psychopathology - definitions of abnormality and characteristics of disorders

Statistical Infrequency

Behaviour is abnormal as it is numerically rare for that society.

examples of this in everyday life:

Statistically, 3.45% of the UK population was diagnosed with schizophrenia. 1% of the population is diagnosed as a psychopath, therefore, it is infrequent. This is because it is rare and uncommon, most people do not have a diagnosis of schizophrenia.

Behaviours can be uncommon in extremes. For example individuals with an IQ below 70 and above 130 are abnormal. This is because both behaviours are rare in relation to the rest of the population.

in summary: statistical infrequency:

• behaviour is abnormal as it is numerically rare

• the characteristics of the behaviour are less common/typical

• is definition focuses on the quantity of behaviour measured in standard deviations from the mean rather than the quality.

Strengths:

Usefulness: Can lead to individuals getting help as it has real life applications. For example, IQ tests can be used to highlight infrequent low scores. Under 70 leads to a diagnosis of intellectual disability disorder, therefore this person can be supported. However, it is not always helpful for people to be labelled as abnormal. In relation to the example above, a person with a low IQ may not be distressed and quite happy living their day to day lives and may not need a diagnosis of intellectual disability. Giving a label could have a negative effect on how others view them and how they view themselves.

Quantitative & Objective data: Statistical infrequency is a quantitative measurement and is therefore easy to identify and analyse. For example, there are objective when cut off points are decided e.g. below 70 for IQ. It is based on unbiased data and so may be a more valid compared to other definitions such as social norms which are more subjective.

Weaknesses:

Does not always accurately define abnormality: On the other hand, unusual characteristics can be classed as statistically infrequent, but are they instead positive and desirable. For example, someone who scores highly on an IQ score would be considered a genius, and although this would be abnormal if using the definition, it does not fit in line with abnormal behaviour in terms of mental health. In addition, some behaviours can affect a large number of the population, but are considered abnormal, for example depression is classed as an abnormality but it effects around 25% of the population.

Failure to function adequately

Abnormality is judged as inability to deal with the demands of everyday living such as self-care, holding down a job, interacting meaningfully with others, and making themselves understood. Behaviour is maladaptive, irrational or dangerous and causes personal distress and distress to others. Rosenhan & Seligman believed that there were certain features of dysfunction which help to define an individual as abnormal. The more of these features an individual displays, the more they are classed as abnormal.

classifications of being abnormal:

MOULD:

Maladaptive behaviour – self-destructive behaviour that are carried out to try and relieve anxiety or distress, but they are unhelpful and tend to make your issues worse e.g. heavy drinking to deal with the loss of a family member

Observer discomfort

Unconventional  behaviour (stands out)

Loss of control

Distress & suffering

Strengths:

Usefulness: Considers how the individual feels and matches sufferers perception. This definition is focused on the individual and how they are managing in everyday life from their perspective, so if someone feels as though they are struggling they will be deemed abnormal and can get help. Furthermore, behaviour is also observable by others (observer discomfort) and therefore people can be directed to get help and support.  This means that problems can be picked up by others and if the individual is incapable of making a decision or helping themselves, others can intervene.

Weaknesses:

Does not always accurately define abnormality: Obsessive Compulsive Disorder (OCD) may exhibit excessive rituals that prevent them from functioning adequately, as they constantly miss work; whereas, another person may suffer from the same excessive rituals, but find time to complete their rituals and always attend work on time. Therefore, despite the same psychological and behavioural symptoms, each person would be diagnosed differently, thus questioning the accuracy of this definition. In addition, judging a person as distressed or distressing relies on subjective assessment. This may mean that people’s personal opinions could lead to an inaccurate assumption of abnormality. Furthermore, not all abnormal behaviour is associated with distress e.g. psychopathy

Application difficulties: Not all maladaptive behaviour is an indicator of mental illness e.g. drinking and smoking, are socially acceptable. These behaviours could cause harm but may NOT be identified as an issue, due to some social norms in society. In addition, because the definition relies on observable behaviour, it may not always pick up on but abnormal behaviour. For example, Josef Fritzl who raped and imprisoned his daughter for many years, seemed to be a respectable engineer who worked in properties, but behind the scenes, a very sinister and abnormal man.

Deviance from social norms

Every society has social norms that it maintains through laws, guidelines or societal pressure. It is the idea of how we ‘ought’ to act. Anyone who behaves differently or deviates from social norms are seen as abnormal.

example in everyday life:

For example, we have a social rule that individuals should wear clothes to work, if someone turned up to work with no clothes on, this would be judged ad abnormal behaviour as it does not follow what most people believe to be acceptable.

in summary: deviance from social norms:

• behaviour is abnormal if it is very different to the acceptable behaviour being produced by other members of the same society/cultural group

• behaviour is unexpected by other group members

• behaviour offends in some way the other members of that society/cultural group.

