ABNORMAL

PSYCHOLOG
Y
PREPARED BY: DR. RAYMUNDO B. FAUSTINO, JR. R.PSY.

INTRODUCTION

“An abnormal reaction to an abnormal situation

is a normal behavior." —Victor Frankl

After schools closing down across the world

because of the COVID-19 pandemic, millions of
teachers and students had to adapt to the current set-
up of learning. Bulacan State University as a higher
education is committed to providing education that is
accessible to worthy and eligible students through
globally recognized and industry-friendly programs set
in a learning environment of the 21st century;
therefore, as one of the considerations, the university
will follow a versatile mode of learning in the form of
synchronous, asynchronous and remote printed
learning. Hence, the creation of materials of learning
for students is paramount. Modules will address
concerns about student learning, especially about the
absence of teachers, encouraging self-paced, self-
contained, and self-directed learning that is still
consistent with the curriculum 's target learning skills.

This present module is accompanied by an

excellent package of ancillary materials designed to
make the task of teaching the course subject,
Abnormal Psychology easier, more fun, and more
manageable. Motivating students to read a printed
page, in the age of multimedia which presents images
in information gathering, is a challenging endeavor.
The challenge is to present traditional concepts that
will grab the students' attention, engage their interests
and motivate them to participate in the discussions.
Students found three interesting features in every
teaching material which I would like to incorporate on
these modules:
1. Interesting examples and real-life cases;
2. Application of psychological concepts to
everyday issues, people, and problems;
3. Integration of graphic materials in the
presentation of information.

Responding to the call, the university prepares

learning materials that are sensitive to the current
learning environment. In this regard, the author
proposes these modules, that can enable learners to
achieve a level of competence prescribed by the
course, and can go through the materials at their own
pace. The units and lessons presented herein were
also the contents of the course syllabus extended to
students for their guide throughout the course.

---Doc Bong
Lesson 1—Defining Abnormality and Its Historical Perspectives

Lesson 2—Assessing and Diagnosing Mental Disorders

Lesson 3—Theories of Mental Disorders

Lesson 4—Treatment of Mental Disorders

Lesson 1—Neurodevelopmental Disorders

Lesson 2—Sleep-Wake Disorders

Lesson 3—Substance Related and Addictive Disorders

Lesson 4—Neurocognitive Disorders

Lesson 1—Anxiety and Trauma Related Disorders

Lesson 2—Dissociative and Somatic Symptoms Related Disorders
Lesson 3—Disruptive, Impulse-Control and Behavior Related Disorders
Lesson 4—Feeding, Eating and Elimination Disorders

Lesson 1—Mood Disorders (Depressive and Bipolar types)

Lesson 2—Schizophrenic Spectrum and other Psychotic Disorders
Lesson 3—Sexual, Gender, and Paraphilic Disorders
Lesson 4—Personality Disorders
“To study the abnormal is the best way of understanding the normal.”
—William James

Psychopathology is the scientific

study of abnormal behavior. In the field of mental
health, clinicians are concerned with disturbed
behavior, its severity and duration amongst
patients, and look for indications of diagnosis,
treatment and follow up. At one extreme are the
greatly and visibly disturbed people, once called
insane, mad or lunatic, and now called the
psychotic. At the other hand, the depressed
individuals, unable to cope adequately with the
demands of life, are constrained in their
capacity to love,
work or find purpose
in their lives, either
over long stretches
or in short episodes
related to stress.
These are all
described as forms
of mental disorder or
psychopathology against standards of mental
health or normality. But what defines
psychological normality and abnormality? In this
unit we will deal with this issue.

