Psychopathology

• Statistical Infrequency

  Occurs when an individual has a less common characteristic

  Can be reliably measured, majority of scores cluster around the average, normal distribution

  IQ

  Average set at 100

  68% 85-115

  2% score below 70 abnormal and liable to receive a diagnosis of intellectual disability disorder (mental retardation)
• Deviation from Social Norms

  Concerns behaviour that is different from the accepted standards of behaviour in a community or society

  Society makes a judgment about what defies norms

  Generational and cultural differences

  Few behaviours viewed as universally abnormal

  Homosexuality used to be illegal continues to be in other cultures

  Antisocial personality disorder

  Impulsive, aggressive and irresponsible

  DSM-5: 'absence of prosocial internal standards associated with failure to conform to lawful and culturally normative ethical behaviour'

  Psychopaths abnormal because they do not abide our moral standards and considered abnormal in a wide range of cultures
• Schizotypal Personality Disorder

  Schizotypal personality disorder is defined largely by deviation from social norms

  Individuals are characterised by eccentric behaviour including superstition and beliefs in the supernatural that deviate from cultural norms

  May also see flashes and shadows that are not seen by others

  Often found in families where relatives have a diagnosis of schizophrenia
• Failure to Function Adequately

  Occurs when someone is unable to cope with ordinary demands of day-to-day living

  Unable to maintain basic standards of nutrition and hygeine

  Cannot hold down a job or maintain relationship with those around him

  Rosenhan + Seligman (1989)

  Additional signs to determine if someone is not coping

  When a person no longer conforms to standard interpersonal rules (eye contact or personal space)

  When a person experiences extreme personal distress

  When a person's behaviour becomes irrational or dangerous to themselves or others

  Intellectual disability disorder has low IQ but would also need to be failing to function adequately
• Deviation from Ideal Mental Health

  Occurs when someone does not meet a set of criteria for good mental health

  Consider what makes someone normal and psychologically healthy and then identify who deviates from this ideal

  Jahoda (1958)

  Good mental health:

  We have no symptoms or distress

  We are rational and can perceive ourselves accurately

  We self-actualise (strive to reach our potential)

  We can cope with stress

  We have a realistic view of the world

  We have good self-esteem and lack guilt

  We are independent of other people

  We can successfully work, love and enjoy our leisure

  Overlap between deviation from ideal mental health and failure to function adequately
• DSM-5 Categories of Phobias

  Phobia - an irrational fear of an object or situation

  All phobias categorised by excessive fear and anxiety triggered by an object, place or situation

  Extent of fear out of proportion to any real danger presented by the phobic stimulus

  Specific phobia - phobia of an object or a situation

  Social anxiety - phobia of a social situation

  Agoraphobia - phobia of being outside or in a public place
• Specific phobias

  Arachnophobia - spiders

  Ophidiophobia - snakes

  Zemmiphobia - giant mole rats

  Coulrophobia - clowns

  Kinemortophobia - zombies

  Lutraphobia - otters

  Mycophobia - mushrooms

  Omphalophobia - belly buttons

  Rectaphobia - bottoms

  Xanthophobia - yellow

  Nomophobia - lack of phone signal

  Pogonophobia - beards

  Alphabutyrophobia - peanut butter

  Triskaidekaphobia - thirteen
• Behavioural Characteristics of Phobias

  Feel high anxiety and try to escape

  Panic - may panic in response to the phobic stimulus, involve a range of different behaviours including crying, screaming or running away whereas children may freeze, cling or have a tantrum

  Avoidance - unless making a conscious fear to face their fear, tend to make a lot of effort to prevent coming into contact with the phobic stimulus, making it hard to go about daily life

  Endurance - person chooses to remain in the presence of the phobic stimulus
• DSM-5 Categories of Depression

  A mental disorder characterised by low mood and low energy levels

  Major depressive disorder - severe but often short-term depression

  Persistent depressive disorder - long-term or recurring depression

  Disruptive mood dysregulation disorder - childhood temper tantrums

  Premenstrual dysphoric disorder - disruption to mood prior to and/or during menstruation
• Behavioural characteristics of Depression

  Activity levels - typically reduced energy levels making them lethargic which leads to withdrawing from work, education and social life, can be so severe they don't get out of bed, in some cases energy can do the opposite known as psychomotor agitation, agitated individuals struggle to relax and may end up pacing up and down a room

  Disruption to sleep and eating behaviour - reduced sleep (insomnia) particularly premature waking or an increased need for sleep (hypersomnia), similarly appetite can increase or decrease leading to weight change

  Aggression and self-harm - often irritable and in some cases verbally and physically aggressive which can affect other areas of their life, physical aggression can be directed against the self
• DSM-5 Categories of OCD

  A condition characterised by obsessions and/or compulsive behaviour, obsessions are cognitive, compulsions are behavioural

  Trichotillomania - compulsive hair pulling

  Hoarding disorder - the compulsive gathering of possessions and the inability to part with anything, regardless of its value

