SNHU: Abnormal Psychology: Clinical Perspectives on Psychological Disorders Chapter 4 Notes
Chapter 4: Theoretical Perspectives
- Case Report: Meera Krishnan
- Demographic information: 26-year-old Indian-American female.
- Presenting problem: Meera self-referred to my office upon the urging of a friend. For the past three weeks she reports feeling “profoundly sad for no reason at all,” lethargic, and preoccupied with thoughts of suicide, although she stated that she has no specific plan or intent to commit suicide. Her work performance has suffered. She oversleeps most days, has lost her appetite, and tries to avoid any social contact. She describes feeling that she has greatly let down her family and friends.
- Relevant history: A college graduate, Meera works as a biologist in a hospital research laboratory. The younger of two daughters, Meera reported feeling that her parents favored her older sister. She feels that her parents disapprove of her current lifestyle in comparison to her sister, who married the son of family friends. Although she and her sister had once been very close, they no longer maintain regular contact, and she rarely visits her parents, although they live in a neighboring town. Meera reported that she rarely drank alcohol and had never used any illicit drugs. She has no medical conditions and reported that, in general, her health is very good. Prior to the onset of her current depressive episode, Meera reported that she exercised regularly by participating in a long-distance running club and enjoyed cooking with her friends and listening to music. This is Meera's third depressive episode since her junior year of high school. Each episode has lasted approximately two months or slightly longer. She has not previously sought treatment.
- Symptoms: For three weeks, Meera has been experiencing overwhelming feelings of sadness, not accounted for by bereavement, substance use, or a medical condition. Her symptoms include feelings of worthlessness, tearfulness, loss of interest, sleep disturbance (oversleeping), and loss of appetite. She has experienced recurrent thoughts about death and passive suicidal ideation.
- Case formulation: Meera meets DSM-5 criteria for Major Depressive Disorder (MDD), recurrent. The symptoms of her current depressive episode are interfering with her ability to carry out her normal daily functioning. Since Meera has experienced two previous depressive episodes that have been at least two months apart each, her diagnosis is Major Depressive Disorder, recurrent.
- Treatment plan: The principles of evidence-based practice suggest that the best treatment for Meera is cognitive-behavioral therapy. Following intake, she will receive a complete psychological assessment and be referred to a psychiatrist for a medical evaluation
- Ø 4.1: Theoretical Perspectives in Abnormal Psychology
- Theoretical perspectives, orientations to understanding the causes of human behavior and the treatment of abnormality all guide research and clinical work in abnormal psychology.
- Ø 4.2: Biological Perspective- A theoretical perspective in which it is assumed that disturbances in emotions, behavior, and cognitive processes are caused by abnormalities in the functioning of the body.
- The transmission of information throughout the nervous system takes place at synapses, or points of communication between neurons.
- Electrical signals containing information transmit chemically across the synapse from one neuron to the next. Through this transmission, neurons form complex pathways along which information travels from one part of the nervous system to another.
- Neurotransmitters are the chemical messengers that travel across the synapse, allowing neurons to communicate with their neighbors.
Depressive disorders Anxiety disorders (panic disorder)
Depressive disorders Anxiety disorders Schizophrenia Anorexia nervosa Substance use disorders
Gamma-amino butyric acid (GABA)
Anxiety disorders Substance use disorders
Neurocognitive disorder due to Parkinson's disease Schizophrenia Eating disorders Substance use disorders
Neurocognitive disorder due to Alzheimer's disease
Substance use disorders
- Abnormalities in the brain structures themselves can also cause psychological symptoms. Although it's not always possible to link brain structures that are too large or too small to behavioral impairments, researchers believe that some disturbances in behavior have a connection to abnormally developed or functioning brain structures.
- The causes of nervous system dysfunction range from genetic abnormalities to brain damage. Genetic abnormalities can come about through the inheritance of particular combinations of genes, to faulty copying when cells reproduce, or to mutations that a person acquires over the course of life. Cells do possess the ability to repair many of these mutations. If these repair mechanisms fail, however, the mutation can pass along to the altered cell's future copies.
- Genes contain the instructions for forming proteins, which, in turn, determine how the cell performs. In the case of neurons, genes control the manufacturing of neurotransmitters, as well as the way the neurotransmitters behave in the synapse. Genes also determine, in part, how the brain's structures develop throughout life. Any factor that can alter the genetic code can also alter how these structures perform.
- Inherited disorders come about when the genes from each parent combine in such a way that the ordinary functioning of a cell is compromised.
- Your genotype is your genetic makeup, which contains the form of each gene that you inherit, called an allele.
- EX. - Let's say that Allele A causes a protein to form that leads a neuron to form abnormally. Allele B causes the neuron to be entirely healthy. If you have inherited two genes containing Allele B, then you have no chance of developing that disease. If, on the other hand, you have inherited two genes containing Allele A, you will almost certainly get the disease. If you inherit one Allele A and one Allele B, the situation becomes more complicated.
