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Introduction To Understanding Psychological Disorders

Abnormal psychology is concerned with understanding the nature, causes, and

treatment of mental disorders. It focuses on psychopathology, which is the study of mental

distress symptoms and causes, as well as the various treatments for behavioral and mental

disorders. Although there is a wide range of behavior that could be considered abnormal, this

branch of psychology focuses on what is addressed in a clinical setting. In practice, this refers

to a set of behaviors, emotions, and thoughts that lead to a person seeking the help of a

mental health professional, such as a psychiatrist or a clinical psychologist. Abnormal

psychology attracts researchers who look into the causes of abnormal behavior and try to find

the most effective treatments, whether medication or a talking cure.

In general terms, normality is usually considered to be the common occurrence, while

abnormality is usually defined as undesirable behavior. It is sometimes defined as the

subjective experience of not feeling “normal”. A psychological disorder is a condition

characterized by abnormal thoughts, feelings, or behaviors. However, defining what is

“normal” and “abnormal” is a subject of much debate. There is still no universal

agreement/consensus about what is meant by abnormality. In general, abnormality is defined

as being outside the boundaries of what is acceptable in our society. It refers to behaviors that

are incompatible with the individual's developmental, cultural, and societal norms, causing

emotional distress or interfering with daily functioning.

Criteria’s for Abnormality

There are various criterias which have been laid down to enable a better

understanding of ‘Abnormality’.

● Suffering: If people suffer or experience any physiological or psychological pain one

to inclined to consider this as indicative of abnormality. Although suffering is an

element of abnormality in many cases, it is neither a sufficient condition (all that is

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needed) nor even a necessary condition (a feature that all cases of abnormality must

show) for us to consider something as abnormal. Behaviours should be considered

abnormal if the individual suffers discomfort as a result of the behaviours and wish to

get rid of them. The experience of distress - emotional or physical pain is common in

life. However, here the intensity of pain is so high that it interferes with the person‘s

daily living. For example, a victim of an extremely traumatic event may experience

unrelenting pain or emotional turmoil and may not be able to cope in daily life.

● Maladaptiveness: Maladaptive behavior is often an indicator of abnormality.

Maladaptive behavior interferes with our wellbeing and with our ability to enjoy our

work and our relationships. However, not all disorders involve maladaptive behavior.

Behaviours that threaten one’s ability to function well within that social context can

be considered maladaptive.

● Statistical Deviancy: The word abnormal literally means “away from the normal.” If

something is statistically rare and undesirable (as is severely diminished intellectual

functioning), we are more likely to consider it abnormal than something that is

statistically rare and highly desirable (such as genius) or something that is undesirable

but statistically common (such as rudeness). An interpretation of normality that

depends on literal meaning assumes there is such a thing as average behaviour, or

behaviour that most frequently occurs in particular situations. Thus, behaviour that

does not occur very often in a given context can be considered to be abnormal.

● Violation of the Standards of Society: All cultures have rules. Some of these are

formalized as laws. Others form the norms and moral standards that we are taught to

follow. Although many social rules are arbitrary to some extent, when people fail to

follow the conventional social and moral rules of their cultural group we may
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consider their behavior abnormal. A behavior is most likely to be viewed as abnormal

when it violates the standards of society and is statistically deviant or rare.

● Social Discomfort: When someone violates a social rule, those around him or her

may experience a sense of discomfort or unease. Any behaviour violating the social

norms causing discomfort and distress, could be classified as abnormal behaviour.

● Irrationality and Unpredictability: We expect people to behave in certain ways. For

eg- If a person sitting next to you suddenly began to scream and yell obscenities at

nothing, you would probably regard that behavior as abnormal. It would be

unpredictable, and it would make no sense to you. When a person’s behaviour

appears to be out of their control and is irrational. Such behaviour is often classified

as an abnormal one.

● Dangerousness: Someone who is a danger to him or herself or to another person is

considered to be psychologically abnormal. It often includes mental as well as

physical danger to oneself or others. Conversely, we cannot assume that someone

diagnosed with a mental disorder must be dangerous.

Clinical psychology

Clinical psychology is a subfield of the larger discipline of psychology. The definition

of clinical psychology adopted by the American Psychological Association’s Division of

Clinical Psychology reads as follows: “The field of Clinical Psychology integrates science,

theory, and practice to understand, predict, and alleviate maladjustment, disability, and

discomfort as well to promote human adaptation, adjustment, and personal development.

