introduction to abnormal psychology Flashcards
psychopathology
the scientific study of abnormal behaviour in general of specific mental disorders and the characteristics of mental health
The 4 D’s
- deviance
- distress
- dysfunction
- disability
Distress
Experience of personal suffering or anxiety due to the behaviour (however, not all psychological disorders cause distress & not all behaviour that causes distress is disordered)
Dysfunction
Not being able to perform in daily life
- Biological differences: isn’t mentioned but could also play a role
stigma
destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some manner, such as people with psychological disorders.
stigma
destructive beliefs and attitudes held by a society that are ascribed to groups considered different
self stigma
perceived stigma
personal or public stigma
Perceived stigma
how one perceives the attitudes of others towards mental illness (perceived stigma)
Emma was bullied and ostracised at school, while she also held on to discriminatory fears about having a child who might be ‘¬burdened’ by a mental health illness.
personal and public stigma
“Public Stigma”: attitudes and beliefs of the generalpublictowards persons with mental health challenges or their family members
personal stigma‐a person’s stigmatising attitudes and beliefs about other people (“People with depression should snap out of it.”)
mental health literacy
(i.e., knowledge and awareness about mental illness, symptoms, causal factors and treatment) can differentially affect personal, perceived and self-stigma
influences stigma
Mesmer and hypnosis
Mesmer: one of the earlier practitioners of modern-day hypnosis (physical problems with no physical explanation)
o hysteria was caused by a particular distribution of a universal magnetic fluid in the body.
o people sat around a covered wooden tub, with iron rods protruding through the cover from bottles underneath that contained various chemicals. Mesmer took various rods from the tub and touch afflicted parts of a person’s body.
o The rods adjust the distribution of the universal magnetic fluid, thereby removing the hysterical disorder.
Jean Martin Charcot (1825–1893) accepted hypnosis- also studying hysterical state
o his support of hypnosis as a worthy treatment for hysteria helped to legitimise this form of treatment among medical professionals of the time
o Catharsis: Josef Breuer (1842–1925) treated a young woman Anna O and led to
o catharsis: Breuer hypnotised her, and while hypnotised, she began talking more freely and, ultimately, with considerable emotion about upsetting events from her past.
o Reliving an earlier emotional trauma and releasing emotional tension by expressing previously forgotten thoughts about the event
Carl Jung and analytical psychology
a collective unconscious that is part of the unconscious that is common to all human beings
archetypes: basic categories that all human beings use in conceptualising the world (everyone has masculine and feminine traits that are blended and that people’s spiritual and religious urges are as basic as their id urges)
- various personality characteristics; extraversion (an orientation towards the external world) versus introversion (an orientation towards the inner, subjective world).
Alfred Adler Individual Psychology
- people are inextricably tied to their society and that fulfilment was found in doing things for the social good
- Like jung, stressed the importance of working towards goals (Adler, 1930).
- A central element: helping people change their illogical and mistaken ideas and expectations
- feeling and behaving adaptively depend on thinking more rationally –> which anticipated contemporary developments in cognitive–behavioural therapy
molecular genetics
identify particular genes and their functions.
genetic vulnerability
*polygenic: genes, operating at different times, turning themselves on and off as they interact with a person’s environment (eg. psychopathology)
- alleles: different forms of the same gene
- genetic polymorphism: difference in the DNA sequence on a gene that occurred in population
- 46 chromosomes (23 chromosome pairs) –> each chromosome is made up of hundreds or thousands of genes that contain DNA
challenges
- how genes and environments reciprocally influence one another and which specific combinations are important .
- several genes (not just one) will contribute to a specific disorder very difficult to track
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genotype&phenotype
genotype = genetic make-up of an individual phenotype= physical characteristics & behavioural traits of an individual; product of interactions between genes and environment
gene expression
- The DNA in genes is transcribed to RNA –> RNA is then translated into amino acids, which then form proteins and proteins make cells –> genes thus make proteins
Gene expression involves particular types of DNA called promoters, recognised by proteins called transcription factors.
- Some of these proteins switch other genes on and off!
