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What does the DSM 5 contain?
descriptions, symptoms and other criteria for diagnosing mental disorders
What does the DSM 5 provide?
A common language for all clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in the research of mental disorders
What is statistical deviation?
Its based on the number of times normal and abnormal os observed - a behaviour is seen as abnormal if it it statistically uncommon
What is normal? (statistical deviation)
“usual” behaviours
What is abnormal? (statistical deviation)
Any behaviour different to the usually observed normal.
What is an example of statistically deviating normally?
An example would be a person with an exceptionally high IQ, as this is statistically uncommon compared to the general population.
What is a strength of statistical deviation?
practical application
this way has been influential in the diagnosis of intellectual disability disorder
those who are diagnosed with an IQ below 70, due to its infrequency in society, would be diagnosed
assessments of patients with mental health disorders include some measurements of how severe their symptoms are compared to statistical norms
therefore, statistical deviation is useful due to its help in assessing and treatment of patients
What is a limitation of statistical deviation?
unusual characteristics can be positive
IQ scores of 130 are just as ‘unusual’ as 70 but society does not consider super intelligence as abnormal and needing treatment
this means that just because something is not normal does not mean that it requires treatment and that social norms and cultural expectations play a role as well, not purely statistics
this is a limitation for statistical deviation as a definition as it cannot be used as a stand alone diagnosis because ‘abnormal’ according to statistics does not mean someone needs to labelled and given treatment.
What dos deviation from social norms mean?
Behaviour is different to expectations and the unwritten rules of society.
What is abnormal? (DFSN)
If it is not deemed as acceptable
What is an example of deviation from social norms abnormality?
Antisocial personality disorder (psychopathy). psychopaths do not conform to moral and normative standards
What is a strength of deviation from social norms?
real life application
using the social norms definition led to the diagnosis of antisocial personality disorder
this is based on those with this disorder having an absence of prosocial behaviour and failing to conform with the standards for society
this is a strength as it has been used effectively to diagnose patients with a disorder
however, there are other factors to consider such as whether it is causing distress to themselves or others, as the failure to function adequately would.
this means that we can rarely use the deviation from social norms definition on its own.
What is a limitation of deviation from social norms?
cultural relativism
cultures have different norms to others and this can lead to some behaviour being seen as abnormal in one culture, but not another
for example, approximately 75 countries in the world see homosexuality as illegal and therefore would be considered abnormal
this is a limitation as it would lead to no global standard for defining behaviour as abnormal.
What does failure to function adequately mean?
When someone can’t cope with the demands of everyday life.
What is considered normal? (FTFA)
Cannot maintain normal relationships - friends and romantic partners
What are Rosenhan and Seligman’s 3 signs of not coping?
No longer conforms to interpersonal rules e.g. lack of personal space
Experience of severe personal distress
Irrational or dangerous behaviour
What is the global assessment of functioning?
A measure used to assess how well someone is coping with life
What is an example of abnormality based on failing to function adequately?
Paranoid personality disorder - some people have such severe paranoia they can’t leave the house, make friends or hold down relationships, because of this they would be diagnosed as abnormal because they are not functioning normally on a day to day basis
What is a strength of failure to function adequately?
it considers the patients perspective
by asking the patient about their subjective experience of their levels of distress we can acknowledge the patients experience is important
this means it captures a greater degree of people who may need help, according to their own view
this is a strength as it can lead to a greater number of people being supported through the failure to function definition of abnormality
What is a limitation of failure to function adequately?
requires subjective judgements
someone has to make the judgement that an individual is distressed, but may be judged as not suffering. the GAF scale was used to try and overcome this but, still remains that a health/mental health professional makes the final judgement on their behaviour
this is a limitation as no objective measure can be used to make a judgement
What does deviation from ideal mental health mean?
we focus on what constitutes as normal mental health.
what is considered normal? (DFIMH)
if we know what normal is we can identify abnormal
What is an example of abnormality that deviates from ideal mental health?
Jahoda (1958) identified criteria for ideal mental health: - no distress, -rational + perceive ourselves accurately, -can self-actualise, -cope with stress
What is a strength of deviation from ideal mental health?
