c) Selectively recall information that seems threatening
2. Consistent with our theme that human experience is highly
1. Faravelli and Pallanti (1989) found that patients with panic
disorder had experienced a dramatic increase in stress in the
month prior to the onset of their disorder
2. Brown et al. (1998) found an association between stress and the
development of social phobia. Thus, there is reason to believe
that high stress often helps to precipitate the onset of anxiety
3) Somatoform disorders
a. Psychosomatic diseases involve genuine physical ailments caused in part by
psychological factors, especially reactions to stress. These diseases, which
include maladies such as ulcers, asthma, and high blood pressure, are not
imagined ailments. They are recorded on the DSM axis for physical problems
(Axis III) When physical illness appears largely psychological in origin, we
are dealing with somatoform disorders, which are recorded on Axis I.
Somatoform disorders are physical ailments that cannot be fully explained by
organic conditions and are largely due to psychological factors. Malingering:
Deliberate feigning of illness for personal gain. People with somatoform
disorders typically seek treatment from physicians practicing neurology,
internal medicine, or family medicine, instead of from psychologists or
b. Somatization disorder i. A somatization disorder is marked by a history of diverse physical
complaints that appear to be psychological in origin.
ii. Somatization disorder occurs mostly in women and often coexists with
depression and anxiety disorders
iii. The distinguishing feature of this disorder is the diversity of the
victims‘ physical complaints.
c. Conversion disorder
i. Conversion disorder is characterized by a significant loss of physical
function (with no apparent organic basis), usually in a single organ
ii. People with conversion disorder are usually troubled by more severe
ailments than people with somatization disorder.
iii. Telltale clues reveal the psychological origins of the illness because
the patient‘s symptoms are not consistent with medical knowledge
about their apparent disease.
i. Hypochondriasis (more widely known as hypochondria) is
characterized by excessive preoccupation with health concerns and
incessant worry about developing physical illnesses.
ii. When hypochondriacs are assured by their physician that they do not
have any real illness, they often are skeptical and disbelieving
iii. Hypochondriacs don‘t subjectively suffer from physical distress as
much as they overinterpret every conceivable sign of illness.
Hypochondria frequently appears alongside other psychological
disorders, especially anxiety disorders and depression
e. Etiology of somatoform disorders
i. Personality factors
1. The prime candidates appear to be people with histrionic
2. The histrionic personality tends to be self-centered, suggestible,
excitable, highly emotional, and overly dramatic.
3. Such people thrive on the attention that they get when they
become ill. The personality trait of neuroticism also seems to
elevate individuals‘ susceptibility to somatoform disorders
4. In addition, research suggests that the pathological care-seeking
behavior seen in these disorders may be caused by insecure
attachment styles that are rooted in early experiences with
ii. Cognitive factors
1. Recent evidence suggests that people with somatoform
disorders tend to draw catastrophic conclusions about minor
2. They also seem to apply a faulty standard of good health,
equating health with a complete absence of symptoms and
discomfort, which is unrealistic
3. Some people focus excessive attention on their internal
physiological processes and amplify normal bodily sensations
into symptoms of distress, which lead them to pursue
unnecessary medical treatment.
iii. The sick role 1. Their complaints of physical symptoms may be reinforced by
indirect benefits derived from their illness
2. One payoff is that becoming ill is a superb way to avoid having
to confront life‘s challenges.
3. Attention from others is another payoff that may reinforce
complaints of physical illness.
4) Dissociative disorders
a. Dissociative disorders are a class of disorders in which people lose contact
with portions of their consciousness or memory, resulting in disruptions in
their sense of identity.
b. Dissociative amnesia and fugue
i. Dissociative amnesia is a sudden loss of memory for important
personal information that is too extensive to be due to normal
forgetting. Memory losses may occur for a single traumatic event or
for an extended period of time surrounding the event.
ii. Dissociative fugue, people lose their memory for their entire lives
along with their sense of personal identity.
iii. Despite this whole-sale forgetting, they remember matters unrelated to
their identity, such as how to drive a car and how to do math.
c. Dissociative identity disorder
i. Dissociative identity disorder (DID) multiple personality disorder
involves the co-existence in one person of two or more largely
complete, and usually very different, personalities.
ii. Dissociative identity disorder rarely occurs in isolation. Most DID
patients also have a history of anxiety, mood, or personality disorders
d. Etiology of dissociative disorders
i. Some theorists speculate that certain personality traits— fantasy
proneness and a tendency to become intensely absorbed in personal
experiences—may make some people more susceptible to dissociative
disorders, but adequate evidence is lacking on this line of thought.
ii. Nicholas Spanos (1994, 1996) and others believe that people with
multiple personalities are engaging in intentional role-playing to use
mental illness as a face-saving excuse for their personal failings.
iii. Spanos also argues that a small minority of therapists helps create
multiple personalities in their patients by subtly encouraging the
emergence of alternate personalities.
iv. Some clinicians are convinced that DID is an authentic disorder. They
argue that there is no incentive for either patients or therapists to
manufacture cases of multiple personalities, which are often greeted
with skepticism and outright hostility. They maintain that most cases
of dissociative identity disorder are rooted in severe emotional trauma
that occurred during childhood
v. A substantial majority of people with dissociative identity disorder
reports a childhood history of rejection from parents and physical and
sexual abuse. However, this abuse typically has not been
5) Mood disorders
a. Mood disorders are a class of disorders marked by emotional disturbances of
varied kinds that may spill over to disrupt physical, perceptual, social, and
thought processes. b. Major (unipolar) depressive disorder
i. Crucial considerations in this judgment include the duration of the
depression and its disruptive effects.
ii. In major depressive disorder people show persistent feelings of sadness
and despair and a loss of interest in previous sources of pleasure
iii. Depressed people often give up activities that they used to find
iv. Alterations in appetite and sleep patterns are common. People with
depression often lack energy. They tend to move sluggishly and talk
slowly. Anxiety, irritability, and brooding are commonly observed.
