PsychoPathology Flashcards
(24 cards)
What are the 4 definitions of abnormality
- Deviation from Social Norms, 2. Failure to Function Adequately, 3. Statistical Infrequency, 4. Deviation from Ideal Mental Health
Deviation from social social norms AO1
Abnormality seen as Behaviour that breaks unwritten rules about acceptable conduct.
Each society has unwritten rules (norms) for acceptable behaviour. This definition classes any behaviour as abnormal if it goes against the accepted, expected and approved ways of behaving in a society.
The main difficulty with this definition is that social norms change vary as times change. What is socially acceptable now may not have been socially acceptable 50 years ago. For example, today homosexuality is acceptable but in the past it was included under ‘sexual and gender identity disorders’ in the DSM (a manual used by psychiatrists to diagnose mental disorders).This lack of consistency reduces the reliability of this definition of abnormality.
This definition of abnormality has been criticised because social norms differ between cultures. In order words, norms are culturally relative. For example, hearing voices is viewed as a deviation from social norms in our cultures but in others, it is more accepted and therefore, not necessarily viewed as deviant behaviour. This is a problem as it is argued a reliable definition should be consistent between cultures.
✓ One strength of this definition is that it is a more appropriate definition of abnormality, especially when compared to the ‘statistical infrequency’ definition. This is because it distinguishes
between desirable and undesirable behaviour and the effect the behaviour has on others. For example, spending a lot of time washing your hands may not be statistically infrequent, but it can have a damaging effect on the person and their loved ones
Failure to function adequately
Failure to function adequately means that a person is unable to cope with everyday life or engage in everyday behaviours. Not functioning adequately causes distress and suffering for the individual, and/or may cause distress for others. It is important to include ‘distress to others’,
because, in the case of some mental disorders, the individual may not be distressed at all. People with schizophrenia generally lack awareness that anything is wrong but theirbehaviour
(hallucinations, believing that they are being persecuted) may well be distressing to others
Rosenhan and Seligman proposed characteristics or features of abnormality including: MUSIC
Maladaptive behaviour – this refers a behaviour where a person is stopping themselves from progressing
Unconventionality (odd) – so in order to be abnormal their behaviour needs to be odd in someway
Suffering - they suggest that an abnormal person should be suffering in someway
Irrational and incomprehensibility – this refers to instances where someone may act a certain way which people can’t understand
Unpredictability and loss of control – most people tend to behave in a fairly predictable way on the other hand an abnormal person is expected to act in an inappropriate manner.
The more features a person shows the more abnormal theyre seen to be
failure to function adequately Ao3
One strength of the definition is that it includes the patient’s perspective. This allows us to view
the mental disorder from the point of view of the person experience it. For example, the level
of distress experienced by the patient is considered when defining their behaviour as abnormal.
This suggests that failure to function adequately is a useful criterion for assessing abnormality
as it provides a checklist which patients can use to help them perceive their level of functioning.
X Abnormality is not always accompanied by dysfunction - psychopaths, people with
dangerous personality disorders, can cause great harm yet still appear normal. Harold
Shipman, the GP who murdered at least 215 of his patients over a 23 year period,
seemed to be a respectable doctor. He was abnormal but did not display features of
dysfunction. Therefore using this definition to define abnormality may not be
appropriate.
X The definition is limited by cultural relativism. For example, long periods of grief after
bereavement is more acceptable in some cultures than others. This means that exactly the
same behaviour could be defined as abnormal because it is viewed as a failure to function in
one culture, yet functioning adequately in another. This is a problem because for the definition
to be classed as reliable, the same behaviour should be viewed consistently between cultures.
Statistical Infrequency
According to this definition, any behaviour that is statistically rare would be classed as abnormal. Deciding what is statistically rare requires us to examine a normal distribution curve in order to
identify what proportion of people share the characteristics or behaviour being looked at. In statistical terms, human behaviour is abnormal if it falls outside the range that is typical for most
people, in other words, the average is ‘normal’. Things such as height, weight and intelligence fall within fairly broad areas. People outside these areas might be considered abnormally tall or
short, fat or thin, clever or unintelligent etc. In statistical terms they are abnormal because their behaviour is infrequent in the population i.e. two standard deviations from the mean
Statistical Infrequency
One strength of the statistical infrequency definition is that it is an objective way to define
abnormality, as a clear ‘cut off’ point has been agreed. This makes it easier to decide who meets
the criteria to be labelled as abnormal in comparison to other definitions. Therefore this definition
is seen as less subjective than the other definitions.
