Abnormal
Psychology 15
CHAPTER OUTLINE
LEARNING OBJECTIVES
INTRODUCTION
WHAT DOES ‘ABNORMAL’ MEAN?
WHAT CAUSES ABNORMAL BEHAVIOUR?
Biology and genetics
Psychodynamics and the parent–child relationship
Attachment and security
Learned behaviour
Distorted thinking
Integrative models
DISORDERS – SYMPTOMS AND CAUSES
Schizophrenia – a living nightmare
Mood disorders – depression
Anxiety disorders – when fear takes over
Eating disorders – bulimia and anorexia
Substance use disorders – abuse and dependence
Personality disorders – a way of being
FINAL THOUGHTS
SUMMARY
REVISION QUESTIONS
FURTHER READING
, Learning Objectives
By the end of this chapter you should appreciate that:
n abnormal psychology (or psychopathology) deals with sets of behaviours or symptoms that produce a functional
impairment in people’s lives;
n psychological disorders (e.g. schizophrenia) have been documented across time and culture;
n throughout history, the causes of abnormal behaviour have been construed from a number of different
perspectives;
n biological/genetic models focus on brain defects, biochemical imbalances and genetic predispositions as causes
of psychopathology;
n Freudian, contemporary psychodynamic and attachment models focus on the effects of early parent–child
experiences;
n behavioural models focus on the learning experiences that result in psychopathology;
n cognitive models focus on the effect of distorted thought processes;
n the diathesis–stress perspective suggests that the factors identified by each of the other models may work in
accordance with one another;
n the developmental psychopathology perspective provides a framework for understanding how psychopathology
develops from childhood to adulthood;
n these perspectives can help us understand the numerous disorders documented in classification systems such as
the DSM-IV and the ICD-10;
n there are several major forms of psychopathology, including schizophrenia, mood disorders, substance abuse,
eating disorders and personality disorders.
INTRODUCTION
Abnormal psychology is the study of mental dis- Organization examined the prevalence, or frequency,
orders (also called mental illness, psychological of mental disorders in people visiting medical
disorders or psychopathology) – what they look doctors in primary care settings in 14 countries.
like (symptoms), why they occur (etiology), how As figure 15.1 shows, the study revealed that
they are maintained, and what effect they have on 24 per cent of these people had diagnosable
people’s lives. mental disorders and another 10 per cent had
Mental disorders are surprisingly common. For severe symptoms of mental disorders (Üstün &
example, a study conducted by the World Health Sartorious, 1995).
, 316 Abnormal Psychology
40 60
35 50
% of population
30 Current mental 40
% of patients
25 disorder
30
Subthreshold
20 disorder 20
15 Symptomatic
10
10 Well
0
5 0 1 2 3 or more
Number of disorders
0
Figure 15.1 Figure 15.2
Rates of current mental disorder in patients presenting Comorbidity in lifetime rates of mental disorders. Co-
to primary care facilities across the world. morbidity is the occurrence of two or more disorders at
Source: Adapted from Üstün and Sartorius (1995). the same time. Of the 48 per cent of people reporting
lifetime history of disorder in this study, over half reported
two or more simultaneous disorders. These data come
from a survey in the US, but similar rates of comorbidity
have been found in countries around the world.
Psychopathology can happen to anyone and Source: Kessler et al. (1994).
affects many people around them – there is no
age, race or group that is immune. Furthermore, The frequency and widespread suffering caused
many people experience more than one disorder by mental disorders makes our understanding of
at the same time (see figure 15.2). them critical.
