Introduction to Psychopathology - Part 2

What does it mean to say psychopathology is multiply determined?

Many factors (biological, cognitive, behavioural, social, developmental) contribute at once and interact, so there is no single cause

What are the five groups of contributing factors in the module's multiple-determination diagram?

Biological, cognitive, behavioural, social and environmental, and developmental and cultural context

Which statement respects multiple determination rather than the single-cause trap?

'Genetic vulnerability, chronic stress, and avoidance are fuelling each other.'

Psychodynamic perspective: what is its core claim?

Difficulties arise from unconscious conflicts, early childhood experiences and interacting mental forces; symptoms symbolically express unresolved conflicts

Describe Freud's id, ego and superego and the role of defence mechanisms.

Id (drives, immediate gratification), ego (mediates with reality), superego (moral standards); conflict causes anxiety managed by defence mechanisms such as repression, denial, projection, displacement

Psychodynamic perspective: what are the criticisms and enduring contributions?

Criticised as untestable and lacking empirical support, but contemporary versions emphasise relationships, attachment and emotion regulation, and the idea that history and relationships shape emotional life is backed by research

What is object relations theory?

Emotional bonds with significant people (objects) are carried as internal representations that influence later emotions and relationships, e.g. a punishing parent becoming a harsh inner critic

What is attachment theory?

Both a developmental and psychodynamic theory: early caregiver relationships lay the foundation for later functioning; secure attachment supports adaptive emotion management, insecure attachment is associated with psychopathology

Behavioural perspective: what is its key assumption and why did it arise?

Maladaptive behaviours can be learned and maintained through conditioning and reinforcement; it focuses on testable, observable behaviour

What is classical (Pavlovian) conditioning?

Learning that one stimulus predicts another: a neutral stimulus paired with a biologically significant one becomes a conditioned stimulus eliciting a conditioned response

In what three ways can we acquire fear of a harmless stimulus?

Directly (pairing with something aversive), verbally (being told it is dangerous), or vicariously (watching someone else have an aversive experience)

Define the four operant conditioning terms.

Positive reinforcement: add desirable, behaviour up. Negative reinforcement: remove aversive, behaviour up. Positive punishment: add unpleasant, behaviour down. Negative punishment: remove desirable, behaviour down

What makes something reinforcement or punishment, and which is generally preferred?

Whether behaviour actually changes: reinforcement increases it and punishment decreases it; reinforcement is generally better because punishment can cause anxiety, fear and anger

Classify the Susie examples.

Jodie's sundae = positive reinforcement; escaping Alexandra's nagging = negative reinforcement; losing the iPad = negative punishment; extra chores = positive punishment

How do classical and operant conditioning combine to maintain fears?

Fear is acquired classically, then avoidance is maintained by negative reinforcement (relief), so the person never learns the situation is safe

Cognitive perspective: what is its core claim?

Unhelpful thought patterns and information-processing biases play a central role in developing and maintaining disorders

Define the four information-processing biases.

Attention = what you notice now; interpretation = meaning given to ambiguity; memory = what you recall later; imagery = vivid mental pictures (usually of things going badly)

How do you distinguish an attention bias from a memory bias?

Attention is scanning in the present (e.g. checking skin repeatedly); memory is what can be retrieved from the past (e.g. recalling only fights)

How do processing biases appear across disorders, and why are they hard to shift?

Depression: attend to, recall and interpret things negatively. Anxiety: overestimate threat and underestimate coping; biases in one domain feed the others

Interpersonal/social perspective: what does it emphasise?

It emphasises social and cultural context, asking what relationship patterns the person repeats, what they expect from others, and how others' responses reinforce the pattern

What are the social determinants of mental health?

Broad life conditions affecting stress, safety and opportunity: income, housing, education, job stability and health care access

Social perspective: how do support/buffering and stigma/labelling matter?

Support buffers stress and builds resilience while isolation raises risk; stigma and labels shape self-view, help-seeking and how others treat the person

Social perspective: what role does cultural context play?

It shapes how distress is expressed, what is acceptable to express, what explanations exist (spiritual, medical, moral) and how help is sought; social causes don't make distress less real

Biological perspective: what is the diathesis-stress model?

Genetic predisposition (diathesis) sets the stage, but combined with environmental stress it tips a person toward distress

Biological perspective: what is gene-environment interaction?

Genes influence neural activity, which influences behaviour, which feeds back to shape neural activity; the brain changes with experience (stress, sleep, diet, drugs)

Biological perspective: what are neurotransmitters and why is a single-cause claim too simple?

Chemical messengers involved in mood, arousal, attention, learning and reward; effects depend on circuits and context, so 'one neurotransmitter causes one disorder' is too simplistic

What is the HPA axis cascade, and what does chronic stress do to it?

Hypothalamus releases CRH → pituitary releases ACTH → adrenal glands release cortisol; chronic stress can dysregulate it, affecting sleep, energy, mood and concentration

What is temperament?

