5 Psychopathology

Question 1

Definitions of abnormality: What is deviation from social norms?

Answer 1

Concerns behaviour that is different from the accepted standards of behaviour in a community or society

Question 2

Outline the deviation from social norms definition of abnormality.

Answer 2

*According to the DSN definition, any behaviour that violates the social norms of any given society is psychologically abnormal. *
Social norms are collective judgements about what constitutes normal behaviour. They can be explicit (in law) or implicit (unwritten conventions).
Social norms are specific to cultural context and can vary over** time. **
For example, homosexuality was once regarded as a mental illness in the UK, and although it was removed from the DSM classification manual in 1973, it is still regarded as an abnormality and criminalised in some countries.

Question 3

Strengths of deviation from social norms

(DSN definition for abnormality)

Answer 3

It has real life application
* Eg, antisocial personality disorder has key diagnostic criteria of failing to comply with ethical behaviour which includes being deceitful, reckless or aggressive
* Also in diagnosis of other mental health disorders, such as schizotypal personality disorder: individuals who have a diagnosis display ‘strange’ or eccentric behaviours and hold peculiar beliefs

Question 4

Weakness of deviation from social norms

(DSN definition for abnormality)

Answer 4

Cultural relativism
* 1 cultural group may believe a behaviour to be against social norms but another may think it is socially acceptable
* Eg, hearing voices (from dead) in the UK = abnormal, signs of psychosis disorders of schizophrenia, but in non-Western culture= normal and a gift
* Not generaliseable to all cultures

Human rights abuse
* Historically DSN is used as a form of social control over minority groups as a means to exclude those who do not conform to society and if you challenge the norm you are labled as ‘insane’
* Eg, slaves were said to have drapetomania if they tried to run away from plantations. Then they were whipped to ‘cure’/punish them
* So, categories of mental disorder are really abuses of people’s rights to be different

Question 5

Definitions of abnormality: What is failure to function adequately?

Answer 5

Occurs when someone is unable to cope with the normal demands of every day living

Question 6

Who created the criteria and what are the criteria that determine whether a person is failing to function adequately?

Answer 6

Psychologists Rosenhan and Seligman [1989] proposed seven major criteria that determine whether a person is failing to function adequately.

Personal distress- The person is upset or depressed.
Maladaptive behaviour- Not adapting appropriately to the environment or situation. Engaging in harmful behaviour or behaviour that prevents you from achieving life goals.
Irrationality- There appears to be no good reason why the person should choose to behave that way.
Unpredictability- Behaviour is often unexpected and characterised by a lack of control.
Observer discomfort- Behaviour that makes other people feel uncomfortable.
Violation of moral standards- Breaking moral standards, taboos, unwritten social rules, etc.
Unconventionality- Displaying highly unconventional/unusual behaviours.

Question 7

Strengths of failing to function adequately definition for abnormality

Answer 7

A sensible threshold for seeking psychiatric help
* People struggly with mental health throughout life but they seek support/encouraged to seek support when they fail to function adequately
* MIND states 25% people in the UK will struggle with mental health in a year. Many people push on despite faily severe symptoms
* Allows those who need the support most to access the necessary support

Question 8

Weaknesses of failing to function adequately definition for abnormality

Answer 8

Are alternative lifestyles abnormal?
* hard to identify if someone is failing to function or choosing a lifestyle that deviates from social norms
* Eg, a person without a job who does not have a permanent residence and lives ‘off-grid’ may be classed as maladaptive behaviour
* Alternative lifestyles could be labled as abnormal which is discriminatory and could restrict their freedom of choice.

Is failure to function always psychologically abnormal?
* Sometimes people may be unable to cope due to life events eg bereavement so their behaviour might not be abnormal if it is an appropriate response to an event
* However, a reason for their failure to function doesn’t change the fact their failing to function so might still need help
* So, failing to function might not always be abnormal but it can be used as a guideline to acess if help is required

Question 9

Definitions of abnormality: What is deviation from ideal mental health?

Answer 9

Occurs when someone does not meet a set of criteria for good mental health

Question 10

Outline the deviation from ideal mental health definition for abnormality

Answer 10

This definition attempts to define a state of ideal mental health. It looks at positives rather than negatives – the notion of mental health rather than mental illness.
Maria Jahoda (1958) identified six characteristics that individuals should exhibit in order to be ‘normal’
All six criteria need to be met in order to be normal. The more characteristics an individual fails to meet and the further they are away from realising individual characteristics, the more abnormal they are.

