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 Biological Dimension
Genetics, Brain Anatomy,
Biochemical Imbalances, Central
Nervous System Functioning,
Autonomic Nervous System
Reactivity, etc.

Psychological Dimension
Sociocultural Dimension
MENTAL Personality, Cognition, Emotions,
Race, Gender, Sexual Orientation,
Learning, Stress-Coping, Self-
Religion, Socioeconomic Status, DISORDER
Esteem, Self-Efficacy, Values,
Ethnicity, Culture, etc.
Developmental History, etc.

Social Dimension
Family, Relationships, Social
Support, Belonging, Love, Marital
Status, Community, etc.

Multipath Model of Mental Disorders

The multipath model describes how four major dimensions—biological,

psychological, social, and sociocultural—contribute to the development of
mental disorders. It operates under several assumptions:
• No one theoretical perspective is adequate to explain the
complexity of the human condition and the development of
mental disorders.
• There are multiple pathways and causes to any single disorder.
It is a statistical rarity to find a disorder due to only one cause.
• Not all dimensions contribute equally to a disorder.
• It is guided by the state of research and scientific findings as to
the relative merits of a proposed cause.
• The multipath model is an integrative and interactive one.
It acknowledges that factors may combine in complex and
reciprocal ways so that people exposed to the same factors may
not develop the same disorder and that different individuals
exposed to different factors may develop a similar mental
disorder.
Understanding
Abnormal
Behavior
David Sue
Western Washington University
Derald Wing Sue
Teachers College, Columbia University
Stanley Sue
University of California—Davis

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 Understanding Abnormal Behavior © 2010 Wadsworth, Cengage Learning
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1 2 3 4 5 6 7 12 11 10 09 08
 b r ief con t en t s

Features xv
Preface xvi
About the Authors xxiii

1 Abnormal Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2 Models of Abnormal Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3 Assessment and Classification of Abnormal Behavior . . . . . 66
4 The Scientific Method in Abnormal Psychology . . . . . . . . . . . . 93
5 Anxiety Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
6 Dissociative Disorders and Somatoform Disorders. . . . . . . . 149
7 Stress Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
8 Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
9 Substance-Related Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
10 Sexual and Gender Identity Disorders . . . . . . . . . . . . . . . . . . . . . 264
11 Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
12 Suicide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
13 Schizophrenia: Diagnosis, Etiology, and Treatment . . . . . . . 359
14 Cognitive Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390
15 Disorders of Childhood and Adolescence. . . . . . . . . . . . . . . . . . 412
16 Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
17 Legal and Ethical Issues in Abnormal Psychology . . . . . . . . . 474
Glossary G-1
References R-1
Credits C-1
Name Index I-1
Subject Index I-13

iii
This page intentionally left blank
 con t en t s

Features xv
Preface xvi
About the Authors xxiii

1 Abnormal Behavior 2
The Concerns of Abnormal Psychology 3 Reversion to Supernatural Explanations
Describing Abnormal Behavior 3 (the Middle Ages) 17
Explaining Abnormal Behavior 4 The Rise of Humanism (the Renaissance) 19
Predicting Abnormal Behavior 4 The Reform Movement (Eighteenth and
Controlling Abnormal Behavior 5 Nineteenth Centuries) 20

Determining Abnormality 7 Causes: Early Viewpoints 21

Distress 8 The Biological Viewpoint 21
Deviance 8 The Psychological Viewpoint 22
Dysfunction 8 Contemporary Trends in Abnormal Psychology 23
Dangerousness 9 The Drug Revolution in Psychiatry 23
Contextual and Cultural Limitations The Push by Psychologists for Prescription
in Defining Abnormal Behavior 9 Privileges 24
CONTROVERSY: Is Mental Illness a Myth and a The Development of Managed Health Care 24
Political Construction? 12 An Increased Appreciation for Research 25
The Influence of Multicultural Psychology 26
The Frequency and Burden of Mental Disorders 12
CRITICAL THINKING: I Have It, Too: The Medical
Stereotypes About the Mentally Disturbed 14 Student Syndrome 28
Historical Perspectives on Abnormal Behavior 16 Implications 28
Prehistoric and Ancient Beliefs 16 Summary 29
Naturalistic Explanations (Greco-Roman Thought) 16

