AG

Causality, Etiology, and Causal Factors of Abnormal Behavior (Video Notes)

CAUSAL AND RISK FACTORS OF ABNORMAL BEHAVIOR

  • Topic: Causes and viewpoints in defining abnormal patterns of behavior; overview of etiological factors

ETIOLOGY

  • Etiology refers to the factors or causes responsible for or related to the development of disorders
  • Psychological etiology refers to the study and scientific investigation into the root causes of a psychological disorder so that it might be resolved
  • It explains the causes and causal patterns of abnormal behavior

CAUSES AND RISK FACTORS FOR ABNORMAL BEHAVIOR

  • Study of causes and risk factors for abnormal behavior
  • Includes:
    • Necessary, sufficient, and contributory causes
    • Feedback and bidirectionality in abnormal behavior
    • Diathesis-stress models
  • Source: PEARSON

NECESSARY, SUFFICIENT, AND CONTRIBUTORY CAUSES

  • Etiology: Causal pattern of abnormal behavior
  • Necessary cause:
    • A condition that must exist for a disorder to occur
    • Example: trisomy 21 must be present for developing Down syndrome
    • Severe stress must precede before developing PTSD
    • Most mental disorders do not have a necessary cause
  • Sufficient cause:
    • A condition that guarantees the occurrence of a disorder
    • Example: hopelessness is a sufficient cause of depression
  • Contributory cause:
    • Neither necessary nor sufficient, but contributes to development
    • If cause X occurs, the probability of Y increases
    • Example: parental rejection or abuse may increase probability of adjustment or relationship problems later in life

DISTAL CAUSAL FACTORS, PROXIMAL CAUSAL FACTORS, REINFORCING CONTRIBUTORY CAUSES

  • DISTAL CAUSAL FACTORS (operate on a different time frame):
    • Factors that occur relatively early in life but may not show their effect for many years
    • They contribute to development of a disorder
    • Example: parental loss or neglect in childhood contributing to depression in adolescence
  • PROXIMAL CAUSAL FACTORS:
    • Factors operating shortly before the onset of symptoms or disorder
    • Example: a crushing disappointment or sudden death of a loved one leading to sudden depression
  • REINFORCING CONTRIBUTORY CAUSES:
    • Maintain a maladaptive behavior already occurring
    • Example: over-attention and care from loved ones during a sick phase reinforce maintenance of symptoms (e.g., social withdrawal leading to continued withdrawal)

FEEDBACK AND BIDIRECTIONALITY OF ABNORMAL BEHAVIOR

  • Abnormal behavior follows a cause-and-effect relationship
  • The relationship is bidirectional:
    • Causal factors contribute to the development of the disorder (the effect)
    • The disorder or symptoms in turn influence or maintain the cause
  • Most disorders are caused by more than one cause, forming a causal pattern

EXAMPLE OF FEEDBACK AND BIDIRECTIONALITY

  • Divorce, job loss, etc. can lead to depression
  • Depression can affect sleep and lifestyle, causing insomnia, anhedonia, etc.
  • These effects can negatively affect lifestyle, reducing efforts to search for work or relationships, further perpetuating the cycle

DIATHESIS-STRESS MODEL

  • Diathesis: Predisposition or vulnerability toward developing a disorder (biological, psychological, and/or socio-cultural causal factors)
  • Stress: Response to demands perceived as exceeding personal resources
  • Mental disorders/addictions develop as a result of psychosocial stressors operating on a person with childhood trauma that developed into a diathesis for the disorder
  • Visual: Diathesis-stress interaction requires both vulnerability and stress to yield disorder risk
  • Illustration of factors contributing to vulnerability and stress
    • Genetic predisposition, childhood trauma, etc.

