ABNORMAL BEHAVIOUR:
ABNORMALITY:
1. individual displaying behaviour t. is rare/unusual
2. behaviour t. is regarded as unhelpful/maladaptive to situations/context in w. individual lives
3. MENTAL HEALTH CONTEXT: impairments in individual’s daily functioning
TERMINOLOGY:
AETIOLOGY study of causation of mental disorders
EPIDERMIOLOGY* study of patterns, causes, effects of diseases or disorders in specific populations
PROGNOSIS* prediction of probable course/outcome of disorder for individual
PREVALENCE % of population t. exhibits disorder during specified period
constellation of visible signs/symptoms associated w. particular mental disorder, t.
CLINICAL PICTURE interpretation of w. leads to diagnosis
mental disorder existing simultaneously but independently w. another mental disorder in an
COMORBIDITY individual
extent to w. individual w. mental disorder (/displaying abnormal behaviour) is likely to cause
DANGEROUSNESS harm to self/others
false belief t. is strongly held by individual even though presented w. evidence to t. contrary
DELUSIONS
extent to w. individual’s behaviours/attitudes differ from norms/ accepted social standards
DEVIANCE
determination of nature of case of mental disorder OR distinguishing 1 mental disorder from
DIAGNOSIS another; based on identifying signs/symptoms of mental disorders
DIFFERENTIAL determination of w. disorder may be producing symptoms of mental disorder
DIAGNOSIS
levels of anxiety/ sorrow/ pain individual subjectively experiences due to mental disorder
DISTRESS
false, often vivid, perception in absence of external stimuli t. appears to individual as real +
HALLUCINATION located in outside world
can occur in sensory modality (visual/auditory/olfactory/gustatory/ tactile)
pretending to suffer from physical/psych illness OR exaggerating symptoms to avoid
MALINGERING unwelcome duties (e.g. work/ military service) / gain financial compensation
symptoms/ abnormal behaviour in w. individual has lost contact w. reality + shows profound
PSYCHOSIS deterioration in ability to perform daily activities
SYMPTOMS subjective complaints of individual
SIGNS physical changes observed in individual presenting for treatment
SYNDROME common patterns of symptoms over time
_______________________________________________________________________________________
MEDICAL MODEL OF MENTAL DISORDERS:
Emil Kraepelin (1883): mental illness is rooted in biological/ disease/ medical model
think of mental illness as disease = identify/classify symptoms similar to diagnosis of physical diseases
TODAY structured cognitive tools (i.e. diagnostic manuals) to identify/ describe/ classify / inform treatment of abnormal
behaviour
MEDICAL CLASSIFICATION SYSTEMS:
The Diagnostic Classification of Diseases [10th Edition]
, 1 ICD-10 World Health Organisation
*ICD-11 sent out 2021 = takes effect 2022*
The Diagnostic and Statistical Manual of Mental Health Disorders [5 th Edition]
American Psychiatric Association
based on observable behaviour (symptoms) NOT presumed aetiology (causal pathways)
common language of categories to communicate key features/symptoms of mental disorders
2 DSM-5 DIAGNOSTIC CRITERIA: key features of disorder t. identify symptoms/ behaviours/ cognitive functions /
personality traits / physical signs / duration of key features
categories = collection of related disorders + specific diagnostic criteria
TO ACCURATELY IDENTIFY MENTAL DISORDERS: psychiatrists/ psychologists trained to develop
diagnostic competence + clinical expertise to identify when individuals display abnormal behaviour
NB! mental disorder classification systems continue to evolve considering advance in scientific research
CRITCISM FOR DMS-5:
CATEGORICAL APPROACH: vague boundaries between diagnosis
overlapping symptoms between disorders
↑ comorbidity w. many disorders = specific diagnoses may not reflect distinct disorders RATHER variations of
underlying disorder
MOVE TO DIMENTIONAL APPROACH:
scored on continuum based on experiences of symptoms
no concrete line between abnormal/normal = depends on severity
e.g. NO anxiety disorder RATHER scale of anxiety on w. everyone is placed in different severity levels