Clinical Psychology focuses on the intellectual, emotional, biological, social, and behavioral

aspects of human functioning across the life span, in varying cultures, and at all

socioeconomic levels” (American Psychological Association, Division 12, 2012). The

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definition focuses on the integration of science and practice, the application of this integrated

knowledge across diverse human populations, and the purpose of alleviating human suffering

and promoting health.

According to Saccuzzo & Kaplan (1994), “Clinical psychology is an applied branch

of psychology devoted to helping adjust, solve problems, change, improve, and achieve their

highest potential”. Clinical psychology includes the study and application of psychology for

the purpose of understanding, preventing, and relieving psychologically-based

distress/dysfunction to promote subjective well-being and personal development. The

practice of clinical psychology uses scientifically based methods to reliably and validly assess

both normal and abnormal human functioning. Clinical psychologists work with a range of

individuals, from infants to the elderly.

Difference between clinical and abnormal Psychology

Table 1

Differentiating between Clinical and Abnormal Psychology

Clinical Psychology Abnormal Psychology

Clinical psychology is an integration of Abnormal psychology is the branch of

science, theory and clinical knowledge for psychology that studies unusual patterns of

the purpose of understanding, preventing, behavior, emotion and thought, which may

and relieving psychologically based distress or may not be understood as precipitating a

or dysfunction and to promote subjective mental disorder.

well-being and personal development.

Clinical Psychology is the branch of Abnormal psychology is the branch of

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psychology concerned with the assessment psychology concerned with understanding

and treatment of mental illness and the nature, causes, and treatment of mental

behavioral problems. It concentrates on disorders. It studies the unusual in human

therapy and evaluation on a multiplicity of psychology, everything from pathological

mental illnesses. disease states to intellectual giftedness and

everything in between.

Clinical psychology applies the science of Abnormal psychology invests the science

psychology to evaluate and treat mental of psychology 'and' research to make

disorders. predictions and explanations and explores

causes and review treatments of behavior

deemed as abnormal.

Clinical Psychology deals only with the Abnormal Psychology is a broad field

psychological and the pathological mental which deals with the psychological, the

disorders. pathological and the cultural mental

disorders.

Disorders

The term psychological disorder is sometimes used to refer to what is more frequently

known as mental disorders or psychiatric disorders. Mental disorders are psychological

symptoms or behavioral patterns that reflect an underlying psychobiological dysfunction, are

associated with distress or disability, and are not merely an expectable response to common

stressors or losses.

Within DSM-5, a mental disorder is defined as a syndrome that is present in an

individual and that involves clinically significant disturbance in behavior, emotion regulation,
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or cognitive functioning. These disturbances are thought to reflect a dysfunction in biological,

psychological, or developmental processes that are necessary for mental functioning. DSM-5

also recognizes that mental disorders are usually associated with significant distress or

disability in key areas of functioning such as social, occupational, or other activities.

Predictable or culturally approved responses to common stressors or losses (such as death of

a loved one) are excluded. It is also important that this dysfunctional pattern of behavior does

not stem from social deviance or conflicts that the person has with society as a whole.

4 D’s

Most practitioners agree that mental disorders involve behavior or other distressing

symptoms that depart from the norm and that harm affected individuals or others. The four

major D’S involved in judging psychopathology are:

● Distress- Distress can be defined as anguish or suffering and all of us experience

distress at different times in our lives. However, when a person with a psychological disorder

experiences distress, it is often out of proportion to a situation. It is the degree of distress or

the circumstances in which the distress arises that mark a psychological disorder. Most people

who seek the help of therapists are experiencing psychological distress that affects social,

emotional, or physical functioning. In the social sphere, an individual may become

withdrawn and avoid interactions with others or may engage in inappropriate or dangerous

social interactions. In the emotional realm, distress might involve extreme or prolonged

reactions such as anxiety and depression. Distress also surfaces physically in conditions such

as asthma or hypertension or with symptoms of fatigue, pain, or heart palpitations.

● Deviance- Deviance is a sociological term for individuals who violate the norms of

society (Dijker & Koomen, 2007). The violation can be informal like dress and appearance of

formal, like the rules that govern motoring. Abnormal behaviors deviateor represent a

significant deviation from- social norms. Less frequent or less probable behaviors are
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considered to be abnormal or statistically deviant. Abnormal behavior, thoughts, and

emotions are those that differ markedly from a society’s ideas about proper functioning.

