ABNORMAL PSYCHOLOGY:

SEVEN CRITERIA OF „ABNORMAL BEHAVIOUR” (Rosenhan and Seligmann, 1984)

1. Suffering – experiencing distress and discomfort

2. Maladaptiveness – engaging in behaviors that make life difficult
3. Irrationality – being incomprehensible or unable to communicate in a reasonable
manner
4. Unpredictability – acting in a ways that are unexpected
5. Vividness and unconventionality – experiencing things that are different from most
people
6. Observer discomfort – acting in a way that is difficult to watch or that makes other
people embarrassed
7. Violation of moral or ideal standards – habitual breaking of the accepted ethical and
moral standards of the culture

CHARACTERISTICS OF NORMAL PEOPLE (Jahoda, 1958)

1. Efficient self-perception
2. Realistic self-esteem and acceptance
3. Voluntary control of behavior
4. True perception of the world
5. Sustaining relationships and giving affection
6. Self-direction and productivity

LIMITATIONS TO THE INTERVIEW PROCESS (Kleinmutz, 1967)

1. Information exchange may be blocked if either the patient or the clinician fails to
respect the other, or if the other is not feeling well.
2. Intense anxiety of preoccupation on the part of the patient may affect the process.
3. A clinician’s unique style, degree of experience, and the theoretical orientation will
definitely affect the interview.
METHODS USED TO ASSIST WITH DIAGNOSIS:
• Direct observation of the individual’s behavior
• Brain-scanning techniques such as CAT and PET (especially in cases such as
schizophrenia or Alzheimer’s disease)
• Psychological testing, including personality tests (e.g. MMPI-2) and IQ tests (e.g.
WAIS-R).

Beck et al. (1962) found that agreement on diagnosis for 153 patients between two
psychiatrists was only 54%. Cooper et al. (1972) found that New York psychiatrists were
twice as likely to diagnose schizophrenia than London psychiatrists, who in turn were twice as
likely to diagnose mania or depression.

SEVERAL TYPES OF BIAS THAT MAYAFFECT THE VALIDITY OF A DIAGNOSIS:

1. Racial/ethnic
2. Confirmation bias (“if the patient is there in the first place, there must be some
disorder to diagnose”)  results in institutionalization
a. Powerlessness and depersonalization as a consequence of a institutionalization
3. Cultural considerations in diagnosis
a. Culture-bound syndromes (e.g. neurasthenia is listed only in the second
edition of the Chinese Classification of Mental Disorders (CCMD-2) but in
DSM-IV it would meet criteria for a combination of a mood disorder and an
anxiety disorder under DSM-IV)
b. Syndromes of depression appear to be affective in individualistic societies and
somatic in collectivist societies. (Marsella, 2003)
c. Cultural blindness – Cochrane and Sashidharan (1995) point out that it is
commonly assumed that the behaviors of the white population are normative

How can psychologists avoid cultural bias influencing diagnosis?

• They should learn about the culture of the patient being assessed.
• Evaluation of bilingual patients should be undertaken in both languages.
• Symptoms should be discussed with local practitioners.
 DEPRESSION

SYMPTOMS
1. Affective:
• Feelings of guilt and sadness
• Lack of enjoyment or pleasure in familiar activities or company
2. Behavioral
• Passivity
• Lack of initiative
3. Cognitive
• Frequent negative thoughts
• Faulty attribution of blame
• Low self-esteem
• Suicidal thoughts
• Irrational hopelessness
• Difficulties in concentration
• Inability to make decisions
4. Somatic
• Loss of energy
• Insomnia or hypersomnia
• Weight loss/gain
• Diminished libido

Major depressive disorder can be diagnosed when an individual experiences two weeks of
either a depressed mood or a loss of interest and pleasure. In addition, the diagnosis requires
the presence of at least four additional symptoms, such as insomnia, appetite disturbances,
loss of energy, feelings of worthlessness, thoughts of suicide, or difficulty concentraiting.

Depression affect around 15% of people at some time in their life (Charney and Weismann,
1988)
STUDIES ON DEPRESSION:

Nurnberger and Gershon (1982) in their twin studies found that the concordance rate for
major depressive disorder was consistently higher for MZ twins than for DZ twins. The fact
that the concordance rate for MZ twins is far below 100% indicates that depression might be
the result of a genetic predisposition – also called vulnerability.

Duenwald (2003) has recently suggested that a short variant of 5-HTT gene may be associated
with a higher risk of depression. This gene plays a role in the serotonin pathways which
scientists think are involved in controlling mood, emotions, sleep, aggression and anxiety.

