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S I X T E E N T H E D I T I O N
ABNORMAL PSYCHOLOGY
James N. Butcher I Jill M. Hooley
Susan Mineka I Chandra B. Dwivedi
Since the dawn of civilization, humanity has been toiling hard to win over pain and disease. An incessant urge
of man to understand the ramifications of anomalous mental behavior so that timely and adequate relief to
the afflicted could be provided is a testimony to that effort. Publication of Diagnostic and Statistical Manual of
PSYCHOLOGY
Mental Disorders, Fifth edition (DSM-5), is the most recent effort in making available to readers and
practitioners the most up-to-date information about diagnostic categories, classifications, and criteria.
ABNORMAL
Abnormal Psychology, 16e, has been revised keeping in mind the dynamic and vibrant nature of the subject
and availability of updated diagnostic system with the publication of DSM-5. In order to contextualize the
present edition for Indian readers, either Indian case studies or Indian adaptation of Western case studies
have been included. Several culture-specific modifications have been made in the text to increase familiarity
of the Indian reader to various concept.
NEW TO THE EDITION

 Up-to-date and in-depth information about biological influences on behavioral abnormalities, while
maintaining its comprehensive and balanced biopsychosocial approach to understand abnormal
behavior
 Current DSM-5 diagnostic criteria for various disorders discussed in the book
 Several culture-specific modifications like the coverage of Dhat syndrome, the phenomenon or event S I X T E E N T H E D I T I O N
of spirit possession, and faith healing
 Recent developments like therapies of neurofeedback for the regulation of dysfunctional
ABNORMAL
cortico-cortical arousal syndromes, such as, depression; relapse prevention strategies for bipolar
disorders, and mindfulness and acceptance; and commitment therapy for schizophrenia
 Views about abnormality in ancient Indian texts like the Atharva Veda and Ayurveda
Cover Image: Asya Lysogorskaya. Shutterstock

 Discussion on yoga and meditation, and their role in the management of psychopathology
PSYCHOLOGY
 Policies and legislation of mental health in India, including the Mental Health Act, 1987
SIXTEENTH
EDITION
James N. Butcher
Butcher
www.pearson.co.in
Jill M. Hooley
Hooley
Mineka
Susan Mineka
This edition is manufactured in India and is authorized for sale only
in India, Bangladesh, Bhutan, Pakistan, Nepal, Sri Lanka and the Maldives. Dwivedi Chandra B. Dwivedi
Size: 203x254mm Spine: 29mm ISBN: 9789332579408 Title Sub Title Edition Authors / Editors Name With CD Red Band Territory line URL Price mQuest
psychology
sixteenth edition
James N.
Butcher
University of Minnesota
Jill M.
Hooley
Harvard University
Susan
Mineka
Northwestern University
Chandra B.
Dwivedi
Banaras Hindu University
F01 Abnormal Psychology 16 9408.indd 1 11/9/2016 4:02:10 PM

Copyright © 2017 Pearson India Education Services Pvt. Ltd
Published by Pearson India Education Services Pvt. Ltd, CIN: U72200TN2005PTC057128,

formerly known as TutorVista Global Pvt. Ltd, licensee of Pearson Education in South Asia.
No part of this eBook may be used or reproduced in any manner whatsoever without the
publisher’s prior written consent.
This eBook may or may not include all assets that were part of the print version. The publisher
reserves the right to remove any material in this eBook at any time.
ISBN 978-93-325-7940-8
eISBN 978-93-325-8746-5
Head Office: 15th Floor, Tower-B, World Trade Tower, Plot No. 1, Block-C, Sector 16,
Noida 201 301, Uttar Pradesh, India.
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www.pearson.co.in, Email: [email protected]

brief
1 Abnormal Psychology: An Overview 1
2 Historical and Contemporary Views of Abnormal Behavior 26
3 Causal Factors and Viewpoints 50
4 Clinical Assessment and Diagnosis 93
5 Stress and Physical and Mental Health 120
6 Panic, Anxiety, Obsessions, and Their Disorders 153
7 Mood Disorders and Suicide 197
8 Somatic Symptom and Dissociative Disorders 247
9 Eating Disorders and Obesity 276
10 Personality Disorders 306
11 Substance-Related Disorders 345
12 Sexual Variants, Abuse, and Dysfunctions 381
13 Schizophrenia and Other Psychotic Disorders 415
14 Neurocognitive Disorders 453
15 Disorders of Childhood and Adolescence
(Neurodevelopmental Disorders) 477
16 Therapy 515
17 Contemporary and Legal Issues in Abnormal Psychology 548
iii

This page is intentionally left blank

Features xv Preface xix about the authors xxiii
1 Abnormal Psychology: Retrospective Versus Prospective Strategies 19

Manipulating Variables: The Experimental
An Overview 1 Method in Abnormal Psychology 20
What do We mean by Abnormality? 3 Studying the Efficacy of Therapy 20
The Dsm-5 and the Definition of Mental Disorder 5 developments in ReseaRch:
do magnets help with repetitive-stress injury? 22
the WORLD around us
extreme Generosity or Pathological Behavior? 5 Single-Case Experimental Designs 22
Animal Research 23
ThINKING cRITIcaLLy about DsM-5:
what is the DSM and why was it revised? 6 UNResOLveD issues
Why Do We Need to Classify Mental Disorders? 7 are we all Becoming mentally ill? the expanding
horizons of mental disorder 24
What Are the Disadvantages of Classification? 7
How Can We Reduce Prejudicial Attitudes Toward
summary 25 key terms 25
the Mentally Ill? 8
How Does Culture Affect What Is Considered Abnormal? 8
the WORLD around us
stigma of abnormality in india: abnormality 2 Historical and
Contemporary Views of
is Nothing but Being haunted by evil spirits 9 Abnormal Behavior 26
Culture-Specific Disorders 10
historical views of Abnormal Behavior 27
how Common Are mental disorders? 10
Demonology, Gods, and Magic 27
Prevalence and Incidence 10
Hippocrates’ Early Medical Concepts 28
Prevalence Estimates for Mental Disorders 11
Early Philosophical Conceptions of Consciousness 28
Prevalence of Mental Disorders in India 12
Treatment 12 developments in ThINKING:
melancholia through the ages 29
Mental Health Professionals 12
Later Greek and Roman Thought 29
research Approaches in Abnormal Psychology 13 Early Views of Mental Disorders in China 30
sources of information 13 Ancient Indian Classification of Mental Disorders 30
Case Studies 13 Views of Abnormality During the Middle Ages 31
Self-Report Data 14 toward humanitarian Approaches 32
Observational Approaches 14 The Resurgence of Scientific Questioning in Europe 32
Forming and testing hypotheses 15 The Establishment of Early Asylums 33
Sampling and Generalization 15 Humanitarian Reform 34
Internal and External Validity 16 Nineteenth-Century Views of the Causes and
Criterion and Comparison Groups 16 Treatment of Mental Disorders 37
Changing Attitudes Toward Mental Health
research designs 17
in the Early Twentieth Century 37
Studying the World as It Is: Correlational
Mental Hospital Care in the Twentieth Century 37
Research Designs 17
Measuring Correlation 17 the WORLD around us
chaining mental health Patients 38
Statistical Significance 18
Effect Size 18 the emergence of Contemporary views
of Abnormal Behavior 39
Meta-Analysis 19
Biological Discoveries: Establishing the Link
Correlations and Causality 19
Between the Brain and Mental Disorder 39

The Development of a Classification System 40 sociocultural Causal Factors 87
Development of the Psychological Basis of Low Socioeconomic Status and Unemployment 87
Mental Disorder 41 Prejudice and Discrimination in Race,
developments in ReseaRch: Gender, and Ethnicity 88
the search for medications to cure mental disorders 42 Social Change and Uncertainty 88
The Evolution of the Psychological Research Urban Stressors: Violence and Homelessness 88
Tradition: Experimental Psychology 44
the WORLD around us
UNResOLveD issues culture and attachment relationships 89
interpreting historical events 47
The Impact of the Sociocultural Viewpoint 89
summary 48 key terms 49 UNResOLveD issues
theoretical viewpoints and the causes
of abnormal Behavior 90
3 Causal Factors
and Viewpoints 50
Causes and risk Factors for Abnormal Behavior

Necessary, Sufficient, and Contributory Causes
Feedback and Bidirectionality in Abnormal Behavior
51
52
51
4 Clinical Assessment
and Diagnosis 93
Diathesis-Stress Models 53 the Basic elements in Assessment 94

The Relationship Between Assessment and Diagnosis 95
viewpoints for understanding the Causes
Taking a Social or Behavioral History 95
Ensuring Culturally Sensitive Assessment Procedures 95
the Biological viewpoint and Biological
The Influence of Professional Orientation 96
Causal Factors 55
Reliability, Validity, and Standardization 97
Imbalances of Neurotransmitters and Hormones 56
Trust and Rapport Between the Clinician and the Client 97
Genetic Vulnerabilities 58
developments in ThINKING: Physical Assessment 98
Nature, Nurture, and Psychopathology: The General Physical Examination 98
a New look at an old topic 62 The Neurological Examination 98
Temperament 63 The Neuropsychological Examination 100
Brain Dysfunction and Neural Plasticity 63
Psychosocial Assessment 101
The Impact of the Biological Viewpoint 64
Assessment Interviews 101
the Psychological viewpoints 65 The Clinical Observation of Behavior 102
The Psychodynamic Perspectives 65 Psychological Tests 103
The Behavioral Perspective 70 developments in PRacTIce:
developments in ThINKING: the automated Practice: use of the computer
the humanistic and existential Perspectives 72 in Psychological testing 103
The Cognitive-Behavioral Perspective 74 the Case of Andrea C.: experiencing
What the Adoption of a Perspective violence in the Workplace 109
Does and Does Not Do 76
developments in PRacTIce:
Psychological Causal Factors 77 computer-Based mmPi-2 report for andrea c. 111
Early Deprivation or Trauma 78 the integration of Assessment data 113
Inadequate Parenting Styles 80 Ethical Issues in Assessment 113
Marital Discord and Divorce 82
Classifying Abnormal Behavior 114
Domestic Violence 82
Differing Models of Classification 114
Maladaptive Peer Relationships 83
Formal Diagnostic Classification of Mental Disorders 115
the sociocultural viewpoint 85 ThINKING cRITIcaLLy about DsM-5:
Uncovering Sociocultural Factors Through completion does Not assure acceptance 118
Cross-Cultural Studies 85
vi coNteNts

the WORLD around us
5 Stress and Physical and

Mental Health 120
does Playing tetris after a traumatic
event reduce Flashbacks? 147
Treatment for Stress Disorders 148
What is stress? 121 Psychological Debriefing 148
Stress and the Dsm 122 the WORLD around us
Factors Predisposing a Person to Stress 122 virtual reality exposure treatment for
Ptsd in military Personnel 149
Characteristics of Stressors 123
Challenges in Studying Disaster Victims 150
Measuring Life Stress 123
Trauma and Physical Health 150
Resilience 124
UNResOLveD issues
stress and the stress response 124
why is the study of trauma so contentious? 151
Biological Costs of Stress 125
The Mind–Body Connection 125
Understanding the Immune System 125
Stress, Depression, and the Immune System
stress ANd PhysiCAl heAlth 128
127
6 Panic, Anxiety,
Obsessions,
Cardiovascular disease 128 and Their Disorders 153
Hypertension 129
the Fear and Anxiety response Patterns 155
Coronary Heart Disease 130 Fear 155
Risk and Causal Factors in Cardiovascular Disease 130 ThINKING cRITIcaLLy about DsM-5:
the WORLD around us why is ocd No longer considered to
racial discrimination and cardiovascular Be an anxiety disorder? 155
health in african americans 133 Anxiety 156
treatment of stress-related Physical overview of the Anxiety disorders
disorders 134 and their Commonalities 156
Biological Interventions 134 specific Phobias 157
Psychological Interventions 134 Prevalence, Age of Onset, and Gender
Differences 158
stress ANd meNtAl heAlth 136
Psychological Causal Factors 159
Adjustment Disorder 136
Biological Causal Factors 161
Adjustment Disorder Caused by Unemployment 136
Treatments 161
Posttraumatic stress disorder 137
Criteria for Posttraumatic Stress Disorder 137 social Phobias 162
ThINKING cRITIcaLLy about DsM-5: Prevalence, Age of Onset, and Gender
changes to the diagnostic criteria for Ptsd 138 Differences 162
Acute Stress Disorder 139 Criteria for Social Anxiety Disorder (Social Phobia) 163
Clinical Description 139 Psychological Causal Factors 164
Prevalence of PTSD in the General Population 140 Biological Causal Factors 165
Rates of PTSD After Traumatic Experiences 140 Treatments 165
Causal Factors in Posttraumatic Stress Disorder 144 Panic Disorder 166
Individual Risk Factors 144 Criteria for Panic Disorder 167
Sociocultural Factors 145 Agoraphobia 168
Long-Term Effects of Posttraumatic Stress 146 Prevalence, Age of Onset, and Gender Differences 168
Criteria for Agoraphobia 169
Prevention and treatment of stress
Comorbidity with Other Disorders 169
disorders 147
The Timing of a First Panic Attack 170
Prevention 147
coNteNts vii

Psychological Causal Factors 172 Dysthymic Disorder (Persistent Depressive Disorder) 202
developments in ReseaRch: developments in ThINKING:
Nocturnal Panic attacks 174 a New dsm-5 diagnosis: Premenstrual
Treatments 175 dysphoric disorder 202
Criteria for Persistent Depressive Disorder (Dysthymia) 203
Generalized Anxiety disorder 176 Major Depressive Disorder 204
Criteria for Generalised Anxiety Disorder 177 Causal Factors in unipolar mood disorders 207
Prevalence, Age of Onset, and Gender Differences 177 Biological Causal Factors 207
Comorbidity with Other Disorders 178 Psychological Causal Factors 212
developments in ReseaRch:
Biological Causal Factors 180 why do sex differences in unipolar depression
Treatments 181 emerge during adolescence? 220
Bipolar and related disorders 222
obsessive-Compulsive and related
Cyclothymic Disorder 222
disorders 182
Criteria for Cyclothymic Disorder 223
Obsessive-Compulsive Disorder 182
Bipolar Disorders (I and II) 223
Criteria for Obsessive-Compulsive Disorder 183
Prevalence, Age of Onset, and Gender Differences 184
Causal Factors in Bipolar disorders 226
Comorbidity with Other Disorders 184
Biological Causal Factors 186 sociocultural Factors Affecting unipolar
and Bipolar disorders 229
Treatments 188
Cross-Cultural Differences in Depressive Symptoms 229
Body Dysmorphic Disorder 189
Cross-Cultural Differences in Prevalence 229
Criteria for Body Dysmorphic Disorder 190
treatments and outcomes 230
Hoarding Disorder 192
Pharmacotherapy 230
Trichotillomania 193
Alternative Biological Treatments 232
Cultural Perspectives 193 Psychotherapy 233
Cultural Differences in Sources of Worry 194 suicide: the Clinical Picture and
Taijin Kyofusho 194 the Causal Pattern 236
UNResOLveD issues Who Attempts and Who Commits Suicide? 237
the choice of treatments: medications or Suicide in Children 237
cognitive-Behavior therapy? 195 Suicide in Adolescents and Young Adults 237
summary 195 key terms 196 Other Psychosocial Factors Associated with Suicide 238
the WORLD around us
warning signs for student suicide 239
7 Mood Disorders
and Suicide 197
Biological Causal Factors
Sociocultural Factors 240
239
suicidal Ambivalence 241

mood disorders: An overview 198
Communication of Suicidal Intent 241
Types of Mood Disorders 198
Suicide Notes 242
Criteria for Major Depressive Disorder 199
Criteria for Manic Episode 200
suicide Prevention and intervention 242
The Prevalence of Mood Disorders 200 Treatment of Mental Disorders 242
Crisis Intervention 242
unipolar depressive disorders 200
Focus on High-Risk Groups and Other Measures 243
Other Forms of Depression 201
ThINKING cRITIcaLLy about DsM-5: UNResOLveD issues
was it wise to drop the Bereavement is there a right to die? 243
exclusion for major depression? 201 summary 245 key terms 246
viii coNteNts

