Psychopathology - Paper 1 Flashcards
What is psychopathology?
Refers to either study of mental illnesses or mental distress or manifestation of behaviours and experiences which may be indicative of mental illness or psychological impairment
Concerned with abnormal behaviour
Seeks to define what makes a behaviour abnormal
What is statistical infrequency?
Abnormal behaviours are those that are extremely rare, mathematical method for defining abnormality
Human attributes fall into normal distribution within population (bell shaped curve)
Standard deviations inform us how far scores fall on either side from the mean
EXAMPLE
IQ - 68% of population fall within one standard deviation from mean
95% fall within two standard deviations from the mean
Definition states that 5% of population which fall more than two standard deviations from the mean are abnormal
People who scored below 70 and above 130 are abnormal
What are deviations from social norms?
Abnormality is when a behaviour doesn’t fit within what is socially acceptable
Dependent on the culture in which the behaviour occurs, what is abnormal in one culture is not defined as abnormal in another
Norm must be deeply embedded into culture for deviations to be seen as abnormal, slight deviations such as changing hair colour may not be seen as abnormal if norm isn’t important to society
EXAMPLES - queuing in a shop, being polite, not laughing at a funeral
Some are also policed by laws such as paedophilia
What is failure to function adequately?
When an individual is not able to cope with everyday life, they have the basic inability to manage in everyday life - behaviour is seen as abnormal
Defined by Rosenhan and Seligman into 7 sections - unpredictability, maladaptive behaviour, personal distress, irrationality, observer discomfort, violation of moral standards and unconventionality.
GAF method of measuring this, included 7 sections by Rosenhan and Seligman plus occupational functioning
Schizophrenia defined as abnormal because behaviours are distressing to others even if they’re not personally distressing
However, this definition would not be made if someone with very low IQ on its own. Must have very low IQ which prevents them from daily functioning to be defined as this
What is deviation from ideal mental health?
Abnormality defined as deviating from an ideal positive mental health, defined by Jahoda’s criteria of ideal mental health
Absence of criteria indicates abnormality and potential mental disorder
If some are not fulfilled the person would experience difficulties
1. Positive attitude towards self - level of self esteem
2. Self-actualisation - state of contentment, become the best you can be
3. Autonomy - independence and self reliance, function as individual and not depend on others (doesn’t include physical disabilities)
4. Resistance to stress - shouldn’t feel stressed, handle stressful situations competently
5. Environmental mastery - can adapt to new situations and be at ease in all situations in life
6. Accurate perception of reality - should have similar perspective to others, distorted thinking of some people
What is a strength of statistical infrequency? Real life application in clinical assessment
Real life application to diagnosis of intellectual disability disorder
Therefore a place for statistical deviation in thinking about what are normal and abnormal behaviours and characteristics
All assessments of patients with mental disorders include some kind of measurement of how severe their symptoms are compared to statistical norms
Useful part of clinical assessment
What is a limitation of statistical infrequency? Some abnormal behaviour is desirable
Some abnormal behaviour is desirable
Very few people have IQ over 150 however a lot of people would be liked to be classed as a genius
Definition doesn’t distinguish between desirable and undesirable behaviour
We need a way of identifying behaviours that are both infrequent and undesirable
What is a limitation of statistical infrequency? Subjectively determined
The cut off points are subjectively determined
People disagree on what constitutes an abnormal lack of sleep
This is a symptom of depression therefore its important to know where the cut off point lies for there to be a diagnosis to be made
Disagreements about cut off points make it difficult to define abnormality in terms of statistical infrequency
What is a limitation of statistical infrequency? Can cause distress, negative view on self
Not everyone unusual benefits from a label
Where someone is living a happy fulfilled life, no benefit from being labelled as abnormal no matter how unusual they are
Someone with low IQ may not be distressed and be capable of working however labelling them with ‘intellectual disability disorder’ would not benefit them
Labelling a person using this definition could have negative self effect on their self view and the way others view them
What is a strength of deviation from social norms? Includes issues of desirability of behaviours
Includes those issues
Being a genius is statistically abnormal but we don’t include that in this definition of abnormal behaviour
Narcissism was once viewed as a deviation from social norms however now selfies are a common place
Means that social norms are more useful that other definitions such as statistical norms
What is a limitation of deviation from social norms? Social norms vary all the time
Social norms vary all the time
Homosexuality was considered a mental disorder in DSM, it is now considered to be socially acceptable
Definition is based on prevailing social morals and attitudes about what is deemed to be ‘normal’ and ‘abnormal’
