4. psychopathology

Question 1

statistical infrequency

Answer 1

someone is statistically infrequent if they have a characteristic that lies outside of the -2 and +2 standard deviation of the normal distribution curve

Question 2

statistical infrequency example

Answer 2

— Someone with an IQ two standard deviations from the average on either side is abnormal. An example of a diagnosis Intellectual Disability Disorder (IDD) in the DSM is having an IQ of 70 or lower. Just over 2% of the population is in this intelligence bracket.

Question 3

statistical infrequency strength (AO3)

Answer 3

Individuals who are assessed as being abnormal have been evaluated objectively. This is better than the other definitions as it judges against the general population rather than the subjective opinions of a clinician.

Question 4

statistical infrequency limitations (AO3)

Answer 4

― The psychological community decides the cutoff point for what is statistically rare enough to be defined as abnormal, which is a subjective decision with real-life implications. For example, defining IDD as 70 IQ and under means people with just over 70 may be denied support.

― Not all statistically rare traits are negative. This definition also includes the people at the higher end of intelligence. People with an IQ of 130 are just as statistically rare as IQs of 70.

― There is a range of common psychopathologies such as depression and anxiety. The NHS found that 17% of people surveyed met the criteria for a common mental health disorder. Therefore this definition isn’t appropriate when considering society’s high incidence of mental health disorders

Question 5

failure to function adequately

Answer 5

someone is defined as FFA if they cannot cope in their daily lives, and they cause observer discomfort or personal anguish

Question 6

failure to function adequately criteria

Answer 6

— maladaptive behaviour
— personal anguish
— observer discomfort
— irrationality
— unpredictability
— unconventionality

Question 7

maladaptive behaviour

Answer 7

individuals behave in ways that go against their long-term goals and interests

Question 8

personal anguish

Answer 8

the individual suffers from anxiety and distress

Question 9

observer discomfort

Answer 9

the individual’s behaviour causes distress to those around them

Question 10

irrationality

Answer 10

it is difficult to understand the motivation behind the individuals behaviour

Question 11

unpredictability

Answer 11

unexpected behaviour

Question 12

unconventionality

Answer 12

behaviour doesn’t match what is typically expected by society

Question 13

failure to function adequately (AO3)

Answer 13

― The definition respects the individual and their own personal experience, which is something that other definitions, such as SI and DSN cannot do: these definitions of abnormality are based on what is normal in the rest of the population

Question 14

failure to function adequately (AO3)

Answer 14

― The decision about whether someone is coping is subjective and based on the clinician’s opinion. This judgement may be biased, meaning that two clinicians may not agree on whether someone is managing.

― FFA only includes people who cannot cope; psychopaths can often function in society in ways that benefit them personally. Having lower empathy can lead to success in certain areas. However, while they feel no distress themselves, it often has negative implications for the people around them

― Not all maladaptive behaviour indicates mental illness. Taking part in extreme sports, eating unhealthy food and drinking alcohol all risk the individual’s health, so they are arguably maladaptive. However, most people would disagree that these behaviours indicate mental illness.

Question 15

deviation from social norms

Answer 15

A social norm is an unwritten expectation of behaviour that can vary from culture to culture and changes over time. People who deviate from these societal expectations may be seen as abnormal or social deviants.

Question 16

examples of social norms that vary between cultures

Answer 16

― acceptance of homosexuality
― face and hair coverings
― acceptable foods and how to eat it
― public displays of affection
― level of modesty in clothing choices

Question 17

deviation of social norms strengths (AO3)

Answer 17

― The definition does not impose a western view of abnormality on non-western cultures. For this reason, it is argued diagnosing abnormality according to social norms is not ethnocentric: it respects the cultural differences between societies.

