4.1.4 Psychopathology Flashcards
four definitions of abnormality
- deviation from social norms
- failure to function adequately
- statistical infrequency / deviation
- deviation from ideal mental health
deviation from social norms
when someone’s behaviour goes against the unwritten rules in society (social norms), they’re considered socially deviant and their behaviour is abnormal
deviation from social norms - strengths
- gives a social dimension to the idea of abnormality
- flexible to account for the individual and situation, e.g. a toddler tantrum is normal but wouldn’t be if it was an adult tantrum
- seeks to protect society from a person’s abnormal behaviour
- has a clear indication of what’s considered normal and abnormal as most of us understand socials norms in our own culture
deviation from social norms - limitations
- social norms change over time, so what is considered a mental disorder today may not be in the future, e.g homosexuality was once not socially acceptable
- social norms aren’t objective facts, but are subjective rules created by others
- social norms vary between cultures, e.g. walking barefoot in London would be seen as abnormal but in a tribal community this is the norm
- ethnocentric as it’s based on western societal norms
- doesn’t account for individualistic or eccentric people who simply don’t wish to conform to social norms
failure to function adequately
states that individuals are abnormal when they’re unable to cope with everyday life and may cause distress to others
Rosenhan and Seligman (1989)’s features of dyfunction
- personal distress (e.g. anxiety, depression)
- maladaptive behaviour (behaviour which prevents the person achieving goals)
- unpredictability
- irrationality
- observer discomfort (discomfort to others)
- violations of moral standards (violating social norms)
Global Assessment of Functioning (GAF) scale
provides a way to quantify the extent to which a mental disorder affects an individual’s ability to function adequately, from 0-100, with a lower score meaning they’ll struggle more
failure to function adequately - strengths
- focuses on observable behaviours
- R&S provide a practical checklist / criteria for individuals to check their own behaviours
- individuals can seek professional help themselves
- GAF provides a practical and measurable way of quantifying abnormality
failure to function adequately - limitations
- not everyone with a mental disorder is unable to function normally in society
- doesn’t consider when it can be normal to behave abnormally, e.g. when grieving
- subjective as the person judging whether behaviour is abnormal may have a different view than someone else
- reflects cultural bias as it’ll inevitably be related to how one’s culture believes an individual should live their life
statistical infrequency
defines abnormality as statistically rare characteristics / behaviours, i.e. those which deviate from the mean average or norm
statistical infrequency - strengths
- an objective measure of abnormality which can be quantified and plotted on a graph
- doesn’t imply any value judgements about abnormal behaviours as they just fall outside a statistical range
statistical infrequency - limitations
- infrequency doesn’t always mean abnormality or mental disorder, e.g. having a higher IQ would actually be a desirable trait
- so fails to distinguish between desirable and undesirable traits
- abnormality isn’t necessarily infrequent, e.g. abnormal mental conditions such as anxiety, depression, etc. are quite common
- some psychological disorders are hard to measure objectively
- culture bias is present as some behaviours may be statistically infrequent in one culture but more common in another, e.g. schizophrenia
deviation from ideal mental health
Jahoda (1958) identified 6 features of ideal mental health, and the absence of any of these would indicate abnormality
Jahoda’s characteristics of ideal mental health
- positive self-attitudes (having self-respect and self-esteem)
- self actualisation (personal growth and development)
- autonomy (being independent and self-reliant)
- integration (resisting stress & coping in stressful situations)
- accurate perception of reality (being realistic about oneself and the world)
- environment mastery (successfully adapting to different environments)
deviation from ideal mental health - strengths
- a holistic approach as it looks at the whole person rather than focusing on specific behaviours
- focuses on positive behaviours and what’s desirable - provides a positive goal
- comprehensive as it includes a range of reasons an individual may need help with their mental health
deviation from ideal mental health - limitations
- too idealistic as very few people meet all 6 of the criteria all the time
- the criteria are somewhat subjective and hard to measure
- what is understood as ideal mental health may differ between cultures and change over time
phobias
an anxiety disorder characterised by extreme and irrational fear of a stimuli
categories of phobias
the DSM-5 recognised;
- specific (simple) phobia
- social phobia
- agoraphobia
specific phobia
when a person fears a specific object, e.g. animals, injuries, natural elements, or situations
social phobia
fear of social situations, e.g. performances, interactions, or general situations such as large crowds
agoraphobia
a fear of open or public spaces
behavioural characteristics of phobias
- displaying panic through screaming, crying, running away, etc.
