Abnormal Psychology 9th Edition Book PDF

ABNORMAL PSYCHOLOGY Clinical Perspectives on Psychological Disorders NINTH EDITION SUSAN KRAUSS WHITBOURNE University of Massachusetts Boston ABNORMAL PSYCHOLOGY: CLINICAL PERSPECTIVES ON PSYCHOLOGICAL DISORDERS, NINTH EDITION Published by McGraw-Hill Education, 2 Penn Plaza, New...

ABNORMAL PSYCHOLOGY Clinical Perspectives on Psychological Disorders NINTH EDITION SUSAN KRAUSS WHITBOURNE University of Massachusetts Boston ABNORMAL PSYCHOLOGY: CLINICAL PERSPECTIVES ON PSYCHOLOGICAL DISORDERS, NINTH EDITION Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2020 by McGraw-Hill Education. All rights reserved. Printed in the United States of America. Previous editions © 2017, 2014, and 2013. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of McGraw-Hill Education, including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning. Some ancillaries, including electronic and print components, may not be available to customers outside the United States. This book is printed on acid-free paper. 1 2 3 4 5 6 7 8 9 LWI 22 21 20 19 ISBN 978-1-260-50019-6 (bound edition) MHID 1-260-50019-5 (bound edition) ISBN 978-1-260-07668-4 (loose-leaf edition) MHID 1-260-07668-7 (loose-leaf edition) Portfolio Manager: Ryan Treat Product Development Manager: Dawn Groundwater Senior Marketing Manager: AJ Laferrera Lead Content Project Manager: Jodi Banowetz, Sandy Wille Content Project Manager: Ryan Warczynski, Sandra Schnee Senior Buyer: Sandy Ludovissy Senior Designer: Matt Backhaus Content Licensing Specialists: Traci Vaske Cover Image: ©martin-dm/E+/Getty Images Compositor: Lumina Datamatics, Inc. Library of Congress Cataloging-in-Publication Data Names: Whitbourne, Susan Krauss, author. Title: Abnormal psychology : clinical perspectives on psychological disorders / Susan Krauss Whitbourne, University of Massachusetts Boston. Description: Ninth edition. | New York, NY : MHE, | Includes bibliographical references and indexes. Identifiers: LCCN 2018048679 | ISBN 9781260500196 (alk. paper) Subjects: LCSH: Psychology, Pathological. | Mental illness. Classification: LCC RC454.H334 2020 | DDC 616.89—dc23 LC record available at https://lccn.loc.gov/2018048679 The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website does not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill Education does not guarantee the accuracy of the information presented at these sites. mheducation.com/highered To my wonderful, and growing, family: Richard, Stacey, Jenny, Taylor, Erik, Teddy, and Scarlett  ABOUT THE AUTHOR Susan Krauss Whitbourne is professor emerita of Psychological and Brain Sciences at the University of Massachusetts Amherst, and adjunct professor of Gerontology at University of Massachusetts Boston. She has taught large undergraduate classes in addition to teaching and supervising doctoral students in developmental and clinical psychology. Her clinical experience has covered both inpatient and outpatient settings. Professor Whitbourne is a Fellow of the American Psychological Association. Professor Whitbourne received her PhD from Columbia University and has a Diplomate in Geropsychology from the American Board of Professional Psychology. She taught at the State University of New York at Geneseo and the University of Rochester prior to moving to the University of Massachusetts Amherst, where she received the university’s Distinguished Teaching Award, the Outstanding Advising Award, and the College of Arts and Sciences Outstanding Teacher Award. In 2001, she received the Psi Chi Eastern Region Faculty Advisor Award, and in 2002, the Florence Denmark Psi Chi National Advisor Award. In 2003, she received both the APA Division 20 and Gerontological Society of America Mentoring Awards. In 2018, she was recognized as a Psi Chi Distinguished Member. As the departmental honors coordinator from 1990–2010, Professor Whitbourne was also the Psi Chi faculty advisor from 1990 through 2017, and the director of the Office ©Noah Berg of National Scholarship Advisement in the Commonwealth Honors College from 1999 through 2017. The author of 18 books and over 170 journal articles and book chapters, Professor Whitbourne is regarded as an expert on personality development in middle and late life. She is immediate past president of the Eastern Psychological Association and past chair of the Behavioral and Social Sciences Section of the Gerontological Society of America and was a member of the APA Board of Educational Affairs. She serves as APA Council Representative to Division 20 (Adult Development and Aging), having also served as Division 20 president. She is a fellow of APA’s Divisions 20, 1 (General Psychology), 2 (Teaching of Psychology), 9 (Society for the Psychological Study of Social Issues), 12 (Clinical Psychology), and 35 (Society for the Psychology of Women). In 2018, Professor Whitbourne was nominated for president-elect of APA. She is also a member of the Board of Directors of the Massachusetts Psychological Association, where she also chairs the Nominations and Governance Committee. Professor Whitbourne served as an item writer for the Educational Testing Service, was a member of APA’s High School Curriculum National Standards Advisory Panel, wrote the APA High School Curriculum Guidelines for Life-Span Developmental Psychology, and serves as an item writer for the Examination for Professional Practice of Psychology. Her 2010 book, The Search for Fulfillment, was nominated for an APA William James Award. In 2011, she was recognized with a Presidential Citation from APA. In addition to her academic writing, she writes a highly popular blog on Psychology Today entitled “Fulfillment at Any Age” and has appeared on numerous media outlets, including NBC Dateline and Today Show, AM Canada, and CNN. iv  ABOUT THE CONTRIBUTOR Jennifer L. O’Brien is a staff psychologist at the Massachusetts Institute of Technology’s Mental Health and Counseling Service, providing psychotherapy to undergraduate and graduate students who present with a broad range of psychological concerns. In addition to her clinical role at MIT, Dr. O’Brien supervises clinical psychology trainees and serves on the MIT Medical Gender & Sexuality care team. Dr. O’Brien specializes in treating mood and anxiety disorders and has expertise in working with the LGBTQ+ population. Dr. O’Brien received her PhD in clinical psychology from American University in Washington, D.C. Her dissertation, “Empathic Accuracy and Compassion Fatigue in Therapist Trainees,” is published in Professional Psychology: Research and Practice. She completed her predoctoral internship at the Durham VA Medical Center in Durham, NC, and postdoctoral fellowship at the VA Boston Healthcare System, where she worked with military veterans and received extensive training in providing evidence-based treat- ments for depression, anxiety, PTSD, and substance abuse. In addition to her clinical expertise, Dr. O’Brien has published manuscripts on topics such as gender and aging, and has served as editor on peer-reviewed journals. Dr. O’Brien previously contributed to the seventh and eighth editions of Abnormal Psychology: Clinical Perspectives on Psychological Disorders. Courtesy of Jennifer O’Brien v This page intentionally left blank  BRIEF CONTENTS Preface xvi 1 Overview to Understanding Abnormal Behavior 2 2 Diagnosis and Treatment 28 3 Assessment 50 4 Theoretical Perspectives 76 5 Neurodevelopmental Disorders 112 6 Schizophrenia Spectrum and Other Psychotic Disorders 144 7 Depressive and Bipolar Disorders 170 8 Anxiety, Obsessive-Compulsive, and Trauma- and Stressor-Related Disorders 194 9 Dissociative and Somatic Symptom Disorders 224 10 Feeding and Eating Disorders; Elimination Disorders; Sleep- Wake Disorders; and Disruptive, Impulse-Control, and Conduct Disorders 246 11 Paraphilic Disorders, Sexual Dysfunctions, and Gender Dysphoria 268 12 Substance-Related and Addictive Disorders 294 13 Neurocognitive Disorders 326 14 Personality Disorders 350 15 Ethical and Legal Issues 374 McGraw-Hill Education Psychology’s APA Documentation Style Guide Glossary G-1 References R-1 Name Index I-1 Subject Index I-11 vii  CONTENTS Preface xvi Return to the Case: Rebecca Hasbrouck 26 SUMMARY 26 CHAPTER 1 KEY TERMS 27 Overview to Understanding Abnormal CHAPTER 2 Behavior 2 Diagnosis and Treatment 28 Case Report: Rebecca Hasbrouck 3 Case Report: Pedro Padilla 29 1.1 What Is Abnormal Behavior? 4 1.2 The Social Impact of Psychological Disorders 5 2.1 Psychological Disorder: Experiences of Client and 1.3 Defining Abnormality 6 Clinician 30 WHAT’S IN THE DSM-5: Definition of The Client 30 a Mental Disorder 8 The Clinician 31 1.4 What Causes Abnormal Behavior? 8 2.2 The Diagnostic Process 31 Biological Contributions 8 Diagnostic and Statistical Manual (DSM-5) 32 Psychological Contributions 9 Additional Diagnostic Information 34 Sociocultural Contributions 9 WHAT’S IN THE DSM-5: Changes in the The Biopsychosocial Perspective 9 DSM-5 Structure 35 1.5 Prominent Themes in Abnormal Psychology Cultural Concepts of Distress 36 Throughout History 10 2.3 Steps in the Diagnostic Process 37 Spiritual Approach 11 Diagnostic Procedures 37 Humanitarian Approach 12 Case Formulation 38 Scientific Approach 15 Cultural Formulation 38 1.6 Research Methods in Abnormal Psychology 16 2.4 Planning the Treatment 39 1.7 Experimental Design 16 Goals of Treatment 40 1.8 Correlational Design 18 Treatment Site 40 YOU BE THE JUDGE: Being Sane in Insane Psychiatric Hospitals 40 Places 19 Specialized Inpatient Treatment Centers 41 1.9 Types of Research Studies 20 Outpatient Treatment 41 Halfway Houses and Day Treatment Programs 41 Survey 20 Other Treatment Sites 42 Laboratory Studies 21 Modality of Treatment 42 The Case Study 21 YOU BE THE JUDGE: Psychologists as REAL STORIES: Vincent van Gogh: Prescribers 43 Psychosis 22 Determining the Best Approach to Treatment 44 Single Case Experimental Design 23 2.5 The Course of Treatment 44 Research in Behavioral Genetics 23 The Clinician’s Role in Treatment 44 Bringing It All Together: Clinical Perspectives 25 The Client’s Role in Treatment 44 viii REAL STORIES: Daniel Johnston: Bipolar CHAPTER 4 Disorder 45 Theoretical 2.6 The Outcome of Treatment 46 Perspectives 76 Return to the Case: Pedro Padilla 47 Case Report: Meera Krishnan 77 SUMMARY 47 KEY TERMS 48 4.1 Theoretical Perspectives in Abnormal Psychology 78 CHAPTER 3 4.2 Biological Perspective 78 Assessment 50 Theories 78 Role of the Nervous System 78 Case Report: Ben Role of Genetics 78 Robsham 51 Treatment 83 3.1 Characteristics of 4.3 Trait Theory 86 Psychological Assessments 52 WHAT’S IN THE DSM-5: Theoretical 3.2 Clinical Interview 53 Approaches 88 3.3 Mental Status 4.4 Psychodynamic Perspective 88 Examination 55 Freud’s Theory 88 3.4 Intelligence Testing 56 Post-Freudian Psychodynamic Views 91 Stanford-Binet Intelligence Test 57 Treatment 93 Wechsler Intelligence Scales 57 4.5 Behavioral Perspective 94 3.5 Personality Testing 60 Theories 94 Self-Report Tests 60 Projective Testing 63 YOU BE THE JUDGE: Evidence-Based Practice 95 REAL STORIES: Ludwig van Beethoven: Bipolar Disorder 66 Treatment 96 4.6 Cognitive Perspective 97 3.6 Behavioral Assessment 67 Theories 97 3.7 Multicultural Assessment 67 Treatment 98 3.8 Neuropsychological Assessment 68 4.7 Humanistic Perspective 99 WHAT’S IN THE DSM-5: Section 3 Assessment Measures 69 Theories 99 Treatment 100 YOU BE THE JUDGE: Psychologists in the Legal System 71 4.8 Sociocultural Perspective 102 3.9 Neuroimaging 72 Theories 102 3.10 Putting It All Together 74 Treatment 103 Return to the Case: Ben Robsham 74 REAL STORIES: Sylvia Plath: Major Depressive Disorder 104 SUMMARY 74 4.9 Acceptance-­Based Perspective 106 KEY TERMS 75 Theories 106 Treatment 106 ix 4.10 Biopsychosocial Perspectives on Theories and 5.6 Neurodevelopmental Disorders: The Biopsychosocial Treatments: An Integrative Approach 107 Perspective 140 Return to the Case: Meera Krishnan 108 Return to the Case: Jason Newman 141 SUMMARY 108 SUMMARY 141 KEY TERMS 109 KEY TERMS 142 CHAPTER 5 CHAPTER 6 Neurodevelopmental Schizophrenia Disorders 112 Spectrum and Case Report: Jason Other Psychotic Newman 113 Disorders 144 5.1 Intellectual Disability (Intellectual Developmental Case Report: David Disorder) 115 Chen 145 Causes of Intellectual Disability 116 6.1 Schizophrenia 147 Genetic Abnormalities 116 WHAT’S IN THE WHAT’S IN THE DSM-5: Neurodevelopmental DSM-5: Schizophrenia Subtypes and Dimensional Disorders 118 Ratings 151 Environmental Hazards 119 Course of Schizophrenia 153 Treatment of Intellectual Disability 120 YOU BE THE JUDGE: Schizophrenia Diagnosis 153 5.2 Autism Spectrum Disorder 121 6.2 Brief Psychotic Disorder 154 Theories and Treatment of Autism Spectrum Disorder 123 6.3 Schizophreniform Disorder 155 Rett Syndrome 125 6.4 Schizoaffective Disorder 155 High-Functioning Autism Spectrum Disorder, Formerly Called Asperger’s Disorder 126 6.5 Delusional Disorders 156 REAL STORIES: Daniel Tammet: Autism 6.6 Theories and Treatment of Schizophrenia 157 Spectrum Disorder 127 Biological Perspectives 157 5.3 Learning and Communication Disorders 128 Theories 157 Specific Learning Disorder 128 REAL STORIES: Elyn Saks: Schizophrenia 159 Training in Job Skills for Young Adults with Learning Disabilities 130 Treatments 160 Communication Disorders 131 Psychological Perspectives 161 5.4 Attention-Deficit/Hyperactivity Disorder (ADHD) 131 Theories 161 ADHD in Adults 133 Treatments 163 Theories and Treatment of ADHD 134 Sociocultural Perspectives 163 Theories 163 YOU BE THE JUDGE: Prescribing Psychiatric Medications to Children 136 Treatments 166 6.7 Schizophrenia: The Biopsychosocial 5.5 Motor Disorders 138 Perspective 167 Developmental Coordination Disorder 138 Return to the Case: David Chen 167 Tic Disorders 139 SUMMARY 167 Stereotypic Movement Disorder 140 KEY TERMS 169 x CHAPTER 7 CHAPTER 8 Depressive and Bipolar Anxiety, Obsessive- Disorders 170 Compulsive, and Case Report: Janice Trauma- and Butterfield 171 Stressor-Related Disorders 194 7.1 Depressive Disorders 172 Major Depressive Disorder 172 Case Report: Barbara Wilder 195 Persistent Depressive Disorder (Dysthymia) 174 8.1 Anxiety Disorders 196 Disruptive Mood Dysregulation Disorder 174 Separation Anxiety Disorder 197 Premenstrual Dysphoric Disorder 175 Theories and Treatment of Separation Anxiety Disorder 197 7.2 Disorders Involving Alterations Selective Mutism 198 in Mood 175 Specific Phobias 199 Bipolar Disorder 175 Theories and Treatment of Specific Phobias 199 REAL STORIES: Carrie Fisher: Bipolar Social Anxiety Disorder 201 Disorder 176 WHAT’S IN THE DSM-5: Definition and Cyclothymic Disorder 179 Categorization of Anxiety Disorders 202 7.3 Theories and Treatment of Depressive and Bipolar Theories and Treatment of Social Anxiety Disorder 202 Disorders 179 Panic Disorder and Agoraphobia 203 Biological Perspectives 179 Panic Disorder 203 Biological Theories 179 Agoraphobia 203 Antidepressant Medications 180 Theories and Treatment of Panic Disorder and Agoraphobia 204 WHAT’S IN THE DSM-5: Depressive and Generalized Anxiety Disorder 205 Bipolar Disorders 182 Theories and Treatment of Generalized Anxiety Bipolar Medications 182 Disorder 206 Alternative Biologically Based Treatments 183 8.2 Obsessive-Compulsive and Related Psychological Perspectives 184 Disorders 207 Psychodynamic Approaches 184 Theories and Treatment of Obsessive-Compulsive Disorder 207 Behavioral and Cognitive-Behavioral Approaches 184 Interpersonal Approaches 186 Body Dysmorphic Disorder 209 Sociocultural Perspectives 188 REAL STORIES: Howie Mandel: Obsessive- Compulsive Disorder 210 7.4 Suicide 188 YOU BE THE JUDGE: Do-Not-Resuscitate YOU BE THE JUDGE: Psychosurgery 211 Orders for Suicidal Patients 190 Hoarding Disorder 213 7.5 Depressive and Bipolar Disorders: The Biopsychosocial Trichotillomania (Hair-Pulling Disorder) 214 Perspective 191 Excoriation (Skin-Picking) Disorder 216 Return to the Case: Janice Butterfield 191 8.3 Trauma- and Stressor-Related Disorders 216 SUMMARY 192 Reactive Attachment Disorder and Disinhibited Social KEY TERMS 193 Engagement Disorder 216 xi Acute Stress Disorder and Post-Traumatic Stress Personality Style 241 Disorder 217 Applications to Behavioral Medicine 242 Theories and Treatment of Post-Traumatic Stress Disorder 218 9.4 Dissociative and Somatic Symptom Disorders: The Biopsychosocial Perspective 243 8.4 Anxiety, Obsessive-Compulsive, and Trauma- and Stressor-Related Disorders: The Biopsychosocial Return to the Case: Rose Marston 243 Perspective 220 SUMMARY 244 Return to the Case: Barbara Wilder 221 KEY TERMS 245 SUMMARY 221 KEY TERMS 223 CHAPTER 10 Feeding and Eating CHAPTER 9 Disorders; Elimination Dissociative and Disorders; Sleep- Somatic Symptom Wake Disorders; Disorders 224 and Disruptive, Impulse-Control, and Case Report: Rose Conduct Disorders 246 Marston 225 Case Report: Rosa Nomirez 247 9.1 Dissociative Disorders 226 10.1 Eating Disorders 248 Major Forms of Dissociative Disorders 226 Characteristics of Anorexia Nervosa 249 Theories and Treatment of Dissociative Disorders 227 REAL STORIES: Portia de Rossi: Anorexia REAL STORIES: Herschel Walker: Dissociative Nervosa and Bulimia Nervosa 250 Identity Disorder 228 Characteristics of Bulimia Nervosa 251 YOU BE THE JUDGE: Dissociative Identity Disorder 230 Binge-Eating Disorder 253 Theories and Treatment of Eating Disorders 253 9.2 Somatic Symptom and Related Disorders 232 Avoidant/Restrictive Food Intake Disorder 254 Somatic Symptom Disorder 232 Eating Disorders Associated with Childhood 255 Illness Anxiety Disorder 233 WHAT’S IN THE DSM-5: Reclassifying Eating, Conversion Disorder (Functional Neurological Symptom Disorder) 233 Elimination, Sleep-Wake, and Disruptive, Impulse- Control, and Conduct Disorders 255 Conditions Related to Somatic Symptom Disorders 234 10.2 Elimination Disorders 256 Theories and Treatment of Somatic Symptom and Related Disorders 235 10.3 Sleep-Wake Disorders 256 WHAT’S IN THE DSM-5: Somatic Symptom 10.4 Disruptive, Impulse-Control, and Conduct and Related Disorders 236 Disorders 259 Oppositional Defiant Disorder 259 9.3 Psychological Factors Affecting Other Medical Conditions 237 Intermittent Explosive Disorder 259 Relevant Concepts for Understanding Psychological Factors Conduct Disorder 261 Affecting Other Medical Conditions 237 Impulse-Control Disorders 262 Stress and Coping 237 Pyromania 262 Emotional Expression 240 Kleptomania 262 xii YOU BE THE JUDGE: Legal Implications of REAL STORIES: Sue William Silverman: Sex Impulse-Control Disorders 263 Addiction 287 10.5 Eating, Elimination, Sleep-Wake, and Impulse- 11.4 Gender Dysphoria 288 Control Disorder: The Biopsychosocial Theories and Treatment of Gender Dysphoria 289 Perspective 264 11.5 Paraphilic Disorders, Sexual Dysfunctions, and Gender Return to the Case: Rosa Nomirez 265 Dysphoria: The Biopsychosocial Perspective 290 SUMMARY 265 Return to the Case: Shaun Boyden 290 KEY TERMS 266 SUMMARY 291 CHAPTER 11 KEY TERMS 292 Paraphilic Disorders, CHAPTER 12 Sexual Dysfunctions, Substance-Related and Gender Dysphoria 268 and Addictive Case Report: Shaun Boyden 269 Disorders 294 11.1 What Patterns of Sexual Behavior Represent Case Report: Carl Psychological Disorders? 270 Wadsworth 295 11.2 Paraphilic Disorders 272 12.1 Key Features of Substance Disorders 297 Pedophilic Disorder 273 WHAT’S IN THE DSM-5: Combining Abuse Exhibitionistic Disorder 274 and Dependence 297 Voyeuristic Disorder 274 12.2 Disorders Associated with Specific Substances 298 Fetishistic Disorder 275 Alcohol 300 Frotteuristic Disorder 275 Theories and Treatment of Alcohol Use Disorders 302 Sexual Masochism and Sexual Sadism Disorders 276 Biological Perspectives 302 Transvestic Disorder 276 Psychological Perspectives 303 Sociocultural Perspective 305 Theories and Treatment of Paraphilic Disorders 277 Biological Perspectives 278 Stimulants 306 Psychological Perspectives 278 Amphetamines 306 Cocaine 307 YOU BE THE JUDGE: Treatment for Sex Offenders 279 Cannabis 308 Hallucinogens 310 11.3 Sexual Dysfunctions 280 Opioids 313 Arousal Disorders 281 YOU BE THE JUDGE: Prescribing Prescription Disorders Involving Orgasm 282 Drugs 314 WHAT’S IN THE DSM-5: The Reorganization of Sexual Disorders 284 Sedatives, Hypnotics, and Anxiolytics 315 Caffeine 315 Disorders Involving Pain 284 Tobacco 316 Theories and Treatment of Sexual Dysfunctions 284 Biological Perspectives 284 Inhalants 316 Psychological Perspectives 286 Theories and Treatment of Substance Use Disorders 317 Biological Perspectives 317 xiii REAL STORIES: Robert Downey Jr.: Substance 13.7 Neurocognitive Disorders Due to Another General Use Disorder 318 Medical Condition 346 Psychological Perspectives 319 13.8 Neurocognitive Disorders: The Biopsychosocial Perspective 347 12.3 Non-Substance-Related Disorders 319 Gambling Disorder 319 Return to the Case: Irene Heller 347 SUMMARY 348 Other Non-Substance-Related Disorders 322 KEY TERMS 349 12.4 Substance Disorders: The Biopsychosocial Perspective 322 Return to the Case: Carl Wadsworth 323 CHAPTER 14 SUMMARY 323 Personality KEY TERMS 324 Disorders 350 Case Report: Harold CHAPTER 13 Morrill 351 Neurocognitive 14.1 The Nature of Personality Disorders 326 Disorders 352 Personality Disorders in DSM-5 353 Case Report: Irene Heller 327 WHAT’S IN THE DSM-5: Dimensionalizing the Personality 13.1 Characteristics of Neurocognitive Disorders 328 Disorders 353 13.2 Delirium 329 Alternative Personality Disorder Diagnostic System in Section 3 13.3 Neurocognitive Disorder Due to Alzheimer’s of the DSM-5 354 Disease 331 14.2 Cluster A Personality Disorders 355 Prevalence of Alzheimer’s Disease 332 Paranoid Personality Disorder 356 WHAT’S IN THE DSM-5: Recategorization of Schizoid Personality Disorder 356 Neurocognitive Disorders 333 Schizotypal Personality Disorder 357 Stages of Alzheimer’s Disease 333 14.3 Cluster B Personality Disorders 358 Diagnosis of Alzheimer’s Disease 333 Antisocial Personality Disorder 358 Theories and Treatment of Alzheimer’s Disease 336 YOU BE THE JUDGE: Antisocial Personality Theories 336 Disorder and Moral Culpability 359 YOU BE THE JUDGE: Early Diagnosis of Alzheimer’s Disease 337 REAL STORIES: Ted Bundy: Antisocial Personality Disorder 360 Treatment 339 Borderline Personality Disorder 361 REAL STORIES: Ronald Reagan: Alzheimer’s Disease 341 Histrionic Personality Disorder 364 13.4 Neurocognitive Disorders Due to Neurological Narcissistic Personality Disorder 365 Disorders Other than Alzheimer’s Disease 342 14.4 Cluster C Personality Disorders 367 13.5 Neurocognitive Disorder Due to Traumatic Brain Avoidant Personality Disorder 367 Injury 344 Dependent Personality Disorder 368 13.6 Neurocognitive Disorders Due to Substances/ Medications and HIV Infection 346 Obsessive-Compulsive Personality Disorder 369 xiv 14.5 Personality Disorders: The Biopsychosocial Commitment of Clients 388 Perspective 371 Right to Treatment 389 Return to the Case: Harold Morrill 371 Refusal of Treatment and Least Restrictive Alternative 390 SUMMARY 372 15.3 Forensic Issues in Psychological Treatment 391 KEY TERMS 373 The Insanity Defense 391 REAL STORIES: Susanna Kaysen: Involuntary CHAPTER 15 Commitment 392 Ethical and Legal Competency to Stand Trial 395 Issues 374 Understanding the Purpose of Punishment 395 Case Report: Allison Concluding Perspectives on Forensic Issues 396 Yang 375 Return to the Case: Allison Yang 396 15.1 Ethical Standards 376 SUMMARY 397 WHAT’S IN THE DSM-5: Ethical Implications KEY TERMS 397 of the New Diagnostic System 378 Competence 378 McGraw-Hill Education Informed Consent 380 Psychology’s APA Documentation Style Confidentiality 381 Guide Relationships with Clients, Students, and Research Collaborators 386 Glossary G-1 YOU BE THE JUDGE: Multiple Relationships References R-1 Between Clients and Psychologists 386 Name Index I-1 Record Keeping 387 Subject Index I-11 15.2 Ethical and Legal Issues in Providing Services 388 xv  PREFACE With its case-based approach, Abnormal Psychology: Better Data, Smarter Revision, Improved Clinical Perspectives on Psychological Disorders helps students Results understand the human side of psychological disorders. The Ninth Edition ties concepts together with an integrated, For this new edition, data were analyzed to identify the personalized learning program, providing students the concepts students found to be the most difficult, allowing insight they need to study smarter and improve for expansion upon the discussion, practice, and assessment performance. of challenging topics. The revision process for a new edition used to begin with gathering information from instructors about what they would change and what they would keep. A Personalized Experience Experts in the field were asked to provide comments that pointed out new material to add and dated material to that Leads to Improved review. Using all these reviews, authors would revise the Learning and Results material. But now, a new tool has revolutionized that model. How many students think they know everything about McGraw-Hill Education authors now have access to abnormal psychology but struggle on the first exam? student performance data to analyze and to inform their Students study more effectively with Connect and revisions. These data are anonymously collected from the SmartBook. many students who use SmartBook, the adaptive learning SmartBook helps students study more efficiently by system that provides students with individualized highlighting what to focus on in the chapter, asking assessment of their own progress. Because virtually every review questions, and directing them to resources until text paragraph is tied to several questions that students they understand. answer while using SmartBook, the specific concepts with which students are having the most difficulty are easily Connect’s assignments help students contextualize what pinpointed through empirical data in the form of a “heat they’ve learned through application, so they can better map” report. understand the material and think critically. SmartBook creates a personalized study path Powerful Reporting customized to individual student needs. Whether a class is face-to-face, hybrid, or entirely online, McGraw-Hill Connect provides the tools needed to reduce Connect reports deliver information regarding the amount of time and energy instructors spend performance, study behavior, and effort so instructors administering their courses. Easy-to-use course management can quickly identify students who are having issues or tools allow instructors to spend less time administering and focus on material that the class hasn’t mastered. more time teaching, while reports allow students to monitor New to this edition, SmartBook is now optimized for their progress and optimize their study time. mobile and tablet and is accessible for students with The At-Risk Student Report provides instructors with disabilities. Content-wise, it has been enhanced with one-click access to a dashboard that identifies students improved learning objectives that are measurable and who are at risk of dropping out of the course due to observable to improve student outcomes. SmartBook low engagement levels. personalizes learning to individual student needs, continually adapting to pinpoint knowledge gaps and focus The Category Analysis Report details student learning on topics that need the most attention. Study time performance relative to specific learning objectives and is more productive and, as a result, students are better goals, including APA learning goals and outcomes and prepared for class and coursework. For instructors, levels of Bloom’s taxonomy. SmartBook tracks student progress and provides insights Connect Insight is a one-of-a-kind visual analytics that can help guide teaching strategies. dashboard—now available for both instructors and students—that provides at-a-glance information regarding student performance. Experience the Power of Data The SmartBook Reports allow instructors and students Abnormal Psychology: Clinical Perspectives on Psychological to easily monitor progress and pinpoint areas of Disorders harnesses the power of data to improve the weakness, giving each student a personalized study instructor and student experiences. plan to achieve success. xvi Informing and Engaging Abnormal Psychology helps students gain a deeper McGraw-Hill Connect offers several ways to actively engage understanding of psychological disorders and provides an students. McGraw-Hill Education Connect is a digital opportunity for critical thinking. assignment and assessment platform that strengthens the Interactive Case Studies help students understand the link between faculty, students, and course work. Connect complexities of psychological disorders. Co-developed with for Abnormal Psychology includes assignable and assessable psychologists and students, these immersive cases bring the videos, quizzes, exercises, and Interactivities, all associated intricacies of clinical psychology to life in an accessible, with learning objectives for Abnormal Psychology: Clinical gamelike format. Each case is presented from the point of Perspectives on Psychological Disorders, Ninth Edition. view of a licensed psychologist, a social worker, or a New to the Ninth Edition, Power of Process guides psychiatrist. Students observe sessions with clients and are students through the process of critical reading and asked to identify major differentiating characteristics analysis. Faculty can select or upload content, such as associated with each of the psychological disorders journal articles, and assign guiding questions to move presented. Interactive Case Studies are assignable and students toward higher-level thinking and analysis. assessable through McGraw-Hill Education’s Connect. SUPPORTING INSTRUCTORS WITH TECHNOLOGY With McGraw-Hill Education, you can develop and tailor the course you want to teach. McGraw-Hill Campus (www.mhcampus.com) provides faculty with true single sign-on access to all of McGraw- Hill’s course content, digital tools, and other high-quality learning resources from any learning management system. McGraw-Hill Campus includes access to McGraw-Hill’s entire content library, including eBooks, assessment tools, presentation slides, and multimedia content, among other resources, providing faculty open, unlimited access to prepare for class, create tests/quizzes, develop lecture material, integrate interactive content, and more. With Tegrity, you can capture lessons and lectures in a searchable format and use them in traditional, hybrid, “flipped classes,” and online courses. With Tegrity’s personalized learning features, you can make study time efficient. Its ability to affordably scale brings this benefit to every student on campus. Patented search technology and real-time learning management system (LMS) integrations Through the connection of psychology to students’ own make Tegrity the market-leading solution and service. lives, concepts become more relevant and understandable. With McGraw-Hill Education’s Create, faculty can NewsFlash exercises tie current news stories to key easily rearrange chapters, combine material from other psychological principles and learning objectives. After content sources, and quickly upload content you have interacting with a contemporary news story, students are written, such as your course syllabus or teaching notes, assessed on their ability to make the link between real life using McGraw-Hill Education’s Create. Find the content and research findings. Topics include brain chemistry and you need by searching through thousands of leading depression, eating disorders in boys, and criticisms of the McGraw-Hill Education textbooks. Arrange your book to DSM-5. fit your teaching style. Create even allows you to personalize your book’s appearance by selecting the cover Thinking Critically About Abnormal and adding your name, school, and course information. Psychology Order a Create book, and you will receive a Updated with DSM-5 content, Faces of Abnormal Psychology complimentary print review copy in three to five business connects students to real people living with psychological days or a complimentary electronic review copy via email disorders. Through its unique video program, Faces of in about an hour. Experience how McGraw-Hill Education xvii empowers you to teach your students your way. http:// Image Gallery The Image Gallery features the complete create.mheducation.com set of downloadable figures and tables from the text. These can be easily embedded by instructors into their own Trusted Service and Support PowerPoint slides. McGraw-Hill Education’s Connect offers comprehensive service, support, and training throughout every phase of Clinical Perspectives on Psychological your implementation. If you’re looking for some guidance on Disorders how to use Connect, or want to learn tips and tricks from The subtitle, Clinical Perspectives on Psychological Disorders, super users, you can find tutorials as you work. Our Digital reflects the emphasis on the experience of clients and Faculty Consultants and Student Ambassadors offer insight clinicians in their efforts to facilitate each individual’s into how to achieve the results you want with Connect. maximum functioning. Each chapter begins with an actual case study that typifies the disorders in that chapter, then Integration with Your Learning returns to the case study at the end with the outcome of Management System a prescribed treatment on the basis of the best available evidence. Throughout the chapter, the author translates the McGraw-Hill integrates your digital products from McGraw- symptoms of each disorder into terms that capture the core Hill Education with your school LMS for quick and easy essence of the disorder. The philosophy is that students access to best-in-class content and learning tools. Build an should be able to appreciate the fundamental nature of each effective digital course, enroll students with ease, and disorder without necessarily having to memorize all of its discover how powerful digital teaching can be. diagnostic criteria. In that way, students can gain a basic Available with Connect, integration is a pairing between understanding that will serve them well regardless of their an institution’s learning management system (LMS) and ultimate professional goals. Connect at the assignment level. It shares assignment In this Ninth Edition, the author refreshes many of the information, grades, and calendar items from Connect into cases to reflect stronger ethnic, international, gender, the LMS automatically, creating an easy to manage course sexual orientation, and age diversity. In particular, the mini for instructors and simple navigation for students. Our cases in each chapter are based on cases intended to assignment-level integration is available with Blackboard reflect the importance of cultural variations that Learn, Canvas by Instructure, and Brightspace by D2L, psychologists see in their private offices, clinics, hospitals, giving you access to registration, attendance, assignments, and counseling centers. grades, and course resources in real time, in one location. Above all, the study of abnormal psychology is the study of profoundly human experiences. To this end, the author Instructor Supplements has developed a biographical feature entitled “Real Stories.” Instructor’s Manual The instructor’s manual provides a You will read narratives from the actual experiences of wide variety of tools and resources for presenting the celebrities, sports figures, politicians, authors, musicians, course, including learning objectives and ideas for lectures and artists ranging from Ludwig van Beethoven to Herschel and discussions. Walker. Each story is written to provide insight into the Test Bank By increasing the rigor of the test bank particular disorder covered within the chapter. By reading development process, McGraw-Hill Education has raised the these fascinating biographical pieces, you will come away bar for student assessment. A coordinated team of subject- with a more in-depth personal perspective to use in matter experts methodically vetted each question and set of understanding the nature of the disorder. possible answers for accuracy, clarity, effectiveness, and The author has developed this text using a scientist- accessibility; each question has been annotated for level of practitioner framework. In other words, you will read about difficulty, Bloom’s taxonomy, APA learning outcomes, and research informed by clinical practice. The author presents corresponding coverage in the text. Organized by chapter, research on theories and treatments for each of the the questions are designed to test factual, conceptual, and disorders based on the principles of evidence-based practice. applied understanding. All test questions are available within This means that the approaches are tested through TestGen™ software and as Word documents. extensive research informed by clinical practice. Many PowerPoint Presentations The PowerPoint presentations, researchers in the field of abnormal psychology also treat available in both dynamic, lecture-ready and accessible, clients in their own private offices, hospitals, or group WCAG-compliant versions, highlight the key points of the practices. As a result, they approach their work in the lab chapter and include supporting visuals. All of the slides can with the knowledge that their findings can ultimately be modified to meet individual needs. provide real help to real people. xviii CHAPTER-BY-CHAPTER Expanded section on “Cultural Concepts of Distress” and updated the accompanying Table 3. CHANGES Added new research on evidence-based practice in This edition reflects the most recent revision to the psychology. Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association in 2013 and known as DSM-5. The DSM-5 was written following a CHAPTER 3 lengthy process of revising the previous edition, the DSM- Updated information on the SCID for DSM-5. IV-TR, involving hundreds of researchers contributing to Provided updated descriptions of personality task forces intended to investigate each of the major assessment methods. categories of disorders. Though replaced, the DSM-IV-TR still remains relevant, Added section on Cultural Formulation Interview. if only as a contrast to the DSM-5. Each chapter has a Revised and updated section on neuropsychological section entitled “What’s in the DSM-5” that highlights the assessment. critical changes introduced in 2013 and shows why they matter. Because so much of our current understanding of research on psychological disorders used earlier editions CHAPTER 4 of the DSM for diagnostic purposes, students will still Updated and expanded treatment of genetic theories. encounter findings based on its diagnostic system. It generally takes several years for research to catch up with Expanded the theoretical background and case new diagnostic terminology, both because of the amount regarding Core Conflictual Relationship Theme. of time required for articles to reach publication stage, Revised definitions of positive and negative and also because of the dearth of available research reinforcement with new examples. instruments based on the new diagnostic criteria. From the student’s point of view, the conceptual frameworks Updated description of cognitive perspective. that inform the way we think about psychological Added section on acceptance-based perspective. disorders are most important. Adding to this complexity is the fact that an entirely different classification system, the International Classification CHAPTER 5 of Diseases (ICD), is used by countries outside the United Revised and updated section on intellectual disability. States and Canada, as well as by governmental insurance Updated section on treatment of autism spectrum agencies in the United States. We will discuss the ICD disorder. when relevant, particularly as it relates to international comparisons. Provided updated information and research on learning The heat-map-directed revisions in this new edition are and communication disorders. reflected primarily in Chapters 3, 5, 14, and 15. Other Condensed information in Table 2. content changes include the following: Added section on “Project Search.” CHAPTER 1 Updated information on ADHD, including ADHD in Reorganized presentation of themes throughout adults. history to distinguish how each theme evolved over time. Added new research on motor disorders. Added section on open-access journals and associated difficulties in relying on sources that did not receive extensive peer review. CHAPTER 6 Updated examples of research designs and approaches Provided updated statistics on schizophrenia, including in abnormal psychology. health care costs. Updated section on the course of schizophrenia. CHAPTER 2 Reorganized biological perspectives section and Added further discussion on “client” vs. “patient” updated research evidence in support of genetic terminology. contributions. xix  Updated information about CBT for treatment of Included new research on psychoeducation in psychotic disorders. behavioral medicine. CHAPTER 7 CHAPTER 10 Provided extensive updates of prevalence statistics. Provided new research on the relationship between altered brain activity and eating disorders. Expanded section on health problems for individuals with bipolar disorder. Added information about ACT as treatment for eating disorders. Added new information about biological contributors to mood disorders. Summarized new research on treatment of childhood elimination disorders. Updated research on psychotherapy vs. medication effectiveness. Added information about the role of wearable technology in treatment of sleep disorders. Provided updates from recent data on suicide rates in the United States. Included new information about social competence therapy in treatment of oppositional defiant disorder. CHAPTER 8 Updated prevalence statistics. Updated treatment of intermittent explosive disorder with CBT. Added new information about virtual reality exposure therapy. Added new longitudinal research on conduct disorder. Provided new information about the role of personality traits in agoraphobia and panic disorder. Updated section on treatment of kleptomania with CBT. Added new information comparing younger and older adults in generalized anxiety disorder. CHAPTER 11 Included ACT treatment for anxiety disorders. Clarified terminology in section on definitions of paraphilic disorders. Added new evidence in favor of CBT for obsessive compulsive disorder. Added new perspectives on fetishistic disorder based on updated studies. Added research on PTSD in female combat veterans. Updated information about frotteuristic disorder. Included new treatment guidelines published by APA for treatment of PTSD. Provided new survey data on sexual sadism and sexual masochism disorders. Added new studies on couples therapy and post- traumatic growth in PTSD. Added new information about treatment of paraphilic disorders based on biological approaches. CHAPTER 9 Incorporated new studies on the use of sexual Added new section on treatment of dissociative identity diaries in treatment of women with sexual disorder. dysfunctions. Incorporated new research on brain imaging studies for Summarized research on body image and sexual individuals with motor conversion disorder. dysfunction in women. Updated research on malingering along with Added section on CBT in treating couples with sexual information on structured malingering assessment. dysfunctions. Added new studies on ACT as treatment for illness Clarified terms and theories in gender dysphoria. anxiety disorder. Summarized new APA Guidelines for Transgender and Expanded treatment of workplace stress and health. Gender Nonconforming People. xx CHAPTER 12 Revised section on neurocognitive disorder with Lewy bodies. Updated statistics on use of alcohol and illicit substances based on new SAMHSA data. Updated statistics on traumatic brain injury. Clarified relationship between socialization and alcohol Added new information about chronic traumatic use disorders. encephalography (CTE). Included updated discussion of marijuana based on changes in federal and state legislation on legality. CHAPTER 14 Added new studies on prevalence of caffeine-related Revised and simplified presentation of alternative conditions. personality disorder diagnostic system in DSM-5. Updated information about e-cigarettes. Developed more concise approach to theories and treatments of antisocial personality disorder, along with Evaluated new research on biological treatments for updated research. substance-related disorders. Provided new information about treatment of antisocial Added new research on gambling disorder in older personality disorder. adult women. Added information about attachment style in dependent Provided new evidence on the pathways model of personality disorder. gambling disorder and related treatment. CHAPTER 15 CHAPTER 13 Ensured that all guidelines are compliant with APA Provided streamlined definitions of neurocognitive updates and revisions. disorders and their symptoms. Added information about “duty to warn or otherwise Expanded discussion of delirium and revised Table 2 to protect.” provide more accessible information. Added new section on ruling by Massachusetts Updated prevalence statistics on Alzheimer’s disease Supreme Judicial Court based on MIT lawsuit and clarified distinction between “dementia” and regarding suicide prevention in college students. neurocognitive disorder.” Updated information based on landmark forensic cases Evaluated new treatments for Alzheimer’s disease. and the current status of the offenders. xxi Acknowledgments my research assistant and author of all the Case Reports and Real Stories in the text. A psychologist at the Massachusetts The following instructors were instrumental in the Institute of Technology (MIT) Medical Mental Health and development of the text, offering their feedback and advice Counseling Services, Jenny received her PhD in 2015 from as reviewers: American University and completed a predoctoral internship at the Durham V.A. Hospital and a postdoctoral internship at David Alfano, Community College of Rhode Island the Boston V.A. Hospital. Her wide range of experiences with Bryan Cochran, University of Montana both veterans and university students from all over the world Julie A. Deisinger, Saint Xavier University gives her a unique perspective and set of insights that inform Angela Fournier, Bemidji State University the entire book. Richard Helms, Central Piedmont Community College Finally, a great book can’t come together without a great publishing team. I’d like to thank the editorial team, Heather Jennings, Mercer County Community College all of whom worked with me through various stages of the Joan Brandt Jensen, Central Piedmont Community College publishing process. Ryan Treat was terrific in getting the Cynthia Kalodner, Towson University revision off the ground, and I appreciate his enthusiasm and Patricia Kemerer, Ivy Tech Community College support. Dawn Groundwater has also been wonderful, and her Barbara Kennedy, Brevard Community College–Palm Bay long-term commitment to the book means a great deal to me. Joseph Lowman, University of North Carolina–Chapel Hill I would also like to thank my Content Project Manager Ryan Warczynski, whose patience and diligence helped ensure my Don Lucas, Northwest Vista College vision was carried out effectively. I also wish to thank Sandy James A. Markusic, Missouri State University Wille, who has been wonderful in serving as Production Mark McKellop, Juniata College Project Manager throughout previous editions and who is now Maura Mitrushina, California State University–Northridge back on the team. Kelly Heinrichs, the Program Manager, John Norland, Blackhawk Technical College has ensured that all of the aspects of this revision have gone Karen Clay Rhines, Northampton Community College smoothly. Kristine Janssens, who helped me select photos for this revision, has shown terrific resourcefulness in dealing Ty Schepis, Texas State University with the many issues involved in providing excellent photos to William R. Scott, Liberty University illustrate key points. Traci Vaske, Content Licensing Specialist, Dr. Wayne S. Stein, Brevard Community College has been invaluable in assisting me in the complex process of Marla Sturm, Montgomery County Community College acquiring permissions. Finally, I wish to give heartfelt thanks Terry S. Trepper, Purdue University-Calumet to Elisa Adams, Product Developer, not only for her vigilance Naomi Wagner, San Jose State University in making sure that this revision reads as well as it can, but Nevada Winrow, Baltimore City Community College also for her friendly encouragement throughout the entire process. In this Ninth Edition, I feel very grateful to be part It has been particularly satisfying to work on this edition of the McGraw-Hill family, whose commitment to student with my daughter, Jennifer L. O’Brien, PhD, who served as success is truly remarkable. xxii A Letter from the Author I am very glad that you are choosing to read my textbook. The topic of abnormal psychology has never been more fascinating or relevant. We constantly hear media reports of celebrities having meltdowns for which they receive quickie diagnoses that may or may not be accurate. Given all this misinformation in the mind of the public, I feel that it’s important for you to be educated in the science and practice of abnormal psychology. At the same time, psychological science grabs almost as many headlines in all forms of news media. It seems that everyone is eager to learn about the latest findings, ranging from the neuroscience of behavior to the effectiveness of the newest treatment methods. Advances in brain-scanning methods and studies of psychotherapy effectiveness are greatly increasing our understanding of how to help treat and prevent psychological disorders. Particularly fascinating to me was covering the changes made in the DSM-5. Each revision of the DSM brings with it controversies and challenges, and the DSM-5 was no exception. Despite challenges in the new ways that the DSM-5 defines and categorizes psychological disorders, it is perhaps more than any earlier edition based on strong research. Scientists and practitioners will continue to debate the best ways to interpret this research. We all will benefit from these dialogues. The profession of clinical psychology is also undergoing rapid changes. With changes in health care policy, it is very likely that more professionals, from psychologists to mental health counselors, will be employed in providing behavioral interventions. By taking this first step toward your education now, you will be preparing yourself for a career that is increasingly being recognized as vital to helping individuals of all ages and all walks of life to achieve their greatest fulfillment. I hope you find this text as engaging to read as I found it to write. Please feel free to e-mail me at [email protected] with your questions and reactions to the material. As a long-time user of McGraw-Hill’s Connect in my own abnormal psychology class, I can also vouch for its effectiveness in helping you achieve mastery of the content of abnormal psychology. I am also available to answer any questions you have, from an instructor’s point of view, about how best to incorporate this book’s digital media into your own teaching. Thank you again for choosing to read this book! Best, Susan xxiii Overview to Understanding Abnormal Behavior Learning Objectives OUTLINE Case Report: Rebecca Hasbrouck 1.1 Distinguish between behavior that is unusual but normal and behavior that is unusual and abnormal. What Is Abnormal Behavior? 1.2 Describe how explanations of abnormal behavior have changed through The Social Impact of Psychological time. Disorders 1.3 Identify the strengths and weaknesses of research methods. Defining Abnormality 1.4 Describe types of research studies. What’s in the DSM-5: Definition of a Mental Disorder What Causes Abnormal Behavior? Biological Contributions Psychological Contributions Sociocultural Contributions The Biopsychosocial Perspective Prominent Themes in Abnormal Psychology Throughout History Spiritual Approach Humanitarian Approach Scientific Approach Research Methods in Abnormal Psychology Experimental Design Correlational Design You Be the Judge: Being Sane in Insane Places Types of Research Studies Survey Laboratory Studies ©cybrain/Shutterstock The Case Study Real Stories: Vincent van Gogh: Psychosis Single Case Experimental Design Research in Behavioral Genetics Bringing It All Together: Clinical Perspectives Return to the Case: Rebecca Hasbrouck Summary Key Terms  1 C HAP TE R Case Report: Rebecca Hasbrouck Demographic information: 18-year-­old single health concerns, and she reports no known family Caucasian heterosexual female history of psychological disorders. She shared Presenting problem: Rebecca self-­referred to the that sometimes her mother tends to get “really university counseling center. She is a college stressed out,” though she has never received pro- freshman, living away from home for the first time. fessional mental health treatment. Following the first week of classes, Rebecca Symptoms: Depressed mood, difficulty falling reports that she is having trouble falling and stay- asleep (insomnia), difficulty concentrating on school- ing asleep, has difficulty concentrating in her work. She described feelings of hopelessness but classes, and often feels irritable. She reports she denies any thoughts of suicide or self-harm. is frustrated by the difficulties of her coursework Case formulation: Although it appeared at first as and worries that her grades are beginning to suf- though Rebecca was suffering from a major depres- fer. She also relays that she is having trouble mak- sive episode, she did not meet the diagnostic ing friends at school and that she has been feeling ­criteria. While the age of onset for depression tends lonely because she has no close friends here with to be around Rebecca’s age, given her lack of a whom she can talk openly. Rebecca is very close family history of depression and that her symptoms to her boyfriend of 3 years, though they are were occurring in response to a major stressor, the attending college in different cities. clinician determined that Rebecca was suffering Rebecca was tearful throughout our first session, from adjustment disorder with depressed mood. stating that, for the first time in her life, she feels Treatment plan: The counselor will refer Rebecca overwhelmed by feelings of hopelessness. She for weekly psychotherapy. Therapy should focus reports that although the first week at school felt on improving her mood, and also should allow her like “torture,” she is slowly growing accustomed to a supportive space to discuss her feelings sur- her new lifestyle, despite her struggles with missing rounding the major changes that have been her family and boyfriend, as well as her friends from occurring in her life. high school. Sarah Tobin, PhD Relevant past history: Rebecca has no prior his- tory of depressive episodes or other mental Clinician 4 Chapter 1 Overview to Understanding Abnormal Behavior Rebecca Hasbrouck’s case report summarizes the pertinent features that a clinician would include when first seeing a client after an initial evaluation. Each chapter of this book begins with a case report for a client whose characteristics are related to the chapter’s topic. A fic- titious clinician, Dr. Sarah Tobin, who supervises a clinical setting that offers a variety of services, writes the case reports. In some instances, she provides the services, and in others, she supervises the work of another psychologist. For each case, she provides a diagnosis using the official manual adopted by the profession, known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2013). At the end of this chapter, after you have developed a better understanding of the client’s disorder, we will return to Dr. Tobin’s description of the treatment results and expected future outcomes for the client. We also include Dr. Tobin’s personal reflections on the case to help you gain insight into the clinician’s experience in working with psychologically dis- ordered individuals. The field of abnormal psychology is filled with countless fascinating stories of people who suffer from psychological disorders. In this chapter, we will try to give you some sense of the reality that psychological disturbance is certain to touch everyone, to some extent, at some point in life. As you progress through this course, you will almost certainly develop a sense of the challenges people associate with psychological problems. You will find your- self drawn into the many ways that mental health problems affect the lives of individuals, their families, and society. In addition to becoming more personally familiar with the emo- tional aspects of abnormal psychology, you will learn about the scientific and theoretical basis for understanding and treating the people who suffer from psychological disorders. 