Abnormal Flashcards
what is abnormal psychology?
scientific study of abnormal behaviour emotion and cognition
empirical method - description
Classification
Diagnosis
Delineate from different disorders
Very ongoing process
Aims to help us better understand classification and diagnosis
empirical method - causation
Biological: gene, age, gender.
Psychological: able to cope, emotions, attitude, beliefs.
Social: family, economic status, friends, working, study, culture
empirical method - treatment
Effectiveness
Randomised control trials - testing a treatment
Identify why some treatment methods are more effective.
Need good diagnosis + classification before enacting treatment
The three D’s are used to
classify behaviour/condition as abnormal, must be a combination - cannot classify anything with only one D
Deviant
Rare, inconsistent with social norms
may be positively valued - being extremely tall or fast
Some social norms change, such as homosexuality not being considered a mental illness anymore
Deviated from something
Distressing
E.g. depression and anxiety
But distress is a normal part of life and you can have psychopathology without personal distress
Dysfunctional
Interfering with day to day
E.g. adhd will interfere with day to day life
But some disorders don’t interfere with goals, and dysfunctional does NOT equal psychopathology
issue with diagnosis
Presence of psychological abnormality mental disorder is not as readily definable as a physical illness
Definition of psychological abnormality reflect culture values and social norms
supernatural approach to mental illness
Cause : demons, evil spirits, stars, moon, past live.
Treatment: exorcism, prayer, magic etc.
biological approaches to mental illness
Cause: internal physical problems = biological function
Treatment: bleeding, diet, celibacy, exercise, rest, medication.
psychological approaches to mental illness
Cause: beliefs, perceptions, values, goals, motivation - psychological dysfunction
Treatment: ‘talking therapy’/psychotherapy
sociocultural approach to mental illness
Cause: poverty, prejudice, cultural norms
Treatment: social work to fix social ills, advocating for structural change
integrative approach
bio-psycho-social model
psychiatrist
Fully qualified medical Dr, prescribe medication. Specialised knowledge of the neurobiological feature of mental disorders
clinical psychologist
Specialist training and qualification in psychological assessment, treatment, formulation and prevention of behavioural, mental and emotional health issues - takes bio-psycho-social approach
registered/general psychologist
Less specialist and more generalist - treat people without serious/complex mental disorders
social worker
- Work in direct service for example healthcare, welfare housing etc - Helping people cope with problems such as poverty, legal issues or human rights
- Work in the clinical field (more similar to psychologists) - Diagnose and treat mental, behavioural or emotional health issues.
counsellor
Assist people to gain understanding of themselves and make changes in their lives
May simply provide a non judgemental ‘listening ear’
abnormal
difficult to define, does not have one necessary or sufficient characteristic
psychopathology
mental ill health. Has multiple causes, need to consider relationship between biological, psychological, social cultural factors
biological/medical model
Dominant model in psychiatry, the underlying model of the DSM-5
Can be diagnosed similar to physical illness
Can be explained in terms of a biological disease process such as structural brain abnormalities (grey matter differences in schizophrenia) or neurochemical imbalance (depression)
Biological Model: Criticisms & Limitations
Need to avoid extreme reductionism
Need to avoid over-extrapolation from animal research
Need to avoid assuming causation from treatment efficacy
May not be applicable to conceptualising and diagnosis of mental illness
psychoanalytic model
Id + superego = const conflict. Ego tries to problem solve how to meet the needs of both.
ego
Conscious self (proposed to develop at around age 2)
Rational, organised, obeys ‘reality principle’
According to freud is what people see of you
Balances conflicting demands between id and superego
super-ego
Moral self (proposed to develop at age 5-6)
Develops through socialisation (right and wrong)
Id
Innate, instinctual self
Pleasure principle
Seeks immediate gratification of basic needs (hunger, sex etc.)