Jahoda’s classifications include a broad range of criteria when considering whether somebody is suffering with a mental health disorder
it considers most of the reasons why somebody would seek help from mental health services or be referred for help. compared to failure to function, which primarily considers the role of distress, this definition goes much further
this is a strength as it is a good tool from thinking about mental health as it can have a range of causes and effects on individuals
What is a limitation of deviation from ideal mental health?
cultural relativism
Jahoda’s classifications are specific to Western/American ideals of mental health, meaning they are culturally bound.
for example, self-actualisation would be considered highly self indulgent and undesirable in collectivist cultures. this means it couldn’t be used to effectively identify psychological disorders in these cultures
this is a limitation as this definition of abnormality only explains abnormality in individualist/western cultures
What is the DSM definition of phobias?
an irrational fear of objects or situations
What are 3 examples of phobias?
Spiders
Being in a public place
Public toilets
What are some behavioural (act) characteristics of phobias?
Panic - crying, freezing
Avoidance - staying away from situations in which they are likely to confront their phobias, can result in daily life becoming disrupted
Endurance - people have to stay in the presence of their phobia as an alternative to to avoidance, but results in prolonged anxiety e.g. having a fear of flying but having to fly to go on holiday
What are some emotional (feel) characteristics of phobias?
Anxiety - phobias are classified as an anxiety disorder. anxiety is an unpleasantly high state of arousal. fear also experienced
Emotional responses are unreasonable - they are usually unnecessary based on the phobia stimulus
What are some cognitive (think) characteristics of phobias?
Selective attention - hard to look away from phobic stimulus. keeping focus on dangerous stimuli = adaptive purposes
Irrational belief - irrational beliefs regarding phobic stimuli
Cognitive distortions - cognitive beliefs about phobic stimulus may be distorted. e.g. snakes are monsters
What are the processes involved with phobias acquired through classical conditioning?
The 2 process model - Mowrer (1960) - phobias are learned. they are acquired through classical conditioning and maintained through operant conditioning.
What is an example of phobias being acquired through classical conditioning?
Initially the future phobia (neutral stimulus) would have produced no response.
an unconditioned stimulus paired with the neutral stimulus would have produced an unconditioned response. because now we associate neutral stimulus with something that triggers a fear (unconditioned response) it affects our behaviour in the future/
What is the first step in Watson + Rayner’s Little Albert study?
Unconditioned stimulus → unconditioned response - UCS = loud noise, UCR = crying
What is the second step in Watson + Rayner’s Little Albert study?
Neutral stimulus → no response - NS = rat
What is the third step in Watson + Rayner’s Little Albert study?
Unconditioned stimulus + neutral stimulus → unconditioned response - UCS = loud noise, NS = rat, UCR = crying
What is the last step in Watson + Rayner’s Little Albert study?
Conditioned stimulus → conditioned response - CS = rat, CR = crying
What role does negative reinforcement play in the way phobias are maintained?
Phobias continue because they are negatively reinforced - when confronted with our phobia we usually show avoidance (behavioural characteristic) - by avoiding the situation this reduces our anxiety. removing negative emotion drives us to repeat that behaviour again in the future as we are rewarded for avoidance
this maintains our phobias over time
What is a limitation of the behaviourist explanations for phobias? (environmentally reductionist)
Environmentally reductionist
the behaviourist approach is criticised for being overly simplistic in its reduction of human behaviour to a simple stimulus→response association
for example we associate the neutral stimulus with an unconditioned response causing the phobia to become a conditioned stimulus. it ignores the role of cognition in the formation of phobias, and cognitive psychologists suggest that phobias may develop as a result of irrational thinking not just learning.
this is a limitation because it does not take into account the role of other factors
What is a strength of the behaviourist explanations for phobias? (practical application)
practical application to therapy
the behaviourist ideas have been used to develop treatments including systematic desensitisation and flooding.
systematic desensitisation helps people to unlearn their fears, using the principles of classical conditioning, while flooding prevents people from avoiding their phobias and stops the negative reinforcement from taking place
consequently, these therapies have been successfully used to treat people with phobias, providing further support for the effectiveness of the behaviourist explanation
What is another limitation of the behaviourist explanation for phobias? (can’t explain all)
can’t explain all phobias
for example Bouton (2007) highlights the fact that evolutionary factors could play a role in phobias, especially if the avoidance of a particular stimulus could have caused pain or death to our ancestors
consequently evolutionary psychologists suggest that some phobias are not learned but are innate, such as phobias acted as a survival mechanism for our ancestors.
