Abnormal Psychology

Rodrigo DP. Tomas

Outcome 1: Distinguish between pathological and non-pathological manifestation of behavior.

Outcome 2: Recognize common psychological disorders given specific symptoms.
Outcome 3: Use major psychological theories particularly the commonly recognized ones, in explaining how
psychological problems are caused and how they develop.
Outcome 4: Identify the socio-cultural factors that may impact on problem identification and diagnosis of
abnormal behavior
Outcome 5: Apply appropriate ethical principles in diagnosing cases of abnormal behavior

Everyday our lives we try to understand other people. Determining why another person does or
feels something is a difficult task. Indeed, we do not always understand why we ourselves feel and behave as
we do. Acquiring insight into what we consider normal, expected behavior is difficult enough; understanding
human behavior that is beyond the normal range, is even more difficult
Encountering instances of abnormal behavior is a common experience for all of us. This is not
surprising given the high prevalence of many forms of mental disorder. As we approach the study of
psychopathology, the field concerned with the nature and development of abnormal behavior, thoughts and
feelings, we do well to keep in mind that the subject offers few hard and fast answers. A precise definition of
abnormality is still elusive. Even though we lack consensus on the precise definition of abnormality, there are
clear elements of abnormality: suffering, Maladaptiveness, statistical deviancy, violations of societys
standards, social discomfort, irrationality or unpredictability, and dangerousness.

What is MENTAL DISORDER?

One of the most difficult challenges facing those in the field of PSYCHOPATHOLOGY is to define
MENTAL DISORDER. The best current definition of mental disorder is one that contains several characteristics.
The definition of mental disorder presented in the current American Diagnostic Manual, the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) includes number of
characteristics essential to the concept of mental disorder.
In DSMIV-TR Mental disorder is defined as

A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual

and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more
important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability, or an
important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally
sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must
currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual
(American Psychiatric Association, 2000, p. xxxi)

Here we consider several characteristics that have been proposed as components of abnormal
behavior. We will see that no single one is adequate, although each has merit and captures some part of what
might be the full definition. Consequently, mental disorder is usually determined based on the presence of
several characteristics of statistical infrequency, violation of social norms, personal distress, disability or
dysfunction, and unexpectedness.

A. Statistical Infrequency (statistical rarity). One aspect of abnormal behavior is that it is

infrequent. For example, episodes of depression and mania. The normal curve, or bell-shaped curve, places the
majority of people in the middle as far as any particular characteristic is concerned, very few people fall at
either extreme. An assertion that a person is normal implies that he or she does not deviate much from the
average in a particular trait or behavior pattern.

Statistical infrequency is used explicitly in diagnosing mental retardation. Although some infrequent behaviors
or charactersitics of people do strike us as abnormal, in some instances the relationships breaks down. Having
great athletic ability is infrequent, but few would regard it as part of the field of abnormal psychology. Only
certain infrequent behaviors, such as experiencing hallucination or deep depression fall into the domain of
abnormal behavior.

B. Violation of social norms: Most of our behavior is shaped by norms - cultural expectations about
the right and wrong way to do things. Norms are widely held standards (beliefs and attitudes) that people use
consciously or intuitively to make judgements about where behaviors are situated in such scales as good-bad,
right-wrong, justified-unjustified, acceptable and unacceptable. Behavior that violates social norms might be
classified as disordered.

For example, the repetitive rituals performed by people with obsessive-compulsive disorder and the
conversation with imaginary voices that some people with schizophrenia are engaged in are violation of social
norms. Yet this way of defining mental disorder is both too broad and too narrow
For example is too broad that criminals violate social norms but are not usually studies in the domain of
psychopathology; it is too narrow that highly anxious people typically do not violate social norms.

Also of course, social norms vary across cultures and ethnic groups, so behavior that clearly violates social
norms in one group may not do so at all in another. For example in some cultures but not in others it violates a
social norm to directly disagree with someone.

C. Disability that is impairment in some important area of life (e.g. work or personal relationship)
can also be used to characterize mental disorder. For example, substance related disorders are defined in part
by the social or occupational disability (e.g. serious arguments with one spouse or poor work performance)
created by substance abuse.

Phobias can produce both disability and distress for example, fear of flying prevent someone living in one place
from taking a job in another place. Like distress, however, disability alone cannot be used to define mental
disorder, for example the disorder bulimia nervosa involves binge eating and compensatory purging (vomiting)
in an attempt to control weight gain but does not necessarily involve disability. Other characteristics that might
in some be considered disabilities, -such as being blind does not fall within the domain of psychopathology. We
do not have rule that tells us which disabilities belong to our domain of study and which is not.

