What is Abnormality?

The causes (or etiology) of psychological disorders are up for debate among clinicians; however, they generally agree on symptoms or indicators of abnormality. Psychologists classify abnormal behavior and emotions, or psychopathology, by looking for signs of hallucinations, delusions, or affective disturbances, along with other less severe signs such as distress; maladaptiveness, irrationality, unpredictability, and other undesirable behaviors. Displaying just one of these symptoms is not necessarily enough to be diagnosed with a mental disorder; two or more indicators are usually present in order to make this judgment. Displaying different combinations of these indicators can create different diagnoses of certain disorders. However, it can become difficult for doctors to determine what is "normal" or "abnormal" when the symptoms are not extreme or obvious (such as the aforementioned symptoms).

In David Rosenhan's Experiment, pseudo-patients were admitted into a mental hospital and, although they had no actual disorders, they were not found as frauds. This takes into account that there is no distinctive "line" separating normalcy from psychopathology, which results in a broad spectrum of mental disorder ranging from "no disorder" to "severe disorder" (see chart on page 486).
Historically, psychological disorders were believed to be caused by demons or spirits which needed to be driven out of the body. Then came Hippocrates who proposed that mental disorders were caused by the body's humors, which, when found in excess in the body and causing imbalance, caused the person to have a particular temperament. This basis of thought resulted in what was later known as the medical model which was the common view on psychological disorders in the late 18th century. Through the biomedical model, doctors saw psychological disorders as a disease, and as an interaction between biological, mental, social, and behavioral factors that, like other physical diseases, should be cured with treatments that pertain to the physical causes of the disease,such as drug therapy. In contrast, the psychological view is supported through the social-cognitive-behavioral approach, an alternative to the medical model combining social, cognitive, and behavioral responses.

One should be aware that the diagnoses of whether a person has a psychological disorder is dependent on biology, situation, an individual's thoughts, intensity, frequency, duration, and the judgment of a trained clinician. Do not try to classify friends, family members, or yourself as having a psychological disorder.



Diagnosing and Classifying Disorders

The DSM-IV, or the Diagnostic and Statistical Manual of Mental Disorders, organizes over 300 recognized mental disorders into categories according to mental and behavioral symptoms, such as anxiety, depression, sexual problems, and substance abuse. The DSM-IV allows psychologists to use Multiaxial diagnosis, in which they examine the patient as a whole rather than just looking at their abnormal symptoms. The five axes are Clinical Disorders, Personality Disorders/ Mental Retardation, General Medical Conditions, Psychosocial and Environmental Problems, and Global Assessment of Functioning. In the fourth edition of the book, changes were made, such as the removal of the word neurosis and the replacement with "disorder". In addition, the term Psychosis now relates mainly to a loss of contact with reality, rather than its original broader definition. Finally, homosexuality was removed as a disorder.

Mood Disorders: Extremes of Mood



The first set of disorders that are examined by the DSM-IV are mood disorders which involve sustained extremes of emotion. An example of a mood disorder is major depression, which is a depression that may last for months and does not give way to a manic period. Depression costs billions of dollars for Americans every year through hospitalization, therapy sessions, etc., but it also causes personal losses: loss of appetite, loss of self-worth, suicidal thoughts, removal from friends and family, and more. Before, depression was most common in middle aged woman but has now shifted to teens, though still found to be more common in women. Reasons for this are thought to be the out of control individualism, the self esteem movement, and a culture of victimization that teens experience. Depression is a cross-cultural disability and may be handled differently in different places., but is considered severe virtually everywhere.
Seasonal Affective Disorder (SAD), is a special form of depression that relates to the levels of the light sensitive hormone melatonin which regulates our internal biological clocks. It is why many people seem to be happier in the summer than in the winter.
Bipolar Disorder is thought to be a largely biological disorder. Although they haven't pinpointed the exact genes that cause the disorder, the fact that the disorder responds well to medicine indicates its biological nature. Within it, people experience alternating waves of mania and depression.

