Jerry: Well, after the first of the year, started getting these panic attacks. I didn’t know what the panic attack was. Interviewer: Well, what was it that you experienced? Jerry: Um, the heart beating, racing… Interviewer: Your heart started to race on you. Jerry: And then uh, couldn’t be in one place, maybe a movie, or a church things would be closing in on me and I’d have to get up and leave. Interviewer: The first time that it happened to you, can you remember that? Jerry: Um, yeah I was . . Interviewer: Take me through that, what you experienced.
Jerry: I was driving on an interstate and, Oh I mightn’t been on maybe 10 or 15 minutes. Interviewer: Uh huh. Jerry: All of a sudden I got this fear. I started to uh race. Interviewer: So you noticed you were frightened? Jerry: Yes. Interviewer: Your heart was racing and you were perspiring. What else? Jerry: Perspiring and uh, was afraid of driving anymore on that interstate for the fear that would either pull into a car head on, so um, I just, I just couldn’t function. I just couldn’t drive. Interviewer: What did you do?
Jerry: pulled, uh well at the nearest exit. I just got off uh stopped and, I had never experienced anything like that before. Interviewer: That was just Jerry: Out of the clear blue Interviewer: Out of the clear blue? And what’d you think was going on? Jerry: I had no idea. Interviewer: You just knew you were Jerry: I thought maybe I was having a heart attack. Interviewer: Okay. Source: Exerted from “Panic Disorder: The Case of Jerry,” found on the Videos in Abnormal Psychology CD-ROOM that accompanies this textbook.
Ta FAA Some men in India have a psychological disorder characterized by anxiety over losing semen. (p. 74) TO If Although it is not an exact science, the measurement of the bumps on a person’s head can be used to determine the person’s personality traits. (p. 80) TO F-u An objective test of personality is en that does not require any subjective judgments on the part of the person taking the test. (p. 84) T J OF One of the most widely used personality tests asks people to interpret what they see in a series of inkblots. P. 88) TX 5-2 People in weight-loss programs who carefully monitor what they eat tend to lose less weight than people who are less-reliable monitors. (p. 94) Ta FAA Despite advances in technology, physicians today must still perform surgery to study the workings of the brain. (p. 96) TO r-u Cocaine cravings in people addicted to cocaine have been linked to parts of the brain that are normally activated during pleasant emotions. (p. 99) JERRY BEGINS TO TELL HIS STORY, GUIDED BY THE INTERVIEWER.
PSYCHOLOGISTS AND OTHER mental health professionals use clinical interviews and a variety of other means to assess abnormal behavior, including psychological testing, behavioral assessment, and physiological monitoring. The clinical interview is an important way of assessing abnormal behavior and arriving at a diagnostic impression-?in this case, panic disorder. The clinician matches the presenting problems and associated features with a set of diagnostic criteria in forming a diagnostic impression.
The diagnosis of psychological or mental disorders represents a way of classifying patterns of abnormal behavior on the basis of their common features or symptoms. Abnormal behavior has been classified since ancient times. Hippocrates classified abnormal behaviors according to his theory Of humors (vital bodily fluids). Although his theory proved to be flawed, Hippocrates’ classification of some types of mental health problems generally correspond to diagnostic categories we use today.
His description of melancholia, for example, is similar to our current conception of depression. 69 70 Chapter 3 During the Middle Ages some “authorities” classified abnormal behaviors into two groups, those that resulted from demonic possession and those due to natural causes. The 19th-century German psychiatrist Emil Kremlin was the first modern theorist to develop a comprehensive model Of classification based on the distinctive features, or symptoms, associated with abnormal behavior patterns (see Chapter 1).
The most commonly used classification system today is largely an outgrowth and extension of Grapnel’s work: the Diagnostic and Statistical Manual of Mental Disorders (ADSM), published by the American Psychiatric Association. Why is it important to classify abnormal behavior? For one thing, classification is the core of science. Without labeling and organizing patterns of abnormal behavior, researchers could not communicate their findings to one another, and progress toward understanding these disorders would come to a halt.
Moreover, important decisions are made on the basis of classification. Certain psychological disorders respond better to one therapy than another or to one drug than another. Classification also helps clinicians predict behavior: schizophrenia, for example, follows a more or less predictable course. Finally, classification helps researchers identify populations with similar patterns of abnormal behavior. By classifying groups of people as depressed, for example, researchers might be able to identify common factors that help explain the origins of depression.
This chapter reviews the classification and assessment of abnormal behavior, beginning with the ADSM. HOW ARE ABNORMAL BEHAVIOR PATTERNS CLASSIFIED? The ADSM was introduced in 1952. The latest version, published in 2000, is the DISMISS-TRY, the Text Revision (TRY) of the Fourth Edition (ADSM-IV) (PAPA 2000). Another common system of classification, published by the World Health Organization, is used mainly for compiling statistics on the worldwide occurrence of disorders: the International Statistical Classification of Diseases and Related Health Problems (ACID), which is now in its tenth revision (the ACID-I O).
