4.1.4 - Psychopathology

• Statistical infrequency


  Abnormality is defined as behaviour or characteristics that are rare/uncommon/unusual
• Statistical infrequency


  • Occupies the extreme ends of a normal distribution curve, e.g. low IQ defined as intellectual disability disorder
  • The average IQ is ___ Most people (68%) range between ___ Only 2% have a score below 70
• Statistical infrequency relies on the use of up-to-date statistics
• Statistical infrequency


  • Useful in diagnosis, e.g. intellectual disability disorder requires an IQ in the bottom 2%
  • Helpful in assessing a range of conditions, e.g. the BDI assesses depression, only 5% of people score 30+ (= severe depression)
  • Means statistical infrequency is useful in diagnostic and assessment processes
• Unusual characteristics can be positive, some statistically infrequent behaviour is desirable/highly regarded, e.g. high IQ
• A very low depression score on the BDI would not be seen as abnormal, despite being unusual or at one end of a psychological spectrum
• Statistical infrequency may only form part of assessment and diagnostic procedures and not the sole basis for defining abnormality
• Deviation from social norms


  • All societies make collective judgments about what counts as 'normal'/usual/typical behaviour
  • Any behaviour that does not conform to accepted/expected standards is undesirable and abnormal
• Deviation from social norms


  • Norms vary from culture to culture
• A person from one culture may label someone from another culture as abnormal using their standards rather than the person's standards
• Hearing voices is socially acceptable in some cultures but would be seen as a sign of abnormality in the UK
• It is difficult to judge deviation from social norms from one context to another
• Not all behaviour that deviates from social norms is a sign of illness, e.g. speeding
• Human rights abuse carries the risk of unfair labelling and used for social control, e.g. drapetomania (black slaves running away) were a way to control enslaved people and avoid debate
• Deviation from social norms is necessary for diagnosing conditions such as anti-social personality disorder, where the societal norm is a defining factor
• Deviation from ideal mental health

  • Absence of signs of mental health used to judge abnormality
  • Failure to meet (Jahoda's) criteria − inaccurate perception of reality; problems with self-actualisation; inability to cope with stress; negative attitude towards self; lack of autonomy/independence; poor environmental mastery, self actualisation
  • The more criteria someone fails to meet, the more abnormal they are
• Criteria for deviation from ideal mental health are too demanding - most people would be judged abnormal based on this definition; many aspects not being met is a normal part of life
• Deviation from ideal mental health criteria reflect Western cultural norms of psychological 'normality', e.g. self-actualisation (could be seen as self-indulgent/selfish) and independence (drawing upon and communicating support, could be seen as mentally healthy instead)
• Success in our working, social and personal lives may vary in different cultures
• Failure to function adequately

  • Abnormality judged as inability to deal with the demands of everyday living e.g. not being able to hold down a job, maintain relationships or maintain basic standards of nutrition and hygiene
  • Behaviour is maladaptive, irrational, unpredictable or dangerous
  • Behaviour causes personal distress and distress to others
• Many mental disorders do not cause personal distress; many behaviours, e.g. smoking, are maladaptive but not a sign of psychological abnormality
• What is considered adequate in one culture might not be so in another
• Failure to function adequately might not be linked to abnormality but to other factors, e.g. failure to keep a job may be due to the economic situation not to psychopathology
• Failure to function adequately is context dependent; not eating can be seen as failing to function adequately but prisoners on hunger strikes making a protest can be seen in a different light
• Phobias


  An extreme and irrational fear of an object / situation / activity that leads to avoidance
• Categories of phobias (DSM-5)

  • Specific phobia: of an object/body part/situation (e.g. enclosed spaces or heights)
  • Social phobia: of a social situation e.g. public speaking
  • Agoraphobia: being outside or public space
• Behavioural characteristics of phobias

  • Panic
  • Avoidance
  • Endurance
• Emotional characteristics of phobias

  • Anxiety
  • Fear
• Cognitive characteristics of phobias

  • Selective attention
  • Irrational beliefs
• Two-process model of phobia development

  • Development of phobia through classical conditioning – association of fear/anxiety with neutral stimulus to produce conditioned response; assumes experience of traumatic event; generalisation of fear to other similar objects; one trial learning
  • Maintenance of fear through operant conditioning – avoidance of phobic object/situation is negatively reinforcing; relief as reward/primary reinforcer
• Many people with phobias cannot identify incident/trauma e.g. snake conditioning is not the only way fears are acquired, some phobias have an evolutionary aspect − a biological preparedness
• The two-process model is a reductionist approach, other factors such as cognitive irrational beliefs/catastrophising, psychodynamic explanation (unconscious conflict, ego displace onto something external e.g. Little Hans), diathesis-stress may also play a role
• Systematic Desensitisation (SD)


  • Anxiety hierarchy created by client and therapist designing a list or hierarchy of frightening/ stressful events or objects
  • Relaxation training, e.g. breathing techniques, imagery or meditation. It is impossible to be afraid and relaxed and afraid at the same time, one emotion prevents the other→ reciprocal inhibition
  • Gradual exposure to the anxiety hierarchy
  • At each stage, if the client becomes upset they can return to an earlier stage and regain their relaxed state
  • Exposure: to phobic stimulus, a new response is learned→ e.g. relaxation =counterconditioning
• Flooding


  • Immediate/direct/full exposure, no build up
  • Flooding sessions are usually longer than SD sessions, e.g. 2-3 hrs. Sometimes only 1 session is needed to cure a phobia
  • Prevention of avoidance. Example
  • Until they are calm/anxiety has receded/fear is extinguished
• Systematic Desensitisation and Flooding are reductionist approaches to treatment
• Systematic Desensitisation is effective, Gilroy (2003) followed up 42 people with a spider phobia in 3 45min sessions. At both 3 and 33months the SD group were less fearful
• Flooding has high attrition rates, which raises ethical concerns and questions about its effectiveness
• Flooding is cost-effective
• Comparison between Systematic Desensitisation, Flooding, and alternative therapies would be useful
• Obsessive Compulsive Disorder (OCD)


  • An anxiety disorder characterised by obsessions (recurring and persistent thoughts) and/or compulsions (repetitive behaviours)
  • The DSM system recognises OCD and a range of related disorders, where repetitive behaviour is accompanied by obsessive thinking