Introduction to Abnormal Behaviour
Unit 1
Abnormal Psychology
Ms. Nishita Agrawal
Outline
• Definition of normal and abnormal behaviour
• Classification of psychological disorders: DSM V, ICD 10
• Assessment and diagnosis of mental illnesses- Clinical
Interview and Mental Status Examination; multicultural
contexts of assessment.
What is normality and abnormality?
Mental Disorders
• Mental disorders refer to all diagnosable conditions
involving
• Significant changes in Thinking, Emotion and Behaviour
that may lead to
• Distress and/or Problems functioning in social, work and
family activities
• No universal agreement about what is meant by abnormality or
disorder.
• Definitions exist BUT
• A truly satisfactory definition will probably always remain elusive
(Lilienfeld et al., 2013; Stein et al., 2010).
• No one behavior that makes someone abnormal.
• However, there are some clear elements or indicators of
abnormality (Lilienfeld et al., 2013; Stein et al., 2010).
• No single indicator is sufficient in and of itself to define or
determine abnormality.
Indicators of Abnormality
• Subjective Distress - “I’m suffering”.. depression vs mania
• Maladaptiveness - interferes with our well-being and with our
ability to enjoy our work and our relationships
• Statistical Deviance - abnormal = “away from normal”, but what
about “genius”?
• Violation of the standards of society - rules on papers, norms,
moral standards. Eg?
• Social Discomfort (of others around you)
• Irrationality and Unpredictability
• Dangerousness - suicidal vs soldier
Culture and Time
Cross-culturally - Sex and Temperament in New Guinea tribes - research by Margaret Mead
(1963)
Three tribes, each with very different norms.
1. Arapesh: Both males and females are mild, parental, and nurturing.
2. Mundugumar: Males and females are fierce, oppressive and cannibalistic.
3. Tchumbuli: Males are catty, wear curls and pretty clothes, love to go shopping. Females
are energetic, managerial, unadorned.
Each of these culture is different from the other. By which culture's standards do we judge a
behavior to be abnormal?
Over time - Homosexuality, piercings
Classification of Psychological Disorders
• Why is classification important?
Importance
• To distinguish one psychiatric diagnosis from another, so that the
clinician can offer the most effective treatment.
• Prediction of clinical course (Prognosis).
• To provide a common language among healthcare professionals.
• To explore still unknown causes of Psychological disorders.
• Clinical, basic & epidemiological research.
• Classification is not a closed, static system but an open-ended,
dynamic system that goes on changing with the addition of new
knowledge.
Classification is a process by which phenomena are organized into categories so as to bring together
those phenomena that most resemble each other and to separate those that differ.
Any classification of psychiatric disorders, like that of medical illnesses, should ideally be based on
aetiology (cause).
For a large majority of psychiatric disorders, no distinct aetiology is known at present, although there
are many attractive probabilities for several of them. Therefore, one of the most rational ways to
classify psychiatric disorders at present is probably syndromal.
A syndrome is defined as a group of symptoms and signs that often occur together, and delineate a
recognisable clinical condition.
Brief history of classification
• Krapelin
– Identified dementia praecox (Schizophrenia), bipolar disorder and a variety of organic brain syndromes
– Belief - brain pathology is the cause of this particular disorder
– Greatest impact on classification
• WHO - 1948 - added a section classifying mental disorders to the sixth edition of the International Classification of Diseases and
Related Health Problems (ICD)
• American Psychiatric Association - published Diagnostic and Statistical Manual (DSM-I) in 1952 - not very influential
• DSM II - published in 1968
• DSM III - published in 1980 - most influential due to:
– attempt to take an atheoretical approach to diagnosis, relying on precise descriptions of the disorders as they presented
to clinicians rather than on psychoanalytic or biological theories of etiology. Eg neurosis came under anxiety disorders.
– specificity and detail in the criteria for identifying a disorder
– allowing individuals with possible psychological disorders to be rated on five dimensions, or axes - multiaxial system
• DSM IV - 1994
– distinction between organically based disorders and psychologically based disorders eliminated.
• DSM-5 - 2013
• DSM-5-TR - 2022
Multi-Axial System of the DSM
• IMP - no longer present in DSM-5
• An individual patient is diagnosed on five separate axes, ensuring a more thorough evaluation of
needs.
• Helped in making a more holistic, biopsychosocial assessment of an individual patient.
• Axis I - Clinical Psychiatric Diagnosis
• Axis II - Personality Disorders and Mental Retardation
– The division helped clinicians to distinguish between acute, treatable conditions (Axis I) and more
enduring, pervasive conditions (Axis II), each requiring different diagnostic and therapeutic
strategies.
• Axis III - General Medical Conditions
• Axis IV - Psychosocial and Environmental Problems
• Axis V - Global Assessment of Functioning: Current and in past one year (Rated on a scale)
• There maybe multiple psychiatric syndromes (CO-MORBIDITY) across the axes or within the axis.
Multiaxial Diagnosis - Example
Case: 32-Year-Old Woman
Presenting Issues: Persistent sadness, anxiety about job performance, unstable relationships, fear of abandonment.
Diagnosis:
● Axis I:
○ Major Depressive Disorder, Moderate, Recurrent
○ Generalized Anxiety Disorder
● Axis II:
○ Borderline Personality Disorder
● Axis III:
○ Hypothyroidism
● Axis IV:
○ Occupational Stress
○ Relationship Difficulties
● Axis V:
○ GAF Score: 55 (Current), 60 (Past Year)
DSM-5
• The DSM-5 identifies 22 broad categories of mental disorders, encompassing more than 150 discrete
illnesses, and provides a comprehensive and relatively specific definition for more than 200 diagnostic
categories.
