Abnormal Psychology Flashcards
What is abnormal psychology?
Psychology is the scientific study of behaviour, emotion and cognition.
Abnormal Psychology is the scientific study of abnormal behaviour, emotion and cognition
What is considered abnormal?
- 3 D’s
- Deviant (rare, inconsistent with social norms) e.g. fetishism
- Distressing e.g. depression, anxiety
- Dysfunctional (interfering with day to day functioning) e.g. ADHD
What are some issues with the 3Ds as explanations of abnormal behaviour?
Deviant
- some deviations are positively valued, social norms change
e. g. if someone had really high self-esteem, it may be considered abnormal due to narcissism but if someone had really low self-esteem, could be considered deviant because they are meant to be in a higher place i.e. depression
Distressing
- distress is a normal part of life - grieving a death is a ‘culturally appropriate response’
- you can have psychopathy without personal distress e.g. bipolar disorder - may not experience depression, only manic episodes
Dysfunctional
- But some disorders don’t interfere with goals
And dysfunctional doesn’t mean psychopathy
Defining psychological abnormality
Psychological abnormality exists on a continuum with normality and definitions of psychological abnormality reflect cultural values and social norms
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Published by American Psychiatric Association
Reflects biological/medical model of ‘mental illness’
What are different approaches to mental illness?
Supernatural
- Cause: demons, evil spirits, stars, moon, past lives
- Treatment: exorcism, prayer, magic etc
Biological
- Cause: internal physical problems - biological dysfunction
- Treatment: bleeding, diet, celibacy, exercise, rest, medication
Psychological
- Cause: beliefs, perceptions, values, goals, motivations - psychological dysfunction
- Treatment: ‘talking therapy’/psychotherapy
Sociocultural
- Cause: poverty, prejudice, cultural norms
- Treatment: social work to fix social problems, advocating for structural changes
Integrative approach - Biopsychosocial Model
What is a psychiatrist and qualifications required?
- Fully qualified medical doctor
- Specialist training and qualifications in the diagnosis, treatment and prevention of mental illness
- Specialised knowledge of neurobiological features of mental disorders
- Can prescribe medication for mental disorders
- Treatment takes a biomedical approach
What is a clinical psychologist and qualifications required?
- At least 8 years
- Specialist training and qualifications in psychological assessment, treatment formulation and prevention of behavioural, mental and emotional health issues
- Cannot prescribe medication but may have ‘Dr’
- Therapy takes a bio-psycho-social approach
- Aims to help clients change their thought processes and behaviour
- Develop skills and strategies to cope and function better, to prevent ongoing problems/improve quality of life
What is a general psychologist and qualifications required?
- At least 6 years
- Less specialised and more generalist training than a clinical psychologist
- In general, treat people without serious/complex mental disorder
- Assist people with a range of mental health issues such as:
Depression, anxiety and stress - Relationship difficulties
- Other emotional problems
What is the medical/biological approach to treatment and limitations?
The biological/medical model is dominant in psychiatric practice and is the underlying model of DSM-5. The key assumptions of mental disorders are that they:
- Can be diagnosed similar to physical illness
- Can be explained in terms of a biological disease process
Treated by targeting biological deficiencies through medication and uncommonly, Electroconvulsive Therapy (ECT)
Criticisms and Limitations
- Need to avoid extreme reductionism: complex psychological phenomenon cannot be explained at the neural level
- Need to avoid over-extrapolation from animal research - a lot of important social factors in humans won’ts be recognised in animals
- Need to avoid assuming causation from treatment efficacy e.g. SSRT/Panadol - just because antidepressants improve someone’s mood doesn’t mean the underlying root of their depression is cured
There is a clear boundary between physical health and illness BUT there is a continuum between mental health and disorder - no arbitrary line down the middle of mental illness unlike medical health.
What is the psychoanalytic approach to treatment and limitations?
The Psychoanalytic Model was one of the most dominant model in the first half of the 20th Century popularised by Sigmund Freud - first theory that explained that there are things going on that are not conscious - most of our internal experiences are unconscious.
Revolutionized the concept of mental illness - first time ‘talking therapy’ was used and normalised.
Made no clear dividing line between normal and abnormal processes.
Had a strong influence on the early development of the DSM.
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
- Same individual can develop different symptoms over time (resulting from the same underlying cause)
Treatment
- Goal is to gain insight into our unconscious processes
- Develop awareness of the unresolved conflict and of the defense mechanism/s used
Limitations
- Lacks empirical evidence
- Unfalsifiable
What are the theories of consciousness and unconsciousness according to Freud?
- The conscious is things that we are aware of thinking.
- Pre-conscious is when you have access to thoughts and if needed you can bring them to mind.
- Unconscious is shaped by early life experiences and relationships according to Freud.
