5.2
Concepts and diagnosis
 Examine
the concepts of normality and
abnormality.
 Discuss
 Discuss
validity and reliability of diagnosis.
cultural and ethical considerations in
diagnosis.
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Abnormal Psychology
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5.1 Introduction: What is abnormal psychology.
‘We all try to understand other people. Determining why another person does or feels
something is not easy to do. In fact, we do not always understand our own feelings and
behaviour. Figuring out why people behave in normal, expected ways is difficult
enough; understanding seemingly abnormal behaviour can be even more difficult’.1
‘Abnormal psychology is the branch of psychology that deals with studying, explaining
and treating ‘abnormal’ behaviour. Although there is obviously a great deal of
behaviour that could be considered abnormal, this branch of psychology deals mostly
with that which is addressed in a clinical context. In effect, this means a range of
behaviours, emotions and thinking that tend to result in an individual seeing a mental
health professional, such as a psychiatrist or a clinical psychologist.
Abnormal psychology attracts researchers who investigate the causes of abnormal
behaviour and try to find the most effective treatments for them, whether these involve
medication or talking cure or combination. There are also practitioners, psychologists
who use their knowledge of theory and research to deliver treatment to people in a
therapeutic setting.
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A large number of conditions occur commonly enough to be categorised systematically
within various cultures and, in some cases, across the world. The IB psychology syllabus
deals with only three groups:
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Anxiety disorders
Affective disorders
Eating disorders
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Defining these groups is straightforward because of the diagnostic systems available,
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The word normal usually refers to conformity
to standard or regular patterns of behaviour.
The concept of abnormality is essentially a
label applied to behaviour that does not
conform. Unfortunately, this explanation is
not very precise and it remains difficult for
mental health professionals to agree on who
is abnormal enough to require or deserve
treatment.
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Another way to decide what is abnormal is to assume that all
humans perform behaviours that are good for them in their
particular environment context.
Behaviours that threaten one’s ability to function well within the
social context can be considered maladaptive.
This approach works well when we consider such conditions such as
alcoholism and anorexia, where it is clear that a persons health is in
danger.
What else falls into this category? Discuss.
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Assumes average behaviour.
Experiences between two people very
subjective.
Statistically unusual behaviour is attributed to
mental illness, perhaps because assuming
that people are suffering from some sort of
psychiatric condition helps us understand the
strangeness of their behaviour.
Social norms are not necessarily related to statistical norms.
The expected behaviour is that which the rules of society and culture dictate is appropriate
for that context.
When people violate such rules, we have a tendency to assume there is something wrong
with them, and it is easy to attribute this to some kind of madness. However there are
three key problems with this approach.
First, social norms vary enormously across cultures and social institutions. (in your group
think of an example)
The second problem is historical variation. Past models of madness would now be
acceptable.
Thirdly, what is considered to be sociably acceptable or unacceptable has been established
by groups with social power. (In your groups discuss who in your society/culture,
makes the rules.
Think about behaviour you have seen in another culture that you think is strange, then
think about behaviour that is normal in your culture, but may seem strange by another.
Why is culture so important?
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The Diagnostic and Statistical Manual of Mental
Disorders. (DSM 1V)
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First published in 1952 and is constantly update. It
is currently in its 4th editition.
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The DSM groups disorders into categories and then
offers specific guidance to psychiatrists by listing
the symptoms required for a diagnosis to be given.
In your groups design a rubric to diagnose a
mental disorder
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According to the DSM-IV, a person who suffers from Major Depressive
Disorder must either have a depressed mood or a loss of interest or
pleasure in daily activities consistently for at least a two week period.