Question 11

What are the criteria set out in order to be deemed as normal in the ideal mental health definition of abnormality?

Answer 11

The criteria Mary Jahoda (1958) identified are:
Positive attitude towards self- having high self-esteem and a strong sense of identity
Self-actualization- the extent to which an individual develops their full capabilities, being the best they can be
Resistance to stress- The ability to cope with stressful situations competently
Personal autonomy- Being self-reliant and independent. Not dependent on others
Accurate perception of reality- Being able to see the world realistically (not in an overly negative light or in an overly positive light). Similarly to how others see it
Environmental mastery- Being able to adapt to changes in the environment and new environments to be at ease. Being flexible not rigid.

Question 12

Strengths of deviation from ideal mental health as a definition for abnormality

Answer 12

Positively focused and a comprehensive list
* It covers the majority of reasons people access help regarding mental health and allows people to distinguish good mental health from mental health issues
* So, a person with issues can access a range of support from professionals with varying beliefs eg, focusing on self-actualization in a humanistic approach or focusing on symptoms in a medically-focused approach
* So, there is a checklist people can use to assess mental health so that the right support can be found

Question 13

Weaknesses of deviation from ideal mental health as a definition for abnormality

Answer 13

Criteria are not relevant to all cultures
* Based on values in individualist cultures so not all criteria align with collectivist cultures where focus is on community not individuals
* Eg, collectivist cultures see self-actualization as self-indulgence not good mental health.
* Germany expect people to be more self-reliant than in Italy
* So, success is different across different cultures so this definition is not generalisable

Sets an unrealistically high standard for good mental health
* Unnatainable to achieve and maintain all the characteristic so a person could become upset, burnt out or have a deteriation in mental health because trying for a goal that is unachievable
* However, having a checklist to follow for good mental health makes it more practical and easier to set goals and understand what needs to be improved
* So, although they are positive, the criteria are sometimes unachievable and it needs clarifying how many criteria need to be absent for a diagnosis of abnormality

Question 14

Definitions of abnormality: What is statistical infrequency?

Answer 14

Occurs when an individual has a less common characteristic, for example being more depressed or intelligent than the rest of the population

Question 15

Outline what is meant by statitistical infrequency as a definition of abnormality?

Answer 15

Statistical infrequency occurs when a person has a less common characteristic.
According to this definition, abnormal behaviour is when a behaviour is statistically uncommon. The focus of this definition is quantifiable data as it measures standard deviation from the mean.
For example, IQ is normally distributed, 68% of people fall between 85 points and 115 points and 95% of people will have scores between 70 and 130 (the bell curve of normal distribution). 5% of people fall outside this normal distribution (so they are +2 or -2 standard deviation points from the mean) and these scores are psychologically abnormal. A score of less than 70 means a person has intellectual Disability Disorder (mental retardation) which is abnormal.

Question 16

Strengths of statistical infrequency as a definition for abnormality

Answer 16

Real life application in diagnosis of disorders
* Used to diagnose individuals and assess symptom severity
* Example: A diagnosis of Intellecultual disabilty disorder = an IQ of <70 (bottom 2% of people)
* Example: Severe depression is assesed by Beck Depression Inventory (BDI). Score >30 (top 5%) = severe
* Quantitative measure of abnormality in clincal practice

Question 17

Weaknesses of statistical infrequency as a definition for abnormality

Answer 17

Some abnormalities = statistically common. Some statisticall rare behaviours = desireable
* Doesn’t take into account if trait is desireable or unwanted
* Example: Low BDI = abnormal (according to this definition) but is a positive trait
* Example: An IQ >130 = abnormal but is likely to help in life
* 1 in 6 people report a common mental health condition each week in UK. These would be failed to diagnosed as they are statistically common but they are not ‘normal’ nor desireable
* So, needs to be used along with another definition for abnormality

Not everyone with statistically rare behaviour benefits from a label
Some benefit from label as abnormal
* For example, low IQ score, label abnormal/Intellectual disability disorder allows them to access support
* For example, high BDI allows them to access treatment to manage depression
Some may not benefit from label as abnormal
* For example, a person with low IQ but able to cope and is content with their liefestyle
* Social stigma attatched so people may not want label due to judgement
* So, risk of doing more harm than good if labelling becomes a stigma

Question 18

The DSM-5 recognises three categories of phobias.
What are these and what do they mean?

