Paper 1 - Psychopathology Flashcards
What is abnormality and what are the 4 definitions of abnormality?
Behaviours and mental processes that deviate from the norms or expectations of a given society or culture.
1. Statistical infrequency
2. Deviation from social norms
3. Failure to function adequately
4. Deviation from ideal mental health
Explanation of statistical infrequency
Behaviour is normal if it occurs frequently
Any behaviour that occurs relatively rarely is thought of as abnormal
This approach is most useful when dealing with human characteristics that can be reliably measured
Scores for a particular behaviour (the majority of scores will cluster around the average, further we move away from the average the fewer and fewer people will have this score)
Compare individual behaviour with what the average person does
Refers to the conditions that are rare compared to the normal (behaviour only found in a few people is regarded as abnormal.)
Many human characteristics fall into the normal distributions, this will tell us what is “normal”. (For example, when facing everyday challenges, it is rare to be excessively fearless or fearful and normal to experience some stress.
E.g. asking everybody in this class who fears dogs, I being no fear, 10 being absolutely fearful. Most people would sit around 4,5,6,7. Where there are outliers these become the abnormal.
A03 : Statistical infrequency : Real world application
STRENGTH
Statistical infrequency is useful in diagnosis
Intellectual disability disorder requires an IQ in the bottom 2%
The BDI (Beck depression inventory) assesses depression, only 5% score 30+ (meaning severe depression)
This means that statistical infrequency is useful in diagnostic and assessment processes
A03 : Statistical infrequency : Unusual characteristics can also be positive
WEAKNESS
Just because a behaviour is statistically infrequent doesn’t mean it is abnormal or undesirable
IQ scores above 130 are unusual and statistically infrequent, just like those below 70, but they are not | regarded as undersirable or needing treatment
This means that although statistical infrequency can be part of defining abnormality, it can never be its sole basis
A03 : Statistical infrequency : Benefits versus problems
Some unusual people benefit from being classed as abnormal. For example someone who has a very low IQ and is diagnosed with intellectual disability can then access support services or someone with a very high BDI score is likely to benefit from therapy. On the other hand, not all statistically unusual people benefit from labels. Someone with a low IQ who can cope with their chosen lifestyle would not benefit from a label. There is a social stigma attached to such labels. Therefore sometimes it isn’t good to label people as abnormal
What does deviance mean
Behaviour and emotions that deviate from the norm in a society. Must also be behaviour that is deemed unacceptable by society.
Explain deviation from social norms
Social norms are created by a group of people and thus are “social”.
These compromise what behaviours are acceptable standards of behaviour.
Anyone who behaves differently deviates from social norms are classed as abnormal, therefore deviations from social norms.
These rules are often in place for good reason, i.e politeness, it oils the wheels of interpersonal relations. (Those that are rude are considered to be socially deviant and people find it hard to interact with them.)
Some rules about unacceptable behaviour are implicit whereas others are policed by laws.
They also differ over place and time due to cultural relativism (e.g alcohol consumption in public places). This is the view that behaviour cannot be judged properly unless it is viewed in the context of the culture in which it originates. (I.e Homosexually used to be considered as abnormal, a mental disorder and used to be against the law, in the Uk this has since changed.)
A03 : Deviation from social norms : Real world application
STRENGTH
Deviation from social norms is useful in diagnosis.
Antisocial personality disorder - diagnosis requires failure to conform to ethical standards.
Schizotypal personality disorder - this involves strange beliefs and behaviour.
This means that deviation from social norms is useful in psychiatric diagnosis.
A03 : Deviation from social norms : Social norms are situationally and culturally relative
WEAKNESS
What is considered abnormal in one situation or culture may be considered normal in another.
Hearing voices is socially acceptable in some cultures but would be seen as abnormal in the Uk - cultural norms of the patient and the clinician need to be considered.
Wearing your Pjs to school on a fancy dress day is considered normal, but wearing them everyday when others are in uniform is considered abnormal - it depends on the situation.
This means that it is difficult to judge deviation from social norms from one context to another.
A03 : Deviation from social norms : Human rights abuses
Using deviation from social norms to define someone as abnormal carries the risk of unfair labelling and leaving them open to human rights abuses. Historically this has been the case where diagnoses like nymphomania (women’s uncontrollable or excessive sexual desire) have been used to control women, or diagnoses like drapetomania (black slaves running away) were a way to control slaves and avoid debate. On the other hand it can be argued that we need to be able to use deviation from social norms to diagnose conditions such as antisocial personality disorder.
Consider: Is the use of deviation from social norms as a criterion for defining abnormality ever justifiable?
Define Cultural relativism
Cultural Relativism: the view that behaviour cannot be judged properly unless it is viewed in the context of the culture in which it originates.
Define deviation from social norms
Deviation from social norms: abnormal behaviour is seen as a deviation from unstated rules about how one ought to behave. Anything that violates these rules in considered abnormal.
Define DSM
DSM: Diagnostic and statistical manual disorders, a list of mental disorders that is used t o diagnose mental disorders. For each disorder a list of clinical characteristics if given, i.e. the symptoms that should be looked for.
