ABNORMAL PSYCHOLOGY
Psychology 314
STELLENBOSCH UNIVERSITY 2022
, ~1~
CONTENTS
Abnormal Behaviour in Historical Context ............................................................................................................ 6
Defining Psychological Disorders ....................................................................................................................... 6
What is a psychological disorder? ...................................................................................................................... 6
Distress, Impairment, and Cultural Context ....................................................................................................... 6
An Accepted Definition ...................................................................................................................................... 7
Clinical Description ............................................................................................................................................. 7
Causation, Treatment and Outcome .................................................................................................................. 8
Historical Conceptions of Abnormal Behaviour ................................................................................................. 8
The Psychological Tradition ........................................................................................................................... 8
Humanistic Theory ....................................................................................................................................... 10
The Behavioural Model ................................................................................................................................ 11
Beginnings of Behaviour Therapy ................................................................................................................ 12
The Present: The Scientific Method and an Integrative Approach .................................................................. 12
Psychological Assessment and Psychodiagnostics .............................................................................................. 13
One-Directional v Multidirectional Models ...................................................................................................... 13
Major Influences of Multidimensional Model .................................................................................................. 13
Genetic Contributions to Psychopathology...................................................................................................... 14
Influence of Environment on Genes: Diathesis-Stress Model ..................................................................... 14
Reciprical Gene-Environment Model ........................................................................................................... 14
Neuroscience & Its Contributions to Psychopathology .................................................................................... 15
The Brain ...................................................................................................................................................... 16
Endocrine Systems ....................................................................................................................................... 17
Contributions of Behavioural and Cognitive Science ....................................................................................... 17
Cognitive Science and the Unconscious ........................................................................................................... 18
Role of Emotion in Psychopathology................................................................................................................ 18
Componenets of Emotion ............................................................................................................................ 18
Emotions and Psychopathology ................................................................................................................... 19
Culture, Gender, Social and Interpersonal Factors in Psychopathology .......................................................... 19
Social Stigma ................................................................................................................................................ 20
Life-Span and Developmental Influences .................................................................................................... 20
Psychological Assessment and Psychodiagnostics .............................................................................................. 21
Assessing Psychological Disorders.................................................................................................................... 21
Key Concepts .................................................................................................................................................... 21
The Clinical Encounter ...................................................................................................................................... 21
Mental State Examination ........................................................................................................................... 22
, ~2~
Physical Examination ................................................................................................................................... 22
Behavioural Assessment .............................................................................................................................. 22
Psychological Testing ................................................................................................................................... 23
Neuropsychological Testing ......................................................................................................................... 23
Psychophysiological Assessment ................................................................................................................. 24
Issues w/ Classifying and Diagnosing Psychological Disorders ......................................................................... 25
DSM .................................................................................................................................................................. 25
History .......................................................................................................................................................... 25
DSM-5 .......................................................................................................................................................... 25
Adding New Diagnoses ................................................................................................................................ 25
Unresolved Issues in DSM-5......................................................................................................................... 26
Anxiety, OCD and Trauma-Related Disorders ..................................................................................................... 27
Anxiety Disorders.................................................................................................................................................. 28
Seperation Anxiety Disorder ............................................................................................................................ 28
Specific Phobias ................................................................................................................................................ 28
Social Anxiety Disorder..................................................................................................................................... 28
Panic Disorder .................................................................................................................................................. 29
Agoraphobia ..................................................................................................................................................... 29
Generalised Anxiety Disorder (GAD) ................................................................................................................ 30
Obsessive-Compulsive Disorder and Related Disorders ....................................................................................... 31
Trauma and Stressor Related Disorders ............................................................................................................... 32
Reactive Detachment Disorder ........................................................................................................................ 32
Disinhibited Social Engagement Disorder ........................................................................................................ 32
Post-Traumatic Stress Disorder (PTSD) ............................................................................................................ 32
Acute Stress Disorder ....................................................................................................................................... 33
