Journal of Child and Family Studies, Vol. 15, No.

1, February 2006 (

C 2006), pp. 1–12

DOI: 10.1007/s10826-005-9006-9

Freud was Right. . . About the Origins of Abnormal

Behavior
Peter Muris, Ph.D.1,2
Published online: 24 February 2006

Freud’s psychodynamic theory is predominantly based on case histories of pa-

tients who displayed abnormal behavior. From a scientific point of view, Freud’s
analyses of these cases are unacceptable because the key concepts of his theory
cannot be tested empirically. However, in one respect, Freud was totally right:
most forms of abnormal behavior originate in childhood. In this paper various
factors are discussed that play a role in the etiology of abnormal behavior in chil-
dren and adolescents. Furthermore, problems are signaled that hinder effective
interventions for disordered youths.
KEY WORDS: psychological disorders; etiology; children and adolescents.

FREUD’S THEORY

Freud’s psychoanalytic theory is still one of the most influential theoretical

models of abnormal human behavior. On the basis of a series of intriguing case
studies, Freud illustrated the key constructs of his theory thereby attempting to
explain why his patients were exhibiting aberrant behaviors. For example, take the
case of Little Hans, which was described by Freud as the “Analysis of a phobia in
a five-year-old boy” (Freud, 1909/1955). Little Hans was afraid of horses. He was
so terrified that he did not dare to go outside anymore, a phenomenon that current
clinical psychologists would label as ‘agoraphobia.’ Freud’s analysis of this case
was crystal clear. Hans suffered from a so-called Oedipus complex. That is, Hans
wanted to have sex with his mother and therefore expected to be punished by his
father. As a result, Hans became afraid of his father. However, this was considered
as unacceptable by his Ego and, therefore, the fear was displaced to another object,
1 Professor, Institute of Psychology, Erasmus University Rotterdam, The Netherlands.
2 Correspondence should be directed to Peter Muris, Ph.D., Institute of Psychology, Erasmus University
Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.; e-mail: muris@fsw.eur.nl.

1
1062-1024/06/0200-0001/1

C 2006 Springer Science+Business Media, Inc.
2 Muris

resulting in a phobia of horses. In another case, Freud described an adult lawyer,

Paul Lorentz, also known as the Ratman (Freud, 1909/1955). The Ratman was
plagued by the obsession that his father had to undergo the rat punishment. This
rat punishment implied that a cooking pot was attached to his father’s backside in
which rats were placed. The rats ate their way into the anus of his father. How is it
possible that Lorentz was plagued by such disturbing thoughts about his beloved
father? Freud’s analysis was again clear: the obsessions of the Ratman had to do
with sex-related, hostile impulses against his father.

THE HOLY GRAIL

Freud’s theory is largely based on case studies of abnormal human behavior.

Without exceptions, these cases are fascinating and interesting. However, from
a scientific point of view, Freud’s analyses of these cases are unacceptable, as
the main concepts of his theory cannot be validated empirically (Eysenck, 1985).
Since Freud, a lot of researchers in the field of clinical psychology have devoted
their attention to what can be called “the quest of the Holy Grail.” The purpose of
this quest is to find an answer on two questions: (1) where does abnormal human
behavior come from? and, (2) how can we use this knowledge to help people who
show clear signs of aberrant behavior?
Abnormal behavior or psychopathology is concerned with various types of
disorders, including eating disorders, depression, disruptive behavior, and anxi-
ety disorders (American Psychiatric Association [APA], 2000). In their quest for
the Holy Grail, an increasing number of researchers are focusing on the study
of abnormal behavior in children and adolescents. The reason for this is obvious
and has to do with what is known about the age of onset of many disorders. For
example, specific phobias usually start in childhood (Öst, 1987). Social phobia,
depression, and eating disorders frequently have their onset during adolescence
(Burke, Burke, Regier, & Rae, 1990; Mussell, Mitchell, Weller et al., 1995), while
people who suffer from a personality disorder by definition already show signs
of their problems before the age of 18 (APA, 2000). In other words, many types
of abnormal behavior that are seen in adults have already started in youth. Re-
cent epidemiological research with children and adolescents has demonstrated
that psychopathology indeed is a serious problem in this age group (Costello,
Mustillo, Erkanli, Keeler, & Angold, 2003). In a large sample of youths from the
general population, the one-year prevalence of internalizing (i.e., anxiety disor-
ders, depression) as well as externalizing disorders (i.e., oppositional-defiant and
conduct disorders) was about 5%. The most striking finding of this study was
that before their 16th birthday, 36.7% of all youths at some point in time had
suffered from a psychological problem. It is important to note that these prob-
lems concerned clinical diagnoses, which implies that youths really experienced
considerable discomfort in their daily functioning.
About the Origins of Abnormal Behavior 3

