Psychopathology

Definitions of Abnormality

Statistical Infrequency

  • Definition: A person's behavior is classified as abnormal if it is statistically uncommon or rare. This is often measured using the normal distribution curve, where the majority of the population clusters around the mean.

  • Criteria: Individuals who fall more than 2 standard deviations away from the mean (representing the top and bottom 2.5\% of the population) are considered statistically infrequent.

  • Example: The average IQ is 100. Only 2.2\% of the population has an IQ below 70. These individuals are statistically infrequent and can be diagnosed with Intellectual Disability Disorder (IDD).

  • Assessment: This definition provides an objective, quantitative way to distinguish between normal and abnormal behaviors based on standardized data.

  • Limitations: Not all infrequent characteristics are negative (e.g., extremely high IQ is rare but desirable). Conversely, some frequent behaviors are negative (e.g., depression is statistically common but clinically abnormal).

Failure to Function Adequately (FFA)

  • Definition: Proposed by Rosenhan and Seligman (1989), this definition suggests a person is abnormal if they are unable to cope with the demands of everyday life, such as maintaining self-care, holding down a job, or forming stable relationships.

  • Signs of FFA:

    • Personal Distress: The individual experiences significant internal suffering.

    • Maladaptive Behavior: Behavior that prevents the individual from achieving life goals.

    • Irrationality: Behavior that is difficult for others to understand or follow.

    • Observer Discomfort: Behavior that causes distress to those around them.

  • Strengths: It focuses on the individual's subjective experience and provides a practical checklist for professionals to assess the need for clinical intervention.

  • Limitations: It can be difficult to distinguish between failing to function and choosing an alternative or unconventional lifestyle (e.g., extreme sports enthusiasts or nomadic travelers).

Deviation from Social Norms

  • Definition: Behavior is considered abnormal if it violates the implicit or explicit unwritten rules (social norms) of a specific society.

  • Cultural Relativism: Social norms vary significantly between cultures and across historical periods. For example, homosexuality was classified as a mental disorder in the DSM until the 1970s.

  • Example: Antisocial Personality Disorder (psychopathy) is characterized by impulsive and irresponsible behavior that violates the social and moral standards of the community.

  • Limitations: This definition can be used to justify social control and discrimination against minority groups who do not conform to the dominant culture's expectations.

Deviation from Ideal Mental Health

  • Definition: Proposed by Marie Jahoda (1958), this approach defines abnormality by identifying what makes someone 'mentally healthy' and classifying anyone who lacks these criteria as abnormal.

  • Jahoda’s Criteria:

    • Self-actualization: Striving to reach one's full potential.

    • Positive Attitude toward Self: Having high self-esteem and a strong sense of identity.

    • Resistance to Stress: Having effective coping mechanisms (integration).

    • Autonomy: Being independent and self-reliant.

    • Accurate Perception of Reality: Seeing the world as it truly is, without cognitive distortions.

    • Mastery of the Environment: The ability to adapt to new situations, work, and maintain relationships.

  • Limitations: The criteria are extremely demanding, making most of the population technically 'abnormal.' Furthermore, these values are often culture-bound to individualistic Western societies.

Characteristics of Disorders

Phobias

  • Behavioral:

    • Panic: Visible responses such as crying, screaming, or freezing in the presence of the phobic stimulus.

    • Avoidance: Making a conscious effort to stay away from the stimulus, which can severely limit daily life.

    • Endurance: Remaining in the presence of the stimulus while experiencing intense anxiety.

  • Emotional:

    • Anxiety/Fear: An immediate, persistent, and unpleasant response when encountering the stimulus.

    • Disproportionate Response: The level of fear felt is significantly higher than the actual threat posed.

  • Cognitive:

    • Selective Attention: Fixating on the phobic stimulus and being unable to focus on anything else.

    • Irrational Beliefs: Holding unfounded thoughts about the object (e.g., 'This tiny spider will bite and kill me').

    • Cognitive Distortions: The sufferer’s perception of the stimulus is warped (e.g., seeing a small harmless object as threatening).

Depression

  • Behavioral:

    • Activity Levels: Reduced energy leading to lethargy, or psychomotor agitation where the individual cannot sit still.

    • Disruption to Sleep and Eating: Insomnia (lack of sleep) or hypersomnia (oversleeping); significantly increased or decreased appetite.

    • Aggression: Increased irritability that can lead to verbal or physical aggression toward oneself or others.

  • Emotional:

    • Lowered Mood: Constant feelings of 'emptiness' or sadness.

    • Anger: Frequent experiences of frustration or anger toward the world.

    • Low Self-Esteem: Negative self-concept and feelings of worthlessness.

  • Cognitive:

    • Poor Concentration: Inability to focus on tasks or make simple decisions.

    • Absolutist Thinking: 'Black-and-white' thinking; perceiving a minor setback as a total disaster.

    • Negative Schemas: A tendency to ignore the positive and interpret all incoming information in a negative light.

