6 CLINICAL PSYCHOLOGY

Issues and debates

Idiographic versus nomothetic
Meta-analyses take a nomothetic approach, allowing for generalisations due to the
very large sample sizes. Numerical data from rating scales means statistics can be
used to draw generalisable conclusions. Idiographic studies, such as interviews and
case studies, may help researchers to understand the role of social support and the
therapeutic alliance in the efficacy of treatments.
Cultural differences
ECT is controversial in many cultures (e.g. Slovenia), but in China, more than 50 per
cent of people with schizophrenia receive ECT (Wang et al., 2018a). China is a high
power distance index (PDI) culture – clients may exaggerate the efficacy of ECT due
to the unequal relationship between patients and health professionals/researchers.

NOW TEST YOURSELF

6.9 Lockie has recently been diagnosed with 6.11 With reference to relevant research, explain
schizophrenia. He has been prescribed an one strength of experiments as a way of
atypical antipsychotic. Suggest one reason investigating the effectiveness of treatments
Lockie’s doctor might have decided to for schizophrenia. [4]
prescribe an atypical antipsychotic. [2] 6.12 Outline one weakness of longitudinal studies
6.10 Lockie’s doctor also refers him to a as a way of investigating the effectiveness of
cognitive-behavioural therapist. Suggest treatments for schizophrenia. [2]
two ways Lockie and his therapist might
try to reduce his symptoms. [4]

6.2 Mood (affective) disorders

6.2.1 Diagnostic criteria (ICD-11) for mood (affective)
disorders
Mood is on a continuum from mania/euphoria to severe depression. Typically,
mood fluctuates around the centre. If very high or very low mood dominates for an
extended period and impairs daily functioning, a mood disorder may be diagnosed.

STUDY TIP
When revising the Beck Depression Inventory, you could download a copy from the
internet (see https://tinyurl.com/j9ed7rwb). Choose a few of the items and create a
mnemonic to help you remember them. For example, the first three items are sadness,
pessimism and past failure; you could remember these as SPF: ‘study prominent facts’.

▼ Table 6.10 ICD-11 definitions of mood disorders (World Health Organization, 2018)

Symptoms Duration
Depressive Depressed mood; reduced interest in activities; difficulty Most of the day,
disorder (unipolar) concentrating; feeling worthless; excessive or inappropriate guilt; nearly every day, for
hopelessness; recurring thoughts of death/suicide; changes in appetite at least two weeks
or sleep; feeling agitated; slow movements; low energy; fatigue
Bipolar disorders Alternating depressive and manic episodes; manic episodes include Mania for at least one
euphoria, irritability, grandiosity, highly active, subjective sense of week; depressive and
increased energy, rapid speech, rapidly changing thoughts/ideas, manic symptoms may
decreased need for sleep, easily distracted, impulsive and reckless be experienced within
the same week or even
day (mixed episodes)

Cambridge International AS/A Level Psychology Study and Revision Guide Third Edition 99
 SKILLS BUILDER
Describe one symptom of unipolar disorder. [2]
‘Describe’ means to give a detailed account. Avoid simply identifying or stating
a symptom. Write a full sentence that gives detail about what it might be like to
experience this symptom. For example, ‘Difficulty concentrating means that,
although you are focusing on a task, your mind might wander onto thoughts
about other things that you have to do, or you might be distracted by sights
and sounds around you.’ You could also give an example, such as how the
symptoms might affect a person at school or work.

Measuring depression: Beck Depression Inventory

» The Beck Depression Inventory (BDI) is a psychometric test (see page 100) that
measures symptom severity using 21 items scored from 0–3.
» It considers symptoms from the last two weeks.
» It is designed to be used by qualified health professionals (not self-diagnosis).
▼ Table 6.11 Evaluating the diagnosis and measurement of mood disorders

Strengths Weaknesses
ICD-11 diagnosis of Reliability – inter-rater reliability is high (84!per Reliability – ICD-11 is less reliable when
mood disorders cent) for bipolar disorder and recurrent depressive diagnosing dysthymia (45 per cent)
disorder using ICD-11 (Reed et al., 2018). (Reed!et al., 2018).
The BDI Validity – there is a positive correlation between Self-report – social desirability bias may
the BDI and the Hamilton Psychiatric Rating reduce validity; symptoms may be under-
Scale for Depression. reported or exaggerated.
Practical – provides quick and precise data; good Quantitative data – ignores contextual
for assessing treatment efficacy in research and information (e.g. why a person has
clinical practice. depressive symptoms).

