Psychopathology

Question 1

Definitions of Abnormality

Answer 1

4 Definitions- Deviation from social norms, Failure to Function, Statistical infrequency, Deviation from Ideal Mental Health
For each- A01 must be outlined as well as an example of a disorder and how the definition may define it

Deviation from social norms- OCD
Failure to Function- Depression
Statistical infrequency- IQ & Intellectual Disability disorder
Deviation from Ideal Mental Health- Depression

Question 2

Deviation from Social Norms

Answer 2

Social norm rule for behaviour based on moral standards
Person behaves different from expectation (social norm) classed as abnormal
Example-OCD
Obsession germs, compulsion to wash their hands
Do this hundreds of times, unable live normal life
Not fitting in what we expect in society
Social norm- wash hands once
3 marks A01

Question 3

Deviations from Social Norms Evaluation

Answer 3

Real World Application- Clinicians use this to diagnose abnormality, to diagnose antisocial personality disorder one of the criteria absence prosocial standards (social normal), useful +ve

Counterpoint for above- Part of diagnosis never whole reason, cannot say someone abnormal break social norms, other criteria as well -ve

Cultural Relativism- definition invalid to define abnormality in different groups from own, e.g., speak in tongues we see gibberish Christians see good close to God, not accurate not universal limited, failed definition -ve

6 marks worth of Evaluation (A03)

Question 4

Failure to Function Adequately

Answer 4

Individuals’ behaviour interfere functioning, cannot meet day to day demands in life e.g., holding job, hygiene

Rosenhan & Seligman (1989) proposed criteria for not coping with a normal everyday life, more met more abnormal

Showing signs of distress (emotional signs not able to cope)
Maladaptive behaviour (Behaviour prevents achieving goals like lack motivation)
Unconventional behaviour (Behaving in a way odd, unusual)
Unpredictable behaviour (Unexpected behaviours involving lack of control)
Causing Observer discomfort (Act in way makes others not want to be around you)

Example- Depression may not get out of bed, go to work, interferes with their functioning lead to distress, cause family discomfort

Question 5

Failure to Function Adequately Evaluation

Answer 5

Sensible threshold for deciding when people need professional help, when we cease to function adequately, we seek help, others notice refer help from others, useful because we can target people who need help the most +ve

Discrimination and social control, definition makes it easy to label non-standard lifestyles as abnormal, class high risk leisure activities unreasonably as irrational, danger to self, potentially reduces their freedom of choice to do these activities -ve

Only defines abnormality when person F2F, some abnormal people function well not seen as abnormal Example Dr Harold Shipman respectable doctor, father killed 250+ patients, not useful some abnormal people do not F2F adequately -ve

Question 6

Statistical Infrequency

Answer 6

Define normal, abnormal down to number of times observed

Any behaviour different / statistically rare abnormal, for example on both ends of a normal distribution

Example- IQ & Intellectual disability disorder
Behaviour statistically infrequent when 2 SD or more from mean
IQ normally distributed Average / mean IQ 100
Most IQ 85-115 below 70 seen as statistically rare

Abnormal can be diagnosed with intellectual disability disorder

Question 6

Statistical infrequency Evaluation

Answer 6

Real World Application- Useful for clinicians in the diagnosis of intellectual disability disorder, below 70 severe deficit compared against social norm (average 100 IQ) +ve

Says all statistical infrequent behaviour / traits are abnormal, incorrect geniuses IQ top 2%, definition fails to acknowledge rare can be positive and desirable +ve

Abnormal behaviours can occur frequently, does not have to be rare, depression 25% population experience mental health issue at some point in their lives, definition does not take into account the fact abnormality is not always rare -ve

Question 7

Deviation from Ideal Mental Health

Answer 7

Marrie Jahoda (1958) tries define normality (good mental health) rather than abnormality, came up with following criteria

Self-actualisation (fully achieve potential)
Coping with stress (Cope with demands of different situations)
Realistic view of world (realistic perceptions not affected by delusions)
Good self esteem and lack of guilt
Being autonomous (Independent of other people)

More criteria met more normal you are
Less criteria met more abnormal you are

Question 8

Deviation from Ideal Mental Health Evaluation

Answer 8

Comprehensive definition, covers broad range of relevant criteria, depression (low self-esteem), anxiety (can’t deal stress), good tool for thinking about mental health +ve

Culture bound, only useful for western cultures, western individualist, self-actualisation makes sense to us, collectivist want to see group success do not aspire to self-actualisation, definition only works for Western and Individualists culture -ve

Very high standards, too many people “abnormal” very high standards we cannot attain, very few achieve full self-actualisation definition calls large number of people not fully mentally healthy therefore somewhat abnormal, clearly incorrect -ve

