Classification and Diagnosis of Psychological Abnormality How is psychological abnormality recognised? How many different mental disorders are there, and what are their characteristics? Although there are established guidelines for clinicians working in this area, these have been subject to many criticisms. Exploring how views on this subject have changed over time, and how they vary in different societies, poses important questions about our current practices. This book provides a brief overview of the current definitions and various explanations for psychological abnormality and then focuses on how society diagnoses and classifies behaviour that is deemed to be ‘unusual’. Three key areas of the topic are covered: the procedures involved in the diagnosis and classification of mental disorders (such as schizophrenia); research into the history and origins of multiple personality disorder; and a discussion of the implications of cultural variability (including culture-bound syndromes) for the classification and diagnosis of psychological abnormality. Classification and Diagnosis of Abnormal Psychologyis an intro- ductory text suitable for students and teachers of the AQA Psychology A2 specification and is also useful for other groups who work in the field of mental disorder, such as nurses, social workers and therapists. Sue Caveis a senior examiner and coursework moderator for A level Psychology, and a lecturer at the University of Kent. Routledge Modular Psychology Series editors: Cara Flanagan is a Reviser for AS and A2 level Psychology and lectures at Inverness College. Philip Banyard is Associate Senior Lecturer in Psychology at Nottingham Trent University and a Chief Examiner for AS and A2 level Psychology. Both are experienced writers. The Routledge Modular Psychology series is a completely new approach to introductory-level psychology, tailor-made to the new modular style of teaching. Each short book covers a topic in more detail than any large textbook can, allowing teacher and student to select material exactly to suit any particular course or project. The books have been written especially for those students new to higher-level study, whether at school, college or university. They include specially designed features to help with technique, such as a model essay at an average level with an examiner’s comments to show how extra marks can be gained. The authors are all examiners and teachers at the introductory level. The Routledge Modular Psychologytexts are all user-friendly and accessible and include the following features: • practice essays with specialist commentary to show how to achieve a higher grade; • chapter summaries to assist with revision; • progress and review exercises; • glossary of key terms; • summaries of key research; • further reading to stimulate ongoing study and research; • cross-referencing to other books in the series. Also available in this series (titles listed by syllabus section): 1 2 ATYPICAL DEVELOPMENT AND Introducing Research and Data in 3 ABNORMAL BEHAVIOUR Psychology: A guide to methods 4 and analysis Psychopathology 5 Ann Searle John D. Stirling and Jonathan 6 S.E. Hellewell Theoretical Approaches in 7 Psychology Therapeutic Approaches in Matt Jarvis 8 Psychology Susan Cave Debates in Psychology 9 Andy Bell (forthcoming) 0 BIO-PSYCHOLOGY 11 SOCIAL PSYCHOLOGY Cortical Functions 12 John Stirling Social Influences 13 Kevin Wren The Physiological Basis of 14 Behaviour: Neural and hormonal Interpersonal Relationships processes Diana Dwyer 15 Kevin Silber Social Cognition 16 Awareness: Biorhythms, sleep and Donald C. Pennington 17 dreaming 18 Evie Bentley COMPARATIVE PSYCHOLOGY 19 Determinants of Animal Behaviour 20 COGNITIVE PSYCHOLOGY JoAnne Cartwright 21 Memory and Forgetting Evolutionary Explanations of John Henderson Human Behaviour 22 John Cartwright 23 Perception: Theory, development and organisation Animal Cognition 24 Paul Rookes and Jane Willson Nick Lund 25 Attention and Pattern Recognition 26 OTHER TITLES Nick Lund 27 Sport Psychology 28 DEVELOPMENTAL PSYCHOLOGY Matt Jarvis 29 Early Socialisation: Sociability and Health Psychology attachment Anthony Curtis 30 Cara Flanagan