research on abnormal psychology

Module 1: What is Abnormal Psychology?

3rd edition as of July 2023

Module Overview

Cassie is an 18-year-old female from suburban Seattle, WA. She was a successful student in high school, graduating valedictorian and obtaining a National Merit Scholarship for her performance on the PSAT during her junior year. She was accepted to a university on the opposite side of the state, where she received additional scholarships giving her a free ride for her entire undergraduate education. Excited to start this new chapter in her life, Cassie’s parents begin the 5-hour commute to Pullman, where they will leave their only daughter for the first time in her life.

The semester begins as it always does in mid to late August. Cassie meets the challenge with enthusiasm and does well in her classes for the first few weeks of the semester, as expected. Sometime around Week 6, her friends notice she is despondent, detached, and falling behind in her work. After being asked about her condition, she replies that she is “just a bit homesick,” and her friends accept this answer as it is a typical response to leaving home and starting college for many students. A month later, her condition has not improved but worsened. She now regularly shirks her responsibilities around her apartment, in her classes, and on her job. Cassie does not hang out with friends like she did when she first arrived for college and stays in bed most of the day. Concerned, Cassie’s friends contact Health and Wellness for help.

Cassie’s story, though hypothetical, is true of many Freshmen leaving home for the first time to earn a higher education, whether in rural Washington state or urban areas such as Chicago and Dallas. Most students recover from this depression and go on to be functional members of their collegiate environment and accomplished scholars. Some students learn to cope on their own while others seek assistance from their university’s health and wellness center or from friends who have already been through the same ordeal. These are normal reactions. However, in cases like Cassie’s, the path to recovery is not as clear. Instead of learning how to cope, their depression increases until it reaches clinical levels and becomes an impediment to success in multiple domains of life such as home, work, school, and social circles.

In Module 1, we will explore what it means to display abnormal behavior, what mental disorders are, and the way society views mental illness today and how it has been regarded throughout history. Then we will review research methods used by psychologists in general and how they are adapted to study abnormal behavior/mental disorders. We will conclude with an overview of what mental health professionals do.

Module Outline

1.1. Understanding Abnormal Behavior

1.2. classifying mental disorders, 1.3. the stigma of mental illness, 1.4. the history of mental illness, 1.5. research methods in psychopathology, 1.6. mental health professionals, societies, and journals.

Module Learning Outcomes

• Explain what it means to display abnormal behavior.
• Clarify how mental health professionals classify mental disorders.
• Describe the effect of stigma on those who have a mental illness.
• Outline the history of mental illness.
• Describe the research methods used to study abnormal behavior and mental illness.
• Identify types of mental health professionals, societies they may join, and journals they can publish their work in.

Section Learning Objectives

• Describe the disease model and its impact on the field of psychology throughout history.
• Describe positive psychology.
• Define abnormal behavior.
• Explain the concept of dysfunction as it relates to mental illness.
• Explain the concept of distress as it relates to mental illness.
• Explain the concept of deviance as it relates to mental illness.
• Explain the concept of dangerousness as it relates to mental illness.
• Define culture and social norms.
• Clarify the cost of mental illness on society.
• Define abnormal psychology, psychopathology, and mental disorders.

1.1.1. Understanding Abnormal Behavior

To understand what abnormal behavior is, we first have to understand what normal behavior is. Normal really is in the eye of the beholder, and most psychologists have found it easier to explain what is wrong with people then what is right. How so?

Psychology worked with the disease model for over 60 years, from about the late 1800s into the middle part of the 20th century. The focus was simple – curing mental disorders – and included such pioneers as Freud, Adler, Klein, Jung, and Erickson. These names are synonymous with the psychoanalytical school of thought. In the 1930s, behaviorism, under B.F. Skinner, presented a new view of human behavior. Simply, human behavior could be modified if the correct combination of reinforcements and punishments were used. This viewpoint espoused the dominant worldview of the time – mechanism – which presented the world as a great machine explained through the principles of physics and chemistry. In it, human beings serve as smaller machines in the larger machine of the universe.

Moving into the mid to late 1900s, we developed a more scientific investigation of mental illness, which allowed us to examine the roles of both nature and nurture and to develop drug and psychological treatments to “make miserable people less miserable.” Though this was an improvement, there were three consequences as pointed out by Martin Seligman in his 2008 TED Talk entitled, “The new era of positive psychology.” These are:

• “The first was moral; that psychologists and psychiatrists became victimologists, pathologizers; that our view of human nature was that if you were in trouble, bricks fell on you. And we forgot that people made choices and decisions. We forgot responsibility. That was the first cost.”
• “The second cost was that we forgot about you people. We forgot about improving normal lives. We forgot about a mission to make relatively untroubled people happier, more fulfilled, more productive. And “genius,” “high-talent,” became a dirty word. No one works on that.”
• “And the third problem about the disease model is, in our rush to do something about people in trouble, in our rush to do something about repairing damage, it never occurred to us to develop interventions to make people happier — positive interventions.”

Starting in the 1960s, figures such as Abraham Maslow and Carl Rogers sought to overcome the limitations of psychoanalysis and behaviorism by establishing a “third force” psychology, also known as humanistic psychology. As Maslow said,

“The science of psychology has been far more successful on the negative than on the positive side; it has revealed to us much about man’s shortcomings, his illnesses, his sins, but little about his potentialities, his virtues, his achievable aspirations, or his full psychological height. It is as if psychology had voluntarily restricted itself to only half its rightful jurisdiction, and that the darker, meaner half.” (Maslow, 1954, p. 354).

Humanistic psychology instead addressed the full range of human functioning and focused on personal fulfillment, valuing feelings over intellect, hedonism, a belief in human perfectibility, emphasis on the present, self-disclosure, self-actualization, positive regard, client centered therapy, and the hierarchy of needs. Again, these topics were in stark contrast to much of the work being done in the field of psychology up to and at this time.

In 1996, Martin Seligman became the president of the American Psychological Association (APA) and called for a positive psychology or one that had a more positive conception of human potential and nature. Building on Maslow and Roger’s work, he ushered in the scientific study of such topics as happiness, love, hope, optimism, life satisfaction, goal setting, leisure, and subjective well-being. Though positive and humanistic psychology have similarities, their methodology was much different. While humanistic psychology generally relied on qualitative methods, positive psychology utilizes a quantitative approach and aims to help people make the most out of life’s setbacks, relate well to others, find fulfillment in creativity, and find lasting meaning and satisfaction ( https://www.positivepsychologyinstitute.com.au/what-is-positive-psychology ).

So, to understand what normal behavior is, do we look to positive psychology for an indication, or do we first define abnormal behavior and then reverse engineer a definition of what normal is? Our preceding discussion gave suggestions about what normal behavior is, but could the darker elements of our personality also make up what is normal to some extent? Possibly. The one truth is that no matter what behavior we display, if taken to the extreme, it can become disordered – whether trying to control others through social influence or helping people in an altruistic fashion. As such, we can consider abnormal behavior to be a combination of personal distress, psychological dysfunction, deviance from social norms, dangerousness to self and others, and costliness to society.

1.1.2. How Do We Determine What Abnormal Behavior Is?

In the previous section we showed that what we might consider normal behavior is difficult to define. Equally challenging is understanding what abnormal behavior is, which may be surprising to you. A publication which you will become intimately familiar with throughout this book, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 5th edition, Text Revision (DSM-5-TR; 2022), states that, “Although no definition can capture all aspects of the range of disorders contained in DSM-5″ (pg. 13) certain aspects are required. These include:

• Dysfunction – Includes “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (pg. 14). Abnormal behavior, therefore, has the capacity to make well-being difficult to obtain and can be assessed by looking at an individual’s current performance and comparing it to what is expected in general or how the person has performed in the past. As such, a good employee who suddenly demonstrates poor performance may be experiencing an environmental demand leading to stress and ineffective coping mechanisms. Once the demand resolves itself, the person’s performance should return to normal according to this principle.
• Distress – When the person experiences a disabling condition “in social, occupational, or other important activities” (pg. 14). Distress can take the form of psychological or physical pain, or both concurrently. Alone though, distress is not sufficient enough to describe behavior as abnormal. Why is that? The loss of a loved one would cause even the most “normally” functioning individual pain. An athlete who experiences a career-ending injury would display distress as well. Suffering is part of life and cannot be avoided. And some people who exhibit abnormal behavior are generally positive while doing so.
• Deviance – Closer examination of the word abnormal indicates a move away from what is normal, or the mean (i.e., what would be considered average and in this case in relation to behavior), and so is behavior that infrequently occurs (sort of an outlier in our data). Our culture , or the totality of socially transmitted behaviors, customs, values, technology, attitudes, beliefs, art, and other products that are particular to a group, determines what is normal. Thus, a person is said to be deviant when he or she fails to follow the stated and unstated rules of society, called social norms . Social norms change over time due to shifts in accepted values and expectations. For instance, homosexuality was taboo in the U.S. just a few decades ago, but today, it is generally accepted. Likewise, PDAs, or public displays of affection, do not cause a second look by most people unlike the past when these outward expressions of love were restricted to the privacy of one’s own house or bedroom. In the U.S., crying is generally seen as a weakness for males. However, if the behavior occurs in the context of a tragedy such as the Vegas mass shooting on October 1, 2017, in which 58 people were killed and about 500 were wounded while attending the Route 91 Harvest Festival, then it is appropriate and understandable. Finally, consider that statistically deviant behavior is not necessarily negative. Genius is an example of behavior that is not the norm.

Though not part of the DSM conceptualization of what abnormal behavior is, many clinicians add dangerousness to this list when behavior represents a threat to the safety of the person or others. It is important to note that having a mental disorder does not imply a person is automatically dangerous. The depressed or anxious individual is often no more a threat than someone who is not depressed, and as Hiday and Burns (2010) showed, dangerousness is more the exception than the rule.  Still, mental health professionals have a duty to report to law enforcement when a mentally disordered individual expresses intent to harm another person or themselves. It is important to point out that people seen as dangerous are also not automatically mentally ill.

1.1.3. The Costs of Mental Illness

This leads us to wonder what the cost of mental illness is to society. The National Alliance on Mental Illness (NAMI) states that mental illness affects a person’s life which then ripples out to the family, community, and world. For instance, people with serious mental illness are at increased risk for diabetes, cancer, and cardiometabolic disease while 18% of those with a mental illness also have a substance use disorder. Within the family, an estimated 8.4 million Americans provide care to an adult with an emotional or mental illness with caregivers spending about 32 hours a week providing unpaid care. At the community level 21% of the homeless also have a serious mental illness while 70% of youth in the juvenile justice system have at least one mental health condition. And finally, depression is a leading cause of disability worldwide and depression and anxiety disorders cost the global economy $1 trillion each year in lost productivity (Source: NAMI, The Ripple Effect of Mental Illness infographic; https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers ).

In terms of worldwide impact, data from 2010 estimates $2.5 trillion in global costs, with $1.7 trillion being indirect costs (i.e., invisible costs “associated with income losses due to mortality, disability, and care seeking, including lost production due to work absence or early retirement”) and the remainder being direct (i.e., visible costs to include “medication, physician visits, psychotherapy sessions, hospitalization,” etc.). It is now projected that mental illness costs will be around $16 trillion by 2030. The authors add, “It should be noted that these calculations did not include costs associated with mental disorders from outside the healthcare system, such as legal costs caused by illicit drug abuse” (Trautmann, Rehm, & Wittchen, 2016). The costs for mental illness have also been found to be greater than the combined costs of somatic diseases such as cancer, diabetes, and respiratory disorders (Whiteford et al., 2013).

Christensen et al. (2020) did a review of 143 cost-of-illness studies that covered 48 countries and several types of mental illness. Their results showed that mental disorders are a substantial economic burden for societies and that certain groups of mental disorders are more costly than others. At the higher cost end were developmental disorders to include autism spectrum disorders followed by schizophrenia and intellectual disabilities. They write, “However, it is important to note that while disorders such as mood, neurotic and substance use disorders were less costly according to societal cost per patient, these disorders are much more prevalent and thus would contribute substantially to the total national cost in a country.” And much like Trautmann, Rehm, & Wittchen (2016) other studies show that indirect costs are higher than direct costs (Jin & Mosweu, 2017; Chong et al., 2016).

1.1.4. Defining Key Terms

Our discussion so far has concerned what normal and abnormal behavior is. We saw that the study of normal behavior falls under the providence of positive psychology. Similarly, the scientific study of abnormal behavior, with the intent to be able to predict reliably, explain, diagnose, identify the causes of, and treat maladaptive behavior, is what we refer to as abnormal psychology . Abnormal behavior can become pathological and has led to the scientific study of psychological disorders, or psychopathology . From our previous discussion we can fashion the following definition of a psychological or mental disorder: mental disorders are characterized by psychological dysfunction, which causes physical and/or psychological distress or impaired functioning, and is not an expected behavior according to societal or cultural standards.

Key Takeaways

You should have learned the following in this section:

• Abnormal behavior is a combination of personal distress, psychological dysfunction, deviance from social norms, dangerousness to self and others, and costliness to society.
• Abnormal psychology is the scientific study of abnormal behavior, with the intent to be able to predict reliably, explain, diagnose, identify the causes of, and treat maladaptive behavior.
• The study of psychological disorders is called psychopathology.
• Mental disorders are characterized by psychological dysfunction, which causes physical and/or psychological distress or impaired functioning, and is not an expected behavior according to societal or cultural standards

Section 1.1 Review Questions

• What is the disease model and what problems existed with it? What was to overcome its limitations?
• Can we adequately define normal behavior? What about abnormal behavior?
• What aspects are part of the American Psychiatric Association’s definition of abnormal behavior?
• How costly is mental illness?
• What is abnormal psychology?
• What is psychopathology?
• How do we define mental disorders?
• Define and exemplify classification.
• Define nomenclature.
• Define epidemiology.
• Define the presenting problem and clinical description.
• Differentiate prevalence, incidence, and any subtypes.
• Define comorbidity.
• Define etiology.
• Define course.
• Define prognosis.
• Define treatment.

1.2.1. Classification

Classification is not a foreign concept and as a student you have likely taken at least one biology class that discussed the taxonomic classification system of Kingdom, Phylum, Class, Order, Family, Genus, and Species revolutionized by Swedish botanist, Carl Linnaeus.  You probably even learned a witty mnemonic such as ‘King Phillip, Come Out For Goodness Sake’ to keep the order straight. The Library of Congress uses classification to organize and arrange their book collections and includes such categories as B – Philosophy, Psychology, and Religion; H – Social Sciences; N – Fine Arts; Q – Science; R – Medicine; and T – Technology.

Simply, classification is how we organize or categorize things. The second author’s wife has been known to color-code her Blu Ray collection by genre, movie title, and release date. It is useful for us to do the same with abnormal behavior, and classification provides us with a nomenclature , or naming system, to structure our understanding of mental disorders in a meaningful way. Of course, we want to learn as much as we can about a given disorder so we can understand its cause, predict its future occurrence, and develop ways to treat it.

1.2.2. Determining Occurrence of a Disorder

Epidemiology is the scientific study of the frequency and causes of diseases and other health-related states in specific populations such as a school, neighborhood, a city, country, and the world. Psychiatric or mental health epidemiology refers to the occurrence of mental disorders in a population. In mental health facilities, we say that a patient presents with a specific problem, or the presenting problem , and we give a clinical description of it, which includes information about the thoughts, feelings, and behaviors that constitute that mental disorder. We also seek to gain information about the occurrence of the disorder, its cause, course, and treatment possibilities.

Occurrence can be investigated in several ways. First, prevalence is the percentage of people in a population that has a mental disorder or can be viewed as the number of cases divided by the total number of people in the sample. For instance, if 20 people out of 100 have bipolar disorder, then the prevalence rate is 20%. Prevalence can be measured in several ways:

• Point prevalence indicates the proportion of a population that has the characteristic at a specific point in time. In other words, it is the number of active cases.
• Period prevalence indicates the proportion of a population that has the characteristic at any point during a given period of time, typically the past year.
• Lifetime prevalence indicates the proportion of a population that has had the characteristic at any time during their lives.

