ANSWERS: Abnormality. Contents

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1 ANSWERS: Abnormality Advice: Most of these answers will fit in the boxes if writing is small, and students can use continuation sheets wherever necessary. Please note that they are not definitive answers as the aim is for students to be able to talk around the main points and expand on them wherever possible. This will provide cues to aid memory in revision, and will provide them with the necessary content for AO1 and essay questions. Thus, whilst these answers may be useful to guide students, it is optimal that students write in their own words and practise précis, the skill of writing concisely. Contents Defining Psychological Abnormality (pages 117 to 119) Page 117 Page 118 Page 119 Models of Abnormality (pages 120 to 123) Page 120 Page 121 Page 122 Page 123 Eating Disorders (pages 124 to 125) Page 124 Page 125 Explanations of Eating Disorders (pages 126 to 128) Page 126 Page 127 Page 128 Abnormality APFCCs (pages 129 to 132) Page 129 Page 130 Page 131 Page 132 Abnormality Revision AO1 (pages 133 to 134) Page 133 Page 134 Abnormality Crib Sheets (pages 142 to 144) 1

2 Defining Psychological Abnormality (pages 117 to 119) Page 117 Definition of abnormality: Behaviour that is considered to deviate from the norm (statistical or social), or ideal mental health. It is dysfunctional because it is harmful or causes distress to the individual or others and so is considered to be a failure to function adequately. Abnormality is characterised by the fact that it is an undesirable state that causes severe impairment in the personal and social functioning of the individual, and often causes the person great anguish depending on how much insight they have into their illness. Definition of statistical infrequency: Behaviours that are statistically rare or deviate from the average/statistical norm, as illustrated by the normal distribution curve, are classed as abnormal. Thus, any behaviour that is atypical of the majority would be statistically infrequent, and so abnormal (e.g., schizophrenia is suffered by 1 in 100 people and so is statistically rare.) Description: Fill in the blanks: Statistically infrequent behaviour deviates from the mean of the normal distribution. If the behaviour is rare, i.e., shown by few people, then it is abnormal. Evaluation Give examples of statistically infrequent behaviour: Trait anxiety as measured on Spielberger s State Trait Anxiety Inventory. Only 2% of the population will obtain a high score (55 or more) on this. Schizophrenia affects 1% of the population. Highly aggressive people are also in the minority. Desirability of infrequent behaviours: Using this definition, expert footballers, for example, would be classed as abnormal, as the majority of people do not share their skills. Similarly, extremely low scores on trait anxiety or extremely high scores on intelligence would be desirable, yet classed as abnormal. Also, just because a behaviour is common does not mean it is normal, as on this basis depression and criminal behaviour would be classed as normal. Thus, a criticism of classifying anything that differs from the majority as abnormal is that this fails to take into account the desirability of the behaviour and so it is not an effective way of discriminating abnormality as it is reductionist (oversimplified). The standard (statistical norm) is relative to the population that is being measured: Anxiety, for example, is not the same in children as in adults because children have more irrational fears and so the standard of one population could not be generalised to the other. Thus, whilst the statistical definition does not involve a value judgement, the score distribution produced is relative to the population being measured. Standards or norms differ across cultures and sub-cultures and so the definition is culturally relative as a consequence. 2

3 Definition of deviation from social norms: Behaviour that does not follow socially accepted patterns; violation of them is considered abnormal. These unwritten social rules are culturally relative and era-dependent. For example, homosexuality was once illegal and considered to be a mental disorder because it deviated from the social norm. Now there are campaigns for gay marriages to be recognised and afforded the same benefits as heterosexual marriages, and this shows the extent to which this definition of abnormality is subject to change. Description: Fill in the blanks: Behaviour that deviates from the norms and values of society, that is, the approved and expected ways of behaving in a particular society, is considered to be abnormal. This is called socially deviant behaviour and can be compared with non-conformity. Give examples of behaviour that deviates from social norms: Criminal behaviour, sexual deviancy, and drug and alcohol abuse. This definition does account for the desirability of behaviour, as undesirable behaviours that do not conform to social norms are classed as abnormal. Page 118 Evaluation Subjectivity and era-dependence of moral codes: Value judgements underpin this definition, as what is deviant is a subjective decision made by society, which can change over time and so may be era-dependent. For example, in the Middle Ages women were burned as witches because they were considered to be evil, whereas now it is believed that they may have suffered from mental illness, or were proficient healers, etc. Thus, the interpretation of abnormality has changed greatly. A second memorable example is homosexuality. This was considered a mental abnormality until 1973 when it was removed as a disorder from the DSM classifications (not appearing in the 1980 edition of DSM) and so highlights the issue that social norms are era-dependent. Cultural relativism: Social norms are also culturally relative. For example, in some cultures homosexuality is still a taboo, whereas others have afforded more equal rights than Britain in offering the status of marriage. Within a culture there are many sub-cultures that also have different opinions as to what is and isn t deviant, e.g., the very different opinions about cannabis within Britain. However, this may be overstating relativism because many people who are classed as abnormal do behave in a socially deviant way and so the definition does have some validity in discriminating abnormality. Definition of deviation from ideal mental health: Deviation from optimal psychological well being (a state of contentment that we all strive to achieve). Deviation is characterised by a lack of positive self-attitudes, personal growth, autonomy, accurate view of reality, environmental mastery, and resistance to stress; all of which prevent the individual from accessing their potential, which is known as self-actualisation. 3