For example: John, a 38 male, drinks every day to the point of losing consciousness. He is
argumentative with his family and friends, and has gotten into frequent fights at work. Last week he swore at his
boss, and as a result has been fired. John does not seem to have any motivation to find further employment.
Nevertheless, he spends what little money he has in savings on alcohol and unnecessary items such as candy, video
tapes, and whatever else he might want at the moment. John often dwells on how worthless he thinks he is, but
also on how others do not treat him properly. When not aggressive, he is frequently depressed.

D. Personal distress: One characteristic used to define mental disorder is personal distress-that is, a
persons behavior may be classified as disordered if it causes him or her great distress. This criterion is satisfied
if the individual is extremely upset.

For example: A student began feeling sad and lonely. Although he was still able to go to classes and
work, he finds himself feeling depressed much of the time and he is concerned about what is happening to him.
 But not all mental disorders causes distress, example an individual with anti-social personality
disorder may treat others coldheartedly and violate the laws without experiencing any guilt, remorse, anxiety or
other type of distress.

And not all behavior that causes distress is disordered- for example, the distress of hunger due to
religious fasting or the pain of childbirth.

Put simply, if the person is content with his/her life, then he/she is of no concern to the mental health
field. If, on the other hand, the person is distressed (depressed, anxious, etc), then those behaviors and
thoughts that the person is unhappy about are abnormal behaviors and thoughts.

E. Dysfunction: Wakefield (1992) proposed that mental disorder could be defined as a harmful
dysfunction: this definition has two parts:
1. A value judgment (harmful). A judgment that a behavior is harmful requires some standard, and this
standard is likely to depend on social norms and values.
2. A dysfunction- dysfunctions are said to occur when an internal mechanism is unable to perform its natural
function- the function that is evolved to perform. The broader concept of dysfunction as indicated in DSMIV-TR
definition of mental disorder refers to behavioral, psychological or biological dysfunctions that are supported
by our current evidence.

No one definition is the "correct" or the "best" definition. To a certain extent each one captures a
different aspect of the meaning of abnormality. When we talk about Abnormality, or when we study it, or
treat those suffering from it, we inevitably invoke one or more of these definitions, either explicitly or implicitly
- either we're aware of the definition(s) we're using or we're not. But we do use some definition. All of you
have some definition in your heads about what psychological abnormality is, whether or not you could clearly
state it. In any event, it is important, especially as scientists which we make as explicit as possible the
definition(s) we use, and acknowledge any limitations. To operate implicitly hinders our ability to develop as a
science - our awareness is limited because as long as our definitions are implicit, they remain unchallengeable,
we ignore alternatives, we don't "stretch" ourselves. And each definitional stance can certainly be challenged.

Problems with the definitions of abnormality

There are exceptions with each stance, or in other words "counter - examples". Identifying counter-
examples is a useful exercise: it allows you to uncover a definition's logical flaws.

A. Statistical deviation: This definition would mean a genius should be termed abnormal. Are
deviations from the average a sign of abnormality? In many respects, think how boring life
would be if we were all "average" - all basically the same - no dramatic differences. Indeed,
many of the wonderful advances made in our history (be it in art, science, culture...) resulted
from people who took chances and tried new ways of doing things - people who deviated from
what was the average way of doing things. Deviations can lead to flexibility and progress.

B. Social norm violation:

a) Social reformers, protestors, etc. This definition would require that we label all social reformers
as abnormal, people like Susan B. Anthony, a feminist leader. She wanted social rules changed - she rejected
the norms of society.
b) Cultural relativism. As natural and absolute the norms of our society seem to us. Sociology and
Anthropology have taught us that there is in fact nothing absolute about them.
Each of these cultures is different from the other. By which culture's standards do we judge a
behavior to be abnormal?
 In addition, even in a single society such as the U.S. there are a myriad of subcultures. Add to this
the fact that norms change through the years so that what's normative in one generation, may not be in
another. We are left with a single society where there are no clear norms that apply across all individuals. This
definitional stance implies that normality is the same as conformity to the mainstream, when in fact there are
many streams.

C. Maladaptive behavior: This position ignores the possibility that there may be abnormal situations.
That is, perhaps there are situations in which it would be abnormal to adapt. A woman unable to cope with a
husband who abuses her. The risk here is that we will end up "blaming the victim".
D. Personal distress: To say that abnormal behavior is behavior that causes a person
distress/discomfort is to say that it is normal if there is no discomfort. Thus, a psychotic patient who hears
voices from his dead mother that makes him happy.
Conversely, distress may not always be a bad thing. Indeed, perhaps people who can easily express
their fear, depression, or other forms of distress end up better dealing with their problems. Or some types of
distress may actually be very useful: anxiety, for example, can signal you that danger is afoot and that you
better prepare for it! It seems clear that the definition of abnormality must go beyond the limited confines of
"distress" and "discomfort", at least in certain situations.

