Abnormal and Clinical Psychology
Abnormal psychology studies psychological disorders — their classification, causes, course, and treatment. Clinical psychology is the applied profession that diagnoses and treats such conditions, distinct from psychiatry, which is a medical specialisation.
A clinically significant disturbance in cognition, emotion regulation, or behaviour, usually associated with distress or impairment in social, occupational, or other important areas of functioning, and not merely an expected response to a common stressor or loss.
Defining abnormality — the four Ds
Most textbooks apply some combination of:
- Deviance — behaviour that diverges from cultural norms.
- Distress — subjective suffering for the individual.
- Dysfunction — impairment of daily functioning.
- Danger — risk to self or others.
No single criterion is sufficient. Cultural relativity matters: behaviours normal in one society may be pathologised in another.
Classification: DSM-5 and ICD-11
Two manuals dominate diagnostic practice:
- DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, American Psychiatric Association, 2013; DSM-5-TR, 2022) — used widely in clinical psychology.
- ICD-11 (International Classification of Diseases, 11th revision, WHO, 2022) — official statistical and global health classification.
The DSM-5 abandoned the multiaxial system of DSM-IV in favour of a single-axis approach with severity specifiers.
Major DSM-5 categories
| Chapter | Examples |
|---|---|
| Neurodevelopmental | Autism Spectrum, ADHD, Intellectual Disability |
| Schizophrenia spectrum | Schizophrenia, Schizoaffective, Delusional Disorder |
| Bipolar and related | Bipolar I, Bipolar II, Cyclothymic |
| Depressive | Major Depressive, Persistent Depressive (Dysthymia), PMDD |
| Anxiety | Panic, Generalised Anxiety, Social Anxiety, Phobias |
| Obsessive-compulsive and related | OCD, Body Dysmorphic, Hoarding |
| Trauma- and stressor-related | PTSD, Acute Stress, Adjustment, Reactive Attachment |
| Dissociative | Dissociative Identity, Dissociative Amnesia |
| Somatic symptom | Somatic Symptom, Illness Anxiety, Conversion |
| Feeding and eating | Anorexia Nervosa, Bulimia, Binge-eating |
| Substance-related and addictive | Alcohol, Opioid, Stimulant Use Disorders; Gambling |
| Neurocognitive | Delirium, Mild and Major Neurocognitive Disorders (e.g., Alzheimer's) |
| Personality | Cluster A (odd), B (dramatic), C (anxious) |
- Major Depressive Disorder: at least 2 weeks of depressed mood OR anhedonia plus four other symptoms; affects ~3.8% of the global population.
- Generalised Anxiety Disorder: excessive, uncontrollable worry on most days for 6+ months.
- Schizophrenia: positive (hallucinations, delusions), negative (flat affect, avolition) and cognitive symptoms for 6+ months.
- PTSD: re-experiencing, avoidance, negative cognition/mood, hyperarousal after a Criterion A trauma.
- Lifetime prevalence of any mental disorder globally: roughly 1 in 4 people (WHO).
Causal models
Modern abnormal psychology uses a biopsychosocial framework:
- Biological — genetics, neurotransmitters (serotonin, dopamine, glutamate), brain structure.
- Psychological — cognitive schemas, learned helplessness (Seligman), maladaptive coping.
- Social — life stressors, trauma, poverty, family environment, stigma.
- Diathesis-stress model — an underlying vulnerability is triggered by environmental stress.
Major theoretical orientations
- Psychodynamic (Freudian) — unconscious conflict; brought to consciousness by interpretation.
- Behavioural — disorders as learned responses; treated by extinction, exposure, reinforcement.
- Cognitive (Beck, Ellis) — dysfunctional thoughts cause distress; addressed by Cognitive Behavioural Therapy (CBT).
- Humanistic (Rogers) — incongruence between actual and ideal self; treated by person-centred therapy with empathy, unconditional positive regard, congruence.
- Biological — pharmacotherapy (SSRIs, antipsychotics, mood stabilisers), ECT for treatment-resistant depression.
Treatment
| Modality | Indications | Examples |
|---|---|---|
| Psychotherapy | Most disorders; mild to moderate | CBT, DBT, IPT, ACT |
| Pharmacotherapy | Moderate-severe; chronic | SSRIs, SNRIs, antipsychotics, lithium |
| Combination | Severe depression, schizophrenia, bipolar | CBT + SSRI; CBT + antipsychotic |
| ECT | Treatment-resistant depression, catatonia | Bilateral electroconvulsive therapy |
| Community psychiatry | Long-term care | Assertive Community Treatment, peer support |
Clinical vs. counselling psychology
| Dimension | Clinical | Counselling |
|---|---|---|
| Severity of cases | More severe disorders | Adjustment issues, mild-moderate distress |
| Settings | Hospitals, mental-health clinics | Schools, universities, EAP, private practice |
| Training | MS/PhD Clinical Psychology, supervised hours | MS Counselling, supervised hours |
| Emphasis | Assessment & psychotherapy | Wellness, prevention, vocational |
| Pakistan regulation | Pakistan Psychological Council (proposed PPC Bill 2018) | Same regulator |
Both differ from psychiatry, which is the medical specialisation that can prescribe drugs and is regulated by the Pakistan Medical and Dental Council.
For CSS answers, never write "DSM-IV" — the current edition is DSM-5 (2013) and the text-revised DSM-5-TR (2022). Pairing the right manual edition with a correct disorder definition is a hallmark of an updated answer.
Stigma and access in Pakistan
Pakistan has roughly 0.4 psychiatrists per 100,000 population against a WHO target of about 5; only a fraction of those with disorders ever receive evidence-based care. The Mental Health Ordinance 2001 (devolved post-18th-Amendment to provinces — Sindh 2013, Punjab 2014, KP 2017) replaced the colonial Lunacy Act of 1912. Persistent challenges include stigma, reliance on faith healers (peers, aamils), and gendered access barriers. Tele-mental-health, school-counsellor cadres, and primary-care integration (the WHO mhGAP programme) are key policy directions.