Too much reliance on such definitions could lead to systematic abuse of human rights because of attitudes people hold
What is a limitation of deviation from social norms? Social norms vary depending on the behaviour’s context
Deviance is related to a behaviour’s context
Eg - wearing few clothes on a beach is normal but abnormal at a formal gathering
Sometimes theres no clear line between abnormal deviation and harmless eccentricity (slightly strange)
Social deviance on its own cannot offer a complete definition of abnormality
What is a limitation of deviation from social norms? Cultural differences
Behaviours vary from one community to another
Person from one cultural group may label someone as abnormal from another cultural group based on their own views and standards of ‘normal’ behaviour
Hearing voices is not seen as abnormal in all cultures
Can be problematic to use social norms to define abnormality when diagnosing those from other cultures
Abnormality is culturally relative
What is a strength of failure to function adequately? Includes subjective experience of individual and the people around them
Does attempt to include subjective experience of the individual
Acknowledges that experience of individual and people around them is important
Definition captures experience of many people who need help
Useful criterion for assessing abnormality
What is a limitation of failure to function adequately? Some abnormal behaviours can be functional
Some apparently abnormal behaviours can be functional
Depression may lead to extra attention for an individual, attention is rewarding and therefore functional even if regarded as abnormal
Incomplete definition as fails to distinguish between behaviours that are dysfunctional and those that have some function for the individual
What is a limitation of failure to function adequately? Judgment depends on person diagnosing, can be subjective
Someone needs to decide whether this is actually the case
Sometimes people experience personal distress and recognise their behaviour as undesirable, some may be content with their behaviour and others may be distressed by it
Whether a behaviour is defined as abnormal depends on who is making judgement which may be subjective
What is a limitation of failure to function adequately? Limits personal freedom
Hard to say when someone is failing to function adequately or if they’re deviating from social norms
People may think not having a permanent address or job is a sign of failure to function adequately but what can we say about people with alternative lifestyles who choose not to have those things?
Those who practice extreme sports could be accused of being in a maladaptive way, or those with religious or supernatural beliefs could be seen as irrational
If these behaviours are treated as “failures” of adequate functioning, we risk limiting personal freedom and discriminating against minority groups
What is a strength of deviation from ideal mental health? Comprehensive definition
Comprehensive definition
Covers a broad range of criteria for mental health, may cover most of the reasons someone would seek help from mental health services or be referred help
Range if factors discussed in Jahoda’s mental health definition make it a good tool for thinking about mental health
What is a limitation for deviation from mental health? Cultural differences
Specific to Western European and north Mercian cultures, based on western cultures’ ideals and beliefs
Applying them to non-western members of culture would be inappropriate
Concept of self-actualisation may seem indulgent in many areas around the world
Criteria can only be applied within individualist cultures
Makes findings hard to generalise to the rest of the world
What is a limitation of deviation from mental health? Unrealistic, not everyone reaches every point
Criteria are unrealistic
Few people satisfy all criteria all of the time
Everyone would be described as abnormal to a degree
Need to ask how many of Jahoda’s criteria must be absent before someone is judged as abnormal
What is a limitation of deviation from mental health? Mental and physical health are not the same
Suggests mental health is the same as physical health
Generally, physical illnesses have physical causes so easy to diagnose, however not all mental disorders have physical causes
Unlikely we can diagnose mental abnormality in the same way we can diagnose physical abnormality
What is a specific phobia?
Phobia of an object or a stimulus
Eg - arachnophobia, satanophobia, arithmophobia
What is an agoraphobia?
Phobia of being outside or in an open space or public space
Eg - fear of going outside, fear of crowds
What is social anxiety?
Phobia of a social situation
Eg - fear of using a public toilet, fear of public speaking, fear of anger
What is a phobia?
An anxiety disorder which interferes with daily living
It is an irrational, persistent fear of an object or a situation
The exposure to the phobic stimulus almost always produces a rapid anxiety response, excessive fear of phobic stimulus
Phobia stimulus avoided or responded to with great anxiety
What are behavioural characteristics in response to a phobia?
Panic - crying, screaming, running away, freezing, increasing heart rate
Avoidance - efforts made to avoid phobia stimulus to reduce anxiety
Endurance - remaining in presence of phobic stimulus with high levels of anxiety, some fears may not be completely avoidable
What are emotional characteristics of a phobia?
Anxiety - unpleasant state of arousal that prevents relaxation and positive emotion
Emotional responses are unreasonable - emotions are disproportionate to the danger posed by the phobic stimulus
What are cognitive characteristics of phobias?
