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Overview to Understanding
Abnormal Behavior
Learning Objectives
1.1 Distinguish between normal but unusual behavior and between unusual but abnormal behavior. 1.2 Understand how explanations of abnormal behavior have changed through time. 1.3 Articulate the strengths and weaknesses of research methods. 1.4 Describe types of research studies.
OUTLINE
Case Report: Rebecca Hasbrouck.... 3 What Is Abnormal Behavior?........ 4 The Social Impact of Psychological Disorders............ 5 Defining Abnormality.............. 6 What Causes Abnormal Behavior?.... 7 Biological Causes.............. 7 Psychological Causes........... 7 Sociocultural Causes............ 7 The Biopsychosocial Perspective... 8 Prominent Themes in Abnormal Psychology throughout History....... 9 Spiritual Approach.............. 9 Humanitarian Approach......... 10 Scientifi c Approach............ 12 Research Methods in Abnormal Psychology............. 14 Experimental Design.............. 14 Toward the DSM-5 : Definition of a Mental Disorder.............. 15 Correlational Design.............. 15 You Be the Judge: Being Sane in Insane Places............. 16 Types of Research Studies......... 17 Survey...................... 17 Real Stories: Vincent van Gogh: Psychosis............. 18 Laboratory Studies............ 19 The Case Study Method........ 20 Single Case Experimental Design. 20 Investigations in Behavioral Genetics.................... 20 Bringing It All Together: Clinical Perspectives............. 22 Return to the Case: Rebecca Hasbrouck..................... 22 Dr. Tobin’s Refl ections.......... 22 Summary...................... 23 Key Terms..................... 23
Demographic information: 18-year-old Cau- casian female. Presenting problem: Rebecca self-referred to the university psychotherapy clinic. She is a col- lege freshman, living away from home for the fi rst time. After the first week of school, Rebecca reports that she is having trouble sleeping, is hav- ing difficulty concentrating in her classes, and often feels irritable. She is frustrated by the diffi- culties of her coursework and states she is wor- ried that her grades are beginning to suffer. She also reports that she is having trouble making friends at school and that she has been feeling lonely because she has no close friends here with whom she can talk openly. Rebecca is very close to her boyfriend of three years, though they have both started attending college in different cities. She was tearful throughout our fi rst session, stat- ing that, for the first time in her life, she feels over- whelmed by feelings of sadness. She reports that although the first week at school felt like “tor- ture,” she is slowly growing accustomed to her new lifestyle, but she still struggles with missing her family and boyfriend, as well as her friends from high school. Relevant past history: Rebecca has no family history of psychological disorders. She reported that sometimes her mother tends to get “really
stressed out” though she has never received treatment for this. Symptoms: Depressed mood, difficulty falling asleep (insomnia), difficulty concentrating on schoolwork. She reported no suicidal ideation. Case formulation: Although it appeared at fi rst as though Rebecca was suffering from a major depressive episode, she did not meet the diag- nostic criteria. In order to qualify as a major depressive episode, individuals must display at least five out of the nine criteria, and she only dis- played three (insomnia, depressed mood, and dif- fi culty concentrating). While the age of onset for depression tends to be around Rebecca’s age, given her lack of a family history of depression and that her symptoms were occurring in response to a major stressor, the clinician determined that Rebecca was suffering from an Adjustment Disor- der with depressed mood. Treatment plan: The counselor will refer Rebecca for psychotherapy. Therapy should focus on improving her mood, and also should allow her a space to discuss her feelings surrounding the major changes that have been occurring in her life.
Sarah Tobin, PhD Clinician
CHAPTER
Case Report: Rebecca Hasbrouck
1.2 The Social Impact of Psychological Disorders 5
We hope that reading this textbook will help you go beyond this “other people” syn- drome. Psychological disorders are part of the human experience, touching the life— either directly or indirectly—of every person. As you read about these disorders and the people who suffer with them, you will find that most of these problems are treatable, and many are preventable.
1.2 The Social Impact of
Psychological Disorders
Put yourself in the following situation. An urgent message awaits you from Jeremy’s mother. Your best friend in high school, Jeremy has just been admitted to a psychiatric hospital and begs to see you, because only you can understand what he is going through. You are puzzled and distressed by this news. You had no idea that he had any psycho- logical problems. What will you say to him? Can you ask him what’s wrong? Can you ask him how he feels? Do you dare inquire about what his doctors have told him about his chances of getting better? What will it be like to see him in a psychiatric hospital? Do you think you could be friends with someone who has spent time in such a place? Now imagine the same scenario, but instead you receive news that Jeremy was just admitted to the emergency room of a general hospital with an acute appendicitis. You know exactly how to respond when you go to see him. You will ask him how he feels, what exactly is wrong with him, and when he will be well again. Even though you might not like hospitals very much, at least you have a pretty good idea about what hospital patients are like. It does not seem peculiar to imagine Jeremy as a patient in this kind of hospital. It would probably be much easier for you to understand and accept your friend’s physical illness than his psychological disorder, and you would probably not even consider whether you could be friends with him again after he is discharged. People with psychological disorders often face situations like Jeremy’s in which the people close to them aren’t sure how to respond to their symptoms. Even worse, they experience profound and long-lasting emotional and social effects even after their
The family of individuals with psychological disorders face significant stress when their relatives must be hospitalized.
