What is Abnormal Behaviour?

The difference between normal and abnormal tends to be problematic. Judgements about where the line between normal and abnormal should be drawn tend to differ depending on the time and culture. For example, cannibalism has been practised in many cultures around the world; however, in contemporary Western culture, such behaviour would be viewed as pathological behaviour.

Homosexuality was officially considered to be a mental illness until the 15th of December, 1973, when the American Psychiatric Association removed it from the psychiatric classification system. However, despite the formal change in the psychiatric status of this sexual orientation, some people continue to view homosexuality as an indication of psychological disturbance, illustrating to some the arbitrary nature of abnormality judgements.

Abnormal Behaviour

Despite the arbitrariness of time, place, and value judgements, three criteria—distress, dysfunction, and deviance—seem to govern decisions concerning abnormality, and one or more of them seem to apply to virtually any behaviour that is regarded abnormal. First, we are likely to label behaviours as abnormal if they cause intense distress to the individual. Individuals who tend to be excessively anxious, depressed, or dissatisfied—or otherwise seriously upset about themselves or about life circumstances—could be viewed disturbed, particularly if such individuals seem to have little control over their reactions.

On the other hand, one's personal distress is neither sufficient nor necessary in definition of abnormality, as some seriously disturbed mental patients are so out of touch with reality, making them experience little distress; but their bizarre behaviours are considered to be very abnormal. And although all of us experience suffering as part of our lives, our distress is not likely to be judged as abnormal unless it is disproportionately intense or long-lasting in relevance to the situation.

Second, the behaviours judged most abnormal are dysfunctional behaviours, either for the individual or for society. Behaviours causing interference in an individual's ability to work, or keep satisfying relationships with other individuals, are likely to be seen as maladaptive and self-defeating, especially if such an individual seems unable to control such behaviours. Some behaviours are labelled as abnormal because they interfere with the well-being of society. However, even here, the standards aren't cut and dried. For example, is a suicide bomber who detonates a bomb in a public place a psychologically-disturbed criminal?

The third criteria used for abnormality is the judgement of society concerning the deviance of a given behaviour. Conduct within every society is regulated by norms; behavioural rules which specify the manner in which people are expected to think, feel, and behave. Some norms are explicit codes of law; making violation of these norms to be defined as criminal behaviour. However, other norms are far less explicit. For example, it is generally expected in our culture for one not to carry on animated conversations with individuals who are not present, nor should one face the rear of an elevator staring intently into the eyes of a fellow passenger (don't try this unless you expect to see an elevator empty out quickly. Individuals who violate these unstated norms are viewed as psychologically disturbed, especially if the violations makes other people uncomfortable, which cannot be attributed to environmental causes.

In summary, both personal and social judgements of behaviour enter into considerations of what is considered abnormal behaviour. Thus, we may define abnormal behaviour as behaviour which causes personal distress, personal dysfunction, and/or is so culturally deviant that it makes other people judge it to be inappropriate or maladaptive.

Diagnosis of Psychological Disorders

Classification is a necessary first step towards introducing order into discussions of the nature, causes, and treatment of psychological disorders. In order to be scientifically and practically useful, a classification system needs to meet standards of diagnostic reliability and validity. Reliability means that a clinician using the system should show high levels of agreement in their diagnostic decisions, because professionals with different types and amounts of training—including social workers, psychiatrists, psychologists, and physicians—make diagnostic decisions.

Furthermore, the system needs to be couched in terms of observable behaviour, which can be in order to minimise subjective judgements. Validity means that diagnostic categories need to accurately capture the essential features of various disorders. Thus, if according to research and clinical observations, if a given disorder displays four characteristics, the diagnostic category for that disorder should also have those four features. Moreover, diagnostic categories should allow differentiation of one psychological disorder from another.

Reflecting on awareness of interacting personal and environmental factors, the DSM allows diagnostic information to be represented along five dimensions, or axes, taking both the person and his or her life situation into account. Axis I is the primary diagnosis. It represents the individual's primary clinical symptoms, which is the deviant behaviour of thought processes occurring at the present moment. Axis II represents longstanding personality disorders or mental retardation, both of which can influence this individual's response and behaviour to treatment. Axis III notes any relevant medical conditions such as high blood pressure or a recent concussion. According to the reflection of the stress model, a clinician also rates the intensity of recent psychological/environmental problems and coping resources in the individual's life on Axis IV.

