Dr sani rush copley neurosurgery

Diagnosis of somatic symptom disorder may be given to people who are overly anxious about their medical problems (page 257).

Clinicians no longer need to distin- guish hysteri- cal symptoms from medical symptoms.

People with a

serious medi- cal disease, such as cancer, may receive a psychiatric di- agnosis.

Diagnosis of major depressive disorder may be given to recently bereaved people (page 196).

Clinicians can more quickly spot and treat clini- cal depression among griev- ing people.

People experi-

encing normal grief reactions may receive a psychiatric di- agnosis.

Previous category of

Asperger’s disorder has been eliminated (page 486).

Better alterna- tive diagnoses may now be assigned to people with severe social impairments.

Individu- als may

no longer qual- ify for special educational services if they lose the As- perger’s label.

The new category substance use disorder combines substance abuse and substance dependence into one disorder (page 314).

Patterns of sub- stance abuse and substance dependence were often indistinguish- able.

Sub- stance

abuse and sub- stance depen- dence may re- quire different treatments.

Top DSM-5 DebaTeS Many of the DSM-5 changes have provoked debate. Several have been particularly controversial in some clinical circles.

Who DevelopeD DSM-5?

* World Health Organization ** National Institute of Mental Health

Field Testing DSM-5 From 2010 to 2012, DSM-5 researchers conducted field studies to see how well clinicians could apply the new criteria.

Disorders tested: 23

Clinical participants: 3,646

Clinicians: 879 (APA, 2013; Clarke et al., 2013; Regier et al., 2013)

Two-thirds of the DSM-5 work group members were psychiatrists and one-third were psychologists.

(APA, 2013)

Work groups (pathology groups)

13 160 persons

12 persons per group

Task force (oversight committee)

30 persons

New Categories Hoarding disorder (page 143)

Excoriation disorder (page 143)

Persistent depressive disorder (page 187)

Premenstrual dysphoric disorder (page 209)

Disruptive mood dysregulation disorder (page 472)

Somatic symptom disorder (page 255)

Binge eating disorder (page 288)

Mild neurocognitive disorder (page 511)

WhaT’S NeW iN DSM-5? DSM-5 features a number of changes, new categories, and eliminations. Many of the changes have been controversial.

Name Changes OLD NEW

Mental Retardation

Intellectual Disability (page 489)

Dementia Major Neurocognitive Disorder (page 511)

Hypochondriasis Illness Anxiety Disorder (page 261)

Male Orgasmic Disorder

Delayed Ejaculation (page 355)

Gender Identity Disorder

Gender Dysphoria (page 376)

Dropped Categories Dissociative fugue (page 168)

Asperger’s disorder (page 486)

Sexual aversion disorder (page 348)

Substance abuse (page 314)

Substance dependence (page 314)

CoMpeTiTorS Both within North America and around the world, the DSM faces competition from 2 other diagnostic systems—the International Classification of Disorders

(ICD) and Research Domain Criteria (RDoC).

DSM

ICD

RDoC

Producer Disorders Criteria

APA Psychological Detailed

WHO* Psychological/

medical Brief

NIMH** Psychological Neuro/scanning

Gambling disorder is considered an addiction (page 342).

Excessive gambling and substance addictions often share similar brain dysfunc- tioning.

Many other be-

haviors pursued excessively, such as sex, Internet use, and shopping, could eventually be considered behavioral ad- dictions.

Mild neurocognitive disorder is added as a category (page 515).

This diag-nosis may help clinicians identify early symptoms of Alzheimer’s dis- ease.

People with nor-

mal age-related forgetfulness may receive a psychiatric diag- nosis.

1950

1970

1960

1990

2010

• 1980

book price $32.00

• 1994

book price $49.00

• 2000

book price $75.00

DSM-5 • 2013

book price $199.00

128 diagnoses

• 1952

book price $3.00

• 1987

book price $40.00

DSM-III

DSM-IV

DSM-IV-TR

DSM-I

DSM-III-R

DSM-II • 1968

book price $3.50

193 diagnoses

228 diagnoses

253 diagnoses

383 diagnoses

383 diagnoses

541 diagnoses

DSM-5 vS. ItS PreDeceSSorS The new edition of DSM is bigger and more expensive than all previous editions. It cost the APA $25 million to produce, an amount that was immediately recouped by presales of 150,000 copies (Gorenstein, 2013).

Outside advisors

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n 2013, the American Psychiatric Association (APA) published DSM-5, its new edition of the Diagnostic and Statistical Manual of Mental Disorders — the most widely used classification system in North America. DSM-5 is a 947-page manual that lists 541 diagnoses (Blashfield et al., 2014). The production of DSM-5 was a monumental 12-year undertaking, marked by long delays, controversies, and protests (page 95).

Inside DSM-5

Application Area of Use

Practice/research North America

Practice/research Worldwide

Research United States

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Abnormal Psychology Fundamentals of

this page left intentionally blank

Princeton University

Abnormal Psychology

Ronald J. Comer

EIGHTH EDITION

Fundamentals of

New York

Publisher: Rachel Losh Executive Acquisitions Editor: Daniel McDonough Editorial Assistant: Kimberly Morgan Senior Marketing Manager: Lindsay Johnson Marketing Assistant: Allison Greco Executive Media Editor: Rachel Comerford Associate Media Editor: Jessica Lauffer Director, Content Management Enhancement: Tracey Kuehn Managing Editor: Lisa Kinne Senior Project Editor: Jane O’Neill Media Producer: Eve Conte Photo Editor: Jennifer Atkins Permissions Editors: Felicia Ruocco, Melissa Pellerano Permissions Associate: Chelsea Roden Director of Design, Content Management: Diana Blume Cover and Interior Designer: Babs Reingold Layout Designer: Paul Lacy Infographics Artist: Charles Yuen Senior Production Supervisor: Sarah Segal Composition: codeMantra Printing and Binding: RR Donnelley Cover Image: Ed Fairburn

Credits to use previously published material can be found in the Credits section, starting on page C-1.

