PSYCHOPATHOLOGY
5.1 DEFINITIONS OF ABNORMALITY
Statistical infrequency
occurs when an individual has a less common characteristic
For example having a high IQ
Evaluation
real world application — used in clinical practice as a part of formal diagnosis and as a way to assess the severity of symptoms. An example of this is Becks depression inventory (BDI), a score of 30+ shows severe depression. So can be used to diagnose and assess
Does not apply to all abnormalities. There are some ‘abnormalities’ that are desirable, such as high IQ. Also some mental disorders such as depression or anxiety are statistically common so would not be identified as ‘abnormal’
It can help people receive help/ support, for example those with low IQ. However some with low IQ may not benefit from this label as there is a social stigma attached that may negatively impact them and their lives.
Deviation from social norms
behaviour that is different from the accepted standards of behaviour in a community or society
Norms are specific to the culture we live in
For example a person with antisocial personality disorder is impulsive, aggressive and irresponsible
Evaluation
real world application — used in clinical practice to identify and diagnose disorders such as schizotypal personality disorder
Cultural relativism — it does not have cross cultural validity, for example hearing voices is seen as normal is some cultures and abnormal in others.
Can leave people open to human right abuses. Defining people as abnormal can lead to unfair labels, for example black slaves being diagnosed with drapetomania (black slaves running away) as a way to control slaves and avoid debate
Failure to function adequately
occurs when someone is unable to cope with ordinary demands of day to day life
Rosenhan and seligman proposed signs: when a person no longer conforms to standard interpersonal rules (eye contact), when a person experiences severe personal distress, when a persons behaviour becomes irrational or dangerous to themselves or others
For example depression or having a low IQ
Evaluation
represents a threshold for help — this allows people to recognise they cannot function so they seek professional help or are noticed and referred help by otehrs. So treatment and services can be received
Discrimination and social control — some may choice to deviate from a typical lifestyle. So they are at risk of being labelled as abnormal and their freedom of choice may be restricted
May not be abnormal — there are circumstances in which most of us fail to cope for a time e.g bereavement. So it would be unfair to label someone as abnormal just because they react to difficult circumstances
Deviation from ideal mental health
occurs when someone does not meet a set of criteria for good mental health
What does ideal mental health look like — Jahoda suggested the following criteria
We have no symptoms of distress
We are rational and can perceive ourselves accurately
We self actualise
We can cope with stress
We have a realistic view of the world
We have good self esteem and lack guilt
We are independent
We can successfully work, love and leisure
Evaluation
a comprehensive definition — provides a checklist against which we can assess ourselves and others, and discuss psychological issues with a range of professionals as its very broad
May be culture bound — in collectivist cultures being independent is seen as negative so cannot be applied from one culture to another
Extremely high standards — jahodas criteria is nearly impossible for people to achieve
5.2 PHOBIAS
Phobia = an irrational fear of an object or situation
Behavioural = ways in which people act
Emotional = related to a persons feelings or mood
Cognitive = refers to the process of ‘knowing’, includes thinking, reasoning, remembering, believing
DSM-5 categories of phobia
all phobias are characterised by excessive fear and anxiety, triggered by a certain stimuli. The extent of the fear is out of proportions to any real danger.
