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Flashcards in psychopathology Deck (68):
1

definition of abnormality

something that differs from the norm.

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statistical deviation/ infrequency

> behaviour that is statistically rare should be seen as abnormalities.
> any individual who falls outside of the ‘normal distribution’ are perceived as being abnormal.

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strengths: statistical deviation/infrequency

> it is clearly appropriate for many mental illnesses where by statistical criteria is available eg. intellectual disability disorder.
> all assessments with patients with mental disorders includes some kind of measurement of how severe their symptoms are compared to statistical norms.
> allows for an objective, value-free assessment of the level of mental disability being experienced

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limitations: statistical deviation/ infrequency

> not all infrequent behaviours are abnormal - some rare behaviours and characteristics are desirable
> not all abnormal behaviours are infrequent as some statistically ‘frequent’ behaviours are ‘abnormal. For example
> the cut-off point is subjectively determined as there needs to be a decision about where to separate normality and abnormality.

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deviation from social norms

> each society has norms for what is seen as acceptable behaviour. any behaviour that varies from these norms may be seen as abnormal. the definition draws a line between socially desirable and undesirable behaviours.
> those who do not adhere to what society deems as acceptable in that community or society are labelled as abnormal.

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strengths of 'deviation from social norms'

one strength of this definition is that it allows the consideration of the social dimensions of a behaviour. this means it allows for our understanding that a behaviour may be normal in one situation but not another.

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limitations of 'deviation from social norms'

many individuals regularly break social norms but they are defined as ‘eccentric’ rather than mentally ill. norms change over time, this means that we cannot truly define any certain act as ‘abnormal’ because as norms change so must our beliefs about what constitutes 'abnormal’ behaviour.

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failure to function adequately

this definition perceives individuals as abnormal when their behaviour suggests they cannot cope with everyday life. the behaviour is considered abnormal when it causes distress leading to dysfunction, for example, disrupting the ability to work.

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Rosenhan and Seligman seven features of abnormality (failure to function adequately)

1. suffering
2. maladaptiveness (danger to self)
3. vividness and unconventionality (stands out)
4. unpredictably and loss of control
5. irrationality/ incomprehensibility
6. causes observer discomfort
7. violates moral/social standards

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strengths: 'failure to function adequately'

it takes into consideration the experiences of the patient allowing an assessment to be made from the point of view of the person experiencing it. this is relatively easy to judge objectively through an assessment of criteria (WHODAS) the more symptoms the sufferer shows, the more abnormal they are

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limitations: 'failure to function adequately'

abnormality is not always accompanied by dysfunction; for example psychopaths can commit murder and still appear normal

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deviation from ideal mental health

This definition perceives mental abnormality in a similar way to the perception of physical health and looks for an absence of well being. eg. depression: The symptoms of this disorder illustrates the definition: sufferers generally have low self-esteem (i.e. a negative attitude to one’s self), they can struggle to make decisions (i.e.not autonomous) they experience high levels of stress concerning their low mood condition.

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deviation from ideal mental health: jahoda.

Rather than identifying what is abnormal, jahoda identified six characteristics of what is to be normal and an absence of these characteristics indicates abnormality. The more of the criteria an individual fails to meet, the further away from normality they are. the six characteristics are; positive attitude towards self, self actualisation, resistance to stress, autonomy, accurate perception of reality and, mastery of the environment.

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strengths: 'deviation from ideal mental health'

it takes a positive approach to mental problems. The focus is on what is desirable (for example, working towards being autonomous) rather than what is undesirable (for example focusing a patient on the amount of distress they feel).

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limitations: 'deviation from ideal mental health'

> this definition has been accused of having over demanding criteria - at any given moment most people do not meet all the ideals so in effect we are all ‘abnormal’ for example, few people experience ‘personal growth’ all the time!
> furthermore, the criteria is difficult to measure. jahoda argued mental health can be considered like physical health but diagnosing mental health is far more subjective in the absence of X rays etc.

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dsm: disgnostic and statistical manual of mental disorders

there are a number of systems for classifying and diagnosing mental health problems the best known of these is the dsm. the dsm is updated every so often as ideas about abnormality change. the current version is in its 5th edition (dsm- 5) – this was published in 2013.