According to a 2020 infographic by the National Alliance on Mental Illness (NAMI), for U.S. adults, 1 in 5 experienced a mental illness, 1 in 20 had a serious mental illness, 1 in 15 experienced both a substance use disorder and mental disorder, and over 12 million had serious thoughts of suicide (2020 Mental Health By the Numbers: US Adults infographic). In terms of adolescents aged 12-17, in 2020 1 in 6 experienced a major depressive episode, 3 million had serious thoughts of suicide, and there was a 31% increase in mental health-related emergency department visits. Among U.S. young adults aged 18-25, 1 in 3 experienced a mental illness, 1 in 10 had a serious mental illness, and 3.8 had serious thoughts of suicide (2020 Mental Health By the Numbers: Youth and Young Adults infographic). These numbers would represent period prevalence rates during the pandemic, and for the year 2020. In the, You are Not Alone infographic, NAMI reported the following 12-month prevalence rates for U.S. Adults: 19% having an anxiety disorder, 8% having depression, 4% having PTSD, 3% having bipolar disorder, and 1% having schizophrenia.

Source: https://www.nami.org/mhstats

Incidence indicates the number of new cases in a population over a specific period. This measure is usually lower since it does not include existing cases as prevalence does. If you wish to know the number of new cases of social phobia during the past year (going from say Aug 21, 2015 to Aug 20, 2016), you would only count cases that began during this time and ignore cases before the start date, even if people are currently afflicted with the mental disorder. Incidence is often studied by medical and public health officials so that causes can be identified, and future cases prevented.

Finally, comorbidity describes when two or more mental disorders are occurring at the same time and in the same person. The National Comorbidity Survey Replication (NCS-R) study conducted by the National Institute of Mental Health (NIMH) and published in the June 6, 2005 issue of the Archives of General Psychiatry, sought to discover trends in prevalence, impairment, and service use during the 1990s. The first study, conducted from 1980 to 1985, surveyed 20,000 people from five different geographical regions in the U.S. A second study followed from 1990-1992 and was called the National Comorbidity Survey (NCS). The third study, the NCS-R, used a new nationally representative sample of the U.S. population, and found that 45% of those with one mental disorder met the diagnostic criteria for two or more disorders. The authors also found that the severity of mental illness, in terms of disability, is strongly related to comorbidity, and that substance use disorders often result from disorders such as anxiety and bipolar disorders. The implications of this are significant as services to treat substance abuse and mental disorders are often separate, despite the disorders appearing together.

1.2.3. Other Key Factors Related to Mental Disorders

The etiology is the cause of the disorder. There may be social, biological, or psychological explanations for the disorder which need to be understood to identify the appropriate treatment. Likewise, the effectiveness of a treatment may give some hint at the cause of the mental disorder. More on this in Module 2.

The course of the disorder is its particular pattern. A disorder may be acute , meaning that it lasts a short time, or chronic, meaning it persists for a long time. It can also be classified as time-limited , meaning that recovery will occur after some time regardless of whether any treatment occurs.

Prognosis is the anticipated course the mental disorder will take. A key factor in determining the course is age, with some disorders presenting differently in childhood than adulthood.

Finally, we will discuss several treatment strategies in this book in relation to specific disorders, and in a general fashion in Module 3. Treatment is any procedure intended to modify abnormal behavior into normal behavior. The person suffering from the mental disorder seeks the assistance of a trained professional to provide some degree of relief over a series of therapy sessions. The trained mental health professional may prescribe medication or utilize psychotherapy to bring about this change. Treatment may be sought from the primary care provider, in an outpatient facility, or through inpatient care or hospitalization at a mental hospital or psychiatric unit of a general hospital. According to NAMI, the average delay between symptom onset and treatment is 11 years with 45% of adults with mental illness, 66% of adults with serious mental illness, and 51% of youth with a mental health condition seeking treatment in a given year. They also report that 50% of white, 49% of lesbian/gay and bisexual, 43% of mixed/multiracial, 34% of Hispanic or Latinx, 33% of black, and 23% of Asian adults with a mental health diagnosis received treatment or counseling in the past year (Source: Mental Health Care Matters infographic, https://www.nami.org/mhstats ).

• Classification, or how we organize or categorize things, provides us with a nomenclature, or naming system, to structure our understanding of mental disorders in a meaningful way.
• Epidemiology is the scientific study of the frequency and causes of diseases and other health-related states in specific populations.
• Prevalence is the percentage of people in a population that has a mental disorder or can be viewed as the number of cases divided by the total number of people in the sample.
• Incidence indicates the number of new cases in a population over a specific period.
• Comorbidity describes when two or more mental disorders are occurring at the same time and in the same person.
• The etiology is the cause of a disorder while the course is its particular pattern and can be acute, chronic, or time-limited.
• Prognosis is the anticipated course the mental disorder will take.

Section 1.2 Review Questions

• What is the importance of classification for the study of mental disorders?
• What information does a clinical description include?
• In what ways is occurrence investigated?
• What is the etiology of a mental illness?
• What is the relationship of course and prognosis to one another?
• What is treatment and who seeks it?
• Clarify the importance of social cognition theory in understanding why people do not seek care.
• Define categories and schemas.
• Define stereotypes and heuristics.
• Describe social identity theory and its consequences.
• Differentiate between prejudice and discrimination.
• Contrast implicit and explicit attitudes.
• Explain the concept of stigma and its three forms.
• Define courtesy stigma.
• Describe what the literature shows about stigma.

In the previous section, we discussed the fact that care can be sought out in a variety of ways. The problem is that many people who need care never seek it out. Why is that?  We already know that society dictates what is considered abnormal behavior through culture and social norms, and you can likely think of a few implications of that. But to fully understand society’s role in why people do not seek care, we need to determine the psychological processes underlying this phenomenon in the individual.

Social cognition is the process through which we collect information from the world around us and then interpret it. The collection process occurs through what we know as sensation – or detecting physical energy emitted or reflected by physical objects. Detection occurs courtesy of our eyes, ears, nose, skin and mouth; or via vision, hearing, smell, touch, and taste, respectfully. Once collected, the information is relayed to the brain through the neural impulse where it is processed and interpreted, or meaning is added to this raw sensory data which we call perception .

One way meaning is added is by taking the information we just detected and using 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, believed to apply to all members of the group, and based on experience. You might think of them as organized ways of making sense of experience. So, it is during our initial interaction with someone that we collect information about them, assign the person to a category for which we have a schema, and then use that to affect how we interact with them. First impressions, called the primacy effect , are important because even if we obtain new information that should override an incorrect initial assessment, the initial impression is unlikely to change. We call this the perseverance effect , or belief perseverance .

Stereotypes are special types of schemas that are very simplistic, very strongly held, and not based on firsthand experience. They are heuristics , or mental shortcuts, that allow us to assess this collected information very quickly. One piece of information, such as skin color, can be used to assign the person to a schema for which we have a stereotype. This can affect how we think or feel about the person and behave toward them. Again, human beings tend to imply things about an individual solely due to a distinguishing feature and disregard anything inconsistent with the stereotype.

Social identity theory (Tajfel, 1982; Turner, 1987) states that people categorize their social world into meaningfully simplistic representations of groups of people. These representations are then organized as prototypes , or “fuzzy sets of a relatively limited number of category-defining features that not only define one category but serve to distinguish it from other categories” (Foddy and Hogg, as cited in Foddy et al., 1999). We construct in-groups and out-groups and categorize the self as an in-group member. The self is assimilated into the salient in-group prototype, which indicates what cognitions, affect, and behavior we may exhibit. Stereotyping, out-group homogeneity, in-group/out-group bias, normative behavior, and conformity are all based on self-categorization.

How so? Out-group homogeneity occurs when we see all members of an outside group as the same. This leads to a tendency to show favoritism to, and exclude or hold a negative view of, members outside of, one’s immediate group, called the in-group/out-group bias . The negative view or set of beliefs about a group of people is what we call prejudice , and this can result in acting in a way that is negative against a group of people, called discrimination . It should be noted that a person can be prejudicial without being discriminatory since most people do not act on their attitudes toward others due to social norms against such behavior. Likewise, a person or institution can be discriminatory without being prejudicial. For example, when a company requires that an applicant have a certain education level or be able to lift 80 pounds as part of typical job responsibilities. Individuals without a degree or ability to lift will be removed from consideration for the job, but this discriminatory act does not mean that the company has negative views of people without degrees or the inability to lift heavy weight. You might even hold a negative view of a specific group of people and not be aware of it. An attitude we are unaware of is called an implicit attitude , which stands in contrast to explicit attitudes, which are the views within our conscious awareness.

We have spent quite a lot of space and time understanding how people gather information about the world and people around them, process this information, use it to make snap judgements about others, form groups for which stereotypes may exist, and then potentially hold negative views of this group and behave negatively toward them as a result. Just one piece of information can be used to set this series of mental events into motion. Outside of skin color, the label associated with having a mental disorder can be used. Stereotypes about people with a mental disorder can quickly and easily transform into prejudice when people in a society determine the schema to be correct and form negative emotions and evaluations of this group (Eagly & Chaiken, 1993). This, in turn, can lead to discriminatory practices such as an employer refusing to hire, a landlord refusing to rent an apartment, or avoiding a romantic relationship, all due to the person having a mental illness.

Overlapping with prejudice and discrimination in terms of how people with mental disorders are treated is stigma , or when negative stereotyping, labeling, rejection, and loss of status occur. Stigma takes on three forms as described below:

• Public stigma – When members of a society endorse negative stereotypes of people with a mental disorder and discriminate against them. They might avoid them altogether, resulting in social isolation. An example is when an employer intentionally does not hire a person because their mental illness is discovered.
• Label avoidance –To avoid being labeled as “crazy” or “nuts” people needing care may avoid seeking it altogether or stop care once started. Due to these labels, funding for mental health services could be restricted and instead, physical health services funded.
• Self-stigma – When people with mental illnesses internalize the negative stereotypes and prejudice, and in turn, discriminate against themselves. They may experience shame, reduced self-esteem, hopelessness, low self-efficacy, and a reduction in coping mechanisms. An obvious consequence of these potential outcomes is the why try effect, or the person saying ‘Why should I try and get that job? I am not worthy of it’ (Corrigan, Larson, & Rusch, 2009; Corrigan, et al., 2016).

Another form of stigma that is worth noting is that of courtesy stigma or when stigma affects people associated with a person who has a mental disorder. Karnieli-Miller et al. (2013) found that families of the afflicted were often blamed, rejected, or devalued when others learned that a family member had a serious mental illness (SMI). Due to this, they felt hurt and betrayed, and an important source of social support during a difficult time had disappeared, resulting in greater levels of stress. To cope, some families concealed their relative’s illness, and some parents struggled to decide whether it was their place to disclose their child’s condition. Others fought with the issue of confronting the stigma through attempts at education versus just ignoring it due to not having enough energy or desiring to maintain personal boundaries. There was also a need to understand the responses of others and to attribute it to a lack of knowledge, experience, and/or media coverage. In some cases, the reappraisal allowed family members to feel compassion for others rather than feeling put down or blamed. The authors concluded that each family “develops its own coping strategies which vary according to its personal experiences, values, and extent of other commitments” and that “coping strategies families employ change over-time.”

Other effects of stigma include experiencing work-related discrimination resulting in higher levels of self-stigma and stress (Rusch et al., 2014), higher rates of suicide especially when treatment is not available (Rusch, Zlati, Black, and Thornicroft, 2014; Rihmer & Kiss, 2002), and a decreased likelihood of future help-seeking intention (Lally et al., 2013). The results of the latter study also showed that personal contact with someone with a history of mental illness led to a decreased likelihood of seeking help. This is important because 48% of the university sample stated that they needed help for an emotional or mental health issue during the past year but did not seek help. Similar results have been reported in other studies (Eisenberg, Downs, Golberstein, & Zivin, 2009). It is also important to point out that social distance, a result of stigma, has also been shown to increase throughout the life span, suggesting that anti-stigma campaigns should focus on older people primarily (Schomerus, et al., 2015).

One potentially disturbing trend is that mental health professionals have been shown to hold negative attitudes toward the people they serve. Hansson et al. (2011) found that staff members at an outpatient clinic in the southern part of Sweden held the most negative attitudes about whether an employer would accept an applicant for work, willingness to date a person who had been hospitalized, and hiring a patient to care for children. Attitudes were stronger when staff treated patients with a psychosis or in inpatient settings. In a similar study,

Martensson, Jacobsson, and Engstrom (2014) found that staff had more positive attitudes towards persons with mental illness if their knowledge of such disorders was less stigmatized; their workplaces were in the county council where they were more likely to encounter patients who recover and return to normal life in society, rather than in municipalities where patients have long-term and recurrent mental illness; and they have or had one close friend with mental health issues.

To help deal with stigma in the mental health community, Papish et al. (2013) investigated the effect of a one-time contact-based educational intervention compared to a four-week mandatory psychiatry course on the stigma of mental illness among medical students at the University of Calgary. The curriculum included two methods requiring contact with people diagnosed with a mental disorder: patient presentations, or two one-hour oral presentations in which patients shared their story of having a mental illness, and “clinical correlations” in which a psychiatrist mentored students while they interacted with patients in either inpatient or outpatient settings. Results showed that medical students held a stigma towards mental illness and that comprehensive medical education reduced this stigma. As the authors stated, “These results suggest that it is possible to create an environment in which medical student attitudes towards mental illness can be shifted in a positive direction.” That said, the level of stigma was still higher for mental illness than it was for the stigmatized physical illness, type 2 diabetes mellitus.

What might happen if mental illness is presented as a treatable condition? McGinty, Goldman, Pescosolido, and Barry (2015) found that portraying schizophrenia, depression, and heroin addiction as untreated and symptomatic increased negative public attitudes towards people with these conditions. Conversely, when the same people were portrayed as successfully treated, the desire for social distance was reduced, there was less willingness to discriminate against them, and belief in treatment effectiveness increased among the public.

Self-stigma has also been shown to affect self-esteem, which then affects hope, which then affects the quality of life among people with severe mental illness. As such, hope should play a central role in recovery (Mashiach-Eizenberg et al., 2013). Narrative Enhancement and Cognitive Therapy (NECT) is an intervention designed to reduce internalized stigma and targets both hope and self-esteem (Yanos et al., 2011). The intervention replaces stigmatizing myths with facts about illness and recovery, which leads to hopefulness and higher levels of self-esteem in clients. This may then reduce susceptibility to internalized stigma.

Stigma leads to health inequities (Hatzenbuehler, Phelan, & Link, 2013), prompting calls for stigma change. Targeting stigma involves two different agendas: The services agenda attempts to remove stigma so people can seek mental health services, and the rights agenda tries to replace discrimination that “robs people of rightful opportunities with affirming attitudes and behavior” (Corrigan, 2016). The former is successful when there is evidence that people with mental illness are seeking services more or becoming better engaged. The latter is successful when there is an increase in the number of people with mental illnesses in the workforce who are receiving reasonable accommodations. The federal government has tackled this issue with landmark legislation such as the Patient Protection and Affordable Care Act of 2010, Mental Health Parity and Addiction Equity Act of 2008, and the Americans with Disabilities Act of 1990. However, protections are not uniform across all subgroups due to “1) explicit language about inclusion and exclusion criteria in the statute or implementation rule, 2) vague statutory language that yields variation in the interpretation about which groups qualify for protection, and 3) incentives created by the legislation that affect specific groups differently” (Cummings, Lucas, and Druss, 2013). More on this in Module 15.

• Stigma is when negative stereotyping, labeling, rejection, and loss of status occur and take the form of public or self-stigma, and label avoidance.

Section 1.3 Review Questions

• How does social cognition help us to understand why stigmatization occurs?
• Define stigma and describe its three forms. What is courtesy stigma?
• What are the effects of stigma on the afflicted?
• Is stigmatization prevalent in the mental health community? If so, what can be done about it?
• How can we reduce stigmatization?
• Describe prehistoric and ancient beliefs about mental illness.
• Describe Greco-Roman thought on mental illness.
• Describe thoughts on mental illness during the Middle Ages.
• Describe thoughts on mental illness during the Renaissance.
• Describe thoughts on mental illness during the 18th and 19th centuries.
• Describe thoughts on mental illness during the 20th and 21st centuries.
• Describe the status of mental illness today.
• Outline the use of psychoactive drugs throughout time and their impact.
• Clarify the importance of managed health care for the treatment of mental illness.
• Define and clarify the importance of multicultural psychology.
• State the issue surrounding prescription rights for psychologists.
• Explain the importance of prevention science.

As we have seen so far, what is considered abnormal behavior is often dictated by the culture/society a person lives in, and unfortunately, the past has not treated the afflicted very well. In this section, we will examine how past societies viewed and dealt with mental illness.

