Abnormal Psychology / Edition 4

Integrated and Consistent Coverage and DSM-IV-TR

Integration always has been the overriding theme of our textbook. Rather than see abnormal psychology as fractured by competition among paradigms, split between psychology and psychiatry, or divided between scientists and practitioners, we see the most exciting and promising future for abnormal psychology in the integration of theoretical approaches, professional specialties, and science and practice.

We present abnormal psychology as a cohesive field, even with all its variations. Each disorder chapter unfolds in the same way, providing a coherent framework and consistent outline. We open with an Overview followed by one or two extended Case Studies. We then discuss Typical Symptoms and Associated Features, Classification, Epidemiology, Etiological Considerations and Research, and finally, Treatment. Each chapter reflects DSM-IV TRthroughout.

Embedded in this consistent structure are several features designed to help make the human aspects of mental disorders clearer to readers: Our cases and first person accounts, and a new feature, Getting Help.

New Feature: Getting Help

In the new Getting Help sections included in every chapter of this edition, we address students' personal concerns most directly. We added this feature to begin to answer the sorts of questions that students have asked us privately after lecture or later in our offices. These sections also encourage students to think critically about the psychological information they may encounter on the Web and in self-help section of their bookstore. The Getting Help sections give responsible, empirically sound, and concrete guidance on such personal topics as:

• What treatments are likely to be most effective for particular disorders? (See Chapters 2, 6, 10, and 12)
• What can I do to help someone else? (See Chapters 5, 9, 10, and 16)
• How can I find the right therapist? (See Chapters 3, 5, and 12)
• Where can I get more reliable information from books, the Internet, or professionals in my community? (See Chapters 1, 5, 7, and 11)
• What self-help strategies can I try? (See Chapters 6, 11, and 12)

Students can also find research-based information on the effectiveness and efficacy of various treatments in Chapter 3, Treatment of Psychological Disorders, and in the Treatment headings near the end of every disorder chapter.

The Latest Science

We do not have simple answers to many pressing personal and intellectual questions. Many of our answers are complicated and equivocal. Others are simply incomplete. Such is the state of abnormal psychology at the beginning of the twenty-first century.

But far worse than offering incomplete answers would be to take the route of those well-intentioned experts, and some unscrupulous ones, who are ready to give "definitive" answers to questions that, in reality, cannot be answered definitively. Sometimes these "experts"' answers are wrong or clearly selfservihg. We are candid when the truthful answer is, "Honestly, we do not yet know."

The unanswered questions of abnormal psychology present intriguing and pressing puzzles. These unsolved mysteries challenge all of our intellectual and personal resources as scientific detectives. We include the latest scientific findings throughout this text, including references to hundreds of new scientific studies in this fourth edition. But the measure of a leading edge textbook is not merely the number of new references. It is the number of new studies the authors have reviewed and evaluated before deciding what to include and what to discard. For every new reference in this edition of our text, we have read many additional papers before selecting the one gem to include.

At least as important as including the latest and the best research, we also point to the most promising leads for finding more and better answers in the not-too-distant future. We are seasoned and active investigators, as well as authors. Our research—and this text—are fueled by the suffering of people with emotional conflicts and mental illnesses, and by the intellectual challenges we face in trying to answer some of the very complicated questions posed by abnormal psychology.

Research Methods: How Psychological Detective Work Is Done

We report on the latest scientific findings, and we also explain in detail how psychological scientists do their detective work. Unlike any other text in this field, however, we do not cover research methods in a single chapter. We do this because many of our students have told us that the typical research methods chapter seems dry, difficult, and—to our great disappointment—irrelevant. Students understand the enormous need for new knowledge in this field, but they find the one-shot chapter on research methods to be detached from the substance of abnormal psychology.

Our solution to these problems is to offer brief Research Methods inserts in every single chapter. This approach makes the text flexible, and it makes learning research methods more manageable, more focused, and more relevant by connecting them to the chapter content. By the end of the text, this approach also allows us to cover research methods in more detail than we could reasonably cover in a single, detached chapter.

Research Close-Ups

In addition to these discussions of research methods, we also offer Research Close-Ups, sections devoted to a detailed review of a particular study that has proved important in advancing our knowledge in a given area. These sections help make concrete not only the findings of the study, but also its process. For example, in Chapter 8 we discuss James Pennebaker, Janice Kiecolt-Glaser, and Ronald Glaser's study of the effect of disclosure on the immune system.