DIATHESIS-STRESS INTERACTION – TWO MODELS

  • Additive model:
    • Diathesis and stress sum together to develop a disorder
    • If there is no diathesis and severe stress, disorder can still develop if stress alone is sufficient
    • Notation: D + S
      ightarrow ext{Disorder} (conceptual)
  • Interactive model:
    • Some amount of diathesis must be present before stress will have an effect
    • If there is no diathesis, severe stress will not produce a disorder
    • Both diathesis and stress interact to contribute to development
    • Notation: D imes S
      ightarrow ext{Disorder} ext{ (requires interaction)}

CAUSAL FACTORS AND VIEWPOINTS OF ABNORMAL BEHAVIOR

  • Three broad viewpoints:
    • Biological viewpoints and causal factors
    • Psychological viewpoints and causal factors
    • Sociocultural viewpoints and causal factors

BIOLOGICAL VIEWPOINTS AND CAUSAL FACTORS

  • Mental disorders viewed as disorders of bodily systems (nervous and endocrine systems), inherited or due to organic pathology
  • Four main categories of biological factors:
    • Neurotransmitter and hormonal imbalances in brain and CNS
    • Genetic vulnerabilities
    • Temperament
    • Brain dysfunction and neural plasticity

NEUROTRANSMITTER AND HORMONAL IMBALANCES IN THE BRAIN AND CNS

  • Neurotransmitters: chemical substances released in response to nerve impulses at synapses; can excite or inhibit post-synaptic neurons
  • Imbalances can lead to mental disorders via:
    • Excessive production/release in the synapse (functional excess)
    • Dysfunction in deactivation (reuptake/degradation) of used neurotransmitters
    • Abnormal receptor sensitivity of post-synaptic neurons
  • Example: depression linked to serotonin (5-HT) dysregulation; SSRIs increase serotonin availability by blocking reuptake

NEUROTRANSMITTERS

  • Five major neurotransmitters involved in psychopathology:
    • Norepinephrine: emergency/stress reactions; attention, concentration, orientation, basic motives; role in stress/anxiety disorders
    • Dopamine: pleasure; cognitive processing; roles in schizophrenia, depression, addictive disorders
    • Serotonin: thinking/information processing; affective disorders (depression, suicide, anxiety)
    • Glutamate: excitatory neurotransmitter involved in many symptoms
    • GABA: inhibitory neurotransmitter involved in regulation of anxiety and arousal
  • Note: these form a chemical circuit for normal brain functioning; imbalances contribute to disorders
  • Example: depression linked to decreased serotonin function; medications that block serotonin reuptake sustain serotonin in the synapse

HORMONES

  • Three important axes in psychopathology:
    • HPA axis (Hypothalamic-Pituitary-Adrenal axis)
    • HPG axis (Hypothalamic-Pituitary-Gonadal axis)
    • HPT axis (Hypothalamic-Pituitary-Thyroid axis)
  • HPA axis details:
    • In stress, the hypothalamus releases CRH (corticotropin-releasing hormone)
    • CRH activates the pituitary to release ACTH (adrenocorticotropic hormone)
    • ACTH activates the adrenal cortex to produce adrenaline and cortisol (stress hormones)
    • Cortisol provides negative feedback to hypothalamus to terminate the response
    • Abnormal negative feedback → excessive cortisol/epinephrine → anxiety, depression, stress disorders
  • Neuroendocrine context: nervous and endocrine systems are closely connected
  • Pituitary gland is the master gland; regulated by hypothalamus

HPA AXIS DIAGRAM (ABBREVIATED)

  • Hypothalamus → CRH → Anterior Pituitary → ACTH → Adrenal Cortex → Cortisol
  • Cortisol provides negative feedback to hypothalamus

HPG AXIS (HYPOTHALAMIC-PITUITARY-GONADAL)

  • Imbalances in sex hormones can lead to maladaptive sexual behaviors and other problems
  • Pathway: Hypothalamus → GnRH → Pituitary → LH/FSH → Testis/Ovary → Testosterone/Estrogen/Progesterone

HPT AXIS (HYPOTHALAMIC-PITUITARY-THYROID)

  • Imbalances in thyroid hormones associated with depression, anxiety, stress, and adjustment problems

GENETIC VULNERABILITIES

  • Most mental disorders show at least some genetic influence
  • Inheritance occurs via genes on chromosomes; humans have 23 pairs (22 autosomes + 1 pair of sex chromosomes)
  • Abnormalities in chromosome structure/number can lead to disorders (e.g., trisomy 21 – Down syndrome)
  • Most disorders have a polygenic effect (influenced by additive/interactive action of multiple genes)
  • Polymorphisms: naturally occurring variations in genes
  • Genetically vulnerable individuals often carry many inherited abnormalities/polymorphic genes interacting to affect nervous and endocrine systems

