Psychopathology

Question 1

What is psychopathology?

Answer 1

Psychopathology is the scientific study of psychological disorders, including their underlying causes. It includes phobias, obsessive compulsive disorder (OCD), depression and schizophrenia.

Question 2

What are the 4 definitions of abnormality?

Answer 2

Statistical Infrequency.
Deviation from social norms.
Deviation from ideal mental health.
Failure to function adequately.

Question 3

What is Statistical Infrequency?

Answer 3

This suggests a person’s trait, thinking or behaviour is classified as abnormal if it is rare or statistically unusual. If we can define what is common and usual, we can therefore define what is unusual and abnormal. For example, mental disability is defined as having an IQ 2 Standard deviations below the mean.

Question 4

What are the evaluating points of Statistical Infrequency?

Answer 4

+This definition works well for characteristics such as IQ which can be measured objectively. Only 2% of people have an IQ score below 70 and they may be diagnosed with intellectual disability disorder (previously called mental retardation).

• This definition assumes that anyone whose behaviour differs from average is abnormal, and common behavior is normal. However, some unusual behaviour is desirable, e.g. an IQ score over 130, while some undesirable behavior eg depression is relatively common.
• The cut off point for normality/abnormality is unclear. How far from average does a behaviour have to be? Eg when does energetic and excitable behavior in a child become ADHD (Attention deficit hyperactivity disorder), not liking spiders become a phobia, cleaning the house every day become OCD, or feeling unhappy become depression?

Question 5

What are social norms?

Answer 5

the rules of behaviour in society. these can be explicit or implicit.
Social norms are approved and accepted ways of behaving in a particular society.

Question 6

What are deviations from social norms?

Answer 6

Social norms are approved and accepted ways of behaving in a particular society. This definition suggests that people who break or reject the social norms and behave in a socially deviant way should be regarded as abnormal. For example, sufferers of schizophrenia are sometimes seen shouting and swearing at themselves. This is not acceptable behaviour and would therefore be seen an abnormal.

Question 7

What are the evaluating points of deviation from social norms?

Answer 7

+This definition does distinguish between desirable and undesirable behaviour and takes into account the effects on others. These features are absent from the statistical infrequency definition.
‘ Context. Before the behaviour can be labelled as deviating from social norms it has to be defined by the situation in which behaviour occurs, as well as the behaviour itself. E.g. seeing someone walk past you naked in public would be abnormal but knowing you were on a nudist beach would make it normal.
-Deviation from Social Norms does not offer a universal definition of abnormality, as it is limited to the norms of a given society at any one time. What is considered a social norm in one culture might be unacceptable in another, e.g. hearing voices in your head from your ancestors is considered a social norm in some African cultures but would be considered abnormal in mainstream British culture. Also social norms change over time, e.g. homosexuality was considered abnormal in the UK before the 1970’s. Behaviour could be considered normal in one culture and abnormal in another, so it would be inappropriate to apply the social norms of one society to another.
-Risk of abuse: it may lead to serious abuse of individual rights as there is a risk that anyone who deviates may be labelled ‘mad’eg in Russia political dissidents were declared insane and held in mental institutions.
-Some norms need to be broken for social change to occur. Social deviance may be good. For example, slavery was once considered normal.

Question 8

What is cultural relativism?

Answer 8

The view that norms and values cannot be judged properly unless they are viewed in the context of the culture in which they originate. Both of these definitions are culturally relative i.e. they only relate to a particular culture.

Question 9

What is failure to function adequately?

Answer 9

Failure to function means that a person is unable to live a normal life or engage in a normal range of behaviours. This approach focuses on the individual’s behaviour and emotions. People’s behaviour is considered to be abnormal if it causes great distress and prevents them from living successfully in their own culture. Rosenhan and Seligman (1989) suggested there were 6 features of abnormality. The more of these features that are present, the more abnormal an individual is considered to be.

1. Personal distress
2. Maladaptive behaviour
3. Unpredictability
4. Observer discomfort
5. Violation of moral and ideal standards
6. Irrationality

Question 10

What are the evaluating points of failure to function adequately?

