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Abnormal Psychology Outline

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Abnormal Psychology

Key words

Notes

GF 1: To what extent do biological, cognitive and sociocultural factors influence abnormal behaviour?
GF 2: Evaluate psychological research (theories and/or studies) relevant to the study of abnormal behaviour. C&D 1: Examine the concepts of normality and abnormality.

Normal: conformity to standard or regular patterns of behaviour. Abnormal: essentially a label applied to behaviour that does not conform

Statistical Infrequency Deviation from the statistical norm Statistical averages behaviour is seen as normal whilst rare behaviour is abnormal. Individuals showing extreme deviation from average behaviour are regarded as abnormal. Statistical abnormality does not necessarily refer to qualitative aspects but quantitative.

Objective Scientifically measureable Suitable way to deal with some behaviour

It is difficult to determine how may s.d. are to be considered abnormal Some mental disorders are not statistically rare Lower end of a bell curve is seen as abnormal whereas the higher level is not Common in subcultures but not in majority cultures defined as abnormal Ignore social setting Fails to distinguish between desirable and undesirable behaviour

The results are quantitative in nature and are outside the bell curve being suggestive to abnormality

Deviation from social norms Social norms constitute informal or formal rules of how individuals are expected to behaviour in a society or culture Deviant behaviour is the behaviour that is considered to be undesirable or antisocial by the majority if people in a particular society/culture

• Behaviour: vivid and unpredictable, causes observer discomfort and violates moral or ideal standards

• Thinking: delusional, irrational or incomprehensible

Relevant to society and person's situation Support Szasz's theories on the importance of life events and social reality

Criterion subjective and unstable (time and culture) Based on morals and attitudes, it is vulnerable to abuse Discrimination against minorities

Social, cultural and historical factors may play a role in what is seen as 'normal' or 'abnormal

Failure to function adequately When a person is unable to live a normal life, unable to experience the normal range of emotion or engage in a normal range of behaviour.

Can be used to identify individuals who require psychological assistance The symptoms for functioning inadequately might be linked to the individuals' personality The personal feelings of the individual is considered

Dysfunctional ≠abnormalities Social & cultural construct Can be subjective

Identifying whether an individual is functional the way the normally would or are showing abnormalities in their daily lives. The criteria would be most useful when identifying such behaviour on a long term basis to see whether positive

Abnormal Psychology

Key words

Notes behaviour of the individual is decaying. Deviation from ideal mental health

• Criteria of mental health to define normality:

1. Introspection

2. Integration and balance of personality

3. Self-actualisation

4. Autonomy

5. Ability to cope with stress and see the world realistically

6. Environmental mastery

Universal criteria Positive approach

It is near impossible for any individual to achieve all of the characteristics all of the time Not clear what extent is abnormal Diagnosis is based on the deviation from ideal mental health Absence of normality is the criteria for diagnosis of abnormality

Seven Criteria by Rosenhan and Seligman (1984)

1. Suffering

• Experience distress and discomfort?

2. Maladaptiveness

• engage in behaviour that make life difficult for him

3. Irrationality

• Incomprehensible or unable to communicate in a reasonable manner?

4. Unpredictability

• act in ways that are unexpected

5. Vividness and unconventionality • experience things that are different than most people

6. Observer discomfort

• Acting in a way that is difficult to watch or that makes other people embarrassed?

7. Violation of moral and ideal standards • habitually break the acceptable ethical and moral standards of the culture

Good starting point for doctors to find out if a patient has abnormalities It considers the individual's distress, social judgement, and social norms; therefore it is well rounded in the diagnosis.

