Abnormal Psychology

Learning Outcomes

To what extent do biological, cognitive and sociocultural

factors influence abnormal behaviour?

BIOLOGICAL
Numberger and Gershon (1982) used 7 twin
studies on major depression
MZ twins had 65% concordance rate, 14% for DZ
twins. Supports genetic predisposition
hypothesis.
Important to consider interaction with
environment skill
Comorbidity with anxiety, eating disorders, etc.,
makes conclusions difficult

 Depression etiology: Catecholamine hypothesis

asserts that noradrenaline is influential in depression.
Janowsky et al. (1972) used a drug that decreased
noradrenaline and induced depression in minutes
Drugs that increase noradrenaline reduce depression
symptoms
Cortisol hypothesis states that stress predisposes an
individual to disorders
High levels of cortisol are found in those with
depression
Cortisol may influence the release of neurotransmitters

Cognition
Beck (1976) Cognitive theory of depression
Negative cognitive triad. Negative views of self,
world and future
Depression is caused by inaccurate cognitive
responses. Negative thinking and schemas.
Contrary to other models where negative thinking
is a symptom.
Related to diathesis-stress model. Negative
(depressogenic) schemas are the diathesis, negative
life events are the stresses that active schemas.

Sociocultural
Brown & Harris (1978) Social factors in depression.
Aim: how depression could be linked to social factors and
stressful life events
Procedure: 458 women were surveyed about stress and
depression, interviewed about particular events/coping
Results: 8% had been depressed in past year, 90% of depressed
had experienced negative life event. Working class had higher
rate than middle class with children. Lack of support, 3 young
children, unemployment were identified as vulnerabilities.
Implications: demonstrated social factors involved in depression
and need to be considered. Gender biased sample
Evaluation: generally supported that social stressors (war,
poverty, urbanisation, unemployment) play a role in mental
health. Cultural expectations are also important.

Evaluate psychological research (that is, theories and/or studies)

relevant to the study of abnormal behaviour.
Seligman and Maier (1967)learning to be depressed: electrical shocks on dogs affecting
their ability to jump over barriers
Aims; learn that when dogs were exposed to electrical shocks they could neither control
nor escape from, they later failed to learn to escape from shocks when such escape was
easily available
Procedure; Some dogs were able to control electrical pulses by pushing panels on near
their head, while other dogs were not. Dogs who were able to control the shock became
progressively faster at pushing the panel, showing that they were learning avoidance. All
dogs were then put in a chamber where they were able to jump over a barrier to escape
the shocks (which were administered 10 seconds after a light flashed, warning the dogs
of the impending shock).
Results; While dogs in the "escape group" (able to push panels to stop pulses) got faster
at pushing the panels, the no-escape group eventually stopped pushing the panels at all.
Results showed that all dogs who were previously able to escape the shocks eventually
learned to jump the barrier, while 80% of the no-escape dogs were failed to do so. Dogs
in the control group (no previous shock therapy) reacted almost identically to escapegroup dogs.
Implications/Concerns While this shows that in dogs, learned helplessness can lead to

Examine the concepts of normality and

abnormality.
Normality
Jahoda (1958) Mental health model of normality.
Criteria for normal mental health are: absence of mental
illness, realistic self-perception and contact with reality,
strong sense of identity and positive self-esteem, autonomy
and independence, ability to maintain healthy interpersonal
relationships, ability to cope with stress, capacity for growth.
Deviations would be abnormal. Most people would be
abnormal. Mental health is more difficult to establish than
physical health.
Focus is on the Western ideal

 Abnormality
An abnormality is difficult to define and diagnose because it is subjective
and is based on symptoms instead of biological tests. Rosenhahn &
Seligman (1984) Suggest seven criteria for abnormal
Suffering experience of stress or discomfort
Maladaptiveness engaging in behaviours that make life more difficult
Irrationality incomprehensible or unable to communicate in a
reasonable manner
Unpredictability acting ways that are unexpected for self or buy others
Vividness/unconventionality experiences that are different from most
Observer discomfort acting in a way that is difficult to watch or
embarrassing
Violation of standards breaking accepted moral/ethical standards of a
culture

Discuss validity and reliability of diagnosis.

