Psychopathology

• Definitions for 'clinically abnormal' behaviour

  • Statistical Deviation
  • Deviation from social norms
  • Failure to function adequately
  • Deviation from ideal mental health
• Statistical Deviation

  Abnormal as behaviour is statistically uncommon.

  Characteristics measured using a normal distribution/bell curve and abnormal behaviour occupies the extreme ends.

  Relies on the use of up-to-date statistics.

  e.g. IQ scores:

  • Average IQ = 85-115
  • Statistically uncommon to have an IQ of 70 and below or 130 and over.
• AO3 Evaluation of statistical deviation

  Abnormal has negative connotations and we end up labelling desirable behaviour as abnormal.

  • Strengths: Objective measure, Can be useful in defining some abnormal behaviour e.g. intellectual disability, Real life application as useful part of clinical assessment.
  • Limitations: Infrequent behaviour can still be desirable, Labels can be harmful especially if someone is living happily. Difficult to know where line is between statistically normal/abnormal and subjective interpretation.
• Deviation from social norms

  Social norms = unwritten rules of acceptable behaviour made by collective judgements in society.

  Abnormal if behaviour offends our sense of what is 'acceptable' or the norm.

  Norms vary from culture to culture.

  e.g. homosexuality: still illegal and viewed as abnormal in cultures like Qatar.
• AO3 Evaluation of deviation from social norms

  • Limitations: Subjective. Ethnocentric so difficult to determine universal signs of illness. Not a sole definition (cannot be used alone when defining abnormality). Can lead to abuse of human rights (in the past to control women and minority groups). Not all behaviour that deviates from social norms is a sign of illness (speeding). Social norms lack temporal validity- as they can change over time.
• Failure to function adequately

  Abnormal if a person can no longer face the demands of everyday life.

  Rosenhan and Seligman (1989) proposed signs that illustrated failure to function adequately:

  • No longer conforming to interpersonal rules, e.g. eye contact
  • Serve personal distress or causing distress of others
  • Behaviour becomes maladaptive or irrational and dangerous to themselves or others.
• AO3 Evaluation of failure to function adequately

  • Strengths: Represents a threshold for help and when we should seek professional help.
  • Limitations: Discrimination and social control as easy to label as abnormal, failure to function can be normal e.g. when someone is grieving- this is not abnormal.
• Deviation from ideal mental health

  The more criteria someone fails to meet, the more abnormal they are:

  • Marie Jahoda's (1958) criteria for ideal mental health:
  • No symptoms of distress
  • Rational and able to perceive ourselves accurately
  • Can self actualise
  • Can cope with stress
  • Realistic view of world
  • Good self esteem and lack of guilt
  • Independent of other people/ autonomy
  • Can successfully work, love and enjoy leisure time
• AO3 Evaluation of deviation from ideal mental health

  • Strength: It's a comprehensive definition- broad range of criteria for mental health
  • Limitations: Cultural relativism- personal achievement and self actualisation would seem self-indulgent to collectivist cultures, Unrealistically high standard for mental health- could make people with poor mental health feel worse.
• Behavioural approach to explaining phobias

  Mowrer's Two Process Model (1960)

  • Phobias are learned
  • Phobias are acquired via classical conditioning
  • Phobias are maintained via operant conditioning
• Acquisition of phobias (CC)

  • Initially phobic stimulus is neutral as we have no fear.
  • We associate the neutral stimulus with something which already triggers a fear response- unconditioned stimulus.

  E.g Watson and Rayner- Little Albert: fluffy animals initially produced no fear, however when combined with a loud noise, Albert was conditioned into feeling fear. Fear can then be generalised as Albert was then scared of similar objects like white Santa Claus beard.
• Maintenance of phobia (OC)

  OC occurs when behaviour is reinforced or punished.

  Negative and positive reinforcement increases frequency of behaviour.

  • Negative reinforcement is key- avoiding an unpleasant situation maintains the phobia.
  • As by avoiding the phobic stimulus, we negatively reinforce the behaviour as we have avoided any fear or anxiety.
  • This reduction in fear/anxiety reinforces avoidance behaviour and phobia is maintained.
• Behavioural approach to treating phobias

  1. Systematic Desensitisation
  2. Flooding
• Systematic Desensitisation

  Uses counter conditioning to unlearn the maladaptive (negative response to a situation or object, by eliciting another response (relaxation).