THE ORIGINS OF ABNORMAL BEHAVIOR IN YOUTHS

Why do a substantial proportion of children and adolescents come to suffer

from a psychological disorder? Briefly, the answer to this question can be found in
four groups of factors. The first group of factors is concerned with characteristics
of the child. The second group of factors involves the family, and especially the
interaction between children and their parents. The third group of factors has to
do with influences of the environment and from the child’s point of view can be
labeled as learning experiences. The fourth and final group of factors pertains to
societal influences.
Genetics and Temperament

Genetic make-up is one important child factor that is involved in the origins
of psychopathology. The influence of genetics is typically established in twin
studies. Based on the fact that monozygotic twin pairs share 100% of the genetic
material, whereas dizygotic twin pairs only share 50%, one can determine the level
of agreement and compute a hereditary factor for each type of psychopathology.
For most disorders, the agreement in psychopathology is larger in monozygotic
than in dizygotic twins, which points in the direction of a genetic influence. More
precisely, for the three most common psychological disorders in youths (i.e.,
anxiety disorders, depression, and disruptive behavior disorders), twin studies
have demonstrated that about 50% of the variance in these problems can be
attributed to heredity (Rutter, Silberg, O’Conner, & Siminoff, 1999).
In what way does heredity contribute to the etiology of psychopathology in
youths? One factor that is thought to play a role in this respect is the child’s tem-
perament and, in particular, the temperament factor of emotionality (also known as
neuroticism or negative affectivity). Emotionality refers to emotional instability
and there are clear indications that this temperament factor has a genetic basis
(Eysenck, 1990). Research has also shown that children and adolescents with high
levels of emotionality are at greater risk for developing psychological disorders
(Asendorpf & Van Aken, 2003; Barbaranelli, Caprara, Rabasca, & Pastorelli, 2003;
Erler, Evans, & McGhee, 1999; Huey & Weisz, 1997; John, Caspi, Robins, Moffitt,
& Stouthamer-Loeber, 1994; Muris, Winands, & Horselenberg, 2003). Further, it
is important to note that emotionality consists of various lower-order components
of which fear, anger/frustration, and sadness can be considered as most relevant
as they seem to play an important role in the type of psychopathology from which
children eventually come to suffer (Rothbart & Bates, 1998). That is, a child with
a fearful temperament is more prone to develop an anxiety disorder, a child with a
temperament characterized by high anger/frustration runs greater risk to develop
a disruptive behavior disorder, whereas a child with a sad temperament is more
susceptible to develop a depression (Muris & Ollendick, 2005).
It is important to note that the contribution of temperament to the etiology
of child psychopathology should not merely be viewed as a reactive process
4 Muris

guided by the temperament factor of emotionality. In the past five years, an

increasing amount of research has focused on ‘effortful control,’ which is viewed as
a regulative temperament factor that enables children and adolescents to modulate
their emotional reactions. Effortful control can be defined as “the ability to inhibit
a dominant response to perform a subdominant response” (Rothbart & Bates,
1998), and essentially consists of two important components: inhibitory control,
which pertains to the ability to inhibit one’s behavior if necessary, and attention
control, which can be defined as the ability to focus and shift attention as needed.
Current temperament researchers assume that vulnerability to psychopathol-
ogy is characterized by a combination of high levels of emotionality and low levels
of effortful control (Calkins & Fox, 2002; Lonigan & Phillips, 2001). More specif-
ically, high levels of emotionality make children prone to develop psychological
disorders, but it may well be the case that the negative impact of this reactive
temperament factor can be buffered by effortful control. That is, a stressful life
event will elicit negative emotions in children and particularly in those who are
characterized by high levels of emotionality. However, only children with low
levels of effortful control will experience difficulties to deal adequately with these
negative feelings and hence will react with avoidance behavior, aggression, and
depression. In contrast, children with high levels of effortful control are capa-
ble of regulating these negative emotions by employing more strategic, flexible
and effective coping strategies (Muris & Ollendick, 2005). Recent research has
indeed demonstrated that reactive and regulative temperament factors of respec-
tively emotionality and effortful control each make a unique contribution to the
frequency of psychopathological symptoms in youths (Muris, De Jong, & Engelen,
2004). Finally, it should be mentioned that different aspects of effortful control are
allied to specific psychopathological symptoms (Muris, Meesters, & Rompelberg,
submitted). More precisely, a lack of attentional control was more strongly linked
to internalizing symptoms, whereas a deficiency of inhibitory control was more
clearly related to externalizing symptoms. Note that these differential relations are
in keeping with the clinical observation that internalizing disorders are typically
characterized by uncontrollable negative thoughts, while externalizing disorders
are frequently marked by impulsive and disinhibited behavior (see APA, 2000).

