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PSY3030 Abnormal Psychology 1 – Conceptual Issues

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LO1 – Elements of Abnormality
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*Statistical Rarity* – deviate from the average by a large extent. Includes positive deviations, therefore can not be used alone. *Deviance or Norm Violation* – behaviour is negatively evaluated by society. Supports statistical rarity by not including positive deviations, however can be dangerous as it can oppress non-conformist behaviours. *Distress* – Causes distress to the individual. However, not everyone experiencing psychological abnormality experience distress. And not everyone who is experiencing distress through self-inflicted actions is experiencing psychological abnormality. *Dysfunction* – Is the behaviour dysfunctional or maladaptive? Does the behaviour interfere with the persons ability to meet the requirements of everyday life? Often seen as a crucial element. However, meeting every day life requirements is often determined by social expectations – maybe the social expectations are wrong and not the persons behaviour (e.g. – holding a job).
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LO1 – Mental Disorder
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Not all abnormal behaviours are considered to be a mental disorder (e.g. – domestic violence or obesity). Must be *clinically significant* – causes substantial impairment in social, occupational or other areas of functioning.
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LO2 – Wakefields’ Conceptualisation of Mental disorder
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*Factual component* (there is an underlying dysfunction) and a *value component* (it is seen by society as harmful). Requires an additional component to be seen as a mental disorder – *must cause harm to the individual*. One criticism of Wakefield is that it is hard to define what a normal evolutionary process is and therefore determine deviations from the norm.
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LO2 – How does Wakefield’s notion of ‘harmful dysfunction’ help to differentiate the concept of mental disorder from the concepts of medical disorder and social deviance?
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Wakefield’s harmful dysfunction analysis proposes that a definition of mental disorder involve both a factual component (internal dysfunction) and a value component (harmful). While medical disorders predominantly consider the factual component (e.g., having a broken leg) and concepts of social deviance largely rely on the consideration of a value component (i.e., whether the act is right or wrong in relation to changing social norms), Wakefield’s analysis argues that a conceptualisation of mental disorder include both components.
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In what ways does the classification of psychological disorders (e.g., depression) differ from the classification of medical disorders (e.g., cancer)?
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The medical approach to classification assumes that health and disorders are clearly distinguishable from each other. Further, various categories of illness are also clearly distinguishable from each other. This approach is applicable to cancer, where there is a clear qualitative difference between health and illness (i.e., having cancer versus not having cancer), as well as between different illness categories (i.e., having cancer versus having heart disease). In the case of psychological disorders, these two assumptions are not clearly met. It has been argued that psychological health and disorder exist on a continuum, with a cut-off between, for example, ‘depression’ and ‘no depression’ placed at a somewhat arbitrary point. Similarly, research evidence exists that the various categories of mental disorder are not as clearly distinguishable from each other as medical disorders are. Evidence for this includes high levels of comorbidity (with many individuals having more than one psychological disorder, e.g., an eating disorder also with anxiety and/or depression), diagnostic instability (whereby an individual’s diagnosis changes from one disorder to another over time, e.g., low weight anorexia nervosa into normal weight bulimia nervosa) and a lack of treatment specificity (whereby the same treatment approach can be effective for supposedly distinct disorders, e.g., antidepressant medication for depression and also chronic pain).
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LO3 – The Biological Perspective of Mental Disorder – Historical
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Believe that symptoms of madness arose from underlying biological diseases affecting the brain or nervous system. *Classification and Causation* – classified by syndromes (set of symptoms that appear together) or by underlying cause once it was known. *Treatment* – 19th Century biological treatments included hot/cold baths ,bleeding, electric shock etc.. to treat and straitjackets and confinement to control. – 20th Century saw more enduring and effective treatments administered after experimentation on animals. *Electroconvulsive Therapy ECT* first tried in 1938 until superseded by drug treatment in the 1960s. *Psychosurgery*, a prefontal lobotomy was also used until more effective, less invasive and less expensive drug treatments were developed.
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LO3 – The Biological Perspective of Mental Disorder – Contemporary
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Theories that explain abnormal behaviours in terms of biological dysfunction (also called the medical approach). Two main areas of focus: 1. *Structural brain abnormalities* 2. *Neurochemical imbalances* Which are believed to be caused by: 1. *genetic makeup* 2. *Trauma* affecting the brain or nervous system *Contributions and Limitations of the Biological Perspective* – does the psychological disorder cause the biological abnormality or vice versa??? – Much of the evidence for biological explanations is inconclusive and many of the studies have been conducted on animals and not humans. – One important contribution is effective drug treatments, however these may be overused and cause side effects. – the biological classification and treatment of abnormal behaviour is clearly distinguishable, that it either it is or it isn’t. However, it is becoming increasingly accepted that mental illness falls on a continuum.
