ABNORMAL PSYCHOLOGY ASSIGNMENT

 

Introduction

Abnormal psychology deals with the branches of behavioral, emotional, and thought patterns that deviate from social norms and might contribute to distress or disability. The 5P model is an inclusive framework by which the intricacies of psychological disorders could be considered. Presenting Problem, referring to what the current problem is being addressed; Predisposing Factors, referring to the events or circumstances leading up to the emergence of the disorder; Precipitating Factors, which trigger the presenting problem; Perpetuating Factors, which maintain the problem; and Protective Factors, which cushion the impact of the disorder on the individual's functioning. This assignment will look into the diagnosis of a psychological disorder in two case studies—Barry and William—using the 5P model and suggest an appropriate treatment plan.

 

Case Study 1: Barry

Presenting Problem

Barry, who is 11 years old reported to exhibit acute school refusal, involving consistent reluctance or refusal to attend school. He describes his physical complaints as very severe and adds that they have progressed to repeated abdominal pain and headaches, which are worse in the mornings. Accompanying these somatic symptoms is a fear of something happening to his mother, who has several health problems, including epilepsy. Barry cries or becomes belligerent when attempts are made to compel him to attend school. Despite these problems, he seems to be reasonably well-adjusted when he actually gets to school, although he has complained of bullying and a particularly unsympathetic gym teacher.

Barry's refusal of school has severe consequences for his academics, social development, and the dynamics of his family. His somatic symptoms are probably a manifestation of anxiety that he is going through and also a means of escape from the feared situation in school. His excessive fear for his mother's well-being gives the impression of great anxiety, probably increased by the health problems of the mother and the family's reaction to it.

 

 

Predisposing Factors

Predisposing factors in psychology and medicine are defined as those factors, elements, conditions, or situations that really make a person more vulnerable or susceptible to a certain order of disorder, illness, or condition. In short, predisposing factors are not actually the causes, but they put up a situation in which the risk of developing a certain condition is increased. The nature of predisposing factors may be biological, psychological, or environmental, all linking together to play a role in the cause of developing a certain disorder. Following are such examples for Barry's condition.

 

Family History and Dynamics

Barry has come from a family with a lot issues regarding psychological adjustment. His three other brothers have also suffered from school refusal tendencies, which indicates that it could be being carried down through his family. This may suggest a genetic predisposition and even a learned response to anxiety disorders. The aloof father and a close attachment with the mother may have created disturbances in the emotional development of Barry and in the adjustment to stress.

Attachment to the mother

Barry is attached to his mother who is suffering from chronic health problems, which might be an addition to his reasons for experiencing anxiety. Very strong attachment seems to exist between the mother and the child. This might be as a result of the distant relationship between the father and his children. This attachment might be the means of compensation for the emotional support deficiency from the father. Within the attachment theory, the fear that something will happen to his mother can be regarded as being worry on the part of Barry. According to the theory, secure attachments are necessary for the child in order to regulate and develop emotionally.

 

 

 

Personality Traits

Barry may be predisposed to anxiety or sensitivity, and that he may become more vulnerable to distress from the influence of environmental stressors. Thus highly sensitive or anxious children are much more likely to develop anxiety disorders with stressors.

Cultural and Social Context

Expectations due to cultural norms and family values with regard to close family relationships may be another cause. The surroundings may further teach Barry that family must always be close, thus increasing his fear of separation. Cultural expectations about family roles and the importance of caregiving may also increase Barry's anxiety over his mother's health.

 

Precipitating Factors 

In psychological terms, according to the 5P model, precipitating factors are events or provocative agents that lead to an immediate symptomatology in a particular condition or disorder. The factors are those which trigger the underlying vulnerability resulting from the predisposing risk factor into action, leading to the formation or worsening of symptoms. Following are those precipitating factors.

Mother's Health Concerns

The situation of the mother's health must have been a worry for Barry most of the time. Fear about something possibly happening to her, mainly because psychologically the nature of epilepsy is unpredictable, would be enough to trigger his anxiety and refusal to go to school. Having a chronically ill parent creates a sense of instability and fear among children.              .

Negative School Experiences

Barry has reported bullying and unfavorable treatment by a gym teacher. This could be one of the reasons behind his reluctance to attend school, worsening anxiety and physical symptoms. The adverse interactions with peers and teachers in the school setting will powerfully impact the sense of safety and well-being of children at school, thereby influencing the absence of avoidance behaviors.

Family-related stress

Such as recent change, financial difficulties, or interpersonal conflict within the household, can lead to stress for Barry and trigger his symptoms. Such stressors can improve a sense of instability and fearfulness. This would heighten his anxiety and further fuel the escalation of maladaptive coping strategies, like school refusal.