Binge Eating Disorder 281
8 Somatic Symptom and

Dissociative
Criteria for Binge-Eating Disorder
Age of Onset and Gender Differences 282
281
Disorders 247 ThINKING cRITIcaLLy about DsM-5:

other Forms of eating disorders 283
somatic symptom and related disorders 248 Prevalence of Eating Disorders 283
Somatic Symptom Disorders 249 Medical Complications of Eating Disorders 284
Hypochondriasis 249 Course and Outcome 285
Criteria for Somatic Symptom Disorder 249 Diagnostic Crossover 285
Somatization Disorder 252 Association of Eating Disorders With Other
Pain Disorder 253 Forms of Psychopathology 286
Conversion Disorder (Functional Neurological Eating Disorders Across Cultures 286
Symptom Disorder) 254
risk and Causal Factors in eating
Criteria for Illness Anxiety Disorder 254 disorders 288
Criteria for Conversion disorder 255 Biological Factors 288
Distinguishing Somatization, Pain, and Conversion
Sociocultural Factors 289
Disorders from Malingering and Factitious Disorder 257
Family Influences 290
Criteria for Factitious Disorder 258
Individual Risk Factors 290
dissociative disorders 258
treatment of eating disorders 293
the WORLD around us
Treatment of Anorexia Nervosa 293
Factitious disorder imposed on another
(munchausen’s syndrome by Proxy) 259 Treatment of Bulimia Nervosa 295
Depersonalization/Derealization Disorder 260 Treatment of Binge Eating Disorder 296
Criteria for Depersonalization/Derealization Disorder 261 the Problem of obesity 296
Dissociative Amnesia and Dissociative Fugue 261 Yogic Management of Obesity 297
Criteria for Dissociative Amnesia 262 Medical Issues 297
Dissociative Identity Disorder (DID) 263 Definition and Prevalence 297
ThINKING cRITIcaLLy about DsM-5: Weight Stigma 297
where does conversion disorder Belong? 264
the WORLD around us
Criteria for Dissociative Identity Disorder 265 do Negative messages about Being overweight
the WORLD around us encourage overweight People to eat more or less? 298
did, schizophrenia, and split Personality: Obesity and the Dsm 298
clearing up the confusion 266
risk and Causal Factors in obesity 298
Sociocultural Factors in Dissociative Disorders 271
The Role of Genes 298
Treatment and Outcomes in Dissociative Disorders 272
Hormones Involved in Appetite and Weight
UNResOLveD issues Regulation 299
did and the reality of “recovered memories” 273
Sociocultural Influences 299
Family Influences 300
Stress and “Comfort Food” 301
Pathways to Obesity 301
9 Eating Disorders
and Obesity 276
treatment of obesity
Lifestyle Modifications 302
302
Clinical Aspects of eating disorders 277 Medications 303

Anorexia Nervosa 277 Bariatric Surgery 303
Criteria for Anorexia Nervosa 278 The Importance of Prevention 304
Bulimia Nervosa 280 summary 304 key terms 305
Criteria for Bulimia Nervosa 280
coNteNts ix

Antisocial Personality disorder
10 Personality
Disorders 306
and Psychopathy 332
Psychopathy and Antisocial Personality Disorder 332
The Clinical Picture in Psychopathy and
Clinical Features of Personality disorders 307 Antisocial Personality Disorder 333
difficulties doing research on Causal Factors in Psychopathy and
Personality disorders 309 Antisocial Personality 335
Difficulties in Diagnosing Personality Disorders 309 the WORLD around us
“successful” Psychopaths 337
ThINKING cRITIcaLLy about DsM-5:
why were No changes made to the way A Developmental Perspective on Psychopathy
Personality disorders are diagnosed? 310 and Antisocial Personality 338
Difficulties in Studying the Causes of Treatments and Outcomes in Psychopathic
Personality Disorders 311 and Antisocial Personality 341
developments in PRacTIce:
Cluster A Personality disorders 312
Prevention of Psychopathy and antisocial
Paranoid Personality Disorder 312 Personality disorder 342
Criteria for Paranoid Personality Disorder 313 UNResOLveD issues
Schizoid Personality Disorder 314 DSM-5: how can we improve the classification
Criteria for Schizoid Personality Disorder 315 of Personality disorders? 343
Schizotypal Personality Disorder 315 summary 343 key terms 344
Criteria for Schizotypal Personality Disorder 316
Cluster B Personality disorders 317
Histrionic Personality Disorder 317
Narcissistic Personality Disorder 318
11 Substance-Related
Disorders 345
Criteria for Histrionic Personality Disorder 318 Alcohol related disorders 347
Criteria for Narcissistic Personality Disorder 319 The Prevalence, Comorbidity, and Demographics
Antisocial Personality Disorder 320 of Alcohol Abuse and Dependence 347
Borderline Personality Disorder 321 Prevalence of Alcohol Abuse and Dependence in India 347
Criteria for Borderline Personality Disorder 321 Criteria for Alcohol Use Disorder 348
ThINKING cRITIcaLLy about DsM-5: The Clinical Picture of Alcohol Related Disorders 349
Nonsuicidal self-injury: distinct disorder or symptom developments in ReseaRch:
of Borderline Personality disorder? 322 Fetal alcohol syndrome: how much drinking
Cluster C Personality disorders 324 is too much? 351
Avoidant Personality Disorder 324 Biological Causal Factors in the Abuse of
and Dependence on Alcohol 353
Criteria for Avoidant Personality Disorder 325
Psychosocial Causal Factors in Alcohol
Dependent Personality Disorder 326
Abuse and Dependence 355
Obsessive-Compulsive Personality Disorder 327
the WORLD around us
Criteria for Dependent Personality Disorder 327 Binge drinking in college 358
Criteria for Obsessive-Compulsive Personality Disorder 328 Sociocultural Causal Factors 359
General sociocultural Causal Factors Treatment of Alcohol-Related Disorders 359
for Personality disorders 329
drug Abuse and dependence 363
treatments and outcomes for Opium and Its Derivatives (Narcotics) 364
Personality disorders 329
Cocaine and Amphetamines (Stimulants) 367
Adapting Therapeutic Techniques to
Methamphetamine 369
Specific Personality Disorders 330
Treating Borderline Personality Disorder 330 ThINKING cRITIcaLLy about DsM-5:
can changes to the diagnostic
Treating Other Personality Disorders 331 criteria result in increased drug use? 370
Criteria for Antisocial Personality Disorder 332 Barbiturates (Sedatives) 370
x coNteNts

Hallucinogens: LSD and Related Drugs 371
Ecstasy
Marijuana
372
372 13 Schizophrenia and Other
Psychotic Disorders 415
the WORLD around us
should marijuana Be marketed and sold schizophrenia 416
openly as a medication? 374 Origins of the Schizophrenia Construct 416
Stimulants: Caffeine and Nicotine 375 Epidemiology 417
Gambling disorder 376 Clinical Picture 418
Criteria for Gambling Disorder 377 Delusions 418
UNResOLveD issues Criteria for Schizophrenia 419
exchanging addictions: is this an effective Hallucinations 419
treatment approach? 378 Disorganized Speech and Behavior 420
summary 379 key terms 380 Positive and Negative Symptoms 420
Subtypes of Schizophrenia 421
Other Psychotic Disorders 421
12 Sexual Variants, Abuse,

and Dysfunctions 381
Criteria for Schizoaffective Disorder
Criteria for Schizophreniform Disorder
422
422
Criteria for Delusional Disorder 423
sociocultural influences on sexual
Practices and standards 383 Criteria for Brief Psychotic Disorder 423
Case 1: Degeneracy and Abstinence Theory 383 risk and Causal Factors 423
Case 2: Ritualized Homosexuality in Melanesia 384 Genetic Factors 423
Case 3: Homosexuality and American Psychiatry 384 the WORLD around us
the Genain Quadruplets 425
Gender dysphoria 386
Prenatal Exposures 429
The Paraphilias 386
Genes and Environment in Schizophrenia: A Synthesis 430
Causal Factors and Treatments for Paraphilias 391
A Neurodevelopmental Perspective 431
Gender Dysphoria 392
Structural and Functional Brain Abnormalities 432
Criteria for Gender Dysphoria 393
Criteria for Gender Dysphoria in ThINKING cRITIcaLLy about DsM-5:
Adolescents and Adults 394 attenuated Psychosis syndrome 433
Psychosocial and Cultural Factors 440
sexual Abuse 396
A Diathesis-Stress Model of Schizophrenia 443
Childhood Sexual Abuse 396
Pedophilic Disorder 398 treatments and outcomes 445
ThINKING cRITIcaLLy about DsM-5: Clinical Outcome 445
Pedophilia and hebephilia 399 Pharmacological Approaches 446
Incest 400 UNResOLveD issues
Rape 400 the outcome of schizophrenia in india 446
Treatment and Recidivism of Sex Offenders 403 Psychosocial Approaches 448
the WORLD around us UNResOLveD issues

megan’s law 404 why are recovery rates in schizophrenia
not improving? 451
sexual dysfunctions 405
Sexual Dysfunctions in Men 406
Male Hypoactive Sexual Desire Disorder 406
Female Sexual Interest/Arousal Disorder
UNResOLveD issues
how harmful is childhood sexual abuse?
409
412
14 Neurocognitive
Disorders 453
Brain impairment in Adults 455
Clinical Signs of Brain Damage 455
coNteNts xi

ThINKING cRITIcaLLy about DsM-5: Anxiety and depression in Children
is the inclusion of mild Neurocognitive and Adolescents 487
disorder a Good idea? 455
Anxiety Disorders of Childhood and
Diffuse Versus Focal Damage 456 Adolescence 487
The Neurocognitive/Psychopathology Interaction 458 Criteria for Separation Anxiety Disorder 487
delirium 458 Childhood Depression and Bipolar
Clinical Picture 459 Disorder 489
Treatments and Outcomes 460 developments in ReseaRch:
Bipolar disorder in children and adolescents:
major Neurocognitive disorder (dementia) 460 is there an epidemic? 491
Parkinson’s Disease 460
elimination disorders (enuresis, encopresis),
Huntington’s Disease 461
sleepwalking, and tics 492
Alzheimer’s Disease 461
Enuresis 493
developments in ReseaRch: Encopresis 493
depression increases the risk of
Sleepwalking 494
alzheimer’s disease 465
Tic Disorders 494
the WORLD around us
Nutrition and exercise for a healthier Brain 468 Neurodevelopmental Disorders 495
Neurocognitive Disorder Associated Autism Spectrum Disorder 495

with HIV-1 Infection 469 Criteria for Autism Spectrum Disorder 496
Neurocognitive Disorder Associated developments in PRacTIce:
with Vascular Disease 470 can virtual reality video Games improve
treatment of children with
Amnestic disorder 470
Neurodevelopmental disorders? 499
disorders involving head injury 471
specific learning disorders 500
Clinical Picture 471
Causal Factors in Learning Disorders 500
Treatments and Outcomes 473
Treatments and Outcomes 500
the WORLD around us ThINKING cRITIcaLLy about DsM-5:
Brain damage in Professional athletes 474
changes to the diagnostic system are
UNResOLveD issues Nominal for some disorders 501
should healthy People use cognitive
enhancers? 475
intellectual disability 501
Levels of Intellectual Disability 502
Causal Factors in Intellectual
Disability 502
15 Disorders of Childhood
and Adolescence
Organic Retardation Syndromes
Treatments, Outcomes, and Prevention
503
506
(Neurodevelopmental Planning Better Programs to help

Disorders) 477 Children and Adolescents 508
Special Factors Associated with Treatment
maladaptive Behavior in different life Periods 479 of Children and Adolescents 508
Varying Clinical Pictures 479 the WORLD around us
Special Psychological Vulnerabilities of Young Children 479 the impact of child abuse on
Psychological adjustment 509
The Classification of Childhood and
Adolescent Disorders 480 Family Therapy as a Means of
Helping Children 510
Common disorders of Childhood 480 Child Advocacy Programs 510
Attention-Deficit/Hyperactivity Disorder 480
UNResOLveD issues
Criteria for Attention-Deficit/Hyperactivity Disorder 481 can society deal with delinquent Behavior? 511
Disruptive, Impulse-control and Conduct Disorder 484 summary 513 key Terms 514
Criteria for Conduct Disorder 484
xii coNteNts

