About the authors vii
Chapter 1 Introduction to abnormal psychology 1
Introduction 2
1.1 The basic features of psychological disorder 3
What is psychological disorder? 3
1.2 Stigma associated with psychological disorders and its historical context 6
Stigma and mental health 6
The historical context 8
1.3 Early psychological approaches to psychopathology 10
1.4 The genetic paradigm 16
Behaviour genetics 19
Molecular genetics 21
Gene–environment interactions 23
Evaluating the genetic paradigm 25
1.5 The neuroscience paradigm 26
Neurons and neurotransmitters 26
Structure and function of the human brain 29
The neuroendocrine system 32
The immune system 33
Neuroscience approaches to treatment 35
Evaluating the neuroscience paradigm 38
1.6 The cognitive–behavioural paradigm 39
Influences from behaviour therapy 39
Cognition 44
Cognitive–behavioural therapy 48
Beck’s cognitive therapy 49
The Third Wave of cognitive therapies 52
Evaluating the cognitive–behavioural paradigm 53
1.7 Factors that cut across the paradigms 53
Emotion and psychopathology 53
Sociocultural factors and psychopathology 55
Interpersonal factors and psychopathology 60
Attachment and the concept of the self in psychopathology 64
1.8 Integration across multiple levels of analysis: the diathesis–stress integrative paradigm 66
Chapter 2 Diagnosis and assessment 88
Introduction 89
2.1 Cornerstones of diagnosis and assessment 90
Reliability 90
Validity 91
2.2 The diagnostic system of the American Psychiatric Association: DSM?5 94
Changes in DSM?5 97
Ethnic and cultural considerations in diagnosis 99
Specific criticisms of the DSM 104
2.3 Psychological assessment 108
Clinical interviews 109
Assessment of stress 112
Personality tests 115
Intelligence tests 120
Behavioural and cognitive assessment 122
2.4 Neurobiological assessment 126
Brain imaging: ‘seeing’ the brain 126
Neurotransmitter assessment 129
Neuropsychological assessment 130
Psychophysiological assessment 131
A cautionary note about neurobiological assessment 133
2.5 Cultural and ethnic diversity and assessment 134
Cultural bias in assessment 134
Strategies for avoiding cultural bias in assessment 136
Chapter 3 Mood disorders 146
Introduction 147
3.1 Clinical descriptions and epidemiology of mood disorders 147
Depressive disorders 147
Epidemiology and consequences of depressive disorders 152
Bipolar disorders 155
Epidemiology and consequences of bipolar disorders 159
Subtypes of depressive disorders and bipolar disorders 161
3.2 Aetiology of mood disorders 162
Genetic factors 163
Neurotransmitters 164
Social factors in depression: childhood adversity, life events and interpersonal difficulties 169
Psychological factors in depression 170
Social and psychological factors in bipolar disorder 175
3.3 Treatment of mood disorders 176
Psychological treatment of depression 177
Psychological treatment of bipolar disorder 180
Biological treatment of mood disorders 181
Comparing treatments for major depressive disorder 184
A final note on treatment 186
3.4 Suicide 187
Epidemiology of suicide and suicide attempts 188
Risk factors for suicide 190
Preventing suicide 193
Chapter 4 Anxiety, obsessive?compulsive and trauma?related disorders 211
Introduction 212
4.1 Clinical descriptions of the anxiety disorders 213
Specific phobias 214
Social anxiety disorder 216
Panic disorder 218
Agoraphobia 220
Generalised anxiety disorder 221
4.2 Comorbidity, gender and culture in anxiety disorders 222
Comorbidity in anxiety disorders 222
Gender and cultural factors in anxiety disorders 222
4.3 Aetiology of anxiety disorders 225
Common risk factors across the anxiety disorders 225
Aetiology of specific phobias 230
Aetiology of social anxiety disorder 232
Aetiology of panic disorder 233
Aetiology of agoraphobia 237
Aetiology of generalised anxiety disorder 237
4.4 Treatments of the anxiety disorders 238
Commonalities across psychological treatments 238
4.5 Obsessive?compulsive and related disorders 241
Clinical descriptions of the obsessive?compulsive and related disorders 242
4.6 Aetiology of the obsessive?compulsive and related disorders 249
Aetiology of obsessive?compulsive disorder 250
Aetiology of body dysmorphic disorder 251
Aetiology of hoarding disorder 251
4.7 Treatment of the obsessive?compulsive and related disorders 252
Medications 252
Psychological treatment 252
4.8 Post?traumatic stress disorder and acute stress disorder 255
Clinical description and epidemiology of post?traumatic stress disorder and acute stress disorder 256
Aetiology of post?traumatic stress disorder 258
4.9 Treatment of post?traumatic stress disorder and acute stress disorder 261
Medication treatment of PTSD 261
Psychological treatment of PTSD 262
Chapter 5 Dissociative disorders, and somatic symptom and related disorders 279
Introduction 280
5.1 Dissociative disorders 281
Depersonalisation/derealisation disorder 283
Dissociative amnesia 285
Dissociative identity disorder 290
Other specified dissociative disorder 295
5.2 Somatic symptom and related disorders 296
Neurobiological and cognitive factors that increase awareness of and distress over somatic symptoms 299
Treatment of somatic symptom and related disorders 300
Somatic symptom disorder 300
Illness anxiety disorder 303
Conversion disorder 306
Factitious disorder 308
Chapter 6 Schizophrenia 319
Introduction 320
6.1 Clinical descriptions of schizophrenia 321
Positive symptoms 321
Negative symptoms 326
Disorganised symptoms 327
Cognition 329
Anxiety and depression 330
