Psychopathology Flashcards
(18 cards)
Definitions of Abnormality - Statistical Infrequency (A01+A03)
- Statistical Infrequency A01
- defines abnormality as ‘unusual’ and normal as ‘usual’ based on numbers, rare, majority is considered normal
- characteristics and behaviours that can be reliably measured, eg. intelligence, the normal distribution is the measure of people’s scores around the average on a scale, the further up or down the scale we look the fewer people there are with those grades
- an example is IQ, the average IQ is 100 and those who have 70 or under are considered ‘abnormal’ and are able to be diagnosed with intellectual disabilities - Statistical Infrequency A03
- a strength of this definition is that is it useful in real life and has important application, in clinical practice statistical infrequency is used to measure the severity of patients’ symptoms, for example in the Beck Depression Inventory a client who scores 30+ is categorised as having severe depression, suggesting that statistical infrequency is useful in diagnosis process in clinical practice
- a limitation is that infrequent characteristics can be both positive and negative, these characteristics are characterised as ‘abnormal’ however sometime they can be an individual excelling above the majority in a specific skill or IQ for example, and we would not consider someone who has a high IQ as being ‘abnormal’, this suggests that being at one end of the scale does not necessarily classify someone as abnormal, therefore suggesting that it is useful to use in some situations like diagnosis and assessment however it is not a sufficient way to measure the basis of abnormality
Definitions of Abnormality - Deviation from Social Norms (A01+A03)
- Deviation from Social Norms A01
- this definition refers to an individual noticeably acting in a way that is different from how we expect them to behave, societies define behaviour as abnormal based on what is seen to be acceptable or the ‘norm’ and follows the unwritten rules collectively determines by society
- norms may be different depending on culture, generation or religion, meaning there is few characteristics/behaviours that would be universally considered as abnormal as it depends on each societal norms, such as in the UK homosexuality is not considered as abnormal anymore however in other cultures like the middle-east - Deviation from Social Norms A03
- a strength of this definition is that is has real life application in clinical practices, such as when diagnosing antisocial personality disorder (psychopathy) as a number of characteristics of some with it are classified as going against societal norms like aggression, deceitfulness and violence which are all signs of the disorder that are deviations from social norms, additionally, they play a big part is the schizotypal personality disorder, suggesting that the definition has value in psychiatry
- a limitation is that social norms deviate depending on culture and which society an individual is actually in, a person from one culture could label someone as abnormal for acting in a certain way that is seen as acceptable by someone from a different culture, for example hearing voices is considered as abnormal in most parts of the UK however is some cultures it is considered as normal as it is ‘communication with ancestors’, therefore it is difficult to make judgements on what societal norms are as they differ across the world
Definitions of Abnormality - Failure to Function Adequately (A01+A03)
- Failure to Function Adequately A01
- a person becomes ‘abnormal’ when they can no longer cope with the demands of everyday life, this is sometimes determined by someone being unable to maintain basic hygiene and nutrition standards, as well as not being able to hold down a job or maintain a relationship
- Rosehan and Seligman (1989) proposed some additional signs that can be used to determine some not coping including, someone no longer conforming to standard impersonal rules like maintaining eye contact or respecting personal space, when someone experiences severe distress, or when a person’s behaviour becomes irrational or dangerous to themselves or others,
- an example is the intellectual disability disorder where someone is not only diagnosed on the basis that they have a low IQ but additionally failing to function adequately - Failure to Function Adequately A03
- a strength of the definition is that it represents a sensible threshold for when someone needs professional help, studies show that 25% of people experience problems with their mental health but it is common that people choose to get professional help after they or other people realise that they are failing to function adequately, meaning that the criteria can be used to assess whether people need treatment and services
- a limitation is that it is easy to label non-standard lifestyles as abnormal when people have in fact chosen to or been forced to deviate from social norms, someone who doesn’t have a permanent address or is unemployed may appear to be abnormal but really they just might have chosen an alternative lifestyle, additionally people who may have very physical hobbies like rock-climbing could be wrongly classified for their behaviour being dangerous, therefore people who make unusual choices are at risk of being classified as abnormal and their freedom of choice may be restricted
Definitions of Abnormality - Deviation from Ideal Mental Health (A01+A03)
- Deviation from Ideal Mental Health A01
