Psychopathology
CH1 Abnormal Psychology: Past and Present
Abnormal psychology
Scientific study of abnormal behavior in an effort to describe, predict, explain, and change abnormal patterns of functioning
• Many definitions have been proposed, yet none has won total acceptance
In a Word→unstable→madness→insanity distress disturbed→unbalanced→psychological→dysfunctional impaired
What Is Psychological Abnormality?
Common feature across definitions
The Four Ds→ • Deviance • Distress • Dysfunction • Danger
Influences→ • Norms • Culture • Context
The Elusive Nature of Abnormality
Abnormality is defined by general criteria in society. (for some→no general criteria across different situations →variability)
Criteria are used to judge particular cases.
• Thomas Szasz: societal involvement may invalidate the concept of mental illness.
→Any definition of abnormality may be unable to be applied consistently.
Which behaviors fit the criteria of deviant, distressful, dysfunctional, or dangerous, but would not be considered abnormal
by most people? Bungee jumping, Religious customs (e.g., circumcision, ayahuasca ceremonies), New Years dive
Drinking alcohol, Climbing Mount Everest
What Is Treatment?
Treatment or therapy →Procedure designed to change abnormal behavior into more normal behavior
• Definitional challenges closely related to defining abnormality
Essential features of all therapy forms: • Sufferer or patient • Trained, socially accepted healer or therapist
• Series of therapeutic contacts between the healer and the sufferer
• Despite their differences, most clinicians agree that large numbers of people need therapy of one kind or another
How Was Abnormality Viewed and Treated in the Past?
• Every society, past and present, has witnessed psychological abnormality→ Tried to address it in different ways
• Many present-day ideas and treatments have roots in the past.
Ancient Views and Treatments
Ancient societies→Probably regarded abnormal behavior as the work of evil spirits
→May have begun as far back as the Stone Age
Treatment→ Trephination and exorcism (through skull drilling, holes in the skull to let out spirits)
Greek and Roman Views and Treatments
500 B.C. to 500 A.D.
• Philosophers and physicians offered different explanations and treatments for abnormal behaviors
• Hippocrates believed and taught that illnesses had natural causes; four humors-bodily fluids (blood, phlegm, black bile,
yellow bile) need to be balanced, if not→illness eg.too much blood=too passionate
Treatment→• Quiet life • Vegetable diet • Temperance • Exercise • Celibacy • Bleeding→ changing levels of bodily fluids
Europe in the Middle Ages: Demonology Returns
500–1350 A.D.
• Church rejected scientific forms of investigation and controlled all education, exclusion of people with mental disorders
• Mental disorders had demonic causes; mass madness; shared delusions and hallucinations
• At the close of the Middle Ages, demonology and its methods began to lose favor again
Treatment→• Exorcism • Torture • Gradually more hospitalization
The Renaissance and the Rise of Asylums
1400–1700 A.D.
• With increased scientific knowledge, demonological views of abnormality continued to decline
• Weyer was the first mental health physician; believed that the mind was as susceptible to sickness as the body
• Care at religious shrines (e.g., Gheel→people with mental disorders would go there and get help from local people,
included to families there, still going on) was the precursor of community health programs
• Asylums emerged by the mid-sixteenth century
The Nineteenth Century: Reform and Moral Treatment
Nineteenth century
1
,Care of people with mental disorders began to improve→treated with a humane fashion, more respect
• Pinel (France) and Tuke (England) →Advocated moral treatment that emphasized humane and respectful techniques
• Moral treatment movement ended in the United States and Europe by the early twentieth century
Benjamin Rush (father of American psychiatry) and Dorothea Dix (Boston schoolteacher) Promoted moral treatment in the
United States→Movement disintegrated in the late nineteenth century; mental hospitals warehoused inmates and provided
minimal care (there were more and more people with problems but there weren’t many treatments available so they
became prisons for those people, in which they weren’t really treated)
The Early Twentieth Century: Dual Perspectives
Somatogenic perspective→Abnormal functioning has physical causes
Two factors responsible for the rebirth of this perspective
• Emil Kraepelin: Physical factors are responsible for mental dysfunction, linked together
• New biological discoveries linked such things as untreated syphilis and general paresis
Results were generally disappointing until effective medication was developed, eg, antibiotics to treat syphilis very effective
Psychogenic perspective→Abnormal functioning has psychological causes
Rise in popularity based on work with hypnotism
• Mesmer: Hysterical disorders→hypnosis (mesmerism) →psychological disorders can be treated using
• Freud: Psychoanalysis; outpatient therapy→people would live at home and go there to therapy
Psychoanalytic theory and treatment became widely accepted and available to help people
Recent Decades and Current Trends
Negative public attitudes still exist, but there have been major changes in the last 60 years in the ways clinicians
understand and treat abnormal functioning: • More theories and treatment types • More research and information
• More disagreements about abnormal functioning→Biological theories, Psychological theories, Sociological theories,
Humanistic theories
How Are People with Severe Disturbances Cared For? New psychotropic medications discovered in 1950s
• Antipsychotic drugs • Antidepressant drugs • Antianxiety drugs →Led to deinstitutionalization and rise in outpatient care
How Are People with Severe Disturbances Treated?
