PSYCH 311 Module I. Defining and Classifying Abnormal Behavior.pdf

Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 Schoo...

Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 MODULE I DEFINING AND CLASSIFYING ABNORMAL BEHAVIOR This module aims to discuss and identify the criteria of abnormality and will clarify the manner in which mental health professionals classify abnormal behavior. It will also explore criticisms and usefulness of a diagnostic classification of abnormal behavior. Topic Learning Outcomes: 1. Define abnormal behavior and distinguish it from normal behavior. 2. Understand classification systems and determine their advantages and disadvantages. Psychology is a science that seeks to explain, measure and sometimes change the behavior of man and animals. Abnormal Psychology is the field devoted to the scientific study of abnormal behavior to describe, predict, explain, and change abnormal patterns and functioning. WHY DEFINITIONS ARE IMPORTANT (& TRICKY) Definitions are powerful because they shape how individuals are viewed, treated, and respected within our culture. Definitions are also tricky because they rarely fully encompass the wide range of behaviors that people demonstrate. What is normal to one person/culture/time period is abnormal to another. If your next- door neighbor scrubs his front porch twice every day and spends virtually all his time cleaning and recleaning the house, is he normal? If your sister-in-law goes to one physician after another seeking treatment for ailments that appear imaginary, is she psychologically healthy? How are we to judge what’s normal and what’s abnormal? More importantly, who does the judging?  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 These are complex questions. In a sense, all people make judgments about normality in that all express opinions about others’ and perhaps their own mental health. Of course, formal diagnoses of psychological disorders are made by mental health professionals. Criteria of Abnormal Behavior (The "4 D's" of Abnormality) There are four general criteria that psychologists use to identify abnormal behavior: Deviance There are three different types: deviation from social norms, statistical frequency, and deviation from an ideal. A. Deviation from Social Norms The social norms approach says behavior is considered abnormal if it deviates greatly from accepted social standards, values, or norms. However, a definition of abnormality based solely on deviations from social norms changes with time. For example, 25 years ago, very few males wore earrings; today, many consider earrings very fashionable. Similarly, 40 years ago, a woman who preferred to be very thin was considered to be ill and in need of medical help. Today, our society pressures women to be thin, like fashion models in the media. There are several influences on social norms that need to be taken into account when considering the social norms definition: Culture - Different cultures and subcultures have different social norms. Culture-Bound Syndromes - Some abnormal behavior patterns, called culture-bound syndromes, occur in some cultures but are rare or unknown in others. Examples of Culture-Bound Syndromes from Other Cultures Dhat syndrome - A disorder (described further in Chapter 6) affecting males, found principally in India that involves intense fear or anxiety over the loss of semen through nocturnal emissions, ejaculations, or excretion with urine (in fact, semen doesn’t mix with urine). In Indian culture, there is a popular belief that loss of semen depletes a man of his vital natural energy. Ataque de nervios (“attack of nerves”) - A way of describing states of emotional distress among Latin American and Latin Mediterranean groups, it most commonly involves features such as shouting uncontrollably, fits of crying, trembling, feelings of warmth or heat rising from the chest to the head, and aggressive verbal or physical behavior. These episodes are usually precipitated by a stressful event affecting the family (e.g., receiving news of the death of a family member) and are accompanied by feelings of being out  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 of control. After the attack, the person returns quickly to his or her usual level of functioning, although there may be amnesia for events that occurred during the episode. Context and Situation - At any one time, a type of behavior might be considered normal, whereas at another time, the same behavior could be abnormal, depending on context and situation. Historical Context - Time must also be taken into account, as what is considered abnormal at one time in one culture may be normal at another time, even if the same culture. Age and Gender - Different people can behave in the same way, and some will be normal and others abnormal, depending on age and gender (and sometimes other factors). B. Statistical Rarity From a statistical point of view, abnormality is any substantial deviation from a statistically calculated average. Those who fall within the “golden mean”- those who do what most other people do are normal, while those whose behavior differs from that of the majority are abnormal. The “statistical rarity” approach makes defining abnormality a simple task. However, there are obvious difficulties with this approach. As mentioned earlier, the norm violation approach can be criticized for exalting the shifting values of social groups. Yet the major weakness of statistical approach is that it has no values; it lacks any system for differentiating between desirable and undesirable behaviors. In the absence of such system, it is the average behavior that tends to be considered the ideal. Such a point of view is potentially very dangerous, since it discourages even valuable deviations from the norm. Not only mentally retarded people but also geniuses- and particularly geniuses with new ideas, may be considered candidates for psychological treatment. C. Deviation from an Ideal Mental Health (defined by