Psychopathology - paper 1

what is psychopathology

the study of mental dysfunction or disorders

what are the four ways to define abnormality

deviation from social norms
statistical infrequency
failure to function adequately
deviation from ideal mental health

what is statistical infrequency based on

normal distribution and standard deviation

what is the normal distribution of statistical infrequency for abnormality in the population

those who fall outside 2 standard deviations of the normal distribution curve

How does statistical infrequency define abnormality?

behaviour that is rare in the population - 5% or less

Limitation of statistical infrequency

unusual characteristics can be positive so both ends of the distribution curve wouldnt be thought of as abnormal =
the definition is based on quantity rather than quality of behaviour
it identifies both ends of the scale as 'abnormal' but in some cases only one side would be thought of as abnormal

8-10% of the population of the UK will have depression in any given year
behaviour doesnt have to be rare to be behaviour we want to class as abnormal
it is not helpful identifying more common mental health conditions, it has limited usefulness

Strengths of statistical infrequency

in clinical diagnosis, frequency of behaviour in the population is taken into account; it is useful to know

AND a diagnosis will always require other features rather than just unusualness

deviation from social norms definition

behvaiour that is seen not just as rare but as breaking unwritten rules about what is acceptable behaviour in that culture

what are the characteristics of behaviours that deviate from social norms

different from acceptable behaviour
unexpected by other people
offends people in some way

limitation of deviating from social norms

deviation from social norms isnt a reliable definition for abnormality =
if we call a behaviour 'abnormal' and a 'disorder' because it breaks social norms, when the norms change it wont be seen as a disorder.

social norms vary from culture to culture and across time, so is unreliable to define abnormality

some argue it infringes human rights and can be used to support discrimination on grounds of difference =
until 1977 it was US government policy that LGBTQ+ education groups and charities had to publicly state that homosexuality is a "disease, disturbance, or diseased pathology"
homosexuality was considered a mental disorder by the DSM until 1973
Therefore, the use of social norms as a definition for abnormality can or has led to descrimination, so should be used with caution

strengths of deviation from social norms

includes the idea about desirability of behaviour, which standard deviation fails to do =
it is no longer used alone in practice
in the DSM5, antisocial personality disorder has a diagnosed criteria of:
"absence of prosocial internal standards associated with failure to conform to lawful or culturally ethical behaviour"
so it can be useful for some disorders to refer to what is socially acceptable

when does failure to function adequately occur

when someone is unable to cope with the ordinary demands of day to day living

who outlined the definition of failure to function adequately as a way of defining abnormality

Rosenhan and Seligman (1989)

what are the four criteria for someone to be failing to function adequately

1) the person cant cope with the demands of everyday life (social/occupational)
2) behaviour that us maladaptive/irrational or dangerous
3) behaviour that causes distress to the person
4) behaviour that causes distress to others

Strengths of definition of failure to function adequately

takes into account a persons feelings and effects on those around them =
used in real life diagnosis in the DSM5: depression, anxiety, OCD, schizophrenia - useful tool when combined with symptoms behaviour; "the (behaviour) causes clinically significant distress or impairment in social, occupational or other important areas of functioning

Weakness of the definition, failure to function adequately

failure to function is a subjective judgement made by a psychiatrist - no objective test

others distress may be because social norms are broken - so will share negatives of that definition

deviation from ideal mental health as a definition for abnormality:
the criteria and deviation from them

good self esteem
self actialisation (we reach our potential, link to Maslow and humanist psychology)
ability to cope with stress
realistic view of the world
autonomy/independence from other people
environmental mastery (successfully able to work, love and enjoy our leisure)

Strengths of deviation from ideal mental health

very comprehensive set of criteria =
doesnt label the person with a disorder but says we should all strive for ideal mental health

limitations for deviation from ideal mental health

culture bound - ideal set of behaviours is true to individual cultures =
more collectivist cultures wouldnt see self actualisation or independence from others as criteria for ideal mental health

what are the three most common mental disorders in the UK and roughly what percentage has them

depression - 8-10%
phobias - 7%
OCD - 1-2%

what type of disorder are phobias

anxiety disorder

characteristics of anxiety disorders

fear as an emotional response to real or perceived imminent threat
anxiety is anticipation of a further threat
panic attacks are common

phobia definition

excessive fear and anxiety triggered by an object, place or situation

what are the categories of phobias

specific phobia
social phobia
agoraphobia

what is a social phobia

a phobia of of social situations - public speaking, parties, meeting new people

what is specific phobia

a phobia of objects and situations - most commonly animals, events (flying), situations (enclosed spaces)

What is agoraphobia?

