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Health Psychology: Dysfunctional Behaviour Graph.

DEFINITIONS OF DYSFUNCTIONAL BEHAVIOUR:

CATEGORISING- ICD 10 and DSM -IV

DEFINITIONS- Rosenhan and Seligman (ABNORMAL PSYCHOLOGY)

BIAS IN DIAGNOSIS- Ford and Widiger (SEX BIAS IN DIAGNOSING DISORDERS)

EXPLANATIONS OF DYSFUNCTIONAL BEHAVIOUR

BEHAVIOURAL- Watson and Raynor (LITTLE ALBERT)

BIOLOGICAL- Gottesman and Shields (TWIN STUDIES INTO SCHIZOPHRENIA)

COGNITIVE- Beck (COGNITIVE THERAPY FOR DEPRESSION)

TREATMENTS FOR DYSFUNCTIONAL BEHAVIOUR

BEHAVIOURAL- McGrath (NOISE PHOBIA)

BIOLOGICAL- Karp and Frank (COMBINATION THERAPY)

COGNITIVE- Beck (COMPARING PSYCHOPHARMACOLOGY AND COGNITIVE THERAPY)

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ICD 10 DSM -IV

DSM- Diagnosis Statistics Manual. USED INSIDE USA

ICD- International Classification of Disorders. USED OUTSIDE USA

Created in 2005, the latter by the World Health Organisation and the former by the American Psychiatric Association.

2008 update created ICD -10 and DSM -IV.

Diagnostic tools created to aid practitioners in identifying and treating particular disorders.

Keeps updating every couple of years as research and knowledge of disorders change and become more tolerant and aware. E.g. Homosexuality was considered an illness in 1970s, however now there it is 'sexual disorder' that is created from stress of unknown sexual orientation, and identifying anorexia has been made more cross-cultured and there are more signs and symptons idenitifed.

INTERNATIONAL CLASSIFICATION OF DISEASES AND RELATED HEALTH PROBLEMS (ICD-10)

Used to diagnose both mental and physical health problems.

ICD-08 was revised and allowed for inconsistencies and ambiguities to be removed.

The draft for ICD-10 was used in 40 countries to see if it improved psychiatric diagnoses across cultures.

Each disorder has a description of the main features and any important associated features.

The diagnosis section indicates how many of each types of features are needed to make an accurate diagnosis.

ICD-10 now has 100 difference categories of disorders, including things such as dementia, schizophrenia, mood disorders and personality disorders.

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-IV)

Compiled by over 1000 people who collaborated to produce a practical guide to clinical diagnosis.

Field trials were used before publication to compare DSM-III and DSM-IV and again to compare with ICD-10.

Resulted in simpler classifications using criteria tests, with empirical research used to support criteria.

DSM-IV also recognises limitations in calling itself a manual of mental disorders- mind/body slit that may not exist.

Acknowledges individual differences problems- result in features being different for each case.

DSM-IV main tool in diagnosing in USA, however there have been issues regarding ethnic diversity of the population that may result in diagnosing being more difficult if the culture of the patient is different from that of the clinician.

They use classifications such as learning disorders, communication disorders, dementia, substance-related disorders, sleep disorders and sexual and gender identity disorders.

A MAJOR DIFFERENCE between the DSM-IV and ICD-10 is that THE DSM-IV IS A MULTI-AXIAL TOOL.

This means that the clinician has to determine whether the disorder is from

AXIAL 1- clinical disorders

or

AXIAL 2- personality disorders

Then the patients physical condition is considered, as well as any social or environmental problems, resulting in an assessment of the patients functions on a scale of 1-100 (100 being functioning perfectly normally)

MAKES THE DSM-IV MORE HOLISTIC (taking into account every aspect of the persons mental and physical being) WHEREAS ICD-10 IS MORE REDUCTIONIST (simplifies to basic features) WITH CRITERIA-BASED DIAGNOSIS.

However, even with both manuals being used it takes years or training and experience to correctly and accurately diagnose patients with any physical or mental illness.