6 Chapter 1 Overview to Understanding Abnormal Behavior
symptoms are brought under control and they can resume their former lives. They also must cope with the personal pain associated with the disorder itself. Th ink about Rebecca and her unhappiness. Rather than enjoying her newly found independence while at college like her classmates, she is experiencing extreme amounts of sadness and loneliness. She is unable to focus on her studies, make new friends, or even sleep. Social attitudes toward people with psychological disorders range from discomfort to outright prejudice. Language, humor, and stereotypes all portray psychological disorders in a negative light and people often fear that people suffering from these disorders are violent and dangerous. There seems to be something about a psychological disorder that makes people want to distance themselves from it as much as possible. The result of these stereotypes is social discrimination, which only serves to complicate the lives of the afflicted even more. In the chapters that follow, you will read about a wide range of disorders involving mood, anxiety, substance abuse, sexuality, and thought disturbance. The case descrip- tions will give you a glimpse into the feelings and experiences of people who have these disorders, and you may fi nd that some of these individuals seem similar to you or to people you know. As you read about the disorders, put yourself in the place of the people who have these conditions. Consider how they feel and how they would like people to treat them. We hope that you will realize that our discussion is not about disorders, but about the people with these disorders.
1.3 Defining Abnormality
How would you define abnormal behavior? Read the following examples. Which of these behaviors do you regard as abnormal?
- Finding a “lucky” seat in an exam
- Inability to sleep, eat, study, or talk to anyone else for days after a lover says, “It’s over between us”
- Breaking into a cold sweat at the thought of being trapped in an elevator
- Swearing, throwing pillows, and pounding fists on the wall in the middle of an argument with a roommate
- Refusing to eat solid food for days at a time in order to stay thin
- Engaging in a thorough hand-washing after coming home from a bus ride
- Believing that the government has agents who are eavesdropping on telephone conversations
- Drinking a six-pack of beer a day in order to be “sociable” with friends after work
If you’re like most people, you probably found it difficult to decide between normal and abnormal. It is surprisingly difficult to make this distinction, but it is important to establish some criteria for abnormality. The mental health community currently uses diagnostic procedures to decide on whether a given individual fits the criteria for abnormality. There are currently five cri- teria for a psychological disorder. The first is that of “clinical significance,” meaning that the behavior involves a measurable degree of impairment. Second, the individual must be experiencing distress or must be engaging in behaviors that present the risk of death, hospitalization, or incarceration. Third, the individual’s behavior cannot be a socially expectable response to a particular event such as the death of a close friend or relative. Fourth, the behavior must be linked to some underlying disturbance within the indi- vidual, whether psychological or biological. Fifth, the individual’s behavior cannot be defined solely in terms of social rebellion or deviance. Thus, in some oppressive political symptoms, people were “diagnosed” as having a psychological disorder when in reality, the government sought to find a way to silence protestors.
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gender, can influence the development of abnormal behavior. For people who are diag- nosed with a psychological disorder, social stigmas associated with being “mental patients” can further affect their symptoms. A stigma is a label that causes us to regard certain people as different, defective, and set apart from mainstream members of society. In addition to increasing the burden for them and for their loved ones, a stigma deters people from obtaining badly needed help, and thereby perpetuates a cycle in which many people in need become much worse. The stigma of psychological disorders affects people from ethnic and racial minorities more severely than those from mainstream society. For example, European-American adolescents and their caregivers are twice as likely as mem- bers of minority groups to define problems in mental health terms or to seek help for such problems (Roberts, Alegría, Roberts, & Chen, 2005).