Selective attention to the phobic stimulus - attention placed on phobic stimulus once identified
Irrational beliefs - unsupported view of phobic stimulus (public speaking - may see more people than are actually there, think they’re stupid if they don’t sound intelligent
Cognitive distortions - exaggerated/irrational thought patterns around phobic stimulus, distorted perceptions (spiders - see them as bigger than they are)
Recognition of exaggerated anxiety - conscious awareness that anxiety levels experienced are overstated, exaggerated
What is behaviourism?
Emphasises role of learning in acquisition of behaviour
Behaviour explained in terms of what is observable
What is classical conditioning?
Learning by association
Occurs when two stimulus are repeatedly paired together - unconditioned stimulus (UCS) and new neutral stimulus (NS)
NS eventually produces same response that was first produced by the UCS alone
What is operant conditioning?
Form of learning where behaviour is shaped and maintained by its consequences
Consequences include positive reinforcement, negative reinforcement or punishment
What is the two process model? Mowrer and spider example
Proposed two process model based on behavioural approach to phobias
They’re learnt through classical conditioning and continue/ are maintained because of operant conditioning
Person who is scared of spiders is likely to run from one if spotted, escaping and avoiding acts as negative reinforcer, will continue to avoid spiders in the future as reduces anxiety, phobia is maintained
When situation and fear is avoided it reinforces the avoidance behaviour, avoidance acts as a pleasant consequence which means behaviour is likely to be repeated - we avoid the fear and anxiety we would have faced if we entered its presence or remained near the phobic stimulus.
Little Albert’ study - Watson and Rayner (1920)
Aimed to demonstrate that irrational fears could be induced by use of classical conditioning
Used placid boy, Little Albert, who at 9 months showed no fear of a lab white rat
At 11 months they carried out procedures to induce fear
Whenever rat placed in Albert’s lap, Watson makes loud noise banging two steel bars behind him - total of 7 times
Loud noise - unconditioned stimulus
Albert’s response (crying) - unconditioned response
Before conditioning, rat was a neutral stimulus
By third trial, Albert showed fear when showed a white rat
Rat now a conditioned stimulus and fear response was a conditioned response
What is a strength of the two process model? Good explanatory power
Two process explanation has good explanatory power
Explains how phobias can be maintained overtime, important implications to therapy, explains why patients should be exposed to fear stimulus and should prevent patients practicing their avoidance behaviour - behaviour stops being reinforced
Application to therapy is a strength of the approach
What is a limitation of the two process model? Doesn’t explain development of all phobias/traumatic events did actually happen
Doesn’t explain the development of all phobias
People not aware of having experienced an event related to their phobias, can’t remember incident happening that caused phobia to develop
Different phobias may be the result of different processes
OST says it is possible such traumatic events did happen but phobic has forgotten them
What is a limitation of the two process model? May have biological aspects to the phobia rather than negative incidents
Not all phobias are developed from negative incidents, may have biological aspect
DiNardo et al found that not everyone bitten by a dog has a phobia of dogs
Diathesis stress model says we inherit a genetic vulnerability for developing mental disorders, only manifested by an event to trigger it
Dog bite will only lead to a phobia in people with such a vulnerability
What is a limitation of the two process model? Phobias have cognitive characteristics, cognitive therapies compared to behavioural treatments
Phobias have cognitive aspects that cannot be explained in traditional behavioural framework
Eg - person who thinks they’ll die if trapped in a lift may become extremely anxious and develop a phobia of lifts triggered by this thinking
Shows irrational thinking is involved in development of phobias , explains why cognitive therapies can be more successful in treating phobias than behavioural treatments
What is a limitation of the two process model? Biological preparedness
Biological preparedness may be better explanation than two process model of how phobias are developed
Seligman says - animals more genetically prepared to learn associations between fear and stimuli that were life threatening in our evolutionary past such as snakes
Fear is easier to condition to some things (spiders) than others (toasters) even though toasters are more dangerous than spiders
Behavioural explanations cannot alone explain the development of phobias
What is systematic desensitisation?
Uses classical conditioning to gradually reduce anxiety around the phobic stimulus
Aim is to replace feelings of anxiety with relaxation - counter conditioning
Impossible to be relaxed and afraid at the same time
Relaxation prevents experiencing fear - reciprocal inhibition
It follows a three step process - anxiety hierarchy, relaxation and exposure
What is the three step process of systematic desensitisation?
Anxiety hierarchy - list put together by patient and therapist of most to least frightening situations that provoke anxiety
Relaxation - teaches patient to relax/reduce anxiety as deeply as possible (breathing exercises, meditation, medication if phobia/ anxiety is severe enough
Exposure - patient exposed to phobic stimulus whilst in a relaxed state
What is flooding?