Self-esteem tends to sink as the depressed person begins to feel
worthless. Depression plunges people into feelings of hopelessness,
dejection, and boundless guilt.
v. The onset of depression can occur at any point in the life span, but a
substantial majority of cases emerge before age 40
vi. The median duration of depressive episodes is 5 months
vii. The vast majority (75%–95%) of people who suffer from depression
experience more than one episode over the course of their lifetime
viii. In one longitudinal study, after recovery from a first episode of
depression, the cumulative probability of recurrence was 25% after 1
year, 42% after two years, and 60% after 5 years
ix. Dysthymic disorder, which consists of chronic depression that is
insufficient in severity to justify diagnosis of a major depressive
x. In particular, age cohorts born since World War II appear to have an
elevated risk for depression
xi. Researchers also find that the prevalence of depression is about twice
as high in women as it is in men
xii. Susan Nolen-Hoeksema (2001) argues that women experience more
depression than men be cause they are far more likely to be victims of
sexual abuse and somewhat more likely to endure poverty, harassment,
and role constraints.
xiii. Nolen-Hoeksema also believes that women have a greater tendency
than men to ruminate about setbacks and problems.
Characteristics Depressive Episode
Elated, euphoric, very sociable,
Emotional Gloomy, hopeless, socially withdrawn, irritable
impatient at any hindrance
Characterized by racing thoughts, flight Characterized by slowness of thought processes, obsessive
of ideas, desire for action, and impulsive
Cognitive behavior; talkative, self-confident; Worrying, inability to make decisions, negative
experiencing delusions of grandeur
Self-image, self-blame and delusions of guilt and disease
Hyperactive, tireless, requiring less Less active, tired, experiencing difficulty in sleeping,
Motor sleep than usual, showing increased sex
drive and fluctuating appetite Showing decreased sex drive and decreased appetite
c. Bipolar disorder i. Bipolar disorder (formerly known as manic-depressive disorder) is
characterized by the experience of one or more manic episodes as well
as periods of depression.
ii. Cyclothymic disorder when they exhibit chronic but relatively mild
symptoms of bipolar disturbance.
iii. Unlike depressive disorder, bipolar disorder is seen equally often in
males and females
iv. The onset of bipolar disorder is age related, with the peak of
vulnerability occurring between the ages of 20 and 29
v. About 20% of bipolar patients exhibit a rapid-cycling pattern, which
means they go through four or more manic or depressive episodes
within a year.
d. Etiology of mood disorder
i. Genetic vulnerability
1. Twin studies have found a sizable disparity between identical
and fraternal twins in concordance rates for mood disorders
2. This evidence suggests that heredity can create a predisposition
to mood disorders. Environmental factors probably determine
whether this predisposition is converted into an actual disorder.
3. Research suggests that genetic vulnerability may play a larger
role in women‘s depression than in men‘s
4. The influence of genetic factors also appears to be stronger for
bipolar disorders than for unipolar disorders
ii. Neurochemical and neuroanatomical factors
1. Correlations have been found between mood disorders and
abnormal levels of two neurotransmitters in the brain:
norepinephrine and serotonin
2. Low levels of serotonin appear to be a crucial factor underlying
most forms of depression
3. The best documented correlation is the association between
depression and reduced hippocampal volume
4. The hippocampus, which is known to play a major role in
memory consolidation, tends to be about 8%–10% smaller in
depressed subjects than in normal subjects
5. Jacobs (2004) has theorized that depression occurs when major
life stress causes neurochemical reactions that suppress
neurogenesis, resulting in reduced hippocampal volume.
6. According to this view, the suppression of neurogenesis is the
central cause of depression. Consistent with this view, Jacobs
maintains that antidepressant drugs that elevate serotonin levels
relieve depression because serotonin promotes neurogenesis.
iii. Cognitive factors
1. Martin Seligman‘s learned helplessness model of depression.
2. Based largely on animal research, Seligman (1974) proposed
that depression is caused by learned helplessness—passive
―giving up‖ behavior produced by exposure to unavoidable
3. He originally considered learned helplessness to be a product of
conditioning but eventually revised his theory, giving it a
cognitive slant. The reformulated theory of learned helplessness postulates that the roots of depression lie in how
people explain the setbacks and other negative events that they
4. According to Seligman (1990), people who exhibit a
pessimistic explanatory style are especially vulnerable to
depression. These people tend to attribute their setbacks to their
personal flaws instead of situational factors, and they tend to
draw global, far-reaching conclusions about their personal
inadequacies based on these setbacks.
5. In accord with this line of thinking, Susan Nolen Hoeksema
(1991, 2000) has found that depressed people who ruminate
about their depression remain depressed longer than those who
try to distract themselves. People who respond to depression
with rumination repetitively focus their attention on their
depressing feelings, thinking constantly about how sad,
lethargic, and unmotivated they are. According to Nolen
Hoeksema (1995), excessive rumination tends to extend and
amplify individuals‘ episodes of depression. As we noted
earlier, she believes that women are more likely to ruminate
than men and that this disparity may be one of the primary
reasons why depression is more prevalent in women.
6. In sum, cognitive models of depression maintain that negative
thinking is what leads to depression in many people.
7. The principal problem with cognitive theories is their difficulty
in separating cause from effect
8. Retrospective designs, which look backward in time from
known outcomes. Retrospective designs can yiel