Dysfunctional behavior

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  • Created by: anna
  • Created on: 20-04-14 20:54

ICD-10 and DSM-IV

Internation classification of diseases and related health problems (ICD-10) 

  • published by the world health organisation, used in many countries around the world 
  • each disorder has a description of main features and important associated features 
  • the diagnostic part shows how many of each feature and the balance required between different types of features is required to make an accurate diagnosis 
  • if a diagnosis isnt confident and is less certain fue to some ambiguities it is described as tentative. 
  • Each disorder has a code and in ICD-10 there are 100 disorders 

Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV) 

  • mainly used in America 
  • DSM is multi axial tool, as clinicians consider whether the disorder is Axis 1 (clinical disorder) or Axis 2 (personality disorder), patients general physical condition considered as well as social and environmental problems, patients functioning then assesed on a scale of 1-100 
  • takes a much more holistic approach than the ICD-10 
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Rosenhan and Seligman

1. Statistical frequency: abnormality would mean it doesnt occur often in society, however this includes exceptioanlly high IQ, whereas other behaviours that are abnormal can occur quite often e.g. substance abuse 

2. deviation from social norms: if society does not approve of the behaviour then its dysfuncational. but this makes behaviour dysfunctional in some cultures but not in others such as women wearing trousers is accpeatble in western culture. 

3. Failure to function adaquately: more useful definition is if a person isnt functioning well that enables them to live several ways to do this... 

  • dysfuntional behaviours: such as OCD, a person cant go out as they have rituals to complete
  • behaviour that distresses the person experiencing it: agoraphobics not being able to leave 
  • behavour that makes a person observing the patient feel uncomfortable: people talking to themselves 
  • unpredictable behaviour: dramatic mood swings 
  • irrational behaviour: thinking you are being followed

4. Deviation from idea mental health: if you dont have ideal mental health you must have illness 

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Ford and Widiger

Aim: To find out if clinicians were stereotpying genders when diagnosing disorders 

Sample: 1127 randomly selected from national register in 1983, mean age of 15.6 years experience. Final 354 selected and 266 responded to the case histories 

Method: self report, independent design, they were given scenarios and asked to make diagnosis, IV: gender of patient, DV: diagnosis made by clinician, Ps randomly given one of 9 case histories, case studeis either had antisocial personality disorder, histrionic personality disorder or equal balancce of the two, Ps made diagnosis by rating on a 7 point calse the extent to which they had 9 disorders e.g. alcohol abuse ,naricissitic, passive aggresive. 

Results:

  • ASPD correctley diagnosed in males 42% of the time and 15% in females 
  • females with ASPD misdiagnosed with HPD 46% of time, whereas only 15% for males 
  • HPD correctly diagnosed in 76% of females and 44% of males 
  • females more likely to get diagnosed with HPDm as characteristics of HPD e.g. emotional behaviour can be seen as gender specific 
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Watson and Raynor

Aim: to see if they could induce a fear of an unfeared object, through classical condtioning 

Participant: little albert, lived in a hospital as child of a wet nurse, stolid and unemotional

Procedure:

  • Session 1: when 11 months Albert was presented with a rat and steel bar struck when he reached for the rat. 1st time it made him jump and on the 2nd time he cried 
  • Session 2: 1 week later, 1 presentation of just rat, 3 presentations of rat + noise, 1 presentation of just rat, 2 presentations of rat + noise, 1 presentation of just rat. After five paried presentations albert would cry and crawl away from the rat when it was shown alone. 
  • Session 3: 5 days later he was presented with a neutral stimulus (blocks) the presentation was made of a rat, rabbit, a dog, seal fur coat, etc. blocks given inbetween presentations. other stimuli apart from blocks induced a fear response. 
  • Session 4: 'freshened up' reaction to rat and conditioned response to dog and rabbit. Albert reaction to rat, cat and rabbit pronounced. fear reaction slight when in another room 
  • Session 5: 1 month later, alber tested with various stimuli e.g. santa claus mask, rat, rabbit coat. showed fear reactions to all with a varying degree 

conclusion: possible to classically condition a fear response 

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Gottesman and Shields

Aim: to review research on gentic transmission of schizophrenia 

Sample: reviewed 3 adoption studies and 5 twin studies in total 711 Ps in adoption studies, in twin studies a total of 210 monozygotic twins and 319 dizygotic 