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LO3 – Psychological Approaches to Mental Disorder
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The psychological approach sees the primary causes of abnormal behaviors not in underlying biological disturbances, but in underlying psychological processes, including the manner in which people interpret their environment, their conscious or unconscious beliefs and motivations, or their learning history.
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LO3 – Psychological Approaches to Mental Disorder – *Psychoanalytic Perspective – History – Key Concepts*
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The *unconscious* – the part of the personality of which the conscious ego is unaware. *id, ego and superego* *id* – the id is the most primitive part of the unconscious and consists of drives and impulses seeking immediate gratification. The id operates on the *pleasure principle* – the drive to maximise pleasure and minimise pain as fast as possible. *Ego* – The conscious self which allows the human to respond adaptively to the world. Operates on the *reality principle* – seek to satisfy one’s needs within the constraints of reality. Comprises higher cognitive functions such as learning, memory, language and planning, which have developed to find ways of satisfying id impulses. – Must meet the competing demands of the id and superego. *Superego* – consists of the absolute moral standards internalised from one’s parents and wider society during childhood. Operates on the *morality principle* – the drive to act strictly IAW internalised moral standards. According to this theory, human beings are born with two primitive biological drives: the sexual & aggressive. Energy stemming from the sexual drive is called the *libido*. *Classification and Causation* Anxiety is a result of competing id desires or competition between id, ego & superego.
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LO3 – Psychological Approaches to Mental Disorder – *Psychoanalytic Perspective – History – Stages of Psychosexual Development*
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The id, ego and superego develop in a predictable manner during several stages of *psychosexual development*. In each of these stages, the motivation to gratify the sexual and aggressive urges of the id is centered on different pleasure-producing parts of the body: moth, anus and genitals. *Oral Stage (0-2 yrs)* – Mouths: sucking, biting, chewing. *Anal Stage (2-3 yrs)* – Anus: retaining and expelling faeces. *Phallic Stage (3-6 yrs)* – Oedipus (boys) / Electra (girls) complex has the child desiring the parent of the opposite sex. The children learn to repress this desire and identify with the parent of the same sex, thus internalising that parents values and morals as a representation of society. Theory suggests that girls develop less self control, less sound morality and a weaker ability to use sublimation as a defence mechanism later in life (ie – less able to take part in political, artistic or professional endeavors. *Period of Latency (6-12 yrs)* *Genital Stage (12-18 yrs)* – with the onset of puberty, young people achieve their ability for mature love and healthy functioning in society.
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LO3 – Psychological Approaches to Mental Disorder – *Psychoanalytic Perspective – History – Defence Mechanisms*
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The ego employs defence mechanisms to deal with anxiety resulting from intrapsychic conflicts between the id, ego and superego. If defence mechanisms fail to control the anxiety, it is directly experienced resulting is significant distress. In some instances, defence mechanisms can control the anxiety but cause distress themselves. *Repression* – the person avoids anxiety by not allowing painful or dangerous thoughts to become conscious. *Denial* – The person reduces anxiety by refusing to perceive the anxiety-provoking aspects of external reality. *Projection* – The person attributes his/her own unacceptable thoughts, emotions or desires to another person. *Rationalisation* – The person creates a socially acceptable reason for an action, thought or emotion that has unacceptable underlying reasons. *Reaction Formation* – The person acts in a way that is the exact opposite of the impulses s/he is afraid to consciously acknowledge. *Displacement* – The person reduces anxiety by shifting sexual or aggressive impulses from an unacceptable target to an acceptable substitute. *Intellectualisation* – The person creates an overly logical, rational response to distance him/herself from the unacceptable impulses. *Sublimation* – The person expresses sexual or aggressive impulses in ways that are acceptable to society, such as artistic or professional achievements.
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LO3 – Psychological Approaches to Mental Disorder – *Psychoanalytic Perspective – History – Neuroses & Psychoses*
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*Neurosis* – a set of maladaptive symptoms caused by unconscious conflict and its associated anxiety. *Psychosis* – State involving a loss of contact with reality in which the individual experiences symptoms such as delusions and hallucinations. (The ego withdraws fromreality to deal with the distress of intrapsychic conflict).