Behavior, thoughts, and emotions that break norms of psychological functioning are called

abnormal. All this depends on specific circumstances as well as cultural norms. Some

examples of unusual behavior include false perceptions of reality, an intense preoccupation

with repetitively washing one’s hands, or demonstrating extreme panic in a social setting.

● Dysfunction- Psychological dysfunction refers to a breakdown in cognitive,

emotional, or behavioral functioning. Abnormal behavior tends to be dysfunctional, i.e. it

interferes with daily functioning. It so upsets, distracts, or confuses people that they cannot

care for themselves properly, participate in ordinary social interactions, or work productively.

A person with a psychological disorder may be impaired in functioning at school, at work, or

in relationships. It is the degree of impairment that indicates a psychological disorder. The

person is impaired to a greater degree than most people in a similar situation. One way to

assess dysfunction is to compare someone’s performance with the role requirements.

Dysfunction can also be assessed by comparing a person’s performance with his or her

potential.

● Danger- Perhaps the ultimate in psychological dysfunctioning is behavior that

becomes dangerous to oneself and others. Individuals whose behavior is consistently careless,

hostile, or confused may be placing themselves or those around them at risk. Even though it

is a statistical rarity for individuals who are mentally ill to commit violent crimes, media

coverage of national tragedies has led the public to associate mental illness with violence.

Drug and alcohol abuse is much more likely to result in violent behavior than are other kinds

of mental disorders (Friedman & Michels, 2013). Therapists are required by law to take

appropriate action when a client is potentially homicidal or suicidal. Another component that

must be considered with the determination of abnormal behavior and dangerousness is

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substance abuse. The potential for violence and dangerousness is increased when a person is

under the influence of drugs and/or alcohol.

Brief History Of Abnormality

● Ancient Beliefs and Practices

Early writings of the Egyptians, Chinese, Greeks, and Hebrews identify patterns of,

and concerns about, treating abnormal behavior. Early theoreticians frequently attributed

abnormal behavior to supernatural causes such as possession by demons or evil spirits. The

behavior was viewed spiritually, so the primary form of treatment was exorcism, or an

attempt to cast out a spirit possessing an individual. Various exorcism techniques were used,

including magic, noisemaking, incantations, prayer, ogging, starvation, and medicinal

techniques or potions. These techniques were designed to make a person an unpleasant,

uncomfortable, or painful host for the spirit or demon. Another ancient technique, called

trephination, involved cutting a hole in a person’s skull to help release a harmful spirit.

Trephination might simply have been used to treat head wounds received in battles (Maher &

Maher, 1985). Even today, we are not sure why ancient peoples practiced it.

● Greeks and Roman

The ancient Greeks believed that the gods controlled abnormal behavior and that

defiance of the deities could result in mental illness. During this period, mental illnesses were

considered to result from either traumatic experiences or an imbalance in fluids (such as

blood) found within the body. These fluids were called humors.

Often considered the father of medicine, Hippocrates (460–377 BC) was the most

famous Greek physician. He produced both a diagnostic classification system and a model by

which to explain abnormal behavior. Hippocrates identified common psychological

symptoms such as hallucinations (hearing or seeing things not evident to others), delusions

(beliefs with no basis in reality), melancholia (severe sadness), and mania (heightened states
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of arousal that can result in frenzied activity). He also introduced the term hysteria, now

called conversion disorder, to describe patients who appeared to have blindness or paralysis

for which there was no organic cause, attributed it to an empty uterus wandering throughout

the body searching for conception.

Hippocrates believed that other abnormal behaviors resulted when environmental

factors (changes of seasons) and/or physical factors (fever, epilepsy, and shock) created an

imbalance in four bodily humors. In his model, the four humors were yellow bile, black bile,

blood, and phlegm. Blood was associated with a courageous and hopeful outlook on life, and

phlegm was associated with a calm and unemotional attitude. Excessive yellow bile caused

mania, and excessive black bile caused melancholia, which was treated with a vegetable diet,

a tranquil existence, celibacy, exercise, and sometimes bleeding (controlled removal of some

of the patient’s blood). Another very influential Greek physician was Galen, studied human

anatomy, he discounted the “wandering uterus” theory. Galen also took a scientific approach

to the field, dividing the causes of psychological disorders into physical and mental

categories. Among the causes he named were injuries to the head, excessive use of alcohol,

shock, fear, adolescence, menstrual changes, economic reversals, and disappointment in love.

