How do we define and categorise dysfunctional behaviour
Revision Notes
PLEASE NOTE THAT THESE ARE NOT EXHAUSTIVE NOTES
AND THAT YOU HAVE MUCH MORE RESEARCH THAN THIS –
YOU CAN ANNOTATE/ADD YOUR OTHER EVIDENCE AS A
REVISION TASK
Evidence
Attempts to define and categorise dysfunctional
behaviour have all been full of difficulty and later
proved inaccurate like ‘phrenology’ which looked at
the shape of a person’s head. Others like ‘failure to
function’ have also been used but you may fail to
function but not be mentally ill!
Categorisation of dysfunction has been
used to try and help doctors pinpoint specific differences
between different types of disorders such as anxiety,
affective or psychotic and help to improve the reliability of
diagnosis between clinicians:
DSM Diagnostic and Statistical
Manual
Developed only to help diagnose mental health disorders
and used world wide.
Published in USA by doctors who meet regularly to share
and update information on new disorders.
Is regularly updated in light of new and changing information
for example homosexually was taken out of the DSM and
ADHD put in.
Has over 350 different disorders such as..
Categorises disorders into recognizable symptoms such
as…
Has 5 axis or holistic approach to diagnosis and clinicians
also have to consider other factors such as social situation
or other physical diseases before making a diagnosis.
Is based on the medical or biological model of abnormality
although this approach has changed from its origins. Early
manuals were based more on the psychodynamic approach.
Another categorisation manual is
the ICD
International classification of diseases.
However this only has 100 categories for mental health and
also has categories for physical health.
Was set up to track infectious diseases across the world.
Bias in Diagnosis:
Kaplan argued that diagnosis is biased as authors of the
DSM have been mostly male. Categories use stereotypical
male and female traits ‘such as hystyonic’ disorders which
appear to be based on female behaviours. In a trial they
send case studies to a range of clinicians and found when
the same case study had a female name they were more
likely to be diagnosed with a histrionic or depe4ndent
Evaluation
Reliability:
The DSM is useful as it has helped improved the sharing of
information between doctors, not just in the USA but across
the world. By categorising different disorders it helps
doctors diagnose them in a more reliable and consistent
way. The DSM team meet regularly to discuss and agree
on symptoms and the manual is regularly updated. The
manual also considers other factors such as existing
physical illness or social circumstances before making a
diagnosis which makes the process more holistic.
On the other hand because there is no scientific ways of
identifying dysfunctional behaviour with a reliable test all
diagnosis is difficult. Research has shown that even with
the DSM doctors still interpret symptoms in different ways.
This may be due to either situational, gender or cultural bias
etc.
Also the DSM has over 350 categories for mental illness
whilst the ICD only has about 100, this must lead to the
conclusion that some of the categories in one or the other
must be either incomplete or incorrect (as in they do not
exist or are iatrogenic)
Thigpen and Cleckley were accused of making up multiple
personality disorder (an iatrogenic disorder) and some say
disorders such as hyperactivity disorder may be equally
invented by therapists.
Validity:
Bias affects the validity of diagnosis. This has been
demonstrated because the DSM often has to remove
categories. For example homosexuality used to be a
disorder but is now accepted as ‘normal’ behaviour due to
changes in social norms. This means that some categories
in the DSM may be affected by cultural or ethnocentric
bias.
Kaplan demonstrated how gender bias is also shown in the
categorisation process. As most of the doctors who
designed the DSM were men they incorporated categories
such as ‘hysterical behaviour’ into the process of diagnosis,
his research shows that doctors are more likely to say
women are hysterical than men.
On the other hand there may well be gender differences I
abnormal behaviour that cannot be over looked. If
dysfunctional behaviour is caused by genetic or biological
differences then it could be that there are biological
differences in disorders between genders.
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disorder whilst with a male name antisocial personality
disorder was more likely to be diagnosed.
Definitions of dysfunction:
People have also tried to define what abnormal behaviour
is. This is not a way of identifying specific differences
between disorders only what is or is no generally
dysfunctional:
Rosenhan and Seligman say there
are 7 factors which help define
dysfunction:
1.
2.
3.
4.
5.
6.
7.
