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Clinical psychology trull prinstein 8th edition pdf

26/11/2021 Client: muhammad11 Deadline: 2 Day

A DIMENSIONAL APPROACH

Australia • Brazil • Korea • Mexico • Singapore • Spain • United Kingdom • United States

Christopher A. Kearney University of Nevada, Las Vegas

Timothy J. Trull University of Missouri, Columbia

Abnormal Psychology

& Life

Abnormal Psychology and Life: A Dimensional Approach, Third Edition Christopher A. Kearney and Timothy J. Trull

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Printed in Canada Print Number: 01 Print Year: 2016

To my wife, Kimberlie, and my children, Derek and

Claire, for their great patience and support.

—CHRISTOPHER A. KEARNEY

To my wife, Meg, for her love and support.

To Molly, Janey, and Neko for their smiles and laughter.

—TIMOTHY J. TRULL

Christopher A. Kearney, Ph.D., is Distinguished Professor of Psychol- ogy, Chair of the Department of Psychology, and Director of the UNLV Child School Refusal and Anxiety Disorders Clinic at the University of Nevada, Las Vegas. He is a Fellow of the American Psychological Association, a licensed clinical psychologist, and the author of numerous journal articles, book chapters, and books related to school refusal behavior, social anxi- ety, shyness, and selective mutism in youth. He has also published a work on general child psychopathology, Casebook in Child Behavior Disorders (Cengage), and is or has been on the editorial boards of Journal of Con- sulting and Clinical Psychology, Behavior Therapy, Journal of Clinical Child and Adolescent Psychology, Journal of Abnormal Child Psychology, Journal of Psychopathology and Behavioral Assessment, Journal of Anxiety Disor-of Psychopathology and Behavioral Assessment, Journal of Anxiety Disor-of Psychopathology and Behavioral Assessment, Journal of Anxiety Disor ders, and Journal of Gambling Studies. Dr. Kearney has received several awards for his research, teaching, and mentoring, including the Harry Reid Silver State Research Award among others. In addition to his clinical and research endeavors, Dr. Kearney works closely with school districts and mental health agencies to improve strategies for helping children attend school with less distress.

Timothy J. Trull, Ph.D., is Professor of Psychological Sciences at the University of Missouri, Columbia. Dr. Trull received his Ph.D. from the University of Kentucky and completed his internship at New York Hospital– Cornell Medical Center. His research interests are in the areas of diagno- sis and classi�cation of mental disorders, borderline personality disorder, substance use disorders, clinical assessment, professional issues in clinical psychology, and ambulatory assessment methods. Dr. Trull has received several awards and honors for his teaching and mentoring, including Psi Chi Professor of the Year, the Robert S. Daniels Junior Faculty Teaching Award, and most recently the MU Graduate Faculty Mentor Award. He enjoys teaching Abnormal Psychology and Introduction to Clinical Psychol- ogy; his textbook Clinical Psychology (Wadsworth) is used in classes across the United States and internationally. Dr. Trull is a licensed psychologist, and he continues to train future clinical psychologists in the assessment, prevention, and treatment of psychological disorders.

ABOUT THE AUTHORS

BRIEF CONTENTS

PREFAREFAREF CE xxvi

1 Abnormal Psychology and Life 3

2 Perspectives on Abnormal Psychology 21

3 Risk and Prevention of Mental Disorders 51

4 Diagnosis, Assessment, and Study of Mental Disorders 73

5 Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders 99

6 Somatic Symptom and Dissociative Disorders 141

7 Depressive and Bipolar Disorders and Suicide 173

8 Eating Disorders 215

9 Substance-Related Disorders 243

10 Personality Disorders 281

11 Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria 313

12 Schizophrenia and Other Psychotic Disorders 351

13 Developmental and Disruptive Behavior Disorders 383

14 Neurocognitive Disorders 423

15 Consumer Guide to Abnormal Psychology 453

APPENDIX: STRESS-RELATED PROBLEMS 477

GLOSSARY G-0

REFERENCES R-1

NAME INDEX I-1

SUBJECT INDEX I-17

CONTENTS

1 Abnormal Psychology and Life Abnormal Psychology and Life 3

C Travis / What Do You Think? 4

Introduction to Abnormal Psychology 4

What Is a Mental Disorder? 4 C Treva Throneberry / What Do You Think? 5 Deviance from the Norm 5 Dif�culties Adapting to Life Demands 6 Experience of Personal Distress 7 De�ning Abnormality 7 Dimensions Underlying Mental Disorders Are Relevant

to Everyone 8 INTERIM SUMMARY 11 REVIEW QUESTIONS 11

History of Abnormal Psychology 11 Early Perspectives 12 Early Greek and Roman Thought 12 Middle Ages 12 Renaissance 13 Reform Movement 13 Modern Era 13 INTERIM SUMMARY 14 REVIEW QUESTIONS 14

Abnormal Psychology and Life: Themes 14 Dimensional Perspective 14 Prevention Perspective 14 Consumer Perspective 15 Diversity 16 Stigma 16 INTERIM SUMMARY 17 REVIEW QUESTIONS 18

FINAL COMMENTS 18 KEY TERMS 19

Special Features

• 1.1 FOCUS ON DIVERSITY: Emotion and Culture 7

CONTINUUM FIGURE 1.2 Continuum of Emotions, Cognitions, and Behaviors 10

• 1.2 FOCUS ON LAW AND ETHICS: Heal Thyself: What the Self-Help Gurus Don’t Tell You 15

Personal Narrative 1.1 Alison Malmon 18

Preface xxvi

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2 Perspectives on Abnormal Psychology 21

C Mariella / What Do You Think? 22

Introduction 22

The Biological Model 23 Genetics 23 Nervous Systems and Neurons 24 Brain 24 Biological Assessment and Treatment 25 Evaluating the Biological Model 25 INTERIM SUMMARY 25 REVIEW QUESTIONS 27

The Psychodynamic Model 28 Brief Overview of the Psychodynamic Model 29 Psychodynamic Assessment and Treatment 30 Evaluating the Psychodynamic Model 32 INTERIM SUMMARY 32 REVIEW QUESTIONS 32

The Humanistic Model 32 Abraham Maslow 33 Carl Rogers 34 Rollo May 34 Humanistic Assessment and Treatment 35 Evaluating the Humanistic Model 35 INTERIM SUMMARY 35 REVIEW QUESTIONS 36

The Cognitive-Behavioral Model 36 Behavioral Perspective 36 Cognitive Perspective 37 A Cognitive-Behavioral Model 38 Cognitive-Behavioral Assessment and Treatment 38 Evaluating the Cognitive-Behavioral Model 40 INTERIM SUMMARY 40 REVIEW QUESTIONS 40

The Sociocultural Model 40 Culture 41 Gender 42 Neighborhoods and Communities 43 Family 43 Sociocultural Assessment and Treatment 44 Evaluating the Sociocultural Model 44 INTERIM SUMMARY 45 REVIEW QUESTIONS 45

FINAL COMMENTS 47 KEY TERMS 47

Special Features

• 2.1 FOCUS ON VIOLENCE: A More Complex Approach 28

• 2.2 FOCUS ON LAW AND ETHICS: Dangerousness and Commitment 33

• 2.3 FOCUS ON GENDER: A More Complex Approach 41

Personal Narrative 2.1 An Integrative Psychologist: Dr. John C. Norcross 46

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3 Risk and Prevention of Mental Disorders Risk and Prevention of Mental Disorders 51

C DeShawn / What Do You Think? 52

The Diathesis-Stress Model 52 Diathesis, Stress, and Mental Health 52 Diathesis-Stress: The Big Picture 53 Diathesis-Stress: The Little Picture 53 Implications of the Diathesis-Stress Model 54 INTERIM SUMMARY 54 REVIEW QUESTIONS 54

Epidemiology: How Common Are Mental Disorders? 54 Prevalence of Mental Disorders 55 Treatment Seeking 57 Treatment Cost 58 INTERIM SUMMARY 58 REVIEW QUESTIONS 59

Risk, Protective Factors, and Resilience 59 C Jana / What Do You Think? 59 Risk Factors 59 Protective Factors 61 INTERIM SUMMARY 63 REVIEW QUESTIONS 63

Prevention 63 Prevention on a Continuum 64 Three Types of Prevention 64 Prevention Programs for Mental Disorders 66 INTERIM SUMMARY 69 REVIEW QUESTIONS 69

FINAL COMMENTS 70 KEY TERMS 71

Special Features

• 3.1 JOHN SNOW: A Pioneer in Epidemiology and Prevention 55

• 3.2 FOCUS ON COLLEGE STUDENTS: Suicide 60

• 3.3 FOCUS ON VIOLENCE: Prevention of Femicide 64

• 3.4 FOCUS ON LAW AND ETHICS: Constructs Related to Insanity 69

Personal Narrative 3.1 Kim Dude and the Wellness Resource Center 70

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4 Diagnosis, Assessment, and Study of Mental Disorders 73

C Professor Smith / What Do You Think? 74

De�ning Abnormal Behavior and Mental Disorder 74 Dimensions and Categories 74 DSM 75DSM 75DSM Advantages of Diagnosis 75 INTERIM SUMMARY 76 REVIEW QUESTIONS 76

Classifying and Assessing Abnormal Behavior and Mental Disorder 76 Assessing Abnormal Behavior and Mental Disorder 76 Reliability, Validity, and Standardization 77 Interview 80 Intelligence Tests 80 Personality Assessment 81 Behavioral Assessment 85 Biological Assessment 87 Psychophysiological Assessment 88 Neuropsychological Assessment 89 INTERIM SUMMARY 90 REVIEW QUESTIONS 90