Historical Perspectives on Mental Disorders

According to historical findings, psychological disorders are not just a modern issue. There are historical pages filled with accounts of prominent people who had suffered from such disorders.

For example, one description is in the Bible about King Saul's raging madness and terrors. The 18th-century French philosopher Jean-Jacques Rousseau developed marked paranoid symptoms in the latter part of his life, which plagued him with fears of secret enemies. Mozart was convinced that he was being poisoned during the period of his composing of Requiem.

Abraham Lincoln had suffered frequent bouts of depression throughout his life. At one occasion, he had been so depressed that he failed to show up at his wedding. Winston Churchill, too, periodically suffered from severe bouts of depression, which he referred to as his 'black dog'. The billionaire aviator Howard Hughes became so terrified of being infected by germs that he ended up a bedridden recluse in the last decade of his life.

Assumptions on Supernatural Forces

This sort of dysfunctional behaviour doesn't go unnoticed. Throughout history, human societies have explained and responded to abnormal behaviours in different ways, at different times, based on their values and assumptions on human life and behaviour. The belief of abnormal behaviour being caused by supernatural forces dates back to the ancient Egyptians, Hebrews, and Chinese.

For example, one ancient treatment based on the notion of bizarre behaviour being the reflection of an evil spirit's attempt to escape from a person's body. In order to release this spirit, a procedure called trephination was performed. This was carried out with the help of a sharp tool, which was used to chisel a hole in that person's skull. The hole was about 2 centimetres in diameter. It seems likely that in many cases, the administration of trephination ended the patient's life.

In Medieval Europe, the demonological model of abnormality believed that disturbed individuals were either possessed involuntarily by the devil or had voluntarily made a pact with dark forces. The killing of witches was justified in various 'diagnostic' tests and theological grounds. Examples of such tests include the binding of a woman's hands and feet throwing her into a lake or pond.

This was based on the notion that while impurities floated to the surface, a woman who would sink and drown could be posthumously declared pure. This meant that while the pure drowned, the others thought to be witches due to floating on top wouldn't be spared either. During the 16th and 17th centuries, more than a 100,000 people afflicted by psychological disorders were identified as witches, hunted down, and executed.

Biological Links

Centuries earlier, around 5th century B.C., famous Greek physician Hippocrates suggested that mental illnesses were just like physical diseases. In anticipation of the modern viewpoint, Hippocrates believed the site of mental illness to be the brain. By the time of the 1800s, Western medicine had returned to viewing mental disorders as biologically based and attempted to extend medical diagnoses to them. The biological emphasis was given impetus by the discovery of General Paresis, a disorder characterised in its advanced stages by mental deterioration and bizarre behaviour, resulting from massive brain deterioration caused by Syphilis. This was a breakthrough as the first demonstration of a psychological disorder being caused by a physical malady.

In the early 1900s, Sigmund Freud's theory of psychoanalysis ushered in psychological interpretations of disordered behaviour. Psychodynamic theories of abnormal behaviour were soon joined in by other models based on behavioural, cognitive, and humanistic conceptions. These various conceptions focused on different classes of causal factors and help in capturing the complex determinants of abnormal behaviour. The importance of cultural factors has received increased attention, too. Although, still, many questions remain, these perspectives have given us a deeper understanding of the way biological, psychological, and environmental factors can combine to cause psychological disorders.

Today, many psychologists find it useful to incorporate these factors into a more generalised framework. According to the Vulnerability-Stress Model, each of us has some degree of vulnerability, ranging from very low to very high, to developing a psychological disorder, faced with sufficient amount of stress. The vulnerability can have a biological basis, such as our genotype, over or underactivity of neurotransmitters in the brain, a hair-trigger autonomic nervous system, or hormonal factor. It may also be due to a personality factor, such as low self-esteem or extreme pessimism, or due to previous environmental factors such as poverty, severe trauma, or loss. Cultural factors, too, can create vulnerability to certain kinds of disorders (Ingram & Price).

