research on abnormal psychology

How Psychologists Define and Study Abnormal Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

Abnormal psychology is a branch of psychology that studies, diagnoses, and treats unusual patterns of behavior, emotions, and thoughts that could signify a mental disorder.

Abnormal psychology studies people who are “abnormal” or “atypical” compared to the members of a given society.

Remember, “abnormal” in this context does not necessarily imply “negative” or “bad.” It is a term used to describe behaviors and mental processes that significantly deviate from statistical or societal norms.

Abnormal psychology research is pivotal for understanding and managing mental health issues, developing treatments, and promoting mental health awareness.

Defining Abnormality

The definition of the word abnormal is simple enough, but applying this to psychology poses a complex problem:

What is normal? Whose norm? For what age? For what culture?

The concept of abnormality is imprecise and difficult to define. Examples of abnormality can take many different forms and involve different features, so that, what at first sight seem quite reasonable definitions, turns out to be quite problematic.

There are several different ways in which it is possible to define ‘abnormal’ as opposed to our ideas of what is ‘normal.’

Statistical Infrequency

Under this definition of abnormality, a person’s trait, thinking or behavior is classified as abnormal if it is rare or statistically unusual.

With this definition, it is necessary to be clear about how rare a trait or behavior needs to be before we class it as abnormal. For instance, one may say that an individual who has an IQ below or above the average level of IQ in society is abnormal.

Statistical Infrequency: IQ shown in a normal distribution graph

The statistical approach helps to address what is meant by normal in a statistical context. It helps us make cut–off points in terms of diagnosis.

Limitations

However, this definition fails to distinguish between desirable and undesirable behavior. For example, obesity is statistically normal but not associated with healthy or desirable. Conversely, a high IQ is statistically abnormal but may well be regarded as highly desirable.

Many rare behaviors or characteristics (e.g., left-handedness) have no bearing on normality or abnormality. Some characteristics are regarded as abnormal even though they are quite frequent.

Depression may affect 27% of elderly people (NIMH, 2001). This would make it common, but that does not mean it isn’t a problem.

The decision of where to start the “abnormal” classification is arbitrary. Who decides what is statistically rare, and how do they decide? For example, if an IQ of 70 is the cut-off point, how can we justify saying someone with 69 is abnormal, and someone with 70 is normal?

This definition also implies that abnormal behavior in people should be rare or statistically unusual, which is not the case.

Instead, any specific abnormal behavior may be unusual, but it is not unusual for people to exhibit some form of prolonged abnormal behavior at some point in their lives, and mental disorders such as depression are very statistically common.

Violation of Social Norms

Violation of social norms is a definition of abnormality where a person’s thinking or behavior is classified as abnormal if it violates the (unwritten) rules about what is expected or acceptable behavior in a particular social group. Their behavior may be incomprehensible to others or make others feel threatened or uncomfortable.

Every culture has certain standards for acceptable behavior or socially acceptable norms .

Norms are expected ways of behaving in a society according to the majority, and those members of a society who do not think and behave like everyone else break these norms and are often defined as abnormal.

With this definition, it is necessary to consider the degree to which a norm is violated, the importance of that norm, and the value attached by the social group to different sorts of violations, e.g., is the violation rude, eccentric, abnormal, or criminal?

There are a number of influences on social norms that need to be taken into account when considering the definition of the social norm:

With this definition, it is necessary to consider the following:

The degree to which a norm is violated,
The importance of that norm,
The value attached by the social group to different sorts of violations, e.g., is the violation rude, eccentric, abnormal, or criminal?

The most obvious problem with defining abnormality using social norms is that there is no universal agreement over social norms.

Social norms are culturally specific – they can differ significantly from one generation to the next and between different ethnic, regional, and socio-economic groups.

In some societies, such as the Zulu, for example, hallucinations and screaming in the street are regarded as normal behavior.

Social norms also exist within a time frame and therefore change over time. Behavior that was once seen as abnormal may, given time, become acceptable and vice versa.

For example, drunk driving was once considered acceptable but is now seen as socially unacceptable, whereas homosexuality has gone the other way.

Until 1980 homosexuality was considered a psychological disorder by the World Health Organization (WHO), but today is socially acceptable.

Social norms can also depend on the situation or context we find ourselves in. Is it normal to eat parts of a dead body?

In 1972 a rugby team who survived a plane crash in the snow-capped Andes of South America found themselves without food and in sub-freezing temperatures for 72 days. To survive, they ate the bodies of those who had died in the crash.

Failure to Function Adequately

Failure to function adequately is a definition of abnormality where a person is considered abnormal if they are unable to cope with the demands of everyday life, or experience personal distress.

They may be unable to perform the behaviors necessary for day-to-day living, e.g., self-care, holding down a job, interacting meaningfully with others, making themselves understood, etc.

Rosenhan & Seligman (1989) suggest the following characteristics that define failure to function adequately:

Maladaptiveness (danger to self)
Vividness & unconventionality (stands out)
Unpredictably & a loss of control
Irrationality/incomprehensibility
Causes observer discomfort
Violates moral/social standards

One limitation of this definition is that apparently abnormal behavior may actually be helpful, functional, and adaptive for the individual.

For example, a person who has the obsessive-compulsive disorder of hand-washing may find that the behavior makes him cheerful, happy, and better able to cope with his day.

Many people engage in behavior that is maladaptive/harmful or threatening to self, but we don’t class them as abnormal:

Adrenaline sports
Smoking, drinking alcohol
Skipping classes

Deviation from Ideal Mental Health

Abnormality can be defined as a deviation from ideal mental health.

This means that rather than defining what is abnormal, psychologists define what normal/ideal mental health is, and anything that deviates from this is regarded as abnormal.

This requires us to decide on the characteristics we consider necessary for mental health. Jahoda (1958) defined six criteria by which mental health could be measured:

A positive view of the self
Capability for growth and development
Autonomy and independence
Accurate perception of reality
Positive friendships and relationships
Environmental mastery – able to meet the varying demands of day-to-day situations

According to this approach, the more satisfied these criteria are, the healthier the individual is.

It is practically impossible for any individual to achieve all of the ideal characteristics all of the time. For example, a person might not be the ‘master of his environment’ but be happy with his situation.

The absence of this criterion of ideal mental health hardly indicates he is suffering from a mental disorder.

Ethnocentric

Ethnocentrism , in the context of psychology, refers to the tendency to view one’s own culture or ethnic group as the standard or norm, and to judge other cultures, values, behaviors, and beliefs based on those norms. I

White, middle-class men devise most definitions of psychological abnormality. It has been suggested that this may lead to disproportionate numbers of people from certain groups being diagnosed as “abnormal.”

For example, in the UK, depression is more commonly identified in women, and black people are more likely than their white counterparts to be diagnosed with schizophrenia.

Similarly, working-class people are more likely to be diagnosed with a mental illness than those from non-manual backgrounds.

Models of Abnormality

Behavioral Model of Abnormality

Behaviorists believe that our actions are determined largely by the experiences we have in life rather than by the underlying pathology of unconscious forces.

Abnormality is therefore seen as the development of behavior patterns that are considered maladaptive (i.e., harmful) for the individual.

Behaviorism states that all behavior (including abnormal) is learned from the environment (nurture) and that all behavior that has been learned can also be ‘unlearnt’ (which is how abnormal behavior is treated ).

The behavioral approach emphasizes the environment and how abnormal behavior is acquired through classical conditioning , operant conditioning , and social learning .

Classical conditioning has been said to account for the development of phobias. The feared object (e.g., spider or rat) is associated with fear or anxiety sometime in the past. The conditioned stimulus subsequently evokes a powerful fear response characterized by avoidance of the feared object and the emotion of fear whenever the object is encountered.

Learning environments can reinforce (re: operant conditioning) problematic behaviors. E.g., an individual may be rewarded for having panic attacks by receiving attention from family and friends – this would lead to the behavior being reinforced and increasing in later life.

Our society can also provide deviant maladaptive models that children identify with and imitate (re: social learning theory).

Cognitive Perspective of Mental Health Behavior

The cognitive approach assumes that a person’s thoughts are responsible for their behavior. The model deals with how information is processed in the brain and the impact of this on behavior.

The basic assumptions are:

Maladaptive behavior is caused by faulty and irrational cognitions.
It is the way you think about a problem rather than the problem itself that causes mental disorders.
Individuals can overcome mental disorders by learning to use more appropriate cognitions.

The individual is an active processor of information .

How a person perceives, anticipates, and evaluates events rather than the events themselves, which will have an impact on behavior.

This is generally believed to be an automatic process; in other words, we do not think about it.

In people with psychological problems, these thought processes tend to be negative, and the cognitions (i.e., attributions, cognitive errors) made will be inaccurate:

These cognitions cause distortions in how we see things; Ellis suggested it is through irrational thinking, while Beck proposed the cognitive triad.

Medical / Biological Perspective of Mental Health Behavior

The medical model of psychopathology believes that disorders have an organic or physical cause. The focus of this approach is on genetics, neurotransmitters , neurophysiology, neuroanatomy, biochemistry, etc.

For example, in terms of biochemistry – the dopamine hypothesis argues that elevated levels of dopamine are related to symptoms of schizophrenia.

The approach argues that mental disorders are related to the physical structure and functioning of the brain.

For example, differences in brain structure (abnormalities in the frontal and pre-frontal cortex, enlarged ventricles) have been identified in people with schizophrenia.

The Diathesis-Stress Model

According to the diathesis-stress model , the emergence of a psychological disorder requires first the existence of a diathesis, or an innate predisposition to that disorder in an individual, and second, stress, or a set of challenging life circumstances which then trigger the development of the disorder.

In the diathesis-stress model, these challenging life events are thought to interact with individuals’ innate dispositions to bring psychological disorders to the surface.

For example, traumatic early life experiences, such as the loss of a parent, can act as longstanding predispositions to a psychological disorder. In addition, personality traits like high neuroticism are sometimes also referred to as diatheses.

Furthermore, individuals with greater innate predispositions to a disorder may require less stress for that disorder to be triggered, and vice versa.

In this way, the diathesis-stress model explains how psychological disorders might be related to both nature and nurture and how those two components might interact with one another (Broerman, 2017).

Psychodynamic Perspective of Mental Health Behavior

The main assumptions include Freud’s belief that abnormality came from psychological causes rather than physical causes, that unresolved conflicts between the id, ego, and superego can all contribute to abnormality, for example:

Weak ego : Well-adjusted people have a strong ego that can cope with the demands of both the id and the superego by allowing each to express itself at appropriate times. If the ego is weakened, then either the id or the superego, whichever is stronger, may dominate the personality.
Unchecked id impulses : If id impulses are unchecked, they may be expressed in self-destructive and immoral behavior. This may lead to disorders such as conduct disorders in childhood and psychopathic [dangerously abnormal] behavior in adulthood.
Too powerful superego : A superego that is too powerful, and therefore too harsh and inflexible in its moral values, will restrict the id to such an extent that the person will be deprived of even socially acceptable pleasures. According to Freud, this would create neurosis, which could be expressed in the symptoms of anxiety disorders , such as phobias and obsessions.

Freud also believed that early childhood experiences and unconscious motivation were responsible for disorders.

unconscious motives for abnormal behavior

An Alternative View: Mental Illness is a Social Construction

Since the 1960s, it has been argued by anti-psychiatrists that the entire notion of abnormality or mental disorder is merely a social construction used by society.

Notable anti-psychiatrists were Michel Foucault, R.D. Laing, Thomas Szasz, and Franco Basaglia. Some observations made are:

Mental illness is a social construct created by doctors. An illness must be an objectively demonstrable biological pathology, but psychiatric disorders are not.
The criteria for mental illness are vague, subjective, and open to misinterpretation criteria.
The medical profession uses various labels, e.g., depressed and schizophrenic, to exclude those whose behavior fails to conform to society’s norms.
Labels and treatment can be used as a form of social control and represent an abuse of power.
Diagnosis raises issues of medical and ethical integrity because of financial and professional links with pharmaceutical companies and insurance companies.

Why is abnormal psychology important?

Abnormal psychology is a crucial field that focuses on understanding, diagnosing, and treating atypical behaviors, emotions, and thought processes, which can lead to mental disorders.

Its importance lies in enhancing our comprehension of mental health disorders, developing effective treatment strategies, and promoting mental health awareness to reduce stigma.

Additionally, this field helps in implementing preventive measures, guiding mental health legislation and policies, improving the quality of life for those with mental health issues, and serving as an educational tool for professionals and the public.

Through these various contributions, abnormal psychology helps foster a better understanding and handling of mental health matters in society.

How did the study of abnormal psychology originate?

The study of abnormal psychology originated in ancient times, with early explanations attributing abnormal behaviors to supernatural forces. The Greeks later proposed naturalistic explanations, such as Hippocrates’ theory of bodily humors.

After regression during the Middle Ages, the field progressed in the 19th and 20th centuries, with figures like Philippe Pinel and Sigmund Freud advocating humane treatment and developing therapeutic approaches, respectively.

The 20th century also saw the creation of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Currently, the field draws from various disciplines, including psychology, psychiatry, neuroscience , and genetics.

What are the 4 key objectives of the field of abnormal psychology?

The field of abnormal psychology has four primary objectives:

Description: This involves accurately describing, defining, and classifying different psychological disorders. This is important for practitioners and researchers to communicate effectively about each disorder.

Explanation: This involves determining the causes or etiology of different disorders. Researchers aim to understand the biological, psychological, and social factors that contribute to the development and maintenance of abnormal behaviors or mental health disorders.

Prediction: By understanding the course of different disorders, psychologists can predict how they might develop or change over time. This can help forecast the likely course of a disorder in an individual, given certain characteristics or conditions.

Change: Ultimately, the goal of abnormal psychology is to develop effective interventions and treatments that can alleviate the suffering caused by mental health disorders. This objective seeks to change maladaptive behaviors, thoughts, and emotions, promoting mental well-being and functional life skills.

What makes defining abnormality difficult?

Defining abnormality in psychology is challenging due to cultural variations, subjectivity, context-dependent norms, societal changes over time, and difficulty discerning when behaviors or emotions become clinically significant. Cultural norms heavily influence perceptions of normality and abnormality.

Additionally, what’s considered abnormal in one context may be normal in another. Definitions also evolve with societal and scientific progress. Furthermore, distinguishing when feelings like sadness or anxiety become severe or prolonged enough to be deemed abnormal is complex.

These factors highlight the need for a nuanced, culturally sensitive, and individualized approach to abnormal psychology.

Why are correlational research designs often used in abnormal psychology?

Correlational research designs are often used in abnormal psychology because they allow researchers to examine the relationship between different variables without manipulating them, which can provide valuable insights into mental health conditions. These designs are particularly useful in cases where variables cannot be manipulated for ethical or practical reasons.

For example, it would be unethical and impractical to manipulate a factor such as childhood trauma to observe its effects on mental health in adulthood. However, a correlational design would allow researchers to examine the relationship between these variables as they naturally occur.

Additionally, correlational designs can help identify risk factors for various mental health conditions. For instance, researchers might find that high-stress levels correlate with an increased risk of depression. Such findings can provide a foundation for preventive measures and guide future research.

However, a key limitation of correlational research is that it cannot establish causality. Just because two variables are correlated does not mean one causes the other. Therefore, correlational findings often need to be followed up by experimental or longitudinal studies to explore potential causal relationships.

Fundamentals of Psychological Disorders - 3rd edition

(18 reviews)

Alexis Bridley, Washington State University

Lee W. Daffin Jr., Washington State University

Publisher: Washington State University

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Ray Martin, Affiliate faculty, Metropolitan State University of Denver on 4/3/24

This book does a great job at covering the material in a way that undergraduate students can understand and dive deep into topics they are interested in without being overwhelmed. The appendix and references provided are great. However, there is a... read more

Comprehensiveness rating: 4 see less

Content Accuracy rating: 5

Book has great accuracy. Instructor resources are accurate and correct (except for some very minor editing-related issues on the powerpoints).

Relevance/Longevity rating: 5

The authors have been updating this text. They are doing a great job

Clarity rating: 4

My students have told me mixed reviews about this themselves. I think it is very well done and, when there is an increase in depth and content, the chapters are shorter and easier to digest. However, if students are not undergraduate juniors or seniors or english is not their first language, the reading rate must be slower.

Consistency rating: 5

Excellently done

Modularity rating: 5

Book has chapters and sections that are well organized. Each chapter features headers.

Organization/Structure/Flow rating: 5

Amazing organization. While this book lacks in some disorders, the other book in the series helps.

Interface rating: 4

The book is approachable and looks good. However, when printing (or printing to PDF) the book, the back matter can overwhelm students due to the depth of it. I have been navigating this by just giving students a warning that the chapter is not over 100 pages long.

Grammatical Errors rating: 5

Well done and easy to read.

Cultural Relevance rating: 5

I would like to see more examples, but it is overall well done. The inclusion of ICD-10 adds to the content. Additionally, because models of abnormality feature sociocultural perspectives, this book addresses cultural features and differences in prevalence.

Reviewed by Karen Magruder, Assistant Professor in Practice, University of Texas at Arlington on 3/8/24

Comprehensiveness rating: 5 see less

This book covers all the major categories of mental disorders as codified in the DSM-5-TR. Each category includes a summary of clinical presentation, epidemiology, comorbidity, etiology, and treatment. Additionally, it sets the stage by defining key terms and introducing the topic, including an exploration of what defines abnormal psychology, the impacts of mental illness, types of mental health professionals, and how mental disorders are classified.

Content Accuracy rating: 4

Overall, the information presented is consistent with evidence-based practice and current DSM-5-TR criteria. While I understand collapsing Depressive and Bipolar disorders into one Mood Disorders category, I would prefer to see headers stay consistent with DSM categories, to avoid confusing learners.

The DSM of course goes through updates periodically, and this volume effectively conveys the most relevant statistics, diagnostic criteria, and information. This book will need to be updated as data regarding prevalence and outcomes evolve, but it is set up well to do so.

Clarity rating: 5

Writing is clear and easy to follow. Terminology is consistently defined. Key takeaways are summarized in a clear and accessible manner, which helps reinforce important points.

There is a very consistent flow between chapters, with a predictable rhythm. Language is consistence between sections.

The authors do an excellent job of breaking complex topic into manageable chunks. Modules and subcomponents could easily be assigned for smaller readings. Effective use of headings and subheadings.

This book is very organized. The table of contents provides a helpful overview, with clear and consistent organization within chapters.

Interface rating: 3

Links make navigating through the PDF simple and straightforward. Some minor issues with images detract from professionalism and clarity, such as having Shutterstock watermarks on copyrighted images. Some charts are difficult to read due to contrast issues, granularity, and small fonts. Due to the PDF format (online and xml formats not working), there may be some issues with alt text or screen readers?

No grammatical errors were found.

Cultural Relevance rating: 4

This volume includes case studies to apply some of the mental health issues to real practice settings. It also sets the stage by discussing stigma surrounding mental illness. More examples of cultural factors in diagnosis and treatment would strengthen this.

What a great resource for clinicians and students in a variety of helping professions!

Reviewed by Matthew Hand, Associate Professor, Texas Wesleyan University on 2/29/24

I was very pleased with both the depth and breadth provided by this textbook. It did a good job of covering the major disorders along with their disorder categories. It also did a good job of talking about treatment and important factors related to psychological disorders. I especially appreciated the authors including research findings when discussing various aspects of the disorders.

The most recent version of the textbook included disorders of childhood, which are not always included in books provided by publishers. This was a welcome addition.

Also, the book did a good job of starting the text with talking about the models of abnormality, the history of assessment/treatment, and assessment of psychological dysfunction. They were comprehensive in the way they approached these topics.

Overall, I was pretty happy with the comprehensiveness of the text.

The content in the book accurately conveyed what it's supposed to cover. Descriptions of psychological disorders and the disorder categories were accurate and the authors did a good job of citing relevant research that would provide more depth to the information given.

I did not find any information in the book that seemed inaccurate.

Relevance/Longevity rating: 4

The content of the book focuses on the concepts and theories that are typically taught in an abnormal psychology course. Furthermore, the authors have made the material more relevant by keeping the research presented in the book current and by following the most recent version of the DSM. While many of the OER resources still refer to the DSM-5, this text utilizes information from the DSM-5-TR. I really like seeing studies cited and explained that were in the last few years rather than just focusing on studies that are a decade older or more.

The description of conceptsa nd the discussion of research results seemed appropriately clear.

Since this is a course in abnormal psychology, it should be assumed that the reader has some pre-existing knowledge of psychology concepts and is able to understand the way that these concepts are communicated in a textbook such as this.

The textbook is consistent in both the writing style and the way that content is organized in various sections and subsections.

After reading a chapter or two, a reader can reasonably predict both the tone of the writing as well as how future chapters will be organized.

Modularity rating: 3

The content in the textbook is divided by modules, which are divided by sections and broken up into subsections. This lends itself to easy adaptability because it would be easy to take out pieces and incorporate it into a course.

The one element of the textbook that might make adaptability slightly more complicated is that the chapters of the book are labeled modules. I prefer labeling each content area as chapters instead of modules because the modules in my course might not follow the same order that the textbook prefers to follow. This means that simply adopting the textbook without changing it in such a way to adhere to the order of the course is challenging unless the instructor wants to follow the material exactly in the order that it is presented in the textbook.

