Models of Abnormality

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Chapter 3

• Models of Abnormality

Slides Handouts by Karen Clay Rhines,
Ph.D. Seton Hall University
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What Do You Think?

• A friend comes to you and talks about feeling
  depressed and how lousy a person she is. She
  has a very negative view of herself. You noticed
  that shes stopped exercising and hasnt gone out
  with friends for several weeks. She describes
  difficulty sleeping and studying and generally
  feeling physically unwell. You also know she has
  had difficulty with her family and you suspect
  she has been emotionally abused. She tells you
  she has no future and that no one will ever love
  her.

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What Do You Think?

• Of the following list of issues, which do you
  think is the most relevant to address?
• A. How your friend thinks about herself and her
  future?
• B. What she does and doesnt do (I.e., she is
  isolated and is not getting any exercise)?
• C. She might have a neurochemical imbalance or
  physical disorder and she is not even aware of
  it?
• D. Her problem might stem from her past and
  perhaps she isnt aware of it?
• E. She should realize what a good person she is
  and that she has potential to be anything?

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Models of Abnormality

• What is a model or paradigm?
• Set of assumptions and concepts
• Help us explain and interpret observations
• Currently, there are several competing models of
  abnormality

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The Biological Model

• Takes a medical perspective
• Psychological abnormality is an illness
• Malfunctioning parts of the organism
• Typically focused on the BRAIN

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How Do Biological Theorists Explain Abnormal
Behavior?

• Brain anatomy
• Brain chemistry
• Biological abnormalities
• Genetics
• Evolution
• Viral Infections

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Slide 7
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Biological Treatments

• Biological practitioners attempt to pinpoint the
  physical source of dysfunction to determine the
  course of treatment
• Three types of biological treatment
• Drug therapy
• Electroconvulsive therapy (ECT)
• Psychosurgery

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Biological Treatments

• Drug therapy
• 1950s
• Changed outlook for a number of mental disorders
• Four groups of drugs
• Antianxiety drugs (anxiolytics tranquilizers)
• Antidepressant drugs
• Antibipolar drugs (mood stabilizers)
• Antipsychotic drugs

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Biological Treatments

• Electroconvulsive therapy (ECT)
• Currently experiencing a revival
• Used for severe depression when drugs and other
  therapies have failed
• In 60 of cases, ECT can lift symptoms within a
  few weeks

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Biological Treatments

• Psychosurgery
• Historical roots in trephination
• 1930s first lobotomy
• Much more precise than in the past
• Considered experimental and used only in extreme
  cases

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Assessing the Biological Model

• Weaknesses
• Can limit rather than enhance our understanding
• Evidence is incomplete or inconclusive
• Treatments produce significant undesirable
  (negative) effects
• Any other limitations?

• Strengths
• Earns considerable respect in the field
• Fruitful
• Any other strengths?

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The Psychodynamic Model

• Oldest and most famous
• Behavior determined largely by underlying
  (unconscious) dynamic psychological forces
• Abnormal symptoms are the result of conflict
  among these forces
• Father of psychodynamic theory and psychoanalytic
  therapy
• Sigmund Freud (1856 1939)

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How Did Freud Explain Normal and Abnormal
Behavior?

• Caused by three UNCONSCIOUS forces
• Id guided by the Pleasure Principle
• Ego guided by the Reality Principle
• Superego guided by the Morality Principle
• Conscience unconsciously adopted from our
  parents
• Three parts often in conflict
• A healthy personality compromise
• If id, ego, and superego are in excessive
  conflict, the persons behavior may show signs of
  dysfunction

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How Did Freud Explain Normal and Abnormal
Behavior?

• Developmental stages
• Freud proposed that at each stage of development,
  new events and pressures require adjustment in
  the id, ego, and superego
• If successful personal growth
• If unsuccessful fixation at an early
  developmental stage, leading to psychological
  abnormality
• Because parents are the key figures in early
  life, they are often seen as the cause of
  improper development

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How Did Freud Explain Normal and Abnormal
Behavior?

• Developmental stages
• Oral (0 to 18 months of age)
• Anal (18 months to 3 years of age)
• Phallic (3 to 5 years of age)
• Latency (5 to 12 years of age)
• Genital (12 years of age to adulthood)

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Psychodynamic Therapies

• Range from Freudian psychoanalysis to more modern
  therapies
• All seek to uncover past trauma and inner
  conflicts
• Understanding early life experience critically
  important
• Therapist acts as subtle guide

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Psychodynamic Therapies

• Utilize various techniques
• Free association
• Therapist interpretation
• Resistance
• Transference
• Dream interpretation
• Catharsis
• Working through
• Short-term dynamic therapies

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Assessing the Psychodynamic Model

• Strengths
• First to recognize importance of psychological
  theories treatment
• Saw internal conflict as important source of
  psychological health and abnormality
• First to apply theory and techniques
  systematically to treatment monumental impact
  on the field
• Any other strengths?

• Weaknesses
• Deterministic
• Unsupported ideas difficult to research
• Non-observable
• Inaccessible to human subject (unconscious)
• Any other limitations?