Answer 10

+A strength of this approach is that it does attempt to include the subjective experience of the individual, allowing us to view mental disorder from the point of view of the person experiencing it, unlike the previous 2 definitions.
+Most of the above features may be shown for quite normal reasons such as grieving for a close relative. In these situations personal distress may be quite normal, and it would be considered abnormal not to be distressed.
-It is not clear how extreme the behaviour has to be in order to be considered abnormal. For instance most people engage in unpredictable, irrational or maladaptive behaviour from time to time, but at what point can it be defined as abnormality?
-The features are subjective (they rely on personal judgement) & therefore cannot be measured objectively eg how do you measure observer discomfort?
-Lower class, non-white patients are more often diagnosed with mental disorders. This may be because failure to function is different in different cultures. Eg excessive grief/suicide may be seen as irrational & maladaptive for widows in Western society, but not in India.

Question 11

What is deviation from ideal mental health?

Answer 11

This approach defines the normal characteristics people should possess. Therefore abnormality is seen as lacking from these ideals of mental health.
Doctors use the concept of physical health to measure ill-health e.g. body temperature outside the normal range.
Jahoda (1958) identified six criteria relating to ideal mental health. These factors are required for ‘optimal living’ (living life to the full). The further people are from these ideals, the more abnormal they are:
1. Positive attitude towards self
2. Potential for growth and development
3. Autonomy
4. Resistance to stress
5. Environmental mastery
6. Accurate perception of reality

Question 12

What are the evaluating points of deviation from ideal mental health?

Answer 12

+It is very comprehensive and covers a broad range of criteria for mental health.

• Most people don’t meet all these ideals all of the time, e.g. most people’s attitude towards themselves is often less than positive, and many people find stress hard to deal with. By this definition, most people might be considered abnormal.
• It’s not clear how the features would be measured. They are too subjective. We can measure normal body temperature objectively, but we can’t measure high self-esteem or resistance to stress in the same way.
• The criteria are quite difficult to measure. For example, how easy is it to measure environmental mastery or assess the capacity for personal growth. The criteria are over-demanding. Lots of people lack features of ideal mental health (e.g. people who are not resistant to stress and have low self esteem.) Are all these people abnormal?

Question 13

What is a phobia?

Answer 13

A phobia is an extreme, irrational fear leading to intense anxiety and avoidance of an object or situation. The extent of the fear is out of proportion to any danger presented by the phobic stimulus.

Question 14

What are the 3 types of phobia DSM identifies?

Answer 14

Specific phobia – object (e.g. of clowns) or situation (e.g. of flying).
Social phobia – fear of a social situation (e.g. public speaking, eating in front of others).
Agoraphobia – fear of being outside or in a public place.

Question 15

What are the emotional (feelings) characteristics of phobias?

Answer 15

A phobia produces fear that is marked, persistent, excessive and unreasonable.
It creates anxiety which is an unpleasant state of high arousal.

Question 16

What are the behavioural (Acts) characteristics of phobias?

Answer 16

Fear will usually lead to avoidance of the feared object. This avoidance of the feared situation interferes with the person’s normal life.
Panic will occur as a response to the object/situation – may lead to crying, freezing or running away.

Question 17

What are the cognitive (thoughts) characteristics of phobias?

Answer 17

Irrational beliefs: In the case of phobias the person is thinking is irrational although generally the person recognizes that their fear is excessive or unreasonable.
Selective attention to the phobic object when in its presence.

Question 18

What is depression?

Answer 18

This is a mood disorder.
All forms of depression are characterised by changes to mood. DSM recognises a number of disorders including Major depressive disorder and Persistent depressive disorder.

Question 19

What are the emotional characteristics of depression?

Answer 19

A diagnosis of major depressive disorder requires at least five symptoms including sadness or loss of interest and pleasure in normal activities. Commonly people are sad and may feel worthless, hopeless or experience low self-esteem. There is a loss of interest or pleasure in usual activities and feelings of despair.

Question 20

What are the behavioural characteristics of depression?

Answer 20

Many depressed people show reduced energy, feel tired and sleep may be affected. Some people sleep much more, but others find it difficult to sleep and experienced insomnia. Some people have reduced appetite where others eat considerably more than usual. Some sufferers may be aggressive or self-harm

Question 21

What are the cognitive characteristics of depression?

