Psychopathology Flashcards
1
Q
What does ‘psycho’ mean?
A
The psychological field to do with behaviour and the mind
2
Q
What does ‘pathology’ mean?
A
The study of diseases: their causes, processes and consequences
3
Q
What is psychopathology?
A
The study of psychological disorder
4
Q
What is a basic definition of statistical infrequency?
A
Calculating how often something occurs and defining normality based on how often we observe a behaviour
5
Q
What is considered ‘normal’ and ‘abnormal’ with statistical infrequency?
A
‘Normal’ - frequently observed behaviour
‘Abnormal’ - infrequently observed behaviour
6
Q
What is Ainan Crawley’s IQ and what does this mean?
A
260 IQ, means he is statistically infrequent in terms of IQ
7
Q
How can statistical infrequency vary?
A
Can be on opposite spectrums e.g abnormally high/low IQ
8
Q
What is a low IQ considered as?
A
<70%
9
Q
Talk about statical infrequency with someone with intellectual disability disorder?
A
They are considered abnormal as they have an incredibly low IQ
10
Q
What kind of distribution of data should SI show?
A
A normal distribution (majority in the middle)
11
Q
What are 3 strengths of statistical infrequency?
A
. Objective, clear and mathematical. (Mathematical proof is indefinitely correct)
. Can be observed
. Useful part of clinical assessment for mental disorders
12
Q
What is the problem with using SI as a sign of psychopathology (having a mental disorder)?
A
One end of SI spectrum has a positive and admirable meaning to it and the other side of the spectrum signals a possible problem. Only one side of the spectrum can be a sign of psychopathology so this must be distinguished first
13
Q
What are social norms?
A
Societies views of accepted/expected behaviours
14
Q
How can social norms vary?
A
Norms such as queueing are just rules society has made for convenience (implicit social norms) but norms such as no public indecency is a norm that is also against the law so has a greater consequence for the individual.
15
Q
Define deviation from social norms?
A
When an individual behaves in a way that is different from how we expect them to behave due to societies expectations of social norms
16
Q
What is deviating?
A
Moving away from an expected standard
17
Q
What two types of deviating from social norms are there and what do they cause?
A
Explicit and implicit deviation, cause different forms of judgement
18
Q
What do you call it when deviating from social norms is different based on culture?
A
Cultural relativism
19
Q
What is the DSM-5?
A
Current guide to mental health used by psychiatrists
20
Q
What is antisocial personality disorder according to DSM-5?
A
Absence of prosocial internal standards associated with failure to conform to lawfully or culturally normative ethical behaviour
21
Q
Who was diagnosed with APD and what does it somewhat explain?
A
Jeffrey Dahmer, explains why he deviated from social norms
22
Q
What is a psychopath?
A
Someone who loses touch with reality so they don’t see anything wrong with their behaviour
23
Q
What are statistical norms?
A
The most frequently observed behaviours
24
Q
What are the weaknesses of using deviation from social norms to define abnormality?
A
. Social norms are subjective
. Using social norms to define abnormality suffers from cultural relativism
. Social norms change all the time
. Not a universal way to define abnormality
25
Explain cultural relativism?
Social norms vary from one culture to another so something deemed abnormal in culture may not be in another
26
Give an example of social norms changing over time?
In America, Until 1973, being gay was seen as a mental disorder according to DSM-5
27
Give two examples of cultural relativism impacting the definition of social norms?
1. On the island of Sulauvesi, the people keep bodies of their dead relatives in their house for months, praying with them and giving them food and water.
2. In some cultures, people speak to the souls of their dead relatives. This would look very abnormal in Britain as it would like like someone is talking to themselves
28
What is the main problem with using social norms to define abnormality?
It is not a universal way to describe abnormality (cultural relativism)
29
What are two strengths of using deviation of social norms to define abnormality?
. Serious deviation of behaviour can be a good signal to move forward with a clinical diagnosis (often early stages)
. Having social norms creates a societal boon (benefit to society) as these social norms keep society safe and harmonious. Social norms also make it clear when there is a problem as serious deviation is then easy to pick up and notice
30
What are the three main ways you can failure to function adequately?
. When an individual can’t cope with the demands of everyday life
. Personal functioning such as hygiene may be failing
. Social and professional functioning such as maintaining relationships/jobs may be failing
31
How many of the three aspects of FFA must be fulfilled for a diagnosis?
Only some, not all aspects needed
32
What did Rosenham and Seligman do in 1989?