EVALUATION OF ICD-10 AND DSM-IV

Interpretation of manuals- individual differences amy interpret some features as criteria for other disorders. Patients may also leave features out that they may think are irrelevant and therefore may not be diagnosed at all or incorrectly. However, manuals provide standardisation making diagnosis reliable and replicable, whilst maintaining consistency.

Several disorders may be present at the same time, and so treatment and diagnosis becomes difficult, creating validity problems for both DSM-IV and ICD-10. However, both manuals are constantly being revised and improved and so increasing validity and improving diagnosis.

Some symptoms may not have been shown in manuals making diagnosis more difficult and reduces validity and reliability, however new editions are being created with greater detail of symptoms that will help create a better baseline for clinicians to work with.

Cultural differences can challenge the manuals, as disorders vary within cultures. DSM-IV is based on American perspectives whereas ICD-10 is more Universal. Different countries may also have their own diagnosis manuals (China).

People are living longer, healthier lives and so new disorders are becoming more prominent in older life, however both DSM-IV and ICD-10 are struggling to keep up with new complex issues that are presenting itself.

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ROSENHAN AND SELIGMAN

Rosenhan and Seligman created 7 features of abnormality, after Jahoda's definition of normality:

1- Suffering- patients are in distress by behaviour and feelings.

2- Maladaptiveness- Prevents enjoyment of life and working effectively.

3- Vivid/Unconventional Behaviour- abnormal behaviour deemed normal.

4- Unpredictability/Loss of Control- uncontrolled and inappropriate.

5- Irrationality/Incomprehensibility- others can't understand their behaviour.

6- Observer Discomfort.

7- Violation of Moral/Ideal Standards- judged abnormal when violates societies moral standards.

Used these to identify 4 categories of abnormal behaviour and the limitations that can occur from them:

1- STATISTICAL FREQUENCY

Abnormal would refer to any behaviour that is not seen very often in society.

a NORM is a standard or rule that regulates behaviour in a social setting (E.g. being polite).

IN STATISTICS SOMEONE IS ABNORMAL if they gall outside the range that is typical for most people (AKA AVERAGE)

These include things such as HEIGHT, WEIGHT and INTELLIGENCE. In statistical terms they are abnormal because they have moved away fem the norm.

EXAMPLE OF ABNORMALITY IN STATISTICAL FREQUENCY-

Normal Distribution Curve of IQ.

IQ is calculated using psychometric intelligence tests, which give a mental age that is divided by chronological age and multiplied by 100 to give an IQ score. Average IQ is 100, and anything between 70 and 130 is considered normal IQ.

However, a person with an IQ of 69 or 131 would be considered abnormal, though there is just a one point difference.

Ignores desirability of behaviour, where we all wish for a higher IQ (and so don't consider it abnormal) and would accept someone with a low IQ.

Disorders such as depression are very common but are still classified as abnormal.

Culture differences in statistical frequencies- arranged marriages in India and Marijuana smoking in Jamaica.

2-DEVIATION FROM SOCIAL NORMS

We have the definition that is society does not approve of a behaviour then it is dysfunctional.

These differ in cultures, however there are social norms that are approved and expected ways of behaviour that involve things such as governing dress for different ages, gender and occasions that are culturally agreed upon and is this is not followed it is considered abnormal or dysfunctional.

There is a right and wrong argument that, if followed by all, would lead to society becoming fixed as forward-thinking people would be silenced.

This definition of social abnormality is limited as different societies have different views of what is normal and abnormal (WOMEN WEARING TROUSERS IN WESTERN COUNTRIES ARE DEEMED NORMAL, HOWEVER IN DIFFERENT PARTS NOT)

NO UNIVERSAL AGREEMENT ON SOCIAL NORMS- EVEN DIFFERS FROM ONE GENERATION TO THE NEXT.

there are exceptions to norms- eating dead bodies are deemed socially unacceptable however if a group of people were stranded in the alps then it would be forgiven.

