AQA Psychology Psychopathology 规划

## AQA心理病理 恐惧症 抑郁症 OCD 行为疗法 > A-Level AQA Psychology Psychopathology: Definitions of Abnormality, Characteristics of Phobias, Depression & OCD, plus Behavioral, Cognitive & Biological Approaches to Explaining and Treating Mental Disorders. Bilingual study notes for A-Level Psychology students. --- ### 1. 异常行为的四种定义 / Four Definitions of Abnormality Psychopathology starts with a fundamental question: how do we define what is "abnormal"? The AQA specification requires you to know four definitions, each with strengths and limitations. **Statistical Infrequency / 统计罕见性** A behaviour is abnormal if it is statistically rare — falling more than two standard deviations from the mean on a normal distribution curve. For example, an IQ below 70 (occurring in about 2% of the population) is considered abnormal and may indicate intellectual disability. Strength: Provides an objective, quantitative cut-off point. No subjective judgement is involved — the numbers speak for themselves. Limitation: Not all statistically rare behaviours are undesirable. An IQ above 130 is just as statistically rare as one below 70, yet we consider high intelligence a desirable trait. This definition fails to distinguish between rare positive and rare negative behaviours. **Deviation from Social Norms / 偏离社会规范** Behaviour is abnormal if it violates the unwritten rules or expectations of a given society. Social norms vary across cultures, time periods, and contexts. For instance, wearing heavy makeup to a funeral might be considered deviant in one culture but perfectly acceptable in another. Strength: Takes context into account. What matters is not the behaviour itself but whether it is appropriate for the situation and cultural setting. Limitation: Social norms change over time. Homosexuality was classified as a mental disorder in the DSM until 1973. Using social norms as a definition risks pathologising minority groups and can be used as a tool for social control. **Failure to Function Adequately / 无法正常生活** Rosenhan and Seligman (1989) proposed seven criteria for failing to function adequately: personal distress, maladaptive behaviour, unpredictability, irrationality, observer discomfort, violation of moral standards, and unconventionality. A person who cannot hold down a job, maintain relationships, or take care of basic hygiene may be considered abnormal. Strength: This definition respects the subjective experience of the individual. It recognises that the patient's own distress and inability to cope are central to identifying abnormality. Limitation: Not everyone who is abnormal experiences distress or fails to function. Some individuals with antisocial personality disorder function perfectly well in society while causing harm to others. Conversely, normal life events like bereavement can cause temporary failure to function. **Deviation from Ideal Mental Health / 偏离理想心理健康** Marie Jahoda (1958) identified six criteria for ideal mental health: positive self-attitude, self-actualisation, resistance to stress, personal autonomy, accurate perception of reality, and environmental mastery. The more criteria a person fails to meet, the more abnormal they are considered. Strength: Takes a positive, holistic approach. Rather than focusing on what is wrong, it defines what psychological wellbeing looks like and measures deviation from that ideal. Limitation: Jahoda's criteria are extremely demanding. Most people would fail to meet all six criteria at any given time. This definition sets an unrealistically high standard for mental health and risks labelling the majority of the population as abnormal. --- ### 2. 恐惧症 / Phobias A phobia is an anxiety disorder characterised by an irrational and excessive fear of a specific object, situation, or activity. The DSM-5 recognises three categories: specific phobias, social phobia (social anxiety disorder), and agoraphobia. **Behavioural Characteristics / 行为特征** Panic responses: crying, screaming, running away, or freezing. These are immediate and automatic reactions triggered by exposure to the phobic stimulus. Avoidance: the individual goes to great lengths to avoid encountering the feared object or situation. This can severely disrupt daily life — someone with agoraphobia may become housebound. Endurance: the alternative to avoidance, where the person remains in the presence of the phobic stimulus but experiences extreme anxiety throughout. **Emotional Characteristics / 情绪特征** Anxiety: an unpleasant state of high arousal that prevents relaxation. The emotional response is disproportionate to the actual threat posed by the stimulus. Fear: the immediate and intense emotional reaction upon exposure. This is more acute than general anxiety and is linked to the fight-or-flight response. **Cognitive Characteristics / 认知特征** Selective attention: the person cannot look away from the phobic stimulus. This makes it difficult to concentrate on anything else. Irrational beliefs: the person holds beliefs about the phobic stimulus that are not supported by reality. For example, a person with arachnophobia may believe that all spiders are deadly. Cognitive distortions: the phobic stimulus is perceived as more threatening or dangerous than it actually is. **Behavioural Explanation: The Two-Process Model / 行为解释：双过程模型** Mowrer (1947) proposed that phobias are acquired through classical conditioning and maintained through operant conditioning. Acquisition: A neutral stimulus becomes associated with a fear response through pairing with an unconditioned stimulus that naturally produces fear. Watson and Rayner's (1920) Little Albert experiment demonstrated this process — a white rat (neutral stimulus) was paired with a loud noise (unconditioned stimulus), and Albert developed a phobia of the rat and similar fluffy objects. Maintenance: When the person avoids the phobic stimulus, their anxiety is reduced. This negative reinforcement strengthens the avoidance behaviour, making the phobia resistant to extinction. Strength: The two-process model has real-world application in exposure therapies. If phobias are maintained by avoidance, then preventing avoidance should extinguish the phobia. This is the principle underlying systematic desensitisation and flooding. Limitation: Not everyone who experiences a traumatic event develops a phobia. Diathesis-stress models suggest that genetic vulnerability may play a role. Additionally, some phobias (such as fear of snakes) may have evolutionary origins rather than being learned through classical conditioning — Seligman's (1971) concept of preparedness. **Behavioural Treatment: Systematic Desensitisation / 行为治疗：系统脱敏** Wolpe (1958) developed systematic desensitisation based on counterconditioning — it is impossible to feel fear and relaxation simultaneously (reciprocal inhibition). The process involves three stages: (1) the patient is taught deep relaxation techniques, (2) therapist and patient construct an anxiety hierarchy from least to most frightening scenarios, (3) the patient works through the hierarchy while maintaining relaxation, only moving up when they can remain calm at the current level. Strength: SD is highly effective for specific phobias. Gilroy et al. (2003) found that patients treated with SD for spider phobia showed significantly less fear than a control group at both 3 and 33 months follow-up. Limitation: SD is less effective for phobias with an evolutionary basis (such as fear of heights or darkness) and for social phobias, which may have cognitive components that behavioural treatment alone cannot address. **Behavioural Treatment: Flooding / 行为治疗：满灌疗法** Flooding involves immediate, full-intensity exposure to the phobic stimulus without the gradual build-up of systematic desensitisation. The patient cannot avoid the stimulus, and their fear response eventually subsides as the body cannot maintain a state of high anxiety indefinitely (extinction). Strength: Flooding is faster and more cost-effective than SD. A single session lasting 2-3 hours can sometimes eliminate a phobia. Limitation: Flooding is highly traumatic and has high drop-out rates. It is not suitable for all patients, particularly those with heart conditions or severe anxiety. Ethical concerns arise around informed consent and psychological harm. --- ### 3. 抑郁症 / Depression Depression is a mood disorder characterised by persistent low mood and loss of interest or pleasure in activities. The DSM-5 requires at least five symptoms to be present for at least two weeks for a diagnosis of major depressive disorder. **Behavioural Characteristics / 行为特征** Reduced activity levels: lethargy, withdrawal from work, education, and social life. In extreme cases, the person cannot get out of bed. Disruption to sleep and eating: insomnia or hypersomnia; increased or decreased appetite leading to weight changes. Aggression and self-harm: some indi

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viduals display irritability and aggression; self-harm and suicide attempts are tragically common. **Emotional Characteristics / 情绪特征** Lowered mood: persistent feelings of sadness, emptiness, and worthlessness. This is more than just "feeling down" — it is pervasive and long-lasting. Anger: some individuals experience intense anger directed at themselves or others. This anger may be expressed outwardly or turned inward as self-criticism. Lowered self-esteem: the person dislikes themselves and may express feelings of self-hatred. **Cognitive Characteristics / 认知特征** Poor concentration: difficulty focusing on tasks, making decisions, or remembering information. This can impair academic and occupational performance. Dwelling on the negative: the person pays disproportionate attention to negative events and interprets neutral events negatively. Absolutist thinking: black-and-white thinking patterns where situations are perceived as either complete success or total failure, with no middle ground. **Cognitive Explanation: Beck's Negative Triad / 认知解释：贝克负性三角** Beck (1967) proposed that depression results from faulty information processing and negative schemas developed during childhood. These schemas are activated by stressful life events and produce systematic cognitive biases. The negative triad consists of three interrelated negative views: the self ("I am worthless"), the world ("everyone is against me"), and the future ("things will never get better"). Cognitive biases include: overgeneralisation (drawing sweeping conclusions from a single event), catastrophising (exaggerating the importance of minor setbacks), and personalisation (blaming oneself for events outside one's control). Strength: Research support. Grazioli and Terry (2000) found that pregnant women with high cognitive vulnerability were more likely to develop post-natal depression. This supports the idea that negative schemas precede and predict depression. Limitation: The theory does not explain the biological symptoms of depression such as sleep disturbance, appetite changes, and fatigue. A purely cognitive explanation is incomplete without considering neurochemical factors. **Cognitive Explanation: Ellis's ABC Model / 认知解释：埃利斯ABC模型** Ellis (1962) proposed that depression arises from irrational beliefs. The ABC model explains: A (Activating event) triggers B (Beliefs, which may be rational or irrational), leading to C (Consequences, emotional and behavioural). Irrational beliefs include "musturbation" (the belief that one must always succeed or be approved of) and "awfulising" (the belief that failure is catastrophically terrible). Strength: The ABC model provides a clear, practical framework for therapy. REBT directly challenges irrational beliefs and has been shown to be effective in treating depression. Limitation: The model blames the individual for their depression by locating the cause in their own thinking patterns. This may overlook situational factors such as poverty, abuse, or discrimination that contribute to depression. **Cognitive Treatment: CBT / 认知行为治疗** Cognitive Behavioural Therapy combines Beck's cognitive therapy with behavioural techniques. The therapist helps the patient identify and challenge negative automatic thoughts through techniques such as thought catching, reality testing, and behavioural activation. Patients are given homework assignments to test their negative beliefs against reality. For example, a patient who believes "nobody likes me" might be asked to keep a diary recording every positive social interaction during the week. Strength: March et al. (2007) compared CBT, antidepressant medication, and a combination of both in treating adolescent depression. After 36 weeks, 81% of the CBT group and 81% of the medication group showed improvement, suggesting CBT is as effective as medication. Limitation: CBT requires motivation and engagement from the patient. Severely depressed individuals may lack the energy and concentration needed to participate fully in therapy sessions. --- ### 4. 强迫症 / Obsessive-Compulsive Disorder (OCD) OCD is an anxiety disorder characterised by persistent, intrusive thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) performed to reduce the anxiety caused by obsessions. **Behavioural Characteristics / 行为特征** Compulsions: repetitive behaviours such as hand washing, checking, counting, or ordering. These are performed to reduce anxiety but provide only temporary relief. Avoidance: individuals may avoid situations that trigger their obsessions, leading to significant disruption of daily life. **Emotional Characteristics / 情绪特征** Anxiety and distress: obsessions produce intense anxiety. The compulsive behaviour temporarily relieves this anxiety, reinforcing the cycle. Guilt and disgust: many individuals experience irrational feelings of guilt about their obsessions or disgust at perceived contamination. **Cognitive Characteristics / 认知特征** Obsessive thoughts: intrusive, unwanted thoughts that recur persistently. Common themes include contamination, harm, symmetry, and forbidden thoughts. Cognitive coping strategies: individuals may try to neutralise obsessive thoughts with counter-thoughts or prayers. This paradoxically keeps the thoughts in focus. Insight: most individuals with OCD recognise that their obsessions and compulsions are irrational, yet feel powerless to resist them. **Biological Explanation: Genetic Factors / 生物解释：遗传因素** Family and twin studies suggest a genetic component to OCD. Nestadt et al. (2000) found that first-degree relatives of OCD patients have a 11.7% lifetime risk of developing OCD, compared to 2.7% in the general population. Twin studies show concordance rates of 68% for MZ twins versus 31% for DZ twins. Candidate genes include the SERT gene (regulating serotonin transport) and the COMT gene (regulating dopamine). OCD is polygenic — multiple genes each contribute a small increase in vulnerability. Strength: There is substantial empirical support for a genetic basis. The diathesis-stress model provides a balanced framework: genes create vulnerability, but environmental stressors trigger the onset of the disorder. Limitation: Concordance rates are never 100%, even in MZ twins who share 100% of their DNA. Environmental factors clearly play a significant role. **Biological Explanation: Neural Factors / 生物解释：神经因素** Neuroimaging studies have identified abnormal functioning in the orbitofrontal cortex, which is involved in decision-making and impulse control. The caudate nucleus, which normally filters out worry signals, appears to be dysfunctional in OCD patients, allowing obsessive thoughts to reach conscious awareness. The serotonin hypothesis suggests that low levels of serotonin contribute to OCD. Antidepressants that increase serotonin availability (SSRIs) are effective in reducing OCD symptoms, supporting this hypothesis. **Biological Treatment: Drug Therapy / 生物治疗：药物治疗** SSRIs (Selective Serotonin Reuptake Inhibitors) such as fluoxetine (Prozac) are the standard pharmacological treatment for OCD. They work by blocking the reuptake of serotonin at the synaptic cleft, increasing serotonin availability and improving mood regulation. Tricyclic antidepressants such as clomipramine are used when SSRIs are ineffective. Anti-anxiety medications (benzodiazepines) may also be prescribed for short-term relief. Strength: Drug therapy is effective and relatively non-invasive compared to psychological therapies. Soomro et al. (2009) found that SSRIs significantly reduced OCD symptoms compared to placebo in a meta-analysis of 17 studies. Limitation: Side effects include nausea, headaches, insomnia, and sexual dysfunction. These can lead to patients discontinuing medication prematurely. Additionally, drug therapy treats symptoms rather than underlying causes, and relapse rates are high when medication is stopped. --- ### 5. 考试答题技巧 / Exam Technique Tips AO1 (Knowledge): Always define key terms precisely. For example, do not just say "OCD is caused by low serotonin" — specify "SSRIs increase serotonin availability by blocking reuptake pumps at the presynaptic neuron, leaving more serotonin in the synaptic cleft to bind with postsynaptic receptors." AO3 (Evaluation): Use the PEEL structure — Point, Evidence, Explanation, Link. Every evaluation point should include a named researcher and year where possible. Balance strengths and limitations in every essay. Comparison questions: When asked to compare approaches, identify at least one similarity and one difference. Link comparisons to specific aspects such as methodology, determinism, nature-nurture, or practical applications. ---

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