Answer 21

Depression is associated with negative thoughts/schema such as negative self- belief as well as guilt and a sense of worthlessness. Depressed people often have a negative view of the world and expect things to turn out badly. Generally such negative thoughts are irrational because they do not accurately reflect reality. Poor concentration is another symptom.

Question 22

What is obsessive compulsive disorder (OCD)?

Answer 22

This is an anxiety disorder. Obsessions are recurring thoughts, images etc and compulsions are repetitive behaviours.

Question 23

What are the emotional characteristics of OCD?

Answer 23

Both obsessions and compulsions are a source of anxiety and distress. Patients are aware their behaviour is excessive and this can cause feelings of embarrassment and shame. They may also experience guilt and disgust.

Question 24

What are the behavioural characteristics of OCD?

Answer 24

Compulsive behaviours are performed to reduce the anxiety created by obsessions. They can be repetitive such as hand washing or checking, they may be mental acts such as counting. Patients feel they must perform these actions otherwise something dreadful may happen if they don’t. OCD sufferers may also avoid situations that will trigger their anxiety.

Question 25

What are the cognitive characteristics of OCD?

Answer 25

Obsessions are recurrent intrusive thoughts (e.g. about contamination or unlocked doors) or impulses (e.g. overwhelming urge to shout obscenities) that are seen as inappropriate. They may be frightening or embarrassing so the person does not want to share them.

Question 26

What does the the behavioural approach to explaining phobias - the two process model assume?

Answer 26

This approach assumes that abnormal behaviour is learned. It assumes that all behaviour is learned, but that phobias are a result of faulty learning.

Question 27

What are the 2 ways faulty learning may occur?

Answer 27

Learning a phobia by Classical Conditioning.

Maintaining a phobia by Operant Conditioning.

Question 28

What are the explanations of the 2 ways faulty learning may occur?

Answer 28

1) Learning a phobia by Classical Conditioning. (Pavlov) People learn to associate something that they do not initially fear with something that does cause a fear response. For example Watson and Rayner caused Little Albert to have a phobia of rats. Each time they gave Little Albert a white rat (which he liked) to play with, they made a loud noise (which he didn’t like). This loud noise made him cry. After this had been done a number of times he cried whenever he saw the white rat even when there was no loud bang. Therefore he gained a phobia through associating the rat with a bang.
Albert’s fear generalised to similar objects, so after conditioning Albert showed fear of other similar objects e.g. a rabbit and a fur coat.
2) Maintaining a phobia by Operant conditioning (Skinner): This assumes that if behaviour is reinforced, it is more likely to be repeated.
Positive reinforcement is something pleasant. If family and friends give a person attention when they show fear of an object or situation, the fear response is reinforced (rewarded) and is likely to be maintained.
Negative reinforcement is removal of something unpleasant. When we avoid a feared object or situation we don’t feel anxiety. This means the avoidant behaviour is repeated.

Question 29

What are the evaluating points of the behavioural explanations of phobias?

Answer 29

+The behavioural approach offers a plausible explanation of how phobias develop and is directly supported by the work of Watson and Rayner who created a phobia of white rats in a 9 month old baby using the principles of classical conditioning.
+Furthermore, the addition of operant conditioning in Mowrer’s 2-process model has good explanatory power for the maintenance of phobias. This has important implications for therapies because it explains why patients need to be exposed to the feared stimulus. Once a patient is prevented from practicing their avoidance behaviour, the behaviour ceases to be reinforced and thus declines. This practical application to therapy is a major strength of the behavioural approach.
-However, there are some problems with the behavioural explanation which suggest it might be incomplete. Bounton (2007) points out that evolutionary factors probably have an important role in phobias, but the 2-process model does not mention this. For example, we easily acquire phobias of things that have been a source of danger in our evolutionary past e.g. snakes. It is adaptive to acquire such fears and thus, we seem to have an innate predisposition (biological preparedness) towards developing such fears. However, cars and guns are far more dangerous in the modern world, yet very few people have phobias of these. Presumably, this is because they have existed very recently and so we are not biologically prepared to learn fear responses towards them. This is a serious problem for the behavioural approach and suggests biological factors must also be taken into account when explaining phobias.
-Furthermore, research into the origins of phobias has revealed that many phobics have no recollections of a traumatic event with their feared object. For example, Menzies and Clarke (1993) carried out a study on children with water phobias and found that only 2% of them reported a direct conditioning effect involving water.