GENETIC VULNERABILITIES (CONTINUED) – DIATHESIS-STRESS INTERACTION

  • Genetic factors contribute to vulnerability (diathesis), which combines with significant life stress to produce a disorder
  • Example: genetic risk for depression plus severe stress → depression
  • Genotype vs. phenotype:
    • Genotype: total genetic endowment
    • Phenotype: observed characteristics/results from genotype × environment interaction

GENETIC VULNERABILITIES – TYPES OF GENETIC EFFECTS

  • A child’s genotype can have three types of effects:
    • Passive effect: genotype influences environment (e.g., intelligent parents provide stimulating environment)
    • Evocative effect: a child’s genotype evokes reactions from others (e.g., a happy baby gets more positive responses)
    • Active effects: genotype shapes the environment (e.g., extroverted child seeks many friends)
  • Concept: genotype–environment correlations

METHODS OF STUDYING GENETIC INFLUENCES

  • Behaviour genetics focuses on heritability of mental disorders and behaviors
  • Methods used:
    1) Family history / pedigree method: examine relatives of proband to estimate incidence vs general population
    2) Twin method: compare monozygotic vs dizygotic twins; concordance rates; twins raised apart vs together
    3) Adoption methods: compare biological parents of adopted children with and without disorders
  • Linkage analysis and Association studies:
    • Linkage analysis looks for co-segregation of disorders with known genetic markers
    • Example findings: bipolar disorder linked to chromosome 2
    • Schizophrenia linked to chromosomes 22, 6, 8, and 1
    • Association studies compare large groups with and without disorders to find links between markers and disorders

BRAIN DYSFUNCTION AND NEURAL PLASTICITY

  • Specific brain lesions and neural tissue damage can cause mental disorders; studied via neuroimaging/neuroimaging techniques
  • Neural plasticity: brain’s ability to modify structure/function in response to pre-/post-natal experiences, stress, diet, disease, drugs, maturation
  • Neural circuits can be modified or new circuits generated (beneficial or detrimental)
  • Positive prenatal experience example: enriched environment for pregnant rats yielded offspring less negatively affected by brain injuries
  • Negative prenatal exposure: loud sounds to pregnant monkeys → offspring with neurochemical abnormalities
  • Post-natal: formation of new neural connections influenced by experiences; enriched environments lead to thicker brains and more synaptic connections in offspring
  • Plasticity is lifelong and relevant to humans

DEVELOPMENTAL SYSTEM APPROACH (A SYSTEMS VIEW OF PSYCHOLOGICAL DEVELOPMENT)

  • Gene activity influences neural activity, which influences behavior, which influences environment (bidirectional loop)
  • Environment influences behavior, which alters neural activity and gene expression (suppress or exaggerate)

TEMPERAMENT

  • Temperament: child’s characteristic reactivity and self-regulation; strongly influenced by genetics and early experiences
  • Early temperament (2–3 months) largely inherited; five dimensions:
    • Fearfulness, irritability/frustration
    • Positive affect / happiness
    • Activity level (high/low)
    • Attentional persistence
    • Effortful control
  • Adult personality dimensions related to temperament:
    • Neuroticism / negative emotionality
    • Extraversion / positive emotionality
    • Constraint (conscientiousness and agreeableness)
  • Relationship to adult psychopathology:
    • Behaviourally inhibited children: fearful, shy, hypervigilant; higher risk for anxiety/depression
    • Behaviourally uninhibited children: fearless/extroverted; higher risk for conduct problems and later antisocial personality disorder

PSYCHOLOGICAL VIEWPOINTS AND CAUSAL FACTORS

  • Main psychological perspectives:
    • Psychodynamic perspectives
    • Behavioural perspectives
    • Cognitive-behavioural perspectives
    • Humanistic-existential perspectives

PSYCHOLOGICAL VIEWPOINTS

  • PSYCHODYNAMIC PERSPECTIVE (Freud):
    • Unconscious repressed material drives psychopathology; manifests in fantasies, dreams, slips of tongue, maladaptive behaviors
    • Intrapsychic conflict among id, ego, and superego creates anxiety and influences abnormal behavior
    • Types of anxiety: reality/ objective anxiety (conscious; dealt with by ego); neurotic and moral anxiety (unconscious; ego uses defense mechanisms)

