Psychopathalogy Flashcards
Psychopathology
Psychopathology is the scientific study of mental disorders (abnormalities) such as depression, phobias and obsessive compulsive disorder.
In order to diagnose someone with a mental disorder we must first decide in what way their behaviour differs from what is ‘normal’ i.e. what is abnormal?
Deviation from social norms
Under this definition, abnormal behaviour is that which goes against the unwritten rules in a given society or culture.
All societies have their social norms. These are the standards of acceptable behaviour that are created by a social group, and adhered to by all those who are socialised into that group. For example, do not stand too close a person you have just met.
Anyone who behaves differently (deviates) from these social norms is classed as abnormal by this definition.
Deviation from social norms AO3 (3n)
- In some instances it can be beneficial to break social norms, for example the Suffragettes broke many social norms but this led to women gaining the right to vote.
- The social norms of a society change over time. For example, homosexuality was classed as a mental illness in the International Classification of Diseases (ICD) until 1990 but is no longer considered an abnormality.
- Deviation from social norms does not always have mental health consequences. Those who do not conform to social norms may very well not be abnormal but merely eccentric. For example, naturists break social norms but are not often perceived as having mental health problems.
Failure to function adequately
Under this definition, abnormal behaviour is that which causes an inability to cope with everyday life. A person’s behaviour may disrupt their ability to work or conduct satisfying interpersonal relationships.
Rosenhan and Seligman (1989) suggest personal dysfunction has seven features. The more features an individual has the more abnormal they are considered to be.
- Personal Distress – Feeling sad, anxious, worried or scared.
- Maladaptive Behaviour – Behaviour stopping individuals from attaining life
goals, both socially and occupationally. - Unpredictability – Displaying unexpected behaviours characteristiced by the loss of control.
- Irrationality – Displaying behaviours which cannot be explained in a logical way.
- Observer Discomfort – Displaying behaviour which causes discomfort in others.
- Violation of Moral Standards – Displaying behaviour, which violates society’s ethical standards.
- Unconventionality – Displaying behaviour which does not conform to what is generally done in a certain situation.
Failure to function AO3 (1p,3n)
+ This definition of abnormality recongises the patient’s perspective (e.g. personal distress).
- Abnormality is not always accompanied by a failure to function. Psychopaths can commit murders while still appearing normal. Harold Shipman, the English doctor who murdered 215 patients over 23 years, maintained the outward appearance of a respectable member of his profession, and had a family, the entire time he was committing the murders.
- There are times in a person’s life when it is normal and psychologically healthy to suffer from personal distress, like when a loved one dies. It would be abnormal not to feel distress under these circumstances.
- Behaviour may cause distress to other people and be regarded as dysfunctional when the person themselves feels no personal distress. Stephen Gough has been imprisoned for breaching the peace because he insists on hiking while naked, this makes other people experience observer discomfort, but he himself feels no distress.
Deviation from ideal mental health
Under this definition, behaviour is abnormal if it fails to meet prescribed criteria for psychological normality.
Jahoda (1958) devised the concept of ideal mental health. She identified six characteristics that individuals should exhibit in order to be classed as ‘normal’. An absence of these characteristics indicates that an individual is abnormal. The more criteria individuals fail to meet the more abnormal they are
Jahoda characteristics for deviation from ideal mental health
- Positive Attitudes Towards Oneself - Having self-respect, high self- esteem, confidence and a positive self-concept.
- Self-Actualisation – Experience personal growth and development. Reach one’s full potential and feel fulfilled.
- Autonomy – Being independent, self-reliant and able to make personal decisions for oneself.
- Resistance to Stress – Having effective coping strategies and being able to manage everyday anxiety-provoking and stressful situations.
- Accurate Perception of Reality – Perceiving the world in a non- distorted fashion and having an objective and realistic view of the world (not having hallucinations or delusions).
- Environmental Mastery – Being competent in all aspects of life and the ability to meet the demands of any situation and the flexibility to adapt to changing life circumstances.
Deviation from ideal mental health AO3 (2p, 3n)
+ This is a comprehensive criteria for mental health which is based on similar models for physical health. However, mental health may not be the same.
+ This definition of abnormality is a positive, holistic approach to diagnosis.
- This criteria is very demanding and unrealistic. At any given moment most people do not meet all the ideals. For example, few people experience self-actualisation at all times in their life.
- Many of the criteria, such as self-actualisation are vague and difficult to measure and are therefore subjective. How can we tell that someone has reached their full potential?