4 Description: Fill in the blanks: This is based on the humanistic approach and so the emphasis is on fulfilling one s potential, which is called self-actualisation. Jahoda (1958) suggested six elements for optimal living : 1. Self-attitudes 2. Personal growth 3. Integration 4. Autonomy 5. Perception of reality 6. Environmental mastery Evaluation The focus on positive characteristics is good: The focus on what is requisite for mental health is a refreshing change from the other definitions, which tend to focus on the negative. Cultural relativism, as not all of the characteristics generalise to collectivist cultures, e.g., autonomy: Autonomy would not be seen as essential to mental health in collectivist cultures as this criteria encourages independence, which is discouraged in collectivist cultures where the common good is more important than the individual s needs. Thus, the definition is culturally relative to individualistic cultures. Definition of failure to function adequately: A model of abnormality based on an inability to cope with day-to-day life caused by psychological distress or discomfort. Description: Fill in the blanks: Failure to function adequately refers to failure to fulfil individual, social, and organisational roles. Rosenhan and Seligman (1989) suggested seven features of abnormality: 1. Suffering 2. Maladaptiveness 3. Vividness and unconventionality of behaviour Page Unpredictability and loss of control 5. Irrationality and incomprehensibility 6. Observer discomfort 7. Violation of moral and ideal standards Evaluation Value judgements mean assessment is difficult and may be unreliable: This is a concern because as the deviation from social norms definition demonstrated, decisions about what is and is not desirable are often era-dependent and culturally biased. 4

5 Cultural relativism, as judgements will be influenced by cultural norms, e.g., unconventionality: Each criterion will involve to some extent a value judgement of whether behaviour is undesirable/unacceptable. As this differs across cultures then cultural relativism is also a weakness of this definition. To illustrate, hallucinations would be considered abnormal in our culture, but are desirable in some other cultures. They confer high status because the hallucinating person is thought to be in touch with the gods. Also, we would consider playing football with a ball of fire unconventional and dangerous, yet this is common practice in Java. Definition of cultural relativism: The view that one cannot judge behaviour properly unless it is viewed in the context from which it originates. This is because different cultures have different constructions of behaviour and so interpretations of behaviour may differ across cultures. A lack of cultural relativism can lead to ethnocentrism, where only the perspective of one s own culture is taken. Models of Abnormality (pages 120 to 123) Page 120 Medical (biological) model Description: Fill in the blanks: This model uses physical illness as a model for psychological disorder. Thus, abnormality has physical causes such as brain dysfunction (neurological), biochemical imbalances, infection, or genetics, and so can only be cured through medical treatments. It is the dominant model as medical practitioners naturally favour it but it has been expanded upon by the diathesis stress model, which sees abnormality as an interaction of genetic predisposition and environment. Assumptions on the causes of abnormality Infection: One explanation of schizophrenia is that it is linked to viral infection, as there is a high rate of schizophrenia in mothers who had flu during pregnancy (Barr et al., 1990). Genetic factors: Family, twin, and adoption studies are used to establish concordance rates (i.e., if one family member has it, does the other?) to test for genetic predispositions as an explanation of abnormality. Family studies have shown that relatives of schizophrenics are 18 times more likely to develop the disorder (Masterson & Davis, 1985). Biochemistry: An imbalance of chemical messengers in the brain may explain abnormality, e.g., the neurotransmitters serotonin, dopamine, and noradrenaline are linked to mental disorders, such as depression, schizophrenia, and eating disorders. Neuroanatomy: Brain structural abnormality is linked to abnormality. For example, enlarged ventricles characterise schizophrenia, and hypothalamus dysfunction is one explanation for eating disorders. 5

