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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
the person cant cope with the demands of everyday life (social/occupational)
behaviour that us maladaptive/irrational or dangerous
behaviour that causes distress to the person
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
relaxation - patient is trained in relaxation techniques, so they can relax as quickly and deeply as possible
heirarchy - the anxiety heirarchy is constructed by the patient and therapist - a step by step approach
exposure - patient is exposed to the phobic stimulus whilst practicing the relaxation techniques as feelings of anxiety arise
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
depressed mood - most of the day for most days
loss of interest
weight loss or gain (5%)
insomnia or hypersomnia
agitation or retardation
fatigue or loss of energy
feelings of worthlessness/inappropriate guilt
inability to concentrate or indicisiveness
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
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