Specific phobia - phobia of an object or situation
Social phobia - phobia of a social situation
Agoraphobia - phobia of being outside or in public places
Behavioural characteristics of phobias
panic - this may involve crying, screaming or running away. But for some it may include freezing, clinging or having a tantrum
Avoidance - they put in effort to prevent coming into contact with the phobic stimulus
Endurance - when the person chooses to remain in the presence of the phobic stimulus, and their concentration is primarily focused on the stimulus
Emotional characteristics
anxiety - an unpleasant state of high arousal that prevents a person from relaxing or experiences positive emotion. More long term
Fear - the immediate and unpleasant response we experience when we encounter a phobic stimulus. More short term
These emotional responses are disproportionate to any threat posed
Cognitive characteristics
selective attention - keeping ‘an eye’ on the threat and being unable to concentrate on anything else
Irrational beliefs - the person may hold unfounded beliefs that can’t be explained and don’t have any basis in reality
Cognitive distortions - the perceptions of the phobic stimulus are inaccurate and unrealistic
5.3 DEPRESSION
Depression = a mental disorder characterised by low mood and low energy levels
DSM-5 categories of depression
major depressive disorder — severe but often short-term depression
Persistent depressive disorder — long term or recurring depression, including sustained major depression and dysthymia
Disruptive mood dysregulation disorder — childhood temper tantrums
Premenstrual dysphoric disorder — disruption to mood prior to and/ or during menstruation
Behavioural characteristics
Activity levels
reduced energy levels, making them lethargic
This causes the person to withdraw from work, education and social life. In some cases this can be so severe that the person cannot get out of bed
In some cases depression can lead to the opposite effect - psychomotor agitation, struggling to relax
Disruption to sleep and eating behaviour
May experience reduced sleep (insomnia) or and increased need for sleep (hypersomnia)
Appetite may increase or decreases, leading to weight gain or loss
Aggression and self harm
often irritable and become verbally or physically aggressive
Depression may also lead to physical aggressive directed at themselves. This includes self harm, often in the form of cutting, or suicide attempts
Emotional characteristics
Lowered mood — feeling lethargic and sad, with depressed people often describing themselves as ‘worthless’ and ‘empty’
Anger — being angry at themselves and others, this may lead to aggression or self harming behaviour
Lowered self esteem — liking themselves less than usual, some people describe a sense of self loathing and hating themselves
Cognitive characteristics
poor concentration — hard to complete tasks, or they may find it hard to make decisions
Attending and dwelling on the negative — the person pays more attention to negative aspects. They also recall more unhappy events rather than happy ones
Absolutist thinking — ‘black and white thinking’, where they see situations as all good or all bad
5.4 OCD
OCD = obsessive compulsive disorder
A condition characterised by obsessive/ compulsive behaviour. Obsession are cognitive whereas compulsions are behavioural
DSM-5 categories of OCD
— all of them have repetitive behaviour accompanied by obsessive thinking —
OCD = characterised by either obsessions (recurring thoughts) and/ or compulsions (repetitive behaviour)
Trichotillomania = compulsive hair pulling
Hoarding disorder = the compulsive gathering of possessions
Excoriation disorder = compulsive skin picking
The cycle of OCD
Obsessive thought
Anxiety
Compulsive behaviour
Temporary relief
Behavioural characteristics
— the behavioural component is compulsions —
Compulsions are repetitive. Feel the need to repeat a behaviour
Compulsions reduce anxiety. Compulsions are performed in an attempt to manage the anxiety produced by obsessions
Avoidance. Attempting to reduce anxiety by keeping away from situations that trigger it
Emotional characteristics
Anxiety and distress. Anxiety from the obsessive thoughts and the anxiety from the urge to repeat a behaviour/ compulsion
Accompanying depression. Low mood and lack of enjoyment in activities
Guilt and disguise. Feeling guilt over minor moral issues or disgust towards something external or at the self
Cognitive characteristics
— the cognitive component is obsessions —
Obsessive thoughts. Thoughts that recur over and over, its the major cognitive feature in 90% of people with OCD
Cognitive coping strategies. This may help to manage the anxiety but can make the person appear abnormal to others and can distract them from everyday tasks
Insight into excessive anxiety. They are aware that their obsessions and compulsions are not rational. They experience thoughts about the worst case scenario. They tend to be hypervigilant and focus on potential hazards
5.5 PHOBIAS: BEHAVIOURIST EXPLANATION
Key term
Behaviourist approach — a way of explaining phobias in terms of what is observable and in terms of learning
Two process model — classical conditioning for the onset and operant conditioning for persistence
Classical conditioning — learning by association
Operant conditioning — learning by consequences
The two process model (Mowrer)
emphasise the role of learning in the acquisition of phobias
Acquired through classical conditioning and then maintained by operant conditioning
Classical conditioning
associate the neutral stimulus with something that triggers a fear response (unconditioned stimulus)
