Abnormal Psychology Seventeenth Edition, Global Edition Jill M. Hooley | James N. Butcher Matthew K. Nock | Susan Mineka Lecture1 Abnormal Psychology: An Overview Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. WHAT IS ABNORMAL PSYCHOLOGY?? Understanding the nature, causes, and treatment of mental disorders Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. What Do We Mean by Abnormality? There is no consensus definition Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. There are some clear indicators of abnormality Indicators of Abnormality Subjective Distress Indicators of abnormality include: Maladaptiveness Statistical Deviancy Violation of the Standards of Society Social Discomfort Irrationality and Unpredictability Dangerousness Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Indicators of abnormalities • Subjective distress – Not a must – Could be a normal reaction • Maladaptiveness – Interferes with our well-being and with our ability to enjoy our work and our relationships • Statistical Deviancy – statistically rare ≠ abnormal/ problematic – statistically common ≠ normal Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Indicators of abnormalities • Violation of the Standards of Society – a behavior is most likely to be viewed as abnormal when it violates the standards of society and is statistically deviant or rare. • Parking violations VS Molesting a Child • Social Discomfort – when someone violates an implicit or unwritten social rule, those around him or her may experience a sense of discomfort or unease. • Irrationality and Unpredictability – a little unconventionality may add some spice to life, there is a point at which we are likely to consider a given unorthodox behavior abnormal – unpredictable, as it would make no sense to you • Dangerous – What about someone who engages in extreme sports or who has a dangerous hobby (such as free diving, race car driving, or keeping poison snakes as pet?) – Most MI patient are not dangerous Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Points to remember! Indicators of Abnormality No one element is sufficient to define or determine abnormality Culture plays a role in determining what is/is not abnormal Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Society is constantly shifting and becoming more or less tolerant of certain behaviors, what is considered abnormal or deviant in one decade may not be considered abnormal or deviant a decade or two later. Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. The DSM-5 • Diagnostic and Statistical Manual of Mental Disorders • Accepted standard for defining various types of mental disorders In the America • Developed by the American Psychiatric Association (APA) • revised and updated from time to time – Current version published in 2013 – 947 pages long and contains a total of 541 diagnostic categories – Research based Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Definition of mental disorder by DSM-5 • a syndrome that is present in an individual and that involves clinically significant disturbance in behavior, emotion regulation, or cognitive functioning. • These disturbances are thought to reflect a dysfunction in biological, psychological, or developmental processes that are necessary for mental functioning. • usually associated with significant distress or disability in key areas of functioning such as social, occupational, or other activities. • Predictable or culturally approved responses to common stressors or losses (such as death of a loved one) are excluded. • dysfunctional pattern of behavior not stem from social deviance or conflicts that the person has with society as a whole. Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. The DSM-5 Definition of Mental Disorder Clinically significant Biological, psychological, or disturbance in behavior, developmental dysfunction in emotional regulation, or individual MENTAL cognitive function DISORDER Associated with distress or disability Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. The DSM-5 Definition of Mental Disorder ICD-10 Another psychiatric classification system Developed by WHO Has similarities and differences with DSM-5 Used in U.S. and other countries Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. What Does It Mean to Have a Mental Disorder? Click to see video with closed captioning Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Classification and Diagnosis Classification Systems - Provide a naming system and common language - Allow information structuring - Facilitate research - Establish the range of problems to address Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Classification and Diagnosis Disadvantages of Classification - Loss of individual’s information (e.g. personal history) - Stigma and stereotyping associated with diagnosis - Self-concept impacted by diagnostic labeling (e.g. in remission) Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Problem of Objectivity “The decision to declare someone psychologically disordered or abnormal is always a judgment about behavior.” •“sane” people in an “insane” place •“evidence” to justify slavery – Drapetomania- a mania to seek freedom Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. A continuum Mental illness Continuum/ Normal variation Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Mental health How Can We Reduce Prejudicial Attitudes Toward People Who Are Mentally Ill? Negative reactions are widespread global phenomena Understanding of neurobiological basis does not lessen stigma Contact with individuals does not lessen stigma Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Culture and Abnormality Cultural factors influence • Presentation of disorders found worldwide • Certain forms of highly culture-specific psychopathology Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Culture-Specific Disorders Taijin kyofusho in Japan Certain forms of psychopathology highly specific to certain cultures Examples Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Ataque de nervios in Latinos and Latinas especially from the Caribbean How Common Are Mental Disorders? Planning, establishing, and funding mental health services for specific disorders Significant question for many reasons Providing clues to causes of mental disorders Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Prevalence and Incidence Epidemiology • Study of distribution of diseases, disorders, or healthrelated behaviors in a given population Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Prevalence and Incidence Number of active cases in population during any given period of time Prevalence Typically expressed as percentages Different types of prevalence estimates (point, 1-year, lifetime) Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Prevalence and Incidence Number of new cases in population over given period of time Incidence Incidence figures are typically lower than prevalence figures Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Prevalence Estimates for Mental Disorders Lifetime prevalence: 46.4% (DSM Disorders) Most prevalent category: anxiety disorders, followed by mood disorders Most common individual disorders :major depressive disorder, alcohol abuse, phobias, and conduct disorder Comorbidity Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. How Common is Mental Disorder? Information from World Health Organization ….. Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Some Facts …. (WHO 2023) • Mental disorders such as depression are among the 20 leading causes of disability worldwide • 280 million people in the world have depression • Worldwide, more than 10% of pregnant women and women who have just given birth experience depression • More than 700 000 people die due to suicide every year. • Suicide is the fourth leading cause of death in 15–29-year-olds. Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. More Facts … Some Figures (2011) • Major Depressive Disorder – 280 million (121M in 2011) • Schizophrenia – 24 million people or 1 in 300 people • Dementia – 55 million Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Global Burden of Disease study • The burden of mental illness on health and productivity • Mental illness, including suicide, accounts for over 15 percent of the burden of disease in established market economies, such as the United States • More than the disease burden caused by all cancers Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Figure 1.2 The Burden of Mental Illness for Different Disorders Across the Lifespan Disability adjusted life years (DALYs) for various mental and substance use disorders are shown according to age. DALYs represent the total (worldwide) number of otherwise healthy years of life that are lost or profoundly impacted because of the disorder. Depression causes the greatest total disability. This is because depression is a relatively common disorder. (Adapted from Whiteford et al., 2013. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet, 382, 1580.) Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. In the United States … • An estimated 26.2% of adults (about 1 in 4) suffer from a diagnosable mental disorder in a given year • Main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness • Mental disorders are the leading cause of disability in the U.S. and Canada for ages 1544 (source of information – National Institute of Mental Health) Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. 3 3 Stigmatization-Mind.org.hk • 71% survey respondents were unwilling to live with mental health sufferers, with 1 in 3 even willing to end friendships with those diagnosed with mental illness. • 41% consider “lack of self-discipline and willpower” a main cause of mental illness. • More than half believe they will be penalized at work for talking about their mental health challenges. • 55% have experienced stigma or know someone who experiences stigma. Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. 3 4 Shortage of mental health professionals • • • • • • The number of public sector psychiatrists per 100,000 people is 4.8 for Hong Kong, versus 8.59 for high-income countries. With less than 400 psychiatric doctors, Hong Kong has half the number recommended by the World Health Organisation for our population size. From 2011/12 to 2015/16, the number of Hospital Authority psychiatric patients increased by 22%, but psychiatric staff increased only 13%, with the number of psychiatrists in particular increasing only 3% and psychiatric hospital bed count remaining unchanged. Currently, there is a total number of 25,671 registered social workers , 603 clinical psychologists registered under Hong Kong Psychological Society, and a total of 422 psychiatrists including both public and private sector registered under the Medical Council of Hong Kong. Patients’ wait time to see a psychiatrist can be up to almost 2 years, and each appointment lasts on average only 6-8 minutes. 60% of Hong Kong adults do not know where to seek help regarding mental health outside of hospitals. Low-income families are often unable to afford unsubsidised health as the cost of private sector psychiatric consultations ranges from $790 to $3,000. Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Treatment Not all people receive treatment Vast majority of treatment is done on outpatient basis Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Inpatient hospitalization typically in psychiatric units Mental Health Professionals Diagnosis and assessment involves participants who • Play differing roles in the process • Gather comprehensive evaluation patient data Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Types of Mental Health Professionals How many can you name? Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Mental Hospital Care in the Twentieth Century 1940: most mental hospitals inhumane and ineffective 1946: National Institutes of Mental Health 1946: Ward published The Snake Pit Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. 1963: Community Health Services Act 1946: Hill– Burton Act Mental Hospital Care in the Twentieth Century Deinstitutionalization Movement Large numbers of mental hospital closures and shift to communitybased residences Global movement: Asia, Europe, U.S. Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Considered more humane and cost effective Created problems for both patients and society as a whole From the asylum to prison: rethinking the incarceration revolution Bernard Harcourt Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. 257/780 Washington Post 2015 Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. The Emergence of Contemporary Views of Abnormal Behavior Recent changes • Biological discoveries • Development of mental disorders classification system • Emergence of psychological causation views • Experimental psychological research developments Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Establishing the Link Between the Brain and Mental Disorder Biological and anatomical factors recognized as underlying both physical and mental disorders Cure for general paresis (syphilis of the brain) Mental disorders an illness based on brain pathology • Raised hopes that organic bases would be found for many other mental disorders • Downside: removal of body parts, lobotomies Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Development of the Psychological Basis of Mental Disorder Freud’s psychoanalytic perspective • Comprehensive theory of psychopathology • Emphasis on inner dynamics of unconscious motives (psychodynamics) • Ancestral roots the study of hypnosis Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Development of the Psychological Basis of Mental Disorder Biological Approaches • Assume that psychological disturbances are directly attributable to underlying biological factors Psychological Approaches • Focus causal role of psychological or social factors in development of psychopathology Psychological Approaches • • • • Psychodynamic Behavioral Cognitive Sociocultural Copyright © 2017 Pearson Education, Ltd. All Rights Reserved. Psychological Approaches (i) The psychodynamic model, – (a) Symptoms are rooted in unconscious conflict (between the id and superego). – (b) Defense mechanisms (e.g., repression, denial) are reflexively or unconsciously employed to avoid pain caused by conflicting motives and anxieties. (ii) Behavioral theorists describe abnormal behaviors as being acquired in the same manner as normal behaviors, through learning (e.g., reinforcement). – (a) Symptoms and maladaptive behavior may be maintained by current conditions and reinforcers. – (b) Both classical and operant conditioning models are used to understand the processes that can result in maladaptive behavior. (iii) Cognitive perspectives often refine behaviorist views. – (a) It is important to consider how the individual perceives himself, or sees one’s relations with others and the environment. – (b) Problems result from distortions in perceptions of the reality of a situation. (iv) The sociocultural perspective emphasizes the role culture plays in both the etiology and the diagnosis or labeling of abnormal behavior. Copyright © 2017 Pearson Education, Ltd. All Rights Reserved.
