Some things to keep in mind...

1. You do NOT have all of the disorders you'll read about

Just like medical students in their first pathology class, many students will worry about whether they have the disorders they study.  That's normal enough, since many of us have many of the same problems which, when they become extreme, constitute mental illness.  Everyone gets anxious, but few have Anxiety Disorders.  Don't panic.  Most of these disorders are rare.  Few of you have any disorders, but most of you will see some of yourself in the problems we study.
 
2. Mental illness involves human suffering and certainly isn't funny

We are studying human tragedies, painful and devastating experiences.  Please don't confuse my attempts at keeping you awake and entertained during lecture with anything but that.

What Do We Mean by Psychopathology? Abnormality? 

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1 Abnormality Implies statistical deviance
• usually we reserve the term for "bad" deviance
• deviance implies some absolute standard, or comparison group

deviance, after all, implies something from which one deviates

2 The DSM-IV definition
• Illness involves distress and disability
• A good definition of abnormality involves the 3 Ds:

Deviance, Distress, and Disability
• mental illness is assumed similar cross culturally
• mental illness exists in individuals, not groups
• published by the American Psychiatric Association
• closely parallels ICD-10
• International Classification of Diseases
• published by the World Health Organization (WHO)
3 Cultural relativists say culture determine sickness
• reject the notion of sick societies
• Was obedience to Nazi government adaptive ?
• One group may select normality for others in society

 
4 Problems in defining abnormality through cultural relativism
• Are one set of values as good as another?
• Therapists must seek conformity to social norms

1. Does behavior foster well-being?
2. Abnormal behavior prevents growth and fulfillment
• Actualization is seen as worth striving to attain
• Behavior is evaluated in terms of its consequences for well-being and growth
3. In the US, there are a variety of mental health professions
• Psychiatry
• Clinical psychology
• Psychiatric social work
• Psychiatric nurses
• some states have other types of counselors, such as MFCC (MFT) (Marriage, child, & family counselors)

DSM classification of mental disorders

• Describing the nature or clinical picture of abnormal behaviors
1. Classification systems permit clear communication
2. Classification is a step toward treatment
• The DSM-IV published 1994 by the American Psychiatric Association
• The International Classification of Diseases, 10th Edition (ICD-10) governs

worldwide classification (published by World Health Organization)

• The DSM classification has distinct clinical usefulness
1. Operational criteria are used for definition
2. Subjectivity in diagnosis is diminished
• The DSM has a diagnosis made according to five axes or dimensions

• Axes I and II list the categories of mental disorder
• personality (chronic) disorder are coded on II
• Axis III requires a medical exam and assesses general physical conditions that might relate to the disorder or treatment
• Axis IV life situation and stress
• Axis V summarizes global level of functioning,

• The problem of labeling
• Labels often appear to criticize the person
• The person may act out the label
• Society may stigmatize the "labeled" patient
• People may act negatively toward the patient
• Patients are seen as "dangerous" because of their labels
• Professionals must be cautious in assigning a label to a patient
• Some professionals prefer the term client
• The need for confidentiality is very important, & increasingly difficult

Frequencies of particular disorders are of great interest to professionals

• Research efforts are guided by frequencies
• So is the allocation of treatment resources

• Prevalence identifies the proportion active cases
• Incidence is the rate of occurrence

• Thirty-three percent of the sample were likely to have some psychological disorder
• Most are treated in outpatient facilities, if at all

Observation of behavior
 

1. Overt behavior forms the basis of classification
2. Self reports of inner thoughts has a limit as a data base
3. The observational method is a systematic technique to record behavior
• Hypotheses help to make sense of the observed behavior
• Hypotheses guide empirical research
4. Hypotheses about causation guide treatment strategies
• Various perspectives explain the same behavior differently
• Treatments vary depending upon a therapist's theoretical perspective

1. Studies that examine groups of people are often valued over single cases
• May identify multiple causes for disorders
• Can generalize results to other cases
• Case studies are used to generate hypotheses, and study rare phenomena

2. Sampling is a technique to find representatives of the disorder being researched
Erroneous conclusions can emerge from faulty sampling
3. Control groups are used for comparisons

• examines statistical covariation between variables (what goes with what)
• two or more variables are measured (none are manipulated)
• Correlation or association of variables is not evidence of causation
1. Many conditions or symptoms occur together, but their

relationship can take many forms
2. Complexity is the rule in abnormal behavior
• Path analysis can be used to disentangle complexities
• Epidemiological studies use correlations extensively
• Often useful as source of hypotheses for future research

1. The experimental method strives to control extraneous variables
2. There are limitations to using the experimental method

• Ethical restraints limit possible conditions
• It is impossible to control all variables influencing behavior

• Learned helplessness studies are analogue investigations

Limitations in generalization exist for analogue research

Case studies examine causation of problems and treatment methods

• N=1 experiments use the patient as his/her own control
• A single observer can bias results, questionable generalizability
• Case studies allow for in-depth examination of a patient, and have traditionally been great sources of hypotheses, albeit poor ways of validating them

• Retrospective studies "look backward"
e.g., have depressed people describe childhood losses
• Prospective studies "look forward"
e.g., measure current losses, then assess depression in the future
• Prospective research is supplementing traditional retrospective approach
• Looking forward strengthens causal hypotheses when correct
• Populations with risk factors are followed

• Prospective studies have produced equivocal results
• The methodology is still evolving
• Excessive confidence was initially placed in them

• The DSM-IV uses a disease metaphor for mental disorder
• are mental problems like physical diseases?

• Some professionals differ on the value of DSM classification
• Complex human behavior is overly simplified
• Is it possible to divide behavior neatly into normal and abnormal?
• Symptoms are the foundation for categorization

 
• Alternatives to categorical diagnostic systems have been proposed
• The dimensional approach views behavior as a level of intensity
• The prototypal approach tries to define a classic case, recognizing none my fit the description exactly.