“Inner child”
If the ego is unable to resolve the conflict…
lead to anxiety, shame, guilt, embarrassment etc
To avoid the pain of unresolved conflict, the ego develops defence mechanism
Distorting id impulses into acceptable forms
Repressed id impulses into unconscious
Short term
E.g. oedipus complex
repression
unconscious mechanism - keep disturbing/threatening thoughts from becoming conscious
denial
blocking external events from awareness - too much to handle, refuses to experience it
projection
attributing own unacceptable thoughts/feelings/motives into another person
displacement
satisfying an impulse with a substitute object
regression
movement back in psychological time when one is faced with stress
sublimantion
satisfying an impulse with a substitute, in socially acceptable way
maladjustment
defence mechanisms excessively and/or rigidly applied (symptoms/suffering)
E.g displacement - depression
E.g projection - paranoia
Psychoanalytic Model: Diagnosis
2 people with the same underlying conflicts can have different symptoms
2 people with the same symptoms can have different unresolved conflicts, defences, etc.
Psychoanalytic Model: Treatment
Goal: to gain INSIGHT into unconscious processes
Develop awareness of the unresolved conflict and of the defence mechanism/s used
significance of psychoanalytic model
Revolutionised the concept of mental illness
Made no clear dividing line between normal and abnormal processes
Had a strong influence on the early development of the DSM
criticism/limitations of psychoanalytic model
Lacks empirical evidence
Unfalsifiable
behavioural model and phobias
If someone gets attacked in a park the reaction would be fear so people would avoid the stimulus (the park) and thus develop a pattern of avoidance.
Suggests both normal and abnormal behaviour comes from your learning history
cognitive-behavioural model
What we think influences how we feel and what we do
Currently the dominant model in clinical psychology
Cognitive behavioural therapy (CBT)
Aims to reduce (inflated) threat appraisal
Lower the probability x cost
“Something bad might happen but I will be able to cope”
emotional reasoning
assuming because we feel a certain way it must be true
labelling
assigning labels to ourselves or other people
personalisation
blaming yourself or taking responsibility for something that wasn’t completely your fault. vice versa
all or nothing thinking
something called ‘black and white thinking’ -absolutes
mental filter
only paying attention to certain types of evidence - failure to take a wider perspective on situations
jumping to conclusions
mind reading and fortune telling
over-generalisation
seeing a pattern based upon a single event or being overly broad in the conclusion we draw
disqualifying positive
discounting the good things that have happened or that you have done for some reason or another
magnification and minimisation
blowing things out of proportion (catastrophising) or inappropriately belittling something.
treatment of cognitive distortions
Cognitive restructuring - challenging or testing irrational beliefs
behavioural experiments
why classify?
Identifying diagnosis categories can lead to specific treatment
Delineate from different disorders (difference between social and general anxiety)
why diagnose?
Improve communication
Improve understanding
May help reduce stigma
Will it help or hinder the patient if you tell them their diagnosis (BPD, Narcissistic personality disorder etc.)
Diagnostic and statistical manual of mental disorders (DSM)
American psychiatric association
1st edition: 1952
Currently it is the 5th edition, text revision: DSM-5-TR (2021)
Australia/USA/English speaking world.
International classification of diseases and health related problems (ICD)
World health organisation
Mental disorders added in 1948
changes in DSM
homosexuality removed (1973)
GAD introduced (1987)
binge eating disorder included (2013)
what does the DSM do?
Defines symptoms/criteria/differential diagnosis
Most agreed upon definitions/current consensus
Helpful but only a guideline
first editions of the DSM were problematic because…
Problematic reliability -can we agree on the diagnosis? Not a consensus on the diagnosis and was unhelpful?
Problematic validity - is this really what depression is? Based on unproven theories on causation.
