Clinical Psychology Flashcards
ABNORMALITY V NORMALITY
What are the 4 different approaches to classifying abnormality
Statistical approach, normative approach, functional approach, distress-based approach
explain the statistical approach
attributes or behaviour that deviate from the statistical norm.
good thing about it
offers objectivity and measurability
limitations- 3
1) measurement error- how accurate are the tests, different times of day for example. test retest reliability.
2) regression to the mean- normal fluctuation to go from extreme to normal is common
3) extreme values don’t always mean problems- what about high IQ for exampl
4) where do we draw the cut off
explain the normative approach
deviating from social norms is viewed as normal because acting in an acceptable way is seen as adaptive behaviour to thrive and survive in life.
limitations- 3
1) intolerant of individual differences
2) social normals are constructed and arbitary anyway
3) this approach can lead to an abuse of power- soviet gulag example
explain the functional approach
a compromise between stats and norm- based on a person failing to function correctly to meet their personal needs/goals to survive. if you can’t- its seen as maladaptive behaviour
limitations- 3
1) someone who is maladaptive might not necessarily be abormal (murderers are maladaptive but that doesnt mean every murderer has a mental health condition)
2) assumes ‘universal needs’
3) expects conformity
good thing about the functional approach
this approach says its down to context, so being homeless isnt socially normal but it doesnt make you mentally ill, it compares you to people within that group. So one homeless person might not be functioning the same as another homeless person, who is in their reference group
explain the distress-based approach
based on an individuals distress or inability to cope with their experiences or problems. its about their own perception of normal (good thing)
limitations- 3
1) lack of insight could be a problem- what if they’re a child
2) highly subjective. one person’s sadness is another’s depression.
3) danger of medicalizing/pathologising normal reactions to adverse events
what is the current view on classifying?
contemporary classification systems are informed by a combination of these perspectives
why is it important to classify things? 4 reasons
1) its important for aetiology and epidemiology- we need to study it systematically so we can know how to improve.
2) enables a shared language to recognise and treat
3) enables us to select appropriate treatments
4) enables us to evaluate different interventions
5) ) societal reasons, legal, financial etc- need diagnosis to support
where does classification come from
Emil Kraepelin. devised a way to classify mental disorders based on symptomatology- co-occurring symptoms. interviewed 100’s of patients. entered into the ICD (International classification of diseases) in 1939.
when did the first DSM drop
1952
what parts are diagnostic schemes organised into
1) core criteria. must have a specific 2, aswell as 5 alltogether and for over 2 weeks.
2) symptoms must cause significant distress
3) can’t be attributed to drugs or other medical condition
advantages to the DSM- 5
- specific criteria to diagnose similar conditions
- provides criteria that can be applied systematically
- the diagnostic criteria is theoretically neutral
- takes functional impairment into consideration- you have to consider it a problem
- advances in drugs and treatments and epidemiology
disadvantages of the DSM
- diagnosis is based on symptoms not aetiology
- the illusion of explanation, being diagnosed doesnt mean we know the causes or how to treat it
- different disorders have similar symptoms that need to be treated differently. danger of misdiagnosis
- within category heterogeneity- even in the same diagnosis, the manifestations are completely different. putting people in categories doesnt account for severity
- false positives- pathologising normal distress
- labelling leads to stigmatisation and self-fulfilling prophecy
ALTERNATIVES! what are the alternatives?
dimensional model, network models
describe dimensional models
places mental disorders on a continuum, rather than categories. is on a chart with normal experiences.
good things about the dimensional models
accounts for severity! allows for overlapping traits, symptoms of psychosis and depression can be mapped together.
problems
again problems with cut offs, where is the line between normal and pathological
what are some examples of the dimensional models
internalising/externalising dimensions. transdiagnostic psychosis-bipolar, transdiagnostic negative affectivity
describe the internalising/externalising dimensions
disorders can be thought of as either internalising or externalising.
internalising- anxiety, depression, self-identity, socially awkward
externalising- hyperactivity, aggression, conduct problems, disruptive
describe the transdiagnostic psychosis-bipolar,
all disorders can be mapped somewhere between these 2. high end is hallucinations and manic episodes and low end is nothing
describe the transdiagnostic
negative affectivity
depressive, anxiety traits. scale where at high level you may have full range of common mental health problems. (SA, GAD, MDD, panic)
describe eyesenck’s personality dimensions
everyone is along the spectrum is introvert-extroverted and stable- unstable. suggests all humans have different personalities and these can be mapped between stable and unstable
what is the network model perspective
fairly new, last 5 years- suggests that the way we have been thinking about psychopathology has been too simplistic. this says that psychological problems are a network of symptoms that co-occur in time
what are the 4 phases of the network model
phase 1- Dormant network in stable state. potential for disorder but no symptoms
phase 2- Network activation. something happens to trigger certain symptoms.
phase 3- Symptoms spread. symptoms cause other symptoms.
phase 4- environmental trigger stops but symptoms keep influencing eachother in a mutually reinforcing network
DEPRESSION
Define depression
a mood disorder involving emotional, motivational, behavioural, cognitive and physical aspects.
what do you have to have to diagnose it
5 or more symptoms over 2 weeks. one of them has to be an emotional characteristic. IN SAD CAGES- in- interest lost in activities s- sleep disturbed a- appetite changes d- depressed mood c- concentration difficults a- activity level change g- guilt or worthlessness e- energy loss s- suicidal thoughts
what is the controversy with this? ‘someone has gotlib- this is ridiculous’
Gotlib et al., 1995- why would we ignore those with 3-4 symptoms when its been shown that the level of distress and daily difficults is the same as someone with 5
epidemiology- global burden. how much of worldwide disability does depression account for?
