A common complication of bulimia nervosa is ____

Abnormal Psychology Seventeenth Edition

Jill M. Hooley Harvard University

James N. Butcher University of Minnesota

Matthew K. Nock Harvard University

Susan Mineka Northwestern University

Boston Columbus Indianapolis New York City San Francisco Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montréal Toronto

Delhi Mexico City São Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo

Acknowledgements of third-party content appear on page 730, which constitutes an extension of this copyright page.

Copyright © 2017, 2014, 2013 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Printed in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms and the appropriate contacts within the Pearson Education Global Rights & Permissions department, please visit www.pearson.com/permissions.

PEARSON, ALWAYS LEARNING, and REVEL are exclusive trademarks in the U.S. and/or other countries owned by Pearson Education, Inc. or its affiliates.

Unless otherwise indicated herein, any third-party trademarks that may appear in this work are the property of their respective owners and any references to third-party trademarks, logos or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc. or its affiliates, authors, licensees or distributors.

Library of Congress Cataloging-in-Publication Data

Names: Hooley, Jill M., author. | Butcher, James Neal, author. | Nock, Matthew, author. | Mineka, Susan, author. Title: Abnormal psychology. Description: Seventeenth edition / Jill M. Hooley, James N. Butcher, Matthew K. Nock, Susan Mineka. | Boston : Pearson, [2017] | Revision of: Abnormal psychology / James N. Butcher, University of Minnesota, Susan Mineka, Northwestern University, Jill M. Hooley, Harvard University. Sixteenth edition. | Includes bibliographical references and index. Identifiers: LCCN 2015041946 | ISBN 9780133852059 | ISBN 0133852059 Subjects: LCSH: Psychology, Pathological—Textbooks. | Psychiatry—Textbooks

10 9 8 7 6 5 4 3 2 1

Student Edition: ISBN-10: 0-13-385205-9 ISBN-13: 978-0-13-385205-9

Books a la Carte: ISBN-10: 0-13-422578-3 ISBN-13: 978-0-13-422578-4

VP, Product Development: Dickson Musslewhite Senior Acquisitions Editor: Amber Chow Director of Development: Brita Nordin Sponsoring Editor: Carrie Brandon Development Editor: Stephanie Ventura Editorial Assistant: Stephany Harrington Director of Product Marketing: Maggie Moylan Director of Field Marketing: Jonathan Cottrell Director, Program and Project Management: Lisa Iarkowski Project Management Team Lead: Denise Forlow Senior Project Manager: Sherry Lewis Program Management Team Lead: Amber Mackey Program Manager: Cecilia Turner Field Marketing Manager: Kate Mitchell Product Marketing Manager: Lindsey Prudhomme Gill Marketing Assistant: Frank Alarcon Operations Manager: Mary Fischer Senior Operations Specialist: Carol Melville

Associate Director of Design: Blair Brown Interior Design and Director: Kathryn Foot Cover Art Director and Designer: Janet Slowik Cover Art: (tl) Fritz Cohen/Corbis; (tc) Masterfile/Corbis;

(tr) Patrik Giardino/Corbis; (l) Tony Anderson/Corbis; (cl) Kate Kunz/Corbis; (cr) Eugenio Marongiu/Corbis; (r) JAG Images/Corbis; (bl) Marnie Burkhart/Corbis; (bcl) Becky Yee/Corbis; (bcr) John Smith/Corbis; (br) Blue Images/Corbis

Digital Studio Team Lead: Peggy Bliss Digital Studio Project Manager: Christopher Fegan Media Project Managers: Pamela Weldin and Elissa

Senra-Sargent Full-Service Project Management and Composition:

iEnergizer Aptara®, Ltd. Printer/Binder: Courier Kendallville Cover Printer: Phoenix Color/Hagerstown

http://www.pearson.com/permissions
iii

1 Abnormal Psychology: Overview and Research Approaches 1

2 Historical and Contemporary Views of Abnormal Behavior 32

3 Causal Factors and Viewpoints 60

4 Clinical Assessment and Diagnosis 106

5 Stress and Physical and Mental Health 136

6 Panic, Anxiety, Obsessions, and Their Disorders 173

7 Mood Disorders and Suicide 220

8 Somatic Symptom and Dissociative Disorders 269

9 Eating Disorders and Obesity 303

10 Personality Disorders 341

11 Substance-Related Disorders 384

12 Sexual Variants, Abuse, and Dysfunctions 421

13 Schizophrenia and Other Psychotic Disorders 459

14 Neurocognitive Disorders 503

15 Disorders of Childhood and Adolescence (Neurodevelopmental Disorders) 532

16 Psychological Treatment 570

17 Contemporary and Legal Issues in Abnormal Psychology 607

Brief Contents

iv

Features xiii What’s New in DSM-5? A Quick Guide xv Preface xvii About the Authors xxiii

1 Abnormal Psychology: Overview and Research Approaches 1

What Do We Mean by Abnormality? 3 Indicators of Abnormality 3

The World Around Us Extreme Generosity or Pathological Behavior? 6

Thinking Critically about DSM-5 What Is the DSM and Why Was It Revised? 7

The DSM-5 and the Definition of Mental Disorder 7

Classification and Diagnosis 8 What Are the Disadvantages of Classification? 8 How Can We Reduce Prejudicial Attitudes Toward People Who Are Mentally Ill? 9

Culture and Abnormality 10

How Common Are Mental Disorders? 12 Prevalence and Incidence 12 Prevalence Estimates for Mental Disorders 13 The Global Burden of Disease 15 Treatment 15 Mental Health Professionals 16

Research Approaches in Abnormal Psychology 16

Sources of Information 17 Case Studies 17 Self-Report Data 18 Observational Approaches 18

Forming and Testing Hypotheses 19 Sampling and Generalization 20 Internal and External Validity 21 Criterion and Comparison Groups 21

Correlational Research Designs 22 Measuring Correlation 22 Statistical Significance 23 Effect Size 24 Meta-Analysis 24 Correlations and Causality 24 Retrospective versus Prospective Strategies 24

The Experimental Method in Abnormal Psychology 25 Studying the Efficacy of Therapy 26 Single-Case Experimental Designs 27

Developments in Research Do Magnets Help with Repetitive-Stress Injury? 27

Animal Research 29

Unresolved Issues Are We All Becoming Mentally Ill? The Expanding Horizons of Mental Disorder 29 Summary 30

Key Terms 31

2 Historical and Contemporary Views of Abnormal Behavior 32

Historical Views of Abnormal Behavior 33 Demonology, Gods, and Magic 34 Hippocrates’ Early Medical Concepts 34

Developments in Thinking Melancholia Through the Ages 35

Early Philosophical Conceptions of Consciousness 36 Later Greek and Roman Thought 36 Early Views of Mental Disorders in China 37 Views of Abnormality During the Middle Ages 37

Toward Humanitarian Approaches 39 The Resurgence of Scientific Questioning in Europe 39 The Establishment of Early Asylums 40 Humanitarian Reform 41 Nineteenth-Century Views of the Causes and Treatment of Mental Disorders 45 Changing Attitudes Toward Mental Health in the Early Twentieth Century 45