- defines abnormality as being psychologically unhealthy, Jahoda (1958) suggested a criteria for good mental health in which every individual should meet in order to be classified as ‘normal’,
- have no symptoms or distress
- rational and can percieve ourselves accurately
- we self-actualise
- realistic view of the world
- good self-esteem
- independent of other people
- successfully work, love and enjoy our leisure - Deviation from Ideal Mental Health A03
- a strength is that this criterion is highly comprehensive and distinguishes mental health from mental disorder, covering most of the reasons we may need to seek or be referred for help with mental health, meaning people struggling can then be helped by professionals who specialise in treating and resolving these issues, Jahoda’s criteria therefore provides a checklist which we can assess ourselves agaisnt in order to to determine our mental health, providing the opportunity to recieve treatment from professionals if needed
- a limitation of the criteria is that its specific elements are not generally applicable across a range of cultures, some of the points are located in the context of the US or Europe, disregarding and confusing different cultures, the value of personal independence in Germany is nationally fairly high whereas in Italy it is low, furthermore what defines success in various cultures differs, making it difficult to apply the concept of ideal mental health from one culture to another
- a further limitation is that there is a fairly high standard expressed in the criteria as it is fairly uncommon for people to have all elements, the majority of people in the UK probably don’t meet the full criteria as it has high expectations, making the definition lack credibility and usefulness as it contradicts itself
Phobias A01
DSM-5 Categories of Phobias
- specific phobia, a phobia of an object or situation
- social anxiety, a phobia of social situations
- agoraphobia, a phobia of being outside or in a public place
Behavioural Characteristics
- panic, when someone responds to the presence of the phobic stimulus by crying, screaming or running away, children may act differently and have a tantrum or freeze
- avoidance, some responds by making a conscious effort to prevent themselves from being present with the phobic stimulus which can obstruct every day life
- endurance, alternative to avoidance when a person ensures that they are in the presence of the phobic stimulus so they can keep an eye on it and be weary
Emotional Characteristics
- anxiety, phobias are anxiety disorders and makes people experience high levels of unpleasant arousal, they can struggle to relax and feel positive emotions, can be long term
- fear, people experience immediate unpleasant arousal and it is usually in shorter periods than anxiety
- emotional response is unreasonable, the person’s response to the phobic stimulus is not typical amongst the majority of people
Cognitive Characteristics
- selective attention, people will focus on the stimulus and find it hard to look away as they want to be prepared for danger, however if the stimulus is irrational and not actually dangerous this can obstruct more important things in everyday life
- irrational beliefs, people will have unfounded ideas about the stimulus that have no basis in reality and can not be explained
- cognitive distortions, people will tend to have unrealistic and inaccurate ideas and perspectives about the stimulus
Behavioural Explanation for Phobias (A01)
- the behavioural approach emphasises the role of learning in the acquisition of behvaiour with a two-process model, the approach is geared towards explaining the behavioural characteristics of phobias rather than the emotional and cognitive characteristics
- Mowrer (1920) proposed a two-process model that explaines how phobias are acquired by classical conditioning and maintained by operant conditioning
Acquisition by classical conditioning
- classical conditioning involves a person learning to associate something they initially had no fear of (neutral stimulus) with something that already triggers a fear response (unconditioned stimulus)
- Watson and Rayner (1920) (Little Albert study) created a phobia of white rats in a young boy called Albert, Albert showed no signs of anxiety at the start of the study, when he was shown a white rat in front of him he tried to play with it, when the rat was presented in front of him the experimenters made a loud frightening sound by his ear by banging a iron bar (unconditioned stimulus) which scared Albert (unconditioned response of fear), the rat being presented at the same time as the loud noise caused Albert to associate them (the neutral stimulus and unconditioned stimulus now produce the same response), Albert then showed fear (now conditioned response) when he saw the rat (now condition stimulus), the condition was then generalised to similar objects as Albert showed signs of distress when shown other furry objects like cotton balls and a rabbit
Maintenance by Operant Conditioning
- responses acquired by classical conditioning often decline over time but phobias are long lasting, Mowrer explained that this is a result of operant conditioning which takes place by a behaviour being reinforced or punished
- reinforcement tends to increase the frequency of a behaviour, which is true in both positive and negative reinforcement, in case of negative reinforcement a person would avoid an unpleasant situation and feel a rewarding consequence, causing the avoidance behaviour to be repeated