X The main problem with this definition is that there are many abnormal behaviours that are
actually quite desirable. For example, very few people have an IQ of over 150, yet it would not
be suggested that having a high IQ is undesirable (and therefore abnormal). Equally, there are
some normal behaviours that are undesirable. For example, experiencing depression after a
painful experience is quite common, yet it is undesirable. This is a problem when planning
treatment as only undesirable behaviours need to be identified. Therefore, the definition would
never be used alone to make a diagnosis.
X If abnormality is defined in terms of statistical infrequency, we need to decide where to separate
normality from abnormality. Many disorders, like depression, vary greatly between individuals
in terms of their severity. This makes it difficult to decide where the cut-off point lies. E.g. at
what point does crying (a common symptom of depression) become abnormal? This is a
problem as the cut-off point is subjectively determined, lacking the validity needed to be an
effective method of defining abnormality
X The statistical infrequency definition may be culturally biased. This is because there are some
behaviours that are statistically infrequent in some cultures but are more frequent in others. For
example, one of the symptoms of schizophrenia is claiming to hear voices. However, this is an
experience that is common in some cultures. This is problematic as the statistical infrequency
definition would class these individuals as abnormal even when they were displaying normal
behaviour, so the definition can only be used to define abnormality in some cultur
Deviation from Ideal Mental Health (A01)
Unlike all the other definitions discussed so far, this is not a definition of abnormality. Instead, it attempts to define the criteria required for normality (or ‘ideal mental health’). Therefore, people who lack these criteria, are defined as abnormal. Marie Jahoda (1958)
defined ideal mental health through a list of six characteristics (called characteristics for ‘optimal living’), which argue that a psychologically healthy individual with ideal mental health should be able to show:
P - should be able to see the world as it is
R - being able to cope with stressful situations
A - self-Attitude - High self-esteem and a strong sense of self-identity.
I - Autonomy (Independence) - They should function as independent individuals.
S Self-actualisation (personal growth) – Being focused on the future and on fulfilling their
potential.
E Environmental Mastery – The ability to adjust to new situations; functioning at work and in relationships with others.
The fewer of these qualities you have, the more abnormal you are seen to b
Deviation from ideal mental health ap3
One strength of this definition is that it offers an alternative perspective on mental disorders.
This is because the definition focuses on the positives (the desirable behaviours) rather than
the negatives (the undesirable behaviours). Jahoda’s ideas therefore, are in accord with the
humanistic approach, which also focuses on the positive aspects of human nature.
X The definition may be culturally biased (ethnocentric). This is because the ideals of mental
health are not applicable to all cultures. For example, the criterion of self-actualisation is
relevant to members of individualistic cultures but not collectivists’ cultures, where individuals
strive for the greater good of the community rather than for self-centred goals. This is a problem
because for the definition to be classed as reliable, the same behaviour should be viewed
consistently between cultures.
X One of the major criticism of this definition is that it is unclear how many criteria need to be
lacking before we are seen to be ‘deviating from ideal mental health’. E.g., do all 6 criterion need
to be present, or could we lack one or two and still be viewed as normal? In order to make this
decision, a subjective judgement must be make. In other words, it is left to individual
psychiatrists to judge whether someone is deviating enough to be diagnosed and this could lead
to inconsistency. This lack of objectivity means that this definition of abnormality is rarely used
in the real world.
DSM-5 Categories of Phobias
Phobias are a type of anxiety disorder. All phobias are characterised by excessive fear and anxiety, triggered by an object, place or situation. The extent of the fear is out of proportion to any real danger presented by the
phobic stimulus.
The latest version of the DSM recognises the following categories of phobias and related anxiety disorder:
• Specific phobia: Also known as a simple phobia, this is fear of an object, such as an animal, or a situation such as flying or having an injection.