- avoiding the stimulus, which can make daily life complicated
- or the individual may endure it but continue to suffer high levels of anxiety which isn’t good for their mental health
emotional characteristics of phobias
- immediate emotion would be fear
- may act unreasonably and irrationally
- the person will suffer from anxiety which will stop them from being able to relax or feel any other emotion
cognitive characteristics of phobias
- paying selective attention to the phobia, i.e. the person can’t focus on anything else
- the person’s perception of their phobia can often be distorted
behaviourist approach to phobias
explains phobias through observations of the environment, and behavioural responses (learning), i.e. explains phobias through the two-process model
the two-process model
proposed by Mowrer (1960), and states that phobias are first learnt (acquired) through classical conditioning and then maintained via operant conditioning
classical conditioning (acquisition of phobia)
- phobia is formed through association of a fear response with a stimulus
- phobic objects are a neutral stimulus (NS) at first which don’t produce a fear response
- when the NS is paired with an unconditioned stimulus (UCS) that causes an unconditioned response (UCR), the NS becomes a conditioned stimulus (CS) associated with the conditioned response (CR)
- e.g. a dog (NS) paired with pain from a dog bite (UCS) causes fear (UCR), so the dog becomes a CS linked to fear (CR)
Watson and Rayner (1920)’s Little Albert experiment
- Little Albert was a young child who was given a white rat to play with
- initially, he had no fear response from the rat, but then it was paired with a loud noise made by researchers to frighten him, and this was repeated several times
- after this he demonstrated fear behaviour when presented with the rat, even without the loud noise
- CS could also be generalised to other objects as Albert showed distress at other fluffy objects, e.g Santa’s beard, a fur coat, etc
- however, this experiment wouldn’t be able to take place today due to ethical guidelines and the psychological harm he was put under
operant conditioning (maintenance of phobia)
when someone with a phobia avoids the phobic object, they avoid the unpleasant consequence of fear / anxiety, so that behaviour is negatively reinforced and likely
to be repeated again, hence
maintaining the phobia
behavioural explanations of phobias - strengths
- good explanatory power as it provides a successful explanation for how phobias are both created and maintained
- supported by Watson and Rayner’s Little Albert study
- treatments for phobias which involve reducing avoidance behaviour and reinforcement of the phobia have been successful, thus supporting the explanation
behavioural explanations of phobias - limitations
- not all phobias appear after a bad experience, so it doesn’t account for evolutionary factors
- e.g. Seligman (1971) proposed the idea of biological preparedness, which says that we have an innate predisposition to acquire certain fears, e.g. snakes, darkness, heights, etc.
behavioural treatments of phobias
- systematic desensitisation
- flooding
systematic desensitisation
- involves gradually increasing exposure to the feared stimuli until it no longer induces anxiety
- works through counter-conditioning, i.e. learning to associate the phobic object with something pleasant / relaxing
- involves 3 processes;
1. anxiety hierarchy (patient & therapist create a list of encounters with the phobic stimulus from least to most intense, e.g. in vitro - they imagine the phobic object and in vivo - real life encounters)
2. relaxation (therapist teaches patient relaxation techniques, e.g. through breathing exercises)
3. exposure (when in a relaxed state, the patient is exposed to the phobic stimulus starting at the bottom of the hierarchy and then gradually move up in further sessions, whilst using the relaxation techniques
systematic desensitisation - strengths
- it’s effective for a range of phobias and patients
- in vivo is specifically more effective
- self-administered as patients are in control and fully understand the process
- Gilroy - SD group showed lower levels of fear to spiders in the short and long term
- less traumatic so higher rates of completion
- more ethical than flooding
systematic desensitisation - weaknesses
- can still cause distress
- not appropriate for all phobias - works best for objects
- ignores individual differences as it relies heavily on the patient to imagine their fear
- slow process
flooding
involves direct and immediate exposure to the phobic object until the fear is extinguished, as the patient learns that the feared object doesn’t always lead to negative outcomes so their phobic response stops (extinction)
flooding - strengths
- cost-effective (cheaper)
- quicker treatment
- has a higher success rate than any other behavioural treatment
- informed consent
- works well with simple phobias
flooding - limitations
- very traumatic for the patient
- although informed consent is provided, patients often underestimate the trauma
- ethical concerns
- not suitable for those who are not in good health due to extreme levels of stress and anxiety caused during the sessions
- individual differences - won’t work for everyone
- doesn’t treat complex phobias
depression
