Abnormal Psychology - General

Relevant psychological research
Normality vs Abnormality
1. Difficult to define = Difficult to diagnose
  1. Diagnosis based on self-report and exhibited symptoms (can be faked)
  2. Normality can change over time
    1. Homosexuality considered a disorder in DSM til 1974
    2. Once disorders were based on superstition and the paranormal
  3. Todays criteria of abnormality rely on distress to the individual, maladaptiveness, and in terms of what is (not acceptable to society *statistically different from what others do)
  4. Problems with defining abnormality
    1. Statistical infrequencies
      1. Some behaviors that are statistically "normal" are not healthy/desirable
      2. Some behaviors that are rare are not dysfunctional
    2. Violating social norms
      1. Relies heavily on context
      2. Diversity in culture
      3. Factors unknown to the observer that are causing behavior
        We have a tendancy to attribute other's problems to an internal factor and our own to external factor
    3. Maladaptiveness
      1. Many people engage in behaviors that are maladaptive/harmful but we don't class them as abnormal
      2. Most people fail to function adequately at some point in time but are not considered "abnormal"
2. 6 Characteristics of mental health (Jahoda 1958)
  1. Unrealistic. When strictly applied, so few people would actually meet the criteria for being normal that the term abnormal would not fit
  2. Doesn't account for cultural and social differences
3. 7 Criteria for abnormal behavior (Rosenhan and Seligman, 1984)
  1. Suffering - extent of distress and discomfort
  2. Maladaptiveness - behaviors that make life harder
  3. Irrationality - ability to communicate rationally
  4. Unpredictability - act in unexpected ways
  5. Unconventionality - experience things that are different from most people
  6. Observer discomfort - difficult/embaressing to watch
  7. Violation of moral standards - break the accepted ethical or moral standards
Abnormal behavior influences
1. Diathesis-stress model
  1. "His genetics hold the gun, his psychology loads it, and his environment pulls the trigger." - David Rossi
Diagnostic validity and reliability
1. Kleinmutz (1967) noted the limitations of interview process
  1. Information exchange can be interrupted by either due to lack of respect or not feeling well
  2. Anxiety of preoccupation of patient affects the interview
  3. Clinicians unique style, degree of experience, and the theoretical orientation can affect the interview
2. Abnormal psychology is a social construction that has evolved over time without prescriptive and regulating definitions and is largely gender and culturally biased
3. Diagnosis means identifying a disease on the basis of symptoms and other signs, compares information about disorder to the condition of a particular client
4. Effectiveness of diagnosis measured in validity and reliability
  1. Reliability - same diagnosis with the same procedure
    1. Beck et al (1962) - agreement on diagnosis for 153 patients between two psychiatrists was only 54%
    2. Inter-rater - same diagnosis between two psychiatrists
    3. Test-retest - coming up with the same diagnosis when retested annually, unless treated and cured
    4. Improved with standardized interview schedules, specific symptom sets (clinician still has to make a judgement on severity
    5. Many studies have shown varying results of inter-rater reliability using the same classification manuals
  2. Validity - correct diagnosis
    1. Di Nardo et al (1993) - very low reliability for assessing generalized anxiety disorder (.57) mainly due to validity problem such as interpreting how excessive a person's worries were
    2. It should be possible to clarify a real pattern of symptoms which can then lead to an effective treatment
    3. Receiving the correct treatment and prognisis
      1. Giving prognosis is really difficult
      2. Can have similar symptoms for many disorders
      3. Rosenhan (1973), Caetano (1973)
  3. Studies: Cooper et al (1972), Di Nardo et al (1993), Lipton
5. Diagnosis may be influenced by attitudes and prejudices of the psychiatrists
Cultural and ethical considerations in diagnosis
1. Cultural variation
  1. Stigmatization
    1. Stereotypes of psychological disorders
      1. Psych disorders are incurable
      2. People with psych disorders are often violent and dangerous
      3. People with psych disorders behave bizarrely and are very different from normal
  2. Symptoms can vary between social and cultural groups
    1. Seeing and hearing dead relatives may be normal in some but not others
  3. Cooper et al (1972) - New york psychiatrists were twice as likely to diagnose schizophrenia than London psychiatrists, who in turn were twice as likely to diagnose mania or depression when shown the same videotaped clinical interviews
2. Ethical considerations
  1. Some people use labels such as mentally ill, criminal, or foreign in order to socially people