- The criteria used to judge ideal mental health can be accused of cultural bias. Collectivist cultures (e.g. India and Japan) emphasise communal goals and regard autonomy as undesirable, unlike individualistic cultures (e.g. USA and Germany). Therefore people from these collectivist cultures may be seen as abnormal using the criteria
Statistical infrequency
Under this definition, abnormal behaviour is that which is statistically rare.
In statistical terms, instances of abnormality would lie at both extremes of a normal distribution.
Statistical infrequency AO3 (3n)
- This definition fails to account for behaviour that is statistically rare but desirable. For example, someone who has an IQ above the normal average would not be seen as abnormal; on the contrary they would be very highly regarded for their intelligence.
- Some psychological disorders are not statistically rare. Depression may affect 27% of elderly people (NIMH, 2001). This would make it common but that does not mean that it is not a problem.
- Many rare behaviours or characteristics have no bearing on normality or abnormality (e.g. left handedness).
Behavioural characteristics of phobias
Panic: The person might panic in the presence of the phobic object. They might show behavioural characteristics of crying, running, screaming, freezing, fainting, collapsing, or vomiting.
Avoidance: When faced with the phobic object the response is to evade the object. This can interfere with the person’s normal daily life.
Endurance – The person may remain in the presence of the phobic object frozen and unable to move.
Emotional characteristics of phobias
Fear: Persistent, excessive and unreasonable worry and distress might be felt
in the presence of the phobic object.
Anxiety: When they encounter their phobic object the person will feel terror
and be uncertain and apprehensive about what is going to happen.
Cognitive characteristics of phobias
Irrational Beliefs: The person’s thoughts about their phobia do not make logical sense, and they will resist rational arguments that counter it. For example someone who is scared of flying will not listen to the fact that, “flying is the safest form of transport.” The person will also have a distorted perception of the stimulus. For example, a person with arachnophobia may believe that all
spiders are dangerous and deadly, despite the fact that no spiders in the UK are
actually deadly.
Selective Attention: When the person encounters the phobic object, they will become fixated on it because of their irrational beliefs about the danger posed.
Behavioural explanations of phobias
The Two-Process Model
1. The phobia is initiated through classical conditioning.
2. The phobia is maintained through operant conditioning.
Classical conditioning
Classical conditioning is learning through association. A stimulus produces the same response as another stimulus because they have been constantly presented at the same time. This could be how phobias develop, as the stimulus the person is afraid of has, in the past, been associated with another stimulus.
Watson and Raynor (1920) managed to give an infant boy referred to as ‘Little Albert’, a phobia of a white rat.
- An infant is born with certain reflexes (that they do not have to learn); the stimulus of a loud noise is an unconditioned stimulus and produces the reflex of fear as an unconditioned response.
- A white rat is a neutral stimulus as it produces no reflexes. However, over time the white rat became associated with unconditioned stimulus of a loud noise.
- The white rat then becomes a conditioned stimulus that produces fear as a conditioned response.
- This conditioned response of fear can then be generalised to other objects or situations. Albert became scared of any object that was white or fluffy.
Operant conditioning
Operant conditioning is learning through the consequences of one’s behaviour.
Positive Reinforcement – The behaviour leads to a reward.
Negative Reinforcement – The behaviour stops something unpleasant.
Punishment – The behaviour leads to something unpleasant.
The avoidance of a phobic object reduces fear and so is reinforcing. This is an example of negative reinforcement (escaping from something unpleasant).
Two-process model AO3 (2p,3n)
+ This model does not label people with the stigma of being mentally ill. Such labels can be damaging because they tend to be difficult to remove. Instead the model is positive, perceiving phobias as incorrect responses that can be corrected
+ King (1998) reviewed several case studies and found that children acquire phobias after having traumatic experiences with the phobic object. This supports the idea that phobias are initiated because they are learned through classical conditioning.
- Many people who have a traumatic experience, such as a car accident, do not then go on to develop a phobia (e.g. of cars/driving), so classical conditioning does not explain how all phobias develop.
- Some people are scared of an object, but they have not had a negative experience or even encountered the object before (e.g. being scared of snakes even though you have never seen one), so learning cannot have been a factor in causing them to develop a phobia.
-This model focuses on learning and the environment but does not take account of biological factors that can cause phobias. Some people could have a genetic vulnerability to phobias.
Systematic desensitisation
Systematic desensitization (SD) is a behavioural therapy developed by Wolpe (1958) to reduce phobias by using classical conditioning. A person experiences fear and anxiety as a behavioural response to a phobic object. SD replaces this fear and anxiety with relaxed responses instead. The central idea of SD is that it is impossible to experience two opposite emotions at the same time e.g. fear and relaxation; this is called reciprocal inhibition. Therefore if the patient can learn to remain relaxed in the presence of their phobia, they can be cured. This is called counter-conditioning.
