Chapter Notes

Concepts of Abnormality and Psychological Disorders

When we talk about psychological disorders, we are trying to understand behaviors that are considered "abnormal." Abnormal Psychology is the specific area of psychology that studies this maladaptive behaviour—what causes it, what its effects are, and how it can be treated.

Adaptation is our ability to change our behavior to meet the demands of our environment. When someone's behavior can't be modified to fit the situation and it causes problems in their life, we call it maladaptive.

To identify abnormal behavior, psychologists often look for the 'four Ds':

• Deviance: The behavior is different, extreme, or unusual from what society considers normal.
• Distress: The behavior is unpleasant and upsetting to the person experiencing it or to others around them.
• Dysfunction: The behavior interferes with the person's ability to carry out their daily activities, like going to work or school, or maintaining relationships.
• Danger: The behavior is potentially harmful to the person or to others.

Two Views on Abnormality

There are two main ways to think about what makes a behavior "abnormal."

1. Deviation from Social Norms: This view suggests that abnormality is simply behavior that goes against the rules of a society. Every society has norms, which are spoken or unspoken rules for how to behave. According to this approach, breaking these rules is what makes a behavior abnormal. [!note] A major issue with this view is that norms change over time and vary across cultures. A behavior considered normal in one culture might be seen as abnormal in another. For example, a culture that values competition may see aggressive behavior as normal, while a culture that values cooperation may not.

2. Maladaptive Behaviour: This view focuses on the well-being of the individual. It argues that the best way to judge a behavior is not by whether it follows social rules, but by whether it helps the person grow and function optimally. In this view, even a behavior that conforms to social norms can be considered abnormal if it is maladaptive and prevents a person from reaching their potential. [!example] A student who never asks questions in class is conforming to the norm of being quiet, but this behavior is maladaptive because it interferes with their learning and growth.

It's important to remember that psychological disorders are illnesses, not something to be ashamed of. The stigma attached to mental illness often prevents people from seeking help.

Historical Background

How people have understood psychological disorders has changed dramatically over time. Three main perspectives have recurred throughout history.

• The Supernatural Approach: This ancient theory claims that abnormal behavior is caused by magical forces like evil spirits (bhoot-pret) or the devil (shaitan). Treatments often involved exorcism, where prayers or countermagic were used to drive the spirit out. The shaman or medicine man (ojha) was believed to communicate with these spirits.

• The Biological or Organic Approach: This view holds that abnormal behavior is caused by problems with the body or brain. Ancient Greek philosopher-physicians like Hippocrates and Plato developed this organismic approach, seeing disturbed behavior as a conflict between emotion and reason. Galen explained personality through an imbalance of four body fluids or humours (blood, black bile, yellow bile, and phlegm). This is similar to the Indian concept of the three doshas (vata, pitta, kapha). In the modern era, this approach links disorders to brain processes and biological defects.

• The Psychological Approach: This perspective suggests that psychological problems are caused by flaws in how a person thinks, feels, or perceives the world.

A Timeline of Views

1. Ancient World: Greek thinkers like Plato developed the organismic (biological) approach.
2. Middle Ages: Demonology and superstition became dominant again. People with mental problems were often seen as evil, leading to "witch-hunts." However, St. Augustine wrote about mental anguish and conflict, laying groundwork for modern psychodynamic theories.
3. The Renaissance: A period of increased humanism. Johann Weyer argued that "witches" were actually mentally disturbed people who needed medical treatment, not punishment. He emphasized psychological conflict as a cause of disorders.
4. The Age of Reason and Enlightenment (17th-18th centuries): The scientific method began to replace faith and dogma. This led to a reform movement, increased compassion for those with mental disorders, and reforms in asylums. It also sparked the idea of deinstitutionalisation, focusing on community care for recovered individuals.

The Modern Approach

In recent years, these perspectives have merged into an interactional, or bio-psycho-social approach. This view recognizes that biological, psychological, and social factors all play important roles in causing and influencing psychological disorders.