Said that we may see specific behavioural elements of FFA when people are failing to function adequately.
FFA behaviours:
. Unconventional behaviour (unusual)
. Violation of moral standards/social norms
. Observer discomfort - others won’t to see the person in their state
. Irrationality
. Maladaptive behaviour - not trying to reach goals/bad habits
. Unpredictability
. Personal distress
33
What is the Global assessment of functioning (GAF)?
a numeric scale to assess functioning and diagnose a disability (start at 100 and go down based on what you can’t do)
34
What are the pros of using FFA to describe abnormality?
. Focuses on the person, not in comparison to everyone else and the environment around them
. Includes the lived, subjective experience of the individual
. Good to listen to the personal experiences of people who may be defined as abnormal so it becomes clearer to identify
35
What are the cons of using FFA to describe abnormality?
. Can be hard to differentiate between DSN and FFA
. there is a subjective judgement for FFA as someone else has to make the judgement on whether someone meets the criteria of FFA
. Despite scales such as GAF, psychiatrists make the ultimate decision, not the individual
36
What is the WHODAS 2.0?
World health organisation disability assessment schedule - more detailed and objective than GAF, used currently in the DSM-5 as a way to know if someone is functioning adequately or not
37
What is the problem with the written assessments of functioning?
The individual will usually give a socially expected response
38
What is emphasised in using deviation from ideal mental health to describe abnormality?
What is ‘normal’ rather than what is ‘abnormal’
39
What is the idea in deviation from idea mental health?
If we know what being psychologically healthy looks like, anyone who doesn’t fit this box can be considered ‘abnormal’
40
What quote can describe depression?
‘Depression is more than simply feeling unhappy or fed up for a few days
41
What is clinical depression/major depressive disorder?
A mood disorder characterised by low mood which can change the way you think, feel and behave. Symptoms of clinical depression vary greatly in severity and duration
42
What are the three behavioural characteristics of depression?
. Activity levels
. Disruption to sleeping and eating
. Aggression and self harm
43
Describe what happens to activity levels (behavioural) in sufferers of clinical depression?
. Typically reduced
. Individual becomes lethargic and withdrawn, some people can’t get out of bed
. More rarely, can cause psychomotor agitation - unable to relax
. Disruption to activity levels can vary in highs/lows
44
Describe what happens to sleeping and eating (behavioural) in sufferers of clinical depression?
. Reduced sleep (insomnia) or increased need for sleep (hypersomnia)
. Appetite may increase/decrease = weight gain/loss
45
Describe the behavioural characteristic of aggression and self harm in clinical depression sufferers?
. May have increased aggression which can cause erratic (unpredictable) behaviour and impulsive decisions
. Aggression to yourself (SH) or suicide attempts
46
What are the emotional characteristics of depression?
. Lowered mood
. Anger
. Lowered self-esteem
47
Describe lowered mood in sufferers of depression?
. Very low mood is often accompanied by feelings of emptiness, worthlessness and dejection
48
Out of lowered mood and anger in depression, which is less common?
Anger
49
Describe anger in sufferers of depression?
. Sometimes a lot of it is experienced and it can be very extreme
. This anger can be directed onto self or redirected onto others
50
What is self-esteem?
How much we like ourselves
51
Why is lowered self-esteem often seen in people with depression?
Depression is an emotional experience so reduction in self-esteem is often present, to the point of self-hatred
52
What are the cognitive characteristics of depression?
. Poor concentration
. Dwelling on the negative
. Absolutist thinking
53
Describe poor concentration in people with depression?
. Individual is sometimes unable to stick to a task or lack simple decision-making abilities - these changes in concentration often interfere with work
54
Describe dwelling on negatives in people with depression?
. May ignore positives and focus on negatives
- glass half empty rather than half full
. Frequent recalling of unhappy events
55
Describe absolutist thinking in people with depression?
. Black and white thinking when in reality most situations are grey (mix of good and bad)
- thinking that everything is an ‘absolute unmitigated disaster’
56
What approach is used to understand depression?
Cognitive approach - how we think (negatively in the case of depression)
57
What does Beck’s theory suggest?
That it is a persons cognitions (how they think) that makes them more vulnerable to depression than others
58
What model is used in Beck’s model of depression?
Negative triad of thinking
. Negative views of self
. Negative views of the world
. Negative views about the future
59
What does it mean that Beck’s model is a ‘negative triad’?