1.1 Objectives

After completing this part you should be able to:

1. Define normality
2. Shed light on the concept of normality.
3. Describe the criteria for abnormality.
4. Analyze the growth of the
history of abnormality.
 DESCRIPTION Yes No Information Needed

1. Alice often speaks to herself

while she works out her math
homework. Sometimes her roommate
hears her, and wonders if she's okay.
2. A worshiper speaking in
"tongues" at an Evangelical church
sees himself as "full" of the Holy Spirit
and is considered blessed with the gift
of speaking the "language of angels."
3. Baldwin's always afraid of several
things. He’s concerned about
commuting on the highway and the bad
storms that might come over his
neighborhood. Yet he is still scared of
rodents, frequently looking under his
bed to see if any are there.
4. Charlie claims the noise of cars
and aircraft passing outside his
building has hidden meanings. He is
persuaded that he was born in the
midst of a nuclear war and that
discovering the solution to a
complicated riddle is the only way he
can live.
 1.3 LESSON 1: Defining Abnormalit y

This unit introduces a number of issues that are important to abnormal

psychology. It starts by defining what is meant by normality and abnormality. Next, we
will describe the phenomena of psychopathology in terms of levels of dysfunctions.
Lastly, we will study the history of psychopathology.

There is no clear consensus on how to define normality and what particular

types of disordered behaviors can be considered abnormal. Normality and
abnormality are presented on a continuum with the traits and qualities found in
average people in greater degree than in abnormal individuals.

The following are some of the norms used to define normality:

1. State of perfection—normality refers to a state of excellence which people
strive to but rarely achieve.
2. Level of adjustment—normality
applies to how individuals can manage their l i fe
experiences fairly well.
3. Reality testing—typical people are
able to objectively understand, view and respond
to what is happening in the world around them.
4. Behavior control—normal people feel
in control and are positive in managing and
guiding their behavior.
5. Self-worth—regular people may value their own self-esteem and feel
embraced by society.
6. Self-awareness—normal people are mindful of their thoughts and feelings
and know the reason behind their actions.
7. Social relationships—normal people should establish and maintain strong,
long-term and safe ties with others.
8. Effective functioning—normal people are excited about life and make
successful and imaginative use of their talents and abilities.
 Circumstances or context surrounding a behavior influence whether the behavior
is viewed as normal or abnormal. In addition to context a number of criteria have been
used over the years to draw the line between normal and abnormal. These criteria are:

1. The Social Norms Criteria—is the view that behaviors can only be
abnormal relative to cultural norms for there are no universal standards or rules for
labeling a behavior as abnormal. Social behavior varies markedly when compared with
different cultures. In many Asian cultures a appearance by the deceased is considered
natural but
other communities label it as odd.

Advantages: A behavior can be right away

considered abnormal if it deviates greatly from accepted
social standards, values, or norms.
Disadvantages: When cultural norms are allowed to
dictate what is normal or abnormal can be risky since
social norms change over time.

2. Statistical Frequency Criteria—says that a

behavior is considered abnormal if it occurs rarely or infrequently in relation to the
behaviors of the general population. For instance one may say that an individual who has
an IQ below or above the average level of IQ in society is
abnormal.

Advantages: This criterion has some ties to the

relativist criterion because the unusualness of any
behavior depends in part on a culture's norms.
Disadvantages: Choosing a cutoff is as
subjective as relying on personal opinions as to what
behaviors are abnormal or normal.

3. Maladaptive Behavior Criteria—says that a behavior

is considered abnormal or psychologically damaging if it interferes with the individual's
ability to function in one's personal life or in society. One consequence will be the self-
harming of a woman with extreme anorexia nervosa, which often leads to death. Yet
would we consider the self-destructive behavior of a cigarette smoker evidence of mental
illness?

Advantages: This criterion avoids, to some extent, the

problems of using societal norms as the criterion of
abnormality.
Disadvantages: People are not always aware of
problems their behaviors create for themselves or for
others.
 The most useful definition of abnormal behavior of the three is based on the
maladaptive definition. Maladaptive behavior is a particular behavior or behavioral
patterns that interferes with a person's ability to function normally. However, modern
judgements of abnormality are influenced by the interplay of many dimensions. These
criteria can be summarized according to Comer as the ‘four Ds’:

1. Dysfunction--is when the behaviors and feelings interfere with the person's
ability to function in daily life, to hold a job, or to form close
relationships.

