Abnormal Psychology PDF (2020)

Abnormal Psychology This page intentionally left blank Abnormal Psychology Eighth Edition Susan Nolen-Hoeksema ABNORMAL PSYCHOLOGY, EIGHTH EDITION Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2020 by McGraw-Hill Education. All rights reserved. P...

Abnormal Psychology This page intentionally left blank Abnormal Psychology Eighth Edition Susan Nolen-Hoeksema ABNORMAL PSYCHOLOGY, EIGHTH 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 2011. 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 21 20 19 ISBN 978-1-260-50018-9 (bound edition) MHID 1-260-50018-7 (bound edition) ISBN 978-1-260-08046-9 (loose-leaf edition) MHID 1-260-08046-3 (loose-leaf edition) Portfolio Manager: Ryan Treat Product Development Manager: Dawn Groundwater Marketing Managers: Augustine Laferrera; Olivia Kaiser Lead Content Project Managers: Sandy Wille; Jodi Banowetz Senior Buyer: Laura Fuller Senior Design: Matt Backhaus Senior Content Licensing Specialist: Melisa Seegmiller Cover Image: ©DrAfter123/DigitalVision Vectors/Getty Images Compositor: Lumina Datamatics, Inc. All credits appearing on page or at the end of the book are considered to be an extension of the copyright page. Library of Congress Cataloging-in-Publication Data Names: Nolen-Hoeksema, Susan, 1959-2013, author. Title: Abnormal psychology / Susan Nolen-Hoeksema, Yale University. Description: Eighth edition. | New York, NY : MHE, | Includes bibliographical references and indexes. Identifiers: LCCN 2018044989| ISBN 9781260500189 (alk. paper) | ISBN 9781260080469 (loose-leaf edition) Subjects: LCSH: Psychology, Pathological—Textbooks. | Mental illness—Textbooks. Classification: LCC RC454.N64 2020 | DDC 616.89—dc23 LC record available at https://lccn.loc.gov/2018044989 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  ABOUT THE AUTHOR Susan Nolen-Hoeksema (1959–2013) In January 2013 we lost our esteemed author and friend, Susan Nolen-Hoeksema. Susan was a renowned scholar, teacher, mentor, and academic leader. She was recognized internationally for her work on how people reg- ulate their feelings and emotions and how particular patterns of thinking can make people vulnerable to and recover slowly from emotional problems, especially depression. Her research shaped the field’s perspective on depression in women and girls, and countless empirical studies and theoretical contributions followed as she ­developed her groundbreaking theory of rumination and depression. In her words: “My career has focused on two parallel goals. The first is to use empirical methods to address important social and mental health problems (depression, rumination, women’s mental health). The second goal is to disseminate psychological science. I Courtesy of Susan Nolen-Hoeksema also believe in taking science to the public, through my textbook on Abnormal Psychology and books for the general public on women’s mental health.” Susan taught at Stanford University, the University of Michigan, and Yale University. Susan’s work focused on depression, mood regulation, and gender, for which she was recognized and received the David Shakow Early Career Award from Division 12, the Distinguished Leadership Award from the Committee on Women of American Psychological Association, the James McKeen Cattell Fellow Award from the Association for Psychological Science, a Research Career Award, and multiple grants from the National Institute of Mental Health. In addition, she was the founding editor of the Annual Review of Clinical Psychology, now the most highly cited journal in the field of clinical psychology. In addition to being an accomplished professor, scholar, teacher, and writer, Susan was a loving and devoted mother, wife, daughter, sister, friend, and mentor. Susan touched and inspired the lives of many people both professionally and personally, and she will be dearly missed. ABOUT THE CONTRIBUTOR Brett Marroquín is an assistant professor of psychology at Loyola Marymount University in Los Angeles, California. He received his Ph.D. in clinical psychology from Yale University under the mentor- ship of Susan Nolen-Hoeksema, and completed a National Institute of Mental Health (NIMH) postdoctoral fellowship in biobehavioral issues in physical and mental health at the University of California, Los Angeles. His research examines interpersonal influences on emo- tion, emotion regulation, and cognitive processing in healthy function- ing and mood disorders. His current work focuses on the roles of social contexts and romantic relationships in emotional adjustment to negative events, including cancer diagnosis and treatment, and how effective or ineffective support from partners affects couples’ physical Courtesy of Brett Marroquín and mental health. v BRIEF CONTENTS About the Author, About the Contributor v Preface xiv 1 Looking at Abnormality 2 2 Theories and Treatment of Abnormality 22 3 Assessing and Diagnosing Abnormality 58 4 The Research Endeavor 80 5 Trauma, Anxiety, Obsessive-Compulsive, and Related Disorders 102 6 Somatic Symptom and Dissociative Disorders 146 7 Mood Disorders and Suicide 168 8 Schizophrenia Spectrum and Other Psychotic Disorders 210 9 Personality Disorders 242 10 Neurodevelopmental and Neurocognitive Disorders 274 11 Disruptive, Impulse-Control, and Conduct Disorders 310 12 Eating Disorders 328 13 Sexual Disorders and Gender Diversity 354 14 Substance Use and Gambling Disorders 384 15 Health Psychology 420 16 Mental Health and the Law 452 McGraw-Hill Education Psychology’s APA Documentation Style Guide Glossary G-1 References R-1 Name Index NI-1 Subject Index SI-1 vi  CONTENTS About the Author, About the Contributor Preface xiv v 2 Theories and Treatment of Abnormality 22 1 Looking at Abnormality 2 Approaches Along the Continuum 23 Extraordinary People—Steven Hayes 24 Abnormality Along the Continuum 3 Biological Approaches 26 Extraordinary People 4 Brain Dysfunction 27 Defining Abnormality 4 Biochemical Imbalances 29 Mental Illness 4 Genetic Abnormalities 31 Cultural Norms 5 Drug Therapies 33 The Four Ds of Abnormality 6 Electroconvulsive Therapy and Newer Brain Shades of Gray 6 Stimulation Techniques 34 Historical Perspectives on Abnormality 7 Psychosurgery 35 Ancient Theories 7 Assessing Biological Approaches 35 Medieval Views 9 Psychological Approaches 36 The Spread of Asylums 11 Behavioral Approaches 36 Moral Treatment in the Eighteenth and Cognitive Approaches 39 Nineteenth Centuries 12 Psychodynamic Approaches 41 The Emergence of Modern Perspectives 13 Humanistic Approaches 45 The Beginnings of Modern Biological Shades of Gray 46 Perspectives 13 Family Systems Approaches 46 The Psychoanalytic Perspective 14 Third-Wave Approaches 47 The Roots of Behaviorism 14 Using New Technology to Deliver Treatment 48 The Cognitive Revolution 15 Sociocultural Approaches 49 Modern Mental Health Care 15 Cross-Cultural Issues in Treatment 50 Deinstitutionalization 16 Culturally Specific Therapies 52 Managed Care 17 Assessing Sociocultural Approaches 52 Professions Within Abnormal Prevention Programs 53 Psychology 18 Common Elements in Effective Treatments 53 Chapter Integration 19 Chapter Integration 54 Shades of Gray Discussion 19 Shades of Gray Discussion 55 Chapter Summary 20 Chapter Summary 55 Key Terms 21 Key Terms 56 vii viii Contents 3 Assessing and Diagnosing 4 The Research Endeavor 80 Abnormality 58 Research Along the Continuum 81 Assessment and Diagnosis Along the Extraordinary People—The Old Order Amish of Continuum 59 Pennsylvania 82 Extraordinary People—Marya The Scientific Method 82 Hornbacher 60 Defining the Problem and Stating Assessment Tools 60 a Hypothesis 83 Validity 60 Choosing and Implementing a Method 83 Reliability 61 Shades of Gray 84 Standardization 62 Ethical Issues in Research 84 Clinical Interview 