What is the aim of systematic desensitisation?
Gradually reducing anxiety using classical conditioning
What is reciprocal inhibition?
When someone cannot be relaxed and anxious at the same time
What is the first step of systematic desensitisation?
Anxiety hierarchy - a list of situations related to phobic stimulus that provoke anxiety in order from least to most frightening.
What is the second step of systematic desensitisation?
Relaxation techniques - therapist teaches individual to relax e.g. breathing exercises, mental imagery
What is the third step in systematic desensitisation?
Exposure - individual is exposed to phobic stimulus with relaxed feeling (counterconditioning through classical conditioning)
What is the aim of flooding?
To help individuals confront their fears directly and experience the absence of harm or negative outcomes.
What processes are used during flooding?
Immediate exposure to phobic stimuli - sessions can last 2-3 hours. this is known as extinction - the conditioned stimulus no longer produces the conditioned response
What is the outcome of flooding?
Stops negative reinforcement as it prevents avoidance - anxiety will initially rise then fall
What are the ethical safeguards when completing flooding?
Must get informed consent before flooding begins. patients must be aware that the method is traumatic - no right to withdraw unless under certain extreme circumstances
What is a strength of flooding?
cost effective
research has suggested that flooding is equally effective to other treatments, including systematic desensitisation and cognition therapies, but takes much less time in achieving these positive results
this is a strength of the treatment because patients cure their phobias quicker and it is therefore more cost effective for health service providers who do not have to fund longer options.
What is a strength of systematic desensitisation?
more ethical in nature
in comparison to flooding, treatments for phobias, many patients report a preference for SD as it does not cause the same levels of distress that can occur when presented with the fear inducing stimulus immediately
this is reflected in the high number of patients who persist with SD providing low attrition rates
it is therefore considered a more appropriate treatment for individuals who may have learning difficulties or suffer from severe anxiety disorders since learning the relaxation techniques can be a positive and pleasant experience.
What is a limitation of systematic desensitisation?
cannot be used for all phobias
for phobias which have not developed through classical conditioning such as fear of snakes, SD is not an effective treatment
psychologists believe this is due to some phobias phobias having a survival benefit and are not a result of learning
this is a limitation of SD as it means it is ineffective in treating phobias which have an innate basis
What is the DSM definition of OCD?
It is characterised by obsessions and/or compulsions
What does obsession mean?
reoccurring thoughts
What does compulsion mean?
repetitive behaviours e.g hand washing
What are some types of OCD?
Trichotillomania - compulsive hair pulling
Hoarding disorder - difficulty in parting with possessions
Contamination - an intense fear of dirt
What are behavioural characteristics of OCD?
Compulsions - repetitive, done to reduce anxiety. OCD sufferers feel compelled to repeat a behaviour - 10% of OCD sufferers show compulsions alone
Avoidance - keeping away from situations which trigger their OCD. can lead OCD patients from avoiding very ordinary situations
What are emotional characteristics of OCD?
Anxiety + Distress - sense of fear can be overwhelming - a result of the obsessive thoughts + caused people to fulfil compulsions
Depression - can be accompanied by low mood and compulsive behaviours tend to only bring small temporary relief
Guilt + Disgust - can be directed towards themselves or externally
What are cognitive characteristics of OCD?
Obsessive thoughts - 90% of sufferers have repetitive intrusive thoughts - they vary but are unpleasant
Cognitive Strategies to deal - some employ cognitive strategies as coping mechanisms. some may meditate
Insight - OCD sufferers aware thoughts aren’t normal. necessary otherwise they would be suffering with delusional thoughts. people catastrophise in terms of their thinking .
OCD is polygenic, what does this mean?
It is not caused by a single gene - there are several genes involved. Taylor (2013) said there are up to 230 different genes that could be involved in OCD.