Culture and Clinical Assessment 90 Culture and the Development of Mental Disorders 90 Culture and Clinical Assessment 91 INTERIM SUMMARY 92 REVIEW QUESTIONS 92

Studying Abnormal Behavior and Mental Disorder 92 Experiment 92 Correlational Studies 94 Quasi-Experimental Methods 94 Other Alternative Experimental Designs 94 Developmental Designs 96 Case Study 96 Consuming the Media’s Research 96 INTERIM SUMMARY 96 REVIEW QUESTIONS 97

FINAL COMMENTS 97 KEY TERMS 97

Special Features

• 4.1 FOCUS ON DIVERSITY: Culture and Diagnosis 77

Personal Narrative 4.1 Anonymous 78

• 4.2 FOCUS ON LAW AND ETHICS: Who Should Be Studied in Mental Health Research? 93

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5 Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders 99

C Angelina / What Do You Think? 100

Worry, Anxiety, Fear, and Anxiety; Obsessive- Compulsive; and Trauma-Related Disorders: What Are They? 101

Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders: Features and Epidemiology 103 Panic Attack 103 Panic Disorder 104 Social Phobia 105 Speci�c Phobia 106 Generalized Anxiety Disorder 106

C Jonathan / What Do You Think? 108 Obsessive-Compulsive Disorder 108 Obsessive-Compulsive-Related Disorders 108 Posttraumatic Stress Disorder and Acute Stress Disorder 109

C Marcus / What Do You Think? 109 Separation Anxiety Disorder and School Refusal

Behavior 114 Epidemiology of Anxiety, Obsessive-Compulsive, and

Trauma-Related Disorders 114

Stigma Associated with Anxiety, Obsessive- Compulsive, and Trauma-Related Disorders 117 INTERIM SUMMARY 118 REVIEW QUESTIONS 118

Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders: Causes and Prevention 118 Biological Risk Factors for Anxiety, Obsessive-Compulsive,

and Trauma-Related Disorders 118 Environmental Risk Factors for Anxiety, Obsessive-Compulsive,

and Trauma-Related Disorders 122 Causes of Anxiety, Obsessive-Compulsive, and Trauma-Related

Disorders 124 Prevention of Anxiety, Obsessive-Compulsive, and Trauma-

Related Disorders 126 INTERIM SUMMARY 127 REVIEW QUESTIONS 127

Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders: Assessment and Treatment 127 Assessment of Anxiety, Obsessive-Compulsive, and Trauma-

Related Disorders 127 Biological Treatment of Anxiety, Obsessive-Compulsive, and

Trauma-Related Disorders 130 Psychological Treatments of Anxiety, Obsessive-Compulsive, and

Trauma-Related Disorders 131 What If I Have Anxiety or an Anxiety-Related Disorder? 136 Long-Term Outcome for People with Anxiety, Obsessive-

Compulsive, and Trauma-Related Disorders 137 INTERIM SUMMARY 137 REVIEW QUESTIONS 137

FINAL COMMENTS 138 THOUGHT QUESTIONS 138 KEY TERMS 139

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CONTINUUM FIGURE 5.1 Worry, Anxiety, and Fear Along a Continuum 102

CONTINUUM FIGURE 5.2 Continuum of Emotions, Cognitions, and Behaviors Regarding Anxiety-Related Disorders 102

• 5.1 FOCUS ON COLLEGE STUDENTS: Trauma and PTSD 116

• 5.2 FOCUS ON GENDER: Are There True Gender Differences in Anxiety-Related Disorders? 116

• 5.3 FOCUS ON DIVERSITY: Anxiety-Related Disorders and Sociocultural Factors 117

V THE CONTINUUM VIDEO PROJECT Darwin / PTSD 125

Personal Narrative 5.1 Anonymous 128

• 5.4 FOCUS ON LAW AND ETHICS: The Ethics of Encouragement in Exposure-Based Practices 138

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6 Somatic Symptom and Dissociative Disorders Somatic Symptom and Dissociative Disorders 141

Somatic Symptom and Dissociative Disorders: A Historical Introduction 142

Somatization and Somatic Symptom Disorders: What Are They? 142 C Gisela / What Do You Think? 142

Somatic Symptom Disorders: Features and Epidemiology 144 Somatic Symptom Disorder 144 Illness Anxiety Disorder 145 Conversion Disorder 146 Factitious Disorder and Malingering 146 Epidemiology of Somatic Symptom Disorders 147

Stigma Associated with Somatic Symptom Disorders 148 INTERIM SUMMARY 148 REVIEW QUESTIONS 149

Somatic Symptom Disorders: Causes and Prevention 149 Biological Risk Factors for Somatic Symptom Disorders 149 Environmental Risk Factors for Somatic Symptom

Disorders 149 Causes of Somatic Symptom Disorders 151 Prevention of Somatic Symptom Disorders 152 INTERIM SUMMARY 152 REVIEW QUESTIONS 153

Somatic Symptom Disorders: Assessment and Treatment 153 Assessment of Somatic Symptom Disorders 153 Biological Treatment of Somatic Symptom Disorders 154 Psychological Treatments of Somatic Symptom Disorders 154 What If I or Someone I Know Has a Somatic Symptom

Disorder? 155 Long-Term Outcome for People with Somatic Symptom

Disorders 155 INTERIM SUMMARY 155 REVIEW QUESTIONS 155

Dissociative Disorders 156 C Erica / What Do You Think? 156

Normal Dissociation and Dissociative Disorders: What Are They? 157

Dissociative Disorders: Features and Epidemiology 157 Dissociative Amnesia 157 Dissociative Identity Disorder 158 Depersonalization/Derealization Disorder 160 Epidemiology of Dissociative Disorders 161

Stigma Associated with Dissociative Disorders 162 INTERIM SUMMARY 162 REVIEW QUESTIONS 162

Dissociative Disorders: Causes and Prevention 163 Biological Risk Factors for Dissociative Disorders 163 Environmental Risk Factors for Dissociative Disorders 164 Causes of Dissociative Disorders 165 Prevention of Dissociative Disorders 166 INTERIM SUMMARY 166 REVIEW QUESTIONS 167

Dissociative Disorders: Assessment and Treatment 167 Assessment of Dissociative Disorders 167 Biological Treatment of Dissociative Disorders 167 Psychological Treatments of Dissociative Disorders 168 What If I or Someone I Know Has a Dissociative Disorder? 169 Long-Term Outcome for People with Dissociative Disorders 169 INTERIM SUMMARY 169 REVIEW QUESTIONS 169

FINAL COMMENTS 170 THOUGHT QUESTIONS 170 KEY TERMS 170

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Special Features

CONTINUUM FIGURE 6.1 Continuum of Somatization and Somatic Symptom Disorders 144

• 6.1 FOCUS ON COLLEGE STUDENTS: Somatization 148

• 6.2 FOCUS ON VIOLENCE: Terrorism and Medically Unexplained Symptoms 152

CONTINUUM FIGURE 6.4 Continuum of Dissociation and Dissociative Disorders 158

Personal Narrative 6.1 Heather Pate 160

• 6.3 FOCUS ON COLLEGE STUDENTS: Dissociation 161

• 6.4 FOCUS ON LAW AND ETHICS: Recovered Memories and Suggestibility 162

• 6.5 FOCUS ON DIVERSITY: Dissociation and Culture 163

• 6.6 FOCUS ON VIOLENCE: Dissociative Experiences and Violence Toward Others 166

V THE CONTINUUM VIDEO PROJECT Lani and Jan / Dissociative Identity Disorder 169

xiv

7 Depressive and Bipolar Disorders and Suicide Depressive and Bipolar Disorders and Suicide 173

C Katey / What Do You Think? 174

Normal Mood Changes and Depression and Mania: What Are They? 174

Depressive and Bipolar Disorders and Suicide: Features and Epidemiology 175 Major Depressive Episode 175 Major Depressive Disorder 177 Persistent Depressive Disorder (Dysthymia) 178 Other Depressive Disorders 179 Manic and Hypomanic Episodes 179 Bipolar I Disorder 181 Bipolar II Disorder 185 Cyclothymic Disorder 185 Suicide 186 Epidemiology of Depressive and Bipolar Disorders 187 Epidemiology of Suicide 189

Stigma Associated with Depressive and Bipolar Disorders 190 INTERIM SUMMARY 190 REVIEW QUESTIONS 191

Depressive and Bipolar Disorders and Suicide: Causes and Prevention 191 Biological Risk Factors for Depressive and Bipolar Disorders

and Suicide 191 Environmental Risk Factors for Depressive and Bipolar Disorders

and Suicide 194 Causes of Depressive and Bipolar Disorders and Suicide 198 Prevention of Depressive and Bipolar Disorders and Suicide 199 INTERIM SUMMARY 200 REVIEW QUESTIONS 200

Depressive and Bipolar Disorders and Suicide: Assessment and Treatment 200 Interviews and Clinician Ratings 201 Self-Report Questionnaires 202 Self-Monitoring and Observations from Others 203 Laboratory Assessment 203 Assessment of Suicide 203 Biological Treatment of Depressive and Bipolar Disorders and

Suicide 204 Psychological Treatments for Depressive and Bipolar Disorders

and Suicide 207 What If I Am Sad or Have a Mood Disorder? 210 Long-Term Outcome for People with Depressive and Bipolar