The World Around Us Chaining Mental Health Patients 46

Mental Hospital Care in the Twentieth Century 46

The Emergence of Contemporary Views of Abnormal Behavior 48

Biological Discoveries: Establishing the Link Between the Brain and Mental Disorder 48 The Development of a Classification System 49 Development of the Psychological Basis of Mental Disorder 50

Developments in Research The Search for Medications to Cure Mental Disorders 50

The Evolution of the Psychological Research Tradition: Experimental Psychology 53

Unresolved Issues Interpreting Historical Events 56 Summary 58

Key Terms 59

3 Causal Factors and Viewpoints 60 Risk Factors and Causes of Abnormal Behavior 61

Necessary, Sufficient, and Contributory Causes 61 Feedback and Bidirectionality in Abnormal Behavior 63 Diathesis–Stress Models 63

Contents

Contents v

Assessment Interviews 115 The Clinical Observation of Behavior 116 Psychological Tests 117

Developments in Practice The Automated Practice: Use of the Computer in Psychological Testing 118

The Case of Andrea C.: Experiencing Violence in the Workplace 125

Developments in Practice Computer-Based MMPI-2 Report for Andrea C. 126

The Integration of Assessment Data 128 Ethical Issues in Assessment 128

Classifying Abnormal Behavior 129 Differing Models of Classification 129 Formal Diagnostic Classification of Mental Disorders 130

Unresolved Issues The DSM-5: Issues in Acceptance of Changed Diagnostic Criteria 133 Summary 134

Key Terms 135

5 Stress and Physical and Mental Health 136

What Is Stress? 137 Stress and the DSM 138 Factors Predisposing a Person to Stress 138 Characteristics of Stressors 139 Measuring Life Stress 140 Resilience 140

Stress and Physical Health 141 The Stress Response 142 The Mind–Body Connection 143 Understanding the Immune System 143

Stress and Immune System Functioning 145 Stress and Cytokines 145 Chronic Stress and Inflammation 146 Stress and Premature Aging 147

The World Around Us Racial Discrimination and Cardiovascular Health in African Americans 147

Emotions and Health 149 Personality 149 Depression 150 Anxiety 151 Social Isolation and Lack of Social Support 151 Positive Emotions 151 The Importance of Emotion Regulation 153

Treatment of Stress-Related Physical Disorders 153 Biological Interventions 153 Psychological Interventions 153

Stress and Mental Health 155 Adjustment Disorder 155 Adjustment Disorder Caused by Unemployment 156 Posttraumatic Stress Disorder 156

Perspectives to Understanding the Causes of Abnormal Behavior 66

The Biological Perspective 66 Genetic Vulnerabilities 67

Developments in Thinking Nature, Nurture, and Psychopathology: A New Look at an Old Topic 71

Brain Dysfunction and Neural Plasticity 72 Imbalances of Neurotransmitters and Hormones 73 Temperament 75 The Impact of the Biological Viewpoint 76

The Psychological Perspective 76 The Psychodynamic Perspective 77

Developments in Thinking The Humanistic and Existential Perspectives 82

The Behavioral Perspective 83 The Cognitive-Behavioral Perspective 86 What the Adoption of a Perspective Does and Does Not Do 89

The Social Perspective 90 Early Deprivation or Trauma 90 Problems in Parenting Style 93 Marital Discord and Divorce 95 Low Socioeconomic Status and Unemployment 96 Maladaptive Peer Relationships 97 Prejudice and Discrimination in Race, Gender, and Ethnicity 98 The Impact of the Social Perspective 99

The Cultural Perspective 99 Universal and Culture-Specific Symptoms of Disorders 99 Culture and Over- and Undercontrolled Behavior 100

The World Around Us Culture and Attachment Relationships 101

Unresolved Issues Theoretical Perspectives and the Causes of Abnormal Behavior 102 Summary 103

Key Terms 104

4 Clinical Assessment and Diagnosis 106

The Basic Elements in Assessment 107 The Relationship Between Assessment and Diagnosis 107 Taking a Social or Behavioral History 108 Ensuring Culturally Sensitive Assessment Procedures 109 The Influence of Professional Orientation 109 Reliability, Validity, and Standardization 110 Trust and Rapport Between the Clinician and the Client 110

Assessment of the Physical Organism 111 The General Physical Examination 111 The Neurological Examination 111 The Neuropsychological Examination 114

Psychosocial Assessment 115

vi Contents

Biological Causal Factors 191 Psychological Causal Factors 192

Developments in Research Nocturnal Panic Attacks 194

Treatments 195

Generalized Anxiety Disorder 197

DSM-5 Criteria for. . . Generalized Anxiety Disorder 198

Prevalence, Age of Onset, and Gender Differences 199 Comorbidity with Other Disorders 199 Psychological Causal Factors 199 Biological Causal Factors 201 Treatments 202

Obsessive-Compulsive and Related Disorders 203 Obsessive-Compulsive Disorder 203

Thinking Critically about DSM-5 Why Is OCD No Longer Considered to Be an Anxiety Disorder? 203

DSM-5 Criteria for. . . Obsessive-Compulsive Disorder 205

Prevalence, Age of Onset, and Gender Differences 206 Comorbidity with Other Disorders 206 Psychological Causal Factors 206 Biological Causal Factors 208 Treatments 210 Body Dysmorphic Disorder 212

DSM-5 Criteria for. . . Body Dysmorphic Disorder 213

Hoarding Disorder 215 Trichotillomania 215

Cultural Perspectives 216

The World Around Us Taijin Kyofusho 216

Unresolved Issues The Choice of Treatments: Medications or Cognitive-Behavior Therapy? 217 Summary 218

Key Terms 219

7 Mood Disorders and Suicide 220 Mood Disorders: An Overview 221

Types of Mood Disorders 221

DSM-5 Criteria for. . . Major Depressive Disorder 222

The Prevalence of Mood Disorders 222

DSM-5 Criteria for. . . Manic Episode 223

Unipolar Depressive Disorders 224 Major Depressive Disorder 224 Persistent Depressive Disorder 227

DSM-5 Criteria for. . . Persistent Depressive Disorder 228

Other Forms of Depression 228

Thinking Critically about DSM-5 Was It Wise to Drop the Bereavement Exclusion for Major Depression? 229

Developments in Thinking A New DSM-5 Diagnosis: Premenstrual Dysphoric Disorder 229

Thinking Critically about DSM-5 Changes to the Diagnostic Criteria for PTSD 157

Acute Stress Disorder 158

Posttraumatic Stress Disorder: Causes and Risk Factors 158

DSM-5 Criteria for… Posttraumatic Stress Disorder 159

Prevalence of PTSD in the General Population 160 Rates of PTSD after Traumatic Experiences 160 Causal Factors in Posttraumatic Stress Disorder 162 Individual Risk Factors 162 Biological Factors 163 Sociocultural Factors 164 Long-Term Effects of Posttraumatic Stress 165

