1. Normal vs Abnormal Behavior
Psyc 303
Spring 2013

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

4. 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)

5. 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

6. 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

7. 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

8. 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…

9. 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

10. 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.

11. 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)

12. 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)

13. 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)

14. 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)

15. 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?

16. 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?

18. 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

19. 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.