'fear of the market place' - of public places (not open spaces), of leaving the safety of the house

what are the criteria to be diagnosed with a phobia disorder according to the DSM5

marked fear of anxiety about the feared object/situation
the object/situation almost always provokes an anxiety response
object/situation is avoided or endured with intense fear
the fear and anxiety are out of proportion to the real threat
persistence (symptoms have lasted 6 months or more)
causes distress or impairment in social, occupational or other functioning

how many of the DSM5 criteria does a person need to have to be diagnosed with a phobia disorder

they must have all the criteria otherwise they are 'sub clinical'

Emotional characteristics of phobias

Anxiety
Emotional responses are unreasonable
Fear

Behavioural characteristics of phobias

Panic
Avoidance
Endurance

Cognitive characteristics of phobias

selective attention to the phobic stimulus
Irrational beliefs
Cognitive distortion

what are emotional characteristics

how a person feels

what are behavioural characteristics

Ways in which people act

what are cognitive characteristics

how a person thinks

what is generalisation

a tendency for similar stimulus to evoke the same response as the conditioned stimulus

what is extinction

the gradual weakening of conditioned response that results in the behaviour decreasing or disappearing over time

What is the two process model? by Mowrer 1960

phobias are acquired by classical conditioning and maintained by operant conditioning

strengths of the two process model

can account for unusual phobias as it can explain why some phobias are of unusual objects/situations =
as anything unpleasant can be coupled with an object/situation

applications of therapy =
if something can be learnt it can also be unlearnt

can explain why phobias of cars are rare but phobias of snakes are common =
some classes of stimuli are more common than others (like snakes) - this is known as biological preparedness

limitations of the two process model

some people also develop phobias with no previous awareness of a traumatic triggering event - incomplete
explanation =
interactionist explanation - a full explanation needs to take account of factors such as evolution and biological preparedness in addition to operant and classical conditioning

the two process model ignores congnitions - however cognitions may not be an important part of a phobia =
e.g. irrational thoughts, cognitive distortion and selective attention
therefore its an incomplete explanation

limitations of little Albert

results arent generalisable =
the sample isnt representative - albert may have been unique, there may have been something different about him that meant he was conditioned

protection from harm =
the intention was to give him a phobia, this is harmful, distressed and not soothed or stopped

consent =
mother lived and worked at the hospital so may have felt like she had to give consent
Albert was too young to give assent

two ways to treat phobias

systematic desensitisation and flooding

steps of systematic desensitisation

1) relaxation - patient is trained in relaxation techniques, so they can relax as quickly and deeply as possible
2) heirarchy - the anxiety heirarchy is constructed by the patient and therapist - a step by step approach
3) exposure - patient is exposed to the phobic stimulus whilst practicing the relaxation techniques as feelings of anxiety arise
4) success - treatment is successful when the person can stay relaxed in situations of high anxiety in the hierarchy

Strengths of systematic desensitisation

effective =
Lisa Gilroy et al (2013) followed 42 people who had SD for spider phobias in 3 45 minute sessions. she found that at both 3 and 33 months the SD group were less fearful than the control group

most effective with specific phobias

suitable for a diverse range of patients
includes those with learning difficulties and children

what is flooding

overwhelming the patient - flooding individuals senses with the item or situation that causes anxiety so that the person realises no harm will occur

no relaxation techniques

they are exposed repeated;u and in an intense way to their phobia

eventually they will form a new association between the stimulus and their reaction

strengths of flooding

cost effective =
quick effect means patients are relieved of their symptoms quickly, making the treatment cheaper than alternatives

limitations of flooding

less effective for some types of phobias =
social phobias have cognitive aspects so the individual doesnt simply experience an anxiety response but also has unpleasent thoughts about the situation

treatment is traumatic for patients =
produces high levels of fear which can be traumatic and can cause patients refusing to start or complete treatment - avoidance of therapy is negative reinforcement

what is the DSM5 diagnostic criteria fo major depressive disorder

1) depressed mood - most of the day for most days
2) loss of interest
3) weight loss or gain (5%)
4) insomnia or hypersomnia
5) agitation or retardation
6) fatigue or loss of energy
7) feelings of worthlessness/inappropriate guilt
8) inability to concentrate or indicisiveness
9) thoughts of death or suicidal thoughts

how many symptoms from the DSM5 checklist for depression must a patient have to be diagnosed

5/9 symptoms for a period of 2 weeks; at least on symptom must be 1 or 2

they also must have clinically significant distress or impairment in social, occupational or other areas of functioning

Emotional characteristics of depression

Lowered mood
Anger
Lowered self-esteem

Behavioural characteristics of depression

Activity levels
disruption to sleep and eating behaviour
aggression and self harm

Cognitive characteristics of depression

Poor concentration
attending to and dwelling on the negative
absolutist thinking

what were Aaron Becks cognitive approach to depression

faulty information processing
negative schemas
the negative triad

What is faulty information processing?

Attending to the negative aspects of a situation and ignoring the positives, which causes you to attend to certain attriubutes

what are negative self schemas

a package of ideas that we have about ourselves - depressed people often have negative thoughts about themselves causing a negative self schema

what is the negative triad

Beck suggested that depressed people have a negative view of self, the world and the future

Strengths of Beck's theory

good supporting evidence =
research suggests depression is associated with faulty information processing, negative self schemas and the negative triad
theres also evidence that impairments came before depression

Cohen et al (2019) study of 473 adolescents found that those identified as being cognitively vulnerable were more likely to become depressed

practical application in CBT
Becks cognitive explanation forms the basis of cognitive behavioural therapy. All cognitive aspects of depression can be challenged in CBT, reducing someones vulnerability to depression
it has real world application

limitations of Becks theory

doesnt explain all aspects of depression =
the theory explains the cognitive symptoms of depression however it cant explain all symptoms, for example extreme anger
not a complete explanation

what are Albert Ellis's beliefs

musturbation
I-cant-stand-it-itis
utopianism

What is musturbation?