Classification of Psychological Disorders

To understand and treat psychological disorders, professionals need a clear way to classify them. Classification systems provide a list of disorders grouped by shared characteristics. This helps psychologists, psychiatrists, and social workers to:

• Communicate effectively with each other about a disorder.
• Understand the causes of disorders.
• Study the processes involved in their development.

There are two major classification systems used today:

• The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5): Published by the American Psychiatric Association (APA), this manual provides specific clinical criteria for diagnosing disorders.
• The International Classification of Diseases (ICD-10): Prepared by the World Health Organisation (WHO), this is the official system used in India and many other countries. It describes the main clinical symptoms and diagnostic guidelines for each disorder.

Factors Underlying Abnormal Behaviour

Psychologists use several models to explain the complex causes of abnormal behavior.

Biological Factors

This model states that abnormal behavior has a biochemical or physiological basis.

• Neurotransmitters: These are chemicals that transmit messages between neurons in the brain. Studies have linked abnormal activity of certain neurotransmitters to specific disorders:
  • Low activity of gamma aminobutyric acid (GABA) is linked to anxiety disorders.
  • Excess activity of dopamine is linked to schizophrenia.
  • Low activity of serotonin is linked to depression.
• Genetic Factors: Genes have been linked to disorders like schizophrenia, bipolar disorder, and depression. It's usually not a single gene but a combination of genes that makes a person vulnerable.

Psychological Models

These models emphasize that psychological and interpersonal factors play a key role in abnormal behavior.

• The Psychodynamic Model: Developed by Sigmund Freud, this model suggests that our behavior is determined by unconscious psychological forces. Abnormal symptoms are the result of conflicts between these forces: the id (instinctual needs), the ego (rational thinking), and the superego (moral standards).
• The Behavioural Model: This model states that both normal and abnormal behaviors are learned. Maladaptive behaviors are learned through:
  • Classical conditioning: Learning by association.
  • Operant conditioning: Learning through rewards and punishments.
  • Social learning: Learning by imitating others.
• The Cognitive Model: This model argues that abnormal functioning results from cognitive problems, such as irrational assumptions, inaccurate beliefs about oneself, and illogical thinking patterns like overgeneralisations (drawing broad negative conclusions from a single small event).
• The Humanistic-Existential Model:
  • Humanists believe people are born with a drive to self-actualise (fulfill their potential for goodness). Abnormal behavior arises when this drive is blocked.
  • Existentialists believe we have the freedom to give meaning to our lives. People who avoid this responsibility live empty, dysfunctional lives.

Socio-Cultural Factors

This model explains abnormal behavior in the context of social and cultural forces.

• Family Structure: Certain family systems, like enmeshed families where members are overinvolved in each other's lives, can produce abnormal functioning.
• Social Networks: People who are isolated and lack social support are more likely to become depressed.
• Societal Labels: When people break social norms, they may be labeled "deviant" or "mentally ill." These labels can stick, and the person may start to accept and play the "sick role."

The Diathesis-Stress Model

This is a widely accepted model that combines different factors. It states that psychological disorders develop when a diathesis (a biological predisposition or vulnerability) is triggered by a stressful situation.

1. Diathesis: A biological vulnerability, which may be inherited.
2. Vulnerability: The person is "at risk" or "predisposed" to developing the disorder.
3. Pathogenic Stressors: Life stressors that can trigger the disorder in a vulnerable person.

Major Psychological Disorders

Anxiety Disorders

Anxiety is a vague, unpleasant feeling of fear and apprehension. While some anxiety is normal, an anxiety disorder involves high levels of distressing anxiety that interfere with daily functioning.

• Symptoms: Rapid heart rate, shortness of breath, dizziness, sweating, sleeplessness, tremors.