A child's biologically influenced style of reactivity and self-regulation (e.g. fearfulness, irritability, activity, attentional control), partly inherited and shaping later personality

If one identical twin develops an anxiety disorder, the other does about 40% of the time. What can we conclude?

Genetics contributes to vulnerability, and because the rate isn't 100%, other factors must also be involved; it does not mean 40% genes and 60% environment

What three errors recur in overstated claims about biology?

Single-cause thinking, assuming biological means unreachable by therapy (the brain changes with experience), and treating a scan as showing a cause rather than a correlate

Developmental perspective: what is distinctive about it?

It explains mental health through how physical, cognitive, emotional and social capacities unfold over the lifespan, integrating the other perspectives over time

Developmental perspective: how does it view psychopathology?

Difficulties may emerge when new developmental tasks arrive without needed skills or supports, or appear 'off track' compared with typical development (which varies by culture)

Daniel and Josh start residential college. Why does Daniel struggle while Josh doesn't (developmental view)?

The transition raised the demand for self-management; Daniel arrived without capacities Josh had already built, and earlier scaffolding hid the gap

Alex: what do the social and developmental lenses explain?

Social: pile-up of stressors, shrinking support, family norms against asking for help. Developmental: the first-year transition demands independence and exposes untested coping and help-seeking skills

Alex: what do the behavioural, cognitive and biological lenses explain?

Behavioural: avoidance gives relief so it strengthens. Cognitive: negative thoughts drain motivation and feed hopelessness. Biological: stress, poor sleep, fatigue plus family-history vulnerability

Alex: how do the lenses combine, and what is the feedback loop?

Stress → poor sleep → poor concentration → 'I'm failing' → avoidance → more stress: each factor feeds the others rather than any single one being the answer

Alex: how do you classify vulnerability, trigger and maintaining factors?

Vulnerability: family history, norms against help-seeking. Triggers: move, transition, finances. Maintaining loops: avoidance, withdrawal, untested beliefs, 'I'm failing' thoughts, exhaustion

Alex: what strengths remain in his case?

A close small friend group and sport before moving, relatives who practically support each other, and school success enabling university entry; they are out of reach rather than lost

What is a theory, and how does it differ from a diagnosis?

An organised explanation of how and why something works, tying scattered observations together; a diagnosis only describes

What three things do good theories do?

Explain (why avoidance brings relief now but distress later), predict (continued avoidance will grow anxiety), guide action (gently reduce avoidance)

What are tenets, and how does theory-building work?

Tenets are the theory's parts, each linking one aspect to another; evidence varies across tenets, and theory-building is a cycle of theory → hypothesis → research → revision

What are the steps for critically evaluating a theory?

Locate the tenets → review the evidence for each → weigh how much sound evidence supports each → decide based on the data

What can happen if a theory is accepted at face value, and why is science central to psychology?

It can spread unsupported ideas, deliver ineffective and costly treatment, or leave people worse off; science is what distinguishes psychology from other helping professions

case 1

This first case describes an eight-month-old infant who cried during daily one-hour commutes. The "therapist" hypothesised that the crying was due to the infant car seat belt crossing over the infant's throat. Rather than concluding that few, if any, infants would appreciate that sensation, or being strapped into a car seat for two hours a day, the therapist instead proposed that this experience was not tolerated because it reminded the baby of a traumatic birth in which the umbilical cord was caught around his neck.

Case 1: what happened?

An infant's crying in a car seat was attributed to a memory of a traumatic birth (Character Structure/Bodynamic theory) instead of the ordinary explanation, and a procedure recreating the birth followed

Case 1: why was it not like exposure therapy?

Exposure targets known fears, avoids objective danger and requires consent; here no evidence supports remembering birth, the fear couldn't be identified, and an infant can't consent

case 2

The second case is one of the most serious in our field's history, and it involves the death of a child. In 2000, Candace Newmaker, a ten-year-old, died during an attachment-based "rebirthing" session, a therapy that now appears on lists of treatments that should never be used. During the procedure her distress was interpreted as resistance rather than the lifethreatening emergency it was, and she died.

Case 2: what happened to Candace Newmaker?

A ten-year-old died during an attachment-based 'rebirthing' session in 2000 when her distress was interpreted as resistance rather than an emergency

Case 2: what was the real science and how did the therapy distort it?

Real: caregiver sensitivity shapes children's responses (Strange Situation). Distorted: assuming any technique to 'fix' early trauma is justified, including restraint, which is the opposite of building trust

Breach 1 - Safe, effective, evidence-based practice: how was it breached?

Procedures were based on speculative theories accepted at face value instead of the best available evidence

Breach 2 - Client safety and management of risk: how was it breached?

Both procedures created serious physical danger, and Candace's life-threatening distress was misread as resistance

Breach 3 - Appropriate and necessary services: how was it breached?

A procedure was delivered that was neither needed nor justified, and an ordinary explanation (long car-seat journeys) was ignored

Where does responsibility for the harm rest, and why?

With the practitioners: they accepted unsupported theories without testing their tenets, and professional obligations hold regardless of parental consent