Psychopathology Flashcards
Statistical infrequency
Some abnormal behaviours are desirable- very few people have an IQ over 150 but this abnormality is desirable not undesirable. Equally, some ‘normal’ behaviours are undesirable. Experiencing depression, is relatively common, therefore using statistical infrequency to define abnormality means we are unable to distinguish between desirable and undesirable behaviours.
Subjective (limitation)- need to decide where to separate normality from abnormality. One symptom of depression is ‘difficulty sleeping’. Some people might think abnormal sleep is less than 6 hours a night on average, others may think it is five hours. Such disagreements mean it is difficult to define abnormality in terms of statistical infrequency.
SI is sometimes appropriate- some situations it is deemed appropriate to use statistical criterion to define abnormality. Intellectual disability, is defined in terms of normal distribution using concept of standard deviation to establish a cut off point for abnormality. Any individual whose IQ is more than two standard deviations below the mean is judged as having a mental disorder- however, such a diagnosis is only made in conjunction with failure to function adequately. This suggests statistical infrequency is only one of a number of tools.
Cultural relativism- issue is that behaviours that are statistically infrequent in one culture may be statistically more frequent in another. One of the symptoms of schizophrenia is hearing voices, however this is an experience that is common in some cultures. Therefore, there are no universal standards or rules for labelling a behaviour as abnormal.
Deviation from social norms
Cultural relativism- attempting to define abnormality in terms of social norms is obviously bound by culture because social norms are defined by culture. Classification systems such as the DSM are almost entirely based on the social norms of the dominant culture in the West (white and middle class) and yet same criteria is applied to people from different subcultures. E.g in panic attacks a note is made that uncontrollable crying may be a symptom in some cultures, whereas difficulty breathing may be a primary symptom in other cultures. This shows that it is possible to address this issue by including cultural differences in diagnostic systems.
-susceptible to abuse- what is socially acceptable no way have not been acceptable 50 years ago. For example, homosexuality is acceptable in most countries in the world but in the past it was included under sexual and gender identity disorders in the DSM. Therefore, if abnormality is defined in terms of deviation from social norms then there is a real danger of creating definitions based on prevailing social morals and attitudes.
-deviance is related to context and degree- judgement on deviance are often related to the context of a behaviour. E.g a person on a beach wearing next to nothing is considered normal whereas the same outfit in a classroom or at a formal gathering would be regarded as abnormal and possibly an indication of a mental disorder. Shouting loudly and persistently is deviant behaviour but not evidence of mental disturbance unless it is excessive- even then it might not be a mental disorder. This means social deviance on its own cannot offer a complete definition of abnormality, because it is inevitably related to both context and degree.
Some strengths- does distinguish between desirable and undesirable behaviour. Deviance is defined in terms of transgression on social rules and ideally social rules are established in order to help people live together. According to this definition, abnormal behaviour is behaviour that damages others. This definition, offers a practical and useful way of identifying undesirable and potentially damaging behaviour which may alert others to the need to secure help for the person concerned.
Failure to function adequately
Who judges?: In order to determine the ‘failure to function adequately’ someone needs to decide if this is actually the case. It may be that the person is experiencing personal distress, the patient might recognise that this is undesirable and may feel distressed. On the other hand, it may be that the individual is quite content with the situation and/or completely unaware that they are not coping. It is others who are uncomfortable and judge the behaviour as abnormal.
The behaviour may be quite functional: some dysfunctional behaviour can be adaptive and functional for the individual. Some mental disorders, like eating disorders and depression, may lead to extra attention for the individual. Such attention is rewarding and quite functional rather than dysfunctional for the individual.
Deviation from ideal mental health
Unrealistic criteria: One of the major criticisms of this definition is that, according to these criteria most of us are abnormal, and how many of the criteria do we need to be lacking before judged as abnormal. Furthermore the criteria are difficult to measure so isn’t very useable when identifying abnormality.
Suggests mental health is the same as physical: It is possible some mental disorders also have physical causes (e.g brain injury or drug abuse) but many do not. They are the consequence of life experiences, therefore it is unlikely we could diagnose mental abnormality in the same way we diagnose physical abnormality.
Behavioural approach to explaining phobias
The importance of classical conditioning: people with phobias often do recall a specific incident where there phobia appeared, for example being bitten by a dog or experiencing a panic attack in a social situation. (Sue et al 1994). However, not everyone who has a phobia can recall such an incident. It is possible such traumatic events did happen but have been forgotten since then (öst 1987). Sue et al suggests that different phobias may result of different processes. Agraphobics were most likely to explain their disorder in terms of a specific incident, whereas arachnophobics (scared of spiders) were most likely to cite modelling as the cause.