Using a definition is unavoidable and it is necessary. But choosing one is inherently unscientific - a
value judgment in the final moment. When we choose a definition, we do so in part based on feeling, emotion,
convenience, custom, appeal, ethics. There is an inherent nonscientific arbitrariness in this choice. The
potential result is that psychologist Y and psychologist X could be talking about very different things when
using the word "abnormal." Confusion and controversy ensues, especially if the definitions remain implicit.
However, as a science, we ideally make our definitions explicit and then attempt to clarify and
modify these definitions through scientific/methodological rigor, with an eye always open to the exception and
alternative explanations. It remains a philosophical debate whether the uncertainty of our definition of
"abnormality" is surmountable or is an inherent fuzziness of the field.
Finally, the definition we use in this course is multifaceted - using aspects of each definitional stance.
Their individual shortcomings and mutual incompatibilities will create tensions in our discussions that we can
use to explore some of the important issues in the study of psychopathology.

History of Abnormal Psychology

One strong current of opinion put the causes and treatment of psychological disorders squarely in the
realm of the supernatural. Behavior seemingly outside individual control was subject to similar interpretation.
The bizarre behavior of the people afflicted with psychological disorders was seen as the work of the devil and
witches. Many early philosophers, theologians, and physicians who studied troubled mind believed that
deviancy reflected the displeasure of the gods or possessions by demons.

The search for the causes of mental disorders has gone on for a considerable period of time.
At different periods in history, explanations for mental disorders have been supernatural, biological and
psychological.

Early Demonology
Before the age of scientific inquiry, all good and bad manifestations of power beyond human
control- eclipses, storms, fires, earthquakes, diseases and the changing seasons were all regarded as
supernatural.
The doctrine than an evil being or spirit can dwell within a person and control his or her mind and
body is called demonology. For example in the new testament when Christ curing a man with an unclean
spirit by casting out the devil from within him and hurling them onto a herd of swine
 The primary type of treatment was exorcism. Exorcism, the casting out of evil spirits by ritualistic
chanting or torture. It typically took the form of elaborate rites of prayer, noisemaking, forcing the afflicted to
drink terrible-tasting brews, and on occasions more extreme measures such as flogging and starvation, to render
the body uninhabitable to devils.

Early Biological Explanations

In the Somatogenesis: the notion that something wrong with the soma, or physical body,
disturbs thought and action. Psychogenesis, in contrast is the belief that a disturbance has psychological
origins.

Early Greek Thinkers Hippocrates (460-377BC), Father of modern medicine believed about natural causation
for mental diseases. He separated medicine from religion, magic and superstitions. He rejected the notion that
God sent mental disturbances as punishment and insisted that such illnesses had natural causes and hence
should be treated like other common maladies such as colds and constipation. He classified into three mania,
melancholia, and phrenitis (brain fever). He believed that normal brain functioning and therefore mental health
depended on a delicate balance among four humors, or fluid in the body namely blood, black bile, yellow bile
and phlegm.

If a person was sluggish and dull he contained a preponderance of phlegm.

A preponderance of black bile was the explanation for melancholia.
Too much yellow bile explained irritability and anxiousness.
And too much blood results to changeable temperament

Dark Ages and Demonology

Historians have often suggested that the death of GALEN who is regarded as the last major
physician of the classical era, marked the beginning of the Dark Ages for Western European medicine and for
the treatment and investigation of abnormal behavior
a. Christian monasteries through their missionary and educational work, replaced physicians as healers and
authorities on mental disorders.
b. The monks in the monasteries cared for and nursed for the sick.
c. Monks cared for people with mental disorder by praying over them and touching them with relics.
d. Monks also concocted fantastic potions for them to drink in the waning phase of the moon.
e. During this period, there was a return in a belief that super natural causes mental disorders.

The Persecution of the Witches.

Beginning in the 13th century, modern-day investigators believed that the mental ally ill of the later
middle Ages were considered witches. The accused of witch craft must be tortured if they did not confess,
those convicted and penitent were to be imprisoned for life, and those convicted and unrepentant were to be
handed over the law for execution.
Dancing mania (epidemics of raving, jumping, dancing and convulsions) were reported as early as the 10th
century. Tarantism: a disorder that included an uncontrollable impulse to dance that was often attributed to
the bite of the southern European tarantula or wolf spider. This dancing mania later spread to Germany and to
the rest of Europe where it was known as Saint Vituss dance. Isolated rural areas were also afflicted with
outbreaks of lycanthropy - a condition in which people believed them to be possessed by wolves and imitated
their behavior. Today so called mass hysteria occurs occasionally, the affliction usually mimics some type of
physical disorder such as fainting spells or convulsive movements.

Development of Asylums

Confinement of the mentally ill began in earnest in the 15 th and 16th centuries. Leprosariums
were converted to asylums- refuges established for the confinement and care of the mentally ill.