• Social phobia: Phobia of a social situation such as public speaking or using a public toilet.
• Agoraphobia: Fear of leaving home or a safe place. Can be characterised by fear of being outside or in a public place.
Behavioural Characteristics (A01)
Panic: Most phobic people panic in response to the presence of a phobic stimuli. Panic can be in the form of behaviours such as crying, screaming, running away or freezing.
Avoidance: As anxiety increases by being close to the feared situation, it is natural to avoid certain situations where the object will be. For example, if someone has a fear of ghosts they do not take a short-cut home through a graveyard at midnight.
Disruption of Functioning: Anxiety and avoidance responses are so extreme that they severely interfere with the ability to conduct everyday working and social functioning. For example, a person with a social phobia will find it very hard to socialise with others, or indeed
interact meaningfully with them at work.
Emotional Characteristics (A01)
Anxiety: An unpleasant state of high arousal which makes it very difficult
to experience any positive emotions. The anxiety experienced can be long
term. It is due to the presence of or anticipation of feared objects and
situations.
Fear: The emotional responses of fear which accompanies many phobic stimuli is often extremely unreasonable. For example, an individual’s fear of spiders will involve a very strong emotional response to a tiny, harmless spider. This fear is disproportionate to the actual
danger posed by the spider.
Cognitive Characteristics: (A01)
Irrational beliefs: Sufferers often hold irrational beliefs in relation to the phobic
stimuli. They are also very resistant to rational arguments, for example, a person with a fear of flying is not helped by arguments that flying is actually the safest form of transport.
Selective attention: Sufferers will often look intently at a phobic stimulus and find it very difficult to look away from them. It is usually useful to keep our attention on something dangerous so we can react to the threat quickly. However, it is not useful when the fear is irrational as this can interfere with day to day life. For example, a pogonophobic will struggle
to concentrate on what they’re doing if someone in the room has a bea
The Behavioural Approach to Explaining Phobias
Behaviourists argue that like any behaviour, phobias are learned through the environment.
The Two-Process Model (A01)
According to the two-process model (Mowrer, 1960), phobias are acquired (learned in the first place) by classical conditioning and maintained (continue) because of operant conditioning.
Classical conditioning: initiation (how phobias are acquired)
A phobia is acquired through the association of a stimulus with a response. For example, Watson and Rayner induced a fear of white rats in Little Albert by pairing the rat (neutral stimulus) and a
loud noise (unconditioned stimulus). This resulted in a new stimulus (conditional stimulus) being learnt.
For example, fear of dogs after being bitten:
• Being bitten (UCS) creates fear (UCR)
• Dog (NS) associated with being bitten (UCS)
• Dog (now CS) produces fear response (now CR)
The same steps can explain how a person might develop a fear of social situations after having a panic attack in such a
situation.
Operant Conditioning: (how a phobia is maintained)
With negative reinforcement, an individual avoids a situation that is unpleasant. E.g. a person with a fear of dogs will avoid visiting friends with dogs. A person with a fear of enclosed spaces
(claustrophobia) will avoid going into a lift. In these examples, avoiding the phobic stimulus allows them to escape the fear and anxiety that they would have suffered if they had remained. This reduction in fear reinforces the avoidance
behaviour and maintains the phobia.
Two process model Evaluation: (A03)
A strength of the behaviourist explanation of phobias is that it can be tested in an objective and rigorous way. For example, Mowrer (1960) tested his two-process model by pairing a buzzer sound with an electric shock. Through the use of negative reinforcement, Mower trained rats to escape a shock by jumping over a barrier when the buzzer sounded. This matters because it increases the scientific validity of the behaviourist explanation of phobias.
The behaviourist explanation of phobias has practical applications. There are several behavioural therapies which use the principles of conditioning to successful treat phobias. For example, ‘systematic desensitisation’ (which uses classical conditioning to ‘unlearn’ previously learned phobias) has been shown to be an extremely successful
therapy for a range of different phobias. Evidence to support this comes from McGrath et al (1990) who found that
75% of phobic patients showed an improvement in their symptoms after treatment. The success of these treatments strengthens the validity of the behaviourist explanation of phobias.
