PSYC203 Semester 2

PSYC203 Abnormal Psychology

psychopathology

the scientific study of mental illness or disorders

what some may define as a disorder:

* statistical rarity
* lesion
* harm
* what professionals treat
* biological disadvantage
* unexpected stress

statistical rarity

describes behaviours that do not occur frequently within a population

lesion

can define a disorder as an injury or wound of some sort

harm

disorder is harm; a value judgement *not all harm is disorder*

Wakefield (1992, 2001)

argued that disorder is any situation which there is a combination of value with something objective. value is harm and the objective is the dysfunction.

black bile

associated with a melancholy temperament

melancholy

feeling of sadness typically with no obvious cause

challenges of explanation

* not always possible for a unified definition
* scientific method *observed or inferred closely*
* political functions *social, myths*

upwards levels of explanation

individual within a group (family or society) environment and culture

downwards level of explanation

looking at someone brain structure, genetics (reductionism).

WEIRD acronym

Western, Educated, Industrialised, Rich, Democratic

fetishistic disorder

a form of sexual desire where gratification is limited to an object that is not sexual or a limited body part.

normative

what is normal for a population (statistics)

aberrant

departing from an accepted standard, behaviour that is different from what we would normally accept.

paraphilias

persistent and recurrent sexual interests, urges, fantasies or behaviors

\-anonymous activities

\-anonymous targets

classical conditioning

unconditioned stimulus → unconditional response

conditioned stimulus → conditioned response

symptoms of depression

* sad or irritable
* loss of motivation, interest
* anhedonia
* desire to escape
* low self-esteem, pessimism, guilt and suicidal thinking
* loss of sleep, appetite, weight

Freudians theory

three subconscious components

* the IT
* ego
* super ego

Beck’s research

conducted research to think about depression cognitively

* cognitive triad; the self, the world, the future

__*themes;*__

* errors in logical thinking
* jump to conclusions
* over generalisation
* black and white thinking
* selective abstractions

NATS

negative automatic thoughts

diathesis

predisposition towards a particular state or condition

Beck’s theory of depression

begin with an early experience

* these experiences lead to development of schemas that lie dormant
* stressors cause the activation of schemas
* the causes an outcome of NATs to emerge
* as a consequence there are emergence of depressive symptoms.

limitation of Beck’s theory

* doesn’t explain diversity of symptoms
* argues that cognition comes before affect
* only focuses on one aspect of depression

ABC’s

aberrant, beliefs, consequence

advantages of psychometrics

* To identify boundaries of appropriate use: avert misuse or abuse of measures 
* To know constraints on interpretation of results: limits of meaning 
* To understand the constructs tapped by the measure 
* To ensure that patients can benefit from assessment practice (the instrument will not bring the patient harm 

reliability

* The reproducibility of a score 
* The consistency or stability of a score across measurements 
* The proportion of a true score across measurements 
* The proportion of true-score variable in a fallible score 
* A sampling universe is a multitude of opportunity in respect of a particular domain that is a source of error. 

validity

* The meaningfulness of a score 
* The degree to which a score captures that thing that you think it captures 

concurrent validity

correlation between a score and a criterion score. How a new test measures against a validated test *(a different score that measures the same construct)* 

predictive validity

correlation between a score and a criterion outcome. The ability of a test to predict a future outcome *(two sessions occur apart in time).* 

content validity

is the test fully representative of what it aims to measure 

face validity

does the content of the test appear to be suitable to its aim 

construct validity

does the test measure the concept that it intends to measure

AHS Acute Hassles Scale

a measure of psychological stress sensitivity (discriminant validity) stress should not be related to things like age, sex, ethnicity, if it did then we would be concerned that we were measuring something else.

Meehl

schizotaxia is necessary but not sufficient precondition for schizophrenia, all those with schizotaxia develop a schizotypal personality. Normal and odd is grouped together, then there is a separate dimension of people who are schizotypical.

Hans Eysenck

argued that the normal personality is dimensional and introduced into three dimensions.

1. extraversion/introversion

2. Neutoticism (stability, instability)

3. Psychoticism (schizotypy) Psychoticism (schizotypy) as a continuous diathesis. continuum from a normal state to abnormal or odd, schizoid, schizophrenia.

passive suicidal ideation

person who is experiencing suicide intentions but doesn’t act on it

active suicidal ideation

person who is experiencing it does have the agency to achieve what they want, planning and thinking it through.

variance in suicide

• communication

• behaviour

• temporal variation (how frequently)

• variance in motivation

Suicide in NZ

rates if suicide are considerably higher in NZ than other countries

• higher in men (70-75%)

• higher in Māori

Iatrogenic effect

side effects and risks associated with medical intervention

Single Process Theories

a) Baumeister argued that suicide is used as an escape

b) Durkheim argued that there were 3 or 4 types of suicide each reflecting a different sociological process.

