Abnormal Psychology
Edited by Arnold A. Lazarus and Andrew M. Colman
1995, London and New York: Longman. Pp. xiv + 108. ISBN 0-582-27807-4. [Mexican edition: Lazarus, A. A. & Colman, A. M. (Eds). (1998). Psicología anormal (Mireya García Mulsa, Trans.). México: Fondo de Cultura Económica. Pp. 233. ISBN 968-16-5369-6]
Contents
Notes on editors and contributors
Series editor's preface
Introduction
1 Neuroses: Depressive and Anxiety Disorders
J. Mark G. Williams and Isabel R. Hargreaves University College of North Wales, Wales
2 Psychotic Disorders: Schizophrenia, Affective Psychoses, and Paranoia
Chris Frith and Connie Cahill Medical Research Council Cyclotron Unit and University College London, England
3 Infantile Autism
Simon Baron-Cohen University of London Institute of Psychiatry, England
4 Eating Disorders
Peter J. Cooper University of Cambridge, England
5 Alcohol and Drug Addiction
Geoffrey Lowe University of Hull, England
Glossary
Index
Introduction
Arnold A. Lazarus and Andrew M. Colman
Abnormal psychology is devoted to the study of mental,
emotional, and behavioural aberrations. It is the branch of psychology concerned
with research into the classification, causation, diagnosis, prevention, and
treatment of psychological disorders or psychopathology. Its purview covers a
broad spectrum of afflictions and includes neuroses, psychoses, personality
disorders, psychophysiological disorders, organic mental syndromes, and mental
retardation. Abnormal psychology is not synonymous with clinical psychology,
which is mainly concerned with professional practice and focuses primarily on
diagnostic tests and the application of different treatment approaches. The
essence of abnormal psychology is its emphasis on research into abnormal
behaviour and its endeavour to classify the wide range of mental and emotional
aberrations into coherent categories and to understand them. Abnormal psychology
serves as a backdrop or guide to clinical practice.
What is abnormal behaviour? It is indeed a challenge to provide a widely
accepted definition, but most authorities seem to agree on the following key
components. First, statistically, abnormal behaviour tends to be infrequent in
the general population (not too many people suffer from hallucinations or are
subject to incapacitating depression, for example). A second component is that
abnormal behaviour often disregards social norms. Every society has implicit and
explicit rules of conduct. Those who violate these regulations may be seen as
abnormal in certain respects -- although what is abnormal in one culture may be
the norm in another. Third, the notion of personal suffering is another
important component. Personal distress, for instance, is seen in people
suffering from anxiety disorders and depression. The fourth component relates to
some disability because of which the individual is unable to pursue a desired
goal. Thus, substance abuse creates occupational or social disability (for
example, poor work performance or arguments with family members) and can lead to
widespread dysfunctions. Finally, abnormal behaviour is often exaggerated.
Everyone is subject to certain worries, fears, insecurities, feelings of
depression, and so forth, but these feelings become abnormal only when their
intensity is unexpectedly severe. Thus, someone who is financially very well off
but worries continually about money matters is exhibiting an exaggerated form of
behaviour. The changing nature of the field of abnormal psychology makes it
impossible to offer a simple definition that completely captures its essential
features. The combination of the foregoing five components constitutes a partial
definition that is not equally applicable to every diagnosis.
The American Psychiatric Association (1994) publishes a Diagnostic and
Statistical Manual of Mental Disorders, which is now in its fourth revised
edition (known as DSM-IV). This 880-page tome incorporates the most
detailed classification of mental disorders. Its diagnostic criteria serve as
useful general guidelines and are widely used by researchers and mental health
practitioners, especially psychologists and psychiatrists. The DSM lists
seventeen categories or types of mental disorder including disorders usually
first diagnosed in infancy, childhood, or adolescence; mental disorders due to a
general medical condition; schizophrenia and other psychotic disorders; mood
disorders; anxiety disorders; eating disorders; sleep disorders; adjustment
disorders; and personality disorders.
An important and distinctive feature of the DSM is its multiaxial
system that facilitates treatment planning and outcome predictions. There are
five axes in the DSM-IV classification:
Axis I: Clinical Disorders. Other Conditions That May Be a Focus of Clinical Attention.
Axis II: Personality Disorders. Mental Retardation.