Watson and rayner studied Little Albert. They would make a loud noise every time Albert interacted with the white rat. Albert began to display fear just towards the white rat. This conditioning was generalised to similar objects
Operant conditioning
Behaviour is reinforced or punished
Negative reinforcement - through avoidance, which leads to a desirable consequence so they will repeat the behaviour
Evaluation
Real world application
led the the developed of exposure therapies such as systematic desensitisation and flooding
As we know its importance to prevent avoidance
Cognitive aspects
does not account for cognitive aspects, it only explains avoidance behaviour but does not explain why people have irrational beliefs
Phobias and trauma
link between trauma and phobias. Shown through little Albert
Also found by Jongh who found 73% of people with a fear of dentists had a traumatic experience
Shows that association between the stimulus and the UCR (pain) leads to the development of a phobia
Counterpoint — this is not applicable to all phobias
Evolution
Suggested that phobias are things that have presented danger in our evolutionary past
So having a fear of these would have provided an advantage
5.6 PHOBIAS: BEHAVIOURIST TREATMENT
Systematic desensitisation
behavioural therapy to gradually reduce anxiety through classical conditioning
Phobic stimulus is associated with relaxation instead of anxiety
3 processes involved
The anxiety heirarchy — make a list of situations from least to most frightening
Relaxation — teaches relaxation techniques. Impossible to be relaxed and afraid at the same time (reciprocal determinism)
Exposure — exposed to phobic stimulus while in a relaxed state, starting from the bottom of the anxiety hierarchy
Flooding
immediate exposure to the phobic stimulus
Gives no option for avoidance so the client quickly learns that the phobic stimulus is harmless (extinction)
The learned response is extinguished when the conditioned stimulus (dog) is encountered without the unconditioned stimulus (being bitten)
Ethical safeguards
Important to gain informed consent because the procedure is traumatic
Systematic desensitisation — Evaluation
Effective
Gilroy studied 42 people who had SD for spider phobias. Found body were less fearful than a control group
People with learning disabilities
can be used for those with disabilities as it doesn’t require them to have complex rational thought which is needed in cognitive therapies
Virtual reality
can use virtual reality for exposure to avoid dangerous situations (e.g heights)
However there is evidence that VR exposure is less effective because it lacks realism
Flooding — Evaluation
Cost effective
can work in as little as one session so cheaper for the client and the therapist
Traumatic
provokes high levels of anxiety. Schumacher found that participants rated it significantly more stressful that SD
also attrition (drop out) rates are higher
Symptom substitution
They only mask symptoms and do not tackle the underlying causes of phobias
May just change one fear for another (Jacquelines fear of death declined but her fear of criticism worsened)
5.7 DEPRESSION: COGNITIVE EXPLANATIONS
Beck’s Cognitive Theory of DepressionCognitive Vulnerability
Some people are more vulnerable to depression because of the way they think.
Faulty Information Processing
Depressed people:
Focus on negative aspects of situations.
Ignore positives.
Interpret events pessimistically.
Example:
A person may focus on one criticism instead of many compliments.
Negative Self-Schemas
A schema = mental framework developed through experience.
Negative schemas cause people to interpret information negatively.
Beck’s Negative Triad
Depressed people develop negative views about:
The self
“I’m a failure.”
The world
“Everything is unfair.”
The future
“Things will never improve.”
These thoughts reinforce depression.
Ellis’s ABC ModelPurpose
Explains depression through irrational thoughts.
ABC Model Structure
A – Activating Event, Something happens:
Failing a test
Break-up
Losing a job
B – Beliefs, Irrational beliefs about the event.
Two common irrational beliefs:
Musturbation = unrealistic expectations (“I must succeed.”)
Utopianism = belief life should always be perfect.
C – Consequences, Emotional and behavioural outcomes:
Depression
Anxiety
Withdrawal
Evaluation
Cognitive vulnerability predicts depression.
Negative thinking patterns are linked with depressive symptoms.
Real-World Applications. Led to successful therapies such as CBT. Useful for screening and treatment.
Partial Explanation, Depression also has biological causes.
Cognitive theories do not explain all symptoms (e.g. hallucinations).
Reactive vs Endogenous Depression. Better at explaining depression caused by life events (reactive depression). Less effective for depression with no obvious trigger (endogenous depression).
May appear to blame the individual for their depression.
5.8 DEPRESSION: COGNITIVE TREATMENT
Cognitive Behaviour Therapy (CBT)
A therapy that:
Identifies irrational/negative thoughts.
Challenges them.
Replaces them with healthier thinking.
Combines:
Cognitive techniques
Behavioural techniques
Beck’s Cognitive Therapy
Aim
Identify and challenge negative automatic thoughts and the negative triad.
Method
Clients test whether beliefs are realistic.
Techniques:
Thought challenging
Evidence gathering
Behavioural experiments
Ellis’s REBT (Rational Emotive Behaviour Therapy)
Based on the ABC model.
Adds:
D – Dispute
E – Effective new philosophy
Challenging Irrational Beliefs
Therapist disputes irrational thoughts using:
Logical Disputation. “Does this belief logically make sense?”
