Abnormal Psychology

Abnormal Psychology

The Diagnostic and Statistical Manual (DSM) of mental disorders is used by psychiatrists, as well as psychologists, although since they psychologists are not doctors, they cannot diagnose a patient or prescribe medication. Thus, psychology professionals treatment usually consists of cognitive behavioural (CBT) therapy.

The fourth revised version of the DSM, thus the DSM-IV-TR is divided into five axes. Axis I states any mental disease, Axis II is for personality disorders and mental retardation, Axis III is for general health, axis IV refers to psychosocial and environmental factors, and Axis V is for functioning (coded on a scale). Since its inception in 1952, the manual has changed many times and now includes substance abuse and eating disorders (EDs). All disorders have as a condition that they must cause significant distress to the patient and/or impair his or her functioning in some significant way.

Also, the disorder should not correspond to the expectations of the individual’s culture. In other words, if a person is part of a tribe that ritualistically believes going into trances and seeing mountains dance, a person from that tribe cannot be considered delusional if he or she complies with the norm; this may be a little exaggerated but hopefully it gets the point across. Similarly, the following essay is for information purposes only and in no way sufficient to warrant a diagnosis.

Fight Against Disorder. Be Ready to Fight Any Disorder in Your House and in Your Head! Photo: Megan Jorgensen (Elena)

Along these lines, schizophrenia literally means a splitting of the mind, which is a fairly accurate description since the clinical disorder is a sort of split from reality. There are several types of schizophrenia: paranoid, catatonic, residual, disorganized (hebephrenic) and undifferentiated. Further, symptoms can be positive – aspects that are there but that should not be, and negative – aspects that should be present but are not. The main positive symptoms include delusions (irrational persistent beliefs in spite of evidence to the contrary) and hallucinations (perception in the absence of stimuli). Negative symptoms include flat affect (inability to express emotions), lack of personal hygiene, social and occupational dysfunction. There currently is no cure for schizophrenia but antipsychotics and other drugs can help control the problems.

Further, in Major Depressive Disorder (MDD) some of the recurrent signs are low and sad mood that lasts for over two weeks, loss of concentration, feelings of despair or helplessness, changes in weight and/or appetite, social withdrawal, loss of interest in activities previously enjoyed, lack of energy, and dark thoughts. The causes of MDD are often biological and even genetic (people who are homozygous – have two copies – of the short allele of gene 5-HTT are more vulnerable to develop the sickness even given the same stressors as heterozygotes).

Moreover, the biological explanations stem from the findings that individuals with MDD have a lower production of the neurotransmitter serotonin (feelings of well-being and mood regulator). Consequently, serotonin reuptake inhibitors such as Prozac have been successful, however prescribed antidepressants have also backfired in several, sometimes tragic, ways. Also, depression is almost twice as common in women than in men. Individuals suffering from manic depression (Bipolar Disorder – BD) alternate between days of mania and months of depression. Indeed, during manic episodes, individuals tend to become promiscuous, reckless, very talkative, elated and prone to overspending. The mood stabilizer lithium is often used to treat this condition.

A writer with Obsessive-Compulsive Disorder (OCD) was portrayed by Jack Nicholson in the motion picture As Good as it Gets. The disorder is characterized by intrusive thoughts, repetitive rituals and unusual behavioral patterns. Phobias are irrational fears that persist despite the patient knowing that they are irrational. Examples include fear of spiders, arachnophobia, and agoraphobia (fear of public places). Likewise, agoraphobia can manifest with or without panic attacks. People with Generalized Anxiety Disorder (GAD) tend to worry exceedingly about potential difficulties, in addition to, everyday matters. Thus, the primary distinction between fear and anxiety, is that fear is of something confirmed while anxiety is not. GAD is often treated with anxiolitics as well as antidepressants. Alternatively, ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) are mainly found in children and adolescents. The drug Ritalin has usually been prescribed, and has also been abused by students wishing to increase their intellectual performance, a dubious and dangerous practice. A lot of discussion was generated as to whether the disorder is or not over-diagnosed.