Importantly, both the ICD-10 and the DSM-IV require that
WHAT DOES ‘ABNORMAL’ MEAN? the level of impairment a person is experiencing be taken into
account when deciding whether they meet criteria for any mental
Defining abnormality is deceptively difficult. When asked to disorder. For example, the DSM-IV diagnostic criteria for depres-
describe abnormal behaviour, people typically say that it occurs sion specify that: ‘The symptoms cause clinically significant dis-
infrequently, is odd or strange, is characterized by suffering, or is tress or impairment in social, occupational, or other important
dangerous. All of these are reasonable answers for some types of areas of functioning’ (p. 327). The ICD-10 description of depres-
abnormal behaviour, but none of them is sufficient in itself, and sion also states: ‘The extent of ordinary social and work activities
making them all necessary results in too strict a definition. is often a useful general guide to the likely degree of severity of
One parsimonious and practical way to define abnormal the episode’ (p. 121).
behaviour is to ask whether the behaviour causes impairment in Finally, it is important to be sensitive to how contextual factors
the person’s life. The more a affect judgements about abnormality, so as not to over- or under-
behaviour gets in the way of pathologize groups or individuals. Such factors include ethnicity
impairment extent to which a behavi- and culture, gender, age and socio-political values. For example,
successful functioning in an
our or set of behaviours gets in the way homosexuality was once listed as a disorder in the DSM, but, as
important domain of life
of successful functioning in an import- socio-political values changed to become somewhat more liberal
(including the psychological,
ant domain of the individual’s life and accepting, it was deleted.
interpersonal and achieve-
ment/performance domains),
the more likely it is to be considered a sign of abnormality. When
several such behaviours or symptoms occur together, they may
WHAT CAUSES ABNORMAL
constitute a psychological disorder.
BEHAVIOUR?
Psychological disorders are formally defined in widely used
classification systems, or nosologies: the International Classifica-
tion of Diseases – 10th edition (ICD-10; World Health Organiza- With a basis for understanding how to define abnormal
tion, 1992) and the Diagnostic and Statistical Manual of Mental behaviour, we can focus on its causes. Abnormal behaviour is
Disorders – 4th edition (DSM-IV; APA, 1994). Although they differ construed from a number of different perspectives. Each of the
from one another in format, these two systems cover the same following models tells us something about different aspects of a
disorders and define them in a similar manner. multi-faceted group of mental disorders.
Psychology 15
CHAPTER OUTLINE
LEARNING OBJECTIVES
INTRODUCTION
WHAT DOES ‘ABNORMAL’ MEAN?
WHAT CAUSES ABNORMAL BEHAVIOUR?
Biology and genetics
Psychodynamics and the parent–child relationship
Attachment and security
Learned behaviour
Distorted thinking
Integrative models
DISORDERS – SYMPTOMS AND CAUSES
Schizophrenia – a living nightmare
Mood disorders – depression
Anxiety disorders – when fear takes over
Eating disorders – bulimia and anorexia
Substance use disorders – abuse and dependence
Personality disorders – a way of being
FINAL THOUGHTS
SUMMARY
REVISION QUESTIONS
FURTHER READING
, Learning Objectives
By the end of this chapter you should appreciate that:
n abnormal psychology (or psychopathology) deals with sets of behaviours or symptoms that produce a functional
impairment in people’s lives;
n psychological disorders (e.g. schizophrenia) have been documented across time and culture;
n throughout history, the causes of abnormal behaviour have been construed from a number of different
perspectives;
n biological/genetic models focus on brain defects, biochemical imbalances and genetic predispositions as causes
of psychopathology;
n Freudian, contemporary psychodynamic and attachment models focus on the effects of early parent–child
experiences;
n behavioural models focus on the learning experiences that result in psychopathology;
n cognitive models focus on the effect of distorted thought processes;
n the diathesis–stress perspective suggests that the factors identified by each of the other models may work in
accordance with one another;
n the developmental psychopathology perspective provides a framework for understanding how psychopathology
develops from childhood to adulthood;
n these perspectives can help us understand the numerous disorders documented in classification systems such as
the DSM-IV and the ICD-10;
n there are several major forms of psychopathology, including schizophrenia, mood disorders, substance abuse,
eating disorders and personality disorders.
