Psychopathology

Definition: Concerns behaviour that is different from the accepted standards of behaviour in a community or society.

• Draws a line between desirable and undesirable behaviours 
• Labels individuals acting undersirably as social deviants 
• Allows interference into their lives to help them. 

• These norms will vary across cultures, genders, situations and ages.
  • Whats seen as a norm and acceptable in one culture/situation may not be acceptable in another. 

• Important consideration - degree to which social norm is deviated from and how important society sees thst norm as being.

• Helps People 
  • Soiety gives itself the right to intervene in abnormal peoples lives - could be beneficial 
  • individuals that need it may not be able to get help themselves.
• social dimensions 
  • Definition gives socisl dimention to idea of abnormality 
  • offers an alternative to the isolated 'sick in the head' individuals
• Situational norms 
  • Considers social dimentions of behaviour.
  • A behaviour seen as abnormal in one setting is regarded as normal in another (nudest beach)
• Developmental norms 
  • Establishes what behaviours are normal for different ages (nappys for 2 year olds)
• Distinguishes between normal/abnormal 
  • Clear indication of what is and isnt seen as normal behaviour.
• Protects society.
  • Seeks to protect society from the effects an individual's abnormal behaviour can have on others.

• Subjective
  • Social norms are not real - they ae based on opinions of social elites within society rather than majority opinion.
  • used to control those seen as a threat to social order. 
• Change over time
  • Norms defined by society often relate to moral standards that may vary over time as social attitudes change (homosexuality)  
• Indiviualism 
  • Those whho do not conform to social norms ,ay not be abnormal. 
  • Indivualistic or eccentric - not problematic.
• Ethnocentric bias 
  • Western social norms reflect the behavior of the majority white population. 
  • Deviation from norms by ethnic groups meas ethnic minorities are over representative in the mental illness statistics(Cochran 1977) 
  • Cultural bias / relativism
• Cultural diffrences
  • Cultural norms vary wthin and across cultures 
  • Difficult to know if they are beingn broken 

Definition: Occurs when someone is unable to cope with ordinary demands of day to day living. 

• Sees individual as abnormal when their behavior suggests that they cannot cope with evryday life. 
• Behaviour is abnormal when it causes sidtress leading to an inablitly to function properly 
• Disrupting ablitiy to work and/or conduct satisfying interpersonal relatinships 
• Often ctaegorised by not being able to experience the usual range of emotions or behaviours. 

• Focuses on individual suffering. 
• Drawing attention to the personal experience association with mental disorder

• Personal dysfunction has seven features. The more an individual has the more they are classes as abnormal. 

1. Personal distress - Key feature of abnormality, includes depression and anxiety disorders.

2. Maladaptive behaviour - behaviour stopping individuals from attaining life goals, both socially and occupationally. 

3. Unpredictable - Displaying unexpected behaviours characterised by loss of control (multiple suicide attempts)
4. Irrational - Displacing behaviour that cannot be explained in a rational way. 

5. Observer discomfort - Displaying behaviour causing discomfort to other. 

6. Violation of moral standards - Displaying behaviours that violate society's moral standards 

7. Unconventionality - Unconventional behaviours 

• Matches sufferers' perception
  • Most people seeking help believe they are suffering from psychological problems that interfere with the ability to function properly 
  • Supports definition. 
• Assess degree of abnormality 
  • GAF scored on a continuous scale 
  • see the degree to which individuals are abnormal. 
  • Decides who needs psychiatric help 
• Observable behaviour 
  • Allows judgement by others of whether individuals are functioning properly 
  • focuses on observable behaviours 
• Checklist 
  • provides a practical checklist. 
• Personal perspective
  • Recognises personal experience of sufferers
  • Allows mental disorders to be regarded from the perception of the individual suffering from them. 

• Abnormality is not always accopanied by dysfunction.
  • Psychopaths - dangerous personality disorder - can cause great harm but can still appear normal. 
  • Abnormal but didnt display abnormal behaviour.  
• Subjective nature of the features of dysfunction. 
  • GAF doesnt consider behaviour from an individual perspective 
  • What is normal for an eccentic person is abnormal for someone else 
• Normal abnormality. 
  • Times in peoples lives when it is normal to suffer distress -  when a loved one dies 
  • grieving in psychologically healthy to overcomeloss.
  • Definition doesnt consider this.
• Distress to others 
  • Could cause distress to one person and not another.
• Personally rewarding abnormality 
  • An individuals apparently dysfunctional behaviour may actually be rewarding.
• Cultural differences
  • Whast considered normal functioning varies from culture to culture 
  • Abnormal functioning in one culture should not be used to judge peoples bhaviour in other cultures 

Definintion : Occurs when someone does not meet a set of criteria for good mental health. 