1.4.1. Prehistoric and Ancient Beliefs

Prehistoric cultures often held a supernatural view of abnormal behavior and saw it as the work of evil spirits, demons, gods, or witches who took control of the person. This form of demonic possession often occurred when the person engaged in behavior contrary to the religious teachings of the time. Treatment by cave dwellers included a technique called trephination , in which a stone instrument known as a trephine was used to remove part of the skull, creating an opening. Through it, the evil spirits could escape, thereby ending the person’s mental affliction and returning them to normal behavior. Early Greek, Hebrew, Egyptian, and Chinese cultures used a treatment method called exorcism in which evil spirts were cast out through prayer, magic, flogging, starvation, having the person ingest horrible tasting drinks, or noisemaking.

1.4.2. Greco-Roman Thought

Rejecting the idea of demonic possession, Greek physician Hippocrates (460-377 B.C.) said that mental disorders were akin to physical ailments and had natural causes. Specifically, they arose from brain pathology , or head trauma/brain dysfunction or disease, and were also affected by heredity. Hippocrates classified mental disorders into three main categories – melancholia, mania, and phrenitis (brain fever) – and gave detailed clinical descriptions of each. He also described four main fluids or humors that directed normal brain functioning and personality – blood which arose in the heart, black bile arising in the spleen, yellow bile or choler from the liver, and phlegm from the brain. Mental disorders occurred when the humors were in a state of imbalance such as an excess of yellow bile causing frenzy and too much black bile causing melancholia or depression. Hippocrates believed mental illnesses could be treated as any other disorder and focused on the underlying pathology.

Also noteworthy was the Greek philosopher Plato (429-347 B.C.), who said that the mentally ill were not responsible for their actions and should not be punished. It was the responsibility of the community and their families to care for them. The Greek physician Galen (A.D. 129-199) said mental disorders had either physical or psychological causes, including fear, shock, alcoholism, head injuries, adolescence, and changes in menstruation.

In Rome, physician Asclepiades (124-40 BC) and philosopher Cicero (106-43 BC) rejected Hippocrates’ idea of the four humors and instead stated that melancholy arises from grief, fear, and rage; not excess black bile. Roman physicians treated mental disorders with massage or warm baths, the hope being that their patients would be as comfortable as they could be. They practiced the concept of contrariis contrarius , meaning opposite by opposite, and introduced contrasting stimuli to bring about balance in the physical and mental domains. An example would be consuming a cold drink while in a warm bath.

1.4.3. The Middle Ages – 500 AD to 1500 AD

The progress made during the time of the Greeks and Romans was quickly reversed during the Middle Ages with the increase in power of the Church and the fall of the Roman Empire. Mental illness was yet again explained as possession by the Devil and methods such as exorcism, flogging, prayer, the touching of relics, chanting, visiting holy sites, and holy water were used to rid the person of demonic influence. In extreme cases, the afflicted were exposed to confinement, beatings, and even execution. Scientific and medical explanations, such as those proposed by Hippocrates, were discarded.

Group hysteria, or mass madness , was also seen when large numbers of people displayed similar symptoms and false beliefs. This included the belief that one was possessed by wolves or other animals and imitated their behavior, called lycanthropy , and a mania in which large numbers of people had an uncontrollable desire to dance and jump, called tarantism . The latter was believed to have been caused by the bite of the wolf spider, now called the tarantula, and spread quickly from Italy to Germany and other parts of Europe where it was called Saint Vitus’s dance .

Perhaps the return to supernatural explanations during the Middle Ages makes sense given events of the time. The black death (bubonic plague) killed up to a third, or according to other estimates almost half, of the population. Famine, war, social oppression, and pestilence were also factors. The constant presence of death led to an epidemic of depression and fear. Near the end of the Middle Ages, mystical explanations for mental illness began to lose favor, and government officials regained some of their lost power over nonreligious activities. Science and medicine were again called upon to explain psychopathology.

1.4.4. The Renaissance – 14th to 16th centuries

The most noteworthy development in the realm of philosophy during the Renaissance was the rise of humanism , or the worldview that emphasizes human welfare and the uniqueness of the individual. This perspective helped continue the decline of supernatural views of mental illness. In the mid to late 1500s, German physician Johann Weyer (1515-1588) published his book, On the Deceits of the Demons, that rebutted the Church’s witch-hunting handbook, the Malleus Maleficarum , and argued that many accused of being witches and subsequently imprisoned, tortured, and/or burned at the stake, were mentally disturbed and not possessed by demons or the Devil himself. He believed that like the body, the mind was susceptible to illness. Not surprisingly, the book was vehemently protested and banned by the Church. It should be noted that these types of acts occurred not only in Europe, but also in the United States. The most famous example, the Salem Witch Trials of 1692, resulted in more than 200 people accused of practicing witchcraft and 20 deaths.

The number of asylums , or places of refuge for the mentally ill where they could receive care, began to rise during the 16th century as the government realized there were far too many people afflicted with mental illness to be left in private homes. Hospitals and monasteries were converted into asylums. Though the intent was benign in the beginning, as the facilities overcrowded, the patients came to be treated more like animals than people. In 1547, the Bethlem Hospital opened in London with the sole purpose of confining those with mental disorders. Patients were chained up, placed on public display, and often heard crying out in pain. The asylum became a tourist attraction, with sightseers paying a penny to view the more violent patients, and soon was called “Bedlam” by local people; a term that today means “a state of uproar and confusion” (https://www.merriam-webster.com/dictionary/bedlam).

1.4.5. Reform Movement – 18th to 19th centuries

The rise of the moral treatment movement occurred in Europe in the late 18th century and then in the United States in the early 19th century. The earliest proponent was Francis Pinel (1745-1826), the superintendent of la Bicetre, a hospital for mentally ill men in Paris. Pinel stressed respectful treatment and moral guidance for the mentally ill while considering their individual, social, and occupational needs. Arguing that the mentally ill were sick people, Pinel ordered that chains be removed, outside exercise be allowed, sunny and well-ventilated rooms replace dungeons, and patients be extended kindness and support. This approach led to considerable improvement for many of the patients, so much so, that several were released.

Following Pinel’s lead, William Tuke (1732-1822), a Quaker tea merchant, established a pleasant rural estate called the York Retreat. The Quakers believed that all people should be accepted for who they are and treated kindly. At the retreat, patients could work, rest, talk out their problems, and pray (Raad & Makari, 2010). The work of Tuke and others led to the passage of the Country Asylums Act of 1845, which required that every county provide asylum to the mentally ill. This sentiment extended to English colonies such as Canada, India, Australia, and the West Indies as word of the maltreatment of patients at a facility in Kingston, Jamaica spread, leading to an audit of colonial facilities and their policies.

Reform in the United States started with the figure largely considered to be the father of American psychiatry, Benjamin Rush (1745-1813). Rush advocated for the humane treatment of the mentally ill, showing them respect, and even giving them small gifts from time to time.  Despite this, his practice included treatments such as bloodletting and purgatives, the invention of the “tranquilizing chair,” and reliance on astrology, showing that even he could not escape from the beliefs of the time.

Due to the rise of the moral treatment movement in both Europe and the United States, asylums became habitable places where those afflicted with mental illness could recover. Regrettably, its success was responsible for its decline. The number of mental hospitals greatly increased, leading to staffing shortages and a lack of funds to support them. Though treating patients humanely was a noble endeavor, it did not work for some patients and other treatments were needed, though they had not been developed yet. Staff recognized that the approach worked best when the facility had 200 or fewer patients, but waves of immigrants arriving in the U.S. after the Civil War overwhelmed the facilities, and patient counts soared to 1,000 or more. Prejudice against the new arrivals led to discriminatory practices in which immigrants were not afforded the same moral treatments as native citizens, even when the resources were available to treat them.

The moral treatment movement also fell due to the rise of the mental hygiene movement , which focused on the physical well-being of patients. Its leading proponent in the United States was Dorothea Dix (1802-1887), a New Englander who observed the deplorable conditions suffered by the mentally ill while teaching Sunday school to female prisoners. Over the next 40 years, from 1841 to 1881, she motivated people and state legislators to do something about this injustice and raised millions of dollars to build over 30 more appropriate mental hospitals and improve others. Her efforts even extended beyond the U.S. to Canada and Scotland.

Finally, in 1908 Clifford Beers (1876-1943) published his book, A Mind that Found Itself , in which he described his struggle with bipolar disorder and the “cruel and inhumane treatment people with mental illnesses received. He witnessed and experienced horrific abuse at the hands of his caretakers. At one point during his institutionalization, he was placed in a straitjacket for 21 consecutive nights” ( https://www.mhanational.org/our-history ). His story aroused sympathy from the public and led him to found the National Committee for Mental Hygiene, known today as Mental Health America, which provides education about mental illness and the need to treat these people with dignity. Today, MHA has over 200 affiliates in 41 states and employs 6,500 affiliate staff and over 10,000 volunteers.

“In the early 1950s, Mental Health America issued a call to asylums across the country for their discarded chains and shackles. On April 13, 1953, at the McShane Bell Foundry in Baltimore, Md., Mental Health America melted down these inhumane bindings and recast them into a sign of hope: the Mental Health Bell.

Now the symbol of Mental Health America, the 300-pound Bell serves as a powerful reminder that the invisible chains of misunderstanding and discrimination continue to bind people with mental illnesses. Today, the Mental Health Bell rings out hope for improving mental health and achieving victory over mental illnesses.”

For more information on MHA, please visit: https://www.mhanational.org/

1.4.6. 20th – 21st Centuries

The decline of the moral treatment approach in the late 19th century led to the rise of two competing perspectives – the biological or somatogenic perspective and the psychological or psychogenic perspective.

     1.4.6.1. Biological or Somatogenic Perspective. Recall that Greek physicians Hippocrates and Galen said that mental disorders were akin to physical disorders and had natural causes. Though the idea fell into oblivion for several centuries, it re-emerged in the late 19th century for two reasons.  First, German psychiatrist Emil Kraepelin (1856-1926) discovered that symptoms occurred regularly in clusters, which he called syndromes . These syndromes represented a unique mental disorder with a distinct cause, course, and prognosis. In 1883 he published his textbook, Compendium der Psychiatrie (Textbook of Psychiatry), and described a system for classifying mental disorders that became the basis of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) that is currently in its 5th edition Text Revision (published in 2022).

Secondly, in 1825, the behavioral and cognitive symptoms of advanced syphilis were identified to include a belief that everyone is plotting against you or that you are God (a delusion of grandeur), and were termed general paresis by French physician A.L.J. Bayle. In 1897, Viennese psychiatrist Richard von Krafft-Ebbing injected patients suffering from general paresis with matter from syphilis spores and noted that none of the patients developed symptoms of syphilis, indicating they must have been previously exposed and were now immune. This led to the conclusion that syphilis was the cause of the general paresis. In 1906, August von Wassermann developed a blood test for syphilis, and in 1917 a cure was found. Julius von Wagner-Jauregg noticed that patients with general paresis who contracted malaria recovered from their symptoms. To test this hypothesis, he injected nine patients with blood from a soldier afflicted with malaria. Three of the patients fully recovered while three others showed great improvement in their paretic symptoms. The high fever caused by malaria burned out the syphilis bacteria. Hospitals in the United States began incorporating this new cure for paresis into their treatment approach by 1925.

Also noteworthy was the work of American psychiatrist John P. Grey. Appointed as superintendent of the Utica State Hospital in New York, Grey asserted that insanity always had a physical cause. As such, the mentally ill should be seen as physically ill and treated with rest, proper room temperature and ventilation, and a nutritive diet.

The 1930s also saw the use of electric shock as a treatment method, which was stumbled upon accidentally by Benjamin Franklin while experimenting with electricity in the early 18th century. He noticed that after suffering a severe shock his memories had changed, and in published work, he suggested physicians study electric shock as a treatment for melancholia.

            1.4.6.2. Psychological or Psychogenic Perspective. The psychological or psychogenic perspective states that emotional or psychological factors are the cause of mental disorders and represented a challenge to the biological perspective. This perspective had a long history but did not gain favor until the work of Viennese physician Franz Anton Mesmer (1734-1815). Influenced heavily by Newton’s theory of gravity, he believed that the planets also affected the human body through the force of animal magnetism and that all people had a universal magnetic fluid that determined how healthy they were. He demonstrated the usefulness of his approach when he cured Franzl Oesterline, a 27-year-old woman suffering from what he described as a convulsive malady. Mesmer used a magnet to disrupt the gravitational tides that were affecting his patient and produced a sensation of the magnetic fluid draining from her body. This procedure removed the illness from her body and provided a near-instantaneous recovery. In reality, the patient was placed in a trancelike state which made her highly suggestible. With other patients, Mesmer would have them sit in a darkened room filled with soothing music, into which he would enter dressed in a colorful robe and pass from person to person touching the afflicted area of their body with his hand or a rod/wand. He successfully cured deafness, paralysis, loss of bodily feeling, convulsions, menstrual difficulties, and blindness.

His approach gained him celebrity status as he demonstrated it at the courts of English nobility. However, the medical community was hardly impressed. A royal commission was formed to investigate his technique but could not find any proof for his theory of animal magnetism. Though he was able to cure patients when they touched his “magnetized” tree, the result was the same when “non-magnetized” trees were touched. As such, Mesmer was deemed a charlatan and forced to leave Paris. His technique was called mesmerism , better known today as hypnosis.

The psychological perspective gained popularity after two physicians practicing in the city of Nancy in France discovered that they could induce the symptoms of hysteria in perfectly healthy patients through hypnosis and then remove the symptoms in the same way. The work of Hippolyte-Marie Bernheim (1840-1919) and Ambroise-Auguste Liebault (1823-1904) came to be part of what was called the Nancy School and showed that hysteria was nothing more than a form of self-hypnosis. In Paris, this view was challenged by Jean Charcot (1825-1893), who stated that hysteria was caused by degenerative brain changes, reflecting the biological perspective. He was proven wrong and eventually turned to their way of thinking.

The use of hypnosis to treat hysteria was also carried out by fellow Frenchman Pierre Janet (1859-1947), and student of Charcot, who believed that hysteria had psychological, not biological causes. Namely, these included unconscious forces, fixed ideas, and memory impairments. In Vienna, Josef Breuer (1842-1925) induced hypnosis and had patients speak freely about past events that upset them. Upon waking, he discovered that patients sometimes were free of their symptoms of hysteria. Success was even greater when patients not only recalled forgotten memories but also relived them emotionally. He called this the cathartic method , and our use of the word catharsis today indicates a purging or release, in this case, of pent-up emotion.

By the end of the 19th century, it had become evident that mental disorders were caused by a combination of biological and psychological factors, and the investigation of how they develop began. Sigmund Freud’s development of psychoanalysis followed on the heels of the work of Bruner, and others who came before him.

1.4.7. Current Views/Trends

            1.4.7.1. Mental illness today. An article published by the Harvard Medical School in March 2014 called “The Prevalence and Treatment of Mental Illness Today” presented the results of the National Comorbidity Study Replication of 2001-2003, which included a sample of more than 9,000 adults. The results showed that nearly 46% of the participants had a psychiatric disorder at some time in their lives. The most commonly reported disorders were:

• Major depression – 17%
• Alcohol abuse – 13%
• Social anxiety disorder – 12%
• Conduct disorder – 9.5%

Also of interest was that women were more likely to have had anxiety and mood disorders while men showed higher rates of impulse control disorders. Comorbid anxiety and mood disorders were common, and 28% reported having more than one co-occurring disorder (Kessler, Berglund, et al., 2005; Kessler, Chiu, et al., 2005; Kessler, Demler, et al., 2005).

About 80% of the sample reported seeking treatment for their disorder, but with as much as a 10-year gap after symptoms first appeared. Women were more likely than men to seek help while whites were more likely than African and Hispanic Americans (Wang, Berglund, et al., 2005; Wang, Lane, et al., 2005). Care was sought primarily from family doctors, nurses, and other general practitioners (23%), followed by social workers and psychologists (16%), psychiatrists (12%), counselors or spiritual advisers (8%), and complementary and alternative medicine providers (CAMs; 7%).

In terms of the quality of the care, the article states:

Most of this treatment was inadequate, at least by the standards applied in the survey. The researchers defined minimum adequacy as a suitable medication at a suitable dose for two months, along with at least four visits to a physician; or else eight visits to any licensed mental health professional. By that definition, only 33% of people with a psychiatric disorder were treated adequately, and only 13% of those who saw general medical practitioners.