psychological theories)  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 The concept of ideal mental health was proposed as a criterion of normality by humanistic psychologists Carl Rogers and Abraham Maslow in the 1950s. Deviations from the ideal are taken to indicate varying degrees of abnormality. Maslow (1946) believed that an individual’s life goal was self-actualization, which he described as a desire for self- fulfillment. Many psychoanalytically oriented psychologists have used the concept of consciousness and balance as criteria for abnormality. Humanistic and person-centered psychologists have proposed aspects of maturity, competence, autonomy and resistance to stress as vital to feelings of well- being. In the light of such theories, many people may judge themselves to be abnormal, or at least in need of some treatment, even though they have no particularly troubling behavioral symptoms. The shortcomings of this approach are obvious. First, a person who falls short of an ideal is not necessarily abnormal or in need of treatment. He is simply imperfect like all human beings. Second, psychological theories are relative to time and place as social norms, and they change more quickly. Thus, if norms are weak foundation for the evaluation of mental health, theoretical ideals are even weaker. Dysfunction Dysfunction refers to a breakdown in cognition, emotion, and/or behavior. For instance, an individual who is experiencing delusions that he is an omnipotent deity would have a breakdown in cognition because his thought processes are not consistent with reality. An individual who is unable to experience pleasure would have a breakdown in emotion. Finally, an individual who is unable to leave her home and attend work due to fear of having a panic attack would be exhibiting a breakdown in behavior. Abnormal behavior has the capacity to make our well-being difficult to obtain and can be assessed by looking at an individual’s current performance and comparing it to what is expected in general or how the person has performed in the past. Distress or Impairment Distress can be psychological or physical pain or both concurrently. Simply put, distress refers to suffering. Alone though, distress is not sufficient enough to describe behavior as abnormal. Why is that? The loss of a loved one would cause even the most “normally” functioning individual pain and suffering. An athlete who experiences a career-ending injury would display distress as well. Suffering is part of life and cannot be avoided. And some people who display abnormal behavior are generally positive while doing so. If distress is absent, impairment must be present to deem behavior abnormal. Impairment is when the person experiences a disabling condition “in social, occupational, or other important activities”. In other words, impairment refers to when a person loses the capacity to function normally in daily life (e.g., can no longer maintain minimum  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 hygiene standards, pay bills, attend social functions, or go to work). They also fall short of taking care of their loved ones, including family members and friends. Dangerousness Dangerousness refers to when behavior represents a threat to the person's or others' safety. Individuals expressing suicidal intent, those experiencing acute paranoid ideation combined with aggressive impulses (e.g., wanting to harm people who are perceived as “being out to get them”), and many individuals with antisocial personality disorder may be considered dangerous. Nevertheless, individuals with depression, anxiety, and obsessive-compulsive disorder are typically no more a threat to others than individuals without these disorders. As such, it is important to note that having a mental disorder does not automatically deem one to be dangerous, and most dangerous individuals are not mentally ill. Classifying Abnormal Behavior Classification is a process by which complex phenomena are organized into categories, classes, or ranks so as to bring together those things that most resemble each other & to separate those that differ. All sciences classify – that is, they order the objects of their study by identifying crucial similarities among them and sorting them into groups according to those similarities. The classification of abnormal behavior appears to have begun with Hippocrates (5th century BC). Mental Disorders were classified into mania (abnormal excitement), melancholia (abnormal dejection), phrenitis (brain fever) hysteria, the Scythian disease (transvestism), and epilepsy. However, the first truly comprehensive classification system for severe mental disorders was developed by Kraeplin in the late nineteenth century. All later systems were influenced by Kraeplin’s taxonomy. At present, two different classification systems of behavioral disorders are in use: the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) as proposed by the American Psychiatric Association (DSM 5- 2013), and the “International Classification of Diseases” (ICD) as adopted by the World Health Organization (ICD -11).  