Question 30

What does the the behaviourist approach believe?

Answer 30

The behaviourist approach believes that all behaviour, including abnormal behaviour, is learned; therefore abnormal behaviour can be reversed through training and conditioning.

Question 31

What are the treatments for phobias?

Answer 31

Systematic De-sensitisation (SD).

Flooding.

Question 32

What is Systematic De-sensitisation (SD)?

Answer 32

Systematic desensitization is a behaviour modification technique founded on the principles of classical conditioning, developed by Joseph Wolpe in the 1950s. It reduces the learned link between anxiety and objects or situations that are typically fear-producing. The aim of systematic desensitization is to reduce or eliminate fears or phobias that sufferers find are distressing or that impair their ability to manage daily life. By substituting a new response to a feared situation — a trained contradictory response of relaxation which is irreconcilable with an anxious response — phobic reactions are diminished or eradicated. This is based on the principle of reciprocal inhibition (two opposing physiological states cannot occur at the same time. This learning of a different response is called counter-conditioning. Some of the most common fears treated with desensitization include fear of public speaking, fear of flying, stage fright, elevator phobias, driving phobias and animal phobias. Relaxation responses are trained to occur through progressive relaxation training.

Question 33

What are the three steps to systematic de-sensitisation?

Answer 33

In step one the client is taught deep relaxation techniques. In progressive relaxation, various muscle groups in the body are first tightened and then relaxed. During the alternating clenching and relaxing, the client should be focusing on the contrast between the initial tension and the subsequent feelings of relaxation and softening that develop once the tightened muscles are released. After discovering how muscles feel when they are deeply relaxed, repeated practice enables a person to recreate the relaxed sensation intentionally in a variety of situations.
In step two the client and the therapist create an anxiety hierarchy of the feared stimulus. If the client has a phobia of spiders the lowest level of fear would be to look at a small picture of a spider and the highest level of fear would be holding a spider.
During step three the client, starting with the lowest level of anxiety on the hierarchy, uses their relaxation technique while exposing themselves to the anxiety stimulus. Once they can expose themselves to the anxiety stimulus without fear they move up to the next level on the hierarchy until the phobia is completely removed.
Several means of confronting the feared situations can be used. In the pre-computer era, the exposure occurred either through imagination and visualization -in vitro- (e.g. imagining going on a flight) or through actual real-life — or so-called in vivo — encounters with the feared situation (going on an actual plane flight). More recently, virtual reality or computer simulated exposure has come to be utilized instead of in vivo exposure.

Question 34

What are the evaluating points of Systematic Desensitisation?

Answer 34

+It is effective and long lasting:
Gilroy (2003) compared 42 spider phobic patients treated with three, 45 minute sessions of SD with a control group treated with relaxation alone. Both 3 months and 33 months after treatment the SD group showed less fearful responses than the relaxation group. This shows that for simple phobias SD can be a relatively quick and long lasting therapy. Denholtz et al (1978) found 60% of clients treated for a flying phobia continued to fly during the 3 year follow up period.
+It is acceptable for clients:
Most clients prefer this over flooding. This is largely because it does not cause the same degree of trauma and also the relaxation procedures are pleasant. This is reflected in the low refusal and attrition rates.
+It is less unethical than flooding therapy and therefore also has low attrition rates, meaning more people who access this will be helped.
-SD focuses on learned associations and seeks to recondition the fear response. In doing so SD ignores any deeper underlying psychological or emotional issues that may be involved in the phobia. Wolpe (1973) reported the case of a woman with a phobia of insects who did not respond well to SD. It turned out that her husband was nicknamed after an insect and Wolpe recommended that she see a marriage counsellor which successfully treated her phobia.
-Most evidence indicates that flooding therapy is more effective than SD in the treatment of phobias.

Question 35

What is flooding?

Answer 35

Flooding involves extreme exposure to the phobic situation for lengthy periods of time, until anxiety levels have reduced substantially. As there is a limit to how long the body can sustain a fear response, the assumption is that as the physical response reduces so will the anxiety associated with facing the phobic object. It is important that the client becomes calm before the session ends. A typical session may last for three hours and aims to extinguish the phobic response. This means that the conditioned stimulus (e.g. spider) no longer produces the conditioned response (e.g. fear) but instead becomes calm. Flooding can be used with virtual reality where the patient wears a head mounted display which simulates the phobic object or situation.