In comparison to the original study conducted from 1991-1992, the use of mental health services has increased over 50% during this decade. This may be attributed to treatment becoming more widespread and increased attempts to educate the public about mental illness. Stigma, discussed in Section 1.3, has reduced over time, diagnosis is more effective, community outreach programs have increased, and most importantly, general practitioners have been more willing to prescribe psychoactive medications which themselves are more readily available now. The article concludes, “Survey researchers also suggest that we need more outreach and voluntary screening, more education about mental illness for the public and physicians, and more effort to treat substance abuse and impulse control disorders.” We will explore several of these issues in the remainder of this section, including the use of psychiatric drugs and deinstitutionalization, managed health care, private psychotherapy, positive psychology and prevention science, multicultural psychology, and prescription rights for psychologists.

            1.4.7.2. Use of psychiatric drugs and deinstitutionalization . Beginning in the 1950s, psychiatric or psychotropic drugs were used for the treatment of mental illness and made an immediate impact. Though drugs alone cannot cure mental illness, they can improve symptoms and increase the effectiveness of treatments such as psychotherapy. Classes of psychiatric drugs include anti-depressants used to treat depression and anxiety, mood-stabilizing medications to treat bipolar disorder, anti-psychotic drugs to treat schizophrenia, and anti-anxiety drugs to treat generalized anxiety disorder or panic disorder

Frank (2006) found that by 1996, psychotropic drugs were used in 77% of mental health cases and spending on these drugs grew from $2.8 billion in 1987 to about $18 billion in 2001 (Coffey et al., 2000; Mark et al., 2005), representing over a sixfold increase. The largest classes of psychotropic drugs are anti-psychotics and anti-depressants, followed closely by anti-anxiety medications. Frank, Conti, and Goldman (2005) point out, “The expansion of insurance coverage for prescription drugs, the introduction and diffusion of managed behavioral health care techniques, and the conduct of the pharmaceutical industry in promoting their products all have influenced how psychotropic drugs are used and how much is spent on them.” Is it possible then that we are overprescribing these mediations? Davey (2014) provides ten reasons why this may be so, including leading suffers from believing that recovery is in their hands but instead in the hands of their doctors; increased risk of relapse; drug companies causing the “medicalization of perfectly normal emotional processes, such as bereavement” to ensure their survival; side effects; and a failure to change the way the person thinks or the socioeconomic environments that may be the cause of the disorder. For more on this article, please see: https://www.psychologytoday.com/blog/why-we-worry/201401/overprescribing-drugs-treat-mental-health-problems . Smith (2012) echoed similar sentiments in an article on inappropriate prescribing. He cites the approval of Prozac by the Food and Drug Administration (FDA) in 1987 as when the issue began and the overmedication/overdiagnosis of children with ADHD as a more recent example.

A result of the use of psychiatric drugs was deinstitutionalization , or the release of patients from mental health facilities. This shifted resources from inpatient to outpatient care and placed the spotlight back on the biological or somatogenic perspective.  When people with severe mental illness do need inpatient care, it is typically in the form of short-term hospitalization.

            1.4.7.3. Managed health care. Managed health care is a term used to describe a type of health insurance in which the insurance company determines the cost of services, possible providers, and the number of visits a subscriber can have within a year. This is regulated through contracts with providers and medical facilities. The plans pay the providers directly, so subscribers do not have to pay out-of-pocket or complete claim forms, though most require co-pays paid directly to the provider at the time of service. Exactly how much the plan costs depends on how flexible the subscriber wants it to be; the more flexibility, the higher the cost. Managed health care takes three forms:

• Health Maintenance Organizations (HMO) – Typically only pay for care within the network. The subscriber chooses a primary care physician (PCP) who coordinates most of their care. The PCP refers the subscriber to specialists or other health care providers as is necessary. This is the most restrictive option.
• Preferred Provider Organizations (PPO) – Usually pay more if the subscriber obtains care within the network, but if care outside the network is sought, they cover part of the cost.
• Point of Service (POS) – These plans provide the most flexibility and allow the subscriber to choose between an HMO or a PPO each time care is needed.

Regarding the treatment needed for mental illness, managed care programs regulate the pre-approval of treatment via referrals from the PCP, determine which mental health providers can be seen, and oversee which conditions can be treated and what type of treatment can be delivered. This system was developed in the 1980s to combat the rising cost of mental health care and took responsibility away from single practitioners or small groups who could charge what they felt was appropriate. The actual impact of managed care on mental health services is still questionable at best.

            1.4.7.4. Multicultural psychology. As our society becomes increasingly diverse, medical practitioners and psychologists alike must take into account the patient’s gender, age, race, ethnicity, socioeconomic (SES) status, and culture and how these factors shape the individual’s thoughts, feelings, and behaviors. Additionally, we need to understand how the various groups, whether defined by race, culture, or gender, differ from one another. This approach is called multicultural psychology .

In August 2002, the American Psychological Association’s (APA) Council of Representatives put forth six guidelines based on the understanding that “race and ethnicity can impact psychological practice and interventions at all levels” and the need for respect and inclusiveness. They further state, “psychologists are in a position to provide leadership as agents of prosocial change, advocacy, and social justice, thereby promoting societal understanding, affirmation, and appreciation of multiculturalism against the damaging effects of individual, institutional, and societal racism, prejudice, and all forms of oppression based on stereotyping and discrimination.” The guidelines from the 2002 document are as follows:

• “Guideline #1: Psychologists are encouraged to recognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals who are ethnically and racially different from themselves.
• Guideline #2: Psychologists are encouraged to recognize the importance of multicultural sensitivity/responsiveness, knowledge, and understanding about ethnically and racially different individuals.
• Guideline #3: As educators, psychologists are encouraged to employ the constructs of multiculturalism and diversity in psychological education.
• Guideline #4: Culturally sensitive psychological researchers are encouraged to recognize the importance of conducting culture–centered and ethical psychological research among persons from ethnic, linguistic, and racial minority backgrounds.
• Guideline #5: Psychologists strive to apply culturally-appropriate skills in clinical and other applied psychological practices.
• Guideline #6: Psychologists are encouraged to use organizational change processes to support culturally informed organizational (policy) development and practices.”

Source: https://apa.org/pi/oema/resources/policy/multicultural-guidelines.aspx

This type of sensitivity training is vital because bias based on ethnicity, race, and culture has been found in the diagnosis and treatment of autism (Harrison et al., 2017; Burkett, 2015), borderline personality disorder (Jani et al., 2016), and schizophrenia (Neighbors et al., 2003; Minsky et al., 2003). Despite these findings, Schwartz and Blankenship (2014) state, “It should also be noted that although clear evidence supports a longstanding trend in differential diagnoses according to consumer race, this trend does not imply that one race ( e.g ., African Americans) actually demonstrate more severe symptoms or higher prevalence rates of psychosis compared with other races ( e.g ., Euro-Americans). Because clinicians are the diagnosticians and misinterpretation, bias or other factors may play a role in this trend caution should be used when making inferences about actual rates of psychosis among ethnic minority persons.” Additionally, white middle-class help seekers were offered appointments with psychotherapists almost three times as often as their black working-class counterparts. Women were offered an appointment time in their preferred time range more than men were, though average appointment offer rates were similar between genders (Kugelmass, 2016). These findings collectively show that though we are becoming more culturally sensitive, we have a lot more work to do.

            1.4.7.5. Prescription rights for psychologists . To reduce inappropriate prescribing as described in 1.4.7.2, it has been proposed to allow appropriately trained psychologists the right to prescribe. Psychologists are more likely to utilize both therapy and medication, and so can make the best choice for their patient. The right has already been granted in New Mexico, Louisiana, Guam, the military, the Indian Health Services, and the U.S. Public Health Services. Measures in other states “have been opposed by the American Medical Association and American Psychiatric Association over concerns that inadequate training of psychologists could jeopardize patient safety. Supporters of prescriptive authority for psychologists are quick to point out that there is no evidence to support these concerns” (Smith, 2012).

            1.4.7.6. Prevention science. As a society, we used to wait for a mental or physical health issue to emerge, then scramble to treat it. More recently, medicine and science has taken a prevention stance, identifying the factors that cause specific mental health issues and implementing interventions to stop them from happening, or at least minimize their deleterious effects. Our focus has shifted from individuals to the population. Mental health promotion programs have been instituted with success in schools (Shoshani & Steinmetz, 2014; Weare & Nind, 2011; Berkowitz & Beer, 2007), in the workplace (Czabała, Charzyńska,  & Mroziak, B., 2011), with undergraduate and graduate students (Conley et al., 2017; Bettis et al., 2016), in relation to bullying (Bradshaw, 2015), and with the elderly (Forsman et al., 2011). Many researchers believe it is the ideal time to move from knowledge to action and to expand public mental health initiatives (Wahlbeck, 2015). The growth of positive psychology in the late 1990s has further propelled this movement forward. For more on positive psychology, please see Section 1.1.1.

• Some of the earliest views of mental illness saw it as the work of evil spirts, demons, gods, or witches who took control of the person, and in the Middle Ages it was seen as possession by the Devil and methods such as exorcism, flogging, prayer, the touching of relics, chanting, visiting holy sites, and holy water were used to rid the person of demonic influence.
• During the Renaissance, humanism was on the rise which emphasized human welfare and the uniqueness of the individual and led to an increase in the number of asylums as places of refuge for the mentally ill.
• The 18th to 19th centuries saw the rise of the moral treatment movement followed by the mental hygiene movement.
• The psychological or psychogenic perspective states that emotional or psychological factors are the cause of mental disorders and represented a challenge to the biological perspective which said that mental disorders were akin to physical disorders and had natural causes.
• Psychiatric or psychotropic drugs used to treat mental illness became popular beginning in the 1950s and led to deinstitutionalization or a shift from inpatient to outpatient care.

Section 1.4 Review Questions

• How has mental illness been viewed across time?
• Contrast the moral treatment and mental hygiene movements.
• Contrast the biological or somatogenic perspective with that of the psychological or psychogenic perspective.
• Discuss contemporary trends in relation to the use of drugs to treat mental illness, deinstitutionalization, managed health care, multicultural psychology, prescription rights for psychologists, and prevention science.
• Define the scientific method.
• Outline and describe the steps of the scientific method, defining all key terms.
• Identify and clarify the importance of the three cardinal features of science.
• List the five main research methods used in psychology.
• Describe observational research, listing its advantages and disadvantages.
• Describe case study research, listing its advantages and disadvantages.
• Describe survey research, listing its advantages and disadvantages.
• Describe correlational research, listing its advantages and disadvantages.
• Describe experimental research, listing its advantages and disadvantages.
• State the utility and need for multimethod research.

1.5.1. The Scientific Method

Psychology is the “scientific study of behavior and mental processes.” We will spend quite a lot of time on the behavior and mental processes part throughout this book and in relation to mental disorders. Still, before we proceed, it is prudent to further elaborate on what makes psychology scientific. It is safe to say that most people outside of our discipline or a sister science would be surprised to learn that psychology utilizes the scientific method at all. That may be even truer of clinical psychology, especially in light of the plethora of self-help books found at any bookstore. But yes, the treatment methods used by mental health professionals are based on empirical research and the scientific method.

As a starting point, we should expand on what the scientific method is.

The keyword here is systematic , meaning there is a set way to use it. What is that way? Well, depending on what source you look at, it can include a varying number of steps. I like to use the following:

Table 1.1: The Steps of the Scientific Method

Science has at its root three cardinal features that we will see play out time and time again throughout this book. They are:

• Observation – To know about the world around us, we have to be able to see it firsthand. When a mental disorder afflicts an individual, we can see it through their overt behavior. An individual with depression may withdraw from activities he/she enjoys, those with social anxiety disorder will avoid social situations, people with schizophrenia may express concern over being watched by the government, and individuals with dependent personality disorder may leave major decisions to trusted companions. In these examples and numerous others, the behaviors that lead us to a diagnosis of a specific disorder can easily be observed by the clinician, the patient, and/or family and friends.
• Experimentation – To be able to make causal or cause and effect statements, we must isolate variables. We must manipulate one variable and see the effect of doing so on another variable. Let’s say we want to know if a new treatment for bipolar disorder is as effective as existing treatments, or more importantly, better. We could design a study with three groups of bipolar patients. One group would receive no treatment and serve as a control group. A second group would receive an existing and proven treatment and would also be considered a control group. Finally, the third group would receive the new treatment and be the experimental group. What we are manipulating is what treatment the groups get – no treatment, the older treatment, and the newer treatment. The first two groups serve as controls since we already know what to expect from their results. There should be no change in bipolar disorder symptoms in the no-treatment group, a general reduction in symptoms for the older treatment group, and the same or better performance for the newer treatment group. As long as patients in the newer treatment group do not perform worse than their older treatment counterparts, we can say the new drug is a success. You might wonder why we would get excited about the performance of the new drug being the same as the old drug. Does it really offer any added benefit? In terms of a reduction of symptoms, maybe not, but it could cost less money than the older drug and that would be of value to patients.
• Measurement – How do we know that the new drug has worked? Simply, we can measure the person’s bipolar disorder symptoms before any treatment was implemented, and then again once the treatment has run its course.  This pre-post test design is typical in drug studies.

1.5.2. Research Methods

Step 3 called on the scientist to test his or her hypothesis. Psychology as a discipline uses five main research designs. They are:

            1.5.2.1. Naturalistic and laboratory observation . In terms of naturalistic observation , the scientist studies human or animal behavior in its natural environment, which could include the home, school, or a forest. The researcher counts, measures, and rates behavior in a systematic way and, at times, uses multiple judges to ensure accuracy in how the behavior is being measured. The advantage of this method is that you see behavior as it happens, and the experimenter does not taint the data. The disadvantage is that it could take a long time for the behavior to occur, and if the researcher is detected, then this may influence the behavior of those being observed.

Laboratory observation involves observing people or animals in a laboratory setting. The researcher might want to know more about parent-child interactions, and so, brings a mother and her child into the lab to engage in preplanned tasks such as playing with toys, eating a meal, or the mother leaving the room for a short time. The advantage of this method over the naturalistic method is that the experimenter can use sophisticated equipment to record the session and examine it later. The problem is that since the subjects know the experimenter is watching them, their behavior could become artificial. Clinical observation is a commonly employed research method to study psychopathology; we will talk about it more throughout this book.

            1.5.2.2. Case studies. Psychology can also utilize a detailed description of one person or a small group based on careful observation. This was the approach the founder of psychoanalysis, Sigmund Freud, took to develop his theories. The advantage of this method is that you arrive at a detailed description of the investigated behavior, but the disadvantage is that the findings may be unrepresentative of the larger population, and thus, lacking generalizability . Again, bear in mind that you are studying one person or a tiny group. Can you possibly make conclusions about all people from just one person, or even five or ten? The other issue is that the case study is subject to researcher bias in terms of what is included in the final narrative and what is left out. Despite these limitations, case studies can lead us to novel ideas about the cause of abnormal behavior and help us to study unusual conditions that occur too infrequently to analyze with large sample sizes and in a systematic way.

            1.5.2.3. Surveys/Self-Report data. This is a questionnaire consisting of at least one scale with some questions used to assess a psychological construct of interest such as parenting style, depression, locus of control, or sensation-seeking behavior. It may be administered by paper and pencil or computer. Surveys allow for the collection of large amounts of data quickly, but the actual survey could be tedious for the participant and social desirability , when a participant answers questions dishonestly so that they are seen in a more favorable light, could be an issue. For instance, if you are asking high school students about their sexual activity, they may not give genuine answers for fear that their parents will find out. You could alternatively gather this information via an interview in a structured or unstructured fashion.

            1.5.2.4. Correlational research. This research method examines the relationship between two variables or two groups of variables. A numerical measure of the strength of this relationship is derived, called the correlation coefficient . It can range from -1.00, a perfect inverse relationship in which one variable goes up as the other goes down, to 0 indicating no relationship at all, to +1.00 or a perfect relationship in which as one variable goes up or down so does the other. In terms of a negative correlation, we might say that as a parent becomes more rigid, controlling, and cold, the attachment of the child to parent goes down. In contrast, as a parent becomes warmer, more loving, and provides structure, the child becomes more attached. The advantage of correlational research is that you can correlate anything. The disadvantage is that you can correlate anything, including variables that do not have any relationship with one another. Yes, this is both an advantage and a disadvantage. For instance, we might correlate instances of making peanut butter and jelly sandwiches with someone we are attracted to sitting near us at lunch. Are the two related? Not likely, unless you make a really good PB&J, but then the person is probably only interested in you for food and not companionship. The main issue here is that correlation does not allow you to make a causal statement.