62 Case Studies 85 Symptom Questionnaires 62 Evaluating Case Studies 85 Personality Inventories 63 Correlational Studies 86 Behavioral Observation and Measuring the Relationship Between Self-Monitoring 64 Variables 86 Intelligence Tests 65 Selecting a Sample 88 Neuropsychological Tests 66 Evaluating Correlational Studies 88 Brain-Imaging Techniques 66 Epidemiological Studies 89 Psychophysiological Tests 67 Evaluating Epidemiological Studies 90 Projective Tests 67 Experimental Studies 90 Challenges in Assessment 68 Human Laboratory Studies 90 Resistance to Providing Therapy Outcome Studies 92 Information 68 Single-Case Experimental Designs 93 Evaluating Children 68 Animal Studies 94 Evaluating Individuals Across Genetic Studies 95 Cultures 69 Family History Studies 95 Diagnosis 70 Twin Studies 96 Diagnostic and Statistical Manual of Mental Disorders (DSM) 71 Adoption Studies 96 Shades of Gray 73 Molecular Genetic Studies and Linkage Analyses 96 The Social-Psychological Dangers of Diagnosis 76 Cross-Cultural Research 97 Chapter Integration 77 Meta-Analysis 98 Shades of Gray Discussion 78 Evaluating Meta-Analysis 98 Chapter Integration 98 Chapter Summary 78 Shades of Gray Discussion 99 Key Terms 79 Chapter Summary 99 Key Terms 101  Contents ix 5 Trauma, Anxiety, Obsessive- 6 Somatic Symptom and Dissociative Compulsive, and Related Disorders 146 Disorders 102 Somatic Symptom and Dissociative Disorders Along the Continuum 147 Fear and Anxiety Along the Continuum 103 Extraordinary People—Anna O., The Talking Extraordinary People—David Beckham, Perfection Cure 148 On and Off the Field 104 Somatic Symptom Disorders 148 Posttraumatic Stress Disorder and Acute Stress Disorder 106 Somatic Symptom Disorder and Illness Anxiety Disorder 149 Traumas Leading to PTSD 109 Shades of Gray 151 Theories of PTSD 111 Conversion Disorder (Functional Neurological Treatments for PTSD 113 Symptom Disorder) 153 Specific Phobias and Agoraphobia 115 Factitious Disorder 154 Specific Phobias 115 Dissociative Disorders 155 Shades of Gray 116 Dissociative Identity Disorder 156 Agoraphobia 116 Dissociative Amnesia 160 Theories of Phobias 117 Depersonalization/Derealization Disorder 162 Treatments for Phobias 119 Controversies Around the Dissociative Social Anxiety Disorder 120 Disorders 163 Theories of Social Anxiety Disorder 122 Chapter Integration 165 Treatments for Social Anxiety Disorder 122 Shades of Gray Discussion 166 Panic Disorder 123 Chapter Summary 166 Theories of Panic Disorder 125 Key Terms 167 Treatments for Panic Disorder 126 Generalized Anxiety Disorder 128 Theories of Generalized Anxiety Disorder 129 7 Mood Disorders and Suicide 168 Treatments for Generalized Anxiety Disorder 130 Mood Disorders Along the Continuum 169 Separation Anxiety Disorder 132 Extraordinary People—Kay Redfield Jamison, Theories of Separation Anxiety Disorder 133 An Unquiet Mind 170 Treatments for Separation Anxiety Disorder 134 Characteristics of Depressive Disorders 170 Obsessive-Compulsive Disorder 135 Symptoms of Depression 170 Theories of OCD and Related Disorders 138 Diagnosing Depressive Disorders 171 Treatment of OCD and Related Disorders 140 Prevalence and Course of Depressive Disorders 173 Anxiety Disorders in Older Adults 141 Chapter Integration 142 Shades of Gray 174 Shades of Gray Discussion 143 Characteristics of Bipolar Disorder 175 Symptoms of Mania 175 Chapter Summary 143 Prevalence and Course of Bipolar Disorder 177 Key Terms 145 x Contents Creativity and the Mood Disorders 178 Shades of Gray 226 Theories of Depression 179 Biological Theories 226 Biological Theories of Depression 179 Genetic Contributors to Schizophrenia 226 Psychological Theories of Depression 182 Structural and Functional Brain Abnormalities 228 Theories of Bipolar Disorder 186 Neurotransmitters 230 Biological Theories of Bipolar Disorder 186 Psychosocial Perspectives 231 Psychosocial Contributors to Bipolar Disorder 187 Social Drift and Urban Birth 231 Treatment of Mood Disorders 188 Stress and Relapse 231 Biological Treatments for Mood Schizophrenia and the Family 232 Disorders 188 Cognitive Perspectives 233 Psychological Treatments for Mood Cross-Cultural Perspectives 233 Disorders 192 Treatment 234 Interpersonal and Social Rhythm Therapy and Family-Focused Therapy 195 Biological Treatments 234 Comparison of Treatments 196 Psychological and Social Treatments 236 Suicide 197 Chapter Integration 239 Defining and Measuring Suicide 197 Shades of Gray Discussion 240 Understanding Suicide 201 Chapter Summary 240 Treatment and Prevention 203 Key Terms 241 Chapter Integration 206 Shades of Gray Discussion 207 9 Personality Disorders 242 Chapter Summary 207 Personality Disorders Along the Key Terms 209 Continuum 243 Extraordinary People—Susanna Kaysen, Girl, 8 Schizophrenia Spectrum and Other Interrupted 244 General Definition of Personality Disorder 246 Psychotic Disorders 210 Cluster A: Odd-Eccentric Personality Schizophrenia Spectrum and Other Psychotic Disorders 247 Disorders Along the Continuum 211 Paranoid Personality Disorder 248 Extraordinary People—John Nash, A Beautiful Schizoid Personality Disorder 250 Mind 212 Symptoms, Diagnosis, and Course 213 Schizotypal Personality Disorder 251 Positive Symptoms 213 Cluster B: Dramatic-Emotional Personality Disorders 253 Negative Symptoms 218 Borderline Personality Disorder 254 Cognitive Deficits 218 Histrionic Personality Disorder 258 Diagnosis 219 Narcissistic Personality Disorder 259 Prognosis 221 Cluster C: Anxious-Fearful Personality Other Psychotic Disorders 222 Disorders 261  Contents xi Avoidant Personality Disorder 262 Symptoms of Major Neurocognitive Disorder 297 Dependent Personality Disorder 263 Types of Major and Mild Neurocognitive Shades of Gray 265 Disorder 298 Obsessive-Compulsive Personality The Impact of Gender, Culture, and Education on Disorder 265 Neurocognitive Disorder 303 Alternative DSM-5 Model for Personality Treatments for and Prevention of Neurocognitive Disorders 267 Disorder 303 Chapter Integration 269 Delirium 304 Shades of Gray Discussion 270 Causes of Delirium 305 Chapter Summary 270 Treatments for Delirium 306 Key Terms 272 Chapter Integration 306 Shades of Gray Discussion 307 10 Neurodevelopmental and Chapter Summary 307 Neurocognitive Disorders 274 Key Terms 309 Neurodevelopmental and Neurocognitive Disorders Along the Continuum 275 Extraordinary People—Temple Grandin, Thinking in 11 Disruptive, Impulse-Control, and Pictures 276 Conduct Disorders 310 Attention-Deficit/Hyperactivity Disorder 276 Disorders of Conduct and Impulse Control Along Biological Factors 279 the Continuum 311 Psychological and Social Factors 280 Extraordinary People—Ted Bundy, Portrait of a Serial Killer 312 Treatments for ADHD 280 Conduct Disorder and Oppositional Defiant Shades of Gray 281 Disorder 313 Autism Spectrum Disorder 282 Contributors to Conduct Disorder and Contributors to Autism Spectrum Disorder 285 Oppositional Defiant Disorder 316 Shades of Gray 317 Treatments for Autism Spectrum Disorder 286 Intellectual Disability 286 Treatments for Conduct Disorder and Oppositional Defiant Disorder 320 Biological Causes of Intellectual Disability 288 Antisocial Personality Disorder 321 Sociocultural Factors 290 Contributors to Antisocial Personality Treatments for Intellectual Disability 290 Disorder 323 Learning, Communication, and Motor Treatments for Antisocial Personality Disorders 291 Disorder 324 Specific Learning Disorder 292 Intermittent Explosive Disorder 324 Communication Disorders 293 Chapter Integration 325 Causes and Treatment of Learning and Shades of Gray Discussion 326 Communication Disorders 294 Motor Disorders 295 Chapter Summary 326 Major and Mild Neurocognitive Disorders 296 Key Terms 327 xii Contents 12 Eating Disorders 328 Considerations for Gay, Lesbian, and Bisexual