Notes · PsychologyUK · A-Levels

Psychopathology

Psychopathology is the study of psychological disorders. This chapter examines four ways of defining abnormality, the behavioural, emotional and cognitive characteristics of phobias, depression and obsessive-compulsive disorder, and the way each disorder is explained and treated - phobias by the behavioural approach, depression by the cognitive approach, and OCD by the biological approach.

5 sections~17 min reading time3 competenciesLevel Foundation 1 · Standard 1 · Advanced 3

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Exam profile

AO1 · Describe the definitions of abnormality, the characteristics of the three disorders, and their explanations and treatmentsAO2 · Apply the definitions, explanations and therapies to novel case descriptionsAO3 · Evaluate the definitions, explanations and treatments for effectiveness and appropriateness

Operators:describeoutlineexplainapplyevaluatediscuss

basic level

AS-Level covers the definitions of abnormality, the characteristics of the three disorders, and the behavioural approach to phobias and cognitive approach to depression.

higher level

The full A-Level adds the biological approach to OCD (genetic and neural explanations and drug therapy) and a fuller comparative evaluation of the approaches to explaining and treating abnormality.

Depth

Text

Contents · 5 sections

Psychopathology

Definitions of abnormality#

FoundationAQA 7182 3.1.4DfE GCE Psychology - definitions of abnormality

Statistical infrequency and the normal distribution

Fig. 1Statistical infrequency classes behaviour in the extreme tails of the distribution (beyond about two standard deviations from the mean) as abnormal.

Abnormality is difficult to define, and the specification requires four definitions, each capturing part of the idea and each with limitations. Statistical infrequency defines a behaviour as abnormal if it is statistically rare - if it lies far from the average, in the tails of the normal distribution. For example, a very low IQ (below about 70) is statistically infrequent and used to diagnose intellectual disability. Its limitation is that not all rare behaviours are undesirable (a very high IQ is also rare but not a disorder) and some undesirable behaviours (such as depression) are common, so rarity alone is not enough.

Deviation from social norms defines abnormality as behaviour that violates the unwritten rules (norms) a society expects, such as antisocial or offensive behaviour. Its limitation is that norms vary between cultures and change over time (homosexuality was once classed as abnormal), so this definition is relative and can be misused to label those who simply do not conform, raising issues of social control.

Failure to function adequately defines abnormality as being unable to cope with the ordinary demands of everyday life - not being able to hold down a job, maintain relationships or look after oneself, often with signs of personal distress. Rosenhan and Seligman suggested signs such as suffering, maladaptiveness and unpredictability. Its limitation is that the judgement of who is 'not coping' is subjective, and some apparently dysfunctional behaviour may be a rational response to circumstances.

Deviation from ideal mental health, proposed by Jahoda (1958), takes the opposite approach: it defines what good mental health looks like and treats an absence of these criteria as abnormal. Jahoda's criteria include a positive self-attitude, self-actualisation, autonomy, resistance to stress, accurate perception of reality and mastery of the environment. Its limitation is that the criteria are so demanding that almost everyone would be 'abnormal' by at least some of them, and the criteria are culturally biased towards Western, individualist ideals. In practice clinicians use several definitions together rather than any one alone.

The four definitions of abnormality

Fig. 2Each definition captures part of abnormality but has a limitation, so clinicians combine them.

Worked example

Choosing a definition for a case

A student stops attending lectures, cannot get out of bed and neglects her hygiene. Identify the most appropriate definition of abnormality and justify it.

Identify the key feature
The behaviours all involve an inability to meet the ordinary demands of daily life, with signs of distress.
Match to a definition
This best fits failure to function adequately (Rosenhan and Seligman's signs of maladaptiveness and personal distress).
Justify and qualify
Statistical infrequency and deviation from norms fit less well, but note that judging 'failure to function' is subjective, so the definition should be applied alongside clinical judgement.

Result: Failure to function adequately is the most appropriate definition, applied with awareness of its subjectivity.

Typical mistakes

Confusing statistical infrequency (rare) with deviation from social norms (breaking rules) - a behaviour can be one without the other.
Presenting Jahoda's criteria as a way to define abnormality directly - it defines ideal health, and abnormality is the deviation from it.

Active revision

A man collects thousands of bottle tops and rarely leaves his flat, though he says he is content. Discuss which definition(s) of abnormality apply and their limitations.

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for psychology (Department for Education) · AQA A-level Psychology 7182 specification (AQA)

Characteristics of phobias, depression and OCD#

StandardAQA 7182 3.1.4DfE GCE Psychology - characteristics of disorders

Characteristics of the three disorders

Fig. 3Organising each disorder's symptoms under behavioural, emotional and cognitive headings is essential for the exam.