Prevention and Treatment of Stress Disorders 165 Prevention 165

The World Around Us Does Playing Tetris After a Traumatic Event Reduce Flashbacks? 166

Treatment for Stress Disorders 167 Trauma and Physical Health 168

The World Around Us Virtual Reality Exposure Treatment for PTSD in Military Personnel 169

Unresolved Issues Why Is the Study of Trauma So Contentious? 170 Summary 170

Key Terms 172

6 Panic, Anxiety, Obsessions, and Their Disorders 173

The Fear and Anxiety Response Patterns 174 Fear 174 Anxiety 175

Overview of the Anxiety Disorders and Their Commonalities 176

Specific Phobias 177

DSM-5 Criteria for. . . Specific Phobia 177

Prevalence, Age of Onset, and Gender Differences 179 Psychological Causal Factors 179 Biological Causal Factors 181 Treatments 181

Social Phobia 183 Prevalence, Age of Onset, and Gender Differences 183 Psychological Causal Factors 184

DSM-5 Criteria for. . . Social Anxiety Disorder (Social Phobia) 184

Biological Causal Factors 185 Treatments 186

Panic Disorder 187

DSM-5 Criteria for. . . Panic Disorder 188

Agoraphobia 188 Prevalence, Age of Onset, and Gender Differences 189

DSM-5 Criteria for. . . Agoraphobia 189

Comorbidity with Other Disorders 190 The Timing of a First Panic Attack 190

Contents vii

Developments in Research What Can Neuroimaging Tell Us about Conversion Disorder? 280

Treatment of Conversion Disorder 280

Developments in Practice Treatment of a Patient Who Was Mute 281

Factitious Disorder 281

DSM-5 Criteria for. . . Factitious Disorder 282

Distinguishing Between Different Types of Somatic Symptom and Related Disorders 283

Dissociative Disorders: An Overview 283

Depersonalization/Derealization Disorder 284

DSM-5 Criteria for. . . Depersonalization/ Derealization Disorder 286

Dissociative Amnesia 286

DSM-5 Criteria for. . . Dissociative Amnesia 288

Thinking Critically about DSM-5 Where Does Conversion Disorder Belong? 289

Dissociative Identity Disorder 290

DSM-5 Criteria for. . . Dissociative Identity Disorder 291

The World Around Us DID, Schizophrenia, and Split Personality: Clearing Up the Confusion 292

Causal Factors and Controversies about DID 292 Current Perspectives 296

Cultural Factors, Treatments, and Outcomes in Dissociative Disorders 297

Cultural Factors in Dissociative Disorders 297 Treatment and Outcomes in Dissociative Disorders 297

Unresolved Issues DID and the Reality of “Recovered Memories” 299 Summary 300

Key Terms 302

9 Eating Disorders and Obesity 303 Clinical Aspects of Eating Disorders 304

Anorexia Nervosa 304

DSM-5 Criteria for. . . Anorexia Nervosa 305 Bulimia Nervosa 307

DSM-5 Criteria for. . . Bulimia Nervosa 307 Binge-Eating Disorder 308

DSM-5 Criteria for. . . Binge-Eating Disorder 309 Age of Onset and Gender Differences 310

Thinking Critically about DSM-5 Other Forms of Eating Disorders 311

Prevalence of Eating Disorders 311 Medical Complications of Eating Disorders 312 Course and Outcome 313 Diagnostic Crossover 313 Association of Eating Disorders with Other Forms of Psychopathology 314 Eating Disorders Across Cultures 315

Causal Factors in Unipolar Mood Disorders 230 Biological Causal Factors 230 Psychological Causal Factors 235

Developments in Research Why Do Sex Differences in Unipolar Depression Emerge During Adolescence? 243

Bipolar and Related Disorders 246 Cyclothymic Disorder 246 Bipolar Disorders (I and II) 246

Causal Factors in Bipolar Disorders 249 Biological Causal Factors 249 Psychological Causal Factors 251

Sociocultural Factors Affecting Unipolar and Bipolar Disorders 251

Cross-Cultural Differences in Depressive Symptoms 252 Cross-Cultural Differences in Prevalence 252

Treatments and Outcomes 252 Pharmacotherapy 253 Alternative Biological Treatments 255 Psychotherapy 256

Suicide: The Clinical Picture and the Causal Pattern 259 Who Attempts and Dies by Suicide? 260 Psychological Disorders 261

The World Around Us Warning Signs for Suicide 262

Other Psychosocial Factors Associated with Suicide 262 Biological Factors 263 Theoretical Models of Suicidal Behavior 263

Suicide Prevention and Intervention 264 Treatment of Mental Disorders 264 Crisis Intervention 264 Focus on High-Risk Groups and Other Measures 265

Unresolved Issues Is There a Right to Die? 265 Summary 266

Key Terms 268

8 Somatic Symptom and Dissociative Disorders 269

Somatic Symptom and Related Disorders: An Overview 270

Somatic Symptom Disorder 271

DSM-5 Criteria for. . . Somatic Symptom Disorder 271

Causes of Somatic Symptom Disorder 272 Treatment of Somatic Symptom Disorder 275

Illness Anxiety Disorder 276

DSM-5 Criteria for. . . Illness Anxiety Disorder 276

Conversion Disorder (Functional Neurological Symptom Disorder) 276

DSM-5 Criteria for. . . Conversion Disorder 277

Range of Conversion Disorder Symptoms 277 Important Issues in Diagnosing Conversion Disorder 278 Prevalence and Demographic Characteristics 278 Causes of Conversion Disorders 279

viii Contents

DSM-5 Criteria for. . . Schizoid Personality Disorder 350

Schizotypal Personality Disorder 351

DSM-5 Criteria for. . . Schizotypal Personality Disorder 352

Cluster B Personality Disorders 352 Histrionic Personality Disorder 352

DSM-5 Criteria for. . . Histrionic Personality Disorder 353

Narcissistic Personality Disorder 354

DSM-5 Criteria for. . . Narcissistic Personality Disorder 354

Antisocial Personality Disorder 355

DSM-5 Criteria for. . . Antisocial Personality Disorder 356

Borderline Personality Disorder 359

Thinking Critically about DSM-5 Nonsuicidal Self- Injury: Distinct Disorder or Symptom of Borderline Personality Disorder? 360

DSM-5 Criteria for. . . Borderline Personality Disorder 361

Cluster C Personality Disorders 364 Avoidant Personality Disorder 364

DSM-5 Criteria for. . . Avoidant Personality Disorder 365

Dependent Personality Disorder 365

DSM-5 Criteria for. . . Dependent Personality Disorder 366

Obsessive-Compulsive Personality Disorder 367

DSM-5 Criteria for. . . Obsessive-Compulsive Personality Disorder 368

General Sociocultural Causal Factors for Personality Disorders 368

Treatments and Outcomes for Personality Disorders 369 Adapting Therapeutic Techniques to Specific Personality Disorders 369 Treating Borderline Personality Disorder 370

The World Around Us Marsha Linehan Reveals Her Own Struggle with Borderline Personality Disorder 371