Catecholamine hypothesis – Joseph Schildkraut in 1965. According to this theory, depression

is connected with low levels of noradrenaline. This further developed into ‘the serotonin
hypothesis’ – the idea that the serotonin is the neurotransmitter responsible.
Janowsky et al. (1972) demonstrated this in an experiment in which participants who were
given a drug called physostigmine (lowers levels of noradrenalin) became profoundly
depressed and experienced feelings of self-hate and suicidal wishes within minutes of having
taken the drug.
The fact that a depressed mood can be artificially induced by certain drugs suggests a that
some cases of depression might stem from a disturbance in neurotransmission.

Rampello et al. (2000) found that sufferers from depression have an imbalance of several
neurotransmitters, including noradrenaline, serotonin, dopamine and acetylcholine.

Ellis (1962): Cognitive style theory  psychological disturbances often come from irrational
and illogical thinking.

Beck’s (1976): theory of depression based on cognitive distortions and biases in information
processing: (according to Beck those are activated by stressful events)
• Overgeneralization based on negative events
• Non-logical inference about the self
• Black-and-white thinking
• Selective recall of negative consequences
BROWN’S VULNERABILITY MODEL OF DEPRESSION BASED ON A NUMBER OF
FACTORS THAT COULD INCREASE THE LIKELIHOOD OF DEPRESSION (1978):
1. lacking employment away from home
2. absence of social support
3. having several young children at home
4. loss of mother at an early age
5. history of childhood abuse

Diathesis-stress model – depression may be the result of a hereditary predisposition, with

precipitating events in the environment.

Prince (1968) found that rates of reported depression in Asia and Africa rose with
westernization in the former colonial countries.

Williams and Hargreaves 1995: women are naturally more emotional than men and therefore
more vulnerable to emotional upsets because of hormonal fluctuations.
 BULIMIA NERVOSA

SYMPTOMS
5. Affective:
• Feelings of inadequacy, guilt or shame
6. Behavioral
• Recurrent episodes of binge eating
• Use of vomiting, laxatives, exercise, or dieting to control weight.
7. Cognitive
• Negative self-image
• Tendency to perceive events as more stressful than most people would
• perfectionism
8. Somatic
• Swollen salivary glands
• Erosion of tooth enamel
• Stomach or intestinal problems
• Heart problems

BIOLOGICAL LEVEL OF ANALYSIS:

 Kendler et al. (1991) found concordance rate of 23% in MZ twins and 9% in DZ

twins.

 Strober (2000) has found that first-degree relatives of women with bulimia nervosa
are 10 times more likely than average to develop the disorder.

 Increased serotonin levels stimulate the medial hypothalamus and decrease food
intake. Carraso (2000) found lower levels of serotonin in bulimic patients.
COGNITIVE LEVEL OF ANALYSIS:

 Brunch (1962) suggested the body-image distortion hypothesis, which claims that
many eating disorder patients overestimate their body size.
 Fallon and Rozin (1985) found that girls wrongly believe that they would be more
attractive to the opposite sex if they were thinner. Study carried out on US
undergraduates who were asked to comment on the pictures of the body-shapes given.
 Polivy and Herman suggested the role of cognitive disinhibition – an all-or-nothing
approach to judging oneself. Either you’re perfect or you’re a failure.
o Polivy and Herman (1985) experiment with ice-cream given after drinking a
chocolate milkshake. Dieters ate significantly more than non-dieters.

SOCIOCULTURAL LEVEL OF ANALYSIS

 Jaeger et al. (2002), 1751 medical and nursing students were sampled across 12
nations including western and non-western countries. This was a natural experiment,
as the independent variable (culture) could not be controlled by the experimenter. A
self-report method was used to obtain data on body dissatisfaction, self-esteem and
dieting behavior. The significant differences between cultures support the explanation
that bulimia is due to the “idealized” body images portrayed in the media, which
encourage distorted views and, consequently, body dissatisfaction and dieting
behavior.
 IMPLEMENTING TREATMENT

An eclectic approach to therapy – an approach that incorporates principles or techniques

from various systems or theories.

Klerman et al., 1994: A combination of psychotherapy (cognitive or interpersonal) and drugs

is moderately more successful than either psychotherapy or drugs alone.