2 Models of Abnormal Behavior 30

One-Dimensional Models of Mental Disorders 32 Dimension Two: Psychological Factors 44
Using Models to Describe Psychopathology 33 Psychodynamic Models 44
Behavioral Models 47
A Multipath Model of Mental Disorders 34
Cognitive Models 51
Dimension One: Biological Factors 36 Humanistic and Existential Models 53
The Human Brain 37 Multipath Implications of Psychological
Biochemical Theories 38 Explanations 55
Genetic Explanations 40
Dimension Three: Social Factors 56
Biology-Based Treatment Techniques 41
Social Relational Models 56
Multipath Implications of Biological Explanations 43

v
vi C O NT E N T S

Family, Couples, and Group Perspectives 56 CONTROVERSY: Problems in Using Racial and Ethnic
Social-Relational Treatment Approaches 57 Group References 60
Criticisms of Social-Relational Models 57 Criticisms of the Multicultural Model 61
CRITICAL THINKING: Applying the Models of
Dimension Four: Sociocultural Factors 58
Psychopathology 62
Gender Factors 58
Socioeconomic Class 59 Implications 64
Race/Ethnicity: Multicultural Models of Summary 65
Psychopathology 59

3 Assessment and Classification of Abnormal Behavior 66

Reliability and Validity 67 The Classification of Abnormal Behavior 83
The Assessment of Abnormal Behavior 68 Diagnostic and Statistical Manual of Mental
Disorders (DSM) 83
Observations 68
DSM-IV-TR Mental Disorders 85
Interviews 69
Evaluation of DSM Classification System 85
Psychological Tests and Inventories 71
Objections to Classification and Labeling 90
CONTROVERSY: Should the Rorschach Be Used in
Making Assessments? 74 Implications 91
Neurological Tests 80 Summary 92
The Ethics of Assessment 81
CRITICAL THINKING: Can We Accurately Assess the Status
of Members of Different Cultural Groups? 82

4 The Scientific Method in Abnormal Psychology 93

The Scientific Method in Clinical Research 96 Genetic Linkage Studies 110
CRITICAL THINKING: Attacks on Scientific Integrity 97 The Endophenotype Concept 110
Characteristics of Clinical Research 97 Other Concepts in Biological Research 111
CONTROVERSY: Repressed Memories: Issues and Epidemiological and Other Forms of Research 112
Questions 99
Ethical Issues in Research 113
Experiments 100
Implications 114
The Experimental Group 101
The Control Group 101 Summary 115
The Placebo Group 102
Additional Concerns in Clinical Research 102
Correlations 103
CRITICAL THINKING: Researcher Allegiance:
A “Wild Card” in Comparative Research 105
Analogue Studies 106
Field Studies 107
Single-Participant Studies 108
The Case Study 108
The Single-Participant Experiment 109
Biological Research Strategies 110
The Human Genome Project 110
 C ONT ENT S vii

5 Anxiety Disorders 117

Understanding Anxiety Disorders
from a Multipath Perspective 119
Biological Dimension 119
Psychological Dimension 122
Social and Sociocultural Dimensions 123
Phobias 124
Social Phobias 125
Specific Phobias 127
Etiology of Phobias 128
CONTROVERSY: Fear or Disgust? 129
Treatment of Phobias 131
Panic Disorder and Agoraphobia 133
Panic Disorder 133
Agoraphobia 134
Etiology of Panic Disorder and Agoraphobia 134
Treatment of Panic Disorder 136
CRITICAL THINKING: Panic Disorder Treatment:
Should We Focus on Internal Control? 138
Generalized Anxiety Disorder 138
Etiology of Generalized Anxiety Disorder 139
Treatment of Generalized Anxiety Disorder 140 Etiology of Obsessive-Compulsive Disorder 143
Treatment of Obsessive-Compulsive Disorder 146
Obsessive-Compulsive Disorder 141
Obsessions 142 Implications 147
Compulsions 142 Summary 147

6 Dissociative Disorders and Somatoform Disorders 149

Dissociative Disorders 150 CRITICAL THINKING: Factitious Disorder and Factitious
Dissociative Amnesia 150 Order by Proxy 165
Dissociative Fugue 153 Pain Disorder 167
Depersonalization Disorder 153 Hypochondriasis 167
Dissociative Identity Disorder (Multiple-Personality Body Dysmorphic Disorder 168
Disorder) 154 Etiology of Somatoform Disorders 169
CRITICAL THINKING: Culture and Somatoform and Treatment of Somatoform Disorders 172
Dissociative Disorders 156 Implications 173
Etiology of Dissociative Disorders 157
Summary 174
CONTROVERSY: “Suspect” Techniques Used to Treat
Dissociative Identity Disorder 160
Treatment of Dissociative Disorders 161
Somatoform Disorders 162
Somatization Disorder 164
Conversion Disorder 164
viii CO N T E N T S

