psychopathology Flashcards
what is statistical infrequency/deviation
- This model argues that behaviours that are statistically rare should be seen as abnormal.
- What is regarded as statistically rare depends on normal distribution; most people will be around the mean for the behaviour in question with declining amounts of people away from the mean.
- Any individual who falls outside ‘the normal distribution’ (usually about 5% of the population) are perceived as being abnormal
statistical infrequency/devaition strengths 3
- One strength of this definition is that it is clearly appropriate for many mental illnesses where statistical criteria is available (e.g., intellectual disability disorder)
- All assessments with patients with mental disorders includes some kind of measurement of how severe their symptoms are compared to statistical norms
- This allows for an objective, value-free assessment of the level of mental disability being experienced
statistical infrequency/devaition 3
- Not all infrequent behaviours are abnormal, in fact some rare behaviours and characteristics are desirable for example, high intelligence is statistically rare but desirable.
- Not all abnormal behaviours are infrequent as some statistically ‘frequent’ behaviours are ‘abnormal. For example, depression is experienced by around 10% of the population which suggests depression is so common as to not be seen as abnormal under this definition
- The cut-off point is subjectively determined as there needs to be a decision about where to separate normality and abnormality.
statistical infrequency/devaition
evaluation - real life application
Real life application- a strength is that statistical deviation had real-life application in the diagnosis of intellectual disability disorder. There is therefore a place for statistical infrequency in thinking about what are normal and abnormal behaviours and characteristics. All assessment of patients with mental disorders includes a measurement of some sorts of how severe their symptoms are compared to statistical norms. This illustrates that statistical deviation is therefore a useful part of clinical assessment increasing the validity.
statistical infrequency/devaition evaluation usual characteristics can be positive
- IQ scores over 130 are equally as unusual as those below 70, but we wouldn’t think of super-intelligent as undesirable or something that needs treatment. Just because people can display certain behaviour does make the behaviour statistically abnormal but doesn’t mean it requires treatment to return to normal. This is a limitation to the concept and means that it would never be used alone to make a diagnosis.
statistical infrequency/devaition evaluation - not everyone unusual benefits from a label
another limitation is that where someone is living a happy fulfilled life, there is no benefit being labelled as abnormal regardless of how unusual they are. So, someone with a very low IW but who was not distressed and quite capable of working would not need a diagnosis of intellectual disability. If this person was labelled as abnormal this might have a negative effect on the way others view them and the way, they view themselves.
what is deviation from social Norms 3
- Each society has norms (or unwritten rules) for what is seen as acceptable behaviour- any behaviour that varies from these norms may been seen as abnormal
- The definition draws a line between socially desirable and undesirable behaviours
- Those who do not adhere to what society deems as acceptable in that community or society are labelled as abnormal.
deviation from social norms - strengths
- One strength of this definition is that it allows the consideration of the social dimensions of a behaviour
- This means it allows for our understanding that a behaviour may be normal in one situation but not another
- For example, being naked in a town centre goes against norms, but being naked on a nudist beach does not
deviation from social norms weakness
- Many individuals regularly break social norms, but they are defined as ‘eccentric’ rather than mentally ill e.g. Eddie Izzards preference to wear women’s clothing on occasion; he is not defined as ‘abnormal’ by society.
- A problem with this definition is that norms change over time, for example until 1990 homosexuality was classified as a mental illness and ‘sufferers’ were often subjected to barbaric ‘treatments’ as a result.
- This means that we cannot truly define any certain act as ‘abnormal’ because as norms change so must our beliefs about what constitutes’ abnormal’ behaviour.
deviation from social norms evaluation not a sole explanation
strength of the deviation from social norms is that is had real-life application the diagnosis of antisocial personality disorder. Therefore, there is a place for it in thinking about what is normal and abnormal
deviation from social norms evaluation - counterargument
• However, there are other factors to consider, for example the distress to other people resulting from antisocial personality disorder. So, in practice deviation form social norms is never the sole reason for defining abnormality
deviation from social norms evaluation cultural relativism
a limitation is that social norms vary from general to another and from one community to another. For example, one person from one cultural group may label someone from another culture as behaving abnormally according to their standards rather than the standards of the person behaving that way. This creates problems from one culture living within another culture group.
deviation from social norms evaluation can lead to human rights abuse
too much reliance on deviation from social norms to understand abnormality can also lead to systematic abuse of human rights. Looking at the historical examples of deviation from social normas its clear that these diagnoses were to maintain control over minority ethnic group and women.
failure to function adequalty definition
- This definition perceives individuals as abnormal when their behaviour suggests they cannot cope with everyday life.