However, it is not a significant hurdle as editing the textbook to change the label for content areas isn’t too difficult.

The book is organized really well, and follows the organizational structure one might find in a traditional textbook from a publisher.

There is a logical sequence as to how the book is organized.

Interface rating: 5

There aren't significant issues with the text that cause any reading problems.

The type of font that is used is consistent and the authors use boxes to highlight information such as review questions andsection summaries.

Grammatical Errors rating: 4

Throughout the textbook, grammar was pretty good.

I did not notice any glaring grammatical issues.

Cultural Relevance rating: 3

I think the authors do a good job of structuring the material in a way that it speaks to diversity and they include research findings that also go along with that message. However, there isn't an abundance of content that focuses on the ways that people in different cultures are similar and different in how they express the types of abnormality described in the book. This is pretty normal with abnormal psychology textbooks, so this text does not deviate from the norm all that significantly.

This OER is a good substitute for traditional textbook material provided by a publisher. Additionally, I thought it was better structured and more comprehensive than some of the other OERs that focus on abnormal psychology.

As I mentioned previously, I have not been able to find and review ancillary material, but the content in the textbook itself is comprehensive, current, relevant, and well-written.

This OER is a great candidate for someone wanting to use an OER in an Abnormal Psychology course.

Reviewed by Kathy Harowski, Community faculty, advisor, Metropolitan State University on 2/25/24

Comprehensiveness rating: 3 see less

While this reader found the text comprehensive, at times the level of detail included was overwhelming an questionable for an undergraduate audience. Both General Psychology and Abnormal Psychology are often GEN ED courses taken by the range of undergrads and of course, Abnormal Psychology would be of even more interest and foundational for psychology majors and is often more clinically focused. The level of detail found in sections on the history of treatment and neural transmission as well as other sections was overwhelming and perhaps not key to many students. For this reader, it was too much even with my length of experience in the field in terms of how one would engage students, keep them connected to the material much less useful assessment beyond old school memorization. My concern was intensified by the lack of effort on format, paragraphs full of descriptive statistics, etc. There was a lack of charts and images to help one grasp and retain the points made; in fact, infographics were mentioned at the end of such lengthy ,packed paragraphs and then a link to the original material was provided . DK if that was about costs or how the outside organizations permit use of their work, but rough.

Content Accuracy rating: 3

In the closely read sections, there was at least one quote without attribution. Wondered about personal beliefs - section 1.4.75- to address over use and not great prescribing of psychotropic medications, there one option offered, prescribing psychologists. This is a sentence made without attribution... Really? One might also mention the decreased number of psychiatrists, the fact that most psychotropic medication is prescribed by primary care practitioners, the massive growth of the range of nursing practitioners degrees as well as the ongoing controversy around training for prescribing psychologists- which by the way, I am an advocate for...

Overall the content seemed relevant and up to date. There was a question in my reading when I saw prevelance rates for mental illness from 2001-2003 being used as current.

A strength was the clarity of definitions provided.

Consistency rating: 4

consistent but see comments around the lack of images, graphs.... In the closely read sections, did not see consistency around use of case studies nor did one see a return to the case study at the end of the section/chapter to pull the information from the chapter together as part of the summary. A strength was the amount and clarity of definitions of terms provided.

see comments about format in general. Use of side bars, boxes, more images and graphics, more case studies, would help.

Organization/Structure/Flow rating: 4

well organized, organized around DMS V sections

See comments about the overall lack of images,tables, graphics to help ideas sink in. There were graphics in some sections.

clarity and grammar were solid.

Did not seem to be highlighted in the areas closely read. Was not even mentioned at all in the foundational sections nor was global statistics around mental illness and research.

Reviewed by Tim Boffeli, PhD, Associate Professor of Psychology, Dept. Chair, Clarke University on 1/9/23

Content wise, the phrase “bare bones” would be too harsh. The book is about half the number of pages of the textbook that I am currently using. Plainly sufficient comes to mind especially considering the diminished amount of time that current students are engaging textbooks. Of the not covered topics, most of them are covered in our other courses in our curriculum (Psychology of Sex and Gender). Inclusion of neurodevelopmental disorders in future editions would be encouraged. Specific DSM 5 criteria are not included in the textbook. Inclusion of the criteria during the lecture would be critical for students to comprehend the diagnostic process. Descriptions of the various disorders is sufficient to enable students to understand what transpires life wise for the person who is experiencing the symptoms.

I have no concerns about accuracy.

Relevance was achieved.

The textbook was very readable and should engage a wide variety of students who have variable interests and attention spans.

The textbook was consistent.

The textbook was easy to follow and navigate.

The textbook was organized in a logical manner that did not necessarily dictate a proscribed sequence.

There were multiple empty pages which distracted from the flow. Initially, I wondered if content was missing.

No concerns about grammar.

No concerns about cultural insensitivity.

The textbook has been renamed with assurances that the content is unchanged. Removing the word “Abnormal” is a positive step. In my lectures, we spend quality time discussing what is normal vs abnormal. That continuum is ever culturally changing. Many students who constantly experience disgruntlement bristle in class when the label of “abnormal” is applied to their lives.

Conclusion: I am a licensed mental health counselor. I think this textbook would be fine for faculty who have extensive counseling experiences. Seasoned faculty would know where to enhance the content with clinically relevant supplemental information. I did not review the supplemental instructor resources so maybe additional information are located in those resources. For faculty with limited clinical psychology experiences, I would question/be concerned about enhancements to prepare students who have a career goal involving clinical psychology interventions. With that being said, for a student who desires a general understanding of psychological disorders then this textbook should be fine.

Reviewed by Emily Abel, Visiting Assistant Professor, Wabash College on 11/7/22

This text included all of the major psychological disorders, though was missing some that I plan to discuss (neurodevelopmental disorders, sleep-wake disorders). Some of these are included in their childhood disorders book, though I would like to see at least a discussion of autism spectrum disorder in the newest edition of this book, since it is so relevant to daily life and functioning in adulthood. I also think a greater discussion of developmental psychopathology in the introductory chapters would be helpful in future editions.

I did not find any factual inaccuracies while reviewing this book. I found it to be an accurate reflection of the DSM-5 and relevent recent research studies.

This book is updated to reflect the most recent research and version of the DSM. Some prevalence estimates may need to be updated periodically (before the next update to the DSM) as they tend to change for some disorders over time.

This book is particularrly well written for an undergraduate audience. I found the modules to be clear and concise (a good length for each section that will hold student attention well).

I liked the parallel structure of the each module (to include the clinical presentation, epidemiology, comorbidity, etiology, and treatment of each disorder). This was consistent across all modules.

The book is broken down into modules that are based on the broader set of disorders (e.g., Obsessive-Compulsive and Related Disorders) in the DSM-5.

This book is well organized both in terms of using modules, and within modules (headings and consisent structure of modules across the book).

Interface is easy to use. The links and table of contents all work nicely to jump to individual modules/sections and outside sources.

I did not notice any major grammatical errors throughout the text.

The examples and descriptions I looked at while reviewing the book all appeared to be culturally appropriate. However, I will be sure to look at this element closely when incorporating the textbook this spring. I will also solicit feedback from my students about this aspect of the text.

I am considering using this textbook (or at least portions of the book) for my spring undergraduate course in Abnormal Psychology. Overall, I found it to be well-organized, well-written, and easy to navigate (in addition to a good length in terms of holding student attention). I particularly liked the consistent outline of each module to include the clinical presentation, epidemiology, comorbidity, etiology, and treatment of each disorder. I think this parallel structure would be helpful to students in understanding the key components of each diagnosis we discuss in class. I also liked the inclusion of ‘Learning Outcomes’ and ‘Key Takeaways’ that can help instructors tie the text to lecture content and activities. Within many modules, the authors also include resources where students can find additional information on that topic (e.g., the National Eating Disorders website). I found these resources to be particularly helpful because students can follow the link directly from the online textbook or PDF, and it’s not another thing I need to add to the slides for class. I typically like to give students these additional resources as we never have time to cover everything in as much depth as I would ideally like. I do think this text includes the most common psychological disorders, and the ones that students are often most excited to learn about (e.g., personality disorders). However, it is also missing others from the DSM-5 that I do plan to cover, including neurodevelopmental disorders and sleep-wake disorders. This is not necessarily a negative thing, as many courses do not include these sections. However, I will need to supplement with other materials if I choose to fully adopt this book as my primary text. Below are a few other thoughts I had while reviewing the book: 1) As with most Abnormal Psychology textbooks, this book is focused on understanding how disorders present in adulthood. As a developmental scientist, I do plan to focus a bit more of the progression of these disorders across the lifespan than is done in the book (e.g., how do features of depression change from childhood to adulthood). However, the same authors do have another excellent open text that is specifically focused on behavioral disorders of childhood that I can and will likely easily integrate in my course to address this issue. Their childhood book also does include information on some neurodevelopmental disorders, which I mentioned are missing from the current book. It’s important to note that these are critical to discuss in adulthood as they are not just childhood disorders.

2) I quite like the intro chapter and how it introduces students to important methods, types of professionals (e.g., clinical psychologist, psychiatrist), and professional societies and journals. These are all things I planned to incorporate in my course. My only comment with the two opening sections is that I would have liked to see a more explicit discussion of the developmental psychopathology theory (e.g., work by Dante Cicchetti) included in the models of abnormal psychology. I think discussing the transactional model could also be helpful, but the developmental psychopathology theory is critical to understanding abnormal psychology and is something I will incorporate in my course.

3) It is a great text for students who are interested in understanding how specific disorders are diagnosed and treated and would be great intro information for students who want to pursue clinical careers. I do think I will need to supplement to make the content a bit more applied and community focused for my purposes, though that is not a criticism of this text, but rather something I would be personally looking for in a text directly tailored to my course.

Overall, I think this textbook would be great for an introductory course in abnormal psychology and will also be useful as an open educational resource in my spring course. As I mentioned above, I will likely combine with their open textbook on childhood disorders to emphasize how disorders change across the life course. I appreciate the easy-to-use organization of the book, and I will plan to report back on what my students think after their experiences this spring.

Reviewed by Madison Smart-McCarthy, Adjunct Professor, Tidewater Community College on 8/1/22

The outline of the textbook seemed similar to other abnormal psychology textbooks. The authors did a good job explaining terminology and defining mental health conditions. I think more clinical case examples could be provided throughout the textbook and perhaps inserting "food for thought" sort of sections that highlight recent studies and include questions that help students think critically about those studies. I have found sections in textbooks like that a good way to learn the material, help students apply concepts, and stimulate interesting discussion within the classroom.

I did not find any information to be inaccurate, contain errors, or be biased. Authors brought in DSM definitions and used research studies to support their claims. Authors gave credit to external sources throughout the book.

Authors state in the beginning of the text that they plan to update the sections to align with the newest edition of the DSM. Most of the information is still relevant but it may need to be tweaked in some areas to account for the DSM changes.

Authors select appropriate jargon and define parts that may not be known to an undergraduate student.

Textbook chapters are fairly consistent with how the modules are organized (DSM description, epidemiology, comorbidity, etc.). I found it very easy to review the sections because of the consistency. Students may also find this beneficial when trying to locate certain information within a chapter.

The authors divide the textbook into "Part," "Block," and "Modules," which give instructors a chance to break the chapters into smaller sections. The text for each section has appropriate font size and color.

I noticed that objectives/goals were presented at the beginning of the chapter and for each module. It may be helpful to stick to either objectives for the whole chapter or for each section.

The organization of the textbook seems similar to other abnormal textbooks from publishers, such as Pearson. Personally, I think the sections on epidemiology and comorbidity could be summarized within each section that describes the DSM definition of the disorder or summarized in a single paragraph.

Additionally, the way that the textbook is organized currently it includes "Part," "Block," and "Module." The labels "Part" and "Block" are not very descriptive. Students may benefit from more detailed labels.

The authors mention at the beginning of the textbook that they plan to update the text in August 2022. This may be a reason that images, charts, graphs, etc. were not used in the textbook. There were colored boxes at the end of each chapter that summarized the material and included review questions. No navigation problems were evident.

A discussion of cultural differences were found in various sections of the textbook (e.g. Module 1.4.7.4 and Module 5.5.4). However, I think students could benefit from more examples throughout the textbook that include individuals from a variety of races, ethnicities, and backgrounds as well as explaining how presentations may vary depending on one's identity and/or culture. The explanation about rates of PTSD within the Hispanic population was excellent. .

Images would be a wonderful addition to this textbook. I'm excited to see the edits that will be made soon.

Reviewed by Stephanie RiCharde, Visiting Assistant Professor, Randolph College on 4/10/22

The text covered the major expected content. The authors included an effective glossary and index. The index would be improved it were clickable like the table of contents. read more

The text covered the major expected content. The authors included an effective glossary and index. The index would be improved it were clickable like the table of contents.

The authors included many relevant, accurate ideas and concepts in modules 1 and 2 to set the stage for their discussion of specific mental illnesses. I was very concerned about their lack of primary source citations, which is something about which I speak with my students extensively. I would be uncomfortable assigning a text that cites websites and blogs.

The authors presented up-to-date content that could be updated in the future if necessary.

The text is written in a style that is accessible to undergraduate students. It is easy to read and follow. The authors do not always provide enough information to explain content to those who have no previous knowledge of the topic. For example, their discussion of the disease model is not clear enough nor does it prepare an undergraduate student with no background information to answer the review question about the model at the end of the section. The authors go to great care to highlight and define many key terms in the first chapter, but then describe a study about social distance without describing what social distance is, a term that warrants explanation.

I did not notice any inconsistencies in my review.

The modules are broken down into smaller sections in a way that would make it easy to assign.

Organization/Structure/Flow rating: 3

I did not always feel that the topics were presented in the most effective order to reduce confusion. For example, the prevalence rate for serious mental illnesses was presented before a description of what a serious mental illness is. Another example is presenting information about using psychotropic medications as treatment for specific disorders prior to discussing those disorders.

I used the pdf in my review, which had no major issues. Sometimes the pages broke at places that were not ideal, but I did not see that as a major problem.

The text was well-written for the audience. I notice one grammar error.

I did not observe culturally offensive language. The authors discussed multicultural issues, but more should be added to address the many cultural issues related to the diagnosis and treatment.

In module 1, I was excited to see there was a section on deinstitutionalization, then quickly disappointed that it was a mere three sentences that glossed over the phenomenon nearly entirely.

Reviewed by Kris Owens, Assistant Professor, Grand View University on 10/14/21

As an introductory Abnormal Psychology textbook, it covers most of the main psychological disorders. It is comprehensive and accessible. Future enhancements could include sexual and gender identity disorders, research methodology, and expand on... read more

The concepts and supporting empirical evidence are accurate and not biased. Periodic updates will be needed to stay current. The second edition, August 2020 includes updated references.

The textbook is relevant and it incorporates current research. It should remain relevant until the DSM 5 is revised. The content and links can be easily updated, when necessary.

The design of the textbook and the navigation is accessible and clear. The terms throughout the modules in addition to the glossary and “key takeaways” are features that students should appreciate. The simplicity and clarity of the content is appropriate for an introductory textbook.

The psychological disorders (content related to the etiology, symptoms, and treatment) are presented consistently throughout each block or module. There is uniformity in each section.

The sections are modular. I really appreciated that variety of formats (Pressbook XML, PDF, and online e-book). The navigation is easy to use and it should be accessible for all learners.

The textbook provides a comprehensive overview of the main psychological disorders with a really good structural framework. The chapter organization and uniformity are excellent. The “back matter,” which includes the glossary, references, and index is positioned in a logical order with accessible links.

The interface and navigation are excellent. The infographics are clearly displayed and easy to read online.

It was well-written. No concerns or errors noted.

The book content is culturally appropriate when addressing the complexity and heterogenous nature of psychological disorders. The cultural relevance may vary based on a variety of factors and social environments. The addition of sexual and gender identity disorders would enhance the cultural relevance.

For an introductory textbook, it is very good. Incorporating content related to sexual and gender identity disorders, research methodology, and expand ethical issues would enhance student learning. Several of these topics could serve as discussion prompts to facilitate a more in-depth understanding of cultural differences.

Reviewed by Jason Li, Associate Professor, Wichita State University on 10/5/21

This textbook is quite comprehensive as an overall introduction to Abnormal Psychology. The content of each chapter unfolds each main objective and provides clear explanations with examples and figures. I recommend this book to students in counseling, psychology, and social work or anyone who is in the mental health field. The information is clear and easy to understand.

The content is accurate and unbiased

The content is relevant and straightforward with supporting photographs and links that can be updated.

In my view, its easy to follow each section and build connection between chapters. The language was appropriate for the context.

The framework for each section is consistent. I believe that students will enjoy this easy to follow layout and framework.

The textbook is broken down into logical and manageable sections that could be divided for instructors and students. The subheadings are very helpful in navigating readers to the objective of each section.

The book chapters are presented in a logical, clear fashion. Well organized by chapters and headings.

The interface is issue free and easy to read on a screen. The photo and tables are clearly displayed.

Well-written, with not noticeable grammatical errors.

Its imperative that we teach and address mental disorders across dimensions of race and ethnicity, countries of origin, home languages, socioeconomic status, and religious beliefs. I think that bringing in cultural implications may add to the well-roundness of this textbook.

I would use this textbook in a couple of my classes. However, I did not find references to refer to in-text citations.

Reviewed by Erin Palmwood, Assistant Professor, University of Mary Washington on 6/25/21

This text covers all key groups of psychological disorders that one might want to discuss in an Abnormal Psychology course. It provides an appropriate overview of key components within each subject area and does not "cast too wide a net" - it focuses appropriately on the most up-to-date, empirically-supported information about the etiology, symptoms, and treatment of each disorder. Additionally, the text is appropriately concise, providing key information in a way that is both comprehensive and accessible. Regarding content areas, I would have liked to see a Research Methods chapter and perhaps a designated chapter on Ethical Issues (which is currently a small section of the Contemporary Issues chapter).

The text provides accurate, up-to-date, scientifically sound information regarding the etiology, symptoms, and treatment of each psychological disorder. However, it is missing a significant number of citations for the information provided - which is a problem in terms of (1) assessing the credibility of the claims made in the text and (2) teaching students the importance of citing their work.

The text is up-to-date with current research, and it is also organized in such a way that future updates to our understanding of the etiology and treatment of different psychological disorders should be relatively easy to add to the book.

The clarity of the text is one of its major strengths. It is written in a way that is accessible and concise, and key concepts are presented in a very digestible manner. While many textbooks might take two paragraphs to explain a concept, this textbook achieves an appropriate level of detail in a few sentences - which will likely enhance student engagement with the text.

The book achieves appropriate consistently in style and approach to content.

The text has several headers and sub-headers that are logical and consistent across chapters, as well as "key takeaways" at the end of each section. An instructor could easily break down a chapter into smaller assignments for students without causing high levels of confusion.

The chapters within this textbook are exceedingly well-organized. Across chapters, content is presented in a predictable way that is outlined at the start of the chapter, and key takeaways are presented between each section to facilitate learning consolidation. However, some of the "blocks" which organize the chapters within the textbook are structured in an unclear manner, which makes it difficult to anticipate where certain chapters might be located.

No interface concerns noted.

No grammatical concerns noted.

I did not observe any culturally insensitive language in my review of the text. However, the text's coverage of cultural factors in the etiology, presentation, and treatment of psychological disorders is exceedingly limited, and I would have liked to see increased attention to the role of culture and identity throughout the book.

The information provided in the PTSD section would benefit from increased focus on current empirically-supported treatments. Of the four psychotherapeutic treatments discussed, one is critical incident stress debriefing (CISD), which has been shown to have iatrogenic effects, and one is eye movement desensitization and reprocessing therapy (EMDR), which is controversial at best. While the text does discuss exposure therapy and CBT, it is missing explicit discussions of empirically-supported treatments like CPT and PE.

Reviewed by Janessa Carvalho, Associate Professor, Bridgewater State University on 6/23/21

Bridley's text covers most of the traditional components covered in Abnormal Psychology textbooks, though I was disappointed to see the absence of neurodevelopmental disorders and sexual/gender disorders covered. Historically, students really enjoy learning about neurodevelopmental disorders and sexual/gender disorders chapter offers a nice opportunity to teach sociocultural factors in clinical psychology.

I thought the book overall made very accurate statements, with the exception that some information in the Current Trends section (Module 1) could stand to be updated.

The authors for the most part cover all relevant content in the field.

The book was written in a clear format with good readability for undergraduate level.

I found overall consistency among presentation of disorders and content within each learning module. Though there was some redundancy (classification covered in module 1 and 3).

I found the various sections and content to be relatively will encapsulated and students would be able to review content in small chunks, if thats of their choosing, without disrupting flow of learning. However, I prefer a bit more scaffolding where the content builds up to other information.

Organization and structure were quite aligned with other Abnormal Psychology textbooks I've reviewed and used.

The web format used for this textbook worked just fine for me and figures and tables were viewable without any issue.

No grammatical issues found on my end.