FREUD'S PERSONALITY STRUCTURE

  • Id (unconscious): pleasure-seeking principle
  • Ego (executive mediator): reality principle; mediates id and reality
  • Superego (internalized ideals): moral conscience; develops around age 4-5 years
  • Dynamic: intrapsychic conflict among Id, Ego, Superego leads to anxiety; defense mechanisms operate to reduce anxiety

TYPES OF DEFENSE MECHANISMS

  • Common defenses (from Table 8.1 and related content):
    • Repression, Denial, Projection, Displacement, Rationalization, Reaction formation, Sublimation, Regression, Introjection, Acting out, Hypochondriasis, Somatization, Intellectualization, etc.
  • Descriptions and examples (selected):
    • Repression: unconsciously placing unpleasant memories into the unconscious; e.g., not remembering a traumatic incident
    • Denial: refusing to acknowledge reality
    • Projection: attributing one’s unacceptable feelings to others
    • Regression: reverting to earlier developmental stage behavior
    • Displacement: redirecting unacceptable impulses toward safer targets
    • Sublimation: channeling unacceptable drives into socially acceptable actions (e.g., aggression into sports)
    • Rationalization: creating false excuses for unacceptable thoughts/behaviors
    • Reaction formation: behaving opposite to unacceptable impulses
    • Introjection: internalizing someone else’s characteristics
  • Note: list includes additional defenses such as acting out, somatization, etc.

PSYCHOSEXUAL STAGES

  • Stage, age range, task, and potential problematic traits:
    • Oral: Birth to 18 months; trust, oral gratification
    • Problems: excessive dependency, envy, jealousy, narcissism, pessimism
    • Anal: 18 months to 3 years; independence and control
    • Problems: orderliness, obstinacy, frugality, ambivalence, defiance
    • Phallic/Oedipal: 3 to 6 years; identify with same-sex parent, sexual identity development
    • Problems: sexual identity issues, castration anxiety, penis envy
    • Latency: 6 to 12 years; sublimated sexuality, emphasis on same-sex peers
    • Problems: excessive guilt, inability to sublimate energies
    • Genital: 13 to 20 years; mature relationships
    • Problems: unresolved previous issues, dependency on parents
  • Source: Adapted from Kaplan & Sadock (2004)

NEWER PSYCHODYNAMIC PERSPECTIVES

  • EGO PSYCHOLOGY (Anna Freud):
    • Focus on ego functioning and defense mechanisms; pathology when ego cannot regulate delayed gratification or lack of adequate defenses
  • OBJECT RELATIONS THEORY (Klein, Mahler, Fairburn et al.):
    • Objects are symbolic representations of others in environment (e.g., parent)
    • Focus on internalized relationships with real and imagined objects
    • Introjection: internalizing attributes of objects into one’s own personality

NEWER PSYCHODYNAMIC PERSPECTIVE – CONTINUED

  • OBJECT RELATIONS THEORY – CONTINUED
    • Internalization of a punishing father can create harsh/self-critical personality traits later
    • Splitting among internalized objects can lead to a disintegrated abnormal life
    • Kernberg: borderline personality disorder linked to failure to integrate internalized objects

INTERPERSONAL PERSPECTIVE

  • Focus on social determinants of behavior and relationships; defects lead to psychopathology
  • Alfred Adler: social beings driven by belonging; blocked needs lead to maladaptive behavior
  • Karen Horney: psychopathology from insecure attachment in childhood, leading to neurotic anxiety and maladaptive traits
  • Erikson: life-span stage theory; stage conflicts can cause psychopathology if unresolved
  • John Bowlby: early attachment relationships influence later personality development

BEHAVIOURAL PERSPECTIVE

  • Reaction against psychoanalysis; emphasis on observable behavior; learning as central theme
  • Most behaviors (normal and abnormal) are learned and can be unlearned via learning principles
  • John Watson: founder of behaviorism

MUST: BEHAVIOURIST APPROACH (CLASSICAL, OPERANT, SOCIAL LEARNING)

  • Classical Conditioning: association between a stimulus and a response (Pavlov, 1927)
  • Operant Conditioning: learning via reinforcement (positive/negative) (Skinner, 1938/1974)
  • Social Learning Theory: learning via observation and imitation of others; models rewarded or punished (Bandura, 1965)

BEHAVIOURAL APPROACH TO PSYCHOPATHOLOGY (APPLICATIONS)