The ADSM-IV is compatible with the ACID, so that ADSM diagnoses could be coded in the ACID system as well. Thus the two systems can be used to share information about the prevalence and characteristics of particular disorders. The ADSM has been widely adopted by mental health professionals. However, many psychologists and other professionals criticize the ADSM on several grounds, such as relying too strongly on the medical model. Our focus n the ADSM reflects recognition of its widespread use, not an endorsement.
In the ADSM, abnormal behavior patterns are classified as “mental disorders. ” Mental disorders involve either emotional distress (typically depression or anxiety), significantly impaired functioning (difficulty meeting responsibilities at work, in the family, or in society at large), or behavior that places people at risk for personal suffering, pain, disability, or death (e. G. , suicide attempts, repeated use of harmful drugs).
Let us also note that a behavior pattern that represents an expected or culturally appropriate response to a stressful vent, such as signs of bereavement or grief following the death of a loved one, is not considered disordered within the ADSM, even if behavior is significantly impaired. If a person’s behavior remains significantly impaired over an extended period of time, however, a diagnosis of a mental disorder might become appropriate. The ADSM and Models of Abnormal Behavior The ADSM system, like the medical model, treats abnormal behaviors as signs or symptoms of underlying disorders or pathologies.
However, the ADSM does not assume that abnormal behaviors necessarily reflect biological causes or defects. It recognizes that the causes of most mental disorders remain uncertain: Some disorders may have purely biological causes, whereas others may have psychological causes. Still others, probably most, are best explained within a multifunctional model that takes into account the interaction of biological, psychological, social (socioeconomic, sculptural, and ethnic), and physical environmental factors. 71 TABLE 3. Sample Diagnostic Criteria for Generalized Anxious Disorder 1 . Occurrence of excessive anxiety and worry on most days during a period of 6 months or longer. 2. Anxiety and worry are not limited to one or a few encores or events. 3. Difficulty controlling feelings of worry. 4. The presence of a number of features associated with anxiety and worry, such as the following: a. Experiencing restlessness or feelings of edginess b. Becoming easily fatigued c. Having difficulty concentrating or finding one’s mind going blank d. Feeling irritable e. Avian states of muscle tension f. Having difficulty falling asleep or remaining asleep or having restless, unsatisfying sleep 5. Experiencing emotional distress or impairment in social, occupational, or other areas of functioning as the result of anxiety, worry, or related physical homonyms. 6. Worry or anxiety is not accounted for by the features of another disorder. 7. The disturbance does not result from the use of a drug of abuse or medication or a general medical condition and does not occur only in the context of another disorder.
Source: Adapted from ADSM-IV-TRY (PAPA, 2000). The authors of the ADSM recognize that their use of the term mental disorder is problematic because it perpetuates a long-standing but dubious distinction between mental and physical disorders (American Psychiatric Association, 1994, 2000). They point out that there is much that is “physical” in “mental” crosiers and much that is “mental” in “physical” disorders. The diagnostic manual continues to use the term mental disorder because its developers have not been able to agree on an appropriate substitute.
In this text we use the term psychological disorder in place of mental disorder because we feel it is more appropriate to place the study of abnormal behavior more squarely within a psychological context. Moreover, the term psychological has the advantage of encompassing behavioral patterns as well as strictly “mental” experiences, such as emotions, thoughts, beliefs, and attitudes. We should also recognize that the ADSM is used to classify disorders, not people. Rather than classify someone as a schizophrenic or a depressive, we refer to an individual with schizophrenia or a person with major depression.
This difference in terminology is not simply a matter of semantics. To label someone a schizophrenic carries an unfortunate and systematizing implication that a person’s identity is defined by the disorder he or she has. Features of the ADSM The ADSM is descriptive, not explanatory. It describes the diagnostic features-?or, in medical terms, symptoms-?of abnormal behaviors; it does not attempt to explain their origins or adopt any particular theoretical framework, such as psychodrama or learning theory. Sing the ADSM classification system, the clinician arrives at a diagnosis by matching a client’s behaviors with the criteria that define particular patterns of abnormal behavior (“mental disorders”). Table 3. 1 shows the diagnostic criteria for generalized anxiety disorder. Abnormal behavior patterns are categorized according to the features they share. For example, abnormal behavior patterns chiefly characterized by anxiety, such as panic disorder or generalized anxiety disorder (see Table 3. Are classified as anxiety disorders. Behaviors chiefly characterized by disruptions in mood are categorized as mood disorders.