DSM-5-TR (2021)
Reflects the medial/biological model
No theoretical assumptions about causation
Describes symptoms
Major depressive disorder
a single or recurrent depressive episode
Major depressive episode
- Depressed mood most of the day, nearly every day
- Markedly diminished pleasure/interest in activities
- Significant weight loss or gain
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue/loss of energy nearly every day
- Feelings of worthlessness, excessive guilt nearly every day
- Diminished ability to concentrate nearly every day
- Recurrent thoughts of death, suicide, suicide attempts
what is anxiety
Basic human feeling, evolutionary.
Warn us that something bad is about to happen
Both ‘abnormal’ and ‘normal’ - activated in response to perceived threat
anxiety - physical
Fight or flight
Activated when there is a perceived threat
Alert
Dry mouth, fast breathing HR speeds up etc.
anxiety - cognitive
Perception of threat
Interpretation of the situation
Attentional shift towards threat, to better ‘survive’ the threat
Hypervigilance: we escaped, we didn’t get hurt but we are now constantly scanning for the threat.
anxiety - behavioural
escape/avoidance: flight
Aggression: fight
Freeze
Anxiety has individual differences in
Trait anxiety - Tendency to perceive threat. Extent to which fight/flight is activated
Specific fear - abnormal anxiety
abnormal anxiety/disorders
Same systems are activated, but occurrence is excessive or inappropriate
Overestimation of cost or probability of harmful outcome (e.g. physical fears vs. social fears)
threat appraisal
Generates expectancy of harm - product of perceived probability (how likely will it harm me) x cost (how bad is this going to be for me)
past experiences/instructions
Panic attack specifier
abrupt and intense fear/anxiety - fear of dying/losing control/going mad
may be cued or uncued (panic disorder)
A panic attack is…
NOT a mental disorder, can occur out of the context of anxiety disorder
Panic disorder
uncued and unexpected panic attacks
anxiety/worry about having another attack because it is uncued - behavioural change to avoid this.
Cognitive Theory of Panic Disorder (Clark, 1988)
Individuals with a panic disorder have a higher sensitivity to bodily experiences - misinterpretation of bodily sensations.
Agoraphobia
Marked fear or anxiety of at least 2 of:
- Using public transportation
- Being in open spaces
- Being in enclosed places
- Standing in line or being in a crowd
- Being outside of the home alone
Excessive avoidance of situations where the person believes that escape might be difficult, or help might not be available, in the event of panic symptom
specific phobia
A marked and consistent fear reaction to the presence or anticipation of a specific object or situation - anxiety is out of proportion
subtypes of phobias
animals, blood/injection/injury, natural environment, situational/other
Onset of phobias
Childhood learning (could be vicarious) or following trauma
Common in children and more intense in adults
Typically a chronic course
Causes of specific phobias
Unique genetic disposition
learning/cognitive - accurate appraisal of past dangerous event OR inaccurate appraisal of harmless event
Evolutionary component
Social anxiety disorder (SAD)
Intense fear or avoidance of social or performance situations where social scrutiny may occur
Fear that one will act in a way or show anxiety symptoms that will be negatively evaluated
how do people with SAD think
Assume that others are highly critical
Place a great importance on the evaluation of others
Negative self-evaluation
Provoke immediate anxiety
Self preoccupation and attention on the anxiety
generalised anxiety disorder (GAD)
Excessive and uncontrollable worry about a wide range of outcomes
Sense that they cant control it
Not single trigger
physical symptoms of GAD
Tension
Irritability
Restlessness
Sleep problems
More enduring physical symptoms
Cognitive factors/processes associated with GAD
What if? - constant questioning
High trait anxiety
Intolerance of uncertainty
Positive and negative beliefs about worrying (meta beliefs). “Thinking about your thinking”
Reduced problem solving confidence
obsessions
repeated intrusive, irrational thoughts or impulse which cause anxiety/distress - Thinking about killing someone feels the same as actually killing someone.
overt - washing hands
covert (cog) - counting to 10
compulsions
ritualised behaviours to relieve the anxiety caused by obsessions.