 

Perpetuating Factors

Factors that perpetuate the psychological condition or disorder once it has started to develop are called perpetuating factors. Perpetuating factors can be defined as factors responsible for the continuation of symptoms and, hence, make an individual's recovery from a condition or illness quite difficult. Unlike the predisposing factors, which merely set the stage, or the precipitating factors, which are responsible for the trigger, the perpetuating factors are responsible for the continuous presence and persistence of the disorder. Following are the examples.

 

Avoidance Behavior

School refusal or avoidance of that particular situation that causes anxiety reinforces Barry's symptoms. The firing of his anxiety during staying at home only cements the behavior of avoidance, making the breaking of this cycle all the more difficult. Avoidance behaviors preclude the child from facing the feared situation and from realizing that nothing disastrous happens and that the feelings of anxiety abate with time.

Family Reinforcement

The family's reaction, in the form of acquiescing or overprotection, can often lead to an unintentional perpetuation of the symptoms. Not dealing with the core anxiety problem, a family may turn to one that supports such a refusal to go to school. Overprotective or accommodating behaviors can allow the child to realize and strengthen his fears and avoidance strategies.

Somatic complaints

Physical symptoms, which can be abdominal pain and headaches, will give Barry reasons to stay at home. These somatic complaints will always look like good reasons to stay at home and will therefore further reinforce the behavior. Somatic symptoms can become a learned response to anxiety, where the child associates physical discomfort with the need to escape a stressful situation.

Absence of Professional Intervention

If Barry has not been exposed to appropriate psychological and medical treatment, his symptoms are bound to persist. Early intervention goes a long way in curbing much of his psychological discomfort and physical symptoms. The symptoms of anxiety in the child will deepen without suitable intervention and resistance to change with time.

 

Protective Factors

Despite all these odds, there are still several protective factors which may promote Barry's well-being and recovery. Protective factors are the conditions or characteristics, when present, that help the individual to either resist or lower the potential harm from risk factors, thereby reducing the probability of developing a psychological disorder or other negative outcomes. Those factors may improve resiliency, enhance coping, and provide support during difficult times. The protective factors could be biological, psychological, social, or environmental. Examples are given below.

 

Positive Social Relationships

Barry has evidenced social adjustment in school. This points to the fact that he must have positive relationships with peers or teachers in school. These connections could be used to motivate school attendance and facilitate emotional support. Strong social support networks help as a buffer against stress, promote resilience.

 

Parental Involvement

It will be very beneficial if the parents of Barry, especially the mother, actively take part in the treatment. Participation by the family in therapeutic interventions, if desired and if the patient consents, may markedly help enhance the coping skills of Barry and decrease anxiety. This would provide a caring atmosphere at home and reinforce some therapeutic strategies.

 

The availability and accessibility of mental health services

Especially regarding counseling and therapy arrangements which could provide a critical support system for Barry. Interventions by professionals could be the type of support that Barry needs at this particular time in order to develop some coping strategies against the sources of his anxiety. Further access to specialized mental health services would help in assessment and treatment planning.

 

Resilience and Coping Skills

Therapy can be built on any inherent resilience or formerly acquired coping skills that Barry might have. Such skills will very importantly need to be strengthened to help him deal with his anxiety and return to school. Interventions could focus on building resilience to help a child better deal with stress and adversity.

 

 

 

 

 

Treatment Plan

Cognitive-Behavioral Therapy (CBT)       

Focus: Treating Barry's anxiety and school refusal by applying cognitive restructuring and exposure therapy.

Techniques: Gradual exposure to school settings, challenging irrational thoughts about the safety of his mother, and relaxation techniques to decrease somatic symptoms. Using CBT will help Barry modify his maladaptive thoughts and behaviors and learn more adaptive ways to cope.

Family Therapy            

Goal: Improvement of family dynamics and communication, overcoming overprotective behaviors, and being supportive for Barry.   

Methods: Work with the family in sessions to explore interaction patterns and strategies that will encourage Barry to attend school. Family therapy has good potential for collaborative work in finding ways to address the anxiety of the child and school refusal.                                                 .

Medical Evaluation        

Objective: Emphasize the possibility of medication that may be indicated to decrease acute symptoms, including mild anxiolytics. Observe physical complaints that are amenable to treatment so that they are not used to mask other health-related issues. Certain systematic medical clearance may indicate any underlying medical condition that may be contributing to the child's symptoms.
School-Based Interventions: 

Interventions: Collaborate with school staff to ensure that the school environment remains conducive to Barry. It may include addressing bullying and accommodation issues to make adjustment easier. School-based interventions will offer a safe learning environment.