_______________________________________________________________________________________________
MEDICAL MODEL APPLIED TO ABNORMAL BEHAVIOUR:
DISORDER: conditions in w. disturbance of usual orderly processes of individual’s biopsychosocial development
PRIOR 18TH CENTURY: mental illness in West attributed to supernatural forces + morality of afflicted individual
END 19TH CENTURY: introduction of medical model to understand + treatment improved
RECENT TIMES IN SA: psychiatric patients are abused = NB for mental health professionals to keep human rights in mind
during diagnostic/treatment decisions
medical model proposes to think of abnormal behaviour as disease
uses terms mental illness/ psych disorder/ psychopathology
CRITICISM FOR MEDICAL MODEL:
diagnostics of abnormal behaviour pin potentially derogatory labels on people = leads to
stigmatisation + negative social judgement w. is hard to overcome
1 STIGMATISATION media often portrays mentally ill as erratic/ dangerous/ inferior
stereotypes promote distancing / prejudice/ rejection
Thomas Szasz:
illness can only affect t. body + minds cannot be ‘sick’
2 NOT AN ILLNESS abnormal behaviour involves deviation from social norm rather than illness = ‘problems in
living’
over-pathologizes everyday human distress
3 DSM-5 diagnosing individuals is NOT neutral activity = deeply influenced by professionals /
pharmaceutical companies / patient advocacy groups / media
MEDICAL MODEL CONTINUES TO DOMINATE THINKING:
diagnosis/ aetiology / prognosis is valuable in treatment /study of abnormal behaviour
, medically based concepts have widely shared meanings = clinicians/ researchers / public can communicate ↑ effectively in
discussions
_______________________________________________________________________________________________
CRITERIA FOR ABNORMAL BEHAVIOUR:
behaviour differs from w. society considers acceptable
normal is defined by majority in specific culture/context
1 DEVIANCE normality varies between societies + over time
violate expectations = labelled as mentally ill
ability to perform daily activities become impaired
2 DYSFUNCTIONAL OR behaviour becomes maladaptive /dysfunctional so t. it doesn’t contribute to
BEHAVIOUR individual’s personal growth / society
individual’s report of significant personal suffering
e.g. distressed people may/may not exhibit deviant/maladaptive behaviour BUT
3 PERSONAL DISTRESS describe personal pain/suffering to friends/relatives/ mental health professionals
CRITICISM FOR CRITERIA:
diagnosis = value judgements of abnormality vs normality
criteria not nearly as value-free as physical illness criteria
judgements reflect prevailing culture values/ social trends / political forces / scientific knowledge
e.g. language barriers in SA impact diagnosis/treatment
difficult to draw clear separation between normality vs abnormality = RATHER a continuum
everyone displays some dysfunctional behaviour/ impairment / personal distress sometimes BUT only treated when
behaviour becomes distinctly deviant/maladaptive/distressing
_______________________________________________________________________________________________
1. ANXIETY DISORDERS:
class of disorders marked by feelings of excessive fear/ anxiety + related disturbances in their behaviours
chronic high level of anxiety t. is NOT tied to any specific threat
worry constantly about minor matters = degree of worry out of proportion to
likelihood/impact of anticipated event
1 GENERALISED ANXIETY hope worrying will ward off negative events
DISORDER impairs daily functioning significantly
PHYSICAL SYMPTOMS: trembling, muscle tension, diarrhoea, dizziness, faintness, sweating,
heart palpitations
irrational fear of specific objects/situation t. markedly influences individual’s ability to
function
2 SPECIFIC PHOBIC victims realise irrationality of fear but can’t calm themselves when confronted
DISORDER
PHYSICAL SYMPTOMS: (GAD) trembling, palpitations
reoccurring attacks/surges of overwhelming anxiety t. usually occurs suddenly/
unexpectedly
victims become apprehensive of future panic attacks = fearful of losing control/ dying
3 PANIC DISORDER behavioural changes occur: avoiding situations to avoid panic attacks
PHYSICAL SYMPTOMS: (GAD) accelerated heart rate, sweating, trembling, shortness of breath
