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Abnormal Psychology

Definition: Scientific study of abnormal behaviour: psychological disorders/mental


disorders.
An empirical method to study...

Description

Classification; diagnosis: what is classified as abnormal? How can we tell?

Diagnosis of psychological disorders is very different from physical illness

Causation

Bio-psycho-social factors

The factors all interact with each other; cause is never due to either/or

Treatment

Effectiveness of treatment need to be closely monitored

It is difficult to find out if a treatment is effective since there could also be


many factors that affect the patients mental state
...of Psychological/Mental disorders or abnormality
What is Abnormal?
Deviant (unexpected/rare/unusual)

Distressing (to self or to others)

Dysfunctional (interferes with life goals)

E.g: fetishism (sexual dysfunction)


However: positively valued deviations
exist; eccentricity
Impractical to define a characteristic
as abnormal just because it is rare
Everyone is different
E.g: depression, anxiety
Many symptoms in abnormal
behaviour are found in everyday life
(healthy people have anxiety too)
Some abnormal behaviour does not
involve distress (e.g bipolar disorder)
E.g: ADHD
What is dysfunctional is defined by
society (women wanting to work was
dysfunctional as it interfered with
societys expectation of them as
housewives and child-bearers)
Those with abnormal characteristics
can have a fulfilled life (a person with
psychopathic tendencies could be born
into a wealthy family and thus have a
great life

Accepted guideline to what is abnormal: A mental disorder is whatever is included in the


DSM, aka Diagnostic and Statistical Manual of Mental Disorders
Satisfying one or two of the above three conditions does not mean it is necessary or
sufficient to diagnose that behaviour as abnormal.
It is important to note that abnormality is always defined by society and cultural
values: different societies may classify different behaviours as abnormal
Psychological abnormality exists on a continuum with normality, and a behaviour is
defined as abnormal when it crosses a cut-off point (which can be vague).
Thus, psychological disorders are not as readily definable as physical illness.
Models of Mental Illness
Model
Supernatural
Biological

Psychological

Sociocultural

Cause
Spirits; stars/moon; past
lives
Internal physical problems;
biological dysfunction; all
disorders are from a
biological source
Beliefs, perceptions, values,
goals, motivation etc;
psychological dysfunction;
people see things in a way
that causes them to suffer
Poverty, prejudice, social
and cultural systems

Treatment
Exorcisms, prayers etc
Bleeding, diet, celibacy,
exercise, rest, medication
Psychotherapy

Fixing social issues

Biological/medicinal model of mental illness


Definition

Oldest and currently most


dominant model of mental illness

Assumes that psychological


disorders can be diagnosed
similarly to physical illness

Explains mental illness in terms of


biological disease process such as
Structural brain abnormalities
(schizophrenia)
Neurochemical imbalance
(depression)

Best treated with medication,


surgery etc

Criticisms
Extreme reductionism
Certain complex psychological
phenomena (e.g creativity) may be
impossible to explain at a purely
neural/molecular level
Over-extrapolation from animal
research
Animals dont live in the complex
society that humans do live in, so
animal research overlooks many
social and psychological factors that
affect us in everyday life
Assuming causation from treatment
May not be applicable to
conceptualising and diagnosing mental
illnesses

Clear boundary between physical


health and illness; however mental
health and disorder is a continuum
There are clear boundaries between
different physical illnesses; however
psychological disorders commonly
co-occur
Psychological Models
Psychoanalytic

Most dominant during first half of 20th century; usage discontinued by 1970s

Sigmund Freuds id, ego and superego

Three parts of the mind that are always in conflict

Maladjustment (abnormality) arises from unresolved conflicts causing

Anxiety

Defence mechanisms

Protect us from knowing what is causing us suffering

When overly used can also become abnormal symptoms

Is thus both normal and abnormal behaviour

Critiques: lack empirical evidence and also lack falsifiability


Humanistic

Believe that people are born good rather than evil

Happiness is achieved by becoming fully-functioning, self-actualized persons

Maladjustment arises from blockage of ones path to self-actualization

Environments that impose conditions of worth (e.g not being able to pursue a
dream career because of familys expectations)