Library of Congress Control Number: 2015957306

ISBN-13: 978-1-4641-7697-5 ISBN-10: 1-4641-7697-3

© 2016, 2014, 2011, 2008 by Worth Publishers

All rights reserved

Printed in the United States of America

First Printing

Worth Publishers One New York Plaza Suite 4500 New York, NY 10004-1562

http://www.macmillanhighered.com

http://www.macmillanhighered.com
To Delia and Emmett Comer, The World Awaits

viii

About the Author

Ron ComeR has taught in Princeton University’s Department of Psychology for the past 41 years, serving also as Director of Clinical Psychology Studies and as chair of the university’s Institutional Review Board. His courses—Abnormal Psychology, Theories of Psychotherapy, Childhood Psychopathology, Experimental Psychopathology, and Controversies in Clinical Psychology—have been among the university’s most popular offerings.

Professor Comer has received the President’s Award for Distinguished Teaching at the university. He is also a practicing clinical psychologist and a consultant to Eden Autism Services and to hospitals and family practice residency programs throughout New Jersey.

In addition to writing Fundamentals of Abnormal Psychology, Eighth Edition, Professor Comer is the author of the textbook Abnormal Psychology, now in its ninth edition; coauthor of the introductory psychology textbook Psychology Around Us, Second Edition; and coauthor of Case Studies in Abnormal Psychology, Second Edition. He is the producer of numerous videos for courses in psychology and other fields of education, including The Higher Education Video Library Series, Video Anthology for Abnormal Psychology, Video Segments in Neuroscience, Introduction to Psychology Video Clipboard, and Developmental Psychology Video Clipboard. He also has published journal articles in clinical psychol- ogy, social psychology, and family medicine.

Professor Comer completed his undergraduate studies at the University of Pennsylvania and his graduate work at Clark University. He lives in Lawrenceville, New Jersey, with his wife, Marlene. From there he can keep a close eye on the Philadelphia sports teams with which he grew up. Pa

ul L

. B re

e

ix

Contents in brief Abnormal Psychology in Science and Clinical Practice 1 Abnormal Psychology: Past and Present 1

2 Models of Abnormality 37

3 Clinical Assessment, Diagnosis, and Treatment 77

Problems of Anxiety and Mood 4 Anxiety, Obsessive-Compulsive, and Related Disorders 105

5 Disorders of Trauma and Stress 149

6 Depressive and Bipolar Disorders 183

7 Suicide 221

Problems of the Mind and Body 8 Disorders Featuring Somatic Symptoms 249

9 Eating Disorders 279

10 Substance Use and Addictive Disorders 309

11 Disorders of Sex and Gender 347

Problems of Psychosis 12 Schizophrenia 385

Life-Span Problems 13 Personality Disorders 421

14 Disorders Common Among Children and Adolescents 463

15 Disorders of Aging and Cognition 501

Conclusion 16 Law, Society, and the Mental Health Profession 527

x

Contents

Preface xvii

chapter : 1 Abnormal Psychology: Past and Present 1 What Is Psychological Abnormality? 2

Deviance 3 Distress 3 Dysfunction 4 Danger 4 The elusive nature of Abnormality 4

What Is Treatment? 5

How Was Abnormality Viewed and Treated in the Past? 7

Ancient Views and Treatments 7 Greek and Roman Views and Treatments 8 europe in the middle Ages: Demonology Returns 8 The Renaissance and the Rise of Asylums 9 The nineteenth Century: Reform and

moral Treatment 10 The early Twentieth Century: The Somatogenic

and Psychogenic Perspectives 11

Current Trends 14 How Are People with Severe Disturbances

Cared for? 15 How Are People with Less Severe

Disturbances Treated? 15 A Growing emphasis on Preventing Disorders

and Promoting mental Health 16 multicultural Psychology 17 The Increasing Influence of Insurance Coverage 17 What Are Today’s Leading Theories and Professions? 18 Technology and mental Health 20

What Do Clinical Researchers Do? 22 The Case Study 22 The Correlational method 23 The experimental method 27 What Are the Limits of Clinical Investigation? 31 Protecting Human Participants 32

Putting it together: A Work in Progress 34

Key terms 34

QuicK Quiz 35

LaunchPad 35

PsychWatch Verbal Debuts 2

PsychWatch Marching to a Different Drummer: Eccentrics 6

InfoCentral Happiness 19

MindTech Mental Health Apps Explode in the Marketplace 21

MindTech A Researcher’s Paradise? 24

MediaSpeak Flawed Study, Gigantic Impact 28

chapter : 2 Models of Abnormality 37 The Biological Model 39

How Do Biological Theorists explain Abnormal Behavior? 39

Biological Treatments 42 Assessing the Biological model 44

The Psychodynamic Model 44 How Did Freud explain normal and Abnormal

Functioning? 45 How Do other Psychodynamic explanations Differ

from Freud’s? 47 Psychodynamic Therapies 47 Assessing the Psychodynamic model 49

The Behavioral Model 50 How Do Behaviorists explain Abnormal Functioning? 51 Behavioral Therapies 52 Assessing the Behavioral model 53

The Cognitive Model 54 How Do Cognitive Theorists explain Abnormal

Functioning? 54 Cognitive Therapies 55 Assessing the Cognitive model 56

The Humanistic-Existential Model 58

CONTENTS : xi

Rogers’ Humanistic Theory and Therapy 59 Gestalt Theory and Therapy 60 Spiritual Views and Interventions 61 existential Theories and Therapy 61 Assessing the Humanistic-existential model 63