7 Stress Disorders 175

Acute and Posttraumatic Stress Disorders 176 Migraine, Tension, and Cluster Headaches 186
Diagnosis of Acute and Posttraumatic Stress Asthma 188
Disorders 176 Stress and the Immune System 190
Etiology of Acute and Posttraumatic CONTROVERSY: Can Laughter or Humor Influence the
Stress Disorders 177 Course of a Disease? 191
Biological Dimension 178 Etiology of Psychophysiological Disorders 192
Psychological Dimension 179 Biological Dimension 192
Social Dimension 180 Psychological Dimension 194
Sociocultural Dimension 180 Social Dimension 196
Treatment of Acute and Posttraumatic Sociocultural Dimension 196
Stress Disorders 181 Treatment of Psychophysiological Disorders 197
Physical Stress Disorders: Psychophysiological Relaxation Training 197
Disorders 182 Biofeedback 198
CRITICAL THINKING: The Hmong Sudden Death Cognitive-Behavioral Interventions 198
Syndrome 183 Implications 199
Characteristics of Psychophysiological Disorders 183 Summary 200
Coronary Heart Disease 183
Hypertension 184

8 Personality Disorders 201

Diagnosing Personality Disorders 203 Psychological Dimension 224
Social Dimension 225
Disorders Characterized by Odd
or Eccentric Behaviors 205 Sociocultural Dimension 226
Paranoid Personality Disorder 205 Treatment of Antisocial Personality Disorder 227
CRITICAL THINKING: Is There Gender Bias in CONTROVERSY: Impulse Control Disorders 228
Diagnosing Mental Disorders? 207 Implications 230
Schizoid Personality Disorder 208
Summary 231
Schizotypal Personality Disorder 208
Disorders Characterized by Dramatic,
Emotional, or Erratic Behaviors 210
Antisocial Personality Disorder 210
Borderline Personality Disorder 212
Histrionic Personality Disorder 215
Narcissistic Personality Disorder 216
Disorders Characterized by Anxious
or Fearful Behaviors 217
Avoidant Personality Disorder 217
Dependent Personality Disorder 218
Obsessive-Compulsive Personality Disorder 219
Multipath Analysis of One Personality
Disorder: Antisocial Personality Disorder 221
Biological Dimension 221
 CONT ENT S ix

9 Substance-Related Disorders 232

Substance-Use Disorders 235 Intervention and Treatment of
Depressants or Sedatives 236 Substance-Use Disorders 255
Stimulants 241 Pharmacological Approach 255
Hallucinogens 244 Cognitive and Behavioral Approaches 257
Self-Help Groups 258
Etiology of Substance-Use Disorders 246
CONTROVERSY: Controlled Drinking 259
Biological Dimension 247
Multimodal Treatment 259
Psychological Dimension 249
Prevention Programs 260
CONTROVERSY: Is Drug Addiction a Disease? 250
Effectiveness of Treatment 261
Social Dimension 252
CRITICAL THINKING: Is Drug Use an Indicator of Implications 262
Disturbance? 253 Summary 262
Sociocultural Dimension 254

10 Sexual and Gender Identity Disorders 264

What Is “Normal” Sexual Behavior? 265 Paraphilias 288
CONTROVERSY: Is Compulsive Sexual Behavior Paraphilias Involving Nonhuman Objects 290
an Addiction? 267 Paraphilias Involving Nonconsenting Persons 291
The Study of Human Sexuality 268 Paraphilias Involving Pain or Humiliation 293
The Sexual Response Cycle 268 Etiology and Treatment of Paraphilias 294
Sexual Dysfunctions 270 Rape 296
Sexual Desire Disorders 271 Effects of Rape 298
Sexual Arousal Disorders 273 Etiology of Rape 299
Orgasmic Disorders 275 Treatment for Rapists 299
Sexual Pain Disorders 275 CRITICAL THINKING: Why Do Men Rape Women? 300