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phobias

a phobia may be defined as ‘a persistent and unreasonable fear of a particular object, activity or situation’ - (comer 2008). this definition highlights that almost anything can become a phobia. it is an Intense, persistent, irrational fear a particular object, event or situation. the response is disproportionate and leads to avoidance of phobic object, event or situation. Fear is severe enough to interfere with everyday life.

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phobias: dsm

The dsm recognises the following categories of phobias:
> specific phobias, of animals, events (flying), bodily (blood), situations (enclosed places).

> social phobias, of social situations, public speaking, parties, meeting new people.

> agoraphobia, of public crowded places (not open spaces), of leaving safety of home.

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phobias: signs and symptoms

> behavioural: how a person acts (behaves) around the feared object or situation which is likely to be varying states of panic leading to avoidance.

> emotional: how a person feels when experiencing anxiety

> cognitive: how a person thinks about phobic stimuli

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phobias: key characteristics

the key characteristics of phobias are that they are extreme fears, which are disproportionate to the actual danger, and lead to avoidance of the object or situation.

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phobias: behavioural characteristics

> panic in response to the phobic stimulus such as crying, screaming, running away. Children may react in different ways such as freezing, clinging or having a tantrum.

> avoidance- unless the sufferer is making a conscious effort to face their fear, they will often go out of their way to avoid having to come into contact with the phobia stimulus. This can make it hard to go about daily life.

> endurance- This is the opposite of avoidance in which the sufferer remains in the presence of the phobic stimulus but continues to experience high levels of anxiety.

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phobias: emotional characteristics

> anxiety- phobias are often classed as anxiety disorders. by definition they involve an emotional response of anxiety or fear. this makes it hard for the sufferer to experience any positive emotion. Anxiety can be long term, fear is the immediate and unpleasant response we experience when we encounter the phobic stimulus.

>emotional responses are unreasonable: The emotional responses we experience in relation to phobic stimuli go beyond what is reasonable.

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phobias: cognitive responses

> selective attention to the stimulus- If a sufferer can see the phobic stimulus it can be hard to look away from it. Keeping our attention on something dangerous can be good because it gives us a chance to respond quickly if there is a threat but it is not good if the fear is irrational.

> irrational beliefs- A phobic may hold many irrational beliefs in relation to a phobic stimuli.

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phobias: cognitive distortions

the phobics perceptions of the phobic stimuli may be distorted.

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phobias: behaviourist approach background

founded by jb watson, the behaviourist approach studies observed behavioural responses of humans and animals. the behaviourist approach believes we learn to behave in response to our environment, either by stimulus-response association, or as a result of reinforcement. important contributors to the behaviourist approach are ivan pavlov, with his theory of classical conditioning, and b.f. skinner, and his work into operant conditioning.

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phobias: behaviourist approach classical and operant conditioning

> classical conditioning: a basic form of learning in which a neutral stimulus is repeatedly paired with another stimulus known as the unconditioned response.

> operant conditioning: changing a behaviour because of a reward or for avoidance. once a fear is established, the individual then avoids the object or situation that produces the fear. this in turn reduces the anxiety. it also strengthens the fear and makes it more likely that this object/situation will be avoided in the future.

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phobias: two-process model

mowrer suggests that phobias are acquired as a result of classical conditioning and maintained by operant conditioning. A person who is terrified of spiders is likely to run away when they see one. the escape and consequent reduction of fear acts as a negative reinforcer, increasing the likelihood that they will continue to avoid spiders in future. in this way, the phobia is maintained.

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phobias: behavioural treatments

in his two-process model, of phobia acquisition, mowrer suggests that phobias are acquired as a result of classical conditioning and maintained by operant conditioning. behavioural treatment therefore aims to: reduce phobic anxiety through the principle of classical conditioning whereby a new response to the phobic stimulus is paired with relaxation instead of anxiety.

