Psychopathology

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Definitions of abnormality

Failure to function adequately - Any person who is unable to live a normal life and experience a normal range of emotions or behaviour.

Assessed using Global Assessment of Functioning Scale. Includes causes observer discomfort, disruptive behaviour and irrational behaviour.

Takes the patients perspective into consideration, however, is subjective and may be too similar to ideal mental health. 

Statistical infrequency - Any behaviour that is uncommon in a population. Shown on a normal distribution curve. Any behaviour that falls beyond two standard deviations from the mean is abnormal. 

Only 2% of people have an IQ of under 70. This is called an intellectual disability disorder. Equally 2% of people have an IQ of over 130. They are still abnormal.

Is objective, clear cut and clinically useful, and helps doctors to develop diagnostic tools however does not take into account how desirable a behaviour is, and some disorders are very common but still a psychopathology, e.g. depression.

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Definitions of abnormality pt. 2

Deviation from ideal mental health - Maris Jahoda (1958), includes the ability to cope with stress, the ability to adapt to a changing environment and the extent to which self-actualisation has been achieved.

The more criteria that are absent the more abnormal.

Is very comprehensive and covers a wide range of criteria, and easy to understand and practical. However, some of Jahoda's concepts are only relevant to some cultures, e.g. self-actualisation in the West. May be unrealistic as there are too many criteria to meet all at once. 

Deviation from social norms - Behaviour that is different from the accepted standards of behaviour in a community.

Good as it moves with the times, easy to use and is more holistic than statistics.

However suffers from cultural relativism and some social norms vary from culture to culture, e.g. Native Americans see hearing voices as a positive. 

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Depression Clinical Characteristics

Affects from 8 - 12% of the UK population in any year. 

Diagnostic tool - Beck Depression Inventory or Hamilton Depression Rating Scale. 

5 or more of symptoms persisting for 2 weeks or more including low or angry mood, lost of interest in activities once enjoyed, sleeping and eating changes and self harm. 

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Cognitive explanation of depression

Depression is the result of faulty schemas, distorted information processing and irrational beliefs.

Negative self-schemas - people who are depressed interpret all information about themselves in a negative way. Minimisation, magnification, selective abstraction and all or nothing thinking. 

Beck's Negative TriadNegative views about the world, future and myself. 

Negative self-schemas and cognitive biases maintain the negative triad. 

Supporting evidence: Graziolio and Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after birth. They found that women judged to have been high in cognitive vulnerability were more likely to suffer postnatal depression. 

AO3: Has lead to a practical application: Forms the basis of CBT. A therapist can challenge the cognitive aspects of depression and encourage the patient to test whether it is true. 

Beck's triad can not explain anger, hallucinations or bizarre beliefs experienced by depressed patients. E.g. Cotard syndrome, patients think they are zombies. 

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Albert Ellis' ABC model

Believed that irrational beliefs were the key element of depression. He called this musturbatory thinking. Irrational beliefs led to maladaptive negative emotions.

A - Acitivating event, B - the underlying Belief, C - the Consequent emotion

AO3 - Can explain that irrational thoughts cause depression and has lead to the practical application of a successful therapy that challenges irrational negative beliefs allowing people to reduce their depression. (REBT). However can also not explain the anger, hallucinations or delusions associated with depression.

Lewisohn et al - Asked adolescents to state the extent to which they agreed with a series of irrational beliefs. One year later they asked p's about negative life events that had happened in the last year. From the people that had experienced negative life events, only those who had negative cognitions before became depressed. Supports the role of faulty thinking as a cause for depression.

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Cognitive therapies for depression

Beck suggested that treatment should involve: Identify automatic thoughts about the world, self and future. Challenge these thoughts. Test the reality of negative beliefs. The patient may be set homework to record when they enjoyed an event or when people were nice to them, 'patient as scientist'. The therapist then had evidence to produce if later the patient said no one is nice to them etc.

Ellis suggested that treatment should involve: REBT = Rational emotive behaviour therapy. Identify and dispute irrational thoughts, often using vigorous arguments. Also including behavioural activism = encouraging a depressed patient to be more active and engage in enjoyable activities. Thought catching = Keep a journal recording emotionally rousing events and any associated feelings. 

Evidence for the effectiveness of behaviour activation

Babyak et al (2000) - Compared SSRIs (drugs for depression) to behavioural activation in the form of exercise. They found that the group prescribed exercise had longer lasting benefits and lower relapse rates for depression. This supports the idea that behavioural activation may help to treat depression. Behavioural activation in this study took the form of physical exercise, which we know can be good for mental health in general.

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AO3 cognitive therapies for depression

  • Some people may not benefit immediately from CBT
    • Some patients may be to distressed to engage with CBT and may need assistance from medication
    • May not work for the most severe cases
    • This is a limitation of CBT as it means CBT cannot be used as the sole treatment for all cases of depression
  • Success may be due to the therapist-patient relationship
    • Sometimes patients may really benefit from the opportunity of having someone to talk to who will listen is what matters most
  • Some patients may want to explore their past
    • CBT focuses on the patients current situation not the past
    • This is frustrating for patients that see a link between their childhood and their current depression
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OCD

OCD is an anxiety disorder characterised by the presence of both obsessions and compulsions.

