ABNORMAL PSYCHOLOGY
Abnormal Psychology - The scientific study
of abnormal behaviour, with the objective to:
 Describe
 Explain
 Predict
 Control
Psychological Disorder - a “harmful
dysfunction” in which behavior is judged to
be:
 Atypical - not enough in itself
 Disturbing - varies with time and culture
 Maladaptive - harmful
 Unjustifiable - sometimes there’s a good
reason.
The following are common myths about
those suffering from mental illness:
 Easily recognized as deviant
 Disorder due to inheritance
 Incurable
 Never contribute to society
 Always dangerous
Abnormal behaviour departs from some
norm and harms the affected individual or
others
1. Conceptual Definitions
- Statistical Deviation
- Deviations from Ideal Mental Health
- Multicultural Perspectives
 Cultural Universality
 Cultural Relativism
2. Practical Definitions
- The 4 D’s
Distress, Deviance, Dysfunction,
Danger
3. Surgeon General & DSM-IV
Definitions
- “A clinically significant behavioural or
psychological syndrome or pattern that
occurs in an individual and that is
associated with present distress (e.g., a
painful symptom) or disability (i.e.,
impairment in one or more important
areas of functioning) or with a
significantly increased risk of suffering
death, pain, disability, or an important
loss of freedom”
History
4. Ancient Beliefs
- Demonology
- Exorcism
- Trephining
5. Naturalistic Explanations
- Hippocrates
- Four Humors
 Return to the Supernatural
- Mass Madness
o Tarantism
- Witchcraft
Reforms
• Humanism
– People are sick; not possessed
– Need to be treated with dignity
• Reform Movements
– Moral Treatment
• Shift from prison to
hospital
• Biological View
– Organic explanation for
abnormal behaviour
– Drug revolution
Psychology Student Syndrome
• Many psych students find that the
various disorders apply to them
– Abnormal behaviour is not
qualitatively different from
“normal” behaviour
– Many of us will exhibit similar
symptoms
– Behaviours are only problematic
when they harm or interfere with
your daily functioning
– Diagnosing friends and romantic
partners may lead to conflict.
Mental Health Professions
• Who studies abnormal behaviour?
– Clinical Psychologist
• Ph.D. and internship
– Psychiatrist
• M.D. and internship
– School Psychologist
• M.A. or Ph.D.
– Social Worker
• M.S.W.
Diversity & Multiculturalism
• Social Conditioning
– e.g., gender stereotypes
• Cultural Values
– Interpret complaints with culture
in mind
• Sociopolitical Influences
– Different experiences affect what
is abnormal
• Bias in diagnosis
Diagnosing Abnormal Behavior
• Multiaxial approach
i. Clinical disorders
ii. Personality disorders
iii. General medical conditions
iv. Psychosocial &
environmental problems
v. Level of current functioning
Interrater Reliability
Issues of Classification
• Helps
– To making treatment decisions
– To communicate among clinicians
– Research
• advancing knowledge of
disorders
• diagnosis as a first step to
understanding mechanisms
and developing treatments
• Hinders
– By stigmatizing patients
– Because different labels can mean
different things to different people
– By biasing how we see the patient
– By focusing on one point in the
patient’s development
• Patient may outgrow the label
What causes Abnormal Behavior?
Each perspective of psychology assigns
different reasons.
• Psychoanalytic – abnormal behavior
results from internal conflict in the
unconscious stemming from early
childhood experiences.
Example: failure to resolve childhood
issues.
• Behavioral – Abnormal behavior
consists of maladaptive responses
learned through reinforcement of the
wrong kinds of behavior.
Example: Child getting what they want all
the time.
• Humanistic – Abnormal behavior
results from conditions of worth society
places on the individual, which cause
poor self-concept. (Hierarchical of
needs)
Example: If a person keeps failing (getting
fired) at their job(s), they will show
maladaptive behavior.
• Cognitive – comes from irrational and
illogical perceptions and belief
systems.
Example: We do not handle situations in
the appropriate manner because of some
kind of mental distortion of “truth” or right
or wrong (belief bias).
• Evolutionary – natural selection – you
brain does not perform psychological
mechanisms effectively.
