Psychopathology

Definitions of Abnormality

Deviation from Social Norms

  • Social norms are unwritten behavioural expectations that vary depending on culture, time and context
    • Cultural specificity e.g. tolerance to homosexuality, hair covering, public displays of emotion
  • Social deviants break the norms and are seen as abnormal

:) Respects cultural differences, doesnā€™t impose a set western definition of abnormality on other cultures

:( People living outside of their culture of origin can be judged as abnormal by that societyā€™s norms

:( Some people are eccentric and act outside of social norms but do not have a mental disorder

:( Low temporal validity- social norms change over time e.g. homosexuality

Failure to Function Adequately

  • People with an inability to cope with the challenges of everyday life, e.g. maintaining personal hygiene
  • Maladaptive behaviour- irrational and unpredictable actions go against long term best interests
  • Show personal anguish and observers feel discomfort in their presence

:( Subjective- what is coping in the opinion of one observer could be different for another observer

:( Some people are abnormal but are able to function well in society

:( Not all maladaptive behaviour is an indication of mental illness, e.g. poor diet or smoking

Statistical Infrequency

  • Behaviour that is very rare
  • People that fall more than two standard deviations from the mean (bottom 2.5% and top 2.5%)

:) Most objective as it uses statistical measures

:( Some infrequent traits are desirable, e.g. high IQ

:( Many mental illnesses are common, like depression (1 in 6 adults)

Deviation from Ideal Mental Health

  • Defines features of ideal mental health, deviation from these indicates abnormality
  • Environmental mastery, autonomy, resisting stress, self-actualisation (constantly trying to improve and develop), positive self-attitude and accurate perception of reality

:) Holistic approach, helps identify areas for personal development

:) Patients can set clear goals for improvement

:( Cultural bias- many cultures do not value autonomy and personal success, focus instead on performing a social role

:( Criteria are unrealistic to have all at the same time, so most people would be defined as abnormal

:( Criteria are hard to measure objectively

The Behavioural Approach to Phobias

Characteristics

  • Emotional- high levels of fear and anxiety
  • Cognitive- irrational beliefs about phobic object, overstating potential dangers
  • Behavioural- avoidance of phobic stimulus, panic response and failure to function

Explaining

Learnt via experience- two-process model

Acquired through classical conditioning

  1. Bad event (UCS) = Fear (UCR)
  2. Bad event (UCS) + Phobic stimulus (NS) = Fear (UCR)
  3. Association
  4. Phobic stimulus (CS) = Fear (CR)

Maintained through operant conditioning

  • Negative reinforcement- avoiding phobic stimulus means no fear

Can also be learnt by observing models (SLT)

:) Little Albert- presented with a white rat (NS) and every time he touched it, they made a loud sound (UCS). He later started becoming distressed by the rat (CS), supports the first part of the two-process model

:) Study on people with fears of cars- 50% could recall a traumatic event, many hadnā€™t driven since, supports both parts of the two-process model

:( Study- only 2% of children with a fear of water could recall a traumatic experience with water

:( Common phobias (e.g. snakes) are understandable from an evolutionary perspective, suggesting an innate biological origin

Treating

  • Behavioural therapies counter-condition phobias, replacing the fear association with a calm one

Systematic Desensitisation

  1. Patient makes a fear hierarchy
  2. Patient is taught relaxation techniques
  3. Psychiatrist and patient work through the hierarchy while using relaxation techniques
  4. Gradually desensitised to stimulus
  • 90% effectiveness rate

:) Seen as more ethical, generally more successful as the client is in control

:( Slow and therefore expensive

Flooding

  • Immediate and full exposure to the maximum level of the phobic stimulus
  • Causes panic in the client and they may try to escape so the therapist must keep them in the situation
  • Eventually panic will stop due to exhaustion and the client will be calm and see there is no danger
  • Breaks (extinguishes) association between CS and CR
  • 65% effectiveness rate after 1 session (specific phobias)

:( Not suitable for vulnerable people (e.g. with heart conditions) and can result in reinforcing the phobia if ended too soon

:( Cannot be used on dangerous phobias like snakes

The Cognitive Approach to Depression

Characteristics

  • Emotional- low mood, loss of pleasure
  • Cognitive- irrational negative beliefs, difficulty concentrating
  • Behavioural- social withdrawal, change in sleep pattern, change in appetite
  • To be diagnosed, need 5 symptoms (at least 1 emotional) for more than 2 weeks
  • Manic depression- alternates between depressive episodes (period of low mood for at least a week) and manic episodes (period of high mood for at least a week)