Etiology of Sexual Dysfunctions 276 Implications 301

Biological Dimension 278 Summary 301
Psychological Dimension 278
Social Dimension 279
Sociocultural Dimension 279
Treatment of Sexual Dysfunctions 280
Biological Interventions 280
Psychological Treatment Approaches 282
Homosexuality 283
Aging, Sexual Activity, and
Sexual Dysfunctions 284
Gender Identity Disorder 286
Etiology of Gender Identity Disorder 287
Treatment of Gender Identity Disorder 288
Is GID a Valid Psychiatric Diagnosis? 288
x CO N TE N T S

11 Mood Disorders 303

Unipolar Depression 304 Psychotherapy and Behavioral Treatments for
Symptoms of Unipolar Depression 304 Depressive Disorders 324
Diagnosis and Classification of Depressive Bipolar Disorders 327
Disorders 307 Symptoms and Characteristics of Bipolar
CONTROVERSY: When Is One Depressed? 308 Disorders 327
Prevalence of Unipolar Depression 309 Classification of Bipolar Disorders 328
Etiology of Unipolar Depression 310 Prevalence of Bipolar Disorders 329
Biological Dimension 310 Comparison Between Depressive and Bipolar
Psychological Dimension 313 Disorders 329
Social Dimension 317 Etiology of Bipolar Disorders 329
Sociocultural Dimension 319
Treatment for Bipolar Disorders 330
Treatment for Unipolar Depression 322 Implications 331
Biomedical Treatments for Depressive Disorders 323
Summary 332
CRITICAL THINKING: Should We Increasingly Turn to
Drugs in the Treatment of Depression? 324

12 Suicide 333
Correlates of Suicide 335
CRITICAL THINKING: Why Do People Kill
Themselves? 336
Facts About Suicide 337
A Multipath Perspective of Suicide 343
Biological Dimension 343
Psychological Dimension 344
Social Dimension 345
Sociocultural Dimension 346
Victims of Suicide 347
Children and Adolescents 347
Elderly People 349
Preventing Suicide 350
Clues to Suicidal Intent 351
Crisis Intervention 351
Suicide Prevention Centers 353
The Right to Suicide: Moral, Ethical,
and Legal Issues 354
CONTROVERSY: Do People Have a Right to Die? 356
Implications 357
Summary 358
 CONT ENT S xi

13 Schizophrenia: Diagnosis, Etiology, and Treatment 359

The Symptoms of Schizophrenia 361
Positive Symptoms 361
CONTROVERSY: Should We Challenge Delusions and
Hallucinations? 364
Negative Symptoms 366
Cognitive Symptoms 367
Cultural Issues 367
Types of Schizophrenia 368
Paranoid Schizophrenia 369
Disorganized Schizophrenia 369
Catatonic Schizophrenia 369
Undifferentiated and Residual Schizophrenia 370
Psychotic Disorders That Were Once Considered
Schizophrenia 371
Other Psychotic Disorders 371 The Treatment of Schizophrenia 383
CONTROVERSY: Delusional Parasitosis or Physical Antipsychotic Medication 383
Disease? 373 CONTROVERSY: Balancing Prevention and Harm 385
The Course of Schizophrenia 373 Psychosocial Therapy 385
Long-Term Outcome Studies 374 Interventions Focusing on Family Communication
and Education 388
Etiology of Schizophrenia 374
Implications 389
Biological Dimension 375
Psychological Dimension 378 Summary 389
Social Dimension 379
Sociocultural Dimension 381

14 Cognitive Disorders 390

The Assessment of Brain Damage 392 Cerebral Tumors 406
Epilepsy 406
Types of Cognitive Disorders 393
Use of Psychoactive Substances 408
Dementia 393
Delirium 394 Treatment/Prevention Considerations 408
Amnestic Disorders 395 Medication 408
Cognitive and Behavioral Approaches 409
Etiology of Cognitive Disorders 395
Lifestyle Changes 409
Traumatic Brain Injury 396
Environmental Interventions and Caregiver
Aging and Disorders Associated with Aging 398
Support 410
Alzheimer’s Disease 400
CRITICAL THINKING: Moderators and Mediators:
Implications 410
What Causes What? 402 Summary 411
Other Diseases and Infections of the Brain 404
xii CO N T E N T S

