Abnormality Revision Cards

All you need to know for the Psyca2 exam!

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  • Created by: Charlie
  • Created on: 27-05-12 11:32

DSM - The Diagnostic and Statistical Manual of Men

There are 5 main categories used:

  • Major clinical syndromes
  • Personality disorders and mental retardation
  • Generic medical conditions (liver damage, immunity etc.)
  • Psychosocial and environmental problems (divorce, poverty, which may impact on symptoms.)
  • Global assessment of functioning scale (rated 1-100 on their ability to function effectively in their social world - a person who scores less than ten may be unable to wash themselves or may self-harm or harm others.)
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Symptoms of Schizophrenia

Characteristic Symptoms

  • dellusions
  • hallucinations
  • disorganised speech

Social/Occupational Dysfunction

  • work
  • interpersonal relationships
  • self-care
  • ALL BELOW THE LEVEL ACHIEVED BEFORE

Duration

If problems persist for at least 6 months

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Deviation from Social Norms

Social norms are the explicit and implicit rules a society has about what are acceptable behaviours, values and beliefs.

Explicit rules - doesn't steal, doesn't murder, doesn't break the law etc.

Implicit rules - doesn't invade someone's personal space, are antisocial/withdrawn etc.

Helps us to identify someone who has mental health issues.

Behaviours deviating form social norms could be eccentric rather than psychological, abnormal or criminal? depends on context, changes over time (homosexuality), role of culture.

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Failure to Function Adaquetely

  • Dysfunctional Behaviour - goes against the accepted standards of behaviour
  • Observer Discomfort - behaviour that causes individuals to become uncomfortable
  • Unperdictable Behaviour - impulse behaviour that seems uncontrollable
  • Irrational Behaviour - behaviour that's unreasonable/illogical
  • Personal Distress - being affected by emotion to an excessive degree

Difficult to diagnose, doesn't take context into account, people often maintain adaquete function despite facing clinical levels of depression, FFA may not be tied to a psychological disorder, cultural issues.

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Deviation from Ideal Mental Health

Jahoda's Criteria for Ideal Mental Health

  • Positive mental attitude to oneself
  • Self-actualisation of one's potential
  • Resistance to stress
  • Personal autonomy
  • Accurate perception of reality
  • Adapting to the environment

Positive model.

Many people doubt their abilities, difficult to reach full potential, some benefits to stress (work more effectively in stressful situations), cultural variations.

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The Biological Approach

  • All mental disorders have a physical cause
  • Mental disorders/illnesses can be described in terms of clusters of symptoms (syndromes)
  • Causes; Neurology (Alzheimers), Infection (Schizophrenia), Biochemistry (Depression) and Genetics (Bipolar).

Doesn't blame the sufferers, lots of supporting reserach (McGuffin et al (1996) found 46% concordance in MZ (identical) twins compared to 20% in DZ (non-identical) twins for depression in a tiotal of 109 pairs, suggesting a genetic component in depression).

Carries stigma - more likely to result in avoidance, research done is inconclusive, takes control away from the sufferer, reductionist (simplistic).

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The Psychodynamic Approach

  • Much of our behaviour is driven by unconscious motives
  • Childhood is a critical period in development
  • Mental disorders arise from unresolved, unconscious conflicts originating in childhood
  • Resolution occurs through accessing and coming to terms with repressed ideas and conflicts

Unique approach, suggests disorders may be linked to unresolved conflicts related to biological needs, offers methods of therapy to understand causes of problems, focuses on psychological causes.

Hard to scientifically test; can't be proved right or wrong, psychoanalysis may take a long time and is very expensive, childhood conflicts uncovered may be distressing, focuses on past rather than current issues.

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The Behavioural Approach

  • All behaviour is learned - including 'abnormal behaviour'
  • This learning can be understood in terms of conditioning and modelling
  • What was learned can be unlearned, using the same principles
  • The same laws apply to human and animal behaviour

It's a scientific approach, behavioural therapies can be very effective for treating phobias, eating disorders, obsessions and compulsions.

Cannot explain all behaviours as it neglects the influence of genetics, biology and cognitions, not effective for all disorders, raises ethical issues, only treats the behaviour, not the underlying cause.

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The Cognitive Approach

  • Abnormality is a result of faulty cognition (thinking)
  • The way you think about the problem itself, that's the cause of the disorder
  • Mental disorders can be overcome by learning to use more appropriate ways of thinking
  • The aim is to think positively and rationally
  • Abnormality is the product of faulty control

Useful approach  to certain disorders, therapies have often successfully treated depression, anxiety, stress and eating disorders, allows the person to take control and make positive change.