3-FAILURE TO FUNCTION ADEQUATELY

Failure to function adequately means that a person is unable to lead a normal life or engage in normal behaviour.

These may include failure to function well, such as:

DYSFUNCTIONAL BEHAVIOURS such as OCD where a person cannot go out because of certain rituals or routines they need to undertake.

BEHAVIOUR THAT DISTRESSED THE PERSON EXPERIENCE IT- for example going outside their house is severely distressing for agoraphobics.

BEHAVIOUR THAT IS UNCOMFORTABLE FOR A PERSON OBSERVING THAT PATIENT such as someone talking to themselves on a bus.

UNPREDICTABLE BEHAVIOUR such as violent mood swings and sudden impulses

IRRATIONAL BEHAVIOUR such as paranoia, or talking to oneself.

These represent the two major indicators of abnormal behaviour, and it also shows that the behaviour and thinking of the individual leads to them being unable to lead a normal and healthy life and life without feelings distressed. However, some people may not feel distressed about their condition as they have not enough knowledge or insight to know there is cause for concern. Some things such as talking to oneself is deemed abnormal, however the majority of people who are considered normal admit to speaking with themselves on occasion.

Also, behaviours that are not healthy top an individual are not considered abnormal, such as adrenaline sports and drinking alcohol, and so this definition is subjective and does not take into account if the person actually feels happier with their conditions (such as OCD sufferers)

4- DEVIATION FROM IDEAL MENTAL HEALTH

Psychologist presume that if we are lack in health then we are therefore ill, however there has been no universal agreement on what is committed healthy or normal.

Jahoda tried to list a definition of health, where an individual who has checked all 6 criteria is indeed healthy:

- Positive View of Self

- Personal Growth and Development

- Autonomy

- Accurate View of Reality

- Positive Relationships

- Master of Own Environment

This list holds problems of cultural bias, where some may regard high self-esteem as pride and therefore bad, and even the more emotionally stable people would not be able to tick all of these criteria, and so leaves us with the assumption that there cannot be such thing as normal and that everyone is abnormal is their own way, making it normal in itself.

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FORD AND WIDIGER

BACKGROUND

Diagnosing Disorders are affected by a variety of variables, such as cultural bias where one culture may see hearing voices as normal, or by gender bias where it was determined (BROVERMAN 1970) that the perfect female was submissive and dependant on looks, and that any female who did not fit this image was diagnosed with a disorder.

R&S used a SELF REPORT method with 354 CLINICAL PSYCHOLOGISTS being given scenarios and asked to make a diagnosis on the information given.

IV- Gender of patient

DV- Diagnosis made by clinician

FROM 1127, 354 CLINICAL PSYCHOLOGIST RANDOMLY SELECTED from NATIONAL REGISTER in 1983.

MEAN EXPERIENCE 15.6 YEARS.

266 PSYCHOLOGISTS RESPONDED.

EACH PARTICIPANT received 1 OF THE 9 CASE STUDY HISTORIES

case studies of patients with ANTI-SOCIAL PERSONALITY DISORDER (ASPD) or HISTRIONIC (HYSTERICAL) PERSONALITY DISORDER (HPD) or an EQUAL BALANCE OF SYMPTOMS were given to each therapist.

QUESTIONNAIRES were also given to each therapist, and they were asked to RATE ON A SEVEN POINT SCALE the extent to which the patient had the following disorders:

-DYSTHYMIC (Chronic Mood Disorder. Long Lasting with milder symptoms than depression)

-ADJUSTMENT (response to stressful situations that create high emotions different to those of anxiety)

-ALCOHOL ABUSE

-CYCLOTHYMIC DISORDER (Fits into Bipolar spectrum, however individuals are still fully functioning)

-NARCISSISTIC DISORDER

- HISTRIONIC DISORDER (Emotional and attention seeking behaviour)

-PASSIVE-AGGRESSIVE DISORDER (Excessive negative thoughts - obstructionist in interpersonal and occupational settings)

-ANTI-SOCIAL (Pervasive pattern of disregard for, and violation of, the rights of others_

-BORDERLINE PERSONALITY DISORDER (Prolonged disturbance of personality in mostly characterised by wildly swinging moods)

FINDINGS:

SEX-UNSPECIFIED CASE HISTORIES were diagnosed MOST OFTEN with BORDERLINE PERSONALITY DISORDER.

