Abnormal Flashcards
Models of Abnormality - Supernatural Influences
- cause of psychological abnormality was that you were possessed by evil demon / spirits
Treatments:
- flogging - makes spirit / demon uncomfortable
- psychosurgery - drilling holes into the brain (frontal lobe) which gave the spirit / demon an exit route
- most people didn’t survive or it had an impact on cognitive functioning
- prayer / exorcism
What is “abnormal” behaviour?
*difficult concept to define
- people who have thought / perceptions that may be unrealistic or different to other people
- inappropriate emotions
- harmful / unpredictable behaviour
- psychological stress can result in physiological symptoms
- behaviour that is personally distressing, personally dysfunctional and/or so culturally deviant that other people judge it to be inappropriate or maladaptive
Models of Abnormality - Biological Factors
medical or neurobiological model
- cause = a result of some kind of physical illness or an imbalance in bodily processes
- view that psychological disorde are just like physical illnesses - they can be categorised and treated
- Hippocrates - theory of humours
- treatments - medical treatments
- 18th century - asylums
- 20th century - psychosurgery, electro convulsive therapy, drugs
Successes of the Medical Model
Dementia - loss of intellectual functioning
Caused by - age, lots of strokes, lots of alcohol, certain viruses or bacteria
Identified certain biological features that can help you diagnose certain disorders therefore you can treat them :)
Problems with the Medical Model
- no good biological markers for diagnosis
- diagnoses are largely based on P’s own account of behaviour and the practitioner’s observations of the P’s behaviour - subjective?
- few new treatments have been developed in recent history compared to the previously large increase in research into the area
- some medications don’t actually cure the problem, they just mask the underlying problem eg depression?
- doesn’t explain all abnormalities:
- there are certain environmental factors / reasons that can explain psychological disorders eg loss of a parent in childhood p, traumatic experiences
Models of Abnormality - Psychological Model
Cause = manifestations of psychological problems are a result of psychological processes eg inner conflicts, childhood experiences etc
3 different theories within:
1) Psychodynamic Theory
2) Humanistic / Phenomenological Theories
3) Cogntive-Behavioural Theory
Psychological Model - Psychodynamic Theory
Freud - late 1800s
- cause = unconscious conflicts and desires
- these desires aren’t admitted in public as they are unacceptable - produces anxiety to talk about them
- kept down by defences in the unconscious which causes conflict
- instinctual impulses cannot stay hidden forever - will eventually break through defences into the consciousness
Treatment:
- psychotherapy - looking for slips to gain an insight into the unconscious to make the person aware of these unconscious desires
Psychological Model - Humanistic / Phenomological Model
Developed by Carl Rogers
- cause = self-actualisation has been blocked
- this can be by parents, society, the environment etc
Treatment = therapy - work with a councillor
Psychological Model - Cognitive-Behaviour Therapy (CBT)
Combination of 2 models:
1) Behavioural / Learning Model
- eg Watson or Skinner
- cause = abnormal behaviour has been learned
- eg phobia - little Albert
2) Cognitive Model
- eg Beck
- cause = negative, maladaptive perceptions of the world & self
- focus on internal dialogue - how they understand the world & self
Treatment - Cognitive Behavioural Therapy
- behaviour aspect - trained to be relaxed
- cognitive aspect - challenge the irrational cognitions
Models of Abnormality - Sociocultural Context
- the effect of the environment in which someone develops a disorder and the effect of the sociocultural context on the disorder
2 factors affect:
1) the way the disorder is expressed
- culture specific disorders
- gender differences
- social expectations
2) the way abnormality is viewed
- biases in diagnosis
Models of Abnormality - Diasthesis-Stress Model
Integrated model - aspects of previous models into one another
Vulnerability factors can predispose people to stressors which lead to psychological disorders
Name the three criteria for defining abnormality
1) Statistical infrequency
2) Norm violation
3) Personal suffering
Defining Abnormality - Statistical Infrequency
Normal = average
Abnormal = deviations from the average
Problem - average is not always desirable or healthy and deviations from the average can actually be beneficial or desirable (high IQ)
Defining Abnormality - Social Norms / Norm Violation
- behaviour is seen to be abnormal if behaviour is seen to violate cultural norms
- eg wearing a bikini in public etc
- problem - social norms vary across cultures and historical cues
Cultures - eg Draguns (1986) Amish communities describe different manifestations of affective disorders compared to typical American cultural manifestations
Historical era - views on women & homosexuality
Defining Abnormality - Personal Suffering
- a feature of many abnormal conditions
- problem - not a reliable measure as it’s subjective and not a feature of all conditions
Defining Abnormality - Behavioural Abnormality
3 criteria
Distress:
- excessive anxiety, depression, dissatisfaction or extremely sadness about oneself or life circumstances may be viewed a disturbed behaviour if the individual has little control over these reactions
- but it’s not a feature of all mental health problems however
Dysfunction:
- behaviours can be seen as maladaptive and self-defeating if they interfere with a person’s ability to work or to form / experience satisfying relationships with others
- some behaviours are labelled as abnormal because they interfere with the well-being of society BUT this is a difficult issue eg terrorists or freedom fighters?