Benjamin Rush: The father of American Psychiatry believed that mental disorder was caused by an excess of
blood in the brain. Consequently, his favored treatment was to draw from disordered individuals great
quantities of blood. Rush also believed that people with mental illness can be cured by being frightened, thus
one of his recommended procedures was to convince the patient that death is near.

Rush and Moral Management in America - Benjamin Rush (1745-1813) also one of the signers of the
Declaration of Independence, encourages more humane treatment of the mentally ill. Moral management a
wide ranging method of treatment that focused on a patients social, individual and occupational needs.

Pinels Reform

Philippe Pinel (1745-1826) has often considered a primary figure in the movement for the
humanitarian treatment of the mentally ill in the asylums. Pinel believed that patient in his care were first and
foremost human beings, and thus these people should be approached with compassion and understanding
and treated them with dignity.

a. Pinel removed the chains of the people imprisoned

b. Treat the inmates as sick human beings rather than beasts
c. Light and airy rooms replaced dungeons
d. Incarcerated patient for years were apparently restored to health and eventually discharged from the
hospitals

Moral Treatment

A sympathetic and attentive treatment provided by Pinel and Tuke.

a. Patients has close contact with the attendants

b. Patients are encouraged to do purposeful activity
c. Residents led lives as normally as possible
d. Residents took responsibility for themselves within the constraints of their disorders

William Tuke (1732-1822) - Established the York Retreat in England, a pleasant country house where
mental patients lived, worked and rested in a kindly, religious atmosphere. This retreat represented the
culmination of noble battle against the brutality, ignorance and indifference of Tukes times.

Dorothea Dix and Mental Hygiene Movement (1802-1887) a crusader for improved conditions for people with
mental illness, who fought for hospitals for their care. She advocated a method of treatment that focused
almost exclusively on the physical wellbeing of hospitalized mental patients. She personally helped to see the
32 state hospitals were built.
The Evolutions of Contemporary Thought

Contemporary developments in biological and psychological approaches to the cause sand treatments
of mental disorder were heavily influenced by theorists and scientists working in the late 19 th century and early
20th centuries.

Thomas Sydenham was particularly successful in advocating an empirical approach to classification and
diagnosis that subsequently influenced those interested in mental disorders.

Wilhelm Greisinger who insisted that any diagnosis of mental disorder specify a biological cause,

Emil Kraeplin a well-known follower of Greisinger furnished a classification system in attempt to establish a
biological nature of mental illness. He discerned among mental disorder, a tendency to form a certain group,
of symptoms called, syndrome. Kraeplin proposed two major groups of severe mental disorders: dementia
praecox an early term for schizophrenia and manic-depressive psychosis.

The search for somatogenic causes dominated the field of abnormal psychology until well in the 20th century

Franz Anton Mesmer an Austrian physician believed that hysterical disorders were caused by a particular
distribution of a universal magnetic fluid in the body. He regarded hysterical disorder as strictly physical. He is
generally regarded as one of the earlier practitioners of modern-day hypnosis.

Jean Martin Charcoat: also studied hysterical states including anesthesia (loss of sensations) paralysis,
blindness, deafness and convulsive attacks. Initially he espoused the somatogenic point of view.

Josef Breuer: He became known with his cathartic method reliving an earlier emotional catathostrophe and
the released of the emotional tension produced by previously forgotten thoughts about even

Major Psychological Theories, Particularly the Commonly Recognized Ones, In Explaining How Psychological
Problems Are Caused and How They Develop

Understanding Anxiety Disorders

Psychoanalytic Perspective
o Psychodynamic theorist and many other clinicians believe that
the major determinants of anxiety disorders are internal
conflicts and unconscious motives.
o Psychodynamic theorists frequently mention the following as
causes of anxiety that reaches clinical proportions: (a)
perception of ones self as helpless in coping with
environmental pressures, (b) separation or anticipation of
abandonment, (c) privation and loss of emotional support as a
result of sudden environmental changes, (d) unacceptable or
dangerous impulses that are close to breaking into
consciousness, and (e) threats or anticipation of the
disapproval or withdrawal of love.

o Generalized anxiety occurs when a person feels unable to cope

with many everyday situations and consequently feels
Behavioral Perspective apprehensive much of the time.