  • Phobias: fear acquired through stimulus-response association (e.g., fear of flying from airport cue and bodily symptoms)
  • Anxiety and attention from others can reinforce avoidance or anxious behaviors
  • Eating disorders: avoidance of negative emotions associated with eating; reinforcement patterns
  • Aggression: imitation of role models who are rewarded (observational learning)

BEHAVIOURISM: CLASSICAL CONDITIONING EXAMPLE

  • Before conditioning: UCS = loud noise; NS = white rat; UCR = fear/crying; No fear response to NS
  • During conditioning: UCS + NS paired
  • After conditioning: CS (white rat) elicits fear/crying (CR); example shows how phobias develop

COGNITIVE BEHAVIOURAL PERSPECTIVE

  • Key assumptions:
    • Distorted/irrational thinking styles contribute to maladaptive behavior
    • It is often how problems are interpreted, not the objective problem itself, that causes distress
    • People can change by adopting more adaptive cognitions; thoughts influence feelings and behaviors
  • Cognitive Triad (Beck):
    • Negative views about the world
    • Negative views about the future
    • Negative views about oneself
  • Automatic thoughts and cognitive schemas play central roles

ATTRIBUTION THEORY

  • What causes behavior? Based on perception of internal vs. external causes
  • Internal attribution (dispositional): caused by person’s characteristics
  • External attribution (situational): caused by environment
  • Implications for understanding and treating disorders

PSYCHOLOGICAL CAUSAL FACTORS

  • Factors that make people vulnerable to disorders; interact with genetic and environmental factors
  • Categories (four major):
    1) Early deprivation or trauma
    2) Inadequate parenting styles
    3) Marital discord and divorce
    4) Maladaptive peer relationships

PSYCHOLOGICAL CAUSAL FACTORS – 1. EARLY DEPRIVATION AND TRAUMA

  • Insufficient resources (food, shelter, love) lead to deprivation and long-term issues
  • Institutionalization: abandonment, lack of warmth/physical contact, reduced intellectual, emotional, and social development
  • Parental deprivation: lack of warmth/care; can cause trust issues or other developmental problems
  • Theoretical positions on early deprivation/trauma:
    • Freud: oral-stage fixation
    • Erickson: impaired basic trust development
    • Skinner: reduced social reinforcement
    • Beck: dysfunctional relationship schemas
  • Disturbed attachment and psychopathology; delayed maturation and skill development
  • Neglect and abuse at home: physical neglect, lack of affection, lack of parental involvement

PSYCHOLOGICAL CAUSAL FACTORS – 1. EARLY DEPRIVATION AND TRAUMA (CONTINUED)

  • Parental abuse: physical, emotional, sexual abuse
    • Effects: aggression, bullying, disorganized attachment; language/communication difficulties; depression, anxiety, relational problems, substance use
  • Separation: prolonged separation leads to despair, insecurity, stress vulnerability, anxiety; detachment at reunions

PSYCHOLOGICAL CAUSAL FACTORS – 2. INADEQUATE PARENTING STYLES

  • Bidirectional parent-child relationship; parental psychopathology increases risk for children
  • Parenting styles and warmth/control dimensions
  • Four parenting styles:
    • AUTHORITATIVE: high warmth, moderate control; associated with positive development, secure attachment, resilience, good school performance, fewer disorders
    • AUTHORITARIAN: low warmth, high control; associated with conflict, irritability, moodiness; higher risk of delinquency in adolescence
    • PERMISSIVE/INDULGENT: high warmth, low control; children impulsive, aggressive, demanding; higher antisocial behavior in adolescence
    • NEGLECTFUL/UNINVOLVED: low warmth and low control; disruptive attachment, low self-esteem, anxiety, interpersonal problems
  • Parental psychopathology and parenting styles interplay with child outcomes

PSYCHOLOGICAL CAUSAL FACTORS – 3. MARITAL DISCORD AND DIVORCE

  • Disturbed family structures increase vulnerability to disorders
  • MARITAL DISCORD: conflict, hurt, aggression toward child/partner; negative impacts on children’s development
  • DOMESTIC VIOLENCE: physical, emotional, sexual, or financial abuse; major contributor to mental health problems
  • DIVORCED FAMILIES: high prevalence in many societies; can have detrimental effects on children but may be necessary in highly stressful/abusive marriages
  • Effects on children: insecurity, divided loyalties, overindulgence of one parent, delinquency, anxiety, depression, maladaptive behaviors, step-parent abuse, later relationship issues

