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Psychopathology - Coggle Diagram

- - - - Doesn't Always Fit
        
        There are many highly functioning psychopaths such as Harold Shipman
        
        These people appear completely normal but engage in psychopathic behaviour
      - Individualistic
        
        People that know the individual's regular behaviour are often questioned
        
        Therefore, this definition matches the individual nature of each disorder
        
        This definition has been used in diagnosis with different disorders
      - Role of Context
        
        Most people fail to function adequately at some point but aren't considered abnormal
        
        After bereavement, most people find it difficult to cope normally and they may be considered more abnormal if they functioned as usual
  - - - Difficulty of Self-actualising
        
        It can be hard to know what our full potential actually is
        
        Very few people achieve their full potential
      - Possible Benefits of Stress
        
        Some people actually work more efficiently in stressful situations/under pressure
      - Too High
        
        Few people actually meet this criteria that everyone ends up classes as abnormal so the concept is meaningless
        
        Jahoda's and others' criteria set the bar too high
      - Cultural Limitations
        
        Jahoda's ideas are based on Western ideas of self-fulfilment and individuality
        
        In the East, women aren't permitted to self-actualise
        
        What is considered ideal is historically and culturally specific
    - - Personal autonomy
      - Accurate perception of reality
      - Resistance to stress
      - Adapting to and mastering the environment
      - Self-actualisation of potential
      - Positive attitude towards the self
  - - - The Role of Context
        
        Most of our social norms change according to context
      - Changing with the Times
        
        Social norms change throughout time
      - Eccentric vs Abnormal
        
        Some people that defy norms may just be eccentric, not suffering from a disorder
  - - - Not Always True
        
        Sometimes statistically infrequent behaviour is desirable
        
        Sometimes statistically frequent behaviour is undesirable
      - Subjectivity
        
        The cut-off point for 'statistical infrequency; is subjective
      - Real Life Application
        
        Doctors actually use aspects of statistics in assess whether someone is suffering from a disorder or not
        
        Intellectual Disability Disorder
- - - - Can be used to show OCD's biological roots as MZ twins share 100% same genes and DZ only 50%
      - Comparing concordance rates can separate the effects of nurture and nature
        
        If rates are higher in MZ, this extra likeness should be due to genetics as MZ and DZ twins share the same environment
        
        Higher the concordance rates, the stronger the evidence for biology
    - - Genes involved with dopamine transportation have also been identified as potential causes (COMT gene which regulates dopamine production)
      - AO3
        
        Taylor (2013)
        
        Carried out a meta-analysis and discovered 230 genes which could be implicated in the development of OCD
        
        Psychologists believe OCD could be aetiologically heterogenous
      - SERT gene (5-HTT)
        
        Determines how effective serotonin transportation will be around the brain
        
        Carrying the SERT gene causes a disruption to serotonin transportation and therefore OCD
    - - Inconclusive
        
        Could be just copying or learning beahviour
        
        Concordance rates between twins are never conclusive so the diathesis stress model could be the most valid
        
        Very difficult to separate effects of nature and nurutre when people grow up in the same household
      - Alternative explanation
        
        Abundance of evidence to suggest that many OCD sufferers have a traumatic event in their past
        
        Some psychologists believe that nurture is more important than nature
      - Support from family studies
        
        Nestadt (2010) meta-analysis found 68% of MZ twins shared OCD compared to 31% of DZ
        
        Other family studies show that people with a first degree relative with OCD have a 5x greater chance at developing OCD
      - Real-life application
        
        If drugs that increase serotonin transportation cure OCD symptoms, the theory must be valid
        
        Hundreds of supporting studies have been published, lending validity to the theory
        
        The fact that antidepressants can be used to drastically reduce OCD symptoms gives validity to the neural explanation
    - - Serotonin
        
        If serotonin levels are disrupted, messages involving mood aren't reaching the right parts of brain
        
        Could cause a disturbance in cognition, emotions and behaviour
        
        A neurotransmitter believed to help regulate mood
      - Dysfunction of brain areas
        
        Frontal lobe
        
        This takes place in the frontal lobe
        
        Hoarding OCD seems to involve impaired decision making
        
        There is research suggesting that the lateral parts of the frontal lobe function abnormally in OCD patients compared to controls
        
