Abnormal Psychology 15

PSY_C15.qxd 1/2/05 3:43 pm Page 314 Abnormal Psychology 15 CHAPTER OUTLINE LEARNING OBJECTIVES INTRODUCTION WHAT DOES ‘ABNORMAL’ MEAN? WHAT CAUSES ABNORMAL BEHAVIOUR? Biology and genetics Psychodynamics and the parent–child relationship Attachment and security Learned behaviour Distorted thinking Integrative models DISORDERS – SYMPTOMS AND CAUSES Schizophrenia – a living nightmare Mood disorders – depression Anxiety disorders – when fear takes over Eating disorders – bulimia and anorexia Substance use disorders – abuse and dependence Personality disorders – a way of being FINAL THOUGHTS SUMMARY REVISION QUESTIONS FURTHER READING PSY_C15.qxd 1/2/05 3:43 pm Page 315 Learning Objectives By the end of this chapter you should appreciate that: n abnormal psychology (or psychopathology) deals with sets of behaviours or symptoms that produce a functional impairment in people’s lives; n psychological disorders (e.g. schizophrenia) have been documented across time and culture; n throughout history, the causes of abnormal behaviour have been construed from a number of different perspectives; n biological/genetic models focus on brain defects, biochemical imbalances and genetic predispositions as causes of psychopathology; n Freudian, contemporary psychodynamic and attachment models focus on the effects of early parent–child experiences; n behavioural models focus on the learning experiences that result in psychopathology; n cognitive models focus on the effect of distorted thought processes; n the diathesis–stress perspective suggests that the factors identified by each of the other models may work in accordance with one another; n the developmental psychopathology perspective provides a framework for understanding how psychopathology develops from childhood to adulthood; n these perspectives can help us understand the numerous disorders documented in classification systems such as the DSM-IV and the ICD-10; n there are several major forms of psychopathology, including schizophrenia, mood disorders, substance abuse, eating disorders and personality disorders. INTRODUCTION Abnormal psychology is the study of mental dis- Organization examined the prevalence, or frequency, orders (also called mental illness, psychological of mental disorders in people visiting medical disorders or psychopathology) – what they look doctors in primary care settings in 14 countries. like (symptoms), why they occur (etiology), how As figure 15.1 shows, the study revealed that they are maintained, and what effect they have on 24 per cent of these people had diagnosable people’s lives. mental disorders and another 10 per cent had Mental disorders are surprisingly common. For severe symptoms of mental disorders (Üstün & example, a study conducted by the World Health Sartorious, 1995). PSY_C15.qxd 1/2/05 3:43 pm Page 316 316 Abnormal Psychology 40 60 35 50 30 Current mental 40 disorder 25 30 Subthreshold 20 disorder 20 15 Symptomatic % of population % of patients 10 10 Well 0 5 012 3 or more Number of disorders 0 Figure 15.1 Figure 15.2 Rates of current mental disorder in patients presenting Comorbidity in lifetime rates of mental disorders. Co- to primary care facilities across the world. morbidity is the occurrence of two or more disorders at Source: Adapted from Üstün and Sartorius (1995). the same time. Of the 48 per cent of people reporting lifetime history of disorder in this study, over half reported two or more simultaneous disorders. These data come from a survey in the US, but similar rates of comorbidity have been found in countries around the world. Psychopathology can happen to anyone and Source: Kessler et al. (1994). affects many people around them – there is no age, race or group that is immune. Furthermore, The frequency and widespread suffering caused many people experience more than one disorder by mental disorders makes our understanding of at the same time (see figure 15.2). them critical. Importantly, both the ICD-10 and the DSM-IV require that WHAT DOES ‘ABNORMAL’ MEAN? the level of impairment a person is experiencing be taken into account when deciding whether they meet criteria for any mental Defining abnormality is deceptively difficult. When asked to disorder. For example, the DSM-IV diagnostic criteria for depres- describe abnormal behaviour, people typically say that it occurs sion specify that: ‘The symptoms cause clinically significant dis- infrequently, is odd or strange, is characterized by suffering, or is tress or impairment in social, occupational, or other important dangerous. All of these are reasonable answers for some types of areas of functioning’ (p. 327). The ICD-10 description of depres- abnormal behaviour, but none of them is sufficient in itself, and sion also states: ‘The extent of ordinary social and work activities making them