Before 1950 →Almost all outpatient care took the form of private psychotherapy
Today → Outpatient care is the primary mode of treatment; more insurance coverage, Prevention programs are increasing;
positive psychology has grown, Programs dealing with one kind of psychological problem have been created
Multicultural Psychology
• A new area of study that emerged in response to the growing diversity of the United States
• Multicultural psychologists seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and
thought and how people of different cultures, races, and genders may differ psychologically
The Increasing Influence of Insurance Coverage
Today the dominant form of insurance coverage is the managed care program, in which the insurance company determines
key care issues
• The dominant form of insurance for people in the United States consists of managed care programs
• Reimbursements for mental disorders tend to be lower than those for medical disorders
• In 2014, the Affordable Care Act (ACT) went into effect
• In the Netherlands: Mental health care is (mostly) covered by health insurance. Reference to (specialized) institutions
goes through GP
What Are Today's Leading Theories and Professions?
Numerous theoretical perspectives→• Psychoanalytic, • Biological, • Cognitive-behavioral, • Humanistic-existential,
• Sociocultural, • Developmental psychopathology
No single perspective dominates the clinical field→a lot of different approaches used at the same time
social workers support people, psychologists give therapy, biological develop new medications…
→A variety of professionals offer help to people with psychological problems
psychiatrists→medical decree doctor, can prescribe medications and make diagnoses
Technology and Mental Health
The digital world provides new triggers and vehicles for the expression of abnormal behavior
Use of tele-mental health services rapidly increasing + • Mental health apps in the marketplace are increasing sharply
Enormous volume of Web-based misinformation
2
,Question: Do you think social media has a positive or negative impact on mental health? Why/why not?
What Do Clinical Researchers Do?
Research is the systematic search for facts through the use of careful observations and investigations
Clinical researchers→Discover universal laws and principles
• Search for nomothetic understanding, understanding at a idiographic level isn't that easy
• Do not typically assess, diagnose, or treat individual clients • Rely on the scientific method
Clinical researchers depend, in a broad sense, on three methods of investigation
• Case study • Correlational method • Experimental method
The Case Study
How are case studies helpful? Detailed, interpretative description of a person's life and psychological problems
• Source of new ideas about behavior • Tentative support for a theory • Challenge of a theory’s assumptions
• Introduction of new therapeutic techniques • Opportunities to study unusual problems
What are the limitations of case studies? Biased observers, Subjective evidence (low internal validity), Little basis for
generalization (low external validity)
The Correlational Method
Correlation→Degree to which events or characteristics vary with each other
• Positive correlation (more..more) • Negative correlation (more…less) • Unrelated
Correlational method→Research procedure used to determine the co-relationship between variables
Subjects or participants→People chosen for study are collectively called a sample, Sample must be representative of the
larger population
When Can Correlations Be Trusted?
Correlations can be trusted based on a statistical analysis of probability
• Statistical significance: The finding is unlikely to have occurred by chance, more confident about its reliability
• Generally, confidence increases with the size of the sample and the magnitude of the correlation
What Are the Merits of the Correlational Method?