PSYCHOLOGICAL CAUSAL FACTORS – 4. MALADAPTIVE PEER RELATIONSHIPS

  • Peers influence especially in preschool and adolescence
  • Bullying leads to severe stress and aggression; cyberbullying causes anxiety, school phobia, low self-esteem, suicidal ideation
  • Popularity vs rejection:
    • Prosocial peers: cooperative and constructive behavior
    • Antisocial peers: aggressive and defiant; often boys
  • Rejected children: two types
    • Aggressive/rejecting: hostile, punitive; poor understanding of peers’ emotions
    • Withdrawn/rejected: unassertive; targets of bullying
  • Consequences: negative outcomes such as dropout, delinquency, anxiety, depression, suicidality

SOCIO-CULTURAL VIEWPOINTS

  • Explore relationships between socio-cultural factors and mental disorders
  • CULTURE-SPECIFIC VS UNIVERSAL SYMPTOMS/DISORDERS
  • Some disorders distribute differently across cultures (e.g., schizophrenia course in developing vs. developed countries; depression prevalence varies with social support)
  • CULTURE AND BEHAVIORAL CONTROL:
    • Undercontrolled behaviors: aggression, disobedience, disrespect
    • Overcontrolled behaviors: shyness, anxiety, depression
    • Cultural variation: Thailand tends to discipline undercontrolled behavior less; U.S. shows more undercontrolled problems; Thai culture may exhibit more overcontrolled problems

CULTURE-SPECIFIC SYNDROMES (EXAMPLES)

  • Amok (Malaysia): dissociative episode with brooding followed by violent outburst
  • Arctic Hysteria (Arctic regions): abrupt dissociative episodes with extreme excitement and often seizures/coma
  • Ataque de Nervios (Latin America): sudden emotional upheaval with crying, trembling, heat, aggression
  • Brain Fag (West Africa): difficulties concentrating, remembering, thinking
  • Koro (Malaysia): anxiety about irreversible shrinkage or disappearance of genitalia
  • Mal de Ojo (Evil Eye): beliefs about misfortune and social disruption
  • Windigo (Native North American culture): fear of becoming cannibal and other associated symptoms
  • Source: Glossary of Culture-Bound Syndromes (2001)

SOCIO-CULTURAL CAUSAL FACTORS

  • LOW SOCIOECONOMIC STATUS (SES) & UNEMPLOYMENT
    • Lower SES associated with higher incidence of various disorders; antisocial personality disorders more common in low SES; depressive disorders more common in low SES
    • Reasons: prejudice/stigma, barriers to treatment, poverty as chronic stress
    • Poverty correlates with lower early IQ in children up to age 5; some higher-SES individuals may deteriorate due to maladaptive behaviors
  • UNEMPLOYMENT
    • Economic recessions increase unemployment; financial hardship and uncertainty elevate emotional distress and vulnerability to psychopathology
    • Common problems: depression, marital problems, somatic complaints, anxiety
  • PREJUDICE & DISCRIMINATION (RACE, GENDER, ETHNICITY)
    • Demoralizing stereotypes in employment/education/housing
    • Minority groups face prejudice/discrimination, reducing self-esteem and increasing depression risk
  • DISCRIMINATION AGAINST WOMEN
    • In work: access discrimination (hiring) and treatment discrimination (lower pay, fewer opportunities)
    • Sexual harassment; multiple social roles (mother, homemaker, employee) increase stress and risk of anxiety, depression, marital dissatisfaction
  • SOCIAL CHANGE AND UNCERTAINTY
    • Wars, terrorist attacks, unemployment create stress and psychological issues
    • Migration and displacement associated with poor mental health
    • Examples: post-9/11 anxiety; Israeli-Palestinian conflict effects
  • URBAN STRESSORS: VIOLENCE AND HOMELESSNESS
    • Rapid urban growth leads to unemployment, poverty, illicit activities
    • Urban violence and domestic violence elevate anxiety, depression, PTSD, somatic illnesses
    • Homelessness contributes to insecurity and poor mental health
  • Note: These socio-cultural factors influence mental health in both developed and developing contexts