- If a person cannot do this and are also experiencing distress (or others are distressed by their behaviour) then it is considered a sign of abnormality.
failure to function adequately -Rosenhan and Seligman
identified seven features of abnormality: -suffering maladaptiveness (danger to self) -vividness and unconventionality (stand out) -unpredictable and loss of control -irrationality/ incomprehensibility -causes observer discomfort -violates moral/social standards
failure to function adequately -strengths
- One strength of this definition is it does take into consideration the experiences of the patient allowing an assessment to be made from the point of view of the person experiencing it
- This is relatively easy to judge objectively through an assessment of criterion (WHODAS)
- The more symptoms the sufferer shows, the more abnormal they are
- Therefore, practitioners can decide who needs psychiatric help (treatment) for their mental abnormality.
failure to function adequately - weakness
- Abnormality is not always accompanied by dysfunction
* There is a problem over deciding who has the right to define a behaviour as dysfunctional
failure to function adequately evaluation -patients perspective
a strength is that it attempts to include the subjective experience of the individual. It may not be an entirely satisfactory approach because it is difficult to assess distress but at least this definition acknowledges that the experience of the patient is important. This suggests that failure to function adequately is a useful criterion for assessing normality.
failure to function adequately evaluation -is it simply deviation from social norms
In practice practice it can be hard to say when someone is failing to function and when they are just deviating from social norms. We might think not having a job or permanent address is a sign of failure to function adequately. But then what about people with alternative lifestyles. Similarly, those who practice extreme sports could be seen as behaving in a maladaptive way, whilst those with religious or supernatural beliefs could be seen as irritational
failure to function adequately evaluation-subjective judgements
when deciding whether someone is failing to function adequately someone had to judge whether a patient is distressed or distressing. Some patients mat say they are distressed but may be judged as not suffering. There are methods for making such judgements as objective as possible. However, the principle remains that someone had the right to make this judgement.
deviation from ideal mental health- Jahoda
• Rather than identifying what is abnormal, Jahoda identified six characteristics of what is to be normal and an absence of these characteristics indicates abnormality = Positive Attitude towards self =Self-actualisation =Resistance to stress =Autonomy =Accurate perception of reality
deviation from ideal mental health
- The more of the criteria an individual fails to meet, the further away from normality they are.
- This definition therefore perceives mental abnormality in a similar way to the perception of physical health and looks for an absence of wellbeing
deviation from ideal mental health strengths 2
- One strength of this definition is that it takes a positive approach to mental problems
- The focus is on what is desirable
deviation from ideal mental health limitations 2
- This definition has been accused of having over demanding criteria - at any given moment most people do not meet all the ideals so in effect we are all ‘abnormal’ for example, few people experience ‘personal growth’ all the time
- Furthermore, the criteria are difficult to measure. Jahoda argued mental health can be considered like physical health but diagnosing mental health is far more subjective in the absence of X rays etc.
deviation from ideal mental health evaluation- comprehensive definition
It covers a broad range of criteria for mental health. It covers most of the reasons someone would seek help from mental health service or be referred to help
deviation from ideal mental health evaluation-cultural relativism
emphasis of person achieve in the concept of self-actualisation would be considered self-indulgent in more collectivistic cultures
deviation from ideal mental health evaluation- unrealistic high standard mental health
very few could attain all the goals specified for mental health. Therefore, this approach would see most of us as abnormal. On the positive side it makes it clear to people the ways in which they could benefit from seeking treatment to improve their mental health.
diagnostic features of phobias 4
•Intense, persistent, irrational fear a particular object, event or situation.
•Response is disproportionate and leads to avoidance of phobic object, event or situation.
•Fear is severe enough to interfere with everyday life.