21.2%
what did the 2013 global burden of disease study find
its the most prominent mental health condition, second leading cause of years lived with disability. primary driver of disability in 26 countries
what did the lancet 2017 find
it is in the top 10 causes of death in all buy 4 countries
‘Eiu, surely that can’t be true!’
Liu et al., 2019- there are 258 people living with it currently
Suicide: how many suicides were there in 2014
6,222- 1 death every 2 hours
what year was it the leading cause of death in men under 50
2014
where in the world has the highest rates and where the lowest
highest- north east of england. london has the lowest- maybe to do with deprivation levels/opportunities.
how many people didnt contact a gp a year before suicide
72%
prevalence in age?
steady rise from 16 to 50/60’s and then lowers as you hit 70’s
depression by age and sex?
young women is 4 times as much as young men. older women is 6 times as much as men. Stansfeld et al., 2014- women have higher prevalence
why is it difficult to measure prevalence?
lots of different measures are used and its often comorbid with other disorders (Moffit et al., 2017)
how does employment affect it?
being unemployed makes you more likely to have it and women still almost twice as likely
central ideas for the psychodynamic/psychoanalytic theory of depression
- importance of childhood experiences
- get stuck in the early oral stage, do thinks like chew gum, smoke etc
- people become vulnerable to depression if you needs are not met during the oral stage
- depression is response to actual or symbolic loss
why does freud think loss is so important to depression
thinks that experiencing loss leads to something called ‘introjection’ where the individual regresses to oral stage.
he says that natural loss causes feelings of loss, rejection and disappointment which makes you withdraw feelings from them and put them onto a new person.
he says that when on the depression pathway you refuse to accept the loss and the feelings of anger and disappointment are directed inwards and depression is caused.
good things about psycho
- very influential
- based on really detailed observations that are still used today
- modern theories have actually adopted the idea that childhood experiences are really key
bad things
- there is not much evidence
- many people experience loss and no depression. this doesnt explain that
what does it suggest in terms of the stress-diathesis model
that early experiences in childhood (whether orally fixed or not) are what create the vulnerability to depression
who made some recent adaptations to psychoanalytic theory
robert hobson. a conversational model of therapy. he coined the ‘aloneness-togetherness’ approach which said you need to be comfortable in your own and in others company. said that as long as the person had had 1 significant relationship in their life then they could be treated. also placed massive importance on relationship with the self
what are the central ideas to the interpersonal theories of depression. ‘you must get a job to maintain the coin’
Coyne, 1976- model is more about the maintenance of depression rather than the cause.
idea that-
1) depression arouses guilt, annoyance and eventual avoidance in those AROUND THE DEPRESSED PERSON.
2) this reinforces the idea for the depressed person they they are not loved
3) this results in increased distress and a behaviour-response pattern is established.
basic idea behind it
it is the actual behaviour of the depressed person that puts other people in the position that they start reinforcing the depressed persons view that they aint shit
who explained the idea? ‘i dont want to joiner cos shes so depressing!’
Joiner et al., 1992- explained maintenance in terms of ‘excessive reassurance seeking’- incessantly seeking assurance that they’re loveable. and ‘negative feedback seeking’ tendency to actively seek criticism.
where does negative feedback seeking come from? ‘if you hit a swann they will fucking come for you’
‘Swann, 1990= people want interpersonal feedback that is consistent with their own views because it means they can predict and control their environment
criticisms of interpersonal theories
the evidence is retrospective, its quite reasonable that depressed people would underestimate the support in their lives. also- are these two tendencies predispositions for getting depression or is it depression that causes these tendencies?
describe attachement theory of depression
theory of mono-trophy (single attachment) if this is broken then you get depression. in terms of stress-diathesis- attachment is a very important diathesis. its the basis that makes them vulnerable to not being able to cope with alter life stressors.
what do they say healthy attachment does to avoid depression
you get responsive reactions when you cry, builds up a ‘secure base’ which allows infants to build up internral working model
explain behavioural theory=
Lewinson 1976- you become depressed through lack of positive reinforcement if you lose something- bereavement, loss of job, relationship etc. the person then starts withdrawing, which leads to further reduction in reinforcement, create a cycle- behavioural vacuum
what is evidence for this
depressed people have a lack of motivation= perhaps because it has stopped being reinforced?
what 3 assumptions is it based on
1) low levels of response contingent (positive experiences)- act as a stimulus for depressive behaviour.
2) these low levels are a sufficient explanation for depression
3) the total amount of response-contingent reinforcement is made up of- number of potentially reinforcing events, availability of such events and finally, the behaviour of the individual in trying to get the reinforcement
caveats of the behavioural theory
reductionist- only talks about environment, what about biological or cognitive aspects
deterministic- suggests our behaviour is completely controlled by environment, that if you experience loss then you will get depressed
what about people with great lives who just get depression
ignores nature- only nurture
explain cognitive theory of depression
Beck, 1967- negative cognitive triad.
1) negative view of self
2) negative view of the world
3) negative view of the future
these views lead to cognitive bias, then to failure, then to loss and depression.
distorted thoughts and negative schemas influence what information we select, encode and evaluate.
how are negative schemas made
learned socially by watching family, or experiences that lead to maladaptive coping strategies
how is it explained in context of the stress-diathesis model
diathesis= dysfunctional beliefs
stress= significant life event
leads to negative schemas, leads to becks cognitive triad
vulnerabilities come from experiences, genes and personality and lay dormant until life events activate them
what are the bias’s that the triad leads to? alice sometimes over-magnifies all
Arbitrary interference- jumping to conclusions
Selective abstraction- abstracting info out of context and missing significant info
Overgeneralisation- make a small mistake and say you never do anything right
Magnification and minimisation- catastrophising events
All-or-nothing thinking- events are black or white, good or bad
what is support for this theory?