A special form of correlational research is the epidemiological study in which the prevalence and incidence of a disorder in a specific population are measured (See Section 1.2 for definitions).

            1.5.2.5. Experiments. This is a controlled test of a hypothesis in which a researcher manipulates one variable and measures its effect on another variable. The manipulated variable is called the independent variable (IV) , and the one that is measured is called the dependent variable (DV) . In the example under Experimentation in Section 1.5.1, the treatment for bipolar disorder was the IV, while the actual intensity or number of symptoms serve as the DV.  A common feature of experiments is a control group that does not receive the treatment or is not manipulated and an experimental group that does receive the treatment or manipulation. If the experiment includes random assignment , participants have an equal chance of being placed in the control or experimental group. The control group allows the researcher (or teacher) to make a comparison to the experimental group and make a causal statement possible, and stronger. In our experiment, the new treatment should show a marked reduction in the intensity of bipolar symptoms compared to the group receiving no treatment, and perform either at the same level as, or better than, the older treatment. This would be the initial hypothesis made before starting the experiment.

In a drug study, to ensure the participants’ expectations do not affect the final results by giving the researcher what he/she is looking for (in our example, symptoms improve whether the participant is receiving treatment or not), we might use what is called a placebo , or a sugar pill made to look exactly like the pill given to the experimental group. This way, participants all are given something, but cannot figure out what exactly it is. You might say this keeps them honest and allows the results to speak for themselves.

Finally, the study of mental illness does not always afford us a large sample of participants to study, so we have to focus on one individual using a single-subject experimental design . This differs from a case study in the sheer number of strategies available to reduce potential confounding variables , or variables not originally part of the research design but contribute to the results in a meaningful way. One type of single-subject experimental design is the reversal or ABAB design . Kuttler, Myles, and Carson (1998) used social stories to reduce tantrum behavior in two social environments in a 12-year old student diagnosed with autism, Fragile-X syndrome, and intermittent explosive disorder. Using an ABAB design, they found that precursors to tantrum behavior decreased when the social stories were available (B) and increased when the intervention was withdrawn (A). A more recent study (Balakrishnan & Alias, 2017) also established the utility of social stories as a social learning tool for children with autism spectrum disorder (ASD) using an ABAB design. During the baseline phase (A), the four student participants were observed, and data recorded on an observation form. During the treatment phase (B), they listened to the social story and data was recorded in the same manner. Upon completion of the first B, the students returned to A, which was followed one more time by B and the reading of the social story. Once the second treatment phase ended, the participation was monitored again to obtain the outcome. All students showed improvement during the treatment phases in terms of the number of positive peer interactions, but the number of interactions reduced in the absence of social stories. From this, the researchers concluded that the social story led to the increase in positive peer interactions of children with ASD.

            1.5.2.6. Multi-method research. As you have seen above, no single method alone is perfect. All have strengths and limitations. As such, for the psychologist to provide the most precise picture of what is affecting behavior or mental processes, several of these approaches are typically employed at different stages of the research study. This is called multi-method research.

• The scientific method is a systematic method for gathering knowledge about the world around us.
• A systematic explanation of a phenomenon is a theory and our specific, testable prediction is the hypothesis .
• Replication is when we repeat the study to confirm its results.
• Psychology’s five main research designs are observation, case studies, surveys, correlation, and experimentation.
• No single research method alone is perfect – all have strengths and limitations.

Section 1.5 Review Questions

• What is the scientific method and what steps make it up?
• Differentiate theory and hypothesis.
• What are the three cardinal features of science and how do they relate to the study of mental disorders?
• What are the five main research designs used by psychologists? Define each and then state its strengths and limitations.
• What is the advantage of multi-method research?
• Identify and describe the various types of mental health professionals.
• Clarify what it means to communicate findings.
• Identify professional societies in clinical psychology.
• Identify publications in clinical psychology.

1.6.1. Types of Professionals

There are many types of mental health professionals that people may seek out for assistance. They include:

Table 1.2: Types of Mental Health Professionals

For more information on types of mental health professionals, please visit:

https://www.mhanational.org/types-mental-health-professionals

1.6.2. Professional Societies and Journals

One of the functions of science is to communicate findings. Testing hypotheses, developing sound methodology, accurately analyzing data, and drawing sound conclusions are important, but you must tell others what you have done too. This is accomplished by joining professional societies and submitting articles to peer-reviewed journals. Below are some of the organizations and journals relevant to applied behavior analysis.

1.6.2.1. Professional Societies

• Website – https://div12.org/
• Mission Statement – “The mission of the Society of Clinical Psychology is to represent the field of Clinical Psychology through encouragement and support of the integration of clinical psychological science and practice in education, research, application, advocacy and public policy, attending to the importance of diversity.”
• Publications – Clinical Psychology: Science and Practice and the newsletter Clinical Psychology: Science and Practice(quarterly)
• Other Information – Members and student affiliates may join one of eight sections such as clinical emergencies and crises, clinical psychology of women, assessment psychology, and clinical geropsychology
• Website – https://www.clinicalchildpsychology.org/
• Mission Statement – “Our mission is to serve children, adolescents and families with the best possible clinical care based on psychological science. SCCAP strives to integrate scientific and professional aspects of clinical child and adolescent psychology, in that it promotes scientific inquiry, training, and clinical practice related to serving children and their families.”
• Publication – Journal of Clinical Child and Adolescent Psychology
• Website – https://www.aacpsy.org/
• Mission Statement – The American Academy of Clinical Psychology seeks to “recognize and promote advanced competence within Professional Psychology,” “provide a professional community that encourages communication between and among Members and Fellows of the Academy,” “provide opportunities for advanced education in Professional Psychology,” and “expand awareness and availability of AACP Members and Fellows to the public through promotion and education.”
• Publication – Bulletin of the American Academy of Clinical Psychology (newsletter)
• Website – http://www.sscpweb.org/
• Mission Statement – “ The Society for a Science of Clinical Psychology (SSCP) was established in 1966. Its purpose is to affirm and continue to promote the integration of the scientist and the practitioner in training, research, and applied endeavors. Its members represent a diversity of interests and theoretical orientations across clinical psychology. The common bond of the membership is a commitment to empirical research and the ideal that scientific principles should play a role in training, practice, and establishing public policy for health and mental health concerns. SSCP has organizational affiliations with both the American Psychological Association (Section III of Division 12) and the Association for Psychological Science.”
• Other Information – Offers ten awards ranging from early career award, outstanding mentor award, outstanding student teacher award, and outstanding student clinician award.
• Website – http://www.asch.net/
• Mission Statement – “To provide and encourage education programs to further, in every ethical way, the knowledge, understanding, and application of hypnosis in health care; to encourage research and scientific publication in the field of hypnosis; to promote the further recognition and acceptance of hypnosis as an important tool in clinical health care and focus for scientific research; to cooperate with other professional societies that share mutual goals, ethics and interests; and to provide a professional community for those clinicians and researchers who use hypnosis in their work.”
• Publication – American Journal of Clinical Hypnosis
• Other Information – Offers certification in clinical hypnosis

1.6.2.2. Professional Journals

• Website – http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1468-2850
• Published by – American Psychological Association, Division 12
• Description – “ Clinical Psychology: Science and Practice presents cutting-edge developments in the science and practice of clinical psychology and related mental health fields by publishing scholarly articles, primarily involving narrative and systematic reviews as well as meta-analyses related to assessment, intervention, and service delivery.”
• Website – https://www.clinicalchildpsychology.org/JCCAP
• Published by – American Psychological Association, Division 53
• Description – “It publishes original contributions on the following topics: (a) the development and evaluation of assessment and intervention techniques for use with clinical child and adolescent populations; (b) the development and maintenance of clinical child and adolescent problems; (c) cross-cultural and socio-demographic issues that have a clear bearing on clinical child and adolescent psychology in terms of theory, research, or practice; and (d) training and professional practice in clinical child and adolescent psychology, as well as child advocacy.”
• Website – http://www.asch.net/Public/AmericanJournalofClinicalHypnosis.aspx
• Published by – American Society of Clinical Hypnosis
• Description – “The Journal publishes original scientific articles and clinical case reports on hypnosis, as well as reviews of related books and abstracts of the current hypnosis literature.”
• Mental health professionals take on many different forms with different degree requirements, training, and the ability to prescribe mediations.
• Telling others what we have done is achieved by joining professional societies and submitting articles to peer-reviewed journals.

Section 1.6 Review Questions

• Provide a general overview of the types of mental professionals and the degree, training, and ability to prescribe medications that they have.
• Briefly outline professional societies and journals related to clinical psychology and related disciplines.

Module Recap

In Module 1, we undertook a relatively lengthy discussion of what abnormal behavior is by first looking at what normal behavior is. What emerged was a general set of guidelines focused on mental illness as causing dysfunction, distress, deviance, and at times, being dangerous for the afflicted and others around him/her. Then we classified mental disorders in terms of their occurrence, cause, course, prognosis, and treatment. We acknowledged that mental illness is stigmatized in our society and provided a basis for why this occurs and what to do about it. This involved a discussion of the history of mental illness and current views and trends.

Psychology is the scientific study of behavior and mental processes. The word scientific is key as psychology adheres to the strictest aspects of the scientific method and uses five main research designs in its investigation of mental disorders – observation, case study, surveys, correlational research, and experiments. Various mental health professionals use these designs, and societies and journals provide additional means to communicate findings or to be good consumers of psychological inquiry.

It is with this foundation in mind that we move to examine models of abnormality in Module 2.

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Fundamentals of Psychological Disorders - 3rd edition

(17 reviews)

Alexis Bridley, Washington State University

Lee W. Daffin Jr., Washington State University

Copyright Year: 2022

Publisher: Washington State University

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

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

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... read more

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.

Relevance/Longevity rating: 5

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.

Consistency rating: 5

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

Modularity rating: 5

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.

Organization/Structure/Flow rating: 5

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?

Grammatical Errors rating: 5

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... read more

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.

Content Accuracy rating: 5

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.

Clarity rating: 4

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

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... read more

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... read more

Comprehensiveness rating: 4 see less

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.

Cultural Relevance rating: 5

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... read more

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... read more

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

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 ethical issues. The figures and infographics are clear and easy to comprehend.

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... read more

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... read more

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... read more

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... read more

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.

Interface rating: 4

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

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 mental health.

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

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.

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... read more

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.

Table of Contents

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.

About the Contributors

Alexis Bridley , Washington State University

Lee W. Daffin Jr. , Washington State University

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The ECPH Encyclopedia of Psychology pp 1–4 Cite as

Abnormal Psychology

• Yao Shuqiao 2  
• Living reference work entry
• First Online: 01 February 2024

It is the branch of medical psychology that deals with abnormal psychology or abnormal behavior, and is also known as pathological psychology. Based on the principles and methods of psychology, it studies the manifestations, causes, mechanisms, and development laws of abnormal psychology or morbid behavior, and discusses the methods of discrimination and evaluation and the measures of correction and prevention.

Brief History

As early as the fifth to fourth century BC, Hippocrates, an ancient Greek doctor, began to describe and study people’s abnormal psychology, and tried to explain the abnormal phenomena of psychology with simple materialism. He was opposed to treating patients with praying or cursing, arguing that the cause of disease should be found in the body and brain of the patient. In about the first century BC, the ancient Greek doctor Asclepiades was the first to use the terms psychological disorder and mental disorder. Since then and after a long history of development,...

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Further Reading

Compas BE, Gotlib IH (2002) Introduction to Clinical Psychology: Science and Practice. McGraw-Hill, New York

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Yao S-Q, Yang Y-C (2013) Medical Psychology. People’s Medical Publishing House, Beijing

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Xiangya Second Hospital of Central South University, Changsha, China

Yao Shuqiao

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Shuqiao, Y. (2024). Abnormal Psychology. In: The ECPH Encyclopedia of Psychology. Springer, Singapore. https://doi.org/10.1007/978-981-99-6000-2_399-1

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Understanding Psychopathology

Research on psychopathology is at a historical crossroads. New technologies offer the promise of lasting advances in our understanding of the causes of human psychological suffering. Making the best use of these technologies, however, requires an empirically accurate model of psychopathology. Much current research is framed by the model of psychopathology portrayed in current versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000 ). Although the modern DSMs have been fundamental in advancing psychopathology research, recent research also challenges some assumptions made in the DSM—for example, the assumption that all forms of psychopathology are well conceived of as discrete categories. Psychological science has a critical role to play in working through the implications of this research and the challenges it presents. In particular, behavior-genetic, personality, and quantitative-psychological research perspectives can be melded to inform the development of an empirically based model of psychopathology that would constitute an evolution of the DSM.

Psychopathology research is at a historical crossroads. Powerful technologies, such as molecular genetics and sophisticated statistical models, now exist to aid us in our attempts to understand the origins of psychological suffering. To fully exploit these technologies, however, we need to know how to best conceptualize psychopathology. We need an empirically based model of psychopathology that can guide our inquiries into its origins.

Most psychopathology research is currently framed by the system provided in the fourth edition (text revision) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR ; American Psychiatric Association, 2000 ). A number of specific assumptions underlie the classification of all disorders described in the DSM-IV-TR . A cardinal assumption is that mental disorders are categorical: The manual lists a large number of categories of mental disorder, and for each category, a series of criteria for category membership are listed. People are assumed to be either members of these categories or nonmembers; graded degrees of category membership are not permitted. Importantly, the DSM-IV-TR itself acknowledges potential limitations of this categorical approach to conceptualizing psychopathology, noting that ‘‘a categorical approach to classification works best when all members of a diagnostic class are homogenous, when there are clear boundaries between classes, and when the different classes are mutually exclusive’’ (p. xxxi).

Each of these areas has proven problematic for DSM categories. Members of specific diagnostic classes tend to be heterogeneous, boundaries between classes are often unclear, and classes are rarely mutually exclusive. This is the sense in which psychopathology research is at a historical crossroads. DSM -defined categories are the most frequent targets of psychopathological inquiry, yet reliance on DSM -defined categories often results in significant problems in research design and interpretation. To pick a specific example for illustrative purposes, if one wants to understand depression, what should be done about the fact that the boundary between depression and other DSM categories is often unclear (e.g., depression overlaps with dysthymia; Klein & Santiago, 2003 ) and many people who meet criteria for depression meet criteria for other disorders as well (e.g., anxiety disorders; Kessler, DuPont, Berglund, & Wittchen, 1999 )? Is it possible to develop an empirically based approach to psychopathology that could overcome these limitations?

The development of such a system is a tractable goal, and the pursuit of this goal involves integrating a number of areas of inquiry that represent quintessential strengths of psychological science. Some broad outlines of such a system can be seen by tying together recent research findings from these areas: Specifically, research strategies, concepts, and findings from quantitative psychology, behavior genetics, and personality psychology provide the tools needed to develop an empirically based model of psychopathology.

CONTRIBUTIONS OF QUANTITATIVE PSYCHOLOGY TO UNDERSTANDING PSYCHOPATHOLOGY

One prominent movement in psychology during recent decades has been the use of explicit quantitative models to describe and predict psychological phenomena. Quantitative models are sets of mathematical and statistical equations describing and predicting psychological phenomena. Structural-equation models, item-response models, growth-curve models, and other latent-variable models have allowed tremendous increases in the sophistication of theories that can be tested and in the confidence of our conclusions about those theories. These methods also hold promise for understanding psychopathology, because they allow empirical comparison of different classification paradigms. Such paradigms can be represented by different quantitative models, and can be rigorously compared by comparing the fit of those models to psychological data.

Empirical comparisons between different factor models, for example, have indicated that common forms of psychopathology in adults can be understood in terms of a hierarchical factor model ( Krueger & Markon, 2006 ; see Fig. 1 ) that bears a strong resemblance to influential factor models in child-psychopathology research ( Achenbach & Edelbrock, 1984 ). At a high level of the hierarchy, psychopathological variation and covariation are organized by two broad, correlated dimensions, Internalizing and Externalizing. Internalizing psychopathology represents a spectrum of conditions characterized by negative emotion and includes phenomena such as depression, anxiety, and phobias. At a lower level of the hierarchy, the Internalizing spectrum splits into a Distress subspectrum and a Fear subspectrum; the former is characterized by ruminative disorders such as depression and generalized anxiety, the latter by paroxysmal disorders such as phobia and panic disorder. Externalizing psychopathology, in contrast, is characterized by disinhibition; this spectrum includes phenomena such as antisocial behavior and substance-use disorder. This hierarchical model provides a better account of patterns of psychopathology than do many competing factor models, including ones that contain fewer or more factors.

