Dysfunctional Behaviour

• Categorising
• Definition
• Bias In Diagnosis 

DSM- Diagnostic and Statistical Manual 

Psychiatrist has to evaluate patient on 5 different axis (1-3 most important):

• Axis I: Clinical disorders (schizophrenia, depression)
• Axis II:  Personality disorders (mental retardation)
• Axis III: Physical health (Long term illness influencing depression)
• Axis IV: Envrionmental factors
• Axis V: Global assesment of functioning 

DSM compiled by over 1000 people; Empirical research; Field trials; Reflects ethnic diversity; ICD more symptom based and classifies personality disorders on same axis as clinical disorders

5 Part criteria to define abnormality:

1) Statistical Infrequency

2) Deviation from social norms

3) Failure to function adequatley: Personal distress; Maladaptive behaviour  

4) Deviation from ideal mental health: Positive view of self; Capable of personal growth and dvelopment of talents; Autonomy; Accurate view of reality; Positive relationship 

Aim: Find out if clinicians were stereotyping genders when diagnosing disorders

Participants: 353 clinical psychologists; Random selection from national register in 1983;  266 response rate

Method: Self report; Clinicians given scenarios and asked to make diagnosis; Independent measures design; IV = gender; DV = diagnosis

Findings: ASPD correctly diagnosed 42% in males and 15% with females; HPD correctly diagnosed in 76% females and 44% males

Conclusions: Practitioners biased by stereotypical views of gender; Females more likely to be diagnosed as hsitronic and males antisocial; Misdiagnosis of women greater = sexist interpretation of data 

• Watson & Rayner- Behavioural 
• Gottesman & Shields- Biological 
• Beck- Cognitive

Aim: Investigate possibility of creating fear through classical conditoning; Investigate generalisation of fear

Method: Lab; Casde study; 11 month old little Albert; 'Solid and unemotional' character; No fear to furry animals but feared loud noise of hammer striking metal bar

Procedure: Albert presented with rat; steal bar strcuk over his head; Repeated 5 sessions a week; Generalised fear to all fury things; Fear present a month later

Conclusions: Possible to condition fear response; Generalised to similair objects and last over time; Supports behavioural approach and classical conditioning 

Aim: Review transmission of schizophrenia between 1967 and 1976

Participants: 3 adoption studies; 711 participants (210 MZ and 319 DZ)

Procedure:

• A) (i) Adoption studies: Incidence of schizophrenia of biological siblings and biological parents
• A) (ii) Find out schizophrenia of adopted siblings and adopted parents
• B) Twin studies compared concordance rates of MZ and DZ twins

Findings: Increased incidence of schizophrenia in adopted children with a schizophrenic biological parent; Normal children fostered to schizophrenic parents and adoptive parents of schizoprenic children showe little evidence of schizophrenia; 58% concordance rate in MZ twins and 12% in DZ twins

Conclusions: Genes are important and therefore support nurture side of nature-nurture debate

Aim: Understand cognitive distortions in patients with depression 

Method: Clinical interviews with patients who were undergoing therapy for depression 

Participants: 50 patientsd with depression; most white middles class; Average intelligence; Control of 31 non-depressed patients undergoing psychotherapy, matched for age, sex and class

Particpants: Face-to-face interviews; Patients kept diares of thoughts and brought them in to therapy sessions; Comparison of verbalisations to non-depressed patients

Findings: Depressed = low self-esteem; Overwhelming responsibilities; Desire to escape; Paranoia; Accusations against others; Steroptypical responses in situations; Regarded themselves as inferior to other social groups or occupational groups; Felt unloveable; Illogical self blame <------ Distortions automatic, involuntary and persistent 

Conclusions: Even in mild depression, patients have congitive distrotions that deviate realistic and logical thinking

• Behavioural- McGrath
• Biological- Karp & Frank 
• Cognitive- Beck

Aim: Treat a girl with noise phobia using systematic desensitisation 

Participant: Lucy; 9yo; Fear of sudden loud noises like balloons, party poppers and fireworks; Below average IQ; Not depressed; No anxiety; Not fearful

Procedure: Informed consent given by Lucy's parents; Lucy constructed hierachy of feared noises, balloons and party poppers most prominent; Lucy tuaght breathing and imagrey to to relax and to miagibe she was at home on her bed with her toys; Hypothetical fear thermometer 1-10; Stimulus of loud noise then she relaxed; Repeated until association formed

Findings: 1st session Lucy was reluctant to let ballons be burst and she cried and was taken away; 4th session Lucy had learned to calm down and she now longer had to use imagery and balloon could eb burst 10m away; 5th session Lucy was able to pop balloons herself; Fear thermometer decreased each session

Conclusion: Findings support effectiveness of systematic desenstisation, especially the findings in associating noise with feeling calm

Aim: Compare drug treatment and non drug treatments for depression 

Participants: Women diagnoses with depression; 9 peices of research from 1974 to 1992; 520 women

Design: Meta analysis; Independent measures design; Single drug treatment, single psychological treatment or combined with placebo 

Procedure: Despression was analysed using depression inventories; Patients tested prior to treatment and after; Health practitioners used to assess participants due to nature of study

Findings: Psychological therapy did not increase effectiveness of drug therapy; Less attrition when combination of therpies used (more likely to continue with treatment if combination used)

Conclusions: Patient outcome not affected so much using combined therapy; Drug therapy is more effective on depression; Supports biological approach

Aim: Compare effectiveness of cognitive therapy and drug therapy 

Method: Controlled experiment with participants allocated to one of two conditions 

Participants: 44 patients diagnised with moderate to severe depression attending pschiatrist outpatient clinics

Procedure: Assesed using 3 psychometirc tests (becks depression inventory); has either cognitive therapy session twice a week or 100 imipramine capsules for 12 weeks; Prescribed by visiting doctor; Therapists observed for reliability

Findings: Significant decrease in depression symptoms by both groups; Cognitive group showed significantly greater improvements on self-reports and observer-based ratings; 80% compared wirth 20% of those woth drug therapy; 5% drop out rate in cognitive therapy and 32% in drug treatment group

Conclusions: Congitive therapy leads to a better treatment of depresion, shown by fewer symptoms reported and observed and also better adherence to treatment.