Disorders and Suicide 210 INTERIM SUMMARY 211 REVIEW QUESTIONS 211

FINAL COMMENTS 212 THOUGHT QUESTIONS 212 KEY TERMS 212

Special Features

CONTINUUM FIGURE 7.1 Continuum of Sadness and Depression 176

CONTINUUM FIGURE 7.2 Continuum of Happiness, Euphoria, and Mania 176

Personal Narrative 7.1 Karen Gormandy 180

• 7.1 FOCUS ON GENDER: Forms of Depression Among Women 182

• 7.2 FOCUS ON COLLEGE STUDENTS: Depression 195

V THE CONTINUUM VIDEO PROJECT Emilie / Bipolar Disorder 200

• 7.3 FOCUS ON LAW AND ETHICS: Ethical Dilemmas in Electroconvulsive Therapy 206

• 7.4 FOCUS ON DIVERSITY: Depression in the Elderly 208

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8 Eating Disorders Eating Disorders 215

C Sooki / What Do You Think? 216

Weight Concerns, Body Dissatisfaction, and Eating Disorders: What Are They? 216

Eating Disorders: Features and Epidemiology 217 Anorexia Nervosa 217 Bulimia Nervosa 218

C Lisa / What Do You Think? 218 Binge-Eating Disorder 220 Epidemiology of Eating Disorders 221

Stigma Associated with Eating Disorders 224 INTERIM SUMMARY 225 REVIEW QUESTIONS 225

Eating Disorders: Causes and Prevention 225 Biological Risk Factors for Eating Disorders 225 Environmental Risk Factors for Eating Disorders 227 Causes of Eating Disorders 230 Prevention of Eating Disorders 230 INTERIM SUMMARY 231 REVIEW QUESTIONS 231

Eating Disorders: Assessment and Treatment 231 Assessment of Eating Disorders 231 Treatment of Eating Disorders 234 Biological Treatments of Eating Disorders 234 Psychological Treatments of Eating Disorders 236 What If I Have Weight Concerns or an Eating Disorder? 238 Long-Term Outcome for People with Eating Disorders 238 INTERIM SUMMARY 240 REVIEW QUESTIONS 240

FINAL COMMENTS 240 THOUGHT QUESTIONS 240 KEY TERMS 241

Special Features

CONTINUUM FIGURE 8.1 Continuum of Body Dissatisfaction, Weight Concerns, and Eating Behavior 218

Personal Narrative 8.1 Kitty Westin (Anna’s mother) 220

• 8.1 FOCUS ON COLLEGE STUDENTS: Eating Disorders 223

• 8.2 FOCUS ON GENDER: Why Is There a Gender Difference in Eating Disorders? 223

V THE CONTINUUM VIDEO PROJECT Sara / Bulimia Nervosa 227

Personal Narrative 8.2 Rachel Webb 232

• 8.3 FOCUS ON LAW AND ETHICS: How Ethical Are Pro-Ana (Pro-Anorexia) Websites? 237

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9 Substance-Related Disorders Substance-Related Disorders 243

C Elon / What Do You Think? 244

Normal Substance Use and Substance-Related Disorders: What Are They? 244

Substance-Related Disorders: Features and Epidemiology 245 Substance Use Disorder 245 Substance Intoxication 246 Substance Withdrawal 246 Types of Substances 247 Epidemiology of Substance-Related Disorders 256

Stigma Associated with Substance-Related Disorders 258 INTERIM SUMMARY 259 REVIEW QUESTIONS 259

Substance-Related Disorders: Causes and Prevention 259 Biological Risk Factors for Substance-Related Disorders 259 Environmental Risk Factors for Substance-Related

Disorders 262 Causes of Substance-Related Disorders 266 Prevention of Substance-Related Disorders 267 INTERIM SUMMARY 268 REVIEW QUESTIONS 269

Substance-Related Disorders: Assessment and Treatment 269 Interviews 269 Psychological Testing 269 Observations from Others 271 Laboratory Testing 272 Biological Treatment of Substance-Related Disorders 273 Psychological Treatment of Substance-Related Disorders 274 What If I or Someone I Know Has a Substance-Related Problem

or Disorder? 276 Long-Term Outcome for People with Substance-Related

Disorders 276 INTERIM SUMMARY 276 REVIEW QUESTIONS 278

FINAL COMMENTS 278 THOUGHT QUESTIONS 278 KEY TERMS 278

Special Features

CONTINUUM FIGURE 9.1 Continuum of Substance Use and Substance-Related Disorders 246

• 9.1 The Sam Spady Story 252

• 9.2 The “Meth” Epidemic 254

• 9.3 FOCUS ON GENDER: Date Rape Drugs 256

• 9.4 FOCUS ON VIOLENCE: Alcohol and Violence 264

V THE CONTINUUM VIDEO PROJECT Mark / Substance Use Disorder 264

• 9.5 FOCUS ON COLLEGE STUDENTS: Substance Use 268

Personal Narrative 9.1 One Family’s Struggle with Substance- Related Disorders 270

• 9.6 FOCUS ON LAW AND ETHICS: Drug Testing 273

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10 Personality Disorders Personality Disorders 281

C Michelle / What Do You Think? 282

Personality Traits, Unusual Personality, and Personality Disorder: What Are They? 283

Organization of Personality Disorders 284

Odd or Eccentric Personality Disorders: Features and Epidemiology 285 Paranoid Personality Disorder 285 Schizoid Personality Disorder 285 Schizotypal Personality Disorder 285

C Jackson / What Do You Think? 286 Epidemiology of Odd or Eccentric Personality Disorders 287 INTERIM SUMMARY 288 REVIEW QUESTIONS 288

Dramatic Personality Disorders: Features and Epidemiology 288 C Duane / What Do You Think? 288 Antisocial Personality Disorder 288 Borderline Personality Disorder 289 Histrionic Personality Disorder 289 Narcissistic Personality Disorder 290 Epidemiology of Dramatic Personality Disorders 291 INTERIM SUMMARY 293 REVIEW QUESTIONS 293

Anxious/Fearful Personality Disorders: Features and Epidemiology 293 Avoidant Personality Disorder 293 Dependent Personality Disorder 294

C Betty / What Do You Think? 294 Obsessive-Compulsive Personality Disorder 294 Epidemiology of Anxious/Fearful Personality Disorders 295

Stigma Associated with Personality Disorders 295 INTERIM SUMMARY 296 REVIEW QUESTIONS 296

Personality Disorders: Causes and Prevention 296 Biological Risk Factors for Odd or Eccentric Personality

Disorders 297 Environmental Risk Factors for Odd or Eccentric Personality

Disorders 297

Causes of Odd or Eccentric Personality Disorders 297 Biological Risk Factors for Dramatic Personality Disorders 298 Environmental Risk Factors for Dramatic Personality

Disorders 298 Causes of Dramatic Personality Disorders 299 Biological Risk Factors for Anxious/Fearful Personality

Disorders 299 Environmental Risk Factors for Anxious/Fearful Personality

Disorders 299 Causes of Anxious/Fearful Personality Disorders 300 Prevention of Personality Disorders 300 INTERIM SUMMARY 301 REVIEW QUESTIONS 302

Personality Disorders: Assessment and Treatment 303 Assessment of Personality Disorders 303 Biological Treatments of Personality Disorders 304 Psychological Treatments of Personality Disorders 304 What If I or Someone I Know Has a Personality Disorder? 307 Long-Term Outcomes for People with Personality Disorders 307 INTERIM SUMMARY 310 REVIEW QUESTIONS 310

FINAL COMMENTS 310 THOUGHT QUESTIONS 310 KEY TERMS 311

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Special Features

CONTINUUM FIGURE 10.1 Continuum of Normal Personality and Personality Disorder Traits Related to Impulsivity 282

• 10.1 FOCUS ON COLLEGE STUDENTS: Personality Disorders 292

• 10.2 FOCUS ON VIOLENCE: Personality Disorders and Violence 292

• 10.3 FOCUS ON GENDER: Mirror Images of Personality Disorders? 296

• 10.4 FOCUS ON LAW AND ETHICS: Personality and Insanity 305

V THE CONTINUUM VIDEO PROJECT Tina / Borderline Personality Disorder 307

Personal Narrative 10.1 Anonymous 308

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11 Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria 313

Normal Sexual Behavior and Sexual Dysfunctions: What Are They? 314 C Douglas and Stacy / What Do You Think? 314

Sexual Dysfunctions: Features and Epidemiology 315 Male Hypoactive Sexual Desire Disorder 315 Female Sexual Interest/Arousal Disorder 315 Erectile Disorder 316 Female Orgasmic Disorder 316 Delayed Ejaculation 317 Premature (Early) Ejaculation 317 Genito-Pelvic Pain/Penetration Disorder 318 Epidemiology of Sexual Dysfunctions 318

Stigma Associated with Sexual Dysfunctions 321 INTERIM SUMMARY 321 REVIEW QUESTIONS 322

Sexual Dysfunctions: Causes and Prevention 322 Biological Risk Factors for Sexual Dysfunctions 322 Psychological Risk Factors for Sexual Dysfunctions 322 Causes of Sexual Dysfunctions 323 Prevention of Sexual Dysfunctions 323 INTERIM SUMMARY 323 REVIEW QUESTIONS 324

Sexual Dysfunctions: Assessment and Treatment 325 Assessment of Sexual Dysfunctions 325 Biological Treatment of Sexual Dysfunctions 325 Psychological Treatments of Sexual Dysfunctions 326 What If I or Someone I Know Has a Sexual Dysfunction? 327 Long-Term Outcomes for People with Sexual Dysfunctions 328 INTERIM SUMMARY 328 REVIEW QUESTIONS 328

Normal Sexual Desires, Paraphilias, and Paraphilic Disorders: What Are They? 329

Paraphilic Disorders: Features and Epidemiology 329 Exhibitionistic Disorder 330

C Tom / What Do You Think? 330

Fetishistic Disorder 331 Frotteuristic Disorder 331 Pedophilic Disorder 332 Sexual Masochism and Sexual Sadism 333 Transvestic Disorder 333 Voyeuristic Disorder 334 Atypical Paraphilic Disorders 334 Epidemiology of Paraphilic Disorders 334 INTERIM SUMMARY 337 REVIEW QUESTIONS 337