People 370 Eating Disorders Along the Continuum 329 Paraphilic Disorders 371 Extraordinary People—Fashion Models, Dying to Fetishistic Disorder and Transvestic Disorder 372 Be Thin 330 Sexual Sadism and Sexual Masochism Characteristics of Eating Disorders 331 Disorders 373 Anorexia Nervosa 331 Voyeuristic, Exhibitionistic, and Frotteuristic Disorders 374 Bulimia Nervosa 335 Pedophilic Disorder 374 Binge-Eating Disorder 337 Causes of Paraphilias 375 Other Specified Feeding or Eating Disorder 338 Treatments for the Paraphilic Disorders 376 Obesity 339 Gender Dysphoria 377 Understanding Eating Disorders 341 Contributors to Gender Dysphoria 380 Shades of Gray 342 Treatments for Gender Dysphoria 380 Biological Factors 342 Chapter Integration 381 Sociocultural and Psychological Factors 343 Chapter Summary 382 Treatments for Eating Disorders 348 Key Terms 383 Psychotherapy for Anorexia Nervosa 348 Psychotherapy for Bulimia Nervosa and Binge- Eating Disorder 349 14 Substance Use and Gambling Biological Therapies 350 Disorders 384 Chapter Integration 350 Substance Use Along the Continuum 385 Extraordinary People—Celebrity Drug Shades of Gray Discussion 352 Abusers 386 Chapter Summary 352 Defining Substance Use Disorders 387 Key Terms 353 Depressants 390 Alcohol 390 13 Sexual Disorders and Gender Shades of Gray 393 Diversity 354 Benzodiazepines and Barbiturates 394 Stimulants 395 Sexuality and Gender Along the Continuum 355 Cocaine 396 Extraordinary People—David Reimer, The Boy Who Amphetamines 397 Was Raised as a Girl 356 Nicotine 398 Sexual Dysfunctions 357 Caffeine 399 Disorders of Sexual Interest/Desire and Arousal 358 Opioids 400 Disorders of Orgasm or Sexual Pain 360 Hallucinogens and PCP 401 Causes of Sexual Dysfunctions 361 Cannabis 403 Treatments for Sexual Dysfunctions 365 Inhalants 404  Contents xiii Other Drugs of Abuse 404 Sleep Disorders 438 Theories of Substance Use Disorders 405 Chapter Integration 449 Biological Factors 405 Shades of Gray Discussion 449 Psychological Factors 406 Chapter Summary 450 Sociocultural Factors 407 Key Terms 451 Gender Differences 408 Treatments for Substance Use Disorders Biological Treatments 408 408 16 Mental Health and the Law 452 Mental Health Law Along the Continuum 453 Psychosocial Treatments 409 Extraordinary People—Greg Bottoms, Substance Use Treatment for Older Adults 413 Angelhead 454 Comparing Treatments 413 Civil Commitment 454 Prevention Programs 414 Criteria for Civil Commitment 455 Gambling Disorder 414 Violence by People with Mental Disorders 457 Chapter Integration 416 Prevalence of Involuntary Commitment 459 Shades of Gray Discussion 417 Patients’ Rights 459 Chapter Summary 417 Right to Treatment 459 Key Terms 419 Right to Refuse Treatment 460 Competence to Stand Trial 460 15 Health Psychology 420 The Insanity Defense 461 Insanity Defense Rules 463 Stress Along the Continuum 421 Problems with the Insanity Defense 466 Extraordinary People—Norman Cousins, Healing with Laughter 422 Shades of Gray 466 Psychological Factors and General Health 424 Guilty but Mentally Ill 467 Appraisals and Pessimism 424 Mental Health Care in the Justice System 467 Coping Strategies 424 Chapter Integration 468 Shades of Gray 426 Shades of Gray Discussion 469 Psychological Disorders and Physical Health 426 Chapter Summary 469 Psychosocial Factors in Specific Diseases 427 Key Terms 470 The Immune System 427  cGraw-Hill Education Psychology’s M Coronary Heart Disease and Hypertension 430 APA Documentation Style Guide Interventions to Improve Health-Related Behaviors 435 Glossary G-1 Guided Mastery Techniques 435 References R-1 Name Index NI-1 Internet-Based Health Interventions 435 Subject Index SI-1 Sleep and Health 436 Assessing Sleep 437 PREFACE Abnormal Psychology connects proven scholarship with student revision process for a new edition used to begin with gathering performance. Through an integrated, personalized learning pro- information from instructors about what they would change and gram, the eighth edition gives students the insight they need to what they would keep. Experts in the field were asked to provide study smarter and improve performance. comments that pointed out new material to add and dated material McGraw-Hill Education Connect® is a digital assignment to review. Using all these reviews, authors would revise the material. and assessment platform that strengthens the link between But now, a new tool has revolutionized that model. faculty, students, and course work. Connect for Abnormal ­ McGraw-Hill Education authors have access to student per- Psychology includes assignable and assessable videos, quizzes, formance data to analyze and to inform their revisions. These exercises, and interactivities, all associated with learning objec- data are anonymously collected from the many students who use tives for Abnormal Psychology, Eighth Edition. SmartBook, the adaptive learning system that provides students with individualized assessment of their own progress. Because virtually every text paragraph is tied to several questions that stu- dents answer while using SmartBook, the specific concepts with which students are having the most difficulty are easily pinpointed A PERSONALIZED EXPERIENCE through empirical data in the form of a “heat map” report. THAT LEADS TO IMPROVED POWERFUL REPORTING LEARNING AND RESULTS Whether a class is face-to-face, hybrid, or entirely online, How many students think they know everything about abnormal McGraw-Hill Connect provides the tools needed to reduce the psychology but struggle on the first exam? Students study more amount of time and energy instructors spend administering effectively with Connect and SmartBook. their courses. Easy-to-use course management tools allow instructors to spend less time administering and more time SmartBook helps students study more efficiently by teaching, while reports allow students to monitor their progress highlighting what to focus on in the chapter, asking review and optimize their study time. questions, and directing them to resources until they understand. The At-Risk Student Report provides instructors with one- Connect’s assignments help students contextualize what click access to a dashboard that identifies students who are they’ve learned through application, so they can better at risk of dropping out of the course due to low understand the material and think critically. engagement levels. SmartBook creates a personalized study path customized The Category Analysis Report details student performance to individual student needs. relative to specific learning objectives and goals, including Connect reports deliver information regarding performance, APA learning goals and outcomes and levels of Bloom’s study behavior, and effort so instructors can quickly identify taxonomy. students who are having issues or focus on material that the Connect Insight is a one-of-a-kind visual analytics class hasn’t mastered. dashboard—now available for both instructors and students—that provides at-a-glance information regarding student performance. New to this edition, SmartBook is now optimized for mobile Experience the Power of Data and tablet and is accessible for students with disabilities. Abnormal Psychology harnesses the power of data to improve the Content-wise, it has been enhanced with improved learning instructor and student experiences. objectives that are measurable and observable to improve stu- dent outcomes. SmartBook personalizes learning to individual student needs, continually adapting to pinpoint knowledge gaps BETTER DATA, SMARTER REVISION, and focus learning on topics that need the most attention. Study IMPROVED RESULTS time is more productive and, as a result, students are better pre- For this new edition, data were analyzed to identify the concepts pared for class and coursework. For instructors, SmartBook students found to be the most difficult, allowing for expansion upon tracks student progress and provides insights that can help guide the discussion, practice, and assessment of challenging topics. The teaching strategies. xiv  Preface xv INFORMING AND ENGAGING gamelike format. Each case is presented from the point of view of a licensed psychologist, a social worker, or a psychiatrist. McGraw-Hill Connect offers several ways to actively engage Students observe sessions with clients and are asked to identify students. major differentiating characteristics associated with each of Power of Process guides students through the process of the psychological disorders presented. Interactive Case Studies critical reading and analysis. Faculty can select or upload con- are assignable and assessable through McGraw-Hill Education’s tent, such as journal articles, and assign guiding questions to Connect. move students toward higher-level thinking and analysis. 