Question 9

Characteristics of Phobia

Answer 9

Behavioural (actions)- Panic, Endurance and Avoidance
Panic involves range of behaviours (crying, screaming, running away)
Avoidance, go out of their way to avoid stimulus (different route avoid dog)
Endurance, individual chooses to remain in presence of phobic stimulus

Emotional (feelings)- Anxiety and Fear
Anxiety, high arousal prevents relaxing difficult experience positive emotion
Fear immediate unpleasant response encounter phobic stimulus
Emotional responses unreasonable, wildly inappropriate to the danger posed by the stimulus (screaming, upset by Button)

Cognitive (information processing)- Selective attention and Irrational beliefs
Selective attention, stimulus seen difficult focus on anything else struggle concentrate anything else
Irrational beliefs, beliefs stimulus not rational, social phobias may think “must always sound intelligent”
Cognitive distortions, perception of person with phobia may be inaccurate and unrealistic

Question 10

Behavioural Approach Explaining Phobias

Answer 10

Behavioural approach explaining Phobias is the Two process model

CC, learning association, how phobia acquired
Phobic stimulus starts as NS (Dog), UCS (Bitten by Dog), UCR (Fear)
UCS + NS becomes CS (Dog) with CR (Fear)

OC learning reinforcement how phobia maintained
Person moves away Phobic Stimulus, anxiety decreases, negative reinforcement, continue avoid phobic stimulus, reinforcing the phobia

Question 11

Behavioural Approach Treating Phobias

Answer 11

Therapies based 2 process model aim counter condition phobia
Associate object relaxation rather than fear
Person stays with phobic stimulus avoid running away prevent -ve reinforcement

Systematic Desensitisation, relaxation use of anxiety hierarchy, Hierarchy situations related phobic stimulus provoke anxiety ordered, relaxation techniques (Mediation, imagine relaxing situation, breathing exercises) attempt to relax quickly and deeply, exposed stimulus while practising relaxion techniques move a long hierarchy so long as patient relaxes at previous stage, success stay relaxed higher in hierarchy

Flooding- Expose phobic stimulus immediately, very frightening, stops phobic responses very quickly, avoidance not an option learn phobic stimulus harmless (extinction) CR Extinguished

Question 12

Behavioural Treatments of Phobias Evaluation

Answer 12

SD effective Gilroy et al (2003) 42 patients exposed phobic stimulus according to anxiety hierarchy, control group relax no exposure, SD greater improvements relaxation may inhibit fear but exposure also required +ve

Flooding more effective, study showed real life exposure the most effective less time consuming, extinction occurs +ve

SD appropriate people learning disabilities, easy to understand slow and steady process +ve

SD less traumatic preferred by patients, Flooding causes more attrition (drop outs) but is a lot more cost effective +ve

Question 13

Characteristics of Depression

Answer 13

Behavioural (actions)- Activity Levels, Changes to Sleep and Aggression
Activity Levels High (Struggles to relax) Low (withdraw from work)
Changes to Sleep Reduced (Insomnia) Increased (Hypersomnia)
Aggression Outwards (verbally, physically) Inwards (Self Harm)

Emotional (feelings)- Lowered Mood, Anger and Self Esteem
Lowered Mood (feel worthless) and Self Esteem (Like themselves less, self-loathing)
Anger towards self or others
Cognitive (information processing)- Poor Concertation, Attention to dwelling on negatives and Absolutist thinking
Poor Concertation (straightforward decisions hard)
Attention to dwelling on negatives (Ignore positives, recall past events)
Absolutist thinking (Black and white thinking, everything all good or bad)

Question 14

Cognitive Approach to Explaining Depression

Answer 14

Becks negative triad- Faulty Information Processing, Negative self-schemas and Negative Triad
Faulty Information Processing (Selectively attend negatives in situation, blow small problem out of proportion), Negative self-schemas (Interpret all info about self negatively)
Negative Triad (Negative view of self, world, future)
Beck suggests that some people are more vulnerable to depression than others, 3 parts that make up this cognitive vulnerability that are discussed above

Ellis ABC Model- Activating Event may trigger, Individual Beliefs lead to Consequence, event negative beliefs may be irrational consequence may be depression, Irrational Belief “no reply hate me”
Ellis suggests that depression and anxiety are a result of irrational thoughts, he defined irrational thoughts as thoughts that interfere with being happy and free from pain

Question 15

Cognitive Approach to Treating Depression Beck’s CBT

Answer 15

Becks Cognitive Behaviour Therapy (CBT) challenge negative triad of client
Client assessed discover severity, baseline (starting point) established monitor progress
Client provides info perceive themselves future world
Reality testing client says “I always fail” asked in reality successful in something (assess situation for what it is, see negative beliefs are a reality)
Patient as Scientist evidence recorded against negative thoughts e.g., nice event
Attempts to replace negative thinking with positive i.e., challenging them