Advantages of the correlational method
• Has high external validity (can generalize findings to a broader population)
• Can repeat (replicate) studies with other samples
Difficulties with correlational studies
• Lack internal validity • Describe but do not explain a relationship or causation (+design confounds)
The Experimental Method
Experiment→The variable is manipulated and the manipulation's effect on another variable is observed
• Manipulated variable = independent variable • Variable being observed = dependent variable
Confound→Variables other than the independent variable that may also be affecting the dependent variable
Three features to guard against confounds
• Control group • Random assignment (no systematic differences) • Masked (blind) design
The Control Group
• Research participants who are not exposed to the independent variable, but whose experience is similar to that of the
experimental group Control group→to establish the causal effect
• Rules of statistical significance are applied • Clinicians may also evaluate clinical significance
Random Assignment→Any selection procedure that ensures that every participant in the experiment is as likely to be
placed in one group as another
Masked (blind) design→Experiment in which participants do not know which assigned group they are in • Placebo therapy
Double-masked design→Experiment in which both participants and experimenters are unaware of the groups to which
participants are assigned
Research methods
3
, Alternative Research Designs
Clinical researchers often must settle for designs that are less than ideal and include quasi-experimental designs
• Matched designs • Natural experiments • Analogue experiments • Single-subject experiments • Longitudinal studies
• Epidemiological studies
Matched (mixed) designs→Participants are not randomly assigned to groups, but rather placed in existing groups
• Matched control groups are used to address confounds based on demographic and other variables
Natural experiments→• Nature manipulates the independent variable and the experimenter observes the effects
• Events cannot be replicated at will (eg. people that experience an earthquake have more traumatic experiences)
• Broad generalizations cannot be drawn from a single study
Analogue experiments→Independent variables are freely manipulated while ethical and practical limitations are avoided
• Laboratory subjects are induced to behave in ways that resemble real life • Experimenters cannot be certain that
phenomena observed in the lab are the same as the psychological disorders being investigated
• Animals are often used as participants
Single-subject experiment→A single participant is observed before and after manipulation of the independent variable
• Experiments rely on baseline data to set a standard for comparison→to see if symptoms changed after giving medication
for one week, and then stop it to see if it goes back to baseline→same person followed over time
• Has higher internal validity than case study because the independent variable is manipulated • ABAB (reversal) design
Special Forms of Correlational Research
Longitudinal studies (high-risk/developmental studies)→Same individuals observed on many occasions over a long period
• Independent variable manipulation or random assignment of participants to conditions is not possible
• Causes cannot be pinpointed
Epidemiological studies→Reveal the incidence and prevalence of a disorder in a particular population
• Incidence: Number of new cases that emerge in a given period
• Prevalence: Total number of cases in a given period
Studies→ Epidemiologic Catchment Area Study (Cottler et al.) • National Comorbidity Survey • National Comorbidity
Survey Replication
Protecting Human Participants
Researchers’ primary obligation
• Avoid physical or psychological harm for human participants
• Institutional Review Board (IRB) →check if it meets the criteria
• Ethics committee in a research facility empowered to protect the rights and safety of human research participants
IRBs try to ensure that each study grants the following rights to participants:
• The participants enlist voluntarily.
• Before enlisting, the participants are adequately informed about what the study entails (“informed consent”).
• The participants can end their participation in the study at any time.
• The benefits of the study outweigh its costs/risks.
• The participants are protected from physical and psychological harm.
• The participants have access to information about the study.
• The participants’ privacy is protected by principles such as confidentiality or anonymity
CH 2 Models of Abnormality
Models of Abnormality Models or paradigms used by scientists and clinicians to treat abnormality
• Explain events/basic assumptions • Guide treatment techniques/principles • Involve several models to explain abnormality
The Biological Model
• Has biological basis and medical perspective
• Considers illness to be brought about by malfunctioning parts of the organism
• Points to problems in brain anatomy or brain chemistry
How Do Biological Theorists Explain Abnormal Behavior?