Alloy et al., 1997- depressed people remember more negative info about themselves then positive.
what is still unclear about it
whether depression causes them or they cause depression
what did brown and harris investigate?
Brown and Harris 1978- studied onset of depression in 458 south london women. found massive class effects- working class w children 4 times as likely as middle class w children.
how many women with depression had not experiences adverse life events
only 4 out of 37
what were the 3 major factors that effected it
1) protective factors such as education, employment, good relationship with husband
2) vulnerability factors such as family history, loss of mother before 11, lack of confiding relationship
3) provoking agents such as acute and ongoing stress that results in hopelessness and grief
ANXIETY!!!
When do we need anxiety?
Our brains have cognitive biases that are designed to jump to conclusions- like why we’d jump out of the way of a moving car. but if we start jumping every time we see a car thats when it becomes a problem.
what 3 things make it an issue?
proportionality, frequency, disruptiveness
PREVALENCE ‘kester, my mad fat diary’
Kessler et al., 2005- there is a 28% lifetime prevalence
‘roanoke series of AHS was so morbid’
Kroenke et al., 2007- very likely to be co-morbid with other disorders
‘simon says was played at school, they miss a lot of school’
Simone et al., 1995- anxiety poses high social and health costs to sufferer and government
‘they are anxty, wittchen turn leads to hospitalisation’
often end up in hospital because of the somatic symptoms
anxiety and age
looks very different in children, repetitive play etc.
phobias and GAD more common in older adults
social anxiety and panic disorder get less severe when you get older
gender and anxiety
women are twice as likely to get GAD, panic disorder and PTSD, and phobias. men and women have the same likelihood of OCD and social anxiety
why might this be? ‘kubrick was really sexist’
Pimlott-kubiak et al., 2013– women tend to experience more trauma due to socio-cultural factors, sexual assault.
class and anxiety
less income associated with higher risk of anxiety. they have higher psychological stress and less support
why might this be? ‘booka, they have less to learn’
Buka et al., 2001= more likely to experience trauma, adverse life events and less resources to cope with anxiety
the 9 disorders in the DSM
- separation anxiety
- social anxiety
- GAD
- specific phobias
- selective mutism
- panic disorder
- agoraphobia
- substance induced
- unspecified
what criteria must be present for a diagnosis of a specific phobia? 7
1) marked fear
2) immediate fear
3) object or situ is actively avoided
4) fear is out of proportion of actual threat
5) fear persists for more than 6 months
6) causes clinically significant distress/impairment
7) not better explained by another disorder- fear of spiders, paranoia not phobia?
what are the most common phobias
height, snakes, water, social, dentist, injection
was supposed to be further up but what are the common characteristics of anxiety disorder?
physiological symptoms of panic
bias towards negative/threatening information
worrying, jumping to conclusions
what disorders are within ocd
trichotillomania
hoarding
body dysmorphia
excoriation
what is ocd characterised by
obsessions (intrusive and recurring thoughts that are disturbing or uncontrollable) or compulsions (repetitive behaviour patterns that the individual feels driven to do to prevent bad things from happening)
what is PTSD characterised by
PTSD is a set of persistent anxiety-based symptoms that occur after witnessing a traumatic event
how does PTSD work?
1) exposure to trauma
2) intrusive symptoms
3) avoidance
4) negative alterations in cognition and mood
5) increased arousal
CO-MORBITIY WITHIN. ‘rhymes with frown’ how comorbid are GAD, OCD and social anxiety
Brown, 1996-
GAD- 83% comorbid
social- 45% comorbid
OCD- 56% comorbid
4 advantages to diagnosis
1) reasonably reliable and valid
2) makes communication between professionals easier
3) reassuring to be labelled? reduces self-efficacy
4) improves access to services/resources
4 disadvantages to diagnosis
1) labelling reduces self-efficacy, dont feel like they need to help selves anymore?
2) pathologising normal reactions?
3) high comorbidity, misdiagnosis danger
4) anxiety is common in all disorders
explain the psychoanalytic theory of specific phobias
its to do with hidden, unconscious fear of childhood conflict. hard to substantiate but it is thought that phobias do have something to do with avoiding more troubling life challenges. little hans
explain the learning theory ideas behind specific phobias,
Watson and Rayner, they made a baby anxious with a mental bar so they’ve shown how fear of things can be learnt.
explain how classical and operant conditioning can create anxiety
you have a panic attack (unconditioned response) at work (unconditioned stimulus) and then become fearful of work (conditioned stimulus). then, the reward of not being scared when you’re not at work reinforces the behaviour and it is maintained
learning theory intervention
based around idea of extinction, gradual decrease of conditioned response. either exposure leads to extinction or you over-learn a new conditioned response
what is the only rule in extinction
dont walk away when youre anxious because the reward of not going will reinforce the behaviour. could be used as evidence!
problems with conditioning theory
1) assumes that a bad event has happened, not everyone can trace it back like that
2) not all traumatic events cause phobias
3) doesnt explain why there are generally agreed things which are phobic
4) incubation- when exposure doesnt work
evolutionary accounts for phobias- ‘selig was fucked up’
Seligman- biological preparedness, evolutionary selection processes have meant we have biological predispositions to be fearful of things that could have been a threat to us in the past
evidence for this- ‘tarzan, monkeys’
Cook and Mineka- bred a fear of snakes into rhesus monkeys. shows it can be bred into out biology
what has evolution created and why is this different to before
evolution has created learned threat, out old brain was for relationship seeking, behaviours and emotions- the immediate responses you dont think much about. now we have learned threat that we ruminate on. imagination and rumination of the worst outcomes. treatments are all based on relaxing this phenomenon
criticisms of the evolutionary approach
it is all post hoc and very easy to just justify links- how do we know that selection processes were important for phobic content.
what is the main theory behind becks cognitive theory
it is not the thoughts that give us anxiety, its the processing!