Id (‘the id’) - Instinctual self (innate)
- Driven by pleasure principle
- Seeks immediate gratification of basic needs/instincts
Ego (‘the I’) - Conscious self (around age 2)
- Rational, organised, obeys ‘reality principle’
- Balances conflicting demands between id and superego
Superego (‘above I’) - Moral self (age 5-6)
- Develops through socialization: right and wrong
Id + superego = constant conflict: Ego tries to problem solve how to meet the needs of both
The Ego is unable to resolve conflict, so to avoid the pain, develops defence mechanisms:
- Distorting Id impulses into acceptable forms
- Repressing Id impulses into unconscious
What is the humanistic approach to treatment and limitations?
The Humanistic Model was used in the 60s and 70s as a reaction to the negativity of the psychoanalytic model.
Self actualisation (Maslow) - hierarchy of needs - if you want to become self-actualised you need to tick off immediate essential needs before becoming self-actualised
Fully functioning human (Rogers)
- Maladjustment: self-actualisation thwarted
- Environment imposes conditions of worth
- Own experience, emotions, needs are blocked
Treatment: empathy (and unconditional positive regard)
Criticism: difficult to research - when is self-actualisation achieved?
What is the behavioural approach to treatment and limitations?
The Behavioural Model was a reaction to psychoanalysis being unfalsifiable, where behaviour is observable and measurable.
- Classical conditioning (Pavlov) UCS-UCR, CS-CR -Operant conditioning (Skinner) Reinforcement and punishment The model suggests both normal and abnormal behaviour comes from your learning history
Treatment: many applications e.g. exposure
Limitations (Pavlov/Skinner models)
- Overemphasis on behaviour; excluding cognitive elements
Bandura (1974): observational/vicarious learning
- Showed learning without own experience - child walking with mum and see a job - child looks up at mom who looks panicked and they cross the road - no bad experience but child learns
- Reintroduced the importance of cognitions
What is the cognitive-behavioural approach to treatment and limitations?
This model developed in the mid 20th Century (Aaron Beck) using ‘cognitive revolution’ as a reaction to behaviourism -
What we think influences how we feel and what we do. It is currently the dominant model in clinical psychology.
Maladjustment: Negative Core Beliefs:
- Shape our interpretations of experiences, and our behaviour
- Lead to automatic negative thoughts and cognitive distortions
Cognitive-Behavioural Therapy (CBT)
- Treatment techniques: e.g. exposure, behavioural experiments
- Cognitive restructuring - challenging or testing irrational beliefs
Characteristics of the DSM I (1952) and DSM II (1968)
- Strongly influenced by psychoanalytic theory
- Problematic reliability: inter-rater reliability: Can we agree on the diagnosis?
- Problematic validity: is this really what the disorder is - descriptions based on unproven theories about causation
Characteristics of DSM-III (1980)
- Took a more biological approach
- number of disorders increased with each edition
Characteristics of DSM-V (2013)
- Reflects the medical/biological model
- No theoretical assumptions about causation
- Describes symptoms
- Patient report, direct observation
- No assumptions about unconscious processes
- Clear, explicit criteria and decision rules: improved reliability
What are the 3 interrelated systems activated in response to threat?
- Physical system
- Fight or flight response activated when there is perceived threat
- The brain becomes aware of danger as a result of messages received
- Hormones are released and the involuntary nervous system sends signals to various parts of the body to produce the changes shown on the diagram - Cognitive system
- Perception of threat causes attentional shift towards threat
- Hypervigilance - scanning environment for threat; on alert - Behavioural system
- Escape/avoidance, aggression, freezing
Differences between normal and abnormal anxiety
Normal Anxiety has evolutionary value essential for survival.
- Realistic/objective threat to self
- Specific ‘prepared’ stimuli e.g. insects, animals, heights and novel stimuli
- Threat appraisal: evaluation of the degree to which an event has significant implications
- Generates expectancy of harm
- Product of perceived probability x cost
- Based on past experiences, observations and instructions
Abnormal Anxiety is not qualitatively different from normal anxiety
The same systems are activated: but occurrence is excessive or inappropriate
- Characterised by overestimation of threat
- Deviant, distressing, dysfunctional
- Categorised according to focus of anxiety in DSM
DSM-5 diagnosis of a Specific Phobia
According to the DSM-5, a specific phobia is a marked and consistent fear reaction to the presence or anticipation of a specific object or situation.
- Anxiety experienced is out of proportion to the actual threat
- Persistent, lasting 6 months or more
- Phobic stimulus is avoided or endured with intense fear
- The fear/anxiety/avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- Not better explained by another disorder
DSM-5 diagnosis of a Panic Attack
A DSM-5 Panic Attack is an abrupt and intense fear of anxiety that peaks within 10 minutes.