16 Therapy 515
An overview of treatment 516
17 Contemporary and Legal
Issues in Abnormal
Psychology 548
Why Do People Seek Therapy? 516
Who Provides Psychotherapeutic Services? 517 Perspectives on Prevention 549
The Therapeutic Relationship 518 Universal Interventions 550
Selective Interventions 551
measuring success in Psychotherapy 519
Indicated Interventions 553
Objectifying and Quantifying Change 519
Would Change Occur Anyway? 520
inpatient mental health treatment in
Contemporary society 553
Can Therapy Be Harmful? 520
The Mental Hospital as a Therapeutic
the WORLD around us Community 553
when therapy harms 521 Aftercare Programs 555
What therapeutic Approaches should Deinstitutionalization 555
Be used? 521 Controversial legal issues and the
Evidence-Based Treatment 521 mentally ill 556
Medication or Psychotherapy? 522 Civil Commitment 556
Combined Treatments 522 the WORLD around us
Psychosocial Approaches to treatment 523 Policies and legislation related to
mental health in india 557
Behavior Therapy 523
Assessment of “Dangerousness” 558
Cognitive and Cognitive-Behavioral Therapy 525
Humanistic-Experiential Therapies 527 the WORLD around us
controversial Not Guilty Pleas: can altered
Psychodynamic Therapies 529 mind states or Personality disorder limit
Couple and Family Therapy 532 responsibility for a criminal act? 559
Eclecticism and Integration 533 The Insanity Defense 561
the WORLD around us Competence to Stand Trial 564
yoga, meditation, and other traditional indian Does Having Mental Health Problems Result in
approaches to mental healing 534 Convicted Felons Being Returned to Prison After
Being Released? 564
sociocultural Perspectives 535
Social Values and Psychotherapy 535 organized efforts for mental health 565
Psychotherapy and Cultural Diversity 535 U.S. Efforts for Mental Health 565
India’s Efforts for Mental Health 565
Biological Approaches to treatment 536
International Efforts for Mental Health 566
Antipsychotic Drugs 536
Antidepressant Drugs 536 Challenges for the Future 567
Antianxiety Drugs 540 The Need for Planning 567
Lithium and Other Mood-Stabilizing Drugs 540 The Individual’s Contribution 568
ThINKING cRITIcaLLy about DsM-5: UNResOLveD issues

what are some of the clinical implications the hmos and mental health care 569
of the recent changes? 541 summary 571 key terms 571
Electroconvulsive Therapy 542
Neurosurgery 543
Glossary 572
the WORLD around us references 597
deep Brain stimulation for treatment-
credits 700
resistant depression 544
Name index 706
UNResOLveD issues
do Psychiatric medications help or harm? 545 subject index 721
coNteNts xiii


developments in Research Warning Signs for Student Suicide 239
Factitious Disorder Imposed on Another
Do Magnets Help with Repetitive-Stress Injury? 22
(Munchausen’s Syndrome by Proxy) 259
The Search for Medications to Cure Mental Disorders 42
DID, Schizophrenia, and Split Personality:
Nocturnal Panic Attacks 174 Clearing Up the Confusion 266
Why Do Sex Differences in Unipolar Depression Do Negative Messages About Being Overweight Encourage
Emerge During Adolescence? 220 Overweight People to Eat More or Less? 298
Fetal Alcohol Syndrome: How Much “Successful” Psychopaths 337
Drinking Is Too Much? 351
Binge Drinking in College 358
Depression Increases the Risk of Alzheimer’s Disease 465
Should Marijuana Be Marketed and Sold
Bipolar Disorder in Children and Adolescents: Openly as a Medication? 374
Is There an Epidemic? 491
Megan’s Law 404
The Genain Quadruplets 425
Nutrition and Exercise for a Healthier Brain 468
developments in THINKING
Brain Damage in Professional Athletes 474
Melancholia Through the Ages 29 The Impact of Child Abuse on
Nature, Nurture, and Psychopathology: Psychological Adjustment 509
A New Look at an Old Topic 62 When Therapy Harms 521
The Humanistic and Existential Perspectives 72 Yoga, Meditation, and Other Traditional Indian
A New Dsm-5 Diagnosis: Premenstrual Approaches to Mental Healing 534
Dysphoric Disorder 202 Deep Brain Stimulation for Treatment-
Resistant Depression 544
Policies and Legislation Related to
developments in PRACTICE Mental Health in India 557
The Automated Practice: Use of the Computer Controversial Not Guilty Pleas: Can Altered
in Psychological Testing 103 Mind States or Personality Disorder Limit
Responsibility for a Criminal Act? 559
Computer-Based MMPI-2 Report for Andrea C. 111
Prevention of Psychopathy and Antisocial
Personality Disorder 342
Unresolved issues
Can Virtual Reality Video Games Improve Treatment of
Children with Neurodevelopmental Disorders? 499 Are We All Becoming Mentally Ill? The Expanding
Horizons of Mental Disorder 24
Interpreting Historical Events 47
the WORLD around us Theoretical Viewpoints and the Causes
Extreme Generosity or Pathological Behavior? 5
Why Is the Study of Trauma so Contentious? 151
Stigma of Abnormality in India: Abnormality is
Nothing but Being Haunted by Evil Spirits 9 The Choice of Treatments: Medications or
Cognitive-Behavior Therapy? 195
Chaining Mental Health Patients 38
Is There a Right to Die? 243
Culture and Attachment Relationships 89
DID and the Reality of “Recovered Memories” 273
Racial Discrimination and Cardiovascular
Health in African Americans 133 DSM-5: How Can We Improve the Classification
of Personality Disorders? 343
Does Playing Tetris After a Traumatic
Event Reduce Flashbacks? 147 Exchanging Addictions: Is This an Effective
Treatment Approach? 378
Virtual Reality Exposure Treatment for
PTSD in Military Personnel 149 How Harmful Is Childhood Sexual Abuse? 412
xv

The Outcome of Schizophrenia in India 446 Criteria for Obsessive-Compulsive Personality Disorder 328
Why are Recovery Rates in Schizophrenia Criteria for Antisocial Personality Disorder 332
Not Improving? 451 Criteria for Alcohol Use Disorder 348
Should Healthy People Use Cognitive Enhancers? 475 Criteria for Gambling Disorder 377
Can Society Deal with Delinquent Behavior? 511 Criteria for Gender Dysphoria 393
Do Psychiatric Medications Help or Harm? 545 Criteria for Gender Dysphoria in Adolescents
The HMOs and Mental Health Care 569 and Adults 394
Criteria for Schizophrenia 419
Criteria for Schizoaffective Disorder 422
Criteria for Schizophreniform Disorder 422
DSM-5 Boxes Criteria for Delusional Disorder 423
Criteria for Posttraumatic Stress Disorder 137 Criteria for Brief Psychotic Disorder 423
Criteria for Social Anxiety Disorder (Social Phobia) 163 Criteria for Attention-Deficit/Hyperactivity Disorder 481
Criteria for Panic Disorder 167 Criteria for Conduct Disorder 484
Criteria for Agoraphobia 169 Criteria for Separation Anxiety Disorder 487
Criteria for Generalized Anxiety Disorder 177 Criteria for Autistic Spectrum Disorder 496
Criteria for Obsessive-Compulsive Disorder 183
Criteria for Body Dysmorphic Disorder 190
Criteria for Major Depressive Disorder 199 Thinking Critically about DSM-5
Criteria for Manic Episode 200 What Is the DSM and Why Was It Revised? 6
Criteria for Persistent Depressive Disorder (Dysthymia) 203 Completion Does Not Assure Acceptance 118
Criteria for Cyclothymic Disorder 223 Changes to the Diagnostic Criteria for PTSD 138
Criteria for Somatic Symptom Disorder 249 Why is OCD No Longer Considered
Criteria for Illness Anxiety Disorder 254 to be an anxiety disorder? 155
Criteria for Conversion Disorder 255 Was It Wise to Drop the Bereavement
Exclusion for Major Depression? 201
Criteria for Factitious Disorder 258
Where Does Conversion Disorder Belong? 264
Criteria for Depersonalization/Derealization Disorder 261
Other Forms of Eating Disorders 283
Criteria for Dissociative Amnesia 262
Why Were No Changes Made to the Way
Criteria for Dissociative Identity Disorder 265
Personality Disorders Are Diagnosed? 310
Criteria for Anorexia Nervosa 278
Nonsuicidal Self-Injury: Distinct Disorder or Symptom
Criteria for Bulimia Nervosa 280 of Borderline Personality Disorder? 322
Criteria for Binge-Eating Disorder 281 Can Changes to the Diagnostic Criteria
Criteria for Paranoid Personality Disorder 313 Result in Increased Drug Use? 370
Criteria for Schizoid Personality Disorder 315 Pedophilia and Hebephilia 399
Criteria for Schizotypal Personality Disorder 316 Attenuated Psychosis Syndrome 433
Criteria for Histrionic Personality Disorder 318 Is the Inclusion of Mild Neurocognitive Disorder
a Good Idea? 455
Criteria for Narcissistic Personality Disorder 319
Changes to the Diagnostic System are
Criteria for Borderline Personality Disorder 321
Nominal for Some Disorders 501
Criteria for Avoidant Personality Disorder 325
What Are Some of the Clinical Implications
Criteria for Dependent Personality Disorder 327 of the Recent Changes? 541
xvi FEATURES

What’s New in DSM-5? A Quick Guide • The diagnosis of phobia no longer requires that the person
recognize that his or her anxiety is unreasonable.
Many changes occurred from DSM-IV to DSM-5. Here is a
• Panic disorder and agoraphobia have been unlinked and are
summary of some of the most important revisions. Many of
now separate diagnoses in DSM-5.
these changes are highlighted in the “Thinking Critically about
DSM-5” boxes throughout this edition. • Obsessive-compulsive disorder is no longer classified as an
anxiety disorder. DSM-5 contains a new chapter that covers
• The chapters of the DSM have been re-organized to reflect obsessive compulsive and related disorders.
a consideration of developmental and lifespan issues.
• New disorders in the obsessive compulsive and related dis-
Disorders that are thought to reflect developmental pertur-
orders category include hoarding disorder and excoriation
bations or that manifest early in life (e.g., neurodevelopmen-
(skin picking) disorder.
tal disorders and disorders such as schizophrenia) are listed
before disorders that occur later in life. • Post-traumatic stress disorder is no longer considered to be
an anxiety disorder. Instead, it is listed in a new chapter that
• The multiaxial system has been abandoned. No distinction
covers trauma- and stressor-related disorders.
is now made between Axis I and Axis II disorders.
• The diagnostic criteria for post-traumatic stress disorder
• DSM-5 allows for more gender-related differences to be
have been significantly revised. The definition of what
taken into consideration for mental health problems.
counts as a traumatic event has been clarified and made
• It is extremely important for the clinician to understand more explicit. DSM-5 now also recognizes four-symptom
the client’s cultural background in appraising mental health clusters rather than the three noted in DSM-IV.
problems. DSM-5 contains a structured interview that
• Dissociative fugue is no longer listed as a separate diagnosis.
focuses upon the patient’s cultural background and charac-
Instead, it is listed as a form of dissociative amnesia.
teristic approach to problems.
• The DSM-IV diagnoses of hypochondriasis, somatoform
• The term intellectual disability is now used instead of the term
disorder, and pain disorder have been removed and are now
mental retardation.
subsumed into the new diagnosis of somatic symptom dis-
• A new diagnosis of autism spectrum disorder now encom- order.
passes autism, Asperger’s disorder, and other forms of per-
• Binge eating disorder has been moved from the appendix
vasive developmental disorder. The diagnosis of Asperger’s
of DSM-IV and is now listed as an official diagnosis.
disorder has been eliminated from the DSM.
• The frequency of binge eating and purging episodes has
• Changes to the diagnostic criteria for attention deficit dis-
been reduced for the diagnosis of bulimia nervosa.
order now mean that symptoms that occur before age 12
(rather than age 7) have diagnostic significance. • Amenorrhea is no longer required for the diagnosis of
anorexia nervosa.
• A new diagnosis, called disruptive mood regulation disor-
der, has been added. This will be used to diagnose children • The DSM-IV diagnoses of dementia and amnestic disorder
up to age 18 who show persistent irritability and frequent have been eliminated and are now subsumed into a new cat-
episodes of extreme and uncontrolled behavior. egory called major neurocognitive disorder.
• The subtypes of schizophrenia have been eliminated. • Mild neurocognitive disorder has been added as a new
diagnosis.
• The special significance afforded to bizarre delusions with
regard to the diagnosis of schizophrenia has been removed. • No changes have been made to the diagnostic criteria for
personality disorders.
• Bipolar and related disorders are now described in a sepa-
rate chapter of the DSM and are no longer listed with • Substance-related disorders are divided into two separate
depressive disorders. groups: substance use disorders and substance-induced
disorders.
• Premenstrual dysphoric disorder has been promoted from
the appendix of DSM-IV and is now listed as a new diag- • A new disorder, gambling disorder, has been included in
nosis. substance-related and addictive disorders.
• A new diagnosis of persistent depressive disorder now sub- • Included for the first time in Section III of DSM-5 are
sumes dysthymia and chronic major depressive disorder. several new disorders regarded as being in need of further
study. These include attenuated psychosis syndrome, non-
• The bereavement exclusion has been removed in the diag-
suicidal self-injury disorder, Internet gaming disorder, and
nosis of major depressive episode.
caffeine use disorder.
FEATURES xvii


The guidelines and standards that we follow in our profes- The Butcher–Hooley–Mineka author team is in a unique
sional activities are not set in stone. Change is a big part of life position to provide students with an integrated and compre-
and new research or novel new theories can impact the way hensive understanding of abnormal psychology. Each author
mental health professionals view problems. Although many is a noted researcher, an experienced teacher, and a licensed
of the ideas and diagnostic concepts in the field of abnormal clinician. Each brings different areas of expertise and diverse
psychology have persisted for hundreds of years, changes in research interests to the textbook. Importantly, these different
thinking do occur. And, at some point there are events that perspectives come together in a systematically integrated text
occur that force a rethinking of some issues. Most recently that is accessible to a broad audience. The depth and breadth
in abnormal psychology, the publication of the DSM-5, after of the author team provides students with learning experi-
years of development and considerable controversy, is one of ences that can take them to new levels of understanding. Our
those momentous changes. Reflecting this, we have revised approach emphasizes the importance of research as well as the
this new edition of Abnormal Psychology to reflect the most need to translate research findings into informed and effective
up-to-date information about diagnostic categories, classifica- clinical care for all who suffer from mental disorders.
tions, and criteria. Abnormal Psychology has a long and distinguished tradition
Every time we work on a revision of Abnormal Psychology as an undergraduate text. Ever since James Coleman wrote the
we are reminded of how dynamic and vibrant our field is. first edition many years ago, this textbook has been considered
Developments in areas such as genetics, brain imaging, behav- the most comprehensive in the field. Along the way there have
ioral observation, and classification, as well changes in social been many changes. However, the commitment to excellence
and government policy and in legal decisions, add to our in this now-classic textbook has remained ever constant. In
knowledge base and stimulate new treatments for those whose this new edition, we seek to open up the fascinating world of
lives are touched by mental disorders. This is exciting. But the abnormal psychology, providing students with comprehensive
rapid progress of our field also presents its own challenges. and up-to-date knowledge in an accessible and engaging way.
One of the most important is how best to provide students We hope that this newest edition conveys some of the passion
with an integrated perspective—one that respects new ideas and enthusiasm for the topic that we still experience every day.
and discoveries and places them into the existing body of
knowledge in a way that emphasizes multiple perspectives, pro-
vokes thought, and increases awareness. Why Do You Need This
We use a biopsychosocial approach to provide a sophisti-
cated appreciation of the total context in which abnormalities New Edition?
of behavior occur. For ease of understanding we also pres- If you’re wondering why you should buy this new edition of
ent material on each disorder in a logical and consistent way. Abnormal Psychology, here are 7 good reasons!
More specifically, we focus on three significant aspects: (1)
1. The sixteenth edition of Abnormal Psychology includes the
the clinical picture, where we describe the symptoms of the
most up-to-date and in-depth information about biological
disorder and its associated features; (2) factors involved in the
influences on the entire spectrum of behavioral abnormali-
development of the disorder; and (3) treatment approaches.
ties, while still maintaining its comprehensive and balanced
In each case, we examine the evidence for biological, psycho-
bio-psychosocial approach to understanding abnormal
social (i.e., psychological and interpersonal), and sociocultural
behavior.
(the broader social environment of culture and subculture)
2. After years of planning, DSM-5 was published in May 2013.
influences. Because we wish never to lose sight of the person,
This major revision of the diagnostic system means that
we try to integrate as much case material as we can into each
the diagnostic criteria for many disorders have changed. To
chapter. An additional feature of this book is a focus on treat-
stay current, you need to know about the changes that have
ment. Although treatment is discussed in every chapter in the
been made in DSM-5. Books that do not include coverage
context of specific disorders, we also include a separate chap-
of DSM-5 are books that are out of date.
ter that addresses issues in treatment more broadly. This pro-
3. Our new edition provides you with detailed tables showing
vides students with increased understanding of a wide range
the current DSM-5 diagnostic criteria for all the disorders
of treatment approaches and permits more in-depth coverage
covered in the book.
than is possible in specific disorder–based chapters.
xix