Paraphilic Disorders: Causes and Prevention 337 Biological Risk Factors for Paraphilic Disorders 337 Environmental Risk Factors for Paraphilic Disorders 337 Causes of Paraphilic Disorders 338 Prevention of Paraphilic Disorders 339 INTERIM SUMMARY 339 REVIEW QUESTIONS 339

Paraphilic Disorders: Assessment and Treatment 340 Assessment of Paraphilic Disorders 340 Biological Treatment of Paraphilic Disorders 340 Psychological Treatment of Paraphilic Disorders 341 What If I or Someone I Know Has a Paraphilic Disorder? 342 Long-Term Outcomes for People with Paraphilic Disorders 342 INTERIM SUMMARY 342 REVIEW QUESTIONS 342

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Normal Gender Development and Gender Dysphoria: What Are They? 342 C Austin / What Do You Think? 343

Gender Dysphoria: Features and Epidemiology 343

Gender Dysphoria: Causes and Prevention 344

Gender Dysphoria: Assessment and Treatment 345 Assessment of Gender Dysphoria 345 Biological Treatment of Gender Dysphoria 345 Psychological Treatment of Gender Dysphoria 345 What If I or Someone I Know Has Questions About Gender or

Gender Dysphoria? 345 Long-Term Outcomes for People with Gender Dysphoria 346 INTERIM SUMMARY 347 REVIEW QUESTIONS 347

FINAL COMMENTS 348 THOUGHT QUESTIONS 348 KEY TERMS 348

Special Features

CONTINUUM FIGURE 11.1 Continuum of Sexual Behavior and Sexual Dysfunctions 314

• 11.1 FOCUS ON GENDER: Gender Biases in Sexual Dysfunctions and Disorders 319

• 11.2 FOCUS ON COLLEGE STUDENTS: Sexual Dysfunctions 322

CONTINUUM FIGURE 11.4 Continuum of Sexual Behavior and Paraphilic Disorders 328

• 11.3 FOCUS ON COLLEGE STUDENTS: Sexual Fantasies and Paraphilic Interests 336

• 11.4 FOCUS ON VIOLENCE: Rape 336

• 11.5 FOCUS ON LAW AND ETHICS: Sex Offender Notification and Incarceration 341

Personal Narrative 11.1 Sam 346

V THE CONTINUUM VIDEO PROJECT Dean / Gender Dysphoria 346

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12 Schizophrenia and Other Psychotic Disorders Schizophrenia and Other Psychotic Disorders 351

C James / What Do You Think? 352

Unusual Emotions, Thoughts, and Behaviors and Psychotic Disorders: What Are They? 352

Psychotic Disorders: Features and Epidemiology 353 Schizophrenia 353 Phases of Schizophrenia 357 Schizophreniform Disorder 359 Schizoaffective Disorder 359 Delusional Disorder 361

C Jody / What Do You Think? 362 Brief Psychotic Disorder 362 Epidemiology of Psychotic Disorders 363

Stigma Associated with Schizophrenia 365 INTERIM SUMMARY 365 REVIEW QUESTIONS 366

Psychotic Disorders: Causes and Prevention 367 Biological Risk Factors for Psychotic Disorders 367 Environmental Risk Factors for Psychotic Disorders 370 Causes of Psychotic Disorders 371 Prevention of Psychotic Disorders 373 INTERIM SUMMARY 373 REVIEW QUESTIONS 374

Psychotic Disorders: Assessment and Treatment 374 Interviews 374 Behavioral Observations 374 Cognitive Assessment 375 Physiological Assessment 375 Biological Treatments of Psychotic Disorders 376 Psychological Treatments of Psychotic Disorders 377 What If I or Someone I Know Has a Psychotic Disorder? 379 Long-Term Outcome for People with Psychotic Disorders 380 INTERIM SUMMARY 380 REVIEW QUESTIONS 380

FINAL COMMENTS 381 THOUGHT QUESTIONS 381 KEY TERMS 381

Special Features

CONTINUUM FIGURE 12.1 Continuum of Unusual Emotions, Cognitions, and Behaviors and Psychotic Disorder 354

Personal Narrative 12.1 John Cadigan 360

• 12.1 FOCUS ON DIVERSITY: Ethnicity and Income Level in Schizophrenia 364

• 12.2 FOCUS ON COLLEGE STUDENTS: Psychotic Symptoms 365

• 12.3 FOCUS ON VIOLENCE: Are People with Schizophrenia More Violent? 366

V THE CONTINUUM VIDEO PROJECT Andre / Schizophrenia 373

• 12.4 FOCUS ON LAW AND ETHICS: Making the Choice of Antipsychotic Medication 376

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13 Developmental and Disruptive Behavior Disorders 383

Developmental and Disruptive Behavior Disorders 384 C Robert / What Do You Think? 384

Normal Development and Developmental Disorders: What Are They? 385

Developmental Disorders: Features and Epidemiology 385 Intellectual Disability 385 Autism Spectrum Disorder 387 Learning Disorder 389

C Alison / What Do You Think? 389 Epidemiology of Developmental Disorders 390

Stigma Associated with Developmental Disorders 391 INTERIM SUMMARY 392 REVIEW QUESTIONS 392

Developmental Disorders: Causes and Prevention 392 Biological Risk Factors for Developmental Disorders 392 Environmental Risk Factors for Developmental Disorders 396 Causes of Developmental Disorders 396 Prevention of Developmental Disorders 396 INTERIM SUMMARY 398 REVIEW QUESTIONS 398

Developmental Disorders: Assessment and Treatment 398 Cognitive Tests 398 Achievement Tests 399 Interviews 400 Rating Scales 400 Behavioral Observation 400 Biological Treatment for Developmental Disorders 400 Psychological Treatments for Developmental Disorders 401 What If I Think Someone Has a Developmental Disorder? 403 Long-Term Outcome for People with Developmental

Disorders 403 INTERIM SUMMARY 403 REVIEW QUESTIONS 404

Normal Rambunctious Behavior and Disruptive Behavior Disorders: What Are They? 404 C Will / What Do You Think? 405

Disruptive Behavior Disorders: Features and Epidemiology 405 Attention-De�cit/Hyperactivity Disorder 405 Oppositional De�ant Disorder and Conduct Disorder 406 Epidemiology of Disruptive Behavior Disorders 407

Stigma Associated with Disruptive Behavior Disorders 408 INTERIM SUMMARY 409 REVIEW QUESTIONS 410

Disruptive Behavior Disorders: Causes and Prevention 410 Biological Risk Factors for Disruptive Behavior Disorders 410 Environmental Risk Factors for Disruptive Behavior

Disorders 411 Causes of Disruptive Behavior Disorders 413 Prevention of Disruptive Behavior Disorders 413 INTERIM SUMMARY 414 REVIEW QUESTIONS 414

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Disruptive Behavior Disorders: Assessment and Treatment 414 Interviews 415 Rating Scales 415 Behavioral Observation 415 Biological Treatments for Disruptive Behavior Disorders 415 Psychological Treatments for Disruptive Behavior Disorders 416 What If I Think a Child Has a Disruptive Behavior

Disorder? 417 Long-Term Outcome for Children with Disruptive Behavior

Disorders 417 INTERIM SUMMARY 419 REVIEW QUESTIONS 419

FINAL COMMENTS 420 THOUGHT QUESTIONS 420 KEY TERMS 421

Special Features

CONTINUUM FIGURE 13.1 Continuum of Normal Development and Developmental Disorder 384

• 13.1 FOCUS ON COLLEGE STUDENTS: Autism 392

• 13.2 FOCUS ON LAW AND ETHICS: Key Ethical Issues and Developmental Disorders 394

• 13.3 FOCUS ON DIVERSITY: Testing for People with Developmental Disorders 399

V THE CONTINUUM VIDEO PROJECT Whitney / Autism Spectrum Disorder 401

CONTINUUM FIGURE 13.4 Continuum of Disruptive Behavior and Disruptive Behavior Disorder 406

• 13.4 FOCUS ON COLLEGE STUDENTS: ADHD 410

• 13.5 FOCUS ON VIOLENCE: Juvenile Arrests and “Diversion” 417

Personal Narrative 13.1 Toni Wood 418

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14 Neurocognitive Disorders 423

C William and Laura / What Do You Think? 424

Normal Changes During Aging and Neurocognitive Disorders: What Are They? 425

Neurocognitive Disorders: Features and Epidemiology 426 Delirium 426 Dementia and Major and Mild Neurocognitive Disorder 428 Alzheimer’s Disease 428 Lewy Bodies 430 Vascular Disease 431 Parkinson’s Disease 432 Pick’s Disease 432 Other Problems 433 Epidemiology of Neurocognitive Disorders 434

Stigma Associated with Neurocognitive Disorders 435 INTERIM SUMMARY 436 REVIEW QUESTIONS 436

Neurocognitive Disorders: Causes and Prevention 437 Biological Risk Factors for Neurocognitive Disorders 437 Environmental Risk Factors for Neurocognitive Disorders 440 Causes of Neurocognitive Disorders 441 Prevention of Neurocognitive Disorders 442 INTERIM SUMMARY 443 REVIEW QUESTIONS 443

Neurocognitive Disorders: Assessment and Treatment 443 Assessment of Neurocognitive Disorders 443 Biological Treatments of Neurocognitive Disorders 445 Psychological Treatments of Neurocognitive Disorders 446 What If Someone I Know Has a Neurocognitive Disorder? 448 Long-Term Outcome for People with Neurocognitive

