Topic 3: Psychological problems Revision Notes

Depression (ICD-10/11)

Depression is classified in the ICD as a mood disorder. Core symptoms, according to ICD, include persistently low mood, anhedonia (loss of interest/pleasure), and reduced energy/activity. Additional symptoms comprise changes in sleep (insomnia/hypersomnia), appetite (increase/decrease), psychomotor activity (agitation/retardation), feelings of worthlessness/guilt, difficulty concentrating, and recurrent thoughts of death/suicide. For a diagnosis, symptoms must typically be present for a minimum duration of two weeks and cause significant distress or functional impairment. Severity (mild, moderate, severe) is determined by the number and intensity of symptoms. For instance, in ICD-10, mild depression typically requires two core and two other symptoms, while severe requires all three core and at least four other symptoms, some of which may include psychotic features.

Addiction (Dependence Syndrome - ICD-10/11)

Addiction, referred to as 'dependence syndrome' in ICD-10, is characterised by a strong urge or compulsion to use a substance. Other key features include impaired control over usage (difficulty starting, stopping, or regulating amount), continued use despite clear harmful consequences, higher priority given to substance over other activities, evidence of pharmacological tolerance (needing more for the same effect), and a physiological withdrawal state when use decreases or stops. For an ICD-10 diagnosis, at least three of these six criteria should have been present together in the last year. ICD-11 shifts focus slightly, diagnosing 'disorders due to substance use' on a pattern of substance use leading to significant impairment or distress, including impaired control, increasing priority given to substance use, and continued use despite harm, typically for at least 12 months.

Evaluation of ICD Diagnostic Systems

A key strength of the ICD is its international standardisation, providing a common language for mental health professionals globally. This enhances inter-rater reliability, ensuring more consistent diagnoses across different clinicians and regions, which is crucial for international health statistics and research. However, a limitation is its categorical approach, classifying conditions as either present or absent. This can oversimplify the complex, spectrum-like nature of mental health disorders, potentially leading to 'all-or-nothing' diagnoses that might miss individuals with sub-threshold but clinically significant symptoms. Furthermore, cultural variations in symptom expression or interpretation can challenge the universal applicability of some criteria, potentially affecting diagnostic accuracy in diverse populations.

Defining Nature and Nurture in Psychological Problems

'Nature' refers to the inherited, biological predispositions influencing psychological problems, such as genetic vulnerabilities for schizophrenia or depression. These are innate factors that may increase an individual's risk. 'Nurture' refers to environmental influences contributing to psychological problems, including early childhood trauma, learned dysfunctional thought patterns, family dynamics, or socio-economic stressors. These are experiences and external factors that shape development and mental health.

Interactionist Approach and Evidence from Psychological Problems

Few psychologists today view nature and nurture as separate entities. Instead, most adopt an 'interactionist' perspective, where biological predispositions (nature) and environmental triggers (nurture) combine dynamically. For example, the diathesis-stress model suggests a genetic predisposition (diathesis) for a disorder like schizophrenia or depression may only express itself if the individual experiences significant environmental stressors (stress). Evidence for nature often comes from twin and adoption studies showing higher concordance rates for psychological problems in genetically closer relatives. Evidence for nurture includes studies on the impact of life events, parenting styles, or cultural factors on mental health. Evaluating this interaction is critical for understanding the complex causes of psychological problems.

Young (2007) Study Aim and Procedure

Kimberly Young's 2007 study primarily aimed to investigate the effectiveness of Cognitive Behavioural Therapy (CBT) as an intervention for individuals with Internet Addiction (IA). Participants were diagnosed with IA based on Young's established diagnostic criteria. The procedure involved a single-group, pre-post design where individuals completed a 12-session outpatient CBT program. This program included identifying triggers for problematic internet use, cognitive restructuring to challenge dysfunctional thoughts about internet use, and behavioural strategies like setting limits and finding alternative activities. Data was collected through self-report questionnaires and interviews at various stages of treatment to monitor changes in internet use and associated psychological symptoms.

Young (2007) Findings and Conclusions

The findings of Young's (2007) study indicated that participants showed continuous improvement in their symptoms of Internet Addiction from approximately session three onwards. Most clients were managing their symptoms effectively by sessions eight to twelve, reporting reduced internet usage and fewer addiction-related problems, such as neglecting responsibilities or experiencing withdrawal. A significant majority of participants maintained these gains at a six-month follow-up. The study concluded that CBT could be successfully adapted to treat behavioural addictions like internet addiction, providing a structured approach to address both cognitive and behavioural components of the disorder and improving daily functioning.

Evaluation of Young (2007)

One strength of Young's (2007) study is its pioneering nature, addressing the emerging issue of internet addiction when it was not widely recognised and establishing a foundation for future research and treatment. The use of a structured 12-session CBT program provides a replicable framework, enhancing the reliability of the treatment approach. However, a significant weakness is the reliance on self-report measures for data collection, which are prone to social desirability bias; participants might underreport internet use or overstate improvements. A major limitation is the absence of a control group. This single-group, pre-post design makes it difficult to definitively attribute observed improvements solely to CBT, as other factors or natural remission could have contributed, reducing the internal validity of the causal claims.