A model of common forms of psychopathology. The numerical values are path coefficients, representing the strength of associations between constructs; stronger relationships are associated with larger values. The data on which the figure is based come from a meta-analysis presented in Krueger and Markon (2006) . Reprinted from ‘‘Reinterpreting comorbidity: A model-based approach to understanding and classifying psychopathology,’’ by Robert F. Krueger and Kristian E. Markon, 2006 , Annual Review of Clinical Psychology , 2, page 126. Copyright 2006 by Annual Reviews ( www.annualreviews.org ). Reprinted with permission.

Recent latent-variable-modeling studies have suggested that, indeed, these common forms of psychopathology are best thought of as continuous, rather than categorical, in nature. Generally speaking, continuous models classify people by locating them along graded dimensions, whereas categorical models classify people into distinct groups. Explicit comparisons of continuous and categorical models of the occurrence and co-occurrence of externalizing disorders indicate that this broad domain of psychopathology is continuous in nature, reflecting a liability or underlying level of risk for disorder that is graded in severity rather than discrete and categorical ( Krueger, Markon, Patrick, & Iacono, 2005 ; Markon & Krueger, 2005 ). Although, to our knowledge, continuous and categorical models of the overarching internalizing domain have not been compared directly, relevant research does exist for specific internalizing syndromes. For example, continuous models of depression have increased validity over categorical models ( Aggen, Neale, and Kendler, 2005 ), and depressive symptoms appear to be continuously distributed ( Hankin, Fraley, Lahey, & Waldman, 2005 ). Finding that common forms of psychopathology are best conceptualized as continuous in nature calls into question the current assumption of the DSM that psychopathology is always categorical.

Continuous models of psychopathology help delineate informativeness (how much a disorder or symptom is indicative of a dimension underlying multiple symptoms or disorders, akin to a factor loading in traditional factor analysis) and severity (where a disorder or symptom is located along a dimension underlying multiple symptoms or disorders). For example, such models delineate these characteristics of different disorders within the Internalizing and Externalizing spectra, as well as the informativeness and severity of specific symptoms with regard to individual disorders. Aggen et al. (2005) , for example, evaluated the informativeness and severity of different symptoms of depression. They demonstrated that the most informative symptoms were depressed mood, lack of interest, and duration greater than 2 weeks. The most severe symptoms, however, were suicidal ideation, inability to concentrate, and feelings of worthlessness. This picture of the differential informativeness and severity of depression symptoms is in contrast to the classification approach taken in the current DSM , in which different symptoms are mostly equal in their usefulness as indicators of disorder categories.

CONTRIBUTIONS OF BEHAVIOR GENETICS TO UNDERSTANDING PSYCHOPATHOLOGY

Models that have proven useful in understanding psychopathology can be extended to include information on genetic and environmental influences. By including data on the relatedness of different individuals in families, similarities in patterns of psychopathology across individuals can be modeled as a function of how related the individuals are. For example, to the extent that distinct patterns of psychopathology are manifested more frequently among genetically related individuals than among unrelated individuals, taking into account potential environmental reasons for resemblance, those patterns reflect genetic influences. Such research thereby helps inform the understanding of psychopathology by incorporating information on the origins, or etiology, of disorders.

Evidence suggests that patterns of etiologic influence on common forms of psychopathology generally mimic observed, or phenotypic, patterns. Kendler, Prescott, Myers, and Neale (2003) modeled patterns of psychopathology among twins and concluded that genetic influences have the same hierarchical internalizing–externalizing factor structure seen phenotypically. Their results indicate, for example, that if one identical twin has one internalizing disorder, his or her twin is more likely to have another internalizing disorder than to have an externalizing disorder, and vice versa. These findings are important because they suggest that etiologic influences on common forms of psychopathology share the same organization as psychopathology itself—psychopathology appears to derive its observed structure from the structure of its underlying etiology. That is, the internalizing and externalizing spectra are observable not only in the phenotypic patterning of mental disorders, but also in the patterning of underlying genetic risk factors for these disorders.

As our understanding of molecular neurobiology and genetics improves, it will also become possible to delineate the physical nature of the biological structures underlying psychopathology and its etiology. A greater understanding of the molecular-genetic substrates of psychopathology will help refine psychopathology models by providing details about the structures underlying the phenotypic organization of psychopathology. In this regard, molecular genetics not only helps explain why psychopathology occurs but also what psychopathology is—how it is best thought about and best organized conceptually. Along these lines, recent research indicates that genes are organized in functional systems of variation—that is, genes are inherited together in sets that parallel the functions of the proteins they encode ( Petkov et al., 2005 ). In the future, it may be possible to link gene-expression variation in these systems to dimensions of psychopathology.

Research on psychopathology framed by dimensions such as those described in this article can help delineate the links between phenotypes and functional genetic systems. For example, Stallings et al. (2005) reported that a composite externalizing index provided stronger evidence for linkage to specific areas of the genome, when compared with separate antisocial and substance-dependence indices used alone. This composite index provided the strongest evidence of genetic linkage in a sample of adolescents and young adults, suggesting that a locus on chromosome 9 increases risk for externalizing psychopathology in general, as opposed to risk for only specific externalizing syndromes.

CONTRIBUTIONS OF PERSONALITY PSYCHOLOGY TO UNDERSTANDING PSYCHOPATHOLOGY

Constructs such as the Internalizing and Externalizing spectrums bear a notable resemblance to personality constructs. Like personality constructs, psychopathology-spectrum constructs organize broad domains of human individual differences and provide theoretical coherence for those domains. In addition to these conceptual parallels, data also link personality constructs per se to the model in Figure 1 in a way that is psychologically meaningful. Internalizing-spectrum disorders are associated with the broad personality domain of negative emotionality or neuroticism, whereas externalizing-spectrum disorders are associated both with constructs in that domain and with constructs in the broad domain of disinhibition—a domain that intersects unconscientiousness and disagreeableness (for a meta-analytic perspective on the structure of these personality constructs, see Markon, Krueger, & Watson, 2005 ; for a recent review of these personality–psychopathology connections, see Krueger, 2005 ). Psychologically speaking, negative emotionality confers risk for disorders in the internalizing spectrum, whereas a combination of negative emotionality and disinhibition confers risk for disorders in the externalizing spectrum. Moreover, these connections extend beyond phenotypic associations. Behavior-genetic research supports a genetic basis for these connections, indicating that personality and psychopathology are linked at an etiological level ( Krueger, 2005 ).

CONCLUSIONS

The modern DSM s have been fundamentally helpful in psychopathology research. They have provided explicit definitions of categories of psychopathology. The research we reviewed would not have been possible without the foundation provided by these definitions. Nevertheless, the research reviewed here also underlines the value of some evolutionary steps in the field’s conceptualization of psychopathology to further psychological research on the subject.

One evolutionary focus is the DSM itself. Psychological scientists have important roles to play in pushing for changes to the DSM . The processes that will eventuate in the publication of the next edition of the DSM ( DSM-V ) are just getting underway (see http://www.dsm5.org/ ), and there are reasons for optimism regarding the scientific bases for DSM-V . For example, a number of conferences have been organized to discuss research agendas to help place DSM-V on solid scientific footing (see, e.g., Widiger, Simonsen, Krueger, Livesley, & Verheul, 2005 , for discussion of a research agenda for personality disorders articulated at one of these conferences).

Yet the DSM is a complex document, shaped in understandable and legitimate ways by considerations that extend beyond psychopathology research per se. To pick a single illustrative example, categories of psychopathology provide labels that are used routinely in facilitating third-party payment for professional services. This record-keeping function of the DSM is conceptually separate from the utility of the DSM as a framework for psychopathology research, but it is no less legitimate. As a result of this understandable multiplicity of influences and purposes, the DSM represents a compromise among diverse considerations.

Such compromises may not optimally serve the needs of the psychopathology research community. As a result, an empirically based model of psychopathology may develop separately from the DSM , to help frame and propel novel research. Some specific steps in developing this kind of model can be gleaned from the current review, and constitute expansions of the conceptual framework represented in Figure 1 . Specifically, it is necessary to better understand the substructure of psychopathology-spectrum concepts such as internalizing and externalizing, and it is also necessary to expand the model beyond these two spectra. This will require developing detailed databases at the symptom level, unconstrained by the a priori assumption that these symptoms are optimally sorted into current DSM categories or sorted by current DSM conventions. For example, close links between personality and psychopathology mean that both sorts of constructs should be covered in such databases. With such data in hand, distinct statistical models corresponding to distinct classification paradigms (e.g., categorical vs. continuous paradigms) can be fit, providing an empirical means of sorting symptoms into syndrome-level constructs and sorting syndromes into broader psychopathology spectra.

In developing such databases, it is also necessary to greatly expand the scope of the model in Figure 1 . The model developed out of attempts to understand the comorbidity (co-occurrence) of the limited subset of DSM disorders that have been the primary focus of epidemiological inquiry; many psychopathology constructs were not included simply because the relevant data do not exist. Expanding the scope of the model requires coverage of a greater diversity of psychopathological symptoms and personality constructs, most likely using samples in which the prevalence of diverse forms of maladaptive behavior is higher than in the community-dwelling population (e.g., treatment-seeking samples).

Such an expanded and more detailed model would logically lead to novel questions in both treatment-oriented and etiologically oriented psychopathology research. With regard to studies of treatment, one could ask if interventions are impacting specific symptoms, specific syndromes, or broad spectra. Parallel questions would emerge in attempting to understand the etiology of psychopathology. For example, do specific genetic polymorphisms (distinct forms of genes) influence details of symptom presentation or overall risk for a broad spectrum of psychopathologies?

The development of this kind of empirically based model of psychopathology—separate from the DSM —might be viewed as unfortunate, in the sense that it might further separate science and practice. Yet it may also be a necessary step in realizing the promise of psychological science as a foundation for developing effective means to alleviate human suffering.

Recommended Reading

Kendler, K.S., Prescott, C.A., Myers, J., & Neale, M.C. (2003) . (See References)

Krueger, R.F., & Markon, K. (2006) . (See References)

Widiger, T.A., & Samuel, D.B. (2005). Diagnostic categories or dimensions? A question for the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition. Journal of Abnormal Psychology , 114 , 494–504.

Acknowledgments

Preparation of this paper was supported in part by U.S. Public Health Service Grant MH65137.

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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.

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Get 10% off with 24start discount code, 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.

Read more about Abnormal Psychology:

• History of Abnormal Psychology
• Assessment and Research
• Diagnosis and Treatment

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Revolutionizing the Study of Mental Disorders

March 27, 2024 • Feature Story • 75th Anniversary

At a Glance:

• The Research Domain Criteria framework (RDoC) was created in 2010 by the National Institute of Mental Health.
• The framework encourages researchers to examine functional processes that are implemented by the brain on a continuum from normal to abnormal.
• This way of researching mental disorders can help overcome inherent limitations in using all-or-nothing diagnostic systems for research.
• Researchers worldwide have taken up the principles of RDoC.
• The framework continues to evolve and update as new information becomes available.

President George H. W. Bush proclaimed  the 1990s “ The Decade of the Brain  ,” urging the National Institutes of Health, the National Institute of Mental Health (NIMH), and others to raise awareness about the benefits of brain research.

“Over the years, our understanding of the brain—how it works, what goes wrong when it is injured or diseased—has increased dramatically. However, we still have much more to learn,” read the president’s proclamation. “The need for continued study of the brain is compelling: millions of Americans are affected each year by disorders of the brain…Today, these individuals and their families are justifiably hopeful, for a new era of discovery is dawning in brain research.”

Still, despite the explosion of new techniques and tools for studying the brain, such as functional magnetic resonance imaging (fMRI), many mental health researchers were growing frustrated that their field was not progressing as quickly as they had hoped.

For decades, researchers have studied mental disorders using diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (DSM)—a handbook that lists the symptoms of mental disorders and the criteria for diagnosing a person with a disorder. But, among many researchers, suspicion was growing that the system used to diagnose mental disorders may not be the best way to study them.

“There are many benefits to using the DSM in medical settings—it provides reliability and ease of diagnosis. It also provides a clear-cut diagnosis for patients, which can be necessary to request insurance-based coverage of healthcare or job- or school-based accommodations,” said Bruce Cuthbert, Ph.D., who headed the workgroup that developed NIMH’s Research Domain Criteria Initiative. “However, when used in research, this approach is not always ideal.”

Researchers would often test people with a specific diagnosed DSM disorder against those with a different disorder or with no disorder and see how the groups differed. However, different mental disorders can have similar symptoms, and people can be diagnosed with several different disorders simultaneously. In addition, a diagnosis using the DSM is all or none—patients either qualify for the disorder based on their number of symptoms, or they don’t. This black-and-white approach means there may be people who experience symptoms of a mental disorder but just miss the cutoff for diagnosis.

Dr. Cuthbert, who is now the senior member of the RDoC Unit which orchestrates RDoC work, stated that “Diagnostic systems are based on clinical signs and symptoms, but signs and symptoms can’t really tell us much about what is going on in the brain or the underlying causes of a disorder. With modern neuroscience, we were seeing that information on genetic, pathophysiological, and psychological causes of mental disorders did not line up well with the current diagnostic disorder categories, suggesting that there were central processes that relate to mental disorders that were not being reflected in DMS-based research.”

Road to evolution

Concerned about the limits of using the DSM for research, Dr. Cuthbert, a professor of clinical psychology at the University of Minnesota at the time, approached Dr. Thomas Insel (then NIMH director) during a conference in the autumn of 2008. Dr. Cuthbert recalled saying, “I think it’s really important that we start looking at dimensions of functions related to mental disorders such as fear, working memory, and reward systems because we know that these dimensions cut across various disorders. I think NIMH really needs to think about mental disorders in this new way.”

Dr. Cuthbert didn’t know it then, but he was suggesting something similar to ideas that NIMH was considering. Just months earlier, Dr. Insel had spearheaded the inclusion of a goal in NIMH’s 2008 Strategic Plan for Research to “develop, for research purposes, new ways of classifying mental disorders based on dimensions of observable behavior and neurobiological measures.”

Unaware of the new strategic goal, Dr. Cuthbert was surprised when Dr. Insel's senior advisor, Marlene Guzman, called a few weeks later to ask if he’d be interested in taking a sabbatical to help lead this new effort. Dr. Cuthbert soon transitioned into a full-time NIMH employee, joining the Institute at an exciting time to lead the development of what became known as the Research Domain Criteria (RDoC) Framework. The effort began in 2009 with the creation of an internal working group of interdisciplinary NIMH staff who identified core functional areas that could be used as examples of what research using this new conceptual framework looked like.

The workgroup members conceived a bold change in how investigators studied mental disorders.

“We wanted researchers to transition from looking at mental disorders as all or none diagnoses based on groups of symptoms. Instead, we wanted to encourage researchers to understand how basic core functions of the brain—like fear processing and reward processing—work at a biological and behavioral level and how these core functions contribute to mental disorders,” said Dr. Cuthbert.

This approach would incorporate biological and behavioral measures of mental disorders and examine processes that cut across and apply to all mental disorders. From Dr. Cuthbert’s standpoint, this could help remedy some of the frustrations mental health researchers were experiencing.

Around the same time the workgroup was sharing its plans and organizing the first steps, Sarah Morris, Ph.D., was a researcher focusing on schizophrenia at the University of Maryland School of Medicine in Baltimore. When she first read these papers, she wondered what this new approach would mean for her research, her grants, and her lab.

She also remembered feeling that this new approach reflected what she was seeing in her data.

“When I grouped my participants by those with and without schizophrenia, there was a lot of overlap, and there was a lot of variability across the board, and so it felt like RDoC provided the pathway forward to dissect that and sort it out,” said Dr. Morris.

Later that year, Dr. Morris joined NIMH and the RDoC workgroup, saying, “I was bumping up against a wall every day in my own work and in the data in front of me. And the idea that someone would give the field permission to try something new—that was super exciting.”

The five original RDoC domains of functioning were introduced to the broader scientific community in a series of articles published in 2010  .