A great psychologist. Photo by Elena

Personality Disorders are coded on Axis II. One of the reasons that personality disorders get their own axis is that there is no cure for them and that they are not diseases per se as in the previous cases described. They are considered to be, in a way, the extremes of the bell curve of personalities in the general population. However, the fact does not make them any easier for the incumbent or those around him or her. The most vicious is Antisocial Personality Disorder, also called psychopathy or sociopathy. The rest comprise Paranoid, Histrionic, Borderline, Obsessive-Compulsive, Anxious (Avoidant), Dependent, Passive-Aggressive, Schizoid, Narcissistic, Mixed and Unspecified Personality Disorders (PDs). By the same token, persons with Borderline PD tend to hurt themselves. Narcissistic and Histrionic PDs are characterized by self-centeredness for the former, and excessive need to be the center of attention for the latter; Schizoid PDs comprise the attributes of solitude and emotional withdrawal (to an excess).

Conversely, mental retardation is usually diagnosed before the age of 18, by severe learning disabilities and an IQ score below 70 points on a standardized test. The condition has many genetic, biological, traumatic and environmental causes. Autism Spectrum Disorder and other developmental disorders would also be coded on Axis II, even in children of normal or high intelligence.

Autism Spectrum Disorder (ASD) is a neurodevelopment disorder characterized by impairment in interpersonal communication and social interaction, as well as different cognitive processes. Typically discovered in early childhood, ASD may likewise be characterized by repetitive behaviours or rituals, as well as resistance to change. Psychologists show that even positive change leads to stress, particularly in women as compared to men, but autistic perception may be an extreme of this continuum. ASD remain fairly rare, with a prevalence ranging from 0.1% to 0.6% in the general population. ASD may include the following symptomatology: social impairment, communication and language deficits and intellectual disabilities.

Consequently, a pronounced deficit in children with the neurodevelopment disorder, is a profound lack of Theory of Mind (ToM). ToM refers to the array of mental schemas people hold regarding their social word. In other words, a sort of navigational tool to interact with others and predict the social world, or a set of representations of others’ intentions, emotions, thoughts and mental states. In contrast, individuals with ASD lack ToM, as evidenced by the Sally’s Hidden Marble paradigm. In the paradigm, Sally has a marble that she puts in a drawer and leaves the room. Then, another child comes in and hides Sally’s marble in the closet. When asked “Where will Sally look for the marble?”, most children will answer “in the drawer” because that’s where she left it. Conversely, a child with autistic perception and absence of ToM will answer “in the closet”. To children with ASD, it is unclear that Sally does not know that the marble was hidden, and therefore, will look where she remembers placing it – in the drawer.

Thus, mental health and well-being professionals use the DSM as a diagnostic tool. ASD may be with or without mental retardation, the latter called high-functioning ASD. In the media, ASD has been portrayed in Rainman, starring Tom Cruise and Dustin Hoffman. However, as psychological studies demonstrate, great variation exists between individuals exhibiting the same condition. Naturally, neuroscience provides it own set of answers. Neuroimaging studies, such as fMRI (functional Magnetic Imagery) show images of brain activity. Electrophysiological (ERP – Event-Related Potential) studies shed light on the mechanism from an alternate viewpoint. From research, it may seem that in ASD, the brain may process sensory information differently.

Scientific discussion supports a genetic basis for ASD. Also, genetic studies include studies on inbred and knockout mice. In knockout mice, a particular gene is isolated to measure its effect on behaviour. Thus, the reader is referred to genetic studies to determine the genes predisposing to ASD. In terms of medication, risperidone is an antipsychotic drug licensed to treat the condition.

Furthermore, in an attempt to remain concise, the above list is incomplete. Categories such as NOS (Not Otherwise Specified), and descriptive parameters (comorbidity, prevalence, incidence, demographics) were omitted. Likewise, some disorders, such as Schizoaffective, Dysthymic, Conduct and Learning Disorders, have been left out, since they lay beyond the scope of the present paper. Finally, the present discussion aimed at unraveling abnormal psychology, including Major Depressive Disorder (MDD), schizophrenia and Autism Spectrum Disorder (ASD) as seen from a psychological, theoretical perspective.