  Excoriation disorder - compulsive skin-picking
• Behavioural Characteristics of OCD

  Compulsions behavioural component of OCD

  Compulsions are repetitive - typically people with OCD compelled to repeat a behaviour

  Compulsions reduce anxiety - 10% show compulsive behaviour alone, general majority compulsions reduce anxiety produced by obsessions, compulsive checking is in response to obsessive thoughts

  Avoidance - attempt to reduce anxiety by keeping away from situations that trigger OCD, this can avoid very ordinary situations
• Behavioural Approach to Explaining Phobias - Two Process Model

  An explanation for the onset and persistence of disorders that create anxiety, classical conditioning for onset and operant conditioning for persistence

  Behavioural approach emphasises the role of learning in the acquisition of behaviour

  Mowrer (1960)

  Phobias acquired by classical conditioning

  Continue because of operant conditioning
• Behavioural Approach to Explaining Phobias - Acquisition by Classical Conditioning

  Learning to associate repeatedly paired together neutral stimulus with unconditioned stimulus which produces unconditioned response of fear

  Watson and Rayner (1920)

  9 month old baby called Little Albert

  No unusual anxiety at the start of the study, when shown a white rat he tried to play with it

  Whenever the rat presented researchers made a loud noise by banging iron bar by his ear (repetition)

  Noise, unconditioned stimulus = fear, unconditioned stimulus

  Rat, neutral stimulus + noise, unconditioned stimulus = fear, unconditioned response

  Rat, conditioned stimulus = fear, conditioned response

  Conditioning generalised to other similar objects

  Other furry objects, non-white rabbit, fur coat and Watson wearing cotton ball Santa Claus beard caused Little Albert distressed
• Behavioural Approach to Explaining Phobias - Maintenance by Operant Conditioning

  Behaviour is shaped and maintained by its consequences

  Responses acquired by classical conditioning tend to decline over time however phobias are long lasting

  Reinforcement tends to increase frequency of behaviour

  Negative reinforcement - individual avoids situation that is unpleasant, results in a desirable consequence (relief) which means the behaviour will be repeated

  When we avoid a phobic stimulus we successfully escape the fear and anxiety we would have experienced if we had remained there, reduction in fear reinforces the avoidance behaviour and so the phobia is maintained
• Behavioural Approach to Treating Phobias - Systematic Desensitisation

  A behavioural therapy designed to reduce an unwanted response, involves drawing up a hierarchy of anxiety-provoking situations related to a person's phobic stimulus, teaching the person to relax and then exposing them to phobic situations, the person works through the hierarchy whilst maintaining relaxation

  Classical conditioning, learning to relax in the presence of the stimulus, counterconditioning
• System Desensitisation Processes:

  3 processes involved:

  Anxiety hierarchy, put together by client and therapist, list of situations related to phobic stimulus that provoke anxiety arranged in order from least to most frightening

  Relaxation, therapist teaches the client to relax as much as possible, impossible feel anxiety and relaxed at the same time so one prevents the other, reciprocal inhibition, relaxation might involve breathing exercises or mental imagery or meditation or drugs like Valium

  Exposure, exposed to phobic stimulus while relaxed, across several sessions, start at the bottom of hierarchy and move up when they can stay relaxed, treatment successful when they can stay relaxed high on the hierarchy
• Behavioural Approach to Treating Phobias - Flooding

  A behavioural therapy in which a person with a phobia is exposed to an extreme form of a phobic stimulus in order to reduce anxiety triggered by that stimulus, this takes place across a small number of long therapy sessions

  Immediate exposure to very frightening situation

  One session often lasts 2/3 hours, sometimes only one long session needed to cure a phobia

  Stops response very quickly, no option of avoidance behaviour, learns stimulus is harmless, extinction

  Conditioned stimulus encountered without unconditioned stimulus resulting so no longer produces response

  May be relaxed because they become exhausted by fear response

  Unpleasant experience so clients must give fully informed consent and are fully prepared before the session

  Normally given choice between systematic desensitisation or flooding
• Cognitive Approach to Explaining Depression - Beck's Negative Triad

  Beck (1967)

  Proposed there are 3 kinds of negative cognitions that contribute to vulnerability to becoming depressed:

  Faulty information processing

  Negative self-schema

  The negative triad
• Beck's Triad: Faulty information processing

  Depressed people attend to the negative aspects of a situation and ignore positives

  Blow small problems out of proportion

  Think in black and white terms
• Beck's Triad: Negative self-schema

  Schema is a package of ideas and information developed through experience, act as a mental framework for the interpretation of sensory information

  Self-schema package of information about themselves

  People use schema to interpret the world so if a person has a negative-self schema they interpret all information about themselves in a negative way
• Beck's Triad: The negative triad

  Person develops a dysfunctional view of themselves because of 3 types of negative thinking that occur automatically, regardless of reality at the time

  When a person is depressed, negative thoughts about the world, the future and oneself are uppermost