15 Disorders of Childhood and Adolescence 412

CONTROVERSY: Are We Overmedicating Children? 414
Pervasive Developmental Disorders 414
Autistic Disorder 415
Other Pervasive Developmental Disorders 417
Etiology 419
Prognosis 421
Treatment 421
Attention Deficit/Hyperactivity Disorders and
Disruptive Behavior Disorders 422
Attention Deficit/Hyperactivity Disorders 422
Oppositional Defiant Disorder 426
Conduct Disorders 427
CRITICAL THINKING: School Violence: A Sign of
the Times? 429
Elimination Disorders 431 Mental Retardation 435
Enuresis 431 Diagnosing Mental Retardation 436
CRITICAL THINKING: Child Abuse 432 Etiology of Mental Retardation 437
Encopresis 433 Programs for People with Mental Retardation 440
Learning Disorders 434 Implications 442
Etiology 434 Summary 442
Treatment 435

16 Eating Disorders 443

Eating Disorders 444 Treating Bulimia Nervosa 466
Anorexia Nervosa 446 Treating Binge-Eating Disorder 466
CRITICAL THINKING: Anorexia’s Web 448 Obesity 467
Bulimia Nervosa 449
Etiology of Obesity 469
Binge-Eating Disorders 451
Biological Dimension 469
Eating Disorder Not Otherwise Specified 453
CONTROVERSY: Are the BMI Index Standards
Etiology of Eating Disorders 454 Appropriate? 470
Biological Dimension 454 Psychological Dimension 470
Psychological Dimension 455 Social Dimension 471
Social Dimension 456 Sociocultural Dimension 471
Sociocultural Dimension 457
Treatments for Obesity 471
CRITICAL THINKING: Is Our Society Creating Eating
Disorders? 462 Implications 472

Treatment of Eating Disorders 464 Summary 472

Treating Anorexia Nervosa 464
 C ONT ENT S xiii

17 Legal and Ethical Issues in Abnormal Psychology 474

Criminal Commitment 478
The Insanity Defense 478
Competency to Stand Trial 481
Civil Commitment 482
Criteria for Commitment 483
Procedures in Civil Commitment 484
Rights of Mental Patients 485
CRITICAL THINKING: Predicting Dangerousness: The Case
of Serial Killers and Mass Murderers 486
Right to Treatment 486
Right to Refuse Treatment 488
CONTROVERSY: Court-Ordered Assisted Treatment:
Coercion or Caring? 489
Deinstitutionalization 490 Cultural Competence and the
The Therapist-Client Relationship 492 Mental Health Profession 494
Confidentiality and Privileged Communication 492 Implications 496
The Duty-to-Warn Principle 493 Summary 496
Sexual Relationships with Clients 494

Glossary G-1
References R-1
Credits C-1
Name Index I-1
Subject Index I-13
This page intentionally left blank
 Feat ur es

Critical Thinking Controversy

I Have It, Too: The Medical Student Syndrome, 28 Is Mental Illness a Myth and a Political
Applying the Models of Psychopathology, 62 Construction? 12
Can We Accurately Assess the Status of Members of Problems in Using Racial and Ethnic Group
Different Cultural Groups? 82 References, 60
Attacks on Scientific Integrity, 97 Should the Rorschach Be Used in Making
Researcher Allegiance: A “Wild Card” in Comparative Assessments? 74
Research, 105 Repressed Memories: Issues and Questions, 99
Panic Disorder Treatment: Should We Focus on Fear or Disgust? 129
Internal Control? 138 “Suspect” Techniques Used to Treat Dissociative Identity
Culture and Somatoform and Dissociative Disorders, 156 Disorder, 160
Factitious Disorder and Factitious Disorder by Proxy, 165 Can Laughter or Humor Influence the Course of
The Hmong Sudden Death Syndrome, 183 a Disease? 191
Is There Gender Bias in Diagnosing Mental Impulse Control Disorders, 228
Disorders? 207 Is Drug Addiction a Disease? 250
Is Drug Use an Indicator of Disturbance? 253 Controlled Drinking, 259
Why Do Men Rape Women? 300 Is Compulsive Sexual Behavior an Addiction? 267
Should We Increasingly Turn to Drugs in the Treatment When Is One Depressed? 308
of Depression? 324 Do People Have a Right to Die? 356
Why Do People Kill Themselves? 336 Should We Challenge Delusions and
Moderators and Mediators: What Causes What? 402 Hallucinations? 364
School Violence: A Sign of the Times? 429 Delusional Parasitosis or Physical Disease? 373
Child Abuse, 432 Balancing Prevention and Harm, 385
Anorexia’s Web, 448 Are We Overmedicating Children? 414
Is Our Society Creating Eating Disorders? 462 Are the BMI Index Standards Appropriate? 470
Predicting Dangerousness: The Case of Serial Killers Court-Ordered Assisted Treatment:
and Mass Murderers, 486 Coercion or Caring? 489

