Abnormal Psychology

Abnormal Behaviour

- Violates a norm in society
- maladaptive
- rare given the context of the culture and enviroment
- causing the individual distress.

The Four D's

Danger: The state in which an individual might harm themselves or others.
Deviance: Behaviour that significantly differs from what is common within a cultural group.
Distress: Unpleasant feelings and emotions that impact level of functioning.
Dysfunction: Behaviours or cognitive patterns that interfere in an individual's ability to carry out daily activities.

Conceptual Definitions

Statistical deviation from the norm
Deviation from the social or cultural norms
Deviation from the concept of ideal mental health.

Statistical deviation from the norm

Applying conceptual definitions of abnormality exposes challenges with statistical deviation as a criterion.

Social deviation from the norm

Culture plays a major role in how we manifest our symptoms as well as what treatments are most appropriate.

it is problematic due to evolving social norms influenced by morality and culture.

Deviation from optimal health norms

Jahoda (1958) proposed defining positive mental health to help recognize mental illness.

Self-acceptance
Potential for growth and development
Autonomy
Accurate perception of reality
Environmental competence
Positive interpersonal relationships

Problems with Jahoda's approach

Measurement challenges: How can one quantify these factors.

Ethnocentric perspective: Jahoda's framework originates from an individualistic society.

Recognition of a continuum: Mental health should be viewed as a spectrum, with individuals fluctuating between positive and negative mental health.

Practical definitions

Based on what can be observed and not variations from a norm.

Based on the ability of the person to function in society.

Rosenhan and Seligman's criteria from abnormal behaviour.

Irrationality
Maladaptiveness
Observer Discomfort
Suffering
Unpredictability
Violation of Community Standards
Vividness and Unconvenctionality

What is a psychiatric diagnosis based on?

Self-reported symptoms of the individual.
Clinical observations.
Psychometric testing.
Physiological testing.

Clinitian's Biases

Sick role bias (where a doctor assumes that because someone has come in for advice, s/he is ill and needs a diagnosis), gender bias
bias based on socioeconomic status.
Role of cultural stereotyping. A psychiatrist's stereotypes about culture may influence his or her diagnosis.

Li-Repac (AIM)

Study the role of cultural stereotyping in diagnosis.

Compare the diagnoses of both white and Chinese-American therapists of both white and Chinese male subjects.

Li-Repac (PROCEDURE)

ten patients used in the study - 5 white and 5 Chinese - all of whom had been diagnosed with similar mental illness.

Semi-structured interviews with each of the patients. These interviews were videotaped
"How have you been feeling lately?" and "How do you spend a typical day?"

Tthe clinicians where first asked to describe an ideal, functioning individual using a 112-item test. Then they were randomly assigned videos to rate for normality.
Each rater would rate 4 videos - 2 of white patients and 2 of Chinese patients.

Li-Repac (RESULTS)

In the first test, there was no significant difference in the scores, showing that their training had led to a similar understanding of what constituted normality.

When looking at personal traits:
White raters saw signs of lower self-esteem in the chinese patients.
The chinese raters saw the white patients as more agressive.

When asked to rate the patients on pathology, there were three significant findings:

White raters saw the Chinese patients as more depressed and inhibited than the Chinese raters.
White raters saw Chinese patients as less socially competent and as having less capacity for interpersonal relationships than did Chinese raters.
Chinese raters reported more severe pathology than white raters when judging quiet patients.

Li-Repac (EVALUATION)

control of pathology, age, and wage so these weren't external factors in causing differences between psychiatrists

Extremely small sample, so it's hard to generalize findings.

The white therapists had no previous experience in treating Asian patients.

Testing the rates on their definition of normality allows to check for differences in training or other confounding variables.

Rosenhan (AIM)

To test the hypothesis that psychiatrists cannot reliably tell difference between those who are sane and those who are insane

Rosenhan (PROCEDURE)

8 confederates who would act the part of someone seeking help in a hospital. The participants were the staff of 12 hospitals in five different states across the USA.

The pseudo-patients told the doctor at the hospital that they were hearing voices, a clear sign of schizophrenia for the time.

After being admitted to the hospital, they acted completely normal. They spent time talking with other patients and the staff, taking notes on their experiences.

Rosenhan (RESULTS)

All of the confederates were admitted, and all but one was given a diagnosis of "schizophrenia in remission".

The average lenght of stay was 19 days.

The nurse's notes showed that they observed no signs of abnormality during their stay.

Once the initial diagnosis was made, the label of schizophrenia remained, even though the pseudo-patients showed no signs of abnormality.