The Sociocultural Model: Family-Social and Multicultural Perspectives 64

How Do Family-Social Theorists explain Abnormal Functioning? 65

Family-Social Treatments 67 How Do multicultural Theorists explain Abnormal

Functioning? 71 multicultural Treatments 72 Assessing the Sociocultural model 72

Putting it together: integrAtion of the Models 73

Key terms 75

QuicK Quiz 75

LaunchPad 75

InfoCentral Dietary Supplements: An Alternative Treatment 43

PsychWatch Cybertherapy: Surfing for Help 57

MediaSpeak Saving Minds Along with Souls 62

MindTech Have Your Avatar Call My Avatar 67

chapter : 3 Clinical Assessment, Diagnosis, and Treatment 77 Clinical Assessment: How and Why Does the Client Behave Abnormally? 77

Characteristics of Assessment Tools 78 Clinical Interviews 79 Clinical Tests 81 Clinical observations 89

Diagnosis: Does the Client’s Syndrome Match a Known Disorder? 92

Classification Systems 92 DSm-5 93 Is DSm-5 an effective Classification System? 94 Call for Change 95 Can Diagnosis and Labeling Cause Harm? 96

Treatment: How Might the Client Be Helped? 97 Treatment Decisions 98

The effectiveness of Treatment 98

Putting it together: AssessMent And diAgnosis At A CrossroAds 102

Key terms 103

QuicK Quiz 103

LaunchPad 103

MindTech Psychology’s Wiki Leaks? 83

PsychWatch The Truth, the Whole Truth, and Nothing but the Truth 87

MediaSpeak Intelligence Tests Too? eBay and the Public Good 90

InfoCentral Common Factors in Therapy 101

chapter : 4 Anxiety, Obsessive-Compulsive, and Related Disorders 105 Generalized Anxiety Disorder 106

The Sociocultural Perspective: Societal and multicultural Factors 107

The Psychodynamic Perspective 108 The Humanistic Perspective 110 The Cognitive Perspective 111 The Biological Perspective 116

Phobias 119 Specific Phobias 120 Agoraphobia 120 What Causes Phobias? 122 How Are Phobias Treated? 124

Social Anxiety Disorder 127 What Causes Social Anxiety Disorder? 128 Treatments for Social Anxiety

Disorder 130

Panic Disorder 132 The Biological Perspective 133 The Cognitive Perspective 135

Obsessive-Compulsive Disorder 137 What Are the Features of obsessions

and Compulsions? 137 The Psychodynamic Perspective 138 The Behavioral Perspective 139 The Cognitive Perspective 140 The Biological Perspective 141

: CONTENTSxii

obsessive-Compulsive-Related Disorders 143

Putting it together: diAthesis-stress in ACtion 146

cLinicaL choices 146

Key terms 147

QuicK Quiz 147

LaunchPad 147

PsychWatch Fears, Shmears: The Odds Are Usually on Our Side 113

InfoCentral Mindfulness 115

MediaSpeak The Fear Business 121

MindTech Social Media Jitters 129

chapter : 5 Disorders of Trauma and Stress 149 Stress and Arousal: The Fight-or-Flight Response 151

Acute and Posttraumatic Stress Disorders 152 What Triggers Acute and Posttraumatic

Stress Disorders? 154 Why Do People Develop Acute and Posttraumatic

Stress Disorders? 158 How Do Clinicians Treat Acute and Posttraumatic

Stress Disorders? 161

Dissociative Disorders 166 Dissociative Amnesia 167 Dissociative Identity Disorder 170 How Do Theorists explain Dissociative Amnesia

and Dissociative Identity Disorder? 172 How Are Dissociative Amnesia and Dissociative

Identity Disorder Treated? 176 Depersonalization-Derealization Disorder 177

Putting it together: getting A hAndle on trAuMA And stress 179

cLinicaL choices 180

Key terms 181

QuicK Quiz 181

LaunchPad 181

InfoCentral Sexual Assault 156

PsychWatch Adjustment Disorders: A Category of Compromise? 159

MindTech Virtual Reality Therapy: Better Than the Real Thing? 163

PsychWatch Repressed Childhood Memories or False Memory Syndrome? 169

PsychWatch Peculiarities of Memory 175

chapter : 6 Depressive and Bipolar Disorders 183 Unipolar Depression: The Depressive Disorders 184

How Common Is Unipolar Depression? 184 What Are the Symptoms of Depression? 184 Diagnosing Unipolar Depression 187 Stress and Unipolar Depression 187 The Biological model of Unipolar Depression 188 Psychological models of Unipolar Depression 196 The Sociocultural model of Unipolar Depression 205

Bipolar Disorders 211 What Are the Symptoms of mania? 212 Diagnosing Bipolar Disorders 212 What Causes Bipolar Disorders? 214 What Are the Treatments for Bipolar Disorders? 215

Putting it together: MAking sense of All thAt is knoWn 218

cLinicaL choices 218

Key terms 219

QuicK Quiz 219

LaunchPad 219

InfoCentral Sadness 185

PsychWatch Sadness at the Happiest of Times 190

MediaSpeak Immigration and Depression in the 21st Century 199

MindTech Texting: A Relationship Buster? 207

PsychWatch Premenstrual Dysphoric Disorder: Déjá Vu All Over Again 209

PsychWatch Abnormality and Creativity: A Delicate Balance 214

chapter : 7 Suicide 221 What Is Suicide? 222

How Is Suicide Studied? 226 Patterns and Statistics 226

What Triggers a Suicide? 227 Stressful events and Situations 228

CONTENTS : xiii

mood and Thought Changes 228 Alcohol and other Drug Use 229 mental Disorders 229 modeling: The Contagion of Suicide 230

What Are the Underlying Causes of Suicide? 232 The Psychodynamic View 232 Durkheim’s Sociocultural View 233 The Biological View 234

Is Suicide Linked to Age? 235 Children 235 Adolescents 236 The elderly 239

Treatment and Suicide 242 What Treatments Are Used After Suicide

Attempts? 242 What Is Suicide Prevention? 242 Do Suicide Prevention Programs Work? 245