Obsessive-Compulsive Disorder (OCD)

  • Behavioral:

    • Compulsions: Repetitive actions (e.g., hand-washing, ordering, counting) performed to temporarily reduce the anxiety caused by obsessions.

    • Avoidance: Staying away from situations that might trigger obsessive thoughts.

  • Emotional:

    • Anxiety and Distress: The intrusive thoughts are frightening and cause extreme mental pain.

    • Guilt and Disgust: Feeling shameful about the nature of the obsessions or feeling irrational disgust toward contamination.

  • Cognitive:

    • Obsessions: Recurrent, intrusive, and unwelcome thoughts, images, or impulses.

    • Insight: Most sufferers are aware that their thoughts and behaviors are irrational, yet they feel powerless to stop them.

The Behavioral Approach to Explaining Phobias

  • Mowrer’s (1960) Two-Process Model:

    • 1. Acquisition via Classical Conditioning: Phobias are learned through association. For example, in Watson and Rayner’s (1920) 'Little Albert' study, a fear of white rats was created by pairing a neutral stimulus (the rat) with a loud, frightening noise (the unconditioned stimulus).

    • 2. Maintenance via Operant Conditioning: Fear is maintained through negative reinforcement. When an individual avoids the phobic stimulus, their anxiety levels drop. This 'reward' (reduction in fear) reinforces the avoidance behavior, preventing the person from ever learning that the stimulus is harmless.

The Behavioral Approach to Treating Phobias

  • Systematic Desensitisation (SD):

    • Based on reciprocal inhibition (one cannot be both anxious and relaxed at the same time).

    • Process:

    1. Create an Anxiety Hierarchy from least to most frightening scenarios.

    2. Relaxation Training: Patient learns deep breathing or meditation.

    3. Gradual Exposure: The patient moves up the hierarchy, practicing relaxation at each stage until the fear is extinguished.

  • Flooding:

    • Immediate and intensive exposure to the most frightening stimulus without the possibility of avoidance.

    • Mechanism: The body's fear response is limited; eventually, adrenaline levels drop, and the patient learns that the stimulus is safe (extinction).

    • Ethics: It is highly traumatic and requires full informed consent.

The Cognitive Approach to Explaining Depression

  • Beck’s Cognitive Theory:

    • Faulty Information Processing: Focusing on negative aspects of a situation and ignoring positives.

    • Negative self-schemas: Mental frameworks developed in childhood that lead to negative self-interpretation.

    • The Negative Triad: Automatic negative thoughts about:

    1. The World (e.g., 'The world is a cold place')

    2. The Self (e.g., 'I am a failure')

    3. The Future (e.g., 'I will never succeed')

  • Ellis’s ABC Model (1962):

    • A (Activating Event): An external event (e.g., being fired).

    • B (Beliefs): The irrational interpretation of that event (e.g., 'I must be perfectly competent at everything').

    • C (Consequences): The resulting depressed mood.

The Cognitive Approach to Treating Depression

  • Cognitive Behavioral Therapy (CBT):

    • A therapist helps the patient identify 'automatic thoughts' and challenge them using evidence.

    • Patient as Scientist: Patients are set 'homework' to record instances of success to disprove their irrational beliefs.

  • Ellis’s REBT (Rational Emotive Behavior Therapy):

    • Extends the ABC model to D (Dispute) and E (Effect).

    • Therapists use Empirical Disputing (is there actual evidence for the thought?) and Logical Disputing (does the thought logically follow the facts?).

    • Behavioral Activation: Encouraging patients to participate in activities that were once rewarding to improve their self-belief.

The Biological Approach to Explaining OCD

  • Genetic Explanations:

    • Polygenic Basis: OCD is not caused by one single gene. Taylor (2013) found up to 230 different genes involved in OCD vulnerability.

    • Candidate Genes: Includes the SERT gene (serotonin transport) and COMT gene (dopamine regulation).

    • Diathesis-Stress Model: Genes provide the vulnerability, but an environmental trigger is often required for the disorder to develop.

  • Neural Explanations:

    • Neurotransmitters: Low levels of serotonin and high levels of dopamine are correlated with OCD symptoms.

    • The Worry Circuit: The orbitofrontal cortex (OFC) sends signals to the thalamus about worries. Normally, the caudate nucleus suppresses these signals, but in OCD, the caudate nucleus is faulty so it is overactive, allowing worry signals to cycle continuously.

The Biological Approach to Treating OCD

  • Drug Therapy:

    • SSRIs (Selective Serotonin Reuptake Inhibitors): Drugs like Fluoxetine increase serotonin levels in the synapse by preventing its reabsorption into the presynaptic neuron.

    • Tricyclics: Older antidepressants used for treatment-resistant OCD; they have more severe side effects.

    • SNRIs: Increase both serotonin and noradrenaline levels for patients who do not respond to SSRIs.

  • Evaluation:

    • Strengths: Highly cost-effective and requires less commitment from the patient than psychological therapies.

    • Weaknesses: Drugs only suppress symptoms rather than solving the underlying cause, and they can cause side effects such as nausea, tremors, and insomnia.