Answer 18

Specific phobias:- phobia of an object, eg an animal or body part, or situation eg flying or getting an injection.

Social phobias: - phobia of a social situation eg, public speaking or using a public toilet

Agoraphobia: - phobia of being outside or being in a public place

Question 19

What are the three behavioural characteristics of phobias and what do they mean?

Answer 19

Panic: - A person with a phobia may panic when faced with a specific stimulus. This may include a range of behaviour such as crying, screaming or running away. Children may react slightly differently eg, by clinging to a parent, freezing or having a tantrum.

Avoidance: -Unless a person is actively trying to face their phobia, they often make a lot of effort to not come into contact with their phobia which can make it challenging to go about daily life. For example, someone with a phobia of going to a public toilet may limit the amount of time they spend outside in relation to how long they can go without going to the toilet.

Endurance: -This is when a person chooses to remain with their phobic stimulus. For example, a person with arachnophobia may choose to stay in the same room as the spider to keep an eye on it.

Question 20

What are the three emotional characteristics of phobias and what do they mean?

Answer 20

Anxiety - Phobias are classed as an anxiety disorder. So, they involve an emotional response of anxiety, an unpleasant state of high arousal. This prevents a person from relaxing and so can stop them from experiencing positive emotion. Anxiety can be long term.

Fear - The immediate and extremely unpleasant response when a person thinks about or encounters a phobic stimulus. It is usually more intense but experienced for shorter times than anxiety.

Emotional responses are unreasonable - The anxiety and fear experienced are disproportionate and is greater than a ‘normal’ response to any threat posed.

Question 21

What are the three cognitive characteristics of phobias and what do they mean?

Answer 21

Selective attention to the phobic stimulus - If a person can see the phobic stimulues it is hard to look away from it. This can be useful if it is dangerous so will aid survival, but not if the phobia is irrational.

Irrational beliefs - A person with a phobia my hold unjustified in relation to phobis stimulus. Eg, social phobias my think ‘I must always sound smart’

Cognitive distortion - The perception of a person with a phobia may be innacurate and unrealistic.

Question 22

Behavioural approach to explaining phobias- What is the two-process model?

Answer 22

Mowrer argued that phobias are learned by classical conditioning and then maintained by operant conditioning.

Question 23

Behavioural approach to explaining phobias- Aquisition of phobias

Answer 23

Phobias are aquired by classical conditioning
Classical conditioning involves association
1. UCS triggers a fear response (fear is a UCR) eg, being bitten creates anxiety
2. NS is associated with the UCS eg, being bitten by a dog (the dog previously did not cause anxiety)
3. NS becomes a CS which produces fear (the CR). Eg, the dog becomes a CS causing fear (the CR) due to the event

Question 24

Example of conditioned fear

Answer 24

Watson and Rayner conditioned fear of rats in Little Albert
1. Loud noise behind him when he played with white rat. Noise (UCS) caused fear (UCR)
2. Rat did not create fear initially (NS). Associated bang with rat
3. Albert had fear response (CR) when shown a rat (CS)

Generalisation of fear to other stimuli- Albert got scared of any animal or object with fur eg, santa claus beard

Question 25

**Behavioural approach to explaining phobias**- Maintenance of phobias

Answer 25

**Phobias are maintained by operant conditioning** *Operant conditioning takes place when a behaviour is reinforced either positively (eg praise) or negatively (eg punishment)* 1. Negative reinforcment- individual avoids unpleasant event 2. Causes a positive consequence as they reduce the fear phobic stimulues would've produced 3. Reinforces the idea that the phobic stimulus should be avoided 4. Causes the phobia to remain

Question 26

Example of maintained fear

Answer 26

Somebody has a fear of dogs 1. They avoid going places where dogs can be 2. They feel less fear than if they saw a dog 3. They learn to avoid dogs to avoid fear 4. They remain fearful of dogs

Question 27

**Behavioural approach to explaining phobias**: Two-process model Strengths

Answer 27

**Real-world application in treating phobias** * Idea that phobias are maintained by avoidance is importatant in explaining why people benefit from exposure therapies * When avoidance behaviour is prevented, it stops being reinforced by anxiety reduction so avoidance behaviour declines * Two-process approach is valued in identifying treatments **Evidence linking phobias to bad experiences** * Research= 73% of dental phobics experienced trauma (mosylu involving dentistry) --> evidence of link between bad experiences and phobias * Research= control group of pp w/ low dental anxiety, 21% experienced trauma * Association between stimulus + UCR lead to phobias * ***Counterpoint*** * Not all phobias appear following bad experiences * Eg, snake phobias * Not all frightening experiences lead to phobieas * Eg, control group experienced trauma * So, behavioural theory doesn't explain all phobias