X It has been argued that the behaviourist explanation of phobias is incomplete as it fails to explain the role evolution plays in many people’s fears. For example, Seligman (1971) found in his research that we are innately (naturally) predisposed to fear such things as snakes and spider, as these things have been a source of danger in our evolutionary past. This helps to explain why people may have fear of things they have never experienced or encountered e.g.
sharks. Therefore the two-process model may be too simplistic, as this suggests there is more to acquiring a phobia than simply conditioning.
The behaviourist explanation has also been criticised because it fails to explain the cognitive aspects (e.g. the irrational thoughts) of a phobia. For example, a person in a lift may think ‘I could become trapped in here and suffocate’. This irrational thought creates extreme anxiety and may trigger a phobia. This is a weakness as the behavioural explanation is failing to explain a vital component of the disorder. An approach that incorporates both the behavioural
and cognitive components of a phobia is therefore required in order to provide a thorough explanation of the disorder.
The Behavioural Approach to Treating Phobias systematic desensitisation
Systematic Desensitisation (SD) is a behavioural therapy designed to gradually reduce phobic anxiety through the principles of classical conditioning. If the sufferer can learn to relax in the
presence of the phobic stimulus, they will be cured. Essentially a new response to the phobic stimulus is learned (phobic stimulus is paired with relaxation instead of anxiety). This learning of a different response is called counterconditioning.
There are three processes involved in SD.
1. Anxiety Hierarchy – A phobic patient works with a therapist to develop an ‘anxiety hierarchy’. This is a list of situations related to the phobic stimulus, starting with the least fearful situation at the bottom (e.g. with a fear of dogs, this might involve looking at a picture of a dog), and the most fearful at the top (e.g. stroking a dog).
2. Relaxation - It is impossible to be afraid and relaxed at the same time, as one emotion prevents the over. This is called reciprocal inhibition. Therefore, teaching relaxation techniques is a vital part of SD. Typical relaxation techniques that are taught include deep breathing, mindfulness and visualisation. Alternatively, relaxation is sometimes achieved using anti-anxiety drugs such as Valium.
3. Exposure – Finally, the patient is exposed to a phobic stimulus whilst in a relaxed state. The patient starts at the bottom of the fear hierarchy, and when they can remain relaxed at that level, they progress onto the next level. Over several sessions, the patient gradually moves their way up the hierarchy, SD is successful when the patient can maintain
relaxation in the most feared/highest level on the hierarchy.
Exposure can be done in two ways:
◦ In vitro – the client imagines exposure to the phobic stimulus.
◦ In vivo – the client is actually exposed to the phobic stimulus.
Evaluation of systematic desensitisation
✓ A strength of systematic desensitisation is that it has been proven to be effective at treating phobias. For example, McGrath et al (1990) reported that 75% of patients showed an improvement in their symptoms after systematic desensitisation. Additionally Gilroy, (2003)
followed up 42 patients after they had been treated for a spider phobia. 33 months later, they showed less fear than a control group. This evidence is a strength because it shows that
systematic desensitisation can be used to treat the majority of sufferers, and that the effects are long lasting.
A second strength of systematic desensitisation is that sufferers tend to prefer it to the alternative behavioural therapy of ‘flooding’. This is largely because it does not cause the same degree of trauma as flooding. This is supported by the fact that SD has low attrition rates (the number of people dropping out of treatment is low). This matters because SD is able to help a higher number of patients than flooding. It also empowers sufferers to choose
a therapy that is most acceptable to them.
X However, systematic desensitisation is not an effective treatment for all phobias. Ohman 1975) suggest that SD may not be as effective in treating phobias that have an underlying evolutionary component (e.g., fear of heights, fear of dangerous animals, etc). This reduces the usefulness of this technique of treatment. Additionally, systematic desensitisation is only really suitable for patients who are able to effectively use the relaxation techniques and who have imaginations that are vivid enough to think up images of fear objects/events. Therefore,
the therapy may not be appropriate to use for all sufferers of phobia
Flooding: (A01)
Flooding also involves exposing phobic patients to their phobic stimulus
but without the gradual progression seen in SD. Instead, clients are immediately exposed to a very frightening situation. For example, a person with a fear of flying may be taken up in an aircraft or a person with a fear of spiders may be placed in a room full of them!