Define statistical infrequency
Statistical Infrequency: abnormality is defined as those behaviour that are extremely rare. i.e. if behaviour that is statistically infrequent is regarded as abnormal.
Explain failure to function adequately
Not being able to cope with everyday living
The functioning refers to just going about day to day life, (such as eating regularly, washing clothes, getting ready, going to school, being able communicate with other)
Also causes distress and suffering for the individual and/or others around them (i.e. schizophrenia the person is ok but causes distress to those around them due to their paranoia)
If it distresses only others and but the individual then the judgement of abnormality is inappropriate (I.e. individuals may be content wearing unwashed clothes and not having a job, they just don’t cope in a normal way.)
EXAMPLE : The DSM includes an assessment of ability to function called WHODAS (World health org disability assessment). Individuals rate themselves on a scale of 1-5 and given an overall score. This is a quantitative measure.
WHODAS Questionnaire:
‘None’ (0)
‘Mild’ (1)
‘Moderate’ (2)
‘Severe’ (3)
‘Extreme’ (4)
Add all up and divide by 144, times by 100
A score of 0 means no disability, a score of 100 means full disability
Rosenhan and Seligman (1989), when someone is not coping (the no longer conform to interpersonal rules, e.g. maintaining personal space) (they experience severe personal distress) (they behave in a way that is irrational or dangerous)
A03 : failure to function adequately : Provides a threshold for professional help
STRENGTH
In any given year, 25% of us experiences symptoms of a mental disorder to some degree (mind)
Most of the time we continue day to day life but when we stop being able to function adequately people seek or are referred for professional help
This means that the failure to function adequately criteria provides a way to target treatment and services to those who need them most.
A03 : failure to function adequately : It can lead to discrimination/social control
WEAKNESS
It is hard to distinguish between failure to function adequately and a conscious decision to deviate from social norms
For example people may choose to live off grid as part of an alternative lifestyle choice or take part in high risk leisure activities
This means that people who make unusual choices can be labelled abnormal and their freedom of choice is restricted
A03 : failure to function adequately : Failure to function may not be abnormal
There are some circumstances in which most of us fail to cope for a time (e.g, bereavement). It may be unfair to give someone a label that may cause them future problems just because they react to difficult circumstances. On the other hand the failure to function is no less real just because the cause is clear. Also some people need professional help to adjust to circumstances like bereavement. We shouldn’t call people abnormal when they fail to function following distressing circumstances.
Explain deviation from ideal mental health
Jahoda (1958) we define physical illness in part by looking at the absence of signs of physical health (I.e. temperature, normal skin colour, normal blood pressure). So the absence of these indicate illness. We should do the same for mental illness.
The absence of the following criteria
1. We have no symptoms or distress
2. We are rational and perceive ourselves accurately
3. We self-actualise
4. We can cope with stress
5. We have a realistic view of the world
6. We have good self-esteem and lack guilt
7. We are independent of other people
8. We can successfully work, love and enjoy our leisure
There is some overlap with failure to function adequately - in both definitions not being able to cope with stressful situations.
A03 : deviation from ideal mental health : The ideal mental health approach is comprehensive
WEAKNESS
Ideal mental health includes a range of criteria for mental health
It covers most of the reasons why we might need help with mental health
This means that mental health can be discussed meaningfully with a range of professionals
Therefore ideal mental health provides a checklist against which we can assess ourselves and others
A03 : deviation from ideal mental health : It may be culture-bound
WEAKNESS
Some criteria for ideal mental health are limited to USA and Western Europe (e.g. self actualisation is not recognised in most of the world)
Even in Western Europe there are variations in the value placed on independence (high in Germany, low in Italy)
This means that is is very difficult to apply the concept of ideal mental health from one culture to another
A03 : deviation from ideal mental health : Extremely high standards
Very few of us attain all of Johada’s criteria for mental health, and probably none of us achieve all of them at the same time or keep them up for very long, it can be disheartening to see an impossible set of stand to live up to. On the other hand, having such a comprehensive set of criteria for mental health to work towards might be of practical value to someone wanting to understand and improve their mental health. Is it helpful to have a comprehensive set of criteria for mental health?
Define deviation from ideal mental health?
Abnormality is defined in terms of mental health, behaviours that are associated with competence and happiness. Ideal mental health would include a positive attitude towards the self, resistance to stress and an accurate perception.
Define failure to function adequately
People are judged on their ability to go about daily life. If they can’t do this and area also experiencing distress then it is considered a sign of abnormality.
Diagnostic and statistical manual of mental disorders
The current model of the DSM-V was published in 2013 and had about 300 disorders in.
This is a classification system published by the APA and contains typical symptoms of each disorder and guidelines for clinicians to make diagnosis.
Another model used is the ICD (currently on the 11th edition) produced by the WHO.
Phobias and 3 types of phobias
Phobia disorders are included in diagnostics manuals within the category of anxiety disorders.