Question 28

**Behavioural approach to explaining phobias**: Two-process model Limitations

Answer 28

**Inability to explain cognitive aspect of phobias** * Explains behaviour- avoidance of the phobic stimulus * But, phobias can have cognitive componenet * Eg, irrational beliefs, cognitive distortion etc * Does not fully explain phobia symptoms **Learning and evolution** * Credible explanation for development and maintenance of phobias * Alternative explanation= prepardeness; tendency to develop phobias for things that presented as a danger during evolution * Eg, snakes and the dark * Doesn't explain important properties of phobias

Question 29

Behavioural approach to treating phobias: **Systematic desensitisation**

Answer 29

1. Reduce anxiety through **counterconditioning**- CS id paired with relaxation producing a new CR. 2. Based on **reciprocal inhibition**- Not possible to be afraid + relaxed at same time, so one emotion takes over 3. **Anxiety hierarchy**- Designed by client + therapist. Items on the hierarchy can be in vitro (imagined/virtual images) to in vivo (live contact) 4. **Relaxation at each level**- Taught relaxation techniques, work way through hierarchy over multiple sessions using relaxation texhniques. 5. Successful when the person can stay relaxed in high-anxiety situations

Question 30

Behavioural approach to treating phobias: **Flooding**

Answer 30

1. **Immediate exposure**- Exposed without gradual build up (ie, most anxiety inducing item). Only a couple sessions needed 2. **Prevention of avoidance**- Without option of avoidance, person learns stimulus is harrmless 3. **Extinction of phobia through exhaustion**- become so exhausted by their own fear response that they achieve relaxation, which would trick them into feeling comfortable in the presence of the stimulus 4. **Informed consent**- Unpleasant experience so must be prepared and able to give informed consent. Given option of SD

Question 31

Behavioural approach to treating phobias: **Systematic desensitisation**- **Strengths**

Answer 31

**Evidence of effectiveness** * Research= 42 pp had SD for spider phobia were less fearful than control group at 3 + 33 months * Psychologist= SD is effective for specific phobias, social phobias and agoraphobia **Usefulness for learning disability's** * SD alternatives = unsuitable for learning disabilities * Eg, cognitive therapies need rational thought + flooding= distressing * SD= no understanding or engagement on cognitive level + not traumatising **SD in virtual reality** * exposure can occur in virtual reality =cost effective + less dangerous * May be less effective in VR as it lacks realism eg, social phobias * So, not always appropriate

Question 32

Behavioural approach to treating phobias: **Systematic desensitisation**- **Limitations**

Answer 32

**More time consuming + costly** * Needs multiple sessions with a therapist * Eg, come up with anxiety hierarchy, learn relaxation techniques, gradual exposure * So, more time-consuming for NHS with long waiting lists * So, more costly for cash strapped NHS

Question 33

Behavioural approach to treating phobias: **Flooding**- **Limitations**

Answer 33

**Traumatic + ethical issues** * Research= clients + therapists rated flooding asmore useful * Ethical concerns about knowingly causing stress (even though informed consent prior) * Higher drop out rates than SD due to trauma * May be avoided by therapists + clients **Symptom substitution** * Does not treat cause (just symptoms) so symptoms reappear * Eg, woman with death phobia turned into fear of criticism * But, only evidence for this = case studies so not generaliseable to all cases * So, could worsen phobias not treat them. * But, evidence is limited + theoretical

Question 34

Behavioural approach to treating phobias: **Flooding**- **Strengths**

Answer 34

**Time + Cost effective** * Can work in just 1 session so costs less than SD * As, therapist only required for 1 session means they can see more patients in that time * Helps reduce waiting lists + save NHS money * More beneficial to a larger population **Flooding in virtual reality** * exposure can occur in virtual reality =cost effective + less dangerous * Adds to already cost effectiveness * May be less effective in VR as it lacks realism eg, social phobias * So, not always appropriate