● Middle ages

During the Middle Ages (approximately 500–1400 C.E.), the Greek emphasis on

reason and science lost influence, and madness was once again thought to result from

supernatural forces, now being conceived as a consequence of a battle between good and evil

for the possession of an individual’s soul. Church officials interpreted negative behavior as

the work of the devil or as witchcraft, even when other, less dramatic, explanations existed.

As a result of the church’s powerful influence, witchcraft became a prominent theory to

explain abnormal behavior.

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Prophets and visionaries were believed to be possessed or inspired by the will of

God. Men and women who reported such experiences usually were believed to be possessed

by the devil or were viewed as being punished for their sins. The episodes of mass hysteria

also swept through large groups of people. People affected were convinced that they were

afflicted or possessed by a demonic spirit (again, similar to beliefs regarding alien abduction).

Treatment consisted of attempts to end the possession: exorcism, torture (with the idea that

physical pain would drive out the evil forces), starvation, and other forms of punishment to

the body. Such inhumane treatment was not undertaken everywhere, though. As early as the

10th century, Islamic institutions were caring humanely for those with mental illness (Sarró,

1956).

● The Renaissance

During the Renaissance (15th through 17th centuries), mental illness continued to be

viewed as a result of demonic possession, and witches (who were possessed by, or in league

with, the devil) were held responsible for a wide variety of ills. Indeed, witches were blamed

for other people’s physical problems and even for societal problems, such as droughts or crop

failures.

As before, treatment was primarily focused on ridding the individual of demonic

forces, in one way or another. During the Renaissance, people believed that witches put the

whole community in jeopardy through their evil acts and through their association with the

devil (White, 1948). The era is notable for its witch hunts, which were organized efforts to

track down individuals who were believed to be in league with the devil and to have infl icted

possession on other people (Kemp, 2000). Once found, these “witches” were often burned

alive. The practice of witch burning spread throughout Europe and the American colonies:

Judges were called upon to pass sentence on witches in great numbers.

● 18th century and asylum concept

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At the end of the Renaissance, rational thought and reason gained acceptance again.

French philosopher René Descartes proposed that mind and body are distinct, and that bodily

illness arises from abnormalities in the body, whereas mental illness arises from

abnormalities in the mind. Similarly, according to the 17th-century British philosopher John

Locke, insanity is caused by irrational thinking, and so could be treated by helping people

regain their rational and logical thought process

The Renaissance was a time of widespread innovation and enlightened thinking. For

some people, this enlightenment extended to their view of how to treat those with mental

illness—humanely. Some groups founded asylums, institutions to house and care for

individuals who were afflicted with mental illness. Such institutions coped with the mentally

ill as people. In general, asylums were founded by religious orders. In subsequent decades,

asylums for the mentally ill were built throughout Europe. Initially, asylums were places of

refuge for the mentally ill. But before long, delinquents and others were sent to asylums, and

the facilities became overcrowded. Their residents were then more like inmates than patients.

The most famous asylum from this era was the Hospital of St. Mary of Bethlehem in London

(commonly referred to as “Bedlem” or later as “Bedlam,” which became a word meaning

“confusion and uproar”). In 1547, that institution shifted from being a general hospital to an

asylum used to incarcerate the mad, particularly those who were poor. Residents were

chained to the walls or floor or put in cages and displayed to a paying public much like

animals in a zoo (Sarró, 1956). Officials promoted such displays as educational, allowing the

public to observe what was believed to be the excesses of sin and passion. The idea was that

such exhibitions would deter people from indulging in behaviors believed to lead to mental

illness.

● Rise of preventive movement

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The conditions of asylums or mental hospitals in Europe and America were generally

deplorable and in need of great change. A key leader of change was Philippe Pinel

(1745–1826), who was in charge of a Paris mental hospital called La Bicêtre. Shocked by the

living conditions of the patients, Pinel introduced a revolutionary, experimental, and more

humane treatment. He unchained patients, placed them in sunny rooms, allowed them to

exercise, and required staff to treat them with kindness. These changes produced dramatic

results in that patients’ mental states generally improved and order and peace was restored to

the hospital.

Pinel’s reforms in France soon spread to other places. Dorothea Dix (1802–1887) is

credited with making the most signicant changes in treating those with mental disorder and in

changing public attitudes about these conditions in America. She raised awareness, funds,

and political support and established more than 30 hospitals. The humane type of care

emphasized during the reform movement period, sometimes referred to as moral treatment,

paved the way for the modern approach to mental disorders.

