Abnormal Psychology

I. To what extent do biological, cognitive, and sociocultural factors influence abnormal behavior? A. Depression 1. Biological a) Nurnberger and Gershon - Did a twin study that found the concordance rate for major depressive disorder was consistently higher for MZ twins (65%) than for DZ twins (14%). b) Duenwald - Suggested that a short variation of the 5-HTT gene may be associated with a higher risk of depression. c) Janowsky et al. - Performed an experiment where participants were given a drug that decreases nonadrenaline and found that they began to exhibit depression-like symptoms. 2. Cognitive a) Ellis - Proposed that psychological disturbances come from irrational and illogical thinking. People draw false conclusions, leading to anger, anxiety, and/or depression. Irrational beliefs lead to self-defeating conclusions. b) Beck - Suggested that depression is based on schema processing and depressed patients exhibited a cognitive triad charactierized by: (1) Overgeneralization based on negative events (2) Non-logical inference about the self (3) Dichotomous thinking - black-and-white thinking c) Alloy et al. - Followed a sample of young Americans and grouped them based on positive and negative thinking. Only 1% of those in the positive thinking group had depression while 17% in the negative thinking group did. 3. Sociocultural a) Brown and Harris - Carried out a study concerning the social origins of depression in women. 29 out of 32 depressed women had a severe life event but 78% of women that had a life event didnt become depressed. Life events were, for example: (1) lacking employment away from home (2) absence of social support (3) having several children at home (4) loss of mother at early age (5) history of childhood abuse b) Prince - Found that rates of depression rose with westernization in former colonial countries. c) Kleinman - Showed that, in China, somatization served as a channel of expression of depression and related their feelings to their bodies. B. PTSD 1. Biological a) Geracioti - Found that PTSD patients have higher levels of nonadrenaline than average. Stimulating the adrenal system led to panic attacks in 70% of patients and flashbacks in 40% 2. Cognitive a) People with PTSD feel they have a lack of control over their lives and feel guilt regarding the trauma.

Abnormal Psychology
b) Brewin et al. - Argued that flashbacks to traumatic events occurred due to stimuli similar to the original event triggering the memory. 3. Sociocultural a) Roysircar - Found that 20.6% of black and 27.6% of Hispanic Vietnam War veterans met the criteria for PTSD, as opposed to the 13% of white veterans. b) Kaminer et al. - Found that 73% of girls and 35% of boys in Sarajevo, Bosnia, suffered from symptoms of PTSD. Credited the higher rate of PTSD in girls to fear of rape. C. Bulimia 1. Biological a) Kendler et al. - Studied 2000 female twins and found a concordance rate of 23% in MZ twins and 9% is DZ twins. b) Smith et al. - Found that when seretonin levels were reduced in recovered bulimic patients, they engaged in cognitive patterns related to eating disorders, such as feeling fat. 2. Cognitive a) Bruch - Hypothesized that eating disorder patients suffer from the delusion that they are fat. b) Slade and Brodie - Suggested that those suffering from an eating disorder were unsure of their bodies and and overestimate their body size. 3. Sociocultural a) The medias image of an ideal body in the West cause unrealistic expectations and less than 5% of the female population can achieve it. II. Evaluate psychological research (that is, theories and/or studies) relevant to the study of abnormal behaviour. A. Pick one from above B. Heres another, just in case 1. Fallon and Roxin - Conducted a study dealing the cognitive explanations of bulimia nervosa. They showed that there seems to be a gender difference in the perception of body images. Graduates were shown figures of their own sex and asked to indicate the figure that looked the most like their body shape, ideal body shape, and which body would they consider most attractive to the opposite sex. Men choose relatively the same size for all three body shapes; however, women chose thinner body shapes for all three. This illustrates that women are more likely to become bulimic and tend to think of the ideal shape as thinner than they currently are. III. Examine the concepts of normality and abnormality. A. Abnormality - The subjective experience of feeling not normalintense anxiety, unhappiness, distress. B. Normality - Having the average in any psychological trait, as intelligence, personality, or emotional adjustment or free from any mental disorder; sane. Being abnormal is defined as not falling within the norm, causing distress to either the afflicted person or those around them, and is maladaptive, causing problems to events around them such as work or school. It is difficult to define exactly what abnormality is because in order to know what is abnormal, first one must know what is considered normal. IV. Discuss validity and reliability of diagnosis.

