Psychopathology

The Normality Debate

Drawing the line of what is normal or abnormal

Defining Psychopathology

Statistical Deviance

Use of statistical norms to determine what is normal

What is normal varies between socio-cultural contexts

Maladaptiveness

The extent to which certain behaviours are maladaptive to the self/others

Behaviours that prevent an individual from adapting/adjusting for the good of another individual/the group are abnormal

Personal Distress

Often associated with that makes up a mental disorder

Individuals with antisocial personality disorder often don’t experience appropriate forms of distress but derive pleasure from inflicting pain on others

Classification of Mental Illness

Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V)

By American Psychiatric Association

Released in 2013

International Classification of Diseases 11th edition (ICD-11)

By World Health Organisation
Released in 2018

Defining Mental Illness

DSM-V

A syndrome characterised by clinically significant disturbance in an individual’s cognition, emotional regulaton or behaviour that reflects dysfunction in underlying mental function

ICD-11

Mental, behavioural and neurodevelopmental disorders are syndromes characterised by clinically significant disturbance in an individual’s cognition, emotional regulation or behaviour that reflects a dysfunction in processes that underlie mental and behavioural functioning

Biomedical Perspective

The viewpoint that all mental illness has a biological cause

Genetic Predisposition

Presence of family history of mental illness increases vulnerability to developing a psychological disorder

Abnormal Functioning of Neurotransmitters

An increase/decrease in neurotransmitters

Structural Brain Abnormalities

Could be due to genetic disorders, birth defects, drug related/physical damage

Psychological Perspective

The Psychodynamic Perspective

From Freud’s psychoanalysis

We are influenced by internal forces that exist outside of our consciousness

Psychological symptoms are seen as a result of the compromise between the expression and repression of our forbidden wishes

The Cognitive-Behaviour Perspective

View that cognitions or learned ways of thinking, direct impact on an individual’s emotions and behaviour

Psychological symptoms are seen as irrational

The Community Perspective

Psychopathology stems from within the context of a community

Political Context

Facilitates ideas

After effects of apartheid

Social Context

Social factors can contribute to the development of psychopathology

Factors such as socioeconomic status, access to resources, values, stigma, violence, substance use

Cultural Context

How an individual experinces distress or makes sense of psychological issues

Integrated Approaches to Psychopathology

The Diathesis-Stress Model

Introduced by Meehl 1962

Of the viewpoint that some inherit/develop predispositions (diathesis)

Symptoms of psychopathology, only emerge when there are environmental/biological stressors

The Biopsychosocial Model

Intergrates biological, psychological and social factors that contribute to the development of psychopathology

Biological

• Predisposing: genetic vulnerability, toxic exposure in utero, birth complications, traumatic brain injury

• Precipitating: poor sleep, substance use

• Perpetuating: poor response to medication, chronic illness

• Protective: adequate diet, sleep, good genes, physical exercise, resilience, intelligence

Psychological

• Predisposing: attachment style, personality trait, isolation, insecurities, fear or abandonment

• Precipitating: recent loss, stress, reexperience, abandonment

• Perpetuating: personality traits, coping mechanisms, belief of self, others and the world

• Protective: insightful and cognitive behaviour strategies, coping skills, psychologically minded

Social

• Predisposing: domestic violence, poverty and adversity, unstable home life, divorce

• Precipitating: school stressors, low of significant relationship, loss of home

• Perpetuating: role of stigma to access treatment, poor finance, ongoing transitions

• Protective: communities, family and faith support, financial or disability support, GP support

Predominant features of psychological disorders

Intellectual disability disorder

Subaverage intellectual and adaptive functioning

Autism spectrum disorder

Severely impaired social interaction and communication

Pica

persistent eating of non-nutritious substance

Neurocognitive Disorder

Disturbances of consciousness and cognitive ability

Bipolar I Disorder

Manic and depressive phases of mood

Panic Disorder

Recurrent unexpected panic attack

Obsessive compulsive disorder

Obsessive thoughts and compulsive behaviour

Conversion disorder

Motor/sensory impairment with no physical cause

Factitious disorder

Intentional production of symptoms to play ‘sick role’

Dissociative Identity Disorder

Presence of two/more distinct identities in one person

Male Organismic Disorder

Delay/absence of orgasm following sexual excitement

Insomnia Disorder

Difficulty intiating/maintaining sleep

Adjustment Disorder

Symptoms in relation to a paticular stressor

Narcissistic Personality Disorder

Grandiose sense of self importance

Normal Response to Trauma

After stressful/traumatic experiences most people will experience a degree of distress as they try to adapt to what has. happened

May experience: feelings of anxiety and depression, distressing thoughts and memories of the vent, difficulty sleeping, hyper alert to signs of danger

Trauma & Stressor Related Disorders

Reactive Attachment Disorder

Disinhibited Social Engagement Disorder

Post Traumatic Stress Disorder

Acute Stress Disorder

Adjustment Disorder

Post-Traumatic Stress Disorder

Exposure to actual/threatened death, serious injury or sexual violence

• Directly experiencing

• Witnessing

• Learning that it happened to a close family member

• Experiencing extreme exposure to aversive details

Biological Factors

Genetics: vulnerability to PTSD may be inherited

Neuroimaging Finding: differences in brain activity between people with PTSD and those without, differences occur in brain areas associated with regultating emotion, fight/flight, memory

Biochemical Differences: abnormally low cortisol in those with PTSD

Psychological Factors

Dynamics before the event

Psychoanalytical explanations: re-experiencing symptoms

Congnitive explanations: the assimilation and accommodation of the trauma in cognititeve schemas

Social Factors

Community context: high crime rate, gang violence, theft, murder

Countries experiencing war

Complex PTSD/Continuous Trauma

A reality in many economically disadvantaged communities such as those in SA

Situations of prolonged abuse at the hands of another

Repeated exposure to community violence

Schizophrenia Spectrum Disorder

Delusional disorder

Brief psychotic disorder

Schizophreniform disorder

Schizophrenia

Schizoaffective disorder

Delusions

Fixed beliefs, themes of persecutory, refential, religious, grandiose

Hallucinations

Sensory-like experiences, auditory, visual, kinesthetic, olfactory, gustatory

Disorganised Thinking

Observeable through speech

Grossly Disorganised or Abnormal Motor Behaviour

Cataonia, psychomotor agitation

Negative Symptoms

avolition, alogia, angedonia

Cultural

“Amafufuyana” and “Ukuthwasa” are 2 culture specific descriptive terms used by Xhosa traditional healers

Not yet included in the DSM

Ukuthwasa

A calling to service the ancestors as a traditional healer

Whereas complying with this ‘divine calling’ confers special powers

Amafufuyana

Originally described as a hysterical condition characterised by people speaking in a strange muffled voice

Existing case desciptions

State is believed to be induced by sorcery that has led to possession by multiple spirits that may then speak through the individual