Psychopathology Flashcards
Deviation from social norms
Social norms = approved & expected ways of behaving in a particular society.
Deviation is behaviour that violates the implicit & explicit rules & moral standard of a given society & can be viewed as abnormal behaviour.
Many are unwritten rules; simple expectations that guide generally accepted behaviour.
Strong expectation they are observed.
Some flexibility:
-Western world = normal to eat with knife & fork: in company may eat pizza with utensils but in private less pressure & may eat with your hands.
Many go unnoticed or unquestioned until they are broken:
-You are only passenger on an empty bus, a person gets on and sits next to you.
-You are in a queue & waiting for a while, someone joins queue ahead of you.
One way of defining behaviour a behaviour as abnormal is to consider how it breaks from social norms (sometimes it is unclear) :
-Schizophrenic = will report hearing voices & even converse with ‘someone’ not really there.
-OCD = may wash hands over 50 times a day.
-Anti-Social Personality Disorder = commonly known as psychopaths, impulsive, aggressive & irresponsible. Defining symptom = failure to conform to social norms with respect to lawful behaviours.
Evaluation of deviation from social norms
x Issues with imposed etic - differs culture to culture:
-e.g. Criteria for diagnosing schizophrenia = ‘bizarre behaviour’ - may be perceived differently in different cultures.
-Cochrane (1977) reported incidence of schizophrenia in West Indies (acceptable to converse with dead relatives) & Britain to be similar (1%) but people of Afro-Caribbean orging = 7x likely to be diagnosed when living in Britain.
-Suggests increased rates living in Britain is not due to genetic vulnerability but more cultural bias - i.e. doctors in Afro-Caribbean cultures like West Indies perceive behaviour as ‘socially normal’.
-In UK - same behaviour may be ‘abnormal’ e.g. hallucinations.
-Imposed etic = one culture forces norms & values on another - any deviation from these norms is then misinterpreted (mental illness)
-> Means definition cannot be generalised to all cultures as would lead people to be inaccurately labelled as abnormal.
x Lacks temporal/historical validity - norms change over time:
-Beliefs change of morally acceptable behaviour change over time - what is regarded as deviant in one generation is accepted to the next.
-Consider changes in attitudes towards unmarried mothers & homosexuality.
-Homosexuality = mental illness until 1973 when declassified & removed from medical manuals.
-> Demonstrates difficulty in using social norms to define mental illness as they change frequently - an individual may have been mentally ill at one point in time but not another.
x Value of breaking norms:
-Definition depicts breaking of social norms as negative & something as a definite indicator of mental illness.
-Not all are a sign of psychopathology - may be beneficial.
-Many who do not conform are not abnormal but are expressing individualism.
-e.g. Suffragette campaigners broke social norms for fight for women’s votes resulting in social rejection & frequent prison sentences - without breaking norms, wouldn’t have electoral & social reform & society wouldn’t have advanced.
-> points to difficulties in using definition to classify mental illness as no objective & consistent way of determining whether a breach of social norms is positive or a cause for concern & possible evidence of mental illness.
x Defining mental illness based on social norms has issues with subjectivity:
-Often based on opinions of elites within society rather than majority opinion.
-e.g. Behaviour percieved as ‘abnormal’ by one individual may be perfectly accepted by another.
-Weakens validity of diagnosis, ideally the classification & diagnosis should be par with defining physical illness but by using subjective norm-based definitions - makes it difficult to treat in same way.
-> Defintition lacks objective criteria & makes it difficult to define abnormality in a reliable & valid way.
Failure to function adequately
= a person is unable to live a normal life, unable to experience the normal range of emotions, or engage in the normal range of behaviour.
Rosenhan & Seligmam identified 5 indicators of psychological abnormality grouped under this heading.
It’s argued that the more of these indicators are present, & the more extreme they are, the greater the likelihood of a psychological disorder:
- Dysfunctional behaviour/maladaptiveness:
= behaviour which interferes with ability to lead a normal, everyday life.
-e.g. alcoholism is dysfunctional if it prevents a person from holding down a job; agoraphobia if it prevents a person from shopping at weekend. - Personal distress/discomfort:
-e.g. distress = main symptom of depression - may experience disturbed sleep, constipation, headaches & constant tiredness. Likely to feel intensely unhappy & see themselves as undesirable & inadequate & future as bleak & hopeless. - Observer discomfort:
= cause frequent upset or discomfort to others.