Disorders of Anxiety, Trauma, and Stress



Some of the most common disorders are Anxiety Disorders . A person with an anxiety disorder experiences severe and prolonged fears or anxiety. There are four major psychological disorders which are diagnosed from their anxiety-based components: Generalized anxiety disorder , Panic disorder , Phobic disorder, and Obsessive-Compulsive Disorder.
It is important to note that phobic disorders involve a persistent and irrational fear of a specific object, activity, or situation. Phobic disorders include phobias such as arachnophobia, the fear of spiders, or auto phobia, a very rare phobia, in which the sufferers are afraid of themselves. Phobias can be split into two categories social phobias and specific phobias . Agoraphobia is another phobia, which is a common symptom of victims of panic disorders. It is when one fears public places and open spaces where it would be difficult for them to escape a situation. The more common phobias that people experience can be partially explained by the preparedness hypothesis which states that we are naturally afraid of things which threatened our survival based on innate reactions.
Panic disorders are "hit-and-run" attacks. They come unexpectedly at any point in time and can leave the person feeling afraid and alone. There is believed to be a large genetic influence in panic attacks.

Somatoform Disorders: Physical or Health Related Problems With No Apparent Physical cause
Somatoform disorders are disorders in which psychological disorders appear in the form of bodily symptoms or physical complaints. Two somatoform disorders include conversion disorder and hypochondriasis. Conversion disorder, formerly known as hysteria, is defined with the occurrences of paralysis, weakness, or loss of sensation without a discernible cause. People who suffer from this disorder may experience blindness, deafness, or insensitivity to touch when really their symptoms are not physical problems but are all in their mind. In addition, Hypochondria
sis is a disorder in which a person is paranoid about health concerns; every ache, or imagined ache, seems like a sign of sickness to them. Doctors can conclude that the hypochondriac's concerns are just a psychological problem. Hypochondriacs can be easy targets for health fads and scams.

Dissociative Disorders: Non-psychotic Fragmentation of the Personality
Dissociative disorders are disorders of the personality, where parts of the personality seem to be detached. Some dissociative disorders include dissociative amnesia, dissociative fugue, depersonalization disorder, and dissociative identity disorder.
Dissociative amnesia is the psychologically induced memory loss of personal information, such as one's identity or residence.
Dissociative fugue is very similar to dissociative amnesia but it adds flight from one's home, family, or work. These episodes normally last for hours or possibly days with full recovery afterward, but there are occasional occurrences of extended fugue, from which the patient may never recover the memories lost.
Depersonalization disorder is the sensation that mind and body have been separated. Patients with this often report out-of-body experiences most commonly found in near death experiences, such as a person who is in a car crash.
Dissociative Identity Disorder, previously called multiple personality disorder, is when a person exhibits two, rarely more, personalities that differ in some significant way. If the person is usually shy, the alternative may be outgoing. It is the suggested that this disorder may be caused by traumatic events that the victim is trying to suppress.

Personality Disorders:



Another form of disorders are personality disorders. There are five signs of personality disorders that may be seen in pattern over long periods of time: poor judgment, disordered thinking, emotional disturbances, disrupted social relationships, or lack of impulse control. The three main personality disorders are narcissistic personality disorder, antisocial personality disorder, and borderline personality disorder. Narcissism is characterized by an exaggerated sense of self importance. Antisocial personality disorder is noted by chronic irresponsibility and a distrust in others. And borderline personality disorder is characterized by impulsiveness and instability.

Eating Disorders:



In addition to personality disorders, eating disorders can be dangerous as well, and can have a powerful addictive quality. Anorexia Nervosa is a type of eating disorder that involves someone purposefully starving themselves in order to correct their unreasonably exaggerated body image. Anorexia often is influenced by the media (fashion magazines, TV, movies, etc.) and modern day society. Bulimia nervosa is a disorder, in which, the person will binge or over eat and then purge themselves. These disorders often are associated with, or may lead to, other disorders such as depression.