The Biopsychosocial Perspective
Table 1.1 summarizes the three categories of the causes of abnormality. Disturbances in any of these areas of human functioning can contribute to the development of a psy- chological disorder. However, we cannot so neatly divide the causes of abnormality. There is often considerable interaction among the three sets of influences. Social scientists use the term biopsychosocial to refer to the interaction in which biological, psychological, and sociocultural factors play a role in the development of an individual’s symptoms. The biopsychosocial perspective incorporates a developmental viewpoint. This means that individuals must be seen as changing over time. Biopsycho- social factors interact to alter the individual’s expression of behavioral patterns over time. Thus, it is important to examine early risk factors that make an individual vulner- able to developing a disorder. Similarly, risk factors may vary according to the indi vidual’s position in the life span (Whitbourne & Meeks, 2011). As you will see when reading about the conditions in this textbook, the degree of influence of each of these variables differs from disorder to disorder. For some disorders, such as schizophrenia, biology plays a dominant role. For other disorders, such as stress reactions, psychological factors predominate. For other conditions, such as post- traumatic stress disorder, that result, for example, from experiences under a terrorist regime, the cause is primarily sociocultural. However, certain life experiences can protect people from developing conditions to which they are vulnerable. Protective factors, such as loving caregivers, adequate health care, and early life successes, reduce vulnerability considerably. In contrast, low vulner- ability can heighten when people receive inadequate health care, engage in risky behav- iors (such as using drugs), and get involved in dysfunctional relationships. The bottom line is that we can best conceptualize abnormal behavior as a complex interaction among multiple factors.
stigma A label that causes certain people to be regarded as different, defective, and set apart from mainstream members of society.
biopsychosocial A model in which the interaction of biological, psychological, and sociocultural factors is seen as infl uencing the development of the individual.
TABLE 1.1 Causes of Abnormal Behavior
Biological Genetic inheritance Physiological changes Exposure to toxic substances
Psychological Past learning experiences Maladaptive thought patterns Difficulties coping with stress
Sociocultural Social policies Discrimination Stigma
1.5 Prominent Themes in Abnormal Psychology throughout History 9
1.5 Prominent Themes in Abnormal
Psychology throughout History
The greatest thinkers of the world, from Plato to the present day, have attempted to explain the varieties of human behavior that constitute abnormality. Three prominent themes in explaining psychological disorders recur throughout history: the spiritual, the scientific, and the humanitarian. Spiritual explanations regard abnormal behavior as the product of possession by evil or demonic spirits. Humanitarian explanations view psychological disorders as the result of cruelty, stress, or poor living conditions. Scientific explanations look for causes that we can objectively measure, such as biological altera- tions, faulty learning processes, or emotional stressors.
Spiritual Approach
The earliest approach to understanding abnormal behavior is spiritual; the belief that people showing signs of behavioral disturbance were possessed by evil spirits. Archeo- logical evidence dating back to 8000 b.c. suggests that the spiritual explanation was prevalent in prehistoric times. Skulls of the living had holes cut out of them, a process called “trephining,” apparently in an effort to release the evil spirits from the person’s head (Maher & Maher, 1985). Archeologists have found evidence of trephining from many countries and cultures, including the Far and Middle East, the Celtic tribes in Britain, ancient and recent China, India, and various peoples of North and South America, including the Mayans, Aztecs, Incas, and Brazilian Indians (Gross, 1999). Another ancient practice was to drive away evil spirits through the ritual of exorcism, a physically and mentally painful form of torture carried out by a shaman, priest, or medicine man. Variants of shamanism have appeared throughout history. The Greeks sought advice from oracles who they believed were in contact with the gods. The Chinese practiced magic as a protection against demons. In India, shamanism flourished for centuries, and it still persists in Central Asia.
spiritual explanations Regard psychological disorders as the product of possession by evil or demonic spirits. humanitarian explanations Regard psychological disorders as the result of cruelty, stress, or poor living conditions. scientific explanations Regard psychological disorders as the result of causes that we can objectively measure, such as biological alterations, faulty learning processes, or emotional stressors.
Hieronymous Bosch’sRemoval of the Stone of Folly depicted a medieval “doctor” cutting out the presumed source of madness from a patient’s skull. The prevailing belief was that spiritual possession was the cause of psychological disorder.
The Greeks sought advice from oracles, wise advisors who made pronouncements from the gods.
