4.1.4 Psychopathology Flashcards
What are the 4 definitions of abnormality?
Deviation form social norms
Statistical infrequency
Failure to function adequately
Deviation from ideal mental health
What is deviation from social norms?
Concerned with behaviour that is different from the accepted standards of behaviour in a community or society.
All societies make collective judgements about what counts as normal behaviour.
Behaviour is abnormal is if is very different to the acceptable behaviour in the group, unexpected by other members or offends other members in sone way.
Strengths of deviation from social norms
It is a culturally specific definition so can be tailored for use in very different cultures.
Includes the issue of the desire ability of a behaviour, so behaviours which are deemed as ideal/desireable by the group are not defined as abnormal.
Practical application is the diagnosis of antisocial personality disorder, the defining characteristic of which is the failure to conform to culturally normal/ethical behaviour. This shows it has value as a criteria in psychiatry.
Weaknesses of deviation from social norms
Culturally relative as social norms vary with time and culture, so it is difficult to determine universal signs of illness.
Social norms change over time so the definition lacks temporal validity.
May lead to an ethnocentric bias in diagnosis, as western social norms reflect the majority ‘white’ population, so deviation from these means ethnic minorities are overrepresented in mental health statistics.
Could be abused as an instrument of social control, as a powerful group can establish norms and therefore decide what is abnormal.
Less scientific and objective than other definitions (statistical infrequency)
Limited applicability as it is not clear what norms are being broken when someone displays a mental disorder, so may be difficult to diagnose them.
What is failure to function adequately?
Occurs when someone is unable to cope with the ordinary demands of day-to-day living and lead a normal life.
Who created the criteria to define failure to function adequately?
Rosenhan and Seligman
What are the points on the criteria to determine if someone is failing to function adequately?
Severe personal distress
Displays maladaptive behaviours
Danger to themselves or others
Unpredictable and uncontrollable
Irrational
Discomfort for observers
Violates moral or social standards
Strengths of failure to function adequately?
Recognises the patients perspective - the people seeking help believe that they are suffering from psychological problems that interfere with their daily life. The criteria means help can be directed to those who need treatment and services.
Characteristics are mostly observable, providing an objective measure of abnormality.
Weaknesses of failure to function adequately
Judging a person as failure to function adequately eg. Distressed relies on a subjective assessment and so cannot be standardised
Does not differentiate between behaviour that is abnormal and behaviour that is simply non-conformist, unconventional or eccentric.
Many mental disorders do not cause personal distress, so may go untreated.
Some maladaptive behaviours eg. Smoking are not a sign of psychological abnormality. This could limit peoples freedom of choice.
What is statistical infrequency?
Occurs when an individual has a less common characteristic than the average normal population, based on a statistical average.
How is statistical infrequency measured?
Presumes human characteristics are normally distributed, where normal is seen as the statistical average.
Behaviour is abnormal if it is numerically rare, a certain distance from the statistical average and occupies the extreme ands of a normal distribution curve.
Therefore it focuses on the quantity of a behaviour rather than the quality
Strengths of statistical infrequency?
Real world application as all assessment of patients with mental disorders includes some kind of measurement of how severe their symptoms are compared to statistical norms. This makes it a useful part of clinical assessment. Eg. Beck’s depression inventory shows that a score in the top 5% of participants indicates severe depression.
A scientific explanation- using statistics to define abnormality is objective and standardised.
Weaknesses of statistical infrequency
Issue of who decides where the cut off is, as to how far a behaviour should deviate from the mean to be classed as abnormal
Fails to account for behaviour that is statistically rare, but desirable eg. A high IQ would also be considered abnormal, failing to distinguish between good and bad.
Relies on the use of up-to-date statistics
Assumes human behaviour and experiences can be measured in numerical form
Some disorders eg. Depression, are not statistically rare and so may go undiagnosed.
Doesn’t consider cultural variations so is guilty of cultural relativism - what is statistically normal in one culture may not be in another, which can lead to cultures being deemed abnormal based on the standards of others.
What is deviation from ideal mental health?
Occurs when someone fails to achieve good mental health
What criteria is used to assess deviation from ideal mental health?
Jahoda’s critera
What are the points on jahoda’s criteria for deviation from ideal metal health?
Inaccurate perception of reality
Problems with self-actualisation
Inability to cope with stress
Negative attitude towards self
Lack of autonomy and independence
Poor environmental mastery
Strengths of deviation from ideal mental health
A positive approach to defining abnormality which provides a useful set of criteria for self-improvement, helping sufferers to improve.