6 Assumptions on the treatment of abnormality Implications: Abnormality has a physical cause and so it requires a physical treatment. The medical model assumes that abnormality is an illness with biological causes and so requires medical intervention. Drug therapy, electroconvulsive therapy, and psychosurgery illustrate the implications: Drugs and ECT work be changing the balance of the biochemicals, e.g., the anti-depressant Prozac treats depression by blocking the re-uptake of serotonin and so illustrates that the treatments used by the medical model target the biological causes of abnormality. Evaluation Research evidence is based on well-established science: The medical model takes a scientific approach and mostly relies on experiments, which means the research has scientific validity. The model has validity as it successfully explains phenylketonuria (PKU): A form of mental retardation caused by an inability to process the amino acid phenylalanine, which is treated effectively by targeting the biological abnormality. This demonstrates that the disorder can have physical causes and be successfully treated with medical intervention as the medical model predicts. It does provide insights into schizophrenia and depression: Many of the explanations of these disorders are drawn from the medical model, and treatments based on this have been successful, e.g., anti-depressants. Thus, the medical model does provide valuable insights. The analogy to physical illness is limited: Mental illness is not the same as physical illness as psychological and social factors are involved in both, but more so in abnormality. Cause and effect is not clear: The direction of causation is often unclear, e.g., are biochemical or brain structural abnormalities the cause or effect of a disorder? If these are biological effects then the medical model lacks validity as an explanation of the causes of abnormality. Does not give enough consideration to psychological and social factors and so is biologically deterministic and reductionist: The focus on biological causes (nature) means nurture is largely ignored, which means the medical model s approach is reductionist (oversimplified) as only one factor (biology) is considered. It is biologically deterministic as it suggests that biology controls mental illness, which ignores the individual s ability to control his or her own behaviour. Szasz s (1960) problems in living : Claimed that mental illness was a form of social control; a way to ostracise the people who did not fit society s norms. Ethical implications: Labelling the individual as a sick person raises many ethical issues because the status and authority of medicine means that this is given legitimacy and can create a selffulfilling effect where the individual comes to see themselves as the sick person and so with little chance of recovery. Largely ignoring psychological factors is an ethical issue because treatment can be faster and more effective if both biological and psychological factors are treated. 6

7 Page 121 Psychodynamic model Description: Fill in the blanks: This model focuses on the dynamics of the mind. According to Freud, the mind is like an iceberg with the tip represending conscious thought, and the majority representing the preconscious and the unconscious, which we are unaware of and cannot access. Material is repressed into the unconscious if it is a source of conflict. The unconscious develops during childhood and is the key motivator of adult thinking and behaviour. Thus, conflicts during childhood that have not been resolved are the cause of abnormality. Assumptions on the causes of abnormality Conflict between the id, ego, and superego: These are hypothetical structures. The id develops first and is based on the pleasure principle, as it is our innate drive (libido) for physical satisfaction. The ego is the conscious part of the mind and so is based on the reality principle. The superego operates on the morality principle, as it is our conscience. They conflict with each other because they work on very different principles and, if the conflicts are not resolved, abnormality may result. Fixation at psychosexual stages due to conflict: Freud proposed we all develop through psychosexual stages and that conflict or excessive/lack of gratification at any of these stages can lead to fixation. When problems occur the adult regresses back to the stage they were fixated at during childhood and this may manifest in the nature of the illness, e.g., anal fixation and obsessive-compulsive disorder, or oral fixation and eating disorders. Defence mechanisms that help control conflict: The defence mechanisms manage conflict by protecting the individual from the anxiety it causes. Repression is the major defence mechanism where emotionally threatening material is repressed into the unconscious so that it is no longer in conscious awareness. Another well-known mechanism is denial, when the individual refuses to accept that something has happened (denies reality) as a means of protection from the trauma of having to deal with it. The defence mechanisms deal with the effects of unresolved conflicts, but do not resolve them. They are useful, but are also a way of avoiding the real problem, and so do not prevent abnormality. Assumptions on the treatment of abnormality Implications: It is assumed that unresolved conflicts from childhood are the cause, and so treatments need to bring into consciousness the deeply buried conflicts so that the patient can gain insight by facing and resolving them. Once resolved they become integrated into the ego and so the patient is cured (although this rarely occurs due to the time and difficulty in accessing repressed conflicts). The talking cure, i.e. free association and dream analysis illustrate the implications: Therapies such as free association, hypnosis, and dream analysis are described as the royal road to the unconscious and so illustrate what psychodynamic theory is all about, i.e., accessing the unresolved conflicts in the unconscious and dealing with them. 7

8 Evaluation Positive implications of Freud s work psychoanalysis paved the way for later psychological models: Freud brought psychology to mental illness, which is a significant breakthrough given the monopoly of the medical model. Evidence does support childhood as a factor in the development of abnormality: Childhood experience is well supported as a factor in the development of adult disorders (Barlow & Durand, 1995). Does not give enough consideration to adult experiences, and the power of childhood experience to determine adult behaviour can be criticised as being deterministic: Current experience should never be ignored, as this is usually the trigger of the abnormality, whilst childhood experience is the predisposing factor. Thus, Freud ignored key information due to his belief that childhood was more significant. Overemphasis on sexual factors and underemphasis on social factors: This emphasis may well be era-dependent and context bound as people did have more guilt and other issues about sex due to the repressive Victorian era. It weakens Freud s original theory because social factors are ignored, e.g., gender differences in sexual behaviour are attributed to biologically different sexual natures, which gives no consideration to the role of social and cultural factors. Clinical interview was the main research method and so there is a lack of scientific evidence: The clinical interview lacks scientific validity because it is vulnerable to researcher-bias in question setting and interpretation. These interviews are compiled into case studies, which also raise the issues of generalisability and population validity. Concepts are vague and cannot be operationalised, and so cannot be verified or falsified: Concepts such as the unconscious and the id, etc. cannot be operationalised and so they cannot be tested scientifically, which means that Freud s theory is neither verified nor falsified. People may doubt it but cannot disprove it, and as somebody once said you do accept Freud s ideas more with age. Ethical implications: The relationship between patient and therapist raises many ethical issues. The claim that mental disorders stem from childhood can cause guilt in the parents, as they may feel responsible. Also Freud s theory is very gender-biased, e.g., his claim that men have higher moral standards, and his attribution of gender differences to biologically different sexual natures. 8