Involves exposure without gradual build up
Immediate exposure of phobic stimulus
Don’t have option of avoidance so they learn the phobia is harmless - extinction
Conditioned stimulus no longer produces the previously conditioned response of fear \
Must obtain FULL consent - not unethical but it is unpleasant
What is extinction?
Patient learns that a phobic stimulus is harmless
What is counter conditioning?
Learning a different exposure to the phobic stimulus
What is reciprocal inhibition?
Impossible to be afraid and relaxed at the same time - one emotion prevents the other
What is a strength of systematic desensitisation? Supporting research evidence (McGrath et al (1990))
Research evidence demonstrates effectiveness of this treatment of phobias
McGrath et al (1990) found 75% of patients with phobias were successfully treated using systematic desensitisation - using actual exposure to the phobic stimulus
Shows it is effective in treating phobias
What is a strength of systematic desensitisation? Further support, Gilroy et al (2002)
Gilroy et al examined 42 patients with arachnophobia
Treated using three, 45 mins systematic desensitisation sessions
Examined 3 months then 33 months later, systematic group were less fearful than control group (only taught relaxation techniques)
Provides further support for SD as a long-term treatment for phobias
What is a strength of systematic desensitisation? Suitable for diverse range of individuals, may find it easier to understand than other treatments
Suitable for a diverse range of patients
Anxiety disorders often also have learning difficulties - makes it hard for some individuals to understand procedures such as flooding or engage with cognitive therapies that require you to reflect on what you’re thinking
Therefore an appropriate treatment for many individuals
What is a limitation of systematic desensitisation? Evolutionary survival benefit, not effective in treating all phobias
Not effective in treating all phobias
Phobias which aren’t developed from personal experience (classical conditioning), eg - fear of heights not effectively treated using SD
Some psychologists believe that certain phobias have evolutionary survival benefits and aren’t a result of personal experience - evolution
Ineffective in treating evolutionary phobias
What is a limitation of systematic desensitisation? Symptom substitution
When one phobia goes another may appear in its place
Phobia of snakes may be replaced with a phobia of trains
Suggests its not effective in treating phobias
What is a strength of flooding? Cost effective, treated quicker
Cost - effective treatment for phobias
Research suggested that flooding is comparable to other treatments (SD and cognitive therapies) of effectiveness - significantly quicker
Strength because treated quicker and more cost effective for patient and health service providers
What is a limitation of flooding? High levels of anxiety caused
Cost effective but highly traumatic with high levels of anxiety
Full consent is obtained but may not complete treatment due to stressful experience
Waste of money and time if patients don’t finish treatment
What is a limitation of flooding? Irrational thinking instead of unpleasant experience
Highly effective for specific phobias but treatment less effective for social phobia and agoraphobia
Social phobias are caused by irrational thinking not by unpleasant experiences
More complex phobias can’t be treated by behaviourist treatments and may need to use cognitive behavioural therapy which treats the irrational thinking
What is a limitation of flooding? Symptom substitution
When one phobia goes another may appear in its place
Phobia of snakes may be replaced with a phobia of trains
Suggests its not effective in treating phobias
What are the behavioural characteristics of OCD?
- compulsive behaviour - behavioural component of OCD
- compulsions are repetitive
- compulsions reduce anxiety - 10% of OCD sufferers show compulsive behaviour alone, however for a lot of individuals, compulsions performed to manage anxiety produced by obsessions (recurring thoughts)
- avoidance - attempt to reduce anxiety by avoiding situations that trigger OCD
What are the emotional characteristics of OCD?
- anxiety and distress - obsessive thoughts are unpleasant and frightening, anxiety can be overwhelming, compulsions also create anxiety
- depression - sufferers may have low mood, lack of enjoyment out of activities
- irrational guilt - felt over minor moral issues
- disgust - directed to something external (dirt) or the self
What are the cognitive characteristics of OCD?
- obsessive thoughts - 90% of sufferers have this, thoughts reoccur over and over, vary but are always unpleasant
- cognitive strategies - adopted to deal with obsessions and manage anxiety (religious person may meditate or pray)
- insight into excessive anxiety - aware obsessions and compulsions aren’t rational, needed for diagnosis
What are the two biological explanations of OCD?
Genetic and Neural
What is the genetic explanation for OCD?