ASPD was CORRECTLY DIAGNOSED 42% in MALES and 15% in FEMALES

FEMALES WITH ASPD were MISDIAGNOSED with HPD 46% of the time

WHEREAS MALES were MISDIAGNOSED with HPD only 15% of the time.

HPD was CORRECTLY DIAGNOSED in 76% of FEMALES and 44% of MALES.

GENDER OF CLINICIAN DID NOT MAKE A DIFFERENCE IN DIAGNOSING.

Females would be misdiagnosed with HPD, even if their history shows ASPD.

There was also a tendency to no diagnose males with HPD, however wasn't as great as the misdiagnosis in females.

EVALUATION:

SAMPLE: 354 of 1127 responded. 76% of participants were male- GENDER BIAS however REFLECTS RATIO OF PRACTITIONERS OF EXPERIENCED PSYCHOLOGISTS.

only a small representation of practitioners- LOWERS VALIDITY- BIAS AS TO WHO RESPONDED.

PROCEDURE: written case histories given- STANDARDISED AND REPLICABLE, however NO PHYSICAL CUES OR BODY LANGUAGE GIVEN- LACKS ECOLOGICAL VALIDITY.

METHOD: questionnaire- rating scale used. EASY TO OPTAIN AND ANALYSE AND COMPARE RESULTS. STANDARDISED AND REPLICABLE.

HOWEVER, SOCIAL DESIRABILITY BIAS MAY OCCUR- LACKS ECOLOGICAL VALIDITY, SCALES MAY BE INTERPRETED DIFFERENTLY AND MAY RESULT IN FORCED CHOICE RESPONSES.

DIAGNOSIS: 9 disorders given- CHOICE OF DISORDERS STANDARDISED AND REPLICABLE.

HOWEVER DOES NOT REPRESENT THE NORMAL PATTERN OF PTIENT PRESENTATION.

RESULTS: Gender bias does occur. FACE VALIDITY OCCURS (WEAKEST FORM OF VALIDITY)

However- FOCUS ON ONLY TWO DISORDERS- INTERPRETATION WILL VARY AND INDIVIDUAL DIFFERENCES WILL TAKE PLACE.

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WATSON AND RAYNOR

EXPLANATION OF DYSFUNCTIONAL BEHAVIOUR- BEHAVIOURAL APPROACH.

Behavioural approach believes that we are all born as blank slates and that any dysfunctional behaviour is learned through classical conditioning, operant conditioning or social learning.

This therefore places the responsibility on the older generations to not 'teach' dysfunctional behaviour to others.

TO SEE OF IT IS POSSIBLE TO INDUCE FEAR OF A PREVIOUSLY UNFEARED OBJECT THROUGH CLASSICAL CONDITIONING.

METHOD:

CASE STUDY of 'LITTLE ALBERT' in controlled laboratory conditions (hospital environment).

LITTLE ALBERT:

Was declared STOLID and UNEMOTIONAL, with NO FEARFUL REACTIONS PRIOR to conditioning to a RAT, RABBIT, DOG, MONKEY, CLOWNS MASK or COTTON WOOL.

AT 8 MONTHS ALBERT REACTED VIOLENTLY TO A STEEL BAR BEING HIT BY A HAMMER. this would act as the stimuli.

ALBERT WAS 11 WHEN THE EXPERIMENT BEGAN.

PROCEDURE AND RESULTS (major ones)

AT FIRST Albert was exposed only to the white rat, with NO STIMULI.

however at the second and third sessions, Watson PRODUCED THE STIMULI after Albert was shown the rat.

ALBERT THEN BEGAN TO CRY, SHAKE AND TRY TO GET AWAY FROM THE NOISE.