Schizophrenia and the DSM?5 331
6.2 Aetiology of schizophrenia 333
Genetic factors 333
6.3 The role of neurotransmitters 338
Dopamine theory 338
Brain structure and function 339
Connectivity in the brain 343
6.4 Environmental factors influencing the developing brain 344
Psychological factors 345
Developmental factors 348
6.5 Treatment of schizophrenia 349
Medications 350
Psychological treatments 354
Chapter 7 Substance use disorders 375
Introduction 376
7.1 Clinical descriptions, prevalence and effects of substance use disorders 376
Alcohol use disorder 379
Tobacco use disorder 383
Cannabis 386
Opiates 390
Stimulants 393
Other illicit drugs 397
7.2 Aetiology of substance use disorders 399
Genetic factors 400
Neurobiological factors 400
Psychological factors 402
Sociocultural factors 404
7.3 Treatment of substance use disorders 407
Treatment of alcohol use disorder 407
Treatments for smoking 411
Treatment of drug use disorders 413
7.4 Prevention of substance use disorders 418
Chapter 8 Eating disorders 434
Introduction 435
8.1 Clinical descriptions of eating disorders 436
Anorexia nervosa 436
Bulimia nervosa 441
Binge?eating disorder 443
8.2 Aetiology of eating disorders 448
Genetic factors 448
Neurobiological factors 449
Cognitive–behavioural factors 451
Sociocultural factors 454
Other factors contributing to the aetiology of eating disorders 460
8.3 Treatment of eating disorders 463
Psychological treatment of anorexia nervosa 463
Psychological treatment of bulimia nervosa 464
Psychological treatment of binge-eating disorder 465
Medications 466
Preventive interventions for eating disorders 466
Chapter 9 Sexual disorders 480
Introduction 481
9.1 Sexual norms and behaviour 481
Gender and sexuality 485
The sexual response cycle 486
9.2 Sexual dysfunctions 487
Clinical descriptions of sexual dysfunctions 488
Aetiology of sexual dysfunctions 494
Treatments of sexual dysfunctions 497
9.3 The paraphilic disorders 502
Fetishistic disorder 504
Paedophilic disorder and incest 505
Voyeuristic disorder 508
Exhibitionistic disorder 508
Frotteuristic disorder 509
Sexual sadism and masochism disorders 509
Aetiology of the paraphilic disorders 512
Treatments for the paraphilic disorders 514
Chapter 10 Disorders of childhood 528
Introduction 529
10.1 Classification and diagnosis of childhood disorders 530
10.2 Externalising disorders 532
Attention-deficit hyperactivity disorder 532
Conduct disorder 540
10.3 Depression and anxiety in children and adolescents 549
Depression 549
Anxiety 553
10.4 Specific learning disorder 561
Clinical descriptions 561
Aetiology of specific learning disorder 562
Treatment of specific learning disorder 565
10.5 Intellectual disability 565
Diagnosis and assessment of intellectual disability 566
Aetiology of intellectual disability 567
Treatment of intellectual disability 569
10.6 Autism spectrum disorder 572
Clinical descriptions, prevalence and prognosis of autism spectrum disorder 572
Comorbidity and ASD 576
Prevalence of autism spectrum disorder 577
Prognosis for autism spectrum disorder 577
Aetiology of autism spectrum disorder 577
Treatment of autism spectrum disorder 580
Chapter 11 Late life and neurocognitive disorders 599
Introduction 600
11.1 Ageing: issues and methods 600
Myths about late life 601
The problems experienced in late life 602
Research methods in the study of ageing 604
11.2 Psychological disorders in late life 606
Estimating the prevalence of psychological disorders in late life 606
Methodological issues in estimating the prevalence of psychopathology 608
11.3 Neurocognitive disorders in late life 609
Dementia 609
Delirium 626
Chapter 12 Personality and personality disorders 640
Introduction 641
12.1 The DSM?5 approach to classification 642
Assessment of DSM?5 personality disorders 644
Problems with the DSM?5 approach to personality disorders 645
Alternative DSM?5 model for personality disorders 646
12.2 Common risk factors across the personality disorders 648
12.3 Clinical description and aetiology of the odd/eccentric cluster 650
Paranoid personality disorder 651
Schizoid personality disorder 651
Schizotypal personality disorder 652
12.4 Clinical description and aetiology of the dramatic/erratic cluster 653
Antisocial personality disorder: clinical description 653
Psychopathy: clinical description 654
Borderline personality disorder 658
Histrionic personality disorder 662
Narcissistic personality disorder 662
12.5 Clinical description and aetiology of the anxious/fearful cluster 666
Avoidant personality disorder 666
Dependent personality disorder 667
Obsessive?compulsive personality disorder 668
12.6 Treatment of personality disorders 670
General approaches to the treatment of personality disorders 670
Treatment of schizotypal personality disorder and avoidant personality disorder 671
Treatment of borderline personality disorder 672
Chapter 13 Legal and ethical issues 684
Introduction 685
13.1 Mental health and the criminal justice system 686
The insanity defence 687
Landmark cases and laws 688
The Mental Health Court 691
Magistrates Courts 693
Highly publicised trials and public perception 694
13.2 Fitness to stand trial 694
Victims of unlawful acts 696
13.3 Civil commitment 697
Preventive detention and problems in the prediction of dangerousness 699
Deinstitutionalisation, civil liberties and mental health 709
13.4 Ethical dilemmas in therapy and research 710
Ethical restraints on research 711
Informed consent 712
Confidentiality and ethical limits 714