Parental Rearing and Modeling

The second group of factors that is involved in the etiology of child psy-
chopathology is concerned with the family and, in particular, with parental rear-
ing practices. In the context of abnormal behavior, two important dimensions in
parental rearing behaviors can be discerned. The first dimension is parental care
and has two opposite poles: an accepting and warm rearing style on one side and
a rejecting and cold rearing attitude on the other side. The second dimension is
concerned with parental control and actually opposes an autonomy-promoting and
About the Origins of Abnormal Behavior 5

an overprotective rearing style to each other (Rapee, 1997). Various studies have
found that specific types of abnormal behavior in children are associated with
particular types of parental rearing. For example, anxiety symptoms in youths are
generally linked to high levels of parental control (i.e., overprotection), depressive
symptoms are related to low levels of parental care (i.e., lack of emotional warmth
and rejection), whereas behavioral problems are associated with high levels of
control as well as low levels of care (Muris, Bögels, Meesters, Van der Kamp, &
Van Oosten, 1996; Muris, Meesters, Merckelbach, & Hülsenbeck, 2000; Muris,
Meesters, Schouten, & Hoge, 2004; Muris, Meesters, & Van den Berg, 2003). As
an aside, it should be mentioned that it is difficult to find out what is cause and what
is effect in the relation between parental rearing behavior and child psychopathol-
ogy. It may well be that negative rearing behaviors contribute to the development
of abnormal behavior. Otherwise, it is also possible that children who display
abnormal behavior elicit negative rearing behaviors in their parents. Currently,
researchers assume that both scenarios are applicable, which means that parental
rearing behaviors are thought to play a role in the etiology and maintenance of
psychopathology in youths.
More specific parental rearing behaviors also seem to be involved in the
origins of psychological problems in children. For example, it is a common fact
that children learn by observing and imitating the behaviors of their parents, a
phenomenon that is known as modeling. Experimental research has convincingly
demonstrated that modeling is involved in the acquisition of fear in children. In
a study by Gerull and Rapee (2002), toddlers were shown a rubber snake and
spider, which were alternately paired with either a negative or a positive facial
expression by their mother. Next, both stimuli were presented again after a brief
delay, and fear and avoidance reactions were assessed. Results clearly indicated
that children displayed less fear and more approach behavior when their mothers
had responded positively to the stimuli. Conversely, children showed more fear
and avoidance following negative reactions from their mother. Other examples
that suggest a link between modeling and child psychopathology are numerous
and can be observed inside as well as outside the clinic: obese children often have
fat parents, aggressive children frequently have antisocial parents, and children
with developing personality problems tend to have weird parents (Adshead, 2003;
Bandura, 1976; Gable & Lutz, 2000). Of course, modeling is not the only factor
that contributes to these phenomena but at least seems to play a significant role.