Question 36

What are the evaluating points of flooding?

Answer 36

+Effective - Flooding can be a highly effective and quick treatment for phobias. Kaplin (2011) found 65% of patients with a specific phobia given a single session of flooding showed no symptoms 4 years later.
+Quick - Flooding works quickly and is thus a more cost-effective method for treating phobias. Ougrin (2011) compared flooding to cognitive therapies and found flooding to be highly effective and quicker than alternatives.
- Flooding deliberately creates high levels of anxiety so is a traumatic experience for phobic patients. This raises ethical issues concerning acceptable levels of suffering by patients and means they may drop out of treatment.
- Flooding is less effective for some types of phobia. Although effective for treating simple phobias, it appears to be less so for more complex ones such as social phobias. This may be because social phobias have cognitive aspects e.g. they have many unpleasant thoughts about the social situation, which are not dealt with by flooding therapy.

Question 37

What did the congnitive approach focus on?

Answer 37

This approach is focused on how our mental processes (e.g. thoughts, perceptions and attention) affect behaviour.

Question 38

What are the cognitive approaches to explain depression?

Answer 38

1. Ellis’s ABC Model.

2. Beck’s cognitive theory.

Question 39

What was Ellis’s ABC Model?

Answer 39

Ellis (1962) was an American psychiatrist who suggested good mental health is a result of rational thinking, defined as thinking in ways that allow people to be happy and free of pain. Depression is a result of irrational thoughts – any thoughts that interfere with us being happy and free of pain. He used the ABC model to explain how irrational thinking affects us.
A – Activating event: Something happens to you, e.g. a teacher tells you your work is poor.
B – Beliefs: You have a belief about this event, e.g. you are a failure
C – Consequence: you have an emotional response to this belief e.g. a feeling that you are worthless.
It is the irrational belief about an activating event, not the event itself, which causes the consequence (depression). People who are not depressive will react to the event differently e.g. if a teacher tells you your work is poor you may believe you didn’t work hard enough and be motivated to try harder. Ellis identified a range of irrational beliefs. For example, he called the belief that we must always succeed or achieve perfection ‘musturbation’.

Question 40

What was Beck’s cognitive theory?

Answer 40

Beck (1967) was another American psychiatrist. He suggested depression stems from unrealistic, distorted, negative or irrational thoughts about oneself, others or the environment, and from difficulties in controlling thought processes. This creates a cognitive vulnerability towards depression. For example, a person suffering from depression might see only the negative aspects of situations. They may exaggerate difficulties and failures, ignoring or underplaying successes, and this is responsible for the depressed mood. Beck identified three forms of negative thinking – the Cognitive Triad – which he said were responsible for depressed thinking. These are negative views about oneself, the world and the future.
Depressed people may have developed a negative view of the world during childhood. These negative schemas (negative packages of information) lead to cognitive biases in thinking. Cognitive biases include over-generalisation e.g. one bad thing happens but the person believes bad things always happen to them; focusing on negative aspects e.g. a student focuses on the B grade in French and ignores all their A grades.

Question 41

What are the causes of depression?

Answer 41

According to Beck, depression is caused when people interpret everyday event in negative ways.
Depressed people are more negative in terms of themselves (failure is my fault) the world (failure affects everything) and the future (failure will last for ever).

Question 42

What are the positive evaluating points of the cognitive approach to explaining depression?

Answer 42

+There is evidence that depression is associated with negative thinking. Grazioli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after giving birth. Women judged high in cognitive vulnerability were more likely to suffer post-natal depression. This supports Beck’s notion that cognitive vulnerability and negative thinking comes before depression and is not a consequence of the depression.
+It has a practical application in CBT -Therapy based on Beck’s cognitive approach has been very effective in treating depression. This provides strong support for the cognitive approach. All cognitive aspects, including the negative triad, can be identified and challenged in CBT. Ellis’s REBT (see below) has also been effective in treating depression. Disputing negative thinking reduces depression, suggesting it was the irrational beliefs that had some role in the depression in the first place.