Axis III: General Medical Conditions.
Axis IV: Psychosocial and Environmental Problems.
Axis V: Global Assessment of Functioning.
Note that the term "neuroses" does not appear
in this system. Axis I includes mood disorders, anxiety disorders, schizophrenia
and other psychotic disorders, disorders usually first diagnosed in childhood
(of which infantile autism is a prime example), eating disorders, and
substance-related disorders (alcohol and drug addiction). Each of the foregoing
is the subject of one of the chapters in this book. This volume therefore
concentrates specifically on six major groups of clinical disorders. (Other Axis
I or Clinical Disorders include adjustment disorders, somatoform disorders,
factitious disorders, dissociative disorders, sexual and gender identity
disorders, sleep disorders, impulse-control disorders, as well as delirium,
dementia, amnestic and other cognitive disorders.)
Although the present volume does not address any Axis II disorders, the
reader may be interested in knowing the list of personality disorders included
in DSM-IV. They are: paranoid personality disorder (a pattern of
suspiciousness and distrust wherein others' motives are interpreted as
malevolent); schizoid personality disorder (a pattern of detachment from social
relationships and a restricted range of emotional expression); schizotypal
personality disorder (a pattern of intense discomfort in close relationships,
eccentric behaviour, and perceptual or cognitive distortions); antisocial
personality disorder (a pattern of disregard for, and violation of, other
people's rights); borderline personality disorder (a pattern of unstable
relationships, poor or fluctuating self-image, marked impulsiveness, and
emotional hypersensitivity); histrionic personality disorder (a pattern of
extreme emotionality and attention seeking); narcissistic personality disorder
(a pattern of grandiosity, need for admiration, and lack of empathy); avoidant
personality disorder (a pattern of social inhibition, feelings of inadequacy,
and hypersensitivity to criticism); dependent personality disorder (a pattern of
submissive and clinging behaviour tied into an excessive need to be taken care
of); obsessive-compulsive personality disorder (a pattern of preoccupation with
orderliness, perfectionism, and control); and personality disorder not otherwise
specified (a category that provides for people who may have the traits of
several personality disorders without meeting the criteria for any specific one,
or for those who have a disorder not included in the basic classification, such
as a passive-aggressive personality disorder). In essence, the diagnosis of a
personality disorder calls for personality traits that are inflexible, enduring,
widespread, maladaptive, and cause significant functional impairment or
subjective distress. There are many abnormal psychology texts that cover the
entire range of DSM-IV categories, but the one that we find especially
comprehensive and engaging is the book by Davison and Neale (1994).
Turning now to the contents of the present volume, chapter 1, which is on
"Neuroses: Depressive and Anxiety Disorders" by J. Mark G. Williams
and Isabel R. Hargreaves, addresses various forms of depression and touches on
six types of anxiety disorders. In their discussion of depression the authors
cover important antecedents and the characteristic symptoms of this disorder.
Their treatment section states that cognitive therapy (a technique that involves
helping clients to identify and modify distortions in their thinking) is often
as effective as antidepressive medication. However, it is important to realize
that many people do require medication, and that there are a host of new
generation antidepressant drugs, particularly those that increase the level of
serotonin (a neurotransmitter) in the brain. Limitations of space unavoidably
truncate their discussion of treatments for anxiety, but the reader will obtain
an overall impression of some of the more effective methods. Further details of
the present-day treatment of 12 specific disorders including anxiety,
depression, eating disorders, and alcoholism can be found in Barlow's (1993)
book, Clinical Handbook of Psychological Disorders: A Step-by-step Treatment
Manual.
In chapter 2, on "Psychotic Disorders: Schizophrenia, Affective
Psychoses, and Paranoia", Chris Frith and Connie Cahill provide a succinct
summary of psychotic signs and symptoms, especially the delusions,
hallucinations, passivity experiences, and thought disorders related to
schizophrenia. The authors refer briefly to manic-depressive psychosis (or
affective psychoses), which are often called bipolar mood disorders. They
mention the use of lithium carbonate which is widely regarded as the treatment
of choice for many bipolar mood disorders. In addition to medication, people
suffering from bipolar disorders also often require and respond to cognitive
behaviour-therapy. The same applies to many schizophrenic disorders, where the
proper combination of antipsychotic medication plus effective psychosocial
interventions can make a world of difference. We strongly advise the interested
reader to consult the book by Mueser and Glynn (1995), Behavioral Family
Therapy for Psychiatric Disorders. It provides comprehensive and up-to-date
accounts of the diagnosis and treatment of psychiatric disorders. We also
recommend most highly Bongar and Beutler's (1995) Comprehensive Textbook of
Psychotherapy.