Diagnosis is based on the ABCS, as well as the
classification systems such as the DSMIV and
the ICD. The reason for the lack of validity and
reliability of diagnosis has to do with the lack of
scientific evidence in diagnoses, the cultural
aspects that can contribute to the lack of
reliability, as well as the psychiatrists attitude
and prejudices

 For a classification system to be reliable, it

should be possible for different clinicians, using
the same system, to arrive at the same diagnosis
for the same individuals
For a classification system to be valid ,it should
be able to classify a real pattern of symptoms
which can then lead to an effective treatment
The classification system is descriptive and does
not identify any specific causes for disorders so
its hard to make a valid diagnosis for psychiatric
disorders because there are no objective physical
signs of such disorders

Rosenhan (1973)
Aim: Test the reliability of psychiatric diagnoses
Method:
Field experiment
Description: five men and three women who were normal went to 12
different psychiatric hospitals to get admission by stating that they had
been hearing voices.
7 of them = diagnosed with schizophrenia and it took an average of 19
days before they were discharged and seven of them were labeled as
schizophrenic in remission. Also,
Rosenhan wanted to see if abnormal patients would be able to be
classified as abnormal and out of 41 of these abnormal patients, 19 were
suspected to be frauds by some of the psychiatrists
Conclusion: Not possible to distinguish between sane and insane in
psychiatric hospitals and theres a lack of scientific evidence on which
medical diagnoses can be made.
Strengths: Gives insight to the lack of reliability in psychiatric diagnoses
Limitations: Ethical issues such as deceit to the psychiatrists

 Lipton and Simon (1985):

Randomly selected 131 patients at a NY hospital
and tested them to arrive at a diagnosis. This
diagnosis was then compared with the original
diagnosis. 89 originally diagnosed with
schizophrenia, and only 16 received the same
diagnosis. 50 were diagnosed with mood
disorder, and only 15 had originally been
diagnosed with mood disorders.
Lack of scientific evidence and the diagnoses
may be influenced by the attitudes and
prejudices of the psychiatrist

Discuss cultural and ethical considerations

in diagnosis (for example, cultural
variation, stigmatization).
Cultural considerations
An individuals behaviour is governed to an extent
by the culture they are brought up in.
There are likely to be different perceptions of
behaviour in different cultures, different cultural
norms.
A tendency to favor ones own cultural view of the
world.
Studies on psychological disorders originated from
the west, hence the tendency that the diagnosis
system favor the western culture.

 Erinosho &amp Ayonrinde Nigeria Yoruba Tribe

study
[A] Investigate the cultural differences in criteria of normality
and abnormality.
[P] Participants were tribesmen from the Yoruba tribe in
Nigeria.
Information of patients with schizophrenia were presented to
people of the Yoruba Tribe.
[F] Only 40% of the tribesmen from the Yoruba tribe
identified the patients as mentally ill.
30% of the tribesmen said they would marry such person.
This maybe due to the cultural differences between the
tribesmen and the westernized world (see Binities study).
[C] Shows the importance of an emic approach in studies.
The ability to identify the definition of abnormality in
different cultures can only be done in culture specific approach
in studies.

 Binitie Schizophrenia in Nigeria

[A] Investigate the cultural differences in criteria of
normality and abnormality.
[P] Participants were Nigerians living in the city.
Information of patients with schizophrenia were
presented to the participants.
[F] Most participants correctly identified the
patients as mentally ill.
31% showed aggressive response to such patients e.g.
suggesting that they should be expelled or shot.
[C] Shows how western culture has influenced the
judgement of normality (compared with Yoruba tribe
study).

 Conclusion; Seems that Schizophrenia is a western model,

Tribal Nigerians did not see hallucination as something
negative.
Cultural relativism suggests that abnormality is subjective
cross culturally.
Hallucinations and cultural perspectives was also investigated
in theKasamatsu
& Hirai Monk Serotonin Study. Hallucination is seen to be
a spiritual experience by Japanese monks
.
Ethical considerations
Ethical concerns regarding diagnosis mainly surround the
issue of Labeling and its consequences.
After diagnosis, the patient will inevitably be labeled with the
diagnosed illness.
Labeling will cause Stigmatisation.
Where the patient will have a negative persona attached to
them because they are labeled as mentally ill.

Describe symptoms and prevalence of one

disorder from two of the following groups:
Symptoms of Depression
Physiological:
fatigue, loss of energy, significant weight change, loss of appetite,
headaches, pain
Cognitive:
Feeling worthless, excessive guilt, difficulty concentrating,
negative attitude to world/self/future, feeling a lack of control
Emotional:
Distress, sadness, anhedonia (not feeling positive feelings), loss of
interest in outside activities
Behavioural:
Disturbed sleep patterns, self-destructive behaviour, suicidal
ideation, and avoidance of social company.