4. New highlight boxes alert you to some of the most impor- why is the study of trauma so contentious?; why are recovery
tant changes in DSM-5. These include changes to the diag- rates in schizophrenia not improving?), and new feature boxes
nostic criteria for attention-deficit hyperactivity disorder designed to be of high interest to students (e.g., non-suicidal
as well as new diagnoses such as binge eating disorder and self-injury disorder). Reflecting the ever-changing field of
premenstrual dysphoric disorder. abnormal psychology, numerous new references have been
5. Other feature boxes provide opportunities for critical added. Outdated material has been replaced, current findings
thinking by illustrating some of the controversies asso- have been included, and new developments have been identi-
ciated with the changes that were (or were not) made. fied. The 16th edition also includes the most up-to-date and
Throughout the book we also provide readers with dif- in-depth information about the role of biological factors in
ferent perspectives on the likely implications that these abnormal behavior, while at the same time placing this in the
changes will have for clinical diagnosis and research in context of a comprehensive biopsychosocial approach. Our
psychopathology. coverage of cultural issues and diversity has also been strength-
6. Changes have been made in many chapters to improve the ened. We hope readers will be pleased to know that all of this
flow of the writing and enhance learning. Reflecting the has been accomplished without adding length to the book!
ever-changing field of abnormal psychology, new refer-
ences have been added and new research findings high-
lighted. About the Indian Edition
7. Finally, at the beginning of each chapter clearly defined Ever since the dawn of civilization, humanity has been toil-
Learning Objectives provide the reader with an overview ing hard, both in the East and the West, to conquer pain and
of topics and issues that will be included in the chapter. disease. An incessant urge of man to understand the ramifica-
At the end of each chapter a summary of answers to these tions of anomalous mental behavior so that timely and ade-
Learning Objective questions are provided. In-Review quate relief to the afflicted could be provided is a testimony
Questions at the end of major sections within chapters to that effort. The rapid advances seen in the modern era in
also provide additional opportunities for self-assessment psychopathology highlight the vast uncharted road that is yet
and increased learning. to be treaded, which is indeed a challenge to the scientists and
professionals in the field of abnormal psychology.
Although there are many well-written books on abnor-
What’s New mal psychology in the market, yet Butcher, Hooley, and
A major change in the 16th edition of Abnormal Psychology is Mineka’s Abnormal Psychology, enjoys an unparalleled unique-
the focus on DSM-5. This important revision to the diagnos- ness in terms of its lucidity, style, updated information, and
tic system was published in May 2013. To assist both instruc- coverage, which is attested by students and researchers in
tors and students, we include specialized feature boxes, high- the field. Besides providing the most up-to-date information
lighting many of the key changes that were made in DSM-5. in terms of the material based on DSM-5, the present vol-
This makes new material immediately accessible. Other ume also lets its readers reflect on several issues relating to
important changes in DSM-5 are also mentioned throughout their future research pursuits.
the text. Providing students with this material as soon as To contextualize the present edition for the Indian
possible after the publication of DSM-5 reflects our commit- readers, either Indian case studies or Indian adaptation of
ment to staying ahead of the curve and to providing students Western case studies have been included. This edition also
with the most up-to-date information possible. covers several culture-specific modifications (e.g., coverage
This new edition of Abnormal Psychology has been rede- of Dhat syndrome, the phenomenon or event of spirit pos-
signed to remain visually engaging to the newest generation session as well as faith healing), addition of recent develop-
of students. Chapters begin with learning objective questions. ments (e.g., therapies of neurofeedback for the regulation
These orient the reader to the material that will be presented of dysfunctional cortico-cortical arousal syndromes, such
in each specific chapter. Learning objective questions are also as, depression, relapse prevention strategies for bipolar dis-
repeated at the end of each chapter and answers to each are orders, and mindfulness and acceptance, and commitment
provided. Most chapters also begin with a case study that therapy for schizophrenia), inclusion of views about abnor-
illustrates the mental health problems to be addressed in the mality in ancient Indian texts (e.g., the Atharva Veda and
chapter. This serves to capture students’ interest and atten- Ayurveda), and addition of subsections on Yoga, meditation
tion right from the outset. Numerous new photographs and and their role in the management of psychopathology apart
illustrations have also been added. In addition, this edition also from presenting the incidence and prevalence rate in India of
contains updated case material, new unresolved issues (e.g., almost all major disorders.
xx PREFACE

Of special importance to the Indian readers is the pre- whether treatment with antipsychotic medications is helpful
sentation of policies and legislation of mental health in India or harmful in the very long term.
including Mental Health Act, 1987, in Chapter 17 that has
not found mention in any textbook so far. As far as possible
important Indian research studies and research data, wher- Pedagogy
ever available, have been mentioned along with their original Learning Objectives
sources. Each chapter begins with learning objective questions. These
Taken as a whole, this Indian adaptation of Abnormal orient the reader to the material that will be presented in each
Psychology provides a good blend of global and indigenous specific chapter. Learning objective questions are also repeated
materials in bringing out the complex issues related with at the end of each chapter, along with their answers. This
abnormality. This adaptation hopes to make out a case for provides students with an excellent tool for study and review.
undertaking more researches in abnormal psychology based In this edition, sections of many chapters have also been reor-
on indigenous models to bring to light hitherto less known ganized and material has been streamlined whenever possible.
aspects in this important area. All the changes that have been made are designed to improve
the flow of the writing and enhance pedagogy.
Features and Pedagogy Case Studies

Extensive case studies of individuals with various disorders
The extensive research base and accessible organization of this
are integrated in the text throughout the book. Some are
book are supported by high-interest features and helpful peda-
brief excerpts; others are detailed analyses. These cases bring
gogy to further engage students and support learning. We also
important aspects of the disorders to life. They also remind
hope to encourage students to think in depth about the topics
readers that the problems of abnormal psychology affect the
they are learning about through specific highlight features that
lives of people—people from all kinds of diverse backgrounds
emphasize critical thinking.
who have much in common with all of us.
Features In Review Questions

Feature Boxes Questions appear at the end of each major section within the
Special sections, called Developments in Research, chapter, providing regular opportunities for self-assessment as
Developments in Thinking, Developments in Practice, and students read and further reinforce their learning.
The World Around Us, highlight topics of particular interest,
focusing on applications of research to everyday life, current DSM-5 Boxes
events, and the latest research methodologies, technologies,
Throughout the book these boxes contain the most up-to-date
and findings.
(DSM-5) diagnostic criteria for all of the disorders discussed.
In a convenient and visually accessible form, they provide
Critical Thinking a helpful study tool that reflects current diagnostic practice.
New to this edition are special highlight boxes about DSM-5. They also help students understand disorders in a real-world
Many of the revisions to DSM-5 were highly contentious and context.
controversial. A new feature box called “Thinking Critically
About DSM-5” introduces students to the revised DSM and
Research Close-Up Terms
encourages them to think critically about the implications of
Appearing throughout each chapter, these terms illuminate
these changes.
research methodologies. They are designed to give students a
clearer understanding of some of the most important research
Unresolved Issues concepts in the field of abnormal psychology.
All chapters include end-of-chapter sections that demonstrate
how far we have come and how far we have yet to go in our
understanding of psychological disorders. The topics covered Chapter Summaries
here provide insight into the future of the field and expose Each chapter ends with a summary of the essential points
students to some controversial topics. New to this edition of the chapter organized around the learning objectives pre-
is a discussion of the problems associated with the study of sented at the start of the chapter. These summaries use bul-
trauma. In another chapter, we raise the contentious issue of leted lists rather than formal paragraphs. This makes the infor-
mation more accessible for students and easier to scan.
PREFACE xxi

Key Terms University; John F. Edens, Sam Houston State University;
Key terms are identified in each chapter. Key terms are also Colleen Ehrnstrom, University of Colorado at Boulder;
listed at the end of every chapter with page numbers refer- William Fals-Stewart, The State University of New York at
encing where they can be found in the body of the text. Key Buffalo; John P. Forsyth, The State University of New York
terms are also defined in the Glossary at the end of the book. at Albany; Louis R. Franzini, San Diego State University;
David H. Gleaves, Texas A&M University; Michael Green,
University of California at Los Angeles; Steven Haynes,
Acknowledgments University of Hawaii at Manoa; Kathi Heffner, Ohio
It takes each member of the author team more than a year University; Daniel Holland, University of Arkansas at Little
of focused work to produce a new edition of this textbook. Rock; Steven Hollon, Vanderbilt University; Joanne Hoven
During this time, family and friends receive much less atten- Stohs, California State University Fullerton; Robert Howland,
tion than they deserve. We are aware that a few lines of University of Pittsburgh, School of Medicine; Jean W. Hunt,
acknowledgement in a preface do little to compensate those Cumberland College; Alexandrea Hye-Young Park, Virginia
close to us for all the inconveniences and absences they have Tech; William G. Iacono, University of Minnesota; Jessica
endured. Nonetheless, James Butcher would like to thank his Jablonski, University of Delaware; Erick Janssen, Indiana
wife, Carolyn L. Williams, and his children, Holly Butcher, University; Sheri Johnson, University of Miami; Ann Kane,
Sherry Butcher, and Jay Butcher, for their patience and sup- Barnstable High; Alan Kazdin, Yale University; Lynne Kemen,
port during this time. Jill Hooley is ever grateful to Kip Schur Hunter College; Carolin Keutzer, University of Oregon; John
for his patience, love, support, and ability to retain a sense F. Kihlstrom, University of California at Berkeley; Gerald
of humor throughout the revision process. She also thanks Koocher, Simmons College; David Kosson, Chicago Medical
Blake T. Haskell for providing valuable information used in School; Marvin Lee, Tennessee State University; Brett Litz,
Chapter 9. The efforts of graduate student Sara Masland and
Boston University; Brendan Maher, Harvard University;
undergraduates Lauren Fields and Deirdre Gorman are also
Richard McNally, Harvard University; Edwin Megargee,
gratefully acknowledged. Susan Mineka wishes to thank her
Florida State University; William Miller, University of New
graduate students, friends, and family for their patience and
Mexico; Robin Morgan, Indiana University Southeast;
support for the duration of this project. She also extends spe-
Michael Neboschick, College of Charleston; Matthew Nock,
cial thanks to J. Michael Bailey.
Harvard University; Chris Patrick, Florida State University;
Singled out for special praise and endless appreciation is
Marcus Patterson, University of Massachusetts; John Daniel
our wonderful development editor, LeeAnn Doherty. Her edi-
Paxton, Lorain County Community College; Walter Penk,
torial expertise, insightful recommendations, and grace under
Memorial Veterans Hospital, Bedford, MA; Diego Pizzagalli,
pressure made her a delight to work with. A big thank you
also goes to Erin Mitchell, acquisitions editor, for her advice, Harvard University; Lauren Polvere, Concordia University;
support, and dedication to the book. Without Erin’s ability Andy Pomerantz, Southern Illinois University, Edwardsville;
to manage every challenge that arose, this book might still be Harvey Richman, Columbus State University; Barry J. Ries,
in the production stages. Another special thank you goes to Minnesota State University; Lizabeth Roemer, University of
Sherry Lewis for her skillful management of the production of Massachusetts at Boston; Rick Seime, Mayo Clinic; Frances
this book as well as to Amber Mackey for her efforts to secure Sessa, Pennsylvania State University, Abington; Brad Schmidt,
all the permissions n ecessary for the figures and photographs. Ohio State University; Kandy Stahl, Stephen F. Austin State
Many experts, researchers, and users of this book University; Stephanie Stein, Central Washington University;
provided us with comments on individual chapters. We are Xuan Stevens, Florida International University; Eric Stice,
extremely grateful for their input and feedback. Their knowl- University of Texas at Austin; Marcus Tye, Dowling College;
edge and expertise help us keep this text current and accurate. Beverly Vchulek, Columbia College; Michael E. Walker,
We thank Tia Almpoura and Mohsen Jadidi who provided Stephen F. Austin State University; Clifton Watkins, University
valuable help. We are also especially grateful to the many of North Texas; Nathan Weed, Central Michigan University;
reviewers who have given us invaluable feedback on this and and Kenneth J. Zucker, Centre for Addiction and Mental
previous editions of Abnormal Psychology. Health, Ontario, Canada.
Angela Bragg, Mount Hood Community College;
James N. Butcher, Jill M. Hooley, and Susan Mineka
Greg Carey, University of Colorado; Louis Castonguay,
Pennsylvania State University; Richard Cavasina, California
University of Pennsylvania; Dianne Chambless, University I wish to acknowledge the help provided by Rakesh Pandey,
of Pennsylvania; Lee Anna Clark, The University of Head, Department of Psychology, Banaras Hindu University,
Iowa; Barbara Cornblatt; William Paul Deal, University of in accomplishing this adaptation.
Mississippi; Raymond L. Eastman, Stephen F. Austin State Chandra Bhal Dwivedi
xxii PREFACE