Cognitive Perspective
Biological Perspective
Understanding Mood Disorders
Psychoanalytic Perspective
Behavioral Perspective
Cognitive Perspective
o Phobias are viewed as avoidance responses that may be
learned either directly from frightening experiences or
vicariously by observing fearful responses in others.
o Some phobias appear to result from actual frightening
experiences, others maybe learned vicariously through
observation.
o A cognitive analysis of anxiety disorders focuses on the way
that anxious people think about situations and potential
dangers.
o This kind of mental set makes a person hypervigilant, always on
the lookout for signs of danger.
o Studies of obsessive-compulsive individuals have revealed that
those persons hold unreasonable beliefs and assumptions.
They believe that they (1) should be perfectly competent, (2)
must avoid criticism or disapproval, and (3) will be severely
punished for their mistakes and imperfections
o Strong evidence for a genetic factor in anxiety disorders is
shown in studies of both animals and humans.
o There is also some weaker evidence for an environmental
factor.
o Psychoanalytic theories interpret depression as a reaction to
loss; depressed person reacts to it intensely because the
current situation brings back all the fears of an earlier loss that
occurred in childhood.
o John Bowlby, a British Psychoanalyst, was one of the
prominent theorists who emphasized the importance of
childhood loss or separation to later development, he believed
that the childhood experiences that contribute to these
feelings were not single events, but developed from long- term
patterns of familial interactions.
o Research supports the view that a combination of traumatic
childhood experiences and acute external stressful events in
adulthood is associated with the occurrence of a major
depressive episode.
o Learning theorists assume that lack of reinforcement plays a
role in depression.
o The inactivity of the depressed person and the feelings of
sadness are due to a low rate of positive reinforcement and/or
a high rate of unpleasant experiences.
o People prone to depression may lack the social skills either to
attract positive reinforcement or to cope effectively with
aversive events.
o Once people become depressed and inactive, their main source
of reinforcement is the sympathy and attention they receive
from relatives and friends.
o Cognitive theories of depression focus not on what people do
but on how they view themselves and the world.
o Aaron Beck proposed that the depressed persons negative
self-schema is formed during childhood or adolescence through
such experiences as loss of a parent, social rejection by peers,
criticism by parents or teachers, or a series of tragedies.

Biological Perspective
Humanistic- Existential
Perspective
Understanding Schizophrenia
Biological Perspective
Understanding Anti-social Personalities
Biological Factors
o Aaron Beck grouped the negative thoughts of depressed
individuals into three categories, which he called cognitive
triad: negative thoughts about the self, about present
experiences, and about the future.
o They expect to fail rather than to succeed, and they tend to
magnify failures and minimize successes in evaluating their
performance.
o A tendency to develop mood disorders, particularly bipolar
disorders, appears to be inherited.
o Mounting evidence indicates that our mood are influenced by
the neurotransmitters that transmit nerve impulses from one
neuron to another
o Two neurotransmitters believed to play an important role in
mood disorders: norepinephrine and serotonin.
o The biological hypothesis is that depression is associated with a
deficiency of one or both of these neurotransmitters and that
mania is associated with an excess of one or both of them.
o For existentialist theories, instead of emphasis on the loss of a
loved object or an important person as central to depression,
the loss can be symbolic (power, social rank or money).
o Humanistic theories emphasize the difference between a
persons ideal self and his or her perceptions of the actual state
of things as the source of depression and anxiety.
o They believe that depression is likely to result when the
difference between the ideal and the real selves becomes too
great for the individual to tolerate.
o Family studies show that there is a hereditary predisposition
toward developing schizophrenia.
o Several studies of DNA samples from families with an unusually
high incidence of schizophrenia found evidence of a defective
gene, or cluster of genes, located on chromosome.
o The culprit in schizophrenia is believed to be dopamine. The
dopamine hypothesis proposes that schizophrenia is caused by
too much dopamine at certain synapses in the brain.
o A number of genes acting together may make an individual
susceptible to the disorder, and environmental factors will
determine whether the disorder develops and the degree of its
severity.
o There is a substantial support for a genetic influence on
antisocial behavior, particularly criminal behaviors.
o Research with children who show antisocial tendencies
indicates that a significant percentage, perhaps the majority
have an attention deficit disorder.
o The disruptive behavior of these children leads to frequent
punishment and rejection by peers, teachers and other adults.
o In turn, these children then become even more disruptive and
some become overly aggressive and antisocial in their
behaviors and attitude.
o Although children who develop antisocial personalities may
have some biological predisposition to this disorder, studies
 suggest that they are unlikely to develop them unless they are
also exposed to environments that promote antisocial
behavior.