    1. Langer and Abelson (1974) - showed a video of a young man telling an older man about his job experience. viewed positively if they were told he was a job applicant. Viewed negatively if told he was a patient
  2. One of the adverse effects of labels is the self-fulfilling prophecy - people may begin to act as they are expected to
    1. Doherty (1975) - those who reject the mental illness label tend to improve more quickly than those who accept it
  3. Confirmation bias - clinicians tend to have expectations about the person who consults them, assuming that if the patient is there in the first place there must be a disorder to diagnose (Rosenhans 1973)
  4. When patients have been admitted to a hospital, institutionalization can also be a confounding variable
    1. Powerlessness and depersonalization can be produced from instatutionalization through a lack of rights, constrictive activity, choice, and privacy, as well as verbal and physical abuse from attendants
  5. Seeman (2007) found that diagnostic changes for schizophrenic women could occur as clinicians found out more information about their patients (test-retest reliability)
Diagnostic tools
1. Psychiatrists rely primarily on the patients subjective description of the problem
  1. Other methods can be used to assist with diagnosis (direct observation of behavior, brain-imaging technologies, psychological and IQ test)
  2. ABCS of describing symptoms
    1. Affective symptoms - emotional elements
    2. Behavioral symptoms - observational behaviors (crying/pacing)
    3. Somatic symptoms - physical symptoms (twitching/cramping)
    4. Cognitive symptoms - ways of thinking (pessimism/personalization)
2. Most diagnosis through a formal standardized interview
  1. After interview a mental health status examination is done based on clinician's evaluation of the patients responses
3. Two major systems used by western psychiatrists - based on abnormal experiences and beliefs reported by patients and agreements among professionals as to what criteria should be used
  1. International classification of diseases (ICD)
    1. Put forth by WHO
    2. Designed to promote international comparability in the collection, processing, and classification
    3. Codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury and disease
      1. Works closely with APA for mental disorder chapter, so discrepancies were becoming fewer
  2. Diagnostic and Statistical Manual of Mental Disorders (DSM)
    1. Introduced by APA
    2. Revisions made to make diagnosis more reliable, compatability with ICD
      1. 100 disorders in first copy, now about 300
    3. 3 sections
      1. Introductory section - explains the process of DSM revisions and info on how to use DSM
      2. Listing of all diagnosis and symptoms but not causes
      3. Assessment tools, cultural effects on disorders, conditions and models for further research
    4. Criticisms
      1. Severly increased the number of diagnosis
      2. Labeling people - self-fulfilling prophecy and the media portrayal
      3. Is possible to fake and can lead to misdiagnosis
4. Different classification systems for children
5. Medical model
  1. Abnormal behavior is physiological in origin and is therefore treated in the same fashion
    1. Can be diagnosed, treated, and maybe even cured
  2. Psychopathy - 'mental illness' which is based on the observed symptoms of the patient
  3. Criticisms
    1. Poses that patients are sick vs having poor morals - responsability removed from patient
      1. Can be used irresponsabily to give unwanted treatment
    2. Few psychological disorders with a proven organic pathology (Frude 1998)
      1. Have correlation studies but no cause and effect
      2. Diagnosis are more social than biological - few reliable biological tests for disorders
        A psychiatric diagnosis is not the same as a medical diagnosis, there are value judgements involved (Fernando 1991)
        Diagnosis includes legal and financial implications
        The disease is the problem (the symptoms), not the cause of them
        Can you have depression in the same way that you have the flu?
        Believed in wrong to label behavior that does not conform as an illness
      3. More likely to take the bio-psycho-social approach
  4. Process of diagnosis
    1. Formal standardized interview of the patient
      1. Clinician subjectively evaluates patient response
        Information may be withheld or forgotten by patient
        Anxiety/preoccupation can greatly affect patient
        Clinicians effect upon the interview process
        Socia desirability
    2. Direct observation
    3. CAT, fMRI, PET scans
    4. Personality and IQ tests
    5. ABCS in describing disorders: Affective, behavioral, cognitive, somatic

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Abnormal Psychology - General

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	Created by Becca Colvin about 10 years ago