Putting it together: PsyChologiCAl And BiologiCAl insights lAg Behind 246

Key terms 247

QuicK Quiz 247

LaunchPad 247

MediaSpeak Videos of Self-Injury Find an Audience 225

PsychWatch The Black Box Controversy: Do Antidepressants Cause Suicide? 238

InfoCentral The Right to Commit Suicide 240

MindTech Crisis Texting 243

chapter : 8 Disorders Featuring Somatic Symptoms 249 Factitious Disorder 250

Conversion Disorder and Somatic Symptom Disorder 253

Conversion Disorder 253 Somatic Symptom Disorder 255 What Causes Conversion and Somatic

Symptom Disorders? 257 How Are Conversion and Somatic Symptom

Disorders Treated? 260

Illness Anxiety Disorder 261

Psychophysiological Disorders: Psychological Factors Affecting Other Medical Conditions 262

Traditional Psychophysiological Disorders 262 new Psychophysiological Disorders 267

Psychological Treatments for Physical Disorders 273 Relaxation Training 273 Biofeedback 273 meditation 273 Hypnosis 274 Cognitive Interventions 275 Support Groups and emotion expression 275 Combination Approaches 275

Putting it together: exPAnding the BoundAries of ABnorMAl PsyChology 276

cLinicaL choices 276

Key terms 276

QuicK Quiz 277

LaunchPad 277

PsychWatch Munchausen Syndrome by Proxy 252

MindTech Can Social Media Spread “Mass Hysteria”? 255

InfoCentral Sleep and Sleep Disorders 264

MediaSpeak When Doctors Discriminate 270

chapter : 9 Eating Disorders 279 Anorexia Nervosa 280

The Clinical Picture 281 medical Problems 282

Bulimia Nervosa 282 Binges 284 Compensatory Behaviors 284 Bulimia nervosa Versus Anorexia nervosa 286

Binge-Eating Disorder 288

What Causes Eating Disorders? 289 Psychodynamic Factors: ego Deficiencies 289 Cognitive Factors 290 Depression 290 Biological Factors 291 Societal Pressures 292 Family environment 293 multicultural Factors: Racial and ethnic Differences 295 multicultural Factors: Gender Differences 296

How Are Eating Disorders Treated? 298 Treatments for Anorexia nervosa 298 Treatments for Bulimia nervosa 302

: CONTENTSxiv

Treatments for Binge-eating Disorder 305

Putting it together: A stAndArd for integrAting PersPeCtives 306

cLinicaL choices 306

Key terms 306

QuicK Quiz 307

LaunchPad 307

InfoCentral Body Dissatisfaction 287

MindTech Dark Sites of the Internet 294

PsychWatch The Sugar Plum Fairy 304

chapter : 10 Substance Use and Addictive Disorders 309 Depressants 311

Alcohol 311 Sedative-Hypnotic Drugs 316 opioids 316

Stimulants 319 Cocaine 319 Amphetamines 322 Stimulant Use Disorder 323

Hallucinogens, Cannabis, and Combinations of Substances 323

Hallucinogens 323 Cannabis 326 Combinations of Substances 328

What Causes Substance Use Disorders? 330 Sociocultural Views 330 Psychodynamic Views 330 Cognitive-Behavioral Views 331 Biological Views 332

How Are Substance Use Disorders Treated? 334 Psychodynamic Therapies 335 Behavioral Therapies 335 Cognitive-Behavioral Therapies 337 Biological Treatments 337 Sociocultural Therapies 339

Other Addictive Disorders 342 Gambling Disorder 342 Internet Gaming Disorder: Awaiting official Status 343

Putting it together: neW Wrinkles to A fAMiliAr story 343

cLinicaL choices 344

Key terms 344

QuicK Quiz 345

LaunchPad 345

PsychWatch College Binge Drinking: An Extracurricular Crisis 313

MindTech Neknomination Goes Viral 315

InfoCentral Smoking, Tobacco, and Nicotine 320

PsychWatch Club Drugs: X Marks the (Wrong) Spot 325

MediaSpeak Enrolling at Sober High 336

chapter : 11 Disorders of Sex and Gender 347 Sexual Dysfunctions 348

Disorders of Desire 348 Disorders of excitement 351 Disorders of orgasm 354 Disorders of Sexual Pain 358

Treatments for Sexual Dysfunctions 360 What Are the General Features of Sex Therapy? 360 What Techniques Are Used to Treat Particular

Dysfunctions? 363 What Are the Current Trends in Sex Therapy? 366

Paraphilic Disorders 367 Fetishistic Disorder 369 Transvestic Disorder 370 exhibitionistic Disorder 371 Voyeuristic Disorder 372 Frotteuristic Disorder 372 Pedophilic Disorder 372 Sexual masochism Disorder 374 Sexual Sadism Disorder 375

Gender Dysphoria 376 explanations of Gender Dysphoria 378 Treatments for Gender Dysphoria 378

Putting it together: A PrivAte toPiC drAWs PuBliC Attention 382

cLinicaL choices 382

Key terms 382

QuicK Quiz 383

LaunchPad 383

InfoCentral Sex Throughout the Life Cycle 350

PsychWatch Sexism, Viagra, and the Pill 365

CONTENTS : xv

MindTech “Sexting”: Healthy or Pathological? 368

MediaSpeak A Different Kind of Judgment 380

chapter : 12 Schizophrenia 385 The Clinical Picture of Schizophrenia 387

What Are the Symptoms of Schizophrenia? 387 What Is the Course of Schizophrenia? 391

How Do Theorists Explain Schizophrenia? 392 Biological Views 393 Psychological Views 398 Sociocultural Views 399

How Are Schizophrenia and Other Severe Mental Disorders Treated? 401

Institutional Care in the Past 403 Institutional Care Takes a Turn for the Better 404 Antipsychotic Drugs 406 Psychotherapy 409 The Community Approach 411