interpersonal theory

• perceived burden

• thoughted belonging

• ideation to action framework

each of these would cause passive ideation as there is no agency role. with both present can lead to active ideation.

co-moderation

one thing moderates another and vice versa

Three step theory

Klonsky and May

• describe the conditions for suicide and suicidal attempts need PAIN and HOPELESSNESS. connectivity of the two.

fear

reaction to something that is present

anxiety

involves reaction to something that is not present, futuristic.

paruresis

inability to urinate in public

potential explanations for paruresis

1. behavioural explanation due to classical conditioning (shame) or operant conditioning (negative reinforcement, avoidance)

2. social anxiety disorder

   1. sympathetic nervous system arousal (flight or fight response)

reductionism

may find a lower level explanation for a particular phenomenon but it is not the only answer. there are occasions where lower level explanations may be a legitimate source of pathology.

idiopathic

occurs spontaneously from obscure or unknown cause

acquired

e.g., like a traumatic brain injury that is acquired as a result of something else

primary outcomes

the outcome that is considered to be the most important

secondary outcomes

secondary repercussions of primary impairments

iatrogenic pathology

methods used to assess and treat these problems can have secondary impacts

neuropsychiatric

encompasses a broad range of medical conditions that can involve both neurology adn psychiatry.

neuropsychology

professional practice that looks at how changes in brain function occurs as a result of idiopathic and acquired injurie, leading to changes in the function

cognition

how we think, receptive functions; how information comes in and how it is processed and manipulated.

therapeutic nihilism

impossible to cure people, medical treatments are limited to non-beneficial

what did schizophrenia used to be referred to as?

dementia praecox (dementing process)

schizo

splitting

phenia

originates from the Latin word diaphragm because people used to think that the mind was located in the diaphragm

Bleuler explained key features involved in schizophrenia include:

• associative disturbances (lack of connection between ideas)

• affective disturbances (sharp changes in mood)

• preference for fantasy over reality

  • ambivalence (positive and negative emotions at the same times)

DSM-5 Schizophrenia criteria

two or more present for a significant proportion of time during a 1 month period

• delusions, hallucinations, disorgansied speech.

challenges with schizophrenia diagnosis

• many phenotypes are not captured in the DSM i.e., cognitive impairment, social breakdown.

  • secondary effects, as well as effects of the medication (loss of employment, hard time in education).

formal thought disorder

disordered speech

positive symptoms

hallucinations, delusions, adding to what is there

negative symptoms

disordered behaviour, something that should be there is absent

history of childhood treatment

• children were used as laborers, supplement to household income

• those with behavioural problems were seen as possessed

• kept in cages and treated like animals

UN convention on the rights of children (CRC)

established in 1989

• New Zealand first adopted the principles of CRC in 1993, and in 2016 NZ had first minister for children.

CRC states children have the right to:

• survival

• develop to their fullest potential

• access education

• protection from harmful influences, abuse, and exploitations

• participate fully in family, cultural, and social life

• have their views, wants and needs respected

Erikson’s theory of child development

five stages from birth till late adolescence. these different stages have different factors that are more important for development and if this is disrupted a child may not develop properly or have difficulties later on in life.

stage 1- trust vs. mistrust

stage 2- autonomy vs. shame and doubt

stage 3- initiative vs. guilt

stage 4- industry vs. inferiority

stage 5- identity vs. role confusion

stage 1 (1st year of life)

• a feeling of trust is developed in an environment where the child feels physically comfortable and experiences minimal amount of fear. depends largely on the quality of the parent child relationship.

• babies are vulnerable and fully reliant on others to look after them and therefore need to develop a sense of trust and safety, mistrust can lead to mental health problems and abnormal development.

• physical and emotional needs of the child is needed, this leads to trust. if neglected or needs are not met then it can lead to mistrust and anxiety.

• important that they have positive early experiences, setting the scene as to how they should see the world as a safe place.

stage 2 (1-3 years old)

• assert autonomy and independence given that they feel safe

• harsh punishments or restraints during infancy can lead to a sense of shame and doubt in themselves.

• this is the time where children become more mobile, less dependent on others and can now ask for things.

scaffolding parenting- helping the child develop a sense of autonomy but also steps in when needed. (opposite ends of scaffolding is neglect and helicopter parenting).

helicopter parenting can lead to stunted development

attachment types

secure- thinks of parents as their safe space for support, reassurance or help

insecure- highly anxious, nay no want to leave parents side.

stage 3 (3-5 years old)

• initiative adds to autonomy, undertaking, planning and attacking a task

• developing a sense of responsibility increases initiative

• less reliant on caregivers, problem solving (ASK, SAY, DO method for parents)

guilt feelings may arise if the child is made to feel irresponsible or too anxious about successfully meeting challenges. high criticism can be an issue.