Would like to see more on cultural factors in various areas, including chapter 1 (societies), and the sociocultural model covered in module 2. Again, as I mentioned, the absence of a chapter on sexual/gender disorders takes away an opportunity to discuss more sociocultural factors. This seemed to be an area that the authors could focus on in a revision.

Overall an interesting book, very similar to other (costly) Abnormal psychology textbooks, and a good option for students. However, I was put off in module 2 where WebMD was cited as a source; this was disconcerting as I always encourage my students to use primary sources in their work. This was very offputting to me.

Reviewed by Angela Duncan, Lecturer, Washburn University Institute of Technology on 6/9/21

For many instructors' purposes, this abnormal psychology text will suffice or maybe exceed expectations given its depth regarding introductory material (i.e biopsychosocial model and models of abnormality). It offers an excellent introduction to abnormal psychology without being cumbersome for the student. However, it is not an ideal option if you are wanting to cover childhood, sexual and gender identity disorders or health psychology-related topics such as sleep disorders as these topics are not included.

Overall, the information is consistent with other abnormal psychology textbooks and the scientific literature.

Relevance/Longevity rating: 3

On page 90, the authors discuss the upcoming release of ICD-11 in 2018. This statement should be updated. I would also like to see updated statistics on the prevalence of mental disorders in the “current views/trends” section (pages 31-32) as the most recent citation is dated 2014. In addition, the information about who seeks treatment could use an update as the newest citation is 2013 (page 91). I would also recommend updated empirical citations reflecting the latest research in the field. However, all texts fall prey to the challenge of staying relevant in some respects so this text is not an anomaly in that regard.

Descriptions of symptoms and diagnostic criteria are very clear and presented in simple language. Language overall is easy to understand.

The text's terminology and framework seems internally consistent.

The text is divided into six sections that can easily be reordered as desired, and the chapters make sense as arranged in each module. I appreciate the merging of somatic symptom disorders with anxiety and OCD.

At the end of each section, the authors include helpful “key takeaways” to summarize what was addressed, and “review questions” to assess comprehension. Additionally, they include a “module recap” summarizing key points from the entire module.

Images/charts are minimal, but those that are present are helpful and easy to see and interpret. The only image that may pose a clarity issue for some is figure 2.5 illustrating Pavlov’s classical experiment.

The text is well-written, without grammatical errors.

The authors provide an important section on stigma and its relevance to mental disorders as well as a section on multicultural psychology.

This is the only open access abnormal psychology text that I am aware of, and I commend the authors for a valuable first edition that is easy to read and offers an effective introduction to abnormal psychology. My criticism of this text is minor compared to the accolades. I would highly recommend this text for instructors looking for an abnormal psychology text without the excessive detail but instead concise information palatable to most students.

Reviewed by Ruth Anthony, Faculty, Portland Community College on 6/7/21

The content was appropriate and covered a wide range of disorders that are either interesting and/or common in the practicing field. I am also a clinician and found the particular disorders to be the most prevalent while working in community... read more

Overall, it appeared to be accurate and error-free. Unbiased, is difficult to measure as this text still pertains to the medical model which is a dominant culture lens and perspective.

It is relevant to today's standards. It will need to undergo revision as the DSM-5 is updated. It does lack a bit in cultural relevance (see culture review below). As someone who practices as a clinician, it has some nice definitions/summaries in the disorders section. However, it lacks some in application for someone who is unfamiliar with these disorders and how they manifest. Incorporating examples of what this might look like in real life scenarios or as a presenting concern would be helpful for students. It doesn't have to be in this book, it could be something that the educator adds to further enrich students' understanding.

The text is straightforward, however, a bit dry as most textbooks are. I would recommended this textbook/abnormal phycology class to students who have already completed basic psych courses to have a bit of framework prior to increase their familiarity with the jargon. However, the terminology is well organized with definition for reference.

The entire text stayed consistent in flow, voice, and framework. The tone is similar to that of many textbooks in the field when provided information or definition. The example case studies are nice break and provide a nice reference to work with throughout.

Modularity rating: 4

The modules were outlined clearly in the table of contents and could easily be broken up into sections for class assignments. Some images to break up each module at the beginning would be nice for some added aesthetics and flare. The interface (see below) could have been a bit better though.

I was most impressed by the organization as it was clear and straight-forward. It is formatted exactly how I would which is a more technical writing style. This however makes me a bit bias due to the personal preference in organization.

The text could have been organized a bit better. The section breakage for a more aesthetically appealing read was not there. It was reminiscent of strict APA or MLA guidelines in the breakage of section. It felt a big awkward with a title heading being at the end of a page and the accompanying content being on the next page.

I did not notice any grammatical errors while reading. At least any that stood out enough to make the read difficult or awkward in flow.

I would have liked to have seen a more in-depth look into cultural difference in applying these disorders. There was brief recognition and consideration, however, at the minimum that I see in most Western texts. There are references to build cultural understanding and humility as part of the standard in practice; a good list of sources would be beneficial. I would use this resource along with several other resources with a more in-depth cultural lens.

Reviewed by Ann Tamulinas, Adjunct Professor, Massachusetts Bay Community College on 5/24/21

It covers most topics and more than adequate background as well. I like that it includes at the end of each section specific takeaways. read more

It covers most topics and more than adequate background as well. I like that it includes at the end of each section specific takeaways.

Topics appear to be accurate and references abundant.

Content is very relevant and includes biological information that is accurate and up to date and not prone to become obsolute.

Clear language, but a bit dull. Authors managed to make a fascinating subjects not so!

Text is extremely structured with precise sections and clear language and many definitions.

Text is divided into many sections and vocabulary defined and grouped in each section.

Again the text is extremely organized from beginning to end. The numbering of the sections is very precise.

Sometimes the text is cut off on the bottom of lines. The look and feel is not appealing--does not grab. More visuals needed and perhaps a better font.

The entire book is well written, but gain not in an interesting style. Too clinical.

The text is quite neutral in cultural bias. I didn't see any race, ethnicity inclusiveness of any kind.

I usually teach Computers and Technology and was unable to find a suitable text. I have taught abnormal psychology in the past so I chose this text. I had an excellent textbook (I can't remember the title, though) which was easy to follow as well as informative and interesting to read. While this one is well organized and well written, I would not recommend this text to use other than a reference.

Reviewed by Xin Zhao, Assistant Professor, Salt Lake Community College on 2/24/21

Excellent content offering, comparable to traditional publisher's. The chapters are narrative driven in the beginning. With updated 2nd edition, excellent glossary, references, index, and adequate content. read more

The content is very up to date and accurate, which I compared chapter by chapter during lecture with the DSM-V. Also did a good job noting significant changes from DSM-V-TR and in comparisons with ICD-11.

The authors did a good job incorporating culturally appropriate updates and timely changes, however, the information in this domain is a little bit thin. I find it helpful to incorporate some more updated changes in the field and current events to supplement the text.

The written text is excellent. Very easy to read and engaging for the reader, even without technical background. Very appropriately done, especially for psychology students who most likely have been exposed to some of these content in lower level psychology classes. Language and terminology are up to the latest standard.

Terminology and framework consistent throughout the textbook and in line with DSM-V standards.

The updated 2nd edition improved on the organization of modules, making the different disorder information easily accessible according to appropriate diagnostic areas.

Perhaps one of the significant strength of this textbook is the organization. Very easy to find relevant disorder and learn about them from a student perspective. With the updated version, it follows closely with how DSM-V is organizing the diagnoses.

Both the Pressbook and pdf versions are clear and displayed correctly.

No grammatical errors detected.

The textbook made attempts to introduce cultural factors in each respective chapters. However, I would like to see later versions build upon this interest and facilitate more in depth discussions about multiculturalism.

The ancillary material offered were excellent, including visual-based powerpoint slides, and learning objective based test banks. Highly recommend reaching out to authors to supplement teaching.

Reviewed by Angela Mar, Lecturer, University of Texas Rio Grande Valley on 11/13/20

The textbook does an adequate job of covering the essential topics of the field, and additionally provides a glossary and index that would help a reader find key concepts quickly and efficiently. read more

The textbook does an adequate job of covering the essential topics of the field, and additionally provides a glossary and index that would help a reader find key concepts quickly and efficiently.

To the extent of this review, the text is accurate and error-free. The textbook states facts, so bias should not be an issue.

The topic of abnormal psychology is going to be one that is studied for generations to come. Although, the diagnostic manual (DSM) is already in its 5th edition and was created in a way to allow for evolve with times and society, so this textbook will need to be updated to adhere to the newest diagnostic guidelines.

Students who take an abnormal psychology course are usually in their fourth year, almost ready to graduate. Given this, the textbook's clarity should be on par with that of the students' level.

The terminology is consisten throughout the text and is in line with the DSM diagnostic guidelines.

I like who the textbook is divided into diagnostic blocks to help the student become familiar with diagnostic guidelines.

I like how the book reads like the DSM diagnostic manual. The same class of disorders are paired together to better understand the disorders and the similarities between them, which is helpful because of the incidence of comorbidity.

No problems while reviewing.

No grammatical errors were encountered during the review of this textbook.

The textbook does a fair job of including cultural awareness and sensitivity into the relaying of demographic information about the incidence of each disorder.

Reviewed by Mary Ann Woodman, Adjunct Professor, Rogue Community College on 8/10/20

Bridley and Daffin provide one of the most comprehensive treatments of mental health and illness offered in an open textbook. The authors cover nearly every subject and learning objective required for a college introductory course on Abnormal Psychology. They begin with a story to capture the reader’s interest and lay out the intention and format so that it is uncomplicated and clearly understood. The writing style appears easy to read, full of useful, insightful information. There is a significant glossary, list references and an index at the end.

The content of the text seems quite accurate and up to date. The authors present subject matter in an unbiased and objective manner. The subject matter as well as the notes on changes in the Diagnostic Statistical Manual and International Classification of Diseases are devoid of errors.

The content seems current and relevant especially to college students who are preparing to work in human services careers. The authors interface statistics, modern research articles and web sites to support the concepts. The text is arranged in a way that new additions could be easily added in the future. The book could use more stories, narratives and visuals supporting the content especially case studies which students may encounter in their lives. Examples of how to apply what one learns to real life would greatly enrich the textbook and easy to coalesce.

The text is written in lucid, intelligible, easy to read prose. Brief introductions and summaries are offered throughout the book which enhances clarity. No part of the written material seems confusing to the reader. The language and terminology are standard in terms of the learning objectives and information. It may need to be made accessible to students with learning disabilities and thus easily utilized in online course platforms such as Blackboard.

The text is internally consistent in terms of terminology and framework. The authors might consider spelling out terms in headings such as BDD, BED and FBT. However, the format is totally consistent throughout the entire book.

The outline of the book is most impressive. The text is readily divisible with reading sections and sub- headings that are precise and uncomplicated. There are no areas with large blocks of text that require further subdivision. The learning objectives are implemented with ease and flow. Having the learning objectives explained is an advantage for college curriculum purposes. There are no sections with an overload of written material nor is there overly self-referential material in the book.

The written material is presented in a logical, explicit and clear fashion. The six modules are laid out with titles and each module subdivided into sections. The authors begin “setting the stage” by introducing the notion of what it means to be normal and move into definitions of abnormality citing the traditional criteria: dysfunction, distress, defiance and danger. They integrate positive psychology with abnormal psychology, so the reader has a broader vision of the field. The history of mental illness, various theories and brief descriptions of the major research methods establish a foundation for the study. Concepts are backed up with research and website references. Clinical assessment, diagnosis and treatment contains just the right amount of information. The remainder of the modules treat most of the psychiatric disorders listed in the Diagnostic Statistical Manual, with a concise introduction and focus on clinical presentation, epidemiology, comorbidity, etiology, and treatment options. The authors refer the students back to modules 1-3 for reminders of theory and causality. The book includes some information on psychopathology, law, ethics and leaves the reader wondering if gaming is an addiction. It is missing sexual and sleep disorders. Finally, each module is recapped at its close.

The visuals interfaced in the text regarding the nervous system and classical conditioning support the written material. There does not seem to be any distortions, navigation problems or display features that confuse or distract the reader. The remainder of the book contains very few graphs, tables or visuals which would be very useful learning tools to add in the future.

The text contains no grammatical or spelling errors.

The authors state that “culture-sensitive therapies have been developed increasing awareness of cultural values, hardships, stressors, and/or prejudices, the identification of suppressed anger and pain; and raising the client’s self-worth.” Here is one example: “Individuals from non-Western countries (China and other Asian countries) often focus on the physical symptoms of depression- tiredness, weakness, sleep issues, and less of an emphasis on the cognitive symptoms. Individuals from Latino and Mediterranean cultures often experience problems with “nerves” and headaches as primary symptoms of depression (American Psychiatric Association, 2013). Multi-cultural psychology appears somewhat integrated into the text material. Naturally, more examples inclusive of race and ethnicity could be employed in the future including Native American and other indigenous cultures.

The book includes common treatments used for mental illness: CBT, IPT, Modeling, Biofeedback, Rational-Emotive Therapy, EMDR, Exposure and Desensitization, Hypnosis, Relaxation Training, Aversion Therapy, Emotional Regulation and others. It would be helpful to expand treatment options to include Naturopathy (homeopathy, acupuncture, herbal medicine etc), Orthomolecular Medicine (Nutritional Therapy, and Energy Psychology such as EFT (Emotional Freedom Technique, Reiki, Neuro-linguistic Programming, and Group Therapy Workbooks, such as Anger and Stress Management, Drug and Alcohol Programs or SAMHSA Trauma Informed Care Manual that lists numerous programs for Post Traumatic Stress for example. The authors could provide at least one study on the benefits of spiritual practices such as prayer, ritual, mindfulness, music, tribal dance, yoga etc. The significance of spirituality and religious practices is overlooked. A more comprehensive list of various treatments could be included as an appendix.

In the section on the history of mental illness, there could be a comment on the fact that former methods of treatment are still employed today and have been improvised to meet the challenges of modernity. ECT, still used in psychiatric hospitals and exorcism/deliverance therapy employed in various religious traditions are merely two examples.

Another option would be to place pharmacology at the end of the treatment list instead of the first, primary one in the sections of each module. Then comment about how prescription drugs have side-affects and are sometimes abused by the recipient.

A graph of specific phobias, list of common “stressors” with reference to various stress inventories, and examples of adjustment disorders related to college students would enrich the text . The section on suicide could be expanded further as well as additional treatments and current programs for neurocognitive disorders.

Overall, Bridley and Daffin have accomplished a major task in edition one. It would be a welcomed text for a college course in Abnormal Psychology.

Part I. Setting the Stage

Module 1: What is Abnormal Psychology?
Module 2: Models of Abnormal Psychology
Module 3: Clinical Assessment, Diagnosis, and Treatment

Part II. Mental Disorders - Block 1

Module 4: Mood Disorders
Module 5: Trauma- and Stressor-Related Disorders
Module 6: Dissociative Disorders

Part III. Mental Disorders - Block 2

Module 7: Anxiety Disorders
Module 8: Somatic Symptom and Related Disorders
Module 9: Obsessive-Compulsive and Related Disorders

Part IV. Mental Disorders - Block 3

Module 10: Feeding and Eating Disorders
Module 11: Substance-Related and Addictive Disorders

Part V. Mental Disorders - Block 4

Module 12: Schizophrenia Spectrum and Other Psychotic Disorders
Module 13: Personality Disorders

Part VI. Mental Disorders - Block 5

Module 14: Neurocognitive Disorders
Module 15: Contemporary Issues in Psychopathology

Ancillary Material

Ancillary materials are available by contacting the author or publisher .

About the Book

Fundamentals of Psychological Disorders (formerly Abnormal Psychology) is an Open Education Resource written by Alexis Bridley, Ph.D. and Lee W. Daffin Jr., Ph.D. through Washington State University. The book tackles the difficult topic of mental disorders in 15 modules and is updated through the DSM-5-TR. This journey starts by discussing what abnormal behavior is by attempting to understand what normal behavior is. Models of abnormal psychology and clinical assessment, diagnosis, and treatment are then discussed. With these three modules completed, the authors next explore several classes of mental disorders in 5 blocks. Block 1 covers mood, trauma and stressor related, and dissociative disorders. Block 2 covers anxiety, somatic symptom, and obsessive-compulsive disorders. Block 3 covers eating and substance-related and addictive disorders. Block 4 tackles schizophrenia spectrum and personality disorders. Finally, Block 5 investigates neurocognitive disorders and then ends with a discussion of contemporary issues in psychopathology. Disorders are covered by discussing their clinical presentation and DSM Criteria, epidemiology, comorbidity, etiology, and treatment options.

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Module 2: Research and Ethics in Abnormal Psychology

Introduction to research, what you’ll learn to do: examine how descriptive, correlational, and experimental research is used to study abnormal behavior.

Three researchers review data while talking around a microscope.

As you learned in the previous module, the scientific approach led to major advances in understanding abnormal behavior and treating mental disorders. The essence of the scientific method is objectivity. It expresses the idea that the claims, methods, and results of science are not, or should not be, influenced by particular perspectives, value commitments, community bias, or personal interests, to name a few relevant factors. In addition, researchers must always be open to alternative explanations that could account for their findings. Many researchers have a personal interest in what they are studying and they become involved in the pursuit of knowledge in areas that relate to experiences in their own lives, particularly in the field of abnormal psychology. Clinical psychologists may wonder whether a particular kind of experience led to an individual’s symptoms, whether a certain treatment will be effective to treat the symptoms of a disorder, or they may speculate about the role of genetic predispositions. In either case, when conducting research, however, t hey do not let their personal biases get in the way of collecting the data or interpreting the findings. T he ideal approach to answering these questions involves a progression through a set of steps in which psychological researchers propose a hypothesis, conduct a study, and collect and analyze the data.

In this section, we will take a closer look at how to examine research and the main types of studies used: descriptive, experimental, and correlational. Descriptive, or qualitative, methods include the case study, naturalistic observation, surveys, epidemiological research, archival research, longitudinal research, and cross-sectional research.

When scientists passively observe and measure phenomena, it is called correlational research. Here, psychologists do not intervene and change behavior as they do in experiments. In correlational research, they identify patterns of relationships, but usually cannot infer what causes what. Importantly, with correlational research, you can examine only two variables at a time, no more and no less.

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Abnormal Psychology

There are several key questions for students to answer as they work toward mastering the content of abnormal psychology. How do psychologists define and diagnose something as being abnormal? Who are key historical figures, and how have views of mental health and illness changed over the years? How do psychologists use science to better assess and understand mental disorders? What are the primary theoretical perspectives and treatment options? We explore these questions in the following sections.

What is Abnormal Psychology? Definitions of Abnormal

Defining what is abnormal depends on how one first defines what is normal. This may sound simple and obvious, but it is not always so easy to remember that these are dynamic and relative terms. What people consider normal behavior depends on the time, place, and those involved. For example, most people believe that physical aggression against another person is generally unacceptable, but certain forms of aggression under certain circumstances (e.g., a great hit in a football game) may in fact be encouraged and celebrated. Psychologists therefore face a unique challenge when trying to define abnormality, because normality is a complex moving target directly influenced by evolving social values.

Synonyms for the word abnormal include the following: deviant, unusual, distressing, dysfunctional, and maladaptive (among others). These synonyms can help describe key features or dimensions that psychologists and other professionals may use to help identify abnormality. Each dimension represents a unique perspective and offers specific advantages when trying to describe and define normal vs. abnormal. However, each perspective also has specific limitations, and attempting to use any one of them in isolation as the sole determinant of what is abnormal leaves you with an incomplete and oversimplified view of abnormal behavior.

Perhaps the simplest definition of what is abnormal involves deviation from what a group considers correct or acceptable. Each group develops a set of rules and expectations, or norms, for behavior under a variety of circumstances. A norm may be explicit (e.g., written laws) or implicit, but group membership and acceptance is largely determined by adherence to the norm. Deviation from the norm is often discouraged because it threatens group integrity and cohesion, and repeated norm violations may result in negative consequences for the deviant individual. Obviously, groups can vary in size and construction (e.g., your immediate family versus all people in the United States in your age group), and the degree of influence their norms have on your own behavior will depend in part on how much you value being a member of that group and how influential your own behavior is within the group (i.e., it is a feedback loop—your behavior is influenced by the norm while also helping to define the norm). The advantage of this approach is that it necessarily includes norms that are current and relevant to the group in question. The obvious limitation of this viewpoint is that any behavior that is new or different and runs counter to a group’s preexisting norms will be labeled and treated as deviant, a term that carries a strong negative connotation. The negative connotation and resulting stigmatization associated with being labeled deviant may in fact be one of the potential consequences designed to prevent a person from drifting too far away from the values and beliefs of the group. This may sound very stifling and overly rigid to some people. In Western cultures, such as the United States in particular, maintaining balance between group affiliation and individual identity is important because of the value Americans place on individualism and freedom of choice. Another important limitation is the consideration that even the most pervasive norms are not stable or static; what is generally acceptable today (e.g., hairstyles, fashions, tattoos, and body piercing) may be laughably deviant in the future.

