Overview – Psychopathology

Psychopathology is the study of mental disorders and conditions that are considered psychologically abnormal. Defining ‘abnormal’ is a topic in itself, with the syllabus mentioning 4 definitions of abnormality: deviation from social norms, failure to function adequately, statistical infrequency, and deviation from ideal mental health.

The A level psychology syllabus lists 3 specific mental disorders. Each of these mental disorders is approached from a different psychological viewpoint – both in terms of explanation and treatment:

• Phobias (explained from a behaviourist perspective)
• Depression (explained from a cognitive perspective)
• OCD (explained from a biological perspective)

Note that these are not the only valid psychological approaches to these disorders. For example, phobias can be treated biologically (e.g. with drugs) and OCD can be treated cognitively (e.g. cognitive behavioural therapy). These alternative approaches can be used to evaluate the approach listed in the syllabus.

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Definitions of abnormality

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The syllabus mentions 4 candidate definitions of psychological abnormality:

• Deviation from social norms
• Failure to function adequately
• Statistical infrequency
• Deviation from ideal mental health

Each of these definitions has various strengths and weaknesses, which are covered in the AO3 evaluation points below.

Deviation from social norms

Social norms are the expected rules of behaviour in society. They differ between cultures and between the same culture at different periods in time. Some typical examples of social norms include:

• Wearing clothes in public
• Saying “thank you” when someone does something for you
• Respecting people’s personal space

We can define abnormality as behaviour that deviates from these social norms. For example, going up and touching random strangers or walking around naked is abnormal.

The degree to which a behaviour is abnormal depends on how extreme the deviation is and how important the norm is. For example, not saying “thank you” might be somewhat abnormal – but it’s not dangerous, just rude. However, going up to and touching random strangers is a more extreme deviation of a more important rule and so may justify intervention from other people to stop this behaviour.

Failure to function adequately

Another definition of abnormality is failure to function adequately. This means a person is unable to navigate everyday life or behave in the necessary ways to live a ‘normal’ life. For example, failure to function adequately would prevent a person from having successful interpersonal interactions or get and keep a job.

Rosenhan and Seligman (1989) identify various features of dysfunction, including:

• Personal distress (e.g. anxiety, depression, excessive fear)
• Maladaptive behaviour (i.e. behaviour that prevents the person achieving goals)
• Irrationality
• Unpredictability
• Discomfort to others

The Global Assessment of Functioning (GAF) scale provides a way to quantify (from 0 to 100) the extent to which a mental disorder affects an individual’s ability to function adequately. A person who scores highly (e.g. 80+) will have few if any symptoms that prevent their ability to function, whereas a person with a very low score (<20) will struggle in society and may even be a danger to themself or others.

Statistical infrequency

The statistical infrequency definition of abnormality is a mathematical one. It defines abnormality as statistically rare characteristics and behaviours. The further a characteristic or behaviour is from the mathematical average, the more rare or statistically infrequent it is.

Statistical frequency can be plotted on a histogram like the one below:

The average here is indicated by 0 on the X-axis. The other figures indicate standard deviations (σ) from this average. The more a figure deviates from the average, the rarer it is.

For example, 68.2% of people – the majority – will be within 1 standard deviation of this average (34.1% above and 34.1% below). It is statistically more rare to be above or below 1 standard deviation from the average, and much rarer still to be more than 2 standard deviations from the average.

Many psychological traits and behaviours can be quantified and plotted on a graph like the one above. For example, intelligence can be quantified by IQ tests. The average IQ is 100, and most people will have an IQ within 1 standard deviation of this (i.e. between 85 and 115). An IQ above 130 or below 70 is statistically infrequent – it occurs in only around 2% of people – and so, according to this definition, would be considered psychologically abnormal.

Deviation from ideal mental health

Another definition of abnormality is deviation from ideal mental health.

But in order to understand what it means to deviate from ideal mental health, we first need to define what ideal mental health is. Jahoda (1958) identified 6 features of ideal mental health:

A positive attitude toward oneself	Being happy with who you are and having self-respect and self-esteem.
Self-actualisation	Achieving personal growth and progress, realising one’s potential.
Autonomy	Being independent, self-reliant, and able to make decisions for yourself.
Ability to resist stress	Being able to effectively deal with the challenges of life without excessive stress.
An accurate perception of reality	Being realistic and objective about oneself and the external world.
Mastery of environment	The ability to successfully navigate work, social, and other situations

Someone with ideal mental health would tick all 6 of these boxes. However, if a person fails to tick most of these boxes, or deviates significantly from one of them (e.g. they constantly hallucinate pink elephants and thus do not have an accurate perception of reality), they would be classified as abnormal according to the deviation from ideal mental health definition.

