Psychopathology

Definitions of abnormality
1. Deviation from social norms
  1. A social norm is an unwritten rule describing how we should behave in society. Someone may be considered abnormal if they go against these social norms
    1. Screaming in public
    2. Spitting
    3. Sexuality
  2. + Protects society- allows us to notice and recognise criminal and unacceptable behaviours. + Helps people- allows society to tell when someone needs help by noticing how they act against social norms
  3. - Historically and culturally biased- the definition is not accurate over time and across cultures as Social Norms change. For example, the acceptance of homosexuality.
2. Statistical Infrequency
  1. Someone may be considered abnormal if their behaviour is rare or anomalous. In any population, the majority of people are clustered around the mean for any characteristic . Those who fall two standard deviations away from the mean are considered statistically rare and abnormal.
  2. + This definition can be appropriate and non-judgemental- for example, homosexuality would not be considered 'wrong' or 'unacceptable' under this definition, but instead 'less frequent'
  3. - It doesn't take into account the desirability of the behaviour, such as having a very high IQ, which is abnormal. There is no distinction between rare, slightly odd behaviour and rare, psychologically abnormal behaviour.
3. Deviation from ideal mental health
  1. Jahoda created a list of six characteristics shown by normal people. If someone does not show these (deviate from them) they may be considered abnormal. For example, the behaviours of someone with a severe phobia of leaving their house could be considered abnormal, as their behaviour is preventing them from mastering their environment and being independent.
  2. - Personal Growth (goal orientated). -Resistance to Stress Daily . -Autonomy (independence). -Accurate perception of reality. -Environmental Mastery (socialise). -Self-attitudes (high self esteem.)
  3. +Focuses on positive aspects. +Targets areas of dysfunction. -Subjective criteria-involves personal opinion to decide whether someone is abnormal. -Over demanding criteria- most people don't have all of these characteristics meaning most people are slightly abnormal. -Culturally and historically biased.
4. Failure to Function Adequately
  1. Rosenhan and Seligman said that someone may be considered abnormal if they are unable to cope with the demands of daily life (maladaptive). For example if someone is unable to cope with the demands of a job and relationships, they may be considered abnormal.
  2. -Suffering. -Maladaptiveness (behaviour that stops a person achieving major life goals). - Unconventional behaviour. -Unpredictability and loss of control. -Irrationality. -Observer discomfort. -Violation of moral standards.
  3. +Matches sufferers perceptions- able to check behaviours against the criteria. + Observable behaviours- other people can judge what is normal. -Subjective- Personal choice to decide whether someone is abnormal. -Cultural differences.
Phobias
1. Emotional characteristics
  1. Fear of losing control, knowing you're overreacting and feeling powerless, fear of overwhelming panic or fear, overwhelming anxiety or fear, feeling like you are going to pass out, feeling life you need to escape.
2. Cognitive characteristics
  1. Indecisiveness, negative or distorted thinking, forgetfulness, distractability, difficulty concentrating, memory loss.
3. Behavioural characteristics
  1. Sweating, nausea, difficulty breathing, feeling dizzy, increased blood pressure, panic attacks.
4. Behavioural explanation (two process model)
  1. 1. Initiation - phobias initiate because of classical conditioning (learning through association), where a neutral stimulus is paired with an unconditioned response through repeated presentations.
    1. Little Albert study
  2. 2. Maintenance- phobias continue as a result of operant conditioning (learning through reinforcement). We are more likely to carry out a behaviour if it is negatively reinforced (escaping something unpleasant). We are less likely to carry out a behaviour if it is punished by the environment.
  3. + Provides a valid explanation as it has strong research evidence, such as sue et al who interviewed people and found that many of their phobias were due to a traumatic event. + You can use classical conditioning to re-associate fears with good things, or associate people positively to create safety nets to help treat phobias
  4. -Ignores social learning theory- the model assumes all phobias are learnt through classical and operant conditioning and does not consider modelling the behaviour of others. - Does not consider evolutionary theories where people are naturally fearful of certain things.
5. Behavioural treatments
  1. Systematic desensitisation
    1. The main behaviourist treatment for phobias. SD is based on classical conditioning with patients learning in stages to replace their fear with a feeling of calmness. SD first teaches patients relaxation breathing and muscle techniques before creating a hierachy of fears; with most fearful situation at the top to least fearful at the bottom. The patient works up the hierachy, only progressing when they are entirely relaxed at that level. The client is taught to associate the object with relaxation until they are desensitised to it.
      1. +Highly effective for a range of anxiety disorders due to the patient unlearning maladaptive behaviours through conditioning. + No biological side effects as no medication is used to treat abnormality.
      2. -ineffective for disorders such as depression and schizophrenia which have not been learnt. -expensive as it takes a long time to be effective, this is because it involves gradual exposure to fearful objects over time.
    2. Jones- used SD to eradicate 'Little Peter's' phobia of white fluffy animals.
  2. Flooding
    1. Flooding involves just one long session with a therapist, where the patient experiences their phobia at its worst, whilst at the same time practicing relaxation techniques until their anxiety goes and they are relaxed.
      1. Vivo-exposure: presenting the feared object itself.
      2. Vitro-exposure: imaginary exposure.
    2. +Found to be very effective for a range of anxiety disorders. Choy found that flooding was more effective than SD. +No biological side effects as medication is not used.
    3. -Not always effective for every patient. This is because it can be a highly traumatic experience. -Psychological harm, which participants have the right not to experience , because the participant experiences extreme fear.