Psychoeducation

Barry and his family should be educated about anxiety, school refusal, and about the avoidance behaviors. Information may empower them to become engaged in treatment. Through psychoeducation, the family will likely make better sense of the child's condition and thus improve their participation in treatment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case Study 2: William

Presenting Problem

 

William is a 56-year-old man who shows symptoms typical of Obsessive-Compulsive Disorder (OCD) with symptoms showing contamination fears and safety checks. William repetitively washes his hands, causing his skin to crack and get red; he also compulsively checks doors and windows for closure and lockup. He has an overwhelming urge to clean his house if he sees any dust.

The excessive handwashing and cleaning behaviors were indicative of high distress related to contamination fears, while the compulsive checking behaviors were indicative of great anxiety over safety and security. These compulsions act as maladaptive coping mechanisms to reduce the very high anxiety levels the obsessive thoughts provoke.

These activities are occupying much of his time and, at times, interfere with daily routine, cause enormous distress, and functional impairment. William's OCD has affected his quality of life, day-to-day routine, relationships, and general well-being.

 

Predisposing Factors

Listed below are some predisposing factors that may have added to William's OCD.                      .

Genetic Predisposition

William's chance of getting OCD is higher when there is a family history of anxiety disorders or OCD. Genetic determinants play an important role in the causation of OCD and point out that this has some heritable feature of the disorder. William's genetic makeup will predispose him to being in a state of high anxiety-related conditions and thus affect the development of OCD.               .

Personality characteristics

Perfectionism, high conscientiousness, and a tendency to over-responsibility, can contribute to vulnerability to OCD. William's carefulness and the need for control perhaps underlie such personality characteristics. Accordingly, those with these personality characteristics are more likely to develop obsessive-compulsive behaviors in such a way that will help them decrease anxiety and keep things in order.         

Early Life Experiences

Trauma, neglect, or excessively-protective rearing may be some of the childhood experiences gained by the person who is suffering from OCD. Maybe William had experienced some early environmental factors that were driving his preventive measures and vulnerabilities toward anxiety disorders. Undesirable events happened during childhood affect healthy coping mechanisms, so there could be an increased risk of developing OCD later in life.        

Cultural and Social Influences

Influences such as norms and societal expectations about cleanliness, order, and safety can also play a role in William's OCD.

Cultural values that emphasize cleanliness and personal responsibility further support obsessive-compulsive behaviors. Cultural factors shape the content of obsessions and compulsions and, therefore, should have an impact on the expression of OCD symptoms.

 

Precipitating Factors

Precipitating factors are defined as specific events or stressors that may have triggered William's OCD. Examples regarding those factors are given below.           

 

Stressful Life Events

High-order stressors, such as job loss, financial strain, or personal bereavement, can be a cause of or act as a precursor to a worsening of OCD symptoms. William may have experienced one or more of these high-order stressors in the very recent past that appear to have served to elevate his condition into severe impairment. Stressful life events increase the levels of anxiety and then, by way of a maladaptive coping strategy, will turn on obsessive-compulsive behaviors.                      .


Health Concerns

Fears of recent illness or the existence of chronic medical conditions may have heightened William's contamination fears and safety concerns. This health-related stress might intensify underlying anxiety, which would contribute to the development of OCD symptoms. Health concerns and fears for well-being could be triggers for intrusive thoughts and compulsions about contamination and safety.          

Environmental Change

Any change in living environment, such as moving house or composition of household, can be a stressor. In William's case, symptoms of OCD could alternatively become very intense because of changes in his environment that therefore disturbed his natural balance and sense of security. Environmental changes can result in uncertainties and anxiety which can possibly lead to more acts of obsessive compulsions.    

Interpersonal conflicts

Feeling in strained or conflicted relationships with family or work colleagues leads to increased tensions and anxieties that exacerbate OCD symptoms. Interpersonal conflicts may cause emotional disturbance and a desperate necessity for obsessive-compulsive behaviors to be triggered in order to handle the stress and to control the environment.

 

Perpetuating Factors 

Perpetuating factors are those that further worsen or maintain William's OCD symptoms over time. William's compulsive behaviors, like handwashing and checking, reduce his anxiety in the short term but perpetuate the cycle of OCD in the long term. When he avoids situations that provoke anxiety, habituation does not take place, and thus the compulsions are further reinforced. Avoidance behaviors help maintain the cycle of OCD by preventing the individual from confrontation and overcoming of fears.

 

Family Accommodation

William's family might, unbeknownst to them, enable his OCD by going out of their way in accommodating his compulsions, whether it is cleaning or reassurance for safety checks. Family accommodation thus furthers and maintains this circle of OCD by supporting the individual's fears and compulsions.

 

Lack of Treatment

Most probably, William's symptoms will be persistent or even worsen without proper intervention. The inability to offer effective treatment strategies, such as cognitive-behavioral therapy, maintains this cycle of OCD. This lack of access to specialized treatment for OCD will therefore impede an individual's potential to learn how to manage and reduce their symptoms.