Disorders 449 INTERIM SUMMARY 449 REVIEW QUESTIONS 450

FINAL COMMENTS 450 THOUGHT QUESTIONS 450 KEY TERMS 451

Special Features

CONTINUUM FIGURE 14.1 Continuum of Thinking and Memory Problems and Neurocognitive Disorder 426

• 14.1 FOCUS ON COLLEGE STUDENTS: Delirium 434

• 14.2 FOCUS ON VIOLENCE: Maltreatment of the Elderly 436

V THE CONTINUUM VIDEO PROJECT Myriam / Alzheimer’s Disease 437

• 14.3 FOCUS ON GENDER: Grief in the Spouse Caregiver 448

• 14.4 FOCUS ON LAW AND ETHICS: Ethical Issues and Dementia 449

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15 Consumer Guide to Abnormal Psychology Consumer Guide to Abnormal Psychology 453

Introduction to the Consumer Guide 454

Becoming a Mental Health Professional 454 Types of Therapists and Quali�cations 454 Preparing to Be a Mental Health Professional 455

Becoming a Client 458

Treatment at the Individual Level 459 Active Ingredients of Treatment 459 Process Variables in Treatment 460 Does Treatment Work? 462 Prescriptive Treatment 462 INTERIM SUMMARY 463 REVIEW QUESTIONS 463

Treatment at the Community Level 463 Self-Help Groups 463 Aftercare Services for People with Severe Mental Disorders 464 Residential Facilities for People with Developmental

Disorders 465 Criminal Justice System 466 Public Policy and Mental Health 466 INTERIM SUMMARY 466 REVIEW QUESTIONS 467

Limitations and Caveats About Treatment 467 Client-Therapist Differences 467 Cultural Differences 467 Managed Care 468 Differences Between Clinicians and Researchers 468 Quick Fixes 468 Misuse of Research 468 Weak Research and How to Judge a Research Article 468 Negative Therapist Characteristics 469 Lack of Access to Treatment 470

Ethics 470 General Principles 470 Assessment 470 Treatment 471 Public Statements 472 Research 472 Resolving Ethical Issues 472 INTERIM SUMMARY 473 REVIEW QUESTIONS 473

FINAL COMMENTS 473 THOUGHT QUESTIONS 473 KEY TERMS 474

Special Features

• 15.1 FOCUS ON GENDER: Graduate School and Mentors 459

Personal Narrative 15.1 Julia Martinez, Graduate Student in Clinical Psychology 460

Personal Narrative 15.2 Tiffany S. Borst, M.A., L.P.C. 464

• 15.2 FOCUS ON LAW AND ETHICS: Rights of Those Hospitalized for Mental Disorder 466

• 15.3 FOCUS ON DIVERSITY: Lack of Diversity in Research 467

Personal Narrative 15.3 Christopher A. Kearney, Ph.D. 469

• 15.4 FOCUS ON LAW AND ETHICS: Sexual Intimacy and the Therapeutic Relationship 472

Appendix: Stress-Related Problems 476

Glossary G-0

References R-1

Name Index I-1

Subject Index I-17

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When we, the authors, decided to write this textbook, we wanted to create something different for our students. We wanted to create a book that appealed to students by helping them understand that symptoms of psychological problems occur in many people in different ways. We wanted to avoid character- izing mental disorders from a “yes–no” or “us–them” perspective and focus instead on how such problems affect many people to varying degrees in their everyday lives. In essence, we wanted to illustrate how abnormal psychology was really about the strug- gles that all of us face in our lives to some extent. We represent this approach in our title: Abnormal Psychology and Life.

Abnormal psychology is one of the most popular courses on college campuses. Students are eager to learn about unusual behavior and how such behavior can be explained. Many stu- dents who take an abnormal psychology course crave a scien- ti�c perspective that can help prepare them well for graduate school and beyond. Other students take an abnormal psychol- ogy course because they are curious about themselves or people they know and thus seek application and relevance of the course information to their daily lives. Our book is designed to appeal to both types of students. The material in the book re�ects state- of-the-art thinking and research regarding mental disorders but also emphasizes several key themes that increase personal relevance. These themes include a dimensional and integrative perspective, a consumer-oriented perspective, and emphases on prevention and cultural diversity. Personal relevance is also achieved by providing information to reduce the stigma of men- tal disorder; by illustrating comprehensive models of mental disorder that include biological, psychological, and other risk factors; and by employing various pedagogical aids, visually appealing material, and technological utilities.

A Dimensional and Integrative Perspective A focus on how abnormal psychology is a key part of life comes about in this book in different ways. One main way is our focus on a dimensional perspective toward mental disorder. We believe that thoughts, feelings, and behaviors associated with mental disorders are present, to some degree, in all of us. Everyone experiences some level of anxiety, sadness, odd physical symp- toms, worry about sexual behavior, and memory problems from time to time, for example. Throughout our chapters we vividly illustrate how different mental disorders can be seen along a continuum of normal, mild, moderate, severe, and very severe emotions, thoughts, and behaviors. We also provide examples along this continuum that parallel common scenarios people face, such as interactions with others and job interviews.

Our dimensional perspective is discussed within the context of an integrative perspective that includes an extensive discus- sion of risk and protective factors for various mental disorders. Such factors include biological (e.g., genetic, neurochemical, brain changes), personality, psychological (e.g., cognitive, learn- ing, trauma), interpersonal, family, cultural, evolutionary, and other domains. We emphasize a diathesis-stress model and pro- vide sections that integrate risk factors to present comprehen- sive models of various mental disorders. We also provide an appendix of medical conditions with contributing psychological factors that includes a biopsychosocial perspective to explain the interplay of physical symptoms with stress and other key contributing variables.

A Consumer-Oriented Perspective Our book is also designed to recognize the fact that today’s stu- dent is very consumer-oriented. Students expect textbooks to be relevant to their own lives and to deliver information about diagnostic criteria, epidemiological data, brain changes, and assessment instruments in visually appealing and technologi- cally sophisticated ways. This textbook adopts a consumer approach in several ways. The chapters in this book contain suggestions for those who are concerned that they or someone they know may have symptoms of a speci�c mental disorder. These suggestions also come with key questions one could ask to determine whether a problem may be evident. In addition, much of our material is geared toward a consumer approach. In our discussion of neurocognitive disorders such as Alzheimer’s disease, for example, we outline questions one could ask when considering placing a parent in a nursing home.

The consumer orientation of this book is also prominent in the last chapter when we discuss topics such as becoming a men- tal health professional, becoming a client in therapy, treatments available at the community level such as self-help groups, and how to judge a research article, among other topics. Throughout our chapters, we also focus special attention on issues of gen- der, ethnicity, law and ethics, and violence in separate boxes. In addition, we have separate sections that speci�cally address symptoms of mental disorder in college students. We offer visually appealing examples of a dimensional model for each major mental disorder, brain �gures, and engaging tables and charts to more easily convey important information. The book is also linked to many technological resources and contains 15 chapters, which �ts nicely into a typical 15-week semester.

We also include several pedagogical aids to assist students during their learning process. The chapters are organized in a

PREFACE

similar fashion throughout, beginning with initial sections on normal and unusual behavior and followed by discussions of features and epidemiology, stigma, causes and prevention, assess- ment, treatment, and prognosis. The chapters contain interim summaries and review questions at periodic intervals to help students check their understanding of what they just learned. Bold key terms are placed throughout the chapters and correspond- ing de�nitions are placed in the margin. What Do You Think? questions appear after the chapter-opening case study, which help students focus on important aspects of the case. Boxes that direct readers to related videos from the Continuum Video Project are featured in the disorder chapters (Chapters 5–14). More information on the Continuum Video Project, available in MindTap, is on page xxix. Final comments are also provided at the end of each chapter to link material to previous and future chapters. Broad-based thought questions are also at the end of each chapter to challenge students to apply what they have learned to their daily lives. The writing style of the book is designed to be easy to follow and to succinctly convey key information.

Prevention Another important theme of this book is prevention. Most col- lege students function well in their environment, but everyone has some level of risk for psychological dysfunction or distress. We thus emphasize research-based ways to prevent the onset of psychological problems throughout this textbook. We offer spe- ci�c sections on prevention and provide a detailed discussion of risk factors for mental disorder and how these risk factors could be minimized. We also provide a discussion of protective factors and strategies that could be nurtured during one’s life to prevent psychological problems. Examples include anxiety and stress management, emotional regulation, appropriate coping, healthy diet, and adaptive parenting.

Much of our discussion in this area focuses on primary and secondary prevention, which has great appeal for students. Many prevention programs target those who have not developed a mental disorder or who may be at risk due to individual or environmental factors. A focus on prevention helps students un- derstand what they could do to avert problematic symptoms or to seek help before such symptoms become more severe. Pre- vention material in the book also focuses on tertiary prevention and relapse prevention, so students can understand what steps people can take to continue healthy functioning even after the occurrence of a potentially devastating mental disorder. The pre- vention material in this book thus has broad appeal, relevance, and utility for students.

Cultural Diversity Mental health professionals have made a more concerted effort to achieve greater cultural diversity in their research, to apply �ndings in laboratory settings to greater numbers of people, and to shine a spotlight on those who are traditionally underserved. We emphasize these greater efforts in this textbook. In addition

to the special boxes on diversity, we provide detailed informa- tion about cultural syndromes; how symptoms and epidemiology may differ across cultural groups; how certain cultural factors may serve as risk and protective factors for various disorders; how diagnostic, assessment, and treatment strategies may need to be modi�ed for different cultural groups; and how cultural groups may seek treatment or cope differently with symptoms of mental disorder.