= heart attack misinterpretations
fear of going out to public places = may develop as result of panic disorder
, 4 AGORAPHOBIA fear triggered by real/anticipated exposure to situations of public transport,
open/enclosed spaces, queues/crowds, outside alone
confined to homes (venture out w. trusted companion)
AETIOLOGY:
1. GENETIC VULNERABILITY:
concordance rate: indicates percentage of twin pairs/ other relative pairs who exhibit
same disorder
inherited differences make some ↑ vulnerable than orders
inhibited temperament (shyness, timidity, wariness)
anxiety sensitivity: highly sensitive to internal physiological symptoms of anxiety =
prone to overreact + breeds more anxiety
1 BIOLOGICAL FACTORS 2. NEUROCHEMICAL FACTORS:
neurotransmitters: chemicals t. carry signals from neuron to neuron
medications inhibit excessive anxiety by altering neurotransmitter activity @ GABA
synapses
disturbances in GABA neural circuits + abnormalities in serotonin neural
circuits = OCD
1. CONDITIONING: classical conditioning negative reinforcement disorder
classical conditioning:
neutral stimulus paired w. frightening event
conditioned stimulus = produces anxiety
operant conditioning: negative reinforcement
victim avoids anxiety-producing stimulant = reduces anxiety
sustains anxiety responses
2 CONDITIONING +
LEARNING
2. PREPAREDNESS: people biologically prepared by evolutionary history to acquire some
fears ↑ easily than others
fear automatically activated by ancient stimuli (snakes/spiders) related to past
survival treats
resistant to intentional suppression
produce ↑ rapid conditioning + ↑ fear responses
NEUROTICISM: certain thinking styles make people especially vulnerable to anxiety
disorders
3 COGNITIVE FACTORS 1. misinterpret harmless situations as threatening
2. excessive focus on perceived threats
3. selective recall of info t. seems threatening
studies support t. anxiety disorders are stress related
4 STRESS panic disorder patients experienced dramatic ↑ stress in month prior to onset of
disorder
2. OBSESSIVE-COMPLUSIVE & RELATED DISORDERS:
ABNORMALITY:
1. individual displaying behaviour t. is rare/unusual
2. behaviour t. is regarded as unhelpful/maladaptive to situations/context in w. individual lives
3. MENTAL HEALTH CONTEXT: impairments in individual’s daily functioning
TERMINOLOGY:
AETIOLOGY study of causation of mental disorders
EPIDERMIOLOGY* study of patterns, causes, effects of diseases or disorders in specific populations
PROGNOSIS* prediction of probable course/outcome of disorder for individual
PREVALENCE % of population t. exhibits disorder during specified period
constellation of visible signs/symptoms associated w. particular mental disorder, t.
CLINICAL PICTURE interpretation of w. leads to diagnosis
mental disorder existing simultaneously but independently w. another mental disorder in an
COMORBIDITY individual
extent to w. individual w. mental disorder (/displaying abnormal behaviour) is likely to cause
DANGEROUSNESS harm to self/others
false belief t. is strongly held by individual even though presented w. evidence to t. contrary
DELUSIONS
extent to w. individual’s behaviours/attitudes differ from norms/ accepted social standards
DEVIANCE
determination of nature of case of mental disorder OR distinguishing 1 mental disorder from
DIAGNOSIS another; based on identifying signs/symptoms of mental disorders
DIFFERENTIAL determination of w. disorder may be producing symptoms of mental disorder
DIAGNOSIS
levels of anxiety/ sorrow/ pain individual subjectively experiences due to mental disorder
DISTRESS
false, often vivid, perception in absence of external stimuli t. appears to individual as real +
HALLUCINATION located in outside world
can occur in sensory modality (visual/auditory/olfactory/gustatory/ tactile)
pretending to suffer from physical/psych illness OR exaggerating symptoms to avoid
MALINGERING unwelcome duties (e.g. work/ military service) / gain financial compensation
symptoms/ abnormal behaviour in w. individual has lost contact w. reality + shows profound
PSYCHOSIS deterioration in ability to perform daily activities
SYMPTOMS subjective complaints of individual