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LO3 – Psychological Approaches to Mental Disorder – *Difference between the Medical and Psychoanalytic Models*
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– Psychanalysis sees no qualitative difference between normal and abnormal functioning – the difference is one of degree. – Medical model suggests that different symptom profiles have different underlying causes. The psychoanalytical model suggests that the same underlying cause could produce widely different symptoms – therefor symptoms were not overly important in understanding and treating individuals.
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LO3 – Psychological Approaches to Mental Disorder – *Psychoanalytic Perspective – History – Treatment*
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In order to uncover the true causes of the patient’s feeling and behaviours it is crucial to reduce the ego’s ability to keep conflict out of conscious awareness. *Dream analysis* – dreams interpreted in terms of underlying latent content, which is thought to be an indication of unconscious id impulses. *Free association* – patient is encourage to say freely what comes to mind without attempting to keep any conscious control over the content of his/her speech. *Analysis of transference and countertransference processes* – analysis of emotions directed at the therapist from other parts of the patients life. The therapist must be conscious of countertransference. – no clearly defined goals in terms of symptoms reduction due to the difficulty to distinguish between normal and abnormal behaviour in psychoanalytical therapy.
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LO3 – Psychological Approaches to Mental Disorder – *Psychoanalytic Perspective – Contemporary*
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*Object Relations* – (Margaret Mahler) ‘objects are the people to whom individuals are strongly attached. The primary need for human behaviour is close relationships with others. The prototype of this strong emotional attachment is between the child and primary caregiver. (p16 for further detail). Theorist such as Carol Gilligan propsed that the crucial process in the development of the superego is *separation-individualisation*, rather than Oedipus and Electra conflicts.
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LO3 – Psychological Approaches to Mental Disorder – *Psychoanalytic Perspective – Contributions and Limitations*
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– popularised concepts of mental health and disorder that were radically different from the medical model. – extended boundaries of the definition of mental disorder to include not only symptoms of insanity, but also symptoms of anxiety, depression and other neuroses. -contributed to radical change in mental health professions by extending the client base from a small number of severely psychotic individuals treated in asylums to a large number of neurotic individuals treated as outpatient clinics. – began treatment by non-medical professionals *Limitations* – problematic scientific basis – untestable – infalsifiable – complexity and lack of clarity of the concepts meant that clear and reliable diagnoses often could not be given, treatment progress and outcomes were very difficult to specify, and the length and cost of treatment could not be predicted. With the advent of medical insurance, the demand for clearer and more specific diagnoses and outcomes was ever-increasing. – overall, lack of validity.
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LO3 – Psychological Approaches to Mental Disorder – Behavioural Perspective – Key Concepts
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Emphasises that the cause of behaviour is observable and identifiable in the immediate environment the the bahaviour itself. These causes are simply *stimuli* that *elicit, reinforce or punish* the bahaviour. *Pavlov* – Classical Conditioning Unconditioned Responses *UR* Conditioned Responses *CR* Unconditioned Stimuli *US* Conditioned Stimuli *CS* *Skinner* – Operant Conditiong Behaviour elicits consequences that either reinforce or punish leading to an increased or decreased probability of repeating the behaviour.
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LO3 – Psychological Approaches to Mental Disorder – Behavioural Perspective – Classification & Causation
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Normal and abnormal (adaptive and maladaptive) behaviour is on a continuum. Does not prescribe to the medical model where abnormal behaviour is a result of an underlying disease – does not classify or provide labels. Abnormal/maladaptive behaviour is a result of learning.
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LO3 – Psychological Approaches to Mental Disorder – Behavioural Perspective – Treatment
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A functional analysis of behaviour – it implies that all behaviour can be understood in terms of their function towards receiving rewards or avoiding punishment. From that point on, the task of the therapist is to rearrange environmental contingencies in a way that supports adaptive responses. *Aversion Therapy* – pairing of unpleasant stimulus with a deviant or maladaptive source of pleasure IOT induce an aversive reaction to the formerly pleasurable stimulus. *Systematic Desensitation* – aims to reduce the clients anxiety through progressive, imaginal exposure to feared stimuli paired with the induction of a relaxation response. *Token Economy* – operant conditioning in which individuals receive tokens for exhibiting desired behaviours (taken away with undesired behaviours). *Modelling*
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LO3 – Psychological Approaches to Mental Disorder – Behavioural Perspective – Contributions and Limitations
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Precise, measurable and scientifically testable. Criticised for oversimplifying the understanding of human existence. Criticised for the use of rewards and punishment without connecting with the person.