Explaining

  • Irrational negative beliefs cause depression
  • Beckā€™s negative triad- events are seen with a negative bias due to development of negative schemas about the world, the self and the future
    • Negative cognitive bias- just paying attention to negative information
    • Result in selective perception, absolutist thinking, overgeneralisation and magnification of problems
    • :) Participants with major depression were slower when there were negative distractor words during a reaction time task- supports idea of negative cognitive bias
  • Ellisā€™ ABC model- challenges do not cause depression, the way the person responds to it does
    • A- activating event, B- belief about causes, C- consequence
    • Musturbatory thinking- belief that they must be perfect

:( Cannot explain manic depression, where people have phases of intense energy and confidence

:( Placing responsibility for depression on the patient can be seen as blaming them

:( Evidence of genetic factors- twin study, concordance rate was 46% for MZ and 20% for DZ

Treating

  • Cognitive behavioural therapy- a talking therapy that focuses on identifying and challenging irrational negative beliefs
  1. Identify negative beliefs
  2. Therapist challenges negative beliefs
  3. Patient is set homework to gather evidence to test their hypothesis
  4. Therapist and patient evaluate evidence together
  • Rational emotive behaviour therapy- adapts ABC model and adds D (disputation/challenge of irrational beliefs) leading to E (effective change)
    • Can be logical (do they make sense?) or empirical (is there any evidence?)

:) Study- meta-analysis of effectiveness of CBT across US, participants who received CBT showed significantly more improvement than those with no treatment

:) CBT is as successful as medication, both show an 81% effectiveness rate

:( Access to CBT is limited due to cost and time investment with trained therapists- anti-depressants are often used as a cheaper alternative

:( CBT is not effective for severely depressed clients as they will be unable to take part in the homework

The Biological Approach to OCD

Characteristics

  • Emotional- extreme anxiety caused by persistent obsessive thoughts, low mood due to impact on enjoyable activities
  • Cognitive- obsessions (recurring unpleasant thoughts) and an understanding of the irrationality of their catastrophic thinking
  • Behavioural- compulsions, avoidance of behaviour that causes obsessions and reduction in social interactions due to anxiety

Explaining

Genetic Explanation

  • Disorder is inherited
  • SERT gene
    • Controls serotonin available at synapse by producing re-uptake proteins- more proteins produced, less serotonin available in synapse
    • Short allele- produces less protein
    • Long allele- produces more protein
    • Less serotonin is available in the synapse and there is less inhibition of neural activity
    • Associated with OCD
  • Polygenetic- multiple genes contribute
    • As many as 230 individual genes have been identified
  • Concordance rates- 2% in general population, 10% in first degree relatives, as high as 87% in monozygotic twins

:) Study- 68% concordance rate with MZ twins, 31% with DZ

:( So many candidate genes, it is difficult to find a definitive genetic cause

:( Family and twin studies are flawed- living in a shared environment can affect development of some disorders, and MZ twins are more likely to have more shared environment

Neural Explanation

  • Orbitofrontal cortex- detects worrying stimuli and decides on action, then sends signals to movement centres
  • Basal ganglia- monitors outcome of actions and sends signals to orbitofrontal cortex to inhibit neural activity
  • With OCD, there is impaired communication between basal ganglia and orbitofrontal cortex
    • Neural activity in orbitofrontal cortex is less inhibited than it should be and becomes hyperactive
  • Basal ganglia uses serotonin to inhibit neural activity in orbitofrontal cortex, OCD could be due to a deficit of serotonin in orbitofrontal cortex

:) SSRIs are effective in treating OCD

:) Case study- girl developed OCD after brain damage, MRI scans showed structural damage to basal ganglia, could impair communication

:) Study- higher activity in orbitofrontal cortex of OCD participants than controls

:( Lack of understanding of which neural mechanisms are involved- incomplete explanation

:( Cause and effect relationship cannot be established- change in brain structures could be caused by OCD, or both could be caused by an unknown third factor

Treating

  • Drug therapies are chemical treatments that influence biological functioning
  • As low levels of serotonin are associated with obsessions and compulsions, SSRIs are prescribed, which keep serotonin in the synaptic cleft and makes it inhibit more, reducing hyperactivity in orbitofrontal cortex
  • If SSRIs are ineffective, other drugs like SNRIs are used which influence noradrenaline, but they have more intense side effects
  • Psychosurgery is used in extreme cases- cut the communication between the orbitofrontal cortex and other areas of the brain
    • Deep brain stimulation- placing electrodes in the brain to disrupt signalling
  • 70% success rate
  • Most effective if used with CBT

:) Cost-effective- cheap compared to CBT and less time-consuming

:( Relapse is 45% within 12 weeks, compared to just 12% for CBT

:( Side effects- many drugs can cause insomnia and nausea, leading to many patients ending treatment