Abnormal Psychology s i x t h e d i t i o n Richard P. Halgin Susan Krauss Whitbourne Abnormal Psychology s i x t h e d i t i o n HAlgin WHitbourne ISBN 978-0-07-337069-9 MHID 0-07-337069-X www.mhhe.com 9 7 8 0 0 7 3 3 7 0 6 9 9 9 0 0 0 0 Clinical Perspectives on Psychological Disorders www.mhhe.com/halgin6e Clinical Perspectives on Psychological Disorders MD DALIM #994750 11/17/08 CYAN MAG YELO BLK ABNORMAL PSYCHOLOGY haL7069X_fm_i-xxvii.indd Page i 11/27/08 5:31:59 PM user-s207 haL7069X_fm_i-xxvii.indd Page i 11/27/08 5:31:59 PM user-s207 /Users/user-s207/Desktop/MHSF107-FM /Users/user-s207/Desktop/MHSF107-FM haL7069X_fm_i-xxvii.indd Page ii 11/27/08 5:32:00 PM user-s207 haL7069X_fm_i-xxvii.indd Page ii 11/27/08 5:32:00 PM user-s207 /Users/user-s207/Desktop/MHSF107-FM /Users/user-s207/Desktop/MHSF107-FM S i x t h E d i t i o n ABNORMAL PSYCHOLOGY Clinical Perspectives on Psychological Disorders Richard P. Halgin Susan Krauss Whitbourne University of Massachusetts Amherst haL7069X_fm_i-xxvii.indd Page iii 11/27/08 5:32:00 PM user-s207 haL7069X_fm_i-xxvii.indd Page iii 11/27/08 5:32:00 PM user-s207 /Users/user-s207/Desktop/MHSF107-FM /Users/user-s207/Desktop/MHSF107-FM Published by McGraw-Hill, an imprint of The McGraw-Hill Companies, Inc., 1221 Avenue of the Americas, New York, NY 10020. Copyright © 2010, 2007, 2003, 2000, 1997, 1993. All rights reserved. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of The McGraw-Hill Companies, Inc., including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning. 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Cover: Ryan McVay/Stone/Getty Credits: The credits section for this book begins on page C-1 and is considered an extension of the copyright page. Library of Congress Cataloging-in-Publication Data has been applied for. The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a Web site does not indicate an endorsement by the authors or McGraw-Hill, and McGraw-Hill does not guarantee the accuracy of the information presented at these sites. www.mhhe.com haL7069X_fm_i-xxvii.indd Page iv 11/27/08 5:32:00 PM user-s207 haL7069X_fm_i-xxvii.indd Page iv 11/27/08 5:32:00 PM user-s207 /Users/user-s207/Desktop/MHSF107-FM /Users/user-s207/Desktop/MHSF107-FM To our families, with love and appreciation haL7069X_fm_i-xxvii.indd Page v 11/27/08 5:32:00 PM user-s207 haL7069X_fm_i-xxvii.indd Page v 11/27/08 5:32:00 PM user-s207 /Users/user-s207/Desktop/MHSF107-FM /Users/user-s207/Desktop/MHSF107-FM ABOUT THE AUTHORS Richard Halgin and Susan Krauss Whitbourne are Professors of Psychology at the University of Massachusetts Amherst. Both teach large undergraduate classes in addition to teach- ing and supervising doctoral students in clinical psychology. Their clinical experience has covered both inpatient and out- patient settings. Professors Halgin and Whitbourne are Fel- lows of the American Psychological Association. They have edited A Case Book in Abnormal Psychology: From the Files of Experts (Oxford University Press), containing case studies written by leading international authorities in the fi eld of psychopathology. Both serve on the editorial boards of major professional journals. Professor Halgin received his PhD from Fordham Uni- versity and completed a 3-year fellowship in the Department of Psychiatry at New York Hospital-Cornell Medical Center prior to joining the faculty of the University of Massachusetts in 1977. He is a Board-Certifi ed Clinical Psychologist and has had over three decades of clinical, supervisory, and consult- ing experience. At the University of Massachusetts, his course in Abnormal Psychology is one of the most popular offer- ings on campus, attracting an enrollment of more than 500 students. He also holds the position of Visiting Professor of Psychology at Amherst College, where he teaches Abnor- mal Psychology on an annual basis. At the University of Massachusetts, he has been honored with the Distinguished Teaching Award, the Alumni Association’s Distinguished Faculty Award, and was the university’s nominee for the Carnegie Foundation’s U.S. Professor of the Year Award. His teaching has also been recognized by the Danforth Foundation and the Society for the Teaching