Stages of systematic desensitisation
- Anxiety Hierarchy - A hierarchy of fear is constructed by the therapist and the patient. Situations involving the phobic object are ranked from least fearful to most fearful. If a person has a phobia of snakes the therapist might at first get the patient to merely look at a photo of a snake, then at a snake in a tank, until eventually they are asked to hold a snake.
- Relaxation Training - Patients are taught deep muscle relaxation techniques, such as progressive muscular relaxation (PMR) and the relaxation response. The idea behind PMR is to tense up a group of muscles so that they are as tightly contracted as possible, hold them in a state of extreme tension for a few seconds and then relax the muscles to their previous state. Finally, consciously relax the muscles even further so that you are as relaxed as possible. When doing the relaxation response patients are asked to sit quietly and comfortably and close their eyes.
- Gradual Exposure - The patient is introduced to their phobic object and they work their way up the anxiety hierarchy starting with the least frightening stage. They use their relaxation techniques whilst they are exposed to the phobic object. When they feel comfortable with one particular stage of the hierarchy they move on to the next stage in the hierarchy. Eventually through repeated exposure to phobic objects with relaxation and no fear, the phobia is eliminated.
Systematic desensitisation AO3 (2p, 1n)
+ Jones (1924) supports the use of SD to eradicate ‘Little Peter’s’ phobia. A white rabbit was presented to Little Peter at gradually closer distances and each time his anxiety levels lessoned. Eventually he developed affection for the white rabbit.
+ Klosko et al. (1990) supports the use of SD. He assessed various therapies for the treatment of panic disorders and found that 87% of patients were panic free after receiving SD, compared to 50% on medication, 36% on a placebo and 33% receiving no treatment at all.
- Behavioural treatments address the symptoms of phobias. However some critics believe the symptoms are merely the tip of the iceberg and claim that underlying causes of the phobia will remain. In the future the symptoms will return or symptom substitution will occur, when other abnormal behaviours replace the ones that have been removed.
Flooding
Flooding involves directly exposing the patient to their phobic object. Flooding stops phobic responses very quickly. This is because the patient does not have the option for any avoidance behaviour, and they quickly learn that the phobic object is harmless, and therefore extinction occurs. In some cases the patient might achieve relaxation in the presence of their phobic object because they are so exhausted by their own fear response. Flooding is ethical, even though it can cause a great deal of initial psychological harm; the patient would have to give their fully informed consent so that they were fully prepared for the flooding session. Patients are given the choice of either having SD or flooding. Flooding therapy sessions usually last 2-3 hours, which is much longer than SD sessions.
Flooding AO3 (1p, 1n)
+ Wolpe (1960) supports the use of flooding to remove a patient’s phobia of being in cars. The girl was forced into a car and driven around for four hours until her hysteria was eradicated. This demonstrates how effective flooding is as a treatment for phobias.
- A disadvantage of flooding is that it is a highly traumatic experience and many patients might be unwilling to continue with the therapy until the end. Time and money might be wasted preparing patients for the flooding experience, and then the patient might decide that they do not want to take part or complete the treatment, and their phobia remains uncured. Because flooding is traumatic it is unsuitable for children.
Behavioural characteristics of depression
Change in Activity Levels: Some people with depression experience lethargy (lack of energy) and withdrawal from activities that were once enjoyed (anhedonia). They may also neglect personal hygiene. Other people with depression experience increased activity levels/agitation.
Disruption to Sleep: Depression is often characterised by constant insomnia whereby they have difficulty falling asleep and staying asleep. Alternatively they might require large amounts of sleep and they might oversleep (hypersomnia).
Disruption to Eating Behaviour: Significant increase or decrease in weight is associated with depression. Some people might eat a great deal when they are depressed and therefore put on weight. Other people have a reduced appetite and eat very little, and therefore lose weight.
Aggression: Sufferers of depression are often irritable and they can become physically or verbally aggressive. They might also be physically aggressive towards themselves in the form of self-harming, such as cutting themselves or attempting suicide.
Emotional characteristics of depression
Low Mood: A key characteristic of depression is the ever present and
overwhelming feelings of sadness/hopelessness and feeling empty.
Feelings of Worthlessness: Sufferers of depression often have constant feelings of reduced worth and/or inappropriate feelings of guilt. They might also experience very low levels of self-esteem.
Anger: The person might feel anger towards others, or towards themselves. Depression may arise from feelings of being hurt and wishing to retaliate.