1.5 Prominent Themes in Abnormal Psychology throughout History 11
Over the next 100 years, governments built scores of state hospitals throughout the United States. Once again, however, it was only a matter of time before the hospitals became overcrowded and understaffed. It simply was not possible to cure people by providing them with the well-intentioned, but ineffective, interventions proposed by moral treatment. However, the humanitarian goals that Dix advocated had a lasting influence on the mental health system. Her work was carried forward into the twentieth century by advocates of what became known as the mental hygiene movement. Until the 1970s, despite the growing body of knowledge about the causes of abnormal behavior, the actual practices in the day-to-day care of psychologically disturbed people were sometimes as barbaric as those in the Middle Ages. Even people suffering from the least severe psychological disorders were often housed in the “back wards” of large and impersonal state institutions, without adequate or appropriate care. Institutions restrained patients with powerful tranquilizing drugs and straitjackets, coats with sleeves long enough to wrap around the patient’s torso. Even more radical was the indiscriminate use of behavior-altering brain surgery or the application of electrical shocks—so-called treatments that were punish- ments intended to control unruly patients (see more on these procedures in Chapter 2). Public outrage over these abuses in mental hospitals finally led to a more widespread realization that mental health services required dramatic changes. The federal government took emphatic action in 1963 with the passage of groundbreaking legislation. The Mental Retardation Facilities and Community Mental Health Center Construction Act of that year initiated a series of changes that would affect mental health services for decades to come. Legislators began to promote policies designed to move people out of institutions and into less restrictive programs in the community, such as vocational rehabilitation facilities, day hospitals, and psychiatric clinics. After their discharge from the hospital, people entered halfway houses, which provided a supportive environment in which they could learn the necessary social skills to re-enter the community. By the mid-1970s, the state mental hospitals, once overflowing with patients, were practically deserted. These hospitals freed hundreds of thousands of institutionally confined people to begin living with greater dignity and autonomy. This process, known as the deinstitutionalization movement, promoted the release of psychiatric patients into community treatment sites. Unfortunately, the deinstitutionalization movement did not completely fulfi ll the dreams of its originators. Rather than abolishing inhumane treatment, deinstitutionaliza- tion created another set of woes. Many of the promises and programs hailed as alterna- tives to institutionalization ultimately failed to come through because of inadequate
Although deinstitutionalization was designed to enhance the quality of life for people who had been held years in public psychiatric hospitals, many individuals left institutions only to find a life of poverty and neglect on the outside.
12 Chapter 1 Overview to Understanding Abnormal Behavior
planning and insufficient funds. Patients shuttled back and forth between hospitals, half- way houses, and shabby boarding homes, never having a sense of stability or respect. Although the intention of releasing patients from psychiatric hospitals was to free people who had been deprived of basic human rights, the result may not have been as liberating as many had hoped. In contemporary American society, people who would have been in psychiatric hospitals four decades ago are moving through a circuit of shelters, rehabilita- tion programs, jails, and prisons, with a disturbing number of these individuals spending long periods of time as homeless and marginalized members of society. Contemporary advocates of the humanitarian approach suggest new forms of compassionate treatment for people who suffer from psychological disorders. These advocates encourage mental health consumers to take an active role in choosing their treatment. Various advocacy groups have worked tirelessly to change the way the public views mentally ill people and how society deals with them in all settings. These groups include the National Alliance on Mental Illness (NAMI), as well as the Mental Health Association, the Center to Address Discrimination and Stigma, and the Eliminate the Barriers Initiative. The U.S. federal government has also become involved in antistigma programs as part of efforts to improve the delivery of mental health services through the President’s New Freedom Commission (Hogan, 2003). Looking forward into the next decade, the U.S. government has set the 2020 Healthy People initiative goals as focused on improving significantly the quality of treatment services (see Table 1.2).
Scientific Approach
Early Greek philosophers were the first to attempt a scientific approach to understanding psychological disorders. Hippocrates (ca. 460–377 b.c.), considered the founder of modern medicine, believed that there were four important bodily fluids that influenced physical and mental health, leading to four personality dispositions. To treat a psychological disorder would require ridding the body of the excess fluid. Several hundred years later, the Roman physician Claudius Galen (a.d. 130–200) developed a system of medical knowledge based on anatomical studies.
Table 1.2 Healthy People 2020 Goals
In late 2010, the U.S. government’s Healthy People project released goals for the coming decade. These goals are intended both to improve the psychological functioning of individuals in the U.S. and to expand treatment services.
- Reduce the suicide rate.
- Reduce suicide attempts by adolescents.
- Reduce the proportion of adolescents who engage in disordered eating behaviors in an attempt to control their weight.
- Reduce the proportion of persons who experience major depressive episodes.
- Increase the proportion of primary care facilities that provide mental health treatment onsite or by paid referral.
- Increase the proportion of children with mental health problems who receive treatment.
- Increase the proportion of juvenile residential facilities that screen admissions for mental health problems.
- Increase the proportion of persons with serious mental illness (SMI) who are employed.
- Increase the proportion of adults with mental disorders who receive treatment.
- Increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders.
- Increase depression screening by primary care providers.
- Increase the proportion of homeless adults with mental health problems who receive mental health services.
SOURCE: http://www.healthypeople.gov/2020/topicsobjectives2020/pdfs/MentalHealth.pdf
Dr. Benjamin Rush, founder of American psychiatry, was an ardent reformer who promoted the scientific study of psychological disorders.