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Phobias

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A phobia is an anxiety disorder characterised by extreme and irrational fear towards a stimuli. Examples of phobias include: 

• Arachnophobia: fear of spiders
• Aerophobia: fear of flying in aeroplanes
• Agoraphobia: fear of leaving one’s house
• Social phobias, such as fear of crowds or public speaking

Characteristics of phobias

Emotional characteristics: It is natural to feel some fear in response to potential danger. But people with phobias experience extreme fear that is uncontrollable and disproportionate to the situation.

Behavioural characteristics: Screaming, crying, freezing, or running away from the feared stimuli. A phobic person will typically try to avoid the feared stimuli – for example, a person with aerophobia might stay away from airports.

Cognitive characteristics: Most people with phobias recognise that their fear is irrational and disproportionate. However, this recognition does little to reduce the fear the phobic person feels.

Behaviourist approach to phobias

There are many competing and complementary approaches to psychology, including behaviourism, the cognitive approach, and the biological approach. The syllabus focuses on the behaviourist approach to phobias, but other approaches can serve as a means to evaluate this approach.

Behaviourist explanations of phobias

The behavioural approach (behaviourism) analyses phobias based on external observations of environmental stimuli and behavioural responses (rather than e.g. the underlying thought processes). The two-process model explains how phobias are developed and maintained through behavioural conditioning.

The two-process model

The two-process model explains phobias as:

• Acquired through classical conditioning, and
• Maintained through operant conditioning.

Classical conditioning (acquisition of phobia)

An example of how a person could be conditioned to develop a phobia of dogs is as follows:

Humans naturally fear pain, and so a fear response to pain is unconditioned. But when this natural (unconditioned) response is associated with a neutral stimulus (e.g. a dog) through experience (e.g. a dog biting them), then a person can become conditioned to associate the response (fear) with the stimulus (dogs). This is an example of classical conditioning, which is based on the work of Ivan Pavlov.

An example of this humans can be found in Watson & Rayner (1920). In their experiment, an 11 month old baby – ‘Little Albert’ – was given a white rat to play with. Albert did not demonstrate a fear response towards the rat initially, but the researchers then made a loud noise which frightened Albert. This process was repeated several times, after which Albert demonstrated fear behaviour (e.g. crawling away, whimpering) when presented with the rat (and similar stimuli such as a rabbit and a fur coat) even without the loud noise.

Operant conditioning (maintenance of phobia)

Classical conditioning is outside a person’s conscious control – the conditioned response develops automatically. In contrast, operant conditioning occurs in response to behaviour, which is under a person’s control. If a person behaves in a way that produces a pleasurable outcome, then that behaviour is positively reinforced, making the person more likely to behave that way again. Similarly, if a person behaves in a way that reduces an unpleasant feeling, then that behaviour is negatively reinforced, also making them more likely to behave that way again.

Within the two-process model, this sort of operant conditioning explains how phobias are maintained. Returning to the phobia of dogs example: A person with a conditioned phobia of dogs will feel anxiety in the presence of dogs. And so, avoiding dogs (e.g. by running away from them or avoiding parks) will lessen this anxiety, which negatively reinforces these dog-avoiding behaviours. This pattern of behaviour and reward via operant conditioning reinforces and thus maintains the phobia.

Behaviourist treatment of phobias

Systematic desensitisation

One behavioural treatment for phobias is systematic desensitisation. This involves gradually increasing exposure to the feared stimuli until it no longer induces anxiety. For example, someone with a fear of spiders (arachnophobia) may initially be asked to imagine spiders and guided through relaxation strategies until they can stay calm. Then, the process may be repeated with pictures of spiders, then real-life spiders in cages, and then repeated again with the subject actually holding a spider.

Systematic desensitisation is another example of classical conditioning: the subject is conditioned to associate the object with relaxation instead of anxiety.

An example of successful treatment of phobia using systematic desensitisation is described in Jones (1924). A 2 year old boy – Peter – had a phobia of white rats and similar stimuli. Jones was able to remove Peter’s phobia over several sessions with him by progressively increasing his exposure to a white rabbit.

