Psychopathology - Paper 1 Flashcards
Paper 1
What is OCD?
an anxiety disorder which consists of obsessions and compulsions
What are the behavioural characteristics of OCD?
Compulsive behaviours and avoidance
What are compulsive behaviours? (OCD)
Where a person is compelled to repeat certain behaviours to reduce anxiety e.g., hand-washing, counting or tidying
What is avoidance? (OCD)
A person may avoid situations which trigger anxiety. Aim to reduce anxiety through this avoidance although this may interfere with normal day to day life
What are the emotional characteristics of OCD?
Anxiety and distress, shame/disgust
What is anxiety and distress in OCD?
Obsessions and compulsions are a source of considerable anxiety and stress. Feelings of anxiety are reduced by carrying out compulsive behaviours
What is shame/disgust in OCD?
Sufferers aware that their behaviour is excessive which causes feelings of embarrassment and shame
What are the cognitive characteristics of OCD?
Obsessions and awareness of excessive anxiety
What are obsessions in OCD?
The major cognitive symptom for 90% of OCD sufferers. Obsessions are persistent, recurring internal thoughts that may drive anxious feelings. These could be ideas, doubts, impulses or images which are often seen as uncontrollable and create anxiety
What is awareness of excessive anxiety in OCD?
The individual is aware that their obsessions and compulsions are irrational
What is the biological approach to explaining OCD?
Genetic explanations and neural explanations
What are the genetic explanations of OCD?
SERT and COMT gene
How does genetics explain OCD?
Genes we inherit can predispose us to OCD. Lewis found that 37% of his OCD patients had parents with it suggesting that specific genes are related to the cause of OCD. Two of these genes are COMT and SERT genes
What is the SERT gene in OCD?
When levels of serotonin are low, a person is more likely to get OCD. The SERT gene is involved in the transportation of serotonin, an inhibitory neurotransmitter. In people with OCD, the SERT gene mutates, causing lower levels of serotonin
What is the COMT gene in OCD?
COMT is an enzyme that regulates dopamine however in people with OCD, this gene mutates, preventing the COMT enzyme from regulating dopamine levels. This causes high levels of dopamine seen in many patients with OCD
How many genes are involved in OCD?
Taylor found that up to 230 different genes may be involved. There is also evidence to suggest that different types of OCD may be due to different gene combinations. OCD is polygenic.
What are the neural explanations of OCD?
Abnormal neurotransmitter levels and abnormal brain structure
What are abnormal neurotransmitter levels in OCD?
SEROTONIN helps to regulate mood causing LOW levels to be linked to depression and anxiety disorders such as OCD. Evidence for this that drugs which increase serotonin are effective in treating OCD. DOPAMINE has also been implicated in OCD having HIGH levels associated with compulsive behaviours
What are abnormal brain structures in OCD?
The Worry Circuit: The orbital prefrontal cortex is a region in the brain which converts sensory information into thoughts and actions
What is the process of the Worry Circuit (abnormal brain structure) in OCD?
- The OFC sends signals about potential hazards to the thalamus
- If these worry signals are not serious, they will be suppressed by the caudate nucleus, preventing them from reaching the thalamus
- When the caudate nucleus is damaged it fails to suppress minor or unimportant worry signals
- This causes the unnecessary thoughts and impulses to alert the thalamus
- These signals are then sent back to the OFC, reinforcing that belief that these unnecessary thoughts are impulses are a major concern that need an immediate and powerful response
What are the positive evaluation points of biological explanations of OCD?
- Nestdat et al carried out an a meta-analysis of twin studies and found MZ twins had a concordance rate of 68% compared to 31% for DZ. They found that people with a first-degree relative with OCD were 5X more likely to develop it compared to general population. This increases the validity of the biological explanation and the link between genetics and OCD.
- Antidepressants typically work by increasing levels of serotonin. These are effective in reducing the symptoms of OCD providing support for neural explanations. Soomro et al found that SSRIs were significantly more effective than placebos in treating OCD.
- Menzies conducted MRI scans on OCD patients and their immediate family members without OCD (had a healthy control group). He found that OCD patients and their immediate family had reduced grey matter in OFC. This supports the view that differences in this brain region are inherited and may be contributing to the disorder
What are the negative evaluation points of biological explanations of OCD?
Criticisms of Menzies - researchers have been unable to identify which genes are causing the reduction in grey matter. This means that a genetic explanation is unlikely to be very useful because it provides little predictive value. It is unable to predict which relatives with the reduction in grey matter will develop OCD.
- Diathesis stress model: may be better at explaining OCD. It acknowledges genetic vulnerability and the environment. It suggests that individual genes could cause a vulnerability of OCD but whether it develops depends on environment. Cromer et al found that over half their OCD patients had experienced a traumatic life event and OCD was more severe in patients who experienced more than one traumatic event. This shows that genes alone can’t be predictive of who will develop OCD.
What are the biological approaches to treating OCD?
Antidepressants and anti-anxiety drugs
What are antidepressants in treating OCD?
SSRIs are the standard medical treatment. used to tackle the symptoms of OCD involves an antidepressant called a selective serotonin reuptake inhibitor SSRI for short. Low levels of the serotonin are associated with depression as well as OCD, so drugs that increase levels of serotonin are used with both mental disorders
How do SSRIs work in OCD?
- Serotonin is released into the synapse by the presynaptic neuron
- After serotonin has crossed the synapse from the presynaptic neuron, it is reabsorbed by the presynaptic neuron (reuptake mechanism) ready to be reused
- SSRIs work by inhibiting this reabsorption. This results in more serotonin staying in the synapse for longer. This allows the serotonin to stimulate the postsynaptic neuron for longer, compensating for the deficiency in the serotonin system. SSRIs help to reduce the anxiety associated with OCD and normalise the worry circuit
What is the typical dose for an SSRI for OCD?
Fluoxetine - 20mg. It takes 3-4 months of daily use for SSRIs to have much impact on symptoms
What are anti-anxiety drugs for treating OCD?
Benzodiazepines are commonly used to reduce anxiety. They work be increasing the activity of the neurotransmitter GABA. This has a quieting effect on neurons in the brain helping to slow down brain activity
How does GABA work? (OCD)
- GABA is released into the synapse by the presynaptic neuron
- It locks onto receptors on the postsynaptic neuron
- This opens a channel that increases the flow of chloride ions into the neuron
- Chloride ions make it harder for the neuron to be stimulated by other neurotransmitters, thus slowing down its activity, reducing the anxiety experienced due to obsessions and makes the person with OCD feel more relaxed
What are the definitions of abnormality?
Statistical infrequency, deviation from social norms, failure to function adequately and deviation from ideal mental health
What is statistical infrequency?
Occurs when an individual has a less common characteristic, for example being more depressed or less intelligent than most of the population
What is deviation from social norms?
Concerns behaviour that is different from the accepted standards of behaviour in a community or society
What is failure to function adequately?
Occurs when somebody is unable to cope with ordinary demands of day-to-day living
What is deviation from ideal mental health?
Occurs when somebody does not meet a set of criteria for good mental health
How can we explain deviation from social norms further?
Each society has norms. This definition classes any behaviour as abnormal if it goes against the accepted, expected and approved ways of behaving in a society. This definition suggests abnormality can be seen as breaking the rules of society.
E.g., society doesn’t see it to be acceptable behaviour to hear voices or see things that are not there (hallucinations) - SZ
What are the negative evaluation points of deviation from social norms?
- Social norms change as times change. What is socially acceptable now may not have been 50 years ago. E.g., homosexuality is acceptable but in the past it was included under ‘sexual and gender identity disorders’ in the DSM. This lack of consistency reduces the reliability of the definition
- Has been criticised because social norms differ between cultures. Norms are culturally relative. E.g., hearing voices is viewed as a deviation from social norms in our cultures but in others, it is more accepted and not viewed as deviant. This is a problem, a reliable definition should be consistent between cultures
- Using social norms to define abnormality can be seen as punishing people who are trying to express their individuality and repressing people who don’t conform to the repressive norms of their culture. E.g., World Health Organisation declassified homosexuality as a mental illness in 1992 and transgender health issues in 2019. These recent changes may have followed social norms/acceptance. Limitation because it can be damaging to certain people in society so another definition may be appropriate
What are the positive evaluation points of deviation from social norms?
+ It is a more appropriate definition especially when compared to statistical infrequency. This is because it distinguishes between desirable and undesirable behaviour and the effect the behaviour has on others. E.g., spending a lot of time washing your hands may not be statistically infrequent, but it can have a damaging effect on the person and their loved ones.
How can we explain failure to function adequately further?
This means that a person is unable to cope with everyday life or engage in everyday behaviours. Not functioning adequately causes distress and suffering for the individual and/or cause distress for others.
What did Rosenhan and Seligman say that characteristics of features of abnormality are?
- Suffering
- Maladaptive behaviour - behaviour where a person is stopping themselves from progressing
- Unconventionality - behaviour needs to be odd
- Unpredictability and loss of control - most people tend to behave in a fairly predictable way on the other hand an abnormal person is expected to act in an inappropriate manner
- Irrational and incomprehensibility - refers to instances where someone may act in a certain way which people can’t understand
E.g., someone with SZ - it would be irrational to have delusions of grandeur such as believing you are the Queen
What are the positive evaluation points of failure to function adequately?