How does this happen
the meaning we gives things gives them the emotional impact, the meanings we give are linked to your internal beliefs (schemas), which are linked to your early experiences
what is the difference between behavioural and cognitive theory
behavioural- about consequences after behaviour. cognitive is about the event- the thoughts you have of it, and then the behaviour
what are the 5 steps to becks cognitive theory
1) early experiences
2) create schemas, core beliefs
3) something happens to activate schema!!
4) information processing becomes distorted and negative automatic thoughts come
5) maintenance cycle of emotion, thoughts and behaviour
example of schema becoming assumptions
belief- i hate cats
schema- if i see a cat i will die
how are anxiety schemas made?
overestimating danger and underestimating coping abilities
how do anxiety schemas differ from disorder to disorder. panic, gad and social
panic- anxiety over the symptoms themselves
social- anxiety over rejection
gad- beliefs about general coping abilities
what is unhelpful thought content characteristics
- the manifestation of the negative schemas
- logical in the schema but not outside it
- in or out of conscious awareness
- can be images or verbal
what is the cognitive model of panic. 7 steps
1- misinterpret bodily symptoms (panic attack) 2- feel scared or anxious 3- pounding heart 4- think youre having a heart attack 5- have actual panic attack 6- get fear of panic attacks 7- cycle repeats
‘miss clark used to have panic attacks when i was in her class’
people misinterpret bodily functions and thats what causes panic attacks
what are the safety behaviours that are used
avoidance, escapism, safety seeking
‘reminds me of a land rover, which are spenny’
Rovner et al., 1993- its the most expensive psychological problem
‘m&m, fat people are selective of them’
cognitive bias’s make you selectively attending to threatening stimuli. anxiety is based on cognitive bias’s!
‘tabby had irrational fear of prom’
Chapman 1997- 60.2% of the general pop have ‘unreasonable fears’
‘i dont belieb this’
Lieb et al., 2000- people who have social anxiety are more likely to have phobic parents than non phobic. silly tho cos could be all to do with modelling and growing up around them!
PSYCHOSIS
What is psychosis?
a state of being out of touch with reality
what are the most common diagnosis within psychosis
schizophrenia
delusional
schizoprheniform
- although theres not evidence to say these are totally separate disorders
what are the two main categories they can be split into?
1) schizophrenia spectrum disorders- non affective.
2) affective disorders- mood disorders like bipolar
what 3 categories are the symptoms of psychosis split into
thoughts and perceptions,
feelings and emotions,
behaviours
what is in thoughts and perceptions
hallucinations
delusions
disorganised thinking
poor concentration
what is in emotions and feelings
anhedonia low energy irritation/elation depression anxiety
what is in behaviours
withdrawal/isolation reduced speech irritability aggression impulsivity
what are positive symptoms
presence of undesirable things- hallucinations, delusions etc. excess of normal function
what are negative symptoms
absence of desirable things- anhedonia, apathy, flat effect. diminution of normal function
key points on hallucinations
- can be auditory or visual, auditory most common
- demand hallucinations- ordering behaviours, sometimes violent
- harshly critical
what do hallucinations cause
difficulty in ‘reality monitoring’, hard to know if they’re internal or external
‘georgia o’keefe, mad artists’
O’Keefe et al., 2002-, found that the speech perception and speech generation parts of the brain become disconnected
what is the sometimes in the content of the voices
many schizo sufferers have experiences sexual abuse, sometimes reflected
‘sounds like foghorn, which would be an unmissable cue’
Cleghorn et al., 1992- found that 70% of schizo sufferers have auditory hallucinations
what are delusions
abnormal beliefs held with great conviction
really hard to argue against
seem bizarre to others
‘rhymes with layer, under the layer of delusion there is sense’
Maher, 2001- said that no matter how bizarre, patient usually can see how illogical deep down
so if they know deep down its not true then why does it happen? ‘dads under the delusion he shouldnt be on the dole but he knows deep down’ definition
Frith and Dolan, 2002- delusions are the inability to integrate perceptual info (what the voices are telling you) with your prior knowledge (what you know deep down) even though logical thought processes are still in tact
what are the two main themes in delusions
1) delusions of grandiose
2) delusions of paranoia/ persecution
what are delusions related to which is key
information-processing biases, people jumping to conclusions without sufficient evidence
what are the other common delusions
delusions of control- aliens
delusions of reference- radio is addressing you
nihilistic- you dont exist, something terrible will happen
erotomanic= someone loves you
what is thought disorder?