What are the 2 main neurotransmitters involved with OCD?
Dopamine and Serotonin.
What do candidate genes do, and what is their role in OCD?
They are genes that create vulnerability to OCD - some of these genes are involved in regulating the development of serotonin and transport of serotonin across synapses.
What two other gene types are also involved in OCD?
The COMT gene - associated with production of catechol-o-methyltransferase, which regulates neurotransmitter dopamine.
The SERT gene - linked to serotonin and affects the transport of serotonin. transportation issues cause lower levels of serotonin.
What is the conclusion for the role of genetics?
There is a genetic link but not genes alone.
What is the role of serotonin in a normal body?
It is a neurotransmitter that regulates mood.
What are the implications of low serotonin levels?
Low serotonin levels mens that you are unable to regulate mood levels effectively.
What link does serotonin have to OCD?
People with OCD have lower levels of serotonin so cannot manage their anxiety. mood and mental state becomes affected if serotonin levels are which leads to heightened anxiety.
What are OCD compulsions used to control?
The anxiety they feel due to low levels of serotonin
What is the link between OCD and the Basal Ganglia?
It is a cluster at the base of the forebrain. its involved in processes such as coordination of movement. patients who have brain injuries here often develop OCD-like symptoms
What is the link between OCD and the Orbitofrontal Cortex?
It converts sensory information into thoughts and actions. higher PET scan activity in this region for OCD patients. e.g when asked to hold a dirty item - converts sensory into actions (compulsions). damage in this area can lead to compulsions.
What is a strength of biological explanations for OCD?
research support form family studies
Nestadt et al researched the incidence of OCD within families and found that those with OCD are up to five times more likely to develop the disorder than the general population
this is a strength as it supports the idea that genetics may play a role in the development of OCD
What is a limitation of the biological explanation for OCD?
biologically reductionist
by only focusing on the role of certain genes, brain regions or neurotransmitters, they fail to consider the role of the environment
the diathesis-stress model for example argues that the environment may also play a part in the development of OCD. Cromer et al found that over half of OCD patients had suffered a traumatic event in their lives
this is a limitation as it fails to take into account all factors which can lead to OCD.
What is the aim of drug therapy for OCD?
to increase serotonin levels
What is the aim for treating OCD?
To try and help sufferers manage their anxiety
How do SSRI’S work?
serotonin is released by the presynaptic neurons and travels across a synapse
leftover serotonin is normally re-uptaken or broken down by enzymes
SSRIs prevent serotonin from being re-uptaken - so there is more serotonin that continues to stimulate the post-synaptic neuron by binding to receptors
How do SSRI’s help treat OCD?
this helps with symptoms as they are better able to manage their anxiety. this means that they don’t feel the need to perform their compulsions to manage
How long do SSRI’s need to be taken for?
it takes 3-4 months of daily use for SSRIs to have an impact on OCD symptoms
How are SSRIs and CBT used alongside other treatments?
The drugs reduce feelings of anxiety + emotional symptoms
this allows patients to engage more actively in therapy
the CBT targets the cognitions involved with the disorder (obsessions) in order to hopefully change the patient’s behaviour (compulsions)
What is a strength of drug treatments for OCD? (research support)
research support for their effectiveness
drug trials compare the effectiveness of SSRIs against a placebo, Soomro et al conducted a review examining the effectiveness of SSRIs.
they found that across 17 different trials, SSRIs were significantly more effective than placebos as a treatment for OCD
this is a strength of biological treatments as the main aim of the drug treatments is to treat the symptoms of OCD, as SSRIs do
however, the long-term effects of drug treatments are yet to be researched, with only the short-term effectiveness being researched
What is a limitation of drug treatments for OCD?
possible side effects
despite the fact that SSRIs have been suggested to be effective in treating
OCD, some patients experience mild side effects such as indigestion, while others may experience more serious side effects such as hallucinations and raised blood pressure
BZs are renowned for being highly addictive and can also cause increased aggression and long term memory impairment
this is a limitation as side effects limit the effectiveness of drug treatments as many patients stop taking them as a result of experiencing the negative side effects
What is another strength of drug treatments for OCD? (cost effective)
cost effectiveness
drugs such as SSRIs and BZs are relatively cost-effective compared to alternative treatments like psychological therapies, such as cognitive behavioural therapy (CBT)
as many of these treatments are being provided on the NHS this is particularly important, which is why doctors may prefer to seek cheaper, yet effective treatments for OCD
this is a strength as it means more people can be treated for OCD using the same amount of money
furthermore, psychological treatments such as cognitive behavioural therapy require the patients to be motivated to engage whereas drug therapies are non-disruptive to everyday life and can therefore be more successful in treating symptoms of OCD.