Obsessions are persistent, intrusive, recurring thoughts or images.

Compulsions are repetitive, ritualistic behaviours.

Anxiety and distress (Obsessive thoughts are un-pleasant and frightening with overwhelming anxiety) , accompanying depression (Low mood and lack of enjoyment in activities) and guilt and disgust.

The Cycle of OCD

Obsessive thought - anxiety - compulsion - temporary relief

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Biological explanations of OCD

Genetic explanations for OCD

  • Twin and family studies
  • OCD tends to run in families. In 1936 Lewis noted that 37% of his patients with OCD had parents with the disorder, And had 21% had affected siblings.
  • This suggests a genetic cause. The higher the concordance rate the more likely it is that the trait was inherited.

Rasmussen and Tsuang (1986) found a concordance rate of 53-87% in MZ twins for OCD. Higher than DZ twins or the general population.

AO3 - Cannot separate nature and nurture. There is the confounding variable that they are also exposed to similar environments. Then the findings may be nature rather than nurture.

Concordance rates of 100% are never found in twin studies. This suggests that OCD is not entirely genetic. By focusing on environmental causes instead psychologists may be able to do something about the cause of OCD.

Sample sizes are small and so low population validity.

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Biological explanations of OCD - Candidate genes

Candidate gene = a gene that is a likely cause of the disorder 
To identify, researchers compare genetic material from OCD sufferers with non-sufferers.
A likely candidate gene is the 5HT1-D (beta variation) gene. It is involved in transporting serotonin across synaptic gaps, so it is sometimes known as the SERT gene (SERotonin Transporter)

AO3 - There is no single causative gene involved. Taylor (2003) suggested there may be up to 230 different genes involved in OCD, each working in a different way.

One issue with the genetic explanation of OCD is that it is determinist.
If OCD is caused by one's genotype then in theory it exists in an individual from birth
This matters because it implies that nothing the individual can do will affect whether they develop the disorder, people may then not seek any help.

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Bio explanations of OCD - Diathesis-stress model

Combines nature and nurture.
Suggests that certain genes cause some people to have a vulnerability or predisposition to the disorder.
They only develop the disorder if they experience certain environmental triggers.
This may explain why two MZ twins have the same DNA, but only one develops OCD, because they experienced the right trigger.
The explanation is a much less deterministic explanation.

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OCD - Neurotransmitter explanation

Serotonin is a neurotransmitter linked to OCD, sends mood-relevant information.
IF this process is disrupted then mood & mental processes can be affected
Hu (2006) found low levels of serotonin in people with OCD.
It may well be that these low serotonin levels lead to abnormally functioning in the areas of the brain involved in OCD, areas involved in decision making, e.g. orbitofrontal cortex.

AO3
Drugs called SSRIs can help in cases of OCD is evidence for the involvement of neurotransmitters in the disorder.
This type of drug increases the available levels of serotonin in the brain, so the fact that people who take SSRIs show a reduction in OCD symptoms suggests serotonin is probably involved.
Approximately 40% of OCD patients do not respond to SSRI treatment this suggests that OCD is not entirely caused by maladaptive neurotransmitters.

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Brain structures and OCD

Orbitofrontal cortex-thalamus-caudate nucleus pathway. 

In someone with OCD…

  • The OFC notices something is wrong and sends a worry signal to the thalamus

  • Which responds excessively

  • The caudate nucleus is underactive, so the worry signal is not blocked once the issue is dealt with

  • As a result, the issue escalates until it becomes an obsession

Therefore, we can say that obsessions are the result of the overactive thalamus and underactive caudate nucleus.

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Phobias

The irrational fear of an object or situation produces a conscious avoidance of that object or situation. 

DSM 5 Diagnosis: Exposure to the phobic stimulus produces a rapid anxiety response. They are very distressed about the phobia for at least 6 months. 

Characteristics include: Unreasonable anxiety, panic and avoidance, and selective attention, irrational beliefs and cognitive distortions. 

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Behaviourist explanation for phobias

Stage 1 - Acquisition - Classical conditioning: Learning to associate an unfeared neutral stimulus with an already fear stimulus. Usually requires repeated exposure but a single exposure can be enough. Bagby 1922 reported a woman who got her feet trapped in rocks near a waterfall and developed a phobia of running water. 

Stage 2 - Maintenance - Operant conditioning: When the person avoids the feared stimulus then the avoidance behaviour is reinforced. Negatively reinforced by the reduction of negative feelings towards the phobia.  

AO3 -  One strength is the support from research evidence. Watson and Raynor demonstrated the process of classical conditioning in the formation of phobias in Little Albert, who was conditioned to fear white rats. This supports the idea that classical conditioning is involved in acquiring phobias. The behaviourist approach ignores the role of cognition in the formation of phobias and cognitive psychologists suggest that phobias may develop as a result of irrational thinking, not just learning. E.g. Someone who is claustrophobic may think ‘I will suffocate in this lift’ which is an irrational thought and is not taken into consideration in the behaviourist explanation. Furthermore, the cognitive approach has also led to the development of cognitive behavioural therapy (CBT) which is said to be more successful than behaviourist treatments.

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