Treating Other Personality Disorders 371

Psychopathy 372 Dimensions of Psychopathy 372

Developments in Research Are You Working for a Psychopath? 375

The Clinical Picture in Psychopathy 376 Causal Factors in Psychopathy 377 A Developmental Perspective on Psychopathy 379 Treatments and Outcomes in Psychopathic Personality 380

Unresolved Issues DSM-5: How Can We Improve the Classification of Personality Disorders? 381 Summary 381

Key Terms 383

The World Around Us Ethnic Identity and Disordered Eating 316

Risk and Causal Factors in Eating Disorders 317 Biological Factors 317 Sociocultural Factors 318 Family Influences 320 Individual Risk Factors 320

Treatment of Eating Disorders 324 Treatment of Anorexia Nervosa 324 Treatment of Bulimia Nervosa 325

Developments in Practice New Options for Adults with Anorexia Nervosa 326

Treatment of Binge-Eating Disorder 327

The Problem of Obesity 328 Medical Issues 329 Definition and Prevalence 329 Weight Stigma 329

The World Around Us Do Negative Messages about Being Overweight Encourage Overweight People to Eat More or Less? 330

Obesity and the DSM 330

Risk and Causal Factors in Obesity 330 The Role of Genes 330 Hormones Involved in Appetite and Weight Regulation 331 Sociocultural Influences 332 Family Influences 333 Stress and “Comfort Food” 334 Pathways to Obesity 334

Treatment of Obesity 335 Lifestyle Modifications 335 Medications 336 Bariatric Surgery 336 The Importance of Prevention 337

Unresolved Issues The Role of Public Policy in the Prevention of Obesity 338 Summary 339

Key Terms 340

10 Personality Disorders 341 Clinical Features of Personality Disorders 342

Challenges in Personality Disorders Research 344 Difficulties in Diagnosing Personality Disorders 345 Difficulties in Studying the Causes of Personality Disorders 346

Thinking Critically about DSM-5 Why Were No Changes Made to the Way Personality Disorders Are Diagnosed? 347

Cluster A Personality Disorders 348 Paranoid Personality Disorder 348

DSM-5 Criteria for. . . Paranoid Personality Disorder 349

Schizoid Personality Disorder 349

Contents ix

The World Around Us Should Marijuana Be Marketed and Sold Openly as a Medication? 415

Gambling Disorder 416

DSM-5 Criteria for. . . Gambling Disorder 417

Unresolved Issues Exchanging Addictions: Is This an Effective Treatment Approach? 418 Summary 418

Key Terms 420

12 Sexual Variants, Abuse, and Dysfunctions 421

Sociocultural Influences on Sexual Practices and Standards 422

Case 1: Degeneracy and Abstinence Theory 423 Case 2: Ritualized Homosexuality in Melanesia 424 Case 3: Homosexuality and American Psychiatry 424

Paraphilic Disorders 426 Fetishistic Disorder 426

DSM-5 Criteria for. . . Several Different Paraphilic Disorders 427 Transvestic Disorder 428 Voyeuristic Disorder 429 Exhibitionistic Disorder 429 Frotteuristic Disorder 430 Sexual Sadism Disorder 430 Sexual Masochism Disorder 431 Causal Factors and Treatments for Paraphilias 432

Gender Dysphoria 433

DSM-5 Criteria for. . . Gender Dysphoria in Children 433

DSM-5 Criteria for. . . Gender Dysphoria in Adolescents and Adults 434 Treatment for Gender Dysphoria 435 Transsexualism 435 Treatment for Transsexualism 436

Sexual Abuse 437 Childhood Sexual Abuse 437 Pedophilic Disorder 439

Thinking Critically about DSM-5 Pedophilia and Hebephilia 440 Incest 440 Rape 441 Treatment and Recidivism of Sex Offenders 444

The World Around Us Megan’s Law 444

Sexual Dysfunctions 446 Sexual Dysfunctions in Men 447

DSM-5 Criteria for. . . Different Sexual Dysfunctions 448 Sexual Dysfunctions in Women 452

Unresolved Issues How Harmful Is Childhood Sexual Abuse? 455 Summary 456

Key Terms 458

11 Substance-Related Disorders 384 Alcohol-Related Disorders 385

The Prevalence, Comorbidity, and Demographics of Alcohol Abuse and Dependence 386

DSM-5 Criteria for. . . Alcohol Use Disorder 388 The Clinical Picture of Alcohol-Related Disorders 388

Developments in Research Fetal Alcohol Syndrome: How Much Drinking Is Too Much? 390

Causal Factors in the Abuse of and Dependence on Alcohol 392

Biological Causal Factors in Alcohol Abuse and Dependence 392 Psychosocial Causal Factors in Alcohol Abuse and Dependence 394

The World Around Us Binge Drinking in College 396 Sociocultural Causal Factors 397

Treatment of Alcohol-Related Disorders 397 Use of Medications in Treating Alcohol Abuse and Dependency 397 Psychological Treatment Approaches 398 Controlled Drinking versus Abstinence 399 Alcoholics Anonymous 399 Outcome Studies and Issues in Treatment 400 Relapse Prevention 401

Drug Abuse and Dependence 402

Opium and Its Derivatives 403 Biological Effects of Morphine and Heroin 403 Social Effects of Morphine and Heroin 404 Causal Factors in Opiate Abuse and Dependence 405 Neural Bases for Physiological Addiction 405 Addiction Associated with Psychopathology 406 Treatments and Outcomes 406

Stimulants 406 Cocaine 406 Amphetamines 408 Methamphetamine 409 Caffeine and Nicotine 409

Thinking Critically about DSM-5 Can Changes to the Diagnostic Criteria Result in Increased Drug Use? 409

Sedatives 411 Effects of Barbiturates 411 Causal Factors in Barbiturate Abuse and Dependence 412 Treatments and Outcomes 412

Hallucinogens 412 LSD 412 Mescaline and Psilocybin 413 Ecstasy 413 Marijuana 414

x Contents

Urban Living 492 Immigration 492 Cannabis Use and Abuse 493 A Diathesis–Stress Model of Schizophrenia 494

Treatments and Outcomes 495 Clinical Outcome 495 Pharmacological Approaches 496 Psychosocial Approaches 498

Unresolved Issues Why Are Recovery Rates in Schizophrenia Not Improving? 500 Summary 501

Key Terms 502

14 Neurocognitive Disorders 503 Brain Impairment in Adults 504

Thinking Critically about DSM-5 Is the Inclusion of Mild Neurocognitive Disorder a Good Idea? 505

Clinical Signs of Brain Damage 505 Diffuse Versus Focal Damage 506 The Neurocognitive/Psychopathology Interaction 508

Delirium 509 Clinical Picture 509

DSM-5 Criteria for. . . Delirium 510

Treatments and Outcomes 510

Major Neurocognitive Disorder 510

DSM-5 Criteria for. . . Major Neurocognitive Disorder 511

Parkinson’s Disease 512 Huntington’s Disease 512

Alzheimer’s Disease 512 Clinical Picture 513 Prevalence 514 Causal Factors 515

Developments in Research Depression Increases the Risk of Alzheimer’s Disease 517