about the
James N. BUTCHER Jill M. HOOLEY

Professor Emeritus, University of Minnesota Harvard University
James N. Butcher was born in West Virginia. He enlisted in Jill M. Hooley is a professor of psychology at Harvard University.
the army when he was 17 years old and served in the airborne She is also the head of the experimental psychopathology and
infantry for 3 years, including a 1-year tour in Korea during the clinical psychology program at Harvard. Dr. Hooley was born in
Korean War. After military service, he attended Guilford College, England and received a B.Sc. in psychology from the University
graduating in 1960 with a BA in psychology. He received an MA of Liverpool. This was followed by research work at Cambridge
in experimental psychology in 1962 and a PhD in clinical psy- University. She then attended Magdalen College, Oxford, where
chology from the University of North Carolina at Chapel Hill. He she completed her D.Phil. After a move to the United States and
was awarded Doctor Honoris Causa from the Free University of additional training in clinical psychology at SUNY Stony Brook, Dr.
Brussels, Belgium, in 1990 and an honorary doctorate from the Hooley took a position at Harvard, where she has been a faculty
University of Florence, Florence, Italy, in 2005. He is currently pro- member since 1985.
fessor emeritus in the Department of Psychology at the University Dr. Hooley has a long-standing interest in psychosocial
of Minnesota. He was associate director and director of the clini- predictors of psychiatric relapse in patients with severe psychopa-
cal psychology program at the university for 19 years. He was a thology such as schizophrenia and depression. Her research has
member of the University of Minnesota Press’s MMPI Consultative been supported by grants from the National Institute of Mental
Committee, which undertook the revision of the MMPI in 1989. Health and by the Borderline Personality Disorder Research
He was formerly the editor of Psychological Assessment, a journal Foundation. She uses fMRI to study emotion regulation in people
of the American Psychological Association, and serves as consult- who are vulnerable to depression and in people who are suffering
ing editor or reviewer for numerous other journals in psychology from borderline personality disorder. Another area of research
and psychiatry. Dr. Butcher was actively involved in developing interest is nonsuicidal self-harming behaviors such as skin cutting
and organizing disaster response programs for dealing with or burning.
human problems following airline disasters during his career. He In 2000, Dr. Hooley received the Aaron T. Beck Award for
organized a model crisis intervention disaster response for the Excellence in Psychopathology Research. She is also a past president
Minneapolis-St. Paul Airport and organized and supervised the of the Society for Research in Psychopathology. The author of many
psychological services offered following two major airline disas- scholarly publications, Dr. Hooley was appointed as Associate Editor
ters: Northwest Flight 255 in Detroit, Michigan, and Aloha Airlines for Clinical Psychological Science in 2012. She is also an associate
on Maui. He is a fellow of the Society for Personality Assessment. editor for Applied and Preventive Psychology and serves on the edi-
He has published 60 books and more than 250 articles in the torial boards of several journals including the Journal of Consulting
fields of abnormal psychology, cross-cultural psychology, and and Clinical Psychology, the Journal of Family Psychology, Family
personality assessment. Process, and Personality Disorders: Theory, Research and Treatment.
At Harvard, Dr. Hooley has taught graduate and undergradu-
ate classes in introductory psychology, abnormal psychology,
schizophrenia, mood disorders, clinical psychology, psychiatric
diagnosis, and psychological treatment. Reflecting her commit-
ment to the scientist-practitioner model, she also does clinical work
specializing in the treatment of people with depression, anxiety
disorders, and personality disorders.
xxiii

1987 she has been a professor of psychology at Northwestern,
and from 1998 to 2006 she served as director of clinical training
there. She has taught a wide range of undergraduate and gradu-
ate courses, including introductory psychology, learning, moti-
vation, abnormal psychology, and cognitive-behavior therapy.
Her current research interests include cognitive and behavioral
approaches to understanding the etiology, maintenance, and
treatment of anxiety and mood disorders. She is currently a
Fellow of the American Psychological Association, the American
Psychological Society, and the Academy of Cognitive Therapy.
She has served as editor of the Journal of Abnormal Psychology
(1990–1994). She also served as associate editor for Emotion from
2002 to 2006 and is on the editorial boards of several of the lead-
Susan MINEKA ing journals in the field. She was also president of the Society for
the Science of Clinical Psychology (1994–1995) and was president
Northwestern University
of the Midwestern Psychological Association (1997). She also
Susan Mineka, born and raised in Ithaca, New York, received her served on the American Psychological Association’s Board of
undergraduate degree magna cum laude in psychology at Cornell Scientific Affairs (1992–1994, chair 1994), on the Executive Board
University. She received a PhD in experimental psychology from of the Society for Research in Psychopathology (1992–1994,
the University of Pennsylvania and later completed a formal clini- 2000–2003), and on the Board of Directors of the American
cal retraining program from 1981 to 1984. She taught at the Psychological Society (2001–2004). During 1997 and 1998 she
University of Wisconsin–Madison and at the University of Texas at was a fellow at the Center for Advanced Study in the Behavioral
Austin before moving to Northwestern University in 1987. Since Sciences at Stanford.
xxiv ABOUT THE AUTHORS

abnormal
psychology:
an overview
1
M01 Abnormal Psychology 16 9408.indd 1 11/4/2016 1:57:29 PM
gym who works out intensely despite being worrisomely thin.
1
It may even be the disheveled street person in the aluminum foil
hat who shouts, “Leave me alone!” to voices only he can hear.
The issues of abnormal psychology capture our inter-
est, demand our attention, and trigger our concern. They also
compel us to ask questions. To illustrate further, let’s consider
two clinical cases.
Shabana Shabana is 24 years old, attractive, neatly

learning objectives
dressed, and educated up to class 9. She was concerned about
1.1 cleanliness from a young age and she loved being tidy in her
How do we define abnormality and classify mental disorders? appearance. Her health was fine seven years ago. But then she
1.2 developed an obsession about dirt and contamination. In class,
What are the advantages and disadvantages of classification? she would frequently check to see if her clothes had become
dirty. She would feel guilty for sitting at her desk because she
1.3
How common are mental disorders? Which felt that is what led to her clothes getting soiled. These thoughts
disorders are most prevalent? preoccupied her mind constantly. Gradually, Shabana’s self-
esteem reduced and her interactions with others decreased. She
1.4
Why do we need a research-based approach preferred being on her own and remained in a distressed state of
in abnormal psychology? mind. Her interest in studies also waned because of this exces-
sive preoccupation. Her parents persuaded her to get married.
1.5
How do we gather information about mental disorders? After her wedding, she found herself in a new environment with
more responsibility that further aggravated her depression, and
1.6 caused feelings of hopelessness and helplessness.
What kinds of research designs are used to
conduct research in abnormal psychology?
Jagat Jagat comes from a family with no history of

mental illness. He had a normal birth and seemed to develop
normally when he was a child. However, when he was 12 years
Abnormal psychology is concerned with understanding the old, Jagat developed abdominal distension with a continuous,
n ature, causes, and treatment of mental disorders. The topics dull, aching pain, which lasted for an entire month. About a week
and problems within the field of abnormal psychology surround following the onset of the pain, the parents noticed changes in
us every day. You have only to pick up a newspaper, flip through his behavior. He became irritable, started to believe that there
a magazine, surf the web, or sit through a movie to be exposed was a conspiracy against him, and that the others were always
to some of the issues that clinicians and researchers deal with talking about him. However, there was no thought disorder.
on a day-to-day basis. Almost weekly some celebrity is in the He did not report hearing voices or seeing visions of any kind.
news because of a drug or alcohol problem, an eating disorder, There was no history of head injury or drug abuse. He was given
or some other psychological difficulty. Countless books provide antipsychotic drugs that relieved his symptoms.
personal accounts of struggles with schizophrenia, depression,
phobias, and panic attacks. Films and TV shows portray aspects
of abnormal behavior with varying degrees of accuracy. And Perhaps you found yourself asking questions as you read
then there are the tragic news stories of mothers who kill their about Shabana and Jagat. For example, because Shabana was
children, in which problems with depression, schizophrenia, or always concerned about cleanliness, her fear that her clothes
postpartum difficulties seem to be implicated. might become dirty in the classroom could be natural. You might
Abnormal psychology can also be found much closer to have wondered whether she could really have a serious problem.
home. Walk around any college campus, and you will see fly- She does. We must ask ourselves: what criteria must be met be-
ers about peer support groups for people with eating disorders, fore someone receives a particular diagnosis? Perhaps you also
depression, and a variety of other disturbances. You may even wondered if other members of Shabana’s family had similar
know someone who has experienced a clinical problem. It may problems. They might do. This is a question about what we call
be a cousin with a cocaine habit, a roommate with bulimia, or a family aggregation—that is, whether a disorder runs in families.
grandparent who is developing Alzheimer’s disease. It may be a You may also have been curious about what was wrong with
coworker of your mother’s who is hospitalized for depression, Jagat and why he believed that people were conspiring against
a neighbor who is afraid to leave the house, or someone at your him. Questions about the age of onset of his symptoms and
2 CHAPTER 1 abnormal psychology: an overview

predisposing factors may also have occurred to you. Jagat has What Do We Mean by Abnormality?
schizophrenia, a disorder that often strikes in late adolescence
or early adulthood. As Jagat’s case illustrates, it is not unusual for It may come as a surprise to you that there is still no universal
someone who develops schizophrenia to develop at a perfectly agreement about what is meant by abnormality or disorder. This is
normal rate before suddenly becoming ill. You can read more not to say we do not have definitions; we do. However, a truly
about Jagat’s case and his treatment in a 2014 study on this sub- satisfactory definition will probably always remain elusive
ject by Grover and colleagues. (Lilienfeld & Landfield, 2008; Stein et al., 2010) even though
These cases, which describe real people, give some indica- there is a great deal of general agreement about which condi-
tion of just how profoundly lives can be derailed because of tions are disorders and which are not (Spitzer, 1999).
mental disorders. It is hard to read about difficulties such as Why does the definition of a mental disorder present so
these without feeling compassion for the people who are strug- many challenges? A major problem is that there is no one behav-
gling. Still, in addition to compassion, clinicians and researchers ior that makes someone abnormal. However, there are some
who want to help people like Shabana and Jagat must have other clear elements or indicators of abnormality (Lilienfeld & Marino,
attributes and skills. If we are to understand mental disorders, 1999; Stein et al., 2010). No single indicator is sufficient in and
we must learn to ask the kinds of questions that will enable us to of itself to define or determine abnormality. Nonetheless, the
help the patients and families who have mental disorders. These more that someone has difficulties in the following areas, the
questions are at the very heart of a research-based approach that more likely he or she is to have some form of mental disorder.
looks to use scientific inquiry and careful observation to under- 1. Suffering: If people suffer or experience psychological pain
stand abnormal psychology. we are inclined to consider this as indicative of abnormal-
Asking questions is an important aspect of being a psychol- ity. Depressed people clearly suffer, as do people with anxiety
ogist. Psychology is a fascinating field, and abnormal psychology disorders. But what of the patient who is manic and whose
is one of the most interesting areas of psychology (although we mood is one of elation? He or she may not be suffering. In
are undoubtedly biased). Psychologists are trained to ask ques- fact, many such patients dislike taking medications because
tions and to conduct research. Though not all people who are they do not want to lose their manic “highs.” You may have
trained in abnormal psychology (this field is sometimes called a test tomorrow and be suffering with worry. But we would
psychopathology) conduct research, they still rely heavily on their hardly label your suffering abnormal. Although suffering is an
scientific skills and ability both to ask questions and to put infor- element of abnormality in many cases, it is neither a sufficient
mation together in coherent and logical ways. For example, when condition (all that is needed) nor even a necessary condition
a clinician first sees a new client or patient, he or she asks many (a feature that all cases of abnormality must show) for us to
questions to try and understand the issues or problems related consider something as abnormal.
to that person. The clinician will also rely on current research 2. Maladaptiveness: Maladaptive behavior is often an indicator
to choose the most effective treatment. The best treatments of of abnormality. The person with anorexia may restrict her
20, 10, or even 5 years ago are not invariably the best treatments intake of food to the point where she becomes so emaciated
of today. Knowledge accumulates and advances are made. And that she needs to be hospitalized. The person with depression
research is the engine that drives all of these developments. may withdraw from friends and family and may be unable to
In this chapter, we will outline the field of abnormal psy- work for weeks or months. Maladaptive behavior interferes
chology and the varied training and activities of the people who with our well-being and with our ability to enjoy our work
work within its demands. First we describe the ways in which ab- and our relationships. However, not all disorders involve mal-
normal behavior is defined and classified so that researchers and adaptive behavior. Consider the con artist and the contract
mental health professionals can communicate with each other killer, both of whom have antisocial personality disorder. The
about the people they see. Some of the issues here are probably first may be able glibly to talk people out of their life savings,
more complex and controversial than you might expect. We also the second to take someone’s life in return for payment. Is
outline basic information about the extent of behavioral abnor- this behavior maladaptive? Not for them, because it is the
malities in the population at large. way in which they make their respective livings. We consider
You will notice that a large section of this chapter is devoted them abnormal, however, because their behavior is maladap-
to research. We make every effort to convey how abnormal tive for and toward society.
behavior is studied. Research is at the heart of progress and 3. Statistical Deviancy: The word abnormal literally means
knowledge in abnormal psychology. The more you know and “away from the normal.” But simply considering statistically
understand about how research is conducted, the more educated rare behavior to be abnormal does not provide us with a solu-
and aware you will be about what research findings do and do tion to our problem of defining abnormality. Genius is statis-
not mean. tically rare, as is perfect pitch. However, we do not consider
abnormal psychology: an overview CHAPTER 1 3

