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UOW PSYC251: Psychopathology Lecture Notes

Subject Overview

  • Instructor: Mala Khare

Today's Agenda

  • Subject Introduction: What do we mean by psychopathology?

  • Models of Clinical Psychology

  • Consultation: 6-6:30 PM

Prescribed Major Text

  • Primary Textbook:
      - Hooley, J.M., Butcher, J.N., Nock, M.K., & Mineka, S. (2017). Abnormal Psychology (17th Ed). London: Pearson Education Limited.

  • Recommended Readings: Refer to the Subject Outline

Understanding Psychopathology

  • Definition: Psychopathology is the scientific study of psychological disorders, traditionally termed abnormal psychology, which examines mental disorders and unusual or maladaptive behaviors.
      - Includes aspects such as symptoms, causes, course, development, treatments, strategies, etc.

What Constitutes Abnormal?

  • Lay Person’s View: Abnormality may be defined via cultural or social norm violations.

  • Cultural Relativism: Norms vary across societies; what is abnormal in one may be viewed as a strength in another.

  • Temporal Relativism: Norms can change over time; examples include homosexuality and premarital sex.

  • Situational Relativism: Norms can adjust to specific contexts (e.g., shouting at a music concert).

Abnormal Behavior vs. Mental Disorder

  • Abnormal behavior does not equate to mental disorder.
      - Mental disorders involve abnormal behavior, but not all abnormal behavior indicates a mental disorder.
      - Abnormal behavior often reflects mental illness (e.g., avoidance in phobia), emphasizing that behavior is observable, yet mental disorders encompass more than behavior alone.

Defining Abnormality

  • Complex Concept: The term "abnormal" signifies deviation from norms, which differ across populations and can change with time and conditions.

  • Awareness of Abnormality: Individuals may or may not recognize their abnormality; some may feel distress while others may not.

Myths Associated with Mental Illness

  • Individuals with mental illness are weak (e.g., Abraham Lincoln and Winston Churchill dealt with depression).

  • The misconception that individuals can simply "snap out of it."

  • Creative individuals are often viewed as “a little crazy.”

  • Dangerousness associated with mental disorders.

  • Misconceptions about the elderly being senile.

  • Asthma being attributed to emotional problems.

  • Myths surrounding suicidal individuals rarely discussing their intent.

  • The notion that criminals are inherently ``bad."

Psychopathology Defined

  • A branch of psychology focused on examining unusual patterns of behavior, emotion, and thought.
      - This definition is complex and context-dependent, and relates to the potential development of psychological disorders.

Interests in Psychopathology

  • Key Areas of Interest:
      1. Development (causes/aetiology)
          - Biological, Psychological, Social factors
      2. Characteristics/Symptoms
      3. Diagnostic Criteria
      4. Prevalence among different populations
      5. Comorbidity
      6. Motivating and maintaining factors
      7. The lived experience of mental illness

Assessment in Psychopathology

  • Purpose: Measurement of severity, symptoms, and features.

  • Techniques:
      - Mini Mental State Exam
      - Beck Depression Inventory

  • Treatment Types:
      - Psychological therapies (Cognitive behavior therapy, Systemic family therapy, Dialectic behavior therapy, Interpersonal psychotherapy).   - Pharmacological methods.

Terminology in Mental Health

  • Preferred Terms: Psychological disorder or psychological abnormality is preferred over the term mental illness.

Defining Abnormal Behavior

  • DSM V Definition:
      - “Behavioral, emotional or cognitive dysfunctions that are unexpected in their cultural context and associated with personal distress or substantial impairment in functioning.”
      - “Behavior that departs from the norm and that harms the affected individual or others” (Sue, Sue & Sue, 2003).

Criteria for Defining Abnormal Behavior

  1. Psychological Dysfunction:
       - Impairment in cognitive, emotional, or behavioral functioning.    - “Dysfunction” can be difficult to define; sometimes “abnormal” behavior can be adaptive (e.g., avoiding situations due to phobia).
       - Impairments may not always be obvious (e.g., Narcissistic Personality Disorder).
       - Impairment is a dimensional concept; it is not merely all or nothing.