The specification requires the behavioural (how people act), emotional (how people feel) and cognitive (how people think) characteristics of three disorders. Organising the symptoms under these three headings is essential for the exam, and each disorder has a distinctive pattern.

A phobia is an irrational, persistent fear of an object or situation out of proportion to the actual danger. Its behavioural characteristics are avoidance (going to great lengths to avoid the phobic stimulus) and, when avoidance fails, a panic or freeze/faint response. Its emotional characteristics are anxiety and fear, an immediate and disproportionate emotional response to the stimulus. Its cognitive characteristics are selective attention to the phobic stimulus (finding it hard to look away) and irrational beliefs about it.

Depression is a mood disorder. Its behavioural characteristics are reduced activity levels and disruption to sleep and eating (either an increase or a decrease in each), and sometimes aggression or self-harm. Its emotional characteristics are persistent low mood or sadness, lowered self-esteem and anger. Its cognitive characteristics are poor concentration, dwelling on the negative (attending to and recalling negative rather than positive events) and absolutist 'black-and-white' thinking.

Obsessive-compulsive disorder (OCD) is characterised by obsessions and compulsions. Its behavioural characteristics are compulsions (repetitive actions such as hand-washing performed to reduce anxiety) and avoidance of situations that trigger the anxiety. Its emotional characteristics are anxiety and distress caused by the obsessions, accompanied by depression and guilt. Its cognitive characteristics are recurrent, intrusive obsessive thoughts, an awareness that these thoughts are excessive (insight), and the use of coping strategies such as rituals. Being precise about which symptom is behavioural, emotional or cognitive is a common exam requirement.

Worked example

Classifying symptoms in a vignette

A man with depression sleeps far more than usual, feels worthless, and believes nothing will ever improve. Classify each symptom.

The change in sleep
Sleeping far more than usual is a disruption to sleep - a behavioural characteristic.
Feeling worthless
Worthlessness is lowered self-esteem - an emotional characteristic.
Believing nothing will improve
This hopeless, negative view of the future is a cognitive characteristic (dwelling on the negative).

Result: Behavioural: increased sleep; emotional: worthlessness; cognitive: hopeless negative outlook.

Typical mistakes

Listing symptoms without saying whether each is behavioural, emotional or cognitive.
Confusing obsessions and compulsions - obsessions are the intrusive thoughts, compulsions are the repetitive actions.

Active revision

A person repeatedly checks that the door is locked (an action) because of a recurring fear that the house will be burgled (a thought). Classify each of these as a characteristic of OCD.

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for psychology (Department for Education) · AQA A-level Psychology 7182 specification (AQA)

The behavioural approach to phobias: the two-process model and its treatments#

AdvancedAQA 7182 3.1.4DfE GCE Psychology - the behavioural approach to phobias

The two-process model of phobias

Fig. 4Classical conditioning acquires the phobia; avoidance then reduces anxiety (negative reinforcement), maintaining it.

The behavioural approach explains phobias entirely through learning, using Mowrer's two-process model: phobias are acquired by classical conditioning and maintained by operant conditioning. Acquisition by classical conditioning occurs when a neutral stimulus is paired with something that naturally causes fear: in Watson and Rayner's 'Little Albert' study, a white rat (neutral stimulus) was repeatedly paired with a frightening loud noise (unconditioned stimulus producing a fear response), until the rat alone came to produce fear (a conditioned response) - a learned phobia.

Maintenance by operant conditioning explains why phobias persist rather than fading. When the person avoids the phobic stimulus, their anxiety is reduced, and this reduction is rewarding - it is negative reinforcement (the removal of an unpleasant state). Because avoidance is reinforced every time, the person keeps avoiding the stimulus, so they never learn that it is harmless and the phobia is maintained. Evaluation: the model has real-world application (it explains why exposure-based therapies work) and is supported by evidence that phobias can be conditioned, but it cannot explain all phobias (many phobic people cannot recall a traumatic event, and we more readily acquire phobias of evolutionarily dangerous things such as snakes - biological preparedness - which pure learning cannot explain).

The two treatments follow directly from the model, both based on exposure to unlearn the association. Systematic desensitisation gradually replaces the fear response with relaxation through counterconditioning. The client and therapist build an anxiety hierarchy (a ranked list of feared situations from least to most frightening), the client is taught deep relaxation, and they then work up the hierarchy while staying relaxed - because it is impossible to be relaxed and afraid at the same time (reciprocal inhibition), the fear is gradually extinguished. It is gradual and generally well tolerated.