Culturally inconsistence Defining abnormality is difficult process and depends on implicit theories regarding normality and abnormality. Unclear line between normality and abnormality Reply on subjective judgments Difficult to decide which of the features actually exist

A several being present at the same time Based on observation How the person is living, then social judgements based on conventions (patient) Social norms (family) Must take into consideration the context, behaviour, status, gender

Comer's Four D's Deviance:

• From behaviours, thoughts and emotions considered normal in a specific place and time by specific people

• From social norms o Stated and unstated rules for proper conduct in a given society

• Judgment of deviance also depends on specific circumstances Distress:

• Behaviour must be personally distressing before it can be labelled abnormal o Not always the case Dysfunction:

Abnormal Psychology

Key words

Notes

Abnormal behaviour tends to be dysfunctional Interferes with daily functioning Culture has an influence on determinations of dysfunction Dysfunction alone ≠ Psychological abnormality

Danger:

• May become dangerous to one's self or others

• Behaviour may be careless, hostile, confused or concussed

• Abnormal behaviours ≠ danger Consider the personal feelings of individual Introduces clearly the concept of danger to self and others More comprehensive than some

Imprecise as the criteria can be criticised for being vague and subjective Changes will occur over time in relation to social norms

A criteria used in diagnosing abnormal behaviour Best used within family to members as they know the person well

C&D 2: Discuss validity and reliability of diagnosis.

Diagnosis is needed to accurately treat mental illness. Clinicians use classification systems, such as the Diagnostic &
Statistical Manual V (DSM-V) and International Classification of Diseases (ICD) to ensure this is done objectively. However, questions have been raised about the reliability and validity of such diagnostic systems. In order for a diagnosis to be reliable, clinicians must be consistent in their diagnostic systems. For the diagnosis to be valid the clinician must be able to identify a "real" pattern of symptoms. Both reliability and validity are needed to ensure appropriate application of treatment. Hence, this essay will discuss a considered and balanced review of the reliability and validity of diagnosis. Diagnosis: the process of determining by examination the nature and circumstances of a disorder/diseased condition; the reached from such an examination The purpose of diagnoses

1. To identify groups of similar suffers so that psychiatrists and psychologists may develop explanations and methods to help those groups

2. Billing purposes. The government and many insurance companies require a diagnosis Reliability: One of the most important characteristic of science is replication - the ability to reproduce results obtained from a study. Reliability in this case refers to consistency of diagnosis. There are two types reliability.

3. Inter-rater reliability: can be assessed by asking more than one practitioner to observe the same person and, using the same diagnostic system, attempt to make a diagnosis. If practitioners make the same decision, the system is reliable.

4. test-retest reliability: is concerned with whether the same person will receive the same diagnosis if they are assessed more than once Validity: to what extent is the diagnosis appropriate, leading to treatment that leads to an improved state of health for the patient Diagnostic and Statistical Manual of Mental Disorder (DSM) - include the 5 axis' of the DSM

• Handbook published by the APA, used to identify and classify of symptoms of psychiatric disorders International Classification of Diseases (ICD)

Reliability Beck et al (1962)

• Agreed diagnosis for 153 depressive patients between 2 psychiatrists was only 54%

• Due to vague criteria for diagnosis for depression

• Fernando (1991)

• Is a social process and is not objective

• Clinical assessments, classification and diagnosis can never be totally objective - value judgements involved

• Different from medical diagnosis

• Di Nardo et al (1993)

• DSM-III for anxiety disorders

• 2 clinicians to 267 people (anxiety and stress disorders)

• Score out of 1

• OCD (.80) - high, anxiety disorder (.57) - low

• Interpreting how excessive a person's worries were.

Abnormal Psychology

Key words

Notes

Mary Seeman (2007)

• Test-re-test reliability

• Diagnosis of SZh were susceptible to change (particularly in women) as clinicians found out more information about their patients

• As a number of conditions can cause symptoms of schizophrenia

• Lipton & Simon (1985)

• Diagnose 131 patients selected randomly in a hospital in New York

• Compared with the original diagnosis

• Schizophrenia: Original: 89 | Re-evaluation: 16

• Mood disorder: Original: 15 | Re-evaluation: 50 Validity

• Rosenhan

• Temerline (1970)

• clinically trained psychiatrists and clinical psychologist influenced by respected authority

• Videotaped interview of a completely psychologically 'healthy' individual

• some subject: authority state that, although the person seemed neurotic, he was actually quite psychotic

• Diagnosis highly influenced

• Kendall (1974)