 Prevalence of Depression
Prevalence is the percentage of a population affected by a
disorder during a specific time. The IB does not differentiate
prevalence and incidence
National Institute of Mental Health currently reports a 12month prevalence of 6.7% in US adults.
16.5% lifetime (13.2% males, 20.2% females [Kessler et al.
2005])
Women are 70% more likely to experience depression than
men
Blacks are 40% more like
Age is a major factor: 18-25 year is 200% more like than
someone over 60 for 12-month period.
Variations across cultures
Andrade and Caraveo (2005) found 3% in Japan
Poongothai et al. (2009) found 15.9% in South India

Analyse etiologies (in terms of biological,

cognitive and/or sociocultural factors)

Affective disorders: Depression

Depression etiology: serotonin
Serotonin hypothesis suggests that low levels of serotonin causes depression (Coppen, 1967).
Selective Serotonin Reuptake Inhibitors block reuptake to increase serotonin in the system. Prozac,
Paxil, Zoloft all do this. Effexor & other new drugs are dual reuptake inhibitors (Serotonin
Norepinephrine Reuptake Inhibitors).
Henninger et al. (1996) reduced serotonin and did not find increase in depression
Kirsh et al. (2002) found that 80% of the response in studies may be the placebo effect
There is a link between depression and serotonin, but may only be a correlation and not the cause.
Depression etiology: Genetics
Numberger and Gershon (1982) used 7 twin studies on major depression
MZ twins had 65% concordance rate, 14% for DZ twins. Supports genetic predisposition hypothesis.
Important to consider interaction with environment skill
Comorbidity with anxiety, eating disorders, etc., makes conclusions difficult
Sullivan et al. (2000) used meta-analysis
MZ twins are 2x as likely as DZ twins to develop depression
Strong genetic contribution (31-42%)
Environment is important to account depression
There is a genetic component to depression
must be viewed as an interaction with the environment/cognition to account for depression.

 Depression etiology: Cognition

Beck (1976) Cognitive theory of depression
Negative cognitive triad. Negative views of self, world and
future
Depression is caused by inaccurate cognitive responses.
Negative thinking and schemas. Contrary to other models
where negative thinking is a symptom.
Related to diathesis-stress model. Negative (depressogenic)
schemas are the diathesis, negative life events are the stresses
that active schemas.
Boury et al. (2001) found a correlation between automatic
negative thoughts and severity of depression. Duration of
depression also influenced by thoughts
Evaluation: used in Beck Depression Inventory and part of CBT
treatment. Effectively describes characteristics of depression.
Causal link to depression is hard to estimate.

 Depression Etiology: Sociocultural

Poverty or living in a violent relationship are linked with
depression. Women may experience more stress raising children
Brown & Harris (1978) Social factors in depression.
Aim: how depression could be linked to social factors and
stressful life events
Procedure: 458 women were surveyed about stress and
depression, interviewed about particular events/coping
Results: 8% had been depressed in past year, 90% of depressed
had experienced negative life event. Working class had higher
rate than middle class with children. Lack of support, 3 young
children, unemployment were identified as vulnerabilities.
Implications: demonstrated social factors involved in depression
and need to be considered. Gender biased sample
Evaluation: generally supported that social stressors (war,
poverty, urbanisation, unemployment) play a role in mental
health. Cultural expectations are also important.

Discuss cultural and gender variations in

prevalence of disorders.

Prevalence of Depression
Prevalence is the percentage of a population affected by a disorder during a specific time. The IB does not differentiate
prevalence and incidence
National Institute of Mental Health currently reports a 12-month prevalence of 6.7% in US adults.
16.5% lifetime (13.2% males, 20.2% females [Kessler et al. 2005])
Women are 70% more likely to experience depression than men
Blacks are 40% more like
Age is a major factor: 18-25 year is 200% more like than someone over 60 for 12-month period.
Variations across cultures
Andrade and Caraveo (2005) found 3% in Japan
Poongothai et al. (2009) found 15.9% in South India
Cultural Variation in Prevalence
Weisman et al. (1996) studied 10 countries
19% in Lebanon, Paris 16.4%, 2.9% in Korea, 1.5% in Taiwan. Women higher than men in all countries.
Cultural differences, stigma, methodology may account for differences
Marsella et al. (2002) argues that depression started as a topic of Western medicine.
Rates are increasing throughout the world. May be most common psychiatric problem in world.
Why cultural variations?
Dutton (2009) found that differences could be due to stress, living standards or reporting bias.
War, discrimination, unstable politics, crime, etc. differ.
Sartorius et al. (1983) found differences in stigma of disorders.
More likely to find physical pain in Middle East or China. Neurasthenia more common in China.
Marsella (1995) asserts that urban life has increased stress. May be a cause of increase in depression.