A. The biological paradigm assumes that psychopathology is caused by a biological defect. Two biological
factors relevant to psychopathology are genetic and neurochemistry. Biological therapies attempt to
rectify the specific biological defects underlying disorders are to alleviate symptoms of disorders, often
using drugs to do so.
B. The psychoanalytic or psychodynamic paradigm derives from the work of Freud. It focuses on
repressions and other unconscious processes that are traceable to early childhood conflicts. The
psychoanalytic paradigm generally searched the unconscious and the early of the patient for the
causes of abnormality, although present-day ego analyst place greater emphasis on conscious ego
functions. Therapeutic intervention based on the psychoanalytic theory usually attempt to lift
repressions so that the patient can examine the infantile and unfounded nature of his or her fears.
C. Humanistic and existential therapies are insight oriented, like psychoanalysis and regard freedom to
choose and personal responsibility as key human characteristics. Rogers client-centered therapy
entails complete acceptance of the clients; therapists also use empathy, restating the clients thought
and feelings, and sometimes offer new perspectives on the clients problem. Existential therapies
emphasize personal growth and confronting the anxieties that are part of the choices we have to
make in life. Perls Gestalt therapy tries to help patients better understand and accept their needs,
desires, and fears.
D. Behavioral or learning paradigm suggests that aberrant behavior has developed through classical
conditioning, operant conditioning or modeling. Investigators in this traditions share a commitment to
examine carefully all situations affecting behavior as well to0 define concepts carefully. Behavior
therapists try to apply learning principles to alter overt behavior, thought and emotion. Less attention
is paid to the historical causes of abnormal behavior than to what maintains it, such as the reward and
punishment contingencies that encourage problem response patterns.
E. Cognitive theorists have argued that certain schemas and irrational interpretations are major factors in
abnormality. In both practice and theory, the cognitive paradigm has usually blended with behavioral
in approach to intervention that is referred to as cognitive-behavioral. Therapists such as BECK and
ELLIS focus on altering patients negative schemas and interpretations.
F. Because each paradigm seems to have something to offer to our understanding of mental disorders,
there has recently been a movement to develop more integrative paradigms. The diathesis-stress
paradigm, which investigates several points of view, assumes that people are predisposed to react
adversely to environmental stressors. The diathesis maybe biological or psychological and maybe
caused by early childhood experiences, genetically determined personality traits or sociocultural
influences

Sociocultural Factors That May Impact On Problem-Identification and Diagnosis of Pathological Behavior

For reasons of temperament, conditioning and other individual factors, not all people adapt to
the prevailing cultural patterns. We will examine several factors in the social environment that may increase
vulnerability.
The Sociocultural Environment

In much the same way that we receive a genetic inheritance that is the end product of millions of
years of biological evolution, we also receive a sociocultural inheritance that is the end product of thousands of
years of evolution. Because each group fosters its own cultural patterns by systematically teaching its
offspring, all its members tend to be somewhat alike- to conform to certain basic personality types. Thus in a
society characterized by a limited and consistent point of view, there are not the wide individual differences
typical in a society where children have contact with diverse, often conflicting beliefs. Even in our society,
however, there are certain core values that most of us consider essential.

Subgroups within a general sociocultural environment- such as family, sex, age, class occupational,
ethnic, and religious groups foster beliefs and norms of their own, largely by means of social roles that their
members learn to adopt. Expected role behaviors exists for a student, a teacher, an army officer, a priest, a
nurse, and so on. Because most people are members of various subgroups, they are subject to various role
demands, which also change over time. When social roles are conflicting, unclear, or uncomfortable, or when
an individual is unable to achieve a satisfactory role in a group, healthy personality development may be
impaired- just as a child is rejected by juvenile peer groups.

The extent to which role expectations can influence development is well illustrated by masculine
and feminine roles in our own society and their effects on personality development and on behavior. In recent
years, a combination of masculine and feminine traits (androgyny) has often been claimed to be
psychologically ideal for both men and women. Many people, however, continue to show evidence of having
been strongly affected by traditional assigned masculine and feminine roles. Moreover, there is accumulating
evidence that the acceptance the acceptance of gender-role assignment has substantial implications for
mental-health.

Pathogenic Societal Influences

1. Low Socioeconomic Status and Unemployment An inverse correlation exists between socioeconomic
status (SES) and the prevalence of abnormal behavior- the lower the socio economic class the higher the
incidence of abnormal behavior. The strength of correlation seems to vary with different types of disorder,
however.

For example, antisocial personality disorder is strongly related to social class, occurring at three times the rate
in the lowest income category as in the highest income category, whereas depressive disorders occur only about
50% more often in the lowest income category as in the highest income category.

It is almost certainly true that people living in poverty encounter more and more severe stressors in their lives
than people in the middle and upper class, and they usually have fewer resources for dealing with them. Thus
the tendency for some abnormal behavior to appear more frequently in lower socioeconomic groups may be
atleast partly due to increased stress in the people at risk.