Question 18

deviation from social norms limitations (AO3)

Answer 18

― It can be inappropriate to define people who move to a new culture as abnormal according to the new culture norms. People from an Afro-Caribbean background living in the UK are seven times more likely to be diagnosed with schizophrenia than people living in the UK. This is due to category failure. In Afro-Caribbean cultures, hallucinations and conversations with angels may be considered part of a typical religious experience, so a doctor in the West Indies would be less likely to diagnose schizophrenia based on these symptoms than a doctor in the UK

― The definition can be seen as punishing people who are trying to express their individuality and repressing people who do not conform to the repressive norms of their culture. For example, the World Health Organisation (WHO) declassified homosexuality as a mental illness in 1992 and transgender health issues in 2019; these recent changes may have followed societal norms/social acceptance.

Question 19

deviation from ideal mental health

Answer 19

Marie Jahoda’s definition comes from a humanistic perspective that focuses on ways to improve and become a better person. She identified six features of ideal mental health, such as resistance to stress and environmental mastery.

Question 20

deviation from idea mental health criteria

Answer 20

― environmental mastery
― autonomy
― resistance to stress
― self-actualisation
― positive attitude towards oneself
― accurate perception of reality

Question 21

environmental mastery

Answer 21

the ability to adapt and thrive in new situations

Question 22

autonomy

Answer 22

the ability to act independently and trust in one’s own abilities

Question 23

resistance to stress

Answer 23

the internal strength to cope with anxiety caused by daily life

Question 24

self-actualisation

Answer 24

the ability to reach one’s potential through personal growth

Question 25

positive attitude towards oneself

Answer 25

characterised by high self-esteem and self-respect

Question 26

accurate perception of reality

Answer 26

the ability to see the world as it is without being distorted by personal biases

Question 27

deviation from idea mental health strengths (AO3)

Answer 27

― This definition has a more constructive and holistic approach to mental health compared to other definitions. It considers multiple factors in diagnosis and provides suggestions for personal development, and does not simply state what is wrong but also suggests how problems can be overcome. Additionally, this definition also respects the individual and their own experience.

Question 28

deviation from ideal mental health limitations (AO3)

Answer 28

― This definition comes from its basis in humanistic psychology, which may be culturally biased, reflecting a Western perspective on mental health. It is seen as problematic when a perspective from one culture is assumed to automatically apply to all people as universal. In many cultures, people may not place a high value on autonomy as it is not part of their cultural norms; in collectivist cultures, many people value playing a role in supporting a family or group, not focusing on individual success
― DIMH is very strict when it comes to the criteria of defining mental health. Most people would be defined as abnormal, according to DIMH, as it is difficult to achieve all of the criteria for idea mental health at any one time

Question 29

two-process model

Answer 29

phobias are acquired through classical conditioning and maintained through operant conditioning

Question 30

classical conditioning

Answer 30

learning through association

Question 31

operant conditioning

Answer 31

learning from consequences/reinforcement

Question 32

acquisition of a phobia: classical conditioning (Little Albert Experiment)

Answer 32

— a phobic object starts as a neutral stimulus (NS) [e.g. rat] and causes no response (UCR)

― an unconditioned stimulus (UCS) [e.g. loud noise] produces an unconditioned response (UCR); UCRs don’t need to be learnt

― an association is formed when the NS [rat] is paired with the UCS [loud noise]

― the object [rat] becomes a conditioned stimulus (CS), which produces the conditioned response (CR)

― when Little Albert sees the rat, he will associate it with the loud noise and produce a phobic response. phobias can be generalised, so Albert may have the same response to other small animals such as rabbits.

Question 33

maintenance of a phobia: operant conditioning

Answer 33

― a phobia is maintained through operant conditioning: learning through rewards/punishments

― a person avoids the phobic stimulus through avoidance and gains a reward by doing so and has no emotional response (negative reinforcement)

― the fear is maintained because association is never unlearned

Question 34

the behaviourist approach to EXPLAINING phobias strengths (AO3)

― Little Albert Experiment
— Behaviourist theories

Answer 34

― A child called Albert was introduced to a rat (NS) for the first time and he showed no phobic response. The rat was paired with hitting a large metal pole behind the child’s head, creating a loud noise (UCS) which scared the child (UCR). The child then began to associate the rat (now a CS) with loud noise, in which he ended up showing a phobic response (CR). He also showed generalisation, displaying a fear response to other similar objects such as small dogs and furry blankets.

