Abnormal Psychology

What is normal?
Is the definition of
normal the same on
every country?
Is someone with a high
IQ normal?
 How do you think diagnosis and
treatment differ on each culture?

How can we have ONE book of

disorders for everyone in the
world?
Dictionary Conforming to the standard or the
common type; usual; not abnormal;
definition of regular; natural
normal
What do you think?
Diagnosis
 Essential understandings

• Many factors may affect the reliability and validity of

diagnosis
• There are ethical considerations for diagnosing mental
illness.
• Concepts of normality and the classification of
psychological disorders is not universal.
 • The study of psychological disorders is called
“abnormal psychology”.
• Psychiatrists and psychologists use a
Concepts of standardized system called a diagnostic

normality manual to help them, but such a system is not

without faults.

and • Since there is no clear definition of normality—

or abnormality—and symptoms of the same
abnormality psychological disorders may vary not only
between individuals but also between social
and cultural groups, it is clear that a psychiatric
diagnosis may be biased or even wrong.
• Definitions of normality and abnormality can
also change over time.
 • Conceptual definitions are to a large extent based on
societal norms.
• These definitions include a statistical deviation from the norm,
deviation from social norms or deviation from what is
considered to be “mental health.” 

Conceptual • There are several problems with using “deviation from the
norm” as a criterion for labeling a behavior as “abnormal.”

definitions • Which of following behaviors would you consider to be

abnormal?
• Alcoholism
• Being able to see sounds and hear colours
• Being overextended; taking on too many projects or
activities
• Having conversations with dead ancestors
• Homosexuality
 Being able to see sounds and hear colors is a
phenomenon known as synesthesia. About .
05% of the population experiences the world
in this way. 
ATL: • Although it is abnormal from a statistical
Thinking point of view, it is not recognized as a
disorder.
critically 1.How do you think that having
synesthesia would affect how you live
your life?
2.Why do you think that psychologists do
not label synesthesia as a disorder? Do
you think that they are correct to do so?
 • Defining abnormal behavior as social deviation
is also problematic.
• Morality and cultural practices determine social
Conceptual norms, and they change over time.

definitions • Culture also plays a key role in what is

considered normal.

https://www.youtube.com/watch?v=syjEN3peCJ
w
 • Jahoda (1958) suggested that we could
define positive mental health in order to
recognize mental illness.

Definition of • The key features would be:

normality • self-acceptance, a potential for growth
and development
• Autonomy
• accurate perception of reality
• environmental competence
• positive interpersonal relationships.
 Practical Definition

Rosenhan & Seligman’s (1989) Criteria for Abnormal Behavior

Irrationality Unable to communicate in a reasonable manner.
Maladaptiveness Engages in behaviours that make life difficult.
Acts in a way that is difficult to watch or makes others
Observer discomfort
feel uneasy.
Suffering Experiences distress or discomfort

Unpredictability Acts in a way that is unexpected by him/herself or

others.
Habitually breaks the accepted ethical and moral
Violation of community standards
standards of the culture.
Experiences things that are different from most
Vividness & unconventionality
people.
 According to the latest DSM-V, there is no such
thing as an official diagnosis of "Internet Use
Disorder." However, it is listed as a possible
diagnosis in the future. According to the DSM-V,
ATL: more research is necessary before this can be
labeled as an official disorder.

Thinking • Based on the definitions in this chapter:

critically • Do you think that Internet Use Disorder

could be considered an official disorder?
• What would be the evidence you would use
for your decision? 
• What symptoms would you include as
important for an official diagnosis?
Classification
Systems
 Classification Systems
• Classification systems identify patterns of behavioral or mental
symptoms that consistently occur together to form a disorder.
• In the USA, psychiatrists and other healthcare professionals use
the Diagnostic and Statistical Manual of Mental Disorders,
published by the American Psychiatric Association (DSM-5).
• In addition to the DSM, the World Health Organization has
published the International Classification of Diseases [ICD].  This
system is developed by a global health agency and it is
distributed as broadly as possible at a very low cost.
• A Chinese Classification of Mental Disorders [CCMD] has also
been developed but Chinese psychiatrists also use the ICD-10
manual. 
 Activity: One of the disorders specified by the CCMD-
ATL: 2 is qigong deviation syndrome – also called
zou huo ru mo.
Research
and critical • Do some research on this disorder. 
• To what extent is this disorder rooted in
thinking Chinese culture? 
• What are the similarities between this
disorder and Western disorders?
 Key differences between the ICD-11 and
the DSM 5