Rosenhan (SECOND STUDY)

A second, consenctual study was proposed
The hospitals were told that one or more pseudo-patients would try to be admitted to their hospital over three months.
Each member of staff was asked to rate all patients who came in on a 1 - 10 scale for "likelihood of being a pseudo-patient."

41 people were judged to be pseudo-patients by at least one staff member and one psychiatrist suspected 23. None of the patients where confederates.

This shows that validity can be affected when a doctor's credibility is at risk.

Classification System

systems identify patterns of behavioral or mental symptoms that consistently occur together to form a disorder

Two Classification Systems

Diagnostic and Statistical Manual of Mental Disorders (DSM) -
International Classification of Diseases (ICD)

DSM

Commonly used in the USA. Published by the American Psychiatric Association. Standardized system for diagnoses based on a person's clinical and medical conditions, psychosocial stressors and the extent to which aa person's mental state interferes with his life.

ICD

World Health Organization has published the International Classification of Diseases. A multidisciplinary and multilingual approach. Identifies causes rather than JUST symptoms.

sick role bias.

The individual is automatically labeled as a "patient."
This means that the psychiatrist is "looking for evidence of abnormal behavior."
If a person is seeking assistance, they must have a mental disorder.

reactivity

The fact that the person is being observed or asked personal questions may increase anxiety and therefore change or intensify behavior.

the ABC's

Affective Symptoms
Behavioural Symptoms
Cognitive Sy

Parker (BACKGROUND)

Modern research argues that the disorders may be universal, but that their symptoms may not be.

People who are part of collectivists societies tend to somatize symptoms of depression. They report bodily symptoms rather than emotional symptoms.

Parker (AIM)

Compare how depressed Chinese patiends and Caucasian patients identified cognitive aspects of depression and somatic symptoms.

Parker (PROCEDURE)

All participants were out-patients who had been diagnosed with Major Depressive Disorder.

Questionnaire where based on two sets of symptoms:
mood and cognitive items common in Western diagnostic tools for depression.
Secondly, a set of somatic symptoms commonly observed by Singaporean psychiatrists.

patients were asked to judge the extent to which they had experienced each of symptoms, and where told to rank them in how distressing they were.

Parker (RESULTS)

60% of the Chinese participants identified a somatic symptom, compared to only 13% of the Australian sample.

The chinese also rated the somatic symptoms higher than the affective symptoms. Chinese participants were significantly less likely to identify cognitive or emotional symptoms as part of their problem.

in Western culture, it is more appropriate to discuss one's emotions, and depression is seen as linked to a lack of emotional well-being

In Chinese culture, it is less appropriate and even stigmatized if one speaks about a lack of emotional health.

Parker (EVALUATION)

The study developed a questionnaire based on cultural evidence relevant to participants, rather than a standardized western questionaire.

They chose participants based on the DSM-IV criteria for Major Depressive Disorder. The study demonstrates an imposed etic approach to research. It eliminated people from thes sample who did not fullfill the western view of depression.

Questionnaire was backtranslated to establish credibility.

Bolton (AIM)

Bolton wanted to investigate the local validity of Western mental illness concepts - that is, was a Western diagnosis of depression or PTSD accepted by the local community as a valid description of their response to trauma?

Bolton (PROCEDURE)

Case study on two rural areas in Rwanda after a genocide.
Three interview styles:
free listing
key informant interviews
pile sorts

free listing provided a list of local terms for mental symptoms and disorders. They asked local people to name all the problems that had resulted from the genocide. Using inductive content analysis, they pulled out symptoms that were related to mental health.


Key informant interviews:
Participants were asked for the names of people in the community who were knowledgeable of these problems - and further interviews were then carried out. Local healers where seen as knowledgable.

Pile Sorts:
A set of cards was created which included the mental health symptoms that were identified in the initial interview as well as the symptoms that identify depression as outlined in the DSM. The healers were asked to sort the cards based on similarity and included three symptoms with the DSM diagnosis of depression: lack of trust in others, loss of intelligence, and mental instability.

Bolton (RESULTS)

After the questionnaire was established, 93 people were identified as having mental health issues in the community.
When interviewed, 70 were diagnosed by local healers as showing the symptoms of agahinda gakabije.
When given the newly standardized questionnaire, 30 of those then tested positive for signs of depression.
The relationship between agahinda and depression was the same as that between grief and depression in the Western world.

Bolton (EVALUATION)

An emic approach makes use of local resources to help with the diagnosis of mental health issues, in which clinicians consider how the various components of culture have shaped an individual's health and help to determine an appropriate treatment.