Our discussion of cultural diversity applies to various eth- nic and racial groups, but diversity across individuals is repre- sented in many other ways as well. We focus heavily on gender differences, sexual orientation, sociocultural factors, migrant populations, and changes in symptoms as people age from childhood to adolescence to adulthood to late adulthood. Our emphasis on cultural and other types of diversity is consistent with our life-based approach for the book: Symptoms of mental disorder can occur in many people in many different ways in many life stages.

Stigma A focus on a dimensional approach to mental disorder helps us advance another key theme of this book, which is to reduce stigma. Stigma refers to socially discrediting people because of certain behaviors or attributes that may lead to them being seen as undesirable in some way. People with schizophrenia, for example, are often stigmatized as people who cannot function or who may even be dangerous. Adopting a dimensional per- spective to mental disorder helps reduce inaccurate stereotypes and the stigma associated with many of these problems. You will also see throughout this book that we emphasize people �rst and a mental disorder second to reduce stigma. You will not see us use words or phrases such as schizophrenics or bulimics or the learning disabled. Instead, you will see phrases such as people with schizophrenia, those with bulimia, or children with learning disorder. We also provide special sections on stigma throughout the chapters as well as boxes that contain informa- tion to dispel common myths about people with mental disor- ders that likely lead to negative stereotyping.

Clinical Cases and Narratives Our dimensional perspective and our drive to reduce stigma is enhanced as well by extensive use of clinical cases and personal narratives throughout the book. Clinical cases are presented in chapters that describe a particular mental disorder and are often geared toward cases to which most college students can relate. These cases then reappear throughout that chapter as we dis- cuss features of that disorder as well as assessment and treat- ment strategies. We also include personal narratives from people who have an actual mental disorder and who can discuss its symptoms and other features from direct experience. All of these cases reinforce the idea that symptoms of mental disorder are present to some degree in many people, perhaps including those easily recognized by a student as someone in his or her life.

xxvii

PREFACE

New to the Third Edition The third edition contains many new and exciting changes. Readers will see that the most obvious change is that ongo- ing research has adapted to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), DSM), DSM the DSM-5. State-of-the-art research and citations are thus presented. The chapters remain aligned as they were previ- ously to enhance teaching in a typical semester and to re�ect empirical work that has been done for each set of disorders. DSM-5 criteria and other information are presented to help illuminate symptoms of mental disorders for students and to convey various dimensional aspects as well. Examples include continua based on severity, number of symptoms or behav- ioral episodes, body mass index, and personality traits, among many others.

The third edition also contains many boxes devoted to gen- der, diversity, violence, and law and ethics. In addition, separate sections have been added regarding how symptoms of mental disorders often manifest themselves in college students. Up- dated sections on stigma also illustrate our commitment to this important topic and present fascinating research with respect to others’ views of someone with a mental disorder and treatment and other strategies that have been developed to reduce stigma toward those with mental disorder.

An important process as well has been a thorough review of the material to ensure that students continue to be presented with state-of-the-art research and most current thinking regard- ing mental disorders, including epidemiology. Many sections of the book have thus been redone or reworked to re�ect new data, and hundreds of new citations have been added, most of which are very current. One thing that has not changed, however, is our deep devotion and commitment to this work and to our students and their instructors.

A brief summary of key changes and additions for each chapter in the third edition is provided here. This is not an exhaustive list but provides some general guidance for those familiar with the second edition.

Chapter 1: Abnormal Psychology and Life

• New information regarding worldwide epidemiology of mental disorders.

• Revamped stigma sections to re�ect recent �ndings. Chapter 2: Perspectives on Abnormal Psychology

• Updated citations and enhanced clari�cation of certain sections.

• Enhanced boxes on violence, law and ethics, and gender, including material on dangerousness and commitment.

Chapter 3: Risk and Prevention of Mental Disorders

• Updated information on epidemiology and a new world map in this regard.

• Revamped sections on demographic risk factors and resilience.

• Updated and new information on prevention, including primary prevention of alcohol use disorders on college campuses and selective prevention of eating disorders in college students.

• Updated information on suicide in college students. Chapter 4: Diagnosis, Assessment, and Study of Mental Disorders

• Updated information on all assessment information. • New culture and diagnosis example: ghost oppression. Chapter 5: Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders

• Updated and enhanced information regarding epidemiology.

• Updated heritability and other etiology information and a revamped gender box.

• Updated assessment and treatment information, such as transdiagnostic treatments.

• New box on anxiety in college students. Chapter 6: Somatic Symptom and Dissociative Disorders

• Updated information regarding new somatic symptom disorders, including features and epidemiology.

• Updated and revamped sections on risk factors, assessment, and treatment throughout.

• New boxes on somatic symptoms and dissociative experiences in college students.

Chapter 7: Depressive and Bipolar Disorders and Suicide

• Updated information, including features and epidemiol- ogy, of the mood disorders.

• Revamped sections on suicide, stigma, genetics, neuro- chemical features, stressful life events, and interpersonal factors, among other sections.

• New box on depression in college students. Chapter 8: Eating Disorders

• Updated information, including features and epidemiol- ogy, of eating disorders.

• Revamped stigma and family sections, among others, on eating disorders.

• New box on eating disorder symptoms in college students.

Chapter 9: Substance-Related Disorders

• Updated information throughout and especially with respect to recent �gures regarding substance use.

• Revamped sections on stigma, prevention, and long-term outcome of substance use disorders, among other sections.

• New box on treatment of substance use disorders in college students.

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PREFACE

Chapter 10: Personality Disorders

• Updated information, including features and epidemiol- ogy, of personality disorders.

• Revamped stigma, assessment, and long-term outcome of personality disorders sections, among others.

• New box on features of borderline personality disorder in college students.

Chapter 11: Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria

• Updated information, including features and epidemiol- ogy, of sexual dysfunctions, paraphilic disorders, and gender dysphoria.

• Revamped sections on stigma, cultural factors, psycholog- ical interventions, and long-term follow-up, among other sections.

• New boxes on sexual dysfunctions and sexual fantasies in college students.

Chapter 12: Schizophrenia and Other Psychotic Disorders

• Updated information, including features and epidemiol- ogy, of psychotic disorders.

• Revamped sections on stigma, genetics, cognitive clusters, and long-term outcome of psychotic disorders, among other sections.

• New box on attenuated psychotic symptoms in college students.

Chapter 13: Developmental and Disruptive Behavior Disorders

• Updated information, including features and epidemiology, of developmental and disruptive behavior disorders.

• Revamped sections on stigma, genetics, and long-term outcome of developmental and disruptive behavior disor- ders, among other sections.

• New boxes on autism and attention-de�cit/hyperactivity disorder in college students.

Chapter 14: Neurocognitive Disorders

• Updated information, including features and epidemiol- ogy, of neurocognitive disorders.

• Revamped sections on genetics, alcohol and tobacco use, medication, and long-term outcome for neurocogni- tive disorders, among other sections.

• New box on delirium in college students. Chapter 15: Consumer Guide to Abnormal Psychology

• Editing throughout to enhance clarity as well as reference updating.

• Revamped sections on group therapy, misuse of research, and lack of diversity in research, among other sections.

Appendix: Stress-Related Problems

• New prevalence information. • Revised section and study regarding stressful life events

and trauma among college students.

• Key updates regarding risk factors.

MindTap for Kearney and Trull’s Abnormal Psychology and Life MindTap is a personalized teaching experience with relevant assign- ments that guide students to analyze, apply, and improve thinking, allowing you to measure skills and outcomes with ease.

• Guide Students: A unique learning path of relevant readings, media, and activities that moves students up the learning taxonomy from basic knowledge and comprehension to analysis and application.

• Personalized Teaching: Becomes yours with a Learning Path that is built with key student objectives. Control what students see and when they see it. Use it as-is or match to your syllabus exactly—hide, rearrange, add and create your own content.

• Promote Better Outcomes: Empower instructors and motivate students with analytics and reports that provide a snapshot of class progress, time in course, engagement and completion rates.

In addition to the bene�ts of the platform, MindTap for Kearney and Trull’s Abnormal Psychology and Life includes:Abnormal Psychology and Life includes:Abnormal Psychology and Life

• Pro�les in Psychopathology, an exciting new product that guides users through the symptoms, causes, and treatments of individuals who live with mental disorders.

• Videos, assessment, and activities from the Continuum Video Project.

• Concept Clip Videos that visually elaborate on speci�c dis- orders and psychopathology in a vibrant, engaging manner.

• Case studies to help students humanize psychological disorders and connect content to the real world.

Supplements Continuum Video Project The Continuum Video Project provides holistic, three-dimensional portraits of individuals dealing with psychopathologies. Videos show clients living their daily lives, interacting with family and friends, and displaying—rather than just describing—their symp- toms. Before each video segment, students are asked to make observations about the individual’s symptoms, emotions, and behaviors and then rate them on the spectrum from normal to severe. The Continuum Video Project allows students to “see” the disorder and the person as a human; and helps viewers under- stand abnormal behavior can be viewed along a continuum.

Pro�les in Psychopathology In Pro�les of Psychopathology, students explore the lives of indi- viduals with mental disorders to better understand the etiology,

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PREFACE

symptoms and treatment. Each of the ten modules focuses on one type of disorder. Students learn about six individuals— historical and popular culture �gures—and then match the in- dividual to the disorder that best explains their symptoms and causes. The experiences of a real-life person from the population- at-large is also featured, with video footage of that individual discussing their experience with psychopathology.

Instructor Resource Center Everything you need for your course in one place! This collec- tion of book-speci�c lecture and class tools is available online via www.cengage.com/login. Access and download PowerPoint pre- sentations, images, instructor’s manual, videos, and more.