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 fac- ulty 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 learn- ing 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 make Tegrity the market-leading solution and service. With McGraw-Hill Education’s Create, faculty can easily rearrange chapters, combine material from other content Through the connection of psychology to students’ own sources, and quickly upload content you have written, such as lives, concepts become more relevant and understandable. your course syllabus or teaching notes, using McGraw-Hill NewsFlash exercises tie current news stories to key psychologi- Education’s Create. Find the content you need by searching cal principles and learning objectives. After interacting with a through thousands of leading McGraw-Hill Education text- contemporary news story, students are assessed on their ability books. Arrange your book to fit your teaching style. Create even to make the link between real life and research findings. Topics allows you to personalize your book’s appearance by selecting include brain chemistry and depression, eating disorders in the cover and adding your name, school, and course informa- boys, and criticisms of the DSM-5. tion. Order a Create book, and you will receive a complimentary print review copy in three to five business days or a compli- Thinking Critically About Abnormal mentary electronic review copy via email in about an hour. Psychology Experience how McGraw-Hill Education empowers you to teach Updated with DSM-5 content, Faces of Abnormal Psychology your students your way. http://create.mheducation.com connects students to real people living with psychological disor- ders. Through its unique video program, Faces of Abnormal TRUSTED SERVICE AND SUPPORT Psychology helps students gain a deeper understanding of psy- McGraw-Hill Education’s Connect offers comprehensive ser- chological disorders and provides an opportunity for critical vice, support, and training throughout every phase of your thinking. implementation. If you’re looking for some guidance on how to Interactive Case Studies help students understand the use Connect, or want to learn tips and tricks from super-users, complexities of psychological disorders. Co-developed with you can find tutorials as you work. Our Digital Faculty psychologists and students, these immersive cases bring the Consultants and Student Ambassadors offer insight into how to intricacies of clinical psychology to life in an accessible, achieve the results you want with Connect. xvi Preface INTEGRATION WITH YOUR LEARNING Revised coverage of the cognitive revolution MANAGEMENT SYSTEM Increased attention to disadvantages of McGraw-Hill integrates your digital products from McGraw-Hill deinstitutionalization Education with your school’s learning management system Revised coverage on the role of correctional facilities (LMS) for quick and easy access to best-in-class content and Updated coverage of the Affordable Care Act and mental learning tools. Build an effective digital course, enroll students health with ease, and discover how powerful digital teaching can be. Available with Connect, integration is a pairing between an CHAPTER 2 institution’s LMS and Connect at the assignment level. It shares assignment information, grades, and calendar items from New statistics on benzodiazepines and overdoses Connect into the LMS automatically, creating an easy-to-­manage Updated coverage of electroconvulsive therapy effects course for instructors and simple navigation for students. Our Updated research on brain stimulation assignment-level integration is available with Blackboard Learn, Revised coverage on the difference between modeling and Canvas by Instructure, and Brightspace by D2L, giving you observational learning access to registration, attendance, assignments, grades, and Revised coverage on the distinction between the pleasure course resources in real time, in one location. principle and the reality principle Revised coverage of Freudian concepts Updated coverage of Dialectical Behavioral Therapy Instructor Supplements (DBT) adaptations and Acceptance and Commitment Instructor’s Manual The instructor’s manual provides a wide Therapy (ACT) variety of tools and resources for presenting the course, Added coverage of Unified Protocol (UP) including learning objectives and ideas for lectures and Added content on cultural competence discussions. New content on cultural adaptations of treatment Test Bank By increasing the rigor of the test-bank development process, McGraw-Hill Education has raised the bar for stu- dent assessment. A coordinated team of subject-matter CHAPTER 3 experts methodically vetted each question and each set of New coverage on computerized assessment possible answers for accuracy, clarity, effectiveness, and Revised coverage of key DSM topics accessibility; each question has been annotated for level of Revised coverage concept of DSM axes difficulty, Bloom’s taxonomy, APA learning outcomes, and Updated research on DSM-5 reliability corresponding coverage in the text. Organized by chapter, the questions are designed to test factual, conceptual, and applied understanding. All test questions are available within CHAPTER 4 TestGen™ software and as Word documents. Revised presentation of correlation PowerPoint Presentations The PowerPoint presentations, avail- Strengthened coverage (with new examples) of the able in both dynamic lecture-ready and accessible WCAG- difference between correlation and causation compliant versions, highlight the key points of the chapter Revised presentation of demand characteristics and include supporting visuals. All of the slides can be modi- New example for placebo control group for fied to meet individual needs. therapy Image Gallery The Image Gallery features the complete set of Strengthened coverage on the limitations of laboratory downloadable figures and tables from the text. These can be studies easily embedded by instructors into their own PowerPoint slides. Revised coverage of the types of genetic studies Revised presentation of adoption studies Strengthened coverage of meta-analysis CHAPTER-BY-CHAPTER Added coverage of Research Domain Criteria (RDoC) CHANGES Revisions based on the student heat map are reflected primarily CHAPTER 5 in Chapters 2, 5, 7, 9, and 15. Other content changes include the following: Revised coverage with new example of dissociation in trauma Clarified distinction between nervios and ataque CHAPTER 1 de nervios Updated coverage on the dimensions of abnormality on a Revised presentation of neuroimaging findings related to continuum trauma  Preface xvii Strengthened presentation (with examples) of exposure Updated material on genetic and brain findings relating to therapy in cognitive-behavioral