PSYCHOPATHOLOGY Flashcards
Defining Psychopathology
- Psyche = mind
- Pathology = disease o Mental illness
- What is normal/abnormal? o Depends on gender
o Culture/context/time
The normality debate
- Drawing the line between what is defined as normal, and abnormal, is to this day unclear.
o Notsurprisinggiventhehistoricalconceptualizationsofmentalillness. o Example, homosexuality was originally listed as a mental disorder.
o What does the future hold?
Criteria that can be used in Psychopathology
Statistical deviance:
* The use of statistical norms (or behaviour and experience) to determine what is supposedly normal.
* Anything outside of the norm
o With this viewpoint, anything outside the norm, is considered
abnormal.
* You can’t apply these systems to different cultures
o The problem is that what is considered normal/abnormal is largely
dependent on socio-cultural context.
o For example, behaviours like talking to oneself in public and public
nudity, while abnormal in most western culture are quite normal in
many African cultures
o Thus, abnormality and statistical deviance cannot always be equated.
* You can’t apply it across all groups – saying one person falls outside of the statistical deviance is pathologically abnormal
* Deviation from the norm isn’t always negative – could be positive too o Autism – good in arts
Maladaptiveness = not being able to adapt/adjust to yourself/other people
* The extent to which certain behaviours are maladaptive to the self/ others.
Criteria that can be used
Statistical deviance:
* with this viewpoint, behaviours that prevent an individual from adapting/adjusting for the good of another individual/ the group. are considered abnormal.
* Again, cultural context makes this less straightforward.
* For example, in many African countries female circumcision ceremonies are
still conducted, which is a practice viewed as barbaric and abnormal by
other contexts.
* They don’t see it as barbaric – they might see it more as growth
* It’s adaptive for one person but not for another
Personal distress
* Often associated with what makes up a mental disorder.
* Once again, there are exceptions
* For example, individuals with antisocial personality disorder (psychopaths,
sociopaths), often do not experience appropriate forms of distress but rather
derive pleasure from inflicting pain on others.
* Distress isn’t always abnormal
* Like when one passes away – grief
o Once it lasts longer than the normal time period – then it’s a sign it’s developing into a disorder
* Like when one gets married
* Violence
* Interviews & other pressures
* Not having a certain level of distress – also indicates abnormality
o If an person is numb – PTSD
o The lack of emotional expression is just as bad if not worse than an
abnormal emotional expression
* Conclusion
o There is no clear-cut criteria as to what defines normal/abnormal
o At best – we have developed guidelines & contextual considerations
Mental illness Classification Methods
Diagnostic and Statistical Manual of Mental Disorders, fifth
edition (DSM-V)
* By American Psychiatric Association
* Released in 2013
o We use this in training & practitioners also use this
International Classification of Diseases, eleventh edition (ICD-11)
* By World Health Organization
* Released in 2018
International Classification of Diseases, eleventh edition (ICD-11)
o ICD is more representative and used in more countries
What is a psychological disorder
DSM 5’S definition
* “ A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, behaviour that reflects a dysfunction in the following processes underlying mental functioning” (DSM 5): Psychological, Biological, Developmental
ICD 11’s definition
* “ Mental, behavioural and neurodevelopmental disorders are syndromes characterized by clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental process that underlie mental and behavioural functioning (ICD 11).
Misperceptions about mental illness
- Alarming global trend – despite increased access to mental health services, use of those services have not increased.
- In SA, more that half of all health problems are psychological – patients still avoid seeking treatment. Why?
Public’s stigmatizing attitudes towards the mentally ill Lack of knowledge among the public of mental illness
Roadblock to treatment – stigma
* Weak?
* Violence?
Etiological factors :
perspectives & approaches
- Looks at wat causes psychopathology
- How is it created
Biomedical Perspective
* The viewpoint that all mental illness has a biological cause, and that other factors take on a secondary role.
Biomedical perspective
Abnormalities occur in 3 areas
Genetic predisposition:
* Presence of family history of mental illness increases vulnerability to developing a psychological disorder.
* Inherited factors : psychotic/bipolar present in family history = higher likelihood to be passed onto child
o Serious disorders
Abnormal functioning of neurotransmitters
* An increase/decrease in neurotransmitters e.g. dopamine and serotonin are associated with the presence of certain psychological disorders.
* Neurotransmitters are the chemical in the brain o Serotonin & dopamine associated
o Low serotonin = low levels of serotonin
o Bipolar mood disorder person
▪ High= manic phase
▪ Low= depressive phase
Structural brain abnormalities
* Could be due to genetic disorders, birth defects, drug related / physical damage.
* Certain abnormalities are linked to the presence of psychological disorders.
* Has long been established that different parts of the brain are associated with different functions
o Damage to certain areas – cause damage to specific function o What causes these abnormalities
▪ Genes
▪ Birth defects
▪ Injury (physical)
* In mothers womb or after
* Structural brain damage during development – leads to
psychological issues
▪ Drug use by mother during pregnancy – direct influence on the
brain
Psychological perspective
▪ Psychodynamic
▪ Cognitive-behavior
Psychodynamic perspective
- Derived from Freud’s psychoanalysis
- View that we are influenced by internal forces that exist outside of our
consciousness. - Psychological symptoms are seen as a result of the compromise between the expression and repression of our forbidden wishes.
- The way we relate to others & ourselves are caused by forces outside individual consciousness
- How much is there a push and pull to express our desires & how we repress them
- Views the causation of psychopathology as a constant compromise between the expression & repression of our forbidden desires
Cognitive-behaviour perspective
- Ways of thinking directly impact emotions & behaviors
- View that cognitions or learned ways of thinking, directly impact an individual’s emotions and behaviours.
- Psychological symptoms are seen as due to irrational beliefs and automatic thoughts that result from them.
o Individualistic process with the focus on internal thought processing o Distress e.g due to irrational beliefs
▪ People develop these beliefs very early on
▪ Pattern of reinforcement of these beliefs continue throughout a persons life
Community perspective
- The viewpoint that psychopathology stems from within the context of a community.
- Different considerations within the community
- Community perspective
▪ Political Context
▪ Social Context
▪ Cultural Context
The political context
- Facilitates ideas for e.g., of inferiority and superiority.
- After effects of apartheid - internalization of negative thoughts.
- Plays a role in formations of psychopathology
o One of the major focuses – was to challenge authorities because of the
effect on mental health
▪ Classism
▪ Status
▪ Apartheid – after effects - Inherited internal stereotypes & generalizations
- By the government at that time
- These belief systems continue thereafter
The social context
- Social factors can contribute to the development of psychopathology.
- Factors such as: socioeconomic status, access to resources, values, stigma,
violence, substance use.
o Considers day to day challenges people face : socioeconomic status ▪ Stressor & their effects on community/individual mental health
o Access to services
▪ Lack of clinical psychologist availability
▪ Lack of access
▪ Private sector is still very expensive – medical aid limits the
number of sessions o Values
▪ Facilitates stigma
▪ How does the community view mental health & illness ▪ Religion
▪ Negative perceptions on mental health
o Other things to consider
▪ Gang violence
▪ Crime - Some communities have more vioence than others
o This effects development of psychopathology
▪ Substant abuse – more predominant in one community than
another - More exposure in community with high incidents of this
o Environmental & society factors
The cultural context
- According to this viewpoint, how an individual experiences distress or makes sense of psychological issues, is dependent on deeply ingrained cultural beliefs and practices.
o SA is described as a melting pot of diversity : languages, cultures, religion, etc
▪ Hard to define
▪ Impact of these different viewpoints on psychopathology - For e.g. in Zulu and isiXhosa cultures, ukithwasa can be erroneously mistaken for psychosis or similar.
o Emotional turmoil
o Hearing voices - Western conditions – “psychosis”
o Health practitioners should:
▪ Be aware of such cultural conditions
▪ Not ignore contextual considerations
▪ They shouldn’t go ahead with western diagnosis of psychosis - Globally there has been acknowledgement of the impact of culture in etiology of psychopathology
o GSM – American Psychiatric Association
Acknowledges culture : conditions & research to back the symptoms for these conditions across the globe
o There is also a cultural interview to
▪ Acknowledge the role of culture in the etiology of
psychopathology
▪ Help practitioners in terms of guidance for treatment &
management
▪ The fact that this happens at a global scale empphasises the
need to practice it at a local scale especially in SA where diversity is high
Integrated Approach To Psychopathology
- Takes all perspectives into account
- There are 2 models of integrated etiology
1. The diathesis-stress model
2. The biopsychosocial model
The diathesis-stress model
- Introduced by Meehl (1962)
- Of the viewpoint that some inherit/develop predispositions (diathesis).
- However, symptoms of psychopathology only emerge when there are environmental/biological stressors that convert them into psychopathology.
- Suggests all of us are born with certain vulnerabilities to psychopathology (nature debate)
o Depends on exposure to environmental/biological stressors that convert them into psychopathology
The biopsychosocial model
*Integrates biological, psychological and social factors that contribute to the development of psychopathology.
In recent years the has been expanded to consider cultural & spiritual factors o But at the base line COVERS BIOPSYCHOSOCIAL FACTORS
1. Predisposing factors
* Genetics/family history of mental illness 2. Precipitating factors
* Looks at triggers/recent events
* Bio – car accident – brain injury
3. Perpetuating factors
* Things that maintain the disorder
* Alcohol/ drug addiction (biol)
4. Protective
* Are there thing in place that helps when it comes to treatment/management of disorder
* Social – do they have friends/family
o E.g depression friends/family will help
o Psychological – how well does the person understand themselves
▪ Affects how they deal with it
* We focus on this model for treatment/management informing
o How mental illness comes about in the first place
Intellectual disability disorder
Subaverage intellectual and adaptive functioning