-Can disrupt social interactions & damage social relationships.
-e.g. Alcoholics if they bring distress to friends & family. - Unpredictable behaviour:
= behaviour is unpredictable & unexpected if it does not seem to fit the situation.
-e.g. If people appear to overreact - over enthusiastic, over-concerned, over-anxious.
-Although, who is to say whether someone is over-reacting or whether response is out of proportion to situation? - Irrational behaviour:
= if behaviour does not make sense to others, if others cannot communicate with them in a reasonable way - behaviour is then often seen as irrational.
Examples:
Agoraphobia: may be unable to hold down job, unable to take part in everyday activities like shopping, walking down street, bus = dysfunctional behaviour.
Schizophrenia: may see world in different way which prevents them participating in normal activities - e.g. ‘visions’ ‘voices’ which others cannot see or hear. May live in depths of depression, unable to experience normal range of emotions = personal distress.
Evaluation of failure to function adequately
+ Workplace absence statistics:
-Mental ill health responsible for 72 million working days lost & costs £34.9 billion each year UK.
-Individuals with long-term mental health condition lose jobs every year at around double rate of those without mental health condition - equates to 300,000 people - equivalent population of Newcastle.
-> Statistics support idea that individuals with mental illness struggle to function in same way as individuals without mental illness.
x Some conditions aren’t linked to dysfunctional behaviour:
-People often function quite adequately with anxiety & depression & many with other issues can appear to lead perfectly normal lives most of time.
-According to MIND - 1 in 4 will experience mental health issue in Eng each year, only 1 in 5 said they call in sick due to mental health - suggesting some can still function.
-> Challenges dysfunctional behaviour criterion as it shows some individuals can function despite suffering mental health condition.
x Some disorders don’t involve personal distress:
-People with mania experience intense joy & elation.
-Psychopaths - people with antisocial personality disorder, affects 0.5%-1% in UK - show complete disregard for rights & feelings of others, may lie, cheat & steal, verbally abuse & physically assult, yet show no sign of shame, guilt or remorse.
-> Weakens validity as a definition of abnormality.
x Observer discomfort is subjective:
-Relies heavily on judgement & will vary person to person & worryingly clinician to clinician.
-Individuals diagnosed automatically with schizophrenia if ‘delusions are bizarre’ yet even this creates problems.
-When 50 senior psychiatrists in US asked to differentiate between ‘bizarre’ and ‘non-bizarre’ delusions they produced inter-rater reliability correlations of around 0.40 (only agreed 40% time) forcing researchers to conclude even this central diagnostic requirement lacks sufficient reliability for method for diagnosis.
-> This illustrates difficulty in using observer discomfort as a measurement of mental illness.
Deviation from ideal mental health
Notion first put forward by Jahoda 1958 = turns traditional notion of abnormality by looking at positives rather than negatives.
Jahoda identified 6 major criteria for optimal living which she believed promoted psychological health & wellbeing - the more qualities failed to meet, the more vulnerable to suffering mental disorder.
- Positive attitude towards self:
-Positive self-concept & sense of identity.
-Mentally healthy attitude towards self induced self-respect, confidence, reliance & acceptance - able to live with themselves accepting both limitations & possibilities.
-Viewing oneself realistically & objectively. - Self-actualisation of one’s potential:
-Proposed by Abraham Maslow (1968) - suggested we all have potential in certain directions & constantly strive to fulfill this potential.
-Problems occur when we are prevented to fulfilling. - Resistance to stress:
-Ability to tolerate anxiety without disintegration.
-Developed good coping strategies for stressful situations. - Personal autonomy:
-Person reliant on own inner resources & can remain relatively stable even in hard knocks, frustrations & deprivations.
-Autonomous people are not dependent on other people - are self-contained, depend on own resources
-Ability to make own decisions on bias of what is right four ourselves rather than to satisfy others. - Accurate perception of reality:
-Seeing oneself & world around in realistic terms rather than ‘rose-tinted glasses’ or overly pessimistic manner.
-If someone continually distorts reality, then not really living in real world & views & behaviours are bound to appear abnormal to others.
-If someone only ever sees best in people, may endear to others, also vulnerable for people to take advantage.