If psychologists define what is normal by quantifying what is average or typical of a group, then abnormal is anything unusual, or that which lies outside an accepted range. Psychologists often use a cutoff of two standard deviations above or below the mean to define something as being highly unusual or rare (i.e., statistically significant), as this represents the extreme scores (upper and lower 2.5 percent approximately) of a normal frequency distribution. By comparing an individual’s score to the average score of an entire sample, psychologists can make probabilistic statements about the likelihood of obtaining a specific score randomly or by chance alone, versus obtaining that same score because the individual most likely is truly and statistically different from the sample. This approach has the advantage of being quantified and more objective than other perspectives, and thus applicable in the use of statistical procedures and scientific interpretations of data. However, this approach has the disadvantage of labeling anything that is statistically extreme as abnormal, even if it is a desirable trait (e.g., a very high IQ). Additionally, any cutoff used is an arbitrary one that may be influenced by sample size or the shape of the frequency distribution, and there is lots of gray area between what is easily defined as average and what is obviously atypical in the statistical sense. This issue is made even more apparent when one considers the relative lack of precision and measurement error that psychologists often have to take into account when trying to assess traits and behaviors that may be considered indicators of mental disorder.

If psychologists use measures of daily functioning (occupational success, academic performance, social/ interpersonal interaction, aspects of self-care, etc.) to define what is normal, then they would define as abnormal or dysfunctional anything that prevents maximal or ideal functioning. This approach has the advantage of using behaviors that are typically observable and measurable (e.g., salary, GPA, number of close friends, cholesterol levels, etc.), and is flexible enough to account for different developmental stages and individual differences. This flexibility, however, is also the primary disadvantage of this perspective because maximal functioning is a concept that depends on numerous other factors: age, cultural expectations, personal values, and so on. Getting an average grade on an important exam may be perfectly acceptable to a struggling student simply trying to pass a course, yet thoroughly unacceptable to another student on academic scholarship who wants to pursue a graduate degree. The issue then becomes one of deciding which expert determines what ideal functioning looks like for any given person. This is not impossible to do, but it does require sound clinical judgment combined with a high level of skill and experience to gather and assess relevant data.

Because normality differs from person to person, it might be necessary to use a perspective that pays very close attention to individual levels of distress. Assessing personal distress or unhappiness as a means of defining what is abnormal includes measuring the frequency, intensity, and duration of symptoms that are cognitive, emotional, physical, or some combination of the three. Whereas using dysfunction includes elements of interpersonal functioning as already mentioned, using distress could be thought of as a way of determining intrapersonal functioning. Individual levels of pain, anxiety, anguish, and so forth are important indicators of abnormality regardless of social norms, statistical rarity, or daily functioning. Self-reports of the severity, origin, and meaning of symptoms are an important source of information, and can be a powerful component of a therapeutic relationship. In fact, the goal of therapy may often include work on defining what being happy means and helping a person find ways to move closer to that ideal state. Relying on personal distress as the defining feature of abnormality obviously assumes that personal distress exists in the first place, an assumption that may very well be fallacious, particularly in cases of acute psychosis or severe personality disorders. Additionally, people are often motivated toward productive goals by their anxieties and insecurities, thus one could question if an equal but opposite state of perfect happiness exists, and whether it is even possible or beneficial to eliminate all sources of personal distress. This may be an important philosophical or existential issue, but in reality it represents an artificial and oversimplified dichotomy. When levels of distress paralyze, debilitate, and otherwise prevent individuals from feeling like themselves on a daily basis, even modest relief can be a welcome change of pace and a more achievable goal, thus rendering the issue of achieving total happiness and eliminating all sources of stress a moot point.

Finally, if the synonym “maladaptive” is used as the primary reference point, then anything that causes harm or increases the risk of harm to self or others serves as an indicator of abnormality. Physical injuries, suicide attempts, substance abuse, indiscriminant sexual behavior, and extreme sensation seeking could all be easily seen as maladaptive behaviors, because they all represent a high level of severity and risk. The problem is that even though this elevated level of harm and risk is easy to spot when it occurs, it does not occur in every case of what professionals consider abnormal, and in fact may be the least prevalent of all indicators of abnormality (Comer, 2001). This obviously limits the utility of this criterion to define what is and is not normal.

It should be apparent by now that, as stated previously, no single element can be used in isolation to achieve a definition of abnormality that is sufficient. By combining several of these factors into a working definition of abnormality, psychologists can take advantage of the strengths of each perspective while avoiding or minimizing the inherent individual disadvantages. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000), specifically incorporates several of these dimensions into each set of diagnostic criteria for various disorders and syndromes. However, even this approach is relative and dynamic, and will always depend on the culture and timing surrounding what is defined as normal.

Just as there are multiple dimensions used to define what is abnormal, there are multiple theoretical models in use today to help describe and predict abnormal behavior as well as dictate treatment methods and techniques. In order to fully understand these models and put them in proper perspective, a brief review of the history of abnormal psychology is in order.

How Psychologists Define and Study Abnormal Psychology

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Microgen Images/Science Photo Library / Getty Images

What Is Abnormal Psychology?

Defining abnormality.

Abnormal psychology is a branch of psychology that deals with psychopathology and abnormal behavior, or the patterns of emotion, thought, and behavior that can be signs of a mental health condition. The term covers a broad range of disorders, from depression to obsessive-compulsive disorder (OCD) to personality disorders.

The term "abnormal" is the subject of considerable debate. What exactly is "normal" and who gets to decide? The social norms that are often used to determine what is normal versus abnormal can shift over time, so settling on a standard definition isn't simple or straightforward.

Counselors, psychologists, and psychotherapists often work directly in this field, often in a clinical context. Rather than the distinction between normal and abnormal, psychologists in this field focus on the level of distress that behaviors, thoughts, or emotions might cause.

This article discusses what abnormal psychology is and the different topics studied by this area of psychology. It also covers how abnormality is defined and some of the criticisms of abnormal psychology.

If a behavior is creating problems in a person's life or is disruptive to other people, then this would be an "abnormal" behavior. In such cases, the behavior may require some type of mental health intervention.

According to the National Institute of Mental Health (NIMH), nearly one in five U.S. adults live with a mental illness.

The following characteristics are usually included:

Abnormal behavior occurs infrequently . However, statistical infrequency alone is not a sufficient definition. Some healthy, desirable, and beneficial behaviors also occur infrequently. And other uncommon behaviors or characteristics have no bearing on how a person behaves or functions. So just because something is unusual or uncommon does not mean it should be defined as abnormal.
Abnormal behavior creates distress . These behaviors may disturb the individual, or they may be upsetting and disruptive to others.
Abnormal behavior affects a person's ability to function . People who are displaying these behaviors may struggle to function normally in their daily life, which can affect their relationships, work, school, and home life.
Abnormal behavior is socially disruptive . It may violate social norms and make it difficult for people to function in social settings and maintain social relationships.

Abnormal psychology doesn't just address behaviors that are considered statistically infrequent. Instead, it focuses on behaviors that create distress, make it difficult to function, and that may be socially disruptive.

What Are the Four Approaches to Abnormal Psychology?

There are a number of different perspectives used in abnormal psychology. While some psychologists or psychiatrists may focus on a single viewpoint, many mental health professionals use elements from multiple areas in order to better understand and treat psychological disorders.

Psychoanalytic Approach

This perspective has its roots in the theories of Sigmund Freud. The psychoanalytic approach suggests that many abnormal behaviors stem from unconscious thoughts, desires, and memories.

While these feelings are outside of awareness, they are still believed to influence conscious actions.

Therapists who take this approach believe that by analyzing their memories, behaviors, thoughts, and even dreams , people can uncover and deal with some of the feelings that have been leading to maladaptive behaviors and distress.

Behavioral Approach

This approach to abnormal psychology focuses on observable behaviors. In behavioral therapy, the focus is on reinforcing positive behaviors and not reinforcing maladaptive behaviors.

The behavioral approach targets only the behavior itself, not the underlying causes. When dealing with abnormal behavior, a behavioral therapist might utilize strategies such as classical conditioning and operant conditioning to help eliminate unwanted behaviors and teach new behaviors.

Medical Approach

This approach to abnormal psychology focuses on the biological causes of mental illness, emphasizing understanding the underlying cause of disorders, which might include genetic inheritance, related physical illnesses, infections, and chemical imbalances. Medical treatments are often pharmacological in nature, although medication is often used in conjunction with some type of psychotherapy.

Cognitive Approach

The cognitive approach to abnormal psychology focuses on how internal thoughts, perceptions, and reasoning contribute to psychological disorders. Cognitive treatments typically focus on helping the individual change their thoughts or reactions.

Cognitive therapy might also be used in conjunction with behavioral methods in a technique known as cognitive behavioral therapy (CBT).

Psychologists often look at abnormal behaviors through a number of different perspectives including the psychoanalytic, behavioral, cognitive, and medical approaches. Such perspectives can influence how a condition is treated, but therapists also often draw on techniques from multiple approaches.

Topics in Abnormal Psychology

The main topics in abnormal psychology are the study, understanding, diagnosis, treatment, and prevention of psychological disorders. Psychological disorders are defined as patterns of behavioral or psychological symptoms that impact multiple areas of life. These conditions create distress for the person experiencing symptoms.

Mental health professionals use the " Diagnostic and Statistical Manual of Mental Disorders ," published by the American Psychiatric Association (APA), for a variety of purposes. The manual contains a listing of psychiatric disorders, diagnostic codes, information on the prevalence of each disorder, and diagnostic criteria. Some of the categories of psychological disorders include:

Anxiety disorders , such as social anxiety disorder, panic disorder, and generalized anxiety disorder
Mood disorders , such as depression and bipolar disorder
Neurodevelopmental disorders, such as intellectual disability or autism spectrum disorder
Neurocognitive disorders including delirium
Personality disorders , such as borderline personality disorder, avoidant personality disorder, and obsessive-compulsive personality disorder
Substance use disorders

Criticisms of Abnormal Psychology

The field of abnormal psychology is not without criticism. In addition to debates over the use of the term "abnormal" itself, some believe that this area has a number of shortcomings.

In particular, some feel that this area stigmatizes vulnerable and oppressed people. Critics also suggest that the field of abnormal psychology tends to pathologize normal variations in human behavior.

Some also propose that the medical approach to mental illness often focuses only on biological and genetic determinants of distress rather than taking a more holistic view . It also does not account for the fact that there are major cultural differences in what is deemed normal and abnormal.

Research has also found that learning more about abnormal psychology appears to do little to combat stigma regarding mental illness. One study found that teaching students about abnormal psychology did not reduce mental health stigma, improve attitudes toward mental illness, or increase help-seeking behaviors among students.

Abnormal psychology may focus on atypical behavior, but its focus is not to ensure that all people fit into a narrow definition of "normal." In most cases, it is centered on identifying and treating problems that may be causing distress or impairment in some aspect of an individual's life. By better understanding what is "abnormal," researchers and therapists can come up with new ways to help people live healthier and more fulfilling lives.

Frequently Asked Questions

Correlational research is often used to study abnormal psychology because experimental research would be unethical or impossible. Researchers cannot intentionally manipulate variables to see if doing so causes mental illness. While correlational research does not allow researchers to determine cause and effect, it does provide valuable information on relationships between variables.

Key concepts include that abnormality can be viewed through many different lenses and that mental disorders often have multiple causes, including genetics and experiences. Another is that culture has an influence on how we define abnormality, so what is considered abnormal in one culture is perfectly normal in another.

The study of abnormal behavior dates back to the time of the ancient Greeks. During the late 1800s and early 1900s, thinkers such as Sigmund Freud suggested that mental health conditions could be treated with methods including talk therapy.

The study of abnormal psychology has helped researchers and therapists better understand the causes of mental disorders and develop methods to effectively treat these conditions. By understanding the factors that affect mental health, psychologists can help people overcome impairment, relieve distress, and restore functioning.

National Institute of Mental Health. Mental illness .

Bargh JA, Morsella E. The unconscious mind . Perspect Psychol Sci . 2008;3(1):73-9. doi:10.1111/j.1745-6916.2008.00064.x

Walinga J. Behaviourist psychology . In: Stangor C, Walinga J, eds. Introduction to Psychology: 1st Canadian edition. BCcampus Open Education.

Cheng AW, McCloskey K, Matacin ML. Teaching personality and abnormal psychology with inclusivity . In: Mena JA, Quina K, eds. Integrating Multiculturalism and Intersectionality into the Psychology Curriculum: Strategies for Instructors . American Psychological Association; 2019:225-241. doi:10.1037/0000137-018

Miller RB. Not so Abnormal Psychology: A Pragmatic View of Mental Illness . American Psychological Association; 2015. doi:10.1037/14693-000

Kendra MS, Cattaneo LB, Mohr JJ. Teaching abnormal psychology to improve attitudes toward mental illness and help-seeking . Teaching Psychol . 2012;39(1):57-61. doi:10.1177/0098628311430315

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Research on Child and Adolescent Psychopathology

An official publication of the International Society for Research in Child and Adolescent Psychopathology

Previously known as the Journal of Abnormal Child Psychology (2022 2-year impact factor: 3.6).
The official journal of the International Society for Research in Child and Adolescent Psychopathology (ISRCAP).
Publishes studies with a strong theoretical framework and a diversity of methods, with an emphasis on empirical studies of the major forms of psychopathology found in childhood disorders.
Focuses on the epidemiology, etiology, assessment, treatment, prognosis, and developmental course of childhood and adolescent psychopathology.
Features research highlighting risk and protective factors, ecology, and correlates of children's emotional, social, and behavior problems.
Joshua Langberg

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Latest articles

Young children of mothers with a history of depression show attention bias to sad faces: an eye-tracking study.

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Paternal and Maternal Depressive Symptoms and Sensitivity: Links with Trajectories of Socioemotional Problems in Toddlerhood

Célia Matte-Gagné
Annie Bernier
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Respiratory Sinus Arrhythmia, Effortful Control, and Child Social Anxiety Symptoms

Elizabeth J. Kiel
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Executive Functions and Social-Emotional Problems in Toddlerhood: Nature, Persistence, and Direction of Associations

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Fluctuations in Maternal Depressive Symptoms, Anxiety, and Anger and Children’s Depression Risks in Middle Childhood

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Module 2: Models of Abnormal Psychology

3rd edition as of July 2023

Module Overview

In Module 2, we will discuss three models of abnormal behavior to include the biological, psychological, and sociocultural models. Each is unique in its own right and no single model can account for all aspects of abnormality. Hence, we advocate for a multi-dimensional and not a uni-dimensional model.

Module Outline

2.1. Uni- vs. Multi-Dimensional Models of Abnormality

2.2. the biological model, 2.3. psychological perspectives, 2.4. the sociocultural model.

Module Learning Outcomes

Differentiate uni- and multi-dimensional models of abnormality.
Describe how the biological model explains mental illness.
Describe how psychological perspectives explain mental illness.
Describe how the sociocultural model explains mental illness.

Section Learning Objectives

Define the uni-dimensional model.
Explain the need for a multi-dimensional model of abnormality.
Define model.
List and describe the models of abnormality.

2.1.1. Uni-Dimensional

To effectively treat a mental disorder, we must understand its cause. This could be a single factor such as a chemical imbalance in the brain, relationship with a parent, socioeconomic status (SES), a fearful event encountered during middle childhood, or the way in which the individual copes with life’s stressors. This single factor explanation is called a uni-dimensional model . The problem with this approach is that mental disorders are not typically caused by a solitary factor, but multiple causes. Admittedly, single factors do emerge during a person’s life, but as they arise, the factors become part of the individual. In time, the cause of the person’s psychopathology is due to all these individual factors.

2.1.2. Multi-Dimensional

So, it is better to subscribe to a multi-dimensional model that integrates multiple causes of psychopathology and affirms that each cause comes to affect other causes over time. Uni-dimensional models alone are too simplistic to explain the etiology of mental disorders fully.

Before introducing the current main models, it is crucial to understand what a model is. In a general sense, a model is defined as a representation or imitation of an object (dictionary.com). For mental health professionals, models help us to understand mental illness since diseases such as depression cannot be touched or experienced firsthand. To be considered distinct from other conditions, a mental illness must have its own set of symptoms. But as you will see, the individual does not have to present with the entire range of symptoms. For example, to be diagnosed with separation anxiety disorder, you must present with three of eight symptoms for criteria A whereas for a major depressive episode as part of Bipolar II disorder, you have to display five (or more) symptoms for criteria A. There will be some variability in terms of what symptoms are displayed, but in general, all people with a specific psychopathology have symptoms from that group.

We can also ask the patient probing questions, seek information from family members, examine medical records, and in time, organize and process all this information to better understand the person’s condition and potential causes. Models aid us with doing all of this. Still, we must remember that the model is a starting point for the researcher, and due to this, it determines what causes might be investigated at the exclusion of other causes. Often, proponents of a given model find themselves in disagreement with proponents of other models. All forget that there is no individual model that completely explains human behavior, or in this case, abnormal behavior, and so each model contributes in its own way. Here are the models we will examine in this module:

Biological – includes genetics, chemical imbalances in the brain, the functioning of the nervous system, etc.
Psychological – includes learning, personality, stress, cognition, self-efficacy, and early life experiences. We will examine several perspectives that make up the psychological model to include psychodynamic, behavioral, cognitive, and humanistic-existential.
Sociocultural – includes factors such as one’s gender, religious orientation, race, ethnicity, and culture.

Key Takeaways

You should have learned the following in this section:

The uni-dimensional model proposes a single factor as the cause of psychopathology while the multi-dimensional model integrates multiple causes of psychopathology and affirms that each cause comes to affect other causes over time.
There is no individual model that completely explains human behavior and so each model contributes in its own way.

Section 2.1 Review Questions

What is the problem with a uni-dimensional model of psychopathology?
Discuss the concept of a model and identify those important to understanding psychopathology.
Describe how communication in the nervous system occurs.
List the parts of the nervous system.
Describe the structure of the neuron and all key parts.
Outline how neural transmission occurs.
Identify and define important neurotransmitters.
List the major structures of the brain.
Clarify how specific areas of the brain are involved in mental illness.
Describe the role of genes in mental illness.
Describe the role of hormonal imbalances in mental illness.
Describe the role of bacterial and viral infections in mental illness.
Describe commonly used treatments for mental illness.
Evaluate the usefulness of the biological model.

Proponents of the biological model view mental illness as being a result of a malfunction in the body to include issues with brain anatomy or chemistry. As such, we will need to establish a foundation for how communication in the nervous system occurs, what the parts of the nervous system are, what a neuron is and its structure, how neural transmission occurs, and what the parts of the brain are. All while doing this, we will identify areas of concern for psychologists focused on the treatment of mental disorders.

2.2.1. Brain Structure and Chemistry

2.2.1.1. Communication in the nervous system. To truly understand brain structure and chemistry, it is a good idea to understand how communication occurs within the nervous system. See Figure 2.1 below. Simply:

Receptor cells in each of the five sensory systems detect energy.
This information is passed to the nervous system due to the process of transduction and through sensory or afferent neurons, which are part of the peripheral nervous system.
The information is received by brain structures (central nervous system) and perception occurs.
Once the information has been interpreted, commands are sent out, telling the body how to respond (Step E), also via the peripheral nervous system.

Figure 2.1. Communication in the Nervous System

Please note that we will not cover this process in full, but just the parts relevant to our topic of psychopathology.

2.2.1.2. The nervous system. The nervous system consists of two main parts – the central and peripheral nervous systems. The central nervous system (CNS) is the control center for the nervous system, which receives, processes, interprets, and stores incoming sensory information. It consists of the brain and spinal cord. The peripheral nervous system consists of everything outside the brain and spinal cord. It handles the CNS’s input and output and divides into the somatic and autonomic nervous systems. The somatic nervous system allows for voluntary movement by controlling the skeletal muscles and carries sensory information to the CNS. The autonomic nervous system regulates the functioning of blood vessels, glands, and internal organs such as the bladder, stomach, and heart. It consists of sympathetic and parasympathetic nervous systems. The sympathetic nervous system is involved when a person is intensely aroused. It provides the strength to fight back or to flee (fight-or-flight instinct). Eventually, the response brought about by the sympathetic nervous system must end. The parasympathetic nervous system calms the body.

Figure 2.2. The Structure of the Nervous System

2.2.1.3. The neuron. The fundamental unit of the nervous system is the neuron, or nerve cell (See Figure 2.3). It has several structures in common with all cells in the body. The nucleus is the control center of the neuron, and the soma is the cell body. In terms of distinctive structures, these focus on the ability of a neuron to send and receive information. The axon sends signals/information to neighboring neurons while the dendrites , which resemble little trees, receive information from neighboring neurons. Note the plural form of dendrite and the singular form of axon; there are many dendrites but only one axon. Also of importance to the neuron is the myelin sheath or the white, fatty covering which: 1) provides insulation so that signals from adjacent neurons do not affect one another and, 2) increases the speed at which signals are transmitted. The axon terminals are the end of the axon where the electrical impulse becomes a chemical message and passes to an adjacent neuron.

Though not neurons, glial cells play an important part in helping the nervous system to be the efficient machine that it is. Glial cells are support cells in the nervous system that serve five main functions:

They act as a glue and hold the neuron in place.
They form the myelin sheath.
They provide nourishment for the cell.
They remove waste products.
They protect the neuron from harmful substances.

