Psychopathology Flashcards
How might people define ‘Being Normal’
Acting in a way that society defines as acceptable and natural (socially acceptable manner)
Fits in with with society’s expectations
Seen as being desirable
How might people define ‘Abnormality’
Goes gassing societal norms and expectations
Quite rare/less frequently seen
Generally considered as undesirable
Statistical Infrequency
One way to define anything as ‘normal’ or ‘abnormal’ is to consider and count how often we see it
Any behaviour that is relatively com on is seen as normal
Any behaviour that is rare is seen as abnormal
E.G: - schizophrenia has a 1% prevalence rate
- bipolar disorder has 2.8% prevalence rate
- bpd has a 0.1-2% prevalence rate
- 5% of people have an IQ either under 70 and more than 130
These are all rare and therefore seen as abnormal
Statistical Infrequency Strength
One strength of this definition is that is has real world application
For example, it is used in clinical practise to help assess and diagnose individuals
Fern example, in order to be diagnosed with an intellectual disability you need to be in the bottom 2% of IQ scores (an IQ below 70)
Or to be considered to have severe depression you would need to have a score in the top 5% on the Beck Depression Inventory (a score 30 or above)
This is a strength because ‘abnormal’ diagnosis can benefit individuals because they can then access relevant support services or therapies
Statical Infrequency Limitations
One limitation is that a rare characteristic can also be a positive and seen as desirable
For example, according to this definition, people with a high IQ (which is seen as desirable) are labelled as ‘abnormal’
This is a limitation because ‘abnormal’ implies undesirability and a high IQ is actually desirable
Another limitation is that mental illness is not that rare, but mental illness is considered as abnormal. 1 in 4 people will experience a mental health problem of some kind each year in England, which isn’t rare
Deviation from Social Norms
Most of us notice when people behave in a way that deviates from social norms
- i.e. behave in a way that goes against what a group considers to be socially acceptable ways of acting
These social norms are specific to the culture we live in (both across time and culture)
Any characteristic that deviates from the social norm in which the person lives is seen as abnormal
Behaviours that would deviate from British 21st century social norms and therefore considered abnormal according to this definition
Social norms (explicit laws):
Don’t murder
Don’t steal ext
Implicit (implied):
Showing respect
Behaving appropriately for the occasion (e.g. don’t wear swim wear to college)
Mental Disorder Considered as Deviation
One example of a behaviour that would be considered abnormal under this definition is antisocial personality disorder (psychopathy)
Personality traits of this include:
- manipulativeness
- deceitfulness
- callousness
- hostility
Deviation from Social Norms Strengths
This definition takes into account whether the behaviour shown is desirable or not
For example, people with high IQs do not end up as being labelled abnormal according to this definition as they are not breaking social norms with their intelligence
This is a strength because is it a better definition than statical infrequency because bit takes into account the desirability of the behaviour.
This increases the validity of the definition as it makes it more accurate
Deviation from Social Norms Limitations
Social norms, values, attitudes and morals change over time and consequently so do ideas about what is normal and abnormal
For example, ideas about homosexuality gave changed over the years. In the past in Britain, it was illegal to be gay. People who were gay were considered to deviate from social norms and therefore as abnormal and suffering from mental illness. It wasn’t until 1973 that
homosexuality was removed as a mental illness. However now it is considered very normal.
This is a limitation as it means we never have a definite understanding of abnormality. It makes this definition lack reliability and consistency.
However it can also be seen as strength because it shows that the definitions of abnormality reflect current knowledge and understanding of human behaviour
Deviation from Social Norms Strength 2
It is the case that many people who are clinically abnormal do behave in a way that breaks social norms.