The process used data triangulation to strengthen the credibility of the findings.

Back translation - that is, translating interviews back
into the original language - is used to establish credibility.

It is reliant on determining which Western disorder most resembles the locally defined problems. The diagnosis of depression is then based on local definitions of symptoms, compared to the symptoms as defined in the DSM.

Emic approaches are also limited to the community that is studied and thus has very limited generalizability.

The main limitation of cross-cultural psychiatry, of course, is that it fails to recognize that cultures are dynamic,
complex social constructs that defy easy definitions or measurement.

Etiology of disorders

the investigation or attribution of the cause or reason for something. the manner of causation for many mental illnesses.

Prevalence of disorders

The estimated proportion of people in a particular population that has a particular disorder. Psychologists also often refer to lifetime prevalence which is the proportion of the population that at some point in their life has experienced the disorder.

Anxiety Disorders

Range of disorders that share the common characteristic of a feeling of "anxiety" - that is, an emotional response characterized by feelings of tension, worried thoughts, and physical changes related to the stress response.

Prevalence of Anxiety Disorders

Anxiety disorders are the most common of mental disorders and affect nearly 30 percent of adults at some point in their lives.

The media often makes the claim that anxiety disorders are on the rise in teenagers. In many cases, they argue that social media is to blame.

Curran and Hill (BACKGROUND)

According to the most recent global health estimates from the World Health Organization (2017), serious mental illness afflicts a record number of young people. This increase is said to be due to societal changes, as the industralized world is preoccupied with comparing themselves to others.


It's argued that this is due to an increase in perfectionism. Perfectionism is defined as a combination of excessively high personal standards and overly critical self-evaluations.

Young people today perceive that others are more demanding of them, are more demanding of others, and are more demanding of themselves. This is due to modern society's emphasis on competitiveness, individualism, and irrational ideals of the perfectible self.

Curran and Hill (AIM)

Study if stress levels are higher today than they were 27 years ago.

It looks at how the level of perfectionism in university students has changed over the past generation.

Curran and Hill (PROCEDURE)

Meta-analysis of 164 studies with a total sample size of 41,641 of students who had completed the Multidimensional Perfectionism Scale between 1989 and 2016.

Goal was to see how levels of perfectionism had changed over the 27-year period in cohort groups with the same age and generally the same environment.

Curran and Hill (RESULTS)

There was a 10% increase in self-oriented perfectionism from 1989 to 2017.

There was a 32% increase in the socially prescribed perfectionism score from 1989 to 2017.

There was a 16% increase in the other oriented perfectionism score from 1989 to 2017.

Self-oriented perfectionism is typically the highest among American students. Socially prescribed perfectionism is typically highest among Canadian and British students.

Recent generations of university students are demanding higher expectations of themselves. The large increase in socially prescribed perfectionism scores indicates that young people find their social context increasingly demanding.

Smallest change over time was observed for self-oriented perfectionism. This could be because this type of perfectionism has been found to have greater heritability, so it may be less likely to change due to external factors.

Changes in perfectionism correlate with increased levels of stress and mental illness among the younger generation.

Curran and Hill (EVALUATION)

Meta-analysis with a very large sample size. Including data obtained over a long period of time (27 years) and collected from different laboratories. However, meta-analysis are open to researcher bias.

The study is not able to establish a cause and effect relationship between the cultural norms at the time of taking the test and one's level of perfectionism. It's correlational and demonstrates a trend, but it is not able to definitely explain the nature of the trend.

Research indicates that perfectionism and stress are intricately linked, there is no measure in the study of physiological indicators of stress or self-reported levels of stress.

The findings are restricted to a sample of white university students from higher socioeconomic backgrounds. The findings cannot, therefore, be generalized to all young people.

Comorbitity

the co-occurrence of two or more disorders in a single individual

Biological Etiology of anxiety

Two key arguments.
-Genetic argument that argues that the disorder is inherited and runs in families.
- Neurochemical reasons for anxiety disorders - specifically, levels of noradrenaline and GABA.

Math Anxiety

an extreme lack of confidence in one's ability to learn and to perform mathematics

WANG ET AL (AIM)

Wang et al (2014) wanted to see if math anxiety is the result of what happens in classrooms or whether it is linked to a genetic disposition in some students.
The study examined how fraternal (DZ) and identical (MZ) twins differ on measures of math anxiety,

WANG ET AL (PROCEDURE)

The researchers carried out two home visits when the twins were between about 9 and 15 years old.

All of the twins completed assessments of math anxiety, general anxiety, math problem-solving, and reading comprehension.