Faulty congnitions may be the consequence of a disorder rather than the cause, may take a long time and be expensive, may be more successful combined with other approaches, person could begin to think that they are to blame for their problems.

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Biological Treatments - Electroconvulsive Therapy

Procedure

  • Patient lies on bed in loose clothes
  • Atropine as given as a pre-anaesthetic and muscle relaxant
  • Electrodes are placed on temples and a 70-150 volt shock is administered for 0.04 - 0.1 seconds (nowadays it's common for just one to be used as it helps reduce memory loss)
  • The current involves convulsions that last for approxiametely 1 minute
  • Once the patient comes round from the anaesthetic they recall nothing about the procedure
  • Repeated 3 times per week for 4 weeks

Quick.

Only short-term, not sure how it works, original side effects sould be fractured skull and memory loss, unethical; history of abuse.

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Biological Treatments - Drug Therapy

Drug therapy is the main treatment for mental disorders and is based on the assumption that chemical imbalance is at the root of the problem.

  • Anti-psychotic drugs; major tranquillizers such as phenothiazines sedate and alleviate symptoms of a person suffering from psychotic disorders such as schizophrenia
  • Anti-anxiety drugs; minor tranquillizers such as BZ's (benzodiapines) like valium have a calming effect by inhibiting the nervous system and relaxing the muscles
  • Anti-depressant drugs; MAOI's, TCA's, SSRI's improve mood by increasing the availability of neurotransmitters. E.g. MAOI's block the action of an enzyme that breaks down senotonin, so increasing its availability in the nervous system.
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Biological Treatments - Drug Therapy Evaluation

  • Are effective in relieving the symptoms of mental disorders
  • Possible placebo effects (beneficial effects)
  • Side effects can be considered worse than the original symptoms of the disorder
  • Only treats the symptoms and not thje underlying cause (short-term)
  • Ethical issues; in mental institutions, were patients having drugs administered in order to alleviate pain or the sedate patients so they were more compliant?
  • Right to refuse.
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Psychological Treatments - Psychoanalysis

Treatment shouldbe focused on making the unconscious conscious and should focus on the past.

Procedures:

  • Dream Analysis: Therapist attempts to interpret the symbolism of the dream. Client can work through these issues with the therapist including identifying and hopefully resolving the source of their anxieties.
  • Free Association: Clients are encouragesd to let thoughts wander and say what comes to mind without editing or sensorship. Analyst is able to piece together patterns of association and offer an interpretation of the clients words and behaviour. Helps to ake repressed thoughts available in the conscious mind.
  • Transference: When the client projects onto the analyst the characteristics that are unconsciously associated with parents or other important people. Repeated experiences of this help the client to reveal their represented feelings.
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Psychological Treatments - Psychoanalysis Evaluati

  • Time consuming
  • Expensive
  • Only suitable for a limited range of mental disorders (less suitable for patients with pyschotic disorders such as schizophrenia)
  • Mixed feelings/finding on effectiveness; 30% - 60% success
  • Difficult to judge effectiveness
  • Therapist might abuse their power
  • Focuses on the past: better to concentrate on changing the problem behaviour.
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Behavioural Approach (Psychological Treatments) -

Procedure

  • Relaxation: Starts with teaching an individual how to relax using muscle relaxation techniques
  • Hierarchy: Individual then imagines a graded series of anxiety-provoking situations
  • Reciprocal Inhibition: Says that anxiety and relaxation cannot exist together. When client is completely relaxed, they move onto imagine the next level in the hierarchy etc.
  • Cured when?: Ends when the client is desensitized - able to work through the entire hierarchy without feeling anxious

Clients are advised to place themselves in progressively more anxiety-provoking real-life situations between therapy sessions in order to help them move from merely imagined to actual situations.

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Behavioural Approach (Psychological Treatments) -

  • Lots of evidence to support (Emmelkamp 1994)
  • Commonly used to treat phobias
  • Not everyone is able to imagine
  • Quicker alternatives such as flooding and impulsion therapy
  • Doesn't treat the underlying cause of the phobias.
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Behavioural Approach (Psychological Treatments) -

  • Based on classical conditioning
  • Aims to rid an individual of undesirable habbits (e.g. excessive drinking)
  • Done by pairing the habbit with an unpleasant consequence
  • E.g. May be given an alcoholic drink which is laced with emetic (a nausea-inducing substance) and after a few pairings the person will wish to avoid the taste or smell of alcohol

Support for conditioned aversions (Baker + Brandon 1988), may offer a "window of opportunity" when more appropriate behaviours can be learned.

