Psychopathology

Psychopathology

Disease of the mind

four definitions of abnormality

1. Deviation from social norms

2. Deviation from statistical norms

3. Failure to function adequately

4. Deviation from ideal mental health

DSM-5

Diagnostic and statistical manual of mental health. A tool used to classify and diagnose disorders/illness. Predominantly used in the USA

ICD-10

International Classification of Disorders. A tool used to classify and diagnose disorders/illness. Predominantly used by the rest of the Western world

social norm

an unwritten rule made by society that everyone is expected to follow.

What does it mean to deviate from social norms?

Showing behaviours that are different from the accepted standards of behaviour in a community or society

normal distribution

a symmetrical spread of frequency data that forms a bell-shaped pattern. The mean, median and mode are all located at the highest peak

statistical deviation

Occurs when an individual has a less common characteristic, for example, being less intelligent than the rest of the population

failure to function adequately

When an individual is unable to cope with the ordinary demands of day-to-day living such as basic nutrition, hygiene and social interactions

Rosenhan and Seligman research

they proposed some signs to determine when someone is not coping:

• no longer conforming to standard interpersonal rules such as maintaining eye contact

• experiencing severe personal distress

• irrational behaviour that is dangerous to themselves or others

deviation from ideal mental health

Occurs when someone does not meet a set of criteria for good mental health as outlined by Jahoda

Jahoda’s criteria for ideal mental health

Mastery of the environment, self-actualisation, autonomy, perception of reality, integration, self-esteem

mastery of the environment

we can successfully work, maintain relationships and take part in hobbies/activities

Self-actualisation

we can reach or are striving to reach our potential

autonomy

we are independent of others

perception of reality

we have an accurate, realistic view of the world and don’t search for negatives

integration

we can cope with stress appropriately and effectively

self-esteem

we have good self-esteem and don’t feel guilty

Phobia

An irrational response to something that includes feelings of excessive fear and anxiety. This reaction is disproportional to the threat of the phobic stimulus

emotional characteristics of phobias

• emotional responses are unreasonable and not logical. For example, being scared of a small spider is unreasonable because it is disproportionate to the danger posed

• a person will immediately feel extremely unpleasant when presented with their stimulus such as being frightened. fear is short term

• the individual may experience high levels of arousal, making it difficult to experience any positive emotions. anxiety is long-term

behavioural characteristics of phobias

• people with phobias tend to do anything to avoid their phobia. This can make it hard to go about in their daily life

• if a phobia cannot be avoided the individual may have to endure it. Someone who has to face their phobia experiences high levels of anxiety

• a person may panic in response to seeing their phobia. This may include crying or screaming

cognitive characteristics of phobias

• if a person can see the phobic stimulus, they find it hard to look away because they have the best chance of escaping if it suddenly poses a large threat.

• a person may have irrational beliefs, such as thinking a spider could kill them

• the perception of the phobic stimulus may be distorted.

two-process model

an explanation for the creation and continuation of a phobia. The two processes are CC and OC. CC explains the creation of a phobia, OC explains the continuation of a phobia.

Classical conditioning explanation of phobias

• CC is used to explain how a phobia is developed. It involves leaning to associate something we have no fear of with something that does trigger a fear

• Watson and Rayner created a phobia in little Albert. They repeatedly paired the white rat (NS) with the loud bang (UCS) to produce fear (UCR)

• eventually, little Albert was scared of the white rat alone, meaning it had become a conditioned stimulus

• Over time, the conditioning becomes generalised to similar objects as little Albert began showing fear at other furry objects such as rabbits

How are phobias maintained?

• OC- negative reinforcement (removing an unpleasant feeling such as anxiety)

• For example, someone with a phobia of spiders might avoid all places where a spider might be and therefore do not experience any feelings of anxiety.

• Because the person doesn’t feel any anxiety, the behaviours are repeated and reinforced

Two types of phobia treatment

systematic desensitisation and flooding

systematic desensitisation

a gradual process that uses a hierarchy of fears which the patient goes through, ensuring they are relaxed at each stage before moving on

flooding

an instant process, in which the patient is exposed to an extreme form of their phobia in order to reduce the anxiety triggered by the phobia

• the patient is unable to escape their fear and quickly learns that their phobic stimulus is harmless and their fear is irrational

How flooding works in terms of cc

• known as extinction

• the CS (spider) is encountered without the UCS (being hurt). This results in the CS no longer producing the CR (fear)

How SD works

• the patient and therapist put together a hierarchy of fears, which consists of situations related to the stimulus, arranged from least to most frightening

• the therapist teaches the patient to be as relaxed as possible with things such as breathing or imagery techniques.