people with such uncommon talents to be abnormal in any the most important factor, however, is our evaluation of
way. Also, just because something is statistically common whether the person can control his or her behavior. Few of
doesn’t make it normal. The common cold is certainly very us would consider a roommate who began to recite speeches
common, but it is regarded as an illness nonetheless. from King Lear to be abnormal if we knew that he was play-
On the other hand, intellectual disability (which is statis- ing Lear in the next campus Shakespeare production—or
tically rare and represents a deviation from normal) is con- even if he was a dramatic person given to extravagant out-
sidered to reflect abnormality. This tells us that in defining bursts. On the other hand, if we discovered our roommate
abnormality we make value judgments. If something is statis- lying on the floor, flailing wildly, and reciting Shakespeare, we
tically rare and undesirable (as is severely diminished intellec- might consider calling for assistance if this was entirely out
tual functioning), we are more likely to consider it abnormal of character and we knew of no reason why he should be
than something that is statistically rare and highly desirable behaving in such a manner.
(such as genius) or something that is undesirable but statisti- 7. Dangerousness: It seems quite reasonable to think that
cally common (such as rudeness). someone who is a danger to him- or herself or to another
4. Violation of the Standards of Society: All cultures have rules. person must be psychologically abnormal. Indeed, therapists
Some of these are formalized as laws. Others form the norms are required to hospitalize suicidal clients or contact the police
and moral standards that we are taught to follow. A lthough (as well as the person who is the target of the threat) if they
many social rules are arbitrary to some extent, when people have a client who makes an explicit threat to harm another
fail to follow the conventional social and moral rules of their person. But, as with all of the other elements of abnormality,
cultural group we may consider their behavior abnormal. if we rely only on dangerousness as our sole feature of
For example, driving a car or watching television would be abnormality, we will run into problems. Is a soldier in combat
considered highly abnormal for the Amish of P ennsylvania. mentally ill? What about someone who is an extremely bad
However, both of these activities reflect normal everyday driver? Both of these people may be a danger to others. Yet
behavior for most other Pennsylvania residents. we would not c onsider them to be mentally ill. Why not? And
Of course, much depends on the magnitude of the viola- why is someone who engages in extreme sports or who has
tion and on how commonly the rule is violated by others. As a dangerous hobby (such as free diving, race car driving, or
illustrated in the example above, a behavior is most likely to be keeping poisonous snakes as pets) not immediately regarded
viewed as abnormal when it violates the standards of society as mentally ill? Just because we may be a danger to ourselves
and is statistically deviant or rare. In contrast, most of us have or to others does not mean we are mentally ill. Conversely, we
parked illegally at some point. This failure to follow the rules cannot assume that someone diagnosed with a mental disor-
is so statistically common that we tend not to think of it as ab- der must be dangerous. Although mentally ill people do com-
normal. Yet when a mother drowns her children there is instant mit serious crimes, serious crimes are also committed every
recognition that this is abnormal behavior. day by people who have no signs of mental disorder. Indeed,
5. Social Discomfort: When someone violates a social rule, research suggests that in people with mental illness, danger-
those around him or her may experience a sense of dis- ousness is more the exception than it is the rule (Corrigan &
comfort or unease. Imagine that you are sitting in an almost Watson, 2005).
empty movie theater. There are rows and rows of unoccu-
pied seats. Then someone comes in and sits down right next One final point bears repeating. Decisions about abnormal
to you. How do you feel? In a similar vein, how do you feel behavior always involve social judgments and are based on the
when someone you met only 4 minutes ago begins to chat values and expectations of society at large. This means that
about her suicide attempt? Unless you are a therapist working culture plays a role in determining what is and is not abnormal.
in a crisis intervention center, you would probably consider For example, in the United States, people do not believe that
this an example of abnormal behavior. it is acceptable to murder a woman who has a premarital or an
6. Irrationality and Unpredictability: As we have already extramarital relationship. However, karo-kari (a form of honor
noted, we expect people to behave in certain ways. Although killing where a woman is murdered by a male relative because
a little unconventionality may add some spice to life, there is she is considered to have brought disgrace onto her family) is
a point at which we are likely to consider a given unorthodox considered justifiable by many people in Pakistan (Patel & Gadit,
behavior abnormal. If a person sitting next to you suddenly 2008).
began to scream and yell obscenities at nothing, you would In addition, because society is constantly shifting and
probably regard that behavior as abnormal. It would be becoming more or less tolerant of certain behaviors, what is
unpredictable, and it would make no sense to you. The disor- considered abnormal or deviant in one decade may not be con-
dered speech and the disorganized behavior of patients with sidered abnormal or deviant a decade or two later. At one time,
schizophrenia are often irrational. Such behaviors are also a homosexuality was classified as a mental disorder. But this is
hallmark of the manic phases of bipolar disorder. P erhaps no longer the case. A generation ago, pierced noses and navels
4 CHAPTER 1 abnormal psychology: an overview

