Understanding Abnormal Psychology
In any given society, there are established normal behaviors, thoughts, and emotions. Abnormal psychology studies the atypical or abnormal members of that society. In other words, members who fall outside of the most common parameters, and outside of "regular" psychology.
Falling outside of the normal parameters or being abnormal does not correlate with being good or bad. A genius or somebody with very high intelligence, for example, falls outside of the normal parameters. However, this is not a negative characteristic in this case. Considering this example about higher intelligence, abnormal psychology should be thought of in the same way.
One of the most important aspects of abnormal psychology is the process of diagnosis. According to the Internet Journal of Psychology, there are four elements when diagnosing psychiatric disorders.
The first "D" is deviance. Deviance is defined by the criteria provided in the DSM IV-TR manual. Apart from this criteria, other tests which provide norms for the general population are helpful to determine what the degree of the deviation is from the norm. Also, through clinical interviews information can be collected that is helpful to determine the amount of deviation. However, various disorders share common patterns of deviance and need to be examined through several different diagnostic models.
One example of deviance is pedophilia. Pedophilia is "a specific paraphilia, a class of disorders characterized by recurrent intense, sexually arousing fantasies, behaviors or urges" (Davis). Pedophilia is also described by recurrent urges or behaviors that exist at least six months. These behaviors or urges are directed at children 13 years of age or younger. Another criterion is that the individual must be over 16 years of age and at least five years or older than the subject at hand.
One particular survey showed that between three and nine percent of males admit an interest in underage children. Disturbingly, many of these studies determined this interest could be facilitated into action under particular circumstances. Although there are up to nine percent who fall into this category, this is still a small percentage.
Considering social attitudes and legal. Given the legal and social attitudes concerning pedophilia the number of individuals who can be diagnosed with the disorder is difficult to ascertain. The fact that up to nine percent of males may have a sexual interest in children may set an upper limit to the prevalence.
This, however, may still be questionable given a potential bias against reporting (e.g., potential respondents would find it taboo to admit to certain tendencies/feelings/thoughts). Females with these propensities are even rarer in the literature. Both of these factors are an example of factors that can be taken together to illustrate the statistical and societal specificity of deviance in pedophilia.
The second "D" is dysfunction. Dysfunction is another criterion used to determine whether there is evidence of a presence determining if the problem is large enough to be considered part of a diagnosis. Whatever the dysfunction, it must be major enough to interfere in the individual's life significantly. It is also important to look for dysfunction across other spectrums in their life that may exist in various places. To examine dysfunction, the diagnosis of recurrent major depressant episodes without psychotic features is also examined. When dysfunction is characterized by two or more episodes of a major depressive episode, it then is considered a more severe case.
When each dysfunctional episode is elevated to the point where it interferes with occupations or social life, it warrants a diagnosis. Symptoms are as such:
1) depressed mood most of the day to the point where it interferes with relations with others
2) decrease in pleasure in all aspects of their life
3) extreme insomnia or hypersomnia
4) marked energy loss to the point of possibly neglecting personal hygiene
5) unable to sustain concentration for any length of time
6) increased number of sick days used for work
A third "D," considered distress, is related to dysfunction. It is an important way to relate dysfunction throughout the individual's life. The individual can experience a significant amount of dysfunction and very little distress and vice versa. The factor of the event being related is the extent of the distress affecting the individual, and not the measure of the severity of the dysfunction.
One example of distress could be the diagnosis of hypochondria. The features of hypochondria regard an individual's preoccupation with fears that they have serious medical issues. This preoccupation is based on the individual misinterpretation of their own body's symptoms. Currently, this diagnosis is classified as a somatoform disorder. It also expresses features elements of an anxiety disorder.
The preoccupation and distress caused by it persist in spite of many repetitious medical evaluations and reassurance by their medical providers that there is nothing medically wrong with them. Although a "clean medical bill of health" so to speak helps initially, it increases distress of the individual in the long run. It seems that the more medical tests and reassurance that is seeking the more the distress increases in the long term. This brings the initial problem of distress to the forefront.
If thought restructuring can be accomplished, the individual's attention can be refocused away from his somatic symptoms to other thoughts that are not so distressing to the individual. If the overall amount of distress is decreased, an overall positive outcome may be more likely.