Brain anatomy
• Neurons (process info) and glia cells (support neurons) • Brain structures
• Cerebrum (cortex, corpus callosum, basal ganglia, hippocampus, amygdala)
• Connections found among some psychological disorders and specific brains structure→degree of specialization
4
CH1 Abnormal Psychology: Past and Present
Abnormal psychology
Scientific study of abnormal behavior in an effort to describe, predict, explain, and change abnormal patterns of functioning
• Many definitions have been proposed, yet none has won total acceptance
In a Word→unstable→madness→insanity distress disturbed→unbalanced→psychological→dysfunctional impaired
What Is Psychological Abnormality?
Common feature across definitions
The Four Ds→ • Deviance • Distress • Dysfunction • Danger
Influences→ • Norms • Culture • Context
The Elusive Nature of Abnormality
Abnormality is defined by general criteria in society. (for some→no general criteria across different situations →variability)
Criteria are used to judge particular cases.
• Thomas Szasz: societal involvement may invalidate the concept of mental illness.
→Any definition of abnormality may be unable to be applied consistently.
Which behaviors fit the criteria of deviant, distressful, dysfunctional, or dangerous, but would not be considered abnormal
by most people? Bungee jumping, Religious customs (e.g., circumcision, ayahuasca ceremonies), New Years dive
Drinking alcohol, Climbing Mount Everest
What Is Treatment?
Treatment or therapy →Procedure designed to change abnormal behavior into more normal behavior
• Definitional challenges closely related to defining abnormality
Essential features of all therapy forms: • Sufferer or patient • Trained, socially accepted healer or therapist
• Series of therapeutic contacts between the healer and the sufferer
• Despite their differences, most clinicians agree that large numbers of people need therapy of one kind or another
How Was Abnormality Viewed and Treated in the Past?
• Every society, past and present, has witnessed psychological abnormality→ Tried to address it in different ways
• Many present-day ideas and treatments have roots in the past.
Ancient Views and Treatments
Ancient societies→Probably regarded abnormal behavior as the work of evil spirits
→May have begun as far back as the Stone Age
Treatment→ Trephination and exorcism (through skull drilling, holes in the skull to let out spirits)
Greek and Roman Views and Treatments
500 B.C. to 500 A.D.
• Philosophers and physicians offered different explanations and treatments for abnormal behaviors
• Hippocrates believed and taught that illnesses had natural causes; four humors-bodily fluids (blood, phlegm, black bile,
yellow bile) need to be balanced, if not→illness eg.too much blood=too passionate
Treatment→• Quiet life • Vegetable diet • Temperance • Exercise • Celibacy • Bleeding→ changing levels of bodily fluids
Europe in the Middle Ages: Demonology Returns
500–1350 A.D.
• Church rejected scientific forms of investigation and controlled all education, exclusion of people with mental disorders
• Mental disorders had demonic causes; mass madness; shared delusions and hallucinations
• At the close of the Middle Ages, demonology and its methods began to lose favor again
Treatment→• Exorcism • Torture • Gradually more hospitalization
The Renaissance and the Rise of Asylums
1400–1700 A.D.
• With increased scientific knowledge, demonological views of abnormality continued to decline
• Weyer was the first mental health physician; believed that the mind was as susceptible to sickness as the body
• Care at religious shrines (e.g., Gheel→people with mental disorders would go there and get help from local people,
included to families there, still going on) was the precursor of community health programs
• Asylums emerged by the mid-sixteenth century
The Nineteenth Century: Reform and Moral Treatment
Nineteenth century
1
,Care of people with mental disorders began to improve→treated with a humane fashion, more respect
• Pinel (France) and Tuke (England) →Advocated moral treatment that emphasized humane and respectful techniques
• Moral treatment movement ended in the United States and Europe by the early twentieth century
Benjamin Rush (father of American psychiatry) and Dorothea Dix (Boston schoolteacher) Promoted moral treatment in the
United States→Movement disintegrated in the late nineteenth century; mental hospitals warehoused inmates and provided
minimal care (there were more and more people with problems but there weren’t many treatments available so they
became prisons for those people, in which they weren’t really treated)
The Early Twentieth Century: Dual Perspectives
Somatogenic perspective→Abnormal functioning has physical causes
Two factors responsible for the rebirth of this perspective
• Emil Kraepelin: Physical factors are responsible for mental dysfunction, linked together
• New biological discoveries linked such things as untreated syphilis and general paresis
Results were generally disappointing until effective medication was developed, eg, antibiotics to treat syphilis very effective
Psychogenic perspective→Abnormal functioning has psychological causes
Rise in popularity based on work with hypnotism
• Mesmer: Hysterical disorders→hypnosis (mesmerism) →psychological disorders can be treated using
• Freud: Psychoanalysis; outpatient therapy→people would live at home and go there to therapy
Psychoanalytic theory and treatment became widely accepted and available to help people
Recent Decades and Current Trends
Negative public attitudes still exist, but there have been major changes in the last 60 years in the ways clinicians
understand and treat abnormal functioning: • More theories and treatment types • More research and information
• More disagreements about abnormal functioning→Biological theories, Psychological theories, Sociological theories,
Humanistic theories
How Are People with Severe Disturbances Cared For? New psychotropic medications discovered in 1950s
• Antipsychotic drugs • Antidepressant drugs • Antianxiety drugs →Led to deinstitutionalization and rise in outpatient care
How Are People with Severe Disturbances Treated?