Classic symptoms of:
- autonomic arousal
- Fear of dying, losing control, or going mad
Situationally bound (cued) panic attack
- Occurs in presence or anticipation of feared stimulus
- Can be associated with an anxiety-related disorder
Unexpected (uncued) panic attack
- Associated with panic disorder
DSM-5 diagnosis of a Panic Disorder
Unexpected/spontaneous panic attacks
- At least 2 panic attacks where the trigger cannot be identified
anxiety/worry about having another attack
- Concerns about heart attacks, going mad
- Significant behaviour change trying to avoid another attack
- Symptoms persist for 1 month or more
Cognitive Theory of Panic Disorder proposes that individuals who experience recurrent panic attacks do so because they have an enduring tendency to misinterpret benign bodily sensations as indications of an immediately impending physical or mental catastrophe.
DSM-5 diagnosis of Agoraphobia
- Marked fear or anxiety > or = 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 symptoms.
DSM-5 diagnosis of Social Anxiety Disorder
- Intense fear and avoidance of social or performance situations where social scrutiny may occur
- A fear that one will act in a way or show anxiety symptoms that will be negatively evaluated
- Assume that others are
highly critical (probability) - Place great importance on
the evaluation of others
(cost) - Negative self-evaluation
(self imposed perception of
others) - Self preoccupation and
attention (audience,
internal and external)
- Assume that others are
- Social situations must always provoke anxiety
- Anxiety experienced is out of proportion to the actual threat
- Persistent, lasting 6 months or more
- Causes clinically significant distress or impairment in functioning
DSM-5 diagnosis of General Anxiety Disorder
- Excessive and uncontrollable worry about a wide range of outcomes
- Physical symptoms are different from ‘panic’
- Tension, irritability,
restlessness, sleep
problem - Persistent, lasting 6 months or more
- Causes clinically significant distress or impairment
- Cognitive factors/processes associated with GAD
- High trait anxiety
- Intolerance of uncertainty
- Positive and negative
beliefs about worrying
- Reduced problem solving
confidence
DSM-5 diagnosis of Obsessive Compulsive Disorder
Obsessions: repeated intrusive, irrational thoughts or impulses which cause severe anxiety/distress
Compulsions: ritualised behaviours to relieve the anxiety caused by obsessions
Cognitive factors/processes associated with OCD:
- Intolerance of uncertainty - Inflated responsibility - Thought action fusion (TAF) when you believe that simply thinking about an action is equivalent to actually carrying out that action - magical ideation
Key features of Cognitive Behavioural Therapy
CBT aims to reduce inflated threat appraisal and perceived probability and/or cost
- Psycho-education
- Explaining anxiety as flight/fight response
- Role of thoughts - clients take their thoughts as being true rather than just consciousness
- Role of avoidance - makes sense why they avoid but in the long term it makes the anxiety worse - Cognitive techniques
- Thought diaries - identify thoughts and then challenge the thoughts
- Cognitive restructuring/thought challenging
What is the evidence against the thought?
How helpful/unhelpful is the thought? - Behavioural techniques
- Exposure therapy
- avoidance is negatively reinforced
a) Imaginal exposure - helps
for things that are hard to do
practically
b) In vivo exposure - doing
things in real life
c) VR: virtual reality
- Systematic desensitisation (making a hierarchy of lowest to highest anxiety situations) vs flooding (taking patient to most extreme anxiety situation)
Behavioural techniques such as exposure also affects cognition
- Exposure to feared stimuli reduces estimate of probability
- Exposure to feared outcome reduces estimate of cost
Pros and cons of medications for anxiety disorders
Medication treats the symptoms but not the cause of anxiety.
- Effective in the short term but
- Barbiturates (e.g.
Amobarbital): quick acting
- Addictive, risk of
overdose, interacts
with alcohol, high
relapse rate
- Antidepressants - SSRIs:
slower action
- Fewer side effects,
however relapse still
commonWhat are depressive disorders?
The main 2 Depressive Disorders from DSM-5 are:
- Major Depressive Disorder
- Persistent Depressive Disorder
- Episodic patterns in mood disorders
- In bipolar disorders mood excessively goes up and down
- Unipolar mood is only going down
DSM-5 diagnosis of Major Depressive Episode
At least 5 + symptoms during 2 week period (need number 1 or 2)
- 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
- Fatigue or loss of energy nearly everyday
- Feelings of worthlessness and excessive guilt nearly every day
- Diminished ability to concentrate nearly every day
- Recurrent thoughts of death, suicide, suicide attempts
Clinically significant distress or impairment
Not attributed to substance use or other medical condition
DSM-5 diagnosis of Major Depressive Disorder
Disorder means single or recurrent depressive episodes are common.
