Defining Abnormality

• Abnormality is explored through behavioral and psychological perspectives, including an overview of the DSM.

Defining Abnormality

• Behaviour and mental processes exist on a continuum.
• Criteria to diagnose abnormality includes whether the behaviour is considered strange or odd within the person's culture.
• Other criteria to diagnose abnormality include whether the behaviour causes personal distress, is maladaptive, or poses a danger to self or others.
• Legal responsibility is also considered when diagnosing abnormality.
• Norms change so what is considered abnormal changes, which causes problems with definition and diagnosis.

Normal vs. Abnormal Behaviour

• Normality includes statistical infrequency which is how much a behavior deviates from the statistical norm.
• Normality includes social norms, which is how closely aligned the behaviour is with what is deemed accepted by society
• Harm affects normality if the behaviour causes stress, anxiety, unhappiness, or directly harms someone else without consent.
• Time and culture significantly shape what is considered "normal".

Abnormal Behaviour: A Psychological Perspective

• Biological factors include brain function, genetic predispositions, disease-producing microorganisms, and physical/chemical aspects of the environment.
• Psychological factors include early family life, learning experiences, and cognitive factors.
• Sociocultural factors include cultural views on "normal" and "abnormal" behavior, social roles, and expectations.
• Antisocial behaviors typically have a gradual onset, according to research.

Cumulative Development of Antisocial Behaviours

• Problem behaviors manifest from early childhood through adolescence, indicating continuity and diversification rather than replacement as age increases.

Scale of Disruptive Behavior Dimensions

• Meta-analysis of 44 published studies use a variety of sources.
• Variety of sources includes parents, teachers, peers, children themselves,
• Crimes may indicate a tendency of co-occurrence.
• Destructive versus nondestructive refers to the difference in inflicted harm, distress, or property damage.
• Covert versus overt refers to how easily proven the behaviour is and the ability to infer intent.

History of Abnormality

• The goal is to understand the history of diagnosis, perception, and treatment, and how abnormality is defined.
• Historically people with mental illness have been ostracized, abused, and neglected.

Medieval Beliefs

• Medieval belief was that mental illness was caused by demonic possession, witchcraft, or an angry god (Szasz, 1960).
• Abnormal behaviour was seen as a sign of demonic possession.
• Fixing abnormality meant releasing evil spirits.
• Exorcism involved religious figures using incantations and prayers to expel evil spirits.
• Trephining involved surgically creating a hole in the skull.
• Other methods included execution or imprisonment, and often led to death.

1700s Asylums

• In the 1700s, individuals considered "odd" or "unusual" were placed in asylums with the goal of separating rather than treating them.
• Asylums were cavernous, limited contact, and often involved abuse and neglect.

Late 1700s: Pinel's Reforms

• In the late 1700s, Philippe Pinel argued against isolation and advocated for humane treatment.
• Pinel unchained patients in a Paris asylum in 1795, leading to improved outcomes.

1800s: Dorothea Dix in the USA

• In the 1800s, Dorothea Dix discovered inhumane treatment in U.S. asylums also and pushed for reform.
• Dix advocated for better care and treatment, though this led to more asylums which were unkept, temperature controlled and often treatment rarely focused.

Mid-1900s: Antipsychotic Medications

• Antipsychotic medications were introduced as a new treatment option.
• The medications showed promise to treat psychosis, and were widely used within asylums (a diagnosis at the time), labelled those who experienced hallucinations and loss of reality.

Diagnostic and Statistical Manual of Mental Disorders (DSM)

• 1952: the first DSM publication occurred due to the need for classifying mental disorders throughout medical history.
• The DSM is an authoritative volume which is to improve diagnosis, treatment and research of mental disorders.

1963 Reform in the USA

• The "Mental Retardation Facilities and Community Mental Health Centers Construction Act" in 1963 led to deinstitutionalization.
• It resulted in community mental health centers that changed how mental health services were delivered.

Todays Goal

• Today, asylums are largely replaced by psychiatric hospitals that are publicly funded and aim for short-term stays and reintegration.
• Mental health centers are in communities across the USA and Canada, providing outpatient treatment and therapies combining efforts from teams of community members.
• Mental health still isn't and ideal system due to need of funding, training, public perception and stigma, quality of life, benefits of insurance, access, availability.

Brief History of the DSM

• The DSM is the original authoritative volume that defines and classifies mental disorders.

DSM-I (1952)

• The DSM-I was published by the American Psychiatric Association (APA).
• It had 130 pages and 106 disorders.
• It adopted a psychodynamic model.
• Mental illness was viewed as ego defense mechanisms, and it talks about neurosis reaction.

DSM-II (1968)

• The DSM-II was published in 1968.
• It had 134 pages and 182 disorders.
• Had broad descriptions, and no symptoms and includes inclusion of homosexuality (Freudian perspective)

DSM-III (1980)

• Released in 1980, and included 494 pages with 265 categories.
• Psychodynamic was finally replaced by the medical model
• Symptoms are guided by research diagnostic criteria.
• Has a famous study by Rosenhan included improvements of validity and uniformity of diagnoses, and the need for diagnoses to take place outside the mental hospitals

Rosenhan (1973) Influence

• Eight subjects, including Rosenhan, said that they "On being sane in insane places".
• They got themselves admitted to different mental hospitals across the US
• Rosenhan had patients say three symptoms only saying, “empty,” “hollow,” and “thud."
• Many were given the diagnosis of schizophrenia.
• Stays ranged from 7 to 52 days (M = 19).
• 35 of 118 real patients were suspicious.
• Patients were given over 2100 pills.

Rosenhan Study Aftermath

• It was later revealed that this study was flawed, so it was influential of diagnosis outside mental hospitals, and in thriving for the uniformity of diagnosis.

DSM-IV (1994)

• DSM-IV was released in 1994, with 886 pages containing 297 disorders.
• Over half the disorder categories included criterions like clinically significant distress, or impairment in social , occupational and other areas of functioning.
• Patients are no longer called by their disorder, and are referred to as someone with a disorder for example, "a person with schizophrenia" not "a schizophrenic"

DSM-IV-TR

• The DSM-IV was released with text revision in 2000.
• It included a multiaxial system: Axis I Clinical disorders, Axis II Personality disorders and Mental retardation, and Axis V Global assessment of functioning.
• Goals was to to rate patients and access patients across many areas, not just the distressing symptoms.

DSM-5 (2013)

• The DSM-5 includes 947 pages and 230 disorders, and was released in 2013.
• This publication had the first decrease of disorders in the DSM history.
• Has evidence based approach by basing material of current experimental findings, and not previous translation of DSM versions.
• Included some significant changes by ditching axial system, and included the schizophrenia spectrum disorder combines several types.

DSM-5-TR – Disorder Chapters

• Chapters of the DSM-5-TR are categorized by these disorders in order.
• These disorders include neurodevelopmental, schizophrenia (and "other"), bipolar (and related), depressive, anxiety, elimination, obsessive-compulsive (and related), trauma- and stressor-related, dissociative, somatic symptom (and related).
• These disorders also include: feeding and eating, sleep-wake, sexual dysfunctions, gender dysphoria, disruptive (impulse control and conduct), substance-related (and addictive).
• Other points include neurocognitive, personality, paraphilic, and medication-induced movement.

Alternative options to the DSM

• International Classification of Diseases (ICD)
• Published by the World Health Organization (WHO)
• The current version is the 10th revision

Conclusions

• Criminality must acknowledge current definitions, and description for these terms.