― Behaviourist theories of phobia acquisition and maintenance have been applied to counter-conditioning therapies, systematic desensitisation and flooding. As these treatments are effective, it suggests the behaviourist principles they are based on are valid.

Question 35

behaviourist approach to EXPLAINING phobias limitations (AO3)

― does not fully explain all phobias
― phobias may be hereditary

Answer 35

― Counter-research showed that conditioning events like ‘dog bites’ were common in participants with phobias (56%), however they were just as common in participants with no dog phobias (66%). It was also found that 2% of children could recall a negative experience of water, and 56% of parents told the researchers that the phobia had been present from the child’s first encounter with water. These findings suggest the behaviourist approach does not fully explain all phobias.

― Phobias of animals such as snakes and spiders are more common. These phobias may be better explained by evolutionary theory, as these are dangers that many of our evolutionary ancestors faced. Those with a natural, instinctual fear would have been more likely to survive and reproduce, suggesting phobias are hereditary.

Question 36

reciprocal inhibitation

Answer 36

fear and relaxation can’t exist at the same time as you can’t feel two opposite emotions simulataneously

Question 37

systematic desensitisation

Answer 37

the gradual exposure of an anxiety-producing object, thought, or experience whilst performing relaxation techniques to reduce the symptoms of anxiety

Question 38

systematic desensitisation process

Answer 38

― a therapist teaches the client relaxation techniques such as breathing exercises

― the client creates an anxiety hierarchy from the least feared situation to the most feared situation

― the client is exposed to each level of the anxiety hierarchy, starting at the lowest level. The client must relax at each stage and the therapist only moves to the next step once the client is fully relaxed

― when the client can face the phobic object without fear, the association is extinct and a positive association is formed

Question 39

flooding

Answer 39

immediate and full exposure to the maximum level of phobia stimulus (the top level of an anxiety hierarchy)

Question 40

flooding process

Answer 40

― immediate exposure is expected to cause an extreme panic in response in the client

― the client is unable to avoid the phobic stimulus

― a fear response takes energy. the client will eventually calm down in the presence of the phobic object due to exhaustion

Question 41

the behaviourist approach to TREATING phobias strengths (AO3)

Answer 41

― The principles of systematic desensitisation have been applied to ‘virtual reality exposure therapy’. Researchers found that 83% of participants treated with VR exposure to spiders showed clinically significant improvement compared to 0% in the control group. This proves that the principles of SD are valid and the use of a VR allows a wider range of phobias to be treated

― The client controls SD, making it a more pleasurable experience as they limit their anxiety. Due o it’s stressful nature, flooding isn’t appropriate for older people, people with heart conditions or children.

Question 42

the behaviourist approach to TREATING phobias limitations (AO3)

Answer 42

― The effectiveness of both systematic desensitisation and flooding may be limited to the controlled environment of a therapist’s office and may not translate to real-world experiences. For instance, a person may successfully conquer their fear of birds in the presence of a tame bird within the therapist’s room, but when confronted with numerous wild birds in the outside world, their phobia may resurface.

― Both SD and flooding are more effective in treating specific phobias than social phobias; it is generally easier to advance with an anxiety hierarchy or fully expose a person to snakes within a controlled setting, than to simulate social situations and interactions with unfamiliar individuals in a therapist’s office.