Adjustment Disorders ...................................................................................................................................... 33
Aetiology ............................................................................................................................................................... 33
Biological Perspectives ..................................................................................................................................... 33
Psychological Perspectives ............................................................................................................................... 34
Cognitive Models ......................................................................................................................................... 35
Role of Sex and Gender ................................................................................................................................ 35
Mood Disorders ................................................................................................................................................... 36
Bipolar and Related Disorders .............................................................................................................................. 37
Bipolar I and Bipolar II Disorders ...................................................................................................................... 37
Cyclothymic Disorder ....................................................................................................................................... 38
Depressive Disorders ............................................................................................................................................ 39
, ~3~
Disruptive Mood Dysregulation Disorder ......................................................................................................... 39
Major Depressive Disorder ............................................................................................................................... 39
Persistent Depressive Disorder (Dysthymia) .................................................................................................... 40
Premenstrual Dysphoric Disorder .................................................................................................................... 40
Cross-Cultural and African Perspectives ............................................................................................................... 40
Beck Depression Inventory............................................................................................................................... 40
Aetiology of Mood Disorders ................................................................................................................................ 41
Biological Factors ............................................................................................................................................. 41
Stress ................................................................................................................................................................ 41
Psychosocial Factors......................................................................................................................................... 41
Childbirth ..................................................................................................................................................... 42
Loss and Rejection ....................................................................................................................................... 42
Social Support .............................................................................................................................................. 42
Personality and Temperament .................................................................................................................... 43
Behaviour ..................................................................................................................................................... 43
Cognition ...................................................................................................................................................... 43
Schizophrenia Spectrum and Other Psychotic Disorders.................................................................................... 45
Psychosis and the Psychotic Disorders ................................................................................................................. 45
Schizophrenia ....................................................................................................................................................... 45
History .............................................................................................................................................................. 45
Prevalence and Course ................................................................................................................................ 45
Clinical Picture .................................................................................................................................................. 45
Positive Symptoms ....................................................................................................................................... 47
Negative Symptoms ..................................................................................................................................... 47
Schizophrenia Subtypes ................................................................................................................................... 48
Dangerousness and Mortality RIsk ................................................................................................................... 49
Aetiology ............................................................................................................................................................... 49
Biological Factors ............................................................................................................................................. 49
Genetics ....................................................................................................................................................... 49
Brain Structures ........................................................................................................................................... 50
Neurochemistry: Dopamine Hypothesis ...................................................................................................... 50
Neurdevelopmental Factors ........................................................................................................................ 51
Psychological Factors ....................................................................................................................................... 51
Family Influences ......................................................................................................................................... 51
Sociocultural Factors .................................................................................................................................... 52
Cross-Cultural and African Perspectives ............................................................................................................... 52
, ~4~
Eating and Feeding Disorders .............................................................................................................................. 54
Bulimia Nervosa ............................................................................................................................................... 54
Anorexia Nervosa ............................................................................................................................................. 54
Binge-Eating Disorder ....................................................................................................................................... 55
Causes of Eating Disorders ............................................................................................................................... 55
Management of Eating Disorders .................................................................................................................... 57
Sexual Dysfunctions, Paraphilic Disorders and Gender Dysphoria .................................................................... 58
Sexual and Gender Identity Disorders .............................................................................................................. 58
Cultural Differences ..................................................................................................................................... 58
Development of Sexual Orientation ............................................................................................................ 58
Sexual Dysfunctions ..................................................................................................................................... 58
Context of Sexual Dysfunction ..................................................................................................................... 58