Having ones own experience, emotions and needs suppressed

Treatment: empathy and unconditional positive regard

Critiques: difficult to research

Still used in counselling, though not in critical psychology


Behavioural

Shaping of self purely through environmental influence such as Classical and


Operant (Instrumental) conditioning

Maladjustment arises from aversive learning history

Many treatment applications, such as implanting new learning to cover old learning
(extinction)

Critiques: does not factor in cognition or emotion, implies that we learn by doing
only

Bandura (1974) found that learning is not purely from behaviour with his
observational learning theory, which incorporated cognition to behaviourism

Cognitive-Behavioural Model

Currently dominant model in psychology

Our interpretation of our environment influences our emotions and behaviour

Maladjustment arises from latent core negative beliefs

Negative views of the world formed by past experiences

Could lead to pessimistic/negative interpretation of situations that are consistent


with such core negative beliefs, even if situation is ambiguous

Cognitive biases; only picking up information that fits in with our believes

(Over-generalizing, selective attention, catastrophising, personalizing,


magnification, mistaking feelings for facts, etc)

Negative automatic thoughts


Models are not necessarily either/or; different models could combine to fit a
situation
Classification and Causation (why?)

To improve communication between researchers

To improve communication between health professionals

May improve communication and understanding of mental health in the community

May reduce social stigma against those with mental health issues
Classification Systems

International Classification of Diseases and Health Related Problems (ICD)

Published by World Health Organisation

Mental disorders added for first time in 1948

Currently in 10th edition

DSM

Published by the American Psychiatric Association

1st edition published in 1952

Currently in 5th edition (DSM-5)

Development of DSM
DSM-I (1952), DSM-II (1968)

Strongly influenced by psychoanalytic theory

Therefore had problematic reliability

Had no specific conditions to diagnose patients with

How much self depreciation must one exhibit before they can be diagnosed?

How often must patient display conditions?

Can a patient still be suffering from mental health issues if some conditions are
not met?

Therefore it was difficult for psychiatrists to agree on diagnosis

Problematic validity

Are the descriptors really accurate?

Freuds theories were often not disprovable/cannot be falsified

DSM-III (1980) and beyond


DSM-III (1980), DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), DSM-5
(2013)

Major development in classification

Now reflects the medical/biological model (physiological causation)

No theoretical assumptions about causation - all symptoms and causes can be seen
or shown through patient report, direct observation and measurement

If causation is not known, then descriptions of symptoms can be used to diagnose

No assumptions about unconscious processes

Clear, explicit criteria and decision rules

Has improved reliability and validity


See lecture 2 slides for comparison between descriptors of depression
Anxiety and Related Disorders
Definition: Systems that are activated in response to perceived threat. The experience of
anxiety is the same in normal and abnormal anxiety. Abnormal anxiety is when the
occurrence of anxiety is excessive (more intense than objective level of threat) or
inappropriate (in absence of objective threat). It is characterised by overestimation of
threat, such that the probability and cost of a negative outcome is exaggerated.
There are three interrelated anxiety systems: the Physical, Cognitive and Behavioural
systems;
Physical System

Sympathetic nervous system:


fight/flight response

Mobilises all resources in the body to


deal with threat

Symptoms: sweating, heart rate


increase, trembling etc; classic
symptoms of autonomic arousal
Cognitive System

Perception of threat

Hypervigilance: where attention is


focused onto the threat alone

Leads to difficulty concentration on


other tasks
Behavioural System

Escape/Avoidance

Aggression

Freezing

Anxiety Disorders according to DSM-IV


Categorised according to the focus of anxiety; experience of anxiety is same/similar
in each
Separation anxiety disorder