Example – Your parents handle situations
in a maladaptive so you might do the same.
• Biological – Abnormal behavior is the
result of neuro-chemical and/or
hormonal imbalance
Example – Dopamine levels –
schizophrenia or Parkinson’s
CHAPTER 2
Psychological Disorders
 Medical Model -concept that diseases
have physical causes
- can be diagnosed, treated, and in most
cases, cured
- symptoms can be cured through therapy,
which may include treatment in a
psychiatric hospital
Medical Model Terms:
• Psychopathology – study of the origin,
development, and manifestations of
mental or behavioral disorders
• Etiology – the apparent cause and
development of the illness
• Prognosis – forecasts the probable
cause of an illness
 Bio-Psycho-Social Perspective
- assumes that biological, sociocultural,
and psychological factors combine and
interact to produce psychological
disorders
PSYCHOLOGICAL DISORDERS
 Neurotic Disorder
- usually distressing but that allows one to
think rationally and function socially
 Psychotic Disorder
-
person loses contact with reality
experiences irrational ideas and
distorted perceptions
Insanity – the inability to determine right
from wrong.
ANIMISM AND SPIRITUAL THEORIES
Animism - belief in the existence and power
of a spirit world
Cultural and Historical Relativism
The Ancient Greeks: Early Biological
Theories:
• Hippocrates
Four Humors
 Yellow bile
 Black bile
 Blood
 Phlegm
The Renaissance: Asylums
Phillipe Pinel - Moral treatment
 According to him insane people did not
need to be chained, beaten, or otherwise
physically abused. Instead, he called
for kindness and patience, along with
recreation, walks, and pleasant
conversation.
Deinstitutionalization - the process of
replacing long-stay psychiatric hospitals with
less isolated community mental health
services for those diagnosed with a mental
disorder or developmental disability.
Dorothea Dix – Moral treatment
 she brought humane treatment to the
insane. Dix insisted that hospitals for the
insane be spacious, well ventilated, and
have beautiful grounds.
Paradigms - overall scientific worldviews
which radically shift at various points in
history.
-
The Principle of Causality
Reductionism - Explaining a disorder or other
complex phenomenon using only a single idea
or perspective.
The Principle of Multiple Causality
• Precipitating cause - The immediate
trigger or precipitant of an event.
•
Predisposing cause - The underlying
processes that create the conditions
making it possible for a precipitating
cause to trigger an event.
Diathesis-stress model
 The view that the development of a
disorder requires the interaction of a
diathesis (predisposing cause) and a stress
(precipitating cause).
Mind- Body Connection
• Monism - mind
• Dualism – mind and body
General Paresis - A disease due to a syphilis
infection, that can cause psychosis, paralysis
and death.
Psychosocial dwarfism - A rare disorder in
which the physical growth of a children
deprived of emotional care is stunted.
Biopsychosocial model
 A perspective in abnormal psychology that
integrates biological, psychological, and
social components.
The Theoretical Perspectives
Biological Perspectives
 The Central Nervous System
The control center for transmitting
information and impulses throughout the
body, consisting of the brain and the spinal
cord.
Neuron – an individual nerve cell
• Cortex – the folded matter on the
outside of the brain that controls
human’s advanced cognitive functions.
• Thalamus – a subcortical brain
structure involved in routing and
filtering sensory input.
• Hypothalamus – a subcortical brain
structure that controls the endocrine, or
hormonal, system.
• Basal ganglia – a subcortical brain
structure involved in the regulation of
movement.
Neurotransmitters - chemicals that allow
neurons in the brain to communicate by
traveling between them.
Synapse - point of connection between
neurons
Synaptic Cleft - the tiny gap between one
neuron and the next at a synapse
Receptors - the areas of a neuron that receive
neurotransmitters from adjacent neurons
Peripheral Nervous System (PNS) – network
of nerves throughout the body that carries
information and impulses to and from the
CNS.
Somatic Nervous System – connects the
central nervous system with the sensory
organs and skeletal muscles.
Autonomic Nervous System (ANS) – The
part of the peripheral nervous system that
regulates involuntary bodily systems, such as
breathing and heart rate; it is made up of the
sympathetic and parasympathetic nervous
system.