Practical application as it allows targeting of areas of dysfunction when treating disorders, giving the person clear and specific goals to work towards.
Weaknesses of deviation from ideal mental health
Criteria are not equally applicable across a range of cultures, being located in Western context. This variation across cultures eg. Self-actualisation and independence, means it is difficult to apply the concept of ideal mental health from one culture to another.
Criteria are difficult to assess- they rely on self-reports of people who may be mentally ill and so unreliable in their description of their problems.
The criteria were devised over half a century ago so may lack temporal validity.
What is a phobia?
An irrational fearful anxiety response to a specific object or situation
What is the DSM-5?
Diagnostic and statistical manual of mental disorder
How does the DSM-5 categorise phobias?
All phobias show an out of proportion fear response to a phobic stimulus.
They can either be…
Specific phobias
Social anxiety
Agoraphobia
What is a specific phobia?
A phobia of an object or situation
What is social anxiety?
A phobia of a social situation
What is agoraphobia?
A phobia of being outside or in a public place.
What is a behavioural characteristic of a phobia?
How people respond when presented with the phobic stimulus
Panic, avoidance or endurance
What is avoidance?
Making an effort to avoid coming into contact with the phobic stimulus
What is endurance
Remaining in the presence of the phobic stimulus despite experiencing high levels of anxiety
What are emotional characteristics of phobias?
How people feel when presented with the phobic stimulus
Anxiety and fear
What is anxiety?
An unpleasant state of high arousal, usually long term
What is fear
The immediate and extremely unpleasant response when we first encounter the phobic stimulus, usually short term.
What are cognitive characteristics of phobias?
Ways in which the information is processed about phobic stimuli, and what the person is thinking or believing.
Selective attention, irrational beliefs and cognitive distortions
What does irrational mean in relation to phobias?
The fear and anxiety response to the phobic stimulus is widely disproportionate to the danger posed by the phobic stimulus.
What is selective attention
Cannot focus on anything else but the phobic stimulus, and does not look away from it
What is irrational beliefs
Beliefs that are disproportionate and untrue about the phobic stimulus
What are cognitive distortions
Perceptions about the phobic stimulus are distorted
What is behaviourism?
A way of explaining behaviour in terms of learning from the environment.
Who proposed the two-process model?
Mowrer
What is the two-process model?
An explanation for the onset and persistence of a phobia in terms of classical an operant conditioning.
It states that the original learnt fear is acquired by classical conditioning and is maintained by operant conditioning.
How can a phobia develop through classical conditioning?
After a traumatic event (UCS) that results in fear/anxiety (UCR) is associated with the neutral stimulus to produce a conditioned response of fear/anxiety.
This often leads to generalisation of the fear so the person becomes afraid of other similar objects.
What is generalisation of a phobia?
When the phobia is generalised so the person becomes afraid of other similar objects.
How is a phobia maintained by operant conditioning?
Once developed, a phobia is maintained by operant conditioning, as the person becomes anxious about their phobic stimulus so avoids it. The reduction in fear/anxiety due to the avoidance acts as negative reinforcement so they continue to avoid the phobic stimulus.
Who discovered classical conditioning?
Pavlov
Who discovered operant conditioning?
Skinner
What is depression?
A mental disorder characterised by low mood and low energy levels
What are the DSM categories of depression?
Major depressive disorder- severe but often short term
Persistent depressive disorder- long term or recurring depression
Disruptive mood disregulation disorder- childhood temper tantrums
Premenstrual dysphoric disorder- disruption to mood prior or during menstruation
What are the behavioural characteristics of depression?
Reduced activity levels
Psychomotor agitation- struggle to relax
Social withdrawal
Disrupted sleep
Changes in eating behaviour
Verbal or physical aggression
Self harm
What are the emotional characteristics of depression?
Low mood- feeling worthless or empty
Anger or extreme anger towards themselves of others
Low self esteem- self-loathing
What are the cognitive characteristics of depression?
Poor concentration so difficulty sticking to tasks or making decisions
Dwelling on the negatives of a situation and ignoring the positives
Absolutist thinking- thinking situations are either all good or all bad
Catastrophising- seeing an unfortunate situation as an absolute disaster
What do cognitive explanations for depression focus on?
How mental processes affect behaviour, and how negative or maladaptive biases in thinking lead to depression.
What are the two cognitive explanations for depression?
Beck’s negative triad
Ellis’s ABC model
What is Beck’s negative triad?
Explains why some people are more vulnerable to depression than others.
It is a cognitive model with 3 components.
What are the 3 components of Beck’s model?
Negative triad
Faulty information processing
Negative self schemas
What is the negative triad?
