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苏珊·诺伦-霍克西玛的《变态心理学》（Abnormal Psychology）是一本系统描述心理病理学的教科书，结合了心理病理学的前沿研究，重视实证和多元化，并清晰地陈述了相关的生物学基础。此书影印自该教材的*版（第6版），反映了DSM-5的诊断标准。

全书共16个章节，依次为：异常心理和行为一瞥，异常的理论与治疗，异常的评估和诊断，研究方法，创伤、焦虑、强迫及相关障碍，躯体症状障碍和分离障碍，心境障碍和自杀，精神分裂症谱系及其他精神病性障碍，人格障碍，神经发育障碍与神经认知障碍，破坏性、冲动控制及品行障碍，进食障碍，性障碍，物质使用和赌博障碍，健康心理学，精神健康与法律。此书还附有关于批判性思考的讨论、术语表，以及参考文献。另外，书中不仅加入了多幅美丽生动的精美图片，还设立了多个独立的模块，如非常人物、批判性思考、灰色地带等，给予读者立体的学习感受，提升他们的阅读体验，并帮助其深入理解。

诺伦-霍克西玛的文字简洁兼具流畅，风格活泼不失严谨，读起来轻松愉悦又富有知识性，适合心理学专业的广大师生及相关从业者，也适合对心理学感兴趣并有一定英文基础的普通读者。值得一提的是，此书的中文版本也即将出版，届时有需要的读者可以一起翻阅参考。

Preface xv

1 Looking at Abnormality 2

2 Theories and Treatment of Abnormality 22

3 Assessing and Diagnosing Abnormality 58

4 The Research Endeavor 82

5 Trauma, Anxiety, Obsessive-Compulsive,

and Related Disorders 106

6 Somatic Symptom and Dissociative

Disorders 150

7 Mood Disorders and Suicide 174

8 Schizophrenia Spectrum and Other

Psychotic Disorders 216

9 Personality Disorders 250

10 Neurodevelopmental and Neurocognitive

Disorders 282

11 Disruptive, Impulse Control, and Conduct

Disorders 318

12 Eating Disorders 336

13 Sexual Disorders 362

14 Substance Use and Gambling Disorders 394

15 Health Psychology 432

16 Mental Health and the Law 462

Discussions for Think Critically 481

References R-1

苏珊·诺伦-霍克西玛（1959—2013）

    苏珊·诺伦-霍克西玛是著名的学者、教师、导师和学界领袖。她因以下方面的杰出贡献而享誉国际：人们如何调节情感和情绪，人们容易受到情绪问题（尤其是抑郁）伤害的特定思维模式有何特点，又该如何缓慢复原。她的研究极大地影响了专业领域对于妇女和女孩抑郁的看法，她提出了关于冗思和抑郁的开创性理论，影响了其后不计其数的实证研究和理论贡献。

    苏珊生前先后任教于斯坦福大学、密歇根大学和耶鲁大学。她的研究工作专注于抑郁、情绪调节和性别，并因此获得学界认可和诸多奖项：美国心理学协会（APA）第12分支颁发的David Shakow早期成就奖，美国心理学协会女性委员会颁发的杰出领导奖，美国心理科学协会（APS）颁发的James Mckeen Cattel会员奖以及美国国家精神健康委员会颁发的研究生涯奖和多项研究资助。此外，她还是《临床心理学年鉴》（Annual Review of Clinical Psychology）的创刊主编，该期刊目前是

临床心理学领域引用率的期刊。

    2013年1月，我们不幸失去了一位受人尊敬和爱戴的作者、朋友。

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受过训练的心理健康专业人土所能提供的上述干预手段，远远不足于解决现实世界存在的形形色色的心理健康问题（ Kazdin& Blase，2011）。例如，世界卫生组织最近根据17个国家完成的研究进行估算得出，12%到47%的人在一生中将会出现满足某种精神障碍诊断标准的症状（ Kessler et al，2009）。在美国，精神障碍的终生患病率估计为50%，在任何给定年份，总人口中有25%的人满足某种诊断标准（ Kessler&Wang，2008）。这相当于7500万人，而美国只有70万心理健康专业人士。

超过70%的人都表示想戒烟（ Goldstein，198）。然而戒烟是非常困难的，部分原因是尼古丁的戒断症状令人难以忍受。只有7%的抽烟者在戒烟一年后不抽烟，大多数人在中断抽烟几天后就再次抽烟了（ National Institute on Drug Abuse[ NIDA，2002b）抽烟者在停止抽烟后仍然渴求抽烟一一有50%的戒烟者说自己在过去24小时里仍渴望抽烟（ Goldstein1994）。尼古丁贴片和口香糖可以帮助人们抵制这种强烈的欲望。

咖啡因刺激中枢神经系统，提高多巴胺、去甲肾上腺素和5-羟色胺水平。它也会加快新陈代谢，使体温和血压升高，食欲减退，警觉性增强。摄入约两到三杯咖啡的剂量后，就会引起许多不适的症状，包括烦躁不安、神经质和手部震，人们可能会感到胃部不适、心跳过速或心律不齐，还可能难以人睡和尿频。这些都是咖啡因中毒的症状极大剂量的咖啡因会造成极端的激越、痉挛、呼吸衰竭和心脏病。