all necessary results in too strict a definition. is often a useful general guide to the likely degree of severity of One parsimonious and practical way to define abnormal the episode’ (p. 121). behaviour is to ask whether the behaviour causes impairment in Finally, it is important to be sensitive to how contextual factors the person’s life. The more a affect judgements about abnormality, so as not to over- or under- behaviour gets in the way of pathologize groups or individuals. Such factors include ethnicity impairment extent to which a behavi- successful functioning in an and culture, gender, age and socio-political values. For example, our or set of behaviours gets in the way important domain of life homosexuality was once listed as a disorder in the DSM, but, as of successful functioning in an import- (including the psychological, socio-political values changed to become somewhat more liberal ant domain of the individual’s life interpersonal and achieve- and accepting, it was deleted. ment/performance domains), the more likely it is to be considered a sign of abnormality. When several such behaviours or symptoms occur together, they may WHAT CAUSES ABNORMAL constitute a psychological disorder. BEHAVIOUR? Psychological disorders are formally defined in widely used classification systems, or nosologies: the International Classifica- tion of Diseases – 10th edition (ICD-10; World Health Organiza- With a basis for understanding how to define abnormal tion, 1992) and the Diagnostic and Statistical Manual of Mental behaviour, we can focus on its causes. Abnormal behaviour is Disorders – 4th edition (DSM-IV; APA, 1994). Although they differ construed from a number of different perspectives. Each of the from one another in format, these two systems cover the same following models tells us something about different aspects of a disorders and define them in a similar manner. multi-faceted group of mental disorders. PSY_C15.qxd 1/2/05 3:43 pm Page 317 What Causes Abnormal Behaviour? 317 BIOLOGY AND GENETICS and how the child negotiated them as s/he progressed through the early relationship with the child’s parents. For example, if Biological and genetic models assert that mental disorders are dis- an adult male found himself unable to deal with authority figures, eases, and symptoms of mental disorders are caused by factors this might be interpreted as unresolved aggressive impulses to- such as brain defects (abnor- wards his father. Whether his father behaved as a harsh authority malities in the structures of figure or not would be considered less relevant. So, according to biochemical imbalance complex neuro- Freud, mental illness is due to intrapsychic (i.e. within the mind) transmitter dysregulation process invol- the brain), biochemical imbalances (complex dysregulation conflict. This means a person may have very little insight into ving the various neurotransmitters in the ‘true’ causes of their symptoms, as these are thought to be the brain processes involving various neurotransmitters) and genetic occurring at an unconscious level of processing. predispositions (risk for psycho- Many of Freud’s ideas have gone unsupported by research, but pathology carried via our a number of them have proven to be fairly accurate. For example, genetic predisposition likelihood of genetic material). there is ample evidence that people experience and process things showing condition or characteristic By and large, the evid- at a non-conscious level (see Westen, 1998; also chapter 14) and carried by genetic material ence for brain defects and that early interpersonal experiences affect later outcomes. In fact, biochemical imbalances as this latter hypothesis became central to contemporary psycho- causes of mental disorders is correlational, which means that, dynamic models of abnormal behaviour. although we know that such biological problems occur among Contemporary psychodynamic models (e.g., Kohut, 1977; people with mental disorders, we don’t know whether they Kernberg, 1976; Mitchell, 1988) also suggest that the early actually cause the disorder. Because the brain is a fairly malle- parent–child relationship is the original source of mental illness, able organ, our behaviour and experiences can also affect our and that what goes on in the mind of the child (and the adult) brain functioning, suggesting that the association between is important. biology and abnormal behaviour may be reciprocal rather than But these models differ from Freud’s in that they focus more unidirectional. on interpersonal relationships than on intrapsychic conflict. These Genetic models of mental disorder suggest that psychopatho- later models suggest that the early relationship between the child logy is inherited from parents, and there is certainly

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