 Gender variation in prevalence

Nolen-Hoeksema (2001) found that women are twice as likely as men to
develop depression. No single variable can account for difference.
Lifetime prevalence in the US is 21.3% for women and 12.7% for men.
(Kessler et al. 1993). Women more likely to seek help and report symptoms.
Piccinelli & Wilkinson (2000) found that gender differences are
genuine. Not a product of different diagnostic procedures.
Explaining gender variation
May be due to different sex hormones (oestrogen & progesterone) and the
effect on mood.
Weiss et al. (1999) found that women are more likely to give experienced
early trauma. Disrupts HPA-axis and disrupts stress response
Nolen-Hoeksema (2001) asserts that women respond to the stressor
differently than men. Biological factors, coping styles, self-concepts.
Diathesis-stress model. May also be socio-cultural because women have
less power. Could lead to a feeling of less control or diminished status. Also
supported by Brown and Harris (1978).
Role strain hypothesis suggests that social roles and culture contribute to
the ratio. Lack of employment/equality, marriage roles (Bebbington,
1998).

Examine biomedical, individual and group

approaches to treatment.
Depression Treatment: Biomedical
Assumes that restoring the biological system with drugs will treat
problem. Most common drug treatment for depression is SSRI.
SSRIs are drugs that interfere with the serotonin reuptake. Take up
to two weeks to see relief of symptoms. Block the reuptake process
of serotonin during neurotransmission. Increases amount of
serotonin in synaptic gap.
Have fewer side effects than previous drugs. May cause headaches,
nausea, agitation, sleeplessness, sexual problems
Neale et al. (2001) conducted meta-analysis of antidepressants
vs. placebos
Three groups: only placebo, only anti-depressant, switch to placebo
Placebo only had 25% risk of relapse, 42% for switch. Drugs
interfere with natural regulation of brain.

 Depression Treatment: Individual

The most commonly used individual treatment is Cognitive
Behavioural Therapy (CBT)
Related to Becks (1976) cognitive theory of depression.
Faulty thinking includes: arbitrary inference, selective
abstraction, overgeneralisation, exaggeration,
personalisation, dichotomous thinking.
Aims to change negative thinking patterns
Uses 12 to 20 weekly sessions and daily exercises to help
identify automatic negative thoughts/patterns and change
them
Step 1: identify and correct faulty cognition (reality testing
and cognitive restructuring)
Step 2: increase activity and learn alternative problem solving
strategies (increase rewarding acitivites).
Teasdale (1997) states that teaching the ability to think
about own thoughts is important in CBT.

 Depression Treatment: Group

Therapist will meet with a group (family, same disorder)
Generally less expensive. Couples therapy has been most
successful with women suffering depression related to
marital stress
Toseland & Siporin (1976) reviewed 74 studies
comparing individual and group treatment. Group as
effective as individual 75% studies, more in 25%.
McDermut et al. (2001) looked at 48 studies. 43
showed reduction after group therapy, 9 showed no
difference between group/individual.
8 found CBT more effective
Yalom (2005) identifies factors to consider in group
therapy
Group cohesion, exclusion, confidentiality and
relationships with therapist.

Evaluate the use of biomedical, individual

and group approaches to the treatment of
one disorder.
Evaluation of Biomedical Treatment
Drugs are common for treating severe depression
Treat symptoms but do not cure. Side effects and studies with high rates of placebo effect
indicate that biomedical approach may not be effective. Long term impact on brain is
unknown.
Leuchter et al. (2001) Changes in brain function during treatment with placebo.
Examined brain function of 51 with depression
Received placebo or medication, double-blind
EEG used to measure brain function
Results showed increase in prefrontal cortex for placebo group immediately, slower for SSRI,
both improved.
Belief in treatment may be enough to have brain heal itself.
Kirsh et al. (2008)
Meta-analysis of clinical trials
Used clinical trials of 6 most used anti-depressants 1987-1999. FDA analysed. SSRI was
below recommended criteria for clinical significance.
Highest effect was found in the most severe cases of depression.
Placebo may account for the observed effect in the clinical trials.