a mood disorder characterised by low moods, loss of motivation, and low energy levels
behavioural characteristics of depression
- low energy
- reduced social interaction
- increased restlessness
- affected sleep (insomnia)
- affected appetite
- self-harm
emotional characteristics of depression
- sadness
- anger
- loss of interest in daily activities
- lower self-esteem
- feeling empty
cognitive characteristics of depression
- negative self-concept
- negative views of the world
- irrational thoughts
- poor concentration
cognitive explanations of depression
analyses depression in terms of a person’s cognition (the way they think), i.e. their irrational and undesirable thoughts / thought processes
- Beck’s negative triad
- Ellis’s ABC model
Beck’s negative triad
- Beck (1967) argues that depression is characterised by a negative triad of beliefs about oneself, the world, and the future
- this triad results from and is maintained by a person’s cognitive biases (errors in thinking when someone has a clouded / influenced judgement) and negative schemas (negative lenses through which the individual views themselves and the world)
- he describes how childhood experiences can lead to negative schemas developing
Beck’s negative triad - strengths
- personal life events are recognised as a potential cause of depression
- had real-world application as it’s allowed therapists to understand cognitive vulnerability and apply it in treatments such as CBT
Beck’s negative triad - limitations
- doesn’t explain the symptoms of depression
- not all irrational thoughts are irrational - Alloy and Abrahamson (1979) found that depressed people had the ‘sadder but wiser effect’ where they gave more accurate estimates of the likelihood of disaster than non-depressed people
Ellis’s ABC model
- Ellis (1962) argued that rational thoughts lead to good mental health, so depression is caused by irrational thoughts which cause the person to be unhappy
- he developed the ABC model to explain how these thoughts affect individuals;
> A - activating event - a negative event which triggers irrational thoughts, e.g. losing your job
> B - beliefs - the thoughts which the person associates with the event and the cause of it; can be rational, e.g. not liking the job, or irrational, e.g. thinking you don’t deserve a job
> C - consequences - rational beliefs lead to healthy consequences, e.g. job searching, and irrational beliefs lead to unhealthy consequences which will lead to depression, e.g. believing you’ll never find a job
Ellis’s ABC model - strengths
- REBT (a form of CBT) has been successful in treating depression and changing thought processes
- David et al. (2018) stated that REBT can change both negative beliefs & the symptoms of depression
- it gives the individual responsibility & thus the power to change the way things are
Ellis’s ABC model - limitations
- not all irrational thoughts are irrational - Alloy and Abrahamson (1979) ‘sadder but wiser’ effect
- giving the individual responsibility can in turn be seen as blaming them
- only accounts for reactive depression, where the patient has had an activating event, but doesn’t count for endogenous depression where it isn’t traceable to life events
cognitive treatments of depression
cognitive behavioural therapy (CBT) which aims to change the way you think and behave
- Beck’s cognitive therapy
- Ellis’s rational emotive behavioural therapy (REBT)
Beck’s cognitive therapy
- a therapist helps the client identify negative thoughts in relation to themselves, their world & their future, using Beck’s negative triad
- they then work together to challenge these irrational thoughts by discussing evidence for / against them
- patients can then test the reality of their beliefs and realise how irrational they are, e.g. by keeping a log of whenever someone was nice to them, then looking back at it when they believe that everyone hates them
Ellis’s rational emotive behavioural therapy (REBT)
- REBT extends Ellis’s ABC model to ABCDE, with D for ‘disputing irrational thoughts’ and E for ‘effective attitudes to life’
- the main technique is to replace irrational beliefs with effective ones
- the therapist may set their patient ‘homework’ to identify their own irrational beliefs and prove themselves wrong, thus causing their beliefs to change into effective ones
cognitive treatments of depression - strengths
- quicker than other therapies - it usually lasts around 16 weeks
- can be repeated if it’s not successful the first time round
- many clinical studies have shown that CBT is effective in treating depression
- March et al. (2007) proved CBT is as effective as antidepressants & even more so when used in combination with them
- CBT prevents mild depression from progressing into severe depression
cognitive treatments of depression - limitations
- has been criticised for blaming the client, as the whole focus is on their irrational thoughts
- some clients with severe depression can’t motivate themselves to engage with CBT
- isn’t suitable for clients who can’t express themselves verbally
- has a high relapse rate, so benefits from the treatment may not be long-lasting
- gives the therapist power so the client may become dependent on them
obsessive-compulsive disorder (OCD)
an anxiety disorder characterised by continuous and repeated undesirable thoughts (obsessions) which cause uncontrollable behaviours (compulsions)