- depressed mood for most of the day, for more days than most, for at least 2 years
- no more than 2 months ‘normal’ mood in 2 years
- no manic features
Prevalence of depressive disorders
1 in 7 people will experience depression in their lifetime
Depression has the 3rd highest burden of all diseases in Australia
Onset emerges during adolescence
Women are twice as likely to have a depressive disorder
High comorbidity with anxiety and substance abuse
What are the different perspectives and theories surrounding depression?
The Cognitive Perspective: Schema Theory (Beck, 1976)
- Pre-existing negative schemas + stress = depression
- Results in information processing biases: biased attention, memory, interpretations
Learned Helplessness Theory (Seligman, 1974)
- Dogs would be getting electric shocks but could stop it by performing an action and other group had no ability to stop it - dogs with no control developed a learned helplessness
Ruminative response styles (Nolen-Hoeksema, 1991)
- Some people are more predisposed to make one choice over another (to ruminate about something - go over and over something mentally)
The behavioural Perspective
- Fatigue and lack of motivation makes less chances for achievement and pleasure.
Biomedical and psychological treatment of depressive disorders
Cognitive Behavioural Therapy addresses cognitive errors in thinking and takes behavioural action.
- There are lower relapse rates than biological treatments
Medication
- Selective serotonin reuptake inhibitors (SSRIs) e,g, Prozac, Zoloft
- effectiveness: 70-80%
Electroconvulsive therapy (ECT)
- Involves applying brief electrical current to the brain
- Uncertain to how/why it works
- Last resort: effective for severe depression (80%)
Relapse is common with biomedical treatments as you are treating the symptoms not the cause.
What is the DSM classification of Anorexia Nervosa?
A life threatening psychological disorder characterized by:
- Intense fear of gaining weight
- Body image distortion
- Persistent lack of recognition of seriousness of low weight
- Undue influence of body weight/shape on self-evaluation - Leads to self-starvation and too low body weight (BMI < 18.5)
- Important to consult normal growth charts and historical growth trajectories for the individual
Restricting vs binging/purging types
What is the DSM classification of Bulimia Nervosa?
A serious psychological disorder characterised by:
- Recurrent episodes of bingeing
- (compensatory) behaviours that prevent weight gain
- Distorted body image
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
The binge eating AND inappropriate behaviours both occur, on average, at least once a week for 3 months
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
Behaviours to prevent weight gain
Recurrent inappropriate compensatory behaviors (purging and nonpurging) in order to prevent weight gain such as
- Self-induced vomiting
- Misuse of laxatives
- Diuretics
- Fasting
- Excessive exercise
- Other medication
Proposed causes for anorexia and bulimia nervosa
- Genetic factors
- Family and twin studies: moderate heritability for AN and BN
- Higher depression, personality disorders, substance use runs in families
- No adoption studies have been conducted - difficulty separating genetics and environment - Neurotransmitter disturbances
- Serotonin involved in appetite regulation
- Mixed findings regarding direction of causation - Psycho-Social Causes
Family factors
- Higher parental criticism, control and conflict
- Lower parental empathy and support
- Comments regarding child’s eating and body
- Parental modelling of eating/body concerns
Peer factors: social approval
Sociocultural values
- Emphasis on thinness as a key basis of attractiveness (especially for females)
Epidemiology of anorexia nervosa
Gender: females > males (10:1)
Lifetime prevalence - Australia: 1.9%
Onset: most common age is between 12-25
Course: 5-7 years, slow recovery - around 40% of people with AN will later develop bulimia nervosa
Comorbidity: depressive disorder, anxiety disorders (especially social anxiety), personality disorders (especially obsessive compulsive personality disorder)
Has the highest mortality rate of all psychological disorders
Epidemiology of bulimia nervosa
Gender: 90% female
Lifetime prevalence: 1.9%
Onset: commonly adolescence or young adulthood
Course: chronic, lasts at least several years
Long term outcome: better than for AN (10% still affected after 10 years)
Comorbidity: mood disorders, anxiety disorders, substance abuse, personality disorders (e.g. borderline personality disorder)
Features of anorexia nervosa
Psychological
- pre-occupation or obsessive thoughts about food and weight
- low self esteem
- mood swings, irritability
- clinical depression
Behavioural
- excessive exercise and/or food restriction
- secretive behaviour
- overly sensitive to comments about weight
- frequently checking appearance
- adopting rigid meal or eating rituals
- obsessive interest in cooking for others
- refusal to eat in front of others
Physical
- low body temp
- brittle hair and nails
- hair covering body
- dry/yellowish skin
- anaemia
- immune system suppression
- malnutrition
- low blood pressure
Stages of cognitive behavioural therapy
Stage 1: engaging and educating patients; self monitoring and assisted meals
Stage 2: reviewing the progress and planning stage 3
Stage 3: body image, dietary restraint; event, mood and eating maintenance
Stage 4: identifying goals and residual problems; developing strategies to prevent relapse