Question 35

Depression characteristics: Behavioural

Answer 35

**Activity levels** * Reduced --> Lethargic --> Withdrawn. * Increased --> Psychomotor agitation = opposite, can’t relax **Disruption to sleep/eating** * reduced sleep, insomnia * need more sleep, hypersomnia * appetite may increase/decrease **Aggression/self harm** * irritable * verbal + physicall egression aggression eg, quitting job, breaking up with partner * physical aggression towards self --> cutting + suicide

Question 36

Depression characteristics: Emotional

Answer 36

**Lowered mood** * Lethargic, sad mentality, describing themselves as “worthless” and “empty” **Anger** * The sadness state can progress to anger, directed at themselves or others. * May lead to self-harming behaviour. **Lowered self esteem** * Self esteem = emotional experience of how we like ourselves * Reduced self esteem * Can be extreme --> self loathing

Question 37

Depression Characteristics: Cognitive

Answer 37

**Poor concentration** * Poor concentration + decision making. * Unable to stick with tasks or make easy decisions. **Attending to + dwelling on the negative** * Ignore positives. Pay attention to negatives. * Bias to recalling unhappy events. --> opposite to those without depression * Glass half empty. **Absolutist thinking** * All-good or all-bad thinking. Black and white thinking. * Unfortunate situation = absolute disaster.

Question 38

Cognitive approach to explaining depression: **Beck's negative Triad**

Answer 38

*Person's cognitions creates vulnerability to depression* **Faulty information processing:** * Focusing on the negative * Negative thoughts = cause (not just symptom) * Principle of cognitive primacy: thoughts shape feelings and behaviour * *Eg: did badly in a maths test they might catastrophize eg, I am never going to get into university or get a job.* **Negative Self Schema** * Start = childhood/adolescence --> authority figures place unrealistic demands + are highly critical * Continue to adulthood, encouraging negative cognitive framework * Interpret info about self in a negative way **Negative triad** * A triad of impairments in viewing the world. * Dysfunctional view of themselves: 1. Negative view of self --> unloveable/incompetant 2. Negative view of world --> hostile/difficult 3. Negative view of future --> no hope

Question 39

Faulty thinking types (depression, Beck's explanation)

Answer 39

1. All or nothing thinking 2. overgeneralization 3. catastrophizing 4. (magnification) and minimisation 5. disqualifying the positive 6. jumping to conclusions 7. mental filter

Question 40

Cognitive approach to explaining depression: Ellis' ABC model

Answer 40

1. **Good mental health** --> rational thinking: allows a person to be happy and free of pain **Poor mental health** --> Irrational thinking = prevents us from being happy and free of pain, **not** illogical or unreasonable thinking 2. . **ABC model** * A- Activating event --> triggers irrational beliefs * B- Beliefs --> Irrational beliefs occur * C- Consequence --> Emotional + behavioural consequences (from beliefs) which can trigger depression 2. **Irrational thinking styles:** * Mustubatory thinking- Must always succeed * Utopian thinking- Life must always be fair

Question 41

Strength of Beck's cognitive explanation for depression

Answer 41

**Strength** * **Research support** * Clark + Beck in a review --> cognitive vulnerabilities were common in those w/ depression + preceeded depression * Prospective study by Joseph Cohen et al --> tracked development of 473 adolescents + measured cognitive vulnerability * Results = those w/ cognitive vulnerability showed depression later in life

Question 42

Limitation of Ellis' cognitive explanation for depression

Answer 42

**Weakness** * **Partial explanation** * Reactive depression = when a life event has triggered the depression (what Ellis would call activating events) * Endrogenous depression = depression is not related to life events so it is not obvious what leads to a person becoming depressed * Ellis only explains reactive depression

Question 43

Strength of Ellis' + Beck's explanations for depression

Answer 43

**Real-world application** * **Ellis** * Approach to CBT is REBT (rational emotive behaviour therapy) * Therapist can alter irrational beliefs by vigorously arguing w/ them * Some evidence = REBT can relieve symptoms + change irrational beliefss * **Beck** * Value in screening + treatment * screen for cognitive vulnerabilities --> predict those at risk for depression --> monitor them * Cognitive vulnerabilities applied to CBT: * cognitions that make people vulnerable to depression are altered --> increase resilience to life

Question 44

Limitations of Ellis' + Beck's explanations for depression

Answer 44

**Ignores biological factors** * Could be caused by low seretonin levels * This is supported by SSRI use * This is successful in treating depressions by working to increase serotonin levels * Creates doubt in cognitive explanation as sole cause **Emotionally damaging** * Stating someone's irrational or negative thinking is causing it, could mean they blame themself * Decrease their mental health and lower their self esteem * Ethical issues --> causing a person harm