WANG ET AL (RESULTS)

The researchers determined that genetic factors accounted for roughly 40% of the variation in mathematical anxiety, with the remaining being accounted for by environmental factors.
The researchers argued that genetic risk factors for anxiety may lead to poor math performance - and then this may lead to further anxiety - an example of spiraling causality, a positive feedback loop.

WANG ET AL (EVALUATION)

The study is correlational in nature; therefore, drawing
conclusions about causality may be premature, even though it is a relatively large sample.

Bidirectional ambiguity could be a problem - making it impossible to know if math performance leads to anxiety or vice versa. The study is also done in the US where there is a
cultural context for math and anxiety.

In addition, as the study was a twin study, no actual gene(s)
is/are identified and linked to math anxiety. Finally, one has to question the validity of the various tests that were given with regard to age and gender.

Hettema (AIM)

To examine genetic and environmental factors in anxiety disorders in an effort to explain the high rates of comorbidity in anxiety disorders.

Hettema (PROCEDURE)

The researchers used a sample of more than 5000 twins from the Virginia Adult Twin Study.

A personal interview was conducted to collect lifetime diagnoses of six different anxiety disorders in the participants.

These diagnoses were then used to conduct an analysis of the existing genetic and environmental data on these twins (collected during a previous study) to seek correlations between genetic factors, environmental factors and anxiety. Multiple models and analyses were conducted upon the data.

Hettema (RESULTS)

The variance in specific phobias was influenced by one common genetic factor, while the variance in other anxiety disorders was influenced by another common genetic factor. The remaining variance was explained by a mix of environmental factors.

The genetic and environmental factors explaining anxiety disorders appeared to be the same for females and males, yet anxiety disorders are nearly twice as prevalent in females. This suggests that there is something more going on beyond genetic predisposition and environmental influences to explain the higher prevalence in females.

Hettema (EVALUATION)

The use of meta-analysis enhanced the statistical power and reliability of the findings.
Included multiple anxiety disorders, providing a broad perspective on the genetic and environmental influences.

Results may not generalize to the broader population, as twins may not represent the genetic and environmental variance of non-twin populations. Additionally, there is a lack of temporal data.

Meta-analyses can be influenced by the selective reporting of studies, potentially skewing results.

Association Studies

research strategies for comparing genetic markers in groups of people with and without a particular disorder.

Londsdorf et al (AIM)

How polymorphisms in two gene play a role in anxiety disorders: the serotonin transporter 5HTT gene and the gene for the enzyme COMT.

The COMT gene

The COMT gene is involved in breaking down dopamine. A specific polymorphism in this gene results in higher levels of dopamine in the prefrontal cortex, leading to greater levels of anxiety.

The 5HTT gene

The 5HTT gene can come in two different versions that differ in their length. The shorter version of the gene is associated with higher neuroticism scores and anxious behavior.

Londsdorf et al (PROCEDURE)

volunteers received a mild electric shock after being shown a picture (A). They were then shown another picture (B) but with no electric shock. The participants learned to fear picture A.

The participants came back into the lab the next day. First, they were shown the same pictures but without any shocks to see if they would still show the fear response. In addition, blood samples were taken to test for the two genetic variations (5 HTT and COMT).

Londsdorf et al (RESULTS)

The participants with the shorter version of the serotonin transporter gene developed a very strong physiological fear response to picture A, but participants with a longer version of the gene did not.

In addition, participants with the COMT variant were able to very quickly overcome their fear while volunteers with the other variant failed to do so.

These findings may indicate that individuals with specific polymorphisms may be more susceptible to anxiety disorders and less responsive to treatment

Londsdorf et al (EVALUATION)

The use of fear conditioning paradigms provides an experimental framework to study anxiety-like responses in a controlled environment.
As with all studies on anxiety, the construct of "anxiety" is operationalized in different ways - and this may mean that there is a lack of construct validity with regard to actual anxiety disorders.

GABA

Gamma-Aminobutyric acid (GABA) is a neurotransmitter found in the brain that has an inhibitory effect, particularly on the noradrenergic system - that is, neurons that release noradrenaline. Low levels of GABA have been linked to anxiety disorders.

Sanders & Shekhar (AIM)

determine whether GABA receptors in the amygdala might be involved in regulating experimental anxiety.

Sanders & Shekhar (PROCEDURE)

Researchers injected BMI (bicuculline methiodide, a GABA receptor antagonist) directly into the amygdala of rats. They also injected a GABA agonist (muscimol). Then, the rats, which are usually very social, were put in a cage with another male rat. The amount of time interacting with the other male was measured.