Specific phobias
Social phobia
Generalized anxiety disorder

Obsessive-Compulsive disorder

Post-traumatic stress disorder


Panic disorder (with/without
Agoraphobia)

Selective Mutism (DSM-V)

Anxiety when away from primary


caregiver
Occurs mostly in children
Irrational fear of things such as
animals, blood, specific situations etc
Fear of negative social evaluation
Excessive and uncontrollable worry
about a range of outcomes
No specific focus of anxiety; worried
about everything
Obsessions: intrusive thoughts or
impulses
Compulsions: ritualized behaviours to
relieve the anxiety caused by
obsessions (such as hand-washing)
Often subjects are aware of their
compulsive behaviour
Anxiety at thoughts/memories of
traumatic experience
Unexpected/spontaneous panic attacks
(at least 2), leading to anxiety about
having another attack
Agoraphobia: fear and avoidance of
places where panic attacks have
occurred
Strong avoidance of source of anxiety
will maintain the anxiety (because no
experience of going to the place and
not having an attack)
Those with severe agoraphobia cannot
even leave their homes
Occurs mostly in children
Will not talk to strangers/will only talk
to certain people

Anxiety disorders are highly comorbid (tend to occur with each other. Most people
with mental disorders will have several disorders at the same time) with each other as
well as Depression.

Contrast between DSM-IV and DSM-V in Anxiety Disorders Chapter


DSM-IV
DSM-V

Separation Anxiety Disorder

Separation Anxiety Disorder

Specific Phobia

Selective Mutism

Social Phobia

Specific Phobia

Generalized Anxiety Disorder

Social Phobia

Panic Disorder

Generalized Anxiety Disorder

Post-traumatic Stress Disorder

Panic Disorder

Acute Stress Disorder

Agoraphobia

Obsessive-Compulsive Disorder
New Chapters in DSM-V:
Trauma- and Stressor-Related Disorders:
Inc. Post-traumatic stress disorders and Acute stress disorder
Obsessive-Compulsive and Related Disorders:
Inc. Obsessive-Compulsive disorder
Panic Attack

Abrupt and intense fear or anxiety

Anxiety peaks within 10 minutes

Has classic symptoms of autonomic arousal and other associated physical symptoms

Produces fear of dying, losing control, going mad, epilepsy and hear attacks

Two types:

Cued panic (situationally bound): occurs in presence or anticipation of feared


stimulus and can be associated with any anxiety or related disorder

Uncued panic (unexpected): specifically associated with panic disorder

Average duration is 10 years before receiving psychological treatment


Anxiety and Stress Related Disorders Chart
Disorder
Panic disorder

Diagnostic (DSM-V)
At least 2 uncued panic
attacks
Having anxiety/worry
about having another
attack
Having concerns about
heart attacks, going mad,
epilepsy etc because of
the panic attacks
Significant behavioural

Causes/Associations
Cognitive theory of Panic
disorder:
Bodily sensations (heavy
breathing, shaking etc) maybe
after strenuous activity

Misinterpretation of
sensations as cues for heart
attack, death etc

Specific phobias

Generalized anxiety
disorder

changes to try and avoid


having another attack (e.g
agoraphobia)
Symptoms persisting for
1+ months

Anxiety

Increased bodily sensations


(physical system activated)

Increased anxiety

Persist in cycle until panic


attack
Extreme, disabling fear of Classical conditioning:
specific objects or
previous experience may
situations that pose
cause fear of things
little/no objective danger
related to that event
E.g animals, injections,

However: conditioning is
heights etc
not sufficient nor
Person knows what they
necessary to cause phobia
fear and therefore will

Some stimuli are more


have great anxiety when
likely to become phobic
encountering the feared
than others (e.g cliffs,
object
snakes)
Anxiety experienced

Associated with
when encountering object
evolution: objects that
is exaggerated to danger
once posed significant
level
threat to survival
Can be associated with

Therefore easier to learn


cued panic attacks
to fear/exists as innate
Symptoms persist for 6+
fear
months
Excessive and

