You are on page 1of 17

Ch.

1 Defining and classifying Psychological Abnormality


Ch. 2 The Biomedical approach
Ch. 3 The Learning approach
Ch. 4 The Cognitive approach
Ch. 5 The Psychodynamic approach
Ch. 6 The Humanistic approach
Ch. 7 The Social approach
Ch. 8 Schizophrenia
Ch. 9 Depression
Ch. 10 Eating disorders
Ch. 11 Anxiety disorders

Ch. 1 Defining and classifying Psychological Abnormality

Abnormal Vs. Atypical (roughly same thing but more/less judgemental)


Normal/Abnormal and Typicam/Atypical
4 ways to classify
Statisticlly unusual people
Rare=unusual=abnormal
Measurable characteristics (intelligence, anxiety, depression, height...)
Normal distribution - clusters around average (IQ example)
Limitations, high IQ is abnormal, statistila infrequency is not enough for final
conclusion but plays part
Deviation from social norms
Right, moral, normal offend (common) sense
Behavour out of social norms and expectations
Antisocial personality disorder psycholpahy if offends vast majority of
population/culture (impulsive, aggressive, irresponsible, careless..)
Failiure to conform social norms with respect to lawful behaviors as indicated by
repeatedly performing acts that are grounds for arrest
Limitation abuse human rights, freedom
We all want to be different from others-even having idols
Table 1.1 mainteaining social control over group (today?)
Social conventions are changing
People in psychological distress
How somebody feels (seeking for help or not)
Mental disorder must never be diagnosed just on suffering (sleep, eating issues must
be present)
Psychopaht thiks he/she is ok no distress
Maladaptive and dangerous behaviour
Adaptive/Maladaptive behavior for survival and reproducing
Redused chances = abnormal behavior
Maladaptive also causes problems/interference for fulfilled, happy life, jobs, partners
everyday
Limitations
People want to be different, show off, making statement political, musical,
cultural
Do dangerous stuff/sports irresponsible abnormal
Civil rights/liberties (boxing)
When to force someone to accept treatment? Risk to themselves or others
Ideal mental health
No symptoms of distress, rational, introspect accurately, self-actualize, cope with stress, no
guilt (unless deserved), successful at work, love, enjoy leisure...
Several modes of behavior
Biomedical focus on symptoms and distress
Cognitive-behavioral rationality and ability to cope with stress
Humanistic selfesteem and acctualisation
Psychodynamic introspect and realistic look at the world
Where is the line between normal and abnormal
o Global assesment functioning overall mental health 0-100
Abnormality mix of criteria, never single symptom, but problem with cultural relativism + time
change
o Mental retardation must meet ALL three criteria - low iq, inability to meet standards of their
group i ncommunication, self care, social skills, work, safety
Systems for classification and diagnosis of abnormality
o Diagnostic and Statistical Manual of Mental Disorder DSM by Americam Asychyatric
Association

First in 1952, current verion - 4th in 1994, + text revisions in 2000 (changed structure
of the classification, not classification themselves DSM-IV-TR, over 200 distinct
mental disorders
Changes in how long the symptoms must be present, change in social norms
(homosexuality), anorexia and bulimia
14 categories - Box 1.1
Since 1987 5 different axes multiaxial diagnosis box 1.2
o Intrnational Classification of the Causes of Disease and Death ICD by WHO
First in 1948., current in 1992. Similar to DSM-IV but 11, a bit brader categories
Primary classification system, while DSM full comprehensive manual for diagnosis/tests
o Both must be reliable (constant diagnoses) and valid (real/distinct condition and treatment)
o Reliability Inter-rated among different clinicians some issues
o Validity p.11 e.g.; Criterion validity between two systems (not if both are right/wrong)
o +/- p. 14
o Does diagnosis create mental disorder iatrogenesis
Dissociative identity disorder or MPD (e.g. Eve) causeg by dissociation cope with
trauma by splitting self a part and withdrawing from contact to the trauma
Hypnosis may cause iatrogenesis symptoms follow hypnosis
o Social stigmatation prejudice if someone is diagnosed causem more stress- loop
Stereotypes negative, even positive can cause stress, great expectations
Patients refuse to disclose experience from fear of others
o Cultural issues around the world and within same group; cultural bias, supstance abuse
(normal)
o Racial disscrimination Black, Jamaica...
o Cultural-bound syndromes some culture have different syndromes single culture only
Somewhere bizzare but if cause issues with patients = disorder
Dhat Indian, severe anxiety and an odssesive concerne over the discharge of
semen=eeakness and fatigue
Not in ICD or DMS byt an independent disorder
Cultural issues with blood, semen and energy discharge cause weakness and
depression
Koro South chinese sexual anxiety due to shrinking sex organs in abdomen=death
Genital retraction syndrome reduced blood supply to male penis
Not a delusion, just interpretation
+/- p. 23
Conclusion
o Thin/broad line between normal and abnormal
o No single criterion
o Two systems
o Cultural issues