2. Distress--behaviors and feelings

should be considered abnormal if the
individual suffers distress or to others around
him or her.

3. Deviant--highly unusual behaviors, such

as chronic lying or stealing, or hearing voices when no one is
around, lead to judgments of abnormality.

4. Dangerous--some behaviors and feelings that are

of potential harm to the individual, such as suicidal
gestures, or to others, such as excessive aggression.

There is no sharp line between what is normal and abnormal. Though the
four Ds capture what most of us mean by maladaptive. A person's behavior
(e.g, fetishism) can be more or less dysfunctional, distressing, deviant, or
dangerous based on this continuum model:
 The earliest view of a b n o r
mal behavioremph
a s i z e d t h e supernatural
theories. In societies from
China to
ancient Babylon, weird behavior was generally
attributed to possession by evil spirits or other
outside forces. Ancient Chinese believed that the
human body was said to contain a positive force
(yang) and a negative
f o r c e ( y i n ) w h ich
complemented and
confronted each other.
Excited insanity was the
result of an excessive
yang.
The Egyptians
believed that the uterus could become disconnected
and wander throughout a woman's body, interfering
with other organs. Holding to the same theory, the
Greeks later named this disorder hysteria from the
Greek word hystera which means uterus. The
prescribed treatment for this in Egyptian papyri
involved the use of strong-smelling substances to
drive the uterus back to its proper place.

Hippocrates, a famous Greek physician

before the common era, suggested that mental
illness had natural causes such as heredity, brain
damage, and the
imbalance of body
humors--four
essentialfluid
s (blood, phlegm,
yellow bile, and b l
a c k b i l e ) t h at
shaped our behavior
and influenced our
health. Abnormal b e
h a v i o r w e r e
classified into four
categories: epilepsy, mania, melancholia, and brain fever.
He even suggested rest, solitude, and good food as
treatments. Most of the Greek and Romans saw madness
as an affliction from the gods.

One treatment from ancient times have

been to drill holes in the skull of a person displaying
abnormal behavior to allow the spirits to depart. This
crude form of brain operation is called trephination.

The Middle Ages was

dominated by an obsession
with supernatural forces. P e r
s o n s w i t h s e r i o u s
psychological disorders were
seen as being punished for
their sins by evil spirits, thus
subjected to often painful
exorcisms. Some psychiatric
historians have argued that
persons accused of witchcraft
must have been mentally ill
Accused witches were but
diseased wretches suffering
from melancholy.

During this time

also, reports of dance frenzies or manias were frequent.
Psychic epidemics are phenomenon in which large
numbers of people engage in unusual behaviors that
appear to have a psychological origin. A large epidemic
of uncontrolled dance frenzy occurred in 1518 at the
chapel of Saint Vitus at Hohlenstein where more than
400 people danced during the 4 weeks the frenzy
lasted. Tarantism was another phenomenon of
developing an acute pain attributed to the bite of
tarantula. Some dance wildly, howled, and made
obscene gestures, others dug hole in the earth and
rolled on the ground.

In the Renaissance period, the

Swiss physician Paracelsus
(1493-1541) theorized that
abnormal behavior stems from
the influence of natural forces
such as the moon--hence the
term lunatic. With the continued knowledge of anatomy
and biology, it began to take hold that abnormal
behavior was a kind of disease or physical illness, and
introduced housing conditions out of society called
asylums. These asylums were typically established
treating abnormal behaviors as mental illnesses. Hence
although the supernatural theories of the Medieval
times have often been decried as leading to brutal treatment of people with mental
illnesses, the physical theories of the Renaissance did not always lead to better
treatment. But while many psychologists prefer to avoid describing psychological
disorders in strictly medical terms, they do accept the view that such disorders often
involve biological causes.

Several psychiatrists became dissatisfied with the term psychiatric

disorder because it means embracing the scientific experience and the
ideas of psychology. Decades of study also shown that understanding
certain psychiatric conditions thoroughly
involves exposure to neurological
mechanisms such as perception,
memory, and comprehension.

