Abnormal psychology learning outcomes Flashcards
Discuss the extent to which biological, cognitive and sociocultural factors influence abnormal behaviour.
Biological:
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Evaluate psychological research relevant to the study of abnormal behaviour.
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Discuss concepts of normality and abnormality.
Normal behaviour ususally refers to behaviour that is considered normal in a culture. Abnormality is essentially behaviour that does not conform to the norms.
If normal behaviour is defined, it means that there is an exptected behaviour. This is created by the society and the culture.
What is normal and abnormal differs in different situations and cultures, therefore it is perhaps impossible to create definitions that are relevant at anytime, anywhere.
Social norms vary across cultures, times, situations and the extent to which rules and norms created by the society are considered true or important.
Defining normality
One of the definitions are by Jahoda (1958)
It is the Mental health model of normality
-The model has criteria which constitute “normal” mental health, such as:
-The absence of mental illness, autonomy and independence, positive self-esteem, realistic self-perception, ability to cope with stressful situations, capacity for personal growth etc.
Evaluation:
Majority of people would be “abnormal” if the criteria would be applied to them.
-According to many, culture defines normality. Therefore the criteria are invalid.
-The criteria are rather “value judgements” i.e. the ideals of what a perfect person in Western culture would be like.
Defining abnormality
-The mental illness criterion sees psychological disorders as psychopathology: illness of the psyche
-Linked to psychiatry-branch of medicine. Patients treated in the same way as those who are ill physiologically
-Diagnosis based on patients self-reports, clinicians observations, diagnostic manuals
Evaluation:
-Argued that it is beneficial to be diagnosed sick to not be responsible for their acts.
-Most psychological disorders cannot be linked to physiology
-Szasz argues that mental problems are impossible to be like biological illnesses, rather they are “problems of living.”
Abnormality as a statistical deviation from a norm:
-The norm is the statistically common behaviour
-Some of the things that are out of the norm are desirable, some are undesirable
For ex. high IQ is out of the statistical norm, but it is considered desirable, whereas mental retardation is also not the norm but is considered undesirable
-It is not possible to define normality and abnormality with statistics, as some are undesirable and some not.
-Also, the normal behaviour depends on culture, so the statistical abnormality is always bound to culture
Discuss validity and reliability of diagnosis.
Diagnosis in abnormal psych. means identifying and classifying abnormal behaviour from patients’ self reports, observations, clinical tests and other factors (like relatives reports)
Clinicians use diagnostic manuals to make a diagnosis. They help to classify and standardize diagnosis:
DMS-5: the diagnostic manual of the American Psychiatric Association.
-The manual lists the “mental disorders”, as it calls them. The manual lists the symptoms, but doesn’t mention the etiologies.
ICD-10 (The International Classification of Diseases), published by the World Health Organization.
- Also uses the term “mental disorder”.
- Includes references to the etiologies of the disorders.
Diagnostic manuals are good for:
- making a prognosis
- develop treatment plans
- to study the etiology
- Labelling is often helpful for the person themselves & the professional
Reliability of diagnosis:
- Are the results consistent
- do different professionals get same results from same patients with same manual=inter-rater reliablity
- Test-retest reliability: the person gets same diagnosis when tested again
- Reliability is a requirement for validity
Studies:
Cooper et al. 1972
Nicholls 2000
Validity of diagnosis:
- Whether the measurement measure what it is supposed to measure
- Whether the diagnostic systems diagnose correctly
- Valid classification allows accurate statements and proper treatment
Rosenhan et al. 1973
Caetano 1973
Discuss cultural and ethical considerations in diagnosis.
Ethical problems:
Correct diagnosis and treatment:
problems with validity and reliability that can cause wrong diagnoses can be serious.
Labelling theory by Caetano 1973
-The patients actual behaviour and thoughts are not as important in an ambiguous situation: the label of being mentally ill strongly affects.
This causes problems with the ethics of a diagnosis.
-Assumption that there is an illness to be diagnosed.
Szasz (1972) said that there is more harm than help from classifications:
-labelling causes certain behaviour, force people to behave as expected
Stigmatization (by Rosenhan 1972)
- Diagnosis carries a social, personal and legal stigma
- Diagnosis can be based on limited information (Study by Rosenhan et al. 1973)
- Being diagnosed often causes undesirable reactions from society and people
Cultural considerations in diagnosis
Kleinman 1982: neurasthesia in China is the same as depression??
Culture affects what is interpreted to be abnormal:
Schizophrenia is recognized everywhere as a disorder,
AD/HD is recognized in Western culture but not in some other cultures.
Also, norms change: what has previously been abnormal or normal might not be nowadays.