- Promoters and transcription factors are the focus of much research in molecular genetics and psychopathology
neuroscience paradigm
psychological disorders linked to aberrant processes in the brain and nervous system
- depression associated with neurotransmitter problems
- anxiety disorders related to autonomic nervous system;
- dementia= impairments in structures of the brain or neurons.
Criticism
- reductionism: reducing complex mental and emotional responses to simple biological processes.
- ultimately nothing more than biology–> eugenics movement
neuroscience approaches to treatment
medications acting on psychological symptoms.
- Antidepressants: increase neural transmission of serotonin as a neurotransmitter by inhibiting the reputake of serotonin.
- Benzodiazepines effective in reducing the tension associated with anxiety disorders –> stimulating GABA neurons to inhibit other neural systems that create the physical symptoms of anxiety.
- Antipsychotic drugs: reduce activity of neurons using dopamine ; blocking their receptors and also impact serotonin.
- Stimulants: operate on several neurotransmitters that help children pay attention.
antidepressants neuroscience approach
- Antidepressants (Prozac), increase neural transmission in neurons that use serotonin as a neurotransmitter by inhibiting the reputake of serotonin.
benzodiazepines neuroscience approach
- Benzodiazepines (xanax), effective in reducing the tension associated with some anxiety disorders, stimulating GABA neurons to inhibit other neural systems that create the physical symptoms of anxiety.
antipsychotic drugs neuroscience approach
-Antipsychotic drugs (Olanzapine), used in the treatment of schizophrenia, reduce the activity of neurons that use dopamine as a neurotransmitter by blocking their receptors and also impact serotonin.
stimulants neuroscience approach
- Stimulants, such as Ritalin, are often used to treat children with attention-deficit hyperactivity disorder; they operate on several neurotransmitters that help children pay attention.
cognitive theory
- the way people construe themselves, the world and the future is a major determinant of psychological disorders.
- In cognitive approaches to therapy, the therapist typically begins by helping clients become more aware of their maladaptive thoughts. By changing cognition, therapists aim to help people change their maladaptive feelings, behaviours and symptoms.
Albert Ellis and REBT
- sustained emotional reactions are caused by internal self statements that people repeat to themselves (irrational beliefs)
- aim is to eliminate self-defeating beliefs.
- people interpret what is happening around them on the basis of set beliefs (e.g., ‘I must be perfect’)
- interpretations cause emotional turmoil t
- unproductive demand that creates the kind of emotional distress and behavioural dysfunction that bring people to therapists.
- original form of cognitive-behavioral therapy.
- not aware that thoughts about themselves are irrational and negatively affect the way they behave
- it is these thoughts that lead people to suffer negative emotions and engage in self-destructive behaviour.
- humans are capable of challenging and changing their irrational beliefs
- an individual’s own faulty and irrational belief system that causes the most problems.
- By letting go of negative thoughts and replacing them with positive beliefs, one is better able to accept one’s self and others and, in turn, live a happier life.
Aaron Beck and Cognitive therapy
- Irrational and unrealistic thoughts lead to negative misinterpretations of situations or about the world, one’s self worth and the future –> leads to distress, unhelpful behaviours WHICH results in personal impairment and reinforces the distorted thinking.
- Negative emotional distress leads biased cognitive processing and easier access to further negative interpretations that, in turn, perpetuate the emotional distress.
- proposes that psychopathology is caused by faulty cognitive content (irrational beliefs about the world, self and future) and distorted information processing (cognitive distortions).
- collaborative treatment between a therapist and the person
- person with depression “nothing ever goes right” - therapist offers counterexamples, pointing out how the person has overlooked favourable happenings.
GOAL: provide people with experiences, both inside and outside the therapy room, that will alter their negative schemas, enabling them to have hope rather than despair.
cognitive science
focuses on how people (and animals) structure their experiences, how they make sense of them and how they relate their current experiences to past ones that have been stored in memory
cognitive behavioural therapy
- incorporates cognitive therapy (CT) and behaviour therapy (BT)
- increase their awareness of irrational thinking and the behavioural actions leading to emotional distress thus supporting the maladaptive thinking patterns.