-Someone overly morbid & pessimistic likely to develop depressive disorder & not endear to others easily. - Adapting to environment:
-Being competent in all areas of life: work, relationships & leisure activities.
-Flexible rather than rigid, able to adapt & adjust to change.
-Someome fixed on old ways of thinking - abnormal to younger people & those who have been able to adjust to a changing environment.
Examples:
Agoraphobia: Being to go to school or work without too much anxiety = requirement for normal functioning. With this phobia = unable to leave house - abnormal = difficult to ‘self-actualise’.
Depression: can be explained through lack of ‘positive attitude towards self’. Beck found depressed people tend to draw illogical conclusions when evaluating themselves. Negative thoughts lead to negative feelings -> can result in depression.
Evaluation of deviation from ideal mental health
+ Positive approach:
-Offers alternative perspective by focusing on positive behaviours & what is desirable - positive & holistic.
-Some influence & in accord with ‘positive psychology’ movement which is synonymous with humanistic psychology.
-> Influential in changing negative perception of mental illness.
x Criteria is too demanding/unrealistic:
-Majority would appear to be abnormal - clearly not the case, suggesting conditions for ideal mental health = too stringent.
-e.g. Very few people achieve their full potential in life, may be because of own particular environment or through some failing within themselves.
-e.g. If someone devotes to being best employee - abilities as a parent may suffer.
-e.g. Student who attempts to achieve best possible grade - may suffer socially.
-> Would seem most people would be regarded as mentally unhealthy.
x Resistence to stress - possible benefits of stress:
-Some work efficiently in moderately stressful situations.
-e.g. many actors say they give best performance when experiencing certain amount of anxiety.
-e.g. student may perform better in actual assessment than mock as experience some stress about more serious consequences of failure.
-> Healthy levels of stress can actually be seen as indicator of mental well-being as it is an indicator of an individual’s motivation to succeed.
x Problems trying to classify mental illness in the same way as physical illness:
-Similar approach to diagnosing & classifying same way as physical illness.
-Physical illness - physical causes like virus, bacterial infection - easy to detect & diagnose.
-Possible that some mental disorders may have physical causes (e.g. brain injury, drug abuse) many do not - concequences of life experiences & environmental influences.
-Symptoms do not always present themselves in a way that allows them to be detected using objective measures.
-> Unlikley we could diagnose mental abnormality in the same way we can diagnose physical abnormality which weakens validity of the definition.
Statistical infrequency
= human behaviour is abnormal if it falls outside the range which is typical for most people i.e. it’s abnormal if it deviates from statistical norms.
Statistics are gathered to measure certain behaviours & characteristics with a view showing how they are distributed throughout general population.
What’s regarded as statistically rare depends on normal distribution - curve can be drawn to show what proportions of people share characteristics or behaviour in question.
Most people will be near mean with declining amounts away from mean (either above or below)
Any individuals falling outside ‘normal distribution’ (usually 5% population) are perceived abnormal.
Example: Intellectual Disability:
-Can be illustrated by distribution of IQ scores - average = 100, most fall around middle.
-Those with very low or high scores fall at extremes - relatively few in number - statistical terms = abnormal.
-Statistical infrequency forms the basis for diagnosing mental retardation (classified psychological disorder).
-DSM-IV (4th edition of American Psychiatric Association’s diagnostic & statistical manual of mental disorders 1994) defines mental retardation as an IQ of 70 and below.
-Around 2%-3% of population fall into this category (Barlow & Durand 1999)
Mental illness:
Every 7 years a surgery is done in Eng to measure no. people who have different types of mental health problems each year. Last published 2009:
-Depression - 2.6 in 100 people (2.6%)
-Anxiety - 4.7 in 100 people (4.7%)
-Mixed anxiety & depression - 9.7 in 100 people (9.7%)
-Eating disorders - 1.6 in 100 people (1.6%)
Evaluation of statistical infrequency
+ Attempt at applying objective measures to mental illness:
-Offers clear guidelines for identifying behaviours as normal or abnormal.
-Introduces element of objectivity into the process so different mental health care workers can all view same kind of behaviour in same way.
-As a result has been successfully deployed to define mental illness.
-e.g. Intellectual Disability is defined in terms of normal distribution using concept of standard deviation to establish cut-off point for abnormally - any individual whose IQ is more than 2 standard deviations below mean is judged as having mental disorder.