logical/illogical
common obsessions in OCD
contamination
harm
aggression/losing control
perfectionism
religion
unwanted sexual thoughts
Cognitive factors/process associated with OCD:
Intolerance of uncertainty
Inflated responsibility
Thought-action fusion (TAF)
Magical ideation: illogical connections between obsessions and compulsions.
psychoeducation
improve knowledge of mental illness
understanding what is happening
role of thoughts and avoidance
avoidance is brings temporary relief
anxiety is natural but can be excessive/inappropriate
cognitive techniques
thought diaries - make client more aware of their thoughts and identify patterns
cognitive restructuring/thought challenging - what is the evidence, is it helpful, different perspectives
exposure therapy
exposing individuals to feared stimulus and keeping them in that state to prove that nothing happens and anxiety decreases
Systematic desensitisation vs. flooding
Slowly building up to the situation that provokes the most anxiety is the best for exposure therapy
Exposure effects cognition
Exposure to stimuli reduces estimate of probability
Exposure to outcome reduces estimate of cost
medication
Treating symptoms but not the cause
side effects and relapse - isn’t used on its own
Depressive disorders
Characterised by a disturbance of mood
Mood exist on a continuum
Extreme low mood
major depressive episode
Depressed mood most of the day, nearly every day
Markedly diminished pleasure/interest in activities (anhedonia)
Significant weight loss or weight gain
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation
Fatigue or loss of energy nearly every day
Feelings of worthlessness and excessive guilt nearly every day
Diminished ability to concentrate nearly every day
Recurrent thoughts of death, suicide, suicide attempts
somatic symptoms of depression
fatigue, sleep or appetite change
cognitive symptoms of depression
indecisiveness, lack of concentration
affective symptoms of depression
depressed mood, anhedonia
Depressive Disorder
Poor appetite or overeating
Insomnia or hypersomnia
Fatigue or loss of energy
Low self-esteem
Feelings of hopelessness
Poor concentration or decision making difficulty
No more than 2 months ‘normal’ mood in 2-years
Major Depressive Disorder: Epidemiology
1 in 7 people will experience depression in their lifetime (Kessler et al, 2003)
Depression has the 3rd highest burden of all diseases in Australia
onset of major depressive disorder
Emerges during adolescence
Women are twice as likely to have a depressive disorder (but also could be more likely that they have a higher behaviour to seek help)
High comorbidity with anxiety and substance abuse
Schema Theory (Beck, 1976)
(Pre-existing negative schemas + Stress) leads to (Depression)
cognitive triad
negative view of the:
self
world
future
Learned Helplessness Theory (Seligman, 1974)
- Uncontrollable bad events
- Perceived lack of control
- Generalised this helpless behaviour
Behavioural Activation
Do things that they previously enjoyed
Scheduling time for pleasant activities
Make it homework, work towards goals
Break lethargy cycle
Selective Serotonin Reuptake Inhibitors (SSRIs)
e.g. Prozac, Zoloft, etc
fewer side effects than older drugs
Effectiveness: 70-80%
Electroconvulsive Therapy (ECT)
Involves applying brief electrical current to the brain
uncertain how/why ECT works
Last resort: effective for severe depression (80%)
Anorexia Nervosa (AN)
Intense fear of gaining weight
Body image distortion
Leads to self-starvation and to low body weight (BMI <18.5 - arbitrary)
AN - Restricting
Individual has not eaten or taken in binge eating behaviours
Diet, fasting, excessive exercise.
AN - Binging/Purging
Self induced vomiting, improper use of laxatives etc.
Bingeing in anorexia nervosa is different because the individual may view eating a punnet of strawberries a “binge”
Onset and course of AN
Most common age is between 12-25.
5-7 years, slow recovery (egosyntonic, they view the disorder as part of how they are, recovery would be having a higher BMI and changing their cognitions). ~40% of people with AN will later develop Bulimia Nervosa.