Sympathetic Nervous System – the part of
the autonomic nervous system that activates
the body’s response to emergency and arousal
situations.
Parasympathetic Nervous System – the part
of the autonomic nervous system that
regulates the body’s calming and energy
conserving factors.
Genetics
 Family pedigree studies - studies designed
to investigate whether a disorder runs in
families.
Twin studies – studies which compare
concordance rates for identical and
nonidentical twins for a given disorder.
Concordance rate - in a group of twins, the
percentage that both have the same disorder.
Adoption studies – studies designed to
compare the concordance rates for a given
disorder of biological versus non-biological
parent-child pairs.
Genetic linkage – studies looking for the
specific genetic material that may be
responsible for the genetic influence on
particular disorders.
Prefrontal lobotomy – the surgical
destruction of the brain tissue connecting the
prefrontal lobes with other areas of the brain.
Electroconvulsive therapy (ECT) – a
treatment for severe depression that involves
passing electric current through the brain to
induce seizures.
Most common biological treatments
 Psychotropic drugs
 Antianxiety (or anxiolytic)
 Antidepressant
 Antipsychotic
 Mood-stabilizing drugs
 Agonists – drugs that increase
neurotransmission
 Antagonists – drugs that reduce or
block neurotransmission
PSYCHODYNAMIC PERSPECTIVES
Sigmund Freud
Unconscious – descriptively, mental contents
that are outside of awareness; also, the
irrational, instinctual part of the mind in
Freud’s topographic theory.
Freud’s Topographic model
 Conscious
 Preconscious
 Unconscious
Freud’s Structural Model
 Id – the part of the mind containing
instinctual urges
 Superego –
 Ego – the part of the mind that is
oriented to the external world and
mediates the demands of the id and
superego
Common Defense Mechanisms
• Repression – Motivated forgetting
• Denial/minimization – Ignoring or
minimizing particular facts
• Projection – Attributing one’s own
feelings to someone else
• Rationalization – a false but
personally acceptable explanation for
one’s behavior
• Displacement – Transferring a feeling
about one situation onto another
situation
• Reaction formation – turning an
unacceptable feeling onto its opposite
Contemporary Perspectives
 Kleinian School of Psychoanalysis
(Melanie Klein)
 The Object-relational perspective
 Self-Psychology
Psychodynamic Treatment Intervention
• Free association
• Resistance
• Transference
• Countertransference
• Interpretation
• Working through
HUMANISTIC AND EXISTENTIAL
PERSPECTIVES
Humanistic Explanations (Carl Rogers)
Self-actualization – the pursuit of one’s true
self and needs
Unconditional positive regard – the
provision of unconditional love, empathy, and
acceptance in relationships.
Conditions of worth – parental standards that
must be met in order to be loved or valued.
Humanistic Treatment Interventions
 Client-centered therapy – a
humanistic treatment approach
developed by Carl Rogers
 Motivational interviewing – it is
effective in treating substance-use
disorders.
Existential Explanations and Treatment
Interventions
 Existentialists view emotional health as
the ability to face these facts and to
create a meaningful life by accepting
this responsibility.
 Common principles in existential
therapy techniques include encouraging
clients to face painful truths and to
develop courage in the face of life’s
inevitable difficulties.
BEHAVIORAL PERSPECTIVE
(John Watson)
Behaviorism - The theoretical perspective
that emphasizes the influence of learning, via
classical conditioning, operant conditioning,
and modeling, on behavior.
Classical Conditioning (Ivan Pavlov)
 Learning that takes place via automatic
associations between neutral stimuli
and unconditioned stimuli.
Temporal contiguity – two events occurring
closely together in time.
• Unconditioned stimulus – a stimulus
that automatically elicits a response
through a natural reflex
• Unconditioned response – the natural
reflex response elicited by an
unconditioned stimulus.
• Conditioned stimulus - a previously
neutral stimulus that acquires the
ability to elicit a response through
classical conditioning.
• Conditioned response – the response
elicited by a conditioned stimulus.
Operant Conditioning - A form of learning
in which behaviors are shaped through
rewards and punishments.
Reinforcement - Any environmental response
to a behavior that increases the probability that
the behavior will be repeated.