its assessed through someones external speech. 6 signs that someone has it are
what are the 6 signs of though disorder
1) neologisms
2) word salads
3) clanging
4) derailment
5) tangentiality
6) poverty of content
what did thought disorder prompt
to look into actual thinking processes in schizophrenics. found that it actually not their reasoning that is wrong, its their expression. its also more prominent when people are talking about emotional topics
‘saying tits in western bank would be impulsive’
Titone et al., 2002- sufferers struggle to inhibit associations between phrases so they just say whatever comes to mind
what is the psychosis spectrum
the old view was that these symptoms were super rare, severe and impossible to recover from. we now know you make substantial recovery. there are those who simply carry on with life and dont need psychological help (support idea of a spectrum)
prevalence of symptoms- hallucinations, delusions ‘the wizard was an illusion’, paranoia, ‘poultry, paranoid vegans’ bipolar spectrum,
- hallucinations, Tein- 10-15%
- delusions, Van Os et al- 12%
- paranoia, Poulton- 12.6%
- bipolar spectrum, Judd and Akiskal- 6.4%
what story supports the continuum idea
the lady who just decided that she was an ancient greek and it made her more comfortable. sometimes accepting the delusions is the best way
diagnostic criteria for schizophrenia, brief psychotic disorder
more than 6 months, less than 1 month
briefly explain brief psychotic disorder
happens within 2 weeks. accounts for 9% of onset of psychosis, usually associated with emotional turmoil
what did akiskal et al., 2000 say about bipolar
that there a spectrum of bipolar
what is it characterised by
episodes of mania, hypomania, mixed episodes, euthymic, mixed episodes
‘iceburg- ppl dying on the titanic’
Newburg et al., 2008- has relatively high mortality and relapse rates
9 symptoms of mania
1- elation 2- impulsivity 3- goal-directed behaviour 4- fast speech 5- sexual promiscuity 6- no sleep 7- distractibility 8- drugs and drink 9- flight of ideas
what did johnson say about manis?
Johnson et al., 2011= mania being the opposite to depression is a myth. mixed episodes are common. positive and negative symptoms fluctuate independently
PREVALENCE
What is the risk of developing bipolar, and of any psychotic disorder
1%, 3%
where has the highest rate
disadvantaged suburban areas
when is the most common time for diagnosis
late teens to late twenties. men have earliest onset age
what are the problems with diagnosing psychotic disorders
- disagreement amongst professionals
- symptoms dont always neatly fit
- diagnosis doesnt predict cause or course
- doesnt suggest treatments will work
‘swans are graceful, reminds me of continuum rather than set stages’
Swann, 2006- said that continuum is much more helpful because the bipolar and schizo symptoms overlap so much they only seem to be distinguished by the severity of symptoms
what do we use instead of diagnostic categories now
formulation/explanatory models
why?
- they provide theoretical and conceptual framework to understand individual cases with.
- offer a basis for internvetions
- enable communication to understand everything- causes and all!
what are the explanatory models?
the stress vulnerability model and cognitive theories
what is the stress vulnerability model. is it not environmental to throw everything in zu-bin’
Zubin et al., 1992- biological and environmental factors interact to create psychosis.
underlying vulnerabilities can be biological or psychological
what 3 symptoms do these cognitive theories explain-
paranoid delusions, thought disorder and delusions
paranoid delusions ‘does colin firth know what his characters are thinking’
Firth 1994- paranoid delusions associated with T.O.M deficits. Says that people with delusions can’t understand the mental health and intentions of others, and this makes them believe someone is hiding something from then
‘they think people are lying’ evidence
Lysaker and Olesek 2011- T.O.M deficits are a key marker in schizophrenics
Thought disorder ‘dont slag them off, they cant ignore whatever is currant’
Slaghuis and Curran, 1999- the reason people have disordered thinking and negative symptoms as a result, is that they have ATTENTIONAL processing problems which means they cant resist distraction.
Delusions. ‘what the huq- of course not!’
Huq et al., delusions are a result of REASONING BIAS. did a jumping to conclusions paradigm and found that schizophrenics made decisions much more quickly then non sufferers.
What did varese say?
Trauma in childhood triples the risk of psychosis
‘ptsd from dropping the vodka in morrisons’
Morrison et al., 2013- 20-4-30% of psychosis sufferers met criteria for PTSD
socio-cultural factors
says that low ses, means more adverse life events, means more chance of psychosis. attentional, behavioural and motivational problems that happen with psychosis cause a downward drift and maybe thats how you end up with los ses!
INTELLECTUAL DISABILITY
Terminology issues
Historically it has been referred to as moron, feeble-minded etc.
People started using learning difficulty but UK government settled on learning disabilities because learning difficulties are used to define specific disorders, but learning disabilities are global issues.
What are the 3 criteria used to define intellectual disability
1) Significant limitations in intellectual functioning
2) Significant limitations in adaptive functioning
3) Must be acquired before adulthood
how do the UK department of health define intellectual disability
‘a significant impairment of intelligence and social functioning acquired before adulthood’
how do the american psychiatric association 2013 define intellectual disability
they had a longer definition that includes ‘must have deficits in intellect, lack of adaptive functioning that results in failure to meet developmental and sociocultural criteria for independence. without support, deficits will limit communication, social functioning and social participation’
what is the theory behind diagnosing intellectual disability
all based on statistical norms. must be two standard deviations below the norm. main population lies between 85-100. those with intellectual disability are less than 70.
how has this changed through the times
in the DSM-4 in 1959, it was 1 SD below the norm, and stayed that way in the reassessment in 1973. but now it is 2 SD’S
why might this be?
cost could play a factor. it meant a lot of people were no longer included as ‘disabled’
what is the problem with basing it just on stats (intellectual disability)
‘failure in adaptive behaviour’ also needed to be part of it because it cant just be based on stats
who decided that adaptive behaviour has always been part of the definition, and therefore stats alone is not sufficient
Tredgold 1998
how did diagnosis change in 2002
they started basing it off a clinical basis, where they asked people if they could do things etc like cooking
now what do we use
psychometric tests that incorporate intellectual and adaptive functioning are now used
what are difficulties and disorders
specific problems. intellectual function is usually normal (above 70) in these. they are identified in school by educational psychologists and dyslexia and dyspraxia are examples
so how are disabilities different
global and incurable, lifelong, problems include: problem solving, reasoning, vocab, comprehension, information, attention processing. Effects can me ameliorated through education!