        Parahippocampal gyrus
        
        Evidence suggests that the left parahippocampal gyrus (associated with processing unpleasant emotions) functions abnormally in patients with OCD
  - - - If SSRIs have been taken long term with no benefits, then two alternative drugs can be tried
        
        Tricyclics (older type) which have severe side effects
        
        SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors) new in last 5 years
    - - Cost Effective
        
        Drugs are much more cost effective than therapy
        
        Using drugs is therefore beneficial to the NHS
      - Issues with drugs
        
        Tolerance
        
        Patients begin to need a higher dose for the drug to have the same effect
        
        Addiction
        
        Whether that be psychological or physical
        
        Side Effects
        
        SSRIs - indigestion and blurred vision
        
        Tricyclics - weight gain, tremors, increased risk of suicide
      - Combining Treatments
        
        The best combination appears to be CBT and SSRIs
        
        We are tackling both biological and psychological components, which is always likely to be more effective
        
        Research shows that the most effective way of treating OCD is to use psychological and biological treatments
      - What if biology isn't the cause
        
        However, for some people, research has shown that, they have developed OCD due to trauma, so this won't be an effective treatment
        
        It will never get the root of the problem, only mask it by treating the symptoms not the cause
        
        Using drugs to treat OCD is going to be effective if biology is the root of each individual's disorder
      - Effective
        
        Research uses randomised controlled trials with ptps randomly allocated either SSRI or placebo
        
        Soomro (2009) reviewed 17 studies and found that SSRIs were more effective than placebos at curing OCD
        
        SSRIs have a huge body of reserach backing their efficacy
    - - When serotonin travels from one neuron to another it travels via a synapse
        
        In OCD patients, something is malfunctioning in this system
        
        Serotonin is released from the presynaptic neuron, travels via the synapse an is then absorbed via the postsynaptic neuron
      - SSRIs stop the reuptake of serotonin by the presynaptic neuron and its breakdown, allowing more to flow through the synapse and be absorbed by the postsynaptic neuron
      - Type of antidepressant
      - Dosage varies according to the type of SSRIs
        
        Fluoxetine is the most common - 20mg typical starting dose
      - Selective Serotonin Reuptake Inhibitors
      - It usually takes at least 6 weeks before a change in symptoms is noticed
  - - - Depression
      - Guilt/disgust
      - Anxiety/distress
    - - Hypervigilance
      - Awareness their thoughts & behaviours are excessive and unreasonable
      - Obsessive thoughts
    - - Compulsion
        
        Repetitive
        
        Sufferers feel they must repeat the same behaviours
        
        Reduce anxiety
        
        Carrying out compulsions relieves anxiety so is negatively reinforcing
      - Avoidance
        
        Sufferers tend to try to manage their condition by avoiding the source of their anxiety
- - - - A schema is like a packet of information that is unique to use
      - Self-Schemas
        
        The types of schemas psychologists think cause abnormality
        
        Beck believes negative self-schemas lead to depression
        
        Beliefs we have about ourselves
        
        Negative self-schemas are difficult to change but therapy can make this possible
      - Our belief systems about the world
    - - Causes a negative view of the future
      - Causes a negative view of the world
      - Found that negative views of self lead to a chain of further negative thoughts which cause depression
    - - All or nothing thinking
        
        Example - really smart or really stupid
      - Catastrophizing
        
        Blowing everything out of proportion
      - These biases prevent the person from focusing on the positive side of life and so reinforce their negative views/depression
      - Ellis' ABC Model
        
        Suggested an Activating event is affecting an individual's Beliefs which results in a Consequence
        
        Contributes to depression
        
        Used the ABC model to explain how irrational thoughts affect our behaviour and emotional state
      - Negative thoughts which are unconscious and rapid responses to certain sitatuions
    - - Direction of causality
        
        Depression could lead to negative thinking rather than the other way around
      - Terry (2000)
        
        Assessed 65 pregnant women before they gave birth to find out how vulnerable they were to negative thinking
        
        Those that developed PND were the ones labelled as vulnerable
      - Could make it worse
        
