Concepts of Abnormal Behaviour

Concepts of Abnormal Behaviour 1.1 Normal behavior is known as behavior that is widely accepted as the prescribed norms of a particular society. For example, it is normal for an American to greet someone by shaking hands. Adhering to normal behavior satisfies individuals’ need to fit into society. The ability to behave normally also allows one to fulfill the innate need to interact with others. Abnormal behavior contrasts normal behavior in that it is unacceptable behavior which is outside of the norm of functioning behavior. Abnormal behaviors could range from minor deviations from societal norms to very severe behaviors that are considered taboo, or forbidden. There is a dilemma in defining how these concepts are defined in that behaviors which are known to be acceptable in one culture may not be tolerated in another. No single culture can determine a paradigm for normalcy within another society, since this would imply that another culture’s societal rules are incorrect. Instead, it is necessary to consider behaviors in the appropriate cultural context, as suggested in an article entitled, Epidemiology of major depression in four cities in Mexico. [1] 1.2 To effectively treat the underlying pathological disorders that cause abnormal behaviors, researchers have created paradigms that describe possible explanations for psychopathology. The Biological Paradigm of abnormal behavior states that mental disorders are the result of biological processes. For instance, research in the field of Behavior Genetics describes how genes play a significant role in individuals’ behavior. Also, irregularity in the amount of neurotransmitters released between neurons is the root of some disorders, such as Depression and Manic Disorder. Another model is the Humanistic and Existential Paradigm. It holds that people who suffer from abnormal behavior lack insight into their life issues (Davison et. al., 2003). [2] Paradigms such as the ones described above are invaluable in working with individuals who suffer from pathological behavior. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a universal diagnostic tool that categorizes models of abnormal behavior and provides clinicians with information about a client’s mental functioning (American Psychiatric Association, 2000).[3] The DSM lists specific criteria that are required for an individual to either have features of a particular mental disorder or further, be diagnosed with one. The DSM also incorporates portions of the International Classification of Diseases (ICD) manual that pertain to mental disorders. The ICD is typically used by medical professionals. The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines categories of disorders according to the Multiaxial Assessment Model, which breaks up disorders into five axes of functioning. Axis I includes clinical disorders such as Depression, Manic Disorder and Schizophrenia. Axis II encompasses personality disorders such as Histrionic Personality Disorder and Borderline Personality Disorder. It also includes Mental Retardation. Axis III is comprised of medical disorders. Axis IV contains Psychosocial and Environmental Problems such as life problems not attributed to a clinical, personality or medical disorder. The last axis encapsulates an individual’s Global Assessment of Functioning, which is a rating system that represents a person’s overall level of mental health. The classification system for mental disorders is comprehensive in covering various areas of mental disorders and symptomology. However, most studies that have assisted researchers in gathering the information included in the DSM were performed by homogenous researchers and did not include diverse study participants. Thus, applicability of the DSM to other cultures is disputed by professionals. Details about the inapplicability of Western cultural values upon other cultures are displayed in an article titled, Mental health issues for Asian Americans, by Lin and Cheung.[4] In order to attempt to deflect this shortcoming, DSM collaborators decided to include popular disorders of other cultures within the DSM. For example, the DSM incorporates Taijin kyofusho, a Japanese disorder described in an article titled, The place of culture in psychiatric nosology: Taijin kyofusho and DSM-III-R.[5] Although this approach is somewhat helpful, results of a study titled, The place of culture in DSM -IV, focused on better integrating diverse populations encourages statisticians to integrate multicultural issues into diagnostic systems.[6] 1.3 One of the greatest struggles a mental health professional faces in diagnosing a client is differentiating which disorder a client may potentially have. Spitzer portrays this difficulty through research titled, The DSM-III-R field trial of disruptive behavior disorders.[7] The difficulty lies in categorizing symptoms into only one disorder. For example, â€Å"sleep disturbance† is both a symptom of depression and anxiety. Although there are notable difficulties in diagnosing a client, differentiation is an important component of diagnosis, and eventually in administrating the appropriate treatment. If a client is misdiagnosed due to lack of scrutiny during the assessment and diagnosis period, the results could be detrimental. 