However, vulnerability happens to be only part of the equation. In most instances, a predisposition creates a disorder only when a stressor, such as a recent event which requires a person to cope, combined with a vulnerability to trigger the disorder (Van Praag). Thus, a person with a genetic predisposition to depression, or who suffered a traumatic loss of a parent early in life, may be primed to develop a depressive disorder, if faced with a stressor or a loss later in life. In conclusion, biological, psychological, and environmental levels of analysis have all contributed to the Vulnerability-Stress Model, as well as to our understanding of behavioural disorders and their development.

Childhood Disorders: Diagnosis of ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex psychological childhood disorder. Left untreated, ADHD can affect a child's overall life, continuing into adulthood. If you suspect you or your child to be suffering from ADHD, talk to your general practitioner (GP). But its best to first talk with your child's teachers and find out if there has been any change in their behaviour. General practitioners (GP) are not formally equipped to diagnose ADHD, but they can discuss your concerns with you and refer your child to a specialist.

Questions Asked by Your GP

• You or your child's symptoms
• The time duration of the start of symptoms
• The place the symptoms occur; at home or at school
• If the symptoms affect you or your child's day-to-day lives
• Significant occurrences in your or your child's life, such as a death or divorce
• If there is a family history of ADHD

 The Next Step

If your GP suspects ADHD in your child, he or she may suggest to you a period of' watchful waiting, lasting for around 10 weeks, in order to see if the child's symptoms improve, stay the same, worsen. They may also suggest starting a group-based ADHD parent-training or educational programme.

The offering of parent-training and educational programmes is not meant to make you feel that you are a bad parent who has failed your child, but to teach you ways in order to help you help your child, and yourself. If your child's condition doesn't seem to improve despite your efforts, and if you believe that it's affecting your day-to-day lives, your GP will refer you and your child to a specialist for a formal assessment.

Formal Assessment

There are a number of different specialists that you and your child may be refereed to in order to get a formal assessment, which includes:

• Child/adult psychiatrist
• Paediatrician
• Learning disability specialist
• Social worker
• Occupational therapist

The reference depends on age and availability in the local area.

There is no simple test to determine whether you or your child has ADHD, but your specialist will be able to determine an accurate diagnosis after a detailed assessment of you or your child, which may include:

• Physical examination (to help rule out other possible causes)
• Series of interviews with you/your child
• Interviews with other parties (teachers, parents and partners)

Diagnosis in Children and Teenagers

Diagnosing ADHD in children depends on a set of strict criteria. In order to diagnose a child with ADHD, he or she also needs to display six or more symptoms of inattentiveness, or six or more symptoms of impulsiveness and hyperactivity.

In order to be diagnosed with ADHD your child will also need to be:

• Displaying symptoms continuously for at least 6 months
• Have symptoms before the age of 12
• Have shown symptoms in at least two different settings (home and school, in order to rule out the possibility of the behaviour being a reaction to certain teachers and parental control)
• Symptoms that make their lives to be considerably more difficult on social, academic, and occupational level
• Symptoms which are not just part of a developmental disorder, or difficult phase and are not better accounted for by another condition

Diagnosis in adults

Diagnosing ADHD in adults is a difficult process due to some disagreements; whether the list of symptoms used to diagnose children and teenagers are viable for adult diagnosis of ADHD. In some cases, adults may be diagnosed with ADHD on the likelihood of them showing five or more symptoms of inattentiveness, or five or more symptoms of impulsiveness and hyperactivity, which are listed as the symptoms of child ADHD diagnostic criteria.

As part of your assessment, the specialist will ask about your present symptoms. Under current diagnostic guidelines, however, you can't be diagnosed with ADHD unless your symptoms were present from childhood.

If you are unable to remember whether you had problems during your childhood, or whether you weren't diagnosed with ADHD as a child, the specialist may request to see your old school records or talk to your teachers, parents, or anyone else who knew you well as a child.

In order for an adult to be diagnosed with ADHD, their symptoms need to have a moderate effect on different areas of their lives:

• Underachieving in education or work
• Difficulty in relationships with partners
• Difficulty in making or keeping friends
• Driving dangerously

If your problems are recent, with no regular past occurrence, you won't be considered as having ADHD. The reason for this being the current belief of ADHD not being able to develop for the first time as an adult.