Online Instructor’s Manual with Test Bank Available online for instructors, the Instructor’s Manual with Test Bank offers a convenient and thorough overview of each chapter and a wealth of teaching suggestions developed around the chapter content. And the Test Bank section is an extensive collection of multiple-choice questions for objective tests, all closely tied to the text chapters. We’re con�dent that you will �nd this to be a dependable and usable resource. [ISBN 9781337278232]

Cengage Learning Testing Powered by Cognero Cengage Learning Testing Powered by Cognero is a �exible, on- line system that allows you to:

• author, edit, and manage test bank content from multiple Cengage Learning solutions

• create multiple test versions in an instant • deliver tests from your LMS, your classroom or wherever

you want.

Online PowerPoint Slides These vibrant, Microsoft PowerPoint lecture slides for each chapter assist you with your lecture, by providing concept cover- age using images, �gures, and tables directly from the textbook!

All of these instructor supplements are available online for download.

[ISBN 9781337288125]

Acknowledgments Producing this book required the joint efforts of Cengage and Graphic World Publishing Services. We thank our editors, Tim Matray and Carly McJunkin, and our content developer, Tangelique Williams-Grayer. We thank Cassie Carey at Graphic World for management of the book’s production. We are grateful for Kimiya Hojjat and Katie Chen, product assistants; Ruth Sakata Corley, content production manager; and Vernon Boes, art director. We also appreciate the work of Jennifer Levanduski, marketing director; and James Findlay, market- ing manager.

We would like to recognize and thank Ileana Arias, Marianne Ta�inger, Jaime Perkins, and Kate Barnes for their help with this text’s initial development.

We also thank those who agreed to contribute their personal stories for this book. Their narratives were essential to this book and helped bring the material to life.

The feedback and comments from the reviewers were extremely helpful. First, we thank the instructors who responded to the Third Edition survey:

Nicole Brandt, Columbus State Community College Andrew Blair, Palm Beach State College Acacia Parks, Hiram College Elizabeth DenDekker, Silver Lake College Andrea Phronebarger, York Technical College Nina Slota, Northern State University Jennifer Spychalski, College of Charleston Bettina Veigel, College of Charleston Sherry Molock, George Washington University Patti Lou Watkins, Oregon State University Marie D. Sjoberg, University of West Florida Anna Ciao, Western Washington University Brenda Ingram-Wallace, Albright College Angela Spaniolo-DePouw, Muskegon Community College David M. Feldman, Barry University

We also thank the following First and Second Editions re- viewers, as well as those who wished to remain anonymous:

Craig Abrahamson, James Madison University; Dave Alfano, Community College of Rhode Island; Randolph Arnau, University of Southern Mississippi; Stephen Balsis, Texas A&M University; Kira Banks, St. Louis University; Ollie Barrier, Park University at Parkville; Lee Ann Bartolini, Dominican University of California; Evelyn Behar, University of Illinois–Chicago; Kathryn Bell, Northern Illinois University–Dekalb; Laurie Berkshire, Erie Community College; James Bexendale, Cayuga Community College; Amy Badura Brack, Creighton University; Nicole Bragg, Mount Hood Community College; Jo Anne Brewster, James Madison University; Seth Brown, University of Northern Iowa; Emily Bullock, University of Southern Mississippi; David Carpenter, Texas State University; Sherri Chandler, Muskegon Community College; Bryan Chochran, University of Montana; Brian Cowley, Park University–Parkville; Trina Cyterski, University of Georgia; Dale Doty, Monroe Community College; Anthony Drago, East Stroudsburgh University; Wendy Dunn, Coe College; Christopher Echkhardt, Purdue University at West Lafayette; Georg Eifert, Chapman University; Carlos A. Escoto, Eastern Connecticut State University; Joe Etherton, Texas State University; Gabriel Feldmar, Nassau Community College; Meredyth Fellows, West Chester University; David Fresco, Kent State University; Gina Golden-Tangalakis, California State University, Long Beach; Barry Greenwald, University of Illinois–Chicago; Ron Hallman, Emmanuel Bible College; Julie Hanauer, Suffolk Community College at Ammerman; Kevin Handley, Germanna Community College; April Hess, Southwest Virginia Community College; Cecil Hutto, University of Louisiana–Monroe; Robert Rex Johnson, Delaware Community College; Samuel Joseph, Luzerne County Community College; Guadalupe King, Milwaukee Area Technical College–Downtown; Laura Knight, Indiana University of Pennsylvania; Victor Koop, Goshen College; Martha Lally, College of Lake County; Steve Lee, University of California, Los

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Angeles; David Lester, The Richard Stockton College of New Jersey; Don Lucas, Northwest Vista College; Polly McMahon, Spokane Falls Community College; Susan Meeks, University of Louisville; Rafael Mendez, Bronx Community College; Paul Moore, Quinnipiac University; Regan Murray, Briar Cliff University; Francis P. O’Neill, Montgomery County Community College–West Campus; Leanne Parker, Lewis-Clark State College; Deborah S. Podwika, Kankakee Community College; Skip Pollack, Mesa Community College; Jay Pope, Fresno Paci�c University; Frank J. Provenzano, Greenville Technical College; Kelly Quinn, East Texas Baptist University; Barry Ries, Minnesota State University at Mankato; Eric Rogers, College of Lake County; John Roop, North Georgia College & State University; Patricia Sawyer, Middlesex Community College; Kerry Schwanz, Coastal Carolina University; Norman A. Scott, Iowa State University; William Scott, Liberty University; Laura Seligman, University of Toledo; Nancy Simpson, Trident Technical College; Ashlea Smith, Paradise Valley Community College; Randyl Smith, Metropolitan State College of Denver; Scott Stehouwer, Calvin College; Stephanie Stein, Central

Washington University; Betsy Stern, Milwaukee Area Technical College–Downtown; Joanne Hoven Stohs, California State University, Fullerton; Diane Tarricone, Eastern Connecticut State University; Ronald Theobald, SUNY–Jefferson Community College; Ayme Turnbull, Hofstra University; Michelle Vanbuskirk, Monroe Community College; Fabian Vega, Baltimore City Community College at Liberty Campus; J. Celeste Walley-Jean, Clayton State University; Stephen Weiss, Adams State College; Adam Wenzel, Saint Anselm College; Gene White, Salisbury University; Fred Whitford, Montana State University at Bozeman; Beth Wiediger, Lincoln Land Community College; Amy Williamson, Moraine Valley Community College.

In addition, we thank those who helped us create the supplements for this text, including the Instructor’s Manual, Test Bank, and PowerPoint preparers.

Finally, we thank all of the instructors who use this text- book, as well as the students who take their courses. As al- ways, we welcome your comments and suggestions regarding the book.

PREFACE 1

Special Features

• 1.1 Emotion and Culture

CONTINUUM FIGURE 1.2 Continuum of Emotions, Cognitions, and Behaviors

• 1.2 Heal Thyself: What the Self-Help Gurus Don’t Tell You

Personal Narrative 1.1 Alison Malmon

C / What Do You Think?

Introduction to Abnormal Psychology

What Is a Mental Disorder?

History of Abnormal Psychology

Abnormal Psychology and Life: Themes

FINAL COMMENTS

KEY TERMS

CHAPTER 1 Abnormal Psychology and Life4

Some of us may also be asked to help a friend or sibling strug- gling with symptoms of a mental disorder. In addition, all of us are interested in knowing how to improve our mental health and how to prevent mental disorders so we can help family members and friends.

In this book, we provide information to help you recognize mental problems and understand how they develop. We also ex- plore methods used by professionals to prevent and treat mental distress and disorder. Knowing this material will not make you an expert, but it could make you a valuable resource. Indeed, we will present information you can use to make informed deci- sions and direct yourself and others to appropriate sources of support and help. Based on information in Chapters 5 and 7, for example, you will become knowledgeable about how anxiety and depression affect health and behavior in yourself and others as well as ways of dealing with these common problems.

What Is a Mental Disorder?

As we mentioned, a mental disorder is a group of emotional (feelings), cognitive (thinking), or behavioral symptoms that cause distress or signi�cant problems. Abnormal psychol- ogy is the scienti�c study of problematic feelings, thoughts, and behaviors associated with mental disorders. At �rst glance, de�ning problematic or abnormal behavior seems fairly straight- forward—isn’t abnormal behavior simply behavior that is not normal? In a way, yes, but then we �rst must know what normal

Introduction to Abnormal Psychology

You and your classmates chose to take this course for many reasons. The course might be required, or perhaps you thought learning about abnormal, deviant, or unusual behav- ior was intriguing. Or you might be interested in becoming a mental health professional and thought this course could help prepare you for such a career. Whatever the reason, you have likely known or will eventually know someone with a mental disorder. A mental disorder is a group of emotional (feelings), cognitive (thinking), or behavioral symptoms that cause distress or signi�cant problems. About 29.2 percent of adults worldwide have had a mental disorder in their lifetime (Steel et al., 2014). Students in our abnormal psychology classes often tell us that they know at least one person with a mental disorder. These students often say that they or an immediate family member— such as a parent, sibling, or child—had a disorder. A commonly reported disorder is depression, a problem that Travis seemed to be experiencing.

Abnormal psychology is the scienti�c study of problematic feelings, thoughts, and behaviors associated with mental disor- ders. This area of science is designed to evaluate, understand, predict, and prevent mental disorders and help those who are in distress. Abnormal psychology has implications for all of us. Everyone has feelings, thoughts, and behaviors, and occasion- ally these become a problem for us or for someone we know. Travis’s situation at the beginning of the chapter represents some daily experiences people have with mental disorders.