Psychology and Crime 31 Social and Personality David Putwain and Aidan Sammons 32 Development Psychology and Education 33 Tina Abbott Susan Bentham 34 Psychology and Work 35 PERSPECTIVES AND RESEARCH Christine Hodson 36 Controversies in Psychology Philip Banyard STUDY GUIDE 37 38 Ethical Issues and Guidelines in Exam Success in AQA(A) Psychology Psychology 39 Cara Flanagan and Philip Banyard Paul Humphreys (forthcoming) 40 (forthcoming) 41 Classification and Diagnosis of Psychological Abnormality Susan Cave First published 2002 by Routledge 27 Church Road, Hove, East Sussex, BN3 2FA Simultaneously published in the USA and Canada by Taylor & Francis Inc., 29 West 35th Street, New York, NY 10001 Routledge is an imprint of the Taylor & Francis Group This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Cave, Susan, 1949– Classification and diagnosis of psychological abnormality / Susan Cave. p. ; cm. – (Routledge modular psychology series) Includes bibliographical references and index. 1. Mental illness–Classification. 2. Mental illnes–Diagnosis. I. Title. II. Routledge modular psychology. [DNLM: 1. Mental Disorders–diagnosis. 2. Mental Disorders–classification. WM 141 C378s 2002] RC455.2.C4 C385 2002 616.89–dc21 2001048729 ISBN 0-203-99397-7 Master e-book ISBN ISBN 0-415-23101-9 (hbk) ISBN 0-415-23102-7 (pbk) Contents List of illustrations xi Preface xiii Acknowledgements xv 1 Introduction 1 Historical background 1 Prehistory and evil spirits 1 Ancient Greece and medical explanations 2 The Middle Ages and demonology 2 The ‘Age of Reason’ and moral treatment 3 The modern era and mental illness 5 Criteria for defining abnormality 6 Legal criteria 7 Statistical criteria 8 Deviation-from-the-norm criteria 9 Mental health criteria 10 Psychological and social criteria 11 The four Ds 12 Mental illness criteria 12 Perspectives on abnormality 14 Issues 14 Debates 16 Approaches/models 18 The medical (or biomedical) model 18 CONTENTS The psychodynamic model 19 The behavioural model 20 The cognitive model 21 The social constructivist model 22 The humanistic/existentialist model 23 The evolutionary approach 23 The family systems model 24 The socio-cultural model 25 The feminist model 25 The eclectic approach 25 Chapter summary 27 2 Classification, assessment and diagnosis 29 Background 29 Diagnostic and Statistical Manual of Mental Disorders (DSM) 30 Axes I and II: Major categories 37 Schizophrenia 37 Major depression 39 Obsessive-compulsive disorder 41 Bulimia nervosa 42 Antisocial personality disorder 44 International Classification of Diseases (ICD) 46 Comparing DSM and ICD 47 Clinical assessment procedures 47 Principles of assessment 48 Methods of assessment 51 Evaluation of classification and diagnosis 62 Criticisms of the existing systems of classification 63 Practical issues regarding classification 69 Ethical issues regarding classification 70 Chapter summary 72 3 Multiple personality disorder (MPD) 75 What is MPD? 75 Diagnosis 75 Measurement 76 History 77 Evaluation: reasons for variation in prevalence 79 viii CONTENTS Case studies 83 Eve 83 Sybil 86 Billy Milligan 88 Origins of MPD 92 The biological approach 92 The psychodynamic approach 93 Self-hypnosis approach 94 The behavioural approach 94 Socio-cultural approach 94 MPD and child abuse 95 Treatment 95 Does the treatment work? 95 How frequent are recovered memories of child abuse? 97 Are the recovered memories accurate? 98 Does childhood abuse lead to adult disorder? 104 Are traumatic memories repressed? 105 Conclusion 105 Evaluation: spontaneous or iatrogenic? 106 Trends in prevalence 106 Social changes 106 The mass media 107 Conclusion 108 Chapter summary 109 4 Cultural and subcultural issues in abnormality 111 The relevance of culture and subculture 111 Some definitions 111 Relevance 112 Cultural differences in behaviour 113 Culture and mental disorder 113 How culture defines what is normal and abnormal 114 Response to unusual behaviours 114 Differences in interpretation of symptoms 115 Conclusion 116 Differences in prevalence and expression of mental disorders 117 Differences in prevalence in different cultures 117 ix
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