Ch. 2 The Biomedical/Desease model approach

Disorders as physical illness, disruption of biological processes, genes, biochemistry of nervous


system
Old approach, firt ay of treating psychological issues hich are being called mental illneses
Assumptions of the approach
Psychological disorders caused by biological malfunction can be under control by
supstences/surgery
Inbalance of chemical supstances cause depressionm not emotions, low self-esteem
Treatment to correct or reduce issues
Mental disorder as illness = physical condition
Psychological aspects rather then behavioral, cognitive, emotional
Explanation in malfunction of medical systems (abnormal developent, faulty genes,
physical damage...)
Treatment drugs, surgery, shocks, magnetic fields, light...
Medical practitioners do care for other angles (emotions, cognitive...)
Interaction of physiology and environment causes problems
Role od genes Behavioral genetics
Individual differences in psychological characteristcs based od differences in genetic makeup
Humans 23 pairs of hromosomes (except eggs only 23, one of each pair)
Each hromosome thausends of genes which carry genetic information DNA
Total genetic makeup genotype
Phenotype Observable physical and behavioral characteristics of an individual (genes +
environment)
Genotypes are simiral but phenotypes are very different
Direct or indirect consequences genotype on phenotype
Psychopatological conditions are disorders of the phenotype not genotype
People do not inherit problems, bur are vulnerable
Diathesis voulnerable genotype
Diathesis-stress model Diathesis + environment cause problems (war gene)
Family studies
50% of genes from parents, 25% next to kin
Correlation between ampunt of shared material (consafuinity) and prevelance of
disorder = inhereted or not (assumption/guessing)
Twin studies
Identical monozygotic (monoegg) MZ or non-identical (fraternal) dizygotic DZ
Concordance rate similarity between twins
Not all twins devolop same disorder so environment and experience must be involved
Twins do live in same environment hard to distinguish real cause so...
Adoption studies
10% of adopted childern inherit schizophrenia from mothers (same as own child),
more then 1% in general population
Molecular genetics try to link particular gene(s) to a particular condition
Genetic markers known genes for a particular characterictic (not just conditions) and
compare to family members
+/- p. 30
Bioshemistry of the nervous system
Neurons nerve cells that receive, process and/or transmit information to other cells
Chemical and electrical connections
Stimulation of neuron start electrical voltage nerve impuls to the terminal ending (fig
2.2)
Synapse gap between end of the nerve ending and next cell
Neurotransmiters chemical messsages to fill the synapse
Play role in mood and emotions (too little or too much)
Reuptake return of neurotrasmitters to the cell so syapse is ready for next message

Noradrenaline associated with anxiety disorders


Serotonine depression and eating disorders
Dopamine schizophrenia

Evaluation of biomedical explanations for mental disorders


Criticism and limitations
1. Model is reductionst to most basic levels, dont see individual as whole but only part
(book)
2. Not only biology affects chemistry but vice versa (environment affects chemicals in
body)
3. Researsh maily on animals
4. Family/twin studies only indicate link between genes and syndroms
+/- p. 34
Therapies based on the biomedical approach
Therapies based on accidental discoveries
Drugs - form 1950s, but without appreciation of side-effects physical/physiological
1. Anti-anxiety
Tranquillisers to relax and reduce tension e.g. benzodiazepins class known as
Valium/Librium
Problem if used long must for lifetime. Today only one-off times
2. Antidepressants
Elevate mood and lift depression Prozac
SSRI - Selective Serotonin Reuptake Inhibitor no dependence/overdose, but
suicidal
3. Antibipolar
Lithium carbonate Stabilise mood that swings between depression and mania
4. Antipsychotic
Phenothiasines class for Schizophrenia Olanzapine and Risperidone
Side-effects of movment disorder shaking, spasms, jearky movements
Drugs are never enough for treatment, psychotherapy is neccessary. Some do not react
to drugs.
Electroconvulsive therapy ECT
1. Short application of electricity to induce seizure (second or less)
2. Anaestheised + muscule relaxant for paralysis + shock = 30sec-1min seizure, back to
normal in 15min
Confusion, hadache but no memory of event
2-3 times a week, 1-4 weeks. After recovery+2more for prevention
3. For severe depression, drugs take weeks to have effect, if any
4. For acute mania and schezoprenia
5. Contraversy, lack of knowledge how it works and side-effects. Is aneesthesia or drugs
acctualy cause improvment? Long term solving problem?
6. Alternative Transcranial Magnetic Brain Stimulation
Psychosurgery
1. Severing or diabling areas of brain lobotomy big issues and complications
2. Irreversible effectss improve procedures
3. Stereotactic magnetic resonance imaging to guide electrode to burn leison of 1cm
4. Cingulotomy cutting cingulate gyrus connection limbic system-frontal lobe
5. Rare even today due to lack of knowledge even for successful ones irreversable
6. 3 of 4 patients show improvemnts using electrodes, not surgery
+/- p. 41
Conclusions
Rarely without other therapies combination with other therapies
Not always direct link between biology and mental problems cause and effect what to
treat

