Psychopathology

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  • Psychopath-ology
    • Definitions of Abnormality
      • Deviation from Social Norms
        • norm: an expected form of behaviour. holds societies together: living is more predictable and safe if we all follow
        • some norms are explicit and written: fundamental to society and punished by law e.g. respect other's property
        • also unwritten, strong expectations:eating with knife and fork
        • a way of defining a behaviour as abnormal is the way it breaks from social norms - ppl who behave undesirably labelled as social deviants, so intervention can take place
        • Evaluation
          • real life application in diagnosis of anti-social personality disorder - useful way of thinking about abnormality
          • considers situational norms: behaviour seen as normal in one setting is abnormal in another: nudist beach
          • definition seeks to protect society from the effects of an individual's abnormal behaviour
          • social norms are specific to cultures - behaviour abnormal in one place may be normal in another (eating dogs)
          • social norms vary over time - homosexuality used to be a mental disorder until 1990
          • Not all behaviours that break social norms are a sign of psychopathology: fine line between eccentric and abnormal
      • Failure to Function Adequately
        • sees individuals as abnormal when their behaviour suggests they cannot cope with everyday life
        • Rosenhan and Seligman suggest personal dysfunction has a number of features, the more they have the more likely they are abnormal
        • Observer discomfort: another's behaviour causes distress to the observer
        • Unpredictability, irrationality (behaviour cannot be explained in a rational way)
        • Maladaptiveness: struggles to adjust to situations, personal suffering and distress (failure to cope with everyday life distresses the individual)
        • Evaluation
          • Global assessment of functioning scale (GAF) is measured on a scale, allows us to see what degree someone is abnormal and assess if they need help
          • focuses on observable behaviour which is easy too see
          • provides a practical checklist used to assess levels of abnormality - straightforward to diagnose someone
          • Some psychopaths appear as normal: Harold Shipman murdered over 200 of his patients yet appeared normal and respectable
          • sometimes its normal to suffer distress (loved one dies, grieving is psychologically healthy)
          • Subjective: doesn't consider individual perspective - bright clothing is normal for eccentrics
          • need to consider context: starving yourself meets the criteria but its normal in a hunger strike
      • Deviation from ideal mental health
        • looks for absence of mental well being: any deviation from what is normal is abnormal
        • Jahoda devised 6 characteristicof ideal mental health - absence indicates abnormality
        • Positive attutire towards self, self-actualisation (full potential), Autonomy (independent, self reliance)
        • Resisting stress (coping), accurate perception of reality, environmental mastery (adapt)
        • the more characteristics failed to meet, the more abnormal
        • Evaluation
          • emphasised positive achievements instead of undesirable things, also considers them as a whole not specific behaviour
            • criteria over demanding - most people fail to meet these so would be seen abnormal - more of a set of ideals
          • states what is needed for normality - allowing goal setting and personal growth
          • Subjective criteria - vague and difficult to measure, e.g. difficult to assess someones self esteem, person doing diagnosis just guessing
            • Culturally biased definition as based on western ideas of ideal mental health & poor people may struggle more in achieving
              • collectivist cultures focus on communal goals rather than personal so this would not help diagnose their abnormality
      • Statistical Infrequency
        • abnormality: the number of times a behaviour deviates from the statistical average
        • the less frequently a behaviour occurs, the more likely it is abnormal: the majority are normal and the minority are abnormal
        • any individuals who fall outside the 'normal distribution' (usually 5% of the population) are perceived as abnormal
        • Evaluation
          • Objective - using data with an agreed cut off point avoids confusion and bias
          • different mental health workers can view behaviours in the same way: useful part of clinical assessment - provides statistical evidence of mental disorder
          • Requires a decision about the point statistical behaviour becomes statistically abnormal - not clear when how energetic a child is becomes abnormal
          • Not all infrequent behaviours are abnormal: highly intelligent people are statistically rare but not abnormal
          • Not all abnormal behaviours are infrequent: about 10% of people suffer depression, meaning its so common its normal according to the definition
          • cultures differ in what they call normal: cannot judge one culture with the norms of another
    • Behavioural Approach - explaining and treating phobias
      • Phobias
        • a type of anxiety disorder - extreme and irrational fears out of proportion to any actual risk
        • 5-10% of the Uk population have phobias , mostly females
        • DSM V recognises the following types of phobias
          • Specific  Phobia - anxious in presence of particular object/situation