- Mowrer suggested that when we avoid a phobic stimulus we escape experiencing fear and anxiety that we would have felt, which therefore reinforces us to keep avoiding it and therefore maintains the phobia
Behavioural Explanation for Phobias (A03)
- a strength of the two-process model is that it has real-life application in exposure therapies, the model explains that phobias are maintained by avoidance of the phobia stimulus, which helps therapists understand the importance of exposing clients to them in order to reduce the phobia, once the avoidance behaviour is prevented it ceases to be reinforced and the experience of anxiety reduction and avoidance declines, in behavioural terms the phobia is the avoidance behaviour so when avoidance is prevented the phobia is cured, therefore the two-process model is valuable and useful as it identifies a means for treating phobias
- another strength is that the model is evidence for a link between experiences and phobias, Little Albert shows that an unpleasant/traumatising experience is linked to developing a phobia, Jongh et al. (2006) found that 73% of people with a phobia of the dentist had experinced traumatic situations with dentistry equipment whilst the rest had experienced violent crimes, which can be compared to a control group of people with low dentist anxiety where only 21% had traumatic experiences, this suggests there is an association between a stimulus and an unconditioned response when people have phobias
However, not all phobias are developed from traumatic experiences, as some people who have phobias of snakes have never even been in contact with a snake, which suggests that there are other meanings for how phobias are developed, furthermore not all traumatic experiences lead to people developing phobias, therefore the behavioural explanation is less strong as it does not provide a complete explanation for how all phobias are developed - a limitation of the two-process model is that is does not account for cognitive characteristics of phobias, the behavioural explanation only explains behavioural characteristics of phobias and explains a phobia to be an avoidance response, however there are other significant elements of phobias such as irrational beliefs that a person holds about a phobic stimulus, the two-process model explains the avoidance response but does not offer adequate explanations for phobic cognitions (selective attention, irrational beliefs, cognitive distortions), therefore the model does not completely explain the symptoms of phobias
Treatments for Phobias (A01)
- the behavioural approach to treating phobias involves systematic desensitisation and flooding
Systematic Desensitisation
- a behavioural therapy that aims to gradually decrease a phobia through the process of classical conditioning and helping the client learn to be calm around the phobic stimulus, ie. curing them
- conditioning a new response to the phobic stimulus, replacing anxiety with relaxation, which is known as counterconditioning
1. the first stage of SD is creating the anxiety heirarchy, which is a list of situations related to the phobia put in order from least provoking to most provoking put together by the client and therapist
2. the second stage is relaxation, the therapist teaches the client how to deeply relax as it is impossible to feel calm and anxious at the same time as one emotion prevents the other, this is known as reciprocal inhibition, this can be taught using breathing techniques, imagery and imagination exercises, and sometimes drugs like Valium
3. the third stage is exposure, the client is exposed to the phobic stimulus while relaxed, typically over several sessions, they start at the bottom of the anxiety heirarchy and work their way up when the client manages to remain relaxed in each stage, the treatment is successful once the client manages to remain relaxed while in the highest stage
Flooding
- behavioural therapy that involved a client being exposed immediately to the phobic stimulus (frightening situation), the sessions are typically longer and there are less than SD
- flooding reduces phobias quickly, the client is unable to avoid the stimulus so realises that it is harmless and then anxiety is reduced, known as extinction, the conditioned stimulus no longer produces the conditioned response of fear
- in some cases the client may become relaxed in the presence of the stimulus since they are too exhausted by their own response
- flooding is not unethical but it is an unpleasant experience for the client, therefore it is important that the client gives full informed consent previous to the session
- they would normally be given the choice of flooding or systematic desensitisation
Treatments for Phobias (A03)
Systematic Desensitisation
- a strength is that there is evidence for its effectiveness, Gilroy et al. (2003) followed up 42 people with spider phobias who went through three 45 minute sessions of SD, after 3 and 33 months the clients were less fearful of spiders than a control group who used relaxation and didn’t have exposure to the phobic stimulus, Wechsler (2019) also reviewed evidence and concluded that SD is effective for specific phobias, social anxiety and agoraphobia, this means that SD is likely to be effective and useful for people with phobias
- a strength is that SD is also more suitable for people with learning disabilities than the alternative treatments, people with learning difficulties often struggle with cognitive therapies as they are unable to use complex cognitive techniques and exercises, as well as feeling confused and distressed by the traumatic experience of flooding, therefore SD is suggested to be a more suitable therapy for people with learning difficulties who have phobias