Question 43

What the positive evaluating points of the cognitive approach to explaining depression?

Answer 43

-The cognitive approach ignores biological factors (e.g. genetic and neurological) that might be involved in depression. There is strong evidence (from family studies etc.) that biological factors play a very important role in depression. For example, Wender (1986) found that adopted children who develop depression are more likely to have a depressive biological parent. -A better explanation might be the diathesis stress model which suggests some people inherit a vulnerability to disorders such as depression.

Question 44

What was the main goal of the cognitive approach to treating depression?

Answer 44

The main goal of CBT is to challenge negative and irrational thoughts. Therapist may use techniques based on Ellis’s ABC model, Beck’s cognitive theory, or both.

Question 45

What is REBT (Rational Emotional Behaviour Therapy)?

Answer 45

Rational Emotive Behaviour Therapy is one for of CBT which focuses on challenging or disputing irrational beliefs and replacing them with effective, rational beliefs. It extends the ABC model to an ABCDE model where D stands for dispute and E for effect.

Question 46

What are the different methods of disputing that Ellis identified?

Answer 46

• Logical disputing- getting the client to realise that their self-defeating beliefs are not logical. E.g. does this thinking make sense?
• Empirical disputing- getting the client to realise that their self-defeating beliefs are not realistic E.g. where is the proof that this belief is accurate?
• Pragmatic disputing- Getting the client to realise that their self-defeating beliefs are not useful E.g. how is this belief likely to help me?

Question 47

What is another form of CBT that is based on Beck’s negative triad?

Answer 47

The therapist identifies and challenges automatic thoughts about the world, the self and the future. Once identified, these thoughts must be challenged. To test the reality of the beliefs the therapist could ask the client to do homework e.g. record an occasion when someone is nice to them or when they enjoyed an event. This is referred to as the ‘patient as scientist’ investigating the reality of their negative beliefs in the way a scientist would. This can later be used as evidence to challenge a belief that no-one is ever nice to them/there is no point going to future events.

Question 48

What are the positive evaluating points of cognitive behaviour therapy?

Answer 48

+ A lot of research has shown that CBT is the most effective therapy for moderate and severe depression. For instance Hollon et al (2006) studied the relapse rates of those with moderate to severe depression and found rates of 40% in those who’d had 16 weeks of CBT, 45% in the drug therapy group and 80% in the placebo group. This suggests CBT is more effective than drug therapy and much better than no treatment at all.
+ CBT attempts to deal with the cause of depression (i.e. negative thoughts) not just the symptoms of it. Therefore it offers a long term solution for dealing with mental distress that other therapies, such as drug therapy may not offer. The client can use the techniques beyond the therapeutic setting, whereas drugs seem to just suppress the symptoms.

Question 49

What are the negative evaluating points of cognitive behaviour therapy?

Answer 49

• CBT is not appropriate for all clients, as they need to have the ability to rationalise and talk about their thoughts and feelings. For those suffering from very severe depression it might be very difficult to motivate themselves to engage with and complete CBT. For those patients, they may have to take anti-depressants before commencing CBT, suggesting that CBT cannot be used as the sole treatment for all patients.
• There is a risk that too much emphasis is placed on thought processes and not enough on the circumstances in which a patient is living, e.g. poverty, poor housing etc. If therapy focuses just on thoughts when circumstances need changing, this may prevent a client from dealing with a major source of their problems.
• CBT may take a relatively long time to complete. Ellis claimed that clients would need on average 27 sessions to complete the treatment. This makes the treatment expensive.

Question 50

What are the evaluating points of the cognitive approach?

Answer 50

There is strong evidence that cognitive factors play a part in explaining depression.
The success of CBT in treating depression is evidence for the cognitive approach.

Question 51

What are the explanations for OCD?

Answer 51

Genetic

Neural

Question 52

What is the genetic explanations for OCD?

Answer 52

This suggests our genetic code is not only responsible for physiological characteristics, but also behavioural characteristics, including mental disorders.
Like many disorders, OCD seems to be polygenic. This means that it is caused by several genes, maybe up to 230, rather than a single gene.
Some of these genes are involved in regulating the development of the serotonin system. Eg the gene 5HT1-D beta is involved with the transport of serotonin across synapses. (OCD may be associated with a reduction in the functioning of the serotonin system in the brain.)

Question 53

What are the two candidate genes?

Answer 53

The SERT gene (Serotonin Transporter) appears to be mutated in individuals with OCD. The mutation causes an increase in transporter proteins at a neuron’s membrane. This leads to an increase in the reuptake of serotonin into the neuron which decreases the level of serotonin in the synapse.
The COMT gene is a gene that regulates the function of dopamine. It appears that this gene is also mutated in individuals with OCD. However this mutation causes the opposite effect as the SERT mutation discussed above. The mutated variation of the COMT gene found in OCD individuals causes a decrease in the COMT activity and therefore a higher level of dopamine.

Question 54

What are the evaluating points of genetic explanations for OCD?

Answer 54

+ Research evidence: Pauls et al (1995) reported up to 10% of first-degree relatives of those with OCD were more likely to develop the disorder compared with approximately 2% prevalence in the general population. However, one of the problems with family studies is that they do not control for the effects of the environment on the development of OCD. First degree relatives may have similar life events or learning experiences which could also be involved in the development of the disorder. For this reason, twin studies may offer more convincing evidence. Twin studies compare concordance rates (the likelihood of both twins being affected with the disorder) for identical (MZ) and fraternal (DZ) twins. Only MZ twins have identical genetic make-up. DZ twins are no more similar genetically than siblings. A genetic component is supported by Nestadt et al (2010) who reviewed twin studies and found 68% of identical twins showed concordance for OCD compared to 31% in non-identical twins.

• Research provides strong evidence of a genetic component for OCD, but there are no studies that show 100% concordance in MZ twins, suggesting that other factors must be involved. This is consistent with the diathesis-stress model which brings nature and nurture together, suggesting that genetic factors predispose an individual to developing OCD, but environmental factors (e.g. life events/learning) are needed to trigger the disorder.
• It is difficult to separate the effects of nature and nurture. MZ twins may be treated more similarly than DZ twins, which may partly account for Nestadt’s findings. Twin and family studies have not all found the same concordance rates.
• Genetic research is a relatively new area, and it is still not known exactly which gene or combination of genes is relevant.

Question 55

What is the neural (brain abnormalities) explanation for OCD?

Answer 55

Abnormal levels of Neurotransmitters:
Neurotransmitters are chemical messengers in the brain and nervous system that send messages to nerve cells. It is believed that OCD may be caused by low levels of the neurotransmitter serotonin. If a person has low levels of serotonin, then normal transmission of mood-relevant information does not take place and mood – and sometimes other mental processes are affected. This is based on the findings that OCD can be relieved by using anti-depressant drugs, especially those which increase levels of serotonin in the brain. Another idea is that OCD is caused by a disruption of serotonin levels which has a knock-on effect on regulating the levels of other neurotransmitters, such as glutamate, GABA, and dopamine.
Abnormal brain circuits:
Many areas of the brain have been implicated in OCD. The orbitofrontal cortex (OFC) sends signals to the thalamus about worrying things such as a potential germ hazard. These are normally supressed by the caudate nucleus (part of the basal ganglia). When the caudate nucleus is damaged it fails to suppress minor worry signals and the thalamus is alerted. This sends signals back to the OFC, acting as a worry circuit.
Neurotransmitters are chemical messengers that send messages to nerve cells.
OCD may be caused by low levels of the neurotransmitter serotonin. This is based on the findings that OCD can be relieved by using anti-depressant drugs, especially those which increase levels of serotonin in the brain.
OCD may be caused by disruption of serotonin levels which has a knock-on effect on regulating the levels of other neurotransmitters, such as glutamate, GABA, and dopamine.

Question 56

What are the evaluating points of neural explanation for OCD?

Answer 56

Neurotransmitters
+/-Zohar et al (1996) found that drugs which increase serotonin have been beneficial for up to 60% of patients with OCD. This supports the idea that low levels of serotonin may be associated with OCD. However, most studies have found only 50% improvement of OCD symptoms when using medication, suggesting other factors may be involved.
-It is not known if the problems with neurotransmitters are a cause or a consequence of OCD. This is known as the aetiology fallacy - just because serotonin reduces symptoms of OCD doesn’t necessarily mean the symptoms were caused by lack of serotonin. In the same way aspirin may cure a headache, but this doesn’t mean the headache was caused by lack of aspirin.
Brain Circuits
+/- There is some evidence from brain-damaged patients and from brain imaging studies indicating that brain regions such as the OFC and caudate nuclei are associated with OCD e.g. MacGuire et al (1994). Sufferers were shown items designed to trigger their obsessional thoughts while undergoing PET scans. There was an increase in activity in the OFC and Caudate nucleus suggesting that this circuit is involved in OCD. However, when brain activity is assessed, what is found is an association between elevated activity in certain brain areas and OCD. As it is only an association, it doesn’t show that those brain areas play a role in causing OCD. Indeed, it seems as likely that having OCD leads to increased activity in brain areas concerned with thinking and action.
- The relationship between OCD and parts of the brain is not straightforward. Neuroimaging studies have not identified basal ganglia impairments in all OCD sufferers and some people with impairments in the basal ganglia show no sign of OCD.

Question 57

Who does drug therapy offer an explanation for OC?

Answer 57

Low levels of serotonin in the ‘worry circuit’ (OFC, caudate nuclei and thalamus) offers an explanation for OCD. Increasing levels of serotonin may therefore normalise this circuit and therefore antidepressants may be effective in reducing OCD symptoms.

Question 58

What are the different drugs that can be used in drug therapy?

Answer 58

SSRI’s (Selective serotonin reuptake inhibitors).
Tricyclics.
Anti-anxiety drugs - benzodiazepines.

Question 59

What are SSRI’s (Selective serotonin reuptake inhibitors)?

Answer 59

The standard treatment used for OCD is SSRI’s (Selective serotonin reuptake inhibitors) e.g. fluoxetine. These block the re-uptake or reabsorption of serotonin in the brain. This enables serotonin to remain active at the synapse where it continues to stimulate the post-synaptic neuron, reducing the symptoms of anxiety.
If an SSRI such as Fluoxetine is not effective after 3 or 4 months, the dosage may be increased, it may be used in conjunction with CBT, or a different anti-depressant may be used.

Question 60

What are Tricyclics?

Answer 60

Tricyclics (an older type of anti-depressant) block the transporter mechanism that reabsorbs both serotonin and noradrenaline into the presynaptic cell after it had fired. Clomipramine was the first antidepressant used for OCD and today is primarily used for OCD rather than depression. However, tricyclics generally have more side effects than SSRI’.

Question 61

What are anti-anxiety drugs - benzodiazepines?

Answer 61

BZ’s slow down the activity if the CNS by enhancing the activity of GABA.
GABA us a neurotransmitter that has a quietening effect on many of the neurons in the brain. GABA locks onto receptor sites outside the neuron.
This opens a channel which allows chloride ions to flow in to the neuron.
Chloride ions make it harder for the neuron to be stimulated by other neurotransmitters, thus slowing down its activity and making the person feel more relaxed.

Question 62

What are the evaluating points of drug therapy?

Answer 62

+There is considerable evidence for the effectiveness of SSRI’s for the treatment of OCD. For example, Soomro (2009) reviewed 17 studies of the use of SSRI’s with OCD and found them to be more effective than placebos in reducing the symptoms of OCD as measured with Y-BOCS up to 3 months after treatment i.e. in the short term.
-However, it has been suggested that 30-50% if clients with OCD derive no benefit from these drugs, so they are not effective for a large minority. Furthermore, relapse rates are thought to be as 90%. Therefore drugs do not provide a permanent ‘cure’ for the disorder as soon after treatment stops, symptoms return.
+/-Relapse is reduced when the drugs are combined with behavioural therapy.
-Drugs may dehumanise patients by taking away any sense if personal responsibility or control.
-Some people whose OCD is very disruptive may consent to drug treatments without being fully aware that they are consenting to.
-SSRI’s have side effects - drowsiness, anxiety, increase in OCD, indigestion and blurred vision.

Question 63

What are the evaluating points of the biological approach?

Answer 63

There is strong evidence that genes, biological structures and neurochemistry all play a part in OCD.
The success of drug therapy in treating OCD is evidence for the biological approach.