Abnormal Psychology - Exploring Mental Disorders

Abnormal behavior is a major public health problem. Depression is sometimes called the common cold of mental disability. Chronic anxiety in the form of persistent worry is approximately as common as depression. About 1 percent of adults suffer from schizophrenia, a severe mental disorder. This percentage translates into a figure approaching 2 million people in the United States alone. Conservatively, about one in ten adults have some kind of definable mental health problem.

Defining Abnormal Behavior: It Takes More than Deviation

Abnormal behavior is behavior that deviates from a given norm or standard of behavior.

It takes more than deviation alone for a behavior pattern to be considered pathological. Additional criteria help mental health professionals to identify the presence of a mental disorder. 

1. First, there is almost always suffering associated with a mental disorder. Often it is the self that suffers. Depression, anxiety, and confusion are miserable mental and emotional states.
2. Second, pathological behavior is often self-defeating. Self-defeating behavior is behavior that provides momentary gratification with an excessive long-term cost.
3. Third, pathological behavior is often self-destructive. Self-destructive behavior tends to injure the body.
4. Fourth, pathological behavior is salient. Salient behavior is behavior that stands out. It tends to be striking and conspicuous.
5. Fifth, pathological behavior is illogical behavior. An observer of the behavior thinks, “What this person is doing right now makes no sense.” In some instances the victim of a mental disorder recognizes the nonsensical aspect of a thought or a behavior.

Other criteria of pathology could be specified. However, these five are sufficient to establish that it takes more than statistical abnormality to think of a behavior pattern as a sign of a mental disorder.

Classifying Mental Disorders: Clusters of Signs and Symptoms

A mental disorder is a disorder characterized by both abnormal behavior and the presence of pathological signs and symptoms. A symptom is something that the individual himself or herself experiences. It is internal. A cluster of signs and symptoms is called a syndrome. Psychiatrists and clinical psychologists use recognizable syndromes as the primary basis for classifying and diagnosing mental disorders.

The handbook used in actual clinical practice is called the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and it is published by the American Psychiatric Association. DSM-IV uses a five-axis system to classify disorders.

1. Axis 1 refers to clinical syndromes. As already indicated, these are clusters of signs and symptoms that allow a mental health professional to say that a given individual is suffering from a particular mental disorder.
2. Axis 2 refers to personality disorders. A personality disorder may or may not be present. However, if one does exist, it often complicates the clinical syndrome.
3. Axis 3 refers to medical conditions. If a person’s health is poor, this may complicate treatment.
4. Axis 4 refers to psychosocial problems. These are problems relating to others and the patient’s life situation.
5. Axis 5 refers to a global assessment. This consists of a broad, general assessment of how well the patient had been functioning in everyday life before the appearance of a mental disorder.

The five axes provide mental health professionals with a comprehensive picture of the status of a given individual’s mental disorder.

Anxiety Disorders: Suffering from Chronic Worry

Anxiety disorders are disorders characterized by a core of irrational fear. Anxiety itself is experienced as a kind of psychological fire alarm. Neurotic anxiety is irrational, and it is the kind of anxiety that plays a significant role in the anxiety disorders. Rational anxiety is identical to realistic fear.

Four types of anxiety disorders will be identified:

1. Generalized anxiety disorder is characterized by vague feelings of apprehension. This is called free-floating anxiety.
2. Phobic disorders are characterized by feelings of apprehension with a relatively definable source.
3. Obsessive-compulsive disorder (OCD) is characterized by ideas that induce anxiety, and rituals that in turn reduce that anxiety.
4. Post-traumatic stress disorder (PTSD) is characterized by anxiety and related symptoms following a genuinely threatening experience.

Somatoform Disorders: When the Body Is Involved

Somatoform disorders are disorders in which anxiety is converted into a bodily symptom. Soma is a Greek root meaning “body.” Consequently, in a somatoform disorder, anxiety takes a somatic, or bodily, form. Four types of somatoform disorders will be identified:

1. Somatization disorder is characterized by various complaints.
2. Hypochondriacal disorder (or hypochondriasis) is characterized by irrational worry about one’s health.
3. Pain disorder is characterized by sustained painful sensations.
4. Conversion disorder is characterized, in most cases, by symptoms resembling a neurological problem such as paralysis, inability to control a limb or limbs, or loss of the capacity to see or hear.