Disorder Charts
Anxiety Disorders, 119
Dissociative Disorders, 151
Somatoform Disorders, 163
Personality Disorders, 206
Substance-Related Disorders, 235
Sexual Dysfunctions, 272
Paraphilias, 289
Mood Disorders, 305
Schizophrenia, 368
Cognitive Disorders, 391
Pervasive Developmental Disorders, 418
Attention Deficit and Disruptive Behavior
Disorders, 423
Learning Disorders, 435
Mental Retardation, 436
Eating Disorders, 445

xv
p r efa ce

A bnormal behaviors both fascinate and are of concern to scientists and the
general public. Why people exhibit abnormal behaviors, how they express their
disturbances, and how such behaviors can be prevented and treated are questions
that continue to intrigue us. We now know that all human beings are touched in
one way or another by mental disturbance in their lives, either directly through their
own struggles to deal with mental disorders or indirectly through affected friends
or relatives.
Over the years, major research discoveries in genetics, neurobiology, and psy-
chology have made unprecedented contributions to our understanding of abnormal
behaviors. This is clearly evident in the Human Genome Project, where scientists
have mapped the location of all genes in the human nucleus. The hope among mental
health professionals is that the “map of life” will allow for increased understanding
of mental disorders and their subsequent treatments. In addition to this tremendous
biological breakthrough, we also know that psychological forms of intervention are
effective in treating abnormal behaviors. The move to identify empirically supported
treatments has taken the profession by storm. Finally, research has revealed the great
cultural variations in abnormal behaviors and what other cultures consider effective
treatments. In the Ninth Edition of our book, we examine all of these areas.
In writing and revising this book, we have sought to engage students in the excit-
ing process of understanding abnormal behavior and the ways that mental health
professionals study and attempt to treat it. In pursuing this goal, we have been
guided by three major objectives:
• To provide students with scholarship of the highest quality,
• To offer an evenhanded treatment of abnormal psychology as both a scientific
and a clinical endeavor, giving students the opportunity to explore topics thor-
oughly and responsibly, and
• To make our book inviting and stimulating to a wide range of students.
In each edition, we have strived to achieve these objectives, working with com-
ments from many students and instructors and our own work in teaching, research,
and practice. The Ninth Edition, we believe, builds on the achievements of previous
editions and surpasses them.

Our Approach
We take an eclectic, multicultural approach to the field, drawing on important con-
tributions from various disciplines and theoretical stances. The text covers the major
categories of disorders listed in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR), but it is not a mechanistic reiteration of DSM. We believe
that different combinations of life experiences and constitutional factors influence
behavioral disorders, and we project this view throughout the text. These combina-
tions of factors are demonstrated in our multipath model, which is a way of looking
at the causes of disorders new to the Ninth Edition. There are several elements to
our multipath model. First, the contributors to mental disorders are divided into
four dimensions: biological, psychological, social, and sociocultural. Second, factors
x vi in the four dimensions can interact and influence each other in any direction. Third,
 PR EFA CE xvii
different combinations within the four dimensions may cause abnormal behaviors.
For instance, assume that a person has severe depression. That depression may be
caused primarily by a single factor (e.g., death of a loved one) or by an interaction
of factors at different dimensions (e.g., caused by child abuse occurring in early
life and stressors in adulthood). Thus, a disorder such as depression may be caused
by different factors and different combination of factors. Fourth, many disorders
appear to be heterogeneous in nature. Therefore, there may be different types or ver-
sions of a disorder (a spectrum of the disorder). Finally, different disorders may be
caused by similar factors. For example, anxiety as well as depression may be caused
by child abuse and interpersonal stress. In fact, anxiety and depression often occur
concurrently in people.
Sociocultural factors, including cultural norms, values, and expectations, are
given special attention. Because we are convinced that cross-cultural comparisons
of abnormal behavior and treatment methods can greatly enhance our under-
standing of disorders, cultural and gender phenomena are emphasized. Indeed,
Understanding Abnormal Behavior was the first textbook on abnormal psychology
to integrate and emphasize the role of multicultural factors, and although many
texts have since followed our lead, the Ninth Edition continues to provide the most
extensive coverage and integration of multicultural models, explanations, and con-
cepts available. Not only do we discuss how changing demographics have increased
the importance of multicultural psychology, but we also introduce multicultural
models of psychopathology in the opening chapters. As with other models of psy-
chopathology (such as psychoanalytic, cognitive, behavioral, biological), we address
multicultural issues throughout the text whenever research findings and theoretical
formulations allow. For example, cultural factors as they affect assessment, classifi-
cation, and treatment of various mental disorders are presented to students. Such an
approach adds richness to our understanding of mental disorders. As psychologists
(and professors), we know that learning is enhanced whenever material is presented
in a lively and engaging manner. We achieve these qualities in part by providing case
vignettes and clients’ descriptions of their experiences to complement and illustrate
research-based explanations. Our goal is to encourage students to think critically
rather than merely assimilate a collection of facts and theories. As a result, we hope
that students will develop an appreciation of the study of abnormal behavior.