14 Chapter 1 Overview to Understanding Abnormal Behavior
problems after they occur, it would benefit people more if they could avoid developing symptoms in the first place. Although its goals are similar to those of the humanitarian approach, the positive psychology movement has a strong base in empirical research and as a result is gaining wide support in the field.
1.6 Research Methods in
Abnormal Psychology
As you’ve just learned, the scientific approach led to significant advances in the understanding and treatment of abnormal behavior. The essence of the scientific method is objectivity, the process of testing ideas about the nature of psychological phenomena without bias before accepting these ideas as adequate explanations. The scientific method involves a progression of steps from posing questions of interest to sharing the results with the scientific community. Th roughout the scien- tific method, researchers maintain the objectivity that is the hallmark of the scientific approach. Th is means that they do not let their personal biases interfere with the data collection or interpretation of fi ndings. In addition, researchers must always be open to alternative explanations that could account for their fi ndings. Although the scientific method is based on objectivity, this does not mean that sci- entists have no personal interest in what they are studying. In fact, it is often quite the opposite. Many researchers become involved in the pursuit of knowledge in areas that relate to experiences in their own lives, particularly in the field of abnormal psychology. They may have relatives afflicted with certain disorders or they may have become puz- zled by a client’s symptoms. In conducting their research, however, they cannot let these personal biases get in the way. Thus, in posing questions of interest, psychological researchers may wonder whether a particular kind of experience led to an individual’s symptoms, or they may speculate about the role of particular biological factors. Clinical psychologists are also interested in finding out whether a certain treatment will effectively treat the symptoms of a dis- order. In either case, the ideal approach to answering these questions involves a progres- sion through a set of steps in which the psychologist proposes a hypothesis, conducts a study, and collects and analyzes the data. Eventually, they communicate results through publication in scientific journals.
1.7 Experimental Design
When using experimental design in research, an investigator sets up a test of a hypothesis by constructing a manipulation of a key variable of interest. The variable that the investi- gator manipulates is called the independent variable, meaning that the investigator con- trols it. The investigator sets up at least two conditions that reflect different levels of the independent variable. In most cases, these conditions are the “experimental” or treatment group (the group that receives the treatment) and the “control” group (the group that receives no treatment or a different treatment). The researchers then compare the groups on the dependent variable, which is the variable that they observe. Key to the objectivity of experimental research is the requirement that the researchers always randomly assign participants to the different groups. A study would be flawed if all the men were in the experimental group, for example, and all the women were in the control group. In research on the causes of abnormal behavior, it may be difficult to set up a true experimental study. Many of the variables that are of most interest to psychologists are ones that the investigator cannot control; hence, they are not truly “independent.” For example, depression can never be an independent variable because the investigator cannot manipu- late it. Similarly, investigators cannot randomly assign people to groups based on their biological sex. Studies that investigate differences among groups not determined by random assignment are known as “quasi-experimental.”
independent variable The variable whose level is adjusted or controlled by the experimenter.
dependent variable The variable whose value is the outcome of the experimenter’s manipulation of the independent variable.
1.8 Correlational Design 15
The majority of true experimental studies in abnormal psychology, at least those on humans, test not the causes of abnormal behavior, but the effectiveness of particular treatments where it is possible to design ran- domly assigned control and experi- mental groups. Investigators evaluate a treatment’s effectiveness by compar- ing the groups on dependent variables such as symptom alleviation. There may be more than one experimental group, depending on the nature of the particular study. It is common practice in studies evaluating therapy effectiveness to have a placebo condition in which participants receive a treatment simi- lar to the experimental treatment, but lacking the key feature of the treat- ment of interest. If the study is evalu- ating effectiveness of medication, the placebo has inert ingredients. In stud- ies evaluating effectiveness of therapy, scientists must design the placebo in a way that mimics, but is not the same as the actual therapy. Ideally, the researchers would want the placebo participants to receive treatments of the same frequency and duration as the experimental group participants who are receiving psychotherapy. Expectations about the experiment’s outcome can affect both the investigator and the participant. These so-called “demand characteristics” can compromise the conclusions about the intervention’s true effectiveness. Obviously, the investigator should be as unbiased as possible, but there still may be subtle ways that he or she communicates cues that affect the participant’s response. The participant may also have a personal agenda in trying to prove or disprove the study’s supposed true intent. The best way to eliminate demand characteristics is to use a double-blind method, which shields both investigator and par- ticipant from knowing either the study’s purpose or the nature of the patient’s treatment. In studies involving medication, a completely inert placebo may not be sufficient to establish true experimental control. In an “active placebo” condition, researchers build the experimental medication’s side effects into the placebo. If they know that a medica- tion produces dry mouth, difficulty swallowing, or upset stomach, then the placebo must also mimic these side effects or participants will know they are receiving placebos.