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phobias: behavioural treatments - systematic desensitisation

Wolpe (1958) – two competing emotions cannot occur at the same time so if fear is replaced with
relaxation the fear cannot continue. systematic desensitisation aims to teach a patient to learn a more appropriate association and is designed to reduce an unwanted response, such as anxiety, to a stimulus
reciprocal inhibition is the process of inhibiting anxiety by substituting a competing response. the anxiety hierarchy is constructed by the patient and the therapist. this is a stepped approach to getting the person to face the object or situation of their phobia from least to most frightening. the patient is trained in relaxation techniques, the patient is then exposed to the phobic stimulus whilst
practising the relaxation techniques as feelings of tension and anxiety arise. When this has been achieved the patient continues this process by moving up their hierarchy.

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phobias: systematic desensitisation pei 1

research has shown that systematic desensitivity is an effective treatment of specific phobias. gilroy et al followed up with 42 patients who had been through systematic desensitivity to see how well the treatment had worked for them. questionnaires were used to assess the change in how scared they were before and how scared they were afterwards. there was also a control group that were treated for their fear by relaxation but not exposure. they found that at both three months and 33 months, the systematic desensitisation group showed much less fear than the relaxation group. this is a strength because it shows that systematic desensitisation is helpful when trying to get rid of specific phobias.

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phobias: systematic desensitisation pei 2

systematic desensitisation can be used on a wide range of patients. the alternative techniques for systematic desensitisation - flooding and cognitive therapies - are not well suited to some patients and their fears. People with learning difficulties can make it very hard for people to undergo flooding or cognitive therapies as it can make them very hard to understand or engage in therapies that require an ability to reflect on your thinking. this means that systematic desensitivity is probably the appropriate form of behavioural treatment for most people.

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phobias: systematic desensitisation pei 3

a strength of systematic desensitisation is that most patients prefer it and would choose it over other forms of phobia treatment. patients are more likely to choose systematic desensitisation because it doesn’t cause the same degree of trauma as flooding does. it also includes some elements that could be seen as pleasant such as relaxation techniques that can be used for other things in life too. this reflects the low refusal rates and low attrition rates of systematic desensitisation.

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phobias: behavioural treatments - flooding

this involves overwhelming the individual’s senses with the item or situation that causes anxiety so that the person realises that no harm will occur. no relaxation techniques or step by step build up. individual is exposed repeatedly and in an intensive way with their phobia. Individual has their senses flooded with thoughts, images and actual experiences of the object of their phobia. flooding stops phobic responses very quickly. without the option for avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless – this process is called extinction. a learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten). the result is that the conditioned stimulus no longer produces the conditioned response (fear).

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phobias: behavioural treatments - flooding positive

a positive of flooding is that it is cost effective. studies comparing the different forms of behavioural phobia therapy have found that it is highly effective and the quickest of any therapy type. the quick effect that flooding can have means that patients are free of their symptoms as soon as possible and this makes the treatment cheaper than alternatives.

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phobias: behavioural treatments - flooding negative

> it is less effective for some types of phobia: Flooding is less effective for treating more complex phobias like social phobias. this may be because social phobias have cognitive aspects, an individual does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation.
> a large problem with flooding is that it can be a highly traumatic experience for people with drastic phobias. there is not a problem with the ethics of it, as patients give consent, but that often the patient is not willing to go all the way through with the procedure. this is a limitation because it is a waste of time and money used on patients who do not actually complete the therapy.

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depression

depression is a mood disorder. a mood disorder is the term used to explain disorders that affect the emotional state of those suffering from them, i.e. – the current emotional mood is distorted or inappropriate to the circumstances. depression is characterised by low mood and low energy levels.

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depression: diagnostic features

depression can affect the thoughts (cognitions), feelings (emotion), behaviour (actions) and the physical well-being of an individual. clinical depression for example is not merely a feeling of sadness (although this forms a major part of the illness), but rather a set of complex symptoms. the symptoms must be causing distress or impaired functioning in social and/or occupational roles.

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depression: dsm-5

the dsm recognises the following categories of depression and depressive disorders:
> major depressive disorder – severe but often short-term depression.

> persistent depressive disorder – long-term or recurring depression, including sustained major depression.

> disruptive mood dysregulation disorder – childhood temper tantrums.

