Abnormal-Psychological disorders

Question 1

Symptoms of depression

Answer 1

•	Loss of pleasure in activities you used to enjoy
•	Loss of appetite 
•	Loss of memory 
•	Inability to concentrate 
•	Feelings of guilt 
•	Negative thoughts
•	Irritable
•	Loss of sex drive 
•	Disrupted sleep 
•	Devoid of feeling 
Feeling of isolation

Question 2

Biological etiologies of depression: Genetic Factors

Answer 2

Nurnberger & Gershon review of 7 twin studies:
-MZT twins concordance rates 65%
-DTZ twins concordance rate 14%
(not 100% -environment and psychological factors)
*Diathesis-stress model- vulnerability (genetic) needs other factor to trigger

Question 3

Biological etiologies of depression: Monoamine hypothesis

Answer 3

*monoamine deficiencies, particularly noradrenaline and serotonin, are an important neural substrate of depression.
Evidence: Reserpine drug
-depletes monoamine stores
-produced symptoms of depression in in patients given drug as treatment for hypertension
-drugs which increase e.g. cocaine have euphoriant effects
*drugs increase serotonin amongst most effective

Question 4

Biological etiologies of depression: The cortisol hypothesis

Answer 4

*stress hormone
*D=elevated levels like when stressed
Fernald & Gunnar (2008):
-639 Mexican mothers + children
-children of depressed mothers living in extreme poverty had low levels of cortisol, stress system ‘worn out’ tf vulnerable to D
*Cushing’s syndrome=excessive production -drugs the normalise alleviate
*relationship with neurotransmitters=complicated

Question 5

Evaluations of Biological etiologies

Answer 5

1) Brain chemistry v.complex, tf unlikely a simple neural substrate of depression will be found
2) even if found, not necessarily cause tf not necessarily best treatment.
could be environmental or cognitive factors lead to neurological abnormalities tf best treatment could still target these environmental or cognitive factors

Question 6

Cognitive aetiologies of depression: Ellis (1962) ‘Cognitive Style Theory’

Answer 6

*irrational & illogical thinking
*draw false conclusions based on faulty reasoning about meaning of events
=feelings of anger, anxiety, depression
Eg: “work must be perfect” + observation “last essay was bad”=”I am stupid

Question 7

Cognitive etiologies of depression: Beck’s (1976) ‘Cognitive theory of depression’

Answer 7

*“Negative Automatic Thoughts”=existence of a stream of conscious, self-directed thoughts in depression which were self-loathing and self-blaming.
3 levels:
1) Underlying systems: dysfunctional beliefs, attitudes & assumptions can develop early in life
2) Processing errors & biases:
patterns of illogical or irrational reasoning that lead to negative conclusions. (overgeneralisation, selective focusing and personalisation)
3) Content: negative automatic thoughts arise from processing errors on the basis of negative underlying assumptions and beliefs, their content forms a cognitive triad, negative views about oneself, negative views about the future and negative views about the world.

Question 8

Evidence for Cognitive theories: Alloy et al (1999)

+ Evaluation

Answer 8

-prospective study
-2 groups chosen on basis of having negative/positive thinking styles
-6 year follow up: only 1% of the “positive thinking” group had developed depression compared to 17% of the “negative thinking” group
tf suggests negative thought patterns play role in ethology of depression

• depressed individuals recall more of the unpleasant words than control participants. Suggests greater focus on negative things in depression.
• depressed individuals are shown ambiguous pictures, they are more likely than controls to make negative interpretations of the situation.
• well-supported by the evidence
• criticised for ignoring the role of mood
• believes that depressed mood only arises at the end of the process, as a result of negative automatic thoughts. It seems likely that affect plays a greater role than this.
• theory recognises that negative thought patterns are activated by ‘critical incidents’. tf does not tell the whole story about the etiology of depression: these external factors need to be included as well.

Question 9

Sociocultural etiologies of depression: social factors Brown and Harris (1978)
Provoking and Vulnerability factors

Answer 9

Brown and Harris (1978)
*investigated depression in the working-class female community in Camberwell
*found: 82% of depressive episodes followed stressful life events
only 20% of women who experienced a ‘life event’ became depressed
=distinguish vulnerability factors & provoking
->could experience a stressful life event (a provoking factor) without developing depression, but people with one or more vulnerability factor are much more likely to become depressed in the presence of a provoking factor.

Question 10

Sociocultural etiologies of depression: social factors Brown and Harris (1978)
Poverty

Answer 10

23% of the working class women had been depressed in the previous year vs only 3% of the middle-class women

Question 11

Sociocultural etiologies of depression: social factors Brown and Harris (1978)
Marital status

Answer 11

women who were widowed, divorced or separated had relatively high rates of depression.