1.8 Correlational Design
Studies based on a correlational design involve tests of relationships between variables that researchers cannot experimentally manipulate. We express the correlation statistic in terms of a number between 1 and 1. Positive numbers represent positive correla- tions, meaning that, as scores on one variable increase, scores on the second variable increase. For example, because one aspect of depression is that it causes a disturbance in normal sleep patterns, you would expect then that scores on a measure of depression would be positively correlated with scores on a measure of sleep disturbances. Con- versely, negative correlations indicate that, as scores on one variable increase, scores on the second variable decrease. An example of a negative correlation is the relationship between depression and self-esteem. The more depressed people are, the lower their scores are on a measure of self-esteem. In many cases, there is no correlation between
placebo condition Condition in an experiment in which participants receive a treatment similar to the experi- mental treatment, but lacking the key feature of the treatment of interest.
double-blind An experimental procedure in which neither the person giving the treatment nor the person receiving the treatment knows whether the participant is in the experimental or control group.
Toward the DSM-
Definition of a Mental Disorder There are five criteria for a mental disorder in the DSM-5 , the same number as was included in DSM-IV. There will be slight wording changes, but the criteria still refer to “clinically significant” to establish the fact that the behaviors under consideration are not passing symptoms or minor difficulties. DSM-5 refers to the behaviors as having a “psychobiological function,” a term that DSM-IV does not use. Both the DSM-IV and DSM-5 state that disorders must occur outside the norm of what is socially accepted and expected for people experiencing particular life stresses. DSM-5 also specifies that the disorder must have “diagnostic validity,” meaning that, for example, the diagnoses predict future behavior or responses to treatment. The diagnosis of abnormality also must be clinically useful, meaning that it provides either a better understanding of the disorder or leads to better assessment and treatment than would otherwise be the case. Finally, the authors of DSM-5 provide a caution against changing the lists of disorders (either adding to or subtracting) without taking into account potential benefits and risks. For example, adding a new diagnosis might lead to labeling as “abnormal” a behavior previously considered “normal.” The advantage of having the new diagnosis must outweigh the harm of categorizing a “normal” person as having a “disorder.” Similarly, deleting a diagnosis for a disorder that requires treatment (and hence insurance coverage) might leave individuals who still require that treatment vulnerable to withholding of care or excess payments for treatment.
1.9 Types of Research Studies 17
disturbed sleep patterns. Or, a third variable that you have not measured could account for the correlation between the two variables that you have studied. Both depression and sleep disturbance could be due to an underlying physiological dysfunction. Investigators who use correlational methods in their research must always be on guard for the potential existence of unmeasured variables influencing the observed results. However, beyond simply linking two variables to see if they are correlated, researchers can use advanced methods that take more complex relationships into account. For example, we can assess the relative contributions of sleep disturbances, self-esteem, gender, and social class with correlational methods that evaluate several related variables at the same time.
1.9 Types of Research Studies
How do investigators gather their data? There are several types of studies that psy- chologists use. The type of study depends in large part upon the question and the resources available to the investigator. Table 1.3 summarizes these methods.
Survey
Investigators use a survey to gather information from a sample of people representative of a particular population. They use surveys primarily in studies involving a correla- tional design when investigators seek to find out whether potentially related variables actually do relate to each other as hypothesized. In a survey, investigators design sets of questions to tap into these variables. They may conduct a survey to determine whether age is correlated with subjective well-being, controlling for the influence of health. In this case, the researcher may hypothesize that subjective well-being is higher in older adults, but only after taking into account the role of health. Researchers also use surveys to gather statistics about the frequency of psychological symp- toms. For example, the Substance Abuse and Mental Health Services Administration of the United States government (SAMHSA) conducts yearly surveys to establish the frequency of use of illegal substances within the population. The World Health Organization (WHO) con- ducts surveys comparing the frequency by country of psychological disorders. These surveys provide valuable epidemiological data that can assess the health of the population.
survey A research tool used to gather information from a sample of people considered representative of a particular population, in which participants are asked to answer questions about the topic of concern.
Type of Method Purpose Example
Survey Obtain population data Researchers working for a government agency attempt to determine disease prevalence through questionnaires administered over the telephone.
Laboratory study Collect data under controlled conditions
An experiment is conducted to compare reaction times to neutral and fear-provoking stimuli.
Case study An individual or a small group of individuals is studied intensively
A therapist describes the cases of members of a family who share the same unusual disorder.
