Week 3: Abnormal Psychology

Aetiology: The study of the causation of mental disorders.

Clinical picture: The constellation of visible signs or symptoms associated with a particular
mental disorder, the interpretation of which leads to a specific diagnosis.

Comorbidity: A mental disorder existing simultaneously, but independently, with another

mental disorder in the same individual.

Dangerousness: The extent to which an individual with a mental disorder (or displaying
abnormal behaviour) is likely to cause harm to self or others.

Diagnosis: The determination of the nature of a case of a mental disorder, or the

distinguishing of one mental disorder from another; based on identifying signs and
symptoms of mental disorders.

Differential diagnosis: The determination of which disorder may be producing the symptoms
of a mental disorder.

Distress: The level of anxiety, to a mental disorder.

Epidemiology: The study of patterns, causes and effects of diseases or disorders in specific
populations.

Malingering: Pretending to suffer from a physical or psychological illness, or exaggerating

symptoms, in order to avoid unwelcome duties such as work or military service, or to
gain benefits such as financial compensation.

Prognosis: The prediction of the probable course and outcome of a disorder for an
individual.

Psychosis: Symptoms and abnormal behaviour in which an individual has lost contact with
reality and shows a profound deterioration in the ability to perform daily activities.
Symptoms: Subjective complaints of the individual (eg: Gail relays to the doctor that she is
experiencing pain and tenderness in her breasts).

Signs: Physical changes observed in the individual presenting for treatment.

Syndrome: Common patterns of symptoms over time.

Prevalence: The percentage of a population that exhibits a disorder during a specified time
period.

Defining Abnormal Behaviour

● Emil Kraepelin was a German psychiatrist (father of psychiatry). Kraepelin
believed the chief origin of psychiatric disease to be biological and genetic
malfunction (man behind the biomedical model of mental illness).
● Abnormality: The significant deviation from commonly accepted patterns of
behaviour, emotion or thought.
● Normality: The absence of illness and the presence of a state of well being otherwise
called normalcy. It can be difficult to draw the line between normal and abnormal
behaviours.
● Diagnostic manuals: Allow doctors to identify, describe, classify and inform.

Two of the most common diagnostic manuals for mental illnesses (disorder, symptoms, diagnosis,
aetiology and prognosis, allow for genetic and biological factors):
● International Classification of Diseases, 11th ed. (ICD-11) by the World Health
Organisation, in 2018.
● Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V) by
American Psychiatric Association, in 2013.

Before the biomedical model of mental illness:

● Labelling, stigmatisation, diagnosis influenced by professionals, pharmaceutical,
patient advocacy and media.
● Categorical
● Vague boundaries, similarities and comorbidity.
● Dimensional
The normality debate:
● Drawing the line between what is defined as normal, and abnormal, is to this day
unclear.
→ Not surprising given the historical conceptualizations of mental illness (eg:
homosexuality was originally listed as a mental disorder).
● Thus, it is preferential to view mental illness as occurring along a continuum.
→ DSM V supports this, many disorders include a severity specification.
● This is why the existence of some symptoms are not enough to classify one as
having a mental disorder.
→ DSM V and ICD 11 provide lists of symptom criteria.

Criteria of Abnormal Behaviour

● Deviance: People often said to have a disorder because their behaviour differs from
what their society considers acceptable, closely influenced by culture and time.
● Dysfunctional behaviour: In many cases, people are judged to have a psychological
disorder because their ability to perform their day-to-day activities becomes
impaired, or their behaviour becomes maladaptive or dysfunctional in so much as
the individual's behaviour is not contributing to their personal growth or to society.
● Personal distress: Frequently, the diagnosis of a psychological disorder is based on
an individual's report of significant personal suffering (pain or significant stress).

What is a psychological disorder?

● A mental disorder is a syndrome characterised by clinically significant disturbance
in an individual’s cognition, emotion regulation, or behaviour that reflects a
dysfunction in the psychological, biological, or developmental processes
underlying mental functioning (DSM 5).
● Mental, behavioural and neurodevelopmental disorders are syndromes
characterised by clinically significant disturbance in an individual's cognition,
emotional regulation, or behaviour that reflects a dysfunction in the psychological,
biological, or developmental processes that underlie mental and behavioural
functioning (ICD 11).

Main categories to cover when understanding mental disorders:

● Clinical description (it’s a combination of behaviours, thoughts and feelings that
make up the disorder, DSM – diagnostic features).
→ Clinical disorders found in clinic/hospital settings, also to activities associated with
assessment and treatment.
● Aetiology (the origins of the disorder – bio-psycho-social causes)
● Onset (when they usually occur):
→ Acute: Disorders occur/begin suddenly.
→ Insidious: Develop gradually over a period of time (eg: children with anxiety).
● Prevalence, gender, age and related issues (if any):
→ How many people in the population have this disorder (statistics nationally;
globally).
→ What percentage of males and females have this disorder?
→ What is the typical age of onset?
● Culture related issues.
● Prognosis (the anticipated course of the disorder over time):
→ Chronic: Lasts a long time (usually life long) such as schizophrenia.
→ Episodic: Individual likely to recover but it may reoccur (eg: depression).
→ Time-limited: Will improve in a short period, even without treatment (eg: adjustment
disorder).

Conceptualizations of mental illness:

● Alarming global trend – despite increased access to mental health services, use of
those services have not increased.
● In SA, more than half of all health problems are psychological – patients still
avoid seeking treatment.
→ Public’s stigmatising attitudes towards the mentally ill.
→ Lack of knowledge among the public of mental illness.

Examples of etiological and treatment beliefs:

Schizophrenia Genetic, chemical Best treated by health

imbalance and witchcraft. professionals.