Types of Anxiety Disorders

• Generalised Anxiety Disorder: The person experiences prolonged, vague, and intense fears that are not tied to any specific object. Symptoms include constant worry, hypervigilance (always scanning for danger), and motor tension (restlessness, shakiness).
• Panic Disorder: This involves recurrent, unpredictable panic attacks—abrupt surges of intense terror. Symptoms include shortness of breath, palpitations, trembling, choking, and a fear of going crazy or dying.
• Phobias: An irrational fear of a specific object, person, or situation.
  • Specific Phobias: Fear of things like a certain animal or enclosed spaces.
  • Social Anxiety Disorder (Social Phobia): Intense fear and embarrassment when dealing with others.
  • Agoraphobia: Fear of entering unfamiliar situations, often leading to a fear of leaving home.
• Separation Anxiety Disorder (SAD): Developmentally inappropriate fear and anxiety about being separated from attachment figures (like parents). Children with SAD may refuse to be alone or go to school.

Obsessive-Compulsive and Related Disorders

People with obsessive-compulsive disorder (OCD) are unable to control their preoccupation with specific ideas or prevent themselves from repeatedly performing certain acts.

• Obsessive behaviour: The inability to stop thinking about a particular idea or topic. These thoughts are often unpleasant.
• Compulsive behaviour: The need to perform certain behaviors (like counting, checking, or washing) over and over again.
• Other disorders in this category include: hoarding disorder, trichotillomania (hair-pulling), and excoriation (skin-picking).

Trauma- and Stressor-Related Disorders

These disorders develop in response to a traumatic or stressful event.

• Post-Traumatic Stress Disorder (PTSD): Can occur after experiencing a natural disaster, terrorist attack, serious accident, or war.
• Symptoms: Recurrent dreams or flashbacks of the event, impaired concentration, and emotional numbing.

Somatic Symptom and Related Disorders

In these disorders, a person has physical symptoms without any physical disease to explain them.

• Somatic Symptom Disorder: The person has persistent body-related symptoms and is excessively preoccupied with them, causing significant distress.
• Illness Anxiety Disorder: The person is persistently preoccupied with the possibility of developing a serious illness and constantly worries about their health.
• Conversion Disorders: The person reports a loss of a basic body function, like paralysis, blindness, or deafness, with no medical cause. These symptoms often appear suddenly after a stressful experience.

Dissociative Disorders

Dissociation involves a severance of the connections between ideas and emotions, leading to feelings of unreality, depersonalization, or a loss of identity.

• Dissociative Amnesia: Characterized by extensive but selective memory loss with no organic cause. Some people can't recall anything about their past, while others forget specific events or people.
  • Dissociative Fugue: A part of dissociative amnesia where a person unexpectedly travels away from home, assumes a new identity, and cannot recall their previous one.
• Dissociative Identity Disorder (Multiple Personality Disorder): The person assumes alternate personalities that may or may not be aware of each other. This is often associated with childhood trauma.
• Depersonalisation/Derealisation Disorder: Involves a dreamlike state where the person feels separated from themself and reality. Depersonalisation is a change in self-perception, while derealisation is a change in the perception of the external world.

Depressive Disorders

Depression is one of the most common mental disorders, involving negative moods and behavioral changes.

• Major Depressive Disorder: Defined by a period of depressed mood or loss of interest/pleasure in most activities.
• Symptoms: Changes in body weight, sleep problems, tiredness, inability to think clearly, agitation, thoughts of death or suicide, feelings of worthlessness or excessive guilt.
• Factors Predisposing towards Depression:
  • Genetic make-up (heredity)
  • Age (women at risk in young adulthood, men in early middle age)
  • Gender (women are more likely to report depression)
  • Negative life events and lack of social support.

Bipolar and Related Disorders

These disorders involve shifts in mood between two poles: mania and depression.

• Bipolar I Disorder: Involves episodes of both mania (a state of intense elation, excitement, and energy) and depression, often with periods of normal mood in between. These were formerly called manic-depressive disorders.

Schizophrenia Spectrum and Other Psychotic Disorders

Schizophrenia is a group of psychotic disorders where personal, social, and occupational functioning deteriorates due to disturbed thought processes, strange perceptions, and unusual emotional states.