- a limitation is that SD sessions can take longer to be effective and have cost implications, there are typically a lot more sessions of SD than flooding which leads to clients spending more money on the therapy, this can have economic implications on people who are less affluent and can therefore not be suitable for everyone
Flooding
- a strength is that it is highly cost effective, flooding is clinically effective and inexpensive for the client and the NHS (or other health organisations), flooding can be effective in as little as one session in comparison to ten sessions of SD, meaning that more people can be treated at the same cost with flooding than with SD or other therapies
- a limitation is that flooding is a traumatic experience for someone with a phobia, for someone to confront their phobic stimulus without any way of escaping it is highly distressing and unpleasant and leads to high anxiety and panic levels, Schumacher et al. (2015) found that therapists and clients rated flooding as more stressful than SD, which raised ethical issues since therapists were knowingly causing their clients to ensure stress, however this is covered by giving informed consent, additionally since the treatment is traumatic and unpleasant there are higher attrition rates that come with it, which can delay or prevent people from recovering from their phobias, as well as potentially decreasing the likelihood of therapists choosing to use flooding and therefore potentially limiting its usefulness
Depression (A01)
DSM-5 Categories of Depression
- major depressive disorder, severe but often short term depression
- persistent depressive disorder, long term and recurring depression including sustained major depression
- disruptive mood dysregulation disorder, childhood temper tantrums
- premenstrual dysphoric disorder, disruption to mood prior to or during menstruation
Behavioural Characteristics
- activity levels, people with depression have lowered activity levels which makes them feel lethargic, this has a knock on effect as people withdraw from social situations or education/work which further increases depression, alternatively people can have high activity levels (psychomotor agitation) where they struggle to relax
- disruption to sleep and eating behaviour, depressed people may experience insomnia or hypersomnia, people may also experience an increase or decrease in appetite which can lead to weight gain or loss, overall people eating and sleeping habits and routines are disrupted by depression
- aggression and self harm, people with depression are often irritable and can become verbally or physically aggressive which can have serious knock-on effects on other aspects of their life, depression can also lead to aggression towards one’s self which can include self harm or suicide
Emotional Characteristics
- lowered mood, someone with depression experiences sadness at a clinical and more pronounced level rather than typical ‘normal’ sadness and typically for longer periods of time, they can describe themselves as feeling empty or worthless
- anger, people with depression can also feel anger and sometimes extreme anger which can be directed at others of themselves, this anger can lead to more aggressive behaviours
- lowered self-esteem, people with depression have reported to have low self-esteems which in other words means they like themselves less than usual, people have said to hate themselves or feel self-loathing
Cognitive Characteristics
people process information differently when they are depressed
- poor concentration, depression is associated with poor concentration as people are less able to stick to one task or make decisions that they would usually be able to, poor concentration and decision making can have knock-on effects on people’s work
- absolutist thinking, people with depression tend to see things as either all-good or all-bad, this can be referred to as ‘black and white thinking’ as people could experience a minor unfortunate situation and see it as an absolute disaster
- attending to and dwelling on the negatives, people tend to pay more attention to the negative aspects of a situation and ignore the positives, people also tend to have a bias towards recalling unhappy events rather than happy events which is the opposite to when people are not depressed
Cognitive Explanation of Depression (A01)
Beck’s Negative Triad
- Beck (1967) proposed a cognitive approach to explaining why some people are more prone to developing depression based on their individual cognitions, he suggested three parts to the cognitive vulnerability
1. faulty information processing, when people attend to the negative aspects of a situation and ignore the positives, similar to ‘black or white thinking’ where everything is either all-good or all-bad
2. negative self-schema, a schema is a package of information and ideas that develops through experience, a self-schema is package of information people feel about themselves, people with a negative self-schema interpret everything about themselves negatively
3. the negative triad, Beck suggests that people develop dysfunctional views of themselves because of three types of negative thinking that happen automatically regardless or a situation or context, the three elements of the negative triad are a negative view of the world, a negative view of the future, and a negative view of themselves