          • Social phobia: can effect their quality of life as they get anxious in social situations
          • Agrophobia: anxious when they leave home/ a safe place, hate crowds
      • Symptoms
        • Cognitive
          • attention - difficult for them to look away from the phobic stimulus
          • Irrational beliefs In reaction to the phobia stimuli
        • behavioural symptoms
          • panic in response to the phobia stimulus: crying, screaming, running away
          • Avoidance - efforts made to avoid phobia to reduce anxiety occurrence
          • endurance: remains with phobias stimulus but feels high anxiety levels
        • Emotional symptoms
          • Anxiety and fear - individual cannot relax
          • Unreasonable response: not appropriate to the actual danger posed
      • Explaining phobias
        • behaviourists suggest phobias are explained using the two process model
          • 1) phobias are acquired through direct classical conditioning / indirect SLT
          • 2) maintenance of phobias through operant conditioning
        • 1) Classical Conditioning
          • associating a neutral stimulus (initially have no fear) with a unconditioned stimulus (naturally triggers a reflex fear response)
          • Supporting evidence (Pavlov's dogs)
            • Food (UCS) causes salivation (UCR) - a reflex response
            • Bell is a NS, but when put with the food the dog associates them. When repeated the bell (CS) produces saliva (CR)
          • Supporting Evidence - Little Albert
            • Wanted to condition Albert to fear a white rat by pairing it with a loud noise
              • he initially had no fear of rats, but once repeatedly paired with a loud noise he became afraid
            • this generalised to similar white fluffy objects - shows classical conditioning can create phobias
        • can occur indirectly through SLT - e.g. observing someone being bitten by a dog can cause a fear response to dogs
        • 2) Phobia maintained through operant conditioning
          • involves learning through the consequences of behaviour - good outcome means more likely to be repeated
          • pleasant outcome known as positive reinforcement, escaping something unpleasant known as negative reinforcement
          • Pioneered by Skinner
            • phobic response is unpleasant, so avoidance acts as negative reinforcementin removing these feelings of anxiety
              • this means they are more likely to continue avoiding the phobic stimulus
                • this makes the phobias resistance to extinction because constant avoidance reinforcing responses are carried out
        • Evaluation of explanations
          • A lot of supporting evidence: lil Albert supports the idea that phobias can be learned through classical conditioning
            • Bandura and Rosenthal electric shocked participants every time a buzzer sounded, and they eventually showed a fear response to the sound of the buzzer
          • theory predicts a trigger event from the past is involved - the moment the fear and stimulus were associated. supported by SiNardo et al who found over 60%of people w/ dog phobias could refer to a particular experience
            • however in a control group 50% of people had experienced a fearful event but not developed a phobia - individual differences not explained by theory
          • supported by effectiveness of behavioural treatments: systematic desensitisation explains how u need to prevent a patience from avoiding and reinforcing their phobia
          • can be combined with biological explanations to give a better understanding of phobias, gene vulnerability makes conditioning more likely
          • some aspects not considered: evolutionary explanation, Bounton shows we acquire phobias through dangers In our evolutionary past (snakes, the dark) - more to it than conditioning alone
          • Reductionist - neglects cognitive processes, attention bias and distorted thoughts
      • Treating phobias
        • Systematic desensitisation
          • based on classical conditioning, aims to gradually reduce phobic anxiety
          • instead of anxiety, patient learns to be relaxed-counterconditioning (you cannot be in a state of relaxation and fear at the same time)
          • three processed involved in SD:
            • The anxiety hierarchy: patient and therapist put a least to post frightening list together related to the phobia to create anxiety
              • Relaxation: taught to relax deeply
                • exposure: hierarchy is worked through, move on when they can stay relaxed in that stage, either VR or real life
          • Evaluation
            • Patients prefer it to flooding - does not have as much trauma, relaxation pleasant - low refusal rates
            • Effective - Gilroy et al followed up 42 patients who had SD treatment, found effective and long lasting effects compared to a control group
            • Rothbaum et al found the advantage of VRET - patient doesn't have to leave the room, phobic stimuli more controlled - reducing harm and embarrassment
        • Flooding
          • forcing the phobic individual to face their phobia - lasts until the fear response disappears
          • there is a limit to how long the body can sustain a fear response, so they have to calm down in the presence of the stimulus
          • in terms of conditioning, the learned response is extinguished when the CS is encounter without the UCS - no longer produces the CR
          • sometimes uses VR for ease
          • effectiveness proven by Wolpe - used flooding to remove a girls phobia of being in cars by driving her around for 4 hours until she relaxed
          • Evaluation
            • cost effective and quicker due to less sessions
