Normal vs Abnormal Behavior Psyc 303 Spring 2013

Definition of Abnormal Behavior No consensus But clear elements of ‘abnormality’!?

Psychological Disorders I felt the need to clean my room … would spend four to five hours at it… At the time I loved doing it. Then I didn't want to do it any more, but I couldn’t stop… The clothes hung… two fingers apart… I touched my bedroom wall before leaving the house… I had constant anxiety… I thought I might be nuts. Marc, diagnosed with ……(from Summers, 1996)

Normal vs. Abnormal Behavior Being different: Individuals possessing abilities that distinguish them from the general public No harm to self, no harm to others, no dysfunction, then no abnormality

Normal vs. Abnormal Behavior Deviant behavior: Behaviors straying from societal “norms” or standards Statistical norms: how common or rare it is in the general population Critical to consider the context – goodness of fit Group expectations – culture (shared behavioral patterns and lifestyles) /culture-bound syndrome Developmental level

Normal vs. Abnormal Behavior Behaving dangerously Result from intense emotional states or may signal the presence of a psychological disorder, but alone is not necessary or sufficient

Normal vs. Abnormal Behavior Behaving dysfunctionally Patterns of behavior that interfere with normal daily routines, such as one’s social, occupational, and emotional functioning, causing significant distress Dysfunction: a dysfunction in general mental functioning such as consciousness, orientation, intellect, or temperament or specific mental functioning such as attention, memory, emotion, psychomotor, perception, thought…

Definition of Abnormal Behavior DEVIANT: Inconsistent with developmental norms DEVIANT: Inconsistent with societal norms DEVIANT: Inconsistent with cultural norms Abnormal Behavior HARMFUL AND DYSFUNCTIONAL: Interferes with daily functioning and/or threatens ones health Abnormal behavior is defined as behavior that is inconsistent with the individual’s developmental, cultural, and societal norms; creates significant emotional distress; or interferes with daily functioning. Emotional Distress

Definition used in Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM-IV-TR Behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress or impairment in functioning or with increased risk of suffering, death, pain, disability, or an important loss of freedom. The best way to diagnose or tell whether a behavior is a disorder, may be to consider how apparent the disorder is – the match to prototypical examples.

DSM-V Proposal for the Definition of Mental/Psychiatric Disorder Features A: a behavioral or psychological syndrome or pattern that occurs in an individual B: the consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) C: must not be merely an expectable response to common stressors and losses (for example, the loss of a loved one) or a culturally sanctioned response to a particular event (for example, trance states in religious rituals) D: that reflects an underlying psychobiological dysfunction E: that is not solely a result of social deviance or conflicts with society F: that has diagnostic validity using one or more sets of diagnostic validators (e.g., prognostic significance, psychobiological disruption, response to treatment) G: that has clinical utility (for example, contributes to better conceptualization of diagnoses, or to better assessment and treatment)

DSM-V Proposal for the Definition of Mental/Psychiatric Disorder Features A: a behavioral or psychological syndrome or pattern that occurs in an individual B: the consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) C: must not be merely an expectable response to common stressors and losses (for example, the loss of a loved one) or a culturally sanctioned response to a particular event (for example, trance states in religious rituals) D: that reflects an underlying psychobiological dysfunction E: that is not solely a result of social deviance or conflicts with society F: that has diagnostic validity using one or more sets of diagnostic validators (e.g., prognostic significance, psychobiological disruption, response to treatment) G: that has clinical utility (for example, contributes to better conceptualization of diagnoses, or to better assessment and treatment) Other Considerations H: no definition perfectly specifies precise boundaries for the concept of either “medical disorder” or “mental/psychiatric disorder” I: diagnostic validators and clinical utility should help differentiate a disorder from diagnostic “nearest neighbors” J: when considering whether to add a psychiatric condition to the nomenclature, or delete a psychiatric condition from the nomenclature, potential benefits (for example, provide better patient care, stimulate new research) should outweigh potential harms (for example, hurt particular individuals, be subject to misuse)

Recognizing the Presence of a Disorder Duration or persistence of maladaptive behaviors/emotions/thoughts Frequency of maladaptive behaviors/emotions/thoughts Intensity of maladaptive behaviors/emotions/thoughts (Impairment in the ability to perform social and occupational roles)

Basic Concepts One symptom by itself is seldom sufficient to make a diagnosis. Syndrome: A group of symptoms that appear together and are assumed to represent a specific type of disorder. Mental disorders: a set of characteristics. Clusters of persistent, maladaptive behaviors that are associated with personal distress Most individuals with a mental disorder are in touch with reality (When one is out of contact with reality, it is called psychosis/psychotic behavior)

Approaches to Diagnosis: Current System Requires Classification of Psychological Disorders Diagnostic classification aims to describe a disorder as well as predict its course, suggest treatment, and stimulate research. The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological disorders. The edition, DSM-IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to 60 in the 1950s. The most recent edition is DSM-V Preview Question 3: How and why do clinicians classify psychological disorders?

Approaches to Diagnosis: Current System Requires Classification of Psychological Disorders Focus on symptoms and science What specific symptoms cluster together ? (clinical presentation) What causes the disorder? (etiology) Developmental stage Functional impairment (short and long-term effects of having the disorder) Preview Question 3: How and why do clinicians classify psychological disorders?

Factors to Consider When Addressing Abnormal Behavior Socioeconomic status (most frequently the lower income, the higher PD) Education level (the lower the education, the higher PD) Biological changes (particularly hormonal changes associated with puberty) Personal characteristics (sex, race, ethnicity) Age (chronological age vs. developmental maturity) Developmental trajectory

How does the impact of mental disorders compare with that of other health problems? Although mental disorders are responsible for only 1% of all deaths, they produce 47% of all disability in developed countries and 28% of all disability worldwide. Disease burden is measured by combining two factors: mortality and disability Epidemiologists measure disease burden by combining factors of mortality and disability.