Flooding is the opposite: the client is exposed immediately and without escape to the most frightening version of the phobic stimulus (for example being in a room with a large spider) for a prolonged period. Because avoidance is prevented, the fear response cannot be reinforced and eventually exhausts itself, and the client learns that the stimulus is harmless (extinction). Flooding is quicker and cheaper than systematic desensitisation but is highly unpleasant and can be traumatic, so informed consent and client suitability are essential, and it is less effective for complex phobias such as social phobia that have a strong cognitive component.

Worked example

Designing an anxiety hierarchy

Outline how you would use systematic desensitisation to treat a fear of flying, including a brief hierarchy.

Teach relaxation
The client first learns a deep-relaxation technique (e.g. controlled breathing) that is incompatible with anxiety.
Build the hierarchy
Rank situations from least to most feared: looking at a picture of a plane; visiting an airport; boarding a stationary plane; a short flight; a long flight.
Work up while relaxed
The client progresses up the hierarchy only when relaxed at each step; because relaxation and fear cannot coexist (reciprocal inhibition), the fear is gradually extinguished.

Result: A relaxation-based, graded exposure that replaces fear with calm through counterconditioning.

Typical mistakes

Saying avoidance is positive reinforcement - it is negative reinforcement (removal of anxiety).
Confusing systematic desensitisation (gradual, with relaxation) and flooding (immediate, full exposure).

Active revision

Explain how systematic desensitisation would be used to treat a phobia of dogs, referring to reciprocal inhibition.

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for psychology (Department for Education) · AQA A-level Psychology 7182 specification (AQA)

The cognitive approach to depression: Beck, Ellis and CBT#

AdvancedAQA 7182 3.1.4DfE GCE Psychology - the cognitive approach to depression

Beck's negative triad

Fig. 5Beck's negative triad: automatic negative views of the self, the world and the future maintain depression.

The cognitive approach explains depression as the result of faulty, irrational thinking rather than external events themselves. Beck (1967) proposed a cognitive vulnerability made up of three elements. Faulty information processing means depressed people attend to the negative and ignore the positive, and think in absolutist 'black-and-white' terms. Negative self-schemas are packages of negative beliefs about the self, developed in childhood, through which all experience is interpreted. The negative triad is three automatic negative thoughts - a negative view of the self, of the world and of the future - that maintain the depression, each reinforcing the others.

Ellis (1962) offered the ABC model to explain how irrational beliefs cause emotional distress. A is the activating event (something that happens), B is the belief about that event (which may be rational or irrational), and C is the consequence (the emotional and behavioural reaction). Ellis argued that it is not the event (A) but the belief (B) that produces the consequence (C): irrational beliefs, such as the demand that one must always succeed (which Ellis called 'musturbation'), lead to depression when reality falls short. This is why two people can experience the same event but react very differently.

The cognitive approach is evaluated as influential but partial. Its strength is strong support and a highly successful therapy derived from it (see below), and it usefully shifts responsibility for change from the situation to the person's thinking. Its weaknesses are that it may confuse cause and effect - negative thinking could be a symptom of depression rather than its cause - and that by locating the problem in the individual's cognition it can overlook genuine situational and biological causes; depression also has a well-established biological component that a purely cognitive account ignores.

The therapy derived from the approach is cognitive behaviour therapy (CBT). CBT combines cognitive elements (identifying and challenging the irrational or negative thoughts) with behavioural elements (setting behavioural activation tasks). In Beck's version the therapist helps the client test their negative thoughts as hypotheses against reality; in Ellis's version, REBT, the model is extended to ABCDE, where D is disputing the irrational belief and E is the effect of a more rational outlook. CBT is the leading psychological treatment for depression and has strong evidence of effectiveness, but it requires motivation and effort, may be less suitable in severe cases, and its success may depend heavily on the therapist-client relationship.

Ellis's ABC model

Fig. 6In Ellis's ABC model the belief (B), not the event (A), determines the emotional consequence (C).

Worked example

Applying the ABC model

A person is not invited to a party (A) and concludes 'nobody likes me and they never will' (B), becoming very low (C). Analyse this using Ellis's model and suggest the therapeutic 'D' step.

Identify A, B and C
A = not being invited; B = the irrational belief that nobody likes them and never will (over-generalisation); C = the depressed mood.
Explain the causal claim
Ellis argues C follows from B, not A: the same event with a rational belief ('one missed invitation is not a verdict on my worth') would not produce depression.
Add the D step (REBT)
The therapist disputes the irrational belief - challenging the evidence for 'nobody likes me' - leading to E, a more balanced outlook and improved mood.

Result: The irrational belief B drives the low mood C; disputing B (D) produces a healthier effect (E).