            • less effective for some phobias - social phobias are more cognitive & they experience unpleasant thoughts which flooding cannot solve
            • highly traumatic - patients often quit mid treatment which can worsen their phobia and waste effort
            • not suitable for patients with bad health - extreme anxiety can be stressful on the body - hear attacks
    • The Biological Approach To Treating OCD
      • Obsessive compulsive disorder is an anxiety related condition where people experience frequent obsessive thoughts and worries (irrational)
      • the only way to release this anxiety it to perform compulsive behaviours ( prevent harm to themselves and others)
      • compulsions are repeated physical behaviours, any relief they cause is only temporary and often reinforce the obsession, worsening the cycle of OCD
      • Symptoms of OCD
        • Cognitive symptoms
          • obsessive thoughts: 90% experience this, they recur over and over again e.g. this has germs
          • Attentional bias: focus on anxiety generating stimuli - hyper vigilance
          • aware of their obsessions but still have catastrophic thoughts
        • Behavioural symptoms
          • Compulsions are repetitive - feel compelled to keep repeating
          • Compulsions reduce anxiety: manage anxiety produced by obsessions
          • avoidance: try and reduce anxiety by keeping away from trigger, hinders every day life
        • Emotional symptoms
          • anxiety and distress - compulsions and obsessions can be frightening and overwhelming
          • OCD is often accompanied by depression- anxiety produces low mood
          • irrational guilt and disgust
      • Genetic Explanation
        • focuses on an individual's vulnerability to OCD and how it is inherited through genetic transmission from parents to offspring
        • genetically researched through twin studies and family studies with correlation statistics and concordance rates, more recently gene mapping is used
        • Lewis conducted a family study - assessed 50 patients with OCD, found 37% had parents with OCD and 21% had siblings with it
          • shows OCD runs in families providing genetic evidence. according to the diathesis stress model, certain genes  pre dispose people to developing the disorder
        • Nestadt et al reviewed twin studies and found 68% of MZ twins shared OCD compared to to 31% of DZ twins - strong evidence for a genetic influence on OCD
        • researchers have more recently identified genes that create a vulnerability for OCD Called candidate genes
          • some involved in regulating the development of the serotonin system
        • Samuels et al used gene mapping on OCD sufferers with hoarding behaviour and found a link to chromosome 14 marker, suggests different variations of genes can cause OCD in different people
        • Taylor did a meta analysis and found up to 230 genes may be involved in OCD: OCD is Polygenic
        • Evaluation of the genetic explanation of OCD
          • variety of evidence from twin studies, metal analysises ect
          • we have not pinned down all the genes involved - too many candidate genes, each variation only increases the chance by a fraction - cannot predict OCD due to genetic makeup
          • MZ rates not 100% - if it was pure genetic it would be so there must be other factors involved
            • Cromer et al found over half OCD patients had a traumatic past - and the more traumatic, the worse the OCD - need to focus on environmental causes
          • twin studies overlook the fact that MZ twins may be similar in terms of their shared environment not just genes - more so than DZ twins
          • if a disorder was genetic the symptoms would be the same, however they differ from person to person
          • Biological reductionism - simplistic focusing on genes, overlooking the holistic complexity of the whole person and ignoring other possible factors
      • Biological Approach to Treating OCD
        • treatments based on correcting the biological abnormalities seen to cause OCD
        • drug therapy is the most common - aims to increase/ decrease levels of / activity of neurotransmitters in the brain
        • SSRI's (selective serotonin reuptake inhibiters)
          • work at the synaptic gap (end of a neuron), any neurotransmitter left in the synaptic gap after diffusion is reabsorbed back to the pre synaptic neuron
          • Bio explanation says OCD is caused by too little serotonin, so SSRI's intervene the re uptake process so serotonin stays in the receptor sites longer
          • iBrand names include prozac and 3-4 months of daily use has an impact
          • can be combined with other drugs such as tricyclics which target serotonin and dopamine and noradrenaline- but more powerful so side effects increase
            • only used when patients do nit respond to SSRI's
        • Evaluation of Biological treatments
          • effective treatment: Soomro et al reviewed studies comparing SSRI's to placebos, found ti was effective and mores when combined with CBT - however they no don cure but reduce symptoms
          • cheap and don't require a therapist, meaning they are less disruptive to a patient's life
          • side effects: loss of sexual appetite, irritability, disturbance to sleep - reduces effectiveness bc people stop taking them before it begins to work - also can heighten suicidal thinking
          • drug companies sponsor research - may not be honest about dangers
          • Other causes and treatments: traumatic life event cause cannot be treated bt drugs, CBT would be more beneficial

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