It is impossible to see the bright side
60
What does each stage in the negative triad cause?
. Negative views about yourself - low -self esteem
. Negative views of the world - a feeling of hopelessness
. Negative views about the future - reduces hopefulness
61
How is Beck’s negative triad a sign of depression?
As the incredible thoughts stemming from each stage are incredibly irrational. The world shouldn’t bother you to that extent
62
What does Beck’s negative triad become for people with depression?
An automatic cycle
63
What is meant when saying there is confirmation in each stage of Beck’s model?
When the sufferer always sees things negatively to CONFIRM their negative feelings
64
What are the features of faulty information processing in people with depression?
. People who are depressed pay selective attention to their environment
. Depressed people attend to the negative aspects of the world, ignoring the positives
. Linked to ‘black and white thinking’, making small issues seem worse
65
What is a schema?
A ‘pocket’ of ideas and information developed through lived experiences
66
What do schemas act as?
The mental framework to interpret the sensory information we receive from the world around us
67
What did Beck suggest about schemas?
Individuals can develop negative self-schemas from life experiences, and this means all new information about ourselves is interpreted negatively
68
How do cognitive treatments of depression relate to Beck’s model?
Each stage of the model is a cognitive distortion, not an objective truth. They are lies that the brain is telling itself and the individual is believing. Beck’s model represents the thoughts, expectations and beliefs that need to be challenged in treatment for sufferers of depression
69
What are pros of Beck’s model in explaining depression?
It has strong supporting evidence -
There is a host of evidence suggesting that depression is associated with faulty information processing, negative self-schemas, and the negative triad. E.g. Clark and Beck (1999) concluded that these cognitions are often present before depression arises.
Practical application in CBT -
Beck’s theory has led to successful therapy! It forms the basis for cognitive behavioural therapy (CBT). Cognitive aspects of depression are challenged during CBT, including the negative triad. CBT is successful, and the main talking therapy used by the NHS.
70
What are pros of Beck’s model in explaining depression?
It has strong supporting evidence -
There is a host of evidence suggesting that depression is associated with faulty information processing, negative self-schemas, and the negative triad. E.g. Clark and Beck (1999) concluded that these cognitions are often present before depression arises.
Practical application in CBT -
Beck’s theory has led to successful therapy! It forms the basis for cognitive behavioural therapy (CBT). Cognitive aspects of depression are challenged during CBT, including the negative triad. CBT is successful, and the main talking therapy used by the NHS.
71
What is the problem with using Beck’s model to explain depression?
Doesn’t explain all aspects of depression
Depression is complex. What about sufferers who are deeply angry? Hallucinations? Bizarre beliefs? Cotard syndrome - the delusion that sufferers are zombies (Cotard, 2013).
72
How does Ellis’ ABC model explain how someone can suffer from depression and how someone with depression views life?
A (Activating event) - an external, negative event triggers irrational thoughts
B (negative beliefs) - irrational thoughts lead to irrational beliefs
C (consequences) - irrational beliefs lead to maladaptive, negative emotional responses, leading to depression
73
What is the main positive in Ellis’ model of explaining depression?
Practical application in CBT -
Ellis’s explanation of depression has led to successful therapy. Cognitive Behavioural Therapy (CBT) is centred around challenging irrational negative beliefs, and is well supported in research (Lipsky et al, 1980). This shows that irrational beliefs had a part to play in depression.
74
What are the cons of using Ellis’ model to explain depression?
. Partial explanation
Some cases of depression follow activating events (reactive depression), others arise without an obvious cause.
. Doesn’t explain all aspects of depression
As per Beck. What about anger that some sufferers feel, or delusions, or hallucinations? It doesn’t address of explain these aspects.
75
What are the detailed strengths of using the cognitive approach to explain depression?
. It has strong supporting evidence as CBT is overwhelmingly used by the NHS to treat depression. The fact that CBT is a leading treatment supplies evidence that your negative thoughts can cause depression as CBT works cognitively, challenging your negative thoughts and changing depressed behaviour to more clinically normal behaviour.
. Hammen and Krantz found that depressed participants made more errors in logic when asked to interpret written material than non-depressed people. This shows that cognition and depression are linked, although the negative thoughts are not evidenced to be the rooted cause behind depression
76
What are the weaknesses of using the cognitive approach to explain depression?