● Foundation of modern psychology

The modern approach to abnormal psychology includes accepting those with mental

disorder as people who need professional attention; scientic, biomedical, and psychological

methods are used to understand and treat mental disorder. In Clifford Beers’s 1908 book, ‘A

Mind That Found Itself’, described his own experiences with mental disorder and his

subsequent treatment in an institution. His description of maltreatment while hospitalized

sparked a mental health reform movement in the United States and later across the world.

After his recovery, Beers founded the Connecticut Society for Mental Hygiene in 1908 and

the National Committee for Mental Hygiene in 1909. These groups were designed to improve

quality of care for those with mental disorder, help prevent mental disorder, and disseminate
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information to the public about mental disorder. These goals are just as relevant and

important today as they were a century ago.

Several theoretical perspectives were developed during the late 19th century and

throughout the 20th century to guide work on understanding and treating mental disorders.

These perspectives include biological, psychodynamic, cognitive, behavioral, sociocultural,

and other theories of abnormal behavior.

Theoretical perspective to abnormality

Scientists and mental health professional develop perspectives or models- ways of

looking at things- to piece together why people have mental disorders. Perspectives or models

are systematic ways of viewing and explaining what we see in the world. Mental health

professionals use models to help explain unusual behavior or mental disorders in people.

Each model has strengths and weaknesses, but each provides mental health professionals with

ways of understanding what is happening to people with mental disorders.

● Psychodynamic Perspective

The psychodynamic model is the oldest and most famous of the modern psychological

models. Psychodynamic theorists believe that a person’s behavior, whether normal or

abnormal, is determined largely by underlying psychological forces of which he or she is not

consciously aware. These internal forces are described as dynamic—that is, they interact with

one another—and their interaction gives rise to behavior, thoughts, and emotions. Abnormal

symptoms are viewed as the result of conflicts between these forces. Freud developed the

theory of psychoanalysis to explain both normal and abnormal psychological functioning as

well as a corresponding method of treatment, a conversational approach also called

psychoanalysis.

Freud believed that three central forces shape the personality—instinctual needs, rational

thinking, and moral standards. Freud called the forces the id, the ego, and the superego.
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According to Freud, these three parts are often in some degree of conflict. The ego develops

basic strategies, called ego defense mechanisms, to control unacceptable id impulses and

avoid or reduce the anxiety they arouse. Freud proposed that at each stage of development,

from infancy to maturity, new events challenge individuals and require adjustments in their

id, ego, and superego. If the adjustments are successful, they lead to personal growth. If not,

the person may become fixated, or stuck, at an early stage of development. Then all

subsequent development suffers, and the individual may well be headed for abnormal

functioning in the future.

● The behavioural model

Behavioral theorists believe that our actions are determined largely by our

experiences in life. Behaviors can be external (going to work, say) or internal (having a

feeling or thought). In turn, behavioral theorists base their explanations and treatments on

principles of learning, the processes by which these behaviors change in response to the

environment. Many learned behaviors help people to cope with daily challenges and to lead

happy, productive lives. However, abnormal behaviors also can be learned.

Learning theorists have identified several forms of conditioning, and each may

produce abnormal behavior as well as normal behavior. In operant conditioning, for example,

humans and animals learn to behave in certain ways as a result of receiving

rewards—consequences of one kind or another—whenever they do so. In modeling,

individuals learn responses simply by observing other individuals and repeating their

behaviors. In a third form of conditioning, classical conditioning, learning occurs by temporal

association.

● Cognitive model

In the early 1960s two clinicians, Albert Ellis (1962) and Aaron Beck (1967),

proposed that cognitive processes are at the center of behaviors, thoughts, and emotions and
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that we can best understand abnormal functioning by looking to cognition—a perspective

known as the cognitive model. Ellis and Beck claimed that clinicians must ask questions

about the assumptions and attitudes that color a client’s perceptions, the thoughts running

through that person’s mind, and the conclusions to which they are leading.

According to cognitive theorists, abnormal functioning can result from several kinds

of cognitive problems. Some people may make assumptions and adopt attitudes that are

disturbing and inaccurate (Beck & Weishaar, 2014; Ellis, 2014).