To establish the new framework, the RDoC workgroup (including Drs. Cuthbert and Morris) began a series of workshops in 2011 to collect feedback from experts in various areas from the larger scientific community. Five workshops were held over the next two years, each with a different broad domain of functioning based upon prior basic behavioral neuroscience. The five domains were called:

• Negative valence (which included processes related to things like fear, threat, and loss)
• Positive valence (which included processes related to working for rewards and appreciating rewards)
• Cognitive processes
• Social processes
• Arousal and regulation processes (including arousal systems for the body and sleep).

At each workshop, experts defined several specific functions, termed constructs, that fell within the domain of interest. For instance, constructs in the cognitive processes domain included attention, memory, cognitive control, and others.

The result of these feedback sessions was a framework that described mental disorders as the interaction between different functional processes—processes that could occur on a continuum from normal to abnormal. Researchers could measure these functional processes in a variety of complementary ways—for example, by looking at genes associated with these processes, the brain circuits that implement these processes, tests or observations of behaviors that represent these functional processes, and what patients report about their concerns. Also included in the framework was an understanding that functional processes associated with mental disorders are impacted and altered by the environment and a person’s developmental stage.

Preserving momentum

Over time, the Framework continued evolving and adapting to the changing science. In 2018, a sixth functional area called sensorimotor processes was added to the Framework, and in 2019, a workshop was held to better incorporate developmental and environmental processes into the framework.;

Since its creation, the use of RDoC principles in mental health research has spread across the U.S. and the rest of the world. For example, the Psychiatric Ratings using Intermediate Stratified Markers project (PRISM)   , which receives funding from the European Union’s Innovative Medicines Initiative, is seeking to link biological markers of social withdrawal with clinical diagnoses using RDoC-style principles. Similarly, the Roadmap for Mental Health Research in Europe (ROAMER)   project by the European Commission sought to integrate mental health research across Europe using principles similar to those in the RDoC Framework.;

Dr. Morris, who has acceded to the Head of the RDoC Unit, commented: “The fact that investigators and science funders outside the United States are also pursuing similar approaches gives me confidence that we’ve been on the right pathway. I just think that this has got to be how nature works and that we are in better alignment with the basic fundamental processes that are of interest to understanding mental disorders.”

The RDoC framework will continue to adapt and change with emerging science to remain relevant as a resource for researchers now and in the future. For instance, NIMH continues to work toward the development and optimization of tools to assess RDoC constructs and supports data-driven efforts to measure function within and across domains.

“For the millions of people impacted by mental disorders, research means hope. The RDoC framework helps us study mental disorders in a different way and has already driven considerable change in the field over the past decade,” said Joshua A. Gordon, M.D., Ph.D., director of NIMH. “We hope this and other innovative approaches will continue to accelerate research progress, paving the way for prevention, recovery, and cure.”

Publications

Cuthbert, B. N., & Insel, T. R. (2013). Toward the future of psychiatric diagnosis: The seven pillars of RDoC. BMC Medicine , 11 , 126. https://doi.org/10.1186/1741-7015-11-126  

Cuthbert B. N. (2014). Translating intermediate phenotypes to psychopathology: The NIMH Research Domain Criteria. Psychophysiology , 51 (12), 1205–1206. https://doi.org/10.1111/psyp.12342  

Cuthbert, B., & Insel, T. (2010). The data of diagnosis: New approaches to psychiatric classification. Psychiatry , 73 (4), 311–314. https://doi.org/10.1521/psyc.2010.73.4.311  

Cuthbert, B. N., & Kozak, M. J. (2013). Constructing constructs for psychopathology: The NIMH research domain criteria. Journal of Abnormal Psychology , 122 (3), 928–937. https://doi.org/10.1037/a0034028  

Garvey, M. A., & Cuthbert, B. N. (2017). Developing a motor systems domain for the NIMH RDoC program.  Schizophrenia Bulletin , 43 (5), 935–936. https://doi.org/10.1093/schbul/sbx095  

Insel, T. (2013). Transforming diagnosis . http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

Kozak, M. J., & Cuthbert, B. N. (2016). The NIMH Research Domain Criteria initiative: Background, issues, and pragmatics. Psychophysiology , 53 (3), 286–297. https://doi.org/10.1111/psyp.12518  

Morris, S. E., & Cuthbert, B. N. (2012). Research Domain Criteria: Cognitive systems, neural circuits, and dimensions of behavior. Dialogues in Clinical Neuroscience , 14 (1), 29–37. https://doi.org/10.31887/DCNS.2012.14.1/smorris  

Sanislow, C. A., Pine, D. S., Quinn, K. J., Kozak, M. J., Garvey, M. A., Heinssen, R. K., Wang, P. S., & Cuthbert, B. N. (2010). Developing constructs for psychopathology research: Research domain criteria. Journal of Abnormal Psychology , 119 (4), 631–639. https://doi.org/10.1037/a0020909  

• Presidential Proclamation 6158 (The Decade of the Brain) 
• Research Domain Criteria Initiative website
• Psychiatric Ratings using Intermediate Stratified Markers (PRISM)  
• Roadmap for Mental Health Research in Europe (ROAMER)  

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.

• www.simplypsychology.org
• www.newworldencyclopedia.org
• www.britannica.com
• www.bbc.co.uk
• www.famousscientists.org
• www.courses.lumenlearning.com
• www.psychologytoday.com
• www.consumer.healthday.com

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Learning Objectives

By the end of this section, you will be able to:

• Describe the different research methods used by psychologists
• Discuss the strengths and weaknesses of case studies, naturalistic observation, surveys, and archival research
• Compare longitudinal and cross-sectional approaches to research

There are many research methods available to psychologists in their efforts to understand, describe, and explain behavior and the cognitive and biological processes that underlie it. Some methods rely on observational techniques. Other approaches involve interactions between the researcher and the individuals who are being studied—ranging from a series of simple questions to extensive, in-depth interviews—to well-controlled experiments.

Each of these research methods has unique strengths and weaknesses, and each method may only be appropriate for certain types of research questions. For example, studies that rely primarily on observation produce incredible amounts of information, but the ability to apply this information to the larger population is somewhat limited because of small sample sizes. Survey research, on the other hand, allows researchers to easily collect data from relatively large samples. While this allows for results to be generalized to the larger population more easily, the information that can be collected on any given survey is somewhat limited and subject to problems associated with any type of self-reported data. Some researchers conduct archival research by using existing records. While this can be a fairly inexpensive way to collect data that can provide insight into a number of research questions, researchers using this approach have no control on how or what kind of data was collected. All of the methods described thus far are correlational in nature. This means that researchers can speak to important relationships that might exist between two or more variables of interest. However, correlational data cannot be used to make claims about cause-and-effect relationships.

Correlational research can find a relationship between two variables, but the only way a researcher can claim that the relationship between the variables is cause and effect is to perform an experiment. In experimental research, which will be discussed later in this chapter, there is a tremendous amount of control over variables of interest. While this is a powerful approach, experiments are often conducted in very artificial settings. This calls into question the validity of experimental findings with regard to how they would apply in real-world settings. In addition, many of the questions that psychologists would like to answer cannot be pursued through experimental research because of ethical concerns.

CLINICAL OR CASE STUDIES

In 2011, the New York Times published a feature story on Krista and Tatiana Hogan, Canadian twin girls. These particular twins are unique because Krista and Tatiana are conjoined twins, connected at the head. There is evidence that the two girls are connected in a part of the brain called the thalamus, which is a major sensory relay center. Most incoming sensory information is sent through the thalamus before reaching higher regions of the cerebral cortex for processing.

Link to Learning

To learn more about Krista and Tatiana, watch this New York Times video  about their lives.

The implications of this potential connection mean that it might be possible for one twin to experience the sensations of the other twin. For instance, if Krista is watching a particularly funny television program, Tatiana might smile or laugh even if she is not watching the program. This particular possibility has piqued the interest of many neuroscientists who seek to understand how the brain uses sensory information.

These twins represent an enormous resource in the study of the brain, and since their condition is very rare, it is likely that as long as their family agrees, scientists will follow these girls very closely throughout their lives to gain as much information as possible (Dominus, 2011).

In observational research, scientists are conducting a clinical or case study when they focus on one person or just a few individuals. Indeed, some scientists spend their entire careers studying just 10–20 individuals. Why would they do this? Obviously, when they focus their attention on a very small number of people, they can gain a tremendous amount of insight into those cases. The richness of information that is collected in clinical or case studies is unmatched by any other single research method. This allows the researcher to have a very deep understanding of the individuals and the particular phenomenon being studied.

If clinical or case studies provide so much information, why are they not more frequent among researchers? As it turns out, the major benefit of this particular approach is also a weakness. As mentioned earlier, this approach is often used when studying individuals who are interesting to researchers because they have a rare characteristic. Therefore, the individuals who serve as the focus of case studies are not like most other people. If scientists ultimately want to explain all behavior, focusing attention on such a special group of people can make it difficult to generalize any observations to the larger population as a whole. Generalizing refers to the ability to apply the findings of a particular research project to larger segments of society. Again, case studies provide enormous amounts of information, but since the cases are so specific, the potential to apply what’s learned to the average person may be very limited.

NATURALISTIC OBSERVATION

If you want to understand how behavior occurs, one of the best ways to gain information is to simply observe the behavior in its natural context. However, people might change their behavior in unexpected ways if they know they are being observed. How do researchers obtain accurate information when people tend to hide their natural behavior? As an example, imagine that your professor asks everyone in your class to raise their hand if they always wash their hands after using the restroom. Chances are that almost everyone in the classroom will raise their hand, but do you think hand washing after every trip to the restroom is really that universal?

This is very similar to the phenomenon mentioned earlier in this chapter: many individuals do not feel comfortable answering a question honestly. But if we are committed to finding out the facts about hand washing, we have other options available to us.

Suppose we send a classmate into the restroom to actually watch whether everyone washes their hands after using the restroom. Will our observer blend into the restroom environment by wearing a white lab coat, sitting with a clipboard, and staring at the sinks? We want our researcher to be inconspicuous—perhaps standing at one of the sinks pretending to put in contact lenses while secretly recording the relevant information. This type of observational study is called naturalistic observation : observing behavior in its natural setting. To better understand peer exclusion, Suzanne Fanger collaborated with colleagues at the University of Texas to observe the behavior of preschool children on a playground. How did the observers remain inconspicuous over the duration of the study? They equipped a few of the children with wireless microphones (which the children quickly forgot about) and observed while taking notes from a distance. Also, the children in that particular preschool (a “laboratory preschool”) were accustomed to having observers on the playground (Fanger, Frankel, Hazen, 2012).

It is critical that the observer be as unobtrusive and as inconspicuous as possible: when people know they are being watched, they are less likely to behave naturally. If you have any doubt about this, ask yourself how your driving behavior might differ in two situations: In the first situation, you are driving down a deserted highway during the middle of the day; in the second situation, you are being followed by a police car down the same deserted highway ( Figure 1.7 ).

Figure 1.7 Seeing a police car behind you would probably affect your driving behavior. (credit: Michael Gil)

It should be pointed out that naturalistic observation is not limited to research involving humans. Indeed, some of the best-known examples of naturalistic observation involve researchers going into the field to observe various kinds of animals in their own environments. As with human studies, the researchers maintain their distance and avoid interfering with the animal subjects so as not to influence their natural behaviors. Scientists have used this technique to study social hierarchies and interactions among animals ranging from ground squirrels to gorillas. The information provided by these studies is invaluable in understanding how those animals organize socially and communicate with one another. The anthropologist Jane Goodall, for example, spent nearly five decades observing the behavior of chimpanzees in Africa ( Figure 1.8 ). As an illustration of the types of concerns that a researcher might encounter in naturalistic observation, some scientists criticized Goodall for giving the chimps names instead of referring to them by numbers—using names was thought to undermine the emotional detachment required for the objectivity of the study (McKie, 2010).

Figure 1.8 (a) Jane Goodall made a career of conducting naturalistic observations of (b) chimpanzee behavior. (credit “Jane Goodall”: modification of work by Erik Hersman; “chimpanzee”: modification of work by “Afrika Force”/Flickr.com)

The greatest benefit of naturalistic observation is the validity, or accuracy, of information collected unobtrusively in a natural setting. Having individuals behave as they normally would in a given situation means that we have a higher degree of ecological validity, or realism, than we might achieve with other research approaches. Therefore, our ability to generalize the findings of the research to real-world situations is enhanced. If done correctly, we need not worry about people or animals modifying their behavior simply because they are being observed. Sometimes, people may assume that reality programs give us a glimpse into authentic human behavior. However, the principle of inconspicuous observation is violated as reality stars are followed by camera crews and are interviewed on camera for personal confessionals. Given that environment, we must doubt how natural and realistic their behaviors are.

The major downside of naturalistic observation is that they are often difficult to set up and control. In our restroom study, what if you stood in the restroom all day prepared to record people’s hand washing behavior and no one came in? Or, what if you have been closely observing a troop of gorillas for weeks only to find that they migrated to a new place while you were sleeping in your tent? The benefit of realistic data comes at a cost. As a researcher you have no control of when (or if) you have behavior to observe. In addition, this type of observational research often requires significant investments of time, money, and a good dose of luck.

Sometimes studies involve structured observation. In these cases, people are observed while engaging in set, specific tasks. An excellent example of structured observation comes from Strange Situation by Mary Ainsworth (you will read more about this in the chapter on lifespan development). The Strange Situation is a procedure used to evaluate attachment styles that exist between an infant and caregiver. In this scenario, caregivers bring their infants into a room filled with toys. The Strange Situation involves a number of phases, including a stranger coming into the room, the caregiver leaving the room, and the caregiver’s return to the room. The infant’s behavior is closely monitored at each phase, but it is the behavior of the infant upon being reunited with the caregiver that is most telling in terms of characterizing the infant’s attachment style with the caregiver.

Another potential problem in observational research is observer bias . Generally, people who act as observers are closely involved in the research project and may unconsciously skew their observations to fit their research goals or expectations. To protect against this type of bias, researchers should have clear criteria established for the types of behaviors recorded and how those behaviors should be classified. In addition, researchers often compare observations of the same event by multiple observers, in order to test inter-rater reliability : a measure of reliability that assesses the consistency of observations by different observers.

Often, psychologists develop surveys as a means of gathering data. Surveys are lists of questions to be answered by research participants, and can be delivered as paper-and-pencil questionnaires, administered electronically, or conducted verbally ( Figure  1 .9 ). Generally, the survey itself can be completed in a short time, and the ease of administering a survey makes it easy to collect data from a large number of people.

Surveys allow researchers to gather data from larger samples than may be afforded by other research methods . A sample is a subset of individuals selected from a population , which is the overall group of individuals that the researchers are interested in. Researchers study the sample and seek to generalize their findings to the population.

Figure 1.9 Surveys can be administered in a number of ways, including electronically administered research, like the survey shown here. (credit: Robert Nyman)

There is both strength and weakness of the survey in comparison to case studies. By using surveys, we can collect information from a larger sample of people. A larger sample is better able to reflect the actual diversity of the population, thus allowing better generalizability. Therefore, if our sample is sufficiently large and diverse, we can assume that the data we collect from the survey can be generalized to the larger population with more certainty than the information collected through a case study. However, given the greater number of people involved, we are not able to collect the same depth of information on each person that would be collected in a case study.

Another potential weakness of surveys is something we touched on earlier in this chapter: People don’t always give accurate responses. They may lie, misremember, or answer questions in a way that they think makes them look good. For example, people may report drinking less alcohol than is actually the case.

Any number of research questions can be answered through the use of surveys. One real-world example is the research conducted by Jenkins, Ruppel, Kizer, Yehl, and Griffin (2012) about the backlash against the US Arab-American community following the terrorist attacks of September 11, 2001. Jenkins and colleagues wanted to determine to what extent these negative attitudes toward Arab-Americans still existed nearly a decade after the attacks occurred. In one study, 140 research participants filled out a survey with 10 questions, including questions asking directly about the participant’s overt prejudicial attitudes toward people of various ethnicities. The survey also asked indirect questions about how likely the participant would be to interact with a person of a given ethnicity in a variety of settings (such as, “How likely do you think it is that you would introduce yourself to a person of Arab-American descent?”). The results of the research suggested that participants were unwilling to report prejudicial attitudes toward any ethnic group. However, there were significant differences between their pattern of responses to questions about social interaction with Arab-Americans compared to other ethnic groups: they indicated less willingness for social interaction with Arab-Americans compared to the other ethnic groups. This suggested that the participants harbored subtle forms of prejudice against Arab-Americans, despite their assertions that this was not the case (Jenkins et al., 2012).