Abnormal Psychology
A. Rosenhan - He and seven mentally healthy associates, called "pseudopatients", attempted to gain admission to psychiatric hospitals by calling for an appointment and feigning auditory hallucinations. The hospital staffs were not informed of the experiment. The pseudopatients included a psychology graduate student in his twenties, three psychologists, a pediatrician, a psychiatrist, a painter and a housewife. None had a history of mental illness. During their initial psychiatric assessment, they claimed to be hearing voices of the same sex as the patient which were often unclear, but which seemed to pronounce the words "empty", "hollow", "thud" and nothing else. Though presented with identical symptoms, 7 were diagnosed with schizophrenia and one with manic-depressive psychosis. The pseudopatients were required to get out of the hospital on their own by getting the hospital to release them, though a lawyer was retained to be on call for emergencies when it became clear that the pseudopatients would not ever be voluntarily released on short notice. Once admitted and diagnosed, the pseudopatients were not able to obtain their release until they agreed with the psychiatrists that they were mentally ill and began taking antipsychotic medications, which they flushed down the toilet. B. Rosenhan - Did a follow-up experiment where he claimed that one or more pseudopatients would try to gain admission to the psychiatric hospital and the staff would try to find which where impostors. Out of 193 patients, 41 were considered to be impostors and a further 42 were considered suspect. In reality, Rosenhan had sent no pseudopatients and all patients suspected as impostors by the hospital staff were ordinary patients. Discuss cultural and ethical considerations in diagnosis A. Confirmation Bias - favor info that confirms that favors pre-conceptions; a tendency for people to prefer information that confirms their preconceptions or hypotheses B. Stigmatization - People who are diagnosed are looked at as not just a person but an abnormal person with a disease, even after they stop showing symptoms. The disease will always be stuck with them. Another ethical consideration when it comes to diagnosis is culture blindness. In 1982, Rack pointed out that if a member of a minority ethnic group exhibits a set of symptoms that is similar to that of a white British-born patient, and then they are assumed to be suffering from the same disorder, which may not be true, which leads to a misdiagnosis. This misdiagnosis is what leads to the ethical consideration. This misdiagnosis is unethical internationally because a misdiagnosis can lead to treatment of that person, which means therapy and medicine which they do not need. It is also unethical to diagnose people with diseases based on their culture, ethnicity, or race.

V.

VI.

Describe symptoms and prevalence of one disorder from two of the following groups -anxiety disorders -affective disorders -eating disorders A. Depression (affective disorder) 1. Symptoms a) 2 weeks of either depressed mood or loss of interest/ & pleasure plus the presence of four additonal symptomsinsomnia, appetite, loss of energy, feelings of worthlessness, thoughts of suicide, or difficulty concentrating

Abnormal Psychology
2. Prevalence a) affects around 15% of people at some time in their life b) 2-3 times more common in women than in men (most likely because women are more likely to report depression than men) c) occurs frequently in lower socio-economic groups d) frequently among young adults B. Bulimia (eating disorder) 1. Symptoms a) binge eating b) compensatory methods to prevent weight gaininduced vomiting(purging) excessive exercise, laxative abuse c) both must occur at least twice a week for 3 months to be diagnosed with bulimia nervosa 2. Prevalence a) 2-3% of women, .02-.03% men, diagnosed with bulimia b) Affects about 2% of all adults c) 40% of college women d) more common in industrialized countries VII. Analyze etiologies (in terms of biological, cognitive and/or sociocultural factors of one disorder from two of the groups A. PTSD (anxiety disorder) 1. Biological a) It is shown in studies that people who have developed PTSD have an increased level of noradrenaline. b) Noradrenaline is a neurotransmitter that plays a role in emotional arousal. c) Geracioti- Found that the high level of noradrenaline causes a person to express more emotions on a certain situation or topic more than a normal person. d) Bremmer -The high levels of Noradrenaline often lead to people having flash back and panic attacks. 2. Cognitive a) If a person tries to blame themselves and takes responsibility for the situation then they will suffer significantly. b) When the person feels this way they also beginning to feel they have lack of control over their surroundings and the world. c) Development of PTSD is associated with a tendency to take personal responsibility for failures and to cope with stress by focusing on the emotion, rather than the problem. d) Sutker et al. - Found that Gulf War veterans who had a sense of purpose and commitment to the military had less of a chance of suffering from PTSD than other veterans. 3. Sociocultural a) The majority of research on PTSD focuses on sociocultural explanations. Research suggests that experiences with racism and oppression are predisposing factors for PTSD. b) Dyregrov - Researched PTSD in Rwandan children. Argued that death was the factor evidencing the strongest influence on intrusive thoughts and avoidance of be-