  1.Establish a fear hierarchy

  The client and therapist work together to rank phobic situations from least to most terrifying.

  2.Relaxation

  Individual is taught relaxation techniques- like breathing, muscle relaxation or mental imagery.

  Alternatively can be achieved using drugs like Valium.

  This works because a person is unable to be anxious and relaxed at the same time and the relaxation should overtake the fear (reciprocal inhibition)

  3.Exposure

  Patient is exposed to the phobic stimulus while in a relaxed state.

  Takes place across several sessions, starting at bottom of hierarchy, they move up when they can remain relaxed. Treatment is successful when patient stays relaxed in high anxiety situations on hierarchy.
• What categories does the DSM recognise of phobia and related anxiety disorder?

  • Specific phobia: phobia of an object, such as an animal or body part, or a situation such as flying or having an injection.
  • Social anxiety (social phobia): phobia of a social situation such a public speaking or using a public toilet.
  • Agoraphobia: phobia of being outside or in a public place.
• Behavioural characteristics of phobias

  • Panic: A phobic person may panic in response to the presence of the phobic stimulus. Panic may involve a range of behaviours including crying, screaming or running away. Children may react by freezing, clinging or having a tantrum.
  • Avoidance: Unless the sufferer is making a conscious effort to face their fear they tend to go to a lot of effort to avoid coming into contact with the phobic stimulus. This can make it hard to go about daily life.
  • Endurance: Alternative to avoidance is endurance, in which a sufferer remains in the presence of the phobic stimulus but continues to experience high levels of anxiety.
• Emotional characteristics of phobias

  • Anxiety and Fear: Phobias are classed as anxiety disorders. Anxiety is an unpleasant state of high arousal. Fear is the immediate and extremely unpleasant response we experience when we encounter or think about the phobic stimulus.
  • Emotional responses are unreasonable: E.g. fear of small spiders (arachnophobia) involves a very strong emotional response to a tiny and harmless spider. Widely disproportionate to the danger posed by any spider.
• Cognitive characteristics of phobias

  • Selective attention to the phobic stimulus: If a sufferer can see the phobic stimulus it is hard to look away from it. Keeping our attention on something really dangerous is a good thing as it gives us the best chance to react to a threat, but not so useful when the fear is irrational.
  • Irrational beliefs: A phobic may hold irrational beliefs in relation to phobic stimuli.
  • Cognitive distortions: The phobic's perceptions of the phobic stimulus may be distorted. E.g. omphalophobic is likely to see belly buttons as ugly and/or disgusting.
• What characteristics does the DSM recognise of depression and depressive disorders?

  • Major depressive disorder: severe but often short term depression.
  • Persistent depressive disorder: long term or recurring depression and what used to be called dysthymia.
  • Disruptive mood dysregulation disorder: childhood temper tantrums.
  • Premenstrual dysphoric disorder: disruption to mood prior to and/or during menstruation.
• Behavioural characteristics of depression

  • Sleep disturbance (insomnia/hypersomnia)
  • Changes in eating patterns/appetite
  • Social withdrawal
  • Reduced movement
  • Reduced energy
  • Reduced speech
• Cognitive approach to treating depression

  Challenging irrational thoughts through...

  • Rational confrontation: ABCDE model- D for dispute and E for effect (reduction of irrational thoughts), shame attacking activities, empirical and logical argument (Ellis)
  • Patient as scientist, data gathering to test validity of irrational thoughts, reinforcement of positive beliefs (Beck)
• Biological approach to treating OCD

  • Drug therapy to 'correct' imbalance of neurochemicals e.g. serotonin, to reduce symptoms associated with OCD
  • SSRIs- prevent the reabsorption and breakdown of serotonin in the brain, continue to stimulate the postsynaptic neuron
  • Timescale: 3-4 months of daily use for SSRI's to impact upon symptoms
  • Alternatives to SSRIs: tricyclics, SNRIs
  • Other drugs: benzodiazepines for general relaxation and reduction of anxiety