The French Revolution in the late 1700s brought

about a dramatic shift in the manner mentally ill persons
are treated. Philippe Pinel, a French scientist, was
surprised to see the conditions in which asylum prisoners
were forced to live and, in the spirit of revolt, called for their
unchainment. Pinel's enlightened approach , known as
moral treatment, attracted the attention of other like-
minded individuals and gradually changed attitudes toward
how best to manage people with mental illness spread
throughout Western Europe.

Dorothea Dix (1802–1887), a schoolteacher from Boston,

moved around the world, protesting the deplorable
conditions of prisons and almshouses where
individuals were mentally ill. As a result of her
efforts, 32 psychiatric hospitals were built throughout
the United States devoted to treating individuals with
psychological problems. The institutional care of the
mentally ill in India dates back to ancient times,
supported by contemporary rulers, as evidenced by
the Asoka Edicts (BC 250), and others. A special
hospital exclusively for the mentally ill patients was
established at Dhar, near Mandu in Madya Pradesh
in the 15th century AD by Mohammed Khilji. This
was the first asylum in the
country. This asylum provided treatment according to the Ayurvedic and Unani systems
of medicine.

Interestingly, the popularity of psychological therapy has led to its

deterioration in the later stages of the nineteenth century, when it was
clear that mental illness was much more severe than commonly
believed. When more citizens were identified when suffering from
mental illness, big development projects in Europe and the United
States were launched, leading to the rapid growth in the number of
state-run asylums for the mentally ill. Over a relatively short period in Victorian England,
several hundred hospitals were built to accommodate many thousands of patients.
 Given the eventual decline of the care for mentally ill individuals, there was a
revived interest of science and the somatogenesis theory that Hippocrates first mentioned
2,000 years ago by the end of the century. Under this This was under this backdrop that
the psychological profession began to develop and Kraepelin and Bleuler 's research
came to attention.backdrop that the psychological profession began to develop and Emil
Kraepelin and Eugen Bleuler 's research came to attention. At the time, depression,
mania and phrenitis, first mentioned by Hippocrates, were recognized as psychiatric
illnesses and this classification was extended to include, among many others, hysteria,
catatonia and hebephrenia.

The suggestion that psychiatric disorders should be

classified into two specific syndromes became Kraepelin's most
known contribution to psychopathology: dementia praecox and
manic-depressive psychosis. He drew this conclusion on the basis
of a thorough analysis of the manifestations (signs and symptoms)
of his patients' illness over long stretches of time. Although Bleuler
disagreed with Kraepelin on details, he too adopted precise
methods and was characterized by his fascination with the nature
and causes of psychiatric symptoms.

Between them, Kraepelin and Bleuler shaped the direction that psychiatry has
subsequently taken and their contributions are still much in evidence today. Kraepelin and
Bleuler were convinced that mental illnesses had physical origins (the somatogenic
approach). However, others believed that there were psychological
(psychogenic) explanations of mental illness.

Among them, Kraepelin and Bleuler influenced the course

taken subsequently by psychiatry, and their contributions are still
much in evidence today. Kraepelin and Bleuler were convinced
that mental illnesses had physical origins (the somatogenic
approach). However, others believed that there were psychological
(psychogenic) explanations of mental illness.

During the past one hundred years, the pendulum has

continued to swing between somatogenic and psychogenic
explanations of disorder. Initially, the camps divided geographically,
with the Europeans favouring somatogenesis, while practitioners in
the United States preferred psychogenic explanations of mental
illness. The divide has, to some extent, fallen along occupational
lines, with medically trained psychiatrists resorting to somatogenic approaches and
psychologists, not surprisingly, tending to rely upon psychogenic explanations.

One of the main strengths of psychopathology over the past century has been a
willingness on the part of practitioners to rely on empirical evidence gathered through
scientific research. This approach has, for example, led to the demise of unsupportable
procedures such as insulin coma therapy (an early treatment for schizophrenia).
On the other hand, it has established the advantages of equally controversial
procedures such as electro-convulsive therapy (ECT). Not all scientific discoveries have
favoured somatogenic approaches. For example, the value of biofeedback training to
help control anxiety and the adoption of a procedure known as cognitive therapy in the
treatment of depression, both tend to support psychogenic arguments.