ARCHIVAL RESEARCH

Some researchers gain access to large amounts of data without interacting with a single research participant. Instead, they use existing records to answer various research questions. This type of research approach is known as archival research . Archival research relies on looking at past records or data sets to look for interesting patterns or relationships.

For example, a researcher might access the academic records of all individuals who enrolled in college within the past ten years and calculate how long it took them to complete their degrees, as well as course loads, grades, and extracurricular involvement. Archival research could provide important information about who is most likely to complete their education, and it could help identify important risk factors for struggling students ( Figure 1.10 ).

Figure 1.10 A researcher doing archival research examines records, whether archived as a (a) hardcopy or (b) electronically. (credit “paper files”: modification of work by “Newtown graffiti”/Flickr; “computer”: modification of work by INPIVIC Family/Flickr)

In comparing archival research to other research methods, there are several important distinctions. For one, the researcher employing archival research never directly interacts with research participants. Therefore, the investment of time and money to collect data is considerably less with archival research. Additionally, researchers have no control over what information was originally collected. Therefore, research questions have to be tailored so they can be answered within the structure of the existing data sets. There is also no guarantee of consistency between the records from one source to another, which might make comparing and contrasting different data sets problematic.

LONGITUDINAL AND CROSS-SECTIONAL RESEARCH

Sometimes we want to see how people change over time, as in studies of human development and lifespan. When we test the same group of individuals repeatedly over an extended period of time, we are conducting longitudinal research. Longitudinal research is a research design in which data-gathering is administered repeatedly over an extended period of time. For example, we may survey a group of individuals about their dietary habits at age 20, retest them a decade later at age 30, and then again at age 40.

Another approach is cross-sectional research. In cross-sectional research , a researcher compares multiple segments of the population at the same time. Using the dietary habits example above, the researcher might directly compare different groups of people by age. Instead a group of people for 20 years to see how their dietary habits changed from decade to decade, the researcher would study a group of 20-year-old individuals and compare them to a group of 30-year-old individuals and a group of 40-year- old individuals. While cross-sectional research requires a shorter-term investment, it is also limited by differences that exist between the different generations (or cohorts) that have nothing to do with age per se, but rather reflect the social and cultural experiences of different generations of individuals make them different from one another.

To illustrate this concept, consider the following survey findings. In recent years there has been significant growth in the popular support of same-sex marriage. Many studies on this topic break down survey participants into different age groups. In general, younger people are more supportive of same-sex marriage than are those who are older (Jones, 2013). Does this mean that as we age we become less open to the idea of same-sex marriage, or does this mean that older individuals have different perspectives because of the social climates in which they grew up? Longitudinal research is a powerful approach because the same individuals are involved in the research project over time, which means that the researchers need to be less concerned with differences among cohorts affecting the results of their study.

Often longitudinal studies are employed when researching various diseases in an effort to understand particular risk factors. Such studies often involve tens of thousands of individuals who are followed for several decades. Given the enormous number of people involved in these studies, researchers can feel confident that their findings can be generalized to the larger population. The Cancer Prevention Study-3 (CPS-3) is one of a series of longitudinal studies sponsored by the American Cancer Society aimed at determining predictive risk factors associated with cancer. When participants enter the study, they complete a survey about their lives and family histories, providing information on factors that might cause or prevent the development of cancer. Then every few years the participants receive additional surveys to complete. In the end, hundreds of thousands of participants will be tracked over 20 years to determine which of them develop cancer and which do not.

Clearly, this type of research is important and potentially very informative. For instance, earlier longitudinal studies sponsored by the American Cancer Society provided some of the first scientific demonstrations of the now well-established links between increased rates of cancer and smoking (American Cancer Society, n.d.) ( Figure 1.11 ).

Figure 1.11 Longitudinal research like the CPS-3 help us to better understand how smoking is associated with cancer and other diseases. (credit: CDC/Debora Cartagena)

As with any research strategy, longitudinal research is not without limitations. For one, these studies require an incredible time investment by the researcher and research participants. Given that some longitudinal studies take years, if not decades, to complete, the results will not be known for a considerable period of time. In addition to the time demands, these studies also require a substantial financial investment. Many researchers are unable to commit the resources necessary to see a longitudinal project through to the end.

Research participants must also be willing to continue their participation for an extended period of time, and this can be problematic. People move, get married and take new names, get ill, and eventually die. Even without significant life changes, some people may simply choose to discontinue their participation in the project. As a result, the attrition rates, or reduction in the number of research participants due to dropouts, in longitudinal studies are quite high and increases over the course of a project. For this reason, researchers using this approach typically recruit many participants fully expecting that a substantial number will drop out before the end. As the study progresses, they continually check whether the sample still represents the larger population, and make adjustments as necessary.

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Module 2: Research and Ethics in Abnormal Psychology

Descriptive and epidemiological research, learning objectives.

• Describe how archival, longitudinal, cross-sectional, and epidemiological research are valuable to abnormal psychology
• Differentiate between prevalence and incidence

Archival Research

Some researchers gain access to large amounts of data without interacting with a single research participant. Instead, they use existing records to answer various research questions. This type of research approach is known as archival research. Archival research relies on looking at past records or data sets to look for interesting patterns or relationships.

Archival research is generally more complex and time-consuming than research that involves the summary, collation and/or synthesis of existing research, and it is frequently also undertaken in other disciplines within the social sciences, including psychology. For example, a psychologist may seek out and extract evidence from original mental institution records from the 1900s in order to determine the prevalence of depressive symptoms in patients at the time. There has been much speculation about modern environments causing an epidemic of depression. [1] Archival research could provide important information about the increasing prevalence (Figure 1).

Figure 1 . A researcher doing archival research examines records, whether archived (a) physically or (b) electronically. (credit “paper files”: modification of work by “Newtown graffiti”/Flickr; “computer”: modification of work by INPIVIC Family/Flickr)

In comparing archival research to other research methods, there are several important advantages and disadvantages.

Advantages of Archival Research

• Archival research minimizes the response biases of subjects because the researcher is not present while the data is recorded.
• Archival data is very plentiful and has already been collected. This makes it easier and often less costly than alternative research methods.
• Archival research is effective in helping to confirm that the results and theories derived from experiments reflect the “real world” and do not just exist in artificial or simplistic laboratory settings.
• This approach can help researchers create new ideas for hypotheses and experiments.

Limitations of Archival Research

• Not all archives endure, and those that do not may not have been randomly lost. When the survival of records is selective, there may be bias in the remaining archival data.
• People make mistakes in entering data in archives or there may be biases when data is recorded. For example, suicides may be recorded as accidental deaths to help maintain the privacy of the victims’ families.
• Sometimes definitions change so that even though long‐term records use the same label, what is being included may change over time. For example, the definition of family may change from comprising a mother, a father, and children to same‐sex couples or single‐parent families.
• Perhaps most importantly, we cannot conclude causal relations from archival research. After all, the researcher did not control and manipulate the variables that may have played a role. Because the data were not assembled to answer a particular research question, it might not be exactly the data the researcher requires.

Longitudinal and Cross-Sectional Research

Sometimes we want to see how people change over time. When we test the same group of individuals repeatedly over an extended period of time, we are conducting longitudinal research. Longitudinal research is a research design in which data-gathering is administered repeatedly over an extended period of time. For example, we may survey a group of individuals about their dietary habits at age 20; retest them a decade later at age 30; and then again at ages 40, 50, and 60 to possibly find correlations between diet and early-onset dementia. In this case, the longitudinal design is used to uncover risk factors of certain diseases, like Alzheimer’s. Longitudinal studies are also used in social-personality and clinical psychology to study rapid fluctuations in behaviors, thoughts, and emotions from moment to moment or day to day.

Another approach is cross-sectional research. In cross-sectional research, a researcher compares multiple segments of the population at the same time. Using the dietary habits example above, the researcher might directly compare different groups of people by age. Instead of observing a group of people for 20 years to see how their dietary habits changed from decade to decade, the researcher would study a group of 20-year-old individuals and compare them to a group of 30-year-old individuals and then to a group of 40-year-old individuals, and so on. While cross-sectional research requires a shorter-term investment, it is also limited by differences that exist between the different generations (or cohorts) that have nothing to do with age per se, but rather reflect the social and cultural experiences of different generations of individuals that make them different from one another.

Longitudinal research is a powerful approach because the same individuals are involved in the research project over time, which means that the researchers need to be less concerned with differences among cohorts affecting the results of their study.  Often longitudinal studies are employed when researching various mental disorders in an effort to understand particular risk factors. Such studies often involve tens of thousands of individuals who are followed for several decades. Given the enormous number of people involved in these studies, researchers can feel confident that their findings can be generalized to the larger population.

To illustrate this concept, consider the following research tracked by  Alzheimer’s Disease Neuroimaging Initiative  (ADNI). Alzheimer’s Disease Neuroimaging Initiative (ADNI) is a multisite study that aims to improve clinical trials for the prevention and treatment of Alzheimer’s disease (AD). Researchers at 63 sites in the U.S. and Canada track the progression of Alzheimer’s disease (AD) in the human brain with neuroimaging, biochemical, and genetic biological markers.  This knowledge helps to d etect the  earliest signs of Alzheimer’s disease (AD)  and to track the disease, to  find better clinical trials for the prevention and treatment of AD, and  to make all data and samples available for sharing with clinical trial designers and scientists worldwide. Alzheimer’s Disease Neuroimaging Initiative (ADNI) enrolls participants between the ages of 55 and 90 who are recruited at 57 sites in the U.S. and Canada. One group has dementia due to AD, another group has mild memory problems known as mild cognitive impairment (MCI), and the final control group consists of healthy elderly participants.  Studies using ADNI cross-sectional and longitudinal MRI, PET, genetics, cognitive, biological fluid, and autopsy data have reported that  AD pathology is already present in people with no outward sign of memory loss. These cognitively normal people may already have subtle brain atrophy.

Cohort studies  are one type of longitudinal study that samples a  cohort  (a group of people who share a defining characteristic, typically who experienced a common event in a selected period, such as birth or graduation) and perform cross-section observations at intervals through time. The Minnesota Center for Twin and Family Research (or MCTFR) is a series of behavioral genetic longitudinal studies of families with twin or adoptive offspring conducted by researchers at the University of Minnesota. It seeks to identify and characterize the genetic and environmental influences on the development of psychological traits. The primary cohorts of participants include the Minnesota Twin Family Study, Sibling Interaction and Behavior Study, Minnesota Twin Registry, and a variety of other cohorts of participants.

In twin studies, researchers identify individuals with a specific disorder who are members of an MZ or a DZ twin pair and then study the other twin in the pairs. The Minnesota Twin Family Study is a  twin study  established in June 1989 with 1,300 same-gendered twin pairs ages 11 or 17, with an additional cohort of 500 such pairs recruited around 2004. Twins were born between 1972 and 2000. All twins born in Minnesota at that time were eligible to participate using birth registry data. Both identical and fraternal twins share certain aspects of their environment. This allows researchers to estimate the relative impact of environmental and genetic influences on  phenotypes,  an individual’s observable or expressed traits . The focus of the Minnesota Twin Family Study (MTFS) is on behavioral phenotypes, such as academic outcomes, cognitive abilities, personality, and interests; family and social relationships; mental and physical health; physiological measurements.

Figure 2 . Pedigree chart showing an inheritance pattern consistent with autosomal dominant transmission. Behavioral geneticists have used pedigree studies to investigate the genetic and environmental basis of behavior.

Clearly, this type of research is important and potentially very informative.  While the name behavioral genetics  connotes a focus on genetic influences, the field broadly investigates genetic and environmental influences, using  research designs  that allow removal of the  confounding  of genes and environment. T he field has seen renewed prominence with research on  inheritance  of behavior and  mental illness  in (typically using  twin and family studies ) (Figure 2).

As with any research strategy, longitudinal research is not without limitations. For one, these studies require an incredible time investment by the researcher and research participants. Given that some longitudinal studies take years, if not decades, to complete, the results will not be known for a considerable period of time. In addition to the time demands, these studies also require a substantial financial investment. Many researchers are unable to commit the resources necessary to see a longitudinal project through to the end.

Research participants must also be willing to continue their participation for an extended period of time, and this commitment can be problematic. People move, get married and take new names, get ill, and eventually die. Even without significant life changes, some people may simply choose to discontinue their participation in the project. As a result, the attrition rates, or reduction in the number of research participants due to dropouts, in longitudinal studies are quite high and increase over the course of a project. For this reason, researchers using this approach typically recruit many participants fully expecting that a substantial number will drop out before the end. As the study progresses, they continually check whether the sample still represents the larger population and make adjustments as necessary.

Epidemiological Studies

The  epidemiological method  examines rates of occurrence of abnormal behavior  in the population as a whole and in various subgroups classified according to factors such as race, ethnicity, gender, or social class.  One type of epidemiological study is the survey method, which is used to discover rates of occurrence of various disorders.  Often, occurrence of a single disease entity is set as an event.  The events can be characterized by i ncidence  rates ( the number of new cases occurring during a specific period of time)  and  prevalence  rates ( the overall number of cases of a disorder existing in the population during a given period of time) .  Prevalence rates, then, include both new and continuing cases.

Full epidemiological studies are expensive and laborious undertakings. Before any study is started, a case must be made for the importance of the research. Epidemiological studies only point to potential causal factors in psychological disorders, as they lack the power of experiments. Epidemiological (and other observational) studies typically highlight  associations  between exposures and outcomes, rather than causation. Moreover, many research questions are impossible to study in experimental settings, due to concerns around ethics and study validity. By finding that disorders cluster in certain groups for example, researchers can identify distinguishing characteristics that place these groups or regions at higher risk. In  the process of an epidemiological study, researchers identify p redisposing factors  that increase the likelihood of getting a disorder , such as g enetic history, age, and gender, enabling/disabling factors such as exercise and diet, precipitation factors, and r einforcing factors such as  excessive environmental stresses. They also look for patterns and similarities in the cases that may identify major risk factors for developing the disorder.

Figure 3 . The United States Substance Abuse and Mental Health Services Administration (SAMHSA) collects and reports on the epidemiology of mental disorders.

Yet such epidemiological studies cannot control for selection factors; that is, because epidemiological studies can rarely be conducted in a laboratory, the results are often polluted by uncontrollable variations in the cases. This pollution often makes the results difficult to interpret. Therefore, they must be tested further in experimental studies.

The Substance Abuse and Mental Health Services Administration of the U.S. government (SAMHSA) is charged with improving the quality and availability of treatment and rehabilitative services in order to reduce illness, death, disability, and the cost to society resulting from substance abuse and mental illnesses. Surveys are conducted yearly to establish the frequency of use of illegal substances within the population. The World Health Survey was implemented by WHO in 2002–2004 in partnership with 70 countries to generate information on the health of adult populations, including  psychological disorders  and health systems. The total sample size in these cross-sectional studies includes over 300,000 individuals. These surveys provide valuable epidemiological data. We will rely upon and report about some of this epidemiological data when we learn about specific mental disorders.

adoption   studies: studies that compare the trait and behavior similarity between an adoptee and their biological versus adoptive relatives

archival research:  method of research using past records or data sets to answer various research questions or to search for interesting patterns or relationships

attrition:  reduction in number of research participants as some drop out of the study over time

cohort : a group of people who share a defining characteristic, typically who experienced a common event in a selected period, such as birth or graduation

cohort studies:  one type of longitudinal study which sample a cohort and perform cross-section observations at intervals through time

cross-sectional research:  compares multiple segments of a population at a single time

incidence:  the number of new cases occurring during a specific period of time

longitudinal research:  studies in which the same group of individuals is surveyed or measured repeatedly over an extended period of time

phenotypes:  an individual’s observable or expressed traits

prevalence:  the overall number of cases of a disorder existing in the population during a given period of time

twin study: study in which researchers identify individuals with a specific disorder who are members of an MZ or a DZ twin pair and then study the other twin in the pairs

• Hidaka B. H. (2012). Depression as a disease of modernity: explanations for increasing prevalence. Journal of affective disorders , 140(3), 205–214. https://doi.org/10.1016/j.jad.2011.12.036 ↵
• Modification, adaptation, and original content. Authored by : Sonja Ann Miller for Lumen Learning. Provided by : Lumen Learning. License : CC BY-SA: Attribution-ShareAlike
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