9 Page 122 Behavioural model Description: Fill in the blanks: This model is based on the principles of learning and the assumption that all behaviour is learned through association (classical conditioning), reinforcement (operant conditioning), or social learning (social learning theory). Abnormality is a result of learning maladaptive and dysfunctional behaviour. Assumptions on the causes of abnormality Classical conditioning (Pavlov, 1927): Learn to associate a neutral stimulus with an automatic stimulus. A stimulus response bond is created, e.g., weight phobia is when anxiety is associated with food and weight gain. Classical conditioning explains how abnormality can be caused by learned maladaptive emotional responses. Operant conditioning (Skinner, 1938): Positive reinforcement (e.g., receiving rewards), negative reinforcement (e.g., avoiding unpleasant consequences), and punishment (experiencing unpleasant consequences) all explain how abnormality can develop and be maintained. Depression may be due to a lack of positive reinforcement from social interactions. Weight phobia is maintained by negative reinforcement as the unpleasant consequence of gaining weight is avoided. Positive reinforcement, e.g., compliments, may also be involved. Social learning theory (Bandura, 1965): Abnormality may develop from modelling role models, e.g., young children may observe and imitate the obsessive-compulsive behaviour of a parent. Such early learning is ingrained because the child may not even have any recollection of learning it. Assumptions on the treatment of abnormality Implications: Treatment is based on the assumption that if it is learned then it can be unlearned. Maladaptive learning causes abnormality, and so the treatment seeks to change the learned responses through treating the conditioning or observational learning that has caused the abnormality. Thus, behavioural treatments assume that changing the maladaptive behaviour cures the abnormality. Systematic desensitisation, token economy, and aversion therapy illustrate the implications: Counter conditioning underpins many of the behavioural therapies as this involves replacing the abnormal learned response with a more acceptable one, e.g., systematic desensitisation treats phobias by replacing anxiety with relaxation and so illustrates the assumption of the behavioural model that abnormality is treated by unlearning maladaptive responses and replacing them with more adaptive responses. 9

10 Evaluation Underlying causes are ignored because the behaviourists refuse to investigate internal processes. They investigate only that which is observable and measurable, i.e., behaviour, and so ignore the influence of cognition and emotion: This is a significant weakness as cognitions and emotions are often the motivators of behaviour. Consequently therapies treat symptoms not causes: In treating behaviour, the therapist treats the first layer of the abnormality and may successfully eliminate the abnormal behaviour, but hasn t even penetrated the actual causes, as cognition and emotion are ignored. Consequently, symptom substitution may occur, which is when another disorder develops because the causes of the initial disorder have not been treated. The behavioural therapies do work well for phobias: Specific phobias (e.g., spiders, heights, etc.) are successfully treated using systematic desensitisation and flooding, and so the behavioural principles have been applied successfully, which many would agree is where it counts the most. Exaggerates the importance of environmental factors and so is environmentally deterministic: The behavioural model is environmentally deterministic because it suggests that the environment determines behaviour, which ignores the free will and ability of the individual to control their own behaviour. Extrapolation of Pavlov s and Skinner s research from animals must be questioned: Pavlov s and Skinner s theories are based on animal research, which raises the issue of extrapolation, as humans are qualitatively different to animals. Psychological factors such as cognition play a greater role in human behaviour, but of course the behavioural model ignores this. Artificiality of lab research means ecological validity can be questioned: Research such as that of Pavlov and Skinner lacks mundane realism and so it can be questioned if it is generalisable to reallife situations. However, the applications and amount of further research evidence showing the role of conditioning in relationships, abnormality, and gender development (to name just some) does show that the original research has ecological validity. Oversimplified and so reductionist: Behaviourism considers one factor only; the influence of the environment on behaviour. It is a strength that it takes into account social and cultural factors (i.e., the environment) but it is reductionist because in reality behaviour is a consequence of multiple factors, including biological factors, which are ignored. Ethical implications: A strength is that it tends to be non-judgmental of the individual as it is assumed that abnormality is learned from the environment and so the individual is not responsible. The main issue is the potential for abuse of power in the patient/therapist relationship as treatments such as aversion therapy are deeply unpleasant and can be manipulative. Moreover, it raises the issue of morality and humanity due to the pain caused and the fact that behaviourism is seen as mechanistic (reduces humans to machines). 10

11 Page 123 Cognitive model Description: Fill in the blanks: This model suggests cognitive dysfunction underpins abnormality. The individual is an information processor and it is a breakdown in cognitive processing that causes abnormality. Irrational, obsessive, and faulty thinking can affect emotion and behaviour. Assumptions on the causes of abnormality Cognitive dysfunction: Faulty/distorted thinking underpins abnormality. This causes abnormal emotional reactions and behaviour, which can deeply distress the individual. The computer is used as an analogy because the individual is seen as an information processor. Breakdown in processing leads to irrational thinking, an example of such a breakdown is when the individual fails to distinguish between imagination and reality. Assumptions on the treatment of abnormality Implications: It is assumed that if the faulty thinking that causes abnormality is challenged effectively then the abnormality will be eliminated. Treatment involves replacing the individual s irrational thoughts with more rational ones. Cognitive restructuring, stress inoculation training (Meichenbaum, 1977), and the cognitive triad (Beck, 1976) illustrate the implications: The above techniques all involve challenging the individual s cognitive distortions and so illustrate the main assumption of the cognitive model, which is that it is the individual s irrational thoughts that need to be changed. Evaluation The model has validity (i.e., truth) as it helps to explain anxiety disorders and depression: There is no doubt that distorted and irrational thinking does characterise a mental disorder. The irrational fear of anxiety disorders, disturbed view of the world in depression, and many cognitive distortions in schizophrenia (such as thought insertion and thought broadcasting) support the validity of this explanation. Cause and effect is not clear: The thoughts could be a cause of the disorder but they could equally be an effect. For example, with depression it is difficult to know if the disturbed view of the world has caused the disorder or if it is a consequence of being depressed. If the distortions are effects then the cognitive model lacks validity as an explanation of the causes of abnormality. The cognitive model has led to the development of the cognitive-behavioural model: This has proven even more effective at treating mental disorders than either model on its own. Thus, it is an important advancement, which shows that a disorder is best dealt with by treating more than one level. Ignores other important factors such as genetics and social factors: Therefore it is also a reductionist explanation. 11

12 Ethical implications: The main ethical issue is that the assumption that faulty thinking is the cause means that the individual is largely responsible for their abnormality. This can be productive as the individual then has the power to do something about it, but can also be counterproductive if the individual is overwhelmed with the responsibility and/or the blame for their disorder. Moreover, the individual s thinking may reflect the influence of others or unfortunate circumstances. So it is questionable if the individual does have the power ascribed to them by this model. Conclusion: The multi-dimensional approach Fill in the blanks: To fully understand abnormal behaviour a multi-dimensional approach is necessary that draws from all of the models of abnormality. A particularly useful example is expressed by the diathesis stress model that takes into account the interaction of genetic predisposition (diathesis) and environment (stress) to explain psychological disorder. Thus, according to the diathesis stress model, the gene loads the gun but the environment pulls the trigger. Eating Disorders (pages 124 to 125) Page 124 Definition of an eating disorder: A dysfunctional relationship with food. The dysfunction may be gross under-eating (anorexia), binge purging (bulimia), over-eating (obesity), or healthy eating (orthorexia). These disorders may be characterised by faulty cognition and emotional responses to food, maladaptive conditioning, dysfunctional family relationships, early childhood conflicts, or a biological and genetic basis, but the nature and expression of eating disorders show great individual variation. Definition of anorexia nervosa: An eating disorder characterised by the individual being severely underweight; 85% or less than expected for size and height. There is also anxiety, as the anorexic has an intense fear of becoming fat and a distorted body image. The individual does not have an accurate perception of their own, or normal, body size, has a distorted belief in the importance of body size, and may minimise the dangers of being severely underweight. 12

13 Clinical characteristics Weight. Less than 85% of that expected for height and body size. Amenorrhoea. Menstruation is absent. Absence for 3 or more consecutive cycles is sufficient for diagnosis. Body image distortion. Anorexics have a distorted idealised body image and perception of their own body weight is also distorted as they fail to recognise their emaciation. Also, they overemphasise its importance to their self-esteem and minimise the dangers of being underweight. Anxiety. An intense fear of becoming fat, which is even more irrational given that they are considerably underweight. Age of onset tends to be during adolescence. Prevalence of the disorder in individuals with the following characteristics: Over 90% are female, onset is usually during adolescence, and it is more common in middle-class than working-class individuals. It is more common in people from Western cultures, but is on the increase in populations where it used to be rare (e.g., Black Americans) because of the pervasiveness of Westernisation into subcultures and Eastern cultures. Definition of bulimia nervosa: An eating disorder in which excessive (binge) eating is followed by compensatory behaviour such as self-induced vomiting or misuse of laxatives. It is often experienced as an unbreakable cycle where the bulimic impulsively overeats and then has to purge to reduce anxiety and feelings of guilt about the amount of food consumed, which can be thousands of calories at a time. Clinical characteristics Binge. When more food is eaten within a 2-hour period than most people would consume in that time, and the bulimic is not in control of their behaviour. Purge. Compensatory behaviours, such as vomiting, laxatives, exercise, or skipping meals to prevent weight being gained from the binge. Frequency. Binge eating and compensatory behaviour must occur twice a week or more, over a 3- month period, for diagnosis. Body image. Bulimics have a distorted idealised body image, and perception of their own body weight is also distorted as they fail to recognise that their weight falls within the normal range. Also, they overemphasise its importance to their self-esteem, which depends excessively on their shape. Age of onset tends to be during early adulthood. Prevalence of the disorder in individuals with the following characteristics: The majority of sufferers are female, and onset tends to be in their 20s. It is more common in people from Western cultures and is more common in middle-class than working class individuals. 13

14 Page 125 Comparing and contrasting anorexia and bulimia Traits that sufferers with each condition have in common Distorted body image: Both anorexics and bulimics have a distorted body image. They have a distorted idealised body image and perception of their own body weight is also distorted, particularly as they overemphasise its importance as their self-evaluation depends excessively on their shape. Obsessive thinking: Anorexics and bulimics think excessively about food and this thinking is motivated by the same anxiety: fear of being fat. Dysfunctional eating behaviour: Both anorexics and bulimics have dysfunctional eating behaviour because it differs from what would be considered normal eating behaviour. Differences between anorexics and bulimics Weight: Anorexics are 85% or less than normal body weight for their height and body size, whereas bulimics are within 10% of normal body weight. Eating patterns: Anorexics severely under eat, and this can be as little as 100 calories per day. Bulimics do the opposite as they overeat, and can consume vast quantities of food in a binge, where calories can range from 2,000 to 10,000 calories per binge. Age of onset: Age of onset for anorexics is earlier, usually adolescence, whereas for bulimia onset tends to occur during the sufferer s 20s. Fill in the blanks: Garner (1986) argues that there is an overlap between anorexia and bulimia. The term anorexiabulimia describes sufferers who show characteristics of both disorders, e.g., between 30 50% of anorexics binge and purge, and bulimics may fast. Moreover, some sufferers move between the two disorders. However, some forms are entirely distinct, e.g., restrictive anorexia compared to obese bulimia. The diverse expression of anorexia and bulimia means that some cases are similar and others are dissimilar. 14

15 Explanations of Eating Disorders (pages 126 to 128) Page 126 Biological explanations Description Genetic factors: Family study shows that relatives of patients with an eating disorder are 4 to 5 times more likely to suffer from an eating disorder (Strober & Humphrey, 1987). Twin studies have shown higher concordance for MZ twins than DZ twins. For example, Holland et al. s (1988) study of anorexia found the concordance for MZ was 56% compared to 7% for DZ. Kendler et al. s (1991) study on bulimia found 23% for MZ and 9% for DZ. This research evidence supports a genetic basis to eating disorders. Biochemical factors: Fava et al. (1989) found a link between anorexia and levels of serotonin and noradrenaline, and the fact that anti-depressants are effective in treating eating disorders further supports biochemical imbalance as an explanation of anorexia and bulimia. Neuroanatomy: Hypothalamus dysfunction may be an explanation as the ventromedial hypothalamus (VMH) and the lateral hypothalamus (LH) are the stop/start mechanism for hunger and maintain weight homeostasis. Thus, anorexics and bulimics may have an abnormality in the LH, which produces feelings of hunger, or they may have an abnormality in the VMH, which suppresses hunger. Evaluation Not 100% concordance rates and so other factors must be involved; genetics predispose rather than cause the conditions: The fact that there are no 100% concordance rates suggests that other factors must be involved, particularly as genes cannot explain the recent rapid rise in eating disorders. Social and cultural factors are more likely to explain this rise. Thus, eating disorders are likely to be an interaction of nature and nurture, but it is difficult to separate out their respective influences. However, it is indisputable that genes alone do not cause eating disorders. Cause, effect, or correlate? The biochemical imbalances and neuroanatomical abnormalities are difficult to interpret, as it is difficult to determine if they are a cause of the disorder or a consequence of having the disorder. For example, low levels of serotonin in anorexia may be due to insufficient food and so an effect of the disorder. Furthermore, as research evidence is rarely experimental, causation cannot be inferred and so it is only possible to conclude that biochemical imbalances and neuroanatomical abnormalities are associated with eating disorders rather than a cause. 15

16 Reductionist because it is oversimplistic to reduce complex behaviour to biological mechanisms only: Trying to explain behaviour using only one factor is reductionist and, as a consequence, the explanations lack conviction. For example, the explanation that hypothalamus dysfunction may explain eating disorders is oversimplified as motivation and cognition can override this to some extent. Thus, the explanations are also biologically deterministic because they ignore the free will and ability of the individual to control their own behaviour. Ignores nurture, i.e., psychological and social factors: The biological explanations ignore the role of nurture, as they do not account for psychological or social factors. Thus, they are biased and cannot fully account for eating disorders because, as the concordance rates show, other factors must be involved. The compromise position of the diathesis stress model is more convincing, as according to this, the the genes (nature) load the gun, but it is the environment (nurture) that pulls the trigger. Psychological and biological explanations, i.e., a multi-perspective are needed to fully explain eating disorders. Page 127 Psychological explanations Behavioural Classical conditioning (Leitenberg et al., 1968): Anorexia may be explained by weight phobia, which originates when anorexics learn to associate eating with anxiety because this can lead to weight gain. Operant conditioning (Rosen & Leitenberg, 1985): The weight phobia is then reinforced as food avoidance is rewarding (negative reinforcement) because the unpleasant consequence of weight gain is avoided. It may also be positively reinforcing due to the attention received. This attention may be concern about the food avoidance and/or possibly compliments on the weight loss. Operant conditioning has been applied to bulimia as the anxiety caused by bingeing is reduced through compensatory behaviours and the reduced anxiety reinforces the compensatory behaviours, which perpetuates the cycle of binge purge. Social learning theory modelling (Barlow & Durand, 1995; Nasser, 1986): Barlow and Durand found that more than half of Miss America contestants are 15% or more below their expected body weight. Nasser compared Egyptian women studying in Cairo and London; none of those studying in Cairo developed eating disorders, but 12% of those studying in London did. This shows the influence of Western standards of idealised body images and that eating disorders are linked to cultural norms and role models. Culture-bound syndrome: The fact that eating disorders are considerably more common in Western than Eastern cultures has led to them being classed as a culture-bound syndrome. Lee et al. (1992) reported the rarity of anorexia in China, but eating disorders are becoming more common in cultures where the West has greater influence, such as Japan. This demonstrates the importance of cultural factors in eating disorders and supports the validity of social learning theory, which does account for eating disorders as a cultural phenomenon. 16

17 Evaluation Behavioural explanations do not account for individual differences in vulnerability: Conditioning does not account for individual differences because it cannot explain why some people just diet and why anorexics and bulimics take it further. If the environment were determining behaviour then we would not expect such variation. Conditioning is in fact environmentally deterministic and reductionist. May explain maintenance rather than cause: The influence of operant conditioning to perpetuate eating disorders does make sense and so has face validity. However, the explanation that it is caused by the association of anxiety with food lacks conviction, as many people feel anxious about their food intake yet do not restrict it. Which brings us back to the point that conditioning cannot account for individual differences. Social learning theory accounts for cognition and appears to be valid (correct): Social learning theory is more sophisticated than the traditional learning theories; it accounts for cognition in its explanation that we can learn through vicarious reinforcement and imitation. Moreover, it accounts for eating disorders as a cultural phenomenon, as role models and social learning differ across cultures. Research on cultural differences provides support for the validity of social learning theory, as do patients accounts of their susceptibility to the idealised body images shown in magazines. Psychodynamic Sexual development: Anorexia has been linked to fear about sexual development such as becoming pregnant. Alternatively it has been suggested that the emaciated body is an attempt to remain pre-pubescent. Family systems theory (Minuchin et al., 1978): conflict, overprotectiveness, rigidity, enmeshment (note the mneumonic CORE): An enmeshed family is smothering and can lead to a lack of identity. Such families find it hard to resolve conflict and this has been found in families of anorexics and bulimics, as negative interactions outnumber positive interactions. The eating disorder is an attempt at independence. Refusing to eat is a rebellion against the dysfunctional ties of the family. Anorexics and bulimics use their bodies to take control, as the family situation is beyond any control. Autonomy and identity confusion (Bruch, 1971): Bruch proposed that anorexia is the individual s struggle for identity and autonomy. There is conflict with the mother because she has never been able to identify and successfully meet the needs of the sufferer. This is linked to food being used as a comfort. Anorexia is a rejection of food as a reward, as it is not used for comfort, whereas bulimia involves using food as a reward to oneself. This also suggests that the eating disorder is a way to take control. 17

18 Evaluation Conflict cause or consequence? Family conflicts may be more a result of having a family member suffering with an eating disorder, and so may be an effect rather than a cause. Furthermore, many families have conflicts but this does not necessarily result in abnormality, nor does it explain why the disorders occur in women more than men. Doesn t account for sudden increase in eating disorders: Psychodynamic explanations tend to be dated and have not addressed the sudden dramatic rise in eating disorders. Psychodynamic explanations are based on case studies and clinical interviews that lack objectivity and thus scientific validity: Psychodynamic explanations are subjective (not objective) as they are based on clinical interviews and case studies, which are vulnerable to researcher bias. They are opinion rather than fact because they have not been tested rigorously and objectively. Lack of scientific evidence means these explanations cannot be verified or falsified: Concepts are vague and hard to define and consequently cannot be operationalised. This means they cannot be tested empirically and so can neither be falsified nor verified. Nobody can prove they are right, but they also cannot be proven to be wrong. Page 128 Cognitive Distortion of body image (Garfinkel & Garner, 1982; Cooper & Taylor, 1988): People with eating disorders have a distorted view of their own body image and what an ideal body image should look like. They place too much importance on their weight and its role in their well being. They usually overestimate their body size. Garfinkel and Garner found that this overestimation in people with anorexia is greater than that found in controls. Cooper and Taylor reported similar overestimation in patients with bulimia. Cognitive dysfunction, e.g., obsessive thinking and perfectionism: Eating disorders are characterised by obsessive thinking about food and weight gain. Recent research has also linked the disorder to perfectionism, which is where the individual has impossibly high standards for themselves. Evaluation Research evidence is scientific as based on the experimental method: The research on body size distortion has been tested experimentally and so has scientific validity. Thus, we can be confident that the findings are true. Cognitive dysfunction cause or consequence? The cognitive explanations can only explain eating disorders so far, as they do not explain what caused the breakdown in information processing in the first place. Moreover, they may be an effect rather than a cause of the disorder, in which case they are a characteristic, rather than a causal factor. 18