. Depression is complex so can’t explain every meaning for depression
- no cause and effect: we don’t know which way negative thoughts and depression are linked
. CBT changes the symptoms of depression but we can’t treat the cause as we don’t know it for sure, meaning the depression can re-emerge
. Telling a person they experience negative thoughts and need CBT implies the individual is responsible for their depression. This is a sensitive topic and can lead to stigma, leaving the person with even more negative thoughts (ethically wrong)
- depression shouldn’t be blamed on the person as there is often a biological cause such as low levels of serotonin.
77
What are the two types of therapy for depression?
. CBT
. Rational emotive behavioural therapy (REBT)
78
How do many therapists treat depression?
With both CBT and REBT in conjunction
79
What is the more standard psychological therapy for depression and what is it based on?
CBT, based on cognitive and behavioural techniques
80
What is REBT based on?
Based on Ellis’ model,
81
What do both depression treatments focus on?
Challenging irrational thoughts and beliefs
82
What does behavioural activation relate?
Levels of activity and the mood you experience
83
What is BA used in?
Both CBT and REBT
84
What is BA good for?
Breaking the cycle of depression if it had been associated with low levels of activity
85
Explain how BA works?
Main idea: if you feel better about yourself, you are more likely to resume daily activities.
. Starts by understanding that the cycle of inactivity and low mood needs to be broken
. Increase activity and engage in fun events
. Continue this process by logging and monitoring daily activities (evident as you often get hw for CBT)
. Should end with improved mood and self-worth, lessening your depression
86
What is the difference between maladaptive and adaptive behaviour?
Maladaptive is when you aren’t attempting to reach your goals but adaptive behaviour is when you are
87
What are the cognitive steps in CBT?
. Identify, challenge and change irrational, negative thinking
- improve understanding of the self, others and the world
- actively address the negative beliefs of the individual and challenge them
88
What are the behavioural steps in CBT?
. Identify, challenge and change maladaptive behaviour that is causing or maintaining depression
- become more active
- use role play in therapy, preparing for potentially problematic situations
- rediscover confidence in your abilities
89
What are the 3 main points in CBT?
. CBT is a talking therapy which aims to identify and challenge negative, automatic, irrational thoughts
. Helps patients test the reality of their negative, irrational beliefs
. It is a scientific therapy - directive, collaborative, scientific, structured, specific problem-solving therapy, aimed at reducing psychological distress
90
What happens in sessions 1-5 of CBT?
. Assessment to identify and clarify patients problems
. Goals put together with a plan for achievement
- can take a long time for sufferers to achieve this plan, depending on the severity of the depression
91
What happens in session 5-15 of CBT?
Sessions phase
. Sessions around an hour, weekly
. During sessions, working together to actively and consistently challenge negative, irrational thoughts and behaviours
92
What happens in sessions 15-20 of CBT?
. More adaptive, positive behaviours are put in place to reinforce
. Referring back to previous evidence, patients are able to review and see how irrational their thoughts were.
93
What is the problem with the 20 set session the NHS supplies for CBT?
Your problems may be too complex to deal with in the set amount of sessions
94
How does REBT extend Ellis’ model on depression?
Adds a D (Dispute) and E (effect)
Dispute - therapist actively challenges belief and emotion
Effect - old irrational beliefs is now turned into a rational belief
95
What are the differences between CBT and REBT?
The difference is in the approach. CBT is structured, calm, and process-driven. REBT is more confrontational and aims causing an argument against irrational thoughts
96
What is the goal of REBT?
to identify and challenge irrational thoughts, beliefs and behaviours, in the hope to break the negative cycle of depression.
97
What is an example of REBT with class presentations using the extension of Ellis’ model?
A - you have a presentation at work
B - I can’t do it
C - considering calling of sick
D - I can do something despite feeling fearful and uncomfortable
E - completing presentation
98
What are the three main points of REBT?
. Talking therapy, involving the direct, strong and sometimes confrontational challenging of irrational beliefs
. Differentiator to CBT, more vigorous argument
. Aims to reduce psychological distress from Ellis’ irrational ideas and the patients personal experience
99
What are Ellis’ ‘three basic musts’ in people with irrational beliefs and what happens if these demands aren’t met?
1. I must do well and win the approval of others for my performances or else I am no good
2. Others must treat me considerately, fairly and kindly, and in exactly the way I want them to treat me. If they don’t, it’s terrible and they deserve to be punished.
3. I must get what I want, when I want. If I don’t get what I want, it’s awful and I can’t stand it
In irrational beliefs, if these demands aren’t met, they lead to self-defeating thoughts, which can lead to emotional distress and behavioural dysfunction
100
What is the main strength of CBT and REBT to treat depression?