Diathesis-stress model: according to the two process model of phobias, an association between a neural stimulus and a fearful experience will result in a phobia. However, research has found, not everyone who is bitten by a dog develops a phobia of dogs (Di Nardo et al 1988). This could be explained by the diathesis-stress model. This proposes we inherit a genetic vulnerability for developing mental disorders. However, a disorder will only manifest itself if triggered by a life event, such as being bitten by a dog. So a dog bite would only lead to a phobia in those people with such vulnerability.
Support for social learning: Bandura and Rosenthal (1996) supported the social learning explanation. In the experiment a model acted as if he was in pain every time a buzzer sounded. Later on, those participants who had observed this showed an emotional reaction to the buzzer, demonstrating an acquired ‘fear’ response.
Behavioural approach to treating phobias (systematic de-sensitisation)
Effectiveness of SD: successful for a range of phobias. McGrath et al (1990) reported that about 75% of patients with phobias respond to SD. They key to success appears to lie with actual contact with the feared stimulus, so in vivo techniques are more successful than ones just using pictures or imagining the feared stimulus (in vitro) (Choy et al 2007). Often a number of different exposure techniques are involved- in vivo, in vitro and also modelling, where the patient watches someone else who is coping well with the feared stimulus (comer, 2002).
Not appropriate for all phobias: Öhman et al (1975) suggests SD may not be as effective in treating phobias that have an underling evolutionary survival component t (e.g fear of the dark, fear of heights or fear of dangerous animals), than in treating phobias which have been acquired as a result of personal experience.
Strengths of behavioural therapies: Generally relatively fast and require less effort on the patients part than other psychotherapies. CBT requires a lot of willpower from the patient in trying to understand their behaviour and apply these insights. This lack of ‘thinking’ means the technique is also useful for people who lack insight into their motivations or emotions, such as children or patients with learning difficulties.
A further strength of SD is it can be self-administered- a method that has proved successful, for example, social phobia (Humphrey 1973) also found that self-administered therapy was as effective as therapist-guided therapy, which obviously makes it much cheaper.
Behavioural approach to treating phobias: flooding
An alternative is to have one long session where the patient experiences their phobia at its worst while at the same time practises relaxation. The session continues until the patient is fully relaxed and their anxiety disappears.
EVALUATION OF FLOODING: individual differences: flooding is not for every patient. It can be highly traumatic procedure. Patients are obviously made aware of this beforehand but, they may quit during the treatment, which reduces the ultimate effectiveness of the therapy for some people.
Effectiveness: For those patients who do choose flooding as a treatment and do stick with it, it appears to be an effective treatment and is relatively quick (compared to CBT). Choy et al reported that both SD and flooding were effective but flooding was more effective at treating phobias. On the other hand, another review Craske et al (2008) concluded that SD and flooding were equally effective in the treatment of phobias.
Cognitive approach to explaining depression
Support for the role of irrational thinking: Hammen and Krantz (1976) found that depressed participants made more errors in logic when asked to interpret written material than non-depressed participants. Bates et al (1999) found depressed participants who were given negative automatic thought statements became more and more depressed, supporting the view that negative thinking leads to depression. However, due to their being a link between negative thoughts and depression does not mean negative thoughts cause depression. A depressed individual develops a negative way of thinking because of their depression rather than the other way around. It is also possible faulty thinking is a vulnerability factor for abnormality. People with maladaptive cognitive processes are at greater risk of developing mental disorders because of a genetic predisposition.
Blames the client rather than situational factors: the cognitive approach suggests it is the client who is responsible for their disorder. In one sense this is a good thing because it gives the client the power to change the way things are. However, it may leas to the client or therapist to overlook situational factors (how life events or family problems may have contributed to the mental disorder). The disorder is simply in the clients mind and the recovery lies in changing that, rather than considering how the client/ therapist might change other aspects of the client’s environment and life.
Practical applications in therapy: One evaluation point for any theory is the consideration of wether it can be usefully applied. CBT is consistently found to be the best treatment for depression especially when used in conjunction with drug treatments (Cuijpers et al 2013). The particular reason why these explanations are so useful is they have specific implications for the success of the therapy and the therapy supports the explanation- if depression is alleviated by challenging irrational thinking then this suggests such thoughts had a role in the depression in the first place.
Cognitive approach to treating depression
Research support: Ellis (1957) claimed a 90% success rate for REBT, taking an average of 27 sessions to complete the treatment. However, he recognised that the therapy was not always effective, and suggested that this could be because some clients did not put their revised beliefs into action (Ellis, 2001). REBT and CBT in general, have done well in outcome studies of depression. For example, a review by Cuijpers et al (2013) of 75 studies found that CBT was superior to no treatment.