Question 43

cognitive approach of depression

Answer 43

depression is due to irrational thoughts, resulting from maladaptive internal mental processes

Question 44

schema

Answer 44

― mental frameworks/expectations based on experience
― they allow us to quickly process large amounts of sensory information and make automatic assumptions and responses
― negative schemas result in negative cognitive biases

Question 45

Beck’s negative triad

Answer 45

― the self
― the world
― the future
― can lead to avoidance, social withdrawal and inaction
― develops in childhood but provides the framework for persistent biases in adulthood

Question 46

the self (negative schema)

Answer 46

feeling inadequate or unworthy

Question 47

the world (negative schema)

Answer 47

thinking people are hostile or threatening

Question 48

the future (negative schema)

Answer 48

thinking things will always turn out badly

Question 49

cognitive distortion

Answer 49

perceiving the world inaccurately
― overgeneralisation
― selective abstraction

Question 50

overgeneralisation

Answer 50

one negative experience results in an assumption that the same thing will always happen

Question 51

selective abstraction

Answer 51

mentally filtering out positive experiences and only focusing on the negative

Question 52

Ellis’s ABC model

Answer 52

― activating event
― belief
― consequence

Question 53

activating event (ABC model)

Answer 53

something that happens to someone. it can be large or small

Question 54

belief (ABC model)

Answer 54

for people without depression, beliefs about the activating event are rational; people with depression have irrational beliefs

Question 55

consequence (ABC model)

Answer 55

rational beliefs lead to positive consequences, irrational beliefs lead to negative consequences

Question 56

mustabatory thinking

Answer 56

the consequence of not accepting that we live in a perfect world

Question 57

cognitive approach to EXPLAINING depression strengths (AO3)

Answer 57

― Two researchers assessed the thinking styles of 65 women before giving birth and six weeks after. It was found that the women with negative thinking styles were the most likely to develop postpartum depression,. This supports the idea that faulty thinking leads to depression; negative thinking is a vulnerability which can be triggered by aversive life experiences.

― Cognitive theories that explain depression have led to highly effective cognitive therapies; March showed CBT had an effectiveness rate of 81% after 36 weeks of treatment, the same as drug therapy. The fact these treatments are successful suggests the underlying cognitive explanations are valid.

Question 58

cognitive approach to EXPLAINING depression limitations (AO3)

Answer 58

― Many people with depression also experience oppositional emotions. This means that some types of depression are harder to explain with theories like Beck’s that explain depression as due to negative schemas, as schemas are resistant to change.

― Family studies and genetic research suggests a predisposition to depression is inherited; the likelihood that genes influence the activity of neurochemicals like serotonin in the brain. The effectiveness of drug treatments like SSRIs also suggest that the cognitive explanation is not complete, and there is a biological aspect to depression.

― Cognitive theories depend on the assumption that the person with depression’s thoughts are irrational; depression could be a reasonable response to the challenges they face, such as death of a loved one. People without depression may have a cognitive bias, and may see the world in a positive light, whereas people with depression do not.

Question 59

cognitive approach to treating depression

Answer 59

Beck’s CBT and Ellis’ REBT attempt to change negative schemas and challenge irrational thoughts through cognitive restructuring

Question 60

Beck’s CBT (cognitive behavioural therapy)

Answer 60

― patient as a scientist: the patient tests the validity of their irrational thoughts; when they realise their thoughts don’t match reality, this will change their schemas and the irrational thoughts can be discarded

― thought catching: identifying irrational thoughts coming from the negative triad of schemas

― homework tasks: keeping a diary, which is used to record negative thoughts and identify situations that cause negative thinking

― behavioural activation: taking part in activities that the patient used to enjoy

Question 61

Ellis’s REBT (rational emotive behaviour therapy)

Answer 61

― a further development of the ABC model, adding D for dispute and E for effect

― dispute: the therapist confronting the client’s irrational beliefs. empirical arguments challenge the client to provide evidence for their irrational beliefs, while logical arguments attempt to show the beliefs don’t make sense

― effect: reduction of irrational thoughts which leads to better consequences in the future

― shame attacking exercises: the client performs a behaviour they fear doing in front of others. this shows the client they can act against their emotions and cope with an unpleasant experience

