Psychopathology

• What are the four definitions of abnormality?

  • statistical infrequency
  • deviation from social norms
  • failure to function adequately
  • deviation from ideal mental health
• Statistical infrequency

  > Any usual behaviour or characteristic can be thought of as ‘normal’, and any behaviour that is unusual is ‘abnormal’ - statistical infrequency

  > Example = IQ and intellectual disability disorder:

  Average IQ = 100, 68% have range between 85-115.

  Only 2% have score below 70 - unusual/‘abnormal’ - liable to receive diagnosis of intellectual disability disorder (IDD)

  Also a very high IQ can be known as a statistical infrequency
• Evaluation of statistical infrequency

  (+) real-world application: clinical practice - diagnosis and assessing severity of symptoms.

  E.g. diagnosis of IDD require IQ of under 70, and Beck's depression inventory (BDI) require 30+ score (top 5%) to indicate severe depression -> shows value in diagnostic & assessment processes

  (-) infrequent characteristics can be positive:

  Having an IQ about 130 wouldn't be deemed as abnormal neither would a low score on the BDI -> being at one end of spectrum doesn't necessarily make someone abnormal -> not sufficient for defining abnormality
• Deviation from social norms

  > People chose to define behaviour as abnormal on basis it offends what is ‘acceptable’ or the norm. Make collective judgement as society.

  > Norms are specific to culture: few behaviours universally ‘abnormal’ -> E.g. homosexuality considered abnormal in past, still considered abnormal (and illegal) in some cultures.

  > Example = antisocial personality disorder (psychopath): impulsive, aggressive and irresponsible. We make social judgement that psychopaths are abnormal - don’t conform to moral standards - would be classed as abnormal in wide range of cultures
• Evaluation of deviation from social norms

  (+) real-world application: clinical practice - antisocial personality disorder - fault to conform to culturally normal ethical behaviour I.e. aggression -> deviation from social norms criterion has value in psychiatry

  (-) variability in different cultures and situations: diff cultures may see other cultures actions as abnormal using their standards

  E.g. hearing voices is norm in some cultures (Afro-Carribean), abnormal in UK. difficult to judge across diff cultures
• Failure to function adequately

  >No longer cope with demands of everyday life - unable to maintain basic standards of nutrition and hygiene or maintain job or relationship

  > Rosenhan & Seligman proposed additional signs: no longer conform to standard interpersonal rules (maintain eye contact), person experiences severe personal distress, irrational and dangerous behaviour

  > Example = intellectual disability disorder - less than 70 IQ for diagnosis and failure to function adequately.
• Evaluation of failure to function adequately

  (+) represents sensible threshold for when people need professional help: many press on face fairly severe symptoms - be at point where failure to function adequately that people seek help or are referred to help by others -> treatment and services targeted to those who need them

  (-) easy to label non-standard lifestyle choices as abnormal: can be hard to say when someone is really failing to function and when they simply chose to deviate from social norms -> risk of being labelled abnormal and their freedom being restricted
• Deviation from ideal mental health

  > Can identify from what deviates from this ideal once pictures how we should be psychologically healthy.

  > Jahoda suggested following criteria (good mh): self-actualise, cope with stress, realistic view of world, independent

  > some overlap on deviation from ideal mh and failure to function adequately. inability to keep job as either failure to cope with pressures of work or deviation from ideal of successfully working
• Evaluation of deviation from ideal mental health

  (+) highly comprehensive: Jahoda's concept includes rangeof criteria for distinguishing mh -> mh can be discussed meaningfully with range of professionals who might take different theoretical views. means: provides checklist you can assess against yourself or with professionals

  (-) its different elements aren’t equally applicable across range of cultures: e.g. within Western Europe there’s quite a bit of variation in value placed in personal independence, e.g. high in Germany, low in Italy -> difficult to apply concept to different cultures.
• DSM-5 categories of phobias

  > All phobias characterised by excessive fear and anxiety, triggered by object, place or situation.

  > Extend of fear = out of proportion to real danger presented by phobic stimulus.