  Negative view of the world - creates the impression there is no hope anywhere

  Negative view of the future - reduce hopefulness and enhance depression

  Negative view of the self - enhance existing depressive feelings because they confirm the existing emotions of low self-esteem
• Cognitive Approach to Explaining Depression - Ellis's ABC Model

  Ellis (1962)

  Depression occurs when an activating event triggers an irrational belief which in turn produces a consequence, the key to this process is the irrational belief

  Good mental health as a result of rational thinking, defined as thinking in ways that allow people to be happy and free from pain

  Anxiety and depression result from irrational thoughts

  Irrational thoughts - any thoughts that interfere with us being happy and free from pain

  Activating event - situations where irrational thoughts are triggered by external events

  Belief - irrational beliefs, belief we must always achieve success or perfection (musturbation), major disaster whenever something does not go smoothly (I-can't-stand-it-itis), life is always meant to be fair (utopianism)

  Consequences - when an activating event triggers irrational beliefs there are emotional and behavioural consequences
• Cognitive Approach to Treating Depression - Ellis's Rational Emotive Behaviour Therapy

  Extends the ABC model

  Dispute + Effect, identify and dispute irrational thoughts

  Vigorous argument with the intended effect is to change the irrational belief and so break the link between negative life events and depression

  Empirical argument - disputing whether there is actual evidence to support the negative belief

  Logical argument - disputing whether the negative thought logically follows from the facts
• Cognitive Approach to Treating Depression - Behavioural Activation

  As individuals become depressed they tend to increasingly avoid difficult situations and become isolated which maintains or worsens symptoms

  The goal of behavioural activation is to work with depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve moods aiming to reinforce such behaviour
• Cognitive Approach to Treating Depression - Cognitive Behaviour Therapy

  Most commonly used psychological treatment for depression and a range of other mental health problems

  Cognitive element - CBT begins with assessment in which the client and the cognitive behaviour therapist work together to clarify the client's problems, jointly identify goals and put together a plan to achieve them, one of the central tasks to identify where there might be negative or irrational thoughts that will benefit from challenge

  Behaviour element - working to change negative and irrational thoughts and finally put more effective behaviours into place
• Biological Approach to Explaining OCD - Genetic Explanations

  Lewis (1936)

  Assessed 50 OCD patients at Maudsley Hospital in London: 37% parents + 21% siblings with OCD

  Runs in families, genetic vulnerability

  Diathesis-stress model, certain genes increase likelihood to develop mental disorder, environmental stress necessary trigger

  Candidate genes - create vulnerability for OCD, some involved regulating development of serotonin system, 5HT1-D beta implicated in the transport of serotonin across synapses

  Polygenic - OCD caused by combination of genetic variations that together significantly increase vulnerability

  Taylor (2013)

  Analysed previous studies, found 230 different genes may be involved in OCD, genes studied associated with dopamine + serotonin, both neurotransmitters have a role in regulating mood

  Aetiologically heterogeneous - origins of OCD differ between people, types of OCD result of particular genetic variations
• Drug Therapy

  Drugs to treat OCD increase level of serotonin in the brain

  SSRIs

  Tricyclics

  SNRIs
• SSRIs

  Selective serotonin reuptake inhibitor

  Standard medical treatment used to tackle symptoms of OCD

  Significantly reduces symptoms in around 70% of patients

  Antidepressant

  Serotonin released by presynaptic neurons and travels across a synapse, neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron where it is broken down and reused

  By preventing reabsorption and breakdown SSRIs increase serotonin in the synapse and continue to stimulate the postsynaptic neuron

  Fluoxetine, daily dose 20mg but may be increased, available as capsules or liquid

  Takes 3 to 4 months of daily use to have much impact on symptoms

  Drugs used alongside CBT

  Drugs reduced emotional symptoms so they can engage more effectively with CBT

  Occasionally other drugs are prescribed alongside SSRIs
• Alternatives to SSRIs

  30% don't respond to SSRIs

  When SSRIs not effective after 3/4 months dosage may increase or combined with other drugs

  Tricyclics - older type, clomipramine, acts on various systems including serotonin system, more serious side effects

  SNRIs - recent, different class of antidepressants, increase serotonin as well as noradrenaline

  Bogetto et al. (2000)

  Trialled a drug called olanzapine

  23 people who had not responded to SSRIs

  10 responded to olanzapine

  Mean symptom rating improved from 26.8 to 18.9 on the Yale Brown Obsessive Compulsion Scale
• Beck's Cognitive Therapy

  Identify automatic thoughts about the world, the self and the future (negative triad)

  Once identified these thoughts must be challenged

  Alongside challenging these thoughts directly, also aims to encourage the client to test the reality of their negative beliefs

  Might be set homework such as writing down every time someone was nice to them

  Client as a scientist, investigating the negative beliefs in the ways a scientist would

  In future if client says no one likes or is nice to them, therapist has evidence to debunk negative belief