Putting it together: An iMPortAnt lesson 418

cLinicaL choices 418

Key terms 419

QuicK Quiz 419

LaunchPad 419

InfoCentral Hallucinations 390

PsychWatch Postpartum Psychosis: The Case of Andrea Yates 394

MindTech Can Computers Develop Schizophrenia? 396

PsychWatch Lobotomy: How Could It Happen? 405

MindTech Putting a Face on Auditory Hallucinations 410

MediaSpeak “Alternative” Mental Health Care 416

chapter : 13 Personality Disorders 421 “Odd” Personality Disorders 424

Paranoid Personality Disorder 425 Schizoid Personality Disorder 427 Schizotypal Personality Disorder 428

“Dramatic” Personality Disorders 431 Antisocial Personality Disorder 431 Borderline Personality Disorder 436

Histrionic Personality Disorder 441 narcissistic Personality Disorder 444

“Anxious” Personality Disorders 447 Avoidant Personality Disorder 447 Dependent Personality Disorder 450 obsessive-Compulsive Personality Disorder 452

Multicultural Factors: Research Neglect 454

Are There Better Ways to Classify Personality Disorders? 455

The “Big Five” Theory of Personality and Personality Disorders 456

“Personality Disorder—Trait Specified”: Another Dimensional Approach 458

Putting it together: disorders of PersonAlity—redisCovered And reConsidered 460

cLinicaL choices 460

Key terms 460

QuicK Quiz 461

LaunchPad 461

PsychWatch Mass Murders: Where Does Such Violence Come From? 434

MediaSpeak The Patient as Therapist 440

MindTech Selfies: Narcissistic or Not? 446

InfoCentral Lying 457

chapter : 14 Disorders Common Among Children and Adolescents 463 Childhood and Adolescence 464

Childhood Anxiety Disorders 465 Separation Anxiety Disorder 467 Treatments for Childhood Anxiety Disorders 468

Childhood Depressive and Bipolar Disorders 469 major Depressive Disorder 469 Bipolar Disorder and Disruptive mood

Dysregulation Disorder 471

Oppositional Defiant Disorder and Conduct Disorder 473

What Are the Causes of Conduct Disorder? 474 How Do Clinicians Treat Conduct Disorder? 474

Elimination Disorders 476 enuresis 476 encopresis 476

: CONTENTSxvi

Neurodevelopmental Disorders 479 Attention-Deficit/Hyperactivity Disorder 479 Autism Spectrum Disorder 483 Intellectual Disability 488

Putting it together: CliniCians DisCover ChilDhooD anD aDolesCenCe 498

CliniCal ChoiCes 498

Key terms 499

QuiCK Quiz 499

launChPad 499

InfoCentral Child and Adolescent Bullying 466

MindTech Parent Worries on the Rise 470

PsychWatch Child Abuse 478

PsychWatch A Special Kind of Talent 485

PsychWatch Reading and ‘Riting and ‘Rithmetic 491

chapter : 15 Disorders of Aging and Cognition 501 Old Age and Stress 502

Depression in Later Life 503

Anxiety Disorders in Later Life 505

Substance Misuse in Later Life 505

Psychotic Disorders in Later Life 508

Disorders of Cognition 509 Delirium 509 Alzheimer’s Disease and Other Neurocognitive

Disorders 511

Issues Affecting the Mental Health of the Elderly 522

Putting it together: CliniCians DisCover the elDerly 524

CliniCal ChoiCes 524

Key terms 525

QuiCK Quiz 525

launChPad 525

PsychWatch The Oldest Old 503

InfoCentral The Aging Population 506

MindTech Remember to Tweet; Tweet to Remember 510

MediaSpeak Focusing on Emotions 521

chapter : 16 Law, Society, and the Mental Health Profession 527 Law and Mental Health 528

How Do Clinicians Influence the Criminal Justice System? 528

How Do the Legislative and Judicial Systems Influence Mental Health Care? 536

In What Other Ways Do the Clinical and Legal Fields Interact? 541

What Ethical Principles Guide Mental Health Professionals? 544

Mental Health, Business, and Economics 546 Bringing Mental Health Services to the Workplace 546 The Economics of Mental Health 546

Technology and Mental Health 548 The Person Within the Profession 550

Putting it together: operating Within a larger system 552

Key terms 553

QuiCK Quiz 553

launChPad 553

PsychWatch Famous Insanity Defense Cases 531

PsychWatch Serial Murderers: Madness or Badness? 543

MindTech New Ethics for a Digital Age 549

InfoCentral Personal and Professional Issues 551

Glossary G-1 References R-1 Credits C-1 Name Index NI-1 Subject Index SI-1

xvii

It was the spring of 1981. Over the previous eight months, the Philadelphia Phillies had won the World Series, and the Eagles, Sixers, and Flyers had made it to the Super Bowl, NBA Finals, and Stanley Cup Finals, respectively. I had two adorable children ages 5 and 3. I had been granted tenure at Princeton. My life was full—or so I thought.

Then, Linda Chaput, at that time an editor at W. H. Freeman and Company and Worth Publishers, walked into my office. During a lively discussion, she and I discovered that we had similar ideas about how abnormal psychology should be presented in a textbook. By the time Linda departed two hours later, we had out- lined the principles that should underlie the “ideal” abnormal psychology textbook. We had, in effect, a deal. All that was left was for me to write the book. A decade later, the first edition of Abnormal Psychology (“the BOOK,” as my family and I had come to call it) was published, followed a few years later by the first edition of Fundamentals of Abnormal Psychology.

As I look back to that fateful day in 1981, I cannot help but note that several things have changed. With a few exceptions, my Philadelphia sports teams have returned to form and have struggled year in, year out. My sons have become ac- complished middle-aged men, and their previous “adorable” tag is now worn by my 2-year-old and 4-year-old grandchildren, Emmett and Delia. I am older, humbler, and a bit more fatigued than the person who met with Linda Chaput 35 years ago.