Finally, nerves are a group of axons bundled together like wires in an electrical cable.

Figure 2.3. The Structure of the Neuron

2.2.1.4. Neural transmission. Transducers or receptor cells in the major organs of our five sensory systems – vision (the eyes), hearing (the ears), smell (the nose), touch (the skin), and taste (the tongue) – convert the physical energy that they detect or sense and send it to the brain via the neural impulse. How so? See Figure 2.4 below. We will cover this process in three parts.

Part 1. The Axon and Neural Impulse

The neural impulse proceeds across the following steps:

Step 1 – Neurons waiting to fire are said to be in resting potential and polarized , or having a negative charge inside the neuron and a positive charge outside.
Step 2 – If adequately stimulated, the neuron experiences an action potential and becomes depolarized . When this occurs, voltage-gated ion channels open, allowing positively charged sodium ions (Na+) to enter. This shifts the polarity to positive on the inside and negative outside. Note that ions are charged particles found both inside and outside the neuron.
Step 3 – Once the action potential passes from one segment of the axon to the next, the previous segment begins to repolarize . This occurs because the Na channels close and potassium (K) channels open. K+ has a positive charge, so the neuron becomes negative again on the inside and positive on the outside.
Step 4 – After the neuron fires, it will not fire again no matter how much stimulation it receives. This is called the absolute refractory period . Think of it as the neuron ABSOLUTELY will not fire, no matter what.
Step 5 – After a short time, the neuron can fire again, but needs greater than normal levels of stimulation to do so. This is called the relative refractory period .
Step 6 – Please note that this process is cyclical. We started at resting potential in Step 1 and end at resting potential in Step 6.

Part 2. The Action Potential

Let’s look at the electrical portion of the process in another way and add some detail.

Figure 2.4. The Action Potential

Recall that a neuron is usually at resting potential and polarized. The charge inside is -70mV at rest.
If it receives sufficient stimulation, causing the polarity inside the neuron to rise from -70 mV to -55mV ( threshold of excitation ), the neuron will fire or send an electrical impulse down the length of the axon (the action potential or depolarization). It should be noted that it either hits -55mV and fires, or it does not fire at all. This is the all-or-nothing principle . The threshold must be reached.
Once the electrical impulse has passed from one segment of the axon to the next, the neuron begins the process of resetting called repolarization.
During repolarization the neuron will not fire no matter how much stimulation it receives. This is called the absolute refractory period.
The neuron next moves into a relative refractory period, meaning it can fire but needs higher than normal levels of stimulation. Notice how the line has dropped below -70mV. Hence, to reach -55mV and fire, it will need more than the normal gain of +15mV (-70 to -55 mV).
And then we return to resting potential, as you saw in Figure 2.4

Part 3. The Synapse

The electrical portion of the neural impulse is just the start. The actual code passes from one neuron to another in a chemical form called a neurotransmitter . The point where this occurs is called the synapse . The synapse consists of three parts – the axon of the sending neuron, the space in between called the synaptic space , gap , or cleft , and the dendrite of the receiving neuron. Once the electrical impulse reaches the end of the axon, called the axon terminal , it stimulates synaptic vesicles or neurotransmitter sacs to release the neurotransmitter. Neurotransmitters will only bind to their specific receptor sites , much like a key will only fit into the lock it was designed for. You might say neurotransmitters are part of a lock-and-key system. What happens to the neurotransmitters that do not bind to a receptor site? They might go through reuptake , which is the process of the presynaptic neuron taking up excess neurotransmitters in the synaptic space for future use or enzymatic degradation when enzymes destroy excess neurotransmitters in the synaptic space.

2.2.1.5. Neurotransmitters. What exactly are some of the neurotransmitters which are so critical for neural transmission, and are essential to our discussion of psychopathology?

Dopamine – controls voluntary movements and is associated with the reward mechanism in the brain
Serotonin – regulates pain, sleep cycle, and digestion; leads to a stable mood, so low levels lead to depression
Endorphins – involved in reducing pain and making the person calm and happy
Norepinephrine – increases the heart rate and blood pressure and regulates mood
GABA – blocks the signals of excitatory neurotransmitters responsible for anxiety and panic
Glutamate – associated with learning and memory

The critical thing to understand here is that there is a belief in the realm of mental health that chemical imbalances are responsible for many mental disorders. Chief among these are neurotransmitter imbalances. For instance, people with Seasonal Affective Disorder (SAD) have difficulty regulating serotonin. More on this throughout the book as we discuss each disorder.

2.2.1.6. The brain. The central nervous system consists of the brain and spinal cord; the former we will discuss briefly and in terms of key structures which include:

Medulla – regulates breathing, heart rate, and blood pressure
Pons – acts as a bridge connecting the cerebellum and medulla and helps to transfer messages between different parts of the brain and spinal cord
Reticular formation – responsible for alertness and attention
Cerebellum – involved in our sense of balance and for coordinating the body’s muscles so that movement is smooth and precise. Involved in the learning of certain kinds of simple responses and acquired reflexes.
Thalamus – the major sensory relay center for all senses except smell
Hypothalamus – involved in drives associated with the survival of both the individual and the species. It regulates temperature by triggering sweating or shivering and controls the complex operations of the autonomic nervous system
Amygdala – responsible for evaluating sensory information and quickly determining its emotional importance
Hippocampus – our “gateway” to memory. Allows us to form spatial memories so that we can accurately navigate through our environment and helps us to form new memories about facts and events
The cerebrum has four distinct regions in each cerebral hemisphere. First, the frontal lobe contains the motor cortex, which issues orders to the muscles of the body that produce voluntary movement. The frontal lobe is also involved in emotion and in the ability to make plans, think creatively, and take initiative. The parietal lobe contains the somatosensory cortex and receives information about pressure, pain, touch, and temperature from sense receptors in the skin, muscles, joints, internal organs, and taste buds. The occipital lobe contains the visual cortex for receiving and processing visual information. Finally, the temporal lobe is involved in memory, perception, and emotion. It contains the auditory cortex which processes sound.

Of course, this is not an exhaustive list of structures found in the brain but gives you a pretty good idea of function and which structure is responsible for it. What is important to mental health professionals is some disorders involve specific areas of the brain. For instance, Parkinson’s disease is a brain disorder that results in a gradual loss of muscle control and arises when cells in the substantia nigra , a long nucleus considered to be part of the basal ganglia, stop making dopamine. As these cells die, the brain fails to receive messages about when and how to move. In the case of depression, low levels of serotonin are responsible, at least partially. New evidence suggests “nerve cell connections, nerve cell growth, and the functioning of nerve circuits have a major impact on depression… and areas that play a significant role in depression are the amygdala, the thalamus, and the hippocampus.” Also, individuals with borderline personality disorder have been shown to have structural and functional changes in brain areas associated with impulse control and emotional regulation, while imaging studies reveal differences in the frontal cortex and subcortical structures for those suffering from OCD.

2.2.2. Genes, Hormonal Imbalances, and Viral Infections

2.2.2.1. Genetic issues and explanations. DNA , or deoxyribonucleic acid, is our heredity material. It exists in the nucleus of each cell, packaged in threadlike structures known as chromosomes , for which we have 23 pairs or 46 total. Twenty-two of the pairs are the same in both sexes, but the 23rd pair is called the sex chromosome and differs between males and females. Males have X and Y chromosomes while females have two Xs. According to the Genetics Home Reference website as part of NIH’s National Library of Medicine, a gene is “the basic physical and functional unit of heredity” ( https://ghr.nlm.nih.gov/primer/basics/gene ). They act as the instructions to make proteins, and it is estimated by the Human Genome Project that we have between 20,000 and 25,000 genes. We all have two copies of each gene, one inherited from our mother and one from our father.

Recent research has discovered that autism, ADHD, bipolar disorder, major depression, and schizophrenia all share genetic roots. They “were more likely to have suspect genetic variation at the same four chromosomal sites. These included risk versions of two genes that regulate the flow of calcium into cells.” Likewise, twin and family studies have shown that people with first-degree relatives suffering from OCD are at higher risk to develop the disorder themselves. The same is true of borderline personality disorder.

WebMD adds, “Experts believe many mental illnesses are linked to abnormalities in many genes rather than just one or a few and that how these genes interact with the environment is unique for every person (even identical twins). That is why a person inherits a susceptibility to a mental illness and doesn’t necessarily develop the illness. Mental illness itself occurs from the interaction of multiple genes and other factors–such as stress, abuse, or a traumatic event–which can influence, or trigger, an illness in a person who has an inherited susceptibility to it” ( https://www.webmd.com/mental-health/mental-health-causes-mental-illness#1 ).

For more on the role of genes in the development of mental illness, check out this article from Psychology Today:

https://www.psychologytoday.com/blog/saving-normal/201604/what-you-need-know-about-the-genetics-mental-disorders

2.2.2.2. Hormonal imbalances. The body has two coordinating and integrating systems, the nervous system and the endocrine system. The main difference between these two systems is the speed with which they act. The nervous system moves quickly with nerve impulses moving in a few hundredths of a second. The endocrine system moves slowly with hormones, released by endocrine glands, taking seconds, or even minutes, to reach their target. Hormones are important to psychologists because they manage the nervous system and body tissues at certain stages of development and activate behaviors such as alertness or sleepiness, sexual behavior, concentration, aggressiveness, reaction to stress, and a desire for companionship. The pituitary gland is the “master gland” which regulates other endocrine glands. It influences blood pressure, thirst, contractions of the uterus during childbirth, milk production, sexual behavior and interest, body growth, the amount of water in the body’s cells, and other functions as well. The pineal gland helps regulate the sleep-wake cycle while the thyroid gland regulates the body’s energy levels by controlling metabolism and the basal metabolic rate (BMR). It regulates the body’s rate of metabolism and so how energetic people are.

Of importance to mental health professionals are the adrenal glands , located on top of the kidneys, and which release cortisol to help the body deal with stress. Elevated levels of this hormone can lead to several problems, including increased weight gain, interference with learning and memory, reduced bone density, high cholesterol, and an increased risk of depression. Similarly, the overproduction of the hormone melatonin can lead to SAD.

For more on the link between cortisol and depression, check out this article:

https://www.psychologytoday.com/blog/the-athletes-way/201301/cortisol-why-the-stress-hormone-is-public-enemy-no-1

2.2.2.3. Bacterial and viral infections . Infections can cause brain damage and lead to the development of mental illness or exacerbate existing symptoms. For instance, evidence suggests that contracting strep throat, “an infection in the throat and tonsils caused by bacteria called group A Streptococcus” (for more on strep throat, please visit https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html ), can lead to the development of OCD, Tourette’s syndrome, and tic disorder in children (Mell, Davis, & Owens, 2005; Giedd et al., 2000; Allen et al., 1995; https://www.psychologytoday.com/blog/the-perfectionists-handbook/201202/can-infections-result-in-mental-illness ). Influenza epidemics, caused by viral infections (for more on influenza, please see the following: https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719 ), have also been linked to schizophrenia (Brown et al., 2004; McGrath and Castle, 1995; McGrath et al., 1994; O’callaghan et al., 1991) though more recent research suggests this evidence is weak at best (Selten & Termorshuizen, 2017; Ebert & Kotler, 2005).

2.2.3. Treatments

2.2.3.1. Psychopharmacology and psychotropic drugs. One option to treat severe mental illness is psychotropic medications. These medications fall under five major categories.

Antidepressants are used to treat depression, but also anxiety, insomnia, and pain. The most common types of antidepressants are SSRIs or selective serotonin reuptake inhibitors and include Citalopram, Paroxetine, and Fluoxetine (Prozac). Possible side effects include weight gain, sleepiness, nausea and vomiting, panic attacks, or thoughts about suicide or dying.

Anti-anxiety medications help with the symptoms of anxiety and include benzodiazepines such as Clonazepam, Alprazolam, and Lorazepam. “Anti-anxiety medications such as benzodiazepines are effective in relieving anxiety and take effect more quickly than the antidepressant medications (or buspirone) often prescribed for anxiety. However, people can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need higher and higher doses to get the same effect.” Side effects include drowsiness, dizziness, nausea, difficulty urinating, and irregular heartbeat, to name a few.

Stimulants increase one’s alertness and attention and are frequently used to treat ADHD. They include Lisdexamfetamine, the combination of dextroamphetamine and amphetamine, and Methylphenidate. Stimulants are generally effective and produce a calming effect. Possible side effects include loss of appetite, headache, motor or verbal tics, and personality changes such as appearing emotionless.

Antipsychotics are used to treat psychosis or “conditions that affect the mind, and in which there has been some loss of contact with reality, often including delusions (false, fixed beliefs) or hallucinations (hearing or seeing things that are not really there).” They can be used to treat eating disorders, severe depression, PTSD, OCD, ADHD, and Generalized Anxiety Disorder. Common antipsychotics include Chlorpromazine, Perphenazine, Quetiapine, and Lurasidone. Side effects include nausea, vomiting, blurred vision, weight gain, restlessness, tremors, and rigidity.

Mood stabilizers are used to treat bipolar disorder and, at times, depression, schizoaffective disorder, and disorders of impulse control. A common example is Lithium; side effects include loss of coordination, hallucinations, seizures, and frequent urination.

For more information on psychotropic medications, please visit:

https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml

The use of these drugs has been generally beneficial to patients. Most report that their symptoms decline, leading them to feel better and improve their functioning. Also, long-term hospitalizations are less likely to occur as a result, though the medications do not benefit the individual in terms of improved living skills.

2.2.3.2. Electroconvulsive therapy. According to Mental Health America, “Electroconvulsive therapy (ECT) is a procedure in which a brief application of electric stimulus is used to produce a generalized seizure.” Patients are placed on a padded bed and administered a muscle relaxant to avoid injury during the seizures. Annually, approximately 100,000 undergo ECT to treat conditions such as severe depression, acute mania, suicidality, and some forms of schizophrenia. The procedure is still the most controversial available to mental health professionals due to “its effectiveness vs. the side effects, the objectivity of ECT experts, and the recent increase in ECT as a quick and easy solution, instead of long-term psychotherapy or hospitalization” ( https://www.mhanational.org/ect ). Its popularity has declined since the 1960s and 1970s.

2.2.3.3. Psychosurgery . Another option to treat mental disorders is to perform brain surgeries. In the past, we have conducted trephination and lobotomies, neither of which are used today. Today’s techniques are much more sophisticated and have been used to treat schizophrenia, depression, and some personality and anxiety disorders. However, critics cite obvious ethical issues with conducting such surgeries as well as scientific issues.

For more on psychosurgery, check out this article from Psychology Today:

https://www.psychologytoday.com/articles/199203/psychosurgery

2.2.4. Evaluation of the Model

The biological model is generally well respected today but suffers a few key issues. First, consider the list of side effects given for psychotropic medications. You might make the case that some of the side effects are worse than the condition they are treating. Second, the viewpoint that all human behavior is explainable in biological terms, and therefore when issues arise, they can be treated using biological methods, overlooks factors that are not fundamentally biological. More on that over the next two sections.

Proponents of the biological model view mental illness as being a result of a malfunction in the body to include issues with brain anatomy or chemistry.
Neurotransmitter imbalances and problems with brain structures/areas can result in mental disorders.
Many disorders have genetic roots, are a result of hormonal imbalances, or caused by viral infections such as strep.
Treatments related to the biological model include drugs, ECT, and psychosurgery.

Section 2.2 Review Questions

Briefly outline how communication in the nervous system occurs.
What happens at the synapse during neural transmission? Why is this important to a discussion of psychopathology?
How is the anatomy of the brain important to a discussion of psychopathology?
What is the effect of genes, hormones, and viruses on the development of mental disorders?
What treatments are available to clinicians courtesy of the biological model of psychopathology?
What are some issues facing the biological model?
Describe the psychodynamic theory.
Outline the structure of personality and how it develops over time.
Describe ways to deal with anxiety.
Clarify what psychodynamic techniques are used.
Evaluate the usefulness of psychodynamic theory.
Describe learning.
Outline respondent conditioning and the work of Pavlov and Watson.
Outline operant conditioning and the work of Thorndike and Skinner.
Outline observational learning/social-learning theory and the work of Bandura.
Evaluate the usefulness of the behavioral model.
Define the cognitive model.
Exemplify the effect of schemas on creating abnormal behavior.
Exemplify the effect of attributions on creating abnormal behavior.
Exemplify the effect of maladaptive cognitions on creating abnormal behavior.
List and describe cognitive therapies.
Evaluate the usefulness of the cognitive model.
Describe the humanistic perspective.
Describe the existential perspective.
Evaluate the usefulness of humanistic and existential perspectives.

2.3.1. Psychodynamic Theory

In 1895, the book, Studies on Hysteria , was published by Josef Breuer (1842-1925) and Sigmund Freud (1856-1939), and marked the birth of psychoanalysis, though Freud did not use this actual term until a year later. The book published several case studies, including that of Anna O., born February 27, 1859 in Vienna to Jewish parents Siegmund and Recha Pappenheim, strict Orthodox adherents who were considered millionaires at the time. Bertha, known in published case studies as Anna O., was expected to complete the formal education typical of upper-middle-class girls, which included foreign language, religion, horseback riding, needlepoint, and piano. She felt confined and suffocated in this life and took to a fantasy world she called her “private theater.” Anna also developed hysteria, including symptoms such as memory loss, paralysis, disturbed eye movements, reduced speech, nausea, and mental deterioration. Her symptoms appeared as she cared for her dying father, and her mother called on Breuer to diagnosis her condition (note that Freud never actually treated her). Hypnosis was used at first and relieved her symptoms, as it had done for many patients (See Module 1). Breuer made daily visits and allowed her to share stories from her private theater, which she came to call “talking cure” or “chimney sweeping.” Many of the stories she shared were actually thoughts or events she found troubling and reliving them helped to relieve or eliminate the symptoms. Breuer’s wife, Mathilde, became jealous of her husband’s relationship with the young girl, leading Breuer to terminate treatment in June of 1882 before Anna had fully recovered. She relapsed and was admitted to Bellevue Sanatorium on July 1, eventually being released in October of the same year. With time, Anna O. did recover from her hysteria and went on to become a prominent member of the Jewish Community, involving herself in social work, volunteering at soup kitchens, and becoming ‘House Mother’ at an orphanage for Jewish girls in 1895. Bertha (Anna O.) became involved in the German Feminist movement, and in 1904 founded the League of Jewish Women. She published many short stories; a play called Women’s Rights , in which she criticized the economic and sexual exploitation of women; and wrote a book in 1900 called The Jewish Problem in Galicia , in which she blamed the poverty of the Jews of Eastern Europe on their lack of education. In 1935, Bertha was diagnosed with a tumor, and in 1936, she was summoned by the Gestapo to explain anti-Hitler statements she had allegedly made. She died shortly after this interrogation on May 28, 1936. Freud considered the talking cure of Anna O. to be the origin of psychoanalytic therapy and what would come to be called the cathartic method.

For more on Anna O., please see:

https://www.psychologytoday.com/blog/freuds-patients-serial/201201/bertha-pappenheim-1859-1936

2.3.1.1. The structure of personality. Freud’s psychoanalysis was unique in the history of psychology because it did not arise within universities as most major schools of thought did; rather, it emerged from medicine and psychiatry to address psychopathology and examine the unconscious. Freud believed that consciousness had three levels – 1) consciousness which was the seat of our awareness, 2) preconscious that included all of our sensations, thoughts, memories, and feelings, and 3) the unconscious , which was not available to us. The contents of the unconscious could move from the unconscious to preconscious, but to do so, it had to pass a Gate Keeper. Content that was turned away was said to be repressed.

According to Freud, our personality has three parts – the id, superego, and ego, and from these our behavior arises. First, the id is the impulsive part that expresses our sexual and aggressive instincts. It is present at birth, completely unconscious, and operates on the pleasure principle , resulting in selfishly seeking immediate gratification of our needs no matter what the cost. The second part of personality emerges after birth with early formative experiences and is called the ego . The ego attempts to mediate the desires of the id against the demands of reality, and eventually, the moral limitations or guidelines of the superego. It operates on the reality principle , or an awareness of the need to adjust behavior, to meet the demands of our environment. The last part of the personality to develop is the superego , which represents society’s expectations, moral standards, rules, and represents our conscience. It leads us to adopt our parent’s values as we come to realize that many of the id’s impulses are unacceptable. Still, we violate these values at times and experience feelings of guilt. The superego is partly conscious but mostly unconscious, and part of it becomes our conscience. The three parts of personality generally work together well and compromise, leading to a healthy personality, but if the conflict is not resolved, intrapsychic conflicts can arise and lead to mental disorders.

Personality develops over five distinct stages in which the libido focuses on different parts of the body. First, libido is the psychic energy that drives a person to pleasurable thoughts and behaviors. Our life instincts, or Eros , are manifested through it and are the creative forces that sustain life. They include hunger, thirst, self-preservation, and sex. In contrast, Thanatos , our death instinct, is either directed inward as in the case of suicide and masochism or outward via hatred and aggression. Both types of instincts are sources of stimulation in the body and create a state of tension that is unpleasant, thereby motivating us to reduce them. Consider hunger, and the associated rumbling of our stomach, fatigue, lack of energy, etc., that motivates us to find and eat food. If we are angry at someone, we may engage in physical or relational aggression to alleviate this stimulation.