Anorexia Nervosa (AN): Psychological features
Pre-occupation or obsessive thoughts about food and weight
Low self esteem
Mood swings, irritability, anger
Clinical depression
Withdrawal from relationships
Past trauma
Perfectionism
Emotional dysregulation
Anorexia Nervosa (AN): Behavioural features
Excessive exercise and/or food restriction
Secretive behaviour/lying
Overly sensitive to references about weight or appearance
Frequently checking appearance
Adopting rigid meal or eating rituals (spitting food after chewing it)
Obsessive interest in cooking / preparing food for others but not eating it
Refusal to eat in the presence of others
Wearing baggy clothes to hide appearance
Anorexia Nervosa (AN): Physical features
Low body temperature (intolerant of cold)
Brittle hair and nails
Hair covering body: lanugo, counteract always being cold
Osteoporosis
Dry, yellowish skin
Anaemia
Immune system suppression
Malnutrition
Low blood pressure
Irregular heart rhythm
Can lead to death
Anorexia Nervosa (AN): Physical features
Low body temperature (intolerant of cold)
Brittle hair and nails
Hair covering body: lanugo, counteract always being cold
Osteoporosis
Dry, yellowish skin
Anaemia
Immune system suppression
Malnutrition
Low blood pressure
Irregular heart rhythm
Can lead to death
Anorexia Nervosa (AN) in the media
Can be glamorised
Is it awareness or causing harm?
Bulimia Nervosa (BN)
serious psychological disorder characterised by:
Recurrent episodes of bingeing
(compensatory) behaviours that prevent weight gain
Distorted body image
BMI could still be normal
Recurrent episodes of BINGE EATING
Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
There is a sense of lack of control over eating during the episode.
Recurrent inappropriate compensatory behaviours (purging and nonpurging), in order to prevent weight gain - such as:
Self-induced vomiting
Misuse of laxatives
Diuretics
Fasting
Excessive exercise
Other medication
Smoking
Bulimia Nervosa (BN): Associated features
weight fluctuation
chewing gum/drinking water
toilet after meals
secretive behaviour
puffy face
calusses knuckles
sore throat
tooth decay
stomach rupture
bowel function problems
heart problems
electrolyte disturbances
Muscle Dysmorphia
Fears of being too small or not muscular enough
Similarities between Anorexia Nervosa and Bulimia Nervosa
Tendency to base self-worth on weight/shape
Desire to attain unrealistic levels of thinness
Intense fear of gaining weight
onset and course of BN
Commonly adolescence or young adulthood. Chronic, lasts at least several years
family factors and eating disorders
Higher parental criticism, control and conflict
Lower parental empathy & support
Comments regarding child’s eating and body
Parental modelling of eating/body concerns
Sociocultural values, Peer factors and eating disorders
social approval
Emphasis on thinness as a key basis of attractiveness (especially for females)
CBT-Enhanced (CBT-E)
- Starting well - engaging/educating, weighing, assisted meals
- taking stock - reviewing progress and planning
- addressing maintaining mechanism - body image, dietary restraint, events, mood, eating
- ending well - identify goals/residual problems, prevents relapse
What are the main problems associated with diagnosing an individual with a psychological disorder?
Hinder the ability to be further diagnosed - put in a box
Diagnosis may have a stigmatising effect on the individual
What are the advantages of diagnosing an individual with a psychological disorder?