what are the tools for diagnosis. one for intellectual functioning and one for adaptive functioning.
the WAIS-IV (wechsler adult intelligence scale) and the Vineland Adaptive Behaviour Scales
explain the Wechsler adult intelligence scale
A fully standardised IQ test which is used for intellectual functioning. IQ examined across 10 areas. We use the same standardised norms as the US as little difference was found when we tested it with a small group in the UK. You get a manual to learn, have to ask questions how it specifies. recording sheet, supplements which are the tests and a booklet with puzzles. half the test is non-verbal. 1) 9 blocks which are used for pattern making, have to mimic block. demonstrate first few items if they have an intellectual disability. they get time credits the more quickly they do the tasks. 2) verbal parts are similarities, say how 2 words are alike. ‘2 and 7’. 3) then a digit-span for working memory
explain the Vineland Adaptive Behaviour Scales
there a lot of different ones but this is the best as it has an adult norm (over 21) a lot of the others are for children. covers conceptual skills (communication), practical skills and socialisation skills. asked the carer how capable they are at different tasks otherwise you get ‘passing’. assesses things like microwaves and atm’s, must make sure that the test is up to date and relevant and takes into account any motor problems that affect performance in the test
why do we need to diagnose?
before the industrial revolution we didnt really need to as they seemed to get by in communities. but they started to fall behind when they couldnt work in factories. now we diagnose for 5 reasons:
1) understanding
2) mitigation
3) protection
4) benefits
5) services
the debate about whether diagnosis is useful? ‘wwhy’
Webb and Whitaker- intellectual disability is a social construct anyway and not based on medical or psychological science. diagnosis is moving away from ‘what they cant do’ and focusing on what they can/
what does the american association of developmental disabilities think about diagnosis
we should do it to focus on individual cases with different strategies for support, not just to put people in categoeis
EPIDEMIOLOGY
how much of the official population should statistically be below the normal curve, and how much are officially reported?
predicted: 2.2%
actual: 0.5-1%
a study that suggests a missing population
Simonoff et al., 2005- more people are suffering who arent recognised. a lot of people only get recognised when they have a child
what is common with trying to find aetiology
can only really find causes in the really severe cases
split up the 100% of cases that we know causes of
prenatal/genetic- 50%
perinatal- 20%
postnatal- 10%
unknown- 20%
‘people who drink whilst preg are pretty wild’
Wildsmith, social deprivation has been linked, put down to exposure to toxins, maternal use of drugs/drink and exposure to abuse.
Tenkku 2011
interventions could include conversations about strategies to stop drinking whilst pregnant, perhaps web-based
what is the role of a clinical psychologist in services for those with intellectual disability. 6 things
- diagnostic assessment
- assess behavioural and mental health
- assess support needs
- service design (curved walls, dimmed lighting)
- psychological intervention administering
- looking at individuals, teams, families
how does intellectual disability impact every day life
- not understanding day to day functioning
- finance support
- dependent on others
- complex relationships (negotiating sexual, family relationships)
- trauma more likely and more likely to continue through life
- mental health problems
- annihilation
what are clinical psychologists basically trying to do
move them up maslow’s hierarchy of needs. from food, water, warmth and rest to achieving ones potential and creative activities
examples of interventions used
arousal management (CBT) for anxiety depression etc, experiential and exploratory work (psychodynamic). challenging behaviour support instead of behaviour modification which was ECT and shit
5 important things to consider when working with someone with int dis
1) their level of understanding
2) how to communicate best
3) expectations of client and professionals
4) diversity, each one is different
5) values based and person centred
EATING DISORDERS
what is the definition of an eating disorder
‘they get so fair and obsessively wash’
Fairburn and Walsh, 2002- a persistent disturbance in eating behaviour intended to control weight which significantly impairs physical health or psychosocial functioning
what is an issue with the diagnosis of eating disorders
‘his bed sheets must be cos this is a massive knob comment’
historically they have been stereotyped as being a ‘white, female problem’. Crisp 1973- ED’s are a retreat from maturity, said its women not wanting to experience puberty
what is the reality of eating disorders
they span all ages 6-80
10-15% of cases are male
most people with an ED are NOT THIN!
there is an equal number of non-whites. it is westernisation thats the problem not race.
what did russel say about AN and BN
Russel 1979- Anorexia is the least common, 15% of cases, was discovered centuries ago but officially coined in 1970. BN there are 35% of cases, was discovered in 1970. harder to spot?
‘it wouldnt be a fair burn to have a hairy son, this is really worrying!’
Fairburn and Harrison, 2003- Atypical disorders, which are all other disorders is the most common, 50% of cases! This is really worrying as we’ve missed a lot due to the white thin female stereotype
what is another issue with the defintion including ‘impairment in psychosocial functioning’
this is a problem of context, an athelete or model needs to stay thing for their career. they wouldnt have an impairment in psychosocial functioning in this context
explain anorexia nervosa, the 3 criteria
1) persistant restriction of energy intake- leads to significantly low body weight
2) intense fear of gaining weight or persistant behaviour that interfers with that, even though already significantly low weight
3) disturbance in way body shape or weight is experienced, come to value themselves only on their weight. consistent lack of recognition at how low their weight is
explain bulimia nervosa. 6 criteria
1) its the same as anorexia but the main difference is BMI, if you purge and are thin- anorexia, if you purge and are normal weight- bulimia.