Symptoms of Schizophrenia

The symptoms are grouped into three categories:

1. Positive Symptoms ('Pathological Excesses'): Bizarre additions to a person's behavior.

   • Delusions: False beliefs that are firmly held despite evidence to the contrary.
     • Delusions of persecution: Believing one is being plotted against or spied on.
     • Delusions of reference: Attaching special personal meaning to objects or the actions of others.
     • Delusions of grandeur: Believing oneself to be a specially empowered person.
     • Delusions of control: Believing one's thoughts and actions are controlled by others.
   • Disorganised thinking and speech: Illogical thinking, rapidly shifting topics (loosening of associations), and inventing new words (neologisms).
   • Hallucinations: Perceptions that occur without any external stimuli. Auditory hallucinations (hearing voices) are the most common.
   • Inappropriate affect: Emotions that are unsuited to the situation.

2. Negative Symptoms ('Pathological Deficits'): Deficits in thought, emotion, and behavior.

   • Alogia: Poverty of speech; a reduction in speech content.
   • Blunted and flat affect: Showing less emotion than most people (blunted affect) or no emotion at all (flat affect).
   • Avolition: Apathy and an inability to start or complete a course of action.
   • Social withdrawal.

3. Psychomotor Symptoms:

   • Odd grimaces, gestures, or moving less spontaneously.
   • Catatonia: Extreme forms, such as remaining motionless for long periods (catatonic stupor), maintaining a rigid posture (catatonic rigidity), or assuming bizarre positions (catatonic posturing).

Neurodevelopmental Disorders

These disorders manifest early in development, often before a child starts school, and hamper personal, social, and academic functioning.

• Attention-Deficit/Hyperactivity Disorder (ADHD): Main features are:
  • Inattention: Difficulty sustaining mental effort, not listening, easily distracted, forgetful.
  • Hyperactivity-Impulsivity: Constant motion ('driven by a motor'), fidgeting, talking incessantly, inability to wait or think before acting.
• Autism Spectrum Disorder: Characterized by widespread impairments in social interaction and communication, and stereotyped patterns of behavior and interests. They have difficulty relating to others, may never develop speech, and often show repetitive behaviors like rocking or hand flapping.
• Intellectual Disability: Refers to below-average intellectual functioning (IQ of 70 or below) and deficits in adaptive behavior (self-care, social skills, etc.) that appear before age 18.
• Specific Learning Disorder: Difficulty in perceiving or processing information, leading to problems in basic reading, writing, or math skills. The child performs below average for their age.

Disruptive, Impulse-Control and Conduct Disorders

This category includes disorders characterized by age-inappropriate actions that violate the rights of others or societal norms.

• Oppositional Defiant Disorder (ODD): Children display age-inappropriate stubbornness, irritability, defiance, and hostility.
• Conduct Disorder: Involves actions and attitudes that violate family expectations and societal norms. Behaviors include aggression towards people or animals, property damage, theft, and serious rule violations.

Feeding and Eating Disorders

• Anorexia Nervosa: The individual has a distorted body image, seeing themself as overweight even when they are dangerously thin. They refuse to eat, exercise compulsively, and may starve themself.
• Bulimia Nervosa: The person eats excessive amounts of food (binges) and then purges their body by using laxatives or vomiting. They often feel disgusted and ashamed after a binge.
• Binge Eating Disorder: Involves frequent episodes of out-of-control eating, often at a high speed and until uncomfortably full, even when not hungry.

Substance-Related and Addictive Disorders

These disorders involve maladaptive behaviors resulting from the regular use of substances that alter how people think, feel, and behave.

• Alcohol: Abuse involves drinking large amounts regularly, which interferes with social behavior, thinking, and work. Users build a tolerance (needing more to feel the effect) and experience withdrawal when they stop. Alcoholism can destroy families and careers and seriously damage physical health.
• Heroin: Intake interferes with social and occupational functioning. Abusers develop dependence, and an overdose can slow breathing and cause death.
• Cocaine: Regular use can lead to poor functioning in relationships and at work, and cause problems with short-term memory and attention. Dependence can develop, and stopping can result in depression, fatigue, and anxiety.