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gentleman a valuable source of information. He told Olivia, “I wouldn’t
come to the house except for you. I can’t bear to think of you there ...
always alone ... always troubled.”
And in the evenings, while they played bridge or listened to Jean’s
music, she sometimes caught his eye, watching her with the old admiration,
telling her that he was ready to support her no matter what happened.
A week after the encounter with Miss Peavey at the catnip-bed, Peters
came to Olivia’s room late in the afternoon to say, with a curious blend of
respect and confidence, “He’s ill again, Mrs. Pentland.”
She knew what Peters meant; it was a kind of code between them.... The
same words used so many times before.
She went quickly to the tall narrow library that smelled of dogs and
apples and woodsmoke, knowing well enough what she would find there;
and on opening the door she saw him at once, lying asleep in the big leather
chair. The faint odor of whisky—a smell which had come long since to fill
her always with a kind of horror—hung in the air, and on the mahogany
desk stood three bottles, each nearly emptied. He slept quietly, one arm
flung across his chest, the other hanging to the floor, where the bony fingers
rested limply against the Turkey-red carpet. There was something childlike
in the peace which enveloped him. It seemed to Olivia that he was even free
now of the troubles which long ago had left their mark in the harsh, bitter
lines of the old face. The lines were gone, melted away somehow, drowned
in the immense quiet of this artificial death. It was only thus, perhaps, that
he slept quietly, untroubled by dreams. It was only thus that he ever
escaped.
Standing in the doorway she watched him for a time, quietly, and then,
turning, she said to Peters, “Will you tell Higgins?” and entering the door
she closed the red-plush curtains, shutting out the late afternoon sunlight.
Higgins came, as he had done so many times before, to lock the door and
sit there in the room, even sleeping on the worn leather divan, until John
Pentland, wakening slowly and looking about in a dazed way, discovered
his groom sitting in the same room, polishing a bridle or a pair of riding-
boots. The little man was never idle. Something deep inside him demanded
action: he must always be doing something. And so, after these melancholy
occasions, a new odor clung to the library for days ... the fresh, clean,
healthy odor of leather and harness-soap.
For two days Higgins stayed in the library, leaving it only for meals, and
for two days the old lady in the north wing went unvisited. Save for this
single room, there was no evidence of any change in the order of life at
Pentlands. Jean, in ignorance of what had happened, came in the evenings
to play. But Sabine knew; and Aunt Cassie, who never asked questions
concerning the mysterious absence of her brother lest she be told the truth.
Anson, as usual, noticed nothing. The only real change lay in a sudden
display of sulking and ill-temper on the part of Miss Egan. The invincible
nurse even quarreled with the cook, and was uncivil to Olivia, who thought,
“What next is to happen? I shall be forced to look for a new nurse.”
On the evening of the third day, just after dinner, Higgins opened the
door and went in search of Olivia.
“The old gentleman is all right again,” he said. “He’s gone to bathe and
he’d like to see you in the library in half an hour.”
She found him there, seated by the big mahogany desk, bathed and
spotlessly neat in clean linen; but he looked very old and weary, and
beneath the tan of the leathery face there was a pallor which gave him a
yellowish look. It was his habit never to refer in any way to these sad
occasions, to behave always as if he had only been away for a day or two
and wanted to hear what had happened during his absence.
Looking up at her, he said gravely, “I wanted to speak to you, Olivia.
You weren’t busy, were you? I didn’t disturb you?”
“No,” she said. “There’s nothing.... Jean and Thérèse are here with
Sybil.... That’s all.”
“Sybil,” he repeated. “Sybil.... She’s very happy these days, isn’t she?”
Olivia nodded and even smiled a little, in a warm, understanding way, so
that he added, “Well, we mustn’t spoil her happiness. We mustn’t allow
anything to happen to it.”
A light came into the eyes of Olivia. “No; we mustn’t,” she repeated, and
then, “She’s a clever girl.... She knows what she wants from life, and that’s
the whole secret. Most people never know until it’s too late.”
A silence followed this speech, so eloquent, so full of unsaid things, that
Olivia grew uneasy.
“I wanted to talk to you about ...” he hesitated for a moment, and she
saw that beneath the edge of the table his hands were clenched so violently
that the bony knuckles showed through the brown skin. “I wanted to talk to
you about a great many things.” He stirred and added abruptly, “First of all,
there’s my will.”
He opened the desk and took out a packet of papers, separating them
carefully into little piles before he spoke again. There was a weariness in all
his movements. “I’ve made some changes,” he said, “changes that you
ought to know about ... and there are one or two other things.” He looked at
her from under the fierce, shaggy eyebrows. “You see, I haven’t long to
live. I’ve no reason to expect to live forever and I want to leave things in
perfect order, as they have always been.”
To Olivia, sitting in silence, the conversation became suddenly painful.
With each word she felt a wall rising about her, shutting her in, while the
old man went on and on with an agonizing calmness, with an air of being
certain that his will would be obeyed in death as it had always been in life.
“To begin with, you will all be left very rich ... very rich ... something
over six million dollars. And it’s solid money, Olivia ... money not made by
gambling, but money that’s been saved and multiplied by careful living. For
seventy-five years it’s been the tradition of the family to live on the income
of its income. We’ve managed to do it somehow, and in the end we’re rich
... very rich.”
As he talked he kept fingering the papers nervously, placing them in neat
little piles, arranging and rearranging them.
“And, as you know, Olivia, the money has been kept in a way so that the
principal could never be spent. Sybil’s grandchildren will be able to touch
some of it ... that is, if you are unwise enough to leave it to them that way.”
Olivia looked up suddenly. “But why me? What have I to do with it?”
“That’s what I’m coming to, Olivia dear.... It’s because I’m leaving
control of the whole fortune to you.”
Suddenly, fiercely, she wanted none of it. She had a quick, passionate
desire to seize all the neatly piled papers and burn them, to tear them into
small bits and fling them out of the window.
“I don’t want it!” she said. “Why should you leave it to me? I’m rich
myself. I don’t want it! I’m not a Pentland.... It’s not my money. I’ve
nothing to do with it.” In spite of herself, there was a note of passionate
resentment in her voice.
The shaggy brows raised faintly in a look of surprise.
“To whom, if not to you?” he asked.
After a moment, she said, “Why, Anson ... to Anson, I suppose.”
“You don’t really think that?”
“It’s his money ... Pentland money ... not mine. I’ve all the money I need
and more.”
“It’s yours, Olivia....” He looked at her sharply. “You’re more a Pentland
than Anson, in spite of blood ... in spite of name. You’re more a Pentland
than any of them. It’s your money by every right in spite of anything you
can do.”
(“But Anson isn’t a Pentland, nor you either,” thought Olivia.)
“It’s you who are dependable, who are careful, who are honorable,
Olivia. You’re the strong one. When I die, you’ll be the head of the
family.... Surely, you know that ... already.”
(“I,” thought Olivia, “I who have been so giddy, who am planning to
betray you all.... I am all this!”)
“If I left it to Anson, it would be wasted, lost on foolish ideas. He’s no
idea of business.... There’s a screw loose in Anson.... He’s a crank. He’d be
giving away this good money to missionaries and queer committees ...
societies for meddling in the affairs of people. That wasn’t what this fortune
was made for. No, I won’t have Pentland money squandered like that....”
“And I,” asked Olivia. “How do you know what I will do with it?”
He smiled softly, affectionately. “I know what you’ll do with it, because
I know you, Olivia, my dear.... You’ll keep it safe and intact.... You’re the
Pentland of the family. You weren’t when you came here, but you are now. I
mean that you belong to the grand tradition of Pentlands ... the old ones
who hang out there in the hall. You’re the only one left ... for Sybil is too
young. She’s only a child ... yet.”
Olivia was silent, but beneath the silence there ran a torrent of cold,
rebellious thoughts. Being a Pentland, then, was not a matter of blood: it
was an idea, even an ideal. She thought fiercely, “I’m not a Pentland. I’m
alive. I am myself. I’ve not been absorbed into nothing. All these years
haven’t changed me so much. They haven’t made me into a Pentland.” But
for the sake of her affection, she could say none of these things. She only
said, “How do you know what I’ll do with it? How do you know that I
mightn’t squander it extravagantly—or—or even run away, taking all that
was free with me. No one could stop me—no one.”
He only repeated what he had said before, saying it more slowly this
time, as if to impress her. “I know what you’ll do with it, Olivia, because I
know you, Olivia dear—you’d never do anything foolish or shameful—I
know that—that’s why I trust you.”
And when she did not answer him, he asked, “You will accept it, won’t
you, Olivia? You’ll have the help of a good lawyer ... one of the best ... John
Mannering. It will please me, Olivia, and it will let the world know what I
think of you, what you have been to me all these years ... all that Anson has
never been ... nor my own sister, Cassie.” He leaned across the table,
touching her white hand gently. “You will, Olivia?”
It was impossible to refuse, impossible even to protest any further,
impossible to say that in this very moment she wanted only to run away, to
escape, to leave them all forever, now that Sybil was safe. Looking away,
she said in a low voice, “Yes.”
It was impossible to desert him now ... an old, tired man. The bond
between them was too strong; it had existed for too long, since that first day
she had come to Pentlands as Anson’s bride and known that it was the
father and not the son whom she respected. In a way, he had imposed upon
her something of his own rugged, patriarchal strength. It seemed to her that
she had been caught when she meant most to escape; and she was
frightened, too, by the echoing thought that perhaps she had become, after
all, a Pentland ... hard, cautious, unadventurous and a little bitter, one for
whom there was no fire or glamour in life, one who worshiped a harsh,
changeable, invisible goddess called Duty. She kept thinking of Sabine’s
bitter remark about “the lower middle-class virtues of the Pentlands” ... the
lack of fire, the lack of splendor, of gallantry. And yet this fierce old man
was gallant, in an odd fashion.... Even Sabine knew that.
He was talking again. “It’s not only money that’s been left to you....
There’s Sybil, who’s still too young to be let free....”
“No,” said Olivia with a quiet stubbornness, “she’s not too young. She’s
to do as she pleases. I’ve tried to make her wiser than I was at her age ...
perhaps wiser than I’ve ever been ... even now.”
“Perhaps you’re right, my dear. You have been so many times ... and
things aren’t the same as they were in my day ... certainly not with young
girls.”
He took up the papers again, fussing over them in a curious, nervous
way, very unlike his usual firm, unrelenting manner. She had a flash of
insight which told her that he was behaving thus because he wanted to
avoid looking at her. She hated confidences and she was afraid now that he
was about to tell her things she preferred never to hear. She hated
confidences and yet she seemed to be a person who attracted them always.
“And leaving Sybil out of it,” he continued, “there’s queer old Miss
Haddon in Durham whom, as you know, we’ve taken care of for years; and
there’s Cassie, who’s growing old and ill, I think. We can’t leave her to half-
witted Miss Peavey. I know my sister Cassie has been a burden to you....
She’s been a burden to me, all my life....” He smiled grimly. “I suppose you
know that....” Then, after a pause, he said, “But most of all, there’s my
wife.”
His voice assumed a queer, unnatural quality, from which all feeling had
been removed. It became like the voices of deaf persons who never hear the
sounds they make.
“I can’t leave her alone,” he said. “Alone ... with no one to care for her
save a paid nurse. I couldn’t die and know that there’s no one to think of her
... save that wretched, efficient Miss Egan ... a stranger. No, Olivia ... there’s
no one but you.... No one I can trust.” He looked at her sharply, “You’ll
promise me to keep her here always ... never to let them send her away?
You’ll promise?”
Again she was caught. “Of course,” she said. “Of course I’ll promise you
that.” What else was she to say?
“Because,” he added, looking away from her once more, “because I owe
her that ... even after I’m dead. I couldn’t rest if she were shut up
somewhere ... among strangers. You see ... once ... once....” He broke off
sharply, as if what he had been about to say was unbearable.
With Olivia the sense of uneasiness changed into actual terror. She
wanted to cry out, “Stop!... Don’t go on!” But some instinct told her that he
meant to go on and on to the very end, painfully, despite anything she could
do.
“It’s odd,” he was saying quite calmly, “but there seem to be only
women left ... no men ... for Anson is really an old woman.”
Quietly, firmly, with the air of a man before a confessor, speaking almost
as if she were invisible, impersonal, a creature who was a kind of machine,
he went on, “And of course, Horace Pentland is dead, so we needn’t think
of him any longer.... But there’s Mrs. Soames....” He coughed and began
again to weave the gaunt bony fingers in and out, as if what he had to say
were drawn from the depth of his soul with a great agony. “There’s Mrs.
Soames,” he repeated. “I know that you understand about her, Olivia ... and
I’m grateful to you for having been kind and human where none of the
others would have been. I fancy we’ve given Beacon Hill and
Commonwealth Avenue subject for conversation for thirty years ... but I
don’t care about that. They’ve watched us ... they’ve known every time I
went up the steps of her brownstone house ... the very hour I arrived and the
hour I left. They have eyes, in our world, Olivia, even in the backs of their
heads. You must remember that, my dear. They watch you ... they see
everything you do. They almost know what you think ... and when they
don’t know, they make it up. That’s one of the signs of a sick, decaying
world ... that they get their living vicariously ... by watching some one else
live ... that they live always in the past. That’s the only reason I ever felt
sorry for Horace Pentland ... the only reason that I had sympathy for him. It
was cruel that he should have been born in such a place.”
The bitterness ran like acid through all the speech, through the very
timbre of his voice. It burned in the fierce black eyes where the fire was not
yet dead. Olivia believed that she was seeing him now for the first time, in
his fulness, with nothing concealed. And as she listened, the old cloud of
mystery that had always hidden him from her began to clear away like the
fog lifting from the marshes in the early morning. She saw him now as he
really was ... a man fiercely masculine, bitter, clear-headed, and more
human than the rest of them, who had never before betrayed himself even
for an instant.
“But about Mrs. Soames.... If anything should happen to me, Olivia ... if
I should die first, I want you to be kind to her ... for my sake and for hers.
She’s been patient and good to me for so long.” The bitterness seemed to
flow away a little now, leaving only a kindling warmth in its place. “She’s
been good to me.... She’s always understood, Olivia, even before you came
here to help me. You and she, Olivia, have made life worth living for me.
She’s been patient ... more patient than you know. Sometimes I must have
made life for her a hell on earth ... but she’s always been there, waiting, full
of gentleness and sympathy. She’s been ill most of the time you’ve known
her ... old and ill. You can’t imagine how beautiful she once was.”
“I know,” said Olivia softly. “I remember seeing her when I first came to
Pentlands ... and Sabine has told me.”
The name of Sabine appeared to rouse him suddenly. He sat up very
straight and said, “Don’t trust Sabine too far, Olivia. She belongs to us, after
all. She’s very like my sister Cassie ... more like her than you can imagine.
It’s why they hate each other so. She’s Cassie turned inside out, as you
might say. They’d both sacrifice everything for the sake of stirring up some
trouble or calamity that would interest them. They live ... vicariously.”
Olivia would have interrupted him, defending Sabine and telling of the
one real thing that had happened to her ... the tragic love for her husband;
she would have told him of all the abrupt, incoherent confidences Sabine
had made her; but the old man gave her no chance. It seemed suddenly that
he had become possessed, fiercely intent upon pouring out to her all the
dark things he had kept hidden for so long.
(She kept thinking, “Why must I know all these things? Why must I take
up the burden? Why was it that I should find those letters which had lain
safe and hidden for so long?”)
He was talking again quietly, the bony fingers weaving in and out their
nervous futile pattern. “You see, Olivia.... You see, she takes drugs now ...
and there’s no use in trying to cure her. She’s old now, and it doesn’t really
matter. It’s not as if she were young with all her life before her.”
Almost without thinking, Olivia answered, “I know that.”
He looked up quickly. “Know it?” he asked sharply. “How could you
know it?”
“Sabine told me.”
The head bowed again. “Oh, Sabine! Of course! She’s dangerous. She
knows far too much of the world. She’s known too many strange people.”
And then he repeated again what he had said months ago after the ball. “She
ought never to have come back here.”
Into the midst of the strange, disjointed conversation there came
presently the sound of music drifting toward them from the distant drawing-
room. John Pentland, who was a little deaf, did not hear it at first, but after a
little time he sat up, listening, and turning toward her, asked, “Is that Sybil’s
young man?”
“Yes.”
“He’s a nice boy, isn’t he?”
“A very nice boy.”
After a silence he asked, “What’s the name of the thing he’s playing?”
Olivia could not help smiling. “It’s called I’m in love again and the
spring is a-comin’. Jean brought it back from Paris. A friend of his wrote it
... but names don’t mean anything in music any more. No one listens to the
words.”
A shadow of amusement crossed his face. “Songs have queer names
nowadays.”
She would have escaped, then, going quietly away. She stirred and even
made a gesture toward leaving, but he raised his hand in the way he had,
making her feel that she must obey him as if she were a child.
“There are one or two more things you ought to know, Olivia ... things
that will help you to understand. Some one has to know them. Some one....”
He halted abruptly and again made a great effort to go on. The veins stood
out sharply on the bony head.
“It’s about her chiefly,” he said, with the inevitable gesture toward the
north wing. “She wasn’t always that way. That’s what I want to explain.
You see ... we were married when we were both very young. It was my
father who wanted it. I was twenty and she was eighteen. My father had
known her family always. They were cousins of ours, in a way, just as they
were cousins of Sabine’s. He had gone to school with her father and they
belonged to the same club and she was an only child with a prospect of
coming into a great fortune. It’s an old story, you see, but a rather common
one in our world.... All these things counted, and as for myself, I’d never
had anything to do with women and I’d never been in love with any one. I
was very young. I think they saw it as a perfect match ... made in the hard,
prosperous Heaven of their dreams. She was very pretty ... you can see even
now that she must have been very pretty.... She was sweet, too, and
innocent.” He coughed, and continued with a great effort. “She had ... she
had a mind like a little child’s. She knew nothing ... a flower of innocence,”
he added with a strange savagery.
And then, as if the effort were too much for him, he paused and sat
staring out of the window toward the sea. To Olivia it seemed that he had
slipped back across the years to the time when the poor old lady had been
young and perhaps curiously shy of his ardent wooing. A silence settled
again over the room, so profound that this time the faint, distant roaring of
the surf on the rocks became audible, and then again the sound of Jean’s
music breaking in upon them. He was playing another tune ... not I’m in
love again, but one called Ukulele Lady.
“I wish they’d stop that damned music!” said John Pentland.
“I’ll go,” began Olivia, rising.
“No ... don’t go. You mustn’t go ... not now.” He seemed anxious, almost
terrified, perhaps by the fear that if he did not tell now he would never tell
her the long story that he must tell to some one. “No, don’t go ... not until
I’ve finished, Olivia. I must finish.... I want you to know why such things
happened as happened here yesterday and the day before in this room....
There’s no excuse, but what I have to tell you may explain it ... a little.”
He rose and opening one of the bookcases, took out a bottle of whisky.
Looking at her, he said, “Don’t worry, Olivia, I shan’t repeat it. It’s only
that I’m feeling weak. It will never happen again ... what happened
yesterday ... never. I give you my word.”
He poured out a full glass and seated himself once more, drinking the
stuff slowly while he talked.
“So we were married, I thinking that I was in love with her, because I
knew nothing of such things ... nothing. It wasn’t really love, you see....
Olivia, I’m going to tell you the truth ... everything ... all of the truth. It
wasn’t really love, you see. It was only that she was the only woman I had
ever approached in that way ... and I was a strong, healthy young man.”
He began to speak more and more slowly, as if each word were thrust
out by an immense effort of will. “And she knew nothing ... nothing at all.
She was,” he said bitterly, “all that a young woman was supposed to be.
After the first night of the honeymoon, she was never quite the same again
... never quite the same, Olivia. Do you know what that means? The
honeymoon ended in a kind of madness, a fixed obsession. She’d been
brought up to think of such things with a sacred horror and there was a
touch of madness in her family. She was never the same again,” he repeated
in a melancholy voice, “and when Anson was born she went quite out of her
head. She would not see me or speak to me. She fancied that I had
disgraced her forever ... and after that she could never be left alone without
some one to watch her. She never went out again in the world....”
The voice died away into a hoarse whisper. The glass of whisky had
been emptied in a supreme effort to break through the shell which had
closed him in from all the world, from Olivia, whom he cherished, perhaps
even from Mrs. Soames, whom he had loved. In the distance the music still
continued, this time as an accompaniment to the hard, loud voice of Thérèse
singing, I’m in love again and the spring is a-comin’.... Thérèse, the dark,
cynical, invincible Thérèse for whom life, from frogs to men, held very few
secrets.
“But the story doesn’t end there,” continued John Pentland weakly. “It
goes on ... because I came to know what being in love might be when I met
Mrs. Soames.... Only then,” he said sadly, as if he saw the tragedy from far
off as a thing which had little to do with him. “Only then,” he repeated, “it
was too late. After what I had done to her, it was too late to fall in love. I
couldn’t abandon her. It was impossible. It ought never to have happened.”
He straightened his tough old body and added, “I’ve told you all this,
Olivia, because I wanted you to understand why sometimes I am....” He
paused for a moment and then plunged ahead, “why I am a beast as I was
yesterday. There have been times when it was the only way I could go on
living.... And it harmed no one. There aren’t many who ever knew about
it.... I always hid myself. There was never any spectacle.”
Slowly Olivia’s white hand stole across the polished surface of the desk
and touched the brown, bony one that lay there now, quietly, like a hawk
come to rest. She said nothing and yet the simple gesture carried an
eloquence of which no words were capable. It brought tears into the burning
eyes for the second time in the life of John Pentland. He had wept only once
before ... on the night of his grandson’s death. And they were not, Olivia
knew, tears of self-pity, for there was no self-pity in the tough, rugged old
body; they were tears at the spectacle of a tragedy in which he happened by
accident to be concerned.
“I wanted you to know, my dear Olivia ... that I have never been
unfaithful to her, not once in all the years since our wedding-night.... I
know the world will never believe it, but I wanted you to know because,
you see, you and Mrs. Soames are the only ones who matter to me ... and
she knows that it is true.”
And now that she knew the story was finished, she did not go away,
because she knew that he wanted her to stay, sitting there beside him in
silence, touching his hand. He was the sort of man—a man, she thought,
like Michael—who needed women about him.
After a long time, he turned suddenly and asked, “This boy of Sybil’s—
who is he? What is he like?”
“Sabine knows about him.”
“It’s that which makes me afraid.... He’s out of her world and I’m not so
sure that I like it. In Sabine’s world it doesn’t matter who a person is or
where he comes from as long as he’s clever and amusing.”
“I’ve watched him.... I’ve talked with him. I think him all that a girl
could ask ... a girl like Sybil, I mean.... I shouldn’t recommend him to a
silly girl ... he’d give such a wife a very bad time. Besides, I don’t think we
can do much about it. Sybil, I think, has decided.”
“Has he asked her to marry him? Has he spoken to you?”
“I don’t know whether he’s asked her. He hasn’t spoken to me. Young
men don’t bother about such things nowadays.”
“But Anson won’t like it. There’ll be trouble ... and Cassie, too.”
“Yes ... and still, if Sybil wants him, she’ll have him. I’ve tried to teach
her that in a case like this ... well,” she made a little gesture with her white
hand, “that she should let nothing make any difference.”
He sat thoughtfully for a long time, and at last, without looking up and
almost as if speaking to himself, he said, “There was once an elopement in
the family.... Jared and Savina Pentland were married that way.”
“But that wasn’t a happy match ... not too happy,” said Olivia; and
immediately she knew that she had come near to betraying herself. A word
or two more and he might have trapped her. She saw that it was impossible
to add the burden of the letters to these other secrets.
As it was, he looked at her sharply, saying, “No one knows that.... One
only knows that she was drowned.”
She saw well enough what he meant to tell her, by that vague hint
regarding Savina’s elopement; only now he was back once more in the
terrible shell; he was the mysterious, the false, John Pentland who could
only hint but never speak directly.
The music ceased altogether in the drawing-room, leaving only the
vague, distant, eternal pounding of the surf on the red rocks, and once the
distant echo of a footstep coming from the north wing. The old man said
presently, “So she wasn’t falling in love with this man O’Hara, after all?
There wasn’t any need for worry?”
“No, she never thought of him in that way, even for a moment.... To her
he seems an old man.... We mustn’t forget how young she is.”
“He’s not a bad sort,” replied the old man. “I’ve grown fond of him, and
Higgins thinks he’s a fine fellow. I’m inclined to trust Higgins. He has an
instinct about people ... the same as he has about the weather.” He paused
for a moment, and then continued, “Still, I think we’d best be careful about
him. He’s a clever Irishman on the make ... and such gentlemen need
watching. They’re usually thinking only of themselves.”
“Perhaps,” said Olivia, in a whisper. “Perhaps....”
The silence was broken by the whirring and banging of the clock in the
hall making ready to strike eleven. The evening had slipped away quickly,
veiled in a mist of unreality. At last the truth had been spoken at Pentlands
—the grim, unadorned, terrible truth; and Olivia, who had hungered for it
for so long, found herself shaken.
John Pentland rose slowly, painfully, for he had grown stiff and brittle
with the passing of the summer. “It’s eleven, Olivia. You’d better go to bed
and get some rest.”
2
She did not go to her own room, because it would have been impossible
to sleep, and she could not go to the drawing-room to face, in the mood
which held her captive, such young faces as those of Jean and Thérèse and
Sybil. At the moment she could not bear the thought of any enclosed place,
of a room or even a place covered by a roof which shut out the open sky.
She had need of the air and that healing sense of freedom and oblivion
which the sight of the marshes and the sea sometimes brought to her. She
wanted to breathe deeply the fresh salty atmosphere, to run, to escape
somewhere. Indeed, for a moment she succumbed to a sense of panic, as
she had done on the other hot night when O’Hara followed her into the
garden.
She went out across the terrace and, wandering aimlessly, found herself
presently moving beneath the trees in the direction of the marshes and the
sea. This last night of August was hot and clear save for the faint, blue-
white mist that always hung above the lower meadows. There had been
times in the past when the thought of crossing the lonely meadows, of
wandering the shadowed lanes in the darkness, had frightened her, but to-
night such an adventure seemed only restful and quiet, perhaps because she
believed that she could encounter there nothing more terrible than the
confidences of John Pentland. She was acutely aware, as she had been on
that other evening, of the breathless beauty of the night, of the velvety
shadows along the hedges and ditches, of the brilliance of the stars, of the
distant foaming white line of the sea and the rich, fertile odor of the
pastures and marshes.
And presently, when she had grown a little more calm, she tried to bring
some order out of the chaos that filled her body and spirit. It seemed to her
that all life had become hopelessly muddled and confused. She was aware
in some way, almost without knowing why, that the old man had tricked
her, turning her will easily to his own desires, changing all the prospect of
the future. She had known always that he was strong and in his way
invincible, but until to-night she had never known the full greatness of his
strength ... how relentless, even how unscrupulous he could be; for he had
been unscrupulous, unfair, in the way he had used every weapon at hand ...
every sentiment, every memory ... to achieve his will. There had been no
fierce struggle in the open; it was far more subtle than that. He had subdued
her without her knowing it, aided perhaps by all that dark force which had
the power of changing them all ... even the children of Savina Dalgedo and
Toby Cane into “Pentlands.”
Thinking bitterly of what had passed, she came to see that his strength
rested upon the foundation of his virtue, his rightness. One could say—
indeed, one could believe it as one believed that the sun had risen yesterday
—that all his life had been tragically foolish and quixotic, fantastically
devoted to the hard, uncompromising ideal of what a Pentland ought to be;
and yet ... yet one knew that he had been right, even perhaps heroic; one
respected his uncompromising strength. He had made a wreck of his own
happiness and driven poor old Mrs. Soames to seek peace in the Nirvana of
drugs; and yet for her, he was the whole of life: she lived only for him. This
code of his was hard, cruel, inhuman, sacrificing everything to its
observance.... “Even,” thought Olivia, “to sacrificing me along with
himself. But I will not be sacrificed. I will escape!”
And after a long time she began to see slowly what it was that lay at the
bottom of the iron power he had over people, the strength which none of
them had been able to resist. It was a simple thing ... simply that he
believed, passionately, relentlessly, as those first Puritans had done.
The others all about her did not matter. Not one of them had any power
over her ... not Anson, nor Aunt Cassie, nor Sabine, nor Bishop Smallwood.
None of them played any part in the course of her life. They did not matter.
She had no fear of them; rather they seemed to her now fussy and pitiful.
But John Pentland believed. It was that which made the difference.
Stumbling along half-blindly, she found herself presently at the bridge