Life Events and Negative Information

A third group of factors that is relevant in the context of the genesis of

abnormal behavior in children is concerned with negative learning experiences.
Obviously, children who experience aversive life events run greater risk for devel-
oping psychopathology (Cuffe, McKeown, Addy, & Garrison, 2005; Tiet et al.,
6 Muris

2001). Maltreatment, abuse, parental divorce, being teased at school, or the death
of a significant person are all negative life events that may give rise to abnor-
mal behavior in children, and especially in those characterized by a vulnerable
temperament. However, there are also more subtle forms of learning experiences
that may promote the development of psychopathology. For example, research has
demonstrated that negative information promotes children’s fear (Field, Argyrus,
& Knowles, 2001). Seven- to 9-year-old children received either negative or pos-
itive information about an unknown monster doll. Results showed that negative
information significantly increased children’s fear ratings, whereas after positive
information fear ratings slightly decreased. These results were replicated by Muris,
Bodden, Merckelbach, Ollendick, and King (2003) who provided children with
either negative or positive information about an unknown, doglike animal, called
“the beast.” This study demonstrated that information-induced fear effects endured
over a 1-week follow-up period and generalized to other stimuli; that is, children
who became more fearful of the beast after receiving negative information also
became more apprehensive of other dogs and predators.
It is good to keep in mind that children are confronted with negative infor-
mation in various ways: they may hear things from adults or other children, but
they may also see things on television or come across certain information while
surfing on the internet. These learning experiences not only play a role in anxiety
phenomena, but also seem to contribute to other forms of abnormal behavior in
youths. For instance, Greenfield (2004) studied the effects of inadvertent exposure
to pornographic material on the internet, and noted that children who regularly
come across such information are more likely to develop different sexual attitudes,
and even engage in age-inappropriate sexual activity and sexual violent behaviors.

Society and Culture

The fourth and final group of factors that is involved in the etiology of
abnormal behavior in youths is operating at a societal and cultural level. For
example, research on the prevalence of anxiety symptoms in South African chil-
dren has consistently demonstrated that black and colored youths in this country
display higher anxiety levels than their white counterparts (Burkhardt, Loxton,
& Muris, 2003; Muris, Schmidt, Engelbrecht, & Perold, 2002). This difference
was almost completely explained by the socio-economic background of the chil-
dren (Muris, Loxton, Neumann, & Du Plessis, in press). That is, in the after-
math of the Apartheid regime black and colored children still live in poor and
threatening neighborhoods, whereas white children are raised under rich and safe
living conditions. While such marked differences in socio-economic background
are seldom seen in Western countries, this example illustrates that a societal
factor can make a significant contribution to the psychological (dys)functioning of
children.
About the Origins of Abnormal Behavior 7

Further evidence for a link between society and anxiety comes from a meta-
analytic study by Twenge (2000) who compared children’s scores on a commonly
employed anxiety questionnaire for various birth cohorts between 1952 and 1993.
Results indicated that youths in the 1990s displayed considerably higher anxiety
levels as compared to youths in the 1950s. To put it even stronger, the mean
score of the normal children in the 1990s was even higher than the mean score
of clinically referred children in the 1950s. Interestingly, this increase in anxiety
across various age cohorts was significantly related to a variety of social parameters
(e.g., divorce rate, number of violent crimes), which made Twenge (2000) conclude
that a decrease in social connectedness and an increase in environmental danger
may be responsible for the rise in anxiety among youths.
Another example illustrating the role of society in the etiology of child psy-
chopathology is concerned with culturally determined body ideals. In Western
countries, children and adolescents are attracted by good-looking idols of whom
women look slim and men look slender and muscular. It has been demonstrated
that early adolescent youths frequently engage in body change strategies, with
girls engaging in dieting in order to lose weight and boys doing exercises in or-
der to develop their muscles (Ricciardelli & McGabe, 2001). Further research
indicates that culturally determined body ideals have a substantial impact on the
development of abnormal manifestations of body change strategies, and this influ-
ence remains statistically significant when controlling for various biological (e.g.,
Body Mass Index) and psychological factors (e.g., self-esteem; Muris, Meesters,
Van de Blom, & Mayer, 2005).

INCREASED PRESSURE

In sum, it can be concluded that psychopathology is highly prevalent among

youths, and there are clear indications that a substantial proportion of these psy-
chological problems will continue into adulthood. Various child, family, environ-
mental, and societal factors have been discussed that are thought to be involved
in the etiology of abnormal behavior in youths. Two additional remarks should
be made with regard to the role of these factors. First, it should be kept in mind
that in reality factors frequently interact with each other (Wenar & Kerig, 2000).
For example, a child is particularly vulnerable if he/she is characterized by an
emotional temperament and is raised by parents who are rejective and show little
emotional warmth. Thus, it should be kept in mind that it is often the combination
of vulnerability factors and/or the lack of protective variables that are responsible
for the emergence of abnormal behavior. Second, when studying factors that are
involved in the etiology of child psychopathology, one should adopt a developmen-
tal perspective. For example, when raising a 2-year-old child it may be perfectly
adequate for parents to rely on a controlling rearing style. However, this style
8 Muris

