Psychopathology AO3

This definition provides a positive holistic approach to diagnosis that identifies areas for personal development. This list is simple and comprehensive so it can be applied to contexts such as therapy where diagnosis is required

The criteria are culturally biased to reflect an ethnocentric western viewpoint on what ideal mental health is. This is an example of an emic viewpoint being applied to all individuals as an etic construct. For example, many cultures place less value on autonomy and personal freedom than western cultures, and more value is placed upon social roles

It may be argued that the criteria are overinclusive. It can be difficult to achieve all of these criteria at the same time, so most people would be judged as failing to achieve ideal mental health and would therefore be classed as abnormal

It can be difficult to distinguish between desireable and undesirable traits as not all statistically infrequent traits are negative. For example, a high IQ is statistically rare but also highly desireable

Where the cut off point falls results in some individuals receiving treatment and some not. This means that deciding where to put the cut off point of what is considered "normal" is subjective and may mean individuals who do not need attention are treated and those who need treatment are not seen

Some disorders such as depression and anxiety are common. Approximately 17% of the population met the criteria for a common health disorder in 2014. Therefore, the statistical infrequency definition does not match with the high incidence of mental health disorders within society

Deciding whether an individual is coping or not is a subjective judegment that is affected by the opinions of the observer. This means two different observers may not rate the individual in the same way and therefore the definition may have low inter-rater reliabilty

Some abnormal behaviour may not be linked to the inability to cope or to stress. It is thought that there are many psychopaths that may be more able to function in certain roles in society, which may be more at the detriment of others than themselves

It could be argued that not all maladaptive behaviour is an indication of mental illness. For example, smoking and poor diet are seen as against an individual's long term interests in their personal health but these behaviours are not assumed to constitute mental illness. Other socioeconomic factors may also have a role in determining behaviours such as these

The definition recognises and respects the patient's own lived experiences and persepective, which statistical infrequency and deviation from social norms cannot address

The definition respects differences by not imposing a set defintion of abnormality and thus avoids western ethnocentrism that would cause other cultures to be viewed as abnormal, taking context into consideration

Different social classes within the same society may have different social norms. This could result in the overdiagnosis of mental health problems in those of working class backgrounds if most of the psychiatrists are from middle or upper class backgrounds, and so are applying their own idea of social norms to clients

The definition can create problems for people living in a culture different to their culture of origin. For example, Cochrane suggests that there is a 7x higher diagnosis rate of schizophrenia for people from Afro-caribbean heriatge living in the UK compared to those native to the UK living in the UK or those native to the caribbean living in the caribbean. Fernando considered this to be a 'category failure' that has occurred due to western definitions of mental illness being applied to non-western cultures, particularly on how hallucinations and reglious experiences are interpreted

This definiton can result in society imposing punishments onto unconventional mentally healthy people for expressing individuality, which is unethical. To add to this, people who participate in activities such as extreme sport may also be labelled abnormal which could affect wellbeing

There is supporting research from Watson and Rayner (1920) who used Little Albert to demonstrate how phobias could be induced. They did this by making a loud noise while presenting a rat to him, and were able to generalise this fear to other white fluffy objects. This study provides evidence for the two-process model via demonstrating how acquisition and generalisation of phobias work. However, it was a highly unethical study as it caused the participant emotional harm

There is conflicting research from Menzies and Clarke (1993) who found that only 2% of children with a fear of water could recall a traumatic experience with water, suggesting that the behaviourist explanation cannot account for all phobias

Phobias of snakes and dogs have an evolutionary origin as early ancestors could have been hunted by these. This could explain why these are common phobias, acquired by knowledge. This is the evolutionary biological theory, however this nature explanation opposes the nurture explanation of the behavioural approach

Behaviourist theories of phobia formation and maintenance have led to the development of effective counter-conditioning treatments such as flooding and systematic desensitisation. This demonstrates the high application of the theory and how it can improve the quality of individuals' lives

Flooding is not appropriate for older people, people with heart conditions, children or abuse victims due to ethical concerns, whereas systematic desensitisation is suitable for almost all people. This is because flooding exposes indivduals to emotional harm, which could also end up reinforcing the phobia if treatment is ended too soon

A strenght of flooding is that it provides a cost effective treatment for phobias. Research has suggested that flooding is comparable to other treatments, including systematic desensitisation and cognition therapies (Ougrin 2011). However, it is significantly quicker

Although flooding is considered to be a cost effective solution, it is highly traumatic for patients and causes a high level of anxiety. Although patients do provide informed consent, many do not complete their treatment because the experience is too stressful and therefore flooding is sometimes not an effective use of money and time. Systematic desensitisation has a higher completion rate, perhaps because it is a more pleasant experience

Although flooding is highly effective for specific phobias, the treatment is less ideal for other times of phobias, including social phobias and agoraphobia. Some psychologists suggest that social phobias are caused by irrational thinking and not unpleasant experiences or learning through classical conditioning. Therefore, more complex phobias cannot be treated by behaviourist treatments and may be more responsive to other forms of treatment, for example cognitive behavioural therapy which targets irrational thinking

McGrath et al (1990) found that 75% of patients with phobias were successfully treated using systematic desensitisation when using in vitro techniques, showing the effectiveness of the treatment