  > Specific phobia: phobia of object or situation, e.g. spiders, needles or flying

  > Social anxiety: phobia of social situation, e.g. public speaking

  > Agoraphobia: phobia of being outside or in public place
• Behavioural characteristics of phobias

  > Panic: response to presence of phobic stimulus e.g. crying, screaming or running away

  > Avoidance: make effort to prevent coming in contact with phobic stimulus - makes daily life complicated. E.g. fear of outside (agoraphobia) - unable to function in day-to-day life

  > Endurance: opposite of avoidance - remain in presence of phobic stimulus. Still suffers and experience high levels of anxiety
• Emotional characteristics of phobias

  > Anxiety: anxiety disorder = an unpleasant state of high arousal. Prevents person relaxing and difficulty experiencing any positive emotion.

  > Fear: Immediate and extremely unpleasant response when encounter or think about phobic stimulus. Usually more intense but experienced for shorter period than anxiety.

  > Emotional responses: unreasonable & irrational. anxiety or fear is disproportionate to 'danger' they are facing
• Cognitive characteristics of phobias

  > Selective attention to the phobic stimulus: if sees phobic stimulus - hard to look away from it. Can't focus on anything else

  > Irrational beliefs: may hold unfounded thoughts in relation to phobic stimuli. E.g. social phobias - ‘must always sound intelligent’. These beliefs increases pressure to perform well in social situations

  > Cognitive distortions: perception may be inaccurate and unrealistic. E.g. spiders angry and aggressive looking - feel like they running towards like to attack
• DSM-5 catergories of depression

  > All forms of depression and depressive disorders are characterised by changes to mood

  > Major depressive disorder: severe but often short-term depression

  > Persistent depressive disorder: long-term or recurring depression, including sustained major depression and what used to be called dysthymia

  > Disruptive mood days regulation disorder: childhood temper tantrums

  > Premenstrual dysphoric disorder: disruption to mood prior to and/or during menstruation
• Behavioural characteristics of depression

  > Activity levels: typically reduced levels of energy - lethargic. Withdraw from work, education and social life. Some cases = psychomotor agitation (struggle to relax)

  > Disruption to sleep/eating behaviour: reduced sleep (insomnia), particularly premature waking, increased need for sleep (hypersomnia). Appetite and eating may increase or decrease - weight gain or loss.

  > Aggression and self-harm: Irritable -> verbally or physically aggressive - end relationship or quit job (verbal), self-harm or suicide attempts (physical against self)
• Emotional characteristics of depression

  > Lowered mood: more pronounced of daily kind of experience of feeling lethargic and sad. Often describe themselves as ‘worthless’ and ‘empty’

  > Anger: Frequently experience anger - directed at self or others. On occasions such emotions lead to aggression and self-harming behaviour - why it appears under behavioural characteristics.

  > Lowered self-esteem: People with depression tend to have reduced self-esteem. Can be quite extreme - some describe themselves as self-loathing I.e. hating themselves.
• Cognitive characteristics of depression

  > Poor concentration: Unable to stick with a task they usually would, or might find it hard to make decisions they would normally find easy - likely to interfere with individuals work

  > Attending to and dwelling on the negative: Pay more attention to negative aspects of situation and ignore positives. Have bias towards recalling unhappy events rather than happy ones.

  > Absolutist thinking: ‘black-and-white’ thinking. Means: when situation is unfortunate they tend to see it as absolute disaster.
• DSM-5 categories of OCD

  > Repetitive behaviour accompanied by obsessive thinking

  > OCD: characterised by either obsessions (recurring thoughts, images, etc) and/or compulsions (repetitive behaviours such as hand-washing). Most diagnosed have both obsessions and compulsions

  > Trichotillomania: compulsive hair-pulling

  > Hoarding disorder: the compulsive gathering of possessions and the inability to part with anything, regarding of its value

  > Excoriation disorder: compulsive skin-picking
• Behavioural characteristics of OCD

  > Compulsions are repetitive: feel compelled to repeat behaviour. Common example is hand-washing.

  > Compulsions reduce anxiety: around 10% with OCD show compulsive behaviour alone - no obsessions, just general sense of irrational anxiety. For vast majority, compulsive behaviours performed in attempt to manage anxiety produced by obsessions.

  > Avoidance: avoidance as attempt to reduce anxiety by keeping away from situations that trigger it. E.g. those who wash compulsively may avoid coming into contact with germs -> could interfere with living normal life.
• Emotional characteristics of OCD

  > Anxiety and distress: Obsessive thoughts = frightening and unpleasant, with overwhelming anxiety. Urge to repeat behaviour (compulsion) creates anxiety.

  > Accompanying depression: OCD often accompanied by depression, so anxiety being accompanied by low mood and lack of enjoyment in activities. Compulsive behaviour tends to bring some temporary relief from anxiety.

  > Guilt and disgust: involves other emotions such as irrational guilt - over minor moral issues, or disgust, may be directed against something external like dirt or at the self.
• Cognitive characteristics of OCD

  > Obsessive thoughts: around 90% with OCD experience (recur over and over again). Vary but always unpleasant. E.g. worries of being contaminated by germs

  > Cognitive coping strategies: adopt cognitive coping strategies to deal with obsessions. May help manage anxiety but can make them appear abnormal to others and distract from everyday tasks.

  > Insight into excessive anxiety: aware obsessions and compulsions not rational - necessary for diagnosis. Tend to be hyper vigilant - maintain constant alertness and keep attention focused on potential hazards.
• What’s the two-process model?

  > Mower proposed two-process model beaded on behavioural approach to phobias.

  > An explanation for the onset and persistence of disorders that create anxiety such as phobias. The two processes are classical conditioning for onset and operant conditioning for persistence.
• Two-process model - acquisition by classical conditioning

  > Watson & Rayner - created phobia in 9 month old (Little Albert).

  > Showed no usual anxiety at start of study - when shown white rat, tried to play with it.

  > When rat present - loud noise (frightening). Noise = UCS which creates UCR of fear.

  > When rat (NS) and UCS encountered together in time - become associated together - both produce fear response.

  > Albert displayed fear when saw rat - rat now CS that produced CR.

  > Conditioning generalised to similar objects
• Two-process model - maintenance by operant conditioning

  > Phobias often long-lasting. Mowrer explained this as result of operant conditioning.

  > Takes place when behaviours reinforced or punished.

  > Mowrer suggested whenever we avoid phobic stimulus we successfully escape fear and anxiety we would have experienced if we remain there. This reduction in fear reinforces avoidance behaviour and so phobia maintained (negative reinforcement)
• Strengths of the two-process model

  > real-world application (exposure therapies): phobias maintained by avoidance of phobic stimulus - helps explain why people with phobias benefit from exposure - stops neg reinforcement, phobia weakens -> identifies means of treating phobias

  > evidence for link (bad experiences & phobias): Little Albert illustrates how experience involving stimulus can lead to phobia. confirms classical conditioning does lead to development of phobia

  > counterpoint: not all phobias appear following a bad experience (e.g. snakes) -> association not as strong of explanation.
• Limitation of the two-process model

  > doesn’t account for cognitive aspects of phobias: behavioural explanations are geared towards explaining behaviour. In case of phobias, key behaviour = avoidance of phobic stimulus.

  We know phobias aren’t simply avoidance responses - also have significant cognitive component. E.g. people hold irrational beliefs about phobic stimulus. Two-process model explains avoidance behaviour but doesn’t offer adequate explanation for phobic cognitions.

  Means: two-process model doesn’t completely explain symptoms of phobias
• What are the two behavioural approaches to treating phobias?

  • systematic desensitisation
  • flooding
• Systematic desensitisation - treating phobias (behavioural therapy)


  > Designed to gradually reduce phobic anxiety through classical conditioning.

  > Three processes:

  • anxiety hierarchy: list of situations linked to phobia - arranged least to most frightening.
  • relaxation: teaches client to relax as deeply as possible - impossible to be afraid and relaxed at same time.
  • exposure: client exposed to phobic stimulus while in relaxed state. Over several sessions - start at bottom of hierarchy. When stay relaxed move up hierarchy. Treatment successful when stay relaxed at top of hierarchy
• Evaluation of systematic desensitisation

  (+) evidence base for its effectiveness: Gilroy followed 42 people - had SD for spider phobia in 3x45min sessions. At both 3 & 33 months SD group less fearful than control group treated without exposure -> SD helpful for treating phobias

  (+) can be used to treat learning disabilities: some alternatives to SD aren’t suitable for those with learning disabilities and phobias - often struggle with cognitive therapies (require high level of rational thought)

  Means: SD often most appropriate treatment for people with learning disabilities who have phobias.
• Flooding - treating phobias

  > Exposing people with phobia to phobic stimulus without gradual build-up in anxiety hierarchy (immediate)

  > Typically longer sessions (2-3 hours) than systematic desensitisation

  > Sometimes only one session needed to cure phobia

  > Stops phobic response quickly - no option of avoidance behaviour, quickly learn phobic stimulus = harmless - may achieve relaxation in presence as exhausted by own fear response.

  > Not unethical but is an unpleasant experience - important clients give fully informed consent.

  > Normally given choice of SD or flooding
• Evaluation of flooding

  (+) highly cost effective: cost-effective if its clinically effective and not expensive. Can work in one session as opposed to ten sessions of SD for same result. Means: more people can be treated at same cost with flooding compared to other therapies.

  (-) highly unpleasant/traumatic experience: experience provokes tremendous anxiety. Schumacher found ppts and therapists rated flooding as significantly more stressful than SD. Raises ethical issues -

  knowingly causing stress, not serious as informed consent. traumatic nature means higher drop out rates -> may avoid
• What are the cognitive approaches to explaining depression?

  • Beck’s negative triad
  • Ellis’s ABC Model
• Beck’s negative triad - explaining depression

  > explains why some more vulnerable.

  > Faulty information processing: attend to negative aspects of situations, ignoring positives. Blow small problems out of proportion, think in ‘black-and-white’ terms

  > Negative self-schema: If person has neg self-schema, they interpret all info about themselves in neg way

  > Neg triad: neg view of world = ‘world is cold hard place’ - no hope, neg view of future = ‘isn’t much chance the economy will really get better’ - enhance depression, neg view of self: ‘I am failure’ - enhance existing neg self-schema.
• Evaluation of Beck’s negative triad

  (+) supporting research: ‘cognitive vulnerability’ refers to way of thinking that may predispose a person to becoming depressed (negative self-schema, etc). Clark & Beck concluded not only were these cognitive vulnerabilities more common in depressed people - confirmed in more recent study by Cohen -> shows association

  (-) partial explanation: Cognitive vulnerabilities partial explanation for depression. But, some aspects aren't particularly explained by cognitive explanations - anger, hallucination and delusions
• Ellis’s ABC model - explaining depression

  > Ellis proposed good mh is result of rational thinking - anxiety & depression result from irrational thoughts.

  > A - activating event: Focused on situation where thoughts triggered by external event -> triggers irrational beliefs, e.g. failing test.

  > B - beliefs: Identified range of irrational beliefs - called belief we must always succeed or achieve perfection.

  > C - consequences: emotional and behavioural consequences, e.g. if believe that they must always succeed but fail it could trigger depression.
• Evaluation of Ellis’s ABC model

  (+) real-world application in treatment: Rational emotive behaviour therapy (REBT). Idea REBT is vigorously argue in with depressed person the therapist can alter irrational beliefs that make them unhappy -> evidence that REBT can change negative beliefs and relieve symptoms -> real-world value

  (-) only explains reactive depression, not endogenous depression:

  Doesn't explain depression that isn't linked to life events, so no obvious causes (endogenous depression) -> so ABC model only explain some cases of depression (partial explanation)
• Cognitive behaviour therapy - treating depression

  > Cognitive: assessment - clarifies problems. Identify goals - plan. Identify negative/irrational thoughts - challenge.

  > Behaviour: work to change negative/irrational thoughts, effective behaviours in place.

  > Becks cognitive therapy: clients challenges beliefs in negative triad.

  > Ellis’s REBT: Extends ABC model - ABCDE - D = dispute, E = effect. identify & dispute irrational thoughts

  > Behavioural activation: work to gradually decrease avoidance and isolation, increasing engagement in acitivities that improve mood.
• Strength of cognitive behavioural therapy

  > evidence supporting its effectiveness for treating depression: many studies show CBT works. March compared CBT to antidepressant drugs and combination of both - 327 depressed adolescents. 36 weeks, 81% of CBT group, 81% drug group, 86% combined group significantly improved. Effective when used on own and alongside antidepressants - only requires 6-12 sessions -> cost-effective

  Means: CBT widely seen as first choice of treatment in public health care system (NHS)
• limitations of cognitive behaviour therapy

  > lack of effectiveness for severe cases & clients with learning disabilities: some so severe they can't motivate themselves to engage with cognitive work of CBT - also makes it unsuitable for those with learning disability -> CBT only appropriate for range of people with depression

  > high relapse rates: some recent studies suggest long-term outcomes are not good. Ali assessed 439 people every month for 12 months following course of CBT. 42% relapsed into depression within 6 months. 53% within a year -> CBT may need to be repeated periodically.
• What are the biological approaches to explaining OCD?

  • genetic explanations
  • neural explanations