It is an effective therapy
- lots of evidence supporting success of CBT to treat depression
- March et al (2007) compared CBT with only drugs, or both
- after 36 weeks, 81% of CBT group, 81% of drugs group and 86% of both groups saw significant improvements
101
Explain all 4 cons of CBT and REBT to treat depression?
1. May not work for most severe cases
- sometimes you are so depressed that it is impossible to engage in therapy sessions and can’t concentrate, making them extremely difficult
2. Is it the therapy itself or the therapist-patient relationship?
- Luborksy et al 2002 suggested that the differences between different therapies is small
- it may just be whether you like who you are talking to that matters
3. Some patients want to explore their past
- CBT focuses on the here, now and future. This ‘present-focus’ can be frustrating for people trying to unpick past trauma
4. Overemphasis on cognition
- focus on the mind can neglect other factors (e.g environment)
- shouldn’t a holistic therapy include these factors?
102
What category are phobias in in the DSM-5?
‘anxiety disorders’ - the main symptom is extreme anxiety
103
What is the definition of phobias?
Instances of irrational fears that cause a conscious avoidance of the feared object of situation
104
What info does the DSM-5 have on phobias?
. Anxiety disorders involve a persistent fear of an object, place or situation that is disproportional to the threat or danger posed by the object causing fear.
. The individual will go to great lengths to avoid the object or fear and will experience great distress if it is encountered
. These irrational fears must interfere with social life and work to meet the criteria to diagnose a phobia
105
What are the 5 specific types of phobias according to the DSM-5?
. Animal
. Natural environment
. Blood/injections
. Situational (heights)
. Other
106
What are social phobias?
Involves an intense fear of a social situation or an intense fear of having to interact with others
107
What is agoraphobia?
The fear of open spaces. Better characterised as the fear of being away from home
108
What are the 3 diagnostic features of phobias?
1. Intense, persistent, irrational fear of an object, event, or situation
2. Response to the fear is disproportionate to the threat and leads to avoidance of the Phobic thing
3. Fear is severe enough to interfere with everyday life
109
What are the emotional characteristics of phobias?
. Fear that is marked, persistent, excessive and unreasonable
. Anxiety and panic
All these emotions are caused by the presence or even anticipation of the phobic thing and the expressed emotion is often disproportionate to the threat posed
110
What are the behavioural characteristics of phobias?
. Avoidance of phobic object/event/situation e.g person with agoraphobia avoids open spaces
. Freezing or fainting - instead of a fight or flight response, phobias cause a fight, flight or freeze response
- ‘freezing’ is an adaptive response as a predator may think the prey is dead
111
What are the problems with avoidance of phobias?
. Interferes with routine, occupation, activities and relationships
. The marked distress of phobias and avoidance that interfere with everyday life distinguish phobias from more everyday fears
112
What are the cognitive characteristics of phobias?
. Irrational nature of the persons thinking and the resistance to rational arguments e.g a person who is scared of flying isn’t helped by someone telling them how safe it is
. Person recognises their fear is excessive and unreasonable, distinguishing phobias from delusional mental illnesses (although children often don’t have this as they haven’t realised their fear is unreasonable yet)
113
What are the top 5 most likely phobias?
1. Arachnophobia - spiders
2. Social phobia
3. Aerophobia - flying
4. Agoraphobia
5. Claustrophobia
114
Why can’t you be calm and afraid at the same time?
Because when you are afraid, you are in the sympathetic state (fight/flight) but when you are calm you are in the parasympathetic state (resting state). These two states can’t occur simultaneously
115
What are the two types of therapy for phobias?
Systematic desensitisation and flooding therapy
116
What is behavioural therapy purely based on?
Classical conditioning: if you can learn to be afraid, you can also unlearn it
117
What is the aim of systematic desensitisation?
To extinguish an undesirable behaviour by replacing it with a more desirable one
118
What is in stage 1 of SD?
Aim: client taught relaxation techniques to replace fear response (negative) with relaxation (positive)
. Therapist trains client in deep relaxation techniques - expanding your diaphragm so there is more lung space, allowing you to take in more breath, lowering heart rate and calming you
. Controlled breathing/progressive muscle relaxation techniques - tensing and untensing muscles so the body can unwind and feel relaxed
119
What is in stage 2 of SD?