At the same time, several wonderful things remain the same. I am still at Princeton University. I am still married to the same near-perfect person—Marlene Comer. And I still have the privilege of writing abnormal psychology textbooks— Fundamentals of Abnormal Psychology and Abnormal Psychology. The current version, Fundamentals of Abnormal Psychology, Eighth Edition, represents my eighteenth edi- tion of one or the other of the textbooks.

My textbook journey has been a labor of love, but I also must admit that each edition requires enormous effort, ridiculous pressure, and too many sleepless nights to count. I mention these labors not only because I am a world-class whiner but also to emphasize that I approach each edition as a totally new undertaking rather than as a cut-and-paste update of past editions. I work feverishly to make each edi- tion fresh and to include innovative and enlightening pedagogical techniques.

With this in mind, I have added an enormous amount of new material and many exciting new features for this edition of Fundamentals of Abnormal Psychology—while at the same time retaining the successful themes, material, and techniques that have been embraced enthusiastically by past readers. The result is, I believe, a book that will excite readers and speak to them and their times. I have again tried to convey my passion for the field of abnormal psychology, and I have built on the generous feedback of my colleagues in this undertaking—the students and professors who have used this textbook over the years.

New and expanded Features

In line with the many changes that have occurred over the past several years in the fields of abnormal psychology, education, and publishing, and in the world, I have brought the following new features and changes to the current edition.

•NEW• DSM-5 With the publication of DSM-5, abnormal psychology is clearly a field in transition. To help students appreciate the field’s current status and new

PrefACe

: PREFACExviii

directions, I present, integrate, and analyze DSM-5 material throughout the text- book. Controversy aside, this is now the field’s classification and diagnostic system, and it is important that readers understand and master its categories and criteria, appreciate its strengths and weaknesses, and recognize its assumptions and implica- tions, just as past readers learned about previous DSM editions.

DSM-5, as well as discussions of its implications and controversial nature, is pre- sented in various ways throughout my textbook. First, its new categories, criteria, and information are woven smoothly into the narrative of each and every chapter. Second, reader-friendly pedagogical tools throughout the textbook, including a two-page infographic on the inside front cover and regular short features called Dx Checklist and DSM-5 Controversy, help students fully grasp the DSM-5 mate- rial. Third, special topic boxes highlight DSM-5 issues and controversies, such as Premenstrual Dysphoric Disorder: Déjà Vu All Over Again (page 209) and Mass Murders: Where Does Such Violence Come From? (page 434).

•NEW• TECHNOLOGY AND THE “MindTech” FEATURE The breathtaking rate of technological change that characterizes today’s world has had significant effects on the mental health field. In this edition I cover this impact extensively, including many discussions in the book’s narrative, boxes, photographs, and figures. The book examines, for example, how the Internet, texting, and social networks have become convenient tools for those who wish to bully others or pursue pedophilic desires (pages 373, 465, 466); how social networking may provide a new source for social anxiety (page 129); and how today’s technology has helped create new psychologi- cal disorders such as Internet addiction (page 343). It also looks at dangerous new trends such as the posting of self-cutting videos on the Internet (page 225), and it informs the reader about cybertherapy in its ever-expanding forms—from Skype therapy and avatar therapy to virtual reality treatments (pages 57, 67, 163, 410).

In addition, I have added a new feature throughout the book called MindTech— sections in each chapter that give special attention to particularly provocative tech- nological trends in engaging and enlightening ways. The MindTech features examine the following cutting-edge topics:

• Mental Health Apps Explode in the Marketplace (page 21)

• Social Networking Sites: A Researcher’s Paradise? (page 24)

• Have Your Avatar Call My Avatar (page 67)

• Rorschach on Wikipedia: Psychology’s Wiki Leaks? (page 83)

• Social Media Jitters (page 129)

• Virtual Reality Therapy: Better Than the Real Thing? (page 163)

• Texting: A Relationship Buster? (page 207)

• Crisis Texting (page 243)

• Can Social Media Spread “Mass Hysteria”? (page 255)

• Dark Sites of the Internet (page 294)

• Neknomination Goes Viral (page 315)

• “Sexting”: Healthy or Pathological? (page 368)

• Can Computers Develop Schizophrenia? (page 396)

• Putting a Face on Auditory Hallucinations (page 410)

• Selfies: Narcissistic or Not? (page 446)

• Children Online: Parent Worries on the Rise (page 470)

PREFACE : xix

• Remember to Tweet: Tweet to Remember (page 510)

• New Ethics for a Digital Age (page 549)

•NEW• “INFOCENTRALS” It is impossible to surf the Internet, watch TV, or flip through a magazine without coming across infographics, those graphic representa- tions that present complex data in quick, stimulating, and visually appealing ways. Infographics present information in a way that allows us to easily recognize trends and patterns and make connections between related concepts. With the develop- ment of new digital tools over the past decade, the popularity of infographics has exploded. Readers and viewers like them and learn from them.

Thus Fundamentals of Abnormal Psychology, Eighth Edition, introduces a new fea- ture called InfoCentral—numerous, lively infographics on important topics in the field. The infographics provide visual representations of data related to key topics and concepts in each chapter, repeatedly offering fascinating snippets of informa- tion to spur readers’ interest. I am certain that readers will greatly enjoy these special offerings, while also learning from them.

