Unit 5 - Psychological Disorders and Psychotherapy - Item i i) Meaning of “Abnormal Behaviour” biological, psychological and socio - cultural perspectives. Principles of classification of psychological disorders with reference to DSM IV. Common features of abnormal behaviour - deviance, distress, dysfunction, danger. Different views of "abnormal" behaviour - the statistical stand - the biological/medical approach - the psychodynamic perspective - the sociocultural dimension; why classification of disorders is necessary - an understanding of the Diagnostic and Statistical Manual of Mental Disorders – IV (brief explanation of each Axis) Mental disorders: Disturbances of an individual’s behavioural or psychological functioning that are not culturally expected and that lead to psychological functioning that are not culturally expected and that lead to psychological distress, behavioural disability, and/or impaired overall functioning. Abnormal Behaviour Abnormal behaviour of an individual is marked by limited intelligence, emotional instability, personality disorganisation and character defects, who for the most part, have led wretched personal lives and become social misfits or liabilities. Common features of abnormal behaviourBehaviour is classified as abnormal by 4Ds 1. Deviant Behavior - Behavior that usually deviates from social norms and rules. Behaviour that is not acceptable in society. 2. Dysfunctional behaviour - Which interferes with a person's ability to perform day to day activities normally. 3. Distressing Behaviour - Which are unpleasant and upsetting to the person and others. 4. Dangerous Behaviour - That causes harm or injury to the individual's own self or others. Different views of abnormal behaviour: To understand and deal with mental disorders, the biological or medical, psychodynamic, socio- cultural perspective need to be viewed complementary to one another so that it provides a more accurate and complete picture of the disorder and helps in the treating of the mental disorder. According to modern psychologists, there are various perspectives which delineate the causal factors of abnormal behaviour. Some of the viewpoints are as follows: (i)Biological Perspective- emphasises the role of the nervous system in mental disorders. This approach seeks to understand such disorders in terms of malfunctioning of portions of the brain, imbalances in various neurotransmitters and genetic factors. It is seen that many mental disorders show a high degree of concordance among close relatives. If one family member develops a disorder then others are at increasing risk for developing it too. ● Damage/Malfunctioning of brain in nervous system ● Infection/ Physical illness ● Faulty genes ● Neurotransmitters and hormonal imbalance For example - Low levels of activity of neurotransmitter Gaba may lead to anxiety disorders. Certain dysfunctions in various parts of the brain like the frontal lobe and limbic system are linked to schizophrenia. Page 471 - Baron (ii) Psychodynamic perspective: According to this view, abnormality is an outcome of conflicts between unconscious desires and conscious motives. The unconscious includes all hurtful memories, forbidden desires, unresolved conflicts and experiences. They originate from primitive, sexual and aggressive instincts. Individuals need to keep these primitive impulses hidden from one's consciousness. If such matters seep into the person's conscious mind, the mind will be flooded with profound anxiety. This anxiety is manifested in the form of various psychological disorders. Thus, according to this perspective, psychological disorders are outbursts of various primitive, forbidden conflicts in different ways that were repressed in the unconscious. (iii) Socio-cultural perspective: According to this perspective, abnormal behaviours develop due to the adverse effects of society on the person rather than the person himself. Various societal frameworks such as family dynamics, cultural expectation, societal biases cause abnormality. Different socio-cultural factors like poverty, unemployment, less stimulating or negative environment, inadequacy of scope of education and prejudice play a significant role in causing mental disorders. Profound malnutrition, lack of educational and health facilities, poor mental support and a lack of sympathy during childhood makes individuals prone to stress and other psychopathologies. DSM - Diagnostic and Statistical Manual of Mental Disorders (Baron 471) This was made by the American Psychiatric Association (APA) DSM I - 1952 - Freudian Concepts DSM II - 1968 - Slightly influenced by Freud DSM III - 1980 DSM III R - 1987 DSM IV - 1994 DSM IV R - 2000 DSM V - published in 2013, work started in 2000 DSM IV is a widely used guide for mental disorders. It provides descriptions of these disorders plus information about biological factors associated with them. A manual designed to help all mental health practitioners to recognize and correctly diagnose specific disorders. The five axes of DSM IV have been the case since the advent of DSM III in 1980. DSM IV evaluates an individual according to the five axes. The first three axes assess the individuals present clinical status and condition. Axis I - The particular clinical syndromes or conditions that may focus on clinical attention. Axis I provides information about clinical disorders and any mental health condition other than personality disorders and mental retardation. Disorders that fall under this axis: Schizophrenia, Generalised Anxiety Disorder, Major Depression Disorder, Substance Dependence, Eating Disorders, Sleep Disorders, Dissociative Disorders. Axis II -Personality Disorders and Mental Retardation A very broad group of disorders that encompasses a variety of problematic ways of relating to the world such as Histrionic Personality Disorder, Antisocial Personality Disorder and Paranoid Personality Disorder. The last of these, for eg:- refers to an early developing, persistent and pervasive pattern of disregard for accepted standards of conduct including legal ones. Axis II provides a means of coding for long standing maladaptive personality traits that may or may not be involved in the development and expression of an Axis I disorder. Mental Retardation is also diagnosed as an Axis II condition. Axis III - General Medical Conditions Axis III provides information about any medical condition that was present which might impact the patient's mental disorder or its management. For example, where a major depressive disorder is conceived as resulting from unremitting pain associated with some chronic medical disease. A person diagnosed may have multiple symptoms such as panic and major depressive disorder. Personal disorders such as dependent or avoidant or potentially relevant medical problems such as cirrhosis, overdose and cocaine. The last two DSM IV axes are used to assess broader aspects of an individual's situation. Axis IV - Psychosocial and Environmental Problems A psychosocial or environmental problem may be a negative life event, an environmental difficulty or deficiency, a familial or interpersonal stress. The various categories are as follows - problems with primary support groups, problems with social environment, educational problems - inequality, illiteracy, occupational problems unemployment, threat of losing jobs, housing problems - homelessness, economic problems - extreme poverty, problems with access to healthcare services. It deals with stressors that may have contributed to the current disorder, particularly those that have been present during the prior years. The diagnostician is invited to use a checklist approach for various categories of life problems like family, occupational, economic, legal, etc. Axis V - Global assessment of functioning This is where clinicians note how well the individual is coping at the present time. A 100 point rating scale the global assessment of functioning (GAF Scale) is provided for the examiner to assign a number summarising a patient's overall functioning ability. Criticisms: Baron(473) 1. The classifications are not descriptive by nature, they only state the symptoms without describing the causes of mental disorders. 2. DSM IV classification actually leads to labelling a person according to their abnormal behaviour. This may encourage normal people to exhibit a stereotypical attitude towards them. Some stigma may also get attached to receiving psychiatric diagnosis, which often prevents people from seeking treatment even in cases of severe psychological problems. 3. It states some gender based classification, portraying certain disorders like severe depression are more frequently found among one gender male/female. This may sometimes show gender biases in attitudes.