Assessing Sexual Behaviour .............................................................................................................................. 61
Causes of Sexual Dysfunction ........................................................................................................................... 61
Treatment of Sexual Dysfunction ..................................................................................................................... 62
Paraphilic Disorders ......................................................................................................................................... 63
Clinical Descriptions and Causes .................................................................................................................. 63
Paedophilic Disorder .................................................................................................................................... 64
Gender Dysphoria ............................................................................................................................................ 64
Treating ........................................................................................................................................................ 64
Management of Gender Nonconformity in Children ................................................................................... 65
Substance-Related, Addictive and Impulse-Control Disorders........................................................................... 66
Six Main Categories of Subtsnaces ................................................................................................................... 66
Substance-Related Disorders in DSM-5............................................................................................................ 66
The Depressants: Alcohol-Related Disorders ................................................................................................... 67
Progression of Alcohol-Related Disorders ................................................................................................... 67
Sedative, Hypnotic, or Anxiolytic-Related Disorders ........................................................................................ 67
Stimulants ........................................................................................................................................................ 67
Amphetamine-Use Disorders ....................................................................................................................... 68
Cocaine-Related Disorders ........................................................................................................................... 68
Tobacco-Related Disorders .......................................................................................................................... 69
Caffeine-Related Disorders .......................................................................................................................... 69
Opioids ............................................................................................................................................................. 69
Cannabis-Related Disorders ............................................................................................................................. 69
Hallucinogen-Related Disorders ....................................................................................................................... 69
Other Drugs of Abuse ....................................................................................................................................... 70
, ~5~
Inhalants ...................................................................................................................................................... 70
Anabolic-Androgenic Steroids...................................................................................................................... 70
Designer Drugs ............................................................................................................................................. 70
Causes of Substance-Related Disorders ........................................................................................................... 70
An Integrative Model ....................................................................................................................................... 71
Treatment ........................................................................................................................................................ 72
Biological Treatment .................................................................................................................................... 72
Principles of Effective Treatment ................................................................................................................. 72
Psychological Treatment .............................................................................................................................. 73
Relapse Prevention ...................................................................................................................................... 74
Prventing Substance-Related Disorders....................................................................................................... 74
Gambling Disorder ........................................................................................................................................... 74
Treatment .................................................................................................................................................... 74
Impulse-Control Disorders ............................................................................................................................... 74
Personality Disorders ........................................................................................................................................... 76
Categorical and Dimensional Models ............................................................................................................... 76
DSM-5 Personality Disorders............................................................................................................................ 76
Statistics ....................................................................................................................................................... 77
Cluster A: Paranoid Personality Disorder ......................................................................................................... 78
CLuster A: Schizoid Personality Disorder.......................................................................................................... 79
, ~6~
ABNORMAL BEHAVIOUR IN HISTORICAL CONTEXT
DEFINING PSYCHOLOGICAL DISORDERS
Abnormal
psychology
•Maladaptive unusual
behaviour
The scientific Behavioural or
study of cognitive
psychological manifestations of
dysfunction these disorders
Psychopathology
WHAT IS A PSYCHOLOGICAL DISORDER?
Psychological dysfunction associated w/ distress and/or impairment in functioning
Involves a response that is not typical or culturally expected
Cognitive + behavioural + emotional
Is the dysfunction...
•associated w/ distress
•Cuasing impairment in functioning
•Typical or atypical
•Culturally expected or outside the norm?
DISTRESS, IMPAIRMENT, AND CULTURAL CONTEXT
• Distress is normal in some situations
• Dysfunctional distress occurs when person is much more distressed than others would be
• Impairment: Must be pervasive and/or significant
o Mental disorders are often exaggerations of normal processes (e.g. extreme shyness or
sadness)
• Culture: Consider 'normalcy' relative to behaviour of others in same cultural context
• Rule of thumb: Mental disorder = harmful dysfunction
, ~7~
AN ACCEPTED DEFINITION
Behavioural, psychological, or biological dysfunctions that are unexpected in their cultural context and
associated w/ present distress and/or impairment in functioning or increased risk of suffering, death, pain, or
impairment.
Unexpected
in context
Present
distress
Impairment
in
functioning
CLINICAL DESCRIPTION
Describe
Presenting Description prevalence
problem aims to and incidence
Distinguish clinically of disorders Prevalence - how many
Symptoms (Chronic signifcant dysfunction
people in a population
worry, panic attacks) from common human
have the disorder
experience
Distinguish between Incidence - the number
Recorded verbatim what is clinically of new cases over a
significant dysfunction period of time
What the individual Clinically significant =
tells you (their so significant that that
experience) guides you it completely changes
in your investigation of how the person
the problem behaves
, ~8~
• Describe onset of disorders
o Acute versus insidious onset
• Describe course of disorders
o Episodic, time-limited or chronic course
• Prognosis
o What we predict the outcome of the treatment will be
o Good versus guarded
• Consider age of onset, which may shape presentation
CAUSATION, TREATMENT AND OUTCOME
• Aetiology
o What contributes to the development of psychopathology?