Focuses on the role that genes play in the development of a mental disorder, genes make up chromosomes and consist of DNA which codes for psychological features
Genes transmitted from parent to offspring, therefore inherited
How are genes involved in an individual’s vulnerability to OCD? Lewis (1936)
Lewis (1936) observed that 37% of his OCD patients had parents with OCD, 21% had siblings with OCD
Suggests that OCD runs in families, however thought that it is the genetic vulnerability rather than a gene(s)
Diathesis stress model suggests that certain genes leave some individuals more likely to suffer a mental disorder, need some environmental stress (experience) to trigger the OCD
Candidate genes in creating vulnerability of OCD
Researchers have found candidate genes in creating vulnerability of OCD, some of theses genes are involved in regulating development of serotonin system (neurotransmitter involved in OCD)
One of the genes thought to be involved in OCD vulnerability is gene 5HTI - D beta (5 huge tits in Dubai)
- involved in efficiency of transport of serotonin across synapses
OCD is polygenic - Taylor (2013)
Polygenic meaning not caused by one single gene, several genes involved
Taylor (2013) analysed findings of pervious studies and found evidence that up to 230 different genes may be involved in OCD
Genes thought to be associated with action of dopamine as well as serotonin, both neurotransmitters have role in regulating mood
Origin of OCD has different causes
Aetiologically heterogenous, origin has different causes
One group of genes may cause OCD in one person and a different group in a different person
Some evidence to suggest different types of OCD such as hoarding and religious obsessions may be due to particular genetic variations
Strength of the genetic explanation of OCD - evidence support of vulnerability due to genetic makeup - nestadt et al (2010)
Evidence from variety of sources for the idea that some people are vulnerable to OCD as a result of their genetic make-up
Nestadt et al (2010) reviewed previous twin studies, found 68% of identical twins shared OCD as opposed to 31% of non-identical
Suggests theres a genetic influence on OCD
Limitation of genetic explanation of OCD - twin tides flawed, nature vs nurture
Twin studies are flawed as genetic evidence
They assume that identical twins are only more similar than non-identical twins due to genes, overlook that identical twins may be similar in terms of shared environment
Eg - non-identical twins may be boy and girl so have quite different experiences
Reduces value of twin studies, doesn’t separate effects of nature vs nurture on OCD
Reduces validity of supporting evidence for genetic explanation of OCD
Limitation of genetic explanation of OCD - more than one gene involved, cannot specify
Twin studies suggest OCD is largely genetic but psychologists haven’t been able to identify all of genes involved
One reason for this is, there are several genes involved in OCD and each genetic variation only increases risk of OCD by fraction
Consequence is that genetic explanation is unlikely to be very useful because it provides little predictive value about whether an individual will develop OCD and if so what type
Limitation of genetic explanation of OCD - environmental factors can trigger OCD - Cromer et al (2007)
Evidence that environmental factors can also trigger or increase risk of developing OCD
Cromer et al (2007) found over half of OCD patients in their sample had a traumatic event in past and OCD more severe in those who had more than one trauma
Suggests that OCD cannot be fully genetic in origin
May be more productive to focus on environmental causes because we are more able to do something about the environment
What is the neural explanation of OCD?
Explanation which focuses on the structure and function of brain and nervous system in development of mental disorder
OCD explained by reduction in functioning of serotonin system in brain
Less serotonin produced in brain, neurotransmitter for regulating mood
Low serotonin = normal transmission between neurons doesn’t take place so mood and other processes effected
Mutation of SERT gene may lead to this
Abnormal levels of dopamine in people with OCD
Dopamine levels abnormally high in people with OCD
High doses of dopamine in animals induced stereotyped movements resembling compulsive behaviour found in OCD patients
Have to have right balance
Decision making takes place in lateral frontal lobe (side bits)
Abnormal functioning in frontal lobes leads to impaired decision making,
Thought to be responsible for hoarding disorder
Processing unpleasant emotions
Left parahippocampal gyrus may also be involved in OCD
Area associated with processing unpleasant emotions
Found to function abnormally in those with OCD
Evaluating neural explanation of OCD - strength anti-depressants increase serotonin
Evidence for role of serotonin in OCD comes from research examining anti-depressants
Found drugs which increase serotonin are effective in treating patients with OCD
Suggests serotonin involved in OCD
Evaluating neural explanation of OCD - combo whopper co-morbidity, directly involved
Serotonin-OCD link may simply be co-morbidity with depression (having two disorders together)
Many with OCD suffer from depression as well, probably involves disruption to serotonin system
Could be that individuals with OCD, have their serotonin system disrupted because they’re depressed as well
However, fact that anti-depressants with no impact on serotonin don’t work on OCD suggests serotonin directly involved in OCD and not just accompanying depression
Evaluating neural explanation of OCD - limitation don’t know actual causes
Shouldn’t be assumed that natural mechanisms cause OCD
Evidence to suggest many neurotransmitters in brain don’t function normally in OCD patients
Not the same as saying abnormal functioning causes OCD
Biological abnormalities could be a result of OCD rather than cause