Before 1950 →Almost all outpatient care took the form of private psychotherapy
Today → Outpatient care is the primary mode of treatment; more insurance coverage, Prevention programs are increasing;
positive psychology has grown, Programs dealing with one kind of psychological problem have been created
Multicultural Psychology
• A new area of study that emerged in response to the growing diversity of the United States
• Multicultural psychologists seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and
thought and how people of different cultures, races, and genders may differ psychologically
The Increasing Influence of Insurance Coverage
Today the dominant form of insurance coverage is the managed care program, in which the insurance company determines
key care issues
• The dominant form of insurance for people in the United States consists of managed care programs
• Reimbursements for mental disorders tend to be lower than those for medical disorders
• In 2014, the Affordable Care Act (ACT) went into effect
• In the Netherlands: Mental health care is (mostly) covered by health insurance. Reference to (specialized) institutions
goes through GP
What Are Today's Leading Theories and Professions?
Numerous theoretical perspectives→• Psychoanalytic, • Biological, • Cognitive-behavioral, • Humanistic-existential,
• Sociocultural, • Developmental psychopathology
No single perspective dominates the clinical field→a lot of different approaches used at the same time
social workers support people, psychologists give therapy, biological develop new medications…
→A variety of professionals offer help to people with psychological problems
psychiatrists→medical decree doctor, can prescribe medications and make diagnoses
Technology and Mental Health
The digital world provides new triggers and vehicles for the expression of abnormal behavior
Use of tele-mental health services rapidly increasing + • Mental health apps in the marketplace are increasing sharply
Enormous volume of Web-based misinformation
2
,Question: Do you think social media has a positive or negative impact on mental health? Why/why not?
What Do Clinical Researchers Do?
Research is the systematic search for facts through the use of careful observations and investigations
Clinical researchers→Discover universal laws and principles
• Search for nomothetic understanding, understanding at a idiographic level isn't that easy
• Do not typically assess, diagnose, or treat individual clients • Rely on the scientific method
Clinical researchers depend, in a broad sense, on three methods of investigation
• Case study • Correlational method • Experimental method
The Case Study
How are case studies helpful? Detailed, interpretative description of a person's life and psychological problems
• Source of new ideas about behavior • Tentative support for a theory • Challenge of a theory’s assumptions
• Introduction of new therapeutic techniques • Opportunities to study unusual problems
What are the limitations of case studies? Biased observers, Subjective evidence (low internal validity), Little basis for
generalization (low external validity)
The Correlational Method
Correlation→Degree to which events or characteristics vary with each other
• Positive correlation (more..more) • Negative correlation (more…less) • Unrelated
Correlational method→Research procedure used to determine the co-relationship between variables
Subjects or participants→People chosen for study are collectively called a sample, Sample must be representative of the
larger population
When Can Correlations Be Trusted?
Correlations can be trusted based on a statistical analysis of probability
• Statistical significance: The finding is unlikely to have occurred by chance, more confident about its reliability
• Generally, confidence increases with the size of the sample and the magnitude of the correlation
What Are the Merits of the Correlational Method?