>premenstrual dysphoric disorder – disruption to mood prior to and/or during menstruation.

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depression: signs and symptoms

> behavioural: how a person acts (behaves) when in a depressed state. Typically their behaviour
changes and the individual experiences reduced levels of energy

> emotional: how a person feels when in a depressed state. Patients often describe themselves as
feeling ‘worthless’ and ‘empty’.

> cognitive: how a person thinks when in a depressed state. In particular, the tendency to focus on
the negative aspects of a situation

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depression: diagnosis

> can appear gradually or suddenly

> occurs in all social classes and at all ages, from childhood to old age.

> the severe forms are more common in middle and old age although there has been a steady increase in depressive illnesses amongst people in their twenties and thirties

> before a diagnosis of depression can be made, the symptoms should have lasted for at least two weeks

> depression can be relatively mild, or so intense that the sufferer is at serious risk of suicide.

> it is estimated that 5% of adults in Britain will suffer from it at some time in their lives (SANE, 1993).

> the risk of women developing unipolar depression is double that of men.

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depression: cognitive approach

the term ‘cognitive’ means ‘mental processes’, so this approach is focused on how our mental processes affect behaviour.

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depression: negative triad

beck proposed that there were three types of negative thinking that contributed to becoming depressed: negative views of the world, negative views of the future and the self. these negative views lead a person to interpret their experiences in a negative way and so make them more vulnerable to depression.

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depression: beck's cognitive theory

beck is an American psychologist who suggested a cognitive approach to explaining why some people are more vulnerable to depression than others. In particular it is a person’s cognitions that create this vulnerability i.e the way they think. Beck suggested three parts to this cognitive vulnerability.

> faulty information processing - When depressed we attend to the negative aspects of a situation and ignore positives. People tend to blow small problems out of proportion.

> negative self-schemas - a schema is a ‘package’ of ideas of information developed through experience. They act as a mental framework for the interpretation of sensory information.

> a self-schema is the package of information that we have about ourselves. If we have a negative self-schema we interpret information about ourselves in a negative way.

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depression: beck's cognitive theory - negative triad

the negative triad - a person develops a dysfunctional view of themselves because of three types of negative thinking that occur automatically, regardless of the reality of what is happening at the time.

> negative view of the world - an example would be ‘the world is a cold hard place’. This creates the impression that there is no hope anywhere.

> negative view of the future - an example would be ‘there isn’t much chance that the economy will really get better’. Such thoughts reduce any hopefulness and enhance depression.

> negative view of the self - for example I might think ‘I am a failure’. Such thoughts enhance any existing depressive feelings because they confirm the existing emotions of low self-esteem.

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depression: evaluation of beck's theory

> it has good supporting evidence - much research has supported the proposal that depression is associated with faulty information processing, negative self-schemas and the triad of impairments.

> it has a practical application in CBT - beck’s cognitive explanation forms the basis of cognitive-behavioural therapy. All cognitive aspects of depression can be challenged in CBT.

> it does not explain all aspects of depression - the theory explains the basic symptoms of depression however it is a complex disorder with a range of symptoms, not all of which can be explained.

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depression: ellis' abc model

ellis suggested a different cognitive explanation of depression. He proposed that good mental health is the result of rational thinking, defined as thinking in ways that allow people to be happy and free of pain. to ellis, conditions like anxiety and depression result from irrational thoughts. Ellis defined irrational thoughts not as illogical or unrealistic thoughts, but any thoughts that interfere with us being happy and free of pain.

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depression: ellis' abc model - abc meaning

A - activating event: where beck’s emphasis was on automatic thoughts, ellis focused on situations in which irrational thoughts were triggered by external events. according to ellis we get depressed when we experience negative events and these trigger irrational beliefs.

B - beliefs: ellis identified a range of irrational beliefs. he called the belief that we must always succeed or achieve perfection ‘musturbation’. ‘I-can’t-stand-it-itis’ is the belief that it is a major disaster when anything does not go smoothly. utopianism is the belief that life is always meant to be fair.

C - consequences: when an activating event triggers irrational beliefs there are emotional and behavioural consequences. for example, if you believe you must always succeed and then fail at something this can trigger depression.