INTRODUCTION
Abnormal psychology is the study of mental dis- Organization examined the prevalence, or frequency,
orders (also called mental illness, psychological of mental disorders in people visiting medical
disorders or psychopathology) – what they look doctors in primary care settings in 14 countries.
like (symptoms), why they occur (etiology), how As figure 15.1 shows, the study revealed that
they are maintained, and what effect they have on 24 per cent of these people had diagnosable
people’s lives. mental disorders and another 10 per cent had
Mental disorders are surprisingly common. For severe symptoms of mental disorders (Üstün &
example, a study conducted by the World Health Sartorious, 1995).
, 316 Abnormal Psychology
40 60
35 50
% of population
30 Current mental 40
% of patients
25 disorder
30
Subthreshold
20 disorder 20
15 Symptomatic
10
10 Well
0
5 0 1 2 3 or more
Number of disorders
0
Figure 15.1 Figure 15.2
Rates of current mental disorder in patients presenting Comorbidity in lifetime rates of mental disorders. Co-
to primary care facilities across the world. morbidity is the occurrence of two or more disorders at
Source: Adapted from Üstün and Sartorius (1995). the same time. Of the 48 per cent of people reporting
lifetime history of disorder in this study, over half reported
two or more simultaneous disorders. These data come
from a survey in the US, but similar rates of comorbidity
have been found in countries around the world.
Psychopathology can happen to anyone and Source: Kessler et al. (1994).
affects many people around them – there is no
age, race or group that is immune. Furthermore, The frequency and widespread suffering caused
many people experience more than one disorder by mental disorders makes our understanding of
at the same time (see figure 15.2). them critical.
Importantly, both the ICD-10 and the DSM-IV require that
WHAT DOES ‘ABNORMAL’ MEAN? the level of impairment a person is experiencing be taken into
account when deciding whether they meet criteria for any mental
Defining abnormality is deceptively difficult. When asked to disorder. For example, the DSM-IV diagnostic criteria for depres-
describe abnormal behaviour, people typically say that it occurs sion specify that: ‘The symptoms cause clinically significant dis-
infrequently, is odd or strange, is characterized by suffering, or is tress or impairment in social, occupational, or other important
dangerous. All of these are reasonable answers for some types of areas of functioning’ (p. 327). The ICD-10 description of depres-
abnormal behaviour, but none of them is sufficient in itself, and sion also states: ‘The extent of ordinary social and work activities
making them all necessary results in too strict a definition. is often a useful general guide to the likely degree of severity of
One parsimonious and practical way to define abnormal the episode’ (p. 121).
behaviour is to ask whether the behaviour causes impairment in Finally, it is important to be sensitive to how contextual factors
the person’s life. The more a affect judgements about abnormality, so as not to over- or under-
behaviour gets in the way of pathologize groups or individuals. Such factors include ethnicity
impairment extent to which a behavi- and culture, gender, age and socio-political values. For example,
successful functioning in an
our or set of behaviours gets in the way homosexuality was once listed as a disorder in the DSM, but, as
important domain of life
of successful functioning in an import- socio-political values changed to become somewhat more liberal
(including the psychological,
ant domain of the individual’s life and accepting, it was deleted.
interpersonal and achieve-
ment/performance domains),
the more likely it is to be considered a sign of abnormality. When
several such behaviours or symptoms occur together, they may
WHAT CAUSES ABNORMAL
constitute a psychological disorder.
BEHAVIOUR?
Psychological disorders are formally defined in widely used
classification systems, or nosologies: the International Classifica-
tion of Diseases – 10th edition (ICD-10; World Health Organiza- With a basis for understanding how to define abnormal
tion, 1992) and the Diagnostic and Statistical Manual of Mental behaviour, we can focus on its causes. Abnormal behaviour is
Disorders – 4th edition (DSM-IV; APA, 1994). Although they differ construed from a number of different perspectives. Each of the
from one another in format, these two systems cover the same following models tells us something about different aspects of a
disorders and define them in a similar manner. multi-faceted group of mental disorders.