DSM5明确规定，只有当个体因为这些症状而感到明显的心理痛苦或功能损害时，才可以诊断为咖啡因中毒。例如，有些人可能在考试周连续几天喝了太多咖啡，导致如此激越以至于无法坐着考试，颤抖得太厉害而无法驾车这样的人才能诊断为咖啡因中毒。

些喝很多咖啡的人开玩笑说他们是“咖啡上瘾”。实际上，根据DSM5的诊断标准，他们不能被诊断为咖啡因依赖障碍，因为咖啡因依赖似乎没有引起他们严重的社会和职业问题。不过，咖啡因使用者会对咖啡因产生耐受性停止摄入后会经历戒断症状。他们会发现自己在早上必须喝几杯咖啡才能感觉“正常”，如果不喝咖啡，他们就会感到强烈的头痛、疲劳和焦虑。

每当我们面对应激源，就会产生一系列的生理反应正如第5章所讨论的。这些被统称为战斗或逃跑反应（ fight-or flight response；见表5.1），心率加快和血压增高等躯体变化使身体做好了面对威胁或从中逃离的准备。交感神经系统还会刺激多种激素的分泌，包括肾上腺素和去甲肾上腺素，使身体做好反应的准备。最主要的应激激素之一是由肾上腺皮质分泌的皮质醇。最终，当威胁性的刺激过去之后，上升的皮质醇会指示躯体停止释放这些激素。这个过程使得身体可以适应各种程度的应激

即使轻度的应激源也会触发战斗或逃跑反应。如果应激源是即时的，反应会受到激活，随后消退。这种适应称作稳态应变（ allostasis），躯体学习如何在应激源不严重且持续时间不长、在它出现和消失时，更有效地做出反应（ Mcewen2000但如果应激源是长期的，也就是如果它持续较长一段时间，而且人或动物无法与之斗争或从中逃离，那么它所导致的长期生理唤醒就可能对身体有严重的危害，这种情况称作非稳态负荷。

免疫系统（ Immune system）通过识别并系死病原体和瘤细胞来保护我们免遭疾病侵袭。免疫系统分为两种：先天免疫系统（ innate immune system）和特异性免渡系统（ specific immune system），两者都有一系列攻击人侵者的细胞机制。先天免疫系统对进人身体的任何微生物或毒素做出迅速、非特异性的反应，释放出杀死并吸收入侵者的细胞。特异性免疫系统反应较慢，但它的反应是为出现的特定病原体量身打造的。特异性免疫系统会记住该病原体，如果它再次发起攻击，免疫系统就能更迅速有效地对其进行杀灭。

应激可能从几个方面影响免疫系统。尽管短期应激似乎能提高免疫反应的效能，但长时间的应激则会削弱免疫功能，一部分原因是如果应激源持续时间较长，战斗或逃跑反应所释放的皮质醇等生化物质会抑制免疫系统。

生物节律尤其是体温节律强烈地影响着我们入睡和醒来的时间（ Lack et al2008）。如果我们的时间表是夜间睡眠、白天清醒活跃，那么我们的核心体温一般在凌晨4~6点达到最低点；在达到最低点的5~6个小时前（晚上11点到凌晨1点最容易入睡。人们通常在达到最低核心体温的1~3个小时后醒来。有些人的体温节律受到干扰，影响了他们在夜晚入睡或在清晨保持睡眼的能力。

编辑推荐

先后任命于斯坦福大学、密歇根大学和耶鲁大学的权威教授——苏珊·诺伦-霍克西玛的绝笔著作！

一本有趣、易懂的变态心理学入门教材！

以*的DSM-5为诊断标准！

有配套的中文翻译版！

书摘插图

The study of

abnormal psychology is the study of people, like the young woman in the

Extraordinary People feature, who suffer mental, emotional, and often physical

pain, often referred to as psychopathology. Sometimes the experiences of people

with psychopathology are as unusual as those this young woman describes.

Sometimes, however, people with psychopathology have experiences that are

familiar to many of us but more extreme, as Kay Redfi eld Jamison (1995, p.

110) describes in An Unquiet Mind .

In this book, we

explore the lives of people with troubling psychological symptoms to understand

how they think, what they feel, and how they behave. We investigate what is

known about the causes of these symptoms and the appropriate treatments for

them. The purpose of this book is not only to provide you with information, facts

and fi gures, theories, and research but also to help you understand the experience

of people with psychological symptoms. The good news is that, thanks to an

explosion of research in the past few decades, effective biological and

psychological treatments are available for many of the mental health problems we

discuss.

DEFINING ABNORMALITY

In popular

culture, there are a lot of words for people and behaviors that seem abnormal: around

the bend, bananas, barmy, batty, berserk , bonkers , cracked, crazy, cuckoo,

daft , delirious , demented , deranged , dingy , erratic , flaky , flipped out,

freaked out, fruity, insane , kooky, lunatic , mad , mad as a March hare, mad

as a hatter, maniacal , mental , moonstruck, nuts, nutty, nutty as a fruitcake,

of unsound mind, out of one’s mind, out of one’s tree, out to lunch, potty, psycho , screw loose, screwball,

screwy, silly , touched , unbalanced , unglued, unhinged, unzipped, wacky.