Special Features
The Ninth Edition includes a number of new features as well as features that were
popularized in earlier editions and, in some cases, have been revised and enhanced.
These features are aimed at aiding students in organizing and integrating the mate-
rial in each chapter.
• As previously noted, our new multipath model provides a framework through
which students can understand mental disorders. The model is introduced in
Chapter 2 and applied throughout the book.
• New and updated Critical Thinking boxes provide factual evidence and thought-
provoking questions that raise key issues in research, examine widely held
assumptions about abnormal behavior, or challenge the student’s own under-
standing of the text material.
• New Controversy boxes deal with controversial issues with wide implications
for our society. These boxes stimulate critical thinking, evoke alternative views,
provoke discussion, and draw students into issues that help them better explore
the wider meaning of abnormal behavior in our society.
• New and updated Myth and Reality discussions challenge the many myths and
false beliefs that have surrounded the field of abnormal behavior and also helps
students realize that beliefs, some of which may appear to be “common sense,”
must be checked against scientific facts and knowledge.
xviii PRE FAC E

• New Did You Know? margin boxes found throughout the book provide fascinat-
ing, at-a-glance research-based tidbits for students.
• New Implications sections end each chapter, synthesizing the multipath model
implications of the chapter material.
• Chapter outlines and Focus Questions, appearing in the first pages of every
chapter, provide a framework and stimulate active learning—with questions
in mind, students begin thinking about the concepts they are about to explore
within the chapter.
• Integrated chapter Summaries keyed to the Focus Questions provide students
with a concise recap of the chapter’s most important concepts and with tentative
answers to the chapter opener’s Focus Questions.
• New and updated case studies and examples make issues of mental health and men-
tal disorders “come to life” for students and instructors. Many of the cases are taken
from actual clinical files, and all are clearly designated within the text’s design.
• Streamlined disorder charts provide snapshots of disorders in an easy-to-read
format.
• Key terms are highlighted in the text and appear in the margins.

New and Updated Coverage of the Ninth Edition

Our foremost objective in preparing this edition was to update thoroughly and
present the latest trends in research and clinical thinking. This has led to updated
coverage of dozens of topics throughout the text, including the following:
• The growing ethnic and cultural diversity in the United States and its implica-
tions for mental health research, theory, and practice.
• Expanded and balanced coverage of the biological perspective and the latest
research strategies and findings on genetic factors in mental disorders.
• Integrated coverage of the growing prevalence of psychoactive drug use in U.S.
society.
• New developments concerning the implications of managed health care on men-
tal health services and the use of evidence-based treatments.
• Research findings concerning the rates of each mental disorder and the preva-
lence of disorders according to gender, ethnicity, and age.
• Updated suicide coverage.
• Coverage of date rape and reasons for why men rape.
• Expanded coverage on eating disorders and obesity.
• Expanded coverage of learning disorders.
• Identification of psychotherapies and treatments that are likely to increase or
decrease in use in the future.
• Ethical and legal issues raised by recent cases involving insanity pleas, courtroom
testimony by psychologists, and assisted suicide.
• Integrated coverage of culture-specific therapeutic strategies for treating African
American, Asian American, Latino American, and Native American clients.
The design of the book has been revamped to present the content in the clear-
est, most accessible way. As in the previous edition, the Ninth Edition contains an
abundance of tables, illustrations, figures, and photographs that graphically show
research data, illustrate comparisons and contrasts, and enhance the understanding
of concepts or controversies in the field.
In addition to updating the book’s coverage, its look, and its special features, we
have maintained a streamlined organization of the book, as described next.
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