QUESTIONS AND ESSAY PLANS
1. Discuss the issues raised in the classification and diagnosis of OCD. (25 marks)
When answering this question you must not spend much time describing the features of the classification
systems, since the question concerns reliability and validity and does not require you to describe the
systems.
Paragraph 1 Introduction
Give a very brief introduction to what a classification system is and its main purposes (to enable clinicians
to organise data, to provide a summary of the main syndromes, to keep statistics, as the first step in
treatment). Keep it as brief as possible. Then mention the two main systems in use at present, DSM-IV and
ICD-10. Explain how they are very similar in their classification of OCD.
Paragraph 2
Describe what is meant by reliability in the context of a classification system—essentially, the extent of
agreement between clinicians and therefore consistency in diagnosis. Outline what is necessary to achieve
reliability—“tight” and precise descriptions of each category of mental disorder. Similarly, describe what is
meant by validity (i.e. accurate diagnosis) and mention why it is more difficult to establish than reliability.
Reliability is not necessarily hard to achieve—the problem is that it is often done at the expense of validity,
i.e. diagnosis could be consistently wrong! So, essentially, it is difficult to achieve both reliability and
validity, but not necessarily difficult to achieve reliability (although, needless to say, this is pointless
without validity).
Paragraph 3
Explain how the categorical approach, comorbidity, and subjectivity of diagnosis limit reliability and
validity.
Paragraph 4
Discuss the reliability and validity of clinical interviews. Outline the semi-structured interviews for OCD,
the Structured Clinical Interview for DSM-IV-Patient Version (SCID-I/P) and the Anxiety Disorder
Interview Schedule for DSM-IV (ADIS-IV). Note the fact that diagnosis of OCD is more reliable and valid
than it is for other mental disorders and explain why. Use Brown et al. (2001) as support but do explain the
issues that limited reliability. However, consider Steinberger and Schuch’s (2002) research as they found
large differences between DSM-IV and ICD-10 in their diagnoses of children and adolescents having
symptoms of obsessive compulsive disorder. Explain why this is linked to the ICD-10 classification
system.
Paragraph 5
Discuss why both diagnostic interviews and DSM-IV and ICD-10 have content validity. Next, introduce
criterion validity as being assessed by if those diagnosed with OCD differ in predictable ways from those
who do not have OCD. Consider how, on the one hand, this is true but, on the other, it is true of mental
disorders in general, not just OCD.
Paragraph 6
Explain construct validity and use examples as support such as the fact we can hypothesise that patients
with OCD have an exaggerated sense of responsibility and the fact that there is research that shows this
supports construct validity. The successful use of treatments that relate to possible causes such as cognitive
distortions also support good construct validity. Discuss how issues arise when the hypotheses are not
supported.
Paragraph 7
Discuss why diagnosis of OCD is free from gender and culture bias. Explain predictive validity and discuss
how there is evidence for predictive validity as we are able to make reasonably valid predictions about the
outcomes. Discuss how predictions can be made that most patients of OCD take some time to respond to
treatment, and so this supports predictive validity. But what challenges predictive validity?
Paragraph 8 Conclusion
Conclude by mentioning the importance of classification systems but the inevitable problems establishing
reliability and validity at the same time. Both DSM and ICD have been criticised for sacrificing validity on
the altar of reliability. Nevertheless, validity is impossible without reliability, so it is understandable that
there has been a concentration on reliability, which has improved with each subsequent edition. However,
the establishment of a classification system must always be seen as a work in progress. The challenge now
is to attempt to establish not only high reliability but high validity.
2. Outline and evaluate one or more psychological explanation(s) of one anxiety
disorder. (25 marks)
Outline and evaluate two explanations in depth, and cover one superficially if you have time, but don’t
cover more than this as you will sacrifice depth for breadth.
Paragraph 1 Introduction
Outline the psychodynamic explanation, including the role of the ego and the ego defence mechanisms:
isolation, undoing, and reaction formation. Describe how Freud linked OCD to the anal stage of
development and conflict over cleanliness and his linking of anxiety to sexual restriction.