Beck, for example, has found that some people consistently think in illogical ways and keep

arriving at self-defeating conclusions (Beck & Weishaar, 2014). According to cognitive

therapists, people with psychological disorders can overcome their problems by developing

new, more functional ways of thinking. Because different forms of abnormality may involve

different kinds of cognitive dysfunctioning, cognitive therapists have developed a number of

strategies to reconstruct them into functional ones.

● Humanistic model:

The humanistic model was developed in the 1950s and retains some relevance today.

A main assumption is that people are naturally good and strive for personal growth and

fulfilment. Humanistic theorists believe we seek to be creative and meaningful in our lives

and that, when thwarted in this goal, become alienated from others and possibly develop a

mental disorder. A second key assumption is that humans have choices and are responsible

for their own fates. Humanistic theorists adopt a phenomenological approach, which is an

assumption that one’s behavior is determined by perceptions of herself and others.

Humanistic theory was shaped greatly by the works of Abraham Maslow and Carl Rogers.

Abraham Maslow.

● Existential model:
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The existential perspective resembles the humanistic view in its emphasis on the

uniqueness of each individual, the quest for values and meaning, and the existence of

freedom for self-direction and self-fulfilment. However, it takes a less optimistic view of

human beings and places more emphasis on their irrational tendencies and the difficulties

inherent in self-fulfilment. There are several basic themes of existentialism. The first one is

existence and essence. Our existence is a given, but what we make of it- our essence- is up to

us. Our essence is created by our choices because our choices reflect the values on which we

base and order our lives. The second is meaning and value. The will-to-meaning is a basic

human tendency to find satisfying values and guide one’s life by them. The third is existential

anxiety and the encounter with nothingness. Nothingness is the inescapable fate of all

humans. The awareness of our inevitable death and its implications for our living can lead to

existential anxiety. Thus existential psychologists focus on the importance of establishing

values and acquiring a level of spiritual maturity worthy of the freedom and dignity bestowed

by one’s humanness. Much abnormal behavior is seen as the product of a failure to deal

constructively with existential despair and frustration.

● Socio cultural Perspective

According to the sociocultural model, abnormal behavior is best understood in light of

the broad forces that influence an individual. Proponents of the family-social perspective

argue that clinical theorists should concentrate on those broad forces that operate directly on

an individual as he or she moves through life—that is, family relationships, social

interactions, and community events. They believe that such forces help account for both

normal and abnormal behavior, and they pay particular attention to three kinds of factors:

social labels and roles, social networks, and family structure and communication.

Classification systems for disorders

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According to American Psychological Association, classification refers to the

grouping of mental disorders on the basis of their characteristics or symptoms. It is a

procedure of constructing groups of categories and for assigning entities (disorders or people)

to these categories on the basis of their shared attributes or relations (Million, 1991). It is the

activity of ordering or arrangement of objects into groups or sets on the basis of their

relationships (Sokal, 1974).

The Diagnostic and Statistical Manual of Mental Disorders (DSM) (APA, 1980) and

the International Classification of Disease (ICD) (WHO, 1992) are two classification systems

that list and describe criteria for diagnosing mental disorders. Both systems have been revised

with the goals of producing DSM-5 and ICD-11, respectively.

DSM

The American Psychiatric Association was earlier called the Committee on Statistics

of the American Medicopsychological Association. In 1917, DSM (earlier called Statistical

manual for the use of institutions for the insane) was first published. It had 21 disorders

which were psychotic in nature.

● DSM-I: After World War II, American psychiatry was embarrassed by the chaotic

tate of classification in the United States. The APA decided to overcome this situation by

creating a classification that would be acceptable to all members of its organization and that

could unify the diagnostic terms of its psychiatrists. The result was the DSM. The DSM-1

was published in 1952. It contained 128 categories. Organizationally, the DSM-I had a

hierarchical system in which the initial node in the hierarchy was differentiating organic brain

syndromes from “functional” disorders which are physically undetectable. The functional

disorders were further subdivided into psychotic versus neurotic versus character disorders.

The descriptions of disorders were short, vague, and subjective in nature. They mainly

focused on the causes.

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● DSM-II: The DSM-II was published in 1968. It had 182 disorders and the symptoms

were described as reflections of broad underlying conflicts or maladaptive reactions to life

problems rather than in observable behavioral terms (Wilson, 1993). Unlike the DSM-I, many

of the new categories added in the DSM-II were categories of relevance to outpatient mental

health efforts. Anxiety disorders, depressive disorders, personality disorders (PDs), and

disorders of childhood/adolescence were larger subsets than they had been in the DSM-I.