Doubts about aversion being maintained, short-term, pain or discomfort may be inflicted, claims that it is dehumanizing, unethical.

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Behavioural Approach (Psychological Treatments) -

  • Based on operant conditioning
  • Aims to modify behaviour that is anti-social or maladaptive by reinforcing appropriate behaviour and ignoring inappropriate behaviour
  • Has been used in prisons/schools/mental hospitals
  • TOKEN ECONOMY is a behaviour modification procedure where tokens are given when desirable behaviour is performed, and can later be exchanged for goods

Many studies to support (Isaacs et al study of a man with Schizophrenia).

Institutional bias as the behaviour that is considered desirable is influences by the needs of the institution rather than the individual, clients could become dependent on the tokens and not be able to apply it in a real-life situation.

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Psychological Treatments - Cognitive Behavioural T

Cognitive

  • Identifying the faulty or irrational thinking processes that are affecting the client
  • Doen through questioning and getting the client to give examples of situations what they would think they would do
  • Therapist develops ideas about what the clients irrational beliefs are but doesn't challenge them

Behaviour

  • Setting homework for the client to do
  • Gives them taskes that will help them challenge their own unhelpful beliefs
  • As a result their beliefs begin to change
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Psychological Treatments - Cognitive Behavioural T

  • Suitable for treating a wide range of mental disorders
  • Most widely used therapy by clinical psychologists in the UK (NHS)
  • Can be used for a variety of problems (maritial, family, school)
  • As effective as drugs intreating depression (Hollon et al, 1992)
  • Fara et al (1998) combined drugs with CBT and results were better for some and not others
  • Become dependent on therapists
  • Therapists hold all the power
  • Small sample size (lacked population validity)
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Psychological Treatments - Cognitive Behavioural T

REBT (Ellis)

  • Client and therapist work together to identify situations that produce negative emotions
  • Therapist challenges these thoughts but it is slightly more confrontational than Beck's approach

Beck's Cognitive Therapy

  • Therapist helps the client to identify particularly negative thoughts
  • Challenges those by suggesting a positive incidence (reality testing)
  • Setting small achievable goals
  • Focus in on congnitive restructuralizing
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The Psychodynamic Approach - The Triparte Model of

The Id: Pleasure Principle

  • Present at birth, this is the unconsious set of instincts which people are born with. Consequences include addictive behaviour, extreme (psychopathic) and selfish/out of control

The Superego: Morality Principle

  • Appears around the age of 5, develops through the process of specialization when people learn the moral standards and expectations of their culture. Consequences include anxiety, OCD and depression

The Ego: Reality Principle

  • Develops by the age of 3, conscious rational part of personality that arbitrates between demands of a superego. Consequences are it allows the Id and Superego to dominate.
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The Psychodynamic Approach - Defence Mechanisms

  • Denial: An alcoholic may deny that they're dependent on alcohol
  • Repression: A person who is normally placid, acts in a violent way towards someone else and subsequently has no recollection of this
  • Projection: Accusing someone else of being angry when it's actually you
  • Sublimation: Playing a vigorous sport as an expression of aggressive drives
  • Displacement: Diverting onto someone else because emotions can't be expressed to the person involved (bullying)
  • Suppression: To hide feelings
  • Rationalisation: Justify uncomfortable thoughts with socially acceptable motives
  • Regression: Childish behaviour (flicking/stomping)
  • Reaction Formulation: Turn feelings into opposite
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The Psychodynamic Approach - Psychosexual Stages o

Oral Stage (Birth - 8 months)

  • Focus of pleasure: Sucking/Eating - Oral
  • Requirements for completion: Eating Independently
  • Consequences if not completed successfully: Oral aggressive - sarcastic/verbally aggressive. Oral receptive - smoking/biting nails

Anal Stage (8 months - 3 years)

  • Focus of pleasure: Passing of faeces
  • Requirements for Completion: Potty training
  • Consequences if not completed successfully: Anal retentive - sensitive. Anal expulsive - careless
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The Psychodynamic Approach - Psychosexual Stages o

The Phallic Stage (3 - 5 years)

  • Focus of pleasure: Genitals
  • Requirements for completion: Boy must identify with father
  • Consequences if not completed successfully: Weak morality and gender identity, 'penis envy'

Latency Stage (6 years - Puberty)

