Psychopathology

Statisical Infrequency

• Numerically unusual behaviour or characteristic
• E.g. IQ below 70 is part of the diagnosis of intellectual disability disorder

Evaluation

• Real-life application - simple means of assessing patients
• Unusual characteristics can be positive - some unusual behaviours don't require treatment
• Not everyone unusual benefits from a label - some people with a low IQ function adequately, and don't benefit from being labelled

Deviation from Social Norms

• Social judgments about what is acceptable
• What is normal in one culture may not be in another
• Antisocial personality disorder - impulsive, aggressive, irresponsible behaviour is not socially acceptable

Evaluation

• Not a sole explanation - other factors matter such as distress to others
• Cultural relativism - unfair to judge someone from another culture
• Can lead to some human rights abuses - the social norm approach maintains control over minority groups (e.g. women)

Failure to Function Adequately

• Failing to cope with demands of everyday life
• Signs, e.g. not conforming to interpersonal rules, personal distress
• Intellectual disability disorder - failing to function is part of the diagnosis of IDD as well as low IQ

Evaluation

• Patient perspective - captures experiences of people with mental distress problems
• Is it different from 'deviation from social norms'? - Alternative lifestyles or doing extreme sports may be examples of both
• Subjective judgments - requires a subjective judgment during assessment

Deviation from Ideal Mental Health

• Jahoda considered normality rather than abnormality
• Includes lack of symptoms, rationality, self-actualisation, coping with stress

Evaluation

• Comprehensive definition - includes all reasons anyone might seek help
• Cultural relativism - ideas specific to Western culture (e.g. self-actualisation)
• Universally high standards of mental health - few people achieve all or even most of the ideals

Characteristics

• Behavioural
  • Panic 
  • Avoidance
• Affective
  • Irrational and unreasonable fear and anxiety
• Cognitive
  • Selective attention
  • Irrational belief
  • Cognitive distortions

Behavioural Explanation

• Mowrer: two processes of conditioning
• Acquisition by classical conditioning - UCS produces a fear response, UCS then associated with NS
• Maintenance by operant conditioning - avoidance of phobic stimulus reinforced by anxiety reduction so the phobia is maintained

Evaluation

• Good explanatory power - explains how phobias can be both aquired and maintained
• Alternative explanation for avoidance - may be motivated more by seeking safety rather than anxiety reduction
• Incomplete explanation of phobias - cannot account for preparedness to aquire phobias of some stimuli and not others

Systematic Desensitisation

• Anxiety hierarchy - a list of situations ranked for how much anxiety they produce
• Relaxation - reciprocal inhibition; relaxation includes imagery and/or breathing techniques
• Exposure - exposed to phobic stimulus whilst relaxed at each level of the anxiety hierarchy

Evaluation

• Effective - more effective than relaxation alone after 33 months
• Diverse range of patients - e.g. appropriate for patients with learning difficulties
• Acceptable to patients - patients prefer it to flooding so drop-out rates are lower
• Some phobias don't follow trauma
• Cognitive aspects of phobias not explained

Flooding

• Exposes patients to a very frightening situation without a build-up
• Works by extinction of the conditioned fear response
• Patients must give informed consent to and be prepared for flooding

Evaluation

• Cost-effective - more effective than systematic desensitisation and quicker, therefore cheaper
• Less effective for some - less effective for complex phobias like social phobias
• Traumatic treatment - drop out rate is high so ineffective
• Symptom substituation

Characteristics

• Behavioural
  • Lethargy and agitation
  • Increased or decreased sleeping/eating
  • Aggression and self-harm
• Affective
  • Lowered mood
  • Anger towards self and others
  • Low self-esteem
• Cognitive
  • Poor concentration
  • Negative bias
  • Absolutist thinking

Beck's Theory

• Faulty information processing - attending to the negative aspects of a situation
• Negative self-schemas - negative information about ourselves is accessed whenever we encounter a self-relevent situation
• Negative triad - negative views of the world, the self, and the future

Evaluation

• Supporting evidence - solid support for idea that certain cognitions make us vulnerable to depression
• Practical application in CBT - negative thoughts can be identified and challenged by a therapist
• Doesn't explain all aspects - cannot easily explain extremes of anger or hallucinations and delusions

Ellis' ABC Model

• Activating event - a negative life event that triggers a response
• Beliefs - beliefs that lead us to over-react to the activating event (e.g. life should always be fair)
• Consequences - depression results when we over-react to negative life events

Evaluation

• Partial explanation - some cases of depression follow life events, but not all
• Practical application in CBT - irrational thoughts can be identified and challenged by a therapist
• Doesn't explain all aspects - cannot easily explain extremes of anger or hallucinations and delusions
• Cognitive primacy
• Insecure attachment linked to depression

Cognitive Behavioural Therapy

• Beck's CT - aims to identify negative thoughts and challenge them, including through testing them
• Ellis' REBT - aims to identify and challenge irrational beliefs by argument
• Behavioural activation - includes techniques from CT and REBT but also behavioural techniques

Evaluation

• Effective - significantly more effective than no treatment
• May not work for the most severe cases - not effective where patients are too depressed to engage in therapy
• Patient-therapist relationship - all therapies fairly similar
• Some patients want to explore their past
• Overemphasis on cognition

Characteristics

• Behavioural
  • Compulsions usually decrease anxiety
  • Avoid situations that trigger anxiety
• Affective
  • Intense anxiety
  • Depression
  • Guilt and disgust
• Cognitive
  • Obsessive thoughts
  • Cognitive strategies (e.g. prayer)
  • Self-insight

Genetic

• Candidate genes - genes that may be involved in producing symptoms of OCD (e.g. 5HT1-D beta)
• OCD is polygenic - different combinations of up to 230 genetic variations
• Different types of OCD - different combinations of gene variations may cause different kinds of OCD

Evaluation

• Good supporting evidence - twin studies show OCD is influenced by genes (MZ twins concordance rate = 87% for obsessive symptoms + features vs 47% in DZ twins)
• Too many candidate genes - so many genes involved means little predictive value
• Environmental risk factors - OCD is associated with trauma, so it is clearly not entirely genetic in origin; cannot isolate role of nature vs nurture

Neural

• Serotonin - low levels of serotonin linked to OCD
• Decision-making systems - frontal lobes and parahippocampal gyrus may be malfunctioning

Evaluation

• Supporting evidence - antidepressants that work on the serotonin system alleviate OCD
• Not clear what mechanisms are involved - all the neural systems associated with OCD are only involved in some cases
• Shouldn't assume nerural mechanisms cause OCD - neural abnormalities may be the result of OCD, not the cause
• Serotonin-OCD link may be co-morbidity with depression
• Twin studies are flawed as genetic evidence

Drug Therapy

• SSRIs - antidepressants that increase levels of serotonin at the synapse
• Combining SSRIs with other treatments - combine with CBT or other drugs
• Alternatives to SSRIs - clomipramine (acts on the serotonin plus other systems) or SNRIs (noradrenaline)

Evaluation

• Effective at tackling symptoms - Soomro et al: SSRIs are superior to placebos in treating OCD + reduce symptoms for 70% of patients
• Cost-effective - compared to psychological treatments, drugs are cheap and non-disruptive
• Can have side effects - indigestion, blurred vision, and loss of sex drive; worse for clomipramine
• Unreliable evidence for drug treatments - biased for drug companies benefits
• Some cases of OCD follow trauma
• Simpson et al: 45% of drug therapy patients relapsed vs 10% of behavioural therapy patients