● DSM-III: In the DSM-III, categorization was based on description rather than

assumptions about the causes of the disorder, and a more biomedical approach replaced the

psychodynamic perspective (Wilson, 1993). The DSM-III, published in 1980, contained 265

diagnostic categories. Another innovation to the DSM-III was that the system was multiaxial.

Each patient was expected to be diagnosed along five separate axes.

- Axis I - represented clinical disorders and other disorders that may be a focus of

clinical attention (any psychological disorder other than personality disorders and mental

retardation).

- Axis II dealt with specific to personality disorders and developmental delays.

- Axis III dealt with physiological mental disorders (general medical conditions).

- Axis IV included psychosocial and environmental problems (educational,

occupational problems, etc.)

- Axis V represented global assessment of functioning scale in which 100 represented

superior functioning in a wide range of activities and has no symptoms; 60 represented

moderate difficulty in social and occupational functioning; and 10 represented persistent

danger of severely hurting self or others, or persistent inability to maintain minimal personal

hygiene.

● DSM-IV: In 1994, DSM-IV listed 297 disorders. This revision emerged from the
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work of a steering committee, consisting of work groups of experts who (a) conducted an

extensive literature review of the diagnoses, (b) obtained data from researchers to determine

which criteria to change, and (c) conducted multicentre clinical trials (Schaffer, 1996).

DSM-IV-TR (APA, 2000), a “text” revision, was published in 2000 with most diagnostic

criteria unaltered.

● DSM-V: The DSM-V (APA, 2013) includes 237 diagnoses and uses a developmental

approach to abnormal behavior. Also, DSM-5 emphasizes the role of culture and gender in

the expression of psychiatric disorders and, in comparison to previous editions, uses more

dimensional ratings to classify symptom severity. The multiaxial system was completely

removed. Axes I, II, and III represented psychiatric and medical diagnoses. Axis IV

contained etiology or descriptions of disorders. Axis V was dropped altogether.

ICD

The World Health Organization’s (WHO) International classification of diseases and

related health problems (ICD) is well established as the global standard for the diagnosis,

treatment, research, and statistical reporting of all human health conditions, including mental

and behavioral disorders. Thus, it represents a powerful clinical, administrative, scientific,

and epidemiological tool.

● ICD-6: Early editions of the ICD were developed for the primary purpose of

classifying causes of death for statistical and public health purposes. However, with the 1948

publication of ICD6, the scope of the ICD expanded to include not only causes of death, for

the calculation of mortality statistics, but also health conditions, for the calculation of

morbidity statistics (e.g. disease prevalence and incidence). In 1948, the WHO took charge of

the classification system, which was expanded the following year to include coding for

causes of morbidity in addition to mortality. The system was rechristened the International
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Classification of Disease system. There were three main sections under 26 categories in the

chapter “Mental, Psychoneurotic, and Personality disorders”: psychosis, psychoneurotic

disorders, and disorders of character, behavior, and intelligence. The ICD classification of

mental disorders did not change from ICD-6 to ICD-7 (1957), other than to amend errors and

inconsistencies.

● ICD-8: ICD-8 was published in 1968. The section of psychosis was kept as it is. The

sections of neurosis, personality disorders, and non-psychotic mental disorders were

combined together. Another section was mental retardation. Following the approval of ICD-8,

WHO decided that additional guidance was needed for meaningful application of its

categories in clinical settings and published a glossary of terms (WHO, 1974) that provided

definitions for most ICD-8 mental disorder categories as well as other key diagnostic

concepts.

● ICD-9, ICD-10, and ICD-11: ICD-9 came in 1979. There were no major changes as

such. The glossary’s material was largely incorporated into the ICD-9 chapter on mental

disorders, which is the only ICD-9 chapter with operational definitions for each category, and

was readily adopted by nearly all WHO member states. ICD-10 was published in 1994. The

structure was removed. Instead, the disorders were rearranged in accordance to the

commonalities between disorders rather than psychosis and neurosis. ICD-11 was published

in 2019 and will come into effect in 2022.