Typical mistakes

Getting the negative triad wrong - it is self, world and future (not past).
Saying the event causes the emotion in Ellis's model - the belief about the event does.

Active revision

Using Ellis's ABC model, explain why two students who both fail a test might react very differently.

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for psychology (Department for Education) · AQA A-level Psychology 7182 specification (AQA)

The biological approach to OCD: explanation and treatment#

AdvancedAQA 7182 3.1.4DfE GCE Psychology - the biological approach to OCD

Biological explanation and treatment of OCD

Fig. 7Genetic and neural factors contribute to OCD; SSRIs act on the serotonin abnormality to reduce symptoms.

The biological approach explains OCD through genes and brain function. The genetic explanation says people inherit a vulnerability to OCD. Twin studies show much higher concordance in identical (monozygotic) than in non-identical (dizygotic) twins, and OCD runs in families. Candidate genes have been identified - for example genes affecting the serotonin system (such as the SERT/5-HTT gene) and the dopamine system (the COMT gene) - and OCD appears to be polygenic (many genes each making a small contribution) and aetiologically heterogeneous (different combinations of genes cause OCD in different people), which is why no single 'OCD gene' has been found.

The neural explanation points to abnormal brain chemistry and structures. Low levels of the neurotransmitter serotonin are associated with OCD, which fits with the finding that drugs that raise serotonin reduce symptoms. Abnormal functioning of a circuit linking the orbitofrontal cortex, the caudate nucleus (part of the basal ganglia) and the thalamus - sometimes called the 'worry circuit' - is thought to generate the intrusive thoughts: the orbitofrontal cortex sends 'worry' signals that are normally suppressed, but in OCD this suppression fails and the signals are amplified, producing obsessions and the compulsions performed to relieve them.

The biological explanation is evaluated as well supported but incomplete. The twin and family evidence and the success of drug therapy support a biological basis, and the discovery of candidate genes strengthens it. However, concordance in identical twins is well below 100%, so genes cannot be the whole story - environmental triggers matter too - and the neural evidence is largely correlational, so we cannot be sure the brain differences cause OCD rather than resulting from it. A purely biological account also ignores the role of learning and cognition.

Drug therapy follows from the neural explanation. The first-line drugs are SSRIs (selective serotonin reuptake inhibitors, such as fluoxetine), which block the reabsorption of serotonin at the synapse so that more remains available to stimulate the next neuron, correcting the low-serotonin abnormality; they typically take several weeks to work and are often combined with CBT. If SSRIs are ineffective, tricyclics or SNRIs may be used. Drug therapy is evaluated as effective, cheap and non-disruptive (the patient just takes a tablet), but it treats symptoms rather than causes, can have side effects (nausea, loss of libido) and tends to relapse when the drug is stopped, so it is best used alongside psychological therapy.

Worked example

Interpreting twin-concordance data

A study finds OCD concordance of about 68% in identical twins and 31% in non-identical twins. What does this suggest, and why does it not prove OCD is entirely genetic?

Compare the concordance rates
The much higher concordance in identical twins (who share 100% of their genes) than non-identical twins (who share about 50%) suggests a genetic contribution to OCD.
Note the shortfall from 100%
Identical twins share all their genes, yet concordance is only about 68%, not 100%.
Draw the conclusion
If genes fully determined OCD, identical-twin concordance would be 100%; the gap shows environmental factors also contribute, supporting a diathesis-stress rather than purely genetic account.

Result: The data support a genetic vulnerability but, because concordance is below 100%, environment must also play a part.

Typical mistakes

Claiming a single gene causes OCD - it is polygenic and aetiologically heterogeneous.
Saying SSRIs add serotonin - they block its reuptake, leaving more of the body's own serotonin in the synapse.

Active revision

Explain how SSRIs reduce the symptoms of OCD, linking the drug's action to the neural explanation.

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for psychology (Department for Education) · AQA A-level Psychology 7182 specification (AQA)

References & sources

Sources

Department for Education

GCE AS and A level subject content for psychology

AQA

AQA A-level Psychology 7182 specification

Psychopathology

5 sections~17 min reading time3 competenciesLevel Foundation 1 · Standard 1 · Advanced 3

Psychopathology

Key points

Choosing a definition for a case

Key points

Classifying symptoms in a vignette

Key points

Designing an anxiety hierarchy

Key points

Applying the ABC model

Key points

Interpreting twin-concordance data

Sources

Psychopathology

Key points

Choosing a definition for a case

Key points

Classifying symptoms in a vignette

Key points

Designing an anxiety hierarchy

Key points

Applying the ABC model

Key points

Interpreting twin-concordance data

Sources