Often, the Research Methods and Research Close-up features work together. For example, in Chapter 17, the Research Methods discussion is on heritability, while the Research Close-up focuses on research studies examining the gene-environment correlation and the possible heritability of divorce.

Further Thoughts

Sometimes a study or problem suggests a departure from current thinking or raises issues that deserve to be examined. Our Further Thoughts sections cover these sorts of emerging ideas, such as evidence suggesting that, rather than employing the fight or flight response to threat, females appear to choose a "tend and befriend" approach (Chapter 8), or possible ways of classifying rapists, even though this type of abnormal behavior is not included in the official diagnostic manual (Chapter 12), or new ways of thinking about the close connection between depression and anxiety (Chapter 6).

Case Studies

Abnormal psychology is, of course, about real people; people like us. The many case studies we present help readers keep this in mind. Detailed Case Studies appear near the beginning of every chapter so that the symptoms and etiological issues are presented in the context of real lives and in their genuine complexity. In the extended opening cases, briefer cases, and first-person accounts throughout the chapters, readers see how ordinary lives are disrupted and how treatment proceeds in fits and starts.

Most of the cases are our own. Throughout our careers, we both have been active clinicians as well as active researchers. In fact, being a therapist is a lot like being a scientist. As therapists, we develop hypotheses and test them as we work to help individual clients to change. When we gain support for a hypothesis with one client, we wonder if the observation applies to others. Was the cause of this problem unique to this client, or have we discovered a general principle? Did our successful attempt to vary a proven treatment work only for this one client, or are we on to something bigger? Can we prove our clinical hunches to the world in an objective, scientific manner?

The Case Studies help take the reader along on this journey of pain, triumph, frustration, and fresh starts, and are designed to help students to think more deeply about psychological disorders, much as our own clinical experience enriches our understanding.

Paradigms and Systems: The Blind Men and the Elephant

For much of the last century abnormal psychology was dominated by theoretical paradigms, and the belief that someday one single paradigm would triumph and provide all answers to all questions while all other paradigms collapsed into dust.

This circumstance reminds us of the parable of the seven blind men and the elephant. One blind man grasps a tusk and concludes that an elephant is very much like a spear. Another feels a knee and decides an elephant is like a tree, and so on. Our goal from the first edition of Abnormal Psychology has been to show the reader the whole elephant. We do this through our unique integrative systems approach, in which we focus on what we know rather than what we used to think.

In every chapter, we consider how biological, psychological, and social factors work together to produce mental disorders. What causes depression? A chemical imbalance? Cognitive errors? Or racial and gender bias? Our answer is: wrong questions. Depression appears to be caused by a combination of genetic risks, maladaptive patterns of thinking, and dysfunctional social roles (among other influences). Similarly, the appropriate treatment of depression may involve medication, psychotherapy, social action, or all three approaches.

We show how different factors function together in a system of reciprocal influences in producing different psychological disorders. We strive to appreciate the whole elephant even when we know that science has not yet illuminated all of its parts.

What Else is New in the Fourth Edition?

Every revision involves a fresh look at content and coverage and bringing discussions up-todate with current research. We have rewritten the openers to every chapter in order to help convey our "us, not them" theme, highlighting the connection between disordered and "normal" behavior. For example, the opener to the personality disorders chapter (Chapter 9) invites readers to consider the relationship between being skeptical and being paranoid and between self-confidence and grandiosity. There are many changes within the chapters of Abnormal Psychology, Fourth Edition as well:

• Chapter 1: Expands on coverage of how culture affects the way we define disorders; also includes updated information on variations in the frequency of disorders across countries.
• Chapter 2: Includes a new section on evolutionary psychology, a streamlined and more accessible presentation of the systems approach„ an updated account of psychological factors in. mental illness, and an enhanced discussion of' behavior genetics, including two new figures designed to illustrate the differences between, and different implications of, autosomal dominant inheritance and polygenic inheritance.
• Chapter 3: Addresses new research on the benefits of limited therapist self-disclosure; evidence on the controversial increase in prescribing psychotropic medications to children; a controversial new meta-analysis questioning the empirical support for some "empirically supported" therapies.
• Chapter 4: Updates the debate regarding the use of projective tests; new information on fMRIs and brain imaging.
• Chapter 5: Expands on coverage of the neurobiology of depression, including the HPA axis as well as neurohormones and brain areas related to depression. Includes a new first person account of clinical depression (from Andrew Solomon's The Noonday Demon). Also includes expanded discussion of evolutionary views of depression and new information on antidepressant medications, especially Selective Serotonin Reuptake Inhibitors (SSRIs.)
• Chapter 6: Updated information on the neurobiology of panic; expanded coverage of developmental issues and anxiety. New information regarding the comorbidity of anxiety and depression and the use of SSRIs in treating anxiety disorders. Includes recent research on the effectiveness of cognitive behavioral therapy for Obsessive-Compulsive Disorder (OCD.)
• Chapter 7: Expanded and updated section on Posttraumatic Stress Disorder (PTSD) including biological factors and the impact of September 1 1. Over 50 new references, including current research on Acute Stress Disorder (ASD) and subclinical ASD as a predictor of future PTSD; the benefits of antidepressants in treating PTSD; the psychological effects of torture; cognitive behavioral treatments for somatoform disorders; and the development of somatic symptoms in Gulf War mortuary workers. Added emphasis on emotional processing and meaning making in coping with trauma.
• Chapter 8: Updated discussion of stress and its consequences, including new statistics on causes of death. New Further Thoughts feature on possible evolutionary influences and gender differences in responses to stress. New research on the cognitive behavioral treatment of sleep disorders, the health benefits of forgiveness, and health and intimate relationships.
• Chapter 9: Expanded discussion of evolutionary views of personality disorders; new coverage of the role a distorted self image and misperceptions of others' motives can play the development of Personality Disorders (PDs.) Updated discussion of dimensional approaches to classifying PDs; new information regarding the prevalence of PDs in community samples; increased coverage of dialectical behavior therapy.
• Chapter 10: New Research Close-Up on using the Internet to change attitudes and prevent eating disorders; new research on the longitudinal course of eating disorders following treatment and coverage of eating disorders in men. Expanded discussion of the contribution of genetic factors to eating disorders.
• Chapter 11: New discussion of the neurobiology of addiction, including mechanisms promoting psychoactive substance tolerance and treatment of drug dependence. New coverage of MDMA (Ecstacy) ; new first person brief case study on effects of heroin. Updated discussion of developmental influences on drug use.
• Chapter 12: New brief cases on erectile dysfunction; new first person accounts on vaginismus (Kayseri) and sexual masochism (Merkin) ; new Consensus Conference information on classifying female sexual dysfunctions.
• Chapter 13: New information on schizophrenia and social class and other environmental risk factors; updated information on brain imaging studies; expanded coverage of second generation or "atypical" antipsychotic drugs. Updated coverage of expressed emotion and relapse.
• Chapter 14: New information on classification of demential, including frontotemporal dementia and dementia with Lewy bodies; updated information on the neuropathology and genetics of Alzheimer's disease. Expanded and updated discussion of the prevalence of vascular dementia and Alzheimer's disease in men and women.
• Chapter 15: Includes new 2002 American Association on Mental Retardation (AAMR) definition of metal retardation and new evidence on unusual brain growth patterns in autistic disorder. New Further Thoughts discussion of eugenics. New research on specific genes involved in some cases of autistic disorder and Rett's disorder; new evidence regarding the validity of the Asperger's disorder diagnostic criteria.
• Chapter 16: New research on the treatment of children's anxiety disorders; new findings from research to identify youth with psychopathic tendencies. Expanded and updated discussion of gender differences in the development of depression; new information on the treatment of Attention Deficit-Hyperactivity Disorder (ADHD) based on the Multi-Modal Treatment (MTA) study and the prevention of children's behavior problems through parent education, school, and peer interventions.
• Chapter 17: Expanded discussion of development in later life. Expanded discussion of identity development particularly among youth without a college education. New research findings on marriage and emotional well-being.
• Chapter 18: Discussion of new Supreme Court cases banning the execution of people with mental retardation, upholding the confinement of sexual offenders even when risk is not imminent, and requiring the community care of the mental ill under the Americans with Disabilities Act. New evidence on the effectiveness of outpatient commitment; new evidence and trends in family law, including the long-term benefits of divorce mediation and distinctions between severe and less serious child abuse.