PMT version

• Statistical infrequency = Implies that a disorder is abnormal if its frequency is more than two standard deviations away from the mean incidence rates represented on a normally-distributed bell curve.
• + Statistical infrequency is almost always used in the clinical diagnoses of mental health disorders as a comparison with a baseline or ‘normal’ value. This is used to assess the severity of the disorder e.g. the idea that Schizophrenia only affects 1% of the general population, but subtypes are even less frequent (such as hebephrenic or paranoid Schizophrenia)
• — Statistical infrequency assumes that any abnormal characteristics are automatically negative, but this is not always true. For example, displaying abnormal levels of empathy (and thus qualifying as a Highly Sensitive Person) or having an IQ score above

  130 (and thus being a genius) would rarely be looked down upon as having negative characteristics which require treatment.
• The failure to function adequately definition of abnormality was proposed by Rosenhan and Seligman (1989) and suggests that if a person’s current mental state is preventing them from leading a ‘normal’ life, alongside the associated normal levels of motivation and obedience to social norms, then such individuals may be considered as abnormal. This occurs when the patient does not obey social and interpersonal rules (e.g. standing precariously close to others), are in distress or are distressing, and their behaviour has become dangerous.
• + A major strength of failure to function adequately as a definition is that it takes into account the patient’s perspective, and so the final diagnosis will be comprised of the patient’s (subjective) self-

  reported symptoms and the psychiatrist’s objective opinion. This may lead to more accurate diagnoses of mental health disorders because such diagnoses are not constrained by statistical limits, as is the case with statistical infrequency
• — A major weakness of using the failure to function adequately definition is the idea that it may lead to the labelling of some patients as ‘strange’ or ‘crazy’, which does little to challenge traditional negative stereotypes about mental health disorders. Not everyone with a mental health disorder requires a diagnosis, especially if they have a high quality of life and their illness has little impact on themselves or others. Instead, such labelling could lead to discrimination or prejudice faced against them by employers and acquaintances
• The deviation from social norms definition of abnormality suggests that ‘abnormal’ behaviour is based upon straying away from the social norms specific to a certain culture. There are general norms, applicable to the vast majority of cultures, as well as culture-specific norms. For example, an individual would be diagnosed with antisocial personality disorder (APD) if they behave aggressively towards strangers (breaching a general social norm) and if they experience certain hallucinations.
• — The fact that mental health diagnoses based on deviation from social norms vary so significantly between different cultures has historically led to discrimination as a mechanism for social control. For example, in the nineteenth century in Great Britain, ‘nymphomania’ described the mental health disorder suffered by women who demonstrated sexual attraction towards working-class men. In reality, this diagnosis was simply made to prevent infidelity, cement the differences between social classes and further discriminate against women, thus being a reflection of a patriarchal society.
• — Due to its reliance on subjective social norms, this explanation also suffers from cultural relativism. One such example would be the hearing of voices which have no basis in reality, or ‘hallucinations’. Some African and Asian cultures in particular would look upon this symptom positively, viewing it as a sign of spirituality and a strong connection with ancestors, as opposed to a symptom of Schizophrenia. This therefore suggests that the use of this definition of abnormality may lead to some discrepancies in the diagnoses of mental health disorders, between cultures.
• Deviation from ideal mental health is the fourth definition of abnormality, and was proposed by Jahoda (1958). Instead of focusing on abnormality, Jahoda looked at what would comprise the ideal mental state of an individual. The criteria include being able to self-actualise (fulfil one’s potential, in line with humanism!), having an accurate perception of ourselves, not being distressed, being able to maintain normal levels of motivation to carry out day-to-day tasks and displaying high self-esteem
• The main issue with deviation from ideal mental health is that Jahoda may have had an unrealistic expectation of ideal mental health, with the vast majority of people being unable to acquire, alone maintain, all of the criteria listed. This means that the majority of the population would be considered abnormal, even if they have missed a single criterion e.g. being able to rationally cope with stress (which most people would agree does not merit a diagnosis). Therefore, deviation from ideal mental health may be considered a very limited method of diagnosing mental health disorders.
• Deviation from ideal mental health, like deviation from social norms, suffers from cultural relativism. In collectivist cultures, where group needs outweigh individual ones, self-actualization may seem selfish. However, it aligns with the values of individualist cultures that prioritize personal growth. This indicates that using deviation from ideal mental health as a definition of abnormality is culturally dependent.
• The behavioural characteristics of phobias are panic, avoidance and endurance.
• Panic — the patient suffers from heightened physiological arousal upon exposure to the phobic stimulus, caused by the hypothalamus triggering increased levels of activity in the sympathetic branch of the