• Treatment development
o How can we help alleviate psychological suffering?
o Includes pharmacological, psychosocial and/or combined treatments
HISTORICAL CONCEPTIONS OF ABNORMAL BEHAVIOUR
• Major psychological disorders have existed across time and cultures
• Perceived causes and treatment of abnormal behaviour varied widely, depending on context
• Three dominant traditions have existed in the past to explain abnormal behaviour
o Supernatural (good vs. Evil)
o Biological (Hippocrates - Western Medicine - mental illness as having physical/biological
roots)
o Psychological (Freud, psychoanalysis, moral theory)
THE PSYCHOLOGICAL TRADITION
RISE OF MORAL THERAPY
• 19th century
• Moral = psychological/emotional factors
• The main idea is to treat patients as normally as possible in a normal environment
• More human treatment of institutionalised patients
• Encouraged and reinforced social interaction
• Proponents
o Philippe Pinel and Jean-Baptiste Pussin – patients should not be restrained
o Benjamin Rush – led reforms in USA
o Dorothea Dix – mental hygiene movement
, ~9~
• Asylum reform – more patients getting care
o Moral therapy declined because more difficult with large groups of patients
• Soon followed by emergence of competing alternative psychological models
PSYCHOANALYTIC THEORY
• Freudian theory of the structure and function of the mind
o Unconscious
o Catharsis
o Psychoanalytic model sought to explain development and personality
• Structure of the mind
o Id (pleasure principle; illogical, emotional, irrational)
o Superego (moral principles)
o Ego (rational; mediates between id and superego)
• Defence mechanisms: Ego's attempt to manage anxiety resulting from id/superego conflict
o Displacement and denial
o Rationalisation and reaction formation
o Projection, repression and sublimation
• Psychosexual stages of development
o Oral, anal, phallic, latency and genital stages
o Theory: Conflicts arise at each stage and must be resolved
LATER DEVELOPMENTS IN PSYCHOTHERAPY
• Anna Freud and self-psychology
o Emphasised influence of the ego in defining behaviour
• Melanie Klein, Otto Kernberg and object relations theory
o Emphasised how children incorporate (introject) objects
o Objects – significant others and their images, memories and values
• The 'Neo-Freudians': Departures from Freudian thought
• De-emphasised the sexual core of Freud's theory
• Examples:
o Carl Jung emphasised the 'collective unconscious'
o Alfred Adler focused on feelings of inferiority, invented 'inferiority complex'
Psychology 314
STELLENBOSCH UNIVERSITY 2022
, ~1~
CONTENTS
Abnormal Behaviour in Historical Context ............................................................................................................ 6
Defining Psychological Disorders ....................................................................................................................... 6
What is a psychological disorder? ...................................................................................................................... 6
Distress, Impairment, and Cultural Context ....................................................................................................... 6
An Accepted Definition ...................................................................................................................................... 7
Clinical Description ............................................................................................................................................. 7
Causation, Treatment and Outcome .................................................................................................................. 8
Historical Conceptions of Abnormal Behaviour ................................................................................................. 8
The Psychological Tradition ........................................................................................................................... 8
Humanistic Theory ....................................................................................................................................... 10
The Behavioural Model ................................................................................................................................ 11
Beginnings of Behaviour Therapy ................................................................................................................ 12
The Present: The Scientific Method and an Integrative Approach .................................................................. 12
Psychological Assessment and Psychodiagnostics .............................................................................................. 13
One-Directional v Multidirectional Models ...................................................................................................... 13
Major Influences of Multidimensional Model .................................................................................................. 13
Genetic Contributions to Psychopathology...................................................................................................... 14
Influence of Environment on Genes: Diathesis-Stress Model ..................................................................... 14
Reciprical Gene-Environment Model ........................................................................................................... 14
Neuroscience & Its Contributions to Psychopathology .................................................................................... 15
The Brain ...................................................................................................................................................... 16
Endocrine Systems ....................................................................................................................................... 17
Contributions of Behavioural and Cognitive Science ....................................................................................... 17
Cognitive Science and the Unconscious ........................................................................................................... 18
Role of Emotion in Psychopathology................................................................................................................ 18
Componenets of Emotion ............................................................................................................................ 18
Emotions and Psychopathology ................................................................................................................... 19
Culture, Gender, Social and Interpersonal Factors in Psychopathology .......................................................... 19
Social Stigma ................................................................................................................................................ 20
Life-Span and Developmental Influences .................................................................................................... 20
Psychological Assessment and Psychodiagnostics .............................................................................................. 21
Assessing Psychological Disorders.................................................................................................................... 21
Key Concepts .................................................................................................................................................... 21
The Clinical Encounter ...................................................................................................................................... 21
Mental State Examination ........................................................................................................................... 22
, ~2~
Physical Examination ................................................................................................................................... 22
Behavioural Assessment .............................................................................................................................. 22
Psychological Testing ................................................................................................................................... 23
Neuropsychological Testing ......................................................................................................................... 23
Psychophysiological Assessment ................................................................................................................. 24
Issues w/ Classifying and Diagnosing Psychological Disorders ......................................................................... 25
DSM .................................................................................................................................................................. 25
History .......................................................................................................................................................... 25
DSM-5 .......................................................................................................................................................... 25
Adding New Diagnoses ................................................................................................................................ 25