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LO3 – Psychological Approaches to Mental Disorder – Cognitive Perspective
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Theories that focus on dysfunctional ways of thinking as causes of abnormal behaviour. *ABC Model* – it is the individuals interpretation of an event (rather than the event itself) that results in emotional and behavioural responses. As a result, different interpretations of the same event can result in different emotional and behavioural responses. *Cognitive distortions* are the errors made when interpreting events. – Black and white thinking – Setting unrealistic expectations – Selective thinking (looking on the dark side) – Converting positives into negatives – Over-generalising – Magnifying unpleasantness – Catastrophising – Personalising (it’s all my fault) – Mistaking feelings for facts – Jumping to negative conclusions. On a continuum – that is abnormal behaviour is an exaggeration of normal behaviour.
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LO3 – Psychological Approaches to Mental Disorder – Cognitive Perspective – Treatment
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*Cognitive Restructuring* – client learns to identify, challenge and replace dysfuntional beliefs with more realistic or helpful beliefs.
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LO3 – Psychological Approaches to Mental Disorder – Cognitive-Behavioural Perspective
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Incorporates aspects of contemporary behaviourism and cognitivism. Current dominant approach There is a large body of research that supports the bahavioural-cognitive perspective
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LO3 – Psychological Approaches to Mental Disorder – Cognitive-Behavioural Perspective – Treatment
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CBT – Cognitive Bahaviour Therapy combines both behavioural and cognitive techniques. CBT is highly compatible with the scientist-practitioner model of clinical psychology. CBT therapists set clear, measurable goals at the beginning of treatment and monitor the attainment of these goals throughout the course of therapy. In addition, their understanding of the causes of the client’s symptoms and interventions are informed by recent empirical findings rather than purely theoretical considerations.
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LO3 – Psychological Approaches to Mental Disorder – Cognitive-Behavioural Perspective – Contributions and Limitations
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– still a large number of unanswered questions… what is the causal factor. Negative cognitions may be a result or symptom of psychological disorder. Nevertheless, it is likely that negative cognitions play a maintaining role in psychological disorders (regardless of the initial cause), and, as such, are appropriate and important targets in therapy.
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LO3 – Psychological Approaches to Mental Disorder – Humanistic Perspective – Key Concepts
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Theories based on the view that the natural tendency of hums is towards growth and self-actualisation; abnormality arises as a result of societal pressures to conform to dictates that clash with a person’s self-actualisation process. Unconditional positive regard – essential part of person-centred therapy; the therapist expresses full acceptance of the client as a person, without judgement. Maslow’s Hierarchy of Needs
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LO3 – Psychological Approaches to Mental Disorder – Humanistic Perspective – Classification and Causation
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Psychological disturbance stems from twarted self-actualisation. Holds a non-pathologising view of the person and does not ascribe to the medical model. Equal relationship between client and therapist.
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LO3 – Psychological Approaches to Mental Disorder – Humanistic Perspective – Treatment / Contributions & Limitations
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Therapist needs to see the client through his/her eyes IOT provide the client with unconditional positive regard. Has been criticised for for involving concepts that are difficult to measure and to falsify (self-actualisation).
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LO3 – Psychological Approaches to Mental Disorder – Sociocultural Persoective
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Argues that abnormal behaviours are best understood in terms of the social environment of the individual. Focuses on the importance of family functioning, social networks, access to social resources, cultural values and influences, and religious and spiritual beliefs in influencing individual’s behaviour, emotions and thinking.
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An Integrative Approach
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*Biopsychosocial approach* *Diathesis-Stress Model* – the view that abnormality is caused by the combination of a vulnerability or predisposition (the diathesis) and life events (stressor).
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LO4 -Classification and Diagnosis of Mental Disorders
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Diagnostic and Statistical Manual of Mental Disorders (DSM) – APA (USA & AUS) International Classification of Diseases and Related Health Problems (ICD) – WHO (Europe) *Advantages of Diagnosis* Communication with colleagues and outside organisations *Disadvantages of Diagnosis* – Diagnosis implies a set of symptoms, however these are sometimes used as causes instead. e.g. he is hallucinating because he has schizophrenia. – Can cause stigmatisation
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LO5 – Describe the DSM
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*History* DSM-I (1952) & DSM-II (1968). The DSM-III (1980) was seen as a significant advancement in classification. Adopted a neo-Kraepelinian descriptive approach to classification Avoided unproven and untestable assumptions about the aetiology of disorders Similar approach adopted by subsequent DSM editions *DSM-5 & Beyond* #Difficulties with the current system include: -diagnostic instability -lack of treatment specificity -high levels of co-morbidity #The DSM-5 added a dimensional option to the existing categorical diagnoses but did not replace the categorical approach #Need to ascertain the applicability of diagnostic criteria across cultures