TREATMENT OF DEPRESSION
BIOMEDICAL APPROACH
 Selective serotonin re-uptakes inhibitors (SSRIs) which increase the level of available
serotonin. (The most common SSRI is fluoxetine a.k.a. Prozac)
 Kirsch and Sapirstein (1998) found that antidepressants were only 25% more effective
than placebos.
 Blumenthal et al. (1999) found that exercise was just as effective as SSRIs in treating
depression
 Elkin et al. (1989) – one of the best controlled outcome studies in depression,
conducted by the National Institute of Mental Health. This study included 28
clinicians who worked with 280 patients diagnosed as having major depression.
Individuals were randomly assigned to treatment using either an antidepressant drug,
interpersonal therapy (IPT) or cognitive-behavioral therapy (CBT). In addition, the
control group was given a placebo pill together with weekly therapy sessions. The
results showed that just over 50% of patients recovered of the CBT and IPT groups, as
well as in the drug group. Only 29% recovered from the placebo group. The study
showed that it does not matter which treatment patients received, all the treatments
had the same result.

INDIVIDUAL APPROACH

Cognitive psychologists suggest that replacing negative cognitions by more realistic and
positive ones can help the depressed person.
Aaron Beck’s COGNITIVE RESTRUCTURING (core to many cognitive therapies):
• Identify negative, self-critical thoughts that occur automatically
• Note the connection between negative thought and depression
• Examine each negative thought and decide whether it can be supported
• Replace distorted negative thoughts with realistic interpretations of each situation

COGNITIVE-BEHAVIORAL THERAPY (CBT)

CBT focuses on current issues and symptoms. Typically, there are around 12-20 weekly
sessions, combined with daily practice exercises specifically designed to help the client to use
new skills on a day-to-day basis. The client is encouraged to find out which thoughts are
associated with depressed feelings and to correct them (while using cognitive restructuring).

Beck’s patterns of faulty thinking (they should be get ridden of):

1. Arbitrary inference – drawing wrong conclusions about oneself by making invalid
connections (e.g. when it rains on the day that you have organized a picnic, you think
that only you have bad luck and that the world is against you)
2. Selective abstraction – drawing conclusions by focusing on a single part of a whole –
for example focusing on a single bad grade and ignoring the fact that you are actually
an A-student
3. Overgeneralization – applying a single incident to all similar incidents (e.g. if you
have a relationship problem with a friend, you reckon that you’re unsuccessful in
relationships and have no true friends)
4. Exaggeration – overestimating the significance of negative events
5. Personalization – assuming that others’ behavior is done with the intention of hurting
you
6. Black-or-white thinking (“you either love me or you hate me”)

AIMS OF CBT:
• Help the client to change faulty thinking patterns and underlying schemas
• Help the client to develop coping strategies and problem solving skills, and to
engage in behavioral activation.
According to Teasdale (1997), the important feature in cognitive therapy may be to teach the
client meta-awareness. That is the ability to think about one’s own thoughts.

Dobson, 1989, found that CBT is superior to no treatment or to a placebo.

GROUP THERAPIES
• “couples’ therapy”
o Jacobsen et al. (1989) have found that this form of group therapy is as effective
as other forms treating the symptoms of depression, but is more effective in
improving the quality of the martial relationship.

Factors to consider in group therapy:

• No one should be different from the rest
• Are there any characteristics that should be excluded from the group?
• People must trust that they can speak freely in a group
• Group mist recognize the fact that the therapist is not “one of us”
 TREATMENT OF BULIMIA

 BIOMEDICAL APPROACH - Since people who suffer from bulimia often suffer also
from depression, SSRIs are used
o McGilley and Pryor (1998) – a study with 382 patients conducted by a
collaborative study group found reduction of vomiting in 29% of those
receiving Prozac compared to 5% in those given placebo.
 CBT addresses cognitive aspects of bulimia such as:
o Obsession with body weight
o Black-or-white thinking
o Negative self-image
o Behavioral components of the disease such as binge eating and vomiting.
Its aim is to restore some control of eating. Wilson (1996) found that 50% of the
patients who receive CBT stop binge eating and purging.
 GROUP THERAPY
o McKisack et al. (1997) found that group therapy is relatively effective
especially if it consisted of individuals who have been matched on certain
characteristics.
o Schmidt et al. (2007) found that CBT and family therapy are both effective in
the same way.

CONCERNS ABOUT GROUP THERAPY

• Patients may get negative ideas from each other
• The group may adopt a pessimistic attitude towards improvement
• The group might arrive at a conclusion that such binge eating is normal
• Competition in a group may lead members to engage in behavior to gain the attention
of the therapist
• Well-meaning group members often become co-therapists of a group, to the point of
insisting on change or judging others who don’t comply with suggestions.