Therapies

● Behavior Therapy- It is a direct and active treatment that recognizes the importance

of behavior, acknowledges the role of learning, and includes thorough assessment and

evaluation. Instead of exploring past traumatic events or inner conflicts, behavior therapists

focus on the presenting problem—the problem or symptom that is causing the patient great
 21

distress. A major assumption of behavior therapy is that abnormal behavior is acquired in the

same way as normal behavior—that is, by learning. A variety of behavioral techniques have

therefore been developed to help patients “unlearn” maladaptive behaviors by one means or

another, some of which are - exposure therapy, aversion therapy and modelling.

● Cognitive and cognitive-behavioral therapy- They stem from both cognitive

psychology (with its emphasis on the effects of thoughts on behavior) and behaviorism (with

its rigorous methodology and performance-oriented focus). They focus on mental processes

and their influences on mental health and behavior. A common premise of all cognitive

approaches is that how people think largely determines how they feel and behave (Beck &

Weishaar, 2014). Some of which are- rational emotive behavioral therapy (REBT) and

cognitive therapy (CT). The first form of behaviorally oriented cognitive therapy was

developed by Albert Ellis and called rational emotive behavior therapy (REBT). It attempts to

change a client's maladaptive thought processes, on which maladaptive emotional responses,

and thus behavior, are presumed to depend. Beck's cognitive therapy is used for a broad range

of conditions, including eating disorders and obesity, personality disorders, substance abuse,

depression, anxiety disorders, and even schizophrenia (Beck, 2005; Beck & Rector, 2005;

Hollon & Beck, 2004).

● Humanistic-Experiential Therapies- The humanistic-experiential therapies are

based on the assumption that we have both the freedom and the responsibility to control our

own behavior—that we can reflect on our problems, make choices, and take positive action.

The client-centered therapy of Carl Rogers focuses on the natural power of the organism to

heal itself (Rogers, 1951, 1961). Motivational interviewing is a brief form of therapy that can

be delivered in one or two sessions. At its center is a supportive and empathic style of relating

to the client that has its origins in the work of Carl Rogers. Gestalt therapy emphasizes the
 22

unity of mind and body-placing strong emphasis on the need to integrate thought, feeling, and

action.

● Psychodynamic therapy is a broad treatment approach developed by Freud and his

immediate followers, classical psychoanalysis is an intensive (at least three sessions per

week), long-term procedure for uncovering repressed memories, thoughts, fears, and conflicts

presumably stemming from problems in early psychosexual development—and helping

individuals come to terms with them in light of the realities of adult life. There are four basic

techniques to this form of therapy: (1) free association, (2) analysis of dreams, (3) analysis of

resistance, and (4) analysis of transference.

● Couple and Family Therapy- Many problems that therapists deal with concern

distressed relationships. A common example is couple or marital distress. Here, the

maladaptive behavior exists between the partners in the relationship. Extending the focus

even further, a family systems approach reflects the assumption that the within-family

behavior of any particular family member is subject to the influence of the behaviors and

communication patterns of other family members. It is, in other words, the product of a

“system” that may be amenable to both understanding and change.

● Eclecticism and Integration- Also called multimodal therapy, most psychotherapists

today use “eclectic,” which usually means that they borrow and combine concepts and

techniques from various schools, depending on what seems best for the individual case. This

inclusiveness extends to efforts to combine biological and psychosocial approaches as well as

individual and family therapies.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed., text rev.)

Barlow, D. H., & Durand, V. M. (2014). Abnormal Psychology: an Integrative approach.

Cengage Learning.

Beidel, D. C., Bulik, C. M., & Stanley, M. A. (2013). Abnormal Psychology.

Butcher, J. N., Mineka, S., & Hooley, J. M. (2014). Abnormal Psychology.

Dalal, P. K., & Sivakumar, T. (2009). Moving towards ICD-11 and DSM-V: Concept and

evolution of psychiatric classification. Indian Journal of Psychiatry, 51(4), 310.

https://doi.org/10.4103/0019-5545.58302

DSM History. (n.d.).

https://www.psychiatry.org/psychiatrists/practice/dsm/about-dsm/history-of-the-dsm

Kosslyn, S., & Rosenberg, R. (2014). Abnormal Psychology. Worth.

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Kearney, C.A. & Trull, T.J. (2018). Abnormal psychology and life: a dimensional approach.

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Kring, A.M. et al. (2012). Abnormal psychology. (12th ed). Wiley & Sons.

Oltmanns, T.F. & Emery, R.E. (2019). Abnormal psychology. (9th ed). Pearson.

Trull, T.J. & Prinstein, M.J. (2013). Clinical psychology: an introduction. Clinical

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