Deviance:
- concerned with the deviance of a given behaviour
- conduct within every society is regulated by norms - behavioural rules that specify how people are expected to think, feel & behave
- some are explicitly codified as laws and violations of these norms defines criminal behaviours
- others however aren’t explicit but are expected eg making eye contact on public transport / an elevator
- people are likely to be viewed as psychologically disturbed if they violate these norms especially if the violations make others uncomfortable and cannot be attributed to environmental causes
Describe research into the prevalence of mental abnormality
Srole et al - 1500 participants:
- 25% marked degree of psychological problem
- 55% mildly impaired psychologically
- 20% psychologically healthy / unimpaired
- so it is actually normal to have had a mental health issue*
National Institute of Mental Health (USA) 1984
- 20,000 participants, 3 cities
- 29-38% experienced at least one psychiatric disorder
Üstün & Satorius (1995) - 14 countries
- 24% had a diagnosable disorder, 9% experienced severe symptoms of a disorder, 31% were symptomatic & 36% were well
What are the 2 classification systems for diagnosing mental health?
ICD-10 and DSM-IV-TR
Describe the ICD-10
World Health Organisation International Classification of Diseases
- covers mental health problems & other disorders
- more of a complete diagnostic classification system
Describe the DSM-IV-TR
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
- only covers mental health problems
- very widely used around the world
Describe the DSM axes
Axis 1 - Clinical Syndromes / Primary diagnosis
Axis 2 - Personality Disorders & Mental Retardation
Axis 3 - General / Relevant Medical Conditions
Axis 4 - Psychosocial & Environmental Problems
Axis 5 - Global Assessment of Functioning Scale
Problems of classification
Reliability:
- clinicians using the system should show high levels of agreement in their diagnostic decisions
- this means that the classification systems should be couched in terms of observable behaviours that can be reliably detected in order to minimise subjective judgements
- inter-rater reliability?
Validity:
- the diagnostic categories should accurately capture the essential features of the various disorders
- the categories should allow us to differentiate one psychological disorder from another
- overlap between conditions? co-morbidity?
Criticisms of Classification - Not a mental illness
Szasz
Szasz - there is no such thing as mental illness
- diseases of the brain rather than diseases of the mind - mental illnesses are no different from other diseases
- the term is widely used to describe something very different than a disease of the brain; it’s a name for problems in living
- mental illness is regarded as the cause of human disharmony as living is now taken for granted as being an arduous process
Eg schizophrenia in different cultures - hearing voices????
Criticisms of Classification - Labelling
Effects of labelling - Rosenhan (1973)
- reduces responsibility
- self-fulfilling prophecy
- stigmas that come along with it - clinicians hold predisposed views, society views people differently and the patient themselves
What are anxiety disorders?
- disorders where the frequency and intensity of the anxiety responses are out of proportion to the situations that trigger them and the anxiety interferes with daily life
What are the symptoms of anxiety disorders?