THIS RESULTED IN ALBERT BEGINNING TO CRY WHEVER THE RAT WAS PRESENT.

this fear was ALSO INDUCED INTO THE OTHER STIMULI'S, SUCH AS THE RABBIT AND COTTON WOOL.

THE FEAR RESPONSE IS NOT UNLEARNED OVER TIME.

EVALUATION:

SAMPLE- 1, 8 month old little Albert. OPPORTUNITY TO STUDY CASE IN DEPTH, DETAIL WITH THOROUGH ANALYSIS. HOWEVER DIFFICULT TO GENERALISE TO ANY OTHER CASE OF PHOBIA OR FEAR INDUCING STUDY. ZEITGEIST PRESENT.

PROCEDURE- associated learning occurs through classical conditioning.

TRANSFERENCES CAN OCCUR AND THAT CHILDREN CAN BE CONDITIONED TO FEAR THINGS. HOWEVER NO LONG-TERM EFFECTS WERE DISCOVERED OR RECORDED SO NO INDICATION IF ALBERT WAS AFFECTED INTO ADULTHOOD.

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GOTTESMAN AND SHIELDS.

BIOLOGICAL EXPLANATIONS see dysfunctional behaviour as something that has been passed down through our genes, or have been caused by something inside our genetic make up or our anatomy.

METHOD:

REVIEW of ADOPTION and TWIN STUDIES into SCHIZOPHRENIA between 1967 and 1976.

study reviewed THREE ADOPTION STUDIES and FIVE TWIN STUDIES.

SAMPLE: in total there were 711 PARTICIPANTS in ADOPTION STUDIES.

TWIN STUDIES had 210 MONOZYGOTIC (identical) TWINS and 319 DIZYGOTIC TINS.

PROCEDURE:

INCIDENCE of schizophrenia in adopted children and monozygotic twins were EXTRAPOLATED from the research.

COMPARISON between BIOLOGICAL PARENTS and SIBLINGS and ADOPTIVE PARENTS and SIBLINGS in adoption studies.

in TWIN STUDIES the CONCORDANCE RATES WERE COMPARED.

IF THERE WAS AN INCREASED INCIDENCE OF SCHIZOPHRENIA IN BIOLOGICAL RELATIVES AND HIGHER CONCORDANCE RATES BETWEEN MONOZYGOTIC TWINS, THEN IT WOULD INDICATE GENTIC BASIS FOR THE DISORDER.

FINDINGS:

ALL THREE ADOPTION STUDIES FOUND AN INCREASE INCIDENCE OF SCHIZOPHRENIA IN ADOPTED CHILDREN WITH A SCHIZOPHRENIC BIOLOGICAL PARENT. (19.2%)

WHEREAS normal children fostered to schizophrenic parents or vice vedas showed little evidence. (6.3%)

MONOZYGOTIC TWINS HAD A HIGHER CONCORDANCE RATE FOR SCHIZOPHRENIA THAN DIZYGOTIC TWINS. (58% chance, compared to 12% of dizygotic twins)

EVALUATION:

SAMPLE: LARGE SAMPLE- REDUCES INDIVIDUAL DIFFERENCES. HOWEVER DIFFICULT TO OBTAIN THIS TYE OF SAMPLE- EXPENSIVE AND TIME CONSUMING.

DIAGNOSIS: degrees of schizophrenia not specified, will differ with different doctor and individual cope. REDUCE VALIDITY. HOWEVER, MAY BE STANDARDISED BY USING DSM OR ICD.

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BECK

Behaviour is consequence of INTERNAL PROCESSING OF INFORMATION.

METHOD: CLINICAL INTERVIEWS with patients who were UNDERGOING THERAPY for depression.

SAMPLE: 50 PATIENTS DIAGNOSED with depression. 16M 34F AGED 18-48.

Patients were COMPARED WITH A GROUP OF 31 NON-DEPRESSED PATIENTS undergoing psychotherapy. MATCHED FOR AGE, SEX AND SOCIAL POSITION.

