Psychopathology and development notes
07-09-2021
22 october 23:59, deadline for practical assignments
29 october, exam
The scientist practitioner
- Consumer of science, enhancing the practice
- Evaluator of science, determining the effectiveness of the practice
- Creator of science, conducting research that leads to new procedures useful in
practice
in today’s lecture
- How can we define a psychological disorder? (what is normal – what is abnormal?)
- How does the DSM define it? – and are there better ways?
- What are classifications good for?
- How can we diagnose a disorder?
What is psychopathology?
- The study of abnormal thoughts, behavior, and feelings (for example mental illness,
abnormal/maladaptive behavior)
- ‘psycho’ means ‘mind’
- ‘pathos’ means ‘feeling suffering’
- ‘logia’ means ‘the study of…’
Psychopathology and lifespan
- What factors lead to psychopathology?
- How may psychopathology arise in early childhood and then intensify over a lifetime?
o What is the individual’s initial level of vulnerability?
o And what types and amount of stress are experienced by that individual?
o Bio-psycho-social model
Biology; physical health, genetic vulnerabilities, drug effects
Psychological; coping skills, social skills, family relationships, self-
esteem, mental health
Social; peers, family circumstances, family relationships
Life-span and developmental influences on psychopathology
- life-span developmental perspective
- Some things that are normal at a certain age or stage, are not normal at another
- Stressors over the lifespan:
o Equifinality/multifocality
The same outcome can come from different origins
The same origin can end up at different outcomes
Global incidence of psychological disorders
- Mental health accounts for 13% of world disease burden
- Mental health care is very limited in developing countries
, o Sub-saharan Africa; only one psychiatrist per 2 million people
- Even in the US, only 1 in 3 people with a mental disorder has received any treatment
When is the problem starting?
The age when anxiety disorder and severe depression starts, anxiety starts much earlier,
shows importance to look at the lifespan
How do we look at health and illness?
- Categorical, 2 categories: healthy and ill
- Typological, 2 categories: health and ill but they can overlap
- Dimensional, one arrow that goes from healthy towards ill
What is normal and abnormal
Can be dependent on certain norms, but how do we define disease?
- Deviance
o Abnormal means deviating from social norms (which norms? What limitations
do they bring?)
- Statistically infrequent (mania and depression occur in 1% of the population, but
anxiety in 20-30%...)
Not all unusual behavior is abnormal (e.g., superior athletic ability, geniuses)
- Violation of social norms
o Abnormal behavior often violates the social norms of a given culture (e.g.,
experiencing and acting upon hallucinations, talking to inanimate objects)
o The violation of norms explicitly makes abnormality a relative concept
(criminals and prostitutes violate social norms, but would not fall within the
context of abnormal psychology)
- Distress
o Behavior or feelings may be abnormal if it creates great distress (e.g., people
with depression experience considerable distress)
o Not all distressed individuals are mentally ill
o Some mentally ill induvial do not show distress (e.g., psychopaths)
- Dysfunction
o Does the behavior impair an individual’s ability to function in life? (school,
work, personal, relationships) (e.g., substance-use disorders)
o Some individuals with an actual diagnosis, live functional lives (e.g., specific
phobias)
o Some do not function – but we have no diagnoses (e.g., some homeless)
Several factors need to be considered to determine what is abnormal and can accordingly be
considered as psychopathology
How does the DSM define disorders? And are there better ways?
- Dysfunction: a mental disorder is a syndrome characterized by clinically significant
disturbance in an individual’s cognition, emotion regulation, or behavior that reflects
a dysfunction in the psychological, biological, or developmental processes underlying
mental functioning (thoughts/feelings/behaviors)
- Distress: in social, occupational, or other important activities
, - Deviance: different from the norm, uncommon, rare. (But socially deviant behavior
(e.g., political, religious, or sexual) and conflicts between the individual and society
are not mental disorders)
- Danger: an in individual may be of danger to her/himself or others
We need this perceptive to classify, but why do we diagnose or classify?
1. accurate description
2. Prediction
3. Intervention
But does diagnosing always work?
“On being sane in insane places’ David Rosenhan
In 1970, 8 people, with no mental disorder tried to get admitted. Said they heard voices
(hallucinations). Once admitted no further reference to voices, normal behavior, courteous
and cooperative. Diagnosed as schizophrenic, all discharged in remission (average 28 days),
normality was not detected! This shows the power of labeling
Classification of mental disorders; pros and cons
- Cons
o Typologies can ‘hide’ basic dimensions
o Confusion between description and ‘explanation’
o Reifying diagnosis; seeing diagnosis as an existing entity, rather than a
product of set of judgments and conventions
o Losing information due to ‘labels’ (e.g., comorbidity)
o Stigmatizing due to labeling
- Pros
o Communication (standardized)
o Organization and reduction of information
o Efficient transfer of information
o Basis for the accumulation of knowledge (treatment, research)
o Instructions for clinical diagnostics and therapy
o Explicit classification is better than implicit classification
NIMH strategical plan: RDoc
‘develop, for research purposes, new ways of classifying mental disorders based on
dimensions of observable behavior and neurobiological measures’
Conclusions
- A ‘translational’ approach: disorders in terms of disruption of basic mechanisms
- A framework: studying mechanisms cutting across borders from traditional disordes
- Development of personalized healthcare in psychiatry
How do we diagnose?
- Clinical interviews
o Can be structured as well as unstructured
In an instructed interview, the clinician asks mostly open questions
In a structured interview, the clinician asks prepared questions, often
based on a published interview, can contain a ‘mental status exam’
, - Entrance interview
- The goal of the interview? Inform treatment
o A therapeutic decision must be based on knowledge of the disorder and
change
- The steps in the therapy should have a plan and a goal
- The professional psychotherapist is critical: evaluation of the own procedure
- Therapeutic decisions must be scientifically justified
- Standardized assessment
o Validity, the ability of an instrument to measure what it is supposed to
measure
Face validity: when the items seem to measure what the test is
intended to
Content validity: when the test assesses all important aspects of a
phenomenon
Concurrent validity: when a test gives similar results as compared to
established test of the same phenomenon
Predictive validity: when a test predicts well future thoughts, feelings,
and behaviors
Construct validity: when a test measures the psychological construct it
is supposed to measure (and not something else)
o Reliability, consistency in measuring what it is supposed to measure
Test-retest reliability: consistency over time
Internal reliability: when splitting a test in 2, each half gives similar
results
Inter-rater reliability: when a test administered by 2 different people
gives similar results
Diagnosis
- Is more than an interview
- Interview (classification) -> hypothesis
- Background information (history, stressors, context)
- Assessment with standardized tools (e.g., questionnaires)
- Behavior analyses…
- Observations
o This all results in a therapeutic plan
Questions you should be able to answer in response of the first lecture
- What is normal, what is abnormal?
- How is psychological ‘abnormality’ defined? How does the DSM define it?
- What is the Rosenhan study about? What where the consequences?
- Why do we need classifications?
- What are the pros and cons of the classification?
- Why are standardized or structured clinical interviews beneficial?
- What is inter-rater reliability?
- Describe different types of psychological assessment tools (e.g., clinical interviews,
symptom questionnaires, personality inventories)
o Use chapter 1 and 3 of ‘abnormal psychology’