2) reccurent episodes of binge eating, (eating large amounts in small space of time) often eat at v similar times under similar circumstances.
3) feel a lack on control when you are binging
4) inappropriate behaviour to prevent gain, such as vomitting, laxatives, direutics, fasting, excessive exercise
5) binges and purges happen 1 a week for 3 months
6) self-evalutation only influenced by body weight/ appearence
explain binge eating disorder 7 criteria
1) like bulimia but without the purging/compensatory behaviours
2) often likely to be overweight
3) characterised by episodes of
- eating faster then normal
- eating until uncomfortably full
- eating when not hungry
4) eat alone because embarrassed
5) feel disgusted and guilty after
6) also must happen once a week for more than 3 months
name 5 other specified disorders
these dont meet the full criteria but still should not be discarded
1) atypical AN- anorexia but started at a really high weight so are normal weight
2) atypical BN- low frequency/duration of bingeing and purging
3) atypical binge-eating disorder- low frequency of bingeing/purging
4) purging disorder- eat normally but still purge
5) night-eating syndrome
what is avoidant/restrictive food intake disorder ARFID-
Previously known as selective or fussy eating, common in children, basically an aversion to food because of certain criteria. often results in reliance on supplements, significant weight gain/loss and nutrition deficiency
what are the 3 subtypes of ARFID
1) sensory-based ARFID- hate texture, smell, colour, brand
2) lack of interest
3) food associated with fear evoking stimulu, created through learned history (choked once for example)
why is diagnosis so difficult and what has been suggested to overcome it
‘brick wall. set caregories. isnt FAIR’
the disorders overlap so much and there are so many different ones. 40-50% dont fit into these categories. Waller and Fairburn, 2003- the transdiagnostic model suggests that we should stop putting labels on people and simply say ‘you have an ED’ just focus on symptoms.
comorbidity with other mental disorders. 4
relatively high levels of comorbidity with
- anxiety (social and OCD)
- depressed mood, (due to low serotonin)
- personality disorders, although this is a controversial one as 1, you cant be diagnosed with a PD if you have a biological instability like an ED and 2, symptoms of a PD usually go away when you treat the ED.
- alcohol or substance abuse, copious alcohol sometimes used as part of a binge
comorbidity with physical problems. 6
- cardiovascular problems from irregular heartbeats
- muscle weakness
- osteroperosis
- liver damage
- fainting
- suicide
who did a study into mortality in ED
Arcelus- 1 in 5 deaths in ed’s is down to suicide
how many people in the UK have an eating disorder
750,000- 1% of the population
why is it better to look at prevalence and not incidence
when someone goes to the gp they have been auffering for an average of 7 years, so its really hard to know onset
‘hoe’ prevalence in young women
Hoek- looked into prevalence in young women.
AN- 0.3% cases
BN- 1.0 %
Other- 1-3%
This makes up 5-6% of the female population in the UK and 0.5% of males.
julie walters and kendal jenner 2 of the most famous women
Walters and Kendler- 10x more likely to get it if a women
‘rate this point SON!!!’
Harrison, 2001- this is because of the constant idealisation of women’s bodies in the western world
is it growing
looks like it is but more likely that there are just more people reporting it
two studies that look at the cutural effects of ED’s
‘can watch beckham on tele now’
‘not the keel all and end all’
Becker 2011- fiji study, half the women had eating disorders after 2 years of introducing tv
Keel and Klump, 2003- there have been cases without westernisation so its more likely that westernisation can explain influences on it but not causes it
why is causation very hard to know
7 year til gp thing!
the 3 biological theories
‘faker, you cant fake genes’
1) Hypothalamic disturbance
- the hypothalamus is responsible for appetite, animal lesion studies have shown that if you cut it, their appetite does decrease- but that is silly because sufferers do experience extreme hunger whilst restricting
2) Temporal lobe disturbance, body image distorion
3) Genetic loading- somewhat well accepted that their is a genetic component but also twin studies have shown that there is moderat genetic influence but that also environment is v important.
- Baker et al., 2010- causation is likely to be an interaction between genetics and environment.
psychosocial factors that could play a part
Family dysfunction
Teasing by others
Trauma
Pressure to conform
what is the cognitive-behavioural perspective on maintenance of eating disorders
1) over evaluation of body image, shape and weight. society tells us youre only acceptable if youre thin
2) the broken cognitive link between eating and weight, no matter what i eat i will still be fat
what are the 4 elements to maintaining ed’s
Physiological- when you starve healthy people (keys minnesota study) they act the same as those with ed’s, are ED’S just a symptom of starvation?