-> Such disagnosis only made in conjunction with failure to function adequately, illustrating validity of definition.
x Some abnormal behaviour desireable:
-e.g. few people have IQ over 150 yet we would not want to suggest that having a high IQ is undesirable.
-> Using statistical infrequency to define abnormality means we are unable to distinguish between desirable & undesirable behaviours. To identify behaviours that need treatment, there needs to be a means of identifying infrequent desirable & undesirable behaviour.
x Some mental illnesses are quite frequent in the population:
-e.g. Statistics presented show us anxiety & depression is experienced by almost 10% population.
-According to this definition this condition is relatively ‘normal’ & far and beyond 2% required to be classed as mental illness.
-> If we use statistical infrequency to define mental illness then harmful conditions such as depression would go undiagnosed & untreated.
x Labels can be damaging:
-Someone living happy & fulfilled life - no benefits to being labelled as abnormal regardless of how unusual they are.
-Someone with a low IQ but not distressed, quite capable of working etc, would simply not need diagnosis.
-> If that person ‘labelled’ as abnormal this may have a negative effect on the way others view them & the way they view themselves.
Depression characteristics
= classified as a mood disorder.
Behavioural:
- Activity Levels:
-Reduced levels of energy, making them lethargic - knock-on effect, some withdraw from work, education, social life. Can be so severe cannot get out of bed.
-Some cases can lead to opposite effect - psychomotor agitation - struggle to relax, may end up pacing up & down. - Disruption to Sleep & Eating behaviour:
-May experience reduced sleep (insomnia), particularly premature waking, or increased need for sleep (hypersomnia)
-Appetite & eating may increase or decrease - weight loss or gain.
-Key point = behaviours are disrupted by depression. - Aggression & Self-Harm:
-Often irritable, some cases verbally or physically aggressive - serious knock-on effects to aspects in life like relationships.
-Can also lead to physical aggression directed against self (self-harm, suicide attempts)
Emotional:
- Lowered Mood:
-Defining emotional element of depression, more pronounced than in daily kind of experience of feeling lethargic & sad.
-Often describe themselves as ‘worthless’ or ‘empty’ - Anger:
-Tend to experience more positive emotions & fewer positive during an episode, experience of negative emotion is not limited to sadness.
-Extreme depression - frequently experience anger - directed at self or others, aggressive or self-harm. - Lowered Self-Esteem:
-How much we like ourselves, sufferers tend to report reduced levels.
-Can be quite extreme - some describe self-loathing, i.e. hating themselves.
Cognitive:
1. Poor Concentration:
-May find themselves unable to stick to a task as they usually would, might find it hard to make decisions they normally find straightforward - likely to interfere with individual’s work.
2. Attending to and Dwelling on the Negative:
-Inclined to pay more attention to negative aspects of situation & ignore positives i.e. tend to see glass half empty rather than half full.
-Bias towards recalling unhappy events rather than happy ones - opposite bias most people have when not depressed.
3. Absolutist Thinking:
-Most situations are not all good or all bad, when a sufferer is depressed they tend to think in these terms - ‘black and white thinking’.
-When a situation is unfortunate they tend to see it as an absolute disaster.
Phobias characteristics
= characterised by excessive fear & anxiety, triggered by an object, place or situation. The extent of the fear is out of proportion to any real danger presented by the phobic stimulus.
Behavioural:
- Panic:
-In response to presence of stimulus - may involve range of behaviour like crying, screaming or running away.
-Children may react differently e.g. freezing, clinging, tantrum. - Avoidance:
-Unless the sufferer is making a conscious effort to face their fear they tend to go to a lot of effort to avoid contact.
-This can make it hard to go about daily life e.g. fear of public toilets may have to limit time spent outside home.
-Can interfere work, education & social. - Endurance:
-Alternative to avoidance, sufferer remains in presence of stimulus but continues to experience high levels of anxiety.
-May be unavoidable in some situation e.g. extreme fear of flying.
Emotional:
- Anxiety:
-Phobias = anxiety disorders - involve emotional response of anxiety & fear.
-Unpleasant state of high arousal.
-Prevents sufferer relaxing & difficult to experience any positive emotion.
-Can be long-term.