- It includes the patient’s perspective. This allows us to view the mental disorder from the point of view of the person who experiences it. E.g., the level of distress experienced by the patient is considered when defining their behaviour as abnormal. This suggests FFA is a useful criterion for assessing abnormality as it provides a checklist which patients can use to help them perceive their level of functioning
- Abnormality is not always accompanied by dysfunction. Psychopaths can cause great harm yet still appear normal. E.g., Harold Shipman was abnormal but didn’t display features of dysfunction therefore the definition may not be appropriate
- Definition is limited by cultural relativism. Long periods of grief after bereavement is more acceptable in some cultures than others. This means that the same behaviour could be defined as abnormal because it is viewed as a failure to function in one culture but not another, the definition is not reliable
- Abnormality could be due to other factors. E.g., someone who is unable to hold down a job may be in this situation due to the economic situation of their country, not mental health. This means that by using this definition, people would incorrectly be labelled as abnormal when other definitions may not label them as abnormal. Suggests that it is not appropriate in all cases and another definition may be more valid
How can we explain statistical infrequency further?
Any behaviour that is statistically rare would be classed as abnormal. Deciding what is statistically rare requires us to examine a normal distribution curve in order to identify what proportion of people share the characteristics or behaviour being looked at. A person is abnormal because their behaviour is infrequent i.e. two standard deviations from the mean.
E.g., only 1% suffer with SZ so it is considered statistically rare because it is more than two standard deviations away from the mean
What is a positive evaluation point of statistical infrequency?
It is an objective way to define abnormality, as a ‘clear cut off’ point has been agreed. This makes it easier to divide who meets the criteria to be labelled as abnormal in comparison to other definitions. Therefore this definition is seen as less subjective than the other definitions
What are the negative evaluation points against statistical infrequency?
- There are many abnormal behaviours which are desirable e.g., high IQ. There are some normal behaviours which are undesirable e.g., depression is common. This is a problem when planning treatment as only undesirable behaviours need to be identified. Therefore, the definition would never be used alone to make a diagnosis
- We need to decide where to separate normality from abnormality. Many disorders like depression vary greatly between individuals in terms of severity. This makes it difficult to decide where the cut-off point lies e.g., at what point does crying (a common symptom of depression) become abnormal? This is a problem as the cut-off point is subjectively determined, lacking the validity needed to be an effective explanation
- The definition may be culturally biased. This is because there are some behaviours that are statistically infrequent in some cultures but are more frequent than others. E.g., one symptom of SZ is claiming to hear voices, however this is an experience that is common in some cultures. This is problematic as statistical infrequency would class these individuals as abnormal even when they were displaying normal behaviour, so the definition can only be used to define abnormality in some cultures
How can we explain deviation from ideal mental health further?
It attempts to define the criteria required for ideal mental health, people who lack these are abnormal. Jahoda defined ideal mental health through 6 characteristics which argue that a psychologically healthy individual with ideal mental health should be able to show
E.g., SZ would be seen as abnormal as seeing or hearing things that are not there is not an accurate perception of reality
What are Jahoda’s 6 characteristics for optimal living?
-Perception of reality - they should be able to see the world as it it
-Resistance to stress - being able to cope with stressful situations
-Self-attitudes - high self-esteem and a strong sense of self-identity
-Autonomy - they should function as independent individuals
-Self-actualisation and personal growth - being focused on the future and on fulfilling their potential
-Mastery of the environment - the ability to adjust to new situations; functioning at work and in relationships with others
What are the positive evaluation points of deviation from ideal mental health?
It offers an alternative perspective on mental disorders. This is because the definition focuses on the positive desirable behaviours rather than the negative undesirable behaviours. Her ideas are in accord with the humanistic approach which also focuses on the positive aspects of human nature
What are the negative evaluation points of deviation from ideal mental health?
- The definition may be culturally biased (ethnocentric) this is because the ideals of mental health are not applicable to all cultures. E.g., the criterion of self-actualisation is relevant to members of individualistic cultures but not collectivist’ cultures, where individuals strive for the greater good of the community rather than for self-centred goals. This is a problem because for the definition to be classed as reliable, the same behaviour should be viewed consistently between cultures
- It is unclear how many criteria need to be lacking before we are seen to be ‘deviating from ideal mental health’ E.g., do all 6 criterion need to be present etc a subjective judgement must be made. It is left to individual psychiatrists to judge whether someone is deviating enough to be diagnosed and this could lead to inconsistency. This lack of objectivity means that this definition of abnormality is rarely used in the real world
What are behavioural characteristics?
Ways in which people act
What are phobias?
An irrational fear of an object or situation
What are emotional characteristics?
Ways in which people feel
What are cognitive characteristics?
Ways in which people process information, including perception, attention and thinking
What is the DSM?
A classification and diagnosing system which is published by the American Psychiatric Association. It is updated every so often as ideas about abnormality change
How does the DSM-5 categorise phobias?
Phobias are a type of anxiety disorder, all are characterised by excessive fear and anxiety, triggered by an object, place or situation. The extent of the fear is out of proportion to any real danger presented by the phobic stimulus. It recognises specific, social and agoraphobia as categories of phobias