Punishment - In operant conditioning theory,
any environmental response to a behavior that
decrease the probability that the behavior will
be repeated.
• Law of effect – Thorndike’s principle
that behaviors followed by pleasurable
consequences are likely to be repeated
while behaviors followed by aversive
consequences are not.
THE CLINICAL INTERVIEW
Clinical interview - is a conversation between
a psychologist and client that is intended to
help the psychologist diagnose and treat the
patient.
The Interviewer - The most pivotal element
of a clinical interview is the person who
conducts it.
General Skills
• Quieting yourself – minimize
excessive internal, self-directed thought
that detract from listening.
• Being self-aware – know how you tend
to affect others interpersonally, and
how others tend to relate to you.
• Develop positive working
relationships – can turn into
psychotherapy.
-respecting and caring attitude is key.
Specific Behaviors
 Body Language - General rules; face
the client, appear attentive, minimize
restlessness, display appropriate facial
expressions and so on.
 Eye contact
 Vocal Qualities - Use pitch, tone,
volume, and fluctuation of voice to let
clients know that their feeling and
words are being deeply appreciated.
 Verbal Tracking - Ensure clients that
they have been accurately heard.
- Monitor the train of thought of client,
if able to shift topics smoothly rather
that abruptly.
 Referring to the client by the proper
name - Misuse of names in this way
may be disrespectful and be received as
microaggression.
Components of an Interview
 Rapport – positive, comfortable
relationship between interviewer and
client.
 Technique – what an interviewer does
with clients.
- Directive vs, non-directive styles
Open-ended questions - Allow
individualized and spontaneous responses
from clients.
- Elicit long answers that may or may not
provide necessary information.
Close-ended questions - Allow less
elaboration and self-expression by client.
- Yield quick and precise answers
Pragmatics od Interview
• Note taking - Provide a reliable written
record but can be distracting to client
and interviewer.
• Audio and Video-recording - Also,
reliable but can be inhibiting to clients
• The interview rooms - Professional
but yet comfortable with your client.
• Confidentiality - Involves a set of
rules or a promise that limits access or
place restrictions on certain types of
information.
Types of Interviews
Intake Interviews - To determine whether to
“intake” the client into the agency or refer
elsewhere.
Diagnostic Interviews – to provide DSM
diagnosis.
- Structured interviews often used
- Minimize subjectively, enhance
reliability.
Mental Status exam – typically used in
medical settings.
- To quickly access how a client is
functioning at that time.
Crisis Interviews – Assess problem and
provide immediate interventions.
Clients are often considering suicide or other
harmful act.
Cultural Components
Appreciating the Cultural Context
-knowledge of the client’s culture, as well as the
interviewer’s own culture.
-for behavior described or exhibit during interview
Acknowledging Cultural Differences
-wise to discuss cultural differences rather than ignore
-sensitive inquiry about client’s cultural experiences can
be helpful
Psychiatric Mental Status Examination
- The purpose of the exam is to give a
"snapshot" of the patient as he presented
during the interview.
- It is cross sectional, but it is not limited
to one point—the examiner assesses
throughout the interview, and then
records the data in a structured format
The Mental Status Exam, or MMSE, is just
that, an exam. It is your chance to observe
the patient, and record for the reader an
accurate account of your observations of
what the patient was like at the time you
saw them. It is not a place for summation,
and the use of terms like “normal” or
“within normal limits” to summarize
aspects of the exam is inadequate and
inappropriate.
The Psychiatric History
 Chief complaint
 History of Present Illness
 Past History
 Medications
 Family History
 Social History
 Review of Systems
Overview - These are the part of the exam,
and though any given exam may include or
leave out some subsections, each of these
major sections should always be commented
on during and exam.
1. General – general description of the
patient
 Appearance – prominent features
such as portrait, eye contact, dress
and grooming, age/appearance
 Motor Behavior – pace of
movements, degrees of agitation,
any involuntary movements
 Speech – rate, spontaneity,
intonation, volume, defects
 Attitudes – how patient related,
degree of cooperativeness,
evaluator’s attitude
2. Emotion
Mood – the sustained feeling tone that
prevails over time for a patient. At times the
patient will verbalize this mood. Otherwise,
evaluator must inquire or infer
Mood (Inquired): A sustained state of inner
feeling.