-Fear is immediate response & extremely unpleasant we experience when we encounter or think of stimulus.
-Fear is persistent & likely to be excessive & unreasonable.
-Triggered by presence or anticipation of specific object or situation & out of proportion to danger posed.
Cognitive:
- Selective Attention to the Phobic Stimulus:
-If sufferer can see stimulus it can be hard to look away from it.
-Keeping attention on something dangerous is a good thing as gives best chance of reacting quickly to a threat, but not so useful when fear is irrational.
-e.g. arachnophobia - will struggle to concentrate if spider in room. - Irrational Beliefs:
-May be resistant to rational arguments about stimulus.
-e.g. Fear of flying not helped by arguments that flying is safest form of transport. - Cognitive Distortions:
-Perceptions of phobic stimulus may be distorted.
-e.g. Omphalophobic likely to see belly buttons as ugly and/or disgusting.
OCD charateristics
= an anxiety disorder where anxiety arises from both obsessions & compulsions. Compulsions are a response to obsession & the person believes the compulsions will reduce anxiety.
Behavioural:
- Compulsions are repetitive:
-Typically feel compelled to repeat a behaviour e.g. hand washing, ordering groups of objects. - Compulsions reduce anxiety:
-Around 10% show compulsive behaviour alone - no obsessions, just general irrational anxiety.
-Vast majority are performed in attempt to manage anxiety produced by obsessions e.g. hand washing carried out as a response to obsessive fear of germs.
-Compulsive checking e.g. door locked in response to obsessive thought it might be unsecure. - Avoidance:
-In attempt to reduce anxiety by keeping away from situations that trigger it.
-e.g. Sufferers who wash hands compulsively may avoid coming into contact with germs - can lead people to avoid very ordinary situations like emptying bins.
Emotional:
- Anxiety & Distress:
-OCD regarded as unpleasant emotional experience because of powerful anxiety accompanying it.
-Obsessive thoughts are unpleasant & frightening & anxiety with it can be overwhelming.
-Urge to repeat a behaviour creates anxiety. - Accompanying Depression:
-Anxiety can be accompanied by low mood & lack of enjoyment in activities.
-Compulsive behaviour tends to bring some relief from anxiety but this is temporary. - Guilt & Disgust:
-Also other negative emotions involved such as irrational guilt over minor moral issues or disgust which may be directed against something external like dirt or at the self.
Cognitive:
- Obsessive thoughts:
-For around 90% the major cognitive feature.
-Vary considerably from person to person but always pleasant.
-e.g. Worries of being contaminated by dirt or germs. - Cognitive Strategies to deal with Obsession:
-People also respond by adopting cognitive coping strategies.
-e.g. Religious person tormented by obsessive guilt may respond by praying or meditating.
-May help manage anxiety but can make the person appear abnormal to others & can distract them from everyday tasks.
Behavioural approach to explaining phobias
Behaviourists claim abnormal behaviour is learned.
Two-Process Model:
States phobias are acquired through classical conditioning & then maintained through operant conditioning.
Classical:
-Takes place when we come to associate something that initially does not produce any response (neutral stimulus) with something that already produces that response (unconditioned stimulus).
-This sort of association develops when the NS & UCS are paired - experienced together.
-Leads us to respond to NS in same way we responded to UCS.
-NS no longer neutral - leads to a response = conditioned stimulus.
-CS now evokes conditioned response.
Operant:
-Likelihood of a behaviour being repeated is increased if the outcome is rewarding.
-Individuals with a phobia are rewarded through negative reinforcement by avoiding the situation (withdrawing the potentially harmful consequences)
-This reduces anxiety & fear and thus is reinforcing/rewarding.
-This behaviour results in a desirable consequence, which means it will be repeated.
Evaluation of behavioural approach to explaining phobias
+ Support from research: Little Albert:
-Watson & Raynor (1922) conditioned 11mo baby to fear white rat.
-Played with rat for several weeks, showed no fear of rat, rat = NS.
-Paired NS with UCS (loud noise) - noise frightened him (UCR). Repeated 5x
-Albert had now paired NS with UCR so rat = CS & fear = CR.
-> Experimenters had conditioned Albert to fear the rat, showing strength of approach to explaining phobias.
+ Has led to successful treatment:
-Applied to treatment of the condition.
