Psychopathology

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  • Created on: 24-03-19 18:55

Deviation From Social Norms

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.
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Deviation From Social Norms - Strengths

  • 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.
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Deviation From Social Norms - Limitations

  • 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 
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The Failure to Function Adequately

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
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Rosenhan & Seligaman (1989):

  • 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 

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Failure to Function Adequately - Strengths

  • 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. 
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Failure to Function Adequately - Limitations

  • 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 
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Deviation From Ideal Mental Health

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. 
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Marie Jahoda (1958)

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. 
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Deviation from ideal metal health - Strengths

  • 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 
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Deviation from ideal metal health - Limitations

  • 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
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Statistical Infrequency

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. 
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Statistical Infrequency - Strengths

  • 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 
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Statistical Infrequency - Limitations

  • 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. 
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Phobias

  • 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.  
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Phobia - Symptoms

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
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Phobia - Types

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
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Phobia - Types - Part 2

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. 
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Depression

  • 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. 
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Unipolar Depression

  • 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 
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Unipolar Depression Symptoms

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 
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Bipolar Depression

  • 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 
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OCD

  • 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. 
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Obsessions

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.

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Compulsions

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.

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Explaining Depression - Becks negative triad

  • 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. 
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Beck's negative triad - Cognitive bias

  • 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.
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Explaining Depression - Ellis' ABC Model

  • 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. 
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Explaining Depression - Boury et al (2001)

  • 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. 
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Explaining Depression - Mcintosh et al (2000)

  • 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. 
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Explaining Depression - Genetic explanation

  • 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. 
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Explaining Depression - Behavioural explanations

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. 
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Treating Depression - CBT

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. 
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Treating Depression - REBT

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 
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REBT - David et al. (2008)

  • 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. 
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Treating Depression - Evaluation

  • 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.
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