Further support comes from Gilroy et al (2002) who examined 42 patients with arachnophobia. Each patient was treated was treated using three 45 minute systematic desensitisation sessions. When examined 3 months and 33 months later, the systematic desensitisation group were less fearful than the control group (who were only taught relaxation techniques). This provides support for systematic desensitisation a long-term treatment for phobias

However, systematic desensitisation is not effective at treating all phobias. Patients with phobias which have not developed through personal experience, for example a fear of heights, are not effectively treated using systematic desensitisation. Some psychologists believe that certain phobias have an evolutionary survival benefit and are not the result of conditioning. These phobias highlight a limitation of systematic desensitisation which is ineffective in treating evolutionary phobias

Alternative treatments for phobias exist, such as drug treatments. These are often used as a short term solution before therapies. Examples are anxiety disorder tranquilisers such as benzodiazepines and beta blockers. Antidepressants can also be prescribed but all of these drugs simply suppress the symptoms without addressing the underlying cause and also cause side-effects. As talking therapies are more effective in the long term, they are the preferred treatment plan. But both systematic desensitisation and talking therapies take a number of sessions to complete and require 1:1 time with the therapist, resulting in a higher cost than for drug treatments

Research from studies such as Lewis provide support for a genetic exlanations for OCD. While evidence from family studies seem to indicate a strong genetic factor, these studies cannot fully control the influence of shared environmental factors such as diet. Conversations about and awareness of OCD will be more common with a sufferer in the household making other family members more likely to seek treatment, making the genetic link seem greater than it is

Further support for the biological explanation of OCD comes from twin studies which have provided strong evidence for a genetic link. Nestadt et al (2010) conducted a review of previous twin studies examining OCD. They found that 68% of identical twins and 31% of non-identical twins experience OCD. This suggests a very strong genetic component in OCD. However, no twin study has found a 100% concordance rate in identical twins which means that biological factors may not be the only factor contributing to OCD and environmental factors may play a role

Research from Hu (2006) found genetic differences between 169 OCD sufferers and 253 controls that impacted the function of serotonin transporters in the brain, supporting both the genetic and neural explanations in OCD

Support for the neural explanations of OCD come from research examining biological treatments including antidepressants. These typically work by increasing levels of the neurotransmitter serotonin. They have been shown to be effective in reducing the symptoms of OCD and provide support for the neural explanation

The effectiveness of drug treatments, for example SSRI's, indicate that the neural explanations are valid but drugs that work on serotonin simply conceal the symptoms, without treating the root cause

The biological explanation could be seen as biologically deterministic as it suggests that OCD is due to uncontrollable genetic and neural factors. However cognitive explanations suggest that OCD is due to faulty information processing, and can be treated by challenging irrational beliefs. Some psychologists suggest that OCD may be learnt through classical conditioning and maintained through operant conditioning; the stimulus, for example dirt, is associated with anxiety and this association is then maintained through operant conditioning, where a person avoids dirt and constantly washes their hands. This washing reduces their anxiety and negatively reinforces their compulsions. As OCD symptoms have been shown to be reduced by cognitive therapies such as CBT, the validity of this deterministic viewpoint can be questioned

Greist (1995) conducted a meta-analysis and reviewed placebo-controlled trials of the effects of 4 drugs on OCD using a total of 1520 particpants. All 4 drugs were found to be significantly more effective than the placebo, with clomipramine being the most effective. So biological treatments for OCD often have strong evidence such as highly controlled drug trials to show the effectiveness of treatment

Soomro et al (2008) conducted a review of the research examining the effectiveness of SSRI's and found that SSRI's were more effective than placebos in the treatment of OCD in 17 different trials. This supports the use of biological treatments for OCD

Research has led to the development of cognitive neuroscience. When applied to OCD, this is now producing biological treatments that involve direct deep brain stimulation using electrodes on the affected areas of the brain to reduce the presence of obsessions. In the future, these treatments may replace drug treatments

Publication bias is an issue when considering the effect of drug treatments, as positive results are more likely to be published than negative results. It is argued that drug companies often run trials with the financial incentive to show that their drug is effective, potentially leading to researcher bias and demand characteristics in participants. This limits the validity of the findings

A strength of biological treatments is the cost. Treatments, including antidepressants and anti-anxiety drugs are relatively cost-effective in comparison to psychological treatments such as CBT. Consequently, many doctors prefer the use of drugs over psychological treatments, as a cheaper cost is more beneficial for the health service. To add to this, psychological treatments require a patient to be motivated. Drugs however are non-disruptive and can simply be taken until the symptoms subside. As a result, drugs are more likely to be more successful for patients who lack motivation to complete intense psychological treatments

A limitation of drug treatments for OCD is the possible side effects of drugs such as SSRI's and BZ's. Although evidence suggests that SSRI's are effective in treating OCD, some patients experience mild side effects like indigestion while others may experience more serious problems such as hallucinations. BZ's are renowned for being highly addictive and can also cause increased aggression and long-term memory impairments. As a result, BZ's are usually only prescribed for short-term treatment. Consequently, these side effects diminish the effectiveness of drug treatments, as patients will often stop taking medication if they experience these side effects

Drug treatments are criticised for treating the symptoms of the disorder and not the cause. Simpson (2004) found a relapse rate of 45% in OCD cases within 12 weeks of stopping medication, compared to only 12% of cases for CBT patients. This suggests that the drugs are not a long-term solution as they do not treat the underlying cause of OCD