  • Focus of pleasure: Social relationships and sports
  • Requirements for completion: No particular requirements
  • Consequences if not completed successfully: No lasting consequences

Genital Stage (Puberty - Adult)

  • Focus of pleasure: Genitals (not as much as phallic stage)
  • Requirements for completion: Develop healthy adult relationships
  • Consequences if not completed successfully: Whether the earlier stages were successful
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The Psychodynamic Approach - Psychosexual Stages o

  • Was the first model to establish talking therapy as an effective form of treatment in mainstream mental health practice
  • Ideas have had an impact on the way we think about what motivates behaviour
  • Proved difficult to test scientifically
  • Research indicates that many people with psychological problems do recollect having experienced emotional trauma in childhood; may be unreliable
  • Suggests individuals are portrayed as having very little conscious involvement in their own personality development
  • Blames the parents
  • Underestimates the importance of current difficulties that clients may be facing and doesn't account for external factors.
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The Behavioural Approach - Classical Conditioning

Before Conditioning:

  • Unconditioned Stimulus (food) --> Unconditioned Response (drool)

During Conditioning:

  • Neutral Stimulus (bell) + Unconditioned Stimulus (food) --> Unconditioned Responce (drool)

After Conditioning:

  • Conditioned Stimulus (bell) --> Conditioned Response (drool)
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The Behavioural Approach - Little Albert (Watson a

Aim: To condition fear into a child

Procedure: Paired presentation of a tame white rat with a sudden loud noise. The noise caused fear, an unconditioned reflex, equivalent to the salvation in Pavlov's experiment while the rat was the equivalent of the bell.

Results: Eventually he was conditioned to associate the rat with fear. He also became scared of fluffy objects similar to the rat such as a rabbit and a white dog. This is known as Stimulus Generalisation.

Single case study, no systematic and objective measure of any signs of fear, relied on general vocal description, scared a young child, psychological harm, didn't de-condition the child as the mother removed him from the research programme.

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The Behavioural Approach - Operant Conditioning

Positive Reinforcement:

  • Recieving something pleasant increasing the probability of a behaviour recurring because the response is pleasurable.
  • E.g. Recieving a smile when you kiss someone.

Negative Reinforcement:

  • Escaping from an unpleasant stimulus is pleasurable and increases the probability of the same response in the future.
  • E.g. Finding that a smile stops your mother shouting at you.

Punishment:

  • Recieving something unpleasant decreases the probablility of future behaviour.
  • E.g. Being told off for smiling at an inapporopriate moment.
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The Behavioural Approach - Social Learning Theory

States that we learn much of how to behave through watching other people and then copying their behaviour. A behaviour is most likely to be repeated if it is positively reinforced.

Bandura (1965)

  • Procedure: Under controlled conditions, Bandura arranged for boys and girls to watch a video of male or female models behaving aggressively towards a toy called 'Bobo doll'. Children were shown one of the two films each with a differenct outcome. (1) Model was punished after (2) Model was reinforced - given sweets.
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The Behavioural Approach - Social Learning Theory

  • Results: More boys imitated the boy model and more girls imitated the girl model. When the model was reinforced, this produced the highest level of children's irritation and aggression.
  • Conclusion: Children learn behaviour by observation and imitation, and gender roles have an impact on this.
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The Cognitive Approach - Irrational Thinking

  • Polarized Thinking: Seeing everything in black and white. E.g. If one person dislikes you, you could assume that you're worthless
  • Over-Generalisation: When you draw negative conclusions on the basis of a single event. E.g. You could get one bad grade in a subject test and then think you're worthless at that subject
  • Believing 'I should' 'I ought' and 'I must': Revealed in the language people use. E.g. "I must get all A's in my AS' otherwise something bad will happen."
  • Catastrophising: Exaggerating a small situation "making a mountain out of a mole hill"

ABC model. Activating Events, Beliefs, Conseqences.

Same cognitive biases as in Beck's model.

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The Cognitive Approach - Errors in Logic (Beck, 19

Depressed people tend to draw illogical conclusions when they evaluate themselves.

This faulty logic is called Over-Generalisation: Drawing conclusions on the basis of a single event.

These negative thoughts lead to negative feelings which can end up resulting in depression.

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The Cognitive Approach - The Cognitive Triad (Beck

3 Negative Schemata:

  • Negative view of the self
  • Negative view of the world
  • Negative view of the future

The 3 components interact and interfere with normal cognitive processing and can lead to impairments in perception, problem solving, memory and negative thoughts.

Constant exposure to these faulty cognitions can lead to depression.

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