What is abnormality?
- What factors influence its definition?
- Deviance: deviating from the majority, violating social norms, or being statistically infrequent or 'rare'
- Distress: experience of personal suffering or anxiety due to the behaviour
- Dysfunction: not being able to perform in daily life
describes the scientific study of abnormal behaviour in general, of specific psychological disorders, and the characteristics of mental health.
What is psychological disorder?
- Must consider:
- The impact on the life of the affected individuals, such as behaviours, thoughts and emotions.
- A person’s behaviour may be classified as disordered if it causes him or her great distress.
- Not all disorder cause distress and presence of distress does not mean a disorder.
- Disability can also characterise psychological disorder.
The degree of threat or actual danger
that specific behaviours bear on affected individuals or to the community more generally.
, including abnormal physiological features (e.g., brain structures and functions) and genetic abnormalities
impairment in some important area of life (e.g., work, study or personal relationships)
Define social norms
widely held standards (beliefs and attitudes) that people use consciously or intuitively to make judgements about where behaviours are situated on such scales as good–bad, right–wrong, justified–unjustified and acceptable–unacceptable.
Changes between DSM 5 and 4
- Changes in organisation of diagnoses
- – DSM-IV-TR clusters diagnoses on similarity of symptoms
- – DSM-5 diagnoses are reorganized to reflect new knowledge of comorbidity and shared aetiology
- • e.g. OCD moved from anxiety cluster to new cluster that also includes hoarding and body dysmorphic disorder due to shared symptomology
- Combining diagnosis (e.g. autism and Asperger’s disorder = ASD)
- Ethnic and cultural consideration in diagnosis
- – Appendix includes a ‘Cultural Formulation’ interview and a section in culturally specific ways of expressing distress
DSM 5 characteristics of psychological disorder
- – the disorder occurs within the individual
- – it involves clinically significant difficulties in thinking, feeling or behaving
- – it usually involves personal distress of some sort, such as in social relationships or occupational functioning
- – it involves dysfunction in psychological, developmental and/or neurobiological processes that support mental functioning
- – it is not a culturally specific reaction to an event (e.g., death of a loved one)
- – it is not primarily a result of social deviance or conflict with society.
DSM 5 limitations
- Too many diagnoses?
- Inter-rater reliability is relatively low (being diagnosed by bipolar and schizophrenia by diff psychs)
- Categorical: They assume that one either has or does not have a disorder, rather than considering a dimensional framework.
- Symptoms associated with all disorders can be seen throughout the population and are not unique to specific disorders.
- For instance, mood problems, intrusive thoughts, and unusual beliefs and thinking are not seen specifically in depression, obsessive-compulsive disorder and schizophrenia, respectively.
Classification systems also tend to ‘medicalise
’ problems of daily living. Depression and anxiety are a part of life and need not be considered abnormal conditions.
Categorical vs dimensional systems of diagnosis
- DSM-5 based on categorical classification
- If you have minimum number of symptoms, you are diagnosed with
- disorder. If one short, you are not.
- Little research support for this diagnosable threshold
- NOS (“Not Otherwise Specified”) remains in use for subthreshold cases (e.g., Eating Disorder NOS)
- In DSM-5 categories are supplemented by a severity rating for each disorder.
Criticisms of classification
- Stigma against mental illness- labelling theory
- Categories do not capture the uniqueness of a person- experiential approach
- Self-fulfilling- 8 mentally well people were diagnosed with schizophrenia and kept in hospital for between 7 and 52 days. Normal behaviour was pathologised.
- Classification reflects social/cultural/political/commercial biases
- Over pathologisation
- Inclusion of everyday issues: mathematics disorder, caffeine intoxication, bereavement, sadness
a conceptual framework or approach within which a scientist works — that is, a set of basic assumptions, a general perspective, that defines how to conceptualise and study a subject, how to gather and interpret relevant data, even how to think about a particular subject.
Paradigms specify what problems scientists will investigate and how they will go about the investigation
- refers to the destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some manner, such as people with psychological disorders.
- Stigma encompasses:
- (a) ignorance or limitations in knowledge about mental health;
- (b) prejudice or negative attitudes to mental illness; and
- (c) unhelpful or discriminatory responses to people with mental health problems
Stigma 4 characteristics
- 1. A label is applied to a group of people that distinguishes them from others (e.g., ‘crazy’).
- 2. The label is linked to deviant or undesirable attributes by society (e.g., ‘crazy people are dangerous’).
- 3. People with the label are seen as essentially different from those without the label, contributing to an ‘us’ versus ‘them’ mentality (e.g., ‘we are not like those crazy people’).
- 4. People with the label are discriminated against unfairly (e.g., ‘a clinic for crazy people can’t be built in our neighbourhood’).
The extent to which one accepts or internalises the negative attitudes of others towards one's self.
Freud's id, ego and superego
- id is present at birth and is the repository of all of the energy needed to run the psyche, including the basic urges.
- Individual cannot consciously perceive this energy (unconscious).