Every chapter features a full-page InfoCentral, including the following ones:

• Happiness (page 19)

• Dietary Supplements: An Alternative Treatment (page 43)

• Common Factors in Therapy (page 101)

• Mindfulness (page 115)

• Sexual Assault (page 156)

• Sadness (page 185)

• The Right to Commit Suicide (page 240)

• Sleep and Sleep Disorders (page 264)

• Body Dissatisfaction (page 287)

• Smoking and Tobacco Use (page 320)

• Sex Throughout the Life Cycle (page 350)

• Hallucinations (page 390)

• Lying (page 457)

• Bullying (page 466)

• The Aging Population (page 506)

• Personal and Professional Issues (page 551)

•NEW• ADDITIONAL CUTTING-EDGE BOXES I have grouped the book’s other boxes into two categories: PsychWatch boxes examine text topics in more depth, emphasize the effect of culture on mental disorders and treatment, and explore ex- amples of abnormal psychology in movies, the news, and the real world. MediaSpeak boxes offer provocative pieces by news, magazine, and Web writers and bloggers on current issues in abnormal psychology. In addition to updating the PsychWatch and MediaSpeak boxes that have been retained from the previous edition, I have added many new ones. For example, new MediaSpeak boxes include the following:

• Flawed Study, Gigantic Impact (Chapter 1)

• Saving Minds Along with Souls (Chapter 2)

• The Fear Business (Chapter 4)

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• Immigration and Depression in the 21st Century (Chapter 6)

• When Doctors Discriminate (Chapter 8)

•NEW• “CLINICAL CHOICES” INTERACTIVE CASE STUDIES This eighth edi- tion of Fundamentals of Abnormal Psychology includes 11 new interactive case studies (one for each of the disorders chapters), available online through LaunchPad, our online course management system. Through an immersive mix of video, audio, and assessment, each interactive case allows the student to simulate the thought process of a clinician by identifying and evaluating a virtual “client’s” symptoms, gather- ing information about the client’s life situation and family history, determining a diagnosis, and formulating a treatment plan. The student will also answer various questions about each case to help reinforce the chapter material. Each answer will trigger feedback, guidance, and critical thinking in an active learning environment.

•NEW• ADDITIONAL AND EXPANDED TEXT SECTIONS Over the past few years, a number of topics in abnormal psychology have received special attention. In this edition, I have provided new sections on such topics, including the psychology of mass killings (pages 434), the impact of the Affordable Care Act (pages 17, 547), the growing role of IRBs (pages 32–33), dimensional diagnoses (pages 94, 456–459), new treatments in the field (pages 30, 57, 410), spirituality and mental health (pages 61, 62), overuse of certain diagnoses (pages 471, 492), the psychological price of celebrity (pages 200, 231), transgen- der issues (pages 376, 381), alternative views of personality disorders (pages 455–459), self-injury (pages 224, 437), the pro-Ana movement (page 294), poor medical treatment for people with psychological disorders (page 270), ethics and psychology (pages 544–546), culture and abnormality (pages 71, 454), race and the clinical field (pages 107–108), and sexism in the clinical field (pages 209, 365).

•NEW• ADDITIONAL CASE MATERIAL One of the hallmarks of my textbooks is the inclusion of numerous and culturally diverse clinical examples that bring theoretical and clinical issues to life. In my continuing quest for relevance to the reader and to today’s world, I have replaced or revised more than one-third of the clinical material in this edition. The new clinical material includes the cases of Franco, major depressive disorder (pages 77, 79); Tonya, Munchausen syndrome by proxy (page 252); Meri, major depressive disorder (page 183); Eduardo, paranoid personality disorder (page 425); Luisa, dissociative personality disorder (page 170); Kay, bipolar disorder (page 216); Shani, anorexia nervosa (page 279); Ricky, ADHD (page 463); Lucinda, histrionic personality disorder (pages 441–442); Jonah, separa- tion anxiety disorder (pages 467–468); and many others.

•NEW• CRITICAL THOUGHT QUESTIONS A very stimulating and popular feature of my previous edition of Fundamentals of Abnormal Psychology was the “critical thought questions”—questions that pop up within the text narrative, asking stu- dents to pause at precisely the right moment and think critically about the material they have just read. Given the enthusiastic response to this feature by professors and readers alike, I have added many new critical thought questions throughout the textbook, including ones in the MindTech and MediaSpeak features.

•NEW• “BETWEEN THE LINES” The textbook not only retains but also expands a fun and thought-provoking feature from past editions that has been very popu- lar among students and professors—reader-friendly elements called “Between the Lines,” consisting of text-relevant tidbits, surprising facts, current events, historical notes, interesting trends, enjoyable lists, and stimulating quotes.

•NEW• THOROUGH UPDATE In this edition I present the most current theories, research, and events, including more than 2,000 new references from the years 2013–2015, as well as hundreds of new photos, tables, and figures.

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•EXPANDED COVERAGE• PREVENTION AND MENTAL HEALTH PROMOTION In accord with the clinical field’s growing emphasis on prevention, positive psychol- ogy, and psychological wellness, I have increased the textbook’s attention to these important approaches (for example, pages 16–17, 19, 524).

•EXPANDED COVERAGE• MULTICULTURAL ISSUES Over the past 30 years, clinical theorists and researchers increasingly have become interested in ethnic, racial, gen- der, and other cultural factors, and my previous editions of Fundamentals of Abnormal Psychology certainly have included these important factors. The study of such factors has, appropriately, been elevated to a broad perspective in recent years—the multicul- tural perspective. Consistent with this clinical movement, the current edition includes yet additional multicultural material and research throughout the text. Even a quick look through the pages of this textbook will reveal that it truly reflects the diversity of our society and of the field of abnormal psychology.

•EXPANDED COVERAGE• “NEW-WAVE” COGNITIVE AND COGNITIVE- BEHAVIORAL THEORIES AND TREATMENTS The current edition of Abnormal Psychology has expanded its coverage of the “new-wave” cognitive and cognitive- behavioral theories and therapies, including mindfulness-based cognitive therapy and Acceptance and Commitment Therapy (ACT), presenting their propositions, techniques, and research in chapters throughout the text (for example, pages 56, 114, 115, 410).

•EXPANDED COVERAGE• NEUROSCIENCE The clinical field continues to witness the growth and impact of remarkable brain-imaging techniques, genetic map- ping strategies, and other neuroscience approaches, all of which are expanding our understanding of the brain. Correspondingly, the new edition of Fundamentals of Abnormal Psychology has further expanded its coverage of how biochemical factors, brain structure, brain function, and genetic factors contribute to abnormal behavior (for example, pages 39, 116, 118, 393).

continuing Strengths

As I noted earlier, in this edition I have also retained the themes, material, and techniques that have worked successfully and have been embraced enthusiastically by past readers.