Affect – manifestation of the mood
- An observed expression of inner feeling.
- Possible descriptors
These are some of the aspects of affect we
may wish to comment on:
Appropriateness: does the person look the
way they say they feel?
Intensity: is the too much (“heightened”
dramatic”) or too little (“blunted”, “flat”)
strength of affect during the exam?
Mobility: does the affect change at an
appropriate rate, or does there seem to be too
much variation (“labile affect”) or too little
“constricted”, “fixed”).
Range: appropriate a full or restricted range
of affect.
Reactivity: Is the response to external factors,
and topics as would be expected for the
situation. Or is there too little change
(“nonreactive” or “nonresponsive”).
3. Thought
Process
- Manner of organ./form. thought.
- Stream of Thought
- Goal directedness/Continuity
- Other Abnormalities of Thought Process
 Circumstantiality: lack of goal
directedness, incorporating tedious and
unnecessary details, with difficulty in
arriving at an end point. . If they are
exhibiting circumstantial speech, they
may begin by talking about the history
of pets followed by their childhood pet's
favorite food.
 Tangentiality: digresses from the
subject, introducing thoughts that seem
unrelated, oblique, and irrelevant.
Thought blocking: a sudden cessation
in the middle of a sentence at which
point a patient cannot recover what has
been said. “How was your week?” a
person may respond with, “When I was
five, my cat was killed.
 Loose associations: jumping from one
topic to another with no apparent
connection between the topics
 There was an example, a rambling block
quotation that strung together a
grandmother's death, sunlight, dinner,
and cats that didn't exist, interspersed
with inappropriate laughter.
Other Abnormalities of Thought Process.
 Neologisms: words that patients make
up and are often a condensation of
several words that are unintelligible to
another person.
 Word salad: incomprehensible mixing
of meaningless words and phrases.
 Clang associations: the connections
between thoughts may be tenuous, and
the patient uses rhyming and punning.
 Echolalia: irreverent parroting of what
another person has said.
 Perseveration of speech is when
someone repeats words, phrases, or
sounds. They might say the same word
or phrase over and over. Another
example is a person being unable to
change the topic of conversation once
they are stuck on that topic.
4. Cognition
 Consciousness - alert versus
obtunded/comatose
 Orientation - person, place and time
- approximately oriented (off by 1 day)
versus totally off.
 Concentration and attention - ability
to attend to interview, repeat.
- ask to repeat, including after
interrupting.
- For a cognitive exam screening tool,
see the next page.
 Calculations
ex. Serial sevens, other simple
calculations
 Memory
Registration - ability to repeat information
immediately
Short term recall - debatable how long to
wait. Should introduce other information in
the interim
Long term - Historical events, etc.
 Intelligence - can be somewhat
deduced from use of language.
5. Judgment and Insight
Insight - The capacity of the patient to be
aware and to understand that he or she has
a problem or illness and to be able to
review its probable causes and arrive at
tenable solutions.
Patient’s capacity to
- Acknowledge/Appreciate illness
- Associated implications
- Consequences
Judgment

The patient's capacity to make
appropriate decisions and appropriately
act on them in social situations.
 assessment of this function is best made
in the course of obtaining the patient's
history.
 Formal testing is rarely helpful. An
example of testing would be to ask the
patient, "What would you do if you saw
smoke in a theater?"
 no necessary correlation between
intelligence and judgment.
The process of
 Consideration
 Formulation
Leading to a
 Decision
 Action
Requires
 Insight
 Cognitive functioning
 Other abstract abilities
 Conceptualization
 Forward thinking
 Appreciation of what “rational
people” would do.
6. Reliability
- Upon completion of an interview, the
psychiatrist assesses the reliability of
the information that has been obtained.
Factors affecting reliability include:
- the patient's intellectual endowment
his or her (perceived) honesty and
motivations
the presence of psychosis or organic
defects
The patient's tendency to magnify or
understate his or her problems
 Intellect
 honesty and motivations
 psychosis/organic defects
 magnification/understatement
ANXIETY DISORDERS
- Feelings of impending doom or disaster
from an unknown.