Question 62

the difference between CBT and REBT

Answer 62

in CBT, the client is helped to figure out the irrationality of their thoughts THEMSELVES. in REBT, the therapist explains the irrationality of the thoughts directly to the patient through disputation

Question 63

cognitive approach to TREATING depression strengths (AO3)

Answer 63

― A researcher assigned 327 patients to one of three groups: CBT, drug therapy, and combined treatment. After 36 weeks, the CBT and drug therapy had an effectiveness rate of 81%. CBT also had a more significant reduction in suicidal events rather than drug treatment. The best results came from the combined treatment, with an effectiveness rate of 86% and fewer suicidal events than either treatment alone.

― Some people with depression are too severely depressed to engage with the demands of CBT; completing homework, challenging irrational thoughts and attending sessions require motivation and commitment. Therefore, drug therapy may be required to stabilise a patient before psychological treatment.

Question 64

cognitive approach to TREATING depression limitations (AO3)

Answer 64

― Both REBT and CBT may be overly focused on the present and how to restructure how the client thinks about their current situation cognitively. Clients may not want to discuss severe trauma in their past. Also reinterpreting present experiences does not necessarily improve the present situation: the client may be grieving, in an unhealthy relationship. Concerns about these social problems are not irrational

― CBT can take 16 to 20 sessions with a trained therapist which makes it an expensive treatment option. However, many patients prefer CBT to drugs due to the lack of side effects and a belief that CBT addresses the root cause of depression, not just reducing symptoms.

Question 65

the biological approach

Answer 65

explains mental health conditions as being due to faulty physical processes. This explanation includes the physical structure of your DNA, inherited from parents. DNA codes for other aspects of your biology, such as how neurotransmitters are processed in the synapse and the development and functioning of larger structures such as brain regions

Question 66

what is OCD?

Answer 66

― mental health condition in which its symptoms include obsessive thoughts and compulsive behaviours

― obsessive thoughts are repetitive, distressing mental images, or concerns that provoke anxiety

― compulsions are actions that individuals feel they need to perform to reduce the discomfort caused by these thoughts

Question 67

genetic explanation of OCD

Answer 67

― thought a vulnerability or predisposition to OCD is inherited from parents

― genetic analysis has revealed around 230 separate candidate genes are found more frequently in people with OCD; many candidate genes influence the functioning of neural systems in the brain

― SERT gene affects reuptake in the serotonin system.

― as many candidate genes have been identified, it suggests OCD is polygenic, meaning a predisposition to OCD requires a range of genetic changes

Question 68

genetic explanation to explaining OCD strength (AO3)

Answer 68

― Evidence for the heritability of OCD comes from family and twin studies. As the prevalence rate of OCD in the general population is 2%, the concordance rate between someone with OCD and a random stranger is also 2%.
― However, the more closely genetically related two people are, the higher the concordance for OCD.
― First-degree relatives have 10% concordance rate, and non-identical/dizygotic twins have 31% concordance rate (50% shared genes). Identical monozygotic twins share 100% of their genes and have a 68% concordance rate. This suggests a predisposition to OCD is inherited

Question 69

neural explanations for OCD

Answer 69

― biochemical causes
― an imbalance of neurotransmitters and the large neural structures in the brain

Question 70

serotonin levels

Answer 70

― low levels thought to cause obsessive thoughts. the low level is likely due to it being removed too quickly from the synapse before it has been able to transmit its signal

Question 71

neurotransmission of serotonin & other neutrotransmitters

Answer 71

― presynaptic neurons release neurotransmitters
― receptors on the postsynaptic neuron detect these; if the signal is strong enough, the message is passed on > the neurotransmitters detach from the receptors and are taken back to the presynaptic neuron through a process called reuptake
― this process may happen too quickly in people with OCD, leading to reduced serotonin levels in the synapse
― the SERT gene is responsible for serotonin transportation in the synapse