Stage 2: negotiation
. Therapist asks client to create a fear hierarchy from the least feared situation to the highest level of fear associated with the phobia
120
Why does the fear hierarchy of SD have to come from the client?
As the client knows what causes/ influences an irrational fear associated to the phobia
121
What is in stage 3 of SD?
stage 3: graduated exposure
. Client works their way through the fear hierarchy, performing the relaxation techniques learnt at each stage
. Once the client feels comfortable at each level, the therapist moves up a stage
. If the fear becomes too much at any stage, the client moves down to the previous one until they feel in a relaxed enough state to move back up
122
What does graduated exposure to your fears cause?
What was a feared response to become a calm response
123
Explain how number of sessions for SD works?
Depends on the severity of the phobia but generally between 4-6 sessions, and up to 12 for severe phobias
124
What is the research support for SD and what does it emphasise?
Gilroy (2003) - emphasises gradual exposure to phobia
125
Explain what happened in Gilroy (2003) research?
. Following up on 42 patients who had been treated for arachnophobia using SD
. Their phobia was assessed with a spider questionnaires and by assessing their responses to spiders
. A control group was treated using relaxation techniques without exposure
. Followed up 3 months and 33 months after treatment
. SD group were less fearful than the relaxation group, showing gradual exposure was important in treating phobias
126
What is unavoidable exposure?
Introducing an individual to the thing that they fear in the most immediate and unavoidable way
127
What is extinction in terms of phobias?
Learning to associate the thing you fear with something neutral. It is the exposure to phobia without a gradual build up in an anxiety hierarchy way
128
Explain the 4 step process to flooding therapy?
. Immediate exposure to frightening situation
. Prevention of avoidance until you are calm or anxiety has reduced
. Learns that the stimulus of the phobia is harmless
. The conditioned response of fear is no longer produced
129
What is exposure in vitro?
When the client has to imagine the exposure to the phobic stimulus as some phobias can’t be replicated in therapy such as social phobias
130
What is exposure in Vivo?
When the client is actually physically exposed to the phobic stimulus
131
How many sessions does flooding therapy usually take?
One
132
Give the biopsychological explanation behind flooding therapy?
. Flooding therapy puts you in a place where you can’t avoid your fear you would usually have in your fight/flight state, your sympathetic state. Once you realise your fear isn’t harming you, you start to return to a parasympathetic state as you see the phobia is irrational and your hypothalamus learns that the fear isn’t a threat anymore as you’ve encountered the fear now without avoiding it.
133
What is the research support for flooding therapy?
Flooding Keane et al (1989)
134
Explain what happened in Flooding Keane et al (1989)?
. Studied 24 Vietnam veterans with PTSD
- soldiers received 14-16 sessions of flooding therapy (very severe PTSD)
. They were tested before, after and 6 months later for symptoms of PTSD
. Compared to a control group who didn’t receive any therapy
. The flooding group had fewer terrifying flashbacks
Shows flooding therapy works
135
What are the strengths of flooding therapy?
. Cost effective as it is only one session - compared to cognitive therapies and SD, it is effective and quicker
. Research suggests that flooding is comparable to other treatments but is significantly quicker (Ougrin, 2011) - evidenced
. Backed up by evidence and research
. Don’t need any long-term commitment
136
What are the weaknesses of flooding therapy?
. Less effective for some types of phobias such as social phobias as you may not co-operate with the therapist at all (if it’s the source of the phobia)
. Ethical issues - the treatment can be traumatic for patients as there is unavoidable exposure
137
What are the strengths of SD?
. Appropriateness - behavioural therapies are quick and require far less effort than psychotherapy
. SD is successful for a range of phobias it can treat
. Research supported
. Far less traumatic than flooding
138
What are the weaknesses of SD?
. May appear to resolve problems, but simply eliminating or suppressing the fear may lead to symptom substitution
. Costly
. Long-term commitment required
139
What kind of disorder is OCD?
anxiety disorder
140
What does OCD stand for?
Obsessive compulsive disorder
141
What is OCD characterised by?
Irrational, persistent and intrusive thoughts (obsessions)
Intense, uncontrollable urges to complete tasks (compulsions)
142
What is an example of obsessive thoughts?
The thought that germs lurk everywhere
143
What is an example of compulsions?
Repetitive hand-washing
144
What are the differences between obsessions and compulsions?
Obsessions have to do with thoughts but compulsions are the actions the sufferer takes
145
What are the behavioural characteristics of OCD?