Ellis’ ABC Model
- Ellis (1962) proposed that good mental health comes from rational, defined as thinking in ways that make a person feel happy and free from pain, meaning that people with poor mental health or mental health conditions think irrationally, which he defined as having thoughts that interfere with happiness and positivity not unrealistic thinking, he uses the ABC model to explain how irrational thoughts affect our behaviour and emotional state
A. activating event, situations which irrational thoughts are triggered by external events/experiences, Ellis suggested that people get depressed after experiencing negative events which lead to irrational thoughts
B. beliefs, Ellis defined a bunch of beliefs, utopianism is that belief that everything is always meant to be fair, musturbation is the belief that we must always succeed or be perfect
C. consequences, when an activating event triggers an irrational belief there are behavioural and emotional consequences, the consequence is typically depression
Cognitive Explanation for Depression (A03)
Beck’s Negative Triad
- a strength is that there is supporting research, Beck practically proposes that people become depressed because of a cognitive vulnerability that affects the way think and predisposes a person to becoming depressed, in a review Clack and Beck (1999) concluded that people who were depressed commonly had it predisposed and preceded it, this was confirmed in a more recent study by Cohen et al. (2019) who tracked 473 adolescents regularly measuring their cognitive vulnerability and found that those with higher were more likely to develop depression, this research also suggests that there is an association between cognitive processes and depression
- a further strength is that the model had real-life application in screening and treating depression, Cohen et al. suggested that assessing cognitive vulnerability helps predict who is likely to develop depression which allows them to be monitored, understanding cognitive vulnerability also helps therapists in CBT which is a sort of therapy that helps patients alter their cognitions that increase their vulnerability to depression and help them become more resilient to negative experiences, meaning that understanding cognitive vulnerability is useful to apply to clinical practices
Ellis’ ABC Model
- a strength of the model is that it has real-life application in psychological treatment for depression, known as REBT (rational emotive behavioural therapy), which involves a therapist arguing the client’s depressive thoughts and points to show them that they are irrational, there is some evidence that REBT is effective at reducing irrational believes and symptoms of depression (David et al. 2018), therefore meaning the model has real-life use
- a limitation is that it only explains reactive depression and not endogenous depression. reactive depression refers to depression that occurs as a result of an event (activating event to Ellis), however many cases of depression are not caused by events and it is even a struggle to trace it back to something in particular, known as endogenous depression, Ellis’ model is less useful for explaining endogenous depression therefore limiting its usefulness as it cannot be used to explain all types of depression
Cognitive Treatments for Depression (A01)
Cognitive Behavioural Therapy
- a specific type of therapy that involves the cognitive therapist and client identifying their problems, and putting together goals and a plan for the therapy, one of the central tasks is to identify whether they experience irrational or negative thoughts, they then work to change the irrational thoughts and put effective behaviours in place
- Cognitive therapy is the application of Beck’s cognitive explanation for depression, which is geared by the idea that depression is caused by negative views of the world, the future and the self, (the negative triad) , they identify these thoughts and challenge them (central component of therapy), they also help clients to understand the reality of their beliefs, they may also set homework such as giving them a diary to record when they enjoy themselves or when people are nice to them (client as scientist), they then later can refer back to their recordings when they experience irrational beliefs in a way to prove to them that they are unrealistic
Ellis’ Rational Emotive Behaviour Therapy (REBT)
- REBT extends the ABD model to the ABCDEF model with D for dispute E for effect, the central technique of REBT is to identify and dispute (challenge) irrational beliefs
- when the therapist challenges they would have a vigorous argument in order to change the belief and break the link between the topic of the belief and depression
- the dispute of the belief is the basis of the therapy, Ellis identified different forms of disputes, empirical arguments involve the belief being argued by looking if there is any actual evidence to back it up, logical arguments involve finding whether the belief logically follows facts
- as individuals become depressed they tend to avoid situations and isolate themselves which further worsens the symptoms, the goal on behavioural activism is to work with clients to gradually decrease their avoidance and isolation and increase their involvement in activities that are proven to improve mood, such as exercise or spending time with friends
Cognitive Treatments for Depression (A03)