Travis is a 21-year-old college junior who has been struggling recently. He and his longtime girlfriend broke up 2 months ago, and he took this very hard. Travis and his girlfriend had been together for 17 months, and she was his �rst serious romantic relationship. However, the couple eventually became emotionally distant from one another and mutually decided to split following several arguments. Travis initially seemed �ne after the breakup but then became a bit sullen and withdrawn about a week later. He began to miss a few classes and spent more time in his dorm room and on his computer.

Since the breakup several weeks ago, Travis seems to be getting worse each day. He rarely eats, has trouble sleeping, and stays in bed much of the day. He “zones out” by play- ing video games, watching television, or staring out the window for hours per day. Travis has lost about 10 pounds in recent weeks and looks tired

and pale. He has also been drinking alcohol more in recent days. In addition, his classroom attendance has declined signi�cantly, and he is in danger of failing his courses this semester.

Travis says little about the breakup or his feelings. His friends have tried everything they can think of to help him feel better, with no suc- cess. Travis generally declines their offers to go out, attend parties, or meet other women. He is not mean-spirited in his refusals to go

out but rather just shakes his head. Travis’s friends have become worried that Travis might hurt himself, but they cannot be with him all the time. They have decided that Travis should speak with someone at the psychological ser- vices center on campus and plan on escorting him there today.

What Do You Think? 1. Which of Travis’s emotional or behavioral

problems concern you the most? Why? 2. What do you think Travis should do? 3. What would you do if you had a friend who

was experiencing dif�culties like Travis? 4. What emotional or behavioral problems

have you encountered in yourself or in others over the past year?

5. Are you surprised when people you know experience emotional or behavioral problems? Why or why not?

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Deviance from the Norm Treva’s actions are certainly not typical of most teenagers or young adults. Because Treva’s behavior is so different from others—so different from the norm—her behavior would be considered abnormal. De�ning abnormal behavior based on its difference or deviance from the norm is common and has some mass appeal—most people would agree Treva’s behaviors are abnormal. Do you? Mental health professionals also rely on deviance from the norm to de�ne abnormal behavior, but they often do so statistically by measuring how frequently a behavior occurs among people. Less frequent or less probable behaviors are considered to be abnormal or statistically deviant. Suddenly disappearing from home and assuming a new identity, as Treva did, is a very infrequent behavior that is statistically far from normal behavior.

An objective, statistical method of de�ning abnormality involves determining the probability of a behavior for a pop- ulation. Note the bell curve in Figure 1.1. This curve shows how likely a behavior is based on its frequency in large groups of people. In this case, a 0 to 100 rating scale indicates level of physical activity among 10-year-olds during a 30-minute recess period. In this graph, 0 � no physical activity and 100 � con- tinuous physical activity. The left axis of the scale shows how many children received a certain activity score: you can see that almost all children received scores in the 20 to 80 range. Based on this distribution of scores, we might statistically de�ne and label the physical activity of children scoring 0 to 19 or 81 to 100 as “abnormal.” Note that extremely low and extremely high scores are considered abnormal. Some physical activity is the norm, but too little or too much is not. A mental health profes- sional might thus focus on underactive and overactive children in her scienti�c studies.

Statistical deviance from the norm is attractive to research- ers because it offers clear guidelines for identifying emotions,

behavior is. We often refer to normal behavior as that which characterizes most people. One normal behavior for most peo- ple is to leave home in the morning to go to school or work and to interact with others. If a person was so afraid of leav- ing home that he stayed inside for many weeks or months, this might be considered abnormal—the behavior differs from what most people do.

But what do we mean by most people? How many people must engage in a certain behavior for the behavior to be con- sidered normal? And which group of people should we use to decide what is normal—women, men, people of a certain eth- nicity, everyone? You can see that de�ning normal and abnormal behavior is more complicated than it might appear. Consider the following case:

case Treva Throneberry was born in Texas. Her sisters describe their family as a peaceful and loving one, but Treva paints a different picture. At age 15 years, Treva accused her father of sexual molestation. She later recanted her accu- sation but was removed from her parents’ home and placed in foster care. At age 17 years, Treva ran away from her foster home and was found wandering alone by a roadside before spending time in a mental hospital. A year later, Treva moved into an apartment but soon vanished from town. Years later, she was charged by Vancouver police with fraud and forgery. Her �ngerprints matched those of Treva Throneberry, who was born 30 years before, but Treva said she was an 18-year-old named Brianna Stewart. She had been attending Evergreen High School in Vancouver for the past two years, where everyone knew her as Brianna Stewart. This was the basis for the fraud and forgery charges.

Since her disappearance from Texas, Treva had been known by many other names in places across the country. In each town, she initially pre- sented herself as a runaway 15- or 16-year-old in need of shelter who then left suddenly before her new identity turned 18 years old. She would then move to another town and start again as a 15- or 16-year-old. Her foster care mother said Treva could not envision living beyond age 18.

Treva was examined by a psychiatrist and found competent to stand trial. At her trial, Treva represented herself. She would not plea-bargain because she insisted she was Brianna Stewart and not Treva Throneberry. She argued in court that she was not insane and did not have a mental disorder that caused her to distort reality or her identity. Despite her claims, however, Treva was convicted of fraud and sentenced to a 3-year jail term. She continues to insist she is Brianna Stewart.

You may think Treva’s behavior is abnormal, but why? To address this question, we may consider one of three criteria commonly used to determine whether an emotion, thought, or behavior is abnormal: (1) deviance from the norm, (2) dif-dif-dif �culties adapting to life’s demands or dif�culties functioning effectively (including dangerous behavior), and (3) experience of personal distress.

FIGURE 1.1 A STATISTICAL METHOD A STATISTICAL METHOD A ST OF DEFINING ABNORMALITY. Extremely low and extremely high levels of activity are considered abnormal from a statistical perspective.

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CHAPTER 1 Abnormal Psychology and Life6

chapter, you can see his depression kept him from interacting with others and could even lead to self-harm. Indeed, dangerous behavior toward oneself or others clearly interferes with an ability to function effectively.

Everyone occasionally has feelings of sadness and discour- agement, especially after a tough event such as a breakup. Most people, however, are eventually able to focus better on school, work, or home regardless of these feelings. For other people like Travis, however, feelings of sadness or discouragement become maladaptive. A maladaptive behavior is one that interferes with a person’s life, including ability to care for oneself, have good relationships with others, and function well at school or at work. Feelings of sadness and discouragement, which at �rst can be normal, can lead to maladaptive behaviors such as trouble getting out of bed, concentrating, or thinking.

Think about Sasha, who has been very worried since her mother was diagnosed with breast cancer last year. Her mother is currently doing well, and the cancer seems to be in remission, but Sasha cannot stop worrying that her mother’s cancer will return. These worries cause Sasha to be so anxious and upset that she can- not concentrate on her schoolwork, and she �nds herself irritable and unable to spend much time with her friends. Sasha’s worries and behavior, which were understandable at �rst, have become maladaptive. According to the dif�culties-adapting-to-life-demands criterion, Sasha’s behaviors might be considered abnormal. Her continual thoughts about her mother’s health, coupled with irrita- bility and trouble concentrating, prevent her from functioning well as a family member, student, and friend. In fact, Sasha may bene�t from some professional intervention at this point. In this case, the focus is not on deviance or norms but on the extent to which a behavior or characteristic interferes with daily functioning.

One advantage of this approach is that problems in daily living—as in school, work, or relationships—often prompt peo- ple to seek treatment. Unfortunately, the difference between good

functioning and maladaptive behavior is not always easy to measure. In addition, the difference be- tween good functioning and maladaptive behavior

differs from person to person. Another prob- lem with this criterion is that different people may view a certain behavior dif- ferently. Sasha’s family members might see her behaviors as caring and thought- ful, but one of her professors might see her behavior as laziness. Mental health professionals often struggle with how to determine whether a person’s behavior is maladaptive or truly interferes with a person’s daily functioning.

Another problem with the criterion of dif�culties adapting to life demands is that people may engage in odd behaviors but experience little interference in daily functioning. Consider Henry, a telemar- keter living alone in Seattle. He never leaves home because of fear of contamina- tion by airborne radioactivity and bacterial

thoughts, or behaviors as normal or abnormal. However, this ap- proach has some disadvantages. One major disadvantage is that people who differ signi�cantly from an average score are techni- cally “abnormal” or “disordered.” But does this make sense for all behaviors or characteristics? Think about intelligence. Using a deviance-from-the-norm criterion, people who score extremely high on an intelligence test would be considered abnormal! But high intelligence is certainly not a disorder. In fact, high intelli- gence is valued in our society and often associated with success instead of failure. A deviance approach to de�ning abnormality is thus easy to apply but may fall short for determining what is abnormal.

Another disadvantage of the deviance-from-the-norm crite- rion is that cultures differ in how they de�ne what is normal. One culture might consider an extended rest period during the workday to be normal, and another culture might not. Likewise, symptoms of mental disorders differ from culture to culture. We often consider self-critical comments and expressions of sadness as indicators of depression, but such behaviors are not always viewed the same way in East Asia (see Box 1.1). This is impor- tant for mental health professionals to consider when treating someone. Mental health professionals must recognize their own cultural biases and refrain from applying these views inappro- priately to someone from another culture. Mental health profes- sionals must also understand that deviance within a culture can change over time—what was considered deviant 50 years ago may be acceptable today.

A �nal problem with the deviance-from-the-norm criterion is that deciding the statistical point at which a behavior is abnor- mal can be arbitrary and subject to criticism. The method does not tell us what the correct cutoff should be. Refer again to Figure 1.1. If a child has an activity score of 81, she might be considered abnor- mal. Realistically, however, is a score of 80 (normal) much different from a score of 81 (abnormal)? Where should the cutoff be, and how do we know if that cutoff point is meaningful?

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