• Percieves abnormality in a similar way to how physical health is assessed.
• By looking for signs of an absence of wellbeing
• Any deviation away from what is seen as normal is classed as abnormal. 
• Needs set of characteristics of what is required to be normal
• More characteristics individuals fail to meet, the more abnormal they are. 
• Focuses on behaviours and characteristics seen as desirable, ratehr than undesirable. 

Six characteristics that individuals should exhibit in order to be normal. 

• Positive attitude towards oneself - Having self respect and a positive self-concept. 
• Self actualisation - Experiencing personal growth and development. 
• Autonomy - being independant, self-reliant and able to make personal decisions. 
• Resisiting stress - having effectivecoping stratehies and being able to cope with everyday anxiety-provoking situations. 
• Accurate perception of reality - perceiving the world in a non-distorted fashion. Having an objective and realistic view of the world. 
• Environmental mastery - Being competent in all aspects of life and able to meet the demands of any situation  - flexibility to adapt to changing life circumstances. 

• Positivity 
  • Emphasises positives achievements rather than failures and distress. 
  • Stressed positive approach to menatl problems by focusing on what is desirable not undesirable. 
• Targets areas of dysfunction
  • Allows targeting of which area to work on when treating abnormality.
  • Important when treating different disorders.  
• Holistic 
  • Considers individuals as whole person rather than focusing on areas of their behaviour.
• Goal Setting 
  • Permits identification of exactly what is needed to achieve normality. 
  • Allows creatiom of personal goals to work towards. 
  • Facilitating self-growth 

• Over demanding criteria 
  • Most people do not meer all the ideals 
  • critera may be ideals, rather than actuality.
• Subjective critera 
  • Criteria is vague and difficult to measure 
  • Relises largely on self-report - mentally ill not reliable. 
• Contextual effects 
  • Mental health criteria are affected by context. 
• Changes over time 
  • Perceptions of reality change over time. 
• Cultural Variation 
  • Criteria - culturally relative 
  • Should not be used to judge others of different cultures 
• Non-desiablity of autonomy 
  • Collectivist cultures stress communal goals and behaviours  - sees autonomy as undesirable 
  • Culuturally biased

Definition: Occurs when an individual has a less common characteristic, for example being more depresses or less intelligent than most of the population. 

• Behaviours that are statistically rare should be seen as abnormal. 
• Statistics gathered that claim to meausre characteristics and behaviours 
• Show how they are distributed throughout general popluation. 
• What is regarded as statistically rare depends on normal distribution. 
• Most people are on or around the mean 
• Declining amounts of people away from mean (above or below) 
• Individuals who fall outside 'normal distribution' - usually about 5% of the population re perceivedas abnormal. 

• Can be appropriate
  • In many situations can define abnormality  
• Objective 
  • Cut off point 
• No value judgements 
  • Behaviour isnt seen as wrong or unacceptable - just less frequent (hommosexuality) 
• Evidence for assistance 
  • used to justify requests for psychiatric assessments 
• Based on real data
  • Relies on real, unbiased data 
• Overall view
  • Gives overview of what behaviours and characteristics are infrequent in a given population 

• Where to draw the line
  • Not sure how far deviate from the norm to be seen as abnormal. 
  • Many disorders may vary greatly between individuals in terms of severity. 
• Not all infrequent behaviours are abnormal 
  • Some rare behaviors and characteristics are desirable rather than undesirable. (high intelligence) 
• Not all abnormal behaviours are infrequent 
  • Some statisitaclly frequent normal behaviours are abnormal. 
  • E.g. 10% of the population will be chronically depressed at some point in life. this isnot seens as abnormal under this definition. 
• Cultural factors 
  • Doesnt consider cultural factors
  • Whats statistically normal in onecountry and not in another. 

• Type of anxiety disorder 
• Anxiety - a state of emotional and physical arousal. The emotions include having worried thoughts and feelings of tension. physical changes include an increased heart rate and sweatiness. Anxiety is a normal reaction to stressful situations, but can affect the accuracy and detail of eyewitness testimony. 
• Phobias - An irrational fear of an object or situation.
  • Anxiety levels out of proportion to any actual risk.  