This mood must represent a change from the person's normal mood;
social, occupational, educational or other important functioning must
also be negatively impaired by the change in mood. A depressed mood
caused by substances (such as drugs, alcohol, medications) is not
considered Major Depressive Disorder, nor is one which is caused by a
general medical condition. Major Depressive Disorder cannot be
diagnosed if a person has a history of Manic, Hypomanic, or Mixed
Episodes (e.g., a Bipolar Disorder) or if the depressed mood is better
accounted for by Schizoaffective disorder and is not superimposed on
Schizophrenia, Schizophreniform Disorder, a Delusional Disorder or
Psychotic Disorder. Further, the symptoms are not better accounted for
by Bereavement (i.e., after the loss of a loved one) and the symptoms
persist for longer than two months or are characterized by marked
functional impairment, morbid preoccupation with worthlessness,
suicidal ideation, psychotic symptoms, or psychomotor retardation.
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This disorder is characterized by the presence of the majority of these symptoms:
Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad or empty) or observation made by others (e.g.,
appears tearful). (In children and adolescents, this may be characterized as an
irritable mood.)
Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day
Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month), or decrease or increase in appetite nearly
every day
Insomnia or hypersomnia nearly every day
psychomotor agitation or retardation nearly every day
fatigue or loss of energy nearly every day
feelings of worthlessness or excessive or inappropriate guilt nearly every day
diminished ability to think or concentrate, or indecisiveness, nearly every day
recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide.
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Definition:
Panic disorder is a type of anxiety disorder. To have a diagnosis of panic
disorder, you need to meet the following criteria.
First, you need to have experienced a panic attack. The DSM-IV
describes a panic attack as the experience of intense fear or discomfort
where four or more of the following are experienced:
pounding heart or increased heart rate
sweating
trembling or shaking
feeling as though you are being smothered or having trouble breathing
choking
chest pain/discomfort
nausea or abdominal pains and/or discomfort
feeling dizzy, lightheaded, or faint
feeling as though things around you are unreal or feeling detached from
yourself
feeling like you are going to lose control or go crazy
fear of dying
numbness or tingling in extremities
chills or hot flashes
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To have a diagnosis of panic disorder, you must
also have experienced recurrent unexpected
panic attacks. These are panic attacks that occur
"out of the blue," not triggered by anything in
your environment.
At least one of the attacks must be followed by
one month or more of one or more of the
following experiences:
Concern about having additional panic attacks
Worry about the consequences or implications of
a panic attack (e.g., concern that your are going
to die).
A change in behavior because of the attacks.
Panic disorder is a common condition.
Approximately 5% of people will develop panic
disorder at some point in their lifetime.
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The ICD 10 is more common and internationally used than
the DSM. It was originally intended by the World Health
Organisation to be a means of standardising recording of
cause of death. It covers a wider range of disorders. With
consultation and revision the differences between DSM and
ICD are becoming becoming fewer.
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The CCMD focused on Chinese culture.
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Diagnosis for Ego-dystonic homosexuality included.
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Eating disorders. Only reconised in western diagnosis.
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There are strong arguments that these systems are
not reliable and in some cases it is not valid to take
such a medical approach. For example is it ethical
to suggest that Ego-dystonic homosexuality is
considered a disorder and therefore can be treated.
Receiving a diagnosis can be a difficult experience
for some and a huge relief for others. It is
important to ask if the systems are reliable.
Two key forms of reliability are:
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Inter-rater reliability; assessed by asking more than one
practitioner to observe the same person, and using the same
diagnostic system, attempt to make a diagnosis.
One of the most famous studies was carried out by Nicholls
et al. Two practitioners from Great Ormond St London used
either the DSM1V or ICD 10 or the hospitals own (GOS) to
diagnose 81 children with eating disorders.
In groups discuss the data p,150.
Do diagnostic systems need to be culturally specific?
Gender specific?
Age specific?
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The key concern for diagnostic systems is whether they
correctly diagnose people who really have particular disorders
and do not give a diagnosis to people who do not.
Unfortunately, there is a circular logic involved here – it is
difficult to establish whether a person truly has a disorder
without using a diagnostic system
Workbook. Summerise validity issues by examining the work
of R.D Laing; Thomas Szasz. P150 Law et al
Examine: Labelling theory (Caetona 1973) What is normal
behaviour (Rosenham et al 1973) and Peters et al Criterian
related validity
Write a short paragraph to summerise the problems of validity
illustrated by the Caetano, Rosehan and Peters studies.
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