Question 45

Cognitive approach to treating Depression: CBT 1. Key assumption 2. Initial assessment and goal setting 3. Behavioural Activation

Answer 45

1. faulty thinking/thought processes --> a person vulnerable to depression + that irrational + **negative thoughts can be changed to more positive ones** --> person to feel + behave better. 2. Initial assessment of the patient’s problems + setting goals for the client * **The cognitive element:** Identify the irrational thoughts about self, world and future (negative triad) **The behavioural element:** Identify and dispute the irrational thoughts (ABCDE) 3**. Behavioural activation =** therapist works with the depressed person to decrease their avoidance + isolation + increase their engagement in activities --> to increase mood.

Question 46

Cognitive approach to treating Depression: CBT * Identifying and challenging negative/irrational thinking- **Beck's approach**

Answer 46

* **Uses negative triad**- identify, negative thoughts surround self, world + fututure * **Challenge thoughts**- discuss evidence for + against * Pt encouraged to **check validity** of thoughts * Set **homework** eg, thought journal * **Client as the scientist**- eg, recording when people are nice to them ie looking for evidence * therapist **uses evidence to challenge** the client’s negative beliefs

Question 47

Cognitive approach to treating Depression: CBT * Identifying and challenging negative/irrational thinking- **Ellis' approach**

Answer 47

* **REBT**- Rational, Emotive, Behavioural, Therapy * **ABCDE**- Developed ABC model to include Dispute + effective * **Challenge** irrational thoughts through **dispute** (argument) * **Logical dispute**: where the therapist questions the logic of a person’s thoughts * *Eg, Does the way you think about that situation make any sense?* * **Empirical dispute**: where the therapist seeks evidence for a person’s thoughts * *Eg, Where is the evidence those thoughts are true?*

Question 48

Strength of Cognitive approach to treating Depression: CBT

Answer 48

**Effective** * Supporting evidence of effectiveness * Study compared CBT to antidepressants comparing their usage vs % of pps w/ improved symptoms 1. CBT alone = 81% improved 2. Antidepressant alone = 81% improved 3. CBT + antidepressant = 86% improved

Question 49

ESCAPE of Cognitive approach to treating Depression: CBT

Answer 49

* **Effectiveness**- very effective shows research * **Suitability**- not suitable for those w/ learning disabilities, where the depression is a reult of reduced seretonin, where the situation needs to change ie, domestic violence * **Criticisms**- High relapse rate * **Alternative treatments**-SSRIs * **Practical issues**- Costs time + money to pay therapist + time for client there * **Ethics**- REBT might be ofeensive to some???

Question 50

Limitations of Cognitive approach to treating Depression: CBT

Answer 50

**Low suitability** * Emphasises cognitions role + often ignores situation or context * Eg, a domestic violence sufferer doesn't need to chang irrational/negative thoughts but instead their circumstance * Unsuitable for those with sever depression +/or learning disabilities * Complex rational thinking needing in talking therapy **Criticism- Relapse rates** * 2017 study depression = assessed in 439 clients in every month for 12 months following CBT * 42% relapsed back into depression after 6 months * 52% within a year * If people need to repeat = Costs NHS time + money --> increases waiting lists **Practical issues- time + money + work** * CBT requires client to do homework and if suffering from low motivation due to depression, this can be hard * Requires therapist to prepare + deliver session * Therapist needs to be paid --> NHS money or expensive privately * Waiting lists for therapist * SSRIs are a cheaper, less time consuming alternative * Client's least favourite

Question 51

OCD categories

Answer 51

1. OCD 2. Hoarding (hoarding disorder) 3. Trichotillomania 4. Excoritation disorder (skin picking)

Question 52

OCD charactertistics- Cognitive

Answer 52

**Obsessive thoughts** * Recurring thoughts * 90% of ppl w/ OCD have this as a major cognitive feature * Always unpleasant, vary between people * Eg, contaminated by germs, certainty a door has been left unlocked + an intruder will enter, impulses to hurt somebody **Cognitive coping strategies** * cognitive strategies to deal w/ compulsions * manage anxiety * can appear abnormal + interfere with daily tasks * Eg, a religious person with obsessive guilt may excessively pray **Insight into obsessive anxiety** * * Aware that obsessions + compulsions are not rational * If a person believed thoughts to be based on reality it wouldn't be OCD * Experience catastrophic thoughts about worst case scenario * Tend to be hypervigilant