Individual differences: CBT appears to be less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change (elkin et al 1985). CBT also appears to be less suitable in situations where high levels of stress in the individual reflect realistic stressors in the persons life that therapy cannot resolve (simons et al 1995). Ellis also explained a possible lack of success in terms of suitability- some people simply do not want the direct sort of advice that CBT practitioners tend to dispense. They prefer to share their worries with a therapist without getting involved in the cognitive effort that is associated with recovery (Ellis 2001).
Support for behavioural activation: The belief that changing behaviour can go some way to alleviating depression is supported by a study on the beneficial effects of exercise. Babyak et al (2000) studied 156 adult volunteers disavowed with major depressive disorder. They were randomly assigned to a four month course of aerobic exercise, drug treatment (an antidepressant) or a combination of the two. Clients in all three groups exhibited significant improvement at the end of fourth months. Six months after the end of the study, those in the exercise group had significantly lower relapse rates than those in the medication group, particularly among those who had continued with an exercise regime of their own.
-requires commitment and motivation from patient, this may be difficult for a depressed person
-requires self -report about their thoughts, which are unreliable and difficult to verify, may lead to social desirability bias
-alternative treatments: use of SSRIs
-success may depend on quality of client - therapist relationship
Biological approach to explaining OCD
Family and twin studies: Evidence for the genetic basis of OCD comes from the studies of first-degree relatives (parents or siblings) and twin studies. Nestadt et al (2000) indemnified 80 patients with OCD and 343 of their first degree relatives and compared them with 73 control patients without mental illness and 300 of their relatives. They found that people with a first degree relative with OCD had five times greater risk of having the illness themselves at some time in their lives, compared to the general population. A meta-analysis of 14 twin studies of OCD found that, on average identical (monozygotic) twins were more than twice as likely to develop OCD in their co-twin had the disorder than was the case for non-identical (dizygotic) twins (Billett et al 1998). However, these concordance rates are never 100%, which means environmental factors must play a role too (the diathesis stress model). Indeed it is the occurrence of OCD that seems to run in families rather than specific symptoms (such as obsession with dirt) which shows that there is at least an environmental contribution to OCD in terms of symptoms.
Tourette’s syndrome and other disorders: Pauls and Leckman (1986) studied patients with Tourette’s syndrome and their families, and concluded OCD is one form of expression of the same gene that determines tourettes. The obsessional behaviour of OCD and tourette’s patients is also found in children with autism, who display stereotyped behaviours and rituals as well as compulsions. Furthermore, it is reported that two out of every three patients with OCD also experience at least one episode of depression (Rasmussen and Eisen 1992). This all supports the view that there is not one specific gene or genes unique to OCD but they merely act as predisposing factors towards obsessive-type behaviour.
Research support for genes and OFC: Many studies demonstrate that genetic link to abnormal levels of neurotransmitters. For example, Menzies et al (2007) used MRI to produce images of brain activity in OCD patients and their immediate family members without OCD (a sibling, parent or child) and also a group of unrelated healthy people. OCD patients and their close relatives had reduced grey matters in key regions of the brain, including the OFC. This supports the view that anatomical differences are inherited and these may lead to OCD in certain individuals. Menzies et al concluded that, in the future, brain scans may be used to detect OCD risk.
Biological approach to treating OCD
Effectiveness: there is considerable evidence for the effectiveness of drug treatments. Typically a randomised control trial is used to compare the effectiveness of the drug vs a placebo. Soomro et al (2008) reviewed 17 studies of the use of SSRIs with OCD patients and found them to be more effective than placebos in reducing the symptoms of OCD up to three months after treatment i.e, in the short term. One of the issues regarding the evaluation of the treatment is that most studies are only three to four months duration and therefore little long term data exists (Koran et al 2007).
Drug therapies are preferred to other treatments: one of the great appeals of using drug therapy is that it requires little effort from the user and little input in terms of time, considerably less than required for therapies such as CBT where the patient has to attend regular meetings and put considerable thought into tackling their problems. From the point of view of the health service they are also cheaper because they require little monitoring and are cheap compared to psychological treatments. Furthermore they may still benefit from the fact that simply talking with a doctor during consultations may help.
Side effects: All drugs have side effects, some more severe than others, like nausea, headache and insomnia are common side effects of SSRIs. These may not seem that terrible but often are enough to make a patient prefer not to take the drug. Tricyclic antidepressants tend to have more side effects such as hallucinations and irregular heartbeat than SSRIs. This means that tricyclics are only used in cases where SSRIs are not effective. The possible side effect of BZs include increased aggressiveness and long term impairment of memory. There are also problems with addiction, so the recommendation is that BZ use should be limited to a maximum of four weeks (Ashton 1997)