Behavioural:

• Avoidant / anxiety response:
  • Confrontation with fear object/situation produces high anxiety.
  • Efforts amde to avoid fear objects - reduces chances of such anxiety occurring.
• Disruption of functioning:
  • Anxiety and avoidance - so extreme - severly interfere with the ability to conduct everyday working and social functioning. 
  • Emotional:

• Persistant, excessive fear 
  • produces high leels of anxiety - presence of anticipation of fear object/situation.
• Fear from exposure to phobia stimulus. 
  • Immediate fear response - panic attacks 
  • Due to presentation of fear objective/situation 

Cognitive:

• Recognition of exaggerated anxiety
  • Phobic's - consciously aware that anxiety levels they experience are overstated

Simple Phobias: 

• Fears of specific things and environments. 
  • Animal phobias - e.g. Arachnophobia (spiders) 
  • Injury phobas - e.g. Haematophobia (blood) 
  • Situational phobias - e.g. Aerophobia (flying)
  • Natural environnment phobias - e.g. Hydrophobia (water)

Social Phobias :

• Common 
• Over-ancious in social situations
• Perception of being judged and feeling inadequate 
• Often find conducting meaningful relationships difficult 
  • Performance phobias - Anxious about going out in public - e.g. Speaking in public
  • Interaction phobias - Anxious about mixing with others - e.g. Interviews, Going on a date
  • Generalised phobias - Anxious about situations where other people are present - e.g. Crowds, Concerts, Football matches

Agoraphobia: 

• Fear of leaving home or a safe place. 
• Experience panic attacks - feel vulnerable in open spaces.
• Can be brought on by simple phobias. 
• Natural avoidance is too find and stay in safe place (home). 

• Animals tend to have early onset - followed by other simple phobias - social phobias - agrophobia. 
• Can either be learnt from experience or genetically transmitted. 

• Affective mood disorder involving lengthy disturbance of emtions. 
• 20% of people will suffer from some sort of depression.
• Women are twice as vulnerable to suffer from depression. 
• Can occur in cycles - symptoms comig and going overtime. 
• Episodes lasting around 2-6 months. 
• High suicide rates - 10% od depression sufferers commit suicide. 
• To be diagnosedd the sufferer must experience at least 5 sympotms everyday for two weeks - impairment in general functioning must also be present
• There must not be any other medical condition or event that could contribute to the symptoms - e.g. mourning. 
• Major depression - one of 5 symptoms, must be constant depressed mood or lesssend interest in daily activities. 
• Dysthmic depression - 3 or more symptoms shown, including depressed mood - shows symptoms for more than 2 months. 

• Depression occurring without mania. 
• Only experience depression. 
• 25% of women will suffer from Unipolar depression, 12% of men. 
• Characterised by clinical symptoms, usually occuring in cycles. 
• Severe version - delusions - more social impairments and episodes of depression occur more frequenty. 
• Doesnt respond well to anti-depressants but does respond to a comdination of of anti-depressants and anti-psychotics 

Behavioral: 

• Loss of energy 
• Social impairment 
• Weight changes 
• Poor personal hygiene
• Disturbance of sleep pattern 

Emotional:

• Loss of enthusiasm 
• Constant depressed mood 
• Worthlessness 

Cognitive:

• Delusions
• Reduced concentration
• Thoughts of death 
• Poor memory 

• Less common 
• Effects 2% of people 
• Mixed episodes  of mania and depression. 

Symptoms:

Behaviour:

• High energy levels 
• Reckless behaviour 
• Talkative 

Emotional: 

• Elevated mood states
• Irritability 
• Lack of guilt 

Cognitive: 

• Delusions 
• Irrational thought process 

• Anxiety disorder. 
• Experience persistent and intrusive thoughts occuring as obsessions, compulsions or a combination of the two. 
• Obsessions
  • Things people think about. 
  • Comprise forbidden or inappropriate ideas and visual images that arent base on reality. 
    • e.g. Beingn convinced germs are everywhere.
  • Leads to feelings of extreme anxiety. 
• Compulsions
  • What peopple do as a result of obsessions.
  • Comprise intense, uncontrollable urges to reperirively perform tasks and behaviours. 
    •  e.g. Washing hands for an extensive amount of time to get rid of germs. 
  • Attempt to reduce distress or prevent feared events 
• Most realise their obsessive ideas and compulsions are excessive, cannot consiously control them. 
• Become time-consuming - interfere with ability to conduct every day activities. 
• Only effects 2% of the population. 

Symptoms:

Behaviour:

• Hinder to function properly everyday. 
• Social impairment 

Emotional: 

• Extreme anxiety 

Cognitive:

• Recurrent and persistant thoughts 
• Recognised as self-generated 
• Realisation of inappropriateness
• Attention to bias 

Common obsessions - Contamination - germs, fear of losing control, perfectionism, religion - fear of being immoral.

Symptoms:

Behavioural:

• Repetative 
• Hinder to function adequately in everyday life
• Social impairment 

Emotional: 

• Distress 

Cognitive:

• Uncontrollable urges 
• Realisation of inappropriateness. 

Common compulsions - Excessive washing/cleaning, excessive checking, repetitions - body movements, metal compulsions, hoarding.

• Beck (1987) - people become depressed because the worls is seen through negative schemas. 
• Dominated thinking.
• Triggered whenever in siyuations similar to when negative schemas were learnt. 
• Beck - schemas are developed in childhood and adolescence. 
• Then continue into adulthood. 
• Negative framework to view life in pessimistic fashion.
• Negative schemas fuel and are fuelled by cognitive biases - misperceived reality. 