Flooding

Another behavioural approach to treating phobias is flooding. Whereas systematic desensitisation increases exposure step-by-step, flooding involves exposing the subject to the most extreme scenarios straight away. For example, returning to arachnophobia, the subject would be placed in direct contact with spiders until their anxiety response subsides.

The idea behind flooding is that extreme anxiety cannot be maintained indefinitely. Eventually, the fear subsides and, in theory, the phobia.

An example of successful treatment of phobia using flooding is described in Wolpe (1969). A girl with a phobia of cars was driven around in a car for four hours until she calmed down and her phobia disappeared.

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Depression

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Depression is a mood disorder characterised by feelings of low mood, loss of motivation, and inability to feel pleasure.

There are two kinds of depression: unipolar and bipolar. Bipolar depression (sometimes called manic depression) is characterised by the descriptions below + occasional manic symptoms whereas unipolar depression is characterised by these symptoms only with no manic episodes.

Characteristics of depression

Emotional characteristics: People with depression experience persistent feelings of sadness and hopelessness. This low mood may come and go in cycles lasting months or years. Depression is also typically accompanied by feelings of worthlessness and a lack of enthusiasm.

Behavioural characteristics: Low energy, reduced activity, and reduced social interaction. Depressed people may also have irregular sleep patterns (either sleeping too much or too little (insomnia)) and gain or lose weight from over- or under-eating.

Cognitive characteristics: Depressed people may have exaggerated or delusional negative thoughts about themselves and what people think of them. They may have difficulty concentrating and remembering things. A depressed person may also regularly think about death and suicide.

Cognitive approach to depression

There are many competing and complementary approaches to psychology, including behaviourism, the cognitive approach, and the biological approach. The syllabus focuses on the cognitive approach to depression, but other approaches can serve as a means to evaluate this approach.

Cognitive explanations of depression

The cognitive approach analyses depression in terms of irrational and undesirable thoughts and thought processes (rather than e.g. the behaviours that result from these thought processes). The syllabus lists two cognitive explanations of depression: Beck’s negative triad and Ellis’ ABC model.

Example question: Discuss cognitive explanations of depression. [16 marks]

Beck’s negative triad

Beck (1979) argues that depression is characterised by a negative triad of beliefs about the self, the world, and the future:

He argues that this negative triad results from and is maintained by two cognitive processes:

• Negative schema
• Cognitive biases

Schema are patterns of thought – shortcuts/generalisations/frameworks – that are learned from experience to help make sense of the world and categorise information. Beck argued that experiences in childhood, such as criticism or failure to meet expectations, can cause depression-prone individuals to develop negative schema (i.e. a negative lens through which the individual views themself and the world). For example, experiences of failure in childhood may lead an individual to develop an ineptness schema whereby they constantly expect to fail.

These negative schema are caused by and amplify cognitive biases. Biases are systematic deviations from an accurate perception of reality in favour of some less accurate interpretation. For example, a person who loses a game of chance may falsely interpret this as proof that he is simply an unlucky person.

Together, these negative schema and cognitive biases maintain a negative triad of depressive beliefs about the self, the world, and the future.

Ellis’ ABC model

Ellis (1962) argued that depression results from irrational interpretation of negative events, rather than the negative events themselves. He explains this process using the ABC model of activating event, belief, and consequence.

According to Ellis, we all have assumptions and beliefs (think schema) about ourselves and the world. With depressed people, though, these beliefs are often irrational and this leads them to interpret events (activating events) in an unrealistic way that causes a negative emotional reaction (consequence).

Again, it is not the activating event itself that causes the negative emotional consequence, but the irrational belief through which the activating event is interpreted.

Cognitive treatment of depression

Cognitive behavioural therapy (CBT)

The cognitive approach sees depression as caused by negative, irrational, and maladaptive thought patterns. Cognitive behavioural therapy (CBT) seeks to treat depression by identifying these depressed thought patterns and replacing them with alternate ones.

CBT therapists help patients to identify depressed thought patterns. The therapist may then encourage the patient to question these depressed thought patterns and recognise them as unhelpful and not representative of reality. The patient is then encouraged to replace these irrational and unhelpful thoughts with more accurate and helpful thoughts. Replacing the depressed thoughts with more helpful thoughts affects the patient’s mood, which in turn affects the patient’s behaviour.

There is often also a behavioural component to CBT. For example, therapy may involve scheduled activities, keeping a diary of thoughts, etc.

Albert Ellis developed a form of CBT based on his ABC model, known as rational emotive behaviour therapy (REBT).

