psychopathology Flashcards
Definitions of abnormality
Statistical infrequency: This definition says behaviour is abnormal if it is rare or uncommon. It is not performed by most people in the population. An example of this is intellectual disability only 2% of the population have an IQ below 70. Generally if the trait is only seen in less than 5% of the population it will be abnormal.
This is a useful definition in some ways because it has helped us to diagnose intellectual disability disorder. An IQ test can be used and if the individual has a score of below 70 they have intellectual disability disorder. This is simple to diagnose and can then lead to help being offered.
However, some behaviours that are rare are not really undesirable or abnormal. Based on this definition those with a very high IQ (or geniuses) would be classed as abnormal which is not appropriate. Conversely, some traits that would fit our understanding of mental illness would not be abnormal using this definition such as depression which is relatively common. This shows that this approach is too simplistic in defining abnormality.
Deviation from social norm
Deviation from social norms: This definition says behaviour is abnormal if it is different to how people are expected to behave in society at that point in time. Social norms can be described as unwritten rules eg be polite, don’t stare at people, don’t stand too close to people. Someone with schizophrenia might show inappropriate emotions and psychopathy deviates from moral norms.
This definition is useful in the diagnosis of antisocial personality disorder (APD). This is when a person is impulsive and often aggressive, pleasing only themselves. One important symptom is an absence of prosocial internal standards and a failure to conform to lawful or culturally ethical behaviour. So this definition can help us in diagnosing APD.
One limitation of this definition is that social norms vary over time and between cultures. What is deemed as deviation from social norms in one culture may not deviate in another. For example, homosexuality is social acceptable in some countries but not others and views on this have also changed significantly over time within the UK. This shows how this definition could not be used as a universal guide as some people’s behaviour may be misrepresented as abnormal when it isn’t.
Failure to function
Failure to function: This definition sees people as abnormal if they cannot cope with everyday life. For example, eating regularly, washing clothes, being able to communicate with others and having some degree of control over your life is seen as functioning adequately. If a person cannot do this and are also experiencing distress (or others are distressed by their behaviour) then it is considered a sign of abnormality.
One strength of this theory is that it does include the patient’s perspective (the distress they are experiencing) which definitions that look at how common behaviours are do not. This is useful for diagnosis as practitioners can talk to the sufferer and decide if they need psychiatric help based on the number of symptoms they show.
However this definition can be criticised for ignoring some forms of abnormality. Some abnormality does not include dysfunction (psychopaths are able to cope with everyday life and would not report being unable to cope but are abnormal). So this is not a complete definition
Deviation from Ideal mental healt
Deviation from Ideal mental health: According to Jahoda there are a number criteria for ideal mental health (deviating from these would be classed as abnormal) positive attitude about self, self-actualisation (achieving goals), resistant to stress, autonomy (don’t rely on others too much), accurate perception of reality, no symptoms of distress. Eg those with depression have a low self-esteem so a negative attitude to self and are very distressed.
This is quite a positive approach as the focus is on what is desirable and what we can work towards so this is quite an optimistic definition. It is also quite comprehensive, it includes lots of different elements so it’s more of a holistic approach than say statistical infrequency. Hopefully this should lead to a more complete definition.
However many argue that the criteria are too over-demanding and expect a lot of us. Most people do not meet some of these criteria at some point in their lives (low self-esteem and stress are incredibly common) so this may in fact not be a valid definition of abnormality.
The behavioural approach to explaining phobias A01
Behaviourists would say that phobias are learnt. We are born a blank slates and our experiences determine the phobia. The two-process model says that we acquire a phobia through classical conditioning by associating a fearful event (an unconditioned stimulus) with a previously neutral object/ situation (neutral stimulus) which will become frightening after the pairing (conditioned stimulus/ response). We maintain a phobia through operant conditioning. Avoiding the phobic stimulus is negative reinforcement and anxiety when in the presence of the phobic stimulus is punishment.
The behavioural approach to explaining phobias A03
Watson and Raynor can offer support for this theory. Little Albert was classically conditioned to be afraid of white fluffy things when a white rat was paired with a loud noise behind his head. He has no fear of white fluffy things before the experiment so he had clearly learnt the phobia through classical conditioning.
This explanation however fails to explain the cognitive characteristics of a phobia such as the irrational beliefs about the danger of the source of the phobia. This approach only explains phobias on an observable behavioural level so does not explain where this irrational belief came from. So this approach must not be a complete explanation.
There are however practical applications of this theory to treatments for phobias. Systematic desensitisation is based on the idea that what has been learned can be unlearned and seeks to reverse the process of classical conditioning by pairing the phobic stimulus with relaxation. Therefore this explanation is useful as it has led to successful treatments.
However the behavioural approach (nurture) fails to explain why some objects or situations are more likely than others to form the basis for phobias. This might be better explained by evolutionary factors (nature). Being phobic of heights or snakes therefore avoiding them at all cost would enhance survival for our ancestors. Therefore we might be genetically programmed to develop phobias of some stimuli and the evolutionary approach might be needed to further understand phobias.
The behavioural approach to treating phobias
Systematic desensitisation is a behavioural therapy based on reversing the process of classical conditioning. It is used to treat phobias and it is based on the idea that we learn phobias by association. The therapist will first ask the client to make a fear hierarchy (from least to most scary) of stimulus related to their phobia. For example if you were afraid of dogs the least scary might be seeing a picture of their fur and the most might be stroking a real dog. Next the therapist will teach the client relaxation techniques such as deep breathing and counting back from 10. The client will be presented with the 1st step of their hierarchy and must use the relaxation techniques to replace the fear with relaxation (this is called reciprocal inhibition). When they feel relaxed they can move on to the 2nd step and they must repeat this process. When they can feel relatively relaxed around their most scary step then they are thought to be recovered.
SD has been found to be effective in treating phobias. Gilroy et al followed up 42 patients who had SD for spider phobias at both 3 and 33 months and found that the SD group were less fearful than the control group (treated with just relaxation). This shows that SD is helpful in reducing spider phobias.
Additionally patients do prefer SD to flooding as it does not cause as much trauma and you can move at your own pace. If patients prefer it they are less likely to drop out which will increase the effectiveness.
When a treatment for phobias is effective it will be beneficial for the economy. The phobia might be preventing the sufferer from living a normal day to day life like going to work. If they can get back to work they can be more productive, earn more, consume more and pay more taxes all of which are beneficial for the economy. However, this approach is slightly more expensive than flooding as it requires more sessions and more therapist hours which will put more strain on the NHS which is less beneficial for the economy
FLOODING
Flooding is a behavioural therapy for phobias it involved immediate exposure to the phobic stimulus. The phobic patient is bombarded with the phobic object without any gradual build up. Without the option of avoidance behaviour the patient should learn quickly that the phobic object is harmless through exhaustion of the fear response. This is known as extinction. Flooding is not unethical but it is unpleasant experience so informed consent is an important element of the process.
FLOODING A03
Flooding is a traumatic treatment for patients so there is a chance that they will not be able to stand it until extinction occurs. This makes the treatment ineffective. It is also not appropriate for children or those with learning difficulties who may not be able to understand what is happening so this is not a flexible treatment for all sufferers.
Additionally flooding is less effective for some types of phobias. It may be effective for some simple phobias but more complex ones that include cognitive elements such as social phobias will not be helped by a simple behavioural treatment that does not tackle thought processes. This treatment therefore does not have a wide application.
One benefit of this approach however is that in the cases where is will work it may be preferable over SD because it will require less time and resources to be successful. It could be resolved in 1 session whereas SD takes multiple sessions. This is therefore more cost-effective.
Biological explanations for OCD
One biological explanation for OCD is that it is inherited in our genes. Research has identified a number of candidate genes (genes which increase the risk of having OCD). An example of a candidate gene is 5HT1-D this has been linked to serotonin production. OCD is thought to be polygenic meaning there are several genes involved (Taylor found up to 230 separate genes may be involvE
Another biological explanation for OCD is neural explanations. This states that low levels of serotonin in the synapse are involved. Serotonin is a neurotransmitter which relays information about mood from neuron to neuron. Low levels of serotonin is therefore linked to low mood which is linked to the anxiety felt in OCD.
Another neural explanation is low levels of general activity in the frontal lobes. The frontal lobes are involved with decision making and logical thinking. Low activity here is linked to impaired decision making which may be why those with OCD cannot stop performing their compulsive rituals even though they want to and why they experience the illogical thoughts
biological explanation A03
GENES
There is good supporting evidence for the genetic explanation of OCD. For example, Nestadt found that 68% of monozygotic (MZ) identical twins shared OCD as opposed to 31% of dizygotic (DZ) non-identical twins. This strongly supports the genetic explanation because MZ twins share 100% of their DNA and DZ twins share 50%. However, if OCD was a purely genetic disorder we would expect the risk of having OCD to be 100% is your MZ twin had it. So there must be some other (nurture) influences involved.
Another limitation of the genetic explanation is the fact that too many genes have been identified as increasing the risk (not as direct causes). This means we cannot really use this theory to predict who might suffer from OCD. Or use this information to create interventions. So this is reduces the usefulness of genetic explanations
NEURAL EXPLANTION
One strength of neural explanations is the practical application to antidepressants (SSRIs). SSRIs work by increasing levels of serotonin in the synapse (by blocking reuptake). This has been found to reduce the symptoms of OCD suggesting that serotonin must be involved in OCD.
However, it is difficult to tell whether serotonin levels have actually caused OCD or if they are just a part of the disorder. For example, it is possible that OCD (perhaps the thought patterns involved) cause the low levels of serotonin rather than the other way around. This reduces the strength of this theory.
The biological approach to treating OCD
Biological treatment for OCD involves drug therapy. In general, drug therapy for mental disorders works by increasing or decreasing levels of neurotransmitters in the brain to increase or decrease their activity. Drug therapy for OCD seeks to increase the activity of serotonin. Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant which block reuptake to the presynaptic neuron so that more serotonin is available in the synapse and more can bind with the receptors on the post-synaptic neuron. An example of an SSRI is Fluoxetine which is usually taken as a tablet. A typical daily dose is 20mg. SSRIs help the sufferer to cope with low mood and anxiety symptoms of OCD.
An alternative so SSRIs (if they don’t work with the individual) is SNRIs these are a new antidepressant which increase levels of serotonin and also noradrenalin
biological approach to treating OCD A03
There is evidence for the effectiveness of SSRIs on OCD. Soomro reviewed 17 studies comparing SSRIs to placebo and found significantly better results for SSRIs than placebo condition it was also better when combined with CBT. This suggests that SSRIs can help OCD sufferers and that the best approach might be to take SSRIs and then to engage in CBT.
Drug therapy is cost effective to prescribe and cheaper than other psychological treatments such as CBT. Drugs can be taken at home and do not require therapist hours which reduces the strain on NHS resources. Therefore more people can be treated by SSRIs than by CBT and this is beneficial for the economy.
However SSRIs do have potential side effects. Some of the more common side effects include indigestion, loss of sex drive and blurred vision. This may put some people off taking them and therefore they will no longer be effective.
SSRIs are also not a long term solution unless you continue taking them. They do not address any potential psychological causes which may have led to the development of OCD, they simply mask the symptoms. So if you stop taking them the symptoms are likely to return. This is why it is best to engage in both drug therapy and CBT to address the cognitive aspects as well as the biological aspects of the disorder.
