Abnormal
Abnormal Psychology
General framework
- To what extent do biological, cognitive and sociocultural factors influence abnormal behaviour?
- Evaluate psychological research (that is, theories and/or studies) relevant to the study of abnormal behaviour.
Concepts and diagnosis
Examine the concepts of normality and abnormality
- Abnormality defined by the APA as behavior that causes distress, loss of freedom, physical or emotional pain, increased risk of death or injury to self or causes a disability of some sort
- 7 Criteria for Abnormal Behavior (Rosenhan & Seligman, 1984)
- Suffering
- Maladaptiveness
- Irrationality
- Unpredictability
- Vividness and unconventionality
- Observer discomfort
- Violation of moral or ideal standards
- 6 Characteristics of Mental Health (Jahoda, 1958)
- Efficient self-perception
- Realistic self-esteem and acceptance
- Voluntary control of behavior
- Accurate perception of the world
- Sustaining relationships and providing affection
- Self-direction and productivity
- Evaluation
- Actually applying these criteria means most people would be considered abnormal
- Normalness is culturally determined
Discuss validity and reliability of diagnosis
- Problems with classification
- No physical signs of disorders making it difficult to diagnose
- Lack of agreement using same classification system
- DSM-IV - 64% agreed
- ICD-10 - 36% agreed
- Great Ormond Street System - 88% agreed
Discuss cultural and ethical considerations in diagnosis
Culture-bound Syndrome
- Shenjing shuairuo accounts for over 50% of outpatient cases in China
- Not included in DSM-IV but many symptoms are similar to the crtieria for a combo of mood and anxiety disorder in DSM-IV
Ethical Considerations in Diagnosis
- Self-fulfilling prophecy
- People who believe they are 'abnormal' may begin to act abnormal thus fulfilling the prophecy they have a psychological illness (Scheff, 1966)
- Racial and ethnic (Jenkins-Hall & Sacco, 1991)
- African American women rated more negatively and less socially competent than European women by therapists watching them on videos of a clinical interview
- Only women were used, possible gender difference
- Confirmation bias
- Cognitive bias that leads practioners to assume that patients seeking help are sick and thus look for signs/symptoms that can lead to a diagnosis even if patient is 'normal' (Rosenhan, 1973)
- Powerlessness and depersonalization
- Makes assessing patients properly difficult
- Effect of institutionalization where patient has little choice, few rights, not much privacy and a lack of constructive activities affects their 'normal' behavior
Psychological disorders
Describe symptoms and prevalence of one disorder from two of the following groups
Anxiety disorders - PTSD
Symptoms
- Affective - anhedonic (=inability to experience pleasure), callousness
- Behavioral - flashbacks, paranoia and hypervigilance, nightmares
- Cognitive - intrusive memories of traumatic event, problems concentrating, hyperarousal
- Somatic - lower back pain, digestion issues, insomnia, losing ability to control bladder
Prevalence
- US - 1-3% with lifetime prevalence of 5% in men and 10% in women
- Affects 15-24% of people who experience a traumatic event (Davidson et al., 2007; Breslau et al., 1998)
- Usually cooccurs with other disorders like depression andsubstance abuse
Affective disorders - Unipolar Depression
Symptoms
- Affective - sadness, inability to find joy in things once found enjoyable
- Behavioral - lacking desire to do any activities, extremely passive and idle
- Cognitive - negative thoughts, attribute failures to self, poor self-esteem, possible suicidial thoughts, hopelessness and lack of confidence in their condition improving
- Somatic - low energy levels, insomnia or hypersomnia (=sleeping all the time), lack of sex drive
Prevalence
- US - lifetime prevalence of 15% (Charney & Weismann, 1988)
- 2-3x more likely to occur in women
- 80% diagnosed will experience a subsequent episode
Eating disorders - Bulimia
Symptoms
- Affective - feelings of inadequacy, guilt, shame
- Behavioral - binge eating, vomiting after eating, laxative use, excessive exercising
- Cognitive - distorted perception of body, perfectionism
- Somatic - irregular menstrual cycle, tooth enamel erosion, gastrointestinal problems, risk of heart palpitations
Prevalence
- Affects 2-3% of women
- Roughly 5 million experience an eating disorder in US
- Some symptoms reported in up to 40% of college women in US (Keel et al., 2006)
- 5.79% for women aged 15-29 in Japan
Analyse etiologies (in terms of biological, cognitive and/or sociocultural factors) of one disorder from two of the following groups
Anxiety disorders - PTSD
Biological
- Twin research showed a potential genetic disposition (Hauff & Vaglum, 1994)
- High levels of noradrenaline cause individuals more openly and PTSD patients had above average noradrenaline levels (Geracioti, 2001)
- PTSD patients have Increased sensitivity in noradrenaline receptors (Bremner, 1998)
Cognitive
- PTSD patients believe they have no control over their lives
- Intrusive memories in the form of flashbacks occur because of cue-dependent memory
- Cues in the real world are similar to the cues of the traumatic experience which cause the same level of panic as the cues in the traumatic event (Brewin et al., 1996)
- Recovering from child abuse may be related to the patient's tendency to think the abuse was their fault - patients who did not think it was their fault were more likely to recover
Sociocultural
- People exposed to racism and oppression are more likely to develop PTSD
- Vietnam War veterans (Roysircar, 2000)
- 20.6% black developed PTSD
- 27.6% hispanic developed PTSD
- 13% white developed PTSD
- Threat of death linked to PTSD so patients should avoid situations that cause anxiety and panic (Dyregrov)
- Sarajevo, Bosnia 1998
- 73% girls had PTSD
- Higher rate linked to girls being threated with rape (Kaminer et al., 2000)
Cultural Considerations
- Non-western variants of PTSD should be treated for somatic symptoms even if atypical somatic symptoms are not in the DSM
- Non-westerners exhibit body memory symptoms
Gender Considerations
Affective disorders - Unipolar Depression
Biological
- Recent research shows too much serotonin in a different serotonin receptor subtype has been linked to depression summary (Barter et al., 2008)
Cognitive
Sociocultural
Eating disorders
Biological
Cognitive
Sociocultural
Discuss cultural and gender variations in prevalence of disorders
Implementing treatment
Examine biomedical, individual and group approaches to treatment
Biomedical
Individual
Group
Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder
Biomedical
Individual
Group
Discuss the use of eclectic approaches to treatment
Discuss the relationship between etiology and therapeutic approach in relation to one disorder
Additional Resources
