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1 – Abnormal versus normal & paraphilia
Definitions of psychopathology:
1. The study of mental illness or mental distress or the manifestation of behaviours and
experiences which may be indicative of mental illness or psychological impairment.
Whether something is abnormal or not is usually evaluated by people using these 7 factors:
1. Personal suffering
2. Dysfunctionality, maladaptiveness (e.g. social, occupational, educational)
a. Not all maladaptive behaviour is a disorder, and vice versa.
3. Statistical: a deviation from the norm
4. Violation of society’s standards
a. Criticism: this is highly dependent on cultural differences
5. Social discomfort (aka observer discomfort)
6. Irrationality
7. Dangerousness
There are at least 3 needed in most cases, to “safely” state that something is abnormal behaviour.
Cultural differences:
More stigmatising in western cultures, more emphasis on physical symptoms in eastern cultures.
DSM-V
The DSM-V gives another factor; distress and disability. The judgement of how normal we are ourselves
also differs per culture, and therefore there are no universal standards. With distress they are talking
about chronic pain or suffering, while with disability it is about the impairment of social, occupational,
and/or educational parts of your life. There are 4 criteria on handling disorders:
1. Providing necessary/sufficient criteria
2. Providing the mean (statistical approach)
3. Applied for all psychologists (universal)
4. Theoretically neutral and objective
There is also an alternative list of 4 criteria:
1. Essential features
2. Associated features
3. Diagnostic criteria
4. Differential diagnosis
3 things the DSM does:
1. Categorising
a. Grouping similar disorders together
2. Dimensional approach
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a. Some disorders are not permanent, DSM-V takes into account for how much
percent of e.g. a day someone is suffering from a disorder
3. Prototypical approach
a. The DSM-V tries to be open to changes so it’s able to adapt.
Changes DSM IV-tr to DSM-V:
Axes I, II, and III are combined, not lifelong
(??) Dimensional assessment (section III)
Takes differences in gender and culture into account
Many disorders reorganised, some added (e.g. hoarding, binge eating), some put
together (e.g. ASD), some specified (e.g. paraphilia and paraphilic disorders)
Pros and cons of the DSM-V/the DSM in general
Disadvantages:
Causes stigmatising, labelling,
stereotyping Adoption of disorders
Self-fulfilling prophecy
Ideas about and treatments for different disorders vary across
cultures Loss of information, focus on criteria in DSM
Focused mainly on western cultures, DSM-V tries to improve on this, but still has a lot to
do Mainly based on research published in English
Changes are too specific, which can lower the sensitivity
Comorbidity causes unclear diagnoses, DSM-V tried to improve this, but still has a lot to
do Hybrid disorders; combined disorders are sometimes hard to spot
Advantages:
DSM-V finally includes comorbidity
More criteria are added when needed
Integrative, uses all different fields e.g. when talking about
treatments Connects causes which can help think of new treatments
Society has a need to have some boxes to put people in to make things
comprehensible o DSM classifies disorders, not people!
Provides structure through e.g. classification and same
criteria Provides universal guidelines
Terms:
Prevalence: How many people in the population have a disease. Expressed in
percentages. o Point prevalence
▪ Number of active cases at an exact point in
time o Period prevalence
▪ Number of active cases over a certain period of
time o Lifetime prevalence
▪
Number of all people who have or have had a (specific) disorder in
their lifetime that are alive right now.
Epidemiology: How (certain) diseases spread and can be controlled
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Incidence: The new cases at a time, given in absolute values. E.g. in that year there were
x new cases of children diagnosed with autism.
Paraphilia:
An unusual sexual interest. Becomes a paraphilic disorder when it causes harm and/or distress. It also
has to be present for at least 6 months. Males are generally more affected. The causes may be:
Abused in childhood
Antisocial environment in childhood
Biological differences (e.g. hormones,
brain) Dysfunctional beliefs
Hypersexuality (correlation, not
causation) Psychoanalytic
8 types will be discussed:
1. Voyeuristic disorder
a. Becoming sexually aroused from observing an unsuspecting person who is (getting)
naked or engaging in sexual activity. This is non-consensual. The sexuality is
directed towards the person that is being watched. There is usually no interaction
between the person watching and the person being watched.
b. One cannot be diagnosed with voyeuristic disorder before the age of 18
c. 12% is male, 4% is female.
d. It is the most common sex offense (people actually apprehended)
2. Exhibitionistic disorder
a. Sexual aroused by exposing genitals to a non-consenting person. This often causes
a lot of distress to this person, young children can get traumatised. The victims are
most often children or women.
b. People suffering from this often deny having a disorder. They also tend to have
certain patterns, e.g. going back to the same park at the same time, which makes
it easy for the police to apprehend them.
c. Often comes up before the age of 18. They get aroused from the shocks their
victims get. They also tend to have interpersonal problems.
3. Frotteuristic disorder
a. Rubbing the genitals on a non-consenting person. Usually comes up in
adolescence, then decreases after the age of 25.
4. Sexual masochism disorder
a. Sexually aroused by being made to suffer, either by self or by dominating
partner. Most dangerous version is asphyxiophilia, aka hypoxyphilia, i.e. being
strangled/strangling oneself (auto-asphyxiation).
5. Sexual sadism disorder
a. Sexually aroused by making someone else suffer. Usually concurs with
excessive porn-watching, is linked to personality disorders.
b. There is a very large scale in severity, from inflicted small punishments to murder.
6. Paedophilic disorder
a. Sexually attracted to a prepubescent child or children (i.e. generally younger than 13)
b. Individual is at least 16 and at least 5 years older than the child(ren). Usually
starts with watching child-porn.
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7. Fetishistic disorder
a. Attraction to non-genital body parts or inanimate objects. It involves all senses, and the
sexuality is not directed towards the person but towards the object or body part
8. Transvestic disorder
a. Sexually aroused by cross-dressing. Not directed towards another person.
b. Closely linked to autogynephilia, i.e. become sexually aroused by thoughts/images
of self as female.
c. Usually starts in adolescence.
Treatments for paraphilia;
Behavioural
o Conditioning, aversion therapy (giving negative stimuli, masturbation
saturation, orgasmic reorientation)
Medication
o Anti-androgen drugs, lower testosterone levels lower the sex drive.
o Is not sufficient on its own, should be combined with behavioural and/or
cognitive Cognitive
o Changes schemata, uses victim identification, thus using
empathy. Improving social relationships
Most effective: combination of first three (cognitive-behavioural treatment with medication).