- Id seeks immediate gratification of its urges, operating on the pleasure principle.
- Ego: contents are primarily conscious. Task is to deal with reality.
- Operates on the reality principle- mediates between the demands of reality and the demands of the id for immediate gratification.
: conceived of as a person’s conscience
. Develops throughout childhood
- To reduce discomfort by conflict between Id and superego.
- Discomfort experienced by the ego as it attempts to resolve conflicts and satisfy the demands of the id and superego can be reduced in several ways.
- Repressions: Keeping unacceptable impulses or wishes from conscious awareness
- Denial: Not accepting a painful reality into conscious awareness
- Projection: Attributing to someone else one’s own unacceptable thoughts or feelings
- Displacement: Redirecting emotional responses from their real target to someone else
- Reaction formation: Converting an unacceptable feeling into its opposite
- Regression: Retreating to the behavioural patterns of an earlier stage of development
- Rationalisation: offering acceptable reasons for an unacceptable action or attitude
- Sublimation: converting unacceptable aggressive or sexual impulses into socially valued behaviours.
Stages of psychosexual development
- Oral stage: 0-18months
- Demands of id are satisfied by feeding, sucking and biting.
- Body parts which the infant receives gratification are the lips, mouth, gums and tongue.
- Anal stage: 18 months to 3 years of age, a child receives pleasure mainly via the anus, by passing and retaining faeces.
- Phallic: age 3 to age 5 or 6; during this stage, maximum gratification of the id is obtained through genital stimulation.
- Latency period: 6-12
- during these years the id impulses do not play a major role in motivating behaviour.
- Genital stage: final stage. During which heterosexual interests predominate.
- During each stage, developing person must resolve conflicts between what the id wants and what the environment will provide.
- How this is accomplished determines basic personality traits.
- A person who experiences either excessive or deficient amounts of gratification at a particular stage develops a fixation and is likely to regress to that stage when stressed.
- Psychological treatment that emanates from Freud’s theory.
- Based on helping affected individuals resolve their unconscious conflicts and use more adaptive defences.
- The goal of the therapist is to understand the person’s early-childhood experiences, the nature of key relationships, the patterns in current relationships and unhelpful defence mechanisms.
Major techniques of psychoanalysis
- Free association: A person tries to say whatever comes to mind without censoring anything.
- Interpretation: The analyst points out the meaning of a person’s behaviour.
- Analysis of transference: The person responds to the analyst in ways that the person has previously responded to other important figures in his or her life, and the analyst helps the person understand and interpret these responses.
Jung's collective unconscious
- The part of the unconscious that is common to all human beings.
- Consists primarily of what Jung called archetypes- basic categories that all human beings use in conceptualising the world.
Alfred Adler individual psychology
- regarded people as inextricably tied to their society because he believed that fulfilment was found in doing things for the social good.
- Stressed importance of working towards goals.
- Central element was his focus on helping people change their illogical and mistaken ideas and expectations.
- Believed that feeling and behaving adaptively depend on thinking more rationally (CBT)
- Conducted no formal research on the causes and treatments of psychological disorders.
- Based on anecdotal evidence.
- Some theories are grounded in objectivity and are not scientifically testable.
Freud's impact on the field of psychopathology
- 1. Childhood experiences help shape adult personality
- 2. There are unconscious influences on behaviour- people can be unaware of the causes of their behaviour.
- 3. The causes and purposes of human behaviour are not always obvious
Genetic paradigm used to understand psychopathology
- Gene expression: whether genes are switched 'on' or 'off' based on interaction with environment.
- Heritability: Heritability refers to the extent to which variability in a particular behaviour (or disorder) in a population can be accounted for by genetic factors.
- 1. Heritability estimates range from 0.00 to 1.0, higher the number, the greater the heritability
- 2. only relevant for a large population, not particular individual.
- Shared environment: things that family members have in common eg. income level
- Non-shared: factors believed to be distinct among members of a family eg. friends
The study of the degree to which genes and environmental factors influence behaviour.
- Seek to identify particular genes and their functions
- Transcription: mirroring dna to mRNA
- Translation: reading mRNA to make protein
Effects of stress on immune system
- Infants of rhesus monkey mothers who were exposed to chronic stress during pregnancy were observed to have emotion regulation difficulties as babies and adolescents that negatively impacted their place in the social group.
- Also exhibited immune system disturbances , including a deficiency of pro-inflammatory cytokines such as interleukin-6
- Exposure to stress also slows the process of wound healing, which relies on the immune system.
- Older adults are more likely than younger adults to show a harmful immune response to stress.
- Evidence indicates that stress trigger the release of cytokines (eg. IL-6), as if the body were fighting off an infection- inflammation and higher levels of IL-6 have been linked with a number of diseases in older adults.
- Associations between HPA hyperactivity and both depression and a range of anxiety related disorders.
Neuroscience approaches to treatment
- Numerous medication available that act on psychological symptoms.
- Eg. antidepressants increase neural transmission in neurons that use serotonin as a neurotransmitter by inhibiting the reuptake of serotonin.