Abnormal Psychology
havior, which simply means avoiding situations can trigger anxiety and panic. This appears to have support in Bosnia, where in 1998 close to 73 % of girls and 35% of boys in Sarajevo suffered from symptoms of PTSD. B. Bulimia (eating disorder) 1. Biological a) Kendler et al. - Found that bulimic patients had low serationin levels, bulimic relatives. Concordance rate of 23% MZ, 9% DZ. b) Strober - Found that first degree relatives of women with bulimia nervosa are 10 times more likely than average to develop the disorder. c) Carraso - Found lower levels of serotonin in bulimic patients. 2. Cognitive a) Bruch - body image distortion hypothesis: Many eating disorder patients suffer from the delusion that they are fat; found that people overestimate their body size. b) Fallon and Rozin - Aimed to see if people if people who suffer from an eating disorder are uncertain about their body size and shape. US undergraduates shown figures of their own sex & asked to indicate: their own shape, ideal shape and the figure they thought would be most attractive to the opposite sex. Men selected similar figures for al 3 body types; women chose ideal and attractive body shapes that were much thinner than the shape indicated for their own body type. Women tended to choose all three body types thinner compared to men. 3. Sociocultural a) People often compare themselves to other people which affects their self esteem. The media has made the standard of beauty difficult to attain especially for women. b) Sanders and Bazalgette - Aimed to analyze the body shape of 3 of the most popular dolls available for young girls (Barbie, Sindy, and The Little Mermaid). They measured their height, hips, waist, and bust. Then they applied measurements to a women of average height and found that relative to real women the dolls had tiny hips and waists and greatly exaggerated inside leg measurements. VIII. Discuss cultural and gender variations in prevalence of disorders. A. Bulimia 1. Individuals with bulimia are afraid of weight gain, and they will undertake binge eating and then use compensatory methods to lose weight, such as induced vomiting, excessive exercise and use of laxatives. Symptoms of bulimia include swollen salivary glands, due to vomiting, stomach and intestinal problems, feelings of guilt after binge eating and negative distorted image about their body weight. 2. According to statistical evidence, eating disorders are more common in females than in males. An estimated 35% of those with binge-eating disorders are males, with the rest of it being females. Eating disorders are also more common in teenagers, with 50% of girls between the ages 11-13 seeing themselves as overweight. 3. Fallon and Rozin - Wanted to see if there was a gender difference in body image. They showed US undergraduates figures of their own sex and asked them to indicate the figure that looked most like their shape and their ideal figure. Men selected very similar figures, whereas women tend to choose thinner attractive bodies that were much thinner than the shape they indicated as their own. They also asked men to choose a female fig-

Abnormal Psychology
ure that they thought was attractive to them, and found that the figure they found attractive was heavier than the ideal figure that women chose. Women believed that men prefer thinner women than they actually do. They concluded that there is a gender difference in the perception of body image, which explains why women are more susceptible to eating disorders than men. 4. Lee, Hsu and Wing - found that bulimia and anorexia was non-existent among the Chinese in Hong Kong. Chinese people are usually slim, and therefore they do not share the Western fear of being fat. The Chinese regard thinness as a sign of ill-health, unlike the Western view that it is a sign of self-discipline. Obesity is a sign as a sign of weak control in the West, whereas Chinese people see it as a sign of wealth and prosperity. 5. Baguma et al - Found cultural differences in the susceptibility of bulimia. It seems that the culture we live in really affects our eating behaviors. He asked British and Uganda students to examine a set of nude bodies ranging from very thin to very obese. When asked to rate which body they thought were ideal, the British people tend to chose very thin bodies, whereas Uganda students chose very obese bodies. In the Uganda society, fat is beautiful, and in the British society, slim is attractive. Thus this shows that cultural factors affect the way we think, which may explain why the Western society has such a high rate of people with eating disorders. B. Depression 1. People with depression usually experience feelings of guilt and sadness, lack of enjoyment and pleasure in anything. They will have frequently negative thoughts, including low self-esteem and suicidal thoughts. 2. According to statistical evidence, women are two to three times more likely to be clinically depressed than men. Women are also more likely to experience several episodes of depression. This may be explained by gender norms or gender differences in society. 3. Koss et al. - Found that discrimination against women began early in their lives. Women are twice as likely to suffer sexual abuse in childhood and this pattern of victimization is maintained in adulthood, where women make up the majority of victims in physical assault. 4. Chiao et al. - Found that depression was higher in individualistic cultures than in collectivistic cultures. 5. Gabilondo et al. - Found that depression occurs less frequently in Spain (collectivistic culture) and there there is a lower suicidal rate compared to Europe countries (individualistic). This is perhaps because collectivist groups discourage depression as they have more social support than individualistic cultures, who encourage independence. 6. Brown and Harris - Did a study on depression in women. 29 out of 32 women who became depressed experienced a severe life event 72% of those women did not become depressed. Severe life events include: a) lacking employment away from home b) absence of social support c) having several young children at home d) loss of mother at an early age e) history of child abuse 7. Men are less likely to admit depression since they are supposed to be portrayed as the strong working man and are brought up not to be as emotional.