- a strength of CBT is that there is evidence to support its effectiveness, March et al. (2007) compared CBT to anti-depressant drugs and the combination of both when treating 327 depressed adolescents, 81% of the CBT group and 81% of the antidepressant group and 86% of the combination group all significantly improved after 36 weeks, meaning that CBT was just as effective as the drug therapy and even more effective when used together, CBT involves fairly brief sessions that typically go on for 6-12 weeks, it is also fairly cost-effective which all together makes it the typical first choice for treatments in public health care organisations
- a limitation of CBT is that it is not suitable for patients with severe cases of depression of patients with learning disabilities, patients with more severe depression are a lot less likely to feel motivated and willing to participate in the therapy and do the homework set as they are more likely to isolate themselves from social interactions (with therapist) as well as not paying attention in the sessions, the therapy also involves cognitive thinking exercises which makes it less suitable for patients with learning disabilities as they are less able to carry out complex cognitive activities, Sturmey (2005) suggested that any form of talking therapy is unsuitable for patients with learning disabilities which includes CBT, this therefore suggests that CBT is only useful when treating a certain range of people
However there is some more recent evidence to challenge this, Lewis and Lewis (2016) concluded that CBT is as effective as antidepressant drugs and behavioural therapies when treating severe depression, another review by Taylor (2008) found that CBT is effective for treating people with learning disabilities - a further limitation is that CBT often leads to high relapse rates, although it tackles and reduces symptoms when patients are having the therapy there is question and concern about how long the effect actually lasts, few early studies of the therapy effectiveness look at the long term effects, and some more recent studies suggest that the long term effect is not as successful as assumed, Ali et al. (2017) reviewed 439 depressed participants every month for 12 months after they had completed CBT, 42% of patients relapsed into depression within 6 months of finishing therapy and 53% relapsed after 1 year, this suggests that CBT may need to be repeated periodically in order to be effective in the long-term, this can have economic implications such as more therapists needing to be qualified and more expensive
Biological Explanation for OCD - Genetic Explanation (A01+A03)
Genetic Explanation A01
- genes are involved in individual vulnerability to OCD, Lewis (1936) observed that of his OCD patients 37% of them had parents with OCD and 21% of them had siblings with OCD. suggesting that it runs in families, although what is passed on in probably a genetic vulnerability rather than OCD itself, some environmental stress is necessary to trigger the condition development
- candidate genes are the genes responsible for creating the vulnerability, some are responsible for regulating the development of the serotonin system, an example of this is the gene 5HT1-D beta which is implicated in the transport of serotonin across the synapse
- OCD is polygenic meaning it is causes by a combination of genetic variations that together significantly increase vulnerability rather than one gene, Taylor (2013) has analysed previous findings of studies and found evidence that over 230 different genes are involved, specific genes that have been studied and associated with OCD include dopamine and serotonin which are both neurotransmitters that are related to mood regulation
- one group of genes may cause OCD in on person but a different group in another which is known as aetiologically heterogeneous, meaning that the origins of OCD vary from person to person, there is also some evidence to suggest that particular genetic variations can result in different types on OCD, such as hoarding disorder and religious obsession
Genetic Explanation A03
- there is various supporting evidence that suggests that OCD is developed as a result of genetic make-up, Nestadt et al. (2010) reviewed twin studies and found that 68% of monozygotic twins shared OCD as opposed to 31% of dizygotic twins, another source of evidence is family studies, research has found that a person with a family member who has OCD is four times more likely to develop it as someone without (Marini and Stebnicki 2012), this evidence suggests that genetic make-up does have an impact on whether a person develops OCD
- a limitation of the genetic model is that it ignores environmental factors, although there is lots of evidence to suggest that OCD is developed because of genetic make-up, there are also environmental risk factors that can trigger or increase the risk of development of OCD, Cromer et al. (2007) found over half of their clients had experienced a traumatic event in their past, OCD was also found to be more severe with people who had more than one trauma, meaning genetic vulnerability is only a partial explanation of the development of OCD
Biological Explanation for OCD (A03)
Neural Explanation
- the genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain
- serotonin plays a key role in explaining OCD, neurotransmitters are responsible for relaying information from one neuron to another, if a person has low serotonin then the relay of mood-related information will be irregular and a person will experience low-moods and other mental processes will be affected, some OCD cases can be explained by a reduction in the functioning of the serotonin system in the brain