SIGNS physical changes observed in individual presenting for treatment
SYNDROME common patterns of symptoms over time
_______________________________________________________________________________________
MEDICAL MODEL OF MENTAL DISORDERS:
Emil Kraepelin (1883): mental illness is rooted in biological/ disease/ medical model
think of mental illness as disease = identify/classify symptoms similar to diagnosis of physical diseases
TODAY structured cognitive tools (i.e. diagnostic manuals) to identify/ describe/ classify / inform treatment of abnormal
behaviour
MEDICAL CLASSIFICATION SYSTEMS:
The Diagnostic Classification of Diseases [10th Edition]
, 1 ICD-10 World Health Organisation
*ICD-11 sent out 2021 = takes effect 2022*
The Diagnostic and Statistical Manual of Mental Health Disorders [5 th Edition]
American Psychiatric Association
based on observable behaviour (symptoms) NOT presumed aetiology (causal pathways)
common language of categories to communicate key features/symptoms of mental disorders
2 DSM-5 DIAGNOSTIC CRITERIA: key features of disorder t. identify symptoms/ behaviours/ cognitive functions /
personality traits / physical signs / duration of key features
categories = collection of related disorders + specific diagnostic criteria
TO ACCURATELY IDENTIFY MENTAL DISORDERS: psychiatrists/ psychologists trained to develop
diagnostic competence + clinical expertise to identify when individuals display abnormal behaviour
NB! mental disorder classification systems continue to evolve considering advance in scientific research
CRITCISM FOR DMS-5:
CATEGORICAL APPROACH: vague boundaries between diagnosis
overlapping symptoms between disorders
↑ comorbidity w. many disorders = specific diagnoses may not reflect distinct disorders RATHER variations of
underlying disorder
MOVE TO DIMENTIONAL APPROACH:
scored on continuum based on experiences of symptoms
no concrete line between abnormal/normal = depends on severity
e.g. NO anxiety disorder RATHER scale of anxiety on w. everyone is placed in different severity levels
_______________________________________________________________________________________________
MEDICAL MODEL APPLIED TO ABNORMAL BEHAVIOUR:
DISORDER: conditions in w. disturbance of usual orderly processes of individual’s biopsychosocial development
PRIOR 18TH CENTURY: mental illness in West attributed to supernatural forces + morality of afflicted individual
END 19TH CENTURY: introduction of medical model to understand + treatment improved
RECENT TIMES IN SA: psychiatric patients are abused = NB for mental health professionals to keep human rights in mind
during diagnostic/treatment decisions
medical model proposes to think of abnormal behaviour as disease
uses terms mental illness/ psych disorder/ psychopathology
CRITICISM FOR MEDICAL MODEL:
diagnostics of abnormal behaviour pin potentially derogatory labels on people = leads to
stigmatisation + negative social judgement w. is hard to overcome
1 STIGMATISATION media often portrays mentally ill as erratic/ dangerous/ inferior
stereotypes promote distancing / prejudice/ rejection
Thomas Szasz:
illness can only affect t. body + minds cannot be ‘sick’
2 NOT AN ILLNESS abnormal behaviour involves deviation from social norm rather than illness = ‘problems in
living’
over-pathologizes everyday human distress
3 DSM-5 diagnosing individuals is NOT neutral activity = deeply influenced by professionals /
pharmaceutical companies / patient advocacy groups / media
MEDICAL MODEL CONTINUES TO DOMINATE THINKING:
diagnosis/ aetiology / prognosis is valuable in treatment /study of abnormal behaviour
, medically based concepts have widely shared meanings = clinicians/ researchers / public can communicate ↑ effectively in
discussions
_______________________________________________________________________________________________
CRITERIA FOR ABNORMAL BEHAVIOUR:
behaviour differs from w. society considers acceptable
normal is defined by majority in specific culture/context
1 DEVIANCE normality varies between societies + over time
violate expectations = labelled as mentally ill
ability to perform daily activities become impaired
2 DYSFUNCTIONAL OR behaviour becomes maladaptive /dysfunctional so t. it doesn’t contribute to
