Psychopathology

A sever deviation from what social norms and seems to be harmful to the individual. The behaviour is also usually exhibited over a long period of time, so they must alsways act oddly, not just once. 

- v subjective and depends on whos making the decision of diagnoses

- change of norms in society is volitile so not a temporally consistant definition

+ behaviour is judged within the context so more holistic

+ abnormality definitions adapt with age of the individual

+ an example of the individual differences approach so no generalsiations  

Statistical abnormalilty is plotted against the normal distribution curve. anyone one outside the farthest percentile (5%) are considered abnormal. An example of this being used is the percentile of indivuals in the smallest standard deviation for those exibiting the behavioiur of self harm. 

- some statistically abnormal behvaiour is desirable such as high IQ

- doesnt consider cultural differences that may effect behaviour (e.g. cannibalism)

+ uses the objective point of 2 standard deviation to define abnormality

+ applicable to meausre child development against normal percentiles.

Rosenhan and Seligmans seven features of personal dysfunction describe when a person is no longer able to cope with normal life. 

• Personal distress: feeling upset 
• Maladaptive behaviour: behviour that causes harm to them self
• Unpredictability: erratic behviour 
• Irritationality: doing illogical things 
• Observer discomfort: other people experience discomfort at seeing the behaviours 
• Violation of moral standards: breaking societies taboos 
• Unconventionality: not following social norms 

- doesnt consider context (funeral berevement)

- cultural bias 

+ can be used to asses severity of disorders 

+ list of conditions are visible, unlike cognitive issues

Mary Jahoda suggested a set of criteria for idea mental health, any absense of these characteristics suggest deviation from ideal mental health. 

• Symptom free 
• Rational 
• Self actualised 
• Unstressed
• Grasp on reality 
• Good self esteem

- varies over time and culture 

- subjective definitions 

- most people do not self-actualise but we would not categorise them as abnormal 

+ a holistic view so looks at many variables 

Classed as an anxiety disorder, an irrational response to stimuli or an idea of stimuli.

Emotional:

• panic and anxiety
• immidate fear response 

Behavioural:

• avoidance or freezing 
• fight or flight response 

Cognitive:

• irrational thoughts 
• resistance to logic 
• self-awareness of irrationality 

DSM-5 categorisation: the DSM categorises all phobias into three subtypes

1. Specific phobias (of specific objects etc) - 0.075%

2. Social phobia ( social anxiety) - 17.2%

3. Agoraphobia (fear of being in large outside places) - 9.9%

A phobia is created through an association between a stimulus and a fear response to another stimulus, as suggested by the case study of Little Albert:

White rat (NS) ---------------------------------------------> no response 

Loud bang (UCS)-----------------------------------------> fear response (UCR)

Loud band (UCS) + white rat (NS)-------------------> fear response (UCR)

White rate (CS)-------------------------------------------> fear response (CR)

A fear can be maintained by negative reinforcement (removal of something negative) through avoidance or removal of the phobia stimulus 

- ignores cognitive factors such as selective attention, irrational beliefs and distortions 

+ application to systematic desensitisation and flooding 

+ phobia person can often pinpoing when the association was mad (i.e traumatic event)

Systematic Desensitisation (SD): developed by Wolpe and is now the most common treatment for phobias. Based on hierarchy, reciprocal inhibition and relaxation techniques.

• client taught relaxation techniques 
• therapist and client make hierarchy of feared stimulus, and client imagines them 
• starts with least feared 
• move up hierarchy while practising relaxation techniques 
• face most feared situatio succesfully. 

- works for simple phobias but not social or agoraphobia

+ Little Peter case study: fear of white rabbit while working through hierarchy used food as a reward until he was stroking rabbbit on lap

+ works well for those who can relax and imagine fears 

Flooding:developed by Stampfl, directly faces phobias in high emotional arousal until calm 

• client taught relaxation techniques 
• face most feared situation for one long session while being supported by therapist until they calm down and stop fearing stiumulus 

- unethical as cuases extreme emotional distress even if client has consented (can cause further psycological damage if client quits half way through)

+ evidence suggests flooding and SD are equally effective 

+ cheaper than SD and quicker 

Classed as an affective disorder, disrupts daily functioning. Unipolar and bipolar.

Emotional:

• sadness
• emptiness/hopelessness
• low self esteem

Behavioural:

• agitation
• sleeping too much or too little 

Cognitive:

• negative self-belief
• suicidal intentions 
• feelings of guilt

Bipolar depresison: sufferes still experinece symptoms of unipolar depression, but with manic episodes of high energy and reckless behaviour.

Feature of depression:

• 2% of the population experience depressive episodes with co-morbid anxiety
• most liekly to recur if one episode has been had (70% relapse)
• After a third episode, relapse is 90%
• 1/5 people condition is chronic 
• more men than women effected

Cognitive apprach sees depression as a result of developing poor coping mechanisms. Negative thinking is triggered, and personality factors interact with this stressor. Negative thinking is not a cause, but it perpetuates depression through creating negative self-schemas.