High trait anxiety


uncontrollable worry

Trait: tendency to
About wide range of
experience anxiety
outcomes (2+ for

Intolerance of uncertainty
diagnosis)

Need to be 100% certain


Physical symptoms
negative outcome will not
different from Panic:
occur
Tension, irritability,

Therefore would rather


restlessness, sleep
100% negative outcome
problems, being on edge,
than uncertain positive
inability to relax

Reduced ability to
3-6(+) needed for
tolerate distress (have a
diagnosis
need to reduce possibility
Not classic autonomic
of distress)
arousal symptoms

Reduced problem solving


(anxiety)
confidence/success (since
Symptoms persist for 6+
needs to find a perfect
months
solution; thinks of

negative outcome with


each solution)
Obsessive-Compulsive
behaviour

Post-traumatic stress
disorder

Obsessions: repeated,
intrusive, irrational
thoughts or impulses that
cause severe anxiety or
distress
A minor thought could
cause big distress
Compulsions: ritualized
behaviours to relieve
anxiety caused by
obsessions
No longer anxiety
disorder because while
anxiety is a big part, lots
of other negative
emotions also occur

Intrusive symptoms (1+):


Intrusive images,
memories, dreams
Re-experiencing: as if
events were recurring
Persistent avoidance of
stimuli (1+):
Avoidance of reminders
of traumatic event
Negative changes in
cognition, mood (2+):
Fear, helplessness, selfblame, anger,
hopelessness
Changes in arousal,
reactivity (2+):
Sleep disturbance, poor
concentration,
hypervigilance,
exaggerated startle,
recklessness

Intolerance of
uncertainty: need to be
sure obsessive thought
will not occur (leads to
repetition of compulsive
behaviour)
However trying to not
think about something
makes thoughts stronger
Inflated responsibility:
blames self for possible
negative outcome
Thought-action fusion:
thinking is as bad as
doing
Magical ideation: creating
superstitions and rules
that the self believes will
lead to good outcome
Exposure to actual or
threatened death, serious
injury or sexual violence
in 1(+) following ways:
Direct experience
Witnessing event that
occurred to others
Learning that traumatic
event occurred to close
family/friends (violent or
accidental)
Experiencing repeated or
extreme exposure to
aversive details of
traumatic events

Eating Disorders

DSM-IV
Anorexia Nervosa
Bulimia Nervosa
EDNOS

Subclinical AN or BN

Binge Eating Disorder

Purging Disorder

Night Eating Syndrome

Grazing

DSM-V
Anorexia Nervosa
Bulimia Nervosa
Pica
Rumination Disorder
Avoidant/Restrictive Food Intake
Disoder
Binge-Eating Disorder
Other Specified Feeding or Eating
Disorder
Unspecified Feeding or Eating
Disorder

Eating Disorders Chart (DSM-IV)


Description

Anorexia Nervosa
Refusal to maintain body weight
at a minimally normal weight
for age and height

Weight is less than 85% of


that expected
Intense fear of gaining weight or
becoming fat even though
already underweight
Two types:

Restricting: successful in
restricting intake of foods;
usually eat same foods
every day

Binging/Purging: sometimes
break restriction; then feel
like have to compensate for
extra calorie intake

Objective binging: eating


larger than normal human
amount

Subjective binging: larger


than normal restricted

Bulimia Nervosa
Binge eating +
compensatory behaviours
Recurrent episodes of binge
eating

Objective binging

Lack of control over


eating during episode

Eating because cannot


stop eating

Tend to be ashamed of
binging episodes
Recurrent inappropriate
compensatory behaviour to
prevent weight gain

Purging: self-induced
vomiting, laxative abuse

Non-purging: fasting,
excessive exercise
Tend to be normal/slightly
over weight

Because compensatory
methods do not work

Associated
Features

Epidemiology

amount
Body image disturbance

Denial/unable to realize
extent of underweight

Undue influence of body


weight/shape on self
evaluation: believe they will
only be happy/good person
if they are skinny
Amenorrhoea (periods stop)
Psychological problems:

Depressed mood, irritability,


anger, social withdrawal,
preoccupation with food,
poor concentration

Often associated with


starvation syndrome:
become obsessed with food
as result of starvation;

Unable to maintain social


relationship; complete daily
tasks
Comorbid with: mood disorder,
anxiety disorders (esp. Social
phobia), substance abuse
(amphetamines to suppress
appetite); personality disorders
(OCPD [obsessive])
Physical problems:

Low body temperature,


brittle hair/nails, hair
growth

Low estrogen ->


osteoporosis (brittle bones)

Malnutrition, anaemia,
immune system suppression
Mortality rate of 5-10% over 10
year period
Anorexic thinking remains (e.g
obsessing over calories) even
after patient symptoms no longer
meet criteria for DSM-V
Prevalence

Affects 0.5-1.0% of females

90% of individuals with AN


are female

Body image disturbance

Psychological problems:

Comorbid mood
disorders, anxiety
disorders, substance
abuse, personality
disorders (BPD
[impulsive])
Physical problems:

Associated with binges


(e.g stomach rupture)

Associated with
compensatory
behaviours e.g:

Loss of dental enamel,


scarring/ulceration of
oesophagus, salivary
glad enlargement,

Loss of normal bowel


function,

Dehydration,

Electrolyte disturbances
(irregular heartbeat,
heart failure)

Prevalence

Affects 1.0-3.0% of
females

90% of individuals with

Age of onset

Mid-late adolescence
(though getting earlier)
Course

Slow recovery (up to 10


years for most)

20% remain chronically ill

50% then develops BN

BN are female
Age of onset

Late adolescence-early
adulthood
Course

Long term outcome


better than for AN

10% still affected after


10 years

Proposed Causes of Eating Disorders

Biological
Genetic factors

Family and twin studies suggest


moderate heritability component
for AN and BN

Chances of depression, personality


disorders, substance abuse are also
higher in families of persons with
ED

No adoption studies have been


conducted because of difficulty
separating genetics and
environment
Neurotransmitter disturbances

Serotonin involved in appetite


regulation

There are mixed findings


regarding direction of causation

As in serotonin could cause ED, or


ED could cause disturbance in
serotonin levels
NOTE: ED is becoming more
recognised in males (who display the
same symptoms), except they want to
be overly buff rather than skinny

Psychological

AN and BN have many features in


common

Tendency to base self-worth on


weight/shape

Desire to attain unrealistic levels


of thinness

Intense fear of gaining weight

High degree of overlap in proposed


causes

Cognitive-Behavioural theory
(refer to Lecture 5 ppt)
Proposed Psycho-Social Causes

Family factors

Higher parental criticism, control


and conflict

Lower parental empathy and


support

Comments regarding childs


eating/body

Parental modeling of eating/body


concerns

Peer factors: social approval

Social-cultural values

Emphasis on thinness as key basis


for attractiveness for females

Note that many non-western


cultures had low levels of ED
before west invaded

Mood Disorders
Mood Disorders Chapter in DSM-IV:
Depressive Disorders

Unipolar: negative end of mood


spectrum only [Depressive]

Depressive: abnormally low mood

Such as:

Major Depressive Disorder

Dysthymic Disorder

DD-NOS

Bipolar Disorders

Bipolar: extremes in both ends of


mood spectrum:

Both Depressive and Manic

Manic: abnormally elevated mood

Manic episodes are extreme highs in


normal mood, as opposed to a normally
energetic person

Such as:

Bipolar I Disorder

Bipolar II Disorder [mild version of I]

Cyclothymic Disorder

NOS
NOTE: DSM-V both are given own chapters rather than under Mood Disorders
Depressive Disorders:
Major Depressive Disorder
Symptoms
Diagnosis
1. One or more major depressive episodes Major Depressive EPISODE:
with symptoms:

5 or more symptoms including 2. or 3.