2.3.1.2. The development of personality. Freud’s psychosexual stages of personality development are listed below. Please note that a person may become fixated at any stage, meaning they become stuck, thereby affecting later development and possibly leading to abnormal functioning, or psychopathology.

Oral Stage – Beginning at birth and lasting to 24 months, the libido is focused on the mouth. Sexual tension is relieved by sucking and swallowing at first, and then later by chewing and biting as baby teeth come in. Fixation is linked to a lack of confidence, argumentativeness, and sarcasm.
Anal Stage – Lasting from 2-3 years, the libido is focused on the anus as toilet training occurs. If parents are too lenient, children may become messy or unorganized. If parents are too strict, children may become obstinate, stingy, or orderly.
Phallic Stage – Occurring from about age 3 to 5-6 years, the libido is focused on the genitals, and children develop an attachment to the parent of the opposite sex and are jealous of the same-sex parent. The Oedipus complex develops in boys and results in the son falling in love with his mother while fearing that his father will find out and castrate him. Meanwhile, girls fall in love with the father and fear that their mother will find out, called the Electra complex . A fixation at this stage may result in low self-esteem, feelings of worthlessness, and shyness.
Latency Stage – From 6-12 years of age, children lose interest in sexual behavior, so boys play with boys and girls with girls. Neither sex pays much attention to the opposite sex.
Genital Stage – Beginning at puberty, sexual impulses reawaken and unfulfilled desires from infancy and childhood can be satisfied during lovemaking.

2.3.1.3. Dealing with anxiety. The ego has a challenging job to fulfill, balancing both the will of the id and the superego, and the overwhelming anxiety and panic this creates. Ego-defense mechanisms are in place to protect us from this pain but are considered maladaptive if they are misused and become our primary way of dealing with stress. They protect us from anxiety and operate unconsciously by distorting reality. Defense mechanisms include the following:

Repression – When unacceptable ideas, wishes, desires, or memories are blocked from consciousness such as forgetting a horrific car accident that you caused. Eventually, though, it must be dealt with, or the repressed memory can cause problems later in life.
Reaction formation – When an impulse is repressed and then expressed by its opposite. For example, you are angry with your boss but cannot lash out at him, so you are super friendly instead. Another example is having lustful thoughts about a coworker than you cannot express because you are married, so you are extremely hateful to this person.
Displacement – When we satisfy an impulse with a different object because focusing on the primary object may get us in trouble. A classic example is taking out your frustration with your boss on your wife and/or kids when you get home. If you lash out at your boss, you could be fired. The substitute target is less dangerous than the primary target.
Projection – When we attribute threatening desires or unacceptable motives to others. An example is when we do not have the skills necessary to complete a task, but we blame the other members of our group for being incompetent and unreliable.
Sublimation – When we find a socially acceptable way to express a desire. If we are stressed out or upset, we may go to the gym and box or lift weights. A person who desires to cut things may become a surgeon.
Denial – Sometimes, life is so hard that all we can do is deny how bad it is. An example is denying a diagnosis of lung cancer given by your doctor.
Identification – When we find someone who has found a socially acceptable way to satisfy their unconscious wishes and desires, and we model that behavior.
Regression – When we move from a mature behavior to one that is infantile. If your significant other is nagging you, you might regress by putting your hands over your ears and saying, “La la la la la la la la…”
Rationalization – When we offer well-thought-out reasons for why we did what we did, but these are not the real reason. Students sometimes rationalize not doing well in a class by stating that they really are not interested in the subject or saying the instructor writes impossible-to-pass tests.
Intellectualization – When we avoid emotion by focusing on the intellectual aspects of a situation such as ignoring the sadness we are feeling after the death of our mother by focusing on planning the funeral.

For more on defense mechanisms, please visit:

https://www.psychologytoday.com/blog/fulfillment-any-age/201110/the-essential-guide-defense-mechanisms

2.3.1.4. Psychodynamic techniques. Freud used three primary assessment techniques—free association, transference, and dream analysis—as part of psychoanalysis , or psychoanalytic therapy, to understand the personalities of his patients and expose repressed material. First, free association involves the patient describing whatever comes to mind during the session. The patient continues but always reaches a point when he/she cannot or will not proceed any further. The patient might change the subject, stop talking, or lose his/her train of thought. Freud said this resistance revealed where issues persisted.

Second, transference is the process through which patients transfer attitudes he/she held during childhood to the therapist. They may be positive and include friendly, affectionate feelings, or negative, and include hostile and angry feelings. The goal of therapy is to wean patients from their childlike dependency on the therapist.

Finally, Freud used dream analysis to understand a person’s innermost wishes. The content of dreams includes the person’s actual retelling of the dreams, called manifest content , and the hidden or symbolic meaning called latent content . In terms of the latter, some symbols are linked to the person specifically, while others are common to all people.

2.3.1.5. Evaluating psychodynamic theory. Freud’s psychodynamic theory made a lasting impact on the field of psychology but also has been criticized heavily. First, Freud made most of his observations in an unsystematic, uncontrolled way, and he relied on the case study method. Second, the participants in his studies were not representative of the broader population. Despite Freud’s generalization, his theory was based on only a few patients. Third, he relied solely on the reports of his patients and sought no observer reports. Fourth, it is difficult to empirically study psychodynamic principles since most operate unconsciously. This begs the question of how we can really know that they exist. Finally, psychoanalytic treatment is expensive and time consuming, and since Freud’s time, drug therapies have become more popular and successful. Still, Sigmund Freud developed useful therapeutic tools for clinicians and raised awareness about the role the unconscious plays in both normal and abnormal behavior.

2.3.2. The Behavioral Model

2.3.2.1. What is learning? The behavioral model concerns the cognitive process of learning , which is any relatively permanent change in behavior due to experience and practice. Learning has two main forms – associative learning and observational learning. First, associative learning is the linking together of information sensed from our environment. Conditioning , or a type of associative learning, occurs when two separate events become connected. There are two forms: classical conditioning, or linking together two types of stimuli, and operant conditioning, or linking together a response with its consequence. Second, observational learning occurs when we learn by observing the world around us.

We should also note the existence of non-associative learning or when there is no linking of information or observing the actions of others around you. Types include habituation , or when we simply stop responding to repetitive and harmless stimuli in our environment such as a fan running in your laptop as you work on a paper, and sensitization , or when our reactions are increased due to a strong stimulus, such as an individual who experienced a mugging and now panics when someone walks up behind him/her on the street.

Behaviorism is the school of thought associated with learning that began in 1913 with the publication of John B. Watson’s article, “Psychology as the Behaviorist Views It,” in the journal Psychological Review (Watson, 1913). Watson believed that the subject matter of psychology was to be observable behavior, and to that end, psychology should focus on the prediction and control of behavior. Behaviorism was dominant from 1913 to 1990 before being absorbed into mainstream psychology. It went through three major stages – behaviorism proper under Watson and lasting from 1913-1930 (discussed as classical/respondent conditioning), neobehaviorism under Skinner and lasting from 1930-1960 (discussed as operant conditioning), and sociobehaviorism under Bandura and Rotter and lasting from 1960-1990 (discussed as social learning theory).

2.3.2.2. Respondent conditioning. You have likely heard about Pavlov and his dogs, but what you may not know is that this was a discovery made accidentally. Ivan Petrovich Pavlov (1906, 1927, 1928), a Russian physiologist, was interested in studying digestive processes in dogs in response to being fed meat powder. What he discovered was the dogs would salivate even before the meat powder was presented. They would salivate at the sound of a bell, footsteps in the hall, a tuning fork, or the presence of a lab assistant. Pavlov realized some stimuli automatically elicited responses (such as salivating to meat powder) and other stimuli had to be paired with these automatic associations for the animal or person to respond to it (such as salivating to a bell). Armed with this stunning revelation, Pavlov spent the rest of his career investigating the learning phenomenon.

The important thing to understand is that not all behaviors occur due to reinforcement and punishment as operant conditioning says. In the case of respondent conditioning, stimuli exert complete and automatic control over some behaviors. We see this in the case of reflexes. When a doctor strikes your knee with that little hammer, your leg extends out automatically. Another example is how a baby will root for a food source if the mother’s breast is placed near their mouth. And if a nipple is placed in their mouth, they will also automatically suck via the sucking reflex. Humans have several of these reflexes, though not as many as other animals due to our more complicated nervous system.

Respondent conditioning (also called classical or Pavlovian conditioning) occurs when we link a previously neutral stimulus with a stimulus that is unlearned or inborn, called an unconditioned stimulus. In respondent conditioning, learning happens in three phases: preconditioning, conditioning, and postconditioning. See Figure 2.5 for an overview of Pavlov’s classic experiment.

Preconditioning. Notice that preconditioning has both an A and a B panel. All this stage of learning signifies is that some learning is already present. There is no need to learn it again, as in the case of primary reinforcers and punishers in operant conditioning. In Panel A, food makes a dog salivate. This response does not need to be learned and shows the relationship between an unconditioned stimulus (UCS) yielding an unconditioned response (UCR). Unconditioned means unlearned. In Panel B, we see that a neutral stimulus (NS) produces no response. Dogs do not enter the world knowing to respond to the ringing of a bell (which it hears).

Conditioning. Conditioning is when learning occurs. By pairing a neutral stimulus and unconditioned stimulus (bell and food, respectively), the dog will learn that the bell ringing (NS) signals food coming (UCS) and salivate (UCR). The pairing must occur more than once so that needless pairings are not learned such as someone farting right before your food comes out and now you salivate whenever someone farts (…at least for a while. Eventually the fact that no food comes will extinguish this reaction but still, it will be weird for a bit).

Figure 2.5. Pavlov’s Classic Experiment

Postconditioning. Postconditioning, or after learning has occurred, establishes a new and not naturally occurring relationship of a conditioned stimulus (CS; previously the NS) and conditioned response (CR; the same response). So the dog now reliably salivates at the sound of the bell because he expects that food will follow, and it does.

Watson and Rayner (1920) conducted one of the most famous studies in psychology. Essentially, they wanted to explore “the possibility of conditioning various types of emotional response(s).” The researchers ran a series of trials in which they exposed a 9-month-old child, known as Little Albert, to a white rat. Little Albert made no response outside of curiosity (NS–NR not shown). Panel A of Figure 2.6 shows the naturally occurring response to the stimulus of a loud sound. On later trials, the rat was presented (NS) and followed closely by a loud sound (UCS; Panel B). After several conditioning trials, the child responded with fear to the mere presence of the white rat (Panel C).

Figure 2.6. Learning to Fear

As fears can be learned, so too they can be unlearned. Considered the follow-up to Watson and Rayner (1920), Jones (1924; Figure 2.7) wanted to see if a child who learned to be afraid of white rabbits (Panel B) could be conditioned to become unafraid of them. Simply, she placed the child in one end of a room and then brought in the rabbit. The rabbit was far enough away so as not to cause distress. Then, Jones gave the child some pleasant food (i.e., something sweet such as cookies [Panel C]; remember the response to the food is unlearned, i.e., Panel A). The procedure in Panel C continued with the rabbit being brought a bit closer each time until, eventually, the child did not respond with distress to the rabbit (Panel D).

Figure 2.7. Unlearning Fears

This process is called counterconditioning , or the reversal of previous learning.

Another respondent conditioning way to unlearn a fear is called flooding or exposing the person to the maximum level of stimulus and as nothing aversive occurs, the link between CS and UCS producing the CR of fear should break, leaving the person unafraid. That is the idea, at least. So, if you were afraid of clowns, you would be thrown into a room full of clowns. Hmm….

Finally, respondent conditioning has several properties:

Respondent Generalization – When many similar CSs or a broad range of CSs elicit the same CR. An example is the sound of a whistle eliciting salivation much the same as a ringing bell, both detected via audition.
Respondent Discrimination – When a single CS or a narrow range of CSs elicits a CR, i.e., teaching the dog to respond to a specific bell and ignore the whistle. The whistle would not be followed by food, eventually leading to….
Respondent Extinction – When the CS is no longer paired with the UCS. The sound of a school bell ringing (new CS that was generalized) is not followed by food (UCS), and so eventually, the dog stops salivating (the CR).
Spontaneous Recovery – When the CS elicits the CR after extinction has occurred. Eventually, the school bell will ring, making the dog salivate. If no food comes, the behavior will not continue. If food appears, the salivation response will be re-established.

2.3.2.3. Operant conditioning. Influential on the development of Skinner’s operant conditioning, Thorndike (1905) proposed the law of effect or the idea that if our behavior produces a favorable consequence, in the future when the same stimulus is present, we will be more likely to make the response again, expecting the same favorable consequence. Likewise, if our action leads to dissatisfaction, then we will not repeat the same behavior in the future. He developed the law of effect thanks to his work with a puzzle box. Cats were food deprived the night before the experimental procedure was to occur. The next morning, researchers placed a hungry cat in the puzzle box and set a small amount of food outside the box, just close enough to be smelled. The cat could escape the box and reach the food by manipulating a series of levers. Once free, the cat was allowed to eat some food before being promptly returned to the box. With each subsequent escape and re-insertion into the box, the cat became faster at correctly manipulating the levers. This scenario demonstrates trial and error learning or making a response repeatedly if it leads to success. Thorndike also said that stimulus and responses were connected by the organism, and this led to learning. This approach to learning was called connectionism .

Operant conditioning is a type of associate learning which focuses on consequences that follow a response or behavior that we make (anything we do or say) and whether it makes a behavior more or less likely to occur. This should sound much like what you just read about in terms of Thorndike’s work. Skinner talked about contingencies or when one thing occurs due to another. Think of it as an If-Then statement. If I do X, then Y will happen. For operant conditioning, this means that if I make a behavior, then a specific consequence will follow. The events (response and consequence) are linked in time.

What form do these consequences take? There are two main ways they can present themselves.

Reinforcement – Due to the consequence, a behavior/response is strengthened and more likely to occur in the future.
Punishment – Due to the consequence, a behavior/response is weakened and less likely to occur in the future.

Reinforcement and punishment can occur as two types – positive and negative. These words have no affective connotation to them, meaning they do not imply good or bad. Positive means that you are giving something – good or bad. Negative means that something is being taken away – good or bad. Check out the figure below for how these contingencies are arranged.

Figure 2.8. Contingencies in Operant Conditioning

Let’s go through each:

Positive Punishment (PP) – If something bad or aversive is given or added, then the behavior is less likely to occur in the future. If you talk back to your mother and she slaps your mouth, this is a PP. Your response of talking back led to the consequence of the aversive slap being given to your face. Ouch!!!
Positive Reinforcement (PR) – If something good is given or added, then the behavior is more likely to occur in the future. If you study hard and receive an A on your exam, you will be more likely to study hard in the future. Similarly, your parents may give you money for your stellar performance. Cha Ching!!!
Negative Reinforcement (NR) – This is a tough one for students to comprehend because the terms seem counterintuitive, even though we experience NR all the time. NR is when something bad or aversive is taken away or subtracted due to your actions, making it that you will be more likely to make the same behavior in the future when the same stimulus presents itself. For instance, what do you do if you have a headache? If you take Tylenol and the pain goes away, you will likely take Tylenol in the future when you have a headache. NR can either result in current escape behavior or future avoidance behavior. What does this mean? Escape occurs when we are presently experiencing an aversive event and want it to end. We make a behavior and if the aversive event, like the headache, goes away, we will repeat the taking of Tylenol in the future. This future action is an avoidance event. We might start to feel a headache coming on and run to take Tylenol right away. By doing so, we have removed the possibility of the aversive event occurring, and this behavior demonstrates that learning has occurred.
Negative Punishment (NP) – This is when something good is taken away or subtracted, making a behavior less likely in the future. If you are late to class and your professor deducts 5 points from your final grade (the points are something good and the loss is negative), you will hopefully be on time in all subsequent classes.

The type of reinforcer or punisher we use is crucial. Some are naturally occurring, while others need to be learned. We describe these as primary and secondary reinforcers and punishers. Primary refers to reinforcers and punishers that have their effect without having to be learned. Food, water, temperature, and sex, for instance, are primary reinforcers, while extreme cold or hot or a punch on the arm are inherently punishing. A story will illustrate the latter. When I was about eight years old, I would walk up the street in my neighborhood, saying, “I’m Chicken Little and you can’t hurt me.” Most ignored me, but some gave me the attention I was seeking, a positive reinforcer. So I kept doing it and doing it until one day, another kid grew tired of hearing about my other identity and punched me in the face. The pain was enough that I never walked up and down the street echoing my identity crisis for all to hear. This was a positive punisher that did not have to be learned, and definitely not one of my finer moments in life.

Secondary or conditioned reinforcers and punishers are not inherently reinforcing or punishing but must be learned. An example was the attention I received for saying I was Chicken Little. Over time I learned that attention was good. Other examples of secondary reinforcers include praise, a smile, getting money for working or earning good grades, stickers on a board, points, getting to go out dancing, and getting out of an exam if you are doing well in a class. Examples of secondary punishers include a ticket for speeding, losing television or video game privileges, ridicule, or a fee for paying your rent or credit card bill late. Really, the sky is the limit with reinforcers in particular.

In operant conditioning, the rule for determining when and how often we will reinforce the desired behavior is called the reinforcement schedule. Reinforcement can either occur continuously meaning every time the desired behavior is made the subject will receive some reinforcer, or intermittently/partially meaning reinforcement does not occur with every behavior. Our focus will be on partial/intermittent reinforcement.

Figure 2.9. Key Components of Reinforcement Schedules

Figure 2.9 shows that that are two main components that make up a reinforcement schedule – when you will reinforce and what is being reinforced. In the case of when, it will be either fixed or at a set rate, or variable and at a rate that changes. In terms of what is being reinforced, we will either reinforce responses or time. These two components pair up as follows:

Fixed Ratio schedule (FR) – With this schedule, we reinforce some set number of responses. For instance, every twenty problems (fixed) a student gets correct (ratio), the teacher gives him an extra credit point. A specific behavior is being reinforced – getting problems correct. Note that if we reinforce each occurrence of the behavior, the definition of continuous reinforcement, we could also describe this as an FR1 schedule. The number indicates how many responses have to be made, and in this case, it is one.
Variable Ratio schedule (VR) – We might decide to reinforce some varying number of responses, such as if the teacher gives him an extra credit point after finishing between 40 and 50 correct problems. This approach is useful if the student is learning the material and does not need regular reinforcement. Also, since the schedule changes, the student will keep responding in the absence of reinforcement.
Fixed Interval schedule (FI) – With a FI schedule, you will reinforce after some set amount of time. Let’s say a company wanted to hire someone to sell their product. To attract someone, they could offer to pay them $10 an hour 40 hours a week and give this money every two weeks. Crazy idea, but it could work. Saying the person will be paid every indicates fixed, and two weeks is time or interval. So, FI.
Variable Interval schedule (VI) – Finally, you could reinforce someone at some changing amount of time. Maybe they receive payment on Friday one week, then three weeks later on Monday, then two days later on Wednesday, then eight days later on Thursday, etc. This could work, right? Not for a job, but maybe we could say we are reinforced on a VI schedule if we are.

Finally, four properties of operant conditioning – extinction, spontaneous recovery, stimulus generalization, and stimulus discrimination – are important. These are the same four discussed under respondent conditioning. First, extinction is when something that we do, say, think/feel has not been reinforced for some time. As you might expect, the behavior will begin to weaken and eventually stop when this occurs. Does extinction happen as soon as the anticipated reinforcer is removed? The answer is yes and no, depending on whether we are talking about continuous or partial reinforcement. With which type of schedule would you expect a person to stop responding to immediately if reinforcement is not there? Continuous or partial?

The answer is continuous. If a person is used to receiving reinforcement every time they perform a particular behavior, and then suddenly no reinforcer is delivered, he or she will cease the response immediately. Obviously then, with partial, a response continues being made for a while. Why is this? The person may think the schedule has simply changed. ‘Maybe I am not paid weekly now. Maybe it changed to biweekly and I missed the email.’ Due to this endurance, we say that intermittent or partial reinforcement shows resistance to extinction , meaning the behavior does weaken, but gradually.

As you might expect, if reinforcement occurs after extinction has started, the behavior will re-emerge. Consider your parents for a minute. To stop some undesirable behavior you made in the past, they likely took away some privilege. I bet the bad behavior ended too. But did you ever go to your grandparent’s house and grandma or grandpa—or worse, BOTH—took pity on you and let you play your video games (or something equivalent)? I know my grandmother used to. What happened to that bad behavior that had disappeared? Did it start again and your parents could not figure out why?

Additionally, you might have wondered if the person or animal will try to make the response again in the future even though it stopped being reinforced in the past. The answer is yes, and one of two outcomes is possible. First, the response is made, and nothing happens. In this case, extinction continues. Second, the response is made, and a reinforcer is delivered. The response re-emerges. Consider a rat trained to push a lever to receive a food pellet. If we stop providing the food pellets, in time, the rat will stop pushing the lever. If the rat pushes the lever again sometime in the future and food is delivered, the behavior spontaneously recovers. Hence, this phenomenon is called spontaneous recovery.