Dissociative Disorders: Loss of Identity

Dissociative disorders are disorders in which the individual experiences either a loss of identity or a distortion in the sense of self. Four types of dissociative disorders will be specified:

1. Psychogenic amnesia is characterized by a loss of personal memories. (The word amnesia means “without memory.”) 
2. Pyschogenic fugue is characterized by running away from a home territory.
3. Dissociative identity disorder (DID) is characterized by the presentation to others of two or more selves. The older name for this condition is multiple personality disorder.
4. Depersonalization disorder is characterized by a disturbance in the way in which the individual perceives the self.

The Mood Disorders: Emotional Ups and Downs

Mood disorders are characterized by significant variations in emotional states. Mood is experienced as positive or negative. A positive mood is associated with feeling well and optimistic thinking. A negative mood is associated with fatigue and pessimistic thinking. Mood is an involuntary reaction; it cannot be directly willed.

Four mood disorders will be identified:

1. Dysthymia is characterized by mild, relatively persistent depression. Depression refers to a negative mood state.
2. Major depressive episode is characterized by severe, highly persistent depression.
3. Cyclothymia is a characterized by excessive mood swings.
4. Bipolar disorder is characterized by severe, highly disruptive mood swings.

The Psychotic Disorders: Suffering from Delusions

Psychotic disorders are disorders characterized by a loss of touch with reality. The primary distinguishing features are the presence of delusions and cognitive distortions. Delusions are false beliefs, ideas about the world that most people think are impossible or absurd. Cognitive distortions are thoughts that are illogical or irrational. Frequently psychotic disorders are accompanied by hallucinations. Hallucinations are false perceptions.

Two types of psychotic disorders will be identified: schizophrenia and delusional disorder.

Schizophrenia is a psychotic disorder that fits all of the criteria specified above. A schizophrenic patient suffers from delusions and cognitive distortions. An older term for schizophrenia is dementia praecox, meaning madness with an early, or youthful, onset. Schizophrenia takes on several shapes.

Consequently, it is possible to divide the disorder into categories: The paranoid type is characterized by delusions or mistrust and suspicion. The catatonic type is characterized by mutism and odd postures. The disorganized type is characterized by silliness and completely inappropriate behavior.  The undifferentiated type is a diagnostic category used when the patient is schizophrenic, but displays behaviors that overlap with the earlier described categories.

Delusional disorder, not a kind of schizophrenia, is a psychotic disorder characterized by an organized, systematic delusional system. An older term for this disorder is paranoia.

The difference between the two disorders is that in delusional disorder the false ideas form a coherent whole. In schizophrenia they do not.

The Personality Disorders: Making Others Suffer

Personality disorders are characterized by maladaptive behavioral traits.

Three kinds of personality disorders will be identified:

1. A narcissistic personality disorder is characterized by self-absorption. The individual is in love with himself or herself. Such people are described as vain and selfish. They are often overly preoccupied with their appearance. They tend to be cold and lacking in sympathy.
2. The antisocial personality disorder is characterized by a lack of guilt feelings. People with this disorder can lie, cheat, steal, and manipulate others without remorse.
3. The obsessive-compulsive personality disorder is characterized by perfectionism.

The Organic Mental Disorders: When the Nervous System Itself Has Pathology

Organic mental disorders are characterized by constellations of signs and symptoms that suggest there is actual damage to the brain and nervous system. This damage may be caused by a genetic tendency, a toxic agent, a vitamin deficiency, or an infection.

Three organic mental disorders will be identified: 

1. Alcohol amnestic disorder is characterized primarily by memory difficulties.
2. Dementia of the Alzheimer’s type is characterized by a progressive decline in mental functioning.
3. General paresis is characterized by both dementia and paralysis.

Viewpoints: Ways to Explain Abnormal Behavior

Five such viewpoints will be identified:

1. The biological viewpoint assumes that pathological behavior is caused by an organic factor. A genetic tendency, a biochemical imbalance, a brain injury, or an infection can all play roles in mental disorders.
2. The psychodynamic viewpoint assumes that pathological behavior arises because of repressed emotional conflicts.
3. The learning viewpoint assumes that pathological behavior is a maladaptive response to an adverse experience (or a set of related experiences).
4. The humanistic viewpoint assumes that pathological behavior is a response to an inability to become self-actualizing.
5. The sociocultural viewpoint assumes that pathological behavior is a maladaptive response to large, inescapable forces and events arising from the social world, the world of other people. Such forces include war, economic depression, overcrowded housing, a totalitarian government, and so forth.