Ch. 3 The Learning/behavioral approach

Process of learning used to explain mental disorders


Abnormal behavior is being developed like any other behavior as result of learning
Symptoms of disorders learned self-defeating or ineffective ways od behaving
1. Mental disorder patterns of learned maladaptive behavior
2. Only observable behavior not emotion/thinking
3. Based on operational/conditional/social learning
4. Therapy unlearned maladaptive and replaced wtih new behavior
1.
Classical conditioning
Pavlov dog, bell, food UCS, salivation UCR, bell CS, salivation CS (learned response)
1. Emotional response (positive or negative) conditioned to previously neutral
stimuli (bell)
2. If constant (sometimes strong just one) can be adopted for lifetime (fears)
Paraphilias (sexual fetishes) sexual response to neutral stimuli
2. Operant conditioning
Learning through consequences of actions
1. Posotive or negative results. Negative not same as punishments (avoidance).
Can cause anxeity
2. Law of effect (Thorndike) Plesent consequences strenghtened actions,
unpleasent weakend
3. Substance abuse drugs, alcohol dependance, rehab, habit, not easy to stop
3. Social/Modeling/Observational
Through imitation parents/peers/idols
Good-bad sides choice?
Potential problems with approach
Therapies do work but no proof faulty learning caused problems
Underestimates complexity and flexibility of human mind we think and reason with
free will based on personal view of situation, plans, hopes with some control over
lives
+/- p. 49
Behavioral therapies
Behavioral therapy based on classical conditioning, behavioral modification based on
operational conditioning
As maladaptive behavior is result of early conditioning it can be modifies through
reconditioning
Focus changing specific behavior (psychodynamic focus on unconscious mind, cognitive on
thoughts)
Find problem, what need to be learnd reduce maladaptive , encourage adaptive
Concept of extinction losing learnd behavior
Not in case of phobias treated by exposure to phobia and evironment
Systematic desensitisation
Gradual introduction to phobic object while introducing responses that are
incompatibile with fear
Three stages procedure:
1. Training in deep relaxation
2. Asking to imagine anxeity situation (Subjective units of disconfort SUD scale)
3. Asking to gradually imagine more and more phobic situatio, but encouraged to
relax before move to the next level

Some argue that real life phobias are neccessary to successful treatment (not just
imaging alone)
Flooding and implosion
Flooding exposure to the most disturbing for of fear for a long time
Implosion same as flooding, only imagined
Different to systematic desensitisation by deliberately elict a masive anxeity
Base on automatic arosam is impossible to sustain, so it will disappear (2 e.g. p.53)
Proved to work or at least reducing phobias and some OCD
Problem very traumatic experience, specially if therapy is nod finished. Virtual reality may help.
+/- p. 55
Aversion therapy
Pairing classical conditioning to undesirable behavior with unpleasent aversiove stimulus
Classical and conditional learning
Emetic to alcoholic, but some possitive rewards are possible
Problems
High drop-out rate as being unpleasent
Laboratory conditions
Can cause anxeity
Ethical issues pain, disconfort, electricity ...
Potential abuse/misuse
1. Covert sensitisation imagining unpleasent consequences
Mainly as preliminary treatment to prepare for new, more appropriate learning with better
results
Token economies
Based on operational conditioning for problemativ children
Rewards for expected behavior food, day-off...
Problem inappropriate behavior is unwittingly reinforced by attention it receives. Ignore
inappropriate actions.
Some improvement is seen, but not cure
Practical and ethical issues:
Improvemnts can stay in lab/institution
Only for simple behavior (not for learning languages)
Manipulative and inhumane but we do work for tokens
Common these days, in addition to punishement for inappropriate behavior
Modeling
Role play for dealing with different situations, specially for shy and submissive people
Best work if p.60
Everyone do it every day. As babies and adults. Painless
+/- p.61
Conclusions:
Pros:
Work well if condition/behaviour is well defined, for anxiety based problems, phobias,
OCDs, PTSDs...
Benefictial even for schesofrenia (not cure)
For children bet-wetting, social withdrawal
Cons:
Treating symptoms/cosequences, not causes of disorders