STRENGTHS:

Usefulness: Can lead to individuals getting help, as society would notice when something doesn’t fit in with social norms, it means that individuals who may not get help themselves can be identified. For example, people with Schizophrenia are not in touch with reality, and this means they often don’t feel they have a problem.

Accuracy of definition: It can be flexible, depending on the situation, context, age and gender of the individual. Therefore, it considers a number of factors with in social norms increasing its generalisability to understanding abnormality. For example, we know that wearing a bikini on the beach is normal to do on the beach during the summer. However, if someone turned up to work wearing a bikini in the winter, this would be judged as abnormal. This helps to improve the accuracy of the definition because it considers multiple factors within a social norms

WEAKNESSES:

Cultural differences: Another issue is that social norms differ greatly from one culture to another. This may mean that a person from one cultural group may judge someone else from another cultural group as abnormal. When we live in a multi-cultural society, it may mean that some cultures are judged abnormally, because they are applying their own culturally specific norms. For example, in western society we believe that scarring of the skin is classed as self-harm and a sign of depression, but in some parts of Africa such as Nigeria and Ghana, they participate in something called scarification, where deep cuts are carved into the skin to express identity and a spiritual connection. This is an issue because this definition could create division within multi-cultural societies.

Definition may not always be accurate: those who do not conform to social norms may not have a mental health issue, but would be classed as abnormal according to the definition. For example, someone who is being eccentric and unique, may not be problematic to society, but could be seen as abnormal in this definition. This can restrict freedom to be different.

Deviation from ideal mental health

Marie Jahoda (1958) noted that we define physical illness by looking at the absence of certain signs in physical health. Therefore she believed that the same should apply to mental illness. Jahoda created 6 criteria that are generally believed to represent ideal mental health. Jahoda believed that the absence from any one of these criteria indicates abnormality, and therefore potential mental illness. The more criteria someone fails to meet, the more abnormal they are.

the 6 criteria for ideal mental health:

PRAISE:

Positive attitude towards self

Resistance to stress

Accurate perceptions of reality

Independence & self-reliance

Self-actualisation – believing to have personal growth

Environmental mastery – adaptability

Strengths:

Usefulness: Can lead to individuals getting help. Takes a positive approach and states specific goals – giving direction to become healthy. It’s also holistic – as it considers a number of factors and therefore may better reflect the complexity of human behaviour.

Weaknesses:

Subjective and vague criteria which makes it difficult to measure, therefore setting goals can be difficult, compared to physical health e.g. exercise, diet and blood tests

Ethnocentrism: Culturally specific very focused on western culture. People in China are collectivist and therefore work towards a collective goal, where this clearly highlights individualist culture. This means that the definition is not global. Things like independence is very individualistic and would not accurately define people in collectivist cultures

Limited applications and gender bias: because of its unrealistic high standards most people would be classed as abnormal, when in fact they are not. Broverman et al. (1970) asked therapists to complete a questionnaire in which they were asked to describe the characteristics of people. A healthy male was described and rated in the same way as a healthy person. The healthy female was described differently from both, with such terms as submissive, emotional, easily influenced, sensitive to hurt, excitable and dependent. With this in mind it would be fairly unlikely that women would ever be described as normal given that one of Jahoda’s criteria is independence.

Temporal Validity:

Would this definition hold true across time? Would the passage of time and social attitudes change over time affecting what is classed as abnormal?

Ethnocentrism:

Does this definition allow for differences in cultures? Can you compare results across cultures consistently? Would one culture call a behaviour abnormal whereas another culture wouldn’t?

Achievable

Does this definition set an unachievable standard of normality? Is it practical to implement?

Socially Sensitive:

Does this definition pose an issue with incorrectly or negatively labelling individuals or groups? Can it feed into social stigma or negative social stereotypes?

Positive or negative approach

Does this give individuals something to strive for or does it have a detrimental impact by being too negative?

Identification

Does this definition make identification quicker, easier or more effective? How?

Exceptions?

Are there any examples that would be in the DSM-5 that wouldn’t fall under this definition?

Subjectivity

Does this assessment require personal opinion or perspective? Is it based on the individuals perception or the practitioners?

what is the DSM-5?

Diagnostic Statistical Manual of Mental Health Disorders

what does it contain?

information regarding every official psychiatric disorder. Each diagnostic listing contains detailed information regarding the specific criteria required for a diagnosis, as well as a thorough overview of that particular disorder.

how does the DSM change?

Clinicians go through the diagnostic features and decide which symptoms best reflects the behaviour they are displaying in order to determine the most accurate diagnosis. The DSM is constantly adapting and changing in order to try and make diagnosis as reliable and accurate as possible.