Schizophrenia:



One of the most severe psychological disorders is Schizophrenia, where an individual's mind is separate from reality. They can experience hallucinations, delusions and other abnormal twists of the mind. Many tests have been done to find the source in the brain that causes schizophrenia, one particularly involving twins. Scientists look at the differences between a set of twins brains where the chemical make up and features are the same. What they have found is that in the twin that suffers from schizophrenia, the ventricles in that individual's brain are larger than the normal twin. It is more common for twins to both have this disorder than any other biological relationship, however their concordance rate is still only around 50%.
Diathesis-stress hypothesis says that environmentally stressed situations can bring on a schizophrenic disorder.
Schizophrenia also takes different schizophrenic forms or types. The disorganized type may involves hearing voices, hallucinations, delusions, bizarre behavior, and talking to imaginary people. The types then decrease in severity down to the residual type which is similar to a sort of state of remission. The other types include, Catatonic type, Paranoid type, and the Undifferentiated type.

Developmental Disorders: Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence
Furthering the disorders are three types of developmental disorders. Developmental disorders can arise at any age, but are usually found to be diagnosed during the childhood years. Autism is a developmental disorder that many people misinterpret. It is a disability that a person has with social skills, language, and understanding others. The social aspect that is affected by this disorder is the ability to comprehend social gestures and mannerisms. Dyslexia is a disorder that causes reading difficulties, although there is doubt to whether it is a distinct disorder or just given to explain people who have reading problems. Another developmental disorder is Attention-Deficit Hyperactive Disorder (ADHD), which is characterized by a lack of focus and an inability to remain still.

Other:
Adjustment disorders and other conditions that may be a focus of clinical attention, are the catch bin for all other problems and disorders that do not fit under the above headings. They span physical complaints, life problems, relationship problems, and even malingering. However, little space is spent on these extras.


What are the Consequences of Labeling People?
Labels can create hurt, confuse, and even change the way people behave. When people are labeled as having a mental disorder, it can cause society to view them differently and it can severely damage the patient's own self-image. Labeling can transform people into stereotypes, masking their unique characteristics, which then provokes prejudices and social rejection.

There have been many great studies done on the differences found in the labeling of disorders among various cultures. The studies found that different cultures have radically different definitions for disorders and that, specifically, the United States is far more apt to diagnose patients with severe mental disorders such as schizophrenia. In other countries, for example, those with mental disorders are sometimes seen as prophets, and would not be judged the same as they would in the United States.
Psychiatrists Arthur Kleinman and Alex Cohen dispelled three persistent myths about psychiatry:
  • Psychological disorders have a similar prevalence in all cultures.
  • Biology creates psychological disorder, while culture merely shapes the way a person experiences it.
  • Culture-specific disorders occur only in exotic places, rather than here at home.

As for legal relevance to mental disorders, the plea of insanity is rarely authentic and is often unsuccessful. Infamous cases, such as M'Naughten's murder of the British Prime Minister, have formed a low public opinion of the insanity defense. Accused criminals use the plea of insanity far less often than the public assumes. According to David Rosenhan, the plea of insanity occurs in only about two of 1000 criminal cases, and actually, the most successful pleas do not occur in murder cases. Today's society blames psychologists and psychiatrists for letting these "maniacs" plead insanity to get treatment rather than punishment. The term "insanity" does not appear in the DSM-IV listing of disorders recognized by psychologists or psychiatrists. In fact, the term Insanity is a legal term, meaning only a court can officially diagnose an individual with the illness. Public concern about the abuses of the insanity plea have led some states to require separate verdicts on the act and the intent, allowing the jury to reach an alternative verdict of "guilty but mentally ill."

Thomas Szasz, a radical psychologist, claimed that mental illness was a myth, because the symptoms that were used as evidence of these mental diagnosis were actually just medical labels that gave professionals excuses to intervene in what were, in fact, just social problems. Many other psychologists advocate an ecological model, where abnormality is displayed as interactions
between individuals versus society.

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