Children from low SES families also tend to have more problems. A number of studies have documented a
strong relationship between the poverty status of parents and lower IQs in children. These adverse effects of
poverty on cognitive functioning seems to occur as a function of variety of factors associated with poverty
including

a. poor physical health or low birth weight at birth

 b. higher risks of prenatal exposure to drugs
c. higher risk of lead poisoning
d. less cognitive stimulation to home environment
In addition to studies on the effects of poverty, other studies examined the effects of UNEMPLOYMENT per se
on adults and children. Such studies have repeatedly found out unemployment to be associated with enhance
vulnerability and thus, elevated rates of abnormal behavior. Recession and inflation coupled with high
unemployment are sources of chronic anxiety for many people. Unemployment has placed a burden on a
sizeable segment of our population, bringing with financial hardships and self-devaluation, demoralization, and
emotional distress.
Periods of extensive unemployment are typically accompanied by adverse effects of mental and
physical health. In particular, rates of depression, marital problems and somatic complaints increase during
periods of unemployment but usually normalize following redeem unemployment. The physical and
psychological health problems are more severe in lower socioeconomic status groups.
It also seems that physical violence among couples is associated with unemployment. Not
surprisingly, the wives of unemployed men are also adversely affected, with higher levels of anxiety, depression
and hostility, which seem to be atleast partially caused by the distress of the unemployed husband. One of the
best predictor distinguishing children (especially boys) who experienced significant problems with mental
health or delinquency from those who did not was whether the father was lost his job when his children were
small.
Maternal unemployment can also have adverse effects especially if the mother is single. Mcloyd
and colleagues found out that single African-American mothers who were unemployed showed more frequent
punishment of their adolescent children, which in turn led to cognitive distress and depressive symptoms in
adolescent.

Disorder-Engendering Social Roles

An organized society, even an advanced one, sometimes asks its members to perform roles in
which the prescribed behaviors either are deviant themselves or may produce maladaptive reactions. Soldiers
who are called by their superiors (and ultimately by their society) to deliberately kill and maim other human
beings may subsequently develop serious feelings of guilt. They may also have latent emotional problems
resulting from the horrors commonly experienced at combat and hence be vulnerable to disorder.

Epidemiology

The scientific study of the incidence, distribution, and consequences of a particular

problem or set of problems (physical and mental disorders) in one or more populations.

Epidemiological research focuses on three features of a disorder:

1) Prevalence. The proportion of people with the disorder either currently or during their
lifetime

2) Incidence. The proportion of people who develop new cases of the disorder in some period
usually a year

3) Risk factor. Variables that are related to the likelihood of developing the disorder
 Epidemiological studies of risk factors are usually correlational studies because they
examine how variables relate to each other without including a manipulation of the
Independent variable.
Epidemiological studies are designed to be representative of the population being
studiedresearchers test a group of people who match the population on key
characteristics, like gender, economic status, and ethnicity.
The epidemiological approach serves to indicate both the social conditions that are
correlated with a high incidence of given disorders and the high-risk areas and groups
those for whom the risk of pathology is especially high.

Comorbidity

Is the term used to describe the presence of two or more disorders in the same person.
Comorbidity is especially high in people who have severe forms of mental disorders.

Sociocultural Causes of Abnormal Behavior

War and violence

The conditions of warfare have placed great stress on large numbers of people. Privation,
mutilation, death, grief and social disorganization have been irritable accompaniments of war.

Deviance-Producing Social Rules

An organized society sometimes calls on its members to perform roles in which the prescribed
behaviors are either deviant or may produce maladaptive reactions in persons asked to perform
them.

Group Prejudice and Discrimination

We have made progress in recognizing the demeaning and often disabling social roles our society
has historically assigned to women. Many women than men suffers from various emotional
disorders, notably depression and many anxiety disorders. One of the most destructive forms of
group prejudice is that of racial discrimination. Racial discrimination, poverty and social
disorganization tend to degrade and confuse human beings.

Economic and Employment Problems

Unemployment has placed a burden on a sizeable segment of our population bringing with it both
financial hardship and self-devaluation. In fact, unemployment can be debilitating psychologically
as it is financially.

Accelerating Technological and social change

Constantly trying to keep up with the new adjustment demanded by changes in the society is a
source of considerable stress.

The sociocultural viewpoint has led to the introduction of programs designed to alleviate social
conditions that foster maladaptive behavior and to the provision of community facilities for the early
detection, treatment and long-range prevention of mental disorders.
Outcome 5: Legal, Ethical and professional Issues In Diagnosis

The DSM 5 is published by the American Psychiatric Association, not by psychologists and it presupposes that
a medical model is appropriate for categorizing the various forms of psychopathology because it disregards
some theory like fixations and neuroses. Psychiatry only believes that psychopathology is only caused by
biological factors; while Psychology gives us another idea that psychopathology is caused by repressed
emotion, faulty cognitions and traumatic events.

Almost by default, psychologist have capitulated the use of DSM 5, like most social workers, counselors and
other non-psychiatric professionals.