Neuropathology 517 Treatment and Outcome 519 Early Detection 519

Developments in Research New Approaches to the Treatment of Alzheimer’s Disease 520

The World Around Us Exercising Your Way to a Healthier Brain? 521

Supporting Caregivers 521

Neurocognitive Disorder Resulting from HIV Infection or Vascular Problems 522

Neurocognitive Disorder Associated with HIV-1 Infection 522 Neurocognitive Disorder Associated with Vascular Disease 523

Neurocognitive Disorder Characterized by Profound Memory Impairment (Amnestic Disorder) 523

13 Schizophrenia and Other Psychotic Disorders 459

Schizophrenia 460 Origins of the Schizophrenia Construct 460 Epidemiology 461

Clinical Picture 462 Delusions 462

DSM-5 Criteria for. . . Schizophrenia 463 Hallucinations 464

The World Around Us Stress, Caffeine, and Hallucinations 465 Disorganized Speech 465 Disorganized Behavior 466 Negative Symptoms 466 Subtypes of Schizophrenia 467

Other Psychotic Disorders 467 Schizoaffective Disorder 467

DSM-5 Criteria for. . . Schizoaffective Disorder 467 Schizophreniform Disorder 467

DSM-5 Criteria for. . . Schizophreniform Disorder 468 Delusional Disorder 468 Brief Psychotic Disorder 468

DSM-5 Criteria for. . . Delusional Disorder 468

DSM-5 Criteria for. . . Brief Psychotic Disorder 469

Genetic and Biological Factors 469 Genetic Factors 469

The World Around Us The Genain Quadruplets 471 Prenatal Exposures 476

Developments in Thinking Could Schizophrenia Be an Immune Disorder? 477 Genes and Environment in Schizophrenia: A Synthesis 477 A Neurodevelopmental Perspective 478

Thinking Critically about DSM-5 Attenuated Psychosis Syndrome 480

Structural and Functional Brain Abnormalities 481 Neurocognition 481 Social Cognition 482 Loss of Brain Volume 483 Affected Brain Areas 483 White Matter Problems 484 Brain Functioning 485 Cytoarchitecture 486 Brain Development in Adolescence 487 Synthesis 487 Neurochemistry 488

Psychosocial and Cultural Factors 490 Do Bad Families Cause Schizophrenia? 490 Families and Relapse 491

Contents xi

Intellectual Disability 556 Levels of Intellectual Disability 557 Causal Factors in Intellectual Disability 558 Organic Intellectual Disability Syndromes 559 Treatments, Outcomes, and Prevention 562

Special Considerations in the Treatment of Children and Adolescents 563

Special Factors Associated with Treatment of Children and Adolescents 563

The World Around Us The Impact of Child Abuse on Psychological Disorders 565

Family Therapy as a Means of Helping Children 565 Child Advocacy Programs 566

Unresolved Issues How Should Society Deal with Delinquent Behavior? 566 Summary 567

Key Terms 569

16 Psychological Treatment 570 An Overview of Treatment 571

Why Do People Seek Therapy? 571 Who Provides Psychotherapeutic Services? 573 The Therapeutic Relationship 573

Measuring Success in Psychotherapy 574 Objectifying and Quantifying Change 574 Would Change Occur Anyway? 576 Can Therapy Be Harmful? 576

The World Around Us When Therapy Harms 576

What Therapeutic Approaches Should Be Used? 577 Evidence-Based Treatment 577 Medication or Psychotherapy? 578 Combined Treatments 578

Psychosocial Approaches to Treatment 579 Behavior Therapy 579 Cognitive and Cognitive-Behavioral Therapy 582 Humanistic-Experiential Therapies 584 Psychodynamic Therapies 587 Couples and Family Therapy 590 Eclecticism and Integration 591 Rebooting Psychotherapy 591

Sociocultural Perspectives 592 Social Values and Psychotherapy 592 Psychotherapy and Cultural Diversity 592

Biological Approaches to Treatment 593 Antipsychotic Drugs 593 Antidepressant Drugs 594 Antianxiety Drugs 597 Lithium and Other Mood-Stabilizing Drugs 598

Thinking Critically about DSM-5 What Are Some of the Clinical Implications of the Recent Changes? 599

Nonmedicinal Biological Treatments 600

Disorders Involving Head Injury 524 Clinical Picture 525 Treatments and Outcomes 527

The World Around Us Brain Damage in Professional Athletes 528

Unresolved Issues Should Healthy People Use Cognitive Enhancers? 529 Summary 530

Key Terms 531

15 Disorders of Childhood and Adolescence (Neurodevelopmental Disorders) 532

Special Considerations in Understanding Disorders of Childhood and Adolescence 534

Psychological Vulnerabilities of Young Children 534 The Classification of Childhood and Adolescent Disorders 534

Anxiety and Depression in Children and Adolescents 535 Anxiety Disorders of Childhood and Adolescence 535 Childhood Depression and Bipolar Disorder 537

Developments in Research Bipolar Disorder in Children and Adolescents: Is There an Epidemic? 539

Disruptive, Impulse-Control, and Conduct Disorder 540 Oppositional Defiant Disorder 541 Conduct Disorder 541

DSM-5 Criteria for. . . Conduct Disorder 541

Causal Factors in ODD and CD 542 Treatments and Outcomes 543

Elimination Disorders 544 Enuresis 544 Encopresis 545

Neurodevelopmental Disorders 545 Attention-Deficit/Hyperactivity Disorder 545

DSM-5 Criteria for. . . Attention-Deficit/ Hyperactivity Disorder 546

Autism Spectrum Disorder 549

DSM-5 Criteria for. . . Autism Spectrum Disorder 551

Tic Disorders 552

Developments in Practice Can Video Games Help Children with Neurodevelopmental Disorders? 553

Specific Learning Disorders 554 Causal Factors in Learning Disorder 555 Treatments and Outcomes 555

Thinking Critically about DSM-5 What Role Should Cultural Changes Have in Developing Medical Terminology? 556

xii Contents

The World Around Us Controversial Not Guilty Pleas: Can Altered Mind States or Personality Disorder Limit Responsibility for a Criminal Act? 619

The Insanity Defense 622 Competence to Stand Trial 625 Does Having Mental Health Problems Result in Convicted Felons Being Returned to Prison After Being Released? 626

Organized Efforts for Mental Health 627 U.S. Efforts for Mental Health 627 International Efforts for Mental Health 629

Challenges for the Future 629 The Need for Planning 630 The Individual’s Contribution 630

Unresolved Issues The HMOs and Mental Health Care 631 Summary 633

Key Terms 634

Glossary 635

References 658

Credits 730

Name Index 737

Subject Index 753

The World Around Us Deep Brain Stimulation for Treatment-Resistant Depression 603

Unresolved Issues Do Psychiatric Medications Help or Harm? 604 Summary 605

Key Terms 606

17 Contemporary and Legal Issues in Abnormal Psychology 607

Perspectives on Prevention 608 Universal Interventions 609 Selective Interventions 610 Indicated Interventions 613