1.1 What Is Abnormal Behavior? It’s possible that you know someone very much like Rebecca, who is suffering from more than the average degree of adjustment difficulties in college. Would you consider her psy- chologically disturbed? Would you consider giving her a diagnosis? What if she showed up at your door looking as if she were ready to harm herself? At what point do you draw the line between someone who has a psychological disorder and someone who, like Rebecca, has an adjustment disorder? Is it even necessary to give Rebecca any diagnosis at all? Questions about normality and abnormality such as these are basic to advancing our understanding of psychological disorders. Perhaps you yourself are, or have been, unusually depressed, fearful, or anxious. If not you, possibly someone you know has struggled with a psychological disorder or its symptoms. It may be that your father struggles with alcoholism, your mother has been hospitalized for severe depression, your sister has an eating disorder, or your brother has an irrational fear. If you have not encountered a psychological disorder within your immediate family, you have very likely encoun- tered one in your extended family and circle of friends. You may not have known the formal psychiatric diagnosis for the problem, and you may not have understood its nature or cause, but you knew that something was wrong and recognized the need for profes- sional help. Until they are forced to face such problems, most people believe that “bad things” happen only to other people. You may think that other people have car accidents, succumb to cancer, or, in the psycho- logical realm, become dependent on opioids. We hope that reading this textbook will help you go beyond this “other people” syndrome. Psychological disorders are part of the human experience, directly or indirectly touching the life of every person. However, they don’t have This young woman’s apparent despair may be the symptoms to destroy those lives. As you read about these disorders and the peo- of a psychological disorder. ple who suffer them, you will find that these problems can be treated, ©wavebreakmedia/Shutterstock if not prevented.  1.2 The Social Impact of Psychological Disorders? 5 1.2 The Social Impact of Psychological Disorders Psychological disorders affect both the individual and the other people in the individual’s social world. Put yourself in the following situation. You receive an urgent text from the mother of your best friend, Jeremy. You call her and find out he’s been admitted to a behav- ioral health unit of the local hospital and wants to see you. According to Jeremy’s mother, only you can understand what he is going through. The news comes out of the blue and is puzzling and distressing. You had no idea Jeremy had any psychological problems. You ponder what you will say to him when you see him. Jeremy is your closest friend, but now you wonder how your relationship will change. How much can you ask him about what he’s going through? How is it that you never saw it coming? Unsure about what to do when you get there, you wonder what kind of shape he’ll be in and whether he’ll even be able to com- municate with you. What will it be like to see him in this setting? What will he expect of you, and what will this mean for the future of your friendship? Now imagine the same scenario, but instead you receive news that Jeremy was just admit- ted to the emergency room of a general hospital with acute appendicitis. You know exactly how to respond when you go to see him. You will ask him how he feels, what exactly is wrong with him, and when he will be well again. Even though you might not like hospitals very much, at least you have a pretty good idea about what hospital patients are like. The appendectomy won’t seem like anything special, and you would probably not even consider whether you could be friends with Jeremy again after he is discharged. He’ll be as good as new in a few weeks, and your relationship with him will resume unchanged. Now that you’ve compared these two scenarios, consider the fact that people with psy- chological disorders frequently face situations such as Jeremy’s in which even the people who care about them aren’t sure how to respond to their symptoms. Furthermore, even after their symptoms are under control, individuals like Jeremy continue to experience profound and long-­lasting emotional and social effects as they attempt to resume their former lives. Their disorder itself may also bring about anguish and personal suffering. Like Rebecca in our opening example, they must cope with feelings of loneliness and sadness. The families of individuals with psychological disorders face significant stress when their relatives must be hospitalized. ©Ghislain & Marie David de Lossy/Getty Images 6 Chapter 1 Overview to Understanding Abnormal Behavior stigma Psychological disorders are almost inevitably associated with stigma, a negative label that A negative label that causes certain causes certain people to be regarded as different, defective, and set apart from mainstream people to be regarded as different, members of society. This stigma exists even in today’s society, despite greater awareness of defective, and set apart from the prevalence of mental health issues. Social attitudes toward people with psychological mainstream members of society. disorders range from discomfort to outright prejudice. Language, humor, and stereotypes portray psychological disorders in a negative light, and many people fear that those who have these disorders are violent and dangerous. There seems to be something about a psychological disorder that makes people want to distance themselves from it as much as possible. The result is social discrimination, which serves only to complicate the lives of the afflicted even more. Making matters worse, people experiencing symptoms of a psychological disorder may not avail themselves of the help they could receive from treatment because they too have incorporated stigmatized views of mental illness (Clement et al., 2015). Some individuals are able to resist the stigma of psy- chological disorders due to their ability, for example, to define their identity separate from their disorder and to reject the labels other people apply to them (Firmin et al., 2017). In the chapters that follow, you will read about a wide range of disorders affecting mood, anxiety, substance use, sexuality, and thought disturbance. Case descriptions will give you a glimpse into the feelings and experiences of real people who have these disorders, and you may find that some of them seem similar to you or to people you know. As you read about the disorders, put yourself in the place of the people who have these conditions. Consider how they feel and how they would like people to treat them. We hope you will realize that our discussion is not about the disorders but about the people who have them. 1.3 Defining Abnormality There is a range of behaviors people consider normal. Where do you draw the line? Decide which of the following actions you regard as abnormal. Feeling jinxed when your “lucky” seat in an exam is already occupied when you get to class Being unable to sleep, eat, study, or talk to anyone else for days after your boyfriend says, “It’s over between us” Breaking into a cold sweat at the thought of being trapped in an elevator Swearing, throwing pillows, and pounding fists on the wall in the middle of an argument with a roommate Refusing to eat solid food for days at a time in order to stay thin Engaging in a thorough hand-­washing after coming home from a bike ride Protesting the rising cost of college by joining a picket line outside the campus administration building Being convinced that people are constantly being critical of everything you do Drinking a six-­pack of beer a day in order to be “sociable” with friends Playing videogames for hours at a time, avoiding other study and work obligations If you’re like most people, you probably found it surprisingly difficult to decide which of these behaviors are normal and which are abnormal. So many are part of everyday life. You can see now why mental health professionals struggle to find an appropriate definition of abnormality. Yet criteria need to exist so they can provide appropriate treatment in their work with clients. Looking back at this list of behaviors, think now about how you would rate each if you applied the five criteria for a psychological disorder that mental health professionals use. In  1.3 Defining Abnormality 7 reality, no one would diagnose a psychological disorder on the basis of a single behavior, but using these criteria can at least give you some insight into the process that clinicians use when deciding whether a given client has a disorder or not. The first criterion for a psychological disorder is clinical significance, meaning the behav- clinical significance ior includes a measurable degree of impairment that a clinician can observe. People who The criterion for a psychological feel jinxed about not having a lucky seat available for an exam would fit this criterion only if disorder in which the behavior