Question 16

Cognitive Approach to Explaining Depression Evaluation

Answer 16

Support Clark and Beck (1999), cognitive vulnerabilities more common in depressed people but they preceded (Came before) depression, shows association between cognitive vulnerability and depression prospective study Joseph (2019) found Cog Vul predicted later depression (Becks) +ve

Real world application, therapy alter cognitions that were making people vulnerable to depression, makes them more resilient negative events (Becks) +ve

Evidence Depression caused genetics, Zhang (2005) found gene 10x more common in depressed people, genetic factor not taken into consideration incomplete, may not be down to thought (Beck, Ellis) wrong -ve

ABC requires cause (A) only one type depression involves cause (Reactive) does not explain all depression misses endogenous depression (Ellis) -ve

Question 17

Cognitive Approach to Treating Depression Ellis REBT

Answer 17

Rational Emotive Behaviour Therapy ABCDE model

Dispute, challenge the thoughts Effect, see beneficial effect on thoughts behaviour
Irrational beliefs challenged argument to break link between negative life events depression, done through following

Empirical argument disputing evidence exists that support negative belief
Logical argument disputing negative thought logically follows on from fact

Behavioural activation- encourage to engage enjoyable activities.

Question 18

Cognitive Explanations of Depression Evaluation

Answer 18

ABC model produced successful therapy (Real world application), Lipsky (1980) found effective treating depression, explanation produces practical application, Therapy involves questioning irrational thinking to address Belief’s client has (Ellis) +ve

Blame client for depression saying caused by negative / irrational thoughts, does give client control over disorder also places unfair blame on them, ignores clients past and current life experiences may be the real cause (Beck and Ellis) -ve

Ethical Issues of the above -ve

Question 19

Cognitive Treatments of Depression Evaluation (Beck & Ellis)

Answer 19

Real World Application- March et al (2007) found CBT alone just as effective drugs alone, both together best treatment, CBT is effective +ve

CBT not working severe depression, CBT hard work need to contribute difficult when severely depressed, may not work for everyone, not enough energy to challenge -ve

CBT has high relapse rates, effective short term, long term does not stay as positive, study followed 400 over 1 year half relapsed (depressed again) within a year, prone to relapse -ve

CBT focus present future not past, depression can be caused earlier events, ignored may need to be talked about, not good people past trauma -ve

Question 20

Characteristics of OCD

Answer 20

Behavioural (actions)- Compulsive Behaviour and Avoidance

Compulsive Behaviour (need to do)- repetitive behaviour (hand washing) compelled to repeat, reduce anxiety compulsions temp lower anxiety produced by obsessions (hand wash response fear of germs)

Avoidance (Lower anxiety keep away situation, avoid germs by not emptying bins, could interfere with normal life)

Emotional (feelings)- Anxiety/Distress, Depression and Guilt/Disgust

Anxiety/Distress (thoughts unpleasant frightening increase anxiety) as well as urge to repeat

Depression (accompanies OCD, low mood, lack enjoyment activities)

Guilt/Disgust directed inwards or outwards

Cognitive (information processing)- Obsessive Thoughts, Excessive Thoughts and Hyper Vigilant

Obsessive Thoughts (repeat)

Excessive thoughts (catastrophic worse case)

Hyper Vigilant (alertness)

Question 20

Biological Approach to Explaining OCD Genetic

Answer 20

Genetic- Family history (Lewis 1936) OCD patients 37% parents OCD, 21% Siblings OCD could be genetic link most likely passing genetic vulnerability

Diathesis stress (gain vulnerability to OCD through genes) environmental stressor required (experiencing stress like when someone dies)

OCD thought to be polygenic (few genes 230 not just one)

Candidate genes (Create vulnerability)- COMT and SERT

COMT gene involved production of enzyme (catechol-o-methyltransferase) which regulates dopamine, gene causes low level of this enzyme, increases levels of dopamine = OCD

SERT gene creates protein removes serotonin recycles it, if gene creates more protein less serotonin level = OCD

Question 21

Biological Approach to Explaining OCD Evaluation Genetic

Answer 21

Research Support- variety sources suggest some people vulnerable OCD result of their genetic makeup, Twin studies found 68% identical twin shared OCD as opposed to 31% non-identical twins, suggest genetic influence on development of OCD +ve

Environmental risk factors, OCD not appear to be entirely genetic, environmental risk factors also trigger or increase risk of developing OCD, found in one study over half the OCD clients experienced traumatic event in past, OCD more severe those with one or more traumas, genetic only partial explanation for OCD -ve

Animal Studies- Found particular genes are associated with repetitive behaviour in other species such as mice, animal extrapolation cannot be generalised -ve