SKILLS BUILDER
Explain one strength of the Beck Depression Inventory of quantitative data and how these strengthen the
with reference to quantitative data. [2] BDI as a measure of the severity of depressive
symptoms. Think about what the BDI does: it
Read the question carefully. You are not being
categorises people’s symptoms as mild, moderate
asked for a strength of quantitative data or just
and severe. Why is this a good thing and why is
any strength of the BDI. Think about the strengths
using numerical data helpful in achieving this goal?

SKILLS BUILDER
a Describe the Beck Depression Inventory. [6] and two weaknesses. Use the points in Table 6.11
b Evaluate the Beck Depression Inventory, to create full PEEL paragraphs (state your point,
including a discussion of psychometrics. [10] explain evidence, link back to your argument, e.g.
‘This is important because … ‘). When discussing
Although this question seems unlikely, it is still a psychometrics (see page 65), you could give an
legitimate Paper 3 extended response question. alternative, such as the trauma-informed approach,
It is a good one to practise as it will push you to which uses a psychological formulation and is
really elaborate your points. Your evaluation is therefore more idiographic.
likely to include two well-elaborated strengths

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 6 CLINICAL PSYCHOLOGY

Issues and debates

Cultural differences
ICD-11 explains that people from low-to-middle-income countries (LMICs) report
bodily (somatic) symptoms such as aches and pains more than emotional or
cognitive symptoms.
Individual versus situational explanations ▲ Figure 6.2 Somatisation
ICD-11 views mood disorders as an individual difference in the way a person refers to the idea that people
thinks, feels and behaves. Alternatives such as the trauma-informed approach with depression from low-to-
(Johnstone, 2018) focus more on situational factors, including what has happened middle-income cultures often
to the person that has led them to feel like this. report aches and pains rather
than emptiness or apathy

SKILLS BUILDER
When answering question 6.16 below, think about is based. This could be the ICD-11 criteria for
general features such as aim(s), procedure, sample/ unipolar depression or the BDI, which you could
sampling technique and ethical considerations, as use as your measure of severity of symptoms. The
well as ensuring that the findings will be valid and required method is correlation, so you will need two
reliable. Also think about the type(s) of data Sissi variables, each measured using quantitative data.
might collect and the descriptive statistics she Remember, if you use a rating scale, show how the
should use to analyse her data. responses will be scored, e.g. ‘How often do you
exercise? 1 (never) to 7 (at least once a day)’.
Part b of the question asks about a piece of
psychological knowledge on which your plan

NOW TEST YOURSELF

6.13 Kari is a mother and a secondary school a Plan a correlational study that will allow
teacher. She has been diagnosed with unipolar Sissi to investigate this topic. Your plan
depression. Explain two ways in which her must include details about:
diagnosis may affect her functioning in – the measurement of the two co-
everyday life. [4] variables
6.14 Suggest one way to improve the validity of the – a suitable directional hypothesis. [10]
Beck Depression Inventory. [2] b For one piece of psychological knowledge
6.15 Explain what is meant by a psychometric on which your plan is based:
test, with reference to the Beck Depression i Describe this psychological knowledge.
Inventory. [2] [4]
6.16 Sissi is planning a correlation in which she ii Explain how you used two features of
will investigate whether people with unhealthy this psychological knowledge to plan
lifestyles have more severe depressive your correlation. [4]
symptoms.

6.2.2 Explanations of mood (affective) disorders:

depressive disorder (unipolar)
Biological explanations
Biochemical
» Depression is caused by low levels of noradrenaline.
» Serotonin regulates noradrenaline.
» A serotonin imbalance could cause noradrenaline levels to decrease, leading to
depression, or increase, leading to mania.
» A serotonin deficiency may result from:
– a low tryptophan diet
– a high level of cortisol (stress hormone)

Cambridge International AS/A Level Psychology Study and Revision Guide Third Edition 101
 – overly sensitive, post-synaptic receptor sites
– high levels of monoamine oxydase (an enzyme)
– abnormalities of the presynaptic reuptake pumps (transporter molecules).
Genetic
» Vulnerability is inherited.
» Specific alleles of candidate genes linked to serotonin may increase the risk.
» For example, short alleles of the 5-HTT gene appear to increase depression risk
when facing stressful life events compared with long alleles (Caspi et al., 2003).