Observer discomfort
Suffering of the person
Maladaptiveness to the environment
Vividness of behaviour or unconventionality
Irrationality or incomprehensiveness
Unpredictability or loss of control
Violation of normal moral standards
Situational bias is also a problem. For example Rosenhan
showed how simply being in a hospital caused a bias in the
way behaviour was interpreted. Abelson showed that just
telling a doctor a person has or has not got mental health
problems with affect the way in which behaviour is
interpreted.
Doctors who devise the DSM have also been accused of
being biased as they often are also employed by drug
companies who stand to make large sums of money out of
doctors prescribing drugs for new illnesses
Ethics:
There are ethical concerns with diagnosing dysfunctional
behaviour. As Rosenhan showed once you are diagnosed
with a mental illness this diagnosis remains with you for life.
This may cause you not to be able to obtain a job or to be
labelled negatively by society.
On the other hand it is important that people do get a label
as getting labelled does help people get the treatment and
support that they may need and helps them and their
relatives understand and deal with their diagnosis.
Characteristics of Disorders: Revision Notes
Evidence
Anxiety disorders
Persistent fear of object or situation
Stimulus provokes an immediate fight or flight response
intense feeling of terror
Is out of proportion to danger of stimulus
Person recognizes the fear is out of proportion
Effects life as person avoids stimulus
Has lasted more than 6 months
Evaluation – The same as DSM / ICD
Usefulness and problems of
categorisation:
By categorising different disorders it helps doctors diagnose
them in a more reliable and consistent way. The DSM
team meet regularly to discuss and agree on symptoms and
the manual is regularly updated.
Delusions
Hallucinations / auditory and visual
Paranoia
Disorganised speech
Disorganized behaviour
Social or occupational dysfunction
Lasted more than 6 months
No other explanation such as developmental disorders or
drug abuse
However, some disorders can be more reliably categorised
than others. For example there is some biological
measure with schizophrenia as a genetic test could be
carried out. However other disorders rely 100% on a
subjective judgement. Research has shown that even with
the DSM doctors still interpret symptoms in different ways.
This may be due to either situational, gender or cultural
bias etc. An example of this is that if a man says he is
tired, guilty and unable to concentrate be may be diagnosed
with stress due to perceived work and family commitments
however a woman is still more likely to be diagnosed with
depression. This could be because women are more likely
not to be identified as having pressured jobs or be more
likely to cry during a consultation than a man due to different
socially acceptable behaviours.
Affective disorders (Depression)
Also the DSM has over 350 categories for mental illness
whilst the ICD only has about 100, this must lead to the
conclusion that some of the categories in one or the other
must be either incomplete or incorrect (as in they do not
exist or are iatrogenic). For example depression may not be
a disorder but just a reaction to a serious bad life event.
Psychotic disorders
Patients also often do not fit into just one category so
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Depression:
Insomnia
Fidgety or lethargic
Tiredness
Guilt
Inability to concentrate
Recurrent thoughts of death and planning to die
for example a patient with manic depression (bi polar) may
also show evidence of hallucinations, this makes making
specific categories very difficult.
Because the categories have got so complicated doctors
use ‘personality disorder unknown’ instead.
There are ethical concerns with diagnosing dysfunctional
behaviour. As Rosenhan showed once you are diagnosed
with a mental illness this diagnosis remains with you for life.
This may cause you not to be able to obtain a job or to be
labelled negatively by society.
On the other hand it is important that people do get a label
as getting labelled does help people get the treatment and
support that they may need and helps them and their
relatives understand and deal with their diagnosis
Validity:
Bias affects the validity of diagnosis. This has been
demonstrated because the DSM often has to remove
categories. For example homosexuality used to be a
disorder but is now accepted as ‘normal’ behaviour due to
changes in social norms. This means that some categories
in the DSM may be affected by cultural or ethnocentric bias.
Mania may not be seen by some as an illness but more a
positive advantage in some areas of work like writing,
painting etc when people can be very prolific and
successful.
Explanations for dysfunctional behaviour: Revision Notes
Evidence
Anxiety disorders (Behaviourist
explanations)
Evaluation
Reductionism :
Dysfunctional behaviour is learned and is not best explained
by biological theory
Genetic inheritance only shows part genetics (12% in DZ
twins) so has to be large environmental component)
Classical conditioning (part of behaviourist theory)
Anxiety disorders are learned (nurture)
Example:
Little Albert and white rat (lab experiment – case study)
Paired presentations of hitting a metal bar (neutral stimulus
)which child was frighten off (neutral response) with a white
rat. Soon child developed association of fear with rat.