Question 22

Biological Approach to Explaining OCD Neural

Answer 22

Low Serotonin- Serotonin regulates mood, low = abnormal transmission of mood relevant information and mood

Basal Ganglia- Hypersensitivity gives rise to repetitive motor behaviours seen in OCD e.g., repetitive washing / cleaning / checking

Left parhippocampal gyrus- associated with processing unpleasant emotions these functions abnormally in OCD

Question 23

Biological Approach to Explaining OCD Evaluation Neural

Answer 23

Research support- Antidepressants effective reducing OCD symptoms, serotonin may be involved in OCD, biological disorder produces OCD symptoms we may assume biological processes underlie OCD, bio factors may be responsible for OCD +ve

No unique neural system- serotonin OCD link may not be unique to OCD, comorbidity (two disorders) of OCD depression, Depression involves disruption to action of serotonin, cannot assume serotonin causes OCD could be depression -ve

Correlation and causality, some neural systems not work normally in people with OCD correlation not cause and effect -ve

Question 24

Biological Approach to Treating OCD Drug Therapy

Answer 24

Drug Therapy- chemical cause chemical treatment

SSRIs (selective serotonin reuptake inhibitors) works on increasing serotonin in brain by preventing reabsorption of serotonin to the presynaptic neuron, increased levels in synapse continue to stimulate post synaptic neuron e.g., 20mg Fluoxetine daily

Combining SSRIs with other treatment- Alongside CBT, reduce emotional symptoms (anxiety, depression) so patient can engage more effectively with CBT

Question 25

Biological Approach to Treating OCD Drug Therapy

Answer 25

Alternatives to SSRIs

SSRI not effective after 3 4 months dose can be increased or combined with other drugs

Patients respond differently different drugs, alternatives great some not at all others

Tricycles- Same effect on serotonin system as SSRIs, more side effects

SNRIs- Increase serotonin and noradrenaline

Question 26

Behaviourist Approach to Explaining Phobias Evaluation

Answer 26

• RWA, exposure therapies, when avoidance prevented phobia is cured
• Shows value of two-process approach, identifies means of treating phobias
• Does not account cognitive aspects, model explains avoidance behv, does not offer adequate explanation for phobic cognitions
• Model not complete, does not explain symptoms of phobias
• Link between phobias and traumatic experiences, Little Albert, when Albert played with rat, loud noises played close to Albert
• Noise (UCS), Rat (NS), Fear (UCR), Rat (CS), Fear (CR)
• Conditioning generalised to similar objects, Albert did not like furry objects
• Systematic evidence, De Jongh et al, 73% people with fear of dental treatment experienced traumatic experience involving dentistry
• Compared to control group with low dental anxiety, only 21% experience traumatic event
• Confirms association between stimulus and unconditioned response does lead to development of phobia
• Counterpoint, not all phobias stem from bad experience, snake trauma happens in populations with no snakes, also not all frighting experiences leads to phobias
• This suggests association not as strong as we would expect, explanation incomplete
• Model credible for individual explanations of phobias, however, phobias do have general properties that may be better explained by evolutionary theory
• Preparedness, suggests we tend to acquire phobias that presented danger in evolutionary past (darkness, animals)
• Phobia developed because it is an adaptive advantage to fear these objects rather than association with anxiety
• Two process model only provides partial explanation for phobias

Question 27

Evaluation for deviation from social norms

• RWA|CSR|HRA

Answer 27

• Real-world application
• Cultural and situational relativism
• Human rights abuse

Question 28

Real-world application

Answer 28

• Strength, usefulness, used in clinical practice
• For example, key defining charac of antisocial personality disorder is failure to conform to culturally acceptable ethical behv
• Instead, they act reckless and aggressive, violate rights of others and act deceitful (dishonest), all these behvs are deviations from social norms
• Shows this definitions criterion has value in psychiatry

Question 29

Cultural and situational relativism

Answer 29

• Limitation, variability between social norms in different cultures and different situations
• Ppl from one cultural group may label something in another as abnormal using their standards (Imposed etic)
• Example, “speaking in tongues” seen by Christians as being close to God, the rest of us may not see this
• The norms, values, ethics and moral standards can only be meaningful and understood within a specific social and cultural context
• Aggressive and deceitful behv in context off family life is more socially unacceptable than in context off corporate deal-making
• This means it’s difficult to judge the definition across different situations and cultures, lacks universality

Question 30

Human rights abuse

Answer 30

• This definition carries a risk of unfair labelling, leaving ppl open to human rights abuse
• In the past, nymphomania (women’s high sex drive) used to control women
• On the other hand, we need this definition to diagnose conditions like APD and schizotypal disorder where socially unacceptable behv is the defining feature of the disorders
• This means the use of this definition has been abused in history and could potentially cause more harm than good