Inpatient Mental Health Treatment in Contemporary Society 613

The Mental Hospital as a Therapeutic Community 613 Aftercare Programs 615 Deinstitutionalization 615

Controversial Legal Issues and the Mentally Ill 617 Civil Commitment 617

The World Around Us Important Court Decisions for Patient Rights 617

Assessment of “Dangerousness” 618

xiii

Features

Developments in Research

Do Magnets Help with Repetitive-Stress Injury? 27

The Search for Medications to Cure Mental Disorders 50

Nocturnal Panic Attacks 194

Why Do Sex Differences in Unipolar Depression Emerge During Adolescence? 243

What Can Neuroimaging Tell Us about Conversion Disorder? 280

Are You Working for a Psychopath? 375

Fetal Alcohol Syndrome: How Much Drinking Is Too Much? 390

Depression Increases the Risk of Alzheimer’s Disease 517

New Approaches to the Treatment of Alzheimer’s Disease 520

Bipolar Disorder in Children and Adolescents: Is There an Epidemic? 539

Developments in Thinking

Melancholia Through the Ages 35

Nature, Nurture, and Psychopathology: A New Look at an Old Topic 71

The Humanistic and Existential Perspectives 82

A New DSM-5 Diagnosis: Premenstrual Dysphoric Disorder 229

Could Schizophrenia Be an Immune Disorder? 477

Developments in Practice

The Automated Practice: Use of the Computer in Psychological Testing 118

Computer-Based MMPI-2 Report for Andrea C. 126

Treatment of a Patient Who Was Mute 281

New Options for Adults with Anorexia Nervosa 326

Can Video Games Help Children with Neurodevelopmental Disorders? 553

The World Around Us

Extreme Generosity or Pathological Behavior? 6

Chaining Mental Health Patients 46

Culture and Attachment Relationships 101

Racial Discrimination and Cardiovascular Health in African Americans 147

Does Playing Tetris After a Traumatic Event Reduce Flashbacks? 166

Virtual Reality Exposure Treatment for PTSD in Military Personnel 169

Taijin Kyofusho 216

Warning Signs for Suicide 262

DID, Schizophrenia, and Split Personality: Clearing Up the Confusion 292

Ethnic Identity and Disordered Eating 316

Do Negative Messages about Being Overweight Encourage Overweight People to Eat More or Less? 330

Marsha Linehan Reveals Her Own Struggle with Borderline Personality Disorder 371

Binge Drinking in College 396

Should Marijuana Be Marketed and Sold Openly as a Medication? 415

Megan’s Law 444

Stress, Caffeine, and Hallucinations 465

The Genain Quadruplets 471

Exercising Your Way to a Healthier Brain? 521

Brain Damage in Professional Athletes 528

The Impact of Child Abuse on Psychological Disorders 565

When Therapy Harms 576

Deep Brain Stimulation for Treatment-Resistant Depression 603

Important Court Decisions for Patient Rights 617

Controversial Not Guilty Pleas: Can Altered Mind States or Personality Disorder Limit Responsibility for a Criminal Act? 619

Unresolved Issues

Are We All Becoming Mentally Ill? The Expanding Horizons of Mental Disorder 29

Interpreting Historical Events 56

Theoretical Perspectives and the Causes of Abnormal Behavior 102

The DSM-5: Issues in Acceptance of Changed Diagnostic Criteria 133

Why Is the Study of Trauma So Contentious? 170

The Choice of Treatments: Medications or Cognitive-Behavior Therapy? 217

Is There a Right to Die? 265

DID and the Reality of “Recovered Memories” 299

The Role of Public Policy in the Prevention of Obesity 338

DSM-5: How Can We Improve the Classification of Personality Disorders? 381

Exchanging Addictions: Is This an Effective Treatment Approach? 418

How Harmful Is Childhood Sexual Abuse? 455

Why Are Recovery Rates in Schizophrenia Not Improving? 500

xiv Features

DSM-5 Criteria for… Gambling Disorder 417

DSM-5 Criteria for… Several Different Paraphilic Disorders 427

DSM-5 Criteria for… Gender Dysphoria in Children 433

DSM-5 Criteria for… Gender Dysphoria in Adolescents and Adults 434

DSM-5 Criteria for… Different Sexual Dysfunctions 448

DSM-5 Criteria for… Schizophrenia 463

DSM-5 Criteria for… Schizoaffective Disorder 467

DSM-5 Criteria for… Schizophreniform Disorder 468

DSM-5 Criteria for… Delusional Disorder 468

DSM-5 Criteria for… Brief Psychotic Disorder 469

DSM-5 Criteria for… Delirium 510

DSM-5 Criteria for… Major Neurocognitive Disorder 511

DSM-5 Criteria for… Conduct Disorder 541

DSM-5 Criteria for… Attention-Deficit/Hyperactivity Disorder 546

DSM-5 Criteria for… Autism Spectrum Disorder 551

Thinking Critically About DSM-5

What Is the DSM and Why Was It Revised? 7

Changes to the Diagnostic Criteria for PTSD 157

Why Is OCD No Longer Considered to Be an Anxiety Disorder? 203

Was It Wise to Drop the Bereavement Exclusion for Major Depression? 229

Where Does Conversion Disorder Belong? 289

Other Forms of Eating Disorders 311

Why Were No Changes Made to the Way Personality Disorders Are Diagnosed? 347

Nonsuicidal Self-Injury: Distinct Disorder or Symptom of Borderline Personality Disorder? 360