The belief that we must always succeed or achieve perfection

What is 'I-can't-stand-it-itis'

It is the belief that is a disaster when things do not go smoothly

What is Utopianism?

The belief that life is always meant to be fair

What does Ellis's ABC stand for

A - activating event - something happens in the world around you
B - beliefs about A
C - consequences - your emotional and behavioural responses to your belief

strengths of Ellis' theory

practical application in CBT =
Ellis' explanation has led to successful therapy
research shows that when irrational negative beliefs are challenged this can be used to reduce depressive symptoms suggesting that the irrational beliefs have a role in depression

Weakness on Ellis' theory

doesnt explain all aspects of depression
doesnt explain why some individuals experience anger associated with the depression - not a complete explanation

cant explain all depression =
some depression does occur as a result of an activating event (reactive depression) such as loosing a job. However, not all depression arises as a result of an obvious cause

what is CBT

a way of talking about how you think about yourself, the world and others and how what you do affects your thoughts and feelings
negative thoughts and irrational beliefs are challenged
the therapy also includes behavioural techniques such as behavioural activation (encouraging patients to engage in activities they're avoiding)

CBT helps break the vicious cycle of maladaptice thinking, feeling and behaviour
CBT focuses on the here and now
when unhelpful thoughts and behaviours are identified and understood, they can be changed - this helps improve emotions
Aim: DIY - patients are given the tools to be able to help themselves in the future

what are obsessions

recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted

What are compulsions?

repetitive behaviors or mental acts that an individual feels driven to perform

what is the order of the cycle of OCD

Obsessive thoughts (images/urgers)
Anxiety
Compulsive behaviour (mental acts)
Relief (short lived)

Emotional characteristics of OCD

Anxiety and distress
accompanying depression
guilt and disgust

Behavioural characteristics of OCD

Compulsions are repetitive
compulsions reduce anxiety
avoidance

Cognitive characteristics of OCD

Obsessive thoughts
cognitive strategies to deal with obsessions
insight into excessive anxiety

what are the two main areas of study in the biological approach for OCD

genetic explanation - vulnerability in our DNA
neural explanation - neurotransmitters and brain structure

evaluation of the genetic explanation of OCD

family and twin studies =
strength - evidence to suggest theres a genetic component to the disorder. One of the best sources of evidence is twin studies
limitations - family studies can be used as evidence for environmental influence - concordance rates are never 100% therefore the environment must play a role
ultimately it can be difficult to untangle influence of environmental and genetic factors as families live in the same house, share the same experiences - so its difficult to determine whats environments and whats genetic

candidate genes =
strength - research implicated a number of candidate genes in the development of OCD
limitation - many genes involoved and could be more that are yet to be identifies. Each genetic varient only increases the risk of OCD by a small amount so we lack predictability

interaction of genes and environment =
strength - research supports the individuals may have a genetic vulnerability towards OCD that is then triggered by an environmental trigger
limitation - maybe we should focus on the environment rather than biological factors

Evaluation of neural explanations of OCD

brain function =
strength - advances in technology have allowed accurate investigation; OCD sufferers do seem to have excessive activity in the orbital frontal cortex and basal gangila
we know that cleaning and checking behaviours are "hard wired" in the thalamus where there is also increased activity
limitation - repetative acts may be explained by abnormality of the basal ganglia but this doesnt explain obsessive thoughts
limitation - the data does not show cause and effect. Neural changes could be as a result of experiencing OCD rather than the cause of the disorder

The role of neurotransmitters =
strength - an understanding of this allows medication to be developed which helps many sufferers
limitations - drugs arent completely effective (help around 70%)
limitation - just because administrating SSRIs decrease OCD symptoms this doesnt mean that low serotonin was the cause of OCD symptoms in the first place - known as aetiological fallacy

What does SSRI stand for?

selective serotonin reuptake inhibitor

What us the biological treatment for OCD

SSRIs is the standard treatment, effective for 70% of patients
SSRIs increasr the amount of serotonin in the synapse of the brain by inhibiting re-uptake to the pre synaptic neuron
by preventing the reuptake of serotonin SSRIs effectively increase its activity level in the synapse, allowing it to continue to stimulate the post synaptic membrane

alternative treatments to SSRIs

Tricyclics - these are older medicines that also alter the amount of serotonin at the synapse of the brain; but they have more side effects and are fatal if overdosed

Newer antipsychotic medications - these are primarily used to treat serious psychotic disorders like schizophrenia and can have unpleasant side effects. They are used when other OCD treatments have failed to work