Question 72

neural structures in OCD

Answer 72

― the worry circuit is a set of brain structures including the (orbito)frontal cortex (rational decision making), the basal ganglia system, and the thalamus. communication between these structures appears to be overactive in people with OCD

― in normal functioning, the basal ganglia filter out minor worries coming from the OFC, but if this area is hyperactive even small worries get to the thalamus, which are then passed back to the OFC, forming a loop

― repetitive motor functions (compulsions) are an attempt to break this loop. while carrying out the compulsion may give temporary release, the hyperactive basal ganglia will soon resume the worry circuit

Question 73

biological approach to EXPLAINING OCD strengths (AO3)

Answer 73

― There is a high concordance rate between close family members. Non-identical twins have 31% concordance, and identical twins have 68%. MZ and DZ twins grow up sharing similar environments like food, upbringing and education, and life events like bereavement or parental divorce. This suggests that the additonal shared DNA is responsible for the increased concordance

― Several neuroimaging studies using PET scanners have shown hyperactivity in the OFC and the caudate nucleus in people with OCD both while scanning the brain at rest and when symptoms are stimulated, but there is a problem with neural evidence: it is correlational. Researchers cannot be sure if the hyperactivity in these areas is the cause of OCD or a consequence of having OCD

Question 74

biological approach to EXPLAINING OCD limitations (AO3)

Answer 74

― The correlation in family and twin studies does not automatically equal causation. It may not be the shared genetics behind the high concordance rates; closer family members also share similar environments: identical monozygotic twins may be treated more similarly because they look alike compared to dizygotic twins. As the concordance rate for identical twins is at 68%, the level we would expect for an entirely genetically determined psychological feature, so the environment must play some role in it

Question 75

SSRIs

Answer 75

― the primary class of drugs used to control the symptoms of OCD

― SSRIs are called Selective Serotonin Reuptake Inhibitors. They only influence serotonin in the brain
― They inhibit the reuptake process in the synapse.
― Therefore serotonin is still present in the synaptic cleft and continues to stimulate the postsynaptic neuron.

― Can take 3 to 4 months to reduce symptoms, and may not be effective for some.
― Dosage can be increased for drug-resistant patients or other treatment options such as anti-anxiety drugs.
― Tricyclics and SNRIs work by increasing serotonin and noradrenaline; these drugs can be effective when SSRIs fail, but they work on multiple neurotransmitters so they tend to have more intense side effects

Question 76

biological approach to TREATING OCD strengths (AO3)

Answer 76

― Soomo conducted a meta-analysis combining the data from 17 studies that compared SSRIs to placebos. In total, there were 3097 participants. The results of this large-scale meta-analysis showed that SSRIs significantly reduced the symptoms of OCD compared to placebos between 6 and 17 weeks post treatment. These results suggest drug therapy is effective in the short term

― Drug therapy is a relatively inexpensive and potentially more convenient treatment for the patient; this is in comparison to psychological therapies like CBT, which require the patient to find time for multiple sessions with a trained therapist. As CBT is much more expensive than drug therapy, from an economic perspective, health services like the NHs are more likely to provide drug therapy

Question 77

biological approach to TREATING OCD limitations (AO3)

Answer 77

― Many patients prefer CBT as drug therapy can have a range of potential side effects. In the Soomro meta-analysis, it was found nausea, headache, and insomnia were the most common side effects. Also, with drug therapy, it can take four months before the patient experiences symptom reduction, and patients can become dependent on the drugs

― Drug therapies only cover up the symptoms and not treat the cause. It’s argued serotonin imbalance is a result of OCD, not the cause. This means the origins of OCD may not be biological, but due to a traumatic experience. Cromer showed that 54% of 265 participants with OCD reported at least one traumatic life event, and those with traumatic life events reported increased severity of OCD symptoms. This suggests drug therapy may only be a temporary solution, and psychological therapiest that address these traumatic life events may be a more effective long-term treatment