• 1913 patents admitted to hospital since 1964, readmitted after 1969

• Schizophrenia was more often diagnosed as a form of depression than reverse

• Mitchell et al. (2009)

• Meta-analysis (41 studies, 50,000 depression patients)

• Accurate 47% of cases

• improved over an extended period of time

• general practitioners should see individuals at least twice before making a diagnosis in order to improve validity

There is a large amount of research supporting the view that the reliability and validity of diagnosis are poor. This is due to many reasons There are significant individual and cultural differences for the symptoms of mental disorders. An individual may have multiple mental disorders A wrong diagnosis may lead to a social stigma (an ethical issue)

C&D 3: Discuss cultural and ethical considerations in diagnosis. Culture

• Culture is the learnt, shared behaviour of members of a society.

• It includes social norms, values, attitudes and beliefs which are generally shared by people living in the same society.

• Culture Bond Syndrome o Conceptions of abnormality differ between cultures, and this can have a significant influence on the validity of diagnosis of mental disorders. Though many disorders appear to be universal—that is, present in all cultures—some abnormalities, or disorders, are thought to be culturally specific. o These disorders are called culture- bound o Many of the symptoms of neurasthenia listed in CCMD-2 are similar to the symptoms that would meet the criteria for a combination of a mood disorder and an anxiety disorder under DSM-IV.

• Manson et al

• Marsella

• WHO

• Hofstede Ethics Correct diagnosis and treatment o Reliability and validity of a diagnosis o A reliable and valid diagnosis is the prerequisite for a correct treatment o many disorders are not easy to identify correctly because they often occur together with symptoms of other disorder

• Biases in diagnosis o Various bias to prevent correct diagnosis o May be influenced by confirmation bias

• Consideration of normality and abnormality o Give treatment to patient that is not ill and not in need for treatment

• Stigmatization

Abnormal Psychology

Key words

Notes Psychiatric diagnosis carries a personal, legal and social stigma Serious mental illness could be based on limited information Psychiatric diagnosis is often associated with significant consequences in terms of being considered "deviant" Self-Fulfilling Prophecy o Scheff (1966) argued that one of the adverse effects of labels is the self-fulfilling prophecy—people may begin to act as they think they are expected to. o They may internalize the role of "mentally ill patient" and this could lead to an increase in symptoms. o Doherty (1975) points out that those who reject the mental illness label tend to improve more quickly than those who accept it.

o o o

PD 1: Describe symptoms and prevalence of two disorders. Depression Symptoms

• 5 in two or more weeks

• Affective

1. depressed mood

2. loss of hope

• Behavioural

1. loss of pleasure from and interest in previously enjoyed activities

2. slow speech

3. changes in activity level

4. loss of initiative

5. Crying

6. constant complaining

• Cognitive

1. worry

2. negative self-concept

3. concentration difficulties

4. suicidal thoughts

• Somatic

1. Insomnia

2. weight loss of gain

3. loss of sexual appetite Prevalence

• Major depression is famously common

1. average 10% lifetime prevalence rate

2. Average onset age: 25

• The global statistics:

1. Leading cause of disability as measured by YLDs

2. 4th leading contributor to the global burden of disease (DALYs) in 2000

3. 2020: 2nd place of the ranking of DALYs

4. Already the 2nd cause of DALYs in age 15-44

5. YLDs = Years Lived with Disability

6. DALYs = Disability Adjusted Life Years Gender:

• Nolen-Hoeksema (2001)

1. Women : Men | 2:1

2. no cause

• Kessler et al.

1. Woman = 21.3% | Men = 12.7%

• Piccinelli and Wilkinson (2000)

1. the gender differences are genuine

2. same diagnostic procedures

Biological factor of hormones

1. sex hormones, oestrogen and progesterone, on mode

2. Weiss et al. (1999)
▪ More likely to develop depression due to a dysregulation of the stress response system (HPA axis) caused by adverse experiences in childhood (e.g. childhood sexual abuse).

3. Nolen-Hoeksema (2001)
▪ both experience the same stressors
▪ different biological responses to these stressors, self-concepts or coping styles

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