PSYCHOPATHOLOGY

AO1 give the four definitions of abnormality

statistical infrequency (SI), deviation from social norms (DSN), failure to function adequately (FFA) and deviation from ideal mental health (DIMH)

AO1 define statistical infrequency (SI)

in statistical terms human behaviour is abnormal if it falls outside the range that is typical for most people, in other words the average is ‘normal’. this behaviour may be seen as abnormal if it is rare and not many people display the behaviour. abnormal behaviour would be seen at the far ends of a normal distribution curve, so that numerically very few people would possess the behaviour. e.g. the norm for IQ is anything between 70-130, an IQ of less than 70 is statistically infrequent and therefore considered ‘abnormal’

AO3 explain how SI has real life application but give a counter criticism

once a way of collecting data about a behaviour and a cut-off is agreed, it becomes an unbiased method as no-value judgement are involved - the behaviour is objectively rare. evidence of real life application in the diagnosis of intellectual disability disorders and other disorders may be statistically uncommon e.g. schizophrenia affects 1% of the general population

→ counter criticism : there may be a lack of validity e.g whether certain symptoms do actually measure a behaviour and the cut off may be subjectively determined

AO3 explain why SI does not take desirability into question

some behaviours are statistically infrequent but are desirable and should not be considered as ‘abnormal’ e.g. high IQ. also, some behaviours are quite common e.g. depression affects 15-20% of the population but would be considered abnormal. statistical infrequency should never be used alone to make a diagnosis

AO3 explain why SI is culturally dependent

SI is culturally relative as a behaviour may be rare in some cultures but relatively common in other cultures. this could lead to practitioners being culturally biased in their view of abnormality and may lead to over-diagnosis of psychological abnormality in people of a different culture

AO3 explain the effects of labelling as a result of SI

where someone is living a happy fulfilled life, there is no benefit to them being labelled as abnormal regardless of how unusual they are. e.g. someone with a very low IQ who is not distressed, capable of working etc, would not need a diagnosis of intellectual disability. if that person was ‘labelled’ as abnormal, this might have a negative effect on the way others view them and how they view themselves

AO1 define deviation from social norms (DSN)

every society or culture has standards of acceptable behaviour (norms). behaviour that breaks these social rules is considered as abnormal. this would involve acting in a way that is unexpected and unacceptable. this behaviour is seen as undesirable for the individual and for society, even if it may be quite common.

AO3 explain the benefit of DSN considering desirability

considers the desirability of the behaviour for both the individual and society - in comparison to SI which does not consider desirability - some behaviours are desirable but are statistically rare e.g. high IQ.

AO3 give real-life application to DSN

some psychological disorders do break unwritten rules about how people are expected to behave. e.g. people with eating disorders may not keep to the norms about the frequency and quantity of eating food (evidence of real life application). it has also been helpful in the diagnosis of antisocial personality disorder and therefore there is a place for DSN in thinking about what is normal and abnormal

AO3 explain how DSN could lead to human rights abuse

norms are subjective and generally based on the opinions of the elite and not the majority. Szasz believes the term ‘mental illness’ is used to control nonconformist who may be a threat to the social order e.g. political dissenters in the USSR after WW2 were proclaimed ‘mentally ill’ and sent to hospitals

AO3 explain how breaking social norms may be positive and not an indicator of abnormality

it may be valuable to break norms. e.g. the suffragette movement chained themselves to railings and went on hunger strikes which helped to change society. therefore norm violation may just represent innovative behaviour that could be ultimately desirable and positive for the culture.

AO3 explain how social norms are era and culture dependent

e.g. homosexuality was seen as ‘abnormal’ in the past but is now considered ‘normal. similarly, auditory hallucinations may be viewed as normal in some cultures. serious limitation as it could lead to misdiagnosis of people from minority groups. cochrane found that african-carribean immigrants in the UK were often diagnosed with schizophrenia however this high diagnosis was not found in jamaica.

AO1 define failure to function adequately (FFA) and its 5 characteristics

a failure to function adequately means that a person is unable to cope with the demands of day-to-day life. e.g. a person with depression may be unable to leave their bed which would seriously impair their ability to live a normal life. rosenhan and seligman have suggested the following components that indicate how a person may be failing to function adequately.

5 characteristics :

• personal distress - the behaviour causes personal distress e.g. people with depression may experienced disturbed sleep/constant tiredness/guilty thoughts

• observer discomfort - the behaviour may be distressing to other people - it may upset other people or cause them to feel uncomfortable

• unpredictability - the behaviour may be unexpected or out of proportion to the situation

• irrationality - the behaviour may be difficult to understand and does not seem logical

• maladaptiveness - the behaviour may interfere with an individuals ability to lead a normal, everyday life. it may be harmful and unhelpful.

AO3 explain how FFA allows for patient perspective

most people seeking clinical help believe they are experiencing psychological problems that are stopping them from functioning properly. allows mental disorders to be regarded from the perspective of the individuals experiencing them.

AO3 explain how FFA allows for objective judgement but give a counter criticism

the assessment of whether a person is failing to function adequately is helped by the use of global assessment of functioning scale (GAF). this definition has had a useful application to clinical practice as those the test allows clinicians to see the degree of which individuals are ‘failing to function’

→ counter criticism - there may be subjectivity as someone has to judge whether the persons behaviour is maladaptive or whether they are not coping with their everyday life

AO3 explain how abnormality is not always accompanied by dysfunction

some people with psychopathic disorders may cope with daily life e.g. harold shipman murdered 215 of his patients yet appeared to be a respectable doctor and did not show features of dysfunction

AO3 explain why there may be an external reason for the FFA

it may not be due to a psychological disorder but may be e.g. due to bereavement or they might not be working due to low availability of employment

AO3 explain why FFA is culturally relative

culture bias could lead to more non-mainstream groups being diagnosed with mental illness, because their lifestyles are different from the dominant culture and this may lead to a judgement of failing to function adequately

AO1 define deviation from ideal mental health (DIMH)

someone is considered abnormal if they do not meet a set of criteria for good or ‘ideal’ mental health

jahoda suggested that we are in good mental health if we meet the following 6:

• positive view of self - high self-esteem and self-acceptance

• personal growth and development/self-actualisation - developing talents and abilities to the full

• autonomy - ability to act independently and make their own decisions

• accurate view of reality - seeing the world as it is without distortions e.g. distortions/hallucinations

• resistance to stress - effective coping strategies

• environmental mastery - can meet demands within different situations and are able to adapt to change

AO3 explain why DIMH is comprehensive

it covers a broad range of criteria for mental health - it probably covers most of the reasons someone would seek help from mental health services or be referred for health

AO3 explain why DIMH is culture bound to individualist cultures

some of the ideas are specific to western european and north american cultures - e.g. the emphasis on personal achievement in the concept of self-actualisation would be considered self-indulgent in much of the world because the emphasis is on the individual rather than the family or community.

AO3 explain why DIMH is unrealistic

very few of us attain all jahoda’s criteria and probably none of us achieve all of them at the same time or maintain them for long. therefore, everyone would be considered abnormal. it can be positive as it makes it clear to people the ways in which they could benefit from seeking treatment (e.g. counselling) to improve their mental health. however, the negative is that DIMH may lead to those being forced to go through treatment

AO3 explain why DIMH is unmeasurable

jahoda’s criteria cannot be measured and therefore may lead to misdiagnosis. it may also mean that it cannot be used in diagnosis

AO1 define phobias and the 3 categories

phobias are irrational fears of an object or a situation. all phobias are characterised by excessive fear and anxiety. the latest DSM recognises three categories or phobias :

• specific phobia - phobia of a specific object or situation e.g. an animal or getting an injection

• social anxiety (social phobia) - phobia of a social situation e.g. public speaking

• agoraphobia - phobia of being outside or in a public place

AO1 give the 3 behavioural characteristics of phobias

• panic - crying, screaming or running away. children may react slightly differently e.g. freezing, clinging or having a tantrum.

• avoidance - may make a conscious effort to avoid contact, which can make it very hard to go about daily life

• endurance - remains in the presence of the phobic stimulus but continues to experience high levels of anxiety. may be unavoidable in some situation e.g. someone who has a fear of flying

AO1 give the two cognitive characteristics of phobias

• selective attention to the stimulus - may have difficulty looking away from the phobic stimuli, it can be seen as helpful as we can react quicker to danger but it is not useful if the fear is irrational

• irrational beliefs - may hold irrational beliefs to phobic stimuli e.g. those with social anxiety may feel pressured to behave a certain way in public places

• cognitive distortions - phobic’s perceptions of the phobic stimuli may be distorted e.g. an omphalophobic may see belly buttons are ugly and/or disgusting

AO1 give the two emotional characteristics of phobias

• anxiety - anxiety can be the general long term response to a situation whereas fear is the immediate and unpleasant response we experience when we encounter or think about the phobic stimulus

• unreasonable responses - the emotional responses we experience in relation to phobic stimuli go beyond what is reasonable

AO1 explain the behavioural approach to explaining phobias

AO1 - phobias are seen as learnt behaviour. the two process model argues that phobias are acquired through classical conditioning but are then maintained through operant conditioning.

AO2 explain how phobias are a result of classical conditioning - learning by association

watson and rayner conditioned a baby boy known as little albert to fear white rats. for several weeks, albert played happily with a white rat showing no fear. one day, while he was playing with the rat, the experimenters struck a steel bar with a hammer close to albert’s head. he was very frightened on the noise and they repeated this each time he reached for the rat. he then developed a intense fear of white rats.

unconditioned stimulus (noise) ——>unconditioned response (fear)

UCS (noise) + neutral stimulus (rat) ——> UCR (fear)

conditioned stimulus (rat) ——> conditioned response (fear)

AO1 explain how phobias are a result of operant conditioning

learning to behave in certain ways because behaviour is reinforced, by removal or avoidance of something negative (negative reinforcement). in terms of phobias, avoidance of the phobic object or situation is negatively reinforced by the reduction of anxiety

AO3 explain why it is not clear why some people may not have frightening experiences yet they develop phobias

• an alternative explanation is called biological preparedness. seligman, claims that animals, including humans, are genetically programmed to rapidly learn an association between potentially life threatening stimuli e.g. heights and fear. known as ancient fear and it is adaptive to acquire such fears. explains why people are more likely to have a fear of heights than cars as they have only existed recently. bregman failed to condition a fear response in infant using a loud bell and wooden blocks.

→ counter criticism : not everyone who has had a frightening experience with an ancient fear develops a phobia

AO3 explain why the behavioural explanation is reductionist

it reduces our understanding to a simple stimulus-response explanation

• neglects the intervening variable of cognition between the stimulus and response — incomplete explanation. cognitive factors need to be considered - if they have a cognitive bias such as a judgemental bias where they over-estimate the probability of the negative experience happening again, then they may be more likely to develop a phobia.

AO3 explain why the reductionist focus has had a useful application to therapy

two process model shows that patients need to be exposed to the feared stimulus and stop avoiding it to stop negative reinforcement. used in systematic desensitisation and flooding. success of this therapy for treating phobias provides indirect support for the underpinning ideas of the two-process model

AO3 explain how social learning theory provides an alternative explanation

the behavioural approach assumes phobias are only acquired through direct conditioning experiences but some phobias seem to exist without any personal bad experience

• social learning theory claims that phobias mat be acquired through modelling. a child might see a parent react fearfully and learn this behaviour due to observation and limitation. bandura and rosenthal did an experiment where a model acted like he was in pain whenever a buzzer sounded. later on participants who observed this showed an emotional response, demonstrating an acquired ‘fear’ response.

AO1 what are the two therapies for treating phobias

the two therapies are called systematic desensitisation and flooding. both involve counterconditioning, whereby a fear response to an object or situation is replaced with a relaxation response. this is a form of classical conditioning

AO1 explain the process systematic desensitisation - wolpe

this is designed to gradually reduce phobic anxiety. a new response of relaxation to the phobic stimulus is learned this is known as counter conditioning. this also involved reciprocal inhibition because the response of relaxation inhibits the response of anxiety. there are three processes involved.

1. anxiety hierarchy - is put together by the patient and therapist. this is a list of situations related to the phobia, arranged from least to most frightening.

2. relaxation - therapist teaches the patient relaxation techniques such as breathing exercises or mental imagery techniques

3. exposure - the patient is exposed to the phobic stimulus while in a relaxed state. this takes place across several sessions, starting at the bottom of the anxiety hierarchy. when the patient can feel relaxed they move up the hierarchy. treatment is successful when the patient can stay relax in situations high on the anxiety hierarchy.

AO2 give research by gilroy on systematic desensitisation

procedures

• followed up 42 patients who had been treated for spider phobia in three 45 minute sessions of systematic desensitisation

• phobia was assessed on several measures including the spider questionnaire

• control group was treated by relaxation without exposure

findings

• at both 3 months and 33 months, the systematic group was less fearful than the relaxation group

conclusion

• shows that systematic desensitisation is effect and the effects are long lasting

AO3 explain how systematic desensitisation is suitable for a diverse range of patients

requires less patient effort than CBT (cognitive behavioural therapy) which asks them to understand their behaviour which means that it can be then suitable for those with learning difficulties.

AO3 explain why systematic desensitisation may not appropriate to those who lack a vivid imagination

ohman claim it may be less successful for treating phobias that have an evolutionary survival component.

AO3 give research support for the effectiveness of systematic desensitisation

mcgrath reported that about 75% of patients respond to SD

AO3 explain why patients may prefer systematic desensitisation over flooding

it is a gradual process and less sudden and traumatic

AO3 explain why systematic desensitisation may not solve any underlying deeper reasons for the phobia

focuses on changing behaviour but does not treat any underlying neurochemical imbalance which may have made people vulnerable to phobias. psychodynamic theorists might argue that SD doesn’t address any unconscious conflict. matters as the underlying problem remains

AO1 define flooding and the process

it also involves counterconditioning of the conditioned response. it can conducted in vivo (actual exposure) or in vitro. it involves immediate exposure to a terrifying situation. it stops phobic responses very quickly as without the option of avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless. in classical conditioning terms this is called extinction. in some cases the patient may achieve relaxation in the presence of the phobic stimulus simply because they have been exhausted by their own fear response.

1. learning relaxation techniques to use during the flooding session

2. sudden exposure to the most feared object or situation

3. avoidance behaviour is prevented

4. high anxiety is experienced but there is eventual exhaustion of the anxiety response

5. this leads to ‘extinction’ of the conditioned response

6. a new stimulus-response link can be learned between the feared stimulus and relaxation

one session usually lasts 2-3 hours. sometimes only one long session is required

AO3 explain why flooding cost effective

studies compared flooding to cognitive therapies, such as ougrin, have found that flooding is highly effective and quicker than alternatives. this quick effect is a strength because it means that patients are free of their symptoms as soon as possible and that makes the treatment cheaper

AO3 explain why flooding is less effective for more complex phobias such as social phobias

may be because social phobias have cognitive aspects e.g. someone who struggles with social phobia does not experience an anxiety response but thinks unpleasant thoughts about the social situation. this type of phobia may benefit more from cognitive therapies because such therapies tackle the irrational thinking

AO3 explain why flooding can be traumatic

the most serious issue with flooding is that it is a highly traumatic experience. the problem is not that flooding is unethical (as patients give consent) but that patients are unwilling to see it through to the end. this is a limitation as time and money are sometimes wasted preparing patients only to have them refuse to start or complete treatment

AO1 define depression

is a mood or affective disorder. there are no laboratory tests so doctors must diagnose from behaviour and what patients tell them. in order to be suffering from clinical depression a person should have experienced at least five of the following symptoms and a persistent low mood over at least two weeks :

1. loss of interest or pleasure in usual activities

2. bad eating happens

3. sleep difficulty or oversleeping

4. loss of energy

5. body slowed down or agitated

6. feelings of excessive guilt

7. inability to concentrate or think clearly

8. recurrent thoughts of death or suicide or suicidal behaviour

AO1 give the three behavioural characteristics of depression

• change in activity levels - may have reduced energy levels which causes them to withdraw from work, education and social life. the opposite may be difficulty relaxing which is called psychomotor agitation

• change in sleeping and eating habits - reduced sleep (insomnia) or an increased need for sleep (hypersomnia). eating may increase or decrease

• aggression or self-harm - verbally and physically aggressive to others and themselves

AO1 give the three emotional characteristics of depression

• low mood - over at least two weeks and patients describe themselves as worthless or empty

• anger - extreme anger towards themselves or others

• low self esteem - can be extreme and self loathing

AO1 give the three cognitive characteristics of depression

• poor concentration - unable to stick to tasks or may find it difficult to make simple decisions

• attending to or dwelling on the negative - inclined to pay more attention to negative aspects and ignore the positives. they also have a bias towards recalling unhappy events

• absolutist thinking - ‘black and white thinking’ - a slightly bad situation is an ‘absolute’ disaster

AO1 give the cognitive approach to explaining depression

the cognitive approach focuses on how thinking shapes our behaviour. if a person has faulty information processing, it may make them vulnerable to depression. depression is seen as being caused by negative automatic thought processes.

AO1 explain becks cognitive theory of depression

beck suggested that some people are more vulnerable to depression than others. in particular it is a persons cognitions that create this vulnerability. beck suggested three parts:

faulty information processing

• when depressed we attend to the negative aspects of situations and ignore the positives. we tend to blow small problems out of proportion and think in ‘black and white terms’

negative self-schemas

• a schema is a ‘package’ of ideas and information developed through experience. they act as a mental framework of the interpretation of sensory information. a self-schema is the package of information we have about ourselves. we use schemas to interpret the world, so if we have a negative self-schema we interpret all information about ourselves in a negative way

the negative triad

• a person develops a dysfunctional view pf themselves due to three types of automatic thinking, regardless of reality. these three elements are called the negative triad. negative view of:

• the self - e.g. ‘i’m a failure’ such thoughts enhance any existing depressive feelings because they confirm the existing emotions of low self-esteem

• the world - e.g. ‘the world is a cold place’ this creates the impression that there is no hope anywhere

• the future - e.g. ‘it won’t get better’ such thoughts reduce any hopefulness and enhance depression

AO3 give supporting evidence to becks cognitive theory

• range of evidence supports the idea that depression is associated with faulty information processing, negative self-schemas and the cognitive triad of negative automatic thinking

• e.g. grazioli and terry assessed 65 pregnant women for cognitive vulnerability and depression before and after birth. they found that those women judged to have been high in cognitive vulnerability were more likely to suffer post-natal depression

• clark and beck reviewed research on this topic and concluded that there was solid support for all these cognitive vulnerability factors. these cognitions can be seen before depression develops suggesting that beck may be right about cognition causing depression

AO3 explain how becks cognitive theory has practical application in CBT

it forms the basis of CBT. all cognitive aspects of depression can be identified and challenged in CBT. these includes the components of the negative triad that are easily identifiable. this means a therapists can challenge them and encourage the patient to test whether they are true

AO3 explain how becks cognitive theory does not explain aspects of depression

depression is complex, some depressed patients are deeply angry and beck cannot easily explain this extreme emotion. some sufferers of depression suffer hallucinations and bizarre beliefs. very occasionally depressed patients suffer cotard syndrome, the delusions that they are zombies (jarrett)

AO1 explain ellis’ abc model

ellis focuses on irrational thoughts (defined it as thoughts that interfere with us being happy and free of pain) as the source of depression.

• A : activating event - an external event or situation that may trigger irrational beliefs. likely to be negative e.g. losing their job

• B : beliefs - thoughts about the event e.g. they always had it in for me

• C : consequences - emotional and behavioural consequences e.g. feeling sad and insomnia

AO2 give research into ellis’ abc model - nyarko and amissah

asked an opportunity sample of 200 undergraduates (100 males and 100 females) to complete the beck’s depression inventory (DBI) and the automatic thoughts questionnaire (ATQ).

the BDI measures the intensity of depression by measuring symptoms such as helplessness, irritability and feelings of guilt. the ATQ measures the frequency of automatic negative thoughts associated with depression.

FINDINGS

similarly to Beck and Ellis, the findings showed a significant positive correlation between cognitive distortions and depression. the researchers concluded that having dysfunctional thoughts positively predicts depression

AO3 explain how the abc model can explain the link between childhood attachment and later depression

children may form negative schemas and self-schemas as a consequence of inconsistent caregiving linked to an insecure attachment. may explain why children with an insecure attachment may go on to develop depression in later life

AO3 explain why the abc model is a partial explanation

it is undoubtable that some cases of depression follow activating events. psychologists call this reactive depression and see it as different from the kind of depression that arises without an obvious cause. this means that ellis’ explanation only applies to some kinds of depression and is therefore only a partial explanation

AO3 explain how the abc model has practical application in CBT

similar to beck. the idea that, by challenging irrational negative beliefs a person can reduce their depression is supported by research e.g. lipsky. this in turn supports the basic theory as it suggests that the irrational beliefs had some role in depression

AO3 explain how the abc model does not explain all aspects of depression

similar to beck, it doesnt easily explain the anger associated with depression or the fact that some patients suffer hallucinations adn delusions

AO3 explain why not all irrational beliefs are irrational

alloy and abramson suggest that depressive realists tend to see things for what they are. they found that depressed people gave more accurate estimates of the likelihood of a disaster than ‘normal’ controls and they called this the sadder but wiser effect.

AO1 explain the process of CBT

CBT begins with an assessment in which the patients and the therapist work together to clarify the patient’s problems. they jointly identify goals for the therapy and put together a plan to achieve them.

the treatment of negative automatic thoughts. this therapy is relatively brief, consisting of approximately 20 sessions over 16 weeks, it is an active and directive therapy which focuses on the ‘here and now’. as well as trying to challenge maladaptive thoughts

PROCESS

• STEP ONE - ASSESSMENT: they clarify the problems and identify goals for therapy, they may identify any negative/irrational thoughts that need to be challenged. the client is also educated about the relationship between cognitions/low emotional mood and depressed behaviour

• STEP TWO - BEHAVIOURAL ACTIVATION AND PLEASANT EVENT SCHEDULING: aimed at increasing physiological activity and engagement in social or other rewarding activities. e.g. call a friend or go for a swim

• STEP THREE - THOUGHT CATCHING: as part of the previous step clients may be asked to keep a diary to record any emotion-arousing events and automatic negative thoughts associated with these events. the therapist will then challenge these thoughts e.g. where is the evidence

AO2 give research on CBT by march

• 327 teenagers with depression

• randomly allocated to three groups

• SSRI (anti-depressants), CBT or SSRI and CBT

findings

improvement after 12 weeks :

• SSRI 62%

• CBT 48%

• SSRI and CBT 73%

improvement after 36 weeks

• SSRI 81%

• CBT 81%

• SSRI and CBT 86%

conclusion

• CBT is as effective as SSRI

• but SSRIs worked quicker than CBT

• combination is the best treatment

AO3 explain why CBT is as effective as SSRIs

elkin’s study involved the random allocation to different treatment groups. after 16 weeks : CBT and tricyclic anti-depressants were equally effective, drugs tended to work quicker. after 18 months the CBT group were less likely to relapse

AO3 explain why it is a limitation for CBT to require patient motivation and engagement

• may be difficult for people with severe depression as they lack motivation and may need to be treated with anti-depressants before they can engage with CBT

• may not be suitable for people with rigid and inflexible views as they may not be open to having their thoughts challenged and changes

AO3 explain why CBT can be versatile

can be offered face-to-face, by phone or can be computer mediated. can be provided in a cost-effective way to suit the needs of the participants

AO3 explain why CBT may be less suitable for clients experiencing situations of high stress

can be offered face-to-face, by phone or can be computer mediated. can be provided in a cost-effective way to suit the needs of the participants

AO3 explain why clients may find CBT frustrating

CBT focuses on here and now and does not include an exploration into their past. clients may believe that their depression is linked to their past and may want to discuss it

AO1 define OCD

OCD is a serious anxiety-related condition where a person experiences frequent intrusive and unwelcome obsessional thoughts, often followed by repetitive compulsions, impulses or urges

AO1 define the behavioural aspects of OCD

the behavioural aspect is the compulsive behaviours which they are unable to control

• the compulsions have two elements : they are repetitive and reduce anxiety. the majority of compulsive behaviours are an attempt to manage the anxiety produced by obsessions

• avoidance : suffers attempt to reduce anxiety produced by keeping away from situations that trigger it

AO1 define the emotional aspect of OCD

the emotional aspect is the concern and upset caused by the knowledge that their obsessions and behaviour are irrational and abnormal but feel powerless to control them

• anxiety and distress : thoughts are unpleasant and frightening and the anxiety that goes with these can be overwhelming

• accompanying depression : anxiety can be accompanied by low mood and lack of enjoyment in activities

• guilt and disgust : emotions such as irrational guilt or disgust towards things such as dirt or themselves

AO1 define the cognitive aspect of OCD

the cognitive aspect is obsession, the constant thoughts OCD sufferers’ experience which take the form of persistent and uncontrollable thoughts, images, impulses, worries, fears or doubts

• obsessive thoughts : thoughts that occur again and again and are always unpleasant

• cognitive strategies to deal with obsessions : people respond by adopting cognitive coping strategies. although it may help them manage anxiety, it can make them appear abnormal to others and can distract them from daily tasks

• insight into excessive anxiety : suffers experience catastrophic thoughts about the worst case scenarios that might result if their anxieties were justified. they tend to be hypervigilant (maintain constant alertness and keep attention focused on potential hazards

AO1 explain the difference between identical and non-identical twins

• identical - monozygotic (MZ), genetically identical, concordance rate OCD 68%

• non-identical - dizygotic (DZ), share 50% of the genes, concordance rate OCD 31%

AO1 genetic explanations - explain how genes are involved in individual vulnerability to OCD

lewis observed that of his OCD patients 37% had parents with OCD and 21% had siblings with OCD. this suggests that OCD runs in families, although what is probably passed on from one generation to the next is genetic vulnerability not the certainty of OCD. according to the diathesis-stress model certain genes leave some people more likely to suffer a mental disorder, but it is not certain - some environmental stress (experience) is necessary to trigger the condition

AO1 genetic explanations - explain the role of candidate genes

• the COMT gene is involved in the production of Catechol-O-Methyltransferase. it regulates the production of the neurotransmitter dopamine. one form of the gene has been found more common in OCD patients and this variation leads to higher levels of dopamine. higher levels of dopamine are associated with stereotyped movements which manifest themselves as OCD compulsions. Tukel found that lower levels of activity of the COMT gene leads to higher levels of dopamine.

• another candidate gene is the SERT gene which affects the transport of serotonin, creating lower levels of this transmitter. low levels of serotonin are also implicated in OCD. ozaki found evidence of two unrelated families with mutations of this gene where 6 of the 7 family members had OCD

AO1 explain why OCD seems to be polygenic

this means that it is not caused by a single gene but several variations are involved. taylor has found evidence that up to 230 different genes may be involved in OCD

AO1 explain why OCD is aetiologically heterogenous

this means that it has different causes so one group of genes may be implicated in one person with OCD and a different group of genes in another persons OCD

AO2 give research into genetic explanations for OCD - nesdadt

procedure

• 80 patients with OCD and 343 of their first-degree relatives

• compared them with 73 control patients with mental illness and 300 of their relatives

findings

found that people with a first degree relative with OCD had a five times greater risk of having the illness themselves at some point in their life

conclusion

supports the genetic explanation of OCD as it suggests that genetic inheritance contributes to the predisposition to develop OCD

AO3 explain why there are too many candidate genes

psychologists have been less successful on what genes are involved in OCD. one reason is that it appears that several genes are involved and that each genetic variation only increases the risk of OCD by a fraction. this means that a genetic explanation is unlikely to ever be useful as it provides little predictive value

AO3 explain why the genetic explanation is biologically reductionist

it seems that environmental factors can also trigger or increase the risk of developing OCD (the diathesis-stress model). e.g. cromer found that over half the OCD patients in their sample had a traumatic event in their past and that OCD was more severe in those with more than one trauma. suggests that OCD cannot be entirely genetic in origin, at least not in all cases.

AO3 explain the difficulty distinguishing between genetic and environmental influence in family and twins studies

MZ twins have a more similar shared environment than DZ twins e.g. may be treated in similar ways. higher concordance rate may be influenced by their similar shared environmental experiences rather than their shared genes

AO1 neural explanation - explain how abnormal levels of neurotransmitters links to OCD

• lower levels of serotonin - people with OCD may have too little serotonin for their nerve cells to communicate effectively

• higher levels of dopamine - induce stereotyped movements resembling the compulsive behaviours in OCD patients

AO1 neural explanations - explain how abnormal brain circuits is linked to OCD

• the orbitofrontal cortex (OFC) sends signals to the thalamus (in the limbic system) about potential minor worries e.g. which the caudate nucleus supresses. however if the caudate nucleus is damaged, the worry is not suppressed and the thalamus is alerted and confirms the worry to the OFC. this creates a ‘worry circuit’ which leads to obsessive thought.

• abnormal levels of serotonin causes the OFC and caudate nucleus to malfunction (comer)

• high levels of dopamine causes over activity in the basal ganglia (sukel)

AO1 neural explanations - explain how decision making systems are linked to OCD

OCD may be associated with abnormal functioning of the lateral (sides) of the frontal lobe. frontal lobe is responsible for logical thinking and making decisions. there is evidence that the parahippocampus gyrus - associated with processing unpleasant emotions, functions abnormally in OCD patients

AO2 - give research into neural explanations for OCD - menzies

procedures

mri scans were used to produce images of brain activity in OCD patients and their immediate family members without OCD and also a control group of unrelated healthy people

findings

they found the OCD patients and their close relatives had reduced grey matter in key regions of the brain including the OFC

conclusion

this supports the view that anatomical differences are inherited and these may lead to OCD in certain individuals. menzies stated that in the future, brain scans may be used to detect OCD risk

AO3 give research support for neural explanations

• anti-depressant medication that increase serotonin activity have been shown to reduce OCD symptoms (pigott).

• contradicting - however about 30% of people do not respond to the medication which suggests that their serotonin activity may not be the reason for their OCD

AO3 explain why it is difficult to determine cause and effect

there is evidence that serotonin, dopamine and various structures of the brain do not function normally in patients with OCD but this is not saying that abnormal functioning causes OCD. biological abnormalities could be a result of OCD rather than the cause

AO3 explain why it may be possible that the low serotonin activity implicated in OCD may be due to the person being depressed

• many people with OCD become depressed and the two disorders are often co-morbid. therefore, it is difficult to know the extent to which low serotonin activity is directly related to OCD.

• contradicting - the fact that classes of anti-depressants that don’t work on the serotonin system have no effect in reducing symptoms of OCD suggests that serotonin is involved in OCD, as only anti-depressants that work on the serotonin system

AO1 explain the aim of drug therapy for mental disorders

drug therapy for mental disorders aim to increase or decrease levels of neurotransmitters in the brain or to increase/decrease their activity

AO1 explain how SSRIs help OCD

• ssri stands for selective serotonin reuptake inhibitor and they work on the serotonin system in the brain

• serotonin is released by certain neurons in the brain, it is released by the presynaptic neurons and travels across the synapse. the neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron where it is broken down and re-used

• by preventing the re-absorption and breakdown of serotonin SSRIs effectively increase its levels in the synapse and thus continue to stimulate the postsynaptic neuron. this compensates for whatever is wrong with the serotonin system in OCD

• typical SSRI is fluoxetine

AO1 explain why SSRIs are often combined with other treatments

drugs are often used alongside CBT to treat OCD. the drugs reduce a patient’s emotional symptoms, such as feeling anxious or depressed which means that they can engage more effectively with the CBT

AO3 give alternatives to SSRIs

where an SSRI is not effective after 3-4 months, the dose can be increased or it can be combined with other drugs, even antidepressants

• tricyclics - older type of antidepressant, such as clomipramine. same effect on the serotonin system as SSRIs. it has more severe side effects than SSRIs so it only for patients who do not respond to SSRIs

• SNRIs - serotonin-noradrenaline reuptake inhibitors. like clomipramine, its for patients who do not respond to SSRIs. it increases levels of serotonin as well as another transmitter - noradrenaline

AO3 give evidence for the effectiveness of SSRIs

• soomro reviewed studies comparing SSRIs to placebos and concluded that all 17 studies reviewed showed significantly better results for the SSRIs than for placebo conditions. effectiveness is greatest when SSRIs are combined with psychological treatment, usually CBT

• typical symptoms decline significantly for around 70% of patients taking SSRIs. of the remaining 30% alternative drug treatments or combinations of drugs and psychological treatments will be effective for some. so drugs can help most patients with OCD

AO3 explain why drugs are cost-effective and non-disruptive

they are cheap compared to psychological treatments. using drugs to treat OCD is therefore good value for a public system like the NHS. compared to psychological therapies, SSRIs are non-disruptive to patients’ lives. if you wish you can simply take drugs until your symptoms decline and not engage with the hard work of psychological therapy

AO3 give the side effects of the drugs

• some patients suffer side-effects as indigestion, blurred vision and loss of sex drive. these side effects are usually temporary

• for those taking clomipramine, side effects are more common and serious. more than 1 in 10 suffer erection problems, tremors and weight gain. more than 1 in 100 become aggressive and suffer disruption to blood pressure and heart rhythm

AO3 explain why the evidence for treatments may be seen as unreliable

some psychologists e.g. goldacre believe the evidence favouring drug treatments is biased because the research is sponsored by drug companies who do not report all the evidence

AO3 explain why drugs may not always be useful

• OCD is widely believed to be biological in origin so it makes sense that the standard treatment should be biological.

• however, it is acknowledged that OCD can have a range of other causes, and that in some cases it is a response to a traumatic life event