Single case experimental design
The same person serves as subject in experimental and control conditions
Researchers report on the frequency of a client’s behavior while the client is given attention (experimental treatment) and ignored (control condition) for aggressive outbursts in a psychiatric ward.
Behavioral genetics Attempt to identify genetic patterns in inheritance of particular behaviors
Genetic researchers compare the DNA of people with and without symptoms of particular psychological disorders
Table 1.3 Research Methods in Abnormal Psychology
18 Chapter 1 Overview to Understanding Abnormal Behavior
REAL STORIES
Vincent van Gogh: Psychosis
“There is safety in the midst of danger. What would life be if we had no courage to attempt anything? It will be a hard pull for me; the tide rises high, almost to the lips and perhaps higher still, how can I know? But I shall fight my battle... and try to win and get the best of it.” Vincent van Gogh, December, 1881.
V
incent van Gogh, a Dutch- born post-impressionist painter, lived most of his life in poverty and poor physical and mental health. After his death, his work grew immensely in recogni- tion and popularity. His now in- stantly recognizable paintings sell for tens of millions of dollars, while during his lifetime his brother, Theo, mainly supported the painter, sending him art supplies and money for living expenses. Van Gogh strug- gled with mental illness for much of his life, spending one year in an asy- lum before the last year of his life, when he committed suicide in 1890 at the age of 37. Though the specific nature of van Gogh’s mental illness is un- known, his 600 or so letters to Theo offer some insight into his experi- ences. Published in 1937, Dear Theo: The Autobiography of Vincent van Gogh provides an unfiltered glimpse into all aspects of his life including art, love, and his psycho- logical difficulties. Van Gogh never received a formal diagnosis in his lifetime, and to this day many psy- chologists argue over the disorder from which he may have been suf- fering. Psychologists have sug- gested as many as 30 possible diagnoses ranging from schizo- phrenia and bipolar disorder to syphilis and alcoholism. Van Gogh’s constant poor nutrition, excessive consumption of absinthe, and a ten- dency to work to the point of ex- haustion undoubtedly contributed to and worsened any psychological issues he experienced. Van Gogh’s romantic life was highlighted by a series of failed re- lationships, and he never had chil- dren. When he proposed marriage
to Kee Vos-Stricker in 1881, she and her parents turned him down be- cause he was having difficulty sup- porting himself fi nancially at the time. Kee was a widow with a child and van Gogh would not have been able to support the family fully. In response to this rejection, van Gogh held his hand over a lamp flame, demanding her father that he be allowed see the woman he loved, an event he was later unable to recall entirely. Unfortunately for van Gogh, the affection was never reciprocated. His longest known romantic relationship lasted for one year, during which he lived with a prostitute and her two children. Van Gogh fi rst learned to draw in middle school, a hobby that he carried on throughout his failed at- tempt at becoming a religious mis- sionary. He failed his entrance exam for theology school in Am- sterdam, and later failed mission- ary school. In 1880 he decided to devote his life to painting. After at-
tending art school in Brussels, van Gogh moved around the Nether- lands and fi ne-tuned his craft, of- ten living in poverty and squalid conditions. He spent some time liv- ing with his parents, but never stayed with them long due to his tu- multuous relationship with his fa- ther. By 1885, he began to gain recognition as an artist and had completed his fi rst major work, The Potato Eaters. The following year, he moved to Paris where he lived with his brother and began to im- merse himself in the thriving art world of the city. Due to his poor living conditions, van Gogh’s health began to deteriorate, and so he moved to the countryside in the south of France. There he spent two months living with and working alongside his good friend and fel- low painter Paul Gauguin. Their artistic differences led to frequent disagreements that slowly eroded their amiable companionship. In Dear Theo , Johanna van Gogh, Vin- cent’s sister-in-law, writes about
Vincent Van Gogh’s Starry Night over the Rhone, painted in 1888, one year before his death.
20 Chapter 1 Overview to Understanding Abnormal Behavior
Laboratory studies may also involve comparison of brain scan responses taken under differing conditions. Another type of laboratory study may involve observing people in small group settings in which the investigators study their interactions. Although laboratories are ideal for conducting such experiments, they may also be appropriate settings for self-report data such as responses to questionnaires. Researchers can ask participants to complete their responses in a fi xed period of time and under conditions involving a minimum of distractions. They may also provide them with self- report instruments to complete on a computer, allowing for the investigator to collect data in a systematic and uniform fashion across respondents.