. Repetitive compulsions
. Compulsions reduce anxiety
. Avoidance
146
What is meant by repetitive compulsions?
Sufferers often feel compelled to repeat a behaviour such as excessive hand-washing
147
Why are compulsions performed for sufferers of OCD?
. They are performed in an attempt to reduce anxiety produced by the obsessions. For example, excessive hand washing is performed as a response to an obsessive fear of germs, in an attempt to reduce anxiety
148
Explain what is meant by avoidance in sufferers of OCD?
. Sufferers may try to reduce anxiety levels by staying away from situations that trigger/heighten the anxiety.
. Sufferers may have irrational, intrusive thoughts about germs in the bin, leading them to avoid emptying it
149
What are the emotional characteristics of OCD?
. Anxiety and distress
. Depression
. Guilt and disgust
150
Explain 3 features of anxiety and distress coming from OCD?
. It can be a very unpleasant emotional experience
. Powerful anxiety, couple with obsessions and compulsions
. Can be frightening, overwhelming and paralysing
151
What emotional feature often accompanies OCD?
Depression - OCD is a depressing disorder due to the discomfort and inference in life it is linked to
152
According to IOCDF 2023, what % of OCD sufferers had depression?
25-50%
153
How do sufferers of OCD present their guilt and disgust?
Either directed internally onto the self or externally at the world
154
What are the cognitive characteristics of OCD?
. Obsessive thoughts
. Cognitive strategies
. Insight to excessive anxiety
155
What % of OCD sufferers have obsessive thoughts as their main cognitive feature?
90%
156
What is meant by cognitive strategies for OCD?
Sufferers can respond to obsessive thoughts by using cognitive coping strategies such as using attention redirection if they are experiencing extreme guilt
157
What is meant by OCD sufferers having an insight to excessive anxiety?
. Sufferers are aware that their obsessions and compulsions are irrational (necessary for clinical diagnosis). Despite this, sufferers feel very real and often feel catastrophic levels of anxiety.
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Describe the OCD cycle?
Obsessive thoughts cause anxiety which cause compulsive behaviours which cause temporary relief before the obsessive thoughts recur.
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Where are genetics inherited from?
Your parents through genes which carry the DNA ‘codes’
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What do DNA ‘codes’ determine?
The physical characteristics of an individual and psychological characteristics such as intelligence
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What does the neural explanation of OCD suggest?
That both your physical and psychological characteristics are determined by the brain, the nervous system, and individual neurones.
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What structures are essential to the neural explanation of OCD?
Neurotransmitters and physical structures of the brain
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What are the 3 main features of the genetic explanation to OCD?
. OCD is largely biological in nature
. OCD is inherited, via specific genes which cause OCD
. The two genes associated with OCD are the COMPT gene and SERT gene
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What is the COMPT gene responsible for?
Regulating dopamine levels
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What is the COMPT gene supposed to do?
Carry dopamine away from synapses
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How has the COMPT gene been shown to be related with OCD?
low activity of the COMPT gene has been shown to be related to OCD = high dopamine levels as the dopamine isn’t cleared away quickly
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What is the SERT gene also called?
5-HTT gene
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What does the SERT gene affect?
Serotonin (neurotransmitter) transportation
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What can poor functioning of the SERT gene cause and how is this associated with OCD?
Poor functioning of the SERT gene can cause low levels of serotonin as it isn’t transported properly, causing low levels of serotonin which is associated with OCD
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What levels of dopamine and serotonin are associated with OCD?
Dopamine - high
Serotonin - low
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What are the two pieces of supporting evidence for the genetic explanation of OCD?
Family studies (Lewis 1936)
Twin studies (Nestadt et al. 2010)
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What did the family study for OCD find?
. Assessed OCD sufferers and found that 37% had parents who also had OCD
. 21% of the sufferers had siblings who also had OCD
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What did the twin study for OCD find?
. Reviews previous twins studies examining OCD
. found a concordance rate of 68% in Mz twins and 31% in Dz twins
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What is a diathesis?
A predisposed vulnerability to developing a mental disorder
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What is the diathesis stress model about?
The likelihood of having OCD, not the causation
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What does the diathesis stress model suggest?
That everyone has a predisposed vulnerability to OCD based on their genes but these genes that code a disorder may only emerge when stress-related pressures (stressors) are underneath it all
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What are candidate genes?
Mutations of certain genes which create vulnerability for OCD (SERT and COMPT gene)
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What do OCD candidate genes interact with?