• the patient is exposed to the phobic stimulus while in a relaxed state, once relaxed they will move up the hierarchy and aim to become relaxed again, repeating the process until they are at the top

depression

a mental disorder characterised by low mood and low energy levels. it lasts for a long amount of time and can be triggered by stressful events but this is not always the case

cognitive characteristics of depression

• the person may find it difficult to concentrate on a task or make decisions that they would normally find straightforward

• they focus more on the negative aspects of a situation rather than the positives

• they see situations as absolutely good or absolutely bad - no in-between

behavioural characteristics of depression

• reduced levels of energy, making them lethargic

• reduced (insomnia) or increased (hypersomnia) amount of sleep. appetite might also decrease or increase

• the anger felt by someone with depression can sometimes lead to self-inflicted physical harm

emotional characteristics of depression

• the person is more than just “sad“ - they have feelings of worthlessness and emptiness

• they experience anger directed at themselves or others

• they experience low self-esteem and can be extreme as self-loathing

Beck’s cognitive theory of depression

1. faulty information processing - when depressed, a person focuses on the negative aspects of a situation and ignore the positive

2. negative self-schemas - a schema is a package of info developed from experience. Someone with depression has a negative self-schema, leading to interpreting information about themselves in a negative way

3. the negative triad - a person develops a dysfunctional view about themselves because of the three types of automatic negative thinking:

   1. negative view of the world

   2. negative view of the future

   3. negative view of the self

Ellis’ ABC model

• activating event - Ellis stated that there are situations that trigger our thoughts. An example of an activating event might be ending a relationship

• beliefs - the activating event leads to irrational beliefs. two types of irrational beliefs are: musterbation (we must always achieve perfection) or utopianism (life is always meant to be fair)

  • consequence - irrational beliefs lead to emotional and behavioural consequences. For example, having musterbation and then failing a test may trigger depression

cognitive behavioural therapy

Most commonly used psychological treatment for depression and other mental health problems

• cognitive - identifying negative, irrational thoughts

• behavioural - changing the negative, irrational thoughts

Beck’s treatment

Begins with an assessment in which the patient and the therapist work together to clarify the patient's problems. Identifies and challenges negative/irrational thoughts. Positive thoughts are reinforced. Aims to help patients test the reality of their negative beliefs through setting homework such as recording when they enjoyed an event/when someone was nice to them. Therapist can then challenge these thoughts using the recording of events and prove the patient is being irrational.

Ellis’ treatment

Begins with an assessment in which the patient and the therapist work together to clarify the patient's problems. Extends the ABC model to the ABCDE model (D - dispute and E- effect). Aims to help patients challenge their irrational beliefs by arguing vigorously. This attempts to break the link between negative life events and depression. Positive thoughts are reinforced. Disputing can be through empirical arguments (is there any evidence?) or logical arguments (based on the facts, is this a logical way of thinking?).

OCD

a mental health problem in which a person has certain thoughts repeatedly (obsessions) or feels the need to perform certain routines repeatedly (compulsions) to an extent where it causes distress or limits functioning

emotional characteristics of OCD

• a person may experience anxiety and distress, caused by the urge to carry out a compulsion

• they may experience depression due to avoiding carrying out compulsions

• they may experience negative emotions, such as guilt over minor moral issues, or disgust at something external like dirt

cognitive characteristics of OCD

• a person may have obsessive thoughts about certain things, like worrying about leaving a door unlocked

• they may develop coping strategies to help them deal with obsessions, e.g. mindfulness

• They may know that their obsessions and compulsions are irrational, but still remain hypervigilant

behavioural characteristics of OCD

• they may feel compelled to repeat compulsions

• they may carry out behaviour repeatedly as an attempt to manage the anxiety caused by obsessions

• they may avoid certain situations that trigger their OCD

genetic explanation of OCD

• Genes contribute to vulnerability to OCD, rather than directly causing it.

• Lewis (1936) found higher concordance rates for OCD among relatives (37% of parents, 21% of siblings), suggesting OCD runs in families.

• The diathesis–stress model explains OCD: individuals inherit a genetic vulnerability, and environmental triggers activate the disorder.

• Researchers have identified candidate genes linked to OCD, particularly those involved in regulating serotonin.

• OCD is polygenic, meaning it is influenced by many genes, not one single gene.

• Taylor (2013) suggested up to 230 genes may be involved, linked to neurotransmitters such as serotonin and dopamine.

• OCD is aetiologically heterogeneous, meaning different genes may cause OCD in different individuals and may be linked to specific OCD subtypes (e.g. hoarding, religious obsessions).

Brain- explanation of OCD

• some causes of OCD are associated with impaired decision making, as a result of abnormal functioning of frontal lobes, which are responsible for logical thinking and making decisions

• another brain region that might be responsible is the parahippocampul gyrus, in which abnormal functioning results in unpleasant emotions

synaptic transmission

the way neurones communicate with each other. it involves a message being passed chemically (between neurons) and electrically

How can OCD be explained using neurons?

If not enough serotonin enters the post- synaptic neuron, the normal transmission of mood-relevant information does not take place and mood (and other mental processes) are affected.

Therefore, OCD can be explained by a reduction in the functioning of the serotonin system in the brain.

SSRIs as a treatment for OCD

SSRIs work by increasing the levels of serotonin in the brain. Serotonin is released from vesicles in the presynaptic neuron into the synapse. It is received by receptor sites in the postsynaptic neuron however some remains in the synaptic cleft .SSRIs work by blocking the reuptake of serotonin back into the presynaptic neuron, forcing it to remain in the synapse. It often takes 3-4 months of taking SSRIs for them to become effective and the average dose is around 20mg.

Alternative to SSRIs

If an SSRI is not effective after 3-4 months, the dose can be increased or it can be combined with other drugs.

Tricyclics are sometimes used, such as Clomipramine. These work in the same way as SSRIs but have more severe side effects so are generally kept for patients who do not respond to SSRIs.

combining SSRIs with other treatments

As well as tricyclics and SNRIs, SSRIs are sometimes paired with CBT. The drugs work to reduce emotional symptoms which then allows to engage more effectively with the CBT