Negative Schemas: 

• Ineptness schemas 
  • Expected to fail 
• Self blame schemas 
  • Feel responsible for misfortunes. 
• Negative self-evaluation schemas 
  • Constantly reminded of their worthlessness. 

• Arbitrary inference 
  • Conclusions drawn in the absence of sufficient evidence. 
• Selective abstraction
  • Conclusions drawn from one part of a situation. 
• Overgeneralisation
  • Sweeping conclusions drawn on the basis of a single event. 
• Magnification and minimisation 
  • Exaggerations in evaluation of performance.

• Depressives mistakenly blame external events for their unhappiness. 
• Interpretation of these events that is to blame 
• A - Activating event:
  • Something happens in the environment around you.
• B - Beliefs: 
  • You hold a belief about the event or situation.
• C - Consequences: 
  • Having an emotional response to your belief. 
• Activating event triggers an emotion that is seen as true and the consequence is that the individual becomes depressed. 
• Negative view abut themselves and no confidence in ability. 
• Difference between depressed and non-depressed and how they perceive themselves.
• Explains depression in terms of faulty and irrational thought processes and perceptions.
• Focuses on maladaptive cognitions that underpin malapative behaviours. 

• Monitored students negative thoughts with the Beck depression inventory. 
• Found that depressives misinterpretnfacts and experiences in a negative fashion, and feel hopeless about the future. 
• Supports Beck's cognitive explanation. 

• Found no clear separation of negative thoughts - found single one-dimentional negative perception of oneself. 
• Three area of triad as separate dimensions is unnecessary. 

Evaluation:

• + Lots of reserach supporting cognitive vulnerablitlity being linked to onset of depression and depressives attending to negative stimuli. 
• + Based upon scientific principles - allowing improvement of model and greater understanding.
• + Higher success in treating depression with cognitive therapies in comparison to therapies from other explainations. 
• + Acknowledges other aspects (genes, development and early experiences) can lead to certain thinking patterns that can lead to depression. 
• - Less success in explaining and treating bipolar depression - lessening support for model as explaination for depression. 
• - Not all depressed peole have distorted view of their own ablitites. 

• Genetic explainations - vulnerability to depression in inherited. 
• Research through teins and adportion studies. 
• Wender et al. (1986) 
  • Adpoted children who developed depression were more likely to have depressive parent.
  • Suggesting biological factors are more important than genetic explainations. 

Behavioural explanations - depression as a learnt condition. 

• Negative life events incur a decline in positive reinforcement. 
• Learned helplessness - cant bring about positive life outcomes. 
• Coleman (1986)
  • Individuals receiving low rates of positive reinforcement for social behaviours became passive and non-responsive. Leading to depressive moods. 
  • Provided support for learning theory. 

CBT stands for Cognitive behavioural therapy

• Main psychological treatment. 
• Based on cognitive model - abnormla behaviour as caused by disorder thought process. 
• beliefs, expectations and cognitive assessments of self, environment and nature of personal problems affect how individuals perceive themselves and others. 
• CBT - identify irrational and maladaptive thought and alter them. 

The Department of Health 2001 

• REview research papers of treatments for depression. 
• CBT is most effective. 

Rational emotive behavioural therapy 

• Developed by Albert Ellis 
  • "People are not disturbed by things, but rather by their view of things". 
• Believed the way people feel is influencedby how they think. 
• Saw irrational thoughts as causing emotional distressand behavioural disorders. 
• Irrational thoughts cause negative self-statements. 
• REBT involves making pateints irrational and negative thoughts more rational and positive.
• Ellis identified 11 basic irrational masturbatory beliefs that are emotionally damaging and can lead to psychologic problems. 
• E.g. I must be loved by everyone ... otherwise everyone will hate me. 
• therapists aims to challenge patients thinking 
• Patients asked to practise positive and optimistic thinking. 
• Therapy uses ABC model to record  irrational beliefs. 
• Reframing negative thoughts - reinterpreting ABC in more positive and logical way 

• 170 patients suffering from depression treated with REBT for 14 weeks
• Better treatment outcomes than those with drug treatments after 6 months.
• REBT is better long-term treatment than drug therapy. 

• CBT is most effective psychological treatment for moderate and severe depression. 
• Has few side effects
• CBT - short time period compared to other treatments, more cost effective. Long-term benefits - techniques stop symptoms returning. 
• Ethical concerns with CBT - too therapist centred. Can abuse power over patients, patients can become too dependant. 
• Unsuitable for patients with difficulty concentrating.
• Not suitable for patients with difficult talking about feelings or those without verba skills.