- exposure-based and contingency-based strategies, facilitate the development of alternative thinking styles and behaviours
cognitive therapy
- Cognitive therapists pay attention to private events (thoughts, perceptions, judgements, self-statements and even tacit (unconscious) assumptions) — and have studied and manipulated these processes in their attempts to understand and modify overt and covert disturbed behaviour.
- Cognitive restructuring changing a pattern of thought.
- Tracking of unhelpful thoughts and practising more helpful behaviours and thinking styles are core components of CBT, which are incorporated into homework assignments so that ‘therapy’ is taken out of the session with the therapist and into the client’s daily life.
CT and its associated behavioural interventions, usually comprising exposure-based and contingency-based strategies, facilitate the development of alternative thinking styles and behaviours
evaluating cognitive behavioural therapy
- CBT, BT and CT have been found to be effective across a range of disorders (including mood and anxiety-based disorders)
- Exposure-based behaviour therapy: effective for adult depression and OCD.
- CBT was superior to antidepressant medication for adult depression –> r
- moderate effects of CBT for marital distress, anger, childhood somatic disorders and chronic pain, while small effects were found in sexual offenders
- lends itself to scientific evaluation
- much research is required to delineate the exact role of cognitive processes in psychopathology.
The Third Wave of cognitive therapies
- variants of cognitive therapies (third wave) include a focus on cognitive processes as distinct from content, self schemas and elements
- Acceptance and Commitment therapy (ACT), dialectical behaviour therapy, mindfulness-based cognitive therapy, metacognitive therapy and post rationalist approaches (narrative therapy)
- focus on spirituality, values, emotions, acceptance and mindfulness
- easily integrate older approaches, are more adaptable to the assimilation of different therapeutic strategies + involves a broader range of therapeutic changes and processes.
- not empirically supported treatments
- mindfulness-based therapies in treating anxiety and depression = moderately effective for both post-treatment & follow-up, with a better result for disorders than mood problems.
diagnosis
provides information about the possible causes of a patient’s symptoms and the direction of treatment
positives of a diagnosis
- provides relief = understand why certain symptoms are occurring
- depression and anxiety are common; knowing a diagnosis is common makes someone feel less unusual
- allows clinicians and scientists to communicate accurately with one another about cases or research.
- important for further research on causes and treatments of symptoms.
- Sometimes researchers discover unique causes and treatments associated with a certain set of symptoms
Reliability
consistency of measurement
- typically measured on a scale from 0 to 1.0; the closer the number is to 1.0, the higher the reliability
interrater reliability
degree to which two independent observers agree on what they have observed.
Eg. two clinicians observing the behaviour of the same patients agree on a diagnosis
test-retest reliability
measures the extent to which people being observed twice or taking the same test twice, perhaps several weeks or months apart, receive similar scores.
alternate-form reliability
the extent to which scores on the two alternative forms of the test are consistent
internal consistency reliability
assesses whether the items on a test are related to one another.
Eg. items on an anxiety questionnaire to be interrelated or to correlate with one another, if they truly measure anxiety
validity
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whether a measure measures what it is supposed to measure
validity is related to reliability; Reliability, however, does not guarantee validity ( Height can be measured very reliably, but height would not be a valid measure of anxiety)
content validity
whether a measure adequately samples the domain of interest. Eg. a test to assess social anxiety ought to include items that cover feelings of anxiety in different social situations.
criterion validity
- whether a measure is associated in an expected way with some other measure (the criterion).
- OR the extent to which the results and conclusions are valid compared with other measures.
- In psychometrics, criterion or concrete validity is the extent to which a measure is related to an outcome
criterion validity refers to a test’s correlation with a concrete outcome.
predictive validity and concurrent validity.
predictive validity
the extent to which the results and conclusions can be used to predict real life applications of the study.
concurrent validity
measures how well a new test compares to a well-established test.
- Concurrent validity is a type of evidence that can be gathered to defend the use of a test for predicting other outcomes
It can also refer to the practice of concurrently testing two groups at the same time, or asking two different groups of people to take the same test.
construct validity
extent to which a study or test measures the concept which it claims to
( a self-report measure would achieve construct validity if the people with anxiety disorders scored higher than the people without anxiety disorders)
- Or that the self-report measure was related to other measures thought to reflect anxiety, such as observations of fidgeting and trembling, and physiological indicators, such as increased heart rate and rapid breathing.