• The ICD is produced by the World Health Organization, while the DSM is
produced by the American Psychiatric Association.
• The ICD's approach is multidisciplinary and multilingual with the intent that it
will be used globally to increase mental health; the primary users of the DSM
are American psychiatrists.
• The ICD is more likely to indicate causes rather than purely symptoms.
• The ICD is approved by the health ministers of all 193 WHO member
countries; the DSM is approved by the assembly of the American Psychiatric
Association.
• The ICD is distributed at a very low cost, with substantial discounts to low-
income countries, and available free on the Internet; the DSM generates a
very substantial portion of the American Psychiatric Association's revenue.
 Diagnosing psychological disorders

• When an individual seeks help for a potential psychological disorder, how do

psychiatrists go about making a diagnosis?
• There are several limitations of relying on a clinical interview for diagnosis:
• The individual is automatically labeled as a “patient.” This means that the
psychiatrist is “looking for evidence of abnormal behavior.” This
assumption that if a person is seeking assistance, s/he must have a
mental disorder is known as sick role bias.
• The fact that the person is being observed or asked personal questions
may increase anxiety and therefore change or intensify behavior. This is
called reactivity. This may then be seen by the psychiatrist as further
evidence of dysfunctional symptoms.
• A clinician’s unique style, degree of experience, and the theoretical
orientation will definitely affect the interview.
The ABCs to describe symptoms of a disorder

• Affective symptoms: emotional elements, including fear, sadness, anger

• Behavioral symptoms: observational behaviors, such as crying, physical
withdrawal from others, and pacing
• Cognitive symptoms: ways of thinking including pessimism, personalization
and self image
• Somatic symptoms: physical symptoms, including facial twitching, stomach
cramping, and amenorrhoea.
Validity and
Reliability
 https://www.youtube.com/watch?v=wuhJ-GkRRQ
c

• Diagnosis: identifying a disease on the basis of

symptoms and other signs.
Validity and • Reliability: this is high when different
psychiatrists/psychologists agree on a patient´s
Reliability diagnosis when using the same diagnostic
system.
• Validity: this is the extent to which the diagnosis
is accurate. This is much more difficult to assess
in psychological disorders.
Research in psychology: Rosenhan (1973)

• Rosenhan wanted to test the validity of psychiatric diagnoses as well as determine the negative consequences of institutionalization.

• He conducted a field study where eight healthy people tried to gain admission to 12 different psychiatric hospitals. They complained that they had been hearing
voices. The voices were unfamiliar, of the same sex and said single words like “empty” or “thud”. These were the only symptoms they reported. Once they were
admitted to the hospital, they immediately stopped reporting symptoms and act “normally.”

• The study played a key role in raising awareness about the way that diagnosis is carried out and the treatment that patients receive in mental hospitals. Rosenhan
showed that when people come into a hospital, it is assumed that there is a problem that needs treatment. Then, once a diagnosis is made, health professionals may
notice behaviors that they believe are in line with the diagnosis (confirmation bias).

• When discussing the validity of diagnosis, this study has several limitations:

• The study is unethical because no consent was given by the people working in the hospitals. In addition, deception was used by the confederates. Rosenhan
did not debrief the hospitals on his findings or allow them to withdraw from the study. Some consider the outcome of the study important enough to justify
the lack of consent.
• There is no way to verify the validity of the claims made by the “patients.” Rosenhan wrote that the nurses saw note-taking as an “aspect of their pathological
behavior.” However, the nurses’ notes simply said: “engages in writing behavior.” This is an example of researcher bias.
• Only a single disorder was studied – schizophrenia. It is not possible to say from this single study that diagnostic systems are therefore invalid.
Think
• What are the ethical concerns
with Rosenhan´s study?

• In what ways did this study

illustrate the problem of reliability
and validity of diagnosis at the
time?
Reliability of diagnosis

• Another limitation of classification systems is their level of reliability.

• Why is it so difficult to come up with a reliable diagnosis?
• Blood and urine testing cannot currently be used to diagnosis psychological
disorders, although there is much research trying to accomplish this goal.
• Disorders are “clusters of symptoms.” These symptoms are assumed to be related
to one another, even though this may not be the case.
• Many symptoms are difficult to measure. For example, a decrease in concentration,
feelings of helplessness or hearing voices. Psychiatrists are heavily dependent on
self-reported data and this is known to result in some bias.
• Individuals may suffer from two or more psychological disorders simultaneously.
This is known as comorbidity. For example, clinical depression and alcohol use
disorder are comorbid – that is, many people suffering from alcohol use disorder,
also have clinical depression
Research in Psychology: Lipton & Simon (1985)
• The difficulty in establishing a reliable diagnosis was demonstrated by Lipton &
Simon (1985).
• The researchers randomly selected 131 patients in a hospital in New York.  All of the patients
had been diagnosed with a psychological disorder. Seven clinical experts at the Manhattan
Psychiatric Center reevaluated the selected patients and their diagnosis was then compared
with the original diagnosis. Of the original 89 diagnoses of schizophrenia, only 16 received the
same diagnosis on re-evaluation; 50 were diagnosed with a mood disorder, even though only
15 had been diagnosed with such a disorder initially.
• One of the limitations of the Lipton & Simon study was that patients were already undergoing
treatment. This may have led to changes in symptoms and could be one reason for the
different diagnoses. 
• Studying the reliability of diagnosis in a naturalistic setting presents such problems, and this
could be a reason for why less ecologically valid approaches are often used.
Research in psychology: Lobbestael, Leurgans & Arntz (2011)

• Lobbestael, Leurgans & Arntz (2011)  investigated the reliability of diagnosis using the DSM IV
with a sample of 151 participants, consisting of both patients and non-patients.  The original clinical
interviews, often lasting up to two hours, were audio-taped. The interviews were then assessed by
a second psychiatrist who did not know the diagnosis made by the first psychiatrist.
• The results showed that generally there was higher reliability for personality disorders over other
disorders. There was a 71 percent rate of reliability in the diagnosis of major depression, whereas
there was an 84 percent rate of reliability of personality disorders.
• A strength of this study is that the researchers used a single-blind procedure - the second
psychiatrist did not know the diagnosis made by the first psychiatrist. 
• Also, by using only audiotapes, non-verbal behavior or the appearance of the patient did not affect
the diagnosis process.  However, this can also be seen as a limitation. It is difficult to know the
extent to which non-verbal behavior may have played a role in the first diagnosis.  Therefore, the
second diagnosis may be too controlled and could have missed important non-verbal data which
may have changed the diagnosis.
Reliability of the DSM
• Research into earlier editions of the DSM showed its reliability to be
alarmingly low.
• Reliability of DSM III was further improved when the Structured
Clinical Interview for DSM was published.
• From the DSM III to the DSM 5 diagnostic categories were further
refined and new, more standardized versions of SCID developed, in an
attempt to increase consistency further.
Validity of diagnosis: Key problems
1. Heterogeneity of the clinical presentation
2. Classification is based on symptomology rather than etiology
3. Where do we draw boundaries between disorders?
4. Stability of symptoms
5. Cut-off point between “clinically significant” and “clinically
insignificant” symptoms.
6. Selecting treatment
Factors
Influencing
Diagnosis
 Clinical biases

• When an individual comes into a clinic and complains about certain symptoms, the
clinician will assume that he or she wants to know what is wrong and also wants a
treatment. However, when we are dealing with mental disorders it is not as clear-cut
as one would think.

• The clinician will always have to interpret symptoms and the patient's own account,
and this could lead to biases even though a modern classification system is part of
the diagnostic process. For example, it is known that gender, socioeconomic status,
and ethnicity could influence diagnosis.

• There is always a risk that a clinician may fall victim to confirmation bias.
• Confirmation bias is a result of schema that allow us to understand and predict
a situation. In other words, the psychiatrist sees what he expects to see.
Confirmation bias is influenced by both stereotyping and social norms.
Research in psychology: Temerlin (1970)

• In this study, clinical psychologists watched a video of an interview of a healthy individual. One
group heard a respected psychologist say, “a very interesting man because he looked neurotic, but
actually was quite psychotic.” 
• After viewing the tape, participants selected their best-guess diagnosis from a list of 30 choices: 10
psychotic disorders, 10 neurotic disorders, and 10 miscellaneous personality types, including
“normal or healthy personality.”
• The majority (60%) of the psychiatrists diagnosed the patient as psychotic, whereas in a control
group, none of the 78 participants made this diagnosis.
• This is an example of confirmation bias; after hearing the respected psychologist make an informal
diagnosis, the participants paid attention to behaviors that agreed with the idea that the man was
psychotic. This shows that having a previous diagnosis and making that known to a doctor may
influence the objectivity of a second opinion.
 Gender bias in diagnosis

• Another consideration in diagnosis in the role of gender schema. For some disorders, women are diagnosed more frequently than
men – and vice versa.
• According to statistical evidence, women are two to three times more likely to become clinically depressed than men.
• Research shows girls become more susceptible to depression than boys only after puberty when they begin menstruating and
experience hormonal fluxes.
• As you will see in the next section of this chapter, Brown & Harris (1978) argued that women are exposed to more stressors than
men are as a result of social hierarchies. This higher level of stress could be linked to depression, demonstrating the role of the
interaction of biological and social factors in the disorder.

• Swami (2012) carried out an extensive study of 1218 British adults. Participants were given a paper survey to fill out in which they
were given a vignette – a short description – of either a male (Jack) or a female (Kate). The description met the diagnostic criteria
for depression according to the DSM IV and the ICD-10. The vignettes were exactly identical except for the gender. After reading
the vignette, the participants were asked if the individual described suffered from a mental health disorder.

• The results were that participants were more likely to indicate that a male vignette did not suffer from a mental health
disorder compared to a female vignette. This study may indicate that gender stereotyping has an effect on diagnosis;
however, the study did not use professional psychiatrists – but instead used members of the general public.
 Cultural bias in diagnosis

• It is generally accepted that culture is a determining factor in the

experience and expression of psychiatric symptoms, but cultural
biases may also affect diagnosis. 
• Cochrane and Sashidharan (1996) point out that it is commonly
assumed that the behaviors of the white population are normative
and that any deviation from this by another ethnic group reveals
some racial or cultural pathology.
• Conversely, as Rack (1982) points out, if a member of a minority
ethnic group exhibits a set of symptoms that is similar to that of a
white British-born patient, then they are assumed to be suffering
from the same disorder, which may not actually be the case.
Research in psychology: Li-Repac (1980)

• In order to test the role of stereotyping in diagnosis, Diana Li-Repac wanted to compare the diagnoses of both white and Chinese-
American therapists of both white and Chinese male subjects.
• She hypothesized that the therapists would generally agree on the concept of normality as they all had similar training. She
hypothesized that differences would exist in the actual diagnoses when diagnosing someone of a different cultural group.
• There were ten patients in the study - five European-American and five Chinese - all of whom had been diagnosed with mental
illness. Three of the Chinese were diagnosed with schizophrenia, one neurotic and 1 depressive. Of the European American
patients, two were diagnosed as schizophrenic, one as neurotic, one as character disorder and one as depressive.
• All of the Chinese subjects were born either in China or Hong Kong.
• There were three significant findings:
• European American clinicians saw the Chinese patients as more depressed and lower in self-esteem than did the Chinese-
American raters.
• European American clinicians saw Chinese patients as less socially competent and as having less capacity for
interpersonal relationships than did Chinese-American clinicians.
• Chinese-American clinicians reported more severe pathology than did the European American clinicians when judging quiet
clients.
• Such results indicate that diagnosis is not necessarily a neutral process and that it is important to include cultural considerations in
the diagnostic process.
ATL: Thinking critically

Answer the following questions with regard to the research by Li-Repac.

1. The aim of this study was to test the role of stereotyping on diagnosis.
Do you think that this study accomplishes that? Why or why not?
2. Why was it important that all of the Chinese patients were born either in
China or in Hong Kong?
3. Which of the three findings do you think is the most significant? Why is
this important in a discussion of the findings?
Cultural considerations in diagnosis

• Conceptions of abnormality differ between cultures

• Universalist approach (etic)

• Relativist approach (emic)

• Culture bound syndromes

• Shenjing shuairuo (Neurasthenia) (mood disorder and anxiety)
• Depression appears to be absent in Asian cultures
 Socioeconomic considerations in diagnosis

• Stressors of all kinds are more likely to affect individuals living in

poverty.
• Although there is definitely evidence of bias, there appear to be
actual differences in the prevalence of disorders. 
• As seen in studies of stress, individuals with low socioeconomic
status suffer more from both physiological and psychological
illnesses. 
• Several psychologists propose vulnerability models as
explanations for mental illness.  Lower classes have less access
to protective factors that can help them to maintain positive
health.  This will be explored more in the etiologies section of this
unit.
Ethics in
Diagnosis
Ethics in Diagnosis

• The goal of diagnosis is to decide on a treatment that should help people to

improve a patient's quality of life. However, because the validity and
reliability of diagnosis are questionable, this leads to some ethical concerns.
• Another ethical concern is the question of labelling and stigmatization.
• Langer & Abelson (1974) carried out an experiment to see how a
diagnosis would influence a person’s perception. Psychiatrists watched a
video of a younger man talking to an older man with the sound
removed. Half the therapists were told that the younger man was a
patient; the other half, that he was a job applicant.
ATL: Ethics

• On March 24, 2015, the world was stunned to read about the crash of Germanwings Flight 9525. It appeared that in mid-
flight, the plane had crashed into the French Alps.
• After retrieving the black box, the world learned that the co-pilot, Andreas Lubitz, had locked the captain out of the
cockpit and had deliberately crashed the plane, killing all 150 people aboard.
• Later it was learned that Lubitz had a history of depression and had been referred to a psychiatric clinic two weeks before
he caused the crash.

• This story raises some difficult questions. Should the doctors have been required to inform his employer?
• Reflect on the two sides of this issue. When should an employer be informed about the mental health of employee?
What are the potential consequences of reporting an employee's mental health status to an employer?
ATL: Communication and CAS

• In a survey of over 1700 adults in the UK, Crisp et al. (2000) found
that people held the following beliefs about people with mental illness:

1.People with mental health problems were dangerous – especially

those with schizophrenia, alcoholism and drug dependence.
2.Mental health problems such as eating disorders and substance
abuse are a choice.
3.It is very difficult to talk to people with mental health problems.
Prevalence
rates and
disorders
Essential Questions
• Why do we see an increase or decrease in the level of a disorder?
• Why do some groups seem to have a higher prevalence of disorder
than other groups?
• Finally, there is the question of the "globalization" of the Western
model of mental illness and it’s impact 
Prevalence of disorders
• Prevalence rates are not simply statistical accounts of how many
people suffer from a specific disorder.  They also provide us with
information about the nature of disorders.  
• Prevalence rates are not universal - and they also change over time. 
• The role of globalization
Evaluate the following claim
• Claim: Women are diagnosed as having a depressive
disorder significantly more frequently than are men
and, with a few exceptions, report more depressive
symptoms than do men in most geographical areas of
the world
Media Prevalence
• The theory argues that there is a cultural "symptom pool" which
characterizes mental illness within a cultural group. 
• The argument is that when an individual within that culture
experiences distress, they then "adopt" the symptoms that are
relevant to their gender and age within that culture.
• The theory is very interesting but it is descriptive rather than
explanatory. 
• There is no explanation of how people actually "adopt" these
symptoms.
Media Prevalence:
https://www.youtube.com/watch?v=wRBZ0Kjisl4&feature=emb_logo

• The following video is a historic example of the spread of Dissociative

Identity Disorder (formerly known as multiple personality disorder) in
the US. 
• Watch the video and see if you can explain why you think that there
was a rise in DID in the US during this time period.
• What arguments are presented for why there was a change in the
prevalence of the disorder?
A Modern Example: Refugees
https://www.youtube.com/watch?v=EYLg74dzKBA&feature=emb_logo

• Watch the following news coverage of phenomenon called

"Resignation syndrome." 
• This syndrome is pretty much found only in the children of asylum
seekers in Sweden.
• Consider what you think may be the reason for this disorder and
its rise in prevalence in Sweden. 
Look at Ameson et al in Key Studies
Ethan Watters: Crazy like us
• An example that he gives is the growth of anorexia in Hong Kong.
• In Hong Kong, prior to the late 1990's, there were almost no women diagnosed with anorexia nervosa.
The prevalence rate was negligible.  There was a similar disorder which existed in which patients wasted
away.  Patients often complained that their stomachs felt distended and that they were not hungry. The
patients complained of a lack of meaning to their existence, or that they had let down their families and
as a result, experienced and relentless sense of shame.  The key difference between this disorder and
Western anorexia is that the patients did not have a false perception of their body weight. They were
fully aware that they were wasting away but felt unable to stop the process.
• In the case of anorexia in Hong Kong, Watters argues that the women are attracted to the "cultural
template of behavior" which shows dysfunction or distress. In other words, when an individual feels
psychological distress, the symptoms that one adopts come out of the "symptom pool" that is
appropriate for one's culture, age and gender. The society dictates what the appropriate "illness" is.  As
the society becomes more globalized, we see a rise in illnesses formerly seen outside of the culture.

• https://www.youtube.com/watch?v=4RoUjILza0c
Major
Depressive
Disorder
Key Concepts
• Affective symptoms: symptoms linked to emotional health
• Anhedonia: the inability to experience pleasure
• Avolition: a lack of motivation or ability to carry out daily tasks
• Comorbidity: when a person has more than one psychological disorder at
the same time - e.g. anxiety and depression.
• Dysthymia: depressed mood most of the time for at least two years,
along with at least two of the following symptoms: poor appetite or
overeating; insomnia or excessive sleep; low energy or fatigue; low self-
esteem; poor concentration or indecisiveness; and hopelessness
• Somatic symptoms: physical symptoms
MDD and the DSM 5
Statistics
• Globally, more than 264 million of all ages suffer from depression
(WHO)
• Depression is a leading cause of disability worldwide and is a major
contributor to the overall global burden of disease
• More women are affected by depression than men
• Close to 800000 people die due to suicide every year. Suicide is the
second leading cause of death in 15-29 year old.
Diagnosis with the DSM 5

• An individual must be experiencing five or more symptoms during the

same 2 week period and at least one of the symptoms should be
either (1) depressed mood most of the day or (2) markedly
diminished interest or pleasure in all, or almost all, activities most of
the day, nearly every day.
Symptoms
• Significant weight loss when not dieting or weight gain, or decrease or
increase in appetite nearly every day.
• A slowing down of thought and reduction of physical movement
• Fatigue or loss of energy nearly every day
• Diminished ability to think or concentrate, or indecisiveness, nearly every
day
• Feeling of worthlessness or excessive or inappropriate guilt nearly every
day
• Recurrent thoughts of death, suicidal ideation without a specific plan, or
suicide attempt or a specific plan for committing suicide.
Diagnosis with the DSM 5
• https://www.youtube.com/watch?v=XiCrniLQGYc
The concept of etiology
• Science in general pursues four goals:
• Description, explanation, prediction and control

• Etiology: a set of causes of a disease or condition

Biological explanations for depression
Key Concepts
• Cortisol hypothesis (also called the Neurogenesis theory of
depression)
• Genetic mapping
• Genetic vulnerability
• GWAS
• Serotonin hypothesis
• SERT (the serotonin transporter gene: 5-HTT)
Biological explanations for depression
• The biological approach argues that both genetics and
neurochemistry may explain the origin of Major Depressive Disorder.  
• The biological approach is often considered a reductionist approach
to understanding mental health - and it is the basis for medical
treatment.
Genetic Arguments
• How do researchers study genetics?
Kendler et al (2006)
• Used 42161 twins from the Swedish Twin Registry.
• They found the concordance rate for female MZ twins was 44%, while
female DZ twins, only 16%. In male MZ twins the rate was 31% and
for male DZ twins the rate was 11%
• No evidence was found for differences in the roles of genetic and
environmental factors across generations spanning almost 60 years.
Silberg et al (1999)
• They investigated the trajectories of depressive symptoms among
boys and girls from childhood to adolescence.
• They study the link between susceptibility to depression and
environmental factors.
• The results showed that the effect of negative life events on
depressive symptoms in adolescent girls was stronger, suggesting that
genetic predisposition causes girls at this age to be more vulnerable
to negative or stressful life events.
Caspi et al (2003)
• 1000 children from New Zealand were followed longitudinally. The
sample was divided in three:
• Both short alleles of 5HTT
• One short allele and one long allele
• Both long alleles
• Results: people who had inherited one or more short versions of the
5HTT allele demonstrated more symptoms of depression and suicidal
ideation in response to stressful life events. The effect was stronger
for those with three or more stressful life events.
Strengths of genetic arguments
• Twin studies have been highly reliable in their results
• Modern research has allowed us to actually locate genetic variations
using very large sample sizes
• Modern research recognizes the interaction of environmental and
biological factors and does not use a solely reductionist approach.
Limitations of genetic arguments
• Correlational studies do not establish a cause and effect relationship
• Twin studies have the problem of population validity (do not
represent the population)
• It is impossible to isolate variables and separate out social factors in
twin studies
• Genetic arguments do not account for the variations in symptomology
in different cultures
• It is not yet clear how genetic markers interact
The role of neurotransmitters

• How does neurotransmission works?

The Serotonin Hypothesis
Evidence:
• Altering serotonin levels by diet (neurotransmitter depletion studies)
leads to depressive symptoms in formerly depressed patients
(Moreno and Delgado, 2000)
• The 5HTT gene studied by Caspi is responsible for serotonin transport
• Some patients taking SSRIs show improvement of their symptoms.

https://www.youtube.com/watch?v=uiXcAbrO8kU
The Cortisol Hypothesis
• Also called the Neurogenesis theory of depression, this is a complex
theory that looks at the role of the HPA Axis in the development of
depression.
• Argues that depression is the result of the cessation of neuron birth in
the hippocampus as well as in other neural networks related to
serotonin, dopamine and norepinephrine
• Cortisol appears to be the reason for this lack of neurogenesis.
Patients with major depressive disorder display a symptom called
HPA-axis hyperactivity that results in the over secretion of cortisol
Evidence of the Cortisol Hypothesis
• Animal models:
• Malberg et al 2000 found that injecting rats with SSRIs led to neurogenesis in
the hippocampus.
• Argued that this neurogenesis is part of the way we recover from depression.
• Videbech and Ravnkilde (2004) - a meta-analysis of 12 studies using brain
scans to compare hippocampal volume of patients diagnosed with MDD and
healthy controls.  A total of 351 patients and 279 controls.  They found up to a
ten percent reduction of the hippocampus in the brains of depressed
patients. The shrinkage was correlated to the number of depressive episodes.
https://www.youtube.com/watch?v=GOK1tKFFIQI
Evaluation of Biological Etiologies