Key study: Oruč et al. (1997)

Context: depression research has focused on serotonin-specific genes. For example:
» 5-HTR2c: codes for postsynaptic receptors; linked to appetite, which is often
disrupted in depression
» 5-HTT: codes for presynaptic transporter molecules; short alleles linked to
depression (Caspi et al., 2003).
Aim: to determine whether specific alleles of the 5-HTR2c and 5-HTT genes are more
frequent in people with bipolar disorder than controls.
Research method(s) and design:
» Method/design: correlation.
» Data collection technique: interviews and blood tests.
Co-variables: whether a person has bipolar disorder or not; whether the person is
carrying the 5-HTR2c alleles Cys (C) or Ser (S) and the 5-HTT alleles 1 or 2.
Sample: opportunity sample of 82 adults from Croatia, 42 with bipolar disorder.
Procedure:
» Interviews and medical records were used to diagnose bipolar disorder.
» Blood samples were used to determine 5-HTR2c and 5-HTT alleles.
Controlled variables: bipolar diagnoses checked; control group matched for age/sex.
Ethics:
» Confidentiality: medical records had to be kept secure.
» Informed consent: participants needed to understand why their blood was being
tested and why their medical records were being accessed.
Results:
» In the bipolar group, 38 per cent had at least one first-degree relative with a
mood disorder, compared with 0 per cent in the control group.
» The S and 1 alleles were more common in diagnosed females than healthy female
controls.
Conclusion: S and 1 variants of the 5-HTR2c and 5-HTT genes may increase
depression risk in females.

SKILLS BUILDER
Cordelia is worried about developing unipolar depression vulnerable). Now your memory is refreshed,
since she found out that both her biological parents have start your answer. For example, Cordelia might
this disorder. Explain why Cordelia might be worried, be worried because she thinks she has inherited
with reference to one or more biological explanations. [4] specific gene variants (alleles) from her parents
that could increase her vulnerability to depression.’
This question gives you the option to include
You could also explain why this is a worry. Improve
one or more explanations. Bullet-point two
your answer by referencing specific knowledge, like
explanations in the margin before you start (e.g.
the role of the S allele of the 5-HTR2c gene, which
genetic and biochemical). Write down a few key
codes for serotonin transporter molecules on the
words associated with each explanation before
presynaptic cell.
you start writing your answer (e.g. alleles, inherit,

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 6 CLINICAL PSYCHOLOGY

▼ Table 6.12 Evaluating Oruč et al. (1997)

Strengths Weaknesses
Validity – two experienced psychiatrists checked Generalisation – the sample size was small; only three
whether participants had bipolar or not using the people (all male) had the SS genotype of the 5-HTR2c
Croatian version of a structured interview schedule. gene.
Reliability – other studies had the same results for both Validity – cause and effect cannot be be established as
the 5-HTR2c and 5-HTT genes (Gutiérrez et al., 1996; the variables were naturally occurring and the groups
Kelsoe et al., 1996). were only matched on age and sex.

SKILLS BUILDER
Explain one strength of the key study by Oruč et al. gene were determined with a blood test. This type
(1997) with reference to reliability. [2] of data requires little interpretation (objective); two
or more researchers are likely to code the data in
Reliability refers to the consistency of an instrument
the same way, so the measurements are reliable.
used to make measurements in a psychological
Another way of answering would be to talk about
study. In this study, S or C alleles of the 5-HTR2c
the reliability of bipolar diagnoses.

Psychological explanations
Beck’s cognitive theory of depression
» Depressive symptoms are caused by negative thoughts stemming from
dysfunctional core beliefs (Beck, 1962).
» The more negative thoughts a person has, the worse their symptoms.
» Depressed people hold negative beliefs about the self, the world and the future
(the negative cognitive triad).
» These beliefs develop in childhood due to criticism, rejection, neglect, abuse,
bullying, experiences of loss and overprotective parenting.
» Confirmation bias means depressed people focus on information that supports
negative beliefs and ignore conflicting evidence.
» Other faulty thinking strategies include catastrophising and personalising.
Learned helplessness/attributional style
» Depression is a learned response to a negative experience.
» If a neutral stimulus becomes associated with an unavoidable negative stimulus,
people may fail to initiate coping strategies when faced with a similar situation
in the future.
» Apparent lack of control over the environment leads to hopelessness, passive
acceptance and overgeneralisation to other situations.
» Depressive attributional style (pessimism) is a negative bias in the way that
people process information about success and failure (see Table 6.13).
▼ Table 6.13 Psychological explanation of depression: depressive attributional style

Pessimism Internal: failures Global: failure is Stable: expectation of

are blamed on generalised to many continued failure.
dispositional factors. areas of life.
Optimism External: failures are Specific: failure is Unstable: expectation
blamed on situational seen as specific to of future success.
factors. one area of life.