The fourth element when diagnosing psychiatric disorders throughout abnormal psychology is a danger. The danger concept consists of two themes, which include danger to self and danger to others. In every diagnosis, there is an element of danger and a degree of the severity of the danger. An acute dependence on nicotine can illustrate one very mild example of danger. The nicotine dependence is categorized as a substance abuse disorder. Primarily, nicotine dependence can be a danger to others through the effects of second-hand smoke.
The first-hand effects, in other words, danger to self, are obviously a result of the usage of the substance. The diagnosis of being nicotine dependent obviously has dangerous physical effects on health conditions related to it. Over eight million Americans are diagnosed with over twelve million smoking-related diseases. Ten percent of all smokers or former smokers have a smoking-related disease. Examples include emphysema, cancer, heart disease, emphysema, and strokes. Nearly a million Americans die prematurely every year due to a smoking-related illness.
Tolerance and withdrawal are also included. There are dangerous mental health effects evidenced by the continuous emotional impacts and behaviors that people exhibit when nicotine is unavailable, limited, or when they are trying to quit.
Certain individuals who are very addicted to nicotine may altogether avoid activities that impair their ability to use nicotine. Interestingly, eighty percent of smokers express an interest in quitting their nicotine habit. Even though thirty-five percent of smokers try to quit smoking every year, sadly only five percent of the thirty-five who try are successful. This obviously shows the cognitive dissonance by many smokers.
Though the danger of Nicotine Dependence may be obvious given the statistics, it is also clear that other mental illnesses carry substantial elements of danger. This is true even for those diagnosed not involving dependence on chemical substances that negatively impact one's health. Hiroeh, Mortensen, and Dunn3 followed over 257,000 individuals in the Danish psychiatric register and documented their causes of death.
They found that individuals with mental illnesses had a 25 percent higher chance of dying from any unnatural cause, including homicide, suicide, and accidents. Further, they found that almost all psychiatric diagnoses show elevated mortality as compared to the general population. Of all types of unnatural deaths, suicide was the most prevalent. This evidence shows the necessity of assessing danger when conceptualizing a mental diagnosis.
As deviance, distress, dysfunction, and danger are agreed upon by all clinicians, a fifth element some belief is that of duration. Some believe duration can become important since it can contribute to or detract from emotions, cognitions, or behaviors, being persistent or consistent enough to contribute and better define the diagnosis.
In general, abnormal psychology deals with various psychological disorders, including anxiety disorders, cognitive disorders, mood disorders, developmental disorders, adjustment disorders and more specific disorders such as depression, severe phobias, and bipolar disorder.
There are three basic therapy approaches employed in clinical practice as follows:
- Cognitive: Cognitive therapy focuses on a person's thinking patterns and beliefs as well as how they contribute to mental illness. The cognitive therapist helps the patient change their thinking to a healthier pattern.
- Behavioral: a Behavioral approach to abnormal psychology focuses on the person's outward behavior. Each goal focuses on reinforcing positive behaviors and diminishing the harmful ones. This approach can often be combined with cognitive therapy to use thinking and behavior in conjunction with each other. This is called cognitive-behavioral therapy (CBT).
- Medical: Medical approach specifically examines the biological cause of mental illness. This could be anything from a chemical imbalance or an infection. Patients under the medical approach are typically treated with medication.
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Comer, RJ. Abnormal Psychology. New York, NY: Worth Publishing; 2010.
Diagnostic and statistical manual of mental disorders. 4th text revision ed. Washington D.C.: American Psychiatric Association; 2000
Hiroeh U, Mortensen P, Dunn G. Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. The Lancet. 2001; 358(9299): 2110-2112.
Remick R. Diagnosis and management of depression in primary care: a clinical update and review. Journal of the Canadian Medical Association. 2002; 167(11): 1253-1260.
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T Davis. Conceptualizing Psychiatric Disorders Using "Four D's" of Diagnoses. The Internet Journal of Psychiatry. 2009 Volume 1 Number 1.
Wilmhurst L. Essentials of Child Psychopathology. Hoboken: NJ: John Wiley & Sons; 2005.