  autonomic nervous system.
• Avoidance — avoidance behaviour is negatively reinforced (in classical

  conditioning terms) because it is carried out to avoid the unpleasant consequence of exposure to the phobic stimulus. Therefore, avoidance severely impacts the patient’s ability to continue with their day-to-day lives.
• Endurance — this occurs when the patient remains exposed to the phobic stimulus for an extended period, but also experiences heightened levels of anxiety during this time
• The main emotional characteristic of phobias is anxiety (the emotional consequence of the physiological response of panic) and an unawareness that the anxiety experienced towards the phobic stimulus is irrational (from an evolutionary perspective, the phobic anxiety is not

  proportionate to the threat posed by the stimulus).
• The cognitive characteristics of phobias are selective attention to the phobic stimulus, irrational beliefs and cognitive distortions.
• Selective attention — this means that the patient remains focused on the phobic stimulus, even when it is causing them severe anxiety. This may be the result of irrational beliefs or cognitive distortions
• Irrational beliefs — this may be the cause of unreasonable responses of anxiety towards the phobic stimulus, due to the patient’s incorrect perception as to what the danger posed actually is.
• Cognitive distortions — the patient does not perceive the phobic stimulus accurately. Therefore, it may often appear grossly distorted or irrational e.g. mycophobia (a phobia of mushrooms) and rectaphobia (a phobia of bottoms).
• The behavioural characteristics of depression include changed activity levels (may result in psychomotor agitation or, on the other end of the spectrum, an inability to wake up and get out of bed in the morning), aggression (towards oneself and others, which may be verbal or physical) and changes in patterns of sleeping and eating (insomnia and obesity on one end of the spectrum, whilst constant lethargy and anorexia may appear on the other)
• The emotional characteristics of depression include lowered self-esteem, constant poor mood (lasting for months at a time and high in severity, therefore not simply ‘feeling down’) and high levels of anger (towards oneself and others).
• The cognitive characteristics of depression include absolutist thinking (jumping to irrational conclusions e.g. “I am unable to visit my mother today and so I am a failure of a son”), selective attention towards negative events (patients with depression often recall only negative events in their lives, as opposed to positive) and poor concentration (the consequent disruptions to school and work add to the feelings of worthlessness and anger).
• The main behavioural characteristics of OCD are compulsions (repetitive and intrusive thoughts focused around the stimulus which reduces anxiety through being a method of acting upon obsessive thoughts) and avoidance behaviour. This avoidance behaviour is once again negatively reinforced (in terms of classical conditioning) because an individual who avoids the specific stimulus will avoid the anxiety associated with having to carry out compulsive behaviours and suffer from obsessive thoughts
• The emotional characteristics of OCD are guilt and disgust, depression (due to the constant compulsion to carry out compulsive/repetitive behaviours, which often interfere with day-to-day functioning and relationships) and anxiety (associated with the acknowledgement that the obsessive thoughts are irrational, but despair at the fact that they will always lead to compulsive behaviours).
• The cognitive characteristics of OCD include the patient’s acknowledgement that their anxiety is excessive and irrational (a hallmark of OCD), the development of cognitive strategies to deal