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The Behavioral Model

• Behaviorism also deterministic
• Actions are determined largely by our life
  experiences
• Emphasis is on observable behavior and
  environmental factors
• Focus on how behavior is acquired (learned) and
  maintained over time

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The Behavioral Model

• Historical beginnings in laboratories where
  conditioning studies were conducted
• Several forms of conditioning
• Operant conditioning
• Modeling
• Classical conditioning
• May produce normal or abnormal behavior

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How Do Behaviorists Explain Abnormal
Functioning?

• Operant conditioning
• Organism operates on environment and produces
  an effect
• Humans and animals learn to behave in certain
  ways as a result of receiving rewards whenever
  they do so

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How Do Behaviorists Explain Abnormal
Functioning?

• Modeling
• Individuals learn behavioral responses by
  observing and repeating behavior
• No direct reinforcement

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How Do Behaviorists Explain Abnormal Functioning?

• Classical conditioning
• Learning by temporal association
• When two events repeatedly occur close together
  in time, they become fused in a persons mind
  before long, the person responds in the same way
  to both events
• Father of classical conditioning Ivan Pavlov
  (1849 1936)
• Classic study using dogs meat powder

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Classical Conditioning
UR Salivate
US Meat
UR Salivate
Tone
US Meat

CS Tone
CR Salivate
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How Do Behaviorists Explain Abnormal Functioning?

• Classical conditioning
• If, after conditioning, the CS is repeatedly
  presented alone, it will eventually stop
  eliciting the CR
• This process is called extinction
• Explains many familiar behaviors (both normal and
  abnormal)

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Behavioral Therapies

• Aim is to identify the behaviors that are causing
  problems and replace them with more appropriate
  ones
• Therapist is teacher rather than healer

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Behavioral Therapies

• Classical conditioning treatments may be used to
  change abnormal reactions to particular stimuli
• Example systematic desensitization for phobia
• Step-by-step procedure
• Learn relaxation skills
• Develop a fear hierarchy
• Confront feared situations (covertly or in vivo)

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Assessing the Behavioral Model

• Strengths
• Powerful force in the field
• Rooted in empiricism
• Phenomena can be observed and measured
• Significant research support for behavioral
  therapies
• Other strengths?

• Weaknesses
• Too simplistic
• Unrealistic
• Downplays role of cognition
• New focus on self-efficacy, social cognition, and
  cognitive-behavioral theories
• Other limitations?

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The Cognitive Model

• Studying the ways in which the person attends to,
  interprets, and uses available information
• Argues that clinicians must ask questions about
  assumptions, attitudes, and thoughts
• Concerned with internal processes
• Present-focused

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How Do Cognitive Theorists Explain Abnormal
Functioning?

• Maladaptive thinking is the cause of maladaptive
  behavior
• Several kinds of faulty thinking
• Faulty assumptions and attitudes
• I should feel happy because Im a mother
• The world is fair.
• Illogical thinking processes
• Example overgeneralization

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Cognitive Therapies

• People must be taught a new way of thinking to
  prevent maladaptive behavior
• Main model Becks Cognitive Therapy
• The goal of therapy is to help clients recognize
  and restructure their thinking
• Therapists also guide clients to challenge
  dysfunctional thoughts, try out new
  interpretations, and apply new ways of thinking
  in their daily lives
• Widely used in treating depression

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Assessing the Cognitive Model

• Strengths
• Broad appeal
• Clinically useful effective
• Focuses on a uniquely human process
• Correlation between symptoms and maladaptive
  cognition
• Therapies effective in treating several disorders
• Adapt well to technology
• Research-based
• Other strengths?

• Weaknesses
• Singular, narrow focus
• Overemphasis on the present
• Limited effectiveness
• Verification of cognition is difficult
• Precise role is hard to determine
• Other limitations?

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The Humanistic-Existential Model

• Combination model
• The humanist view
• Emphasis on people as friendly, cooperative, and
  constructive focus on drive to
  self-actualization
• The existentialist view
• Emphasis on self-determination, choice, and
  individual responsibility focus on authenticity

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Rogers Humanistic Theory and Therapy

• Basic human need for unconditional positive
  regard
• If received, leads to unconditional self-regard
• If not, leads to conditions of worth
• Incapable of self-actualization because of
  distortion dont know what they really need,
  etc.
• Rogers client-centered therapy
• Therapist provides unconditional positive regard
• Both accurate genuine in reflection (reflective
  listening)
• Focus on the experiencing person
• Little research support

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Gestalt Theory and Therapy

• Humanistic approach
• Developed by Fritz Perls
• Goal is to achieve self-recognition through
  challenge and frustration
• Techniques
• Role playing
• Rules, including Here and Now and I language

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Spiritual Views and Interventions

• For most of the twentieth century, clinical
  scientists viewed religion as a negative factor
  in mental health
• This alienation now seems to be ending
• Numerous books have been published
• Ethical codes now include religion under
  diversity
• Researchers have begun to systematically study
  the influence of religion and spirituality on
  mental health
• Many therapists now address spiritual issues when
  treating religious clients

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Existential Theories and Therapy