The Case Study Method
Many of the researchers, from what the profession regards as classic studies in early abnormal psychology, based their findings on the case study, which is an intensive inves- tigation of an individual or small group of individuals. For example, Freud based much of his theory on reports of his own patients—the development of their symptoms and their progress in therapy. In current research, investigators carry out case studies for a number of reasons. They afford the opportunity to report on rare cases, or the develop- ment of a disorder over time may be the focus of the study. For example, a clinical psychologist may write a report in a published journal about how she provided treatment to a client with a rare type of fear. The advantage of an in-depth case study is also a potential disadvantage in that it does not involve enough experimental control to make a useful addition to the literature. Investigators using case studies, therefore, must be extremely precise in their methods and, as much as possible, take an objective and unbiased approach. There are standards for use in qualitative research that can ensure that researchers present case study data in a way that will be valuable to other investigators.
Single Case Experimental Design
In a single case experimental design (SCED) , the same person serves as the subject in both the experimental and control conditions. Particularly useful for studies of treat- ment effectiveness, a single-subject design typically involves alternating off-on phases of the baseline condition (“A”) and the intervention (“B”). The profession also refers to SCEDs as “ABAB” designs, reflecting the alternation between conditions A and B. Figure 1.1 shows an example of an SCED involving self-injurious behavior. In cases where withholding the treatment in the “B” phase would present an ethical problem (because of an elimination of an effective treatment), researchers use a varia- tion called the multiple baseline method. In a multiple baseline design, the researcher applies the treatment in an AB fashion so that it is never removed. The observation occurs across different subjects, for different behaviors, or in different settings. The researcher takes repeated measures of behavior in relation to introduction of the treatment. For example, in treating a suicidal client, an investigator may first target suicidal thoughts, and second, target suicidal behaviors. The power of the design is in showing that the behaviors change only when the researcher introduces specific treat- ments (Rizvi & Nock, 2008).
Investigations in Behavioral Genetics
Researchers in the field of behavioral genetics and psychopathology attempt to determine the extent to which people inherit psychological disorders. Behavioral geneticists typically begin an investigation into a disorder’s genetic inheritance after observing that the dis- order shows a distinct pattern of family inheritance. This process requires obtaining complete family histories from people whom they can identify as having symptoms of the disorder. The investigators then calculate the concordance rate, or agreement ratios, between people diagnosed as having the disorder and their relatives. For example, a
case study An intensive study of a single person described in detail.
qualitative research A method of analyzing data that provides research with methods of analyzing complex relation- ships that do not easily lend themselves to conventional statistical methods.
single case experimental design Design in which the same person serves as the subject in both the experimental and control conditions.
concordance rate Agreement ratios between people diagnosed as having a particular disorder and their relatives.
1.9 Types of Research Studies 21
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FIGURE 1.1 SCED In an ABAB design, researchers observe behaviors in the “A” phase, institute treatment in the “B” phase, and then repeat the process. In this hypothetical study, suicide ideation seems to improve with treatment in the top set of graphs but shows no effect of treatment in the bottom set of graphs (Rizvi & Nock, 2008).
researcher may observe that 6 out of a sample of 10 twin pairs have the same diagnosed psychological disorder. This would mean that, among this sample, there is a concordance rate of .60 (6 out of 10). We would expect an inherited disorder to have the highest concor- dance between monozygotic or identical twins (whose genes are the same), with somewhat lower rates between siblings and dizygotic or fraternal twins (who are no more alike genet- ically than siblings of different ages), and even lower rates among more distant relatives. A second approach in behavioral genetics is to study families who have adopted. The most extensive evidence available from these studies comes from the Scandinavian coun- tries, where the governments maintain complete birth and adoption records. The research studies two types of adoptions. The first is an adoption study in which researchers establish the rates of the disorder in children whose biological parents have diagnosed psychological disorders, but whose adoptive parents do not. If the children have the disorder, this suggests that genetic factors play a stronger role than the environment. In the second adoption study, referred to as “cross-fostering,” researchers examine the frequency of the disorder in chil- dren whose biological parents had no disorder, but whose adoptive parents do. Twin studies are a third method of behavioral genetics. In these studies, researchers compare monozygotic twins reared together to those reared apart. Theoretically, if twins reared apart share a particular disorder, this suggests that the environment played a relatively minor role in causing that behavior. These kinds of studies enable researchers to draw inferences about the relative contribu- tions of biology and family environment to the development of psychological disorders. However, they are imprecise and have several potential serious flaws. Adoption studies can be suggestive, but are hardly definitive. There may be unmeasured characteristics of the adoptive parents that influence the development of the disorder in the children. The most significant threat to the usefulness of twin studies is the fact that the majority of monozy- gotic twins do not share the same amniotic sac during prenatal development (Mukherjee et al., 2009). They may not even share 100 percent of the same DNA (Ollikainen et al., 2010).