Question 12

Sociocultural etiologies of depression: Social rank and depression

Answer 12

Price et al (1977)
Increased status->elevated mood
Decreased status-> depressed mood
Raleigh&McGuire (1991) vervet monkeys
-alpha males had twice as high serotonin levels as any other male
-position lost=serotonin levels dropped

Question 13

Sociocultural etiologies of depression: Cultural factors- higher rated in different cultures

Answer 13

• Higher rates of somatisation disorders in other countries
• different cultures= different ways of understanding, experiencing & expressing mental distress.
• reporting biases: stigma or inadequate health care or thinks docs only treat physical illnesses

Question 14

Evaluation Sociocultural etiologies of depression

Answer 14

• important role in ethology
• act as vulnerability or provoking factors tf some people more likely to experience
• can affect was people from different cultures understand, experience and express mental distress
• mediated by biological and cognitive factors
• monkey study demonstrates the inter-relationship between social and biological factors
• cog factors might explain why some people develop depression in response to social vulnerability and provoking factors whilst others don’t

Question 15

Etiologies of depression: Conclusion

Answer 15

• generally accepted not caused by solely biological, cognitive or sociocultural factors
• interaction between them
• referred to as Diathesis-stress model: suggests that some individuals have a biological predisposition to the disorder, but that it only manifests itself as depression when triggered by other factors, i.e. by cognitive or sociocultural events.
• supported by treatment options for depression
• eclectic approach more effective

Question 16

Symptoms of anorexia

Answer 16

• Dry hair & skin, loss of hair
• Obsessive exercise
• Weight loss 15% below body weight
• Loss of periods
• Fear of weight gain
• Lanugo
• Intolerance to cold
• Body dysmorphia
• Solitude
• Obsession with calories/fat content

Question 17

Prevalence of anorexia

Answer 17

• 1%
• 10:1 female:male
• peak onset ages 14&18
• dancers, long-distance runners, gymnasts
• Industrialised countries
• White, female, middle/upper class adolescents

Question 18

Biological etiologies of anorexia: Genetic factors

Answer 18

• heritability rates ranging from 56% to 84%
• molecular genetics studies: 43 genes involved in regulation of PREEM
• ‘genes of small effect’

Question 19

Biological etiologies of anorexia: Neurotransmission

Answer 19

• Serotonin Dysregulation
• particularly brain systems linked to anxiety, mood and impulse control
• starvation=reduction in serotonin tf reduction of anxiety

Question 20

Biological etiologies of anorexia: hormones

Answer 20

• Leptin: hormones which inhibits appetite, inducing feelings of fullness (satiety)
• Ghrelin: hormone which induces appetite
• abnormal levels of both linked with AN

Question 21

Biological etiologies of anorexia: Starvation dependence

Answer 21

• condition where an individual becomes addicted to starvation
• Szmuckler (1984)
• initial self-starvation explained by cognitive factors e.g. body image distortion
• develops because the individual becomes addicted to the rewarding effects of starvation.

Question 22

Cognitive etiologies of anorexia: Fairburn et al (1999)

Answer 22

• cognitive model of anorexia
• extreme need to control eating as the central feature
• western societies:1) tendency to judge self-worth in terms of shape and weight is superimposed on this need for self-control.

Question 23

Cognitive etiologies of anorexia: Onset of anorexia

Answer 23

• need for self-control in general
• product of individuals’ characteristic sense of ineffectiveness and perfectionism + long-standing low self-esteem

1st- might try control other aspects of life e.g. sport
-soon control over eating central importance because experienced as successful, results clear&rewarding

Question 24

Cognitive etiologies of anorexia: Maintenance of anorexia

Answer 24

• Further dietary restrictions enhance the sense of being in control
• Aspects of starvation such as hunger pangs threaten the sense of control and so lead to further restriction
• Extreme concerns about shape and weight encourage dietary restriction – this is a cultural factor

Question 25

Sociocultural etiologies of anorexia: Industrialised nations

Answer 25

• far more commonly diagnosed in industrialised nations

- popular knowledge and understanding: a disorder that people only suffer from when they know about it.

Question 26

Sociocultural etiologies of anorexia: Lindberg and Hjern (2003)

Answer 26

• 989,871 Swedish residents
• indicated gender, ethnicity and socioeconomic status were large influences on the chance of developing

with those with non-European parents among the least likely to be diagnosed with the condition, and girls in wealthy, white families being most at risk

*unclear why-could be because greater emphasis is placed on perfectionism and achievement in such families.

Question 27

Sociocultural etiologies of anorexia: Minuchin et al (1978)

Answer 27

“Family systems” model of anorexia

• Ids 4 characteristics seen in families
  1) Enmeshment-highly involved with one another, excessive togetherness
  2) Overprotectiveness
  3) Rigidity-highly motivated to maintain status quo
  4) avoidance of conflict/lack of conflict resolution- low tolerance for overt conflict, problems left unresolved & prolonged by avoidance

*develop anorexia as protest, taking control, asserting independence

Question 28

Sociocultural etiologies of anorexia: Evidence for family systems theory

Answer 28

• Minuchin et al (1978) demonstrated that “anorexic families” scored more highly on measures of all four of the above features.
• Selvini-Palazzoli observed family system characteristics similar to the ones described by Minuchin. She reported faulty communication patterns, and observed that the parents appeared unable to take responsibility or a leadership role, typically blaming one another for bad decisions.
• Blinder et al (1988) report that empirical studies have failed to show that particular family patterns consistently set the stage for the development of eating disorders. In fact, it has been found that families with eating disorders such as anorexia nervosa or bulimia nervosa vary widely

Question 29

Etiologies of anorexia: conclusion

Answer 29

seems likely that biological, cognitive and sociocultural factors are involved in the etiology and maintenance of anorexia nervosa. Biological factors may include the reinforcing feelings of starvation; cognitive factors may include anxieties and conflicts relating to puberty and adolescence; and sociocultural factors may include dysfunctional family dynamics and a cultural emphasis on thinness.
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Question 30

Cultural Variations in prevalence: Medical model + universalism vs cultural relativism

Answer 30

Western psychiatry: medical model

• believe mental illness are universal
• physical abnormalities in brain responsible

However:

• others think mind unlike body, an organ built by nature tf can be differences in mental illnesses between cultures.
  universalism: a belief that mental illnesses are caused by biological factors. Tf, mental illnesses are universal and there are no differences between cultures

cultural relativism: a belief that they mind is built by culture as well as nature. There are differences in mental illness between cultures.

Question 31

Cultural Variations in prevalence: The DSM + culture-bound syndromes

Answer 31

-way constructed DSM: demonstrates belief in universalism

• appendix of “Culture-bound syndromes”, disorders specific to certain cultural groups
  e. g. Amok (Malaysia): a dissociative episode characterised by a period of brooding followed by an outburst of violent, aggressive or homicidal behavior

Universalists believe that whilst culture can affect the symptoms of a mental illness, the underlying problem is universal and biological – the differences are just surface variation that can be ignored, while cultural-relativists believe that whilst some mental illnesses are universal, many of them genuinely differ between cultures.

Question 32

Cultural Variations in prevalence: Somatisation and depression

Answer 32

• many non-Western cultures, recorded rates of depression are extremely low
• however many more people here complain of somatic symptoms

-thought that people in Western cultures experience and report affective symptoms, in non-Western cultures experience and report somatic symptoms.

Question 33

Cultural Variations in prevalence: Anorexia Nervosa

Answer 33

• described as Western culture-bound syndrome
• 0.1% of adults and 1% or adolescent girls
• Hong Kong in 1989 the prevalence was 0.002%
• certain aspects specific to Western cultures: citing of fear of fatness and a desire to be thin as reasons for self-starvation
• hard to explain prevalence rates from universalist perspective
• highly dependent on culture & only exists in certain cultures

Question 34

Cultural Variations in prevalence: Reporting bias

Answer 34

• hospital admissions-info may be subject to reporting biases
• certain cultural groups:tendency not to report cases of depression

Rack (1982)
Asian doctors report that depression is equally common among Asians, but that Asians only consult their doctors for physical problems rather than for emotional distress – a reporting bias.

-attitude might explain higher rates of somatisation in certain cultures: socially acceptable experience somatic, not complain about emotion distress

-many cultures: negative views
India: cursed and looked down on (Cohen 1988)
China: mental illness carries a great stigma, so people are careful to only label people who are obviously psychotic (out of contact with reality) as mentally ill (Rack, 1982).

Question 35

Cultural Variations in prevalence: Practical lessons

Answer 35

*culture blind: clinicians need to be aware of cultural differences in symptoms and attitudes towards mental illness

Two aspects:
1) Over-diagnosis-when unfamiliar with a cultural group so views behaviours as abnormal that are actually normal for that group

Cochrane & Sashidharan (1995) point out that it this has led to the behaviour of the white population being seen as normal. For example, in some ethnic groups it is quite normal to see or hear deceased relatives during the bereavement period, but this could be misinterpreted as a symptom of a psychotic disorder

2)under-diagnosis- clinician doesn’t realise that a person is mentally ill either because not expressing distress in way clinician used to or hiding symptoms because in their culture frowned to express and complain about them