• DSM-5 takes a descriptive approach, attempting to describe the symptoms of mental disorders rather
than attempting to explain how they occur. Disorder diagnoses often consist of descriptions of clinical
features.
• Diagnostic Criteria: The DSM-5 provides detailed criteria for the diagnosis of various mental disorders.
These criteria outline the specific symptoms, duration, and other factors necessary for a clinical
diagnosis.
• Each condition is thoroughly described in terms of its associated aspects, including specific age,
culture, and gender-related features; frequency, incidence, and risk; course; complications;
predisposing factors; familial pattern; and differential diagnosis.
Key Features of the DSM V
• Dimensional vs. Categorical Approach - Recognizes Spectrum of Symptoms: Mental
disorders are viewed on a continuum, not just as distinct categories. Eg depression,
autism
• Cultural Sensitivity - Cultural Impact on Diagnosis: Includes tools and guidelines to
account for cultural differences in mental health.
• Developmental and Lifespan Perspective - Disorders Across Ages: Reflects how
mental disorders change from childhood to old age.
• Comorbidity Consideration - Acknowledges Multiple Disorders: Recognizes that
patients often have more than one mental disorder. Eg anxiety + depression;
substance abuse + PTSD
• Integration with ICD - Global Consistency: Aligned with the International
Classification of Diseases (ICD) for worldwide use.
Key Features of the DSM V
• Emerging Disorders - New Areas of Study: Includes conditions that need further
research. Eg. Internet Gaming Disorder.
• Revised Criteria and Classification - Updated Understanding: Reflects the latest
research with changes to diagnostic criteria and classifications. Eg autism
• Focus on Gender and Sexuality - Inclusive and Affirming: Updates on gender
dysphoria and sexual health, with less stigma. Eg. gender identity disorder removed,
gender dysphoria added.
• Incorporation of Neuroscience - Biopsychosocial Model: Considers biological,
psychological, and social factors in mental health.
• Stigma Reduction - Respectful Language: Uses terminology that is less stigmatizing
and more person-centered. Eg. intellectual disability instead of mental retardation.
ICD 10
• Mental disorders listed in ch V
• 10 main groups
– F0 - F9: Organic, including symptomatic, mental disorders
– F10 - F-19: Mental and behavioural disorders due to use of psychoactive substances
– F20 - F25: Schizophrenia, schizotypal and delusional disorders
– F30 -F39: Mood [affective] disorders
– F40 - F49: Neurotic, stress-related and somatoform disorders
– F50 - F59: Behavioural syndromes associated with physiological disturbances and physical factors
– F60 - F69: Disorders of personality and behaviour in adult persons
– F70 - F79: Mental retardation
– F80 - F89: Disorders of psychological development
– F90 - 98: Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
– In addition, a group of F99 "unspecified mental disorders".
Eg: GAD [Link]
ICD 11
• Disorder groupings - 21
• New diagnostic categories + changes in old diagnostic criteria
– [Link]
– [Link]
• Categorical approach maintained with addition of dimensional expansions regarding severity, course,
and specific symptoms for some diagnoses.
– Eg - Personality disorders - severity rated as mild, moderate, severe; specification of one or more
maladaptive personality traits (detachment, dissociality, disinhibition, etc.)
– Eg - Depressive episodes - described with qualifiers (the melancholic features qualifier, the
anxiety symptoms qualifier; the panic attacks qualifiers, and the seasonal pattern qualifier)
– Eg - Schizophrenia - symptom and course specifiers
What are the dangers of classification?
• Stigmatisation and labelling
• Oversimplification
• Subjectivity and bias
• Effect on self - self-fulfilling prophecy
• Focus on pathology
• Overdiagnosis
• Medicalization of Everyday Life
• Legal and Ethical Implications
Assessment and Diagnosis of Mental Illness
Introduction
• Psychological assessment refers to a procedure by which
clinicians, using psychological tests, observation, and
interviews, develop a summary of the client’s symptoms
and problems.
• Clinical diagnosis is the process through which a clinician
arrives at a general “summary classification” of the
patient’s symptoms by following a clearly defined system
such as DSM-5 or ICD-10.
Clinical Interview
• Face-to-face interaction in which a clinician obtains
information about various aspects of a client’s situation,
behavior, and personality (Berthold & Ellinger, 2009; Craig,
2009; Sharp et al., 2013).
Clinical Interview
• Presenting Problem: Chief complaint and reason for
seeking help
• Psychiatric History: Previous mental health issues and
treatments
• Medical History: Physical health and medical treatments
• Family History: Mental health issues in the family
• Social and Developmental History: Childhood, education,
employment, relationships
Multicultural contexts of assessment
What are some key considerations one should keep in mind
when doing an assessment in a multicultural context?
Multicultural contexts of assessment
1. Cultural Context and Expressions: Understand the individual's cultural background and how it influences
the expression of symptoms.
2. Communication and Language: Ensure effective communication by addressing language barriers and using
interpreters if needed.
3. Stigma and Help-Seeking: Be aware of cultural attitudes towards mental illness and their impact on seeking
treatment.
4. Cultural Competence: Clinicians should be culturally competent, recognizing their own biases and
understanding the patient’s cultural perspective.
5. Social and Family Influences: Consider the role of family, community, and spirituality in the individual’s
mental health and treatment preferences.
Multicultural contexts of assessment
Assignment 1: Reflect on how psychological symptoms and
mental health issues might be perceived and expressed
differently across various cultures. Consider how your own
cultural background and potential biases could influence your
interpretation of these symptoms during the assessment
process. Discuss the potential impacts of cultural differences
and personal biases on the accuracy and fairness of
psychological assessments. What strategies can you use to
ensure that your assessments are culturally sensitive and free
from bias?