(Source: https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/diagnosis/)

Childhood Disorders: Causal Factors of ASD

Leo Kanner, who was the first to identify autism in 1943, offered a psychodynamic explanation for it. According to his speculation, the reasons for children to be driven into their own worlds were cold and ungiving family environments during their infancy. Their parents (the mothers, in particular), were described as 'refrigerator parents', who had thawed out just long enough to conceive a child.

These were purely theoretical statements, with no evidence of the existence of such family patterns. But generations of parents who were exposed to this hypothesis suffered from the thought that they were the cause of their children's autistic condition. While scientists can't pinpoint the exact causes of Autism Spectrum Disorder (ASD), it is believed that genes, as well as environmental factors, may act together in affecting the ways in which ASD develops. However, scientists are still trying to understand the reason for which some individuals develop ASD while others do not. One in 68 children in the USA are diagnosed with Autism.

Biological factors

According to Kabot, today, it is widely-accepted that Autism has a biological basis, but these factors remain undetermined. However, there have been widespread abnormalities found in the structures and functioning of the brains in autistic children. For example, brain imaging studies show autistic children's brains to be larger than average, reflecting abnormal brain growth during the first year of life. These children also reveal abnormal development in their cerebellum, which coordinates movement and is also involved in the shifting of attention (Courchesne).

Genetic factors have been linked to autism with siblings of autistic children being 200 times more likely to have the disorder than those in the general population. According to Piven, the concordance rate is highest in identical twins. No single gene seems to be involved; instead, there may be multiple interacting genes. According to a notable finding by Rutter, many relatives of autistic children with no manifestation of the disorder themselves, tend to have unusual personality characteristics that parallel autism, including aloofness and very narrow and specialised interests.

Theory of Mind

Another line of research is the examination of autism from the Theory of Mind perspective. According to Ritblatt, the Theory of Mind refers to awareness of what others are thinking, as well as their 'internal reactions'. Normal children tend to be aware of other people's characteristics by the time they reach the age of 3 or 4. Autistic children, however, seem to have poorly-developed skills in this area, which makes it difficult for them to communicate with others or understand the internal reactions of other people towards them (Heerey).

Autistic children also show poor comprehension of other people's emotional responses, such as expressions of distress. The deficits mentioned in the Theory of Mind could severely impair their language and social development—which makes them a strong focus of current research on autism.

Risk factors:

• Having a sibling with ASD
• Being born to older parents
• Having certain genetic conditions (Down/Rett/Fragile X Syndromes)
• Very low birth rate

Diagnosis

ASD is diagnosed by looking at such a person's behaviour and development. By the time a child is 2 years old, ASD can be reliably diagnosed. It is important for concerned parties to seek out an assessment as soon as possible in order for a diagnosis to be made and treatment to begin as soon as possible for better treatment. Diagnosis in young children is often a two-stage process.

Stage I:General development screening during well-child checkups

Every child should have a well-child checkup by a paediatrician or an early childhood healthcare provider. The American Academy of Paediatrics recommends all children to be screened for development delays at their 9, 18, 24 or 30-month well-child visits and, specifically, for autism at their 18 and 24-month well-child visits. Additional screening may be needed in the case of a child being of high risk for Autism or development issues such as having a family member with ASD, having certain autistic behaviours or genetic conditions, having older parents, or low birth rates.

Parents’ experiences and concerns are of utmost importance in the screening process of young children. Doctors may ask parents questions about their child's behaviour in order to combine the answers with information from ASD screening tools, as well as his or her observations. Children who exhibit developmental problems during this screening process will be referred to a second stage evaluation.

Stage II:Additional evaluation

The second stage evaluation would be conducted by a team of doctors and healthcare professionals experienced in diagnosing ASD. This team may include a developmental pediatrician, such as a doctor who is specially trained in child development; a child psychologist and or psychiatrist (a doctor with specialised training in brain development and behaviour); a neuropsychologist (a doctor focusing in the evaluation, diagnosis, as well as and treatment of neurological, neurodevelopmental, and medical conditions); and a speech-language pathologist, a health professional with special training in communication difficulties.

The evaluation may cover, on a cognitive level, thinking skills, language abilities, as well as age-appropriate skills needed for completing daily activities independently (eating, dressing, and toileting). As ASD is a complex disorder sometimes occurring with other disorders, a comprehensive evaluation may include blood tests as well as hearing tests.