therapy (CBT) depression Revised coverage of prolonged exposure and cognitive Added coverage of psychosocial contributors to bipolar processing therapy disorders Strengthened coverage of exposure treatment for Added example of reward sensitivity phobia Updated findings on selective serotonin reuptake inhibitors Revised coverage of social anxiety disorder (SSRIs) and suicide Revised coverage of panic disorder diagnosis Revised coverage of selective serotonin-norepinephrine New coverage of the cognitive aspect of panic reuptake inhibitors (SNRI) Integrated coverage of cognitive factors of posttraumatic Revised coverage of the pros and cons of lithium stress disorder (PTSD) Added lamotrigine to medical treatments for bipolar Revised coverage of benzodiazepines in treating PTSD disorders Improved coverage of general anxiety disorder definition Updated coverage of suicide epidemiology and (GAD) demographics Added coverage of emotion regulation therapy (ERT) for Added coverage of African American suicide rates and GAD updated all coverage of ethnicity rates Revised presentation of obsessive compulsive disorder Added coverage of anxiety and suicide (OCD) diagnosis Added content on new media and suicide New example of compulsions Updated research on impulsivity Revised coverage of body dysmorphic disorder Added content on the interpersonal theory of suicide Added definitions of treatment vs. prevention Updated coverage of nonsuicidal self-injury CHAPTER 6 Revised coverage of the reliability and controversies of CHAPTER 8 DSM-5 Updated treatment coverage Added historical factors in discussion of delusions Revised presentation of research on stress and Updated research on hallucinations in general population maltreatment Added research on anticipatory emotion Updated coverage of prognosis relating to conversion Updated research on prognoses for psychotic disorders, disorders including for suicide Updated coverage of the science on theories of dissociative Integration of cognitive and biosocial theories of identity disorder (DID) schizophrenia New coverage of treatment outcome research Added material on schizophrenia and bipolar family Revised coverage of dissociative fugue comorbidity Updated status of social drift research Updated status of stressful events research CHAPTER 7 Updated evidence on treatment efficacy Clarified definition and organization of subtypes of depression CHAPTER 9 Revised coverage relating to the different bipolar disorders New material on cognitive treatment for schizotypal Strengthened coverage of bipolar episodes and diagnoses personality disorder Revised presentation of cyclothymia Added example of splitting New material on the distinction between episodes and Updated status of pharmacological treatment for general reactivity in bipolar disorder borderline personality disorder Improved coverage, with examples, of creativity in mood Clarified coverage of therapy for histrionic personality disorders disorder Strengthened coverage of hopelessness in depression Revised coverage of narcissism subtypes New material on the different bipolar disorders Clarified difference between avoidant and schizoid Revised coverage of cohort effects personality disorders Revised coverage of gender differences in depression Clarified distinction between obsessive-compulsive New material on puberty and gender differences in personality disorder and obsessive-compulsive disorder depression Clarified and updated coverage of alternative dimensional New material on racial and ethnic differences models for personality disorders xviii Preface CHAPTER 10 Revised heading of LGB section to separate sexual orientation from disorders Updated coverage of attention-deficit/hyperactivity Added unique considerations for LGB sexual disorder (ADHD) dysfunction Updated status of psychosocial factors Revised coverage of nonpathological consensus and Update on cognitive-behavioral therapy for adult position on conversion therapy ADHD Emphasized continuum aspect of sadism/masochism New material on genetic research Added evidence regarding sadism disorder in offenders Added research on name processing Revised heading for treatment of paraphilic disorders to Updated status of autism spectrum disorder (ASD) emphasize the disorders rather than the interests and medications behaviors Updated statistics on sports traumatic brain injury Updated coverage of cognitive-behavioral therapy for Added research on early identification paraphilias Updated coverage of delirium research and treatment Significant revision of the gender dysphoria (GD) section to emphasize distress and impairment criteria CHAPTER 11 Updated research on GD prevalence, associated psychopathology, and risk factors for HIV Updated contradictory findings on physiological reactivity Added new coverage of gender diversity and transgender in conduct disorders along the continuum Updated findings on Fast Track and conduct disorders Updated findings on brain in GD Updated coverage on drugs are not first-line treatments for New coverage of GD in childhood and persistence into conduct disorder and oppositional defiant disorder adulthood New coverage of genetic and epigenetic findings in Added coverage of biological treatment of GD in antisocial personality disorder children Updated findings on amygdala and striatum CHAPTER 14 CHAPTER 12 Updated U.S. and world statistics throughout (prevalence Updated with DSM-5 prevalence of anorexia nervosa of use, abuse, ER visits, and deaths) Updated with DSM-5 prevalence of bulimia nervosa Increased emphasis on recent increases in use/abuse of New research on leveling-out of prevalence of bulimia methamphetamine and opioids nervosa since 2000s Updated coverage of e-cigarettes Updated DSM-5 and international prevalence of binge- Added coverage of opioid epidemic eating disorder Updates on laws regarding medical and recreational uses Revised coverage of DSM-5 categories eating disorders not of marijuana otherwise specified (EDNOS) and other specified feeding Updated coverage of gambling diagnosis and treatment or eating disorder Added coverage of Internet gaming disorder and other Updated coverage of obesity drugs behavioral addictions Added coverage of male eating disorders and muscularity ideal Updated research on thinness ideal CHAPTER 15 Revised coverage of the treatment of eating disorders Updated epidemiology and statistics throughout New coverage of treatment access, Internet-based Revised coverage of link between psychological diagnosis intervention, and prevention of eating disorders and physical health Updated cancer intervention research Updated status of research on psychosocial treatment and CHAPTER 13 coronary heart disease (CHD) New title: Sexual Disorders and Gender Diversity Streamlined coverage of depression and CHD Updated coverage of sexual desire prevalence Added discussion of culturally sensitive interventions Added material on cognitions to include men New coverage of mobile health interventions (along with New material on culture and gender roles updates to Internet intervention) Updated research on testosterone Clarified sleep brain-wave language Updated research on biological treatments for women Added examples for sleep study Revised heterosexual-specific language for early ejaculation Updated research on narcolepsy as autoimmune problem treatment Revised definition of hypoventilation  Preface xix Updated prevalence of sleep apnea Revised coverage of states’ use of insanity rules Revised coverage of circadian rhythm disorders New introduction to section on justice system Revised coverage of arousal Updated rates of mental illness in prisons Increased coverage of confusional arousals Added examples for REM sleep disorder Added coverage of medications for nightmare disorder ACKNOWLEDGMENTS We