(Conditioned stimulus and conditioned response)
Can also use operant conditioning (people are rewarded
by the attention which reinforces the phobia)
Being reductionist is useful as it enables us to identify some
critical issues which may increase a patient’s chance of
recovery from a disorder. For example there is evidence
that patients recover from phobias with desensitisation
therapy which is based on reversing the effects of classical
conditioning (McGrath and noise phobia). If we can identify
a gene for schizophrenia we may be able to screen for this
disorder and eventually eradicate it.
On the other hand different explanations only consider one
aspect. The biological approach does not tell us what it is in
the social environment that triggers the behaviour of
schizophrenia. Could it be stress or could it be a virus?
Beck has found that patients given cognitive therapy as well
as drug therapy improve their recovery and are also more
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Social learning theory
They have observed fear in others and copied behaviour –
evidence is that phobias do run in families
adherent to drug regimes. Therefore a holist approach to
explaining disorders would be more effective than a
reductionist one alone.
Psychotic Disorders (Biological
explanations)
Reliability, validity, generalisability /
method
Explained by biological model
Brain structure – schizophrenic patients appear to have
enlarged ventricles in the brain
Brain function – too much dopamine
Genetics – evidence for schizophrenia being genetically
inherited.
Nature not nurture
Drugs can improve behaviour and are effective in reducing
hallucinations
People without genetic inheritance do not get schizophrenia
Reliability is an issue with explanations. For example
Watson’s study on Little Albert and classical conditioning is
supported by a wide range of laboratory studies which are
controlled and therefore reliable. Studies into genetic
inheritance and schizophrenia are also based on laboratory
tests which are scientific.
Gottesman and Shields (Review of other research)
Review of 3 adoption studies
Increase in schizophrenia of adoptive children when
biological parents have the disorder
58% chance in MZ twins
12% chance in DZ twins
However studies such as Beck’s into cognitive explanations
relied on self report methods to obtain data. As a self report
method may have demand characteristics or social
desirability bias which affects data, this reduces its validity.
Some explanations are better suited to some disorders than
others. For example classical conditioning explains phobias
and helps to treat phobias but does not account well for
schizophrenia and cannot be used to treat schizophrenia.
This makes explanations difficult to generalise from one
disorder to another,
Affective Disorders (cognitive
explanations)
Depression explained by cognitive approach:
Faulty thinking causes some disorders like depression.
Beck – self report by diary & interview
Patients kept diaries of thoughts
Patients were also interviewed
Findings: people with depression had
Low self esteem
Blamed themselves
Felt overwhelmed by responsibilities
Felt desire to escape
Were paranoid making false accusations against other
people
Beck:
Alternative explanations:
The psychodynamic approach would say that dysfunctional
behaviour is based in problems that have occurred during
early childhood. Problems may be buried into the
unconscious and the patient is not aware of the reasons for
their dysfunctional behaviour. Early childhood experience
and poor parenting maybe to blame. Psychodynamic
researchers for example say that people with schizophrenia
are more likely to come from dysfunctional families. These
behaviours would therefore have to be treated with hypnosis
or projective personality tests to uncover the unconscious
motivations behind them. They would say that biological
explanations or cognitive explanations are not useful.
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Treatments for disorders Revision Notes
Evidence
Therapies or treatments are based
on the approach that the researcher is coming
from. For example if you believe the most important
problem in dysfunctional behaviour is your biology then it
makes sense to treat the condition with drugs how ever it
you believe it is largely a leaned problem then you will treat
the condition with behaviour therapy. Make sure you
describe the approach – when describing the treatment!
Behavioural Treatments
Based on principles of classical & operant
conditioning and social learning
Anxiety disorders. Systematic desensitisation – based on
classical conditioning
McGrath used systematic desensitisation on a
child who had a phobia of noise specifically doors banging,
balloons etc.
They slowly introduced relaxation techniques and visual
imagery to a pairing of a noise, slowly conditioning the child
to associate noise with a relaxed body posture and an
image of being in her own bedroom with her toys.
Token Economy systems – based on operant
conditioning. Schizophrenic patients given
rewards for changing some of their outward
dysfunctional behaviours. This had effect of
helping people fit into society and be more
accepted.
Cognitive Treatments
Affective Disorders - Cognitive Therapy
Beck found that cognitive therapy was better than drug
therapy alone in treating depression.