where the lane from Pentlands crossed the river on its way to Brook
Cottage. Since she had been a little girl, the sight of water had exerted a
strange spell upon her ... the sight of a river, a lake, but most of all the open
sea; she had always been drawn toward these things like a bit of iron toward
a magnet; and now, finding herself at the bridge, she halted, and stood
looking over the stone parapet in the shadow of the hawthorn-bushes that
grew close to the water’s edge, down on the dark, still pool below her. The
water was black and in it the bright little stars glittered like diamonds
scattered over its surface. The warm, rich odor of cattle filled the air,
touched by the faint, ghostly perfume of the last white nympheas that
bordered the pool.
And while she stood there, bathed in the stillness of the dark solitude,
she began to understand a little what had really passed between them in the
room smelling of whisky and saddle-soap. She saw how the whole tragedy
of John Pentland and his life had been born of the stupidity, the ignorance,
the hypocrisy of others, and she saw, too, that he was beyond all doubt the
grandson of the Toby Cane who had written those wild passionate letters
glorifying the flesh; only John Pentland had found himself caught in the
prison of that other terrible thing—the code in which he had been trained, in
which he believed. She saw now that it was not strange that he sought
escape from reality by shutting himself in and drinking himself into a
stupor. He had been caught, tragically, between those two powerful forces.
He thought himself a Pentland and all the while there burned in him the fire
that lay in Toby Cane’s letters and in the wanton look that was fixed forever
in the portrait of Savina Pentland. She kept seeing him as he said, “I have
never been unfaithful to her, not once in all the years since our wedding-
night.... I wanted you to know because, you see, you and Mrs. Soames are
the only ones who matter to me ... and she knows that it is true.”
It seemed to her that this fidelity was a terrible, a wicked, thing.
And she came to understand that through all their talk together, the
thought, the idea, of Michael had been always present. It was almost as if
they had been speaking all the while about Michael and herself. A dozen
times the old man had touched upon it, vaguely but surely. She had no
doubts that Aunt Cassie had long since learned all there was to learn from
Miss Peavey of the encounter by the catnip-bed, and she was certain that
she had taken the information to her brother. Still, there was nothing
definite in anything Miss Peavey had seen, very little that was even
suspicious. And yet, as she looked back upon her talk with the old man, it
seemed to her that in a dozen ways, by words, by intonation, by glances, he
had implied that he knew the secret. Even in the end when, cruelly, he had
with an uncanny sureness touched the one fear, the one suspicion that
marred her love for Michael, by saying in the most casual way, “Still, I
think we’d better be careful of him. He’s a clever Irishman on the make ...
and such gentlemen need watching. They’re usually thinking only of
themselves.”
And then the most fantastic of all thoughts occurred to her ... that all
their talk together, even the painful, tragic confidence made with such an
heroic effort, was directed at herself. He had done all this—he had emerged
from his shell of reticence, he had humiliated his fierce pride—all to force
her to give up Michael, to force her to sacrifice herself on the altar of that
fantastic ideal in which he believed.
And she was afraid because he was so strong; because he had asked her
to do nothing that he himself had not done.
She would never know for certain. She saw that, after all, the John
Pentland she had left a little while before still remained an illusion, veiled
in mystery, unfathomable to her, perhaps forever. She had not seen him at
all.
Standing there on the bridge in the black shadow of the hawthorns, all
sense of time or space, of the world about her, faded out of existence, so
that she was aware of herself only as a creature who was suffering. She
thought, “Perhaps he is right. Perhaps I have become like them, and that is
why this struggle goes on and on. Perhaps if I were an ordinary person ...
sane and simple ... like Higgins ... there would be no struggle and no
doubts, no terror of simply acting, without hesitation.”
She remembered what the old man had said of a world in which all
action had become paralyzed, where one was content simply to watch
others act, to live vicariously. The word “sane” had come to her quite
naturally and easily as the exact word to describe a state of mind opposed to
that which existed perpetually at Pentlands, and the thought terrified her
that perhaps this thing which one called “being a Pentland,” this state of
enchantment, was, after all, only a disease, a kind of madness that paralyzed
all power of action. One came to live in the past, to acknowledge debts of
honor and duty to people who had been dead for a century and more.
“Once,” she thought, “I must have had the power of doing what I wanted
to do, what I thought right.”
And she thought again of what Sabine had said of New England as “a
place where thoughts became higher and fewer,” where every action
became a problem of moral conduct, an exercise in transcendentalism. It
was passing now, even from New England, though it still clung to the world
of Pentlands, along with the souvenirs of celebrated “dear friends.” Even
stowing the souvenirs away in the attic had changed nothing. It was passing
all about Pentlands; there was nothing of this sort in the New England that
belonged to O’Hara and Higgins and the Polish mill-workers of Durham.
The village itself had become a new and different place.
In the midst of this rebellion, she became aware, with that strange
acuteness which seemed to touch all her senses, that she was no longer
alone on the bridge in the midst of empty, mist-veiled meadows. She knew
suddenly and with a curious certainty that there were others somewhere
near her in the darkness, perhaps watching her, and she had for a moment a
wave of the quick, chilling fear which sometimes overtook her at Pentlands
at the times when she had a sense of figures surrounding her who could
neither be seen nor touched. And almost at once she distinguished,
emerging from the mist that blanketed the meadows, the figures of two
people, a man and a woman, walking very close to each other, their arms
entwined. For a moment she thought, “Am I really mad? Am I seeing ghosts
in reality?” The fantastic idea occurred to her that the two figures were
perhaps Savina Pentland and Toby Cane risen from their lost grave in the
sea to wander across the meadows and marshes of Pentland. Moving
through the drifting, starlit mist, they seemed vague and indistinct and
watery, like creatures come up out of the water. She fancied them, all
dripping and wet, emerging from the waves and crossing the white rim of
beach on their way toward the big old house....
The sight, strangely enough, filled her with no sense of horror, but only
with fascination.
And then, as they drew nearer, she recognized the man—something at
first vaguely familiar in the cocky, strutting walk. She knew the bandy legs
and was filled suddenly with a desire to laugh wildly and hysterically. It
was only the rabbitlike Higgins engaged in some new conquest. Quietly she
stepped farther into the shadow of the hawthorns and the pair passed her, so
closely that she might have reached out her hand and touched them. It was
only then that she recognized the woman. It was no Polish girl from the
village, this time. It was Miss Egan—the starched, the efficient Miss Egan,
whom Higgins had seduced. She was leaning on him as they walked—a
strange, broken, feminine Miss Egan whom Olivia had never seen before.
At once she thought, “Old Mrs. Pentland has been left alone. Anything
might happen. I must hurry back to the house.” And she had a quick burst
of anger at the deceit of the nurse, followed by a flash of intuition which
seemed to clarify all that had been happening since the hot night early in the
summer when she had seen Higgins leaping the wall like a goat to escape
the glare of the motor-lights. The mysterious woman who had disappeared
over the wall that night was Miss Egan. She had been leaving the old
woman alone night after night since then; it explained the sudden
impatience and bad temper of these last two days when Higgins had been
shut up with the old man.
She saw it all now—all that had happened in the past two months—in an
orderly procession of events. The old woman had escaped, leading the way
to Savina Pentland’s letters, because Miss Egan had deserted her post to
wander across the meadows at the call of that mysterious, powerful force
which seemed to take possession of the countryside at nightfall. It was in
the air again to-night, all about her ... in the air, in the fields, the sound of
the distant sea, the smell of cattle and of ripening seeds ... as it had been on
the night when Michael followed her out into the garden.
In a way, the whole chain of events was the manifestation of the
disturbing force which had in the end revealed the secret of Savina’s letters.
It had mocked them, and now the secret weighed on Olivia as a thing which
she must tell some one, which she could no longer keep to herself. It burned
her, too, with the sense of possessing a terrible and shameful weapon which
she might use if pushed beyond endurance.
Slowly, after the two lovers had disappeared, she made her way back
again toward the old house, which loomed square and black against the
deep blue of the sky, and as she walked, her anger at Miss Egan’s betrayal
of trust seemed to melt mysteriously away. She would speak to Miss Egan
to-morrow, or the day after; in any case, the affair had been going on all
summer and no harm had come of it—no harm save the discovery of Savina
Pentland’s letters. She felt a sudden sympathy for this starched, efficient
woman whom she had always disliked; she saw that Miss Egan’s life, after
all, was a horrible thing—a procession of days spent in the company of a
mad old woman. It was, Olivia thought, something like her own
existence....
And it occurred to her at the same time that it would be difficult to
explain to so sharp-witted a creature as Miss Egan why she herself should
have been on the bridge at such an hour of the night. It was as if everything,
each little thought and action, became more and more tangled and hopeless,
more and more intricate and complicated with the passing of each day.
There was no way out save to cut the web boldly and escape.
“No,” she thought, “I will not stay.... I will not sacrifice myself. To-
morrow I shall tell Michael that when Sybil is gone, I will do whatever he
wants me to do....”
When she reached the house she found it dark save for the light which
burned perpetually in the big hall illuminating faintly the rows of portraits;
and silent save for the creakings which afflicted it in the stillness of the
night.
3
She was wakened early, after having slept badly, with the news that
Michael had been kept in Boston the night before and would not be able to
ride with her as usual. When the maid had gone away she grew depressed,
for she had counted upon seeing him and coming to some definite plan. For
a moment she even experienced a vague jealousy, which she put away at
once as shameful. It was not, she told herself, that he ever neglected her; it
was only that he grew more and more occupied as the autumn approached.
It was not that there was any other woman involved; she felt certain of him.
And yet there remained that strange, gnawing little suspicion, placed in her
mind when John Pentland had said, “He’s a clever Irishman on the make ...
and such gentlemen need watching.”
After all, she knew nothing of him save what he had chosen to tell her.
He was a free man, independent, a buccaneer, who could do as he chose in
life. Why should he ruin himself for her?
She rose at last, determined to ride alone, in the hope that the fresh
morning air and the exercise would put to rout this cloud of morbidity
which had kept possession of her from the moment she left John Pentland in
the library.
As she dressed, she thought, “Day after to-morrow I shall be forty years
old. Perhaps that’s the reason why I feel tired and morbid. Perhaps I’m on
the borderland of middle-age. But that can’t be. I am strong and well and I
look young, despite everything. I am tired because of what happened last
night.” And then it occurred to her that perhaps Mrs. Soames had known
these same thoughts again and again during her long devotion to John
Pentland. “No,” she told herself, “whatever happens I shall never lead the
life she has led. Anything is better than that ... anything.”
It seemed strange to her to awaken and find that nothing was changed in
all the world about her. After what had happened the night before in the
library and on the dark meadows, there should have been some mark left
upon the life at Pentlands. The very house, the very landscape, should have
kept some record of what had happened; and yet everything was the same.
She experienced a faint shock of surprise to find the sun shining brightly, to
see Higgins in the stable-yard saddling her horse and whistling all the while
in an excess of high spirits, to hear the distant barking of the beagles, and to
see Sybil crossing the meadow toward the river to meet Jean. Everything
was the same, even Higgins, whom she had mistaken for a ghost as he

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Abnormal Psychology: Perspectives 6th Edition Dozois

Abnormal Psychology 18th Edition Jill M Hooley

Abnormal Psychology (6th Canadian Edition) Gordon L.

LaunchPad for Fundamentals of Abnormal Psychology

Abnormal Psychology An Integrative Approach Eighth

Abnormal Psychology and Life: A Dimensional Approach

Abnormal Child Psychology, 7th Ed 7th Edition Eric J.

Abnormal psychology: clinical perspectives on

NEW TO THE EDITION

Cover Image: Asya Lysogorskaya. Shutterstock

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Published by Pearson India Education Services Pvt. Ltd, CIN: U72200TN2005PTC057128,

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F01 Abnormal Psychology 16 9408.indd 3 11/9/2016 4:02:11 PM

F01 Abnormal Psychology 16 9408.indd 4 11/9/2016 4:02:11 PM

1 Abnormal Psychology: Retrospective Versus Prospective Strategies 19

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Causes and risk Factors for Abnormal Behavior

Diathesis-Stress Models 53 the Basic elements in Assessment 94

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5 Stress and Physical and

Clinical Description 139 Psychological Causal Factors 164

Rates of PTSD After Traumatic Experiences 140 Treatments 165

Causal Factors in Posttraumatic Stress Disorder 144 Panic Disorder 166

Individual Risk Factors 144 Criteria for Panic Disorder 167

Sociocultural Factors 145 Agoraphobia 168

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suicidal Ambivalence 241

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8 Somatic Symptom and

Disorders 247 ThINKING cRITIcaLLy about DsM-5:

Clinical Aspects of eating disorders 277 Medications 303

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12 Sexual Variants, Abuse,

the WORLD around us UNResOLveD issues

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Neurocognitive Disorder Associated Autism Spectrum Disorder 495

(Neurodevelopmental Planning Better Programs to help

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ThINKING cRITIcaLLy about DsM-5: UNResOLveD issues

summary 546 key terms 547

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F01 Abnormal Psychology 16 9408.indd 15 11/9/2016 4:02:19 PM

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Features and Pedagogy Case Studies

Features In Review Questions

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James N. BUTCHER Jill M. HOOLEY

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xxiv ABOUT THE AUTHORS