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depression: evaluation of ellis' abc model

> it only offers a partial explanation - some depression does occur as a result of an activating event
(reactive depression). however not all depression arises as a result of an obvious cause.

> it has practical application in CBT - Like Beck’s explanation, Ellis’ explanation has led to successful therapy. Irrational negative beliefs are challenged and this can help to reduce depressive symptoms suggesting that the irrational beliefs had some role in the depression.

> it does not explain all aspects of depression - This explanation also does not explain why some individuals experience anger associated with their depression or why some patients suffer hallucinations and delusions.

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depression: alternative explanations

> the biological approach to understanding mental disorders suggests that genes and neurotransmitters may cause depression.

> the success of drug therapies for treating depression suggest that neurotransmitters do play an important role; the medication alters the levels of specific neurotransmitters and reduces the symptoms.

> at the very least, a diathesis-stress approach might be advisable, suggesting that individuals with a genetic vulnerability for depression are more prone to the effects of living in a negative environment, which then leads to negative irrational thinking .

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depression: cognitve approach to treatment

cbt is the most commonly used psychological treatment for depression and a range of other psychological disorders. if you see a clinical psychologist for treatment for a mental health problem, the chances are you will receive cbt. this is a method for treating mental disorders based on both behavioural and cognitive techniques.

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definition of obsessive

a persistent thought, idea, impulse, or image that is experienced repeatedly. Feels intrusive and causes anxiety.

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definition of compulsions

repetitive and rigid behaviour or mental act that a person feels driven to perform.

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ocd: dsm certified symptoms

>recurrent obsessions and compulsions.

>recognition by the individual that the obsessions and compulsions are excessive and/or unreasonable.

>that the person is distressed or impaired, and daily life is disrupted by the obsessions and compulsions.

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ocd: signs and symptoms

> behavioural: how a person acts (behaves) which typically leads to the carrying out of repetitive actions to reduce anxiety. this often leads to avoidance of situations that trigger anxiety.

> emotional: how a person feels when experiencing the anxiety which accompanies the obsessions /compulsions. OCD may feel depressed and/or other negative emotions.

> cognitive: how a person thinks and OCD sufferers are usually plagued with obsessive thoughts.
They also tend to develop cognitive strategies.

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basic assumptions of the biological approach

> everything psychological is at first biological.

> the approach investigates how biological structures and processes within the body impact on behaviour.

> much of human behaviour has a physiological cause which may be genetically or environmentally altered.

> genes affect behaviour and influence individual psychological differences between people. Evolutionary psychology considers genetic influences in common behaviours

>psychologists should study the brain, nervous system and other biological systems e.g. hormones, chemicals acting on the brain.

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ocd: biological approach to treatment

OCD has been explained in a number of ways but the biological approach offers particularly useful suggestions as to how it is caused. It has been proposed that there is a genetic component to OCD which predisposes some individuals to the illness. The genetic explanation suggests that whether a person develops OCD is at least partly due to their genes. This may explain why many patients often have other family members with OCD.

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ocd: biological approach to treatment - genes researchers

> bellodi et al (2001). - claim that genetic factors play a role in the disorder. using evidence from twin studies and family studies, they showed that close relatives are more likely to have the disorder than more distant relatives.

>mckeon and murray. - patients with OCD are more likely to have first degree relatives who suffer from anxiety disorders.

> pauls et al. - there is a much higher percentage of OCD sufferers in relatives of patients with OCD than in the control group without OCD.

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ocd: biological approach to treatment - genetic explanations

candidate genes are ones which, through research, have been implicated in the development of OCD. a possible candidate gene is the SERT gene which is involved in regulating serotonin, a neurotransmitter which facilitates message transfer across synapses. another possible candidate is the COMT gene - this regulates the production of dopamine which effects motivation and drives. it is recognised however that not everyone in a given family gets OCD so there must be additional factors. the diathesis–stress model suggests that people gain a vulnerability towards OCD through genes but an
environmental stressor is also required. this could be a stressful event, for example a bereavement. OCD is thought to be polygenic – this means that its development is not determined by a single gene but a few (maybe as many as 230 genes) – this means that there is little predictive power from this explanation.