  2. Personal Distress:
       - Some individuals exhibit severe distress while others (e.g. Charles Manson) show none.

  3. Atypical or Unexpected Cultural Response:
       - Norms are not stable; examples include historical perspectives on homosexuality.

  4. Dangerousness:
       - Most individuals with mental disorders are not harmful to others, though some (e.g., ASPD) may be dangerous to themselves (risk of suicide, impulsivity).

The Boundary Between Normal and Abnormal Behavior

  • Difficulty arises in determining levels of depression or anxiety that constitute abnormality, lacking a definitive standard.

Assessing the Level of Disturbance

  1. Bizarreness: How extreme is the behavior?

  2. Duration: How long have symptoms persisted? (1 month? 6 months? Years?)

  3. Social Functioning: Impact on social functioning (e.g., ability to leave home, maintain employment).

Continuum of Symptomology

  • Symptoms exist on a continuum that reflects two perspectives:
      - Individual perspective: Distress and dysfunction.
      - Cultural perspective: Deviance from cultural norms and potential threat to society.

Clinical Description of Abnormal Behavior

  • Presenting Problem: The initial reason a client seeks clinical assistance; functions to differentiate a disorder from normal behavior and other disorders.

Case Study: Jenny

  • Background: 18-year-old Jenny presents with emotional distress due to her boyfriend’s infidelity.
      - She exhibits signs of sadness, conflict, and confusion during the interview process.

  • Presenting Problems:
      1. Psychological distress from her boyfriend's betrayal.
      2. Conflicted feelings regarding her family of origin.

Prevalence and Incidence

  • Prevalence: Refers to the total number of individuals within a certain population exhibiting a disorder (e.g., depression in Singapore - 9%).

  • Incidence: The number of new cases occurring in a specific period (e.g., annually).

  • Course: Patterns of disorders can be termed chronic, episodic, or time-limited.   - Acute Onset: Disorders that appear suddenly.
      - Insidious Onset: Disorders that develop gradually.

Etiology of Psychopathology

  • Factors contributing to psychological disorders include biological, psychological, and social dimensions.

  • Treatment may involve psychological, pharmacological, or a combination.

Case Study: Gina

  • Background: 20-year-old Gina exhibits rebellious behavior and familial conflicts. She has a history of therapy visits.

  • Presenting Problems:
      - Anger towards parents and threats of violent behavior.

  • Clinical Interview: Explores Gina's perceptions of her parents' actions and her feelings about unmet expectations from them.

Assessing Psychological Disorders

  • Goal: Identify and measure factors influencing cognitive, emotional, and behavioral aspects involved in psychopathology.

  • Clinical Assessment: A systematic evaluation encompassing psychological, biological, and social factors for individuals with potential psychological disorders.

Psychological Assessment Techniques

  • Techniques include:
      a. Clinical interview
      b. Mental Status Exam (MSE)
      c. Physical examination
      d. Behavioral observation
      e. Psychological tests (e.g., Rorschach, Beck Depression Inventory)

Mental Status Exam (MSE)

  • Systematic observation focusing on:
      1. Appearance and behavior
      2. Mood and affect
      3. Thought processes
      4. Intellectual functioning
      5. Sensorium

Diagnosis of Mental Disorders

  • Diagnosis is a shorthand reference for co-occurring behaviors and beliefs.
      - Implication for Families: Diagnosis can provide relief to families like Gina's by defining the condition, which can combat feelings of isolation.

Classification Systems for Psychological Disorders

  • ICD-10: International Classification of Diseases published by WHO.

  • DSM-5: Diagnostic and Statistical Manual of Mental Disorders published by the APA.

Functions of the DSM Classification System

  1. Provides diagnostic criteria for mental disorders.

  2. Assists with effective treatment selection.

  3. Offers administrative support for medical aids and legal systems.

  4. Serves as clinical shorthand for professional communication.

  5. Provides prognostic information.

Reliability of Diagnoses

  • Reliability is gauged by inter-clinician agreement, represented by Kappa values.
      - Examples:
        - Major Depressive Disorder: Kappa = 0.32
        - Generalized Anxiety Disorder: Kappa = 0.20
      - A Kappa value below 0.2 indicates poor reliability.