Can Changes to the Diagnostic Criteria Result in Increased Drug Use? 409

Pedophilia and Hebephilia 440

Attenuated Psychosis Syndrome 480

Is the Inclusion of Mild Neurocognitive Disorder a Good Idea? 505

What Role Should Cultural Changes Have in Developing Medical Terminology? 556

What Are Some of the Clinical Implications of the Recent Changes? 599

Should Healthy People Use Cognitive Enhancers? 529

How Should Society Deal with Delinquent Behavior? 566

Do Psychiatric Medications Help or Harm? 604

The HMOs and Mental Health Care 631

DSM-5 Boxes

DSM-5 Criteria for… Posttraumatic Stress Disorder 159

DSM-5 Criteria for… Specific Phobia 177

DSM-5 Criteria for… Social Anxiety Disorder (Social Phobia) 184

DSM-5 Criteria for… Panic Disorder 188

DSM-5 Criteria for… Agoraphobia 189

DSM-5 Criteria for… Generalized Anxiety Disorder 198

DSM-5 Criteria for… Obsessive-Compulsive Disorder 205

DSM-5 Criteria for… Body Dysmorphic Disorder 213

DSM-5 Criteria for… Major Depressive Disorder 222

DSM-5 Criteria for… Manic Episode 223

DSM-5 Criteria for… Persistent Depressive Disorder 228

DSM-5 Criteria for… Somatic Symptom Disorder 271

DSM-5 Criteria for… Illness Anxiety Disorder 276

DSM-5 Criteria for… Conversion Disorder 277

DSM-5 Criteria for… Factitious Disorder 282

DSM-5 Criteria for… Depersonalization/Derealization Disorder 286

DSM-5 Criteria for… Dissociative Amnesia 288

DSM-5 Criteria for… Dissociative Identity Disorder 291

DSM-5 Criteria for… Anorexia Nervosa 305

DSM-5 Criteria for… Bulimia Nervosa 307

DSM-5 Criteria for… Binge-Eating Disorder 309

DSM-5 Criteria for… Paranoid Personality Disorder 349

DSM-5 Criteria for… Schizoid Personality Disorder 350

DSM-5 Criteria for… Schizotypal Personality Disorder 352

DSM-5 Criteria for… Histrionic Personality Disorder 353

DSM-5 Criteria for… Narcissistic Personality Disorder 354

DSM-5 Criteria for… Antisocial Personality Disorder 356

DSM-5 Criteria for… Borderline Personality Disorder 361

DSM-5 Criteria for… Avoidant Personality Disorder 365

DSM-5 Criteria for… Dependent Personality Disorder 366

DSM-5 Criteria for… Obsessive-Compulsive Personality Disorder 368

DSM-5 Criteria for… Alcohol Use Disorder 388

xv

Many changes occurred from DSM-IV-TR to DSM-5. Here is a summary of some of the most impor-tant revisions. Many of these changes are high- lighted in the “Thinking Critically about DSM-5” boxes throughout this edition.

• The chapters of the DSM have been reorganized to reflect a consideration of developmental and lifespan issues. Disorders that are thought to reflect develop- mental perturbations or that manifest early in life (e.g., neurodevelopmental disorders and disorders such as schizophrenia) are listed before disorders that occur later in life.

• The multiaxial system has been abandoned. No distinc- tion is now made between Axis I and Axis II disorders.

• DSM-5 allows for more gender-related differences to be taken into consideration for mental health problems.

• It is extremely important for the clinician to understand the client’s cultural background in appraising mental health problems. DSM-5 contains a structured inter- view that focuses on the patient’s cultural background and characteristic approach to problems.

• The term intellectual disability is now used instead of the term mental retardation.

• A new diagnosis of autism spectrum disorder now encompasses autism, Asperger’s disorder, and other forms of pervasive developmental disorder. The diag- nosis of Asperger’s disorder has been eliminated from the DSM.

• Changes to the diagnostic criteria for attention deficit disorder now mean that symptoms that occur before age 12 (rather than age 7) have diagnostic significance.

• A new diagnosis, called disruptive mood dysregula- tion disorder, has been added. This will be used to diagnose children up to age 18 who show persistent irritability and frequent episodes of extreme and uncontrolled behavior.

• The subtypes of schizophrenia have been eliminated.

• The special significance afforded to bizarre delusions with regard to the diagnosis of schizophrenia has been removed.

• Bipolar and related disorders are now described in a separate chapter of the DSM and are no longer listed with depressive disorders.

• Premenstrual dysphoric disorder has been promoted from the appendix of DSM-IV-TR and is now listed as a new diagnosis.

• A new diagnosis of persistent depressive disorder now subsumes dysthymia and chronic major depressive disorder.

• The bereavement exclusion has been removed in the diagnosis of major depressive episode.

• The diagnosis of phobia no longer requires that the per- son recognize that his or her anxiety is unreasonable.

• Panic disorder and agoraphobia have been unlinked and are now separate diagnoses in DSM-5.

• Obsessive-compulsive disorder is no longer classi- fied as an anxiety disorder. DSM-5 contains a new chapter that covers obsessive-compulsive and related disorders.

• New disorders in the obsessive-compulsive and related disorders category include hoarding disorder and exco- riation (skin-picking) disorder.

• Posttraumatic stress disorder is no longer considered to be an anxiety disorder. Instead, it is listed in a new chapter that covers trauma- and stressor-related disorders.

• The diagnostic criteria for posttraumatic stress disor- der have been significantly revised. The definition of what counts as a traumatic event has been clarified and made more explicit. DSM-5 now also recognizes four-symptom clusters rather than the three noted in DSM-IV-TR.

• Dissociative fugue is no longer listed as a separate diagnosis. Instead, it is listed as a form of dissociative amnesia.

• The DSM-IV-TR diagnoses of hypochondriasis, somato- form disorder, and pain disorder have been removed and are now subsumed into the new diagnosis of somatic symptom disorder.

• Binge-eating disorder has been moved from the appendix of DSM-IV-TR and is now listed as an offi- cial diagnosis.

• The frequency of binge-eating and purging episodes has been reduced for the diagnosis of bulimia nervosa.

What’s New in DSM-5? A Quick Guide

xvi What’s New in DSM-5? A Quick Guide

• Substance-related disorders are divided into two sepa- rate groups: substance use disorders and substance- induced disorders.

• A new disorder, gambling disorder, has been included in substance-related and addictive disorders.

• Included for the first time in Section III of DSM-5 are several new disorders regarded as being in need of fur- ther study. These include attenuated psychosis syn- drome, nonsuicidal self-injury disorder, Internet gaming disorder, and caffeine use disorder.

• Amenorrhea is no longer required for the diagnosis of anorexia nervosa.

• The DSM-IV-TR diagnoses of dementia and amnestic disorder have been eliminated and are now sub- sumed into a new category called major neurocogni- tive disorder.

• Mild neurocognitive disorder has been added as a new diagnosis.

• No changes have been made to the diagnostic criteria for personality disorders, although an alternative model is now offered as a guide for future research.

xvii

We are so excited about this course and hope that you are too! We (the authors) all took this course when we were undergraduate students because we were curious about abnormal aspects of human behavior. Why do some people become so depressed they can’t get out of bed? Why do others have trouble controlling their use of alcohol and drugs? Why do some people become violent toward others, and in other cases toward themselves? We continue to be intensely curi- ous about, and fascinated by, the answers to these and many other questions about abnormal human behavior. The purpose of this book is to provide a comprehensive (and hopefully engaging) introduction to the primary psy- chological disorders studied within abnormal psychology.

As you will learn, there are many different types of psychological disorders, and each is caused by the interac- tion of many different factors and can be considered from many different perspectives. We thought a lot about how best to present this information in a way that will be clear and engaging and will allow you to gain a solid, funda- mental understanding of psychological disorders. As such, we use a biopsychosocial approach to provide a sophisti- cated appreciation of the total context in which abnormali- ties of behavior occur. This means that we present and describe the wide range of biological, psychological, and social factors that work together to lead to the develop- ment of psychological disorders. In addition, we discuss treatment approaches that target each of these different factors.

For ease of understanding we also present material on each disorder in a logical and consistent way. More specifi- cally, we focus on three significant aspects: (1) the clinical picture, where we describe the symptoms of the disorder and its associated features; (2) factors involved in the development of the disorder; and (3) treatment approaches. In each case, we examine the evidence for biological, psy- chosocial (i.e., psychological and interpersonal), and socio- cultural (the broader social environment of culture and subculture) influences. Because we wish never to lose sight of the person, we try to integrate as much case material as we can into each chapter. An additional feature of this book is a heavy focus on treatment. Although treatment is discussed in every chapter in the context of specific disor- ders, we also include a separate chapter that addresses issues in treatment more broadly. This provides students with increased understanding of a wide range of treatment approaches and permits more in-depth coverage than is possible in specific disorder–based chapters.