2.3.2.4. Observational learning. There are times when we learn by simply watching others. This is called observational learning and is contrasted with enactive learning , which is learning by doing. There is no firsthand experience by the learner in observational learning, unlike enactive. As you can learn desirable behaviors such as watching how your father bags groceries at the grocery store (I did this and still bag the same way today), you can learn undesirable ones too. If your parents resort to alcohol consumption to deal with stressors life presents, then you also might do the same. The critical part is what happens to the person modeling the behavior. If my father seems genuinely happy and pleased with himself after bagging groceries his way, then I will be more likely to adopt this behavior. If my mother or father consumes alcohol to feel better when things are tough, and it works, then I might do the same. On the other hand, if we see a sibling constantly getting in trouble with the law, then we may not model this behavior due to the negative consequences.

Albert Bandura conducted pivotal research on observational learning, and you likely already know all about it. Check out Figure 2.10 to see if you do. In Bandura’s experiment, children were first brought into a room to watch a video of an adult playing nicely or aggressively with a Bobo doll, which provided a model. Next, the children are placed in a room with several toys in it. The room contains a highly prized toy, but they are told they cannot play with it. All other toys are allowed, including a Bobo doll. Children who watched the aggressive model behaved aggressively with the Bobo doll while those who saw the gentle model, played nice. Both groups were frustrated when deprived of the coveted toy.

Figure 2.10. Bandura’s Classic Experiment

According to Bandura, all behaviors are learned by observing others, and we model our actions after theirs, so undesirable behaviors can be altered or relearned in the same way. Modeling techniques change behavior by having subjects observe a model in a situation that usually causes them some anxiety. By seeing the model interact nicely with the fear evoking stimulus, their fear should subside. This form of behavior therapy is widely used in clinical, business, and classroom situations. In the classroom, we might use modeling to demonstrate to a student how to do a math problem. In fact, in many college classrooms, this is exactly what the instructor does. In the business setting, a model or trainer demonstrates how to use a computer program or run a register for a new employee.

However, keep in mind that we do not model everything we see. Why? First, we cannot pay attention to everything going on around us. We are more likely to model behaviors by someone who commands our attention. Second, we must remember what a model does to imitate it. If a behavior is not memorable, it will not be imitated. We must try to convert what we see into action. If we are not motivated to perform an observed behavior, we probably will not show what we have learned.

2.3.2.5. Evaluating the behavioral model. Within the context of psychopathology, the behavioral perspective is useful because explains maladaptive behavior in terms of learning gone awry. The good thing is that what is learned can be unlearned or relearned through behavior modification , the process of changing behavior. To begin, an applied behavior analyst identifies a target behavior, or behavior to be changed, defines it, works with the client to develop goals, conducts a functional assessment to understand what the undesirable behavior is, what causes it, and what maintains it. With this knowledge, a plan is developed and consists of numerous strategies to act on one or all these elements – antecedent, behavior, and/or consequence. The strategies arise from all three learning models. In terms of operant conditioning, strategies include antecedent manipulations, prompts, punishment procedures, differential reinforcement, habit reversal, shaping, and programming. Flooding and desensitization are typical respondent conditioning procedures used with phobias, and modeling arises from social learning theory and observational learning. Watson and Skinner defined behavior as what we do or say, but later behaviorists added what we think or feel. In terms of the latter, cognitive behavior modification procedures arose after the 1960s and with the rise of cognitive psychology. This led to a cognitive-behavioral perspective that combines concepts from the behavioral and cognitive models, the latter discussed in the next section.

Critics of the behavioral perspective point out that it oversimplifies behavior and often ignores inner determinants of behavior. Behaviorism has also been accused of being mechanistic and seeing people as machines. This criticism would be true of behaviorism’s first two stages, though sociobehaviorism steered away from this proposition and even fought against any mechanistic leanings of behaviorists.

The greatest strength or appeal of the behavioral model is that its tenets are easily tested in the laboratory, unlike those of the psychodynamic model. Also, many treatment techniques have been developed and proven to be effective over the years. For example, desensitization (Wolpe, 1997) teaches clients to respond calmly to fear-producing stimuli. It begins with the individual learning a relaxation technique such as diaphragmatic breathing. Next, a fear hierarchy, or list of feared objects and situations, is constructed in which the individual moves from least to most feared. Finally, the individual either imagines (systematic) or experiences in real life (in-vivo) each object or scenario from the hierarchy and uses the relaxation technique while doing so. This represents the individual pairings of a feared object or situation and relaxation. So, if there are 10 objects/situations in the list, the client will experience ten such pairings and eventually be able to face each without fear. Outside of phobias, desensitization has been shown to be effective in the treatment of Obsessive-Compulsive Disorder symptoms (Hakimian and Souza, 2016) and limitedly with the treatment of depression when co-morbid with OCD (Masoumeh and Lancy, 2016).

2.3.3. The Cognitive Model

2.3.3.1. What is it? As noted earlier, the idea of people being machines, called mechanism , was a key feature of behaviorism and other schools of thought in psychology until about the 1960s or 1970s. In fact, behaviorism said psychology was to be the study of observable behavior. Any reference to cognitive processes was dismissed as this was not overt, but covert according to Watson and later Skinner. Of course, removing cognition from the study of psychology ignored an important part of what makes us human and separates us from the rest of the animal kingdom. Fortunately, the work of George Miller, Albert Ellis, Aaron Beck, and Ulrich Neisser demonstrated the importance of cognitive abilities in understanding thoughts, behaviors, and emotions, and in the case of psychopathology, show that people can create their problems by how they come to interpret events experienced in the world around them. How so?

2.3.3.2. Schemas and cognitive errors. First, consider the topic of social cognition or the process of collecting and assessing information about others. So what do we do with this information? Once collected or sensed ( sensation is the cognitive process of detecting the physical energy given off or emitted by physical objects), the information is sent to the brain through the neural impulse. Once in the brain, it is processed and interpreted. This is where assessing information about others comes in and involves the cognitive process of perception , or adding meaning to raw sensory data. We take the information just detected and use it to assign people to categories , or groups. For each category, we have a schema , or a set of beliefs and expectations about a group of people, presumed to apply to all members of the group, and based on experience.

Can our schemas lead us astray or be false? Consider where students sit in a class. It is generally understood that the students who sit in the front of the class are the overachievers and want to earn an A in the class. Those who sit in the back of the room are underachievers who don’t care. Right? Where do you sit in class, if you are on a physical campus and not an online student? Is this correct? What about other students in the class that you know? What if you found out that a friend who sits in the front row is a C student but sits there because he cannot see the screen or board, even with corrective lenses? What about your friend or acquaintance in the back? This person is an A student but does not like being right under the nose of the professor, especially if he/she tends to spit when lecturing. The person in the back could also be shy and prefer sitting there so that s/he does not need to chat with others as much. Or, they are easily distracted and sits in the back so that all stimuli are in front of him/her. Again, your schema about front row and back row students is incorrect and causes you to make certain assumptions about these individuals. This might even affect how you interact with them. Would you want notes from the student in the front or back of the class?

2.3.3.3. Attributions and cognitive errors. Second, consider the very interesting social psychology topic attribution theory , or the idea that people are motivated to explain their own and other people’s behavior by attributing causes of that behavior to personal reasons or dispositional factors that are in the person themselves or linked to some trait they have; or situational factors that are linked to something outside the person. Like schemas, the attributions we make can lead us astray. How so? The fundamental attribution error occurs when we automatically assume a dispositional reason for another person’s actions and ignore situational factors. In other words, we assume the person who cut us off is an idiot (dispositional) and do not consider that maybe someone in the car is severely injured and this person is rushing them to the hospital (situational). Then there is the self-serving bias , which is when we attribute our success to our own efforts (dispositional) and our failures to external causes (situational). Our attribution in these two cases is in error, but still, it comes to affect how we see the world and our subjective well-being.

2.3.3.4. Maladaptive cognitions. Irrational thought patterns can be the basis of psychopathology. Throughout this book, we will discuss several treatment strategies used to change unwanted, maladaptive cognitions, whether they are present as an excess such as with paranoia, suicidal ideation, or feelings of worthlessness; or as a deficit such as with self-confidence and self-efficacy. More specifically, cognitive distortions/maladaptive cognitions can take the following forms:

Overgeneralizing – You see a larger pattern of negatives based on one event.
Mind Reading – Assuming others know what you are thinking without any evidence.
What if? – Asking yourself ‘what if something happens,’ without being satisfied by any of the answers.
Blaming – You focus on someone else as the source of your negative feelings and do not take any responsibility for changing yourself.
Personalizing – Blaming yourself for adverse events rather than seeing the role that others play.
Inability to disconfirm – Ignoring any evidence that may contradict your maladaptive cognition.
Regret orientation – Focusing on what you could have done better in the past rather than on improving now.
Dichotomous thinking – Viewing people or events in all-or-nothing terms.

2.3.3.5. Cognitive therapies. According to the National Alliance on Mental Illness (NAMI), cognitive behavioral therapy “focuses on exploring relationships among a person’s thoughts, feelings and behaviors. During CBT a therapist will actively work with a person to uncover unhealthy patterns of thought and how they may be causing self-destructive behaviors and beliefs.” CBT attempts to identify negative or false beliefs and restructure them. They add, “Oftentimes someone being treated with CBT will have homework in between sessions where they practice replacing negative thoughts with more realistic thoughts based on prior experiences or record their negative thoughts in a journal.” For more on CBT, visit: https://www.nami.org/About-Mental-Illness/Treatments/Psychotherapy . Some commonly used strategies include cognitive restructuring, cognitive coping skills training, and acceptance techniques.

First, you can use cognitive restructuring , also called rational restructuring, in which maladaptive cognitions are replaced with more adaptive ones. To do this, the client must be aware of the distressing thoughts, when they occur, and their effect on them. Next, help the client stop thinking these thoughts and replace them with more rational ones. It’s a simple strategy, but an important one. Psychology Today published a great article on January 21, 2013, which described four ways to change your thinking through cognitive restructuring. Briefly, these included:

Notice when you are having a maladaptive cognition, such as making “negative predictions.” Figure out what is the worst thing that could happen and what alternative outcomes are possible.
Track the accuracy of the thought. If you believe focusing on a problem generates a solution, then write down each time you ruminate and the result. You can generate a percentage of times you ruminated to the number of successful problem-solving strategies you generated.
Behaviorally test your thought. Try figuring out if you genuinely do not have time to go to the gym by recording what you do each day and then look at open times of the day. Add them up and see if making some minor, or major, adjustments to your schedule will free an hour to get in some valuable exercise.
Examine the evidence both for and against your thought. If you do not believe you do anything right, list evidence of when you did not do something right and then evidence of when you did. Then write a few balanced statements such as the one the article suggests, “I’ve made some mistakes that I feel embarrassed about, but a lot of the time, I make good choices.”

The article also suggested a few non-cognitive restructuring techniques, including mindfulness meditation and self-compassion. For more on these, visit: https://www.psychologytoday.com/blog/in-practice/201301/cognitive-restructuring

The second major CBT strategy is called cognitive coping skills training . This strategy teaches social skills, communication, assertiveness through direct instruction, role playing, and modeling. For social skills training, identify the appropriate social behavior such as making eye contact, saying no to a request, or starting up a conversation with a stranger and determine whether the client is inhibited from making this behavior due to anxiety. For communication, decide if the problem is related to speaking, listening, or both and then develop a plan for use in various interpersonal situations. Finally, assertiveness training aids the client in protecting their rights and obtaining what they want from others. Those who are not assertive are often overly passive and never get what they want or are unreasonably aggressive and only get what they want. Treatment starts with determining situations in which assertiveness is lacking and developing a hierarchy of assertiveness opportunities. Least difficult situations are handled first, followed by more difficult situations, all while rehearsing and mastering all the situations present in the hierarchy. For more on these techniques, visit http://cogbtherapy.com/cognitive-behavioral-therapy-exercises/ .

Finally, acceptance techniques help reduce a client’s worry and anxiety. Life involves a degree of uncertainty, and at times we must accept this. Techniques might include weighing the pros and cons of fighting uncertainty or change. The disadvantages should outweigh the advantages and help you to end the struggle and accept what is unknown. Chances are you are already accepting the unknown in some areas of life and identifying these can help you to see why it is helpful in these areas, and how you can apply this in more difficult areas. Finally, does uncertainty always lead to a negative end? We may think so, but a review of the evidence for and against this statement will show that it does not and reduce how threatening it seems.

2.3.3.6. Evaluating the cognitive model. The cognitive model made up for an apparent deficit in the behavioral model – overlooking the role cognitive processes play in our thoughts, feelings, and behaviors. Right before his death, Skinner (1990) reminded psychologists that the only thing we can truly know and study was the observable. Cognitive processes cannot be empirically and reliably measured and should be ignored. Is there merit to this view? Social desirability states that sometimes participants do not tell us the truth about what they are thinking, feeling, or doing (or have done) because they do not want us to think less of them or to judge them harshly if they are outside the social norm. In other words, they present themselves in a favorable light. If this is true, how can we know anything about controversial matters? The person’s true intentions or thoughts and feelings are not readily available to us, or are covert, and do not make for useful empirical data. Still, cognitive-behavioral therapies have proven their efficacy for the treatment of OCD (McKay et al., 2015), perinatal depression (Sockol, 2015), insomnia (de Bruin et al., 2015), bulimia nervosa (Poulsen et al., 2014), hypochondriasis (Olatunji et al., 2014), and social anxiety disorder (Leichsenring et al., 2014) to name a few. Other examples will be discussed throughout this book.

2.3.4. The Humanistic and Existential Perspectives

2.3.4.1. The humanistic perspective. The humanistic perspective, or third force psychology (psychoanalysis and behaviorism being the other two forces), emerged in the 1960s and 1970s as an alternative viewpoint to the largely deterministic view of personality espoused by psychoanalysis and the view of humans as machines advocated by behaviorism. Key features of the perspective include a belief in human perfectibility, personal fulfillment, valuing self-disclosure, placing feelings over intellect, an emphasis on the present, and hedonism. Its key figures were Abraham Maslow, who proposed the hierarchy of needs, and Carl Rogers, who we will focus on here.

Rogers said that all people want to have positive regard from significant others in their life. When the individual is accepted as they are, they receive unconditional positive regard and become a fully functioning person . They are open to experience, live every moment to the fullest, are creative, accepts responsibility for their decisions, do not derive their sense of self from others, strive to maximize their potential, and are self-actualized. Their family and friends may disapprove of some of their actions but overall, respect and love them. They then realize their worth as a person but also that they are not perfect. Of course, most people do not experience this but instead are made to feel that they can only be loved and respected if they meet certain standards, called conditions of worth . Hence, they experience conditional positive regard . Their self-concept becomes distorted, now seen as having worth only when these significant others approve, leading to a disharmonious state and psychopathology. Individuals in this situation are unsure of what they feel, value, or need leading to dysfunction and the need for therapy. Rogers stated that the humanistic therapist should be warm, understanding, supportive, respectful, and accepting of his/her clients. This approach came to be called client-centered therapy .

2.3.4.2. The existential perspective. This approach stresses the need for people to re-create themselves continually and be self-aware, acknowledges that anxiety is a normal part of life, focuses on free will and self-determination, emphasizes that each person has a unique identity known only through relationships and the search for meaning, and finally, that we develop to our maximum potential. Abnormal behavior arises when we avoid making choices, do not take responsibility, and fail to actualize our full potential. Existential therapy is used to treat substance abuse, “excessive anxiety, apathy, alienation, nihilism, avoidance, shame, addiction, despair, depression, guilt, anger, rage, resentment, embitterment, purposelessness, psychosis, and violence. They also focus on life-enhancing experiences like relationships, love, caring, commitment, courage, creativity, power, will, presence, spirituality, individuation, self-actualization, authenticity, acceptance, transcendence, and awe.” For more information, please visit: https://www.psychologytoday.com/therapy-types/existential-therapy

2.3.4.3. Evaluating the humanistic and existential perspectives. The biggest criticism of these models is that the concepts are abstract and fuzzy and so very difficult to research. Rogers did try to investigate his propositions scientifically, but most other humanistic-existential psychologists rejected the use of the scientific method. They also have not developed much in the way of theory, and the perspectives tend to work best with people suffering from adjustment issues and not as well with severe mental illness. The perspectives do offer hope to people suffering tragedy by asserting that we control our destiny and can make our own choices.

According to Freud, consciousness had three levels (consciousness, preconscious, and the unconscious), personality had three parts (the id, ego, and superego), personality developed over five stages (oral, anal, phallic, latency, and genital), there are ten defense mechanisms to protect the ego such as repression and sublimation, and finally three assessment techniques (free association, transference, and dream analysis) could be used to understand the personalities of his patients and expose repressed material.
The behavioral model concerns the cognitive process of learning, which is any relatively permanent change in behavior due to experience and practice and has two main forms – associative learning to include classical and operant conditioning and observational learning.
Respondent conditioning (also called classical or Pavlovian conditioning) occurs when we link a previously neutral stimulus with a stimulus that is unlearned or inborn, called an unconditioned stimulus.
Operant conditioning is a type of associate learning which focuses on consequences that follow a response or behavior that we make (anything we do, say, or think/feel) and whether it makes a behavior more or less likely to occur.
Observational learning is learning by watching others and modeling techniques change behavior by having subjects observe a model in a situation that usually causes them some anxiety.
The cognitive model focuses on schemas, cognitive errors, attributions, and maladaptive cognitions and offers strategies such as CBT, cognitive restructuring, cognitive coping skills training, and acceptance.
The humanistic perspective focuses on positive regard, conditions of worth, and the fully functioning person while the existential perspective stresses the need for people to re-create themselves continually and be self-aware, acknowledges that anxiety is a normal part of life, focuses on free will and self-determination, emphasizes that each person has a unique identity known only through relationships and the search for meaning, and finally, that we develop to our maximum potential.

Section 2.3 Review Questions

What are the three parts of personality according to Freud?
What are the five psychosexual stages according to Freud?
List and define the ten defense mechanisms proposed by Freud.
What are the three assessment techniques used by Freud?
What is learning and what forms does it take?
Describe respondent conditioning.
Describe operant conditioning.
Describe observational learning and modeling.
How does the cognitive model approach psychopathology?
How does the humanistic perspective approach psychopathology?
How does the existential perspective approach psychopathology?
Describe the sociocultural model.
Clarify how socioeconomic factors affect mental illness.
Clarify how gender factors affect mental illness.
Clarify how environmental factors affect mental illness.
Clarify how multicultural factors affect mental illness.
Evaluate the sociocultural model.

Outside of biological and psychological factors on mental illness, race, ethnicity, gender, religious orientation, socioeconomic status, sexual orientation, etc. also play a role, and this is the basis of the sociocultural model . How so? We will explore a few of these factors in this section.

2.4.1. Socioeconomic Factors

Low socioeconomic status has been linked to higher rates of mental and physical illness (Ng, Muntaner, Chung, & Eaton, 2014) due to persistent concern over unemployment or under-employment, low wages, lack of health insurance, no savings, and the inability to put food on the table, which then leads to feeling hopeless, helpless, and dependency on others. This situation places considerable stress on an individual and can lead to higher rates of anxiety disorders and depression. Borderline personality disorder has also been found to be higher in people in low-income brackets (Tomko et al., 2012) and group differences for personality disorders have been found between African and European Americans (Ryder, Sunohara, and Kirmayer, 2015).

2.4.2. Gender Factors

Gender plays an important, though at times, unclear role in mental illness. Gender is not a cause of mental illness, though differing demands placed on males and females by society and their culture can influence the development and course of a disorder. Consider the following:

Rates of eating disorders are higher among women than men, though both genders are affected. In the case of men, muscle dysphoria is of concern and is characterized by extreme concern over being more muscular.
OCD has an earlier age of onset in girls than boys, with most people being diagnosed by age 19.
Females are at higher risk for developing an anxiety disorder than men.
ADHD is more common in males than females, though females are more likely to have inattention issues.
Boys are more likely to be diagnosed with Autism Spectrum Disorder.
Depression occurs with greater frequency in women than men.
Women are more likely to develop PTSD compared to men.
Rates of SAD (Seasonal Affective Disorder) are four times greater in women than men. Interestingly, younger adults are more likely to develop SAD than older adults.

Consider this…

In relation to men: “While mental illnesses affect both men and women, the prevalence of mental illnesses in men is often lower than women. Men with mental illnesses are also less likely to have received mental health treatment than women in the past year. However, men are more likely to die by suicide than women, according to the Centers for Disease Control and Prevention . Recognizing the signs that you or someone you love may have a mental disorder is the first step toward getting treatment. The earlier that treatment begins, the more effective it can be.”

https://www.nimh.nih.gov/health/topics/men-and-mental-health/index.shtml

In relation to women: “Some disorders are more common in women such as depression and anxiety . There are also certain types of disorders that are unique to women. For example, some women may experience symptoms of mental disorders at times of hormone change, such as perinatal depression, premenstrual dysphoric disorder, and perimenopause-related depression. When it comes to other mental disorders such as schizophrenia and bipolar disorder , research has not found differences in the rates at which men and women experience these illnesses. But women may experience these illnesses differently – certain symptoms may be more common in women than in men, and the course of the illness can be affected by the sex of the individual. Researchers are only now beginning to tease apart the various biological and psychosocial factors that may impact the mental health of both women and men.”

https://www.nimh.nih.gov/health/topics/women-and-mental-health/index.shtml

2.4.3. Environmental Factors

Environmental factors also play a role in the development of mental illness. How so?