may be totally inappropriate for a 16-year-old who generally fares better with an
autonomy-granting attitude of his parents.
The general impression is that contemporary youths run greater risk for
developing psychopathology. Changes in society (increased individualization) and
family (increased divorce rate) and increased confrontation with the negative and
even dark sides of life (not only via television and internet, but also in the direct
environment) put children under greater pressure and will result in an increase of
psychopathology.

INTERVENTION

Fortunately, there is also good news. In the past decade, researchers in the
field of clinical psychology have developed effective intervention methods for
treating the most prevalent psychological problems among youths (Barrett &
Ollendick, 2004). When detected in good time, disruptive behavior disorders can
be treated effectively by training parental rearing skills (Barkley, 1997). Depres-
sion can be successfully handled with cognitive-behavioral therapy (CBT) of the
child (Lewinsohn, Clarke, Hops, & Andrews, 1990). Impressive progress has also
been made with the treatment of childhood anxiety disorders (Kendall, 1994),
which also respond well to CBT-based interventions. For example, in a study by
our research group (Muris, Meesters, & Van Melick, 2002), children with anxi-
ety disorders were randomly assigned to three conditions: CBT, a psychological
placebo intervention (i.e., emotional disclosure), or a no-treatment control con-
dition. Therapy outcome measures were obtained three months before treatment,
at pretreatment, and at posttreatment. Results showed that levels of psychopatho-
logical symptoms remained relatively stable during the three months preceding
treatment. Most importantly, pretreatment-posttreatment comparisons indicated
that CBT was superior to psychological placebo and no-treatment control. That
is, only in the CBT condition significant reductions of anxiety symptoms were
observed. Recently, research has demonstrated that these positive effects of CBT
in anxious children are maintained over very long time periods (Barrett, Duffy,
Dadds, & Rapee, 2001).
In spite of this positive news, there are also a number of problems. The first
problem has to do with the dissemination and implementation of the intervention
methods that have been developed by scientists (Weisz, Jensen, & McLeod, 2005).
Effective programs frequently remain in the research institute and, as a result, they
are not used by clinicians who actually work with disordered youths. A second
problem pertains to the late detection of abnormal behavior in youths (Angold,
Costello, Farmer, Burns, & Erkanli, 1999; Champion, Goodall, & Rutter, 1995).
This is not only true for disruptive behavior problems which either elicit shame
in parents or are not seen as a serious problem (because parents show antisocial
behavior themselves) but also for emotional problems such as anxiety disorders
About the Origins of Abnormal Behavior 9

and depression that are less clearly visible to the outside world. As a result,
many children already suffer from their problem for many years. When they are
eventually referred to the clinic the problem has become so severe that effective
treatment is difficult. A third and final problem concerns the organization and
quality of the mental health service system. Even in such a civilized and well-
organized country as the Netherlands, it is still surprising to note that not all
clinicians are using empirically validated, effective treatment methods. Further, it
is far from clear for children and their parents where they can get the most optimal
treatment for psychological problems.

WAS FREUD RIGHT?

Was Freud right in his ideas on the origins of abnormal behavior? Formally,
the answer to this question is of course negative, as Freud developed an almost
unreal theory about the etiology of psychopathology in which constructs such
as Id-Ego-Superego, repression, and Oedipus complex play a prominent role. It
has become clear that such constructs are difficult to validate empirically and as
such a firm scientific basis for Freud’s theory is still lacking. However, there is
at least one important issue on which Freud was right: that is, human abnormal
behavior frequently has its origins in childhood. Researchers and clinicians seem
to have accepted this idea, but it is time that politicians and other policy makers
also become convinced of this notion, so that they put more effort in tackling the
problems that hinder the effective detection and intervention of disordered youths.

ACKNOWLEDGMENT

This paper is based on the academic lecture given by the author on February
18, 2005 when accepting his position as full professor in Clinical and Health
Psychology at the Erasmus University Rotterdam, The Netherlands.

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