Question 53

OCD characteristics- Emotional

Answer 53

**Anxiety + distress** * Powerful anxiety accompanies obsessions + compulsions so it is an unpleasant emotional experience * Frightening, unpleasant + overwhelming thoughts * Urge to repeat a behaviour creates anxiety **Accompanying depression** * OCD is often accompanied by depression * So anxiety can be accompanied by low mood + a lack of enjoyment for activities * Compulsions can give a small relief from anxiety temporarily **Guilt + disgust** * Irrational guilt + disgust * Directed at self or others * Eg, over minor moral issues or over dirt

Question 54

OCD characteristics- behavioural

Answer 54

**Compulsive behaviour:** There are two elements to compulsive behaviour: 1. **Compulsions are repetitive**- compelled to repeat a beahviour eg, handwashing 2. **Compulsions reduce anxiety**- attempt to manage anxiety produced by obsessions. It is a response to obsessive thoughts **Avoidance** * Avoid situations that trigger anxiety * Manges OCD + reduces anxiety * Leads to avoidance of ordinary situations + can interfere w/ life

Question 55

Biological approach to explaining OCD- Genetic

Answer 55

* OCD is **biological in natur**e; inherited **genes** make a person **more vulnerable** to developing OCD. * **Diathesis stress model**- Certain genes leave certain people more vulnerable to developing OCD. But, it must be triggered by life events . * **Candidate genes**= specific genes --> more vulnerable to OCD. * One candidate gene = **SERT gene** = involved in regulating the serotonin system + helping serotonin to transport across synapses. * **Low** levels of **serotonin** are implicated in OCD. * One candidate gene = **COMT gene** = involved in regulating the neurotransmitter dopamine * **High** levels of **dopamine** are implicated in OCD. . * OCD is **polygenic** (caused by a combo of genes --> up to 230) * OCD is **aetiologically heterogeneous** = genetic origins vary between ppl = different combo of genes --> OCD in different ppl

Question 56

Biological approach to explaining OCD- Genetic: Strentghs

Answer 56

**Strength- Support from twin studies** * Meta-analysis of twin studies. Concordance rate of both twins having OCD: * MZ= 68% * DZ= 31% * MZ twins = share 100% genes, = >2X concordance rate for OCD vs DZ twins = share 50% genes --> genetic basis for the disorder. ***Counterpoint*** * Cannot be completely genetic as the concordance rate for MZ twins is not 100% * higher rate in MZ twins could = environmental factors (nurture), not shared genetics (nature) * MZ twins = more similar treatment + life experience vs DZ twins --> sharing the same sex + looking identical **Strength- Animal studies** * Evidence from animal studies --> particular genes are associated with repetitive behaviours * Excessive grooming and hair removal in mice w/ genetic abnormalities resembles humans w/ trichotillomania. ***Counterpoint*** * Human brain = more complex than in mice * Not generaliseable to humans

Question 57

Biological approach to explaining OCD- Genetic: Limitations

Answer 57

**Weakness- Environmental Risk Factors** * Cromer --> more than 1/2 of OCD pts in sample =traumatic event in past --> OCD = more severe in those with more than one trauma. * Support a diathesis-Stress explanation * genetic explanation alone is biologically reductionist + ignores the evidence for environmental factors.

Question 58

Biological approach to explaining OCD- Neural

Answer 58

**Neurotransmitters: Serotonin and Dopamine** 1. **SEROTONIN** --> transmit mood-related information * **LOW** levels of serotonin --> **LOW** MOOD + **ANXIETY** + impairments in **THINKING** * Cause = serotonin **being removed too quickly** from the synapse in a **REUPTAKE** to the **PRESYNAPTIC neuron** before it has had the chance to **transmit** information to the **POSTSYNAPTIC neuron** 2. **HIGH** levels of the neurotransmitter **DOPAMINE** * In one study, high doses of dopamine given to RATS induced repetitive behaviours akin to compulsions. **Abnormalities in neural structures** 1. **Basal ganglia**--> coordination of movement + **routine** behaviours * at the base of the forebrain * **Hyperactivity** in basal ganglia is implicated in OCD * Overactivity of this brain region in OCD patients is thought to cause **compulsions**. * Evidence= People w/ **head injurie**s to this region can **develop OCD symptoms** eg, repetitive behaviours 2. **Orbitofrontal cortex ** * at the base of the frontal lobes above the eye sockets * It converts **sensory** information into **thoughts** and **actions**. * Part of the ‘**worry circui**t’ --> sending worry signals to other parts of the brain (the **thalamus** via the **caudate nucleus**), which work together to **process** these **worries**. * Worry circuit = **overactive** in OCD * OFC is sending **too many worry signals ** * Caudate nucleus (part of the basal ganglia) = **not** working to **filter** out those worries --> **obsessions** + **compulsions** * Evidence= **PET** scans --> **heightened** activity in the OFC is --> patients with OCD when holding a **dirty rag**.