BEHAVIOUR individual’s personal growth / society
individual’s report of significant personal suffering
e.g. distressed people may/may not exhibit deviant/maladaptive behaviour BUT
3 PERSONAL DISTRESS describe personal pain/suffering to friends/relatives/ mental health professionals
CRITICISM FOR CRITERIA:
diagnosis = value judgements of abnormality vs normality
criteria not nearly as value-free as physical illness criteria
judgements reflect prevailing culture values/ social trends / political forces / scientific knowledge
e.g. language barriers in SA impact diagnosis/treatment
difficult to draw clear separation between normality vs abnormality = RATHER a continuum
everyone displays some dysfunctional behaviour/ impairment / personal distress sometimes BUT only treated when
behaviour becomes distinctly deviant/maladaptive/distressing
_______________________________________________________________________________________________
1. ANXIETY DISORDERS:
class of disorders marked by feelings of excessive fear/ anxiety + related disturbances in their behaviours
chronic high level of anxiety t. is NOT tied to any specific threat
worry constantly about minor matters = degree of worry out of proportion to
likelihood/impact of anticipated event
1 GENERALISED ANXIETY hope worrying will ward off negative events
DISORDER impairs daily functioning significantly
PHYSICAL SYMPTOMS: trembling, muscle tension, diarrhoea, dizziness, faintness, sweating,
heart palpitations
irrational fear of specific objects/situation t. markedly influences individual’s ability to
function
2 SPECIFIC PHOBIC victims realise irrationality of fear but can’t calm themselves when confronted
DISORDER
PHYSICAL SYMPTOMS: (GAD) trembling, palpitations
reoccurring attacks/surges of overwhelming anxiety t. usually occurs suddenly/
unexpectedly
victims become apprehensive of future panic attacks = fearful of losing control/ dying
3 PANIC DISORDER behavioural changes occur: avoiding situations to avoid panic attacks
PHYSICAL SYMPTOMS: (GAD) accelerated heart rate, sweating, trembling, shortness of breath
= heart attack misinterpretations
fear of going out to public places = may develop as result of panic disorder
, 4 AGORAPHOBIA fear triggered by real/anticipated exposure to situations of public transport,
open/enclosed spaces, queues/crowds, outside alone
confined to homes (venture out w. trusted companion)
AETIOLOGY:
1. GENETIC VULNERABILITY:
concordance rate: indicates percentage of twin pairs/ other relative pairs who exhibit
same disorder
inherited differences make some ↑ vulnerable than orders
inhibited temperament (shyness, timidity, wariness)
anxiety sensitivity: highly sensitive to internal physiological symptoms of anxiety =
prone to overreact + breeds more anxiety
1 BIOLOGICAL FACTORS 2. NEUROCHEMICAL FACTORS:
neurotransmitters: chemicals t. carry signals from neuron to neuron
medications inhibit excessive anxiety by altering neurotransmitter activity @ GABA
synapses
disturbances in GABA neural circuits + abnormalities in serotonin neural
circuits = OCD
1. CONDITIONING: classical conditioning negative reinforcement disorder
classical conditioning:
neutral stimulus paired w. frightening event
conditioned stimulus = produces anxiety
operant conditioning: negative reinforcement
victim avoids anxiety-producing stimulant = reduces anxiety
sustains anxiety responses
2 CONDITIONING +
LEARNING
2. PREPAREDNESS: people biologically prepared by evolutionary history to acquire some
fears ↑ easily than others
fear automatically activated by ancient stimuli (snakes/spiders) related to past
survival treats
resistant to intentional suppression
produce ↑ rapid conditioning + ↑ fear responses
NEUROTICISM: certain thinking styles make people especially vulnerable to anxiety
disorders
3 COGNITIVE FACTORS 1. misinterpret harmless situations as threatening
2. excessive focus on perceived threats
3. selective recall of info t. seems threatening
studies support t. anxiety disorders are stress related
4 STRESS panic disorder patients experienced dramatic ↑ stress in month prior to onset of
disorder
2. OBSESSIVE-COMPLUSIVE & RELATED DISORDERS:
