psychopathology Flashcards
4 definitions of abnormality
- statistically infrequent
- deviation from social norms
- failure to function adequately
- deviation from ideal mental health.
statistical infrequency
defining abnormality in terms of statistics
any statistically common behaviour is normal
any statistically infrequent (rare) behaviour is abnormal.
application of statistical infrequency
IQ and intellectual disability disorder
the average IQ is 100
most people have an IQ score between 85 and 115
only 2% have a score below 70
those individuals scoring below 70 are statistically unusual or abnormal and are diagnosed with intellectual disability disorder ( IQ is shown as a bell curve)
evaluation of statistical infrequency
- real life application: all assessments of patients includes a comparison to statistical norms
- unusual characteristics +ve: just because it is infrequent doesn’t mean a disorder. High IQ are rare but not consider to be negative. limitation never should be used alone to diagnose
- not everyone unusual benefits from a label: when someone is living a happy life there is no benefit from labelling them abnormal. If someone has a low IQ but is not distressed or out of work they do not require a label. negative effect on perception
deviation from social norms
definition of abnormality
based on social context.
when a person behaves differently to social norm
societies and social groups make collective judgements about correct behaviours.
relatively few behaviours considered to be universally abnormal. definition relates to cultural context
this includes historical differences within the same society.
example of deviation from social norms
antisocial personality disorder (APD)
one important symptom of APD is a failure to conform to lawful and culturally normative ethical behaviour
a psychopath is abnormal because they deviate from social norms / standards. the generally lack empathy
evaluation of deviation from social norms
- not sole explanation: APD shows there is a place for the definition but there are often other factors to consider. in practise never sole reason for defining.
- culturally relative: what may be normal to one culture is abnormal to another. creates problem of universality
- leads to human rights abuses: lead to systematic abuse of rights. Nymphomania (women attracted to working class men) are examples of where it was used for social control. some classification abuse rights to be different
failure to function adequately
the inability to cope with everyday living
abnormal when they cannot deal with the demands o every day life. e.g holding a job, maintaining relationships, maintaining basic standards of nutrition and hygiene
Rosenhan and seligman (1989)
- signs of failure to cope
- they can no longer conform to inter personal rules
- they experience personal distress
- they behave in a way that is irrational and dangerous
example of failure to function
intellectual disability disorder
having very low IQ could result in a person not being able to cope with demands of everyday living
evaluation of failure to function adequately
- recognises patient’s perspective: difficult to assess distress acknowledges experience of patient
- same as deviation from social norms: hard to say if someone is failing to function or deviation from social norms. live alternative lifestyles extreme sports behaving manipulatively. limiting freedom
- subjective judgement: some patients may feel distressed but judged fine. objective methods such as using checklists - does a psychiatrist have the right to make these judgements.
deviation from ideal mental health
think about what makes someone normal and psychologically healthy
then identify anyone who deviates from this ideal
Jahoda criteria of deviations from ideal mental health (8)
- we have no symptoms or distress
- we are rational and perceive ourselves accurately
- we self actualise
- we can cope with stress
- we have a realistic view of the world
- we have good self esteem and lack guilt
- we are independent of other people
- we can successfully work, love and enjoy our leisure.
how does deviation from ideal mental health overlap with other definitions
someones inability to keep a job may be a sign of failure to function or deviation from ideal mental health
evaluation of deviation from ideal mental health
- comprehensive: covers broad range of criteria and reasons someone would seek help or be referred
- culturally relative: specific to western culture emphasis on self actualisation considered as self indulgence in collectivist cultures
- unrealistically high standards: very few people can meet the high criteria so most people would be abnormal. positive clear ways on how to improve someone but has not value if it is against their will.
define phobia
a persistent and unreasonable fear of a particular object, activity or situation
behavioural characteristics of phobias
- panic
- this may involve crying, screaming or running away from the phobic stimulus - avoidance
- considerable effort to avoid coming into contact with the phobic stimulus. this can make it hard to go about everyday life
cognitive characteristics of phobias
- selective attention to the phobic stimulus
- the phobic finds it hard to look away from the phobic stimulus - irrational beliefs
e. g social phobias may involve beliefs such as I must always sound intelligent
emotional characteristics of phobias
- anxiety and fear
- fear is the immediate experience when a phobic encounters or thinks about the phobic stimulus. fear leads to anxiety - responses are unreasonable
- response is widely disproportionate to the threat posed.
two process model of explaining phobias
phobias are learned through classical conditioning and maintained by operant conditioning
acquisition of a phobia
classical conditioning
- UCS triggers a fear response (UCR)
e. g being bitten - NS is associated with the UCS e.g being bitten by a dog
- NS becomes a CS producing fear (CR)
e. g the dog becomes CS causing a CR of anxiety / fear.
little albert
watson showed how fear of rats could be conditionined
- whenever albert played with a white rat a loud noise was made close to his ear (UCS) with caused fear response (UCR)
- the rat (NS) did not create fear untol the bang and the rat had been paired together
3. albert showed a fear response (UR) every time he came into contact the the rat (CS)
maintenance of phobias by operant conditioning
negative reinforcement
an individual produces a behaviour that avoids something unpleasant
when a phobic avoid a phobic stimulus they escape the anxiety that would have been experienced
this reduction of fear is negative reinforcement so the avoidance behaviour and the phobia is maintained
evaluation of the 2 process model for phobias
- important implications for therapy and explains why patients need to be exposed to stimulus. application strength
- not all avoidance behaviour is associated with phobia is anxiety reduction. agoraphobia is motivated by safety so they will often leave the house with a trusted friend.
- does not explain where all phobias come from. some phobias are acquired without bad experiences. biological factors
- ignores cognitive aspects such as irrational thinking
- not all bad experiences lead to phobias
counter conditioning
systematic desensitisation SD
phobias is learned so that phobic stimulus CS produces fear (CR)
CS is paired with relaxation and this becomes the new CR
systematic desensitisation (SD)
treating phobias therapy aims to gradually reduce anxiety through counter conditioning includes: counter conditioning reciprocal inhibition anxiety hierarchy relaxation practises behavioural approach
reciprocal inhibition
systematic desensitisation
it is not possible to be afraid and related at the same time, so one emotion prevents the other
formation of an anxiety hierarchy
patient and therapist design one - a list of fearful stimulus arranged in order from least to most frightening
relaxation practices
systematic desensitisation (SD)
phobic individuals is taught relaxation techniques such as deep breathing or meditation
patient then works through anxiety hierarchy. at each level the phobic is exposed to phobic stimulus in a related state
this takes place over several sessions starting at the bottom of the hierarchy. Treatment is successful when the person can stay relaxed in situation high on the hierarchy.
evaluation of systematic desensitisation
- technique proven most effective with specific phobias. 42 patients with spider phobias. less fearful than control long lasting effect
- suitable for diverse range of patients: causes less trauma and involves pleasant experience. suitable for people with learning difficulties who struggle with cognitive which require reflection. acceptable to patients as it does not cause as much trauma as flooding.
low refusal rates and low attrition rates.
flooding
behavioural approach for treating phobias
flooding involves the immediate exposure to the phobic stimulus
how does flooding work?
extinction
without an option for avoidance behaviour, the participant quickly learns that the phobic object is harmless through exhaustion of their fear response
ethical safeguards in flooding
flooding is not unethical but it is an unpleasant experience
it is important patients give informed consent. they must be fully prepared and know what to expect
evaluation of flooding
- cost effective. studies found it highly effective and much quicker with less sessions needed
- less effective at treating more complex phobias such as social ones. as they experience more cognitive factors e.g irrational thinking and may benefit more from cognitive therapies
- treatment is highly traumatic. although not unethical with informed consent. participants often unwilling to see it through. wasting money and time. treatment not effective.
definition of depression
a mood disorder characterised by low mood and low energy levels
behavioural characteristics of depression (3)
- reduce activity level.
suffers have reduced levels of energy making them lethargic. in extreme cases cant get out of bed. - disruption to sleep and eating behaviour.
suffers may experience reduced sleep or increased need for sleep. appetite may increase or decrease leading to weight gain or loss - aggression and self harm
cognitive characteristics of depression (3)
- poor concentration
suffers unable to stick with a tasks as they usually would, or find simple decision making difficult. - absolutist thinking
when a situation is unfortunate it is seen as an absolute disaster - attending to and dwelling on the negative
emotional characteristics of depression
- lowered mood
- more pronounced than daily feeling lethargic or sad. suffered describe themselves as worthless or empty - anger
on occasions, such emotions lead to aggression or self harming behaviour - lowered self esteem
overall characteristics of depression (9)
behavioural 1. lowered activity levels 2. disruption to sleep and eating 3. aggression and self harm emotional 4. lowered mood 5. lowered self esteem 6. anger cognition 7. poor concentration 8. absolutist thinking 9. attending to and dwelling on the negative
overall characteristics of phobias (6)
behavioural 1. panic 2. avoidance emotional: 3. anxiety and fear 4. unreasonable responses cognitive: 5. selective attention to phobic stimulus 6. irrational beliefs
what are the 2 cognitive explanations of depression
- beck’s cognitive theory of depression
- Ellis’s ABC model
what does ABC stand for in Ellis’s ABC model
activating event
beliefs
consequences
Ellis’s ABC model
A - activating event
depression arises from irrational thoughts
depression occurs when we experience a negative event which acts as a activator
Ellis’s ABC model
B- beliefs
negative events trigger irrational beliefs
- musterbation: Ellis called the belief that we must always succeed
- I can’t stand it itis: the belief that it is a disaster when things do not go smoothly
- utopianism: is the belief that the world must always be fair and just.
Ellis’s ABC model
c- consequences
when an activating event triggers irrational beliefs there are emotional and behavioural consequences
e.g if you believe you must always succeed and then you fail at something the consequence is depression.
evaluation of Ellis ABC model
partial explanation: does not explain why some depression has no obvious cause so explanation only applies to certain kinds
- cognition may not cause all aspects: anxiety and distress can store physical energy that energy after an event. cause of doubt on cognition
- does not explain less common symptoms such as hallucinations, delusions or bizarre beliefs
- piratical application to CBT which is successful. irrational beliefs are challenged reducing symptoms
what does Beck’s cognitive theory involve
- faulty information processing
- the negative triad
- negative self schemas
Beck’s cognitive theory
faulty information processing
- Beck suggested some people are more prone to depression because of faulty information processing
- when depressed people attend to the negative aspects of a situation and ignore the positive
they also tend to blow small problems out of proportion and think in black and white terms
beck’s cognitive theory
the negative triad
- negative view of the world
- negative views of the future
- negative views of the self
Beck’s cognitive theory
negative self schemas
- schema is a package of ideas and information developed through experience
- we use schemas to interpret the world
- if a person has a negative self schema they will interpret all information about themselves in a negative way.
evaluation of Beck’s cognitive theory
- research supports. pregnant women tested for cognitive vulnerability due to faulty info processing were more likely to get post natal depression
- makes up the basis of CBT. leads to successful therapy challenging the negative triad. practical application
- cannot explain less common symptoms such as hallucinations, bizarre beliefs, cotord syndrome
what does cognitive behaviour therapy involve
patients and therapists working together
challenging negative thoughts relating to the negative triad
patients encouraged to test reliability of their irrational beliefs
how do the patient and therapist work together in CBT
work together to clarify the patients problems
identify where there might be -ve or irrational thoughts that will benefit from challenge
CBT
challenging negative thoughts
the aim is to identify the negative thoughts inside the negative triad
these thoughts are then challenged by the patient
CBT
patient as scientist
patients are encouraged to test the reality of their irrational beliefs
they might set homework
in future sessions if patient says repeats the negative belief the therapist can use the evidence they produced to prove their beliefs to be incorrect
how do we treat depression
- cognitive approach
- cognitive behaviour therapy (CBT)
- Ellis rational emotive behaviour therapy REBT
Ellis’s REBT
ellis rational emotive behaviour therapy REBT extends the ABC model to the ABCDE model
D- dispute (challenge) irrational beliefs
E - effect
Ellis’s REBT
challenging irrational beliefs
REBT therapist would identify negative belief as say utopianism and challenge it
- empirical argument: disputing whether there is evidence to support belief
- logical argument
disputing whether negative thought actually follows the facts
what are the 2 types of arguments used by REBT therapists to challenge irrational and negative beliefs
- empirical argument
disputing whether there is evidence to support the irrational belief - logical argument
disputing whether the negative thoughts actually follow the facts
Ellis’s REBT behavioural activation
as individual becomes depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms
the goal of treatment, therefore is too work with the depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that have been shown to improve mood.
evaluation of the cognitive approach to treating depression (CBT) strengths
- large body of evidence supporting effectiveness after 36 weeks. 81% effective CBT, 81% effective medication, 86% both. adolescents. as effective as drugs. helpful alongside medication
- success due to therapist patient relationship all psychotherapies are very similar 1 essential ingredient relationship and the quantity of this determine success. all therapies share this basis
evaluation of the cognitive approach to treating depression (CBT) limitations
- does not work on severe cases: cannot motivate themselves to take part in hard cognitive work. medication started and the CBT once improved. cant be the sole treatment
- explore their past: CBT focuses on the present and future ignoring aspects of patient experience. limitation
- overemphasis on cognition: CBT minimises importance of living circumstances poverty and abuse. overemphasis on the mind not the environment. CBT used inappropriately more important to change a persons situation.
define obsession
a persistent thought that is intrusive and causes anxiety
define compulsion
repetitive rigid behaviour performed to reduce anxiety
overall characteristics of obsessive compulsive disorder (OCD)
behavioural 1. compulsions 2. avoidance emotional 3.anxiety and distress 4. guilt and disgust cognitive 5. obsessive thoughts 6. insight into excessive anxiety
what are the behavioural characteristics of OCD
- compulsions
actions that are carried out repeatedly. the same behaviour is repeated in a ritualistic way to reduce anxiety. - avoidance
the OCD is managed by avoiding situations that trigger anxiety
emotional characteristics of OCD
- anxiety and distress
obsessive thoughts are unpleasant and frightening and the anxiety that goes with these can be overwhelming - guilt and disgust
irrational guilt e.g over minor moral issues or disgust which is directed towards oneself or something external
cognitive characteristics of OCD
- obsessions
about 90% suffers have this. recurring intrusive thoughts that are upsetting and upleasent - insight into excessive anxiety
awareness that thoughts and behaviour are irrational and in spite of this suffers experience catastrophic thoughts and are hyper vigilant.
the 2 biological approach explanations of OCD
- genetics
2. neural
explaining OCD - genetic explanation
candidate genes
researchers have identified specific genes which create a vulnerability for OCD
- serotonin genes- implicated in the transmission of serotonin across synapses
- dopamine genes
both dopamine and serotonin are neurotransmitters that have a role in regulating mood.
genetic explanation
OCD is poly-genetic
- OCD is not caused by one single gene but several genes are involved
- Taylor (2013) found evidence that up to 230 different genes may be involved in OCD
genetic explanation
how does genetics relate to the different types of OCD
- one group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person - aetiologically heterogeneous
evidence that different types of OCD may be result of particular genetic variations such as hording or religious obsession
aetiologically heterogenous
one group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person
neural explanation
low levels of serotonin does what
lowers mood
neurotransmitters are responsible for relaying information from one neuron to another.
if a person has low levels of serotonin then normal transmission of mood relevant information does not take place and mood is affected
neural explanation
abnormal functioning of the lateral frontal lobes
impairs decision making
particularly associated with hoarding
frontal lobes are responsible for logical thinking and decisions
abnormal functioning of the lateral frontal lobes is associated with impaired decision making
neural explanation
parahippocampal gyrus
evidence that the left parahippocampal gyrus associated with processing unpleasent emotions functions abnormally in OCD
evaluation of genetic explanations of OCD
supporting evidence twin studies 80% identical twins shared OCD. 31% in nonidentical
- too many candidate genes: each variation only increase risk slightly provides little predictive value
- environmental risk factors. 50% OCD patients experience traumatic events. more severe the OCD the more severe the trauma. not entirely genetic. more productive to focus on environmental causes
evaluation of neural explanations of OCD
- drugs that increase serotonin reduce OCD symptoms. suggesting serotonin is involved in OCD symptoms. suggesting serotonin is involved OCD symptoms associated with other biological conditions. biological processes may be responsible
- serotonin- OCD link not unique: many suffers of OCD become depressed. co-morbidity depression caused by serotonin. could be that serotonin system disrupted because the OCD patient is depressed.
how does drug therapy in treating OCD work?
- drug therapy aims to increase / decrease levels of neurotransmitters in the brain or to increase / decrease their activity.
- low levels of serotonin are associated with OCD
- drugs work in various ways to increase the level of serotonin in the brain
biological treatment of OCD
SSRIs
- selective serotonin re uptake inhibitors
SSRIs prevent the re absorption and breakdown of serotonin in the brain
this increases its level in the synapses and thus serotonin continues to stimulate the postsynaptic neurons
this compensates for whatever is wrong with the serotonin system in OCD
biological treatment of OCD
typical dose of SSRIs
a typical daily dose is 20 mg although this may be increased
it take 304 months of daily use for SSRIs to impact upon symptoms
increased up to 60 mg if appropriate
what is SSRIs often combined with…
drugs are often used alongside cognitive behaviour therapy (CBT) to treat OCD
the drugs reduce a patient’s emotional symptoms, such as feeling anxious and depressed. this means that patient can engage more effectively with CBT
alternative to SSRIs (2)
- tricyclics
- SNRIs
biological treatment of OCD
Tricyclics
older type of antidepressants such as clomipromine
these have the same effect on serotonin system as SSRIs but the side effects can be more severe.
biological treatment of OCD SNRIs
over the last 5 years a new class of antidepressant has been developed
serotonin nor-adrenaline re-uptake inhibitor
like tricylcis they are second for people who don’t respond to SSRIs
SNRIs increase levels of serotonin as well as
nor-adrenaline
evaluation of drug treatment of OCD
limitations
- side effects. significant minority will get no improvements, SSRIS ingestion, blurred vision, loss of sex drive. clomiprame more common and serious side effects stop patient from taking it.
- unreliable: some believe favouring drugs treatment is biased because sponsored by drug companies who suppress evidence for economic gain
- OCD following trauma: may not be appropriate to use drugs treating cases that follow trauma to use drugs treating cases that follow trauma when psychological therapies may provide the best option
evaluation of drug treatments for OCD strengths
- effective. clear evidence from 17 studies show better results for SSRIs than placebo. symptom decline in 70% of patients
- cost effective and non disruptive: drugs are cheap compared to psych treatment and less disruptive to patients as psych therapy can be hard work.