In chapter 3, which is on "Infantile Autism", Simon Baron-Cohen
provides a brief summary of one of the most puzzling childhood disorders. The
author discusses associated language disorders and social abnormalities, various
cognitive mechanisms, and the autistic child's inability to appreciate other
people's mental states, which he refers to as "mind-blindness." His
chapter concludes with a brief section on treatment of infantile autism. In
addition to the further reading that Baron-Cohen has recommended, we would like
to mention the excellent book by Schreibman (1988).
In chapter 4 on "Eating Disorders", Peter J. Cooper discusses
anorexia nervosa and bulimia nervosa, provides interesting background
information and epidemiological statistics, and discusses important aetiological
and treatment considerations. Anorexia nervosa is a life-threatening disorder
that predominantly affects young women, especially girls from upper
socio-economic families. Their intense fear of gaining weight or becoming fat
can literally lead them to starve themselves to death. Bulimia nervosa also has
the underlying intent of weight control, but here the person has recurrent
episodes of binge eating followed by such compensatory behaviours as
self-induced vomiting, misuse of laxatives, fasting, and/or extreme exercise.
The treatment of anorexia nervosa usually needs to involve family members and
often calls for hospitalization and nursing care. Bulimia nervosa has a better
prognosis, and many studies have examined the impact of drugs (for example,
certain antidepressants), cognitive behaviour therapy, and interpersonal
therapy. As additional reading, we strongly recommend a chapter on eating
disorders by Wilson and Pike (1993).
Finally, chapter 5 on "Alcohol and Drug Addiction", by Geoffrey
Lowe rounds out this introductory volume on abnormal psychology. The ravages of
alcohol addiction and substance abuse throughout our society can hardly be
overstated. The suffering, crime, and dire economic consequences of alcoholism
and drug addiction are immense. In his chapter, Lowe spells out various models
that have been put forth to account for problem drinking -- notably the disease
model and the social and cognitive learning models. His account of drug
addiction also surveys many different factors and concludes that
"addictions are best viewed as behaviours developed and maintained by
multiple sources". Lowe focuses on different explanatory models but does
not comment on treatment approaches. Providing treatment to individuals with
drinking problems or drug addiction is a complex process. The clinician is faced
with intricate decisions about matching each client to the appropriate level of
care, the best treatment setting, and the selection of the necessary treatment
modalities and techniques. Every client needs to be assessed and diagnosed in
terms of concomitant medical, psychological, psychiatric, and cognitive
problems. Again, for additional reading, we recommend the book by Barlow (1993),
which contains an outstanding chapter on alcoholism (McCrady, 1993).
All in all, we hope that this book will provide a good sampling of the
field of abnormal psychology. The topics that are discussed in the five chapters
that follow cover the vast majority of people with mental disorders in our
society. We feel that this book will provide students and interested readers
with a basic knowledge of some of the most significant mental disorders and may
even wet the appetite of some readers to consider pursuing a career in clinical
psychology. For those who wish to pursue aspects of abnormal psychology in
greater depth, in addition to the books and articles mentioned in this
introduction, suggestions for further reading are given at the end of each
chapter.
REFERENCES
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Barlow, D. H. (Ed.). (1993). Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: Guilford.
Bongar, B., & Beutler, L. E. (Eds). (1995). Comprehensive textbook of psychotherapy. Oxford: Oxford University Press.
Davison, G. C., & Neale, J. M. (1994). Abnormal psychology (6th ed.). New York: Wiley.
McCrady, B. S. (1993). Alcoholism. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (2nd ed., pp. 362-395). New York: Guilford.
Mueser, K. T., & Glynn, S. (1995). Behavioral family therapy for psychiatric disorders. New York: Allyn & Bacon.
Schreibman, L. (1988). Autism. Newbury Park, CA: Sage.
Wilson, G. T., & Pike, K. M. (1993). Eating disorders. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (2nd ed., pp. 278-317). New York: Guilford.