BREADTH AND BALANCE The field’s many theories, studies, disorders, and treat- ments are presented completely and accurately. All major models—psychological, biological, and sociocultural—receive objective, balanced, up-to-date coverage, without bias toward any single approach.

INTEGRATION OF MODELS Discussions throughout the text, particularly those headed “Putting It Together,” help students better understand where and how the various models work together and how they differ.

EMPATHY The subject of abnormal psychology is people—very often people in great pain. I have tried therefore to write always with empathy and to impart this awareness to students.

INTEGRATED COVERAGE OF TREATMENT Discussions of treatment are pre- sented throughout the book. In addition to a complete overview of treatment in the opening chapters, each of the pathology chapters includes a full discussion of relevant treatment approaches.

RICH CASE MATERIAL As I mentioned earlier, the textbook features hundreds of culturally diverse clinical examples to bring theoretical and clinical issues to life.

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More than 25 percent of the clinical material in this edition is new or revised significantly.

MARGIN GLOSSARY Hundreds of key words are defined in the margins of pages on which the words appear. In addition, a traditional glossary is available at the back of the book.

ROLLING SUMMARIES Instead of waiting until the end of a chapter for a summary, SUMMING UP sections appear throughout each chapter, at the completion of each major section, helping students to better retain the material under discussion.

“PUTTING IT TOGETHER” A section toward the end of each chapter, “Putting It Together,” asks whether competing models can work together in a more integrated approach and also summarizes where the field now stands and where it may be going.

FOCUS ON CRITICAL THINKING The textbook provides tools for thinking criti- cally about abnormal psychology. As I mentioned earlier, in this edition, “critical thought” questions appear at carefully selected locations within the text discussions. The questions ask readers to stop and think critically about the material they have just read.

CHAPTER-ENDING KEY TERMS AND QUICK QUIZ SECTIONS These sections, keyed to appropriate pages in the chapter for easy reference, allow students to re- view and test their knowledge of chapter materials.

STRIKING PHOTOS AND STIMULATING ILLUSTRATIONS Concepts, disorders, treatments, and applications are brought to life for the reader with stunning photo- graphs, diagrams, graphs, and anatomical figures—all reflecting the most up-to-date data available. The photos range from historical to today’s world to pop culture. They do more than just illustrate topics: they touch and move readers.

ADAPTABILITY Chapters are self-contained, so they can be assigned in any order that makes sense to the professor.

MeDIA and other Supplements

I have been delighted by the enthusiastic responses of both professors and students to the supplements that accompany my textbooks. This edition offers those supple- ments once again, revised and enhanced, and adds a number of exciting new ones.

FOR PROFESSORS

WORTH VIDEO COLLECTION FOR ABNORMAL PSYCHOLOGY Produced and edited by Ronald J. Comer, Princeton University, and Gregory Comer, Princeton Academic Resources. Faculty Guide included. This incomparable video series offers 128 clips that depict disorders, show historical footage, and illustrate clinical topics, pathologies, treatments, experiments, and dilemmas. Videos are available in LaunchPad and on the Video Collection for Abnormal Psychology Flash Drive. I also have written an ac- companying guide that fully describes and discusses each video clip, so that profes- sors can make informed decisions about the use of the segments in lectures.

INSTRUCTOR’S RESOURCE MANUAL by Charlie Harris, Clayton State University and Danielle Gunraj, SUNY Binghamton. This comprehensive guide ties together the ancillary package for professors and teaching assistants. The manual includes de- tailed chapter summaries, lists of principal learning objectives, topic overviews, ideas for lectures, lecture outlines, discussion launchers, classroom activities, extra credit

PREFACE : xxiii

projects, and DSM criteria for each of the disorders discussed in the text. It also offers strategies for using the accompanying media, including the video collection. Finally, it includes a comprehensive set of valuable materials that can be obtained from outside sources—items such as relevant feature films, documentaries, teaching references, and Internet sites related to abnormal psychology.

• Lecture Slides available at http://www.macmillanhighered.com/Catalog/product/ fundamentalsofabnormalpsychology-eighthedition-comer. These slides focus on key concepts and themes from the text and can be used as-is or customized to fit a professor’s needs.

• Illustration Slides available at http://www.macmillanhighered.com/Catalog/product/ fundamentalsofabnormalpsychology-eighthedition-comer. These slides featuring all chap- ter photos and illustrations can be used as is or customized to fit a professor’s needs.

• Chapter Figures, Photos, and Tables available at http://www. macmillanhighered. com/Catalog/product/fundamentalsofabnormalpsychology-eighthedition-comer. This col- lection gives professors access to all of the photographs, illustrations, and tables from Fundamentals of Abnormal Psychology, Eighth Edition.

ASSESSMENT TOOLS

TEST BANK by Chrysalis Wright, University of Central Florida. A comprehensive test bank offers more than 2,200 multiple-choice, fill-in-the-blank, and essay questions. Each question is graded according to difficulty, the Bloom’s level is identified, and keyed to the topic and page in the text where the source information appears.

DIPLOMA ONLINE COMPUTERIZED TEST BANK Available for both Windows and Macintosh at http://www.macmillanhighered.com/Catalog/product/fundamentalsofab- normalpsychology-eighthedition-comer. This downloadable Test Bank guides professors step-by-step through the process of creating a test and allows them to add an un- limited number of questions, edit or scramble questions, format a test, and include pictures and multimedia links. The accompanying grade book enables them to record students’ grades throughout the course and includes the capacity to sort student records and view detailed analyses of test items, curve tests, generate re- ports, add weights to grades, and more. These Test Bank files also provide tools for converting the Test Bank into a variety of useful formats as well as Blackboard- and WebCT-formatted versions of the Test Bank for Fundamentals of Abnormal Psychology, Eighth Edition.