Emotional - feelings of tension & apprehension
Cognitive - worry & thoughts about inability to cope
Behavioural - avoidance of feared situations, decreased task performances & increased startle response
Physiological - increased heart rate, muscle tension & other autonomic arousal symptoms
Anxiety Disorders - Prevalence - Alonso et al (2004)
Wanted to describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in 6 European countries
14% reported an anxiety disorder
Anxiety Disorders - Phobic Disorders
- intense, irrational fear of objectively non-dangerous situations or things
- lead to disruptions of behaviour
- Magee et al (1996) - more than 10% of people have a phobia at some point in their lives
Phobic Disorders - Types
Social - excessive fear of situations in which the person might be evaluated and possibly embarrassed
Specific - fear & avoidance of specific things
- eg dogs, snakes, spiders, aeroplanes, lifts, enclosed spaces, water, injections or germs
Agoraphobia - fear of open or public spaces from which escape would be difficult
Anxiety Disorders - Generalised Anxiety Disorder (GAD)
- is a chronic state of diffuse or free-floating anxiety that is not attached to specific situations or objects
- excessive anxiety not focused on a specific situation or object
- Weissman (1994) - affects around 6% of the US population in any year
- can markedly interfere with daily functioning even if the symptoms aren’t continually present for the 6 months required for a formal diagnosis - difficulty in concentration, making decisions & remembering commitments
Anxiety Disorders - Obsessive-Compulsive Disorder
Persistent ideas or worries accompanied by ritualistic behaviours performed to neutralise the anxiety-driven thoughts
- obsessions = repetitive & unwelcome thoughts, images or impulses that invade the consciousness and are often abhorrent to the person and are very difficult to dismiss or control
- compulsions = repetitive behavioural responses that can be resisted only with great difficulty
- can greatly interfere with daily functioning
- compulsions are strengthened through a process of negative reinforcement because they allow the person to avoid anxiety
- Torres et al (2006) prevalence of OCD approx 1.1%
- significant co-morbidity with other problems
- found that it was as high as 62% in those they found with OCD
Anxiety Disorders - Panic Disorder
- repeated attacks of intense fear involving physical symptoms such as faintness, dizziness and nausea
- occur suddenly and unpredictability
- more intense than GAD
- likely to develop agoraphobia because they fear that they will have an attack in public
- American Psychiatric Association (1994) - affects around 2-3% of women and 1% of men
Anxiety Disorders - Biological Causes?
Genetic predisposition - Jang (2005)
- may make a person vulnerable to anxiety disorders
Twin Studies - Carey & Gottesman (1981)
- MZ twins have a concordance rate of about 40% for anxiety disorders compared with a concordance rate of 4% in DZ twins
- far from 100% therefore there are psychological & environmental factors that could be considered?
Abnormal neurotransmitter activity - Bremner (2000)
- abnormally low levels of inhibitory GABA activity in the amygdala and other brain areas involved in emotional arousal may cause some people to have highly reactive nervous system that quickly produce anxiety responses to stressors
- Twin studies
- Oversensitive Autonomic Nervous System
- Abnormal neurotransmitter activity
Anxiety Disorders - Psychological Causes?
Cognitive:
Catastrophising - anticipate that the worst will happen & feel powerless to cope effectively
- Beck - give greater weight to the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable.
Behavioural / Learning:
- Rachman (1988) some fears acquired as a result of traumatic experiences produce a classically conditioned fear response
- operant conditioning - learn behaviours that are successful in reducing anxiety through negative reinforcement
- eg agoraphobia - remaining at home serves as the fear reducing behaviour
Environment - Social & Cultural factors
- traumatic childhood experiences or abuse
- cultures - anorexia has obsessive-compulsive elements & it is found almost exclusively in Western, developed countries where being thin is a cultural obsession (Becker et al 1999)
Anxiety Disorders - Psychodynamic Theories?
Anxiety is a central concept in psychoanalytic conceptions of abnormal behaviour
Freud:
- neurotic anxiety = when unacceptable impulses threaten to overwhelm the ego’s defences & explode I to consciousness or action
- in phobic disorders neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to an underlying conflict
- eg Little Hans
- psychoanalysts believe that obsessions & compulsions are also ways of handling anxiety
- the obsession is symbolically related to the underlying impulse
- a compulsion is a way of taking back or undoing one’s unacceptable urges
- eg thoughts about dirt & hand washing techniques are used to deal with one’s ‘dirty’ sexual impulses
Anxiety Disorder - Post-traumatic Stress Disorder
Severe anxiety disorder that can occur in people who have been exposed to traumatic life events
Four major symptoms:
1) experience severe symptoms of anxiety, arousal & distress that weren’t present before the trauma
2) relive the trauma recurrently in flashbacks, dreams & in fantasy
3) person becomes numb to the world & avoids stimuli that serve as reminders of the trauma
4) individual experiences intense survivor guilt in instances where others were killed & the individual was somehow spared
What are dissociative disorders?
Disorders that are characterised by temporary alterations or disruptions in consciousness, memory, identity or perception
Involve a breakdown of normal personality integration resulting in significant alterations in memory & identity
Dissociative Disorders - Dissociate Amnesia
- Sudden, unexpected loss of memory
- short term
Dissociative Disorders - Dissociative Fugue
- Sudden, unexpected loss of memory
- May result in relocation and start of new life
- American Psychiatric Association (1994) - affects around 2% of people