- When the self-report measure is associated with these multiple measures (diagnosis, observational indicators, physiological measures), its construct validity is increased.
- Thus, construct validation is an important part of the process of theory testing.
DSM
the Diagnostic and Statistical Manual of Mental Disorders (DSM).
- DSM-5 released in 2013 –> continuing today, an effort was made to create more reliable and valid diagnostic categories.
- One of the big changes in DSM-III that remained in place for 33 years was the introduction of the multiaxial system
A history of classification and diagnosis
- investigators of disorders sought to develop classification schemes similar to botany and chemisty.
- Emil Kraepelin (1856–1926); definitively establish the biological nature of psychological disorders.
- Kraepelin noted that certain symptoms clustered together as a syndrome; hypothesised that each had its own biological cause, course and outcome.
- WHO (1939) and DSM systems (1968)
Development of the WHO and DSM systems
- In 1939, the World Health Organization (WHO) added psychological disorders to the International List of Causes of Death
- In 1969, published a new version, International Classification of -Disease (ICD), which was more widely accepted.
- DSM-II (1968), was similar to the WHO system.
changes that took place in DSM5
- Labelling; Arabic numbers (i.e., DSM-5) t
- removal of the multi-axial system
- enhanced sensitivity to developmental nature
- new diagnoses
- combined diagnoses
- Ethnic and cultural considerations in diagnosis
Enhanced sensitivity to the developmental nature of psychopathology
- DSM-IV-TR, childhood diagnoses were considered in a separate chapter.
DSM5
Most of those diagnoses have now been moved into other relevant chapters to highlight the continuity between childhood and adulthood forms of disorder. (eg. children who experience separation anxiety may be at greater risk for developing anxiety disorders as adults) - In DSM-5, separation anxiety disorder was moved to the chapter on anxiety disorders. Across diagnoses, more detail is provided about the expression of symptoms in younger populations.
new diagnoses
- Several new diagnoses were added to DSM-5.
- Eg. disruptive mood dysregulation disorder
- It is hoped that by including this diagnosis, the overdiagnosis of bipolar disorder in children and adolescents will be lessened.
- Other new diagnoses; hoarding disorder, binge eating disorder, premenstrual dysphoric disorder and gambling disorder.
Removal of the multiaxial system in DSM5
Removal of the multiaxial system; originally chapters organised to reflect patterns of comorbidity and shared aetiology (obsessive-compulsive disorder was included in the anxiety disorders chapter because it contained anxiety symptoms.
- The aetiology of this disorder, though, seems to involve distinct genetic and neural influences compared to other anxiety disorders, as we discuss in a later chapter.
- new chapter for obsessive-compulsive and other related disorders. This new chapter includes disorders that often co-occur and share some risk factors, including obsessive-compulsive disorder, hoarding disorder and body dysmorphic disorder.
Combining diagnoses
Some of the DSM-IV-TR diagnoses were combined because there was not enough evidence for differential aetiology, course or treatment response to justify separate diagnostic categories. \
- substance abuse and dependence were replaced with the DSM-5 diagnosis of substance use disorder.
- hypoactive sexual desire disorder and female sexual arousal disorder were replaced with the DSM-5 diagnosis of female sexual interest/arousal disorder.
- The DSM-IV-TR diagnoses of autism and Asperger’s disorder were replaced with the DSM-5 diagnosis of autism spectrum disorder.
Ethnic and cultural considerations in diagnosis
- Psychological disorders are universal.
- many DIFFERENT cultural influences on risk factors for psychological disorders (e.g., social cohesion, poverty, access to drugs of abuse and stress), the types of symptoms experienced, the willingness to seek help and the treatments available.
- healthy migrant hypothesis
ICD
- facilitate international communication, includes a list that cross-references the DSM diagnoses with the International Statistical Classification of Diseases and
diagnositic
- includes a culture-related diagnostic issues for nearly all disorders and an appendix devoted to developing a culturally informed case formulation.
appendix
- cultural formulation interview consisting of 16 questions clinicians can use to help understand how culture may be shaping the clinical presentation.
- cultural concepts of distress that distinguishes syndromes that appear in particular cultures, culturally specific ways of expressing distress and cultural explanations about the causes of symptoms, illness and distress
‘healthy migrant hypothesis’.
- first generation immigrants with non-English speaking backgrounds had lower evidenced prevalence of common mental health disorders in comparison to the Australian-born participants. This group difference is referred to as the ‘healthy migrant hypothesis’.
criticisms on the DSM
- too many diagnoses
- Categorical classification vs. dimensional classification
- Reliability of DSM: The increased explicitness of DSM has improved reliability for many diagnoses
- HOWEVER clinicians don’t rely on criteria of DSM in everyday usage may be lower than that seen in research studies
validity
- Certain categories have less validity than others
too many diagnsoes on DSM5
- Too many diagnoses (<300 different diagnoses)
- comorbidity: includes too many minute distinctions based on small differences in symptoms –> leads to comorbidity, which refers to the presence of a second diagnosis (45 percent meet criteria for at least one more psychiatric diagnosis
- different diagnoses do not seem to be distinct in their aetiology or treatment
General criticisms of diagnosing psychological disorders
- a stigmatising effect.
- minimise the uniqueness of individuals
- diagnosis leads us to focus on disorders thus ignoring important differences among people.
case conceptualisation
- making sense of a patient’s difficulties in the context of a theoretical framework.
- collaboratively working with patients to personalise service.
- a process of further understanding why the person is experiencing their difficulties.
Clinical interviews
- formal/structured as well as informal/less structured
- interviewer pays attention as to how the respondent answers questions — or does not answer them.
- establishing rapport
- empathise with clients to draw them out and to encourage them to elaborate on their concerns.
- clinicians probably operate from only the vaguest outlines.
structured interviews
- The Structured Clinical Interview (SCID) –> generally formatted around the structure of the DSM-5.
- branching interview; person’s response to one question determines the next question that is asked.
- contains detailed instructions on when and how to probe in detail and when to go on to questions about another diagnosis.
- Most symptoms are rated on a three-point scale of severity, with instructions in the interview schedule for directly translating the symptom ratings into diagnoses.
Assessment of stress
- stress subjective experience of distress in response to perceived environmental problems.
- the Life Events and Difficulties Schedule (LEDS) as well as self-report checklist measures of stress
Cultural and ethnic diversity assessment
- issue of cultural bias in assessment: a measure developed for one culture or ethnic group may not be equally reliable and valid with a different cultural or ethnic group.
A cautionary note about neurobiological assessment
- Many of the objective measurements do not differentiate clearly among emotional states.
- Skin conductance increases not only with anxiety but also with other emotions — among them, happiness.
- the investigator interested in measuring brain changes associated with emotion using fMRI must also take the scanning environment into account.
heritability
- the extent to which variability in a particular behaviour (or disorder) can be accounted to genetic factors.
- range from 0.0 to 1.0: the higher the number, the greater the heritability
- heritability applies to large populations, not individuals
- schizophrenia (0.65 to 0.80) does not mean that 65 to 80 percent is due to someone’s genes but for the population
people have…
20 000 genes
single nucleotide polymorphisms SNPs
- variation in a genetic sequence that affects only one of the basic building blocks (nucleotide; A, T, G or C) in a segment of DNA hat occurs in more than 1 percent of a population.
- act as biological markers: detect genes linked to specific disorders and tracking how heritable disorder-specific genes are within families.
- studied in schizophrenia, autism and the mood disorders, to name a few disorders.
copy number variations (CNVs);
- occur in single or multiple genes.
- can be additions or deletions
- can be inherited from parents or spontaneous (de novo) mutations — appearing for the first time in an individual.
- CNVs in different disorders, particularly schizophrenia, autism and attention-deficit hyperactivity disorder (ADHD)
behaviour genetics
- Behaviour genetics : studying the degree to which genes and environmental factors influence behaviour