2.1 Mental illness is a complex subject with various facets. However, there is a major similarity in the mode of treatment options allowed to people suffering from mental illness. In many cases a person’s quality of life can be sustained by managing the illness through therapeutic means and possibly psychotropic medication. Regrettably, however, there are a percentage of people who may not receive the full benefits of treatment. An examination of the differences within mental illness is required in order to grasp a better understanding of why this is so. Mental illness is divided into two major categories: neuroses and psychoses. Neuroses represent those mental illnesses that cause a person distress; however, there is opportunity to remedy the source of distress based on a person’s level of insight into the illness. Mood, anxiety, attachment, eating, and personality disorders are some of the illnesses encapsulated under the category of neuroses. Psychoses are similar to neuroses in that they also cause a level of distress that hampers daily functioning. Conversely, however, psychoses also encompass disorders that include delusional and hallucinatory features. In result, a person suffering from a psychosis lacks the insight to understand that these psychotic features are of a pathological nature (American Psychiatric Association, 2000). Disorders under the neuroses category include schizophrenia, delusional disorder, and psychotic disorder. While treatment options for neurotic disorders are vast and prognosis for long-term ment al health possible, the outlook for treatment and prognosis of psychotic disorders is not optimistic in many cases, as suggested in the article, Recovery from mental illness.[8] 2.2 Several types of psychopathological disorders have been identified over time. These disorders are now categorized in the DSM according to what areas of functioning are affected and symptomology. For instance, one category includes mood disorders. Bipolar Disorder, Anxiety Disorder and Depression are found under this heading because all of them affect mood. A second category, eating disorders, includes anorexia and bulimia. Psychotic Disorders are most severe and include disorders such as Schizophrenia and Delusional Disorder. Schizophrenia is one of the most studied psychotic disorders and deserves further explanation. Based on the DSM, criteria for diagnosing a person with the disorder are that it last for at least six months and contain at least one month of active-phase symptoms. These symptoms include one or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms (such as affective flattening). Other symptomology that is common with Schizophrenia is severe social and occupational dysfunction, which incapacitates important daily living skills. Additionally, there are three subtypes that more clearly identify which symptoms are most prominent within individual sufferers: Paranoid Schizophrenia causes the sufferer to experience delusions and hallucinations in a paranoid state. In result, the person may accuse another entity or person of wanting to harm the sufferer. Disorganized Schizophrenia is diagnosed when a client is ha ving difficulty expressing himself properly. Both thought and speech may be disorganized and incomprehensible. A person with Catatonic Type Schizophrenia displays very little facial expressions, body movements or other normal physical movements and speech. Every client’s symptoms and any applicable subtype may vary. This variation within the disorder makes diagnosis and treatment a difficult task. 3.1 Based on the severity of symptomology, the forecast for effective treatment is not hopeful. However, some treatment options are available. One approach is called Psychosocial Rehabilitation, and is a popular form of treatment for sufferers of schizophrenia, as described in the study, Psychosocial rehabilitation services in community support systems.[9] This model consists of reintroducing clients to basic living skills in order to function in society and in effect, avoid being institutionalized, as stated in the study, Psychiatric and social reasons for frequent rehospitalization.[10] Additionally, the Humanistic Theory is utilized often with this population due to its introspective nature. Theorists who utilize this modality attempt to teach the client to become increasingly self-aware and gain insight into their behaviors and illness. The irony in using this approach is that it is precisely the type of treatment the client needs but has most difficulty applying. Medication is also used as a mode of treatment, mainly to decrease psychotic symptoms. In The Texas medication algorithm project, a study by Chiles et. al, the researchers created an algorithm for administering medication to patients with Schizophrenia.[11] The article details the type of psychotropic medication that should be used, including a â€Å"decision tree† model for administration. The article also details various types of medication used with patients with Schizophrenia. Medication such as Risperidone and haloperidol is mainly used for psychotic symptoms while __________ is used for symptoms related to depressive symptoms as a result of the schizophrenia. 3.2 The types of therapy outlined above can be relatively effective for clients with schizophrenia based on extensive research and application. However, some important factors regarding the implications of therapies and treatment should be considered, particularly due to the nature of the client’s symptoms. Most importantly, it is crucial that there be a positive client-therapist match. The therapist should have the ability to build rapport with the client, be knowledgeable about Schizophrenia, and remain professional in spite of irrational thoughts and processes displayed by the client. Moreover, the therapist should be invested in the client long-term, due to the nature of this type of therapy. There is no timeline for resolution of the client’s problem in the case of Schizophrenia, but rather maintenance of well-being and management of symptoms. This tedious therapeutic process could become increasingly frustrating. However, the onus is upon the therapist to handle this frustration with a sense of beneficence, thereby, remaining emotionally available and dedicated to the client. Once a trusting relationship is established, it is important for the therapist to consider what therapies will realistically be effective. Many modalities can be used, such as group, family and individual therapy; support groups; and various others. However, great importance must be placed on the individual client’s needs. As stated earlier, people who