Dependance on interest of therapist, rather then principles

Ch. 4 The Cognitive approach

Studying mental processes (intput -> process -> output) perception, attention, memory, problem
solving
Cannot be directly observed experimental techniques hoe people remeber thing then best
guesses
Assumptions about studying mental processes:
Focus on specific syndromes (part of a problem)
Focus on role of cognitive processes in mental disorders (not always be causes)
Treating cognitive factors will treat symptoms
Becks cognitive theory on emotinal disorders
In 1976 proposed a theory
Main point People react differently to unpleasant or aversive situation
Aversive life situations + cognitive processes = emotional disorder
Cognition precedes an emotional response so it is caused by cognition
Disfunctional beliefs are formed in early childhool through aquiring schemas, so different
disorders are characterised by different types of schemas (e.g. p.65)
Schemas are not enough to create mental problems, critical life event is necessary
Depression is caused by cognitive triad of negative schemas
Anxeity voulnerability schemas, perceprion of threat
Fig 4.1
Activadet schemas process only consistent (falimiar) information and disregard other
(e.g. p. 66 - loop)
Criticism hypo cognitive processes are causing emotional disturbance very difficult to
prove in practice, since no evidence of previous emotinal state to compare, can cause later
problems if wrongly diagnosed
Two potential ways:
1. Experiments to measure different cognitive processes between participants
with/out emotional disorder
2. Evaluate Becks therapy
Biased info processing in depression but accept childhood trauma
Although therapy does work, hard to prove that theory is correct
Schemas are more belief then well defined scientific proof
! Schemas are proved by certain responses and then schema is used to explain information
processing and response
Not scientific approach, too reductionist and mechanistic approach (people with contradistory
beliefs, dynamic rather then rational thinkers)
+/- p.67
Cognitive neuropsychological approach
Based on relationship between cognitive function and brain function
Brain function has profound effect on cognitive (e.g. p. 68)
Cognitive functions are manifestations of changes in brain functioning, but not in all disorders
(Pure) Cognitive theory states disorders (phobia and depression) are caused by
cognitive function/factors (not brain) while in PTSD and schizopfrenia symptoms are
caused by brain changes
Cognitive theory works with symptoms then disorders, cognition can be mapped onto
brain function
PTSD
Cue dependent memory on teo levels
1. Verbally accessible memory recount event

2. Situationally accessible memory non verbal, sensory, emotional


Different force by which person re-experience traumatic event (real experience complete with full sensory and emotions)
Triggered/alarmed by sights, sounds, smells
Emotionally traumatic memories are at amygdala subconscious memory thet lack
time/space
Corrective information schoud be sent from hyppocampus (storing time/space) to
dismiss the alarm
PTSD people have smaller hyppocampus cant switch off alarm = flashbacks
+/- p.69
Cognitive and cognitive-behavioural approach
Therapeutic techniques aiming to change/modify a persons thoughts/beliefs
Based on belief in cognitive primacy thinking comes before emotions/behaviour
Becks cognitive therapy
Reduce symptoms of emotional disorder by challenging and reversing these
dysfunctional beliefs/attitudes cognitive reconstruction. Rooted in
metacognitive process ability to modify thinking patterns
Two phases
1. Identifying disfunctional beliefs
6 stages box 4.1
Automatic thoughts what we tee ourselves as we go about daily
routine
Box 4.2 + p. 71
2. Use dysfunctional beliefs to identify stabile cognitive patterns

Ch. 5 The Psychodynamic approach

Ch. 6 The Humanistic approach

Ch. 7 The Social approach

Ch. 8 Schizophrenia

Ch. 9 Depression

Ch. 10 Eating disorders

Ch. 11 Anxiety disorders