-Systematic desensitisation uses classical conditioning to help the patient replace their old maladaptive associations with new more adaptive ones, like relaxation, in presence of phobic stimulus.
-Has proven to be successful with approximately 75% of patients treated for phobia.
-> Supports explanation as it suggests we do use association & classical techniques to extinguish the link between the phobic stimulus & fearful response.
x Incomplete as it ignores innate fears/phobias:
-Bounton (2007) points out that evolutionary factors probably have an important role in phobias but two-factor theory does not explain this.
-e.g. We easily acquire phobias of things that have been a source of danger in our evolutionary past e.g. snakes, the dark.
-Seligman (1971) called this biological preparedness.
-It is quite rare to develop a fear of cars or guns - much more dangerous to most of us today in spiders & snakes. - only existed recently so not biologically prepared to learn fear responses.
-> Serious problem for the two-factor theory because it shows there is more to acquiring phobias than simple conditioning.
x Not all phobias are acquired through classical conditioning:
-Some often recall a specific incident wen phobia recalled e.g. 60% people with cynophobia report a frightening incident with a dog i.e. classical conditioning can explain how they acquired their phobia.
-Not everyone can recall an incident - Sue et al (1987) suggested different phobias may be result of different process e.g. agoraphobics most likely to explain disorder in terms of a specific incident, whereas arachnophobes were most likely to cite modelling as the cause.
-> Challenges two-process model which states classical conditioning can explain the acquisition of the phobia & operant conditioning explains how it is maintained.
Systematic Desensitisation
Aims:
-Treatment is based on behavioural approach to phobias which suggests that maladaptive/abnormal behaviours are learned & can therefore be unlearned & eliminated with more positive/adaptive behaviours in their place, using principles of classical conditioning.
-Aims to gradually & systematically reduce the fear response to the phobic object or situation.
Key processes:
1. Relaxation:
-Patient is taught to relax their muscles completely.
-Therapist teaches patient to relax deeply as possible - may involve breathing exercises or mental imagery techniques.
2. Desensitisation Hierarchy:
-Therapist & patient together construct a series of imagined scenes related to phobic stimulus that provoke anxiety.
-Increasingly more anxiety each time.
3. Visualisation:
-Patient gradually works way through hierarchy visualising each anxiety-evoking event while engaging relaxation techniques.
4. Counterconditioning/Reciprocal Inhibition:
-Once patient masters one step in hierarchy they are ready to move on to the next.
-This states that two incompatible emotional states cannot exist at the same time therefore anxiety & relaxation cannot.
5. Exposure & Desensitisation:
-Patient exposed to phobic stimulus while in a relaxed state, takes place over several sessions, starting from bottom and gradually building up.
-Patient eventually masters feared situation that caused them to seek help in first place.
-Treatment ends when patient is desensitised - able to work through hierarchy in relaxed state, without anxiety.
Process can be done either through imagined situations (in vitro) or in real-life (in vivo.
Evaluation of systematic desensitisation
+ Responsibility:
-Responsible for creating own hierarchy (with help of therapist) so can be seen as in control of their therapy.
-If patient finds too much anxiety is caused they can decide to go back down their hierarchy.
-> Huge advantage over biological techniques for phobias (drugs) as it empowers individuals & gives motivation & skills to overcome anxiety.
+ Targets symptoms & cause:
-Criticism of drugs is that they only treat symptoms & when patient stops taking drugs, the symptoms recur.
-SD doesn’t only tackle symptoms but also root of problem & provides individual with set of tools to enable them to understand their phobia is irrational.
-Once a patient is comfortable with their anxiety they will no longer suffer from the symptoms brought by exposure to phobic stimulus.
-> Can lead to long-lasting recovery.
+ Side Effects:
-Patients won’t suffer side effects like they most likely would with drug therapies.
-Patient is working with a professional at own speed in a safe-environment & won’t process hierarchy until entirely comfortable.
-> Refusal rates are low & attrition rates are low, illustrating success of treatment.
x Time & Cost:
-It is a ‘talking therapy’ involving spending a lot of time with a professional & working together to understand their fears & create tools.
-Treatment is available on NHS but waiting list long so many prefer to seek private treatment which can be expensive (£100+ per hr)
-Patients also won’t see instant results .
-> A lot of individuals prefer to seek drug treatments which are cheaper & fast-acting.