For example, people who have antisocial personality disorder will steal from or hurt other people - 2 behaviours that break social norms
People with anxiety also sometimes display behaviours that would be considered abnormal, just not to the same extreme. For example they may:
- avoid eye contact
- doesn’t make conversation
- not speaking up when expected
This is a strength because it suggests the definition has validity
- i.e. it actually measures what it claims to measure (abnormality)
Deviation from Social Norms Limitation 2
This definition can lead to people who are non-conformists and/or eccentric to being labelled ‘psychologically’ abnormal
Fo example people with multitalented extreme piercings or those involved in subcultures like goths do in always differ from implicit social norms at Tim’s, but aren’t actually psychologically abnormal
This is a limitation because it shows the definition cannot always accurately identify abnormality
Failure to Function Adequately
Any characteristic or behaviour that prevents a person from coping and managing with day to day demands is seen as abnormal
Some day to day demands that this might be impacted by a failure to function adequately are:
Holding down a job
Getting an education
Basic self-care
Holding down romantic and platonic relationship
Going shopping
Getting a bus
Measuring How Well an Individual Functions
The Global Assessment of Functioning Scale (GAF) is a method of measuring how well individuals function in everyday life based upon the following criteria:
1 unpredictability
2 maladaptive behaviour
3 personal distress
4 irrationality
5 observer discomfort
6 occupational dysfunction
The more of these criteria met, the less likely you are to be able to function adequately
Based off the DSM-5 criteria for depression, why might someone with depression be considered abnormal under the failure to function definition?
Someone with depression will find it hard to go to work or college due to fatigue and/or due to their reduced or diminished concentration. They will also find it hard to maintain high levels of self-care (e.g. not eating properly). They will find it difficult to hold down relationships due to feelings of worthlessness. So people with depression are likely to score high on the GAF. Their behaviour is maladaptive, it causes personal distress and it results in occupational disfunction too
Failure to Failure Adequately Strengths
The definition as validity - it is the case that the majority of people with a diagnosed mental health illness do fail to function adequately e.g. depression, schizophrenia, agoraphobia
It can be a good indication that someone might need help if they suddenly stop being able to function adequately
It does acknowledge how the person themselves feel. The GAF considers personal distress when measuring the extent to which someone is failing to function
Failure to Function Adequately Limitations
Some abnormal behaviours can actually help a person to function e.g. OCD rituals will reduce anxiety in the short term and help you cope
Not all people with a mental illness fail to function adequately e.g. some addicts can hold won a job, have a normal family, have a nice house and so on. They do appear to functioning adequately, however they are still struggling greatly
At some points in our lives, most of us will fail to function adequately e.g. at a time of bereavement
- it can become difficult to judge when someone’s grief moves from being normal grief levels to abnormal grief levels
Deviation from Ideal Mental Health
Any individual who does not meet the criteria of being ‘normal’ is seen as abnormal
Ideal mental health may look like:
- being happy
- having self-confidence
- good self esteem
- willing to give new things a go
- having good relationships with others
- having good coping strategies
Ideal Mental Health Criteria
The psychologist Maria Jahoda was one of the early pioneers to focus more on mental health than mental illness
In the 1950s, she said that ideal mental health consists of having:
- no symptoms or distress
- a positive attitude towards oneself
- the opportunity to self-actualise
- the ability to resist stress
- personal autonomy
- an accurate perception of reality
- the ability to adapt to one’s environment
Deviation from Ideal Mental Health Strength
A strength is that this definition allows for an individual who is struggling to have targeted intervention is their behaviour is not seen as ‘normal’
For example, a lack of self-esteem could be addressed to help their behaviour becoming normal. This could involve visiting a counsellor who will help them providing unconditional positive regard, warmth and empathy
This is a strength because it allows for clear goals to be set focused upon achieving ideal mental health, and, in Johoda’s opinion, achieve normality
Deviation from Ideal Mental Health Limitation
The criteria outlined by Jahoda makes ideal mental health (normality) practically impossible to achieve
For example, at times, we all struggle to adapt to change (e.g. bereavement our when we are faced with stress or with our self esteem)
This is at limitation because it means that to be ‘mentally healthy’ (i.e. normal) os very hard to achieve, so we are likely to all be diagnosed as ‘abnormal’; according to this definition
Deviation from Ideal Mental Health Limitation 2