of Psychology of the American Psychological Association. Professor Halgin is the author of more than fi fty journal articles and book chapters in the fi elds of psychotherapy, clinical supervision, and professional issues in psychology. He is also the editor of Taking Sides: Controversial Issues in Abnormal Psychol- ogy, Fifth Edition (McGraw-Hill). Professor Halgin served as Chair of the Committee of Examiners for the Psychology Graduate Record Examination and as an Associate Member of the Ethics Committee of the American Psychological Association. Professor Whitbourne received her PhD from Columbia University and has dual specializations in life-span develop- mental psychology and clinical psychology. She taught at the State University of New York at Geneseo and the University of Rochester. At the University of Massachusetts, she received the University’s Distinguished Teaching Award, the Out- standing Advising Award, and the College of Arts and Sci- ences Outstanding Teacher Award. In 2001, she received the Psi Chi Eastern Region Faculty Advisor Award and in 2002, the Florence Denmark Psi Chi National Advisor Award. She is the Honors Coordinator and the Director of the Offi ce of National Scholarship Advisement in the Commonwealth Honors College. The author of seventeen books and over one hundred journal articles and book chapters, Professor Whitbourne is regarded as an expert on personality develop- ment in mid and late life. She was Chair of APA’s Policy and Planning Board and a member of the APA Committee for the Structure and Function of Council. She is APA Council Representative to Division 20 (Adult Development and Aging), having also served as Division 20 President. She is a Fellow of APA’s Divisions 20, 1 (General Psychology), 2 (Teaching of Psychology), and 12 (Clinical Psychology). In 2007, she was the Psi Chi Eastern Region Vice President and is the Program Chair of the 2009 National Leadership Con- ference. Professor Whitbourne serves as an item writer for the Educational Testing Service, is a member of APA’s High School Curriculum National Standards Advisory Panel, and serves on a national task force for the development of train- ing models in clinical geropsychology. vi haL7069X_fm_i-xxvii.indd Page vi 11/27/08 5:32:00 PM user-s207 haL7069X_fm_i-xxvii.indd Page vi 11/27/08 5:32:00 PM user-s207 /Users/user-s207/Desktop/MHSF107-FM /Users/user-s207/Desktop/MHSF107-FM B R I E F C O N T E N T S Preface xvii A Guide to Using Your Text xxii 1 Understanding Abnormality: A Look at History and Research Methods 2 2 Classifi cation and Treatment Plans 36 3 Assessment 68 4 Theoretical Perspectives 102 5 Anxiety Disorders 142 6 Somatoform Disorders, Psychological Factors Affecting Medical Conditions, and Dissociative Disorders 172 7 Sexual Disorders 210 8 Mood Disorders 246 9 Schizophrenia and Related Disorders 276 10 Personality Disorders 306 11 Development-Related Disorders 338 12 Aging-Related and Cognitive Disorders 366 13 Substance-Related Disorders 390 14 Eating Disorders and Impulse-Control Disorders 428 15 Ethical and Legal Issues 458 Glossary G-1 References R-1 Credits C-1 Name Index I-1 Subject Index I-8 haL7069X_fm_i-xxvii.indd Page vii 12/4/08 5:28:06 PM user-s174 haL7069X_fm_i-xxvii.indd Page vii 12/4/08 5:28:06 PM user-s174 /Users/user-s174/Desktop/MHSF107-FM /Users/user-s174/Desktop/MHSF107-FM C O N T E N T S viii Preface xvii A Guide to Using Your Text xxii Chapter 1 Understanding Abnormality: A Look at History and Research Methods 2 CASE REPORT: Rebecca Hasbrouck 3 What Is Abnormal Behavior? 4 Defi ning Abnormality 5 Distress 5 Impairment 5 Risk to Self or Other People 5 Socially and Culturally Unacceptable Behavior 6 Challenges Involved in Characterizing Abnormal Behavior 6 What Causes Abnormality? 