(eg. xanax) can be effective in reducing the tension associated with some anxiety disorders, perhaps by stimulating GABA neurons
to inhibit other systems that create physical symptoms of anxiety.
drugs used in treatment of schizophrenia, reduce the activity of neurons that use dopamine
as a neurotransmitter by blocking their receptors and also impact serotonin.
- Evidence linking neurotransmitters as causal factors in psychopathology is not very strong.
- Contemporary scientists and clinicians also appreciate that non-biological interventions can influence brain functioning.
Evaluating the neuroscience paradigm
- Brain-behaviour relationships
- Caution against reductionism
- Reductionism: refers to the view that whatever is being studied can and should be reduced to its most basic elements or constituents.
- Eg. for psychological disorders- reduce complex mental and emotional responses to simple biological processes.
- Some psychological problems (eg. delusional beliefs, dysfunctional attitudes) may be impossible to explain neurobiologically.
Hence, a comprehensive understanding of psychopathology requires more than consideration of biological factors.
Framework of cognitive therapy
- Cognitive theory emphasises that the way in which people construe themselves, the world and the future is a major determinant of psychological disorders.
- Therapist typically begins by helping clients become more aware of their maladaptive thoughts.
- By changing cognition, therapists aim to help people change their maladaptive feelings, behaviours and symptoms.
Albert Ellis' rational-emotive behaviour therapy (REBT)
- Proposed that sustained emotional reactions are caused by internal sentences that people repeat to themselves- these reflect unspoken assumptions or irrational beliefs about what is necessary to lead a meaningful life.
- Aim is to eliminate self defeating beliefs.
- Proposed that people interpret what is happening around them on the basis of set beliefs (eg. I must be perfect) and that these interpretations cause emotional turmoil and that a therapist's attention should be focused on these beliefs rather than on historical causes.
- Hypothesised that it is this unrealistic, unproductive demand that creates the kind of emotional distress and behavioural dysfunction that bring people to therapists.
Aaron Beck's cognitive therapy
- Proposed that our thoughts determine our feelings and our behaviour.
- Irrational and unrealistic thoughts are proposed as leading to unconstructive or negative misinterpretations of situations or about the world, one’s self worth and the future, which lead to distress and unhelpful behaviours or reactions, resulting in personal impairment and reinforcing the distorted thinking.
cognitive approach proposes that psychopathology is caused by faulty cognitive content (irrational beliefs about the world) and distorted information processing (cognitive distortions).
- Cognition is a term that groups together the mental processes of perceiving, recognising, conceiving, judging and reasoning.
- How people (and animals) structure their experiences, how they make sense of them and how they relate their current experiences to past ones that have been stored in memory.
- Schema: (cognitive set) an organised network of already accumulated knowledge.
- New info may fit schema, if not, person reorganises the schema to fit the info or construe the info in such a way as to fit the schema.
- Have also looked at attention in relation to disorders eg. anxiety tend to focus on threats.
The role of the unconscious
- Study: showing shape of 1 millisecond. No memory of shape but preferred them more.
- Implicit memory: refers to the idea that a person can be influenced (learn) without being aware of it
- Concept of self.
- Negative self-schemas denote a set of implicit and explicit beliefs and expectation about oneself that are unrealistic, unconstructive and negative.
- Beck proposed that individuals susceptible to depression develop such schemas during their childhood
- Cognitive therapy examines how such self-constructs manifest in day-to-day life.
- Cognitive–behavioural therapy (CBT), which incorporates cognitive therapy (CT) and behaviour therapy (BT), aims to help people increase their awareness of their irrational thinking and the behavioural repertoires that lead to emotional distress and support the maladaptive thinking patterns.
- Facilitate the development of alternative thinking styles and behaviours, which impact on emotional functioning and functional impairment.
Cognitive therapy (CT)
- Cognitive restructuring is a general term for changing a pattern of thought.
- Therapists propose that people can change their feelings, behaviours and symptoms by changing their cognitions.
- The therapist begins by tracking the daily thoughts a person experiences but then moves to understanding more about core cognitive biases and schemata that might shape those daily negative thoughts.
Evaluating cognitive-behavioural therapy
- Effective in the treatment of mood and anxiety-based disorders.
- Exposure-based behaviour therapy did equally well in the treatment of adult depression and OCD.
- CBT was also found to be superior to antidepressant medication for adult depression in some but not all studies.
- Some studies have reported equal effectiveness at post-treatment but better outcomes for CT with respect to relapse prevention.
- CBT has also been found to have large effects in helping people with chronic medical conditions
Evaluating the cognitive-behavioural paradigm
- Advantage is that it lends itself to scientific evaluation.
- More evidence to support that distorted thinking is a cause of psychological dysfunction and distress rather than a consequence of it.
- Thoughts are regarded as causing the other features of the disorder.
- CBT criticised for circular arguments.
- Unanswered is where the negative schema came from in the first place.
- Limited research examining sociocultural factors that impact on psychological functioning.