- some cases of OCD can be explained by impaired decision making, this may be associated with abnormal functioning of the lateral (side bits) of the frontal cortex part of the brain, the frontal cortex is responsible for logical thinking and decision making, there is also evidence to suggest that the parahippocampal gyrus is associated with processing unpleasant emotions and functions abnormally in OCD
Neural Explanation A03
- a strength of the neural explanation is that there is evidence that antidepressants that work purely on serotonin are effective in reducing OCD symptoms, OCD symptoms are also parts of other diseases that are known to have biological origin such as the degenerative brain disorder Parkinson’s Disease (Nestadt et al. 2010), if a biological disorder produces OCD symptoms then we can assume that biological processes underlie OCD, suggesting that biological factors may be responsible for OCD
- a limitation of the model is that the OCD-serotonin link may not be specific to OCD, many people who experience OCD also experience depression (co-morbidity) which is also linked to disruption to the serotonin system, this therefore leaves us with a problem when distinguishing the role of serotonin in OCD as there is a possibility it is related to depression rather than OCD, therefore meaning serotonin may not be linked to OCD symptoms and therefore challenges the neural model
Biological Treatments for OCD (A01)
Drug Therapy
- the aim of drug therapies is to increase or decrease the neurotransmitter activity in the brain, low levels of serotonin are linked to OCD so in order to reduce symptoms the drug treatments work to increase serotonin levels
- SSRIs (selective serotonin re-uptake inhibitors) are antidepressants that work to tackle symptoms of OCD by working on the serotonin system, serotonin is released by pre-synaptic neurons in the brain and the neurotransmitters travel across the synapse, it chemically conveys the signal across the synapse from the pre-synaptic neuron to the post-synaptic neuron, where the signal turns electrical, the serotonin is then broken down and reused and reabsorbed by the pre-synaptic neuron, SSRIs work by preventing the reabsorption and breakdown, effectively increasing the amount of serotonin in the synapse which then continue to stimulate the post-synaptic neuron, compensating for whatever is wrong with the serotonin system, the typical dosage given of fluoxetine is 20mg although it can be changed based on the person, it takes 3-4 months of daily use for the drugs to have an impact on symptoms
- drugs are often used alongside CBT tp treat OCD, the drugs reduce a person’s emotional symptoms making them more able to engage with the therapy, some people benefit more from CBT alone whereas others benefit more from a combination
- if an SSRI is not effective after 3-4 months the dose can be increased to up to 60mg, or alternative drugs can be prescribed, tricyclics is an older antidepressant that has the same effect as SSRIs such as clomipramine however there are more severe side effects, SNRIs (serotonin noradrenaline reuptake inhibitors) are in the second line of defense for people who don’t respond to SSRIs similarly to clomipramine and they increase levels or serotonin and noradrenaline
Biological Treatments for OCD (A03)
- a strength of drug treatment is that there is good evidence for its effectiveness, Soomro et al. (2009) provided evidence to show that SSRIs reduce the severity of symptoms and improves the quality of life for patients, Soomro reviewed 17 studies that compared SSRIs to placebos and all 17 studies showed significantly better outcomes for SSRIs than the placebo conditions, symptoms reduced for around 70% of people on SSRIs and the remaining 30% can use CBT or alternative drug treatments, therefore showing the usefulness of SSRIs for treating OCD
however, Skapinakis et al. (2016) suggested that even though they are helpful they may not be the most suitable treatment method for most people, he carried out a systematic review of outcome studies and concluded that CBT and exposure therapies were more useful - another strength is that SSRIs are cost-effective and non-invasive, the drugs are fairly cheap compared to psychological treatments because thousands tablets/liquids can be produced within the time of one psychological therapy session, SSRIs are therefore good value for public health organisations like the NHS and represents good use of limited funds, they are also non-invasive as they don’t disrupt a person’s life like psychological therapies do, and you stop stop taking the drugs once symptoms are reduced, whereas psychological therapies involve spending a lot of time in sessions, therefore the SSRI drugs are very popular with patients and with doctors to prescribe
- a limitation of the treatment is that they potentially have severe side-effects, a small minority of people taking them will not be affected, some people also experience side-effects like loss of sex drive, indigestion, and blurred vision, they are typically temporary however long lasting making them unpleasant, people taking the tricyclic clomipramine have more severe side-effects like 1 in 10 having erectile issues and weight gain, whilst 1 in 100 have heart-related problems and get more aggressive, this means that some people have a reduced quality of life as a result of taking these drugs and may stop taking them all together if theyre not effective