Stage 4 (5-12 years old)

• initiative leads to development of novel information causing mastery and further knowledge

• teacher plays a significant role in a child’s feeling of inferiority/positive sense of self. this is because children spend a lot more time in school and peer/teacher development.

stage 5 (12-18 years old)

• more concerned with how they appear to others

• positive identity develops if they feel they have a clear role and a positive path to follow for the future.

• confusion may occur if a positive path is not identified. higher rates of anxiety and depression if this their role and purpose is not identified.

• peer groups are important in developing a sense of self.

Brofenbrenner’s Ecological Model

immediate close factors that influence child development.

• microsystem; school, family, health services, peers and religion

• mesosystem; extended family and neighbors

• exosystem; school board, government agencies, mass media, social services and healthcare, parents economic situation.

• macrosystem; attitudes and ideologies of the culture

• chronosystem; environmental changes that occur over the life course

factors that influence abnormal child development

• biological

• psychological

• social

biological

• genes

• in utero effects (substance use during pregnancy, drug withdrawals)

• brain structure (brains with ADHD develop differently)

• head injuries/illnesses (birth complications)

• gender

- temperament is genetic aka how you respond to the world. mental illness also has a component of biological factors with increased risk with genes and environment.

psychological

• temperament; becomes more complex in adults overtime, this is how we respond to the environment.

• self-esteem; concept of resilience to bounce back, how we cope and regulate.

• coping

• emotion regulation

• cognition- (how we think about a situation influences how we feel and respond).

social

• family environment (parental relationships, financial situation, stressful environments)

• modeling- children learn by watching, how parents cope and often will react in the same way.

• the interaction between the child and the environment (goodness-of-fit)- do they feel like they fit in and are accepted for who they are?

• peers- want to feel accepted, peers can influence children and development

• school- do they feel safe, do they have a role, do they fit in.

• neighborhood/community/culture

• media- messages about what is ideal and what should be working towards.

Adverse Childhood Experiences (ACE’s)

• adverse childhood experiences have show to significantly influence children’s later life outcomes as well as their brain development.

  • can lead to disruptive behavior and social impairment

  • Abuse. neglect, household dysfunctions

issues with DSM-V

• have to average the sample for different situations

• doesn’t account for contextual settings

• there are interrelationships and diagnosis can overlap

• depending on the raters understanding of a typical behaviour

• black & white

dimensional vs categorical classifications

psychologists ethical code of practice

1. respect for dignity of persons and people

2. responsible caring

3. integrity of relationships

4. social justice

transference

when someone redirects their feelings about one person onto someone else

ADHD

• poorer self-regulation of behaviour

• inborn neurodevelopmental disorder

• inattentive

• high heritability

• difficulties in cognitive and social functioning

3 types of ADHD

1. predominantly inattentive

2. predominantly hyperactive/impulsive

3. combined

ADHD clinical diagnosis

symptoms must be:

• present before 12 yrs

• occur across two or more settings

• not better explained by another disorder (rule out anxiety as a reason for not being able to concentrate).

Garden et al. (2006)

impairment criteria on a group of school children aged (6-17 yrs) only 33% met the full diagnostic criteria for ADHD

ADHD treatment

• stimulants; methylphenidate, amphetamine

• non-stimulants; atomoxetine, Strattera

psychological interventions

ODD

Oppositional defiant disorder

• disruptive, impulse-control and conduct disorder

DSM-V classification of ODD

Oppositional defiant disorder;

4 of the following behaviours regularly for a period of 6 months

• loses temper

• argues with adults

• defies or refuses a request

• deliberately annoys people

• blames other for own mistakes and behaviours

• touchy and easily annoyed

• angry and resentful

• spiteful or vindictive

• impaired in social and academic skills

DSM-V classification of CD

conduct disorder;

• aggression to people and animals

• destruction of property

• deceitfulness or theft

• serious violation of the rules

• disturbance in behaviour causes significant impairment in social, academic, or occupational functioning.

  • subtypes include; childhood onset, adolescent onset, unspecified onset

  • severity; mild, moderate, severe

externalising disorders

ADHD, ODD, OCD- difficulty regulating emotions, projected externally

differentiations between ODD and CD

• ODD typically emerges 2 to 3 years before CD

• 90% of CD patients used to have ODD before diagnosed with CD

• however, 2/3 of children with ODD do not progress to CD

• similar risk factors though stronger associations for CD (e.g., poverty, family history)

• CS is a required precursor to ASPD (anti-social personality disorder)

male to female ratio for CD

4:1

comorbidity of ODD and CD

-comorbidity is the rule rather than the exception

• ADHD most common with 35-70% of children with ADHD develop ODD

• 30-50% develop CD

• anxiety disorder (22-33%) and depression (15-31%)