  with obsessions (such as always carrying multiple bottles of hand sanitiser) and obsessive thoughts (these are repetitive, focus on the stimulus, are intrusive, cause excessive amounts of anxiety and lead to compulsive behaviours)
• Mowrer suggested that phobias are acquired through classical conditioning and then maintained through operant conditioning. Watson and Rayner demonstrated how Little Albert associated the fear caused by a loud bang with a white rat. He was exposed to a white rat (NS), producing no response. When paired with the loud bang (UCS), this produced the UCR of fear. Through several repetitions, Albert made the association between the rat (CS) and fear (CR). This conditioning then generalised to other objects e.g. white fluffy Santa Claus hats
• Operant conditioning takes place when a behaviour is rewarded or punished. For example, phobics practice avoidance behaviours, meaning that they avoid the phobic stimulus. By avoiding this phobic stimulus, they avoid the associated fear. By avoiding such an unpleasant consequence, the avoidance behaviour is negatively reinforced and likely to be repeated again, hence maintaining the phobia
• + Good explanatory power - The main advantage of the behavioural theory is that it can explain the mechanism behind the acquisition and maintenance of phobias, which classical or operant conditioning alone cannot do. Practical benefits include systematic desensitisation and flooding. Mowrer emphasises the importance of exposing the patient to the phobic stimulus because this prevents the negative reinforcement of avoidance behaviour. The patient realises that the phobic stimulus is harmless and that their responses are irrational/disproportionate, thus translating into a successful therapy
• — Alternative explanation for avoidance behaviour (Buck) - Buck suggested that safety is a greater motivator for avoidance behaviour, rather than simply avoiding the anxiety associated with the phobic stimulus. For example, he uses the example of social anxiety phobias - such sufferers can venture out into public but only with a trusted friend, despite still being exposed to hundreds of strangers which would usually trigger their anxiety. This means that Mowrer’s explanation of phobias may be incomplete and only suited for some.
• — Alternative explanation for the acquisition of phobias - Seligman suggested that we are more likely to develop phobias towards ‘prepared’ stimuli. These are stimuli which would have posed a threat to our evolutionary ancestors, such as fire or deep water, and so running away from such a stimulus increases the likelihood of survival and reproduction, and so this behaviour has a selective evolutionary advantage. This means that alternative theories can explain why some phobias (i.e. towards prepared stimuli) are much more frequent than other phobias (i.e. towards unprepared stimuli).
• systematic desensitisation is a behavioural therapy designed to reduce phobic anxiety through gradual exposure to the phobic stimulus. It relies upon the principle of counterconditioning i.e. learning a new response to the phobic stimulus i.e. one of relaxation rather than panic. This works due to reciprocal inhibition i.e. it’s impossible to be both relaxed and anxious at the same time
• Firstly, the patient and therapist draw up an anxiety hierarchy together, made up of situations involving the phobic stimulus, ordered from least to most nerve-wracking. The therapist then teaches the patient relaxation techniques e.g. breathing techniques and meditation, to be used at each of these anxiety levels. The patient works their way up through the hierarchy, only progressing to the next level when they have remained calm at the present level. The phobia is cured when the patient can remain calm at the highest anxiety level.
• + Supporting evidence = Gilroy et al. followed up 42 patients treated in three sessions of systematic desensitisation for a spider phobia. Their progress was compared to a control group of 50 patients who learnt only relaxation techniques. The extent of such phobias was measured

  using the Spider Questionnaire and through observation. At both 3 and 33 months, the systematic desensitisation group showed a reduction in their symptoms as compared to the control group, and so has been used as evidence supporting the effectiveness of flooding
• + Systematic desensitisation is suitable for many patients, including those with learning difficulties. Anxiety disorders are often accompanied by learning disabilities meaning that such patients may not be able to make the full cognitive commitment associated with cognitive behavioural therapy or have the ability to evaluate their own thoughts. Therefore, systematic desensitisation would be a particularly suitable alternative for them.
• + More acceptable to patients, as shown by low refusal and attrition rates. = This idea also has economical implications because it increases the likelihood that the patient will agree to start and continue with the therapy, as opposed to getting ‘cold feet’ and wasting the time and effort of the therapist!
• Flooding is a behavioral therapy that reduces phobic anxiety in a single session by exposing the patient to the phobic stimulus in a secure, inescapable environment. By preventing avoidance behaviors, which reinforce the phobia, the fear is not maintained. For instance, a patient with a spider phobia might be placed in a room with large spiders, which could crawl on them. Over time, as heightened anxiety cannot be sustained indefinitely, the patient learns the phobic stimulus is harmless.
• + Cost-effective - Ougrin compared flooding to cognitive therapies and found it to be cheaper. This is because the patient’s phobia will typically be cured in one session, thus freeing them of their symptoms and allowing them to continue living a normal life.
• -Less effective for complex phobias. Social phobias involve both anxiety and a cognitive aspect i.e. thinking unpleasant thoughts about a situation. Thus, in such cases, cognitive therapy may be more appropriate because this therapy can target the distal causes of the phobia, as opposed to the mere proximal (indirect) causes. This suggests that alternatives may be more effective.