Gradually, research in psychopathology has made

people aware that neither a strictly somatogenic or
psychogenic approach can fully explain how mental
illnesses arise. Indeed, evidence suggests that most occur
as a result of a combination of factors, and a causal model
known as the stress-diathesis model has evolved to
occupy this centre ground.

Tremendous advances in the scientific study of disorders took place in the early
twentieth century. Presently there are three major approaches to understanding and
treating mental disorders:

a) Medical Model Approach—views mental disorders as similar to physical illness. Both

have symptoms that can be diagnosed and treated. It emphasizes the role of nervous
system, chemical balance, and genetic make-up. Mental disorders however, have
similar symptoms that are not always clearly defined, and they may lack identifiable
physical and genetic causes. Non-medical psychotherapy has proven equally effective
with the inefficacy of psychoactive drugs.
b) Cognitive-Behavioral Approach—views mental disorders as resulted from deficits in
cognitive processes, such as thoughts and beliefs, and from behavioral problems,
such as deficits in skills and abilities. The cognitive part grew out of research on how
depression and anxiety were results of our faulty beliefs, attitudes, and thoughts. The
behavioral part grew out of research that problems such as shyness, loneliness, or
helplessness were results of our behavioral deficits. Accordingly, treatment involves
changing a person's maladaptive thoughts and behaviors.
c) Psychoanalytic Approach—views mental disorders as results of unconscious urges
or impulses and to the struggle over their expression that takes place in the hidden
depths of human personality. Conflicts at one or more of Sigmund Freud's
psychosexual stages occur when the id demands instant gratification while the
superego (conscience) denies it. The ego (consciousness) must strive to maintain a
balance between these forces. Mental disorders arise when the ego , sensing that it
may soon be overwhelmed by the id, experiences anxiety. The ego uses many
different defense mechanisms to cope with such anxiety.

Major breakthroughs halfway through the twentieth century, were made in drug
treatments for some of the major forms of abnormality. There has been an explosion of
new drug therapies for psychopathology since then. However, there are still significant
problems in the delivery of mental health care.
 1.4 LEARNING INSIGHTS
Psychopathology is a study of why people behave, think, and feel in unexpected,
sometimes bizarre, and self-defeating ways. A person can be called normal if he is not
sick, if he is average, if he confirms to social norms, or if he approximates an ideally
mature, healthy or fully functioning personality. He should also be able to accurately
perceive what is going on around him, have control over his actions, be mindful of his
feelings and emotions, be able to develop close interpersonal relationships and
eventually lead a successful life. Psychologists find several different features when
determining if activity is abnormal: statistical infrequency, violation of societal norms,
personal distress, behavioral dysfunction and failure to function adequately. Each
characteristic tells something about what can be considered abnormal, but none by itself
provides a fully satisfactory definition.

The debate about whether mental illnesses have somatogenic or psychogenic

origins has dominated the history of psychopathology and can be traced back to the
ideas of Hippocrates. Recently, people have realized that mental disorders are likely to
arise from the combination of factors, rather than from single causes. Integrated models
of causation, like the stress-diathesis model, find the widest acceptance in abnormal
psychology.

1. Describe in depth the different principles that mental health practitioners

use to describe normal behavior?
2. Describe in detail the various criterion and models used by mental health
professions in defining abnormal behavior?
3. Note how has the treatment of people with mental disorders changed over time.

Carson, R. C., Butcher, J. N., & Mineka, S. 2003. Abnormal Psychology and Modern
Life. Pearson Education: New Delhi.

Comer, R.J. 2010. Abnormal Psychology, 7th edition. Worth Publishers. New York.

Davison, G.C., Neale, J.M., Kring, A.M. Abnormal Psychology, 9th edition. Wiley &
Sons:USA.

Sharma, R., 2006. Abnormal Psychology. Atlantic Publishers & Distributors: New Delhi.