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 The DSM The first edition of the DSM was published in 1952 based on census data and psychiatric hospital statistics. Since then, the DSM has been revised five times. The last major revision was the fourth edition (DSM-IV), published in 1994; an update of that document was produced in 2000 (DSM-IV-TR). The fifth edition (DSM-5) is the most recent edition and was published in 2013. The DSM is descriptive, not explanatory. It describes the diagnostic features—or, in medical terms, symptoms—of abnormal behaviors; it does not attempt to explain their origins or adopt any particular theoretical framework, such as psychodynamic or learning theory. A major difference between the DSM-5 and the previous version, the DSM-IV, is that the new version dispenses with the multiaxial framework of the previous version. The DSM-IV included five axes or dimensions, enabling a clinician to evaluate the person’s psychological functioning more comprehensively than merely a diagnosis. These five axes, which constituted a multiaxial system of assessment, comprised an inventory of mental disorders (coded on Axis I and Axis II), as well as symptoms indicating the presence of medical conditions and diseases (Axis III) and of psychosocial and environmental problems or sources of stress affecting the patient’s psychological functioning (Axis IV), and a rating scale used to judge the person’s overall level of functioning (Axis V). However, because the multiaxial system proved too cumbersome to use, the developers of the DSM- 5 replaced it with a simpler system that clinicians can use to render diagnostic judgments as well as identify stressful factors affecting the person’s psychological functioning and disability factors that should be taken into account to provide the most appropriate level of care. DSM 5 The DSM-5 is organized into 20 general categories of mental Disorders. Table 1 lists the 20 diagnostic categories or groupings of disorders in the DSM-5, along with examples of disorders in each category. The DSM-5 diagnostic table below table1 shows the diagnostic criteria for a particular type of Obsessive- Compulsive and Related Disorder called Hoarding Disorder. The DSM classifies disorders people have, not the people themselves. Consequently, clinicians don’t classify a person as a schizophrenic or a depressive. Rather, they refer to an individual with schizophrenia or a person with major depression. This difference in terminology is not simply a matter of semantics. To label someone a schizophrenic carries an unfortunate and stigmatizing implication that a person’s identity is defined by the disorder the person has.  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 DSM -5 Categories of Mental Disorders Diagnostic Categories Examples of Specific Disorders Neurodevelopmental Disorders Intellectual Disabilities Communication Disorders Autism Spectrum Disorder Attention-Deficit/Hyperactivity Disorder Specific Learning Disorder Motor Disorders Tic Disorders Schizophrenia Spectrum and other Psychotic Delusional Disorder Related Disorders Brief Psychotic Disorder Schizophreniform Disorder Schizophrenia Schizoaffective Disorder Bipolar and Related Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Depressive Disorders Disruptive Mood Dysregulation Disorder Major Depressive Disorder Persistent Depressive Disorder Premenstrual Dysphoric Disorder Anxiety Disorders Separation Anxiety Disorder Selective Mutism Specific Phobia Social Anxiety Disorder Panic Disorder Agoraphobia Generalized Anxiety Disorder Obsessive- Compulsive and Related Disorders Obsessive-Compulsive Disorder Body Dysmorphic Disorder Hoarding Disorder Trichotillomania (Hair Pulling Disorder) Excoriation (Skin-Picking) Disorder Trauma- and – Stressor- Related Disorders Reactive Attachment Disorder Disinhibited Social Engagement Disorder Posttraumatic Stress Disorder Acute Stress Disorder Adjustment Disorders Dissociative Disorders Dissociative Identity Disorder Dissociative Amnesia Depersonalization/Derealization Disorder Somatic Symptom and Related Disorder Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Factitious Disorder Feeding and Eating Disorders Pica Rumination Disorder Avoidant/Restrictive Food Intake Disorder Anorexia Nervosa  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 Bulimia Nervosa Binge- Eating Disorder Elimination Disorders Enuresis Encopresis Sleep-Wake Disorders Insomnia disorder Hyper somnolence disorder Narcolepsy breathing-related sleep disorders Circadian rhythm sleep-wake disorders Nightmare disorder Sexual Dysfunctions Male hypoactive sexual desire disorder Erectile disorder Female sexual interest/arousal disorder Female orgasmic disorder Delayed ejaculation Premature (early) ejaculation Gender Dysphoria Gender Dysphoria Disruptive, Impulse- Control, and Conduct Conduct disorder Disorders Oppositional defiant disorder Intermittent explosive disorder Substance-elated and Addictive Disorders Alcohol -Related Disorders Caffeine- Related Disorders Cannabis- Related Disorders Hallucinogen- Related Disorders Inhalant-Related Disorders Opioid- Related Disorders Sedative, Hypnotic – Related Disorders Stimulant- Related Disorders Neurocognitive Disorders Delirium Major and Mild Neurocognitive Disorders Personality Disorders Cluster A – Paranoid, Schizoid, and Schizotypal Cluster B – Antisocial, Borderline, Histrionic, and Narcissistic Cluster C – Avoidant, Dependent, and Obsessive- Compulsive Other Personality Disorders Paraphilic Disorders Voyeuristic Disorder Frotteuristic Disorder Transvestic Disorder Sexual Masochism Sexual Sadism Fetishistic Disorder Other Mental Disorders Medication – Induced Movement Neuroleptic – Induced Parkinsonism Disorders and other Adverse Effects of Neuroleptic Malignant Syndrome Medication  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 Relational Problems Other Conditions that may be a focus Abuse and Neglect of Clinical Attention Source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). DSM 5 Diagnostic Criteria for Hoarding Disorder A. Persistent difficulty discarding or parting with possessions, regardless of their actual value. B. This difficulty is due to a perceived need to save the items and to the distress associated with discarding them. C. The difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, or the authorities). D. The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment safe for oneself or others). E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome). F. The hoarding is not better explained by the symptoms of another mental disorder (e.g., obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive defects in major neurocognitive disorder, restricted interests in autism spectrum disorder). Specify if: With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space. (Approximately 80 to 90 percent of individuals with hoarding