PROCEDURE:

FACE_TO_FACE interviews with RETROSPECTIVE REPORTS on PATIENTS THOUGHTS BEFORE and DURING SESSIONS.

RECORDS ALSO KEPT OF NON-DEPRESSED VERBALISATIONS TO COMPARE.

FINDINGS:

CERTAIN THEMES appeared in the depressed patients reports that did not in the other patients.

LOW SELF_ESTEEM, SELF BLAME, OVERWHELMING RESPONSIBILITY AND A DESIRE TO ESCAPE.

THEY BELIEVED THEMSELVES INFERIOR AND UNLOVED, EVEN WHEN THEIR CONCLUSIONS ARE ILLOGICAL.

EVALUATION:

SAMPLE: GENDER BIAS in sample, however RATIO SIMILAR TO REAL LIFE. SMALL SAMPLE- INDIVIDUAL DIFFERENCES. ALLOWS FOR FACE TO FACE INTERVIEWS TO TAKE PLACE- CONTENT ANALYSIS.

DIAGNOSIS- reason for patients feeling unloved or inferior vary. One might see someone not smiling to them as a inferior whilst another may blame themselves for not smiling first or presenting an approachable manner. NOT ALL SAME COGNITIVE PROBLEMS- THERAPY WOULD REQUIRE TO TREAT EACH SPECIFIC DIFFERENCE.

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MCGRATH

REVERSE WHAT WATSON AND RAYNOR ACCOMPLISHED; TO TREAT A PHOBIA THROUGH CLASSICAL CONDITIONING.

METHOD: CASE STUDY of NOISE PHOBIA in a LITTLE 9 YEAR OLD GIRL, LUCY.

SAMPLE: LUCY- NOISE PHOBIA OF LOUD NOISES. INCLUDED BALLOONS POPPING, PARTY POPPERS, CARS BACKFIRING AND FIREWORKS. LOWER THAN AVERAGE IQ, NOT DEPRESSED OR ANXIOUS.

PROCEDURE: PARENTS GAVE CONSENT FOR LUCY TO ATTEND THERAPY SESSIONS.

TAUGHT BREATHING AND IMAGERY TO RELAX. RATED EACH NOISE OUT OF 10, AND WAS TOLD TO PAIR FEAR OBJECT WITH RELAXATION.

after FOUR SESSIONS she did not need to imagine herself at home playing with her toys.

FINDINGS: at the first sessions, Lucy HAD TO BE TAKEN AWAY AND CALMED DOWN after a balloon was popped in the room.

by END OF FIFTH SESSION, Lucy was able to POP BALLOON HERSELF.

HER FEAR THERMOMETER had gone from 7/10 TO 3/10 (BALLOONS) 9/10 TO 3/10 (PARTY POPPERS) 8/10 TO 5/10 (GAP GUN).

EVALUATION:

DATA COLLECTED: QUANTITATIVE DATA COLLECTED ON IQ AND ANXIETY- ANALYSIS AND COMPARISONS (STANDARDISED AND REPLICABLE).

QUALITATIVE DATA SUCH AS WHAT WOULD CALM HER WAS COLLECTED - DEPTH DETAIL ON SPECIFICS. HOWEVER INDIVIDUAL DIFFERENCE- WOULDN'T GENERALISE TREATMENTS TO ADULTS.

SCORING- FORCED CHOICE - LOWER VALIDITY. REPLICABLE BUT OPEN TO INTERPRETATION.

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KARP AND FRANK

Bio-medical Approach to Treatment of Dysfunctional Behaviour.

Based on assumption that if a mental problem is caused by biological malfunction- treatment should be through drug therapy, electroconvulsive therapy or psychosurgery.

EXAMPLE- Imbalances in the neurotransmitter are known to be involved with depression so drug therapy will attempt to restore an appropriate chemical balance to the brain.

Drug Therapy:

"Symptoms of depression can also be alleviated by other means".

Elkin et al Study: