5.1.3 + 5.1.4

Question 1

3 features of schizophrenia:

Answer 1

• Around 1% of the population will develop schizophrenia, depending on their racial/ethnic background, which country they live in and country of birth
• around 25% fully recover, 50% suffer reoccurring episodes for the duration of their lifetime and 25% never recover
• The average life expectancy for someone with SZ is around 10 years less than average. This may be because of physical health problems associated with the disorder or the higher suicide rate

Question 2

3 symptoms of schizophrenia:

Answer 2

• people with schizophrenia may experience positive symptoms such as delusions which are beliefs held by the individual that are not true or logical, and can’t be changed by others even when clear evidence can be demonstrated that challenges that belief eg paranoid delusions where the individual believes others are trying to mislead, manipulate or even kill them
• They may also have hallucinations where they hear or see something without any stimulus being present e.g. controlling voices telling the person what to do
• Another symptom is disorganized thinking/speech where ideas are loosely connected or in severe cases completely unconnected and their language is completely incomprehensible as they are unable to connect thoughts – word salad

Question 3

Describe one biological explanation for schizophrenia – 6

Genes

Answer 3

• The genes for schizophrenia are inherited and the disorder tends to run in families.
• The presence of certain types of genetic mutations may be needed before environmental factors contributed a disorder, suggested by the diathesis-stress model.
• Such environmental factors can affect body mechanisms that are driven by genes e.g. stress and hormones
• The risk of developing schizophrenia at some point in your life is around 0.2-2% for the general population. However if you have a second-degree relative with schizophrenia, the risk increases to 2 to 6%. If your relative is first degree then your risk of schizophrenia increases even more to 6 to 17%
• Gottesman and Shields (1966) showed that there is a strong genetic element by finding that people who had an MZ twin with schizophrenia had a 42% chance of developing the disorder, where as DZ twins had a 9% concordance rate. It is also possible that it is genetics that may cause excess production of or sensitivity to dopamine

Question 4

Evaluation of Genes as a biological explanation for SZ:

4 strengths

Answer 4

• Tienari et al (2000) found that almost 7% of adoptees with SZ had a biological mother with the same disorder, compared to only 2% of SZ children born to mothers without SZ. Therefore there must be a genetic basis for SZ as those whose mothers also had the disorder had a higher rate of 7% of developing SZ and those who shared genetic with mothers without SZ had a lower rate of developing SZ.
• Studies have shown high levels of heritability eg Tiwari et al showed a meta-analysis of twin studies found 81% heritability and Lichtenstein found 64%. Therefore these high figures suggest that genes are the largest explanation for SZ due to the high rates of developing SZ that exists between a group of individuals with shared genetics.
• Family and twin studies eg Gottesman give support for a genetic component as showed 42% concordance rates between MZ twins and 9% concordance rates with DZ twins. Therefore genetics must have a role in the development of SZ as those who share 100% genetics are around 4 to 5 times more likely to develop SZ if the other twin has SZ compared to twins who only share 50% of their genetics.
• A study by Heston controlled for environmental effect and still found a higher incidence of SZ in those with a family history of the disorder (AO1). Therefore… (AO3)

Question 5

Evaluation of Genes as a biological explanation for SZ:

4 weaknesses

Answer 5

• Sorri et al (2004) conducted a longitudinal study of 21 years on Finnish adoptees. Comparing adoptees with and without biological mothers with SZ while considering family rearing styles and found that those with high genetic risk are more sensitive to non-healthy rearing patterns. Therefore the environmental factors are important too in the development of SZ and it is not just down to biological influences.
• It has been shown that other factors such as social and environmental influences are involved and seem to trigger SZ eg as those in urban areas or low social economic status seem to have a higher risk in developing SZ. Therefore the biological explanation is incomplete as perhaps stressful life events can trigger production or as suggested by the diathesis stress model it is a combination of the genes with the environment that explains SZ.
• As most MZ twins share their environment, both genes and environment are similar, making it hard to determine what’s responsible. MZ twins are also raised more similarly than DZ twins. Therefore MZ twins share a more similar environment which could account for the higher concordance rate with MZ twins compared to DZ twins, rather than the genetic factors.
• Because concordance rates are at around 40-50% and not 100% for MZ twins then it suggests that other factors such as the environment also play a role (AO1). Therefore… (AO3)

Question 6

Describe another biological explanation for schizophrenia - 6

Function of NT

Answer 6

• One explanation is the function of neurotransmitters; the dopamine hypothesis. Research suggests that the presence of an excess number of dopamine receptors at the synapse contributes to schizophrenia
• This overactivity of dopamine controlled synapses is associated with hallucinations and paranoia
• It is possible that an increase in dopamine in one side of the brain, the mesolimbic pathway, contributes to positive symptoms and that problems in another site, the pathway connecting the midbrain to the frontal lobes, to negative symptoms.
• Sensitivity to dopamine can arise in many ways e.g. from genetic inheritance to brain damage, so there are many ways to develop schizophrenia
• It was seen that patients who had abused large amounts of drug amphetamine often showed positive symptoms of psychosis
• the finding that changing dopamine levels resulted in psychotic type behaviour consistent with that shown with SZ sparked the beginning of the dopamine hypothesis

Question 7

Evaluation of NT as a biological explanation for SZ

4 strengths

Answer 7

• Drugs to increase dopamine production in suffers from Parkinson’s disease give psychotic symptoms. For example, people given levodopa, which adds to dopamine production for Parkinson’s disease can experienced similar symptoms to schizophrenia such as hallucinations and delusions. Therefore suggesting that the dopamine hypothesis is a strong explanation for schizophrenia as excess dopamine is involved in type one symptoms
• Randrup and Munkvad (1966) raised dopamine levels in the brains of rats by injecting them with amphetamines. Results showed a change to the rats behaviour through stereotypical schizophrenia behaviour such as aggression and isolation. Therefore the finding that increase dopamine levels resulted in psychotic type behaviour consistent in those with schizophrenia sparked the Dopamine hypothesis as an explanation for schizophrenia
• SZ’s are more sensitive to dopamine uptake; scanning shows that if those with SZ are given amphetamines there is a greater release of dopamine than if non SZ are given amphetamines. Therefore this suggests those with SZ are more sensitive to dopamine than other people which makes the dopamine a strong explanation for SZ as it affects these individual more.
• Many traditional antipsychotic medications used to treat SZ act by reducing the effect of dopamine by blocking dopamine receptors (AO1) . Therefore…(AO3)

Question 8

Evaluation of NT as a biological explanation for SZ:

4 weaknesses

Answer 8

• It has been shown that blocking dopamine receptors takes a few days to work. Anti-schizophrenic drugs block the dopamine receptors almost immediately but any calming effect is not notice for several days or even weeks. Therefore this suggests that the idea of excess dopamine explaining schizophrenia is not the only explanation as something else is causing the psychotic symptoms
• Animals are used to investigate dopamine pathways and the effects of drugs on them eg lesioning is used with animals to explore the effects of dopamine on their functioning. Therefore although results may show schizophrenia type symptoms, it cannot be generalized to humans as a biological explanation as there are many differences in the biology of human brains and the functioning of our nervous systems
• Evidence has only been gathered from patients after they has diagnoses so its unclear whether the brain was the same before diagnosis. Therefore a cause and effect relationship cannot be established as you don’t know whether the increased levels of sensitivity to dopamine are the cause of SZ or if developing the illness changes brain chemistry
• Carlsson et al (2000) suggests that it is unlikely that dopamine is the only dysfunctional neurotransmitter in SZ. It is thought that other NT eg noradrenaline, serotonin, glutamate and GABA also relate to SZ (AO1). Therefore the explanation of raised levels of dopamine is likely to be to simplistic…(AO3)

Question 9

Describe non-biological explanation for schizophrenia - 6

Social Causation/Adversity Hypothesis

Answer 9

• There is evidence that people in the lowest social classes and groups such as immigrants have a higher incidence of SZ than others in the UK
• In the UK a higher incidence of SZ has been found in bot the lowest social class of the white population and in the black immigrant groups
• It seems that social class and environment may either be a cause or at least be involved in its development as suggested by the diathesis-stress model
• Studies regularly show that SZ is found more among the unemployed and those living in deprived city areas. SZ is more associated with cities than rural communities so it may be that something in city life leads to SZ
• Other features in the environment that might affect the development of SZ seem to be adversity in adult life, poverty, social isolation, poor housing and overcrowding, high levels of crime and drug use, and separation from parents as a child.

Question 10

Evaluation of social causation hypothesis as a non-bio explanation for SZ:

4 strengths

Answer 10

• Pedersen and Mortensen (2001) found that there is a correlation between the risk of schizophrenia and urban density and that longer length of exposure to highly populated areas increase the risk compared to that in a rural environment. Therefore this suggests that an explanation for schizophrenia is social causation due to a link between stresses in our environment e.g. growing up in busy urban areas, and a risk of developing schizophrenia
• Veling et al. (2008) showed that in the Hague there was more schizophrenics living in a place where their ethnic group was not predominant compared with the places where their ethnic group did predominate. Therefore this suggests that an explanation for schizophrenia may be due to a social cause as living in an area where your ethnic group doesn’t predominate could be very stressful e.g. if you’re experiencing racism or discrimination
• Mortensen et al (1999) found a two-fold increase of risk of developing SZ for those born in the capital compared with those born in a rural region of Denmark. Therefore this suggests that twice as many people are at risk of developing SZ if they are born in urban areas compared to rural. This means that there is a social causation factor at play if the environment someone is born in is having such an influence on the risk of SZ development.
• Tiwari et al (2010) found factors that relate to SZ such as growing up in an urban environment, cannabis use, male gender, stress and malnutrition (AO1). Therefore there are environmental factors… (AO3)

Question 11

Evaluation of social causation hypothesis as a non-bio explanation for SZ:

4 weaknesses

Answer 11

• The social drift hypothesis suggests that those with schizophrenia drift into the lower social classes and into adversity because of the disorder, such as not being able to work and also through symptoms of the disorder e.g. difficulty with personal care. Therefore it is difficult to explain schizophrenia as being due to social causation as it’s hard to separate environmental factors to see if they cause or are the result of schizophrenia
• Cooper (2005) found that a tendency to schizophrenia seems to come from what happens to someone in childhood and the early stages of their lives, rather than developing because of lower socioeconomic status and related issues. Therefore the link between schizophrenia and lower socioeconomic status may not be an explanation of schizophrenia but rather that it may come from children living in these circumstances as much as the social status of an adult
• Living in crowded urban areas can lead to toxins in the environment eg from petrol and other factors eg not having social support in communities leading to isolation and communication difficulties. Therefore there are social factors that help explain SZ but it is difficult to know which social factors are involved as it is very difficult to isolate any confounding variables to establish a single cause.
• White people in the lowest socioeconomic groups do not show the increased risk of SZ that black immigrants do (AO1). Therefore this suggests that there is more than just a social cause eg social adversity and lower social class, which is impacting the risk of developing SZ… (AO3)

Question 12

Describe a biological approach as a treatment for SZ - 6

Drug Treatment

Answer 12

• Drug therapy started in the 1950s; up until then treatment for psychotic patients were basic and did not allow patients to function normally.
• If neurotransmitter functioning causes symptoms, drug treatments that affect such functioning can help to treat those symptoms. Eg Chlorpromazine (Typical - 1952), which acts by blocking dopamine receptors so that there is no excess dopamine.
• They want to suppress hallucinations and delusions. Atypical drugs are newer from the 1990s and less widely used eg risperidone.
• They tend to have fewer side effects and act in different ways to typical antipsychotic drugs
• Drugs can reduce the positive symptoms in about 2 weeks, although typical antipsychotics seem not to work on negative symptoms or cognitive symptoms
• Atypical drugs seem to be better for negative symptoms and for improving cognitive function

Question 13

Evaluation of Drug therapy as a treatment for SZ

linked strengths and weaknesses

1) Haloperidol 2) Clozapine 3) Drugs 4) Ethics

Answer 13

• Meltzer et al (2004) found that Haloperidol gave significant improvements in all aspects of functioning compared with the placebo group. Two of the new drugs also showed improvements in both positive and negative symptoms. Therefore it is an effective treatment for schizophrenia has it improved symptoms and functioning for those on drug treatment, allowing them to live in society and be less of a risk to themselves or others
• However Haloperidol is an example of a typical antipsychotic which can be associated with disturbances of movement and posture such as tremors and muscle spasms. Long term use of these typical drugs can lead to TD which can be irreversible. Therefore these severe side effects may be enough to discourage schizophrenics to not take their drug treatment shown by around 50% of SZ’s stopping their drugs due to forgetting or side effects. This then puts them at risk of relapse or re-hospitalisation
• Brar et al (1997) found that Clozapine highly effective in treating positive symptoms of hallucinations and other psychotic symptoms including negative ones eg emotional withdrawal. Therefore this means that people who had not previously responded to other drugs found newer Atypical drug treatment that were effective in treating both positive and negative symptoms of schizophrenia which allows these schizophrenics to fit into society and eg avoid institutionalisation which would have been previously unavoidable.
• However clozapine has also been found to increase the risk of patients developing agranulocytosis which reduces the white blood count and increases the risk of infections. Therefore patients must have blood tests every two weeks to monitor their blood count which can be a commitment that disrupts the schizophrenic from being able to try and be independent while also having strong negative health risks
• Emsley (2008) found that those who had the injection of the antipsychotic drug early in the course of their disorder had higher remission rates and lower relapse rates. They found that drug treatment is effective at treating schizophrenia in 84% of patients. Therefore there was at least a 50% reduction in symptoms which improves the quality of lives for many SZ as they can function independently and avoid long term hospital stays.
• However drugs do not take into account a patients environmental or social problems which might contribute to rehospitalisation and relapses. Therefore drug treatment is more effective when used with therapy which is able to address these issues eg stressors in their life such as struggling financially as alone drug therapy is not a cure for patients with SZ.
• Drugs are thought to be better than former pre 1950s treatments eg insulin shock therapy, as they are seen as more ethical and more effective (AO1). Therefore…(AO3)
• Ethically drugs have been called a ‘chemical strait-jacket’ and some people think such control by society is unacceptable (AO1). Therefore…(AO3)

Question 14

Describe a non-biological approach as a treatment for SZ - 6

Assertive Community Treatment - ACT

Answer 14

• ACT is used to help patients who have frequent relapses and bouts of hospitalisation to be focused on from the community health service.
• They can help patients with independence, rehabilitation and recovery and to avoid homelessness and hospitalisation.
• ACT offers a holistic treatment that looks at all of their needs in a multidisciplinary approach through eg counselling, halfway houses or day centres.
• Treatment of the patient is in a real life settings as they are visited and helped, rather than offering therapies, with enough staff to offer this support and related treatment
• Teams are made up of lots of professionals, such as psychiatrists, nurses, social workers and people with whom the treatment has worked so that a whole team can focus on the individual.

Question 15

Evaluation on ACT as a treatment for SZ

strengths and weaknesses are linked

1) Leff 2) team/staff 3+4) more general ACT eval.

Answer 15

• Leff (1997) found that schizophrenics in long term sheltered accommodation had less severe symptoms than those still in hospital. Therefore ACT is effective at treating schizophrenia as patients given a range of services with the aim of rehabilitation allowed them to function as normally as possible in society and improve their quality of life so that they can recover better in comparison to those in the hospital environment
• However Leff (1994) found the balance between hospital and community services was inappropriate as there weren’t enough hospital beds for those that needed them and not enough residential places for those released from hospital. Therefore it is not an effective treatments if community care programmes are underfunded as it can be unethical, impacting the patients recovery and even make them worse
• Van Vugt et al (2012) in the Netherlands found that ACT could be effective and that it was the team structure that was important. Therefore ACT is an effective treatment for schizophrenia if there is a whole team of professionals eg psychiatrists, nurses and social workers who can all focus on the individuals so that they avoid relapses and re-hospitalisation
• However ACT works best in heavily populated areas where there is a high incidence of people with schizophrenia needing care in the community. Otherwise it can be difficult to bring in these teams of professionals as there are not enough cases to warrant it. Therefore in less densely populated areas it may not be provided because of the cost implications making it less effective as a treatment as it can’t always be accessed.
• Bond (2002) found that ACT was extremely effective in most mental disorders across gender, age and culture and suggested it allows the client to have choices. Therefore this is an effective treatment for many people with SZ as they can have improved quality of life and avoid hospitalisation despite patient factors eg age, race and religion.
• Although therapies such as ACT help to prevent relapses they do not seem to have an effect on actual functional as they do not reduce positive or negative symptoms of schizophrenia or help with employment prospects. Therefore they are not effective as a treatment by itself as it needs to be used alongside antipsychotic drugs to actually be an affective treatment for schizophrenia
• It is thought to be good for those who have many relapses, because it might be problems with living outside the hospital that lead to such episodes eg works by helping the individual to function in society (AO1). Therefore… (AO3)
• Gomory (2001) found that ACT is paternalistic and coercive as the patient does not have the choice of whether to undergo the treatment ie there is social control. It is suggested that around 11% of patients feel forced into the treatment (AO1). Therefore…(AO3)

Question 16

3 features of AN:

Answer 16

• 90% of AN cases are in females 13-18 yrs and it rarely begin before puberty
• The onset often appears to coincide with a significant life stressor eg starting university or leaving home
• 20% of people with AN have one episode and recover completely, 60% follow an episodic pattern of weight gain and relapse whilst 20% continue to be affected and often require hospitalisation

Question 17

3 Symptoms of AN:

Answer 17

• Criterion A is a restriction of energy intake resulting in body weight being significantly below expected for a patients age and height.
• Criterion B is an intense fear of gaining weight or participating in behaviour to interrupt the gaining of weight even when current weight is very low
• Criterion C is a distortion of body image where body weight is hugely overestimated and the patient is unable to accept the severity of the low body weight

Question 18

Describe one biological explanation for AN - 6

Malfunctioning Hypothalamus

Answer 18

• This assumes our behaviour is controlled by the activity in the central nervous system, specifically the brain. The brain itself is organised into regions which have different roles, so a malfunction in one region may cause a behaviour problem in the individual
• The hypothalamus plays an important role in the regulation of eating. the lateral hypothalamus produces hunger and the ventromedial hypothalamus depresses hunger.
• A malfunction here may be the cause of lack of appetite in some, anorexia, if they’re ventromedial hypothalamus is jammed in the on position. This would make them constantly feel like they are full and not hungry to eat anything.
• As a malfunctioning hypothalamus may run in families, inheritance and genetics could play a part; gathered by research using MZ and DZ twins
• Studies have shown that concordance rates are higher for MZ twins than for DZ twins suggesting a role for genetics

Question 19

Evaluation of the malfunctioning hypothalamus as an explanation for AN

4 Strengths

Answer 19

• Holland et al (1984) studied 34 pairs of twins to establish how many suffered from anorexia. Findings found that can concordance rates were 56% for MZ twins and 5% for DZ twins. This therefore supports that there is a strong genetic basis for anorexia as MZ twins have higher rates suggesting that anorexia is genetic through the inheritance of a malfunctioning hypothalamus as MZ twins share 100% genetics
• Another strength is that explanation of malfunctioning hypothalamus means that the anorexic is not held responsible for their behaviour and is more likely to be seen as a victim of the disorder where they have no control, taking away blame and labelling on the individual and onto the disorder. Therefore there is less stigma and blame attached so patients may be taken more seriously and receive better treatment
• Current research has shown that AN does have at least a degree of biological basis eg Kortegaard et al (2001) found concordance rates for AN in MZ twins was 25% and was 13% for DZ twins. Therefore genetics eg inheritance of a malfunctioning hypothalamus must have a role in the development of AN as those who share 100% genetics are more likely to develop AN if the other twin has AN compared to twins who only share 50% of their genetics
• Studies on rats/mice have found that removing the ventromedial hypothalamus resulted in the rats starving to death (AO1). Therefore… (AO3)

Question 20

Evaluation of the malfunctioning hypothalamus as an explanation for AN

3 Weaknesses

Answer 20

• As most MZ twins share their environment, both genes and environment are similar, making it hard to determine what’s responsible. MZ twins are also raised more similarly than DZ twins. Therefore MZ twins share a more similar environment which could account for the higher concordance rate with MZ twins compared to DZ twins, rather than the AN being due to a malfunctioning hypothalamus
• However the fact that MZ twins can be discordant for anorexia suggest that the environment plays a significant role in the disorder. Genes are thought to be involved but they are likely to predispose someone to developing anorexia rather than a sole cause. Therefore this diathesis stress model suggests that this biological explanation for anorexia is incomplete as it is a combination of factors that explain anorexia not just an inherited malfunctioning hypothalamus
• However it is difficult to differentiate between the cause and the effect since the behavioural symptoms of anorexia have a direct and significant adverse effect on the person’s physiology which in turn may affect their biochemistry. Therefore it is difficult to establish whether a biochemical imbalance in the hypothalamus causes anorexia or if anorexia cause a biochemical imbalance
• Explanations are not helpful for an as there is little application as they do not offer any possibility for a treatment (AO1). Therefore (AO3)

Question 21

Describe one non-biological explanation for AN - 6

SLT

Answer 21

• The media is a powerful force in SLT as Western cultures portray extreme thinness, through female models in magazines who are often airbrushed, as being desirable. Eating disorders tend to be found more in industrialised countries where the idea of being thin is more emphasised.
• Anorexia can be explained by social learning theory as many role models give expectations which shape an adolescents body Image. An anorexic may see classmates or role models receive attention through compliments on being skinny.
• This leads to retention of the mental image as that anorexic thinks if they were skinny they would get similar treatment.
• They would then reproduce this image by dieting or not eating so that they get attention and compliments.
• This that motivates them to imitate the behaviour so that when they get complimented their behaviour is reinforced beyond healthy levels

Question 22

Evaluation of SLT as an explanation for AN:

4 Strengths

Answer 22

• One strength is that Becker (2002) found that in Fiji, before TV was introduced, girls were unlikely to be concerned with diets and slimming, but when TV was introduced they became conscious of body Image and diet. This suggests that anorexia was learnt as the girls only showed the behaviour when introduced to a role model for them to imitate and learn from vicariously
• Another strength is that SLT has a practical application to society as many companies eg Dove only use as normal / plus sized models to promote their products so that they are not setting unrealistic expectations of body image. Therefore due to the understanding of SLT it can be counteracted by the use of Media to reduce the observation and imitation of thin role models
• Mumford at al 1991 found heightened levels of AN among Arab and Asian woman who moved to western cultures, which suggests that cultural pressures via the media were to blame. Therefore we can understand that the behaviour is learnt through the differences in role models and body image in different cultures, to explain AN.
• Gender differences can be explained in that females are more prone to AN due to social pressures and stereotypes expected from them (AO1). Therefore suggesting AN is based around observing behaviours…(AO3)

Question 23

Evaluation of SLT as an explanation for AN:

4 Weaknesses

Answer 23

• However it is difficult to show that anorexia is acquired through SLT. As the person has not been studied from birth, it is impossible to identify the specific causes or consequences which may have led to the behaviour. Therefore SLT is an incomplete explanation as they may have been a childhood trigger or it may have been caused by a biological Factor. This makes it difficult to identify a single explanation as it may be an influence of multiple factors
• However SLT cannot explain why dieting continues after the point at which complements for losing weight stop, and when negative comments start. Therefore this suggests that there may be other factors motivating the behaviour if it’s still continues when an anorexic is no longer having their behaviour reinforced. This suggests that the explanation of SLT is incomplete and there may be other factors to explain anorexia.
• SLT doesn’t really consider the cognitive aspects of AN eg the presence of faulty perceptions of body image that often underpins the disorder. Therefore this suggests that SLT is an incomplete explanation as there must be something else influencing the AN behaviour eg a biological factor, as the faulty perceptions are not socially learnt.
• Most people in the west are exposed to thin models, but only a small percentage develop AN - individual differences (AO1). Therefore… (AO3)

Question 24

Describe one non-biological treatment for AN - 6

Cognitive Treatment - RET

Answer 24

• Ellis (1991) devised the ABC model to show how irrational, self-defeating thoughts can turn into manipulative behaviour which can be applied to AN through
• Activating event eg one of friends ask if u put on weight, Beliefs - cognitive reaction to unpleasant even eg u stop eating as lose as much weight as u can, consequences - anxious eg feel isolated and worthless and continue to loose weight past the point which is healthy
• The aim of RET is to help the identify their negative irrational thoughts eg they need to starve themselves to be skinny, and to replace these with more positive rational ways of thinking eg setting new realistic goals
• The therapist and client devise experiments which can be carried out either during the lesson as roleplays or as homework tasks later eg trying to look in the mirror and say something they love about their appearance
• The aim is that by testing out possibilities, clients will come to recognise the consequences of their faulty cognitive processes eg their inaccurate perceptions of body image making them loose weight beyond healthy levels

Question 25

Evaluation of RET as a treatment for AN:

2 Strengths

Answer 25

• One strength of RET is that Brandsma et al (1978) reported that RET is effective in producing behaviour change amongst those who are self-demanding and who feel guilty for not living up to their own high standards. Therefore it is a very useful therapy for AN as many have perfectionist personality traits which make them put pressure on themselves to be perfect so if its successful in producing change in this behaviour it would effectively help to treat AN.
• Another strength is that RET is seen as more effective than psychoanalytic therapies as it aims to help people get better eg eg setting goals to not lie about what they are eating, rather than to just feel better during the session. Therefore it has practical application where the client can learn and implement the therapy in real life which actually resolves the problem as ANs can accept that their faulty perceptions of body image are not true and so they don’t need to keep loosing weight.

Question 26

Evaluation of RET as a treatment for AN:

4 Weaknesses

Answer 26

• However many people who have AN have been suffering psychologically from the illness for a long time before they get referred or seek treatment. Therefore it may be too complex for RET if its been a long-term illness, making the negative irrational thoughts very difficult to reverse.
• However the argumentative nature of the therapy has been questioned, particularly by those who stress the importance of empathy in therapy and it can be very difficult to identify the activation event eg if multiple people have made negative comments on their weight. Therefore these both question how ethical the therapy is, especially as the processes may bring up negative feelings due toa difficult experience. If this isn’t handled well then RET could actually make AN worse eg if they start thinking about all the negative comments that have been made about their body.
• Francher (1995) also argues that cognitive therapist may not be capable of identifying faulty thinking; what is illogical to the therapist eg continuing to not eat despite severe health problems eg weak heart, when this may not be foolish in the eyes of the individual. Therefore this makes RET ineffective as their therapist cant fully empathise with the patient and accurately identify their negative and irrational thoughts which it makes it difficult to provide an effective therapy session.
• Another weakness of RET as a treatment for AN is that it doesn’t consider the biological cause of AN eg a malfunctioning hypothalamus. Therefore this treatment would not help anorexics who didn’t develop the disorder through SLT as it is focused on the irrational thoughts rather than physiological biochemical imbalances that cannot be improved from therapy.

Question 27

Describe one biological treatment for AN - 6

Drug Therapy

Answer 27

• NICE states that drugs should not be used as a primary or only treatment for patients with AN and there is little evidence that they are useful treatment
• However many patients with AN suffer from comorbid conditions for which drug therapy may be effective eg depression and anxiety including OCD
• SSRIs are used as serotonin function can be disturbed by AN as this disturbance can continue after recovery, so focusing on serotonin levels using medication can be helpful
• Antipsychotic drugs eg Olanzapine can also be used as they treat anxiety through block absorption of dopamine/serotonin in certain bran pathways
• This could help patients benefit more from psychological therapies to treat AN eg a patient anxious about weight gain which is necessary for recovery is less likely to drop out of therapy if they are being treated for their anxiety

Question 28

Evaluation of Drug Therapy as a treatment for AN:

2 Strengths

Answer 28

• Kaye et al (2001) compared outcomes for patients given fluoxetine (an SSRI) with patients given a placebo and found that those on fluoxetine had lower relapse rates, measured by an increase in weight and improved symptoms. Therefore this drug therapy was an effective treatment for AN if it can get people to a healthy weight and allows negative symptoms impacting the ptient to be removed
• Vandereycken (1984) found that antipsychotics that blocked dopamine, enabled patients to achieve some weight gain. Therefore this is effective as it helps those with AN to be healthier so that they are less at risk of cardiac problems, hair loss and infertility
• Reduce anxiety = can do therapy better

Question 29

Evaluation of Drug Therapy as a treatment for AN:

4 Weaknesses

Answer 29

• However if taking these drugs makes an AN start to gain weight then although itsa positive outcome, ANs may find it difficult to cope psychologically due to the nature of the illness. Therefore it can make continual taking of the drug very difficult and then they wont get treated. It also explains how medication alone is ineffective
• However patients with AN often have poor health issues sue to malnutrition, so often suffer quite serious heart problems and poor cardiac function. Therefore prescribing medications that have bad side effects such as heart failure is very risky for someone with AN as their hearts are already weak, making the drug treatment ineffective if they could die
• Drug therapy also has limitations as it isn’t directly useful for AN even though it helps with symptoms of anxiety, depression and OCD. Therefore it is not the most effective treatment as t has to be used alongside psychological treatments for the management of comorbid conditions.
• Ferguson et al (1991) compared 24 patients taking SSRIs and 16 treated on the same ward without taking SSRIs and found no significant difference in terms of body weight, clinical symptoms or reports of anxiety. Therefore this suggests that the use of drugs had no significant impact on the patients treatment outcomes and so it is not an effective treatment for AN.