What are the 4 D’s used to define psychological abnormality?
- deviant
- distressing
- dysfunctional
- dangerous
What is meant by “deviant”?
Being different to what you would expect
e.g. behaviour that may be unusual, extreme
What is meant by “distressing”?
Having unpleasant experiences that are very upsetting to the individual
What is meant by “dysfunctional”?
The inability to conduct daily activities and maintain social relationships
What is meant by “dangerous”?
The individual poses a danger both to themselves and to others
What is the main problem with defining abnormality?
Abnormality is relative to society/ cultural norms and values
What may appear “abnormal” or deviant to one group may be completely normal for another group
What is the problem with having agreed definitions for abnormality?
They are often not applied consistently
e.g. for alcohol dependence, the recommended healthy alcohol intake is often changed and what defines dependence is changed
What is the ICD-10?
International classification of disease
It has diagnosis criteria and treatment options of every disease
What are the 7 broad categories of mental health disorders under ICD-10?
- organic disorders - e.g. dementia
- psychoactive substance use
- psychotic disorders
- mood, stress and anxiety disorders
- physiological disorders e.g. eating disorders
- development disorders
- disorders of childhood e.g. ADHD, autism
According to the Adult Psychiatric Morbidity Survey, how many adults in England have a common mental disorder?
Around 1 person in 6
In which groups was the prevalence of mental disorders higher?
- single or divorced individuals
- living alone
- in receipt of state benefits (lower income)
How were mental disorders seen to relate to physiological disorders?
There is a comorbidity with chronic physical illness
e.g. cancer, asthma, diabetes, epilepsy, high blood pressure
What is the “key high risk group” when it comes to mental illness?
Young women
What percentage of GP appointments are taken up by mental health disorders?
30%
The appointments also require more time per appointment
What are the most prevalent mental health disorders?
Why are they difficult to diagnose?
- generalised anxiety disorder
- depressive episodes
- mixed anxiety and depressive disorder
The presentations of anxiety and depression overlap - and they may be symptoms of an underlying physical health problem
What are the 5 categories of anxiety disorders?
- panic disorder
- post-traumatic stress disorder (PTSD)
- generalised anxiety disorder
- obsessive compulsive disorder (OCD)
- phobias
What do the 5 anxiety disorders have in common in terms of character?
There are 4 quadrants of features that are shown in mental health disorders
- physiological/somatic (heart racing, muscle tension)
- subjective experience (terror, dread)
- behaviour (escape, unable to move)
- cognition (“I’m dying”)
What is the biological focus to treatment for mental health disorders?
- neurotransmitters and brain imaging
2. pharmacological management
e. g. benzodiazepines, SSRIs
What is the psychological focus to treatments for mental health disorders?
- learning mechanisms
2. psychological interventions such as education, relaxation and CBT
What are the stages in the self-maintaining cycle of symptoms of panic disorder?
- physical sensation, thought or image perceived as threatening
- anxiety
- physical sensations (e.g. rapid heart beat, chest pain, etc.)
- catastrophic interpretation of physical symptoms
- amplification of anxiety and physical sensations
- hyper-vigilance
What is involved in the maintenance of panic disorder?
- person pays selective attention to bodily events
- they have in-situation safety behaviours
- avoidance of the situation in future
How do people try to cope with anxiety, which leads to maintenance of the condition?
They avoid situations that they know will cause them to become anxious
They will increase the performance of behaviours that reduce anxiety
What is the main experience of generalised anxiety disorder?
There is excessive and uncontrollable worry about future events and outcomes
People fell anxious about everything, not just one particular area
Extreme anxiety is present at all times
How many people are affected by generalised anxiety disorder?
What does it often co-occur with?
Affects 1-5% of the population in the last 12 months
It often co-occurs with other anxiety disorders, depression and many medical conditions
What are the main symptoms of generalised anxiety disorder?
Tension and dread alongside somatic symptoms
What is meant by intolerance of uncertainty?
It is the “what if” process that drives worry
People overestimate the risk of something happening and the negative consequences of this happening
What are the features of intolerance of uncertainty?
- seeking excessive reassurance
- list-making
- double checking
- refusing to delegate tasks to others
- procrastination/avoidance
- distraction
Why are particular actions performed by someone with intolerance of uncertainty?
Performing these actions gives a temporary reduction in their anxiety
What will the lives of someone with OCD be dominated by?
- obsessions
this is intrusions of thoughts, images and impulses that produce anxiety (e.g. fear of contamination)
- compulsions
these are behaviours or rituals that reduce anxiety (e.g. washing, checking)
What happens to the behaviours that people use to reduce anxiety in OCD?
These behaviours become dominating, repetitive and ritualistic
They begin to dominate people’s lives - if they don’t perform the behaviours they become more anxious
What is meant by a phobia?
There is an irrational fear of specific objects or situations
Why is a phobia characterised by an “irrational fear”?
It is irrational as there is realisation that the fear is disproportionate to the effect
How do people tend to respond to a phobia?
What process does this lead to?
There is a desire to avoid the object/situation
This avoidant behaviour is negatively reinforced by a reduction in anxiety
What is meant by negative reinforcement in phobias?
Avoidance maintains the phobia
Behaviours that reduce anxiety are increased (this includes avoiding the feared object)
This is negative reinforcement
What is always involved in treatment of a phobia?
Encountering the thing that you are fearful of
Unless you learn that the object is harmless, you will never overcome the phobia
What are the stages involved in classical conditioned acquisition of a phobia?
- Signal (CS) - sight of needle
- Trauma (UCS) - injection/pain
- Reaction (UCR) - fright/withdrawal
- Result (CR) - needle phobia
UCS = unconditioned stimulus UCR = unconditioned response
What is involved in negatively (operant conditioning) reinforced maintenance of a phobia?
- there is an avoidance or escape from the aversive event
(e. g. avoidance of hospital) - this leads to a reduction of fear (reinforcement)
What are the two types of fear involved in agoraphobia?
- fear of crowded/enclosed places and open spaces
2. fear of panic attack and resultant embarrassment
What is meant by social anxiety disorder?
This is a social phobia
It involves an extreme and persistent fear of embarrassment and humiliation
Who is more affected by social anxiety disorder?
How do they cope with this?
Onset in teens and affects more men
It involves avoidance of social and public activities