Independent measures design experiment with 44 patients
wither severe or moderate depression
12 week period patients had cognitive and drug or drug
therapy. Becks depression inventory used to measure
depression.
Both groups improved but cognitive treatment combined
with drugs caused greater improvement and greater
adherence to drug regime.
Biological Treatments
This is composed of drug therapy, gene therapy, brain
surgery, ECT therapy. Drug therapy is the most common
treatment for dysfunctional behaviour. Drug therapies work
on neuro transmitters in the brain. Too much dopamine has
been found in schizophrenia so Lithium reduces the effect of
dopamine in the brain. Low levels of serotonin have been
found in depressive patients so Prozac increases the uptake
Evaluation
Reductionism / effectiveness
/individual differences
Each treatment takes a reductionist view – that it is only
considers one view as it is based on the approach that the
doctor believes to be the one which accounts best for the
condition. This can be useful if the treatment is effective.
Behavioural treatments for anxiety disorders are based on
reliable laboratory research and appear to be affective in
many cases. However treatments based on behavioural
techniques are not as effective for all disorders as they are
for phobias. For example it is difficult to effect changes on
schizophrenia through learning although some support has
been given to operant conditioning enable schizophrenic
patients to appear to be more normal by changing some
outward behaviour which can make their integrations into
their society less difficult.
Using one treatment alone is also not as effective as taking
a holistic approach. For example Beck found that combing
drug therapy with cognitive therapy there was not only a
better outcome but also the cognitive therapy helped
improve adherence to the drug therapy.
However this research is open to criticism as some
evidence for the effectiveness of treatments conflicts.
For example Karp and Frank showed there was no
difference in outcome when drug therapy was combined
other therapies. Also there are few examples of cognitive
therapy that does not consider some kind of behavioural
therapy alongside it (for example relaxation whilst changing
thought processes - CBT).
There are also considerable individual differences in the
effectiveness of treatments. For example over 20% of
patients with schizophrenia are not helped by any drug
therapy.
Ethics
There are serious ethical considerations with treatments of
dysfunctional behaviour. One problem is the serious side
effects of biological treatments. Many drugs like lithium can
have long time effects like kidney damage and other side
effects such as shaking, shuffling and inability to
concentrate. If patients have serious mental dysfunctional
then they are unable to give informed consent. Some
patients may also be dangerous to themselves or others and
so drug treatment is considered important however this
denies them the right to withdraw from treatments. This is
made even more unethical by the fact that most disorders
are diagnosed without any scientific evidence that they have
the disorder.
On the other hand many patients are helped by treatments
such as lithium. Their hallucinations are reduced which may
then help them make an informed choice about continuing
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of serotonin in the brain etc. Lithium reduces hallucinations
in schizophrenia.
ECT – electric shock treatment to the brain can reduce
depression
Some psychosurgery can improve some dysfunctional
behaviours like extreme aggression.
Karp and Frank showed that in depression drug therapy
was more effective than drug therapy combined with
cognitive therapy.
the treatment.
Costs / benefits of different treatments
Biological treatments are often more cost effective and can
increase the ability of a patient to live alone without care.
Behavioural therapies are time consuming and costly in
terms of time a patient has to attend and in training for the
therapist.
Alternative treatments
Psychodynamic therapists would say that therapy is
necessary which uncovers unconscious motivations for
behaviour. This cannot be done through drug therapy or
behaviour or cognitive therapy alone. An example of this is
that Thigpen and Cleckley thought that in order to cure MPD
Eve had to know about her other personalities in order to
deal with them.
Explanations and treatments for one disorder - Schizophrenia
Revision Notes
Evidence
Biological Explanations
Explained by biological model
Brain structure – schizophrenic patients appear to have
enlarged ventricles in the brain. Brain function – too much
dopamine
Genetics – evidence for schizophrenia being genetically
inherited.
Nature not nurture. Drugs can improve behaviour and are
effective in reducing hallucinations. People without genetic
inheritance do not get schizophrenia
Gottesman and Shields (Review of other research)
Review of 3 adoption studies
Increase in schizophrenia of adoptive children when
biological parents have the disorder. 58% chance in MZ
twins
12% chance in DZ twins
Biological Treatments
This is composed of drug therapy. Drug therapy is the most
common treatment for dysfunctional behaviours like
schizophrenia. Drug therapies work on neuro transmitters in
the brain. Too much dopamine has been found in
schizophrenia so Lithium reduces the effect of dopamine in
the brain. Lithium reduces hallucinations in schizophrenia. (It
would be helpful to explain how neurotransmitters work!).