Unresolved Issues in DSM-5......................................................................................................................... 26
Anxiety, OCD and Trauma-Related Disorders ..................................................................................................... 27
Anxiety Disorders.................................................................................................................................................. 28
Seperation Anxiety Disorder ............................................................................................................................ 28
Specific Phobias ................................................................................................................................................ 28
Social Anxiety Disorder..................................................................................................................................... 28
Panic Disorder .................................................................................................................................................. 29
Agoraphobia ..................................................................................................................................................... 29
Generalised Anxiety Disorder (GAD) ................................................................................................................ 30
Obsessive-Compulsive Disorder and Related Disorders ....................................................................................... 31
Trauma and Stressor Related Disorders ............................................................................................................... 32
Reactive Detachment Disorder ........................................................................................................................ 32
Disinhibited Social Engagement Disorder ........................................................................................................ 32
Post-Traumatic Stress Disorder (PTSD) ............................................................................................................ 32
Acute Stress Disorder ....................................................................................................................................... 33
Adjustment Disorders ...................................................................................................................................... 33
Aetiology ............................................................................................................................................................... 33
Biological Perspectives ..................................................................................................................................... 33
Psychological Perspectives ............................................................................................................................... 34
Cognitive Models ......................................................................................................................................... 35
Role of Sex and Gender ................................................................................................................................ 35
Mood Disorders ................................................................................................................................................... 36
Bipolar and Related Disorders .............................................................................................................................. 37
Bipolar I and Bipolar II Disorders ...................................................................................................................... 37
Cyclothymic Disorder ....................................................................................................................................... 38
Depressive Disorders ............................................................................................................................................ 39
, ~3~
Disruptive Mood Dysregulation Disorder ......................................................................................................... 39
Major Depressive Disorder ............................................................................................................................... 39
Persistent Depressive Disorder (Dysthymia) .................................................................................................... 40
Premenstrual Dysphoric Disorder .................................................................................................................... 40
Cross-Cultural and African Perspectives ............................................................................................................... 40
Beck Depression Inventory............................................................................................................................... 40
Aetiology of Mood Disorders ................................................................................................................................ 41
Biological Factors ............................................................................................................................................. 41
Stress ................................................................................................................................................................ 41
Psychosocial Factors......................................................................................................................................... 41
Childbirth ..................................................................................................................................................... 42
Loss and Rejection ....................................................................................................................................... 42
Social Support .............................................................................................................................................. 42
Personality and Temperament .................................................................................................................... 43
Behaviour ..................................................................................................................................................... 43
Cognition ...................................................................................................................................................... 43
Schizophrenia Spectrum and Other Psychotic Disorders.................................................................................... 45
Psychosis and the Psychotic Disorders ................................................................................................................. 45
Schizophrenia ....................................................................................................................................................... 45
History .............................................................................................................................................................. 45
Prevalence and Course ................................................................................................................................ 45
Clinical Picture .................................................................................................................................................. 45
Positive Symptoms ....................................................................................................................................... 47
Negative Symptoms ..................................................................................................................................... 47
Schizophrenia Subtypes ................................................................................................................................... 48
Dangerousness and Mortality RIsk ................................................................................................................... 49
Aetiology ............................................................................................................................................................... 49
Biological Factors ............................................................................................................................................. 49
Genetics ....................................................................................................................................................... 49
Brain Structures ........................................................................................................................................... 50
Neurochemistry: Dopamine Hypothesis ...................................................................................................... 50
Neurdevelopmental Factors ........................................................................................................................ 51
Psychological Factors ....................................................................................................................................... 51
Family Influences ......................................................................................................................................... 51
Sociocultural Factors .................................................................................................................................... 52
Cross-Cultural and African Perspectives ............................................................................................................... 52
, ~4~
Eating and Feeding Disorders .............................................................................................................................. 54
Bulimia Nervosa ............................................................................................................................................... 54
Anorexia Nervosa ............................................................................................................................................. 54
Binge-Eating Disorder ....................................................................................................................................... 55
Causes of Eating Disorders ............................................................................................................................... 55
Management of Eating Disorders .................................................................................................................... 57
Sexual Dysfunctions, Paraphilic Disorders and Gender Dysphoria .................................................................... 58
Sexual and Gender Identity Disorders .............................................................................................................. 58
Cultural Differences ..................................................................................................................................... 58
Development of Sexual Orientation ............................................................................................................ 58
Sexual Dysfunctions ..................................................................................................................................... 58
Context of Sexual Dysfunction ..................................................................................................................... 58
Assessing Sexual Behaviour .............................................................................................................................. 61
Causes of Sexual Dysfunction ........................................................................................................................... 61
Treatment of Sexual Dysfunction ..................................................................................................................... 62
Paraphilic Disorders ......................................................................................................................................... 63
Clinical Descriptions and Causes .................................................................................................................. 63
Paedophilic Disorder .................................................................................................................................... 64
Gender Dysphoria ............................................................................................................................................ 64
Treating ........................................................................................................................................................ 64
Management of Gender Nonconformity in Children ................................................................................... 65
Substance-Related, Addictive and Impulse-Control Disorders........................................................................... 66
Six Main Categories of Subtsnaces ................................................................................................................... 66
Substance-Related Disorders in DSM-5............................................................................................................ 66
The Depressants: Alcohol-Related Disorders ................................................................................................... 67
Progression of Alcohol-Related Disorders ................................................................................................... 67
Sedative, Hypnotic, or Anxiolytic-Related Disorders ........................................................................................ 67
Stimulants ........................................................................................................................................................ 67
Amphetamine-Use Disorders ....................................................................................................................... 68
Cocaine-Related Disorders ........................................................................................................................... 68
Tobacco-Related Disorders .......................................................................................................................... 69
Caffeine-Related Disorders .......................................................................................................................... 69
Opioids ............................................................................................................................................................. 69
Cannabis-Related Disorders ............................................................................................................................. 69
Hallucinogen-Related Disorders ....................................................................................................................... 69
Other Drugs of Abuse ....................................................................................................................................... 70
, ~5~
Inhalants ...................................................................................................................................................... 70
Anabolic-Androgenic Steroids...................................................................................................................... 70
Designer Drugs ............................................................................................................................................. 70
Causes of Substance-Related Disorders ........................................................................................................... 70
An Integrative Model ....................................................................................................................................... 71
Treatment ........................................................................................................................................................ 72
Biological Treatment .................................................................................................................................... 72
Principles of Effective Treatment ................................................................................................................. 72
Psychological Treatment .............................................................................................................................. 73
Relapse Prevention ...................................................................................................................................... 74
Prventing Substance-Related Disorders....................................................................................................... 74
Gambling Disorder ........................................................................................................................................... 74
Treatment .................................................................................................................................................... 74
Impulse-Control Disorders ............................................................................................................................... 74
Personality Disorders ........................................................................................................................................... 76
Categorical and Dimensional Models ............................................................................................................... 76
DSM-5 Personality Disorders............................................................................................................................ 76
Statistics ....................................................................................................................................................... 77
Cluster A: Paranoid Personality Disorder ......................................................................................................... 78
CLuster A: Schizoid Personality Disorder.......................................................................................................... 79
, ~6~
ABNORMAL BEHAVIOUR IN HISTORICAL CONTEXT
DEFINING PSYCHOLOGICAL DISORDERS
Abnormal
psychology
•Maladaptive unusual
behaviour
The scientific Behavioural or
study of cognitive
psychological manifestations of
dysfunction these disorders
Psychopathology
WHAT IS A PSYCHOLOGICAL DISORDER?
Psychological dysfunction associated w/ distress and/or impairment in functioning
Involves a response that is not typical or culturally expected
Cognitive + behavioural + emotional
Is the dysfunction...
•associated w/ distress
•Cuasing impairment in functioning
•Typical or atypical
•Culturally expected or outside the norm?
DISTRESS, IMPAIRMENT, AND CULTURAL CONTEXT
• Distress is normal in some situations
• Dysfunctional distress occurs when person is much more distressed than others would be
• Impairment: Must be pervasive and/or significant
o Mental disorders are often exaggerations of normal processes (e.g. extreme shyness or
sadness)
• Culture: Consider 'normalcy' relative to behaviour of others in same cultural context
• Rule of thumb: Mental disorder = harmful dysfunction
, ~7~
AN ACCEPTED DEFINITION
Behavioural, psychological, or biological dysfunctions that are unexpected in their cultural context and
associated w/ present distress and/or impairment in functioning or increased risk of suffering, death, pain, or
impairment.
Unexpected
in context
Present
distress
Impairment
in
functioning
CLINICAL DESCRIPTION
Describe
Presenting Description prevalence
problem aims to and incidence
Distinguish clinically of disorders Prevalence - how many
Symptoms (Chronic signifcant dysfunction
people in a population
worry, panic attacks) from common human
have the disorder
experience
Distinguish between Incidence - the number
Recorded verbatim what is clinically of new cases over a
significant dysfunction period of time
What the individual Clinically significant =
tells you (their so significant that that
experience) guides you it completely changes
in your investigation of how the person
the problem behaves
, ~8~
• Describe onset of disorders
o Acute versus insidious onset
• Describe course of disorders
o Episodic, time-limited or chronic course
• Prognosis
o What we predict the outcome of the treatment will be
o Good versus guarded
• Consider age of onset, which may shape presentation
CAUSATION, TREATMENT AND OUTCOME
• Aetiology
o What contributes to the development of psychopathology?
• Treatment development
o How can we help alleviate psychological suffering?
o Includes pharmacological, psychosocial and/or combined treatments
HISTORICAL CONCEPTIONS OF ABNORMAL BEHAVIOUR
• Major psychological disorders have existed across time and cultures
• Perceived causes and treatment of abnormal behaviour varied widely, depending on context
• Three dominant traditions have existed in the past to explain abnormal behaviour
o Supernatural (good vs. Evil)
o Biological (Hippocrates - Western Medicine - mental illness as having physical/biological
roots)
o Psychological (Freud, psychoanalysis, moral theory)
THE PSYCHOLOGICAL TRADITION
RISE OF MORAL THERAPY
• 19th century
• Moral = psychological/emotional factors
• The main idea is to treat patients as normally as possible in a normal environment
• More human treatment of institutionalised patients
• Encouraged and reinforced social interaction
• Proponents
o Philippe Pinel and Jean-Baptiste Pussin – patients should not be restrained
o Benjamin Rush – led reforms in USA
o Dorothea Dix – mental hygiene movement
, ~9~
• Asylum reform – more patients getting care
o Moral therapy declined because more difficult with large groups of patients
• Soon followed by emergence of competing alternative psychological models
PSYCHOANALYTIC THEORY
• Freudian theory of the structure and function of the mind
o Unconscious
o Catharsis
o Psychoanalytic model sought to explain development and personality
• Structure of the mind
o Id (pleasure principle; illogical, emotional, irrational)
o Superego (moral principles)
o Ego (rational; mediates between id and superego)
• Defence mechanisms: Ego's attempt to manage anxiety resulting from id/superego conflict
o Displacement and denial
o Rationalisation and reaction formation
o Projection, repression and sublimation
• Psychosexual stages of development
o Oral, anal, phallic, latency and genital stages
o Theory: Conflicts arise at each stage and must be resolved
LATER DEVELOPMENTS IN PSYCHOTHERAPY
• Anna Freud and self-psychology
o Emphasised influence of the ego in defining behaviour
• Melanie Klein, Otto Kernberg and object relations theory
o Emphasised how children incorporate (introject) objects
o Objects – significant others and their images, memories and values
• The 'Neo-Freudians': Departures from Freudian thought
• De-emphasised the sexual core of Freud's theory
• Examples:
o Carl Jung emphasised the 'collective unconscious'
o Alfred Adler focused on feelings of inferiority, invented 'inferiority complex'