19 Conclusions Fill in the blanks: A multi-dimensional approach is needed to fully account for eating disorders. The compromise position of the disthesis stress model best accounts for the influence of nature (genes) and nurture (environment) and so is the most comprehensive account of anorexia and/or bulimia. Abnormality APFCCs (pages 129 to 132) Page 129 A study into biological explanations of anorexia Holland et al. s (1988) study of genetic vulnerability in anorexics Aims: Holland et al. aimed to investigate whether there was a higher concordance rate of anorexia nervosa for monozygotic (MZ) than dizygotic (DZ) twins. This was based on past research, which suggested that abnormality might have a genetic basis. A difference is being sought between MZ and DZ twins because MZ are 100% genetically identical whereas DZ have only 50% in common. Thus, it follows that there should be higher concordance for MZ than DZ if there is a genetic basis to anorexia nervosa. Procedure: An opportunity sample of 34 pairs of twins (30 female and 4 male) and 1 set of triplets was selected because one of the pair (or triplet) had been diagnosed with anorexia. This was a natural experiment as the IV (genetic relatedness) is naturally occurring and cannot be controlled by the experimenter. A physical resemblance questionnaire established genetic relatedness, that is, whether the twins were MZ or DZ (16 were MZ and 14 were DZ). Usually MZ twins have greater physical resemblance but if there was any uncertainty a blood test was carried out. This was a longitudinal study; the researchers checking over time to establish whether the other twin went on to develop anorexia (the DV). A clinical interview and standard criteria were used for diagnosis of anorexia. Findings: A significant difference was found as there was a much higher concordance rate of anorexia for MZ (56% 9 of 16) than DZ (7% 1 of 14) twins. Further findings were that in 3 cases where the non-diagnosed twin did not have anorexia they were diagnosed with other psychiatric illnesses, and 2 had minor eating disorders. Conclusions: The results suggest a genetic basis for anorexia and general psychiatric illness. The percentage suggests that genes are not wholly responsible and so they constitute a predisposition; that is, they make the individual vulnerable but do not trigger the disorder. Implications include the need to identify the precipitating factors, i.e., environmental triggers, which interact with the genetic predisposition. 19

20 Criticisms The study ignores any role nurture may play in causing anorexia, that is, the environmental explanations for the disorder. Certainly nurture plays a role, as the concordance rates are only 56%. They would have to be 100% if anorexia was exclusively due to genetic factors. Furthermore, the 56% concordance may be due to nurture as MZ twins may experience a more similar environment and may be treated more similarly than DZ twins due to the fact that they look and behave more alike. Whilst this does not account for the considerable difference found between MZ and DZ twins, it does show that it is difficult to separate out the influence of nature and nurture. Thus, it is over-simplistic and reductionist to consider only one factor, genes, as a basis for anorexia. The natural experiment lacks control of the variables. The IV, genetic relatedness, is not isolated, as multiple other factors (confounding variables) may be implicated, e.g., environmental factors (as identified above), individual-specific experiences, and socio-economic factors. Consequently, internal validity is low, as factors other than the IV may have resulted in anorexia. Also the IV is not controlled and so causation cannot be inferred. This means conclusions are limited as it cannot be said that genes cause anorexia, at best they are strongly implicated. Page 130 A study into biological explanations of bulimia Kendler et al. s (1991) study of genetic vulnerability in bulimics Aims: Kendler et al. aimed to investigate whether there was a higher concordance rate of bulimia nervosa for monozygotic (MZ) than dizygotic (DZ) twins. This was based on past research, which suggested that abnormality might have a genetic basis. A difference is being sought between MZ and DZ twins because MZ are 100% genetically identical whereas DZ have only 50% in common. Thus, it follows that there should be higher concordance for MZ than DZ if there is a genetic basis. Procedure: A sample of 2163 female twins was selected, based on one of the pair being diagnosed with bulimia. This was a natural experiment as the IV (genetic relatedness) is naturally occurring and cannot be controlled by the experimenter. This was a longitudinal study: the researchers checked over time to establish whether the other twin went on to develop bulimia (the DV). The clinical interview and standard criteria were used for diagnosis of bulimia. Findings: There was a higher concordance rate of bulimia for MZ (23%) than DZ (9%) twins and the difference was statistically significant. Overall, 123 cases of bulimia were reported. Furthermore, significant evidence of other mental disorders was also reported: 10% of the nonbulimic twins reported anorexia, 5% a phobic disorder, and 11% an anxiety disorder. Conclusions: The results suggest a genetic basis for bulimia, but the evidence is less strong than that for anorexia. The percentage concordance suggests that genes are not wholly responsible but constitute a predisposition for the disorder. That is, they make the individual vulnerable but do not trigger the disorder. Implications include the need to identify the precipitating factors (environmental triggers), which interact with the genetic predisposition. 20