Other biological treatments are being trialled such as use of
magnetic impulses on the part of the brain responsible for
hallucinations. This treatment is proving effective in some
patients.
Behavioural Explanations:
Based on principles of classical & operant
conditioning and social learning
Evidence for Behavioural Treatments
There is little evidence that classical conditioning would
work to treat schizophrenia however:
Token Economy systems – based on operant
conditioning. Schizophrenic patients given
rewards for changing some of their outward
Evaluation
Evaluate explanations/treatments of one
psychotics disorder – you will have to adapt
to the question of either treatments or
explanations! In the exam make sure you do
address the actual question clearly!
Biological explanations are reliable as they are based on
scientific evidence carried out under controlled laboratory
conditions. However they do not account for the social
aspects of the disorder as we do know that schizophrenia is
not inevitable just because you have the genetic
predisposition. This means we have to also take other
explanations into account. However ultimate this
explanation has led to drug therapy to control some aspects
of the disorder and may lead to a cure for schizophrenia by
developing gene therapy and so has to be considered an
extremely useful explanation.
Drug therapy such as lithium can decrease hallucinations
but has sever side effects. These side effects can be so
severe that ethics of treatment are brought into question. If
patients are too ill to give informed consent should we be
giving them drugs that can cause liver failure?
Although operant conditioning has been found to be
affective in some serve cases of schizophrenia the
effectiveness is only in changing the observed behaviour
and does not change the condition. This is useful as it can
help schizophrenics feel more accepted in a social situation
but is limited as a more general explanation of the disorder.
Behaviour therapy has been also criticised for its ethics.
Should we be changing the behaviour of others just because
we in society feel uncomfortable?
Psychodynamic explanations do help to explain why some
conditions like schizophrenia may occur in families without
the link being entirely 100% genetic. However there is little
scientific evidence to support the explanation and the
explanation does not account for the onset of schizophrenia
in patients that do have stable early childhoods. Hypnosis
is also an unreliable treatment and patients have accused
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dysfunctional behaviours. This had effect of
helping people fit into society and be more
accepted.
Social Learning – this would account for the increase
in levels of schizophrenia in the same family by saying some
of the behaviours may be due to modelling.
Cognitive Explanations:
Based on principles of faulty thinking patterns.
Cognitive Treatments
Research into the value of cognitive therapy is new in this
area but there is some evidence to support the fact that
even thought it cannot make symptoms like hallucinations
go away, learning which thoughts are real or unreal can
reduce the stress of the patients and increase their control
over their condition.
Psychodynamic Explanations
Based on Freud’s idea of crucial role of early development
of personality and effect of trauma and parenting in early
childhood. Research in this field shows a correlation
between schizophrenia and dysfunctional families.
Psychodynamic Treatment
Family therapy, personal therapy, hypnotherapy aimed at
identifying unconscious processes that may be caused the
behaviour. Would try to identify problems that occurred
during early childhood to do with parenting, development of
personality or identity etc and resolve those problems by
bringing them into the conscious mind. May involve
interpretation of dreams and projective tests.
doctors of giving them false memories when under
hypnosis.
Cognitive explanations for schizophrenia are also limited.
The advantage of cognitive explanations appears to be that
the therapy can give extra control to the patient and
therefore reduce the emotional effects of the disorder but
there is no effect of the treatment on the cause of the
disease.
Each explanation and therefore each treatment is therefore
reductionist as each tries to explain the cause/treatment
through one approach but no approach offers an full
explanation or a complete cure. However each approach /
explanation / treatment has something to offer. It seems that
a holistic approach would be the best way to explain / treat
this disorder as the biological model offers useful solutions
for the future and drugs which can help control the effects of
the disease whilst cognitive and behavioural approaches
offer ways of giving the patient more control and
understanding over his condition. The psychodynamic
approach maybe useful in some patients where family
dysfunction is known.
However there are considerable individual differences in
schizophrenia so those with a severe form of the disorder
may not yet be helped with any explanation/ treatment whilst
those on the other end of the spectrum may be helped more
by therapies such as CBT as they are able to take more
control and hopefully avoid the side effects of strong drug
therapy.
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