    4. Wolpe- used flooding to remove a girls phobia of cars by driving her around for 4 hours.
Depression
1. Emotional characteristics
  1. Lower mood, feeling worthless or empty, anger, low self esteem.
2. Cognitive characteristics
  1. Poor concentration, unable to make decisions, pessimistic thinking, dwells on negative factors, lack of hope.
3. Behavioural characteristics
  1. Reduced activity, low energy levels, disrupted sleep and changes in eating, aggression, increased risk of self-harm.
4. Cognitive explanation
  1. Beck's negative triad
    1. Suggested that depression is a result of a cognitive vulnerability and irrational beliefs
    2. Automatic Negative Thoughts: Negative views about SELF: "I'm a failure" "I can't do anything right". Negative views about the WORLD: "There is no hope, life is unfair". Negative views about the FUTURE: "Nothing will get better."
    3. Negative Self schemas- dysfunctional views we have created due to experience since childhood. They are mental frame works that help us sort and understand information and alter how we interpret the world.
    4. Negative cognitive biases- Pessimistic outlook on life, they focus on the negative aspects and ignore positives.
  2. Ellis' ABC model
    1. Suggested that depression is a result of irrational thoughts. Irrational, illogical thinking interferes with our ability to be happy and free from pain.
    2. A: Activating event- A traumatic, upsetting or negative event happens (failing a test). B: Belief- A person either creates a positive, rational belief from this (It's okay, it's just one test) or creates a negative, irrational belief (I am a failure), which is depressive. C: Consequence- Rational beliefs cause rational actions (I'll revise more next time) and irrational beliefs cause maladaptive actions (I give up).
  3. + Both Beck and Ellis have been used as the base for the development of CBT, both theories transcend into real life treatments. +Has supporting evidence- Clark and beck concluded that there was solid support for the cognitive vulnerability factors, even before the depression started.
  4. -Does not explain all depression - only explains basic symptoms and cannot explain anger. - Cannot explain depression that hasn't been caused by something i.e an event.
5. Cognitive treatments
  1. Ellis introduced REBT (rational emotive behavioural therapy), a form of CBT used to treat patients with depression.
    1. Sessions are structured and time-limited. Early sessions involve the patient describing their negative self-schemas, negative automatic thoughts ad negative cognitive biases. The therapist identifies their irrational thinking and relates it to depression. The therapist aims to challenge their irrational beliefs, replacing them with effective, rational ones. Behavioural techniques are used such as setting lists of small goals and achievements. The therapist must show unconditional positive regard for the client to help develop positive beliefs about themselves.
  2. + Proven to be effective in treating particular mental disorders. + No biological side effects since there is no use of medication. +Aims to deal with and treat the cause of the abnormality not just the symptoms
  3. -Expensive as it can take up to months to be effective, requiring many sessions and requires a specialist therapist. -Difficult to identify improvement- it is difficult to know how honest the client is being and for the therapist to know if they have had any real influence.
OCD
1. Behavioural characteristics
  1. Repetitive compulsions, compelled to carry out a behaviour, compulsions reduce stress and anxiety, not carrying out a compulsion can cause stress and fear.
2. Emotional charcteristics
  1. Powerful anxiety often accompanies the behaviour, often linked with depression, may feel embarrassment, guilt or disgust for carrying out the behaviour.
3. Cognitive characteristics
  1. Recurring thoughts or worries that if the behaviour is not carried out something bad may happen, sufferers are aware that their thoughts aren't rational, may experience catastrophic thinking about worst case scenarios.
4. Biological explanation
  1. OCD is thought to be inherited through genes, it has been tested by looking at concordance rates in twins. Research has suggested that the gene 5-HT1D is involved in OCD. However, OCD is polygenic (not one single gene responsible).
    1. Gottesman - 70% OCD concordance with MZ twins. 34.5% concordance with DZ twins.
  2. Neurotransmitters are influenced by genes and have been shown to effect OCD. Dopamine ( COMT gene) increased levels linked with OCD. Serotonin (SERT gene) lower levels linked with OCD.
    1. Hu- compared serotonin activity in 169 OCD sufferers and 253 non-sufferers and found that levels were significantly lower in the OCD sufferers.
  3. PET scans have shown that OCD sufferers have high levels of activity in their orbital frontal cortex. The lobes are responsible for initiating behaviour and emotional responses.
    1. Borkowska et al- used neuro-imaging to examine the frontal lobes and found a significant difference in activity there between OCD sufferers and patients with depression.
  4. +treats mental illness in the same way as physical illness- because it suggests that illness is caused by physical changes. This means that the patient will not blame themselves for the disorder. +Responsible for producing effective treatments such as anti-depressant drugs. +culturally absolute- genetics and brain chemistry is the same cross-culturally.
  5. -Responsible for producing medical dependency -people think they need doctors and drugs to cure them. -Simplistic- looks at biology and chemistry alone and is too simplistic to find singular genes/causes.
5. Biological treatments
  1. Anti-depressants (SSRIs)
    1. They increase low levels of serotonin (which regulates mood) which is associated with OCD. They inhibit re-absorbtion of the serotonin in neurotransmitters so that there is more present across the synapse.
      1. PROZAC
  2. Anti-anxiety drugs
    1. They help adjust neurotransmitter so that the person feels less anxious. They slow down the activity of the CNS by increasing levels of the transmitter GABA, which has a general relaxing effect on the neurones.
      1. BENZODIAZEPINES

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