When a person develops a dysfunctional view of themselves because of automatic negative cognitions about the self, the world and the future.
These thoughts affect their mood, behaviour and physiology.
These thinking patters predispose people to experience depression.
What is faulty information processing?
When individuals selectively attend to negative interpretations and ignore positives, whilst blowing small problems out of proportion.
Processing is cognitively biased, as people rely on existing beliefs/schemas.
Said to ensure depression will occur and need to change cognitions to get better.
What are negative self-schemas and why are they a problem?
Schemas allow us to selectively process information rapidly due to expectation.
If our self-schemas (self-beliefs) are negative, then we selectively take in information that confirms these negative beliefs, and ignore contrary evidence.
These are likely acquired in childhood due to repeated criticism or rejection
When are negative self schemas usually acquired?
in childhood due to repeated criticism or rejection
When does a dysfunctional belief lead to depression according to beck?
If the individual encounters a critical life event, which triggers dysfunctional assumptions and biased information processing that results in symptoms of depression.
What are the effects of negative schemas in adulthood?
Overgeneralisation- one negative event means everything is negative
Magnification- blowing things up out of all proportion
Selective perception- perceiving only bad events and ignoring others
Absolutist thinking- believing everything must be perfect or else it is a disaster.
What is Ellis’s ABC model?
Suggests that good mental health is the result of rational thinking, meaning thinking in ways that allow people to be happy and pain-free.
Anxiety and depression are therefore the result of irrational thoughts- not illogical or unrealistic, but prevent us being happy and pain-free.
What is the A in Ellis’s ABC model?
Activating event
Negative, irrational thoughts and beliefs are triggered by an external event eg. Failing a driving test
What is the B in Ellis’s ABC model?
Beliefs
Beliefs about the event are irrational, like thinking we must always achieve perfection (musturbation) or that life should always be fair (Utopianism).
What is the C in Ellis’s ABC model?
Consequences
When an event triggers irrational beliefs, there will be emotional and behavioural consequences eg. Triggering of depression
What is musturbation?
Thinking that we must always achieve perfection
What is Utopianism?
Thinking that life should always be fair
What is CBT?
Cognitive behaviour therapy
A method for treating mental disorders by challenging negative thoughts and altering dysfunctional behaviours.
What is CBT an application of and how?
Beck’s cognitive theory of depression, as it identifies negative thoughts about the self, the world and the future (beck’s negative triad) to challenge them.
What strategies are used in CBT?
Viewing the patient as a scientist and setting hypotheses to test the negative thoughts, gathering evidence to prove the belief wrong
Challenging irrational thoughts by asking for evidence
Asking them to keep a diary to record events where negative thoughts occur so that they can be targeted in the future.
What is behavioural activation?
An element of CBT that gradually decreases the patients avoidance and isolation, and improve their engagement in activities that have been shown to improve mood.
What is thought-catching?
Keeping a record of automatic negative thoughts in response to events, so that they can be challenged and replaced.
Why does CBT give patients coping strategies?
To reduce recurrence of depression
What is REBT?
Rational emotive behaviour therapy
A cognitive therapy for mental disorders that aims to identify and dispute irrational thoughts, to replace them with more rational ones.
What is REBT based on?
Ellis’s ABC model- extends to ABCDE model with d standing for dispute and e for effect.
What are irrational thoughts?
Those that are negative or self-defeating, and are likely to interfere with the individual’s happiness.
How is REBT carried out?
The therapist identifies irrational thoughts, challenging them through rational confrontation/argument, supported by evidence or logical argument.
The irrational belief is replaced by an irrational one.
What are the different types of disputing and how are they done?
Logical disputing- whether the thought processes make sense
Empirical disputing- whether there is evidence to support the belief
Pragmatic disputing- whether thought processes are useful to the patient
What are all cognitive therapies based on?
Aiming to achieve cognitive restructuring- changing the way individuals think about their life situation and self, in order to change emotional responses and behaviour.
What are drug therapies?
Treatments involving chemicals that have an effect on the functioning of the brain
In psychological treatments, they increase or decrease levels or activity of neurotransmitters in the brain.
How do drug therapies aim to treat OCD?
Aims to increase serotonin levels, decrease anxiety and lower arousal.
What are SSRIs?
Selective serotonin reuptake inhibitors
A type of antidepressant that is the main treatment for OCD, by working on the serotonin systems in the brain.
How do SSRIs work?
When serotonin is released by certain neurones in the brain, it is released into the synapse by the pre-synaptic neurone.