are grateful to Brett Marroquín, Loyola Marymount University, CHAPTER 16 for his invaluable contributions to this edition. Updated research on violence Added prevalence of incompetence to stand trial  Chapter 1 ©travelview/Shutterstock Looking at Abnormality CHAPTER OUTLINE Abnormality Along the Continuum Shades of Gray Discussion Extraordinary People Chapter Summary Defining Abnormality Key Terms Shades of Gray Historical Perspectives on Abnormality The Emergence of Modern Perspectives Modern Mental Health Care Chapter Integration 2 Abnormality Along the Continuum Behaviors, thoughts, and feelings are one Behaviors, thoughts, and feelings are or more of the following: the following: Highly unusual for the social context Typical for the social context The source of significant individual distress Not distressing to the individual Significantly interfering with social or Not interfering with social life or work/school occupational functioning Not dangerous Highly dangerous to the individual or others (Example: College students who are self-confident Socially established (Example: College students who are hopeless about and happy, perform to their capacity in school, division between the future, are self-loathing, chronically abuse drugs, and have good friends) normal and abnormal fail courses, and have alienated all their friends) Normal Abnormal Behaviors, thoughts, and feelings are one or more of the following: Somewhat unusual for the social context Distressing to the individual Interfering with social or occupational functioning Dangerous (Example: College students who are often unsure and self-critical, occasionally abuse prescription drugs, fail some courses, and avoid friends who disapprove of their drug use) As humans, we think, we feel, we behave. Most of the time, our think there is a clear dividing line between normal variations in thoughts, feelings, and behaviors help us function in everyday thoughts, emotions, and behaviors and what we would label life and are in the service of important goals or values we hold. “abnormal.” Once an individual’s behaviors or feelings crossed Sometimes, however, we all have thoughts that upset us, expe- that line, we would be justified in saying that there is something rience feelings we’d rather not have, and act in ways that are wrong with that person or that he or she has a disorder. As we self-­defeating or detrimental to others. We may find ourselves in discuss in this chapter and throughout this book, however, there situations in which we can’t think, feel, or behave as others is increasing evidence that no such dividing line exists, perhaps would—­as when, for example, we can’t let go of a failed relation- for any of the mental health problems that are currently recog- ship. We may become upset over a situation that others don’t nized. As you can see above, it can be hard to determine when find distressing, such as getting an average grade on an exam. behaviors, thoughts, and feelings become unusual, distressing, Our thoughts, feelings, or behaviors may be interfering with our functionally impairing, or dangerous—­key determinants of abnor- functioning in everyday life—­for example, if we become afraid to mality. We make decisions about where to draw the line that walk alone after being mugged. Or we may be acting in ways indicates a sufficient amount of abnormality to warrant a diagno- that are dangerous to ourselves or others, such as driving a car sis or treatment. You will see that this continuum model of when intoxicated. abnormality applies to all the disorders we discuss in this book. Problems in thoughts, feelings, and behavior vary from nor- In this chapter, we discuss some of the factors that influence how mal to abnormal, as illustrated in the diagram above. We’d like to thoughts, emotions, and behaviors are labeled abnormal. Abnormality Along the Continuum 3 4 Chapter 1 Looking at Abnormality Extraordinary People My illness began slowly, gradually, when I was between Utah: The cliffs along the side of the road took on a the ages of 15 and 17. During that time reality became human appearance, and I perceived them as women, distant and I began to wander around in a sort of haze, bedraggled and weeping. At the time I didn’t know what foreshadowing the delusional world that was to come to make of these changes in my perceptions. On the one later. I also began to have visual hallucinations in which hand, I thought they came as a gift from God, but on the people changed into different characters, the change other hand, I feared that something was dreadfully indicating to me their moral value. For example, the wrong. However, I didn’t tell anyone what was happen- mother of a good friend always changed into a witch, ing; I was afraid of being called insane. I also feared, per- and I believed this to be indicative of her evil nature. haps incredibly, that someone would take it lightly and Another type of visual hallucination I had at this time is tell me nothing was wrong, that I was just having a rough exemplified by an occurrence during a family trip through adolescence, which was what I was telling myself. Source: Anonymous, 1992. The study of abnormal psychology is the study of People talk as if they have an intuitive sense of what ­people, like the young woman in the Extraordinary abnormal behavior is. Let’s explore some of the ways People feature, who suffer mental, emotional, and often abnormality has been defined. physical pain, often referred to as psychopathology. Sometimes the experiences of people with psychopa- thology are as unusual as those this young woman Mental Illness describes. Sometimes, however, people with psychopa- A common belief is that behaviors, thoughts, or feel- thology have experiences that are familiar to many of us ings can be viewed as pathological or abnormal if they but more extreme, as when everyday sadness trans- are symptoms of a mental illness. This implies that forms into life-­altering depression. a disease process, much like hypertension or diabetes, In this book we explore the lives of people with is present. For example, when many people say that troubling psychological symptoms to understand how an individual “has schizophrenia” (which is character- they think, what they feel, and how they behave. We ized by unreal perceptions and severely irrational investigate what is known about the causes of these thinking), they imply that he or she has a disease that symptoms and the appropriate treatments for them. should show up on some sort of biological test, just as The purpose of this book is not only to provide you hypertension shows up when a person’s blood pres- with information, facts and figures, theories, and sure is taken. research but also to help you understand the experi- To date, however, no biological test is available to ence of people with psychological symptoms. The diagnose any of the types of abnormality we discuss in good news is that, thanks to an explosion of research this book (Hyman, 2010). This is not just because we in the past few decades, effective biological and psy- do not yet have the right biological tests. In modern chological treatments are available for many of the conceptualizations, mental disorders are not viewed as mental health problems we discuss. singular diseases with a common pathology that can be identified in all people with the disorder. Instead, mental health experts view mental disorders as collec- DEFINING ABNORMALITY tions of problems in thinking or cognition, in emo- In popular culture, there are a lot of words for people tional responding or regulation, and in social behavior and behaviors that seem abnormal: around the bend, (Cuthbert & Insel, 2013; Hyman, 2010). Thus, for bananas, barmy, batty, berserk, bonkers, cracked, example, a person diagnosed with schizophrenia has a crazy, cuckoo, daft, delirious, demented, deranged, collection of problems in rational thinking and in dingy, erratic, flaky, flipped out, freaked out, fruity, responding emotionally and behaviorally in everyday insane, kooky, lunatic, mad, mad as a March hare, life, and it is this collection of problems that we label mad as a hatter, maniacal, mental, moonstruck, nuts, schizophrenia. It is still possible, and in the case of nutty, nutty as a fruitcake, of unsound mind, out of schizophrenia likely, that biological factors are associ- one’s mind, out of one’s tree, out to lunch, potty, psy- ated with these problems in thinking, feeling, and cho, screw loose, screwball, screwy, silly, touched, behaving. But it is unlikely that a singular disease pro- unbalanced, unglued, unhinged, unzipped, wacky. cess underlies the symptoms we call schizophrenia.  