        The individual is seen as being responsible for their behaviour/problems
        
        This could increase suicidal thoughts and make depression worse
      - Development of CBT
        
        The approach has developed an effective treatment, CBT
        
        CBT is used internationally and is the most successful treatment in managing depression
        
        CBT can be provided by the NHS for free and is available to everyone via referral by your GP
      - Schemas are vague
        
        We cannot test for them scientifically
        
        A weakness as the concepts of psychology should be testable
        
        Idea of schemas is vague and unclear about how irrational thoguths should be defined and measured
  - - - Characteristics
        
        A collaborative effort between therapist and client
        
        Client role - define goals, express concerns, learn and implement learning
        
        Therapist role - help client define goals, listen, teach and encourage
        
        Teaches the benefit of remaining clam or neutral when faced with difficult situations
        
        Emphasis placed on current behaviour
        
        Based on rational thought
        
        Brief and time limited
        
        Average of 6 sessions
      - Homework
        
        Can include multiple diff. activities
        
        Practical exercises
        
        Journalling
        
        Reading
        
        Thought-stopping
        
        Therapy sessions are training sessions, between each sessions the client tries out and uses what they've learnt
        
        The most important strategy in CBT
      - Main goals
        
        Negative views of self are the root of all depression (Beck) therefore CBT primarily sets out to increase self esteem
        
        Irrational and automatic thoughts are also key in causing depression so CBT seeks to change the way people think - helping you think rationally and have more control over cognition
    - - Alternative for success rate
        
        Success rates may not be useful comparisons because it may be due to the relationship not the therapy itself
        
        It doesn't matter what therapy you have if you get along with your therapist
        
        All talking therapies have a relationship between patient and therapist
      - Ignoring the past
        
        It doesn't look into the client's past
        
        This is problematic if the client feels the problem relies in their past
      - Not consistently suitable
        
        Patients need to be motivated to get better
        
        Those with no motivation and no longer care whether they recover won't benefit from CBT
        
        CBT cannot be used to treat all patients
      - Overemphasis on cognition
        
        The assumption that changing thoughts will cure depression may be wrong
        
        A patient living in poverty or abuse needs to change their circumstances not their thoughts
      - Research support
        
        It is offered free on the NHS and is the most widely used therapy internationally
        
        March (2007) compared success rates of treatments for CBT and found that CBT was as successful as antidepressants (81%)
        
        Abundance of research support that shows CBT is the most effective psychological treatment for depression
  - - - Lowered self-esteem
      - Anger
      - Persistent lowered mood/sadness, despair, emptiness
    - - Pessimism
      - Absolutist thinking
      - Poor concentration and decision making
      - Suicidal thoughts
    - - Disruption to sleep and eating behaviour
        
        Hypersomnia
        
        Appetite loss
        
        Insomnia
        
        Appetite gain
      - Aggression and self harm
        
        Can become verbally and physically aggressive
        
        Aggression against the self in form of self harm or attempted suicide
        
        Sufferers often become irritable
      - Activity levels
        
        Diminished enjoyment in activities
        
        Causes social withdrawal
        
        The individual may feel very lethargic
        
        Affects attendance at work or school
- - - - Fears are acquired when an individual associates a neutral stimulus, such as a cat, with a fear response
      - From this point onwards, the individual associates all cats with the fear/pain they felt in the situation and a phobia emerges
    - - So avoiding cats makes the person feel much better, relieving their fear and anxiety
      - This behaviour has become positively reinforcing and operant conditioning has occurred
      - Avoiding the phobic stimulus is reinforcing and rewarding because it greatly relieves anxiety
    - - Diathesis Stress Model
        
        The idea that we may be born with a biological predisposition to make us more susceptible to developing a phobia but its depends whether experiences in our environment bring it out
        
        This is an interactionist approach - both nature and nurture contribute to our psychology
      - Alternative Evidence
        
        Evidence from studies using brain scanning techniques that phobias could be purely cause by our biology - specifically being investigated is too much blood flowing through the amygdala
        
        Explains why not everyone who experiences a traumatic event goes on to acquire a phobia through classical conditioning
      - Munjack (1984)
        