Symptoms: sweating, muscular tension, and
increased HR and BP
 Panic Disorder - marked by a minuteslong episode of intense dread in which
a person experiences terror and
accompanying chest pain, choking, or
other frightening sensation.
- Can last anywhere from a few minutes
to a few hours.
- These attacks have no apparent trigger
and can happen at any time.
 Generalized Anxiety Disorder
- This is basically an extended version of
a panic disorder.
- The person may experience multiple
episodes which may occur quite
frequently or for a long duration.
- May have trouble sleeping, be tense,
and irritable.
 Phobia - persistent, irrational fear of a
specific object or situation.
- Nearly 5% of the population suffers
from some mild form of phobic
disorder.
- A fear turns into a phobia when a person
avoids the fear at all costs, disrupting
their daily life.
Common Phobias
• Agoraphobia – fear of being out in
public
• Acrophobia – fear of heights
• Claustrophobia – fear of enclosed
spaces
• Zoophobia – fear of animals (snakes,
mice, rats, spiders, dogs, and cats)
• Didaskaleinophobia- Fear of going to
school
• Hemophobia - Fear of blood
How do you cure a person with a Phobia
Systematic Desensitization – Provide the
person with a very minor version of the
phobia and work them up to handling the
phobia comfortably.
Example: Fear of snakes:
1. Have them watch a short movie about
snakes
2. Have them hold a stuffed animal snake
3. Have them hold a plastic snake
4. Have them hold a glass container with a
snake inside
5. Have them touch a small harmless snake
6. Gradually work to holding a regular size
snake.
Another way:
Flooding – over stimulating the patient with
the fearful object.
- This works for some patients but for
others the systematic desensitization is
much better.
Obsessive-Compulsive Disorder - unwanted
repetitive thoughts (obsessions) and/or actions
(compulsions)
Obsessions – Persistent, intrusive, and
unwanted thoughts that an individual cannot
get out of his/her mind.
- These differ from worries
- They usually involve topics such as dirt
or contamination, death, or aggression.
Compulsions – Ritualistic behaviors
performed repeatedly, which the person does
to reduce the tension created by the obsession.
 Common Compulsions include hand
washing, counting, checking, and
touching.
•
In the United States, 1 in 50 adults have
OCD
• Most people obsess about something
• One third to one half of adults with
OCD report that it started during
childhood.
• No specific genes for OCD have been
identified
• When a parent has OCD, there is a
slightly increased risk that a child will
develop OCD, although the risk is still
low
• There is no proven cause of OCD
Treatments for OCD
 talking therapy – usually a type of
therapy that helps you face your fears and
obsessive thoughts without "putting them
right" with compulsions.
 Medicine – usually a type of
antidepressant medicine that can help by
altering the balance of chemicals in your
brain.
Post Traumatic Stress Disorder
- After a trauma or life-threatening event, a
person suffering from PTSD may:
1. Have upsetting memories (flashbacks)
of what happened
2. Have trouble sleeping
3. Feel jumpy (hyper alertness)
4. Lose interest in things you used to enjoy.
5. Have feelings of guilt
NOTE: For some people these reactions
do not go away on their own, or may even
get worse over time.
Events that can cause PTSD
•
•
•
•
•
•
•
Combat or military exposure
Child sexual or physical abuse
Terrorist attacks – 9/11
Sexual or physical assault
Serious accidents, such as a car wreck.
Natural disasters, such as a fire,
tornado, hurricane, flood, or earthquake
Why does this happen? – Flash bulb
memory
Treatments
1. Anti-anxiety medications
2. Removal from stressful stimuli (war,
work, etc.)
3. Systematic desensitization
Causes of Anxiety Disorders
• Behavioral – Acquired through
Classical conditioning, maintained
through operant conditioning. (What
does this mean?)
• Cognitive – misinterpretation of
harmless situations as threatening (may
selectively recall the bad instead of the
good)
• Biological – Neurotransmitter
imbalances – too little GABA (Valium,
Xanum) – OCD is treated with antidepressants (Prozac, Xoloft) – low
levels of serotonin