Abnormal Psychology
8. Williams and Hargreaves - Found that women are 2 to 3 times more likely to become clinically depressed than men and are more likely to experience several episodes of depression. 9. Marsella - Argued that affective symptoms i.e. sadness, loneliness and isolation) are typical of individualistic cultures. In collective cultures they have a more stable collectivism social network to support an individual. Somatic Symptoms such as headaches are more prevalent and common to occur. 10. Cross cultural research has demonstrated that there is a virtually identical core of symptoms present in depression in many different cultures. However, in addition this core set of symptoms, there are manifestations which are culturally specific because depression is not exactly the same the world over. Examine biomedical, individual and group approaches to treatment A. There are many approaches to treatment, including biomedical, individual, and group approaches. An example of biomedical treatment would be taking medicine; however, this does not always work. This is explained by many studies that have shown that taking medicine with CBT treatment worked just as well as a placebo with CBT treatment. Individual and group therapy also have their different sides. Individual therapy gives someone the one-on-one attention and assures that person that they are only sharing their personal lives with one person, instead of a group. Whereas in a group, they talk about their problems together and help and support each other through it. Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder. A. PTSD 1. Biomedical a) Two medications were approved by the FDA (1) Sertraline (Zoloft) (2) Paroxetine (Paxil) b) These drugs are antidepressants that help treat depression. It helps control symptoms such as sadness, worry, anger, and the feeling of emptiness. 2. Individual a) Vocal therapy lets the person recognize ways of thinking or cognitive patterns that keep the patient stuck. This method can be used along with behavioral therapy also known as exposure therapy. b) Eye movement desensitization and reprocessing (EMDR) - This combines exposure therapy with a series of guided eye movements that can help process traumatic memories. 3. Group a) Friedman and Schnurr - Looked at the role of group therapy on Vietnam War veterans. They had a total of 325 war veterans as participants. There was a group that held trauma-focused therapy which had three components: exposure to traumatic memories, cognitive restructuring, and coping skills development. Compared to a controlled group who only talked about current life issues, the group that had trauma-focused therapy had a better improvement rate. However, the trauma-focused group had a very high attrition rate (participants dropping out). Attrition rate was 27 percent compared to 17 percent.

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X.

Abnormal Psychology
XI. Discuss the use of eclectic approaches to treatment. A. People can go to a Freudian or a cognitive or any other type of therapist but it is more likely he or she will go to a therapist who practices an eclectic approach to therapy. B. Eclectic therapy recognizes strengths and limitations of various therapies. These sessions tend to tailor the needs of the individual client or group. For example a patient who is suicidal may not be able to use Cognitive Behavioral therapy because it may take too long to take effect or the individual may not be in a state that would not allow for discussion about his or her cognitive processes. Drug therapy may be used in order to lessen the symptomology of the disorder, and then once the individual is stabilized CBT might be used. As the individual becomes more independent or self-reliant they may then join group therapy sessions to help develop strategies with others. XII. Discuss the relationship between etiology and therapeutic approach in relation to one disorder. A. Etiology: to find out why people suffer from a disorder; this way is more difficult to establish for a psychological disorder, than for physical illness in general. B. Therapeutic: treating or curing of the disease. C. Therapy is the most effective approach to try to cure PTSD. D. Symptoms can vary depending on the sex of the patient. Most men develop aggression, become irritable, and violent while women are more prone to anxiety, avoidance of social situations, and depression. E. The patient and therapist develop techniques to help relieve the triggers that can cause an onset of PTSD responses. The therapeutic approach and the relationship with etiology become more clear once the patient can identify the triggers sooner and implement the techniques to help relieve the symptoms of PTSD.