 Evaluation of Individual Treatment

CBT effectively treats patients with depression. Superior to
no treatment or placebo. CBT to be as effective as IPT or
AD.
Riggs et al. (2007) studied CBT with SSRI or placebo.
Randomised double blind 126 12-19 y-o.
Depression, substance use conduct disorders.
67% of CBT + placebo and 76% of CBT + SSRI improved
after 4 months. Decrease in depression and other problems.
CBT is cost-effective because short duration
Effective for mild depression, no negative effects found,
CBT + AD (anti-depressant) more effective in chronic cases
or childhood trauma vs. drugs alone
Criticised for focusing on symptoms, not causes

 Evaluation of Group Treatment

Segal, Williams & Teasdale (2001) Mindfulness-based cognitive
therapy (MCBT) to treat depression
Goal is to prevent relapse after successful treatment. Based in
Buddhist meditation and relaxation to focus so negative thoughts
can be observed and reduced. Teach people to recognise signs of
depression and adopt decentred perspective of negative thoughts
so they are not central to self-concept or thought to represent reality.
Kuyuken et al. (2008) randomised to controlled trial of MBCT
and anti-depressant medication.
Aim: investigate effectiveness of MBCT with anti-depressant
Procedure: 123 participants with at least three depressive episodes,
15 month study. One group used anti-depressant alone, other used
MBCT & AD (decreasing)
Results: relapse of 60% in control, 47% in experimental- 75%
stopped taking medication.
Implications: MBCT group reported higher quality of life (enjoyment
and physical well-being), more positive effects.

Discuss the use of eclectic approaches to

treatment.
Depression Treatment: Eclectic
Antidepressants are the most common treatment
Effective, but take time and dropout is high
Keller et al. (2004) found that 50-60% improved with first antidepressant, only 1 in 3 will have
complete recovery. Relapse is common, but combining with therapy reduces risk
Klerman et al. (1974) treatment of depression by drugs and/or psychotherapy
Aim: test efficacy of drugs/psychotherapy alone/combined
Procedure: 150 females with depression in 4 groups- AD, therapy, AD + therapy, placebo
Results: relapse highest for placebo group (36%), 12% for AD, 16.7% for therapy, 12.5% for AD +
therapy.
Why use eclectic treatment
Pampallona et al. (2004) meta-analysis of efficacy of drug treatment alone versus drug treatment
and psychotherapy in depression
Aim: analyse whether combining AD and therapy was more effective in treatment of depression
Procedure: 16 randomised, controlled studies with 932 taking AD only and 910 combined
Results: patients in combined treatment improved significantly more than drug alone. Greater effect
over time (>12 weeks) and lower dropout.
Eclectic treatments may be helpful because individuals may dropout drug treatment when beginning
to feel better. May also be due to side effects, combining benefits of AD and therapy generally leads to
greater improvement (Pampallona et al., 2004) psychotherapy also heals keeps patients in
treatment.

Discuss the relationship between etiology

and therapeutic approach in relation to one
disorder.

Etiology & depression treatment

There are no simple explanations for the etiology of depression (or other psychological disorders).
Logically we want use a treatment for the cause for the best outcome.
Serotonin hypotheses (Coppen, 1967) relates los serotonin to depression. Use of SSRI. Henninger
et al. (1996) reduced serotonin in healthy individuals and did not see increase in depression.
Depression treatment often involves the use of anti-depressants
Interferes with neurotransmission and shows effect. Some question the use of SSRIs because it
disrupts brain. Serotonin system is complex and is little long term info is known. Do not cure
depression and have side effects, placebo may be as effective, psychotherapy is as effective.
Elkin et al. (1989)
Controlled outcome study of treatment for depression. 280 patients randomly assigned to AD +
clinical management, placebo + clinical management, CBT or IPT
16 week treatment. Tested at beginning, after 6 weeks and after 6 months
Results showed that therapy and drug groups had reduction in depression in over 50% only 29%
placebo.
No difference in effectiveness of the AD CBT or IPT. Most severe cases had most improvement with
AD.