Sanders & Shekhar (RESULTS)

Rats injected with the antagonist showed less desire to interact, possibly indicating a higher level of anxiety.

infusions of GABA or GABA receptor agonists (benzodiazapines) into the amygdala decreases fear and anxiety in several animal species

Long et al (AIM)

to investigate the activity of GABA in the prefrontal cortex of panic disorder patients.

Long et al (PROCEDURE)

researchers studied 11 panic disorder patients and 8 "healthy" control patients without a family history of anxiety disorders. All of them were subject to an MRS (magnetic resonance spectroscopy) to measure the activity of neurotransmitters.

Long et al (RESULTS)

GABA deficits were present in the medial prefrontal cortex of panic disorder patients. (Lower GABA activity)
Research showing that lower levels of GABA are linked to anxiety disorders has led to the use of GABA agonists in the treatment of anxiety disorders, like Xanax.

Long et al (EVALUATION)

Bidirectional ambiguity is a problem. It is unknown if the GABA deficit is due to anxiety or anxiety is due to GABA deficiency.

It is unclear what enviromental conditions might cause GABA deficiency, or if it is a genetic condition.

The practical application of the theories has led to successful drug treatments that have improved some people's lives.
The Treatment Aetiology Fallacy - that is, the mistaken notion that the success of a given treatment reveals the cause of the disorder.

COGNITIVE AETIOLOGIES (social anxiety)

The cognitive approach to explaining anxiety disorders focuses on how people process information. Individuals with anxiety disorders tend to focus on threat-relevant information in their environment.

Catastrophizing

A cognitive distortion where a person exhibits an exaggerated sense of negativity, assuming the worst outcomes and interpreting even minor problems as major calamities. Catastrophising also results in a belief that one's own personal risk is higher than that of others.

Butler and Matthews (AIM)

Butler and Mathews (1983) hypothesized that anxious individuals overestimate subjective personal risk. In other words, they demonstrate an interpretative bias.

Butler and Matthews (PROCEDURE)

The sample was made up of 12 highly anxious individuals, 12 depressed individuals, and 12 control participants. The participants were presented negative and positive scenarios of events.

On one of the surveys that they were asked to complete, participants were asked to subjectively rate the scenarios on a 0 - 8 scale of future probability, where 0 = "not at all likely" and 8 = "extremely likely." They were asked to indicate both the probability that the event could happen to them and to others.

Butler and Matthews (RESULTS)

Anxious individuals significantly overestimated subjective personal risk for negative events when compared with controls, especially when considering the threat to themselves. Although depressed individuals demonstrated lower levels of subjective risk than anxious individuals, the levels were higher than the control group.

Telch and Harrington (AIM)

Study the role that one's sense of control would play in panic attacks.

In addition to cognitive biases, one's sense of control over their situation - and especially with regard to being able to control their own fears - plays a critical role in anxiety disorders.

Telch and Harrington (PROCEDURE)

The participants were labeled as "high" or "low" risk for panic attacks based on their scores on the Anxiety Sensitivity test.
The test measures their self-reported anxiety as a response to physical symptoms - eg. heart beating rapidly or feeling faint.

First, participants for both the high and the low anxiety groups were randomly allocated to either the "relaxation" group or the "arousal" group.

In each of those groups, participants would be asked to breathe either room air or air with a high concentration of carbon dioxide.

In the relaxation condition, they were told they would experience positive feelings. The arousal condition was told that they may experience negative feelings.

They were then asked to fill in two forms - the API and SUDS, which both are used to describe unpleasant experiences.

Telch and Harrington (RESULTS)

when arousal was expected - individuals could prepare
for the feelings of arousal from the carbon dioxide. This resulted in a low panic symptoms from both the low and the high anxiety participants.

In the case where they were expecting to relax and were then experiencing unexpected symptoms, those with
high levels of anxiety started to panic. It was the lack of control over their situation which is believed to have led to their panic response.

Evaluation of cognitive explanations of anxiety disorders

Strengths
Experimental research has been used to support the role of cognitive factors in anxiety disorders.
The practical application of the theories has led to successful treatments that have improved some people's lives.

Limitations
For ethical reasons, people with actual anxiety disorders are often not used in research. As a result, "anxiety" or "panic symptoms" are measured, rather than actually diagnosed anxiety disorders.
Correlational research means that causation cannot be established and bidirectional ambiguity cannot be resolved. It is unclear whether the thinking patterns are the cause or the result of anxiety disorders.
The Treatment Aetiology Fallacy - that is, the mistaken notion that the success of a treatment reveals the cause of the disorder.