behavioural characteristics of OCD
- compulsive behaviours performed in response to obsessive thoughts to reduce the anxiety caused by them
- avoiding situations which may cause an individual to show their compulsions
emotional characteristics of OCD
- anxiety due to obsessive thoughts and the inability to control compulsive behaviours
- worry
- distress
- embarrassment
- guilt
- shame
cognitive characteristics of OCD
- recurring obsessive thoughts
- catastrophic thoughts about what may happen if their anxieties came true
- recognising that one’s thoughts are irrational but they can’t stop them
biological explanations of OCD
- genetic explanations
- neural explanation
genetic explanations of OCD
- this describes how individuals inherit specific genes from their parents which are related to OCD
- there are many candidate genes involved in OCD, e.g. COMT and SERT, and it’s polygenic as several genes are involved
- COMT gene regulates the production of the neurotransmitter dopamine, which has been involved with OCD
- Tukel et al. (2013) found that a form of the COMT gene which produces lower activity of the gene and so higher dopamine levels, has been found to be more common in OCD patients than those without the disorder
- the SERT gene (5-HTT) is thought to affect the transport of serotonin, creating lower levels of it, and this has also been linked to OCD
genetic explanations of OCD - strengths
- Nestadt et al. (2010) reviewed evidence that 68% of identical twins will both have OCD compared to 31% of non-identical twins
- Marini et al. (2012) found that someone with a family member diagnosed with OCD is around 4x more likely to develop it than someone without
genetic explanations of OCD - limitations
- ignores environmental factors, e.g. twins also share the same environment which can trigger OCD
- there’s also evidence to say that identical twins are treated more similarly, which can explain why it’s more common in them
- genetics aren’t the sole reason why an individual can develop OCD, so it makes more sense to suggest the person is genetically vulnerable and the combination of this with the environment causes OCD
neural explanations of OCD
- this suggests that imbalanced neural networks may cause OCD
- high dopamine levels are associated with OCD and Szechtman (1998) found that high doses of drugs which increased dopamine levels caused stereotyped movements in animals, which resembled the compulsive behaviours witnessed in OCD patients
- low serotonin levels are associated with OCD and Pigott (1990) found that anti-depressants (which increase serotonin activity) have been shown to reduce OCD symptoms
- some forms of OCD have been linked to poor-decision making, which could be down to abnormal functioning in the lateral parts of the frontal lobes (the parts of the brain responsible for logical thinking & decision-making)
- the orbital frontal cortex (OFC), (an area of the prefrontal cortex), sends signals to the thalamus about things that are worrying you, and this area is overactive in OCD sufferers
- the thalamus instructs you to do a certain activity, i.e. the compulsive behaviour for OCD patients,
- the caudate nucleus, which normally suppresses messages from the OFC and normalises any worries, isn’t completing its job due to damage or overstimulation, thus making the sufferer worry
neural explanations of OCD - strengths
- antidepressants such as SSRIs, which control serotonin levels, are effective in reducing OCD symptoms, supporting the idea of an imbalanced neural network
neural explanations of OCD - limitations
- not all OCD patients respond positively to antidepressants (serotonin levellers), suggesting it’s not the neural network causing OCD
- there’s evidence that environmental triggers play a large role in triggering OCD - one study found that over half the participants suffered a traumatic event which led to their OCD
biological treatments of OCD - drug therapy
- SSRIs (selective serotonin re-uptake inhibitors) inhibit the absorption / re-uptake of serotonin, which happens too fast in OCD patients, so they increase the serotonin levels available in the synapse so more serotonin is received by the post-synaptic neuron
- if OCD symptoms don’t approve with SSRIs, antipsychotic drugs may also be prescribed, e.g. risperidone, which reduces dopamine activity, supporting the neural explanation
- SNRIs (serotonin-noradrenaline re-uptake inhibitor) which increase serotonin levels as well as another neurotransmitter called noradrenaline
- tricyclics - an older antidepressant which has more severe side effects, so it’s reserved for those who haven’t been helped by other drug therapies
drug therapy - strengths
- cost-effective as it’s cheaper than other psychological treatments
- non-disruptive as people don’t need to give up time to attend therapy
- NICE (the national institute for health & care excellence) stated that a mix of therapy and drugs works best
- allows for a significant improvement in patient’s lives as it reduces their compulsive behaviours
drug therapy - limitations
- potential serious side effects, e.g. for SSRIs these can include blurred vision, irritability, indigestion, sleep disruption
- high relapse rates once the patient stops taking the drug
- publication bias has shown that positive results are more likely to be published, so may not be that effective as believed to be