• Psychological dysfunction is caused by
  self-deception people hide from lifes
  responsibilities and fail to recognize that it is
  up to them to give meaning to their lives
• Therapy is focused on patient acceptance of
  personal responsibility and recognition of
  freedom of action
• Goals more important than technique
• Great emphasis placed on client-therapist
  relationship

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Assessing the Humanistic-Existential Model

• Strengths
• Emphasizes the individual
• Taps into domains missing from other theories
• Non-deterministic
• Optimistic
• Emphasizes health

• Weaknesses
• Focuses on abstract issues
• Not much influence
• Weakened by disapproval of scientific approach
• Changing somewhat

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The Sociocultural Model

• Abnormal behavior best understood in light of the
  social and cultural forces that influence an
  individual
• Influenced by sociology and anthropology
• Examine a persons social surroundings to
  understand their (abnormal) behavior

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How Do Sociocultural Theorists Explain Abnormal
Functioning?

• Focus on
• Family structure and communication
• Family systems theory
• Examples enmeshed relationships
• Role of culture
• Role of social networks/support

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How Do Sociocultural Theorists Explain Abnormal
Functioning?

• Focus on
• Societal conditions
• Abnormality more common in lower classes. Why?
• Societal labels roles
• Diagnostic labels (example Rosenhan study)
• Sick role

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Sociocultural Treatments

• May include traditional individual therapy
• Broadened therapy to include
• Culturally-sensitive therapy
• Group therapy
• Family therapy
• Couples therapy
• Community treatment
• Includes prevention work

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Assessing the Sociocultural Model

• Strengths
• Added greatly to the clinical understanding of
  abnormality
• Increased awareness of labeling
• Clinically successful when other treatments have
  failed
• Other strengths?

• Weaknesses
• Research is difficult to interpret
• Correlation ? causation
• Model unable to predict abnormality in specific
  individuals
• Other limitations?

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Integration of the Models

• Each perspective is valuable to understanding
  abnormal behavior
• Different perspectives are more appropriate under
  differing conditions
• An integrative approach provides a general
  framework for thinking about abnormal behavior
  while also allowing for specification of the
  factors that are especially pertinent to
  particular disorders

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Integration of the Models

• Many theorists, clinicians, and practitioners
  adhere to a biopsychosocial model
• Abnormality results from the interaction of
  genetic, biological, developmental, emotional,
  behavioral, cognitive, social, and societal
  influences
• Also popular
• Diathesis-stress approach
• Diathesis predisposition (bio, psycho, or
  social)
• Reciprocal effects explanation

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Integration of the Models

• Integrative therapists are often called
  eclectic taking the strengths from each model
  and using them in combination

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Now, What Would You Do?

• Based on your perspective, discuss and then write
  a brief description of the treatment you would
  use to treat your friend..

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Class Discussion
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Diagnosis Does the Clients Syndrome Match a
Known Disorder?

• Using all available information, clinicians
  attempt to paint a clinical picture
• Influenced by their theoretical orientation
• Using assessment data and the clinical picture,
  clinicians attempt to make a diagnosis
• A determination that a persons problems reflect
  a particular disorder or syndrome
• Based on an existing classification system

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Classification Systems

• Lists of categories, disorders, and symptom
  descriptions, with guidelines for assignment
• Focus on clusters of symptoms (syndromes)
• In current use in the US DSM-IV
• Diagnostic and Statistical Manual of Mental
  Disorders (4th edition)

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DSM-IV

• Published in 1994, revised slightly in 2000
• Lists approximately 400 disorders
• Listed in the inside back flap of your text
• Describes criteria for diagnoses, key clinical
  features, and related features which are often
  but not always present
• People can be diagnosed with multiple disorders

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Lifetime Prevalence of DSM Diagnoses
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The DSM-IV

• Multiaxial
• Uses 5 axes (branches of information) to develop
  a full clinical picture
• People usually receive a diagnosis on either
  Axis I or Axis II, but they may receive diagnoses
  on both

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The DSM-IV

• Axis I
• Most frequently diagnosed disorders except
  personality disorders and mental retardation

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Major Axis I Diagnostic Categories
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The DSM-IV

• Axis II
• Personality disorders and mental retardation
• Long-standing problems
• Axis III
• Relevant general medical conditions
• Axis IV
• Psychosocial and environmental problems

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The DSM-IV

• Axis V
• Global assessment of psychological, social, and
  occupational functioning (GAF)
• Current functioning and highest functioning in
  past year
• 0100 scale

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Are Classifications Reliable and Valid?

• In this case reliability different
  diagnosticians agreeing on a diagnosis using the
  same classification system
• DSM-IV has greater reliability than any previous
  editions
• Used field trials to increase reliability
• Reliability is still a concern

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Are Classifications Reliable and Valid?

• In this case validity accuracy of information
  that the diagnostic categories provide
• Predictive validity is of the most use clinically
• DSM-IV has greater validity than any previous
  editions
• Conducted extensive literature reviews and ran
  field studies
• Validity is still a concern

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Can Diagnosis and Labeling Cause Harm?

• Misdiagnosis always a concern
• Major issue is reliance on clinical judgment
• Also present is the issue of labeling and stigma
• Diagnosis may be a self-fulfilling prophecy