Culture-bound syndromes:
In different cultures specific disorders exist that are thought to be physiological but in western medicine they are considered psychological
Koro: Chinese men scared that their penis will withdraw into their abdomen
Amok: In Malesia, males have periods of aggression where they try to kill others
Anorexia Nervosa: In western cultures, a distorted body image where person thinks they are overweight.
Cultural stereotypes can also influence the diagnosis,
as well as gender and ethnicity.
Describe symptoms and prevalence of one disorder from two of the following groups: anxiety disorders, affective disorders, eating disorders.
Depression symptoms:
Physiological: Fatigue and loss of energy
Behavioural: Disturbed sleeping and eating patterns
Cognitive: Feelings of worthlessness or excessive guilt, difficulties concentrating, negative attitudes towards self, the world and future.
Emotional: Distress and sadness, loss of interest in the world
Prevalence:
Lifetime in USA 16.6%, with 13% for males and 20% for females.
More in young adults and in lower socioeconomic classes.
Varies accross cultures: in Japan, only 3% lifetime prevalence.
Phobia symptoms:
Person recognizes the fear is irrational
Excessive fear of things that shouldn’t cause that much fear.
Seeing the stimulus causes an immediate anxiety response:
physical symptoms such as: sweating, shaking, heart rate increases etc.
Emotional response: feeling of everything being out of control, fear that is uncontrollable. Scared of dying
Prevalence of phobias:
Most commonly diagnosed of the anxiety disorders in the USA.
Lifetime prevalence of 12.5%. Third among all disorders.
Women make up a larger part of statistics: might be because they seek help more. Symptoms usually start at around 7 years of age.
Analyse etiologies (in terms of biological, cognitive, and sociocultural factors) of one disorder from two of the following groups: anxiety disorders, affective disorders, eating disorders.
Biological etiology of anxiety disorder.
BLOA and phobias:
Fight or flight
Åhs et al. 2009
The role of amygdala in phobias. Women with snake or spider phobias were shown pictures of them while their brains were scanned with PET scans.
The results showed correlation between ratings of distress and activity in amygdala. The amygdala then works to activate the brain areas related to the fight or flight response.
Classical conditioning
Disgust vs. danger
Davey et al. 1998
Cross-cultural study, ratings of fear were higher in disgust relevant animals, not in dangerous.
Suggests that this is an evolutionary development that aims to save humans from disease. Seeing disgusting things would therefore activate fight or flight response.
More in women as well -> evolution
Twin studies show that identical twins have similar phobias more often than non-identical twins.
No concrete example of a gene that could cause phobias. Although knowledge on the different symptoms and what happens in the body
Analyse etiologies (in terms of biological, cognitive, and sociocultural factors) of one disorder from two of the following groups: anxiety disorders, affective disorders, eating disorders. Biological etiology affective disorder
Biological etiology of depression:
Serotonin hypothesis by Coppen 1967
- The basis of it is that depression is caused by low levels of the neurotransmitter serotonin.
- It is produced in the brain by specific neurons.
- The Selective Serotonin Reuptake Inhibitors (SSRI) are used to treat depression
- They block the reuptake process of serotonin, leaving more serotonin in the synaptic gap.
The effect of genes on depression:
Nurnberger and Greshon 1982
Sullivan et al. 2000
-Study showed that on average the influence of genes on developing major depression is between 31% and 42%.
There seems to be a genetic component to major depression, but it is a complex disorder that is also affected by individual psychology, environment and other factors.
Analyse etiologies (in terms of biological, cognitive, and sociocultural factors) of one disorder from two of the following groups: anxiety disorders, affective disorders, eating disorders. Cognitive etiology and anxiety disorder
The Beck and Emery model of the effect of cognitive schemas on phobias
- Schemas are responsible for the increased and maladaptive perception of threat
- Schemas create a misinterpretation of environmental stimuli that triggers the fear response
A sense of vulnerability combines with low self-efficacy and appraisal theory:
low self-efficacy by Bandura: person doesn’t believe they are capable of acting or behaving like the situation demands.
Appraisal theory means that when the person encounters a fear, they make a primary appraisal and to evaluate whether the situation is threatening.
Then they make the secondary appraisal on whether they can cope with it or not.
If either part of the appraisal is based in a maladaptive direction, the chance of a strong anxiety attack increase.
The person then uses learned avoidance strategies.
Study by Thorpe and Salkovskis 1995
Cognitive etiology and affective disorder
Depression and cognitive factors:
The role of thinking, negative cognitive schemas.
By Beck 1976: the Cognitive theory of depression.
According to theory depression is caused by negative schemas about the world and one self. Rather than the symptom of depression, it is its cause.
The negative schemas and depressive thinking is assumed to develop during childhood and adolescence from negative experiences.
- These experiences cause a vulnerability to stressors
- The stressors cause negative automatic thoughts, or cognitive biases:
- —negative views about the world
- —negative views about oneself
- —negative views about the future
The theory has evoked a treatment, called cognitive behavioural therapy, and an instrument to measure depression.