Paragraph 2
Evaluate Freud’s theory, including the fact there is no scientific evidence, the lack of generalisability, and
the issue of cause and effect.
Paragraph 3
Describe the behavioural explanation that the association of fear with particular stimuli leads to obsessions
and compulsions and explain how the compulsions are maintained through reinforcement. Describe how
Mowrer’s (1947) two-process theory explains more fully how classical and operant conditioning account
for OCD. Use Rachman and Hodgson (1980) as evidence.
Paragraph 4
Evaluate the behavioural explanations, including: face and scientific validity; the exposure and response
prevention therapy; determinism; explain maintenance better than cause; nature vs. nurture; and lack of
explanatory power. Focus finally on reductionism because one of the key weaknesses of the behavioural
explanation is that it does not account for the obsessive thinking because the behavioural approach does not
account for cognition.
Paragraph 5
Describe how the cognitive approach expands on the behavioural approach by accounting for faulty
cognition; in particular, explain the emphasis given to patients’ inflated sense of personal responsibility.
Use the evidence of OCD beginning during pregnancy and Abramowitz’s (2006) research as evidence for
this inflated sense of personal responsibility.
Paragraph 6
Cognitive explanations have face validity but they also have weaknesses, such as: they lack explanatory
power; they don’t establish cause and effect; and are more descriptive than explanatory.
Discuss the key issue is that any one explanation cannot account for OCD because to account fully for
OCD it is necessary to consider how cognition interacts with other approaches. For example, faulty
thinking could be due to an interaction of biological and social factors, which are ignored by the cognitive
approach, and so it is too simplistic (reductionist).
A key issue with psychological explanations is that they do not account for biological factors. Explain why
biological factors must be considered. In particular, why evolution can explain the origins of OCD more
than the psychological explanations. Use the diathesis–stress model to conclude.
3(a). Outline one or more biological therapy(ies) for one anxiety disorder. (9 marks)
Note the question is divided into AO1 in part (a) and AO2 in part (b).
Paragraph 1
Introduce drug therapy as the main biological approach in the treatment of OCD. Describe the use of SRIs
and SSRIs.
Paragraph 2
Outline research evidence such as Dougherty et al. (2002), who explain why SSRIs take 6 weeks to work,
and Eddy et al.’s (2004) comparison of different types of drugs.
3(b). Evaluate the therapy(ies) described in (a). (16 marks)
Paragraph 1
Conclude what the above research suggests about the effectiveness of drug therapy. Discuss why a
combined approach of SRIs/SSRIs and antipsychotics may be optimal.
Paragraph 2
Consider issues that limit effectiveness, such as drop-out rate, the unpleasant side effects (dry mouth,
drowsiness, sedation, and sweating), treats symptoms not causes, relapse rates, and the placebo effect.
Paragraph 3
Consider in what ways the treatment is appropriate. For example, effectiveness and that there is a valid
basis for therapy. Consider the ways in which drug therapy is not appropriate. For example, individual
differences, slow-acting, side effects, drop-out rate, and we lack understanding of their effect.
Paragraph 4
Discuss why drug therapy should be combined with other treatments and consider why the psychological
therapies provide strong alternatives.
Paragraph 5
Consider the strongest arguments for drug therapy—their effectiveness in reducing anxiety. Patients may
find the psychological treatments too demanding in terms of effort and motivation so drugs compare well in
terms of ease of use. Furthermore, some patients may need drug therapy to calm them down to a state in
which they can benefit from psychological therapy.
However, drugs are only reasonably effective. The length of any improvement is a key issue because
research suggests the improvement lasts only as long as patients stay on the drugs, and of course being on
drugs is not a permanent solution!
Discuss how comparisons of the effectiveness of different treatments should be treated with caution due to
issues such as individual differences of the patient or therapist, the “general therapy effect”, the “hellogoodbye effect”, and publication bias. Consider the ethical issues of therapy such as informed consent and
confidentiality. Conclude by saying why a multi-dimensional approach is optimal.