Better understand how they feel and think and why - underlying pathology (aetiology)
Allow them to be put on medication to help them - treatment
What their prognosis is - what are the next steps
Incidence:
the number of new cases occurring during a specified time. It can also be thought of as the infection rate, or the probability (risk) of contracting the disease.
incidence rate =
New instance of disease in population ÷ Duration in which individuals are at risk of contracting disease
prevalence
the prevalence of a disease is the proportion of the population that have the disease at a given time
prevalence rate =
Total cases of disease in population at a given time ÷ Total number of individuals in the population at risk
Obsessive-compulsive disorder (OCD)
Feel compelled to act in a rigid, repetitive way to reduce their anxiety or distress
Strongly related to anxiety
Post-traumatic stress disorder (PTSD)
- Intrusion symptoms such as intrusive images, memories and dreams, that cause the person to re-experience that traumatic event as if it were recurring again and again
- Persistent avoidance of any reminders of the event
- Negative changes in cognition and mood, which can involve fear, helplessness, self-blame, anger or hopelessness
- Changes in arousal and reactivity, which can manifest in sleep disturbance, poor concentration, hypervigilance, exaggerated startle responses, and reckless or impulsive behaviours.
bipolar disorder
Alternating from depression and mania
Mania: state of highly excited mood and behaviour
suicide prevention
Ask person directly if they are considering suicide
Provide social support and empathy
Help them see their situation from a wider time perspective
Seek professional assistance
suicide warning signs
verbal/behavioural threat for suicide
could be an explicit statement of intent or could be more subtle (taking unusual risks, getting rid of treasured possessions etc)
History of suicide
Substance use/abuse
suicide motives
No other way to deal with emotional distress - end problems
Attempt to influence others: cries for help or attempts to coerce people to meet one’s needs
Prevent lover from ending a relationship
Inducing guilt
Dramatising one’s suffering
Desire to no longer be a burden on others, sense of social alienation
schizophrenia
Severe disturbances in thinking, speech, perception, emotion and behaviour
Psychotic disorder
“Split mind”
Misinterprets reality
delusions
false beliefs that are sustained in the face of evidence that normally would be sufficient to negate these beliefs
grandeur - great purpose
persecution - threat
disorganised thought
unwanted thoughts constantly intrude into consciousness
hallucinations
false perceptions that have a compelling sense of reality
Auditory - voices, most common
visual/tactile
Schizophrenic language
Contain strange words
Disorganised
Contain words based on rhyme/association rather than meaning
emotion in schizophrenia
Flat affect - no emotions, voice monotone and faces impassive
Blunted affect - less emotion
Inappropriate affect - expressing emotions in the wrong way (laughing when hearing about a tragedy)
Paranoid schizophrenia
Delusions of persecution (others mean harm to them) and delusions of grandeur (they are enormously important).
Suspicion, anxiety, anger may accompany delusions.
Hallucinations may occur.
disorganised schizophrenia
Confusion and incoherence, severe deterioration of adaptive behaviour (personal hygiene, social skills, self-care etc).
Difficult to communicate with individuals in this subtype
Behaviour may appear silly/childlike
Inappropriate emotional responses
catatonic schizophrenia
Striking motor disturbances ranging from muscular rigidity to random or repetitive movements.
Alternate between stuporous state and agitated excitement (they can become a danger to others in this state)
Stuporous state: oblivious to reality, waxy flexibility (limbs can be moulded by another person in grotesque positions that they will maintain for hours)
negative symptoms of schizophrenia
absence of normal interactions
- Lack of emotional expression
- Loss of motivation
- Absence of speech
- Associated with a long history of poor functioning prior to diagnosis with a poor outcome following treatment
positive symptoms of schizophrenia
represent pathological extremes of normal processes
- Delusions
- Hallucinations
- Disordered speech and thinking.
- Associated with a better functioning after breakdown and better prognosis for eventual recovery - particularly is if symptoms were sudden and preceded by a history of good adjustment
Brain abnormalities in schizophrenia
Destruction of neural tissues can cause schizophrenia
Brian atrophy and enlarged ventricles
Abnormalities in thalamus
Structural differences are common in those who experience negative symptoms.
dopamine hypothesis
Symptoms (mostly positive) are produced by overactivity of the dopamine symptoms in areas of the brain that regulate emotional expression, motivated behaviour and cognitive functioning
More dopamine receptors on neuron membranes
Antipsychotic drugs - reduce dopamine-produces synaptic activity