Negative views of the world----------> Negative view of future------------------> Negative view of self 

• Ineptness schema: not good enough 
• Minimisation & maximisation
• Overgeneralisation

- Doesnt explain those who experince psychosis instead of being sad

- Evidence linking negative thinking to depression is correlational. There is a realtionship between inventory scores and depression levels but this is not causal. 

+ Bates: got 79 depressies to read lots of negative self statesments. This created a depressed mood state, supporting Becks model. 

A second cognitive explanation where an activating event triggers irrational thought processes.  

Activating event: fail driving test 

Beliefs: Im never going to pass, im not worth it 

Consequences: in a state of anxiety

Beevers: fMRI scans of 27 female, found different areas of brain were activated in low depressed and highly depressed ptps when showed pictures of happy or sad faces. Comcluded that depressives have difficulty activating areas of the brain for emotional control. Supports Ellis; depression pre-sets people to think negatively. 

- Does not exlain psychosis 

- Does not explain why some people recover without therapy

+ Many people become depressed because of evenst such as marriage breakdown etc (reactive depression- model works well)

1. Abnormal behaviour is caused by disordered automatic thoughts (negative triad)

2. Client identifies irrational thought processes

3. Therapist offers alternative thoughts (Where is the evidene for that belief?)

4. Client is set homework: record when they enjoy something or when someone compliments them

5. Behavioural activation: client enchoraged to partake in activities they will enjoy

+ CBT works fast so is cost effective 

- Requires well trained therapists 

+ March et al: compared CBT to antidepresssants alone and together. Found that after 36 weeks, these proportions were significantly improved in agroup of 327 depressed people

• 81% of CBT groups 
• 81% of drug group
• 86% of both group

1. Abnormal behaviour is caused by peoples view of things 

2. Ellis identifies 2 mustabatory beliefs that are emotionally damaging 

• I must be loved
• I must be excellent in all respects

3. Therapist challenges these beliefs through reframing- suggetsing more relaistic beliefs

4. Clients practise postive and optimistic thinking. Usually 12 sessions

5. Behavioural activationa and pleasant event schedually used to get client out and about. Goals set to boost self esteem

- Ethics: Ellis proposes a strongly challenging procedure, not all clients could take this 

- We do not know if irrational thoughts are cause or symptom of depression

- Embling showed not all clients benefit from REBT. Personality factors such as perfectionism can hinder its effects

Classed as an anxiety disorder, obsessive thoughts and/ or compulsive behvaiour.

Emotional:

• digust at touching objects (germs)
• anxiety and distress

Behavioural:

• repetitive behaviours (checking)
• compulsions reduce anxiety so reinforced

Cognitive:

• obsessive thoughts (intrusive and dominating)
• hyper-vigilant (lookign for disasters)
• self-awareness of irrationality

DSM-V classification:

The DSM classifies OCD as described above as well as 3 other types

• Trichotillomaina: compulsive hair pulling 
• Hoarding disorder: compulsive keeping of objects and distress parting with them
• Excoriation disorder: compulsive skin picking 

Heritability of 45% (Grootheest)

Diathesis stress model: genetic precurser with an activating event can bring onset of OCD, usually developed late teen-early adult. Several genes have been identified as releavnt (candidate genes). OCD may be associated with a rare combination of two mutations within the human seretonin transporter gene (hSERT).

+ Samules et al found a genetic link to hoarding behaviour through gene mapping 

- Twin studies flawed as non 100% concordance in monzygotic twins 

Neural: Dopamine and Seretonin affect mood and are implicated in OCD. Frontal lobes are involved in plannign and deciosn making, and activity levels in this part of the brain incrases as clients increasingly have obsessive thoughts.

Strepptococal (Szymanski) : onset of strep (weakened immune system) create fast onset OCD through damage to the neural systems. This can be teeated and cure is done promptly. The same principle applies to Lymes disease form ticks but is less treatable.

+ Hu: compared seretonin in sufferers and non-sufferers. Low seretonin in sufferers

+ Some antidepressants work on OCD patients meaning higher levels of seretonin are left in the synapse.

- Not known whether neural changes are a cause of OCD or a symptom 

- Not knwon how genes interact with neural factors (resrach in infancy)

Selective Seretonin Reuptake Inhibitors (SSRI's) are a standard treatment for OCD. People with OCD have a high reuptake of seretonin, so not as much reaches the next neurone. SSRI's work to block that reuptake, and increase activation is seretonin receptors. 

2- 6 weeks needed for the full effect to be reached . Current NICE* guidlines say drugs should be used either after the failure of CBT or alognside it. 

- side effects: increase in suicidal thoughts, weight gain, heart problems, loss of libido

- CBT has better remission rates (NICE)

+ Soomro: meta-review of 17 studies on SSRI's on OCD patients, found drus more effective than placebos in short term (3 months)

+Treatment resistant cases offered antipsychotics as well as SSRI's which seems to help

+ Drug therapy quick and easy compared to CBT, cheaper, no training required

*NICE= national institute for health and care excellence