Relevant research: Seligman et al. (1988)

Aim: to replicate previous research showing a positive correlation between
depressive attributional style and severity of depressive symptoms.
Methodology:
» Mood-disordered participants completed the BDI (see page 100) and a
questionnaire measuring attributions relating to 12 positive and negative events.
Cambridge International AS/A Level Psychology Study and Revision Guide Third Edition 103
 » They were interviewed to check their diagnosis and reassessed after six months
of cognitive therapy.
» Post-therapy reassessments were completed at one and twelve months.
» Scores were compared with a matched control group.
Results:
» Depressive attributions for negative events were positively correlated with
severity of depressive symptoms before and after therapy, including follow-up
assessments.
» The greater the decrease in pessimism post-therapy, the greater the improvement
in depressive symptoms.
» Improvements were impressive and stable over time.
» Post-therapy pessimism scores were associated with relapse at 12 months.
Conclusions: people with mood disorders tend to make internal, global and stable
attributions about negative events, but this tendency can be altered in therapy.
▼ Table 6.14 Evaluating Seligman et al. (1988)

Strengths Weaknesses
Validity – pessimism was relatively stable in the control Generalisations – the sample included 50 per cent more
group, suggesting that pessimism is a fixed trait rather females than males, who may not represent all men with
than a reaction to current circumstances, i.e. a cause of depression.
depression and not an effect.
Validity – triangulation (BDI and interviews) increased Attrition – 33 per cent dropped out before the final
the validity of measures of symptom severity. follow-up. The remaining participants may not be
representative of all people with depression (e.g. they
may have had less severe symptoms).

▼ Table 6.15 Evaluating explanations for mood disorders

Approach Explanation Strengths Weaknesses

Biological Biochemical Evidence – reducing tryptophan Evidence – low serotonin may be an
through diet increased depressive effect of depression, not a cause.
symptoms in people with depression. Serotonin decreases in monkeys whose
social status changes from dominant
to submissive.
Applications – enabled the Deterministic – suggests that
development of drug treatments, everyone responds in the same way to
helping people improve daily reduced serotonin and noradrenaline.
functioning, e.g. working, caring for
family.
Genetic Supporting evidence – concordance Validity – the shared environment
rate for MZ twin pairs = 38 per cent, fallacy reduces the validity of the
DZ = 14 per cent. findings of MZ/DZ twin studies
(see page 94).
Applications – a better understanding Reliability – genome-wide
of the genes associated with association studies (GWAS) have failed
different types of depression could to identify consistent patterns of
mean treatments can be tailored to genes associated with depression.
each patient’s individual genome
(pharmacogenomics).
Psychological Beck’s cognitive Scientific: Experiments can be Overly deterministic: Some people
theory designed to test hypotheses derived may exercise their freewill and regain
from the theory, e.g. whether control of automatic thinking through
depressed people use confirmation therapy or coaching.
bias more than non-depressed people.
Learned Evidence: Seligman et al. (1988) Bidirectional ambiguity: Depressive
helplessness/ (see above) attributional style may be an effect
attributional style rather than a cause of depression.

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 6 CLINICAL PSYCHOLOGY

Issues and debates

Nature versus nurture
Twin studies support nature, but adoption studies are unclear. For example, Kendler
et al. (2018) found an increased risk for depression in adoptive children where the
adoptive parent had depression (supporting nurture). However, Mendlewicz and
Rainer (1977) found that 31 per cent of biological parents of adopted children
with bipolar disorder also had a mood disorder, compared with only 12 per cent of
adoptive parents (supporting nature).
Oruč et al. (1997) support nature, whereas Seligman et al. (1988) support nurture.
Reductionism versus holism
The study by Oruč et al. (1997) is an example of biological reductionism as it
examines the role of single genes and fails to acknowledge epigenetic factors, which
affect gene expression.
Studies that investigate the diathesis-stress model provide a more holistic account
as they explore the ways in which biological and social factors interact.
Determinism versus freewill
Psychological explanations may be seen as overly deterministic. Some people
may exercise freewill and regain control of automatic thinking through therapy or
coaching.