- Whether or not you get the disease depends on whether Allele A is “dominant,” meaning that its instructions to code the harmful protein will almost certainly prevail over those of Allele B. If Allele A is “recessive,” then it alone cannot cause the harmful protein to form. However, because you are an AB combination, you are a carrier because should you produce a child with another AB carrier, that child could receive the two AAs, and therefore develop the disorder
- Your genotype is your genetic makeup, which contains the form of each gene that you inherit, called an allele.
- The dominant-recessive gene inheritance model rarely, if at all, can account for the genetic inheritance of psychological disorders.
- There are multiple genes involved in the development of psychological disorders, the environment plays an important role in contributing to the way our behavior reflects our genetic inheritance.
- Your phenotype is the observed and measurable characteristic that results from the combination of environmental and genetic influences.
- Some phenotypes are relatively close to their genotype. For example, your eye color does not reflect environmental influences.
- Complex organs such as the brain, however, often show a wide disparity between the genotype and phenotype because the environment to which people are exposed heavily influences brain development throughout life.
- There are numerous genes that participate in building the structures in the brain and influencing their changes over time.
- The study of epigenetics attempts to identify the ways that the environment influences genes to produce phenotypes.
- Treating Meera
- A clinician working within a biological perspective would treat Meera's depression with antidepressant medications beginning, most likely, with SSRIs.
- Because these medications do not take effect for several weeks, the clinician would monitor her closely during this period to ensure that Meera remains stable.
- During this time, the clinician would meet with her on a weekly basis at least, to monitor Meera's progress, learn of any side effects that she is experiencing, and make adjustments as necessary particularly after four to six weeks.
- Meera is not a suitable candidate for more radical interventions because, although she has suicidal thoughts, she does not have plans and does not appear to be at significant risk.
- The clinician may also recommend that Meera attempt to resume her prior exercise routines to help augment the therapeutic effects of her medications.
- Researchers studying psychopathology have long been aware of the joint contributions of genes and the environment to the development of psychological disorders. The diathesis-stress model proposed that people are born with a diathesis (genetic predisposition) or acquire vulnerability early in life due to formative events such as traumas, diseases, birth complications, or harsh family environments. This vulnerability then places these individuals at risk for the development of a psychological disorder as they grow older.
- At the present time, biologically based treatment cannot address the disorder's cause in terms of fixing genetic problems. Instead, biological therapies either involve medications, surgery, or other direct treatment forms on the brain.
- Psychotherapeutic medications are intended to reduce the individual's symptoms by altering the levels of neurotransmitters that researchers believe are involved in the disorder.
- Currently, the major categories of psychotherapeutic agents include antipsychotics, antidepressants, mood stabilizers, anticonvulsants, antianxiety medications, and stimulants.
- Biological treatments also include a second major category of interventions. Psychosurgery, or psychiatric neurosurgery, is a treatment in which a neurosurgeon operates on brain regions, most likely responsible for the individual's symptoms
- Ø 4.3: Trait Theory
- The trait theory approach proposes that abnormality occurs when the individual has maladaptive personality traits.
- The predominant trait theory in the field of abnormal psychology is the Five Factor Model, also called the “Big Five”. According to this theory, each of the basic five dispositions has six facets, which leads to a total of 30 personality components. The Five Factor Model includes the personality traits of neuroticism, extraversion, and openness to experience, agreeableness, and conscientiousness. A complete characterization of an individual on the five factors involves providing scores or ratings on each facet.
- According to trait theory, where they fall on the 30 facets strongly influences the shape of people's lives. People high on the traits that define the less psychologically healthy end of each continuum may be more likely to experience negative life events because their personalities make them more vulnerable to life stresses. People high on personality traits representing riskiness (thrill-seeking) are more likely to get hurt because their personalities lead them into situations that can land them in trouble. According to the Five Factor Model, although circumstances can change personality, it's more likely that personality molds circumstances.
- Treating Meera
- Because trait theory does not incorporate treatment, there are no obvious ways in which a clinician would apply this perspective to Meera's depression. However, as Dr. Tobin noted in the Case Report, Meera's Axis II diagnosis is deferred. Assessment of Meera's personality traits could assist in determining whether she in fact would receive such a diagnosis. Even if she does not have a personality disorder, it is possible that Meera's personality trait profile would be relevant to treatment. For example, she seems not to be overly introverted, as she interacts frequently with friends. Her depressive symptoms appear not to be overlaid onto personality traits that include high neuroticism. She seems to enjoy activities that involve creativity and exploration of the outdoors, indicating a normative personality for her age in openness to experience. Prior to her depressive episode, she was, at least, average in conscientiousness, as her successful work history indicated, and there is no evidence to suggest that she is unusually low in agreeableness. Meera's clinician would most likely order an assessment that includes a personality trait-based measure to confirm these hypotheses and to determine whether or not she has a comorbid personality disorder.
- According to research using highly sophisticated data analytic designs to follow up on people over time, people can change even their fundamental personality traits.
- Ex. - As people get older, they are less likely to act impulsively
- The main value of understanding personality trait theory is that it provides a perspective for examining personality disorders. Research based on the Five Factor Model became the basis for the current attempts to reformulate the personality disorders in the DSM-5. Although the Five Factor Model does not necessarily provide a framework for psychotherapy, it has proven valuable as a basis for personality assessment within the context of understanding an individual's characteristic behavior patterns