Defining Abnormality 5 Cultural Norms judgments of abnormality. Yet opponents of cultural relativism argue that dangers arise when cultural Consider these behaviors: norms are allowed to dictate what is normal or abnor- 1. A man driving a nail through his hand mal. In particular, psychiatrist Thomas Szasz (1961, 2011) noted that throughout history, societies have 2. A woman refusing to eat for several days labeled individuals and groups abnormal in order to 3. A man barking like a dog and crawling on the justify controlling or silencing them. Hitler branded floor on his hands and knees Jews abnormal and used this label as one justification 4. A woman building a shrine to her dead husband for the Holocaust. The former Soviet Union some- in her living room and leaving food and gifts for times branded political dissidents mentally ill and him at the altar confined them in mental hospitals. When the slave trade was active in the United States, slaves who tried Do you think these behaviors are abnormal? You to escape their masters could be diagnosed with might reply, “It depends.” Several of these behaviors a mental disease that was said to cause them to desire are accepted in certain circumstances. In many reli- freedom; the prescribed treatment for this disease was gious traditions, for example, refusing to eat for whipping and hard labor. a period of time, or fasting, is a common ritual of Most mental health professionals these days do cleansing and penitence. You might expect that some not hold an extreme relativist view on abnormality, of the other behaviors listed, such as driving a nail recognizing the dangers of basing definitions of through one’s hand or barking like a dog, are abnor- abnormality solely on cultural norms. Yet even those mal in all circumstances, yet even these behaviors are who reject an extreme cultural-­relativist position rec- accepted in certain situations. In Mexico, some ognize that culture and gender have a number of influ- ­Christians have themselves nailed to crosses on Good ences on the expression of abnormal behaviors and Friday to commemorate the crucifixion of Jesus. on the way those behaviors are treated. First, culture Among the Yoruba of Africa, traditional healers and gender can influence the ways people express act like dogs during healing rituals (Murphy, 1976). symptoms. People who lose touch with reality often Thus, the context, or circumstances surrounding a believe that they have divine powers, but whether they behavior, influences whether the behavior is viewed as believe they are Jesus or Mohammed depends on their abnormal. religious background. Cultural norms play a large role in defining abnor- Second, culture and gender can influence peo- mality. A good example is the behaviors people are ple’s willingness to admit to certain types of behaviors expected to display when someone they love dies or feelings (Snowden & Yamada, 2005). People in (Rosenblatt, 2008). In cultures dominated by Shinto Eskimo and Tahitian cultures may be reluctant to and Buddhist religions, it is customary to build altars admit to feeling anger because of strong cultural to honor dead loved ones, to offer them food and gifts, norms against the expression of anger. The Kaluli of and to speak with them as if they were in the room. In cultures dominated by Christian and Jewish religions, such practices would potentially be considered quite abnormal. Cultures have strong norms for what is consid- ered acceptable behavior for men versus women, and these gender-­ role expectations also influence the labeling of behaviors as normal or abnormal (Addis, 2008). In many cultures, men who display sadness or anxiety or who choose to stay home to raise their chil- dren while their wives work are at risk of being labeled abnormal, while women who are aggressive or who don’t want to have children are at risk of being labeled abnormal. Cultural relativism is the view that there are no universal standards or rules for labeling a behavior abnormal; instead, behaviors can be labeled abnormal only relative to cultural norms (Snowden & Yamada, 2005). The advantage of this perspective is that it hon- ors the norms and traditions of different cultures, In Mexico, some Christians have themselves nailed to a cross to commemorate the rather than imposing the standards of one culture on crucifixion of Jesus. ©AARON FAVILA/AP Images 6 Chapter 1 Looking at Abnormality The Four Ds of Abnormality If we do not want to define abnormality only on the basis of cultural norms, and if we cannot define abnor- mality as the presence of a mental illness because no singular, identifiable disease process underlies most psychological problems, how do we define abnormal- ity? Modern judgments of abnormality are influenced by the interplay of four dimensions, often called “the four Ds”: dysfunction, distress, deviance, and danger- ousness. Behaviors, thoughts, and feelings are dysfunc- tional when they interfere with the person’s ability to function in daily life, to hold a job, or to form close relationships. The more dysfunctional behaviors and feelings are, the more likely they are to be considered abnormal by mental health professionals. For exam- ple, thinking that is out of touch with reality (such as believing you are Satan and should be punished) makes it difficult to function in everyday life and so is When the slave trade was active, slaves who tried to escape were sometimes labeled considered dysfunctional. as having mental illness and were beaten to “cure” them. ©Jean Baptiste Debret/Getty Behaviors and feelings that cause distress to the Images individual or to others around him or her are also likely to be considered abnormal. Many of the prob- New Guinea and the Yanomamo of Brazil, however, lems we discuss in this book cause individuals tremen- value the expression of anger and have elaborate and dous emotional and even physical pain; in other cases, complex rituals for expressing it (Jenkins, Kleinman, & the person diagnosed with a disorder is not in distress Good, 1991). but causes others distress—­ for example, through Third, culture and gender can influence the types chronic lying, stealing, or violence. of treatments deemed acceptable or helpful for people Highly deviant behaviors, such as hearing voices exhibiting abnormal behaviors. Some cultures may when no one else is around, lead to judgments of view drug therapies for psychopathology as most abnormality. What is deviant is influenced by cultural appropriate, while others may be more willing to norms, of course. Finally, some behaviors and feel- accept psychotherapy (Snowden & Yamada, 2005). ings, such as suicidal gestures, are of potential harm Throughout this book, we will explore these influences to the individual, whereas other behaviors and feel- of culture and gender on behaviors labeled abnormal. ings, such as excessive aggression, could potentially