7 Biological Causes 7 REAL STORIES: Kelsey Grammer 8 Psychological Causes 9 Sociocultural Causes 9 Abnormality: A Biopsychosocial Perspective 10 Abnormal Psychology Throughout History 10 Prehistoric Times: Abnormal Behavior as Demonic Possession 11 Ancient Greece and Rome: The Emergence of the Scientifi c Model 11 The Middle Ages and Renaissance: The Re-emergence of Spiritual Explanations 12 Europe and the United States in the 1700s: The Reform Movement 14 The 1800s to the 1900s: Development of Alternative Models for Abnormal Behavior 16 The Twenty-First Century: The Challenge of Providing Humane and Effective Treatment 18 Research Methods in Abnormal Psychology 21 The Scientifi c Method 21 The Experimental Method 23 The Correlational Method 25 The Survey Method 25 The Case Study Method 26 Single-Subject Design 27 Studies of Genetic Infl uence 27 The Human Experience of Psychological Disorders 28 Impact on the Individual: Stigma and Distress 28 Impact on the Family 30 Impact on the Community and Society 31 Reducing Stigma 32 Bringing It All Together: Clinical Perspectives 32 RETURN TO THE CASE 33 Summary 34 Key Terms 35 Answers to Review Questions 35 Internet Resource 35 Chapter 2 Classifi cation and Treatment Plans 36 CASE REPORT: Peter Dickinson 37 Psychological Disorder: Experiences of Client and Clinician 38 The Client 38 Defi nitions 38 Prevalence of Psychological Disorders 38 The Clinician 40 The Diagnostic and Statistical Manual of Mental Disorders 40 How the DSM Developed 41 Controversial Issues Pertaining to the DSM 42 Defi nition of Mental Disorder 43 Assumptions of the DSM-IV-TR 44 Medical Model 44 Atheoretical Orientation 44 Categorical Approach 44 Multiaxial System 45 The Five Axes of the DSM-IV-TR 45 Axis I: Clinical Disorders 45 Axis II: Personality Disorders and Mental Retardation 48 Axis III: General Medical Conditions 48 Axis IV: Psychosocial and Environmental Problems 48 Axis V: Global Assessment of Functioning 50 The Diagnostic Process 50 The Client’s Reported and Observable Symptoms 51 Diagnostic Criteria and Differential Diagnosis 51 haL7069X_fm_i-xxvii.indd Page viii 12/10/08 4:45:27 PM user-s174 haL7069X_fm_i-xxvii.indd Page viii 12/10/08 4:45:27 PM user-s174 /Users/user-s174/Desktop/TempWork/DECEMBER/10-12-08/MHSF107-FM /Users/user-s174/Desktop/TempWork/DECEMBER/10-12-08/MHSF107-FM Final Diagnosis 52 Case Formulation 53 Cultural Formulation 53 Treatment Planning 57 Goals of Treatment 57 REAL STORIES: Patty Duke 58 Treatment Site 59 Psychiatric Hospitals 59 Outpatient Treatment 60 Halfway Houses and Day Treatment Programs 60 Other Treatment Sites 60 Modality of Treatment 61 Determining the Best Approach to Treatment 61 Treatment Implementation 62 The Course of Treatment 63 The Clinician’s Role in Treatment 63 The Client’s Role in Treatment 63 The Outcome of Treatment 63 RETURN TO THE CASE 64 Summary 65 Key Terms 66 Answers to Review Questions 66 Internet Resource 67 Chapter 3 Assessment 68 CASE REPORT: Ben Robsham 69 What Is a Psychological Assessment? 70 Clinical Interview 70 Unstructured Interview 70 Structured and Semistructured Interviews 71 Mental Status Examination 74 Appearance and Behavior 74 Orientation 75 Content of Thought 75 Thinking Style and Language 76 Affect and Mood 77 Perceptual Experiences 78 Sense of Self 79 Motivation 79 Cognitive Functioning 79 Insight and Judgment 79 Psychological Testing 79 What Makes a Good Psychological Test? 80 Intelligence Testing 81 Stanford-Binet Intelligence Test 82 Wechsler Intelligence Scales 83 Cultural Considerations in Intelligence Testing 84 Personality and Diagnostic Testing 84 Self-Report Clinical Inventories 84 Projective Testing 87 Behavioral Assessment 89 Behavioral Self-Report 90 Behavioral Observation 91 Multicultural Assessment 91 REAL STORIES: Frederick Frese 92 Environmental Assessment 93 Physiological Assessment 94 Psychophysiological Assessment 94 Brain Imaging Techniques 95 Neuropsychological Assessment 97 Putting It All Together 98 RETURN TO THE CASE 99 Summary 100 Key Terms 101 Answers to Review Questions 101 Internet Resource 101 Chapter 4 Theoretical Perspectives 102 CASE REPORT: Meera Krishnan 103 The Purpose of Theoretical Perspectives in Abnormal Psychology 104 Psychodynamic Perspective 104 Freudian Psychoanalytic Theory 104 Freud’s Background 104 Freud’s Structural Model of Personality: The Id, Ego, and Superego 104 ix haL7069X_fm_i-xxvii.indd Page ix 12/10/08 4:45:49 PM user-s174 haL7069X_fm_i-xxvii.indd Page ix 12/10/08 4:45:49 PM user-s174 /Users/user-s174/Desktop/TempWork/DECEMBER/10-12-08/MHSF107-FM /Users/user-s174/Desktop/TempWork/DECEMBER/10-12-08/MHSF107-FM