3 types in the DSM:

• Emotional: ways in which people feel

• Behavioural: ways in which people act

• Cognitive: refers to the process of thinking – knowing, perceiving, believing – internal processing

Depression

Five (or more) symptoms present during the same two-week period including low mood and disrupted activity levels. In your exams if you are asked ‘Outline characteristics of depression (4)’ You should refer to the core symptom which I have highlighted in bold below and diagnostic criteria which I have stated above i.e. symptoms present during the same two-week period.

MEMORY STRATEGY:

SLAPPED

Self-esteem is low – Emotional: people with depression will often feel very little of themselves. It can become quite extreme and sufferers have described a sense of self-loathing i.e. hating themselves.

Lethargic – Behavioural: reduced levels of energy, everyday tasks such as going to work become difficult. In more severe cases some sufferers describe finding it very difficult to get out of bed.

Absolutist – Negative thinking  – Cognitive: people with depression will often process things in a negative light. Absolutist thinking is when negative situations are magnified and seen as a disaster. People with depression will tend to focus on the negatives and ignore the positives.

Psychomotor agitation – Behavioural: struggle to relax – they may fidget and pace up and down the room.

Poor concentration – Cognitive: a sufferer may find it difficult to remain on task. This links into their negative thinking because they tend to think ‘what’s the point?’

Eat & sleep disruption – Behavioural: sufferers can over eat or under-eat and this leads to weight loss or weight gain. Sleep disruption can also be effected in each extreme, for example, hypersomnia (an increased need to sleep) and insomnia (decreased sleep)

Depressed mood for most of the day – Emotional: this is the main symptom of depression and what separates depression from fleeting moments of sadness. Those with depression have described themselves as  worthless and empty. They feel this overwhelming sense of sadness which seems inescapable. Other people have described this as having a dark cloud hanging over them which follows them everywhere they go.

Phobia:

All phobias are characterised by excessive fear and anxiety, triggered by an object, place or situation. They must disrupt your daily life and be present for 6 months or more to be diagnosed. In your exams if you are asked ‘Outline characteristics of a phobia (4)’ You should refer to the core symptom which I have highlighted in bold below and diagnostic criteria which I have stated above.

different types of phobias:

Different types:

1) Specific phobia – phobia of an specific object such as an animal or situations such as flying or injections

2) Social phobia – phobia of a social situation  – perception of being judged, & inadequate

3) Agoraphobia – a phobia of being outside or in an open space

MEMORY STRATEGY:

FEAR  PAIN 

Fear – Emotional: a feeling of dread and worry that is persistent, people with phobias may have extreme fears for example feeling that they will die in the presence of the phobia

Endurance – Behavioural: remains in the presence of the phobic stimulus, they freeze and cannot seem to move away

Anxiety – Emotional: feeling extreme distress and worry when in the presence of the phobic stimulus

Restricted attention – Cognitive: they focus all their attention on the phobic stimulus and will be extremely distracted. For example, if the phobic stimulus was in the room with them, they would struggle to focus on anything else.

Panicked behaviour – Behavioural: panic may be seen in a range of behaviours such as crying, screaming or running away.

Avoidance – Behavioural: making a real effort to avoid coming into contact with their phobia. For example someone with a phobia of dogs would avoid going to parks or any open fields.

Irrational thinking – Cognitive: For example, a person with arachnophobia may believe that all spiders are dangerous and deadly, despite the fact that no spiders in the UK are actually deadly.

Normal life is disrupted – Behavioural: this links in with avoidance. Because a sufferer will do anything to avoid the phobia this can lead to them not going to work, avoiding certain day to day activities such as shopping. For example, if someone has a fear of buttons, they may not be able to dress themselves, go shopping for new clothes, or even work in an environment where shirts form the dress code.

OCD – Obsessive Compulsive Disorder

OCD is diagnosed if it disrupt the persons on most days for a period of two weeks or more daily. In your exams if you are asked ‘Outline characteristics of a OCD (4)’ You should refer to the core symptoms which I have highlighted in bold below and diagnostic criteria which I have stated above.

MEMORY STRATEGY:

CHAOTIC

Compulsions – Behavioural: e.g. repetitive behaviours, rituals, carrying out actions in threes – shut and open the door 3 times.

Hypervigilant – Cognitive: maintaining constant alertness and keep attention focused on potential hazards

Avoidance – Behavioural: an individual with OCD will keep away from situations which could trigger their anxiety for example, avoiding the use of public toilets.

Obsessive thoughts – Cognitive: these are thoughts that recur over and over again and are typically unpleasant e.g. constantly thinking about germs.

Tenacious Anxiety – Emotional: this is a constant feeling of worry which is directly linked to their obsessive thoughts and compulsions. This feeling of anxiety will be relentless and is extremely distressing.

Insight to irrational behaviour – Cognitive: interestingly, those with OCD have awareness that their obsessions and compulsions are irrational, but they can’t seem to stop the irrational thoughts

Catastrophic thinking – Cognitive: creating worst case scenarios in your head and thinking extreme negative outcomes may occur. For example believing if you don’t carry out your ritual, your family will die.