Condition may or may not be accompanied by PANIC ATTACKS
what is a phobia 2
- A phobia may be defined as ‘A persistent and unreasonable fear of a particular object, activity or situation’ (Comer 2008)
- This definition highlights that almost anything can become a phobia.
what are the three behavioural factors of a phobias
panic
avoidance
endurance
define the behavioural factor panic of a phobia
a phobic person may respond in panic by feeling high levels of anxiety and trying to escape. The fear responses in phobias are irritational
define the behavioural factor avoidance of a phobia
unless a conscious decision is made to face their fear, they tend to go to a lot of effort to avoid coming into contact with phobic stimulus
define the behavioural factor endurance of a phobia
in which the sufferer remains in the presence of the phobic stimulus but continues experiencing high levels of anxiety. This may be unavoidable
what are the two emotional factors of phobias
anxiety
emotional response are unreasonable
define the emotional factor anxiety of phobias
they involve an emotional response of anxiety and fear which is unpleasant state of high arousal. This prevents the sufferer relaxing and makes it very difficult to experience positive emotions. Can be long term.
define the emotional factor of emotional responses are unreasonable of phobias
the responses are unreasonable as it is wildly disproportionate to the danger that the phobias possess.
what are the three cognitive factors of phobias
selective attention to phobic stimulis
irrational beliefs
cognitive distortions
define the cognitive factor of selective attention to phobic stimulus of phobias
If a sufferer can see the phobic stimulus it’s hard to look away from it as keeping our attention on something dangerous so they can quickly react
define the cognitive factor of irrational beliefs of phobias
A phobic may hold irrational beliefs in relation to a phobic stimulus. This kind of belief increases the pressure on the sufferer to perform well in social situations
define the cognitive factor of cognitive distortions of phobias
the phobic’s perception of the phobic stimulus may be distorted.
define OCD
A condition characterised by obsessions and/or behaviour
what are the three behavioural factors of OCD
compulsions are repetitive
compulsions reduce anxiety
avoidance
define the behavioural factor of compulsions are repetitive of OCD
typical sufferers of OCD feel compelled to repeat a behaviour
define the behavioural factor of compulsions are reduced anxiety of OCD
they have no compulsions just a general sense of irrational anxiety to manage the anxiety produced by obsessions.
define the behavioural factor of avoidance of OCD
sufferers might be characterised by their avoidance as they attempt to reduce anxiety by keeping away from situations that trigger it. May manage OCD by avoiding situations that trigger anxiety
what are the three emotional factors of OCD
anxiety and distress
accompanying depression
guilt and disgust
define the emotional factor of anxiety and distress of OCD
regarded as a particularly unpleasant emotional experience because of the anxiety that accompanies obsessions and compulsions. Obsessive thoughts are unpleasant and frightening, and the anxiety is overwhelming as there’s an urge to repeat the behaviour
define the emotional factor of accompanying depression of OCD
low mood and lack of enjoyment in the activities. Compulsive behaviour tends to bring some relief from anxiety, but this is temporary,
define the emotional factor of guilt and disgust of OCD
negative emotions such as irrational guilt for example over minor moral issues or disgust which may be directed at something external like dirt or at themselves
what are the three cognitive factors of OCD
obsessive thoughts
cognitive strategies to deal with obsession
insight into excessive anxiety
define the cognitive factor of obsessive thoughts of OCD
90% of OCD sufferers has obsessive thoughts that recur over and over again. Always unpleasant such as worrying about contamination by germs or dirt.
define the cognitive factor of cognitive strategies to deal with obsession of OCD
may adopt cognitive coping strategies such as meditating. This helps manage anxiety but can make the person appear abnormal and distract from everyday tasks.
define the cognitive factor of insight into excessive anxiety of OCD
not rational obsessions. OCD suffers experience thoughts about the worst-case scenarios that might result if their anxiety is justifies. Tend to be hypervigilant.
acquisition by classical conditioning - behavioural approach to explaining phobias
John Watson and Rosalie Rayner (1920) created a phobia in a 9month old baby called ‘little Albert’. Albert showed no unusual anxiety the start of the study. when shown a white rat he tried to play with it. however the experimenters then set out to give Albert a phobia of the rat. when the rat was presented they made a loud frightening noise by banging a bar close to alberts ears.
what was the unconditioned stimulus in the little Albert study
the noise of the iron bar
what was the unconditioned response in the little Albert study
the noise of the iron bar creating FEAR
what was th neutral stimulus in the little Albert study
a rat
what was the unconditioned stimulus in the little Albert study
no fear of the rat
what was the conditioned stimulus in the little Albert study
the rat
what was the conditioned response in the little Albert study
fear of the rat
what is maintenance by operant conditioning as a behavioural approach to explaining phobias
operant conditioning takes place when behaviour is reinforced or punished. Reinforcement increases the frequency of behaviour- true of positive and negative reinforcement. Whenever we avoid a phobic stimulus we successfully escape the fear and anxiety that we would have suffered if we had remained there. - this reduced in fear reinforces the avoidance behaviour and so the phobia is maintained
good explanatory power - evaluation of the behavioural approach to explaining phobias
two process model went beyond Watson and Rayner’s concept of classical conditioning. it explained how phobias could be maintained over time and has important implications for therapies because it explains why patients need to be exposed to the feared stimulus. once a patient is prevented from practising their avoidance behaviour the behaviour ceases to be reinfored and so it declines
alternative explanation for avoidance behaviour -evaluation of the behavioural approach to explaining phobias
not all avoidance behaviour associated with phobias seems to be the result of anxiety reduction at least in more complex phobias like agoraphobia. there is evidence to suggest that at least some avoidance behaviour appears to be motivated more by positive feelings of safety. this is a problem as it suggests avoidance is motivated by anxiety reduction
an incomplete explanation of phobias -evaluation of the behavioural approach to explaining phobias
bounton 2007 points out that evolutionary factors probably have an important role in phobias but two factor theory does not mention this. for example we can acquire phobias that have been a source of danger in our evolutionary past. Shows there is more to acquiring phobias that simple conditioning.
what is the two process model
a combination of classical and operant condition to phobias
the two process model
- In his two-process model of phobia acquisition, Mowrer suggests that phobias are acquired as a result of classical conditioning and maintained by operant conditioning.
- A person who is terrified of spiders is likely to run away when they see one. The escape and consequent reduction of fear acts as a negative reinforcer, increasing the likelihood that they will continue to avoid spiders in future.
- In this way, the phobia is maintained. When an individual avoids a situation which is unpleasant, the behaviour results in a pleasant consequence which means the behaviour is likely to be repeated.
- Mowrer suggested that whenever we avoid a phobic stimulus we successfully escape the fear and anxiety that we would have suffered if we had entered its presence or remained there. This reduction in fear reinforces the avoidance behaviour and so the phobia is maintained
what is the behaviourist approach 3
- Founded by JB Watson in 1915, the behaviourist approach studies observed behavioural responses of humans and animals.
- The behaviourist approach believes we learn to behave in response to our environment, either by stimulus-response association, or as a result of reinforcement.
- Important contributors to the behaviourist approach are Ivan Pavlov, with his theory of classical conditioning, and B.F. Skinner, and his work into operant conditioning.
what are the aims of the behavioural approach to treating phobias
- reduce phobic anxiety through the principle of classical conditioning whereby a new response to the phobic stimulus is paired with relaxation instead of anxiety - counterconditioning
- reduce phobic anxiety through the principle of operant conditioning whereby there is no option for avoidance behaviour
what is systematic desensitisation
Wolpe (1958) – two competing emotions cannot occur at the same time so if fear is replaced with relaxation the fear cannot continue. Systematic desensitisation aims to teach a patient to learn a more appropriate association and is designed to reduce an unwanted response, such as anxiety, to a stimulus. Reciprocal inhibition is the process of inhibiting anxiety by substituting a competing response.
what are the three stages of systematic desensitisation
anxiety hierarchy, relaxation and exposure
what is the anxiety hierarchy in systematic desensitisation
The anxiety hierarchy is constructed by the patient and the therapist. This is a stepped approach to getting the person to face the object or situation of their phobia from least to most frightening
what is the relaxation in systematic desensitisation
The patient is trained in relaxation techniques, so that they can relax quickly and as deeply as possible
what is the exposure in systematic desensitisation
The patient is then exposed to the phobic stimulus whilst practising the relaxation techniques as feelings of tension and anxiety arise. When this has been achieved the patient continues this process by moving up their hierarchy.
Evaluation of systematic desensitisation
It is effective
•These techniques have proven most effective with specific phobias when a particular phobic object/situation can be identified. Gilroy et all 2003 followed up with 42 patients who had been treated for spider phobia in three 45-minute sessions of systematic desensitisation. A control group was treated by relaxation without exposure. At both three months and 55 months after the treatment the systematic desensitisation group were less fearful than the relaxation group. This is a strength as it shows it can help reduce anxiety. HOWEVER- less effective with agoraphobic and social phobias.
Evaluation of systematic desensitisation
suitable for a diverse range of patients
As this is a simple process that the patient controls, it is often the most suitable form of treatment. Flooding or cognitive therapies are not well suited to some patients. For example, those with learning difficulties can make it harder for patients to understand what is happening during flooding and makes it hard to engage with cognitive therapies that required you to reflect on what is happening.
Evaluation of systematic desensitisation
It is acceptable to patients
When given the choice between SD and flooding, more often patients choose SD as it does not cause the same degree of trauma and actually involves a pleasant aspect (the relaxation techniques). This is reflected in the low refusal rates of the treatment
what is flooding 4
- This involves overwhelming the individual’s senses with the item or situation that causes anxiety so that the person realises that no harm will occur.
- No relaxation techniques or step by step build up.
- Individual is exposed repeatedly and in an intensive way with their phobia.
- Individual has their senses flooded with thoughts, images and actual experiences of the object of their phobia.
the ethics of flooding 3
- Flooding is not unethical as patients give their informed consent, so they know exactly what is involved
- It is of course an unpleasant experience and a patient has to be properly prepared
- A patient would normally be given the choice of systematic desensitisation or flooding
The evaluation of flooding-
It is cost-effective
• The quick effect that flooding can have means that patients are free of their symptoms as soon as possible and this makes the treatment cheaper than alternatives. Ougrin 2011 have found that flooding is highly effective and quicker than alternatives. This means that patients are free of their symptoms as soon as possible and makes the treatment cheaper.
The evaluation of flooding-
less effective for some types of phobia
•Flooding is less effective for treating more complex phobias like social phobias. This may be because social phobias have cognitive aspects – an individual does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation. This type of phobia may be benefit more from cognitive therapies because they tackle the irrational thinking.
The evaluation of flooding- the treatment is traumatic for patients
• Flooding produces high levels of fear and this can be very traumatic and as a result many patients refuse to start or complete treatment. Patients can waste their time and money only to have them refuse to start or complete the treatment.
evaluation of genetic explanations to explaining OCD- genetics
There is evidence to suggest there is a genetic component to the disorder. One of the best sources of evidence for the importance of genes is twin studies (Nestadt – 2010)
•Family studies could also be used to explain environmental influences
•Close relatives of OCD sufferers may have observed and imitated the behaviour (SLT)
•It is difficult to untangle the effects of environment and genetic factors
evaluation of genetic explanations to explaining OCD -candidate genes
Candidate genes are ones which, through research, have been implicated in the development of OCD.
•There are too many genes involved
•Psychologists have not been successful at pinning down all the genes involved
•Each genetic variation only increases the risk of OCD by a fraction
evaluation of genetic explanations to explaining OCD- environmental factors
Individuals may gain a vulnerability towards OCD through genes that is then triggered by an environmental stressor.
•Cromer (2007) found that over half the OCD patients in their sample had a traumatic event in the past, and that OCD was more severe in those with more than one trauma.
•This means that it may more productive to focus on environmental causes as it seems that not all OCD is entirely genetic in origin
evaluation of neural explanations in explaining OCDi role of neurotransmitters
Allows medication to be developed which helps sufferers.
•Drugs are not completely effective
•Just because administering SSRIs decreases OCD symptoms does not mean that this was the cause in the first place
•There is time delay between taking drugs to target the condition and any improvements being made and yet the chemical imbalance is addressed in hours
evaluation of neural explanations in explaining OCD-areas of the brain
Advances in technology have allowed researchers to investigate specific areas of the brain more accurately, and OCD sufferers do seem to have excessive activity in the orbital frontal cortex. Cleaning and checking behaviours are “hard-wired” in the thalamus
•The repetitive acts (compulsions) may be explained by the structural abnormality of the basal ganglia but not necessarily the obsessional thoughts.
•There are inconsistencies found in the research as no system has been found that always plays a role in OCD
•These neural changes could be as a result of suffering from the disorder, not necessarily the cause of it
evaluation of neural explanations in explaining OCD - not clear what neural mechanisms are involved
research identified other brain systems may be involved sometimes in OCD but no system has been found that always plays a role in O D therefore we can’t claim to understand neural mechanisms involved in OCD
neural explanations to the biological approach to explaining old
•The genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain
-Neuroimaging (brain scans) techniques have enabled researchers to study the brain therefore allows for comparisons with abnormal brain patterns
•Researchers have implicated a part of the brain known as the basal ganglia. responsible for innate psychomotor functions
•Rapport and Wise proposed the hypersensitivity of the basal ganglia gives a rise to the repetitive motor behaviours seen in OCD,
•Other brain areas believed to be involved in OCD include the orbitofrontal cortex (OFC) and the thalamus In OCD the OFC and the thalamus are believed to be overactive.
•An overactive thalamus would result in an increased motivation to clean or check for safety. If the thalamus was overactive the OFC would also become overactive as a result.
•An overactive OFC would result in increased anxiety and increased planning to avoid anxiety.
genetic explanations to the biological approach to explaining depression
•It has been proposed that there is a genetic component to OCD which predisposes some individuals to the illness. The genetic explanation suggests that whether a person develops OCD is at least partly due to their genes.
•Candidate genes are ones which, through research, have been implicated in the development of OCD.
•A possible candidate gene is the SERT gene which is involved in regulating serotonin, a neurotransmitter which facilitates message transfer across synapses.
•Another possible candidate gene is the COMT gene – this regulates the production of dopamine. Dopamine effects motivation and drive
•It is recognised however that not everyone in a given family gets OCD so there must be additional factors.
The diathesis–stress model suggests that people gain a vulnerability towards OCD through genes but an environmental stressor is also required. This could be a stressful event, for example a bereavement.
•OCD is thought to be polygenic – this means that its development is not determined by a single gene but a few (maybe as many as 230 genes) – this means that there is little predictive power from this explanation.
•The term used to describe this is aetiologically heterogeneous. Meaning that the origin of OCD has different causes.
•There is also evidence to suggest that different types of OCD may be the result of particular different types of variations, such as hoarding disorder and religious obsession.
what does SSRI stand for
selective serotonin reuptake inhibitors
SSRI treatment 3
- The standard medical treatment used to tackle the symptoms of OCD are SSRIs
- SSRIs work on increasing certain neurotransmitter in the brain by preventing the re-absorption of serotonin.
- By preventing the re-absorption of serotonin, SSRIs effectively increase its levels in the synapse and thus continue to stimulate the post-synaptic neuron
combining SSRI with other treatment 4
- Drugs are often used alongside cognitive-behavioural therapy (CBT)
- The drugs reduce the sufferer’s emotional symptoms, such as anxiety or depression
- This means that the patient can then engage more effectively with CBT
- Some sufferers may respond best to CBT alone without the need for medication
alternatives to SSRI 2
•Where an SSRI is not effective after three to four months the dose can be increased, or it can be combined with other drugs
•Patients respond differently to different drugs and sometimes alternatives work well for some people and not at all for others
tricyclics
SNRIs
evaluation of the biologicals approach to treating OCD- drug therapy is effective at tackling OCD symptoms
•There is clear research to suggest that SSRIs are effective in reducing the severity of OCD symptoms (Soomro: 2009)
evaluation of the biologicals approach to treating OCD- cost effective
•Drug treatments are cheap in comparison to psychological treatments and, unlike psychotherapy, they are non-disruptive to patients’ lives
evaluation of the biologicals approach to treating OCD- can have side effects
evaluation of the biologicals approach to treating OCD-