It is effective in describing the symptoms of individuals with depression. A limitation to the theory is that it is difficult to say whether the negative thinking patterns actually the cause depression.
Socioultural factors in etiology of anxiety disorders
Davey et al. 1998: Japanese were more disgusted by disgusting looking animals than Indian people were. Also, there is a phobia related to the disgustingness of one’s own body that is not reported in Western cultures.
Chapman et al. 2008 found that the Caucasian Americans were more scared of situations and African Americans were more scared of natural environments.
Sociocultural factors in etiology of affective disorders.
Depression and sociocultural factors:
Poverty, major life events, crisis areas
Study by Brown and Harris 1978: social factors in depression. Women in London interviewed on major life events and how they coped. Those of working class were more likely to be depressed. Also those who had to go through stressful events were more depressed.
It is widely accepted that stressful things such as war, urbanization can cause depression.
Prevalence of women might be higher because they face violence more often.
Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder.
Biomedical approach to depression:
Based on the assumption that if depression is caused by biological factors, treating these factors will treat it.
-Based on the Serotonin hypothesis by Coppen (1967)
-Selective serotonin reuptake inhibitors are used.
-They prevent the reuptake of the serotonin and leave more to the synaptic gap.
-Normally take 7 to 14 days to work
-SSRI are popular because they have fewer side effects than previous drugs. However, it can cause headache, agitation, nausea, sleeplessness etc.
Many criticize drug use, as it doesn’t cure and can alter brain and cause severe side effects. Also, the placebo effect is considerable.
Meta-analysis by Kirsch et al. 2008
Elkin et al. 1989 show support that anti-depressants were more effective than placebo.
Neale et al. 2011 is a meta-analysis shows the risk of relapse and SSRI
Individual approach to depression treatment
Cognitive behavioural therapy (CBT)
based on the cognitive theory of depression by Beck.
-CBT aims to change the automatic negative thinking patterns of people
-CBT includes weekly session with a therapist for 12 to 20 weeks.
step 1: identify the faulty thinking patterns and change them
step 2: activate the patients and find alternative problem solving strategies.
Paykel et al. 1999 shows that CBT makes relapse rate smaller.
Elkin et al. 1989
Group approach:
Mindfulness based cognitive therapy (MBCT)
- based on buddhist meditation and relaxation techniques
- Help people to direct thoughts and get rid of negative patterns
Goal is to help people see thoughts as mental events rather than accurate descriptions of reality
Kuyken et al. 2008
McDermut et al. 2001
Discuss cultural and gender variations in prevalence of disorders.
Cultural variation in prevalence of depression:
- Lifetime prevalence of 3% in Japan and 17% in the U.S.
- Weisman et al 1996 found that there is cultural variation, but that for ex. countries with and without war can have similar prevalence
- Marsella et al. 2002: depression has long been a topic of concern in Western medical history, but is becoming a global problem because of wars, disasters, poverty, racism etc.
- Kleinman 1982: chinese neurasthesia is depression? could be difficult to use western diagnostic manuals to find the prevalence of depression, if the disorder goes under another name in other countries.
Gender variation in prevalence of depression:
- Weisman found that women have a higher prevalence in all countries
- In USA, lifetime prevalence for women was 20% and for men 13%. (By national institute of mental health)
Examine biomedical, individual and group treatment approaches to treatment.
Biomedical treatment of depression
Selective serotonin reuptake inhibitors SSRI
They block the reuptake sites of serotonin in the synaptic gap. Therefore there is more serotonin available for the brain.
Neale et al. 2011:
Meta-analysis on the outcomes of studies of anti-depressants vs. placebo.
The focus was on 1. those who took antidepressants
2. those who first took antidepressant then placebo
3. those who only took placebo.
Results showed that the relapse rate was 25% with those who didn’t take SSRI compared to 42% with those who did.
Individual treatment to depression
One of the most widely used: Cognitive behavioural therapy, CBT.
The patient has 12 to 20 weekly sessions with a therapist.
First stage of CBT:
to identify and correct faulty negative thinking patterns and schemas.
The second stage is to activate the patient to do stuff and find alternative problem solving methods.
Paykel et al. 1999
158 patients, some only received medication, some also CBT. Those who got CBT had a lower relapse rate, 29% compared to the 47% of the others.
group approach:
the MBCT: mindfulness-based cognitive therapy
Based on Buddhist mediation and relaxation techniques. Goal is to help people recognise the signs of depression and to think of thoughts as mental events and not something relevant to self-concept or reality.
Study by Kuyken et al. 2008
People who had three or more depressed episodes. One group received SSRI, another SSRI and MBCT and slowly diminished the amount of SSRI.
Those who went to MBCT had a relapse rate of 47% compared to those with a relapse rate of 60%.