In the case of borderline personality disorder, many people report experiencing traumatic life events such as abandonment, abuse, unstable relationships or hostility, and adversity during childhood.
Cigarette smoking, alcohol use, and drug use during pregnancy are risk factors for ADHD.
Divorce or the death of a spouse can lead to anxiety disorders.
Trauma, stress, and other extreme stressors are predictive of depression.
Malnutrition before birth, exposure to viruses, and other psychosocial factors are potential causes of schizophrenia.
SAD occurs with greater frequency for those living far north or south from the equator (Melrose, 2015). Horowitz (2008) found that rates of SAD are just 1% for those living in Florida while 9% of Alaskans are diagnosed with the disorder.

Source: https://www.nimh.nih.gov/health/topics/index.shtml

2.4.4. Multicultural Factors

Racial, ethnic, and cultural factors are also relevant to understanding the development and course of mental illness. Multicultural psychologists assert that both normal behavior and abnormal behavior need to be understood in the context of the individual’s unique culture and the group’s value system. Racial and ethnic minorities must contend with prejudice, discrimination, racism, economic hardships, etc. as part of their daily life and this can lead to disordered behavior (Lo & Cheng, 2014; Jones, Cross, & DeFour, 2007; Satcher, 2001), though some research suggests that ethnic identity can buffer against these stressors and protect mental health (Mossakowski, 2003). To address this unique factor, culture-sensitive therapies have been developed and include increasing the therapist’s awareness of cultural values, hardships, stressors, and/or prejudices faced by their client; the identification of suppressed anger and pain; and raising the client’s self-worth (Prochaska & Norcross, 2013). These therapies have proven efficacy for the treatment of depression (Kalibatseva & Leong, 2014) and schizophrenia (Naeem et al., 2015).

2.4.5. Evaluation of the Model

The sociocultural model has contributed significantly to our understanding of the nuances of mental illness diagnosis, prognosis, course, and treatment for other races, cultures, genders, ethnicities. In Module 3, we will discuss diagnosing and classifying abnormal behavior from the perspective of the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text-Revision). Important here is that specific culture- and gender-related diagnostic issues are discussed for each disorder, demonstrating increased awareness of the impact of these factors. Still, the sociocultural model suffers from unclear findings and not allowing for the establishment of causal relationships, reliance on more qualitative data gathered from case studies and ethnographic analyses (one such example is Zafra, 2016), and an inability to make predictions about abnormal behavior for individuals.

The sociocultural model asserts that race, ethnicity, gender, religious orientation, socioeconomic status, sexual orientation all play a role in the development and treatment of mental illness.

Section 2.4 Review Questions

How do socioeconomic, gender, environmental, and multicultural factors affect mental illness and its treatment?
How effective is the sociocultural model at explaining psychopathology and its treatment?

Module Recap

In Module 2, we first distinguished uni- and multi-dimensional models of abnormality and made a case that the latter was better to subscribe to. We then discussed biological, psychological, and sociocultural models of abnormality. In terms of the biological model, neurotransmitters, brain structures, hormones, genes, and viral infections were identified as potential causes of mental illness and three treatment options were given. In terms of psychological perspectives, Freud’s psychodynamic theory; the learning-related research of Watson, Skinner, and Bandura and Rotter; the cognitive model; and the humanistic and existential perspectives were discussed. Finally, the sociocultural model indicated the role of socioeconomic, gender, environmental, and multicultural factors on abnormal behavior.

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A Short History of Abnormal Psychology

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Infographic transcript, abnormal psychology: milestones and achievements.

As society’s perspective of normal and abnormal rapidly evolves, psychologists find it difficult to classify behaviors into either category. To this day, there is no absolute definition of abnormal psychology because societal norms vary from one culture to the next.

Abnormal psychology concentrates on psychological disorders and how they influence human behavior, particularly when leading to psychopathology. (1) Our helpful timeline outlines how abnormal psychology and its treatment methods have evolved throughout the centuries.

Early Renaissance

Individuals with mental disorders were often treated at home.
Local parishes began providing financial aid to families impacted by mental illness.

Community mental health programs strove to provide gentle and respectful treatment.

The humanism movement began.

As recognizing mental health disorders became more common during the early Renaissance, hospitals and churches started operating as asylums to provide widespread treatment. (2) The patients in these asylums often had a low quality of care due to overpopulation in the facilities and a staff that lacked knowledge about mental illness. That soon changed with the introduction of scientific questioning during the humanism movement.

The Renaissance humanism movement began during the 13th and 14th Centuries. It was a system of education that originated in Italy and eventually spread throughout out other parts of Europe. At the core of the Renaissance humanism movement is the belief that humans should be shown understanding and compassion. (3) During this time, doctors began utilizing the power of suggestion on the human mind, which today is known as hypnosis.

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18th Century

The beginning of the New Age Reform.
Commitment to asylums was still considered the norm, and inhumane treatments were being phased out through education about mental illness.
William Tuke, an English businessman and philanthropist, opened the York Retreat in England, a house that sought to provide humane treatment for those with mental illnesses. (4)

The 18th Century was full of early psychologists who worked hard to educate doctors on mental illnesses and how to appropriately treat them. Philippe Pinel, a French physician, performed an experiment in 1792 that translated into improved quality of care for patients. He helped deploy moral management, which sought to treat those displaying abnormal behaviors based on their social, individual, and occupational needs. (5)

19th Century

(1808) Franz Gall creates a content piece about phrenology, which is the belief that the shape of a person’s skull reveals personality traits.
(1878) G. Stanley Hall becomes the first American to graduate with a doctorate in psychology. Hall went on to create the American Psychological Association.
(1886) Sigmund Freud developed his personality theory, which has continued to impact abnormal psychology treatment methods today.

A large portion of patients who had been kept away from society for decades improved very quickly due to respectful and humane treatment. The moral treatment of patients was highly prioritized, but there was still room for improvements in quality of care provided to patients.

Dorothea Dix played an instrumental role in the field of abnormal psychology during the 19th Century. She investigated the challenges faced by mental health treatment centers and discovered underfunding and an unregulated system contributed to the demise of humane treatment. She lobbied for change and her efforts resulted in the building of asylums for the first time in the United States. These asylums utilized treatment methods that are considered unethical by today’s medical standards, which were later removed from practice. (6)

20th Century

By the end of World War II, most psychologists specialized in particular subdisciplines, with abnormal psychology being a chosen field of study.
Carl Rogers created client-centered therapy, which seeks to tailor treatment methods according to the patient’s life goals and potential achievements.
(1952) The first Diagnostic and Statistical Manual of Mental Disorders was published.
Abnormal behaviors were viewed according to two perspectives: psychogenic and somatogenic.
Existential philosophers created the existential view, which is a belief that everyone has the freedom to find meaning in life or to avoid taking responsibility for actions.

Psychogenic: the belief that the mental disorder has a psychological origin rather than a physical origin.

Somatogenic: the belief that the mental disorder is derived from one or more physiological origins rather than a psychogenic origin.

Once hypnotism gained widespread popularity in the 20th Century for its effectiveness in treating abnormal behaviors, the psychogenic perspective became widely accepted. It’s important to note, however, that psychoanalytic treatment methods showed little promise in being able to treat severely ill patients.

Deinstitutionalization became a common practice in the 20th Century, and many state institutions were shut down. In 1963, the Community Mental Health Centers Act was created to strengthen the future of quality patient care. As a result, research facilities started garnering substantial financial support, and the idea of community-based care began to flourish. (2)

Abnormal Psychology Treatment Today

Research indicates Omega 3 and Omega 6 fatty acids counteract the onset of psychiatric disorders, particularly paranoid schizophrenia.
Researchers seek to cure “incurable” mental health disorders.
Holistic treatment methods are highly encouraged.

Abnormal psychology research today places a heavy emphasis on the study of brain matter and neurotransmitters. Scientists and physicians look closely at hormones and genetics to determine their impact on the human brain. (7) Many forms of prescription medication are used to treat those suffering from mental health issues, but due to extreme withdrawal symptoms and high addiction rates, we are seeing the start of a movement that focuses on holistic treatment methods. (8)

If you’re interested in abnormal psychology, consider earning a psychology degree from King University. Our program will prepare you for careers such as clinical psychologist, neuropsychologist, research psychologist, a clinical social worker, and more.

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The Surprising Benefits of Early Reading

Early reading for pleasure is linked to enhanced thinking, feeling, and acting..

Updated May 9, 2024 | Reviewed by Kaja Perina

Research into children who start reading for pleasure at an early age, shows notable brain enhancement.
Reading for pleasure between 2 and 9 supports healthy development in a variety of brain regions.
Reading rather than screen time is connected to better cognitive, mental health, and behavioural outcomes.
Reading offers children a proven way to reduce anxiety and depression.

In 2023, researchers in the United Kingdom, at the universities of Warwick and Cambridge, and others in China at the University of Fudan, published results of the data they analyzed from over 10,000 teens gathered from the Adolescent Brain and Cognitive Development cohort in the United States.

Their focus was not academic. They were not trying to see who read the earliest and tested the best. They studied children who read for pleasure and how it improved their brain function if they began between two and nine years old, started after that time, or did not read for pleasure at all. The study was cross-sectional. The researchers collected data from many different teens at a single point in time. They were from diverse socio-economic backgrounds in families that had a whole range of educational levels.

The study was longitudinal. They assessed the over 10,000 adolescent participants over a series of years. Furthermore, a “2-sample Mendelian randomization (MR) analysis for potential causal interference was also performed.” While the study revealed “moderately significant heritability of early” reading for pleasure “with considerable contribution from environments,” the brain differences were found to be causally connected to those children who started reading for pleasure early in life.

This major dataset showed that children who start reading early, for the sheer pleasure of it, develop brain structure in such a way that they improve their thinking skills, mental health, and conduct. They show signs of reduced stress , as well as reduced tendencies towards aggressive behaviours such as bullying .

Imagine children excited to go to school because their peers are joyfully turning the pages of stories rather than seeking opportunities to target, humiliate, and harm. Imagine for teachers a classroom where their students have healthy brains, facility with thinking and learning, and a capacity to self-regulate both internalizing and externalizing behaviours. In other words, their students aren’t withdrawing, disengaging, feeling anxiety and depression . Their students aren’t aggressively lashing out or breaking rules.

Twelve hours a week of reading for pleasure, started early in life, could potentially transform today’s classrooms into spaces where education comes alive and mental health issues are significantly reduced. It might even save many teachers from burnout .

The more children read early, the less time they are on screens which has been shown to change the way their brains develop. The early readers for pleasure showed distinct improvements in their brain development as documented on brain scans. The impacts were notably positive for children’s verbal learning, memory , speech development, and overall academic performance. The impacts were also notable for improvements in mental health and behaviour.

The Research

The Warwick, Cambridge, and Fudan researchers put their study into the context of an extensive meta-analysis of other studies. What they add to our understanding is the significant connection between early reading for pleasure and enhanced brain health versus the correlation between screen time and “multiple psychopathological problems” ranging from externalizing behaviours like bullying, and internalizing ones like depression and anxiety, and learning challenges like ADHD .

Not only are structures in the brain linked specifically to reading impacted, other brain regions, such as “the middle frontal, temporal pole, circular insula, left superior frontal” and more, were positively associated with cognitive or thinking performance. Just as important, the positive impact on so many brain regions were also associated with reducing “psychopathology scores.” If we want children and teens to succeed at academics and avoid the sometimes lifetime curse of mental illness and mental disorders then encouraging and facilitating early reading for pleasure is one critical intervention. The improved health of these brain regions didn’t just slightly improve cognition and mental health outcomes, they “significantly mediated” them.

To put these research insights more forcefully, specific brain regions impacted by early reading for pleasure, among the many identified, “play critical roles in cognitive function.” This is vitally important to lay a foundation for learning that underpins academic success. At the same time, these findings show “abnormal pathological dysfunctions/defects and alterations in these brain regions are significantly related to multiple psychiatric and mental health disorders.”

There is that powerful word once again “significantly.” It is not used lightly by scientific researchers who are cautious to overstate their findings.To recap, if we prioritize children’s early reading for pleasure and keep them away from screen time as their brain is developing intensely, we not only give them an enhanced foundation to academically achieve, but we may also help protect them from the immense suffering and loss frequently connected to mental health disorders.

Early Reading for Pleasure is Protective

Research shows that children who spend time with care-givers reading in early childhood suffer less from social-emotional problems. Children who are reading for pleasure, rather than interacting with screen content, suffer less depression and aggression . They disengage less. They have less anxiety. They are less likely to develop ADHD. They don’t bully as much or break rules as frequently.

Why? Is one activity morally better than the other? Is reading the ethical choice and screen time a "bad" choice? Not according to this research. Because reading for pleasure enhances many brain regions associated with thinking and emotions and mood and behaviours, it is a prescription for success and mental health.

If children cannot see properly, we are quick to get them glasses. If children cannot hear effectively, we get them hearing aids. When they cannot walk, we get them crutches or a wheelchair. If children are struggling to think clearly, problem-solve, develop social- emotional intelligence , behave in regulated, empathic ways, we need to get them reading for pleasure, the sooner the better.

If children are struggling to avoid acting with cruelty and aggression, if they struggle to be motivated, engaged, and happy, we need to supply them with books so that they can learn to read for pleasure. We need to surround them with caregivers who read to them, show them pictures, say words out loud, tell stories until they reach that moment when children are keen to read for pleasure on their own. These children become teens who read rather than are addicted to screens.

If we are a society that intervenes when eyes need support, when ears need enhancement, when legs require rehabilitation, recovery, or assistance, then the research encourages us to become a society that prevents pressing mental health issues, strives for all to have educational and career success, and reduces bullying and aggression by intervening on behalf of brains and brain development.

As one of the study’s researchers, Cambridge psychiatry professor Barbara Sahakian explains: “Reading isn’t just a pleasurable experience – it’s widely accepted that it inspires thinking and creativity , increases empathy and reduces stress. But on top of this, we found significant evidence that it’s linked to important developmental factors in children, improving their cognition, mental health, and brain structure, which are cornerstones for future learning and well-being.”

Sun, Y., Sahakian, B., Langley, C., Yang, A., Jiang, Y., Kang, J., Zhao, X., Li, C., Cheng, W., & Feng, J. (2023). Early-initiated childhood reading for pleasure: associations with better cognitive performance, mental well-being and brain structure in young adolescence. Psychological Medicine.

Jennifer Fraser, Ph.D., is an award-winning educator and bestselling author. Her latest book, The Bullied Brain: Heal Your Scars and Restore Your Health , hit shelves and airwaves in April 2022.

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Brain mechanisms underlying sensory hypersensitivity in a mouse model of autism spectrum disorder

Sensory hypersensitivity in grin2b-mutant mice linked to acc hyperactivity and brain-wide hyperconnectivity.

A research team led by Director KIM Eunjoon of the Center for Synaptic Brain Dysfunctions and Director KIM Seong-Gi of the Center for Neuroscience Imaging Research within the Institute for Basic Science (IBS) has identified the primary cause of sensory hypersensitivity related to autism spectrum disorders (ASD).

Autism affects approximately 1 in 36 individuals and is marked by significant challenges in social interaction and communication. Around 90% of autism patients also suffer from abnormal sensory hypersensitivity that deeply affects their daily functioning. This hypersensitivity results in exaggerated or dampened responses to common sensory stimuli such as sound, light, and touch, which leads to considerable stress and further social withdrawal. The precise brain region responsible for this sensory dysfunction is unknown, which hinders treatment efforts.

The IBS researchers studied an ASD mouse model with a mutation in the Grin2b gene, which encodes the GluN2B subunit of NMDA receptors. NMDA receptors, a type of glutamate receptor in the brain, have garnered attention in the context of autism due to their crucial role in synaptic transmission and neural plasticity. It was hypothesized that the Grin2b gene mutation in mice would induce ASD-like phenotypes, including sensory abnormalities, and that certain brain mechanisms may play important roles.

The researchers monitored neural activity and functional connectivity in the brains of these mice using activity-dependent markers and functional magnetic resonance imaging (fMRI). In these mice, the researchers discovered increased neuronal activity in the anterior cingulate cortex (ACC). The ACC is one of the higher-order cortical regions that have been extensively studied for cognitive and emotional brain functions, but have been understudied for brain disease-related sensory abnormalities.

Interestingly, when the hyperactivity of ACC neurons was inhibited using chemogenetic methods, sensory hypersensitivity were normalized, indicating the pivotal role of ACC hyperactivity in sensory hypersensitivity associated with autism.

Director KIM Eunjoon states, "This new research demonstrates the involvement of the anterior cingulate cortex (ACC), which has been known for its deep association with cognitive and social functions, in sensory hypersensitivity in autism."

The hyperactivity of the ACC was also associated with the enhanced functional connectivity between the ACC and other brain areas. It is believed both hyperactivity and the hyperconnectivity of the ACC with various other brain regions are involved with sensory hypersensitivity in Grin2b-mutant mice.

Director KIM Seong-Gi states, "Past studies attributed peripheral neurons or primary cortical areas to be important for ASD-related sensory hypersensitivity. These studies often only focused on the activity of a single brain region. In contrast, our study investigates not only the activity of ACC but also the brain-wide hyperconnectivity between the ACC and various cortical/subcortical brain regions, which gives us a more complete picture of the brain."

The researchers plan to study the detailed mechanisms underlying the increased excitatory synaptic activity and neuronal hyperconnectivity. They suspect that the lack of Grin2b expression may inhibit the normal process of weakening and pruning synapses that are less active so that relatively more active synapses can participate in refining neural circuits in an activity-dependent manner. Other areas of research interest is studying the role of ACC in other mouse models of ASD.

This study was published in the journal Molecular Psychiatry.

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Materials provided by Institute for Basic Science . Note: Content may be edited for style and length.

Journal Reference :

Soowon Lee, Won Beom Jung, Heera Moon, Geun Ho Im, Young Woo Noh, Wangyong Shin, Yong Gyu Kim, Jee Hyun Yi, Seok Jun Hong, Yongwhan Jung, Sunjoo Ahn, Seong-Gi Kim, Eunjoon Kim. Anterior cingulate cortex-related functional hyperconnectivity underlies sensory hypersensitivity in Grin2b-mutant mice . Molecular Psychiatry , 2024; DOI: 10.1038/s41380-024-02572-y

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How Psychologists Define and Study Abnormal Psychology

Defining Abnormality

Statistical Infrequency

Limitations

Violation of Social Norms

With this definition, it is necessary to consider the following:

Failure to Function Adequately

Deviation from Ideal Mental Health

Ethnocentric

Models of Abnormality

Behavioral Model of Abnormality

Cognitive Perspective of Mental Health Behavior

Medical / Biological Perspective of Mental Health Behavior

The Diathesis-Stress Model

Psychodynamic Perspective of Mental Health Behavior

An Alternative View: Mental Illness is a Social Construction

Why is abnormal psychology important?

How did the study of abnormal psychology originate?

What are the 4 key objectives of the field of abnormal psychology?

What makes defining abnormality difficult?

Why are correlational research designs often used in abnormal psychology?

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Fundamentals of Psychological Disorders - 3rd edition

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Handbook of Research Methods in Abnormal and Clinical Psychology

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Module 2: Research and Ethics in Abnormal Psychology

Abnormal Psychology

What is Abnormal Psychology? Definitions of Abnormal

Read more about Abnormal Psychology:

How Psychologists Define and Study Abnormal Psychology

What Is Abnormal Psychology?

What Are the Four Approaches to Abnormal Psychology?

Psychoanalytic Approach

Behavioral Approach

Medical Approach

Cognitive Approach

Topics in Abnormal Psychology

Criticisms of Abnormal Psychology

Frequently Asked Questions

Research on Child and Adolescent Psychopathology

Societies and partnerships

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Paternal and Maternal Depressive Symptoms and Sensitivity: Links with Trajectories of Socioemotional Problems in Toddlerhood

Respiratory Sinus Arrhythmia, Effortful Control, and Child Social Anxiety Symptoms

Executive Functions and Social-Emotional Problems in Toddlerhood: Nature, Persistence, and Direction of Associations

Fluctuations in Maternal Depressive Symptoms, Anxiety, and Anger and Children’s Depression Risks in Middle Childhood

Journal updates

Interview with the Authors: Dr. Qiong Wu and Karina Jalapa

Module 2: Models of Abnormal Psychology

2.1. Uni- vs. Multi-Dimensional Models of Abnormality

Key Takeaways

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A Short History of Abnormal Psychology

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Early Renaissance

Start Your Psychology Career

18th Century

19th Century

20th Century

Abnormal Psychology Treatment Today

The Surprising Benefits of Early Reading

The Research

Early Reading for Pleasure is Protective

Brain mechanisms underlying sensory hypersensitivity in a mouse model of autism spectrum disorder

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