SKILLS BUILDER
When answering ‘Plan a study’ questions such as 6.20 below, think about the
key studies you have revised for the topic area named in the question, such
as Oruč et al. (1997). You could use a similar design as the basis of your study.
How would you recruit a representative sample using random sampling, for
example? Would this be practical? Part b of question 6.20 asks you to justify
your choice of hypothesis. As Oruč et al. (1997) did not find significant results
overall (only the results for women were significant) but others have, which
type of hypothesis would be most sensible, directional or non-directional?

NOW TEST YOURSELF

6.17 Destiny is very tearful and finds it difficult to 6.20 a Plan an experiment to investigate the
concentrate at work. Her doctor explains that genetic explanation of unipolar depression.
this may be due to a serotonin imbalance. Your plan must include details about:
Outline the biochemical explanation of – sampling technique
unipolar depression with reference to – a directional or non-directional
Destiny’s symptoms. [2] hypothesis. [10]
6.18 Explain one strength of the cognitive b Explain one reason for your choice
explanation of depression. [2] of a directional or non-directional
6.19 From the key study by Oruč et al. (1997), hypothesis. [2]
explain one advantage of using blood tests
in this study. [2]

Cambridge International AS/A Level Psychology Study and Revision Guide Third Edition 105
 6.2.3 Treatment and management of mood (affective)
disorders
Biological treatments
▼ Table 6.16 Antidepressant drugs

Type of Mode of action Side effects

antidepressant drug
Tricyclics Block presynaptic serotonin and noradrenaline Dry mouth, dizziness, drowsiness,
transporter molecules, increasing levels of both blurred vision
neurotransmitters in the synapse
Monoamine oxidase Stops serotonin, noradrenaline and dopamine Increased risk of stroke due to
inhibitors (MAOIs) from being broken down by an enzyme, increasing interactions with some foods
availability of all three neurotransmitters
Selective serotonin Increases serotonin by blocking presynaptic Agitation, shakiness and anxiety,
reuptake inhibitors transporter molecules so serotonin cannot be nausea, reduced appetite
(SSRIs) reabsorbed

Psychological treatments SKILLS

Beck’s cognitive restructuring BUILDER
» Depression can be treated by identifying, challenging and changing irrational
beliefs about the self, the world and the future. Compare one
» The goal is to help people to become less reliant on dysfunctional/irrational biological and
beliefs and use all available evidence when making attributions (i.e. become one psychological
more objective/rational). treatment for one
mood disorder. [4]
» Therapists ask clients how they feel when they are thinking differently to
demonstrate the link between thoughts and emotions. ‘Compare’ means
» Techniques include Socratic questioning, psychoeducation and homework. to identify/comment
» Clients usually attend between five and twenty 50-minute sessions. on similarities and/
or differences. You
could write about
SKILLS BUILDER two similarities, two
differences or one of
Explain one weakness of cognitive restructuring as a treatment for mood each. For example,
disorders. [2] non-compliance
can be a problem
Think about how psychologists conduct studies to support therapies for both biological
(e.g. longitudinal studies). A classic weakness of longitudinal research is that and psychological
generalisability can be affected by attrition. Think about why attrition might treatments. This
be high for people undergoing cognitive therapy. Now you should be able to could be your first
state that the evidence base supporting the use of cognitive therapy may be similarity and then
flawed. Elaborate carefully and link specifically to cognitive therapy to get you could elaborate
both marks. your point by
showing why people
stop taking their
Ellis’s rational emotive behaviour therapy (REBT) medications or stop
» Therapy should focus on interpretations of events/situations, as opposed to the attending therapy.
events themselves. Your second point
» REBT focuses on present solutions, not past events. could show how
» Therapists work collaboratively to help clients to challenge self-defeating the treatments are
thoughts and reduce negative emotions and behaviours. similar or different
» Musturbation is tackled through disputing. with regard to one
» The end goal is for clients to accept themselves, other people and their life, of the issues and
including all good and bad points. debates.

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 6 CLINICAL PSYCHOLOGY

▼ Table 6.17 Evaluating treatments for mood disorders

Strengths Weaknesses
Biological Evidence – all 21 drugs investigated in a meta- Side effects – side effects can be debilitating;
analysis of 522 double-blind trials were more some of the most effective drugs have the worst
effective than placebos (Cipriani et al., 2018). compliance rates.
Practical – biological treatments are a cheap Limited effects – differences between drugs and
and low commitment solution for many people, placebos may be statistically significant but may
unlike cognitive therapy, which is time- not lead to a great deal of change in everyday life.
consuming and costly.
Psychological Remission rate – 75 per cent of people who Non-compliance – some people are not
received drug treatment plus cognitive therapy sufficiently organised/self-motivated to carry
were symptom-free after two years, compared with out weekly homework exercises.
25 per cent using drugs alone (Fava et al., 1998).
No side effects – compliance rates may be Accessibility – cognitive therapy requires well-
higher than drug treatments. trained therapists; location and financial cost
may mean this is not an option for many people.