        Investigated people with driving phobia
        
        Found that only half the ppts had actually experienced a car accident
        
        Refuted this theory
        
        More importantly, in the control group, half the people had experienced a serious car accident
      - Biological Preparedness
        
        We have evolved specifically to be afraid of certain things because they could have posed a serious threat to our ancestors
        
        Could explain why phobias don't always develop after a traumatic incident
        
        An evolutionary explanation of phobias that state that all phobias are linked to our evolutionary past
        
        Only 'prepared' fears which posed a threat to our ancestors have the potential to be learned
      - Watson and Rayner (1920)
        
        Albert showed no fear when exposed to white fluffy objects
        
        Albert showed fear when an iron bar was struck loudly behind his head (unconditioned stimulus causing unconditioned response)
        
        They worked with an 11 month old baby called Little Albert
        
        These white fluffy objects were repeatedly paired with the clanging of the bar
        
        Sought to provide experimental evidence that fear could be learnt this way
        
        Albert soon showed great fear to the fluffy objects when presented alone (conditioned stimuli now causing a conditioned response)
        
        Watson had induced a phobia in Albert via classical conditioning
      - The behavioural explanation isn't sufficient on its own to explain how phobias develop
  - - - AO1
        
        Process
        
        Relaxation techniques are taught and practised rigorously at every stage
        
        Relaxation techniques include visualisation, breathing exercises, progressive muscle relaxation
        
        Therapist helps the individual progress through a hierarchy of anxiety provoking situations - starting with those that arouse least anxiety and building to those that provoke the most anxiety
        
        Treatment ends when the client is desensitised
        
        In vivo - real life
        
        This is done by re-teaching the individual to associate the feared object with feelings of being relaxed
        
        In vitro - imagination
        
        The aim is to replace anxiety with relaxation
        
        The idea is that 2 incompatible emotional states can't exist at the same time
      - AO3
        
        Combining Treatments
        
        Research shows that combining SD with CBT/drug treatment is effective
        
        Burke et al found SD and medication was the best treatment for agoraphobia
        
        Psychodynamic
        
        Claim that SD isn't successful because it never tackles the underlying cause
        
        Successful
        
        For people with an injection phobia, research shows SD can relieve it in 90% of cases
        
        Agoraphobia is one of the hardest to treat but meta-analyses have found 60-80% success rates
        
        The success rate has been found in meta-analyses to be 75%
        
        Unfortunately, research shows that relapses are common
        
        SD is one of the most successful treatments to be developed
        
        Evolutionary
        
        You cannot cure phobias with an evolutionary/genetic basis through these methods
    - - AO1
        
        Based on the biological fact that our bodies eventually get exhausted, the stress response has to stop because adrenaline runs out
        
        Process
        
        Client is placed alone in the phobic situation
        
        Client remains there until anxiety decreases (around 1hr)
        
        Emotional exhaustion sets in when the client realises they are safe and nothing bad has happened to them
        
        Client no longer has the phobia after this realisation
        
        The individual is exposed to the feared object in an intense non-graded way
      - AO3
        
        Speed + Cost
        
        Many clients and health providers prefer it
        
        Saves money
        
        One strength is that it's a quick treatment as it only takes one session
        
        Curtis (1976)
        
        Reports 12 patients successfully cured using flooding in London
        
        The patients had either snake, bird, spiders or wasp/bee phobias
        
        Dangerous
        
        During in vitro, clients can suffer high blood pressure that puts them at risk of a heart attack due to stress
        
        Medical supervision is required
        
        In vivo techniques are dangerous and the ethics are questionnable
  - - - A marked and persistent fear/anxiety that is excessive and unreasonable
    - - This avoidance can significantly impact upon the individual's life
      - A panic reaction is experienced when the individual encounters the feared object or situation
      - Phobic object or situation is excessively avoided
    - - Agoraphobia
        
        Fear of being trapped in a public place where escape may be difficult
      - Social Phobia
        
        Extreme shyness
        
        Extreme fear of social situations
        
        Panic attacks
      - Specific Phobia
        
        Of an object or situation e.g. spiders, flying, injections
        
        Most common
    - - Selective attention is given to the feared object and we are hyper alert to its presence
      - Awareness that the fear is irrational
      - Irrational thought is at the root of all phobias