Behavioural- the actual eating behaviour
Cognitions- thoughts that tell you youre only acceptable if thing
Emotions- anxiety, unstable mood and lack of emotions
what are the 6 steps to maintaining the behaviours once they have arisen
1) positive reinforcement from others, causes a sense of control and reinforcement
2) this shifts to anxiety and terror that you might lose that, results in efforts to lose/maintain and behaviours like purging etc
3) if you acc lose control, you feel disguted and guilty. abstience violation- you feel its out of your control. even stronger efforts to stop
4) cognitive dissonance, the behaviour becomes your identity and negative self-perception justifies your behaviour
5) body image goes from bad to terrrible
6) starvation effects kick in
what are two studies that show this
Keys, 1950 study that showed them becoming irratic, isolating and emotional unstable
Dutch hunger winter study
what else can maintain eds
safety behaviours
so what are the 3 ways
the cognitive behavioural perspective, the 6 steps of maintenance and safety behaviours
how do safety behaviours work
they make you feel great in the short term and rewarded and then they become harmful. for example dieting stops anxiety at the time, but then the self-perpetuating cycle starts as these are the thoughts that feed into the anxiety in the first place
what are some body related safety behaviours- 4
body avoidance (dont look in mirror, baggy clothes)
body measuring (constantly weighing)
body comparison to make self feel better
‘mind reading’ you think people think youre fat
what are some safety behaviours that reduce fear and manage stress
vomitting, exercise, restriction, laxatices
what are ones for emotional stress
bingeing (bc they feel numb)
how does slade say a case is ‘formulated’
Slade 1982-
you have to look at multiple things to know where the need for control came from
- Past experiences- usually involve perfectionism and low self esteem
- Trigger happens to lose weight (compliments)
- Start restricting
- Safety behaviours make you feel great
- Body pushes back, desire to binge
- Feel out of control
- Go back to restricting to feel in control
PERSONALITY DISORDERS
what is the definition of personality
tendency towards a certain pattern of behaviour, emotion, cognition and interaction that show, regardless of situation we are in. personality is a trait rather than a state
when does personality become a problem
when it doesnt fit into context, aggressive nun, anxious surgeon, boxer biting off ear
what are the limitations to diagnosing different personality disorders
Its a very sociocultural issue because it could just be a way of telling people they don’t fit in. its very subjective gulag example
what is the danger with diagnosing
could be a slippery slope towards diagnosing people before they have even done anything
categories/dimensions theory of diagnosis
personality disorders come from being at the extreme end of either the stable/unstable spectrum of the introvert/extrovert.
critical point
will always be tricky because some may be in a state not trait but still get diagnosed
the old DSM-5 definition of personality
‘an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of an individuals culture’
what was the problem with this definition
just ‘not fitting in’ wasnt a good enough reason, needs to be about something actually important
what is the new definition that came in 2013
impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits.
what are pathological personality traits?
maladaptive variants of the big 5 personality dimensions (Thomas et al., 2013)
what 5 criteria do you have to meet to get a diagnosis
1) significant impairments in self (self-direction, identity) and interpersonal functioning (empathy, intimacy)
2) one or more pathological personality traits
3) must be stable over time and different situations
4) impairments not better described by developmental stage/socio-cultural development
5) not due to biological instability like trauma or drug abuse or starvation effect of eating disorders.
what is the DSM 4 criteria for making a diagnosis
1) long term presentation, trace back to childhood
2) independent of biological factors
3) not to be diagnosed in childhood
4) not to be diagnosed after a single meeting
what 3 categories can the disorders be put into
the weird, the wild, the wimpish
what disorders are in the werid
all similar to schizo but no hallucination
paranoid pd
schizoid pd
schizotypal pd (magic)
what disorders are in the wild
all emotional, drama based ANTISOCIAL PD histronic pd narcissistic pd borderline pd
what disorders are in the wimpish
all anxiety based
avoidant pd
ocd
dependent pd
critical point for epidimiology
many studies use weak measures which is a huge overestimation
What did sansone and sansone say
10-15% of people have one. this makes them the most common psychopathology
what are the most common kinds
antisocial, borderline, schizotypal and obsessive-compulsive
‘gold digger and throt’ issues with the facts on incidence
Widiger and Trull, 1993= possible gender bias in histronic, borderline and dependent
‘coil is shit’ fact
Coid et al., 2006- Personality disorders are more common in men but 75% of those with borderline were female
what is the mean number of disorders someone might have
there is a high chance of having comorbidity in more than 1 disorder. mean disorders to have is 1.96
what did zanarini say about personality disorders, really interesting fact
Zanarini., 1998- PD’s are diagnosed in one third of psychiatric patients but it is usually comorbid, other specific disorders that bring them in for treatment. this plays in massively to the spectrum idea
what else are personality disorders often comorbid with
depression substance misuse panic disorder eating disorders social phobia
what aetiological factors have been suggested for the WEIRD DISORDERS
‘cameron diaz in the holiday
‘remi, ratatouile- was he schizo’
Emotionless parenting
Cameron, 1974- lack of love makes them untrusting and paranoid
Fervaha and Remington 2013- people with schizotypal have similar brain abnormalities to schizophrenics
what aetiological factors have been suggested for the WILD DISORDERS
‘farrington sounds like a scary head master’
Farrington et al., 1990- those with antisocial personality disorder often have a diagnosis of childhood conduct disorder, lying, fighting, truanting.
Parent modelling
Biological predisposition
Poor childhood care
‘lobe walking down paths’ what does this suggest about causes if antisocial personality
Loeber et al., 1993-
1) an ‘overt’ aggressive pathway- bullying to fighting
2) a ‘covert’ aggressive pathway- lying to stealing
3) an ‘authority conflict’ pathway that progresses through different defiant behaviours
what aetiological factors have been suggested for the WIMPISH DISORDERS
‘albert, dans albert, he is ocd’
‘aycicegi is how complex parent relationships are’
physiological predisposition to anxiety
Albert et al., 2014- OCD is not as similar to OCPD as you think, comorbidity is only 22%, suggests they have similar vulnerability factors but why is it not so comorbid
Aycicegi et al., 2002- underlying vulnerabilities is parenting that includes guilt induction and manipulation
very little research has been done into this cluster!
what other things could play a part
cognitions- developing functional core beliefs due to bad parenting.
what are the risk factors
low SES,
living in inner cities
being divorced or widowed
being a young adult
what did johnson say
Johnson et al., 1999- childhood and sexual abuse massively linked
critical point
are these risk factors symptoms of a personality or the causes (low ses, divorce, trauma)
