MENTAL HEALTH
Its all in your head - literally
NORMALITY AND ABNORMALITY
SOCIO-CULTURAL
 Behaviour that is accepted in a particular society or
culture, but not in others
HISTORICAL
 Behaviour that is accepted, however it depends on the
period of time
SITUATIONAL
 Behaviour that is accepted in a particular situation
MEDICAL
 Abnormal behaviour has a biological cause and can be
diagnosed and treated
FUNCTIONAL
 Normal behaviour is if the individual can function
effectively in society
ABNORMAL? BY WHICH MEASURE?
ABNORMAL? BY WHICH MEASURE?
ABNORMAL? BY WHICH MEASURE?
NORMALITY AND ABNORMALITY STATISTICAL
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Normal Distribution = behaviour in a large
group of individuals that is distributed in a
particular way
Statistical Average = the majority that
demonstrate this behaviour = normal
Statistical Extremity = the minority that
demonstrate this behaviour = abnormal
NORMALITY AND ABNORMALITY - STATISTICAL
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Normal behaviour = a characteristic that is common in a
large group
Disadvantage: Not everyone is normal or average in all ways. It
suggests there are distinct dividing lines between normal and
abnormal behaviour.
Central Tendency (average) = most results being in the middle
Mean = average of all the individual scores
Average = add up all the scores / how many scores there are
Median = the middle score of the group
Mode = the most common score
Range = spread of scores between the highest and lowest.
Highest number-lowest number
Standard deviation = the average distance each score falls from
the mean
THE BELL OR ‘NORMAL’ CURVE
NORMAL? STATISTICALLY?
NORMAL? STATISTICALLY?
ABNORMALITY – A WORKING DEFINITION
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Abnormality – pattern of thoughts feelings and
behaviours that are deviant, distressing and
dysfunctional
Serial killer Ted
Bundy fits our
definition of
abnormality
MENTAL HEALTH VS MENTAL ILLNESS
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Mental health – capacity to interact with others, cope effectively
with problems and stress
Mental health problem - when the difficulties experienced by a
person are mild, temporary and able to be treated within a relatively
short period of time
Mental illness – psychological dysfunction that usually involves
impairment in coping ability with feeling and behaviours that are
atypical and inappropriate within their culture
Mental illness can sometimes be referred to as a psychological
dysfunction experienced by an individual and usually involving
Emotional distress
Impairment in the ability to cope with everyday life
Thoughts, feelings and/or behaviour that are not typical of the person
or appropriate within their society and/or culture
THE BIOPSYCHOSOCIAL FRAMEWORK
Mental health and
wellbeing depends on a
combination of
biological, social and
psychological factors
SYSTEMS OF CLASSIFICATION OF MENTAL
DISORDERS
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Classification – organising items into groups based on their
shared characteristics
Categorical approaches – organises mental disorders into
categories, each with specific symptoms and characteristics.
Diagnosis involves a comparison of patients symptoms to the
listed symptoms within each category
Check your patients list against the lists in the DSM-IV to find a
fit – then make diagnosis
Dimensional approaches – classifies symptoms quantitatively
Diagnosis involves asking how much of a characteristic is
normal, numerical values are assigned to each characteristic
score
Measure all characteristics and the combination of scales that
are statistically extreme might point to the type of illness being
suffered
WHICH IS BEST?
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Often both are used
Categorical approach used to classify the
symptoms
Dimensional approach used to determine the
severity of these symptoms
CATEGORICAL APPROACHES
CATEGORICAL APPROACHES - ASSUMPTIONS
Assumes that mental disorders can be diagnosed
from specific symptoms reported by the patient or
observed by the professional
 Thoughts feelings and behaviours can be
categorised – certain categorisation relates to
specific disorders
 There are distinct sub categories within each
disorder
 All or nothing – they either have it or they don’t.
You cant kind of have schizophrenia
 The system must be valid and reliable
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THE DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS IV-R
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The system most widely used by mental health
professionals throughout the world to identify
and classify mental illnesses for the purposes of
diagnosis is the Diagnostic and Statistical
Manual of Mental Disorders, or the DSM as it is
more commonly called
An important feature of the DSM-IV-TR is that it
does not suggest causes of specific disorders
unless a cause can be definitely established
 It simply names the disorders and describes them
in specific terms
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DSM – IV - TR
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365 disorders comprehensively described (one for
every day of the year!)
Grouped into 16 categories
Diagnosis matches patient symptoms to the disorder
symptoms
Symptoms are considered characteristics of disorders
to looking at these enables diagnosis
Inclusion criteria – symptoms that must be present
for diagnosis
Exclusion criteria – symptoms that must not be
present
Polythetic criteria – only some symptoms not all
need to be present for diagnosis – eg. 3 0f the
following 8
Provides info on the typical course of the disorder
THE DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS IV-R
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Axis I: clinical disorders Symptoms that cause distress or significantly
impair social or occupational functioning (such as anxiety disorders,
depression)
Axis II: personality disorders and mental retardation Chronic and
enduring problems that generally persist throughout life and impair
interpersonal or occupational functioning (such as multiple personality
disorder)
Axis III: general medical condition Physical disorders that may be
relevant to understanding or treating a psychological disorder
Axis IV: psychosocial and environmental problems (such as
interpersonal stressors and negative life events) that may affect the
diagnosis, treatment and prognosis (prediction of the course of a disease) of
psychological disorders
Axis V: global assessment of functioning The individual's overall level of
functioning in social, occupational and leisure
ICD – 10
Diagnosis and classification of mental disorders
based on recognised symptoms
 Includes detailed description of each disorder listed
 Identifies symptoms that indicate the presence of a
disorder
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The original text covered all of medical practice
 Chapter V covered mental disorders
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Chapter V now printed as a separate book
 Less detailed than the DSM -IV
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STRENGTHS / WEAKNESSES
Allow diagnosis
 Help communication
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Historically low inter-reliability
 Much better now with DSM-IV-R 70% agreement
between mental health professionals
 Lots of overlap between symptoms can make
diagnosis difficult
 Stigma and labelling – Rosenham study!
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DIMENSIONAL APPROACHES
DIMENSIONAL APPROACHES
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A dimension viewed as a cluster of related
psychological/behavioural characteristics that occur
together
Quantifies persons symptoms and other
characteristics with numerical values
 These values are compared with the statistically
‘normal’ expected values for each characteristic
 Lower scores equate to lower impairment
 Higher scores equate to higher impairment
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THE MMPI
SCALES ON THE MMPI
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2.
3.
4.
5.
6.
7.
8.
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10.
Hs Hypochondriasis Concern with bodily symptoms
D Depression Depressive Symptoms
Hy Hysteria Awareness of problems and
vulnerabilities
Pd Psychopathic Deviate Conflict, struggle, anger,
respect for society's rules
MF Masculinity/Femininity Stereotypical masculine
or feminine interests/behaviors
Pa Paranoia Level of trust, suspiciousness,
sensitivity
Pt Psychasthenia Worry, Anxiety, tension, doubts,
obsessiveness
Sc Schizophrenia Odd thinking and social alienation
Ma Hypomania Level of excitability
Si Social Introversion People orientation
MMPI – THE T SCORES
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Asking how different is each score is from the
mean score
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Is the difference big enough to be significant?
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Statistical normality is the key here!
STRENGTHS / WEAKNESSES
Take into account a wider range of factors than
categorical approaches
 More detailed information on each symptom –
quantifying
 Reduced stigma as labelling not used instead a
profile is created
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There is no standard inventory to compare scores
to, thus diagnosis is difficult
 Time consuming
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