The definition can be seen as culture-bound to western, individualistic cultures
(Individualistic ‘what is in it for me’. Non-western collectivist ‘how well my actions impact on others)
For example, the criteria of autonomy makes the collectivist cultures, where the greater good hand helping/relying on others is encouraged, seem abnormal. As most western cultures are individualistic, the criteria outlined by Jahoda seem a reasonable fit, but non-western cultures cannot relate yo the criteria she outlines
This is a limitation because it mans that this definition lacks population validity i.e. it is not true for all people
DSM-5 Categories of Phobias
Phobias are an excessive fear and anxiety triggered by an object or a situation
Separate from specific phobias, the DSM-5 recognised the categories social phobia
- phobia of a social situation such as public speaking
They also recognise agoraphobia
- phobia of being outside
Characteristics of Phobias
Regardless of the type of phobia, they are characterised by the same behavioural, environmental and cognitive responses
- i.e. how we act, feel and think in the presence of the phobic stimulus
Behavioural Characteristics of Phobias
When we are faced with something that may threaten our safety, we respond by behaving in a particular way
Generally this is high levels of anxiety or trying to escape (fight or flight)
There are three that we need to know about:
- panic
- avoidance
- endurance
Behavioural Characteristics of Phobias - Avoidance
Unless someone is making a conscious effort to face their phobia, people will typically go to extreme lengths to avoid and prevent coming in to contact with the phobic stimulus
This type of avoidance behaviour can make everyday life very difficult
E.g. someone with a fear of public toilets may limit the amounts of time they spend outside of the home
Behavioural Characteristics of Phobias - Endurance
In direct opposing to avoidance is endurance
This is where an individual exposes themselves to the phobic stimulus but is in a constant stat of high naxie ty while doing so
Someone with arachnophobia may do this by picking up a spider in their house
Someone might do this if their stimulus is unavoidable. For example, a person with agoraphobia may need to leave the house to get food shopping to continue to live
Behavioural Characteristics of Phobias - Panic
Someone with a phobia may panic in the presence of the phobic stimulus
This could involve a range of behaviours. This might involve:
- shaking
- crying
- heavy breathing
Children may respond differently and may freeze, have a tantrum or cling to their caregiver
Emotional Characteristics of Phobias
These characteristics are related to a person’s feelings or mood
There are three that we need to know about:
- anxiety
- fear
- unreasonable emotional response
Emotional Characteristics of Phobias - Anxiety
DSM-5 classifies phobias as anxiety disorders
- therefore by definition they involve an notional response of anxiety
This prevents a person from relaxing because they are in a very unpleasant state of high arousal which makes it very difficult for the individual to experience any positive emotions
This can be long term
Emotional Characteristics of Phobias - Fear
We may use ‘anxiety’ and ‘fear’ interchangeably, but we need to know their distinct definitions and meaning in terms of phobias
Fear is immediate and extremely unpleasant, experienced when we encounter or even thinjk about the phobic stimulus
- (anxiety is more feeling uneasy or distressed about a situation or object)
It is generally more intense but for shorter periods than anxiety
We experience fear when our fight or flight response is activated
Emotional Characteristics of Phobias - Unreasonable Emotional Response
The degree of anxiety and fear experienced by omens with a phobia is significantly greater than the average person and can be seen as an unreasonable emotional response to the phobic stimuli
Cognitive Characteristics of Phobias
The cognitive aspect of phobias is concerned with how individuals process information
People with a phobia generally process information about the phobic stimulus differently from other objects or situations
The three we need to know about are:
- selective attention to the stimulus
- irrational beliefs
- cognitive distortions
Cognitive Characteristics of Phobias - Selective Attention to the Stimulus
If an individual can see the phobia stimulus, it can be very difficult to look away from it
Keeping an eye on something that could potentially be dangerous is a good thing as it give us the best chance of reacting quickly, should we need to
This is not so useful when he fear is irrational,m as it is with the phobia
Obsessively checking for the phobic stimulus may put you in danger
- e.g. you may be distracted while looking and getting hit by a moving vehicle
Cognitive Characteristics of Phobias - Irrational Beliefs
People with phobias typically hold unfounded irrational beliefs about the phobic stimulus
- i.e. having very little basis in reality but persist in the absence of evidence for them
Form example, people with social phobias may think that if they blush, others will perceive them as weak
This irrational belief increases the pressure on the individual to perform well in social situations, and so increases the anxiety and so on
Cognitive Characteristics of Phobias - Cognitive Distortions
People with phobias generally have distorted perceptions that maybe inaccurate or unrealistic
They may consider the phobic stimulus to be ugly or disgusting, compared to the opinion of most of he population
The Two-Process Model
The two-process model explanation of phobias is based on they behaviourist approach and therefore it suggests that phobias are learnt
The behavioural explanation of phobias isn particularly concerned with the three behavioural characteristics of phobias (panic, avoidance, endurance)
Mowrer (1960) proposed the two-process model as a way of explaining phobias
This states that phobias are acquired by classical conditioning and are maintained by operant conditioning
The Two-Process Model - Classical Conditioning
The basic idea here is that we first acquire the phobia through the process of classical conditioning
We have an unpleasant and scary experience with an object or situation and then we associate the object or situation with fear
This is the first process in the two-process model
The Two-Process Model - Operant Conditioning
A response (including a phobia) that is acquired by classical conditioning will generally be extinguished, unless it is maintained by operant conditioning
- i.e. deteriorate over time
This might happen if the idea of the phobia is continued to be reinforced reinforcement (specifically negative reinforcement) and punishment
In the case of negative reinforcement, an individual avoids a situation that is unpleasant, which results in a desirable consequence so the behaviour is not repeated
Mowrer also said that when we avoid the phobic stimulus, we escape the anxiety and fear that we would have experienced, which reinforces the avoidance behaviour and maintains the phobia
The Two-Process Model Strength
One strength is that there is evidence to support the two-process model with studies that show a link between bad experiences and phobias
For example, in addition to the Little Albert Study, Jongh et al (2006) found that 73% of people with a fear of dental treatment has experienced a traumatic experience (mainly involving dental treatment) compared to only 21% of a control group with low fear of dental treatment
This is a strength because it adds validity to the theory that phobias develop due to classical conditioning, due to a fearful experience being paired with a stimuli
The Two-Process Model Limitation (linked to a strength)
However, the Jongh et al (2006) dentist study shows that the evidence isn’t fully conclusive
It shows that 27% of people who have a phobia of the dentists did not ever have a traumatic experience that triggered the phobia. How are their phobias then explained?
There was also 21% of people in the control group of low fear of the dentist had a traumatic experience at the dentist, but didnb’t have a phobia. Why is this?
Finally, many people in the UK have a phobia of snakes yet there is a low likelihood of exposure ton these for a traumatic experience to occur. These phobias may be better explained through evolution and the theory of biological preparedness
The Two-Process Model Limitation 2
One limitation is that the two-process model focuses mainly on the behavioural elements such as avoidance.
Other characteristics are ignored, such as the emotional characteristics (anxiety, fear and unreasonable emotional response) and the cognitive characteristics (selective attention to the stimulus, irrational beliefs and cognitive distortions)
This is a limitation because this is not then a complete explanation of the characteristics of phobias
The Two-Process Model Strength 2
One strength is that the two-process model has practical applications with exposure therapies for phobias
For example, exposure therapies such as systematic desensitisation and flooding work by preventing the avoidance response. This will help because it means the phobia is not being negatively reinforced. This means that people can face their phobia and it can be extinguished
This is a strength of the two-process model identifies a means of treating phobias. This also adds to the validity of the model because if it was ‘wrong’ then any therapies based on it wouldn’t work
Systematic Desensitisation
At the heart of SD is counterconditioning
This refers to learning a new stimulus-response association that runs counter to the original association
So in the context of phobias, the client will move from responding to a stimulus with fear too responding to it with relaxation
First Process of SD
Anxiety Hierarchy:
They therapist and client work together to create an anxiety hierarchy in which we arrange situations related to the stimulus in order from the least frightening (at the bottom) to the most frightening (at the top)
Second Process of SD
Relaxation and reciprocal inhibition:
- deep breathing exercises
- muscle relaxation exercises
- mental imagery techniques
- use of drugs such as Valium
It is important that the client can relax because it is physically impossible to be both anxious and relaxed at the same time as they are opposite physical states
- known as reciprocal inhibition
Third Process of SD
Exposure:
- work up the hierarchy, starting with the least feared situation
- you are exposed to it and employ your relaxation
- once you can be exposed to it and stay calm and more relaxed, move up to the next level
- the goal is to reach the top, the most feared situation, and stay relaxed
In Vivo - work up the hierarchy with actual exposure at each level (so, for example, you are in a room with a real dog on a lead)
In Vitro
SD Strength - Supporting Research
One strength of SD is that there is supporting research showing that is it an effective therapy
For example:
- McGrath (1990) reported that approx. 75% of people with phobias responded successfully to SD
- Capafons (1998) found that 20 clients with a fear of flying who received a 12-25 week programme of SD showed less psychological signs of fear and reported lower fear levels whilst in a flight simulator compared to a control group of 21 clients with a fear of flying two received no treatment
- Gilroy et al (2003) followed up on 42 people who had three 45 minute SD sessions for a spider phobia compared to a control group who were treated with relaxation without exposure. At both 3 months and 33 months, the SD group were less fearful than the control group
- a recent review by Wechsler et al (2019) concluded that SD is effective for specific phobias, social phobias and agoraphobia
This is a strength because it adds validity to SD as a therapy - it shows that it can help people over come phobias, suggesting it is a valuable therapeutic technique
SD Limitation
One limitation of SD is that it isn’t an appropriate treatment for all phobias
For example , Seligman (1970) argued that SD would not be effective for treating phobias that have a biological evolutionary explanation (e.g. snakes, heights) rather than a conditioning explanation, because these phobias are not learnt and therefore cannot be ‘unlearnt’
This is a limitation because it means that not everyone with a phobia will benefit from SD and it might waste time on a therapy that would never work for them because it wasn’t learnt
SD Strength - a more accessible therapy
One strength of SD is that as a therapy it is readily accessible to most people, including people who might usually struggle to use psychological therapy for some reason
For example:
- people with learning disabilities who have phobias who may struggle with other forms of therapy with their phobia (e.g. cognitive therapy which requires a high level of cognitive processing to examine thoughts and reasons behind the phobia) can work with SD
This is a strength because it means that a number of people who who otherwise might not be able to treat their phobia can be helped to over come it
SD Strength - Cost-effective and safe options
One strength of SD is that it can be seen as being both a cost-effective and safe option fo treating phobias
For example, in vitro SD could be sued where exposure would be dangerous and expensive, e.g if a client has a phobia of sharks where it could potentially be dangerous and very expensive to take them swimming with sharks in the sea with a shark cage
This is a strength because it shows that clients don’t actually have to face their fear in order to benefit from SD, showing that it is a very flexible therapy that can save money
However, there is some evidence to suggest in vitro SD is less effective than in vivo exposure. This could be because you are never actually put in a situation where you actually have to physically face their phobia, and therefore you are never putting into practise your strategies that you have in case you ever do
SD Strength - Ethics
One strength of SD is that it can be seen as a more ethical treatment of phobias compared to other exposure therapies, such as flooding
From example, the anxiety hierarchy is drawn up with the client and the therapist together and each step up the hierarchy is conducted at the pace of the client
This is a strength because it means that the client is more likely to stick withy the therapy and ultimately be counter-conditioned
However, there is still inevitably still going to be stress for the client given the nature of SD, as it exposes them to their phobic stimuli
Flooding
Flooding also involves exposing people with a phobia to their phobic stimulus, but without a gradual build-up in an anxiety hierarchy
Instead, flooding involves immediate exposure to a very frightening situation
So a person with arachnophobia receipt flooding treatment might have a large spider crawl over them for an extended period
Flooding sessions are typically longer than SD sessions, one session lasting two to three hours
Sometimes only one session is needed to cure a phobia
How Does Flooding Work?
Flooding stops phobic responses very quickly
This may be because, without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless
In classical conditioning terms, this process is called extinction
- a learned response is extinguished when the conditioned stimulus (e.g. dogs) is encountered without the unconditioned stimulus (e.g. being bitten)
- the result isn that the conditioned stimulus no longer produces the conditioned response (fear)
Ethical Safeguards
Flooding is not unethical per se but it is an unpleasant experience, so it is important that clients give fully informed consent to this traumatic procedure and they are fully prepare before the flooding session
A client would normally be given the choice of systematic desensitisation or flooding