Depression Contextual factors; Best treated by health

character weakness. professionals, vacation.
 Substance Use Academic pressure, Self help groups (eg: AA)
contextual factors and
character weakness.

Anxiety Disorders, Obsessive Compulsive and Related Disorders and Trauma and Stressor
Related Disorders
What is anxiety, why do we experience anxiety and what is the function of anxiety?
● It serves as a psychophysiological response mediating adjustment to the
environment.
● Mediates social behaviour: Self-restraint at a get-together.
● Motivates action during time of threat: Studying during exams; locking your home at
night.
● Maintains safety behaviour: Attending lectures; having an armed response; staying
close to safety (child and parent).
● Maintains avoidance of threat/danger: Friends who encourage illegal behaviour;
children-jumping onto moving cars.
● Motivates us to seek safety: After failing a test that you didn’t study for thereafter
prioritising studying/passing; a child playing outside who sees something
dangerous seeks the parent.

Anxiety Disorders
● Generalised anxiety disorder: Marked by excessive, exaggerated anxiety and worry
about everyday life events for no obvious reason. People with symptoms of
generalised anxiety disorder tend to always expect disaster and can't stop worrying
about health, money, family, work, or school.
● Specific phobic disorder: Persistent, unrealistic, intense anxiety about and fear of
specific situations, circumstances, or objects. The anxiety caused by a phobic
disorder can interfere with daily living because people avoid certain activities and
situations. The diagnosis is usually obvious based on symptoms.
● Panic disorder: When you've had at least two panic attacks (you feel terrified and
overwhelmed, even though you're not in any danger) and constantly worry and
change your routine to keep from having another one.
● Agoraphobia: A fear of being in situations where escape might be difficult or that
help wouldn't be available if things go wrong.
 ● Separation anxiety disorder: Diagnosed when symptoms are excessive for the
developmental age and cause significant distress in daily functioning. Symptoms
may include recurrent and excessive distress about anticipating or being away
from home or loved ones.
● Selective mutism: A severe anxiety disorder where a person is unable to speak in
certain social situations, such as with classmates at school or to relatives they do
not see very often. It usually starts during childhood and, if left untreated, can
persist into adulthood.
● Social anxiety disorder (social phobia): A long-term and overwhelming fear of social
situations. It's a common problem that usually starts during the teenage years. It
can be very distressing and have a big impact on your life. For some people it gets
better as they get older.

When does anxiety become pathological?

● Dysfunctional anxiety is anxiety that is so high/intense that it disables the
mediating functions mentioned.
● Social anxiety disorder, there is too much anxiety and worrying for the person to
be able to think, communicate, or be themself.

Aetiology of Anxiety
Biological factors:
● Genetic vulnerability, concordance rate (twin or relatives). In studies that assess
the impact of heredity on psychological disorders, investigators look at
concordance rates.
● A concordance rate indicates the percentage of twin pairs or other pairs of relatives
who exhibit the same disorder. If relatives who share more genetic similarity show
higher concordance rates than relatives who share less genetic overlap, this finding
supports the genetic hypothesis. The results of both twin studies and family studies
suggest a moderate genetic predisposition to anxiety disorders.
● Anxiety sensitivity may make people more vulnerable to anxiety disorders.
Individuals with high anxiety sensitivity believe physiological symptoms and thus
are prone to overreact with fear.
● A link may exist between anxiety disorders and neurochemical activity in the
brain. Neurotransmitters are chemicals that carry signals from one neuron to
another. Therapeutic drugs (such as Valium or Xanax) that reduce excessive
anxiety appear to alter neurotransmitter activity at synapses that release a
 neurotransmitter called GABA. Disturbances in the neural circuits using GABA
may play a role in some types of anxiety disorders.

Conditioning and learning:

● Many anxiety responses can be acquired through classical conditioning and
maintained through operant conditioning. According to Mowrer, an originally
neutral stimulus can be paired with a frightening event so that it becomes a
conditioned stimulus eliciting anxiety. Once a fear is acquired through classical
conditioning, the person may start avoiding the anxiety-producing stimulus. The
avoidance response is negatively reinforced because it is followed by a reduction
in anxiety. This process involves operant conditioning.
● The tendency to develop phobias of certain types of objects and situations can be
explained by Martin Seligman’s concept of preparedness. Like many theorists,
Seligman believes that classical conditioning creates most phobic responses.
However, he suggests that people are biologically prepared by their evolutionary
history to acquire some fears much more easily than others.

Cognitive factors:
● Cognitive theorists maintain that certain styles of thinking make some people
particularly vulnerable to anxiety disorders.
● According to these theorists, some people are more likely to suffer from anxiety
problems because they tend to (1) misinterpret harmless situations as threatening,
(2) focus excessive attention on perceived threats, and (3) selectively recall
information that seems threatening.

Stress:
● Cases of posttraumatic stress disorder are attributed to individuals' exposure to
extremely stressful incidents. Research has also demonstrated that other types of
anxiety disorders can be stress related.
● Thus, there is reason to believe that high stress often helps to precipitate or to
aggravate anxiety disorders.

Obsessive Compulsive and Related Disorders

● Obsessions: Thoughts that repeatedly intrude on one's consciousness in a distressing
way.
● Compulsions: Actions that one feels forced to carry out.
 ● Thus, obsessive-compulsive disorder (OCD) is marked by persistent, uncontrollable
intrusions of unwanted thoughts (obsessions) and urges to engage in senseless
rituals (compulsions).

Trauma and Stressor-Related Disorders

Posttraumatic stress disorder (PTSD) involves enduring psychological disturbance
attributed to the experience of a major traumatic event.

Required reading:
● Chapter 15, pg 583-605: Psychology, Themes and Variations