 

Cognitive Distortions

William's distorted beliefs about contamination and safety maintain his OCD. Cognitive distortions that go on and on will involve overestimation of threat and intolerance of uncertainty, continuing to fuel his compulsive behavior issues. Challenging such cognitive distortions and restructuring them are considered one very important component in reducing OCD symptoms.

 

Environmental Triggers

In William's case, the continuous environmental triggers such as uncleanliness or perceived risks to safety will hold up the symptoms of OCD. These triggers further increase his compulsive behaviors and prevents him from recovery. The environment holds factors that may trigger the obsessive thoughts, thus increasing anxiety in the individual and compulsive behaviors.

 

Protective Factors  

Although on the whole case, risks seem to be at a little disadvantage, there are several protective factors that can still help William in his recovery process. Such factors are given bellow.

Supportive Relationships

William's relationships with family members or even friends who understand his condition, who can support him, may be the key ingredient in his recovery journey. Social support can decrease feelings of isolation and increase motivation to engage in treatment. Such supportive relationships can provide both emotional and concrete help in better management of OCD symptoms.


Motivation to Change

William's distress and ability to recognize the effects of symptoms on daily living can motivate him to seek help and abide by treatment. There is evidence that intrinsic motivation strongly predicts good treatment outcomes. The stronger the desire to change, the greater the commitment to the process of treatment.    

Access to Treatment

Availability and Accessibility of Mental Health Services, in Particular, Specialized Treatment for OCD: Services are so much needed. Professional intervention, more so through cognitive-behavioral therapy, will give some effective strategies for symptom management. Access to specialized treatment may ensure proper assessment with evidence-based interventions.

Previous Coping Skills

Any previous experience of overcoming anxiety or stress may turn out to be building blocks for new coping skills. Building from existing skills will tend to increase William's resilience. Building up on the current coping skills will facilitate a platform to build newer ways of managing the OCD symptoms.

 

Treatment Plan

Cognitive-Behavioral Therapy (CBT)        

Focus: The most common form of inpatient therapy for OCD, particularly ERP, is to reduce compulsions slowly by exposing William to the situations that he fears and then preventing responses.

Techniques: The ERP exercises for William are tailored to his individual obsessions and compulsions; there is cognitive restructuring for the challenging irrational beliefs and the development of alternative coping. Outcomes of this course will enable William to have acquired thought patterns and coping strategies that are more adaptive.     

Medication Management 

Meds: The most common therapy for OCD is selective serotonin reuptake inhibitors (SSRIs). Evaluation and monitoring of medications and possible medications and medications' effects and side effects often are required. Medication management can be symptomatic and significantly enhances the impact of CBT.           

 

Psychoeducation

William and his support network will be educated about OCD, obsessions, compulsions, the treatment process, and the necessity for consistency. Psychoeducation can help increase understanding and involvement in the treatment process. Mindfulness and Relaxation Technique.           

Objectives: To employ mindfulness activities and relaxation strategies to help William manage his anxiety and urge so that he can do less compulsions. Mindfulness and relaxation strategies will assist him in emotional self-regulation and stress reduction. Support Groups:                    

Participation: Patients with OCD should be enrolled in active support groups. In such a setting, they will be able to share their experiences and strategies with others who understand what it feels like to face such challenges. Support groups offer a sense of community and therefore decrease feelings of isolation.     

Plan: Relapse prevention, through identifying any potential triggers and very early signs of relapse, coupled with regular follow-up sessions beyond the above-mentioned treatment course to assess progress and further treatment planning. A relapse prevention plan would be useful, therefore, to maintain treatment gains and prevent symptom recurrence.

 

 

 

 

 

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Barlow, D. H., & Durand, V. M. (2020). Abnormal psychology: An integrative approach (8th ed.). Cengage Learning.

Butcher, J. N., Mineka, S., & Hooley, J. M. (2017). Abnormal psychology (17th ed.). Pearson.

Carson, R. C., Butcher, J. N., & Mineka, S. (2000). Abnormal psychology and modern life (11th ed.). Allyn & Bacon.

Comer, R. J. (2018). Abnormal psychology (10th ed.). Worth Publishers.

Freud, S. (1901). The Psychopathology of everyday life. Macmillan.

Maslow, A. H., & Mittelmann, B. (1941). Principles of abnormal psychology. Harper & Brothers.

Millon, T., Blaney, P. H., & Davis, R. D. (Eds.). (1999). Oxford textbook of psychopathology (1st ed.). Oxford University Press.

Nolen-Hoeksema, S. (2014). Abnormal psychology (6th ed.). McGraw-Hill Education.