Empirical Disputation. “Where is the evidence?”
Pragmatic Disputation. “Is this belief helpful?”
Behavioural Activation
Encourages depressed individuals to engage in enjoyable activities.
Reduces avoidance and withdrawal.
Improves mood through positive reinforcement.
Evaluation
Often as effective as antidepressants.
Works especially well combined with medication.
Cost Effective. Widely used in healthcare systems.
Suitable for Many Clients. Can be adapted for different populations.
Some patients are too depressed to engage fully.
Learning Disabilities. CBT may be difficult for people with severe cognitive impairments.
Relapse Rates. Relapse can occur after treatment ends.
Client Preference. Some clients prefer medication or other therapies.
5.9 OCD: BIOLOGICAL EXPLANATION
OCD has:
Genetic influences
Neural/brain influences
Genetic Explanations of OCD
Genetic Vulnerability
OCD tends to run in families.
Individuals may inherit vulnerability.
Candidate Genes
Genes linked to OCD include:
Genes affecting serotonin regulation.
Example: SERT gene.
OCD is Polygenic
Many genes contribute to OCD risk.
OCD is Aetiologically Heterogeneous
Different combinations of genes may produce OCD in different people.
Neural Explanations of OCD
Role of Serotonin
Low serotonin activity may affect:
Mood regulation
Impulse control
Associated with OCD symptoms.
Decision-Making Systems
OCD linked to abnormal functioning in:
Frontal lobes
Parahippocampal gyrus
These areas are involved in:
Decision making
Behaviour regulation
Evaluation
Twin studies show higher concordance in identical twins.
Antidepressants affecting serotonin reduce OCD symptoms.
Scientific Basis. Objective and evidence-based.
Environmental Risk Factors. Stressful life events may trigger OCD. Biology alone cannot explain all cases.
Animal Studies. Difficult to generalise from animals to humans.
Correlation vs Causation. Brain abnormalities may not directly cause OCD.
No Unique Neural System. Serotonin is involved in several disorders, not only OCD.
5.10 OCD: BIOLOGICAL TREATMENTS
Biological Treatment of OCD
Focuses mainly on *drug therapy**.
Based on the idea that OCD is linked to *abnormal neurotransmitter levels**, especially low serotonin.
Drug Therapy
Aim
* To increase or decrease neurotransmitters in the brain to improve functioning.
In OCD, treatment usually aims to *increase serotonin levels**.
SSRIs (Selective Serotonin Reuptake Inhibitors)
A type of *antidepressant** commonly used to treat OCD.
* Examples:
* Fluoxetine (Prozac)
* Sertraline
* Paroxetine
How SSRIs Work
Neurons communicate through the *synapse** using serotonin.
Normally, serotonin released into the synapse is later *reabsorbed** (reuptake).
SSRIs *block reuptake**, leaving more serotonin in the synapse.
* This increases stimulation of the postsynaptic neuron and improves mood/OCD symptoms.
Dosage
* Usually taken daily.
Often takes *3–4 months** before symptoms improve noticeably.
* Dose may be increased if symptoms persist.
Combining SSRIs with Other Treatments
CBT + SSRIs
SSRIs are often used alongside *Cognitive Behaviour Therapy (CBT)**.
* Drugs reduce emotional symptoms so patients can engage more effectively in CBT.
* Combination therapy is often more effective than drugs alone.
Alternatives to SSRIs
Tricyclics
Example: *Clomipramine**
* Older antidepressant that affects serotonin.
* Usually prescribed when SSRIs fail.
* More side effects than SSRIs.
SNRIs
Example: *SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors)**
* Increase both serotonin and noradrenaline.
* Used if SSRIs are ineffective.
Evaluation
Effective Treatment
* Research shows SSRIs reduce OCD symptoms for many patients.
* Drugs are generally more effective than placebos.
Around *70%** of patients improve with SSRIs.
Cost-Effective and Convenient
* Cheaper than psychological therapies.
* Easy to administer.
* Requires less therapist time.
* Useful for severe OCD symptoms.
Side Effects
* Some patients experience: Nausea, Insomnia, Headaches, Loss of sex drive
* Clomipramine may cause: Weight gain, Aggression
* Side effects can reduce quality of life and stop people taking medication.
Not Effective for Everyone
* Some patients do not respond to drugs.
* Psychological therapies may still be required.
Biased Evidence
* Drug research is often funded by pharmaceutical companies.
* Positive results may be more likely to be published.