SKILLS BUILDER
Joel is carrying out research into patient experiences regarding the treatment of
mood disorders. Plan a study using semi-structured interviews to help
Joel to investigate this topic. Remember to think about the aim(s), procedure,
sampling and ethical considerations. [10]
Think of some open and closed questions Joel could ask and then think about
how he would analyse the answers. Would the interviews be better face to
face, online or over the phone? Think about how he could ensure people
answer the questions honestly, to increase validity, and how he can check that
his data is reliable.

Issues and debates

Individual versus situational explanations
Both biological and psychological treatments focus on changing aspects of the
individual – that is, their biochemistry or their beliefs.
This sidelines the role of situational factors. Tackling sources of stress in society
(e.g. poverty and discrimination) could also improve wellbeing without the need for
treatment.
Determinism versus free will
Free will means people are not at the mercy of negative/irrational beliefs. Instead,
they can wilfully choose to control these thoughts through cognitive restructuring
and/or REBT.

SKILLS BUILDER
Evaluate one or more psychological treatments for mood (affective) disorders,
including a discussion of reductionism versus holism. [10]
If the essay question asks explicitly about biological or psychological
treatments, you can always use the other one as part of your evaluation. You
could mention that the treatment named in the question is either stronger
or weaker than the alternative (e.g. why psychological treatments might be
considered better than biological treatments). Often people are prescribed
antidepressants and offered cognitive therapy (e.g. restructuring or REBT).
This is known as eclectic approach and could lead into a discussion of
reductionism versus holism.

Cambridge International AS/A Level Psychology Study and Revision Guide Third Edition 107
 NOW TEST YOURSELF
6.21 Annie has weekly REBT for unipolar depression. She is not enjoying the
sessions and wants to stop going. Suggest one reason that Annie may
not enjoy REBT. [2]
6.22 Explain one similarity and one difference between Beck’s cognitive
restructuring and Ellis’s rational emotive behaviour therapy. [4]
6.23 With reference to studies investigating the effectiveness
of treatment, suggest one reason why the findings might not be
generalisable. [2]
6.24 Outline one individual and one situational factor that might reduce the
effectiveness of treatments for mood disorders. [4]

6.3 Impulse control disorders

6.3.1 Diagnostic criteria (ICD-11)
Impulse control disorders (ICDs) involve:
» a build-up of tension
» recurrent, irresistible urges to carry out specific behaviours
» short-lived euphoria/relief when the behaviour is performed
» distress and dysfunction due to shame/guilt.
▼ Table 6.18 Impulse control disorders

Type Urge/compulsion Prevalence Age/gender differences

Kleptomania Stealing unwanted/unnecessary 0.6 per cent of general Can develop at any age; more
items population common in women
Pyromania Fascination with fire, fire- Between 3 and 6 per cent of Relatively young age of onset;
starting paraphernalia and the psychiatric inpatients (Burton severity increases over time
fire service et al., 2012)
Gambling Impaired control over 4 per cent (in the US; Black Average age of onset is mid-30s but
disorder gambling; prioritising gambling and Shaw, 2019) can be 8–80; earlier onset in men
over other daily activities than women (Black et al., 2015)

SKILLS BUILDER
Omid works in a casino. He wonders whether any of might see people with gambling disorders coming
his customers have a gambling disorder. Explain one to the casino when he knows they should be at work
difference Omid might observe between people with (prioritising gambling over other daily activities),
and without a gambling disorder. [2] whereas other people only visit the casino after
working hours.’ Notice how the example includes
Your answer needs to link a characteristic of
‘whereas’, showing that the answer includes both
gambling disorder to something Omid might
people with and without gambling disorder.
observe in his customers. For example, ‘Omid

Measuring impulse control disorders

The Kleptomania Symptom Assessment Scale
» The Kleptomania Symptom Assessment Scale (K-SAS) is an 11-item self-report
scale, scored from 0 to 4.
» The respondent considers thoughts, feelings and actions in the past week.
» More than 31 out of 44 is considered severe; more than 21 is considered
moderate.
» Sample item: ‘If you had urges to steal during the past week, on average, how
strong were your urges? None (0) Mild (1) Moderate (2) Severe (3) Extreme (4)’.

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