Three ethical issues in diagnosis are

1. Deliberate misdiagnosis- There are two main types of deliberate misdiagnosis, relevant to the ethical
standards of psychologists.

a. Up-coding or over diagnosis- occurs when clinician select a more severe diagnosis than the accurate
diagnosis. This would be done in situations where the accurate diagnosis is severe enough to qualify for
reimbursement from a third-party payer. This is probably the most common type of deliberate diagnosis. The
practice of submitting inaccurate diagnoses so that clients can receive treatments has been called diagnosing
for dollars In these cases, since the clinicians will not be paid unless the client conditions is over diagnosed,
the rationale that it is done for the clients benefit is not completely convincing, Another type of up-coding
involves making a diagnosis of a mental disorder when no such disorder exists.

b. Down coding or under diagnosis- the second type of deliberate misdiagnosis is down coding or under
coding, which occurs when the clinician selects a less severe diagnosis than the accurate diagnosis, perhaps to
minimize the danger of potentially damaging information being recorded in the clients medical record. Down-
coding may also be done to avoid the potentially stigmatizing effect of a more severe diagnostic label, and too
avoid harming the clients self-esteem.

One yardstick by which to measure the maturity of a profession is its commitment to a set of
ethical standards. Psychology was a pioneer in the mental health field establishing a formal code of ethics. The
APA published a tentative code as early as 1951; in 1953, it formally published Ethical Standards of Psychologist.
The 2002 version of the Ethical Principles of Psychologists and Code of Conduct presents five general
principles as well as specific ethical standards relevant to various activities and so on.
The general principles include the following:

1. Beneficence and non-maleficence: Psychologists strive to benefit those they serve and to do no harm.
2. Fidelity and responsibility: Psychologists have professional and scientific responsibilities to society
and establish relationships characterized by trust.
3. Integrity: In all their activities, psychologists strive to be accurate, honest and trustful.
4. Justice: All persons are entitles to access to and benefit from the profession of psychology,
psychologists should recognize their biases and boundaries of competence.
5. Respect for people rights and dignity: Psychologists respect the rights and dignity of all people and
enact safeguards as to ensure protection of these rights

A. COMPETENCE
Issues of competence have several aspects.
1. Clinicians must always represent their training accurately.
 2. Clinicians have an obligation to actively present themselves correctly with regard to training
and all other aspects of competence. (ex. Counseling psychologist, should not be called Clinical
psychologist}
3. Clinicians should not attempt treatment or assessment procedures for which they lack specific
training or supervised experience.
4. It is equally important that clinicians be sensitive to treatment or assessment issues that could be
influenced by patients gender, ethnic or racial background, religion, disability, sexual orientation
or socioeconomic status
5. So as not to deprive individuals or group of necessary services, which we do not have existing
competence, we may provide the service; as long as:
a. We have closely related training or experience and
b. We make a reasonable effort to obtain the competence required by undergoing relevant
research, training, consultation or thorough study.
6. We shall undertake continuing education and training to ensure our services continue to be
relevant and applicable.

B. PRIVACY AND CONFIDENTIALITY

1. Clinicians have a clear ethical duty to respect and protect the confidentiality of the client
information.
2. Clinicians should be clear and open about matters of confidentiality and the conditions under
which it could be breached.
In todays climate, not all information is deemed privileged for example (insurance company)
may be paying for a clients therapy). They may demand periodic access to records for purposes of
review. Sometimes schools records that involve assessment data may be accessible outside the
school system under certain conditions (e.g. if they are subpoenaed by a court)
3. Clinicians should become well acquainted with their state laws regarding confidentiality and
privileged communication in psychotherapy.

C. HUMAN RELATIONS
1. Dual relationships pose many ethical questions regarding clients welfare. Sexual activities with
clients, employing a client, selling a product to client, or even becoming friends with a client after
the termination of therapy are all behaviors that can easily lead to exploitation of and harm to the
client.
2. In our work-related activities, we shall not discriminate against person based on gender, age,
gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, SES
or any basis proscribed by law.
3. We do not engage in sexual harassment.
4. We shall take reasonable steps to avoid harming our clients/patients, students, supervisees,
research participants, organizational clients, and others with whom we work, and to minimize
harm where it is foreseeable but unavoidable
D. INFORMED CONSENT
1. When conducting research or providing assessment, therapy counseling, or consulting services in
person via electronic transmission or other forms of communication, we shall obtain the informed
consent of the individual using language that is reasonably understandable to that person.
2. For a persons, who are legally incapable of giving informed consent, we shall nevertheless (a)
provide an appropriate explanation (b) seek the individuals assent (c) consider such persons
preference and best interests (d) obtain appropriate permission from legally authorized person.
3. When psychological services are court ordered or otherwise mandated, we shall inform the
individual of the nature of the anticipated services, including whether the services are court
ordered or mandated and any limits of confidentiality.
4. We shall appropriately document written or oral consent, permission and accent.
References:
Philippine Journal of Psychology (December 2010), Psychological Association of the Philippines
Abnormal Psychology 9th edition (2004), Gerald C. Davison, John M. Neale, Ann M. Kring
Clinical Psychology 2nd edition (2013), Timothy J. Trull, Mitchell J. Prinstein