Cultural Considerations in Diagnosis

  • Validity of diagnoses can be affected in varying cultural contexts; culture influences how disorders manifest.
      - Examples include somatic expressions in depression and cultural syndromes (e.g., dhat in India).

Negative Effects of Diagnosis

  • Labeling can lead to stigmatization and may cause individuals to identify with their labels, potentially reinforcing negative behaviors.

  • Such classifications may serve as instruments of social control, giving mental health professionals authority over individuals’ lives.

Case Study Reflection

  • The case of Gina raises questions about her diagnosis and the potential stigma attached to labels, reinforcing the idea that diagnoses can have broader social implications.

Clinical Assessment Context in Singapore

  • Cultural nuances such as the term “stress” often describing anxiety and depression, use of traditional healers, and the phenomenon of somatization.

Formulation in Therapeutic Context

  • Diagnosis alone is insufficient; understanding the issue's underlying causes and maintaining factors is crucial for effective intervention.

  • Four P Formulation Format:
      - Predisposing Factors: Vulnerabilities leading to problems.
      - Precipitating Factors: Events triggering the problem.
      - Perpetuating Factors: Ongoing issues that sustain the problem.
      - Protective Factors: Strengths and supports aiding recovery.

Case Study: Katie

  • Background: Katie, who recent gave birth, experiences panic attacks, which signify anxiety.

  • Diagnosis: Panic attack characterized by intense fear or discomfort.

  • Factors:
      - Predisposing Factors: Anxious temperament influenced by her mother's behavior.
      - Precipitating Factors: Stressors of motherhood and relational reminders from her own upbringing.   - Perpetuating Factors: Avoidance behaviors and cognitive distortions (e.g., catastrophic thinking).

Panic Attack Cycle

  • Physical Sensations: Sweaty palms, racing heart, etc.

  • Interpretations: Misinterpretation leads to panic and terror.

Protective Factors in Katie's Case

  • Acceptance of her situation, early detection of her issues, and commitment to treatment.

Models of Clinical Psychology

  • The quest for understanding psychological illness and effective treatment methods has generated various approaches and models to interpret abnormal behavior.

Historical Conceptions of Abnormal Behavior

  • Psychological disorders have been observed across cultures and time periods.

  • Conceptualizations of causes and treatments vary significantly depending on era and culture.

Major Historical Traditions

  1. Supernatural Tradition

  2. Biological Tradition: Mental disorders viewed as diseases, with medications becoming the norm since the 1950s.

  3. Psychological Tradition: Explores behaviors and thoughts through various models.

The Biological Tradition

  • Dominant in contemporary psychiatry, viewing mental disorders as rooted in genetics and brain abnormalities.

  • Genetic Contribution: Less than 50%, varies per disorder, and interactions create complexities in attributing behavior solely to biology.

Financial Incentives in Psychiatry

  • Financial incentives may prioritize biological explanations and drug treatments over psychotherapy, prompting alternative psychological models to emerge.

Modern Psychological Models

  1. Psychoanalytic Theory: Freud’s approach, emphasizing unconscious processes.

  2. Humanistic Theory: Rogers’ concepts of self-actualization and client-centered therapy.

  3. Behavioral Model: Focused on learning through behavior therapy techniques.

  4. Cognitive-Behavioral Therapy: Incorporates cognitive techniques into behavioral therapy.

  5. Systems Theory: Family-centered therapeutic approaches.

Interaction of Genetics and Environment

  • Diathesis-Stress Model: Genetic predispositions may require less stress to trigger disorders.

  • Reciprocal Gene-Environment Model: Individuals may create environments that heighten vulnerabilities.

Environmental Influence on Genetics

  • Environmental factors can alter genetic expressions and influence brain function, illustrating the interplay between genetics and lived experience.

Impact of Social Factors

  • Socio-cultural influences (race, gender, religion, etc.) and biological factors (genetics, brain structure, etc.) impact mental health and disorders.

Conclusion

  • Multiple Causation: Recognized as a key principle in understanding mental and abnormal behavior.

  • Encourages a broad and comprehensive perspective acknowledging varied influences on psychological conditions and treatments.