2. Depressed mood for most of the day,

Over 2 week period


nearly every day

NOTE: bereavement waives time


3. Markedly diminished pleasure/interest
condition as many symptoms can be
in activities
also caused by grief
4. Significant weight loss/gain

NOTE 2: bereavement condition


5. Recurrent thoughts of death/suicide
deleted in DSM-V
attempts

Now anyone can be diagnosed with


Nearly every day:
depression after 2 weeks of symptoms
6. Insomnia/hypersomnia
Major Depressive DISORDER:
7. Psychomotor agitation or retardation

Single or recurrent episodes, not


8. Fatigue/loss of energy
accounted for by other disorders
9. Feeling worthlessness, excessive guilt One episode will increase risk of
10. Diminished ability to concentrate
recurrent episodes
11. Indecisiveness

Risk will build up

Dysthymic Disorder
Renamed persistent depressive disorder in DSM-V
Symptoms
Diagnosis

Milder depressed mood compared to

Persistent: continues for at least 2 years


MDD e.g

Symptoms may remain unchanged

Does not enjoy life; no mood


over long periods (20+ years)
fluctuations

Risk of Double Depression: both


MDD and Dysthymia occur where:

Patient sinks into MDD, recovers back


into Dysthymia
Cause
Biological Theories
Genetic Vulnerability

Heritability: 35-60%

Some genes associated with


vulnerability to mood disorders in
general

More vulnerable to mood disorders


when situation triggers it

No specific gene associated with mood


disorder/depression
Neurochemistry

Low levels of Noradrenalin and/or


Serotonin

Only correlation: causal direction is


uncertain
Neuroendocrine System

Also uncertain if legit cause:

Excess cortisol in response to stress

Cortisol interacts with neurochemicals

Mood disorder = unable to turn stress


off (?)

Increased stress strongly related to


mood disorders
Biological vulnerability + stress = depression (?)

Psychological Theories
Schema Theory

Learned Helplessness Theory

Ruminative Response Styles


Interpersonal Factors

Cognitive vulnerability + stress = depression

Pre-existing negative schemas based


on previous experience

Have distorted view of self, others and


environment

Negative schemas activated in


bad/stressful situations:

Result in biased [negative] information


processing

In turn strengthens schema


Negative events are interpreted based on 3
kinds of factors:

Internal (self is cause of bad outcome)

Stable (situation will always be bad)

General (because world and I are bad)


Positive events are associated to luck

Positive events are diminished and


negative are exaggerated

Unable to disengage from negative


outcomes in a situation

Cannot move on from bad event

The way patients interact with others


Poor social skills =

Less positive reinforcers in life e.g


good job, friends

Rejected by others because of


negativity

Gravitate to those who confirm


negative self-views

Treatments
Biological

Psychological

Method
Drugs

SSRIs

Effective in 70-80%
Electroconvulsive Therapy (ECT)

Used as last resort for severe


depression

Effective in 80%

Cognitive-Behavioural Therapy

Addresses cognitive errors in


thinking
Include behavioural components:

Behavioural Activation

Behavioural Experiments
Compared to drug therapy there is
lower rate of relapse

29% vs 60%

Explanation/Limitations
SSRIs only inhibit serotonin
re-uptake

Fewer side effects compared


to older drugs

ECT causes seizure to cure


depression

Uncertain why it works


Limitation:

Relapse common when


treatment stopped

Suggests treatment only


suppresses symptoms rather
than targeting cause

Aims to lead patient into


developing more realistic and
complex view of world/event

Compared to unrealistically
negative viewpoint

NOT encouraging blind


positive thinking
Behavioural Activation:

Encourage patient to start


doing previously enjoyable
things again

Helps to see positively on a


cognitive level
Behavioural Experiments:

Testing beliefs - is there really


no one who loves you?

Tests to deconstruct negative


beliefs

Develops skill to recognise


relapse and refrain from it