Usually one long session is used in which the patient experiences their phobia at its worst, while at the same time practising relaxation. The session continues until the patient is fully relaxed.
Flooding stops phobic responses very quickly. This may be because the patient cannot avoid the stimulus. Therefore they quickly learn that the phobic stimulus is harmless. In classical conditioning terms, this processes is called ‘extinction’
A learned response (CR) is extinguished
when a CS (e.g. dog) is encountered without the UCS (e.g., being bitten), resulting in the CS no longer producing the CR (fear).
Evaluation of flooding
✓ One strength of flooding is that it is a cost effective treatment for phobias. Research has shown that that flooding is just as effective at treating phobias as SD, however it is significantly quicker (Ougin, 2011). This is a strength as patients are free of their symptoms as soon as possible, and this makes the treatment cheaper than SD.
X Perhaps the most serious issue with flooding is that it is a highly traumatic experience for patients. The problem is not that flooding is unethical (as patients will have given consent) but that patients are often unwilling to see it through to the end. This is a limitation of flooding
because time and money are sometimes wasted preparing patients only to have them refuse to start or complete treatment.
X Finally, although flooding is highly effective for simple (specific) phobias, the treatment is less effective for other types of phobias, including social phobia and agoraphobia. This is because behavioural treatments are unable to treat the irrational thinking that is more common with these complex phobias. This suggests that other forms of treatment, such as CBT, which treats the irrational thinking, may be a more effective method of treating social and agoraphobia. This is a problem because it appears that flooding is restricted in its usefulness
to just specific phobia
Behavioural characteristics of Depression: (A01
Disruption of Sleep and Eating - Depression is associated with disruption in our normal eating and sleeping behaviours. Insomnia (reduced sleep) and hypersomnia (increased need for sleep)
are common and appetite can also increase or decrease with depression, which can lead to weight loss or gain.
Loss of energy - Some depressed people have reduced energy resulting in fatigue, lethargy and high levels of inactivity e.g. they may struggle to get out of bed and do usual daily activitie
Whats depression?
Depression is classified as a mood disorder characterised by low mood and
low energy levels. DSM-5 distinguishes between major depressive disorder, which is severe but often short term, and persistent depressive disorder, which is longer term and/or recurring.
Emotional characteristics of Depression: (A01)
Sadness - Sadness is the most common description people give of their depressed state, along with feeling empty. Associated with this, people may feel worthless, hopeless and/or experience low self-esteem.
Anger - Negative emotions can, also be shown in the form of anger. This anger can be directed as aggression towards oneself (e.g. self-harming) or towards others (e.g. close family member
Cognitive Characteristics of Depression: (AO1)
Focusing and dwelling on the negative - People with depression often view themselves, the world and the future in negative ways. They may have a bias towards reporting unhappy events
in their lives rather than happy events. Such negative thoughts are irrational i.e. they do not accurately reflect reality.
Poor Concentration - Sufferers often find themselves unable to stick to a task or make decisions (indecisiveness). This is then likely to interfere with a sufferer’s work and ability to communicate.
The Cognitive Approach
According to the cognitive approach, it is not the events in people’s lives that cause depression, it is the way they think about these events. There are two main examples of the cognitive approach to explaining depression, the ABC model, and the Negative Triad.
Ellis’ ABC Model: (A01)
Albert Ellis (1962), proposed that the key to mental disorders such
as depression, lay in irrational beliefs. In his ‘ABC Model’:
A refers to an ‘activating event’ (A) - e.g. getting sacked at work. Events like failing an important test or ending a
relationship might trigger irrational beliefs.
B is the belief, which may be rational or irrational (e.g., ‘The company was overstaffed’ or ‘I was sacked because they’ve always had it in for me’). According to Ellis, the source of irrational beliefs lies in mustabatory thinking. This is the belief that we must always
succeed or achieve perfection. E.g., ‘I must be liked by everyone’.
‘I must get an A on all my tests’.
• C is the consequences – rational beliefs lead to healthy emotions
(e.g. acceptance) whereas irrational beliefs lead to unhealthy emotions, including depressio