SHADES OF GRAY Consider the following descriptions of two students. Mark is what you might call a “heavy drinker.” Although he is only 18, he has ready access to alcohol, In the year between her eighteenth and nineteenth and most nights he typically drinks at least five or six birthdays, Jennifer, who is 5′6″, dropped from a weight beers. He rarely feels drunk after that much alcohol, of 125 pounds to 105 pounds. The weight loss began though, so he might also throw back a few shots, espe- when Jennifer had an extended case of the flu and cially when he is out partying on Saturday nights. He’s lost 10 pounds. Friends complimented her on being been caught a few times and received tickets for thinner, and Jennifer decided to lose more weight. underage drinking, but he proudly displays them on She cut her intake of food to about 1,200 calories, his dorm wall as badges of honor. Mark’s grades are avoiding carbs as much as possible, and began run- not what they could be, but he finds his classes boring ning a few miles every day. Sometimes she is so hun- and has a hard time doing the work. gry she has trouble concentrating on her schoolwork. Jennifer values her new lean look so much, however, Do you find Jennifer’s or Mark’s behaviors that she is terrified of gaining the weight back. Indeed, abnormal? How would you rate their level of she’d like to lose a few more pounds so she could fit dysfunction, distress, deviance, and danger? into a size 2. (Discussion appears at the end of this chapter.)  Historical Perspectives on Abnormality 7 harm others. Such dangerous behaviors and feelings Driving Away Evil Spirits are often seen as abnormal. Historians speculate that even prehistoric people had The four Ds together make up mental health pro- a concept of insanity, probably one rooted in super- fessionals’ definition of behaviors or feelings as abnor- natural beliefs (Selling, 1940). A person who acted mal or maladaptive. The experiences of the woman oddly was suspected of being possessed by evil spirits. described in Extraordinary People presented at the The typical treatment for abnormality, according to beginning of this chapter would be labeled abnormal supernatural theories, was exorcism—­driving the evil based on these criteria because the symptoms inter- spirits from the body of the suffering person. Shamans, fere with her daily functioning, cause her suffering, or healers, would recite prayers or incantations, try to are highly unusual, and are potentially dangerous talk the spirits out of the body, or make the body an to her. uncomfortable place for the spirits to reside—­often We are still left making subjective judgments, through extreme measures such as starving or beating however. How much emotional pain or harm must the person. At other times, the person thought to be a person be suffering? How much should the behav- possessed by evil spirits would simply be killed. iors be interfering with daily functioning? We return One treatment for abnormality during the Stone to the continuum model to acknowledge that each of Age and well into the Middle Ages may have been to the four Ds lies along its own continuum. A person’s drill holes in the skull of a person displaying abnormal behaviors and feelings can be more or less dysfunc- behavior to allow the spirits to depart (Tatagiba, tional, distressing, deviant, or dangerous. Thus, there Ugarte, & Acioly, 2015). Archaeologists have found is no sharp line between what is normal and what is skulls dating back to a half-­million years ago in which abnormal. sections of the skull have been drilled or cut away. The tool used for this drilling is called a trephine, and the HISTORICAL PERSPECTIVES operation is called trephination. Some historians believe that people who were seeing or hearing things ON ABNORMALITY that were not real and people who were chronically Across history, three types of theories have been used sad were subjected to this form of brain surgery to explain abnormal behavior. The biological theories (Feldman & Goodrich, 2001). Presumably, if the per- son survived this surgery, the evil spirits would have Some scholars have viewed abnormal behavior as similar to physical believe that holes diseases, caused by the breakdown of systems in the been released and the person’s abnormal behavior found in ancient body. The appropriate cure is the restoration of bodily would decline. However, we cannot know with cer- skulls are from health. The supernatural theories have viewed abnor- tainty that trephination was used to drive away evil trephination, mal behavior as a result of divine intervention, curses, spirits. Other historians suggest that it was used pri- a crude form of marily for the removal of blood clots caused by stone surgery possibly demonic possession, and personal sin. To rid the performed on ­person of the perceived affliction, religious rituals, weapons during warfare and for other medical pur- people acting exorcisms, confessions, and atonement have been pre- poses (Maher & Maher, 1985). abnormally. ©PHAS/ scribed. The psychological theories have viewed abnor- Getty Images mal behavior as a result of traumas, such as Ancient China: Balancing Yin and Yang bereavement, or of chronic stress. According to these Some of the earliest written sources on abnormality theories, rest, relaxation, a change of environment, are ancient Chinese medical texts (Tseng, 1973). The and certain herbal medicines are sometimes helpful. Nei Ching (Classic of Internal Medicine) was probably These three types of theories have influenced how written around 2674 bce by Huang Ti, the legendary people acting abnormally have been regarded in the third emperor of China. society. A person thought to be abnormal because he Ancient Chinese medicine was based on the con- or she was a sinner, for example, would be regarded cept of yin and yang. The human body was said to differently from a person thought to be abnormal contain a positive force (yang) and a negative force because of a disease. (yin), which confronted and complemented each other. If the two forces were in balance, the individual Ancient Theories was healthy. If not, illness, including insanity, could result. For example, excited insanity was considered Our understanding of prehistoric people’s concep- the result of an excessive positive force: tions of abnormality is based on inferences from archaeological artifacts—­fragments of bones, tools, The person suffering from excited insanity ini- artwork, and so on—­as well as from ancient writings tially feels sad, eating and sleeping less; he then about abnormal behavior. It seems that humans have becomes grandiose, feeling that he is very smart always viewed abnormality as something needing spe- and noble, talking and scolding day and night, cial explanation. singing, behaving strangely, seeing strange things, 8 Chapter 1 Looking at Abnormality hearing strange voices, believing that he can see Ancient Egypt, Greece, and Rome: the devil or gods, etc. As treatment for such an Biological Theories Dominate excited condition, withholding food was sug- Other ancient writings on abnormal behavior are gested, because food was considered to be the found in the papyri of Egypt and Mesopotamia (Veith, source of positive force and the patient was 1965). The oldest of these, a document known as the thought to be in need of a decrease in such force. Kahun Papyrus after the ancient Egyptian city in (Tseng, 1973, p. 570) which it was found, dates from about 1900 bce. This Chinese medical philosophy also held that human document lists a number of disorders, each followed emotions were controlled by internal organs. When by a physician’s judgment of the cause of the disorder the “vital air” was flowing on one of these organs, an and the appropriate treatment. ind