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Obsessive-compulsive disorder

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Obsessive-compulsive disorder (OCD) is an anxiety disorder characterised by continuous and repeated undesirable thoughts (obsessions) and uncontrollable behaviours and rituals in response to these thoughts (compulsions).

For example, a person may have an obsessive fixation on germs, which leads them to constantly worry that everything is unclean and dirty. These thoughts may lead to compulsive hand-washing behaviour and rituals as the individual tries to alleviate these obsessive worries.

Characteristics of OCD

Emotional characteristics: High levels of anxiety and stress in response to obsessive thoughts and inability to control compulsive behaviours.

Behavioural characteristics: Continuous repetition of rituals and behaviours in response to obsessive thoughts. Both the obsessive thoughts and the compulsive behaviours get in the way of everyday functioning, disrupting normal activities such as work and social interaction.

Cognitive characteristics: OCD sufferers will continually repeat thoughts to do with their obsession and cognitive biases mean they have difficulty focusing on anything else. Many OCD sufferers are aware their obsessive thoughts are inappropriate and exaggerated but are unable to control them.

Biological approach to OCD

There are many competing and complementary approaches to psychology, including behaviourism, the cognitive approach, and the biological approach. The syllabus focuses on the biological approach to OCD, but other approaches can serve as a means to evaluate this approach.

Biological explanations of OCD

Biological approaches analyse OCD in physiological terms, i.e. as a result of abnormal biological processes. The syllabus lists two different biological explanations of OCD: genetics and neural problems.

The genetic explanation of OCD

Genes are inherited biologically from parents. There is evidence that genes contribute to the development of OCD.

For example, twin studies suggest a genetic component to OCD. Grootheest et al (2005) conducted a review of more than 70 years of studies on twins and OCD using various methods. One of these methods compared the rates of OCD between identical twins and between non-identical twins. The researchers found it was far more likely for both identical twins to have OCD than for both non-identical twins to have OCD. This supports a genetic role in OCD: Identical twins have identical genetics and so if there is a genetic component to OCD it would make sense that both twins would be similarly prone to developing OCD. With non-identical twins, the different genes could explain why one twin was more likely to develop OCD than the other.

Other studies have used gene mapping to identify correlations between certain genes and OCD. For example, Davis et al (2013) compared the genetic profiles of 1500 OCD sufferers with 5500 non-OCD controls. The researchers’ method (genome-wide complex trait analysis) looked for traits across the entire genome (rather than looking for individual genes) and found the OCD sufferers often shared similar genetic elements that were not present in the non-OCD controls.

The neural explanation of OCD

Another biological mechanism for OCD is neural (i.e. brain and nervous system) abnormalities. These abnormalities may be structural and/or neurochemical.

Brain structures

Brain scans consistently show that OCD sufferers have increased activity in the orbital frontal cortex area of the brain (e.g. Saxena and Rauch (2000)). The orbital frontal cortex is sometimes called the ‘worry circuit’ and is responsible for high-level decision making and thinking (as opposed to low-level primal instincts). When you have an impulse (e.g. to wash your hands when they are dirty), the orbital frontal cortex translates that impulse into action (e.g. washing your hands), and performing that action reduces the impulse. However, with OCD sufferers, it may be that the overactivity of the orbital frontal cortex means these impulses continue even after performing the behaviour, becoming obsessions and compulsions.

Other studies implicate hyperactivity of the basal ganglia in OCD (e.g. Max et al (1995)).

Neurochemistry

Another possible neural explanation of OCD is neurochemistry. For example, several studies (e.g. Hu et al (2006)) suggest that OCD sufferers have lower levels of the neurotransmitter serotonin compared to controls. Some brain scans also suggest OCD sufferers have higher dopamine levels than healthy controls.

Biological treatment of OCD

Biological treatment of OCD aims to address the biological mechanisms that cause OCD. The most common biological treatment for OCD is drug therapy.

The most common drugs prescribed for OCD are selective serotonin reuptake inhibitors (SSRIs) such as Prozac. SSRIs are also known as antidepressants. SSRIs work by increasing serotonin levels, which often reduces obsessive thoughts and compulsive behaviours to a level that allows the patient to live a more normal life. The effectiveness of SSRIs fits with the neural explanation of OCD that OCD is caused (at least in part) by low serotonin.

If OCD symptoms do not improve with SSRIs, a doctor may also prescribe antipsychotic drugs such as risperidone. One mechanism of risperidone is to reduce dopamine activity, which supports the neural explanation that high dopamine contributes to OCD.

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