People talk as if they have an intuitive sense of what abnormal behavior is.

Let’s explore some of the ways abnormality has been defined.

Mental

Illness

A common belief

is that behaviors, thoughts, or feelings can be viewed as pathological or

abnormal if they are symptoms of a mental illness . This implies that a disease

process, much like hypertension or diabetes, is present. For example, when many

people say that an individual “has

schizophrenia”(which is characterized

by unreal perceptions and severely irrational thinking), they imply that he or

she has a disease that should show up on some sort of biological test, just as hypertension

shows up when a person’s blood pressure

is taken.

To date,

however, no biological test is available to diagnose any of the types of

abnormality we discuss in this book (Hyman, 2010). This is not just because we

do not yet have the right biological tests. Modern conceptualizations of mental

disorders view them not as singular diseases with a common pathology that can

be identifi ed in all people with the disorder. Rather, mental health experts

view mental disorders as collections of problems in thinking or cognition, in

emotional responding or regulation, and in social behavior (Hyman, 2010; Insel

et al., 2010; Sanislow et al., 2011). Thus, for example, a person diagnosed with

schizophrenia has a collection of problems in rational thinking and in

responding emotionally and behaviorally in everyday life, and it is this

collection of problems that we label schizophrenia. It is still possible, and

in the case of schizophrenia likely, that biological factors are associated with

these problems in thinking, feeling, and behaving. But it is unlikely that a

singular disease process underlies the symptoms we call schizophrenia.

Cultural

Norms

Consider these

behaviors:

1. A man driving

a nail through his hand

2. A woman

refusing to eat for several days

3. A man barking

like a dog and crawling on the floor on his hands and knees

4. A woman building

a shrine to her dead husband in her living room and leaving food and gifts for

him at the altar

Do you think

these behaviors are abnormal? You may reply, “It depends.” Several of

these behaviors are accepted in certain circumstances. In many religious

traditions, for example, refusing to eat for a period of time, or fasting, is a

common ritual of cleansing and penitence. You might expect that some of the

other behaviors listed, such as driving a nail through one’s hand or barking like a dog, are abnormal in all circumstances, yet

even these behaviors are accepted in certain situations. In Mexico, some

Christians have themselves nailed to crosses on Good Friday to commemorate the

crucifi xion of Jesus. Among the Yoruba of Africa, traditional healers act like

dogs during healing rituals (Murphy, 1976). Thus, the context, or circumstances

surrounding a behavior, infl uences whether the behavior is viewed as abnormal.

Cultural norms

play a large role in defining abnormality. A good example is the behaviors

people are expected to display when someone they love dies. In cultures

dominated by Shinto and Buddhist religions, it is customary to build altars to

honor dead loved ones, to offer them food and gifts, and to speak with them as

if they were in the room (Stroebe, Gergen, Gergen, & Stroebe, 1992). In

cultures dominated by Christian and Jewish religions, such practices would

potentially be considered quite abnormal.

Cultures have

strong norms for what is considered acceptable behavior for men versus women,

and these gender-role expectations also influence the labeling of behaviors as

normal or abnormal (Addis, 2008). In many cultures, men who display sadness or

anxiety or who choose to stay home to raise their children while their wives

work are at risk of being labeled abnormal, while women who are aggressive or

who don’t want to have children are at risk of being labeled abnormal.

书籍介绍

苏珊·诺伦-霍克西玛的《变态心理学》（Abnormal Psychology）是一本系统描述心理病理学的教科书，结合了心理病理学的前沿研究，重视实证和多元化，并清晰地陈述了相关的生物学基础。此书影印自该教材的最新版（第6版），反映了DSM-5的诊断标准。

全书共16个章节，依次为：异常心理和行为一瞥，异常的理论与治疗，异常的评估和诊断，研究方法，创伤、焦虑、强迫及相关障碍，躯体症状障碍和分离障碍，心境障碍和自杀，精神分裂症谱系及其他精神病性障碍，人格障碍，神经发育障碍与神经认知障碍，破坏性、冲动控制及品行障碍，进食障碍，性障碍，物质使用和赌博障碍，健康心理学，精神健康与法律。此书还附有关于批判性思考的讨论、术语表，以及参考文献。另外，书中不仅加入了多幅美丽生动的精美图片，还设立了多个独立的模块，如非常人物、批判性思考、灰色地带等，给予读者立体的学习感受，提升他们的阅读体验，并帮助其深入理解。

诺伦-霍克西玛的文字简洁兼具流畅，风格活泼不失严谨，读起来轻松愉悦又富有知识性，适合心理学专业的广大师生及相关从业者，也适合对心理学感兴趣并有一定英文基础的普通读者。值得一提的是，此书的中文版本也即将出版，届时有需要的读者可以一起翻阅参考。