This is reabsorbed by the post-synaptic neurone once bound, and is broken down to be reused.
SSRIs prevent the reuptake of serotonin by the post-synaptic neuron so they continue to stimulate it.
This compensates for the reduction in functioning of the serotonin system in the brain, to correct imbalance of neurochemicals that leads to OCD.
How are SSRIs normally used?
Fluoxetine (20mg) is usually used but dosages may vary
It takes 3-4 months for them to have an impact on symptoms of OCD.
SSRIs may be combined with other treatments such as CBT. The drugs reduce emotional symptoms (anxiety or depression) so the patient can engage effectively with CBT.
What other drugs can SSRIs be combined with if they do not work?
SNRIs- serotonin-noroadrenaline reuptake inhibitors increase elevens of serotonin and noradrenaline
Tricyclics- block reuptake of serotonin and noradrenaline to prolog their activity in the synapse, but usually have greater side effects
Anti-anxiety drugs- reduce anxiety by slowing down the CNS by enhancing GABA (a neurotransmitter) which makes the person feel more relaxed.
What is OCD?
A condition characterised by either obsessions, such as recurring thoughts and images, and/or compulsions, which are repetitive behaviours.
It becomes time-consuming and interferes with everyday life.
What are OCD obsessions?
Internal components that are cognitions or thoughts
Private and non-observable to the individual
Intrusive, recurring and unwanted
What are OCD compulsions?
External component of repetitive behaviours
Observeable
Usually as a result of the obsession
What are the behavioural characteristics of OCD?
Compulsions- repetitive behaviours performed repeatedly, usually to reduce anxiety
Avoidance- reduces anxiety by keeping away from situations that trigger it
What are the emotional characteristics of OCD?
Anxiety and distress
Accompanying depression
Guilt and disgust at things they are obsessed with
What are the cognitive characteristics of OCD?
Recurrent and persistent thoughts that are intrusive
Attentional bias- hyper vigilance to anxiety gathering stimuli
Catastrophic thinking
Cognitive strategies to deal with obsessions
Insight to excessive anxiety so aware it is irrational
What is the focus of the biological approach?
To emphasise the importance of brain structures and physical processes in the body on behaviour
What are the two ways the biological approach explains OCD?
Genetic explanations
Neural explanations
What are the genetic features for OCD?
Genetic vulnerability
Candidate genes
Polygenic
Different types of OCD
What is genetic vulnerability?
Genes make an individual more likely to develop OCD
OCD runs in families, but what is passed on is a vulnerability to develop OCD rather than a certainty
The diathesis-stress model says that certain genes make people more likely to develop a mental disorder- but some environmental stress or experience is necessary to trigger OCD.
What did Lewis discover about ocd?
Observed that 37% of his ocd patients had parents with ocd and 21% had siblings with ocd, which suggests that it runs in families.
What are candidate genes? And an example
Create a vulnerability to ocd eg. 5HT1-D Beta is involved in transport of serotonin across the synapse (ocd= low levels of seretonin)
What does it mean if OCD is polygenic?
OCD is not caused by one single gene but a combination of several genetic variations that together increase vulnerability
What did Taylor find about OCD?
Found evidence from analysing previous studies that up to 230 different genes may be involved in OCD, showing it is polygenic.
How do genetic explanations for OCD explain different types of OCD?
Different groups of genes cause ocd in different people
Term to describe this is aetiologically heterogenous
Also Evidence that different types of ocd are a result of genetic variations
What does aetiologically heterogenous mean?
That origins of OCD vary from one person to another
What are genetic explanations for OCD?
Genes are involved in the development of OCD and so it is an inherited condition
Genes are passed on through generations, and make up chromosomes and consist of DNA which comes for the physical and psychological features of an organism
What are neural explanations for ocd?
The genes associated with ocd affect the levels of neurotransmitters and physical structures of the brain
Focuses on the role of the nervous system in the development of ocd.
What is the two elements of the neural explanations on ocd?
Role of seretonin
Decision-making systems
What is the role of serotonin in development of ocd according to neural explanations?
Serotonin is a neurotransmitter that helps to regulate mood
If a person has low levels of serotonin then the normal transmission of mood-relevant information does not take place so mood is affected
Some cases of ocd explained by the poor functioning of serotonin systems in the brain
How are decision-making systems associated to OCD according to neural explanations?
Cases of ocd are associated with impaired decision-making
This may be associated with abnormal functioning of the lateral frontal lobes (responsible for logical thinking and decision-making)
Evidence that the left parahippocampal gurus is associated with processing and regulating unpleasant emotions, and it functions abnormally in OCD.