Procedure: incidence of schizophrenia in adopted children and monozygotic twins was extrapolated. In the adoption studies this was done by comparing biological parent and siblings with adoptive parents and siblings. For twin studies concordance rates calculated (how often both twins had schizophrenia) for monozygotic and dizygotic twins 

Results: 

  • all 3 adoption studies showed increased incidence of schizophrenia in adopted children with a schizophrenic biological parent 
  • normal children with schizophrenic adoptive schizophrenic parents/ siblings showed little incidence of schizophrenia 
  • All twin studies had a high concordance rate for schizophrenia in monozygotic twins
  • in their study concordance rate was 58% for monozygotic twins and 12% for dizygotic twins 
  • schizophrenia is genetic but also must be enviro factors as rates not 100%
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Beck et al.

Aim: To understand cognitive distortions in patients 

Sample: 50 Ps diagnosed with depression, 16 men and 34 women, aged 18-48, were middle or upper class with an average intelligence 

Procedure: clinical interviews with Ps undergoing therapy for depression, retrospective reports of patients thoughts were kept during the session as well as spontaneous reports of thoughts during session, some Ps kept diaries of their thoughts. records kept of the non depressed patients verbalisations to compare to the depressed patients 

Results: 

  • Certain themes appered in depressed patients but not non depressed these included... low self esteem, self blame, overwhelming responsibilities and desire to escape. 
  • depressed Ps had sterotpyical but inappropriate responses to situations, e.g. if they smiled at a passer by and the passer by didnt smile back, the P would feel inferior 
  • Depressed patients saw themselves as inferior e.g. less intelligent in their social/ work groups 
  • there are cognitive distortions in patients that are exclusive to depression and are automatic, involuntary, illogical, and persistent
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Mcgrath

Aim: to treat a girl with specific noise phobias using systematic desensitisation 

Sample: Lucy, a 9 year old, had a fear of sudden loud noises, including balloons, party poppers, guns, she had lower than average IQ but was not depressed, anxious or fearful

Method: came to a therapy session and was explained the procedure and consent gained from parents. At first session she constructed a hierarchy of feared noises, lucy was taught breathing and imagery to relax and told to imagine herself at home with toys, she had a hypothetical 'fear thermometer' to rate her fear on a level from 1 to 10. She was given the stimulus of the loud noise, and then paired the noise with relaxation. 

Results: 

  • at end of first session, lucy was relucatant to have balloon burst at other end of corridor and would cry and be told to breathe and relax
  • at end of fourth session, lucy could signal a balloon to be burst 10m away 
  • at end of fifth session lucy could pop balloon herself 
  • by tenth and final session lucys fear thermometer had gone from 7/10 to 3/10 for ballons popping, 9/10 to 3/10 for party poppers, and cap gun from 8/10 to 5/10 
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Karp and Frank

Aim: To compare drug treatments and non drug treatments for depression 

Sample: concentrated on women diganosed with depression 

Method: review article of previous research, a lot of the research was independent measures, with Ps having either, drug treatment, single psycholoical treatment, combined treatment and sometimes placebo. Depression analysed using a range of depression inventories and Ps were tested before and after treatment, some times after a period of time 

Results: 

  • many studies found that adding psychological treatments to drug therapy did not increase effectiveness 
  • some studies showed less attrition when combination therapies used 
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Rush, Kovacs, Beck and Hollon

Aim: To compare the effects of cognitive and drug therapy 

Sample: 44 patients diagnosed with moderate to severe depression attending outpatient clinics

Method: experiement, with independent design. Ps assesed with beck depression inventory, hamilton rating scale, and rasking scale. for 12 weeks Ps had either a 1 hour cognitive therapy session twice a week or 100 imopramine capsules prescribed by visiting the doctor for 20 minutes once a week. the cognitive therapy sessions were prescribed and cotrolled and the therpists were observed for reliability 

Results: 

  • depression reduced on all three rating scales 
  • the cognitive group showed better improvement on self reports and observer based ratings. 78.9% compared to 22.7% 
  • drop out rate was 5% in the cognitive group and 22.7% in drug therapy group 
  • cognitive treatment the better treatment 
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