Neurotransmitters such as dopamine and serotonin
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What is meant by OCD being polygenic?
Not a single gene is involved and related to OCD but multiple. Biologically, OCD is a very complex and unclear disorder
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What is meta-analysis?
When a researcher reviews other studies and tries to find a pattern in the data
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What did Taylor (2013)’s meta analysis find?
Evidence of up to 230 different genes in OCD, showing it can be caused by different genes
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What is meant by OCD being etiologically heterogenous?
OCD can be caused by different genes
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What is there evidence to suggest that different types of OCD may result from?
Particular genetic variations (e.g for hoarding disorder)
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What are neurotransmitters responsible for?
Relaying information from one neurone to another (chemical messengers)
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How do low levels of serotonin cause depression and poor mental processing?
Normal transmitting of mood-relevant information isn’t possible with low levels of serotonin. This can be described as abnormal functioning of the serotonin system
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How is the role of serotonin a neural explanation for OCD?
As brain ‘systems’ make up the brain, that is how parts of the brain interact
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As hoarding disorders and other forms of OCD seem to be associated with poor decision-making, what does this suggest about an association with the brain?
OCD could affect the frontal lobe of the brain which is in charge of decision-making
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What is the frontal lobe responsible for?
Executive functioning, personality, impulse control, movement, abnormal functioning (in OCD sufferers)
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What have orbiofrontal cortex (OFC) PET scans shown?
Heightened activity in this region in sufferers with OCD symptoms
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Explain the worry circuit entirely
1. The OFC is the part of the brain that notices when something is wrong
2. OFC sends signals to the thalamus about things that are worrying
3. The caudate nucleus (located in the basal ganglia) is in between the OFC and thalamus and regulates the signals from the OFC. This stops the thalamus from getting hyperactive
4. When the caudate nucleus is damaged or abnormal, it cannot suppress minor ‘worry’ signals, so the thalamus is alerted and the response back to the OFC is of anxiety and impulsive behaviours as thalamus becomes hyperactive
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How can an analogy be used for the caudate nucleus in the worry circuit?
As a brake in a car
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What is the main strength of the genetic explanation for OCD?
It has good supporting evidence:
. Evidence from wide range of sources suggesting genetic vulnerability
. However, in twins study, concordance rate isn’t 100% so environment must play a role (DSM)
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What are two weaknesses of the genetic explanation for OCD?
Too many candidate genes:
. Impossible to pin down all genes involved
. Can’t provide a predictive value for the disorder, only the implication of certain genes
Environmental risk factors:
. Cromer et al. 2007 found that of the sufferers in their sample, more than 50% had a traumatic event in their past, and those with more than one suffered more severely. (Link between trauma and OCD symptoms)
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What did Max (1994) study do and what does it suggest?
Disconnected frontal lobe from the thalamus/caudate nucleus, and OCD symptoms improved. Suggests there is a possible link between neural mechanisms as OCD as when the worry cycle is cut off, symptoms improve. However, the symptoms didn’t completely dissipate. This means Max’s study only somewhat supports evidence for the neural explanation of OCD
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What is a practical piece of evidence to support the biological explanation of OCD?
Effective biological treatments (e,g antidepressants solely target serotonin system). The fact that chemical imbalances of serotonin can be altered with medications and can alleviate symptoms supports evidence for the biological explanation of OCD
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How is the causation of OCD linked to the neural explanation?
The cause of OCD is unknown as we don’t know if OCD causes low serotonin levels of low serotonin levels causes OCD. In the same way, no neural system has been shown to be consistently and undeniably involved with OCD. Implicating certain neural systems in OCD is not the same as saying that their abnormal functioning causes OCD
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What did Cavedini et al 2002 find?
That abnormal functioning in neural systems is associated with OCD
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What is the evolutionary explanation of phobias (AO3 alternative explanation to learning theory)?
. Our ancestors survived by avoiding perceived threats in order to survive, hence the reaction of avoidance when experiencing a phobia
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What is the research support that rejects the behaviourist approach to phobias but supports a cognitive approach?
Di Nardo (1988)
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What did Di Nardo’s study find?
56% of participants with dog phobias had unpleasant experiences but 50% normal controls also had same experiences but no phobia
Conclusion: behaviourism ignores the cognitive factors at play that account for individual variation in phobias
- the patients perception and interpretation of the experience must be taken into account, hence why a social learning theory approach may be more suitable