disorder display this trait.) Specify if: With good or fair insight: The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic. With poor insight: The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary. With absent insight/delusional beliefs: The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary. Source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 Using the DSM classification system, the clinician arrives at a diagnosis by matching the client’s behaviors with the specific criteria that define a particular mental disorder. The examining clinician determines whether a person’s symptoms or problem behaviors match the DSM’s criteria for a particular mental disorder, such as hoarding disorder or schizophrenia. A diagnosis is given only when the minimum number of symptoms or features is present to meet the diagnostic criteria for the particular diagnosis. The DSM is based on a categorical model of classification, which means that clinicians needs to make a categorical or yes–no type of judgment about whether the disorder is present in a given case. This is how it is done: Step one: Engage in the clinical assessment of the client or collect information and draw conclusions through observation, psychological tests, and interviews. This collection of information involves learning about the client’s skills, abilities, personality characteristics, cognitive functioning, emotional functioning, and social context in terms of environmental stressors that are faced. Step two: Organize and analyze the information gathered to determine signs and symptoms manifested. Signs are observable indications of a disorder, whereas symptoms are self- reported physical or psychological effects of a disorder. Step three: Determine whether the particular problem with which the individual presents meets all criteria for mental disorder as described in the DSM 5. Note: The clinician's ability to recognize the signs of psychopathology often determines whether or not a correct diagnosis is made. Making diagnoses requires clinical judgment, not just checking off the symptoms in the criteria. The DSM-5 also emphasizes the need to consider not just the presence of symptoms but also whether those symptoms affect functioning when attempting to understand abnormal behavior. In DSM-5, the use of the Global Assessment of Functioning (GAF) scale, representing the clinician's judgment of the individual’s overall level of functioning, was discontinued for “several reasons, one is the conceptual lack of clarity (i.e., including symptoms, suicide risk, and disabilities in its descriptors). The recommended GAF  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 replacement is the World Health Organization’s Disability Assessment Schedule (WHODAS). The WHODAS was developed through a collaborative international approach with the aim of developing a single generic instrument for assessing health status and functional impairment across different cultures and settings. This psychometrically established measure covers six domains of functioning: Cognition – understanding and communicating Mobility – moving and getting around Self-care – hygiene, dressing, eating, and staying alone Getting along – interacting with other people Life activities – domestic responsibilities, leisure, work, and school Participation – joining in community activities Criticisms of Diagnostic Classification of Abnormal Behavior While diagnostic labels are widely used, they are also widely criticized. Three criticisms merit consideration. 1. Diagnostic labels falsify reality by implying that most abnormal behavior is qualitatively different from normal behavior. In reality, most forms of psychopathology are simply the far end of a long continuum from normal to abnormal, with many gradations in between. The truth, in other words, is far less clear-cut than the diagnostic system. 2. Diagnostic labels give the illusion of explanation. For example, the statement “he hallucinates because he is schizophrenic” seems to have explanatory value. In fact, it has none whatsoever, for “schizophrenic” is simply a term that has been made up to describe a certain behavior pattern involving hallucinations - a behavior pattern of which the cause is unknown. Likewise, “depression,” “phobia,” “paranoid,” and other diagnostic labels are simply descriptive terms, not explanations. This fact is often forgotten. 3. Diagnostic labeling is actually harmful to people, because the label obscures the person’s individuality, inviting therapists to treat the “phobia” or “depression” rather than the human being. In addition, diagnostic labels can do concrete harm, damaging people’s personal relationships, and making it hard for them to get jobs. These three criticisms can be applied to any diagnostic method. But because a psychopathological diagnosis interacts with social values, it is that system that they are most often directed. Although the foregoing criticisms have some validity, some system of diagnosing and classifying disordered behavior has some usefulness: ❖ Classification systems provide us with a nomenclature (a naming system) and enable us to structure information in a more helpful manner. ❖ To distinguish one psychiatric diagnosis from another, so that clinicians can offer the most effective treatment;  Document Code FM-STL-013 COURSE LEARNING PACKETS TEMPLATE Revision No. 01 Saint Louis University Effectivity June 07, 2021 School of Teacher Education and Liberal Arts Page of 202 ❖ To provide a common language among health care professionals; ❖ To organize clinical information that is concise and coherent; ❖ Making the necessary prognosis; ❖ Conducting research in this field; ❖ And to explore the still unknown causes of many mental disorders. References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Durand, V. M., & Barlow, D. H. (2019). Abnormal Psychology Barlow (7th ed.). Australia: Cengage. Hooley, J., Butcher, J., Nock, M., & Mineka, S. (2017). Abnormal psychology (17th ed.). Boston: Pearson.