Primary symptoms are extreme anxiety, irrational fear and conscious avoidance of a feared object or situation (i.e
Agrophobia (extreme or irrational fear of open or public place)
Social phobia (is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations
Specific phobia (specific phobia is any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure of a specific object/situation
DSM-V : Criteria for diagnosis
Symptoms for 6 months
Marked and persistent fear of a specific object or situation
Exposure to the phobic stimulus nearly always produces a rapid anxiety response
Fear of robe phobic object or situation is excessive
The phobic stimulus is either avoided or responded to with great anxiety
The phobic reactions interfere significantly with the individuals working or social life or he/she is very distressed about the phobia
Phobia : define, emotional/cognitive/behavioural characteristics
An irrational fear of an object or situation
Emotional characteristics: Anxiety, fear and emotional response is unreasonable
Cogntive characteristics: Selective attention to the phobic stimulus, irrational beliefs and cognitive distortions
Behavourial characteristics: Panic, avoidance and endurance (e.g. stay in room with spider to keep a wary eye on it instead of leave/avoid it)
Depression : define, emotional/cognitive/behavioural characteristics
A mental disorder characterised by low mood and low energy
Emotional characteristics: Lowered mood, anger and lowered self-esteem
Cognitive characteristics: Poor concentration, attending to and dwelling on the negative and absolutist thinking
Behavioural characteristics: Activity levels, distrusting to sleep & eating behaviour and aggression & self harm
OCD : define, emotional/cognitive/behavioural characteristics
A condition characterised by obsessions and/or compulsive behaviour. Obsessions are cognitive whereas compulsions are behavioural.
Emotional characteristics: Anxiety & distress, accompanying depression and guilt & disgust
Cognitive characteristics: Obsessive thoughts, cognitive coping strategies and insight into excessive anxiety
Behavioural characteristics: Compulsions are repetitive, compulsions reduce anxiety and avoidance
Define agrophobia
Agrophobia - extreme or irrational fear of open or public places
Define compulsion and obsession
Compulsion: behaviour that is repeated over and over in order to reduce anxiety
Obsession: persistent, intrusive and unwelcome thoughts
Define DSM and ICD
DSM: This is classification system published by the APA and contains typical symptoms of each disorder and guidelines for clinicians to make diagnosis.
ICD: This is a Statistical Classification of Diseases and Related Health Problems, produced by the World Health Organisation
Define social phobias and specific phobias
Social phobia - is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations
Specific phobia - A specific phobia is any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to specific objects or situations
Who proposed a model to explain phobias and what was this model called?
Known as the two process model
Mowrer (1947) proposed the two process model, incorporating both classical and operant conditioning to explain the initiation and persistence of phobia.
Explains phobias with behaviourist approach
How does classical conditioning explain phobias & what is generalisation?
Classical conditioning - Initiation (how you get the phobia)
Learnt by association by Pavlov
Behaviourists believe that usually with phobias a traumatic event has lead to the development of a phobia.
E.g. Little Albert (white rate), Clown example
Generalisation - Generalise fear response to other stimuli (e.g. Little Albert also showed fear to other white furry objects (e.g. Santa’s beard & fur coats)
How does operant conditioning explain phobias?
Operant conditioning - Maintenance (how you keep the phobia)
Learnt through consequences by Skinner
If the behaviour is rewarded it is more likely to be repeated. Negative reinforcement (remove an unpleasant stimulus to increase a behaviour). Escape from the phobia stimulus reduces fear = negative reinforcement (unpleasant consequence of fear/anxiety removed, increases avoidance behaviour and maintains phobia)
A03: Phobia Explanations : Real world application
STRENGTH
Idea that phobias are maintained by avoidance is important in explaining why some people benefit from exposure therapies - once avoidance is prevented it is no longer reinforced, avoidance behaviour then declines. This shows that the two-process approach is valuable because it identifies a way to treat phobias.
A03: Phobia Explanations : Evidence linking phobias to bad experiences
STRENGTH
Phobics often recall a specific incident when their phobia appeared, for example being bitten by a dog or experiencing a panic attack in a social event (Sue, 1994).
De Jongh et al (2006) : 73% of dental phobics had experienced a trauma (control group with low dental anxiety, only 21% had experienced traumatic events).
This confirms that the association between stimulus and an unconditioned response does lead to a phobia.
A03: Phobia Explanations : Cognitive elements that the behaviourist cannot explain
WEAKNESS
The cognitive approach proposes that phobia may develop as the consequence of irrational thinking.
Cognitive therapies designed to treat this, such as CBT, may be more successful than the behaviourist treatments for certain phobias (cognitive treats obsession and behaviourist treatments the compulsion)
A03: Phobia Explanations : Alternative explanations
WEAKNESS
Not everyone can remember a traumatic experience/incident. DiNado found 50% of people could not remember a traumatic experience when they feared dogs.
The diathesis-stress model could explain this (we inherit a genetic vulnerability for developing a mental disorder, however it will only manifest itself when triggered by a traumatic event).
People without this vulnerability would not develop a phobia
Social learning theory says we acquire a phobia and maintain it through social learning theory and vicarious reinforcement