What is the DSM definition os depression?
A mental disorder characterised by low mood and low energy levels.
What are some examples of types of depression?
Major depressive disorder
Disruptive mood dysregulation disorder
Persistent depressive disorder
Premenstrual dysphoric disorder
What are the behavioural characteristics of depression?
Activity levels - withdrawal and feeling lethargic - can affect work and day to day life
Disruption to sleep + eating behaviours - reduced sleep (insomnia) or increased need to sleep (hypersomnia)
Aggression + self harm - depression can result in aggression, either to others or directed at themselves
What are the emotional characteristics of depression’?
Low mood - “feeling sad” feeling worthless and empty
Anger - sometimes sufferers can experience high levels of anger - can be directed at self or others
Low self-esteem - depressed individuals like themselves less than they usually do - can result in self loathing
What are the cognitive characteristics of depression?
Poor concentration - cannot stick to tasks or make usual decisions
Dwelling on negative - people are inclined to pay more attention to the negative aspects rather than positives
Absolutist thinking - thinking that promotes emotional distress - particularly anger, when confronted with situations they do not conform
What is the name of the theorist and the model he created for the cognitive explanation for depression?
Beck and the cognitive triad of impairment
What link does faulty information processing have with the cognitive explanation for depression?
Depressed individuals are more likely to attend to the negative aspects of a situation and ignore the positives.
Is the cognitive explanation for depression based on negative schema?
Depressed individuals see themselves negatively and everything about themselves is seen negative e.g. appearance, success and abilities
What does negative schema lead to?
The negative triad: a negative view of the world, the future and the self. these negative feelings cause and maintain depression
What does Beck’s negative triad include?
childhood negative schemas develop providing a negative framework for viewing events pessimistically - in adulthood these become biases such as overgeneralisation, magnification, selective perception and absolutist thinking.
What link does cognitive bias have to depression?
A depressed person may make over generalisations - “i have failed one end of unit test so i’m going to fail all of my exams!”
What is the name of the theorist that came up with the ABC model?
Ellis
According to the ABC model, what is depression?
irrational thoughts
What does A stand for in the ABC model, and what does it mean?
Activating event - situations in which irrational thoughts are triggered through environmental triggers
What does B stand for in the ABC model, and what does it mean?
Beliefs - A range of irrational thoughts e.g mursturbation - always wanting to succeed and utopianism - the belief that life is always meant to be fair.
What does C stand for in the ABC model, and what does it mean?
Consequences - An activating event that triggers irrational beliefs - results in emotional and behavioural consequences
How does the thinking from the ABC model lead to depression?
An individual who has these assumptions is bound to be disappointed and therefore depressed.
What is a strength of the cognitive explanation for depression? (supporting evidence)
strong supporting evidence
a range of studies support the idea that depression is associated with faulty information processing, negative self-schemas, and the cognitive triad impairment
Grazioli and Terry assessed 65 pregnant women for cognitive vulnerability and depression before and after birth. those with cognitive vulnerability were more likely to suffer from post-natal depression.
importantly, these cognitions can be seen before depression develops, suggesting Beck may be right
this is a strength as we can see a clear cause-and-effect relationship between thoughts and depression
What is another strength of cognitive explanations for depression? (application to therapy)
application to therapy
cognitive explanations have been used to develop effective treatments for depression, including CBT and rational emotive behaviour therapy, which has developed from Ellis’ ABC model
these therapies attempt to identify and challenge negative, irrational thoughts and have been successfully used to treat people with depression providing further support for the cognitive explanation of depression
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