Abnormal Psychology has a long and distinguished tradi- tion as an undergraduate text. Ever since James Coleman wrote the first edition many years ago, this textbook has been considered the most comprehensive in the field. Along the way there have been many changes. This is very much the case with this new edition. Perhaps the most exciting change, however, is the addition of Harvard Professor Matthew Nock to the author team. Matt, a recent MacArthur Award (aka, “Genius Grant”) recipient, brings his bril- liance, scholarship, and wry sense of humor to the book, providing fresh approaches and new perspectives. We are delighted that he has joined the author team and welcome him with great enthusiasm!

The Hooley-Butcher-Nock-Mineka author team is in a unique position to provide students with an integrated and comprehensive understanding of abnormal psychol- ogy. Each author is a noted researcher, an experienced teacher, and a licensed clinician. Each brings different areas of expertise and diverse research interests to the text. We are committed to excellence. We are also committed to making our text accessible to a broad audience. Our approach emphasizes the importance of research as well as the need to translate research findings into informed and effective clinical care for all who suffer from mental disor- ders. In this new edition, we seek to open up the fascinat- ing world of abnormal psychology, providing students with comprehensive and up-to-date knowledge in a clear and engaging way. We hope that this newest edition con- veys some of the passion and enthusiasm for the topic that we still experience every day.

Why Do You Need This New Edition? The book you are reading is the seventeenth edition of Abnormal Psychology. Why so many revisions? And why not just use an old copy of the fifteenth or sixteenth edi- tion? The reason is that our field is constantly making advances in our understanding of abnormal psychology. New research is being published all the time. As authors, it is important to us that these changes and new ways of thinking about the etiology, assessment, and treatment of psychological disorders are accurately presented in this text. Although many of the ideas and diagnostic concepts in the field of abnormal psychology have persisted for hundreds of years, changes in thinking often occur. And, at

Preface

xviii Preface

makes it easier for readers to identify what they should be learning in each section. At the end of each chapter a summary of the learning objectives is also provided. In Review questions at the end of major sections within chapters also provide additional opportunities for self- assessment and increased learning.

What’s New This new edition of Abnormal Psychology has been rede- signed to reflect the newest and most relevant research findings, presented in a way that is engaging to the new- est generation of students. We’ve done a lot of updating! Our focus has been on streamlining material throughout the book to decrease the length of each chapter while retaining all of the important information that students should be learning.

We have also done our best to include the most excit- ing changes and advances occurring in our field. For example, throughout the text, we have significantly increased the focus on the manifestation and treatment of psychological disorders around the globe, using data from a recently completed cross-national series of studies in more than 20 different countries. In Chapter 3, we have added a new and more accessible description of why cor- relation does not equal causation—and what does! In Chapter 5, we now adopt a more broad and integrative approach to the health consequences of stress, including a focus on the mechanisms through which stress is thought to cause physical health problems. Chapter 7 has been updated substantially and now includes more information about some of the problems most relevant to college stu- dents, such as suicide and self-injury.

New case studies have also been added throughout the book. Chapter 8, for example, has four new case stud- ies, as well as two new highlight boxes. These illustrate recent neuroimaging research on patients with conversion disorder, as well as a very creative new approach to the treatment of this fascinating disorder. Chapter 11 has sig- nificant new material on how alcohol and drugs affect the brain, what causes hangovers, and information on new synthetic drugs that have recently hit the streets. In Chap- ter 13, the most current genetic findings concerning schizo- phrenia are described, and new developments in our understanding of the nature of dopamine abnormality in schizophrenia are discussed. A new Developments in Thinking highlight box also presents new ideas about the possibility that schizophrenia might be an immune func- tion disorder. Chapter 15 has been reorganized and updated throughout; for instance, it now includes cutting- edge findings on the potential causes and most effective treatments for autism spectrum disorders. And throughout the book we have included information about some of the newest ways in which researchers and clinicians are

some point, events occur that force a rethinking of familiar topics. A major example here is the revision of the manual that is used to classify mental disorders (called the DSM-5). This new edition of Abnormal Psychology includes the most up-to-date information about DSM-5 diagnostic categories, classifications, and criteria.

Every time we work on a revision of Abnormal Psychol- ogy we are reminded of how dynamic and vibrant our field is. Developments in areas such as genetics, brain imaging, behavioral observation, and classification, as well changes in social and government policy and in legal decisions, add to our knowledge base and stimulate new treatments for those whose lives are touched by mental disorders.

If you’re wondering what exactly is so new in this edi- tion of Abnormal Psychology, here are seven big revisions that we have made.

1. We have a new author! Matt Nock brings a fresh and new perspective to this authoritative and established text.

2. The seventeenth edition of Abnormal Psychology in- cludes the most up-to-date and in-depth information about biological influences on the entire spectrum of behavioral abnormalities, while still maintaining a comprehensive and balanced biopsychosocial ap- proach to understanding abnormal behavior.

3. As a result of the publication of DSM-5, the diagnostic criteria for many disorders have changed. This edition includes detailed boxes listing the current DSM-5 diag- nostic criteria for all the disorders covered in the book. Specific highlight boxes and discussions in the text also alert you to some of the most important changes in DSM-5.

4. Other feature boxes provide opportunities for critical thinking by illustrating some of the controversies asso- ciated with the changes that were (or were not) made. Throughout the text we also provide readers with dif- ferent perspectives on the likely implications that these changes will have (or are having) for clinical diagnosis and research in psychopathology.

5. Reflecting the ever-changing field of abnormal psy- chology, hundreds of new references have been added, highlighting the newest and most important research findings.

6. Changes have been made in many chapters to improve the flow of the writing and enhance learning. The pre- sentation of material in many chapters has also been reorganized to provide a more logical and coherent narrative.

7. Finally, at the beginning of each chapter, clearly de- fined learning objectives provide the reader with an overview of topics and issues that will be included in the chapter. These learning objectives also appear again in the specific sections to which they apply. This

Preface xix

and how far we have yet to go in our understanding of psychological disorders. The topics covered here provide insight into the future of the field and expose students to some controversial topics.

Pedagogy LEARNINg OBJECTIVES Each chapter begins with learning objectives. These orient the reader to the material that will be presented in each specific chapter. Learning objectives are also repeated by the section they apply to and summarized at the end of each chapter. This provides students with an excellent tool for study and review. In this edition, sections of many chapters have also been reor- ganized and material has been streamlined whenever pos- sible. All the changes that have been made are designed to improve the flow of the writing and enhance pedagogy.

CASE STUDIES Extensive case studies of individuals with various disorders are integrated in the text through- out the book. Some are brief excerpts; others are detailed analyses. These cases bring important aspects of the dis- orders to life. They also remind readers that the problems of abnormal psychology affect the lives of people—people from all kinds of diverse backgrounds who have much in common with all of us.