Question 59

Biological approach to explaining OCD- Neural: Evaluation

Answer 59

**Strength+ counterpoint: Weighing up the evidence for low levels of serotonin** * Antidepressants that soley increase sereotonin work on OCD --> sereotinin is involved in OCD * OCD symptoms are part of symptoms of conditions biological in orgin * Eg, Parkinson's --> muscle tremours + paralysis * If bio disorders produce OCD symptoms then bio processes could underlie it ***Counterpoint*** * Seretonin-OCD link might not be unique to OCD * Many with OCD suffer w/ clinical depression = co-morbidity * Depression probs involves disruption to action of sereotonin * So, seretonin level may be disrtupted because of depression, not OCD **Weakness: Causation or correlation?** * Evidence --> neural systems (eg seretonin) do not work normally w/ ppl w/ OCD * Biological model ofmental disorder --> brain dysfunction causes OCD * But, this is causation between neural abnormality + OCD * No causual relationship indicated * OCD may cause abnormal brain function or a third factor may influence both

Question 60

Biological Treatments for OCD: SSRIs

Answer 60

**What are SSRIs and how do they work** * SSRIs improve the **transmission** of mood-related information * **Reducing the anxiety** associated with OCD. * Effective transmission of serotonin also works to **decrease the activity of the OFC** --> reducing OCD symptoms. *Steps:* 1. SSRIs **inhibit** (block) the **reuptake** of serotonin by the **presynaptic** neuron. 2. This leads to an **increase** of **serotonin** levels in the **synapse** 3. This encourages serotonin to **bind** to serotonin **receptors** on the **postsynaptic** neuron 4. This continues the **transmission** of mood-related information **Dosage**- **20mg** but after 4 months, dosage of SSRI can be increased or combined with another drug if not working. **Combining SSRIs** * Often combined w/ **CBT** * Drugs reduce **emotional** symptoms * So, **engage** better in CBT **Alternative treatments** * **Tricyclics** e.g. clomipramine: * Older type of antidepressant * Effect of an SSRI * More severe side effects than SSRIs * So is generally only used for those resistant to SSRIs. * **SNRIs (serotonin-noradrenaline reuptake inhibitors)** * Recent + different type of antidepressant * Used if not responding to SSRIs * Increase seretonin levels + noradrenaline (a neurotransmitter)

Question 61

Biological Treatments for OCD: SSRIs- Evaluation ESCAPE = E, C/E, A, P

Answer 61

**Strength- Effectiveness:** * Evidence --> reduce symptoms + improve quality of life * Meta-analysis of 17 studies --> significantly better outcomes for SSRIs vs placebos * Symptoms reduced by 70% for SSRIs * Remaining 30% helped by alternative treatments: therapy + SSRI or different antidepressant **Weakness (Criticism/ethics)- Reduce quality of life:** * Minority get no benefit * Side effects include: loss of sex drive, indigestion + blurred vision * Usually temporary (minority can be long lasting) but very distressing * Tryclic clomipramine has more common side effects * 1 in 10 = weight gain or erection problems * 1 in 100 = agressive or heart problems * STOP TAKING DRUGS ALTOGETHER --> REDUCED EFFECTIVENESS **Strength- Very practicle** * SSRIs are cheap compared to psychological therapies * No need to pay therapist or building etc * Less invasive on patients lives --> no travel time * Higher suitability to those w/ learning disabilities or lacking motivation * Popular with patients + doctors --> preferred choice to some * Saves NHS time + money **Weakness- just cures symptoms unlike CBT** * SSRIs treat OCD symptoms eg, emotional experience eg anxiety * Doesn't address behavioural causation * So, more likely to relapse * CBT may be more effective in long term * CBT could solve cause