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ocd: evaluation of genetic explanations - genetics

> there is evidence to suggest there is a genetic component to the disorder. One of the best sources of evidence for the importance of genes is twin studies (Nestadt – 2010).

> family studies could also be used to explain environmental influences.

> close relatives of OCD sufferers may have observed and imitated the behaviour (SLT). it is difficult to untangle the effects of environment and genetic factors.

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ocd: evaluation of genetic explanations - candidate genes

> candidate genes are ones which, through research, have been implicated in the development of OCD.

> there are too many genes involved.

> psychologists have not been successful at pinning down all the genes involved.

> each genetic variation only increases the risk of OCD by a fraction.

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ocd: evaluation of genetic explanations - environmental factors

> individuals may gain a vulnerability towards OCD through genes that is then triggered by an environmental stressor.

> cromer (2007) found that over half the OCD patients in their sample had a traumatic event in the past, and that OCD was more severe in those with more than one trauma.

> this means that it may more productive to focus on environmental causes as it seems that not all OCD is entirely genetic in origin.

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ocd: neural explanations

the genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain. these are neural explanations.
> neuroimaging techniques have enabled researchers to study the brain in detail and to identify normal brain patterns - this therefore allows for comparisons with abnormal brain patterns.

>researchers have implicated a part of the brain known as the basal ganglia - this area of the brain is responsible for innate psychomotor functions.

>rapport and wise proposed the hypersensitivity of the basal ganglia gives a rise to the repetitive motor behaviours seen in OCD, for example, repetitive washing/cleaning/checking.

>other brain areas believed to be involved in OCD include the orbitofrontal cortex (OFC) and the thalamus

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ocd: biological treatment

most commonly used biological therapy for anxiety disorders is drug therapy. this therapy assumes that there is a chemical imbalance in the brain. this can be corrected by drugs, which either increase or decrease the levels of neurotransmitters in the brain.

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ocd: biological treatment SSRIs

Selective Serotonin Reuptake Inhibitors: the standard medical treatment to tackle the symptoms of OCD are SSRIs. SSRI’s work on increasing certain neurotransmitter in the brain by preventing the reabsorption of serotonin. by preventing the reabsorption of serotonin, SSRIs effectively increase its levels in the synapse and thus continue to stimulate the postsynaptic neuron.

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ocd: biological treatment combining SSRIs with other treatment

drugs are often used alongside CBT. the drugs reduce the sufferer’s emotional symptoms, such as anxiety or depression. this means that the patient can then engage more effectively with CBT. some sufferers may respond best to CBT alone without the need for medication.

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ocd: biological treatment alternatives to SSRIs

where an SSRI is not effective after three to four months the dose can be increased or it can be combined with other drugs. patients respond differently to different drugs and sometimes alternatives work well for some people and not at all for others.

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ocd: drug therapy evaluations pt.1

> drug therapy is effective at tackling OCD symptoms: There is clear research to suggest that SSRIs
are effective in reducing the severity of OCD symptoms (Soomro: 2009)

> drugs are cost-effective and non-disruptive: Drug treatments are cheap in comparison to
psychological treatments and, unlike psychotherapy, they are non-disruptive to patients’ lives

> drugs can have side-effects: Although the use of drugs is effective for most, a significant minority receive no benefit and/or may suffer side-effects: weight gain, dry mouth, sexual dysfunction and loss of memory. coming off a drug is a slow process in which the dosage has to be gradually reduced over a period of six months – risk of relapse.

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ocd: drug therapy evaluations pt.2

> unreliable evidence for drug treatments: If drug companies sponsor the research they may decide
to supress any results that do not support the drug they are marketing. currently many drug companies do not publish all of their results and may indeed be suppressing evidence. this suggests that the data on the effectiveness of drugs may not be trustworthy.

> some cases of OCD follow trauma. although OCD is widely believed to be biological in origin, it is
also accepted that OCD can have different causes. there is a case for proposing that cases of OCD where there is no family history of OCD, but there is a relevant life event, should be treated differently from those where there is a family history and no trauma. It may be that for these cases drugs are not appropriate.