suffer from schizophrenia have very little insight into their behaviors and symptoms. It is important to address the client’s current stressors in a practical and resourceful manner. For instance, if a therapist is dealing with someone who suffers from paranoid schizophrenia, a group setting may be difficult for this client. In many cases, medication is also applied as a treatment approach, although carefully. Though many of the recommended medication that exists for schizophrenia seems to work quite effectively, there are long-term side effects. Because schizophrenia is a life long disorder, medication may only make matters worse by igniting damaging side effects. Additionaly, it is important to know whether clients can accurately assess whether a certain medication is helping or hurting. At times, they may not be able to determine this objectively. Professionals have the responsibility of advocating for their clients so that clients are not misled or disadvantaged. Also, both clinicians and psychiatrists must collaborate closely due to for client’s need for both medication and long term therapy. As several studies show, any of the two given alone would not be as effective (Chiles, 1999). Ultimately, professionals must make decisions that are most beneficial for the client. There is opportunity for this population to be taken advantage of quite easily due to their lack of understanding about their circumstances. Unfortunately, sometimes therapists decide not to terminate therapy even though they believe the client has learned appropriate life skills and does not need therapy at the time. Psychiatrists can prescribe medication to a client only because they are promoting a certain type at the time, although the medication might not be the most compatible. Due to disheartening situations such as these, it is important for professionals who are dedicated to the field to work beneficently for the client while considering the most practical and ethical modalities of treatment (Davison, 2003). Bibliography American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association. Anthony WA. (1993). Recovery from mental illness: the guiding vision of the mental health system in the 1990s. Innovations and Research 2(3):17-24. Chiles, J, Miller, A., Crismon, M., Rush, A., Krasnoff, A., and Shon,S. (1999). The Texas Medication Algorithm Project: Development and Implementation of the Schizophrenia Algorithm. Psychiatric Services, 50:69-74. Davison, G; Neale, J., Kring, A. (2003). Abnormal Psychology with Cases, 9th Edition. California: John Wiley Sons, Inc. DeSisto MJ, Harding CM, McCormack RV, et al. (1995). The Maine and Vermont three-decade studies of serious mental illness. British Journal of Psychiatry 167:331-342. Harding CM, Zahniser JH. (1994). Empirical correction of seven myths about schizophrenia with implications for treatment. Acta Psychiatrica Scandinavica 90:140-146. Kent S, Yellowlees PM. (1994). Psychiatric and social reasons for frequent rehospitalization. Hospital and Community Psychiatry 45:347-350. Kirmayer L.J. (1991). The place of culture in psychiatric nosology: Taijin kyofusho and DSM-III-R. Journal of Nervous Mental Disorders. 179(1):19-28. Lin, K., Cheung, F. (1999). Mental health issues for Asian Americans. Psychiatric Services 50:774-780. Mezzich JE, Kirmayer LJ, Kleinman A, Fabrega H Jr, Parron DL, Good BJ, Lin KM, Manson SM. (1999). The place of culture in DSM-IV. Journal of Nervous Mental Disorders, 187(8):457-64. Rogler LH. (1996). Framing research on culture in psychiatric diagnosis: the case of the DSM-IV. Psychiatry, 59(2):145-55. Roshel Lenroot, M.D., Juan R. Bustillo, M.D., John Lauriello, M.D. and Samuel J. Keith. (2003). Integration of Care: Integrated Treatment of Schizophrenia. Psychiatric Services 54:1499-1507. Slone LB, Norris FH, Murphy AD, Baker CK, Perilla JL, Diaz D, Rodriguez FG, de Jesus Gutierrez Rodriguez J. (2006). Epidemiology of major depression in four cities in Mexico. Journal of Depression and Anxiety. Spitzer RL, Davies M, Barkley RA. (1990). The DSM-III-R field trial of disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 29(5); 690-7. Thakker J, Ward T. (1998). Culture and classification: the cross-cultural application of the DSM-IV. Clinical Psychology Review, 18(5):501-29. Footnotes [1] Slone LB, Norris FH, Murphy AD, Baker CK, Perilla JL, Diaz D, Rodriguez FG, de Jesus Gutierrez Rodriguez J. (2006). Epidemiology of major depression in four cities in Mexico. Journal of Depression and Anxiety. [2] Davison, G; Neale, J., Kring, A. (2003). Abnormal Psychology With Cases, 9th Edition. California: John Wiley Sons, Inc. [3] American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association. [4] Lin, K., Cheung, F. (1999). Mental health issues for Asian Americans. Psychiatric Services 50:774-780. [5] Kirmayer L.J. (1991). The place of culture in psychiatric nosology: Taijin kyofusho and DSM-III-R. Journal of Nervous Mental Disorders. 179(1):19-28. [6] Mezzich JE, Kirmayer LJ, Kleinman A, Fabrega H Jr, Parron DL, Good BJ, Lin KM, Manson SM. (1999). The place of culture in DSM-IV. Journal of Nervous Mental Disorders, 187(8):457-64. [7] Spitzer RL, Davies M, Barkley RA. (1990). The DSM-III-R field trial of disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 29(5); 690-7. [8] Anthony, W. (1993). Recovery from mental illness: the guiding vision of the mental health system in the 1990s. Innovations and Research 2(3):17-24. [9] Barton, R. (1999). Psychosocial rehabilitation services in community support systems: a review of outcomes and policy recommendations. Psychiatric Services, 50:525-534. [10] Kent S, Yellowlees PM. (1994). Psychiatric and social reasons for frequent rehospitalization. Hospital and Community Psychiatry 45:347-350. [11] Chiles, J, Miller, A., Crismon, M., Rush, A., Krasnoff, A., and Shon,S. (1999). The Texas Medication Algorithm Project: Development and Implementation of the Schizophrenia Algorithm. Psychiatric Services, 50:69-74.