Advantages of the correlational method
• Has high external validity (can generalize findings to a broader population)
• Can repeat (replicate) studies with other samples
Difficulties with correlational studies
• Lack internal validity • Describe but do not explain a relationship or causation (+design confounds)
The Experimental Method
Experiment→The variable is manipulated and the manipulation's effect on another variable is observed
• Manipulated variable = independent variable • Variable being observed = dependent variable
Confound→Variables other than the independent variable that may also be affecting the dependent variable
Three features to guard against confounds
• Control group • Random assignment (no systematic differences) • Masked (blind) design
The Control Group
• Research participants who are not exposed to the independent variable, but whose experience is similar to that of the
experimental group Control group→to establish the causal effect
• Rules of statistical significance are applied • Clinicians may also evaluate clinical significance
Random Assignment→Any selection procedure that ensures that every participant in the experiment is as likely to be
placed in one group as another
Masked (blind) design→Experiment in which participants do not know which assigned group they are in • Placebo therapy
Double-masked design→Experiment in which both participants and experimenters are unaware of the groups to which
participants are assigned
Research methods
3
, Alternative Research Designs
Clinical researchers often must settle for designs that are less than ideal and include quasi-experimental designs
• Matched designs • Natural experiments • Analogue experiments • Single-subject experiments • Longitudinal studies
• Epidemiological studies
Matched (mixed) designs→Participants are not randomly assigned to groups, but rather placed in existing groups
• Matched control groups are used to address confounds based on demographic and other variables
Natural experiments→• Nature manipulates the independent variable and the experimenter observes the effects
• Events cannot be replicated at will (eg. people that experience an earthquake have more traumatic experiences)
• Broad generalizations cannot be drawn from a single study
Analogue experiments→Independent variables are freely manipulated while ethical and practical limitations are avoided
• Laboratory subjects are induced to behave in ways that resemble real life • Experimenters cannot be certain that
phenomena observed in the lab are the same as the psychological disorders being investigated
• Animals are often used as participants
Single-subject experiment→A single participant is observed before and after manipulation of the independent variable
• Experiments rely on baseline data to set a standard for comparison→to see if symptoms changed after giving medication
for one week, and then stop it to see if it goes back to baseline→same person followed over time
• Has higher internal validity than case study because the independent variable is manipulated • ABAB (reversal) design
Special Forms of Correlational Research
Longitudinal studies (high-risk/developmental studies)→Same individuals observed on many occasions over a long period
• Independent variable manipulation or random assignment of participants to conditions is not possible
• Causes cannot be pinpointed
Epidemiological studies→Reveal the incidence and prevalence of a disorder in a particular population
• Incidence: Number of new cases that emerge in a given period
• Prevalence: Total number of cases in a given period
Studies→ Epidemiologic Catchment Area Study (Cottler et al.) • National Comorbidity Survey • National Comorbidity
Survey Replication
Protecting Human Participants
Researchers’ primary obligation
• Avoid physical or psychological harm for human participants
• Institutional Review Board (IRB) →check if it meets the criteria
• Ethics committee in a research facility empowered to protect the rights and safety of human research participants
IRBs try to ensure that each study grants the following rights to participants:
• The participants enlist voluntarily.
• Before enlisting, the participants are adequately informed about what the study entails (“informed consent”).
• The participants can end their participation in the study at any time.
• The benefits of the study outweigh its costs/risks.
• The participants are protected from physical and psychological harm.
• The participants have access to information about the study.
• The participants’ privacy is protected by principles such as confidentiality or anonymity
CH 2 Models of Abnormality
Models of Abnormality Models or paradigms used by scientists and clinicians to treat abnormality
• Explain events/basic assumptions • Guide treatment techniques/principles • Involve several models to explain abnormality
The Biological Model
• Has biological basis and medical perspective
• Considers illness to be brought about by malfunctioning parts of the organism
• Points to problems in brain anatomy or brain chemistry
How Do Biological Theorists Explain Abnormal Behavior?
Brain anatomy
• Neurons (process info) and glia cells (support neurons) • Brain structures
• Cerebrum (cortex, corpus callosum, basal ganglia, hippocampus, amygdala)
• Connections found among some psychological disorders and specific brains structure→degree of specialization
4
